Vaccine Adverse Reaction Reporting System Data 1 Pub 23oct09
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VAERS_IDRECVDATESTATE 336349 1/2/2009 CA 336350 1/2/2009 MA 336352 1/2/2009 IL 336359 1/2/2009 ID 336373 1/2/2009 336376 1/2/2009 MA 336377 1/2/2009 MA 336378 1/2/2009 GA 336379 1/2/2009 MA 336380 1/2/2009 MA 336381 1/2/2009 MA 336382 1/2/2009 IL 336383 1/2/2009 KS 336384 1/2/2009 KS 336385 1/2/2009 IL 336386 1/2/2009 IL 336387 1/2/2009 MA 336388 1/2/2009 MA 336389 1/2/2009 MA 336390 1/2/2009 CA 336391 1/2/2009 FL 336392 1/2/2009 NC 336393 1/2/2009 WA 336394 1/2/2009 MT 336395 1/2/2009 WA 336416 1/2/2009 OH 336417 1/2/2009 OH 336419 1/2/2009 MA 336420 1/2/2009 MA 336421 1/2/2009 IL 336422 1/2/2009 OH 336423 1/2/2009 WI 336424 1/2/2009 WI 336425 1/2/2009 WI 336426 1/2/2009 WI 336427 1/2/2009 WI 336428 1/2/2009 WI 336429 1/2/2009 WI 336430 1/2/2009 WI 336431 1/2/2009 WI 336432 1/2/2009 WI 336433 1/2/2009 IN 336434 1/2/2009 WI 336435 1/2/2009 NH 336436 1/2/2009 AR 336437 1/2/2009 MA 336438 1/2/2009 NJ 336396 1/3/2009 MI 336397 1/3/2009 AK 336398 1/3/2009 NJ
AGE_YRS CAGE_YR CAGE_MOSEX U 0.2 F 14 14 F 62 62 M U 5 5 F 1 1 0M 32 31 M 0.6 0 0.6 F 0.5 0 0.6 M 0.3 0 0.3 M 15 15 F 5 5 M 5 5 F 0.5 0 0.5 F 0.5 0 0.5 F 0.3 0 0.3 F 9 0 0.4 F 20 20 F 18 18 F 53 53 F 17 17 F 17 17 F 2 1 0.9 M 38 38 M 1.5 1 0.5 M 37 37 F 4 4 F 37 37 F 10 10 M 48 48 F 46 46 M 40 40 M 55 55 F 48 48 F 33 33 F 27 27 F 48 48 M 23 23 M 45 45 M 38 38 F 61 61 F 41 41 M 1.1 1 0.1 F 17 17 F 69 69 F 0.3 0 0.3 F 11 11 M 63 63 F 9 9 M
RPT_DATESYMPTOM_TEXT DIED ### Information has been received from ### Information has been received from ### Information has been received from ### Information has been received from ### Information has been received from 1/2/2009 Local reaction of redness, swelling, 1/2/2009 Vesicular eruption, 3-4 lesions cons 1/2/2009 As reported by patient, he began to 1/2/2009 Fever of 102 within 24 hours of imm 1/2/2009 Fever of 101 beginning within 24 ho 1/2/2009 Fever of 100.5 within 24 hours of im 1/2/2009 Was in reception area immediately a 1/2/2009 Child was given an adult Hep A dos 1/2/2009 Adult Hep A given to child instead o 1/2/2009 Approximately 8 hours after receivin 1/2/2009 Received vaccines along with twin s 1/2/2009 Pt fussy with low-grade fever of 100 1/2/2009 3cm x 4cm raised tender eryth arou 1/2/2009 Slight fever, chills; local redness, sw 1/2/2009 syncope or seizure still being determ 1/2/2009 Beginning 12/11/08 Pt reports bump 1/2/2009 BROKE OUT W/ CHICKEN POX 1/2/2009 Marked local swelling, induration, er 1/2/2009 None 1/2/2009 Patient describes reaction as increa ### Seizure lasting 1-5minutes. Fever 1 ### Has area on L arm located about 2### Seen at hospital 12/03/08 for swellin ### Swelling, redness, induration, warm ### Pt received vaccines below and app ### Swollen, tender supra clavicular lym 12/3/2008 Nov 3rd got flu shot and needle inse 12/7/2008 (2008) Received flu shot Nov 3 & ok 12/8/2008 Received flu shot left deltoid on 11/3 ### Nov 3rd 2008 rec'd flu shot pt sore f ### Pt reports getting her shot 11/3/200 12/3/2008 Nov 3, 2008, shot given Nov 4 & 5 s 12/3/2008 c/o left arm pain. Refusal RN intervi ### He received his flu shot on Nov 3, 2 12/3/2008 Flu shot received 11/3/08. States to 12/3/2008 Since 11/3/08- W/E of Nov 8 & 9. -> 1/2/2009 Patient got rash after getting vaccin 12/3/2008 On Nov 3, 2008 flu shot given left a ### Site of injection was blistered , raise ### Mom reports child with "severe" hip ### Redness, itching one vaccine left ar 1/3/2009 Fever on 12/30/2008- Temp 101 de 1/3/2009 Patient received Menactra vaccine o 1/3/2009 Patient developed Shingles 3 days 1/3/2009 Reaction occurred immediately afte
336399 336400 336401 336402 336403 336404 336405 336406 336407 336408 336409 336410 336411 336412 336413 336414 336415 336439 336440 336441 336442 336443 336444 336445 336446 336447 336448 336449 336450 336451 336452 336453 336454 336455 336456 336457 336458 336459 336460 336461 336463 336466 336471 336472 336473 336474 336475 336476 336477 336478 336479
1/3/2009 NJ 1/4/2009 IN 1/4/2009 VA 1/5/2009 VA 1/5/2009 VA 1/5/2009 CT 1/5/2009 TN 1/5/2009 KY 1/5/2009 NE 1/5/2009 PA 1/5/2009 CA 1/5/2009 PA 1/5/2009 1/5/2009 UT 1/5/2009 OR 1/5/2009 IA 1/5/2009 IL 1/5/2009 OH 1/5/2009 KY 1/5/2009 KY 1/5/2009 MA 1/5/2009 MA 1/5/2009 NC 1/5/2009 MA 1/5/2009 MA 1/5/2009 MA 1/5/2009 TX 1/5/2009 MA 1/5/2009 TX 1/5/2009 MA 1/5/2009 MA 1/5/2009 MA 1/5/2009 MS 1/5/2009 MA 1/5/2009 SD 1/5/2009 MA 1/5/2009 WI 1/5/2009 FL 1/5/2009 KY 1/5/2009 CA 1/5/2009 OH 1/5/2009 NY 1/5/2009 MO 1/5/2009 CO 1/5/2009 TN 1/5/2009 1/5/2009 MT 1/5/2009 NY 1/5/2009 NY 1/5/2009 PA 1/5/2009 NY
4 77 74 75 60 0.5 59 3 34 1.7 6 39 63 38 48 45 6 70 19 20 1 1 6 1 0.5 1.5 21 4 21 0.3 0.3 11 1.1 1 59 15 14 65 1.3 16 1.3 41 0.2 67 18 13 46 17 65 75 29
4 77 74 75 60 0 59 3 34 1 6 39 63 38 48 45 6 70 19 20 1 1 6 1 0 1 21 4 21 0 0 0 1 1 59 15 14 65 1 16 1 41 0 67 18 13 46 17 65 75 29
F M M M M 0.5 F F F F 0.7 M F M F F F F M F M M 0M 0M F 0F 0.5 M 0.5 M M M M 0.4 M 0.3 F 0F 0.1 F 0M F F M M 0.3 M M 0.3 M F 0.2 M F F F F F M F F
1/3/2009 Raised red area approximately 4 inc 1/4/2009 The patient complains of major swe 1/4/2009 Patient was given Zostavax vaccine ### Pt states he had itching at injection ### Chest tightness, Y shortness of breath ### Received flu vaccine 12/8. On 12/10 ### Severe congestion-nasal,ears,head ### 3 days after DTaP was given right th 1/2/2009 States fatigue, itching around face, ### Large red bumps on legs after shots 1/2/2009 Mother reports temp of 103 degrees ### Redness and swelling around vacci 1/2/2008 On December 26 at 10 am received ### 3 days following Flu vax developed ### Severe pain "10/10" in deltoid area ### About 4 weeks after the f/u shot, I e ### Child was struggling before shot- he 1/5/2009 Patient states she recieved Zostava 1/5/2009 Patient complains of generalized ur 1/5/2009 Patient observed having trouble bre 1/5/2009 Suspect post- MMR reactions; fine p 1/5/2009 Suspect MMR rash. Pt developed p 1/5/2009 PATIENT SEEN FOR WELL CHILD 1/5/2009 Local redness at vaccine site with lo 1/5/2009 Localized heat, redness, and swellin 1/5/2009 Firm nodule, red skin at DTaP imm 1/5/2009 PT PRESENTED TO ALLERGY/IMM 1/5/2009 Localized rxn to DTaP- area of eryth 1/5/2009 Erythematous, maculopapular rash 1/5/2009 Induration, bruising at site of immun 1/5/2009 3-4 mm subcutaneous swelling at im 1/5/2009 Site of varicella vaccine swollen to t 1/5/2009 patient received the MMR & Varicel 1/5/2009 Redness and swelling in left thigh w 1/5/2009 Got flu shot on 12/2/08 and on 12/4 1/5/2009 Extreme Hives, trouble breathing / p 1/5/2009 Weakness, pain in back, headache, 1/5/2009 within 2 days developed ipsilateral u 1/5/2009 patient received vaccine on decemb 1/5/2009 Menactra was ordered for the patien ### Initial information was received on 2 1/5/2009 This case was reported by a lawyer ### Admitted to hospital on 12/24/08 fo ### Pt got ZOSTAVAX shot 6-16-08. Ha ### Onset increased muscle pain, fatigu ### After my daughter received her 1st 12/8/2008 1) Headaches 2) Visual Change: fel ### She received flu shot and Pneumov 12/9/2008 Patient was given PNEUMOVAX an 1/1/2009 Pt came to clinic on 12/30/08. After ### She developed severe right arm pai
336480 336482 336483 336484 336485 336486 336487 336488 336489 336490 336491 336492 336493 336494 336495 336496 336497 336498 336499 336500 336501 336503 336504 336505 336506 336507 336508 336509 336510 336511 336512 336513 336514 336515 336518 336520 336521 336522 336462 336550 336551 336552 336553 336554 336555 336556 336557 336558 336559 336560 336561
1/5/2009 FL 1/5/2009 MI 1/5/2009 FL 1/5/2009 VA 1/5/2009 NY 1/5/2009 MA 1/5/2009 CO 1/5/2009 NY 1/5/2009 1/5/2009 MS 1/5/2009 IN 1/5/2009 FL 1/5/2009 MN 1/5/2009 GA 1/5/2009 TX 1/5/2009 NC 1/5/2009 NC 1/5/2009 WA 1/5/2009 NY 1/5/2009 WA 1/5/2009 CA 1/5/2009 1/5/2009 CA 1/5/2009 TX 1/5/2009 NJ 1/5/2009 LA 1/5/2009 NJ 1/5/2009 PA 1/5/2009 MA 1/5/2009 MD 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/6/2009 CA 1/6/2009 NJ 1/6/2009 WI 1/6/2009 WI 1/6/2009 MA 1/6/2009 GA 1/6/2009 AL 1/6/2009 MO 1/6/2009 LA 1/6/2009 CA 1/6/2009 NV 1/6/2009 IL 1/6/2009 OK
0.2 66 66 69 7 11 39 1
0 66 66 69 7 11 38 1
26 5 50 1.3 34 1.1 13 17 60 2 46 1.2 15 1.1 60 4 26 23 37 57 49 14 32 0.5 11 47 12 29 85 1 30 53 60 1 44 64 17 18 4 42
26 5 50 1 34 1 13 17 60 2 46 1 15 1 60 4 26 23 37 57 49 14 32 0 11 47 12 29 85 1 30 53 60 1 44 64 17 18
1
0
42
0.2 F M F F M M F 0M F F F F 0.3 M F 0.1 F F F M 0.5 F F 0.2 F F 0.1 F F M M M F M F M F 0.5 F F F M F F 0F F F F 0M F F F F F F F 1M
### Vaccine was administered 12/15/08 ### On 12-22-08 Patient received PNEU ### Possible reaction to vaccine 1-2 day ### Muscle pain (next morning) extendin ### Patient presents with stomach pain, ### Left deltoid hypersensitivity reaction ### 2 days after vaccine had slight rash ### scattered diffuse maculo-papular ra ### Soon after receiving Hep A vaccine ### None Stated ### Mother called, daughter is very wea ### Heat, tenderness, erythema left upp ### Rash started 12/27, started on face ### 3 1/2 X 5 inch raised, erythematous ### Erythema 20X26 ### Immunization was administered in le ### None. Hep B injection in gluteal reg 1/5/2009 Mild swelling, tingling and redness a 1/5/2009 Pt here for well child visit and had ju 1/5/2009 C/o nausea, light headed, dizziness 1/4/2009 Red rash after getting immz on rt lg. 5/15/2008 SM reported receipt IM Influenza ag ### 13 mo brought by mom for over 1 w ### Patient left arm still sore. Hard to gr ### Right arm red and swollen 12cm by 3/10/2008 Description: rash 10 days after SMP ### Noticed 12/15/08, notes soreness, s 1/5/2009 Patient had suspected immune reac 1/5/2009 Pain at injection site x 2 days. On 3 1/5/2009 Ringing in ears, jaw tightness, lighth 11/6/2008 Pt received vaccine on Friday. Satu ### 12/3/2008 TWINRIX given. Blistery ### Received on immunizations on 10-2 ### Child in school nurse office-phone c 10/7/2008 Patient complains of swelling at site ### Mother called and stated this (L) arm 10/9/2008 Client complains of swelling at injec ### Had PNU on 12/10/08 arm red from 1/5/2009 Within 5 hours, patient experienced 1982 I was given vaccines for Typh ### 11/30 T 101 Dr. ran rapid strep -> n 1/2/2009 Headache within 15 min - 5 cm red ### Vaccines administered in L thigh on ### Patient reports that a rash began 3 ### Approximately 1 wk following injecti ### Patient blacked out after receiving H Increased headache, increase men ### Site of DTaP on L deltoid very red, s ### Raised red area at vaccine site + ab 4 female school teachers c/o S.O.B ### Patient RTC on 12/31/08- c/o .5cm
336562 336564 336565 336578 336580 336581 336582 336583 336586 336603 336604 336605 336606 336607 336608 336609 336610 336611 336612 336613 336614 336615 336616 336617 336618 336620 336625 336626 336627 336628 336629 336630 336631 336632 336633 336634 336635 336636 336637 336638 336654 336655 336656 336657 336664 336665 336666 336667 336668 336669 336670
1/6/2009 FL 1/6/2009 AZ 1/6/2009 WI 1/6/2009 NJ 1/6/2009 FL 1/6/2009 1/6/2009 NJ 1/6/2009 IL 1/6/2009 PA 1/6/2009 MD 1/6/2009 MA 1/6/2009 MA 1/6/2009 PA 1/6/2009 OH 1/6/2009 MT 1/6/2009 TN 1/6/2009 MA 1/6/2009 CO 1/6/2009 IA 1/6/2009 VA 1/6/2009 MA 1/6/2009 PA 1/6/2009 MO 1/6/2009 IL 1/6/2009 OH 1/6/2009 NJ 1/6/2009 FL 1/6/2009 ME 1/6/2009 PA 1/6/2009 NE 1/6/2009 MN 1/6/2009 MN 1/6/2009 MN 1/6/2009 CA 1/6/2009 ME 1/6/2009 IN 1/6/2009 MI 1/6/2009 MD 1/6/2009 NY 1/6/2009 FL 1/7/2009 NC 1/7/2009 CO 1/7/2009 MA 1/7/2009 MI 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH
32 16 61 19 25 18 9 65 71 48 1.3 1.3 71 74 0.3 0.2 9 45 73 0.2 0 1 12 41 41 36 52 0.6 71 52 54 22 29 69 41 30 15 25 1.5 34 0.2 55 1.4 63 38 32 31 28 38 29 30
32 16 61 19 18 9 65 48 1 1 71 74 0 0 9 45 74 0 0 1 12 41 41 36 0 71 52 54 22 29 69 41 30 15 25 1 0 55 1 63 38 32 31 28 38 29 30
M F F F F F F F F F 0.3 F 0.3 F F F 0.3 M 0.2 F F F F 0.2 M 0F 0M F M M F F 0.6 M M F F M F M F F M F 0.5 M F 0.2 M M 0.4 F F F F F F F F F
### Swollen shoulder w/red itchy rash ### 12/26/08 1520 client fainted 5-10 se ### Left upper arm just distal to shoulde 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/6/2009 Post viral symptoms 4 weeks post In 1/6/2009 Redness swelling and induration an 1/6/2009 Patient had a seizure two hours afte 1/6/2009 pain in arm, mild redness, progress 1/6/2009 Client stated that the evening after r 1/6/2009 Parents stated that pt developed a m 1/6/2009 Within 5 minutes of getting vaccines 1/6/2009 Pt presented with approx 5 cm area 1/6/2009 Fever of 101 -102, body aches, and 1/6/2009 12/16/08 RECIEVED VACCINE. 12 1/6/2009 High fever (102.9F), SOB & rash 3 d 1/6/2009 Patient was given Hep B shot at 1 m 1/6/2009 Vesicles noted on right arm near sit 1/6/2009 Vaccines given in same arm 12/20/0 1/6/2009 Associate was given Tdap vaccinati 1/6/2009 Approx. 10 hours after getting Tetan 1/6/2009 This case was reported by a lawyer ### A serious spontaneous report of Be This is a previously health 8-month1/6/2009 On November 10 pt received Flu va 1/6/2009 Injection site hurt longer than any pr 1/6/2009 Arm was sore for prolonged amount 1/6/2009 Arm was sore at site of injection for 1/6/2009 Arm was sore after receiving flu sho 1/6/2009 Bell's palsy-absence of muscular co 1/6/2009 Patient got dizzy, was short of breat 1/6/2009 Severe bilateral leg pain with cramp 1/5/2009 Within 12 hrs of vaccine. L arm at va ### 12/11/08 6:00pm, Rash appeared o Localized swelling (L) lateral thigh. 1/6/2009 Pt given vaccine and after a few min ### Pt developed Y decreased PO intake ### Began with left elbow pain, progress 1/2/2009 As part of flu clinic 17 mo was given ### Woke up on the 11th with a horrend 1/5/2009 This serious case was received from 1/5/2009 Initial report was received 27 Decem 1/6/2009 Initial report received on 27 Decemb 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial report received on 27 Decemb 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial report was received 27 Decem
336671 336672 336673 336675 336698 336699 336700 336701 336702 336703 336704 336705 336706 336707 336708 336709 336710 336711 336712 336713 336714 336715 336716 336722 336723 336724 336725 336726 336727 336728 336729 336730 336731 336732 336733 336773 336777 336778 336783 336784 336785 336786 336788 336789 336790 336791 336792 336793 336794 336795 336796
1/7/2009 NH 1/7/2009 NH 1/7/2009 NC 1/7/2009 FL 1/7/2009 FL 1/7/2009 VA 1/7/2009 AR 1/7/2009 NY 1/7/2009 WI 1/7/2009 PA 1/7/2009 WI 1/7/2009 PA 1/7/2009 LA 1/7/2009 NY 1/7/2009 WV 1/7/2009 PA 1/7/2009 UT 1/7/2009 VA 1/7/2009 CA 1/7/2009 CA 1/7/2009 GA 1/7/2009 MI 1/7/2009 NJ 1/7/2009 TX 1/7/2009 MN 1/7/2009 IA 1/7/2009 CA 1/7/2009 1/7/2009 CA 1/7/2009 CA 1/7/2009 CO 1/7/2009 MI 1/7/2009 VT 1/7/2009 IL 1/7/2009 TX 1/8/2009 1/8/2009 TN 1/8/2009 DC 1/8/2009 CA 1/8/2009 IL 1/8/2009 IL 1/8/2009 SC 1/8/2009 PA 1/8/2009 PA 1/8/2009 AZ 1/8/2009 PA 1/8/2009 AR 1/8/2009 MN 1/8/2009 OH 1/8/2009 AZ 1/8/2009
29
29
51 6 77 44 1 65 0.2 64 13 12 11 13 65 4 29 11 38 0.8 14 73 46 62 40 40 4 9 1 4 15 21 14 14 14 0.3
51 6
0.6 78 2 1 5 63 38 18 6 6
0 78 2 1 5 63 38 18 6 6
77 60 1.3
77 60 1
44 1 65 0 64 13 12 11 13 65 4 28 11 38 0 14 73 46 62 40 40 4 9 1 4 15 21 14 14 14 0
F M F M F F 0F F 0.2 M F M F M F F M M M F 0.7 F F M F F F F F F 0M F F F F F M 0.3 U M 0.6 F F 0F 0M M F M M F M U F M 0.3 F
1/5/2009 Initial report was received on 27 De 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial information was received on 2 ### Some shots have given patient the 1/6/2009 Information has been received from 1/7/2009 Rash appeared 3 days after immun 1/7/2009 10 days past her 1 yr. shots she sta 1/7/2009 Severe headache 48 hours after ad 1/7/2009 Patient developed upper respiratory 1/7/2009 Severe dizziness lasting 6 - 8 hours 1/7/2009 Pt developed a blister like rash on to 1/7/2009 Dizziness, nauseous, ringing in the 1/7/2009 Child came in one day later with hiv 1/7/2009 Patient presented to Immunization c 1/7/2009 Patient complained of severe pain, 1/7/2009 1 day after vaccine administration, p 1/7/2009 PT SUFFERED FROM HIVES, RAS 1/7/2009 Left Deltoid area on arm warm and 1/7/2009 f/u redness and swelling to left uppe 1/7/2009 One day after receiving the first dos 1/7/2009 Patient had Gardasil shot and then 1/7/2009 I Called Pt. Wed night to check up o 1/7/2009 This case was reported by a lawyer 1/7/2009 On Jan 2, arm began itching. Got w 1/6/2009 Arm was sore after receiving flu sho 12/3/2008 Initial information was received on 0 ### Left cellulitis; red, warm, tender trea 1/5/2009 My daughter received her second in 1/7/2009 Mild varicella-like rash - Rt upper ar 1/6/2009 Local reaction with itching, redness, 1/7/2009 Dizziness, fever 106 degrees F, red 1/7/2009 Patient received first dose of GARD 1/7/2009 Syncope within minutes of administr 1/6/2009 GARDASIL administered 12/22/08, 1/6/2009 Sleepless night, back pain, fever, he 1/7/2009 Initial report received from health au 1/6/2009 Initial reportYwas received 05 Janua 1/6/2009 Initial report received on 05 January On Oct. 27th Monday: Nurse at me 1/8/2009 Pt developed seizure activity < 12 h 1/7/2009 Patient seen Y on 12/18/08, received 1/8/2009 Diagnosed with juvenile onset diabe ### 10/17/08 3:30 am Hives hospital ER 1/5/2009 10/22/08 - 8pm- Body aches, fever/ ### Patient administered flu vaccine; pa 1/7/2009 Local redness & swelling - started ### Child had facial swelling hives body Injected in left arm - net sore at first ### Swollen left arm, pain ### 60 y/o male with left arm swelling fro 1/6/2009 Patient received VARIVAX on 9/26/
336797 336798 336799 336801 336802 336803 336810 336819 336820 336821 336822 336823 336824 336825 336826 336827 336828 336829 336830 336831 336832 336833 336834 336835 336836 336837 336838 336839 336840 336841 336842 336843 336844 336845 336846 336847 336848 336850 336851 336852 336853 336854 336861 336865 336866 336867 336868 336870 336871 336872 336873
1/8/2009 1/8/2009 OR 1/8/2009 1/8/2009 OR 1/8/2009 1/8/2009 1/8/2009 TX 1/8/2009 SC 1/8/2009 ND 1/8/2009 OR 1/8/2009 WI 1/8/2009 MO 1/8/2009 WV 1/8/2009 NY 1/8/2009 CA 1/8/2009 DE 1/8/2009 NM 1/8/2009 TX 1/8/2009 IA 1/8/2009 VA 1/8/2009 TX 1/8/2009 MI 1/8/2009 CA 1/8/2009 MN 1/8/2009 1/8/2009 NV 1/8/2009 CT 1/8/2009 FL 1/8/2009 WI 1/8/2009 IL 1/8/2009 AZ 1/8/2009 VA 1/8/2009 HI 1/8/2009 NM 1/8/2009 TX 1/8/2009 NY 1/8/2009 PA 1/8/2009 AZ 1/8/2009 1/8/2009 MN 1/8/2009 CO 1/8/2009 NY 1/9/2009 WY 1/9/2009 OR 1/9/2009 FL 1/9/2009 OH 1/9/2009 OH 1/9/2009 NM 1/9/2009 CT 1/9/2009 WI 1/9/2009 MD
1.3 1.2
1 1
12
12
18 25 40 15 66 18 60 16 2 0.8 29 4 68 20 23 52 44 5 15 72 64 42 4 0.2 0.2 66 1.2 82 54 74 13 0.2 4 26 15 16 18 2 8 14 11 18 38 15 25
25 40 15 66 18 60 16 2 0 29 4 68 20 22 52 44 5 14 72 64 42 4 0 0 66 1 82 54 74 13 0 26 15 16 2 8 14 11 18 38 15 25
0.3 F 0.2 F U F M U F F M F F F F F 0.9 M 0.8 F F M F F F F F F F M F F F 0.2 F 0.2 M F 0.2 M F F F F 0.2 M F F F F F 0.5 F M M M F M F F
1/6/2009 Patient received VARIVAX on 1/12/ 1/6/2009 Patient received VARIVAX on 5/7/0 1/6/2009 Patient received VARIVAX on 2/15/ 1/6/2009 Patient received VARIVAX on 12/27 Reacci¢n alergica, ronchas, comez¢ Allergic reaction, hives, itchiness, di ### Information has been received from 1/8/2009 12/15/08--Patient received Td on 9/ 1/8/2009 Pt. has increased swelling on L arm 1/8/2009 Redness on arm and spreading. Ho 1/8/2009 The patient received the Pneumova 1/8/2009 Within about one minute of receivin 1/8/2009 Pt telephoned 1/08/09 and stated th 1/8/2009 after the vacc,pt c/o dizzyness,when 1/8/2009 Flumist was administered at 11:00a 1/8/2009 Hives, starting 1 day after shot. Str 1/8/2009 Received a call from patient above 1/8/2009 Fell asleep after injection. Awoke lim 1/8/2009 Patient experienced acute leg weak 1/8/2009 9:50 am: phone call received by he 1/8/2009 23 year old female presented to Stu 1/8/2009 Pt came three days later w/complain 1/8/2009 Pt reports tingling and numbness/ne 1/8/2009 Received the shots on 10/23/2008 a 1/8/2009 Five to ten minutes after Td shot pt. 1/8/2009 SHINGLES FACE; NOSE; EYE NO 1/8/2009 Gillian Barre Syndrome after receivi 1/8/2009 I received an MMR shot on Decemb 1/8/2009 Diagnosis of double pneumonia one 1/9/2009 Patient found Y unresponsive in crib b 1/7/2009 Onset of bilious vomiting, abd. bloat 1/7/2009 Numbness of upper lip < lower lip a 1/8/2009 Several fluid-filled vesicles on red b 1/8/2009 Cellulitis to RUE to include erythem 1/8/2009 Local reaction to ADACEL . Pt has 1/7/2009 Pain & redness - Left deltoid - pt. di 1/7/2009 Loss of consciousness approximate 1/7/2009 12 hrs after vaccine, infant became 1/7/2009 Information has been received rega 1/7/2009 Initial and follow up information has 1/7/2009 Information has been received from 1/7/2009 Information has been received from ### Information has been received from 1/5/2009 Prolonged soreness/pain complaint ### Mother states child developed swell 1/5/2009 After vaccination patient appeared p 1/5/2009 Approximately ten minutes after his ### Patient was mistakenly administered 1/4/2009 Pt presented with redness on his to ### Rec'd varicella and FLUZONE R arm 1/6/2009 Pt passed and approximately 15-30
336875 336876 336877 336878 336879 336880 336881 336882 336888 336913 336914 336915 336916 336917 336918 336919 336920 336921 336922 336923 336924 336925 336926 336927 336928 336929 336930 336931 336932 336933 336934 336935 336936 336937 336938 336939 336940 336941 336942 336943 336944 336945 336946 336961 336962 336963 336964 336968 336969 336970 336971
1/9/2009 IL 1/9/2009 NC 1/9/2009 PA 1/9/2009 WA 1/9/2009 CA 1/9/2009 LA 1/9/2009 NJ 1/9/2009 1/9/2009 MI 1/9/2009 VA 1/9/2009 VA 1/9/2009 OH 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 TX 1/9/2009 WA 1/9/2009 TX 1/9/2009 UT 1/9/2009 MS 1/9/2009 VA 1/9/2009 AZ 1/9/2009 KY 1/9/2009 TX 1/9/2009 MA 1/9/2009 MA 1/9/2009 TX 1/9/2009 MO 1/9/2009 FL 1/9/2009 AR 1/9/2009 AR 1/9/2009 TX 1/9/2009 OH 1/9/2009 CO 1/9/2009 CO 1/9/2009 AZ 1/9/2009 AZ 1/9/2009 NY 1/9/2009 MT 1/9/2009 MI 1/9/2009 MI 1/9/2009 KY
76 0.1 50 14 69 1.1 0.7 28 18 28 5 31 49 27 45 23 36 27 29 43 42 29 38 37 18 32 27 49 3 26 0.2 24 62 17 4 17 21 39 24 47 5 18 47 0.2 0.2 32 65 0.4 8 57
76 0 50 14 69 1 28 18 28 5 31 49 27 45 23 36 27 29 41 41 29 38 37 18 32 27 49 3 26 0 24 62 17 4 17 21 39 24 47 5 18 47
32 65 0 8 57
F 0.1 M F M U 0.1 F F F F M F F F M F F M M M M M M M M F M F F M F 0.2 F F F F F F F F F M F F F F U U F M 0.4 M F F
1/6/2009 Information has been received from 1/6/2009 Crying nonstop day of vaccines unc 1/2/2009 Patient had right deltoid IM injection Right deltoid soreness, dizziness an 1. Received vaccine on 12-10-08. 2 1/5/2009 Patient received vaccines (PREVNA No physical exam. Child received H 1/6/2009 Migraine with auras, nausea and he ### Information has been received from 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 Redness/Swelling 4 inches around 1/9/2009 Had been sick the week before vacc 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 RECEIVED INFLUENZA IM VACCI 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 pain from left elbow to left shoulder 1/9/2009 Patient recieved Flumist (lot 500570 1/9/2009 TC from patient @ 11am. Started w 1/9/2009 1) 5 min after injection, heat flush & ### Mom noted swelling to left upper arm 1/9/2009 HAD THE SERIES OF 3 GARDISIL 1/9/2009 ON 1/1/2009 CHILD STARTED RUN 1/9/2009 Received tdap in the afternoon of 11/9/2009 AFTER TWO DAYS OFIMMUNIZAT 1/9/2009 Patient received HPV vaccine on 10 1/9/2009 Left arm where dtap and polio was g 1/9/2009 Mother of patient called immunizatio 1/8/2009 1/7/09@1000-Patient calls this offic 1/9/2009 On January 6, 2009, 2.5 weeks afte 1/9/2009 COMPLAINING OF PAIN AND TEN 1/9/2009 Patient received vaccine on 12/18/0 1/9/2009 Per mom C/O at about 5 - 6 PM sta 1/9/2009 Woke up that Sunday a.m. feeling v 1/9/2009 Got the vaccine at 4 in the afternoon 1/8/2009 This case was reported by a healthc 1/8/2009 This case was reported by a physici 1/8/2009 This case was reported by a physici 1/8/2009 This case was reported by a physici 1/9/2009 Pt phoned 1/8/09 stating that he had 1/7/2009 Mother states child developed Temp 1/7/2009 No information Provided 1/9/2009 Patient reported to facility with 5 1/2
336972 336973 336974 336975 336977 336978 336979 336980 336981 336982 336983 336984 336985 336986 336947 336948 336949 336950 336951 336952 336953 336954 336955 336956 337031 337032 337033 337035 337036 337037 337038 337039 337040 337041 337042 337043 337045 337046 337047 337048 337049 337050 337051 337052 337053 337054 337055 337056 337057 337058 337059
1/9/2009 ND 1/9/2009 IN 1/9/2009 AZ 1/9/2009 NY 1/9/2009 HI 1/9/2009 UT 1/9/2009 OR 1/9/2009 TX 1/9/2009 NY 1/9/2009 NH 1/9/2009 CO 1/9/2009 VA 1/9/2009 CA 1/9/2009 CA 1/10/2009 TX 1/10/2009 PA 1/10/2009 CA 1/11/2009 MA 1/11/2009 NE 1/11/2009 MN 1/11/2009 UT 1/11/2009 FL 1/11/2009 CA 1/11/2009 TN 1/12/2009 1/12/2009 TN 1/12/2009 1/12/2009 GA 1/12/2009 NY 1/12/2009 FL 1/12/2009 AZ 1/12/2009 WI 1/12/2009 CT 1/12/2009 NV 1/12/2009 FL 1/12/2009 MN 1/12/2009 NC 1/12/2009 IN 1/12/2009 TN 1/12/2009 TN 1/12/2009 FL 1/12/2009 LA 1/12/2009 HI 1/12/2009 MN 1/12/2009 MT 1/12/2009 MI 1/12/2009 WV 1/12/2009 OR 1/12/2009 FL 1/12/2009 CO 1/12/2009 MI
20 1.1 11 18 20 19 18 1.2 75 12 0.3 1.5 1.3 1.5 31 80 65 3 28 42 50 29 72 0.3 18 18
20 1 11 18 20 19 18 1 75 12 0 1 1 1 31 80 65 3 28 42 50 29 72 0 18
0.2 71 25 32 17 17 60 1.2 53 0.2 47 0.8 1 1.1 0.4 11 2 65 51 4 8 1 12 62
0 71 25 32 17 60 1 53 0 47 0 1 1 0 11 2 65 51 4 8 1 12 62
M 0.1 F F F F F M 0.2 F F M 0.3 M 0.5 M 0.3 F 0.5 F F F F M F F F M F 0.3 F F F U 0.2 M M F M M F F 0.2 M F 0.2 M F 0.8 M 0M 0.1 M 0.4 M F 0.2 F F F F M 0M M F
1/2/2009 1-2-09 client received MENACTRA 1/9/2009 Rash over body started 1/8/09, wors 1/9/2009 B/L deltoid area with erythema/ war 1/9/2009 Patient given GARDASIL- fainted af 1/5/2009 Dizzy, lightheaded, tachycardia, inte 1/9/2009 15 min after immunization complain 1/9/2009 Mini stroke. 2/18/09 Neurology cons 1/9/2009 DTAP 0.5 cc IM right deltoid. With in 1/9/2009 Patient developed shingle along C3 1/9/2009 Patient developed redness and pain 1/9/2009 Within 72 hrs of receiving 4 month v 1/9/2009 Profuse Vomiting 1/9/2009 8:51 am onset of 104 degree fever. 1/9/2009 (L) chin swelling. Increase fever of 4 1/10/2009 Low grade fever, sore throat, swolle 1/10/2009 Patient's son (a DMD) is visiting from 1/10/2009 Dermatofibroma at site (subcutaneo 1/11/2009 Vomiting and fever. Had Vaccine m 1/11/2009 Erroneously received two doses of M 1/11/2009 Fever (<100dF), which lasted sever 1/11/2009 Wed, 7 Jan afternoon, shut van slid 1/11/2009 high temperature, respiratory illness 1/11/2009 Swelling, inflamation, pain at shot s 1/11/2009 Behavior changes including fussine 1/9/2009 Information has been received from 1/9/2009 Information has been received from 1/9/2009 InformationYhas been received from 1/9/2009 Information has been received from 1/7/2009 6-27-02 1st PNEUMOVAX - 0 reach ### Cellulitis infection near injection site 1/6/2009 Nausea, vomiting, fatigue and hot fl ### Loss of consciousness sonorous br Fluctuating total body urticaria. Tre 1/7/2009 Client called and reported a rash all 1/7/2009 rash ### 4 Inch redness at injection site that ### High pitched unconsolable crying + 1/3/2009 Received MMR + VARIVAX vaccine ### Local reaction redness, swelling for ### Had temp 102.4 evening following v 1/5/2009 Red bumps all over face, neck, arm ### 1 by 1 cm redden area to (R) thigh & ### Right arm redness 7.5cm x 3.5cm, t Temperature unknown. Symptoms i 12/3/2008 Female complains of sore right arm 1/6/2009 Pain at injection site for 2 months. ### At approx 11:30 am pt developed ra ### 12/30 Mom noticed swelling at injec 1/7/2009 Pt received varicella immunization o ### Developed diffuse, maculopapular r Pt states about 2-3 days after inject
337060 337061 337062 337063 337064 337065 337067 337068 337069 337070 337071 337072 337073 337074 337075 337076 337077 337078 337079 337080 337081 337082 337083 337084 337086 337099 337100 337101 337102 337103 337104 337105 337113 337087 337088 337089 337094 337095 337096 337097 337098 337115 337130 337132 337133 337134 337135 337136 337137 337138 337139
1/12/2009 OH 1/12/2009 PA 1/12/2009 MN 1/12/2009 WV 1/12/2009 MI 1/12/2009 GA 1/12/2009 PA 1/12/2009 VA 1/12/2009 SC 1/12/2009 CA 1/12/2009 ND 1/12/2009 OH 1/12/2009 OK 1/12/2009 GA 1/12/2009 CA 1/12/2009 TN 1/12/2009 HI 1/12/2009 MD 1/12/2009 MD 1/12/2009 LA 1/12/2009 OK 1/12/2009 1/12/2009 AZ 1/12/2009 CO 1/12/2009 KY 1/12/2009 1/12/2009 AL 1/12/2009 KY 1/12/2009 MI 1/12/2009 AL 1/12/2009 AL 1/12/2009 FL 1/12/2009 MN 1/13/2009 GA 1/13/2009 WA 1/13/2009 OH 1/13/2009 AZ 1/13/2009 MN 1/13/2009 PA 1/13/2009 TX 1/13/2009 WA 1/13/2009 MO 1/13/2009 TX 1/13/2009 CA 1/13/2009 WA 1/13/2009 OR 1/13/2009 MN 1/13/2009 NC 1/13/2009 IN 1/13/2009 NH 1/13/2009 VT
71 0.4 23 42 90 44 57 50 6 26 14 18 0.2 0.3 14 0.2 19 63 0.1 0 55 4 46 34 67 21 1.8 46 0.5 9 41 62 70
71 0 23 42 90 44 57 50 6 26 14 18 0 0 13 8 19 65 0 0 55 4 46 34 67 21 1 46 0 9 41 62
70
70
1.4 60 12 35 19
1 60 12 35 19
0.3 1.8 16 44 0.9 1.6 33 26 54
0 1 16 44 0 1 33 26 54
F 0.4 F F F F F M F F F M F 0.2 F 0.3 F M F M M 0.1 M 0F F F F F F M 0.8 F F 0.5 M F M F U F F F 0.4 M F F F M F 0.3 M 0.8 F F F 0.9 F 0.6 F F M F
Hard, warm swelling shoulder to elb 1/12/2009 Intussusception. 2/23/09 Received 1/12/2009 Patient felt hot, dizzy, lightheaded, h 1/8/2009 Right deltoid developed edema afte 1/7/2009 Elevated swelling with in duration an 1/6/2009 States she had nausea and chest p 1/12/2009 Patient received a pneumococcal va 1/12/2009 "Tender anterior cervical adenoopat 1/12/2009 Parent reported temp of 101.1 on ev 1/12/2009 Received TDAP Vaccine on 1/7/200 1/12/2009 Four hours after vaccination, patien 1/12/2009 Patient left message on voicemail 0 1/12/2009 gave pt wrong immunization in wron 1/12/2009 SPOKE WITH MOTHER AND NOT 1/12/2009 fever 104, Rt arm swollen from elbo 1/12/2009 diarrhea 1/12/2009 FEVER 102F, VOMITING X1 DAY. 1/12/2009 Malaise onset 36-48 h after immuniz 1/12/2009 3 DAYS AFTER VACCINES PT DE 1/12/2009 Pt recieved two Hep B vaccines dur 1/12/2009 Complains of upper right arm pain s 1/12/2009 RASH ALL OVER BODY 1/12/2009 Nerve tingling at all sites from bottom 1/12/2009 "Breathing difficulty, fever, body ach 1/12/2009 Arm developed a 3 inch diameter re ### 18 Days after small pox and anthrax 1/5/2009 Febrile seizure - Had flu shot 11-141/9/2009 Patient had Tdap injection LT arm o ### Infant found listless, poor muscle to FLUMIST received 12/27/08. On 12 ### Flumist received on Saturday, 12/27 1/6/2009 Had a headache from 12-17-08 time ### Information has been received from 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 Vomiting, fever, Heat @ site. 1/12/2009 Shortness of breath, bodyaches. Tr 1/12/2009 Pt recvd menactra + Hep A vaccine 1/12/2009 Developed shaking, shivering with p 1/12/2009 Patient filled out info sheet stating h ### Information has been received from Pt. examined Y and vaccinated on 12 1/8/2009 Developed cold, cough, vomiting aft ### Within 5 mins of receiving HPV injec 1/6/2009 Saw PCP With X 3days fever 99 , H 1/8/2009 Hours after flu vaccine administered 1/9/2009 Seen on 1-7-09 = lt leq red + swolle 1/9/2009 Patient had a flu shot in October 20 ### Member developed a satellite pustu 12/3/2008 Burning itch over upper body, extrem
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1/13/2009 MN 1/13/2009 PA 1/13/2009 NJ 1/13/2009 IL 1/13/2009 TX 1/13/2009 TX 1/13/2009 VA 1/13/2009 MA 1/13/2009 MN 1/13/2009 MA 1/13/2009 AL 1/13/2009 1/13/2009 1/13/2009 FL 1/13/2009 OH 1/13/2009 MN 1/13/2009 MI 1/13/2009 OK 1/13/2009 MI 1/13/2009 OK 1/13/2009 GA 1/13/2009 WI 1/13/2009 LA 1/13/2009 VA 1/13/2009 FL 1/13/2009 TX 1/13/2009 GA 1/13/2009 TX 1/13/2009 CO 1/13/2009 AZ 1/13/2009 FL 1/13/2009 PA 1/13/2009 IL 1/13/2009 CA 1/13/2009 MI 1/13/2009 MO 1/13/2009 NV 1/13/2009 ME 1/13/2009 IL 1/13/2009 HI 1/13/2009 HI 1/13/2009 HI 1/13/2009 CA 1/13/2009 NM 1/13/2009 KY 1/13/2009 NY 1/13/2009 NY 1/13/2009 NC 1/13/2009 NC 1/13/2009 CA 1/13/2009 NY
63 3 18 1.1 26 26 5 11 49 37
63 3 18 1 26 26 5 11 49 37
63 15 4 22 5 16 0.8 6 41 0.3 14 0.2 11 0.6 0.5 0.3 63 58 35 75 11 0.2 38 12 17 35 15 20 20 20 4 52 1.3 1.7 1 37 26 1.3 18
63 15 4 22 5 16 0 6 41 0 14 0 11 0 0 0 63 58 35 75 11 0 38 12 17 34 15 20 20 20 4 52 1 1 1 37 26 1 18
U F F F 0.1 M F F M M F F M F F M F M F 0.8 M F M 0.4 M F 0.2 F F 0.6 F 0.5 U 0.3 M F F F F F 0.2 M F M F M F F F F M F 0.3 M 0.7 M 0M F F 0.3 M M
Right Arm cellulitis. 10/20/08 Vaccinated at 9AM- Pain i ### Slept 14 hours; woke up dizzy; then 1/6/2009 Patient fainted 4 days after vaccinat 1/8/2009 Erythema 20 x 20 over (L) arm PCV 1/6/2009 Dizzy, headache, brown spot in visio 1/9/2009 Blister at the side where HEPTAVAX 1/7/2009 (L) deltoid with 11.5cm x 13cm area ### 20cm erythema, pruritis and pain at 1/8/2009 Generalized body rash with mild ede 11/4/2008 Nerve damage in right arm. I have p 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received for th 1/13/2009 Redness noted at injection site on le 1/13/2009 after first two HPV shots had muscle 1/13/2009 Patient has received two Varicella v 1/13/2009 PT RECEIVED GARDASIL, MENAC 1/13/2009 On 1-9-09 patient had a seizure at 7 1/13/2009 PT PRESENTED TO OFFICE ON 1 1/13/2009 Headache, malaise, myalgias began 1/13/2009 3 days following vaccination patient 1/13/2009 Started complaining with joint pain, 1/13/2009 1/8, 11:40am - parent returned to he 1/13/2009 My daughter recived the first HPV g 1/13/2009 Child had seizure 7 hours after 2nd 1/13/2009 Flush race on face and swelling of f 1/13/2009 Sseizure within 24 hours of vaccina 1/13/2009 WEAKNESS; PAIN & NUMBNESS 1/13/2009 10/16/08 1 PM-PT REPORTED FRE 1/13/2009 Right deltoid slightly swollen, with w 1/13/2009 Four days of chills without fever, my 1/13/2009 Itchy rash, raised bump at the site, s 1/13/2009 My son was a very happy and relax 1/13/2009 1-10-09 11am stiff neck, tight jaw m 1/13/2009 Within five minutes of vaccine admin 1/13/2009 Pt developed strong daily headache 1/13/2009 Site was mildly painful, warm, red, s 1/8/2009 Patient developed genital herpes pr Dizziness, lightheaded, tachycardia Dizziness, lightheaded, tachycardia Dizziness, lightheaded, tachycardia 1/12/2009 L upper arm- erythematous mac rais Swelling of entire arm down to finge 1/8/2009 Developed fever of 104 degrees foll 1/13/2009 Swelling to LL at site of vaccine. Ad 1/9/2009 Fever (low grade), rash of a vesicula ### (L) dt area where she got ADACEL ### Patient developed low back pain tha 1/9/2009 Fever 104 - x2Days, Motrin/Tylenol. 1/13/2009 Night of vaccines pt broke out in hiv
337195 337196 337197 337199 337204 337205 337206 337207 337208 337209 337210 337211 338020 338021 338022 338023 338024 337227 337242 337243 337245 337246 337247 337248 337249 337250 337251 337252 337301 337302 337303 337304 337309 337310 337321 337322 337323 337324 337325 337326 337327 337328 337330 337331 337332 337333 337334 337335 337336 337337 337338
1/13/2009 NY 1/13/2009 CT 1/13/2009 CT 1/13/2009 CT 1/13/2009 CT 1/13/2009 OH 1/13/2009 MO 1/13/2009 OR 1/13/2009 NC 1/13/2009 NC 1/13/2009 VA 1/13/2009 NY 1/13/2009 NY 1/13/2009 1/13/2009 TX 1/13/2009 NY 1/13/2009 OH 1/14/2009 1/14/2009 NM 1/14/2009 PA 1/14/2009 OH 1/14/2009 MA 1/14/2009 PA 1/14/2009 1/14/2009 1/14/2009 1/14/2009 1/14/2009 1/14/2009 PA 1/14/2009 1/14/2009 CT 1/14/2009 OK 1/14/2009 MA 1/14/2009 IL 1/14/2009 RI 1/14/2009 FL 1/14/2009 NE 1/14/2009 MI 1/14/2009 AZ 1/14/2009 TX 1/14/2009 FL 1/14/2009 TX 1/14/2009 MN 1/14/2009 CT 1/14/2009 NC 1/14/2009 NC 1/14/2009 MI 1/14/2009 MI 1/14/2009 MI 1/14/2009 KS 1/14/2009 FL
16 26 70 72 50 73 79 56 18 57 19 48 1.3 1.1 0.3 1.3 61 20 0.4 1 14 38 27 20 77 65 16 17 12 67 66 55 78 51 12 76 2 4 4 12 44 0.5 28 5 14 36 18 22 65
16 26 70 72 50 73 79 56 18 57 19 48 1
1 20 0 1 14 38 27 20
16 17 12 66 55 78 51 12 76 2 4 4 12 44 0 28 5 14 36 18 22
M F M M F F F F M F F F M 0.1 F U M 0.3 M F F 0.4 M 0M F F F F F M M F F F F F M M M F F 0.2 F M M M F 0.5 M F F F M F F M
1/13/2009 Mom stated child had congestion, s 1/6/2009 Left arm pain since flu shot reported 1/6/2009 Pt states his whole right arm was sw 1/12/2009 Pt states his whole right arm was sw 1/6/2009 12/10/08 Reported persistent pain a 1/12/2009 1/6/09 left upper arm became red, w 1/5/2009 30x50 mm area of erythema and wa 1/13/2009 Day 3 post tetanus/pertussis vaccin ### Pt given RECOMBIVAX HB instead ### Infection of left deltoid following Influ 1/12/2009 C/O redness and swelling at injectio 1/12/2009 45 minutes after injection - develope 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from ### Information has been received from 1/9/2009 My daughter Y had her 3rd GARDASI 1/9/2009 Patient developed Y hemorrhagic sho 1/9/2009 Can the chicken pox vaccine cause 1/12/2009 VARIVAX & influenza given in left a 1/8/2009 Pain in L upper arm with 2 hours of 1/12/2009 Hives after ZOSTAVAX vaccination 1/12/2009 Diagnosed with rheumatoid arthritis ### Pt describes onset of pain at R shou ### 12/22/08 patient called after hours w 1/3/2009 Fever, Erythema Multiforme, Diarrhe 1/13/2009 Information has been received from 1/13/2009 Information has been received from 1/13/2009 Information has been received from 1/13/2009 Initial and follow-up information has ### PNEUMOVAX 23 given 12/2/08 bet 1/13/2009 Persistent right deltoid pain after He 1/14/2009 Patient began with cough and uppe 1/14/2009 01/05/2009 Increase Tempature/ 0 1/14/2009 Provider notified Y on 1/2/09 that patie 1/14/2009 TWO WEEKS AFTER VACCINATIO 1/14/2009 A little more than 24 hours I noticed 1/14/2009 2 days after receiving Hepatitis A an 1/14/2009 THE DAY AFTER I ADMINISTERED 1/14/2009 Pt ran fever to 102. Had a large kno 1/14/2009 upper arm 7cm red/warm tender bu 1/14/2009 Pt developed fever of 104.5 with irri 1/14/2009 Flushot given around 11AM? About 1/14/2009 RED,SWOLLEN LEFT DELTOID RE 1/14/2009 Arm swelling (site of innoculation), a 1/14/2009 Approximately 2 hours after receive 1/14/2009 Given Meningococcal (MCV4) vacci 1/14/2009 Sharp stomach pains within 2 hours 1/14/2009 yfvax administered 01/12/09, 01/13/
337340 337341 337342 337343 337344 337345 337346 337347 337348 337353 337354 337355 337356 337357 337358 337359 337361 337362 337363 337364 337365 337417 337419 337420 337421 337422 337423 337424 337425 337426 337427 337428 337429 337430 337431 337432 337433 337434 337435 337436 337437 337438 337439 337440 337442 337444 337452 337453 337454 337455 337456
1/14/2009 IL 1/14/2009 MN 1/14/2009 NC 1/14/2009 UT 1/14/2009 ME 1/14/2009 VA 1/14/2009 1/14/2009 GA 1/14/2009 OR 1/14/2009 NY 1/14/2009 TX 1/14/2009 FL 1/14/2009 CA 1/14/2009 CA 1/14/2009 AZ 1/14/2009 NC 1/14/2009 NY 1/14/2009 MI 1/14/2009 IN 1/14/2009 NC 1/14/2009 IL 1/15/2009 1/15/2009 1/15/2009 OH 1/15/2009 NH 1/15/2009 AZ 1/15/2009 WA 1/15/2009 WA 1/15/2009 AZ 1/15/2009 AZ 1/15/2009 1/15/2009 WA 1/15/2009 1/15/2009 NC 1/15/2009 NC 1/15/2009 1/15/2009 NC 1/15/2009 NC 1/15/2009 NC 1/15/2009 1/15/2009 1/15/2009 1/15/2009 NC 1/15/2009 FL 1/15/2009 1/15/2009 1/15/2009 1/15/2009 OR 1/15/2009 CO 1/15/2009 AZ 1/15/2009 AZ
4 26 45 23 64 65 63 6 4 47 20 68 4 0.4 67 7 48 1.2 12 1.3 16 33 25 60 53 22 67 52 2 2 21 12 27 19 40 32 21 41 22 19 21 28 29
4 26 45 23 64 65 63 6 4 47 20 68 4 0
16 0.2 55 0.5 64 0.3 5
16 0 55 0 64 0 5
7 48 1 12 1 16 33 25 60 53 22 67 52 2 21 12 27 19 40 32 21 41 22 19 21 28 29
F F M F F F F F F F U F F 0.4 M F F F 0.2 M F 0.3 M F M M F F F U F 0.1 F M F F M M F M M M M M M F F M F 0.2 U F 0.5 M F 0.3 M F
1/14/2009 DTaP given on 1/12/09 right arm, H 1/14/2009 4 hours after shot administered, felt 1/14/2009 1 1/2 hours after receiving the MMR 1/14/2009 Shots at 2:30pm 12/30/08 Slight he 1/14/2009 Patient reported having a fever, loca 1/14/2009 Shingle Shot was administered and 1/14/2009 patient came down with Shingles. W 1/14/2009 SHE RECEIVED THE FLU SHOT IN 1/14/2009 Fever at least 103, chills, fatigue, lo 1/11/2008 Description: 47 y/o female AD SM re 1/14/2009 The patient states with every flu vac 1/14/2009 Pt came in c/o pain to L side of face 1/14/2009 Mild local hypersensitivity Rxn to va 1/14/2009 Injection given on 01/13/09 in arm. M 1/7/2009 Rash- has been to 2 Doctors who s 1/19/2009 Rt arm red & swelled where VARIVA 1/14/2009 C/O chills, fever, headache, body ac 1/14/2009 There is a 6x7cm hard red patch on 1/14/2009 Patient eyes swollen shut, itchy. BE 1/14/2009 3 erythematous areas distal to site o 1/6/2009 Lower abdominal discomfort, onset 1/12/2009 This patient was a 34 year old male 1/15/2009 SM who received multiples doses o 1/12/2009 1-05-2009 received flu vaccine. Pt r 1/12/2009 Pt developed cellulitis on the site of 1/13/2009 Patient received yellow fever and ty Within 18 hours-swelling 2"x3" raise 1/11/2009 Flu Shot was fine at first but overtim 1/10/2009 Pain at sight, fever, non-weight bea 1/10/2008 Pain at injection site, fever, non-wei 1/10/2009 Prior to 3 doses of GARDASIL I had 1/7/2009 After first shot of GARDASIL on 2-7 6/2/2008 27 y.o. AD AA male SM presents wi 1/15/2008 SM received his primary SPV on 11 1/9/2008 Less than one minute after receiving 1/4/2008 SM developed redness, swelling, pa ### noted rash on arm, redness into his ### SM with h/o eczema that received S ### SM noted redness, swelling around ### SM had large local reaction with his 12/7/2007 SM notes he had large local reactio ### Developed large local reaction to an 11/7/2007 SM went to PCP for evaluation of H 1/14/2009 Information has been received from 1/14/2009 Information has been received, for t 1/14/2009 Information has been received from 1/15/2009 This case was reported by a consum 1/15/2009 Intussusception. First began with bl 1/12/2009 Bright red, hard area approximately 1/13/2009 Mother reported elevated temperatu 1/13/2009 Redness developed at injection site
337457 337458 337459 337460 337461 337462 337463 337464 337465 337466 337467 337468 337469 337470 337471 337472 337473 337474 337475 337476 337477 337478 337479 337480 337481 337482 337483 337484 337485 337486 337487 337488 337489 337490 337491 337492 337493 337494 337495 337496 337499 337502 337503 337506 337507 337541 337542 337544 337545 337546 337547
1/15/2009 NY 1/15/2009 NY 1/15/2009 CA 1/15/2009 KS 1/15/2009 PA 1/15/2009 KY 1/15/2009 IA 1/15/2009 OH 1/15/2009 MD 1/15/2009 CA 1/15/2009 WA 1/15/2009 GA 1/15/2009 WA 1/15/2009 ID 1/15/2009 NY 1/15/2009 CA 1/15/2009 OR 1/15/2009 CO 1/15/2009 TN 1/15/2009 CA 1/15/2009 MI 1/15/2009 CA 1/15/2009 IN 1/15/2009 NC 1/15/2009 NH 1/15/2009 NC 1/15/2009 1/15/2009 CA 1/15/2009 WI 1/15/2009 TX 1/15/2009 GA 1/15/2009 MA 1/15/2009 NC 1/15/2009 CA 1/15/2009 IN 1/15/2009 1/15/2009 ME 1/15/2009 IA 1/15/2009 OH 1/15/2009 IN 1/15/2009 MD 1/15/2009 CA 1/15/2009 MI 1/15/2009 VT 1/15/2009 NY 1/16/2009 CA 1/16/2009 CA 1/16/2009 FL 1/16/2009 MO 1/16/2009 MO 1/16/2009 NY
17 18 1.4 0.2 0.2 2 86 0.5 17 69 12 4 63 54 3 40 6 50 62 25 1.3 42 1 4 1.6 0.3 0.8 0.2 5 46 5 23 9 15 68 32 10 0.4 0.2 0.9
17 18 1 0 0 2 85 0 17 69 12 4 63 54 3 40 6 50 62 25 1 42 0 4 1 0 0 0 5 46 5 23 9 15 68 32 10 0 0 0
35 29 58 1.5 4 25 75 15 15 61
35 29 58 1 4 25 75 15 15 61
M F 0.4 F 0.2 M 0.2 M 0.6 F F 0.6 F F F F F F F F F M M F F 0.3 M F 0M M 0.6 F 0.3 M 0.8 M 0.2 F F M M F F F F M M 0.4 F 0.2 M 0.9 M U F F M 0.5 F F M F F F F
1/15/2009 About 2-3 mins after receiving vacci 1/15/2009 Patient states that right wrist was sw 1/15/2009 Red, warm to touch rash at injection 1/15/2009 Mother noted blood in infant's stool 1/15/2009 high pitched screaming for hours on 1/15/2009 Mother reports hives on back- uppe 1/15/2009 Patient reported raised red very pai 1/15/2009 Motehr called and reported need to 1/15/2009 Within 3 days of receiving the 2nd r 1/15/2009 patient was accidently give Tdap ins 1/15/2009 High fevers 102+, Nausea, Dizzy, le 1/15/2009 Pt R leg 11 x 7 cm reddened area n 1/15/2009 Lower upper arm is very swollen an 1/15/2009 Received 3rd hep B injection on 12/ 1/15/2009 low grade fever, vomiting, dehydrati 1/15/2009 Patient complained of persistent red 1/15/2009 Acute icshemic stroke (basilar artery 1/15/2009 Following receipt of vaccines in trav 1/15/2009 Patient received vaccine 01/06/2009 1/15/2009 Hepatitus B Vaccine series given at 1/15/2009 Uncontrollable screaming and fits of 1/15/2009 Onset of reactive lymphadenopathy 1/15/2009 Jacob had a febrile seizure with a te 1/14/2009 Dar reported patient "almost passed 1/15/2009 Mom called-mosquito bite size area 1/13/2009 When pt was brought to my office fo 1/6/2009 Hepatitis A given to 9 month old chi ### persistent severe irritability, 4-6 hrs 1/8/2009 Upper leg Swelling, warmth redness 1/8/2009 12/20 1 1/2 area of redness with ele 1/9/2009 Left upper arm - redness and swellin 1/9/2009 C/O light headedness and inability t 9/22/2008 Client given Tdap - recommended fo 1/15/2009 Complained of pain radiating from in 1/15/2009 Five inch red circle around administ 11/1/2007 SM changed bandage over SPV site 1/15/2009 1/12/09- Area swelled red raised. V 1/14/2009 Child came to appointment for 4 mo 1/12/2009 Abnormal sounding cry, crying cons 1/15/2009 On 1-14-09 per mother at 10:30 pm None stated 1/15/2009 Within 2 hours of vaccination Pt exp 1/15/2009 11-14-09 back of neck began to itch 1/13/2009 Severe Shaking Chills myalgias for ### Here with both parents for rash, Frid 1/12/2009 1/5/09 received DTAP, IPV, MMR,V 1/13/2009 Left arm cellulitis 24 hours after vac Vaccine injection 3:45p- woke up 9: 1/8/2009 10/07- Vomiting, Diarrhea Daily-No 1/12/2009 Within 24 hours of HPV dose given 1/12/2009 1/9/09 0830 Pt. called to report that
337548 337549 337550 337551 337552 337553 337584 337585 337586 337590 337591 337592 337595 337596 337600 337601 337602 337603 337605 337606 337607 337608 337609 337610 337611 337612 337613 337614 337615 337616 337617 337618 337633 337649 337650 337651 337652 337663 337664 337665 337666 337667 337668 337670 337671 337672 337674 337675 337688 337689 337690
1/16/2009 NY 1/16/2009 CA 1/16/2009 NY 1/16/2009 IL 1/16/2009 AZ 1/16/2009 1/16/2009 PA 1/16/2009 1/16/2009 1/16/2009 IL 1/16/2009 FL 1/16/2009 CA 1/16/2009 1/16/2009 NJ 1/16/2009 FL 1/16/2009 FL 1/16/2009 FL 1/16/2009 NY 1/16/2009 TX 1/16/2009 NM 1/16/2009 NM 1/16/2009 DC 1/16/2009 SC 1/16/2009 TN 1/16/2009 FL 1/16/2009 CA 1/16/2009 WY 1/16/2009 AZ 1/16/2009 WY 1/16/2009 AZ 1/16/2009 CA 1/16/2009 PA 1/16/2009 CT 1/16/2009 UT 1/16/2009 1/16/2009 1/16/2009 MA 1/16/2009 NJ 1/16/2009 NY 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 NY 1/16/2009 AL 1/16/2009 AR 1/16/2009 MA 1/16/2009 GA 1/16/2009 IL 1/16/2009 VA 1/16/2009 KS 1/16/2009 MN
60 0.1 4 2 1.1 62 0.2
60 0 4 2 1 62 0
22 13 19 59
22 13 19 59
66 69 67 24 1 15 13 5 42 42 44 54 0.2 34 33 18 2 29 64 1.1 90
66 69 67 24 1 15 13 5 42 42 44 54 0 34 33 18 2 29 64 1 90
48
48
52
52
46 0.1 0.5 5 8 32 87 19 44
46 0 0 5 8 32 87 19 44
F 0.1 F F 0M 0.1 F U 0.2 F U M F F F F F F F M F 0F F M F F F F F 0.2 F F M F 0.1 F F F 0.1 M F F F M M M M F M 0.1 M 0.5 F F F U F M F
patient developed a 1"x1 1/2" indura 1/12/2009 Bloody, mucousy stools after ROTA 1/4/2009 24 hrs after UMM placed erythema, 1/12/2009 Child received PEDIARIX/PREVNA ### Started 10-15 min after getting vacc Large lump- size of "grape" in arm 12/1/2008 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information was obtained on reques 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/16/2009 Within 30 minutes of vaccination to 1/16/2009 The patient presented with swelling 1/16/2009 Patient presented with cellulitis of rig 1/16/2009 I HAD SEVERE PAIN AT THE SITE 1/16/2009 Patient had a rash on the thighs and 1/16/2009 Abdominal pain/stomach cramps for 1/16/2009 Was disoriented, unable to answer 1/16/2009 PT RECEIVED EXPIRED FLUMIST 1/16/2009 Reported rash & periorbital swelling 1/16/2009 Patient reported burning and stingin 1/16/2009 Pt experienced large local reaction 1/16/2009 Patient came to clinic today and pre 1/16/2009 Patient developed watery diarrhea 1 1/16/2009 Patient came to Health Center at 12 1/16/2009 eyes itching, tightness in chest, cou 1/16/2009 Had 1st HPV on November 4th, 200 1/16/2009 Patient had an afebrile seizure even 1/16/2009 Sore arm, fever, body aches, chills, 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/15/2009 This case was considered medically 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/12/2009 Found by father Y not breathing appro 1/16/2009 Pt was administered Y vaccines on 01 1/12/2009 Developed hives/facial swelling, loc 1/16/2009 11/4 had varicella shot R arm. 11/5 Lt deltoid became red, swollen, war 1/14/2009 VARICELLA- like rash 1/15/2009 Chills, fever of 101.9, aches, stiffnes 1/9/2009 My left shoulder started pinching. T
337691 337692 337693 337694 337695 337696 337697 337698 337699 337700 337701 337702 337703 338026 338027 338028 338029 338034 338035 338036 338037 338038 338039 338040 338041 338042 338043 338044 338045 338046 338047 338048 338075 338076 338077 338078 338079 338080 338081 338082 338083 338084 338085 338086 338087 338088 338089 338090 338091 338092 338093
1/16/2009 MN 1/16/2009 NC 1/16/2009 WI 1/16/2009 AZ 1/16/2009 TX 1/16/2009 FL 1/16/2009 WI 1/16/2009 1/16/2009 1/16/2009 CA 1/16/2009 MI 1/16/2009 MN 1/16/2009 OH 1/16/2009 1/16/2009 1/16/2009 DC 1/16/2009 GA 1/16/2009 MO 1/16/2009 NY 1/16/2009 CT 1/16/2009 WI 1/16/2009 OK 1/16/2009 CA 1/16/2009 1/16/2009 1/16/2009 CA 1/16/2009 IN 1/16/2009 NY 1/16/2009 1/16/2009 1/16/2009 IN 1/16/2009 1/16/2009 NC 1/16/2009 PA 1/16/2009 1/16/2009 1/16/2009 IL 1/16/2009 OH 1/16/2009 OH 1/16/2009 NJ 1/16/2009 TX 1/16/2009 TX 1/16/2009 TX 1/16/2009 MI 1/16/2009 PA 1/16/2009 NC 1/16/2009 TX 1/16/2009 WI 1/16/2009 1/16/2009 IN 1/16/2009 IN
43 0.6 15 53 1.4 1.3 12 36 31 9 65 1 1
43 0 15 53 1 1 12 36 31 9 65 1 1
21 45
21 45
10 39
10 39
38 8
38
48 0.3
0
0.1 38 26 48
0 38 26 48
50 72 45
50 72 45
3
3
26
26
27
27
F 0.6 F F M 0.4 F 0.3 M M M M F F 0F 0M U U F M M U F M F F F U U F 0.3 F F F 0.1 M F M M F U M M M M F M M F F M M F F U U
1/9/2009 Worst shot ever given- hurt immedia 3/5/2008 Redness, induration, swelling on R 1/16/2009 Syncopal episode following GARDA 1/16/2009 Redness, firm, warm to touch 6.0cm Area is swollen, hot red to left thigh. 1. Inconsolable, crying within 6 hrs. 1/14/2009 Confused/blurriness/head pain/naus 1/25/2008 SM developed redness, swelling an 1/31/2008 Developed redness, pain and swelli 1/15/2009 Pt received vaccine at our office on 1/16/2009 Vaccines given 1/14/09. Left arm s 1/19/2009 Patient developed hives within 2 hrs 1/12/2009 Red raised rash over torso, about 3 1/12/2009 On unspecified dates, the subjects r 1/12/2009 This case was reported by a sales r 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharm 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a health 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a nurse a 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a pharma
338094 338095 338096 338097 338098 338138 338147 338148 338150 338151 338152 338154 338155 338156 338157 338158 338159 338160 338161 338162 338163 338164 338165 338166 338167 338168 338169 338170 338171 338172 338173 338174 338175 338176 338177 338178 338179 338180 338181 338182 338183 338184 338185 338186 338187 338188 338189 338190 338191 338192 338193
1/16/2009 IN 1/16/2009 DE 1/16/2009 1/16/2009 TX 1/16/2009 SC 1/16/2009 SC 1/16/2009 1/16/2009 TX 1/16/2009 1/16/2009 1/16/2009 MO 1/16/2009 IN 1/16/2009 NY 1/16/2009 MO 1/16/2009 1/16/2009 1/16/2009 CT 1/16/2009 1/16/2009 GA 1/16/2009 NY 1/16/2009 CT 1/16/2009 CT 1/16/2009 1/16/2009 AZ 1/16/2009 1/16/2009 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 1/16/2009 FL 1/16/2009 GA 1/16/2009 MD 1/16/2009 TX 1/16/2009 MI 1/16/2009 MN 1/16/2009 AZ 1/16/2009 AZ 1/16/2009 1/16/2009 1/16/2009 KY 1/16/2009 ND 1/16/2009 1/16/2009 NY 1/16/2009 1/16/2009 1/16/2009 1/16/2009 1/16/2009 AK 1/16/2009 1/16/2009 TX 1/16/2009 IA
50
22 18
18
36 13 37 55 77
36
62
62
29 42 31
29 42
75 52
75 52
25 23 32 54 79 30 78 76 60
25
58
58
37 55 77
32 79 78 76
53
53 29 15
29 15
U M U M M M M F U M U F M F M U M U F F M F F F U U M M U M F F F M M F F F U M U U F M U M F M F F M
1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a pharma 2/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported a physician, 1/12/2009 The subject was in clinic for day 180 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by healthca 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc
338194 338195 338196 338197 338198 338199 338200 338201 338202 338353 338354 338355 338356 338357 338358 338359 338360 338361 338362 338363 338364 338365 338366 338367 338368 338369 338370 338371 338381 338383 338385 338388 338389 338390 338391 338392 338393 338394 338395 338396 338397 338398 338399 338524 338525 338526 338527 338528 338529 338530 338531
1/16/2009 1/16/2009 1/16/2009 1/16/2009 TX 1/16/2009 1/16/2009 WI 1/16/2009 TX 1/16/2009 TX 1/16/2009 MI 1/16/2009 FL 1/16/2009 CO 1/16/2009 IL 1/16/2009 IA 1/16/2009 CA 1/16/2009 1/16/2009 1/16/2009 1/16/2009 TN 1/16/2009 IN 1/16/2009 NC 1/16/2009 NC 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 TX 1/16/2009 VA 1/16/2009 NY 1/16/2009 WA 1/16/2009 1/16/2009 IL 1/16/2009 GA 1/16/2009 GA 1/16/2009 GA 1/16/2009 1/16/2009 CA 1/16/2009 MI 1/16/2009 IN 1/16/2009 IL 1/16/2009 PA 1/16/2009 IN 1/16/2009 IL 1/16/2009 OR 1/16/2009 1/16/2009 TX 1/16/2009 MO 1/16/2009 CT 1/16/2009 KS 1/16/2009 KY 1/16/2009 IN 1/16/2009 CA 1/16/2009 TN 1/16/2009 GA
56
21 0.5 5 2 5 0.3 0.5
21 0 5 2 5
0.2 0.2 0.3 0.3 0.2 0.2
0 0
2 0.6 11 1.1 0.6 1 0.2 0.2
2 0
1.3 1.5 0.3 0.3 0.4 0.2 0.1
1 1 0
57 0.7 4 1.8 1.6 0.9 4 0.6 2
57
0
0 1 0 0
0 0 0
1 4
U U M U U F U M M 0.5 M M 0.7 M F U F U U 0.2 M 0.2 M U U F 0.2 M U 0.1 M 0.6 F M F 0.6 M 0F 0.2 M 0.2 M M M 0.3 M 0.5 F 0.3 F U 0.4 M 0.2 F 0.1 M U F M M F 0.6 M M M U F
1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This Case was reported by a pharm 1/12/2009 This case was reported by a healthc 1/12/2009 On 18 September 2007 the subject 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc ### This case was reported by a healthc ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a pharma ### This case was reported by a pharma ### This case was reported by a healthc ### This case was reported by the moth ### This case reported by a physician, v ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a consum ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by the moth ### This case was reported by a consum ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a consum ### This case was reported by a healthc ### This case was reported by a physici 1/12/2009 This case was reported by a healthc ### A non-serious spontaneous report o 12/3/2008 A non-serious spontaneous report a 12/4/2008 A spontaneous non serious report o 12/8/2008 A non-serious report "given FLUMIS ### A non serious report of "gave FLUM ### A non-serious report of administratio ### A non serious, spontaneous report o ### Expired vaccine used (Expired drug
338532 338533 338534 338535 338536 338537 338538 338539 337619 337620 337621 337676 338994 337622 337623 337624 337625 337626 337627 337628 337629 337630 337634 337635 337636 337637 337638 337639 337640 337645 337669 337673 337677 337678 337679 337680 337681 337682 337683 337684 337685 337686 337687 337704 337705 337706 337707 337708 337709 337710 337711
1/16/2009 FL 1/16/2009 CA 1/16/2009 WV 1/16/2009 MO 1/16/2009 1/16/2009 MI 1/16/2009 MI 1/16/2009 MI 1/17/2009 TN 1/17/2009 NY 1/17/2009 1/17/2009 IL 1/17/2009 TX 1/18/2009 NJ 1/18/2009 CO 1/18/2009 IA 1/18/2009 VA 1/19/2009 TX 1/19/2009 WY 1/19/2009 TN 1/19/2009 SC 1/19/2009 WY 1/19/2009 TN 1/19/2009 TX 1/19/2009 NJ 1/19/2009 UT 1/19/2009 TX 1/19/2009 GA 1/19/2009 AZ 1/20/2009 VA 1/20/2009 MI 1/20/2009 OH 1/20/2009 GA 1/20/2009 KY 1/20/2009 DE 1/20/2009 NJ 1/20/2009 NJ 1/20/2009 OR 1/20/2009 OR 1/20/2009 CA 1/20/2009 AL 1/20/2009 AL 1/20/2009 WA 1/20/2009 1/20/2009 MO 1/20/2009 MA 1/20/2009 TN 1/20/2009 PA 1/20/2009 MI 1/20/2009 TX 1/20/2009 LA
4 1.9 4 2 3 3 4
1 4
61 1 59 4 60 48 66 15 19 0.5 60 17 63 70 31 41 2 0.5 43 1.3 5
61 0 59 4 60 48 66 15 19 0 60 17 63 70 31 41 2 0 43 1 5
1 0.3 0.4 12 73 1.9 0.9 80 53 42 16 11 67 54 16 18 54 20 64 1.6 11
1 0 0 12 73 1 0 80 53 42 16 11 67 54 16 18 54 20 63 1 11
M 0.9 F F F F F M U M 0F U M M F F F F 0.6 F F F F F F M 0.5 M 0.5 M M 0.3 M F M 0M 0.3 F 0.4 M F F 0.9 M 0.9 M F F F F M F M F F F F M 0.6 M F
### A non serious spontaneous report o ### A non serious report of a child unde ### A non serious report of administered ### A non serious, spontaneous report o ### A non-serious report of administratio ### A non-serious report of administered ### A non-serious spontaneous report o 1/5/2009 This case was reported by a healthc 1/17/2009 Redness, swelling, itching, pain and 1/17/2009 Patient has history of seizures. She 1/17/2009 Raised bubble 2 inches by 4 inches 1/17/2009 8cm wide x 10cm long, redness, wa 1/7/2009 This case was reported by a pharma 1/18/2009 Patient suffered Severe back pain, T 1/18/2009 lower leg,ankle,and foot were swolle 1/18/2009 Seizure activity, lower paralysis, exh 1/18/2009 Immediately after receiving shot,sev 1/19/2009 Prolonged crying spell for hours afte 1/19/2009 Slight, itchy red rash area across be 1/19/2009 SYNCOPE 1/19/2009 PATIENT FELT LIKE HER HEART 1/19/2009 Patient reported slight rash across b 1/19/2009 Approximately 6-8 hrs after taking th 1/19/2009 30 minutes after vaccine developed 1/19/2009 Pt received MMR on 1/10/09. On 1 1/19/2009 Acute onset right hemisphere ische 1/19/2009 Pt developed Myocardial infarction a 1/19/2009 On 04/13/07, my son was treated in 1/19/2009 Temperature 104.1, heavy chest co 1/16/2009 This case was considered medically 1/19/2009 Pt given HIB Y #4; PREVNAR #4; Hep 1/14/2009 Abd. pain, (+) Stool Guaiac, scream 1/8/2009 4 month old male, received shots by 1/19/2009 Mother states "eye lids swelling, and 1/16/2009 Presented to office on 1/9/09 c/o "ra 1/19/2009 ? febrile sz on 1/16/09 - started seiz 1/19/2009 Localized redness, lump, tendernes 1/19/2009 Pt complained of pain in muscle aro 1/11/2009 1st attempt to administer dose: Una 1/19/2009 Lymph Node swelling 1/19/2009 red wheel apprx 3" immediately afte 1/19/2009 Red wheal immediately after giving 1/19/2009 Red disc at eye of 50 cent piece pin 1/20/2009 Within a few hours after immunizatio 1/13/2009 Headache in "forehead". Nausea - n 1/20/2009 Tdap administered R deltoid 1/16/08 1/20/2009 After 24 hours, injection site swelled 1/20/2009 Client given dose of adult hep A. Cl ### PATIENT CAME INTO OFFICE ON 1/20/2009 behavioral changes, encephalopath 1/20/2009 I believe the symptoms started after
337712 337713 337714 337715 337716 337717 337718 337719 337720 337721 337722 337723 337724 337725 337735 337736 337737 337738 337739 337740 337741 337742 337743 337744 337745 337746 337747 337748 337749 337751 337752 337753 337754 337755 337756 337758 337759 337760 337761 337762 337763 337764 337765 337766 337767 337768 337769 338540 338542 338543 338544
1/20/2009 TX 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 CA 1/20/2009 WI 1/20/2009 IA 1/20/2009 TX 1/20/2009 TX 1/20/2009 HI 1/20/2009 MA 1/20/2009 1/20/2009 IN 1/20/2009 MT 1/20/2009 FL 1/20/2009 AR 1/20/2009 PA 1/20/2009 OH 1/20/2009 OR 1/20/2009 NY 1/20/2009 NY 1/20/2009 CA 1/20/2009 ID 1/20/2009 MN 1/20/2009 CA 1/20/2009 MI 1/20/2009 CA 1/20/2009 WA 1/20/2009 NY 1/20/2009 MD 1/20/2009 NC 1/20/2009 NJ 1/20/2009 NE 1/20/2009 CA 1/20/2009 WI 1/20/2009 LA 1/20/2009 NM 1/20/2009 PA 1/20/2009 GA 1/20/2009 KY 1/20/2009 PA 1/20/2009 1/20/2009 PR 1/20/2009 CT 1/20/2009 PA 1/20/2009 CA 1/20/2009 SC 1/20/2009 1/20/2009 IL
23 25 23 21 20 23 1.1 47 1.3 5 0.9 47 4 4 2 15 41 16 1 17
23 25 23 21 20 23 47 1 5 11 0 47 4 4 2 15 41 16 1 17
21 0.2 65 11 0.2 15 80 69 15 15 12 13 57 13 1.3 12 14 0.4 0.4 0.5 7 59 29 4 18 16
21 0 65 11 0 15 80 69 15 15 12 13 57 13 1 12 14 0 0 0 7 59
13
13
4 18 16
F M M M M M M F 0.3 F F M 0.9 F M U F 0.1 M M F F 0F F U F 0.2 F F M 0.2 F F F F F M F F M F 0.3 M F F 0.4 M 0.4 M 0.5 F F M F M F F F F F
1/20/2009 Tues - Administered vaccine Wed 1/20/2009 Patient complains of excessive swe 1/20/2009 Patient came in on Friday 16 Jan 20 1/20/2009 Patient came in complaining of exce 1/20/2009 Patient complains of lump, hardnes 1/20/2009 Patient complaining of fever. 1/20/2009 PT DEVELOPED ,MACULOPAPUL 1/20/2009 PATIENT RECIEVED VACCINATIO 1/20/2009 Cheeks swollen and hot 1/20/2009 PATIENT STARTIED TO BREAK O 1/20/2009 PT HAD LOCALIZED HIVE REACT 1/20/2009 I have seen the slightest symptoms 1/20/2009 A week after I received my flu shot I 1/20/2009 Patient received 2 varicella vaccines 1/20/2009 6:45pm Jan 17th mom noticed welts 10/8/2008 Severe seizure (grand mal) lasting o 1/5/2009 Seizures X 2 1-5-09. First time seiz 1/6/2009 Pt had TDAP vaccine on 10/29/08, 1/15/2009 Arm Pain- Contests Rash 1/20/2009 Child broke out in lesions mostly on 1/12/2009 Bilateral leg weakness / had to use 1/20/2009 24 After immunization unable to ma 1/20/2009 Felt faint 30 sec post injection, laid d 1/20/2009 Rash is diffuse in location, reddish a 1/20/2009 Phone call from patient stating a po 1/19/2009 Patient received 1st Tdap in L uppe 1/13/2009 2 months old girl with one day histo Hypotensive, unresponsive for NSR 1/20/2009 24 hrs after ZOSTAVAX - develope ### Redness, induration, just below delt 1/13/2009 25 days after GARDASIL #3 develo 1/14/2009 No adverse symptoms known-3rd M 1/12/2009 Induration - 2x2, Erythema - 5x3 lef 1/14/2009 1/12/09 received call from mother sh ### 7pm 12/14/08 received flu shot 10p 1/20/2009 Patient had fainted about 2-4 min po 1/5/2009 Patient developed fever, irritability a 1/7/2009 Vomiting x 2 approx 6-8 hours after 1/16/2009 Week of 1/23/2007 pain at site of G 1/13/2009 No adverse reactions. Child was giv 1/8/2009 4 month old male, received shots by 1/18/2009 Patient seen in office today for seizu 1/20/2009 Err:508 1/20/2009 Patient was given Td vaccine and in None Stated 1/13/2009 1-9 Had immunization at 11 am tem June 1 Sun- fever, chills, abdomina 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from
338545 338546 338547 338548 338550 338551 338552 338553 338554 338572 338573 338576 338577 338578 338579 338580 338581 338582 338583 338584 338585 338586 338587 338588 338589 338590 338591 338592 338593 338643 338644 338645 338646 338648 338649 338650 338651 338652 338653 338654 338655 338656 338657 338658 338659 338660 338661 338662 338663 338664 338665
1/20/2009 CO 1/20/2009 CA 1/20/2009 CA 1/20/2009 CA 1/20/2009 1/20/2009 IL 1/20/2009 CA 1/20/2009 KS 1/20/2009 CA 1/20/2009 ID 1/20/2009 VA 1/20/2009 1/20/2009 IL 1/20/2009 NJ 1/20/2009 NJ 1/20/2009 1/20/2009 WA 1/20/2009 TX 1/20/2009 CA 1/20/2009 CA 1/20/2009 CA 1/20/2009 FL 1/20/2009 DE 1/20/2009 1/20/2009 1/20/2009 MI 1/20/2009 FL 1/20/2009 NY 1/20/2009 AL 1/20/2009 PA 1/20/2009 CA 1/20/2009 UT 1/20/2009 PA 1/20/2009 CA 1/20/2009 NJ 1/20/2009 VA 1/20/2009 OR 1/20/2009 TX 1/20/2009 TX 1/20/2009 1/20/2009 MD 1/20/2009 CO 1/20/2009 VA 1/20/2009 1/20/2009 GA 1/20/2009 1/20/2009 CA 1/20/2009 IN 1/20/2009 IL 1/20/2009 PA 1/20/2009 DE
14 26 40 26 15 24 2 15 23 18 19 19
14
23 22 14 15 24 15 23 13 20 20 16 21 18
23
16 19 20 16 17 12 23 24 19 14
16
40 26 15
15 23 18 19
14
23 13 20 16 21 18
20 16 17 12 24
26 21 25 22 12 23 15 25 11 14
22 12
25 11
F F F F F F F F F F F F F F F F F F F F F F F F F F M F F F F F F F F F F F F F F U F F F F F F F F F
1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received a co 1/18/2009 Initial and follow-up information has 1/16/2009 Information has been received from 1/16/2009 Initial Information and follow up has 1/16/2009 Information has been received from 1/16/2009 Information has been received for th 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received for th 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from
338666 338674 338675 338676 338677 338678 338680 338681 338682 338683 338684 338685 338686 338687 338688 338699 338700 338701 338702 338703 338748 338749 338750 338751 338752 338753 338754 338755 338756 338757 338758 338759 338760 337726 337727 337770 337771 337772 337773 337774 337775 337776 337777 337778 337779 337780 337781 337782 337783 337784 337785
1/20/2009 NY 1/20/2009 PA 1/20/2009 WI 1/20/2009 MA 1/20/2009 1/20/2009 1/20/2009 PA 1/20/2009 1/20/2009 NJ 1/20/2009 MI 1/20/2009 1/20/2009 IN 1/20/2009 MA 1/20/2009 AZ 1/20/2009 MD 1/20/2009 CA 1/20/2009 MO 1/20/2009 CT 1/20/2009 1/20/2009 NE 1/20/2009 TN 1/20/2009 NJ 1/20/2009 TX 1/20/2009 MI 1/20/2009 1/20/2009 CA 1/20/2009 NJ 1/20/2009 NY 1/20/2009 PA 1/20/2009 1/20/2009 1/20/2009 CT 1/20/2009 CA 1/21/2009 CA 1/21/2009 NY 1/21/2009 MI 1/21/2009 MI 1/21/2009 MI 1/21/2009 MI 1/21/2009 DC 1/21/2009 DC 1/21/2009 CO 1/21/2009 VA 1/21/2009 MD 1/21/2009 FL 1/21/2009 TX 1/21/2009 IL 1/21/2009 CA 1/21/2009 AZ 1/21/2009 NJ 1/21/2009 OH
18 12 0.6 14 18 22 18 19 23
14 22 18 19
16
16
24 12 18 20 25
24 12 18 20 25
14 19 0.6 0.4
14 19 0
0.8 0.3 1.1 0.2 0.2 0.3 0.4 0.2 0.1 62 12 0 54 56 0.4 2 2 15 33 22 62 29 1.3 82 51 3 10
1 0
0 62 12 0 54 56 0 2 2 15 33 22 62 29 1 82 51 3 10
F F M F F F F F F U F U F F F F F F F F 0.6 M U U M U 0.1 F 0.2 M U F U F F 0.1 M M F 0F F F 0.5 M 0.4 M 0F F M F M M 0.3 M M F F F
1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Initial and follow-up information has 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Pediatric medical records were rece 1/21/2009 Severe swelling and pain. Took Cep 1/21/2009 Within a couple hours of receiving th 1/21/2009 3 day old recieved comvax. Nurse w 1/21/2009 No known reaction because patient 1/21/2009 No knowm symptoms. She never ca 1/21/2009 The day after infant was given Tdap 1/21/2009 PT RECEIVED EXPIRED FLUMIST 1/21/2009 PT RECEIVED EXPIRED FLUMIST 1/21/2009 Received HPV vaccine on January 1/21/2009 approximately 1100 1-20-08 given s 1/21/2009 PT is complaining of post smallpox 1/21/2009 Soreness of skin on abdomen and l 1/21/2009 16 Jan 09 arms were sore. 17 Jan 0 1/21/2009 PATIENT CAME IN OFFICE ON 1-7 1/21/2009 Patient developed herpes zoster on 1/21/2009 Local reactions on upper Lt. arm, re 1/21/2009 Child received the Flu vaccine betw 1/21/2009 RECEIVED VARICELLA VACCINE
337786 337787 337788 337789 337790 337791 337792 337793 337794 337795 337796 337797 337798 337799 337800 337801 337802 337803 337804 337805 337806 337808 337809 337810 337812 337815 337817 337819 337820 337821 337822 337823 337824 337825 337826 337827 337828 337829 337830 337831 337832 337833 337834 337835 337837 337838 337840 337845 337848 337849 337850
1/21/2009 TX 1/21/2009 DC 1/21/2009 GA 1/21/2009 FL 1/21/2009 NM 1/21/2009 VT 1/21/2009 IL 1/21/2009 MI 1/21/2009 MI 1/21/2009 SC 1/21/2009 MO 1/21/2009 NM 1/21/2009 CO 1/21/2009 TX 1/21/2009 VA 1/21/2009 MT 1/21/2009 TX 1/21/2009 CA 1/21/2009 AZ 1/21/2009 NY 1/21/2009 MN 1/21/2009 PA 1/21/2009 IN 1/21/2009 ND 1/21/2009 MI 1/21/2009 FL 1/21/2009 CA 1/21/2009 GA 1/21/2009 1/21/2009 1/21/2009 MI 1/21/2009 PA 1/21/2009 VA 1/21/2009 MI 1/21/2009 1/21/2009 NJ 1/21/2009 ME 1/21/2009 TX 1/21/2009 MA 1/21/2009 MA 1/21/2009 MA 1/21/2009 1/21/2009 WI 1/21/2009 NJ 1/21/2009 NJ 1/21/2009 MI 1/21/2009 1/21/2009 1/21/2009 1/21/2009 NJ 1/21/2009 NC
24 4 0.5 47 4 24 25 65 9 27 14 18 0.5 13 50 27
23 4 0 47 4 24 25 65 9 27 14 18 0 13 50 27
0.4 4 13 23 0.6 0.3 79 21 21 11 0.2 6 1.7 1 81 1.3 86 61 12 68 1 13 0.3 5
0 4 13 23 0 0 79 21 21 11 0
76 26 19 51 26 28 0.3 41 0.4
76
1 81 1 86 61 12 68 1 13 0 5
19 51
0 41 0
M F 0.5 F F M F F F F F F F 0.5 F F F M M 0.4 M F F F 0.6 M 0.3 F F F F F 0.2 M F M 0M F 0.3 M M F F M 0M F 0.3 M F U F M F F F U 0.3 M F 0.4 M
1/21/2009 HA, temp of 104.8, B/P 168/80, ach 1/21/2009 EXPIRED FLUMIST GIVEN TO CH 1/21/2009 Mom phoned today 01/21/2009 @9 1/21/2009 Approximately 12 hours after vaccin 1/21/2009 itching, difficulty breathing, lips swel 1/21/2009 Headache, Nausea, Vomiting, Diarr 1/21/2009 extreme weakness, fatigue, dizzines 1/21/2009 Pt felt fine after shot. 6 hrs later site 1/21/2009 Patient developed large area of eryt 1/21/2009 Client reports noticing itching and so 1/21/2009 Passed out immediately after HPV s 1/21/2009 Headaches,Yperiods were very errat 1/21/2009 Possible seizures (repetitive head tu 1/21/2009 Pt c/o pain, swelling, redness to righ 1/10/2009 Fever developed; Right arm red, sw 1/22/2009 Jan 16 received vaccine (Anthrax) in 1/21/2009 Patient reported a lot of pain in left a 1/20/2009 Within a few hours of shots pt devel 1/21/2009 Left upper arm 6 inch by 9 inch eryt 1/21/2009 Site never got swollen or red. Just v 1/21/2009 Gave pediatric dose of HEP A was 1/21/2009 Child received PENTACEL, HEP B, 1/21/2009 Developed red rash around injection 1/21/2009 Red, slightly warm to touch, swelling 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/21/2009 Patient developed erythematous pa 1/21/2009 Patient lips were swelling. Patient w 1/20/2009 Quarter- sized erythema around inje 1/21/2009 Erythema and pruritis on forehead & 1/20/2009 Information has been received from 1/20/2009 1. Legs pain. 2. Some time weake 1/21/2009 Patient had vaccination- shortly afte 1/20/2009 1 yr old boy (WM) seen 1/9/2009 fo ### Localized reaction to VARIVAX give ### Patient received 2nd dose of Rotate 12/5/2008 7x6cm area erythema, warm, tende 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/16/2009 Left upper arm & shoulder; edema & 1/15/2009 Vaccination small pox, left shoulder ### Deep aching pain in upper arm, and 1/20/2009 Information has been received from W/in 30 seconds: tingling & numbne 1/21/2009 This male subject was enrolled in th 1/16/2009 T 98.0 degree rash on left arm surro 1/21/2009 Fever to 103.5, lethargy with crying
337851 337853 338761 337950 337951 337952 337953 337958 337959 337962 337963 337965 337966 337967 337968 337969 337970 337971 337972 337973 337974 337975 337976 337977 337978 337979 337980 337981 337982 337983 337984 337985 337986 337988 337989 337990 337991 337992 337993 337994 337995 337996 337997 337998 337999 338000 338002 338003 338004 338005 338006
1/21/2009 ME 1/21/2009 CA 1/21/2009 FL 1/22/2009 1/22/2009 1/22/2009 1/22/2009 CA 1/22/2009 VA 1/22/2009 OH 1/22/2009 OH 1/22/2009 OR 1/22/2009 NJ 1/22/2009 IL 1/22/2009 AL 1/22/2009 NC 1/22/2009 NC 1/22/2009 IA 1/22/2009 PA 1/22/2009 CA 1/22/2009 CA 1/22/2009 NC 1/22/2009 KY 1/22/2009 OH 1/22/2009 WA 1/22/2009 KY 1/22/2009 SC 1/22/2009 MO 1/22/2009 MN 1/22/2009 HI 1/22/2009 SC 1/22/2009 IN 1/22/2009 KY 1/22/2009 NJ 1/22/2009 NH 1/22/2009 MD 1/22/2009 NY 1/22/2009 UT 1/22/2009 TX 1/22/2009 1/22/2009 VA 1/22/2009 HI 1/22/2009 AZ 1/22/2009 PA 1/22/2009 CA 1/22/2009 1/22/2009 NC 1/22/2009 NY 1/22/2009 NY 1/22/2009 CA 1/22/2009 NJ 1/22/2009 OH
0.4 0.4 17 13 14 22 19 70 34 5 21 15 1.6 0.2 59 58 65 0.2 46 25 54 17 54 16 0.2 20 1 11 5 61 11 17 1.3 0.6 1 10 1.1 1 63 1.4
0 0 17
2 0.6 57 27 0.6 17 29 3 32 0.3
2 0 57 27 0 17 29 3 32 0
70 34 5 21 15 1 0 59 58 65 0 46 25 54 17 53 16 0 19 1 11 5 61 11 17 1 0 1 10 1 1 1
0.4 M 0.4 M M F F F F M F F F F 0.6 F 0.2 F F F F 0.2 F F F F F F F 0.2 F F 0M F F M F F 0.3 M 0.6 M 0M F 0.1 M 0F F 0.4 F F 0M 0.6 F F M 0.6 F F F F M 0.3 M
1/15/2009 Patient was admitted to medical cen 1/20/2009 On 12/17 and 12/18 4-5 episodes w 9/29/2008 Initial report received on 12 March 2 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from ### DKA New onset juvenile diabetes. 1/14/2009 Soon after Gardasil, pt developed fe 1/22/2009 ON 1/21/2009 APPROXIMATELY @ 1/22/2009 NEST DAY AFTER INJECTION, 2 S 1/22/2009 No adverse event, just diagnosed w 1/22/2009 Injection site swelled about the size 1/22/2009 Patient described area around vacc 1/22/2009 Patient was vaccinated on 01/08/20 1/22/2009 2 month shots (HepB, Rotavirus, Pn 1/22/2009 I have had pain in my Deltoid area t 1/22/2009 On 15Jan2009, pt was administered 1/22/2009 The 2 nights after the inject I was ve 1/22/2009 Patient fainted miniutes after the inj 1/22/2009 Pain/swelling/erythema at injection s 1/22/2009 dizziness, hot flushing, sweating, bl 1/22/2009 no adverse event at this date and tim 1/22/2009 Approximately 10 minutes after rece 1/22/2009 Mild varicella disease, less than 50 1/22/2009 Adolescent became lightheaded the 1/22/2009 Local swelling, erythema, warmth an 1/22/2009 In the week following the vaccinatio 1/16/2009 About 12 hrs after vaccines, mild diz 1/21/2009 Vaccine given 6 days ago Pt noticed 1/22/2009 Fever to 102, maculopapular rash o 1/22/2009 Neck: normal, supple, no lymphade 1/22/2009 Started breaking out 1/19. Itches - r 1/19/2009 Left upper arm - hot and swollen, re 1/21/2009 Patient received VARIVAX (chicken 1/22/2009 Received vaccine 1-16-09 - On 1-21 1/14/2009 Patient received ZOSTAVAX shot o 1/16/2009 Pt developed fever to 102 degree a 1/18/2009 Pt. scratching at site & next day arm 1/22/2009 Had temp of 101-102 X 24 hours - s 1/13/2009 Fussiness in the hours after vaccine 12/1/2008 Nerve in arm feel affected. Cannot l 1/22/2009 Denied problems with AVA #1 and # 1/15/2009 105 fever night that vaccines given. 1/8/2009 Swelling in both wrist, itching on pal 1/22/2009 Large area of erytheima & edema & 1/20/2009 Pt given 1 (HEP A) vaccine/left offic 1/14/2009 Within 2 minutes of vaccination c/o 1/19/2009 Vomiting, fussiness X 24 hrs, vomiti
338007 338008 338009 338010 338011 338012 338013 338014 338015 338016 338017 338049 338050 338052 338057 338058 338061 338064 338065 338066 338067 338068 338069 338070 338071 338072 338073 338074 338099 338100 338101 338102 338103 338104 338105 338106 338107 338109 338110 338111 338112 338113 338114 338122 338123 338124 338125 338126 338127 338128 338129
1/22/2009 VA 1/22/2009 1/22/2009 DC 1/22/2009 AL 1/22/2009 UT 1/22/2009 RI 1/22/2009 OR 1/22/2009 PA 1/22/2009 PA 1/22/2009 CA 1/22/2009 OR 1/23/2009 KY 1/23/2009 SC 1/23/2009 MO 1/23/2009 FL 1/23/2009 GA 1/23/2009 NJ 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 MA 1/23/2009 FL 1/23/2009 MD 1/23/2009 KS 1/23/2009 MI 1/23/2009 TX 1/23/2009 NH 1/23/2009 GA 1/23/2009 CO 1/23/2009 PR 1/23/2009 TX 1/23/2009 GA 1/23/2009 VA 1/23/2009 NJ 1/23/2009 PA 1/23/2009 CA 1/23/2009 MT 1/23/2009 MI 1/23/2009 IL 1/23/2009 FL 1/23/2009 OR 1/23/2009 MA 1/23/2009 NC 1/23/2009 NM 1/23/2009 IA 1/23/2009 GA 1/23/2009 MD
0.4 37 55 12 13 2 12 1.9 0.7 62 70 14 17 15 0.2 0.2 27 4 6 29 39 27 59 58 15 4 43 0.3 1.3 5 21 0.4 10 39 5 26 5 41 1 0.2 59 18 1.5 0.2 12 5 6 11 71 66 13
0 37 12 13 2 12 1 0 62 70 14 17 0 0 4 6 29 39 27 59 58 15 4 43 0 1 5 21 0 10 39 4 26 41 1 0 59 18 1 0 12 5 6 11 71 66 13
0.4 F M F M F 0.9 F F 0.9 F 0.7 F F F F F F 0.2 F 0.2 F F F M M F F F F F F F 0.3 M 0.3 F F F 0.4 F M F F M M M 0M 0.2 M F F 0.5 M 0.2 M F M M M F M M
1/14/2009 Pt developed temp to 106 degrees a 1/21/2009 2 days post ava #1 broke out in a ra 1/16/2009 Patient complains of pain in left delt 1/19/2009 None Stated 1/22/2009 No side effect, patient was fine. 1/22/2009 1 cm nodule. 7 cm erythema + indu 1/14/2009 After receiving 3 shots, client becam 1/13/2009 Non stated. 1/13/2009 None stated. 1/22/2009 Pt called 10/31/08 said had blurring 1/22/2009 11/27/2006 Patient noticed pain in h 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from ### Developed angio edema of face, lar 10/2/2008 Redness occurred evening of vaccin ### Client woke up following morning wi ### Afternoon of day HEB B# 3 received ### 1 hr after HBV #1 patient experienc ### Incident occurred on 7/16/08 and ag ### Received TDAP on 11/24/08 for trav 1/20/2009 Pt reports had significant vomiting d 1/9/2009 Lat 4 1/2" X 4" circular swelling red, 1/21/2009 Few hours after TdAP in left deltoid 1/14/2009 Immunizations given (Hib in upper R 1/23/2009 After receiving immunizations the pa 1/23/2009 "Rash" 1 day after MMR. Parent con 1/23/2009 Vaccine given in error. PCP ordere 1/23/2009 NO ADVERSE REACTIONS NOTE 1/23/2009 Dizziness, very pale, fainted getting 1/23/2009 Numbness of hand and legs, cough 1/23/2009 Patient went came into the Immuniz 1/23/2009 PT had an itching sensation in the b 1/23/2009 Left arm swollen and warm to touch 1/23/2009 generalized rash noticed approxima 1/23/2009 On 1/21/09 at the time of immunizat 1/23/2009 It happen over night (Dec 16th 2008 1/23/2009 Immediately following venipuncture 1/23/2009 Received MCV4, Hep.A, Varicella o 1/23/2009 rash on the body and neck, has bee 1/8/2009 Severe diarrhea, dehydration, 1 wee 1/23/2009 She received her immunizations on 12/5/2008 S1. erythematous left upper arm, sli 1/23/2009 24 hours after influenza and HAVRI 1/23/2009 Received both MENACTRA and BO Patient broke out with a couple of re 1/23/2009 Patient stopped by the clinic and sta 1/23/2009 Possible erythema multiform.
338130 338131 338136 338137 338500 338789 338828 338829 338830 338837 338115 338116 338117 338118 338119 338120 338121 338209 338210 338212 338213 338214 338215 338216 338217 338218 338219 338220 338221 338222 338223 338224 338225 338226 338229 338240 338241 338242 338243 338244 338245 338246 338247 338248 338249 338250 338251 338252 338253 338254 338255
1/23/2009 CA 1/23/2009 KY 1/23/2009 GA 1/23/2009 SC 1/23/2009 1/23/2009 NY 1/23/2009 TX 1/23/2009 CT 1/23/2009 OH 1/23/2009 NC 1/24/2009 TN 1/24/2009 IN 1/24/2009 MA 1/24/2009 IL 1/24/2009 CA 1/24/2009 CA 1/26/2009 1/26/2009 OH 1/26/2009 CA 1/26/2009 1/26/2009 1/26/2009 1/26/2009 PA 1/26/2009 TX 1/26/2009 MA 1/26/2009 UT 1/26/2009 LA 1/26/2009 IA 1/26/2009 NY 1/26/2009 TX 1/26/2009 GA 1/26/2009 WA 1/26/2009 CA 1/26/2009 PA 1/26/2009 LA 1/26/2009 GA 1/26/2009 MI 1/26/2009 OK 1/26/2009 MA 1/26/2009 MI 1/26/2009 NC 1/26/2009 MT 1/26/2009 NC 1/26/2009 KY 1/26/2009 ID 1/26/2009 MI 1/26/2009 GA 1/26/2009 MO 1/26/2009 TX 1/26/2009 OK 1/26/2009 FL
1.1 1.6 54 1 21 39 5 68 71 55 0.2 54 1.3 21 68 50 22 27 47 71 74 71 2 0.5 14
1 1 54 1
63 1 63 1 1 5 5 79 54 68 17 11 52 14 77 1 17 22 21 40 1 69 42 3 13
63 1 63 1 1 5 5 79 54 68 17 11 53 14
5 68 71 55 0 54 1 21 67 50 22 27 47 71 74 1 0 14
1 17 22 21 40 1 69 42 0 13
0.1 M 0.6 F F 0M F M M M F M 0.2 F F 0.3 F M F M M F F M M F 1U 0.5 F F F F 0F F 0M 0M F M F U F M M M F F 0M F F F F 0M M F 0.2 F F
1/23/2009 About 10 hrs after giving immunizat 1/23/2009 Fever 103.3 Febrile seizure X 5 min 1/7/2009 Client reports shortly after the shot, 1/23/2009 Rash- looks like measles. No fever 1/21/2009 I took the GARDASIL shot series. I ### Initial report received from the patie 8/27/2008 Initial report was received 08 May/2 ### Initial report received on 02 Septem ### A 71-year-old female patient experie 7/17/2008 Initial report was received from a he 1/24/2009 Developed rash within 24 hours of a 1/24/2009 Patient stated pain began 4 hours a 1/24/2009 About 3 hours, after the vaccines, m 1/24/2009 His a 21yo navy recruit that present 1/24/2009 Patient called to report reddened ar 1/24/2009 Mild rash on thorax. Lasted for 5 da 1/26/2009 mild cellulitis of arm. 3/3/09 MR rece 1/22/2009 Initial information received on 21 Ja 1/20/2009 Acute to chronic resp. congestion, m 1/26/2009 On Wednesday had sore throat, run 1/1/2009 Pt has no history of shingles, but in 1/20/2009 I received the vaccine ZOSTAVAX. None Stated 1/24/2009 Seizure approx 16 hour after immun 1/23/2009 After waiting in office for 15 minutes 1/22/2009 Intermittent soreness let deltoid sub 1/21/2009 Three days after I received the ZOS 12/1/2008 11-12 day after injection developed 1/26/2009 See note attached. Called patient 1 1/22/2009 The infant had an immediate reactio 1/20/2009 Rash at injection site- plus erythema 1/22/2009 Developed hives 12 hrs after receiv 1/23/2009 Swollen Left thigh with redness arou 1/23/2009 Information has been received from 1/23/2009 Information has been received from 1/26/2009 Pt called Health Department this am 1/26/2009 2:13 pm - shots given,alert and orie 1/26/2009 Left arm red, hot and swollen 1/26/2009 Received vaccine at 9:30 am, stated 1/26/2009 Passed out with seizure like behavio 1/26/2009 Swelling of arm and itching one day 1/26/2009 Patient had his 1 yr well-baby check 1/26/2009 7/16/07 - Developed severe case of 1/26/2009 On 1/12/09 pt received a Tdap inj b 1/26/2009 Client received Engerix B vaccine o 1/26/2009 Pt was fine fol shot. Woke up the ne 1/26/2009 DIAGNOSED WITH SHINGLES 01/ 1/26/2009 Hospitalized and diagnosed with Gu 1/26/2009 Symptoms started two days after re 1/26/2009 Mother reports high fever (104.7, se 1/26/2009 15 minutes after the vaccine the pat
338256 338257 338258 338259 338260 338265 338266 338267 338268 338269 338270 338271 338272 338273 338274 338275 338276 338277 338280 338281 338282 338283 338284 338285 338286 338287 338288 338289 338290 338291 338292 338293 338294 338295 338296 338297 338298 338299 338300 338301 338302 338303 338304 338305 338306 338307 338308 338309 338310 338311 338312
1/26/2009 CA 1/26/2009 MA 1/26/2009 WI 1/26/2009 CA 1/26/2009 MI 1/26/2009 PA 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 MO 1/26/2009 NH 1/26/2009 VA 1/26/2009 TX 1/26/2009 KS 1/26/2009 KS 1/26/2009 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 FL 1/26/2009 FL 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 PA 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 NH 1/26/2009 WA 1/26/2009 KY 1/26/2009 TX 1/26/2009 WA 1/26/2009 1/26/2009 ND
60 13 65 64 18 0.2 54 53 42 58 58 56
60 13 65 64 18 0 54 53 42
26 58 46 61 1 1.2 1.5 52 14 12 5 14 14 5 18 11 36 13 23 18 57 58 10 4 0.4 1.1 11 10 10 4 0.5 20 1 4 9 58 4 45
26 58 46 61 1 1 1 52 14 12 5 14 14 5 18
58 56
36 13 23 18 57 58 10 4 0 1 11 10 10 4 0 20 1 4 9 58 4 45
F F M F M 0.2 F F F F F F U U F F F F 0M 0.2 M 0.5 F M M F M M M M F F M F U F F F F M 0.4 M 0.1 F M F F M 0.5 F F 0F F M F M F
1/26/2009 Patient called to report swelling of ri 1/26/2009 Patient received the Varivax on Sat 1/26/2009 After receiving vaccination at 11am 1/26/2009 64 yo F calling to report possible rea 1/26/2009 3-4 hours after being vaccinated pt. 1/26/2009 Right leg with erythema and edema ### Redness, swelling, warmth to site fe 11/3/2008 Approximately 24 hrs after injection, Tetanus shot. Red, sore. Bump 3 to 12/4/2007 Swollen, warm, painful area 2"x4" a 11/7/2007 Where shot given-is red and warm t Moderate headache with fatigue ap Hot swelling, hives, feverish. ### 12/10 Wed. got shot. Thursday the ### 2" red, round, fever, swollen area, te 1/20/2009 Dizziness (severe vertigo) vomiting, 2/9/2009 1/24/08 onset right flank rash-itchy v 1/22/2009 Rash - erythematous maculopapula 1/26/2009 Mom returned to clinic 2d after vacc ### Right lower back - few small red rais ### Pt received ADACEL RA upper delt 11/7/2008 C/O pain left shoulder, et with deep 8/19/2008 Headache, chills, fatigue, fever (hig 8/8/2008 Left arm with erythema, warmth + s 8/12/2008 Patient immediately began to feel tir 8/12/2008 Headache, fever 101.0F, neck ache 7/25/2008 Pt. on 7/23/05-1445- after receiving 7/2/2008 Very fearful - Hyperventilating - trem 1/26/2009 Patient's mother reported that child 1/26/2009 Patient states developed muscle an Mother states" child can not move h Was given HPV during her pregnan ### After giving MMR patient eyes rolled ### Got vaccination 10-27-2008. 10-29### Headache, weakness, decreased co 10/1/2008 Redness, Tenderness, difficulty bre 9/29/2008 Redness at swelling from top of kne 8/25/2008 Incorrect immunization administered 8/8/2008 Redness/ Rash immediately around 7/8/2008 Mother called clinic at 5:15 pm 7/8/ 6/9/2008 10 Minutes after administering vacc 5/8/2008 TDAP administered 6 mo too soon p ### Mother noticed last NOC right thigh 1/5/2009 101-102 Temp- eyes matted - clear ### W/ 1st dose broke out in hives, w/2n 1/23/2009 Erythematous Maculopapular rash a 1/23/2009 Rash over abdomen, onset 1-22-09 1/23/2009 FLUMIST and VARIVAX vaccine we 1/22/2009 Morning of 1-16-2009 noticed back 1/22/2009 Patient has about 2in erythema and 1/23/2009 Patient received pediatric dose of A
338313 338314 338315 338316 338317 338318 338261 338372 338374 338376 338379 338386 338406 338407 338419 338420 338421 338422 338423 338424 338425 338426 338427 338428 338429 338430 338431 338432 338433 338434 338435 338491 338492 338493 338494 338497 338498 338499 338504 338505 338436 338437 338438 338439 338440 338441 338443 338444 338445 338448 338454
1/26/2009 TX 1/26/2009 IA 1/26/2009 NC 1/26/2009 IA 1/26/2009 MA 1/26/2009 MI 1/27/2009 MI 1/27/2009 LA 1/27/2009 NY 1/27/2009 MA 1/27/2009 AZ 1/27/2009 FL 1/27/2009 FL 1/27/2009 1/27/2009 GA 1/27/2009 NY 1/27/2009 NY 1/27/2009 KY 1/27/2009 WI 1/27/2009 TX 1/27/2009 TX 1/27/2009 WI 1/27/2009 LA 1/27/2009 MI 1/27/2009 OK 1/27/2009 OK 1/27/2009 FL 1/27/2009 WA 1/27/2009 AL 1/27/2009 LA 1/27/2009 WA 1/27/2009 NC 1/27/2009 GA 1/27/2009 NC 1/27/2009 GA 1/27/2009 WA 1/27/2009 OH 1/27/2009 NJ 1/27/2009 KY 1/27/2009 CA 1/28/2009 SC 1/28/2009 VA 1/28/2009 OH 1/28/2009 NC 1/28/2009 MO 1/28/2009 NJ 1/28/2009 PA 1/28/2009 PA 1/28/2009 1/28/2009 1/28/2009 LA
0.5 15 20 67 14 63 60 1.1 65 16 14
0 15 20 67 14 63 60 1 65 16 14
0.4 1.1 34 14 1.5 30 17 24 65 15 47 83 12 13 51 23 68 22 17 23 66 68 18 33 0.4 13 7 1.1 11 0.3 69 1.3 1 78 65 49
0
18 15
34 14 1 30 17 24 65 15 57 83 12 13 51 23 68 22 17 23 66 68 18 33 0 13 7 1 11 0 69 1 78
18
0.5 F F F F F F M 0.1 M M M F F 0.4 F F M F 0.5 M F F F F F F F F F F F F F F F M F F M 0.4 M F F 0.1 M M 0.3 F M M 0.1 F F M M U F F
1/23/2009 Received DPH and IPV. Reporting m 1/20/2009 C1 woke up at 5pm with vomiting. F 1/22/2009 Redness-itching-blistering at injectio 1/2/2009 Red swollen arm - about size of bas 1/26/2009 Onset of nausea, dizziness within 3 1/12/2009 Pt. given Tdap in left upper arm-IM 1/27/2009 Shingles vaccine was administered 1/23/2009 Initial report received on 13 January 1/23/2009 Initial report received on 15 January 1/23/2009 Initial report was received 16 Janua 1/26/2009 Information has been received from 1/26/2009 Information has been received from 1/26/2009 Information has been received from 1/26/2009 It was reported Y in a published article 1/27/2009 erythema, edema of the eye, distort 1/27/2009 About 7 minutes after patient had th 1/27/2009 coughing, wheezing, hives, dyspnea 1/27/2009 Received Hepatitis B #2 and TdaP. 1/27/2009 Few minutes after vaccine administe 1/27/2009 I had my first injection on 7/10/2008 1/27/2009 Upset Stomach, sore Muscles, joint 1/27/2009 Client received two vaccines after o 1/27/2009 Left upper arm pain that remains se 1/27/2009 Mild cellulitis and soreness in left ar 1/27/2009 Within 5 minutes of receiving the Td 1/27/2009 Approximately 6 minutes after recei 1/27/2009 PT CLAIMS TO HAVE FLU AFTER 1/27/2009 Pt Received Anthrax vaccine 10 De 1/27/2009 Redness, swelling, heat, bruising & 1/27/2009 approximately 3-6 wks after vaccina 1/27/2009 Localized inflamation at injection sit 1/9/2009 12X12 can area of redness + swellin 1/23/2009 Patient had injury to left arm and ca 1/27/2009 Redness, swelling at injection site; s 1/27/2009 Patient presented in Health Departm 1/27/2009 TDAP administered 1-21-09 pt wife 1/23/2009 Hives + fever on arms and legs 1/21 1/27/2009 Started with redness on 01/23/09 an 1/27/2009 Large red swollen area at injection s Localized reaction to MMR & VARIV 1/28/2009 Local reaction to Tdap 1/28/2009 Baby was fussy and very gassy for 1/28/2009 redness, inflammation and pain at in 1/28/2009 Presented 1/27/09 with Zoster L1 de 1/28/2009 Mild varicella rash started 1/27/2009 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received throu 1/27/2009 Information has been received from
338457 338458 338459 338466 338467 338468 338469 338470 338471 338472 338473 338474 338475 338476 338477 338478 338479 338480 338481 338483 338484 338485 338486 338487 338488 338489 338495 338496 338501 338502 338503 338506 338508 338509 338510 338511 338512 338522 338523 338556 338557 338558 338559 338560 338563 338567 338568 338569 338570 338571 338594
1/28/2009 PA 1/28/2009 NY 1/28/2009 DE 1/28/2009 NC 1/28/2009 TX 1/28/2009 CA 1/28/2009 CA 1/28/2009 OH 1/28/2009 IL 1/28/2009 WI 1/28/2009 NC 1/28/2009 NY 1/28/2009 OH 1/28/2009 CA 1/28/2009 TX 1/28/2009 NY 1/28/2009 MO 1/28/2009 MI 1/28/2009 MS 1/28/2009 MO 1/28/2009 CA 1/28/2009 OR 1/28/2009 CA 1/28/2009 UT 1/28/2009 AK 1/28/2009 OH 1/28/2009 NC 1/28/2009 TN 1/28/2009 GA 1/28/2009 KS 1/28/2009 NJ 1/28/2009 AZ 1/28/2009 IL 1/28/2009 CA 1/28/2009 VA 1/28/2009 FL 1/28/2009 IL 1/28/2009 IL 1/28/2009 NC 1/29/2009 1/29/2009 NJ 1/29/2009 1/29/2009 1/29/2009 OH 1/29/2009 1/29/2009 1/29/2009 1/29/2009 KY 1/29/2009 WY 1/29/2009 NV 1/29/2009 NY
48 46 47 62 15 58 33 0.2 64 46 79 3 24 4 68 0.3 1 15 24 1 1.1 5 5 49 1 16 22 28 71 5 4 60 1.8 1 4 70 65 35 2 0.5 1 24 15 73 61 43 73 2 1.3
48 46 47 62 15 33 0 64 46 79 30 24 4 68 0 1 15 24 1 1 5 47 -1 49 1 16 22 28 71 5 4 60 1 1 4 70 65 35 0 1 24 73 61 43 73 2 1
F M M M M M F 0.2 F F M M F F F F 0.4 F 0F M M 0M 0M U F 1M F 0M F F F F M F M 0.8 F 0M F M M M U 0.5 F 0F F F F F F F F 1M 0.2 F
1/28/2009 This case was reported by a lawyer 1/28/2009 This case was reported by a lawyer 1/28/2009 This case was reported by a lawyer 1/28/2009 Retiree who received flu and ZOSTA 1/28/2009 In AM: Post vaccination: dizzy, dimm 1/22/2009 58 yo M with ESRD on HD, HTN, an 1/22/2009 Pt had vaccination 1/20/09, and 1/2 1/21/2009 Parents state that infant cried screa 1/25/2009 24 hours after the injection patient n 1/27/2009 Received FLUZONE 1/15/09. 1 we 1/28/2009 Five days after administration, a 2 in 1/28/2009 CELLULITIS TO LT. DELTOID REG 1/28/2009 I received 2 of the 3 Gardisil shots. 1/28/2009 Patient recieved vaccines on 1/16/0 1/28/2009 patient experienced swollen, red, ho 1/28/2009 24 hours after 1st PCV, baby's thigh 1/28/2009 Varicella rash; about 2 dozen lesion 1/28/2009 None 1/28/2009 Chills, fevers of up to 103.2, body a 1/28/2009 20-25 ERYTHEMATOUS LESIONS 1/28/2009 FOURTH IPV GIVEN AT 12 MONTH 1/28/2009 Area of swelling 10.5 cm x 9.5 cm, f 1/28/2009 Patient developed a rash 7-10 days 1/28/2009 Mom to clinic with 5 yo with concern 1/28/2009 THE FLU SHOT WAS GIVEN DIRE 1/28/2009 My son was on target with speech a 1/28/2009 1. Bruising x 3 weeks. 2. Local pain 1/27/2009 Pt describes temp 102.2 F orally se 1/28/2009 Employee c/o headache, nausea, v 1/28/2009 Very stiff neck muscles, onset 24 ho 1/26/2009 1-16-09 vaccine given. 1-22-09 at 6 1/28/2009 Left deltoid localized reaction with re 1/28/2009 Patient c/o right upper arm swelling, 1/28/2009 Erythema, Hyperemia and edema a 1/28/2009 Triaged by Dr via telephone and ad 1/26/2009 Swelling, redness with the left shou 1/28/2009 Patient was diagnosed with shingles ### On May 1, 2006 I went to the Hospi 6/10/2008 35 y/o male SM referred to hospital 1/27/2009 Initial report received on 21 January 1/26/2009 Initial report received on 15 January 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/27/2009 Shingles vaccine given 12/31/2008. 1/26/2009 Patient reported rash and itching ar 1/22/2009 L arm - deltoid region with redness, Left arm Pneumonia Vaccine R arm 1/21/2009 MOC called on 1/15/08 at 11 am, st 1/29/2009 Patient developed a facial palsy on
338595 338596 338597 338598 338599 338600 338601 338602 338604 338605 338606 338607 338608 338609 338610 338611 338612 338614 338615 338616 338617 338618 338619 338620 338621 338622 338623 338624 338638 338639 338640 338641 338642 338667 338671 338672 338673 338689 338690 338691 338692 338693 338694 338695 338696 338697 338698 338704 338705 338706 338707
1/29/2009 NY 1/29/2009 MI 1/29/2009 NY 1/29/2009 NC 1/29/2009 VA 1/29/2009 ID 1/29/2009 MS 1/29/2009 AL 1/29/2009 WA 1/29/2009 NY 1/29/2009 MO 1/29/2009 CO 1/29/2009 AZ 1/29/2009 IL 1/29/2009 CA 1/29/2009 CA 1/29/2009 WI 1/29/2009 NE 1/29/2009 WI 1/29/2009 VA 1/29/2009 RI 1/29/2009 PA 1/29/2009 CO 1/29/2009 NJ 1/29/2009 NY 1/29/2009 MA 1/29/2009 WI 1/29/2009 WI 1/29/2009 1/29/2009 PA 1/29/2009 CT 1/29/2009 1/29/2009 NC 1/30/2009 PA 1/30/2009 TX 1/30/2009 NC 1/30/2009 AR 1/30/2009 AZ 1/30/2009 FL 1/30/2009 NC 1/30/2009 VA 1/30/2009 KY 1/30/2009 AZ 1/30/2009 MO 1/30/2009 CA 1/30/2009 AR 1/30/2009 CA 1/30/2009 MI 1/30/2009 ND 1/30/2009 MD 1/30/2009 OH
21 1.5 67 14 0.2 52 26 14 11 14 31 0.3 4 62 13 0.4 61 60 0.2 51 65 1.3 64 65 0.2 12 63 61
21 1 67 14 0 52 26 14 11 14 31 0 4 62 1 0 61 60 0 51 65 1 64 65 0 12 63 61
0.5 8
0 8
28 1 62 32 0.2 61 14 0.5 44 1.2 14 1 4 3 5 14 1
28 1 62 32 0 61 14 0 44 1 14 1 4 3 5 14 1 42 37
35
F 0.5 F F F 0.1 M F M F F F F 0.3 F F F 0.1 F 0.4 F F F 0.2 F M M 0.3 F M F 0.2 F M F F M 0.5 M F F M 0M F F 0.2 M M F 0.5 F F 0.2 F M 0M M M M M 0F F M
1/29/2009 PT. HAD FLUSHOT 12/15/08 AND 1/29/2009 NONE REPORTED 1/29/2009 SWELLING AT INJECTION SITE 1/29/2009 01/28/2009 pt report n&v, confussio 1/29/2009 first vaccinations, including rotateg, 1/29/2009 To start with, I was never alergic to 1/29/2009 20 Jan 2009- received vaccination. 1/29/2009 On 1/20/09 after clinic visit, and @ 7 1/29/2009 Lip swelling for 12 hours. 10 days la 1/29/2009 Bell's palsy 1 week after HPV #3 va 1/12/2009 Within 6 hours of receiving vaccine 1/29/2009 Infant received HIB #1, Prevnar #1, 1/29/2009 Local reaction, erythema, induration 1/29/2009 Six Hours post Injection patient exp 1/29/2009 About 3-5 days after injection, 2 cm 1/29/2009 6 hours after immunization, patient 1/28/2009 2cm X 3cm Reddened Raised area Right sided neck pain/stiffness radia After 1st dose of ROTATEQ pt. had 1/29/2009 Pt states that in 2004 she received 1/23/2009 4x5cm area of redness. Left should 1/29/2009 Localized VARICELLA reaction - red 1/29/2009 Patient complaining of rash on right 1/29/2009 Zosterform eriphan with pain, itching 1/29/2009 Baby has rash on both thighs. No fe 1/29/2009 Developed lump in R. arm circumfer 1/29/2009 Administered ZOSTAVAX IM instea 1/29/2009 None administered IM instead of Su 1/29/2009 This case was reported by a lawyer 1/29/2009 Patient received ROTATEQ on 1-27 1/28/2009 Pt has received FLUMIST in previou 1/29/2009 Patient received injection 6-9-08. Ex 1/29/2009 SM developed erythematous, pruriti 1/28/2009 Sudden death Y at home morning of 1 1/26/2009 Patient called our office approx 30 m 1/8/2009 None stated 1/15/2009 Lethargy started in 1/14/09, had to b ### Received Flu shot 10/14/08 Fry's. T 1/21/2009 Passed out, tremors, eyes rolling in 1/29/2009 No known reaction. KINRIX acciden 1/30/2009 Pt states she gets frequent breakou 1/30/2009 On 12-19-08 increased temp 105.8 1/29/2009 Immediately after the 2 vaccines ad 1/30/2009 Pt received VARIVAX vaccine on 09 1/30/2009 Redness, Swelling, itching, warmne 1/30/2009 Itchy, red, swollen. Cold compress a 1/30/2009 Early Thursday morning fever of 100 1/30/2009 HE HAD CONVULSIONS FOR A D 1/30/2009 Incident occured 1/2/09 mid-mornin 1/30/2009 Pt states that the Last flu vaccine ca ### Within 4 hours, patient began cough
338708 338709 338710 338711 338712 338713 338714 338715 338716 338717 338718 338719 338720 338721 338722 338723 338724 338725 338726 338727 338738 338740 338741 338742 338743 338744 338745 338746 338747 338886 338887 338888 338889 338890 338924 338925 338926 338927 338928 338929 338930 338931 338932 338933 338934 338935 338936 338937 338938 338939 338940
1/30/2009 IL 1/30/2009 DC 1/30/2009 PA 1/30/2009 KY 1/30/2009 NY 1/30/2009 PA 1/30/2009 IL 1/30/2009 OK 1/30/2009 NY 1/30/2009 GA 1/30/2009 NY 1/30/2009 NJ 1/30/2009 OR 1/30/2009 AZ 1/30/2009 OH 1/30/2009 DC 1/30/2009 TX 1/30/2009 CA 1/30/2009 OR 1/30/2009 NE 1/30/2009 NM 1/30/2009 WA 1/30/2009 CO 1/30/2009 MA 1/30/2009 CT 1/30/2009 VA 1/30/2009 MO 1/30/2009 CA 1/30/2009 AR 1/30/2009 TX 1/30/2009 CA 1/30/2009 WV 1/30/2009 WV 1/30/2009 CT 1/30/2009 MA 1/30/2009 MD 1/30/2009 IN 1/30/2009 IN 1/30/2009 IN 1/30/2009 IN 1/30/2009 1/30/2009 1/30/2009 IN 1/30/2009 1/30/2009 1/30/2009 1/30/2009 TX 1/30/2009 TX 1/30/2009 IA 1/30/2009 AZ 1/30/2009 AZ
43 39 41 51 0.5 52 1.7 67 11 4 24 4 6 4 79 63 19 28 1 61 0.6 77 14 9 4 51 3 25 29 47 48 27 27 65 42 66 47 23 37 22 44 39 47 18 45 39 42 37 31 27 81
43 39 41 51 0 52 1 67 11 4 24 4 6 4 79 63 19 28 1 61 0 77 14 9 4 51 3 25 29 47 27 27 65 42 66 47 23 37 22 44 39 47 18 45 39 42 37 31 27 81
M F F M 0.5 M M 0.7 F F M M M M F M F F F F 0M F 0.6 F F M F M M F F M F F M F F F M M F M F M F F M M F F F F F F
1/30/2009 Patient presented to BHC 237 with 1/30/2009 TDAP given 1/14/09 in L arm Patien 1/30/2009 Fever 102.7 degrees, chills, body ac 1/30/2009 MEMBER REPORTED TO SICK CA 1/30/2009 Immunized 1/21 morning. Rash to n 1/30/2009 On 1/08/09 Pt. awoke with flu like sy 1/29/2009 CLIENT HAS IMMUNIZATIONS ON 1/30/2009 Patient experienced soreness at the 1/30/2009 Father reports fever of 100-103 for 3 1/30/2009 Five minutes post administration of 1/30/2009 right arm swelling, pain & redness 2 1/30/2009 Seen in our office on 1/22/09 and re 1/30/2009 One day after administration of Vari 1/30/2009 ACCORDING TO MOTHER, CHILD 1/30/2009 patient with extremely sore arm limi 1/30/2009 Fever (Tmax 102F 2 days after shin 1/30/2009 Vaccine administered around 11 Ju 1/30/2009 Skin rash all over the body, mostly i 1/30/2009 Evening of 7/22/2008 child had a pr 1/30/2009 The pain in my upper left arm is som 1/30/2009 This case was reported by a healthc 1/31/2009 Started with lower back progressing 1/30/2009 In the evening after his shot, he dev 1/30/2009 Left arm large red, warm, painful are 1/30/2009 R arm. 15x15 cm. edema, erythema 1/29/2009 To H.D. 12-23-08 for vaccines to tra 1/30/2009 Left deltoid area red, swollen, warm 1/30/2009 Pt. C/O redness some swelling at si 1/29/2009 C/O diarrhea and aching approxima 1/16/2008 Patient received TD vaccination on 2/4/2008 The patient received a routine boos 3/24/2008 Patient received TD-171 on 01/25/0 1/9/2009 Patient received TD on 03/12/2008. 9/4/2008 Patient was vaccinated on 02/01/08 9/4/2008 Patient experienced a high fever of 6/16/2008 Patient received TD vaccine on 6/12 8/14/2008 A male patient received vaccine on 8/14/2008 A female patient received vaccine o 8/14/2008 A male patient received vaccine on 8/14/2008 A female patient received vaccine o 8/15/2008 C.K. received TD vaccine on 06/20/ 8/15/2008 Patient received TD vaccine on 06/2 1/21/2009 Patient received Td injection intrade 7/16/2008 A male patient came to doctor's offic 8/12/2008 Patient was administered TD vaccin 8/12/2008 Patient was administered Td vaccin 9/12/2008 Patient received TD injection on 04/ 9/12/2008 Patient received TD injection on 10/ ### On 08/25/08 TD was administered t 1/22/2009 Patient developed induration at inje 1/9/2009 Patient reported not feeling good af
338941 338942 338943 338944 338945 338946 338947 338948 338949 338950 338951 338952 338953 338954 338955 338956 338957 338958 338959 338961 338962 338963 338964 338965 338966 338967 338968 338969 338970 338971 338972 338973 338974 338975 338982 338983 338984 338985 338986 338987 338988 338989 338990 338991 338992 338993 338995 338996 339055 339056 339057
1/30/2009 AZ 1/30/2009 MA 1/30/2009 IN 1/30/2009 MA 1/30/2009 MA 1/30/2009 MN 1/30/2009 FL 1/30/2009 FL 1/30/2009 NY 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 FL 1/30/2009 CA 1/30/2009 VA 1/30/2009 MA 1/30/2009 UT 1/30/2009 1/30/2009 KY 1/30/2009 CT 1/30/2009 CT 1/30/2009 CT 1/30/2009 NY 1/30/2009 PA 1/30/2009 TN 1/30/2009 NV 1/30/2009 NV 1/30/2009 AZ 1/30/2009 LA 1/30/2009 MD 1/30/2009 FL 1/30/2009 CA 1/30/2009 CA 1/30/2009 DC 1/30/2009 MN 1/30/2009 CT 1/30/2009 NM 1/30/2009 IN 1/30/2009 MA 1/30/2009 AZ 1/30/2009 AZ 1/30/2009 AZ 1/30/2009 TX 1/30/2009 1/30/2009 1/30/2009 VA 1/30/2009 VA 1/30/2009 KY
13 71 18
13
1.3 65
1 65
37 35 30 60 57
37 35
82 69 77 68 29 68 58 20 52 54 65 21 64 34 62 34 37 35 8 13 17 42
82 69 77 68 29 68 58 20 52
81 33
81
18
57
65 21 64 34 62 34 37 35
42
F F M F F 0.3 M M F F F F M M M U F F F F F U U F F F F F F F F F F M M F F F F F F F M F M M F U U U F F
1/22/2009 Patient developed induration and re 12/2/2008 Patient received TD vaccine, lot TD ### Fever, sweating, migraine headach 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by an allerg 1/27/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a physici 1/7/2009 This was reported by a healthcare p 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc
339058 339059 339060 339061 339062 339063 339064 339065 339066 339067 339068 339069 339071 339072 339073 339074 339075 339076 339077 339078 339079 339080 339081 338728 338729 338730 338731 338732 338733 338762 338763 338764 338765 338766 338767 338768 338770 338771 338772 338778 338782 338785 338786 338788 338790 338791 338792 338793 338794 338795 338797
1/30/2009 1/30/2009 1/30/2009 UT 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 CO 1/30/2009 CO 1/30/2009 OH 1/30/2009 NC 1/30/2009 IN 1/30/2009 1/30/2009 NC 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 MA 1/30/2009 MA 2/1/2009 2/1/2009 2/1/2009 GA 2/1/2009 AZ 2/1/2009 PA 2/1/2009 NY 2/2/2009 MA 2/2/2009 2/2/2009 LA 2/2/2009 WI 2/2/2009 PA 2/2/2009 PA 2/2/2009 WA 2/2/2009 VT 2/2/2009 2/2/2009 2/2/2009 IN 2/2/2009 PA 2/2/2009 OH 2/2/2009 KS 2/2/2009 2/2/2009 OK 2/2/2009 MN 2/2/2009 MA 2/2/2009 MI 2/2/2009 MI 2/2/2009 PA 2/2/2009 FL
15 39 25
15 39 25
39
39
40 41 4 0.5 70 16 20
40 41 4 0 70 16 20
1.2 63 4 16 0.2 51 67 41 41 26 0.4 1.3 0.3 54 69 24 11 1.2 29 65
1 63 16 0 51 67 41 41 26
54 68 24 11 1 29 65
U U F M M F F F F M F F F F F F M M F F F F F M M M 0.5 M M F F F 0.2 M F M F 0.2 F M F F M F F F F F M F U 0.2 F F F
1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 2/1/2009 On January 8, 2009, patient recieve 1/3/2009 LEFT SIDE UPPER BODY MUSCL 2/1/2009 My son had a seizure the day after 2/1/2009 Patient received the vaccine on 1/30 2/1/2009 Patient devleoped herpes zoster on 2/1/2009 February 2008 first shot experience 1/29/2009 I got the first HPV vaccine, and 1 hr 1/29/2009 Pt. received ZOSTAVAX IN; approx 1/23/2009 Pt given 5th PCV7 instead of Hept A 1/29/2009 1-2 inch red & warm spot just below 1/28/2009 5 m. erythema, swelling L upper arm 1/28/2009 LA posterior redness 3x4 1/2 in elev 2/18/2009 Started giving RATATEQ by mouth, 1/16/2009 Fever, Chills, and cramps, vomiting 1/29/2009 Patient was given 0.5 ml pneumocc 1/28/2009 12/1/08 patient received tetanus/dip 1/29/2009 Initial report received on 07 October 1/30/2009 Information has been received from 1/30/2009 Information has been received from 1/30/2009 Information has been received from 1/30/2009 Information has been received on re 2/2/2009 Early the next day after receiving in 2/2/2009 Red and swollen underarm muscle 2/2/2009 Severe swelling, cold sweats, vomit 2/2/2009 2 DAYS AFTER INJECTION, SHE D 2/2/2009 Mom states child had a seizure 1/31 2/2/2009 DAY AFTER INJECTION-FEVER A 2/2/2009 swelling lips , throat and very itchy r
338798 338799 338800 338801 338802 338803 338804 338805 338806 338807 338808 338809 338811 338812 338813 338814 338815 338817 338818 338820 338821 338822 338824 338825 338826 338827 338823 338839 338840 338841 338844 338845 338846 338847 338849 338851 338856 338867 338868 338869 338870 338873 338891 338892 338893 338894 338895 338896 338897 338898 338899
2/2/2009 AK 2/2/2009 MN 2/2/2009 CA 2/2/2009 OH 2/2/2009 UT 2/2/2009 CT 2/2/2009 NC 2/2/2009 KY 2/2/2009 VA 2/2/2009 CA 2/2/2009 WA 2/2/2009 CA 2/2/2009 OH 2/2/2009 AZ 2/2/2009 MI 2/2/2009 LA 2/2/2009 OH 2/2/2009 VA 2/2/2009 MA 2/2/2009 NH 2/2/2009 WA 2/2/2009 NJ 2/2/2009 OR 2/2/2009 IN 2/2/2009 AL 2/2/2009 PA 2/3/2009 MO 2/3/2009 2/3/2009 TX 2/3/2009 TN 2/3/2009 LA 2/3/2009 LA 2/3/2009 FL 2/3/2009 2/3/2009 NM 2/3/2009 2/3/2009 2/3/2009 CT 2/3/2009 2/3/2009 FL 2/3/2009 2/3/2009 2/3/2009 2/3/2009 IL 2/3/2009 LA 2/3/2009 CA 2/3/2009 NJ 2/3/2009 SC 2/3/2009 CT 2/3/2009 OH 2/3/2009 NY
42 0.2 1 48 33 62 40 1 67 1.1 11 0.4 47 0.4 49 37 30 5 60 45 1 16 4 17 84 5 0.2 16 20 20
42 0 1 48 33 62 40 1 67 1 11 0 47 0 49 37 30 5 60 45 1 16 4 17 84 5 0
81 1.3 0.6 0.3
81
15 14 17 13 23 23 57 2 42 0.8 53 69 0.2 0.7
15 14 17
20
0
23 57 2 42 0 53 69 0 0
F 0.2 F 0F M M M F 0F M 0.1 M M 0.4 F F 0.4 F F F F F M M 0F F M M M F 0.2 F F F F U U M U 0.6 F F F F F F F F M F 0F F 0.8 M M F 0.2 M 0.7 M
2/2/2009 Headache 6 hours after injection las 2/2/2009 2 month old in for immunizations. B 2/2/2009 fever w/ poss tonic seizure, mild ras 2/2/2009 7:00 p.m. fever and dizziness. 8:00 2/2/2009 Received vaccines on 1-12-09. Sym 2/2/2009 Pt presents to the emergency room 2/2/2009 40 yo 70kg WF received 0.5ml Pneu 2/2/2009 After getting the MMR, Hep A, and V 1/30/2009 At approximately 6:00 pm on 1/24/0 2/2/2009 Low grade fever (100-107 F) multifo 2/2/2009 1/30/09 - seen in office with redness 2/2/2009 2pm - received shots. 2:08pm- dev 2/2/2009 Shot 1-27-09 reported 1-30-09 L arm 2/2/2009 fever > 102 X 48 degrees. Fever de 2/2/2009 Flu vaccine received on 1/30/08 her 2/2/2009 Pain upon injection, in 24 hours, ho 2/2/2009 Onset pain in upper outer arm wher 2/2/2009 Fever- few pustules on trunk (small 2/2/2009 Hours after following injection patien 1/29/2009 Bell's Palsy 2/2/2009 This case was Y reported by a healthc 1/31/2009 MENACTRA + VARIVAX given on 1 1/28/2009 (see attached) seizure - like episode 11/4/2008 At about 6pm he received his two v 1/29/2009 Right upper arm swollen and warm1/29/2009 Fever for 4-6 hr > 24 hrs post vaccin 1/27/2009 T 39, diarrhea, mottled, decreased c 2/2/2009 Information has been received from 2/2/2009 Information has been received for th 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 It was reported in a published article 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from ### This case was received on 27 Nove 2/3/2009 Swelling, Inflamation 2/3/2009 I became very light headed, as thou 2/3/2009 Vaccination was administered 11/5/ 2/3/2009 Patient received MMR vaccination o 2/3/2009 Kawaski disease, resulting with the 2/3/2009 Pain in shoulder of same side as va 2/3/2009 Pt. received Zostavax on 01/06/200 2/3/2009 Brought to the office on 01/31/09 fo 2/3/2009 Few hours later high fever. Next day
338900 338901 338902 338903 338904 338905 338906 338907 338909 338910 338911 338912 338913 338914 338915 338916 338917 338918 338919 338920 338921 338922 338923 339054 338960 338978 339004 339014 339015 339016 339017 339018 339019 339020 339021 339022 339023 339024 339025 339026 339027 339028 339029 339030 339031 339032 339033 339034 339035 339036 339037
2/3/2009 HI 2/3/2009 MA 2/3/2009 MI 2/3/2009 OH 2/3/2009 CO 2/3/2009 IL 2/3/2009 MN 2/3/2009 WI 2/3/2009 OK 2/3/2009 NY 2/3/2009 WI 2/3/2009 MI 2/3/2009 2/3/2009 FL 2/3/2009 PA 2/3/2009 2/3/2009 WA 2/3/2009 DC 2/3/2009 WI 2/3/2009 NC 2/3/2009 AL 2/3/2009 GA 2/3/2009 IN 2/3/2009 2/4/2009 MN 2/4/2009 CA 2/4/2009 GA 2/4/2009 NJ 2/4/2009 WI 2/4/2009 IL 2/4/2009 IL 2/4/2009 MO 2/4/2009 KY 2/4/2009 CT 2/4/2009 ME 2/4/2009 CA 2/4/2009 IL 2/4/2009 ME 2/4/2009 FL 2/4/2009 MO 2/4/2009 NM 2/4/2009 FL 2/4/2009 PR 2/4/2009 NY 2/4/2009 IL 2/4/2009 IA 2/4/2009 OH 2/4/2009 CA 2/4/2009 GA 2/4/2009 FL 2/4/2009 WA
1 20 67 70 78 3 14 12 57 1 16 21 23 72 3 73 68 1.2 18 0.2 1 37 8 84 0.4 0.3 1.2 0.6 2 68 1.3 14 68 15 37 10 1.3 1.5 0.2 1 4 56 0.2 1.3 50 52 1.3 11 33 4 19
1 20 67 70 3 14 12 57 1 16 21 23 72 3 68 1 18 0 1 37 8 84
1 0 2 68 14 68 15 37 10 1 0 1 4 56 0 1 50 52 1 11 33 4 19
0F F M M M M M F F 0M F M M F F M F 0.2 M F 0.2 M 0M F F F U M 0.2 M 0.6 F 0M F F F F F F M M 0.5 F 0.2 F 0F M U 0.2 F 0.4 F F F 0.3 M F F F F
2/3/2009 Shingles diagnosed 1/09 2/3/2009 48 hours after administration - Feve 2/3/2009 NO ADVERSE EVENTS, SYMPTOM 2/3/2009 ON FRIDAY, JAN 30 PAT CALLED 2/3/2009 One day after receiving the pneumo 8/19/2008 Rash at injection site after varicella 2/3/2009 father states symptoms started at 1 2/3/2009 FATHER REPORTS CHILD DEVEL 2/3/2009 PATIENT REPORTS TINGLING RIG 2/3/2009 MMR and Varicella shot given on 1/ 2/3/2009 Severe, chronic headaches that beg 2/3/2009 Fever, pain, severe swelling, hives. 2/3/2009 1) Developed vasculltic lesions on le 1/31/2009 On day 7, broke out in welts. Entire 2/3/2009 1/7/09 Large cluster of pinpoint vesi 1/23/2009 Patient had used topical Neosporin 1/31/2009 Shot given 12/23. Pt had ache front 1/12/2009 None Stated 2/3/2009 US Army NG SGT who noticed a sin 1/27/2009 High pitch screaming x 48 hrs. 2/2/2009 Possible staring spells vs sandifer's 1/9/2009 Rash on upper arm flu shot 46 X 44 1/29/2009 Leg turned a little red immediately a 2/3/2009 Almost after the vaccine neck starte 2/3/2009 Initial report received on 23 January 2/3/2009 Initial report received 28 January 20 2/1/2009 The exact dates of adverse events w 2/2/2009 104 degree T 24 hours after shots. 2/4/2009 Right leg pain, fever, vomiting, perio 2/4/2009 Starting on Tues eve (2/3) pat expe 2/4/2009 Received vaccine 1/23/09. Febrile 2/4/2009 Temp 102 degree F the day after Td 1/26/2009 Received ZOSTAVAX vaccine appr 1/29/2009 Fever, headaches, rash prior to imm 2/4/2009 Myalgia beginning w/; 24 hrs- fatigu ### None (patient was given DTap at 10 2/4/2009 Erythematous maculopapular spots 2/2/2009 Given Dtap, Hep A at well child che 2/4/2009 Mucoid diarrhea for 1 month. 1/30/2009 1/23/09 1:30 p.m. I administered MM 2/4/2009 Patient hadYfever within 24 hours of 2/4/2009 Large lump on arm at site of admini 2/4/2009 Irritability and crying for more than 3 2/4/2009 Received MMR and Varivax on 1/30 2/4/2009 Pt. reported headache, upper torso 2/4/2009 Patient underwent surgical debridem 2/4/2009 Developed vomitting, diarrhea, and 2/4/2009 Progressive weakness and muscle 2/4/2009 Client developed fever of 103 and v 2/4/2009 Parent returned to clinic 1/29/09 wit 2/4/2009 Complained of fever last night (2/3/0
339038 339039 339040 339041 339042 339043 339044 339045 339046 339047 339048 339049 339050 339051 339052 339053 339315 339316 339318 339319 339320 339070 339085 339088 339092 339093 339095 339096 339097 339098 339099 339100 339101 339102 339103 339104 339105 339106 339107 339108 339109 339110 339111 339112 339113 339114 339115 339116 339117 339119 339120
2/4/2009 PA 2/4/2009 PA 2/4/2009 CA 2/4/2009 AZ 2/4/2009 WA 2/4/2009 CO 2/4/2009 CA 2/4/2009 HI 2/4/2009 OH 2/4/2009 AL 2/4/2009 WA 2/4/2009 CA 2/4/2009 TN 2/4/2009 WA 2/4/2009 WA 2/4/2009 IN 2/4/2009 OH 2/4/2009 WV 2/4/2009 LA 2/4/2009 LA 2/4/2009 LA 2/5/2009 FL 2/5/2009 WV 2/5/2009 OH 2/5/2009 FL 2/5/2009 2/5/2009 2/5/2009 CA 2/5/2009 2/5/2009 2/5/2009 FL 2/5/2009 MI 2/5/2009 LA 2/5/2009 MD 2/5/2009 NC 2/5/2009 IA 2/5/2009 MO 2/5/2009 WA 2/5/2009 PA 2/5/2009 TX 2/5/2009 VA 2/5/2009 MN 2/5/2009 MO 2/5/2009 MA 2/5/2009 NY 2/5/2009 CA 2/5/2009 OR 2/5/2009 CO 2/5/2009 LA 2/5/2009 MA 2/5/2009 ID
15 55 1.3 16 0.2 2 1.2 79 25 57 12 1.4 1.1 20 11 4 0.2
15
5 4 5 35 2 42 19 17 62 36 50
5 4 5
5 1.5 29 0.3 39 0.4 8 0.2 11 1.6 46 26 54 12 45 2 1 40 85 0.2
16 0 2 1 79 25 57 12 1 1 20 11 4
2 42 19 17 62
5 1 28 0 72 0 8 0 11 1 46 26 15 54 12 45 2 1 40 85 0
F U U F 0.2 M 0.2 M 0.2 F M F M M 0.4 M 0.1 M F M M U U M M F F 0M F F F M F F M M 0.5 M U 0.4 M F 0.4 F F 0.2 F F 0.6 M M F F F F F 0M 0M F M 0.2 M
2/4/2009 HEPATITIS A VACCINE WAS ADM 2/4/2009 Subject in pneumococcal vaccine tr 2/4/2009 RASH INNER L EAR AND CHEEK. 2/4/2009 Patient fainted after vaccines 2/4/2009 Physician ordered pneumo vaccine. 2/4/2009 fever up to 104 24 hours after vacci 2/4/2009 Small blister on the inside, left lower 2/4/2009 PNEUMOVAX administered at 10:0 MMR vaccine administered IM in rig Hives and wheezing 01 hour after In 2/4/2009 6" area of redness and swelling in L 1/29/2009 Mom reports that patient had sudde 2/4/2009 Mild localized reaction 2/4/2009 48 degrees after vaccine given (give 2/4/2009 3"x3 1/2" raised tender erythematou Had area of blanchable erythema a 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a physici 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 2/4/2009 Information has been received from 2/4/2009 Information has been received from 2/4/2009 Information has been received from 2/2/2009 When I joined in March of 1987 I wa 2/2/2009 Patient Received ADACEL vaccine 2/4/2009 Unlikely time vaccine reaction. The 2/2/2009 Chest pain, hoarse throat 3 hrs afte 2/2/2009 Large local reaction 10X18 cm arou 2/5/2009 Area of redness, swelling + warmth 2/3/2009 Seizure activity at 3-4 minutes durat 2/5/2009 Pt is allergic to eggs, and vaccine c 2/5/2009 child deleloped rash bilaterally over 2/5/2009 Severe redness and swelling in arm 2/5/2009 Pt. presented to the family practice 2/5/2009 Local allergic skin reaction. 2/5/2009 Sudden onset of lethargy and vomit 2/5/2009 Parent reports adolescent having hi 2/5/2009 Patient began febrile episode on 1/3 2/5/2009 10"x10" warm erythema area on rt. 2/5/2009 Spoke with pt on Tuesday 2/3/09 sh 2/5/2009 Patient complains of severe pain in 2/5/2009 raised errythematous tender reactio 2/5/2009 Client was administered Hep A in rig 2/5/2009 Immediate localized reaction at injec 2/5/2009 Patient recieved HAV#2 on 2/3/09, 2/5/2009 Recurrent generalized seizures with 2/5/2009 ADMINISTERED IN LEFT DELTOID 2/5/2009 The above client had within 24 hour 2/4/2009 Inconsolable crying X 8 hours
339122 339124 339127 339131 339132 339133 339139 339140 339141 339142 339143 339144 339216 339217 339218 339219 339220 339221 339222 339223 339224 339225 339226 339118 339148 339149 339152 339153 339154 339155 339156 339157 339158 339159 339160 339161 339162 339163 339164 339165 339166 339167 339168 339169 339170 339171 339172 339173 339185 339186 339187
2/5/2009 NM 2/5/2009 HI 2/5/2009 WA 2/5/2009 NH 2/5/2009 MA 2/5/2009 AL 2/5/2009 WA 2/5/2009 OR 2/5/2009 CA 2/5/2009 IL 2/5/2009 PR 2/5/2009 PR 2/5/2009 2/5/2009 2/5/2009 2/5/2009 MA 2/5/2009 NY 2/5/2009 MA 2/5/2009 2/5/2009 CA 2/5/2009 CA 2/5/2009 CA 2/5/2009 CA 2/6/2009 2/6/2009 NE 2/6/2009 2/6/2009 VA 2/6/2009 NE 2/6/2009 OK 2/6/2009 NE 2/6/2009 TX 2/6/2009 MI 2/6/2009 ID 2/6/2009 AZ 2/6/2009 AL 2/6/2009 CA 2/6/2009 AR 2/6/2009 LA 2/6/2009 OH 2/6/2009 OR 2/6/2009 SC 2/6/2009 CA 2/6/2009 OK 2/6/2009 WA 2/6/2009 OH 2/6/2009 SC 2/6/2009 IL 2/6/2009 2/6/2009 NC 2/6/2009 KY 2/6/2009 MO
0.5 1.6 13 15 11 24 0.2 1.6 19 76 25 21 1.3 42
0 1 13 15 11 24 0 1 19 76 21
2 0.7 62 24 1.1 1.3 1.3 1.3 30 21
30 21
0.2
0
26 64 2 38 52 1.3 0.8 2 28 4 0.4 1.5 72 0.4 66 1 20 17 0.2 22 0.3 67 0.3
26 64 2 38 52 1 0 2 28 4 0 1 72 0 66 1 20 17 0 32 0 67 0
0.5 M 0.6 F F F M F 0.2 F 0.6 M M M M M M F F M M F F M M M M M F F 0.2 F M F F 0.2 M M M 0.3 F 0.8 F 0.1 M F M 0.4 M 0.5 F F 0.4 F M 0.8 F F F 0.2 M M 0.3 F M 0.3 F
2/5/2009 Rash all over body. Got shot yester 2/4/2009 Redness, warmth, swelling around s 2/5/2009 Call patient dad who said skin was b ### Patient experienced a vasovagal re Chicken pox rash site 2/2/09 - No o 2/5/2009 c/o right arm & chest with + urticaria 2/5/2009 Sleeping and lethargic and poor fee 2/5/2009 No adverse reactions known patien 2/5/2009 Pt noted right eye to be a "little pink 2/5/2009 Patient developed hundreds of vesi 2/5/2009 Since 2003, hearing loss, sleep diso 2/5/2009 2003-present, hearing loss, scoliosi 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been recieved from 1/26/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 2/6/2009 Bell's Palsy developed 17 DEC 08 2 2/5/2009 Information has been received from 2/5/2009 Information has been received from 2/6/2009 Baby expired Y 7 days after immuniza 2/6/2009 Pt reports swelling due to tetanus to 2/6/2009 The day I got the vaccine I didn't ha 2/6/2009 Employee received a Tdap vaccine 2/6/2009 approx 19 hours after rec'ing the MM 2/6/2009 4:30pm found alert but shaking in b 2/6/2009 Patient started receiving Anthrax va 2/6/2009 Rash at vaccination site and over en 2/6/2009 Received Vaccines on 2/3/2009, an 2/6/2009 Cellulitis of left thigh. Hospital admis 2/6/2009 0815 Hep B vaccine administered. 0 2/6/2009 Left Thigh noted to get red, swollen 2/6/2009 Mom was up with patient around 2-3 2/6/2009 Patient had a hard time walking the 2/6/2009 Day after vaccine, left deltoid becam 2/5/2009 Child presented w. generalized hive 2/6/2009 Pt. was given pneumovax shot (I.M. 2/6/2009 aBOUT 10 MIN. AFTER SHOTS, BA 2/6/2009 Patient fainted immediately after firs 2/6/2009 None at time of Gardasil vaccine, bu 2/6/2009 The day after my 2 month old son re 2/6/2009 Recieved booster anthrax on 2/2/09 2/6/2009 Pt developed L sided seizures 24 ho 2/8/2009 Patient started to feel tingling sensa 2/6/2009 No adverse events. Medication give
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2/6/2009 PA 2/6/2009 NY 2/6/2009 CA 2/6/2009 NC 2/6/2009 WA 2/6/2009 NC 2/6/2009 VA 2/6/2009 NJ 2/6/2009 NC 2/6/2009 CA 2/6/2009 SC 2/6/2009 WI 2/6/2009 OH 2/6/2009 GA 2/6/2009 WI 2/6/2009 NY 2/6/2009 GA 2/6/2009 IN 2/6/2009 OH 2/6/2009 CO 2/6/2009 PA 2/6/2009 WV 2/6/2009 MO 2/6/2009 PA 2/7/2009 PA 2/7/2009 MO 2/7/2009 MI 2/7/2009 WA 2/9/2009 CA 2/9/2009 VA 2/9/2009 AZ 2/9/2009 MS 2/9/2009 CA 2/9/2009 GA 2/9/2009 2/9/2009 NJ 2/9/2009 2/9/2009 2/9/2009 2/9/2009 2/9/2009 2/9/2009 GA 2/9/2009 IL 2/9/2009 VA 2/9/2009 2/9/2009 2/9/2009 NM 2/9/2009 VA 2/9/2009 WV 2/9/2009 OH 2/9/2009 TX
4 3 0.4 22 30 36 37 30 36 32 0.2 0.7 55 13 50 1.5 1.8 40 1.2 0.3 14 11 12 75 1.5 17 4 0.3 25
4 3 0 22 30 36 37 30 36 32 0 0 55 13 50 1 1 40 1 0 14 11 12 75 0 17 4 0 25
75 61 70
75 61 70
6 7
3 17 22 15 17 21 16 51 22 1.3 22 61
22 14 17 16 51 22 1 22 61
M F 0.4 M M F M F M F M 0.2 F 0.7 M M M F 0.5 F 0.8 F F 0.2 F 0.3 F M M M F 0.5 F M M 0.4 U F U F F F F M M M M M F F F F F F F M F 0.3 M F F
2/6/2009 Abdominal pain within 5 min after v 2/6/2009 Mom reported severe local reaction Hives all over. Hives. No respirator 7/29/2008 22 y/o male pt. presents to clinic wi 5/28/2008 "I got my first Anthrax vaccine and a ### 36 y/o male with possible adverse re 10/2/2008 The patient is a 38 year old female. 6/27/2008 34 y/o AD male with hx of hospitaliz 5/25/2008 36 y/o female, spouse of retired SM 2/6/2009 Itching, swelling, discoloration, sore 2/4/2009 Patient received ROTATEQ ON 1/1 Developed emesis and cyanosis a f 2/6/2009 2-6-09 Client phoned in and report h 2/5/2009 Hep A site, fever 104, red, swollen i 1/30/2009 Onset of symptoms began on 1-272/6/2009 After VARIVAX vaccine, developed 2/5/2009 Febrile seizures, temp 103.2 degree 2/3/2009 Pt. c/o L arm "tingling", numbness & 2/3/2009 Per mom, patient developed fever 1 2/6/2009 None stated. 2/6/2009 Left upper arm with 10x7 cm faint e 2/6/2009 Rapid onset of redness, pain, swelli 2/6/2009 red, warm, indurated area left arm. 2/6/2009 fever, chills, arm pain, warm to touc 2/6/2009 At 8 days, large hive appeared first 2/7/2009 Approximately 5 minutes after immu 2/7/2009 r arm cellulitus requiring hospital ad 2/7/2009 Thick mucus in mouth, wheezing,dif 2/9/2009 I have lost at least 25% of my hair. I 11/6/2008 Initial information was received on 2 2/5/2009 Initial information received on 29 Ja 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received via a 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/8/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 On 6/16/00 the pt received HepB #1 1/19/2009 I took GARDASIL shot series, It did 2/5/2009 Daughter had second shot of GARD 2/2/2009 Body aches, fever (>100 degrees), 2/5/2009 Right arm swollen, red, and hot to to 2/2/2009 Evening of vaccination developed ra 2/5/2009 States hives on both arms & trunk d 2/4/2009 Dec. 22, 2008, family medicine--Go
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2/9/2009 MO 2/9/2009 WI 2/9/2009 WI 2/9/2009 WA 2/9/2009 OR 2/9/2009 WI 2/9/2009 WV 2/9/2009 OK 2/9/2009 MI 2/9/2009 UT 2/9/2009 VA 2/9/2009 AZ 2/9/2009 WA 2/9/2009 IL 2/9/2009 TX 2/9/2009 MT 2/9/2009 MD 2/9/2009 CA 2/9/2009 TN 2/9/2009 2/9/2009 WI 2/9/2009 CO 2/9/2009 MD 2/9/2009 CA 2/9/2009 NC 2/9/2009 IA 2/9/2009 CA 2/9/2009 DC 2/9/2009 WA 2/9/2009 IN 2/9/2009 NC 2/9/2009 NY 2/9/2009 NJ 2/9/2009 CA 2/9/2009 IN 2/9/2009 CA 2/9/2009 NC 2/9/2009 NM 2/9/2009 CO 2/9/2009 NH 2/9/2009 MI 2/9/2009 NC 2/9/2009 PA 2/9/2009 WV 2/9/2009 2/9/2009 NC 2/9/2009 NY 2/10/2009 TX 2/10/2009 NY 2/10/2009 NJ 2/10/2009 TX
1.1 17 11 11 42 63 5 41 53 38 4 39 19 60 49 62 0.5 1.3 4 18 0.2 1 65 3 0.3 4 43 1 0.3 2 4 37 4 1.3 8 9 24 28 18 58 43 39 57 21 34 0.2 13 14 12
1 17 11 11 42 63 5 41 53 38 4 39 19 2 60 49 62 0 1 4 18 0 0 65 3 0 4 43 1 0 2 4 37 4 1 8 9 24 28 18 58 43 39
34 0 13 14 12
0.1 F F F F F F M M F M F M F 0M M M F 0.5 M 0.3 F M F 0.2 M 0F M F 0.3 M F F 0F 0.3 M 0.5 F M F M 0.3 M M M F F F F F M F F M 0.2 M M M F F
2/4/2009 Morn after imm. child had fever 101 2/5/2009 Alicia had complained of pain in her 2/5/2009 Daughter complained of pain in her 2/5/2009 I took patient to receive the 3rd sho 1/26/2009 Fever of 101 degrees F > Broke out 2/2/2009 Redness, swelling, pain. 2/4/2009 Chicken pox 2/9/2009 pt reported dog bite in am and need 2/9/2009 Pruritus as soon as injection given t 2/9/2009 Shot given Monday, February 2, 20 2/9/2009 BREAKTHROUGH CHICKENPOX F 2/9/2009 Suspected spread of smallpox due 2/7/2009 pt recieved yellow fever vaccination 2/9/2009 Mom Called in and states that child 2/9/2009 After Zoster vaccination, varicella-zo 2/9/2009 Pt experienced shoulder girdle pain 2/9/2009 12/3/08 pt started with "strangled co 2/9/2009 Diffuse upper and lower extremity s 2/9/2009 Hives over entire body that itches. 2/9/2009 Patient contracted cellulitis in his lef 2/9/2009 Persistent headaches and numbnes 2/9/2009 Patient presented to clinic with moth 2/9/2009 103 Fever (48 hours later) Low-gra 2/9/2009 An itchy, slightly swollen red rash (a 2/9/2009 hives/raised rash at injection site, fe 2/9/2009 None 2/9/2009 Redness, swollen, & rash around va Beginning 1/10/2009, red bumps ap 2/2/2009 Client was noted to have Red spots 2/7/2009 Facial Swelling, rash prescribed Ora 2/9/2009 Vaccine on 25-09 2-6-09 fever (ele 2/9/2009 Hives on face, neck, groin area, bac 2/3/2009 On 2/3/09 student came in with c/o 2/8/2009 Fever + Chills 5 hours after vaccine 2/9/2009 After 10 days fever and runny nose. 2/6/2009 Chills, lethargic 10 minutes after the 2/9/2009 24-30 hours after vaccine pt broke o 2/9/2009 During administration the patient ha 2/9/2009 Pt contacted clinic on 2/6/09 (injecti 2/6/2009 Patient states she had a S/E of righ 2/6/2009 Tdap 1/30/09- Rx scarred immediat 2/6/2009 Pt presented to ER c/o arm sorenes Pt presented to office with erythema 2/6/2009 Excessive swelling at injection site. 2/9/2009 Information has been received from 12/9/2008 Whole body aches, anxiety, high Ch 2/9/2009 After receiving the vaccinations, the 2/6/2009 Initial information received on 02 Fe 2/6/2009 Initial information received on 02 Fe 2/9/2009 Information has been received from 2/9/2009 Information has been received from
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2/10/2009 PA 2/10/2009 FL 2/10/2009 2/10/2009 2/10/2009 2/10/2009 WA 2/10/2009 MI 2/10/2009 ID 2/10/2009 AZ 2/10/2009 MA 2/10/2009 NY 2/10/2009 CO 2/10/2009 WI 2/10/2009 MI 2/10/2009 MA 2/10/2009 PA 2/10/2009 IL 2/10/2009 VA 2/10/2009 TX 2/10/2009 CA 2/10/2009 VA 2/10/2009 OR 2/10/2009 PA 2/10/2009 GA 2/10/2009 TX 2/10/2009 TX 2/10/2009 HI 2/10/2009 OH 2/10/2009 IL 2/10/2009 IL 2/10/2009 2/10/2009 2/10/2009 WI 2/10/2009 CA 2/10/2009 CA 2/10/2009 CA 2/10/2009 PA 2/10/2009 MI 2/10/2009 CA 2/10/2009 MA 2/10/2009 AR 2/10/2009 WA 2/10/2009 NC 2/10/2009 LA 2/10/2009 OR 2/10/2009 IA 2/10/2009 NC 2/10/2009 LA 2/10/2009 MO 2/10/2009 MI 2/10/2009 WI
14 5 67 62 0.6 1.5 0.1 12 4 0.2 12 23 5 39 37 0.5 60 24 7 48 39 0.2 9 35 17 40 20 25 1.3 0.4 10 34 4 11 0.6 0.2 15 11 4 11 0.2 19 1.5 14 61 0.3 17 0.8 1 21
67
1 0 12 4 0 12 23 5 37 0 60 24 7 48 39 0 9 35 17 40 20 25 1 0 10 51 34 4 11 0 0 15 11 4 11 0 19 1 14 61 0 17 0 1 21
F F F M M 0.5 F 0.1 M M M 0.2 M F F M M M 0.5 M F M F F F 0.2 F F F F F M F 0.3 M 0.4 M F M F F M 0.6 M 0.2 M F M F M 0.2 M M 0.5 F F F 0.3 M F 0.8 M 0F F
2/9/2009 Information has been received from 2/9/2009 Information has been received from 2/9/2009 Information has been received from 2/9/2009 Weakness 2/7/2009 Shot given: PENTACEL. persistent 2/4/2009 Mom States child started becoming 2/10/2009 On 01-26-09 patient presented to U 2/9/2009 Mom states child was dizzy, nausea 2/9/2009 Patient received KINRIX (DTap and 2/9/2009 Reported notability, poor feeding, le 2/10/2009 Chronic headache pain. 2/18/09MR 2/10/2009 Severe headache, head congestion 2/9/2009 Redness at sight and swelling of leg 2/10/2009 I feel that I am having an adverse re 2/10/2009 Patient vaccinated on Friday 2/6/20 2/10/2009 Mom noticed redness around neck 2/10/2009 td administered on 01/29/09 left del 2/10/2009 PATIENT HAS A RASH ON HIS FA 2/10/2009 Right arm with 2 1/2" x 1 1/8" erythe 2/10/2009 This patient present with a Swollen 2/10/2009 Approximately 2 hours (10:00 AM) 2/10/2009 2mmx2mm firm cystic lesion on Rt l 2/10/2009 syncopal event fifteen minutes after 2/10/2009 Left axillary lymphadenopathy: swol 2/10/2009 Patient began having frequent UTI's 2/10/2009 Patient states had problems with "le 2/10/2009 Event dated 1 Jan 1992. Approxima 2/10/2009 Severe pain after injection. Few min 2/10/2009 rash that started on face 8 days afte 2/10/2009 Within an hour of arriving home from 2/10/2009 In Spanish: The HPV vaccine Garda 2/10/2009 This case was reported by a law off 2/10/2009 Approximately two hours after recei 2/10/2009 Mom brought child to office 4 days a 2/9/2009 Red, rash to right upper arm Pt. given shots on Feb 02, 2009 - na 2/10/2009 Fever, vomiting x 2 days, lethargic, 2/10/2009 Pt seen for headaches on 1/21/09 2/10/2009 He started to vomiting and diarrhea 2/10/2009 3x4 inch area of ERYTHEMA 2/10/2009 Per pediatrician who saw Pt in office 2/6/2009 None Stated 2/9/2009 19 Y/O White male ADSM is referre 2/10/2009 5 minutes after receiving DTaP, HIB Pt developed a pruritic rash starting 2/10/2009 -Mild headache for 2 days. -Welt at 2/10/2009 Misadministration of vaccine. 2/3/2009 Reported back to clinic with report o 2/10/2008 On 2/04/2007 Child received DTP # 2/9/2009 Child was suppose to receive MMR 2/10/2009 Received dose Amox 2-5-09. C/o H
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2/10/2009 IL 2/10/2009 AK 2/11/2009 OH 2/11/2009 FL 2/11/2009 2/11/2009 2/11/2009 NM 2/11/2009 OR 2/11/2009 PA 2/11/2009 OH 2/11/2009 CA 2/11/2009 NC 2/11/2009 AZ 2/11/2009 CA 2/11/2009 CA 2/11/2009 CA 2/11/2009 IL 2/11/2009 IA 2/11/2009 AZ 2/11/2009 MA 2/11/2009 WA 2/11/2009 2/11/2009 CA 2/11/2009 WI 2/11/2009 AK 2/11/2009 NE 2/11/2009 WI 2/11/2009 CA 2/11/2009 MA 2/11/2009 TX 2/11/2009 CO 2/11/2009 MI 2/11/2009 MD 2/11/2009 AZ 2/11/2009 GA 2/11/2009 PA 2/11/2009 PA 2/11/2009 NY 2/11/2009 AZ 2/11/2009 CA 2/11/2009 NY 2/11/2009 MI 2/11/2009 KY 2/11/2009 MN 2/11/2009 MI 2/11/2009 AZ 2/11/2009 NE 2/11/2009 OR 2/11/2009 IA 2/11/2009 MI 2/11/2009 CA
68 1.1 11 49 1 21
68 1 11 49
18 20 17 15 70 69 41 38 4 9 17 11 0.2 3 6 0.2 4 59 8 45 8 10 65
18
46 49 56 10 16 35 4 4 34 0.2 1.8 42 15 55 4 50 11 0.3 0.6 1
45 48 56 10 16 35 4 6 34 0 1 42 15 55 4 50 11 0 0 0
21
17 15 70 69 41 38 4 9 17 11 0 3 6 0 4 59 8 45 8 10 65
F 0.1 M F M F F F F F F F M F M U M F F M 0.2 F F F 0.2 F M F F F F M F F F M F F F F F M M 0.2 M 0.9 M U F M F M F 0.4 M 0.6 M 1F
2/10/2009 Mild allergic Reactions - Redness, s 2/2/2009 Patient received vaccines at approx 2/11/2009 My dughter became very ill when we 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/3/2009 Ophthalmic rash, vesicles, fever X 2 2/9/09 = Red swollen left arm painfu (L) arm pain, vomiting, malaise, R/O 2/11/2009 6 cm x 6 cm red, warm, swollen are 2/11/2009 Redness and swelling at site of inje 2/10/2009 1-2 minutes after receiving vaccine 2/9/2009 Dizziness after injection 2/9/2009 Severe crying/inconsolable and fuss 2/11/2009 None 2/11/2009 < 50 crusted lesion Pt. had fever for 2/12/2009 Really drowsy and dazed lasting ab 2/11/2009 Swollen, red right arm (hyperimmun 2/6/2009 Rash, itching, Rash spread all over 2/2/2009 Swelling greater than 5cm w/ erythe 2/11/2009 patient with pain, Erythema, warmth 2/10/2009 Patient noticed a 4 in by 3 in area o 2/11/2009 (8x4inch) itching, redness at site 2 d 2/6/2009 Red, irritated blotchy rash at PNEUM 2/10/2009 24 hr after shot she developed redn 2/11/2009 vaccine given 2/6/2009. patient sta 2/11/2009 Pt woke up at 1:00 am with chills, th 2/11/2009 The patient called the Dept of Healt 2/11/2009 4 CM x 4 CM SWOLLEN SPOT ON 2/11/2009 Patient was in office for routine visit 2/11/2009 Fever (102-103, severe arm pain an 2/11/2009 She initially had fever and redness t 2/11/2009 ERYTHEMA APPROX. 4 CM IN SIZ 2/11/2009 On 2/4/09 in received 1st dose of JE 2/11/2009 Onset of diarrhea 4 days after 1st d 2/11/2009 Parent reported increased swelling 2/11/2009 Begab with weakness in right side o 2/11/2009 Developed symptoms of severe hea 2/11/2009 Within 2 hours of getting Pneumova 2/11/2009 HARD TIME BREATHING,NOT FEE 2/11/2009 Joe called and reported about 15 m 2/11/2009 PATIENT STOOD WITHIN A MINU 2/11/2009 erythema at injection site. 2/11/2009 Initial flu vaccine given 1-6-2009. H 2/11/2009 Presented on 02.02.2009 with rash
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2/11/2009 GU 2/11/2009 VA 2/11/2009 CO 2/11/2009 TX 2/11/2009 CA 2/11/2009 MD 2/11/2009 NM 2/11/2009 WA 2/11/2009 VA 2/11/2009 WI 2/11/2009 TX 2/11/2009 KY 2/11/2009 2/11/2009 CA 2/12/2009 MI 2/12/2009 AR 2/12/2009 MI 2/12/2009 NC 2/12/2009 SC 2/12/2009 TX 2/12/2009 SC 2/12/2009 GA 2/12/2009 PA 2/12/2009 AZ 2/12/2009 FL 2/12/2009 WA 2/12/2009 OH 2/12/2009 CO 2/12/2009 TX 2/12/2009 CA 2/12/2009 CA 2/12/2009 MA 2/12/2009 WA 2/12/2009 CA 2/12/2009 WA 2/12/2009 WA 2/12/2009 NC 2/12/2009 WA 2/12/2009 OR 2/12/2009 IA 2/12/2009 OK 2/12/2009 NC 2/12/2009 UT 2/12/2009 SC 2/12/2009 WA 2/12/2009 AL 2/12/2009 MO 2/12/2009 RI 2/12/2009 OH 2/12/2009 OH 2/12/2009 NY
32 14 53 0.1 11 17 1.5 47 30 16 1.2 0.2 34 1.1 0.1 10 58 6 37 0 0.3 8 72 61 28 14 72 0.5 28 1.5 0.5 65 0.9 41 30 30 55 14 2 52 16 16 11 76 9 12 17 1.9 0.4 1.4 10
32 14 53 0 11 17 1 47 30 16 1 0 34 1 0
6 37 0 0 8 71 61 28 14 72 0 28 0 65 0 41 30 30 55 14 2 16 16 11 76 9 12 17 1 0 1 10
M F F 0.1 M M F 0.5 M M F M 0.2 M 0.2 M M 0.1 M 0.1 M F U M F 0M 0.2 M M F F F F F 0.5 M F M 0.5 M F 0.9 F F F F F F 0.9 M M F F M F F M F 0.9 F 0.4 M 0.4 F F
2/11/2009 Redness, swelling, warm Fever 104 2/11/2009 Pt was sitting on exam table after va 2/11/2009 metallic taste in mouth, feeling of sw 2/11/2009 Seizures/Spasms (they look like infa 2/11/2009 GAVE Dtap INSTEAD OF Tdap 2/11/2009 RASH ON HANDS< AND OVER FO 2/11/2009 2/9/09 DTaP: Sanofi Pasture Limite 2/11/2009 shot given 1600(Sun) by 1100 next 2/11/2009 Patient received Merck's Gardasil v 2/11/2009 This case was reported by a physici 2/10/2009 Fever 102.3 (r) for 2 days morning a 2/9/2009 Inconsolable crying for 3 days after 2/10/2009 From shot 1-3 of ANTHRAX I felt ha 2/11/2009 Maculopapular rash over trunk, face 2/11/2009 Information has been received from 2/11/2009 Information has been received from 2/12/2009 Subject in pneumococcal vaccine tr 2/12/2009 5 MIN AFTER GETTING VARICELL 2/12/2009 Client called and reported L arm "pu 2/12/2009 Extreme lethargy after Hepatitis B v 2/12/2009 On 10/25/08, @ 8-9AM, mom obser 2/12/2009 vaccine given 02/09/09. on 02/10/09 2/12/2009 On 1/16/09, two days after vaccine 2/12/2009 temperature 102 deg. - hives - seve 2/12/2009 client returned to clinic 2/9/09 statin 2/12/2009 After the third dose my daughter go 2/12/2009 Client states approximately ten days 2/12/2009 The patient developed diarrhea (10 2/12/2009 40mm x 35mm area of "bruising", er 2/12/2009 MOM STATES "HAD FULL BODY R 2/12/2009 urticarial rash onset 5 days after vac 2/12/2009 Vaccine given 2/20/08. On about 2 2/12/2009 PARENT CALLED AND REPORTE 2/12/2009 I received the TDAP vaccine on the 2/12/2009 pain at injection sight up into should 2/12/2009 Erythema, pain at injection sight up 2/12/2009 6.5 x 12 cm area of erythema, indur 2/12/2009 2/6/2009 7:00 p.m. To E.R. by amb 2/12/2009 Four inches long by three inches wi 2/13/2009 We received from a health care prof 2/12/2009 12/17/08 mom took patient to ER fo 2/12/2009 Patient fainted within 2 minutes of v 2/12/2009 Local rxn both sites - Erythema no f 2/12/2009 Pt's face and neck turned red with a 2/12/2009 Pt had severe bronchospasm and s 2/12/2009 Patient started temp 1:30 am 2/12/0 2nd shot left deltoid swollen and ten 2/12/2009 Immediately after administering, Pt 2/5/2009 2-5-09 mother reports fever 102 deg 2/6/2009 Left thigh- 1/2 dollar sized red rash. 2/12/2009 8x8 cm red, warm to touch. Local re
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2/12/2009 NY 2/12/2009 MO 2/12/2009 MO 2/12/2009 CO 2/12/2009 MO 2/12/2009 VA 2/12/2009 MD 2/12/2009 FL 2/13/2009 AZ 2/13/2009 VA 2/13/2009 FL 2/13/2009 PA 2/13/2009 NY 2/13/2009 NJ 2/13/2009 FL 2/13/2009 WI 2/13/2009 GA 2/13/2009 WA 2/13/2009 OH 2/13/2009 AZ 2/13/2009 NY 2/13/2009 CO 2/13/2009 NC 2/13/2009 TX 2/13/2009 SC 2/13/2009 NJ 2/13/2009 CA 2/13/2009 AL 2/13/2009 NJ 2/13/2009 MO 2/13/2009 CA 2/13/2009 CO 2/13/2009 CT 2/13/2009 CO 2/13/2009 TX 2/13/2009 GA 2/13/2009 NC 2/13/2009 PA 2/13/2009 WI 2/13/2009 CA 2/13/2009 CA 2/13/2009 IN 2/13/2009 KY 2/13/2009 OR 2/13/2009 OR 2/13/2009 GA 2/13/2009 NC 2/13/2009 CT 2/13/2009 CT 2/13/2009 TX 2/13/2009 MO
15 3 2 1.3 1 5 36 10 73 25 22 1 1.5 27 61 1.3 23 60 0.3 8 34 0.7 62 66 5 3 0.3 14 11 0.3 43 1.1 58 13 67 16 1 16 73 53 1.1 1 58 5 61 15 47 5 1.5 67 8
15 3 2 1 0 5 36 10 73 25 22 1 1 27 61 1 23 60 0 8 34 62 66 5 3 0 14 11 0 43 1 13 67 16 1 16 73 53 1 1 58 5 61 15 47 5 1 67 8
M M 0.2 M 0.3 F 1M M F M F F F 0M 0.5 M F M 0.3 F F M 0.3 F M F M F M M M 0.3 M F M 0.3 M F 0.1 M M M F F 0M F F F 0.1 F 0F F F M F F F 0.5 M F F
2/12/2009 Zoster (shingles) developed # days 2/12/2009 Administered FLUMIST with expirat 2/12/2009 Administered FLUMIST with expirat 2/12/2009 None stated 2/11/2009 Rash on chest, back, face, scalp, ar 2/12/2009 Mother reported within 7 minutes of 2/12/2009 ENGERIX B #2 administered at 11 2/11/2009 Had emesis and upset stomach with 2/12/2009 Patient reports she got shingles from 2/9/2009 Patient developed rash on neck, fac 2/12/2009 Information has been received from 2/12/2009 This case was considered medically 2/13/2009 1/14/09 pt received vaccines (Dtap, 2/13/2009 Patient was vaccinated on 1/30/09 a 2/13/2009 PT REPORT RED, BURNING ABDO 2/13/2009 0945: given Varicella/DTaP 1530: 2/13/2009 I received the Gardasil vaccine and 2/13/2009 myalgias, fever, chills, loss of appet 2/13/2009 High pitch shrill cry for 45 minutes (n 2/13/2009 8 year old male received 2nd doe o 2/13/2009 Local injection site reaction to the R 2/13/2009 Within 24 hours of Jeff's first DPT sh 2/13/2009 PATIENTS HUSBAND PRESENTE 2/13/2009 Severe arm pain upper arm, can't lif 2/13/2009 2/5/2009--Back of L arm--upper are 2/13/2009 Mother states he started a fever@ 1 2/13/2009 The child received his second immu 2/13/2009 1st Gardasil vaccination on 2/19/08 2/13/2009 Morning after injection, child woke u 2/13/2009 12/09/08 - patient was administered 2/13/2009 1/14/09 afternoon began chest pain 2/13/2009 TC from State Epidemiologist statin 2/13/2009 4 hours after shot - mild malaise dev 2/13/2009 Diffuse erythematous papular erupt 2/13/2009 Moderate swelling and erythema 2/13/2009 Minutes after vaccine admin., pt. wa 2/13/2009 rash, mildly pruritic chicken pox 2/13/2009 Pt had Px exam 11-25-08. GARDA 2/13/2009 With 4 hours stated arm was the siz 2/12/2009 Patient called and notified that the d 2/11/2009 Brief 1 minute seizure - tonic clonic 2/10/2009 Rash. Mom unsure of onset, but pt. 2/5/2009 Pt. returned to office at 4:00 pm- wit 1/30/2009 Child had Rec'd vaccines in AM and 2/5/2009 Ringing in ears 1 hour post injection 2/6/2009 Redness, swelling to site, itching. (V 2/11/2009 2/15/09 Night of injection L arm bec 2/13/2009 Swelling noticed next day- became 2/13/2009 Swelling a redness noted same eve 2/12/2009 24 hours after shot began headache 2/13/2009 Scattered raised papulovasicular les
339631 339632 339633 339634 339587 339589 339590 339591 339592 339593 339594 339637 339642 339643 339644 339645 339646 339647 339649 339650 339651 339652 339653 339654 339655 339656 339657 339658 339659 339660 339661 339662 339672 339673 339674 339675 339676 339677 339678 339679 339680 339681 339682 339683 339663 339686 339687 339691 339692 339694 339695
2/13/2009 NY 2/13/2009 WA 2/13/2009 WA 2/13/2009 PA 2/14/2009 OR 2/14/2009 NC 2/14/2009 PA 2/14/2009 TX 2/15/2009 PA 2/15/2009 ME 2/16/2009 2/16/2009 2/16/2009 2/16/2009 SC 2/16/2009 SC 2/16/2009 SC 2/16/2009 SC 2/16/2009 IL 2/16/2009 PA 2/16/2009 OH 2/16/2009 NC 2/16/2009 MO 2/16/2009 AZ 2/16/2009 LA 2/16/2009 PA 2/16/2009 LA 2/16/2009 FL 2/16/2009 CA 2/16/2009 2/16/2009 CO 2/16/2009 FL 2/16/2009 WY 2/16/2009 IL 2/16/2009 2/16/2009 SC 2/16/2009 OH 2/16/2009 CA 2/16/2009 WA 2/16/2009 FL 2/16/2009 NY 2/16/2009 KS 2/16/2009 NY 2/16/2009 IN 2/16/2009 AZ 2/17/2009 2/17/2009 2/17/2009 IA 2/17/2009 2/17/2009 NC 2/17/2009 2/17/2009 MI
0.5 41 1.3 1.2 0.3 12 81 0.3 53 20
53 1.8 1.2 5 4 35 4 1 36 17 6 48 78 17 45 14 16 11 0.2 22 1.4
0 41 1 1 0 12 81 0 53 20
1 1 5 4 35 4 1 36 17 6 48 78 17 45 14 11 0 22 1
69 61 8 10 72 1 1 17 18 22 35
69 61 8 10 72 1 1 17 18 22 35
17 5 71 14 17
17 71 14
0.5 M M 0.3 F 0.2 M 0.3 M F M 0.3 F F M U F M 0.8 F 0.2 M M F F M 0F F F F M F F F M F F 0.3 M F 0.4 F F M F M M M 0F 0F F F F F F F M M F F
2/13/2009 8 hours after vaccination, at 7 pm d 2/6/2009 Pt states reoccurrence of Reitens D 2/6/2009 fever w/seizure 24 hours post vaccin 2/5/2009 About 2 weeks after vaccines given 2/14/2009 A few hoursYafter his well child chec 2/14/2009 Patient given 1st dose of Gardasil L 2/14/2009 After Zostavax injection, patient's ar 2/14/2009 She develop a fever, irrability, decre 2/15/2009 24 hours after receiving D/T immuni 2/15/2009 Guillian Barre requiring hospitalizati 2/16/2009 About 2 minutes after the shot I wal 2/12/2009 This serious case was received from 2/9/2009 States after flu injection 9/29/08, pt 9/4/2008 Pt. Rx with VARICELLA on 9-4-08 v ### Few vesicles over trunk x 4 days. 9/19/2008 Mild VARICELLA - few vesicles on t 12/9/2008 Few vesicles on trunk X 3 days Dx 2/9/2009 2/02 5:30PM feet starting itching. 2 2/16/2009 Received vaccines 2/3/09, 2 days la 2/16/2009 Fever started 02/13/09, highest was 2/16/2009 Immediate onset of erythema, prurit 2/16/2009 Headaches starting January 3rd. Na 2/16/2009 Developed Influenza A 2/16/2009 Night after vaccine administered pa 2/16/2009 PATIENT RECIEVED A SUB-Q DO 2/16/2009 Patient received 1st dose of Gardas 2/16/2009 Pt. developed burning, itching rash 2/16/2009 Fever,dizziness & fast heart beat 2/16/2009 My daughter received Gardisil vacci 2/16/2009 Patient experiences severe flushing 2/16/2009 My son has had chronic constipatio 2/16/2009 Fever, headache, nausea, joint pain 2/16/2009 MMR given 1/21/09. Came in with s 2/16/2009 This case was reported by a healthc 2/12/2009 Leg Pain 2/12/2009 Fatigue, myalgia. Episode of tachyc 2/5/2009 Diffuse abdominal pain after first do 2/16/2009 DTap given outside guidelines. Per Fever,chills, weakness, RUQ pain a 2/12/2009 Pink papule on L Tricep Area with w 2/6/2009 Infant had some sinus congestion a 2/16/2009 Pt c/o feeling dizzy after shot. Pt to 2/12/2009 Patient was given two tetanus inject 2/13/2009 Rash. swelling pain @ injection site 2/17/2009 Patient reported pain and swelling a 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/16/2009 Information has been received from 2/16/2009 Information has been received from 2/16/2009 Information has been received throu
339697 339698 339706 339708 339710 339711 339712 339713 339714 339715 339716 339717 339718 339719 339720 339721 339722 339723 339724 339725 339726 339727 339736 339737 339738 339739 339740 340200 340201 340202 340203 340204 340205 340206 340207 340208 340209 340210 340211 340212 340213 340214 340215 340216 340217 340218 340219 340220 340221 339741 339742
2/17/2009 2/17/2009 CA 2/17/2009 2/17/2009 NH 2/17/2009 CA 2/17/2009 WA 2/17/2009 NC 2/17/2009 VA 2/17/2009 NM 2/17/2009 GA 2/17/2009 OR 2/17/2009 FL 2/17/2009 IN 2/17/2009 2/17/2009 ND 2/17/2009 OR 2/17/2009 NC 2/17/2009 IN 2/17/2009 MS 2/17/2009 VA 2/17/2009 SC 2/17/2009 CA 2/17/2009 WI 2/17/2009 FL 2/17/2009 PA 2/17/2009 IN 2/17/2009 VA 2/17/2009 OH 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 KY 2/17/2009 CA 2/17/2009 TX 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 DC 2/17/2009 DC 2/17/2009 AZ 2/17/2009 MO 2/17/2009 MO 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 OH 2/18/2009 IL 2/18/2009 OH
14 18 14 0.5 40 55 65 16 10 0.8 3 79 13 26 5 41 76 13 0.2 68 67 30 1 80 17 1.8 40 30 3 4 4 2.7 5.7 2 3.3 3.2 4 2 2 2 2 3.8 4
14 18
4 2 4 0.4 0.8
4 2 4 0 0
0 40 55 65 16 10 0 3 79 13 26 5 40 75 13 0 68 67 30 1 17 1 40 3 4 4
3 3 4 2 2 2 2 3 4
F F F 0.5 M F F F F F 0.8 M M U F F M M F F 0.2 M F F F 0F F F 0.8 F F F F M F F M F F M F 0F 0.4 M 0U 0.8 F F U U U U M 0F M 0.4 M 0.8 F
2/16/2009 Information has been received from 2/16/2009 Information has been received from 2/15/2009 Information has been received from 2/2/2009 Patient received the three doses of 2/6/2009 Headache, emesis. 2 ED visits. 1/27/2009 (L) arm/hand "pinging" when I tap th 2/11/2009 None 2/12/2009 GARDASIL injection given in left de 1/29/2009 Rt Arm- 6.5X 8cm erythematous, ind 2/11/2009 Patient was seen at the Emergency 2/13/2009 morning after had HEP A shot had b 2/17/2009 pT. STATES GENERALIZED RASH 2/17/2009 Approx 3 weeks after getting 1st se 2/17/2009 Vaccinated during pregnancy. Preg 2/17/2009 Mother called stated that child bega 2/17/2009 Chronic fatigue, difficulty concentrat 2/17/2009 pt contracted shingles 8 months s/p 2/17/2009 Mom states that 4 hours after immu 2/17/2009 He had a high Y fever 4 days after ge 2/17/2009 Red swollen Left arm. Patient came 2/17/2009 Zostavax injection given on 2/10/20 2/17/2009 Observed large reddened area appr 2/17/2009 Erythema multiforme 2/16/2009 Patient developed vesicular rash in 2/17/2009 Patient's mother called 2/17/09 repo 2/17/2009 C/o rash on shoulders, back, (R) sid 2/16/2009 Swelling, pain left index finger mcp 1/23/2009 A non-serious, spontaneous report 1/15/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/21/2009 A non-serious spontaneous report o 1/19/2009 A non-serious spontaneous report o 1/12/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/13/2009 A non-serious, spontaneous report 1/13/2009 A non-serious, spontaneous report 1/7/2009 A non-serious report of "six patients 1/9/2009 A non-serious, spontaneous report 1/9/2009 A non-serious, spontaneous report 1/7/2009 A non-serious report of "six patients 1/8/2009 A spontaneous non-serious report o 1/8/2009 A non-serious spontaneous report o 1/8/2009 A spontaneous non-serious report 1/6/2009 Expired vaccine used Expired drug 1/6/2009 A non-serious spontaneous report o 1/2/2009 A non-serious report of "gave patien Parent went to make f/u apt child no 1/14/2009 Vomiting that started several hours
339743 339744 339745 339747 339748 339749 339750 339751 339752 339753 339754 339755 339756 339757 339758 339759 339760 339761 339762 339763 339764 339765 339766 339767 339768 339769 339770 339771 339772 339773 339774 339775 339776 339777 339778 339779 339780 339781 339782 339783 339784 339785 339786 339787 339788 339789 339790 339792 339795 339796 339797
2/18/2009 MN 2/18/2009 NY 2/18/2009 2/18/2009 CO 2/18/2009 MA 2/18/2009 CA 2/18/2009 IN 2/18/2009 CA 2/18/2009 HI 2/18/2009 TN 2/18/2009 ME 2/18/2009 GA 2/18/2009 NY 2/18/2009 CA 2/18/2009 CA 2/18/2009 NY 2/18/2009 MN 2/18/2009 FL 2/18/2009 OH 2/18/2009 MI 2/18/2009 OR 2/18/2009 IN 2/18/2009 WA 2/18/2009 NJ 2/18/2009 KY 2/18/2009 OH 2/18/2009 WY 2/18/2009 IL 2/18/2009 KY 2/18/2009 UT 2/18/2009 CO 2/18/2009 MD 2/18/2009 TN 2/18/2009 OH 2/18/2009 HI 2/18/2009 CA 2/18/2009 CT 2/18/2009 AL 2/18/2009 IL 2/18/2009 MO 2/18/2009 NY 2/18/2009 PA 2/18/2009 IL 2/18/2009 MA 2/18/2009 VA 2/18/2009 NM 2/18/2009 WV 2/18/2009 WA 2/18/2009 FL 2/18/2009 WI 2/18/2009 TX
24 11 29 22 17 0.4 0.5 1.3 23 0.2 50 11 46 25 18 22 18 73 11 0.2 70 40 1 3 23 38 25 13 0.3 1.3 59 0.5 0.3 34 26 68 53 13 20 67 54 47 42 0.3 0.8 3 26 64 0.2 39 0.3
24 11 29 22 17 0 0 1 23 0 50 11 46 25 18 22 18 73 11 0 70 40 1 3 23 38 25 13 0 1 59 0 0 34 26 68 53 13 20 67 54 47 42 0 0 3 26 64 0 0
F M F F F 0.4 U 0.5 F 0.3 M M 0.2 M F F F F M M F F F 0.2 F M M 0F F F F M F 0.3 M 0.3 M F 0.5 M 0.3 M F F F F F F F M F M 0.3 M 0.8 F M F M 0.2 M M 0.3 F
12/1/2008 Soreness 1/20/2009 11 year boy passed out suddenly af 2/6/2009 Several hours after receiving the va 1/27/2009 Autoimmune-type disorder. Fever, jo 1/29/2009 Immunizations given on 1/12/09 at a Infant was seen 11/12/08 for pulling 1/16/2009 24 hrs after shots had episode of vo 1/28/2009 Convulsions, Shaking, High Fever. 2/10/2009 After receiving the third series of An 1/14/2009 Intussusception - open reduction aft 1/20/2009 Sudden onset arthralgias 12/29/08. ### Pain & swelling to the right deltoid a 1/19/2009 Right after Tdap I started having nu 1/16/2009 Weakness, nausea, tiredness, confu 1/27/2009 Developed Guillain Barre Syndrome 1/22/2009 Chest pain began 4 days after prima 1/15/2009 Pt given GARDASIL vaccine about 1/29/2009 Dead feeling in lower part of body. 1/20/2009 Pt returned to office about 1 hour po 1/20/2009 Baby previously well except noted t 1/20/2009 Headache- intense Flu-like symptom 1/29/2009 Pt suffer very severe local Rxn at si 2/5/2009 Developed petechiae 1/30/09. Diag 1/20/2009 Telephone call from parent - reports 2/9/2009 1/6/09 - Vaccine administered. 1/19 1/19/2009 I had received the Tdap shot in my 2/10/2009 Syncope episode following injection 2/9/2009 She developed Y a pulmonary emboli 2/6/2009 Patient found Y in cardiopulmonary ar 1/20/2009 About one week after shot. Fever 1 2/3/2009 Hospitalization for numbness, pain, 1/12/2009 Pt seen in ER twice for abdominal p 1/12/2009 Intussusception. Required partial co 1/15/2009 Noticed AM 1/15/09 - Right upper a 1/12/2009 Patient vacant 15 minutes after the ### Local area enduration, erythema & 12/1/2008 On 10/24/08 pt. presented to office 1/12/2009 Multiple lesions (>250) on extremitie Approx 10min after injection while s 1/12/2009 After approximately 8 minutes after 1/14/2009 Approx 3 hours after vaccine pt repo 1/13/2009 Achy, Chills, Diarrhea, Malaise follo 1/13/2009 Fever (102 degrees F), severe left a 1/14/2008 Rec'd PENTACEL, PCV7 and Rotav 1/14/2009 Facial flushing & macular rash on th 1/12/2009 Immunizations given on 1/8/09 at ap 1/14/2009 Pt called office and c/o L upper arm 12/23 ZOSTAVAX Received 12/25 1/19/2009 Pt became very irritable Abd pain. 2/17/2009 Information has been received from 1/16/2009 dev. vomiting and diarrhea within 4
339800 339801 339802 339804 339805 339806 339807 339808 339809 339810 339812 339813 339816 339818 339821 339823 339824 339825 339826 339827 339828 339829 339830 339831 339832 339833 339834 339835 339836 339837 339838 339839 339840 339841 339842 339843 339844 339845 339846 339847 339848 339849 339850 339851 339852 339853 339854 339855 339856 339857 339858
2/18/2009 CA 2/18/2009 FL 2/18/2009 IL 2/18/2009 FL 2/18/2009 2/18/2009 NE 2/18/2009 2/18/2009 TN 2/18/2009 MI 2/18/2009 VA 2/18/2009 IL 2/18/2009 NJ 2/18/2009 PA 2/18/2009 CA 2/18/2009 SC 2/18/2009 OR 2/18/2009 ND 2/18/2009 PA 2/18/2009 GA 2/18/2009 PA 2/18/2009 WA 2/18/2009 HI 2/18/2009 MS 2/18/2009 WI 2/18/2009 MA 2/18/2009 FL 2/18/2009 FL 2/18/2009 CA 2/18/2009 GA 2/18/2009 NY 2/18/2009 AL 2/18/2009 IL 2/18/2009 2/18/2009 TN 2/18/2009 MI 2/18/2009 IL 2/18/2009 NE 2/18/2009 CA 2/18/2009 NY 2/18/2009 PA 2/18/2009 NM 2/18/2009 TX 2/18/2009 CA 2/18/2009 CA 2/18/2009 MN 2/18/2009 VA 2/18/2009 GA 2/18/2009 MI 2/18/2009 OR 2/18/2009 WI 2/18/2009 WA
21 0.2 22 44 4 0
21 0 22 44
43 74 68 49 1 14 5 43 1.6 3 17 56 52 54 11 0.2 0.1 1.1 0.4 1.3 1.1 16 35 17 69 24 11
43
82 0 83 62 33 11 1 0.9 30 1.8 62 19 1 68 0.2 10
82 0 82 63 32 11 1 0 30 1 62 19 1 68 0 10
0
68 49 1 14 5 43 1 3 17 56 52 54 11 0 0 1 0 1 1 16 35 17 69 24 11
F 0.2 F F F M 0F M F F F F 0F F F F 0.6 M M F M F F F 0.2 M 0.1 M 0.1 M 0.4 M 0.3 M 0.1 F F M F M M F U M 0F F F M F 0M 0.9 F F 0.8 M F F 0F F 0.2 F F
1/12/2009 Patient complaints of wheezing at n 1/14/2009 Prolonged crying - went to clinic. Se 2/17/2009 Information has been received from 1/11/2009 Received TDAP vaccine 12/29/08 2/17/2009 Information has been received from 1/15/2009 Pt was given Influenza virus vaccine 2/17/2009 Information has been received rega 2/9/2009 Client called my cell phone and left 2/17/2009 Information has been received from 1/15/2009 Started stiff and could not move righ 2/10/2009 Arm became very swollen and red, 2/10/2009 Chicken pox 2/9/2009 Administered HEP A into R deltoid. 2/3/2009 Patient brought back in office by gu 2/2/2009 Patient was given inj f/m PNEUMOV 2/3/2009 1 d after vaccines - on 1/16/09, low 1/22/2009 First influenza vaccine given approx 2/3/2009 Extensive macular rash extending m 2/4/2009 MENACTRA was administered to 56 2/2/2009 Left shoulder discomfort reported 11 3/24/2008 Pt felt tingling in fingers, unable to li 1/31/2009 Increased local redness/swelling wit 1/15/2009 Fever 103.4 and red rash all over ar 1/20/2009 Severe diarrhea after 1st ROTATEQ ### Macular rash c/w RUBELLA. Irritab 1/16/2008 Pt received PREVNAR vaccine 1-14 1/16/2009 fever and rash 1/17/2009 fever 103-104 X 3 days post vaccin ### Within 10 minutes of receiving GAR 2/18/2009 Patient came into the clinic complain 2/18/2009 Approx. 30 minutes after injections 2/18/2009 had 5 weeks of peripheral neuropat 2/18/2009 According to patient he was sufferin 2/18/2009 Red,swollen warm touch left arm 2/1 2/18/2009 Received HPV Vaccine dose #3. D 2/18/2009 On 2/11/09, patient called the health 2/18/2009 a newborn was given an Adacell va 2/18/2009 Bilaterally symmetrical eruption of d 2/18/2009 Client was taking oral Typhoid Feve 2/18/2009 Arm Swollen burned and very hard 2/18/2009 VACCINE GIVEN AT 0915 LD IM W 2/18/2009 on 12/06/08 Mom called provider of 2/18/2009 Baby got vaccine, developed fever i 2/18/2009 After the shot was given I had mild t 2/18/2009 Dtap given right thigh, Hib given left 2/18/2009 noticed spot about the size of a qua 2/18/2009 3rd in the series of Guardasil on 7/2 1/21/2009 Pt was seen 11/16/09 & given VARI 1/16/2009 Received Tdap, influenza and PNEU 1/20/2009 Patient developed severe diarrhea a 1/15/2009 Pt. received Varicella vaccine 1/12/0
339859 339860 339862 339864 339865 339866 339867 339868 339869 339870 339871 339876 339878 339879 339880 339881 339882 339883 339884 339885 339886 339887 339888 339889 339890 339891 339892 339893 339894 339895 339896 339897 339898 339899 339900 339901 339902 339903 339904 339905 339906 339907 339908 339909 339910 339911 339912 339913 339914 339915 339916
2/18/2009 MI 2/18/2009 WI 2/18/2009 CO 2/18/2009 CO 2/18/2009 WA 2/18/2009 IN 2/18/2009 PA 2/18/2009 MI 2/18/2009 PA 2/18/2009 NY 2/18/2009 AZ 2/18/2009 PA 2/18/2009 IN 2/18/2009 HI 2/18/2009 CA 2/18/2009 MD 2/18/2009 NJ 2/18/2009 MI 2/18/2009 TX 2/18/2009 IL 2/18/2009 MD 2/18/2009 TX 2/18/2009 MI 2/18/2009 CA 2/18/2009 MO 2/18/2009 KY 2/18/2009 PA 2/18/2009 ME 2/18/2009 NJ 2/18/2009 NJ 2/18/2009 IA 2/18/2009 NY 2/18/2009 TX 2/18/2009 NY 2/18/2009 SC 2/18/2009 CA 2/18/2009 CA 2/18/2009 FL 2/18/2009 VT 2/18/2009 NC 2/18/2009 NY 2/18/2009 PA 2/18/2009 OH 2/18/2009 MD 2/18/2009 CA 2/18/2009 VA 2/18/2009 NV 2/18/2009 2/18/2009 AZ 2/18/2009 MO 2/18/2009 CA
1 1 34 1 35 1 1.5 4 1.5 4 4 28 24 32 3 15 12 0.3 0.3 17 1
1 1 34 1 35 0 1 4 1 4 4 28 24 32 3 15 12 0 0 17 1
1.6 1.2 34 4 0.2 1.6 6 6 0.5 8 0.3 4 0.5 14 17 4 1.2 65 61 1 4 9 1.9 22 2 1.6 1.3 66 31
1 1 34 4 0 1 6 6 0 8 0 4 0 14 17 4 1 65 61 1 4 9 1 22 2 1 1 66 31
0M 0M F 0F F 1M 0.5 F M 0.5 M F M F F M F F M 0.3 M 0.3 M F 0F M 0.6 M 0.2 F U F 0.2 M 0.6 F F F 0.5 M M 0.3 M M 0.5 F M F F 0.2 F F F 0M U F 0.9 F F 0.4 M 0.6 F 0.3 M M F
2/9/2009 Patient was vaccinated on 1/22/09 ( Rash-12-16 scattered red pin point 2/6/2009 Received MMR#2 2/2/09 woke 2/3/0 4 hours after having 3 vaccines (VA ### Pt's husband called for help Pt foun 2/2/2009 Pt had imm around 4:30PM. Went h 2/4/2009 Febrile seizure. 1/12/2009 None stated 2/4/2009 Febrile seizure. 1/27/2009 RT. arm red swollen - Hot to touch ### Fever of 104 and higher for seven d 2/13/2009 Initial report received on 02 June 20 1/12/2009 Left deltoid pain at injection general 2/18/2009 Pt waited 10 min after receiving YF2/18/2009 Dose #1 J-VAX given 2/10/09 (1cc g 2/19/2009 Given 1st GARDASIL 1/7/09 at rout Received Flu and MENACTRA 10/3 12/8/2008 4 hours post administration infant ve 1/13/2009 Maternal grandmother described sta 2/18/2009 Vaccine given 1/2/09 symptoms beg ### Infant began staring & jerking involu 2/12/2009 The evening after receiving the vacc 1/13/2009 Left thigh swollen upper thigh to me 2/18/2009 Patient received vaccines on 01/23/ Phone call received from family mem 1/14/2009 Vaccines 1/5/9 no problems. 1/6/9 1/14/2009 Patient received PENTACEL injectio 1/14/2009 MMR given R upper arm - minutes l 1/12/2009 Patient received HEP B3 vaccine on 1/12/2009 Patient received HEP B vaccine on 1/15/2009 1) Rash within 24 hrs. Started on le 1/23/2009 Generalized lesions head to toe-not 1/21/2009 Induration and redness over (L) leg 1/23/2009 redness and swelling of right upper 1/20/2009 PENTECEL given right thigh in am 1 2/18/2009 Patient fainted after receiving vaccin 2/17/2009 Patient was given vaccine. Approxim 2/18/2009 Severe right deltoid pain and swellin Intermittent fever and maculopapula 2/18/2009 Pt received a PNEUMOVAX on 2/17 2/18/2009 Pain, swelling, itching, rash, warmth 1/23/2009 Varicella vaccine breakthrough. Dia 2/18/2009 At 48 hours had 3" diameter celluliti 1/19/2009 Wheezing started within 10-15 min a 1/22/2009 Pt is brought by Mom, had vaccinat 1/16/2009 R cervical lymph swelling/tendernes 1/16/2009 12 x 10 cm lesion R thigh around sh 1/22/2009 Pt has dime size swelling and tende 1/23/2009 Hives at injection site, gave BENAD 12/5/2008 Pt c/o shock like sensations in his (L 1/30/2009 Large redness area (4 1/2 inches x
339917 339918 339919 339920 339921 339922 339923 339924 339925 339926 339927 339928 339929 339930 339931 339932 339933 339934 339935 339936 339937 339938 339939 339940 339941 339942 339943 339944 339945 339946 339947 339948 339949 339950 339952 339953 339954 339955 339956 339957 339958 339959 339960 339961 339962 339963 339964 339965 339966 339967 339968
2/18/2009 HI 2/18/2009 PA 2/18/2009 IL 2/18/2009 CA 2/18/2009 MO 2/18/2009 NY 2/18/2009 2/18/2009 DC 2/18/2009 PA 2/18/2009 WA 2/18/2009 PA 2/18/2009 KS 2/18/2009 PA 2/18/2009 OH 2/18/2009 SC 2/18/2009 NJ 2/18/2009 NY 2/18/2009 NY 2/18/2009 NY 2/18/2009 MT 2/18/2009 2/18/2009 NY 2/18/2009 OK 2/18/2009 CO 2/18/2009 PA 2/18/2009 OR 2/18/2009 CA 2/18/2009 NJ 2/18/2009 MA 2/18/2009 CA 2/18/2009 NH 2/18/2009 NH 2/18/2009 NM 2/18/2009 NY 2/18/2009 WI 2/18/2009 MN 2/18/2009 MS 2/18/2009 SC 2/18/2009 TX 2/18/2009 MO 2/18/2009 MN 2/18/2009 PA 2/18/2009 OR 2/18/2009 PA 2/18/2009 MO 2/18/2009 TX 2/18/2009 CA 2/18/2009 FL 2/18/2009 AZ 2/18/2009 AZ 2/18/2009 VT
0.2 9 21 72 71 0.7 21 38 13 6 22 28 1.7 12 12.9 58 49 0.8 49 59 49 1.1 64 4 19 11 0.6 37 6 10 12 10 29 8 15 69 38 16 40 61 9 32 24 68 5 4 69 4 18 12 4
0 9 21 72 71 0 21 38 13 6 22 28 12 12 58 49 0 49 59 49 1 64 4 19 11 0 37 6 10 12 10 29 8 15 69 38 16 40 61 9 32 24 68 5 4 69 4 18 12 4
0.2 M F M F F 0.7 F M F M F F M M F F F F 0.8 F F F F 0.1 F F F F F 0.6 F F F F F F F M F F M F F F M F F M M F F M F F M
1/20/2009 At 2 months old patient received va ### 2 day history of rash prior to presen ### Had immunization at 12:15 pm on T ### weakness-fell to the ground stomac 1/13/2009 Noted 2" diameter, slightly elevated 1/27/2009 Child became limp and unresponsiv 1/27/2009 Developed Ulcerative Colitis after A 1/27/2009 She states she was well at the time 1/23/2009 6 X 4 induration, pain on LT arm co 1/26/2009 Vaccine administered on 1/23/09 - O 1/23/2009 Vaccine given 1-12-09. Pt complain 1/22/2009 Rash on (R) deltoid, fever, swelling 1/26/2009 Red DTG bump on L legs. Shot 2 d 1/23/2009 Urticarial rash - generalized RX - BE 1/19/2009 Approx 5 hours after injection, pt c/o 1/13/2009 According to pt several hrs after inje 1/21/2009 Increasing redness, itching + swellin 1/9/2009 HEP A vaccine given to a patient un 1/23/2009 Right arm became very painful, una 1/23/2009 Felt like touch of flu- woke up with h 1/22/2009 3 days after receiving tetanus shot1/23/2009 Dev'd rash that spread over body an 1/22/2009 Pt reports redness and swelling. It r 1/8/2009 None stated 1/22/2009 Developed Rheumatoid Arthritis-- P 2/6/2009 Client fainted approximately 5 min a 2/6/2009 Woke up with a full body rash and fe 1/16/2009 Had flu shot 1/12/09. Also, exposed 1/26/2009 Low grade fever, symmetric erythem 1/29/2009 Chronic Headache (Migraine) 1/23/2009 1/21/09 woke in AM with redness si 1/23/2009 VARIVAX administered 1/21/2009 R 1/26/2009 C/O pain, redness, inability to perfo 2/5/2009 Patient is on STRATTERA. Mother 1/30/2009 The phone call from Pt's mother sta Bell's palsy 4/08 and 12/08 (Not cer 12/5/2008 Developed hives (urticaria) in under 2/3/2009 Onset severe bilateral knee pain, sp 2/5/2009 Pt c/o rash 3 weeks after injection. 1/21/2009 1/20/09 Client called to report 1/15 a 1/20/2009 No adverse reaction known 2/3/2009 Onset redness, swelling, discomfort 1/21/2009 One day after receiving injection pa 2/7/2009 Sicker than usual, cold or pains afte 2/4/2009 The evening of the vaccines child st 1/22/2009 Localized swelling and redness to in 1/22/2009 Patient developed redness & swellin 1/22/2009 Erythema & swelling @ injection site 1/22/2009 Syncope 3/3/09-records received-br 1/22/2009 Syncope 1/19/2009 Patient developed itchy rash minute
339969 339970 339971 339972 339973 339974 339975 339976 339977 339978 339979 339980 339981 339982 339984 339985 339986 339987 339988 339989 339990 339991 339992 339993 339994 339995 339996 339997 339998 339999 340000 340002 340005 340011 340021 340023 340026 340030 340031 340032 340033 340038 340039 340041 340045 340048 340054 340056 340057 340059 340060
2/18/2009 AK 2/18/2009 NY 2/18/2009 NE 2/18/2009 WA 2/18/2009 PA 2/18/2009 MA 2/18/2009 TX 2/18/2009 TN 2/18/2009 DE 2/18/2009 VA 2/18/2009 ME 2/18/2009 TX 2/18/2009 FL 2/18/2009 NE 2/18/2009 NC 2/18/2009 VA 2/18/2009 WA 2/18/2009 2/18/2009 ID 2/18/2009 DC 2/18/2009 WA 2/18/2009 PA 2/18/2009 FL 2/18/2009 WA 2/18/2009 AZ 2/18/2009 MO 2/18/2009 VA 2/18/2009 MN 2/18/2009 GA 2/18/2009 OK 2/18/2009 OK 2/18/2009 IL 2/18/2009 GA 2/18/2009 MO 2/18/2009 NJ 2/18/2009 NV 2/18/2009 NV 2/18/2009 AK 2/18/2009 SC 2/18/2009 ME 2/18/2009 WI 2/18/2009 2/18/2009 2/18/2009 CA 2/18/2009 WA 2/18/2009 FL 2/18/2009 NJ 2/18/2009 NY 2/18/2009 WA 2/18/2009 MA 2/18/2009 TN
0.2 1 17 1.1 1.6 5 0.5 0.4 68 0.5 55 63 67 33 4 51 74 21 33 32 4 79 4 64 45 17 59 56 17 25 0.4 8 30 10 1.6 5 44 4 18 10 1.5 1.3 15 1 4 6 1.9 71 0.2
0 1 1 1 5 0 0 68 0 55 63 67 33 4 51 74 21 33 32 4 79 4 64 45 17 59 56 17 25 0 8 30 10 1 5 44 4 18 10 1 1 1 15 1 6 1 71 0
0.2 M 0F F 0.1 M 0.6 F M 0.5 F 0.4 F F 0.5 F F F F F F F M M F F M F U F F F F F F F F 0.4 F M F F 0.6 F F F M F F 0.5 F 0F 0.3 M M 0M F F 0.9 F F 0.2 F
2/11/2009 1 hr after screamed. 5 1/2 hrs. after 1/19/2008 Dermatomial shingles left side T 3-6 1/27/2009 Flushed fatigue chills fever - flu- like 2/11/2009 high fever x 3 nights (night only) (hig 1/17/2009 Onset of high fever, irritable beginni 2/7/2009 The day after the immunization was 2/12/2009 Patient was diagnosed with rotaviru 1/13/2009 About 4 hours after immunization, h 2/9/2009 Cellulitis in (R) arm. 2/10/2009 "Low grade " temp 2/9/09 in PM. 2/1 2/9/2009 2/4/09 Discomfort in (L) arm - 2/6/09 2/9/2009 Patient called 24 hours after immun Shingles itchy leaky rash on left side 2/11/2009 Had Td and influenza vaccine on 2/ 2/6/2009 Swelling, redness and itching aroun 2/13/2009 "Bad" headache, fatigue, general fu 2/9/2009 Fever, temperature of 100.0 degree 1/23/2009 Rash on arms, legs, hands, &* feet. 2/7/2009 Symptoms stated within 24 hrs. of th 11/3/2007 Sinus & nasal congestion & pressur 2/11/2009 None at this time 2/12/2009 7:45 P.M. shortly after the injection Hives @ injection site, raised, red, h 2/12/2009 12 cm red area, slightly raised, firm, 2/10/2009 L Arm pain radiating to the neck. Pt 2/13/2009 Shortly after vaccination c/o being li Breathing problems -mucus spitting 2/12/2009 First dizzy, increased blood pressur 2/10/2009 9:25 - TWINRIX + TDAP given 9:35 1/21/2009 On 8/5/08 pt rec'd HPV-4. On 1/12/0 2/4/2009 c/o pain numbness going down L ar ### Approximately 24 hours after vaccin 2/4/2009 Pt developed symptoms of chickenp 2/6/2009 Pt stated she felt faint, nauseated, s 2/4/2009 Child developed varicella on 2/4/200 2/2/2009 PREVNAR 1/28 - Next AM, thigh vis 2/16/2009 2 days after DTaP and VARIVAX in 2/10/2009 Patient stated she has had pain in h 2/11/2009 (L) Thigh swelled within hrs of recei 2/11/2009 Developed blurry vision within 24 h 1/30/2009 Arm began itching in area of vaccin 2/6/2009 Pt had immunization 2-3-09 and wa 1/28/2009 Within 4 hrs of receiving MMR/VZV/ 1/30/2009 Received DTaP at 2:30 pm. Per cal 1/30/2009 C/o arm + generally hot feeling well 1/27/2009 Pt had VARIVAX immunization on 6 1/26/2009 Severe local reaction with 15 cm are 1/29/2009 Mom said child had redness and are 2/3/2009 R Lat, post thigh with mild erythema 1/29/2009 red edematous rash cheek & peri or 2/6/2009 Awoke from nap this p.m. screaming
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2/18/2009 AZ 2/18/2009 ME 2/18/2009 IN 2/18/2009 AZ 2/18/2009 GA 2/18/2009 CA 2/18/2009 IN 2/18/2009 PA 2/18/2009 2/18/2009 OK 2/18/2009 NV 2/18/2009 MD 2/18/2009 NE 2/18/2009 GA 2/18/2009 NC 2/18/2009 WI 2/18/2009 IN 2/18/2009 PA 2/18/2009 AL 2/18/2009 2/18/2009 2/18/2009 FL 2/18/2009 PA 2/18/2009 MN 2/18/2009 WY 2/18/2009 WI 2/18/2009 TN 2/18/2009 TN 2/18/2009 CT 2/18/2009 WI 2/18/2009 WA 2/18/2009 TX 2/18/2009 CA 2/18/2009 VA 2/18/2009 2/18/2009 VA 2/18/2009 2/18/2009 WA 2/18/2009 2/18/2009 2/18/2009 CA 2/18/2009 MD 2/18/2009 2/18/2009 2/18/2009 IN 2/18/2009 2/18/2009 NJ 2/18/2009 CT 2/18/2009 MA 2/18/2009 IL 2/18/2009 CO
64 24 25 33 12 0.4 17 10 16 24 9 34 1 1.5 1.3 3 5 0.4 0.2 0.2
24 25 33 12 0 17 10 15 24 9 34 1 1 1 3 5 0 0
1.9 0.3 2
0
0.2 0.3 1.3
0
0.2 0.7
16
16
11 11
11
26 15 18
26 15
21
21
F F M F M 0.4 M M F M F F F 0F 0.5 M 0.3 F M M 0.4 F 0.2 M U U F 0.3 M M F U 0.2 F M U U F U U U U U F F F F F F F F F U F F F U F
2/13/2009 Redness at site, size of apple swelli 2/10/2009 She developed varicella rash on tru 1/29/2009 tender quarter size area left ECU te 2/10/2009 Immunization was received at 10:45 2/12/2009 2 days after vaccine developed feve 2/11/2009 Rt ear red/swollen Rt injection site s 2/11/2009 Patient became nauseous, lighthea 1/29/2009 Within 24 hrs had pain, swelling, low 2/11/2009 2/4/2009 body aches, headache, fe 2/3/2009 She got a little light headed and sick 2/2/2009 1/26 VARIVAX. That night after sho 1/29/2009 Pt to ER c/o reaction to Varicella va 2/2/2009 (1/26) Subq VARIVAX given Rt lowe 1/29/2009 101 degree fever - 2 hrs after shots 2/2/2009 N/A 2/2/2009 Around 10:00 AM - Fri morning - Ha 1/16/2009 Pt. received his vaccines and when 1/27/2009 Administration site with vesicular les 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received form 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information hs been received from a 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
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2/18/2009 NC 2/18/2009 2/18/2009 2/18/2009 2/18/2009 CT 2/18/2009 TX 2/18/2009 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 VA 2/18/2009 OH 2/18/2009 MO 2/18/2009 MO 2/18/2009 VA 2/18/2009 2/18/2009 TX 2/18/2009 2/18/2009 2/18/2009 2/18/2009 NM 2/18/2009 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 MA 2/18/2009 MO 2/18/2009 PA 2/18/2009 VA 2/18/2009 FL 2/18/2009 2/18/2009 OH 2/18/2009 FL 2/18/2009 OH 2/18/2009 KY 2/18/2009 OH 2/18/2009 CA 2/18/2009 AZ 2/18/2009 KS 2/18/2009 CA 2/18/2009 TN 2/18/2009 2/18/2009 NJ 2/18/2009 PA 2/18/2009 MA 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 FL 2/18/2009 OH 2/18/2009
13
13
14 18 16 22 22 17 23 18 16 18 11 48 26
14 18 16
14 18 15
23
18 11
18 15
12 18 14 16
12
14 19 23
14
19 18 13
19
12 13 15 18 14
12 13 15
16 20
20
18 16 17 21 23 12 14
17 21 23 12
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F U F F F F F F F F
2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/12/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
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2/18/2009 CA 2/18/2009 AL 2/18/2009 2/18/2009 MA 2/18/2009 TN 2/18/2009 CO 2/18/2009 2/18/2009 CA 2/18/2009 2/18/2009 KY 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 2/18/2009 WV 2/18/2009 TX 2/18/2009 NY 2/18/2009 2/18/2009 2/18/2009 2/18/2009 2/18/2009 2/18/2009 OK 2/18/2009 OK 2/18/2009 2/18/2009 RI 2/18/2009 2/18/2009 GA 2/18/2009 2/18/2009 NC 2/18/2009 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 2/18/2009 NJ 2/18/2009 2/18/2009 TX 2/18/2009 2/18/2009 KY 2/18/2009 2/18/2009 CA 2/18/2009 MA 2/18/2009 NC 2/18/2009 VA 2/18/2009 2/18/2009 VA 2/18/2009 2/18/2009 AL 2/18/2009 IL 2/18/2009 NY
14 22 19 9 25
22 19 9
16 14
16 14
17 19
17 19
1.3 12 13 20
12 20
19 16 19
18
20 19 23 22 16 15
16 15
17
17
14 15 26 14 17 19 25 18 19
18
26 17 19 25 18 19
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2/18/2009 2/18/2009 NY 2/18/2009 2/18/2009 CA 2/18/2009 AR 2/18/2009 NJ 2/18/2009 TX 2/18/2009 NY 2/18/2009 2/18/2009 MI 2/18/2009 PA 2/18/2009 NE 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 2/18/2009 NY 2/18/2009 AZ 2/18/2009 TN 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 AZ 2/18/2009 MO 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 CO 2/18/2009 NM 2/18/2009 2/18/2009 OH 2/18/2009 IN 2/18/2009 OH 2/18/2009 2/18/2009 UT 2/18/2009 MA 2/18/2009 2/18/2009 CA 2/18/2009 IL 2/18/2009 LA 2/18/2009 VA 2/18/2009 MA 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 OH 2/18/2009 2/18/2009 AZ
25 15
13 20 23 43 15
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14 13 21 17
17
21 19 16 17
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15 15 17 16 45 22 13 15 10 14 18 24 16 17 18 24 17 16 11
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27 12
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2/18/2009 VA 2/18/2009 PA 2/18/2009 OH 2/18/2009 PA 2/18/2009 2/18/2009 MN 2/18/2009 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 HI 2/18/2009 PA 2/18/2009 GA 2/19/2009 IL 2/19/2009 WA 2/19/2009 PA 2/19/2009 UT 2/19/2009 NJ 2/19/2009 IL 2/19/2009 VA 2/19/2009 WA 2/19/2009 MN 2/19/2009 CA 2/19/2009 MA 2/19/2009 HI 2/19/2009 GA 2/19/2009 CA 2/19/2009 UT 2/19/2009 CA 2/19/2009 OH 2/19/2009 IL 2/19/2009 MN 2/19/2009 NY 2/19/2009 SC 2/19/2009 IL 2/19/2009 MO 2/19/2009 WA 2/19/2009 PA 2/19/2009 NJ 2/19/2009 WI 2/19/2009 WV 2/19/2009 PA 2/19/2009 OH 2/19/2009 NC 2/19/2009 ME 2/19/2009 PA 2/19/2009 NY 2/19/2009 NC 2/19/2009 NJ 2/19/2009 WA
12 17 21 26 16 16 19 24 23 26
17 21 26 16 19 24 23 26
23 17 25 1 22 80 45 34 0.6 45 1
23 17
0.2 64 0.6 27 0.6 0.6 17 1.1 5 1.3 11 1.3 1.3 18 1.2
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58 34 15 16 0.4 74 62 58 60 67 11 51
1 22 80 45 34 0 45 1
0 17 1 4 1 11 1 1 18 1 65 58 34 15 16 0 74 62 58 60 67 11 51
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2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Initial and follow up information has 2/13/2009 Information has been received throu 2/13/2009 Information has been received from 2/13/2009 Information has been received throu 2/5/2009 10 days after vaccinations, he deve Rash, shortness of breath. Rx- BEN Patient received vaccine 01/19/09 ( 2/4/2009 - Hives reported - symptoms of Brac 2/4/2009 102 degree fever, chills, body ache, 2/6/2009 Vaccine was given 1/30/09-same da 1/30/2009 9 cm x 10 cm erythematous plaque, 1/26/2009 Quarter sized swelling @ injection s I had a tetanus shot in my right arm 1/22/2009 Within 5-10 min of giving immunizat 1/23/2009 Pt reported coldness, stiffness, chill 1/26/2009 Developed hives approximately 12h 1/27/2009 1/21/09 pm fever, hot to touch, pain 1/12/2009 Given TDAP instead of DTAP 1/29/2009 fever, seizure like activity 1/28/2009 Gave vaccines, pt. was nervous, I le 1/28/2009 patient received vaccines on 1-16-0 1/29/2009 Upper arm with erythema, length of 1/28/2009 high temp 103.5 degree F X 48 deg 2/12/2009 Local inflammatory reaction to right Pt had an onset of facial rash & rash 1/22/2009 Seizure with fever - suspicious CT 1/6/2009 Reported rash on (R) side of face a 1/19/2009 Shingles- TX: BENADRYL TYLENO 2/6/2009 Administered vaccine to patient. Pa 1/22/2009 Initial report received on 16 January 1/26/2009 Numbness in right thumb that rapidl 1/28/2009 Pt had brief near syncopal episode 1/30/2009 Vomited x 2 since midnight. Fever to 2/2/2009 Influenza vaccine given to child less 1/29/2009 Erythematous, tender to palpitation. 1/30/2009 Tired, chills, nausea, sore at inj site 2/2/2008 Positive local cellulitis (L) deltoid tre 1/30/2009 Received ZOSTAVAX 1/27/09. 1/30 2/2/2009 Redness, tenderness, and warmth @ 1/28/2009 Site of immunization red, swollen, te 2/3/2009 Since receiving Tdap pt. had fever,
340058 340061 340062 340065 340073 340076 340078 340079 340091 340092 340098 340099 340100 340101 340102 340103 340104 340105 340106 340108 340110 340111 340112 340113 340114 340115 340117 340118 340119 340120 340121 340122 340123 340124 340125 340126 340127 340128 340130 340133 340135 340136 340137 340138 340139 340140 340141 340142 340143 340144 340145
2/19/2009 CO 2/19/2009 AZ 2/19/2009 FL 2/19/2009 PA 2/19/2009 LA 2/19/2009 WI 2/19/2009 OH 2/19/2009 CA 2/19/2009 2/19/2009 MO 2/19/2009 MD 2/19/2009 FL 2/19/2009 PA 2/19/2009 WI 2/19/2009 2/19/2009 PA 2/19/2009 CT 2/19/2009 OH 2/19/2009 KY 2/19/2009 NY 2/19/2009 IN 2/19/2009 NH 2/19/2009 CO 2/19/2009 TX 2/19/2009 MD 2/19/2009 MD 2/19/2009 FL 2/19/2009 IL 2/19/2009 OH 2/19/2009 GA 2/19/2009 PA 2/19/2009 VA 2/19/2009 WA 2/19/2009 WA 2/19/2009 WA 2/19/2009 MI 2/19/2009 AZ 2/19/2009 TX 2/19/2009 CA 2/19/2009 2/19/2009 2/19/2009 TX 2/19/2009 TX 2/19/2009 IN 2/19/2009 WA 2/19/2009 CA 2/19/2009 CA 2/19/2009 IA 2/19/2009 IL 2/19/2009 MO 2/19/2009 CA
4 72 12 9 0.2 49 2 17
4 72 12 9 0 49 2 17
33 66 1.9 51 69 0.8 0.2 10 4 38 19 13 18 6 22 64 0.2 22 16 56 84 54 1.8 1.8 2 62 7 0.5
33 65 1 51 69 0 0 10 4 38 19 13 18 6 22 64 0 22 16 56 84 54 1 1 2 62 7 0
68 56
68 56 -1 23 17 3 14 1 1 1 1 1
23 17 3 14 1.1 1.5 1.5 1.1 1.1
F F F F 0.2 M F 0.5 F F U U M F 0.9 M F F 0.8 F 0.2 M M M F M M U F F F 0.2 M M F F M F 0.8 F 0.8 M 0.1 F F M 0.5 F U F F 0.2 M F M M M 0.1 F 0.5 M 0.5 M 0.1 F 0.1 M
1/30/2009 Redness, edema, itchiness @ site o 1/28/2009 Itchy. Red - warm area 2 days and g 2/1/2009 Became dizzy while walking , fainte 2/2/2009 Light headed, heart racing, palpitati Parent states the child had diarrhea 2/2/2009 2/2/09 TC from client states "upper Patient with swelling, induration, wa 1/21/2009 Pt had syncope within 3 min, fell to 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/11/2009 2/2/09 11 PM Tongue "thick and ha 2/1/2009 Received ZOSTAVAX - on 9/17/08 2/14/2009 Ataxic gait on 12/3/08, Flu vaccine 2/16/2009 Patient developed sore right arm the 2/3/2009 Pt. received ZOSTAVAX on 01/06/2 2/13/2009 Pt developed urticaria (Hives) within 2/12/2009 Vaccine @ approx 2 pm, slept for 6 2/17/2009 Patient was given Hepatitis A and V 2/13/2009 After getting 4 y/o shots, 1 day post 2/19/2009 Lt deltoid area of vaccine MIN local 2/19/2009 Generalized Vaccinia characterized 2/19/2009 Patient has been running a fever up 2/19/2009 Nausea, headaches, frequent illnes 2/19/2009 Patient developed temperature of 1 2/19/2009 February 17 started to get a papula 2/19/2009 Per TC from pt: sx's began 2-17-09 2/19/2009 Fever of 102.5 one hour after the D 2/19/2009 That night( 2/12/09) he was shiverin 2/19/2009 Two weeks before Thanksgiving, m 2/19/2009 malaise, headache, right earache, le 2/19/2009 Patient lost his hair- all of it over the 2/19/2009 Left arm pain - stiff after receiving va 2/19/2009 0 reaction-Pt received Fluzone MDV 2/19/2009 0 reaction - Pt received Tdap instea 2/19/2009 0 reaction- Pt received Fluzone MD 2/19/2009 Patient called and questioned soren 2/19/2009 Right arm swollen and tender and h 2/19/2009 Family noticed onset of partial seizu 2/19/2009 slept all day after receiving vaccines 2/19/2009 We received the following informatio 2/19/2009 This case was reported by a lawyer 2/19/2009 This case was reported by a healthc 2/19/2009 This case was reported by a healthc 2/17/2009 Rash on abdomen and spread to ba 2/18/2009 None 2/19/2009 Erythema and swelling at site, Dors 2/19/2009 Rash fever all over body 10 days af 2/19/2009 Rash - Hive like. Swollen Rt leg - re 2/19/2009 Onset of chicken pox disease on 22/19/2009 Patient developed #3 1-2 mm papul 2/18/2009 None stated. 7/7/09 Medical record
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2/19/2009 IL 2/19/2009 OH 2/19/2009 TX 2/19/2009 MI 2/19/2009 VA 2/19/2009 2/19/2009 KS 2/20/2009 WA 2/20/2009 2/20/2009 NM 2/20/2009 MA 2/20/2009 AR 2/20/2009 NY 2/20/2009 FL 2/20/2009 FL 2/20/2009 FL 2/20/2009 WV 2/20/2009 PA 2/20/2009 NY 2/20/2009 NC 2/20/2009 NC 2/20/2009 MD 2/20/2009 MD 2/20/2009 MD 2/20/2009 MD 2/20/2009 NE 2/20/2009 OH 2/20/2009 ME 2/20/2009 NY 2/20/2009 VA 2/20/2009 WI 2/20/2009 IN 2/20/2009 SD 2/20/2009 2/20/2009 WI 2/20/2009 AR 2/20/2009 OH 2/20/2009 KY 2/20/2009 WI 2/20/2009 SC 2/20/2009 CO 2/20/2009 WI 2/20/2009 IL 2/20/2009 DE 2/20/2009 VA 2/20/2009 IN 2/20/2009 VI 2/20/2009 IL 2/20/2009 KS 2/20/2009 CO 2/20/2009 FL
23 0.5 32 14 0.8 41 51 32 19 0.4 18 0.5 1.3 26 4 4 39 74 41 21 18 21 17 48 0.2 47 0.3 50 5 74 61 19 61 1.1 47 27 43 32 4 50 29 5 14 14 24 17 37 16 43
23 0 32 14 0 41 51
0 18 0 1 26 4 4 39 41 21 18 21 17 48 0 47 0 50 5 74 61 19 61 1 47 27 43 32 4 50 29 5 14 14 24 17 37 16 43
F 0.5 M U M 0.8 M F M M F F 0.4 M F 0.5 M 0.3 M M F F F F F F M F M M F 0.2 M F 0.3 F F M F M M U 0.1 F F F M M M F M F F F F F F F F
2/18/2009 On 2-19-09 donor reported a rash s 2/16/2009 High fever reported by parent to be 2/19/2009 Multiple erythematous vesiculopapu 2/18/2009 Pt was give 1 dose of MENACTRA ### On 15 Oct 2008 his mother brought ### developed bilateral red eyes, itching ### I received 3 AVA vaccinations in 20 2/19/2009 Information has been received from 2/19/2009 Information has been received from 2/19/2009 Information has been received from 2/19/2009 None stated. Y 7/20/09 Autopsy repor 2/6/2009 Paralysis - entire body - breathing o 2/10/2009 Admitted to hospital 2/6/9 for intuss 2/20/2009 Thursday Feb. 5, 2009 fever 102- C 2/20/2009 Red pruritic rash encircling entire ba 2/20/2009 Fever, chills, muscle aches. Redness & warmth of left thigh whe 2/20/2009 Hives on inner thighs and lower bac 2/20/2009 Dizziness, tight chest, hives, and dif 2/15/2009 Nauseated, extremely cold chills, di 2/16/2009 12:15 - Pt in today for yellow fever a 2/17/2009 Pt received FLUMIST on 10-8-08, b 2/17/2009 Pt received FLUMIST on 10-9-08, b 2/17/2009 Pt received FLUMIST on 10-8-08, b 2/17/2009 Patient received FLUMIST on 10-91/12/2009 Had flu shot in Oct - (first shot ever 2/4/2009 5 hrs of unconsolable crying, poor fe 2/12/2009 Right deltoid has 2cm annular red in 2/16/2009 high pitch cry after PENTACEL vacc 2/13/2009 3-4 hours after Vaccine given patien 2/13/2009 Was given MMR & DTAP into left de 2/16/2009 Patient called the pharmacy with co 2/15/2009 I received the shingles vaccine 7-07 2/8/2009 Chest Pain got the shot on Jan 7-09- my arm ac 2/9/2009 Mother reports child with facial swel 2/13/2009 Swelling/redness/warmth of (R) arm 2/19/2009 Following 15 min. Wait after Hep B 2/18/2009 Red, warm area longer than palm si 2/17/2009 Patient complained of severe body 2/14/2009 24 hr after injection, itching L deltoid 2/13/2009 developed raised, red area at inject 2/20/2009 High fever (103.6), sweats, chills, m 2/20/2009 The Flu Vaccine was administered a 2/20/2009 the day after the vaccine was given 2/20/2009 Vomiting, headache and achy, a few 2/20/2009 patient states she had itchy, red spo 2/20/2009 Patient was given 4 vaccines on 2/1 2/20/2009 Reported observing redness and sw 2/20/2009 Patient C/O of headache, swelling r 2/20/2009 FINE RED RASH ON UPPER TRUN
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2/20/2009 MI 2/20/2009 CA 2/20/2009 PA 2/20/2009 NY 2/20/2009 HI 2/20/2009 NY 2/20/2009 NH 2/20/2009 NY 2/20/2009 LA 2/20/2009 CA 2/20/2009 GA 2/20/2009 MI 2/20/2009 NY 2/20/2009 WA 2/20/2009 FL 2/20/2009 PA 2/20/2009 CA 2/20/2009 UT 2/20/2009 2/20/2009 CA 2/20/2009 CA 2/20/2009 VA 2/20/2009 CA 2/20/2009 2/20/2009 AZ 2/20/2009 MS 2/20/2009 MO 2/20/2009 CA 2/20/2009 IL 2/20/2009 VA 2/20/2009 FL 2/20/2009 NC 2/20/2009 MI 2/20/2009 FL 2/20/2009 CA 2/20/2009 CA 2/20/2009 MI 2/20/2009 IL 2/20/2009 OH 2/20/2009 OH 2/20/2009 TN 2/21/2009 OR 2/21/2009 OR 2/21/2009 CO 2/21/2009 NC 2/21/2009 MI 2/21/2009 FL 2/21/2009 NE 2/21/2009 OR 2/21/2009 MD 2/21/2009 TX
1.3 11 0.2 38 33 21 2 4 4 8 66 0.2 35 49 4 16 10 11 30 0.3 14 61 4 60 29 18 4 77 29 1.3 67 8 73 2 11 5 62 0.2 1.5 1.6 47 5 0.2 26 1 0.2 47 67 0.3 4 33
1 11 0 38 32 21 2 4 4 8 66 0 36 0 0 15 10 11 30 0 14 61 4 60 29 18 4 77 1 67 8 73 2 11 5 62 0 1 1 47 5 0 26 1 0 47 67 0 4 33
0.3 M F 0.2 F M M F 0.2 M F M M F 0.2 M F 0F 0F F M F F 0.3 M M M F F F F F F U 0.3 F F M F 0.2 M M F M 0.2 F 0.5 M 0.6 M F M 0.2 M F 0M 0.2 F F F 0.3 M M M
2/20/2009 Grandmother called and spoke with 2/20/2009 Local swelling and erythema 2 days 2/20/2009 Approximately 10 minutes after imm 2/20/2009 Injection site swollen, red, itchy and 2/20/2009 Patient received Yellow Fever and H 2/20/2009 Loss of balance, double vision, dizz 2/20/2009 Developed entire body rash with les 2/20/2009 Vaccine administered 2/6/2009 on f 2/20/2009 Approximately 5 min after giving imm 2/20/2009 LEFT UPPER ARM PAIN, SWELLIN 2/20/2009 Pt came back to clinic today to repo 2/20/2009 None at this time 2/20/2009 14-16 days post Varivax immunizati ### "massive" headache. Facial swelling 2/20/2009 Emma passed out about 10 minutes 2/20/2009 After giving Varicella vaccine, Tdap, 2/20/2009 swelling, warmth, pain/soreness and 2/20/2009 Increasing Fever and stomach ache 2/21/2009 Nov. 14, 08 pt received anthrax and 2/20/2009 02/09/09, mother Y of Pt said that 02/ 2/20/2009 Fever, cough. Y Diffuse bilateral pneu 2/16/2009 Tingling both legs and arms with we 2/21/2009 Received DTAP, IPR, MMR & VARI 2/19/2009 Rash on lower back bilateral 2 days 2/19/2009 2/12/09 - tiredness from 14:00pm 2/20/2009 Shots were given 2-09-09 (Monday) 2/20/2009 Left thigh redden, hot to touch at inj 2/20/2009 Pt reports that she had a flu shot he Grand mal seizure. PMH negative. 2/20/2009 4 days ago developed pinpoint red r 2/20/2009 Local swelling & itching. 2/13/2009 Child presents with pain in upper rig 2/20/2009 Redness itching pain began 1 day p 2/18/2008 Hardness at vaccine site with 3X4 c 2/20/2009 Mom notice today 2/20/09 vaccine T 2/20/2009 Today 2/20/09 mom saw arm swolle 2/19/2009 72 hours after vaccine administered 2/2/2009 Swollen reddened thigh with 1 1/2 2 2/20/2009 Localized redness @ injection site2/20/2009 Hives, redness @ injection site - (im 2/20/2009 Complained of itching all over. Rash 2/21/2009 Syncope approximately 5 minutes a 2/21/2009 After his 2 month shots, my son dev 2/20/2009 temp of 100, chills, redness behow 2/21/2009 Child immediately developed fever, 2/21/2009 24hrs-lethargic, not eating well, not 2/21/2009 EXPERIENCED ITCHING ,SHORTN 2/21/2009 Redness occurred at site of adminis 2/21/2009 After recieving the vaccines at his 4 2/21/2009 The same day as receiving the com 2/21/2009 Hiccups continuous non stop, nause
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2/22/2009 ID 2/22/2009 NY 2/22/2009 2/22/2009 CA 2/22/2009 KY 2/22/2009 NC 2/23/2009 IL 2/23/2009 2/23/2009 FL 2/23/2009 CA 2/23/2009 2/23/2009 NM 2/23/2009 NM 2/23/2009 NM 2/23/2009 OH 2/23/2009 MN 2/23/2009 FL 2/23/2009 2/23/2009 2/23/2009 OH 2/23/2009 OR 2/23/2009 CA 2/23/2009 CA 2/23/2009 OH 2/23/2009 OR 2/23/2009 OR 2/23/2009 MT 2/23/2009 NC 2/23/2009 MI 2/23/2009 FL 2/23/2009 GA 2/23/2009 VA 2/23/2009 IA 2/23/2009 AL 2/23/2009 AZ 2/23/2009 GA 2/23/2009 MN 2/23/2009 HI 2/23/2009 WV 2/23/2009 LA 2/23/2009 LA 2/23/2009 PA 2/23/2009 NC 2/23/2009 FL 2/23/2009 MA 2/23/2009 AR 2/23/2009 OH 2/23/2009 2/23/2009 MN 2/23/2009 OR 2/23/2009 UT
4 1.3
4 1
59 1 60 16 19 20
59 0 61 16
58 49 38 60 10 15 20 11 1.1 14 1 1 0.3 77 4 67 56 65 0.4 2 58 1.5 16 14 0.2 11 1.1 11 0.3 0.2 15 28 29 0.7 1.2 11
58 49 38 60
3 8 42
3 8 42
15 11 1 14 1 1 0 77 4 67 56 65 0 2 58 1 16 14 0 11 1 11 0 0 15 28 29 1 11
F 0.3 M M F 1M F F F F F F F F F M F F F F 0.1 M F 0F 0F 0.3 M F F F F F 0.4 M 0.4 M M 0.5 F F F 0.2 M F 0.1 F M 0.3 F 0.2 F F F M M 0.2 F F U M F M
2/22/2009 No reaction 5 hours post vaccinatio 2/22/2009 Immediately after the proquad and h 2/20/2009 Contact tranfer from sharing towels/ 2/22/2009 Temperature of 102.6. Headache. 2/22/2009 loss of muscle control in both arms, 2/22/2009 Single patch of shingles in C5 distrib 2/20/2009 Information has been received from 2/20/2009 Information was viewed on the Inter 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/17/2009 My daughter started to get restless 2/13/2009 Patient received her 1st GARDASIL 2/19/2009 I was given the GARDASIL shot. A 2/19/2009 My daughter had the vaccine GARD 2/18/2009 Pt developed trunkle red micropapu 2/7/2009 pt c/o "fuzziness". Slumped in chair 1/30/2009 Blanchable nonspecific rash. Descri 2/16/2009 Blanchable non-specific rash descri 2/18/2009 Fever, crying non stop x 1-2 hr. 2/18 2/12/2009 Pt. began to have stiff neck on (L) s 2/18/2009 2 days after receiving shots RT leg, 2/10/2009 2 days after shot injection site itched 2/16/2009 L arm sore and client dizzy evening Acute onset of excruciating right sho 2/16/2009 Ran fever after imm Fever 101.1 2/18/2009 Mother called Health Dept @ 3:45p 2/18/2009 Patient was given vaccines on 2/13 2/16/2009 Hives started 2 days after flu vaccin 2/16/2009 Pt received varicella vaccine RA SQ 2/6/2009 Pt learned she was pregnant 2 mon 2/16/2009 Patient received Tdap instead of DT 2/16/2009 Gave 3 immunizations, about 3-4 m 2/11/2009 Fever (low grade) starting five days 2/16/2009 Mom states erythema in shot area s 2/13/2009 Pt administered 2nd dose of ROTAT 2/13/2009 Pt administered 1st dose ROTATEQ 2/12/2009 Headache - post immunization even 2/17/2009 Local reaction - mild redness, soren 2/21/2009 Soon after receiving the tetanus, inf 2/20/2009 Mistakenly gave DTAP #4 to 8 mon 2/23/2009 Parent's report on 2/21/09 at 1 pm p 2/19/2009 Pt with initial syncope, nausea, lasti 2/19/2009 Although GSK labels their pre-filled 2/19/2009 Temp 103 degrees within hours of i 2/18/2009 Received DTD on 2/7/09. Mom up 1/28/2009 Client returned 7 days after immuniz
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2/23/2009 CO 2/23/2009 MI 2/23/2009 PR 2/23/2009 NY 2/23/2009 AK 2/23/2009 CT 2/23/2009 AZ 2/23/2009 MT 2/23/2009 NC 2/23/2009 PR 2/23/2009 OR 2/23/2009 PR 2/23/2009 WI 2/23/2009 CO 2/23/2009 MN 2/23/2009 NM 2/23/2009 NY 2/23/2009 TX 2/23/2009 TX 2/23/2009 FL 2/23/2009 CA 2/23/2009 OH 2/23/2009 GA 2/23/2009 NC 2/23/2009 MD 2/23/2009 IL 2/23/2009 CT 2/23/2009 MA 2/23/2009 NY 2/23/2009 PA 2/23/2009 PA 2/23/2009 LA 2/23/2009 2/23/2009 MO 2/23/2009 CA 2/23/2009 TX 2/24/2009 MA 2/24/2009 IL 2/24/2009 CO 2/24/2009 2/24/2009 DE 2/24/2009 2/24/2009 WA 2/24/2009 2/24/2009 ME 2/24/2009 PA 2/24/2009 OK 2/24/2009 CA 2/24/2009 MD 2/24/2009 OR 2/24/2009 MA
75 29 39 36 28 24 12 45 14 4 61 0.6 1 1.8 0.5 37 12 69 66 76 0.3 14 52 1.7 1 31 11 19 5 49 1.5 4 54 24 1.2 78 0.2 79
75 29 39 36 28 24 12 45 14 4 61 0 1 1 0 38 12 69 66 76 0 14 52 1 0 31 11 19 5 49 1 54 24 1 78 0 79
23 19 14 49 64 11 1.1 0.2 13 45
64 11 1 0 13 45
M M M M F F F M F F F 0.6 F 0.1 F 0.8 M 0.5 F F F M F F 0.4 M F F 0.7 F 1F M M F M M 0.5 F M F F 0.2 M F 0.2 F F U M F F F F F F F 0.1 M 0.2 F F F
2/13/2009 Received Hepatitis A inoculation on 2/10/2009 Severe headache day of vaccine, th 2/11/2009 Rash on skin. 2/14/2009 2/9/09 started with rash, fever and H 2/10/2009 Discomfort started around 2pm. Slig 2/13/2009 Information has been received from 2/23/2009 PATIENT FAINTED IMMEDIATELY 2/23/2009 Dizziness, nausa, shakiness increas 2/23/2009 After receiving 2 IM injections in left 2/23/2009 TWENTY SECONDS AFTER VACC 2/23/2009 Injection site became red, swollen, s 2/23/2009 MOTHER REFERS THE CHILD SU 2/23/2009 Redness & swelling at injection sites 2/23/2009 Per father of child= developed high 2/23/2009 Day after vaccine child had general 2/23/2009 PAIN AND SWELLING AT INJECTI 2/23/2009 Varicella vaccine administered in a 2/23/2009 bump, redness, rash (2"x1"), itching 2/23/2009 bump, redness, rash (1"x1"), itching 2/23/2009 Patient woke up the morning of 2/19 2/23/2009 Reported today to our Health Cente 2/23/2009 Client became pale and complained 2/23/2009 Redness, soreness, and swelling at 2/23/2009 itching began 4 days after receiving 2/23/2009 Patient was running a fever on and 2/23/2009 Patient states, awakened with fever 2/20/2009 Received ADACEL @ 10:30 am - w 2/23/2008 Pt called @ 10:20 AM stating she h 2/23/2009 Per mom-since the vaccines pt. has 2/23/2009 Tdap given on 2/18. C/o sitting sore 2/18/2009 Vomited <1hr post immunization an 2/23/2009 This case was reported by a physici 2/23/2009 This case was reported by a lawyer 2/23/2009 Pt received GARDASIL injection 1/2 2/20/2009 Urticarial rash that resolved with ora 1/26/2009 Called the patient and she states th 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Initial and follow-up information has 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information was viewed on the inter 2/19/2009 Initial information received on 21 Ja 2/17/2009 At time weakness in extremities, nu 2/19/2009 Left arm was swollen from shoulder 2/18/2009 None stated 2/19/2009 vomited immediately following rotov 2/17/2009 Fever same day, then stomach ups 2/20/2009 Received ADACEL, in Left delt and
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2/24/2009 UT 2/24/2009 IA 2/24/2009 CA 2/24/2009 IL 2/24/2009 FL 2/24/2009 MN 2/24/2009 VA 2/24/2009 SD 2/24/2009 OR 2/24/2009 MT 2/24/2009 OR 2/24/2009 MA 2/24/2009 IN 2/24/2009 PA 2/24/2009 OR 2/24/2009 MI 2/24/2009 PA 2/24/2009 OR 2/24/2009 VT 2/24/2009 OR 2/24/2009 NC 2/24/2009 FL 2/24/2009 MI 2/24/2009 TX 2/24/2009 KY 2/24/2009 AZ 2/24/2009 OH 2/24/2009 OH 2/24/2009 WA 2/24/2009 CA 2/24/2009 TN 2/24/2009 CA 2/24/2009 CA 2/24/2009 PA 2/24/2009 SD 2/24/2009 NY 2/24/2009 TX 2/24/2009 NE 2/24/2009 NY 2/24/2009 MS 2/24/2009 OR 2/24/2009 MI 2/24/2009 CA 2/24/2009 IN 2/24/2009 2/24/2009 UT 2/24/2009 AZ 2/24/2009 NC 2/24/2009 CA 2/24/2009 UT 2/24/2009 AL
60 1.3 67 11 12 1.1 0.2 1 17 17 12 31 8 18 12 50 1 10 74 9 11 1.6 39 77 16 76 48 32 48 37 0.2 0.2 2 76 56 11 14 64 25 1.4 1 60 1.4 0.2 4 4 0.5 69 4 68 0.2
60 1 67 11 12 1 0 1 17 17 12 31 8 18 12 50 1 10 74 9 11 1 39 77 16 76 48 32 48 37 0 0 2 76 56 11 14 64 25 1 1 60 1 0 4 4 0 69 4 68 0
M 0.3 M F M F 0.1 F 0.2 M 0F F F F M F F F M 0M F F F M 0.6 M F M F F F M F F 0.2 F 0.2 F 0M M M F M F F 0.4 F 0.1 M F 0.4 F 0.2 M F M 0.5 F F M F 0.2 M
2/11/2009 According to patient he was seen by 1/19/2009 Rash appeared 2 days after shot lig 2/18/2009 Pt. received ZOSTAVAX 12/18/09; Left sided facial paralysis began da Quick fever up to 103.3 degrees F, 2/17/2009 Within 1 hr of vaccines being given 2/19/2009 Inconsolable crying, pallor, & loss o 2/19/2009 Rash on face, stomach, back, legs s 2/18/2009 < 1 hr post vaccine admin. Pt c/o lig 2/19/2009 TC from pt one hour after recurring 2/17/2009 Swollen glands, (femoral), redness 2/17/2009 12/27/08 - Presented with 3 weeks 2/19/2009 Received flu shot 2-16-09 came to o 2/17/2009 1 hour after receiving MENACTRA d 2/18/2009 C/O feeling hot, HA, eyes burning th 9/24/2008 Pain and warmth and firmness felt a 2/19/2009 Has red bumps on stomach, legs & 2/18/2009 DTaP+IPV combo administered 2-1 1/27/2009 Developed Bells Palsy 8/12/08 rece 2/17/2009 Pt given HEP A (VAQTA) on 2/11/0 2/18/2009 02-07-09 (L) arm 8X8 in redden- wa 2/16/2009 Rash after antibiotics + MMR. Face Had knot & a lot of pain after receiv 2/18/2009 4 days after receiving the shingles v 2/17/2009 Hyperpigmentation on (L) arm (Line 2/17/2009 Itching at injection site urthen 1 hr. Extreme muscle pain, edema to 3x 2/17/2009 Rabies immunization given 2/15/09 2/18/2009 Appointment for Hep-B vaccine. Prio Localized Rxn. Redness, Swelling & 2/21/2009 Right side of her face red and swoll 2/19/2009 Swollen Right thigh. 2/19/2009 Fever temperature 105 core. 2/24/2009 Vesicular lesions around left flank 2/24/2009 Diarrhea, gas, distended stomach. p 2/24/2009 Has had a dull frontal headache sin 2/24/2009 6-7 hours after Tdap given had 101 2/24/2009 Pt was given two injections in the le 2/24/2009 pt states after she received 2nd vac 2/24/2009 Urticaria to anterior and posterior tru 2/24/2009 DTAP administered to Left deltoid a 2/24/2009 Started hurting when given and nev 2/23/2009 Infant patient started having fevers 2/24/2009 Received first Y set of baby shots, left 2/24/2009 DEVELOPED SIGNIFICANT ERYT 2/24/2009 Rt. thigh became erythematous, wa 2/24/2009 Patient had hives all over body few 2/24/2009 2 hours after vaccination patient exp 2/24/2009 Redness swelling L arm 2/24/2009 Pneumococcal vaccination given on 2/24/2009 Patient had seizures and had to be
340566 340567 340577 340578 340579 340580 340581 340582 340583 340584 340585 340586 340587 340588 340589 340590 340591 340592 340593 340594 340595 340568 340659 340663 340667 340668 340669 340670 340671 340672 340673 340674 340675 340676 340677 340678 340679 340680 340681 340682 340683 340684 340685 340686 340687 340688 340689 340690 340691 340696 340698
2/24/2009 MI 2/24/2009 CA 2/24/2009 TN 2/24/2009 WA 2/24/2009 MA 2/24/2009 SC 2/24/2009 NE 2/24/2009 NE 2/24/2009 NE 2/24/2009 NC 2/24/2009 KY 2/24/2009 MT 2/24/2009 SD 2/24/2009 MD 2/24/2009 MO 2/24/2009 MN 2/24/2009 MA 2/24/2009 CA 2/24/2009 VA 2/24/2009 MD 2/24/2009 NY 2/25/2009 2/25/2009 MI 2/25/2009 2/25/2009 2/25/2009 NY 2/25/2009 MA 2/25/2009 TX 2/25/2009 NC 2/25/2009 OH 2/25/2009 VA 2/25/2009 KY 2/25/2009 FL 2/25/2009 NJ 2/25/2009 SC 2/25/2009 FL 2/25/2009 GA 2/25/2009 MI 2/25/2009 CA 2/25/2009 TX 2/25/2009 CA 2/25/2009 NH 2/25/2009 CA 2/25/2009 RI 2/25/2009 MO 2/25/2009 MA 2/25/2009 PA 2/25/2009 CA 2/25/2009 TX 2/25/2009 CA 2/25/2009 PA
0.1 4 0.7 1.4 37 0.3 0.5 31 28 24 73 30 81 14
0 4 0 1 37 0 0 31 28 24 73 30 81 14
67 0.4 1.1 0.4 17 32 27 46 71
67 0 1 0 17 32 27 46
18 11 23 56 1 1.3 26 11 11 11 12 13 59 48 3 51 29 62 1.9 15 0.5 17 1 74 18 0.2
18 11 23 56 1 1 26 11 11 11 12 59 3 29 62 1 15 0 17 1 74 0
0.1 M M 0.7 M 0.4 M F 0.3 M 0.5 F F F F F M F F U M 0.4 F 0.1 F 0.4 F F M M F F M F F M F 0F 0.4 M F F F F F F M F F F F F 0.9 M F 0.6 M M 0M M F 0.2 M
2/24/2009 Advised parent of error.Will call in A 2/24/2009 Redness of face around eyes; no sw 2/24/2009 Reported from mother: Pt was admi 2/24/2009 Cellulitis Right thigh 2/24/2009 Day # 12 post immunization with 2 s 2/23/2009 Melena 1/11/2009 Left leg - red, swollen, warm to touc 2/24/2009 ADACEL shot given right arm 2/15. 2/24/2009 ADACEL given 2/14 2/17 - arm puf 2/23/2009 Patient calls VHC x 3 in past week. 2/24/2009 Injection was on 02/19. On 02/22 in 2/23/2009 Patient called 6 days following vacc 2/24/2009 Pt complained to dentist about sore 2/23/2009 2/19/09. Local Reaction with contin 2-10-09 MMR & VARICELLA given. 2/23/2009 Had ZOSTAVAX injection 2-12-09. 2/24/2009 Erythematous nodule app 0.5 cm in 2/23/2009 Received MMR and VARIVAX on 1/ 2/24/2009 4 month-old female who came for a 2/24/2009 3rd dose of GARDASIL administere 2/23/2009 Developed fever < 12 alter shot swo 2/25/2009 Early in the morning following the va 2/23/2009 This non-serious event was reported 2/24/2009 Information has been received from 2/24/2009 Information has been received from 2/23/2009 Abdominal pain, diahrrea, general il 2/20/2009 Received a BOOSTRIX vaccine (R) 2/25/2009 within 24 hours, urticarial rash on ch 2/25/2009 approximately 12 hrs after reaction, 2/23/2009 Per parent, Kitra Woodall, child had 2/25/2009 seizure 2/25/2009 Local reaction and cellulitis at inject 2/25/2009 10 days following the vaccine, pt be 2/25/2009 fainting episode which lasted for ap 2/25/2009 mild nausea immediately following G 2/25/2009 Fainted shortly after administration o 2/25/2009 Mom calling office c/o site where va 2/25/2009 Within 24 hours of receiving vaccine 2/25/2009 Tellow Fewver, Polio and oraL 7/14 2/23/2009 On 10/17/09 patient was taken to ho 2/25/2009 fever,myalgia. pt received rabies va 2/25/2009 Very ill with fever, chills, severe mya 2/25/2009 In January patient reported pain on 2/25/2009 redness and tenderness where sho 2/25/2009 Patient was administered the Merck 2/25/2009 On 1/30/09 Pt presented with a tem 2/25/2009 Mother called office today and repo 2/25/2009 Injec. site became red and indurate 2/25/2009 PT RECEIVED ZOSTAVAX ON 2/2 2/25/2009 Information has been received from 2/24/2009 Two days after the shot was admini
340700 340701 340702 340703 340704 340705 340706 340707 340708 340709 340710 340711 340712 340713 340714 340715 340716 340717 340718 340773 340775 340776 340777 340778 340779 340780 340781 340782 340783 340784 340785 340786 340787 340788 340789 340790 340792 340793 340794 340795 340796 340797 340798 340799 340800 340801 340802 340803 340804 340805 340806
2/25/2009 NM 2/25/2009 IL 2/25/2009 OR 2/25/2009 WA 2/25/2009 CA 2/25/2009 CA 2/25/2009 MI 2/25/2009 NY 2/25/2009 WA 2/25/2009 KY 2/25/2009 CA 2/25/2009 AZ 2/25/2009 IN 2/25/2009 KY 2/25/2009 MO 2/25/2009 KY 2/25/2009 FL 2/25/2009 IN 2/25/2009 TX 2/26/2009 MI 2/26/2009 NJ 2/26/2009 IN 2/26/2009 CA 2/26/2009 OR 2/26/2009 OR 2/26/2009 OR 2/26/2009 WI 2/26/2009 2/26/2009 WV 2/26/2009 MN 2/26/2009 FL 2/26/2009 PA 2/26/2009 ME 2/26/2009 IL 2/26/2009 2/26/2009 CA 2/26/2009 PA 2/26/2009 MI 2/26/2009 MI 2/26/2009 TN 2/26/2009 AZ 2/26/2009 FL 2/26/2009 AR 2/26/2009 FL 2/26/2009 FL 2/26/2009 FL 2/26/2009 OH 2/26/2009 MI 2/26/2009 TX 2/26/2009 MN 2/26/2009 FL
11 16 33 9 10 4 50 8 4 0.5 15 67 4 4 1 29 10 24 41 32 4 0.5 17 13 93 12 17 54 12 47 24 0.6 1.1 64 69 61 1 31 61 3 24 52 12 16 1.5 1.3 31 0.9 65 3
11 16 33 9 10 4 8 4 0 15 67 4 4 1 29 10 24 41 32 4 0 17 13 93 12 17 12 47 24 0 1 1 69 61 1 31 61 29 52 12 16 1 1 31 0 65 3
F F M M M F U F F 0.5 F F F M M 0M F F F F F F 0.5 M F M F M F F F F F 0.6 M 0.1 F 0.5 F M F F 0M M F M M M F M 0.5 F 0.3 M F 0.9 M F M
2/25/2009 About 1 wk after 1st GARDASIL, my 2/25/2009 Pt had an episode of syncope, swea 2/24/2009 2/24/09 At 9am Donor started havin 2/25/2009 Rash on back & face. 2/25/2009 - Large firm (3 inch wide) round tend 2/24/2009 Large Erythema, hyperemia and pru Injection administered 10-17-08, on 2/21/2009 Within 5 minutes of injection into rig 2/24/2009 Redness at injection site (L) thigh, h 2/25/2009 Staring, rolled eyes back of head ? 2/24/2009 Pt seen on 2/23/09. Complaining of 2/25/2009 Vaccines administered on 2-17-09 2/24/2009 Within 30 minutes patient experienc 2/25/2009 Fever of 102 degree at home the ni 2/25/2009 None stated. 2/20/2009 Noticed 30 min after while on elevat 2/25/2009 Left arm SQ swelling, local reaction 2/25/2009 Information received from patient's m 2/25/2009 Fever, nausea, vomiting; patient rec Received Hepatitis B & MMR vaccin 2/26/2009 Redness, swelling 5"X51/2" 2/20/2009 Received vaccines on 2-17-09 No b 2/19/2009 Patient's mother informed clinic on 0 2/18/2009 Pt fainted after receiving vaccines, a 2/10/2009 2/9/09 Call from pt that she had acu 2/17/2009 Mother called 2-13-09 reporting ash 2/24/2009 About 1 month after vaccination dev 2/24/2009 Patient received a flu vaccine on 10 2/26/2009 Erythema, edema around immuniza 2/18/2009 Swelling & erythema of left upper ar 2/12/2009 Migraine headache for 11-13 days f 2/20/2009 Fever - Tmax 104.8 oral per parent; 2/20/2009 Pt with runny nose, fuzziness and 2 2/20/2009 Severe nausea and vomiting. 2/24/2009 Symptoms: 1. Pain and swelling. 2/23/2009 2/13 Vaccine given in left arm. On 2 2/26/2009 I received a pneumonia shot on Mo 2/26/2009 PT GIVEN VARICELLA VACCINE O 2/26/2009 Client called with c/o pain and swell 2/26/2009 Swelling and heat at injection site 2/26/2009 After the vaccine he stated starring 2/26/2009 Pain, swelling w/ warm to the touch 2/26/2009 Shot adminstered at work. A week a 2/26/2009 Temp 102.6 12:20 pm 2/26/09 2/26/2009 Vaccine administered on 1/14/2009 2/26/2009 Mother complained that baby vomiti 2/26/2009 On 2/18/09 at about 9:30PM, his ey 2/26/2009 2-25-2009 at 6pm pt stated had nau 2/26/2009 Pt's mother c/o diahrrea, decreased 2/26/2009 Given Pneumonvax Immunization o 2/26/2009 AFter recieving the pentacel in his le
340807 340808 340809 340815 340816 340817 340818 340819 340820 340821 340822 340823 340824 340825 340826 340827 340829 340830 340810 340831 340832 340833 340834 340835 340839 340840 340841 340848 340849 340850 340851 340852 340853 340854 340855 340856 340857 340858 340859 340860 340861 340862 340863 340867 340868 340869 340870 340871 340872 340873 340874
2/26/2009 CO 2/26/2009 MI 2/26/2009 MA 2/26/2009 VA 2/26/2009 FL 2/26/2009 FL 2/26/2009 WI 2/26/2009 MO 2/26/2009 WA 2/26/2009 CA 2/26/2009 CA 2/26/2009 ID 2/26/2009 ID 2/26/2009 ID 2/26/2009 ID 2/26/2009 NC 2/26/2009 MD 2/26/2009 CO 2/27/2009 AR 2/27/2009 2/27/2009 VA 2/27/2009 ME 2/27/2009 2/27/2009 TX 2/27/2009 IN 2/27/2009 IL 2/27/2009 2/27/2009 MN 2/27/2009 CO 2/27/2009 NC 2/27/2009 CA 2/27/2009 WI 2/27/2009 AZ 2/27/2009 TX 2/27/2009 FL 2/27/2009 WI 2/27/2009 OR 2/27/2009 MN 2/27/2009 NY 2/27/2009 WI 2/27/2009 RI 2/27/2009 WI 2/27/2009 IN 2/27/2009 VA 2/27/2009 NY 2/27/2009 VA 2/27/2009 VA 2/27/2009 2/27/2009 GA 2/27/2009 IN 2/27/2009 ND
16 36 67 1.3 3 43 59 5 10 0.2 10 3 47 37 40 1 1.2 11 0.3 19 23 15 26 14
16 36 94 1 3 43 59 5 10 0 10 3 47 37 40 1 1 11 0 19
14
21 68 13 0.8 72 9 11 4 1 26 12 62 31 57 55 11 4 18 1 20 19 30 8 1 58
68 13 0 72 9 11 4 1 26 12 62 31 57 55 11 4 18 1 20 19 30 8 1 58
F M M 0.3 F F F F F M 0.2 F M F F F F 0M 0.2 F F 0.3 F F F F F F F F M F F 0.8 F F F F F 0F M F F F F F M F M 0.1 F F F F M 0M M
2/26/2009 chronic debilitating headaches, chro 2/26/2009 One day after receiving the injection 2/26/2009 within 24 hours after injection Pain a 2/26/2009 Seizure like activity, Loss of conscio 2/24/2009 5-8 min after receiving CODEINE ch 2/26/2009 Pt. reports LUE arm, shoulder pain 1/8/2009 Pt called clinic reporting SOB, throa 2/26/2009 Raised spots - back abd, 12/26/09 s 2/11/2009 None Phenyl & Pt sister PKU + mom 2/26/2009 High pitched screaming started ~45 ### Upon leaving the clinic per mother, 1/26/2009 Phone call - Employee stated recei ### Rash, itching, took BENADRYL 50m ### L arm injection site with large redde ### Site of injection hot to touch, red an 2/26/2009 Received MMR, VARIVAX, and PRE 2/26/2009 The child is a 14 month old female w 2/26/2009 Pt c/o headaches, severe @times (6 2/27/2009 Less than 24 hours after administra 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/12/2009 On 2/12/2009 Pt. talked with PHN + 2/25/2009 Pt with extreme discomfort following 2/23/2009 Patient was administered diluent for 2/13/2009 Patient noticed patch of red skin in a 2/23/2009 patient inadvertently received Tdap 2/16/2009 Day after vaccinations, Pt develope 2/19/2009 10 minutes after the shots where ad 2/23/2009 Mom noted few itch spots on abd 4 2/24/2009 This service member contacted the 2/20/2009 Mother called to report pt c/o "loosin 1/30/2009 Histamine-like reaction. Hives - seve 2/26/2009 Shaking chills, fever X 24 hrs. (X hrs 2/23/2009 The day after shot employee experi 7/7/2008 Headache, Flu- like symptoms, low 2/19/2009 Hives, throughout, injection site arm 2/26/2009 Local Right - swelling redness- cove 2/27/2009 C/o dizziness and weakness approx 2/27/2009 Mom reported child got puffy around 2/27/2009 C/O arm soreness and hand and fin 2/27/2009 C/O dizziness and vomiting (4-5X) a 2/27/2009 On 08 NOV 2005 around noon, swo 2/27/2009 2-3 minutues following administratio 2/27/2009 Each time my identical twin sons we 2/27/2009 Pt called and spoke with RN on 2/19
340875 340876 340877 340927 340928 340929 340930 340931 340933 340878 340879 340880 340881 340882 340883 340884 340885 340886 340887 340888 340889 340890 340891 340892 340893 340894 340895 340896 340897 340899 340900 340901 340907 340911 340920 340921 340922 340923 340924 340925 340926 340932 340934 340935 340936 340937 340938 340939 340940 340941 340942
2/27/2009 PA 2/27/2009 CT 2/27/2009 FL 2/27/2009 KY 2/27/2009 CA 2/27/2009 CO 2/27/2009 AR 2/27/2009 NY 2/27/2009 VA 2/28/2009 WI 2/28/2009 IN 2/28/2009 TX 2/28/2009 NJ 2/28/2009 NV 3/1/2009 MI 3/2/2009 IL 3/2/2009 ME 3/2/2009 AZ 3/2/2009 WA 3/2/2009 WI 3/2/2009 KS 3/2/2009 AL 3/2/2009 CO 3/2/2009 TX 3/2/2009 WA 3/2/2009 CA 3/2/2009 3/2/2009 TX 3/2/2009 MD 3/2/2009 MD 3/2/2009 3/2/2009 3/2/2009 3/2/2009 3/2/2009 CA 3/2/2009 IL 3/2/2009 FL 3/2/2009 MO 3/2/2009 IN 3/2/2009 TX 3/2/2009 MA 3/2/2009 CA 3/2/2009 AZ 3/2/2009 FL 3/2/2009 HI 3/2/2009 GA 3/2/2009 NC 3/2/2009 GA 3/2/2009 CO 3/2/2009 FL 3/2/2009 MO
1 22 60 35 4 11 20 13 54 43 40 2 13 17 53 35
1 22 60 35 4 11 20 13 54 43 40 2 13 17 53 35
58 13 60 1 5 5 63 0.2 20 1 0.2 11 10 16
57 13 60 0 5 5 63 0 20 1 0 11 10 16
12 43 4 14 1 1.6 15 0.5 40 9 70 0.1 25 1 1.4 62 4 1.4 9
4 14 1 1 15 0 40 9 70 0 25 1 1 62 4 1 9
0M F M F F F F F F F F 0.5 M F F F F M F M M 0F F F M 0.2 F M 0M 0.2 M F F F F M F F M 0M 0.6 M F 0.5 F F M F 0.1 M M 0M 0.4 F F F 0.4 M F
2/27/2009 Seen 2/24/09 at 2pm due to rash ov 2/27/2009 Was given the Gardasil shot in Dece 2/27/2009 Generalized joint/body ache, weakn 2/26/2009 Pain at injection site, diffuse myalgia 2/27/2009 Redness Swollen on L deltoid uppe 2/27/2009 Pt rec. vaccine on 2/24, called office 2/27/2009 Pt experienced HA which was const 2/12/2009 Persistent LUQ pain, fatigue and we 2/27/2009 Low grade fever, dizziness, pain an 2/28/2009 Severe Muscle pain to the extent of 2/28/2009 Extensive pain in upper left arm at i 2/28/2009 Patient received the MMR vaccine o 2/28/2009 Syncope,fainting loss of consciousn 2/28/2009 AFTER FIRST GARDASIL VACCIN 3/1/2009 Fever, myalgias, Arthus reaction 2/24/2009 Itching and Hives over entire body e 3/2/2009 received pneumoccal/flu vaccine 2 d 3/2/2009 1/29/09--Pt. stated did not feel shot 3/2/2009 Loss of eyesight startin at about two 3/2/2009 Severe pain swelling and redness a 3/2/2009 Pt has large reddish purple area wit 3/2/2009 PATIENT STATED VACCINES WE 3/2/2009 Two weeks and two days after rece 3/2/2009 64 yr old white male presents with c 3/2/2009 Local reaction with redness and swe 3/2/2009 **suspected** case of progressive v 3/2/2009 Severe raised and hot rash on torso 2/27/2009 Information has been received from 2/27/2009 Initial report received on 17 Februar 2/27/2009 Initial report received on 17 Februar 2/27/2009 Information has been received from 2/27/2009 Information has been received from 2/27/2009 Information has been received from 2/27/2009 Report 2001005622-1 described "lo 3/2/2009 Infection to left thigh where IPV and 3/2/2009 Pt c/o bad HA that started at back o 3/2/2009 Erythemia Multiform Minor, etiology 2/27/2009 local allergic reaction. Redness som 3/2/2009 Costochondritis R side > 1wk. Patient diedYof influenza A on 2/10/0 1/28/2009 Severe headache, chest pain, incre 2/27/2009 Varicella Breakthrough by baby sist 3/3/2009 Local (around area of injection) swe 3/2/2009 Vaccine given 930 AM on 3/2/09: w 3/2/2009 Local reaction to the R forearm. red 3/2/2009 See notes. 3/2/2009 Multiple vesicles 3/2/2009 2 hours after office & receiving PNE 2/23/2009 Shots given 2/18/09. MOC called 2/ Grandmother states rashes appears 3/2/2009 reddened are L upper arm BENADR
340943 340944 340945 340946 340947 340948 340949 340950 340951 340952 340954 340955 340956 340957 340958 340965 340967 340968 340969 340970 340971 340976 340977 340978 340979 340980 340981 340982 340983 340984 340985 340986 340987 340988 340989 340990 340991 340992 340993 340994 340995 340996 340997 340998 340999 341000 341001 341003 341004 341005 341006
3/2/2009 3/2/2009 MT 3/2/2009 NE 3/2/2009 NY 3/2/2009 CA 3/2/2009 MA 3/2/2009 WI 3/2/2009 TN 3/2/2009 MI 3/2/2009 3/2/2009 3/2/2009 NY 3/2/2009 3/2/2009 NJ 3/2/2009 VA 3/3/2009 3/3/2009 3/3/2009 IL 3/3/2009 OR 3/3/2009 OR 3/3/2009 CO 3/3/2009 3/3/2009 NC 3/3/2009 AL 3/3/2009 OK 3/3/2009 IL 3/3/2009 OH 3/3/2009 VA 3/3/2009 LA 3/3/2009 NY 3/3/2009 OR 3/3/2009 CA 3/3/2009 WA 3/3/2009 MN 3/3/2009 NY 3/3/2009 FL 3/3/2009 NM 3/3/2009 CA 3/3/2009 CA 3/3/2009 FL 3/3/2009 TX 3/3/2009 IL 3/3/2009 NY 3/3/2009 MD 3/3/2009 TX 3/3/2009 UT 3/3/2009 IN 3/3/2009 MN 3/3/2009 MI 3/3/2009 TX 3/3/2009 OH
66 9 53 5 57 10 48 4 42 16 13 0.4 62 5 4 15
66 9 53 5 57 10 48 4 42 13 0 62 5 4
15 26 26 65 14 48 29 1.3 32 34 17 12 7 4 69 0.1 0.2 4 66 25 29 60 1.1 1.6 1.3 68 20 54 21 66 35 62 62
14 48 29 1 32 34 17 12 7 4 69 0 0 4 66 25 29 60 1 1 1 68 20 54 21 66 35 61 62
F F M M F F F M M F U 0.4 F F F M F F F F F U M M M F 0.3 M M M F M F M F 0.1 M 0.2 M F F F F F 0.1 F 0.6 F 0.3 M F M M M M F F F
3/2/2009 Multiple lumps - deltoid strength dec 2/27/2007 Redness, swelling of R upper arm 4 9/21/2008 Pt was over 50 yo. and received the 2/19/2009 8" x 5" area of slight erythema and p 2/24/2009 Immediate and excessive pain cont 2/10/2009 Left arm-2cm area of erythema and 2/16/2009 Patient presented to Employee Hea 2/25/2009 L upper arm just below axillae has w 2/9/2009 Pain, swelling, dizziness, nauseous 2/15/2009 My daughter received her 3rd inject 2/26/2009 My daughter received GARDASIL v 2/8/2009 Daughter started throwing up, could 2/27/2009 On 2/24 patient started with breathin 2/24/2009 Within 24 hrs of being given MMR p 2/27/2009 Mother called advising pt's arm whe 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 2/27/2009 Initial reportYreceived on 20 Februar 2/26/2009 Initial information received on 20 Fe 2/27/2009 Initial report received 19 February 2 2/27/2009 Initial information received on 18 Fe 2/24/2009 30 min after shot- hives, pain shooti 1/21/2009 At 2:30 pm on 7/22/2008, fever star 2/24/2009 10/28 flu shot @ store. 10/29 flu-like 2/26/2009 Felt sharp pain in chest approx 3 da 2/25/2009 Tdap and Varicella administered wh 2/26/2009 Crusty and itchy: topical skin reactio 2/25/2009 Client in today with sister who are g 2/24/2009 Redness, induration L deltoid 6cm x 2/27/2009 A week after immunization started w 2/23/2009 Patient here today for Right thigh re 2/26/2009 Profuse diarrhea for 7-8 days on da 2/27/2009 Sudden onset of fever 103.9 with co 2/26/2009 7"-8" wheal, redness, tender to touc 2/24/2009 Redness-trial of ZYRTEC, and if wo 2/25/2009 Redness - ZYRTEC/allergy med, an 2/26/2009 Redness, swelling, pain, itching at s 2/25/2009 On 2/24/09- Rash all over, fever, co 2/25/2009 Mother stated red and swollen right 2/27/2009 Hives noted 7mm took Benadryl non 2/25/2009 Itch and rash on left side of neck arm 3/3/2009 Immediately got left sided eye pain 3/3/2009 Client received immunizations for tra 3/3/2009 nodular, pustular, follicular eruption 3/3/2009 None - vaccine given outside age ra 3/3/2009 2-26-2009 Right Deltoid Red, Swolle 3/3/2009 left arm swellimg at injection site, wi 3/3/2009 Patient developed sores on lip appr
341007 341008 341009 341010 341011 341012 341013 341014 341015 341016 341017 341018 341019 341020 341021 341022 341023 341024 341025 341026 341027 341028 341029 348881 348884 348886 348887 348888 348889 348890 348891 348892 348893 348894 348895 348896 341031 341032 341034 341035 341049 341050 341051 341052 341053 341054 341055 341056 341057 341058 341059
3/3/2009 TX 3/3/2009 UT 3/3/2009 UT 3/3/2009 CA 3/3/2009 NY 3/3/2009 TX 3/3/2009 MI 3/3/2009 NY 3/3/2009 CO 3/3/2009 3/3/2009 ID 3/3/2009 PA 3/3/2009 NH 3/3/2009 CA 3/3/2009 RI 3/3/2009 NY 3/3/2009 PA 3/3/2009 WV 3/3/2009 CA 3/3/2009 OH 3/3/2009 CA 3/3/2009 OH 3/3/2009 TX 3/3/2009 MI 3/3/2009 MI 3/3/2009 WI 3/3/2009 OH 3/3/2009 MI 3/3/2009 MI 3/3/2009 FL 3/3/2009 MI 3/3/2009 MI 3/3/2009 MI 3/3/2009 3/3/2009 MI 3/3/2009 MI 3/4/2009 3/4/2009 TX 3/4/2009 MI 3/4/2009 3/4/2009 MO 3/4/2009 MO 3/4/2009 OH 3/4/2009 MN 3/4/2009 FL 3/4/2009 GA 3/4/2009 SC 3/4/2009 MI 3/4/2009 MN 3/4/2009 MN 3/4/2009 UT
11 1.3 1 5 13 2 13 17 5 4 7 69 1 41 48 1.3 15 11 66 40 4 69 34 42 26 26 22 56 22 26 36 26 23
11 1 1 5 13 2 13 17 5 4 7 69 1 41 48 1 15 11 66 40 4 69 34 42 26 26 22 56 22 26 36 26 23
24 34 1.5
24 34 1
14 17 4 8 4 13 1.1 0.3 29 52 90 69 12
14 17 4 8 13 1 0 29
12
M 0.4 M 0M F F 0.5 F F F F M F M 0F F F 0.3 M F M F M F F F F M F F M F M F F F M M F 0.5 M F F F F M F F 0.1 F 0.3 F F F M F F
3/3/2009 Patient received Menactra vaccine o 3/3/2009 High Fever 106 3/3/2009 fever for 5-6 days. 3/3/2009 Redness, swelling, warm and hard @ 3/3/2009 Patient had pain and swelling at inje 3/3/2009 Mild swelling and redness of the left 3/3/2009 Within 2 days of injection client pass 3/3/2009 Fainting episode within 5 minutes o 3/3/2009 1) Extreme anxiety - moody and irrit 3/3/2009 Pt was given his 4 year old immuniz 2/17/2009 A serious spontaneous report of sei 3/1/2009 Patient had shingles like rash that it 3/3/2009 General hives BENADRYL. Observe 3/3/2009 Severe local erythema, swelling, stif 3/3/2009 Per patient- She had a rash + fever 2/27/2009 Swelling of leg with a fine urticarial r 3/3/2009 Patient experienced a syncope epis 1/16/2009 Received Tdap and meningitis vacc 3/3/2009 - Red itchy injection site rash that sp 3/3/2009 Deep muscle pain @ injection site, 2/27/2009 Localized reaction to vaccines. MO 3/2/2009 Area around vaccine became red. 3/2/2009 Temp to 102, with R shoulder swelli 2/11/2009 Redness, swelling and warmth at in 2/11/2009 Received a haircut on 4/15/08. At th 2/11/2009 Reporter contacted manufacturer in 2/11/2009 Subject experienced moderate (7x6 2/11/2009 Subject reports that at approximatel 2/11/2009 Subject reports being tired on the fir 2/11/2009 Palm-sized dry rash localized to the 2/11/2009 Redness at injection site at 24 hour 2/11/2009 Subject reports that approx 5 hours 2/11/2009 Subject reports that three days after 2/11/2009 Recd via e-mail: Subject has a latex 2/11/2009 Soreness of muscle, left leg, from m 2/11/2009 Pain at injection site, itching at injec 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/2/2009 Initial report received 23 February 2 3/2/2009 Initial report received 23 February 2 3/2/2009 Initial report received on 27 Februar 2/25/2009 4-21 - 4-22-08 was in hospital for sy 2/27/2009 Red raised spots that started on tor 3/4/2009 DIARRHEA AND VOMITING 3/4/2009 Pt c/o pain and swelling in L arm the 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Patient was vaccinated for meningit
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3/4/2009 MN 3/4/2009 MI 3/4/2009 TX 3/4/2009 SC 3/4/2009 ME 3/4/2009 IL 3/4/2009 IL 3/4/2009 NY 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 AL 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 ID 3/4/2009 NJ 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 OK 3/4/2009 MO 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 TN 3/4/2009 WA 3/4/2009 MI 3/4/2009 CO 3/4/2009 MN 3/4/2009 MN 3/4/2009 MO 3/4/2009 WI 3/4/2009 MA 3/4/2009 PA 3/4/2009 WI 3/4/2009 NJ 3/4/2009 NJ 3/4/2009 PA 3/4/2009 PA 3/4/2009 MI 3/4/2009 FL 3/4/2009 NJ 3/5/2009 NJ 3/5/2009 3/5/2009 3/5/2009 3/5/2009 CA 3/5/2009 TX
81 66 1.7 15 27 51 50 0.2 22 41 24 49 11 36 35 43 15 34 6 4 44
66 1 15 27 51 50 0 22 41 24 49 11 36 35 43 15 34 6 4 44
0.3 1.1 50 4 5 4 18 53 5 11 13 13 1.5 3 50 66 57 4 0.5 14 0.7 13 84 11 0.5
0 1 50 4 5 4 18 53 5 11 13
0.2
0
1 50 66 57 4 0 14 0 13 84 11
F M 0.7 F F F F F 0.2 M F F F F M F F F F F F M F F M 0.3 M 0.1 M F M M M M F F F M M 0.5 M F F F F F 0.5 M F 0.7 F M F F U U 0.2 F U
3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Sore throat-WATERY EYES-RUNN 3/4/2009 Erythema and edema localized at in 3/4/2009 She recived Gardisil in left arm then 3/4/2009 Patient called and states she has ha 3/4/2009 arm soreness 3/4/2009 no adverse reaction Administer 3/4/2009 Pt. received 2 month vaccines in off 3/4/2009 no adverse event Administered 3/4/2009 sore throat for 24 hours. Adminis 3/4/2009 no adverse events. Administered D 3/4/2009 no adverse reaction. Administere 3/4/2009 Approximately 2 weeks after receivi 3/4/2009 Patient self reported sore arm for 3 3/4/2009 no adverse reaction. Administered 3/4/2009 no adverse reaction. Administered 3/4/2009 Immediately following vaccination g 3/4/2009 Complained of itchy throat, "patient 3/4/2009 SITE OF INJECTION WITH REDNE 3/4/2009 Exagerate local reaction. Painful wit 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a lawyer 3/4/2009 This case was reported by a physici 3/4/2009 Pt experienced vomiting and 1 bloo 3/4/2009 Right thigh began to get red and sw 3/4/2009 Initially redness, soreness at injectio 3/4/2009 Swelling of Right thigh and vomiting 3/4/2009 1.3.5 inches X 3 inches round, red, 3/4/2009 Pt developed fever 101.7. 15 cm are 3/3/2009 T-101.3, achy at site of injection, ten Swelling in tongue - Labored breath 3/5/2009 5 yr injections given - mom calling s 3/3/2009 None 3/3/2009 Severe headache-fever-dizziness. D 3/4/2009 Mother called 2 days after immuniza 8/31/2007 Fever after receiving Tdap at 03/02 2/24/2009 Cellulitis at injection site dx by CHO 3/3/2009 Pt received flu shot at clinic on 11/3 3/4/2009 PNEUMOVAX vaccine administered 3/4/2009 Within 1/2 of immunization, patient r 3/4/2009 (L) thigh has 2.5 X 2.5 cm indurated 3/4/2009 Child became limp, unable to hold h 3/3/2009 Child rcvd ADACEL, MENACTRA, F 2/26/2009 Per Mom and Dad; reporting to us t 3/2/2009 22 hours later had fever of 102.5 de 3/4/2009 Information has been received from 3/4/2009 Information has been received from 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a physici 3/3/2009 This case was reported by a physici 3/3/2009 This case was reported by a healthc
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3/5/2009 TX 3/5/2009 TX 3/5/2009 TX 3/5/2009 TX 3/5/2009 3/5/2009 PA 3/5/2009 CT 3/5/2009 AZ 3/5/2009 NM 3/5/2009 3/5/2009 CA 3/5/2009 VA 3/5/2009 OR 3/5/2009 OR 3/5/2009 OR 3/5/2009 OH 3/5/2009 PA 3/5/2009 TN 3/5/2009 NY 3/5/2009 NC 3/5/2009 OH 3/5/2009 KS 3/5/2009 MI 3/5/2009 IL 3/5/2009 GA 3/5/2009 MA 3/5/2009 MI 3/5/2009 PA 3/5/2009 CA 3/5/2009 NC 3/5/2009 TX 3/5/2009 MA 3/5/2009 MS 3/5/2009 CA 3/5/2009 CA 3/5/2009 IL 3/5/2009 NC 3/5/2009 GA 3/5/2009 CA 3/5/2009 AZ 3/5/2009 CA 3/5/2009 TX 3/5/2009 WA 3/5/2009 NC 3/5/2009 CA 3/5/2009 CA 3/5/2009 IL 3/5/2009 PA 3/5/2009 CA 3/5/2009 CT 3/5/2009 CT
22 54 0.2 66 14 82 0.3 1.1 12 14 11 41 14 28 83 49 34 39 12 1.3 55 5 26 77 12 49 67 25 1 4 65 1.3 1.3 16 3 14 4 62 0.2 62 1.3 13 4 10 0.2 57 1.6
22 54 0 66 14 0 1 12 14 11 41 14 28 49 34 12 1 55 5 26 77 12 49 67 25 1 4 1 1 16 3 14 4 62 0 62 1 13 4 1 0 57 1
U U U U F M 0.2 M F F F 0.3 M 0.1 M M M M F F M U F F F M 0.3 M M F F M F F M F 0F M F 0.3 F 0.4 U F M M F F 0.1 F M 0.3 M F M 0.3 F 0.2 F M 0.6 M
3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 I had the 1st GARDASIL vaccination 3/2/2009 Guillian-Barre Syndrome with loss o 2/27/2009 Vaccines administered 2/05/09 in m 3/2/2009 Approximately 4 days after immuniz 2/26/2009 Student dropped off at Mall. At 5:30 3/3/2009 Pt received ZOSTOVAX vaccine on 3/2/2009 Pt received IZ on 2/18/2009, mothe 3/2/2009 See attached. Neurologist's assessm 2/23/2009 Fainting after vaccines given. 2/23/2009 After 2 shots, pt complained of feeli 2/18/2009 Afternoon after am shot, mom called 2/1/2009 3 days post immunization pt. c/o wh 2/16/2009 Onset of fever, generalized aching 2 2/27/2009 PNEUMOVAX given IM Left deltoid Shingles broke out at 4:30 pm 11/08 2/27/2009 Came in today stating that the day a 3/2/2009 Hive like rash across abdomen with 3/2/2009 Pt got a large reddened area with ra R arm with severe redness/swelling 2/27/2009 Left thigh cellulitis. Treated with Om 3/2/2009 Hemorrhagic purpura - developed 4 2/27/2009 Left cervical lymphadenitis. 3/5/2009 I went in for the 1st of three Guardis 3/5/2009 Developed grouped papules and ve 3/5/2009 Within 5 minutes of injection, arms f 3/5/2009 49 yo WF was given IM Pneumovax 3/5/2009 redm wram swollen right bicep. trea 3/5/2009 RECEIVED YELLOW FEVER VACC 3/5/2009 Localized wheal (3 cm x 1 cm) and 3/5/2009 PATIENT DEVELOPED REDNESS 3/5/2009 Patient received flu shot at unknown 3/5/2009 Developed swelling of right eye with 3/5/2009 localized redness for two days at sit 3/5/2009 Mother called and reported that pati 3/5/2009 multiple wheals around injection site 3/5/2009 Austen was very anxious when give 3/5/2009 5cm x 5 cm Red, Swollen, Hardness 3/5/2009 received the vaccine at 3pm, februa 3/5/2009 Unconsolable crying for 6 hours afte 1/26/2009 Patient received pneumococcal vac 3/5/2009 Erythema and swelling of L upper th 3/4/2009 Pt had seizure while sitting and eati 3/5/2009 3/4/2009 at 7:30pm child had a seiz 3/5/2009 Had 2 doses of VARIVAX, develope 2/26/2009 After receiving all ten shots - PENTA 2/19/2009 Pain, tingling and weakness in legs, 3/5/2009 2 days later (after 3rd DTaP) leg fro
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3/5/2009 FL 3/5/2009 SC 3/6/2009 WA 3/6/2009 MO 3/6/2009 NY 3/6/2009 NC 3/6/2009 3/6/2009 CO 3/6/2009 IA 3/6/2009 WI 3/6/2009 PA 3/6/2009 CA 3/6/2009 NM 3/6/2009 MI 3/6/2009 MD 3/6/2009 WI 3/6/2009 WA 3/6/2009 WA 3/6/2009 FL 3/6/2009 PA 3/6/2009 NJ 3/6/2009 OH 3/6/2009 CO 3/6/2009 GA 3/6/2009 NJ 3/6/2009 WI 3/6/2009 WI 3/6/2009 AZ 3/6/2009 OR 3/6/2009 WA 3/6/2009 MT 3/6/2009 3/6/2009 3/6/2009 NC 3/6/2009 TX 3/6/2009 TX 3/6/2009 IL 3/6/2009 FL 3/6/2009 AR 3/6/2009 NY 3/6/2009 OH 3/6/2009 WV 3/6/2009 WI 3/6/2009 NJ 3/6/2009 MN 3/6/2009 NY 3/6/2009 OK 3/6/2009 MA 3/6/2009 NY 3/6/2009 CO 3/6/2009 PA
15 61 66 26 20 14 23 13 0.3 60 16 4 84 4 16 1 0.3 3 12 21 15 16 16 5 16 70 7 16 1.4 9 33 61 40 38 1.3 0.5 1.2 0.8 1.1 62 74 1.3 4 3 65 9 11 4 47 70 60
15 61 66 26 20 14 23 13 0 60 16 4 84 4 16 1 0 3 12 21 15 16 16 5 16 70 7 16 1 9 33
1 0 1 0 1 62 74 1 4 3 65 13 11 4 47 70 60
F F F F F F F F 0.3 M M F M F F M 0F 0.3 F M F F F F F M F F M M 0.4 M M F F M F 0.3 M 0.5 F 0.2 M 0.8 U 0.1 M F M 0.3 M M M F M F M M M F
3/4/2009 None stated 3/3/2009 Patient had swelling and soreness t 3/6/2009 Hives all over body, very large and r 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 1/30/2009 Lightheadedness. Malaise. Chills. H 2/10/2009 Pt described chest heaviness, naus 2/25/2009 L arm swelling and redness at sight 3/2/2009 Patient received shingles vaccine o 3/3/2009 Left arm red day after vaccines adm 2/27/2009 Pt got FLUMIST and came down wi 3/2/2009 Rash beginning one week after rece 3/2/2009 Pt was given PEDIARIX at 4mo. WC 2/18/2009 Pt was given Hep A vaccination, no 2/24/2009 Patients received HPV # 1 6-26-07. 2/28/2009 2/13/09 stabbing head pain, 2/14/09 2/11/2009 Tingling/numbness in left leg, move 3/2/2009 Mother stated generalized Rash in A 2/4/2009 Ongoing dizziness, dysautonomia, f 3/3/2009 My son age 5 was given the MMR/V 2/27/2009 Broke out in hives on 2/22/09. Wor 1/30/2009 Low grade fever, muscle aches, nau 1/30/2009 Swelling red hot left arm pain Tyleno 3/3/2009 Patient c/o nausea immediately afte 3/3/2009 3/1 Febrile seizure. about 0300 -> E 2/28/2009 Patient stood up after injection, walk 2/11/2009 Clt first noticed a blister at site of inj 3/4/2009 Received shingles vaccine- ZOSTA 2/21/2009 Attached. 2/27/2009 N/A 2/25/2009 Redness & swelling at injection site. 2/27/2009 Fussy, congestion, cough, decrease 2/28/2009 Pt presented to office on 2/28/09 wi Had swelling at site of injection 3/2/2009 Received PREVNAR injection 2/23/ 3/2/2009 Significant swelling, redness, erythe 3/2/2009 Redness & induration 10 inches aro 2/25/2009 Local reaction redness swelling 4 cm 3/3/2009 Patient c/o sore arm on 2-28-09. M 2/27/2009 Mild reaction right upper arm 2 - PN 2/20/2009 Phone call -> Per note from/by Dr. : 3/6/2009 3/5/2009 - Telephonce call from sch 3/6/2009 Approximately 24 hours after admin 3/6/2009 MMR Vaccine was administered on 3/6/2009 Headache, lymph node reacted and 3/6/2009 On 3/2/09 6 PM vacine given- head 3/6/2009 Pt noted a rash 2 days after adminis
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3/6/2009 AZ 3/6/2009 GA 3/6/2009 LA 3/6/2009 GA 3/6/2009 OR 3/6/2009 NY 3/6/2009 NC 3/6/2009 OK 3/6/2009 CA 3/6/2009 TX 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 AZ 3/6/2009 GA 3/6/2009 WA 3/6/2009 AL 3/6/2009 AL 3/6/2009 VA 3/6/2009 VA 3/6/2009 CA 3/6/2009 AZ 3/6/2009 CA 3/7/2009 GA 3/8/2009 3/8/2009 NJ 3/8/2009 KS 3/9/2009 ID 3/9/2009 AZ 3/9/2009 AZ 3/9/2009 TN 3/9/2009 TX 3/9/2009 MI 3/9/2009 TN 3/9/2009 TN 3/9/2009 MI 3/9/2009 MD 3/9/2009 MD 3/9/2009 CA 3/9/2009 MO 3/9/2009 NJ 3/9/2009 OH 3/9/2009 OH 3/9/2009 CT 3/9/2009 CA 3/9/2009 TN 3/9/2009 FL 3/9/2009 TN 3/9/2009 SC
62 17 1 11 5 80 36 12 32 47 5 16 69 0.4 11 7 0.6 25 1.3 1.3 34 26 46 15 66 1.1 9 46 20 17 15 67 61
62 17 1 11 5 80 35 12 32 48 5 16 69 0 11
14 17 17 52 4 5 64 17 14 11 13 0.5 16 12 1.7 68 8
14 17 17 52 4 5 64 17 14 11 13 0 16 12 1 68 6
0 25 1 1 34 26 46 66 1 9 46 20 17 67 61
F F 0M F F M M F F F M F F 0.4 M F U 0.6 M F 0.3 M 0.3 M M F F M M 0.1 F M F M F F F F U F F M F F M F F M F F 0.5 F F F 0.7 M F F
3/6/2009 Severe headache from back of neck 3/6/2009 RED WARM AREA TO RIGHT ARM 3/6/2009 Red bumps all over body that starte 3/6/2009 RED WARM AREA AROUND THE 3/6/2009 Patient received 4 vaccinations on 0 3/6/2009 PT. REC'D ZOSTER VAX. ON 1/29 3/6/2009 UNKNOW 3/6/2009 Patient received Gardasil and Mena 3/6/2009 The morning after receiving the Tda 3/6/2009 area became swollen and red, seve 3/6/2009 Patient developed fever and light se 3/6/2009 Sudden onset full body myalgia and 3/6/2009 Local side effect at injection site (R 3/6/2009 10 min after administrating ROTATE 3/6/2009 The day post vaccine child c/o pain None stated. 3/6/2009 At 2 months, patient had rash at loc 3/5/2009 Pt received #2 GARDASIL vaccine 3/6/2009 Vomiting occurred after having vacc 3/6/2009 Vomiting and low grade fever occur 3/6/2009 8 days post yellow fever vaccination 3/4/2009 Left upper arm cellulitis - treated wit 2/4/2009 Arthralgia - severe, malaise- severe 3/6/2009 Pt received TDAP. He developed fe 2/3/2009 Approx 4 hours after injection patien 3/7/2009 Moderate fever for several days the 3/8/2009 Crystallia sudamina rash developed 3/8/2009 Stiffness, very painful and swollen w 3/8/2009 Became highly anxious after vaccin 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received by a 3/6/2009 Information has been received from 3/4/2009 Initial report received 24 February 2 3/5/2009 Given TDAP & VARIVAX 3/3 0900 A 2/11/2009 Swelling at site of injection- Sorenes 1/22/2009 Pt received TDAP, HEP A, MENAC 2/27/2009 Client states onset of soreness + "S 2/26/2009 Pt received flu shot and came down 2/26/2009 Pt received flu shot and came down 2/23/2009 Shoulders up to neck-soreness still 3/3/2009 C/o frontal headache, neck pain, bo 3/6/2009 Severe leg pain, particularly in knee 2/27/2009 After 5th injection, pt. felt nauseated 2/27/2009 Immediately after 4th injection (HPV 3/5/2009 Fever approximately 7 PM 1/23. Ab 2/25/2009 Left arm/chest area pain and rednes 2/20/2009 10:00, nurse practitioner at clinic ph 3/4/2009 Rash covering body. 3/9/2009 Vaccine administered 0945 1/28/09 3/9/2009 Received flu shot on Thursday. Frid
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3/9/2009 MO 3/9/2009 GA 3/9/2009 MO 3/9/2009 MO 3/9/2009 MN 3/9/2009 IA 3/9/2009 CO 3/9/2009 MI 3/9/2009 MA 3/9/2009 DE 3/9/2009 NC 3/9/2009 NC 3/9/2009 TX 3/9/2009 CA 3/9/2009 NV 3/9/2009 NV 3/9/2009 CA 3/9/2009 AZ 3/9/2009 IN 3/9/2009 WI 3/9/2009 OH 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 GA 3/9/2009 AZ 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 GA 3/9/2009 MO 3/9/2009 NY 3/9/2009 WA 3/9/2009 WA 3/9/2009 WA 3/9/2009 IN 3/9/2009 FL 3/9/2009 TN 3/9/2009 FL 3/9/2009 TX 3/10/2009 NC 3/10/2009 3/10/2009 3/10/2009 KS 3/10/2009 NY 3/10/2009 NH 3/10/2009 3/10/2009 WV 3/10/2009 CO 3/10/2009 NC
26 23 1 3 1.3 1.3 4 17 60 1 14 1 62 23 2 3 66 4 2 64 22 1 1 1 1.7 4 11 1.2 4 4 15 5 1.5 75 65 51 1 4 5 12 56 2
26 23 1 3 1 1 4 17 60 1 14 1 62 23 2 3 66 4 2 64 22 1 1
60 8 12 63 17 0.5 17
60 8 12 63 17 0 17
1 4 11 1 4 4 15 5 1 75 65 51 1 4 5 12 56 2
F F 0F M 0.3 M 0.3 M F F F 0F M 0F M F 1M M F M 0.8 F F M 0F 0M F 0.7 F M F 0.2 F M F F M 0.5 F F F F 0F F M M M 0M F U M F F F F 0.5 M F
2/27/2009 Immediately flushed and hot with in 3/9/2009 Pt presented on 2/11/09 and had a 10/1/2008 Child started having a rash on face ### 10-10 a.m. - swollen right thigh, red 3/9/2009 patient received vaccine on 3/3/09 i 3/9/2009 Diarrhea since 3-6-09; Bloody nose 3/9/2009 pain, swelling, erythema, itching, sig 3/9/2009 HAD HEADACHE AND GENERALI 3/9/2009 Vaccine administered 3/5/2009 3 pm 3/9/2009 Patient developed high fever, erythe 3/9/2009 Redness,swelling,heat and firmness 3/9/2009 Mom reports a blister, smaller than 3/9/2009 i got the shingles vaccine that my D 3/9/2009 Left deltoid area swollen, tender and 3/9/2009 A week after DTAP given mom repo 3/9/2009 72 hours offer IPV given child has d 3/9/2009 3/05- shot given. 3/06- arm swelled 3/9/2009 Swollen red R upper area > resolve 3/6/2009 Cellulilitis L thigh around vaccine ad 3/9/2009 Pt reports she saw Dr for "horrible b 3/9/2009 Approx 10-15 minutes after injection 2/26/2008 Redness, induration and warmth at 2/26/2008 Redness, induration and warmth at 2/26/2009 Redness, induration and warmth at 3/4/2009 Broke out small rash over left upper 3/6/2009 Child developed a tight cough and p 2/24/2009 C/O join pain, and pain in arm of AD 3/9/2009 Warm to touch, redness 6 1/2cm X 3/9/2009 3/4 vaccine; 3/5 arm swelling redne 3/8/2009 Local redness, 2"/3" on Rt. thigh. M 9:15 am 3/3/09 Pt. received HEP A 3/9/2009 Local reaction to IMM. Left deltoid x 3/9/2009 Developed generalized pink maculo 10/1/2008 11 x 19 cm raised, red urticarial-app 10/8/2008 Pt experienced pain, redness and s 9/26/2008 Client walked into clinic stating she 2/26/2009 Rash 3/9/2009 Left leg with Baseball sized knot wa 3/9/2009 Temperature has been normal, it is 3/7/2009 Patient developed rash to left chest 3/6/2009 Fever, myalgias, N/V and arthralgia 3/10/2009 Fourteen days after his vaccine he r 3/9/2009 Information has been received from 3/9/2009 Information has been received from 3/9/2009 Information has been received from 3/4/2009 Bilateral weakness in legs and urina 2/12/2009 8/1/08- 1st shot- fainting began, hea 3/6/2009 Patient was given ZOSTAVAX vacc 3/5/2009 Within 5 minutes after vaccination c 2/27/2009 Pt had no adverse rxn, doctor did no 2/25/2009 Pt has a history of tic disorder in Jan
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3/10/2009 CA 3/10/2009 WI 3/10/2009 VT 3/10/2009 GA 3/10/2009 NM 3/10/2009 TX 3/10/2009 OR 3/10/2009 PA 3/10/2009 3/10/2009 3/10/2009 MA 3/10/2009 NY 3/10/2009 NJ 3/10/2009 MN 3/10/2009 NM 3/10/2009 MN 3/10/2009 CA 3/10/2009 NJ 3/10/2009 VA 3/10/2009 OK 3/10/2009 NC 3/10/2009 MD 3/10/2009 CT 3/10/2009 VA 3/10/2009 FL 3/10/2009 OK 3/10/2009 PR 3/10/2009 IN 3/10/2009 FL 3/10/2009 MI 3/10/2009 PA 3/10/2009 NY 3/10/2009 OR 3/10/2009 NC 3/10/2009 PA 3/10/2009 PA 3/10/2009 MN 3/10/2009 HI 3/10/2009 IN 3/10/2009 IA 3/10/2009 MO 3/10/2009 GA 3/10/2009 WI 3/10/2009 CA 3/10/2009 WA 3/10/2009 CO 3/10/2009 CA 3/10/2009 NJ 3/10/2009 IL 3/10/2009 CO 3/10/2009 TX
14 4 1.5 54 59 77 11 66 13 63 24 31 5 12 2 32 61 4 71 57 13 44 53 42 7 30 14 1 29 17 16 1.3 0.6 61 56 52 20 33 1.3 5 2 42 24 1 15 0.2 26 0.3 7 57 66
14 4 1 54 59 77 11 66 13 24 31 5 12 2 32 61 4 71 57 13 44 53 42 7 30 14 1 29 17 16 1 0 61 52 20 33 1 5 2 42 24 1 15 0 26 0 7 57 66
F F 0.5 M F F U F F F F F F M F 0F M F F M F M M F M M F F 0F F F F 0.3 M 0.6 M F U M F M 0.3 F F 0.7 F F M 0F F 0.2 F F 0.2 M F F F
2/26/2009 Dizzy episode after 1st GARDASIL 3/4/2009 4-6 cm redness left deltoid & soft tis 3/5/2009 Patient spike a fever of 102, becam 2/19/2008 Patient experienced nausea and itc 3/6/2009 Red Rash covering 5 inch Diameter None Stated 3/5/2009 Painful red and swollen x 4 days; be 3/6/2009 Large, red, swollen, itchy lump hurts 3/5/2009 Around February of this year my da 3/5/2009 Recd vaccine on Tues. 3/2/09 abou None Stated 3/18/09-records receiv 3/5/2009 Headache, nausea, vomiting, fatigu 2/25/2009 Per father - child experienced occas 2/24/2009 Day #1 following vaccinations finger 3/2/2009 Red rash & small vesicles on neck, 3/3/2009 Mild dizziness. 3/5/2009 Swelling and puffy red @ site and a 3/7/2009 DTAP shot to my 4 yr old within 8 hr 3/5/2009 Onset of redness only 1hr after sho 1/30/2009 Fever 100.5, myalgias, with redness 3/6/2009 Hives. 3/10/2009 This case was reported by a lawyer 3/10/2009 This case was reported by a lawyer 3/10/2009 Flu Mist administered as part of ann 3/10/2009 sudden paleness, weakness, dizzin 3/10/2009 This Tdap was given as no history o 3/10/2009 PATIENT REFERS DIZZINESS, PE 3/10/2009 Developed 4cm red hive with centra 3/10/2009 Developed shortness of breath, hive 3/10/2009 Within 1 minute of receiving Menact 3/10/2009 After getting the gardasil vaccine th 3/10/2009 RECEIVED 15 MONTH SHOTS 4 D 3/10/2009 Patient started jerking/seizure for ab 3/10/2009 injection site reaction: redness and 3/10/2009 Subject in pneumococcal vaccine tr 3/10/2009 Subject in pneumococcal Y vaccine tr 3/10/2009 Fever, Nausea and vometing, ment 3/10/2009 Onset of bilateral profound bilateral 3/10/2009 At 4:45 PM child felt warm. Mother 3/10/2009 Less than 5 mins after Varivax given 3/10/2009 Mother presented to office with child 3/10/2009 On 03/10/2009 at approximately 2:4 3/10/2009 Pt c/o extremely sore arm with mild 3/10/2009 Child seen in health center on 03/04 3/10/2009 Pt felt dizzy a few minutes after HPV 3/10/2009 The patient received 0.4cc of Infant 3/10/2009 I received my first and only dose of 3/10/2009 Immediately after vaccination, a few 3/10/2009 Within 16 hrs, had sore arm, legs, h 3/10/2009 Patient was given her first flu shot w 3/10/2009 Onset 3/10/09 2 red areas 1 to inne
341483 341484 341486 341487 341488 341489 341490 341491 341492 341494 341496 341499 341510 341514 341516 341517 341518 341519 341520 341521 341522 341523 341524 341525 341526 341527 341528 341529 341530 341531 341532 341533 341534 341535 341536 341537 341538 341539 341540 341541 341542 341543 341544 341545 341546 341547 341548 341549 341550 341551 341552
3/10/2009 OR 3/10/2009 AZ 3/10/2009 WA 3/10/2009 AK 3/10/2009 AL 3/10/2009 AK 3/11/2009 MI 3/11/2009 KY 3/11/2009 3/11/2009 3/11/2009 MO 3/11/2009 CA 3/11/2009 3/11/2009 FL 3/11/2009 FL 3/11/2009 CA 3/11/2009 TX 3/11/2009 TX 3/11/2009 NC 3/11/2009 FL 3/11/2009 MO 3/11/2009 NY 3/11/2009 TX 3/11/2009 MA 3/11/2009 CO 3/11/2009 FL 3/11/2009 WA 3/11/2009 WI 3/11/2009 OH 3/11/2009 WV 3/11/2009 TX 3/11/2009 CT 3/11/2009 TX 3/11/2009 MO 3/11/2009 NC 3/11/2009 NC 3/11/2009 GA 3/11/2009 TX 3/11/2009 KS 3/11/2009 KS 3/11/2009 NC 3/11/2009 AL 3/11/2009 MN 3/11/2009 NY 3/11/2009 AL 3/11/2009 CT 3/11/2009 IL 3/11/2009 WA 3/11/2009 KY 3/11/2009 OR 3/11/2009 WI
40 73 1.6 19 15 72 80 0.4 3 13
40 73 1 19 15 72 0
13
55 53 53 32 67 25 1.2 1.1 12 0.2 17 14 16 4 8 0.2 12 11 35 1.5 1.3 0.2 37 31 1 7 11 71 1.3 48 13 79 4 0.4
55 53 53 32 67 25 1 1 12
23 1.5 21
23 1 21
17 14 16 4 8 0 12 11 35 1 1 0 37 31 1 7 11 71 1 48 13 79 4 0
F M 0.6 M F F F F 0.4 M M M F U U F F M F F M 0.2 M 0.1 F F F M F F M F 0.2 F F M M 0.5 M 0.3 F 0.2 M F F 0F F M F 0.3 F F M F F 0.4 M F F 0.5 F F
3/10/2009 TDAP given 2/27/2009. (left deltoid) 1/7/2009 Rash on trunk and local swelling, pa 5/14/2008 Swollen x 48 hours-entire leg 2x NL 3/4/2009 12/8/08 - Rt shoulder tenderness, p 3/9/2009 None stated 3/5/2009 Localized redness and tenderness t 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/11/2009 This case was reported by a healthc 3/10/2009 This case was considered medically 3/6/2009 Initial information was received on 2 3/3/2009 I was told by the hospital that I had 3/11/2009 Swelling to injection site, no rednes 3/11/2009 Pt. reported: Had L) upper arm swe 3/10/2009 Left SQ red area size of 1/2 dollar 3/11/2009 26 y/o male ADMS is referred to the 3/11/2009 About 10 minutes after vaccines ad 3/11/2009 Came in 3-9-09 with 101-102 degre 3/11/2009 Given HPV & MENACTRA @ 08:30 3/9/2009 Lethargy, poor feeding for 7-10 day 3/6/2009 Site of injection started to ache 3/5/ 3/6/2009 Vaccine administered 3-3-09, on 3-4 3/5/2007 After administering Tdap vaccine th 3/5/2009 10 x 8cm area of erythema/tenderne 3/4/2009 Rash and cellulitis secondary to imm 3/9/2009 Excessive (inconsolable) crying ove 3/8/2009 Vasovagal syncope- twice, oral fluid 3/9/2009 Immediate itching/hiving @ site & lip 3/6/2009 Felt hot and sweaty about 30 min af 3/6/2009 Fever high of 104 degree F vomiting 3/2/2009 Received Dtap + PREVNAR on 2-5 2/19/2009 High pitched scream, inconsolable f 3/4/2009 Fever and chills started about 9 hou 3/5/2009 2/23/09- Dizziness, body aches, fev 3/6/2009 Developed VARICELLA lesions 9 d 3/10/2009 Rash on arms and torso consistent 3/10/2009 Rush on checks, forearms, hands s 3/10/2009 Patient thought she had shingles, n Vomiting onset 3 hrs after vaccine la 3/10/2009 Received TDAP 3/6/09. Within 1-2 d 2/5/2009 Patient received a 3rd dose of varic 3/10/2009 Small red rash around injection site, 3/11/2009 8X11 cm induration at site of KINRI 3/9/2009 None stated 3/5/2009 On 3/2 pneumonia vaccine was give 3/10/2009 Employee complains of dizziness ap Mother reports evening 3/05/09 Pt d 3/11/2009 Self innoculated self on Right index
341553 341554 341555 341556 341557 341558 341559 341560 341561 341562 341563 341564 341565 341566 341567 341568 341569 341570 341572 341573 341574 341575 341576 341577 341578 341579 341580 341581 341582 341775 341776 341777 341778 341779 341780 341781 341782 341783 341970 341971 341973 341974 341571 341584 341587 341588 341589 341593 341599 341600 341601
3/11/2009 OH 3/11/2009 MN 3/11/2009 AZ 3/11/2009 CA 3/11/2009 ID 3/11/2009 WA 3/11/2009 ND 3/11/2009 PA 3/11/2009 KY 3/11/2009 CA 3/11/2009 MD 3/11/2009 IL 3/11/2009 IA 3/11/2009 MO 3/11/2009 IL 3/11/2009 TX 3/11/2009 AK 3/11/2009 CA 3/11/2009 CA 3/11/2009 OR 3/11/2009 CA 3/11/2009 CA 3/11/2009 GA 3/11/2009 NJ 3/11/2009 MO 3/11/2009 IL 3/11/2009 IN 3/11/2009 OH 3/11/2009 IL 3/11/2009 NY 3/11/2009 NY 3/11/2009 NY 3/11/2009 PA 3/11/2009 PA 3/11/2009 DE 3/11/2009 PA 3/11/2009 NY 3/11/2009 IN 3/11/2009 TX 3/11/2009 TX 3/11/2009 TN 3/11/2009 MD 3/12/2009 IN 3/12/2009 PA 3/12/2009 3/12/2009 3/12/2009 3/12/2009 IN 3/12/2009 KY 3/12/2009 3/12/2009 PA
4 13 21 22 41 70 22 63 0.5 1.3 0.5 30 3 1 43 0.5 35 43 64 4 46 18 0.5 17 25 5 1 38
4 13 1 21 22 41 70 22 64 0 1 0 30 2 1 43 0 35 43 4 46 18 0 17 25 5 1 38
5 5 1.5 2 1.3 26 13 14
5 5 1 2 1 26 13 14
12 26 74
12 26
34 1 1.1 65
34
4
4
1 65
F F 0.2 M F F F F F F 0.5 F 0.3 F 0.5 F M 0.9 F 0M F 0.5 F F M F M F F 0.5 F M M F 0F M U U U M M 0.5 M 0.4 F 0.3 F F F F F F F F U F M 0.1 F F U F
3/11/2009 Mom reports pt with hard red area 2 3/11/2009 October, 2007 - Back and Hip pain 3/11/2009 EXPOSE TO CHICKEN POX AT DA 3/11/2009 I got a concussion and with the stitc 3/11/2009 Patient vaccinated with Flu vaccine 3/11/2009 pain, swelling, redness, hotness, ha 3/11/2009 Red- blistery patches and itchy with 3/11/2009 Following Tdap vaccine patient dev 3/11/2009 Herpes zoster rash 2 x 4 cm right th 3/11/2009 Death 7 days Y later 4/20/-09-autopsy 3/11/2009 VACCINATION SITE BECAME RED 3/11/2009 On 3/7/09, pt developed intermitten 3/11/2009 Approximately 7 hours after vaccina 3/11/2009 Kinrix was given to this patient. No r 3/11/2009 developed area of erythema (1 cm d 3/11/2009 PATIENT CLAIMS THAT AS SOON 3/11/2009 10m 3 wk old had INTUSSUSCEPT 3/11/2009 MONDAY(9 MARCH 2009): EVENIN 3/11/2009 Patient just wanted to touch basis w 3/2/2009 (1) welt / swelling at site 5" long X 2 3/10/2009 Erythematous, edematous at vaccin Non stated. 12/9/2008 8-19-08 Slurred speech. 8-13-08 Eq 3/11/2009 Head bobbling; Questionable seizur 3/11/2009 Following Immunizations client sittin 3/11/2009 No adverse events 3/11/2009 Patient received DTaP, IPV, MMR a 3/10/2009 Rash and fussy 20 days after admin 3/9/2009 Generalized rash similar to classic m 5/12/2008 This report was received from a hea 5/12/2008 This report was received from a hea 5/12/2008 This report was received from a hea ### Initial report was received 04 Septe ### Initial report received on 15 Septem 10/7/2008 Initial information was received from ### Initial report was received 17 Octob 7/18/2008 This case was received from a cons 9/26/2008 Initial report received on 22 Septem 1/9/2009 A 13-year-old female patient with a ### Initial report was received 12 Decem ### Initial report received from a physici ### Initial information was received on 1 3/12/2009 Head to toe rash, respiratory distres 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/10/2009 Patient diedY1-11-09. Had received 3/5/2009 Kidney involvement, nerve inflamma 3/6/2009 Red Lumps all over. 3/9/2009 Lump under surface of skin. Small a
341602 341603 341604 341605 341606 341607 341608 341609 341610 341611 341612 341613 341614 341615 341616 341617 341618 341619 341620 341621 341622 341623 341624 341625 341626 341627 341628 341629 341630 341631 341632 341633 341634 341635 341636 341638 341639 341640 341641 341642 341643 341644 341645 341646 341647 341648 341649 341650 341651 341652 341653
3/12/2009 TX 3/12/2009 VA 3/12/2009 CA 3/12/2009 NC 3/12/2009 OH 3/12/2009 ME 3/12/2009 WI 3/12/2009 WI 3/12/2009 NJ 3/12/2009 FL 3/12/2009 3/12/2009 IL 3/12/2009 NC 3/12/2009 TX 3/12/2009 VA 3/12/2009 OK 3/12/2009 CT 3/12/2009 FL 3/12/2009 MO 3/12/2009 DC 3/12/2009 NE 3/12/2009 NY 3/12/2009 GA 3/12/2009 NC 3/12/2009 NC 3/12/2009 WA 3/12/2009 IN 3/12/2009 WA 3/12/2009 AZ 3/12/2009 MO 3/12/2009 CA 3/12/2009 NC 3/12/2009 OR 3/12/2009 TX 3/12/2009 NC 3/12/2009 VT 3/12/2009 CA 3/12/2009 MA 3/12/2009 TX 3/12/2009 CA 3/12/2009 IL 3/12/2009 3/12/2009 VT 3/12/2009 AK 3/12/2009 CA 3/12/2009 CA 3/12/2009 OR 3/12/2009 OH 3/12/2009 IL 3/12/2009 NM 3/12/2009 PA
68 4 68 1.5 16 4 5 13 15 1.1
68 4 68 1 16 4 5 13 15 1
1 1.9 4 0.8 2 15 2 0.5 40 30 27 11 19 18 64 25 56 0.3 0.5 1 3 60 11 37 13 13 4 11 47 1.3 65 1.2 5 1.2 4 62 20 7 4 15
1 1 4 0 2 15 2 0 40 30 27 11 19 18 64 56 0 0 1 3 60 11 37 13 13 4 11 47 1 1 5 1 4 62 20 7 4 15
F F M 0.5 F F F F F F 0.1 F U 0F 0.9 M F 1M 0.7 M M 0.2 F 0.5 M F F F F M M M F F 0.3 F 0.5 F 0F F M F F F M M M F 0.3 M F 0.2 M M 0.2 M M F F F F M
3/6/2009 Localized redness and itching past 3/5/2009 7" area of induration, warmth, erythe 3/6/2009 Malaise, anorexia, SOB on mild exe 3/3/2009 None. Tdap given instead of DTap # 3/9/2009 Patient began noticing rash on ches 3/9/2009 Vaccines administered to patient. P 3/10/2009 Low grade 99 degree-102.4 degree 3/6/2009 Father reports his daughter has had 3/10/2009 Rt arm red, swollen, firm, hot @ are 3/6/2009 Rash all over. 3/6/2009 Bumps all over. 3/7/2009 Vaccine > PREVNAR / VARIVAX a 3/6/2009 Approx. 1 hr after receiving immuniz 3/6/2009 1) Pt. comes in 3 days later. Her VA 3/12/2009 vomiting x 1 day; afebrile and fine th 3/12/2009 erythematous swelling at the site of 3/12/2009 MOM CALLED STATING CHILD HA 3/12/2009 Pt. mother state child had a fever, h 3/12/2009 PENTACEL IMMUNIZATION GIVEN 3/12/2009 Patient with difficulty breathing, itch 3/12/2009 Had Tdap on 3-10-09, right deltoid. 3/12/2009 Appoximately 25 minutes after Stac 3/12/2009 03/11/2009 13:45 Immunization adm 3/12/2009 1. PT hospitalized 4 months prior to 3/12/2009 PT recieved anthrax shot and one h 3/12/2009 Received Shingles Vaccine Zostava 3/12/2009 I never had any types of warts. Afte 3/12/2009 Got Bronchitis and flu like symptom 3/12/2009 Diagnosed with intussusception 8 d 3/12/2009 PENTACEL IMMUNIZATION GIVEN 3/12/2009 ON 2/24/09, AN MMR AND A VARI 3/12/2009 swelling and redness of left deltoid r 3/12/2009 Developed shingles 19 days followin 3/12/2009 MOM STATE FEW MINUTES AFTE 3/12/2009 Major pain at and around injection s 3/12/2009 Mom is requesting VAERS done...o ### Pt has severe headache and was a 3/12/2009 Local reaction w/ erythematous rash 3/12/2009 Injection of VARIVAX (L) shoulder 3/11/2009 Headache, joint aches/pains, chills 3/12/2009 Rash and fever developed 1 week a 3/12/2000 Pt was given Td & pneumonia vacc 3/12/2009 Red, swollen, hard, lump "the size o 3/5/2009 Immunization, INFANRIX, given on 3/12/2009 3/9/09 IZ received @ bedtime T-101 3/10/2009 Pt brought in by aunt to have PPD r 3/10/2008 Pt states her (L) arm has been sore 3/12/2009 Headache, vertigo, tingling in arms, 3/12/2009 Dad noted late on 3-9-09 a red swo 3/12/2009 One hour after injection c/o severe p 3/12/2009 24 hours after shot given swollen fo
341654 341655 341656 341657 341658 341659 341661 341662 341663 341664 341665 341666 341667 341668 341669 341670 341671 341672 341673 341674 341675 341693 341694 341695 341696 341698 341699 341700 341701 341702 341703 341704 341705 341706 341707 341708 341709 341710 341711 341712 341713 341714 341715 341716 341717 341718 341719 341720 342122 342123 342676
3/12/2009 AZ 3/12/2009 3/12/2009 VA 3/12/2009 NJ 3/12/2009 IA 3/12/2009 GA 3/12/2009 SC 3/12/2009 NY 3/12/2009 NC 3/12/2009 NH 3/12/2009 PA 3/12/2009 CO 3/12/2009 3/12/2009 AZ 3/12/2009 3/12/2009 3/12/2009 CA 3/12/2009 PA 3/12/2009 CO 3/12/2009 UT 3/12/2009 IN 3/12/2009 NC 3/12/2009 NM 3/12/2009 3/12/2009 NY 3/12/2009 CT 3/12/2009 3/12/2009 CA 3/12/2009 MI 3/12/2009 GA 3/12/2009 NY 3/12/2009 NY 3/12/2009 NY 3/12/2009 MO 3/12/2009 3/12/2009 3/12/2009 3/12/2009 3/12/2009 IN 3/12/2009 3/12/2009 MD 3/12/2009 SD 3/12/2009 MO 3/12/2009 3/12/2009 NE 3/12/2009 MO 3/12/2009 3/12/2009 NE 3/12/2009 3/12/2009 NY 3/12/2009 CO
6 71 33 74 20 0.4 61 4 42 11 8 19
6 71 33 74 20 0 61 4 42 11 8 19
0.5 64 0.5 16 18 15 13 17 0.8 1.2 1.1 2 3 5 1.1 1.5 1.3 0.3 0.6 0.2 0.2 6 1 5 0.4 0.2 0.5 0.2 0.3 0.2 0.3
0
18 15 17 0 1 1
5 1 1
0 0
0 0 0 0 0 0 0
0.2 0.2 0.4
0 0 0
9 5
5
F F U F F 0.4 F F M M M F F F 0.5 F F F F F F F F 0.8 M 0.2 F 0.1 M M F F 0.1 M 0.5 F F F F 0.2 M 0.2 M F M F 0.4 F 0.2 F 0.5 F 0.2 F 0.3 M 0.2 F 0.3 F F 0.2 F 0.2 M 0.4 M M U M
3/12/2009 (L) swollen arm. Pt. had adverse RXN to PCV Pt. req 3/12/2009 Pt woke with tingling in the heel sur 15 min after ZOSTAVAX numbness 3/10/2009 Within Minutes of receiving HPV vac 3/11/2009 5 days after receiving PENTACEL, P 3/12/2009 Redness, swelling at site of vaccina 3/12/2009 Left deltoid area, red, swollen and w 3/12/2009 PNEUMOVAX administered SQ R a 3/11/2009 (L) hive shaped 9 x 9 cm erythema 3/12/2009 Administered KINRIX as "catch up" 3/12/2009 Pt developed mild case of pyelonep 3/6/2009 Information has been received from 2/24/2009 Initial and follow up information has 2/18/2009 Information has been Roche Pharm 2/24/2009 Information has been received from 2/27/2009 Initial report received on 24 Februar 2/27/2009 Initial report received 23 February 2 3/4/2009 Initial report received 23 February 2 2/24/2009 This non serious case was received 2/20/2009 Initial report received on 11 Februar 2/18/2009 Initial and follow-up information has 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Initial and follow up information has 2/18/2009 Initial and follow-up information has 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received rega 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received for a 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 4/3/2008 This adult male (unknown age) took Initial report was received on 22. Ju 3/12/2009 This case was reported by a physici
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3/13/2009 WA 3/13/2009 IL 3/13/2009 NV 3/13/2009 NY 3/13/2009 TX 3/13/2009 WA 3/13/2009 NY 3/13/2009 IN 3/13/2009 3/13/2009 UT 3/13/2009 IL 3/13/2009 FL 3/13/2009 OH 3/13/2009 OK 3/13/2009 CO 3/13/2009 AK 3/13/2009 CA 3/13/2009 IA 3/13/2009 MI 3/13/2009 NC 3/13/2009 MI 3/13/2009 NC 3/13/2009 OK 3/13/2009 PA 3/13/2009 CA 3/13/2009 OH 3/13/2009 VA 3/13/2009 KY 3/13/2009 CT 3/13/2009 KY 3/13/2009 OR 3/13/2009 PA 3/13/2009 CA 3/13/2009 CA 3/13/2009 CA 3/13/2009 MD 3/13/2009 OR 3/13/2009 AK 3/13/2009 CA 3/13/2009 CA 3/13/2009 VA 3/13/2009 NC 3/13/2009 WI 3/13/2009 KY 3/13/2009 IA 3/13/2009 MA 3/13/2009 AZ 3/13/2009 ME 3/13/2009 NJ 3/14/2009 VA 3/14/2009 MD
1.7 48 5 4
1 48 5 4
65 31 72 16 15
65 31
4 26 36 1.3 55 0.3 1 49 5 18 50 4 62 4 23 3 0.2 17 4 59 70 1.1 1.4 11 42 2 0.3 4 5 12 4 4 1.3 22 14 0.2 16 4 24 1.4
4 26 36 1 55 0 1 49 5 18 50 4 62 4 23
16 15
0 17 4 59 1 1 11 42 2 0 4 5 12 4 1 22 0 4 24 1
0.7 F F M M F F M M F F M M F F 0.3 M F 0.4 M 0F F M F F F M F F M 0.2 M F F F F 0.1 M 0.4 F F F 0.5 F 0.3 M F M M F F 0.3 M F F 0.2 F F M M 0.5 F
3/13/2009 Geneva was given vaccines on 2/25 3/13/2009 First symptoms was my left arm whe 3/6/2009 MOC (mother of child) called to clini 3/9/2009 E. multiforme rash in palms and pla Red rash around shot area. Tingling 3/6/2009 Developed fever 101.8 with chills; re 2/9/2009 Induration and erythema 10X13 cm 3/12/2009 Information has been received from 3/12/2009 Information has been received from 3/12/2009 Information has been received from 3/11/2009 Initial information was received on 0 3/13/2009 RIGHT THIGH BECAME RED, WAR 3/13/2009 MEMBER RECIEVED ANTHRAX V 3/13/2009 reddness, swelling, nausea, headac 3/13/2009 Mother reports the following: Child h 3/13/2009 10/31/08 5pm c/o sore right armpit, 3/13/2009 URTICARIA PRESENTED ITSELF 3/13/2009 DEVELOPED HERPES ZOSTER 5 3/13/2009 One week after immunization she n 3/12/2009 LOCAL REATION OF LEFT ARM. A 3/13/2009 Pt has experienced pain in R arm co 3/13/2009 terrible back, neck shoulder and hea 3/13/2009 MOTHER BROUGHT PATIENT IN 3/13/2009 Rash - 2-3" long by 1&1/2" oval. It i 3/13/2009 RASH & REDNESS ON VACCINAT 3/13/2009 Rash of small blisters in a circular p 3/13/2009 Difficulty with balance within an hou 3/12/2009 Mother stated baby cried nonstop fo 3/12/2009 5 x7 cm induration approx 12 hrs af 3/12/2009 Child was given DAPTACEL on 3-5 3/13/2009 Approximately 24 hours after admin 2/14/2008 Swollen injection site - repeated Be 3/13/2009 rash on body x 2 weeks. Pt got chic 3/13/2009 Localized redness, swelling at site o 3/13/2009 Localized redness, swelling at site o 3/13/2009 On 3/11 in eve., pt. noted onset "sti 3/13/2009 Pt received HIB and DTAP into left 3/11/2009 102 Rectal temp Friday eve 3/06/09 3/13/2009 Approximately 24 hours after receiv 3/13/2009 Large erythematous hyperemic plaq 3/1/2009 12:30 Hives developed on right sho 3/13/2009 Sx: Vessicular erruption with subse 3/13/2009 Generalized rash - hives on chest, b 3/13/2009 Mom noticed he had hives / whelps 3/12/2009 Lt arm swollen, hives (Lt arm), Lt ar 3/13/2009 Received ADACEL 430 PM. 3/11 T 3/12/2009 Within 24 hrs after receiving ROTAV After GARDASIL #3 Pt. c/o stomach 3/12/2009 Approximately 10 minutes following 3/14/2009 Localized Urticaria around (L) Delto 3/14/2009 small amount of hives noted in groin
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3/14/2009 KS 3/15/2009 VA 3/15/2009 NC 3/15/2009 CA 3/15/2009 TN 3/15/2009 PA 3/15/2009 WA 3/16/2009 CO 3/16/2009 PA 3/16/2009 LA 3/16/2009 3/16/2009 PA 3/16/2009 OH 3/16/2009 GA 3/16/2009 CA 3/16/2009 NC 3/16/2009 NJ 3/16/2009 WA 3/16/2009 FL 3/16/2009 SC 3/16/2009 OH 3/16/2009 CA 3/16/2009 NY 3/16/2009 CO 3/16/2009 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 CO 3/16/2009 CA 3/16/2009 FL 3/16/2009 CA 3/16/2009 TX 3/16/2009 WV 3/16/2009 3/16/2009 MA 3/16/2009 SD 3/16/2009 MO 3/16/2009 MO 3/16/2009 CA 3/16/2009 LA 3/16/2009 WI 3/16/2009 OH 3/16/2009 WI 3/16/2009 WI 3/16/2009 NY 3/16/2009 TX 3/16/2009 MN 3/16/2009 KS 3/16/2009 FL 3/16/2009 HI
12 20 28 0 26 70 6
12 20 28 0 26 70 6
84 4
84
0.3 0.3 11 0.4 48 1.1 0.3 11 1.1 5 4 15 1.6 65 12 62 18 3 9 1 1.3 48 81 31 0.4 6 1.2 1 1.1 13 5 46 43 43 11 44 58 57 25 12
0 0 11 0 48 1 0 11 1 5 4 15 1 65 62 18 3 9 1 48 81 31 0 6 0 1 1 13 5 46 43 43 11 44 58 55 25 1
F F F 0F F F M F M M M 0.3 M 0.3 F F 0.4 M F 0.1 M 0.3 M M 0.1 F F F M 0.6 M F F F M M M 0F M F F M 0.4 M M 0.3 F 0F 0.1 M F F F M M M F F F F 0M
3/14/2009 dizziness and seizures. 4/16/09 MR 3/15/2009 encephalitis 24 h after guardasil vac 3/15/2009 Vaccine administered as part of rou 3/15/2009 Was administered Hep B vaccinatio 3/15/2009 After recieving first round of Gardas 3/15/2009 Severe red burning rash on arm 4in 3/15/2009 L upper thigh with erythematous, te 3/12/2009 Initial report received from another m 3/13/2009 Information has been received from 3/13/2009 This report was received from Glaxo 3/13/2009 Information has been received from 3/10/2009 About 2 weeks s/p ROTATEQ vacci Immunizations given 2-26-09 had n 3/10/2009 Left arm- 5.5 - 6.5cm SL. red soft ar 3/10/2009 None at this time 3/12/2009 On 2-18-09 sudden onset of knot in 2/19/2009 Developed urticarial lesions on back 3/11/2009 Mom stated child cried 4-5 hours aft 3/13/2009 Pt had episode of a fainting spell/?s 3/10/2009 Had shots 3/4/09 (MMR, VARIVAX, 3/10/2009 C/O sore left arm at 8am, around 93/5/2009 Mother states noticed L arm swollen 3/9/2009 Pt c/o right arm pain started 24 hou 3/9/2009 Acute cerebellar ataxia 3/3/2009 Pt had severe outbreak of herpes zo 3/12/2009 GARDASIL injection, fever headach 3/10/2009 THIS IS AN UNEXPECTED GOOD 3/11/2009 Immediately after receiving Hepatitis 3/12/2009 Swollen area of shot. immobility - m 3/5/2009 Lip/ facial/ oropharyngeal swelling. V 3/11/2009 Itchy rash covering body. 3/4/2009 5x11 cm erythema with induration a 3/9/2009 The pneumonia vaccine was given 3/10/2009 Left clinic after injection + returned t 2/23/2009 None Stated 3/16/2009 Patient had an ileo-colic intussusce 3/16/2009 High fever, hysterical laughing, non 3/10/2009 3-3-09 Child's mom reported fever, 3/16/2009 Rec telephone call on 3/11/09 from 3/16/2009 This child received 2 doses of Varic 3/16/2009 Returned to facility approximately on 3/16/2009 Mother reported very hard, red, war 3/16/2009 Received Boostrix in right arm on 03 3/16/2009 Developed area cellulitis at innocula 3/16/2009 Developed Cellulitis at innoculation 3/16/2009 L arm 3x4cm induration, redness, itc 3/16/2009 Severe sharp pain and swelling righ 3/16/2009 Sore, swollen left arm. Fever, nause 3/16/2009 Has continued L upper arm pain an 3/16/2009 PT STATES ONE WEEK AFTER VA 3/16/2009 Fever, mild generalized diffuse mac
341842 341844 341845 341846 341847 341848 341849 341850 341851 341852 341853 341854 341855 341856 341857 341858 341859 341860 341861 341862 341863 341864 341865 342061 342062 342063 342064 342065 342066 342067 342068 342069 342070 342071 342072 342073 342074 342075 342076 342077 342078 342124 342125 342126 342127 342128 342129 342130 342133 342134 342135
3/16/2009 NC 3/16/2009 IL 3/16/2009 ID 3/16/2009 CA 3/16/2009 NY 3/16/2009 IN 3/16/2009 IN 3/16/2009 CA 3/16/2009 WI 3/16/2009 NY 3/16/2009 CA 3/16/2009 IL 3/16/2009 MA 3/16/2009 DE 3/16/2009 TX 3/16/2009 CA 3/16/2009 VA 3/16/2009 TX 3/16/2009 NY 3/16/2009 TN 3/16/2009 KY 3/16/2009 MI 3/16/2009 FL 3/16/2009 CA 3/16/2009 3/16/2009 CA 3/16/2009 TN 3/16/2009 NH 3/16/2009 IN 3/16/2009 IL 3/16/2009 OH 3/16/2009 NH 3/16/2009 NC 3/16/2009 TX 3/16/2009 3/16/2009 CA 3/16/2009 CA 3/16/2009 CA 3/16/2009 PA 3/16/2009 NY 3/16/2009 TX 3/16/2009 CA 3/16/2009 3/16/2009 CA 3/16/2009 VA 3/16/2009 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 CA 3/16/2009 CA
30 42 12 19 0.2 5 4 54 16 11 5 10 3 22 59 0.4 3 38 1.6 5 53 11 15 0.6 31 0.8 0.5 0.8 1.1 0.1 0.5 0.3 0.3 0.3
30 42 12 19 0 5 4 54 16 11 5 10 3 22 59 0 3 38 1 5 53 11 15
0
0
0.2 0.3 0.4 0.6 12 18 14 25 13
12
17
17
F F M F 0.2 F F M F F F M M M F F 0.4 M M M 0.6 M F M F F U M F M 0.5 M M U U 0.5 M M M M F M M U U U F F F F F F F F F F
3/16/2009 Received PPV shot around 10:45 a 3/16/2009 Swelling and pain at axilla on left sid 3/16/2009 Pain, swelling, redness at injection s 3/16/2009 Fever, headaches, myalgias, sore th 3/16/2009 Lethargic, listless, not self for 1 wk p 3/16/2009 Notice hive like 1 cm raised area 1 i 3/16/2009 Mom notified us 48 hours after vacc 3/16/2009 Pt C/O redness / itch on L mid arm u 3/16/2009 C/O itchiness on nape of neck @ H 3/16/2009 Approx 10 min after immunizations 3/21/2009 As per dad they noticed redness on 3/16/2009 Pt developed a large red swollen (1 3/16/2009 Pt presented with 30-50 lesions on 3/16/2009 Pt had, chest pains, heaviness on c 3/16/2009 Left arm pain, Fatigue, and nausea. 3/16/2009 Rash at bilateral injection site. 3/16/2009 Was anxious after - then tired/fatigu 3/16/2009 BELL's Palsy 2 weeks after MCV4 v 3/16/2009 Generalized erythema multiforme ex 3/15/2009 Redness and swelling around inject 3/16/2009 Lymphadenopathy of R axillary nod 3/13/2009 Fatigue, joint pain after immunizatio 3/12/2009 Swelling/hematoma at injection site. 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
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3/16/2009 CA 3/16/2009 IL 3/16/2009 NJ 3/16/2009 3/16/2009 VA 3/16/2009 NM 3/16/2009 3/16/2009 MD 3/16/2009 3/16/2009 TN 3/16/2009 3/16/2009 IL 3/16/2009 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 3/16/2009 3/16/2009 TX 3/16/2009 3/16/2009 3/16/2009 3/16/2009 NY 3/16/2009 3/16/2009 IL 3/16/2009 PA 3/16/2009 3/16/2009 OR 3/16/2009 3/16/2009 PA 3/16/2009 MA 3/16/2009 HI 3/16/2009 3/16/2009 GA 3/16/2009 3/16/2009 GA 3/16/2009 CA 3/16/2009 OH 3/16/2009 IL 3/16/2009 NC 3/16/2009 IL 3/16/2009 3/16/2009 KS 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 3/16/2009 MA 3/16/2009 LA 3/16/2009 CO 3/16/2009
15 21 17
15
20
20
18 17 22
18
26 14
26
19 19 15 14 15 24
19 19
15
15
15 24
16 20
16 15 23 16 19 38 17 15 26 16 23 11 20 17 15 14 14
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F F F F U F F F F F M F F F F U U F F F F F F F F F F F F U F F F F F F F F F F F F F F F M F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received initia 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received form 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received form 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
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3/16/2009 TX 3/16/2009 MS 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 PA 3/16/2009 VA 3/16/2009 3/16/2009 KS 3/16/2009 MN 3/16/2009 3/16/2009 NY 3/16/2009 3/16/2009 3/16/2009 3/16/2009 MI 3/16/2009 MI 3/16/2009 3/16/2009 3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 CA 3/16/2009 3/16/2009 KY 3/16/2009 NJ 3/16/2009 NV 3/16/2009 FL 3/16/2009 3/16/2009 WI 3/16/2009 CO 3/16/2009 TX 3/16/2009 TX 3/16/2009 OR 3/16/2009 LA 3/16/2009 3/16/2009 3/16/2009 TN 3/16/2009 SC 3/16/2009 3/16/2009 3/16/2009 MD 3/16/2009 3/16/2009 NY 3/16/2009 WA 3/16/2009 3/16/2009 CA 3/16/2009 3/16/2009 3/16/2009 NY 3/16/2009 PA
20 14 21 19 25 17 20 16 25 38
14 21
25
16 25 17
15 27
27
13
13
17 20 12 17 17
17 17
16 16
16 16
15 13
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23 14 15 22 17 21 14 14 24
14
21
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22 16 18 31 20
18
F F F F F F F F F F M F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
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3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 NJ 3/16/2009 PA 3/16/2009 3/16/2009 3/16/2009 GA 3/16/2009 WA 3/16/2009 MI 3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 NJ 3/16/2009 3/16/2009 PA 3/16/2009 FL 3/16/2009 OH 3/16/2009 OR 3/16/2009 3/16/2009 CA 3/16/2009 3/16/2009 FL 3/16/2009 3/16/2009 CA 3/16/2009 OH 3/16/2009 CT 3/16/2009 LA 3/16/2009 3/16/2009 GA 3/16/2009 KY 3/16/2009 VA 3/16/2009 3/16/2009 3/16/2009 ID 3/16/2009 3/16/2009 TN 3/16/2009 SC 3/16/2009 WV 3/16/2009 PA 3/16/2009 NJ 3/16/2009 WA 3/16/2009 3/16/2009 PA 3/16/2009 3/16/2009 PA 3/16/2009 NJ 3/16/2009 3/16/2009 3/16/2009 3/16/2009 TX
15
15
15 17 15 15
15 17 15
28 13 17 23
28 13
11
11
23 23
23 21
33 19
33 19
24 25 14 21 14 15
23
25 21
26 23 29 14 37 15
14 37
22 15
22 15
18
18
14 12 20 11 21 22 20 24
20
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F F F F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
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3/16/2009 3/16/2009 NJ 3/16/2009 3/16/2009 NJ 3/16/2009 3/16/2009 3/16/2009 3/16/2009 CA 3/16/2009 NY 3/16/2009 PA 3/16/2009 3/16/2009 MD 3/16/2009 MO 3/16/2009 3/16/2009 3/16/2009 DE 3/16/2009 MA 3/16/2009 MN 3/16/2009 TX 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 MI 3/17/2009 CA 3/17/2009 3/17/2009 3/17/2009 3/17/2009 VT 3/17/2009 NJ 3/17/2009 3/17/2009 3/17/2009 3/17/2009 VA 3/17/2009 WA 3/17/2009 IL 3/17/2009 NY 3/17/2009 3/17/2009 TX 3/17/2009 CA 3/17/2009 WA 3/17/2009 TX 3/17/2009 CA 3/17/2009 NC 3/17/2009 MI 3/17/2009 HI 3/17/2009 WA 3/17/2009 IN 3/17/2009 CA 3/17/2009 OR 3/17/2009 CO 3/17/2009 AL
22 24 21
18 22 19 18 16 22 23 21 24 26 20 17 23 18
18 22 19
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5 1.4 0.2 5 0.2 22 75 5 53 4 1.8 35 36 66 56 12 55 12 0.4
16 22 23 21 24 26 20 17 23 18
1 0 5 0 22 75 5 53 4 1 36 66 56 12 55 12 0
F F F F F F F F F F F F F F F F F F F F F U F 0.3 F U U U F M M M M 0.4 M 0.2 M M 0.2 M F F M F F 0.8 M M M F M M U F F 0.4 F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Initial and follow up information has 3/13/2009 Initial information and follow up has 3/13/2009 Information has been received from 3/13/2009 Information has been received throu 3/13/2009 Initial information has been received 3/13/2009 Initial and follow-up information has 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/17/2009 redness, swelling, heat and hard sp 3/16/2009 InformationYhas been received from 3/16/2009 InformationYhas been received from 3/16/2009 InformationYhas been received form 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/12/2009 Apnea 12-24 hours after vaccines. I 3/1/2009 By 11/28 evening upper left arm wa 3/4/2009 "Night tremor" type incident "weird c 3/15/2009 Fever of 103 for 72 hours, severe so 3/11/2009 Increased her neuropathy symptom 3/9/2009 No adverse effects observed. Fathe Pt states her Rt arm has been hurtin 3/12/2009 Pt received shots Monday afternoon 3/11/2009 Malar rash erupted day post vaccina 3/13/2009 None stated. 3/5/2009 lymph node in the deltoid region and 3/10/2009 Itch: 2-21-09. Severe welts (red, pu 3/2/2009 My back of head left side bottom sta 3/11/2009 Began vomiting approx 6-8 hr post i Weakness, Dizziness, Mild Nausea 3/12/2009 Injection site was warm/hot to touch 3/11/2009 Immediately after shot, had onset o 3/10/2009 N&V, diarrhea, Pale, Lethargic, Wea
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3/17/2009 IN 3/17/2009 CA 3/17/2009 PA 3/17/2009 NY 3/17/2009 WA 3/17/2009 IL 3/17/2009 ID 3/17/2009 IN 3/17/2009 MD 3/17/2009 3/17/2009 TX 3/17/2009 MD 3/17/2009 FL 3/17/2009 NH 3/17/2009 NJ 3/17/2009 NJ 3/17/2009 NC 3/17/2009 OR 3/17/2009 CT 3/17/2009 TX 3/17/2009 SD 3/17/2009 MA 3/17/2009 TX 3/17/2009 CA 3/17/2009 WA 3/17/2009 CA 3/17/2009 KY 3/17/2009 PA 3/17/2009 PA 3/17/2009 CA 3/17/2009 IL 3/17/2009 MA 3/17/2009 LA 3/17/2009 IL 3/17/2009 NC 3/17/2009 GA 3/17/2009 IN 3/17/2009 PA 3/17/2009 MN 3/17/2009 SC 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 WV 3/18/2009 PA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 KY
0.8 4 18 10 17 21 7 48 0 44 15 18 16 1 21 43 1 19 20 38 0.8 7 36 31 15 62 24 19 4 0.7 0.2 1 5 23 46 47 1 15 1 11 1 1 1 1.4 23 14 14 14 73 0.4
0 4 10 21 7 48 0 44 15 18 16 1 21 43 1 19 20 38 0 7 36 31 15 62 24 19 4 0 0 1 5 23 46 47 1 15 1 0 0 1 1 23 14 14 73 0
0.8 F M U F M F M M 0F M M M F 0M M F 0M F F M 0.8 M F F F F F M F M 0.7 M 0.2 F 0F M U F F 0M F 0M 1M U 1M 0M 0M M F F F F F 0.4 F
3/5/2009 On 3-2-09 parent called and reporte 3/10/2009 Half hour after vaccines were admin Day after injection of MENACTRA. P 3/11/2009 Local cellulitis at site of injection res 3/12/2009 Patient was given 3 GARDASIL vac 3/2/2009 See attached medical records. 3/3/2009 DTaP given to a 7yr old will count a 3/10/2009 Rubella rash - maculopapular, fine, 3/14/2009 None - just to report accidental (unin 3/17/2009 Diarrhea, GI upset, "flare of Ulcerati 3/17/2009 headache, dizziness, stiff and sore 3/17/2009 Patient informed nurse that he usua 3/17/2009 Within several days of her second s 3/17/2009 1 week after patient was given the F 3/17/2009 Pt is a member on Mobilization Orde 3/17/2009 Pt is a member of the military. Vacc 3/17/2009 pATIENT PRESENTED WITH RED 3/17/2009 Menactra, Varivax, and Havrix admi 3/17/2009 Received Yellow Fever vaccine 2/27 3/17/2009 Day after administration: myalgias, s 3/5/2009 Rash on neck, swelling and redness 3/17/2009 Patient is well appearing and presen 3/17/2009 Immunizations given 3/16/09. Client 3/17/2009 The member was examined in flight 3/17/2009 Pt was given #2 HPV and left area w 3/17/2009 She dies onY12/31/08 - clinicians lis 3/17/2009 Service member was a basic trainee 3/17/2009 Nausea, Dizzy, Weak 3/17/2009 3/10 2pm - immunization administer 3/17/2009 Sterile abscess left thigh. 3/17/2009 Intussusception Y (ileo-cecal) requirin 3/17/2009 Dermal infiltrate L anterior thigh: ind 3/17/2009 Approximately 30min after receiving None stated. 3/17/2009 Patient was given pneumococcal va 3/16/2009 Patient reports developing a pruritic 3/17/2009 Febrile seizure - ER visit treated wit 3/16/2009 Fatigue, severe muscle aches all ov 3/17/2009 High fever - up to 103- March 13-14 3/16/2009 Dx with chicken pox. 3/17/2009 This case was considered medically 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 It was reported in a published repor 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/16/2009 Got shingles vaccine last week. Got 3/12/2009 Rash to head and neck 2 hours afte
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3/18/2009 GA 3/18/2009 GA 3/18/2009 GA 3/18/2009 3/18/2009 OH 3/18/2009 3/18/2009 GA 3/18/2009 KY 3/18/2009 TX 3/18/2009 KS 3/18/2009 AR 3/18/2009 TX 3/18/2009 ME 3/18/2009 TX 3/18/2009 NC 3/18/2009 3/18/2009 ME 3/18/2009 KS 3/18/2009 TX 3/18/2009 MO 3/18/2009 MD 3/18/2009 MO 3/18/2009 MO 3/18/2009 WA 3/18/2009 LA 3/18/2009 IL 3/18/2009 MO 3/18/2009 ID 3/18/2009 PA 3/18/2009 IN 3/18/2009 NY 3/18/2009 PA 3/18/2009 MS 3/18/2009 MS 3/18/2009 TN 3/18/2009 OK 3/18/2009 CA 3/18/2009 TX 3/18/2009 AK 3/18/2009 CT 3/18/2009 GA 3/18/2009 NJ 3/18/2009 NY 3/18/2009 NJ 3/18/2009 CA 3/18/2009 CA 3/18/2009 LA 3/18/2009 CA 3/18/2009 PA 3/18/2009 MA 3/18/2009 TX
6 52 17 0.4 7 67 10 4 25 11 1 38 1.3 22 33 64 17 29 25 40 13 13 5 13 1 0.3 23 45 4 1.3 18 0.8 1.3 13 0.2 4 3 23 4 1.3 53 65 32 4 4 40 16 0.6 24 4
6 52 17 0
67 10 4 25 11 1 38 1 22 33 64 17 29 25 40 13 13 5 13 1 0 23 45 4 1 18 0 1 13 0 4 23 4 1 53 65 32 4 4 40 16 0 24 4
F F M 0.4 F U M M F F M F 0M F 0.3 F M F M M F F U F F F F 0F 0.3 F F M F 0.3 M M 0.8 M 0.3 M F 0.2 F F M F M 0.3 F M M F F F U F 0.6 M F F
1/7/2009 Phone call from mom- stated when ### About 1 1/4 hrs post pneumonia vac 2/26/2009 Dr from mother, reports client had e 3/18/2009 This case was reported by a physici 3/18/2009 This case was reported by a physici 3/18/2009 This case was reported in a literatur 3/17/2009 Pt received TDAP instead of rec. TD 2/26/2009 Soon after administer- flushed chee 3/5/2009 L Thigh with swelling / Erythema. 3/18/2009 Member has small bump on chest, b 3/18/2009 2 days post vaccination, pt presente 3/18/2009 Fever for 2 days. Red spots on face Err:508 3/17/2009 firm, hard knot at injection site R up 3/13/2009 24 y/o male ADSM is referred by Re 3/18/2009 Pt called at 10:20 to Immunization c 3/18/2009 Pt given varicella vaccine in error, s 3/18/2009 Nausea, vomitting, headache, pain, 3/18/2009 Local reaction. 40mm X 26mm area 3/18/2009 Patient complained of a itchy, painfu 3/18/2009 Received Tdap vaccine. Approx. 18 3/18/2009 Approximately one hr. after receivin 3/18/2009 Approximately three hours following 3/18/2009 Pt developed a rash, resembling ch 3/18/2009 She has not had a period after rece 3/18/2009 Right thigh where vaccine was adm 3/18/2009 Patient recieved vaccines on 3/17/0 3/18/2009 Bilateral arms red, raised rash. Wa 3/18/2009 Pt awoke at 7AM on 3/12/2009 with 3/18/2009 Patient presented day after vaccina 3/18/2009 Approximately 1 week after shot wa 3/18/2009 syncopal episode condition and vita 3/18/2009 pt returned to clinic 2 days after vac 3/18/2009 PT RETURNED TO CLINIC WITH R 3/18/2009 Fever, severe abdominal pain; musc 3/18/2009 Baby died 4Ydays after vaccines we 3/18/2009 left deltoid swollen and reddness no 3/6/2009 A serious, spontaneous report of sta 3/18/2009 Client reported of experiencing heav 3/18/2009 swelling, redness, pain, increased te 3/18/2009 Had Hep B # 3, DTaP # 4, PCV # 4 3/16/2009 Started with cough 1900 15MAR09, 3/18/2009 Like usual after vax, jogged for 3 1/2 3/16/2009 3/19/09 T/C to reporter who states p 3/17/2009 Erythematous induration area at the 3/18/2009 Local redness and swelling 13 x 10 6/7/2005 Incidental diagnosis of thrombocyto 3/18/2009 Dizziness and LOC x 30 sec, about 3/17/2009 On 5/28/08, Pt was 7mo old and rec 2/11/2009 Pt had a c/o feeling as though she w 2/12/2009 A serious, study report of right lowe
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3/18/2009 WA 3/18/2009 OK 3/18/2009 OH 3/18/2009 UT 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 GA 3/18/2009 NJ 3/18/2009 NJ 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 OK 3/18/2009 3/18/2009 3/18/2009 3/18/2009 SC 3/18/2009 3/18/2009 MA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 PA 3/18/2009 SD 3/18/2009 MD 3/18/2009 MI 3/18/2009 3/18/2009 3/18/2009 TX 3/18/2009 PA 3/18/2009 IN 3/18/2009 NC 3/18/2009 FL 3/18/2009 3/18/2009 3/18/2009 WI 3/18/2009 MN 3/18/2009 IA 3/18/2009 FL 3/18/2009 PA 3/18/2009 NJ 3/18/2009 3/18/2009 3/18/2009
2.8 2 4
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2/19/2009 A non-serious spontaneous report o 2/11/2009 A non-serious, spontaneous report 2/11/2009 A non-serious, spontaneous report 2/6/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/17/2009 A non-serious, spontaneous report 2/3/2009 A non-serious spontaneous report o 2/3/2009 A non-serious spontaneous report o 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information had been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received for a 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial information has been received
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3/18/2009 3/18/2009 VA 3/18/2009 NJ 3/18/2009 TX 3/18/2009 3/18/2009 AZ 3/18/2009 3/18/2009 PA 3/18/2009 IN 3/18/2009 MN 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 DE 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NH 3/18/2009 3/18/2009 3/18/2009 MD 3/18/2009 3/18/2009 3/18/2009 3/18/2009 OH 3/18/2009 3/18/2009 IL 3/18/2009 TX 3/18/2009 OK 3/18/2009 PA 3/18/2009 OH 3/18/2009 IA 3/18/2009 3/18/2009 UT 3/18/2009 NH 3/18/2009 3/18/2009 PA 3/18/2009 PA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 CO 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NJ 3/18/2009
11 32 49 0.1 0 0 0.1
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3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial information has been received 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Pediatric medical records were rece 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from 3/6/2009 Initial and follow-up information has 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received rega 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received rega 3/6/2009 Information has been received rega 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from
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3/18/2009 WA 3/18/2009 3/18/2009 TN 3/18/2009 NC 3/18/2009 IL 3/18/2009 OH 3/18/2009 OR 3/18/2009 CA 3/18/2009 TX 3/18/2009 NC 3/18/2009 NJ 3/18/2009 MD 3/18/2009 3/18/2009 GA 3/18/2009 NJ 3/18/2009 3/18/2009 VA 3/18/2009 MI 3/18/2009 CA 3/18/2009 3/18/2009 CO 3/18/2009 NV 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NY 3/18/2009 OH 3/18/2009 NY 3/18/2009 CO 3/18/2009 MD 3/18/2009 CO 3/18/2009 NY 3/18/2009 NY 3/18/2009 KY 3/18/2009 TN 3/18/2009 KY 3/18/2009 KY 3/18/2009 NY 3/18/2009 GA 3/18/2009 3/18/2009 WI 3/18/2009 CA 3/18/2009 PA 3/18/2009 MI 3/18/2009 CO 3/18/2009 SD 3/18/2009 PA 3/18/2009 MA 3/18/2009 NC 3/18/2009 3/19/2009
52 28 13 1.3
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3 1.2 18 41 47 45 45 29 27 1.2 20 65
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10 17 3 66
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U M U F F 0.3 M M M 0.2 F F F M F F F F 0.2 F F M F U F U F M F M F F F U M M F F U U M 0.6 M U 0F 0.2 F F 0.1 M M F 0.8 F F 0.6 M U U
3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 The subject's medical history includ 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/18/2009 InformationYhas been received from
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3/19/2009 ME 3/19/2009 OH 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 ND 3/19/2009 NC 3/19/2009 CA 3/19/2009 CA 3/19/2009 WI 3/19/2009 MD 3/19/2009 TX 3/19/2009 WA 3/19/2009 CO 3/19/2009 NY 3/19/2009 NJ 3/19/2009 NJ 3/19/2009 TX 3/19/2009 SC 3/19/2009 MA 3/19/2009 NY 3/19/2009 FL 3/19/2009 OH 3/19/2009 3/19/2009 3/19/2009 MO 3/19/2009 ND 3/19/2009 TX 3/19/2009 IN 3/19/2009 CA 3/19/2009 WA 3/19/2009 AK 3/19/2009 MI 3/19/2009 FL 3/19/2009 OH 3/19/2009 CA 3/19/2009 PA 3/19/2009 CA 3/19/2009 CA 3/19/2009 CA 3/19/2009 WA 3/19/2009 NJ 3/19/2009 CA 3/19/2009 CA 3/19/2009 KS 3/19/2009 CA 3/19/2009 NY
3 1.7 1.4 54 2 5 1.5 15 20 5 0.5 35 17 2 18 72 1.1 81 0.1 0.3 11 0 65 4 2 1.4 20 15 38 35 0.5 14 64 0.3 34 4 11 0.5 5 7 1 4 22 16 20 14 0.2 4 1.2
1 1 54
15 20 5 0 35 17 2 18 72 1 81 0 11 0 65 4 2 1
38 35 0 0 64 0 34 4 11 0 0 5 1 1 5 22 16 20 14 0 4 1
U 0.7 M 0.4 M M M M M U F F M 0.5 M F F 0.9 M F M 0.1 M F 0.1 F M F 0F F M 0M 0.4 M F F F F 0.6 F 0M F 0.4 F F M F 0.2 M 0.5 M M 0.3 M 0M F M F F F 0.2 F F 0.2 F
3/17/2009 A 3-year-old child had received thei 3/17/2009 Initial report received on 13 March 2 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Initial information has been received 3/18/2009 Within 10 min. of vaccines pt. had c 3/13/2009 On 3/13/09 pt. received 3rd dose of 3/14/2009 Approx. 24-28 after 12 pt. noted sw 10/12 - tingling in arms/legs, feeling 3/11/2009 Pt received flu vaccine & got INFLU 3/14/2009 Feb-2-09 at 3:00 pm vaccines were 3/12/2009 Increased somnolence and headach 3/16/2009 Diffuse macular papular rash. 3/6/2009 Pt went to a fast food restaurant afte 3/19/2009 3-4 hrs. of non-stop crying. 3/19/2009 Jerky movements of head to right 3/18/2009 Received Varicella and Hepatitis A v 3/9/2009 Patient was given HEPATITIS B vac 3/9/2009 Red swollen, painful (L) upper arm a 3/13/2009 48 hrs after the vaccine the site bec 3/19/2009 Fever 102.7 48 hrs after administrat 3/19/2009 Starting at 8:00PM on 3/18/09 Temp 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/19/2009 Began having chills, achy joints, sho 3/19/2009 DEVELOPED ACHING/ FEVER AB 3/19/2009 BREAKTHROUGH ROTAVIRUS DI 3/19/2009 has temp of 102, hurts to move,bod 3/19/2009 A red swelling developed that has b 3/19/2009 Tdap given to patient in error, shoul 3/19/2009 Flu vaccine administered at 10 a.m. 3/19/2009 None 3/19/2009 PATIENT NOTED HIVES ONCE AG 3/19/2009 Pt was fully immunized and pretty m 3/19/2009 Infant developed hives 22 hours pos 3/19/2009 Within a few hours after receiving 4 3/19/2009 Saw a black dot on patient's left arm 3/19/2009 Patient had 5 minute tonic clonic se 3/19/2009 Noticed black dot on patient's right a 3/19/2009 Patient complained of tightness and 3/19/2009 supraclavicular lymphadenopathy o 3/19/2009 UTI like symptoms, frequent urinatio 3/19/2009 HPV #1, 8/18/08; HPV #2, 10/20/08 3/19/2009 Red, papular, vesicular, asymptoma 3/18/2009 Left & right thigh swollen, red, pain. 3/19/2009 Fever started 03/16/09 and develop
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3/19/2009 ME 3/19/2009 NM 3/19/2009 MA 3/19/2009 KY 3/19/2009 OR 3/19/2009 KY 3/19/2009 NC 3/19/2009 CA 3/19/2009 WA 3/19/2009 MO 3/19/2009 MA 3/19/2009 VA 3/19/2009 TX 3/20/2009 FL 3/20/2009 MN 3/20/2009 3/20/2009 FL 3/20/2009 3/20/2009 3/20/2009 3/20/2009 CA 3/20/2009 IN 3/20/2009 3/20/2009 WI 3/20/2009 3/20/2009 3/20/2009 3/20/2009 MN 3/20/2009 3/20/2009 NY 3/20/2009 TX 3/20/2009 FL 3/20/2009 ID 3/20/2009 VA 3/20/2009 CA 3/20/2009 MO 3/20/2009 WA 3/20/2009 TX 3/20/2009 PA 3/20/2009 WV 3/20/2009 FL 3/20/2009 TX 3/20/2009 FL 3/20/2009 IN 3/20/2009 OH 3/20/2009 ID 3/20/2009 LA 3/20/2009 ID 3/20/2009 ID 3/20/2009 ID 3/20/2009 TX
5 1.3 17 4 4 4 4 66 1 1.6 12 4 33 46 19
5 1 17 4
22 4 2
22
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1
23 11 0.3
23
4 1.3 11 1.8 73 0.6 20 16 18 72 8 13 11 11 0.7 0.5 42 8 20 46
4 1 11 1 73 0 20 16 18 71 8 13 11 11 0 0 42 8 20 46
4 4 66 1 1 12 4 33 46 19
2
1 1
0
M 0.3 M M M F F F F 0F 0.6 M M F M F F M F F 0.1 F M 0.3 M M 0.4 F 0F M M M F U 0.3 M U M 0.3 M M 0.8 M F 0.6 F F F F F M M M F 0.7 M 0.5 F F M F F
3/19/2009 Patient was given MMR vaccine on 3/19/2009 Child started with redness to right th 3/19/2009 "Blacked out" for a few seconds the 3/19/2009 Redness and warmth to deltoid site Immus given 03-16-09. Called by m 3/19/2009 Patient with local reaction, left uppe 3/19/2009 Left thigh 8x10cm red oval. mild ede 3/18/2009 For the past 15 yrs, pt has had sing 3/19/2009 Hives developed on entire torso 7 h 3/19/2009 Head to toe macular papular rash. P 3/19/2009 2 cm in diameter erythematous lesio 3/18/2009 Chicken pox 3/18/09 after 2 vaccina 3/18/2009 3/14/09- Experienced diarrhea, vom 3/19/2009 Information has been received from 3/19/2009 Initial information has been received 3/19/2009 Information has been received from 3/19/2009 Initial and follow-up information has 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/13/2009 Information has been received form 3/20/2009 This case was reported by a pharma 3/12/2009 12 hours after 4 month vaccines giv 3/6/2009 This non serious case was received 3/20/2009 9 X 9 cm irregular area to left delt. 3/20/2009 Fever up to 105 3/20/2009 Onset of fever to 102, hives under b 3/18/2009 About 1540 pm MA had just finished 3/16/2009 3" x 6" erythema at injection site no 3/13/2009 Pt had nonstop crying for 3 + hours 3/15/2009 Non stated. 1/30/2009 Reactive Lymphadenopathy, cervica 3/16/2009 Head to toe rash and headache. Re 3/16/2009 Received Herpes Zoster Vaccine 5/ 3/16/2009 Initial, hives, abdominal pain ( <5 m 3/9/2009 Extensive local swelling including en 3/16/2009 The a.m. after vaccinations pt. notic 1/26/2009 Mom states that eve after a shower 3/21/2009 Fever 102-103 degrees F wouldn't c 3/13/2009 Vomiting, fever to 103 degrees. Fev 2/19/2009 Client reports that she had a softbal 3/11/2009 Small pea-sized redness @ site of i 3/10/2009 Patient reports approximately 40 mi 3/20/2009 The day after the vaccine was given
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3/20/2009 LA 3/20/2009 MD 3/20/2009 MO 3/20/2009 OH 3/20/2009 KY 3/20/2009 DE 3/20/2009 PA 3/20/2009 VA 3/20/2009 WA 3/20/2009 NY 3/20/2009 ME 3/20/2009 KS 3/20/2009 NJ 3/20/2009 MD 3/20/2009 NY 3/20/2009 MD 3/20/2009 MN 3/20/2009 RI 3/20/2009 PA 3/20/2009 PA 3/20/2009 PA 3/20/2009 PA 3/20/2009 FL 3/20/2009 PA 3/20/2009 VA 3/20/2009 MA 3/20/2009 DC 3/20/2009 MI 3/20/2009 CT 3/20/2009 MD 3/20/2009 OR 3/20/2009 AZ 3/20/2009 CA 3/20/2009 IL 3/20/2009 PA 3/20/2009 OR 3/20/2009 NC 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 AL 3/20/2009 FL 3/21/2009 VA 3/21/2009 SC 3/21/2009 AL 3/21/2009 ID 3/21/2009 NY
71 4 40 11 1.2 76 64 46 1.5 33 21 1 10 58 26 19 12 19 25 4 60 65 20 12 20 1 27 60 13 60 7 12 19 1 41 7 26 20 31 38 51 0 26 4 43 4 16 1.3 74 34
71 4 40 11 1 76 64 46 1 33 0 10 26
19 25 4 60 65 20 12 20 1 27 1 60 13 60 7 12 19 1 41 7 26 20 31 38 51 0 26 4 43 4 16 1 74 34
F M M M 0.2 M M F F 0.5 M M M 1M F F M F F M F M F F M F M 0F M 0F F M F M F F 0M F M F M F M M 0F F F M F F 0.3 M F M
3/20/2009 Pt received shot 12/30/08 - Raised 3/19/2009 Local inflammatory reaction. 7x7 wa 3/2/2009 Stated developed raised red "bump 3/16/2009 Post vaccine VARICELLA. 3/16/2009 3/14/09 Diagnosis of chickenpox Re 3/11/2009 Pt received ZOSTER & TD BOOST 3/17/2009 Pain 24/7. Limited movement of righ 3/16/2009 03/13/2009 pt. called to report "hive 3/6/2009 Abscess on Rt thigh hard red lump, 3/20/2009 Patient presented to the clinic on th 3/20/2009 Patient developed pain and redness 3/20/2009 Crying nonstop from 1am-8am. Sho 3/20/2009 Seen on 3/13/09 for 10 year old wel 3/20/2009 After 1 series of Hepatitis B vaccine 3/20/2009 Member developed erythema swelli 3/20/2009 After 1 series of Hep B vaccine (4/2 3/20/2009 fever to 103.4, muscle spasm, r thu 3/20/2009 Pt received adacel vaccine on 3/18/ 3/20/2009 After receiving the second dose of t 3/20/2009 MMR given at 0930am, developed e 3/20/2009 Pt noted an ugly looking rash, which 3/20/2009 Pt noted a faint red rash around the 3/20/2009 Mother reported to Health Dept. tha 3/20/2009 12 hours after receivng vaccines pa 3/20/2009 PT RECIEVED ANTHRAX VACCIN 3/20/2009 Hives appeared on 3/19/09 and a ve 3/20/2009 Localized soreness/tenderness in u 3/20/2009 One inch area of inderation at the s 3/10/2009 Had cold symptoms in Nov - Dec. F 3/20/2009 3-4 hours after vaccines (and after d 3/21/2009 Redness, itching and shortness of b 3/20/2009 Fever, left arm swelling, redness an 3/18/2009 Within 5 minutes of receiving 3 vacc 3/19/2009 Blurred vision, Nausea. Vomiting 20 3/20/2009 Child noted to have Erythema Multif 3/20/2009 Sensation of swelling in legs, knees 3/20/2009 L arm swollen around site. 1/28/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP 1/28/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP. 1/29/2009 TD given instead of TDAP. 1/28/2009 TD given instead of TDAP. 3/20/2009 Urticaria = Legs and arms. No other 3/20/2009 Swelling @ site of injection. Post 12 3/21/2009 My daughter had her 4yr old injectio 3/21/2009 Shortly after first shot, daughter star 3/21/2009 Sudden onset of fever accompanied 3/21/2009 TDAP ADMINISTERED (L) DELTOI 3/21/2009 In 2002 patient started to loose mus
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3/21/2009 CT 3/21/2009 TN 3/22/2009 CA 3/22/2009 CO 3/23/2009 3/23/2009 3/23/2009 TN 3/23/2009 MS 3/23/2009 3/23/2009 FL 3/23/2009 3/23/2009 VA 3/23/2009 WA 3/23/2009 3/23/2009 3/23/2009 FL 3/23/2009 3/23/2009 3/23/2009 IN 3/23/2009 3/23/2009 3/23/2009 NY 3/23/2009 VT 3/23/2009 PA 3/23/2009 ME 3/23/2009 CT 3/23/2009 GA 3/23/2009 FL 3/23/2009 NC 3/23/2009 TN 3/23/2009 CA 3/23/2009 PA 3/23/2009 MN 3/23/2009 NJ 3/23/2009 3/23/2009 MA 3/23/2009 GA 3/23/2009 CA 3/23/2009 CA 3/23/2009 3/23/2009 ME 3/23/2009 3/23/2009 3/23/2009 3/23/2009 NY 3/23/2009 OK 3/23/2009 NY 3/23/2009 MT 3/23/2009 VA 3/23/2009 IN 3/23/2009 TX
58 0 1.8 1
58 0 1 1
47 17 0.7 71 77 15 4 43
17
1.3 9 4 8 1.3
1
10 5 12 63 14 1.1 0.6 27 4 51 14 14 70 10 62 33 18 20 24 67 23 22 26 30 5 37 64 48 75 29
10 5 12 63 14 1 0 27 4
71 15
14 14 70 62 33 20 24 67 23 22 26 30 5 37 64 48 75 29
F 0M 0.8 M 0M F F U M F F M F F M F 0.3 M F M M M M F M M M F 0.1 F 0.6 F M M F F F F M F F F F F F M M M F F M M F F F
3/21/2009 Patient received both a pneumovax 3/21/2009 We left the clinic and within 1-2 hou 3/22/2009 This previously healthy 22-month-ol 3/22/2009 Complex febrile seizure (15-20 min 3/20/2009 InformationYhas been received from 3/20/2009 InformationYhas been received form 3/19/2009 Initial report received 09 March 200 3/19/2009 This case was received from a heal 3/19/2009 Initial report received on 17 March 2 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/23/2009 Possible vaccine Y failure. Child expir 3/9/2008 7x7 cm local swollen, red , warm on 3/19/2009 3 inch area of erythema, fever to 10 2/26/2009 Vaccines given 2/23/09. Patient mo 3/19/2009 On 3/12/09 Pt presented here with v 3/16/2009 Red maculopapules x 3 clustered o 3/16/2009 Febrile seizure seen at Hospital on 3/10/2009 Pt developed rash approx 10 days p 3/13/2009 Left thigh red, hot and swollen x 6 d 3/1/2009 Induration and tenderness at injectio 3/23/2009 On 12/17/08 patient presented as a 3/23/2009 Patient fainted and hit her head, app 3/20/2009 Zoster 3/20/2009 Local erythema with superficial swe 3/23/2009 Pt developed papulovesicular lesion 3/23/2009 C/o fall with knee pain on 11-19-08 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/23/2009 Unspecified disease of pericardium 3/23/2009 1 inch red raised area at injection si 3/23/2009 Non-specific myocarditis 3/23/2009 Acute pericarditis, unspecified 3/23/2009 Acute pericarditis, unspecified; Unsp 3/23/2009 supraventricular tachycardia, dizzine 3/23/2009 Pediarix given IM to LD and MMR g 3/23/2009 member presented for follow up afte 3/23/2009 Patient received the zoster vaccine 3/23/2009 Rabies vaccine was given on 3-6-09 3/23/2009 ON 3/20/09 BROKE OUT WITH 3-4 3/23/2009 RIGHT ARM SWOLLEN FROM SH
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3/23/2009 MD 3/23/2009 TX 3/23/2009 IL 3/23/2009 3/23/2009 OK 3/23/2009 PA 3/23/2009 NC 3/23/2009 CA 3/23/2009 CT 3/23/2009 CA 3/23/2009 NM 3/23/2009 CA 3/23/2009 NC 3/23/2009 NV 3/23/2009 MT 3/23/2009 AZ 3/23/2009 CA 3/23/2009 CA 3/23/2009 NC 3/23/2009 MN 3/23/2009 MA 3/24/2009 CA 3/24/2009 CA 3/24/2009 3/24/2009 3/24/2009 CA 3/24/2009 3/24/2009 3/24/2009 3/24/2009 3/24/2009 3/24/2009 NV 3/24/2009 OH 3/24/2009 IL 3/24/2009 PA 3/24/2009 SC 3/24/2009 NC 3/24/2009 AL 3/24/2009 VA 3/24/2009 PA 3/24/2009 MI 3/24/2009 IN 3/24/2009 OH 3/24/2009 GA 3/24/2009 NJ 3/24/2009 3/24/2009 NC 3/24/2009 IL 3/24/2009 CA 3/24/2009 TX 3/24/2009 CT
60 46 4 26 18 1 61 39 16 1 8 15 11 5 23 4 1.3 9 0.6 5 37 10 0.2 24 21 0.3 1.5 2 1 6 57 83 0.3 79 9 11 32 5 60 0.2 12 40 64 6 21 14 0.3 1 4 5
60 46 4 26 18 1 61 39 16 1 8 15 11 5 23 4 1 9 0 5 37 0 24
83 0 80 9 11 32 5 0 12 40 64 6 21 14 0 1 4 5
F M F M F 0F M F F 0M F F F M F M 0.3 F F 0.6 M M F M 0.6 M F F U U M M M M F F 0.3 M F F F F F U 0.2 M F F M F F F 0.4 F 0M M M
3/23/2009 The patient received the Tdap immu 1/23/2009 LEFT ARM RED & SWOLLEN FRO 3/23/2009 On 3/20/09, approximately 24 hours 3/23/2009 Pt. developed his initial symptoms o 3/23/2009 Syncope immediately following injec 3/23/2009 One day post vaccine patient develo 3/23/2009 2/12/09 - Shingles Vaccine and Teta 3/23/2009 Neurologic symptoms started in my 3/23/2009 Less then 24 hours after Meningoco 3/23/2009 Varicella - like exanthem 20 days po 3/3/2009 Varicella rash 2 weeks after admin o 3/23/2009 Gave Pt MMR on 2-2-09. Paperwor 3/23/2009 Left arm swollen, red, hot to touch f 3/20/2009 Walked out of exam room after vacc 3/19/2009 Soreness in arm for over a month 3/23/2009 (L) upper arm cellulitis Deltoid area. 3/23/2009 About 7 days after receiving VARIV 3/20/2009 Patient developed hives 2 dys after 3/23/2009 Fever > 100 x 2 days. Rash x3 days 3/23/2009 10x8cm erythema on L thigh around 3/23/2009 Date of injection 3/17/09 - 1st 8 hou 3/24/2009 The must important efect was today 3/24/2009 My son's upper left thigh started to s 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/24/2009 Two events of intussusception, each 3/24/2009 Approximately 8 days after administ 3/24/2009 Pt. was given varivax on 3/5/09. Wit 3/24/2009 reddened area on right arm with a d 3/24/2009 Came in clinic on 03/24/2009 c/o se 3/24/2009 Cellulitis at injection site, redness, s 3/24/2009 Subject in pneumococcal vaccine tr 3/24/2009 NO ADVERSE REACTIONS 3/24/2009 child found on the floor due to faintin 3/24/2009 MMR was given on 3/12/09. She st 3/24/2009 right shoulder swollen & extremely s 3/24/2009 Patient developed left-sided neck pa 3/24/2009 Patient came to ER for 2nd injection 3/24/2009 Patient received her first shot 5/24/0 3/24/2009 Flatulence, vomiting, lack of appetit 3/17/2009 4 days after vaccine got vesicular ra 3/19/2009 Thigh Red, Swollen, hot to touch - A 3/17/2009 Within 24 hours entire upper arm wa
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3/24/2009 PA 3/24/2009 WA 3/24/2009 AL 3/24/2009 NV 3/24/2009 OR 3/24/2009 OK 3/24/2009 SC 3/24/2009 PA 3/24/2009 3/24/2009 CO 3/24/2009 TX 3/24/2009 IA 3/24/2009 FL 3/24/2009 NC 3/24/2009 PA 3/24/2009 MD 3/24/2009 NY 3/24/2009 WA 3/24/2009 MA 3/24/2009 KY 3/24/2009 CA 3/24/2009 CA 3/24/2009 MI 3/24/2009 ID 3/24/2009 PA 3/24/2009 3/24/2009 TX 3/24/2009 WA 3/24/2009 3/24/2009 GA 3/24/2009 NY 3/24/2009 AR 3/24/2009 PA 3/24/2009 CA 3/24/2009 AZ 3/24/2009 CA 3/24/2009 3/24/2009 PA 3/24/2009 PA 3/24/2009 NY 3/24/2009 3/24/2009 NC 3/24/2009 PA 3/24/2009 MI 3/24/2009 PA 3/24/2009 KS 3/24/2009 FL 3/24/2009 IN 3/24/2009 MN 3/24/2009 NY 3/24/2009 PA
1.3 4 36 0.3 32 7 67 4 4 56 40 4 0.2 14 6 18 4 1.7 17 39 53 4 11 1.5 0.9 23 44 54
1 4 36 0 32 7 67 4 4 56 40 4 0 14 6 18 4 1 17 39 53 4 11 1 0 23 44 54
47 1 9 69 15 1.1 1.1 13 1.6 4 30 13 70 0.4 70 29 0.2 0.5 0.5 8 20
47 1 9 69 15 1 1 13 1 4 30 13 70 0 70 29 0 0 0 8 20
0.3 F F M 0.3 F F F F F M M M F 0.2 M F F F M 0.7 M M F F M F 0.5 M 0.9 F F F F U M F 0M F F F 0.1 M 0.1 M F 0.6 M F M F F 0.4 U F M 0.2 M 0.5 F 0.5 M M F
3/13/2009 Developed rash 8 days after receivi 3/19/2009 Erythema multiforme- Itchy red rash 3/15/2009 C/o minor rash on arms & forehead 3/16/2009 Non stop crying for 3 Hour for no re 3/12/2009 Chills, Fatigue, itching, hands hard 3/18/2009 3x3 induration with 2x2 redness in c 3/20/2009 Sat. - site of injection was red and s 3/17/2009 Temperature 104.2 within 12 hours 3/24/2009 This case was reported via a legal c 3/18/2009 Tinnitus - continual ringing in left ea 3/18/2009 I asked pt if he felt ok after I adminis 3/18/2009 Thigh was red, warm + swollen, pai 3/20/2009 Vaccine admin. 12/20/83, immediat 3/16/2009 Mom reports fever started 3/14/09. 3/24/2009 Seizure 13 days post VARIVAX. Se 3/24/2009 GARDASIL given 3/17/2009. Patien 3/24/2009 Right upper arm completely swollen 3/23/2009 24 hours after shots given, swelling 3/27/2009 24 hours after second dose of VARI 2/25/2009 Swelling, redness and induration dis 3/24/2009 I developed a 103 degrees fever for 3/24/2009 Slightly edematous + erythematous 2/24/2009 Patient c/o itchy hives on Left deltoi 3/10/2009 24 hours post injection patient had l 3/13/2009 No adverse reaction reported - *Chi 3/20/2009 My primary care physician informed 3/16/2009 Broke out in hives on arm where inje 3/16/2009 Friday 3-13-09 Body aches, fever, le None Stated None stated 3/20/2009 Patient received TDAP & PNEUMO 2/24/2009 Patient diagnosed with chicken pox 3/13/2009 After receiving MENACTRA, in proc 3/17/2009 Facial and arm rash lasting several 3/19/2009 (D:) BP 102/60; P 60 - R-12;- Pt fee 3/18/2009 3/13/09, fever 104.5, poor appetite, 3/20/2009 Non stated. 3/19/2009 Redness, swelling (half dollar sized) 3/11/2009 Received PENTACEL on 03/10/09. 3/17/2009 Erythema and induration (L) deltoid 3/18/2009 None stated. 3/17/2009 GARDASIL dose #3 1/27/09 2/17/09 3/15/2009 Patient experienced a headache Tu 3/17/2009 Varicella given before age 1 no side 3/17/2009 Patient reported that injection site w 3/15/2009 3 vaccines were given, the patient w 3/16/2009 Mild swelling on legs. Slightly raised 3/16/2009 Patient woke up the day after vaccin 3/12/2009 Hives one day after vaccination. 3/17/2009 Immediately after receiving HAV pa 30 minutes after injection - hive 3x4
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3/24/2009 IN 3/24/2009 IL 3/24/2009 VA 3/25/2009 WA 3/25/2009 TX 3/25/2009 FL 3/25/2009 OK 3/25/2009 3/25/2009 AZ 3/25/2009 AR 3/25/2009 NY 3/25/2009 AR 3/25/2009 AR 3/25/2009 AR 3/25/2009 NC 3/25/2009 AL 3/25/2009 UT 3/25/2009 MO 3/25/2009 GA 3/25/2009 MO 3/25/2009 OH 3/25/2009 NC 3/25/2009 VA 3/25/2009 OR 3/25/2009 FL 3/25/2009 IN 3/25/2009 WY 3/25/2009 TN 3/25/2009 NJ 3/25/2009 SD 3/25/2009 WA 3/25/2009 CO 3/25/2009 CA 3/25/2009 MN 3/25/2009 CO 3/25/2009 UT 3/25/2009 VA 3/25/2009 PA 3/25/2009 NJ 3/25/2009 TX 3/25/2009 PA 3/25/2009 MN 3/25/2009 CA 3/25/2009 PA 3/25/2009 NH 3/25/2009 KS 3/25/2009 CT 3/25/2009 FL 3/26/2009 OH 3/26/2009 3/26/2009 WA
5 5 72 90 67 67 0.3 16 13 59 23 4 11 3 38 54 23 16 15 5 13 59 33 65 29 5 4 82 79 8 37 0.3 13 37 0.4 69 52 11 11 15 25 36 17 70 6 12 33 11 1 17 23
5 5 72 90 67 67 16 13 59 23 4 11 3 38 54 23 16 15 5 13 59 33 65 29 5 4 82 79 8 37 0 13 37 0 69 52 11 11 15 25 36 70 6 33 11 17
M M F M F F M F F F F M F F F F M F F M F F F F M M F F F F M 0.4 F M F 0.4 F F F F M F F F F M M M U M M F F
3/17/2009 Pt given HEP A dose 2 in our office 3/10/2009 Mother called office 2 hrs after vacc 3/19/2009 Rash appeared on neck 1 week afte 3/25/2009 Pt broke out in full body rash consis 3/17/2009 3/17/09 Approx. 11:15am shingles v 3/23/2009 Initial information was received on 2 3/24/2009 Information has been received from 3/24/2009 Information has been received from 3/24/2009 Information has been received from 4-20-07 - onset "bruising" dx: ITP. 4 3/19/2009 Severe Nausea, vomiting, fever + jo 2/26/2009 Mom noticed around 7:00 AM this m 2/13/2009 Red-itchy-warm to touch-rash over e ### Rec'd flu vacc 110708; presented to 3/17/2009 None Stated 3/10/2009 pain in (R) arm at inj site. redness, w 3/16/2009 None stated 3/19/2009 After vaccination, patient collapsed 3/25/2009 Pt experienced vasovagal reaction w 3/25/2009 Mother states client woke up from a 3/25/2009 Approximately 4:00PM 12/7/08 Sym 3/25/2009 59 yo BF presented to clinic 3/24/09 3/25/2009 1. Severe pain/muscle locking appro 3/25/2009 Hep B vaccine administered in Lt De 3/25/2009 29 y/o AD male flyer w/ no significan 3/25/2009 Mother noted a red, hot raised area 3/25/2009 Reported by Mother of client on 3/2 3/25/2009 Zostavax administered Jan 27th, 20 3/25/2009 Elevated Blood pressure, Face and ### Left hand red, swelling and itching, 3/25/2009 Arm redness, tightness in chest. S/s 3/25/2009 no adverse reactions/symptoms. pa 3/25/2009 Had 2 swollen lump area. One lump 3/25/2009 erythematous vessicles at injection 3/25/2009 Nurse gave first dose of Rotateq aft 3/25/2009 I am submitting this report per patie 3/25/2009 Itchy, hot rash broke out the night o 3/25/2009 Localized erythema, plaque lesion; 3/18/2009 DV made by pt to show nurse react 3/25/2009 L arm red and swollen all around ba 3/25/2009 Swelling of throat with difficulty swa 3/25/2009 3-20-09: Tdap left deltoid, 3-22-09: 2/27/2009 Pt was waiting in line about 15 minu 3/25/2009 No reaction reported yet. Misadmin 3/25/2009 Developed Acute L arm swelling + r 3/24/2009 Vomiting Thurs. night Temp 105 Fri Pt reported a fever 103-104 F on Sa 3/25/2009 My son right after getting vaccines s 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from
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3/26/2009 3/26/2009 NJ 3/26/2009 NJ 3/26/2009 LA 3/26/2009 LA 3/26/2009 GA 3/26/2009 NY 3/26/2009 KY 3/26/2009 IL 3/26/2009 CA 3/26/2009 CA 3/26/2009 IL 3/26/2009 VA 3/26/2009 KY 3/26/2009 MA 3/26/2009 AZ 3/26/2009 TX 3/26/2009 UT 3/26/2009 TX 3/26/2009 RI 3/26/2009 3/26/2009 3/26/2009 IN 3/26/2009 TX 3/26/2009 TX 3/26/2009 WI 3/26/2009 VA 3/26/2009 3/26/2009 3/26/2009 GA 3/26/2009 MN 3/26/2009 3/26/2009 IN 3/26/2009 VA 3/26/2009 AK 3/26/2009 PA 3/26/2009 TX 3/26/2009 3/26/2009 LA 3/26/2009 LA 3/26/2009 VA 3/26/2009 MD 3/26/2009 DE 3/26/2009 VA 3/26/2009 OH 3/26/2009 TX 3/26/2009 WI 3/26/2009 AZ 3/26/2009 WA 3/26/2009 NJ 3/26/2009 WA
16 25 25
8 18 67 0.3 12 43 40 6 60 11 65 40 4 1.9 1.5 29 10 2 9 1.9 8 4 23 22 19 18 11 43 1 43 28 19 5 7 27 46 0.3 52 34 0.5 11 13 0.2 22 0.2
25 25
18 67 0 12 43 40 6 60 65 40 4 1 1 29 10 2 9 1 8 4 23 22 19 18 11 43 0 43 28 19 5 7 28 0 52 34 0 11 13 0 23 0
F F F U U M F M 0.3 M M F F F M F F M M 0.9 F 0.5 F M M 0.5 M F 0.9 F F F M U F F F F M 0.1 M M F F F F M F 0.2 F F F 0.6 M M M 0.2 F F 0.2 F
3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/24/2009 This case was received via an autho 3/23/2009 Headache, vomiting approximately 3 3/13/2009 Severe pain - whole body - muscles 3/20/2009 Pt administered PENTACEL, PREV 3/23/2009 MENACTRA given left upper arm 3/ 3/18/2009 Redness and swelling 3/23/2009 Had some significant pain in arm at 3/24/2009 rash - scattered papules -> Probabl 3/12/2009 1) Swollen, red circle about 4" in dia 3/23/2009 Given 11 yr old immunizations on 3/ 3/23/2009 Swelling, Red rash size, 2 " in diam 3/20/2009 None stated. 3/18/2009 Polio vaccine given March 12 3:00 p Urticaria at injection site noted after 3/20/2009 Febrile seizure-no treatment 3/23/2009 A 31 year old male subject presente 3/21/2009 Patient received varicella vaccine at 3/22/2009 4 days after vaccine, he ran a fever 3/20/2009 Chicken pox #2 given on 3/17/09 an 3/21/2009 Urticaria at injection site noted after 3/20/2009 Received immunization on 3/12/09. 3/19/2009 Redness & swelling at injection site. 3/26/2009 Redness, itching, swelling, fever at Redness, itching, swelling and feve 3/13/2009 Information has been received from 3/13/2009 Information has been received throu 3/13/2009 Information has been received from 3/26/2009 c/o numbness, tingling, tightness rig 3/26/2009 Patient received Tdap (Adacel) on 3 3/26/2009 HE BEGAN TO HAVE SEIZURES A 3/26/2009 Patient received vaccine and report 3/26/2009 Itching began about 2 hours after re 3/26/2009 She came in for labs and for a Gard 3/26/2009 SEIZURE LASTING APPROX. 3 MI 3/26/2009 30 minutes post administration of V 3/26/2009 Client received second dose of pre3/26/2009 Arm warm, very edematous, erythm 3/20/2009 Unconsolable crying for more than 3 3/25/2009 After receiving vaccine patient beca 3/26/2009 Received second dose in series of H 3/26/2009 INTERFERENCE WITH LIMB MOV 3/26/2009 Outer aspect of left arm at Varicella 3/26/2009 Patient received his Tdap vaccine fi 3/26/2009 Fever to 103, nausea, vomiting app 3/26/2009 Immediate weakness, lethargic, mu 3/26/2009 Pneumovax was ordered and admin
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3/26/2009 PA 3/26/2009 3/26/2009 MA 3/26/2009 KY 3/26/2009 PA 3/26/2009 OR 3/26/2009 VT 3/26/2009 WA 3/26/2009 WA 3/26/2009 CA 3/26/2009 CA 3/26/2009 CA 3/26/2009 CA 3/26/2009 PA 3/26/2009 CA 3/26/2009 NC 3/26/2009 AL 3/26/2009 MI 3/26/2009 PA 3/26/2009 FL 3/26/2009 MI 3/26/2009 NE 3/26/2009 MA 3/26/2009 NY 3/26/2009 OR 3/26/2009 3/27/2009 3/27/2009 CA 3/27/2009 3/27/2009 HI 3/27/2009 3/27/2009 AZ 3/27/2009 3/27/2009 LA 3/27/2009 3/27/2009 3/27/2009 3/27/2009 LA 3/27/2009 PA 3/27/2009 WA 3/27/2009 NC 3/27/2009 WA 3/27/2009 IA 3/27/2009 IA 3/27/2009 GA 3/27/2009 GA 3/27/2009 GA 3/27/2009 TX 3/27/2009 TX 3/27/2009 VA 3/27/2009 MN
43 51 66 4 49 1.6 1 1.9 42 5 15 12 60 5 21 45 25 36 0.2 4 7 1.1 45 28 1.3
43 51 66 4 49 1 1 1 42 5 15 12 60 5 21 45 25 36 0 4 7 1 45 28 1
30 24 21 23 16 15 4 11 6
30 24 21
0.7 1 28 12 25 2 4 18 14 13 1.3 7 39 58
0 1 28 12 25 2 4 18 14 13 1 7 39 58
11
F M M M F 0.6 M 0F 0.9 M M M F M F M M F F F 0.2 M F M 0.1 M M F 0.3 F U M F F F F F M M M M M 0.7 F 0F F F F 0.8 M F M F F 0.3 M F F M
3/26/2009 This case was reported via medical 3/26/2009 This case was reported by a lawyer 3/16/2009 12/2/08 S&S inc. numbness/tingling 3/26/2009 Pt.'s mother called 2 days after imm 3/25/2009 Within 10min of getting the shot, pt 3/17/2009 Mom reports about 14 hours after s 3/26/2009 Mom calling today to report that on 3/26/2009 Fever ; Febrile Seizure 3/26/2009 Exaggerated local reaction. 3/27/2009 Redness with swelling to R deltoid. 3/26/2009 High fever, achy all over body and n 3/25/2009 Itch. redness. induration pain. Since 3/26/2009 Rash on chest 3 days after adminis 3/26/2009 Redness, swelling and warm to touc 3/26/2009 Pt states felt woozy approx 5pm afte 3/26/2009 1 day after injection - Pt c/o rash, sw 3/26/2009 Local Rx, delayed. Redness, warmt 3/26/2009 Localized swelling and pain after sh 3/23/2009 ROTARIX was reconstituted with ste 1/9/2009 Large, red inflammatory reaction, rig 3/26/2009 Rash on the left upper arm 2cm/3cm 3/19/2009 Redness + minimal swelling @ site. 3/25/2009 Pain in upper right arm and neck an 3/26/2009 Pt received Tdap + Typhoid 3/9/09 f 3/25/2009 Developed 8x15cm local erythema, Pt showed up to ER 2/27/09 after re 3/27/2009 Joint pain and fevers. 3/27/2009 Achy feeling all over started and he 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received rega 3/16/2009 Parent stated that right arm was sw 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/19/2009 Patient was accidentally administere 3/24/2009 Mild fever, fussiness and swollen gl 3/24/2009 Diaphoresis and lightheadedness sh 3/23/2009 1 wk. after pt. received vaccine she 3/18/2009 Rash on back, chest, abdomen with 3/23/2009 Two days after receiving immunizat 3/23/2009 Arm swelling & redness at injection 3/24/2009 Pt was given Tripedia U2397BA ins 3/24/2009 Pt was given Tripedia U2397BA ins 3/24/2009 No adverse problem- Pt was given D 3/23/2009 As per mom left thigh red, hot and s 3/23/2009 As per mom left upper arm with eryt 3/27/2009 Developed headache within 2-3 hou 3/27/2009 DURING LATTER PART OF FEBRU
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3/27/2009 AZ 3/27/2009 NY 3/27/2009 AK 3/27/2009 CA 3/27/2009 TX 3/27/2009 AZ 3/27/2009 NC 3/27/2009 AL 3/27/2009 MD 3/27/2009 MI 3/27/2009 TX 3/27/2009 MI 3/27/2009 MI 3/27/2009 TX 3/27/2009 CO 3/27/2009 KY 3/27/2009 MO 3/27/2009 IA 3/27/2009 3/27/2009 AZ 3/27/2009 IA 3/27/2009 MO 3/27/2009 CA 3/27/2009 CA 3/27/2009 ID 3/27/2009 SC 3/27/2009 CA 3/27/2009 MT 3/27/2009 CA 3/27/2009 NE 3/27/2009 CA 3/27/2009 NC 3/27/2009 MT 3/27/2009 WA 3/27/2009 VT 3/27/2009 CA 3/27/2009 GA 3/27/2009 VA 3/27/2009 VA 3/27/2009 NJ 3/27/2009 NH 3/27/2009 CA 3/27/2009 VA 3/27/2009 MI 3/27/2009 TX 3/27/2009 VA 3/27/2009 3/28/2009 TX 3/28/2009 MI 3/28/2009 OH 3/28/2009 NY
8 22 31 4 64 64 84 1 30 1 2 66 55 4 0.3 0.2 4 17 58
8 22 31 4 64 64 84 1 30 1 2 66 55 4 0 0 4 17
1.3 1.1 0.2 5 4 54 58 24 5 4 12 67 11 0.3 4 4 30 60 73 0.2 11 1.3 67 1.3 15 47 56 1.6 15 1 4
1 -1 0 5 4 54 58 24 5 4 67 11 0 4 4 30 60 73 0 11 1 67 1 15 47 56 1 15 1 4
F F F F M F F 0M M 0F 0M F F M 0.3 M 0.2 F M F F F 0.3 M 0.2 M 0.2 M F M F F F M F F F F 0.3 M F M F F M 0.2 M F 0.3 M F 0.3 F F F M 0.7 F F 0M M
3/27/2009 NOT CLASSIC LESIONS, BUT HAS 3/27/2009 Headaches and Fatigue increasing 3/27/2009 Pt came in to have TB test read 3/1 3/27/2009 VACCINES ADMINISTERED IN AM 3/27/2009 64HM h/o DM, HTN, HLD, BPH p/w 3/27/2009 ITCHING,PAIN LEFT SHOULDER S 3/27/2009 She received vaccine on Fri. She d 3/27/2009 On March 3rd 2009 my son recieved 3/27/2009 Persisting headache from day after 3/27/2009 child presented to er on 3-20-09 wit 3/27/2009 2 y/o male. After receiving Hepatitis 3/27/2009 Left arm and shoulder very sore, sw 3/27/2009 site became red, inflamed, sore, pa 3/27/2009 Child was inoculated with 6 separat 3/27/2009 a rash that started at the site of the 3/27/2009 Day after shot was given, her legs s 3/27/2009 Redness & induration on left arm m 3/25/2009 High fever, injection site pain, redne 3/27/2009 We received the following from a co 3/26/2009 Vaccinated with 2 doses of 2 month 3/27/2009 Lump Rt thigh and red area both siz 3/27/2009 Developed raised blister like lesions 3/27/2009 Fever 103F at 11 PM, following imm 3/27/2009 Left leg swollen @ injection site with 3/27/2009 Left upper leg with large warm eryth 3/27/2009 Left shoulder joint pain with occasio 3/26/2009 Redness and swelling at injection si 3/27/2009 Client received IMOVAX IM on 3/26 3/23/2009 Large area of swelling & redness in 3/24/2009 Gave patient BOOSTRIX instead of 3/27/2009 10 days after GARDASIL (#2) Pt de 3/27/2009 Dizziness, nausea, sweating - soon 3/27/2009 Local reaction - redness and indura 3/28/2009 Seen 3/27/09 for "diffuse maculo - p 3/25/2009 2 hrs after MMR began screaming, Parent brought patient in stated tha Client c/o tingly warm feeling in L fin 3/27/2009 Swelling at injection site, redness an 3/27/2009 None 3/27/2009 Fever > 102, irritable. S/S started pm 3/26/2009 Pt received HPV (GARDASIL) #2 in Rash; Fever. 3/27/2009 Swelling at injection site, redness an 3/26/2009 TDAP was given but it was suppose 3/27/2009 Dizziness, nausea, headache, slurre 3/25/2009 Reported receipt of FLUSHIELD Lo 3/26/2009 The patient reported receipt of IM in 3/28/2009 1 Hour after injections, raised, red a 3/28/2009 FELT DIZZY AND LIGHTHEADED, 3/28/2009 2/24/09REPORTED TO PEDIATRIC 3/28/2009 Received Flu vaccine on 3/12/09. H
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3/28/2009 CA 3/28/2009 NC 3/28/2009 NC 3/28/2009 OH 3/29/2009 AR 3/29/2009 KY 3/30/2009 WA 3/30/2009 TN 3/30/2009 3/30/2009 3/30/2009 ID 3/30/2009 NC 3/30/2009 TX 3/30/2009 KY 3/30/2009 CA 3/30/2009 CT 3/30/2009 WV 3/30/2009 MO 3/30/2009 OH 3/30/2009 MO 3/30/2009 MN 3/30/2009 TX 3/30/2009 3/30/2009 3/30/2009 NJ 3/30/2009 NY 3/30/2009 NY 3/30/2009 TX 3/30/2009 PA 3/30/2009 MO 3/30/2009 WA 3/30/2009 NC 3/30/2009 TX 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 NJ 3/30/2009 UT 3/30/2009 NE 3/30/2009 CA 3/30/2009 MI 3/30/2009 AL 3/30/2009 MA 3/30/2009 MI 3/30/2009 MA 3/30/2009 FL 3/30/2009 VA
12 67 69 18 56 0.4 1 73
12 66 69 18 56 0 1 73
35 4 1 12 4 11 63 61 11 14 35 0.3 0.5 1.6
35 4 1 12 4 11 63 61 11 14 35 0 0
0.7 3 14 15 76 1.1 15 0.2 11 2 60 4 1.2 17 70 43 5 66 4 6 60 24 18 3 12 62
0 14 15 76 1 15 0 11 2 60 4 1 17 70 43 5 66 4 6 60 24 18 3 12 62
F F M M F 0.4 F 0M F M F F F 0F F M M M F F F F 0.3 F 0.5 M M M 0.7 M M F F F 0.1 M F 0.2 F F 0M F M 0.2 F M M M M F F F F F M M F M
3/28/2009 Pt got vaccinated with MCV4 (MENA 3/28/2009 Moderate to severe hives, relieved b 3/28/2009 Severe hives on ankles and lower le 3/28/2009 8/08-High fever-102, chills, body ac 3/29/2009 Hard,painful, hot to the touch, egg s 3/29/2009 Patient received shots Dec. 29th, se 3/30/2009 Fever of 103.5 at 0130 in the AM on 3/26/2009 Initial report received from a health 3/25/2009 Initial report received on 19 March 2 3/25/2009 Initial report received on 19 March 2 3/27/2009 Cellulitis R upper arm injection site. 3/27/2009 Right leg thigh red and swollen over 3/26/2009 Vaccinated 3/9/09 - on 3/14/09 moth 3/24/2009 Mother brought patient to the clinic 3/5/2009 Redness and swelling LUD. Warm 3/25/2009 Redness & swelling on arm - right s 3/26/2009 Fever (102 degrees) multiple muscl 3/23/2009 Patient called 2 days after vaccine t 3/4/2009 Site reaction, large area of redness 3/20/2009 Morning after immunizations, child h 3/24/2009 Initial information was received from 3/27/2009 This case was received on 23 Marc 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/20/2009 C/o chest pain radiating from back t 3/24/2009 Pt given 12mo shots on 3/9/09. Ha 3/23/2009 Awakened with joint pain, & nausea Received 1st immunizations 3/13/09 3/5/2009 Pt's mom reports today that child is 3/4/2009 Fever, rash and hair loss. 2/17/2009 Received ZOSTAVAX 2-2-09, then ### Broke out with red patches and sma 3/18/2009 Mother brought child back to Health 3/17/2009 Vaccines received 3/16/09 5pm, Mo 2/19/2009 Developed redness, swelling, pain a 3/30/2009 This case was reported by a lawyer 3/30/2009 Urticarial type rash on legs and arm 03/24/09 Sore + tender - Hurt with m 3/12/2009 7.5 cm x 11.3 w. with redness, warm 3/3/2009 Patient was given a second dose of 3/23/2009 3/9/09, tingling in jaw and lips, very 3/26/2009 Tingling and numb feeling in legs, it 3/30/2009 Client was given a Tdap on 03/24/2 3/30/2009 CHILD WAS GIVEN HIB AND PCV7 3/30/2009 swelling of injection site, low-grade 3/30/2009 Comes to clinic as walk-in with c/o n
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3/30/2009 AZ 3/30/2009 OK 3/30/2009 DC 3/30/2009 CA 3/30/2009 VA 3/30/2009 MO 3/30/2009 MA 3/30/2009 VA 3/30/2009 TX 3/30/2009 NM 3/30/2009 UT 3/30/2009 CA 3/30/2009 WI 3/30/2009 PA 3/30/2009 IL 3/30/2009 GA 3/30/2009 NM 3/30/2009 AR 3/30/2009 CT 3/30/2009 NC 3/30/2009 MI 3/30/2009 NC 3/30/2009 CA 3/30/2009 MI 3/31/2009 3/31/2009 CA 3/31/2009 3/31/2009 3/31/2009 3/31/2009 NE 3/31/2009 MD 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 NE 3/31/2009 NJ 3/31/2009 OK 3/31/2009 MS 3/31/2009 CA 3/31/2009 KY 3/31/2009 AZ 3/31/2009 WA 3/31/2009 ME 3/31/2009 KS 3/31/2009 CA
50 18 61 54 53 60 65 62 39 4 4 0.1 60 41 1 63 9 10 39 65 0.7 5
50 18 61 54 53 60 65 62 39 4 4 0 60
20 24 70
20 24 70
15 24 0.5 1.6 8
15 24 0 1
1 63 9 10 39 65 0 5
12 1.3
1.4 3 44 36 11 4 4 26 1.1 48 0.3
3 44 36 11 4 4 26 1 48 0
F F F F F F F F F M F 0.1 F M F 0M M F F F F 0.7 M F F F F M F F F 0.5 F 0.6 M M F M U M M U F M M F M M M M F F 0.1 F F 0.3 M
3/30/2009 Soreness and bruising noted at inje 3/30/2009 Clients mother call to Health Depart 3/30/2009 THE DAY AFTER RECEIVING THE 3/30/2009 03/26/09 swelling began left arm. 03 3/30/2009 Infjection on Thursday, March 26, 2 3/30/2009 Chills, full and deep bone & body ac 3/30/2009 First day: Very fatigued, with severe 3/30/2009 Patient claims "huge" bruise near el 3/30/2009 With receipt of AVA # 1, TYPHOID, 3/19/2009 Right thigh with significant swelling, 3/30/2009 Patient was given MMR and Varicel Crying for about 3 hours, didn't wan 3/30/2009 Tdap injection 3/18/09 left deltoid, 3 3/30/2009 Urticarial reaction at injection site 4 3/10/2009 Patient fell over forward while sitting 3/30/2009 Vaccine was given Mon 3/23/09 abo 3/30/2009 Patient had redness, swelling and p 3/30/2009 Rash outbreak - vaccinated 3/5/09. 3/18/2009 Vaccine, associated Varicella rash. 3/30/2009 Injection site reaction. Sore with in 1 3/30/2009 Rota given at 32 weeks and 10 day 3/30/2009 Right thigh swollen, red, warm to tou 3/26/2009 Patient got shingles around 3 days 3/30/2009 Adult patient received a pediatric do 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/27/2009 Initial report received on 17 March 2 3/27/2009 This serious case was received on 2 3/30/2009 Caretaker states pain, erythema, an 3/24/2009 Signs of bruising and petechiae in A 3/27/2009 Developed chest pain, SOB and dia 3/31/2009 Left deltoid 13 1/2 x 12 cm reddene 3/31/2009 Localized reaction, red, warm to tou 3/30/2009 L arm Swelling With mild erythema. 3/31/2009 Patient had a hot, red, swollen lump 3/25/2009 Red ring around injection site. Low 1/23/2009 Right after injection I got very hot an 3/26/2009 Developed rash on Both anterior thi
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3/31/2009 WA 3/31/2009 MA 3/31/2009 OK 3/31/2009 MI 3/31/2009 MI 3/31/2009 AZ 3/31/2009 OH 3/31/2009 IN 3/31/2009 CA 3/31/2009 UT 3/31/2009 CO 3/31/2009 IL 3/31/2009 MA 3/31/2009 OH 3/31/2009 TX 3/31/2009 TX 3/31/2009 TN 3/31/2009 WA 3/31/2009 MI 3/31/2009 MO 3/31/2009 MO 3/31/2009 3/31/2009 NV 3/31/2009 TX 3/31/2009 VT 3/31/2009 PA 3/31/2009 MN 3/31/2009 MA 3/31/2009 NJ 3/31/2009 AZ 3/31/2009 CA 3/31/2009 CA 3/31/2009 IL 3/31/2009 FL 3/31/2009 NY 3/31/2009 CO 3/31/2009 OK 3/31/2009 CO 3/31/2009 OR 3/31/2009 CT 3/31/2009 GU 3/31/2009 SD 3/31/2009 AZ 3/31/2009 WI 3/31/2009 TX 3/31/2009 MA 3/31/2009 VA 3/31/2009 NY 3/31/2009 CA 3/31/2009 MA 3/31/2009 FL
45 6 11 25 65 11 1 61 4 11 5 78 63 4 66 49 2 5 1.9 32 22 1.6 23 51 53 1.6 53 50 1.5 18 0.8 26 0.2 42 0.7 13 1.3 38 11 76 1.5 0.2 46 48 1.1 1.3 10 61 1.6 46 4
45 6 11 25 65 11 1 61 4 11 5 78 63 4 66 49 2 5 1 32 22 1 23 53 1 53 50 1 18 0 26 0 42 0 13 1 38 11 76 1 0 46 48 1 1 10 1 46 4
F F F F F F 0M F M M F F F M M F 0.1 M F 0.9 M F F 0.6 F M M U 0.6 M M F 0.5 M F 0.8 F F 0.2 M F 0.7 M F 0.4 M F F M 0.5 M 0.2 M M M 0.1 F 0.3 M M F 0.6 F F M
3/24/2009 Right arm pain, swelling radiating up 3/25/2009 None as of this date. 3/25/2009 Approximately 48 hours after admin 3/27/2009 No adverse event, dose given 3 we 3/25/2009 Developed low grade fever, arthralg 3/23/2009 Redness, swelling and hot touch. 3/25/2009 Presented in ED 3/11/09 with possib 3/25/2009 Local reaction of pain, warmth, + er 3/19/2009 Whole left arm red and swelling. 3/26/2009 Red, swollen arm, bump, raised and 3/27/2009 Redness, swelling of left arm. 48 hrs 11/24/08 - Office visit - Dr. - Shingle 3/30/2009 3-18-09 3:40p seen for erythema 3. 3/30/2009 4 yr old male received DTAP, MMR 3/31/2009 Redness, hard knot. No fever or chi 3/31/2009 Cellulitis to left arm. Running tempe 3/26/2009 Right leg at injection site was warm 3/26/2009 Chicken Pox. 3/26/2009 Phone call from mom got Imms (HIB 3/25/2009 Approximately 15 minutes after rece 3/25/2009 HEP B vaccine administration on 33/23/2009 Patient was given adult dosage of H 3/24/2009 23 y/o male with generalized mildly 3/23/2009 Non stated Diarrhea for 12 hours 3/25/2009 Patient returned to office 3-23-09, a 3/31/2009 Patient received Pneumovax 23 vac 3/31/2009 Pain, warmth and induraton at vacc 3/31/2009 received IPOL on 3/27/09 and deve 3/31/2009 After administration of GPV, patiien 3/31/2009 Pt was noted to have a thigh mass o 3/31/2009 PATIENT CALL A DAY AFTER AND 3/31/2009 On 3/27/09 Mom reports to IM clinic 3/31/2009 Swollen arm after Tdap vaccine give 3/31/2009 Patient had a tactile fever for 3 days 3/31/2009 Client developed localized eythema 3/31/2009 URTICARIA/HIVES- TREATMENT 3/31/2009 The following was reported by the c 3/31/2009 Fainted aprox 5 min after vaccinatio 3/31/2009 - Pt called clinic and later seen on 3 3/31/2009 High fever for three days (T. Max 10 3/31/2009 On 1-4-09 patient Y had Hep B Vaccin 3/31/2009 Symptoms began the same evening 3/31/2009 1. Swelling warmth, redness injectio 3/31/2009 Scattered erythema rash, primarily t 3/31/2009 Dry, seal barky cough, hard time bre 3/24/2009 Vaccine administered on 3-20-09 in 3/30/2009 Patient c/o body ache, weakness, p 3/26/2009 Lumps on thigh: No tx. Telephone a 3/31/2009 Lump (bigger than a bean) tenderne 3/31/2009 Err:508
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3/31/2009 CA 3/31/2009 MN 3/31/2009 MN 3/31/2009 CA 3/31/2009 CA 3/31/2009 CA 3/31/2009 MT 3/31/2009 PA 4/1/2009 MN 4/1/2009 MI 4/1/2009 NY 4/1/2009 4/1/2009 4/1/2009 NE 4/1/2009 CT 4/1/2009 4/1/2009 4/1/2009 NC 4/1/2009 NJ 4/1/2009 MO 4/1/2009 4/1/2009 MN 4/1/2009 UT 4/1/2009 FL 4/1/2009 TN 4/1/2009 MT 4/1/2009 NC 4/1/2009 TX 4/1/2009 TX 4/1/2009 WI 4/1/2009 NJ 4/1/2009 TN 4/1/2009 NC 4/1/2009 LA 4/1/2009 FL 4/1/2009 NC 4/1/2009 CA 4/1/2009 OR 4/1/2009 MI 4/1/2009 GA 4/1/2009 IL 4/1/2009 CA 4/1/2009 TX 4/1/2009 NE 4/1/2009 IL 4/1/2009 TX 4/1/2009 AZ 4/1/2009 AZ 4/1/2009 NY 4/1/2009 4/1/2009 IN
19 0.5 12 1.1 12 0.6 11
19 0 12 1 12 0 11
15 0.2 1 3
15 0
18 21 16
18 21 16
19 39 9 62 0.2 62 4 1.7 70 14 13 56 19 1.6 1.4 63 22 13 13 61 5 59 1.3 4 0.8 0 83 16 2 18 0.2 5
39 9 0 62 4 1 74 14 13 56 19 1 1 63 22 14 13 61 5 59 1 4 0 0 83 16 2 18 0 18 5
F 0.5 F F 0.1 F F 0.6 F M U F 0.2 F M M M F F F F F F M M 0.2 M F M 0.7 F M F F M M 0.6 F 0.4 M U F M F F F M F 0.3 M F 0.8 F 0M F F 0.3 F F 0.2 F F F
3/31/2009 Tingling around mouth with swelling 3/30/2009 Approx 6 hrs after receiving 6mo va 3/31/2009 1. 2 lesions on labia - lidocaine jelly 3/31/2009 (1) Reactive nodule. No sign of infe 3/31/2009 About 6 minutes after administering Mother brought her daughter in @ 1 3/31/2009 Large red spot, raised area, Lt uppe 3/26/2009 Nonspecific reaction, This case was 3/31/2009 Upon injection, My daughter immed 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information and follow up has been 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from Started having severe stabbing ach 3/26/2009 5.5 X 2.5 Cm red, raised, hot area c 3/30/2009 Patient received PNEUMOVAX vac 3/24/2009 Child developed ROTAVIRUS infec 3/27/2009 Pt returned to clinic the day after rec 4/1/2009 MMR was possible mixed with IPV f 4/1/2009 3-31-09 Mom states light rash on fa 3/31/2009 Has a red heavily speckled line or b 4/1/2009 Client became dizzy after vaccinatio 4/1/2009 several fevers a day, bad headache 4/1/2009 Patient was given flu shot and pneu 4/1/2009 Developed one-sided facial palsy w 4/1/2009 Child developed fever and had febri 4/1/2009 Red macular rash over chest, abdom 4/1/2009 PATIENT LOST CONSCIOUSNESS 4/1/2009 @ 24 hrs post-vaccine: egg-shaped 4/1/2009 Yellow Fever vaccination given on 3 4/1/2009 CLIENT BECAME DIZZY AFTER R 4/1/2009 24 hours after varicella vaccine #2 d 4/1/2009 AFEBRILE - REDDNESS AND ERY 4/1/2009 Last PM temp up to 103 - today 102 4/1/2009 Symptoms:Shortness of Breath, Ra 4/1/2009 Gave Pediarix instead of DTaP. No 4/1/2009 Returned to clinic one day after rece 4/1/2009 Large Welts under skin, muscle feel 4/1/2009 My son received Influenza vaccine ( 4/1/2009 Patient reported redness for a few d 4/1/2009 Gardasil shot was given. Pain start 3/19/2009 A serious, spontaneous report of se 3/27/2009 Pt was given GARDASIL vaccine w 4/1/2009 Started to become fussy, crying - ha 4/1/2009 Rash. 4/1/2009 Left thigh red.
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4/1/2009 CA 4/1/2009 TX 4/1/2009 TX 4/1/2009 ID 4/1/2009 NY 4/1/2009 NY 4/1/2009 WI 4/2/2009 NC 4/2/2009 MA 4/2/2009 4/2/2009 4/2/2009 NC 4/2/2009 WV 4/2/2009 CA 4/2/2009 NY 4/2/2009 OH 4/2/2009 CA 4/2/2009 NY 4/2/2009 NJ 4/2/2009 VA 4/2/2009 NC 4/2/2009 CA 4/2/2009 IA 4/2/2009 KS 4/2/2009 SC 4/2/2009 TX 4/2/2009 RI 4/2/2009 RI 4/2/2009 WY 4/2/2009 PA 4/2/2009 MS 4/2/2009 TX 4/2/2009 TX 4/2/2009 PA 4/2/2009 AZ 4/2/2009 TN 4/2/2009 TN 4/2/2009 TX 4/2/2009 WV 4/2/2009 TX 4/2/2009 MO 4/2/2009 NY 4/2/2009 NY 4/2/2009 CA 4/2/2009 MA 4/2/2009 MN 4/2/2009 IL 4/2/2009 DE 4/2/2009 OR 4/2/2009 NY 4/2/2009 NC
16 26 66 0.2 32 4 16 20 6 23 74 84 0.9 1 1 11 41 17 4 0.2 18 12 1 1 0.6 31 53 0.4 25 12 5 14 1.4 63 25 70 2 48 37 23 4 15 31 12 4 95 16 18
16 41 26 66 0 32 4
84 0 1 0 11 41 17 4 0 18 12 1 1 0 31 53 25 12 5 14 1 63
2 48 23 4 15 31 12 4 95 16 18
F F F F 0.2 F M F F F U M M M M 0.9 F 0F U 1M F M F F 0.2 F F M 0F 0F 0.6 M F F F M M F F 0.4 F F F M 0M M M F M F F F M F F F
3/29/2009 Hot, red area @ injection site. Started getting a rash of small red b 4/1/2009 Pt reports woke up the morning afte 4/1/2009 Severe pain, induration warmth at in 4/1/2009 Pt given vaccines 10:30 am, began 3/23/2009 2 hrs after immunization patient sha 48-72 Hrs after VARIVAX develope 4/1/2009 Information has been received from 4/1/2009 Information has been received from 4/1/2009 Information has been received from 4/1/2009 Information has been received from 3/30/2009 This serious case was received on 2 4/2/2009 This is a 74yo, Male, came to ER w Complete loss of control - 9-13-08. H 4/1/2009 Acute disseminated encephalomyel 4/2/2009 generalized rash over trunk, face & L Leg 4 cm erythema and induration 3/30/2009 Patient developed fever up to 103.2 3/30/2009 105 fever 12 hours later. Headache 2/9/2009 The moment needle was in right de 3/25/2009 Injection about 15:40. Approximatel 3/20/2009 Large area of redness and induratio 3/25/2009 2 doses of PREVNAR were adminis 3/29/2009 Fever, headache, neck soreness, vo 4/2/2009 Malaise, poor appetite, nausea/vom 3/26/2009 Post vaccine hives for 15 min. Then 4/1/2009 fever of 101 degrees, rubbing @ he 4/1/2009 @ 3 AM on 3/18/2009 pt. awoke wit 3/27/2009 Received TDAP vaccine 3/19/09. D 3/30/2009 Patient received Tdap on 3/23/09. C 3/26/2009 None stated 3/18/2009 A rash began to develop around the 3/27/2009 Home visit B/P 106/60 Temp 98.4 P 3/30/2009 VARIVAX breakthrough. Had 2 dos 3/19/2009 Patient turned pale a minute after re 3/11/2009 Child developed diarrhea evening o 3/18/2009 Received TdaP 3/16/09 Developed 4/2/2009 Experienced tightness in throat 30 m 4/1/2009 from pt. States he was in this office 4/2/2009 Fever 101-103.8 and diarrhea. 4/2/2009 Patient states he felt some numbne None stated Facial palsy (R). Pt states a few hou 4/1/2009 Large local swelling @ site of KINR 4/2/2009 0.1 cm in diameter nodule, palpable ### Severe total body itching for 1 1/2 m 4/1/2009 After 2 h erythematous rash and sm 4/2/2009 Right upper arm swollen, warm to to 3/31/2009 Pt had a TETANUS shot a week ag 4/2/2009 2/22/09 to 2/24/09 Fever by report f 4/2/2009 CLIENT RECEIVED 7 VACCINES O
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4/2/2009 CO 4/2/2009 CA 4/2/2009 FL 4/2/2009 MO 4/2/2009 CO 4/2/2009 WA 4/2/2009 CO 4/2/2009 CA 4/2/2009 CA 4/2/2009 CA 4/2/2009 AZ 4/2/2009 NM 4/2/2009 WA 4/2/2009 IL 4/2/2009 WA 4/2/2009 NE 4/2/2009 4/2/2009 SC 4/2/2009 4/2/2009 4/2/2009 MN 4/2/2009 MN 4/2/2009 MN 4/2/2009 TX 4/2/2009 AR 4/2/2009 NC 4/2/2009 IN 4/2/2009 MN 4/2/2009 KY 4/2/2009 WA 4/2/2009 CA 4/2/2009 MA 4/2/2009 TX 4/2/2009 AK 4/3/2009 CT 4/3/2009 4/3/2009 CA 4/3/2009 NY 4/3/2009 NC 4/3/2009 HI 4/3/2009 4/3/2009 4/3/2009 OH 4/3/2009 AL 4/3/2009 OH 4/3/2009 CA 4/3/2009 CA 4/3/2009 NC 4/3/2009 NC 4/3/2009 HI 4/3/2009 NM
64 0.3 4 66 59 0.2 59 77 1.1 4 4 65 32 0.5 0.2 11
64 0 4 66 59 0 59 77 1 4 4 65 32 0 0 11
29 58 28 69 44 6 2 11 3 0.2 58 3 59 4 78 64 31 72 1.4 15 12 33 38 30 37 16 35 29 11 4 12 58 48 0.2
29 57 28 69 44 6 2 11 3 0 58 3 59 4 78 64 31 1 15 12 33 38 30 37 16 29 11 4 12 58 48 0
F 0.3 F F F M 0.2 F M M 0.1 F F M F M 0.5 M 0.2 M F F F M M F M F 0.6 M F M 0.2 M F M F F F F F M 0.4 M F F F F M M M F F F M F M F 0.2 M
3/9/2009 Soreness and erythema (~4 inches 4/2/2009 Child was in office for a 6 month ph 4/2/2009 On the evening of the shots, she de 4/2/2009 Patient call on 4/2/09 stating that on 4/2/2009 Had inner gluteal pain starting four d 4/2/2009 Pt received a vaccination from an e 4/2/2009 Took first oral typhoid capsule as di 4/2/2009 Developed full blown Shingles appr 4/2/2009 Child received subcutaneous injecti 4/2/2009 GAVE 4TH PEDIARIX 4/2/2009 EDEMA AND ERYTHEMA TO RIGH 4/2/2009 Patient started to notice hives on th 4/2/2009 Minor local reaction at the left deltoi 4/2/2009 He vomited about 5 hrs. after being 4/2/2009 N/A 4/2/2009 High fever of 106F, wheezing, uppe 4/2/2009 This case was reported by a consum 4/2/2009 This case was reported by a pharma 4/2/2009 This case was reported by a lawyer 4/1/2009 While attending graduate school, th 4/2/2009 Per pt had orange size lump/ swellin 4/2/2009 None 3/30/2009 About 2 1/2 inches red area with sw 4/2/2009 Swelling red ball under skin @ injec 4/2/2009 Nausea 15 min after GARDASIL Diz 3/31/2009 Febrile seizure. Temp. 105. TYLEN 4/1/2009 12 n Mother gave child TYLENOL 0 4/2/2009 Soreness in joints, muscles - consta 4/2/2009 Lg area of bumps at injection site go 4/2/2009 Redness/ itching at injection site rig 4/2/2009 Moderate redness and swelling of R 4/2/2009 Erythema right upper arm below inje 4/2/2009 3-27-09 1:00 PM - began experienc 4/2/2009 Pain at injection site, malaise, naus 4/2/2009 Information has been received from 4/2/2009 Information has been received from 4/2/2009 Information has been received from 4/2/2009 Information has been received from 3/31/2009 Respiration problems, dizziness, ne 3/31/2009 RUE cellulitis, pain, fever, tachycard 4/3/2009 Pt had SPV on 3/6/09 and AVA on 3 4/3/2009 Vesicular rash on (L) arm, neck and 3/27/2009 Fever (103 degrees), headache, bo 3/31/2009 After last flu shot experienced head 4/3/2009 4cm X 4cm pink area around where 4/3/2009 Patient fainted for a few seconds af 3/18/2009 Reaction began 1 hr after injection. 3/31/2009 Hours after the vaccines, patient c/o None 3/30/2009 4 days after administration, nickel si 3/31/2009 Patient came in 3/31/09 stated that
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4/3/2009 FL 4/3/2009 PA 4/3/2009 MA 4/3/2009 LA 4/3/2009 KY 4/3/2009 NJ 4/3/2009 NY 4/3/2009 KY 4/3/2009 OH 4/3/2009 FL 4/3/2009 KY 4/3/2009 TX 4/3/2009 TX 4/3/2009 PA 4/3/2009 MI 4/3/2009 IN 4/3/2009 NJ 4/3/2009 PA 4/3/2009 OH 4/3/2009 AL 4/3/2009 MO 4/3/2009 GA 4/3/2009 TX 4/3/2009 MI 4/3/2009 WI 4/3/2009 IL 4/3/2009 WA 4/3/2009 WA 4/3/2009 RI 4/3/2009 OK 4/3/2009 CA 4/3/2009 CA 4/3/2009 MO 4/3/2009 OH 4/3/2009 PA 4/3/2009 MN 4/3/2009 AR 4/3/2009 AR 4/3/2009 CA 4/3/2009 CA 4/3/2009 CA 4/3/2009 CT 4/3/2009 PA 4/3/2009 CT 4/3/2009 NM 4/3/2009 IN 4/3/2009 IL 4/3/2009 NJ 4/3/2009 LA 4/4/2009 NC 4/5/2009 GA
46 71 12 13 51 5 0.1 11 4 0.2 1.3 75 7 18 0.8 0.6 0.5 75 0.5 30 14 11 11 39 0.9 14 1 0.2 1.1 16 1 48 68 73 1 5 1.4 5 63 10 8 0.5 0.8 3 0.6 0.2 2 1.3 36 0.2 11
46 71 13 51 5 0 11 4 0 1 75 7 18 0 0 0 75 0 30 14 11 11 39 0 14 1 0 1 16 1 48 68 73 1 5 1 5 10 8 0 0 0 0 2 1 36 0 11
F F M M F F 0.1 M M F 0.2 F 0.3 M M F F 0.8 M 0.6 M 0.6 F F 0.5 M F F F M M 0.9 M F 0M 0.2 M 0.1 F F 0F F F F 0M M 0.4 M M M M M 0.5 M 0.8 M F 0.6 F 0.2 F 0.9 M 0.3 M U 0.2 M M
3/31/2009 Began to feel nauseous, vomited x 3/28/2009 Severe lightheadedness within 15 m 3/25/2009 Baseball sized swelling at site of VA 3/20/2009 Pt reports broke out in small blisters 3/31/2009 Swelling + erythema + pruritis of Rt 4/2/2009 While at home: (Location) bilateral a 3/31/2009 Patient received 6 wks immunization 4/2/2009 Pt presents today 4/1/09 with red ar 4/3/2009 Large local reaction 9X6 cm local ic 4/3/2009 Vaccine administered to left thigh bu 4/3/2009 Swelling of Rt thigh area after vacci 4/3/2009 Redness, soreness, swelling. 4/3/2009 Patient developed redness around b 3/31/2009 3-30-2009 Received Hep A at appro 3/30/2009 Hep A was given at 9 months. 4/3/2009 Given DTap/Hib/IPV and HebB/Hib4/3/2009 NICKEL SIZE DARK PINK RAISED 4/3/2009 Patient broke out in shingles 6 days 4/3/2009 High fever, strong crying, for many h 4/3/2009 Golf ball sized knot on right arm. Re 3/30/2009 Headache adn hives were around s 4/3/2009 Cellulitis on left deltoid where Tdap 4/3/2009 No noted adverse reaction. Patient 4/3/2009 Developed bilateral kidney area pai 4/3/2009 4/1/2009 MOTHER PRESENTED T 4/3/2009 approx two weeks after my daughte 4/3/2009 Pt received a vaccination from an e 4/3/2009 Pt received a vaccination from an e 4/3/2009 My daughter developed a large red 4/3/2009 Within 5-10 minutes of patient recei 4/3/2009 Varicella disease (rash, fever). 4/3/2009 Received TDaP and PNEUMOVAX Pt stopped by Clinic today to report 4/3/2009 Red blistering rash in groin and hip 4/3/2009 Fever, max 100.5; redness, indurati 4/1/2009 Sore arm -> redness + swelling at th 4/1/2009 >10 cm area of redness on L thigh i 4/3/2009 >10 cm area of redness, warmth an 4/3/2009 Myalgias / arthralgias / HA (L) shoul 4/2/2009 Ameliorated varicella rash (Sib with 4/2/2009 Ameliorated Varicella rash (Sib with 1/23/2009 Initial report received on 20 January 3/17/2008 Initial report received on 13 March 2 1/26/2009 Initial report received from a manufa 1/29/2009 Initial report received on 22 January 9/9/2008 Initial information was received on 1 8/19/2008 Initial report received on 08 August 8/12/2008 This case was received from a heal ### This case was received from a heal 4/4/2009 SCREAMING AFTER WAKING, CR 4/5/2009 First 20 hrs- He had extremely sore
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4/5/2009 IN 4/5/2009 DE 4/5/2009 IN 4/5/2009 CA 4/5/2009 CA 4/5/2009 NV 4/5/2009 MO 4/6/2009 4/6/2009 SC 4/6/2009 PA 4/6/2009 4/6/2009 4/6/2009 4/6/2009 4/6/2009 4/6/2009 LA 4/6/2009 ME 4/6/2009 IL 4/6/2009 AL 4/6/2009 HI 4/6/2009 PR 4/6/2009 GA 4/6/2009 TX 4/6/2009 NY 4/6/2009 OH 4/6/2009 IL 4/6/2009 IN 4/6/2009 CA 4/6/2009 IA 4/6/2009 MN 4/6/2009 TX 4/6/2009 FL 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 NE 4/6/2009 IN 4/6/2009 OH 4/6/2009 KS 4/6/2009 CT 4/6/2009 MN 4/6/2009 GA 4/6/2009 AL 4/6/2009 MI 4/6/2009 AL 4/6/2009 CO 4/6/2009 IL 4/6/2009 MI 4/6/2009 CA
57 60 69 36 46 40 24
60 69 36 46 40 24
8 49
8 49
7 1.3 17 2 0.5 1.3 15 0.5 67 1.4 36 1.7 5 8 55 8 65 11 39 0.8 0.2 0.2 0.2 0.2 29 18 40 39 14 19 60 5 6 17 0.4 4 28 34
2 0 1 15 0 67 1 36 1 5 8 55 8 65 11 39 0 0 0 9 0 29 18 40 39 14 19 60 5 6 17 0 4 28 34
M M M M F M F M M F M M M M M U 0.2 U 0.5 F 0.3 F F 0.5 F M 0.4 M M 0.7 F F F F F F M M 0.8 M 0.2 F 0.2 M F 0.2 F F F F M F F F F F F 0.4 M F F F
4/5/2009 Pt had receive.5cc pneumo-vac on 4/5/2009 Moderate Fever ~ 101 F, Malaise, M 4/5/2009 On 11/28/08, pt was in clinic and C/ 4/5/2009 Patient was given scheduled vaccin 4/5/2009 On Friday, 4/3/09, I received two va 4/5/2009 2-3 day after hives around vaccinati 4/5/2009 Had Hep A and Hep B shots on 4/4 4/3/2009 InformationYhas been received from 4/2/2009 This non serious case was received 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 3/24/2009 Information has been received from 3/27/2009 Information has been received from Developed fever 3/26/09/ER visit fo 3/26/2009 4 hours after receiving DTAP, PREV 4/1/2009 Seizure, thought to be febrile seizur 3/23/2009 Syncope 5 minutes after HPV (GAR 3/31/2009 Pt developed erythematous rash, ur 4/2/2009 None. Patient said arm slightly sore 4/1/2009 Developed hives within 15 minutes 3/7/2009 Small localized reaction started day 4/1/2009 1. Erythema around injection site, n 4/3/2009 Received KINRIX (DTaP/IPV) Rt thi 3/28/2009 Received VARIVAX 3/26/09 mom n 4/5/2009 Patient is a USAFR female service m 3/25/2009 Injection given 3-20-09 AM. Seen in 3/30/2009 Sore arm very painful every time I m 4/6/2009 Localized allergic reaction 4/6/2009 Pt. felt weak, muscle soreness for 3 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt called clinic, c/o redness and blo 4/6/2009 Mother called on 4-6-09 stating that 4/6/2009 pain started out as aching 1 hour af 4/6/2009 On 3/27/09 the employee went to th 4/6/2009 swelling pain of both knees. 4/13/09 4/6/2009 Approximately 24 hours after the va 4/6/2009 Patient noticed on 4/5/08 at 2:00AM 4/6/2009 4/3/09 @ 9am- phone call from pare 4/6/2009 Rash - localized papules. No bullae 4/6/2009 Varicella given 3/31/09 approx. 10:3 4/6/2009 Rotateq (rotavirus) vaccine given vin 4/6/2009 Child received IPV and DTAP in Rig 4/6/2009 24hrs after shot pt had swollen, pain 4/6/2009 Pt was given Pneumovax vaccine a
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4/6/2009 OK 4/6/2009 IL 4/6/2009 WI 4/6/2009 WI 4/6/2009 FL 4/6/2009 CA 4/6/2009 WA 4/6/2009 CA 4/6/2009 ID 4/6/2009 IA 4/6/2009 CA 4/6/2009 TX 4/6/2009 CA 4/6/2009 OR 4/6/2009 MO 4/6/2009 FL 4/6/2009 MI 4/7/2009 4/7/2009 TX 4/7/2009 CA 4/7/2009 NY 4/7/2009 OH 4/7/2009 CA 4/7/2009 4/7/2009 4/7/2009 4/7/2009 MA 4/7/2009 MS 4/7/2009 NC 4/7/2009 MN 4/7/2009 CO 4/7/2009 CA 4/7/2009 PA 4/7/2009 AL 4/7/2009 MO 4/7/2009 PA 4/7/2009 PA 4/7/2009 NJ 4/7/2009 NY 4/7/2009 PA 4/7/2009 PA 4/7/2009 CO 4/7/2009 KY 4/7/2009 NJ 4/7/2009 MI 4/7/2009 TX 4/7/2009 WA 4/7/2009 4/7/2009 4/7/2009 OH 4/7/2009 ME
18 19 30 28 79 14 60 11 0.5 15 1.3 12 17 5 14 0.5 7 18 50
18 19 30 27 79 14 60 11 0 15 1 12 17 5 14 0 7 18
4 4 4 66 69 30 20 1.3 0.7 0.3 83 2 12 0.5 69 4 1.2 4 14 1 4 60 11 21 17 1 68
4 4 4 66 69
70 0.5 10
20 1 0 0 83 2 12 0 69 4 1 4 14 1 4 60 11 21 17 1 68
0 10
F F F M F F F F 0.5 M F 0.3 F F M M M 0.5 M U F F U M M M F F F F 0.3 M 0.7 M 0.3 F M 0.1 M F 0.5 F F M 0.2 M F F 0F F F F F M 0M F U M 0.5 M F
4/6/2009 Unexplained sudden and severe ha 4/6/2009 Pt called Clinic on 4-6-09 to report t 4/6/2009 Hypotonic-Hyporesponsive Episode 4/6/2009 PT HAD A TDAP SHOT ON FRIDA 4/6/2009 red, swollen, feverish arm where sh 4/6/2009 He had some numbness and tinglin 4/6/2009 This case was reported by a consum 4/6/2009 On 3/30/09, pt presented w/ about 1 3/31/2009 The grandmother and mother repor 4/2/2009 Progressive Diarrhea, Vomiting, Bac 4/6/2009 She had a reddish purplish area on 4/6/2009 Erythema at injection site "burning" 3/11/2009 Headache: onset: 3/10/09-present. 4/6/2009 Redness and swelling L leg. Started 4/6/2009 Fri - 4-3-09 - School nurse phoned H 4/6/2009 Irritability with long periods of crying 4/6/2009 Both legs red and swollen. Cellulitis 4/6/2009 Information has been received from 4/6/2009 Information has been received from 4/6/2009 Information has been received from 4/2/2009 Fever one week after vaccinations 4/6/2009 Red swollen thigh left - side left day 3/31/2009 Redness to site with induration x 3-4 3/29/2009 Received shingle shot. Asked nurse 4/1/2009 Developed petechial rash on inner t 3/29/2009 Laceration so had ADACEL vaccine 4/2/2009 1st GUARDISIL vaccine administere Increase swelling & erythema of ent 4/2/2009 About a 2cm red wheal appeared af 4/2/2009 Local reaction right thigh with erythe 4/3/2009 Developed rash L side neck in derm 4/2/2009 Vaccine given 3/19/09, fever develo 4/2/2009 Syncopal event. 3/10/2009 Pt. received 6 mo. well baby checku 3/30/2009 3/30 Pt called, c/o erythema (L) upp 4/1/2009 No adverse events recorded 4/1/2009 Presented to the office on 3/31/09 w 3/26/2009 Received KINRIX 3/24/09 (R) deltoi 3/31/2009 Protracted headache 5/26/09 Rece 4/1/2009 Bright red maculo papular rash to fa 4/6/2009 patient received KINRIX as part of 4 4/1/2009 3/30/09 Rec. Yellow Fever Vaccine 3/31/2009 Immediately following injection pt. b 3/25/2009 Complained of itchy throat 40 minut 4/1/2009 Pain, redness, swelling and firmnes 3/31/2009 1-5-09 pm notices red spots on bac 4/7/2009 Reaction to pneumonia vaccine give 3/25/2009 10 mg of Hep B vaccines were give 4/1/2009 Frompt. States he was in his office y Immunization given on 3/27/09 3 ho 4/1/2009 Developed redness around upper a
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4/7/2009 FL 4/7/2009 OK 4/7/2009 DE 4/7/2009 TN 4/7/2009 MA 4/7/2009 AK 4/7/2009 WI 4/7/2009 TN 4/7/2009 OK 4/7/2009 CO 4/7/2009 OH 4/7/2009 IN 4/7/2009 4/7/2009 KY 4/7/2009 4/7/2009 MN 4/7/2009 OH 4/7/2009 NC 4/7/2009 CA 4/7/2009 MI 4/7/2009 4/7/2009 4/7/2009 4/7/2009 CT 4/7/2009 FL 4/7/2009 PA 4/7/2009 TX 4/7/2009 TX 4/7/2009 PA 4/7/2009 NV 4/7/2009 AZ 4/7/2009 MO 4/7/2009 IA 4/7/2009 4/8/2009 KS 4/8/2009 4/8/2009 MA 4/8/2009 4/8/2009 4/8/2009 MO 4/8/2009 CA 4/8/2009 NE 4/8/2009 KY 4/8/2009 4/8/2009 GA 4/8/2009 NC 4/8/2009 4/8/2009 CA 4/8/2009 NE 4/8/2009 NE 4/8/2009
1.5 4 1.5 39 10 0.4 13 9 14 15 34 5 20 12 24 5 2 54 12 69 29 24 36 5 4 81 18 28 56 1.4 74 1.5 0.1 70 16
1 4 1 39 10 0 13 9 14 15 34 5 20 12 24 5 2 54 12 69 29 24 36 5 4 81 18 28 56 1 74 1 0 70 16
16 20 17 51 5 49 4 66 9 9 15 24 12 46 1.3
16 20 51 49 4 66 9 9 15 24 12 46
0.5 M F 0.5 F F F 0.4 M F M F F F F F F F M 0.7 F F M F M F M F F F F F M 0.4 M F 0.5 F 0.1 F M F F F M F F M F F F M F F F M F M
3/30/2009 Fever began two days after shot wa 4/2/2009 Immunization site reaction with mild 4/2/2009 Vomiting X 24 hr, injection site rash 4/2/2009 Redness, heat, swelling left deltoid 3/30/2009 Acute RAD with throat itching within 3/26/2009 5 month old with spots on body, sta 4/1/2009 Left arm pain, left sided facial flushi 4/2/2009 Erythema and swelling to left upper 3/27/2009 Next day noticed itching at site of va 4/2/2009 Redness 5 cm X 5 cm; Swelling + P 4/7/2009 Fever, rash 4/7/2009 felt sick to stomach,head hurt, feet f 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Received 3rd dose of Gardasil on 3 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 patient was given Adacel instead of 4/7/2009 Child missed appt for Well Child Clin 4/7/2009 11/4/08 Optic Neuropathy leading t 4/7/2009 DIZZY,FAINTED.ASSESSED MY M 4/7/2009 2 days following vaccination, pt. dev 4/7/2009 Non-specific myocarditis. This case 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Subendocardial infarction (410.7), u 4/7/2009 MMR and Kinrix innoculations given 4/7/2009 Mother brought child in today for as 4/7/2009 Two weeks after her vaccine was gi 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Patient states he got his second inje 4/6/2009 Rash head to toe. Not sleeping or e 4/7/2009 Shingles (rash with blisters) on lowe 4/7/2009 None reported 4/6/2009 Onset of erythema L thigh day after 4/1/2009 Mar 26, 2009@09-43 from pt. State 4/7/2009 Information has been received from 4/7/2009 Information has been received via a 4/7/2009 Information has been received from 3/31/2009 Developed focal deficits temporally 4/7/2009 Information has been received from 4/3/2009 Client reports pain & burning sensa 4/1/2009 Right deltoid (arm) red and swollen, ### Angloedema & swelling of uvula. 4/3/2009 Rt arm red swollen warm to touch. 3/29/2009 Received shingle shot. Asked nurse 4/3/2009 Pt. had slightly raised, warm to touc 4/4/2009 15x10cm area of blanching erythem 4/7/2009 Information has been received from 4/7/2009 Information has been received from 8/20/2008 Red spot on arm. Not sure if it was 9/22/2008 Patient had syncopal episode, short 4/7/2009 Information has been received from
343726 343736 343737 343739 343740 343741 343742 343743 343744 343745 343746 343747 343748 343749 343750 343751 343752 343753 343754 343755 343756 343757 343758 343759 343760 343761 343762 343763 343764 343765 343766 343767 343768 343769 343770 343771 343772 343773 343774 343775 343776 343883 343884 343885 343886 343887 343888 343889 343890 343891 343892
4/8/2009 CA 4/8/2009 HI 4/8/2009 NY 4/8/2009 CA 4/8/2009 NC 4/8/2009 4/8/2009 MD 4/8/2009 IN 4/8/2009 MD 4/8/2009 TX 4/8/2009 SC 4/8/2009 IL 4/8/2009 NY 4/8/2009 CA 4/8/2009 NY 4/8/2009 CA 4/8/2009 AL 4/8/2009 NY 4/8/2009 NY 4/8/2009 NY 4/8/2009 TX 4/8/2009 MO 4/8/2009 MO 4/8/2009 TN 4/8/2009 TN 4/8/2009 DC 4/8/2009 CA 4/8/2009 MN 4/8/2009 OR 4/8/2009 WA 4/8/2009 CA 4/8/2009 AZ 4/8/2009 CA 4/8/2009 WI 4/8/2009 TN 4/8/2009 MA 4/8/2009 CA 4/8/2009 HI 4/8/2009 HI 4/8/2009 PA 4/8/2009 CA 4/8/2009 SC 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 OH 4/8/2009 WA 4/8/2009 ID 4/8/2009 MA 4/8/2009 CO 4/8/2009 WA
75 8 23 2 41 71 4 9 18 32 2 47 4 44 0 0.3 63 58 25 22 5 11 77 4 62 5 20 12 31 0.4 14 20 1.3 52 1.1 88 60 64 62 22 76 77 74 75 71 55
75 8 23 2 41 72 4 9 18 32 2 47 4 44 0 0 62 17 25 22 5 10 77 4 62 5 19 12 31 0 14 20 1 52 1 88 60 64 62 22 76
61 87 63
61 87
75 71 55
U F F F 1M M F M F F F 0.4 F F M F 0M 0.3 M F F F F M F M F F M F F F 0.4 M F M 0.3 M M 0.1 F F F F F F F F F F F F F F F M
4/3/2009 This case was received from a heal 2/16/2009 See attached copy. 3/19/2009 Whelps developed. Got in waiting a 4/8/2009 1st GARDASIL 1-30-09 - At 2nd app 4/8/2009 Erythema induration at left thigh ele 4/8/2009 Persitant redness, itching and swell 4/8/2009 Rash at injection site. 4/8/2009 Mother called stating that left arm is 4/8/2009 Pt arm Turned red and slightly raise 4/8/2009 Vaccinated with ACAM2000 during 4/8/2009 Edema of the tongue and throat. No 4/8/2009 CLT SCREAMED ALL DAY RIGHT 4/8/2009 The patient received Tdap vaccine ( 4/8/2009 HEP A GIVEN X3 4/8/2009 The patient received Tdap and expe 4/8/2009 Patient has a Methicillin Sensitive S 4/8/2009 Injection site blanched and cool to 4/8/2009 The patient received Tdap and expe 4/8/2009 The patient received the Tdap vacc 4/8/2009 The patient received Tdap and expe 4/8/2009 I had the HPV vaccine Gardisil on M 4/6/2009 Received Hep B shot 3-31-09 VLL. 4/1/2009 Administered DTAP instead of Tdap 4/8/2009 03/14/2009@ 11:05AM, Injection sit 4/8/2009 Approximately 48 hours after immun 4/8/2009 Patient is a 62 year old African Ame 4/8/2009 Vaccinations were received on 04/0 4/8/2009 On 4/7/09 had a rash on neck and c 4/8/2009 At time and the months up to March 4/8/2009 WITHIN 48HRS DEVELOPED LOC 4/8/2009 Within 10 minutes of receiving the v (Per mother), child went to ER 2-13 4/8/2009 Pt received immunizations (FLUMIS 4/8/2009 Local (L) thigh-redness, 14x17 cm s 4/8/2009 Pt states today that he had a reactio 4/9/2009 Developed rash around belly button 4/8/2009 Swelling, redness, 12 cmx8cm. Not 4/3/2009 Headache began about 3 days after 4/8/2009 Patient noticed red welt on site of in 4/8/2009 Silver sized red itchy mark ant injec 4/8/2009 Pt had syncopal episode after GAR 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 MS 4/8/2009 SC 4/8/2009 VA 4/8/2009 GA 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 4/8/2009 AL 4/8/2009 KY 4/8/2009 TN 4/8/2009 IN 4/8/2009 LA 4/8/2009 ME 4/8/2009 FL 4/8/2009 4/8/2009 LA 4/8/2009 CO 4/8/2009 CA 4/8/2009 4/8/2009 MI 4/8/2009 LA 4/8/2009 4/8/2009 4/8/2009 TX 4/8/2009 AR 4/8/2009 IL 4/8/2009 SC 4/8/2009 4/8/2009 4/8/2009 4/8/2009 OK 4/8/2009 ID 4/8/2009 4/8/2009 KS 4/8/2009 4/8/2009 FL 4/8/2009 LA 4/8/2009 FL 4/8/2009 4/8/2009 4/8/2009 MS 4/8/2009 CA 4/8/2009 KS 4/8/2009 OH 4/8/2009 MI 4/8/2009 MD 4/8/2009 MO 4/8/2009 CA 4/8/2009 FL 4/8/2009 FL
65 73 68 68 73 65 60 58 79 3 67 65 80 70 71 67 62 62 4 64 62 70 67 60 80 74 35 81
65 73 68 73
58
67 65 80
71 62 62 4 64
70 60
35
60 67 1
76 87 2 81 76 62 62 62 80 68 62 77 67
67
87 2 76 62 62 62 80 68 62 77
M F F F M F F F M U F F F F F M F M M F F F M F F M M F F F F M F F M F M M M 0.3 M F F F F M F F U F F M
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received form 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information was received from a 80 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received form 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 4/7/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 KY 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 MD 4/8/2009 PA 4/8/2009 MI 4/8/2009 CA 4/8/2009 MO 4/8/2009 PA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 SD 4/8/2009 OH 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 FL 4/8/2009 PA 4/8/2009 NY 4/8/2009 FL 4/8/2009 VA 4/8/2009 WV 4/8/2009 AZ 4/8/2009 IL 4/8/2009 NY 4/8/2009 CO 4/8/2009 IL 4/8/2009 MS 4/8/2009 NC 4/8/2009 VA 4/8/2009 4/8/2009 PA 4/8/2009 FL 4/8/2009 CA 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 LA 4/8/2009 NE 4/8/2009 NC 4/8/2009 RI 4/8/2009 4/8/2009
76 66 64 60 1.2
1
66 70 65 63 1.2
70 65 63 1
66 74
66 74
60 63 72 77 70
61
63 72
61
62
79 88 80 59 77
79 88 80 59 77
76 61 67
61 67
60 78
60
70 80 65
70 80
70
M F F F F 0.2 F U F F F M 0.2 M M U F M F M F F F M F M F U M M U F U U F M F F F U M F F U F M F F F U M U F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 4/8/2009 NY 4/8/2009 4/8/2009 NC 4/8/2009 4/8/2009 IL 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 IN 4/8/2009 NV 4/8/2009 WA 4/8/2009 WV 4/8/2009 NY 4/8/2009 PA 4/8/2009 CA 4/8/2009 VA 4/8/2009 4/8/2009 4/8/2009 KS 4/8/2009 IL 4/8/2009 AR 4/8/2009 NC 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 NY 4/8/2009 4/8/2009 MI 4/8/2009 4/8/2009 4/8/2009 4/8/2009 OH 4/8/2009 MD 4/8/2009 4/8/2009 MI 4/8/2009 FL 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 PA 4/8/2009 IA 4/8/2009 CA 4/8/2009 CA 4/8/2009 AR
65 63 73 67 77 73
65
84 61 61 81 82 70 78 71 64 70 65
84 61 61 81 82 70 78
72 71
73 77
64
71
61 65 81 9 65 60 65 60 66 67 60 78 22 65 80 76
81 9
61 72
61
77 68 61 66 68 69 91 74
77
60 65 60 66 60 78
80 76
61 66
91 74
F F F F F F U F M M F F F M F F F F M F F U F F F F F F F M F F F M M F F F F U M F M M F F F F F F F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been provided from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial information has been received 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 NJ 4/8/2009 4/8/2009 4/8/2009 SD 4/8/2009 PA 4/8/2009 OH 4/8/2009 FL 4/8/2009 OH 4/8/2009 CA 4/8/2009 FL 4/8/2009 OR 4/8/2009 WA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 MD 4/8/2009 KY 4/8/2009 4/8/2009 MA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 IN 4/8/2009 4/8/2009 MD 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 MI 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 MI 4/8/2009 4/8/2009 4/8/2009 MO 4/8/2009 4/8/2009 OK 4/8/2009 OH 4/8/2009 MI 4/8/2009 4/8/2009 FL
62
62
62 65
62 65
82 75
82 75
60 67 63 66
60 67
68 61 63
68
66
63
84 74 62 15
15
62 85 61 85 71
85 71
77 70 59
77
74 71 56 65 60 66
74
59
65 60 66
73 62 74 62 65
62 73 62
F U M F F M F F F U F F F F F F F F U F M M M F U F F F F F U U U F M F F F M M F F U F M F F M F F F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial information has been received 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial and follow-up information has 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 VA 4/8/2009 4/8/2009 4/8/2009 SC 4/8/2009 IL 4/8/2009 ID 4/8/2009 4/8/2009 4/8/2009 NJ 4/8/2009 4/8/2009 4/8/2009 CO 4/8/2009 4/8/2009 CT 4/8/2009 4/8/2009 4/8/2009 HI 4/8/2009 OR 4/8/2009 4/8/2009 NJ 4/8/2009 4/8/2009 OR 4/8/2009 4/8/2009 WI 4/8/2009 CA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 FL 4/8/2009 OH 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 IN 4/8/2009 4/8/2009 MD 4/8/2009 VA 4/9/2009 VA 4/9/2009 MI 4/9/2009 4/9/2009 IL 4/9/2009 4/9/2009 MO 4/9/2009 NE 4/9/2009 IN 4/9/2009 KY 4/9/2009 PA 4/9/2009 NH 4/9/2009 CO
76
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67 61 1.1 74 86
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47
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54 88 61 74
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66 73 75
66
70 67 11 2 79 17 60 49 16 27 4 14 15 13
70 67
75
79 17 49 16 27 4 14 15 13
M U F M 0.1 F F F F F F F M F U M M F F M F U F M M F U U F M F F U M F M F F M F U F M F F F F F F F F M
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial and follow-up information has 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 4/8/2009 InformationYhas been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from When the rib cracked went to docto 4/6/2009 Patient is a 16-year-old female who 4/3/2009 Received vaccines on 3-16-09. The 4/3/2009 Right thigh swollen, red with blisters 4/2/2009 24 hours dizziness, vomiting low gra Developed bilateral pulmonary emb 4/4/2009 Redness, pain and swelling in arm.
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4/9/2009 VA 4/9/2009 MA 4/9/2009 NY 4/9/2009 CA 4/9/2009 FL 4/9/2009 GA 4/9/2009 4/9/2009 4/9/2009 CA 4/9/2009 MI 4/9/2009 PA 4/9/2009 NY 4/9/2009 MS 4/9/2009 CA 4/9/2009 WA 4/9/2009 IN 4/9/2009 MO 4/9/2009 GA 4/9/2009 CA 4/9/2009 4/9/2009 4/9/2009 CA 4/9/2009 NC 4/9/2009 MA 4/9/2009 AL 4/9/2009 KS 4/9/2009 FL 4/9/2009 IN 4/9/2009 KY 4/9/2009 IA 4/9/2009 MI 4/9/2009 TX 4/9/2009 MI 4/9/2009 FL 4/9/2009 CA 4/9/2009 KY 4/9/2009 FL 4/9/2009 MI 4/9/2009 MO 4/9/2009 CA 4/9/2009 IN 4/9/2009 PA 4/9/2009 IA 4/9/2009 CA 4/9/2009 VA 4/9/2009 OH 4/9/2009 WI 4/9/2009 TX 4/9/2009 NY 4/9/2009 GA 4/9/2009 VA
15 13 5 4 0.3 4 64 66 1.1 4 1.7 1.3 40 28 14 31 21 15 52 51 64 1.3 40 38 76 43 44 1.2 12 1.3 61 1 11 0.2 19 1.5 0.2 8 4 1.9 81 31 16 16 22 1 13 14 18 16 33
15 13 5 4 0 4 66 1 4 1 1 40 28 14 31 21 15 52
1 40 47 43 44 1 12 1 61 1 11 0 19 1 8 4 1 81 31 16 16 22 1 13 14 18 16 33
F F M F 0.3 M M M M 0.1 M F 0.7 M 0.3 F M F M M M F M U M 0.3 F U F U F F 0.2 F F 0.3 F M 0F F 0.2 M M 0.5 F M F M 0.9 F M F F F F 0M M M M F U
4/2/2009 During the course on the vaccines, 3/27/2009 Fever 103 at 10:45 am 3/26/09, sha 4/6/2009 410PM LPE complete immunization 4/2/2009 Local reaction lasting 4 days. 4/3/2009 Pt received PREVNAR vaccine @ t 4/3/2009 Positive redness and swelling of left 3/23/2009 Patient received the Zoster vaccine 4/7/2009 I had an injection of ZOSTAVAX on 4/8/2009 Pt. developed rash after vaccines w 4/9/2009 Patient came to pick up a sticker an 4/7/2009 Rash, several scattered vesicles. S 4/9/2009 Urticaria broke out on left thigh as s Large are of redness to the right de 4/9/2009 Patient called 4/9/09 AM to notify us 4/9/2009 VARICELLA vaccine (along with TD 4/6/2009 None stated. 3/31/2009 Gave pediatric/adolescent dose of H 4/6/2009 Patient was inadvertently given DTa 4/3/2009 L arm swelling - Pt reported fever to Rash and fever. 4/2/2009 Urticaria Pruritus 4/9/2009 16 month old female presents with f 4/9/2009 Pt called the dept and left message 4/9/2009 Patient immunized with Varivax vac 4/9/2009 Subject in pneumococcal Y vaccine tr 4/9/2009 Silver dollar sized redness and warm 4/9/2009 Reports felt "woozy,dizzy" when got 4/9/2009 developed fever Y and rash approx. 1 3/30/2009 Appointment at 10:15am, pt. called 4/9/2009 developed Herpes Zoster (C5 distrib 4/9/2009 Patient has a softball sized area at t 4/9/2009 Started fever 6 hours after injection. 4/9/2009 Patient received #2 VZV, #1 HPV, a 4/9/2009 Patient brought Y in the clinic in the af 4/9/2009 During 5 week field exercise, patien 3/17/2009 Child recieved shots at health depa 4/9/2009 Patient bacame cranky cried her de 4/9/2009 About 24 hours after TD was given 4/9/2009 Patient received Kinrix (DTaP,IPV, M 4/9/2009 Fever up to 102.5, rhinorrhea, and e 4/7/2009 Started w/chest Y congestion/shortne 4/9/2009 This case was reported by a physici 4/9/2009 Pt developed acute abdominal pain 3/20/2009 Oval hyperemic swelling on Rt uppe 4/9/2009 On 3/25/09 at 1030 the pt received 4/9/2009 Swelling and rash reaction with ang 4/9/2009 Within a few minutes client turned p Paleness, weakness BP prior to eve 4/8/2009 15 minutes after receiving vaccine s 4/2/2009 Patient was in office to have mening 4/9/2009 Received vaccination on 3/31/09: T
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4/9/2009 AZ 4/9/2009 AZ 4/9/2009 IL 4/9/2009 CO 4/9/2009 TX 4/9/2009 TX 4/9/2009 NY 4/10/2009 NY 4/10/2009 AZ 4/10/2009 4/10/2009 4/10/2009 4/10/2009 4/10/2009 MN 4/10/2009 IL 4/10/2009 NC 4/10/2009 NY 4/10/2009 MO 4/10/2009 NC 4/10/2009 NV 4/10/2009 MI 4/10/2009 KY 4/10/2009 KY 4/10/2009 IL 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 MD 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 SC 4/10/2009 CA 4/10/2009 NV 4/10/2009 4/10/2009 KY 4/10/2009 OR 4/10/2009 WA 4/10/2009 AK 4/10/2009 CA 4/10/2009 MN 4/10/2009 MA 4/10/2009 CT 4/10/2009 MI 4/10/2009 CA 4/11/2009 PR 4/11/2009 TX 4/11/2009 IN
34 34 14 15 12
34 34
0.2 16 16 17
0 16 16 17
81 25 4 68 31 71 4 4 18 0.3 51
81 25 4 68 31 71 4 4 18 0 51 11 10 1 11 36 12 11 0 16 1 12 69 1 4 3 77 4 9 4 4 4 15 40 44 33
10 1 11 36 12 11 2 16 1.5 12 69 1 4 3 77 4 9 4 4 4 15 40 44 33
15 12
F M U F M U 0.2 F F F F F M M M F F F M F F F F M F 0.3 M F M F 0M M M F M 0.2 M F 0.5 F M F 0M M M F F M F M M F M M F
4/8/2009 Patient states she started having co 4/8/2009 Approximately 2 weeks after immun Patient complaining of intermittent s 4/9/2009 48 hrs after vaccine administered ha 4/9/2009 Patient came to our clinic on 4/9/09 1/27/2009 Initial information was received on 2 ### Initial report was received on 08 De 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/7/2009 Initial report was received from anot 3/27/2009 Information has been received from 4/10/2009 Employee reporting disturbed sleep 4/3/2009 Reddness about 4-6 cm left deltoid. 4/10/2009 Patient had rash. She went to the d 4/10/2009 I had rash on all my neck for two da 4/10/2009 Two days after receiving the shingle 4/2/2009 03/31/09 Dtap given, 04/01/09 Pt. h 4/1/2009 Local reaction to Dtap (given on 03/ 4/10/2009 within 20 mins of injections, pain, st 2/10/2009 seizures X2 4/29/09 Received Hos 8/21/2008 Reddened area, size of half-dollar, l 6/13/2008 Pt. had painful red swollen 4 X 3 1/2 4/10/2009 40mmx28mm red raised area at site ### low appetite, fever, seizure ### urticaria- abdomen/chest/lumbar 12/7/2007 Intermittent shooting pains in right a 8/20/2007 Administered Tdap and Gardisil, pt. 8/6/2007 left arm 2" redness, warm to touch, 8/2/2007 high fever and high pitched screami 4/10/2009 After administration of all 4 vaccines 4/10/2009 5 days after MMR vaccination our d 4/9/2009 Protracted vomiting, dehydration an Pt. came in 02-25-09. States she ha 4/10/2009 Pt developed a rash on right arm sh 4/10/2009 Swelling, redness, very hot, doubled 4/11/2009 8X6 cm area of induration over R de 4/10/2009 On March 20, 2009 - developed sev 4/10/2009 L thigh with large erythematous ede 4/10/2009 Eye twitching, blinking, facial grimac 4/8/2009 Bilat parotitis day 13 after MMR. 4/10/2009 Erythematous discoloration with slig 4/10/2009 Positive erythema 15x16cm left thig 4/9/2009 pass out after the shots, became pa 4/11/2009 Joints ache and pain in all of them, 4/11/2009 Weakness and dizziness especially Patient given vaccine IV push instea
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4/12/2009 TN 4/12/2009 FL 4/12/2009 FL 4/12/2009 NC 4/13/2009 CA 4/13/2009 4/13/2009 FL 4/13/2009 NY 4/13/2009 4/13/2009 WI 4/13/2009 4/13/2009 CO 4/13/2009 CA 4/13/2009 CA 4/13/2009 MN 4/13/2009 IN 4/13/2009 OR 4/13/2009 OR 4/13/2009 OR 4/13/2009 UT 4/13/2009 VA 4/13/2009 AL 4/13/2009 KS 4/13/2009 MD 4/13/2009 MS 4/13/2009 DE 4/13/2009 TX 4/13/2009 SC 4/13/2009 CA 4/13/2009 VA 4/13/2009 4/13/2009 MA 4/13/2009 GA 4/13/2009 PA 4/13/2009 HI 4/13/2009 NY 4/13/2009 TX 4/13/2009 NC 4/13/2009 WV 4/13/2009 FL 4/13/2009 MA 4/13/2009 VA 4/13/2009 DE 4/13/2009 4/13/2009 IL 4/13/2009 CA 4/13/2009 KY 4/13/2009 CA 4/13/2009 NJ 4/13/2009 AR 4/13/2009 CA
7 64 88 66
7 64 88 66 -1
0.4 24 24
0 24 24
2 24 1.3 1 0.5 64 18 64 14 45 4 23 48 34 1.5 26 4 21 4 11 33 42 5 69 0.5 55 4 15 5 5 14 4 54 1.4 32 1.2 4 13 31 48
24 1 1 0 64 18 64 14 45 4 23 48 34 1 26 4 21 4 11 42 5 69 0 55 4 15 5 5 14 4 54 1 32 1 13 31 48
M M M F 0.5 U M 0.4 M F F U U F 0.3 F 0M 0.5 F F F F M F F F U F 0.5 F F F F M M F M M F 0.5 F F F F F M F F M U 0.4 F F 0.2 F F F F F
4/12/2009 Patient was extremely exciteable wh 4/12/2009 Right arm is red, no swelling noted, 4/12/2009 ulcerated left upper arm 4/12/2009 Feaver, caugh,weak, breathing prob 4/8/2009 This serious case was received on 0 4/8/2009 Initial report received 01 April 2009 4/9/2009 This serious case was received on 0 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/3/2009 Seizure - Full clonic/tonic 1 hr 45 mi Fever 2 days after vaccine. Hospita 3/25/2009 Erythema multiforme major possible 4/1/2009 Infantile spasms started on the 3rd 4/6/2009 T=99.7 swelling, induration + erythe 3/27/2009 3/20/2009 swelling, redness and pa 3/31/2009 Within 2 hrs of vaccination, Pt deve 3/31/2009 Called 3-27-09 with c/o dizziness, p 3/30/2009 Pt came into clinic after shots for im 4/9/2009 She had a swelling and rash at site 3/17/09 Received PC from Pt states Local Rxn w/ redness & warmth x 4 Afternoon after receiving vaccine fe 4/3/2009 Mom stated child had a tem up to 1 4/7/2009 Pt. notes truncal pruritis (primarily B 3/18/2009 Injection site - swollen, red, sorenes 4/8/2009 Patient received ANTRAX and Typh 4/7/2009 Diagnosed with shingles along L4 4/7/2009 (lt) arm - reddened, "hst to touch", s 4/8/2009 Non stated. 3/27/2009 Fatigue; night sweats 3/12/09 + 3/13 3/30/2009 Right thigh was red & swollen with s 4/2/2009 5cm area erythema, swelling, heat, 4/4/2009 Morning of 04-1-09 : "Restussness" 3/23/2009 Pt received injection and by next mo 4/6/2009 Patient inadvertently received BOO 4/6/2009 Approximately 5 minutes post inject 4/10/2009 Large, red, hard area with streaking 4/13/2009 Patient right shoulder and right delto 4/10/2009 Cellulitis 4X6 inch area of redness 2 4/8/2009 Pt developed hives at the IPV site. 4/8/2009 Patient developed erythema & purit Arthus reaction left shoulder - Swell 4/8/2009 Reddened, warm to touch, swollen 4/7/2009 On 3/9/09 Pt received Td & Hep B o 4/1/2009 3 X 3 cm erythema R upper arm wit 4/5/2009 Left thigh red w swelling. Ice packs 4/3/2009 Significant itch, redness + swelling a 3/20/2009 3/19/09 Started with rash neck + ch 4/8/2009 Fever, total body aches, nausea, fa
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4/13/2009 MI 4/13/2009 CT 4/13/2009 OR 4/13/2009 VA 4/13/2009 IN 4/13/2009 FL 4/13/2009 KY 4/13/2009 AZ 4/13/2009 MA 4/13/2009 LA 4/13/2009 MS 4/13/2009 4/13/2009 NJ 4/13/2009 MN 4/13/2009 NJ 4/13/2009 PA 4/13/2009 WI 4/13/2009 TX 4/13/2009 CA 4/13/2009 VA 4/13/2009 PA 4/13/2009 OH 4/13/2009 IN 4/13/2009 OH 4/13/2009 WY 4/13/2009 OK 4/13/2009 MA 4/13/2009 FL 4/13/2009 OK 4/13/2009 GA 4/13/2009 AZ 4/13/2009 4/13/2009 TX 4/13/2009 NC 4/13/2009 NY 4/13/2009 IA 4/13/2009 FL 4/13/2009 IL 4/13/2009 4/14/2009 TX 4/14/2009 OH 4/14/2009 CT 4/14/2009 MI 4/14/2009 KY 4/14/2009 KS 4/14/2009 KY 4/14/2009 KY 4/14/2009 KY 4/14/2009 KY 4/14/2009 LA 4/14/2009 AR
61 7 21 1 0.3 0.3 1.3 4 12 25 0.2 52 68 58 1.7 24 1 81 10 10 83 5 21 29 4 42 1.3 13 66 0.5 4 38 4 61 11 72 4 14 39 38 45 20 20 11 2 0.2 0.3 5 1.3 8 64
61 7 21 1 0 1 4 12 25 0 52 68 58 1 24 1 81 10 10 83 5 21 29 4 42 1 13 66 0 4 38 4 61 11 72 4 40 38 45 20 20 10 1 0 0 5 1 8 64
F F F 0F 0.3 F M 0.3 M F F M 0.2 F F M F 0.7 M M 0F M M F F F F F M F 0.4 F F M 0.5 M M F F F F F M F F F F M F F 0.4 M 0.2 M 0.3 M F 0.3 U M F
4/13/2009 2 hours after rec vaccine, welts dev 4/13/2009 12x14 cms- erythema on right right 4/6/2009 Pt states rash on face day following 4/8/2009 VARIVAX eruptions treated with BE 4/8/2009 This case was reported by a healthc 4/8/2009 This case was reported by a physici 4/9/2009 Seen 4/9/09 with small induration an 4/9/2009 Right thigh with erythema and swell 4/10/2009 Pt developed 8cm X 4.5 cm warm, e 3/26/2009 Patient reports a rash - itching - dev 4/13/2009 4/3/09 Hx acting different, restless, 4/13/2009 This case was reported by a lawyer 4/13/2009 This case was reported by a lawyer 4/12/2009 Report 1999019267-1 describes join 4/13/2009 fever, irritability 8 days after vaccina 4/13/2009 Vaccinated 12 days ago with MMR. 4/13/2009 Nine days after receiving the 1st MM 4/13/2009 PATIENT CALLED COMPLAINING 4/13/2009 Pt mom reported that son's develop 4/13/2009 Mildly swollen area 1" to 2" wide pe 4/13/2009 Pt noted an oval shaped, bright red 4/13/2009 Parent reported child was not acting 4/13/2009 Severe suicidal ideation, ever since 4/13/2009 HIVES OVER FACE AND NECK AP 4/13/2009 Immunized 4/8/09, The following da 4/13/2009 numbness in fingers/hands/feet app 4/13/2009 Immunization given on 3/31/2009. C 4/13/2009 Client recieved four vaccines on 4/2 4/13/2009 PT STATES HE REC'D PNEUMOV 4/13/2009 6 month old child received Hepatitis 4/13/2009 mother noticed Saturday night 4/11/ See History & Physical. This patient 4/9/2009 Approximately 2" induration and red 4/10/2009 Red spot on arm at shot site. It's the 4/8/2009 11 y/o experienced a short, 5 secon 4/13/2009 Patient received vaccination on 4-84/13/2009 Blister on the site of injection; next d 4/15/2009 VARIVAX given L arm on 4/9/09, Pt 4/13/2009 Severe pain and edema localized a 4/14/2009 April 7,2009 employee came in to c 4/14/2009 Pt developed erythrematous local s 4/14/2009 Non-viral Pustulosis. 4/14/2009 Nausea, fatigue for one week after v 4/14/2009 Local redness, swelling around injec 4/14/2009 Febrile seizure 3/19/2007 Apnea episodes on day after receiv 3/8/2007 Rotateq started after 12 weeks. 3/28/2007 03/28/07 Pt. developed red rash all Redness and hives at injection site 4/14/2009 On 04/07/09 pt. presented to the off 4/14/2009 lightheaded, dizzy, especially when
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4/14/2009 MI 4/14/2009 CA 4/14/2009 FL 4/14/2009 MI 4/14/2009 RI 4/14/2009 PR 4/14/2009 MD 4/14/2009 PR 4/14/2009 FL 4/14/2009 PR 4/14/2009 PA 4/14/2009 ND 4/14/2009 WI 4/14/2009 CA 4/14/2009 CO 4/14/2009 FL 4/14/2009 4/14/2009 FL 4/14/2009 TX 4/14/2009 PA 4/14/2009 KY 4/14/2009 ND 4/14/2009 CA 4/14/2009 TX 4/14/2009 CA 4/14/2009 MA 4/14/2009 AL 4/14/2009 CA 4/14/2009 AZ 4/14/2009 CA 4/14/2009 NM 4/14/2009 4/14/2009 4/14/2009 4/15/2009 PA 4/15/2009 4/15/2009 GA 4/15/2009 4/15/2009 4/15/2009 4/15/2009 WI 4/15/2009 4/15/2009 MI 4/15/2009 OH 4/15/2009 NH 4/15/2009 CO 4/15/2009 OH 4/15/2009 NJ 4/15/2009 NY 4/15/2009 AL 4/15/2009 CA
20 40 4 6 12 0.2 18 0.7 31 27 63 0.2 67 0.3 39
20 40 4 6 12 0 18 0 72 31 27 63 0 67 0 39
71 39 11 0.2 70 4 4 2 28 4 68 9 0.2 1
71 39 11 0 70 4 4 2 28 4 68 9 0 0
20 18 3
20
11
11
4 18 10 18 2 82 1 0.9 1 13
10 18 82 1 0 1 13
F F U M F 0.2 M F 0.7 M F F F M 0.2 M F 0.4 F M M F M M 0.2 M M M F 0.4 F F M F M 0.2 F 1M F F F U U F F U M M M F F F M F 0M 0.9 F 0M F
4/14/2009 Onset of signs/symptoms approxima 4/14/2009 REQUIRED MD VISIT.2 DAYS S/P 4/14/2009 Received call from mom @ 1:29 sta 4/14/2009 Area where varicella (RA-SQ) becam 4/14/2009 Syncopal episode about 5-10 minut 4/14/2009 RASH ALL OVER THE BODY 2 HO 4/14/2009 UNPLANNED PREGNANCY 4/14/2009 SYSTEMIC URTICARIAL RASH A F 4/14/2009 Red and indurated area on left delto 4/14/2009 PATIENT REFERS HAVING A RAS 4/14/2009 Administration site reaction. 2 inch 4/14/2009 Developed nausea and vomiting aft 4/14/2009 Unconsolable crying for several hou 4/14/2009 Patient developed Guillan Bare syn 4/14/2009 Patient experienced 5-6 bouts of dia 4/2/2009 A serious clinical trial report of allerg 4/14/2009 This case was reported by a physici 4/14/2009 Local redness and swelling at the in 4/10/2009 None. WNL. 3/6/2009 Vaccine given in Left deltoid. Redn 4/10/2009 Left thigh redness/swelling/tender 4 4/13/2009 Pt. called @ 11:10 A on 4-13-09 an 4/14/2009 Pt with hot, tender, swollen area rig 4/14/2009 Shingles, recurrent area on face, 4/13/2009 Had IZ on 4-9-09 04-11-09 2/3 of up 4/14/2009 Peri-oral rash and slight numbness, 4/14/2009 9X9 cm red reaction on L thigh with 4/14/2009 Rash at injection site (large lumps) i 4/14/2009 L arm has rash & VARICELLA appe 4/14/2009 Small rash after receiving Rotavirus 4/14/2009 Mother called 8 days after DTap wa 4/9/2009 My daughter is 13 yrs old and has r 4/10/2009 After first dose, there was a very sh 4/11/2009 After injection at 2:33 pm on the dat 4/14/2009 It was reported Y in a newspaper artic 4/14/2009 It was reported Y in a newspaper artic 4/14/2009 InformationYhas been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/13/2009 Information has been received from 4/10/2009 None Stated 4/9/2009 Patient left office after getting 4 vac 4/10/2009 (red, swollen, warm, painful; he had 4/10/2009 2" oval area of redness & induration 4/2/2009 Cough, fever- Sat morning (3/28/09 4/10/2009 Urticaria 4/7/2009 Rash - BENADRYL Rash X 24 hour 4/8/2009 Patient came in for MD visit 4/8/200
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4/15/2009 MN 4/15/2009 CA 4/15/2009 NJ 4/15/2009 NM 4/15/2009 4/15/2009 FL 4/15/2009 AZ 4/15/2009 MN 4/15/2009 TX 4/15/2009 OK 4/15/2009 PA 4/15/2009 NY 4/15/2009 TX 4/15/2009 CO 4/15/2009 IL 4/15/2009 PA 4/15/2009 MI 4/15/2009 4/15/2009 IN 4/15/2009 NE 4/15/2009 IN 4/15/2009 CA 4/15/2009 TN 4/15/2009 PA 4/15/2009 SC 4/15/2009 NJ 4/15/2009 IA 4/15/2009 FL 4/15/2009 MI 4/15/2009 WI 4/15/2009 MI 4/15/2009 CA 4/15/2009 CO 4/15/2009 DC 4/15/2009 HI 4/15/2009 VA 4/15/2009 VA 4/15/2009 NY 4/15/2009 WI 4/15/2009 NY 4/15/2009 MO 4/15/2009 MO 4/15/2009 VA 4/15/2009 VA 4/15/2009 IL 4/15/2009 AL 4/15/2009 NH 4/15/2009 NC 4/15/2009 IA 4/15/2009 MO 4/15/2009 CA
28 4 57 4 26 27 65 14 21 4 1.3 43 9 4 13 1 1.4 28 4 41 1 45 0.5 1.1 12 12 11 15 55 4 55 18 38 62 1.2 9 2 0.2 1.5 0.5 19 45 6 6 49 1.1 0.2 21 52 0.2 62
28 4 57 4 26 27 65 14 21 4 1 43 9 4 13 0 1 28 4 41 1 45 0 1 12 12 11 15 4 55 18 38 62 1 9 2 0 1 0 19 45 6 6 49 1 0 21 52 0 62
F M F M F M M F M F 0.3 M M F U F 1M 0.4 M F F F 0M M 0.5 M 0.2 F F M M F M F M F F M 0.2 M F 0.5 M 0.2 F 0.5 M 0.5 F M M F M F 0.1 F 0.2 M M F 0.2 M F
4/6/2009 Employee reports fever ranging from 4/8/2009 Developed fever, high 103 degrees Pain, redness & edema left deltoid w 4/9/2009 Warm to touch and little swelling LD 4/8/2009 Headache same day lasted 3 days. 4/9/2009 Flu Shot 4/10/2009 On 4/3 observed rash arms, hands, 4/9/2009 Pt received shingles vaccine @ app 4/8/2009 Nodular rash red indurated 1 1/2 inc 4/8/2009 41/2"x 51/2" duration, warm to touch 4/8/2009 As per mom, he was drinking juice, 4/10/2009 Severe left arm pain, fever, chills an 4/2/2009 Redness & slight swelling posterior She got a fever the evening of the im 4/3/2009 Child became very pale, lightheade Erythema multiform - treatment 5 da 4/15/2009 Zoster Vaccine administered to child 4/15/2009 Vaccinated with ACAM2000 during 4/15/2009 Mother noted Left upper arm was sw 4/15/2009 At 1800, noted dime size erythemia 4/15/2009 Patient presented to the emergency 4/15/2009 Chills, fever, joint aches Right shoul 4/15/2009 within half-hour of Pentacel injection 4/15/2009 On 4/14/09 mother reported child ha 4/15/2009 Patient called our office to inform us 4/15/2009 High body temperature 103.2 F 4/15/2009 1.5 CM AREA DIRECTLY OVER LE 4/15/2009 AMENORHEA SINCE DECEMBER 4/15/2009 Was given a shot of PPV Pneumoco 4/15/2009 Woke up with severe pain yesterday 4/15/2009 PPV vacine shot on 4/13, 99.4 feve 4/15/2009 States 2-3 days after recieving 1st G 4/15/2009 One day post-vaccination with JE-V 4/15/2009 This case was reported by a healthc 4/15/2009 Petechial rash + bruising + oral blee 4/14/2009 Fever to 101-102. (R) arm erythema 4/14/2009 L septic hip requiring prolonged IV a 4/15/2009 Pt. received vaccine 3/31/09. Prese 3/19/2009 On 10.14.04 - Patient received FLU 3/31/2009 Patient admitted to hospital for a bo 4/15/2009 Red slightly raised sand paper type 4/15/2009 Scattered red raised itching welts pe 4/14/2009 L upper arm cellulitis at injection site 4/14/2009 R upper arm cellulitis at injection sit 4/15/2009 Hives around neck, hairline and bila 4/15/2009 Erythematous rash, swelling of hand 4/9/2009 Having runny yellow diarrhea stools 4/13/2009 Fainted - had not eaten. 4/13/2009 3/25/09 received vaccination. 3/30/0 4/13/2009 Patients mother called office approx 4/15/2009 Pt noticed there was a 4" circle at in
344249 344250 344251 344252 344304 344305 344221 344255 344256 344260 344262 344264 344265 344266 344268 344269 344270 344271 344272 344273 344274 344275 344277 344278 344279 344280 344281 344282 344283 344284 344285 344291 344292 344293 344294 344295 344296 344297 344298 344299 344300 344301 344302 344303 344306 344307 344308 344309 344310 344311 344312
4/15/2009 CA 4/15/2009 CA 4/15/2009 CA 4/15/2009 WA 4/15/2009 MA 4/15/2009 4/16/2009 CA 4/16/2009 WI 4/16/2009 4/16/2009 CA 4/16/2009 CA 4/16/2009 PA 4/16/2009 NJ 4/16/2009 VA 4/16/2009 NM 4/16/2009 FL 4/16/2009 NC 4/16/2009 CT 4/16/2009 OR 4/16/2009 NY 4/16/2009 SD 4/16/2009 NY 4/16/2009 TX 4/16/2009 AK 4/16/2009 CA 4/16/2009 MD 4/16/2009 SC 4/16/2009 CA 4/16/2009 CA 4/16/2009 CO 4/16/2009 WA 4/16/2009 NC 4/16/2009 NC 4/16/2009 PA 4/16/2009 4/16/2009 CA 4/16/2009 PA 4/16/2009 NY 4/16/2009 UT 4/16/2009 MI 4/16/2009 FL 4/16/2009 PR 4/16/2009 NC 4/16/2009 PA 4/16/2009 MA 4/16/2009 FL 4/16/2009 IA 4/16/2009 UT 4/16/2009 CA 4/16/2009 NC 4/16/2009 MS
41 14 0.5 11 23 1.2 0.3 19 17 36 0.6 42 1.6 0.2 31 0.2 54 0.2 58 68 18 5 1 62 0.5 4 1.3 48 0.5 62 17 5 15.7 13 0.6 16 4 35 21
41 14 0 11 23 1 0
28 43 1 1.5 65 14.4 76 4 0.2 11 3
28 43 1 1 65 14 76 7 0 11 3
36 0 42 1 0 31 0 54 0 58 68 18 5 1 62 0 4 1 47 0 62 17 5 15 13 16 4 35 21
F F 0.5 F M M 0.2 F 0.3 F F F F 0.6 F F 0.6 M 0.2 F F 0.2 M F 0.2 M F M M M 0F F 0.5 F F 0.3 M F 0.6 F F F F F M M F F F F F F M 0F 0.5 F F F F M 0.2 M M F
3/18/2009 Onset of mild - mod fever, nausea, 4/15/2009 Redness with swelling to R deltoid. 4/15/2009 Seizure with fever T 103.8. 4/15/2009 See attached chart note dated 4-15 4/10/2009 Headache, fever muscle weakness. 4/11/2009 Blisters on back and on face. 4/15/2009 ABOUT H+4 HOURS AFTER WE N 4/15/2009 Information has been received from 4/15/2009 Information has been received from 4/13/2009 This serious case was received on 0 4/13/2009 Initial SAE report received on 04 Ap 4/16/2009 Pain, redness, swelling, fever(101), 4/16/2009 LARGE RED LUMP WITH BLISTER 4/13/2009 Parents reported blank stare and un 4/16/2009 I had local pain, irritation, swelling, a 4/16/2009 Polyarticular arthritis within 3days o 4/16/2009 Client c/o pain from Lt shoulder eigh 4/16/2009 He received his vaccination on Mon 4/16/2009 Client reports that 3 weeks after rec 4/16/2009 Right upper arm swelling, edema an 4/3/2009 Severe H/A, Stiff Neck Temp 100 4/16/2009 Less than 1 minute after administer 4/16/2009 seizures, Anemia, low red and white 4/16/2009 5 hours after vaccination, became o 4/16/2009 GAVE ROTARIX AT 6 MONTHS OF 4/16/2009 PATIENT HAD A REACTION ON LE 4/16/2009 vaccine given in left thigh, brought b 4/16/2009 LOCALIZED REACTION ON (R)UP 4/16/2009 A black dot appeared on infant's rig 4/16/2009 EDEMA, ERYTHEMA, PRURITIS, S 4/16/2009 3 days post vaccination, patient had "Red, hot swollen size of dollar bill" 7 x 7 cm raised erythematous plaqu 4/15/2009 Fever 101, headache, malaise durin 4/9/2009 PEDIARIX given R thigh 4-1-09 per 4/16/2009 Patient was given the GARDASIL # 4/16/2009 Mom called office 4/16/09 0900 to r 4/13/2009 Pt presented to PCP 1 wk after she 4/13/2009 Fever, runny nose, itching started e 4/14/2009 Administration of ZOSTAVAX 4-7-0 4/10/2009 Received FLUZONE vaccine on 9/1 4/1/2009 1 hr after vaccine: Headache, neck 4/2/2009 3-4 cm area of redness - right thigh 4/15/2009 Below vaccines were given at abou 4/16/2009 Developed rash on forearms 7 days 4/16/2009 After receiving shot in AM of 4-7-09 4/16/2009 Received ZOSTAVAX 1500 on 4/8/ 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w 4/16/2009 Cried non-stop for at least an hour. 4/16/2009 Swelling, erythema, warmth & indur 4/16/2009 Right thigh hot, swollen and red at i
344313 344319 344321 344323 344326 344327 344328 344329 344330 344332 344333 344334 344335 344336 344337 344338 344339 344340 344341 344343 344344 344345 344346 344347 344348 344349 344350 344351 344352 344353 344354 344355 344356 344357 344358 344359 344360 344361 344362 344363 344364 344365 344366 344367 344368 344369 344370 344371 344376 344377 344378
4/16/2009 KY 4/17/2009 4/17/2009 4/17/2009 VA 4/17/2009 NH 4/17/2009 NH 4/17/2009 MS 4/17/2009 CA 4/17/2009 PA 4/17/2009 OR 4/17/2009 GA 4/17/2009 IA 4/17/2009 NY 4/17/2009 NY 4/17/2009 WA 4/17/2009 OH 4/17/2009 MI 4/17/2009 KS 4/17/2009 PA 4/17/2009 MI 4/17/2009 AL 4/17/2009 OH 4/17/2009 CO 4/17/2009 KS 4/17/2009 KS 4/17/2009 MN 4/17/2009 VA 4/17/2009 WI 4/17/2009 MS 4/17/2009 MT 4/17/2009 WA 4/17/2009 MO 4/17/2009 OH 4/17/2009 TX 4/17/2009 PA 4/17/2009 OR 4/17/2009 MN 4/17/2009 FL 4/17/2009 MD 4/17/2009 LA 4/17/2009 NY 4/17/2009 TX 4/17/2009 CA 4/17/2009 PA 4/17/2009 CA 4/17/2009 CA 4/17/2009 CA 4/17/2009 PA 4/17/2009 IN 4/17/2009 PA 4/17/2009 WY
14 6 18
13 0.5 4 19 14 6 56 13 0.2 22 9 0.2 1 73 4 17 66 80 69 3 10 2 12 41 37 34 13 79 4 5 0.2 9 15 74 14 5 63 53 53 51 0.4 0.5 4 20
14 18 10 13 0 4 19 14 6 56 13 0 22 9 0 1 73 4 17 66 80 80 3 10 2 12 41 37 34 13 78 4 5 0 0 15 74 14 5 62 53 53 48 0 0 4 20
F M F U U M 0.5 F F F F F U F F 0.2 F F M 0.2 M 0M M M F M F F U F M 0.6 M M F F F F F M F 0.2 F 0.2 M F F F M F F M F 0.4 F 0.5 M M F
4/16/2009 Chest pain, slight shortness of brea 4/16/2009 Information has been received from 4/16/2009 Information has been received from 4/16/2009 Information has been received from 5 cm indurated local reaction. 4/16/2009 Large local reaction 10-12 cm, with Fever morning after vaccine T max 4/10/2009 Child had a DTAP on 4/09/09. Bene 3/26/2009 3/20/09 had GARDASIL #2 at appro 4/8/2009 Pt. had acute onset of severe vomit 4/14/2009 Chicken Pox with HX of one dose o None Stated 4/13/2009 Same evening arm soreness + swe 4/10/2009 Headache, bodyache, some nausea 3/24/2009 Patient's leg starting swelling right a 4/10/2009 Rash on stomach, chest, genitals 4/14/2009 Right arm swollen, red, and hot to th 4/9/2009 [As reported to me by ER physician 4/11/2009 04/09/09 vomit, diarrhea, stomach p 4/17/2009 Patient developed chills overnight a 4/17/2009 Phone call from parent on 4/15/09 @ 4/17/2009 Initial fatigue, headaches, muscle cr 4/17/2009 ON 04/12/2009, PT BROKE OUT O 4/17/2009 The patient received the Zostavax v 4/17/2009 The patient received the Zostavax v 4/17/2009 Subject in pneumococcal vaccine tr 4/17/2009 Parent noted redness and swelling 4/17/2009 Pt received immunizations and abou 4/17/2009 moderate sized erythema to left thig 4/17/2009 Patient developed red "Rash" accor 4/17/2009 Received Tdap vaccination on 4/13 4/17/2009 I developed I large area around the 4/17/2009 Redness and swelling at injection si 4/17/2009 fatigue,headache ,feels warm ,no fe 4/17/2009 Patient had some redness appear a 4/17/2009 Tolerated immunizations fine Given 4/17/2009 PT LEFT ARM SWOLLEN AND WA 4/17/2009 Intussusception 4/29/09 Received h 4/17/2009 right arm red and swollen and vomit 4/17/2009 During summer of 2008, patient had 4/17/2009 Vaccinated with Pneumovax on 3/3 4/17/2009 Palm size hot swelling at injection s 4/17/2009 PT REPORTS LOCALIZED (R) UPP 4/17/2009 Red rash on left arm (arm of injectio 4/17/2009 Warm, redness and tenderness 6x1 4/17/2009 6x8 cm area around injection site te 4/17/2009 Left deltoid = 4x5 cm area of erythe 4/17/2009 Paleness, vomiting, lethargic, breath 4/17/2009 Erythematous, warm 7X7 cm. indura 4/17/2009 Local erythema + induration 3X2 cm 4/11/2009 After immunization was given pt we
344379 344380 344381 344382 344383 344384 344726 344730 344732 344733 344736 344737 344738 344739 344740 344741 344742 344744 344747 344750 344751 345209 345210 345211 345212 345213 345214 345215 345216 345217 345218 345219 345220 345221 345222 345223 345224 345225 345226 345227 345228 345229 345230 345231 345232 345233 345234 345235 345236 345237 345238
4/17/2009 NJ 4/17/2009 NM 4/17/2009 UT 4/17/2009 FL 4/17/2009 WA 4/17/2009 IL 4/17/2009 CA 4/17/2009 PA 4/17/2009 VA 4/17/2009 KS 4/17/2009 4/17/2009 GA 4/17/2009 IL 4/17/2009 4/17/2009 4/17/2009 TN 4/17/2009 DC 4/17/2009 4/17/2009 OR 4/17/2009 TX 4/17/2009 4/17/2009 4/17/2009 NY 4/17/2009 CO 4/17/2009 OR 4/17/2009 4/17/2009 CA 4/17/2009 4/17/2009 4/17/2009 MD 4/17/2009 FL 4/17/2009 IL 4/17/2009 TX 4/17/2009 AR 4/17/2009 VA 4/17/2009 TX 4/17/2009 4/17/2009 AZ 4/17/2009 OR 4/17/2009 4/17/2009 4/17/2009 MI 4/17/2009 CA 4/17/2009 4/17/2009 PA 4/17/2009 4/17/2009 TX 4/17/2009 4/17/2009 OH 4/17/2009 OK 4/17/2009
4 1.6 4 1.2 1.3 10 18 14 23 16 14 25 18 14 20 15 17 16 9
4 1 7 1 10 18 14 23 16 14 25 18 20 15 17 16 9
18 27 25 23 21 14
25 23 21
19 22 15 15 21
21
16 17 18 18 15
15
17 22 20 14 16 23
14 16
M 0.6 M M M 0.3 M F F F F F F F F F F F F F F U F F F F F F F F U F F F F F F F F F F F F F F F F F F F F F F
4/17/2009 Localized reaction right upper arm + 4/18/2009 None 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w 4/17/2009 Pt had fever followed by generalized 4/16/2009 Pts mom called on 4/16/09 & said 4 4/13/2009 Patient started on GARDASIL serie 4/14/2009 Information has been received throu 4/14/2009 Information has been received via th 4/14/2009 Information and follow up informatio 4/14/2009 Information has been received from 4/14/2009 Information has been received throu 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Initial and follow-up information has 4/14/2009 Information has been received for th 4/14/2009 Initial and follow-up information has 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received for th 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information hs been received from a 4/14/2009 Information has been received from
345239 345240 345241 345242 345243 345244 345245 345246 345247 345248 345269 345270 345271 345272 345273 345274 345275 345276 345277 345278 345279 345280 345281 345282 345283 345284 345285 345286 345287 345288 345289 345290 345291 345292 345293 345294 345295 345296 345345 345346 345347 345348 345349 345350 345351 345352 345353 345354 345355 345356 345357
4/17/2009 4/17/2009 FL 4/17/2009 4/17/2009 NE 4/17/2009 WI 4/17/2009 MA 4/17/2009 4/17/2009 SC 4/17/2009 NJ 4/17/2009 NY 4/17/2009 4/17/2009 MO 4/17/2009 MO 4/17/2009 MO 4/17/2009 NJ 4/17/2009 4/17/2009 FL 4/17/2009 MD 4/17/2009 NC 4/17/2009 4/17/2009 4/17/2009 CA 4/17/2009 4/17/2009 FL 4/17/2009 MO 4/17/2009 GA 4/17/2009 4/17/2009 IN 4/17/2009 FL 4/17/2009 IL 4/17/2009 4/17/2009 WI 4/17/2009 4/17/2009 NJ 4/17/2009 FL 4/17/2009 MN 4/17/2009 4/17/2009 4/17/2009 4/17/2009 4/17/2009 PA 4/17/2009 PA 4/17/2009 4/17/2009 NJ 4/17/2009 4/17/2009 4/17/2009 4/17/2009 4/17/2009 MD 4/17/2009 KY 4/17/2009 MD
11 18 49
18 49
23 16 22
23
19
19
14 12 16 13 18 21
13 21
15 24
15 24
22
22
11
11
14 15
14
15
15
11 21 16 24 23
11
18
18
11 19 23
11
18 20 15 19
18 20 15 19
16
F F F F F F F F F F F F F F F F F F F F F F U F F F F F F F F F F F F F F U F F F F F F F F F F F F F
4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from
345358 345359 345360 345361 345362 345363 345364 345365 345366 345367 345368 345369 345370 345371 345372 345373 345374 345375 345376 345377 345378 345379 345380 345381 345382 345383 345384 345385 345386 345387 345388 345389 344372 344373 344374 344375 344385 344386 344389 344390 344392 344393 344394 344395 344396 344397 344399 344400 344401 344402 344403
4/17/2009 WI 4/17/2009 4/17/2009 4/17/2009 TX 4/17/2009 4/17/2009 4/17/2009 PA 4/17/2009 CA 4/17/2009 NY 4/17/2009 MO 4/17/2009 4/17/2009 MD 4/17/2009 4/17/2009 VA 4/17/2009 NC 4/17/2009 DE 4/17/2009 4/17/2009 4/17/2009 4/17/2009 FL 4/17/2009 SD 4/17/2009 VA 4/17/2009 4/17/2009 OR 4/17/2009 VA 4/17/2009 4/17/2009 PA 4/17/2009 4/17/2009 4/17/2009 SC 4/17/2009 PA 4/17/2009 4/18/2009 TX 4/18/2009 NY 4/18/2009 NJ 4/19/2009 CA 4/20/2009 CA 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 CA 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009
21
21
13 42 21 20 12
13
25 26 26
21 20 12
26 26
24 25 27
24
19 13 12 20 25
19
16 27 14 26 24 79 20 25 4 16
16
26 11 22
26 11 22
64
27
12 20 25
26 79 20 25 4
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F M F U U U F F F U U U M U U U U
4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/18/2009 Red oval (3/8" x l-l/8") around inject 4/18/2009 Patient inadverently given expired d 4/18/2009 Extreme fatigue (20 hours of sleep f 4/19/2009 Left deltoid area induration 10- to 15 4/17/2009 InformationYhas been received from 4/17/2009 Information was received from an in 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/20/2009 A 64-year-old Y male patient was adm 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from 4/17/2009 Information has been received from
344404 344414 344415 344416 344417 344418 344419 344420 344421 344422 344423 344424 344425 344426 344427 344428 344429 344430 344431 344432 344433 344434 344435 344436 344437 344438 344439 344440 344442 344443 344444 344445 344446 344447 344448 344449 344450 344451 344452 344453 344454 344455 344456 344457 344458 344459 344460 344461 344463 344464 344466
4/20/2009 4/20/2009 MS 4/20/2009 NY 4/20/2009 ID 4/20/2009 ID 4/20/2009 ID 4/20/2009 ID 4/20/2009 VI 4/20/2009 NY 4/20/2009 TX 4/20/2009 TX 4/20/2009 MI 4/20/2009 OH 4/20/2009 IN 4/20/2009 4/20/2009 FL 4/20/2009 CA 4/20/2009 LA 4/20/2009 NY 4/20/2009 NC 4/20/2009 IL 4/20/2009 CA 4/20/2009 OH 4/20/2009 OH 4/20/2009 MD 4/20/2009 SD 4/20/2009 LA 4/20/2009 WI 4/20/2009 VA 4/20/2009 OK 4/20/2009 OR 4/20/2009 GA 4/20/2009 FL 4/20/2009 FL 4/20/2009 UT 4/20/2009 OR 4/20/2009 MN 4/20/2009 NY 4/20/2009 4/20/2009 OH 4/20/2009 NH 4/20/2009 CA 4/20/2009 CA 4/20/2009 CA 4/20/2009 CA 4/20/2009 OH 4/20/2009 NY 4/20/2009 RI 4/20/2009 MD 4/20/2009 NY 4/20/2009 MN
78 68 5 4 5 4 13 64 1 40 1.1 5 2 23 11 5 18 3 4 1.5 0.3 1 0.2 12 15 49 12 12 18 22 0.2 79 14 26 16 13 1 19 1.2 21 4 1.8 1.3 3 11 4 76 0.4 4 30
78 68 5 4 5 4 13 64 1 40 1 5 2 23 11 5 18 3 4 1 0 1 0 12 15 49 12 12 18 22 0 79 14 26 16 13 19 1 21 4 1 1 3 11 4 76 0 4 30
U M F M F M F F F 0M F 0.1 M M 0M M F M M F M 0.5 F 0.3 M 0F 0.2 F F F F F F F F 0.2 M F F M M M F M 0.2 M U M 0.8 M 0.3 F M M M M 0.4 F M M
4/17/2009 Information has been received from 4/3/2009 Drooling, very slurred speech, loss o 4/17/2009 Papular rash, left groin area, about 4/1/2009 Pt woke up this am with redness to 4/10/2009 Pt noticed itching to right arm 2d aft 3/23/2009 Pt here in clinic today with chicken p 4/1/2009 Pt's mom states that pt c/o pain with 4/20/2009 Client state "notice bumps on body 4/3/2009 PNEUMOVAX given on 4/1/09 - had 4/16/2009 As per mom Pt swollen to Lt thigh. 4/15/2009 Patient developed pain/tenderness 4/14/2009 Pt with rash that developed 10 days 4/15/2009 At site of DTaP noticed red welt on 4/16/2009 4-14-09 Mother brought pt to office 4/20/2009 I received 5 doses of the Anthrax va 4/20/2009 Hives and swelling of face and eyes 4/20/2009 Three days after being immunized, 4/20/2009 Severe joint stiffness-difficulty in get 4/20/2009 Patient was given Chicken Pox (Var 4/20/2009 localized rash on left thigh, red patc 4/20/2009 Mother of child reported that child h 4/20/2009 Got a fever after 48 hours of receivi 4/20/2009 vaccines admin 01/08/09, pt started 4/20/2009 fussy and lowgrade fever day of imm 4/20/2009 Pt stated that twice since administra 4/15/2009 Fever 1 day after vaccinations, Face 4/20/2009 Was aware of soreness in arm 4/18 4/20/2009 After recieving vaccine, Mariah start 4/20/2009 Localized swelling at injection site. R 4/20/2009 No complaints-screened Jan 13, 20 4/20/2009 Left sided facial redness, itching an 4/20/2009 Apparant SIDS/Post Y Mortem Exam 4/20/2009 I had the shingles vaccine on April 1 4/20/2009 fever, vomiting,malise, headache co 4/15/2009 Fever (102 degrees F) lasting 36 ho 4/11/2009 Local reaction at injection site, left d 4/13/2009 Redness and swelling at injection si 4/14/2009 Child started with erythematous ma Vasovagal episode Records recieve 4/14/2009 Swelling at sight of injection. Pt complained of severe pain at site 4/16/2009 Left leg swollen to the knee. No pa 4/2/2009 Family took patient to walk-in vaccin 4/13/2009 Swelling, pain, high fever due to mis 4/9/2009 Pain, fever and swelling due to mist 4/15/2009 BOOSTRIX given in (L) deltoid on 4 4/10/2009 Bullae at injection site within 24 h (a 4/20/2009 This case was reported via medical 4/15/2009 2 - PREVNAR administered on 4/13 4/13/2009 10 minutes after shot: body aches4/14/2009 Pt had the TDAP vaccine 10-29-08.
344467 344468 344469 344470 344471 344472 344473 344477 344478 344479 344480 344481 344482 344483 344484 344485 344486 344487 344488 344489 344490 344491 344492 344493 344494 344495 344496 344497 344498 344897 344898 344899 344900 344901 345780 344499 344500 344501 344502 344503 344504 344505 344506 344507 344508 344509 344510 344511 344513 344518 344521
4/20/2009 LA 4/20/2009 NY 4/20/2009 TX 4/20/2009 MN 4/20/2009 NE 4/20/2009 CA 4/20/2009 CA 4/20/2009 IL 4/20/2009 PA 4/20/2009 CA 4/20/2009 MN 4/20/2009 MI 4/20/2009 4/20/2009 KY 4/20/2009 PA 4/20/2009 TX 4/20/2009 RI 4/20/2009 CT 4/20/2009 NV 4/20/2009 CO 4/20/2009 4/20/2009 CT 4/20/2009 NY 4/20/2009 MN 4/20/2009 CA 4/20/2009 VA 4/20/2009 VA 4/20/2009 SC 4/20/2009 CA 4/20/2009 MD 4/20/2009 MD 4/20/2009 MD 4/20/2009 MD 4/20/2009 TX 4/20/2009 4/21/2009 WI 4/21/2009 CT 4/21/2009 AZ 4/21/2009 FL 4/21/2009 CA 4/21/2009 NC 4/21/2009 OH 4/21/2009 MA 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 TX 4/21/2009
53 31 28
53 31
0.6 76 72 0.7 1.4 0.1 1.4 64 1 4 1 12 13 34 19 55 15 5 1.4 28 2 2 5 76 15 4 1.3 3 3 3
0 76 72 0 1 0 1 64 1 4 0 12 13 34 19
11 9 4 32 16 14 1 1
11 9 4 32 16 14 1 1
20
20
0.4
0
15 5 1 28 2 2 5 76 15 4 1 3 3
F M M F 0.6 M F F 0.7 F 0.4 M 0.1 F 0.4 M F 0M F 1F F F M M F M M 0.4 M U 0.1 M 0.3 M F F F F 0.3 F F F M M F F M F F F 0F 0M U U U U U F M 0.4 M
4/6/2009 4/4/09 Sat. noon sudden onset with 4/20/2009 Swelling of arm at injection site, diar 4/13/2009 None stated. 4/13/2009 Extremely swelling to the site. Moth 4/20/2009 6 mos had 3 seizures following 6 mo 4/18/2009 2 days after vaccination, patient had 4/20/2009 Rash, itch, rhinorrhea started the fo 4/17/2009 03/21/2009 started with cold & coug Vesicles and ulcers over scrotum, tr 4/20/2009 Hives, swollen feet + hands 4/15/2009 Within 48 hours, he had an 11 cm s 4/20/2009 Cellulitis (R) upper arm. Started on 4/20/2009 Chicken pox. Patient had vaccine o 4/17/2009 Local reaction 4x5cm, induration an 4/20/2009 Patient experienced a seizure appro 4/20/2009 As per patient on off dizziness since 4/17/2009 Syncope post GARDASIL and MEN 4/20/2009 Developed fever approximately 8 ho 4/17/2009 Student had fever 100.1 and chills. 4/16/2009 Headache, nausea after 1st shot, re 4/15/2009 Patient given VARICELLA & MENA 4/17/2009 Sneezing, congestion, swallowing fr 4/20/2009 04/16/2009 Mother called and spok 4/20/2009 Pt received SPV left arm on 4/4/09. 4/20/2009 Urticaria started 48-72 hours after H 4/20/2009 Oval upper thigh induration 10x9cm 4/20/2009 Within minutes of the DTAP, pt had 4/17/2009 Patient developed shingles 4/15/09. 4/15/2009 Per mother of Pt; Pt arms became t 3/12/2009 A non-serious, spontaneous report 3/12/2009 A non-serious, spontaneous report 3/12/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/2/2009 A non-serious spontaneous report o 4/20/2009 Information has been received from 4/9/2009 Received MENACTRA 4/8/09 at 4:1 4/14/2009 5 minutes post vaccine -> felt dizzy, 4/15/2009 Pt presented with Sx of allergic Rxn 4/15/2009 Rash Tightness of chest next day. 4/16/2009 After Gardasil #3 woke up with shou 4/15/2009 Hives on face and trunk extremities. 4/16/2009 Pt seen with vesicular rash on trunk 4/16/2009 3/30/09 physical with immunization 4/20/2009 Information has been received from 4/20/2009 Via agency concerning a patient wh 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/17/2009 Initial report received 07 April 2009 4/20/2009 Initial report received 09 April 2009
344524 344525 344526 344527 344528 344529 344530 344531 344532 344533 344534 344535 344536 344537 344538 344539 344540 344541 344542 344543 344544 344545 344546 344547 344548 344549 344550 344551 344552 344553 344554 344555 344556 344564 344565 344566 344567 344568 344569 344570 344571 344572 344573 344574 344575 344576 344577 344578 344579 344580 344581
4/21/2009 WI 4/21/2009 MS 4/21/2009 VA 4/21/2009 CA 4/21/2009 NY 4/21/2009 IL 4/21/2009 NC 4/21/2009 MA 4/21/2009 VA 4/21/2009 CA 4/21/2009 TX 4/21/2009 IL 4/21/2009 TX 4/21/2009 TX 4/21/2009 IL 4/21/2009 NY 4/21/2009 LA 4/21/2009 VA 4/21/2009 CA 4/21/2009 NC 4/21/2009 FL 4/21/2009 4/21/2009 NC 4/21/2009 WI 4/21/2009 MO 4/21/2009 CT 4/21/2009 PA 4/21/2009 MI 4/21/2009 CO 4/21/2009 AL 4/21/2009 CO 4/21/2009 CA 4/21/2009 NY 4/21/2009 4/21/2009 NJ 4/21/2009 ME 4/21/2009 NC 4/21/2009 MA 4/21/2009 MA 4/21/2009 KS 4/21/2009 NE 4/21/2009 CA 4/21/2009 IL 4/21/2009 AZ 4/21/2009 OH 4/21/2009 NC 4/21/2009 4/21/2009 MN 4/21/2009 TN 4/21/2009 KS 4/21/2009 CA
1.5 5 0.3 13 0.8 11 1.5 35 1 0.2 40 13 66 73 68 6 1 0.2 58 14 1 22 12 21 8 12 11 13 51 1.1 35
1 5 0 13 0 11 1 35 1 0 40 13 66 73 68 1 0 58 14
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22 12 21 0 12 11 13 51 1 35 18 14
62 21 0.6 1.7 1.3 12 5 53 20 1 12 20 41 5 0.5 1.3 11
62 21 0 1 1 12 5 53 20 1 12 20 41 5 0 1 11
0.5 F M 0.3 M F 0.8 M M 0.5 F F 0F 0.2 M F M F F F M 0M 0.2 F F M M M M F 0F F M M M 0.1 F M F F M M M 0.6 F 0.7 M 0.3 F M M F M 0M F F U F 0.5 F 0.3 M F
4/14/2009 Syncopal episode, fever - 102.7, pa 4/3/2009 Mom stated child c/o pain, redness 4/16/2009 Approximately 15-20 minutes after v 4/15/2009 About 5-10 min after vaccination giv 4/16/2009 Fever to 102 degrees and diffuse ur 4/10/2009 Seen on 4/10/09 left deltoid noted to 4/8/2009 Child received vaccination on 3-27-2 4/16/2009 Pt reported swelling and hardness a 4/16/2009 Blue blotches over body, especially 4/13/2009 2 mo old male received vaccines 4/1 4/15/2009 Rec'd varicella 4/7/09. At 3:30am on 4/16/2009 Patient had swelling and pain of inje 4/21/2009 Patient came down with shingles wi 4/21/2009 Patient developed painful rash with 4/21/2009 Shingles vaccine administered 04/1 4/21/2009 Child received PPD and Flu vaccine 4/21/2009 15 minutes following injection of var 4/21/2009 On 4/15 and 4/16 baby was cranky 4/21/2009 Increase itching and rash on arm wh 4/21/2009 red, swollen, hot area where vaccin 4/21/2009 About 12 days after getting Proquad 4/21/2009 Unspecified disease of the pericard 4/21/2009 red, swollen, hot area around where 4/21/2009 On day of administration, had flu-lik 4/21/2009 NO ADVERSE EVENT-MD ORDER 4/21/2009 Syncopal episode fainted 4/21/2009 Pt recieved tdap and varicella and p 4/21/2009 Patient received a Tdap and 1st He 4/21/2009 Two days following Twinrix vaccine 4/21/2009 2 day h/o rash starting on face and 4/21/2009 fever body aches HA vomitng for 3 4/21/2009 Given HPV injection approx. 8:20 a. 4/21/2009 Previous diagnosis to vaccine-Hypo 4/21/2009 This case was reported via medical 4/21/2009 This case was reported by a lawyer 4/20/2009 Received vaccines 4/2, on 4/9 deve 4/21/2009 Child ran a fever up to 104 with last 3/26/2009 Patient received DTap and VARIVA 3/26/2009 Patient received DTap vaccine in le 4/20/2009 Sore throat, difficulty swallowing, ho 4/21/2009 Large target lesion (7cm x 5 cm) wit 4/15/2009 Pt c/o mild pain at left upper arm at 4/21/2009 Fever and cold sweats and chills 4-2 4/21/2009 Erythema on L thigh with chicken po 4/21/2009 Erythematous papular and plaque li 4/13/2009 Received smallpox 31 Mar 09 Lt up 7/28/2008 This is a follow-up to a previously su Nausea, vomiting and diarrhea, sub 4/20/2009 Knot upper (R) leg. 4/17/2009 Fever, decreased appetite, rash, sh 4/10/2009 After vaccines were given the patien
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4/21/2009 FL 4/22/2009 MN 4/22/2009 NY 4/22/2009 RI 4/22/2009 NJ 4/22/2009 UT 4/22/2009 WA 4/22/2009 MI 4/22/2009 TX 4/22/2009 KY 4/22/2009 4/22/2009 4/22/2009 NC 4/22/2009 GA 4/22/2009 MT 4/22/2009 NH 4/22/2009 4/22/2009 AZ 4/22/2009 4/22/2009 4/22/2009 MO 4/22/2009 WI 4/22/2009 DC 4/22/2009 AR 4/22/2009 NC 4/22/2009 MA 4/22/2009 IN 4/22/2009 DC 4/22/2009 IA 4/22/2009 IA 4/22/2009 MN 4/22/2009 NC 4/22/2009 CA 4/22/2009 CA 4/22/2009 CA 4/22/2009 CT 4/22/2009 4/22/2009 TX 4/22/2009 NY 4/22/2009 NC 4/22/2009 IN 4/22/2009 MI 4/22/2009 TX 4/22/2009 CA 4/22/2009 VA 4/22/2009 SC 4/22/2009 NC 4/22/2009 MN 4/22/2009 NC 4/22/2009 4/22/2009 NJ
1 15 14 0.3 1.5 44 12 58 12 12 21 87 0.2 0.2 5 0.6 31 13
1 15 14
18 15 1 16 4 32 0.2 18 7 17 4 5 0.3 4 4 14 63 60 11 39 36 22 60 53 21 4 0.2 67 4 17 23 22
18 15 1 16 4 32 0 18 7 17 4 5 0 4 4 14 63 60 11 39 36
1 44 12 58 12 21 87 0 0 5 0 31 13
60 53 21 4 67 4 17
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4/21/2009 Sudden (<15min) onset of facial sw Immediately after vaccination, eyes 4/20/2009 Since 8/5/08, 2 wks after her 2nd G 4/10/2009 On 4/15/09 Patient brought by pare 4/17/2009 Choking during swallowing; Febrile 4/17/2009 Fatigue after immunization. Woke u 4/17/2009 Immediately after receiving 2nd GAR 4/9/2009 Customer is having tingling sensatio 4/17/2009 Patient was given Hep A 1st, then H 4/17/2009 area of redness where injection give 4/19/2009 10 days after vaccine with smallpox 4/17/2009 @ 18 hrs after injection erythematou 4/17/2009 Hematochezia, twice - Fussiness - C 4/21/2009 InformationYhas been received from 4/16/2009 3" area of erythema, induration at Iz 4/6/2009 HIB vaccine was mixed with sterile w 4/21/2009 Information has been received from 4/21/2009 Initial and additional information has 4/21/2009 Information has been received from 4/21/2009 Information has been received from 4/22/2009 Mother reports child woke up "Sund 4/22/2009 Patient developed a skin infection a 4/22/2009 PT RECEIVED DTAP INSTEAD OF 4/22/2009 Left upper arm from just above elbo 4/22/2009 Patient had loss of consciousness a 4/22/2009 Child received 2 month vaccines as 4/22/2009 Patient received vaccinations and a 4/22/2009 THIRD VARICELLA VACCINE REC 4/22/2009 Patient turned pale and diphoretic a 4/22/2009 Red and inderated at injection site. 4/22/2009 Large local reaction from left elbow 4/22/2009 3 days after receiving his 4 month b 4/22/2009 WITHIN 24 HR OF VACCINES, PT 4/22/2009 LT DELTOID MACULAR RASH,MIL 4/22/2009 developed large local reaction at sit 4/22/2009 This case was reported by a lawyer 4/22/2009 This case was reported by a lawyer 4/21/2009 Patient became dizzy, pale, clammy 4/22/2009 Received telephone call from patien 4/21/2009 34 y/o ADSM referred from aid stati 4/21/2009 Non stated. Pt given injection 02/13/2009 @ 4:0 4/23/2009 MMR given on 4/8/2009. Pt noted s 4/22/2009 Patient vaccinated with Hepatitis A 4/22/2009 Left thigh large area redness/heat d After leaving office, parents report b Vax given on 4/17 - Sore, red and it 4/21/2009 Swollen left thigh around on a or inj 4/21/2009 Patient had hives 3 days after gettin 4/7/2009 Information has been received from 4/7/2009 Information has been received from
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4/22/2009 4/22/2009 SC 4/22/2009 MI 4/22/2009 4/22/2009 CA 4/22/2009 4/22/2009 4/22/2009 NY 4/22/2009 NY 4/22/2009 4/22/2009 4/22/2009 4/22/2009 4/22/2009 CO 4/22/2009 4/22/2009 4/22/2009 VA 4/22/2009 4/22/2009 OH 4/22/2009 TX 4/22/2009 4/22/2009 4/22/2009 NJ 4/22/2009 4/22/2009 MI 4/22/2009 OH 4/22/2009 TX 4/22/2009 CO 4/22/2009 NE 4/22/2009 4/22/2009 AZ 4/22/2009 4/23/2009 ID 4/23/2009 NC 4/23/2009 4/23/2009 CA 4/23/2009 IL 4/23/2009 WA 4/23/2009 MI 4/23/2009 NM 4/23/2009 OH 4/23/2009 IN 4/23/2009 MI 4/23/2009 PA 4/23/2009 WI 4/23/2009 NH 4/23/2009 AL 4/23/2009 UT 4/23/2009 CA 4/23/2009 SD 4/23/2009 CA
25 16 11 16 19 15 25 13 14 17 16 17 14 41
24 19 14 13
17 13 15 18 23 14 6 3 5 0.7 69 0.4 5 12 4 38 0.7 15 4 0.2 52 18 4 21 4
25 11 19
13 14 16
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23 14 6 3 0 69 0 5 12 4 38 0 15 4 0 52 18 4 21 4
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F M M M 0.7 F F 0.4 M F F M M 0.7 M F M 0.2 F M M F F F
4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/12/2009 Redness, swelling ANT LT Thigh, d 4/18/2009 10 X 12 cm red patch on L thigh 2 d 4/22/2009 This case was considered medically 4/20/2009 Rash appeared over mid back and b 4/20/2009 Call from immunization clerical staff 4/19/2009 Mother called Pt. crying, unable to c 4/17/2009 After receiving a HEP A injection pt 4/16/2009 Acute erythema and edema extend 4/21/2009 3-12-09. Mom called re: 4 bumps to 4/23/2009 Pt. c/o H/A (intense when moves he 4/23/2009 Mother states that a few hours after 4/23/2009 SCHOOL NURSE PHONED TO SA 4/23/2009 On evening of 4/22/09, the day afte 4/23/2009 WCC done on 4/15/09 at which time 4/23/2009 Extreme muscle pain in the deltoid a 4/23/2009 Took 1st dose of oral typhoid in the 4/23/2009 After administration of a subcutaneo 4/23/2009 Diarrhea nausea w/o emesis and Cr 4/23/2009 After a subcutaneous injection of th
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4/23/2009 ND 4/23/2009 PA 4/23/2009 MI 4/23/2009 NC 4/23/2009 WI 4/23/2009 NC 4/23/2009 PA 4/23/2009 ID 4/23/2009 VT 4/23/2009 OR 4/23/2009 CO 4/23/2009 MO 4/23/2009 NY 4/23/2009 PA 4/23/2009 IL 4/23/2009 WA 4/23/2009 TN 4/23/2009 KS 4/23/2009 AK 4/23/2009 CA 4/23/2009 IN 4/23/2009 AZ 4/23/2009 WA 4/23/2009 GA 4/23/2009 NY 4/23/2009 NC 4/23/2009 TX 4/23/2009 IA 4/23/2009 NC 4/23/2009 WI 4/23/2009 MA 4/23/2009 CA 4/24/2009 CA 4/24/2009 LA 4/24/2009 LA 4/24/2009 WA 4/24/2009 NY 4/24/2009 NY 4/24/2009 IN 4/24/2009 IL 4/24/2009 PA 4/24/2009 MD 4/24/2009 CA 4/24/2009 TX 4/24/2009 NV 4/24/2009 MA 4/24/2009 CA 4/24/2009 NY 4/24/2009 CA 4/24/2009 IN 4/24/2009 MI
61 21 38 51
50 61 21 38 51
61 45 16 65 8 4 1.3 11 4 54 5 5 1.4 4 5 5 31 0.3 55 70 45 18 4 1 1 0.5 0.4 0.5 0.5 15 11 30 1.3 60 85 61 16 0.4 14 62 52 0.4 4 15 18
61 45 16 65 8 4 1 11 4 54 5 5 1 4 5 5 31 0 55 70 45 18 4 1 1 0 0 0 0 15 11 30 1 60 85 61 16 0 14 64 52 0 4 15 19
F F F F F U M F F F M F 0.3 F F F F M F 0.4 F M M M M 0.3 F F F F F M 0M 0M 0.5 M 0.4 M 0.5 U 0.5 U F M F 0.3 M M F F M 0.4 F F F F 0.4 M M M F
4/23/2009 RECEIVED T-DAP 4/1/09 AT BEGI 4/23/2009 developed severe pain at injection s 4/23/2009 Within 2-3 minutes after second vac 4/23/2009 On 4/21/2009, arm was sore and re 4/23/2009 L upper arm redness, swelling, feve 4/23/2009 Site where shingles vaccine adminis 4/23/2009 This case was reported by a lawyer 4/23/2009 This case was reported by a consum 4/23/2009 After leaving office Pt had a delayed 4/22/2009 4 hours after injection - pain at site 4/1/2009 Temperature starting within 24 hour 4/23/2009 Left arm is red, swollen, itchy 4/23/2009 Fever 101 degrees (rectal) on 4/23/ 4/16/2009 Pt noticed red area on LA last night 4/17/2009 5-10 min after vaccines given mom 4/17/2009 Pt reported redness, swelling, pain 4/22/2009 On 4/17/09, he was given MMR in r 4/23/2009 10cm X 8cm redness & swelling aro 4/23/2009 Mild rash appeared on arm in vicinit 4/23/2009 4 y. o received varicella vaccine on 4/23/2009 Red, warm to touch, inflammation in Pt L upper arm is red, hot to the tou 4/23/2009 Raised irregular shaped welts - No t 4/23/2009 fever fussiness symptomatic tx 4/21/2009 pain, swelling, redness at site of inje 4/22/2009 Soreness, swelling, heat (L) upper 4/23/2009 Swelling, itching - burning - tired - a 4/23/2009 Half hour post pt left boyfriend calle 4/22/2009 Within 20 min child had cough, whe 4/17/2009 Red hard spot at injection site. 4/23/2009 presented 4/22/09 with rash. 4/21/2009 Tactile. Fever and erythematous, bl 4/23/2009 Parents report that after shots on 24/23/2009 Information has been received from 4/23/2009 Information has been received from 4/23/2009 Initial information has been received 4/22/2009 Initial report was received 17 April 2 4/24/2009 The evening of the vaccine swelling 4/24/2009 The patient had a seizure on the Fri 4/24/2009 This patient received travel vaccines 4/24/2009 Recieved pneumonia vaccine 4/20/0 4/24/2009 Right arm had slight swelling about 4/24/2009 GAVE 2ND MCV 4/24/2009 Patient received her 4 month vaccin 4/24/2009 Symptoms started exactly 2 months 4/24/2009 Patient was vaccinated 4/14. Prese 4/24/2009 I had severe muscle pain in lower le 4/24/2009 about 12 hours Y after receiving his va 4/24/2009 Developed shortness of breath, whe 4/24/2009 Patient experienced two episodes o 4/24/2009 Within 10 minutes of receiving her fi
344800 344801 344802 344803 344812 344816 344817 344818 344819 344820 344822 344824 344825 344827 344828 344829 344832 344833 344835 344836 344838 344841 344843 344845 344846 344848 344850 344852 344853 344854 344855 344870 344872 344873 344878 345009 345010 345011 345012 345013 345014 345015 345016 345017 345022 345024 345025 345030 345124 345125 345126
4/24/2009 WY 4/24/2009 MO 4/24/2009 MN 4/24/2009 FL 4/24/2009 4/24/2009 AR 4/24/2009 NE 4/24/2009 IL 4/24/2009 NC 4/24/2009 NJ 4/24/2009 CA 4/24/2009 WA 4/24/2009 TX 4/24/2009 NC 4/24/2009 AR 4/24/2009 AZ 4/24/2009 NC 4/24/2009 IN 4/24/2009 FL 4/24/2009 GA 4/24/2009 RI 4/24/2009 NY 4/24/2009 CO 4/24/2009 CA 4/24/2009 IL 4/24/2009 WA 4/24/2009 WV 4/24/2009 TN 4/24/2009 NC 4/24/2009 CT 4/24/2009 LA 4/24/2009 WV 4/24/2009 VA 4/24/2009 CO 4/24/2009 MD 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009
18 43 5 4
18 43 5 4
0.2 0.5 4 0.5 11 91 40 1.5 27 12 35 5 5 11 11 0.2 25 12 8 9 16 4 4.8 0.2 58 6 3.8 1 65 65 1
0 0 4 0 11 91 40 1 27 12 35 5 5 11 11 0 24 12 8 9 15 4 4 0 58 6 3 1 65 65 1
1.5
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4/9/2009 Within 24 hrs after receiving the imm 4/24/2009 client called this facility and stated t 4/24/2009 10 minutes after receiving MMR vac 4/24/2009 After the vaccination on April 16th 2 4/24/2009 This case was reported by a lawyer 4/21/2009 None stated. Y 6/22/09 Autopsy repo 4/24/2009 Intussusception, Bilious vomiting, Irr 4/16/2009 1545 vaccines emesis about 10 min Intussusception, s/p surgical reduct 4/22/2009 My daughter received her second G 4/25/2009 4/23/09 - reviewed PROTCOL ques 4/24/2009 -migraine headache, - flu-like sympt 4/23/2009 After receiving IM DTaP and IM PRE 4/24/2009 4-20-09 pt was given a DTaP immu 4/24/2009 Localized swelling, redness, and wa 4/24/2009 Body aches, shortness of breath, ve 4/16/2009 The day of the she c/o itching at the 4/24/2009 Known Cerebral Palsy, 1 seizure pe 4/3/2009 R shoulder to elbow swollen twice th 4/20/2009 Child received 2 chicken pox vaccin 4/16/2009 Developed hives within 10 minutes 4/20/2009 None stated. 4/20/2009 About 2:30PM Hep A #1 given LA. A 4/15/2009 Err:508 4/17/2009 Received vaccines - approx 30 mins 4/20/2009 Received GARDASIL shot. Approx 4/17/2009 As related by parent, Pt.'s R arm an 4/20/2009 Large red warm area without indura 4/20/2009 Administered ROTATEQ orally befo 4/16/2009 Patient is here for evaluation of dizz 4/6/2009 Upper right arm within about 4" from 4/14/2009 Patient was brought back to office 2 4/24/2009 Rash at injection site 2" x 1" rednes 4/24/2009 Pt. c/o pain in Rt. deltoid about 2-3 I am almost 66, have always had a 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 Information regarding PREVENAR w 4/10/2009 This case was considered medically 4/10/2009 Follow-up provided Quality Assuran 4/10/2009 Follow-up received provided additio 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Follow-up information provided patie 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa
345127 345128 345129 345130 345131 345132 345133 345134 345135 345136 345251 345263 345264 345265 345266 345267 345268 345390 345391 345392 345393 345394 345395 345396 345397 345398 345399 345400 345401 345402 345778 345779 344804 344805 344806 344807 344808 344809 344810 344811 344902 344904 344905 344921 344922 344923 344924 344925 344926 344927 344928
4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/25/2009 OR 4/25/2009 MT 4/25/2009 OR 4/25/2009 FL 4/25/2009 MD 4/25/2009 WA 4/26/2009 TX 4/26/2009 FL 4/27/2009 CA 4/27/2009 4/27/2009 NY 4/27/2009 WI 4/27/2009 MS 4/27/2009 NY 4/27/2009 CO 4/27/2009 LA 4/27/2009 TX 4/27/2009 NC 4/27/2009 IL
0.2 0.5
0
0.5 0.2 0.3 4
0 0 0 4
0.4 0.3 0.8
0
0.3 0.3 1.3 0.2 0.6
0
1.1 0.2 0.2 1.1
1 0 0 1
0.3 0.5 0.5 1 1.1 0.5 0.2 11 65 1 40 39 64 1 76 45 1.5 1 42 20 41 12 58 10 13 40
1 0 0 11 65 1 40 39 64 1 75
42 20 40 12 58 10 12 40
F 0.5 F U 0.5 F 0.2 U 0.3 M F U M 0.4 F M U U M U U F 0.6 M U 0.1 F 0.2 M 0.2 M 0.1 M U U U U U U 0.1 M 0.5 M 0.2 M F F 0F F F F 0F M F M M M M M M M M F F
4/10/2009 Information regarding PREVNAR wa 4/10/2009 Follow up information was received 4/10/2009 Information regarding PREVNAR wa 4/10/2009 New information was received in do 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Additional Information provided test 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVENAR w 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Additional information was received 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information was received from a ped 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information was received from a hea 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/25/2009 Pt developed a sore throat and feve 4/25/2009 Localized injection site reaction. So 4/25/2009 Parents told me today at a sibling's 4/25/2009 Warmth, redness, swelling, induratio 4/25/2009 Intense sweating, chills, fainting, pa 4/25/2009 Several hours after the vaccine my 4/26/2009 fever, diarrhea, crying (insolable), st 4/26/2009 After shot(pneumococcal polysacch 4/24/2009 Information has been received from 4/24/2009 Information has been received from 4/24/2009 Information has been received from 4/27/2009 reaction to small pox lot number VV 4/27/2009 PT PRESENTS WIH SKIN IRRITAT 4/27/2009 Pt received TD vaccination 18 April 4/27/2009 Mom states son ran high fever (102 4/27/2009 Local reaction at injection site. Red 4/27/2009 SWELLING RIGHT ARM FROM DE 4/27/2009 CLIENT GIVEN TDAP AND MENAC 4/27/2009 Headache and fever reported on 4/3
344929 344930 344931 344932 344933 344934 344935 344936 344937 344938 344941 344942 344947 344948 344950 344951 344952 344953 344954 344955 344956 344957 344958 344959 344960 344961 344962 344963 344964 344965 344966 344967 344972 344974 344975 344977 344978 344980 344981 344982 344984 344985 344986 344987 344989 344990 344992 344994 344995 344997 344999
4/27/2009 IL 4/27/2009 CA 4/27/2009 KS 4/27/2009 CA 4/27/2009 PA 4/27/2009 LA 4/27/2009 CO 4/27/2009 MN 4/27/2009 AK 4/27/2009 MI 4/27/2009 4/27/2009 WA 4/27/2009 MO 4/27/2009 AK 4/27/2009 AZ 4/27/2009 AZ 4/27/2009 CA 4/27/2009 OH 4/27/2009 MA 4/27/2009 NY 4/27/2009 CA 4/27/2009 CA 4/27/2009 IA 4/27/2009 TX 4/27/2009 CA 4/27/2009 CA 4/27/2009 MN 4/27/2009 VT 4/27/2009 PA 4/27/2009 CA 4/27/2009 AL 4/27/2009 MI 4/27/2009 NY 4/27/2009 VA 4/27/2009 CA 4/27/2009 GA 4/27/2009 OH 4/27/2009 WI 4/27/2009 CO 4/27/2009 AK 4/27/2009 NY 4/27/2009 CO 4/27/2009 CT 4/27/2009 CO 4/27/2009 NJ 4/27/2009 MD 4/27/2009 AZ 4/27/2009 FL 4/27/2009 TX 4/27/2009 WA 4/27/2009 NC
17 50 1 40 1 6 64 17 48 22
17 50 1 40 0 6 64 17 48 22
57 9 4 1 57 29 4 18 65 50 1.4 16 5 4 12 21 36 1.3 44 17 5 1 71 15 0.8 12 63 1.4 18 12 1.2 4
57 9 4 1 57 29 4 18
13 66 79 35 61 17
50 1 16 5 4 12 21 36 1 44 17 5 1 71 15 0 12 63 1 18 12 1 4 4 13 79 35 61 17
M F 0M M 0.1 M F M F F F M M M F F 0M F F F F F M 0.4 F F M M M F M 0.3 F F F F 0M F F 0.8 M M F 0.4 M F F 0.2 M M F F F M F F F
4/27/2009 Per mother, child started with fever 4/27/2009 Diagnosed with severe arthus allerg 4/27/2009 Patient's father reports elevated tem 4/27/2009 After I received the flu shot I develo 4/21/2009 Fever of 104, not responding to infa 4/27/2009 Immediately after receiving her seco 4/27/2009 Started wuth pain on right leg and it 4/27/2009 Soreness at site starting at 4/23 inc 4/27/2009 Patient had increased pain that eve 4/27/2009 autoimmune disease fibromyalgia, r 4/23/2009 Initial report was received on 21 Ap 4/23/2009 Initial report received on 21 April 20 4/20/2009 Flu like symptoms for two to three w 4/20/2009 On 4/20/09 pt came to my office - h 4/27/2009 Redness & swelling after inj. given & On 3-25-09 pt presented with classi 4/24/2009 Given tetanus shot in clinic on 4/21/ 3/26/2009 Approx. 1/2 hr after immunization gi 4/20/2009 L deltoid area with redness, warmth 4/16/2009 Pt's mom called doctors office 4/16/ 4/23/2009 Approx. 4-09-09 I started getting a ' 4/22/2009 Received Flu and PNEUMOVAX 3/2 4/21/2009 1/7/09 Parent called, red puffy (R) le 4/22/2009 Day after injection erythema and pru 4/21/2009 Redness, swollen arm, hot tender 4/21/2009 Redness, swelling of arm; Hot. 4/17/2009 Blotchy rash, few hives occurring af 4/20/2009 Pt received first GARDASIL injection 4/20/2009 Rash on ankles, elbows, arms, and 4/20/2009 Vomiting, loose stools, fever Tyleno 4/20/2009 LP Rash, itching, Skin Inflammation 4/21/2009 HPV# 2 4 1/2 hours after patient g 4/27/2009 5 - 10 minutes after Pt received 2nd 4/26/2009 Local Varicella at VARIAX shot site 4/24/2009 On 4-16-09 around 11:30 A.M. had 4/22/2009 Member complained of itching at inj 4/21/2009 Received vaccine 041409 fever low 4/22/2009 Welts developed on back, abd, arm 4/22/2009 Zoster out break along 2 T-11. Derm 4/17/2009 Mom reported "dime" size swelling4/13/2009 24 hours after vaccine administratio 4/23/2009 Received vaccine on 4-21-2009. Wh 4/21/2009 Limping (unable to bear weight on le 4/23/2009 4-21-09 - 7:50 PM Mother called to 4/17/2009 L lateral upper arm: L red, warm, ind 4/23/2009 Syncope following vaccinations, the 4/16/2009 Welt - 4 X 4 cm allergic skin reaction 4/27/2009 Pt given ZOSTAVAX vaccine 4/14/0 4/22/2009 Red around the area itchy, raised a 4/22/2009 Adenopathy. Knee pain. Fever. Ras 4/22/2009 1) first few hours - splotches noted o
345000 345002 345018 345021 345038 345040 345041 345042 345043 345044 345045 345046 345047 345048 345049 345050 345051 345052 345053 345054 345055 345056 345057 345058 345059 345060 345061 345062 345063 345064 345065 345066 345067 345068 345069 345071 345072 345073 345074 345075 345076 345077 345078 345079 345080 345081 345082 345083 345084 345085 345086
4/27/2009 TX 4/27/2009 OK 4/28/2009 PA 4/28/2009 SC 4/28/2009 NY 4/28/2009 KS 4/28/2009 MI 4/28/2009 MD 4/28/2009 IN 4/28/2009 NJ 4/28/2009 NC 4/28/2009 MA 4/28/2009 TX 4/28/2009 LA 4/28/2009 OH 4/28/2009 IN 4/28/2009 CA 4/28/2009 MN 4/28/2009 TX 4/28/2009 NM 4/28/2009 SC 4/28/2009 IL 4/28/2009 AZ 4/28/2009 CA 4/28/2009 TX 4/28/2009 WY 4/28/2009 VA 4/28/2009 CA 4/28/2009 MT 4/28/2009 GA 4/28/2009 MI 4/28/2009 CA 4/28/2009 FL 4/28/2009 4/28/2009 4/28/2009 FL 4/28/2009 OH 4/28/2009 MS 4/28/2009 HI 4/28/2009 CA 4/28/2009 CA 4/28/2009 MS 4/28/2009 MA 4/28/2009 NH 4/28/2009 PA 4/28/2009 VA 4/28/2009 FL 4/28/2009 ND 4/28/2009 TX 4/28/2009 VA 4/28/2009 KY
32 73 20
32 73 20
42
42
69 1 0.3 2 21 48 5 11 1 16 37 12 68 12 7 57 21 9 60 41 15 15 0.9 17 0.2 0.2 1
69 1 0 2 21 48 5 11 1 16 37 12 68 12 7 57 21 9 60 41 15 15 0 17 0 0 1
0.3 72 19 0.2 51 14 11 64 4 0.5 18 53 41
0 72 19 0 51
10
10
64 4 0 18 53 41
M F F M F M M 0M 0.3 M 0M M M F F 0M F F F M M F F F M F F F M 0.9 F M 0.2 M 0.2 M 0M F M M 0.3 F M F 0.2 F F M M F M 0.5 M F M M M F
4/20/2009 Call received 4/20/09 - Pt states itch 2/3/2009 Redness, tenderness & increased w 4/27/2009 Information has been received from 4/27/2009 Information has been received from 4/24/2009 Initial report received on 15 April 20 4/24/2009 This serious case was received on 2 4/28/2009 No adverse effects. Received the T 4/28/2009 DEVELOPED FEVER ON 4/23/09. 4/28/2009 On 4/22/08 Client received both Pen 4/28/2009 Patient was very irritable and "not h 4/28/2009 None. Patient recieved four doses 4/28/2009 COULD NOT SLEEP AT ALL, JOIN 4/28/2009 collapse, profuse sweating, disorien 4/28/2009 Within 4 hours of Tdap and Varivax 4/28/2009 About 10 minutes after IPV,Prevnar 4/28/2009 seizure activity taken by ambulance 4/28/2009 PATIENT HAD VACCINE ON 4/21/2 4/28/2009 Patient seated on a chair in exam ro 4/28/2009 Patient (68 Y year old male) received 4/28/2009 Symptoms: hives, vasculitis, joint pa 4/28/2009 Pt developed an egg shaped redden 4/28/2009 TDAP GIVEN 4/22/09 IN AFTERNO 4/28/2009 Patient broke out in hives all over he 4/28/2009 he developed hives after injection a 4/28/2009 Client received the influenza, pneum 4/28/2009 Pt received Tdap on 4-22-2009, IM 4/28/2009 Mother states arrived home @ abou 4/28/2009 PATIENT C/O PAIN STARTING 8 H 4/28/2009 Child received a 4th DTaP and IPV 4/28/2009 Approximately 1 minute after receiv 4/28/2009 Initially patient was quite irritable an 4/28/2009 Notable change in feeding pattern a 4/28/2009 Child developed bilateral buccal mu 4/28/2009 This case was reported by a lawyer 4/28/2009 This case was reported by a lawyer 4/28/2009 This case was reported by a lawyer 4/28/2009 Intussusception reduced 5/04/09 R 4/23/2009 Received Yellow fever immunization 4/23/2009 Extensor surfaces rash on elbows, k 4/23/2009 High Pitch screams for 3 days and f 4/25/2009 Received Flu Vaccine on Oct. 10, 2 4/28/2009 Gave pt varicella #2 9/26/9 (1st dos 4/27/2009 R upper arm swelling red, tender, itc 4/27/2009 Herpes zoster type rash developing 4/28/2009 Started with pain at the injection site 4/24/2009 "3 cm circle of erythema on right sid 4/28/2009 Shortness of breath, tingling, sweat 4/27/2009 Body aches, high fever. At night ch 4/28/2009 None stated 4/28/2009 Pt came into office + reported vacci 4/28/2009 About 2hrs after getting vaccine, arm
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4/28/2009 NJ 4/28/2009 NC 4/28/2009 FL 4/28/2009 NC 4/28/2009 NC 4/28/2009 VA 4/28/2009 IL 4/28/2009 MI 4/28/2009 MI 4/28/2009 TX 4/28/2009 NC 4/28/2009 CA 4/28/2009 MI 4/28/2009 WI 4/28/2009 IL 4/28/2009 FL 4/28/2009 MS 4/28/2009 TX 4/28/2009 4/28/2009 NV 4/28/2009 OH 4/28/2009 AR 4/28/2009 CA 4/28/2009 SC 4/28/2009 VA 4/28/2009 MN 4/28/2009 NY 4/28/2009 NY 4/28/2009 4/28/2009 ID 4/28/2009 PA 4/28/2009 MI 4/28/2009 AL 4/28/2009 PA 4/28/2009 4/28/2009 IN 4/28/2009 TN 4/29/2009 MI 4/29/2009 4/29/2009 FL 4/29/2009 4/29/2009 4/29/2009 4/29/2009 VA 4/29/2009 OH 4/29/2009 MA 4/29/2009 NC 4/29/2009 ID 4/29/2009 CO 4/29/2009 MA 4/29/2009 NC
5 27 4 12 41 0.2 1 0.2 5 1.3 16 4 0.3 5 31 81 23 44 14 53 2 27 15 10 4 23 0.7 42 0.5 27 70 0.3 18 0.3 36 13 27 53 11 1 1.5
5 27 4 12 40 0 1 0 5 1 16 4 0 5 31 81 23 44 14 53 2 27 15 10 4 23 0 42 0 27 70 0 18 0 36
18 59 3 3 14 62 65 25 1.3
18 59 3 3 14 62 65 25 1
27 53 0 1
M F M F F 0.2 M 0M 0.2 M F 0.3 F F U 0.3 F M F F F M F F 0M F M M M M 0.7 F F 0.5 F M F 0.3 M F 0.3 M F M F M F 1M 0.7 F M M F F M F F F F 0.3 M
Presented to hospital 4/23/09 with r 4/16/2009 Pt c/o pain at injection site beginnin 4/22/2009 Small area of petechiea under right 4/9/2009 Fever 102 shakes chills abdominal p 4/13/2009 Client reports rash to inner arms ap 4/28/2009 Bloody stools, crying spells, abdomi 4/23/2009 4/18 developed rash behind ears, b 4/23/2009 Pt came back into office. Per mothe 4/23/2009 Pt administered VARIVAX and DAP 4/21/2009 Urticaria generalized 2 days after im 9/18/2008 DTAP given instead of TDAP. -Swelling of LA, tender, hot, itchy - 2 4/22/2009 3 days after vaccine developed diar 4/22/2009 Large redness, itching & induration 4/23/2009 None stated. 4/28/2009 2 days later had bad stiffness on ba 4/28/2009 On 4/27 at 8:45am patient was vacc None Stated 4/26/2009 Excessive rapid hair loss a month a 4/28/2009 Rash developed 2 days after shot 4/27/2009 Rash after HEP A with in 24 hr ATA 4/28/2009 1600 Pt bad at clinic c/o having reac 4/28/2009 Pt with redness, edema 3 d after va 4/17/2009 3-31-09 Mom reports that client "wa 4/17/2009 Redness, swelling and pain at injec 4/21/2009 Received vaccine on 4/13/09- symp 4/23/2009 Local reaction at injection site right 4/24/2009 Patient presented to clinic on 4/24/0 4/22/2009 She was hoarse and hives - She los 4/21/2009 Rash to trunk and back that started 4/23/2009 PNEUMOVAX administered right de 4/22/2009 Pt developed hives right after vaccin 4/24/2009 Within 24 hours, developed fever - 1 4/23/2009 2 days later, with bulging fontanelle 4/23/2009 Red raised rash appox. 1 1/2 " X 1 4/24/2009 Erythematous area surrounding inje 4/22/2009 Pt. became pale after the vaccinatio 4/28/2009 Subject received BIOTHRAX in 200 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 This report was received from a hea 4/27/2009 Initial report was received 28 Janua 4/29/2009 hives covering entire body, swelling 4/29/2009 Within 5 min. post injection patient h 4/29/2009 Client received Tdap without any sy 4/29/2009 Reaction to Tdap, muscle aches, he 4/29/2009 Read area around the Shingles vac 4/29/2009 Member reports beginning to feel na 4/29/2009 HIGH FEVER WITH NORMAL CBC
345170 345171 345172 345173 345174 345175 345176 345177 345178 345182 345190 345191 345192 345193 345194 345195 345196 345197 345198 345199 345200 345201 345202 345203 345204 345205 345206 345207 345208 345249 345252 345254 345257 345260 345261 345299 345301 345302 345303 345304 345305 345306 345307 345308 345309 345310 345311 345312 345313 345314 345315
4/29/2009 AZ 4/29/2009 CA 4/29/2009 KS 4/29/2009 KS 4/29/2009 AZ 4/29/2009 WA 4/29/2009 CA 4/29/2009 OR 4/29/2009 PA 4/29/2009 4/29/2009 NC 4/29/2009 PA 4/29/2009 CA 4/29/2009 CA 4/29/2009 4/29/2009 TX 4/29/2009 NH 4/29/2009 AZ 4/29/2009 CO 4/29/2009 AZ 4/29/2009 CA 4/29/2009 PA 4/29/2009 DC 4/29/2009 NH 4/29/2009 NC 4/29/2009 NC 4/29/2009 4/29/2009 4/29/2009 PA 4/30/2009 MO 4/30/2009 CA 4/30/2009 MI 4/30/2009 TX 4/30/2009 IA 4/30/2009 KS 4/30/2009 MA 4/30/2009 AR 4/30/2009 MA 4/30/2009 SD 4/30/2009 WI 4/30/2009 TX 4/30/2009 4/30/2009 IL 4/30/2009 FL 4/30/2009 UT 4/30/2009 MI 4/30/2009 HI 4/30/2009 4/30/2009 CA 4/30/2009 CA 4/30/2009 IN
1.2 11 9 34 1 63 17 12 0.2 0.6 20 0.1 0.2 20 13 45 9 11 61 1 0.3 65 42 1.3 10 5 80
1 11 9 34 1 63 17 12 0 0 20 0 0 20 13 45 9 11 61 0 0 65 42 1 10 5 80
5 71 0.2 46 23 3 27 35 15 1 28 25 28 28 17 16 50
5 71 0 46 23
63 55 30 16 1.2
27 35 15 1 28 25 28 28 17 16 50 3 55 30 16 1
0.2 M M M M 0.1 M M M F 0.2 M 0.6 F M 0.1 M 0.2 F F M F F F F 1F 0.3 M F F 0.3 M M F F F M M 0.2 F F F M F M F 0M M M M M F F M F F M F M 0.1 M
4/29/2009 Pt received MMR and Varicella vacc 4/29/2009 Right deltoid- 2 days sfter vaccine a 4/29/2009 Herpes Zoster C34 dermatoma G 4/29/2009 The first signs begin with a pain in m 4/29/2009 SCALEY RASH THATS GETTING W 4/29/2009 Pt given injection in deltoid. develop 4/29/2009 27cm from injection site a 15x15cm 4/29/2009 headache, facial swelling- in pts tem 4/25/2009 4-23-09 Child Y had respiratory arrest 4/29/2009 This female subject was enrolled in 4/28/2009 VHC inpatient consult has been req 4/22/2009 Temp 101. Baby presented the day 4/29/2009 04-27-09 patient came for a well ch 4/28/2009 Fever, nausea, HA, sore throat, rhin 4/29/2009 Local reaction on R upper arm (injec 4/27/2009 Pt stated arm was sore for 3 days. T 4/29/2009 Vaccine administered on 4/23/09. Im 4/29/2009 950am student in nurses office or im 4/29/2009 Hives 4/29/2009 Local Pox 3-4 lesions with cellulitic a 4/29/2009 Faint erythematous rash under the s 4/28/2009 (R) arm swollen and red about 10 cm 4/24/2009 Received ADACEL on 4/16/09 and 4/23/2009 Pt broke out in hives face to legs 1 1 4/22/2009 Vaccine given 10:15 A and by 12:00 4/25/2009 .5 cm diameter redness, and warm 4/17/2009 PL received the Zostavax vaccine o 4/27/2009 Our infant received the roto vaccine 4/29/2009 2 days after DTAP, arm red & swolle 4/29/2009 Information has been received from 4/29/2009 Information regarding PREVNAR wa 4/28/2009 This case was received from a heal 4/29/2009 Information has been received from 4/29/2009 Information has been received from 4/29/2009 Information has been received from 4/30/2009 Td administered to patient. Less tha 4/30/2009 Nursing student mistook Menactra a 4/30/2009 Patient developed maculopapular ra 4/30/2009 Fever, Chills, Bodyaches, Nausea, V 4/30/2009 ON 4-3-09 PATIENT WAS ADMINIS 4/30/2009 Circumferential swelling and rednes 4/30/2009 Soldier presented to the ER with R 4/30/2009 Immediate severe pain in left arm, 'a 4/30/2009 PATIENT WAS GIVEN ALL THREE 4/30/2009 left arm warm to the touch and red 4/30/2009 Typical Varicella rash began 04/28/ 4/30/2009 Patient called me the day after the a 4/30/2009 Fever 100.3F and chills and Severe 4/30/2009 Client called today, stating she had 4/30/2009 Patient was seen by this physician t 4/30/2009 Night wakening, fussiness, constan
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4/30/2009 PA 4/30/2009 MA 4/30/2009 4/30/2009 CA 4/30/2009 OH 4/30/2009 AK 4/30/2009 MD 4/30/2009 NM 4/30/2009 MS 4/30/2009 MT 4/30/2009 IN 4/30/2009 CT 4/30/2009 PA 4/30/2009 VA 4/30/2009 TN 4/30/2009 ND 4/30/2009 FL 4/30/2009 NY 4/30/2009 OH 4/30/2009 KY 4/30/2009 MI 4/30/2009 KY 4/30/2009 CO 4/30/2009 KY 4/30/2009 OH 4/30/2009 CT 4/30/2009 SC 4/30/2009 CA 4/30/2009 SD 4/30/2009 SD 4/30/2009 4/30/2009 ID 4/30/2009 FL 5/1/2009 CA 5/1/2009 NY 5/1/2009 NC 5/1/2009 VA 5/1/2009 ID 5/1/2009 WI 5/1/2009 WI 5/1/2009 MO 5/1/2009 WI 5/1/2009 SC 5/1/2009 TX 5/1/2009 SC 5/1/2009 GA 5/1/2009 WI 5/1/2009 CA 5/1/2009 WI 5/1/2009 MA 5/1/2009 GA
0.1 0.5 46 1 15 1.8 1.1 23 7 13 1 26 17 4 11 12 1.1 1 20 1 16 1.2
0 0 46 1 15 1 1 23 7 13 1 26 17 4 11 12 1 1 20 1 16 1
28 18 4 49
28 18 4 49
19 19 58
19 19 58
75 42 13 32 24 11 33 42 1 20 5 47 3 1.3 23 1.6 39 0.5 14
75 42 13 32 25 11 33 42 2 20 5 47 3 1 23 1 39 0 14
0.1 F 0.5 M M 0F F 0.8 M 0.1 F F F M 0F F M F F M 0.1 M 0F F 0M F 0.2 F U F F M F U M M M U M M F M F F M M 0F M M F F 0.2 M M 0.6 M M 0.5 M F
4/28/2009 None. 10/5/09 Y Autopsy received. Ca 4/27/2009 Came down with Evans Syndrome 3 4/30/2009 Developed neck right arm pain imm 4/26/2009 Patient developed severe systemic 4/26/2009 Began with stomach pains, rash on 4/30/2009 Redness + swelling, heat @ site of 4/30/2009 Child received above listed vaccines 4/30/2009 Patient complained of headache, rin 4/30/2009 Redness, warmth to injection site - 4 4/28/2009 Mother reports patient complaining 4/21/2009 Pt received 12 month vaccinations o 4/30/2009 Within 2 Hrs of vaccine, pt noted ex 4/23/2009 Pt waited x 15 min & c/o HR. No se 4/30/2009 Left deltoid swollen with erythema o 4/30/2009 Right upper arm with redness, swell 4/24/2009 Left arm swollen, hot, reddened (siz 4/27/2009 Bumps on face and back. 4/27/2009 Left thigh erythema & swelling exten 4/21/2009 Pt. became slightly lightheaded imm 4/24/2009 Child developed chicken pox diseas 4/24/2009 24 hrs after injection: lip swelling, na 4/13/2009 Mom states 2 days after vaccines p Severe vomiting + diarrhea 48 hour 4/21/2009 Unable to use my arm/shoulder, ext 4/24/2009 Pharyngitis, odynophalgia, nausea, 4/24/2009 Right arm immunization site reaction 4/27/2009 C/o chest pain, local reaction seen i 4/15/2009 This case was reported by a pharma 4/15/2009 This case was reported by a healthc 4/15/2009 This case was reported by a healthc 4/15/2009 This case was reported by a consum 4/15/2009 This case reported by a healthcare 4/15/2009 This case was reported by a consum 5/1/2009 4/17/2009: SM contacted VHC repo 5/1/2009 My daughter was given all three dos 5/1/2009 A GOLF BALL SIZE NODE IN ARM 5/1/2009 fever of 100.7F, body aches, HA, so 5/1/2009 Vomiting, indegestion, lack of appet 5/1/2009 Localized erythema Left shoulder an 5/1/2009 Rash over chest, back, and arms. 5/1/2009 Mother reports client with elevated t 5/1/2009 Painful Hardened red area mid clav 5/1/2009 Patient's mom stated symptoms of r 5/1/2009 Vaccine administered on 04/28/200 5/1/2009 Pt's mom stated sylmptoms of redne 5/1/2009 About 5-6 hrs after DTaP pt had fev 5/1/2009 Rednes and Pain at injection site, in 5/1/2009 FEBRILE SEIZURE ON 28APRIL20 5/1/2009 Extensive Erythema Multiforme on b 5/1/2009 Indurated area at site of each inject 5/1/2009 APPROXIMATELY 3-5 MINUTES A
345421 345422 345435 345439 345440 345441 345442 345443 345444 345445 345446 345452 345453 345454 345455 345456 345457 345458 345459 345460 345461 345462 345463 345464 345465 345466 345467 345468 345469 345470 345471 345472 345473 345474 345475 345476 345477 345478 345479 346027 346028 346029 346030 346031 346032 346033 346034 345423 345424 345425 345426
5/1/2009 NC 5/1/2009 UT 5/1/2009 5/1/2009 NY 5/1/2009 NM 5/1/2009 WA 5/1/2009 VA 5/1/2009 MI 5/1/2009 NC 5/1/2009 TX 5/1/2009 NJ 5/1/2009 KY 5/1/2009 OH 5/1/2009 SD 5/1/2009 5/1/2009 MS 5/1/2009 WY 5/1/2009 MA 5/1/2009 WA 5/1/2009 AZ 5/1/2009 ND 5/1/2009 NY 5/1/2009 ND 5/1/2009 IL 5/1/2009 VA 5/1/2009 WA 5/1/2009 WA 5/1/2009 IL 5/1/2009 MN 5/1/2009 CA 5/1/2009 SC 5/1/2009 NC 5/1/2009 IL 5/1/2009 NC 5/1/2009 PA 5/1/2009 NY 5/1/2009 NC 5/1/2009 CA 5/1/2009 NC 5/1/2009 CT 5/1/2009 CA 5/1/2009 CA 5/1/2009 PA 5/1/2009 TX 5/1/2009 5/1/2009 5/1/2009 5/2/2009 NC 5/2/2009 KS 5/2/2009 CA 5/2/2009 CA
43 5 21 2 17 2 11 17 46 13 70 0.3 12 3
43 5
57 71 5 42 13 1.1 14 14 27 0.4 32 7 2 12 5 1.1 1.4 1 2 5 4 27 3 33 5 5 4 4 4
57 71 5 42 13 1 14 14 27 0 32 7 2 12 5 1 1 1 2 5 4 27 3 33 5 5 4 4
33 17 59 4
33 17 59 4
2 17 2 11 17 46 13 70 0 12 3
F F F 0.6 M F 0F M F F M M 0.3 F M M U M F M F M 0.1 F M F F 0.4 F F M 0.2 U M F 0.1 M 0.4 M 0F 0.8 F F F F F F M F F M F U U U M F M F
5/1/2009 Six days after administration of MMR 5/1/2009 Right and Left legs had cellulitis, red 4/30/2009 InformationYhas been received via th 5/1/2009 On 4/29 (the day after receiving the 5/1/2009 On 4/24/09, Pt came in for #2 GARD 5/1/2009 Within 12 hours after admin of vacc 5/1/2009 4x6cm area on right deltoid of eryth Swollen like a size of a baseball hot 5/1/2009 C/o lightheaded with tunnel vision (c 5/1/2009 L arm SQ area red and swollen abo 5/1/2009 TC from son (MD): Pt had dried like 4/27/2009 Prev. healthy 4 mo. old admitted to 4/27/2009 Approx 3" area right upper arm warm 5/1/2009 16 X 16 cm Erythemic warm rash on Felts like open cut. used rubbing al 4/1/2009 Extreme swelling and redness of wh 5/1/2009 Swelling (L) arm 5/1/2009 Cellulitis 4/27/2009 Patient reported severe injection sit 4/24/2009 R upper arm redness with swelling s 4/27/2009 Patient was given Pediarix vac. but 4/24/2009 Left deltoid region w/ 7x7 cm round, 4/28/2009 Broke out in a rash that evening. Ra 4/24/2009 2 d Hx generalized weakness + mal 5/1/2009 Rotavirus vaccine was administered 4/20/2009 Left arm localized redness + swellin 4/29/2009 Allergic reaction - hives - severe wh Patient was given HEP & DTAP vac 4/27/2009 Patient given MMR vaccine instead 4/30/2009 HEP A, HEP B & MMR given in (L) 3/23/2009 When pt was given MMR & VAR pt 4/27/2009 Erythema multiforme - minor. 4/28/2009 2 wks after VARICELLA was given o 4/28/2009 (B) eyelids swollen, puffy and red w 4/27/2009 Vesicular lesion trunk with scabbing 4/30/2009 Pt developed a local rxn one day af 4/30/2009 At 24-36 hours, pain, swelling at inje 5/1/2009 Caregiver called stating child compl 4/30/2009 At 48 hours, ipsilateral axillary pain, 4/29/2009 This case was reported by a consum 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a physici 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 5/2/2009 Received vaccination 10/30/07; retu 5/2/2009 Fever, ache, lethartic onset 48 hour 5/2/2009 a week later, very tired and rash (sk 5/2/2009 Measle-like rash all over legs and a
345427 345428 345429 345430 345438 345431 345432 345433 345434 345528 345530 345533 345534 345540 345541 345542 345543 345545 345546 345547 345548 345549 345550 345551 345552 345553 345555 345556 345558 345561 345573 345574 345575 345576 345577 345578 345579 345580 345581 345582 345583 345584 345585 345586 345587 345588 345589 345590 345591 345592 345593
5/2/2009 WA 5/2/2009 CA 5/2/2009 FL 5/2/2009 FL 5/2/2009 AZ 5/3/2009 NH 5/3/2009 CO 5/3/2009 CA 5/4/2009 PR 5/4/2009 5/4/2009 5/4/2009 PA 5/4/2009 5/4/2009 5/4/2009 IL 5/4/2009 AR 5/4/2009 TN 5/4/2009 AR 5/4/2009 AZ 5/4/2009 MA 5/4/2009 AR 5/4/2009 PA 5/4/2009 MA 5/4/2009 VA 5/4/2009 IL 5/4/2009 PA 5/4/2009 OR 5/4/2009 MA 5/4/2009 MA 5/4/2009 VA 5/4/2009 MA 5/4/2009 NY 5/4/2009 NY 5/4/2009 MO 5/4/2009 PA 5/4/2009 NY 5/4/2009 TX 5/4/2009 MN 5/4/2009 CA 5/4/2009 FL 5/4/2009 DC 5/4/2009 FL 5/4/2009 MI 5/4/2009 5/4/2009 FL 5/4/2009 KS 5/4/2009 VT 5/4/2009 OK 5/4/2009 UT 5/4/2009 VA 5/4/2009 OH
24 2 12 1 14 44 36 22 44 16 11 83 25 17 29 35
24 2 12 1 14 44 36 22 44
1 11 19 0.2 0.6 54 54 14 5 37 1.3 0.4 0.2 18 32 28 53 31 54 74 0.2 26 36 1.3 1.5 1.6 11 0.5 24 33 61 0.4 26 12
1 11 19 0 0 54 54 14 5 37 1 0 0 18 32 28 53 31 54 74 0 26 36 1 1 1 11 0 24 33 61 0 26 12
83 25 17 29 35
M 0.7 F F 0M M F F M M F M M F F F F F 0F M M 0.2 M 0.6 M F F F F M 0.3 M 0.4 M 0.2 F F F F F F F F 0.2 F F F 0.3 M 0.5 F 0.6 F M 0.5 M F F F 0.5 F F M
5/2/2009 Arm goes numb for approximately 3 5/2/2009 Ataxic symptoms, shaking, "bobbleh 5/2/2009 WITHIN A LITTLE OVER 24 HOUR 5/2/2009 swelling iside of cheeks. 5/2/2009 Mom returned to office - stated "my 5/3/2009 I needed a tetanus shot for an infec 5/3/2009 R deltoid injection 5/1/09 yellow fev 5/3/2009 Papulo-pustular rash extending from 5/4/2009 Diabetis,Vision,Blood restal,soryasis 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 4/30/2009 This serious case was received on 2 4/30/2009 Initial report received on 24 April 20 5/1/2009 This serious case was received on 2 4/24/2009 Pt vaccinated at approx. 0830 4/22/ 4/29/2009 Pt was given SQ left arm of VARICE 4/28/2009 8 hours after shot, fever, headaches 4/24/2009 See ER sheet - mom reports infant 4/21/2009 Patient was given initial dose of RO Suprasternal chest tightness withou 4/29/2009 There is a darkened raised area on 4/22/2009 Child received 2 vaccines, MENACT 4/29/2009 5 days after vaccine was administer 48 hrs - following vaccine, swelling d 4/24/2009 Typical post vaccine rash "mini mea 4/28/2009 Fever >103, start at 9pm & vomited 4/29/2009 Prolonged screaming/crying. 5/4/2009 Within 10 hours of shot fever,palene 5/4/2009 redness and swelling, painful at site 5/4/2009 redness, pain and swelling at injecti 5/4/2009 Patient reports extreme pain at site 5/4/2009 2 days after receiving the for about 5/4/2009 redness and pain at site of injection 5/4/2009 Patient received Zostavax Vaccine 5/4/2009 I received the MMR vaccine on 4-20 5/4/2009 Administered yellow fever vaccinatio 5/4/2009 WITHIN 12 HOURS: SEVERE DRO 5/4/2009 mother noted thigh swelling at injec 5/4/2009 Fever, irritablity and rash about 9 da 5/4/2009 Within 15 minutes post injection pat 5/4/2009 Vaccination was received on 4/28/2 5/4/2009 high fever, projectile vomiting, letha 5/4/2009 Adverse reaction to right deltoid afte 5/4/2009 Temp of 100-102 within 24 hours. M 5/4/2009 Patient described onset of large 'ora 5/4/2009 Pt recieved regular vaccines at two 5/4/2009 10/11/09 awoke with severe pain an 5/4/2009 Right arm cellulitis developed at imm
345594 345595 345596 345597 345598 345599 345600 345601 345602 345607 345608 345609 345610 345611 345612 345613 345615 345616 345617 345628 345630 345631 345633 345634 345636 345638 345639 345640 345641 345643 345644 345645 345646 345647 346062 346063 346064 346065 346066 346067 346068 346069 346127 346128 346129 345676 345677 345678 345679 345680 345681
5/4/2009 FL 5/4/2009 MI 5/4/2009 CA 5/4/2009 GA 5/4/2009 LA 5/4/2009 MI 5/4/2009 IL 5/4/2009 CA 5/4/2009 AZ 5/4/2009 CA 5/4/2009 MI 5/4/2009 IA 5/4/2009 VA 5/4/2009 WI 5/4/2009 ID 5/4/2009 PA 5/4/2009 MD 5/4/2009 NM 5/4/2009 MN 5/4/2009 OH 5/4/2009 NM 5/4/2009 TX 5/4/2009 NY 5/4/2009 WV 5/4/2009 ME 5/4/2009 NY 5/4/2009 CT 5/4/2009 IL 5/4/2009 OH 5/4/2009 OH 5/4/2009 KY 5/4/2009 PA 5/4/2009 CA 5/4/2009 KY 5/4/2009 PA 5/4/2009 MI 5/4/2009 AZ 5/4/2009 FL 5/4/2009 FL 5/4/2009 IN 5/4/2009 IN 5/4/2009 NY 5/4/2009 VA 5/4/2009 WA 5/4/2009 PA 5/5/2009 CA 5/5/2009 NY 5/5/2009 MI 5/5/2009 MI 5/5/2009 MN 5/5/2009 LA
1.3 0.2 4 52 1 1 4 0.8 14 16 1 59 6 11.2 65 0.2 28 53 4 11 1 52 23 0.1 32 4 11 0.6 1 11 31 6 13.3 11 54 62 63
1 0 4 52 1 1 4 0 14 16 1 59 6
39 49 62 31 21 26
39 49 62
28 46 5 7 11 0.4
28 46 5
65 0 27 53 4 11 52 23 0 32 4 11 0 1 11 31 6 13 11 54 62 63
21 26
11 0
0.3 F 0.2 F M M 0.1 M 0.1 M F 0.8 F M F 0F M M F F 0.2 M F F F M F F M 0.1 F F F M 0.6 M 0F M F M F F M F F U M F M F M F M F F M F F 0.4 M
5/4/2009 On 4/26/09 patient started to develo 5/4/2009 Blue streaking across the leg from t 5/4/2009 24 hours after injection - mom noted 5/4/2009 NONE 5/4/2009 Had measle like red, raised bumps 5/4/2009 NO ADVERSE EVENTS, SYMPTOM 5/4/2009 CELLULITIS LEFT LEG DIAGNOSE 5/4/2009 2 days after administration of rotate 5/4/2009 Mother, phoned clinic and left a mes 5/9/2009 Tremors in R hand started 12-24 ho 5/4/2009 Pt broke out with 9 blisters on 5-3-0 5/4/2009 Pt was given 2nd dose of Hep B ser Localized cellulitis at administration 5/3/2009 Teen had syncopal episode after ta 5/4/2009 Pt developed shingles 7 days after Z 5/4/2009 TC received from stating pt seems t 5/4/2009 Pt. presented to GARDASIL clinic 7 4/30/2009 Swelling & Lg redness at injection s 5/1/2009 (L) thigh swollen from upper thigh to 5/4/2009 Fainted - lasting 15 seconds - return 5/4/2009 Uticaria to R upper chest welt 3 cm 5/4/2009 Swollen red left upper arm approx s 5/4/2009 Hepatitis B #3 vaccine given on 4-2 5/4/2009 1 month old given Hep A vaccine in 4/28/2009 L shoulder vaccine site (deltoid) was 5/11/2009 About 5-10 min after vaccinations (H 4/23/2009 Mom reports eyes red, puffy & warm 5/1/2009 Inf received 6 mon vaccinations at 2 4/14/2009 Fever and rash trunk after 8 hrs. Te 4/28/2009 Shot RA- 4/26 - Rt arm swollen, hot 4/30/2009 Pt describes reddened area around 4/29/2009 Parent of patient returned to clinic 2 4/21/2009 Fever on 4-17-09, 7 PM. On 4-18-0 4/28/2009 6 cm red rash with pain and swelling 6/17/2008 Initial report was received 05 June 2 8/27/2008 A cluster of four cases of injection s 10/4/2008 Initial report received from a consum 3/25/2009 Initial report received form a health 12/9/2008 A 39 year old male patient with a his 2/9/2009 A 49-year-old female patient, who h 2/10/2009 A 62-year-old male patient, who had 3/6/2009 Initial report received 27 February 2 7/16/2008 Initial report received from a health 8/18/2008 Initial report was received 15 May 2 Initial report was received 20 May 2 4/27/2009 Pt reports 1 mo after receiving vacc 4/27/2009 Pt received Immunization on 4/22/0 4/27/2009 Gave adult dose of HEP A instead o 4/27/2009 Gave adult dose of Hep A instead o 4/30/2009 4cm localized inflammation to left up 5/1/2009 4mo shots. High pitched crying x1 h
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5/5/2009 IN 5/5/2009 IL 5/5/2009 OH 5/5/2009 NY 5/5/2009 MI 5/5/2009 OH 5/5/2009 5/5/2009 TX 5/5/2009 TX 5/5/2009 TN 5/5/2009 5/5/2009 TX 5/5/2009 5/5/2009 5/5/2009 5/5/2009 PA 5/5/2009 AZ 5/5/2009 AZ 5/5/2009 TN 5/5/2009 OK 5/5/2009 FL 5/5/2009 IN 5/5/2009 NC 5/5/2009 NH 5/5/2009 TX 5/5/2009 OH 5/5/2009 NE 5/5/2009 CA 5/5/2009 CO 5/5/2009 IL 5/5/2009 WI 5/5/2009 NE 5/5/2009 WI 5/5/2009 MD 5/5/2009 GA 5/5/2009 MD 5/5/2009 NY 5/5/2009 MO 5/5/2009 SD 5/5/2009 FL 5/5/2009 FL 5/5/2009 MO 5/5/2009 GA 5/5/2009 NY 5/5/2009 NY 5/5/2009 OK 5/5/2009 MO 5/5/2009 SC 5/5/2009 CA 5/5/2009 OK 5/5/2009 CA
15 4 5 5 14 6 18 62 61 1.9 15 22 19 17 35 1 6 5 23 1.3 20 13 15 9 10 11 1.3 4 20 42 11 1.3 33 29 13 39 1.3 14 24 68 73 0.2 68 28 43 50 5 61 18 16 71
15 4 5 5 14 6 18 62 61 1
19 17 35 1 6 5 23 1 20 13 15 9 10 11 1 4 20 42 11 1 33 29 13 39 1 14 24 67 73 0 68 28 43 50 5 61 18 16 71
F F M M F M M F F 0.9 M F F F F M 0F F F F 0.3 M M F F F M M 0.3 M F F M M 0.3 M F F F M 0.3 F M F M F 0.2 M F F M M M M F M F
4/29/2009 Pt given vaccine 4/16/09 - Mother c 4/30/2009 (1) leg/injection site swollen and pai 4/29/2009 Red, warm and itchy area over TRIP 4/28/2009 10 mm diameter area of erythema o 4/30/2009 Patient fainted, difficult to arouse (1 4/28/2009 Child received Kinrix injection in R t Non Stated 4/29/2009 Pt. called today 4/29/09 at 12:10 PM 4/29/2009 Pt received vaccine on 4/24/09. Sh 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Initial information and follow up has 4/28/2009 Smallpox site still itches. Recently b 4/29/2009 L thigh firm area of redness 1" diam 4/30/2009 Hives at injection site Benadryl 25 m 4/30/2009 Red swollen lump at injection site (R 4/29/2009 c/o itching over all of body, tongue + 4/28/2009 Varicella lesions eruption 4/27/09 A 5/4/2009 Patient received both TWINRIX & T 5/5/2009 Patient became lightheaded, pale, a 5/5/2009 Parents concerned that vaccine (s) 5/5/2009 Pt received Varicella vaccine on 4/3 5/4/2009 8x4 cm redness + swelling at injecti 4/29/2009 Redness/swelling @ upper arm - 8" 5/1/2009 104 fever & fussiness 9 days after M 4/22/2009 Local reaction swollen redness injec 4/13/2009 04/06/09 Rash on Rt leg above kne 5/1/2009 Pt started experiencing rash/hive ty 4/30/2009 Local reaction right arm 5/1/2009 Fever 102.8 at 5:00 pm day followin 4/30/2009 Local reaction left arm 5/5/2009 @ 1/2 hour after vaccine administra 5/5/2009 Hives occured 9 days after administ 5/5/2009 constipation, some lost of vision 5/5/2009 VACCINES ADMINISTERED 4-13-0 5/5/2009 Skin pale with heat and edema surr 5/5/2009 Pt presented for pre-travel vaccinati 5/5/2009 Rcvd call from pt. wife stating husba 5/5/2009 Adm. zoster vax on 2/4/09. Rcvd ca 5/5/2009 MOTHER CALLED AND STATED H 5/5/2009 24 hrs following, swelling, itchiness 5/5/2009 Guillain-Barre' Syndrom 6/8/09 Hos 5/5/2009 Patient states that he developed dif 5/5/2009 PNEUMOVAX .5 CC GIVEN R DEL 5/5/2009 Child received the MMR vaccine an 5/5/2009 dramatic swelling of the site w/ redn 5/5/2009 Patient became lightheaded and los 5/5/2009 Pt c/o tingling, itching on back of arm 5/5/2009 Patient stated area of injection had
345737 345744 345745 345747 345748 345749 345750 345751 345752 345753 345754 345755 345756 345757 345758 345759 345760 345761 345762 345764 345738 345740 345786 345787 345788 345789 345790 345791 345792 345793 345794 345795 345796 345797 345798 345799 345800 345801 345802 345803 345804 345805 345806 345807 345808 345809 345813 345818 345819 345820 345821
5/5/2009 CA 5/5/2009 5/5/2009 NM 5/5/2009 CA 5/5/2009 GA 5/5/2009 OR 5/5/2009 PA 5/5/2009 PA 5/5/2009 5/5/2009 MI 5/5/2009 IL 5/5/2009 AR 5/5/2009 CA 5/5/2009 CO 5/5/2009 AR 5/5/2009 IL 5/5/2009 NC 5/5/2009 CA 5/5/2009 CA 5/5/2009 5/6/2009 NY 5/6/2009 WA 5/6/2009 5/6/2009 5/6/2009 WI 5/6/2009 5/6/2009 5/6/2009 SC 5/6/2009 AZ 5/6/2009 VA 5/6/2009 NY 5/6/2009 IL 5/6/2009 MO 5/6/2009 PA 5/6/2009 OK 5/6/2009 NY 5/6/2009 OH 5/6/2009 NC 5/6/2009 IL 5/6/2009 MI 5/6/2009 GA 5/6/2009 IL 5/6/2009 MO 5/6/2009 CA 5/6/2009 FL 5/6/2009 5/6/2009 5/6/2009 5/6/2009 FL 5/6/2009 WA 5/6/2009 NC
64
64
0.3 0.2 58 1.3 10 52 1.3 37 81 13 52 14 3 1 11 1 72 75 4 2
0 0 58 1 10 52 1 37 81 13 52 14 3 1 11 1 72 75 4 2
61 13 24 64 15 1.3 0.9 14 9 18 14 29 66 64 24 6 11 15 0.5 16 13
61 13
1.1 41 0.2 15 27
1 41 0 15 27
65 15 1 0 14 9 18 14 29 66 64 24 6 11 15 0 16 13
F M 0.3 M 0.2 M M 0.3 F F F 0.3 F F F F F F F 0F F 0M F M M 0.3 M M M F F F M F 0.3 M 0.9 M F F M F F F F F F M F 0.5 F U F F 0.1 M M 0.2 F F M
5/5/2009 Approximately 4-5 hours after receiv 5/5/2009 This case was reported by a physici 5/5/2009 This case was reported by a physici 5/5/2009 3 days of fever, 2 days of rash. Had 3 times Emergency Rooms. 6 days 5/5/2009 Increased redness & swelling @ site 5/5/2009 Received TYLENOL at home. Pt. re 5/5/2009 100 temp 24 after shot, erythema te 5/5/2009 Fever. 5/5/2009 Client found out pregnant 2 wks afte 5/5/2009 Patient had been diagnosed with sh 5/5/2009 3 1/2 cm x 5 cm swelling and redne 5/5/2009 Pt reported swelling, redness, and i 5/5/2009 Immunization administered - child s 5/5/2009 Pt received combination vaccine of 5/5/2009 Fever, redness, swelling at injection 5/5/2009 Mother of child called Health Dept 5 4/16/2009 Per mom, child was in the ER last n 4/22/2009 Blister rash present on knees, elbow 4/22/2009 Early June 2008, noticed large ecch 5/6/2009 Administered 4:05pm. Reacted at 4 5/6/2009 Fussiness, Tiredness and poor app 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/6/2009 left arm turned red, very sore, itchy. 5/6/2009 Had Hep A vaccine--became dizzy a 5/6/2009 Prior to shot child had some conges 5/6/2009 PATIENT PRESENTED WITH TEM 5/6/2009 CLIENT C/O BEING COLD, DIZZY, 5/6/2009 9 year old female had foot stuck wit 5/6/2009 Patient reported to student health se 5/6/2009 Approximately 2 minutes after recei 5/6/2009 received shot in a.m. on Monday 4/2 5/6/2009 PT REPORTS DIFFICULTY BREAT 5/6/2009 Two days after vaccine pt. reports a 5/6/2009 ~ 24 hours after gardasil #1, patient 5/6/2009 RED RASH AROUND INJECTION S 5/6/2009 SITE OF INJECTION-LEFT ARM IS 5/6/2009 Pt. received vaccines listed below a 5/6/2009 within 3 hours of vaccine child had h 5/6/2009 She also received TdaP and menac 5/1/2009 This serious case was received on 2 5/5/2009 Initial report received on 28 April 20 5/5/2009 This case was considered medically 5/1/2009 See HPI: n/v fever, headaches 12-2 5/6/2009 Crying inconsolable. Swelling of thig 5/6/2009 Within 5 mins of receiving immuniza 4/30/2009 Smallpox vaccine received 24MAR2
345822 345823 345824 345825 345826 345827 345828 345829 345830 345831 345832 345833 345834 345835 345836 345837 345838 345839 345840 345841 345842 345843 345844 345845 345846 345847 346131 346132 346133 346134 346135 346136 345848 345849 345850 345851 345855 345857 345859 345861 345864 345865 345866 345867 345868 345869 345870 345871 345872 345873 345874
5/6/2009 MI 5/6/2009 TX 5/6/2009 VA 5/6/2009 VA 5/6/2009 MN 5/6/2009 OH 5/6/2009 5/6/2009 NC 5/6/2009 MN 5/6/2009 TX 5/6/2009 LA 5/6/2009 IL 5/6/2009 CA 5/6/2009 IA 5/6/2009 FL 5/6/2009 PA 5/6/2009 MA 5/6/2009 WA 5/6/2009 AR 5/6/2009 NY 5/6/2009 KY 5/6/2009 MS 5/6/2009 IL 5/6/2009 WI 5/6/2009 NY 5/6/2009 RI 5/6/2009 ME 5/6/2009 VA 5/6/2009 NY 5/6/2009 MI 5/6/2009 WI 5/6/2009 NJ 5/7/2009 TX 5/7/2009 5/7/2009 HI 5/7/2009 5/7/2009 CA 5/7/2009 NY 5/7/2009 5/7/2009 UT 5/7/2009 MS 5/7/2009 NY 5/7/2009 ID 5/7/2009 NJ 5/7/2009 AZ 5/7/2009 PA 5/7/2009 AZ 5/7/2009 CA 5/7/2009 TX 5/7/2009 MD 5/7/2009 TX
18 46 1.3 6 5 51 32 80 53 34 10 5 4 1.5 82 80 60 48 5 23 25 4 18 15 4 1.4 41 21 18 40 59 67 13 15 23
18 46 1 6 5 51 32 80 53 34 10 5 4 1 82 80 60 48 5 23 25 4 18 15 4 1 41 21
0.2 57
0 57
0.2 3 12 5 70 2 0.5 3 77 20 12 45
0 3 12 5 70 2 0 3
40 59 67 13 23
20 12 45
F M 0.3 M M M F M M F F M M M 0.5 M M F F F F F F F F F F 0.4 F F M F F F F F F F M 0.2 F F U 0.2 F F F M F 0M 0.5 F M F F F F
5/5/2009 Immediately after receiving GARDA 5/6/2009 None stated 5/5/2009 Localized cellulitis 5 cm X 5 cm red, Localized cellulitis at administration 5/4/2009 about 4 - inch area of redness, warm Went to ER on 4-29-09 c/o fever na 5/6/2009 Worsening joint pain, numbness (lef 5/5/2009 Patient developed itching on his bac 5/5/2009 Non stated 5/6/2009 Rash appeared at site of vaccinatio 5/6/2009 Redness after 24 hours and warmth 5/6/2009 Erythema 10ml around injection of c 5/5/2009 Left arm red, warm with pain -> trea 5/6/2009 Lt leg @ injection site showed redne 4/16/2009 Large local reaction redness & swel Shooting @ throbbing pain L arm + 5/6/2009 The patient developed shingles on l 5/5/2009 Erythema of the Rt upper arm, temp 5/6/2009 Pain, swelling, redness, large circle 4/28/2009 Injection given @ 4:30 pm- Pt C/0 it 5/6/2009 Pt complained of having dizziness, Swollen right tricep area with indura 4/30/2009 4" diameter erythema 1-2mm vesicl 4/30/2009 Swelling in right arm post receiving 5/1/2009 About 5-10 minutes after vaccinatio 5/6/2009 Fever 102-103, rash on face - dry c 4/2/2008 This case was received from a heal 7/16/2008 Initial report received from a health 7/31/2008 An 18-year-old female patient, who 1/5/2009 Initial non-serious case received fro 2/19/2009 Initial information was received on 0 8/12/2008 Initial non-serious case received fro 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/5/2009 Initial report received 29 April 2009 5/5/2009 This serious case was received on 3 5/5/2009 This case was received on 01 May 2 5/6/2009 Information regarding PREVNAR wa 5/1/2009 4/28 had fever with chills - arm swol 5/13/2009 Daily severe migraine headache un 4/30/2009 On 4/28/09 Mom called on her son 5/3/2009 5 days after flu shot, I developed a r 4/22/2009 Upper L arm was red/irritated no pa 4/30/2009 Had ROTATEQ vaccine 4-14-09. De 4/22/2009 Rash all over body, swollen and hot 5/7/2009 Fever up 102 for 3 days with mild po 5/7/2009 Patients calls the day after immuniz 5/7/2009 Localized reaction 13x26mm indura 5/7/2009 30 cm X 10 cm length width erythem
345875 345876 345877 345878 345879 345880 345881 345882 345883 345884 345885 345886 345887 345888 345889 345890 345891 345892 345893 345894 345895 345896 345897 345905 345906 345907 345908 345909 345910 345911 345912 345913 345914 345915 345916 345917 345918 345919 345920 345922 345925 345926 345927 345928 345929 345930 345931 345932 345934 345935 345937
5/7/2009 NY 5/7/2009 NY 5/7/2009 NC 5/7/2009 NC 5/7/2009 PA 5/7/2009 MI 5/7/2009 NC 5/7/2009 GA 5/7/2009 CT 5/7/2009 CO 5/7/2009 MD 5/7/2009 KS 5/7/2009 WA 5/7/2009 NC 5/7/2009 NC 5/7/2009 CA 5/7/2009 NC 5/7/2009 WA 5/7/2009 CA 5/7/2009 CA 5/7/2009 IN 5/7/2009 IN 5/7/2009 VT 5/7/2009 NC 5/7/2009 TX 5/7/2009 KY 5/7/2009 MI 5/7/2009 WA 5/7/2009 AZ 5/7/2009 FL 5/7/2009 CT 5/7/2009 CA 5/7/2009 FL 5/7/2009 NY 5/7/2009 OH 5/7/2009 FL 5/7/2009 TX 5/7/2009 NY 5/7/2009 OH 5/7/2009 WA 5/7/2009 VT 5/7/2009 OH 5/7/2009 RI 5/7/2009 CA 5/7/2009 OH 5/7/2009 SD 5/7/2009 CO 5/7/2009 TX 5/7/2009 FL 5/7/2009 ME 5/8/2009
0.2 34 11 63 17 52 1 1.5 2 35 35 0.3 18 1 1 11 14 23 4 16 1.1 4 65 0.3 29 0.4 54 1 4 4 2 4 13 1.3 19 0.6 1 5 56 17 61 27 14 15 1 65 50
0 34 11 63 17 52 1 1 2 36 35 0 18 0 0 11 14 23 4 16 1 4 65 0 29 0 54 1 4 4 2 4 13 1 19 0
30 81 24
30 81
5 56 17 61 14 15 1 65 50
0.2 F F F F F M 0F 0.6 M 0.6 M M F 0.3 F F 1M 1M M F M M F 0.1 M F F 0.3 M M 0.4 M F 0F M M 0M F F 0.3 M F 0.6 M F M F F F F F M 0M F F M M F F
5/6/2009 Irritability for 5 hours crying, given T 5/5/2009 2 days after administration of TDAP 5/7/2009 Left upper arm red, warm to touch, 5/6/2009 Arm sore, tired, muscle ache lasting 5/7/2009 Mother of patient states patient rece 5/7/2009 He states Imm given in AM. The foll 5/7/2009 EXTREME FUSSINESS AND 103 D 5/7/2009 Fever highest 104.6, hives off and o 5/7/2009 4/29/09 (Telephone consult) rash on 5/7/2009 Aproximately 28 hours after vaccina 5/7/2009 Developed 5 pox blisters/spots 11 d 5/7/2009 Pt is only 4 months and was given v 5/7/2009 SM tested negative BHCG on 30Ma 5/7/2009 Pt rec'd vaccines at 11a.m. and retu 5/7/2009 Pt rec'd vaccines at 11a.m. and retu 5/7/2009 GAVE DTaP INSTEAD OF Tdap 5/7/2009 Within approximately 5-10 minutes o 5/7/2009 Pt. w/ peri-umbilical follicultis on 2 M 5/7/2009 L arm redness and swelling 4 cm x5 5/7/2009 Pt had syncopal episode 15 min afte 5/7/2009 No adverse event reported. RN gav 5/7/2009 Fell to floor after getting vaccines. P 5/7/2009 L Deltoid muscle was extremely pai 5/6/2009 Seizure activity 3-4 hrs after receivin 5/7/2009 Coughing up blood, chest pain, and 4/30/2009 Seizure - 11 AM 4/28/09 - taken by 5/5/2009 Symptoms: 1. Rash 2. local swelling 5/1/2009 Pt was adopted at about 7 m/o from 5/7/2009 Redness and swelling at injection si 5/7/2009 Cellulitis L thigh - fever 101.7 given 4/25/2009 3/10/09 - AM shaking arm when rea Reddness & swelling noted at inject 5/7/2009 Fever 103 degrees. Diarrhea. Vomit 5/7/2009 Papulo-vesicular rash over torso / p 5/7/2009 April 29, 09 - Injection given R shou PE had a seizure like episode and s 5/5/2009 Given 12 mo vaccines on 4/24/09. 4/30/2009 6 cm x 7 cm area of erythema with s 5/4/2009 Warmth erythema at injection site. 5/7/2009 Pt had vaccines (shots) for flu, polio 4/30/2009 Received vaccination in left arm on Several areas other various location 4/29/2009 Syncope after vaccination given, pa 5/6/2009 Swelling, redness, and warmth. 5/3/2009 Left thigh - No initial local reaction u 5/4/2009 Arm were ZOSTAVAX was given go 5/1/2009 Sever headache and feeling of insid 5/1/2009 None Stated 5/7/2009 Appx 0930 - vaccination administere 5/6/2009 Patient felt a lump on left arm after a 5/7/2009 Information has been received from
345938 5/8/2009 345939 5/8/2009 FL 345941 5/8/2009 IL 345944 5/8/2009 345945 5/8/2009 CA 345948 5/8/2009 MD 345949 5/8/2009 TX 345950 5/8/2009 FL 345951 5/8/2009 WA 345953 5/8/2009 KS 345954 5/8/2009 TX 345955 5/8/2009 345956 5/8/2009 345958 5/8/2009 CA 345959 5/8/2009 MD 345960 5/8/2009 AZ 345968 5/8/2009 PA 345976 5/8/2009 CA 345977 5/8/2009 NC 345978 5/8/2009 WA 345979 5/8/2009 WA 345980 5/8/2009 CA 345981 5/8/2009 PA 345982 5/8/2009 FL 345983 5/8/2009 OR 345984 5/8/2009 NJ 345985 5/8/2009 PA 345986 5/8/2009 PA 345987 5/8/2009 MD 345988 5/8/2009 IN 345989 5/8/2009 345990 5/8/2009 FL 345991 5/8/2009 GA 345992 5/8/2009 PA 345993 5/8/2009 GA 345994 5/8/2009 NJ 345995 5/8/2009 IA 345996 5/8/2009 TN 345997 5/8/2009 NY 346000 5/8/2009 NM 346001 5/8/2009 WV 346002 5/8/2009 IN 346004 5/8/2009 NJ 346007 5/8/2009 PA 346008 5/8/2009 CA 346010 5/8/2009 NC 346184 5/8/2009 CA 345961 5/9/2009 NC 345962 5/9/2009 CA 345963 5/9/2009 345964 5/10/2009 LA
73
73
39 17 33 66 22 25 11 78 32 3 0.2 37 4 0.4 1 47 72 4 84 35 1.6 0.6 5 9 1 5 1.1 0.2 28
39 17 33 66 22 25 11 -23 32 3 0 37 4 0 1 47 72 4 84 35 1 0 5 9 1 5 1 0 28
4 4 0.6 5 15 57 2 1.1 2 0 0.8 2 16 31 1 47 36
4 4 0 5 15 57 2 1 2 0 0 2 16 31 1 36
M F U U F F F F M F F 1M F M 0.2 M F M 0.4 F 0F F F M M F 0.6 M 0.6 F F M 0F F 0.1 M 0.2 M M F F F 0.6 F M F F 0F 0.1 M 0.5 F 0M 0.8 F 0.4 F F F 0F M F
5/7/2009 Information has been received from 5/7/2009 Information has been received from 5/7/2009 This case was considered medically 5/5/2009 This case was received on 01 May 2 5/6/2009 Initial report received from a health 5/8/2009 Pt & Foster Mother walked into Cen 5/8/2009 At 48 hours, significant Local React 5/8/2009 On 3/12/09 Tetanus/Diptheria toxoid 5/7/2009 papular rash back of both hands an 5/8/2009 Elevated temperature of 100 F withi 5/8/2009 reddness swelling upper arms 5/8/2009 ONE WEEK AFTER SHINGLES VA 5/8/2009 Vaccinated with ACAM2000 during 5/8/2009 GAVE 3RD HEP A 5/8/2009 My son was given his 2 month rout 5/8/2009 Small lump Lt upper arm at injection 5/8/2009 This case was reported by a healthc 3/16/2009 Child received oral Rotavirus vaccin 5/8/2009 Prolonged fever 3/14/09 - 3/18/09 w 4/14/2009 Rash, redness pain, swelling at and 5/8/2009 Small red circle around shot. Now w 5/8/2009 Pt had localized erythema/ induratio 5/5/2009 Shaky No appetite Tremors Loss of 5/5/2009 Pt was given shots on 5-1-09. 45 m 5/4/2009 See accompanying note. 4/22/2009 Crying uncontrollably for 5 days afte 5/4/2009 Varicella vaccine breakthrough diag 5/4/2009 Varicella Vaccine Breakthrough. Dia 5/4/2009 Behavior change. Sleepy day after 5/8/2009 Mother states pt has red, swollen, it 5/8/2009 12 mo received immunizations (Pre 5/4/2009 Patient was lethargic moaned and m 5/8/2009 We gave him a shot by annual chec 5/8/2009 Local, allergic reaction, rt arm redne 5/8/2009 Hives with sig. facial swelling Benad 5/8/2009 L deltoid redness and hardness pt. 5/8/2009 Client received vaccinations @ app 5/7/2009 Both thighs red, swollen, hot to touc 5/4/2009 c/o dizziness-instructed to lay down 5/5/2009 swollen lymph nodes @ neck, rapid 5/2/2009 48 hours after receiving MMR she b 5/5/2009 Fever started 6 days after vaccines 5/4/2009 4/28/09 fever 102 degrees - 103 de 5/4/2009 Varicella vaccine break through. Dia 5/4/2009 Erythema multiforme- started 5/2/09 4/24/2009 Fever 103 4/15/2009 Initial report received on 02 April 20 5/9/2009 Woke up with Very sore arm (painfu 5/9/2009 Febrile Seizure lasted 60 seconds s 5/9/2009 I'm currently serving my 4th deploym 5/10/2009 Starting the day the first dose rabies
345965 345966 346046 346052 346053 346054 346055 346056 346058 346059 346060 346070 346071 346072 346073 346074 346075 346076 346077 346078 346079 346080 346081 346082 346083 346084 346096 346097 346098 346099 346100 346101 346102 346103 346104 346105 346106 346107 346108 346109 346110 346111 346112 346113 346114 346115 346116 346117 346118 346119 346120
5/10/2009 NV 5/10/2009 GA 5/11/2009 CA 5/11/2009 NC 5/11/2009 FL 5/11/2009 5/11/2009 5/11/2009 5/11/2009 PA 5/11/2009 CA 5/11/2009 CA 5/11/2009 WY 5/11/2009 MD 5/11/2009 MD 5/11/2009 NY 5/11/2009 IL 5/11/2009 CA 5/11/2009 CA 5/11/2009 WA 5/11/2009 CA 5/11/2009 MI 5/11/2009 VA 5/11/2009 MI 5/11/2009 NY 5/11/2009 AL 5/11/2009 CA 5/11/2009 VA 5/11/2009 5/11/2009 TX 5/11/2009 NC 5/11/2009 KS 5/11/2009 GA 5/11/2009 IA 5/11/2009 CA 5/11/2009 ME 5/11/2009 ME 5/11/2009 VA 5/11/2009 TX 5/11/2009 NV 5/11/2009 GA 5/11/2009 MO 5/11/2009 NM 5/11/2009 NJ 5/11/2009 FL 5/11/2009 NY 5/11/2009 ME 5/11/2009 DC 5/11/2009 ME 5/11/2009 CA 5/11/2009 MN 5/11/2009 NJ
4 65 2 13 21 15 11 20 18 1.3 1.3 54 0.5 7 1.5 0.4 50 32 76 61 4 10 4 22 15 5 4 11 32 87 12 39 15 4 2 12 57 72 0.7 11 10 22 11 16 5 2 60 1.3 5 17 40
4 65 13 22
20 18
54 0 7 1 0 50 32 76 61 4 10 4 22 15 5 4 32 87 12 39 15 4 2 12 57 72 0 11 10 22 11 16 5 2 60 1 5 17 40
M F M F F F F F F U U M 0M F 0.5 F 0.4 F F F F M M M U F F F M F M F F M F F 0F F F M 0.7 F M F M F F M 0.6 F F 0.3 U F F F
5/10/2009 right deltoid with induration, mild ery 5/10/2009 My arms swelled up to double its siz 5/8/2009 Information has been received from 5/8/2009 Initial and follow-up information has 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/11/2009 5/5/09 At time of injections noted cli 5/11/2009 6 month old received immunizations 5/11/2009 Patient and patient's father returned 5/11/2009 RASH STARTED ON 5/10/2009 FR 5/11/2009 Evening of injections got fussy, then 5/11/2009 Developed fevers, malaise and hea 5/11/2009 Skin Rash and/or Hives, swollen fee 5/11/2009 On Day 2 after the injection (5/2), de 5/11/2009 1/2 DOLLAR bill redness c some sw 5/11/2009 LOCAL RXN R>L THIGH W/IN MIN 5/11/2009 Tdap was administered in school se 5/11/2009 LOCAL RXN R THIGH W/IN MINUT 5/11/2009 Approx. 20 hours after receiving vac 5/11/2009 Parent states that patient had on lef 5/11/2009 Noted slight swelling of the left delto 5/7/2009 Toxic synovitis (L) hip. 6/24/09 Hosp 5/7/2009 Received second dose of GARDAS 5/8/2009 None Stated. 5/11/2009 Tingly pains in left hip with weaknes 5/8/2009 Pt Developed a right upper extremit 5/4/2009 Patient reported C/o redness and so 5/8/2009 3-4 Months after 3rd dose of GARD 5/8/2009 Swelling, redness, pain. Entire delt 5/11/2009 Vaccine given instead of VARIVAX 4/30/2009 Hives - began around 6pm on 4/28/ 5/11/2009 May 7 after shot arm sore and some 5/11/2009 Loss of sensation in right arm; arm i 5/11/2009 02/24/2009 Severe Seizures < 3 da 5/11/2009 Local reaction, quarter sized erythe 5/11/2009 Redness Swelling itching warm to to 5/11/2009 Developed tender mildly pruritic ery 5/11/2009 Within 24 hrs following vaccinations 5/11/2009 Pt fainted, gave oxygen and checke 4/30/2009 6cm x 7cm area of erythema with sl 5/6/2009 Diffuse papular/macular erythemato Minor swelling + tenderness at injec Diffuse macular erythematous rash 4/30/2009 Rec'd vacc 4:30 p 4/27. Pt went to s 5/4/2009 About 5 hours after shot developed 5/11/2009 Erythema local. Myalgias. Arthralgia
346121 346122 346123 346124 346125 346130 346137 346139 346145 346146 346147 346148 346151 346153 346155 346156 346157 346158 346161 346163 346165 346170 346171 346172 346173 346174 346175 346176 346177 346178 346179 346180 346181 346182 346183 346186 346187 346188 346189 346190 346191 346192 346193 346194 346195 346196 346197 346198 346200 346201 346202
5/11/2009 OH 5/11/2009 CA 5/11/2009 FL 5/11/2009 WI 5/11/2009 IA 5/11/2009 GA 5/12/2009 5/12/2009 WV 5/12/2009 OK 5/12/2009 5/12/2009 5/12/2009 MD 5/12/2009 NY 5/12/2009 DC 5/12/2009 KY 5/12/2009 PA 5/12/2009 5/12/2009 LA 5/12/2009 NC 5/12/2009 PA 5/12/2009 SC 5/12/2009 IN 5/12/2009 OH 5/12/2009 MD 5/12/2009 CA 5/12/2009 LA 5/12/2009 IL 5/12/2009 PA 5/12/2009 TX 5/12/2009 TX 5/12/2009 NC 5/12/2009 NY 5/12/2009 PA 5/12/2009 OH 5/12/2009 MO 5/12/2009 MI 5/12/2009 IN 5/12/2009 SC 5/12/2009 MI 5/12/2009 VT 5/12/2009 WV 5/12/2009 ME 5/12/2009 NH 5/12/2009 LA 5/12/2009 CT 5/12/2009 CT 5/12/2009 CA 5/12/2009 OH 5/12/2009 KY 5/12/2009 NM 5/12/2009 KY
30 58 13 14 4 0.2 54 11
20 2 0.4 10 2 38 20 30 11 15 22 13 59 53 11 0.5 60 39 39 4 0.2 19 5 5 0.2 5 12 1.3 1.3 13 68 31 33 11 12 5 1.3 11 20 1
30 58 13 14 4
11
20 2 0 10 2 38 20 30 11 15 13 59 53 11 0 60 39 39 4 0 19 5 5 0 5 12 1 1 13 68 31 33 11 12 5 1 11 20 1
M F F F M M U M M U F F 0.6 M 0.4 M F 0.7 M F F F F M M F F F F 0.5 M F F F M 0.2 M F M F 0.2 M M M 0.3 M 0.3 F F F M F M M M 0.3 F F M 0F
5/11/2009 Pt rec VARICELLA vaccine on 4/20 4/17/2009 4-17-09 9:10 AM Pt. c/o ears tinglin 5/5/2009 Syncopal episode - hit head. 4/20/2009 Patient received shots on 4-14-09. 5/6/2009 Mother PHONED 5/5 @ 1 pm. Rep 5/5/2009 This case was reported by a healthc 5/11/2009 InformationYhas been received from 5/7/2009 Initial report received on 04 May 20 Imm - ADACEL, MENACTRA, varic 5/11/2009 Information has been received from 5/11/2009 Information has been received from 5/11/2009 Information has been received from 4/20/2009 Mild fever within 1 week change in c 5/11/2009 Information has been received from 5/6/2009 Cellulitis at injection site of varicella 5/4/2009 Mom called 5/1/09, c/o pain. "limpin None Stated 4/29/2009 None stated 5/6/2009 Localized induration, fever, chills, m 5/4/2009 L arm pain initially & then recurred w 5/7/2009 "Breaking out in bumps all over his 5/6/2009 Popular rash on R deltoid began 5/4 5/7/2009 Arm soreness, fever, joint pains, he 5/15/2009 5/5/09 Administration of L arm eryth 5/2/2009 Less than 24 hrs after injection site 5/7/2009 11 y/o female was administered VA 5/7/2009 Rash appeared 3 days after vaccine 5/10/2009 Began 12 hours post vaccination: F 5/7/2009 Red, fever, painful. 3rd day reaction 5/6/2009 (1) Hives, (2) SOB, (3) Throat swelli 5/7/2009 Redness, warmth, induration - diffus 5/8/2009 Vaccine given 4/23/09 - Pt began ha 5/8/2009 None 5/4/2009 12 cm diameter redness, warmth, sw 5/7/2009 None (received Td. - Should have re 5/6/2009 Blood in stool noted 4-29-09 5 days 5/6/2009 Patient felt weak, lost balance, beca 4/30/2009 Right deltoid swelling, heat, pain. L Possible seizure activity, brief altera 5/6/2009 High fever followed by seizure 24 af 5/7/2009 Patient's arm red, swollen and fever 5/5/2009 (Vac. 4-30-09) - site irritation only th 5/6/2009 Temp 101.7 Po since evening after 5/8/2009 None stated 5/5/2009 Red, swelling and pain at the site of 5/5/2009 Red, swelling & pain at the site of in 5/5/2009 48 hrs post administration child had 5/5/2009 Rash & fever 11 days post vaccine 5/5/2009 Rash 1st noticed behind ears, now 5/1/2009 C/O sore throat, difficulty swallowing 5/4/2009 5/1/09 Patient received immunizatio
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5/12/2009 CA 5/12/2009 OH 5/12/2009 KS 5/12/2009 IL 5/12/2009 ME 5/12/2009 KS 5/12/2009 KS 5/12/2009 CA 5/12/2009 CA 5/12/2009 OH 5/12/2009 OH 5/12/2009 NY 5/12/2009 OH 5/12/2009 MD 5/12/2009 MD 5/12/2009 OH 5/12/2009 AL 5/12/2009 AZ 5/12/2009 MA 5/12/2009 CA 5/12/2009 CA 5/12/2009 NC 5/12/2009 FL 5/12/2009 CT 5/12/2009 NM 5/12/2009 IA 5/12/2009 WA 5/12/2009 WA 5/12/2009 CA 5/12/2009 WA 5/12/2009 CA 5/12/2009 KY 5/12/2009 NC 5/12/2009 MN 5/12/2009 CT 5/12/2009 MI 5/12/2009 PA 5/12/2009 OH 5/12/2009 OR 5/12/2009 NC 5/12/2009 NJ 5/12/2009 TX 5/12/2009 UT 5/12/2009 MI 5/12/2009 OH 5/12/2009 KY 5/12/2009 MN 5/13/2009 NC 5/13/2009 5/13/2009 5/13/2009
5 24 15 0.2 4 14 12 1.1 20 61 4 1.5 1.3 71 71 64 0 4 70 0.2 36 1 12 22 12 74 4 4 0.5 27 11 4 1.6 77 12 30 61 71 73 1 13 48 11 67 4 61 26 24 85 94 25
5 24 15 0 4 14 12 1 19 61 4 1 1
63 0 4 70 0 36 1 12 22 12 74 4 4 0 27 11 4 1 77 12 30 61 71 73 1 13 48 11 67 4 61 26 24 85 94
U F M 0.2 M F M M 0.1 M F F M 0.5 M 0.3 F U U M 0F M F 0.2 M F 0F F F M F M M 0.5 M F M M 0.6 M F F F F F F 0M F F F M M F F F F F U
5/1/2009 Swollen, red & hot to the touch. 5/12/2009 4 DAYS AFTER RECIEVING ANTH 5/12/2009 Experienced fever (102.0 degrees F 5/12/2009 Foster parent says that patient only 5/12/2009 Parents noticed rash on upper arm 5/12/2009 Arm was sore, low grade fever, felt 5/12/2009 Sore arm, low grade fever, fatigue 5/12/2009 IMMEDIATELY AFTER GIVING MM 5/12/2009 Redness and swelling at injection si 5/12/2009 On 1/9/09 the patient called the offic 5/12/2009 Patient received the vaccination on 5/12/2009 Infant screaming in tantrums which 5/12/2009 Per ER Physician varicella rash on b 5/12/2009 Subject in pneumococcal vaccine tr 5/12/2009 Subject in pneumococcal vaccine tr 5/12/2009 Pt received Tdap injection 3/17/09. 5/12/2009 patient had no signs of complication 5/12/2009 5-7-09 Crying, sore arms, couldn't m 5/12/2009 pT DEVELOPED SIGNS AND SYM 5/12/2009 A hard, red lump the size of a blueb 5/12/2009 On Wednesday May 13th I visited m 5/12/2009 FEVER BETWEEN 102.5 AND 103 5/1/2009 Dx-encephalitis etiology unkonwn. F 3/15/2009 At 1248am, I fainted, had possible s Swelling, warmth & hardness at site 1/15/2009 12/27/08 --> Lt scapular pain - gen O 5/12/2009 ?Neck swelling w/ slight tenderness 5/8/2009 Inflammation , tenderness left uppe 5/12/2009 Per Dr possible granuloma. 5/12/2009 Patient fainted after administration o 5/11/2009 About 20 minutes after receiving im 5/6/2009 Mother of child reports that child ha 5/15/2009 Pt developed urticaria (generalized) 5/11/2009 Pt walked into clinic at 10:00 am on 5/12/2009 HPV vaccine give with expired date 5/11/2009 Approximately 24 hrs post receiving 5/11/2009 Injection site {erythema warm sensa 5/1/2009 Client had ZOSTAVAX injection 5/2 5/7/2009 Rash, pain, loss of eye sight for 2 w 5/12/2009 Multiple papules + pustuls on back + 5/12/2009 Pt was home 1 1/2 hrs post vaccine 5/12/2009 Left arm pain and swelling saw Dr 5 5/12/2009 5/9 Cellulitis left arm s/p Tdap place 5/7/2009 Next day developed cough and con 5/6/2009 DTaP administered @ thigh on 5-35/1/2009 Local edema, pain, redness. 5/12/2009 Probable secondary transmission of 5/12/2009 Information has been received from 5/3/2009 Pt receives a PNA vaccine on 5-2-0 5/6/2009 Pt called around 2100 on 5/2/09; sp 4/17/2009 Pt c/o lip tingling and respiratory sym
346264 346265 346266 346267 346268 346269 346270 346271 346272 346276 346277 346278 346279 346280 346281 346282 346283 346284 346285 346286 346287 346288 346289 346290 346292 346293 346294 346295 346296 346297 346298 346299 346300 346301 346302 346303 346304 346306 346307 346291 346308 346309 346310 346311 346312 346316 346317 346318 346319 346321 346322
5/13/2009 TX 5/13/2009 PA 5/13/2009 GA 5/13/2009 NJ 5/13/2009 AR 5/13/2009 WI 5/13/2009 WI 5/13/2009 MD 5/13/2009 MD 5/13/2009 GA 5/13/2009 MI 5/13/2009 SC 5/13/2009 KY 5/13/2009 KY 5/13/2009 FL 5/13/2009 SC 5/13/2009 MI 5/13/2009 PA 5/13/2009 NY 5/13/2009 PA 5/13/2009 PR 5/13/2009 AK 5/13/2009 NY 5/13/2009 VA 5/13/2009 OR 5/13/2009 NE 5/13/2009 CA 5/13/2009 IL 5/13/2009 MD 5/13/2009 AZ 5/13/2009 WI 5/13/2009 IA 5/13/2009 PA 5/13/2009 OR 5/13/2009 MD 5/13/2009 GA 5/13/2009 TX 5/13/2009 CA 5/13/2009 MO 5/14/2009 TX 5/14/2009 5/14/2009 5/14/2009 5/14/2009 5/14/2009 MI 5/14/2009 IL 5/14/2009 WI 5/14/2009 NC 5/14/2009 5/14/2009 IL 5/14/2009 IL
63 1 17 46 4 4 1 38 48 43 10 0.3 33 5 4 30 38 31 0.3 26 0.3 1 44 17 19 1.2 4 70 1.1 0.5 20 1 4 2 1 0.4 9 0.2 16 17 18 1
0.2 0.6 57 21 19 60 11
63 1 17 46 4 4 1 38 48 43 10 0 33 5 4 30 38 31 0 26 0 1 44 17 19 1 4 70 1 0 20 1 4 2 1 0 9 0 16 17 18
0 57 21 19 60 11
F 0F F F F M 0M M M F F 0.3 F F F F F F F 0.3 F M 0.5 M 0F F F F 0.2 M M F 0.1 M 0.5 F F 0M M 0.1 M 0F 0.4 F M 0.2 M F F F M M M M 0.6 F F M M M F
5/13/2009 Patient states awoke to arm red swo 5/12/2009 Rash on back itchy, especially on A 5/11/2009 Patient give hep B (peds) on 5-1-09 5/7/2009 Vaccine administered to pt on 4-1-0 5/4/2009 L upper 2 length area of redness + l 5/8/2009 8 by 7 cm area of erythema + warm 5/7/2009 None Stated 5/5/2009 Constipation, some lost of vision. 5/13/2009 This case was reported by a lawyer 5/13/2009 "...began to hve severe joint pain 5/13/2009 Patient was given a Zostavax vaccin 5/13/2009 Pt seen in hospital on May 11, 2009 5/13/2009 Employee received 2nd dose of Hep 5/13/2009 Immunizations administered at 12:4 5/13/2009 AS SOON AS THE VARICELLA AN 5/13/2009 Pt developed a raised red area on b 5/13/2009 Ct satates that a couple of hours aft 5/13/2009 Patient stated she had received a M 5/13/2009 Patient ran a 102 fever, breathing v 5/13/2009 Reported to clinic 4/21/2009 with sw 5/13/2009 PATIENT'S MOTHER REFERS RA 5/13/2009 Local hives and swelling at site of V 5/13/2009 PATIENT DEVELOPED ITCHY HIV 5/13/2009 Started developing warts on inside o 5/12/2009 Pt saw PCP on 2/4/09 for GYN/PAP 5/13/2009 Ear infection 1 week prior to abnorm 4/26/2009 The following day, noted increased 5/12/2009 Examined by MD 5-12-09 in Derma 10mm induration with redness R lat 5/8/2009 Parents took child across street to g 5/13/2009 15-20 seconds after injection becam 5/13/2009 Fever X 9 days vomiting X 2 days 5/13/2009 Local redness approximately 10mm 5/13/2009 Pt reacted immediately to VAR + MM 5/13/2009 40mm X 30mm area of induration o 5/13/2009 No adverse event of symptoms, wro 5/13/2009 Achy headache, fatigue, tremors, ar 5/13/2009 Infant with "milk protein allergy" at 1 5/13/2009 Deep, aching pain in Rt arm, very te 5/14/2009 First complaint was neck arm stiffne 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from Diagnosed with rotavirus on 4/30/09 4/27/2009 5-day(s) hospitalization for IVIG - ex 5/11/2009 21 y/o patient seen for F/U s/p hosp 3/18/2009 Pt woke up with CP and SOB in the 5/8/2009 "Cold sore on lower lip within 48 hou 5/11/2009 Rt. arm red, slightly warm to touch,
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5/14/2009 NC 5/14/2009 5/14/2009 OH 5/14/2009 CA 5/14/2009 WI 5/14/2009 OH 5/14/2009 KY 5/14/2009 TX 5/14/2009 5/14/2009 MA 5/14/2009 PA 5/14/2009 SD 5/14/2009 TX 5/14/2009 VA 5/14/2009 VA 5/14/2009 AL 5/14/2009 TX 5/14/2009 AZ 5/14/2009 PA 5/14/2009 ME 5/14/2009 NY 5/14/2009 IA 5/14/2009 CA 5/14/2009 MI 5/14/2009 MD 5/14/2009 NJ 5/14/2009 TX 5/14/2009 NC 5/14/2009 CA 5/14/2009 SC 5/14/2009 IN 5/14/2009 NC 5/14/2009 CA 5/14/2009 NC 5/14/2009 NC 5/14/2009 NC 5/14/2009 NY 5/14/2009 IA 5/14/2009 OH 5/14/2009 IL 5/14/2009 NC 5/14/2009 PA 5/14/2009 MA 5/14/2009 TN 5/14/2009 GU 5/14/2009 CA 5/15/2009 IN 5/15/2009 IN 5/15/2009 PA 5/15/2009 IL 5/15/2009 OR
0.8 0.4 0.4 5 4 5 24 1 40 25 30 4 25 11 16 14 0.5 25 40 52 3 1.3 5 65 1 10 11 10 17 4 1 22 1.2 21 45 22 49 14 0.7 11 60 64 4 23 63 10 36 4 16 4
0 0 0 5 4 5 24 1 40 25 30 4 25 11 16 14 0 24 40 52 3 1 5 65 1 10 11 10 17 4 1 22 1 21 45 22 49 14 0 4 11 60 64 4 23 63 10 36 4 16 4
0.8 M 0.5 M 0.4 M F F M F 0.1 M M F F F F M F F 0.3 F F F F M 0.3 F M F 0M F M F F F 0M F 0.2 F F M M F F 0.7 M U F M F F M F M M M F M
5/14/2009 Patient c/o fever 102,less of appetit 5/14/2009 Patient given Rotarix vaccine. On fir 5/14/2009 Pt was found Y face down in his crib a 5/14/2009 Received vaccination on Friday, by 5/14/2009 Warm, red, hard 2.5 X 3 inch cellulit 5/14/2009 On 5-11-09 mom called and spoke 5/14/2009 after few hours of taking the vaccine 5/14/2009 Received Varicella and Hepatitis A v 5/14/2009 Chest Pain 786.5 (5-000008) 5/19 5/14/2009 was administered Tdap, no previous 5/14/2009 sore, warm, red, bruised spot on the 5/7/2009 Right upper arm redden and swollen 5/14/2009 Patient presented to the emergency 5/14/2009 injection site red and swollen x 1 da 5/14/2009 During the series of 3 injections and 5/14/2009 Patient reports that after receiving s 5/14/2009 PATIENT SEEMED TO HAVE PRO 5/14/2009 pt was given hpv vaccine pt was the 5/14/2009 This case was reported by a healthc 5/6/2009 - Hallucinations. - Fever, chills. - Loc 5/14/2009 Cranky and decreased appetite star 5/13/2009 Patient presented to hospital with 15/14/2009 R arm swelling, redness within 48 o 5/6/2009 Developed redness, swelling locally 5/14/2009 Pt received Varicella vaccine (lot #0 5/14/2009 Pt. received vaccines TDAP, Hep A 5/14/2009 Swelling, redness, pain, warmth at i 5/14/2009 1 inch X 1 1/4 inch upper arm redne 5/13/2009 Urticaria- Erythematous Wheals all 5/14/2009 Mom noted redness, heat and swell 5/14/2009 On 5/3/09 Mother noticed L arm red ### 22 y/o pregnant female, ADSM, rep 5/2/2009 Local allergic reaction at site of injec 3/19/2009 21 y/o AD female presents for walk### 45 y/o male, ADSM, is referred to th 5/7/2009 Dr. calls clinic (06May09) re 22 y/o A 5/12/2009 Pt has rash left arm, swelling, no fev 5/9/2009 Swelling, itchiness, redness at site o 5/7/2009 Lip droops down on R side of face w Large 3 1/2" urticarial patch over inj 5/11/2009 After vaccination on way home mom 4/10/2009 Noticed 2 swollen lymph nodes und 5/9/2009 1 wk symptoms 2 wk recovery comp 5/8/2009 2 1/2 round rash on 1 thigh, warm to 5/14/2009 0840- IM injection given - HEPA. HE 5/15/2009 Shingles vaccination: Next few days 5/15/2009 Localized erythema - mom describe 5/15/2009 05-12-09, Feverish, C/o "feeling sick 5/3/2005 Immunization (KINRIX) given on 5/1 5/8/2009 Scattered hives occurred that pm or 4/30/2009 4/29/09 - Rt arm inflamed and swoll
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5/15/2009 IL 5/15/2009 PA 5/15/2009 NJ 5/15/2009 CT 5/15/2009 TN 5/15/2009 TN 5/15/2009 VA 5/15/2009 GA 5/15/2009 NV 5/15/2009 CA 5/15/2009 CA 5/15/2009 RI 5/15/2009 CA 5/15/2009 VA 5/15/2009 VA 5/15/2009 VA 5/15/2009 VA 5/15/2009 NY 5/15/2009 MA 5/15/2009 MN 5/15/2009 KS 5/15/2009 CA 5/15/2009 CA 5/15/2009 AZ 5/15/2009 SC 5/15/2009 NC 5/15/2009 IL 5/15/2009 5/15/2009 FL 5/15/2009 PA 5/15/2009 MI 5/15/2009 LA 5/15/2009 MD 5/15/2009 NM 5/15/2009 WI 5/15/2009 OH 5/15/2009 CA 5/15/2009 MA 5/15/2009 AZ 5/15/2009 UT 5/15/2009 5/15/2009 CO 5/15/2009 NE 5/15/2009 5/15/2009 NC 5/15/2009 MO 5/15/2009 IN 5/15/2009 VA 5/15/2009 FL 5/15/2009 IL 5/15/2009 MO
18 1.6 4 0.4 32 26 10 11 1.1 77 13 54 5 27 13 5 4 32 14 5 29 15 15 10 11 4 14 38 11 79 13 4 40 17 13 24 16 2 1 0.6 25 5 5 13 76 3 5 5 13 78 4
18 1 4 0 32 26 10 11 76 13 54 5 27 13 5 4 32 14 5 29 15 15 10 11 4 14 38 11 79 13 4 40 17 13 25 16 2 1 0 5 5 13 76 3 5 5 13 78 4
F 0.6 U M 0.4 F M F F M M F M M F F M M M F F F F M F F F M M M M F F M F F F M F 0.8 F 0M 0.6 F F U F F F M M F F F F
5/8/2009 Hives and blisters up both arms. Tre Mild hives treated with BENADRYL 5/15/2009 Localized reaction at IM injection sit 3/23/2009 Low grade fever (101), diarrhea, mil 5/1/2009 Pain, redness and swelling in L arm Itching, onset one hour after vaccina 5/8/2009 Received Tdap around 9:00-9:30 am 5/8/2009 Nurse administered 0.5 cc of Tdap t 5/5/2009 Received IZ's 4.29.09 - 5-1-09 pale 5/8/2009 24 hours -->72 hours : 5 x 7 cm eryt 5/7/2009 Hives began at injection sites on rig 5/8/2009 Rigors, increased temperature. See 5/8/2009 Right arm- red and swollen with sma 3/4/2009 2/27/09 Day 8- joint and muscle pai 5/15/2009 vaccinate site red and swollen x 1 d 5/15/2009 Child was brought in for office visit t 5/15/2009 Child was brought in for an office vis 5/15/2009 Received vaccine on may 12,2009 a 5/15/2009 Patient presented to our office on 5/ 5/15/2009 3 inch red, swollen, hot area on left 5/15/2009 Ct received her first rabies vaccine o 5/15/2009 Right outer aspect of arm extending 5/15/2009 developed chest pain and palpation 5/15/2009 Warm, erythamatous, tender lesion 5/15/2009 Rt arm swollen and knot the size of 5/15/2009 Received 5 yo vaccines today, kinrix 5/15/2009 Patient was given Gardisil instead o 5/15/2009 Chest Pain (786.59) 5-000009 6/1 5/15/2009 Within a few days of receiving Mena 5/15/2009 Patient presented 24 hours later wit 5/15/2009 3 RED "WELTS" ON LT ARM TOW 5/15/2009 4 year 7 month old male presents w 5/15/2009 New admission from E.R.,recieved P 5/15/2009 Student came in to my office 5/15/0 5/15/2009 Patient was given MCV4 and Var #2 5/15/2009 I had only experienced a short dura 5/15/2009 10 X 9 welt with swelling and redne 5/16/2009 (L) upper arm injection site swelling 5/15/2009 Developed erythematous rash at sit 5/15/2009 Woke up day after shot with a rash 5/13/2009 Seriousness Criteria: Other- Medica L thigh 7X9 cm, warm, erythematou 5/13/2009 4" x 5" red reaction right thigh. 5/15/2009 This case was reported by a healthc 5/12/2009 Patient received vaccine 5-8-09; no 5/15/2009 Have noticed redness @ swelling to 5/15/2009 Red area of inflammation occurred i 5/14/2009 Indurated red skin in roughly rectan 5/15/2009 1:35 Pt complaints of dizziness, Pt p 5/13/2009 12-18 Hours after receiving injection 5/15/2009 Developed 4.5mm x 5mm areas + r
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5/15/2009 LA 5/15/2009 NC 5/16/2009 NC 5/16/2009 5/16/2009 KY 5/16/2009 AK 5/18/2009 5/18/2009 NJ 5/18/2009 OK 5/18/2009 5/18/2009 5/18/2009 NY 5/18/2009 5/18/2009 FL 5/18/2009 TN 5/18/2009 WI 5/18/2009 MI 5/18/2009 IA 5/18/2009 PA 5/18/2009 5/18/2009 MD 5/18/2009 TX 5/18/2009 PA 5/18/2009 OH 5/18/2009 MA 5/18/2009 MI 5/18/2009 GA 5/18/2009 NY 5/18/2009 VA 5/18/2009 MO 5/18/2009 TX 5/18/2009 GA 5/18/2009 KS 5/18/2009 UT 5/18/2009 IA 5/18/2009 MA 5/18/2009 NC 5/18/2009 SC 5/18/2009 NC 5/18/2009 CA 5/18/2009 CA 5/18/2009 MO 5/18/2009 MI 5/18/2009 MT 5/18/2009 MI 5/18/2009 CA 5/18/2009 PA 5/18/2009 PA 5/18/2009 MO 5/18/2009 CO 5/18/2009 PA
4 53 12 37 41 1 2 0.5 0.5 24 22 1.2 11 0.6 44 18 11 13 6 65 7 4 1.1 67 15 17 32 11 19 38 35 65 19 2 18 25 24 26 4 3 14 69 18 60 12 16 14 12 69 11
4 53 12 37 41 1 0 0 24 22
0 44 18 11 13 6 65 7 4 1 67 15 17 32 11 19 38 35 65 37 19 2 18 26 24 26 4 3 14 69 15 60 1 7 14 12 69 11
M F M M F 0F M 0.5 M 0.5 M F F F M 0.6 M F F M F F F M F 0F F F F M F M F F F F M 0M F F F F F F F F M F 0F M M F F M
5/15/2009 Local reaction Left deltoid; erythema 5/15/2009 Arm sore, red and swollen. 5/16/2009 Severe hives over entire body, head 5/16/2009 Generalized vaccinia with diffuse ra 5/16/2009 On the day of the shot, the injection 5/16/2009 11-28-08 Mom reports body rash fo 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/7/2009 Influenza vaccines rec'd 10/18/07 a 4/28/2009 Pt called 4/28/09 after sx has resolv 5/18/2009 3x3.75 inches erythematous area o Erythema @ injection site edema pa 5/18/2009 Pt. at clinic received HPV, MENACT 5/14/2009 Patient received VARIVAX immuniz 5/18/2009 Bell's Palsy 5/18/2009 On day of vaccination, (hours later) 5/18/2009 localized alergic reaction to left thigh 5/18/2009 macular papular rash post auricular 5/18/2009 Patient presented to the Emergency 5/18/2009 Pt was given Menningicoccal vaccin 5/18/2009 On 5/15/09 Adriana returned to hav 5/18/2009 client complained swollen area abou 5/18/2009 Patient tolerated vaccine well, but u 5/18/2009 PT BROKE OUT WITH PIMPLES O 5/18/2009 Pt reports slight fever and flu like sy 5/18/2009 Delivered baby on 5/11/09. Got MM 5/18/2009 Pt reported localized swelling at inje 5/18/2009 Developed hard bump in arm that g 5/18/2009 Client was administered vaccines, b 5/18/2009 Patient was given Vaccines and 48 5/18/2009 On 4/28/09 the patient was given th 5/18/2009 extreme fatigue, migraines, nose ble 5/18/2009 The site where the vaccine was adm 5/18/2009 diffuse itching began less tan 12 ho 5/18/2009 rash left deltoid from Prevnar admin 5/18/2009 rash at site of vaccine(prevnar) left d 5/18/2009 Pt became weak and dizzy while wa 5/18/2009 Client received Zostavax in am on 0 5/18/2009 Fever (101.9), achiness, headache, 5/18/2009 RAISED INDURATED AND ERYTH 5/18/2009 THE VACCINE WAS INJECTED ON 5/18/2009 Rash started 4/15/09, chicken pox. 5/18/2009 syncope after vaccines 5/18/2009 Left Deltoid raised, reddened, appro 5/18/2009 pt. received in clinic Td and Pneumo 5/18/2009 fine red rash all over body, no urtica
346500 346501 346502 346503 346505 346507 346508 346509 346510 346512 346515 346516 346517 346518 346519 346520 346521 346522 346523 346524 346525 346529 346532 346533 346535 346537 346539 346544 346545 346546 346547 346548 346549 346550 346551 346552 346554 346555 346557 346558 346559 346560 346659 346660 346661 346662 346663 346664 346665 346666 346667
5/18/2009 WI 5/18/2009 NY 5/18/2009 KY 5/18/2009 CA 5/18/2009 WA 5/18/2009 CA 5/18/2009 GA 5/18/2009 TX 5/18/2009 AL 5/18/2009 VA 5/18/2009 ND 5/18/2009 SC 5/18/2009 VA 5/18/2009 CA 5/18/2009 AR 5/18/2009 OH 5/18/2009 NC 5/18/2009 NE 5/18/2009 MN 5/18/2009 FL 5/18/2009 PA 5/18/2009 CT 5/18/2009 IN 5/18/2009 LA 5/18/2009 5/18/2009 LA 5/18/2009 MT 5/18/2009 CA 5/18/2009 OR 5/18/2009 OR 5/18/2009 5/18/2009 AL 5/18/2009 GA 5/18/2009 MA 5/18/2009 PA 5/18/2009 MI 5/18/2009 TX 5/18/2009 5/18/2009 NY 5/18/2009 TN 5/18/2009 5/18/2009 WI 5/18/2009 5/18/2009 IL 5/18/2009 NC 5/18/2009 NY 5/18/2009 KS 5/18/2009 5/18/2009 5/18/2009 IL 5/18/2009
15 13 27 27 0.2 5 0 16 5 23 14 4 35 4 0.4 4 30 5 1.5 4 2 3
15 13 27 28 0 5 0 16 5 23 14 4 35 4 0 4 30 5 1 4 2 3
17 0.3 45 11 4 39 20 2 8 11 38 4 21 1.6 23 4 17 17 69 18 22 14 18
17
26 20 21 29
26 20
45 11 4 39 20 2 8 11 38 4 1 23 4 17
18 22 14 18
29
F F F M 0.2 M F 0M F M U F F M M 0.4 M F F M 0.5 M M 0.7 F F M F U F M F F F 0.1 F F F U M M 0.6 F M F F F M F F F F F F F F F
5/18/2009 Shortly after her first shot patient sta 5/18/2009 She has had dizziness, nausea and 5/18/2009 With the first booster injection given 5/18/2009 Large lump at injection site. Sore a 5/18/2009 Eyes twitching, unresponsive. Fussi 5/18/2009 Left deltoid swollen with redness an 5/18/2009 This case was reported by a pharma 5/18/2009 Fever 103-104 X 2 days 5/18/2009 Site swollen/red 2 days after vaccin 5/18/2009 Pt had AVA and Influenza shot on 4 5/18/2009 In evening of day of shots - She dev 5/15/2009 DTap #5 given in R thigh- 48 hours 5/5/2009 HEPATITIS B #2 (accelerated sche 4/23/2009 L deltoid inflammation 3 cm Rx for B 5/11/2009 Fine rash systemically see clinical d 5/11/2009 Redness, swelling-hard and warm to None stated 5/11/2009 None stated 5/7/2009 Erythematous, swollen, large local r 5/4/2009 Hives 5/7/2009 Right thigh red, indurated 1 1/2 - 2" 5/13/2009 Vomiting, which began a couple of h 5/13/2009 Site on upper right arm appeared re 5/6/2009 Pt's aunt called back 2 days after ER 5/18/2009 This case was reported in a literatur 5/6/2009 Patient came in for Flu vaccine, Rig 5/11/2009 Itching at injection site, right arm. Er 5/11/2009 Left deltoid 13X14 CM Swollen, Red 5/12/2009 Patient should have received a Tda 5/8/2009 Client reports that after HPV vaccine 5/9/2009 Red swollen lump L thigh. 5/13/2009 Several vesicles at injection site, fol 5/11/2009 Patient received VARIVAX vaccine Vaccine given 5/1/09 pri 5/1 - 5/09 R 36% After receiving vaccine, mild sw 5/13/2009 None Stated 5/12/2009 Urticaria, generalized. Benadryl 6.25 5/18/2009 25 y/o WM ADSM is referred from a 5/18/2009 DDX reaction to the pertussis in DT 4/29/2009 4-28-2009 1150/AM.- MMR #2 give 5/12/2009 Daughter received first GARDASIL 3/24/2009 Pt seen by MD on 3/13/09. Pt c/o ra 5/14/2009 Information has been received throu 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from
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5/18/2009 AZ 5/18/2009 CA 5/18/2009 OK 5/18/2009 VA 5/18/2009 NJ 5/18/2009 NY 5/18/2009 NY 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 HI 5/18/2009 5/18/2009 IA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 FL 5/18/2009 MA 5/18/2009 CT 5/18/2009 IL 5/18/2009 PA 5/18/2009 AL 5/18/2009 5/18/2009 5/18/2009 VA 5/18/2009 5/18/2009 TN 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 AR 5/18/2009 5/18/2009 TX 5/18/2009 CO 5/18/2009 IA 5/18/2009 IN 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 TX 5/18/2009 NY 5/18/2009 5/18/2009 5/18/2009 SC 5/18/2009 5/18/2009 5/18/2009 LA 5/18/2009 CA 5/18/2009 MI 5/18/2009
15 15 9 30 23 19 13 14 20
9 30 23 19 14 20
16 19 27 20 21 20 19 17 16
20
23 14 15
23
22
22
19 17
19
18 15 22 26
18 15 22
16
15
17 17
17
46 14
14
18 15
18
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F U F F U F F F F U F F F U U F F
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5/18/2009 5/18/2009 WA 5/18/2009 5/18/2009 5/18/2009 OH 5/18/2009 MA 5/18/2009 NC 5/18/2009 5/18/2009 5/18/2009 NY 5/18/2009 NY 5/18/2009 NY 5/18/2009 MA 5/18/2009 5/18/2009 CA 5/18/2009 5/18/2009 CT 5/18/2009 5/18/2009 5/18/2009 NJ 5/18/2009 NC 5/18/2009 NH 5/18/2009 5/18/2009 TX 5/18/2009 CT 5/18/2009 NY 5/18/2009 OH 5/18/2009 5/18/2009 5/18/2009 5/18/2009 OK 5/18/2009 5/18/2009 FL 5/18/2009 NY 5/18/2009 5/18/2009 MS 5/18/2009 NY 5/18/2009 NJ 5/18/2009 TX 5/18/2009 5/18/2009 FL 5/18/2009 IA 5/18/2009 5/18/2009 MI 5/18/2009 OH 5/18/2009 5/18/2009 5/18/2009 5/18/2009 FL 5/18/2009 5/18/2009 MN
22 12
12
13 15 17
13
25 16 19 26
25 16 19 26
25 10 21 25 21 18 18 27 24 14
17
21 25 21 18 18
14
11
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19 16 29 16
19 16 29 16
17 24 16 25 16 21 16
17 24 16 25 16 21 16
11 14
11 14
16 22
18 19 25 25 22
18 19
F F U F F F F F F F F F F F F F F F F F F F F U F F F F F F F F F F F F F F F F U F F F F F F F F F F
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5/18/2009 OR 5/18/2009 NY 5/18/2009 NY 5/18/2009 NM 5/18/2009 NY 5/18/2009 5/18/2009 IL 5/18/2009 5/18/2009 OH 5/18/2009 5/18/2009 NY 5/18/2009 5/18/2009 WA 5/18/2009 MI 5/18/2009 MI 5/18/2009 5/18/2009 5/18/2009 MD 5/18/2009 WA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 NC 5/18/2009 NC 5/18/2009 5/18/2009 CT 5/18/2009 CT 5/18/2009 CT 5/18/2009 CA 5/18/2009 5/18/2009 NM 5/18/2009 CA 5/18/2009 5/18/2009 NM 5/18/2009 MN 5/18/2009 MA 5/18/2009 5/18/2009 MN 5/18/2009 VA 5/18/2009 5/18/2009 5/19/2009 5/19/2009 CA 5/19/2009 5/19/2009 CA 5/19/2009 TX 5/19/2009 CA 5/19/2009 5/19/2009 CA 5/19/2009 CA 5/19/2009 MO
18 26 14 11
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19 17 24 16 40 19 20 28 22 25 18 18 17
20 22
18 17
19 17 17 21 33 21 19 21 13
19 17 17 20
17 15 21 18 20
17
23 52 69 54 0.3 0.5 1 3 37 41
23 52
19 13
21 19
54 0 0 3 41
F F U F F F F F U F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F 0.3 M 0.5 M M F F F
5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information hs been received from a 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Initial information was received from 5/14/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 4/24/2009 3yo with isolated IgA deficiency, adm 5/14/2009 Initial report received from a consum 5/15/2009 This case was received on 13 May 2
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5/19/2009 TX 5/19/2009 MA 5/19/2009 OH 5/19/2009 TX 5/19/2009 PA 5/19/2009 IL 5/19/2009 PA 5/19/2009 TX 5/19/2009 NM 5/19/2009 TX 5/19/2009 WI 5/19/2009 AZ 5/19/2009 MI 5/19/2009 AZ 5/19/2009 CA 5/19/2009 NC 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 CO 5/19/2009 OK 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 HI 5/19/2009 AZ 5/19/2009 CA 5/19/2009 WA 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 MS 5/19/2009 NY 5/19/2009 CA 5/19/2009 WA 5/19/2009 WA 5/19/2009 PA 5/19/2009 PA 5/19/2009 MD 5/19/2009 MT 5/19/2009 MT 5/19/2009 KS 5/19/2009 AL 5/19/2009 AL 5/19/2009 NC 5/19/2009 NE 5/19/2009 CA 5/19/2009 ND 5/19/2009 AZ 5/19/2009 NC 5/19/2009 OR 5/19/2009 PA
65 14 2 0.2 18 65 11 12 4 17 47 20 16 26 0.3 71 22 26 22 16 22 19 62 19 11 67 20 21 23 21 41 28 4 29 67 0.2 1.2 4 18 14 11
65 14 2 0 18 65 11 12
13 0.5 42 9 4 10 1.1 66
13 0 42 9 4 10 1 66
17 47 20 16 26 0 71 22 26 22 16 -1 19 62 19 11 67 20 21 23 21 41 28 4 29 67 0 1 4 18 14 11
F F 0.1 M 0.2 M F F M M M F F M F M 0.3 F M M M M F 0.6 M M F F F F M M M M M M M F F 0.2 F 0.2 M F M M F U U F 0.5 F F F F F 0.1 F F
5/11/2009 Pt developed pain, swelling and red 5/12/2009 Mother states pt received vaccine th 5/15/2009 6.5 cm long by 8 cm wide erythema 5/15/2009 Abrupt onset (10-12 hours) post vac 4/20/2009 Pt was given Adacel, Menactra + PP 5/8/2009 3 days later, I awoke with a 3 inch r 5/14/2009 Pt was given MENACTRA 0.5 ml @ 5/19/2009 Within 24 hours- Left arm (between 5/19/2009 Approximately 24 post Kinrix vaccin 5/19/2009 HPV #3 GIVEN 4-14-09 AND PATIE 5/19/2009 Temp - 102 degrees Body aches.ch 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient received MCV4 in Left delto 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Adverse side effects include: diarrhe 5/19/2009 None 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient had baseball size knot with 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Accidently administered an expired 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 3 days after second gardasil, pt wen 5/19/2009 Pt. brought immigration form from c 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 5 days after receiving vaccines, he 5/19/2009 First a feeling of nausia. Sycope wi 5/19/2009 PT COM[PLAINING OF VOMITING 5/19/2009 Extreme pain in arm of injection, ina 5/18/2009 Pain, erythema, vesicular rash in de 5/14/2009 Immediately post immunizations bab 5/14/2009 Patient returned 30 min after immun 5/14/2009 Localized warmth, erythema approx 5/13/2009 No adverse effects noted per patien 5/13/2009 His father stated that his "arm is sor 5/12/2009 IM injections were given at 2:30 pm 5/19/2009 This case was reported by a physici 5/19/2009 This case was reported by a physici 5/12/2009 C/o pain in muscles, joints. Felt hot 5/14/2009 Fever 102.5 within 24 hrs of vaccine 5/19/2009 Severe back ache in mid + lower ba 5/18/2009 - Pain & bruised at injection site - hi 5/13/2009 Noticed L upper pain with 3" swellin 5/8/2009 Redness, swelling, 6" down arm, 3Fever, lethargy, rash started 6 days 5/18/2009 Fever blisters branching out / poppi
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5/19/2009 NJ 5/19/2009 MA 5/19/2009 CA 5/19/2009 MT 5/19/2009 LA 5/19/2009 CA 5/19/2009 CA 5/19/2009 MN 5/19/2009 CA 5/19/2009 VA 5/19/2009 CA 5/19/2009 CA 5/19/2009 MO 5/19/2009 CA 5/19/2009 WA 5/19/2009 NC 5/19/2009 AR 5/19/2009 NY 5/19/2009 WV 5/19/2009 ND 5/19/2009 5/20/2009 PA 5/20/2009 5/20/2009 NY 5/20/2009 5/20/2009 NY 5/20/2009 NM 5/20/2009 GA 5/20/2009 PA 5/20/2009 MD 5/20/2009 5/20/2009 NY 5/20/2009 IL 5/20/2009 AZ 5/20/2009 MD 5/20/2009 SC 5/20/2009 FL 5/20/2009 TX 5/20/2009 VA 5/20/2009 SD 5/20/2009 5/20/2009 CO 5/20/2009 WI 5/20/2009 CA 5/20/2009 TX 5/20/2009 NV 5/20/2009 AL 5/20/2009 RI 5/20/2009 MI 5/20/2009 MI 5/20/2009 NC
41 14 43 1.7 36 17 15 2 62 14 16 0.3 5 1.2 68 35 0.2 5 5 1 19 37 12 76 85 67 0.2 55 76 1.2 14 15 18 1 12 0 15 38 2 1.5 27 5 18 59 41 70 38 4 61 68 0.3
41 14 43 1 36 17 15 2 62 14 16 0 5 1 68 35 0 5 5 1 19 37 76 85 67 0 76 1 14 15 18 1 12 0 15 38 2 1 27 5 18 59 41 70 38 4 61 0
M F M 0.7 F F F F 0.5 M M F F 0.3 F F 0.2 F F M 0.2 F U F 0M M M F M F M 0.2 M M M 0.2 F F F F 0M M 0F F F 0.3 M 0.5 M F F F M F M M F F F 0.3 M
5/8/2009 Pt. developed rash behind his leg, f 5/15/2009 Bell's palsy - few hrs. after Gardasil 5/18/2009 Arm swollen and red at injection site 5/14/2009 KINRIX prepared for older sister & a 5/11/2009 HA, dizziness, malaise, swelling of l 5/18/2009 Patient received Hep A on right arm 5/19/2009 Pt received Tdap, HPV and Menact 5/15/2009 Patient was fatigued a few hours aft 5/19/2009 Fever, arm swelling, leg and back 5/7/2009 Nausea, dizziness, pulse rate 100, l 5/19/2009 Patient fainted about 10 minutes aft 5/19/2009 Crying alot. Extreme fussiness trou 5/15/2009 Red, swollen, warm, painful area to 5/19/2009 Patient had high fever to 104 with le 5/8/2009 5/4/09 ZOSTAVAX administered; pa None stated 5/19/2009 Localized reaction with redness & s Patient presented shortly after recei 3/19/2009 Pt received #2 Hep A vaccine. 3 m 5/11/2009 Evening of 5-8-09. Mom noticed a r 4/27/2009 Over 3 day weekend, use bandages 5/18/2009 Initial reportYreceived from an assist 5/19/2009 InformationYhas been received from 5/8/2009 Pt s/p TD vaccine 3/1/09, developed 5/10/2009 85 yo female presented to the office 4/23/2009 6 hours after - chills - increased puls R thigh red with bruise @ site of imm 5/19/2009 The subject identified himself as a c 5/18/2009 Typhoid Herpes Zoster - began 5-35/15/2009 L thigh rash "hives" x 3 days; improv 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/20/2009 Received Menactra on 5/13/09 and 5/20/2009 Patient received a Hepatitis B vacci 5/20/2009 Patient received the HPV vaccine in 5/20/2009 6 days after receiving VZV#2, felt co 5/20/2009 Father reports they were awakened 5/20/2009 Mother reported that child's entire le 5/20/2009 Had employee PE 11/10/08. Receiv 5/20/2009 Had DTaP and IPV vaccines on 4/2 5/20/2009 Pain at injection site, difficulty breat 5/20/2009 Within a few months of the vaccinat 5/20/2009 On March 11, 2009, I went in for a c 5/20/2009 Patient experienced chest pain and 5/20/2009 Patient was immunized with Yellow 5/20/2009 Large hot red spot at injection site; s 5/20/2009 Patient described a tightness in che 5/20/2009 12-24 hours after injection, patient d 5/20/2009 na
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5/20/2009 MI 5/20/2009 AZ 5/20/2009 NJ 5/20/2009 LA 5/20/2009 NY 5/20/2009 SC 5/20/2009 UT 5/20/2009 CA 5/20/2009 OK 5/20/2009 FL 5/20/2009 TX 5/20/2009 MN 5/20/2009 TX 5/20/2009 MD 5/20/2009 AR 5/20/2009 CT 5/20/2009 VA 5/20/2009 NC 5/20/2009 CA 5/20/2009 CA 5/20/2009 MD 5/20/2009 CA 5/20/2009 OK 5/20/2009 NC 5/20/2009 GU 5/20/2009 CA 5/20/2009 NC 5/20/2009 KY 5/21/2009 MI 5/21/2009 IN 5/21/2009 NE 5/21/2009 MI 5/21/2009 AL 5/21/2009 NJ 5/21/2009 CA 5/21/2009 MN 5/21/2009 MN 5/21/2009 OK 5/21/2009 5/21/2009 NM 5/21/2009 CA 5/21/2009 NC 5/21/2009 MD 5/21/2009 MT 5/21/2009 NY 5/21/2009 KS 5/21/2009 MO 5/21/2009 CA 5/21/2009 KY 5/21/2009 PA 5/21/2009 CA
12 28 48 68 72 54 0.2 0.5 0.6 4 28 0.3 0.8 12 28 18 16 21 4 6 66 1 25 29 4 0.4 66 0.2 60 55 66 12 15 4 77 72 72 5 22 17 1.5 20 13 61 1 55 24 1.8 0.6 54 1.3
12 28 48 68 72 54 0 0 0 4 28 0 0 12 28 18 16 21 4 6 66 1 24 29 4 0 66 0 60 54 66 12 15 4 77
5 22 17 1 21 13 61 1 55 24 1 0 54 1
F M M M M F 0.2 M 0.5 F 0.6 F F M 0.3 M 0.8 M F F F F F M F F 0F M M M 0.4 M F 0.2 M F F M F F F F U U F M F 0.5 F M F F 0M F F 0.8 M 0.6 F F 0.3 M
5/20/2009 C/O OF ARM NUMBNESS AFTER 5/20/2009 Patient recieved smallpox vaccine th 5/20/2009 Hepatitis B Vaccine, Dose 2 adminis 5/20/2009 S+O;WALKIN;CC swelling and redn 5/20/2009 Developed herpes simplex in the ey 5/20/2009 Despite have no known allergies (es 5/20/2009 DEVELOPED HIGH-PITCHED SCR 5/20/2009 Seizure requiring 2 doses of IV med 5/19/2009 At 1150 injection administered. Imm 5/20/2009 Left deltoid swollen, hard, hot & red 5/20/2009 Fever, chills, muscle aches. 5/18/2009 None Stated 5/19/2009 Rash on face, trunk and extremities 5/20/2009 15-20 minutes after vaccine adminis 5/20/2009 Vomiting- (R) arm- swollen, unable 5/19/2009 Pt felt faint after receiving ADACEL, 5/20/2009 Sleepy, Swollen, Eye lid, decreased 5/20/2009 Husband vaccinated with SPV arou 5/20/2009 L arm 2x2 in erythema edema and p 5/13/2009 1 d post vaccine onset redness @ v 5/20/2009 Cellulitis R upper extremity treated w 5/19/2009 - Febrile illness. - Generalized skin r ### Description: the day after receiving 5/19/2009 29 y/o Hispanic male, PVT, ADSM r 5/21/2009 3.5 cm x 5 cm slightly tender red sw 5/19/2009 None. 5/20/2009 5/1/09 - Vaccine administered - no a 5/20/2009 Right leg red, warm, and swollen cry 5/21/2009 Patient came down with shingles an 5/21/2009 clinet c/o fine red rash on both her a 5/21/2009 Pt developed a rash thought to be S 5/21/2009 5 vaccines were administered to this 5/21/2009 Received HAV and Depo Provera a 5/21/2009 Seen in our office on 5/12/09 for 4 y 5/21/2009 Next day left deltoid to elbow redne 5/21/2009 Subject in pneumococcal vaccine tr 5/21/2009 Subject in pneumococcal vaccine tr 5/21/2009 Received call from Mom 5/21/2009 5/21/2009 Pt developed myocarditis. Symptom 5/21/2009 Administered vaccines at 11:40; pro 5/20/2009 Shingles - Zoster- Appeared on pati 5/21/2009 SICK, RASHES, JOINT PAIN , MUS 5/21/2009 After receiving vaccinations, patient 5/21/2009 Exactly 7 days after receiving Zosta 5/21/2009 Complaint of rash and swollen on b 5/21/2009 Allergic reaction - itching - immediat 5/21/2009 Patient came in on 8/12/08 for Gard 5/21/2009 Patient returned to clinic two days p 5/14/2009 Notified Provider pt seen in ER 5/13 5/21/2009 Patient stated she had localized sw 5/21/2009 5/21/09 Fever 101.8, eating ok, not
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5/21/2009 CA 5/21/2009 CO 5/21/2009 MA 5/21/2009 TX 5/21/2009 CA 5/21/2009 TX 5/21/2009 IN 5/21/2009 DE 5/21/2009 IN 5/21/2009 AR 5/21/2009 MA 5/21/2009 VT 5/21/2009 VA 5/21/2009 GA 5/21/2009 DE 5/21/2009 5/21/2009 WV 5/21/2009 5/21/2009 IL 5/21/2009 GA 5/21/2009 CA 5/21/2009 NJ 5/21/2009 5/21/2009 OK 5/21/2009 TX 5/21/2009 5/21/2009 IL 5/21/2009 WI 5/21/2009 PA 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 CA 5/21/2009 CA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 LA 5/21/2009 WI 5/21/2009 OH 5/21/2009 5/21/2009 MA 5/21/2009
31 1.3 25 16 4 37 16 19 16 16 9 70 19 9 22 65 0.5 81 2 16 4 0.2 20 38 35 34 22 16 14 11 9 1.1 1.6 11
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5/21/2009 HAVRIX given at about 12:30pm. B 5/21/2009 Erythema multiforme 4 days after ad 5/20/2009 Arm pain and tenderness with local 5/21/2009 Urticaria, rash, hives around injectio 5/20/2009 (Rt) deltoid (+) erythema and edem 5/21/2009 Err:508 5/19/2009 The patient fainted immediately (30 5/15/2009 3rd GARDASIL injected into left del 5/19/2009 The patient turned pale, felt tingling 5/21/2009 Right arm is red, swollen, tingling fe 5/21/2009 4 inch diameter erythema/induration 5/13/2009 Local pain (L) deltoid area began pr 5/20/2009 HPV vaccine number 1 given . Sync 5/21/2009 Whelp left upper arm-hot to touch- V Patient called 2 1/2 hours after shot 5/11/2009 I received a PNEUMOVAX shot on 5/21/2009 Starring spells X 5 lasting approx 3 5/19/2009 Patient given varivax 5/8/9. On 5/14 5/14/2009 Vaccine given Approx 6pm on 5/12/ 5/21/2009 Mom called our office on 5-21-09 to 5/21/2009 Redness and induration (R) thigh. 5/21/2009 ROTATEQ oral vaccine administere 5/14/2009 Information has been received from 5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received throu 5/15/2009 Information has been received throu 5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 NY 5/21/2009 IN 5/21/2009 CT 5/21/2009 AZ 5/21/2009 OH 5/21/2009 NC 5/21/2009 VA 5/21/2009 5/21/2009 NC 5/21/2009 TX 5/21/2009 MN 5/21/2009 5/21/2009 5/21/2009 CT 5/21/2009 CA 5/21/2009 MA 5/21/2009 TX 5/21/2009 IA 5/21/2009 TX 5/21/2009 WA 5/21/2009 MD 5/21/2009 5/21/2009 MD 5/21/2009 LA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 CA 5/21/2009 NJ 5/21/2009 TX 5/21/2009 5/21/2009 TX 5/21/2009 IL 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 IL 5/21/2009 MO 5/21/2009 MO
1 1 1 45 1.1 5 1 3
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5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 5/21/2009 IN 5/21/2009 KY 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 ND 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 IL 5/21/2009 NJ 5/21/2009 5/21/2009 TX 5/21/2009 TX 5/21/2009 IL 5/21/2009 WA 5/21/2009 ID 5/21/2009 5/21/2009 OH 5/21/2009 MA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 NY 5/21/2009 PA 5/21/2009 MA 5/21/2009 MA 5/21/2009 IN 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 ID 5/21/2009 ME 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 MI 5/21/2009 5/21/2009 GA 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 NJ 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 CA
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5/21/2009 CA 5/21/2009 5/21/2009 NJ 5/21/2009 MI 5/21/2009 CA 5/21/2009 MN 5/21/2009 WI 5/21/2009 TX 5/21/2009 5/21/2009 MA 5/21/2009 MA 5/21/2009 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 ME 5/21/2009 MA 5/21/2009 5/21/2009 NY 5/21/2009 FL 5/21/2009 MI 5/21/2009 FL 5/21/2009 TX 5/21/2009 IN 5/21/2009 FL 5/21/2009 5/21/2009 VA 5/21/2009 VA 5/21/2009 5/21/2009 WA 5/21/2009 CT 5/21/2009 NY 5/21/2009 5/21/2009 WI 5/21/2009 NY 5/21/2009 NY 5/21/2009 NY 5/21/2009 5/21/2009 AL 5/21/2009 AL 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 TX 5/21/2009 CA 5/21/2009 AL 5/21/2009 AL
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5/21/2009 AL 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 NJ 5/21/2009 PA 5/21/2009 TX 5/21/2009 5/21/2009 PA 5/21/2009 OR 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 OH 5/21/2009 PA 5/21/2009 KY 5/21/2009 KY 5/21/2009 VA 5/21/2009 NY 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 SC 5/21/2009 NC 5/21/2009 MI 5/21/2009 5/21/2009 NY 5/21/2009 MO 5/21/2009 MI 5/21/2009 MA 5/21/2009 5/21/2009 AR 5/21/2009 5/21/2009 MA 5/21/2009 MI 5/21/2009 MA 5/21/2009 OR 5/21/2009 IN 5/21/2009 5/21/2009 5/21/2009 CO 5/21/2009 5/21/2009 TX 5/21/2009 CA 5/21/2009 TX 5/21/2009 PA 5/21/2009
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5/21/2009 PA 5/21/2009 FL 5/21/2009 AZ 5/21/2009 TX 5/21/2009 TX 5/21/2009 VA 5/21/2009 TX 5/21/2009 IA 5/21/2009 NJ 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 VA 5/21/2009 AZ 5/21/2009 5/21/2009 FL 5/21/2009 NJ 5/21/2009 GA 5/21/2009 PA 5/21/2009 MA 5/21/2009 NE 5/21/2009 TX 5/21/2009 FL 5/21/2009 AZ 5/21/2009 IN 5/21/2009 AZ 5/21/2009 NJ 5/21/2009 MA 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 5/21/2009 FL 5/21/2009 IN
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5/21/2009 IN 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 LA 5/21/2009 TX 5/21/2009 5/21/2009 TX 5/21/2009 MA 5/21/2009 KY 5/21/2009 LA 5/21/2009 LA 5/21/2009 CA 5/21/2009 CT 5/21/2009 MI 5/21/2009 OH 5/21/2009 NY 5/21/2009 NY 5/21/2009 VA 5/21/2009 NY 5/21/2009 FL 5/21/2009 AZ 5/21/2009 MI 5/21/2009 IL 5/21/2009 FL 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 CA 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 CA 5/21/2009 PA 5/21/2009 CA 5/21/2009 NY 5/21/2009 5/21/2009 CA
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5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 NJ 5/21/2009 OH 5/21/2009 GA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 TX 5/21/2009 NJ 5/21/2009 LA 5/21/2009 5/21/2009 OH 5/21/2009 OR 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 NY 5/21/2009 5/21/2009 NJ 5/21/2009 IN 5/21/2009 WA 5/21/2009 5/21/2009 NE 5/21/2009 OH 5/21/2009 MA 5/21/2009 CA 5/21/2009 CA 5/21/2009 CO 5/21/2009 TX 5/21/2009 TX 5/21/2009 CO 5/21/2009 TX 5/21/2009 5/21/2009 CO 5/21/2009 CO 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 AZ 5/21/2009
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5/21/2009 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 KS 5/21/2009 KY 5/21/2009 WI 5/21/2009 VA 5/21/2009 5/21/2009 IL 5/21/2009 VA 5/21/2009 CA 5/21/2009 PA 5/21/2009 FL 5/21/2009 PA 5/21/2009 PA 5/21/2009 WA 5/21/2009 PA 5/21/2009 NJ 5/21/2009 PA 5/21/2009 CA 5/21/2009 PA 5/21/2009 VI 5/21/2009 TX 5/21/2009 NY 5/21/2009 5/21/2009 NY 5/21/2009 PA 5/21/2009 MN 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 TX 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 SD 5/21/2009 ME 5/21/2009 5/21/2009 MA 5/21/2009 CA 5/21/2009 5/21/2009 KY 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 OH
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5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Initial information has been received 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received form 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has
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5/21/2009 5/21/2009 KS 5/21/2009 MI 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 LA 5/21/2009 OH 5/21/2009 NY 5/21/2009 OH 5/21/2009 MI 5/21/2009 IL 5/21/2009 LA 5/21/2009 LA 5/21/2009 NJ 5/21/2009 CA 5/21/2009 MA 5/21/2009 5/21/2009 ME 5/21/2009 OH 5/21/2009 OR 5/21/2009 5/21/2009 IN 5/21/2009 CT 5/21/2009 5/21/2009 CA 5/21/2009 AZ 5/21/2009 OH 5/21/2009 5/21/2009 NC 5/21/2009 5/21/2009 LA 5/21/2009 5/21/2009 KY 5/21/2009 LA 5/21/2009 CA 5/21/2009 CA 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 5/21/2009 GA 5/21/2009 OH 5/21/2009 GA 5/21/2009 OH 5/21/2009 GA 5/21/2009 GA
7 68 11 20 47 24 6 1
68 20
1 7 4 60 10 1.1 1.3 29 2 5 1.1 0.2 5 5 1.6 75 5 10 28 8
4
29 5 1 0 5 1 75 5 28
2.5 1.3 5 10 1.3 11 7 48 1.3 6 29 4 1 4 7 4 4
5 10
1 6
7
M M F F F F M M M F M M M U U F F F F M 0.1 M M 0.2 U M M 0.6 M F M U F U U F F U M F U M U F M 0.3 M F F F U M F U M
5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received via li 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347807 347808 347809 347810 347811 347812 347813 347814 347815 347816 347817 347819 347820 347821 347822 347823 347824 347825 347826 347827 347828 347829 347830 347831 347832 347833 347834 347835 347836 347837 347838 347839 347840 347841 347842 347843 347844 347845 347846 347847 347848 347849 347850 347851 347852 347853 347854 347855 347856 347857 347858
5/21/2009 5/21/2009 CA 5/21/2009 FL 5/21/2009 KY 5/21/2009 5/21/2009 VA 5/21/2009 NY 5/21/2009 PA 5/21/2009 NY 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 MD 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 NJ 5/21/2009 5/21/2009 MD 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 CT 5/21/2009 FL 5/21/2009 GA 5/21/2009 CA 5/21/2009 AR 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 NH 5/21/2009 KY 5/21/2009 TX 5/21/2009 OH 5/21/2009 FL 5/21/2009 MN 5/21/2009 OH 5/21/2009 MO 5/21/2009 CA 5/21/2009 PA 5/21/2009 MI 5/21/2009 IN 5/21/2009 TX 5/21/2009 VA 5/21/2009 5/21/2009 5/21/2009 TX 5/21/2009 5/21/2009 PA 5/21/2009 MT 5/21/2009 VA
20 14 1.3 8 2 13 21 1.1 67 8 12 1
20 14
21 67
1
1.5 4 1 1 30 18 10 1 7 82 4
1 4 0 0 30 18 10
1
1
25 1.2 9 8 70 85 8 1 45 13 8 1 1 12 68 69 12 9 12
7 82 4
9
85 1
13 8 1 1 12
69
12
F M F M U M M F M F M M 0F U 0.5 F M 1M 1F F F F F F F F U U 0F F F M F M F M F 0M U M F F 0M 0F M F U F F U M M
5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2008 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 This report was identified from a line 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347859 347860 347861 347862 347863 347864 347865 347866 347867 347868 347869 347870 347871 347872 347873 347874 347875 347876 347877 347878 347879 347880 347881 347882 347883 347884 347885 347886 347887 347888 347889 347890 347891 347892 347893 347894 347895 347896 347897 347898 347902 347903 347904 347905 347906 347907 347908 347909 347910 347911 347912
5/21/2009 PA 5/21/2009 KS 5/21/2009 PA 5/21/2009 5/21/2009 PA 5/21/2009 TX 5/21/2009 5/21/2009 KY 5/21/2009 NY 5/21/2009 OK 5/21/2009 VA 5/21/2009 CT 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 NY 5/21/2009 PA 5/21/2009 MA 5/21/2009 PA 5/21/2009 IN 5/21/2009 DE 5/21/2009 MO 5/21/2009 IL 5/21/2009 OH 5/21/2009 MO 5/21/2009 MO 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 FL 5/21/2009 PA 5/21/2009 5/21/2009 CA 5/21/2009 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 VA 5/21/2009 VA 5/21/2009 VA 5/21/2009 NC 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 MA 5/21/2009 NY 5/21/2009
19
19
8 3 15
3 15
11
11
12 12 12 12 6 1.8
1
7
7
8 10 10 11 1.2 1.2 11 1.5 9 8 2 58
8 10 10 11 1 1 1
2 58
5 14 40 3 10 1 11 46 63
14 40 3 10 0 11
17
17
4
U F U U U F M F F M F U F F F F F M 0.8 M U M U U M M M M 0.2 M 0.2 M F 0.5 M M M 0F M U F U F F M M 1M M F U M M F U M
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received for a 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received heal 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347930 347931 347932 347933 347934 347935 347937 347940 347942 347943 347944 347945 347946 347948 347961 347963 347965 347966 347967 347968 347969 347970 347971 347972 347973 347974 347975 347976 347977 347978 347979 347980 347981 347982 347983 347984 347985 347986 347987 347988 347989 347990 347991 347992 347993 347994 347995 347996 347997 347998 347999
5/21/2009 MI 5/21/2009 FL 5/21/2009 5/21/2009 TX 5/21/2009 CA 5/21/2009 5/21/2009 KY 5/21/2009 WI 5/21/2009 NY 5/21/2009 AZ 5/21/2009 VA 5/21/2009 CA 5/21/2009 5/21/2009 WI 5/21/2009 PA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 PA 5/21/2009 CA 5/21/2009 IL 5/21/2009 PA 5/21/2009 IL 5/21/2009 OH 5/21/2009 FL 5/21/2009 NY 5/21/2009 5/21/2009 CO 5/21/2009 5/21/2009 OH 5/21/2009 NY 5/21/2009 FL 5/21/2009 VA 5/21/2009 TX 5/21/2009 PA 5/21/2009 PA 5/21/2009 MA 5/21/2009 MA 5/21/2009 MA 5/21/2009 IN 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 TX 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 TX 5/21/2009 PA
4 12 65
60 4 73 24
4 73
1 6 77 20 25 6 1
25 1
4 8
4 8
11 63 5 4 1.3
11 63 5 4 1
1 10 8 1 14 1 13 12
0
1 14 1 13 12
1
1
12 9
9
8 3 10 1.5 7 1.3
8 3
7 1
M F U U M M F F F F F U F M F F M 0F U F F U F F M F 0.3 F F 1F M F 0F F 0M F F U 0F U F M M F U F M M F M M 0.3 F
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348000 348001 348002 348003 348004 348005 348006 348007 348008 348009 348010 348011 348012 348013 348014 348015 348016 348017 348018 348019 348020 348021 348022 348023 348024 348025 348026 348027 348028 348029 348030 348031 348032 348033 348034 348035 348037 348038 348039 348040 348041 348042 348043 348044 348045 348046 348047 348048 348049 348050 348051
5/21/2009 OH 5/21/2009 TX 5/21/2009 5/21/2009 MA 5/21/2009 MD 5/21/2009 5/21/2009 IA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 WA 5/21/2009 FL 5/21/2009 PA 5/21/2009 MI 5/21/2009 WA 5/21/2009 5/21/2009 OH 5/21/2009 MA 5/21/2009 5/21/2009 TN 5/21/2009 OH 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 PA 5/21/2009 NY 5/21/2009 AZ 5/21/2009 MA 5/21/2009 CA 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 MA 5/21/2009 NC 5/21/2009 5/21/2009 LA 5/21/2009 MA 5/21/2009 NE 5/21/2009 TX 5/21/2009 AZ 5/21/2009 5/21/2009 VA 5/21/2009 KY 5/21/2009 FL 5/21/2009 PA 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 SC 5/21/2009 AZ
56 7 1.1
7 1
70 11 17 10 10 7
10 10 7
4 81 12 12 3 7 4 1 14 1.2 1.1 14 9 1 1.5 4 16 42 2 12 10 1.5 5 7 1 1.3 1 33
81 12
1 14 1 1
9 1 1 4
2
10 5 7 1 1 1
75 1 11
75 1 11
1 11 1
1 11 1
F F 0.1 M U F M F F M M U M F M F F M M 0F F U 0.2 F 0.1 M U M F 0M 0.5 M F M F U 0M U M F F M F 0F 0.3 M 0M F F M 0M M U 0M M 0M
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2008 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
348052 348053 348054 348055 348056 348057 348058 348059 348060 348061 348062 348063 348064 348065 348066 348067 348068 348069 348070 348071 348072 348073 348075 348076 348077 348078 348079 348080 348081 348082 348084 348085 348086 348087 348088 348089 348090 348091 348092 348094 348095 348098 348100 348101 348103 348104 348106 348107 348109 348112 348114
5/21/2009 AZ 5/21/2009 AZ 5/21/2009 SC 5/21/2009 AZ 5/21/2009 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 NH 5/21/2009 VA 5/21/2009 5/21/2009 5/21/2009 AZ 5/21/2009 VA 5/21/2009 FL 5/21/2009 MD 5/21/2009 PA 5/21/2009 CA 5/21/2009 PA 5/21/2009 NY 5/21/2009 CA 5/21/2009 MA 5/21/2009 CO 5/21/2009 MA 5/21/2009 KY 5/21/2009 PA 5/21/2009 5/21/2009 ID 5/21/2009 MI 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 GA 5/21/2009 5/21/2009 NJ 5/21/2009 NJ 5/21/2009 OH 5/21/2009 MS 5/21/2009 NY 5/21/2009 5/21/2009 TX 5/21/2009 PA 5/21/2009 TX 5/21/2009 TX 5/21/2009 KS 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 LA 5/21/2009 5/21/2009 5/21/2009 IN
1.3 1 9 1 5 1.2 6 1 18 4 1 1.3 11
1 1 9 1 5 1 6 1
1 11
8
8
7 5 4 5 1.1 1 1.3 57 77 8 1.5 1 2.5 7 12 13
7 5 4 5 1 1 57 8 1 7 12 13
1.1 7 1 14
1 7 1 14
11 4 4 5
11 4 4 5 4
9 52 9 2
52 9 2
0.3 M 0F F 0F M 0.2 F M 0F F M U 0.3 F F M F M F F F F M 0.1 M 0M U F M F F 0M M M F M M 0.1 M F 0F F F U M M M F M U M U F U 0.1 F
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received conc 5/15/2009 Initial information has been received 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received form 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information haws been received fro 5/15/2009 Information has been received from
348117 348125 348126 348127 348131 348132 348133 348134 348205 346932 346934 346938 346942 346944 346946 346949 346952 346955 346956 346960 346961 346964 346965 346966 346967 346969 346971 346973 346974 346975 346976 346977 346978 346991 346992 346993 346994 346995 346996 346997 346998 346999 347000 347001 347002 347003 347004 347005 347006 347007 347008
5/21/2009 TX 5/21/2009 FL 5/21/2009 CA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 PA 5/22/2009 NJ 5/22/2009 MA 5/22/2009 MS 5/22/2009 PA 5/22/2009 CO 5/22/2009 KY 5/22/2009 TX 5/22/2009 GA 5/22/2009 MN 5/22/2009 5/22/2009 TX 5/22/2009 NY 5/22/2009 5/22/2009 5/22/2009 MA 5/22/2009 5/22/2009 NE 5/22/2009 NY 5/22/2009 CA 5/22/2009 NJ 5/22/2009 MO 5/22/2009 AL 5/22/2009 KS 5/22/2009 WI 5/22/2009 MI 5/22/2009 GA 5/22/2009 SD 5/22/2009 OH 5/22/2009 KS 5/22/2009 ID 5/22/2009 MD 5/22/2009 TX 5/22/2009 NJ 5/22/2009 KS 5/22/2009 OH 5/22/2009 IN 5/22/2009 TX 5/22/2009 CA 5/22/2009 HI 5/22/2009 NH 5/22/2009 OK 5/22/2009 SD
4 9 60 1.5 11 1.1 60 29 10 1.2 1.1 66 4 0.6 32 39 0.3 22 21 13 70 19 0.2 1.3 1.5 66 65 10 59 18 36 23 1.6 5 5 0.8 27 20 15 47 10 18 54 25 25 22 1 1
4 9 1 1 28 10 1 1 66 4 0 32 39 22 26 21
70 0 1 66 65 10 18 36 23 1 4 5 0 27 20 15 47 10 18 53 25 25 22 1 1
M M U 0.5 M F 0.1 M U M M F 0.2 F 0.1 F F F 0.6 F M F F F M F F F F F 0.2 M M 0.4 M F F M F M F F 0.4 F F F 0.8 F F F F M F F M F F F 0F 0.1 M
5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/26/2009 Pt. stated he had vaccine on May 2 5/15/2009 Information has been received from 5/18/2009 Vaccine Adm. 3/18/09 for 6 mos. w 5/19/2009 Mom called starting 5/18 that Pt has 5/15/2009 Pt started breaking out into rash on 5/18/2009 Fever blisters breaking out/popping 5/9/2009 Immediate hypersensitivity reaction 5/6/2009 Patient broke out in a rash after RO 5/14/2009 Alvarado stated - that after thigh vac 5/18/2009 Swelling of arm, redness, severe pa 5/18/2009 Red papular rash appeared on foreh 5/21/2009 Information has been received from None stated. 5/21/2009 Information has been received from 5/20/2009 Information has been received from 5/20/2009 Information has been received from 5/19/2009 Apparent vaccine failure. Pt present 5/20/2009 Information has been received from 5/19/2009 Patient had irregular breathing with 5/18/2009 Red mark to R thigh, area hard, red 5/21/2009 Information has been received from 5/21/2009 Information has been received from 5/21/2009 Information has been received from 5/18/2009 24 hours after vaccine redness & sw 5/21/2009 Information has been received from 4/25/2009 -Develop fever of 102 degrees F ora 5/22/2009 4x2.5" area of severe swelling aroun 5/22/2009 As medication was being injected, b 5/22/2009 A 5th Pneumococcal vaccination wa 5/22/2009 Local reaction with arm swelling 5/22/2009 Clinic observation: slight diffuse indu 5/22/2009 Pentacel administered in Right delto 5/22/2009 Pt c/o pain in left arm after receiving 5/22/2009 CLIENT RECEIVED VACCINE ON 5/22/2009 Immediately after administering the 5/22/2009 Patient started having reaction to va 5/22/2009 Family called in on very hectic day w 5/22/2009 Patient complained of dizziness, na 5/22/2009 altered mental status per MD 5/22/2009 Headache and worsening myalgias 5/22/2009 ~2 days after receiving smallpox an 5/22/2009 Pt was given Pneumovax on 5/11/0 5/22/2009 fever, vomiting, eyes rolling to back 5/22/2009 Presented to cinic with herpes zoste
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5/22/2009 WV 5/22/2009 CO 5/22/2009 MA 5/22/2009 CA 5/22/2009 CA 5/22/2009 OR 5/22/2009 HI 5/22/2009 GA 5/22/2009 PA 5/22/2009 TX 5/22/2009 WI 5/22/2009 IL 5/22/2009 CA 5/22/2009 CA 5/22/2009 CA 5/22/2009 PA 5/22/2009 AZ 5/22/2009 NJ 5/22/2009 NC 5/22/2009 TX 5/22/2009 IL 5/22/2009 KS 5/22/2009 AR 5/22/2009 MA 5/22/2009 OH 5/22/2009 MS 5/22/2009 VA 5/22/2009 TX 5/22/2009 NJ 5/22/2009 TX 5/22/2009 TX 5/22/2009 AR 5/22/2009 NM 5/22/2009 NM 5/22/2009 NC 5/22/2009 PA 5/23/2009 AZ 5/24/2009 CA 5/24/2009 CA 5/24/2009 MD 5/25/2009 5/25/2009 CA 5/26/2009 NY 5/26/2009 CA 5/26/2009 FL 5/26/2009 UT 5/26/2009 5/26/2009 5/26/2009 CA 5/26/2009 NC 5/26/2009 PA
47 11 5 1.5 0.5 65 77 0.2 67 0.4 62 11 0.5 13 52 79 5 1.3 4 1.8 3 1.5 0.2 9 14 23 5 8 4 40 16 10 5 5 49 67 0.3 45 4 43 20 66 25 15 42 4 1.1 2 10 4 1.2
47 11 5 1 0 65 76 0 67 0 62 11 0 13 52 79 5 1 4 1 3 1 0 9 14 23 5 8 4 40 16 10 5 5 49 67 0 45 43 20 66 25 15 4
10 4 1
M M U 0.5 M 0.5 M F M 0.2 F M 0.4 M M F 0.5 M M F F F 0.3 M M 0.8 F M 0.5 M 0.2 F F M F M F M M F F M F F F 0.3 F F F M M F M M F F M M F M 0.2 F
5/22/2009 Rash at injection site and on the ba 5/22/2009 patient sitting in chair for injection. a 5/22/2009 Shortly after DTAP vaccine his left u 5/22/2009 After receiving Varicella vaccine on 5/22/2009 Pt received Rotavirus vaccine on 4/ 5/22/2009 Patient developed three lesions at 2 5/22/2009 Pt. developed gradually worsening m 5/22/2009 Baby was brought in today by her m 5/21/2009 Severe local swelling and tendernes 5/24/2009 Patient had soft node to R/L anterio 5/24/2009 Developed shingles on forehead - re 5/23/2009 (R) Posterior arm - 1 area maculopa 5/22/2009 Started with fever - 103 - last night + 5/22/2009 Pt felt dizzy about 2-3 minutes after 5/22/2009 Painful upper (L) arm: Pain radiates 5/22/2009 Patient developed firey red rash on 5/22/2009 Day after injection (L) arm was swol Temp 103 degree 6 days later - Chr 5/22/2009 New onset rash on anterior R thigh, 5/24/2009 Pt was administered a TD vaccine w 5/22/2009 DTAP/IPV combination given into L 5/22/2009 Patient in office for well child visit. G 5/20/2009 Per CoronerY mom was in bed with b 5/27/2009 6 - 7 cm oval red, raised area at site 5/22/2009 Fever to 104 F and whole upper arm 5/21/2009 Initial VAERS filed Feb 2003. This 3 4/29/2009 6 X 5 cm urticarial plaque on left lat Shot given on 5-20-09 Pt came bac 5/22/2009 5/21/09 Swollen, reddened, tender a 5/22/2009 None stated 5/21/2009 Received vacc. approx 1500 5/20/0 5/24/2009 Redness and swelling to left arm ap 5/20/2009 Left deltoid, warm to touch, red, ext 5/20/2009 Left deltoid, slight swelling, light red 5/21/2009 Left arm red, swollen at sight of inje 5/21/2009 5cm x 3cm erythematous indurated 5/23/2009 high pitched crying for at almost 12 5/24/2009 I lost about a cubic inch of muscle, b 5/24/2009 Extreme swelling at injection site, si 5/24/2009 103 fever, tachycardia, myalgias, se 5/25/2009 PT PRESENTED WITH COMPLAIN 5/25/2009 red inflammed area 8 inches by 3 1 5/26/2009 Severe muscle pain in shoulder whe 5/26/2009 Day 2 (May 23rd) after vaccination o 5/22/2009 This case was reported by a physici 5/21/2009 Kawasaki's syndrome. Received IVI 5/22/2009 Information has been received from 5/22/2009 Information has been received from 5/20/2009 Was given SANOFI PASTEUR'S TD 5/20/2009 Huge area of erythema 5" x 5", left u 5/15/2009 5/15 presents with maculopapular p
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5/26/2009 MT 5/26/2009 OR 5/26/2009 LA 5/26/2009 NM 5/26/2009 NJ 5/26/2009 MI 5/26/2009 VA 5/26/2009 AL 5/26/2009 TN 5/26/2009 MI 5/26/2009 PA 5/26/2009 CA 5/26/2009 GA 5/26/2009 MD 5/26/2009 TX 5/26/2009 OH 5/26/2009 FL 5/26/2009 WI 5/26/2009 CA 5/26/2009 PA 5/26/2009 KS 5/26/2009 SC 5/26/2009 IL 5/26/2009 IN 5/26/2009 PR 5/26/2009 GA 5/26/2009 NY 5/26/2009 TN 5/26/2009 MD 5/26/2009 CO 5/26/2009 GA 5/26/2009 TX 5/26/2009 CA 5/26/2009 CA 5/26/2009 WA 5/26/2009 HI 5/26/2009 CA 5/27/2009 WA 5/27/2009 GA 5/27/2009 GA 5/27/2009 OR 5/27/2009 NY 5/27/2009 NH 5/27/2009 CA 5/27/2009 CA 5/27/2009 NE 5/27/2009 TX 5/27/2009 CA 5/27/2009 TX 5/27/2009 NC 5/27/2009 TX
1 1.1 0.2 12 63 48 16 22 1.3 62 10 1 1.3 25 26 14 2 1.6 1.1 4 15 14 59 18 0.3 19 45 1.2 0.2 0.2 1 10 0.2 4 62 1
1 1 0 12 63 48 16 22 1 62 10 1 1 25 26 14 2 1
0.3 19 0.2 45 0.2 50 48 0.3 5 14 4 13 11 16
0 19 0 45
4 15 14 59 18 0 19 45 1 0 0 1 10 0 4 62 1
50 48 0 5 14 4 13 11 16
0M 0.1 M 0.2 F F F F F M 0.3 F F M 0M 0.3 M F F F 0F 0.6 F F M F M F F 0.3 M F F 0.2 F 0.2 M 0.2 M 0M F 0.2 M M F 0M F 0.4 M M 0.2 M F M M F 0.3 M M M F M M F
5/21/2009 5/13/09 Per nurse child was seen to 5/13/2009 One hour after receiving vaccines, p 5/19/2009 Localized reaction to PENTACEL va 5/18/2009 Adolescent received vaccines on 3/ ### Initial non-serious case received fro 5/20/2009 Vaccine given 5/8/09. Fever to 101. 5/20/2009 Sleepy, Swollen eyelid, decreased a 5/21/2009 Patient Rt arm with redness from sh 5/13/2009 Immediately after vaccine administr 5/22/2009 Information has been received from 5/21/2009 Severe local reaction 4 X 5 cm Eryth 5/22/2009 While nursing began to scratch ears 5/26/2009 Seizure/fever. 5/26/2009 24 hours after receiving GARDASIL 5/21/2009 None 5/22/2009 Mom called @12:30 am 5/22/2009 s 5/26/2009 None noted.Y Pt was not seen in our 5/19/2009 Patient with fever, irritability and cry 5/12/2009 T 101 about 12 hours after vaccinat 5/26/2009 Parent noticed increased redness + 5/26/2009 On 5/7/09 patient reports almost im 5/26/2009 Several weeks (end of November) a 5/26/2009 Three days following administration 5/26/2009 tingling of lips and tongue 30 min af 5/26/2009 MOTHER REFERS THAT THE NEX 5/26/2009 THE PT FAINTED AT A RESTURA 5/26/2009 Lesions on chest, back, and arms p 5/26/2009 Patient was healthy at the time she 5/26/2009 Fever 5/26/2009 Necrotizing enterocolitis, symptoms 5/26/2009 blanching macules on trunk, extrem 5/26/2009 Patient developed mucosal wart ins 5/26/2009 Pt was taken to facility on 5/21. Re 5/26/2009 After receiving last vaccine MMR no 5/26/2009 Pt reported a swollen arm that subs 5/21/2009 5/21/09 developed chickenpox rash 5/26/2009 11 days after MMR, developed itch 5/27/2009 Approximately five hours after the v 5/27/2009 memory loss, achy muscles and join 5/18/2009 5/5/09 Pt was Y brought into ED by EM None stated. 9/9/09 Rheumatology 5/19/2009 Fever to 103; diarrhea; lethargy; de 5/21/2009 Weakness and pain in arm. No feve 5/19/2009 4-5 inch swelling with hard middle, i 5/14/2009 8-4-08, received PEDIARIX, HIB an 5/21/2009 L upper deltoid with 100 cm of eryth 5/22/2009 Initial report received on 13 May 20 5/20/2009 woke up and left deltoid dark red, pu 5/22/2009 Initial report received on 13 May 20 5/20/2009 Red swollen area on deltoid of right 5/22/2009 Initial report received on 13 May 20
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5/27/2009 MN 5/27/2009 IN 5/27/2009 IL 5/27/2009 IL 5/27/2009 5/27/2009 CO 5/27/2009 5/27/2009 MA 5/27/2009 IL 5/27/2009 WI 5/27/2009 AK 5/27/2009 CO 5/27/2009 IN 5/27/2009 NC 5/27/2009 AR 5/27/2009 IN 5/27/2009 WA 5/27/2009 MD 5/27/2009 LA 5/27/2009 IL 5/27/2009 CO 5/27/2009 NC 5/27/2009 CA 5/27/2009 FL 5/27/2009 CA 5/27/2009 IN 5/27/2009 IN 5/27/2009 PA 5/27/2009 NC 5/27/2009 NC 5/27/2009 NM 5/27/2009 TN 5/27/2009 CA 5/27/2009 GA 5/27/2009 MA 5/27/2009 TN 5/27/2009 TX 5/27/2009 WI 5/27/2009 NH 5/27/2009 5/27/2009 MA 5/27/2009 MD 5/27/2009 TX 5/27/2009 MA 5/27/2009 CA 5/27/2009 TX 5/27/2009 5/27/2009 CA 5/27/2009 TX 5/27/2009 FL 5/27/2009 OR
18 11 25 22
18 11 25 22
0.5 24 46 10 5 60 5 37 13 0.3 1.1 1.4 4 36 44 26 42 65 65 7 1.3 1.4 5
0 24 46 10 5 60 5 37 13 0 1 1 4 36
20 0.2 53 49 0.6 16 26 0.2 44 5 20 21 23 35 79 5 1 24 42 66 58 7
20 0 53
26 42 65 65 7 1 1 5
0 17 26 0 44 5 20 21 23 44 79 5 1 42 66 58 7
F M M F U 0.5 F F M F M F M F M 0.3 M 0.1 M 0.4 M M F M M F M F F 0.3 F 0.4 F M F M 0F F F 0.6 F F F 0.2 F F M F F M F F M 0M M F M F M
5/18/2009 After vaccine given, pt complained o 5/20/2009 Large area of erythema and swellin 5/20/2009 C/o tightness in chest & throat 20 m 5/28/2009 C/o swelling of throat after receiving None stated. 5/12/2009 Had generalized tonic - clonic seizu Patient was administered SMALLPO 5/19/2009 Patient reports redness at injection 4/1/2009 With erythema and swelling on Rt d 5/19/2009 5/15 TC from mom reporting child d 5/18/2009 Pt fainted 10 min. after leaving phar 5/18/2009 Local reaction - pain, erythema star 5/19/2009 Joint pain and exhaustion started 1s 5/12/2009 5/12/09 PC received from guardian 5/18/2009 This patient was accidently given HP 5/18/2009 Pt. developed 2 cm erythema at loc 5/19/2009 1 red spot on belly 5-17-09 in AM, 1 5/21/2009 Swelling with redness, itchiness ove 5/4/2009 Please see attached encounter 5/18/2009 NONE 5/4/2009 ~ 7-10 vesicles at site of injection of 5/27/2009 None stated 5/19/2009 Pt developed diffuse Myalgias appro 5/20/2009 3 areas (small) of red flat rash in up 5/18/2009 Pustule at VZV injection site on 5/12 5/20/2009 Local reaction on left and right ante 5/20/2009 Mother called the office at 230 PM o 5/20/2009 Varicella vaccine breakthrough. Had 5/19/2009 None stated. 5/19/2009 None stated. 5/27/2009 prevnar was given twice, no adverse 5/27/2009 Patient reports a gradual onset of e 5/27/2009 Severe Hair loss (alopecia) around 5/27/2009 Presented via EMS to Emergency D 5/27/2009 Patient received the Typhoid Vaccin 5/27/2009 I have random twitches and involun 5/27/2009 local reaction red, hot and swollen a 5/27/2009 Pt experiencing flu like symptoms w 5/27/2009 Six days after vaccine administratio 5/27/2009 10July08-First Anthrax vaccination 5/27/2009 Three days after experienced fever 5/27/2009 tightness in chest, shortness of brea 5/27/2009 HAS HX OF GRAVES DISEASE SI 5/27/2009 Received ZOSTAVAX 4/16/09. Dev 5/22/2009 ZOSTAVAX given to 5 year old with 5/27/2009 Fever, Tmax 103.8. Multiple tonic / 5/27/2009 Client seen at ED on 5/11/09 for c/o 5/27/2009 Info reported to our clinic by patient 5/27/2009 48 hours after vaccine administratio 5/27/2009 Called on 5/25 to report severe mus 5/27/2009 Generalized varicella-like rash, grea
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5/27/2009 WA 5/27/2009 AZ 5/27/2009 CA 5/27/2009 GU 5/27/2009 FL 5/27/2009 WI 5/27/2009 WA 5/27/2009 TX 5/27/2009 NC 5/27/2009 NY 5/27/2009 IL 5/27/2009 IL 5/27/2009 MN 5/27/2009 FL 5/27/2009 AZ 5/27/2009 AZ 5/27/2009 MI 5/28/2009 5/28/2009 UT 5/28/2009 MI 5/28/2009 5/28/2009 5/28/2009 5/28/2009 5/28/2009 5/28/2009 TX 5/28/2009 5/28/2009 VA 5/28/2009 FL 5/28/2009 KY 5/28/2009 SC 5/28/2009 5/28/2009 WA 5/28/2009 5/28/2009 OH 5/28/2009 MA 5/28/2009 SC 5/28/2009 NY 5/28/2009 OH 5/28/2009 CA 5/28/2009 MO 5/28/2009 FL 5/28/2009 ND 5/28/2009 CA 5/28/2009 OR 5/28/2009 LA 5/28/2009 OR 5/28/2009 MN 5/28/2009 OR 5/28/2009 TX 5/28/2009 NY
68 52 28 3 0.6 19 4 1.3 81 1.5 8 5 9 28 5 2 31
68 52 28 3 0 19 4 1 81 1 8 5 9 28 5 2 31
17 22 19 35 2 2 16 62 22 22 11 33 5 1.5 81 7
17 21
55 19 27 4 1.2 0.3 63 12 24 32 4 1.5 50 1 4
35
16 62 22 22 11 33 5 1 81 7 5 55 19 27 4 4 1 0 63 12 23 32 4 50 1 4
U M F F 0.6 M M F 0.3 M F 0.5 F M F M F M 0.5 M F F F F F F M M F F F F F M F 0.5 F F F M M F M F F 0.2 F 0.4 F F F F F F F F 0M F
5/27/2009 Unintentionally gave expired Pneum 5/27/2009 pt left hand and forearm had slight s 5/27/2009 paresthesias of bilateral feet and low 5/27/2009 Fever over 103 F 12 hours later last 5/27/2009 Temperature 101-103 approximatel 5/27/2009 Hep A given- immediately after patie 5/27/2009 Patient developed hives about 22 h 5/13/2009 Patient received DTAP, HIB + HEP 5/27/2009 Patient came to office 5-26-09 + rep 4/24/2009 1st Hep A vaccination 2/20/09 - only 5/27/2009 Patient c/o itching at the site, 5min l 5/21/2009 Rash at injection site right deltoid (1 5/26/2009 No adverse event. Mis administratio 5/27/2009 This case was reported by a healthc 5/22/2009 KINRIX & VARICELLA vaccine give 5/22/2009 DAPTACEL and VARIVAX vaccines 5/26/2009 Rash on arm next day, took BENAD 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/27/2009 Information has been received from 5/27/2009 Information has been received from 5/27/2009 Information has been received from 5/28/2009 Pt passed out 5/28/2009 Urticaria/Hives neck back, abdomen 5/21/2009 L. arm "PPD" testing using ANTHRA 5/27/2009 None. HPV vaccine ordered by phy 5/21/2009 Papular (raised) rash in crops over t 5/22/2009 Reaction at Inj site. Red itchy rash 5/15/2009 erythematous patch over the vaccin 5/28/2009 Would consider this a vaccine failur 5/28/2009 Vaccine was administered to left de 5/28/2009 Quarter-sized area of enduration 25/28/2009 Member had small pox vaccine on 5/28/2009 This should probably be considered 5/28/2009 Low grade fever (not even 100) 5/26 5/28/2009 Mom noticed swelling and redness a 5/28/2009 TELEPHONE CALL FROM MOTHE 5/28/2009 2nd day after receiving TdaP imm., 5/28/2009 Rash, decreased sensation and dec 5/28/2009 patient had rash c/ second injection 5/28/2009 Tingling, numbness, pain, limited RO 5/28/2009 Three vaccines given to pt, Lt leg V 5/28/2009 Rash developed 48 hours after imm 5/28/2009 I received this second HB shot durin 5/28/2009 Mom called stated Pt had started ge 5/28/2009 Patient with reddened raised area a
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5/28/2009 MI 5/28/2009 FL 5/28/2009 SC 5/28/2009 FL 5/28/2009 GA 5/28/2009 5/28/2009 PA 5/28/2009 5/28/2009 NC 5/28/2009 MA 5/28/2009 WA 5/29/2009 CA 5/29/2009 5/29/2009 IL 5/29/2009 MN 5/29/2009 5/29/2009 NY 5/29/2009 KY 5/29/2009 AR 5/29/2009 AR 5/29/2009 NY 5/29/2009 GA 5/29/2009 GA 5/29/2009 GA 5/29/2009 MA 5/29/2009 MA 5/29/2009 PA 5/29/2009 CA 5/29/2009 MD 5/29/2009 TX 5/29/2009 CA 5/29/2009 CA 5/29/2009 OK 5/29/2009 GA 5/29/2009 WI 5/29/2009 WV 5/29/2009 VT 5/29/2009 SC 5/29/2009 GA 5/29/2009 MI 5/29/2009 OK 5/29/2009 HI 5/29/2009 TX 5/29/2009 NV 5/29/2009 TX 5/29/2009 KS 5/29/2009 NJ 5/29/2009 AZ 5/29/2009 PA 5/29/2009 5/29/2009 MA
0.3 1 52 18 4
0 1 52 18 4
1.1 44 1 45 37 53 22 81 0.2
1 44 1 45 37 53 22 81 0
68 4 0.2 0.6 1 11 30 30 10 9 67 56 4 23 56 26 21 0.6 11 4 72 48 76 48 77 18 4 50 5 12 0.4 33 36 11 55
68 4 0 0 1 11 30 30 10 9 67 56 4 23 56 21 0 11 4 72 48 76 48 77 19 4 50 5 12 0 33 36 11 55
0.3 F 0F F F M U 0.1 F M 0M F M F F M 0.2 M F F F 0.2 F 0.6 F 0F F M M F F F M M M F F F 0.6 M F F M F F F F F M M M M 0.4 M F M F M
5/28/2009 Inconsolable crying with head twitch 5/26/2009 Hives on arm, legs + face. 5/27/2009 - Fever body aches, arm pain. Appr 5/22/2009 Patient complained of "high" fever s 5/27/2009 Vomited x 1; eyes and lips became Redness- painful - swelling (L) thigh 5/26/2009 None stated. 5/28/2009 2 days post 1st dose pt noted flashe 5/28/2009 Multiple Vesicles 5/28/2009 Generalized rash developed within 5/28/2009 Deltoid muscle pain and swelling. S 5/29/2009 Patient developed myalgias in the n 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/29/2009 We received from a consumer the fo 5/22/2009 Administered ZOSTAVAX vaccine 5 5/21/2009 5/9/09 went to ED with swelling to ri 4/1/2009 Red, hot, firm area on Rt deltoid app 4/1/2009 Rash on back, abdomen, arms, face 5/24/2009 Chief Complaint (1/1): This 12 mont 5/26/2009 2:10 fainted after vaccination and bu 5/22/2009 Right thorax- rash and pain. Treated 5/22/2009 Rash on right thorax returned after 2 5/26/2009 Received VARIVAX 5-21-09, seen i 5/26/2009 On 5/18/09 given VARIVAX, develo 5/29/2009 Rash at injection site 5/29/2009 Approximate 4 minutes after receivi 5/29/2009 4 inch circular redness with warmth. 5/29/2009 Patient states that he had vaccinatio 5/29/2009 Approximate 2 minutes after receivi 5/29/2009 a few minutes after i got the 1st sho 5/29/2009 tdap booster given approx 10 am on 5/29/2009 TEMP103LN,VOMITING,URI.sYMP 5/29/2009 Woke early AM 5/19/09 with frequen 5/29/2009 5/28, mother called and reported tha 5/29/2009 Pt went to a pharmacy clinic to rece 5/29/2009 1-2-09 Tdap administered R deltoid 5/29/2009 within 24 hrs after vaccination, arm 5/29/2009 Hep B #1 adm. 2:30pm,Fri.22 May 2 5/29/2009 localized reaction distal to injection 5/29/2009 Has fever, generalized body aches 5/29/2009 August 18, 1991. "Hold up four finge 5/29/2009 Pt presented 13 days s/p vaccinatio Vesicular rash on trunk 26 days afte 5/28/2009 Patient received vaccines at 12:00 a 5/29/2009 Pt had been lethargic, decreased ap 5/29/2009 Received MMR and VARIVAX vacc 5/26/2009 Large, red area on arm; Warm to to 5/29/2009 2 days after, redness 2-3 " down arm 5/29/2009 Site reaction. mild edema, tenderne
348185 348189 348192 348194 348195 348196 348197 348198 348199 348200 348201 348202 348203 348206 348207 348208 348209 348210 348211 348212 348213 348214 348215 348216 348164 348165 348166 348167 348168 348169 348218 348219 348220 348221 348222 348223 348224 348225 348226 348232 348234 348235 348238 348239 348240 348241 348242 348244 348245 348247 348254
5/29/2009 WI 5/29/2009 MI 5/29/2009 IN 5/29/2009 5/29/2009 VI 5/29/2009 PA 5/29/2009 TX 5/29/2009 NY 5/29/2009 AK 5/29/2009 CA 5/29/2009 WI 5/29/2009 NY 5/29/2009 OH 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 TX 5/29/2009 5/29/2009 CA 5/29/2009 5/30/2009 NY 5/30/2009 AL 5/30/2009 MN 5/31/2009 NJ 5/31/2009 WA 6/1/2009 6/1/2009 CA 6/1/2009 MD 6/1/2009 GA 6/1/2009 OH 6/1/2009 FL 6/1/2009 OR 6/1/2009 OR 6/1/2009 WA 6/1/2009 LA 6/1/2009 WI 6/1/2009 CA 6/1/2009 MD 6/1/2009 FL 6/1/2009 CA 6/1/2009 NY 6/1/2009 6/1/2009 LA 6/1/2009 6/1/2009 LA 6/1/2009 AR 6/1/2009 WA
31 24 4 56 54 57 4 17 58 19 1.3 0.2 4
31 24 4 56 54 57 4 17 58 19 1 0 4
4
4
4
4
0.4 73 12 4 1.3 19 5 47 4 1 1.5 1.1 51 68 0.5 11 28 70 18 0.5
0 73 12 4 1 19 5 47 4 0 1 1 51 68 0 11 28 70 18 0
43
43
16 4 4
16 4 4
F F M M F M M F F M 0.3 M 0.2 M F U U U U U U U F U M U 0.4 M F F F 0.3 F M M F F 1F 0.5 M 0.1 M F F 0.5 M F F M F 0.5 F F M F F F F F
5/29/2009 2-2 1/2 inch area around injection s 5/19/2009 Patient was given initial dose of Gar 5/29/2009 Redness, swelling, warmth, bruising 5/29/2009 This case was reported via a statem 5/29/2009 Patient came in clinic stating that sh 5/29/2009 Pt called on 5/26/09 c/o feeling nerv 5/29/2009 Blotchy, red-macular rash to left thig 5/28/2009 Tdap vaccine given, Patient with h/o 5/29/2009 Patient received Subcutaneous dos 5/21/2009 About 5-10 mm after immunizations 5/29/2009 Approx 15 min after 1 mms given, c 5/29/2009 Fever 101.7 degrees F, vomiting, irr On Tues 05/18/2009 pt told mom le 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/30/2009 Urticarial rash at vaccine site and on 5/30/2009 Shingle Shot;It was not until 3rd day 5/30/2009 Fever - 102.7; Headache; Fatigue; W 5/31/2009 Large area of induration at injection 5/31/2009 Patient had gunk in her eyes real ba 5/31/2009 Patient was vaccinated with Smallpo 5/29/2009 Patients arm swelled up to the wrist 5/28/2009 Feverish, body aches - Patients rela 5/29/2009 Patient in for immunizations on 5/28 5/29/2009 Mother called, client had high tempe 5/28/2009 Fast heart rate, fever, vomiting, diar 5/19/2009 Vaccinated 4/29/09. Mother noticed 5/27/2009 Took 1st Typhoid cap appropriately 5/27/2009 Redness, swelling pruritus in place 5/28/2009 Fever 12-14 hours after vaccines ad 5/27/2009 5/27/09 about 12:00 patient became 5/7/2009 Pain and area of redness over the s 11:30 AM severe hives. 5/26/2009 Patient complain of muscle pain in l 3/12/2009 Rotavirus is not to be started after 1 5/29/2009 Information has been received from 5/29/2009 Information has been received via a 5/13/2009 Patient returned to clinic on 5-13-09 5/29/2009 Information has been received from 4/24/2009 Dizzy head spinning, stomach sore, 5/22/2009 Mom stated redness and swelling b 5/30/2009 Cellulitis 4 x 2 1/2 cm indurated, inc
348255 348256 348257 348258 348259 348260 348261 348262 348263 348264 348265 348266 348267 348268 348269 348270 348271 348272 348273 348278 348279 348280 348281 348282 348283 348284 348285 348286 348287 348288 348289 348290 348291 348292 348293 348294 348295 348296 348297 348299 348300 348301 348302 348303 348304 348305 348306 348310 348317 348324 348325
6/1/2009 AR 6/1/2009 MI 6/1/2009 MI 6/1/2009 TN 6/1/2009 MI 6/1/2009 FL 6/1/2009 MO 6/1/2009 CA 6/1/2009 NC 6/1/2009 MI 6/1/2009 6/1/2009 NY 6/1/2009 KS 6/1/2009 KS 6/1/2009 IL 6/1/2009 CA 6/1/2009 CA 6/1/2009 CA 6/1/2009 TX 6/1/2009 NJ 6/1/2009 CA 6/1/2009 CA 6/1/2009 TX 6/1/2009 CA 6/1/2009 IL 6/1/2009 AZ 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/2/2009 IL 6/2/2009 PR 6/2/2009 LA 6/2/2009 LA 6/2/2009 AR 6/2/2009 TN 6/2/2009 6/2/2009 NH 6/2/2009 PA 6/2/2009 OH 6/2/2009 OR 6/2/2009 CA 6/2/2009 OH 6/2/2009 KS 6/2/2009 NY 6/2/2009 TX 6/2/2009 OR 6/2/2009 MO 6/2/2009 ME
42 9 11 0.5 10 12 1.3 12 3 9 25 54 14 17 51 4 0.2 11 11 20 10 5 12 6 4 44 53 4 53 18 9 1.3 13 32 0 57 0.3 0.2
42 9 11 0 10 12 1 12 3 9
12 1 55 37 1
12 1 55 37 1
4 1 14
4 1 14
0.2 5
0 5
54 14 17 51 4 0 11 11 20 10 5 12 6 4 44 53 4 53 18 9 1 13 32 0 57 0 0
F F M 0.5 M M F 0.3 M F F F M M F F F F 0.2 F U M F M F F F F M F F F F M 0.3 M F M 0M M 0.3 M 0.2 M U F 0F F F 0F F F 0F F F 0.2 M M
6/1/2009 Pain, swelling, redness, heat, and ra 6/1/2009 Pt came into office and never was im 6/1/2009 N/A, Pt was administered the DTaP 6/1/2009 4 days after dose of Rota vaccine g 6/1/2009 N/A, the patient was given the MCV 6/1/2009 I assessed a 12 year old female wh 6/1/2009 Patient received MMR and Varicella 6/1/2009 severe swelling in lympyh node on s 6/1/2009 Based on photographs the patient d 6/1/2009 Child woke up the night of vaccinati 6/1/2009 Left Shoulder soft tissue infection w 6/1/2009 Swelling, Tenderness at surroundin 6/1/2009 Became ill Saturday 05/30/2009 wit 6/1/2009 Day following administration of vacc 6/1/2009 Vaccine given on 5/26/09. Day after 6/1/2009 Reacted post vaccine 2 days ago, n 6/1/2009 Tonic Clonic Seizure acttivity lasting 6/1/2009 Rash to face torso arms and legs on 6/1/2009 After the vaccine was administered, 6/1/2009 Diffuse maculopapular rash on face 5/21/2009 Swelling over injection site - X 2 day 5/21/2009 Swelling at injection site x 2 days. T 6/1/2009 Immediately following injection patie 6/1/2009 Feverish on 5/29/09, raised, itchy, p 6/1/2009 Erythema at site of injection up to 1 5/8/2009 SM reports receipt of third AVA vacc 4/15/2009 Patient received Tdap IM R arm on 4/3/2009 Client presented in clinic on 4/3/09 @ 2/3/2009 Head ache and vomiting within a few 4/9/2009 Immunization were given at 5:25pm 4/14/2009 1635 Generalized itching right shou 3/30/2009 Client received Immunization on 3/2 5/26/2009 Pt had unwitnessed seizure on 5/21 5/23/2009 Left, vocal cord, right vocal cord, po 5/22/2009 Seizures - 4/14/09, diarrhea, diaper 5/26/2009 Numbness in face, body, hands, fee 5/26/2009 Fever; febrile seizure; Negative wo 5/27/2009 Child developed poor appetite with None stated. 5/28/2009 L arm swollen, itchy & hot to touch. 5/27/2009 Varicella vaccine breakthrough. Dia 5/20/2009 Swelling + redness at injection site. 5/26/2009 Tingling in left arm, jaw, left leg for t 5/27/2009 Patient developed an erythematous 5/22/2009 Patient developed furuncle abscess 5/28/2009 Left thigh erythema and induration a 5/28/2009 Approx. 2 days after inj pt was seen 6/1/2009 Information has been received from 5/29/2009 This case was received from a cons 5/21/2009 Approximately two minutes after inje 5/28/2009 On 5/27/2009 24 hours after immun
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6/2/2009 ID 6/2/2009 ID 6/2/2009 ID 6/2/2009 MD 6/2/2009 NY 6/2/2009 MI 6/2/2009 PA 6/2/2009 MD 6/2/2009 FL 6/2/2009 6/2/2009 TX 6/2/2009 MD 6/2/2009 GA 6/2/2009 GA 6/2/2009 CT 6/2/2009 MO 6/2/2009 OK 6/2/2009 TX 6/2/2009 WI 6/2/2009 CO 6/2/2009 IL 6/2/2009 FL 6/2/2009 CA 6/2/2009 CA 6/2/2009 ID 6/2/2009 AZ 6/2/2009 CA 6/2/2009 WI 6/2/2009 NY 6/2/2009 CA 6/2/2009 MI 6/2/2009 IA 6/2/2009 WI 6/2/2009 CA 6/2/2009 TX 6/2/2009 IL 6/2/2009 KY 6/2/2009 OH 6/2/2009 MA 6/2/2009 NE 6/2/2009 AZ 6/2/2009 CA 6/2/2009 TX 6/2/2009 PA 6/2/2009 NY 6/2/2009 CA 6/2/2009 CA 6/2/2009 MD 6/2/2009 NM 6/2/2009 CA 6/2/2009 AZ
52 24 4 4 0.2 82 1.3 1
52 24 4 4 0 82 1 5 1
11 5 1 1 35 17 2 24 2 5 0.5 30 49 4 1.3 1 14 0.2 0.5 16 0.7 21 18 4 0.2 1.3 1 67 43 23 13 30 4 72 77 4 4 9 22 17 1.1
11 5 1 1 35 17 2 24 2 5 0 30 48 4 1 1 14 0 0 16 0 21 18 4 0 1 1 67 43 23 13 30 4 72 77 4 4 9 22 17 1
F F M M 0.2 M F 0.3 M M 0F F F F 0M 0M F F 0F F 0.3 M F 0.5 F M F F 0.3 M 0M F 0.2 M 0.5 F F 0.7 F F F F 0.2 F 0.3 M 0M F F F F F F F F F M F F F 0.1 F
5/22/2009 Patient got a Tdap 5/14/09 and dev 5/20/2009 Pt received ADACEL 4/27/09- And d 4/20/2009 On 4-16-09 Patient received DTaP 5/29/2009 Febrile Seizure. 5/26/2009 Infant rec'd PENTACEL 3/3/09 @ 2 5/26/2009 Patient was given Tdap in error as t 5/27/2009 Varicella vaccine breakthrough. Dia 5/27/2009 Swelling and bruising at site with pa 5/27/2009 Typical shingles of L chest and arm None stated. 5/28/2009 Left deltoid area developed erythem 5/27/2009 Leg Swollen, hard to touch, painful 6/2/2009 Developed diarrhea for 3 weeks, fev 6/2/2009 Diarrhea x 3 weeks 6/2/2009 Pain in the right deltoid since injecti 6/2/2009 Headache and dizziness s/p Tdap a 6/2/2009 Progressing ataxia with onset appro 6/2/2009 5-28-09 Loss of felling in left arm, h 6/2/2009 CLient received dose #4 of DTAP IM 6/2/2009 Menactra administered instead of M 6/2/2009 this patient recevied 3rd dose of Ro 6/2/2009 Vaccine was administered on 5/26/0 2/5/2009 Patient woke up the next day with ra 6/2/2009 Patient returned to clinic 3 days pos 6/2/2009 Developed fever 103 with diffuse sw 6/2/2009 ERYTHEMA, EDEMA AND INDURA 6/2/2009 My daughter fainted and was taken 6/2/2009 This case was reported by a healthc 6/2/2009 Fever - seizures - 5-20 minutes of s 5/18/2009 After 3 vaccines given Pt c/o dizzine 5/18/2009 None - 5/20/09 Spoke to Dad - baby 5/26/2009 Given Immunizations Thurs. PM 5/2 5/21/2009 5/21/09 Midmorning patient develop 48 hr Evolution-Progressive swelling 5/21/2009 Pt. developed petechiae of lower ex 5/26/2009 Fever started Saturday 5/23/09 102 5/26/2009 Scattered chicken pox lesions- head 5/26/2009 Generalized urticarial rash at site L 5/26/2009 Received Tdap to right deltoid 5/22; 6/2/2009 Headache, too warm, flushing and n 6/2/2009 Day after HPV she was weak, T.100 6/2/2009 Left deltoid muscle and tender pain 5/26/2009 Leg swollen, shortness of breath. M 5/20/2009 Swelling, redness, and soreness lef 6/2/2009 Approximately 3 weeks post ZOSTA 5/22/2009 Red, swollen, cellulitis (TYLENOL). 5/29/2009 Erythema and edema, warm to touc 5/22/2009 Fever started 1 day after receiving v 6/1/2009 At site check, Day 7, c/o some naus 5/17/2009 c/o "sick stomach", shaky, jittery, ch 5/28/2009 Red raised bump at the injection sit
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6/2/2009 CA 6/2/2009 CA 6/2/2009 WI 6/2/2009 CA 6/2/2009 NC 6/2/2009 CA 6/2/2009 VA 6/2/2009 TX 6/2/2009 OR 6/2/2009 IA 6/2/2009 NY 6/2/2009 MA 6/2/2009 VA 6/2/2009 OH 6/2/2009 GA 6/2/2009 CO 6/2/2009 CA 6/3/2009 AR 6/3/2009 6/3/2009 6/3/2009 VA 6/3/2009 OH 6/3/2009 MI 6/3/2009 WA 6/3/2009 6/3/2009 6/3/2009 CA 6/3/2009 TX 6/3/2009 WI 6/3/2009 TN 6/3/2009 MI 6/3/2009 NY 6/3/2009 NY 6/3/2009 MO 6/3/2009 CT 6/3/2009 FL 6/3/2009 CA 6/3/2009 NJ 6/3/2009 CA 6/3/2009 OH 6/3/2009 6/3/2009 MA 6/3/2009 6/3/2009 CA 6/3/2009 MO 6/3/2009 GA 6/3/2009 OH 6/3/2009 CA 6/3/2009 PA 6/3/2009 MA 6/3/2009 WA
26 13 0.2 20 40
26 13 0 20 40
1 74 5 57 14 43 1.5 1.1 10 6 43
1 74 5 57 14 43 1 1 10 6 43
22 2 21 27 5 22 23 18 40 12 1.3 35 15 14 4 13 5 0.6 67 22 9 22 22 34 39 4 29 69 4 4 62 27 11
2 21 27 5 22 18 40 1 35 15 14 4 13 5 0 67 22 9 22 34 39 4 29 69 4 4 62 27 11
F F 0.2 F F M F 0M F M F F F 0.5 M 0.1 F M F F F F 0M F F M M F F F M 0.3 M F F F M M M 0.6 M M F F F F M F M F F F M M F M
5/11/2009 C/O HA radiating to her jaw, should 5/15/2009 Per Pt's mother at approx. 9 pm on 6/1/2009 Mom reports child vomited on Thurs c/o dizzy 5/19, 20 c/o pain lt side o 5/26/2009 A few days after 3 17-09 injections ( 5/27/2009 Patient with c/o rash on chest and b 6/1/2009 Received MMR shot on 1/16/09. Dia 5/25/2009 Patient returned to the pharmacy co 6/1/2009 Marked local swelling and erythema 6/2/2009 Shot given 5/28/09 patient noticed n 6/2/2009 Pt felt lightheaded & thinks she may 5/26/2009 Received Tdap to R Deltoid 5/22; d 5/27/2009 Woke up 5 AM on 5/27/09 T 102 Cr 6/2/2009 Err:508 5/27/2009 Patient given a TB vaccine while he 5/28/2009 On 5/14/09 - pt had swelling & redn 5/29/2009 Left upper arm became very red, wa 6/2/2009 Information has been received from 6/2/2009 Information has been received from 6/3/2009 Patient while at home developed 10 6/3/2009 PT PRESENTED WITH COMPLAIN 6/3/2009 Returned to clinic 5/29/09 with 1 da 6/3/2009 Within 7 hrs of receiving vaccines p 6/3/2009 Developed chest pain and was adm 3/27/2009 Patient admitted to hospital with par 5/29/2009 The date above is simply the most r 6/3/2009 R deltoid with erythema, mildly infla 6/3/2009 5/27/09 Immunizations administered 6/1/2009 Full body rash Tylenol given as nee 5/27/2009 Severe pain in left arm w/tingling se 6/2/2009 Nausea, vomiting, fatigue. 5/20/2009 I took my daughter to a physician sh 6/3/2009 Patient vaccinated on 5/28/09, went 6/3/2009 After leaving our office, the patient p 6/3/2009 7 days after receiving the MMR vac 6/3/2009 Mom called approx 1530 on 6/3/09 6/2/2009 1. discomfort in abdomen, like cram 5/26/2009 A LARGE RED BUMP FIRST SHOW 6/3/2009 Cellulitis of right arm where vaccine 6/3/2009 I felt intense headaches and fainted 5/24/2009 About 5 hours after receiving the thi 5/26/2009 Close to 9 months after being given 6/3/2009 On Tuesday arm (R) became painfu 6/3/2009 R deltoid edema erythema hyperem 6/3/2009 5/29/09 Approx. 10:45 AM - Pt faint 5/27/2009 Td given 5/21/09 LDT - RTC 5/27/0 6/3/2009 Itchy, erythematous, macular rash o 6/2/2009 Lt arm lateral 5 inches x 2 inches te 6/3/2009 Immediate red rash raised bumps (h 6/3/2009 Client called Health center on 6/3/09 6/3/2009 Pt had a swollen arm. was seen a E
348446 348447 348422 348448 348449 348450 348452 348453 348454 348456 348457 348459 348460 348461 348462 348463 348464 348465 348466 348467 348469 348470 348471 348472 348473 348474 348475 348477 348478 348479 348480 348481 348482 348483 348484 348485 348486 348487 348488 348489 348490 348491 348492 348493 348494 348495 348496 348497 348501 348505 348513
6/3/2009 CA 6/3/2009 IN 6/4/2009 VA 6/4/2009 MD 6/4/2009 MO 6/4/2009 IN 6/4/2009 PA 6/4/2009 6/4/2009 KY 6/4/2009 GA 6/4/2009 6/4/2009 VA 6/4/2009 PA 6/4/2009 WI 6/4/2009 NE 6/4/2009 PA 6/4/2009 GA 6/4/2009 WI 6/4/2009 WI 6/4/2009 NY 6/4/2009 AZ 6/4/2009 KS 6/4/2009 CA 6/4/2009 MA 6/4/2009 NY 6/4/2009 PA 6/4/2009 IN 6/4/2009 MO 6/4/2009 NY 6/4/2009 6/4/2009 GA 6/4/2009 PA 6/4/2009 NC 6/4/2009 MI 6/4/2009 NM 6/4/2009 CA 6/4/2009 OK 6/4/2009 CA 6/4/2009 CA 6/4/2009 VA 6/4/2009 PA 6/4/2009 KS 6/4/2009 AZ 6/4/2009 AZ 6/4/2009 AZ 6/4/2009 TX 6/4/2009 VA 6/4/2009 OR 6/4/2009 MO 6/4/2009 IA 6/4/2009 PA
54 15 18 1.2 14 13 1.6
54 15 18 1 14 13 1
49
49
7 2 38 4 1.3 13 64 5 18 10 11 11 58 38 4 13 65 60 31 1.1 11
7 2 38 4 1 13 64 5 18 10 11 11 58 38 4 13 65 60 31 1 11 2 1 63 13 1 14 12 1 26 13 4 11 78 1 1 49 22 2 57
1.4 63 13 1.1 14 12 1.6 26 13 4 11 78 1.1 1.6 49 22 2 57
M F M 0.2 M F F 0.6 M F M F M M 0.9 M F F 0.3 M F M F U F F F F F M F M F F 0.1 F M 0.6 M 0.4 F M F 0.1 F F F 0.6 F F M F F F 0.1 M 0.6 F M M 0.1 M F
6/2/2009 Patient given Pneumovax on 5-26-0 6/3/2009 4-30-09 VARICELLA vaccine given 6/1/2009 After receiving immunizations and w 6/4/2009 fever over 103 for 3 days, loss of ap 6/4/2009 w/in 3 minutes of receiving the 1st d 6/4/2009 FEVER OF 101.8, ACHY ALL OVER 6/2/2009 Within 15 minutes cheeks were red 6/3/2009 Information has been received from 6/3/2009 Information has been received from 6/3/2009 Initial information has been received 6/3/2009 Information has been received from 5/29/2009 Pt c/o redness, swelling and itchy @ 5/29/2009 Generalized nodular papular rash 5/5/2009 Redness. swelling, heat @injection 5/29/2009 Redness on the area of injection 5x 5/29/2009 Varicella vaccine break through. Dia 5/28/2009 Ascending motor paralysis 6/9/09 H 5/29/2009 None stated. 6/1/2009 Patient came to the clinic 6-1-09. S Sensation of chest tightness within 5/21/2009 Pt denied being preg. 12/31/08. Ha 6/4/2009 06/04/2009 MILD Other - Fatigue, S 6/3/2009 Received vaccine 5/27/2009 and se 6/4/2009 Large red mildly itching rash, 10 cm 6/4/2009 Periphral Neuropathy. 3-6mo after 6/4/2009 1 day following vaccination, child de 6/4/2009 RECIEVED TDAP, GARDISIL, MEN 6/4/2009 PATIENT HAD PNEUMOVAX ON R 6/4/2009 PATIENT STATED THAT SHE EXP 6/4/2009 Called Immunization clinic 6/04/09 a 6/4/2009 Pt started with rash and fever of 102 6/4/2009 Pt received vaccines on 6/2/09. On 6/4/2009 rash, redness, swelling at site, starte 6/4/2009 facial swelling morning after vaccine 6/4/2009 Shingles symptoms appears one we 6/4/2009 Approx 5 min after receiving immz, 6/4/2009 After well-baby check-up and vaccin 6/4/2009 Was standing in line 5-10 minutes a 6/3/2009 Given 3rd GARDASIL on 5/27/2009 6/8/2009 10 days after receiving MMR, patien 6/4/2009 Hives all over body. 6/4/2009 Felt bad last PM (about 5-6 hours a 6/4/2009 Very itchy rash on chest, abdomen, 6/4/2009 Pt experienced (L) arm pn @ injecti 6/4/2009 Rash developed one month after th 6/4/2009 Rash - Red, papular to trunk & limbs 6/4/2009 Projectile vomiting approximately 86/4/2009 Pt received immunization 9:05 AM, 5/28/2009 Employee had c/o nausea with eme 6/1/2009 2 doses PEDIARIX given simultane 6/4/2009 This case was reported by a healthc
348514 348515 348516 348517 348519 348520 348521 348522 348523 348524 348525 348526 348527 348528 348529 348530 348531 348532 348533 348534 348535 348536 348537 348538 348539 348540 348541 348542 348543 348544 348545 348546 348547 348548 348549 348550 348551 348552 348553 348554 348555 348556 348557 348558 348559 348563 348565 348567 348569 348570 348573
6/4/2009 TX 6/4/2009 GA 6/4/2009 GA 6/4/2009 ND 6/5/2009 6/5/2009 6/5/2009 CA 6/5/2009 CA 6/5/2009 CA 6/5/2009 6/5/2009 NV 6/5/2009 TX 6/5/2009 TX 6/5/2009 CA 6/5/2009 CA 6/5/2009 DE 6/5/2009 IL 6/5/2009 CA 6/5/2009 IN 6/5/2009 6/5/2009 TX 6/5/2009 MN 6/5/2009 MN 6/5/2009 MN 6/5/2009 6/5/2009 WV 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 TN 6/5/2009 CT 6/5/2009 6/5/2009 NC 6/5/2009 NY 6/5/2009 LA 6/5/2009 NJ 6/5/2009 AZ 6/5/2009 PA 6/5/2009 LA 6/5/2009 WI 6/5/2009 PA 6/5/2009 NM 6/5/2009 NM 6/5/2009 NJ 6/5/2009 PA 6/5/2009 6/5/2009 VA 6/5/2009 6/5/2009 OR 6/5/2009 NV
46 8 4 5 5 61 0.2 4 2 0.5 4
46 8 4 5
4 5
4 5
4
4
4 1.6 5 5
1 5
0 4
4
0.3
0.4 68
0 68
12 4 11 43 16 7 11 5 0.2 51 61 18
12 4 11 43 16 7 11 5 0 51 61 18
15 23 5
23 5
F F M M M F 0.2 F M U U M U U M M U U U M U U 0.6 F F M U M U U U U 0.4 F M M F F F M F M F M 0.2 M F F F F M M F M F
6/4/2009 This case was reported by a physici 5/1/2009 3 X 3 cm induration (R) arm 6/4/2009 Baby given VYANESE doses after v 6/3/2009 Pt received shot Fri - Pt brought in M 5/1/2009 This case was reported by the moth 5/1/2009 This case was reported by an other 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by the moth 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a pharma 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/16/2009 3hrs after vaccine administered, mo 5/29/2009 68yo M h/o BPH, intra-cranial hemo 6/3/2009 Born without legs. 6/3/2009 Temp. 100.5 degrees F, achy joints 6/2/2009 Received KINREX + MMR on R del 6/2/2009 Approx 5 minutes after injection Pt b 6/1/2009 100 - 102 degree F fever, body ach 5/29/2009 Pt was injected with 2nd GARDASIL 5/29/2009 Rash- 20-30 papules on trunk and g 5/29/2009 9 cm X 5cm red whelp to (R) deltoid 6/1/2009 Mom stated pt came home form Da 6/1/2009 About 6 hrs after receiving vaccines 5/29/2009 Swelling, redness, heat, bruising aft 5/21/2009 (L) arm SQ site redness, heat. Pt sa 6/1/2009 Urticaria on arms / legs about 1 hou 6/4/2009 Information has been received from 6/4/2009 It was reported in a news magazine 6/4/2009 Information has been received from 6/4/2009 Information has been received from 5/27/2009 5/24/09 experienced swelling in the 5/28/2009 5cm erythema and induration at arm
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6/5/2009 SD 6/5/2009 IL 6/5/2009 VA 6/5/2009 NM 6/5/2009 IN 6/5/2009 TX 6/5/2009 NY 6/5/2009 MO 6/5/2009 CT 6/5/2009 NY 6/5/2009 IN 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 CO 6/5/2009 CO 6/5/2009 CO 6/5/2009 CO 6/5/2009 RI 6/5/2009 CO 6/5/2009 CO 6/5/2009 NH 6/5/2009 6/5/2009 CA 6/5/2009 CA 6/5/2009 CA 6/5/2009 UT 6/5/2009 GA 6/5/2009 TX 6/5/2009 FL 6/5/2009 PA 6/5/2009 MA 6/5/2009 6/5/2009 TX 6/5/2009 TX 6/5/2009 NY 6/5/2009 ND 6/5/2009 VA 6/5/2009 CA 6/5/2009 KS 6/5/2009 PA 6/5/2009 WA 6/5/2009 AR 6/5/2009 NC 6/5/2009 OH 6/5/2009 NY 6/5/2009 CA 6/5/2009 TX 6/5/2009 NY 6/5/2009 CO 6/5/2009 TX
4 15 1.4 2 49 34 3 4 22 11 0.3
4 1 1 4 5 5 3 0.5
4 15 1 2 34 4 22 11 0
5 5 0
0.3
4 4 37 11 61 4 15 1.5 19 69 1.2 0.4 23 13 1.3 3 1.3 0.6 27 50 1.3 57 1 45 60
4 4 37 11 61 4 15 1 19 69 1 0 23 13 1 3 1 -1 27 50 1 67 1 45 60
F F 0.4 M 0.2 M M F M M M M 0.3 F U U U F F M M M F F 0.5 F F F U U F F M F M F F 0.5 M F F 0.2 M 0.4 F M F 0.3 M M 0.3 F 0.5 F F F 0.4 M F 0M F F
6/1/2009 Entire (R) thigh red/warm swollen w 5/13/2009 Patient given dose #2 of GARDASIL 6/3/2009 Swelling and erythema at Lt site of i 5/31/2009 (L) thigh with erythema and purpura 6/2/2009 None stated 5/19/2009 Left arm - substantial swelling of inje 6/2/2009 Erythema Multiforme rash started on 5/29/2009 Pain and swelling of R deltoid area. 6/5/2009 Within 5 min of receiving JE vaccina 6/4/2009 c/o itchiness on neck, arms, legs, ab 6/4/2009 Right knee swollen warm to touch. 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a consum 5/1/2009 This case was reported by the gran 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 6/5/2009 redness and swelling in a 6x6 are to 6/5/2009 - Received shot Tues afternoon; min 6/5/2009 rash began 2 days following the inje 6/5/2009 A feeling of malaize approximately 1 6/5/2009 Mom reports child developed night t 6/5/2009 06052009@9:16am MOC t.c. c/o m 6/5/2009 Developed urticaria all over body 3 6/5/2009 Above client had 3 vaccines admini 6/5/2009 Erythema, Swelling, Tenderness, fe 6/5/2009 TC FROM MOTHER REQUESTING 6/5/2009 Child received rotateq on 4/3/09 and 6/5/2009 swelling in left arm wth mild erythem 6/5/2009 Patient's mother calls to report that 6/5/2009 He received Hib and DTP/DTap vac 6/5/2009 VARICELLA FROM VACCINE 6/5/2009 Mom reports child had 1st seizure 6 6/5/2009 2 WEEKS OF DIARRHEA (5 TIMES 6/5/2009 Around 4 days after Hepatitis B vac 6/5/2009 Dizziness, vomiting, headaches, pa 6/5/2009 child experienced generalized macu 6/5/2009 pt received vaccine on 6-2-09. on 6 6/5/2009 Child break out in hive after MMR a 6/5/2009 Intense pain in deltoid area, swelling 6/5/2009 6/3: Injection site became itchy with
348626 348627 348628 348629 348630 348631 348634 348635 348642 348643 348644 348645 348646 348647 348648 348649 348652 348655 348656 348657 348658 348660 348663 348664 348665 348666 348667 348668 348669 348670 348632 348633 348636 348641 348637 348638 348639 348640 348671 348672 348673 348674 348675 348676 348677 348678 348679 348681 348682 348683 348684
6/5/2009 CA 6/5/2009 OR 6/5/2009 TX 6/5/2009 AZ 6/5/2009 OR 6/5/2009 IA 6/5/2009 CA 6/5/2009 IN 6/5/2009 IN 6/5/2009 NY 6/5/2009 TX 6/5/2009 CO 6/5/2009 CO 6/5/2009 VA 6/5/2009 CA 6/5/2009 VA 6/5/2009 CA 6/5/2009 NC 6/5/2009 MA 6/5/2009 FL 6/5/2009 WA 6/5/2009 NJ 6/5/2009 6/5/2009 AZ 6/5/2009 DE 6/5/2009 NH 6/5/2009 CA 6/5/2009 CO 6/5/2009 CA 6/5/2009 NJ 6/6/2009 MD 6/6/2009 OH 6/6/2009 WA 6/6/2009 OH 6/7/2009 6/7/2009 CA 6/7/2009 DE 6/7/2009 IL 6/8/2009 CA 6/8/2009 PA 6/8/2009 FL 6/8/2009 MI 6/8/2009 MI 6/8/2009 OR 6/8/2009 AR 6/8/2009 PA 6/8/2009 MI 6/8/2009 CA 6/8/2009 GA 6/8/2009 CA 6/8/2009
11 69 78 0.2 63 1.7 66 4 5 11 4 65 53 45 1.3 81 22 11 12 1.6 5 24 24 0.6 16 21 4 67 57 3 18 34 22 0.2 38 1 1 4 32 69 10 57 1 11 1 14 1.5 15 17 16 17
11 99 78 0 63 1 66 4 5 11 4 65 53 1 22 11 12 1 5 24 24 0 16 21 4 67 57 3 18 34 22 0 38 1 1 4 32 69 10 57 1 11 1 14 1 15 17 16 17
M M F 0.2 F M 0.6 F F F F F M M M F 0.3 U M F M F 0.6 F F M M 0.6 M F F M F F M F M M 0.2 F M 0M 0M M M F M F 0F F 0M F 0.5 F F F F F
6/5/2009 GAVE 2ND TdAP 6/5/2009 During the evening on the day of inj 6/5/2009 Pt. described itching during the nigh 6/5/2009 MOTHER NOTICED ON 06/04/2009 6/5/2009 The injection site was found to be s 6/5/2009 Pt comes for evaluation of red swoll 6/3/2009 An hour later of administration of the 6/5/2009 Skin swelling, erythema (10 x 10 cm 6/6/2009 4.0cm x 6.5 cm erythema around in 6/5/2009 Severe swelling, tenderness, redne 6/4/2009 Lower 2/3 of left arm with edema an 6/5/2009 Localized reaction. Sore and swellin 6/5/2009 Patient had severe localized reactio 6/5/2009 This case was reported by a healthc 2/5/2009 Child presented to clinic 6-4-09 w. c 6/5/2009 This case was reported by a consum 6/5/2009 Shortness of breath and dizziness 6/5/2009 Pt was admitted to clinic with warm 6/5/2009 1 inch diameter induration with 2 in 6/5/2009 Pt started 2 days after vaccine T. 10 6/4/2009 Redness, pain, swelling left arm ons 6/1/2009 5/23/09 - chest & back rash red, bum 6/3/2009 Red, irritated skin under bandage a 6/5/2009 Pt developed intussusception requir 6/5/2009 Low grade fever, overall "joint achin 6/5/2009 Acute muscle spasms to arm x 24hr 6/5/2009 Right deltoid with erythema and swe 6/5/2009 Swelling, excessive of arm, shoulde Redness and swelling after 6 hours Acute onset of wheezing approx 10 6/6/2009 Patient had received the Typhoid va 6/6/2009 Received Tetanus booster and Hep 6/6/2009 PT CAME IN TO RECIEVE ANTHR 6/6/2009 Pedal pecechiae & edema - transien 6/7/2009 Soreness in all muscle groups, Fatig 6/7/2009 Child went from a typically developin 6/7/2009 Broke out in hives (10/19/07). Deve 6/7/2009 Left upper thigh was red, warm, swo 6/8/2009 Two weeks after the vaccination, I'm 6/2/2009 It looked like a huge hive 2 x 3 1/2 i 5/29/2009 Reddness, swelling and warmth to s 5/12/2009 After each rabies vaccine, had prog 5/7/2009 Patient's mom, states she tried to fe 5/27/2009 Has hard, red swollen area at one in 5/28/2009 Received immunizations @ 9AM - b 6/4/2009 Immediately following administration 3/16/2009 Vaccines 2/20/09 ----> mom reports 5/14/2009 Pt had small area of urticaria @ flex 6/5/2009 Information has been received from 5/14/2009 Pt developed severe urticaria over e 6/5/2009 Information has been received from
348687 348688 348689 348690 348691 348700 348701 348702 348703 348704 348705 348706 348707 348708 348709 348710 348712 348713 348714 348715 348716 348717 348718 348719 348720 348721 348722 348724 348725 348723 348726 348729 348730 348734 348736 348737 348738 348739 348740 348741 348742 348743 348744 348745 348747 348749 348750 348751 348752 348756 348758
6/8/2009 HI 6/8/2009 6/8/2009 6/8/2009 MD 6/8/2009 NC 6/8/2009 MA 6/8/2009 IA 6/8/2009 IL 6/8/2009 AL 6/8/2009 FL 6/8/2009 TX 6/8/2009 WA 6/8/2009 CA 6/8/2009 MN 6/8/2009 CA 6/8/2009 FL 6/8/2009 NY 6/8/2009 NY 6/8/2009 CO 6/8/2009 IN 6/8/2009 KS 6/8/2009 LA 6/8/2009 WA 6/8/2009 CA 6/8/2009 OR 6/8/2009 MN 6/8/2009 GA 6/8/2009 FL 6/8/2009 NJ 6/9/2009 CA 6/9/2009 6/9/2009 MI 6/9/2009 6/9/2009 GA 6/9/2009 TX 6/9/2009 MI 6/9/2009 OH 6/9/2009 NC 6/9/2009 PA 6/9/2009 IA 6/9/2009 CT 6/9/2009 VA 6/9/2009 MI 6/9/2009 OR 6/9/2009 DE 6/9/2009 IN 6/9/2009 AR 6/9/2009 OR 6/9/2009 ME 6/9/2009 CA 6/9/2009 NE
3 16 12 1 1 18 9 1.4 36 29 20 55 30 27 12 12 43 18 72 14 4 56 64 1 48 52 4 31 35 24 13 55 1.1 26 17 53 7 36 4 5 4 0.2 53 0.3 0.3 27 5 69
3
12 1 1 18 9 1 35 29 20 55 30 27 12 12 43 18 72 14 4 56 64 1 48 52 4 31 35 13 55 1 26 17 53 7 36 4 5 4 0 66 53 0 0 27 5 69
M F M F 0F 0M F M 0.2 F M F M M M M F F F F F M F F M 0F F F F F F F F M F 0.1 M F F F F F F F M 0.2 M F F 0.3 F 0.3 M U M F
5/29/2009 Redness and induration at injection 6/5/2009 Information has been received from 6/5/2009 Information has been received from 6/5/2009 Information has been received from 6/4/2009 Morbilliform rash 24-36 degrees afte 6/8/2009 5/7/09 VARIVAX + PCV given. 5/15 6/8/2009 Reddened, raised, tender, warm to 6/8/2009 6/5/09 - Mom brought child in, Dr sa 6/8/2009 Parent stated 18 hrs after vaccine c 6/8/2009 Nausea, diarrhea, vomiting, fatique, 6/8/2009 Diarrhea and itching palms on even 6/8/2009 3 weeks following vaccination with A 6/8/2009 Pneumococcal vaccine given at 090 6/8/2009 Headache and diplopia accompany 6/8/2009 Tonic Seizure lasted 1 min about 2 6/8/2009 I ASSESSED A 12 YEAR OLD FEM 6/8/2009 fever, nasal congestion, lost voice, b 6/8/2009 Within 12 hours: Significant swelling 6/8/2009 Varicella administered on Tuesday,6 6/8/2009 On 6/2/09 / 6 days post vaccine not 6/8/2009 Patient woke up with a very sore arm 6/8/2009 Immediately after having vaccines, p 6/8/2009 Patient received injection on 5/26/09 6/8/2009 Onset of head ache, nausea, bloatin 6/8/2009 PARENT RECORD OF FEVER x48 6/8/2009 breast on side of injection swelled s 6/8/2009 Pt's states her arm was very swollen 6/8/2009 Developed a large local reaction at 6/8/2009 Fever x 24 hours, body ache and so 6/9/2009 Tetanus shot was given on Friday, J 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/2/2009 Fever 104.7, Myoclonic movements 6/4/2009 GARDASIL vaccine - neuritis (LUE 6/3/2009 Joint pain in arms & shoulders. Eva 6/4/2009 Dtap given in LDMIM. 30 minutes af 6/3/2009 Redness and induration at site injec 6/4/2009 Patient reports pain at site, fever, so 6/4/2009 Total body urticaria, agitation about 6/4/2009 Induration and warmth to left thigh a 4/20/2009 (R) Leg reaction to KINRIX DTAP-P 6/5/2009 Patient received PENTACEL vaccin 6/4/2009 Pt states 6/3/09 she noticed onset o 5/1/2009 Sore arm and low grade temperatur 6/3/2009 103 degree temperature and letharg 6/5/2009 Pt. was given PENTACIL at 9:00 am Pain with arm swollen below injectio 6/3/2009 ER Report states: Left upper extrem 6/3/2009 Large red rash at injection site. Ras
348759 348760 348761 348762 348763 348764 348765 348766 348767 348768 348769 348770 348771 348772 348773 348774 348775 348776 348777 348778 348779 348780 348781 348782 348783 348784 348785 348786 348787 348788 348789 348790 348791 348792 348793 348794 348796 348797 348798 348799 348800 348801 348802 348803 348804 348805 348806 348807 348810 348811 348812
6/9/2009 AZ 6/9/2009 NY 6/9/2009 CA 6/9/2009 CA 6/9/2009 VA 6/9/2009 OH 6/9/2009 IL 6/9/2009 VA 6/9/2009 FL 6/9/2009 IA 6/9/2009 WA 6/9/2009 CA 6/9/2009 KS 6/9/2009 MA 6/9/2009 MA 6/9/2009 IA 6/9/2009 LA 6/9/2009 FL 6/9/2009 AR 6/9/2009 TX 6/9/2009 PA 6/9/2009 PA 6/9/2009 WA 6/9/2009 WA 6/9/2009 NC 6/9/2009 NY 6/9/2009 AZ 6/9/2009 PA 6/9/2009 NJ 6/9/2009 DE 6/9/2009 IN 6/9/2009 IA 6/9/2009 TX 6/9/2009 AZ 6/9/2009 GA 6/9/2009 CT 6/9/2009 TN 6/9/2009 CA 6/9/2009 CO 6/9/2009 CT 6/9/2009 PA 6/9/2009 FL 6/9/2009 MN 6/9/2009 TX 6/9/2009 OH 6/9/2009 WA 6/9/2009 IA 6/9/2009 TX 6/9/2009 CA 6/9/2009 OR 6/9/2009 AZ
0.3 4 0.3 0.3 22 14 4 0.2 4 0.5 0.6 4 33 13 0.5 1.2 18 1.2 4 8 1.4 6 1 37 28 72 22 4 20 22 4 16 36 49 1 64 4 85 24 4 0.2 20 20 11 1.2 1.3 18 17 65 76 51
0 4 0 0 22 14 4 0 4 0 0 4 33 13 0 1 18 1 4 8 1 6 37 28 72 22 4 20 22 4 16 36 49 1 64 4 85 4 0 20 20 11 1 1 18 17 65 76
0.3 F M 0.3 U 0.3 U F F F 0.2 M F 0.5 M 0.6 F F F F 0.5 F 0.2 M F 0.2 M M M 0.4 M F F F M F F M F F F F F F 0F F F F F F 0.2 F F F F 0.2 M 0.3 M M F F F F
6/2/2009 Persistent inconsolable crying. DTa 6/5/2009 Hives, eye swelling approximately 1 Persistent diarrhea 12-15 x 1 day. L Persistent diarrhea 12-15 x 1 day la 6/3/2009 Per patient legs broke out in hives e 2/26/2009 Weakness, fatigue, rapid HR, abd p 6/4/2009 Child's mother states that pt was a l 6/3/2009 High pitch cry for 4 hrs - hard to con 6/3/2009 Left upper thigh, redness, some pai 6/2/2009 Mom noticed hives on torso, no feve 6/1/2009 Pt given vaccines and approximatel 6/1/2009 Gave school IZ's 5/26/09, when chil 5/29/2009 7 x 10 cm Erythema 6/2/2009 Pt fainted 5 min after 3rd GARDASI 6/3/2009 Temp 101-102 rash on 6-3-09 seen 6/2/2009 Red, raised rash. Started on 5/30/09 2X5 cm whelps, cellulitis treated wit 5/28/2009 Rash head to toe entire body on 5/2 5/22/2009 Right upper arm red, swollen, and w 6/4/2009 Pt got fever, T: 99 - 101 degree F fr 6/4/2009 "(+) Local reaction to INFANRIX vac 6/5/2009 Varicella vaccine break through. Dia 6/9/2009 Pt was given HIB that was expired. 4/27/2009 Swelling redness pain at injection si 6/4/2009 None Stated 6/3/2009 Pt received ENGERIX B vaccine IM 5/30/2009 Arm pain, redness, and swelling ext 6/8/2009 Client inadvertently received ZOSTA 6/8/2009 Passed out after received shot with 6/9/2009 Patient received #2 GARDASIL on 5 6/8/2009 10 cm erythematous indurated lesio 6/8/2009 Pt. stated stomach felt queasy; sat d 6/5/2009 None stated. 6/8/2009 Employee given 5th HEP B today w 5/19/2009 The above named patient was seen 5/29/2009 Sterile abcess @ site of injection. N 6/9/2009 Mom states high temp starting 1 ho 6/9/2009 85 y/o F NKA, PMH: Dementia, Hyp 6/9/2009 Patient did not know she was pregn 6/9/2009 Developed meningitic like illness wh 6/9/2009 3-5 minutes after receiving Pediarix 6/9/2009 Beginning with 2nd gardasil vaccina 6/9/2009 The client's sister also received an i 6/9/2009 Syncope <5 min. after admin of vac 6/9/2009 ANTHONY DEVELOPED HIGH FEV 6/9/2009 2 episodes of L facial drooping sinc 6/9/2009 None 6/9/2009 Gardasil #1 (1423X) given in right a 6/9/2009 Pt c/o redness, swelling of about 3 i 6/9/2009 Drunk stare, drooling, swelling of inj 6/4/2009 Severe rash on arms and hives + jo
348813 348814 348815 348816 348817 348818 348819 348820 348821 348823 348824 348826 348827 348828 348829 348834 348836 348839 348841 348846 348847 348848 348849 348850 348851 348852 348853 348854 348855 348856 348857 348858 348859 348860 348861 348862 348863 348864 348865 348866 348867 348869 348870 348871 348872 348873 348874 348875 348876 348877 348878
6/9/2009 WI 6/9/2009 AZ 6/9/2009 NC 6/9/2009 WA 6/9/2009 NC 6/9/2009 MA 6/9/2009 NV 6/9/2009 TX 6/9/2009 TX 6/9/2009 OH 6/10/2009 MO 6/10/2009 IN 6/10/2009 MA 6/10/2009 NC 6/10/2009 OH 6/10/2009 GA 6/10/2009 6/10/2009 CA 6/10/2009 PA 6/10/2009 CA 6/10/2009 MD 6/10/2009 OH 6/10/2009 MI 6/10/2009 WA 6/10/2009 CO 6/10/2009 DE 6/10/2009 MI 6/10/2009 VA 6/10/2009 VA 6/10/2009 MD 6/10/2009 VA 6/10/2009 IL 6/10/2009 IL 6/10/2009 GA 6/10/2009 MN 6/10/2009 WI 6/10/2009 GA 6/10/2009 WA 6/10/2009 AZ 6/10/2009 NY 6/10/2009 IL 6/10/2009 IL 6/10/2009 TX 6/10/2009 OH 6/10/2009 ND 6/10/2009 CA 6/10/2009 WI 6/10/2009 CA 6/10/2009 CA 6/10/2009 WA 6/10/2009 MI
18 0.2 4 7 68 15 5 22 12 1 15 24 56 0.4 11 46
18 0 4 7 68 15 5 22 12 1 15 24 56 0 11 46
58 47 4 44 1 65 60 52 25 64 11 4 29 0.2 18 32 24 11 1.6 4 830 4 1.6 1.3 1.6 17 0.3 59 11 1 2 4 11 4
58 47 4 44 1 65 60 52 25 64 11 4 29 0 18 32 24 11 1 4 83 4 1 1 1 17 0 59 11 0 2 4 11 4
F 0.2 F M M F F F M F 0M F F F 0.4 M M F U M F F M 0F F F F F F F F F 0.2 M F M F M 0.6 F F F M 0.6 M 0.4 F 0.6 F F 0.3 M F F 1F 0.5 M M F M
Within 24 hours of vaccine c/o sore 6/9/2009 Fever even with TYLENOL, fussines 6/9/2009 Fever 104 degrees about 12 hours 6/8/2009 Arm swollen 2X NL size, Red, hot v 6/4/2009 Fever 102 - large hives at site of inje 6/9/2009 1 day after the immunization, child d 6/8/2009 Erythematous swelling, right deltoid 5/7/2009 A 22 year old male patient received 5/27/2009 This non serious case was received 6/9/2009 Rash started on (L) ear - Spread do 6/5/2009 Patient had syncope episode imme 5/1/2009 None stated 6/3/2009 Within 4 hours, fever (up to 101 deg 6/3/2009 Petechiae and small purpuric areas 6/4/2009 Started 24-36 hours after vaccine (R 6/9/2009 Information has been received from 6/9/2009 Information has been received from 6/8/2009 Initial report received on 29 May 20 6/8/2009 Initial report received on 05 June 20 6/9/2009 Received MMR II and HAVRIX vacc 6/10/2009 Patient received DT on 6/1/09. Star 6/9/2009 Vaccines given 5/26/2009. Left leg 6/9/2009 "Tennis ball" sized area around inje 6/9/2009 Noticed low fever, broke out in tiny h 6/8/2009 Headache within 2 hours. Had fastin 6/10/2009 Patient had severe vaso response a 6/10/2009 Right upper extremity cellulitis. Swo 6/10/2009 Patient received Tdap vaccine durin 6/10/2009 Swelling to right thigh 5 cm around 6/10/2009 Pt received Hep B #2 dose on 06/08 6/10/2009 vomiting and diarrhea, dehydration. 6/10/2009 Parent called clinic approximately 2 6/10/2009 Client received Y Twinrix vaccination o 6/10/2009 Client was given an adolescent dos 6/10/2009 Patient's mother reported patient ha 6/10/2009 This child was given shots 05/06/09 6/10/2009 10 to 12 red papules. Red base with 6/11/2009 VACCINE GIVEN ON THURSDAY, 6/10/2009 EDEMA, ERYTHEMA 1"X 2" TO RI 6/10/2009 Anaphylaxis (w/in 30 min, irritability, 6/10/2009 After child received DTaP and Prevn 6/5/2009 Vaccines given 5/20/09. Vomited st 6/10/2009 Rash beginning on bilateral arms. O 6/10/2009 Bloody stools 24 hours after admini 6/9/2009 Pt had flu vaccine on 1-23-09. Since 5/20/2009 Diagnose Juvenile Rheumatoid Arth 6/3/2009 7 days following inj - inj site slowly t 6/10/2009 Approx. 30 minutes after receiving v 6/10/2009 Inflammation, redness and tenderne 6/10/2009 About 5 mins after rec'vg all imm. ap 6/10/2009 Redness started (L) thigh increased
348879 348880 348882 348883 348885 348898 348899 348900 348902 348903 348904 348905 348906 348907 348908 348915 348918 348919 348920 348926 348927 348928 348929 348930 348931 348932 348933 348934 348935 348936 348937 348938 348939 348940 348942 348943 348944 348945 348946 348947 348948 348958 348959 348960 348961 348962 348963 348964 348965 348966 348967
6/10/2009 6/10/2009 CA 6/10/2009 IN 6/10/2009 CA 6/10/2009 KY 6/10/2009 6/10/2009 VA 6/10/2009 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/11/2009 6/11/2009 AR 6/11/2009 NJ 6/11/2009 TX 6/11/2009 IL 6/11/2009 FL 6/11/2009 NY 6/11/2009 TN 6/11/2009 MI 6/11/2009 NC 6/11/2009 GA 6/11/2009 MS 6/11/2009 PA 6/11/2009 OR 6/11/2009 MA 6/11/2009 MO 6/11/2009 PR 6/11/2009 6/11/2009 TN 6/11/2009 IN 6/11/2009 IN 6/11/2009 6/11/2009 IL 6/11/2009 CA 6/11/2009 MT 6/11/2009 MA 6/11/2009 IL 6/11/2009 6/11/2009 MN 6/11/2009 MN 6/11/2009 6/11/2009 GA 6/11/2009 MO 6/11/2009 KY 6/11/2009 FL 6/11/2009 PR 6/11/2009 MD 6/11/2009 CA
0.8 8 5 60 40 30 22 35 36 33 37 1.9 25 18 1.3 23 26 16 65 14 51 12 41 4 17 77 39 5 32 51 2 12 52 54 5 60 4 0.3 66 26 72 82 39 28 10 1 15 17 1.3 11
0 8 5 60 30 30 22 35 36 33 37 1 25 18 1 26 16 65 14 51 12 41 4 17 77 5 32 2 12 52 54 5 60 4 0 66 26 72 82 39 28 10 1 15 17 1
U 0.8 M F F F M M F F F F F 0.9 F F F 0.3 M F F F M M M F M F M F M F F F 0.6 M M F F F F M 0.3 F F M F F M F F 0F F F 0.2 F M
No data given. 6/2/2009 Gave PEDIARIX but didn't need a d 6/10/2009 Redness -"Kiwi size"- approx. 3-4 in 6/10/2009 Seen in clinic 1 week after vaccine 6 6/10/2009 Arm sore next day with increased re 7/15/2005 Description: 11/10/98. Received ant 6/23/2005 Multiple medical conditions diagnos 6/16/2005 Symptom: Dermatitis, focal Start: 0 11/9/2006 Patient received FLUMIST and ADA 11/7/2006 Patient received Tdap into the left s 11/3/2006 Symptom: Fever start: 10/31/2006 11/6/2006 Description: 37 y/o female develope ### 22 month old female received DTaP 6/11/2009 NOTE: Reported Y Adverse Event is d 6/10/2009 None stated 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/11/2009 rash, uticaria 5/15/2009 Pt recd ADACEL and MENACTRA 0 ### Fever 103 degree and rigor 12 hour 6/4/2009 Generalized Urticaria Patient treated 6/5/2009 The shot was given to me months a Red, warm to touch 2x2 circumferen 6/5/2009 Varicella vaccine breakthrough. Dia At 3d after vaccine. Severe local rea 6/5/2009 Pt called on 6/5/09 c/o pain in (L) ar 6/8/2009 Right upper arm area of induration a 6/8/2009 See attached side effects which hav 6/9/2009 Patient received PNEUMOVAX 23 v 5/20/2009 Pt came in the clinic on 5/20. Mom s 5/29/2009 Local reaction with marked erythem 6/11/2009 Had rash on neck after 1st shot (4-5 6/11/2009 About 2min after injection (s/s) Pt go 6/11/2009 Redness, swelling from shoulder to 6/10/2009 Right arm red, swollen, bruised, war 6/11/2009 Patient given ADACEL instead of D 6/11/2009 Forceful vomiting 24 degrees after v 6/11/2009 Swollen, itchy, warm, sore, rash 6" l 6/11/2009 This case was reported via medical 6/11/2009 Pt received Tdap vaccine in the ED 6/11/2009 From physician note: "her right arm 6/11/2009 3day fever to 101F responded to NS 6/11/2009 client received vaccines MMR, and 6/11/2009 C/O pain, erythema, swelling 3-4" in 6/11/2009 Diffuse drug reaction of head chest 6/11/2009 Immediately after vaccine was given 6/11/2009 HEADACHE, DIZZINESS, PROBLE 6/11/2009 maculopapular, red in color, blanchi 6/11/2009 rash on trunk and forearms present
348968 348969 348970 348971 348972 348973 348974 348975 348976 348978 348979 348980 348981 348982 348983 348984 348985 348986 348987 348988 348977 348989 348990 348991 348992 348993 348994 348995 348996 348997 348998 348999 349000 349001 349002 349003 349004 349005 349007 349010 349011 349012 349013 349014 349015 349016 349017 349018 349019 349020 349022
6/11/2009 CA 6/11/2009 MI 6/11/2009 TX 6/11/2009 FL 6/11/2009 NC 6/11/2009 TX 6/11/2009 CA 6/11/2009 SD 6/11/2009 AR 6/11/2009 CA 6/11/2009 CA 6/11/2009 KY 6/11/2009 KY 6/11/2009 WI 6/11/2009 CA 6/11/2009 AZ 6/11/2009 AZ 6/11/2009 WA 6/11/2009 AZ 6/11/2009 CO 6/12/2009 WA 6/12/2009 MI 6/12/2009 CA 6/12/2009 VA 6/12/2009 MO 6/12/2009 VA 6/12/2009 TX 6/12/2009 CA 6/12/2009 SC 6/12/2009 NC 6/12/2009 MD 6/12/2009 NE 6/12/2009 CT 6/12/2009 OR 6/12/2009 WI 6/12/2009 MI 6/12/2009 OH 6/12/2009 OH 6/12/2009 IA 6/12/2009 FL 6/12/2009 GA 6/12/2009 OH 6/12/2009 PA 6/12/2009 KY 6/12/2009 TX 6/12/2009 KY 6/12/2009 TX 6/12/2009 PA 6/12/2009 PA 6/12/2009 CT 6/12/2009 WI
42 1.3 1.8 7 28 26 14 17 16 47 1 11 4 11 1 4 5 5 65 15 57 0 19 9 8 5 1 78 2 5 1 66 63 0.2 16 15 17 16 69 1.9 2 17 65 0.5 13 18 25 11 5 67 18
42 1 1 7 28 26 14 17 16 42 1 11 4 11 1 4 5 5 65 57 0 19 9 8 5 1 78 2 5 1 66 63 0 16 15 17 69 1 2 17 65 0 13 18 25 11 5 67 18
M 0.3 M 0.8 F M F M F M F U 0F F F M 0F M M F M M M 0F F M M F 0M F 0.2 F F 0F F F 0.2 F F F F F F 0.9 F 0.4 M F F 0.5 M F M F M F F F
6/11/2009 Rash to trunk and back with some it 6/11/2009 2-3 minute long seizure associated 6/11/2009 Rash: onset 6/7/09, duration of 3 da 6/11/2009 patient experienced yesterday (6/10 6/11/2009 55 X 60 mm area of induration, war 6/11/2009 redness, induration, pain, itching, w 6/11/2009 April 2009: Pt. had conjunctivitis in b 6/11/2009 Second dose of Hepatitis A given by 6/11/2009 Approx 90 seconds after the first inj Not recently, but want to report now 6/11/2009 Varicella Molluscum after previous d 6/11/2009 Woke up from a nap around 5pm on 6/11/2009 Pt presents with red, raised area on 6/11/2009 Fainted after Tdap, Menactra , Varic 6/11/2009 Urticarial rash within 6 H of adminis 6/11/2009 Localize reaction. Injection site, swe 6/11/2009 (L) arm 2x2 cm red, cellulitic area w 6/11/2009 Shingles - dx 5/5/09. 6/11/2009 Red arm syndrome, headache + fev 6/11/2009 Broke out with blisters on mouth. 6/11/2009 Thickness of the eyelids, dizziness, 6/8/2009 Febrile (101) 24 hours after immuniz Bilateral finger rash, erythematous n 6/9/2009 1 1/2" diameter redness no induratio 6/9/2009 6/9/09 Mother of the client reported 6/9/2009 Marked by swollen upper left arm sh 6/8/2009 Child broke out in hives within 24 hr 6/6/2009 Patient developed rash about 1 1/2" 6/5/2009 Shortly after vaccine administration, 6/8/2009 Pt developed redness, swelling & in 6/10/2009 Received MMR, varicella, PREVNA 6/10/2009 Developed spots located on her sca Difuse varicellaform rash on chest, b 6/5/2009 very fussy 6/8/2009 After administration of GARDASIL p 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/12/2009 Patient had vaccines 6/10/09. Had H 6/11/2009 Swelling and warmth at the site of in 6/11/2009 Sore at injection site. Low grade fev 6/11/2009 Site reaction- Red, itchy, warm 2 1/2 6/12/2009 Stated after patient received shots c 6/12/2009 Pt given VAQTA and MENACTRA. 6/12/2009 Pt received vaccines approx. at 2:30 6/12/2009 acute postvaccinial lymphadenitis b 6/12/2009 on 5/23/09 developed headaches th 6/12/2009 6/10/2009 Patients Mother called of 6/12/2009 14:30 vaccine administered pt beca 6/12/2009 Client fainted for a few seconds. I h
349023 349024 349025 349026 349027 349028 349029 349030 349031 349032 349033 349045 349046 349047 349048 349049 349050 349051 349052 349053 349054 349055 349056 349057 349058 349059 349060 349061 349062 349063 349064 349065 349066 349034 349035 349036 349037 349067 349076 349080 349082 349083 349084 349085 349086 349087 349088 349090 349091 349092 349093
6/12/2009 GA 6/12/2009 FL 6/12/2009 VA 6/12/2009 NM 6/12/2009 OK 6/12/2009 MO 6/12/2009 GA 6/12/2009 CA 6/12/2009 OR 6/12/2009 CA 6/12/2009 OH 6/12/2009 6/12/2009 WA 6/12/2009 WA 6/12/2009 CA 6/12/2009 TX 6/12/2009 TX 6/12/2009 SC 6/12/2009 AR 6/12/2009 NE 6/12/2009 KY 6/12/2009 KY 6/12/2009 TX 6/12/2009 NC 6/12/2009 OH 6/12/2009 CA 6/12/2009 FL 6/12/2009 MN 6/12/2009 MO 6/12/2009 OR 6/12/2009 ID 6/12/2009 WI 6/12/2009 NE 6/13/2009 NY 6/13/2009 CT 6/14/2009 TX 6/14/2009 MI 6/15/2009 6/15/2009 PA 6/15/2009 ME 6/15/2009 TX 6/15/2009 RI 6/15/2009 MD 6/15/2009 CA 6/15/2009 DE 6/15/2009 NY 6/15/2009 6/15/2009 NY 6/15/2009 OH 6/15/2009 KY 6/15/2009 MI
58 24 23 36 1.6 27 43 28 17 5 8
58 24 23 36 1
68 1.1 4 1.3 12 15 2 0.2 29 36 10 4 66 1.1
68 1 4 1 12 15 2 0 29 36 10 4 66 1
25 1.2 28 11 1.5 0.6 0.2 1 34 50 64 66
25 1 28 11 1 0 0 1 34 50
18 86 18 29
18 86
0.8 15 6 19 0.4
43 28 17 5 8
66
29
6 19 0 15
F F F M 0.6 M M F M F F M M F 0.1 M M 0.3 F M M 0.8 M 0.2 M F F M F F 0.1 M U F 0.2 M F F 0.5 M 0.6 M 0.2 M 0F F M M F F F F F F F F F M F 0.4 F F
6/12/2009 Exactly 24 hours from the vaccinatio 6/12/2009 decreased sensation in left arm, left 6/12/2009 Approximately 24 hrs after vaccinati 6/10/2009 Pt was experiencing itchy palms and 6/12/2009 area surrounding vaccine site was r 6/12/2009 Patient is 28 year old male with com 6/12/2009 Day after immunizations began hav 6/12/2009 Individual developed a maculopapu 6/12/2009 Reports rash and swelling noted in 6/12/2009 Left Deltoid muscle red/swollen and 6/12/2009 CHILD RECEIVED VACCINE ON 0 6/12/2009 This case was reported via a statem 6/12/2009 Rash & pain at injection site (~ 3" in 6/12/2009 Pt came in with what looked like bug 6/12/2009 Redness with swelling to right arm. 6/12/2009 Large erythematous rxn to both legs 6/12/2009 Large, warm and tender indurated a 6/12/2009 After MENACTRA injection. Child ha 6/12/2009 Erythema confluent smooth area L d 6/1/2009 On 05/26/09 after receiving immuniz 6/12/2009 Patient complains of headache afte 6/12/2009 Donor states she has muscle cramp 6/12/2009 Red puffy reaction at site of VARIVA 6/12/2009 Patient presented to office with redn 6/12/2009 Pt received ZOSTAVAX vaccine on 6/12/2009 Instant swelling and redness at injec Swelling and redness at injection sit 6/11/2009 Right deltoid pain with radiating to n 6/9/2009 6/7/09 Head to toe rash. Blisters m 6/12/2009 Tightness, in chest, pale, warm, nau 6/11/2009 Evening of 5/27. arm pain On 5/28. 6/12/2009 Child was at daycare. He took a lon 6/1/2009 Had immunization on 5/26/09, had e 6/13/2009 Child developed Abnormal Seborrhe 6/13/2009 rash to MMR 10 days post vaccine 6/14/2009 About two days after my 2nd vaccin 6/14/2009 Pt received vaccine in the hospital. 6/12/2009 Report obtained Y from literature case 6/11/2009 Initial report was received 04 June 2 6/10/2009 Initial report received on 08 June 20 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/10/2009 Patient started sneezing approx. 20 6/14/2009 Achy joints (not just in shoulders wit 6/15/2009 THURSDAY, JUNE 4TH, RIGHT SI 6/15/2009 syncope and briefly passed out a fe
349094 349095 349096 349097 349098 349099 349100 349101 349102 349103 349104 349105 349106 349107 349108 349110 349111 349112 349113 349114 349115 349116 349120 349123 349125 349127 349128 349129 349130 349131 349132 349133 349134 349135 349136 349137 349138 349139 349140 349141 349142 349143 349144 349145 349146 349147 349148 349149 349150 349151 349152
6/15/2009 TX 6/15/2009 WI 6/15/2009 KS 6/15/2009 PA 6/15/2009 MI 6/15/2009 MI 6/15/2009 WA 6/15/2009 WA 6/15/2009 CO 6/15/2009 NC 6/15/2009 WA 6/15/2009 WA 6/15/2009 MN 6/15/2009 CO 6/15/2009 RI 6/15/2009 OK 6/15/2009 OK 6/15/2009 FL 6/15/2009 MA 6/15/2009 6/15/2009 CT 6/15/2009 AK 6/15/2009 IL 6/15/2009 CO 6/15/2009 IL 6/15/2009 MN 6/15/2009 VA 6/15/2009 CA 6/15/2009 PA 6/15/2009 NC 6/15/2009 CA 6/15/2009 OH 6/15/2009 NY 6/15/2009 KS 6/15/2009 MA 6/15/2009 OH 6/15/2009 MT 6/15/2009 TX 6/15/2009 FL 6/15/2009 NC 6/15/2009 OH 6/15/2009 NY 6/15/2009 OR 6/15/2009 NJ 6/15/2009 NH 6/15/2009 VA 6/15/2009 VA 6/15/2009 MD 6/15/2009 6/15/2009 CT 6/15/2009 MA
29 11 62 40 69 8 1.6 1.5 56 71 1.5 4 13 61 66 4 11 37 1 16 0.7 19 10.4 69 61 11 60 4 4 1.4 54 11 17 40 18 24 4 22 10
29 11 62 40 69 8 1 1 56 71 1 4 13 61 66 17 4 11 37 1 16 0 10 69 61 11 60 4 4 1 54 11 17 40 18 24 4 22 10
64 66 30 30 13 12 72
64 66 30 29 11 12 72
19
19
F F F F M M 0.6 M 0.6 M F F 0.5 F M F F F F F F F 0F F 0.7 M F M F M F F M M 0.4 M F F F F M F M F M U F M F F M M M U F F
6/15/2009 CLIENT RECEIVED ALL THE VACC 6/15/2009 Day of injection patient complained 6/15/2009 3010/29 Itching under armpits 10/30 6/15/2009 Following anthrax vaccination, mem 6/15/2009 Pt developed zoster rash within 24h 6/15/2009 Vaccination given at 9:20 a.m. Patie 6/15/2009 4 days after receiving DTaP #4 and 6/15/2009 Shots were given on 5/20/09. Shot s 6/15/2009 HAD yellow fever INJECTION ON 6 6/15/2009 Developed zoster pain 48 hours afte 6/15/2009 Redness/extreme swelling to injectio 6/15/2009 Pt received vaccinations on 6/9/09. 6/15/2009 Fainting spells started in January 20 6/15/2009 4x4 Swelling, redness, irritation at in 6/15/2009 Varicella-like rash developed 3 days 6/1/2009 Red swollen dots around injection s 6/15/2009 At injection site approximately equa 6/8/2009 Patient suddenly fell to the floor abo 6/9/2009 Severe bilateral lower extremity ede 6/10/2009 Developed erythema multiforme w/i 6/15/2009 This case was reported by a healthc 5/28/2009 Mom reports she noticed hives on b 6/10/2009 Pt. was seen on 6/9/09 for pap sme 6/11/2009 Pt fainted in waiting area. 6/10/2009 (No pain) 11/11/08 - 1st sore on out 6/9/2009 Patient has red rash, left side of fore 6/15/2009 5/27/09 S.T. Congestion; 6/2/09 Fev 6/15/2009 Swelling, pain, erythema in (whole u 6/9/2009 At bedtime on 6/5/09 mother noticed 6/15/2009 Rt facial nerve palsy "Bell's palsy" 6/9/2009 Given vaccines 6/3/09, started with 6/13/2009 On 5-29-09-4AM started vomiting/di 5/22/2009 Numbness in wrist, elbow and shou 6/14/2009 Pt developed body aches, myalgias 6/10/2009 Red, swelling R Deltoid 6/15/2009 Red raised rash on hands, chin 6/12 6/15/2009 Syncope in waiting room. Fell and h 6/15/2009 Lt thigh with large area of erythema 6/12/2009 R interior deltoid ~ 3 cm oval shape 6/15/2009 Varicella vaccine adm. on 6/10/09. M Patient received her vaccine on 4/2 6/9/2009 (1) Severe headache and swelling R 6/11/2009 Pt states he had swelling and pain a 6/9/2009 On 5/21/09 Pt saw Doctor reports re 6/15/2009 T to > 102 within 4 hours, cellulitis p (Hep A and MENACTRA) Tdap 8/40 5/13/2009 After HepA on 10/29/08 HA started 5/29/2009 Administered 5/22/09; on Sunday, 5 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
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6/15/2009 6/15/2009 CT 6/15/2009 6/15/2009 MO 6/15/2009 WV 6/15/2009 MA 6/15/2009 AZ 6/15/2009 6/15/2009 IL 6/15/2009 NC 6/15/2009 IL 6/15/2009 MN 6/15/2009 NC 6/15/2009 AK 6/15/2009 WA 6/15/2009 ME 6/15/2009 6/15/2009 6/15/2009 6/15/2009 MI 6/15/2009 6/15/2009 CA 6/15/2009 PA 6/15/2009 NC 6/15/2009 NY 6/15/2009 6/15/2009 NJ 6/15/2009 CA 6/15/2009 6/15/2009 OH 6/15/2009 CT 6/15/2009 OK 6/15/2009 AR 6/15/2009 6/15/2009 FL 6/15/2009 WA 6/15/2009 6/15/2009 NJ 6/15/2009 MI 6/15/2009 6/15/2009 6/15/2009 CT 6/15/2009 CO 6/15/2009 6/15/2009 SC 6/15/2009 NY 6/15/2009 IN 6/15/2009 6/15/2009 6/15/2009 6/15/2009 CO
18 21 17 19 21
18 21 16 19 20
21 11 10 16 14 2 43 16 17 20
21 11 10 16 14 1
17 15 16
17 15
15 15
15 15
19
19
16 17 20
12 21 17 25 25 14 16 23 23 15 23 27 20 21 25 14 16 16 15 21
21 17 25 14 16
27 21 25 16 16 15 21
U F F F F F F F F F F F F 1M F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received for th 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received throu 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 5/28/09: Client received MMR and V None stated 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Initial and follow up information has 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
349304 349305 349306 349307 349308 349309 349310 349311 349312 349313 349314 349315 349316 349317 349318 349319 349320 349321 349322 349323 349324 349325 349326 349327 349328 349329 349330 349331 349332 349333 349334 349335 349336 349337 349338 349366 349367 349368 349369 349370 349371 349372 349373 349374 349375 349376 349377 349378 349379 349380 349381
6/15/2009 CA 6/15/2009 CA 6/15/2009 6/15/2009 CA 6/15/2009 6/15/2009 CA 6/15/2009 6/15/2009 MI 6/15/2009 NY 6/15/2009 AR 6/15/2009 6/15/2009 IN 6/15/2009 GA 6/15/2009 MA 6/15/2009 CT 6/15/2009 NC 6/15/2009 6/15/2009 6/15/2009 6/15/2009 OK 6/15/2009 PA 6/15/2009 6/15/2009 PA 6/15/2009 IL 6/15/2009 NV 6/15/2009 CA 6/15/2009 6/15/2009 OR 6/15/2009 NY 6/15/2009 FL 6/15/2009 CT 6/15/2009 FL 6/15/2009 6/15/2009 CT 6/15/2009 6/15/2009 RI 6/15/2009 CA 6/15/2009 CA 6/15/2009 MN 6/15/2009 6/15/2009 OH 6/15/2009 GA 6/15/2009 6/15/2009 IN 6/15/2009 NY 6/15/2009 FL 6/15/2009 CT 6/15/2009 LA 6/15/2009 SC 6/15/2009 6/15/2009
33 17
17
21 21 26
21 26
17 24 14
17
25
25
15 18 24 25 14 16 19 15 11 20 16
14
18 24 14 16 19 15 11 19 16
15 23
23
12 34
12 34
17 16 25 11 14 23 15 24 16 25 14 15
17
23 15
25 11 14 15 24 25 15
14
F F U F F F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
6/12/2009 Information has been received form 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/21/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
349382 349383 349384 349385 349386 349387 349388 349389 349390 349391 349392 349393 349109 349173 349174 349177 349179 349184 349186 349188 349190 349192 349194 349196 349197 349198 349199 349202 349204 349205 349214 349215 349216 349217 349218 349219 349220 349221 349222 349223 349224 349225 349226 349227 349228 349229 349230 349231 349232 349233 349234
6/15/2009 VA 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 NY 6/15/2009 6/15/2009 6/16/2009 CA 6/16/2009 FL 6/16/2009 FL 6/16/2009 6/16/2009 NJ 6/16/2009 6/16/2009 6/16/2009 CO 6/16/2009 OR 6/16/2009 MA 6/16/2009 TX 6/16/2009 NY 6/16/2009 GA 6/16/2009 WV 6/16/2009 WV 6/16/2009 OR 6/16/2009 OR 6/16/2009 SC 6/16/2009 IN 6/16/2009 OH 6/16/2009 NC 6/16/2009 IN 6/16/2009 OH 6/16/2009 OK 6/16/2009 CT 6/16/2009 LA 6/16/2009 FL 6/16/2009 OR 6/16/2009 CA 6/16/2009 NY 6/16/2009 NE 6/16/2009 FL 6/16/2009 NC 6/16/2009 CA 6/16/2009 FL 6/16/2009 AZ 6/16/2009 IN 6/16/2009 NY 6/16/2009 TX
11
11
14 25
22 0.2 0.6 16 18 18 65 5 6 16 17 22 18 52 59 4 4 32 0.5 5 4 66 0.3 5 45 37 25 66 4 0.6 12 45 4 14 60 13 39 21 14
22 0
18 18 65 5 6 16 17 22 18 59 4 4 32 0 5 4 66 0 5 45 37 25 66 4 0 12 45 4 14 60 13 39 21 14
F F F F F F F U F F F F F 0.2 F F F F F M M M F F F F F F M F F 0.5 F M M F 0.3 F F M F F F F 0.6 F M M F F M F F F F
6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/15/2009 DURING A ROUTINE PHYSICAL, I 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/11/2009 Developed Alopecia Areata Univers 6/6/2009 I received the vaccine and a month 6/9/2009 Pt was seen 6/8/09 for 5 year WCC 6/10/2009 6/3/09 office visit: Red, warm area 6/11/2009 Light headedness, dizziness since v 6/12/2009 Patient fainted 6/12/2009 Tingling & numbness of the Rt finge 6/11/2009 Immediately after receiving vaccine, 6/11/2009 Severe pain at the injection, Limited 6/11/2009 Severe tenderness and swelling at s 6/10/2009 6/3/09 Came in for office visit - Urtic 6/10/2009 6/10/09 office visit- firm, red, tender 6/11/2009 Allergic reaction rash, swollen area 6/16/2009 EXFOLIATIVE ERYTHRODERMA 6/8/2009 Mom described area on (R) leg is ap 6/10/2009 Vaccine given on 6/5/09. On 6/7/09 6/8/2009 Patient has a quarter-sized red area 6/8/2009 Received PCV-7 in (R) thigh and PE 6/5/2009 Child has a 6cm x 3cm erythematou 6/10/2009 Member woke during night with chill 6/9/2009 Redness 7cm x 5 1/2 cm warm to to 5/4/2009 Spreading, redness, pain 5/31/2009 Within 1/2 hr. - hives and swelling th 6/5/2009 (L) leg red and swollen 35 mm X 35 5/29/2009 Child received PENTACEL, PREVE 6/10/2009 Right deltoid, red, warm to touch. S 6/8/2009 Frontal headache "head pounding" 6/8/2009 Pt received Immunisation and then 6/4/2009 Pt was given MENACTRA - Vaccine 6/15/2009 A developed shingles like rash in le 6/14/2009 Rash 10 days post vaccination seen 6/12/2009 6-2-09 Rcvd MMR SubQ @ Health 6/3/2009 Fever, chills, headache, sore throat 6/9/2009 Fatigue X 2 days
349235 349236 349237 349238 349239 349240 349241 349242 349243 349244 349245 349246 349247 349248 349249 349250 349251 349252 349253 349254 349255 349256 349257 349258 349259 349260 349261 349262 349263 349264 349265 349266 349267 349269 349270 349271 349272 349273 349274 349275 349277 349279 349281 349282 349288 349289 349290 349276 349339 349358 349359
6/16/2009 AZ 6/16/2009 MN 6/16/2009 CA 6/16/2009 MI 6/16/2009 AL 6/16/2009 ME 6/16/2009 WA 6/16/2009 WI 6/16/2009 PA 6/16/2009 LA 6/16/2009 CO 6/16/2009 6/16/2009 CO 6/16/2009 GA 6/16/2009 SC 6/16/2009 WA 6/16/2009 6/16/2009 IN 6/16/2009 MN 6/16/2009 IL 6/16/2009 ME 6/16/2009 TX 6/16/2009 NY 6/16/2009 MI 6/16/2009 MI 6/16/2009 CA 6/16/2009 WI 6/16/2009 MA 6/16/2009 CO 6/16/2009 CO 6/16/2009 WA 6/16/2009 MO 6/16/2009 MA 6/16/2009 CA 6/16/2009 NM 6/16/2009 GA 6/16/2009 CO 6/16/2009 NC 6/16/2009 NE 6/16/2009 6/16/2009 AR 6/16/2009 CA 6/16/2009 ID 6/16/2009 MO 6/16/2009 6/16/2009 CA 6/16/2009 6/17/2009 6/17/2009 6/17/2009 NC 6/17/2009 IA
0.1 16 58 17 47 72 9 75 43 12 38
0 16 58 18 47 72 9 75 72 43 12 38
1.3 83 51
1 83 51
7 17 37 1 16 42 73 73 62 47 24 15 29 23 49 1.3 18 67 0.2 56 2 1.9 8 1 10 0.2 5 63 37 13 8
7 17
1.3 0.2
1 0
1 16 43
47 24 15 29 23 49 1 18 67 0 56 2 1 8 1 10 0 5 63 37 13 8
0.1 M F F M M F F F F M M F F 0.3 M F F U F F M 0M F M U U U F F M F M M 0.3 M F F 0.2 F F 0.5 M 0.9 M M 0F M 0.2 F M F F F F U 0.3 F 0.2 M
6/8/2009 Increased irritability with green/muc 6/9/2009 Woke up at 2 AM on 6/9/09 with tem 6/6/2009 Hives occurred 5 to 7 days after shi 4/23/2009 Received vaccines 4/21/09. That nig 6/8/2009 None stated 6/9/2009 Large 9 cm red area with 3x4 cm ra 6/12/2009 Localized itching, erythema, and sw 6/16/2009 Tenderness, swelling, erythema. No 6/9/2009 Pain in arm neck back, chills fever s 6/10/2009 None stated 6/11/2009 Had IZs 6/9/09, on 6/11/09 MOC ca None stated 6/10/2009 No adverse reactions previously 6/9/2009 Patient had fever and a seizure afte 6/11/2009 Pt came in and stated that 2 months 6/10/2009 Left arm edema, tenderness, fatigue UTD 6/10/2009 Injection site is reddened and raised 6/8/2009 Redness, tenderness, nausea 6/5/2009 None stated 6/9/2009 Break through. Chicken pox 6-8-09 6/16/2009 pt c/o itching at menactra injection s 6/16/2009 member was given Typhoid at 0915 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 On the 12th and 13th day after rece 6/16/2009 One month after injection the patien 6/16/2009 3/29/2009 Was hospitalized with me 6/16/2009 After Tdap given, employee experie 6/16/2009 Pt received smallpox vaccination on 6/3/2009 6/03/09 1:10 p.m. - phone call from 6/16/2009 Err:508 6/16/2009 1 month following 1st gardasil inject 6/16/2009 Red, swollen, Painful, warm to touch 6/16/2009 Patient was given Hepatitis A vaccin 6/16/2009 6/12/09 9am: Two days after vaccin 6/16/2009 Patient fell asleep on the car ride ho 6/16/2009 My son got his vaccinations on Thu 6/16/2009 Right Arm reddened, swollen and p 6/16/2009 Pt. had vaccines on 6-5-09, and on 6/12/2009 MOC states child has been seizure 6/16/2009 Shots given around 11am 6-12-09. 6/15/2009 2" red area to injection site- Rt. leg ( 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/11/2009 sWELLING AND REDNESS ON RIG 6/16/2009 InformationYhas been received from 6/12/2009 2 days after had a seizure with vom 6/17/2009 Presented to Y ER -Died 6/26/09 Aut
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6/17/2009 IA 6/17/2009 AZ 6/17/2009 IN 6/17/2009 NC 6/17/2009 MI 6/17/2009 NY 6/17/2009 SC 6/17/2009 OR 6/17/2009 MO 6/17/2009 NY 6/17/2009 TX 6/17/2009 AR 6/17/2009 NJ 6/17/2009 NC 6/17/2009 WV 6/17/2009 UT 6/17/2009 FL 6/17/2009 VA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 6/17/2009 NC 6/17/2009 WV 6/17/2009 NE 6/17/2009 CT 6/17/2009 TX 6/17/2009 LA 6/17/2009 TN 6/17/2009 6/17/2009 AL 6/17/2009 PA 6/17/2009 PA 6/17/2009 6/17/2009 CA 6/17/2009 NC 6/17/2009 CA 6/17/2009 NC 6/17/2009 TX 6/17/2009 ND 6/17/2009 NC 6/17/2009 NC 6/17/2009 VA 6/17/2009 VA 6/17/2009 TX 6/17/2009 CA 6/17/2009 WI 6/17/2009 MA 6/17/2009 AK 6/17/2009 NC
0.2 63 26 13 39 2 11 28 0.3 64 14 68 24 10 14 49 1.1 22 28 34 35 25 18 34 5 12 27 63 0.3 0.5 22 1.6 4 4 25 53 39 19 33 0.2 1.1 45 28 17 15 11 4 11 4 9 38
0 63 26 29 2 11 28 0 64 14 68 24 10 14 49 1 22 28 34 35 25 18 34 5 12 63 0 0 22 1 4 4 25 53 39 19 0 1 45 28 17 15 11 4 11 4 9 38
0.2 F F F F F 1F M M 0.4 M M M M F M F F 0.1 M F M M U F M M M F F F 0.3 F 0.5 M M 0.6 M F M M M M U U 0.2 M 0.1 F F M F F M F F M M M
6/17/2009 Mom foundYbaby unresponsive 12-2 6/15/2009 GBS - numbness, tingling, burning o 6/17/2009 i got the hep shot on 4-22-09. it was 6/17/2009 since having gardasil shots my daug 6/17/2009 Tremendous chills and pain in the le 6/17/2009 My son was sore for the remainder 6/17/2009 Three hours after immunizations pa 6/17/2009 Patient was administered vaccine. P 6/17/2009 One day after vaccine was given, on 6/17/2009 Inability to breath, extreme shortnes 6/17/2009 varivax received approx 8 hrslater e 6/17/2009 Fever (104) reduced with acetamino 6/17/2009 Dianosis: Left brachial neuritis after 6/17/2009 CLIENT GIVEN VACCINES BECAM 6/17/2009 Patient developed bacteremia witho 6/17/2009 I received my Zostavax DS PWD #1 6/17/2009 High fever, greater than 103F, axilla 6/17/2009 Wasnt told to wait immediately after ### Description: Had febrile illness withi 2/10/2005 Description: diffuse puritic rash 2 da 6/14/2005 Description: Diffuse maculopapular 6/17/2009 Rash- competent w/ past - MMR ras 2/8/2005 12/13/86 - received spv, yellow feve 6/15/2009 Tdap given on 06-11-09. Began ha 6/17/2009 No fever, redness and swelling from 6/17/2009 Swelling and red reaction with indur 6/9/2009 Received a phone call from patient 6/16/2009 Developed rash on face and upper 6/10/2009 On 6/10/09 grandmother presented 6/17/2009 Seizure 12/7/2004 Anthrax vaccine #1, #2, #3- no prob 6/17/2009 Apparent seizure that evening after 6/15/2009 Received Kinrix on 6/11/09, IM/L ar 6/15/2009 Received Kinrix on 6/10/09 IM/Larm 1/27/2005 2/17/04 - received ANTHRAX vaccin 6/17/2009 Body ache, fever, right hand swellin 2/22/2005 Description: 1/21/05- received prima Rash, but not around injection site. ### Vaccination site erythema, induratio 6/17/2009 Vaccines administered 06/10/09 at 6/17/2009 Patient broke out on forehead, face ### Persistent, reproducible arthralgias 3/15/2005 08/17/04 - received smallpox vaccin 6/17/2009 Erythematous, non-fluctuant, indura 6/17/2009 Mildly indurated, mildly erythematou 6/17/2009 Local reaction to vaccine 6/17/2009 (L) Deltoid - swollen, red AMOXICIL 6/17/2009 7 by 2 cm area of erythema/swelling 6/17/2009 Erythema, induration, swelling, itchi 6/16/2009 9 cm roughly circular red/warm/itchi ### 1/13/03 - received anthrax vaccine #
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6/17/2009 6/17/2009 6/17/2009 CT 6/17/2009 NC 6/17/2009 NC 6/17/2009 NC 6/17/2009 GA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 CA 6/17/2009 IL 6/17/2009 6/17/2009 IL 6/17/2009 SC 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 CO 6/17/2009 MA 6/17/2009 IN 6/17/2009 ME 6/17/2009 6/17/2009 6/17/2009 VA 6/17/2009 6/17/2009 6/17/2009 CO 6/17/2009 CO 6/17/2009 NY 6/17/2009 6/17/2009 MA 6/17/2009 SC 6/17/2009 6/17/2009 MO 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MN 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 AZ 6/17/2009 AR 6/17/2009 MN 6/17/2009 6/17/2009 6/17/2009 IN
39 30 24 22 20 34 40 42 21 35 0.1 3 15 0 10 0.2 2
39 30 21 21 20 34 40 42 21 35 0 15 9 2
36 1.3 3
1 3
0
0
14 49
14 4 32 1.3
14 4
1
0
32 1 65 34 8 6
65 33
19 5 19 47 1 28
6
M M F U M U U U U U 0.1 U M M U M M 0M M F 0.2 M F F F 0U F U F F M F M M F F F 1M M F M M F F F F U F M F F M F
2/1/2005 DOD call received from patient on 1 ### Progressive L arm / shoulder pain w 4/15/2005 Description: 2/3/05- received SPV (3 9/17/2007 Description: SM developed, N&V, H 6/11/2009 20 y/o male, ADSM, presents as a r ### Description : progressive fatigue, co 6/17/2005 Description: This patient reports bac 2/18/2005 Description: Headache, arthralgias, ### Progressive, persistent bilateral sho ### Description: Headache, Myalgias, U 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received rega 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Initial information has been received 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2008 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from
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6/17/2009 NY 6/17/2009 PA 6/17/2009 NE 6/17/2009 OH 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MA 6/17/2009 NJ 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 OH 6/17/2009 6/17/2009 6/17/2009 IA 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 PA 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 IL 6/17/2009 6/17/2009 MD 6/17/2009 MN 6/17/2009 VA 6/17/2009 PA 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 ME 6/17/2009 NY 6/17/2009 CA 6/17/2009 KS 6/17/2009 6/17/2009 NY 6/17/2009 KS 6/17/2009 IL 6/17/2009 PA 6/17/2009 MI 6/17/2009 TX 6/17/2009 CO
1.7 1.3 12 1 8 1 1.2
1 12 1 8
1.3 5
1 5
1 27 1 5 4 30 2 5 5
5 4
5
1 51 9 1.1 4 1 9 2 2 4
1.2 1.7 1 5 19 1.1 1 10 14 50 1.5
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0.7 M F M 0M M F F U 0.3 F F F F M U M M F F F F F F U U F M F M M F U M M M F M M U U U 0.2 F 0.7 F 0M F F F 0F F F F M
5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 A caller reported that her daughter e 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from
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6/17/2009 6/17/2009 CT 6/17/2009 6/17/2009 6/17/2009 CT 6/17/2009 PA 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 OH 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 FL 6/17/2009 6/17/2009 AZ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 KY 6/17/2009 6/17/2009 6/17/2009 MI 6/17/2009 MI 6/17/2009 MO 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 WI 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 KY 6/17/2009 TX 6/17/2009 6/17/2009 TX 6/17/2009 PA 6/17/2009 NY 6/17/2009 MS 6/17/2009 MD 6/17/2009 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 6/17/2009 NY
42
4 37
4 37
33 46 5 55 1 11 45 4
1 11 45 4
1.5
1
30 4 5 1 5 1.5
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1
36
36
0.4 4 1.1
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39
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23 14 1 4
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42 30 48 36 1.3 5 20
1
41
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F F M F F F F F F F M F M F 0F M M F F 0.5 M F F M F F F 0.5 M F F F M U 0.4 F F 0.1 M M M M M F 0M F F M F F M F M M F
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6/17/2009 PA 6/17/2009 6/17/2009 TN 6/17/2009 PA 6/17/2009 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 MS 6/17/2009 6/17/2009 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NJ 6/17/2009 MO 6/17/2009 IN 6/17/2009 6/17/2009 VA 6/17/2009 6/17/2009 GA 6/17/2009 CA 6/17/2009 NY 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 FL 6/17/2009 WV 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 IN 6/17/2009 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 NM 6/17/2009 MN 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NM 6/17/2009 6/17/2009
4 3 34
34
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5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/26/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been viewed on the
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6/17/2009 LA 6/17/2009 6/17/2009 IL 6/17/2009 FL 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 FL 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MI 6/17/2009 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 6/18/2009 NJ 6/18/2009 PA 6/18/2009 6/18/2009 OK 6/18/2009 VA
28 30 1 6 2 1.3
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5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been receive from a 5/29/2009 The consumer reported that 10 yea 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received form 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received form 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 6/17/2009 Information has been received from 6/17/2009 Information has been received from 6/16/2009 This case was received on 09-June 6/15/2009 Initial report was received 11 June 2 3/21/2009 PT PRESENTED TO MEDICAL C/O
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6/18/2009 PA 6/18/2009 TN 6/18/2009 PA 6/18/2009 CO 6/18/2009 6/18/2009 FL 6/18/2009 MI 6/18/2009 OR 6/18/2009 NC 6/18/2009 FL 6/18/2009 FL 6/18/2009 NC 6/18/2009 NC 6/18/2009 NC 6/18/2009 NY 6/18/2009 CA 6/18/2009 TX 6/18/2009 NY 6/18/2009 TN 6/18/2009 NC 6/18/2009 OH 6/18/2009 6/18/2009 IN 6/18/2009 CA 6/18/2009 TX 6/18/2009 CA 6/18/2009 CA 6/18/2009 TX 6/18/2009 OH 6/18/2009 TX 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 ME 6/18/2009 VA 6/18/2009 CA 6/18/2009 CA 6/18/2009 FL 6/18/2009 AL 6/18/2009 MA 6/18/2009 VA 6/18/2009 IL 6/18/2009 MA 6/18/2009 HI 6/18/2009 PA 6/18/2009 PA 6/18/2009 MA 6/18/2009 OR 6/18/2009 NC
55 80 54 13 1 18 1 6 35 52 60 45 21 35 35 4 33 38 0.2 21 11
55 61 54 13 1 18 1 6 35 52 60 45 21
41 1.3 64 4 1.4 1.3 18 11 1.2 5 11 33 1 19 27 75 5 0.6 5 19 12.5 0.4 2 4 56 34 2 5 17
41 1 64 4 1 1 18 11 1 5 11 33 1 19 27 75 5 0 5 19 12 0 2 4 56 34 2 5 17
35 4 33 38 0 21 11
F M M F 0M F 0F F M M F M M M M F F M 0.2 M M M U F 0.3 M F F 0.4 M 0.3 M M M 0.2 M M M F 0F F F M M 0.6 M F F F 0.4 F 0.9 M F F M 0.6 F M F
6/18/2009 Fever 102.1 6/18/2009 patient broke out with shingles in his 6/18/2009 Patient received pneumococcal vac 6/18/2009 06-17-09 Fainting episodes x2 afte 6/18/2009 rash 6/18/2009 Patient had vaccine 9/11/08 and be 6/18/2009 Pt presented to our office on 6/18/0 6/18/2009 24 hours after vaccine patient comp 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Patient's throat 10 minutes after the 6/18/2009 Difuse red papule rash and itching f 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Complaining of continued pain and 6/18/2009 2 large blisters on lt arm where varic 6/18/2009 I began to have the following sympt 6/18/2009 Member called stating that he was r 6/18/2009 seen in emergency room twenty-fou 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Patient was entered into the electro 6/18/2009 Fever, chills, muscle aches, sore joi 6/18/2009 Fever 103, body aches, blotchy red 6/18/2009 could not walk 5 hours after shot wa 6/18/2009 Vaccine administered, vaccine 2 we 6/18/2009 Dr. requested that these side-effect 6/18/2009 L thigh swollen, red, + bump Dxper 6/18/2009 L upper thigh with induration, red 4x 6/18/2009 Sudden LOC onset about 10 minute 6/18/2009 Pt. c/o left arm pain and swelling. N 3/2/2009 See sheet 2/26/2009 Redness and swelling onset 1 day a 2/11/2009 Injection given left Deltoid on 2-7-09 2/13/2009 Fever of 101 degrees, - fever at 5:0 1/21/2009 Patient was in her car seat, after gra 6/18/2009 Information has been received from 6/18/2009 Started day of vaccine 17 hr HA and 6/17/2009 Pt had Td and ZOSTAVAX on 5/4/0 6/17/2009 Within minutes of injections, pt beca 6/18/2009 Convulsions (seizures) approx. 1 da Facial twitching and drooling 6/16/2009 Fainted after injection. No adverse a 6/18/2009 5 cm round, swollen red lesion on R 2 days after 4 month shots, develop 6/15/2009 VARICELLA complications: None 6/10/2009 Cold urticaria. ZYRTEC. 6/16/2009 Pt received Tdap @ 9:30 am on 6/1 6/9/2009 Right deltoid where Tdap administe 6/12/2009 The patient received DTaP vaccine 6/18/2009 Parent noticed the injection site was 6/16/2009 Pt. had fainting episodes with 1st do
349528 349530 349531 349532 349533 349498 349499 349534 349536 349537 349538 349539 349540 349542 349543 349544 349545 349549 349550 349557 349558 349559 349560 349561 349562 349563 349564 349565 349566 349567 349568 349569 349570 349571 349572 349573 349574 349575 349576 349577 349579 349580 349581 349582 349583 349584 349585 349586 349587 349588 349589
6/18/2009 OH 6/18/2009 NJ 6/18/2009 NJ 6/18/2009 VT 6/18/2009 MI 6/19/2009 6/19/2009 WA 6/19/2009 SD 6/19/2009 NE 6/19/2009 6/19/2009 6/19/2009 FL 6/19/2009 6/19/2009 NY 6/19/2009 6/19/2009 6/19/2009 CA 6/19/2009 6/19/2009 CO 6/19/2009 OH 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 IA 6/19/2009 NY 6/19/2009 MD 6/19/2009 WI 6/19/2009 OH 6/19/2009 OK 6/19/2009 NY 6/19/2009 NC 6/19/2009 FL 6/19/2009 NY 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 CA 6/19/2009 WI 6/19/2009 NC 6/19/2009 NC 6/19/2009 GA 6/19/2009 CA 6/19/2009 NC 6/19/2009 NC 6/19/2009 MI 6/19/2009 GA 6/19/2009 IL 6/19/2009 IL 6/19/2009 NY 6/19/2009 MI
0.1 32 25 1 69 35 15 24 31 48
0 32 25 1 69 35 15 24 31 48
5
5
22
22
25 96 0.2 18 36 31 21 26 10 86 4 24 22 10 12 34 4 1.3 34 70 27 1.8 70 27 23 11 65 46 41 1.2 64 18 10 2 1
25 0 18 36 31 21 26 20 86 4 24 22 10 12 34 4 1 34 70 27 1 70 27 23 11 65 46 41 1 64 18 10 1 1
0.1 M M M 0F F M F F M F M M M F F U F F 0.2 M M M M M M F F M M M F F M F 0.4 M M M M 0.8 F F M F F F M M 0.2 M M F F 1F 0F
6/3/2009 Diarrhea, vomiting 5/15/2009 Patient came to IMMs complaining o 5/15/2009 Patient came to IMMS complaining 6/18/2009 Pt father reported "it looked like hive 4/23/2009 On March 7, 2009, I noticed a rash 6/19/2009 PT STATES EVERY TIME HE REC 6/18/2009 Vaccines given at about 12:15 PM J 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received throu 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/19/2009 Mother driving client home. Client c 6/18/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Grandmother called clinic on 6/19/0 6/19/2009 Cellulitis to upper right arm noted th 6/19/2009 redness and swelling at site of vacc 6/19/2009 Local redness and swelling on site. 6/19/2009 fever, irritability, muscle/joint aches, 6/19/2009 unknown 6/19/2009 Left arm swelling and redness. No f 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Swelling injection site, Left upper ar 6/19/2009 Left arm swelling and redness. No f 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Vaccine administered 6/16 @ 10am 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 LOCAL REACTION TO VACCINE 6/19/2009 Patient developed Shingles on 1st b 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Around 6-7 pm on 6/17/09, client ha 6/19/2009 Patient received Pneumo vaccine ri 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 LYMPHNODE ENLARGED ON L IN 6/19/2009 ON the site of the flu shot there is a 6/19/2009 The day following administration of 6/19/2009 Patient Received Havrix (Peds Hep 6/19/2009 pt recieved varivax on 11-21-1997, 6/19/2009 NONE
349590 349591 349592 349593 349594 349595 349596 349597 349608 349609 349612 349614 349615 349617 349618 349619 349620 349621 349623 349624 349625 349626 349627 349628 349629 349630 349631 349632 349633 349634 349635 349636 349637 349638 349639 349640 349641 349642 349643 349644 349645 349646 349647 349648 349649 349650 349651 349598 349599 349600 349601
6/19/2009 KS 6/19/2009 AL 6/19/2009 NY 6/19/2009 TX 6/19/2009 NJ 6/19/2009 WA 6/19/2009 CA 6/19/2009 MI 6/19/2009 CA 6/19/2009 HI 6/19/2009 OR 6/19/2009 CA 6/19/2009 GU 6/19/2009 FL 6/19/2009 AL 6/19/2009 OH 6/19/2009 WI 6/19/2009 MA 6/19/2009 PR 6/19/2009 IL 6/19/2009 TN 6/19/2009 AK 6/19/2009 PA 6/19/2009 MI 6/19/2009 KS 6/19/2009 DC 6/19/2009 WA 6/19/2009 6/19/2009 GA 6/19/2009 FL 6/19/2009 CA 6/19/2009 CT 6/19/2009 VA 6/19/2009 IL 6/19/2009 IL 6/19/2009 NV 6/19/2009 MT 6/19/2009 OH 6/19/2009 MD 6/19/2009 VA 6/19/2009 NC 6/19/2009 MD 6/19/2009 OH 6/19/2009 SC 6/19/2009 GA 6/19/2009 MA 6/19/2009 FL 6/20/2009 CA 6/20/2009 CA 6/20/2009 NE 6/21/2009
60 16 1.3 38 0.4 37 20 34 51 2 45 58 53 1.5 0.4 1 7 29 48 88 3 9 0.4 6 5 1.3 5
60 16 8 38 0 37 20 34 51 2 45 58 53 1 0 0 7 29 46 88 3 9 0 6 5 1 5
0.4 29 0.5 7 5 61 51 4 5 15 44 14 66 29 45 41 10 19 18 5 70 34
0 29 0 7 5 61 51 4 5 15 44 14 66 29 45 41 10 19 18 5 70 34
F F M F 0.4 M M F F M 0.9 M F F M 0.5 M 0.4 M 1M M M M F F M 0.4 M F U 0.3 F M U 0.4 M F 0.5 M M M M M F M M F F M F F M F F F M M F U
6/19/2009 Ct obtained the prescription for the 6/19/2009 Client reports back on 6-18-2009, o 6/19/2009 PT RECEIVED VARIVAX ON 1-146/19/2009 rec'd MMR on 6/11/09. Kristin states 6/19/2009 Patient developed afebrile Seizures 6/19/2009 Smallpox shot was uneventful. Afte 6/19/2009 Patient became faint, diaphoretic an 6/19/2009 Received vaccine 6/16/09, each day 6/19/2009 Pt has persistent low grade pain sin 6/19/2009 6.17.09 @ 2:30 pm immunization gi 6/13/2009 On 6/10/09 patient felt generalized j 6/20/2009 Redness, swelling at injection site (l 6/22/2009 Soreness at site of injection - 6/17/0 6/19/2009 Child had redness and edema arou 6/19/2009 This case was reported by a physici 6/16/2009 Developed zoster PCR confirmed. 6/5/2009 Pt had tightness in throat, pale, whe 6/17/2009 04-20-09 - 04-24-09 = left arm, shou 6/11/2009 None stated 6/19/2009 Patient felt pain in her back on 6/10 6/12/2009 Gave HAVRIX in prefilled syringe in 6/19/2009 Right arm swelling at site of injection 6/19/2009 Office visit 6.18.09 Acute URI 4 mo 6/19/2009 Developed 1/2 dollar size hive arou Pt developed localized redness and 6/12/2009 Lethargy soon after immunization fo 6/10/2009 Redness and swelling at injection si Mildly erythemic area approx 3cm d 4/28/2009 Diagnosed with C. difficile on 2/27/0 6/11/2009 None stated 6/18/2009 fever 99.2, Redness around injectio 6/11/2009 Child c/o cough.. mother brought ch 6/19/2009 (L) arm swelling/redness, pain and b 6/8/2009 Pt was given a DTaP rather than a T 4/29/2009 None stated 6/18/2009 Fever, lethargy began 24 hrs after s 6/18/2009 3 inch circular raised red area at (R) 6/18/2009 Near syncopal reaction minutes afte 6/10/2009 Symptoms, started 11 hours after th 6/15/2009 Facial edema (notable lips & (L) eye 6/15/2009 1 hr after receiving Pneumovax & Z 6/12/2009 Vaccine given 6/4/09. Pt developed 6/16/2009 Vaccination LUE with YF Vax 2:30p 6/15/2009 Swelling, redness at site one day af 6/12/2009 (R) arm - swollen to shoulder & dow 6/11/2009 Had PAP at Gyn which came back p 6/9/2009 None stated. 6/20/2009 Child became lethargic, flushed, dip 6/20/2009 Twenty-four hours after the PPV va 6/20/2009 Confusion; Severe and continuing h 6/21/2009 pain at site, chills, unwell, slightly sw
349602 349603 349604 349605 349606 349607 349913 350071 350311 349653 349660 349661 349664 349665 349666 349667 349670 349671 349672 349673 349674 349675 349676 349677 349678 349679 349680 349681 349682 349683 349684 349685 349686 349687 349688 349689 349690 349691 349692 349693 349694 349695 349696 349698 349699 349700 349701 349702 349703 349704 349705
6/21/2009 6/21/2009 PA 6/21/2009 6/21/2009 NV 6/21/2009 TX 6/21/2009 OH 6/21/2009 6/21/2009 CA 6/21/2009 6/22/2009 MI 6/22/2009 WV 6/22/2009 WV 6/22/2009 VA 6/22/2009 WA 6/22/2009 AL 6/22/2009 TX 6/22/2009 AR 6/22/2009 GA 6/22/2009 MI 6/22/2009 VT 6/22/2009 NH 6/22/2009 CA 6/22/2009 SD 6/22/2009 NC 6/22/2009 GA 6/22/2009 WA 6/22/2009 NC 6/22/2009 OK 6/22/2009 NY 6/22/2009 NC 6/22/2009 MI 6/22/2009 SC 6/22/2009 NY 6/22/2009 MI 6/22/2009 MI 6/22/2009 CA 6/22/2009 MN 6/22/2009 FL 6/22/2009 NJ 6/22/2009 TX 6/22/2009 MT 6/22/2009 CA 6/22/2009 PA 6/22/2009 ND 6/22/2009 CT 6/22/2009 OH 6/22/2009 OR 6/22/2009 NY 6/22/2009 NY 6/22/2009 6/22/2009 NM
42 11 16 5 0.8 1.6 1.3 1 6 82 49
42 11 15 5 0 1
0.2 17 14 16 28 20 69 0.2 0.1 19 70 24 38 33 40 5 16 4
0
35 17 79 27 10 17 70 1.3 60 39 13 70 1 37 34 1.2 15 18 33 15
82
14 16 28 20 69 0 0 19 70 24 38 33 40 5 16 5 35 16 27 10 16 70 1 61 39 13 70 1 37 34 1 15 33 15
F M F M 0.8 M 0.6 M M F F F M F 0.2 M F F F F F M 0.2 F 0.1 M M F F F F F F F F M F M U F M F M 0.3 F F F F F 0M F F 0.2 M F F M F
6/21/2009 I was administered the Anthrax Vac 6/21/2009 Extreme tiredess within 1 hour of va 6/21/2009 endocraneal hipertension after 1.5 6/21/2009 local exaggerated reaction at site of 6/21/2009 DALLAS RECEIVED HEP B, POLIO 6/21/2009 My son had his 4th dose of DTAP a 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 6/19/2009 InformationYhas been received from 6/18/2009 This case was received from a heal 6/18/2009 This case was received from a heal 6/19/2009 Information has been received from 6/19/2009 Information has been received from 6/19/2009 Information has been received throu 6/19/2009 Information has been received from 6/22/2009 The morning after receiving the vac 6/22/2009 Patient in for doctor's visit and was 6/22/2009 Approximately 2 to 4 days after 2nd 6/22/2009 Mother came in 6/22/09 stating that 6/22/2009 THERE WERE Y NO ADVERSE EVE 6/22/2009 Complaining of lesions on right wris 6/22/2009 Patient presented with red, swollen, 6/22/2009 Immediately after Pt received secon 6/22/2009 patient examined - tender, urticarial 6/22/2009 Within about 3-4 hours I had a tight 6/22/2009 MMR given 4/07/09- she developed 6/22/2009 Large area (from knee to buttock) o 6/22/2009 child received HPV and had fingers 6/22/2009 ON 6-17-2009, ONE DAY AFTER R 6/22/2009 Fever 103 & throbbing headache 6/22/2009 Local tenderness and swelling over 6/15/2009 Mother notified office approx 45 min 6/22/2009 Subject in pneumococcal vaccine tr 6/22/2009 Pneumovax 23 was given 6/17/09. W 6/22/2009 VACCINE WAS GIVEN ALONE IN D 6/22/2009 Patient was given a HPV injection a 6/22/2009 Reaction to Pneumovax with the sw 6/22/2009 ITP treated with Win. 9/29/09. Hosp Pt mentioned she had warm facial c 6/22/2009 6/19/09 MMR given Left arm. 2nd in 6/17/2009 Pt. had syncopal event after admini 6/22/2009 Since Zostavax was administered in 2/3/2009 Classic measles vaccination rash. R 6/22/2009 Pain, swelling of from deltoid to just 6/22/2009 Pt. States 2 days post injection. Lef 6/22/2009 Began with rash (small red dots) in 6/22/2009 Pt c/o. not feeling well. Generalized 4/13/2009 Pt c/o feeling dizzy. V/S - HR 100/m 6/22/2009 Generalized pain and swelling of 3" 6/16/2009 Patient became faint for about 15 se
349706 349707 349714 349715 349716 349718 349719 349720 349721 349722 349724 349725 349726 349727 349728 349729 349730 349731 349732 349733 349734 349735 349736 349737 349738 349739 349740 349741 349742 349743 349744 349745 349746 349747 349748 349749 349750 349751 349752 349697 349791 349793 349805 349807 349809 349818 349821 349822 349823 349824 349826
6/22/2009 CA 6/22/2009 NY 6/22/2009 VT 6/22/2009 6/22/2009 CA 6/22/2009 6/22/2009 CO 6/22/2009 CA 6/22/2009 CA 6/22/2009 IL 6/22/2009 NC 6/22/2009 OR 6/22/2009 KS 6/22/2009 CT 6/22/2009 KY 6/22/2009 GA 6/22/2009 IL 6/22/2009 OH 6/22/2009 AR 6/22/2009 OH 6/22/2009 SC 6/22/2009 PA 6/22/2009 NJ 6/22/2009 IL 6/22/2009 6/22/2009 6/22/2009 CA 6/22/2009 PA 6/22/2009 TX 6/22/2009 GA 6/22/2009 TX 6/22/2009 FL 6/22/2009 CO 6/22/2009 ND 6/22/2009 AR 6/22/2009 WI 6/22/2009 IL 6/22/2009 CA 6/22/2009 NH 6/23/2009 6/23/2009 OH 6/23/2009 OH 6/23/2009 6/23/2009 6/23/2009 6/23/2009 6/23/2009 NY 6/23/2009 AR 6/23/2009 CO 6/23/2009 NE 6/23/2009 WA
40 1.6 2
40 1 1
0.6 71 11 4 4 0.6 53 14 5 24 15 2 11 0.2 0.3 0.2 35 18 14 14 30 90 4 4 9 27 1.5 7 1 5 5 78 43 15 0.3 32
0 11 4 4 0 53 14 5 24 16 2 11 0 0 0 35 18 14 14 30 90 4 4 9 27 1 7 1 5 5 78 43 15 0 32
21 15
21 14
0.2 63 60 5 4
0 63 60 5 4
F 0.6 M 1F U 0.6 F U F M F 0.6 F F F M F F 0.4 F M 0.2 F 0.3 F 0.2 F F F F F F F F M M F 0.5 M F 0F M F M M F 0.3 F F F M F F F U 0.2 M M F M F
No adverse events reported by patie 6/15/2009 About 10 cm, overlying cellulitis. 6/15/2009 - Child received MMR and Hep A on 6/22/2009 Information has been received from 6/11/2009 Fever (103.8) and febrile seizure 12 6/17/2009 Given adult diphtheria/tetanus vacc 6/16/2009 Baseball-sized red area back of righ 6/16/2009 Redness 13 1/2 cm x 17 1/2 cm, sw 6/16/2009 Left arm deltoid 10 cm bruise. Warm 6/16/2009 Mother of pt states she developed a 6/15/2009 Employee's left deltoid was red + sw 6/8/2009 Date: 5/28/09. Vaccines were admin 6/17/2009 Imm. 2 days ago. No pain or fever. 6/17/2009 First GARDASIL given 5/11/09. She 6/18/2009 Woke up this am with shot area pain 6/15/2009 MD ordered LPN to give Hep A and 6/18/2009 Rec #2 VARICELLA left deltoid on 6 Diarrhea (5-8/day) for 2 weeks follow 6/18/2009 Fever up to 103.3 within 24 hours o 6/22/2009 Vomited the day of the vaccine, had 6/22/2009 Swollen glands on left side of neck. 6/19/2009 Patient at check-out area stating "i j 6/22/2009 Seconds after PPD placement and 6/22/2009 Pt started with dizziness and SOB 6/14/2009 I work in a hospital. I was informed a 6/15/2009 Patient was given ZOSTAVAX on M 6/22/2009 Rt Arm edema erythema hyperemia 6/22/2009 Leg swollen; red and 3 in x 4 in area 6/22/2009 Pt's mother called 6-19-09 reporting 6/19/2009 Hepatitis B vaccine booster adminis 6/12/2009 Right and left arm red and swollen. 6/19/2009 Pt was checking out after check-up Developed rash c/w very mild VARI 6/22/2009 3rd varicella given, supposed to be 6/22/2009 9 1/2 x 7cm red area (L) Thigh. DTa 6/17/2009 Left deltoid redness/swelling, fatigue 6/18/2009 Donor reported a rash that develope 6/19/2009 Given vaccine 6/3/09. Fever 101 de 6/12/2009 Pain/redness starting 6/11/2009. R 6/23/2009 I took Gardasil 1st dose on Aug 23, 6/18/2009 Initial report was received 10 June 2 6/18/2009 Initial report was received 10 June 2 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/21/2009 - Fever of 103 degrees - diarrhea - l 6/2/2009 112408 - Pt c/o pain in feet; 112508 5/28/2009 Patient received ZOSTAVAX vaccin 6/17/2009 R-Deltoid (Dtap) whole arm swollen 6/17/2009 Localized urticarial lesion w/o any s
349827 349828 349829 349830 349831 349832 349833 349834 349835 349836 349837 349838 349839 349840 349841 349842 349843 349844 349845 349846 349847 349848 349849 349850 349851 349852 349853 349854 349857 349858 349859 349860 349861 349862 349863 349864 349866 349868 349871 349873 349874 349875 349877 349878 349879 349880 349881 349882 349883 349884 349885
6/23/2009 MO 6/23/2009 IN 6/23/2009 WA 6/23/2009 NE 6/23/2009 AZ 6/23/2009 NY 6/23/2009 FL 6/23/2009 NY 6/23/2009 NJ 6/23/2009 MI 6/23/2009 FL 6/23/2009 TX 6/23/2009 MO 6/23/2009 VT 6/23/2009 TX 6/23/2009 CA 6/23/2009 FL 6/23/2009 FL 6/23/2009 VA 6/23/2009 NY 6/23/2009 NH 6/23/2009 IL 6/23/2009 FL 6/23/2009 CO 6/23/2009 CO 6/23/2009 VA 6/23/2009 MA 6/23/2009 TX 6/23/2009 PA 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 AZ 6/23/2009 CA 6/23/2009 CA 6/23/2009 TX 6/23/2009 TX 6/23/2009 6/23/2009 TX 6/23/2009 NJ 6/23/2009 NC 6/23/2009 CA 6/23/2009 VA 6/23/2009 SC 6/23/2009 TX 6/23/2009 NE
53 67 9 44 4 4 11 4 4 46 1.4 86 0.2 19 9 60 12 0.2 18 5 0 0.2 0.9 65 23 0.2 18 49 65 38 19 22 39 22 23 24 24 11 54 22 18 11 22
53 67 8 44 4 4 11 4 4 46 1 86 0 19 9 60 12 0 18 5 0 0 0 65 23 0 18 49 65 38 19 22 39 22 23 24 24 11 54 22 18 11 22
18 1.3
18 1
39 8
39 8
18
18
F F F F F M M M M M 0.4 M F 0.2 F F F M M 0.2 F F M 0F 0.2 M 0.8 M M M 0.2 M F F M M M M M M F M M M F F M F M U M 0.3 F F U F F F
6/19/2009 Swollen, reddened, feverish knot wi 6/19/2009 Vaccine administered 6/17. Arm turn 6/5/2009 Vaccine given to early per manufac 6/15/2009 Received TDAP on 6/9/09 noticed h 6/17/2009 Left shoulder swelling. 6/17/2009 Left arm red and swollen. 6/10/2009 (R) deltoid swollen, warm, red and h 5/4/2009 5/4/09- Pt c/o L upper arm redness 6/23/2009 SEEN IN OUR OFFICE FOR 4 YEA 6/23/2009 The patient is a 46-year-old man wh 6/23/2009 Seizure 9 days after receiving MMR 6/23/2009 Patient received the shingles vaccin 6/23/2009 Child's mother reports 3 to 4 hours a 6/23/2009 pt's mother called pt complained of 6/23/2009 Called in by Father, stated school n 6/23/2009 Received a Shingles vaccination at 6/23/2009 Pt had the vaccine around 9:00 am, 6/23/2009 Inconsolable crying, would not nurs 6/23/2009 She had tdap immunization yesterd 6/23/2009 COMPLAIN OF REDNESS, WARM 6/23/2009 UNKNOWNY6/29/09-autopsy report 6/23/2009 Client developed a few small, raised 6/23/2009 Per Mother and Grandmother after 6/23/2009 Sudden Hearing Loss and balance 6/23/2009 12 Jun 09/1:32pm-Anthrax vax rec'd 6/23/2009 high grade fever, polymorphous ras 6/23/2009 Swelling of both ankles, purple/red c 6/23/2009 I attributed the initial left bicep musc 6/23/2009 Patient had a headache shortly afte 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin Member complains of "severe itchin 6/23/2009 Member complains of "severe" itchin 6/23/2009 Member complains of "serve itching 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin 6/23/2009 6/23/09 0935 Upon rising client stat 6/23/2009 Pt returned c/o pain + swelling (LD) 6/22/2009 Seizure 3 hours post administration 6/23/2009 Expired lot- MENACTRA 6/23/2009 Expired Lot- MENACTRA 6/23/2009 Received the typhoid vaccine on 26 Expired Lot-MENACTRA 6/23/2009 Patient was shaking violently for les 6/12/2009 Approximately equal to 2 hours afte 6/23/2009 Pt had 2 doses of varicella on 2-176/23/2009 The pt states that after the receipt o 6/19/2009 Significant induration, redness, tend 6/18/2009 Received vaccinations 6/8/2009, de 6/23/2009 Adacel given at the site of redness a
349886 349887 349888 349889 349890 349891 349892 349893 349894 349895 349896 349897 349898 349899 349900 349902 349903 349904 349905 349906 349907 349987 350304 349855 349856 349966 349968 349970 349973 349974 349988 349989 349990 350006 350007 350008 350009 350010 350011 350012 350013 350014 350015 350016 350017 350018 350019 350020 350021 350022 350023
6/23/2009 VA 6/23/2009 NC 6/23/2009 TX 6/23/2009 NC 6/23/2009 TX 6/23/2009 TX 6/23/2009 KY 6/23/2009 CA 6/23/2009 VA 6/23/2009 NC 6/23/2009 OK 6/23/2009 TX 6/23/2009 IL 6/23/2009 NJ 6/23/2009 MI 6/23/2009 IL 6/23/2009 IL 6/23/2009 CA 6/23/2009 NY 6/23/2009 CA 6/23/2009 CA 6/23/2009 WI 6/23/2009 TX 6/24/2009 VA 6/24/2009 TX 6/24/2009 IL 6/24/2009 NJ 6/24/2009 6/24/2009 6/24/2009 TX 6/24/2009 SC 6/24/2009 PA 6/24/2009 LA 6/24/2009 GA 6/24/2009 IN 6/24/2009 GA 6/24/2009 NE 6/24/2009 OR 6/24/2009 TN 6/24/2009 PA 6/24/2009 NY 6/24/2009 MA 6/24/2009 WI 6/24/2009 CA 6/24/2009 VT 6/24/2009 OK 6/24/2009 NC 6/24/2009 NC 6/24/2009 TX 6/24/2009 TX 6/24/2009 PA
50 81 11 19 0.6 0.4 35 4 20 19 11 12 0.4 63 17 9 1.6 0.6 1 0.2 9 32 1.3 20 4 14 18 6 0.2 0.1 50 14 4 14 12 39 0.5 0.3 0.2 1.1 51 27 59 4 23 1.3 65 5 12 34 19
81 11 19 0 0 35 4 20 19 11 11 0 63 17 9 1 0 1 0 9 32 1 20 1 18 0 0 50 14 4 14 12 39 0 0 0 1 51 27 59 4 23 0 65 5 12 34 19
F F M F 0.6 M 0.4 F M M M F M F 0.4 F F F F 0.6 F 0.6 F 0F 0.2 F F F 0.3 M M 0M F F F 0.2 F 0.1 M M F M F M F 0.5 M 0.2 F 0.2 M 0.1 F M F F M F 0.2 M F M F M F
6/19/2009 Arm where she received Tdap is red 6/23/2009 Patient reports an itching bump at s 6/23/2009 Fri Jun 19, 2009 12:04 PM After pt 6/15/2009 As per mother, patient c/o headache 6/22/2009 Inadvertently gave PEDIARIX at sam 6/22/2009 PEDIARIX given inadvertently @ sa Minor + progressive body aches. T 6/18/2009 Significant swelling involving the wh 6/23/2009 Fever, headaches - Given medicatio 6/22/2009 Syncopal episode after MMR vaccin 4/3/2009 1 day of local erythema of skin appr 6/23/2009 R arm swelling from elbow to neck. 6/22/2009 4 mo shot, given & explanation of p 6/12/2009 R arm rash ~ 2" diameter with corre 6/23/2009 The day following vaccine pt - had s 6/17/2009 Right arm, deltoid region : 4x6 cm in 6/18/2009 Client woke up screaming @ 2am. P 6/18/2009 3 to 5 minutes after intramuscular; in 6/18/2009 Patient received VARIVAX 5/21/09 6/23/2009 Urticaria seconds after vaccines giv 6/17/2009 Erythematous circular area around s 5/21/2009 Reddened lump at injection site. 6/26/2009 Scattered macular rash trunk, limbs 6/23/2009 Injection site pain after 20 mins. 2 w 6/24/2009 My son have two knot very swollen 6/22/2009 This case was received from a phys 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/22/2009 Pt states he felt sinus congruent wit ### Shakiness legs + arms heaviness a 6/12/2009 Swelling to injection site 3x3 round 6/24/2009 Client became pale and lightheaded 6/24/2009 Redness, warmth and swelling at ad 6/24/2009 Vaccinated with ACAM 2000 (lot VV 6/24/2009 Patient screamed inconsolably for 3 6/24/2009 The patient inadvertantly received a 6/24/2009 Patient received 4 immunizations in 6/24/2009 pt was given 1st varicella on 06/12/2 6/24/2009 Patient received Rabies Post Expos 6/24/2009 swollen right parotid gland without f 6/24/2009 2nd day after administration of zosta 6/24/2009 Left arm redness and swelling appro 6/24/2009 Right after i recieved the vaccination 6/24/2009 The evening of immunizations he th 6/24/2009 Itching at site the day after immuniz 6/24/2009 Received immunizations on 06.16.0 6/24/2009 Mom stated Pt developed hearing lo 6/24/2009 On 6/16/2009 center was notified by 6/24/2009 Pt. received Tdap and then GARDA
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6/24/2009 VI 6/24/2009 WA 6/24/2009 AZ 6/24/2009 KY 6/24/2009 FL 6/24/2009 CA 6/24/2009 MA 6/24/2009 TX 6/24/2009 WI 6/24/2009 MA 6/24/2009 MN 6/24/2009 CA 6/24/2009 ME 6/24/2009 ME 6/24/2009 NY 6/24/2009 CA 6/25/2009 NC 6/25/2009 NC 6/25/2009 CA 6/25/2009 MS 6/25/2009 PA 6/25/2009 PA 6/25/2009 NY 6/25/2009 NJ 6/25/2009 MN 6/25/2009 MA 6/25/2009 PA 6/25/2009 MD 6/25/2009 MD 6/25/2009 IL 6/25/2009 AR 6/25/2009 CO 6/25/2009 AL 6/25/2009 MO 6/25/2009 OR 6/25/2009 6/25/2009 6/25/2009 TX 6/25/2009 TX 6/25/2009 TX 6/25/2009 TN 6/25/2009 MD 6/25/2009 TX 6/25/2009 TX 6/25/2009 NY 6/25/2009 NH 6/25/2009 OR 6/25/2009 MA 6/25/2009 VA 6/25/2009 TX 6/25/2009 IA
1.2 28 11 1.3 0.5 11 65 1.4 38 38 26 8 62 53 68 76 23 16 20 13 19 26 21 14 65 1.1 39 14 4 4 12 5 29 1.3 14 16 57 12 14 11 14 37 17 5 12 0.1 49 22 25 11 61
1 28 11 1 0 11 65 1 38 38 26 8 62 53 68 76 23 16 13 19 26 21 14 65 1 39 14 4 4 12 5 29 1 14 16 12 14 11 14 37 17 5 12 0 49 22 25 11 61
0.2 F F M 0.3 F 0.5 M F F 0.4 M F F M F F F F F F F F F M M F F F 0.1 F F F F F F M F 0.3 M M F F M F M F F F M M 0.1 F F F F F M
6/22/2009 Mother states "bumpy rash" to both 6/24/2009 28 y/o female who presented as wa 6/24/2009 Mild fever. Soreness at site (L arm). 6/24/2009 6/19/09 at 3PM increased fussiness 6/24/2009 Mom reports that approximately 7 h 6/22/2009 Pt came in upper arm swelling, warm 6/24/2009 Pt given PNEUMOVAX (L) deltoid 6 6/24/2009 Urticaria rash involving mainly the a 6/22/2009 11:45 am: RN at Dr's office called s 6/22/2009 Hot, reddened skin from elbow to sh 6/24/2009 Pt. reported "low grade fever" the ev 6/24/2009 R arm warmth eryth and 1 vesicle ju 6/24/2009 Late evening of day she received va 6/24/2009 Received vaccine at 830 AM and by 6/24/2009 Pt. with erythematous plaque to L d 6/24/2009 6-11-09 approx 2 pm ZOSTAVAX g 6/24/2009 Information has been received throu 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/20/2009 Pt had stroke-like symptoms such a 6/20/2009 Pt was given a flu shot on Monday. 6/16/2009 Received PNEUMOVAX 0.5 ml IM 6 6/19/2009 Pt came to hospital for routine medi 6/11/2009 ADACEL given in high left shoulder 6/22/2009 6/21 fussy, cranky, clingy, sl. decrea 6/18/2009 redness, swelling, warm to touch at 6/22/2009 45 to 60 seconds after injection, pat 6/22/2009 L thigh with erythema, swelling, war 5/12/2009 Swelling and redness, tenderness in 6/2/2009 Mother and patient reports that patie 6/20/2009 Had bilat. leg pain and refusal to wa 6/19/2009 Tired, weakness, SOB on exertion ( 5/27/2009 Mom called on 5-27 and stated child 6/16/2009 T 00:30 on 6-10-09 c/o headache th 6/19/2009 pt sits on exam table - gave MENAC 6/21/2009 I received the shingles vaccine hopi 6/25/2009 None Stated 6/25/2009 None stated. 6/25/2009 None given 6/25/2009 Patient presented with Bell's Palsy o 6/25/2009 Pt Rcd Pneumococcal vaccine in th 6/25/2009 None Stated 6/25/2009 None stated. 6/22/2009 Patient had temp 100.3, unable to w 6/25/2009 None known. Y 7/2/09 Medical Exami 6/25/2009 Lump at injection site, feels tender a 6/25/2009 6/19/09 patient felt some pain in her 6/25/2009 On June 3, 2009, client returned to 6/25/2009 SWOLLEN RED PATCH ON RIGHT 6/25/2009 Patient is a 61 year old MALE who p
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6/25/2009 OH 6/25/2009 MI 6/25/2009 TX 6/25/2009 IN 6/25/2009 CA 6/25/2009 6/25/2009 NY 6/25/2009 IL 6/25/2009 PA 6/25/2009 FL 6/25/2009 6/25/2009 MA 6/25/2009 AL 6/25/2009 AZ 6/25/2009 ME 6/25/2009 NH 6/25/2009 IA 6/25/2009 WA 6/25/2009 NY 6/25/2009 OR 6/25/2009 TX 6/25/2009 TX 6/25/2009 TX 6/25/2009 AZ 6/25/2009 NY 6/25/2009 6/25/2009 IL 6/25/2009 MT 6/25/2009 WA 6/25/2009 WA 6/25/2009 WA 6/25/2009 WA 6/25/2009 6/26/2009 6/26/2009 NY 6/26/2009 6/26/2009 MI 6/26/2009 TN 6/26/2009 OR 6/26/2009 VA 6/26/2009 MI 6/26/2009 TN 6/26/2009 PA 6/26/2009 GA 6/26/2009 WI 6/26/2009 MD 6/26/2009 ME 6/26/2009 RI 6/26/2009 LA 6/26/2009 MD 6/26/2009 OR
21 15 24 0.2 22 50 0.1 4 20 17 11 0.2 5 0.5 21 6 0.6 19 7 63 3 2 3 1 4
21 15 24 0 22 50 0 4 11 17 11 0 5 0 21
59 80
59
79 15 22 15 1 1 0.2 14 1.4 0.5 0.2 17 0.5 1.5 66 49 57 4 0.2
79
0 19 7 63 3 2 3 1 4
22 15 1 1 0 14 1 0 0 17 1 66 49 57 4 0
F F F 0.2 F F M 0.1 F F F F F 0.2 F M 0.5 M M M 0.6 M F M M M 0.1 M F 0F M M F M U U U U F M F F 0F 0M 0.2 M F 0.4 F 0.5 M 0.2 F M M 0.5 M F F M F 0.2 F
6/25/2009 6/15/09 Fever of 102, vomiting, and 6/25/2009 Patient given VFC DTAP. No adver 6/25/2009 Employee recieved 4 vaccines, Hep 6/25/2009 Administered 2 doses of hepatitis B 6/25/2009 Patient received Hep A and Tdap va 6/29/2009 Immediate myalgias after injection. 6/25/2009 All vaccines listed given at 29 days 6/25/2009 Received KINRIX on 6.22.09. Per m 6/24/2009 Mother called @ 10 am 6/24/09 to s 6/23/2009 Pt had a vasovagal reaction abut 5 6/25/2009 Cellulitis to R arm. 6/25/2009 Fussy baby T-99. Red, swollen at si 5/11/2009 Patient would present himself off & 6/19/2009 Swelling of right thigh and bruising. 6/11/2009 Itching, redness, heat, tender, firm a 6/19/2009 Extensive macular rash started 2 da 6/18/2009 progressive decreased motor skills 6/25/2009 VHC re-contacted by pt mid-Jun 200 6/22/2009 One day after administration of vacc 6/15/2009 Evening of injection: Chills, Nausea 6/25/2009 None stated. 6/25/2009 None stated. 6/25/2009 None stated 6/25/2009 Red papular rash at injection site - ( 6/25/2009 Developed AM of 6/25/09 L upper a 6/19/2009 Report received from a physician on 6/22/2009 Migraine. Migraine with loss of centr 6/22/2009 Report received from a nurse on 03 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Injection site pain lasting 3 months 6/25/2009 Information has been received from 6/25/2009 Information has been received from 6/25/2009 Information has been received from 6/25/2009 Follow-up information received from 6/19/2009 Vaccines given MMR and Varicella. 6/22/2009 Extreme crying baby in severe pain6/22/2009 Mother came to health dept today a 6/25/2009 None stated 5/19/2009 Mo states child spiked temp of 101. 4/1/2009 Symptom: Bright red blood in stool 6/18/2009 Tongue and throat swelling, chest p Hives- Diphenhydramine 6/24/2009 5/26/09 Fever, went to ED -> Dx wit 5/21/2009 Developed elbow and knee burning 6/22/2009 Persistent pain in left arm after rece 6/17/2009 6/17/09 Dr reported to me that 3 da 6/24/2009 Fever, runny nose, coughing Dx 6/1 6/22/2009 Extremely fussy, screaming, incons
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6/26/2009 AZ 6/26/2009 AZ 6/26/2009 FL 6/26/2009 OR 6/26/2009 DC 6/26/2009 GA 6/26/2009 IA 6/26/2009 PA 6/26/2009 PA 6/26/2009 WI 6/26/2009 AZ 6/26/2009 IL 6/26/2009 TX 6/26/2009 PA 6/26/2009 OK 6/26/2009 NV 6/26/2009 MO 6/26/2009 NC 6/26/2009 OR 6/26/2009 VA 6/26/2009 MN 6/26/2009 MN 6/26/2009 WI 6/26/2009 CA 6/26/2009 MO 6/26/2009 IA 6/26/2009 OK 6/26/2009 ME 6/26/2009 CA 6/26/2009 CA 6/26/2009 MA 6/26/2009 NJ 6/26/2009 CA 6/26/2009 UT 6/26/2009 CO 6/26/2009 PA 6/27/2009 MI 6/28/2009 GA 6/28/2009 PA 6/28/2009 RI 6/29/2009 6/29/2009 NJ 6/29/2009 6/29/2009 6/29/2009 NY 6/29/2009 IL 6/29/2009 MI 6/29/2009 GA 6/29/2009 MA 6/29/2009 MI 6/29/2009 TX
11 15
11 15
71 27 0.3 59 20 20 24 25 5 4 63 2 4
71 27 0 59 20 20 24 25 5 4 63 2 4 72 0 61 64 32 1 13 13 19 37
0.2 61 64 32 1.1 13 13 19 37 1.3 1.2 5 16 1 0.2
1 4 1 5 16 0 0
11 66 2 68 1.1 16 18 20
11 66 2 68 1 16 18 20
72 13 74 15 36 0.3
72 13 74 15 36 0
F F F U F 0.3 F U M M F F M M F 0.1 M M F 0.2 M F F F 0.1 M F F M F U 0.3 U F 0.2 F F F 1F 0.2 M M F M 0.1 M M 0.1 F F F F F F F M F F 0.3 M F
6/19/2009 Erythema @ injection site 6/23/2009 Immediately after varicella vaccine, 6/24/2009 Post immunization client developed 6-11-09 After shot, arm swell up, tur On 6/1/09, pt. called & left a messag 6/26/2009 Fever started about 6 to 8 hours aft 6/26/2009 Achey on 6-3-09. Severe pain in arm 6/26/2009 Patient had symptoms of dizziness 6/26/2009 About eight hours after vaccine adm 6/26/2009 Developed nausea and vomiting, in 6/26/2009 Patient presents to clinic at approxim 6/26/2009 Client was given a Dtap/Polio IM inj 6/26/2009 PATIENT HAD KINRIX ON 06-23-2 6/26/2009 itchy red welt, larger then usual 6/26/2009 Large area of erythema with a sligh 6/26/2009 red, blotchy, hard, swollen around th 6/26/2009 red, raised swollen area approx 4x4 6/26/2009 Several hours after receiving Oral R 6/26/2009 A couple hours after the vaccination 6/26/2009 Her arm was swollen all the way do 6/26/2009 Expired vaccine administered inadv 6/26/2009 Expired vaccine administered inadv 6/26/2009 Patient received Menactra and variv 6/26/2009 Immediately following vaccine, patie 6/28/2009 Pt given TWINRIX 1ml, Tdap 0.5 ml 6/26/2009 Patient was given an MMR by agen Temp 102 sweats, dizziness. Diffuse urticaria that started about 1 6/25/2009 Arm swelling - 1 1/2 cm circumferen 6/26/2009 Per mother of child: See attachmen 6/26/2009 DTaP given 6/24/09. 6/26/09 woke 6/26/2009 30 minutes after receiving GARDAS 6/25/2009 After few minutes of MMR + Varicel 6/26/2009 Child with 3hr prolonged crying epis 6/26/2009 Received imms. 6/9/09. On 6/10/09 6/26/2009 R arm red with warmth ~ 6-7 cm dia 6/27/2009 On March 24,2009 received injectio 6/28/2009 fussy, loss of appetite, fever as high 6/28/2009 severe asthma attack, no fever, sinu 6/28/2009 PATIENT STARTED WITH A FEVE 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/22/2009 Patient experienced two episodes o 6/29/2009 For 2 days, pt experience moderate 6/29/2009 Pt contacted Merck first to report ad 6/29/2009 Chronic Hives...They were first notic 6/29/2009 Next day, pt called to report GI sxs: 6/29/2009 TEMP 99.7 TO 100.8 FOR 2 DAYS 6/29/2009 right arm started getting red over 24
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6/29/2009 MD 6/29/2009 MA 6/29/2009 CA 6/29/2009 PA 6/29/2009 TX 6/29/2009 MO 6/29/2009 OH 6/29/2009 NY 6/29/2009 AZ 6/29/2009 CA 6/29/2009 WA 6/29/2009 WA 6/29/2009 CA 6/29/2009 6/29/2009 CO 6/29/2009 IN 6/29/2009 NE 6/29/2009 6/29/2009 6/29/2009 6/29/2009 LA 6/29/2009 6/29/2009 6/29/2009 6/29/2009 6/29/2009 LA 6/29/2009 6/29/2009 MA 6/29/2009 6/29/2009 6/29/2009 PR 6/29/2009 6/29/2009 6/29/2009 6/29/2009 AZ 6/29/2009 6/29/2009 SD 6/29/2009 PA 6/29/2009 6/29/2009 CA 6/29/2009 SC 6/29/2009 IL 6/29/2009 ID 6/29/2009 CA 6/29/2009 IN 6/29/2009 CO 6/29/2009 CO 6/29/2009 6/29/2009 NJ 6/29/2009 MN 6/29/2009 ND
1.1 21 4 17 64 45 0.9 23 1 63 43 62 5
1 21 4 17 64 45 0 23 0 63 43 62 5
17 10 0.6
17 10 0
12
12
32
32
65
65
21
21
1.8 0.4 68 19 18 19 14 4 0.2 14 12 25 17 18 49
1 0 19 18 14 4 0 14 12 25 17 18 49
0.1 F F F F F F 1M F 0M F F F M U M F 0.6 M U U U M U U U U M U M U U U U U U M U 0.8 M 0.4 M F F F F M F 0.2 F F M M F M F
6/29/2009 rash at injection site, R leg "hundred 6/29/2009 First event 4 days after vaccine (2nd 6/29/2009 Received DTaP, MMR, IPV, Varivax 6/29/2009 Patiet received Menactra, Gardisil, A 6/29/2009 ON 6/27/2009 CLIENT NOTICED T 6/29/2009 Severe aches in joints, especially in 6/29/2009 Uncontrollable crying, arching back 6/29/2009 Client stated that she developed hiv 6/29/2009 RED ITCHY BUMPS ON BADY NO 6/29/2009 Patient received Zostavax vaccine o 2 days after vaccination temp. - sore 6/22/2009 05-27-09 Right hand swollen, numb 6/24/2009 Reported by mother: 5/8 Right arm 6/30/2009 We received the following literature 6/23/2009 After taking 2 doses of VIVOTIF, de 6/26/2009 Client immediately suffered syncope 6/15/2009 1st set (PENTACEL, HVB, PCV7, R 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/9/2009 Approx. 5 minutes after receiving va 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/4/2009 Pt reported swollen lymph nodes to 6/30/2009 We received the following literature 6/18/2009 Pt experienced arm pain and should 6/30/2009 We received the following literature 6/30/2009 We received the following literature Headaches, irritation, lack of sweat 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/8/2009 Fevers, rash/pustules, RX with NSA 6/30/2009 We received the following literature 6/23/2009 Tdap given instead of DTaP, no rea 6/29/2009 Sudden Death. Y 8/12/09 Autopsy re 6/1/2009 Erythema, swelling, tenderness (all 6/29/2009 Pt c/o headache, the began c/o sen 6/25/2009 Severe HA, myalgias, back pain, LE 6/26/2009 Fainted about 2 - 3min after receivin 6/25/2009 Child was accidently given PCV-7 in 6/25/2009 Left arm with 4/3" reddened area. W 6/29/2009 Diarrhea since day after vaccine up 6/29/2009 Pt was given dose of TDAP, MENAC 6/29/2009 Pt was given 2 doses of TDAP and 6/29/2009 Consultation with the Vaccine Healt 4/9/2009 Hives seen @ ER 3/6/09 6/24/2009 Spiked temp > 103 degrees F @ 2A 6/26/2009 Redness & swelling size - began 50
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6/29/2009 AZ 6/29/2009 CA 6/29/2009 WI 6/29/2009 NV 6/29/2009 CA 6/29/2009 CA 6/29/2009 OH 6/29/2009 CA 6/29/2009 WA 6/29/2009 6/30/2009 OH 6/30/2009 MD 6/30/2009 FL 6/30/2009 6/30/2009 CA 6/30/2009 GA 6/30/2009 IL 6/30/2009 CA 6/30/2009 PA 6/30/2009 IL 6/30/2009 MI 6/30/2009 NY 6/30/2009 CT 6/30/2009 VA 6/30/2009 6/30/2009 PA 6/30/2009 KY 6/30/2009 TN 6/30/2009 OR 6/30/2009 OR 6/30/2009 PA 6/30/2009 LA 6/30/2009 MI 6/30/2009 CO 6/30/2009 CO 6/30/2009 MO 6/30/2009 NC 6/30/2009 VA 6/30/2009 VA 6/30/2009 OK 6/30/2009 CA 6/30/2009 OH 6/30/2009 CO 6/30/2009 CA 6/30/2009 MA 6/30/2009 NY 6/30/2009 PA 6/30/2009 PR 6/30/2009 CO 6/30/2009 WI 6/30/2009
21 60 15 1.3 43 32 80 72 1 54 16 14 14 15 80 0.5 17 11 33 11 1 4 4 38 0.5 15 16 52 1 15 10 0.5 82 6 5 56 10 75 18 18 54 14 52 0.6 4 5 46 77 43 21
21 60 15 1 43 32 80 72 1 16
0 17 33 11 1 4 4 38 0 15 16 52 1 15 10 0 82 6 5 56 10 75 18 54 14 52 4 0 4 5 46 77 43 21
F F M 0.3 M F F F M 0M F F F F F F 0.5 F F U M M 0M M F F 0.5 M F F F 0M M F 0.5 M F F F F F M M M F F F F 0.6 F M F M F F M
6/28/2009 Severe abdominal cramping & pain Injection site swollen, red, itchy - Pt 6/2/2009 Redness, swelling localized to injec 6/29/2009 Father of pt called office 6/25/09 sts 6/29/2009 06/29/09 Pt came in today c/o redn 6/16/2009 See attached notes. Edema, redness of entire circumfere 6/23/2009 L Deltoid persistent pain and mild te 6/22/2009 Patient developed 10 vesicular rash 6/22/2009 Redness, swelling, and a hard lump 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/26/2009 This case was received from a heal 6/26/2009 Initial report received 19 June 2009 6/25/2009 This case was retrieved from a new 6/24/2009 Pt. developed onset of paresthesias 6/25/2009 Pt was seen for annual physical 5/1 6/24/2009 1 yr old w/ h/o recurrent cough w/ w 6/25/2009 1. 6/15/09 called arm red & swollen 6/26/2009 C/o cellulitis of the left arm at the sit 6/26/2009 Pt received vaccine on 06/18/2009, 6/24/2007 Low grade fever w/ knot in left thigh 6/23/2009 (LT) upper arm weak & numb x 6 da 6/23/2009 PNEUMOVAX given @ 0900 on 6/2 6/24/2009 6/11/09 - Vaccine given. 6/12/ - 6/1 6/21/2009 Approximately 24 hours after vaccin 6/22/2009 Unwitnessed syncope vs possible s 6/29/2009 Generalized red papular rash every Hematoma to right thigh. Size smal 5- 27 - 28 - Hot flush - 5-28 - red rai 6/24/2009 Developed 20cm X 25cm area of re 6/24/2009 Developed 105 cm x 70 cm area of 6/24/2009 Tdap given Lt deltoid 6/20/09 - no p 6/24/2009 Pt given adacel - recommended for 6/25/2009 Redness in area of injection site. La 6/12/2009 FLUVIRIN was in box labeled PPD 6/23/2009 About 1 hr after immunization (10:3 6/23/2009 Pt returned c/o pain and swelling (L 6/24/2009 On 6-23-09 received Hep A and MC 6/25/2009 Area of Lt arm, red tender and hot. 5/24/2009 Swollen arm, redness, hardness pa 6/25/2009 Mom reported fever 103 + irritability 6/24/2009 Significant local reaction on L arm, r 6/25/2009 Red rash local to inject - fussy and f 6/24/2009 Hand pain, joint pain, diarrhea, high 6/25/2009 Redness, tender, sore, red, warm to 6/25/2009 2 inch lump, itching, hot to the touch 6/18/2009 Right shoulder pain for a couple of w
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6/30/2009 WA 6/30/2009 TX 6/30/2009 AR 6/30/2009 NY 6/30/2009 CA 6/30/2009 MI 6/30/2009 MI 6/30/2009 KS 6/30/2009 MD 6/30/2009 OK 6/30/2009 TN 6/30/2009 TN 6/30/2009 OR 6/30/2009 PA 6/30/2009 MI 6/30/2009 TX 6/30/2009 NC 6/30/2009 IN 6/30/2009 CO 6/30/2009 TN 6/30/2009 NJ 6/30/2009 TX 6/30/2009 IL 6/30/2009 HI 6/30/2009 WA 6/30/2009 NY 6/30/2009 MO 6/30/2009 UT 6/30/2009 LA 6/30/2009 NV 6/30/2009 NY 6/30/2009 WA 6/30/2009 VT 6/30/2009 NJ 6/30/2009 CA 6/30/2009 IA 6/30/2009 KY 6/30/2009 VA 6/30/2009 CO 6/30/2009 AL 6/30/2009 CA 6/30/2009 WI 6/30/2009 MN 7/1/2009 WV 7/1/2009 TX 7/1/2009 NC 7/1/2009 ND 7/1/2009 HI 7/1/2009 FL 7/1/2009 NJ 7/1/2009
22 16 4
22 16 4
14 0.5 1.5 2 14 12 20 51 19 1 14 27 49 11 63 0.6 1 18 11 16 13 14 0.2 5 3 4 11 66 2 15 20 4 49 19 4 1 59 29 5 18 11 0.2 13 48 12
14 0 1 2 14 12 20 51
26
26
1 14 27 49 11 63 0 1 18 11 16 13 14 0 5 3 4 11 66 2 15 20 4 49 19 4 0 59 29 5 16 11 0 13 48 12
F M M M F 0.5 M 0.5 M 0.4 F M F F M F 0M F M F M F 0.6 M 0M M F F F F 0.2 M F M M M M 0.3 M M M F F M F 1F F F M F M 0.2 M F F M F F
6/29/2009 Pt. turned white and became sick/fe 6/30/2009 Headache, nausea, fatigue 6/25/2009 Significant local reaction. - *see atta 6/30/2009 This case was reported by a physici 6/28/2009 Faints - blacks out - low blood press 6/30/2009 No reaction 6/30/2009 Pt came in w/ rash all over body on 6/30/2009 Pain in left leg, high fever, refused t 6/30/2009 starting having bloody noses at app 6/30/2009 Pt left clinic with mom approx 5 min 6/30/2009 Pt called office to report approx 12 h 6/30/2009 Vaccine administered 6-22-09, 2nd 6/30/2009 Erythema, edema, hives, lymphade 6/30/2009 pt with c/o rash onset 6/28/2009 and 6/30/2009 fainted immediatley with slight jerkin 6/30/2009 Pt received vaccines ~ 1230 pm. Pt 6/30/2009 Patient states that Right arm becam 6/30/2009 Patient passed out in the hallway ab 6/30/2009 The patient experienced hives 1 we 6/30/2009 Patient received Rotateq 6-12-09, o 6/30/2009 Temperature elevation 104 degrees 6/30/2009 No adverse reaction noted. Verified 6/30/2009 Shot was administered around 4:15 6/30/2009 Pt c/o "dizziness", stomach pain wit 6/30/2009 Inability to close right eye, facial num 6/30/2009 Patient received Varivax, Gardasil, a 6/30/2009 Rotateq given on 6-18-09 & patient 6/30/2009 Patient had swelling of the eye's, lip 6/30/2009 My son received two vaccinations, H 6/30/2009 Child was evaluated on 6/30/09 and 6/30/2009 Matthew developed bright red macu 6/30/2009 About 2 hours after vaccine adminis 6/30/2009 High fever,lethargic,shakes,chills,no 6/30/2009 chest pain, myocarditis treated with 6/30/2009 Pt was in excellent health prior to se 6/26/2009 24 hrs after shot 2 areas of large bli 6/30/2009 Swelling and redness of right arm. 6/30/2009 Corneal abrasion/ shield ulcer follow 6/29/2009 About 10 minutes after vaccination 6/30/2009 06/25/09 - Started with multiple sma 6/30/2009 Within a few hours of receiving TDA 6/30/2009 Hard lump in arm swelling & pain 6/25/2009 This case was reported by a physici 7/1/2009 felt very weak/ shakey. Chest was t 6/24/2009 Wheeze, stridor, cough and shortne 6/26/2009 6 days following ROTATEQ vaccine 6/29/2009 Depression, mood swings, change i 6/24/2009 Swelling, Redness, Soreness 6cm X 6/27/2009 Fever, chills, cold hands, pain in leg 6/29/2009 Initial report was received 25 June 2 6/30/2009 Information has been received from
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7/1/2009 WA 7/1/2009 7/1/2009 MO 7/1/2009 OK 7/1/2009 WV 7/1/2009 PA 7/1/2009 OH 7/1/2009 NV 7/1/2009 MI 7/1/2009 NC 7/1/2009 CA 7/1/2009 OH 7/1/2009 DE 7/1/2009 IL 7/1/2009 TX 7/1/2009 VA 7/1/2009 WA 7/1/2009 NC 7/1/2009 AZ 7/1/2009 CA 7/1/2009 IL 7/1/2009 WA 7/1/2009 IL 7/1/2009 OH 7/1/2009 GA 7/1/2009 MI 7/1/2009 MN 7/1/2009 NH 7/1/2009 TX 7/1/2009 TX 7/2/2009 GU 7/2/2009 MI 7/2/2009 7/2/2009 NM 7/2/2009 PA 7/2/2009 VA 7/2/2009 OH 7/2/2009 IL 7/2/2009 VA 7/2/2009 SC 7/2/2009 NY 7/2/2009 IL 7/2/2009 IL 7/2/2009 7/2/2009 VA 7/2/2009 KS 7/2/2009 IL 7/2/2009 GA 7/2/2009 KY 7/2/2009 LA 7/2/2009 WI
53 2 36 18 1.3 52 20 53 4 5 0 11 25 45 12 11 12 60 38 5 0.5 43 13 0.2 0.5 1 33 0.7 12 15 20 0.1 1 77 4 14 17 16 20 5 14
53 2 36 18 1 52 20 53 4 5 0 11 25 45 12 11 12 60 38 5 0 43 13 0 0 12 1 33 0 12 15 20 0 1 77 4 14 17 16 20 5 14
5 17 0.2 69 0.2 4
5 17 0 69 0 4
F F 0.1 F F M 0.3 M F F F F M 0F M F F M F F F M F 0.5 F M F 0.2 M 0.5 F M 0F F 0.7 M F F F 0.1 F 0F F M F F U F F F F F M M 0.2 M M 0.2 F M
6/29/2009 Initial report received 25 June 2009 6/30/2009 Information has been received from 7/1/2009 After patient's Hepatitis A immuniza 7/1/2009 Patient was given inital dose of Tda 7/1/2009 Developed syncope immediately fol 7/1/2009 Varicella vaccine breakthrough. Dia 7/1/2009 6/12/09 - Pt presented to the emerg 7/1/2009 Pt stopped breathing and had a car 7/1/2009 On 06/19/09 pt received Tdap.That 7/1/2009 06/30/09 MT REPORTS CHILD FEL 7/1/2009 LOCAL REACTION TO L UPPER A 7/1/2009 FIRST DOSE OF HEPATITIS B WA 7/1/2009 With in 10 min after Varivax vaccine 7/1/2009 PERSISTENT PAIN IN LEFT DELT 7/1/2009 Rcvd Varivax on 5/29/09. Reports s 7/1/2009 Circular area (1 3/4"x1 1/4") of mild 7/1/2009 After giving last injection (which was 7/1/2009 4 cm area of swelling/induration aro 6/30/2009 Extreme watery diarrhea, nausea, s 6/16/2009 Visual changes after AVA 1 and 2. 6/30/2009 Child recd #2 dose of VARICELLA o 7/1/2009 Received immunizations 6/29/2009 7/1/2009 Localized skin reaction. Red raised 6-30-09 4:45 pm pt. c/o tingling in a 6/26/2009 Hypotensive episode - pallor & unre 7/1/2009 None 7/1/2009 R arm pain, redness and swelling. 7/1/2009 Mom reported to -us on 6-30-09 tha 7/1/2009 It happened around March 12 and t 6/29/2009 I did not mix the DTaP IPV solution 7/2/2009 SHE WAS GIVEN GARDASIL 1 ST 7/1/2009 Pt was also given T-DAP- MENACT 6/30/2009 I am unsure if the lateral neuropathy Right deltoid area of redness, heat, 6/28/2009 None stated 6/30/2009 Cluster of blisters on hand. Tender 6/25/2009 Erythema around site and down me 6/30/2009 Immediately following immunization 7/7/2009 Tetanus has been hurting since inje Vaccines prior to 11:30 AM 7/1/200 7/12/2009 Dizziness, light headed, fever, naus 6/29/2009 Red, swollen. Hard lump at injection 7/2/2009 Developed pain, swelling and decre 7/1/2009 InformationYhas been received from 7/1/2009 Information has been received from 7/2/2009 This case was reported by a healthc 7/2/2009 4/20/09 Later in the day, respiratory 7/2/2009 Patient was given Immunizations on 7/2/2009 I am experiencing itchiness--Thumb 7/2/2009 Persistent (more than 3 weeks) muc 7/2/2009 Mother reported temperature of 104
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7/2/2009 WI 7/2/2009 GA 7/2/2009 AK 7/2/2009 CA 7/2/2009 VA 7/2/2009 PA 7/2/2009 CA 7/2/2009 CA 7/2/2009 NJ 7/2/2009 7/2/2009 NH 7/2/2009 LA 7/2/2009 MS 7/2/2009 MI 7/2/2009 PA 7/2/2009 CA 7/3/2009 OH 7/3/2009 PA 7/3/2009 PA 7/3/2009 IL 7/3/2009 TX 7/4/2009 MN 7/4/2009 NY 7/4/2009 PA 7/4/2009 AR 7/5/2009 MD 7/5/2009 MD 7/6/2009 CT 7/6/2009 RI 7/6/2009 7/6/2009 NY 7/6/2009 7/6/2009 PA 7/6/2009 KY 7/6/2009 7/6/2009 7/6/2009 PA 7/6/2009 DC 7/6/2009 NJ 7/6/2009 OH 7/6/2009 NY 7/6/2009 IL 7/6/2009 MO 7/6/2009 IL 7/6/2009 WA 7/6/2009 OH 7/6/2009 CA 7/6/2009 NE 7/6/2009 CA 7/6/2009 NC 7/6/2009 MI
5 0.2 35 71 64 20 4 21 4 33 11 16 4 1.8 49 12 10 5 2 14 0.5 1 29 0.4 1 60 17 23 16 16 22 15 18 14 0.3 0.3 19 17 16 75 5 14 14 14 69 52 5 0.2 52 48 76
5 0 45 71 64 20 4 21 4 33 11 16 4 1 49 12 10 5 2 14 0 1 29 0 1 60 17 16 16 22 18
17 16 75 4 14 14 14 69 52 5 0 52 48 76
M 0.2 M F F F F M F M F M F M 0.8 M F F F F 0.2 F F 0.5 U 0F F 0.4 F 0F M F F F F F F F F M M F M M F M F M F M F U 0.2 M F F M
7/2/2009 Fever began 6-4-09 with small red a 7/2/2009 Fussy, crying, hard to console, on a 7/2/2009 Severe pain in upper arm at site of i 7/2/2009 generalize rash - chicken pox lesion 7/2/2009 Bump and rash at injection site deve 7/2/2009 Pt came for Adagio visit, HPV # 3 d None stated. 7/2/2009 6/15/09 Pt. to clinic to receive HPV 7/2/2009 RA swollen the whole length of the 7/2/2009 Same day as received last AVA, no 7/2/2009 (L) arm where he received MENACT 7/2/2009 TDAP administered, then MCV - 4 g 7/1/2009 Pt. received vaccines Monday 6/29/ 7/1/2009 Patient had bumps- Red on arm and 7/1/2009 Erythema, edema, tenderness at inj 6/25/2009 Swelling & redness left arm @ site o 7/3/2009 After administration of albuterol neb 7/3/2009 child recieved dtap on 7\2\2009 was 7/3/2009 Approximately 45 minutes after the 6/19/2009 Pt. received HPV vaccine for 1st tim Swelling and redness at injection sit 7/3/2009 Herpes Zoster involving the left side 7/4/2009 received tetanus shot and was diag 7/4/2009 Patient was unusually sleepy the da 7/4/2009 Mild rash of varicella 7/5/2009 My left upper arm, where the injectio 7/5/2009 The patient received gardisil #1, Td 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Initial and follow-up information has 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/6/2009 Patient developed fevers about 2-3 7/6/2009 SEEN ON 6/30/09 FOR 16 YEAR O 7/6/2009 Client reports on Sat., July 4, 09, sh 7/6/2009 redness, diaphoresis, early analphy 7/6/2009 Fainted after recieving immunization 6/29/2009 Felt ill day after infection, by 7:00 p. 7/6/2009 Patient recieved shots, walked out o 7/6/2009 PATIENT DEVELOPED ATRIAL FL 7/6/2009 After receiving both vaccines, patien 7/6/2009 reddness and swelling at injection s 7/6/2009 Edema at site approx 3 hours post i 7/6/2009 severe rash developed by 7/1/09. ra 7/6/2009 PATIENT COMPLAINS OF SWELL 7/6/2009 Hives Tx 50 mg prednisone x 3 day
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7/6/2009 FL 7/6/2009 WA 7/6/2009 NJ 7/6/2009 TN 7/6/2009 MI 7/6/2009 KY 7/6/2009 UT 7/6/2009 NC 7/6/2009 MS 7/6/2009 FL 7/6/2009 FL 7/6/2009 FL 7/6/2009 OR 7/6/2009 CA 7/6/2009 NJ 7/6/2009 IA 7/6/2009 AR 7/6/2009 NC 7/6/2009 AZ 7/6/2009 WI 7/6/2009 NJ 7/6/2009 MI 7/7/2009 TX 7/7/2009 TX 7/7/2009 TX 7/7/2009 7/7/2009 PA 7/7/2009 PA 7/7/2009 7/7/2009 VA 7/7/2009 7/7/2009 TX 7/7/2009 KY 7/7/2009 AR 7/7/2009 TX 7/7/2009 WI 7/7/2009 CA 7/7/2009 TX 7/7/2009 LA 7/7/2009 NY 7/7/2009 7/7/2009 VA 7/7/2009 CA 7/7/2009 NY 7/7/2009 TX 7/7/2009 VA 7/7/2009 PA 7/7/2009 OH 7/7/2009 MA 7/7/2009 PA 7/7/2009 PA
1.3 25 70 4 1.4 14 10 0 1.8 1.7 0 0 54 4 4 80 16 15 0.3 2 12 68 7 9 72
1 25 70 4 1 14 10 0 1 1 0 0 54 4 4 80 16 15 0 2 12 68 7 9
24 15
24 15
23 18
23
11 0.4 0.5 17 61 0.3 1.1 17 27 14 1.6 1 61 1.3 52 22 63 1 13.5
11 0 0 17 61 0 1 17 27 14 1 1 61 1 52 22 63 1 13
0.3 F M F F 0.4 F F F 0F 0.8 M 0.7 F 0M 0F F M M F F F 0.3 M 0.1 F F F F F F U F F F F F F M 0.4 F 0.5 F F F 0.3 M 0.1 M F M F 0.6 M 0M F 0.3 M F F F 0M F
7/6/2009 Temp to 103 degrees started at 6pm 7/6/2009 Pt presents to the clinic with 3 day h 6/25/2009 OV made to inform PHN that approx 7/1/2009 Redness, warmth, tenderness to lef 7/6/2009 Wheal and flared urticaria scattered 6/30/2009 14 yr old fe here today with Aunt (w 1/6/2009 Arm swelled up after it was given. R 6/26/2009 1 X 3 cm area of erythema but no in 6/29/2009 Mom called office 9:10 am 6/29/09 r 6/24/2009 On 6/11/09, we have this 20-month 7/6/2009 Infant accidentally received RUBEL 7/6/2009 Infant accidentally received Rubella 7/6/2009 Low grade fever, nausea, headache 7/3/2009 Pt had DTAP vaccine 6/29/09 @ Lt 7/6/2009 Area red, swollen, warm to touch at 7/6/2009 1 day lump X 2 days 1 1/2 dollar siz 7/6/2009 Red, raised area to right upper arm. 7/6/2009 This case was reported by a physici 7/2/2009 On 6/21/09 mother put infant to slee 6/30/2009 Unable to bear full weight. Fever, R 6/23/2009 GARDASIL. Redness, swelling area 6/23/2009 Less than one week later sleepines 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Initial information has been received 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 It was reported in a newspaper artic 7/6/2009 Information has been received from 7/2/2009 Initial report received on 24 June 20 6/15/2009 Mom states infant started having dia 6/26/2009 Pt was admitted to hospital on 4/13/ 7/2/2009 Pt had 3rd GARDASIL Injection and 7/6/2009 2 cm raised red wheal 7/2/2009 Patient became very fussy and deve 6/25/2009 Local tissue reaction Left arm and R Day after injection had raised, red, h 6/23/2009 Onset of whole body maculopapula 6/29/2009 Pt. Was given 1st GARDASIL shot t 6/27/2009 Large induration over entire left oute 6/29/2009 While administering vaccines MMR 6/30/2009 Pt. stated that the next day. After th 7/1/2009 Erythematous blanchable rash on tr 6/30/2009 Pt 1st noticed pain in (L) hip on 6/23 4/25/2009 4/21/09 Headache, itching, rash, ch 6/30/2009 3 days after administration of vaccin 6/30/2009 Evening of 6/23 pt whole body turne 6/26/2009 6/24/09 redness, swelling, warmth,
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7/7/2009 IL 7/7/2009 NY 7/7/2009 NY 7/7/2009 TN 7/7/2009 NY 7/7/2009 AZ 7/7/2009 NE 7/7/2009 7/7/2009 NE 7/7/2009 CA 7/7/2009 NY 7/7/2009 MN 7/7/2009 IN 7/7/2009 AL 7/7/2009 CA 7/7/2009 TN 7/7/2009 NH 7/7/2009 CO 7/7/2009 NC 7/7/2009 IN 7/7/2009 TX 7/7/2009 MA 7/7/2009 CA 7/7/2009 CT 7/7/2009 NY 7/7/2009 PA 7/7/2009 AZ 7/7/2009 MN 7/7/2009 OR 7/7/2009 TX 7/7/2009 AL 7/7/2009 TN 7/7/2009 MA 7/7/2009 VT 7/7/2009 NY 7/7/2009 IN 7/7/2009 PA 7/7/2009 VT 7/7/2009 TX 7/7/2009 KS 7/7/2009 WI 7/7/2009 OH 7/7/2009 TX 7/7/2009 PA 7/7/2009 IA 7/7/2009 MI 7/7/2009 MN 7/7/2009 OR 7/7/2009 VT 7/7/2009 AZ 7/7/2009 MI
62 1.1 12 1 4 30 1.7 1 70 4 16 67 0.2 47 4 6 9 24 14 5 4 23 9 1.3 0.1 7 30 55 76 0.6 46 6 3 30 66 1.7 61 71 12 18 50 5 4 8 18 0.4 0.3 4 77 4 15
62 1 12 1 4 30 1 1 70 4 16 67 0 47 4 6 9 24 14 5 4 23 9 1 0 7 30 55 76 0 46 6 3 30 66 1 61 71 12 18 50 5 4 8 18 0 0 4 77 4 15
M 0.1 F F 0M M M 0.7 M 0U U F F F 0.2 F F F M M M M F M F F 0.3 M 0.1 M F F F F 0.6 M F M F F M 0.7 F F F M F F F F M F 0.4 F 0.4 M M F F F
6/25/2009 Patient developed bruising at injecti 7/1/2009 Fever + rash typical of rubella. 7/1/2009 At 12:15 pm pt. felt dizzy (6/30/09) a 6/25/2009 Patient had a area - 10 cm- area of 6/25/2009 Area of erythema and induration at 6/29/2009 14 days after vaccination postular ra 7/2/2009 8.5 cm X 3 cm area of tan/lt. brown Pt had eruption of pustules on eryth Red swollen, painful, hard felling (so 7/3/2009 Erythema and induration 7/1/2009 Patient received HPV #2 @ 4 pm 6/ 6/25/2009 Patient developed a red raised area 6/25/2009 Dad stated that immediately after th 7/1/2009 Pt had fever 102-103, body aches, s 9 x 7,5 cm erythematous induration 6/29/2009 Erythematous, swelling at site of inje 6/29/2009 Patient received the varicella vaccin 6/20/2009 Patient fainted, went white, no treat 7/2/2009 Pt had severe HA, myalgias followe 7/7/2009 Half dollar sized area of redness ov Left thigh swollen & hot to touch 7/3 6/30/2009 ER x2 6/22/09, Redness, fever, nau 6/28/2009 Within a few hours of vaccination th 6/30/2009 None. 7/1/2009 Admin IM Hep B dose # 2 of 3 at ap 6/29/2009 Rash started at site of injection with Pt received ACAM2000 on 6/25/09. 5/26/2009 No inflammation at deltoid but very 7/6/2009 Patient had ZOSTAVAX vaccine ad 7/7/2009 10 minutes after receiving DTaP, de 7/7/2009 Pt received vaccine on 6/26/09. On 6/29/2009 Erythematous swelling at site of inje 7/1/2009 Received DTaP on 6/30/09. c/o pain 7/7/2009 Three days after receiving started w 7/1/2009 Redness and swelling of arm. 6/29/2009 0 / parent notified of dose given out 6/19/2009 5/14/09 - Vaccination (itch, no fever 7/7/2009 Small bump, reddened ongoing afte 7/7/2009 Patient became extremely pale, ligh 7/7/2009 Site at varicella injection site becam 7/7/2009 On 7-3-09 came to work at 7am with 7/7/2009 Mother states has red spots with a w 7/7/2009 As per phone conversation w/ grand 7/7/2009 Varicella vaccine breakthrough. Ha 7/7/2009 7/01/2009 Dr. reported that patient h 7/7/2009 Mother states at 7 pm infant began 7/7/2009 About 30 minutes after vaccines we 7/7/2009 Left lower extremity swelling from th 7/7/2009 pt experienced swelling and rednes 7/7/2009 Redness and swelling of left arm tw 7/7/2009 Fever, Headache, Syncope
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7/7/2009 CT 7/7/2009 PA 7/7/2009 NV 7/7/2009 AZ 7/7/2009 CO 7/7/2009 CA 7/7/2009 CA 7/7/2009 NY 7/8/2009 CA 7/8/2009 7/8/2009 7/8/2009 7/8/2009 7/8/2009 OH 7/8/2009 7/8/2009 7/8/2009 GA 7/8/2009 GA 7/8/2009 NE 7/8/2009 IN 7/8/2009 GA 7/8/2009 SC 7/8/2009 CA 7/8/2009 WA 7/8/2009 NY 7/8/2009 MN 7/8/2009 VA 7/8/2009 NC 7/8/2009 KY 7/8/2009 IL 7/8/2009 MN 7/8/2009 AZ 7/8/2009 PA 7/8/2009 CA 7/8/2009 MA 7/8/2009 MI 7/8/2009 CA 7/8/2009 CA 7/8/2009 SD 7/8/2009 TX 7/8/2009 MA 7/8/2009 NC 7/8/2009 GA 7/8/2009 OH 7/8/2009 MI 7/8/2009 MO 7/8/2009 MN 7/9/2009 PA 7/9/2009 NY 7/9/2009 FL 7/9/2009
20 9.5 0.2 11 71 1.3 1.1 66 12 25 19
20 9 0 11 71 1 1 66 12
63 47
47
19 61 19 0.3 0.5 20 24 62 50 70 4 4
19 61 19 0 0 20 24 62 50 70 5 4
28 4 1 29 4 1 0.6 65 43
28 4 1
1.2 1 54 1.1 51 5 5 12 1.3 62 12
1 1 54 1 51 5 5 12 1 62
4 1 0 65 43
F F 0.2 F M F 0.3 M 0.1 M F F M F M M F U U F F F F 0.3 F 0.6 F F F F F F F M U F F 0M F F 0M 0.6 M F M F 0.2 M 0F M 0.1 F F M M F 0.3 M M F
7/7/2009 The injection was given on May 1, 2 7/1/2009 Varicella vaccine break through. Ha 7/7/2009 Right tonic-clonic seizure with left fa 7/7/2009 Pt. came in with headache, pain in l 7/7/2009 Developed 2 chickenpox like rashes 7/7/2009 Dtap and MMR where given on 06/2 7/7/2009 infant had shots app 11 days ago no 7/1/2009 Arm swelling at injection site - red fr 7/8/2009 Nausea and weakness days before 7/2/2009 After taking required doses of the A 7/4/2009 My daughter was encouraged to ha 6/17/2009 Narrative: The patient had a mild fe 6/8/2009 Per clinic note on 5/11/09- Patient h 7/6/2009 Initial report received on 30 June 20 7/7/2009 It was reported Y from an article publis 7/7/2009 It was reported Y from an article publis 7/7/2009 Information has been received from 7/8/2009 No adverse events or treatment nee 7/8/2009 Received S Zostavax and within an 7/8/2009 Pt received Hepatitis A & typhoid @ 7/8/2009 BLOOD IN STOOL 7/8/2009 Patient developed jerking movemen 7/8/2009 lower body paralysis. 7/9/09 Hospita 7/8/2009 after receiving inj. pt sat down and p 7/8/2009 Patient received TDaP injection to le 7/8/2009 Expired vaccine given inadvertantly 7/8/2009 area right outer and anterior upper a 7/8/2009 Patient was given Boostrix instead o 7/8/2009 Patient recieved vaccinations at the 7/8/2009 well he was looking at wheni was ca 7/8/2009 She is a 28-year-old intern in biosta 7/8/2009 Client's Mother called stating that sh 7/8/2009 Child screamed and cried for two fu 7/8/2009 Allergic Reaction five days after inje 7/8/2009 07/07/2008 PM (Less than 24 hours 7/7/2009 MMR vaccination given IM route. 7/7/2009 Fever/Seizure. Febrile seizure- eval 7/8/2009 Patient received ZOSTAVAX vaccin 7/7/2009 Severe pain at injection site. 6/29/2009 None Stated 7/8/2009 Received Varicella 7/1/09, 7/6/09 no 5/14/2009 Rash on chest, back and legs. 6/26/2009 1. Chin numbness. TX: CT of head. 7/8/2009 Multiple blisters at various stages of 7/8/2009 Pt presented to office one day after 7/8/2009 Right upper arm, redness, swollen, 6/25/2009 This case was reported by a physici 7/8/2009 Information has been received from 7/8/2009 Information has been received from 7/8/2009 Information has been received from 7/8/2009 Information has been received from
351039 7/9/2009 VA 351040 7/9/2009 ID 351049 7/9/2009 FL 351050 7/9/2009 PA 351051 7/9/2009 NY 351052 7/9/2009 MI 351053 7/9/2009 OR 351054 7/9/2009 CA 351055 7/9/2009 OH 351056 7/9/2009 MN 351057 7/9/2009 MD 351058 7/9/2009 AR 351059 7/9/2009 NC 351060 7/9/2009 OK 351061 7/9/2009 MA 351062 7/9/2009 OR 351063 7/9/2009 CA 351064 7/9/2009 CA 351065 7/9/2009 CA 351066 7/9/2009 OR 351067 7/9/2009 NJ 351068 7/9/2009 CA 351070 7/9/2009 NJ 351071 7/9/2009 WI 351072 7/9/2009 MD 351073 7/9/2009 IL 351074 7/9/2009 CO 351075 7/9/2009 CA 351076 7/9/2009 CA 351077 7/9/2009 PA 351078 7/9/2009 AZ 351079 7/9/2009 NJ 351080 7/9/2009 NJ 351081 7/9/2009 TX 351082 7/9/2009 CA 351083 7/9/2009 NJ 351084 7/9/2009 IL 351085 7/9/2009 KS 351086 7/9/2009 AZ 351087 7/9/2009 IN 351088 7/9/2009 NY 351089 7/9/2009 KY 351090 7/9/2009 CA 351091 7/9/2009 DE 351092 7/9/2009 IN 351093 7/9/2009 CA 351094 7/9/2009 MN 351095 7/9/2009 MN 351096 7/9/2009 PA 351069 7/10/2009 CA 351098 7/10/2009 NY
14 63 24 7 50 15 1 20 65 2 11 42 24 73 75 5 50 9 1.5 14 13 6 18 5 69 4 10 11 67 10 1.2 17 49 4 4 63 11 5 5 1.3 11 36 1.3 1.5 19 71 5 13 16 1 1.4
14 63 24 7 50 15 1 20 65 2 11 42 24 73 75 5 50 9 1 14 13 6 18 5 69 4 10 11 67 10 1 17 49 4 4 63 11 5 5 1 11 36 1 1 19 71 5 13 16 1 1
F F F F F M 0F F F 0M F F F M F M F F 0.4 M F F U M M F F F M F F 0.2 F F F M M F M F M 0.3 M M M 0.3 M 0.5 F M F F M F 0M 0.4 M
7/7/2009 Initial report was received 01 July 20 7/8/2009 Initial report received on 02 July 200 7/9/2009 It has been over 2 weeks since my 7/9/2009 Near syncope event. 7/9/2009 PINKISH DISCHARGE AT INJECTI 7/9/2009 After administration of vaccines. Clie 7/9/2009 Rash x1 week, develops water filled 7/9/2009 Client fainted after receiving immuiz 7/9/2009 Aproximately 15 minutes after vacci 7/9/2009 Within 12 hours of immuniation Chil 7/9/2009 Swelling, redness and warmth at inj 7/9/2009 Pt received Tdap 0.5ml Im in left de 7/9/2009 Pt received HPV vaccine on 14 Apr 7/9/2009 Received a call from son-in-law of p 7/9/2009 Shingles vaccine given at 1:35PM. A 7/9/2009 Vaccine given in Right deltoid. Nex 7/9/2009 Pt report onset of pain in joints on in 7/9/2009 Measures 10cm x 10cm Flat with ra 7/9/2009 Duplicate doses of DTap and IPV w 7/9/2009 Extreme fatigue (sleeping 20-22 hou 7/9/2009 Coughing, trouble breathing, loss of 7/9/2009 Severe swelling, induration, pain an 7/7/2009 Approx. less than a minute after vac 6/30/2009 Redness around injection site "hard 7/6/2009 1. Shot administered on Wed. 2. Th 7/1/2009 Right thigh (injection site) with 4 in x 6/26/2009 ZOSTAVAX was administered on 6/ 7/3/2009 Induration and erythema. 6/15/2009 Back pain, nausea and vomiting - p 7/3/2009 Patient received GARDASIL and DT 6/26/2009 Pt developed Varicella infection; < 5 7/8/2009 5cm by 4cm swollen right upper arm 7/9/2009 Received yellow fever vaccine on 7/ 7/9/2009 Redness, swelling R arm deltoid. 7/9/2009 Swelling, redness and pruritus. Mar 7/9/2009 Herpetic vesical 2" X 1" surrounded 7/9/2009 Child received vaccination 7-7-09; c 7/7/2009 Pt. received MMR and VARIVAX su 7/9/2009 Large area of erythema at deltoid ar 7/9/2009 L thigh sterile abscess with 5 X 3 cm 7/6/2009 Pt noticed erythema ~2 1/2 inches o 7/6/2009 7-2-09 - Leg, knee pain. 7-3-09 - Nu 7/2/2009 Received 15 mos vaccines. Develop 6/26/2009 Pt with sl swelling at site of injection 7/9/2009 Palpitations. 7/9/2009 (L) arm - red, swollen, tender to touc 6/18/2009 L upper arm swelling, temp and pain 7/9/2009 Approximately 12 hours after admin 6/8/2009 Initial report received on 02 June 20 7/10/2009 The varicella vaccination administer 7/1/2009 Febrile seizure 3:38 am after vaccin
351101 351102 351103 351104 351108 351109 351110 351111 351112 351113 351114 351115 351116 351117 351118 351119 351120 351121 351122 351123 351124 351125 351145 351146 351147 351148 351150 351151 351152 351153 351154 351155 351156 351157 351158 351159 351160 351161 351162 351163 351164 351165 351126 351127 351128 351129 351130 351131 351132 351133 351134
7/10/2009 AR 7/10/2009 7/10/2009 VA 7/10/2009 7/10/2009 CT 7/10/2009 TX 7/10/2009 NC 7/10/2009 AL 7/10/2009 MI 7/10/2009 TX 7/10/2009 CA 7/10/2009 MA 7/10/2009 MA 7/10/2009 PA 7/10/2009 IA 7/10/2009 AZ 7/10/2009 GA 7/10/2009 MI 7/10/2009 CA 7/10/2009 CA 7/10/2009 WI 7/10/2009 TX 7/10/2009 VA 7/10/2009 NC 7/10/2009 GA 7/10/2009 NY 7/10/2009 NY 7/10/2009 CA 7/10/2009 PA 7/10/2009 CA 7/10/2009 WA 7/10/2009 CA 7/10/2009 CA 7/10/2009 CA 7/10/2009 DE 7/10/2009 DC 7/10/2009 NC 7/10/2009 IA 7/10/2009 FL 7/10/2009 UT 7/10/2009 CA 7/10/2009 AR 7/11/2009 NJ 7/11/2009 NJ 7/11/2009 NC 7/11/2009 NY 7/11/2009 GA 7/11/2009 PR 7/11/2009 TX 7/12/2009 TX 7/12/2009 NY
12 72 65 88 10 0.7 74 5 17 15 74 60 76 11 0.2 26 18 1 22 0.3 56 12 37 19 0.2 20 16 8 66 4 18 11 4 1.2 75 4 8 85 38 53 3 52 27 31 60 15 37 18 0.1 24 24
65 88 10 0 74 5 17 15 74 60 76 11 0 26 18 1 22 0 56 12 37 19 0 20 16 8 66 4 18 11 4 1 75 4 8 85 38 53 3 52 27 31 60 15 37 18 0 24 24
F F M F F 0.7 F F F M F F F F M 0.2 F M M 0M F 0.2 M F M M F 0.2 M F F M M F F F F 0.2 F M M F F M M M F M F M F M M 0.1 F F M
7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Anaphylaxis - Vaccine given @ 1:45 7/9/2009 Immunizations followed about 4-5 h 7/10/2009 patient developed approx 12 raised 7/10/2009 Immunization given on 6/30/09. Par 7/10/2009 Patient feeling nausea and dry heav 7/10/2009 Patient developed a bright red, irreg 7/10/2009 extreme burning & itching, extensive 7/10/2009 soreness, redness and swelling left 7/10/2009 SORENESS AND SWELLING, SLIG 7/10/2009 after vaccine administration the pt w 7/10/2009 Patient rec'd vaccines 7/8/09 and on 7/8/2009 Diffuse Musculostreleted pain and w 7/10/2009 2:53 P.M. 18 y.o w/m administered 7/10/2009 Spoke with Mother who has noticed 7/10/2009 Inflamation around the smallpox site 7/10/2009 Diarrhea 4 days after Rotateq (6/26 7/10/2009 Patient presented with redness, war 7/10/2009 The second evening after patient re 7/6/2009 Received AVA #3 and Tdap on 6/29 7/10/2009 No adverse event/pregnancy outcom 7/9/2009 Received 2m vaccination with oral R 7/10/2009 4 hours after receiving vaccine pt c/ 7/10/2009 1 day after GARDASIL developed fe 7/12/2009 About 24h after vaccination, child de 7/11/2009 Swollen (slight), looks reddish (as if 7/9/2009 1 cm raised patch ~ 1cm above MM 7/9/2009 Pt A and O x3. HPV given L deltoid. 7/7/2009 Local redness and swelling 4 days a 7/10/2009 Swelling: blistering of arm. 7/9/2009 1- Vaccine and Anaphylactic reactio 7/10/2009 Pt given PNEUMOVAX in left deltoid 6/19/2009 Vaccine Administration error HIB va 7/10/2009 Patient developed a 3cm erythemat 6/23/2009 Pt states started burning itchy area 7/11/2009 Left arm soreness, tenderness, kno 7/10/2009 30 min- after given, sudden onset h 7/10/2009 Left upper arm is red, swollen from 7/10/2009 Redness at injection site, left deltoid 7/11/2009 ANTHRAX WAS GIVEN AS PPD. 0 7/11/2009 SERVICE MEMBER GIVEN ATHRA 7/11/2009 Arm and head have hurt enough to 7/11/2009 Seizure 7:30PM on 7/10/09 and at 8 7/11/2009 Multiple pustules at site of inoculatio 7/11/2009 FACIAL PALSY(RIGHT SIDE) DAY 7/11/2009 On Tues.7th my 5 week old daught 7/12/2009 after the third vaccine of GARDISIL 7/12/2009 Woke up at 0200 with pounding hea
351135 351136 351168 351172 351173 351181 351184 351185 351191 351192 351193 351194 351195 351197 351198 351199 351200 351201 351203 351204 351205 351206 351207 351208 351211 351212 351213 351214 351215 351216 351217 351218 351219 351220 351221 351222 351223 351224 351225 351226 351227 351228 351229 351230 351231 351232 351233 351234 351235 351236 351239
7/12/2009 NY 7/12/2009 DC 7/13/2009 PA 7/13/2009 7/13/2009 MD 7/13/2009 WA 7/13/2009 OH 7/13/2009 OH 7/13/2009 WI 7/13/2009 PA 7/13/2009 OH 7/13/2009 NY 7/13/2009 CA 7/13/2009 MO 7/13/2009 KY 7/13/2009 KY 7/13/2009 MA 7/13/2009 FL 7/13/2009 CA 7/13/2009 TX 7/13/2009 NY 7/13/2009 FL 7/13/2009 FL 7/13/2009 WI 7/13/2009 CA 7/13/2009 HI 7/13/2009 WA 7/13/2009 CA 7/13/2009 PA 7/13/2009 MA 7/13/2009 CT 7/13/2009 VA 7/13/2009 CT 7/13/2009 DC 7/13/2009 FL 7/13/2009 HI 7/13/2009 CA 7/13/2009 GA 7/13/2009 GA 7/13/2009 GA 7/13/2009 GA 7/13/2009 ME 7/13/2009 IL 7/13/2009 GA 7/13/2009 7/13/2009 MS 7/13/2009 CA 7/13/2009 NC 7/13/2009 UT 7/13/2009 CA 7/13/2009 FL
38 58 63
38 58 63
15 57 5 5 14 4 42 24 12 52 83 28 75 4 69 38 28 34 63 14 4 56 63 14 4 69 4 21 63 45 12 1 61 50 18 18 51 39 17 1.1 2 10 21 1.4 4 65 79
15 57 5 5 14 4 42 24 12 52 83 28 75 4 69 38 34 63 14 56 63 14 4 69 4 21 63 45 12 1 61 50 18 18 51 39 17 1 2 10 21 1 4 65 79
F F F F F F M F F F F F F M F F M F F F F F F M F F F F M F M M F M M 0F F M F F F F M 0.1 F 0.9 M M M 0.4 M M U F
7/12/2009 CHills, myalgias, headache all starte 7/12/2009 3 weeks after Tdap vaccine, awake 7/10/2009 Information has been received from 7/10/2009 Information has been received from 7/10/2009 Information has been received from 7/9/2009 Initial report received on 06 July 200 7/13/2009 This case was reported by a healthc 7/13/2009 This case was reported by a healthc 7/13/2009 Immun. given Mon., 7/6/09 at 3:30 p 7/13/2009 Varicella Vaccine breakthrough. Ha 7/13/2009 Patient complaining of dizziness an 7/13/2009 PATIENT COMPLAINED OF AN ITC 7/13/2009 Patient with fever >102.0 less than 1 7/13/2009 Fever, nights sweats, weight loss, a 7/13/2009 PT PHONED ON MONDAY (7/13/0 7/13/2009 c/o soreness of R arm, mild swelling 7/13/2009 Developed red, hot, raised, itchy blo 7/13/2009 REDNESS WITH EDEMA AROUND 7/13/2009 This 69-year-old female was brough 7/13/2009 Fever of 101, redness, raised bump 7/13/2009 Patient reports having an MMR vacc 7/13/2009 Rec'd one dose Varicella, 48hrs late 7/13/2009 broke out with a rash on buttovk, sid 7/13/2009 Recieved vaccine without incident a 7/1/2009 L deltoid induration (+) erythema, w 7/13/2009 Vaccination site indurated, erythem 7/13/2009 Patient woke up this morning (7-137/13/2009 Scared before injection. Syncopal e 7/13/2009 Woke up 07/11/09 Swelling & cellul 7/13/2009 Headaches Fevers- per pt. None w 7/10/2009 Blistering irregular rash on upper L a 7/13/2009 This 31 year old male reported rece 7/13/2009 Flu-like malaise, weakness, low gra 7/6/2009 Extended rash - additional sores. Pt Had TDAP/Menactra in (L) Deltoid o 7/8/2009 After receiving MMR shot at age 1, 6/22/2009 Redness. pain, swelling localized to 5/29/2009 Broke out with rash 5/26/09. Mild fe 6/5/2009 Received 5 immunizations. After re 6/19/2009 See attached Notes. See back. Cli 6/22/2009 Pt. called 6-19-09 spoke with RN c/o 7/10/2009 7-8-09 receive injection - next day b 7/13/2009 Immediately after the 2 vaccines we Hives Rash over abdomen and extr 7/13/2009 Parents report change of affect of p 7/13/2009 Severe swelling/induration of deltoid 7/6/2009 21 y.o. c/o rash on arms torso ches 7/9/2009 Low grade fever since immunization 7/9/2009 Night after vaccines, right thigh gros None stated 6/19/2009 Onset pulsating pain in shoulder rad
351241 351242 351243 351244 351245 351246 351247 351248 351249 351250 351251 351252 351253 351254 351255 351256 351257 351258 351259 351260 351261 351262 351263 351264 351265 351266 351267 351268 351269 351270 351271 351272 351273 351274 351275 351276 351277 351278 351279 351280 351281 351282 351283 351284 351285 351286 351287 351288 351289 351290 351291
7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 WA 7/13/2009 IN 7/13/2009 CA 7/13/2009 VA 7/13/2009 CO 7/13/2009 MI 7/13/2009 7/13/2009 WY 7/13/2009 7/13/2009 AZ 7/13/2009 TX 7/13/2009 PA 7/13/2009 OH 7/13/2009 PA 7/13/2009 WI 7/13/2009 7/13/2009 7/13/2009 NJ 7/13/2009 NJ 7/13/2009 7/13/2009 7/13/2009 NE 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 OR 7/13/2009 MT 7/13/2009 GA 7/13/2009 OR 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 7/13/2009 NJ 7/13/2009 CA 7/13/2009 OK 7/13/2009 7/13/2009 7/13/2009 7/13/2009 MA 7/13/2009 IL 7/13/2009 7/13/2009 WA 7/13/2009 AL 7/13/2009 PA 7/13/2009 FL
84 57 79 66 85 76 63 61 62 71
84 57 79 85 76 63 61 62 71
73 74 64 63 67 66 72 60 71 60 86 42 63 67 67 65 71 73 71
74 64 63 67 66 72 71 60
42 63 67 65 71
70 62 79 74 84 78 65
79 74 84
67 70
67 69
63 67 80
F F F F M F F M M F F F M F F M M F F F F M U M F F F F F M M F F F F F F M M F F U F F F F F F F F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351292 351293 351294 351295 351373 351374 351375 351376 351377 351378 351379 351380 351382 351383 351384 351385 351386 351387 351388 351389 351390 351391 351392 351393 351394 351395 351396 351397 351398 351399 351400 351401 351402 351403 351404 351405 351406 351408 351409 351410 351411 351412 351413 351414 351490 351492 351493 351494 351495 351496 351497
7/13/2009 7/13/2009 NY 7/13/2009 MO 7/13/2009 OK 7/13/2009 IA 7/13/2009 OH 7/13/2009 CT 7/13/2009 FL 7/13/2009 PA 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 TX 7/13/2009 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 NC 7/13/2009 IL 7/13/2009 IL 7/13/2009 IL 7/13/2009 SC 7/13/2009 MA 7/13/2009 OR 7/13/2009 CA 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 GA 7/13/2009 MI 7/13/2009 7/13/2009 CT 7/13/2009 TX 7/13/2009 ID 7/13/2009 7/13/2009 AZ 7/13/2009 VA 7/13/2009 FL 7/13/2009 7/13/2009
50 70 63 75 56 82 61 70 65 81
63 64 64 57 68
70 63 75 82 61 70 65
64 68
68 61 69
61 69
85 82 59
59
70 73 64 70 61
70
75 66 74 77 75 82 78
75
66 61 65 76 70
64 70 61
78
65
F F F F F F F F M M F F U F M F F F F F M F M F M F F F F F F F M F F F F M F F F F M F F M M F F F U
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 7/7/2009 This case was reported by a healthc 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/21/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351498 351499 351500 351501 351502 351503 351504 351505 351506 351507 351508 351509 351510 351511 351512 351513 351514 351515 351516 351517 351518 351519 351520 351521 351522 351523 351524 351525 351526 351527 351528 351529 351530 351531 351532 351559 351560 351561 351562 351563 351564 351565 351566 351567 351568 351569 351570 351571 351572 351641 351642
7/13/2009 SC 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 OR 7/13/2009 FL 7/13/2009 FL 7/13/2009 7/13/2009 VA 7/13/2009 7/13/2009 TX 7/13/2009 FL 7/13/2009 AL 7/13/2009 FL 7/13/2009 CA 7/13/2009 AZ 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 LA 7/13/2009 IL 7/13/2009 7/13/2009 7/13/2009 MN 7/13/2009 NM 7/13/2009 CA 7/13/2009 MN 7/13/2009 VA 7/13/2009 NY 7/13/2009 WA 7/13/2009 7/13/2009 NJ 7/13/2009 MI 7/13/2009 7/13/2009 7/13/2009 NY 7/13/2009 PA 7/13/2009 7/13/2009 TX 7/13/2009 CA 7/13/2009 IL 7/13/2009 SC 7/13/2009 MD 7/13/2009 7/13/2009 IN 7/13/2009 WA
62
62
60 60
60
55 60 66 38 90
66 90
78 73
72 73
81 67 61
67 61
60 64 70 62 72 63 65 67 64 59
64
72 63 65 67 59
62 63 74 68 63
62 63 74 68
76 67 65 16 60
76 67
73 65 25
25
F F U U F F U U F M M M F M F F M F F F F F F F F M F F F M F F M F F M F F U M U M F F U M F F F U F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351643 351644 351645 351646 351647 351648 351649 351650 351651 351652 351653 351654 351655 351656 351657 351658 351659 351660 351661 351662 351663 351664 351665 351666 351667 351668 351669 351670 351671 351672 351673 351674 351675 351676 351677 351678 351679 351680 351681 351682 351683 351684 351685 351686 351687 351688 351689 351690 351691 351692 351693
7/13/2009 HI 7/13/2009 NJ 7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 MA 7/13/2009 PA 7/13/2009 7/13/2009 TX 7/13/2009 SD 7/13/2009 MO 7/13/2009 CO 7/13/2009 7/13/2009 AZ 7/13/2009 OK 7/13/2009 IN 7/13/2009 OH 7/13/2009 7/13/2009 CA 7/13/2009 HI 7/13/2009 NC 7/13/2009 PA 7/13/2009 TX 7/13/2009 7/13/2009 CO 7/13/2009 7/13/2009 PA 7/13/2009 CT 7/13/2009 ME 7/13/2009 7/13/2009 7/13/2009 MN 7/13/2009 7/13/2009 PA 7/13/2009 PA 7/13/2009 CO 7/13/2009 7/13/2009 PA 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 KS 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 IL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 FL 7/13/2009 RI
66 61 63 70 65 79 70 76 70 65 77 71 81 65 62 68 83 67 61 67 74
61 63
79
70 65 77 71
62 68 83 61
64 69 63 70 69
64
67 60 66 78 62 61
67 60
77 71 80
77 71
63 69
78 61
63 66 82 60
60
65 70 65
70 65
U M F M F F F F U F M M F U F F M F M F F F F M M F F M F F F F F F M F F M F F F M F F F M U U F F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has with allergies to PE 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351694 351695 351696 351697 351698 351699 351728 351729 351730 351731 351732 351733 351734 351735 351736 351737 351738 351739 351740 351760 351761 351762 351763 351764 351765 351807 351808 351809 351810 351811 351812 351813 351814 351815 351816 351817 351818 351819 351820 351821 351823 351824 351825 351826 351827 351828 351829 351830 351831 351832 351833
7/13/2009 7/13/2009 7/13/2009 NV 7/13/2009 7/13/2009 7/13/2009 ME 7/13/2009 7/13/2009 MO 7/13/2009 7/13/2009 NY 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 AZ 7/13/2009 FL 7/13/2009 TN 7/13/2009 TX 7/13/2009 DC 7/13/2009 7/13/2009 WV 7/13/2009 7/13/2009 PA 7/13/2009 7/13/2009 7/13/2009 OH 7/13/2009 7/13/2009 TX 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 OK 7/13/2009 NC 7/13/2009 LA 7/13/2009 MA 7/13/2009 MI 7/13/2009 7/13/2009 AZ 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 CT 7/13/2009 AR 7/13/2009 7/13/2009 IN 7/13/2009 7/13/2009 7/13/2009 7/13/2009 FL 7/13/2009 CA
63 61 72 72 57 67 61 1.5 74 64 87 58 24 68 66 65 65 89 55 75 62 74 60 68 52 62 70 84 79 60 80 72 62 65 60 86 60
61 72 72 57
74 87
68 66 65 65 89
75 62 74
52 62 70 84 79 80 72 62 65 60 86 60
69 65 91 1.2 69 87 76 84 66
69 87 76 84 66
F F M F M U F F M F F M U F F F F M F M M F M F F M F F M F M M F M M F F M F F F F M F M U F M F M F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Initial and follow-up information has 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351834 351835 351836 351837 351838 351839 351840 351841 351842 351843 326259 351238 351296 351299 351300 351303 351304 351307 351309 351310 351311 351312 351313 351314 351315 351316 351317 351318 351319 351321 351322 351323 351324 351325 351326 351328 351329 351330 351331 351332 351333 351334 351335 351336 351337 351338 351340 351341 351342 351343 351345
7/13/2009 ID 7/13/2009 7/13/2009 CA 7/13/2009 TX 7/13/2009 WY 7/13/2009 7/13/2009 7/13/2009 7/13/2009 MI 7/13/2009 7/14/2009 CO 7/14/2009 NY 7/14/2009 LA 7/14/2009 SC 7/14/2009 7/14/2009 7/14/2009 CA 7/14/2009 NV 7/14/2009 KS 7/14/2009 OH 7/14/2009 MI 7/14/2009 AZ 7/14/2009 SD 7/14/2009 NC 7/14/2009 CO 7/14/2009 FL 7/14/2009 VT 7/14/2009 CT 7/14/2009 TX 7/14/2009 NY 7/14/2009 NJ 7/14/2009 7/14/2009 MI 7/14/2009 IL 7/14/2009 CA 7/14/2009 CA 7/14/2009 FL 7/14/2009 CA 7/14/2009 TX 7/14/2009 NC 7/14/2009 TX 7/14/2009 AZ 7/14/2009 WA 7/14/2009 CA 7/14/2009 CA 7/14/2009 AZ 7/14/2009 VA 7/14/2009 FL 7/14/2009 WA 7/14/2009 CA 7/14/2009
62 63 60 58
62
61 63 60 68 18 18 0.6 0.6 12 0.2 17 28 0.4 5 63 1 1 4 18 0.4 61 13 10 4 0.3 16 44 17 46 72 23 1 1 2 2 4 65 0.5 0.5 11 1 11 1 20 26
61
68 18 18 0 0
17 28 0 5 63 1 1 4 18 0 61 13 10 4 0 16 44 17 46 70 23 1 1 2 2 4 65 0 0 11 0 11 20 26
F M F F F U F F F F M F 0.6 M 0.6 F F F F F 0.4 F M F 0F 0M F F 0.4 M F F F M 0.3 F F F F F F F 0F 0M 0.6 M 0F F F 0.5 F 0.5 F F 1M M M F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 10/7/2008 Initial information received from a he 7/13/2009 Coughing, shortness of breath edem 6/22/2009 Imun given Thursday - 6/18/09 appr 7/7/2009 Intussusception requiring surgical re 7/12/2009 Daughter has adverse reaction to G 7/10/2009 At 2 mo, child was given her 1st dos 7/13/2009 Information has been received from 6/25/2009 Shot Saturday, swollen knot on righ At 2 mo. well child visit, pt. was give 7/10/2009 13x8 cm region of erythema and ed 7/13/2009 Information has been received from 7/8/2009 On 6/12/2009 MMR, Varicella, PCV 7/9/2009 None stated 6/29/2009 MMR + Varicella given in (L) upper/ 7/6/2009 Per client, 30 minutes after vaccine, 7/6/2009 After last immunization pt had fever 5/29/2009 Vaccine given 5-26- AM. Symptom 7/6/2009 Painful arms at inj. site - warm to tou 7/3/2009 The child had an episode of dizzine 7/14/2009 This case was reported by a healthc 7/14/2009 6/22/09 - ER Hospital for elevated te 7/7/2009 Pt became light headed. Blood pres 7/14/2009 Patient presented today to emergen 7/14/2009 90 minutes after receiving vaccine c 7/14/2009 Soreness at injection site and sever 7/14/2009 4 inch redness, bumpy, warm, itchin 7/14/2009 Client stated that she experienced c 7/14/2009 On 7/8/09 patient received Prevnar, 7/14/2009 STARTED WITH A RASH ALL OVE 7/14/2009 SEVERE GENERALIZED RASH AN 7/14/2009 Urticaria Mom noticed rash upon aw 7/14/2009 Flat, red rash and spots on chest; in 7/14/2009 Shingles vaccination 7/1/09; 7/2/09 7/14/2009 VACCINE WAS ADMINISTERED A 7/14/2009 6month term previously healthy fem 7/14/2009 severe headache,soreness in arms 7/6/2009 Within 5 min of vaccines being given 6/26/2009 Edema, Tenderness (L) Deltoid, wa 6/30/2009 Hard, warm to touch, red area state 7/7/2009 Developed headache p.m. of 7/2/09 7/14/2009 Vaccine administered 7-10-09, pt re
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7/14/2009 AR 7/14/2009 AR 7/14/2009 AR 7/14/2009 CA 7/14/2009 WA 7/14/2009 WI 7/14/2009 FL 7/14/2009 CA 7/14/2009 FL 7/14/2009 NC 7/14/2009 NC 7/14/2009 MN 7/14/2009 CA 7/14/2009 CA 7/14/2009 CA 7/14/2009 AZ 7/14/2009 OH 7/14/2009 WA 7/14/2009 NY 7/14/2009 CA 7/14/2009 CA 7/14/2009 TX 7/14/2009 WA 7/14/2009 WA 7/14/2009 WA 7/14/2009 MI 7/14/2009 IA 7/14/2009 7/14/2009 NC 7/14/2009 CA 7/14/2009 SC 7/14/2009 TX 7/14/2009 NC 7/14/2009 KY 7/14/2009 CO 7/14/2009 PA 7/14/2009 NJ 7/14/2009 TN 7/14/2009 TN 7/14/2009 TN 7/14/2009 TN 7/14/2009 UT 7/14/2009 OR 7/14/2009 CA 7/14/2009 7/14/2009 7/14/2009 7/14/2009 7/14/2009 MD 7/14/2009 CA 7/14/2009 NC
33 5 18 0.4 1 4 0.2 11 12 5 57 12 12 14 57 42 46 1.3 0.9 9 3 3
33 5 18 0 1 4 0 11 12 5 57 12 12 14 57 42 46 1 0 9 3 3
10 14 1.8 18
14 1 18
42 73 29 20 57 58 43 60
42 73 28 20 57 58 43 60
56
56
38
38
31 58 42 34 26 74 34 42
31
74 34 42
F F M 0.4 U 0M F 0.2 F F F F F M F F F F F 0.3 M 0.9 M M M M F M M 0.8 M M U U F F F F F F F M F F F F F U F F F F F F F F
Vaccine administered 9/10/08 and n 6/16/2009 Mom stated that she took client to P 6/5/2009 Pt was given MMR II, RECOMBIVA None stated 7/14/2009 Fever 103, crying, fussy, red rash o 7/14/2009 Redness, swelling, tenderness on le 7/14/2009 (B) legs - 5-10 min after vax bright r 7/13/2009 Per Grandma- patient got a "pimple 7/14/2009 About 20 seconds after administerin 7/2/2009 Mom noted red knot on arm and leg 7/6/2009 Injection site was red, tender, itchy. 7/14/2009 7/10/09 Pt. presented to doctor with 7/14/2009 12 year old child, new to area, no va 7/13/2009 1600 pt passed out, in the lobby on 7/13/2009 Severe pain and inability to lift arm h 7/6/2009 Painful, swollen, red right arm. 7/7/2009 Started feeling sluggish on 6/27/09, 7/7/2009 Received DTAP, HIB and PREVNA 7/6/2009 High fever up to 104.8 (R) for 3 day 7/2/2009 4 cm round reddish area at site of in 7/3/2009 Erythema and induration. 7/7/2009 12 X 13 cm red mildly tender area a 7/7/2009 Injection site red, itchy, hot to touch 7/7/2009 Swollen, irritated, itchy Injection site 7/7/2009 7 cm swelling with 5cm induration/s 7/13/2009 Fever, vomiting, fussiness/irritability 7/2/2009 Transient vision loss. 6/24/2009 Information has been received from 6/24/2009 Information has been received from 9/9/2008 A 42-year-old female patient had re 8/5/2008 Initial report was received 29 May 2 9/9/2008 This non-serious case was received 5/6/2009 Initial report received on 24 June 20 8/26/2008 Initial report received on 07 July 200 ### Initial non-serious case received fro ### Initial report received from a health ### This non-serious case was received 2/13/2009 Initial report received from a healthc 2/13/2009 Initial report received from a healthc 2/13/2009 Initial report received from a healthc 3/18/2009 Initial report received from a healthc 2/9/2009 Initial information was received on 1 4/27/2009 Initial report received on 05 Februar 4/28/2009 Initial report received 19 February 2 3/4/2009 This non serious case was received 3/4/2009 This case was extracted from the VA 3/4/2009 This non serious case was received 3/3/2009 This case was extracted from the VA 3/5/2009 This non serious case was received 3/26/2009 A cluster of 3 patients who received 4/30/2009 Initial report received on 20 March 2
351880 351881 351882 351883 351884 351885 351886 351961 351963 351964 351965 351966 351967 351968 351969 351339 351415 351416 351417 351418 351419 351420 351421 351422 351423 351424 351425 351426 351427 351428 351430 351434 351435 351436 351438 351440 351443 351444 351445 351446 351447 351448 351449 351450 351451 351452 351453 351454 351455 351456 351457
7/14/2009 PA 7/14/2009 PA 7/14/2009 AZ 7/14/2009 NJ 7/14/2009 LA 7/14/2009 MA 7/14/2009 OH 7/14/2009 NY 7/14/2009 7/14/2009 TN 7/14/2009 CA 7/14/2009 ID 7/14/2009 CA 7/14/2009 NC 7/14/2009 GA 7/15/2009 7/15/2009 NE 7/15/2009 FL 7/15/2009 CO 7/15/2009 VA 7/15/2009 WI 7/15/2009 NC 7/15/2009 7/15/2009 VA 7/15/2009 FL 7/15/2009 PA 7/15/2009 AZ 7/15/2009 CO 7/15/2009 NH 7/15/2009 AZ 7/15/2009 MN 7/15/2009 MN 7/15/2009 CA 7/15/2009 NY 7/15/2009 OR 7/15/2009 MA 7/15/2009 NY 7/15/2009 WI 7/15/2009 MN 7/15/2009 MN 7/15/2009 SC 7/15/2009 OH 7/15/2009 OK 7/15/2009 PA 7/15/2009 CA 7/15/2009 AZ 7/15/2009 OH 7/15/2009 MI 7/15/2009 ME 7/15/2009 CA 7/15/2009 RI
40 28 47 58 54 49 47 11 28
40 28 47 58 54 49 47 11 28
41 37 61 54 37 2 16 0.5 0.9 28 25 0.2
41 37 61 54 37 0 16 0 0 28 25 0
11 15 5 48 23 12 11 39 40 5 0.4 4 45 51 4 61 20 70 40 54 73 32 27 26 0.2 3 8 65
11 5 48 12 11 39 40 0 4 45 51 4 61 20 70 40 54 32 27 26 0 3 8 65
F F F F F F F F M F F F F F F 0.6 M M 0.5 M 0.9 F M M 0.2 F U M F F F F F F M F M 0.4 F M F M M F M F M F M F M M 0.2 F M F M
4/8/2009 This non serious case was received 4/23/2009 This non serious case was received 5/13/2009 A 47 year old female patient with a 6/17/2008 This case was received from a cons 10/9/2008 Initial report received on 22 Septem 3/21/2009 This non serious case was received 3/11/2009 This report was received from a con 9/8/2008 Initial information was received from 9/29/2008 A 28 year old male patient, with no 2/13/2009 Case received from a healthcare pro 9/30/2008 A cluster of 2 adult patients who rec 3/31/2009 A 37-year-old female patient who w ### Initial non-serious case received fro ### Initial information was received on 2 2/20/2009 Initial report received from a health 7/15/2009 SWELLING, REDNESS AND WARM 7/7/2009 Severe nausea; weight loss over 20 7/10/2009 Information was extracted from his d 7/7/2009 Patient developed small lump at site 7/6/2009 Chills x 3 days ago. Cellulitis 6.5 cm 7/9/2009 Cellulitis secondary to smallpox vac 7/9/2009 Redness & swelling at site. Mostly 7/14/2009 InformationYhas been received from 7/8/2009 Pt. received 2 vaccines @ approxim 7/14/2009 Information has been received from 7/9/2009 Swelling, redness, warmth of right u 7/9/2009 Chills, cramps, severe weakness, d 7/14/2009 Information has been received from 7/9/2009 This child developed hives within 48 7/14/2009 Information has been received from 6/29/2009 None stated 6/29/2009 None 7/14/2009 Information has been received from 7/8/2009 Fever up to 106 degrees and irritab 7/9/2009 R arm swelling > 2 in width & length 7/14/2009 Information has been received from 7/15/2009 Typical Arthur reaction at right delto 7/9/2009 Local vaccine reaction. Left arm ext 7/8/2009 2cm swelling at injection site. No sig 7/2/2009 No adverse reaction. MMR II given 7/6/2009 Denied any symptoms-soreness, fe Inflammation of optical, nerves + mu 7/17/2009 Redness, Swelling at site of injectio 7/7/2009 Shortly after admin of ZOSTAVAX p 6/17/2009 Pt. reports "severe pain" in muscles 6/29/2009 Found vomiting x 2 in waiting room7/8/2009 Pt called 7/2/09 stating he became 7/7/2009 Unconsolable crying/screaming x 37/9/2009 1 -1/2 hrs after receiving vaccine pa 6/26/2009 Raised, red, round- approx. 2 inche 7/7/2009 Generalized pruritus. Fatigue. Myalg
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7/15/2009 OH 7/15/2009 NC 7/15/2009 NH 7/15/2009 TX 7/15/2009 NC 7/15/2009 NC 7/15/2009 IN 7/15/2009 NY 7/15/2009 NM 7/15/2009 IN 7/15/2009 CA 7/15/2009 CA 7/15/2009 VA 7/15/2009 MD 7/15/2009 CA 7/15/2009 OH 7/15/2009 AZ 7/15/2009 CA 7/15/2009 NC 7/15/2009 UT 7/15/2009 OR 7/15/2009 CO 7/15/2009 PA 7/15/2009 7/15/2009 IA 7/15/2009 IL 7/15/2009 NM 7/15/2009 NC 7/15/2009 NC 7/15/2009 OH 7/15/2009 CA 7/15/2009 CA 7/16/2009 CA 7/16/2009 CA 7/16/2009 PA 7/16/2009 AZ 7/16/2009 MI 7/16/2009 KY 7/16/2009 PA 7/16/2009 MD 7/16/2009 NY 7/16/2009 OH 7/16/2009 MA 7/16/2009 GA 7/16/2009 CO 7/16/2009 HI 7/16/2009 PA 7/16/2009 AZ 7/16/2009 CO 7/16/2009 CO 7/16/2009 TX
6 55 3 37 46 21 34 62 37 5 1.2 25 62 22 5 1.5 1 4 18 66 0.5 1.3
6 55 3 37 46 21 34 62 37 5 1 25 62 22 5 1 1 4 18 66 47 0 1
0.4 45 10 23 21 4 0.1 54 5 5 4 20 67 5 1.3 0.2 0.2 1.5 53 1.6 0.4 23 72 27 0.4 10.5 1.4
0 45 10 23 21 4 0 54 5 5 4 20 67 5 1 0 0 1 53 1 0 23 72 27 0 10 1
M F M F M F M F F M 0.2 M F F F F 0.5 F 0.1 F M F M M 0.5 F 0.2 M F 0.4 F F M M M M 0.1 M F M F M F F M 0.3 M 0.2 F 0.2 F 0.5 M F 0.6 F 0.4 F M F M 0.4 F F 0.4 F
7/15/2009 Mild erythema 4cm X 6cm at injectio 7/15/2009 approximately 42 hours post Zostav 7/15/2009 3 year old male brought in by his mo 7/15/2009 Within 1 hour of administration patie 7/15/2009 He had a varivax booster on Monda 7/15/2009 She has developed generalized vac 7/15/2009 Patient developed a burning sensat 7/15/2009 1-2 days later: dizziness, malaise fo 7/15/2009 Hour after immunization, experience 7/15/2009 Child was given a double dose of V 7/15/2009 12 1/2 x 10cm Circular, swollen leas 7/15/2009 Nausea, chest pain, asthsma, diarrh 7/15/2009 arm became swollen down to elbow 7/15/2009 Rabavert (Rabies vaccine)#1 given 7/15/2009 REDNESS AND SWELLING AROU 7/15/2009 Legs were tender to touch where va 7/15/2009 On 7-5-09, child developed raised p 7/15/2009 pt developed local reaction to vaccin 7/15/2009 Shortly after receiving her Gardasil, 7/15/2009 Woke up with head ache, slight nau 7/15/2009 c/o that he felt poorly last night. He 7/15/2009 Given 6 month vaccines including P 7/15/2009 104.2 fever taken at 2:15 a.m. on 4/ 7/15/2009 This case was reported by a lawyer 7/14/2009 On 7-2-09 at 10pm father noticed ey 7/14/2009 Symptoms of Bells Palsy returned. T 7/15/2009 Raised papule, erythema at site of V 7/15/2009 SM woke up with chest pain that go 7/15/2009 Sm developed chest pain that lasted 7/15/2009 Sneezing, coughing, wheezing, leth 7/15/2009 L thigh area red and swollen, hot to 7/15/2009 Redness, tender swelling at site of i 6/5/2009 R Leg - Varicella red + swollen + itc 7/7/2009 Redness and induration in right thig 7/7/2009 On 6-20-9, child complained of rt ch 7/6/2009 Fever, nausea, diarrhea, itchy Skin/ 7/10/2009 ZOSTAVAX administered 7/7/09. P 7/9/2009 In less than 24 hours after vaccinati 7/4/2009 Pt's family called on 6/2/09 to let us 7/14/2009 Intermittent cyclical crying/ screamin 7/10/2009 Outstretching of arms & legs for a fe 7/10/2009 Complex partial seizure, head nodd 7/13/2009 Approximately 10-15 min after vacc 7/6/2009 Child loss the use of her muscles, b 7/1/2009 Whole body tremor/spasmed (seizu 7/7/2009 Patient had moderate swelling R de 7/9/2009 Neck pain began on LFT side (wher 7/7/2009 Pt presented 10 d. after vaccines w 7/9/2009 Infant vomited at home x 3 and had 7/9/2009 Patient rec'd Hep A and VZV #2 on 7/2/2009 7/2/09 1500. Received call from pts
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7/16/2009 FL 7/16/2009 NY 7/16/2009 MA 7/16/2009 GA 7/16/2009 PA 7/16/2009 7/16/2009 7/16/2009 CO 7/16/2009 CO 7/16/2009 7/16/2009 MI 7/16/2009 VA 7/16/2009 GA 7/16/2009 OH 7/16/2009 OR 7/16/2009 MI 7/16/2009 FL 7/16/2009 FL 7/16/2009 IL 7/16/2009 CT 7/16/2009 WI 7/16/2009 TX 7/16/2009 OH 7/16/2009 TN 7/16/2009 TX 7/16/2009 ID 7/16/2009 TN 7/16/2009 OK 7/16/2009 TX 7/16/2009 IN 7/16/2009 NM 7/16/2009 MI 7/16/2009 NM 7/16/2009 IL 7/16/2009 MO 7/16/2009 MD 7/16/2009 NM 7/16/2009 MI 7/16/2009 TX 7/16/2009 NJ 7/16/2009 NC 7/16/2009 GA 7/16/2009 7/16/2009 7/16/2009 NJ 7/16/2009 LA 7/16/2009 MN 7/16/2009 FL 7/16/2009 TX 7/16/2009 GA 7/16/2009 AK
11.9 24 14 0.4 12 49
11 24 14 0 12 49
30 30 18 18 27 5 15 62 12 12 8 18 4 12 12 59 10 4 5 10 1.3 11 46 48 36 64 67 25 2 60 0.1 0.2 1.2 28 1.1 68 30 9 12 4 11 64 9 17
30 30 18 5 15 62 12 12 8 18 14 12 12 59 10 4 5 9 1 11 46 48 36 67 25 2 60 0 0 1 28 1 30 9 12 4 11 64 9 17
F M F 0.4 F F F M M M M F M M F F F F F F M F M F F M M M 0.3 F F F F F F F F 0F F 0.1 M 0.2 M 0.2 F M 0.1 M F F M M M M F M F
7/9/2009 Child almost bumped in the door as 7/8/2009 Pt reports temp of 104.3 degrees F, 7/13/2009 Pt received varivax vaccine sc in lef 7/13/2009 Mom stated child had a rash to both 7/7/2009 Redness, slight elevation. 6/30/2009 Migratory skin rash, diarrhea, soren 7/15/2009 Information has been received from 7/16/2009 This case was reported by a pharma 7/16/2009 This case was reported by a pharma 7/16/2009 This case was reported by a physici 7/16/2009 Fever onset of 9:00pm on 7/14/09, b 7/16/2009 localized swelling, redness and itchi 7/16/2009 4 hours after receiving IPV vaccine, 7/16/2009 This 15 year old received the follow 7/16/2009 Client presented to clinic 2 days afte 7/16/2009 Mom states that pt had a nose blee 7/16/2009 My daughter received the HPV Vac 7/16/2009 Per mother, patient experienced an 7/16/2009 07-08-2009 Patient came home with 7/16/2009 Arm swelling, redness, pain, itching 7/16/2009 2 X 3 inch reddened area on left arm 7/16/2009 Right arm swollen at sight of injectio 7/16/2009 EXTENSIVE REEDNESS AND PAI 7/16/2009 Received Varivax and had a local re 7/16/2009 redness streaks from scratching irrit 7/16/2009 On 7/8/09 patient received following 7/16/2009 Received Varivax on 7/13/09 on 7/1 7/16/2009 Mother called office at 8:30 am on 7 7/16/2009 Patient was vaccinated on July 14, 7/16/2009 Mumps titer came back too low on 5 7/16/2009 Approx 2 minutes after pneumococc 7/16/2009 fever, chills, shakiness, nausea, join 7/17/2009 Dizziness and profuse sweating for 7/16/2009 Pt received vaccine on Mon 7/13/09 7/16/2009 Pt received GARDASIL #2 on 7/10/ 7/16/2009 June 16th onset of fever and child c Area surrounding injection site redd 7/14/2009 None Known 7/15/2009 Increased "startle reflex" every few 6/17/2009 MOC brought child to clinic 7 days a 7/15/2009 28 y/o male ADSM is referred from 7/14/2009 Pt with macular rash on trunk - antih 7/13/2009 I was given the shingles vaccination 7/13/2009 Pt was given TDAP and VARIVAX v 7/15/2009 Immediately after giving vaccines - V 7/16/2009 24 hrs after injection outer aspect o 7/8/2009 Red & swollen at injection site. Ice 7/16/2009 Mom states hot, red and painful ind 7/16/2009 Pt. called on 7/16/09 self reported e 7/16/2009 '15min episode of nausea then vom 7/16/2009 Swelling around injection sight, eryt
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7/16/2009 NJ 7/16/2009 OH 7/16/2009 WA 7/16/2009 PA 7/16/2009 CA 7/16/2009 CA 7/16/2009 KS 7/16/2009 NY 7/17/2009 KY 7/17/2009 WA 7/17/2009 WA 7/17/2009 GA 7/17/2009 NY 7/17/2009 7/17/2009 MN 7/17/2009 NY 7/17/2009 NE 7/17/2009 WA 7/17/2009 MA 7/17/2009 MI 7/17/2009 MD 7/17/2009 TX 7/17/2009 TX 7/17/2009 PA 7/17/2009 IL 7/17/2009 WI 7/17/2009 OH 7/17/2009 MN 7/17/2009 WA 7/17/2009 NY 7/17/2009 MT 7/17/2009 TX 7/17/2009 OH 7/17/2009 AL 7/17/2009 MO 7/17/2009 MI 7/17/2009 GA 7/17/2009 OH 7/17/2009 WI 7/17/2009 WI 7/17/2009 IN 7/17/2009 WI 7/17/2009 WA 7/17/2009 NY 7/17/2009 NJ 7/17/2009 TX 7/17/2009 WI 7/17/2009 TX 7/17/2009 NC 7/17/2009 PA 7/17/2009 OR
74 23 46 22 56 29 21 22 1.8 24 11 4 26 28 12 4 13
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35 4 26 12 10 19 4 29 46 25 1.2 56 55 42
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27 14 47 11 18 4 11 5 24 12 24 1 38 1 27 21 17 12
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7/16/2009 Swelling and redness of left upper a 7/16/2009 Friday after injection arm became e 9/2/2008 A 46-year-old male, with no illness a 1/23/2009 Initial information was received on 0 3/27/2009 Initial report was received 03 Decem 3/10/2009 This case was received from a heal 4/3/2009 This non serious case was received 5/21/2009 This non serious case was received 7/17/2009 Fever that lasted 2 days straight. Ev 7/17/2009 June 24th - Reported to the ER with Redness and swelling up to 5" in pla 7/13/2009 Rash on abdominal, face, legs, and 7/13/2009 After 2nd HPV vaccine 5 days later 7/13/2009 A 28-year-old male patient received 7/10/2009 Patient felt clinic was reported by m 7/13/2009 7/11 - arm (upper) was reported as 7/11/2009 Pain 24 hours after shot - swelling r 7/7/2009 4-5 inch raised, red, hot area aroun 7/15/2009 Initial report was received 14 July 20 7/16/2009 7-13-09 child received 4 immunizati 7/16/2009 Information has been received for th 7/16/2009 Left upper arm below injection site i 7/15/2009 Left deltoid at injection site red\swol 7/16/2009 Information has been received from 7/17/2009 Right upper arm swollen, warm to to 7/9/2009 Pediatric dose of Hep B given to ad 7/13/2009 Pain. Pressure both lower legs (calf 7/13/2009 Tetanus booster given on: DECAVA 7/14/2009 Local Rxn. 2 Red papules L thigh, s 6/29/2009 High fever, chills, diarrhea, weaknes 7/14/2009 Patient described dizziness, vision d 7/17/2009 Pt c/o pain and swelling to R arm se 7/17/2009 This case was reported by a healthc 7/16/2009 Pt recieved four shots right arm (Me 7/9/2009 6-24-09 Fever 103 and nausea 6-2 7/17/2009 severe joint pain, headache, nausea 7/17/2009 Had swelling and redness at the inje 7/17/2009 PATIENT CAME TO HEALTH DEPA 7/17/2009 Local reaction, red, swollen, hurts, n 7/17/2009 Local reaction, red, swollen, hurts, n 7/17/2009 The patient received a Dtap in the le 7/17/2009 Calls to say is declining 3rd Gardas 7/17/2009 Red, warm, raised area at vaccine s 7/17/2009 SEVERAL HOURS AFTER RECEIV 7/17/2009 Painfull swelling of joints(knees and 7/17/2009 Less than 24 hours after vaccination 7/17/2009 Fever began on 7/16/2009, 8 days a 7/17/2009 Localized erythema, warmth to touc 7/17/2009 PT'S MOM CALLED TODAY TO RE 7/17/2009 Client had vaccines 7/16/2009. Rep 7/17/2009 4in by 4in redness surrounding vacc
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7/17/2009 CA 7/17/2009 WA 7/17/2009 MN 7/17/2009 KY 7/17/2009 AR 7/17/2009 TX 7/17/2009 FL 7/17/2009 AK 7/17/2009 MD 7/17/2009 MO 7/17/2009 CA 7/17/2009 IL 7/17/2009 CO 7/17/2009 TN 7/17/2009 NY 7/17/2009 GA 7/17/2009 TX 7/17/2009 7/17/2009 TX 7/17/2009 7/17/2009 OK 7/17/2009 TX 7/17/2009 7/17/2009 CA 7/17/2009 AZ 7/17/2009 OR 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 TX 7/17/2009 PA 7/17/2009 OK 7/17/2009 NJ 7/17/2009 WV 7/17/2009 OH 7/17/2009 PA 7/17/2009 7/17/2009 FL 7/17/2009 VA 7/17/2009 AL 7/17/2009 7/17/2009 VA 7/17/2009 FL 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 NY 7/17/2009 CT 7/17/2009 7/17/2009 7/17/2009
16 67 42 4 4 60 80 12 1 13
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7/10/2009 Pt. developed acute arm pain at the 7/17/2009 Shingles vaccine resulted in a case 7/17/2009 Woke am after injection with chills, m 7/17/2009 7 mm brawny edema area on right u 7/17/2009 7-16-09 pm noticed swelling adn red 7/17/2009 Approx. 24 hours after vaccination, 7/17/2009 Patient received Zostavax vaccine f 7/17/2009 Moderate fever, hoarseness, palene 7/17/2009 13 mth old male received MMR #1, 7/17/2009 6"X4" area on back of left arm. Red 7/17/2009 (L) side Deltoid swollen noticed 7.16 7/17/2009 Urticana @ vaccine sites 0 anaphyl 7/17/2009 L deltoid injection, 2 hours later L ar 7/17/2009 DPT and IPV given in lower mid Lt t 7/17/2009 Persistent crying with loss of appetit 7/16/2009 Developed stools with bloody mucu Client given 6 shots on 7-14-09. Re 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received throu 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/17/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Initial information has been received 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from
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7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 MN 7/17/2009 CO 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 VA 7/17/2009 7/17/2009 AZ 7/17/2009 7/17/2009 IL 7/17/2009 CA 7/17/2009 7/17/2009 NY 7/17/2009 VA 7/17/2009 7/17/2009 CA 7/17/2009 NY 7/17/2009 FL 7/17/2009 7/17/2009 MA 7/17/2009 7/17/2009 PA 7/17/2009 NY 7/17/2009 TX 7/17/2009 7/17/2009 PA 7/17/2009 7/17/2009 MO 7/17/2009 7/17/2009 NJ 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 TX 7/17/2009
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7/17/2009 7/17/2009 7/17/2009 KY 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 7/17/2009 VA 7/17/2009 MI 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 OH 7/17/2009 7/17/2009 TX 7/17/2009 FL 7/17/2009 7/17/2009 PA 7/17/2009 7/17/2009 SC 7/17/2009 TX 7/17/2009 MI 7/17/2009 VA 7/17/2009 NY 7/17/2009 7/17/2009 MI 7/17/2009 7/17/2009 IL 7/17/2009 CT 7/17/2009 KY 7/17/2009 PA 7/17/2009 7/17/2009 NY 7/17/2009 CT 7/17/2009 NY 7/17/2009 TX 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 VA 7/17/2009 7/17/2009 CA 7/18/2009
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7/18/2009 FL 7/18/2009 WA 7/18/2009 AR 7/18/2009 FL 7/20/2009 MI 7/20/2009 NE 7/20/2009 7/20/2009 7/20/2009 MI 7/20/2009 AZ 7/20/2009 NJ 7/20/2009 NV 7/20/2009 NC 7/20/2009 7/20/2009 FL 7/20/2009 MS 7/20/2009 LA 7/20/2009 NC 7/20/2009 NC 7/20/2009 AZ 7/20/2009 NC 7/20/2009 NE 7/20/2009 VA 7/20/2009 GA 7/20/2009 NJ 7/20/2009 FL 7/20/2009 MI 7/20/2009 MN 7/20/2009 MI 7/20/2009 CO 7/20/2009 NY 7/20/2009 IN 7/20/2009 TN 7/20/2009 WA 7/20/2009 NY 7/20/2009 IN 7/20/2009 IN 7/20/2009 PA 7/20/2009 MA 7/20/2009 NC 7/20/2009 TN 7/20/2009 VA 7/20/2009 OH 7/20/2009 TN 7/20/2009 WI 7/20/2009 MD 7/20/2009 IL 7/20/2009 KS 7/20/2009 CA 7/20/2009 MA 7/20/2009 WA
26 54 14 40 16 14 15 1.3 61 0.3 29 1 21 70 4 10 0.2 6 29 79 12 13 51 4 1.2 0.2 1.3 65 25 3 1.4 8 1 20 0.2 17 4 66 32 22 1 72 17 18 17 67 14 59 1 70 38
26 54 14 40 16 14 1 61 0 29 0 21 70 4 10 0 6 29 12 13 51 4 1 0 1 65 25 3 1 8 1 20 0 17 4 66 32 22 1 72 17 18
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7/18/2009 at 9:00 am I had the 3rd gardasil sh 7/18/2009 Had the injection 7-6-09 at 5 pm. B 7/18/2009 2nd dose of gardasil administered in 7/18/2009 7/11/09: Abdominal pain, nausea, v 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/16/2009 Initial report received on 08 July 200 6/30/2008 Loss of eye contact, words, repetitiv 7/15/2009 Developed GUILLAIN BARRE Synd 7/20/2009 This case was Y reported by a consum 7/17/2009 Red swollen area measuring 4 1/4 " Child began to have emesis around 7/8/2009 Mom reported blister at injection site 7/14/2009 3 x 3 cm area of redness at vaccina 7/20/2009 This case was reported by a healthc 7/15/2009 Dermatologist - gave Valtrex 16m + 7/16/2009 Developed severe headache on 7/1 7/14/2009 Myalgias, nausea, episode of faintin 7/14/2009 Administration site became red & sw 7/14/2009 Eyes swollen, clear runny nose. Sw 7/13/2009 10 AM 7/13/2009- Seizure activity- f 7/14/2009 Pt start crying inconsolable the day 7/20/2009 C/O LEFT LEG RED AND SWOLLE 7/20/2009 Received vaccine July 10, 2009 with 7/20/2009 Rec'd Boostrix on 7/17/09; reports v 7/20/2009 Shingles 7/20/2009 the next day his leg was blistered, r 7/20/2009 On 7/19/09 noted lethargy, headach 7/20/2009 Pt developed marked thrombocytop 7/20/2009 rash on hands, elbows, and chest. c 7/20/2009 Patient received Pentacel, Prevnar, 7/20/2009 none 7/20/2009 none 7/20/2009 Outbreak of vessicular rash in L5/S1 7/20/2009 Patient describes receiving Tetanus 7/20/2009 Employee reported that approximat 7/20/2009 Received her 1st Varivax 7/6/09 in h 7/20/2009 temp 100, rash, itching, left upper u 7/20/2009 Client received a Menactra on 7/20/ 7/20/2009 Varicella virus vaccine was ordered 7/20/2009 The injection site began to itch, turn 7/20/2009 Subject in pneumococcal vaccine tr 7/20/2009 6 cm wide tender erythmatous area 7/20/2009 I gave a pediatric dose of Hep B ins 7/20/2009 Low Platlet Count 7/20/2009 Vaccine administered Friday afterno 7/20/2009 Employee who works in Dental scho
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7/20/2009 CA 7/20/2009 TX 7/20/2009 FL 7/20/2009 AZ 7/20/2009 CA 7/20/2009 WA 7/20/2009 IL 7/20/2009 NC 7/20/2009 AZ 7/20/2009 ME 7/20/2009 NV 7/20/2009 WV 7/20/2009 MA 7/20/2009 WI 7/20/2009 MI 7/20/2009 MS 7/20/2009 TN 7/20/2009 GA 7/20/2009 AZ 7/20/2009 CA 7/20/2009 OR 7/20/2009 ID 7/20/2009 TX 7/20/2009 MN 7/21/2009 WI 7/21/2009 VT 7/21/2009 7/21/2009 GA 7/21/2009 PA 7/21/2009 NC 7/21/2009 RI 7/21/2009 MS 7/21/2009 7/21/2009 NV 7/21/2009 MD 7/21/2009 NH 7/21/2009 OH 7/21/2009 ID 7/21/2009 OH 7/21/2009 MS 7/21/2009 TX 7/21/2009 NC 7/21/2009 GA 7/21/2009 MD 7/21/2009 MA 7/21/2009 TX 7/21/2009 OK 7/21/2009 VA 7/21/2009 PA 7/21/2009 LA 7/21/2009 MD
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M M 0.3 M M M M F F M M F M 0F M 0.6 F F F 0.4 F 0.2 F F 0.3 M M F F F F F F F 0.3 M M F M M 0.2 F M 0F M M F 0.2 F F F M F F M 0.2 M F F F
7/15/2009 Per translator Y client died 2 to 3 hrs. 7/20/2009 Within 1-2 days c/o headache, naus 7/20/2009 Increased temperature 105 degrees 7/20/2009 Left arm - noted severe redness, er 7/20/2009 Patient received VARIVAX IM instea 7/20/2009 Pt reports insect bite like sensations 7/10/2009 Patient here for physical with foster 7/14/2009 7-14-09 8:35 AM - Patient received 7/13/2009 Redness and swelling on the left arm "Fever, chills, body aches began 2 h 7/14/2009 Redness, swelling, warmth & streak 7/17/2009 Redness at injection site, knot in arm Less than 24 hrs, acute onset, on b 7/20/2009 Within 1 min after vaccines adminis 7/20/2009 Pt was given Adult dose of Hep A Child began to have emesis around 7/18/2009 Patient complained of pain in injecti 7/10/2009 Hives started on shoulders and then 7/14/2009 Swelling, erythematous, hot, 3/12 cm 7/2/2009 All of patient's upper arm, where va 7/15/2009 Lump & pustule on right thigh. 7/11/2009 Red - indurated - pruritic 12 X 6 cm 7/14/2009 None Stated 7/1/2009 Received vaccine 6/29 - developed 6/24/2009 Information has been received from 10/3/2008 Initial report received on 16 Septem 7/20/2009 InformationYhas been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 3/26/2009 Fatigue for the first few weeks, pani 7/8/2009 50yo male received pneumococcal 7/15/2009 After 15 minutes of giving KINRIX, V 7/20/2009 G. mom - Reports crying x 2/2 hrs a 7/14/2009 Raised erythematous somewhat con 7/16/2009 On 7/3/09 patient started running a 7/16/2009 N/A 7/17/2009 Swelling, redness, pain and itching 7/17/2009 7/16/09 pm - Received care from M 7/16/2009 X 1 Hive at the site of injection. Mea 7/21/2009 Patient received Zostavax vaccine o 7/21/2009 Administered adult dose of Hep B v 7/21/2009 Received two doses of Tdap. First 7/21/2009 Patient complained of right swollen 7/21/2009 Varicella vaccine given 7-18-09 in L 7/21/2009 Starting the night of immunization h 7/21/2009 Approximately seven hours after rec 7/21/2009 BURNING REDNESS AND EXTRE 7/21/2009 Pain right deltoid starting the day af 7/21/2009 Tdap received IM on 7/16/09. Emplo
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7/21/2009 ME 7/21/2009 NV 7/21/2009 IL 7/21/2009 TX 7/21/2009 CA 7/21/2009 CA 7/21/2009 WA 7/21/2009 VA 7/21/2009 NC 7/21/2009 CA 7/21/2009 IL 7/21/2009 NC 7/21/2009 IL 7/21/2009 GA 7/21/2009 OR 7/21/2009 WV 7/21/2009 OR 7/21/2009 PA 7/21/2009 MN 7/21/2009 MT 7/21/2009 IL 7/21/2009 ND 7/21/2009 LA 7/21/2009 NC 7/21/2009 7/21/2009 KY 7/21/2009 VA 7/21/2009 WI 7/21/2009 CA 7/21/2009 PA 7/21/2009 MN 7/21/2009 CA 7/21/2009 AR 7/21/2009 OH 7/21/2009 AL 7/21/2009 OH 7/21/2009 IL 7/21/2009 MO 7/21/2009 CA 7/21/2009 IL 7/21/2009 ID 7/21/2009 CA 7/21/2009 CA 7/21/2009 WI 7/21/2009 NY 7/21/2009 PA 7/21/2009 MA 7/21/2009 OH 7/21/2009 IL 7/21/2009 NV 7/21/2009 TN
43 24 56 48 11 15 65 15 12 1 0.3 62 14 14 0.2 1.2 0.2 36 12 15 18 23 6 48 27 4 11 4 0.2 2 70 18 32 10 12 1 68 4 1.4 80 10 17 13 18 9 58 44 6 45 66 5
43 24 56 48 11 15 65 15 12 1 0 62 14 14 0 1 0 36 12 15 18 23 6 48 27 4 11 4 0 2 70 18 32 10 12 1 68 4 1 80 10 17 13 18 9 58 44 6 45 5
F F F F M F F F M 0M 0.3 F F M M 0.2 F 0.2 M 0.2 F F M F F F F F M M M F 0.2 F 0.2 F F F F M M 0F F M 0.4 F F M F F F M F M F F F F
7/21/2009 Patient reports fever last evening. M 7/21/2009 Patient with history of cluster heada 7/21/2009 fever, rash at site, swelling at site, d 7/21/2009 Localized inflammatory irritation with 7/21/2009 VARICELLA 3 7/21/2009 Immediately after administration of H 7/17/2009 Left upper arm rash/pain starting 1 d 7/21/2009 LEFT SIDED FACIAL SWELLING, T 7/21/2009 Beginning at 6:00 pt c/o soreness. 7/21/2009 VACCINE GIVEN ON THE 10 OF J 7/4/2009 Received vaccines at 2:30 pm office 7/16/2009 Monday administration, dizziness fo 7/21/2009 Pt developed chills Monday evening 7/22/2009 2 d. after immunization began havin 7/14/2009 The day after child received rotaviru 7/16/2009 Inconsolable crying last evening (77/14/2009 After child received rotavirus vaccin 7/16/2009 Temp. 1004, body aches, nausea. 7/16/2009 Dizziness, weakness, had to stop u 7/16/2009 Client experienced dizziness, faintin 7/16/2009 Immediately after shots were given 7/17/2009 Rt arm-area red-warm-swollen-tend 7/16/2009 Developed hives after KINRIX immu 7/11/2009 Zostavax vaccine given subcutaneo 7/7/2009 Pruritis, painful, papular rash of han 7/14/2009 Anaphylaxis: Child presented with h 7/16/2009 11 yo with large amount of swelling 7/14/2009 Shots given on 7/10/09 Pt in to U.C 7/13/2009 Tonic-clonic seizures, 3 hours after 7/15/2009 Pts father stated that pt developed f 7/10/2009 Patient was given Tdap immunizatio 7/14/2009 Pt was given GARDASIL vaccine up 7/14/2009 Patient called 7-6-09 c/o (L) arm stif 7/21/2009 - Acting delirious - severe headache 7/21/2009 Pt had redness & swelling to injectio 7/20/2009 Morbilliform rash - generalized - Rx 7/21/2009 Redness + itching at site, has persis 7/21/2009 Developed urticaria, angio edema, t 7/21/2009 Right arm (erythematous & edemato 7/21/2009 Swelling, redness, severe itching at 7/21/2009 N/A given TDAP before age 11 yrs. 7/21/2009 Dizziness with Pt blurring of vision a 7/21/2009 Fainted briefly after immunization: in 7/21/2009 Patient was given GARDASIL on 7/ 7/21/2009 Became lightheaded and nauseous 7/20/2009 7-17-09 - Sleep & H/A 7-19-09 - H/ 7/16/2009 Client states about 4o after shot his 7/20/2009 L lump at injection site - egg size, re 7/21/2009 Pt. has persistent left arm pain since Arm swelled, red rash, itchy, ice 15 7/16/2009 16 cm + 11cm red area surrounding
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7/21/2009 CA 7/21/2009 OH 7/22/2009 CA 7/22/2009 MD 7/22/2009 CA 7/22/2009 7/22/2009 VA 7/22/2009 AZ 7/22/2009 IL 7/22/2009 OH 7/22/2009 TX 7/22/2009 UT 7/22/2009 KS 7/22/2009 WA 7/22/2009 CO 7/22/2009 PA 7/22/2009 SC 7/22/2009 TX 7/22/2009 NV 7/22/2009 TX 7/22/2009 PA 7/22/2009 ND 7/22/2009 AR 7/22/2009 CO 7/22/2009 NC 7/22/2009 NJ 7/22/2009 NM 7/22/2009 KS 7/22/2009 NY 7/22/2009 OR 7/22/2009 MI 7/22/2009 MI 7/22/2009 CA 7/22/2009 AK 7/22/2009 7/22/2009 MN 7/22/2009 MN 7/22/2009 FL 7/22/2009 AK 7/22/2009 MD 7/22/2009 MD 7/23/2009 CA 7/23/2009 WA 7/23/2009 7/23/2009 TX 7/23/2009 MI 7/23/2009 MN 7/23/2009 NH 7/23/2009 MO 7/23/2009 MO 7/23/2009 MO
4
4
0.5 0.2 59 63 62 26 21 17 10 60 12 66 43 22 77 4 0.2 4 8 1.5 5 60 10 26 1.1 4 17.8 2 58 23 8 12 0 1.1 11 23 4
0 0 59 63 62 26 21 17 10 60 12 66 43 22 77 4 0 4 8 1 5 60 10 26 1 4 17 2 58 53 23 8 12 0 1 11 23 4
11
11
15 17 15 12 16 16 15
15 17 15 12 16 16 15
M F 0.5 F 0.2 M F F F F F M F F F M M F M F 0.2 F F F 0.5 M F F F M 0.1 F M F 0.2 M F U F M F 0M 0.1 F F F F F F M M F M M F F F F
Spiked a fever, began vomiting, & s 7/15/2009 Information has been received from 7/21/2009 The patient had what were describe 7/17/2009 25 wker now 11 wks old received 2 7/17/2009 Blister like spots to back, arms,ches 7/20/2009 I have received the ZOSTAVAX vac 7/16/2009 Bright red rash 3 x 7 cm at injection 7/22/2009 This case was reported by a pharma 7/22/2009 Seizures, Slurred speech, Dizziness 7/22/2009 Acute disseminated encephalomyel 7/22/2009 Small, bumpy, itchy rash at injection 7/22/2009 PT REPORTS WAKING WITH HEA 7/22/2009 Parent states child c/o right arm pai 7/22/2009 Per patient secure message (email) 7/22/2009 Patient experienced change in sens 7/22/2009 Patient received a gardasil vaccine 7/22/2009 Patient presents with redness and w 7/22/2009 Site of injection red, swollen, with pa 7/22/2009 The baby died Y under suspicious con 7/22/2009 Left upper arm wheal measured at 5 7/22/2009 5/20/09 received telephone call from 7/22/2009 SEIZURE LASTED 10-30 SECOND 7/22/2009 localized swelling, redness, and war 7/22/2009 patient reports vaccination site with 7/22/2009 On 7-14-09 pt received varicella and 7/22/2009 Pt went to ER on 6/26/09. Pt states 7/22/2009 Petechial Rash entire body. Fever t 7/22/2009 Mother reported erythema swelling 7/22/2009 Evening of vaccines, pt developed r 7/22/2009 None Stated. 7/22/2009 Onset of swelling, erythema <48 ho 7/22/2009 Approximately 4 days after vaccinat 7/22/2009 Fever, sweats, nausea, vomiting & s 7/22/2009 Pt came in on 20 Jul 09 to receive V 7/10/2009 Left upper arm over Tricep with 3x4 7/21/2009 7-10 days post injection, site of VAR 7/21/2009 7-10 days after injection, at site of V 7/22/2009 Headache, dizziness AP 89 reg R-2 Pt came back to clinic after 15 min c 6/24/2009 Vaccine administered on 6/22/2009 7/15/2009 Information has been received from 7/23/2009 Complained of feeling faint, lighthea 7/22/2009 Information has been received from 7/22/2009 Information has been received from 7/22/2009 This case was received from a heal 7/21/2009 Pt complained of thirst after receivin 7/22/2009 3 hours after injections-pt became m 7/22/2009 Mom called said she wanted it docu 7/23/2009 HPV #1 lot# 0171U, exp 6/29/09 wa 7/23/2009 Received HPV # 3 on 7/15/2009. T 7/23/2009 Received HPV #3 on 7/15/09. This
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7/23/2009 MO 7/23/2009 OH 7/23/2009 NY 7/23/2009 NY 7/23/2009 ME 7/23/2009 PA 7/23/2009 CT 7/23/2009 GA 7/23/2009 NY 7/23/2009 NC 7/23/2009 NC 7/23/2009 GA 7/23/2009 TX 7/23/2009 NE 7/23/2009 ME 7/23/2009 CA 7/23/2009 AZ 7/23/2009 NY 7/23/2009 IN 7/23/2009 NY 7/23/2009 MO 7/23/2009 OK 7/23/2009 OK 7/23/2009 NY 7/23/2009 AK 7/23/2009 7/23/2009 TN 7/23/2009 IA 7/23/2009 OR 7/23/2009 IN 7/23/2009 IN 7/23/2009 TX 7/23/2009 WA 7/23/2009 CA 7/23/2009 CA 7/23/2009 TX 7/23/2009 AL 7/23/2009 PA 7/23/2009 AZ 7/24/2009 7/24/2009 7/24/2009 CA 7/24/2009 7/24/2009 MD 7/24/2009 WA 7/24/2009 TX 7/24/2009 IL 7/24/2009 ID 7/24/2009 NY 7/24/2009 AL 7/24/2009 VT
12 60 5 21 66 10 5 1.3 8 67 65 11 18 17 6 1.1 4 72 11 19 57 0.3 11 73 66 9 0.2 4 8 22 57 72 39 51 14 4 9 15
12 60 5 21 66 10 5 1 8 67 65 11 18 17 6 1 4 71 11 19 57 0 11 72 66 58 9 0 4 8 22 57 72 39 51 14 4 9 15
12
12
11 0.2 22
11 0 22
3 4 71 5
3 4 71 5
F F M F F F M 0.3 F M F F M F F F 0.1 F M F F F M 0.3 F F F F M F 0.1 M F F M F F F M M F M F F F F U F 0.2 M F U F M M M
7/23/2009 Received HPV #2 7/21/09. This vac 7/20/2009 7 X 9 cm. area of redness and edem 7/20/2009 Patients arm swelled up and appea 7/17/2009 Pt fell to floor post GARDASIL vacc 7/20/2009 Broke out in severe rash left side ne 7/17/2009 Mother reports child began having r 7/17/2009 Upper left deltoid area reddened, sw 7/8/2009 -Skin redness over body, -Rash, -Itc 7/16/2009 Red, warm, swollen "2x2 " tender co 7/17/2009 Redness, itching, and induration aro 7/17/2009 Redness, swelling, and pain surroun 9/23/2009 After MENACTRA, TDAP, vaccinati 7/23/2009 Reported 7/23/09 - came to clinic to 7/23/2009 Seizure - like activity noted on 7-227/23/2009 Patient arrived at ED 17 Jul 2009 @ 7/23/2009 Macular - papular rash 1 day after v 7/25/2009 Local erythema, induration, warmth, 7/23/2009 chicken pox like rash/hive like, occu 7/23/2009 large, red welt at site of vaccine. Pa 7/23/2009 erythema to left tricep area started d 7/23/2009 3 days after shots, had joint aches a 7/23/2009 She was born Y August 22nd, 2008, p 7/23/2009 Right upper arm with large red, indu 7/23/2009 off balance with nausea and vomitin 7/23/2009 Shingles vacccine: first and second 7/23/2009 PT REPORTED FEVER AND PAIN 7/23/2009 Patient received 2nd Varivax on 7/2 7/23/2009 Unconsolable crying for 3 and 1/2 h 7/23/2009 10 cm x 11 cm red, warm, localized 7/23/2009 Patient returned to District Health O 7/23/2009 CLIENT RETURNED TO CLINIC FO 7/23/2009 Severe rash to arms and legs, seen 7/23/2009 Patient reported experiencing wide7/23/2009 SWOLLEN ARM, FEELING LOTS O 7/23/2009 Suffered a transverse myelitis which 7/23/2009 Ten minutes after receiving immuniz 7/23/2009 (L) thigh red, swollen with heat. War 7/23/2009 Pt had syncopal episode post receiv 7/23/2009 Swelling / redness with 3 cm x 2 cm 7/16/2009 This case was initially reported by a 7/23/2009 Information has been received from 7/17/2009 Developed progressive lower extrem 7/21/2009 Not an adverse event, but I have ha 7/13/2009 Had a panic attack (shortness of bre 7/21/2009 (1) very pale, white - bluish lip - one 7/17/2009 TDAP given in left arm 7-13-2009. P Facial swelling, rash No adverse events. I gave a Hepati 7/20/2009 Red/ swollen left deltoid, warm to to 6/30 - Small dark bump around righ 7/21/2009 5 cm X 6 cm erythema, red, tender
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7/24/2009 IL 7/24/2009 CA 7/24/2009 NM 7/24/2009 MI 7/24/2009 OH 7/24/2009 PA 7/24/2009 VA 7/24/2009 CO 7/24/2009 NC 7/24/2009 GA 7/24/2009 GA 7/24/2009 CA 7/24/2009 TX 7/24/2009 GA 7/24/2009 FL 7/24/2009 MI 7/24/2009 FL 7/24/2009 FL 7/24/2009 NC 7/24/2009 OK 7/24/2009 MO 7/24/2009 IA 7/24/2009 MI 7/24/2009 IL 7/24/2009 MI 7/24/2009 CA 7/24/2009 ID 7/24/2009 NY 7/24/2009 TN 7/24/2009 WI 7/24/2009 CO 7/24/2009 MI 7/24/2009 OH 7/24/2009 NC 7/24/2009 NY 7/24/2009 AR 7/24/2009 NY 7/24/2009 CA 7/24/2009 MI 7/24/2009 MO 7/24/2009 MN 7/24/2009 MI 7/24/2009 PA 7/24/2009 NH 7/24/2009 MA 7/24/2009 AZ 7/24/2009 AZ 7/24/2009 IL 7/24/2009 AK 7/24/2009 KY 7/24/2009 CA
79 20 64 18 1.1 15 36 40 18 5 10
79 20 64 18 1 15 36 40 18 4 10
23 16 11 21 16 11 4 57 8 65 0.4 15 15 34 1.3 0.2 12 18 10 0.5 57 5 0.2 37 65 7 22 4 0.2 4 63 0.5 4 12 14 11 65 4 0.2
23 16 11 21 16 11 4 57 8 65 0 15 15 34 1 0 12 18 10 0 57 5 0 37 65 7 22 4 0 4 63 0 4 12 14 11 65 4 0
F F M F 0.1 M F F F M M M M M F F F F F M F M F 0.4 F F F F 0.3 M 0.2 M M F F 0.5 F F F 0.2 M F M M M F 0.2 M M M 0.5 M F M F F M M 0.2 M
7/21/2009 4 days after injection, vomited biliou 7/20/2009 Patient received MMR vaccine on 7 7/16/2009 After patient received SUB-Q injecti 6/22/2009 On 6/20/09 per parent, client got ou 7/21/2009 On 10/11/2007 client had his first co 7/24/2009 Patient got lightheaded immediately 7/20/2009 Four hours after taking pill # 1 - bac 7/8/2009 None stated. 7/17/2009 Redness, puffiness + warm to touch 7/20/2009 Swelling/ redness < 24 hrs after adm 7/21/2009 Red papulo-vesicular rashes all ove Red and itchy and a lump at the site 7/23/2009 Difficulty swallowing began 15 minu 7/24/2009 Presented with Health Dept today, 7 7/24/2009 Swelling and redness/induration (R) 7/23/2009 Patient fainted directly after adminis 7/24/2009 Patient tolerated the HPV vaccine in 7/24/2009 clammy skin, right sided chest pain, 7/24/2009 REDNESS AND SWELLING 3CM B 7/24/2009 I received a flu shot at this clinic on 7/24/2009 Local reaction at injection sites, red 7/24/2009 Patient had large, swollen, firey red 7/24/2009 Per patient's mother, baby had 4 da 7/24/2009 Injection site swollen to softball size 7/24/2009 Immediately after receiving Tdap, M 7/24/2009 Swollen glands around neck, breast 7/24/2009 07-21-09 Given vaccines. Started w 7/24/2009 patient had 2 episodes of seizure-lik 7/24/2009 On 7/9/09 Patient received Hep a, M 7/24/2009 Varicella administered on 7/22/09. 7/24/2009 Initially patient had a red, swollen, w 7/24/2009 N/A 7/24/2009 Client treated at ER for steam burn 7/24/2009 OBLONGED SHAPE RED RASH(P 7/24/2009 positive guiac stool 1 day after rotav 7/24/2009 12 hours later started continuous sh 7/24/2009 Swelling, redness at site and upper 7/24/2009 VACCINE WAS GIVEN 2 DAYS AG 7/24/2009 TEMP OF 102.1 FOR TWO DAYS. 7/24/2009 Pt. develped redness at site and low 7/24/2009 Parents report (at 4 mo visit) excess 7/22/2009 Swelling of thigh, development of er 7/24/2009 Patient developed a debilitating hea 7/24/2009 Lethargy, poor feeding, fever to 103 7/24/2009 (R) arm red, warm to touch, red rash 7/24/2009 Client talking while receiving vaccin 7/24/2009 7/24/09 1300 client became pale, L 7/25/2009 Fainting immediately after MENACT 7/26/2009 Pt had received ZOSTAVAX on 7-1 7/24/2009 4x4 cm erythema around injection s 7/23/2009 Developed Inflammatory Diarrhea w
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7/24/2009 NJ 7/24/2009 PA 7/24/2009 LA 7/24/2009 GA 7/24/2009 SC 7/24/2009 IL 7/25/2009 MI 7/25/2009 NJ 7/25/2009 NJ 7/25/2009 AZ 7/25/2009 NJ 7/26/2009 PA 7/26/2009 FL 7/27/2009 SC 7/27/2009 7/27/2009 CA 7/27/2009 CA 7/27/2009 PA 7/27/2009 NC 7/27/2009 WA 7/27/2009 CA 7/27/2009 NY 7/27/2009 OH 7/27/2009 CA 7/27/2009 7/27/2009 NC 7/27/2009 SC 7/27/2009 AZ 7/27/2009 CA 7/27/2009 7/27/2009 CO 7/27/2009 WI 7/27/2009 WY 7/27/2009 GA 7/27/2009 NM 7/27/2009 NY 7/27/2009 NC 7/27/2009 7/27/2009 NV 7/27/2009 NV 7/27/2009 PA 7/27/2009 MN 7/27/2009 TX 7/27/2009 VA 7/27/2009 VA 7/27/2009 PA 7/27/2009 NY 7/27/2009 AL 7/27/2009 TN 7/27/2009 WA 7/27/2009 NJ
0 10 11 11 0.7 32 5 0.8 0.7 9 70 73 59 17 41 19 82 14 0.2 40 59 71 28 4 47 67 1 1.8 25 19
0 10 11 11 -1 32 5 0 0 9 70 73 59 17 41 19 82 14 0 40 59 71 18 4 47 67 0 1
1 1.7 11 54 0.3 2 52 0.2 0.3 0.5 12 13 13 15 9 0.5 10 1 52 8
1 1 11 54 0 2 52 0 0 0 12 13 15 9 0 10 1 52 8
0M F M M 0.7 M F M 0.8 M 0.7 M F F M M F M F F F 0.2 F F F F F F M F 1F 0.8 M F F F 0M 0.7 F M F 0.3 M 0.7 F M 0.2 M 0.3 F 0.5 F F F F F M 0.5 M M 0M F F
7/24/2009 7-17-09 pt was given Hep B vaccine 7/24/2009 Tender, erythematous, slightly warm 7/24/2009 Four hours after injection pt started 7/23/2009 Site reaction to vaccine in left deltoi 7/24/2009 This case was reported by a pharma 7/24/2009 This case was reported by a healthc 7/25/2009 entire arm swelled that the shot was 7/25/2009 Within an hour of the shot (took plac 7/25/2009 Lump at injection site, lasted 4 wks( 7/25/2009 Erythema (14cm X 15cm), itchiness 7/25/2009 Slight itching at injection site immed 7/26/2009 Redness and itching at injection site 7/26/2009 6 months post shingles vaccine, I be 7/27/2009 Nausea & vomiting, abdominal pain 7/27/2009 Guillain Barre Syndrome developed 7/27/2009 Fainted briefly after - body was shak 7/23/2009 Pt developed red lesions with itchin 7/23/2009 Mother reports,7/17/09 Pt. had redn 7/24/2009 Prolonged high pitched screaming a 7/20/2009 Received TDAP 4/21/09. At 7/7/09 7/17/2009 Blister like spots to back, arms, che 7/20/2009 Began having painful needle like pri 7/22/2009 Initially cold, chills, achy, arm pain T 7/20/2009 Patient experienced severe adverse 7/6/2009 Macular rash 4 x 4 cm surrounding 7/21/2009 The vaccine was to prevent further 7/20/2009 Rash and mild fever X 2 days starte 7/21/2009 Rash 3 cm X 4 cm patch of erythem 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/24/2009 Diagnosed with Idiopathic thromboc 7/27/2009 Had a small outbreak of pox with fe 7/27/2009 (R) deltoid - MENACTRA - large sw 7/24/2009 Injection given 7/20/09 right deltoid; 7/23/2009 10 seconds head & hands shaking. 7/22/2009 Fever to 102 degrees F nausea, vom 7/1/2009 Leg problems, sleep difficulties, phy 1/29/2008 ROTATEQ given 12/17/07. 12/19/0 12/5/2008 Received immunization 9/11/08- PE 7/21/2009 Fever 105(R) 2 days after immuniza 7/20/2009 12 yr old received VARIVAX and TD 7/27/2009 Local redness, swelling, blanching, 7/27/2009 Varivax on 7/20/09 - Developed, 2 d 7/27/2009 Received VARIVAX #2 on 7/22/09, 7/27/2009 Pt stated it started hurting right awa 7/28/2009 5 seconds hands shaking w/ head s 7/27/2009 Rash 5 X 5 to right arm, around inje 7/23/2009 Elevated temperature with diminishe 7/10/2009 Erythema, heat, mild edema, pain 7/22/2009 Hives on cheeks, chest, arms & legs
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7/27/2009 7/27/2009 7/27/2009 CA 7/27/2009 AR 7/27/2009 NV 7/27/2009 7/27/2009 7/27/2009 PA 7/27/2009 ME 7/27/2009 NM 7/27/2009 MI 7/27/2009 ME 7/27/2009 PA 7/27/2009 MI 7/27/2009 IN 7/27/2009 CA 7/27/2009 TX 7/27/2009 CA 7/27/2009 ID 7/27/2009 KS 7/27/2009 VA 7/27/2009 MO 7/27/2009 TN 7/27/2009 OR 7/27/2009 FL 7/27/2009 KY 7/27/2009 AZ 7/27/2009 ND 7/27/2009 GA 7/27/2009 CO 7/27/2009 CO 7/27/2009 KY 7/27/2009 KS 7/27/2009 PA 7/27/2009 WA 7/27/2009 IN 7/27/2009 AZ 7/27/2009 TX 7/27/2009 CA 7/27/2009 FL 7/27/2009 NY 7/27/2009 OK 7/27/2009 CA 7/27/2009 7/27/2009 WI 7/27/2009 KY 7/27/2009 IA 7/27/2009 OK 7/28/2009 AR 7/28/2009 CA 7/28/2009 CA
17 17 45 0.2 36 1.3 13 50 22 26 33 3 4 1.4 17 12 14 4 61 14 30 1.1 52 10 44 67 1 62 62 30 30 18 15 75 4 5 16 11 1.3 0.2 12 19 0.3 66 4 2 56 77 15 12 1
17 17 45 0 36
50 22 26 33 3 4 1 17 12 14 4 61 14 30 1 52 10 44 67 1 62 62 30 30 18 15 75 4 5 16 11 1 0 12 19 0
2 77 15 12 1
F F F 0.2 F F M U F F F F M F 0.4 U M M U M M F F 0.1 M F F F F 0M F F M M F F F F M F F 0.3 F 0.2 F F F 0.3 F F M 0.2 F F F F F 0M
7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/22/2009 Post 1st Dose 07.15.09 Throbbing b 6/12/2009 "Cried for 3 d"; cried for more than 3 2/19/2009 Hives on thighs BENADRYL and Alo 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/22/2009 Initial report was received 20 July 20 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/27/2009 Patient states she had fatique, weak 7/27/2009 Redness, swollen, nodule, tender to 7/27/2009 24 hours after immunization, Left ar UPON PHONE CALL WE MADE TO 7/27/2009 Immunized on 7/15/09, on 7/16/09 a 7/27/2009 After the 4th vaccine was given (me 7/27/2009 3 CM AREA OF ERYTHEMA, WAR 7/27/2009 KINRIX GIVEN TWICE 7/27/2009 Patient presented to the ER the follo 7/27/2009 The back of the right arm where the 7/27/2009 This employee of the hospital receiv 7/27/2009 Parent noted swollen lymph nodes i 7/27/2009 3 inch by 3 inch indurated area with 7/27/2009 7/25/09 patient came in with 4 x 5 in 7/27/2009 approximately 30 minutes after Tda 7/27/2009 24 hours after injection developed a 7/27/2009 RASH ALL OVER BODY 7/27/2009 Received the Shingles vaccination o 7/27/2009 Large red, hot and itchy patch or 4" 7/27/2009 First vaccine in series was given on 7/27/2009 Twinrix dose #2 given on 7/13/09. P 7/27/2009 Patient experienced problems breat 7/27/2009 Had a syncopal episode in the park 7/27/2009 Red blotch ~ 2 inches in length and 7/27/2009 upper extremities became stiff imme 7/27/2009 Left thigh red and raised 7/13/2009 VARICELLA - redness / swelling 7/1 7/23/2009 Localized hives, erythema, itchy wit Patient got MMR #1, VARICELLA # 7/27/2009 48 hrs after DTaP Imm. infant sleep 7/27/2009 Site warm, firm erythematous mild a 7/27/2009 HEP B injection given on Monday. W 7/24/2009 Pt developed enlarged left inguinal Redness - Soreness proximal to inje 7/25/2009 erythema, edema, warmth entire rig 7/22/2009 Cellulitis left thigh 7/15/2009 This case was reported by a healthc 7/7/2009 This case was reported by a physici 7/21/2009 After vaccine started having severe 7/21/2009 1) Pt fainted / or passed out after va 7/23/2009 Febrile seizure the night after immu
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7/28/2009 ID 7/28/2009 UT 7/28/2009 PA 7/28/2009 CO 7/28/2009 NC 7/28/2009 IN 7/28/2009 HI 7/28/2009 KY 7/28/2009 AR 7/28/2009 MD 7/28/2009 IN 7/28/2009 OH 7/28/2009 OH 7/28/2009 MI 7/28/2009 FL 7/28/2009 PA 7/28/2009 OH 7/28/2009 KS 7/28/2009 WI 7/28/2009 CA 7/28/2009 MA 7/28/2009 TN 7/28/2009 NH 7/28/2009 CA 7/28/2009 IL 7/28/2009 KS 7/28/2009 TN 7/28/2009 FL 7/28/2009 7/28/2009 PA 7/28/2009 PA 7/28/2009 NC 7/28/2009 SC 7/28/2009 OH 7/28/2009 NC 7/28/2009 WI 7/28/2009 VA 7/28/2009 WA 7/28/2009 TX 7/28/2009 TX 7/28/2009 FL 7/28/2009 TX 7/28/2009 NY 7/28/2009 PA 7/28/2009 CA 7/28/2009 LA 7/28/2009 MI 7/28/2009 CO 7/28/2009 TX 7/28/2009 CA 7/28/2009 NV
17 12 1.2 11.2 5 18 10 11 63 19 5 0.3 6 13 73 76 61 12 16 75 0.2 46 64 1.3 14 18 10
17 12 1 11 5 18 10 11 63 19 5 0 6 13 73 76 61 12 16 75 0 46 64 1
73 4 4 16 11 12 35 40 61 24 11 5 1.1 12 49 36 3 11 14 32 15 3 26
73 4 4 15 11 12 35 40 61 24
18 10
5 1 12 49 3 11 14 32 15 3 26
F M 0.2 M M M F F M F F F 0.3 F F M F F F M F F 0.2 M M M 0.3 F F F F U M F M F M M F F F F F U 0.1 M M F M M F F F F M F
7/22/2009 Before administering vaccine patien 7/23/2009 Within 1-2 minutes of administration 7/21/2009 Shingles on 7/19/09. - Acyclonir 7/22/2009 Redness and heat at vaccine sites. 7/22/2009 Child fever 102 degrees F, sleepy, l 6/22/2009 Parent stated RA swelled and redde 7/22/2009 She got vaccinated on Monday 7/20 7/20/2009 Rash on left forearm and trunk, Sat 7/17/2009 Pt developed shingles like rash acro 7/21/2009 7 hours after GARDASIL (HPV) vac 7/21/2009 Localized rxn with redness, warmth 7/22/2009 c/o rash, fever, fussy x 1 day. c/o sw 7/22/2009 Mom called office and stated child w 7/23/2009 Left arm (entire upper arm) edemato Face only. Swollen cheeks, hot and 7/22/2009 Patient is allergic to AVELOX. Deve 7/22/2009 9 days after ZOSTAVAX - began wi 7/22/2009 General malaise began day 1 follow 7/20/2009 Mom reported posterior right arm, 1 7/3/2009 Raised red area, long, around inject 7/23/2009 Received 2 mo vaccines at 11 AM o 7/21/2009 Pt given 4 vaccines (Tdap, MMR, H 7/21/2009 Temp. 101.2 B.P. elevated @ 160/9 7/23/2008 Bump on Left leg where vaccine wa 7/14/2009 High fever 102 degrees, about 3 da 7/17/2009 Pt. with brief (< 1 minute) syncopal 7/24/2009 Initial report received on 07 July 200 7/27/2009 Information has been received from 7/27/2009 Information has been received from 7/27/2009 Received KINRIX on 7/23/09, grand 7/27/2009 Received KINRIX on 7/21/09, paren 7/16/2009 Pt experiencing erythema, warmth, 7/24/2009 Menactra + varicella given wed. 7-2 7/27/2009 Immediately after shot pt felt light he 7/7/2009 Patient began having swelling pain, 7/28/2009 Got injection on 07/24/09. On 07/2 7/28/2009 Referred to health dept. by Dr. for y 7/27/2009 L arm pain for five days following va 7/28/2009 This child was given a Dtap instead 7/28/2009 swollen and redness right leg dtap # 7/28/2009 Patient developed fever, seizure, Le 7/28/2009 Painful rash to abdomen. treatment 7/28/2009 Pain, swelling at site of injection on 7/28/2009 Discomfort to Left Arm Constant pai 7/28/2009 Redness,swelling and tenderness 1 7/28/2009 Tdap, Varicella, MCV4, & Gardasil w 7/28/2009 Per patients mom, patient complain 7/28/2009 Dimple at injection site (left upper ar 7/28/2009 Localized allergic reaction to vaccin 7/28/2009 L lateral upper extremity with ~ 4 cm 7/28/2009 Pt developed systemic hives, pruriti
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7/28/2009 MO 7/28/2009 VA 7/28/2009 NE 7/28/2009 NY 7/28/2009 IN 7/28/2009 CT 7/28/2009 IL 7/28/2009 PA 7/28/2009 ID 7/28/2009 IL 7/28/2009 7/28/2009 7/29/2009 CA 7/29/2009 7/29/2009 CO 7/29/2009 7/29/2009 7/29/2009 WV 7/29/2009 7/29/2009 MO 7/29/2009 GA 7/29/2009 7/29/2009 FL 7/29/2009 7/29/2009 TX 7/29/2009 IN 7/29/2009 MA 7/29/2009 VA 7/29/2009 NY 7/29/2009 PA 7/29/2009 IA 7/29/2009 MA 7/29/2009 TX 7/29/2009 TN 7/29/2009 CA 7/29/2009 TN 7/29/2009 NC 7/29/2009 CA 7/29/2009 WA 7/29/2009 KY 7/29/2009 PA 7/29/2009 FL 7/29/2009 MO 7/29/2009 IA 7/29/2009 MN 7/29/2009 MD 7/29/2009 SD 7/29/2009 SD 7/29/2009 ID 7/29/2009 NV 7/29/2009 NC
68 4 1 68 18 11 0.3 43 66 9
68 4 1 68 18 11 0 43 66 9
41 4 85 11 66
41 4
59 25 11 78 10 20 12 0.3 0.5 11 0.2 19 26 12 5 11 0.2 14 1.1 1.3 1 83 13 72 18 14 5 21 0.9 0.9 67 67 40
11 67 59 25 11 10 12 0 0 11 0 19 26 12 5 11 0 14 1 1 1 83 13 71 18 14 5 21 0 0 67 67 40
F M 0M F F F 0.3 F F F M M M M F M M M F F F M M F F M 0.3 M 0.5 M F 0.2 F M F F M M 0.2 F M 0.6 M 0.3 F 0M F F F F M F F 0.9 M 0.9 M M M F
7/28/2009 redness at site of injection; c/o left s 7/28/2009 vaccine related varicella (skin rash) 7/15/2009 Child had fever for 2 weeks (intermi 7/28/2009 0 adverse events 7/28/2009 Feels warm though no fever. Edem 7/24/2009 Vaccine given: 7/21/09 - Fever day 7/22/2009 Projectile vomiting irritability Clingy 7/28/2009 Began 7-25-09 with "mild achy". W 7/28/2009 TDAP given instead of TD. No adve 7/24/2009 Vesicular eruption at injection site d 4/3/2009 Initial report received from a consum This case was received on 05 May 2 7/29/2009 Had injections at 11:20 am on 7-277/23/2009 On 03/20/09 I received ZOSTAVAX 7/23/2009 Patient contracted Chicken Pox dise 7/15/2009 Had shingles vaccine injected on 77/23/2009 ZOSTAVAX vaccine injection side e 7/25/2009 For 1 wk after - can't lift arm (left) - h 7/24/2009 6 days post MMR/VARIVAX adminis 7/21/2009 Patient c/o lightheadedness, "feeling 7/24/2009 On 7/22/2009 right arm became sw 7/28/2009 Information has been received from 7/28/2009 Information has been received from 7/28/2009 Information has been received from 7/24/2009 Got shots just after 9 AM. Left office 7/28/2009 Child had rectal temp of 101.4 F an 7/22/2009 Approx. 10 minutes after receiving v Received VARIVAX #2 on 7/27/09 7/26/2009 More than three weeks of moderate 7/28/2009 Sitting in waiting area after administ 7/29/2009 Patient had fainting episode shortly 7/29/2009 At yearly physical this year 7/22/07, 7/29/2009 Mother reports she noted large red 7/29/2009 Patient received Varivax on 7/27/09 7/29/2009 Intussusception. 8/24/09 Hospital re 7/29/2009 Patient received 2nd Varivax on 7/2 7/29/2009 EYTHERMA, WARMTH AND TEND 7/29/2009 Patient woke up with several large a 7/29/2009 Febrile illness without ill contacts, G 7/29/2009 Patient received vaccine at pharma 7/29/2009 Received HPV #3 on 7/22/09. Abou 7/29/2009 Zostavax (0561Y/4131x)administere 7/29/2009 Within 2-3 minutes following mening 7/29/2009 Ben went to the school to lift weight 7/29/2009 4" x 3" area of swelling, hard, red, h 7/29/2009 bilateral arm rash 7/29/2009 PATIENT WAS ADMINISTERED A 7/29/2009 PATIENT WAS GIVEN SECOND D 7/29/2009 Redness - silver dollar size - at adm 7/29/2009 Half dollar sized rash and swelling a 7/29/2009 Moving severe pain in arm from sho
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7/29/2009 DE 7/29/2009 MS 7/29/2009 CA 7/29/2009 PA 7/29/2009 PA 7/29/2009 7/29/2009 FL 7/29/2009 VI 7/29/2009 CO 7/29/2009 OR 7/29/2009 IL 7/29/2009 NC 7/29/2009 KY 7/29/2009 FL 7/29/2009 KY 7/29/2009 IA 7/29/2009 FL 7/29/2009 NM 7/29/2009 TN 7/29/2009 WI 7/29/2009 SC 7/29/2009 AZ 7/29/2009 TX 7/29/2009 AL 7/29/2009 NJ 7/30/2009 IA 7/30/2009 OK 7/30/2009 MD 7/30/2009 7/30/2009 VA 7/30/2009 ME 7/30/2009 NE 7/30/2009 NJ 7/30/2009 NY 7/30/2009 TX 7/30/2009 MI 7/30/2009 NC 7/30/2009 MI 7/30/2009 OH 7/30/2009 NY 7/30/2009 AZ 7/30/2009 GA 7/30/2009 KY 7/30/2009 WV 7/30/2009 AZ 7/30/2009 WV 7/30/2009 SC 7/30/2009 NY 7/30/2009 NC 7/30/2009 NC 7/30/2009 NY
15 24 21 16 10
15 24 21 16 10
14 1.5 17
14 1 17
5 4 0.2 18 16 18 12 5 0 19 1.3 8 6 52 0.3 64 0.1 67 60
5 4 0 18 16 18 12 5 0 19 1 8 6 52 0 64 0 67
14 9 5 4 5 0.2 37 0.2 5 1.8 67 0.6 11 16 4 0.4 11 69 5 18 2
14 9 5 4 5 0 37 0 5 1 67 0 11 16 4 0 11 69 5 18 2
F M M M F U F 0.5 M F U M F 0.2 F F F F F F 0M F 0.3 F F F F 0.3 F F 0.1 M M F M F F F M F 0.2 M M 0.2 M F 0.8 F F 0.6 F F F F 0.4 F M U M F 0.1 M
7/29/2009 Fever 102.9, chills, body aches, mild 7/29/2009 Vaccine administered day 0, 1000. 7/28/2009 Pt had seizure (new onset) 19 Apr 2 7/29/2009 This case was reported by a healthc 7/29/2009 This case was reported by a healthc 7/29/2009 This case was reported by a healthc 7/24/2009 Pt received vaccine - at above clinic 7/29/2009 On 7/27/09 presented with rash on Patient got dizzy, 30-60 minutes aft Redness at site with swelling and sk 7/29/2009 Entire L thigh swollen and erythema 7/29/2009 Pt. reported back to clinic after rece 7/29/2009 Cellulitis R vastus lateralis Patient received HPV vaccine (3rd d 7/29/2009 Hives after injection #1 Gardasil. 1 7/28/2009 After administering vaccines listed b 7/29/2009 1-2 seconds after immunizations ad 7/20/2009 Red and swollen area (approx 31/2" 7/29/2009 Mother reports that he spent Sat. ni 7/29/2009 Period delayed 3 days after 2nd dos 7/29/2009 Fever 105.7, febrile seizure, eyes ru 7/29/2009 Area warm, rash, redness & from pr 7/29/2009 Right arm posterior area red; very s 7/29/2009 Vaccinated 7/24/09. 7/25/09 evenin 7/29/2009 Rash B/L legs - Bumpy rash with fev 7/29/2009 Information has been received from 7/29/2009 Information has been received from 7/19/2009 May 26, 2007 couldn't walk right - to 7/27/2009 After receiving the new shingles vac 7/27/2009 None Stated 7/24/2009 Low grade fever, muscle aches, site 7/28/2009 Red raised rash on neck, legs, arms 7/23/2009 Swollen, red, warm 31/2X4cm area 7/27/2009 Raised, red, hot, tender to touch. Le 7/29/2009 Severe swelling at injection site day Temperature 102 - 103 x 2 days 4 h 7/29/2009 SM noticed some chest discomfort o 7/27/2009 Five hours after immunizations, pt. d 7/24/2009 Gave KINRIX on 7/22/09 in left upp 7/20/2009 Patient developed an unexplained o 7/24/2009 I was in pain felt sick on Sat. and Su 7/24/2009 7 month old was given pediatric HE 7/27/2009 10:45 AM fainted - ice pack, counse 7/24/2009 Shortly after receiving vaccine, while 7/24/2009 Rash developed to the medical area 7/28/2009 Foster-mother reports that approx. 1 7/24/2009 On right arm: (cm) 11x9 erythemato Vaccine administered to upper L arm 7/27/2009 Client was given a TDAP and shoul 7/27/2009 Client received VARIVAX 17 days a 7/16/2009 Thrush on lips and tongue Dr. presc
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7/30/2009 7/30/2009 MS 7/30/2009 FL 7/30/2009 MI 7/30/2009 WI 7/30/2009 CA 7/30/2009 NY 7/30/2009 MO 7/30/2009 PA 7/30/2009 NY 7/30/2009 AZ 7/30/2009 WA 7/30/2009 7/30/2009 FL 7/30/2009 FL 7/30/2009 FL 7/30/2009 TX 7/30/2009 WV 7/30/2009 MD 7/30/2009 KS 7/30/2009 CA 7/30/2009 CA 7/30/2009 NC 7/30/2009 NC 7/30/2009 OK 7/30/2009 MI 7/30/2009 FL 7/30/2009 AL 7/30/2009 IL 7/30/2009 CA 7/30/2009 CA 7/30/2009 CA 7/30/2009 VA 7/30/2009 CA 7/30/2009 MN 7/30/2009 WI 7/30/2009 MI 7/30/2009 CA 7/30/2009 SD 7/30/2009 IL 7/30/2009 WA 7/30/2009 TX 7/30/2009 TX 7/30/2009 GA 7/30/2009 TX 7/30/2009 NC 7/30/2009 NC 7/30/2009 7/31/2009 7/31/2009 MA 7/31/2009 NV
20 11 31 63 18 2 14 12 4 3 11 71
20 11 31 63 18 2 14 12 4 3 11 71
45 18 35 73 4 51 15 6 61 18 46 4 71 37 5 1.5 38 42 39 11 60 12 68 1.7 13 18 17 5 22 10 12 1.5 38 30 28 39 66 20
45 18 35 73 4 51 15 6 60 18 47 4 71 0 5 1 38 42 38 11 67 12 68 1 13 18 17 5 22 10 12 1 38 30 28 39 66 20
M F F F F 0M F F M F M M U M F F F M F F F F F M M M 0F M 0.5 F F F F F M M F 0.7 F F F F F F M F 0.5 M M U F M F F
7/30/2009 Member was recieving a routine ser 7/30/2009 Seizure lasting thirty seconds, follow 7/30/2009 CLIENT RETURNED TO ADULT CL 7/30/2009 redness, swelling, itching, hardness 7/30/2009 Immediately following administration 7/30/2009 Injection site pain to the point where 7/30/2009 Came in for Gardisil #3. Layed down 7/21/2009 Patient recedived vaccines. While p 7/30/2009 Patient recieved DTaP, MMR, IPV in 7/30/2009 Patient c/o knee pain x 1 week then 7/30/2009 Pt. with syncope x 2 events. Synco 7/30/2009 Employee was given Tdap by me (M 7/30/2009 Patient received her 2nd Varivax on 7/30/2009 CLIENT RETURNED TO CLINIC FO 7/30/2009 PATIENT RECEIVED VZV ON 7-21 7/30/2009 AFTER RECEIVING MMR INJECTI 7/30/2009 Client did not state on the screening 7/30/2009 Patient had wheezing, swelling of lip 7/30/2009 Initially an area of erythema of abou 7/30/2009 Less than 8 hours later right leg itch 7/30/2009 LEFT ARM SWOLLEN, REDDNESS 7/30/2009 Patient reported to our facility on 4/6 7/30/2009 Pt was administered Tdap and Men 7/30/2009 RECEIVED PHONE CALL FROM P 7/30/2009 Patient went into his Primary Care P 7/30/2009 location reaction,cellulitis L arm, pt. 7/30/2009 Fever of 102.7, extreme weakness 7/30/2009 Within 15 minutes of administration 7/30/2009 Progressive vesicular eruptions on t 7/30/2009 Red, swollen, itchy, hot to touch. Lt 7/30/2009 Pain, redness, raised semi solid kno 7/30/2009 Subdermal nodule, pain L axilla x 37/27/2009 Pt came to doctors office on 7/25/09 7/30/2009 10 days after injection, chronic urtic 7/30/2009 Right arm, began to become red/sw 7/30/2009 3 - 5 cm raised red area. Pt treated 7/28/2009 MENACTRA given from Lot #U2867 7/30/2009 Patient almost fainted. 7/29/2009 HPV vaccine given, no adverse eve Hives on upper chest. BENADRYL 7/30/2009 Shot was given on 07/23/09 at clinic 7/30/2009 22 y/o female, developed unexplain 7/30/2009 Redness, swelling, warmth, tendern 7/30/2009 Mother states when client woke up 7/29/2009 Severe swelling and redness at inje 7/27/2009 SM developed HA approx 4 hrs afte 7/30/2009 Approx 5 hrs after receiving his mos 7/23/2009 SM developed redness, swelling, pa 7/31/2009 Extreme red skin color, loss of moto 7/23/2009 1/14-8/3/09. Large local reaction las 7/27/2009 The following day my throat was sw
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7/31/2009 MO 7/31/2009 PA 7/31/2009 NE 7/31/2009 TX 7/31/2009 NY 7/31/2009 IN 7/31/2009 CA 7/31/2009 NY 7/31/2009 MI 7/31/2009 CA 7/31/2009 NV 7/31/2009 OH 7/31/2009 7/31/2009 FL 7/31/2009 7/31/2009 NC 7/31/2009 CA 7/31/2009 TN 7/31/2009 CA 7/31/2009 AL 7/31/2009 GA 7/31/2009 WV 7/31/2009 VA 7/31/2009 TX 7/31/2009 AZ 7/31/2009 IL 7/31/2009 MO 7/31/2009 OK 7/31/2009 AR 7/31/2009 TX 7/31/2009 WI 7/31/2009 MD 7/31/2009 CO 7/31/2009 PA 7/31/2009 CA 7/31/2009 WA 7/31/2009 NY 7/31/2009 TX 7/31/2009 MI 7/31/2009 CO 7/31/2009 KY 7/31/2009 NY 7/31/2009 PA 7/31/2009 TX 7/31/2009 WA 7/31/2009 CA 7/31/2009 TX 7/31/2009 CA 7/31/2009 TX 7/31/2009 NY 7/31/2009 WA
1 64 12 11 11 0.5 18 4 57 47 50 18 67 1
1 64 12 11 11 0 18 4 57 47 50 18
1.5 1.4 1.6
1 1 1
72 4 55 5 0.5 8 12 5 0.2 74 12 13 15 35 11 4 18 0.3 45 5 68 67 1 26 11 12 34 2 0.4 1 25 24
72 4 55 5 0 11 12 5 0 74 12 13 15 35 11 4 18 0 45 5 68 67 1 26 11 12 34 2 0 1 25 24
1
0M F M M M 0.5 M F M F F M M F 0M U 0.5 F 0.4 M 0.6 M F F M F F 0.5 F F F M 0.2 M F F F F F M F M 0.4 M F M F F 0F F M F F 0F 0.4 M 0F F F
7/25/2009 Rash all over body x 6 days. Fever 7/18/2009 Rash around injection site - size of 5 7/27/2009 Pt received Tdap in Rt deltoid on 7/ None stated 7/25/2009 C/O redness and slight swelling on 7/28/2009 Patient developed multiple pruritic e 7/23/2009 18 year old female became dizzy an 7/30/2009 Erythematous Edematous and firm 7/24/2009 Noted red, warm sore area on Lt. de 7/27/2009 Nausea, vomiting, dizziness. 4/21/2009 Tetanus (L) arm 6 d ago. Next AM n 7/27/2009 Red rash on neck and legs. 7/30/2009 InformationYhas been received from 7/27/2009 - Pt began to have fever 8 days afte 7/30/2009 InformationYhas been received from 7/27/2009 Swelling and redness from elbow to 7/27/2009 Temp. 98.8, redness at the site of im 7/27/2009 Per mother - 7/25/09 A.M. had feve 7/30/2009 Information has been received from 7/31/2009 Large red circle where vaccine was 7/31/2009 07/20/2009 PATIENT RCD VARICE 7/31/2009 Shoulder pain, lack of back range m 7/31/2009 Started a low grade fever yesterday 7/31/2009 on 07/28/09 patient was brought in 7/31/2009 Clt. was administered Varicella vacc 7/31/2009 Incident occured 7-30-09. After adm 7/31/2009 Client at clinic for kindergarten immu 7/31/2009 Vaccines given 7/22/09. Child deve 7/31/2009 HAD LOCAL RASH, AS WELL AS R 7/31/2009 Patient received hpv vaccine on 7/2 7/31/2009 Broke out in hives all over her body 7/31/2009 Patient received Gardasil immuniza 7/31/2009 Received the injections in my left ar 7/31/2009 Redness, swelling, warm to touch, p 7/31/2009 3" x 3" erythema muscle hot to touc 7/31/2009 Approximately 5-10 minutes after in 7/31/2009 intussusception 7/31/2009 Diffuse papular rash erupted 6/17/0 7/31/2009 Patient came down with Varicella 8 7/31/2009 24 hours after vaccination pt noticed 7/31/2009 Patient did not have any initial probl 7/31/2009 patient received 12 mo vaccinations 7/31/2009 Pt was given the following injections 7/31/2009 RIGHT ARM HAS A 13CM RED IRR 7/31/2009 PT'S MOTHER STATED THAT ABO 7/31/2009 Severe emesis (x7) 24 - 30 hours fo 7/31/2009 Approx 1 day after vaccines given, p 7/30/2009 4 month old male had had upper ex 7/31/2009 Vaccines given at 2:40 pm. 2 hives 7/31/2009 Pt came to clinic 2 days after receiv 7/31/2009 Red Itching
352926 352927 352928 352929 352930 352931 352932 352933 352934 352935 352936 352937 352939 352940 352941 352942 352943 352944 352945 352946 352947 352948 352949 352950 352951 352913 352914 352915 352916 352921 352938 352953 352954 352955 352957 352958 352960 352962 352966 352969 352971 352976 352980 352981 352982 352986 352987 352989 352997 352998 352999
7/31/2009 CA 7/31/2009 CA 7/31/2009 CA 7/31/2009 AK 7/31/2009 TX 7/31/2009 IL 7/31/2009 IN 7/31/2009 FL 7/31/2009 IL 7/31/2009 NY 7/31/2009 FL 7/31/2009 CA 7/31/2009 NJ 7/31/2009 FL 7/31/2009 SC 7/31/2009 7/31/2009 OH 7/31/2009 OH 7/31/2009 OH 7/31/2009 7/31/2009 7/31/2009 7/31/2009 7/31/2009 IL 7/31/2009 8/1/2009 NJ 8/1/2009 PA 8/1/2009 CA 8/1/2009 CA 8/2/2009 IA 8/3/2009 MA 8/3/2009 OH 8/3/2009 MI 8/3/2009 NJ 8/3/2009 TX 8/3/2009 IA 8/3/2009 PA 8/3/2009 NC 8/3/2009 MT 8/3/2009 NY 8/3/2009 IN 8/3/2009 CA 8/3/2009 8/3/2009 FL 8/3/2009 NY 8/3/2009 KS 8/3/2009 8/3/2009 SC 8/3/2009 MD 8/3/2009 FL 8/3/2009 GA
12 11 45 5 12 75 32 11 21 23 25 10 68 1.5 11
12 11 45 5 12 75 32 11 21 23 25
5 5 4
5 5 4
5
5
11 66 4 1.1 19 68 1.3 44 5 0.2 12 45 0.3 17 45 0.1 62
11 66 4 1 19 68 1 44 5 0 12 45 0 17 45 0 62
4 5 15 16 82 0.2 17 65
4 5 15 16 82 0 17 65
68 1 11
F M F M F F F F F F F F F 0.5 M M U M F M U U U U M U F F M 0.1 F F F 0.3 M F M 0.2 F F F 0.3 M M F 0.1 F F U F F F F M 0.2 F F M
7/20/2009 - L.O.C for 2 sec. - Paleness in face 7/31/2009 Severe headaches evening of vacci 7/31/2009 Developed golf ball size swelling at 7/31/2009 Vaccines given 29JUL2009. Mom re 7/31/2009 She received her vaccines 1 week a 8/1/2009 Pt received shot on Wed 7/29/9. On 7/31/2009 7-28-09 Vaccine admin after approp 7/30/2009 Dizziness and headache. 7/31/2009 Pt. here today for TBST reading C0 7/31/2009 Pt presented to clinic 2 days after in 8/2/2009 The patient received a 1st Hep-B va 7/31/2009 Dizziness starting - few hours after v 7/31/2009 1-2 min after vaccination of HAVRIX 7/31/2009 Crankiness at 10:30. Fell asleep, wo 7/31/2009 Pt received VZV and Hep A immuni 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a physici 8/1/2009 Within 48 hours of receiving vaccine 8/1/2009 large red mark at injection site 8/1/2009 pt developed large area of firmness 8/1/2009 Within hours, Jonah became letharg 8/2/2009 After first gardasil shot on 03/27/08 7/31/2009 None stated 7/10/2009 Decreased-low eye contact, unresp 7/28/2009 Went to emergency room, transferre 7/29/2009 R arm - swelling on 7/24/09 - site of 8/3/2009 Intussusception, diarrhea, vomiting, 8/3/2009 Pt. passed out, 1 day laid back on ta 8/3/2009 Approximately 5 minutes after being 7/31/2009 Rash noted this morning by mother 7/23/2009 Client sitting in chair while vaccines 7/30/2009 Pt reported fever to 101-102. Pt rep 7/30/2009 Patient had no adverse event. Patie 7/24/2009 Developed left arm swelling, rednes Eczematoid rash both legs @ immu 7/28/2009 Rash, itching and red patch of skin 7/28/2009 Fever 101 degrees --> 12 hr. after v 7/31/2009 Information has been received from 7/31/2009 Information has been received from 7/31/2009 Information has been received from 8/3/2009 possible seizure 8/3/2009 Patient had the menactra vaccine o 8/3/2009 Approximately 24 hours after pneum
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8/3/2009 MI 8/3/2009 KS 8/3/2009 NJ 8/3/2009 NC 8/3/2009 NV 8/3/2009 MN 8/3/2009 GA 8/3/2009 IN 8/3/2009 AR 8/3/2009 IN 8/3/2009 CA 8/3/2009 WY 8/3/2009 CA 8/3/2009 IN 8/3/2009 MN 8/3/2009 CA 8/3/2009 WI 8/3/2009 MI 8/3/2009 OK 8/3/2009 OK 8/3/2009 GU 8/3/2009 TX 8/3/2009 CA 8/3/2009 MO 8/3/2009 SD 8/3/2009 WA 8/3/2009 OR 8/3/2009 TN 8/3/2009 WA 8/3/2009 WI 8/3/2009 OK 8/3/2009 WI 8/3/2009 NC 8/3/2009 PA 8/3/2009 OR 8/3/2009 NM 8/3/2009 OR 8/3/2009 8/3/2009 NY 8/3/2009 NE 8/3/2009 NJ 8/3/2009 CA 8/3/2009 IL 8/3/2009 KS 8/3/2009 NJ 8/3/2009 MI 8/3/2009 UT 8/3/2009 AZ 8/3/2009 NY 8/3/2009 MS 8/3/2009 TN
16 12 21 1.2 21 60 19 11 72 11 4 88 1.7 2 65 47 66 17 61 61 4 68 1.8 15 0.2 16 34 15 67 62 10 1.6 49 18 4 4 0.5 13 10 1.1 0.4 1.6 5 14 0.2 17 34 25 5 19
16 12 21 1 21 60 19 11 72 11 4 88 1 2 65 47 66 17 61 61 4 68 1 15 0 16 34 15 67 62 10 1 49 18 4 4 0 13 10 1 0 1 5 14 0 17 5 34 25 5 19
M M F 0.1 F M F M F F F F M 0.7 F 0.3 M F F F M M F M M 0.8 M F 0.2 F F F F F F M 0.6 F M M M F 0.5 M U F 0.1 F 0.4 F 0.6 M M M 0.2 F F M F F M M
8/3/2009 2- 2 1/2 inch sized red/hot painful sw 8/3/2009 Varivax vaccine administered to Rig 8/3/2009 rash on face 8/3/2009 My daughter got her MMR and Varic 8/3/2009 Fever, Chills, Neausa 8/3/2009 Client called local health departmen 8/3/2009 Autoinoculation with the following sk 8/3/2009 Syncope occurred 5 minutes after im 8/3/2009 Patient developed a 4 inch are of re 8/3/2009 Syncopal episode occurred 2 minut 8/3/2009 patient here with mother for ppd rea 8/3/2009 A day or two after his vaccination fo 8/3/2009 Patient developed hives after secon 8/3/2009 CT'S MOTHER REPORTS CT VOM 8/3/2009 Patient complained of jaw pain, dizz 8/3/2009 Pt states a rash on arms and joint p 8/3/2009 Patient developed a large red and s 8/3/2009 Evening of imm. (07/23)developed r 8/3/2009 patient reports no known drug allerg 8/3/2009 patient reports no drug allergies. pa 8/3/2009 Pt developed cellulitis in his right up 8/3/2009 Two days after administration of Va 8/3/2009 According to Dr. Lee's report, "VAC 7/27/2009 Pt fainted very shortly after injection 7/13/2009 Rash to torso told to leave t-call with 7/28/2009 Approx. 2 min after injections, beca 7/22/2009 Nine hours after vaccination, pt dev 7/24/2009 7/22 Woke up during the night from 7/29/2009 Injection site visible. Redness is 8-9 7/27/2009 Patient reported symptoms began in 6/30/2009 He said it burned. 7/24/2009 Nausea, vomiting, diarrhea, fever. M 8/3/2009 Pt received his 3rd AVA booster on 7/31/2009 Pt received Tdap, MCV, & Varicella 7/8/2009 7-2-09 per report taken, pt. had c/o 8/3/2009 Swelling and redness of rt arm. Tx c 7/7/2009 TC from mother of client on 6/30/09 None Stated 8/3/2009 Swollen harden area, 7cm x 7cm re 7/31/2009 Rash over upper torso and fever Ra 8/3/2009 Fever 102.4 7-29-09.7-28-09- Seen 8/3/2009 The Tdap immunization was given i 8/5/2009 Swelling noted on arm same day af 8/3/2009 Pt had received a 4th dose of DTP w 8/2/2009 Received vaccinations approx. 345p 7/30/2009 L arm has two welt sites one aprox. 8/3/2009 Pt came in on 07/31/09 for vaccines 8/3/2009 Had sore throat & some mild swellin 7/15/2009 Erythema, edema, induration at inje 8/3/2009 Varicella vaccine admin 7-30-09. Fa 8/3/2009 None.
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8/3/2009 MA 8/3/2009 CA 8/3/2009 AZ 8/3/2009 TN 8/3/2009 TN 8/3/2009 DE 8/4/2009 CA 8/4/2009 WA 8/4/2009 8/4/2009 SC 8/4/2009 NJ 8/4/2009 8/4/2009 8/4/2009 NY 8/4/2009 NH 8/4/2009 IN 8/4/2009 NJ 8/4/2009 IL 8/4/2009 MO 8/4/2009 CA 8/4/2009 ID 8/4/2009 NC 8/4/2009 LA 8/4/2009 OK 8/4/2009 MN 8/4/2009 MN 8/4/2009 NC 8/4/2009 LA 8/4/2009 TN 8/4/2009 FL 8/4/2009 GA 8/4/2009 NY 8/4/2009 IL 8/4/2009 8/4/2009 MI 8/4/2009 AR 8/4/2009 MA 8/4/2009 PA 8/4/2009 OH 8/4/2009 NC 8/4/2009 GA 8/4/2009 IN 8/4/2009 CA 8/4/2009 CO 8/4/2009 OK 8/4/2009 FL 8/4/2009 AL 8/4/2009 8/4/2009 VA 8/4/2009 TN 8/4/2009 KY
1.1 2 28 16 15 1.6 5 17 0.5 23 23 16 23 0.5 0 12 22 16 1 11 61 12 17 13 50 59 15 16 4 18 1.1 15 14 12 15 60 60 13 65 61 12 4 23 2 27 1.3 36 14 1.6 10
2 28 16 15 1 5 17 23 23 16 23 0 0 12 22 16 1 11 61 12 17 13 50 59 15 16 4 18 1 15 14 12 15 20 61 60 13 65 61 12 4 23 2 27 1 36 14 1 10
M 0.4 F F F F 0.6 F M F F F F F F 0.5 M 0M M M F 0F M F M F F F F F F M M 0.1 M M F F F M F M F F M F F F 0.2 M F 0.3 M M M 0.6 M F
7/28/2009 Fever 102.2. 8/3/2009 7/30 PM left thigh big red welt at site 8/3/2009 Had sore throat nasal congestion co 7/24/2009 I want to give a little history on this p 7/24/2009 1/08 - school reported she was very 7/29/2009 Received Hep#2 only 4 months afte 8/4/2009 Redness, pain, swelling, itching, an 8/4/2009 Was doing fine after first after first s 8/3/2009 Information has been received from 8/3/2009 Initial and follow-up information has 8/3/2009 Information has been received from 8/3/2009 Information has been received from 8/3/2009 Information has been received from 7/29/2009 Intussusception 4 mo after completi 8/4/2009 This case was reported by a consum 6/5/2009 Fever - started night after vaccine. F 8/4/2009 Received smallpox vaccination on 7 7/29/2009 7-8" of redness, itchy and painful fo 7/31/2009 Fever, rash. (R) arm red swollen X 2 days; tende 7/29/2009 Vaccine was given IM rather than S 7/31/2009 Pt fainted following immunization. P 7/31/2009 Rash to hands and feet (blisters) so 7/31/2009 On 27 July 09 child received 3rd HP 7/29/2009 Paula woke up on 7-11-09 and her 7/10/2009 7/6 Arm aches pm. 7/7 Body aches, 7/31/2009 Neck stiffness, Headache, Extreme 7/28/2009 7-27-09 1:00 PM Mom called to rep 7/30/2009 Patient returned to clinic after 30 mi 7/29/2009 Dizziness, 0 Syncope, diaphoretic w 7/29/2009 Pt 2 wks after MMR/Varicella develo 7/27/2009 According to parents woke up next 7/29/2009 2-3" circular redness-itchy and pain 7/24/2009 Night of immunization mac/pap rash 7/30/2009 Vaccine administered to pregnant fe 8/4/2009 Possible secondary innoculation to 8/4/2009 After a few hours the injected arm u 8/4/2009 TETANUS SHOT WAS GIVEN ON 8/4/2009 Childs mother called at 9:30am this 8/4/2009 Patient presented 8/3/2009 concern 8/4/2009 24 hours after vaccine, arm had slig 8/4/2009 Syncopal episode 2 minutes after im 8/4/2009 Redness, swellling and induration o 8/4/2009 Approximately 1 week prior patient w 8/4/2009 Pt given combo vaccine of Dtap/IPV 8/4/2009 Approximately 1 month after receivi 8/4/2009 Pt had a seizure 2:00 a.m. the follow 8/4/2009 had body aches and muscle cramps 8/4/2009 Herpes Zoster Rash on trunk on the 8/4/2009 Pt received second Hep A vaccine a 8/4/2009 About one minute after shot Kayla b
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8/4/2009 KY 8/4/2009 MA 8/4/2009 NJ 8/4/2009 PA 8/4/2009 WI 8/4/2009 UT 8/4/2009 NY 8/4/2009 KS 8/4/2009 PA 8/4/2009 KY 8/4/2009 MA 8/4/2009 MI 8/4/2009 MI 8/4/2009 NJ 8/4/2009 CA 8/4/2009 OH 8/4/2009 MA 8/4/2009 MA 8/4/2009 AZ 8/4/2009 KS 8/4/2009 CA 8/4/2009 KS 8/4/2009 NJ 8/4/2009 VA 8/4/2009 VA 8/4/2009 LA 8/4/2009 FL 8/4/2009 FL 8/4/2009 TX 8/4/2009 OK 8/4/2009 TX 8/4/2009 NM 8/4/2009 AZ 8/4/2009 NJ 8/5/2009 8/5/2009 NJ 8/5/2009 8/5/2009 8/5/2009 NJ 8/5/2009 RI 8/5/2009 ID 8/5/2009 8/5/2009 8/5/2009 KY 8/5/2009 DE 8/5/2009 NM 8/5/2009 ND 8/5/2009 MN 8/5/2009 TX 8/5/2009 IA 8/5/2009 OH
0.5 18 0.2 56 26 60 5 12 60 31 25 4 14 4 1.5 20 45 46 19 38 0.1 14 42 54 12 27 54 66 8 30 14 9 5 0.7 63 21 25 76 61 1.8 5
28 39 15 85 19 4 11
0 18 0 56 26 60 5 12 60 31 25 4 14 4 1 20 45 46 19 0 14 42 54 12 27 54 66 8 30 14 9 5 0 21 25
1
28 39 15 85 19 4 11
0.5 M M 0.2 F M F F M M F F F M F F 0.5 M F M F F F 0.1 F M F F F M F F F F F F F 0.7 M F F F F F M 0.8 F M M F M F F F F M F
8/4/2009 Child had 6 month shots at 11:00am 8/4/2009 Shots administered at 2:30 p.m. app 8/4/2009 Intussusception 7/20/09 - symptoms 8/4/2009 6/23/09 BOOSTRIX given -> mild so 7/24/2009 Pt has history of seizures. Has C.P. 8/4/2009 Sweating, dizzy, nausea, rash on fa 8/4/2009 Temp 101 F x 2 days of markedly sw 8/4/2009 Temp of 103.1 a few hrs after gettin 8/4/2009 Local reaction left upper arm 7/23-7 8/4/2009 Pt noticed redness, swelling, tender 8/4/2009 Fever, feeling "off", dizziness, red lo 8/3/2009 Onset of coughing and hives within 8/4/2009 Within 5 min of receiving HPV #3 in 8/4/2009 1/2 upper arm on right side, swollen Father of patient came to our office 8/4/2009 Pt. came in 2/+ pain in L elbow on 8 8/4/2009 Redness, swelling and pain in R arm 8/4/2009 Redness at injection site, pain at inj 7/28/2009 Hives 8/4/2009 08/04/2009 MODERATE Other IND 8/4/2009 Crying, fussy after the vaccines wer 8/4/2009 07/23/2009 MODERATE Other. FA 7/31/2009 7/10/09 Received vaccinations. 7/15 8/3/2009 (R) upper arm was slightly swollen & 8/3/2009 Patient fainted after administration o 7/30/2009 None stated. 7/29/2009 Red rash/welts on inside portion of 7/13/2009 6/23/09. Itch developed and got wo 7/28/2009 Pt with severe erythema localized & 7/30/2009 Developed VARICELLA Disease (ch 7/29/2009 Redness, warm, 7 cm X 7 cm 7/28/2009 Right arm red and warm to touch. 8/4/2009 Left arm with immediate itching and 8/4/2009 At 10 PM parents reported increase 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 7/20/2009 Febrile seizure. 8/21/09 ERrecords 7/31/2009 Initial report was received 27 July 20 8/2/2009 Initial report received on 27 July 200 7/31/2009 Initial report was received from anot 8/5/2009 I received an anthrax shot at 0830 o 8/5/2009 Vaccination administered in left delt 8/5/2009 SHORTNESS OF BREATH, CHEST 8/5/2009 Patient complained of rash, redness 8/5/2009 Immediately after receiving vaccines 8/5/2009 Red Swollen at site of injection 8/5/2009 Vaccines were given at about 1030a
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8/5/2009 CA 8/5/2009 MI 8/5/2009 MD 8/5/2009 CT 8/5/2009 MD 8/5/2009 MA 8/5/2009 OH 8/5/2009 NC 8/5/2009 CA 8/5/2009 NM 8/5/2009 OR 8/5/2009 VA 8/5/2009 IL 8/5/2009 IL 8/5/2009 IL 8/5/2009 IL 8/5/2009 LA 8/5/2009 TX 8/5/2009 IA 8/5/2009 CO 8/5/2009 8/5/2009 8/5/2009 ID 8/5/2009 ID 8/5/2009 FL 8/5/2009 8/5/2009 NM 8/5/2009 DC 8/5/2009 PA 8/5/2009 NC 8/5/2009 8/5/2009 MN 8/5/2009 CA 8/5/2009 WA 8/5/2009 NM 8/5/2009 IA 8/5/2009 TX 8/5/2009 ND 8/5/2009 PA 8/5/2009 MN 8/5/2009 WI 8/5/2009 CA 8/5/2009 OH 8/5/2009 TX 8/5/2009 CA 8/5/2009 CA 8/5/2009 TX 8/6/2009 8/6/2009 8/6/2009 ID 8/6/2009 PA
2 18 11 21 18 21 12 15 70 4 3 40 25 44 49 64 4 4 72 20 60 5 5 63 66 0.3 21 15 44 55 4 36 14 12 12 12 12 1.2 63 28 72 5 28 23 2 86 31 72 11 64
2 18 11 21 18 21 12 15 69 4 3 40 25 44 49 64 4 4 72 11 60 5 5 63 66 0 21 15 44 4 36 12 12 12 12 1 63 28 72 5 28 23 2 86 31 11 64
0.1 F F M F F F F F F F F F M F F F M M F M F F F M F F 0.3 M F F M M M M F M M F F 0.2 M F F F M F M 0.1 F M F F F F
8/5/2009 Received vaccines on 7/13/09. Fam 8/5/2009 Immediately after Hepatitis B vaccin 8/5/2009 Fluid-filled blister, scab forming afte 8/5/2009 Weakness, body aches, joint pain, h 8/5/2009 After receiving MCV4, while seated, 8/5/2009 Headache, Nausea, Vomiting, Chills 8/5/2009 Mother brought child to HD office 8/ 8/5/2009 48 hours after the vacination of Gar 8/5/2009 Within a week, I had begun to expe 8/5/2009 Mother is stating that 7days after va 8/5/2009 My daughter received a DTAP vacc 8/5/2009 Arms and fingers feeling numb. Bo 8/5/2009 Redness and pain at injection site fo 8/5/2009 skin erythema and warm to touch 8/5/2009 vomiting, diarrhea, fever of 102 x 2 8/5/2009 Noticed redness/swelling/warmth at 8/5/2009 Patient received Pentacel vaccine c 8/5/2009 CHILD SEEN IN EMERGENCY RO 8/5/2009 Pneumovax administered at approx 8/5/2009 Localized red, warm , tender, inflam 7/31/2009 Severe stomach pain and weakness 7/31/2009 Developed vestibular neuritis 12 da 7/22/2009 Lost consciousness with skin pallor, 6/26/2009 Large (about size of baseball) Lt thi 7/30/2009 After a few days of the initial vaccin 7/31/2009 Pt with Hx radiation to skin years ag 8/3/2009 Vaccines (PENTACEL, PREVNAR & 7/31/2009 On the day of the vaccine was given 8/5/2009 Patient given GARDASIL vaccine a 8/5/2009 On 12/15/07, SM received AVA (2), 7/28/2009 Pt. c/o fever of 102.5, left arm red, s 8/4/2009 Would this 8/4 L thigh swollen red + 8/5/2009 Patient reported fever, left arm pain Pt getting up from exam table fell fo 8/5/2009 Red, sore, hot, fever, blister pustule 8/5/2009 After vaccine given mom then tells R Pt. received vaccines. Mom stated p 8/5/2009 Left upper arm, shoulder pain, swel 8/15/2009 Shingles 8/3/2009 Pt got a rash on her wrist, arm, ches 8/5/2009 Redness to upper arm fever 102 de 8/5/2009 Cellulitis, redness, swelling, warmth Anaphylaxis ~ 1/2 in after receipt o 8/5/2009 28 yo girl presented to clinic at 4:05 8/4/2009 On 7/20/09 received a T booster F a 8/3/2009 Local popular pruritic rash around s 8/15/2009 Debilitating weakness all over, unab 8/6/2009 Urticaria without systemic symptom 8/2/2009 On March 3rd, I received a shingles 6/22/2009 Patient had a reaction to VARIVAX 7/23/2009 PPV shot given at top of left should
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8/6/2009 8/6/2009 GA 8/6/2009 NV 8/6/2009 LA 8/6/2009 WA 8/6/2009 OR 8/6/2009 VA 8/6/2009 CO 8/6/2009 CA 8/6/2009 CO 8/6/2009 UT 8/6/2009 NY 8/6/2009 CA 8/6/2009 RI 8/6/2009 PA 8/6/2009 NE 8/6/2009 MO 8/6/2009 NC 8/6/2009 8/6/2009 8/6/2009 SC 8/6/2009 PA 8/6/2009 TX 8/6/2009 NC 8/6/2009 MO 8/6/2009 SD 8/6/2009 NC 8/6/2009 OH 8/6/2009 VA 8/6/2009 MI 8/6/2009 PA 8/6/2009 LA 8/6/2009 NH 8/6/2009 MN 8/6/2009 TX 8/6/2009 GA 8/6/2009 LA 8/6/2009 NE 8/6/2009 MI 8/6/2009 AL 8/6/2009 AL 8/6/2009 CO 8/6/2009 AL 8/6/2009 LA 8/6/2009 MO 8/6/2009 TX 8/6/2009 OH 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CO
4 6 11 71 18 19 8 1.3 67 60 11 76 80 16 28 4 11 14 61 0.3 11 20 2 69
4 6 11 71 18 19 8 1
1.6 14 14 19 2 11 1.3 8 12 11 13 15 5 14 13 0.2 4 10 0.3 12 42 17 32 42 31
1 14 14 19 2 10 1 8 12 11 13 15 5 14 13 0 4 10 0 12 42 17 32 42 31
60 11 76 16 28 4 11 61 11 20 2 69
F M M M M F F M 0.3 M F F M F F F F M M F F U F F 0.2 F F M 0.6 F M M M 0.2 M M 0.3 F F F M F F M F F 0.2 M M F 0.4 M F F M F M M
8/4/2009 My daughter had serious problems 8/6/2009 Patient received Immunizations, we 8/6/2009 Anaphylaxis - instant hives - lip swe 7/31/2009 Localized warm redness to vaccine 8/4/2009 This case was received from a heal 7/30/2009 Within one week of vaccination the 8/3/2009 Following vaccines, episode of sync 7/29/2009 Itchy sensation, hives. Went to ER, 7/30/2009 Febrile Illness 103.5 Bronchiolitis po 7/30/2009 Developed shingles 3 days after vac 8/5/2009 Information has been received from 8/1/2009 Seen on 8/1 (2 days later) with swe 8/5/2009 Information has been received from 8/5/2009 Information has been received from 8/5/2009 Information has been received from 7/27/2009 Chills, muscle weakness, body ache 7/31/2009 Lt. thigh with 5 X 5 cm erythema dis 8/3/2009 6x5 cm area of pruritic angioedema 8/4/2009 Severe fatigue and soreness. 8/3/2009 side effect to ZOSTAVAX, bright red Pt had PENTACEL given (never ha 8/5/2009 Patient received 3 vaccines MENAC 8/6/2009 8/5/09 upper outer arm red, warm 4 8/4/2009 R thigh red, swollen and painful. Fe 8/6/2009 Pt was bit by lab confirmed rabid fox 7/31/2009 Local reaction with swelling of thigh 7/31/2009 First & 2nd Hep A local erythema in 8/6/2009 This clinic client became nauseated 8/6/2009 Mother of patient came by clinic at 8 8/6/2009 Administered a pediatric Hepatitis A 8/6/2009 Baby woke up three days after vacc 8/6/2009 Varicella was administered to the le 8/6/2009 Pt in office on 7/31/09 for 15 month 8/6/2009 Received rabies pre-exposure #3 on 8/6/2009 Pt represents to clinic with a 4cm x 8/6/2009 Patient received vaccination of Tdap 8/6/2009 PT.HERE STATED AREA WHERE 8/6/2009 APPROXIMATELY 2 MINUTES AFT 8/6/2009 Redness, rash and swelling at injec 8/6/2009 7/27/09 Came in to HD c/o side effe 8/6/2009 Started vomitting at noon 8/4/09 and 8/6/2009 none, 9/25/09 Y Autopsy report receiv 8/6/2009 Awake, Thurday a.m., 7/30/09, with 8/6/2009 PT. MOTHER PHONED OFFICE ST 8/6/2009 Fever 2 days after vaccination, rash 8/6/2009 On 11/16/08, pt went about her day 8/6/2009 24 hours after Tdap, client had pain 8/6/2009 18 yo recruit on day 24 of his trainin 8/6/2009 Vaccine (Pneumovax 23) was admi 8/6/2009 8/4/09 TDaP given to client who is a 8/6/2009 This case was reported by a consum
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8/6/2009 OH 8/6/2009 UT 8/6/2009 CA 8/6/2009 VA 8/6/2009 MI 8/6/2009 IN 8/6/2009 PA 8/6/2009 FL 8/6/2009 MO 8/6/2009 CA 8/6/2009 TX 8/6/2009 AZ 8/6/2009 NM 8/6/2009 CA 8/6/2009 IL 8/6/2009 CA 8/6/2009 CA 8/6/2009 FL 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 AR 8/6/2009 PA 8/6/2009 CA 8/6/2009 FL 8/6/2009 MS 8/6/2009 NE 8/6/2009 8/6/2009 FL 8/6/2009 FL 8/6/2009 OR 8/6/2009 NJ 8/6/2009 VA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 MI 8/6/2009 GA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 MI 8/6/2009 8/6/2009 FL 8/6/2009 NY
5 4 56 5 15 0.5 39 4 11 16 5 0.9 8 3 5 48 14 76 66 97 19 60
5 4 56 5 15 0 39 4 11 16 5 0 8 3 5 48 14
81 61 27
81 61 27
79 85 70 36 49 18 71 41
79 85 70 36 49 18 71
46 66 1.1 68 67
46
66 19 60
1 68
70 64 68 71 61 71
68 61 71
M M F M F 0.5 M M F M F M 0.9 F F M F F F F F F M M M F M F U F M F F F F M F U M F 0.1 M F M U M F F F U F F F F
8/6/2009 This case was reported by a healthc 8/6/2009 (L) injection (MMR & DTaP) 8/3/09 2 8/6/2009 Adverse effect fever 100.8, myalgia 8/6/2009 10cm x 6cm area of induration, warm 8/6/2009 Became pale 5 min after injection. L 8/6/2009 Fever began a few hours after immu 8/6/2009 Headache, (leg, neck, and back pai 7/29/2009 Patient received vaccines- KINRIX, 8/6/2009 Pt. c/o wheezing & swelling of face 8/6/2009 About 4 pm, pt was at a restaurant, 8/7/2009 Erythema multiforme minor 8/6/2009 Diffuse rash to face, torso, buttocks 8/6/2009 Lt arm swollen, hot touch. Onset Au 8/6/2009 Right leg with 12cm macule, warm t 8/6/2009 Received DTAP shot (5th shot) on 8 6/10/2009 Day after vaccination Pt. experience 8/6/2009 Presented to urgent care clinic with 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Initial and follow up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has
353455 353497 353498 353499 353500 353502 353503 353504 353505 353506 353507 353509 353510 353511 353531 353532 353533 353534 353535 353536 353537 353539 353540 353542 353544 353546 353548 353549 353550 353552 353554 353555 353558 353560 353562 353563 353564 353566 353568 353569 353572 353573 353575 353651 353652 353653 353654 353655 353656 353657 353658
8/6/2009 MI 8/6/2009 NE 8/6/2009 MN 8/6/2009 MN 8/6/2009 TX 8/6/2009 8/6/2009 TX 8/6/2009 TX 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 MN 8/6/2009 FL 8/6/2009 MN 8/6/2009 8/6/2009 CA 8/6/2009 KY 8/6/2009 KY 8/6/2009 VA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 8/6/2009 GA 8/6/2009 PA 8/6/2009 8/6/2009 CA 8/6/2009 TX 8/6/2009 CA 8/6/2009 KS 8/6/2009 OR 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NC 8/6/2009 NC 8/6/2009 MI 8/6/2009 MI 8/6/2009 MD 8/6/2009 MD 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 GA 8/6/2009 WA 8/6/2009 FL 8/6/2009 TX 8/6/2009 TX
62 60 78 87 35
62
72 65 68 0.4 60 69 36 66
72 65
65 94 55
65
78 87 35
0 69 66
84 71 82 57 62 76 50 72 60 0.5 65 61 38 76 58 56 60 44 13 5 67 28 0.3 48
71 82 57 76 72 60 65 38
60
67
48
F F M F M F M F F 0.4 F F F F M F F F M U U U M F U F M F F M F F M M F F F U F M F F F F F M F F M F U U
6/24/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initials and follow up information ha 7/30/2009 Initial and follow up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up formation has b 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
353659 353660 353661 353662 353663 353664 353665 353666 353667 353668 353669 353670 353671 353672 353673 353674 353675 353676 353677 353678 353679 353680 353681 353682 353683 353684 353685 353686 353687 353688 353689 353690 353695 353696 353697 353698 353699 353700 353701 353702 353703 353704 353705 353706 353707 353708 353709 353710 353711 353712 353713
8/6/2009 VA 8/6/2009 8/6/2009 OK 8/6/2009 NJ 8/6/2009 FL 8/6/2009 8/6/2009 OK 8/6/2009 OK 8/6/2009 8/6/2009 WV 8/6/2009 8/6/2009 WV 8/6/2009 WV 8/6/2009 8/6/2009 AR 8/6/2009 MI 8/6/2009 FL 8/6/2009 WV 8/6/2009 CA 8/6/2009 8/6/2009 8/6/2009 MO 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 TX 8/6/2009 TX 8/6/2009 OR 8/6/2009 TX 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 WA 8/6/2009 MA 8/6/2009 CA 8/6/2009 CA 8/6/2009 IA 8/6/2009 IA 8/6/2009 8/6/2009 MA
4
4
46 63 32
46 63
97 72
72
74 86 55
55
65 73 44 46 31 69 61
73 44 46 31 69
65 56 66 60 64
66 49 65 65
65 56 66 60
49
66 60 22 29 0.5 52 71 2 50
22 29 0
F F M F F F M F F U U M M F M M M M F F F F M F U F M F M M U U F F F F U F U M F F F 0.5 U U F U F F M U
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 IA 8/6/2009 CA 8/6/2009 WV 8/6/2009 WV 8/6/2009 8/6/2009 8/6/2009 KY 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 MI 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 NC 8/6/2009 MI 8/6/2009 CA 8/6/2009 MA 8/6/2009 8/6/2009 NC 8/6/2009 NC 8/6/2009 NC 8/6/2009 CA 8/6/2009 PA 8/6/2009 OR 8/6/2009 8/6/2009 NY 8/6/2009 NJ 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 GA 8/6/2009 MO 8/6/2009 CT 8/6/2009 WA 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 FL 8/6/2009 VA 8/6/2009 NY 8/6/2009 MS 8/6/2009 NJ 8/6/2009 NJ 8/6/2009 NJ 8/6/2009 NC 8/6/2009 NC
65 65
65
66 64 60 65 66
64
49 0.3 36 73
49
82 26 0.4 50 66 82 56 66 60 88 53 64
82 26
63 52 43 70 57
63 52 43 70 57
87 85 70 50 36 57 70
87 85
43
43
82 61 63
82 61
64
65 66
36 73
66 82 56 66 88
50 36 57 70
F F M M F M M F M M M F U M M M F F M M F F F F M F F F F F F F F F F F F F F F F F F F F M F M F F F
7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from
353851 353852 353853 353854 353855 353856 353857 353862 353863 353929 353931 353935 353937 353938 353939 353940 353941 353942 353943 353944 353945 353946 353947 353948 353949 353950 353951 353952 353953 353954 353955 353956 353957 353958 353959 353960 353961 353962 353963 353964 353965 353966 353967 353968 353969 353970 353971 353972 353973 353974 353975
8/6/2009 NY 8/6/2009 OH 8/6/2009 MN 8/6/2009 ME 8/6/2009 MN 8/6/2009 MN 8/6/2009 MS 8/6/2009 MS 8/6/2009 VA 8/6/2009 VA 8/6/2009 8/6/2009 MI 8/6/2009 TX 8/6/2009 LA 8/6/2009 FL 8/6/2009 WA 8/6/2009 WA 8/6/2009 NJ 8/6/2009 8/6/2009 WA 8/6/2009 IA 8/6/2009 NJ 8/6/2009 VA 8/6/2009 8/6/2009 CA 8/6/2009 UT 8/6/2009 UT 8/6/2009 8/6/2009 NY 8/6/2009 IL 8/6/2009 IN 8/6/2009 CA 8/6/2009 8/6/2009 CT 8/6/2009 CT 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 OH 8/6/2009 FL 8/6/2009 UT 8/6/2009 8/6/2009 8/6/2009 SD 8/6/2009 VA 8/6/2009 TX 8/6/2009 MO 8/6/2009 WI
48 66 61 67 65
48 66 61 67 65
60
66
66
55 65
65
66 50 75
66 50 75
60 51 70 53
60 51
69 69 20 81
69 69
65 76
65
53
81
65 50
63
63
M M F F F F M M F F U F U M F F F F F F F F F U F F F M F U F F F F F F M F F U F F M F F M F F F F F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has
353976 353977 353978 353979 353980 353981 353982 353983 353984 353985 353986 353987 353988 353989 353990 353991 353992 353993 353994 353995 353996 353997 353998 353999 354000 354001 354002 354003 354004 354005 354006 354007 354008 354009 354010 354011 354012 354013 354014 354015 354016 354018 354019 354020 354027 354028 354030 354031 354101 354102 354103
8/6/2009 ID 8/6/2009 8/6/2009 GA 8/6/2009 8/6/2009 TX 8/6/2009 WI 8/6/2009 8/6/2009 8/6/2009 IN 8/6/2009 IN 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 OR 8/6/2009 8/6/2009 8/6/2009 MI 8/6/2009 PA 8/6/2009 WI 8/6/2009 CA 8/6/2009 8/6/2009 NY 8/6/2009 CA 8/6/2009 FL 8/6/2009 OH 8/6/2009 8/6/2009 8/6/2009 8/6/2009 IL 8/6/2009 IL 8/6/2009 IL 8/6/2009 8/6/2009 NC 8/6/2009 8/6/2009 OH 8/6/2009 OH 8/6/2009 OH 8/6/2009 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 NY 8/6/2009 8/6/2009 VA 8/6/2009 VA 8/6/2009 NC 8/6/2009 AZ 8/6/2009 MD 8/6/2009 8/6/2009 MD 8/6/2009 NJ
63 76 59 20 52 63
63
67 65 70
67 65 70
59 20 52 63
65 53
53
73 72 13 0.2 60 46
73 72 13 0
86 63
86 63
59 71 0.5 53 35 62 70
70
30 65 84
65
7 6
7 6
67
37
37
F F F F F F F F F F F F U F F U F F M 0.2 U M F M M F U U M U U U F F F F F F F U F F F F F F U M M U M F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial information has been received 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial information has been received 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 This report was received from Sano 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354104 354105 354106 354107 354108 354109 354110 354111 354146 354147 354148 354149 354150 354151 354152 354153 354154 354155 354156 354157 354158 354159 354160 354161 354162 354163 354164 354165 354166 354167 354168 354169 354171 354172 354173 354174 354175 354176 354177 354178 354179 354180 354181 354182 354183 354184 354185 354186 354187 354188 354189
8/6/2009 8/6/2009 ID 8/6/2009 NJ 8/6/2009 CT 8/6/2009 ID 8/6/2009 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 VA 8/6/2009 VA 8/6/2009 CA 8/6/2009 WV 8/6/2009 8/6/2009 CT 8/6/2009 MI 8/6/2009 NJ 8/6/2009 FL 8/6/2009 MI 8/6/2009 ID 8/6/2009 CT 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 KS 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 MD 8/6/2009 OR 8/6/2009 MD 8/6/2009 GA 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 NH 8/6/2009 8/6/2009 8/6/2009 VA 8/6/2009 WI 8/6/2009 8/6/2009 TX 8/6/2009 8/6/2009 CT 8/6/2009 CA 8/6/2009 CA 8/6/2009 GA 8/6/2009 GA 8/6/2009
67 49 73 17 72 80 60 0.5 69 61 73 67 61
73
80
61 73 67 61
70 77 50 69 3
70 77 50 69 3
62 65 42 31
62 65 42 31
72 56 53 50 70 17 17 37
72 56
51 64
50 17 37
64
2
56 71 65 66 71
66 71
F F U F F F F F U U F M M F M M F F F F F M M M M F F U F U F F F F F F F M U U M F M U F M F M M F M
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354191 354192 354198 354199 354201 354204 354206 354207 354211 354212 354213 354214 354215 354216 354220 354221 354222 354223 354224 354225 354226 354227 354228 354229 354230 354231 354232 354233 354234 354238 354239 354240 354243 354244 354247 354249 354252 354254 354255 354256 354327 354328 354329 354330 354331 354332 354333 354334 354335 354336 354337
8/6/2009 MN 8/6/2009 FL 8/6/2009 CA 8/6/2009 8/6/2009 TX 8/6/2009 AZ 8/6/2009 8/6/2009 8/6/2009 8/6/2009 OK 8/6/2009 8/6/2009 8/6/2009 IL 8/6/2009 GA 8/6/2009 CA 8/6/2009 8/6/2009 CT 8/6/2009 CT 8/6/2009 CT 8/6/2009 CO 8/6/2009 TX 8/6/2009 8/6/2009 AZ 8/6/2009 NJ 8/6/2009 GA 8/6/2009 CO 8/6/2009 CA 8/6/2009 WA 8/6/2009 VA 8/6/2009 VA 8/6/2009 WA 8/6/2009 8/6/2009 KY 8/6/2009 8/6/2009 KY 8/6/2009 KY 8/6/2009 KY 8/6/2009 KY 8/6/2009 8/6/2009 8/6/2009 NJ 8/6/2009 VA 8/6/2009 CA 8/6/2009 NJ 8/6/2009 OR 8/6/2009 AZ 8/6/2009 MO 8/6/2009 MO 8/6/2009 MO 8/6/2009 CA 8/6/2009 AZ
70 52
70 52
53 52 52 43 57 74
53
54 75 71 50 58 51
54 75 71 50 58 51
1 66
1
66 83 67 71
66
1 55 62
1 55 62
2 60 2 41 79 68 81 53 65 80 79 74 69 80 75 32 65
67 71
60 41 79 68
79 74 69 80 75 32 65
F M F F F F F F F F M F F M F F M F M 0M M U F F F F M 0F M F F M M F M U F M F F F F F F F M F F F M U
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received by a 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 ID 8/6/2009 NC 8/6/2009 AZ 8/6/2009 CA 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 VA 8/6/2009 NM 8/6/2009 MN 8/6/2009 ID 8/6/2009 ID 8/6/2009 ID 8/6/2009 8/6/2009 IA 8/6/2009 OH 8/6/2009 8/6/2009 MD 8/6/2009 8/6/2009 FL 8/6/2009 FL 8/6/2009 NC 8/6/2009 DC 8/6/2009 VA 8/6/2009 IN 8/6/2009 TX 8/6/2009 TX 8/6/2009 TX 8/6/2009 TX 8/6/2009 8/6/2009 MN 8/6/2009 TX 8/6/2009 8/6/2009 AZ 8/6/2009 8/6/2009 NC
58 72 50 85 78 83 84 84 65 32 81 43 36 32 65 65 67 26 50
58
50 85 78 83 84 65 32 81 43 36 32 65 65
26 50
57 66 50 4
66
0.7 36 43
0 36 43
67 81 1 46 75
67 81 1 46 75
71
71
69 77 65 60 45
77 65
65
65
45
F M U F F F F M F M F M F F F M F F F F M M M M F F M F U 0.7 F F F U M F M 0M F U F M F F F F F M M M F M
7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received via N 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354693 354694 354695 354696 354697 354698 354699 354700 354701 354702 354703 354704 354705 354706 354707 354708 354709 354710 354711 354712 354713 354714 354715 354716 354717 354718 354719 354720 354721 354722 354723 354724 354725 354757 354758 354759 354760 354761 354762 354763 354764 354765 354766 354788 354789 354790 354822 354826 354827 354828 354829
8/6/2009 NV 8/6/2009 PA 8/6/2009 FL 8/6/2009 VA 8/6/2009 FL 8/6/2009 PA 8/6/2009 MA 8/6/2009 MO 8/6/2009 FL 8/6/2009 IL 8/6/2009 FL 8/6/2009 8/6/2009 IL 8/6/2009 NY 8/6/2009 NY 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 WV 8/6/2009 WV 8/6/2009 VA 8/6/2009 PA 8/6/2009 FL 8/6/2009 FL 8/6/2009 GA 8/6/2009 MO 8/6/2009 IN 8/6/2009 GA 8/6/2009 PA 8/6/2009 8/6/2009 PA 8/6/2009 PA 8/6/2009 RI 8/6/2009 8/6/2009 GA 8/6/2009 FL 8/6/2009 SC 8/6/2009 CA 8/6/2009 GA 8/6/2009 8/6/2009 MI 8/6/2009 FL 8/6/2009 NJ 8/6/2009 SC 8/6/2009 CA 8/6/2009 NY 8/6/2009 FL 8/6/2009 AZ 8/6/2009 PA 8/6/2009 OH
1.5 71 67 65 0.2
71 67 65
81 72 71
72 71
58 65 62 60
62 60
19 75 48 33 2 59 40 71 67
48 33 2 59 71 67
85 80 51
85 80 51
17 64 73 56
17 64 73
27 65 65 1 60 47 80 29 72 0.8
65 1 47 80 29 72 0
U F F F F F M M F F U M M M F M F F F F U F F F F 0.2 M F F M F M M F F U M F F M U F M F F 0F F M F F F 0.8 M
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/3/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 RI 8/6/2009 FL 8/6/2009 8/6/2009 SC 8/6/2009 KS 8/6/2009 TX 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 FL 8/6/2009 SC 8/6/2009 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 SC 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 SC 8/6/2009 ID 8/6/2009 8/6/2009 IN 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 CT 8/6/2009 SC 8/6/2009 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 OR 8/6/2009 8/7/2009 8/7/2009 OH 8/7/2009 MD 8/7/2009 FL 8/7/2009 GA 8/7/2009 NY 8/7/2009 NJ 8/7/2009 WI 8/7/2009 NC 8/7/2009 8/7/2009 CA
21 58 74 30 54 32 0.3 0.6 1 0.2 0.2 0.4 54 0.5
21 58 74 30 54 32 0 0 1 0 0 0 54 0
1
1
0.7 1
0 1
78 0.2 64 0
78 0
0.2 64 71 49 0.6
0 64 71 49 0
0.2 1 0.3 0.5 0.2 0.4 55
0 1 0 0 0 0
16 34 4 84 4 5 73 69 70 4
16 34 4 84 4 5 73 69
0
4
M F M F F F 0.3 M 0.6 F 0M 0.2 M 0.2 F 0.4 F F 0.5 F F 0M F U 0.7 M 0F F U F 0.2 F F 0M M 0.2 F F M F 0.6 M F 0.2 F 0F 0.3 F 0.5 M 0.2 M 0.4 F M M F M M F F F F F U F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 8/6/2009 Information has been received from 8/6/2009 Information has been received from 8/4/2009 Service member reports that in Jan 7/28/2009 Vaccine on the 10th, Left thigh into 8/3/2009 ZOSTAVAX administered 2/18/08. H 7/28/2009 None stated. 7/31/2009 Suspected seizure. Disoriented. Diff Pt. was given zoster vaccine 7/10/0 8/3/2009 Rash, small dots on neck 7/14/09 Shingle shot - 4 days later b 8/5/2009 (R) upper arm red warm to touch. B
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8/7/2009 WA 8/7/2009 WA 8/7/2009 IA 8/7/2009 KS 8/7/2009 8/7/2009 CO 8/7/2009 TX 8/7/2009 VA 8/7/2009 NE 8/7/2009 OH 8/7/2009 MI 8/7/2009 TX 8/7/2009 MD 8/7/2009 IL 8/7/2009 TX 8/7/2009 VA 8/7/2009 CA 8/7/2009 WI 8/7/2009 DC 8/7/2009 MI 8/7/2009 MA 8/7/2009 CA 8/7/2009 TX 8/7/2009 LA 8/7/2009 AZ 8/7/2009 NY 8/7/2009 TX 8/7/2009 PA 8/7/2009 MN 8/7/2009 PA 8/7/2009 CA 8/7/2009 IL 8/7/2009 CA 8/7/2009 DC 8/7/2009 DC 8/7/2009 TX 8/7/2009 CA 8/7/2009 TX 8/7/2009 OH 8/7/2009 CA 8/7/2009 AZ 8/7/2009 DC 8/7/2009 8/7/2009 WI 8/7/2009 LA 8/7/2009 GA 8/7/2009 MD 8/7/2009 MI 8/7/2009 NC 8/7/2009 NV 8/7/2009 TX
10 69 18 12 0.3
10 69 18 12 0
12 4 0.3 67 63 11 19 67 0.5 58 0.5 10 4 13 0.3 14 13 4 68 5 10 5 4 58 2 17
12 4 0 67 63
0.5 4 12 68 13 65 6 15 55 70 11 9 1.5 9 4 18 23 10
0 4 12 68 13 65 6 15 55
19 67 0 58 0 10 4 13 0 14 13 4 68 5 10 5 4 58 2 17
11 9 1 9 4 18 23 10
F F F F 0.3 M F M M 0.3 M F F U F F 0.5 M M 0.5 F M F F 0.3 F F F F F M M M M M 0.4 M F U 0.5 M F F F M F F F M F F M 0.5 M M F F M F
8/3/2009 Pt had TDAP vaccination in the (L) 7/16/2009 Dev a rash 6d after ZOSTAVAX inje 8/6/2009 Pt received immunizations at 0800 a 8/7/2009 103.0 fever the night of injection, he 8/7/2009 This case was Y reported by a healthc 8/7/2009 This case was reported by a physici 8/7/2009 Surrounding erythema and swelling 8/7/2009 VARIVAX given 8/5/09 - 48hrs later 8/7/2009 (L) upper thigh dime size red swolle 8/7/2009 Received ZOSTAVAX on Friday, Ju 8/7/2009 Fever developed day of immunisatio Redness at the site of injection. Ant 7/15/2009 Initial report received on 14 July 200 8/8/2009 Mild headaches all day long. 8/8/2009 Stridor and bronchospasm gave Ra 8/7/2009 Patient had some arm swelling that 8/7/2009 7 AM red face, trouble breathing 3 P 8/8/2009 Pt fainted after receiving BOOSTRIX 8/6/2009 Live vaccine administered less than 7/29/2009 This report was received from a hea 8/7/2009 Lethargy and poor feeding in the 1s 8/5/2009 Four days after vaccines (8/4/09), te 8/7/2009 Tenderness, inflammation, runny no 8/6/2009 Erythema to L deltoid with edema n 8/7/2009 Swollen left arm- inflammation and t 8/6/2009 Patient had cough and shortness of 8/6/2009 2 inch by 4 inch erythematous on (L 8/5/2009 Left lateral thigh SC with 3 inch in d 8/5/2009 Multiple large masses of lymph nod 8/5/2009 Localized redness and swelling at in 8/7/2009 Left leg upper medial side swollen, 8/6/2009 Received Hepatitis A #1 vaccine on Noted to have maculopapular rash 1 8/6/2009 3rd Hepatitis B administered 7 week 8/6/2009 Live vaccines administered less tha 8/7/2009 5 X 8 cm erythema at site of VARIV 8/5/2009 Pt. given VARIVAX instead of ZOST 8/4/2009 5 X 8 erythema at site of VARIVAX 8/7/2009 Local skin reaction with warmth, dis 8/6/2009 L arm red in area vaccinated not wa Presyncope, Hypotension, diaphore 8/4/2009 55 year old staff physician, active du 7/30/2009 Information has been received from 7/31/2009 Noticed round red spot size of a bas 8/3/2009 (L) leg (pt seen @ urgent care) 2" d 7/30/2009 Patient developed redness and swe 8/7/2009 Vaccine given 8/4/09; Seen on 8/6/ 8/7/2009 2" x 3" raised erythema on L thigh, s 8/7/2009 AFTER RECEIVING VACCINES, C 8/7/2009 Red, itchy rash on trunk, shest, and 7/30/2009 Patient had syncope ~ 10 min after
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8/7/2009 CA 8/7/2009 PA 8/7/2009 IN 8/7/2009 WA 8/7/2009 IL 8/7/2009 MT 8/7/2009 PA 8/7/2009 PA 8/7/2009 MD 8/7/2009 MN 8/7/2009 MA 8/7/2009 PA 8/7/2009 MA 8/7/2009 PA 8/7/2009 PA 8/7/2009 MO 8/7/2009 NC 8/7/2009 MI 8/7/2009 CA 8/7/2009 MI 8/7/2009 FL 8/7/2009 KS 8/7/2009 TN 8/7/2009 CA 8/7/2009 WA 8/7/2009 VA 8/7/2009 NC 8/7/2009 NY 8/7/2009 NY 8/7/2009 MD 8/7/2009 GA 8/7/2009 GA 8/7/2009 8/7/2009 8/7/2009 MN 8/8/2009 MO 8/8/2009 MI 8/8/2009 MA 8/8/2009 AL 8/8/2009 CA 8/8/2009 MA 8/8/2009 CA 8/8/2009 CA 8/9/2009 PA 8/9/2009 CA 8/9/2009 NY 8/10/2009 MI 8/10/2009 CA 8/10/2009 TX 8/10/2009 MI 8/10/2009 AL
60 19 72 46 14 64 55 55 54 66 0.5 55 1 54 56 1 12 56 1.3 5 35 12 67 67 70 0.2 0.3 0.2 0.3 0.2 0.1 0.3 5 14 0.2 0.6 24 4 20 72 1.3 0 2 15 14 1.3 19 18
60 20 72 46 14 64
0 1
1 12 56 1 41 5 35 65 12 67 67 70 0 0 0
0 5 14 0 0 24 4 20 72 1 2 15 14 1 18
F F F F F F U U U U 0.5 M U 0M U U 0M F M 0.3 M F F F F F F F F F 0.2 F 0.3 F 0.2 F F F F 0.3 M F F 0.2 F 0.6 M M M F M M 0F 0.1 M F F 0.3 F F F
8/7/2009 7/29/09 TDaP placed in Travel Clini 8/7/2009 Patient received Tdap on 07-31-09. 8/7/2009 Patient reported that she received Z 8/7/2009 First injection of Engerix B: 04/17/02 8/7/2009 Child received Menactra 8/6/2009am 8/7/2009 First, dizziness and diarrhea. Later, 8/7/2009 subject in pneumococcal vaccine tri 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Received 6 mo immunizations on 7/ 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Recieved Prevnar on 7/28/09, on 7/ 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 High fever ranging from 101.5-104 d 8/7/2009 Patient received Tdap. Approximat 8/7/2009 12 hours after injection, arm becam 8/7/2009 6.5cmX6.0cm erythematous indurat 8/7/2009 24 hours after receiving Tdap client 8/7/2009 Cellulitis around injection site. Hive 8/7/2009 Fever 102.5, headache, chills, naus 8/7/2009 pt said she had a reaction, it was th 8/7/2009 fainted as leaving clinic after receivi 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 8/5/2009 This case was reported by a healthc 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a consum 8/5/2009 This case was reported by a consum 8/5/2009 This case was reported by a healthc 8/8/2009 Destiny had fevers of 102 for 3 days 8/8/2009 Stomach hurt, body red and itchy, m 8/8/2009 Dramatic irritability several hours aft 8/8/2009 he receved vaccination on a friday a 8/8/2009 Sweating, chills, headache, head c 8/8/2009 Limping, favoring right leg. Limitatio 8/8/2009 Tingling and numbness in both hand 8/8/2009 PER PATIENT'S FAMILY, PATIENT 8/9/2009 fever, seizure x2 8/9/2009 After first vaccination (Hepatitis B) 8/9/2009 On August 6, 2009 my son recieved 8/7/2009 Client received 1st GARDASIL and 8/6/2009 Pt was nervous prior to receiving va 8/9/2009 she has developed hives all over he 8/7/2009 Information has been received from 8/7/2009 Information have been received from
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8/10/2009 8/10/2009 KS 8/10/2009 IL 8/10/2009 TX 8/10/2009 8/10/2009 8/10/2009 NY 8/10/2009 WA 8/10/2009 OH 8/10/2009 OH 8/10/2009 FL 8/10/2009 AZ 8/10/2009 TX 8/10/2009 TX 8/10/2009 FL 8/10/2009 AK 8/10/2009 VA 8/10/2009 OK 8/10/2009 NC 8/10/2009 IA 8/10/2009 WI 8/10/2009 GA 8/10/2009 NC 8/10/2009 CA 8/10/2009 IL 8/10/2009 GA 8/10/2009 CA 8/10/2009 NC 8/10/2009 IN 8/10/2009 KS 8/10/2009 LA 8/10/2009 AZ 8/10/2009 OH 8/10/2009 NC 8/10/2009 8/10/2009 8/10/2009 TX 8/10/2009 TX 8/10/2009 MD 8/10/2009 NY 8/10/2009 8/10/2009 SC 8/10/2009 MO 8/10/2009 TX 8/10/2009 KS 8/10/2009 SD 8/10/2009 IL 8/10/2009 CA 8/10/2009 CA 8/10/2009 WA 8/10/2009 WA
17 17 18 62 73 72
17 18 62 72
32 5 5 4 1 0.5 57 1.2 74 14 1.1 1.4 17 73 27 18 37 5 11 15 80 11 16 4 0.3 11 10 12
32
11 11 30 11
11 11 30 11
51 18 14 15 12 5 4 0.3 7 1.5
51 18 14 15 12 5 4 0 7 1
4 1 0 57 1 74 14 1 1 17 73 27 18 37 5 11 15 80 11 16 4 0 11 10
F F F F F M F F U U F 0F 0.5 F F 0.2 F F F 0.1 M 0.4 M M F F M F M F F F U F M 0.3 F F F F U F F F F M F F M F F M F 0.3 M F 0.5 M
8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received for th 8/6/2009 Initial report received on 29 July 200 8/6/2009 Initial report received on 29 July 200 8/3/2009 Following administration of DTaP-IP 5/28/2009 Upper lip swelling 3 hour after Immu 7/23/2009 None Stated 3/10/2009 After immunization, patient develop 8/3/2009 Temp on & off X 4 days, rash on ba 8/4/2009 Pt reported 35 days post vaccinatio 8/4/2009 14 yo female fainted for seconds an 8/3/2009 VARICELLA lesions erupted 8/3/09 8/4/2009 Erythema multiforme skin RXN. 8/4/2009 8/3/09 Mother phoned at approx. 3: 8/5/2009 Headache - Induration at site of inje 8/3/2009 Patient reports pain at injection site 8/15/2009 Headache, neck, back pain, nausea 8/3/2009 Site was reddened warm to touch, & Left leg swelling, left arm bumps. Client received MCV4 on 8/4/09 in l Patient fainted and fell to the floor, s 8/5/2009 Pt received ZOSTAVAX on 7/16/09 Vaccines given on Aug. 4, 2009, we 8/6/2009 Arm pain followed by tingling in the 8/6/2009 Red, swollen upper/forearm, warmth 8/5/2009 Fever, hives 7/27 went to ER CXR N 8/7/2009 8x9mm area of redness, warm to to 8/4/2009 Pt fainted with assistance to floor. P 8/5/2009 My daughter received her 1st dose Fatigue, achy muscles, fever warmt 8/7/2009 Reddened/ raised area. Warm to to 8/7/2009 Pt developed nausea, paleness, dia 2-3 days mild itchy scattered pruritic 8/10/2009 Injection site red and swollen - Advi Developed diffuse macular rash and 8/10/2009 SC DAY AFTER VACCINES- FATIG 8/10/2009 Mom reports that Friday (8/7/09)eve 8/10/2009 Patient had just received Tdap, Hep 8/10/2009 Pt presents to HD 08/10/09 @ 800a 8/10/2009 No contraindications to vaccine on s 8/10/2009 Swollen left arm-deltoid area-was se 8/10/2009 PT GIVEN IPV AND MMR RIGHT A 8/10/2009 Persistent high pitched crying x 3 da 8/10/2009 Localized swelling measuring 3.5 in 8/10/2009 Localized redness measuring 6.5 in
353605 353606 353607 353608 353609 353610 353611 353612 353613 353614 353615 353616 353617 353618 353619 353620 353624 353625 353626 353627 353628 353629 353630 353631 353632 353633 353634 353635 353636 353637 353638 353639 353640 353641 353642 353643 353644 353645 353646 353647 353648 353649 353650 353692 353693 353731 353732 353734 353736 353738 353740
8/10/2009 DE 8/10/2009 AK 8/10/2009 MO 8/10/2009 TN 8/10/2009 PA 8/10/2009 CA 8/10/2009 WI 8/10/2009 CA 8/10/2009 MS 8/10/2009 WI 8/10/2009 OH 8/10/2009 SD 8/10/2009 CA 8/10/2009 WA 8/10/2009 LA 8/10/2009 8/10/2009 TX 8/10/2009 KS 8/10/2009 NC 8/10/2009 KS 8/10/2009 KS 8/10/2009 NJ 8/10/2009 AZ 8/10/2009 CA 8/10/2009 WA 8/10/2009 MN 8/10/2009 TN 8/10/2009 TN 8/10/2009 MD 8/10/2009 MD 8/10/2009 OR 8/10/2009 8/10/2009 TX 8/10/2009 MA 8/10/2009 CA 8/10/2009 GA 8/10/2009 NV 8/10/2009 MO 8/10/2009 GA 8/10/2009 CT 8/10/2009 NE 8/10/2009 NC 8/10/2009 TX 8/11/2009 8/11/2009 KS 8/11/2009 TN 8/11/2009 TN 8/11/2009 CA 8/11/2009 NE 8/11/2009 PA 8/11/2009 MS
44 11 14 25 11 61 24 0.2 37 1 16 11 1.3 25 4
44 11 14 25 11 61 24 0 37 1 16 11 1 25 4
20 18 20 19 0.4 20 0.3 4 19 5 4 5 4 65 2 2 8 69 14 7 4 1.5 9 7 39 7 8
20 18 20 19 0 20 0 4 19 5 4 5 4 65 1 1 8
0.2 17 2 1.6 26 4 4
0 17 2 1 26 4 4
14 7 4 1 9 7 39 7 8
F M M F F F F 0.2 F F 0F F M 0.3 F F F F F M M F 0.4 M F 0.3 F F M F F M F F 1M 1M M F F M F 0.5 M F M F M M F 0.2 M M 0.1 M 0.6 M F F M
8/10/2009 States 12-14 hours after immunizati 8/10/2009 2.5 inch raised red welt formed the 8/10/2009 Several minutes after shots were giv 8/10/2009 Approx. 2 days after the vaccine wa 8/10/2009 Received Gardasil dose #2. Walked 8/10/2009 Shingles vaccination Zostevax rece 8/10/2009 Vaccine administered May22, 2009 8/10/2009 Non stop crying for more than 4 hou 8/10/2009 chills, dizziness, difficulty breathing, 8/10/2009 Varicella vaccine administered on 7 8/10/2009 Immediately following HPV#2 and V 8/10/2009 Developed papular rash over entire 8/10/2009 left thigh with mild erythema, 3cm w 8/10/2009 Received vaccines on 07/29/09, Va 8/10/2009 c/o Rash for 3 days left side around 8/10/2009 This case was reported by a lawyer 8/6/2009 Severe erythema, warmth, tenderne 8/10/2009 Pain left arm, armpit, down side from 8/10/2009 20 y/o AA male ADSM/Specialist is 8/10/2009 08/09/2009 Mild, other. Redness. 3 7/28/2009 Inj. site top R thigh covered by band 8/10/2009 Syncope. Bradycardia - pulse < 40. 7/27/2009 Vaccines given 7/20 including ROTA 8/7/2009 On 8/5/09 pt rec'd KINRIX on L arm 6/17/2009 Per clinical notes: 19 y/o male who 8/10/2009 5 yo with onset of LE and buttock pu 8/10/2009 Gave pt vaccine in R DM. approxim 8/10/2009 Approx dime sized induration, quart 8/6/2009 Local red indurated area @ site of v 10 days post vaccine increase itchy 8/3/2009 Mother described red swollen extrem 8/3/2009 Red, warm, swollen extremity where 7/31/2009 Had HA and was nauseated 7/29 ev 8/3/2009 Received pneumococcal vaccine in 7/27/2009 6-10-09 at 5 PM lips started swelling 8/4/2009 Pt had urticaria, and extreme erythe 7/31/2009 Mom reports swelling & redness in r 8/5/2009 An 18 cm X 14 cm red, warm to tou 8/4/2009 Varicella vaccine administered with Facial and nasal swelling, throat cle 8/5/2009 Very painful. States on 7/2 her Lt. a 8/5/2009 Within 24 hours the pt. developed e 8/7/2009 Swelling, redness, warmth @ site o 8/10/2009 Information has been received from 8/10/2009 Information has been received from Pt. committed Y suicide on 8-3-09. 9/2 8/4/2009 Wheezing - admitted 7/31/09 for 24 8/4/2009 5/15/9 - MMR given with Hep A, Hib 6/17/2009 Pt had taken an MMR vaccine 2 day 8/6/2009 A LU arm slightly red and tender. 8/1/2009 Fever and shaking chills X 16-17 hr
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8/11/2009 CA 8/11/2009 AZ 8/11/2009 IN 8/11/2009 IN 8/11/2009 PA 8/11/2009 HI 8/11/2009 HI 8/11/2009 DE 8/11/2009 MI 8/11/2009 VA 8/11/2009 TX 8/11/2009 OH 8/11/2009 OH 8/11/2009 NY 8/11/2009 KY 8/11/2009 UT 8/11/2009 TX 8/11/2009 IN 8/11/2009 KY 8/11/2009 TN 8/11/2009 NC 8/11/2009 NC 8/11/2009 8/11/2009 MS 8/11/2009 NY 8/11/2009 8/11/2009 CO 8/11/2009 KY 8/11/2009 MS 8/11/2009 MI 8/11/2009 CA 8/11/2009 WI 8/11/2009 DE 8/11/2009 IN 8/11/2009 MI 8/11/2009 MI 8/11/2009 IN 8/11/2009 IA 8/11/2009 PA 8/11/2009 OH 8/11/2009 CA 8/11/2009 KY 8/11/2009 MI 8/11/2009 NC 8/11/2009 WA 8/11/2009 OH 8/11/2009 CA 8/11/2009 MN 8/11/2009 MA 8/11/2009 MT 8/11/2009 CA
0.4 5 16 5 59 66 64 22 15 11 14 13 13 19 11 12 15 15 4 18 18 10 0.2 73 5 9 5 1 36 4 3 29 25 12 69 4 5 0.5 20 0.2 2 24 51 26 1 24 17 5 18 5 24
0 5 16 5 59 66 64 -1 15 11 14 13 13 19 11 12 15 15 4 18 18 10 73 5 9 5 1 36 4 3 29 25 12 69 4 5 0 20 0 2 24 51 26 1 24 17 5 18 5 24
0.4 M F F F M F M 0.9 F F M F M F M F F F F M M F M M F F M M 0M F F F F U F F M M 0.5 F F 0.2 F 0.7 M F M F 0F F F F F F U
8/7/2009 Pt. had vaccine on 7/31/09 in late a 8/6/2009 Left arm swollen, tight 24 hours. 8/3/2009 C/o fainting 8/5/2009 20 minutes post immunizations pt.'s Servere left hip pain at injection site reddened area (4 cm X 6 cm) below 8/5/2009 Redness and slight swelling below a 7/30/2009 Seen @ Sick call with headache aft 8/6/2009 Left health department, in car-driven 8/6/2009 Seizure within 2-3 minutes after give 8/4/2009 On 08/04/09 approx 10:10 AM vacc 8/5/2009 Developed "tiny red bumps" on arm 7/30/2009 Syncope, vomiting, grey skin tone. S 8/5/2009 Fever to 101 degrees F, myalgias, c 8/5/2009 About 24 hrs after receiving vaccine 8/10/2009 Polyarthralgias, rash 24 hours post 8/11/2009 Pt developed marked redness and s 8/11/2009 Body aches, fatigue, blisters inside 8/11/2009 R arm swollen, red, hot over entire a 7/28/2009 Received MENACTRA 7/24/09. Felt 8/10/2009 Severe diarrhea w/in 48 hrs. of 3rd 8/3/2009 Pt received HEP A & VARIVAX on 7 7/31/2009 Severe crying episode lasting > one 8/5/2009 On 7/27/09, Pt. was administered te 7/15/2009 Edema & mild erythema of injection 8/6/2009 Pt presented to clinic today one day 8/5/2009 Pt. developed large red area around 8/6/2009 5/24 developed fever 103.4 given A 8/5/2009 (Left arm) swelling, redness, itching 8/1/2009 Redness around injection site. Swe 8/6/2009 On 8/6/09, Pt was brought in by her 7/27/2007 1115 immediately c/o light headedn Anthrax vaccine administered Frida 8/11/2009 About 10-15 minutes after receiving 8/11/2009 11x11" R deltoid, 7x7" distal, increa 8/11/2009 Swollen, hot and red on anterior left 8/11/2009 Mother noted redness, swelling, and 8/11/2009 Patient was given vaccines in AM a 8/11/2009 had 2 episodes of numbness and tin 8/11/2009 7/29/09 - 2Pm Shots. Fever - mid. 8/11/2009 Fever to 103, tachycardia, flushing o 8/11/2009 C/o itching on arms and legs. Fine r 8/11/2009 Generalized body aches, elevated t 8/11/2009 Induration and erythema at the injec 8/11/2009 Fevers to 104.8 starting ~36 hours a 8/11/2009 Spoke to patient. States had pain rig 8/11/2009 Pt received HPV4 vaccine injection 8/11/2009 Pt was given kindergarden immuniz 8/11/2009 Two episodes of malaise, headache 8/11/2009 rt arm red and very warm to touch. s 8/11/2009 Arrythmia, Rapid Heart Rate, Exces
353795 353796 353797 353801 353803 353804 353805 353806 353807 353808 353809 353810 353811 353812 353813 353814 353815 353816 353817 353818 353819 353820 353821 353798 353799 353800 353858 353859 353860 353861 353870 353872 353879 353880 353881 353882 353883 353884 353885 353886 353887 353888 353889 353890 353891 353892 353893 353894 353895 353896 353897
8/11/2009 AZ 8/11/2009 FL 8/11/2009 TX 8/11/2009 TX 8/11/2009 CO 8/11/2009 CA 8/11/2009 KS 8/11/2009 CO 8/11/2009 IA 8/11/2009 IA 8/11/2009 NC 8/11/2009 NY 8/11/2009 TX 8/11/2009 MD 8/11/2009 NE 8/11/2009 CA 8/11/2009 VA 8/11/2009 VA 8/11/2009 CA 8/11/2009 FL 8/11/2009 OH 8/11/2009 GA 8/11/2009 CA 8/12/2009 TN 8/12/2009 AZ 8/12/2009 FL 8/12/2009 MI 8/12/2009 8/12/2009 TX 8/12/2009 MO 8/12/2009 8/12/2009 8/12/2009 SC 8/12/2009 LA 8/12/2009 AZ 8/12/2009 NC 8/12/2009 GA 8/12/2009 NC 8/12/2009 AZ 8/12/2009 TX 8/12/2009 TX 8/12/2009 CO 8/12/2009 TX 8/12/2009 MI 8/12/2009 MI 8/12/2009 MI 8/12/2009 MI 8/12/2009 TX 8/12/2009 MI 8/12/2009 PA 8/12/2009 TX
51 1.4 15 0.5 21 4 60 11 79 67 5 1.4 3 16 27 4 2 69 73 70 1.6 9 4 11 59 0.9 28 57 36 17 14
51 1 15 0 21 4 60 11 79 67 5 1 3 16 27 4 2 69 73 70 1 9 4 11 59 0 28 57 36 17 14
12 1.1 4 13 0.9 18 4 0.4 61 14 1.3 30 51 82 76 18 0.3 67 4
12 1 4 13 0 18 4 0 61 14 1 30 51 82 76 19 0 67 4
F 0.4 F F 0.5 F F F F M F F M 0.4 F M M F M 0.6 F F F M 0.6 F F F F M 0.9 F F F M F F U U 0.1 M M M 0.9 M F F 0.4 M F M 0.3 M F F F M F 0.4 M F F
8/11/2009 received hepatitis B vaccine at emp 8/11/2009 8th and 9th day after shot patient ra 8/11/2009 APPROX 3-4 MIN AFTER ADMINIS 8/10/2009 Vomiting. Bile stained. Abdominal 7/29/2009 A couple of hours after 1st shot, my 8/10/2009 4 1/2 X 4 cm left arm swollen with re 8/11/2009 "3 days after vaccination pt develop 7/29/2009 Approximately 24 hours after receiv 8/11/2009 Injection site reaction- 1/2 dollar size 8/10/2009 Injection site reaction - 2.5 inch diam 8/11/2009 Pt had erythema of head, chest, arm 8/16/2009 Within 10-15 min's developed hives 8/11/2009 Given R upper lat leg - VARIVAX - 4 8/6/2009 Localized erythema/induration w/ sp 8/5/2009 Received 7/31/09- R. arm hives tha 8/4/2009 Erythematous, indurated are 4.5 x 4 8/6/2009 Patient started coughing, wheezing, 8/10/2009 5 X 7 erythematous swelling of the l 8/11/2009 Localized redness at injection site. 8/10/2009 Localized edema/erythema. 8/11/2009 - Pt developed swelling of and eryth 7/27/2009 Approximately 5 minutes after vacci 8/11/2009 Pt. rev'd 3 vaccines on left arm (DTA 8/12/2009 Severe pain at injection sight in left 8/11/2009 I had a flu vaccine on 10-18-26 on t 8/12/2009 Red un-raised splotches appeared o 8/12/2009 no fever, but pain from the shoulder 8/12/2009 LEFT DELTOID 6 X 8 CM OF ERYT 8/12/2009 Received Varicella vaccine on June 8/5/2009 15-20 minutes after injection client e 8/11/2009 Information has been received from 8/11/2009 Information has been received from 8/12/2009 Fever 102, dizzy, nausea weak nex 8/12/2009 Pt presented to clinic on 8/11/09 wit 8/10/2009 Pt had diffuse swelling/redness of (L 7/31/2009 Severe headache and low grade tem 8/6/2009 1) Approximately 2.5 + 2.0 erythema 8/7/2009 Tdap given before realizing patient Patient given 4 go shots (DTAP, IPV 7/31/2009 Swelling to injection sites 2 1/2 cm. Went to eye doctor = pt thought she 8/6/2009 Arm red, swollen, warm to touch. Sk 7/31/2009 Increase swelling thigh - 10 cm swe 8/4/2009 A cluster of four patients (patient ide 7/20/2009 A cluster of four patients (patient ide 8/4/2009 This non serious case was received 7/20/2009 This non serious case was received 8/12/2009 Patient developed severe and longl 8/12/2009 Day after vaccines were given, pt w 8/12/2009 Pt received Zostavax on 08/10/09 a 8/12/2009 Parent states the child had "vomitin
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8/12/2009 MA 8/12/2009 TX 8/12/2009 TX 8/12/2009 TX 8/12/2009 TX 8/12/2009 AZ 8/12/2009 WI 8/12/2009 WA 8/12/2009 SC 8/12/2009 IA 8/12/2009 WA 8/12/2009 IL 8/12/2009 PA 8/12/2009 CA 8/12/2009 PA 8/12/2009 OH 8/12/2009 WA 8/12/2009 CA 8/12/2009 MO 8/12/2009 8/12/2009 GA 8/12/2009 CT 8/12/2009 GA 8/12/2009 PA 8/12/2009 VA 8/12/2009 CA 8/12/2009 CA 8/12/2009 NC 8/12/2009 AK 8/12/2009 TX 8/12/2009 CO 8/13/2009 MI 8/13/2009 TN 8/13/2009 8/13/2009 8/13/2009 MN 8/13/2009 AZ 8/13/2009 MO 8/13/2009 NJ 8/13/2009 UT 8/13/2009 KS 8/13/2009 PA 8/13/2009 PA 8/13/2009 PA 8/13/2009 PA 8/13/2009 AL 8/13/2009 PA 8/13/2009 PA 8/13/2009 AL 8/13/2009 WA 8/13/2009 TN
0.2 0.5 16 15 12 9 61 5 22 17 13 11 4 16 83 15 1 5 5 21 5 60 2 5 4 28 4 8 9 1.8 24 24 14 22 23 37
0 0 16 15 12 9 61 5 22 17 13 11 4 16 83 15 0 5 5 21 5 60 2 5 4 28 4 8 9 1 24 24 14
0.5 16 12 15 15 5 11 2 10 1.5 1.5 13 4 5
0 16
37
15 15 5 11 2 10 1 1 13 4 5
0.2 F 0.5 F F M F M F M F F F F M F F F 1M F M F F F 0.4 F F F F F F F 0.8 F F F F F F F F 0.5 M F F M F M F 0.4 F F 0.5 F 0.5 F F F M
8/12/2009 According to parents child had decr 8/12/2009 Patient with symptoms c/w partial se 8/6/2009 Maryan rec'd 6 immunizations here 8/6/2009 Pt rec'd 6 immunizations. Waiting fo 8/4/2009 Welps on arms, trunk, back, neck 8/12/2009 Redness, swelling at injection site, e 8/12/2009 Pt was given Zostavax to LUE on 08 8/12/2009 Onset of low-grade fever (100.2 ora 8/12/2009 Fever of 100.0,joint pain, body ache 8/12/2009 Patient was sent to the nurses statio 8/12/2009 Patient passed out about 5 minutes 8/12/2009 Patient experienced vomitting appro 8/12/2009 PATIENT WOKE UP LAST NIGHT, 8/12/2009 PT WAS GIVEN AN EXTRA IPV NA 8/12/2009 3 days after receiving Zostavax pati 8/12/2009 Pt became shaky and nauseuos wit 8/12/2009 Febrile Seizure 8-11-09 Seen in ER 8/12/2009 pt presented 2 days post vaccinatio 8/12/2009 The area is very red and swollen. It 8/12/2009 This case was reported by a physici 8/11/2009 Pt c/o acute abdominal pain then sy 8/13/2009 Swelling pain at site of vaccine 8/6/0 8/12/2009 After receiving 4 mos. vaccines child 8/12/2009 Pt's mother, called this RN at 12:15 8/12/2009 Pt had redness; Itching and warmth 8/12/2009 Rash / Urticaria appears 2 days afte 8/12/2009 Swollen injection site with vesicles, 8/10/2009 Left thigh @ injection site by day 2 a Varicella administered R upper arm 8/12/2009 Rash and lump to site fever 103.4. 8/12/2009 Pt received DTaP left deltoid at hos 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/11/2009 This case was received from a heal 8/11/2009 Initial report received on 07 August 8/12/2009 Intussusception. Vaccine give 7/22/ 8/5/2009 Vaccine was administered, patient b 8/11/2009 Approximately 20 seconds after the 7/30/2009 Pt. passed out in lobby after receivin 8/13/2009 Pt acquired PCR positive for pertuss 8/13/2009 Patient acquired pertussis (positive 8/13/2009 Pt developed pertussis (PCR positiv 8/13/2009 Patient acquired pertussis and was 8/13/2009 Approximately 5 minutes after inject 8/13/2009 Pt acquired pertussis and was PCR 8/13/2009 Patient acquired PCR positive pertu 8/13/2009 Approximately 5 minutes after recei 8/13/2009 Irritation at site of injection (right sho 8/13/2009 Mother of patient reported some sw
354051 354052 354053 354054 354055 354056 354057 354058 354059 354075 354076 354077 354078 354080 354081 354082 354083 354084 354085 354086 354087 354088 354090 354091 354092 354093 354094 354095 354096 354097 354098 354099 354100 354112 354113 354114 354115 354116 354117 354118 354119 354120 354121 354122 354123 354124 354125 354126 354127 354128 354129
8/13/2009 WI 8/13/2009 VA 8/13/2009 FL 8/13/2009 MN 8/13/2009 TN 8/13/2009 MD 8/13/2009 FL 8/13/2009 PA 8/13/2009 IL 8/13/2009 IL 8/13/2009 OH 8/13/2009 IA 8/13/2009 CA 8/13/2009 WA 8/13/2009 8/13/2009 8/13/2009 8/13/2009 PA 8/13/2009 TN 8/13/2009 NC 8/13/2009 MN 8/13/2009 VA 8/13/2009 8/13/2009 AZ 8/13/2009 MN 8/13/2009 NC 8/13/2009 NV 8/13/2009 CO 8/13/2009 FL 8/13/2009 CA 8/13/2009 NC 8/13/2009 NC 8/13/2009 CA 8/13/2009 AZ 8/13/2009 NH 8/13/2009 FL 8/13/2009 MI 8/13/2009 AL 8/13/2009 TX 8/13/2009 WI 8/13/2009 WA 8/13/2009 SD 8/13/2009 CA 8/13/2009 TX 8/13/2009 TX 8/13/2009 NY 8/13/2009 CA 8/13/2009 WI 8/13/2009 NE 8/13/2009 WI 8/13/2009 NH
64 21 4 0.3 5 69 16 11 14 4 5 39 1.3 65 5 16 13 11 26 66 3 5 9 17 1.3 62 14 4 4 8 5 11 21 22 19 4 10 72 23 0.4 74 4 12 0.4 5 12 11 11
64 21 5 0 5 69 16 11 14 4 5 5 39 1 65 74 5 16 13 11 26 66 3 5 17 1 62 14 4 4 8 5 11 21 22 19 4 11 72 23 0 74 4 12 0 5 12 11 11
F F F 0.3 F F M F M M M F F F 0.3 M F F M U F F F F F F M F 0.3 M F F F F F F M F F F F F M F 0.4 F M F F 0.4 M M F M F F
8/12/2009 Pt developed shingles 8/12/09. 8/5/2009 Patient reported to us on 8/5/09. Sh 8/13/2009 R arm. Site of injection became hard 8/7/2009 Vaccinated 8/5/09. Projectile vomitin 8/7/2009 Red, raised area on left upper thigh 8/9/2009 4 days after admin - diffuse trunk pa 7/23/2009 Patient experienced dizziness and n Vomiting, high fever (104 Rectal), h 8/4/2009 Received Tdap & Varicella L arm 7/ 8/6/2009 Left leg 4" diameter erythema with m 8/10/2009 L arm site. Mother called Health De 8/10/2009 Immunizations listed below given in 8/7/2009 Patient came in on 7/27/09 c/o sore 8/7/2009 6-0.5-1 mm red papules with surrou 8/8/2009 I had the ZOSTAVAX injection at a 8/8/2009 I received the ZOSTAVAX on April 1 5/3/2006 About 24 hours after DTaP + IPU gi 8/13/2009 pt had headace and stomache slef r 8/13/2009 Patient received 4 immunizations on 8/13/2009 Fever to Tmax of 103, soft tissue sw 8/13/2009 Pt described feeling lousy, muscle a 8/13/2009 reddish rash and swelling, similar to 7/23/2009 Redness, swelling, cool compress. 7/23/2009 Redness & swelling of arm. Cool co 8/11/2009 Developed a 4x4 in erythematous, w 8/6/2009 1st dose of HEP A gave pt. "severe 7/31/2009 PCV 7 #4 vaccine given @ 12 mont 8/10/2009 High fever, accelerated heart rate, m 8/12/2009 Patient became very dizzy, nauseou 8/12/2009 Pt mother called health center on 88/13/2009 Injection site reaction- erythema, wa 8/14/2009 Varicella vaccine given in left arm a 8/12/2009 Pt given immunization and within fiv 8/13/2009 Pain, redness right upper arm. 8/13/2009 urticaria, throat scratchiness 8/13/2009 Blood work was done as a routine p 8/13/2009 Patient received third dose of series 8/13/2009 Hundres of lesions on body 8/13/2009 Received the following vaccinations 8/13/2009 08/13/2009 Caregiver noted a red a 8/13/2009 Pt was given Smallpox vaccine and 8/13/2009 2 days after 1-09 4 month shots of D 8/13/2009 Swollen Arm, Muscle Aches, 100 F 8/13/2009 Both legs swollen & red. Both arms swollen & red. 8/11/2009 Mom called office child screaming (u 8/13/2009 8/12/09 - Swelling of left arm where 7/28/2009 Loc for a few seconds body stiffene 8/13/2009 Hives on right arm, right leg and abd 8/13/2009 Pt felt lightheaded and was pale. 8/13/2009 Red, Raised, Warm, Size -->1.5 in d
354130 354131 354132 354133 354134 354135 354136 354137 354139 354140 354141 354143 354144 354145 354941 355008 355011 355104 355105 355106 355107 355108 355114 355115 355116 355117 355118 355119 355120 355121 355122 355123 355124 355125 355126 355127 355129 355151 355152 355153 355154 355155 355156 355157 355158 355159 355160 355161 355162 355163 355164
8/13/2009 MN 8/13/2009 NC 8/13/2009 KS 8/13/2009 SD 8/13/2009 MO 8/13/2009 MI 8/13/2009 WV 8/13/2009 MO 8/13/2009 TX 8/13/2009 CA 8/13/2009 GA 8/13/2009 CA 8/13/2009 8/13/2009 AZ 8/13/2009 CA 8/13/2009 NC 8/13/2009 MN 8/13/2009 CA 8/13/2009 8/13/2009 MI 8/13/2009 PA 8/13/2009 8/13/2009 8/13/2009 OH 8/13/2009 NY 8/13/2009 MD 8/13/2009 MO 8/13/2009 FL 8/13/2009 MN 8/13/2009 VA 8/13/2009 MD 8/13/2009 MD 8/13/2009 KY 8/13/2009 MN 8/13/2009 NY 8/13/2009 IL 8/13/2009 FL 8/13/2009 8/13/2009 TX 8/13/2009 PA 8/13/2009 IL 8/13/2009 MI 8/13/2009 MI 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 NC 8/13/2009 TX
12 1.2 1.2 33 1.9 13 18 0.5 10 8 10 1.8 34 1.5 4 4 9 5 14 31 7
12 1 1 33 1 13 18 0 10 10 1 34 1 4 9 5
13 52 27 7 6 5 12 40 5 31 5 11 5 5 9 8 9 5 7.5 19 18 21 26 21 22 5 7
27
40 5 5
8 5
M 0.2 M 0.2 M F 0.9 M M F 0.5 M F M M 0.8 M F 0.5 F M U M F F F M U M M M F M F F M M M F F M F M M F M M F M M M M F M F M F
8/13/2009 Local reaction: swelling, redness, w 8/13/2009 Varicella - low grade temp and red s 8/13/2009 8/12 3:40 PM- vomited - (crying sinc 7/22/2009 None 8/13/2009 Child received immunization 1 on 88/12/2009 R shoulder (trapezius muscle) enlar 8/13/2009 Immediately following HPV injection 8/13/2009 Parent brought pt into clinic on 7/24 8/13/2009 Both legs swollen & red. 8/13/2009 Patient came in with ~24 hr history o 8/10/2009 Blisters around injection site swellin 8/13/2009 08/12/09 Pt returned with reddened 8/11/2009 This 42 year old USAF services me 8/11/2009 Diagnosed with R OM 7/22/09, put o 9/5/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A serious labeled spontaneous repo ### A non-serious report of expired dos 8/11/2008 A non-serious spontaneous report o 8/20/2008 A non-serious spontaneous report o 8/21/2008 A non-serious spontaneous report o 8/22/2008 A non-serious spontaneous report o 8/22/2008 A non-serious spontaneous report o 9/3/2008 A non-serious spontaneous report o 9/29/2008 A non-serious spontaneous report o 9/30/2008 A non-serious spontaneous report o 3/24/2009 A non-serious spontaneous report o 9/11/2008 A non-serious spontaneous report o 9/19/2008 A Non - serious spontaneous report 9/25/2008 A non-serious spontaneous case of 9/17/2008 A non-serous spontaneous report o 9/17/2008 A non-serious spontaneous report o 9/19/2008 A non-serious spontaneous report o 9/30/2008 A non-serious spontaneous report o 9/24/2008 A non-serious spontaneous report o 9/25/2008 A non-serious spontaneous report o 9/26/2008 A non-serious spontaneous report o 9/29/2008 A non-serious report of administratio 9/29/2008 A non-serious, spontaneous report 11/6/2008 A serious report of vomiting, diarrhe 1/12/2009 A non-serious unlabeled spontaneo 10/3/2008 A non-serious spontaneous report o 10/6/2008 A non-serious spontaneous report o 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 10/6/2008 A non-serious, spontaneous report 10/6/2008 A non-serious labeled, spontaneous
355165 355166 355167 355168 355169 355170 355171 355172 355173 355174 355175 355176 355177 355178 355179 355180 355181 355182 355183 355184 355185 355186 355188 355189 355190 355191 355192 355193 355194 355195 355196 355197 355279 355284 355286 355287 355290 355292 355294 355297 355298 355299 355300 355304 355305 355306 355307 355308 355309 355310 355311
8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 TN 8/13/2009 TX 8/13/2009 TX 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 IA 8/13/2009 SD 8/13/2009 NJ 8/13/2009 FL 8/13/2009 KY 8/13/2009 CO 8/13/2009 OH 8/13/2009 CO 8/13/2009 GA 8/13/2009 GA 8/13/2009 KS 8/13/2009 UT 8/13/2009 NC 8/13/2009 TX 8/13/2009 KS 8/13/2009 MD 8/13/2009
21 34 31 24 21 25 22 37 21 19 20 24 5 5
85 24 48 45 28 43 7
8 7 52 69 16 56
69
M M M M M M M M F M M F F F F F F F M F F M M M F M F M M M M M M F F M F M F F F M M M M F M U F M F
11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio A non-serious report of administratio 4/9/2009 A non-serious report of administratio A non-serious report of administratio A non-serious report of administratio 4/9/2009 A non-serious report of administratio 10/6/2008 A non-serious, spontaneous report 10/7/2008 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A nonser 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non - s 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 Inappropriate dose of vaccine admin 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non ser 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se ### A non-serious spontaneous report o 10/9/2008 A non-serious, spontaneous report 10/9/2008 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious Spontaneous report o ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious spontaneous report o 11/3/2008 A non-serious spontaneous report o 11/3/2008 A non-serious spontaneous report o 11/7/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious, spontaneous report A non-serious report of inadvertentl ### A non-serious spontaneous report o ### A non-serious, spontaneous report
355312 355313 355314 355315 355317 355318 355319 355320 355321 355322 355323 355324 355325 355326 355327 355328 355329 355330 355331 355332 355333 355334 355335 355336 355337 355338 355339 355340 355341 355342 355343 355344 355345 355346 355347 355348 355349 355350 355351 355352 355353 355354 355355 355356 355357 355358 355359 355360 355361 355362 355363
8/13/2009 TX 8/13/2009 OH 8/13/2009 NC 8/13/2009 OH 8/13/2009 KY 8/13/2009 FL 8/13/2009 GA 8/13/2009 MN 8/13/2009 KY 8/13/2009 8/13/2009 IN 8/13/2009 NV 8/13/2009 MN 8/13/2009 MN 8/13/2009 IL 8/13/2009 IL 8/13/2009 UT 8/13/2009 MN 8/13/2009 WA 8/13/2009 TX 8/13/2009 NC 8/13/2009 IN 8/13/2009 MN 8/13/2009 WI 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 NM 8/13/2009 KS 8/13/2009 KS 8/13/2009 VA 8/13/2009 KS 8/13/2009 FL 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 CA 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 CA 8/13/2009 KS 8/13/2009 KS 8/13/2009 AL 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS
76 62 7 5 5 28 10 9 12 13 50 34 5 8 13 8 34 37 6 35 9 59
76 7 5
28
12
34
9
58
30 5
8
5
5
U F M M M F M F M F F M M M M M U M F M F M M F U U U U U F U U F U M U U U F U U U U M U U F U U U U
### A non-serious, spontaneous report 11/7/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious report of Henoch Sch ### A non-serious, spontaneous report ### A non-serious report of runny nose 11/3/2008 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious spontaneous report o 1/8/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o 11/7/2008 A non-serious, spontaneous report ### A serious spontaneous report of par 3/24/2009 A non-serious spontaneous report o A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious report of swelling of t ### A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious spontaneous report o ### A non-serious, spontaneous report 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious, spontaneous report 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 1/13/2009 A non-serious spontaneous report o 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/3/2008 A non-serious, spontaneous report 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU
355364 355365 355366 355367 355368 355369 355370 355371 355372 355373 355374 355375 355376 355377 355378 355379 355380 355381 355382 355383 355384 355385 355386 355387 355388 355389 355390 355391 355392 355393 355394 355395 355422 355423 355424 355425 355426 355427 355428 355429 355430 355431 355432 355433 355434 355435 355436 355437 355438 355439 355440
8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 PA 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 SD
6
24
24
U U U U U U U U U U U U U U U U U U U U U U U U U U F U U U U U U U U U U U U U U U U U U U U U U U F
4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/3/2008 A non-serious, spontaneous report 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FluM 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-used report of expired FluMis 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o
355441 355442 355443 355444 355445 355447 355448 355449 355450 355451 355452 355453 355454 355455 355456 355457 355458 355459 355460 355461 355462 355463 355464 355465 355466 355467 355531 355532 355533 355534 355535 355536 355537 355538 355539 355540 355541 355542 355543 355546 355560 355561 355563 355564 355565 355566 355567 355568 355569 355570 355571
8/13/2009 MN 8/13/2009 OR 8/13/2009 KS 8/13/2009 CA 8/13/2009 MA 8/13/2009 NC 8/13/2009 TN 8/13/2009 MN 8/13/2009 8/13/2009 CO 8/13/2009 PA 8/13/2009 NY 8/13/2009 VA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 IN 8/13/2009 VA 8/13/2009 NV 8/13/2009 CT 8/13/2009 TX 8/13/2009 MD 8/13/2009 NY 8/13/2009 OH 8/13/2009 OH 8/13/2009 KY 8/13/2009 WI 8/13/2009 CA
27 11 11
11
8 7 54 41 43 7 17
8 6 57 10 31 19 10 10 9 7 52 34
41
17
6
31 19 10 9
F F F F F M F F F F F M F F F F U F F F F F F F F F F M M F M M M M M M M M M F F F F F M F F F M F F
11/5/2008 A non-serious, spontaneous report 11/4/2008 A non-serious spontaneous report o 11/5/2008 A non-serious, spontaneous report 11/5/2008 A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o 11/6/2008 A non-serious, spontaneous report 11/6/2008 A non-serious spontaneous report o 11/5/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report 11/7/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### Inappropriate dose of vaccine admin ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious report of administrati 12/3/2008 A non-serious, spontaneous report ### A spontaneous non-serious report o 1/8/2009 A non-serious spontaneous report o 12/2/2008 A non-serious unlabeled spontaneo 12/3/2008 A non-serious spontaneous report o 12/3/2008 A non-serious spontaneous report o ### A spontaneous non-serious report o
355572 355573 355574 355575 355576 355577 355578 355579 355580 355581 355582 355583 355584 355585 355586 355587 355588 355589 355596 355597 355598 355599 355600 355601 355602 355603 355604 355605 355606 355607 355608 355609 355610 355611 355612 355613 355614 355615 355616 355617 355618 355619 355620 355622 355623 355625 355628 355631 355633 355636 355637
8/13/2009 NV 8/13/2009 IA 8/13/2009 KY 8/13/2009 VT 8/13/2009 WI 8/13/2009 MD 8/13/2009 GA 8/13/2009 TX 8/13/2009 TX 8/13/2009 IA 8/13/2009 NY 8/13/2009 NY 8/13/2009 IN 8/13/2009 TX 8/13/2009 CA 8/13/2009 MI 8/13/2009 PA 8/13/2009 PA 8/13/2009 MO 8/13/2009 TX 8/13/2009 OH 8/13/2009 NV 8/13/2009 MD 8/13/2009 MI 8/13/2009 IN 8/13/2009 MI 8/13/2009 CA 8/13/2009 MI 8/13/2009 MI 8/13/2009 MD 8/13/2009 MI 8/13/2009 MI 8/13/2009 MI 8/13/2009 KY 8/13/2009 WI 8/13/2009 WA 8/13/2009 WV 8/13/2009 RI 8/13/2009 AZ 8/13/2009 MN 8/13/2009 TX 8/13/2009 CT 8/13/2009 MN 8/13/2009 AL 8/13/2009 TX 8/13/2009 MO 8/13/2009 IA 8/13/2009 OR 8/13/2009 MO 8/13/2009 MO 8/13/2009 MO
35 12 55 10 48 46
35 12
12 9 42 6 9 6 9 7 54 5 26 49 14 6 22 23 6 55
12 9
48
6 7
26 49
22
55
6 24 5 28 6 52 14 11 7 9 14 15 15 13 17 9 19 29 43 22 5 5 8
24 28
11 7
13 9 29 43 5 5 8
F F M F F U M F F M F M M U M F F F F F F F F M M F F F F M F F F F M M M M M M M F F F F M F F M F F
### A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o 12/8/2008 A spontaneous non-serious report o ### A non-serious report of fever, vomiti ### A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o ### Neither relevant medical history nor ### A non-serious, spontaneous, report 3/31/2009 A non-serious spontaneous report o 12/8/2008 A spontaneous non-serious report o 12/8/2008 A spontaneous non-serious report o ### A non-serious spontaneous report o 12/1/2008 A non-serious spontaneous report o 1/5/2009 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A spontaneous non-serious report o 4/21/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A spontaneous non-serious report o ### A spontaneous non-serious report o ### A non-serious spontaneous report o ### Vaccine exposure during pregnancy 4/9/2009 A non-serious, spontaneous report 1/13/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A spontaneous non-serious report o ### A spontaneous non-serious report o 4/9/2009 A non-serious spontaneous report o 3/27/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious report of administered 4/9/2009 A non-serious, spontaneous report 3/13/2009 A spontaneous non-serious report o 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 1/5/2009 A spontaneous non-serious report o 3/31/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of administratio 3/20/2009 A non-serious report of administratio 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious, spontaneous report
355640 355643 355645 355648 355649 355650 355651 355652 355653 355654 355655 355656 355657 355658 355660 355661 355662 355664 355666 355667 355668 355669 355670 355671 355672 355754 355755 355756 355757 355758 355759 355760 355761 355762 355763 355764 355765 355766 355767 355768 355769 355770 355771 355772 355773 355774 355775 355776 355777 355778 355779
8/13/2009 MD 8/13/2009 AR 8/13/2009 AZ 8/13/2009 RI 8/13/2009 AZ 8/13/2009 RI 8/13/2009 CA 8/13/2009 AZ 8/13/2009 MN 8/13/2009 OH 8/13/2009 DC 8/13/2009 DC 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 MO 8/13/2009 GA 8/13/2009 RI 8/13/2009 8/13/2009 RI 8/13/2009 NC 8/13/2009 NJ 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 NJ 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 NM 8/13/2009 IA 8/13/2009 FL 8/13/2009 TX 8/13/2009 TX 8/13/2009 MN 8/13/2009 TX 8/13/2009 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 VA 8/13/2009 MA 8/13/2009 IL 8/13/2009 MN 8/13/2009 SC
12 5 10 15 5 18
12 5 10
6
6
5 10 11 5 5 5 5 7 6 9 26 12 9 33 20 13 6 5 5 40 7 16 7 7 7 27 13 9 5 6 59 9 5 9 8 5 35 30 11
5 10 11 5 5 5 5 7 6
36 6
5
26 9 20 13
7
M U U M U F U U U F F F F M F F M F F F F F F F M M F M F M F F F M F F M M M M F M F M F F F M F F F
4/9/2009 A spontaneous non-serious report o 1/7/2009 A non-serious report of "six patients 1/7/2009 A non-serious report of "six patients 3/27/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of "six patients 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious spontaneous report o 4/9/2009 A spontaneous non-serious report o 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serous, spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 1/13/2009 A spontaneous non-serious report o 1/13/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/20/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/23/2009 A non-serious spontaneous report o 1/27/2009 A non-serious spontaneous report o 1/27/2009 A spontaneous, non-serious report 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/27/2009 A spontaneous, non-serious report 2/5/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/2/2009 A non-serious spontaneous report o 2/2/2009 A spontaneous, non-serious report 4/9/2009 A spontaneous, non-serious report 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o
355780 355781 355782 355783 355784 355785 355786 355787 355788 355789 355790 355791 355792 355793 355794 355795 355796 355797 355798 355799 355800 355801 355802 355803 355804 355805 355806 355807 355808 355809 355810 355811 355812 355813 355814 355815 355816 355817 355818 355819 355820 355821 355822 355823 355824 355825 355826 355827 355915 355918 355920
8/13/2009 TX 8/13/2009 TN 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 LA 8/13/2009 NJ 8/13/2009 MD 8/13/2009 AZ 8/13/2009 AZ 8/13/2009 FL 8/13/2009 IN 8/13/2009 FL 8/13/2009 MD 8/13/2009 FL 8/13/2009 MD 8/13/2009 MD 8/13/2009 8/13/2009 MD 8/13/2009 8/13/2009 NJ 8/13/2009 MD 8/13/2009 MD 8/13/2009 MD 8/13/2009 MD 8/13/2009 TX 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ
9 11 5 6 6 9 7 14 10 65 42 8 11 10 24 12 4 7 14 9 5 38 6 6 8 6 11 19 26 26 24 21 20 28 21 34 28 36 45 45 41 22 38 34 40 40 39 27 40
7
11 24 4 7 9 38 6 6 8 6 19 26 26 24 21 20 28 21 34 28 36 45 45 41 22 38 34 40 40 39 27 40
F M M F M U F M M M F M M F F M F M F M F M F M M M M F F M M F F M M M M F M M F M M F M M M F F M M
3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/6/2009 A non-serious spontaneous report o 2/10/2009 A non-serious spontaneous report o 2/11/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 4/28/2009 A non-serious spontaneous report o 3/9/2009 A non-serious, spontaneous report 4/28/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 2/19/2009 A non-serious spontaneous report o 2/27/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 2/23/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 2/27/2009 A non-serious, spontaneous report 3/18/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 4/9/2009 A spontaneous, non-serious report 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o
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8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ
48 44 36 44 38 27 48 21 34 48 23 23 38 21 26 26 31 49 37 23 26 24 28 40 45 33 29 25 27 45
48 44 36 44 38 27 48 21 34 48 23 23 38 21 26 26 31 49 37 23 26 24 28 40 45 33 29 25 27 45
25
25
27 43 23 49 24 37 21 41 19 19 21 41 43 28 23 27 33 28
27 43 23 49 24 37 21 41 19 19 21 41 43 28 23 27 33 28
F F F M M F M M M M F M M M M M M M M M M M M M M M M M M M M M M F M M M M M F M F F M M F M M F M M
5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 3/18/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou
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8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NC 8/14/2009 8/14/2009 8/14/2009 8/14/2009 8/14/2009 IL 8/14/2009 8/14/2009 ME 8/14/2009 MO 8/14/2009 NY 8/14/2009 OK 8/14/2009 MI 8/14/2009 TX 8/14/2009 GA 8/14/2009 IN 8/14/2009 KS 8/14/2009 IN 8/14/2009 MI 8/14/2009 TX
23 20 36 37 21
23 20 36 37 21
23 20 33 20 44 21 24 24 20 35 20 26 20 45 23 26 35 26 32 46 20 30
23 20 33 20 44 21 24
38 28 23 8 26
38 28 23
64 79 4 48 23 1.2 9 12 11 1 0.5 4 7 36 68
64
20 35 20 26 20 45 23 26 35 26 32 46 20 30
26
4 48 33 1 9 12 11 1 0 4 11 38 68
M M F M M M M M M M M F F M M F F F M M M M M M M M M U M M M M F F F M F M M M M 0.2 F M F M 0M 0.5 F F M M F
5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 3/18/2009 A non-serious spontaneous report o 5/12/2009 A non - serious spontaneous report 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/19/2009 A non-serious report of positive influ 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/14/2009 Pt presented on 14 Aug 2009 for cli 8/14/2009 24 hours post Pneumococcal Vacci 8/14/2009 Complains of muscle soreness at in 8/14/2009 Pt has had a fever with rash on face 8/13/2009 Pt received shots stayed in office fo 8/13/2009 Severe headache 2-3d after vaccine 8/13/2009 (1) Fever (T max 103.2) began with 8/11/2009 MMR and PREVNAR given, child w 8/11/2009 Temperature of 104.5 R. 8/10/2009 Erythema surrounding injection site 8/14/2009 Hep A vaccine given IM L deltoid. R 8/14/2009 injection give 8-13-2009 approx. 11 8/14/2009 Extreme pain, swelling, unable to m
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8/14/2009 IA 8/14/2009 TX 8/14/2009 OK 8/14/2009 WI 8/14/2009 VA 8/14/2009 PA 8/14/2009 MO 8/14/2009 WI 8/14/2009 NC 8/14/2009 FL 8/14/2009 TX 8/14/2009 IN 8/14/2009 MI 8/14/2009 AL 8/14/2009 AL 8/14/2009 TX 8/14/2009 TX 8/14/2009 TX 8/14/2009 CA 8/14/2009 TX 8/14/2009 TX 8/14/2009 IL 8/14/2009 WA 8/14/2009 TX 8/14/2009 AL 8/14/2009 TX 8/14/2009 IL 8/14/2009 TX 8/14/2009 AR 8/14/2009 OH 8/14/2009 NC 8/14/2009 NJ 8/14/2009 OH 8/14/2009 MN 8/14/2009 WY 8/14/2009 MT 8/14/2009 OR 8/14/2009 CT 8/14/2009 CA 8/14/2009 MO 8/14/2009 NY 8/14/2009 MI 8/14/2009 NV 8/14/2009 MO 8/14/2009 TX 8/14/2009 MI 8/14/2009 CA 8/14/2009 MN 8/14/2009 MN 8/14/2009 TX 8/14/2009 WY
4 12 9 4 11 4 5 17 36 4 1 42 15 5 42 3 12 4 5 14 11 3 40 11 4 11 64 9 11 13 12 22 5 37 83 12 61 4 0.5 14 5 4 11 18 12 11 12 1 4 34 1.6
4 12 9 4 11 4 5 17 36 4 1 42 15 5 41 3 12 4 5 14 11 3 40 11 4 11 64 9 11 13 12 22 5 37 83 12 61 4 0 14 5 4 11 18 12 11 11 1 4 34 1
F M F M M M M M F M 0F M F F F F F F M M F F F M F M M F F M M F M M F F F F 0.5 M F F M M F F F M 0F M F 0.6 F
8/14/2009 large area of erythema, warm to tou 8/14/2009 Had Fever on day after shots was g 8/14/2009 REDNESS AND SWELLING AT INJ 8/14/2009 Patient developed fever to 102 per m 8/14/2009 Mother called stating son had Tdap 8/14/2009 Patient was diagnosed in our office 8/14/2009 Woke up on 8/13/09 with a temp of 8/14/2009 Call received from mom 8/13/09, sta 8/14/2009 Pain in Left arm that began as soon 8/14/2009 Symptoms: Circular swelling 3"x3", 8/14/2009 Pt. developed high fever one day af 8/14/2009 Localized erythema/edema affecting 8/14/2009 Mom states that pt had cracked lips 8/14/2009 Fever of 103 axcillary with 2 minute 8/14/2009 Swelling of leftside of lower lip occu 8/14/2009 We think Grace had a seizure that l 8/14/2009 Mother states that the child began t 8/14/2009 Swelling, redness, warm and slightly 8/14/2009 High fever for 6 days, Full body rash 8/14/2009 12 hours later, fever, headache, nec 8/14/2009 Redness to vaccine site, tenderness 8/14/2009 R DELTIOD NOTICE SWELLING, R 8/14/2009 8/11/00: vaccine (varicella #2). 8/12 8/14/2009 Redness and swelling to vaccine sit 8/14/2009 REDNESS AND SWELLING AT INJ 8/14/2009 Redness and swelling to vaccine sit 8/14/2009 Single non erythematous raised les 8/14/2009 PT. RECEIVED HPV AND VARICE 8/14/2009 Localized redness, edema, and itch 8/14/2009 Pt developed a red circular rash on 8/14/2009 15x11 cm area reddness and swelli 8/14/2009 After receiving gaurdicil, lauren faint 8/14/2009 Shortly after receiving vaccines pati 3-4 hours after taking the Tdap I ha 8/14/2009 Silver dollar size redness - Site is w 8/14/2009 Pt reported HR 100, temp. 100 degr 8/14/2009 Shingles Left herpes zoster ophthal 8/14/2009 6"x 6" erythema, slight warmth, sligh 8/14/2009 Was seen at hospital on 8/4/09 for I 8/13/2009 Approximately 15 minutes after imm Approx 5am after injection Pt starte 8/6/2009 Swelling to left deltoid at injection si 8/13/2009 Redness Swollen Warm to touch } in 8/14/2009 Client was inadvertently given a Tda 8/14/2009 Mother states "At 6:30 pm pt c/o nu 8/14/2009 Mom did Reading on GARDSIL and 8/15/2009 2 days after MENACTRA L deltoid o 8/19/2009 Developed hives 24 hours after MM 8/14/2009 To ER via ambulance. Got epi pen b 8/14/2009 EMS notified 7:02 (Numbness in ton 8/11/2009 Grandmother reports scattered hive
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8/14/2009 NC 8/14/2009 WA 8/15/2009 PA 8/15/2009 IN 8/15/2009 CA 8/16/2009 DC 8/16/2009 UT 8/16/2009 MN 8/16/2009 OR 8/16/2009 OH 8/17/2009 8/17/2009 8/17/2009 IL 8/17/2009 IL 8/17/2009 NV 8/17/2009 8/17/2009 8/17/2009 KY 8/17/2009 KY 8/17/2009 NY 8/17/2009 FL 8/17/2009 FL 8/17/2009 MA 8/17/2009 MA 8/17/2009 CA 8/17/2009 CA 8/17/2009 VA 8/17/2009 NJ 8/17/2009 MN 8/17/2009 PA 8/17/2009 MA 8/17/2009 NC 8/17/2009 MA 8/17/2009 AZ 8/17/2009 AR 8/17/2009 LA 8/17/2009 LA 8/17/2009 GA 8/17/2009 GA 8/17/2009 GA 8/17/2009 NH 8/17/2009 PA 8/17/2009 OR 8/17/2009 TX 8/17/2009 NV 8/17/2009 KS 8/17/2009 OH 8/17/2009 CA 8/17/2009 OH 8/17/2009 CT 8/17/2009 GA
0.2 8 1 0.2 22 0.4 15 25
0 8 1 0 22
47 16 14 1 0.2 3 73 77 5
47
45 20 12 0.4 0.1 17 11 46 11 0.5 4 65 41 1.3 10 1.3 11 13 2 1 1 15 65 65 60 37 1.3 18 0.2 18 11 4
45 20 12 0 0 17 11 46 11 0 4 65 41 1 10 1 11 13 2 1 1 15 65 65 60 37 1 18
15 25
14 1 0
77 5
18 11 4
0.2 F M 0F 0.2 M F F F F U F F F 0F 0.2 F M F M F U F F F 0.4 M 0.1 M F F F M 0.5 F F M F 0.3 F F 0.3 F M M 0M 0F 0F F F F F F 0.3 F F M F U F
8/11/2009 Parents state child became very list 8/13/2009 Rash with papules on erythematous 8/15/2009 Rash on right cheek and both upper 8/15/2009 Pt develop a rash consistent with er 8/15/2009 Encephalopathy, severe malnutritio 8/6/2009 None- Vaccine administered @ inap 8/16/2009 I had the last shot in early Novembe 8/16/2009 Within one week of receiving the firs 8/16/2009 Not feeling well two hours after vacc 8/18/2009 Right arm cellulitis following ADACE 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/17/2009 This case was reported by a healthc 8/17/2009 This case was reported by a healthc Dizziness, chronic flu like symptoms 8/10/2009 Pt. presented to clinic Aug. 04/09 - S 8/12/2009 After receiving Tdap, VZV, MENACT 8/17/2009 Quarter size lump R. leg sm Lump o 8/6/2009 Pt received TDAP 8/4/09 @ 3:50 PM 8/12/2009 Started feeling dizzy, ears felt plugg 8/10/2009 Mom and daughter back today. Pati 8/12/2009 Left upper arm swollen, redness, wa 8/11/2009 Painful 4.5 cm X 4.5 cm Red Raised 8/13/2009 4 x 3 cm Reddened with lump unde 8/13/2009 Red, scabbed dots upper R arm. 8/12/2009 Received vaccine 2/1/8 but develop 8/12/2009 6/12 by history hives like rash, fever 8/13/2009 Irritable leg pain, limping, unsteady 8/10/2009 Swelling, warm. TX: KEFLEX, BEN 7/31/2009 Pt. ran fever 6 hours after vaccines 8/3/2009 Presents to clinic today, 8/3/09, c/o 7/23/2009 Client reports left arm started swellin 8/12/2009 Lesions noted 2 days prior to visit 8/13/2009 3 days ago developed rashes with d 8/12/2009 Vesicular lesions together w/crusted 8/12/2009 Pt vaccinated 8-5-09. Onset 8-6-09 19th July, Fever, unable to swallow 8/10/2009 26 hrs. later I got the chills (6pm) by 8/9/2009 Redness, great deal of swelling (righ 8/11/2009 Pt reported swelling in same side up 8/5/2009 No known adverse reaction. Tdap a 8/10/2009 12 minutes after injection patient go 8/11/2009 Excessive diarrhea - watery. X 2/ 88/11/2009 8/7/09. c/o redness. Swelling and so Varicella vaccine administered 8/7/0 8/17/2009 COUGH(WHOOPING COUGH LIKE
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8/17/2009 FL 8/17/2009 FL 8/17/2009 MI 8/17/2009 TX 8/17/2009 TX 8/17/2009 IA 8/17/2009 TX 8/17/2009 CO 8/17/2009 GA 8/17/2009 MI 8/17/2009 AR 8/17/2009 AK 8/17/2009 PA 8/17/2009 TX 8/17/2009 FL 8/17/2009 OR 8/17/2009 NY 8/17/2009 VA 8/17/2009 MI 8/17/2009 FL 8/17/2009 MO 8/17/2009 OK 8/17/2009 CA 8/17/2009 KS 8/17/2009 PA 8/17/2009 IL 8/17/2009 TX 8/17/2009 PA 8/17/2009 TX 8/17/2009 MT 8/17/2009 OH 8/17/2009 TX 8/17/2009 OH 8/17/2009 NC 8/17/2009 CO 8/17/2009 NJ 8/17/2009 LA 8/17/2009 NC 8/17/2009 MD 8/17/2009 TX 8/17/2009 IL 8/17/2009 FL 8/17/2009 MN 8/17/2009 LA 8/17/2009 NV 8/17/2009 AZ 8/17/2009 CA 8/17/2009 MD 8/17/2009 WA 8/17/2009 AL 8/17/2009 IL
31 83 18 12 13 29 2 59 0.3 81 16 4 65 31 49 15 12 13 5 4 4 1.3 2 19 81 0.3 11 61 11 18 13 13 17 14 4 24 11 10 19 34 5 27 12 11 4 4 59 22 8 32 9
31 83 18 12 13 29 59 0 81 16 4 75 31 49 15 12 13 5 4 4 1 2 19 81 0 11 61 11 18 13 13 17 14 4 24 11 10 19 34 5 27 12 11 4 4 59 22 8 32 9
F M M F M F M M 0.3 F F F M F M F M F F M M M 0.3 M 1F F F 0.3 M M F M F F F F F F M M F F M M F M F F M F F M F M
8/17/2009 Difused rash, erythemaos, macular, 8/17/2009 TD vaccine ordered and TDAP give 8/17/2009 Patient became light headed, dizzy 8/11/2009 Fever of 102. Body aches. Both sta 8/17/2009 After completion of vaccinations pat 8/17/2009 3x5 inch area in SQ tissue on back 8/22/2009 HIB dilute with wrong solution. No a 8/17/2009 At approximately 2100, Pt complain 8/17/2009 Child developed fever with 24 hours 8/17/2009 Significant skin reaction at site of in 8/17/2009 Ongoing chest pain intermittently sin 8/17/2009 Localized - Red, swelling, warmth to 8/17/2009 Patient has a reddened area at injec 8/17/2009 Patien developed rash approximate 8/17/2009 Patient states that she suffered from 8/17/2009 After receiving 2nd injection (MMR) 8/17/2009 Redness, painful hard lump with Pn 8/17/2009 AFTER RECEIVING 1ST GARDAS 8/17/2009 Patient developed a fever, headach 8/7/2009 URTICARIAL LESIONS ON FACE, 8/17/2009 Left lateral thigh was swollen, red, f 8/17/2009 On 8/15/09 about 6:00pm child deve 8/17/2009 Localized inflammatory reaction of s 8/17/2009 None reported 8/17/2009 1 week after receiving Zostavax, on 8/17/2009 THE PATIENT PRESENTED WITH 8/17/2009 R arm 7.0 x 6.0 cm wider. 8/17/2009 Raised red blotchy rash at site of in 8/17/2009 Swollen and red left arm. 8/15/2009 Vaccine on 8-7-09. 8-10-09 elevate 8/17/2009 20 m after given GARDASIL, had 20 8/15/2009 Pts arm got swollen up and pt had a 8/17/2009 Fever of 102 or above and headach 8/11/2009 2-3 min after immunization of HPV g 8/12/2009 Morning after receiving vaccines aw 7/8/2009 Non stated. 8/18/09 spoke w/pt say 8/7/2009 Approx. 30 min after administration 8/11/2009 HPV injection given IM in R deltoid. 8/12/2009 Immediately became pale and fainte 7/27/2009 Tdap, red hard tricep, inflamed large 7/31/09, left leg is swollen, red, and 8/7/2009 2:30pm Nausea / emesis shaking h 8/7/2009 Less than 24 hours post imm starte 8/10/2009 Reported both cheeks, chin and fore 8/17/2009 Child received DTAP, VARAIVAX va 8/17/2009 Redness to R deltoid area. 8/17/2009 Employee received MMR vaccine 5 7/16/2009 Episode of tremors X approx. 30 se 8/17/2009 Redness and rash. 8/17/2009 LEFT UPPER ARM REDNESS WIH 8/14/2009 Talked to mom 9:00 am- completely
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8/17/2009 CO 8/17/2009 IL 8/17/2009 SC 8/17/2009 SD 8/17/2009 CA 8/17/2009 8/17/2009 NJ 8/18/2009 PA 8/18/2009 FL 8/18/2009 LA 8/18/2009 ND 8/18/2009 FL 8/18/2009 CA 8/18/2009 KS 8/18/2009 OK 8/18/2009 FL 8/18/2009 NJ 8/18/2009 NC 8/18/2009 NC 8/18/2009 TX 8/18/2009 MO 8/18/2009 FL 8/18/2009 TX 8/18/2009 GA 8/18/2009 OR 8/18/2009 VA 8/18/2009 KY 8/18/2009 OR 8/18/2009 NC 8/18/2009 NE 8/18/2009 VA 8/18/2009 VA 8/18/2009 WI 8/18/2009 AZ 8/18/2009 VT 8/18/2009 PA 8/18/2009 PA 8/18/2009 CA 8/18/2009 OR 8/18/2009 WI 8/18/2009 NY 8/18/2009 AZ 8/18/2009 WA 8/18/2009 VA 8/18/2009 WI 8/18/2009 NV 8/18/2009 TX 8/18/2009 TX 8/18/2009 IA 8/18/2009 IA 8/18/2009 SD
32 9 1 5 67 0 20 62 70 17 0 18 17 16
32 9 1 5 67 0 20 62
0.5 17 12 12 0.5 11 38 4 9 66 68 4 16 11 19 15 4 18 1.1 11 5 5 67 4 5 11 14 12 42 15 6 19 12 60 29 5
0 17 12 12 0 11 38 4 9 66 68 4 16 11 19 15 4 18 1 11 5 5 67 4 5 11 14 12 42 15 6 19 12
17 0 18
29 5
M F 0M F F 0M M F F F 0M F F F F 0.5 M M F M 0.5 M F F F F F F M F M F F F F 0.1 M M F F F F M F F F M F M F F F M M
8/17/2009 None stated. 8/17/2009 Allergic reaction from the chicken po 8/10/2009 Febrile seizure on evening. 8/10/2009 Rash and bruise on leg Rt red 8/10/2009 Local skin reaction large 12cm x 9cm Coatinous breakouts hives, rashes, 5/12/2009 A non-serious spontaneous report o 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/14/2009 Initial report was received on 07 Au 8/13/2009 2-23-09 Office visit vomiting, diarrhe 8/12/2009 Shortly after receiving Hepatitis A an 7/28/2009 Severe headaches, belly pain, bilate 8/17/2009 (Rt) Deltoid vaccine site swollen, ery 8/12/2009 Mom describes child as "limp" "wea 8/13/2009 Fever - Nausea x 2 days - vomiting 8/12/2009 8-12-09 Am RN Supervisor received 8/11/2009 X1 Hive on site of administration 18 8/5/2009 Pt given TDaP < 10 yrs of age. No 8/13/2009 Redness, soreness, swelling and itc 8/14/2009 Typical. Redness, soreness -swellin 8/13/2009 7"x5" red area, swelling, 8/13/09 8:0 8/12/2009 About 5 min after receiving the belo 6/29/2009 Hep A #1 given 6-26-2009 - Also giv 8/13/2009 11:30pm 8-11-2009 vomited, upset 8/4/2009 7/29/09 - Client called Health Depar 8/13/2009 @ site of injection- large area of ery 8/7/2009 About 12 hours after HPV & HEP A 8/12/2009 Child received MMR and VARIVAX 8/12/2009 5 inch by 3 3/4 red raised area at si 8/12/2009 Pt's mother, called this RN at 12:15 8/12/2009 Pt's mother called RN at 12:15 pm a Vesicular eruption c/u varicella Zost 8/12/2009 Hives on torso- anterior ! Posterior ! L rash, hematoma approximately 2 8/12/2009 Patient became light headed and m 8/12/2009 Gave HAVRIX #1 in (L) arm and pa 8/8/2009 5:00 am following day awoke with b 8/12/2009 While at son's football game pt start 8/12/2009 08/10/09 - @ approximately 3:15 pm 8/12/2009 L shoulder area is erythematous, m 8/12/2009 Received GARDASIL 6/4/2007, 7/3 8/17/2009 Itching swelling to vaccine site. ABX 8/18/2009 round faint red rash around injection 8/18/2009 Pt called the following day with c/o f 8/18/2009 Pt. was given a DTaP on August 6th
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8/18/2009 GA 8/18/2009 NC 8/18/2009 TX 8/18/2009 MT 8/18/2009 MA 8/18/2009 NJ 8/18/2009 VA 8/18/2009 CO 8/18/2009 FL 8/18/2009 MO 8/18/2009 KS 8/18/2009 CA 8/18/2009 NY 8/18/2009 AL 8/18/2009 TX 8/18/2009 TN 8/18/2009 OK 8/18/2009 IL 8/18/2009 OR 8/18/2009 OR 8/18/2009 VA 8/18/2009 NY 8/18/2009 NC 8/18/2009 VT 8/18/2009 CA 8/18/2009 LA 8/18/2009 GA 8/18/2009 FL 8/18/2009 MI 8/18/2009 CA 8/18/2009 OH 8/18/2009 ME 8/18/2009 KY 8/18/2009 GA 8/18/2009 MS 8/18/2009 GA 8/18/2009 OH 8/18/2009 PA 8/18/2009 WI 8/19/2009 KY 8/19/2009 WI 8/19/2009 NJ 8/19/2009 TN 8/19/2009 GA 8/19/2009 8/19/2009 NY 8/19/2009 NY 8/19/2009 TX 8/19/2009 MI 8/19/2009 PA 8/19/2009 NC
39 12 14 57 33 5 5 11 25 0.3 13 1.2 16 36 4 11 4 5 5 1.2 11 11 13 11 1.1 9 1 1.6 4 1.8 71 46 10.5 16 31 4 8 22 22 12 1 14 79 21 54 44 27 42 20 44
39 1 14 56 33 5 5 11 25 0 13 1 16 35 4 11 4 5 5 1 11 11 13 11 1 9 61 1 1 4 1 71 46 10 16 32 4 8 22 22 11 1 79 21 54 43 27 42 20 44
F 0M M F F M M U F 0.3 M M 0.2 F F M F F F F M 0.2 M F M M M 0.1 M M F 0F 0.6 F M 0.8 U M F F F F M F F F F 0M M M F F F F F F F
8/18/2009 Varicella Vaccine received 08/13/20 8/18/2009 fever of 103 for 28 hours, with conti 8/18/2009 5-6 hours following vaccination, pat 8/18/2009 Within 24 hours of the vaccination h 8/18/2009 Noted rash on arms and chest 24 h 8/18/2009 Patient received MMR and Varivax 8/18/2009 Brysen is here because he had his 8/18/2009 Syncopal episode following Tdap va 8/18/2009 Within 10 seconds of vaccine, I got 8/18/2009 RECEIVED 4 MO SHOTS 1PM @ H 8/18/2009 Pt received varicella vaccine 08/17/ 8/18/2009 New onset generalized tonic-clonic 8/18/2009 My daughter had been suffering from 8/18/2009 mild fever of 100 degrees F.; heada 8/18/2009 Patient was found walking outside r 8/17/2009 12cm area of erythema at site of ME 8/13/2009 Local reaction to left shoulder/deltoi 8/18/2009 Left upper arm redness and swelling 8/19/2009 Parent reports 7pm Pt C/o throat dis 8/18/2009 R Thigh, indurated, erythematous, s 8/18/2009 Child has fever to 103.5 headache " 8/18/2009 Swelling upper arm c/erythema - las 8/17/2009 Day after vaccines, woke up feeling Temp 104 degrees & some delirium 8/18/2009 Child right away react w/ hives. 8/18/2009 Pt Rcvd vaccine @ 11am - went ho 8/11/2009 4/29/09 Pt. given Tdap injection dur 8/13/2009 Crying hysterically. Lips and hands 8/13/2009 Shots done on Tuesday August 11, 8/10/2009 Red area of warmth and itching on R 3-5 days after the Hib vaccine my so Site was "hot and red to the touch. A 8/12/2009 Approx. 1 minute after inj. patient st 8/7/2009 Pt had swelling, erythema and bruis 8/3/2009 Itchy rash - of neck, trunk, arms. 8/17/2009 Swelling at injection site, red with fe 8/18/2009 High Fever, bellyache, tired with MO 8/18/2009 About 5min after receiving Hep A va 8/18/2009 This case was reported by a healthc 8/19/2009 I received the 1st round of Gardasil 8/14/2009 Nausea, vomiting, low grade fever x 8/18/2009 InformationYregarding PREVNAR wa 8/17/2009 This case was received from a heal 8/18/2009 Information has been received from 8/18/2009 Information has been received from 8/10/2009 Body aches and temp. 99 started 8/ 8/12/2009 Burning sensation and pain in shou 8/13/2009 Pt. felt light headed & weak at 01:00 8/19/2009 Received flu vaccine Nov. 2008 - wi 8/19/2009 08.17.09 - R arm soreness, immed. 7/30/2009 Arm swollen, itching in arm, warm to
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8/19/2009 NC 8/19/2009 DC 8/19/2009 NC 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 FL 8/19/2009 VA 8/19/2009 MD 8/19/2009 TX 8/19/2009 IN 8/19/2009 NC 8/19/2009 FL 8/19/2009 MI 8/19/2009 CT 8/19/2009 FL 8/19/2009 CA 8/19/2009 AL 8/19/2009 CA 8/19/2009 AZ 8/19/2009 CA 8/19/2009 MN 8/19/2009 PA 8/19/2009 MO 8/19/2009 PA 8/19/2009 MI 8/19/2009 HI 8/19/2009 NC 8/19/2009 NE 8/19/2009 MN 8/19/2009 CA 8/19/2009 CA 8/19/2009 LA 8/19/2009 UT 8/19/2009 TX 8/19/2009 WA 8/19/2009 CA
13 65 1.2 4 3 4 4 3 3 3 3 3 3 4 4 4 4 2 2 3 11 22 14 13 12 8 66 12 14 16 17 4 0.4 0.2 4 19 70 77 1 24 9 30 5 66 0.6 15 11 11 11 55 1
13 65 1 4 3 4 4 3 3 3 3 3 3 4 4 4 4 2 2 3 11 22 14 14 12 8 66 12 14 16 17 4 0 0 4 19 70 77 1 24 11 30 5 66 0 15 11 11 11 55 0
M F 0.2 F F F M F M M F M F M F M F F 0.1 F 0.5 M F F F F F M M M M M F F M 0.4 F 0.2 F M F F F 0F F F F F F 0.6 M F F F F F 0F
8/13/2009 Vaccine were given, pt tolerated we 8/13/2009 Patient was given PNEUMOVAX mo 7/31/2009 Red area a site of injection - dime s 7/21/2009 A serious report of lymphadenitis ha 7/21/2009 A serious report of septic arthritis ha 7/21/2009 A serious report of hearing loss/dea 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of urinary tract infec 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of nail disorder has 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of sleep apnea and 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of sleep apnea and 7/21/2009 A serious report of encopresis has b 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of abscess and pos 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of abdominal pain a 7/21/2009 A serious report of trauma has been 8/19/2009 Patient was in waiting room about 1 8/19/2009 Pt. had seizure like activity after the 8/19/2009 First injection of Garadsil was given 8/19/2009 Near Fainting Heart rate 52 pale 8/19/2009 On 7-18-07, DTaP vaccine was give 8/19/2009 circular red edematous area at site 8/19/2009 The patient came in to see the doct 8/19/2009 PATIENT'S MOTHER STATES THA 8/19/2009 Approx 5 hours after receiving vacc 8/19/2009 acute idiopathic autoimmune hemol 8/1/2009 Fatigue, dry skin, extreme fatigue, li 8/17/2009 Lip swelling, earlobe swelling and e 8/19/2009 Patient had sudden onset of rolling 8/19/2009 Seizure. 8/18/2009 (L) lateral upperarm onset redness 1 8/19/2009 Patient Reported intermittent hives 8/19/2009 Developed ocular viral, herpes infec 8/19/2009 Patient stated she received the ZOS 8/19/2009 Mother stated first vesicle rash on a 8/19/2009 Pt observed following inj./ After 15 m 7/22/2009 Erythema, slight tenderness @ injec 8/19/2009 30 year old female complains of fac 8/19/2009 Allergic Rx -Mod/Severe local with o 8/19/2009 Swollen, erythematous, indurated a Low grade temp (<105 degrees F), 8/19/2009 stood up after injection and had pro 8/19/2009 Had seizure 7/25/09. Had Mri & Ct s 8/19/2009 My daughter is going into junior high 8/19/2009 Severe headaches that come on su 8/19/2009 Arm very sore, headache, fever/chil 8/19/2009 10 days after receiving her MMR va
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8/19/2009 FL 8/19/2009 NY 8/19/2009 IN 8/19/2009 AR 8/19/2009 PA 8/19/2009 IN 8/19/2009 NH 8/19/2009 MO 8/19/2009 8/19/2009 CA 8/19/2009 8/19/2009 CA 8/20/2009 8/20/2009 AR 8/20/2009 ME 8/20/2009 CO 8/20/2009 NJ 8/20/2009 KY 8/20/2009 KY 8/20/2009 MN 8/20/2009 NY 8/20/2009 IL 8/20/2009 TX 8/20/2009 IL 8/20/2009 NE 8/20/2009 GA 8/20/2009 MI 8/20/2009 TN 8/20/2009 IL 8/20/2009 NV 8/20/2009 NV 8/20/2009 CO 8/20/2009 8/20/2009 VI 8/20/2009 SC 8/20/2009 NM 8/20/2009 PA 8/20/2009 IL 8/20/2009 NY 8/20/2009 KS 8/20/2009 TN 8/20/2009 MI 8/20/2009 AZ 8/20/2009 AZ 8/20/2009 WI 8/20/2009 NY 8/20/2009 MO 8/20/2009 MI 8/20/2009 WA 8/20/2009 NC 8/20/2009 NM
38 42 54 11 1.1 14 18 14 2 12 9 14 5
38
57 0.5 0 9 11 21 14 5 4 5 12 56 46 12 0.3 4 16 21 15 10 39 5 12 11 58 18 14 4 11 4 1 35 1.3 1.9 17 0.3 13
57 0 0 9 11 21 14 5 4 5 12 56 46 12 0 4 16
54 11 1 14 18 14 2 12 9 14 5
15 10 39 5 12 11 58 18 14 4 11 4 1 35 1 1 17 0 13
F F F F 0.1 F F M M 0M F F F F F F 0.5 M 0M F M F F F M M F F F F 0.3 F F F F F F M M F F F F F M F F 0F M 0.3 M 0.9 M F 0.3 F M
8/19/2009 Client stated that she felt a tingling f 8/19/2009 BELL'S PALSY DIAGNOSED BY P 8/19/2009 6 hours following vaccine administra 8/19/2009 Sine the shot was given, pt. has had 8/19/2009 Vomiting, Fever, Seizure. 8/25/09 H 8/19/2009 Administered four vaccines during im 8/19/2009 large hives all over body appeared d 8/19/2009 Hives on chin, arms, legs, caps of s 8/19/2009 Child's father reported that the fever 8/19/2009 bad muscle pain, severe headache, 8/20/2009 PT COMPLAINED THAT INJECTIO 8/19/2009 Pt received the Gardasil series of sh 8/20/2009 ON 19 AUG 09, PT COMPLAINED 8/19/2009 Information has been received from 8/13/2009 Jan 2008 diagnosed Sensory Guilla 8/14/2009 Pt had vomiting, bloody diarrhea. Se 8/7/2009 Anaphylaxis, admitted to hospital. B 6/10/2009 Approx. 1 1/2 weeks after receiving 8/19/2009 Hives, rash, swelling of most of arm 8/20/2009 Had 2nd HPV vaccine 2/10/09; star 8/17/2009 Pt felt lightheaded/dizzy - No LOC, 8/10/2009 Pt was ok day of injections, got low 8/17/2009 6X8 cm area with redness - 3X3 cen 8/12/2009 4cm Red-firm-warm to touch Rx for 8/13/2009 Left deltoid warm, red, swollen, pain ### Approx. 1 hour post injection, pt. ca 8/14/2009 6-8-09 Presented to our ER with an 8/14/2009 VARIVAX vaccine given in right arm 8/17/2009 Awoke early morning with shallow b 8/5/2009 Inappropriate DTAP given (extra) an 8/14/2009 Mom states pt felt tired yesterday, li A couple of hours after first shot, my 8/18/2009 Took my three daughters to their do 8/20/2009 8/19/09 mother called clinic stating 8/20/2009 LOCAL REACTION, FEVER, CHILL 8/20/2009 While administering MMR vaccine p 8/20/2009 Initially loss of hair. Then dizziness 8/20/2009 Local reaction within 24hrs. But las 8/20/2009 About two weeks after I received the 8/20/2009 Patient started vomiting and having 8/20/2009 1st vaccination was on 07/15/08, sh 8/20/2009 Client developed fever of 100, vomi 8/20/2009 Red area to back of left arm the size 8/20/2009 LEFT SQ AREA LARGE SWELLING 8/20/2009 Cranky overnight after receiving vac 8/20/2009 Patient had Vaccinations at 8 am w 8/20/2009 Increased temperature leading to se 8/20/2009 started with a fever on 8/13/09 rash 8/20/2009 Patient had first Gardisil injection at 8/20/2009 HAD 1ST ROTATEQ 06/25/2009 AN 8/20/2009 Less than 24 hours after vaccine ad
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8/20/2009 VA 8/20/2009 UT 8/20/2009 CA 8/20/2009 NH 8/20/2009 SC 8/20/2009 GA 8/20/2009 FL 8/20/2009 NH 8/20/2009 ND 8/20/2009 ND 8/20/2009 OH 8/20/2009 PA 8/20/2009 IL 8/20/2009 IL 8/20/2009 OK 8/20/2009 GA 8/20/2009 CA 8/20/2009 MD 8/20/2009 NE 8/20/2009 8/20/2009 MA 8/20/2009 NC 8/20/2009 NC 8/20/2009 8/20/2009 8/20/2009 WA 8/20/2009 KY 8/20/2009 TX 8/20/2009 NC 8/20/2009 CA 8/20/2009 VA 8/20/2009 NE 8/20/2009 CA 8/20/2009 8/20/2009 8/20/2009 CO 8/20/2009 AZ 8/20/2009 WA 8/20/2009 IL 8/20/2009 MN 8/20/2009 MN 8/20/2009 AZ 8/20/2009 PA 8/20/2009 PA 8/20/2009 VA 8/20/2009 OH 8/20/2009 NC 8/20/2009 OR 8/20/2009 KS 8/20/2009 TX 8/20/2009 NC
0.6 20 0.2 13 32 16 10 15 10 20 15 11 11 0.1 45 13 1.8 18 27 18 23 15 54 20 54 70 4 5 8 24 15 65 0 30 4 11 10 26 12 66 12 11 5 10 5 74 4 11 11 11
0 20 0 13 32 16 0 10 15 10 20 15 11 11 0 45 13 1 18 27 23 15 54 20 54 70 4 5 8 24 65 0 30 4 11 10 26 12 66 12 11 5 10 5 4 11 11 11
0.6 M F 0.1 F M F F 0.5 M F F F F F F F 0.1 F F F 0.8 F F M F F F F F F F F F F U M F 0F F M F F M M F F F M F M F M M F F
8/20/2009 About 72 hours after DtaP vaccinati 8/20/2009 She started having "seizures" or "st 8/20/2009 Patient vomited and then became le 8/20/2009 Swelling, tenderness at the injection 8/20/2009 Cluster of itchy read rash on face, a 8/20/2009 Received varicella, TDAP, MCV4 on 8/20/2009 FEVER OF 105 ON 8/8/09 WENT T 8/20/2009 Developed itchy scattered vesicles 7 8/20/2009 ON July 21 had shot. On July 26 pa 8/20/2009 patient developed a hive appearanc 8/20/2009 FAINTING, DIZZYNESS HEADACH 8/20/2009 - approx 2 minutes post-vaccination 8/20/2009 Convulsive syncope 5min post vacc 8/20/2009 Client was given Tdap, Hep A, Men 8/20/2009 blood in stool 8/20/2009 Onset of flu-like symptoms ~4 hours 8/20/2009 RAISED AREA LOA, APPROX.70M 8/20/2009 01/30/09 with diarrhea (day 0 only); 8/20/2009 Large local reaction noted 2 days af 8/20/2009 Pain and redness X 1 day 8/20/2009 Shortly after receiving third dose of 8/20/2009 Within seconds of receiving vaccine 8/20/2009 Prompted seizures to reappeared. H 8/17/2009 This report might have been reporte 8/15/2009 I've had the same reaction to GARD 8/19/2009 The day after the vaccination, she d 8/20/2009 Herpes Zoster, R side breast (under 8/20/2009 Patient presented with vesicular les 8/20/2009 Left deltoid swelling & redness. 3 X 8/20/2009 On Aug. 18, 2009, patient came for 8/20/2009 Pt received Hep B #1 in her left arm 7/30/2009 15 yo developed herpes zoster in T 8/16/2009 Throat swelled/ made swallowing di 8/14/2009 Baby received varicella vaccination 8/10/2009 Date of inj 7/16/09, Date of event 7/ 8/20/2009 R upper arm significant edema, redn 8/20/2009 c/o Headaches, Right arm numbnes 8/20/2009 TDAP given left deltoid about 11:30 8/20/2009 ADACEL administered (L) deltoid 8/ 8/20/2009 Pt. has fever 99.0 - C/o SA last nigh 8/20/2009 Redness spreading into armpit/brea 8/20/2009 Sudden onset left sided chest pain a 8/19/2009 Left arm swelling one day after vacc 8/20/2009 98 degrees - not noticed until visit 4 8/20/2009 Tues PM 8/18/09 left arm red swolle 8/20/2009 After vaccination mom reports the p 8/20/2009 Patient presented to Doctor 8/20/20 8/20/2009 Left thigh 20 X 18 cm swelling / war 8/20/2009 08/20/2009 Other Red raised rash. 8/13/2009 L Deltoid erythematous wheal 8/20/2009 TDAP injection site left deltoid. Are
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8/20/2009 IL 8/20/2009 AR 8/20/2009 MO 8/20/2009 IA 8/20/2009 CA 8/20/2009 NM 8/20/2009 OH 8/21/2009 8/21/2009 NY 8/21/2009 8/21/2009 KY 8/21/2009 OR 8/21/2009 OH 8/21/2009 MI 8/21/2009 MI 8/21/2009 RI 8/21/2009 OH 8/21/2009 LA 8/21/2009 MD 8/21/2009 NH 8/21/2009 AZ 8/21/2009 TX 8/21/2009 WA 8/21/2009 IN 8/21/2009 IL 8/21/2009 IL 8/21/2009 NC 8/21/2009 SC 8/21/2009 NE 8/21/2009 RI 8/21/2009 PA 8/21/2009 AZ 8/21/2009 FL 8/21/2009 IN 8/21/2009 CO 8/21/2009 MA 8/21/2009 FL 8/21/2009 OH 8/21/2009 PA 8/21/2009 OH 8/21/2009 AL 8/21/2009 WA 8/21/2009 CA 8/21/2009 CA 8/21/2009 CA 8/21/2009 CA 8/21/2009 WA 8/21/2009 OH 8/21/2009 WI 8/21/2009 MT 8/21/2009 KS
0.3 1.1 26 1 9 1.3 1.3 1.4 25
0 1 26 1 9 1 1 1 25
16 63 81 46 0.4 1.3 5 0.7 14 4 26 12 12 74 0.2 5 71 18 41 11 15 0.1 3 48 15 75 24 54 31 53 0.2 20 14 14 0.2 53 39 4 11 5 14
16 63 81 46 0 1 5 0 14 4 26 12 12 74 0 5 71 18 41 11 15 3 48 15 75 24 54 31 53 0 20 14 14 0 53 39 4 11 5 14
0.3 M 0.1 M F 0M M 0.3 F 0.3 M 0.4 M F F F F F F 0.4 F 0.3 F M 0.7 F F F F M F F 0.2 F F F F F F M F F M F M F F F M 0.2 M M F F 0.2 F F M F F M F
8/20/2009 Blood in stool no Tx given. 1 wk po 8/20/2009 2 days w/ rash, Dx: chickenpox . 8/13/2009 Swollen glands on side shot admini 8/20/2009 103.4 temp 8/20/2009 Reaction at the injection site. Lump 8/20/2009 - Fever up to 101 x 72 degrees - Sw 8/17/2009 Mother called stating son broke out 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/19/2009 Initial report received on 17 August 8/6/2009 None. I gave Pentacel inadvertently 8/18/2009 15 days after varicella vaccine deve 8/12/2009 From knee up on left leg swollen. A 8/14/2009 Redness to thigh quarter sz. 8/13/09 Within 10 minutes of receiving vacc 8/17/2009 None stated. 8/17/2009 Patient received MMR injection left 8/13/2009 High fever, nausea, stiff neck 103 d 8/17/2009 5 min after rec GARDASIL, HAVRIX 8/12/2009 Itching - mostly on chest - arm and h 8/12/2009 Pt noticed right eyelid swollen. No o Extreme redness, warmth of left arm 8/20/2009 Injection site swollen and warm to to 8/20/2009 Dizzy, headache, increased heart ra 8/21/2009 Pain in chest and along shoulder bla 8/19/2009 Vasovagal syncope w/in 2 minutes 8/17/2009 Pain behind eye vomiting, nausea; p 8/11/2009 Patient was crying for about 6hrs; R 7/31/2009 5x7cm red area noted to LT injectio 8/18/2009 Rash (localized) 8/14/2009 Has large lump - tennis ball size at s 8/21/2009 Pt received PPV23 in his right arm o 8/21/2009 Patient noted a history of eczema o 8/21/2009 Two days of wide spread urticarial e 8/21/2009 Following my fourth rabies booster s 8/21/2009 Wide spread urticarial pruitic rash. N 8/21/2009 had seizure 3 days after vaccines g 8/21/2009 MULTIPLE SATELLITE LESIONS O 8/21/2009 She got very dizzy immediately afte 8/21/2009 Pt had Tdap and varicella shots 6/1 8/21/2009 Patients mother reports that at 2:00 8/21/2009 8-18-09 Pt with severe left arm indu 8/21/2009 Pt was initially vaccinated for smallp 8/21/2009 Was informed child was on Zithroma 8/21/2009 Arm where Tdap and varicella vacci 8/21/2009 8-20-09--Pt. came to medical center 8/21/2009 rapid heart beat,weakness of the lef
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8/21/2009 NC 8/21/2009 PA 8/21/2009 VA 8/21/2009 NC 8/21/2009 FL 8/21/2009 WI 8/21/2009 AZ 8/21/2009 WI 8/21/2009 MN 8/21/2009 MN 8/21/2009 8/21/2009 8/21/2009 8/21/2009 GA 8/21/2009 PA 8/21/2009 8/21/2009 TX 8/21/2009 CA 8/21/2009 TX 8/21/2009 TX 8/21/2009 IL 8/21/2009 NC 8/21/2009 KS 8/21/2009 MA 8/21/2009 TX 8/21/2009 NH 8/21/2009 AL 8/21/2009 MN 8/21/2009 MO 8/22/2009 CA 8/22/2009 CA 8/22/2009 TX 8/22/2009 MD 8/22/2009 CA 8/22/2009 FL 8/22/2009 TX 8/22/2009 MD 8/22/2009 OH 8/22/2009 WA 8/23/2009 MD 8/23/2009 NY 8/23/2009 WI 8/23/2009 FL 8/23/2009 IN 8/24/2009 AZ 8/24/2009 WV 8/24/2009 PA 8/24/2009 FL 8/24/2009 OH 8/24/2009 MD 8/24/2009 LA
0.2 39 14 39 10 4 71 18 82 52 52 1.4 71 7
12 4 12 55 11 11 5 14 72 1 23 4 17 55 2 40 14 16 14 4 53 22 38 45 67 1.5 40 14 0.4 1.8 67 74 2 16
0 39 14 39 10 4 71 18 82 -1
1 71 7
12 4 12 55 11 11 5 72 1 23 4 17 55 2 40 14 16 14 4 53 22 38 45 67 1 40 14 0 1 67 74 2 16
0.2 M F F F M M M F F 0.7 M F F 0.4 F M M M U F F M F M F M F F 0M F M F F 0.1 M M M M F M F F F F M 0.5 F F F 0.4 F 0.8 M F F 0M F
8/21/2009 PT WAS GIVEN THIRD HEP B TO 8/21/2009 Left deltoid swelling, pain, erythema 8/21/2009 Dizziness, nausea, vomiting starting 8/21/2009 Received vaccines at 4:30 pm. At 1 8/21/2009 Pt. was given the vaccine at 4:00 PM 8/21/2009 Arm swelling from elbow to shoulde 8/21/2009 Within a day after Shingles shot, I d 8/21/2009 Light-headed, dizzy, and nauseous 8/21/2009 Redness and swelling from site of in 8/21/2009 This case was reported by a healthc 8/21/2009 This case was reported and describ 8/21/2009 This case was reported in a literatur 8/21/2009 This female subject was enrolled in 8/22/2009 Noticed when went to bed last night 8/22/2009 Right deltoid area was a little pale 8 8/22/2009 Patient report soreness to right delto Fell to floor - pale, fainted. V/S take 8/21/2009 Pt. received (1) Tdap in (L) arm then 8/21/2009 Local reaction (L) upper arm/tricep a 8/21/2009 Varicella vaccine reaction started 24 8/21/2009 Pt given vaccine about 11 o'clock, A 8/21/2009 Knot in (L) arm 1 1/2 inch circle. 8/21/2009 Parent of client called reporting that 8/21/2009 Pt. had IZS 8-20-09, began wheezin 8/21/2009 Rec'd HPV #1 12-16-08- No reactio 8/21/2009 At 3:30 pm pt developed swelling sl 8/21/2009 Left thigh, red swollen warm to touc 8/21/2009 Developed fever, pain, redness & sw 8/21/2009 None Stated 8/20/2009 From the time of vaccination until ab 8/22/2009 fever 8/22/2009 A few days after the shot, he started 8/22/2009 My husband received the vaccinatio 8/22/2009 approx 12 hours after the shots my 8/22/2009 Pt was given shot on 08/18/09 in Le 8/22/2009 8 hours after shot: Tremors,vertigo,h 8/22/2009 Fever of 103, complaint of headach 8/22/2009 Arm soreness never went away afte 8/22/2009 Patient given vaccin afternoon of 8/ 8/23/2009 severe hives, itching, wheezing with 8/23/2009 Severe dizziness cuasing inability to 8/23/2009 Administered just prior to discharge 8/23/2009 Pt had a fever of 102.7 F taken und 8/23/2009 injection @ 2130--urticaria bilat han 8/18/2009 Diagnosed with Type 1 Diabetes Me 8/17/2009 Hypoxic brain injury after a possible 8/18/2009 Child received both vaccines in righ 8/17/2009 Received Shingles Vaccine ZOSTA 8/19/2009 Outbreak of shingles Post Vaccine R 8/23/2009 I saw him for well check up at 09:30 8/14/2009 Immediately following vaccine (abou
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8/24/2009 MN 8/24/2009 TN 8/24/2009 IL 8/24/2009 NC 8/24/2009 KS 8/24/2009 MA 8/24/2009 8/24/2009 CA 8/24/2009 8/24/2009 WY 8/24/2009 TX 8/24/2009 8/24/2009 VA 8/24/2009 CT 8/24/2009 KY 8/24/2009 LA 8/24/2009 LA 8/24/2009 CT 8/24/2009 CA 8/24/2009 TX 8/24/2009 VA 8/24/2009 OH 8/24/2009 CA 8/24/2009 WI 8/24/2009 CA 8/24/2009 NY 8/24/2009 MI 8/24/2009 CO 8/24/2009 TN 8/24/2009 MN 8/24/2009 TX 8/24/2009 MT 8/24/2009 MN 8/24/2009 MI 8/24/2009 TX 8/24/2009 FL 8/24/2009 TX 8/24/2009 SC 8/24/2009 SC 8/24/2009 TX 8/24/2009 VA 8/24/2009 MI 8/24/2009 PA 8/24/2009 NC 8/24/2009 MO 8/24/2009 MO 8/24/2009 VA 8/24/2009 FL 8/24/2009 MD 8/24/2009 KS 8/24/2009 OH
27 11 18 0.2 33 19 0.2
27 11 18 0 33 0
3 13 15
13 15
13
13
4 11 33 13 0.5 23 39 5 4 10 3 11 44 11 0.5 63 12 12 9 5 6 50 15 13 4 5 37 18 73 16 1 78 59 58 65 18 27
4 11 33 13 0 23 39 5 4 10 3 11 44 11 0 63 12 12 9 5 6 50 15 13 4 5 37 18 73 16 1 79 59 58 65 18 11
U F F 0.2 M F F 0.2 M M M F F F F F M M M M 0.5 F F F F M F M F F M 0.5 M F M M F F M M M F F F F F F F 0M M F M M M F
Left shoulder pain, decrease ROM a 8/14/2009 Pain- redness - firm - Golf ball size t 8/19/2009 Right leg had no feeling/wd not sup 8/19/2009 12 noon approx Received Pentacel 8/20/2009 7" length x 6" width. Redness, with Fainting and dizzy 1 hour after shot 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/12/2009 arm pain - severe fatigue, lethargy, 8/4/2009 Right arm injection site with large X 8/21/2009 Localized reaction to left thigh. 8/19/2009 Vaccines given on 8/11/09 (Tdap, M 8/11/2009 Patient states he developed a rash 8/21/2009 9:35AM pt. returns with c/o malaise, 8/21/2009 No adverse reaction noted to extra 8/17/2009 Client going into nursing school, rec 8/18/2009 Febrile illness t max 103. Severe my 8/20/2009 Area of induration & erythema at sit 8/19/2009 Redness & swollen where immuniza Local reaction: red, swollen, hard to 8/20/2009 Father states child began favoring le 8/22/2009 Patient had syncopal episode & fell 8/20/2009 Rt upper arm 2in x 2in reddened ha 8/24/2009 This case was reported by a healthc 8/24/2009 This case was reported by a healthc 8/24/2009 initial small erythema for 2 days, res 8/24/2009 Received vaccinations around 12:30 8/24/2009 Extensive Left Deltoid swelling, eryt 8/24/2009 Pt given outside of FDA approved a 8/24/2009 Vaccine administered 08/20/2009. C 8/24/2009 After patient received the immuniza 8/24/2009 anaphylaxisY(immediate) 8/24/2009 some temp, difficulty breathing, tired 8/24/2009 Mother reports fatigue and complain 8/24/2009 Received 4 year vaccines on 8-20-0 8/24/2009 Within a few days of the vaccination 8/24/2009 Recieved first hep b shot and IPV s 8/24/2009 Gave vaccines to pt while she was l 8/24/2009 Injection given on 08/20. Approx 3" 8/24/2009 Pt became dizzy 20 min. after first G 8/14/2009 Broke out with rash all over extremit 8/17/2009 8-14-09 Ball of left foot extremely so 8/24/2009 20 MINUTES AFTER RECEIVING H 8/24/2009 Patient complained of continued mu 8/24/2009 8/21/09 Received phone call from p 8/24/2009 Sean is complaining of muscle fatig 8/24/2009 Developed an increased heart rate
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8/24/2009 TX 8/24/2009 AL 8/24/2009 TX 8/24/2009 VA 8/24/2009 DC 8/24/2009 8/24/2009 UT 8/24/2009 MO 8/24/2009 MI 8/24/2009 TX 8/24/2009 CO 8/24/2009 VA 8/24/2009 CA 8/24/2009 AZ 8/24/2009 WI 8/24/2009 CA 8/24/2009 PA 8/24/2009 MI 8/24/2009 PA 8/24/2009 CA 8/24/2009 MO 8/24/2009 VA 8/24/2009 OH 8/24/2009 MI 8/24/2009 TX 8/24/2009 SD 8/24/2009 CA 8/24/2009 TX 8/24/2009 MD 8/25/2009 NC 8/25/2009 NC 8/25/2009 TX 8/25/2009 WA 8/25/2009 OH 8/25/2009 FL 8/25/2009 TN 8/25/2009 NC 8/25/2009 WI 8/25/2009 LA 8/25/2009 AL 8/25/2009 8/25/2009 HI 8/25/2009 8/25/2009 IA 8/25/2009 8/25/2009 AR 8/25/2009 CA 8/25/2009 KS 8/25/2009 NC 8/25/2009 GA 8/25/2009 OR
13 11 40 2 4 12 1 15 63 14 14 1 4 12 5 12 11 19 4 4 4 11 9 3 13 35 0.6 4 11 5 12 34 0.3 1.1 4 0.4 12 11 13 18 14
13 11 40 2 4 12 1 15 63 14 14 1 4 12 5 12 11 19 4 4 4 11 9 3 13 35 0 4 11 5 12 34 0 1 4 0 12 11 13
63 69 71 4 13 14 11 68 75
63 69 71 4 13 14 11 68 75
14
F F M 0.2 M F M 0M M F F F 0M M F F M F F F F M F F F F F 0.6 M M F F F M 0.3 F 0.1 M F 0.4 M F M F F F F M F F M F F M M F
8/24/2009 SWELLING AND REDNESS TO LE 8/24/2009 Long-term chronic nausea, chronic 8/24/2009 Reoccurring headaches, chronic fat 8/24/2009 loss of appetite & 102 degree fever; 8/24/2009 8/7/09- 4 y.o. Received immunizatio Swelling, redness, and itching of the 8/24/2009 On 9/28/08 he developed a tremor a 8/24/2009 8/10/09: Rash (small) on the tummy 8/24/2009 Shot given 8/19/09 -Weds- Onset o 8/24/2009 Report by parent of "nodule" develo 8/19/2009 4 days after HPV #3 and MENACTR 8/24/2009 Fever-developed 8 days after vaccin 8/24/2009 (R) deltoid reddened - size 8cm x 4c 8/20/2009 Sudden onset left sided chest pain a 8/21/2009 Began with true urticarial rash on 8/ 8/21/2009 Swollen, red, hard, hot. 8/20/2009 10 minutes following shot pt becam 8/24/2009 - Had rash and soreness developed 8/24/2009 8-19 developed swelling of face/han 8/24/2009 3.5cm indurated dark red. 6cm total 8/24/2009 Approx 2 1/2 cm x 3 cm area of red Erythema circumferentially 2/3, leng 8/24/2009 Child rec'd VARIVAX and HAV; left 8/29/2009 None 8/24/2009 Reports "feeling bad" about an hour 8/24/2009 8/13 - Vaccine given at 11 am - 8/14 9/19/2009 Low grade temp (100 degrees F) an 8/24/2009 Rash on upper thigh. Red and raise 8/24/2009 Pt received #2 varicella on 7/28/09. 8/20/2009 2 1cm. Blisters above sight where I 8/12/2009 Rash on legs. One leg shape of a tr 8/25/2009 Received booster dose of AVA 18 A 8/21/2009 Pt found dead Y in crib on 8/14/09. Pr 8/8/2009 2 days after my son received MMR 8/20/2009 Immediately after vaccines started t 8/21/2009 Intussusception 2 wks after receivin 8/14/2009 She was seeing black shapes, said 5/4/2009 This patient has been diagnosed wi 8/21/2009 Daughter was given two injections o 8/20/2009 This year my daughter and two of m 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/19/2009 Red swollen area (Lt) thigh, no feve 8/17/2009 Approximately 38 hrs after administ 8/20/2009 Vaccinations given on 8-10-09, scre 8/21/2009 Acute onset hives about 40-44 hrs a 8/20/2009 Received ZOSTAVAX (shingles vac 8/21/2009 "Quarter-sized" lump at injection site
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8/25/2009 OR 8/25/2009 MN 8/25/2009 OH 8/25/2009 MN 8/25/2009 MA 8/25/2009 MA 8/25/2009 OK 8/25/2009 PA 8/25/2009 AZ 8/25/2009 AR 8/25/2009 AR 8/25/2009 FL 8/25/2009 PA 8/25/2009 KS 8/25/2009 MO 8/25/2009 OH 8/25/2009 MI 8/25/2009 AL 8/25/2009 TX 8/25/2009 MI 8/25/2009 MI 8/25/2009 CA 8/25/2009 MO 8/25/2009 PA 8/25/2009 VA 8/25/2009 IL 8/25/2009 MI 8/25/2009 CA 8/25/2009 FL 8/25/2009 TX 8/25/2009 MI 8/25/2009 MA 8/25/2009 AZ 8/25/2009 CA 8/25/2009 CA 8/25/2009 MS 8/25/2009 MN 8/25/2009 CA 8/25/2009 CA 8/25/2009 ID 8/25/2009 TX 8/25/2009 WA 8/25/2009 WA 8/25/2009 DE 8/25/2009 ID 8/25/2009 NY 8/25/2009 CA 8/25/2009 AR 8/25/2009 CA 8/25/2009 FL 8/25/2009 IN
64 36 36 11 25 36 7 10 65 72 41 49 68 17 65 14 17 67 0 59 8 64 37 4 11 57 0.2 11 15
45 36 11 25 36 7 10 65 72 41 50 68 17 65 14 17 67 0
14 11 66 17 15 3 62 70 16 0.5
8 64 37 4 11 57 0 11 15 5 14 11 66 17 15 3 62 70 16 0
16 5 69 27 11 59 28 71 15 14
16 5 69 27 11 59 28 71 15 14
M F M F F F F F M M F F M M F F F F 0F U F M F M F F 0.2 F F F M F M U F F F F F F 0.5 M U M M F M M F F M F M
Has bitterness in mouth, unable to e 8/20/2009 Gradual onset pain, redness swellin 8/4/2009 Temperature of 103 F and fever like 8/19/2009 Bump at injection site - difficulty bre 8/14/2009 Erythema induration right deltoid. M 8/20/2009 Pt complained of "mild" shortness o 8/25/2009 Pt received varicella vaccination on 8/25/2009 Pt received varicella vaccine sub-Q 8/25/2009 S: pt returned to clinic 2 days after v 8/25/2009 Severe flushing, back pain, shortne 8/25/2009 Reaction started on July 31 - had so 8/25/2009 Pt's left arm began to swell x 3 days 8/25/2009 Sub normal temperature, Headache 8/25/2009 2 days after getting vaccine, arm be 8/25/2009 CELLULITIS, BUTTOCKS AT INJEC 8/25/2009 Patient received Menactra vaccine i 8/25/2009 3 minutes after client received5 vac 8/25/2009 Shingles vaccine received on 08/11 8/25/2009 Decedent isYa 7 day old neonate wh 8/25/2009 Subject in pneumococcal vaccine tr 8/25/2009 Child in for vaccinations, she had 2 8/25/2009 Patient with moderate to severe pai 8/25/2009 Received vaccine on 9/5/08. On 10 8/25/2009 Call from mother on 8/25/09. States 8/25/2009 Pt. received her Adacel booster and 8/25/2009 Client called on 8/24/09 that she ha 8/25/2009 2.5 mo Female received the Oral Ro 8/25/2009 redness, swelling and tenderness o 8/25/2009 Severe Gastritis, weakness, wt. loss 8/18/2009 Pt started sneezing, and eyes got v 8/25/2009 Received vaccine 08-24 PM. C/O di 8/25/2009 11 year old generally healthy male w 8/25/2009 Got slight rash on inner upper thigh 8/25/2009 24 hours post injection, high fever (m 8/25/2009 24 hours after injection had fever re 8/14/2009 Local reddness, warmth and swellin 8/17/2009 On 8/14 local reaction - red firm are 8/19/2009 Within 5 minutes of injection of ZOS 8/19/2009 Pt had reaction after giving HPV vac 8/19/2009 Within a couple of minutes of giving 8/14/2009 None. 8/18/2009 After receiving MENACTRA and He 8/18/2009 (L) arm swollen and red from elbow 8/17/2009 I had the vaccination for the shingle 8/19/2009 TWINRIX give IM in the dorsoglutea 8/19/2009 Itching at and around injection site a Inflammation at injection site - Eye a 8/12/2009 Developed hives 2 days after shot t 8/21/2009 Developed shingles L facial (V- 1 n 8/25/2009 As per patient - 2hrs after vaccines 8/25/2009 Received call from mother. Says ab
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8/25/2009 PA 8/25/2009 MA 8/25/2009 WA 8/25/2009 MI 8/25/2009 CA 8/25/2009 8/25/2009 OH 8/25/2009 MN 8/25/2009 TX 8/25/2009 TX 8/25/2009 PA 8/25/2009 GA 8/25/2009 NC 8/25/2009 NC 8/25/2009 WA 8/25/2009 NY 8/25/2009 IA 8/25/2009 NC 8/25/2009 VT 8/25/2009 WI 8/25/2009 LA 8/25/2009 WA 8/25/2009 OH 8/25/2009 TX 8/25/2009 SC 8/25/2009 IN 8/25/2009 TX 8/25/2009 CA 8/25/2009 8/25/2009 MA 8/25/2009 CT 8/25/2009 NC 8/25/2009 SC 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/26/2009 KY 8/26/2009 ID 8/26/2009 MN 8/26/2009 CA 8/26/2009 MO 8/26/2009 AL 8/26/2009 PA 8/26/2009 GA 8/26/2009 GA 8/26/2009 TX 8/26/2009 KS 8/26/2009 TN
15 8 11 1.6 60 72 48 8 1.3 0.9 3 66 5 5 50 25 5
15 8 11 1 60 72 48 8 1 0
15 12
15 12
11 4 24 1.1 11 12 49 77 5 4 1.7 6 9 0.2 2
11 4 24 1 11
0.2 63 85 5 19 4 1 1.3 1 10 13 11 11
0 63
66 5 5 50 25 5
49 77 5 4 1
0 2
5 19 4 1 1 1 10 13 11 11
M M M 0.6 M F F M M 0.3 F 0.9 M F M F F F M F M M F M M M M 0.1 M M U F F M M 0.7 F F F 0.2 F 0.1 M F F 0.2 F M F M M F 0M 0.3 F 0F M F M M
8/25/2009 Had flu vaccine - shortly after got lig 8/27/2009 Mother states after receiving vaccin 8/19/2009 Child had generalized non-febrile se 8/19/2009 DTAP given on 8-11-09 Hives on 88/25/2009 Mondays night noticed a red/pink kn Small raised red rash at site of injec 8/21/2009 Vaccine (TWINRIX #3) Administere 8/19/2009 Developed a lump Rt upper arm. It 8/19/2009 Developed blister link rash over both 8/25/2009 Rash all over body. 8/25/2009 Attended facility on 8-15-07. Rash e 8/19/2009 Patient noticed stinging during injec 8/24/2009 Within 30 minutes of injection of all 8/24/2009 Pt. returned to office approximately 8/14/2009 Received Hepatitis B vaccination (E 6/10/2009 Pt became pale approx 1/2 min afte 8/25/2009 Fever 103.0 8/22/09 8/14/2009 Information has been received from 8/25/2009 Syncope x 2 8/25/2009 Patient experienced fainting, and na 6/4/2009 Vesicular, blanching rash with pruiri 8/20/2009 Left deltoid red, swollen and painful 8/25/2009 Erythema multiforme, seen on 8/24/ 8/24/2009 10 Minutes after shot pt. complained 8/21/2009 Pt given shot Sat 830A. Returns at 8/25/2009 Following vaccination, pt. and his m Redness, warmth, firmness to uppe 8/21/2009 Facial edema ("puffy eyelids"). Incre 8/25/2009 3 days after vaccines patient develo 8/12/2009 Received DTaP, IPV in left arm 8/5/ 8/25/2009 6 d after DTaP given, patient recove 8/25/2009 Fever began a few hours after vacc ### A spontaneous non-serious report o 8/18/2009 Hive broke out on her body - Hypera 8/18/2009 Respiratory alway clearing her nose 9/25/2008 Flu like symptoms every time. Folde 9/25/2008 Vomiting, diarrhea, rocking back an 9/25/2008 Folded bowel movement, vomiting a 9/25/2008 Flu like symptoms, picky skin, thinni 8/25/2009 On 10-01-08 Y he complained of sore 8/20/2009 Shortly after vaccinated: broke out o 8/21/2009 Night tremors; upset agitated; not q 8/18/2009 Pt vaccinated smallpox 8/8/09; left a 8/19/2009 Swelling of arm at injection site with 8/3/2009 Had fever for 1st 2 sets of shots for 8/20/2009 Shot RXN left thigh red, sore, fever. 7/24/2009 Within 48 hours: High fever, irritabili 8/25/2009 Injection site is warm to touch, red & 8/26/2009 Morbilliform rash of trunk. 8/26/2009 Pt passed out after receiving vaccin 7/21/2009 Approx 5 min post vaccine became
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8/26/2009 UT 8/26/2009 MI 8/26/2009 IL 8/26/2009 AZ 8/26/2009 PA 8/26/2009 8/26/2009 GA 8/26/2009 NC 8/26/2009 AR 8/26/2009 MN 8/26/2009 MI 8/26/2009 VA 8/26/2009 GA 8/26/2009 NY 8/26/2009 MI 8/26/2009 MN 8/26/2009 MI 8/26/2009 IL 8/26/2009 TN 8/26/2009 VA 8/26/2009 ND 8/26/2009 NY 8/26/2009 VI 8/26/2009 CO 8/26/2009 VI 8/26/2009 MI 8/26/2009 IN 8/26/2009 OH 8/26/2009 IL 8/26/2009 MO 8/26/2009 NE 8/26/2009 CT 8/26/2009 CO 8/26/2009 TX 8/26/2009 SC 8/26/2009 IA 8/26/2009 MN 8/26/2009 WA 8/26/2009 CA 8/26/2009 RI 8/26/2009 OR 8/26/2009 AZ 8/26/2009 TX 8/26/2009 MN 8/26/2009 OH 8/26/2009 NV 8/26/2009 CA 8/26/2009 TX 8/26/2009 NC 8/26/2009 MN 8/26/2009 MN
4 33 72 17 17
4 33
61 11 4 33 12 20 18 54 59 4 5 74 0.2 16 14 1.3 11 11 44 75 17 63 1.1 10 31 19 65 8 13 31 51 18 1.4 48 66 13 67 41 2 11 4 44 0.1 37 12
61 11 4 33 12 20 18 54
17 17
4 5 74 0 16 14 1 11 11 44 75 17 63 1 10 31 19 65 8 13 30 51 18 1 48 66 13 67 41 2 11 4 44 0 37 12
M F F F F F F M M M F F F F M M M M 0.2 F F F 0.3 M F M F M F F 0.1 M M F F F U M F F F 0.4 M F F F F F 0.1 M F M F 0.1 M M M
8/26/2009 Pain in leg with TETNUS shot, fever 8/25/2009 Initial report received on 13 August 8/24/2009 Initial report received on 14 August 8/25/2009 Information has been received from 8/25/2009 Information has been received from 8/25/2009 Information has been received from 8/26/2009 BREAKOUT IN OOZING SENSITIV 8/26/2009 Pt developed swelling and itching a 8/26/2009 Had Gma Seizures starting at 10pm 8/26/2009 This individual received the flu shot 8/26/2009 Multiple Uriticariae Shoulders. Raise 8/26/2009 Pt became pale,weak c/o dizziness 8/26/2009 Adverse event onset was 8-08-09 8/26/2009 Within a few days I became ill with a 8/26/2009 Subject in pneumococcal vaccine tr 8/26/2009 By 5:30 on the night of his immuniza 8/26/2009 pulled up mcir the night before didn 8/26/2009 4 days after vaccination I experienc 8/26/2009 Patient received Rotarix oral vaccin 8/26/2009 Initial near syncopal episode at time 8/26/2009 Severe headaches/migraines which 8/26/2009 7/30/09 temp 101, febrile sz, seen b 8/26/2009 mother and client report at this vist ( 8/26/2009 Developed dizziness, high-fever (10 8/26/2009 Patient had swelling in the back of t 8/26/2009 Pt has been on Humira and methotr 8/26/2009 After a few minutes patient lost cons 8/26/2009 Local reaction to LT posterior upper 8/26/2009 Pt. vaccinated 7/31/09, His mother, 8/26/2009 Within 15 minutes of vaccination, pt 8/26/2009 The patient received the Tdap vacc 8/26/2009 First acute schizophrenic episode (d 8/26/2009 Patient developed 2 inch red circle a 8/26/2009 Varicella vaccine administered to rig 8/26/2009 pt recieved vaccine on 8/24/09. Pt s 8/26/2009 PATIENT RECEIVED THIS VACCIN 8/26/2009 She recieved the flu vaccine on 8-1 8/26/2009 Redness and swelling, the size of g 8/26/2009 Extensive local reaction 8/26/2009 Had vaccine at approx 9:30am felt s 8/26/2009 Large red and swollen area around 8/26/2009 1515: Client c/o nuasea after vaccin 8/26/2009 Developed shingles in nose the nex 8/26/2009 Deltoid muscle weakness. Pain in d 8/25/2009 21 days after primary Varicella vacc 8/26/2009 MENACTRA shot given in LD Wedn 8/26/2009 Redness with swelling to R Deltoid. 8/26/2009 Itching, redness, warmth, swelling. 8/25/2009 Excessive prolonged crying, rednes 8/26/2009 Pt feels fine- When I called to his ho 8/26/2009 Pt feels fine - when I called to his ho
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8/26/2009 IL 8/26/2009 MN 8/26/2009 TX 8/26/2009 MI 8/26/2009 KS 8/26/2009 AZ 8/26/2009 TX 8/26/2009 TX 8/26/2009 CA 8/26/2009 IL 8/26/2009 TX 8/26/2009 OH 8/26/2009 CA 8/26/2009 VA 8/26/2009 CA 8/26/2009 IL 8/26/2009 TX 8/26/2009 FL 8/26/2009 NY 8/26/2009 TX 8/26/2009 PA 8/26/2009 WV 8/26/2009 PA 8/26/2009 PA 8/26/2009 FL 8/26/2009 FL 8/26/2009 CA 8/26/2009 WA 8/26/2009 MA 8/26/2009 ME 8/26/2009 ME 8/26/2009 ME 8/26/2009 NY 8/27/2009 SD 8/27/2009 8/27/2009 8/27/2009 8/27/2009 8/27/2009 WA 8/27/2009 GA 8/27/2009 PA 8/27/2009 IL 8/27/2009 CA 8/27/2009 CA 8/27/2009 IN 8/27/2009 MI 8/27/2009 SC 8/27/2009 8/27/2009 VA 8/27/2009 MI 8/27/2009 TN
4 11 0.6 4 5 31 13 16 4 4 1.5 0.2 28 61 5 1.6 4 4 0.2 4 28 4 4 0.2 0.4 0.2 4 0.5 5 5 5 5 1.4 12
4 11 0 4 5 31 16 4 4 1 28 61 5 1 4 4 4 28 4 4 0 0 0 4 0 5 5 5 5 1 12
17 14
14
52 13 13 11 4 5 49 53 4 11 31 44
52 13 13 11 4 5 49 53 4 11 31 44
F M 0.6 M F M M F F F M 0.5 M M M F F 0.6 M F F U M F F M 0.2 F 0.3 F 0.2 F F 0.5 M M F F F 0.4 M F F F F F M F F F M F F F F F F F M
8/26/2009 Develop rash that resembles Rubell 8/24/2009 Seen 2 days after vaccine with prog 8/26/2009 "none reported by parent". 8/26/2009 Lt leg (anterior thigh) 10 x 10 cm ery 8/25/2009 Minor hives, swelling around eye. N 8/26/2009 Pt received shot 8pm on 8/24/09. A 8/26/2009 Red, swollen X 4 days. 8/22/2009 Headache. Momentarily passed out 8/26/2009 Redness swollen to (L) deltoid. 8/26/2009 Erythema & mild pain at site of DTa 8/24/2009 None provided. 8/27/2008 Initial report received on 21 August ### This non-serious case was received 2/17/2009 Initial report received from a health 5/26/2009 This non serious case was received 4/13/2009 Case is linked with case 2009-0055 3/6/2009 This event was received from a hea 5/11/2009 This non serious case was received 6/19/2009 Initial report was received 16 June 2 6/26/2009 This case was received from a heal 7/31/2008 Initial report was received 18 July 20 10/7/2008 Initial report received on 25 August 9/30/2008 This case was received from a heal 9/29/2008 This case was received from a heal 9/18/2008 Initial information was received from 9/18/2008 Initial information was received from 12/8/2008 Initial non-serious report received fr ### Initial report was received 19 Novem 1/6/2009 Initial report was received 17 Decem 5/26/2009 This case was received from a heal 5/26/2009 This case was received from a heal 5/26/2009 This case was received from a heal 6/2/2009 A 17 months old male patient receiv 8/19/2009 CNP present after incident. 1550- B 8/26/2009 InformationYhas been received from 8/26/2009 Information has been received from 8/26/2009 Information has been received from 8/26/2009 Initial and follow-up information was 8/26/2009 Information has been received from 8/21/2009 Initial report received on 17 August 8/25/2009 Initial report received on 21 August 8/21/2009 Developed Hodgkins lymphoma. We 8/19/2009 About 3-4 hours after vaccine admin 8/7/2009 L humeral area 5x5cm red in duratio 8/21/2009 9 cm across, redness, warm to the t 8/20/2009 Report of muscle ache throughout e 8/21/2009 Severe pain at injection site & arm ( 8/19/2009 Localized erythema & swelling of De 8/20/2009 18-20 hrs after injection, pt develop 8/19/2009 L deltoid soft tissue abscess. 7/23/2009 "I wake up at 4:30 AM with my Rt ja
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8/27/2009 TN 8/27/2009 VA 8/27/2009 PA 8/27/2009 TX 8/27/2009 MN 8/27/2009 TX 8/27/2009 TX 8/27/2009 FL 8/27/2009 NH 8/27/2009 NH 8/27/2009 NY 8/27/2009 NH 8/27/2009 VA 8/27/2009 CT 8/27/2009 MD 8/27/2009 NY 8/27/2009 8/27/2009 IL 8/27/2009 LA 8/27/2009 PR 8/27/2009 NJ 8/27/2009 NC 8/27/2009 TX 8/27/2009 MI 8/27/2009 CA 8/27/2009 TX 8/27/2009 WI 8/27/2009 FL 8/27/2009 8/27/2009 CA 8/27/2009 FL 8/27/2009 MI 8/27/2009 NJ 8/27/2009 CA 8/27/2009 MD 8/27/2009 DE 8/27/2009 MO 8/27/2009 WA 8/27/2009 CO 8/27/2009 CA 8/27/2009 NC 8/27/2009 NM 8/27/2009 CA 8/27/2009 CA 8/27/2009 CA 8/27/2009 CA 8/27/2009 IL 8/27/2009 CA 8/27/2009 MI 8/27/2009 NC 8/27/2009 SD
4 12 20 65 5 12 16 18 18 9 16 11 8 33 44 22 0.3 72 60 16 15 65 10 0.2 0.3 4 12 4 11 68 40 11 66 6 27 1 1 40 38 28 24 65 42 5 72 19 0.9 59 5 69
4 12 20 65 5 12 16 18 18 9 16 11 8 33 47 22 0 72 60 16 15 65 10 0 0 4 12 4 11 68 40 11 53 66 6 27 0 1 40 29 18 24 65 42 5 72 18 59 5 69
F F F F F M M F M M F M F M M F 0.3 M M F F F F M 0.2 F 0.4 M F M M M F F M F F F F 0M 0F F F F M F M M F F M M M M
7/29/2009 (1) 4 + Local reaction (L) arm (2) C/ 8/27/2009 Received 1st GARDASIL 8/13/09; m 8/27/2009 Few minutes after shots, patient had 8/27/2009 Reports a lump as large as a baseb 8/19/2009 On 8/18/09, day following vaccinatio 8/26/2009 9x10 cm warm\pink\non-tender; 2x3 8/25/2009 30min after shot-BOOSTRIX mom r 8/26/2009 Patient had Tdap and GARDASIL th 8/21/2009 Patient started to experience warmt 8/21/2009 Patient developed tenderness, redn 8/21/2009 Injection site shows a swollen lump 8/21/2009 Redness, swelling, and tenderness 8/24/2009 8-10-09 Received varicella vaccine. 8/27/2009 Approximately 20 hrs after administ 8/27/2009 knots on arm at vaccine site that did 8/27/2009 Pt. was a 22 yr old Female, inproce 8/27/2009 Rotavirus Vaccine administered on 8/27/2009 Pt was due to be discharged after u 8/27/2009 80mm red circle 8/27/2009 MOTHER REFERS THE PATIENT 8/27/2009 APPROX. 20 SECONDS AFTER RE 8/27/2009 Hives developed on face and neck w 8/27/2009 Vomitting; Loss Consciousness with 8/27/2009 Pentacel along with IPV was admin 8/27/2009 HAIR FALLING OUT 8/27/2009 Patient left clinic after vaccinations a 8/27/2009 redness, hardness & swelling, mildly 8/27/2009 CLIENT COMPLAINING OF PAIN A 8/27/2009 mild localized erythema 7 X 5.5 cm 8/27/2009 DAY 2 - SORE, TENDER, ITCHING 8/27/2009 REC'D FLU VACCINE @9AM. @ 1 8/27/2009 Rt Deltoid swollen, red, hot,itchy an 8/27/2009 developed fever 101 degrees 12 hr 8/27/2009 Zostavax administered on 8/10/200 8/27/2009 PT LEFT ARM (DELTOID AREA) B 8/27/2009 Patient has had moderate to severe 8/27/2009 Febrile seizure, temp 104.3(tempora 8/27/2009 High fever (102.2) and Fever Seizur 8/27/2009 After about 10 minutes after receivin 8/27/2009 VET CALLED BACK REPORTING P 8/27/2009 Pt. presented to clinic for second M 8/27/2009 RASH AND ITCHING COVERING W 8/27/2009 65 y/o female/employee who presen 8/27/2009 Vet reporting tender, warm and sligh 8/27/2009 RIGHT THIGH RED, SWOLLEN AN 8/27/2009 4 episodes of atrial fibrillation (new o 8/27/2009 1st vaccine: 11/28/08; Rash on han 8/27/2009 SWELLING AND REDNESS WITH 8/27/2009 Shoulders, hips, neck weakness, m 8/27/2009 (L) lateral upper thigh 13x13 cm, lig 8/27/2009 Patient has a rash at rt side T5 & T1
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8/27/2009 MA 8/27/2009 VT 8/27/2009 NE 8/27/2009 MT 8/27/2009 NJ 8/27/2009 CA 8/27/2009 PA 8/27/2009 WI 8/27/2009 NY 8/27/2009 IA 8/27/2009 WA 8/27/2009 NM 8/27/2009 PA 8/27/2009 CA 8/27/2009 MA 8/27/2009 WA 8/27/2009 MA 8/27/2009 HI 8/27/2009 MI 8/27/2009 KS 8/27/2009 WI 8/27/2009 WI 8/28/2009 KY 8/28/2009 NJ 8/28/2009 TN 8/28/2009 PA 8/28/2009 8/28/2009 IN 8/28/2009 8/28/2009 NC 8/28/2009 VA 8/28/2009 VA 8/28/2009 CT 8/28/2009 NY 8/28/2009 ME 8/28/2009 MI 8/28/2009 WI 8/28/2009 GA 8/28/2009 WI 8/28/2009 VA 8/28/2009 VA 8/28/2009 VA 8/28/2009 IL 8/28/2009 IN 8/28/2009 PA 8/28/2009 IA 8/28/2009 AR 8/28/2009 TX 8/28/2009 AR 8/28/2009 VA 8/28/2009 KY
48 4 12 12 16 8 16 12 5 12 11 9 1 4 21 10 54 10 0.6 5 11 15 1.3 0.5 0.2 18 26
48 4 12 12 16 8 16 12 5 12 11 9 1 4 21 10 54 10 0 5 11 15 0 0 0 18 26
0.2 31 28 18
0 31 28 18
18 52 17 26 1 11 34 20 11 64 72 24 6 3 10 5 4
52 17 26 1 11 34 20 11 64 72 24 6 3 10 5 4
F F M M F M F F F M F M 0M F F F M M 0.6 F M F M 0.2 F 0.5 M 0.2 M F F F U 0.2 M F F F M F F F F 0M F F F M M F F M F F F F
8/27/2009 Pt received ADACEL vaccine on 8/2 8/27/2009 Upper arm redness, swelling & disc 8/27/2009 Upper L) arm red swollen, itchy area 8/27/2009 10 x 7 cm red erythema. Decreased 8/27/2009 Induration of 1 cm diameter at site o 8/26/2009 Erythema, swelling, pain to site of in 8/25/2009 1118AM 3 minutes after shots were 8/27/2009 Pt fainted, subsequent headache di 8/27/2009 none 8/27/2009 Patient received MENACTRA and V 8/26/2009 Redness, slight swelling, hot to touc 8/27/2009 None stated. 8/27/2009 8/28/09 Was shaking and off balanc 8/27/2009 1 d after immunization; pt developed 8/27/2009 Reported local redness and pruritis. 8/26/2009 Redness, slight swelling, hot to touc 8/27/2009 Administered DTAP instead of inten 8/27/2009 4:55 p: Decreased O2 saturation, 70 7/17/2009 Fever. Hive type rash widespread. 8/27/2009 Rash slight warm area to left leg. Ashley received MENACTRA & TDA Patient received Tdap and MENACT 8/28/2009 Fever that was 103.5, Vomiting, Ra 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/25/2009 Fever 103.8 later on day of vaccine 8/28/2009 "Trouble breathing & getting air" R e 8/28/2009 Started with hives on wrist, itching a 8/24/2009 Second dose of GARDASIL given to 8/26/2009 Syncopal episode after receiving TD 8/25/2009 8/24/09 around 1:30pm after I gave 8/28/2009 Red, Rash on left upper arm, warm 8/28/2009 11:30am-Pt was given Tdap, HPV, 8/28/2009 Patient received FLu Mist on 25Aug 8/28/2009 The pt developed fever later in the d 8/28/2009 Mother called stating child had red s 8/28/2009 7/9/2009 Associate reports cold sx , 8/28/2009 Pt's mom called and says that expi 8/28/2009 Pt presented to clinic 2 days after a 8/28/2009 Chills, sweats, body aches, light-hea 8/28/2009 Received pneumovax at about 10am 8/28/2009 Patient developed hives and itching 8/28/2009 No adverse events noted to date. 8/28/2009 None noted at present. But client go 8/28/2009 NO Adverse Events to date. 8/28/2009 Tired, sleepy after vaccines. 2 am 8/28/2009 Patient presented on 8/27/09 with re
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8/28/2009 AR 8/28/2009 MI 8/28/2009 VA 8/28/2009 IL 8/28/2009 WA 8/28/2009 WI 8/28/2009 WI 8/28/2009 NC 8/28/2009 CA 8/28/2009 OK 8/28/2009 UT 8/28/2009 NY 8/28/2009 AZ 8/28/2009 ID 8/28/2009 TX 8/28/2009 AK 8/28/2009 OH 8/28/2009 TX 8/28/2009 MO 8/28/2009 CA 8/28/2009 WA 8/28/2009 PA 8/28/2009 WA 8/28/2009 ND 8/28/2009 IA 8/28/2009 MA 8/28/2009 OH 8/28/2009 NE 8/28/2009 MI 8/28/2009 NY 8/28/2009 NM 8/28/2009 GA 8/28/2009 MA 8/28/2009 AZ 8/28/2009 OR 8/28/2009 AZ 8/28/2009 NC 8/28/2009 MA 8/28/2009 CO 8/28/2009 MA 8/28/2009 MA 8/28/2009 MA 8/28/2009 PA 8/28/2009 WA 8/28/2009 8/28/2009 MN 8/28/2009 TX 8/28/2009 IN 8/28/2009 MA 8/28/2009 VA 8/29/2009 NY
4 8 4 76 82 17 35 5 63 16 28 63 11 71 14 25 15 6 17 10 0.5 5 19 51 12 15 12 12 17 11 73 3 13 11 11 5 63 90 15 11 11 12 69 48 4 68 17 5 11 5 5
4 8 4 76 82 17 35 5 63 16 28 63 11 71 14 25 15 6 17 10 0 5 19 51 12 15 12 12 17 11 73 3 13 11 11 5 63 90 15 11 11 12 69 48 4 68 17 5 11 5 4
F M F F F M F M F F F F M F F F F M F M 0.5 M F F M F F F M F F M F F F M F M F F F M M F F F F F M M M M
8/28/2009 NO ADVERSE EVENTS TO DATE 8/28/2009 Patient left the office and came imm 8/28/2009 Swelling of Left arm & shoulder and 8/28/2009 Client recieved Pnuemovax 23 Rt a 8/28/2009 Patient took 2nd dose of Vivotif on e 8/28/2009 Fainting on and off for about 20 min 8/28/2009 8/19 2:30 noticed itching, 3:00 notic 8/28/2009 2 TO 3 MINUTES AFTER RECEIVI 8/28/2009 Pox-like structure on the arm where 8/28/2009 None noted 8/28/2009 The pneumvax vaccine was adminis 8/28/2009 Tenderness, pruitic, macular rash a 8/28/2009 After vaccination parent and child le 8/28/2009 Client called EIPHD on 8/27/09 repo 8/28/2009 8/25/2009: VZV#2 given SQ to Righ 8/28/2009 Pt had a left leg pain withing hours a 8/28/2009 between shot 2 and 3 started having 8/28/2009 The patient was seen 2 days after th 8/28/2009 Developed migrane headache 8/27/2009 1605 Administered Hep A and VZV 8/28/2009 10/31/08 Pt seen in office for vomiti 8/28/2009 TC received by grandmother; states 8/20/2009 Patient developed ASCUS PAP and 8/28/2009 Child broke out with pox-like rash a 8/27/2009 Patient was given ADACEL first with 8/28/2009 8/24 afternoon- pt received vaccine 8/27/2009 Patient had low grade fever and hea 8/28/2009 Large welt measuring 4x3 on back o 8/27/2009 Joint swelling to include digits, knee 8/27/2009 When child woke up next morning a 8/28/2009 Stated the night of 25 Aug 09 she d (L) thigh erythematous w/ clearing p 8/28/2009 Pt. had nasal flu mist. Fell back in w 8/28/2009 Patient received MENACTRA 0.5cc 8/28/2009 11x18 cm area of well demarcated e 8/28/2009 Left deltoid swelling, red, hot touch. 8/28/2009 About 2 hrs following vaccine he aw 8/28/2009 full blown case of Zost 2 wks after 8/28/2009 After administration GARDASIL pt w Tdap expired on 5/2/09 and was ad Tdap expired 5/2/09 and was admin Tdap expired on 5/2/09 and was ad 8/24/2009 Pt had herpes zoster outbreak. 8/27/2009 Swollen lymph nodes under right ar 8/28/2009 Pt. given vaccines on 8/24/2009; ca 8/28/2009 Severe swelling and redness down 8/28/2009 Collar bone sore. Bump on left side 8/21/2009 Large amt swelling next AM redness 8/28/2009 Pt. Received vaccines in office. Whe 8/29/2009 8-18-09 Erythema, swelling at site. T 8/29/2009 24 hours after vaccination the patien
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8/29/2009 NY 8/29/2009 PA 8/29/2009 CA 8/29/2009 CA 8/29/2009 NE 8/30/2009 OH 8/30/2009 LA 8/30/2009 CA 8/30/2009 AZ 8/30/2009 CA 8/31/2009 NJ 8/31/2009 NJ 8/31/2009 OH 8/31/2009 8/31/2009 IN 8/31/2009 IN 8/31/2009 OH 8/31/2009 8/31/2009 AZ 8/31/2009 AZ 8/31/2009 OH 8/31/2009 OH 8/31/2009 8/31/2009 LA 8/31/2009 NE 8/31/2009 LA 8/31/2009 IL 8/31/2009 CA 8/31/2009 WI 8/31/2009 TX 8/31/2009 MO 8/31/2009 AZ 8/31/2009 OR 8/31/2009 MI 8/31/2009 ID 8/31/2009 FL 8/31/2009 TX 8/31/2009 NY 8/31/2009 MI 8/31/2009 GA 8/31/2009 FL 8/31/2009 MI 8/31/2009 MN 8/31/2009 TX 8/31/2009 IL 8/31/2009 GA 8/31/2009 NY 8/31/2009 MI 8/31/2009 MO 8/31/2009 CA 8/31/2009 MO
11 65 0.5 15 5 21 8 62 32 62
11 65 0 15 5 21 8 62 32 62
31 70
31 70
12 16 15 7 4 18 13 17 12 5 77 4 17 4 3 16 53 18 5 4 26 3 14 19 74 35 37 4 15 39 31 15 48 61 15
15 7 4 18 13 17 12 5 77 4 17 3 16 53 18 5 4 26 3 14 19 73 35 37 4 15 39 31 15 48 61 15
M F 0.5 F F M M M F M M M M F F M U F F F M M F F F F F F M M M M F M F M F M M F M F F F M M F F F F M M
8/29/2009 Pt. complained that he wasn't feelin 8/29/2009 Patient received the vaccine today a 8/29/2009 Fever to 103 degrees 8/29/2009 fatigue, fainting, dizziness and seizu 8/28/2009 (L) upper thigh swollen to softball si 8/30/2009 Constant tingling in right hand. Red 8/30/2009 Hives. Received Dexamethasone IM 8/30/2009 Week of NOv. 24th did not have ene 8/30/2009 Vaccine was given on a Wednesday 8/30/2009 Vaccinated 8/28/09 about 4 p.m. Fi 5/12/2009 Expired vaccine used (expired drug 5/12/2009 Expired vaccine used (Expired drug 8/26/2009 This case was received from a heal 8/27/2009 Initial report received on 18 August 8/27/2009 Initial information received on 19 Au 8/27/2009 Initial report was received 19 Augus 8/27/2009 Initial report was received 24 Augus 8/28/2009 Information has been received via in 8/28/2009 Information has been received from 8/23/2009 Daily intermittent headaches, fatigu 8/25/2009 Received vaccines and left office to 8/27/2009 My daughter had the series of GAR 8/25/2009 My daughter received all three injec 8/20/2009 See copies of pt's record 7/31/09. 8 8/26/2009 Local redness & swelling at injection 8/26/2009 Rash 5 days after shot around site r 8/27/2009 Headache started shortly after injec 8/27/2009 Pt began to swell on (LF) leg. 8/26/2009 Client received MCV4 and TDAP. A TM 101 at 50 + hrs after injection w 8/28/2009 Gave client TD by mistake. Should 8/27/2009 Developed fever of 100 last night an 8/21/2009 Pt reported "rash on abd and groin a 8/25/2009 Urticaria. Rx BENADRYL 25 mg P. 8/28/2009 Swelling in R thigh, redness - tende 8/28/2009 Guillan - Barre syndrome. Respirat 8/31/2009 Onset of pruritic and painful papular 8/28/2009 Large area of erythema and blisters 8/31/2009 Patient presented in the office on 8/ 8/31/2009 large erythematous edematous patc 8/31/2009 Headache, Fever, Facial Swelling, H 8/31/2009 Inflammation a few days after vaccin 8/31/2009 Redness with orange peel texture, s 8/31/2009 Swollen red left arm. hot sensation 8/31/2009 Approx. 10 minutes after receiving T 8/31/2009 Toxic Drug reaction; Severe dehydr 8/31/2009 Sore and numbness in arm 8 hours 8/31/2009 Client became lightheaded, pale an 8/31/2009 Patient received vaccination at prim 8/31/2009 Adverse reaction to Shingles vaccin 8/24/2009 Reaction started 45 minutes after T
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8/31/2009 MI 8/31/2009 MI 8/31/2009 AR 8/31/2009 VA 8/31/2009 MN 8/31/2009 MO 8/31/2009 TN 8/31/2009 OR 8/31/2009 GA 8/31/2009 CA 8/31/2009 WA 8/31/2009 WA 8/31/2009 OH 8/31/2009 IN 8/31/2009 CA 8/31/2009 IN 8/31/2009 IN 8/31/2009 IN 8/31/2009 AZ 8/31/2009 WI 8/31/2009 OH 8/31/2009 NE 8/31/2009 FL 8/31/2009 IA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CO 8/31/2009 IL 8/31/2009 PA 8/31/2009 VA 8/31/2009 IA 8/31/2009 NJ 8/31/2009 MT 8/31/2009 MA 8/31/2009 IN 8/31/2009 NH 8/31/2009 NC 8/31/2009 NC 8/31/2009 IN 8/31/2009 WI 8/31/2009 SC 8/31/2009 VA 8/31/2009 OH 8/31/2009 TX 8/31/2009 AZ 8/31/2009 IN 8/31/2009 OR 8/31/2009 8/31/2009 IL
9 61 6 4 36 32 32 2 13 4 82 70 0.3 1 4 14 29 62 15 14 34 12 4 31 4 63 4 0.5 9 5 61 5 4 16 5 5 20 0.4 16 38 1.9 5 0.4 44 19 15 52 0.6 17 8 2
9 61 6 4 36 32 32 3 13 4 82 70 0 1 5 14 29 62 15 14 34 12 4 31 4 63 4 0 9 5 61 5 4 16 5 5 20 0 16 38 5 0 44 19 15 52 0 17 8 2
F F M F F M M M F M F M 0.4 M 0M M F F F F F M F F F F M F 0.5 F F F F F M F M F F 0.4 F F F F M 0.4 F F F F F 0.6 F F U 0F
8/31/2009 24 HOURS AFTER SHOTS SHE BR 8/31/2009 24 hours after vaccination patient de 8/31/2009 Within an hour after receiving immu 8/31/2009 6 days after vaccines were given pa 8/31/2009 Flu shot received 08/24/09 @ 10:30 8/31/2009 Shortly after receivcing vaccinations 8/31/2009 swelling of lower lip, soreness of thr 8/31/2009 Redness, heat, swelling and discom 8/31/2009 Patient received vaccine on 8/17/09 8/31/2009 CELLULITIS RIGHT THIGH. KEFLE 8/31/2009 redness at the site of injection. the r 8/31/2009 Maculopapular rash of trunk and ex 8/31/2009 urticarial rash 5 minutes following P 8/31/2009 <20 red papules on trunk, not itchy, 8/31/2009 none 8/31/2009 MOTHER REPORTED CHILD HAD 8/31/2009 Patient complains of severe pain in 8/31/2009 chills, sweats, body ache, difficulty s 8/31/2009 After receiving vaccine daughter c/o 8/27/2009 N, stomach, dizzy, HA, backache, c 8/31/2009 Headache, tiredness, nausea, diarrh 8/31/2009 Area around injection site red & bum 8/31/2009 8-31-09 mother phoned, client ok ev 8/31/2009 Severe myalgia - fatigue - started 8/ 8/28/2009 Pt received vaccine on 8-26-09 on 8 8/31/2009 Fever to 103 F with shaking chills da 8/31/2009 None Stated 8/31/2009 Infant developed edema, redness/p 8/31/2009 VARIVAX administered 8/28/09 to R 8/28/2009 Redness, swelling & induration at in 8/31/2009 Injection site reaction (redness; abo 8/14/2009 Approximately 36 hours after vax ad 8/28/2009 Pt began having rash on leg admini 8/31/2009 Headache, fatigue. Local swelling, r 8/21/2009 Pt. returned to clinic 20 minutes afte 6/25/2009 See attached 8/25/2009 Fever 100.4, chills, H/A, swollen lips 8/24/2009 Post vaccine fever. Temperature ele 8/25/2009 Per pts. mother, pt. started experien 8/26/2009 Shots given and instructed to use co 8/24/2009 Mild case of chicken pox. 8/5/2009 Noted orange sized, red, hard, warm 8/24/2009 Diarrhea/ Hematocrit leading to sev Pt received TDAP (BOOSTRIX) on 8/25/2009 Patient called our office 4 hours afte 8/12/2009 Jerking, shaking, "locked up" (2 min 8/24/2009 By 08/22/09 around 3:30 pm there w 8/21/2009 Temp up to 105 degrees duration 2 8/24/2009 Pt had HPV, Hep A, & Verasella. S Swelling of LA, red, hot. 8/31/2009 Presented to office with rash - Bega
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8/31/2009 OH 8/31/2009 CA 8/31/2009 MD 8/31/2009 WV 8/31/2009 8/31/2009 AZ 8/31/2009 OR 8/31/2009 OR 8/31/2009 AZ 8/31/2009 MN 8/31/2009 LA 8/31/2009 FL 8/31/2009 NC 8/31/2009 MS 8/31/2009 CA 8/31/2009 LA 8/31/2009 OR 8/31/2009 OR 8/31/2009 IL 8/31/2009 8/31/2009 FL 9/1/2009 TX 9/1/2009 ME 9/1/2009 PA 9/1/2009 MI 9/1/2009 MS 9/1/2009 TN 9/1/2009 FL 9/1/2009 OH 9/1/2009 MD 9/1/2009 9/1/2009 OH 9/1/2009 TX 9/1/2009 WA 9/1/2009 NJ 9/1/2009 9/1/2009 OK 9/1/2009 TX 9/1/2009 AZ 9/1/2009 CA 9/1/2009 MT 9/1/2009 CA 9/1/2009 OH 9/1/2009 HI 9/1/2009 HI 9/1/2009 LA 9/1/2009 OK 9/1/2009 ID 9/1/2009 WA 9/1/2009 TX 9/1/2009 GA
9 4 65 5 37 8 1.1 1.1 4 11 0.5 30 15 5 20 1.1 55 10 80 71 2 54
9 4 65 5 37 8 1 1 4 11 0 30 15 5 20 1 55 10 80 71 2 54
1.7 18 5 0.2 48 9 7 6 49 11 12 6 0.5 0.6
1 18 5 0 48 9 7
17 19 18 1.7 5 12 11 56 10 11 54 12
17
49 11 12 6 0
18 1 5 12 11 56 11 54 12
F F F M F M 0.1 M 0.1 M M M 0.5 M M F F M 0.1 F F M F F 0.4 M F F 0.7 M M F 0.2 F F F M M M F F F U 0.6 M F M F F 0.7 F M F F F M F F F F
8/28/2009 Erythema & swelling upper arm (16 8/28/2009 Skin rash & swelling 6x7 cm. Requir 8/24/2009 PNEUMOVAX 8/17/09 developed h 8/26/2009 Pt received Hep A vaccine on 8/25/ 8/26/2009 Developed suddenly around 21 May 8/24/2009 Left arm 6 inch erythematous area. 8/21/2009 Fever, vomiting. 5 cm swelling and e 8/21/2009 Fever, vomiting, diarrhea, and fussin 8/26/2009 Slight swelling and redness to inject 8/31/2009 Rash, low grade fever, fatigue, head 8/21/2009 Fever 103 degrees. Lt thigh swollen 8/26/2009 2-3 day after flu like symptoms, leth 8/24/2009 After administration of GARDASIL v 8/19/2009 Pt. displayed redness at the site of i 12 days following vaccination pt dev 8/12/2009 Rash. Fussiness. 8/10/2009 8/10/09 - Pt in for HEP B #3 - Repo 8/18/2009 Pt was given MENACTRA before he 8/31/2009 Back & thigh pain within 24 hrs afte 8/31/2009 Cold sores 8/27/2009 Parent reported increased swelling 9/1/2009 Shingles Vaccine on Left arm: 1st d 8/26/2009 Was admin. 8/21/09. Noticed reactio 8/27/2009 Left thigh became red and swollen o 8/21/2009 24 hours after vaccine broke out in 8/25/2009 Rash - red, raised - to chest, back, s 8/26/2009 See attached sheets. 8/27/2009 This spontaneous case was receive 8/31/2009 Information has been received from 8/31/2009 Swelling in (L) arm - site of where va 8/31/2009 Information has been received from 8/24/2009 Approx 9-10:00pm on day of immun 8/24/2009 Both vaccines administered in same 8/24/2009 Presented to clinic 4/30/07 with 2d m 8/29/2009 Mother states patient ran a fever of 8/31/2009 Information has been received from 8/20/2009 Stop sleeping nights, fever, irritabilit 8/24/2009 None 8/28/2009 Patient had Varicella vaccination ab 8/31/2009 Information has been received from 8/27/2009 Pt. given Hep A VFC, instead of He 8/26/2009 Pt received vaccine on 8/14/09. Pt 8/25/2009 Pt. broke out in a rash, swelling, vom 8/28/2009 Fever to 102, night of GARDASIL # 8/28/2009 Fever to 102, night of GARDASIL a None. 8/26/2009 None stated. Pt received hep A (L deltoid) and AD 8/26/2009 Redness and swelling of injection si 8/24/2009 Both arms between shoulders and e 7/21/2009 I received the shingles vaccine on 2
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9/1/2009 9/1/2009 IL 9/1/2009 WV 9/1/2009 NC 9/1/2009 FL 9/1/2009 9/1/2009 VA 9/1/2009 NC 9/1/2009 NC 9/1/2009 NJ 9/1/2009 NY 9/1/2009 WA 9/1/2009 VA 9/1/2009 CO 9/1/2009 LA 9/1/2009 WI 9/1/2009 MA 9/1/2009 VT 9/1/2009 MA 9/1/2009 PA 9/1/2009 GA 9/1/2009 MN 9/1/2009 PA 9/1/2009 WI 9/1/2009 WI 9/1/2009 OK 9/1/2009 MS 9/1/2009 TX 9/1/2009 GA 9/1/2009 IL 9/1/2009 MD 9/1/2009 NE 9/1/2009 ID 9/1/2009 MS 9/1/2009 KY 9/1/2009 TX 9/1/2009 DE 9/1/2009 MI 9/1/2009 AZ 9/1/2009 IL 9/1/2009 IL 9/1/2009 GA 9/1/2009 NH 9/1/2009 PA 9/1/2009 NY 9/1/2009 KY 9/1/2009 OH 9/1/2009 MI 9/1/2009 OH 9/1/2009 MA 9/1/2009 IA
11 68 14 46 15 34 37 4 10 11 21 11 60 4 12 12 17 46 1 0.2 4 5 12 12 1 25 17 77 20 14 73 5 11 0.1 14 1 4 3 48 32 78 13 12 1 0.3 5 1 7 6 4 0.3
11 14 46 15 34 37 4 10 11 21 11 60 4 12 12 17 46 1 0 4 5 12 12 1 25 17 77 20 14 73 5 11 0 14 1 4 3 48 32 78 12 1 0 5 1 7 6 4 0
F F F F F M M F M M F M F M M M F F 0M 0.2 F M F F M 0M M F F F F F M M 0.1 F F 0M F M F F F M M 0M 0.3 F M 0.1 F F M M 0.4 F
8/30/2009 Female vaccinated with GARDASIL 8/30/2009 Vaccinated with ZOSTAVAX for shin 8/20/2009 Fainting/feeling hot. Placed patient 9/1/2009 Received ADACEL 8/27/09 - 8/28/0 8/21/2009 On 8/10/09 - 7 pm client taken to ER 8/31/2009 On 27 April 2009 he received AVA # 8/27/2009 This 37 year old AD US Navy office 9/1/2009 No adverse symptoms noted. 9/1/2009 Swelling redness pain warmth of lef 8/28/2009 Within 1 hour child developed angry 8/26/2009 Pt. developed chills, fever, SOB afte 8/27/2009 Telephone call from parent reporting 8/26/2009 24 hours after receiving vaccine, be 8/26/2009 Erythema and inflammation onset a 8/17/2009 About 30 min - 1 hr after vaccines p 8/27/2009 Passed out. Stomach pain. 8/27/2009 Near syncope - some chest pain & d 8/25/2009 HA, neck stiffness, myalgias and pa 8/26/2009 Developed <12 erythematous papul 8/27/2009 Hep B-dose #3 given at age 8 wks b 8/27/2009 Swelling, inflammation, bruising, wa 8/27/2009 Redness, warmth, slight bruising to 8/27/2009 Left deltoid area redness, itching wi 8/27/2009 Passed out. Stomach pain. 8/26/2009 Local hypersensitivity reaction to MM 8/20/2009 Isolated pox developed on right foot 7/23/2009 Severe headache with fever 100 de 8/28/2009 Shot on 8/19/09. Next day large red 9/1/2009 This case was reported by a healthc 9/1/2009 Patient received HPV #3 on 07/13/0 Dizziness (within 10 minutes of FLU 9/1/2009 Erythema multiforme within 24 hour 9/1/2009 A couple hours after vaccines L side 9/1/2009 Student Nurse gave vaccines to you 8/20/2009 Extreme fatigue- persistent, precede 9/1/2009 Net like rash, itching, 12 days after 9/1/2009 Mother reported high fever and fron 8/31/2009 Approx. 10-20 minutes after receivin 8/31/2009 Persistent pain; numbness in injecti 9/1/2009 Symptoms of feeling overheated, ta 9/1/2009 After receiving her shots pt c/o shor 9/1/2009 Within 2-4 days of receiveing menac 9/1/2009 Per patient and mother, Shad felt "fu 9/1/2009 Ryan (22 pounds, 7 oz; 31 inches) h 9/1/2009 Intussusception. Failed reduction. R 9/1/2009 Patient had high fever spikes of 104 8/31/2009 Within three days had head to toe ra 9/1/2009 According to mom approximately 59/1/2009 Developed hives around injection si 9/1/2009 Varicella and MMR vaccines given o 9/1/2009 After my daughter's 4mo check up a
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9/1/2009 IL 9/1/2009 FL 9/1/2009 KS 9/1/2009 VA 9/1/2009 PA 9/1/2009 NJ 9/1/2009 MN 9/1/2009 OH 9/1/2009 NC 9/1/2009 AL 9/1/2009 UT 9/1/2009 AL 9/1/2009 CA 9/1/2009 IL 9/1/2009 MD 9/1/2009 IL 9/1/2009 CO 9/1/2009 NC 9/1/2009 WA 9/1/2009 LA 9/1/2009 UT 9/1/2009 CA 9/1/2009 VA 9/1/2009 GA 9/1/2009 CA 9/1/2009 NY 9/1/2009 AL 9/1/2009 TX 9/1/2009 NE 9/2/2009 WI 9/2/2009 AL 9/2/2009 OK 9/2/2009 OH 9/2/2009 NM 9/2/2009 TX 9/2/2009 PA 9/2/2009 PA 9/2/2009 NC 9/2/2009 IN 9/2/2009 IL 9/2/2009 NC 9/2/2009 NC 9/2/2009 NC 9/2/2009 VA 9/2/2009 LA 9/2/2009 ID 9/2/2009 VA 9/2/2009 AZ 9/2/2009 WA 9/2/2009 KY 9/2/2009 VA
0.5 16 18 8 9 11 73 20 72 5 5 10 70 8 56 12 16 48 24 13 15 74 61 1 30 1.8 61 0 2 15 70 12 50 13 4 14 14 43 17 25 12 16 5 55 13 12 11 93 0.3 4 0.8
0 16 18 8 9 11 20 72 5 5 10 70 8 56 12 16 48 24 13 15 74 61 1 30 1 61 0 15 70 12 50 13 4 14 14 43 17 25 12 16 5 55 13 12 11 93 0 4 0
0.5 F F F F F M F F F F F F F M F M F F M F M F F 0F M 0.8 M F 0F M F F F F F M M M F F F F M F F F U M F 0.3 F F 0.8 M
9/1/2009 received vaccineson 8/4/09. On 8/6 9/1/2009 Bell's palsy (unilateral). 9/2/09 Cons 9/1/2009 Patient fainted and fell to floor hittin 9/1/2009 Received Hep A and Flumist, left ro 9/1/2009 Child received TD, IPV,HEP A,MMR 8/31/2009 syncope, occured about 2 min after 9/1/2009 Subject in pneumococcal vaccine tr 9/1/2009 Severe leg cramps in the calves 9/1/2009 Patient reports a rash, fever and he 9/1/2009 Had a rash with blisters over some p 9/1/2009 Patient came to clinic on 8-17-09 co 9/1/2009 On 8/21/09 Mother reported child ha 9/1/2009 10 cm x 6.5cm mild erythema left ar 9/1/2009 1 day following varicella administrat 9/1/2009 client had twinrix vaccine (3rd dose) 9/1/2009 4 cm erythematous oval shaped are 9/1/2009 Patient administered Hep A and HP 9/1/2009 Approximately 10-12 hours after rec 9/1/2009 Pt had satellite lesions 1/2 an inch t 9/1/2009 Stiffening and aching muscles, ches 9/1/2009 HIGH FEVER 102.4, HEADACHE 9/1/2009 pt recevied flu shot on left arm,and 9/1/2009 Her whole arm(on which vaccine wa 9/1/2009 Approx. 4 hours after receiving MMR 9/1/2009 Vertigo and stomach cramps beginn 9/1/2009 Superficial skin reaction occurred th 9/1/2009 Zoster L chest 9/1/2009 Dr. went did physical & came out th 8/18/2009 A serious, spontaneous report of me 8/27/2009 Lg reddened area - Warm & itchy rt 9/1/2009 Information has been received from 9/1/2009 Information has been received from 8/11/2008 I received 2 of the 3 HEPATITIS B V 8/25/2009 Aggression, seizures, rapid heart ra 8/27/2009 Swelling and erythema to site; exten 8/28/2009 After receiving immunizations at offi 8/26/2009 None stated 8/28/2009 Patient went to ER 8/13/09 with com 8/25/2009 Bradycardia, arrythmias, heart block 8/28/2009 More than normal bleeding at time o 8/25/2009 Angioedema 8 cm on right posterior 8/25/2009 Angioedema noted in right posterior 8/25/2009 Erythema on right arm - posterior 3 8/25/2009 Fever, chill, muscle pain all over, bo 8/27/2009 Severe hair loss. Headaches. 10/14 Broke out in rash on 8/18/09, seen i 8/29/2009 Pt developed chickenpox 10 days a 9/2/2009 Face swollen, eyes swollen, itching 8/28/2009 Day of vaccine administration, patie 8/27/2009 Localized reaction at site of injection 8/28/2009 Approx < 2 hrs after HEP B vaccine
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9/2/2009 CO 9/2/2009 CO 9/2/2009 MI 9/2/2009 IL 9/2/2009 TX 9/2/2009 NJ 9/2/2009 MN 9/2/2009 NV 9/2/2009 AL 9/2/2009 MO 9/2/2009 IA 9/2/2009 IN 9/2/2009 VA 9/2/2009 TN 9/2/2009 MI 9/2/2009 TX 9/2/2009 WA 9/2/2009 SC 9/2/2009 MI 9/2/2009 OR 9/2/2009 WA 9/2/2009 MA 9/2/2009 NJ 9/2/2009 VA 9/2/2009 NV 9/2/2009 WA 9/2/2009 CA 9/2/2009 OK 9/2/2009 NJ 9/2/2009 NC 9/2/2009 PA 9/2/2009 PA 9/2/2009 WA 9/2/2009 AK 9/2/2009 CO 9/2/2009 TX 9/2/2009 OH 9/2/2009 OR 9/2/2009 CA 9/2/2009 NM 9/2/2009 NM 9/2/2009 OH 9/2/2009 CA 9/2/2009 TX 9/2/2009 ME 9/2/2009 NY 9/2/2009 IL 9/2/2009 SC 9/2/2009 IN 9/2/2009 WI 9/2/2009 TX
56 80 8 34 4 56 17 59 47 0.2 43 41 4 32 6 31 46 54 1.3 32 1.3 13 12 0.6 62 61 61 65 0.2 0.3 0.2 11 56 12 76 11 51 17 12 17 3 7 13 10 0.3 1.3 62 2 14
8 34 4 73 56 17 59 47 0 43 41 4 31 6 31 46 54 1 32 1 13 12 0 62 61 60 65 0 0 0 56 12 76 11 51 17 12 17 3 7 13 10 0 1 62 2 14
U U F M M F F F F F 0.2 F F F M F M M F F 0.3 F M 0.3 M F F 0.6 M F F F M 0.2 F 0.3 M 0.2 M M F F F M F U F F F M F F F 0.3 F 0.3 M M 0.2 M F
Reported general malaise - Temp u Reported: Didn't feel good, shaky, a 9/1/2009 Behavior changes with in 1-2 days. 9/2/2009 PAIN, ITCHING, REDNESS AND S 9/2/2009 Within 12 hours of flu shot injection 9/2/2009 nausea, Vomiting, throat tightness w 9/2/2009 At the time of the vaccination, she fe 9/2/2009 Sore arm evening of vaccination. W 9/2/2009 Employee developed large welped, 9/2/2009 The day after vaccine was administe 9/2/2009 Generalized tonic clonic seizure as 9/2/2009 Received shot in clinic around 2:00 9/1/2009 Patient experienced wheezing and c 9/2/2009 Administered PENTACEL vaccine in 9/2/2009 8/5/2009 Soreness of Right upper a 9/2/2009 SITE OF INJECTION IS SWOLLEN 9/2/2009 Patient inadvertantly innoculated sp 9/2/2009 Recieved Tdap in L deltoid on 08/29 9/2/2009 Induration and redness/swelling in a 9/2/2009 Diffuse urticaria after receiving DTa 9/2/2009 Patient with pustular lesions on eryt 9/2/2009 My child suffered severe reactions t 9/2/2009 About 5 minutes after receiving Gar 9/2/2009 Outbreak of pruritic small papules o 9/2/2009 Vaccines were given and we left Dr 9/2/2009 Patient reports that she had a Shing 9/2/2009 developed "headache,chills, fever o 9/2/2009 Pt developed 5 painful, fever blister 9/2/2009 Patient had pneumovax 9 am on 8/2 9/2/2009 Patient developed fever of 104 in th 8/24/2009 Patient developed abdominal disten 8/24/2009 Increased number of apneic and bra 9/2/2009 Swelling & redness in right arm. 9/1/2009 Patient was given 0.5 mL of flu vacc 9/12/2009 Pt given flu shot (told to hang aroun 9/2/2009 Patient developed large rash that sh 9/1/2009 11 am 8/31/09 vaccines administere 9/2/2009 Redness, warmth in shoulder and s Redness, swollen tender to touch. 9/2/2009 Pt had nausea & vomiting after GAR 9/2/2009 Right arm red, swollen. 9/1/2009 Pt got GARDASIL # 3 given as injec 9/2/2009 Erythema, edema, hyperemia meas 9/2/2009 Cough, runny nose congestion snee Imm Friday- Saturday had fever 10 9/2/2009 FEVER ONSET 9/1 at 9PM,CHILLS 9/2/2009 7/2/09 irritable since 7/01/09 noc ; d 9/2/2009 Patient administered PCV, Hep A, a Rash, hives, tongue swelling, itching 9/2/2009 Approximately 1/2 hr. after receiving 8/31/2009 Redness and swollen right arm. AU
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9/2/2009 WA 9/2/2009 NC 9/2/2009 TN 9/2/2009 WA 9/2/2009 OR 9/2/2009 IL 9/3/2009 HI 9/3/2009 OR 9/3/2009 9/3/2009 CA 9/3/2009 VA 9/3/2009 CA 9/3/2009 9/3/2009 KY 9/3/2009 NC 9/3/2009 MI 9/3/2009 KY 9/3/2009 IN 9/3/2009 FL 9/3/2009 PA 9/3/2009 NJ 9/3/2009 AR 9/3/2009 VA 9/3/2009 ND 9/3/2009 PA 9/3/2009 PA 9/3/2009 NC 9/3/2009 NY 9/3/2009 IL 9/3/2009 OR 9/3/2009 CA 9/3/2009 NJ 9/3/2009 TX 9/3/2009 WI 9/3/2009 CA 9/3/2009 ND 9/3/2009 MI 9/3/2009 9/3/2009 NV 9/3/2009 NE 9/3/2009 CA 9/3/2009 CA 9/3/2009 MI 9/3/2009 TX 9/3/2009 MA 9/3/2009 CA 9/3/2009 AZ 9/3/2009 WA 9/3/2009 GU 9/3/2009 WA 9/3/2009 CO
19 11 15 47 46 33 21 18 72 19 25 19 18 0.2 11 65 17 0.7 20 56 4 41 16 35 65 16 18 42 16 62 11 0.8 65 39 15 11 2 17 15 12 3 4 51 72 3 4 41 0.7 0.3 11 57
19 11 15 47 46 21 18 19 24
0 11 65 17 0 20 56 4 41 16 35 65 16 18 42 15 62 11 0 65 39 15 11 1 17 15 12 3 4 51 72 3 4 41 0 0 11 57
M M M F F F M M M F F F F 0.2 M F F F 0.7 F M F F F F F F M F F F F F 0.8 F M M F M 1M F F F M F F F M F F 0.7 F 0.3 M F M
9/2/2009 19 y/o male, US Army AD PFC, dev 9/2/2009 Pt presented. Was given TDAP. W 8/19/2009 Arthalgia of joints. Stiffness of extre 9/2/2009 Severe Bruising. 9/2/2009 Severe GI, vomiting, diarrhea. Neg 9/6/2009 Received Hep B vaccine IM @ 08:3 9/3/2009 The patient was febrile to 102.1 with 8/28/2009 Edema of lips, red eyes, hives on ar 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 This case was received from a heal 9/3/2009 No known adverse Y reactions. Aunt r 9/3/2009 CHILD RETURNED WITH MOTHER 9/3/2009 Received Influenza and PPV23 vac 9/3/2009 Recieved menactra on june 24 2009 9/3/2009 That evening the child became cong 9/3/2009 After receiving Hepatitis A vaccine p 9/3/2009 began developing symptoms approx 9/3/2009 Red, raised and very hot at site of s 9/3/2009 Tightness in throat, radiating to che 9/3/2009 Patient claims that she felt lighthead 9/3/2009 Member was administered the Anth 9/3/2009 Patient noticed a small red rash aro 9/3/2009 Fever 104 9/3/2009 A 3 cm round erythromatous indura 9/3/2009 The patient received the flu shot on 9/3/2009 patient lying on exam table. While ly 9/3/2009 PAINFUL, SWOLLEN, WARM TO T 9/3/2009 PT BECAME PALE, WEAK AND DI 9/3/2009 swelling, red and hot at the site, crie 9/3/2009 Patient received Pneumovax injectio 9/3/2009 Warmth, redness, pain at site of vac 9/3/2009 PT BECAME PALE, WEAK AND DI 9/3/2009 9/1/2009 Jonathan experienced a ra 9/3/2009 Pt developed rash on whole body, it 9/3/2009 Had seizure aporx 1 month after ha 9/3/2009 Fever per patient's mother (temp no 9/3/2009 About 2 weeks after vaccine admini 9/3/2009 Redness, swelling warmth to L thigh 9/3/2009 R arm red swollen warm "band" pos 9/3/2009 Pain in left tricep 1 hour following sh 9/3/2009 A 72 year old female came in to the 9/3/2009 The patient developed a headache 9/3/2009 DTap #5 administered to left Deltoid 9/3/2009 R Arm - site of injection swollen red 9/3/2009 Death. 9/11/09 Y Autopsy received DO 9/3/2009 Vomiting started within 2hrs after va 9/3/2009 Redness & swelling around site of in 9/3/2009 Fever, chills, aches, hard to move, h
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9/3/2009 PA 9/3/2009 VA 9/3/2009 CA 9/3/2009 NC 9/3/2009 TN 9/3/2009 IL 9/3/2009 DE 9/3/2009 CA 9/3/2009 WA 9/3/2009 WA 9/3/2009 CA 9/3/2009 NV 9/3/2009 AZ 9/3/2009 IL 9/3/2009 IN 9/3/2009 KY 9/3/2009 CO 9/3/2009 CA 9/3/2009 VA 9/3/2009 OR 9/3/2009 CO 9/3/2009 NC 9/3/2009 GA 9/3/2009 GA 9/3/2009 GA 9/3/2009 GA 9/3/2009 NY 9/3/2009 CA 9/3/2009 OR 9/3/2009 WA 9/3/2009 CA 9/3/2009 GA 9/3/2009 KS 9/3/2009 MN 9/3/2009 VA 9/4/2009 FL 9/4/2009 NY 9/4/2009 AR 9/4/2009 FL 9/4/2009 CA 9/4/2009 IL 9/4/2009 MO 9/4/2009 MO 9/4/2009 OR 9/4/2009 FL 9/4/2009 CT 9/4/2009 OH 9/4/2009 PA 9/4/2009 WI 9/4/2009 NM 9/4/2009 MD
12 12 1.7 15 14 5 60 5 1.1 1.1 4 22 11 62 50 1 3 11 19 51 16 1.8 23 19 11 18 15 4 3 0.3 54 11 66 65 49 0.2 13 62 26 4 11 11 68 15 12 71 5 69 45 13 8
12 12 1 15 14 5 60 5 1 1 4 22 11 62 50 1 3 11 19 51 16 1 23 19 11 18 15 4 3 0 11 66 65 49 0 13 62 26 4 11 11 68 15 12 71 5 69 45 13 8
M M 0.7 F M M M F M 0.1 F 0.1 M M F F F F 0M F M F U F 0.8 M F F M F F M M 0.3 F F F F F F 0.2 M M F M F F F U F F F M F F F F
9/2/2009 Fever x 1 day. Itching, vomiting x 1. 9/3/2009 Received VARIVAX # 2 on 08/31/09 9/3/2009 skin r thigh Erythemic rash with few 9/3/2009 Patient presented to office on 9/1/09 9/3/2009 Pain and soreness to left deltoid on 9/3/2009 Patient had reaction to shots give o 9/3/2009 Large rash at injection site, radiating 9/3/2009 Vaccine 8/27/09 8/29/09 Urticaria sw 9/3/2009 Quarter size hive at site of VARIVAX 9/3/2009 Quarter size hive @ site of Varicella 9/3/2009 Small rash all body with no SOB or 9/3/2009 Stiffness on left side of neck and the 9/3/2009 Patient had syncopal episode after 9/3/2009 Right arm hurts, patient says can't li 8/26/2009 Swollen, red, hot area - hard to mov 9/3/2009 Non febrile seizure on 9/12/2009. L 9/3/2009 Fever - 103 degrees, stomach-ache 9/1/2009 Received phone call from mother, c 9/3/2009 Pt. had generalized reaction at injec Pt reports onset of fever, chills & all 9/2/2009 Youth here today complaining of sw 9/4/2009 Immunizations were given 8-28-09. 6/17/2009 No adv s/sx. 7/1/2009 Client reported feeling weak and un 7/28/2009 Right arm swollen, red, and warm to 4/14/2009 MCV given in left deltoid at approxim 8/31/2009 Local reaction with varicella vaccine 9/3/2009 Left thigh 10 mm X 8 mm red, inflam 9/2/2009 Low grade fever started last night re 9/3/2009 Within day or two of vaccine started 9/3/2009 Urticaria around the injection site. P 8/17/2009 Swollen, red area where varicella va 9/1/2009 On 8/29/09- morning Pt noticed a sw 8/29/2009 Upper arm turned black/blue first nig Swelling erythema warmth around s 6/8/2009 Fever 101-105 w/in 24hrs of receivin 8/31/2009 Transverse myelitis of acute onset o 9/1/2009 Within 24 hrs I had a red rash at the 8/28/2009 Pt received MMR vaccine on 8/19/0 8/28/2009 Right deltoid swollen, red, warm to t 8/27/2009 By the evening. Child had redness, 8/27/2009 None stated. 9/15/09 PCP Medical With erythema, redness to (L) latera 8/29/2009 Within 1 hour of receiving the injecti 8/31/2009 Pt passed out while in hall after rece 9/1/2009 Pt diagnosed with shingles 9-1-09. 9/1/2009 Soon after vaccines petechial rash n 8/31/2009 Patient had redness and itching at t 8/31/2009 Urticarial rash beginning 2 days afte 8/31/2009 Mother reported hive-like eruption a 9/2/2009 Erythema of upper arm & few vesicl
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9/4/2009 MS 9/4/2009 OH 9/4/2009 NC 9/4/2009 NC 9/4/2009 OH 9/4/2009 MN 9/4/2009 KY 9/4/2009 MS 9/4/2009 9/4/2009 WI 9/4/2009 CA 9/4/2009 WI 9/4/2009 MI 9/4/2009 VA 9/4/2009 NY 9/4/2009 GA 9/4/2009 NY 9/4/2009 TN 9/4/2009 CA 9/4/2009 OH 9/4/2009 CA 9/4/2009 CA 9/4/2009 NJ 9/4/2009 MI 9/4/2009 MO 9/4/2009 AK 9/4/2009 MD 9/4/2009 VA 9/4/2009 VA 9/4/2009 IL 9/4/2009 KY 9/4/2009 TX 9/4/2009 CO 9/4/2009 TX 9/4/2009 KS 9/4/2009 IA 9/4/2009 IL 9/4/2009 ND 9/4/2009 PA 9/4/2009 TX 9/4/2009 TX 9/4/2009 WY 9/4/2009 WA 9/4/2009 IN 9/4/2009 GA 9/4/2009 IA 9/4/2009 GA 9/4/2009 TX 9/4/2009 KS 9/4/2009 TX 9/4/2009 CT
3 21 12 1 20 15 1 30
3 21 12 1 20 15 0 30
11 51 13 4 65 29 11 45 66 57 4 26 0.5 10 15 74 15 19 14 1.3 0.3 12 27 14 76 50 37 82 66 39 4
11 51 13 4 65 29 11 45 66 56 4 26 0 10 15 74 15 19 14 1 0 12 27 14 76 50 37 82 66 39 4 4 65 11 13 1 13 11 48 75 69 57
65 11 13 1.3 13 11 48 75 69 57
F F M 0F F F 1F F F M F M M F M M F M F M F 0F M F M F M M 0.3 M 0.4 F F F F F M F F F F M M F F M 0.3 M F F F F F F
4/24/2009 Hives and slight shortness of breath 8/31/2009 Given Td on 8/28/09 along with PPD 8/31/2009 Vesicular rash - 17 days post vaccin 9/4/2009 Received 12 month immunizations o 8/19/2009 8-14-09 - 8-19-09 pt c/o eye lids bei 8/28/2009 Large area of redness surrounding 8/31/2009 Hoarseness, diarrhea - 24 hours aft 9/3/2009 7/27 = vaccine. 8/3 = swollen lymph 9/3/2009 Information has been received from 9/4/2009 Travis received Intranasal Influenza 9/4/2009 patient experienced a deep aching p 9/4/2009 After receiving the Hepatitis A vacci 9/4/2009 RIGHT UPPER THIGH ERYTHEMA 9/4/2009 Patient reported a 2 inch area surro 9/4/2009 Patient was given Day 14 HDCV 1c 9/4/2009 ADVERSE ONSET WAS ON 9/2/20 9/4/2009 Patient received Day 14 HDCV 1cc 9/4/2009 Patient called on 09/04/09 to report 9/4/2009 Contracted Shingles about 9 month 9/4/2009 Right arem very swollen, red and ho 9/4/2009 Patient called this am c/o pain and r 9/4/2009 12 hours after the injection my son h 9/4/2009 Clear or white areas on fingertips an 9/4/2009 Patient received Gardasil HPV vacc 9/4/2009 Received vaccine at primary care ph 9/4/2009 Received Tdap on 8/28/09. Reports 9/4/2009 Rash/Itching following FLUMIST (Fl 9/4/2009 Following Tdap and Hepatitis A vac 9/4/2009 developed pustules/papules differen 9/4/2009 Diarrhea 6 times a day for 2 weeks 9/4/2009 Gardasil #1, Hep A #1, Menactra an 9/4/2009 SITE RXN 2.5-3 INCH DIAMETER, 9/4/2009 Father states that his daughter beca 9/4/2009 Patient received Flulaval Vaccine IM 9/4/2009 Vaccine administered 8/19/09 at 09 9/4/2009 Pneumonia vaccine received this m 9/4/2009 Patient started to feel numbness in 9/4/2009 Shortness of Y breath, initially with ex 9/4/2009 This case was reported by a physici 9/3/2009 Patient returned to office on 9/2/09 9/4/2009 Patient came in to office on 9/2/09. 9/3/2009 Swelling (local), pain, fever. Husba 8/31/2009 Local reaction (R) arm, red, swollen 9/4/2009 Woke up at 3AM on 9/2/09 & felt ve 9/3/2009 MMR given 8/25/09. Taken to ER o 9/4/2009 Pt's parent reports pt fainted while a 9/4/2009 Pt. complains of pain and swelling in 9/7/2009 She received vaccine on Friday 9-4 9/7/2009 Patient called in. Itchy rash to upper 9/6/2009 Patient received vaccines (FLUVIRI 9/5/2009 Shortly after FLUVIRIN administere
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9/4/2009 TX 9/4/2009 CA 9/4/2009 FL 9/4/2009 CA 9/4/2009 CA 9/4/2009 MD 9/4/2009 KY 9/4/2009 TX 9/4/2009 WI 9/4/2009 CO 9/4/2009 TN 9/4/2009 WI 9/4/2009 MN 9/4/2009 NY 9/4/2009 SC 9/4/2009 NH 9/4/2009 NY 9/4/2009 TX 9/4/2009 NY 9/4/2009 OR 9/4/2009 NC 9/4/2009 PA 9/4/2009 NC 9/4/2009 IN 9/5/2009 TX 9/5/2009 TX 9/5/2009 FL 9/5/2009 CO 9/5/2009 WA 9/5/2009 CA 9/5/2009 AL 9/5/2009 TX 9/5/2009 TX 9/6/2009 MD 9/6/2009 9/6/2009 TX 9/6/2009 OH 9/6/2009 TX 9/6/2009 MI 9/6/2009 OH 9/6/2009 AZ 9/7/2009 VA 9/7/2009 OH 9/7/2009 GU 9/7/2009 NC 9/7/2009 WV 9/7/2009 TX 9/8/2009 9/8/2009 9/8/2009 9/8/2009 OH
65 32 68 53 72 64 51 67 5 36 55 17 12 17 13 11 4 12 9 4 1.6 15 38 84 13 2 12 60 58 1.3 0.3 2 4 66 13 65 35 68 61 66 1.1 49 43 71 0.6 4 65 0 18 10 24
65 32 68 53 72 64 51 67 5 36 55 17 12 17 13 11 4 12 9 4 1 15 38 84 13 2 12 60 58 1 0 2 4 66 13 65 35 68 61 66 1 49 43 72 0 4 65 0 18 10 24
F F F M M F F F M M F F M M F F F U M M 0.6 M F F F M 0.8 M F M F 0.2 M 0.3 F 0.7 F F F F F U F M F 0.1 M F F F 0.6 F M F 0M F F F
9/6/2009 5 minutes after receiving PNEUMOV 9/5/2009 Reports of soreness in the whole ar 9/6/2009 Pt came to pharmacy states she wo 9/4/2009 Right arm had vaccine injected was 9/5/2009 9/2 at noon receive influenza, pneum 9/5/2009 2"-3" flat red rash now itching at inje 9/5/2009 Redness at injection site - swelling f 9/5/2009 Swelling - warm. Aches - all over es 9/4/2009 Pt developed chicken pox after havi 9/4/2009 Patient appeared okay after flu vacc 9/4/2009 Administered vaccine at 1:15pm on 9/4/2009 10:05A - received vaccines shortly a 9/3/2009 1 day after vaccine had area at site 9/3/2009 Red face & eyes after vaccine - sne 9/4/2009 Where VARIVAX was given (subcut 9/4/2009 Pt presented with large red area sur 9/4/2009 Swelling of her thigh. 9/3/2009 Patient had vaccines on 8/31/09. Pa 9/2/2009 He has a "dent" on his upper arm 9/4/2009 Pt received immunization 8/27, 8/30 9/6/2009 Low grade fever. Multiple bumps bil 9/5/2009 Seen @ 48 hours ago - got 3 shots 9/4/2009 Nummular induration 2-3 cm X 3-4 d 9/4/2009 Pt stated that was very sore on 9-39/5/2009 Patient was ordered to get meningo 9/5/2009 none 9/5/2009 After recieving the Gardasil vaccine 9/5/2009 Swelling from ankles to knees, wors 9/5/2009 At approximately 9:00 pm, my left a 9/5/2009 Vaccines Administered 08/26/09. H 9/5/2009 extreme irritability for 6 days. chron 9/5/2009 left leg swollen,stiff and really red at 9/5/2009 had a fever redness and now has a 9/6/2009 local site or injection became inflam 9/6/2009 My daughter was adminstered GAR 9/6/2009 Next day after receiving Zostavax va 9/6/2009 pneumonia shot given while patient 9/6/2009 WITHIN 24 HOURS PATIENT DEV 9/6/2009 Difficult Breathing. Rapid Heart Rat 9/6/2009 Received pneumovax and influenza 9/6/2009 DIARHHEA AND FEVER BEGINNIN 9/7/2009 Redness, pain, extreme swelling & b 9/7/2009 Administered 8/11/09 for pre-emplo 9/7/2009 Patient phoned the pharmacy to com 9/7/2009 Gardasil vaccinations administered 9/7/2009 self injurous behavior, tantrums, reg 9/7/2009 neuropathic pain (tingling, numbnes 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from
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9/8/2009 9/8/2009 9/8/2009 9/8/2009 AZ 9/8/2009 9/8/2009 VA 9/8/2009 PA 9/8/2009 9/8/2009 NY 9/8/2009 MN 9/8/2009 NM 9/8/2009 VA 9/8/2009 NJ 9/8/2009 MN 9/8/2009 WV 9/8/2009 MI 9/8/2009 CA 9/8/2009 MA 9/8/2009 CA 9/8/2009 NY 9/8/2009 OR 9/8/2009 CA 9/8/2009 OR 9/8/2009 AZ 9/8/2009 MI 9/8/2009 MI 9/8/2009 PR 9/8/2009 CA 9/8/2009 CA 9/8/2009 MD 9/8/2009 VA 9/8/2009 OH 9/8/2009 AR 9/8/2009 OR 9/8/2009 OH 9/8/2009 NC 9/8/2009 WA 9/8/2009 AR 9/8/2009 NY 9/8/2009 NC 9/8/2009 OH 9/8/2009 CA 9/8/2009 WA 9/8/2009 CA 9/8/2009 CT 9/8/2009 VA 9/8/2009 WA 9/8/2009 NY 9/8/2009 OH 9/8/2009 CO 9/8/2009 CO
15 18 0.5
18
56 15
56 15
31 5 12 18 24 3 4 4 34 67 47 16 4 4 11 4 70 40 18 39 3 31 11 13 1.3 35 13 64 9 52
31 5 12 18 24 3 4 4 34 67 47 16 4 4 11
54 4 51 1.1 5 9 10 65 0.3 31 50 25
70 40 18 39 3 31 11 13 1 35 13 64 9 52 34 54 4 52 1 5 9 10 65 0 31 50 25
F F F M U F F U F F F F F M M M F F F F M F M F F F F F F M M M 0.3 M M F F M F M F F M 0.1 M M F F F 0.3 M F F F
9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/3/2009 Started hurting and then swelling. P 9/4/2009 Onset of chest pain, SOB, cough - 2 9/8/2009 This case was Y reported by a physici 9/8/2009 Chest tightness - monitored a little li 9/8/2009 Extensive swelling, redness and ind 9/8/2009 Developed severe and prolonged al 9/14/2009 (L) Deltoid Cellulitis after MENACTR 9/8/2009 Hives 9/8/2009 Flu mist administered 8/27/2009, On 9/3/2009 Immunization 9-1-09 and on 9-2-09 9/4/2009 Generalized swelling to L thigh from 8/31/2009 LA subcutaneous nodule noted app 9/1/2009 Patient complained of dizziness, ligh 9/1/2009 Patient stated that on Saturday (8-2 9/2/2009 Pt was given GARDASIL and ADAC 8/11/2009 Shots given on 8-10-09. Mom notic 8/31/2009 Redness, edema induration is warm 8/25/2009 12:54 pm pt arms and legs retracted 8/17/2009 Rt posterior arm reddened. 8/20/2009 On 8/17/09 on right arm injection sit 8/14/2009 8/9/09 rash started on lower buttock 9/3/2009 Swelling eyes and lips, and all over 7/15/2009 Employee agreed to receive the HE 9/3/2009 Pt woke up 9/1 - clingy, didn't eat, li 9/8/2009 Developed type 1 diabetes. 9/16/09 9/8/2009 5 hrs after vaccination, arm sore, m 9/8/2009 5-6 Minutes after varicella vaccine w 9/8/2009 NO ADVERSE EVENTS NOTED AT 9/8/2009 Redness, warmth, swelling, left delt 9/8/2009 9-3-09 Rec'd T/C from MGM, advise 9/8/2009 Pt. received vaccine on 8/17/09 11: 9/8/2009 Swelling and itchiness at injection s 9/8/2009 headache, difficulty breathing, ches 9/8/2009 Pt woke up 3days post flu mist adm 9/8/2009 Patient was administered Pneumov 9/8/2009 Localized reddened area left anterio 9/8/2009 patient reported low grade fever, ac 9/8/2009 Developed rash 3 days after recievi 9/8/2009 Pt's R. arm at inj. site became swoll 9/8/2009 Cellulitis at vaccine site. Seen at ER 9/8/2009 RASH, ITCHING, BLEEDING AT IN 9/8/2009 Pt presented to facility after recievin 9/3/2009 Pt had episodes on significant cryin 9/8/2009 Flu shot administered about 5:30 PM 9/8/2009 Patient described "pain in arm with 9/8/2009 Headache, dizziness and shortness
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9/8/2009 IA 9/8/2009 IL 9/8/2009 WA 9/8/2009 CO 9/8/2009 MO 9/8/2009 TX 9/8/2009 MI 9/8/2009 SC 9/8/2009 MA 9/8/2009 KY 9/8/2009 AK 9/8/2009 GA 9/8/2009 PA 9/8/2009 CT 9/8/2009 MA 9/8/2009 9/8/2009 PA 9/8/2009 WA 9/8/2009 FL 9/8/2009 NE 9/8/2009 MN 9/8/2009 MN 9/9/2009 CA 9/9/2009 OH 9/9/2009 VA 9/9/2009 MD 9/9/2009 NY 9/9/2009 AZ 9/9/2009 IN 9/9/2009 9/9/2009 OK 9/9/2009 9/9/2009 CA 9/9/2009 TX 9/9/2009 VA 9/9/2009 SD 9/9/2009 MA 9/9/2009 VA 9/9/2009 OH 9/9/2009 NH 9/9/2009 NH 9/9/2009 VA 9/9/2009 GA 9/9/2009 OH 9/9/2009 MO 9/9/2009 NC 9/9/2009 CA 9/9/2009 WA 9/9/2009 TX 9/9/2009 AZ 9/9/2009 MS
37 52 4 45 5 38 16 75 38 32 60 50 2 11 1.4
37 52 4 45 5 38 16 75 38 32
24
24
17 0.2 0.4 74 16 12 63 5 69
17 23 0 0 74 16 12 63 5 69
22 14 27 46 1.3 0.3 61
22 14 27 46 1 0 61
4 5 5 5 11 77 2 5 12 4 1.2 30 8 5
4 5 5 5 11 76 2 5 12 4 1 30 8 5
50 2 1
F F M F M F M F M F U F 0.2 M M 0.4 M U M F F M 0.2 M 0.4 M M F M M M M U F F F F 0.3 M 0.3 F F F M F F F F F 0.1 F M F F 0.2 F F M M
9/4/2009 Had "asthma-like" attack, body ache 9/8/2009 Pt experienced "heart racing" follow 9/8/2009 6.5 x 4.5 cm raised erythematous d 9/8/2009 Myalgia, muscle joint pain, fatigue, n 9/8/2009 Child received vaccine on 9/1/09. A 9/7/2009 Pt only reported sharp pain in left ar 9/8/2009 Erythema and pain in upper deltoid 9/8/2009 15 minutes after patient received inj 9/1/2009 T 97.2 - loss of appetite, fatigue, va 9/4/2009 Hoarseness, wheezing, weakness, Pt developed hives 1 day later on in 9/4/2009 Circular raised silver-dollar sized are 9/8/2009 Developed serum sickness with hive 8/31/2009 5cm x 5cm area of redness & swelli 9/3/2009 At 16 mo visit on 1/23/09, child had Initial report was received 10 Augus 8/19/2009 Fever, headache, injection site pain 8/20/2009 Initial information received on 18 Au 8/25/2009 Initial report was received 20 Augus 8/27/2009 Inappropriate schedule of vaccine a 9/3/2009 This case was reported by a healthc 9/3/2009 This case was reported by a healthc 9/9/2009 Patient reported that he had not rec 9/4/2009 None Stated. 9/8/2009 Hives appeared within 6 hours of va 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/3/2009 11/27/07 had scratchy throat, cough 9/3/2009 1412 Shots given PENTACEL, MMR 9/3/2009 One week after 4 month check, pres 9/2/2009 Swelling and bruising at injection sit 8/28/2009 RN here this AM for flu vaccination. Pt woke up day after injections with 9/2/2009 Mom brought in 2 children for vaccin 9/2/2009 9-1-09 4 P fever 101.7 temp. TYLE 9/2/2009 9-1-09 2:30 PM fever 100.9 temp - v 9/3/2004 Generalized urticaria 6 days after re 9/1/2009 One year after administration of ZO 9/2/2009 Mom reported hives over entire bod 8/26/2009 DTaP & MMR administered approx 9/1/2009 - Fever x 2-3 days (102.0). - Alterna 8/31/2009 None reported. 8/31/2009 Onset of seizures and development 9/3/2009 Warmth and swelling up left arm, itc 9/4/2009 8/27/09 pt came in this morning c/o 9/4/2009 Mother states fever of 101 degrees
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9/9/2009 WA 9/9/2009 IL 9/9/2009 NY 9/9/2009 CO 9/9/2009 OH 9/9/2009 MN 9/9/2009 MN 9/9/2009 AZ 9/9/2009 NH 9/9/2009 PR 9/9/2009 IN 9/9/2009 NY 9/9/2009 NY 9/9/2009 IL 9/9/2009 IN 9/9/2009 MD 9/9/2009 TN 9/9/2009 CO 9/9/2009 CT 9/9/2009 CA 9/9/2009 CA 9/9/2009 FL 9/9/2009 WI 9/9/2009 NC 9/9/2009 FL 9/9/2009 MI 9/9/2009 NY 9/9/2009 NY 9/9/2009 PA 9/9/2009 9/9/2009 OH 9/9/2009 NY 9/9/2009 NY 9/9/2009 TX 9/9/2009 NC 9/9/2009 VA 9/9/2009 AZ 9/9/2009 AZ 9/9/2009 AL 9/9/2009 TX 9/9/2009 TX 9/9/2009 MI 9/9/2009 OH 9/9/2009 CO 9/9/2009 MO 9/9/2009 NH 9/9/2009 MI 9/9/2009 FL 9/9/2009 TX 9/9/2009 FL 9/9/2009 NC
67 19 4 61 1.4 14 39 14 5 15 0.6 66 11 18 58 5 66 12 14 55 39 12 12 19 14 3 4 14 13
67 19 4 61 1 14 39 14 5 15 0 66 11 18 58 5 66 12 14 55 39 12 12 19 14 3 4 14 13
76 2 47 42 86 4 15 10 12 13 40 0.2 42 1 61 1 75 0.2 39 15 40
76 2 47 42 86 1 15 10 12 13 40 0 42 1 61 0 75 0 39 15 40
F M M F 0.4 F F M F M F 0.6 F F M M F F F F F F F F F F F F F F F U F 0.5 F F F M 0M F M M M F 0.2 F F 0F M 1M F 0.2 M F F F
9/4/2009 Red, hot. Tues evening using ice pa see attached SF 600 9/2/2009 After my son received his booster sh 9/2/2009 Redness and inflammation at the in 9/1/2009 8-31-09 @ 7:30 pm - lower right thig 9/3/2009 Postural Syncope immediately follow 9/2/2009 Developed fever to 103. Painful sw 9/1/2009 Patient fainted after administering H 9/3/2009 12x19 cm, red, swollen, warm to the 9/3/2009 Patient developed dizziness after ad 9/3/2009 Localized allergic reaction. 9/3/2009 Difficulty breathing, rash developme 9/1/2009 Pt complained of left arm swelling / See attached. 9/3/2009 Within 5 mins of receiving flu shot, p 3/6/2009 (R) arm red 3 X 2 cm. 9/1/2009 8-29-09 (Mild Fever). 8-30-09 & 8-3 9/1/2009 Syncopal episode immediately follow 9/4/2009 Onset of chronic headaches 21/2 m 8/28/2009 All my muscles are sore. My back h 8/28/2009 Distinct pain @ injection site within 8/31/2009 Swelling & Redness 8-6-09 R arm. 9/1/2009 Received Wed 8/26/09 fever next d 9/9/2009 -itching of the face, swelling of lips; 9/9/2009 2 weeks after administration of Gard 9/9/2009 24 hrs after MMR shot, Patient stop 9/9/2009 Red raised welts around injection si 9/9/2009 Pt fainted at about 3:50pm at the wa 9/9/2009 Pain, swelling, lump on arm at injec 9/9/2009 REACTION NOTED POST VACCIN 9/8/2009 After receiving vaccine, pt states he 9/9/2009 Parent reported 1 day following vac 9/9/2009 Employee reported progressively wo 9/9/2009 Clent stated a few days after receiv 9/9/2009 Left upper arm was very swollen, re 9/9/2009 AREA OF ERYTHEMA ON UPPER 9/9/2009 Received Tdap & MCV4 9/8/2009 @ 9/5/2009 Within 2 minutes of vaccination, Pt c 9/9/2009 Left arm swelling- inflammation arou 9/9/2009 As per client's mother, he started co 9/9/2009 I received the seasonal flu shot arou 9/9/2009 Hives, severe crying and localized R 9/9/2009 Painful at site when arm moved up 9/9/2009 Large localized swelling, urticaria (g 9/9/2009 While there was no pain when shot 9/9/2009 developed fever 103 2 days after 9/9/2009 Right arm redness(softball size), sw 9/9/2009 2 days after receiving his scheduled 9/9/2009 PT COMPLAINED OF HER THROA 9/9/2009 Evans Syndrome. Autoimmune hem 9/9/2009 fevers, tmax 100.6 within 12 hrs of a
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9/9/2009 SD 9/9/2009 PA 9/9/2009 GA 9/9/2009 AZ 9/9/2009 CA 9/9/2009 CA 9/9/2009 IL 9/9/2009 PA 9/9/2009 IN 9/9/2009 NJ 9/9/2009 WA 9/9/2009 CA 9/9/2009 MS 9/9/2009 PA 9/9/2009 CO 9/9/2009 CA 9/9/2009 AZ 9/9/2009 IL 9/9/2009 NY 9/9/2009 LA 9/9/2009 AL 9/9/2009 OR 9/9/2009 PA 9/9/2009 MA 9/9/2009 VT 9/9/2009 CA 9/9/2009 OK 9/9/2009 CA 9/9/2009 TX 9/9/2009 OR 9/9/2009 IL 9/9/2009 NJ 9/9/2009 NH 9/9/2009 9/9/2009 AR 9/9/2009 OR 9/9/2009 OH 9/9/2009 FL 9/9/2009 AZ 9/9/2009 KY 9/9/2009 MN 9/9/2009 VA 9/9/2009 NY 9/9/2009 WA 9/9/2009 MN 9/9/2009 IL 9/9/2009 AK 9/9/2009 MN 9/9/2009 IL 9/9/2009 IL 9/9/2009 AZ
61 57 4 29 5 52 55 63 5 13 60 1 41 0.8 50 72 30 31 39 11 39 58 13 46 15 69 25 21 0.5 24 0.4 69 9 38 1.8 69 26 1.2 12 1.3 2 45 1.2 13 55 4 4 4 69 51 34
61 57 4 29 5 52 55 63 5 13 60 1 41 0 50 72 30 31 39 11 39 58 13 46 15 69 25 21 0 24 0 69 9 38 1 69 26 1 12 1 2 45 1 13 55 4 4 4 69 51 34
M F F M F F F F M F F 0M F 0.8 F M F F M F F F F F F F F F F 0.5 F F 0.4 F F M M 0.8 M F M 0.2 F F 0.3 M 0.9 M M 0.2 F M F M M F M F F
9/8/2009 Breathing Difficulty, body ache, chill 9/9/2009 Noticed mild redness on Saturday. E 9/9/2009 HOT, RED, SWOLLEN AREA FROM 9/9/2009 23 days after vaccination pt. develo 9/9/2009 Erythema, induration and warmth ov 9/9/2009 Onset of intense myalgias, fever, di 9/9/2009 Injection site red & hot inflammation 9/9/2009 Experienced the expected redness, 9/8/2009 Pt received KINRIX IM and Varicella 9/8/2009 Diagnosed w/ juvenile rheumatoid a 9/8/2009 Jaw -> eye numbness *Sx's gone @ 8/31/2009 Onset VARICELLA vesicles sympto 9/2/2009 Tingling sensation heavily on tongu 9/1/2009 My baby almost immediately becam 8/30/2009 2 days post inj pt had large localized 9/1/2009 Skin, rash and hives. 8/17/2009 Reports "cold" with intermittent cong 9/9/2009 Sweating, Lethargic after 5 minutes 9/9/2009 1 1/2 hrs after immunization (flu) c/o 9/9/2009 Patient presented with swollen, infla 9/9/2009 MMR administered 09/04. Reports 9/3/2009 Pt arm 4 cm x 3.5 cm red, raised, ho 9/4/2009 Numbness and paresthesias in arm 9/9/2009 15 min. post vaccine, reported red b Syncope several seconds after HPV 9/9/2009 Swelling of entire left arm. Pressure 9/2/2009 Rabavert given @ 1635 on 9-1-09. 9/1/2009 Noted (L) upper arm very sore 8/26/ 9/2/2009 Rash all over legs and arms 9/4/2009 Client got vaccine 9/3/09 and called 9/2/2009 Brief seizure following vaccine < 1 m 9/4/2009 Tetanus-diphtheria vaccine given 5/ 9/3/2009 Patient has a 5 in. x 4 in. raised, red 8/20/2009 Approx 12 hrs after receiving vaccin 8/20/2009 Pruritic rash surrounding polio and h 8/31/2009 Fever (101 degrees), myalgias, redn 9/1/2009 Received tetanus injection on 8/28/0 8/31/2009 Developed rash on L arm & body cl 9/5/2009 Had arrived home - made bagel and 9/9/2009 Immediately after receiving varicella 9/9/2009 15-20 small red papulopustules. 9/9/2009 Pt received AVA in his right arm on 9/9/2009 104+ fever followed by rash. Platele 9/8/2009 Generalized varicella-like eruption w 9/9/2009 Seen in ER. Voice hoarse, throat sw 9/9/2009 This case was reported by a physici 9/9/2009 Inflammatory reaction to DTaP in Rt 9/8/2009 Vesicular rash in S2 dermatome - R 9/9/2009 Localized reaction to flu shot. 5:25P 9/9/2009 Patient received influenza vaccinati 8/28/2009 Pain in the arm, swelling, itching wa
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9/10/2009 LA 9/10/2009 NJ 9/10/2009 TX 9/10/2009 MD 9/10/2009 VA 9/10/2009 NC 9/10/2009 CT 9/10/2009 GA 9/10/2009 9/10/2009 IA 9/10/2009 MA 9/10/2009 MA 9/10/2009 NJ 9/10/2009 KY 9/10/2009 WV 9/10/2009 NC 9/10/2009 NY 9/10/2009 MD 9/10/2009 NM 9/10/2009 WA 9/10/2009 NE 9/10/2009 MO 9/10/2009 ID 9/10/2009 PA 9/10/2009 NY 9/10/2009 OR 9/10/2009 MI 9/10/2009 MI 9/10/2009 MI 9/10/2009 NC 9/10/2009 FL 9/10/2009 OK 9/10/2009 LA 9/10/2009 CA 9/10/2009 GA 9/10/2009 TX 9/10/2009 ME 9/10/2009 TX 9/10/2009 PA 9/10/2009 IN 9/10/2009 NC 9/10/2009 CO 9/10/2009 ND 9/10/2009 ID 9/10/2009 CA 9/10/2009 NY 9/10/2009 OR 9/10/2009 KS 9/10/2009 AZ 9/10/2009 AZ 9/10/2009 CA
14 46 10 17 44 58 0.3 46 15 13 24 17 1.1 2 4 58 4 24 39 55 1.1 12 32 66 74 45 37 36 49 1.8 3 19 17 2 36 17 20 32 24 46 68 62 18 76 20 26 9 56 17 1
46 10 17 58 0 46
24 17 1 2 4 58 4 24 39 55 1 12 32 66 74 45 37 36 49 1 4 19 17 2 36 17 20 32 24 46 68 62 18 76 20 26 9 56 17 1
F F M F F F 0.3 F F F F F F 0.1 M 0.4 F M F M F F F 0.1 F F F F F F F F F 0.7 M U F F 0.9 F F M M F F F F F F U F F F F M F 0F
9/9/2009 Information has been received from 9/4/2009 Initial report was received 26 Augus Headaches. 9/27/09 Hospital recor 9/8/2009 Received MENACTRA & Tdap on 6 With 24 hrs of receiving AFLURIA 0 8/12/2009 Rash - 8-13-09 - Groups of raised re 9/3/2009 4 month old given inactivated flu va 9/3/2009 Eye itch night of day of injection. Fa Diffuse myalgias, fatigue, nausea, s 8/25/2009 Severe headache and dizziness afte 9/4/2009 Seizure (unwitnessed). Date. Sever 9/4/2009 Patient reports feeling nauseated ap 9/10/2009 Had syncopal episode at home. Fel 9/10/2009 Hives, temp 102.3, fussy-given stero 9/3/2009 Within 5 minutes developed wheezi 9/10/2009 Had vaccine at 6p, dry cough and h 9/10/2009 Mother stated child's Left arm very r 9/10/2009 Immediately after receiving Gardasi 9/10/2009 rash/hives rt upper arm and upper b 9/10/2009 I received a flu shot from walk-in fac 9/10/2009 Initial low grade temp (99F) treated 9/10/2009 My daughter has passed out TWICE 9/10/2009 Flu vaccination was given to me on 9/10/2009 Patient complained of pain and ting 9/10/2009 Returned to clinic 9-9-09 with a red 9/10/2009 10cm localized swelling to left deltoi 9/10/2009 Pt was given double dose of flu vac 9/10/2009 Pt given double dose of flu vaccine9/10/2009 Pt given double dose of flu vaccine9/10/2009 WITHIN 48 HOURS FEVER OF 105 9/10/2009 rt arm swollen,red,hard and hot to to 9/10/2009 Headache, Y Nausea, dizziness, chilli 9/10/2009 Mental status changes starting 7 da 9/10/2009 Patient ran fever of 100-102 for 3 da 9/10/2009 Roughly 10 minutes after injection, 9/10/2009 Approximately 4 hours after vaccine 9/10/2009 Patient was sitting receiving vaccina 9/10/2009 Itchy arms and chest. No hives or b 9/10/2009 Pt received TDaP and varicella in L 9/10/2009 Influenza shot was received at 3:25 9/10/2009 Redness and soreness at site 9/10/2009 vomiting, nausea, diarehha, chills, b 9/10/2009 Symptoms began with hair loss two 9/10/2009 This case was reported by a pharma 9/10/2009 Patient was given 0.5ml of Influenza 9/6/2009 1 minute after administering FLUEN 9/10/2009 Raised, red, warm to touch bilateral 9/10/2009 Mother presented child for flu vaccin 9/14/2009 Left deltoid region became erythem 9/10/2009 Severe pain 2 days after injection- n 9/10/2009 Left thigh with 3 areas of raised pink
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9/10/2009 AK 9/10/2009 GA 9/10/2009 NC 9/10/2009 NE 9/10/2009 VA 9/10/2009 MN 9/10/2009 OR 9/10/2009 PA 9/10/2009 NV 9/11/2009 9/11/2009 TX 9/11/2009 SC 9/11/2009 MI 9/11/2009 UT 9/11/2009 9/11/2009 MD 9/11/2009 GA 9/11/2009 MD 9/11/2009 KY 9/11/2009 NY 9/11/2009 NC 9/11/2009 PA 9/11/2009 MI 9/11/2009 AR 9/11/2009 MI 9/11/2009 TX 9/11/2009 OH 9/11/2009 TX 9/11/2009 AK 9/11/2009 MT 9/11/2009 OH 9/11/2009 OR 9/11/2009 PA 9/11/2009 MI 9/11/2009 TX 9/11/2009 AZ 9/11/2009 MI 9/11/2009 9/11/2009 MA 9/11/2009 WA 9/11/2009 OH 9/11/2009 NV 9/11/2009 OH 9/11/2009 NV 9/11/2009 IN 9/11/2009 CA 9/11/2009 PA 9/11/2009 VA 9/11/2009 MA 9/11/2009 NM 9/11/2009 GA
16 11 76 66 47 58 43 2 3.8 4 4 18 18 12
16 11 76 66 47 58 43 2
43 55 20 16 0.5 6 24 33 5 48 29 1.5 54 52 60 78 40 1.5 15 1.6 36 35
0 54 20 16 0 6 24 33 5 48 29 1 54 52 60 78 40 1
3 29 53 71 2 12 56 15 4 5 5 72 4
4 18 12
1 36 35
29 53 71 2 56 15 4 5 5 72 4
F F M F U F M 0.1 F F U M F F F F 0.5 F M M F 0.5 F F F M F F M 0.5 M M F F F F 0.6 M U 0.4 M F F M M F F F 0M F F F F M M F M
9/10/2009 6x7 cm erythema at injection site lef 9/10/2009 Client c/o swelling, soreness bilatera 9/10/2009 Once I gave shot, his arm immediat 9/10/2009 In ER 1 am had a fever 103. Diagn 9/10/2009 The pt states in approx. 2005 while 9/10/2009 Sore Throat, swollen tonsils, T 100. 9/10/2009 Raised red area silver dollar size ho 9/18/2009 Hives on both arms within 5 minutes 9/10/2009 FOC called 9/2/09. States child had 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/11/2009 Body itching, eyes swollen shut, red 9/11/2009 Inability to concentrate, cognitive dif 9/11/2009 Generalized rash and puritis develo 9/11/2009 patient recieved Gardasil on 12/19/0 9/11/2009 Patient received vaccine on 8/25/09 9/11/2009 Pt left office, vomit x1 on the way ho 9/11/2009 Patient developed redness, swelling 9/11/2009 pt states arm was swollen whole bic 9/11/2009 LEFT ARM RED,WARM TO TOUCH 9/11/2009 Pt.states that her left arm started hu 9/11/2009 Complete loss of appetite. Body chi 9/11/2009 9/9/09 at 6 PM started screaming an 9/11/2009 Patient first experienced headache 9/11/2009 2 inch diameter redness, slight swel 9/11/2009 Pt received Flu vaccine and pneum 9/11/2009 Right arm (inside bicep) was slightly 9/11/2009 Labrynthitis diagnosed after second 9/11/2009 My son had fever 99.1 degree last n 9/11/2009 Pt did not have any reaction to the v 9/11/2009 Severe swelling and fever at injectio 9/11/2009 REDNESS,SWELLING, INDURATIO 9/11/2009 Tingling in Right arm from deltoid to 9/10/2009 This case was considered medically 9/9/2009 Initial information received on 31 Au 9/8/2009 This spontaneous case was receive 9/7/2009 Pt. presented to E.R. on 7/27/09 aft 9/3/2009 Guillain-Barre Syndrome - LE Weak 9/4/2009 Febrile seizure 7 days after HIB and 8/14/2009 3rd Varicella given accidentally. Pre 9/4/2009 Received shot around 2pm 9/2. App 9/4/2009 Pt came back on 9/3 (1 day later) w 9/4/2009 9-1-09 DTAP in R thigh. 9-3-09 mo 9/3/2009 Tongue swelling, hives, itching, flus 9/3/2009 Pt noticed "rash" on trunk that sprea 9/3/2009 Gave too low - fluid went into tissue 9/3/2009 Fever x3 day 102 & increasing. Loc
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9/11/2009 VA 9/11/2009 DE 9/11/2009 GA 9/11/2009 GA 9/11/2009 IL 9/11/2009 SD 9/11/2009 TX 9/11/2009 CT 9/11/2009 CA 9/11/2009 WV 9/11/2009 TX 9/11/2009 PA 9/11/2009 WA 9/11/2009 CO 9/11/2009 MN 9/11/2009 UT 9/11/2009 CA 9/11/2009 TN 9/11/2009 MT 9/11/2009 MN 9/11/2009 GA 9/11/2009 SC 9/11/2009 MI 9/11/2009 TN 9/11/2009 MA 9/11/2009 MA 9/11/2009 MA 9/11/2009 TX 9/11/2009 CA 9/11/2009 MN 9/11/2009 IL 9/11/2009 WA 9/11/2009 CA 9/11/2009 OH 9/11/2009 OR 9/11/2009 IL 9/11/2009 GA 9/11/2009 OH 9/11/2009 MO 9/11/2009 MN 9/11/2009 WI 9/11/2009 CA 9/11/2009 AL 9/11/2009 OR 9/11/2009 CA 9/11/2009 NY 9/11/2009 NY 9/11/2009 OH 9/11/2009 WI 9/11/2009 PA 9/11/2009 NE
25 71 10 17 3 90 14 0.4 10 0.4 2 15 0.2 53 60 55 61 21 26 37 29 1.6 11 31 39 25 50 76 23 25 61 25 75 55 81 33 9 1.2 1 4 0.2 66 56 83 4 16 67 13 20 66 76
25 71 10 17 3 90 14 0 10 0 2 15 0 53
61 21 26 37 29 1 11 28 39 25 50 76 23 61 25 75 55 81 33 9 1 1 4 0 66 56 83 4 16 67 13 20 66 76
F F F F F F U 0.4 M F 0.4 M 0.1 F F 0.2 M F F F F F M F F 0.6 F M F F M F F F M F F F U M M F 0.2 F 0M F 0.2 M M F M F F M F F M M
7/30/2009 On 7-28-09 Patient received TDAP 9/2/2009 Received pneumonia shot at 3:30 p 9/3/2009 Redness & Warmth 2-3 hours after 9/3/2009 Localized swelling (quarter size), re 9/11/2009 Swallowing dysfxn and annuciation 9/4/2009 Received ZOSTAVAX vaccine 8/28 Rash at site developed 28 hours sp 9/10/2009 Very fussy- inconsolable through mo 9/3/2009 Tingling sensation of (L) arm lasted 9/11/2009 Hives/urticaria Redness and swelling of entire (R) t 9/3/2009 Patient developed urticaria/lesions f 9/6/2009 Coded. Former 28 wk gest infant wa 9/11/2009 Feeling disoriented and dizzy within 9/11/2009 Subject in pneumococcal vaccine tr 9/11/2009 Severe sore throat, extreme red eye 9/11/2009 Zoster vaccine was given after stro 9/11/2009 PT. EXPERIENCED PAIN,REDNES 9/11/2009 At 5:30 pm,William came in with a re 9/11/2009 Patient reports feeling "fine" after in 9/11/2009 redness, swelling, and warmth at sit 9/11/2009 MOTHER STATES CHILD "NOT AC 9/11/2009 Large red swollen area on right arm 9/11/2009 Onset of weakness and tingling in L 9/11/2009 Immediately after receiving the Td v 9/11/2009 Reports feeling dizzy right after adm 9/11/2009 At the time of administrtion, patient 9/11/2009 patient experience swelling/warmne 9/11/2009 Pt noted pruritis in the area 9/10/09 9/11/2009 Coughing. Troubles breathing. Sw 9/11/2009 Patient not feeling well after receivin 9/8/2009 Rashes on face and legs and gener 9/9/2009 C/o rash forming a ring approximate Patient claims her blood pressure h 9/12/2009 Vaccine on 8/13/09 rash on lower to 9/12/2009 Patient reported diaphoresis, tachyc 9/13/09 - 3PM - Patient received ina 9/11/2009 Local redness, warmth & tendernes Patient has a localized reaction also 9/10/2009 Rt thigh redness and swelling devel 9/10/2009 Rash following immunization, not ut 9/13/2009 Patient received FLUVIRIN flu shot 9/13/2009 Day following immunization, patient 9/12/2009 Painful injection site followed with a 9/12/2009 Swelling, erythema, pruritus (L) delt 9/11/2009 Fainting, feeling of coldness and we 9/10/2009 Vaccine administered 09/01/09; On 9/11/2009 Urticaria on face, legs, torso - impro 9/11/2009 Patient had hotflush, passed out an 9/11/2009 Pt got a flu shot in the pharmacy at 9/11/2009 Err:508
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9/11/2009 MN 9/11/2009 CA 9/11/2009 IL 9/11/2009 AR 9/11/2009 KS 9/11/2009 MO 9/11/2009 PA 9/11/2009 NY 9/11/2009 RI 9/11/2009 NY 9/11/2009 TX 9/11/2009 NC 9/11/2009 GA 9/11/2009 CA 9/11/2009 MO 9/11/2009 PA 9/11/2009 TX 9/11/2009 CO 9/11/2009 SC 9/12/2009 WA 9/12/2009 WI 9/12/2009 WI 9/12/2009 VA 9/12/2009 OR 9/12/2009 SC 9/12/2009 FL 9/12/2009 CA 9/12/2009 IN 9/13/2009 GA 9/13/2009 OH 9/13/2009 DE 9/13/2009 NY 9/13/2009 OR 9/14/2009 CA 9/14/2009 9/14/2009 9/14/2009 TX 9/14/2009 NY 9/14/2009 MA 9/14/2009 FL 9/14/2009 NY 9/14/2009 9/14/2009 9/14/2009 AR 9/14/2009 CA 9/14/2009 CA 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 WA
5 26 17 4 66 11 18 15 30 2 34 65 1.5 54 12 86 4 76 18 49 4 10 39 27 73 19 85 21 3 42 38 39 68 11
5 26 17 4 66 11 18 15 30 2 34 65 1 54 12 86 4 76 18 49 4 10 39 27 72 19 85 21 3 42 38 39 68 11
44 62 6 22 19 21 1.5 25 1 23 61 49
44 62
30 4
30 4
22 17 21 25 1 23 61 49
F M F F M F F M M 1M F F 0.5 F F F F M F M F M F F M F M F F F M M F F M F F M M M F F F F F 0M F F F F M M
9/11/2009 Immunization on 9/9/09. Mom noted 9/11/2009 Pt said he got some itchy hives dev 9/11/2009 Miscarriage Pt was not aware she w 9/10/2009 Fever, swelling in L upper arm. Reaction to pneumonia vaccine -arm 9/4/2009 Pt. rec'd VARIVAX injection subcuta 9/10/2009 10 mins after vaccine admin. pt c/o 9/11/2009 Per mother pt. experienced hallucin 9/10/2009 Patient very apprehensive re flu vac 9/11/2009 Pt sneezing, face red, no breathing 9/11/2009 States that about 30 minutes after s 9/11/2009 Chills, tired all over, tenderness + p 9/10/2009 Fever 105.9, no appetite. 9/13/2009 Patient received PNEUMOVAX on 9 9/4/2009 None stated. 9/11/2009 Fever 101- injection site red and sw 9/11/2009 Swelling, redness, tenderness, to le 9/11/2009 Reported to Dr's office on 9-4 arm w 9/14/2009 Pt received immunizations (FLUMIS 9/12/2009 redness, warmth, soreness at swelli 9/12/2009 Significant irritability, back pain, mus 9/12/2009 Shot given under the arm, odd spot 9/12/2009 Numbness and tingling in arm wher 9/12/2009 Red bumps on upper left chest and 9/12/2009 Patient was given vaccination at ab 9/12/2009 pt described numbness in arm wher 9/12/2009 Left arm red, swollen, and hot from 9/12/2009 Had dizziness after first shot on 5/1 9/13/2009 MY Daughter received the "MIST" in 9/13/2009 Got shot at 1:00 pm on thursday se 9/13/2009 Muscle and joint pain all over, fatigu 9/13/2009 Began to feel dizzy and light headed 9/13/2009 8/21 Zoster vaccine administered; 8 9/9/2009 (R) deltoid sore, (R) arm mild-mode 9/14/2009 We received the following informatio 9/14/2009 We received the following informatio 9/7/2009 Initial report received on 02 Septem 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 1/26/2009 Very busy immunization clinic. Bes 6/30/2009 Went to ER 6/17/09 0200 for chills, 9/10/2009 Pt developed redness and itching a 9/10/2009 Patient was injected with Fluvirin ins 9/8/2009 Noted pain (Lt) lower back. While dr 9/2/2009 Localized warmth and pruritus at inj 9/8/2009 Was given Influenza on 8/31/009, s 8/27/2009 Flu vaccine given (Lt) upper arm , n 9/8/2009 6.5 X 4.5 cm raised erythematous d
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9/14/2009 PA 9/14/2009 MN 9/14/2009 NV 9/14/2009 FL 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 VA 9/14/2009 FL 9/14/2009 KS 9/14/2009 TX 9/14/2009 SC 9/14/2009 TX 9/14/2009 CA 9/14/2009 NC 9/14/2009 VA 9/14/2009 IA 9/14/2009 NC 9/14/2009 WA 9/14/2009 AZ 9/14/2009 NJ 9/14/2009 NJ 9/14/2009 NC
4 8 3 1 25 22 20 24 27 25 22 21 22 11 23 17 21 22 18 20 21 24 20 21 22 22 25 15 24 23 14 23 23 21 19 17 34 12 4 55 4 5 21 65 2 56 53 73 4 2 4
4 8 3 0 25 22 20 24 27 25 22 22 11 23 17 21 22 18 20 21 24 20 21 22 22 25 15 24 23 14 23 23 21 19 17 34 12 4 55 4 5 21 65 2 56 53 73 4 2 4
M F F 1F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F M F M F M F F F 1M F F F F 0.7 M M
9/9/2009 After shots, patient returned within a 8/28/2009 Received VARICELLA vaccine 8/17 9/10/2009 FOC called 9/2/09. States child had 9/8/2009 Rash, Acycliver 200 1/2 tp to qil 45D 8/24/2009 GARDASIL vaccine was noted at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was noted at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was not stored 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at a 8/25/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was store at tempe 8/30/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was stored at temp 8/30/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was stored at temp 8/20/2009 GARDASIL vaccine was stored at te 8/21/2009 GARDASIL vaccine was stored at te 8/21/2009 GARDASIL vaccine was stored at te 8/29/2009 GARDASIL vaccine was stored at te 9/14/2009 LEFT SHOULDER AND DELTOID 3 9/14/2009 3 days ago 4 mm rash inceased, pr 9/14/2009 Mom reports pt developed jaundice 9/14/2009 Left arm became very red and swoll 9/14/2009 Patient contacted the health dept th 9/14/2009 Patient received Tdap instead of Dt 9/14/2009 2 days after vaccine administration, 9/14/2009 Patient presented 24 hours followin 9/14/2009 Received Yellow Fever Vaccine (Lo 9/14/2009 pt had varicella vaccine, within 2 hrs 9/14/2009 Patient felt dizzy 30 minutes after th 9/14/2009 Pt received injection on the 11th, sh 9/14/2009 Patient's husband described: within 9/14/2009 Patient began complaining of sore t 9/14/2009 Began running fever, almost immed 9/14/2009 C/O BURNING AND REDNESS LE
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9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 NM 9/14/2009 MD 9/14/2009 LA 9/14/2009 TN 9/14/2009 NV 9/14/2009 NE 9/14/2009 NV 9/14/2009 CA 9/14/2009 WV 9/14/2009 AZ 9/14/2009 MO 9/14/2009 MO 9/14/2009 OH 9/14/2009 NY 9/14/2009 NY 9/14/2009 NH 9/14/2009 VI 9/14/2009 PA 9/14/2009 MA 9/14/2009 OH 9/14/2009 OH 9/14/2009 OH 9/14/2009 OH 9/14/2009 CA 9/14/2009 NM 9/14/2009 NM 9/14/2009 CO 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 MI 9/14/2009 9/14/2009 MI 9/14/2009 WA 9/14/2009 NC 9/14/2009 IN 9/14/2009 ID
17 20 22 21 27 22 23 19 51 50 23 24 1.5 6 0.1 4 59 8 21 23 19 35 50 0.1 4 16 12 14 13 19 73 4 26 63 0.5 27 24 26 26 41 43 34 41 49 62 9 64 5 44 65 11
17 20 22 21 27 23 19 51 50 23 24 1 6 0 4 59 8 21 23 19 35 50 0 4 16 12 14 13 73 4 26 0 27 24 26 26 41 43 34 41 49 62 9 64 5 44 65 11
F F F F F F F F F F F F 0.5 F M 0.1 M M F F F F M F F 0.1 M M F M F F F F F F F 0.5 M F F F F F F F F F M F F F F F F
9/14/2009 On 9/4/09@ 1400 client called me a 8/24/2009 Gardisil vaccine was stored at at tem 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/29/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 Gardisil vaccine was store at tempe 9/14/2009 extreme achiness at site and into jo 9/14/2009 Client reported 4" X 11/2" area of in 9/14/2009 morning after receiving the Pneumo 9/14/2009 Enlarged, grape-sized nodule above 9/14/2009 High Fever (104 degrees), dizziness 9/14/2009 48 hours after nasal flu mist vaccina 9/14/2009 My son's whole body was shaking. H 9/14/2009 SWOLLEN,REDNESS ON VACCIN 9/14/2009 Severe shoulder pain beginning ~2 9/14/2009 Daughter vomitted 4 hours after rec 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 Gardisil vaccine was stored at temp 9/6/2009 He got PNEUMOVAX vaccine (SC) 9/14/2009 Itchy all over, feels warm all over Be 9/14/2009 "Throat closing" - itching, hives - Lo 9/14/2009 Infant was given vaccines. Cried, an 9/14/2009 The patient developed erosive lesio 9/10/2009 Received flu shot and Hep A. 3 min 9/21/2009 Urticarial rash all over body. 8/27/2009 Swelling 4.5cm x 4.5 cm, erythema, 8/27/2009 Swelling, erythema, warmth at injec 9/14/2009 Several minutes after vaccine patien 9/9/2009 4 hours after immunization, left delto 9/14/2009 Left outer aspect of arm swollen wit 9/14/2009 Err:508 9/14/2009 Indigestion, 20 minutes. 9/14/2009 Episode of apparent limpness, letha 9/10/2009 Received flu shot on 9/1/09 by 1200 9/10/2009 By evening a nickel size welt appea 9/10/2009 Two Quarter size welts on left deltoi 9/10/2009 1/2 dollar size welt on (L) deltoid. W 9/10/2009 "Right deltoid burned on injection an 9/10/2009 Over the course of 2 days develope 9/10/2009 Developed redness and started to it 9/10/2009 Received the flu shot on 9/2/09 at 0 9/10/2009 On 9/3/09 in the evening face and e 9/14/2009 Patient said shortly after vaccination 9/14/2009 Patient received Boostrix one month Was not feeling well prior to shot (na 9/14/2009 Pt awoke approx 18 hours after vac 9/14/2009 Pt reported on 09-12-09 at 9:30 AM 9/14/2009 4 hours post vaccination 5 episodes 8/13/2009 Patient immunized in am, a few hou
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9/14/2009 ID 9/14/2009 ID 9/14/2009 ID 9/14/2009 ID 9/14/2009 IL 9/14/2009 HI 9/14/2009 HI 9/14/2009 WI 9/14/2009 TX 9/14/2009 NY 9/14/2009 NY 9/15/2009 OR 9/15/2009 IA 9/15/2009 CA 9/15/2009 NC 9/15/2009 NC 9/15/2009 NC 9/15/2009 NC 9/15/2009 OH 9/15/2009 OH 9/15/2009 KS 9/15/2009 AZ 9/15/2009 AZ 9/15/2009 VA 9/15/2009 VA 9/15/2009 WA 9/15/2009 CA 9/15/2009 ID 9/15/2009 CA 9/15/2009 PA 9/15/2009 PA 9/15/2009 PA 9/15/2009 ID 9/15/2009 MN 9/15/2009 PA 9/15/2009 FL 9/15/2009 VA 9/15/2009 DE 9/15/2009 PA 9/15/2009 NJ 9/15/2009 PA 9/15/2009 CA 9/15/2009 CT 9/15/2009 CT 9/15/2009 ME 9/15/2009 LA 9/15/2009 NH 9/15/2009 MD 9/15/2009 CA 9/15/2009 IA 9/15/2009 OH
5 1.3 72 5 69 49 59 19 42 69 23 13 62 47 8 8 11 10 35 11 15 85 5 19 8 62 4 66 1.3 18 21 18 65 56 77 55 6 57 72 1.6
5 1 72 5 69 49 59 19 42 69
21 13 14 33 34 1 43 68 5 72
21 13 14 33
13 62 46 8 8 11 10 35 11 15 85 5 19 8 62 4 66 1 18 21 18 65 56 77 55 6 57 72 1
1 43 68 5 72
M 0.3 F M M F F F F F F M F F U M M F M F M F F F F M F F F 0.3 F F F F F F F F M F U 0.6 M F F M M F F 0M F F F F
7/31/2009 Redness began 7/30 with swelling o 8/17/2009 Patient vaccinated 8-4-09, pt presen 8/29/2009 None Stated 8/14/2009 Diffuse swelling of entire L thigh to k 9/14/2009 Redness, swelling, not itching, very 9/9/2009 Slight sore throat. Aches & pains in 9/5/2009 Received vaccine @ 08:40, @ 10:0 9/12/2009 I was driving home from a friends ho 9/19/2009 arm swelling, large red streak, itchin 9/14/2009 Patient c/o itchiness after taking 3rd 9/14/2009 Pt in few hour experienced numbne 9/15/2009 Shortly after vacinnation with Garda 9/15/2009 About 3 hours after vaccine was giv 9/15/2009 Received Samllpox vaccine along w 9/8/2009 Red area on back of left arm. Cool p 8/21/2009 Heat, red, itching, swelling @ site ( 9/8/2009 9-3-09 Back of Lt arm red, > than go 9/6/2009 2 1/2 hours post vaccination, swellin 9/15/2009 Pt call 9AM rash developed/itching 9/15/2009 Administered FLULAVAL 0.5ml to h 9/14/2009 Approx. 3 days after varicella immun 9/14/2009 Information has been received from 9/14/2009 Information has been received from 9/14/2009 Information has been received from 9/4/2009 Flu vaccine licensed for 18 yrs and 9/1/2009 Chills, fevers, sweating, severe pain 9/3/2009 Pt received DTaP 9/1/09 came into 9/9/2009 No adverse events. 9/11/2009 Maculo papular rash starting on fac 9/9/2009 The student received the flu shot R 9/9/2009 The student became lightheaded ab 9/9/2009 The student received a flu vaccinati 9/10/2009 Vaginal Herpes infection 9/9/2009 9/4/09, low grade fever, vomiting, na 9/10/2009 Patient came back to our pharmacy 9/8/2009 IM (R) deltoid - injection of PNEUMO 9/11/2009 Pt received FLUMIST at about 14:2 9/9/2009 Itching in area of injection down to e Patient called 9-15, reported itching 9/15/2009 Grand mal febrile Seizure. 9/3/2009 Eyes red, swollen throat and face sw 9/14/2009 Pt given GARDASIL left deltoid on 9 9/14/2009 Administered GSK to < 18 yr old. 9/14/2009 Administered GSK to < 18 yr old c/o 9/8/2009 Body ache from injection site to top 9/8/2009 None stated 9/2/2009 Maculo papular blanching pink rash 9/10/2009 7.0 x 5.0 cm wheal. 25mg BENADR 9/11/2009 My veins all around site of shot pron 9/10/2009 Child woke up crying with a headac 9/10/2009 9/9/09- Injection 1100 am. 2-Tyleno
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9/15/2009 NC 9/15/2009 AL 9/15/2009 MA 9/15/2009 MA 9/15/2009 DE 9/15/2009 CT 9/15/2009 CT 9/15/2009 OH 9/15/2009 VA 9/15/2009 KY 9/15/2009 FL 9/15/2009 NE 9/15/2009 CA 9/15/2009 CO 9/15/2009 TX 9/15/2009 OH 9/15/2009 WA 9/15/2009 HI 9/15/2009 OH 9/15/2009 AL 9/15/2009 SC 9/15/2009 WA 9/15/2009 VA 9/15/2009 GA 9/15/2009 MI 9/15/2009 SC 9/15/2009 MD 9/15/2009 OK 9/15/2009 MS 9/15/2009 GA 9/15/2009 OK 9/15/2009 HI 9/15/2009 MN 9/15/2009 CA 9/15/2009 KY 9/15/2009 NC 9/15/2009 FL 9/15/2009 NJ 9/15/2009 KY 9/15/2009 TN 9/15/2009 VA 9/15/2009 CA 9/15/2009 AL 9/15/2009 CA 9/15/2009 MD 9/15/2009 ID 9/15/2009 DE 9/15/2009 AK 9/15/2009 MI 9/15/2009 MI 9/15/2009 NJ
1.3 87 60 80 78 11 4 14 66 3 68 2 12 62 69 27 5 74 44 51 64 57 22 31 17 5 25 18 1 15 67 17 12 4 41 13 16 2 42 16 4 47 38 11 1.7 12 15 11 7 8 11
1 87 60 80 78 11 4 14 66 3 68 2 12 62 69 27 5 74 44 51 64 57 22 31 17 5 25 18 1 15 67 18 12 4 41 13 16 2 42 16 4 47 38 1 12 15 11 7 8 11
0.3 M F F F F M M F M F F 0.9 F F F F F M F F F F F M M F M F F 0F F F F F M F F F 0.9 M M F M F F M 0.7 M M F M F M M
9/15/2009 Deep febrile seizure 11 days after M 9/15/2009 Knot under skin at site of injection 9/14/2009 Once given flu shot, patient immedi 9/11/2009 Redness approx. 4 inches in diam. 9/3/2009 Swelling from elbow upwards, mild p 9/4/2009 Parents noted malaise, headache, s 9/4/2009 Swelling and cellulitis at sight. 9/5/2009 Swollen area around injection site. T 9/8/2009 Approx 12 hours after ZOSTAVAX v MCA stroke on 9/4/09. Aphasia. He 9/6/2009 Redness, inflammation, hardening o 9/9/2009 Facial swelling, nose & eyes, 12 hrs 8/31/2009 12yr female who had a syncope spe 9/4/2009 Bitter taste in mouth that happened 9/8/2009 Patients arm was in pain the evenin 9/9/2009 In the afternoon the day the vaccine 9/15/2009 "Clumps of Blistering Hives" to L arm 8/27/2009 Tingling, stinging, itching, at and ab 9/8/2009 Extreme muscle pain on L side arm 9/3/2009 Patient feels like she has a cold com 9/8/2009 Patient reported redness, swelling, 9/4/2009 About 1 hour after receiving flu shot 9/11/2009 Fever, sweats, headache, swollen/r 9/9/2009 Swollen lips in AM after - Treated w 9/15/2009 Blood Clot in lung on 4-12-2009 and 9/15/2009 Administered immunization to patien 9/15/2009 Reports pain, reddness and swelling 9/15/2009 Pt. stated that she didn't feel well af 9/15/2009 1:00 p.m. on September 12th, 2009 9/15/2009 Client was given a Tdap on 2/6/09 a 9/15/2009 Pt received Pneumovax 0.5mL IM R 9/15/2009 the first two vaccines were no extrem 9/15/2009 fever, arm-swollen, red, sore, nause 9/15/2009 Redness, swelling, warm to the touc 9/15/2009 Patient received yellow fever vaccin 9/15/2009 Grandmother/guardian reports head 9/15/2009 Dizzines,Hypotension,Blurred Vison 9/15/2009 Hives post flu vaccine, pain in leg 9/15/2009 Patient received an subcutaneous in 9/15/2009 Patient had the 1st shot of Gardasil Pt grandmother reported to staff on 9/8/2009 Throat tightness, chest congestion , 9/1/2009 Approximately 2 hours after receivin 9/10/2009 Vaccines given 8/24/09 - red swolle 9/15/2009 PT FATHER SAID A KNOT DEVEL 9/15/2009 Bilateral axillary lymphadneopathy 4 9/15/2009 within 20 minutes of shot, became d 9/8/2009 Head shaking, approximately every 9/15/2009 Concerns about dosage. Child given 9/15/2009 no advers events reported. Concern 9/15/2009 Hives (urticaria) from head to toe ap
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9/15/2009 WA 9/15/2009 CA 9/15/2009 OK 9/15/2009 OR 9/15/2009 MI 9/15/2009 WA 9/15/2009 UT 9/15/2009 IN 9/15/2009 LA 9/15/2009 AZ 9/15/2009 WA 9/15/2009 MS 9/15/2009 FL 9/15/2009 GA 9/15/2009 CA 9/15/2009 FL 9/15/2009 VA 9/15/2009 OH 9/15/2009 DC 9/15/2009 NM 9/15/2009 MO 9/15/2009 MN 9/15/2009 CA 9/15/2009 ND 9/15/2009 SC 9/15/2009 PA 9/15/2009 CA 9/15/2009 WA 9/15/2009 AZ 9/15/2009 FL 9/15/2009 IL 9/15/2009 MI 9/15/2009 MI 9/15/2009 AZ 9/15/2009 TX 9/15/2009 MO 9/15/2009 CA 9/15/2009 KS 9/15/2009 CA 9/15/2009 IA 9/15/2009 NC 9/15/2009 OR 9/15/2009 NY 9/15/2009 IL 9/15/2009 VA 9/15/2009 OH 9/15/2009 WA 9/16/2009 DC 9/16/2009 PA 9/16/2009 9/16/2009 WA
23 5 48 18 18 16 2 5 5 40 38 48 72 31 80 77 5 81 4 67 1 40 61 3 12 42 18 2 57 49 5 73 13 0.2 28 45 77 1 63 17 11 19 11 18
23 5 49 18 18 16 2 5 5 40 38 48 72 31 80 77 5 81 4 67 1 40 61 3 12 42 18 2 57 49 5 73 13 0 28 45 77 1 63 17 11 19 11 18 63
20 11 4
4
19
19
F F F F F M 0.2 F M F M F F F F F F M F M F 0F M F F F F M 0.1 F M F M F M 0.2 M F F F 0M F F M F F M U F F M F U F
9/15/2009 After beng given a Hep A vaccinatio 9/15/2009 Pt. got red cheeks, forehead, nose a 9/15/2009 Redness on arm, soreness of arm, f 9/7/2009 On 12/1/08 patient given GARDASI 9/8/2009 After injection patient started turning 7:45 pm 8-21-09 nausea, headache 9/15/2009 ITP 9/8/2009 R leg is Red, warm, and swollen the 9/8/2009 Knot-swollen-red 9/15/2009 L arm cellulitis-Rx Keflex 500 QiD< 9/15/2009 Patient reported CHill, panic, Racing 9/9/2009 None stated. 9/15/2009 None stated. 9/18/2009 General weakness 10 minutes after 9/15/2009 Patient complaint of nose bleeding a 9/4/2009 Patient returned three days after va 9/15/2009 Rash at injection site area - Erythem 9/15/2009 9/15/09 Pt. had 0.5ml of FLUVIRIN 9/15/2009 DTAP/IPV given 2 months after 4th 9/15/2009 Reaction @ injection site [redness] 9/15/2009 9/11/09 broke out all over red, raise 9/12/2009 Pt filled a VAR and said he had prev 9/11/2009 Site swollen on injected (L) arm, beg 9/14/2009 Given PEDIARIX, MMR, Chickenpo 9/15/2009 Received 3rd dose HPV vaccine in 9/11/2009 Pt complained of right forearm tend 9/15/2009 Fainted in car a few minutes after sh 9/15/2009 Pt has a raised bump at the injectio 9/4/2009 Tingling in throat & cough for appro 9/13/2009 Left arm very swollen, red, hot to to 9/3/2009 L arm became swollen & warm & pa 9/8/2009 No History of allergy to getatin of Ne 7/8/2009 I placed injection (IM) on 7-7-09 & re 9/11/2009 Patient developed a bump with redn 9/6/2009 Patient noticed numbness below elb 9/4/2009 TDAP given 9-1-09. On 9-2-09 at 2: 9/11/2009 Received shingles vaccination 7/15 4/23/2009 Staring, dazed appearance for 4 hrs 9/9/2009 July 29 got shingles vaccine. On 8-3 9/9/2009 Eyes became red & sore, face red, 9/11/2009 Temp up to 103.4 & Headache x 4 d 9/8/2009 Approx. 3 hours after receiving TDA After the nurse administered the vac 9/8/2009 Patient fainted after receiving flu va 9/14/2009 Received vaccine same time as hus 9/11/2009 C/o left upper extremity numbness a 9/24/2009 Complaints of blurry vision, R knee 9/14/2009 Client in advertently given KINRIX fo 9/15/2009 Redness swelling and itching of R a 9/15/2009 Initial and follow-up information has 9/11/2009 Left upper arm local reaction with er
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9/16/2009 MD 9/16/2009 DE 9/16/2009 NY 9/16/2009 MS 9/16/2009 FL 9/16/2009 MN 9/16/2009 VA 9/16/2009 FL 9/16/2009 TX 9/16/2009 IL 9/16/2009 FL 9/16/2009 LA 9/16/2009 ME 9/16/2009 MI 9/16/2009 NY 9/16/2009 MD 9/16/2009 MA 9/16/2009 OH 9/16/2009 TX 9/16/2009 ND 9/16/2009 CA 9/16/2009 OH 9/16/2009 TN 9/16/2009 IN 9/16/2009 KY 9/16/2009 CA 9/16/2009 PA 9/16/2009 IN 9/16/2009 NY 9/16/2009 WA 9/16/2009 PA 9/16/2009 WA 9/16/2009 WA 9/16/2009 UT 9/16/2009 MO 9/16/2009 TX 9/16/2009 WA 9/16/2009 TX 9/16/2009 IL 9/16/2009 OR 9/16/2009 TX 9/16/2009 FL 9/16/2009 NC 9/16/2009 IA 9/16/2009 FL 9/16/2009 SC 9/16/2009 MI 9/16/2009 OH 9/16/2009 9/16/2009 KS 9/16/2009 CA
23 11 1.6 3 27 15 51 54 81 43 40 33 15 5 55 0.5 64 39 67 61 26 48 18 34 13 16 55 45 69 42 56 14 4 81 54 34 12 14 61 1.8 35 23 58 42 26 79 49 74 65 5 13
23 11 1 3 27 15 51 54 81 43 39 33 15 5 55 0 64 39 67 61 26 48 18 34 13 16 55 45 69 42 56 14 4 81 54 33 12 14 61 1 35 22 58 42 26 79 49 74 65 5 13
F M 0.6 M M F F F F M M F F M M F 0.6 M F F F F U F F F F M F F F F F F F F F F F F F 0.8 M F F F F F F F F F F U
9/15/2009 9-9-09 - Pt received 3rd GARDASIL 9/11/2009 1 day after shot felt nauseate pale f 9/14/2009 Swelling and tenderness to left uppe 9/16/2009 Pt developed oval rash adjacent to 9/16/2009 Diffuse hives and pruiritis- onset 2hr 9/16/2009 Varicella given Rt arm SQ on 9/14/0 9/14/2009 Pt reported pain, redness and bliste 9/16/2009 Throat constriction, stomach pains & 9/16/2009 Took Influenza & Pneumoccal shot 9/16/2009 Red and itchy eyes, upper back pai 9/16/2009 Individual called my office to report 9/16/2009 Received flu shot at 0900 am Septe 9/16/2009 MALAISE, JOINT PAIN, NUMBNES 9/16/2009 LEFT LEG BECAME SWOLLEN AN 9/16/2009 Patient stated that she had fever, ch 9/16/2009 RECEIVED VACCINES AT APPRO 9/16/2009 Within 5 minutes of immunization, p 9/16/2009 APROXIMATELY 40HRS AFTER R 9/16/2009 Employee states that after 2 hours o 9/16/2009 After receiving the seasonal flu shot 9/16/2009 Patient reported a hive-like rash to a 9/16/2009 Received the flu shot around 4:30-5 9/16/2009 Patient fainted and was assisted to 9/16/2009 Within a half an hour, I began to sw 9/16/2009 Vaccine administered 9/14/09 at 2:0 9/16/2009 patient got VZV/Tdap/MCV 4, and w 9/16/2009 received influenza vaccine 9/14/200 9/16/2009 extreme fatigue, tingling of left arm 9/16/2009 Patient presented with rash 1 month 9/16/2009 Swelling started soon after the shot 9/16/2009 Received shot on Sept 14 at 1:30PM 9/16/2009 Pt was to receive Gardasil #1, Fluvi 9/16/2009 5 days after receiving her 2nd varcil 9/16/2009 Patient complained of agitation, trem 9/16/2009 Patient developed redness, warmth 9/16/2009 The patient developed high fever >1 9/16/2009 at 25 days after shot she developed 9/16/2009 Per mother, pt awoke on Saturday, 9/16/2009 On four occasions in the two years 9/16/2009 Induration, swelling, redness and ra 9/16/2009 RASH AT INJECTION SITE CONSI 9/16/2009 I received the injection around 10 am 9/16/2009 Beginning 9/15/09 at 6 or 7 PM EST 9/16/2009 Patient complained feeling slight fai 9/16/2009 Received a call from a patient reque 9/16/2009 Right after vaccine administered ble 9/16/2009 Received injection 10:30am within o 9/16/2009 Serious swelling of upper arm, shou 9/16/2009 Red, swelling at injection site. lastin 9/16/2009 Approx 30-40 min after receiving a i Patient received vaccine 9/14/09 &
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9/16/2009 CA 9/16/2009 GA 9/16/2009 MN 9/16/2009 MN 9/16/2009 CA 9/16/2009 PA 9/16/2009 MO 9/16/2009 CA 9/16/2009 IL 9/16/2009 FL 9/16/2009 TX 9/16/2009 TX 9/16/2009 OH 9/16/2009 MA 9/16/2009 KY 9/16/2009 OH 9/16/2009 KY 9/16/2009 NC 9/16/2009 WI 9/16/2009 RI 9/17/2009 WA 9/17/2009 9/17/2009 MI 9/17/2009 MA 9/17/2009 PA 9/17/2009 PA 9/17/2009 9/17/2009 9/17/2009 MD 9/17/2009 9/17/2009 9/17/2009 IL 9/17/2009 CA 9/17/2009 OH 9/17/2009 SC 9/17/2009 VA 9/17/2009 NY 9/17/2009 NY 9/17/2009 KS 9/17/2009 PA 9/17/2009 FL 9/17/2009 SC 9/17/2009 IL 9/17/2009 OH 9/17/2009 CT 9/17/2009 WI 9/17/2009 NM 9/17/2009 AR 9/17/2009 MN 9/17/2009 OH 9/17/2009 IL
18 1.5 76 65 15 73 79 71 86 46 22 9 5 15 31 0.3 31 65 67 75 3 6 0.5 23 23 15
18 1 76 65 15 73 79 71 86 46
14
14
12 3 2 9 81 17 68 4 0.8 58 10 17 12 69 19 13 45 10 2 29 19 5
9 5 15 31 0 31 65 67 75 3 6 0 23 23 15
2 81 17 68 4 0 58 10 16 12 69 19 13 45 10 2 19 5
F 0.5 M M F F M F M F M F F F M F 0.3 F F F F F M F 0.5 F F F F F F F F F 0.4 M F M F F M 0.8 M F F M F F F F F F 0.8 F F M M
9/11/2009 Redness & swelling to site. Doctor 9/15/2009 Mom called our office later in the da 9/16/2009 None stated. 9/16/2009 Given FLUZONE vaccine injection o 9/15/2009 Nausea, dizziness (Patient received 9/16/2009 Vaccinated 9-12-2009 @ 3:15PM. S 9/15/2009 Pt complained of severe arm pain. S 9/8/2009 At 9:30 PM (4 hrs after injections/ p 9/16/2009 Pt experienced unusual swelling an 9/14/2009 Pain, redness & swelling at site, R a 9/26/2009 Approx. 2 1/2 - 3 hours after injectio 9/16/2009 Pt developed redness of about 3 1/2 9/16/2009 Sterile abscess and cellulitis on upp 9/16/2009 Nausea and vomiting s/p flu vaccina 9/15/2009 Patient received FLUZONE shot - a 9/12/2009 PENTACEL, PREVNAR and ROTA 9/14/2009 Day after flu shot patient relied com 9/16/2009 TD given 9-14-09; patient experienc 9/16/2009 On 9-15-09 pt developed nausea, th 9/16/2009 Most painful shot ever gotten, walke 9/17/2009 Received Hep A and Flu Mist on 12 9/17/2009 Large local reaction, 3x4 cm wheal, Had nasal congestion for 2-3 days p 9/16/2009 Information has been received from 9/16/2009 Initial information from a consumer w 9/16/2009 Information has been received from 9/16/2009 Information has been received from 9/16/2009 Information has been received from 9/14/2009 Initial information was received on 0 9/14/2009 Initial report received on 08 Septem 9/14/2009 Initial report received on 10 Septem 9/17/2009 Patient received Varicella Vaccine o 9/17/2009 Cough and stuffy nose lasting more 9/17/2009 Patient experienced nausea and run 9/17/2009 PATIENT STATES THAT ON 9-149/17/2009 Fever 100-101.4 developed approx. 9/17/2009 Left arm with erythema and edema 9/17/2009 CBC obtained 3 days post influenza 9/17/2009 Approx. 12:30 p.m. Inluenza injectio 9/17/2009 pt developed Graves Disease an au 9/17/2009 30-45 min after vaccines given child 9/17/2009 Approximately 2 minutes after recei 9/17/2009 Received pneumonia vaccine 9/14/0 9/17/2009 Swelling at injection site which got w 9/17/2009 Extreme Fatigue, Nausea, migratory 9/17/2009 Influenza vaccine administered at 7 9/17/2009 Fever of 104 degree noted by schoo 9/17/2009 scratching/clawing at eyes crying 9/9/2009 Severe dizziness, nausea, vomiting 9/12/2009 About 5 min after vaccination, pt c/o Behavioral changes, agitation, obse
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9/17/2009 AZ 9/17/2009 GA 9/17/2009 OR 9/17/2009 NY 9/17/2009 CO 9/17/2009 SD 9/17/2009 FL 9/17/2009 WA 9/17/2009 VT 9/17/2009 ME 9/17/2009 CA 9/17/2009 OH 9/17/2009 MN 9/17/2009 ME 9/17/2009 SC 9/17/2009 PA 9/17/2009 VA 9/17/2009 IL 9/17/2009 MN 9/17/2009 MI 9/17/2009 TN 9/17/2009 KY 9/17/2009 OH 9/17/2009 NY 9/17/2009 IA 9/17/2009 9/17/2009 MI 9/17/2009 NM 9/17/2009 TX 9/17/2009 VA 9/17/2009 AZ 9/17/2009 WA 9/17/2009 OH 9/17/2009 MT 9/17/2009 CA 9/17/2009 NY 9/17/2009 VA 9/17/2009 VA 9/17/2009 TX 9/17/2009 CA 9/17/2009 NJ 9/17/2009 TX 9/17/2009 CA 9/17/2009 KY 9/17/2009 GA 9/17/2009 LA 9/17/2009 OH 9/17/2009 PA 9/17/2009 MA 9/17/2009 MA 9/17/2009 IA
11 66 64 50 73 4 1 1.3 3 14 1.4 15 22 43 34 38 70 29 25 1.1 22 51 32 4 93 41 18 49 13 41 24 29 62 65 3 14 0.5 18 62 67 0.2 65 4 28 0.2 70 14 60 53 44
11 66 64 50 73 4 1 1 3 14 1 15 22 43 34 38 70 29 25 0 22 51 32 4 93 41 18 49 13 42 24 29 62 65 3 14 0 18 62 67 0 65 4 28 0 70 14 60 53 44
F F F F F M 0M 0.3 F M F 0.4 M F F F F F F M F 0.1 U F F F F F M F F F M F M F F M M 0.5 M M F F 0.2 M F F M 0.2 M F F F M F F
9/9/2009 "Persistent crying for 3 hrs, with fev 9/14/2009 Red, swollen, heat in area, hard kno 8/24/2009 Next morning: red blister/rash 1" lon 9/11/2009 Positive cellulitis on vaccine site. 9/15/2009 Red skin at injection site approx 199/11/2009 Entire thigh to under knee of left leg Red rash all over. Fever coughing ru 9/10/2009 Fever 101.0 - 103.0. 9/10/2009 Pt received Shot Thur and reported 9/6/2009 Patient and mother report - after HP 9/10/2009 Pt's mother stated swelling, red and 9/17/2009 Five days after receiving the guardis 9/17/2009 Pt is an International student from C 9/17/2009 She had injection on tuesday here i 9/17/2009 Received T/C from Carole Chiv. Sta 9/17/2009 rash on chin, abdomen, and both ar 9/17/2009 At 2pm pt got Zostavax shot. By the 9/17/2009 5 minutes after recieving vaccine, cl 9/17/2009 approx. 12 hrs after vaccine I starte 9/17/2009 slight rash and low fever. 9/17/2009 Patient broke out in hives/rash withi 9/17/2009 c/o of itching at the site of injection i 9/16/2009 Pain in Left Shoulder where vaccine 9/17/2009 Progress Notes JOSEPH LURIO 9/ 9/17/2009 Redness and swelling from the shou 9/17/2009 2 days after anthrax vaccination to t 9/17/2009 Client received HPV, HAv, MCV4. A 9/17/2009 arm described by employee as "swo 9/17/2009 The study subject is a 13-year-old fe 9/17/2009 LLL pneumonia (fever 101-102 x 3 d 9/17/2009 Diffuse urticarial reaction 9/17/2009 One week after recieving smallpox v 9/17/2009 Pain from mid clavical to upper arm 9/17/2009 Vaccine administered without any n 9/17/2009 Developed itchy rash all over body a 9/17/2009 Patient developed chest tightness/p 9/11/2009 NICU graduate Y (24 5/7 wks) gestatio 9/17/2009 This 19 yo patient reported onset of 9/14/2009 Rt. eye is not clear. Suggested pt. c 9/15/2009 7-8 after receiving PNEUMOVAX, p 9/17/2009 Rash around mouth, and on angle o 9/17/2009 10:10 AM rec'd flu vac 9/1/09. 4:00 8/29/2009 4 y/o female received MMR, IPV in 9/17/2009 Approximately 10 minutes after vacc 7/24/2009 Diarrhea x 4 days 9/17/2009 Redness, cellulitis at site of injection 9/17/2009 Vaccine given on 9-16-09 @ 245/PM 9/17/2009 Injection given 9/11/09 on 9/17/09 p 9/16/2009 Headache, nausea, achy, numbnes 9/17/2009 Flu vaccine received @ 10:30-within 9/17/2009 09/16/09 weak, tired, feeling cold.
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9/17/2009 WA 9/17/2009 AL 9/17/2009 NY 9/17/2009 SC 9/17/2009 SC 9/17/2009 WI 9/17/2009 AZ 9/17/2009 IN 9/17/2009 MI 9/17/2009 MI 9/17/2009 NY 9/17/2009 MI 9/17/2009 DE 9/17/2009 OH 9/17/2009 TX 9/17/2009 MN 9/17/2009 WV 9/17/2009 WA 9/17/2009 MO 9/17/2009 MD 9/17/2009 GA 9/17/2009 GA 9/17/2009 OH 9/17/2009 DE 9/17/2009 DC 9/17/2009 TX 9/17/2009 TX 9/17/2009 ND 9/17/2009 OR 9/18/2009 MA 9/18/2009 NC 9/18/2009 CA 9/18/2009 RI 9/18/2009 IN 9/18/2009 IL 9/18/2009 CA 9/18/2009 FL 9/18/2009 FL 9/18/2009 FL 9/18/2009 NY 9/18/2009 9/18/2009 AZ 9/18/2009 AZ 9/18/2009 GA 9/18/2009 FL 9/18/2009 GA 9/18/2009 TX 9/18/2009 FL 9/18/2009 FL 9/18/2009 NY 9/18/2009 MI
1 50
1 50
69 7 3 60 76 27 44 76 46 40 4 48 17 69 74 26 61 11 4 2 68 28 74 53 66
69 7 3 60 76 27 44 76 46 40 4 48
40
40
73
73
27 7 10 14 71 62 67 39 4 6 7 54 65 59 64 74 3 47
27 7 10 14 71 62 67 39 4 6 7 53 65 59 64 64 3 47
69 74 26 61 11 4 2 68 28 74 53 66
0F F F F F M F M F F F F M F U F F M F F M F 0.9 F M F F F M F F F M F F M F F F F M M M M M F F F F M M F
9/17/2009 Excessive crying, irritability. Resulte 9/17/2009 Redness, puffed or swollen, abut siz 9/17/2009 Numbness & tingling of hands & ext 9/8/2009 Customer noticed red rash on left a 9/11/2009 One day following administration of 9/19/2009 Left Parotitis. 9/14/2009 Received flu shot 9/10/09 @ mid mo 9/11/2009 Patient received shot at approximat 9/11/2009 Redness. Heat radiation aft swelling 9/13/2009 Five minutes after FLUVIRIN injectio 9/15/2009 High fever, vomiting, SPLITTING he 9/11/2009 Lt arm sore and red, firm warm area 9/9/2009 -Bruise on left arm in area of injectio 9/11/2009 DTaP and IPV administered in R thi 9/10/2009 L arm pain & swelling following imm 9/8/2009 Itchy, swelling, lungs filling up, swol 9/10/2009 Lq. red swollen area entire upper ar 9/9/2009 Patient described extreme achiness 9/17/2009 Per pt phone call 9/14/09, pt receive 9/15/2009 Light headed, itchy eyes, red eyes, 9/17/2009 Right arm red and swollen around in 9/17/2009 Right thigh swollen, red area around 9/17/2009 Bruise was next day, swelling starte 9/17/2009 No adverse events 9/14/2009 Reports that within 8 hrs of receiving 9/16/2009 L mild upper arm - Red, warm, sligh 9/17/2009 Pneumonia shot given Sept 14, 200 9/11/2009 Relates the evening of the vaccine t 9/17/2009 Severe pain developed locally at inj 9/10/2009 Rev'd vaccine Wed 9/2/09 and had 9/17/2009 Information has been received from 9/17/2009 Information has been received from 9/18/2009 Pt received pneumonia vaccine 9/16 9/14/2009 Received shot on 9-11-09 approx 1 9/12/2009 Red swollen arm. 9/14/2009 Within 24 hours of receiving varicell 7/27/2009 Within minutes of the administration 9/18/2009 Patient states that she was not able 9/17/2009 9/8 vaccinated -migraine starting ab 9/18/2009 Red rash on left and right hand- Itch 9/18/2009 This case was reported by a lawyer 9/18/2009 2 days after receiving VARIVAX and 9/20/2009 (L) arm erythematous, hot, edemato 9/18/2009 Moderate/Severe swelling and redn 9/18/2009 24 hours after receiving my vaccina 9/18/2009 On 9-17-2009 patient called me to r 9/18/2009 Reddness at site on right arm, down 9/18/2009 shot hurt more than usual shotsSOB 9/18/2009 hurt more at onset; SOB, muscle ac 9/18/2009 Pt. presented 24hrs post immunizat 9/18/2009 Skin rash with some itching appeare
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9/18/2009 WI 9/18/2009 MN 9/18/2009 MN 9/18/2009 AZ 9/18/2009 MN 9/18/2009 LA 9/18/2009 NV 9/18/2009 FL 9/18/2009 TX 9/18/2009 IL 9/18/2009 MI 9/18/2009 WI 9/18/2009 AZ 9/18/2009 AZ 9/18/2009 OR 9/18/2009 OR 9/18/2009 NY 9/18/2009 NM 9/18/2009 IL 9/18/2009 GA 9/18/2009 PA 9/18/2009 CA 9/18/2009 VA 9/18/2009 KS 9/18/2009 MN 9/18/2009 MA 9/18/2009 MA 9/18/2009 UT 9/18/2009 GA 9/18/2009 MN 9/18/2009 TN 9/18/2009 NY 9/18/2009 NC 9/18/2009 MI 9/18/2009 OR 9/18/2009 AL 9/18/2009 TX 9/18/2009 AZ 9/18/2009 WI 9/18/2009 OH 9/18/2009 AZ 9/18/2009 CA 9/18/2009 NY 9/18/2009 OK 9/18/2009 VA 9/18/2009 IL 9/18/2009 CA 9/18/2009 MA 9/18/2009 AR 9/18/2009 NH 9/18/2009 KS
7 0.2 68 4 23 42 29 48 57 54 45 36 46 5 1.1 3 50 0.2 46 1 4 29 19 57 1.1 60 11 16 4 62 18 66 49 43 15 64 59 6 80 2 11 67 32 66 14 36 33 32 43
7 0 63 4 23 42 29 48 53 57 54 45 36 46 5 1 3 50 0 46 1 4 29 19 57 1 60 11 16 4 62 18 66 49 43 15 32 64 59 6 80 2 11 67 32 66 14 36 33 32 43
F 0.2 M F M F M F F F M F F F F M 0.1 F M F 0.2 F F 0M F F M F 0.1 F F M M F F F F M F F F F F F F 0.4 M F F F F F M F F F
9/18/2009 MOTHER CALLED THIS AM TO RE 9/18/2009 Persistent, unconsolable crying all n 9/18/2009 Itching, slight rash, and facial flushin 9/18/2009 12 cm by 10 cm swelling and indura 9/18/2009 Itching, hives, headache, sore throa 9/18/2009 LYMPHNODE SWELLING AND PA 9/18/2009 2330, 16 Sep 09. Pt states the left 9/18/2009 Pain and swelling to left deltoid area 9/18/2009 PATIENT STATES INSIDE ARM AN 9/18/2009 I recieved the Flu shot on 15 Sep 20 9/18/2009 Tdap was administered at 11am 11 9/18/2009 HIVES NEAR LEFT ELBOW 45 MIN 9/10/2009 Pt states when vaccine was injected 9/18/2009 Flat erythematous - "hive like" - area 9/17/2009 Woke on day 2 after KINRIX (DTaP 9/15/2009 Febrile seizure 9 hours p shots. 9/18/2009 Localized vesicular rash/eruption at 9/18/2009 Patient felt lightheaded and needed 9/18/2009 Within 24 hours of administration, m 9/18/2009 Pt noticed increasing redness and s 9/18/2009 Lump & redness at HIB vaccine site 9/17/2009 Extensive local reaction, redness, m 9/18/2009 Enlarging red, tender area around in 9/18/2009 Injected Novartis FLUVIRIN vaccine 9/17/2009 Small ruptured capillary immediately 9/18/2009 Diffuse mildly raised erythematous p 9/19/2009 Within 1 wk of vaccination rash beg 9/18/2009 Arms are swollen. No redness or wa 9/18/2009 Pt was given JE-VAX yesterday at a 9/18/2009 Hives 9/18/2009 Uniformly erythemic, pruritic, round 9/18/2009 Received the vaccine at 12, about 1 9/18/2009 Left arm was red,swollen, and warm 9/18/2009 Client seen in clinic for routine Tdap 9/18/2009 Patient states she had pain, rednes 9/18/2009 Redness, warmth- left arm. 9/18/2009 Adverse reaction occured at about 1 9/18/2009 Lt upper arm above elbow to below 9/18/2009 Three hours after receiving immuniz 9/18/2009 24 hours after second Varivax she d 9/18/2009 9/16/09 1630 patient was in her usu 9/18/2009 GAVE 5TH DTAP TO A 2YR OLD 9/18/2009 Received Tdap and Varicella and M 9/18/2009 Pt. received Pnueovax in right delto 9/18/2009 Received vaccine 9/1/09 at 6:44pm 9/18/2009 Patient's right upper arm became ve 9/18/2009 My daughter had the flu shot given 9/18/2009 Joint pain. Bilat. upper extremity we Pt got vaccine after lunch. Since sh 9/16/2009 Hives all over body, neck and face, 9/17/2009 9/14/09 after shot arm pain. 24 hour
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9/18/2009 CT 9/18/2009 MA 9/18/2009 IL 9/18/2009 PA 9/18/2009 GA 9/18/2009 UT 9/19/2009 IL 9/19/2009 9/19/2009 FL 9/19/2009 OK 9/19/2009 AZ 9/19/2009 NE 9/19/2009 NY 9/20/2009 ID 9/20/2009 IL 9/20/2009 IN 9/20/2009 GA 9/20/2009 MI 9/20/2009 MT 9/20/2009 MT 9/20/2009 WA 9/20/2009 AK 9/20/2009 MA 9/20/2009 FL 9/20/2009 NH 9/20/2009 TX 9/21/2009 MN 9/21/2009 WI 9/21/2009 CO 9/21/2009 DE 9/21/2009 9/21/2009 9/21/2009 9/21/2009 9/21/2009 NV 9/21/2009 IL 9/21/2009 LA 9/21/2009 CA 9/21/2009 WI 9/21/2009 MA 9/21/2009 WA 9/21/2009 NJ 9/21/2009 OR 9/21/2009 OR 9/21/2009 VA 9/21/2009 OH 9/21/2009 AZ 9/21/2009 OR 9/21/2009 CA 9/21/2009 9/21/2009 FL
16 64 53 5 4 45 27 24 13 34 57 0.2 68 59 42 2 49 57 37 61 40 8 9 0.2 70 39
16 64 53 5 4 45 27 24 13 34 57 0 66 59 42 2 49 57 37 61 40 8 9 0 70 39
55 19 19 0 0.2 75
55 19 19 0 0 75
4 27 4 0.2 16 59 4 36 2 4 9 35 11 11
4 27 4 0 16 59 4 36 2 4 9 35 11 11
1 16
16
F F F F F M M M F F M 0.2 M F F F 0.7 F F F M M F F M 0.2 M M F F M F F 0M 0.2 F F F F M F 0.2 M F M F F 0.8 F M M F F F M F F
9/18/2009 None. Student given a second MEN 9/18/2009 Nosebleeds occurring spontaneous 9/19/2009 Patient came to pharmacy for Pneu 9/18/2009 Varivax & IPV given at 3:15 pm. Pt 9/18/2009 Looks like break-through Varicella in 9/18/2009 Left arm sore. By 9pm felt nauseate 9/19/2009 I was having shortness of breath, w 9/19/2009 Mild pericarditis treated with NSAID 9/19/2009 day after immunization generalized 9/19/2009 Nausea, vomiting, fever of 101 degr 9/19/2009 Asthma exacerbation: wheezing, dif 9/19/2009 Patient received the rotavirus vaccin 9/19/2009 Shingles vaccine given on same da 9/20/2009 Unexplained body itching, progress 9/20/2009 On 5/19/09 when making a follow-u 9/20/2009 ABOUT FORTY HOURS AFTER TH 9/20/2009 After receiving the flu vaccine at wo 9/20/2009 I received a flu vaccination around 1 9/20/2009 Had influenza vaccine approx 1:30 9/20/2009 had flu shot at 6pm. 10 pm felt thro 9/20/2009 Extreme pain at injection site, unabl 9/20/2009 Flumist vaccine was given intranasa 9/20/2009 Patient was administered LAIV even 9/20/2009 low grade fever (100.5F), diarrhea in 9/20/2009 Onset of symptoms within a few hou 9/21/2009 Itchy rash across chest. 9/19/2009 Patient had swelling and itching at s 9/20/2009 Swelling at the injection site. 9/18/2009 Patient became light headed, dizzy, 9/18/2009 Patient given PNEUMOVAX on 9/14 9/16/2009 Infant received Hepatitis B vaccine 9/16/2009 2.5 mo. female vaccinated with ROT 9/11/2009 E.R. on 04-29-09: Dry hives - heada 9/16/2009 RN requested DPT vaccine but rece 9/11/2009 One day after immunization, child d 9/16/2009 Maculo papular rash on Bilat upper 9/17/2009 Left deltoid 5 1/2 cm wide to 4 1/2 c 9/18/2009 Enteritis (loose, mucousy stools x 1 9/15/2009 None 9/15/2009 Patient complained of tingling in left 9/16/2009 Pt had got 4 yo imms in May in ano 9/11/2009 Reports left pupil dilated 60" after in 9/14/2009 Shots recd 9-9-09 PM. Lt. leg a littl 9/4/2009 Low grade fever noted @ "bed time 9/18/2009 9/1/09 - Left arm red, hot, tender no 9/1/2009 Client made a phone call to clinic on 9/16/2009 On 9-16-09 clients aunt called clinic 9/15/2009 Patient received all 5 doses of Rabi 9/8/2009 When pt was a little over 1yr old he 9/18/2009 Information has been received from 9/21/2009 Patient had her second injection of
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9/21/2009 MO 9/21/2009 TX 9/21/2009 WI 9/21/2009 WI 9/21/2009 CA 9/21/2009 VA 9/21/2009 TX 9/21/2009 TX 9/21/2009 OR 9/21/2009 CA 9/21/2009 MO 9/21/2009 CA 9/21/2009 FL 9/21/2009 IL 9/21/2009 CA 9/21/2009 GA 9/21/2009 NJ 9/21/2009 IL 9/21/2009 OR 9/21/2009 LA 9/21/2009 AZ 9/21/2009 IL 9/21/2009 IA 9/21/2009 FL 9/21/2009 AL 9/21/2009 NM 9/21/2009 MO 9/21/2009 MI 9/21/2009 OK 9/21/2009 KY 9/21/2009 CA 9/21/2009 WA 9/21/2009 AZ 9/21/2009 PA 9/21/2009 FL 9/21/2009 FL 9/21/2009 CA 9/21/2009 MN 9/21/2009 CT 9/21/2009 MA 9/22/2009 AZ 9/22/2009 AZ 9/22/2009 DE 9/22/2009 OH 9/22/2009 KS 9/22/2009 FL 9/22/2009 FL 9/22/2009 TN 9/22/2009 TX 9/22/2009 PA 9/22/2009 VA
12 12 11 4 74 48 90 18 35 53
12 12 11 4 74 48 90 18 35 53
23 11 66 55 4 67 37 51 80 32 6 71 62 28 0.2 13 58 21 60 2 11 52 81 67 49 53 4 3 42 33 71 18 33 25 68 48 21 55 63
23 11 66 55 4 67 37 51 80 32 6 71 62 28 0 13 58 21 60 2 11 52 81 67 49 4 3 42 33 71 18 33 25 68 48 21 55 63
M F F M F M M F F F F U F M F F F F F F M F F F F F 0.2 M M F M F 1F F F M F F F M M M F F F F F F F M F F
9/21/2009 My son developed a low grade feve 9/21/2009 Mom called 6 days after immunizati 9/21/2009 Pt was given 3 immunizations and w 9/21/2009 Pt was given pre-kindergarten immu 9/21/2009 I was a patient in the hospital for a c 9/21/2009 After pt properly screened and iden 9/21/2009 Within days of receiving Fluvirin pat 9/21/2009 extreme fatigue, mono, chronic stre 9/21/2009 The flu shot was administered via in 9/21/2009 Within 24 hours of the vaccination, I 9/21/2009 Patient recieved flu shot at approxim 9/21/2009 This case was reported by a physici 9/21/2009 This case was reported by a healthc 9/18/2009 Woke up at night with hot flashes, s 9/16/2009 Red, swollen about 4-5 inches below 9/21/2009 4 hours after vaccination she was n 9/21/2009 Seizure - went to ER. Received 4 do 9/22/2009 24 hours after vaccine administratio 9/21/2009 My left arm hurts from shoulder to w 9/21/2009 One minute after receiving vaccine 9/18/2009 Flu like symptoms, chest congestion 9/21/2009 Shortness of breath, lightheadednes 9/21/2009 Urticaria tx with Celadrin 4mg, antih 9/21/2009 Patient states she had a rash 2 day 9/21/2009 Red spot at injection site with little re 9/21/2009 Pt stated a couple of hour after rece 9/21/2009 Swelling of bottom lip with repetitive 9/21/2009 Child was given a VARIVAX and ME 9/17/2009 Day of vaccination- No symptoms. 2 9/21/2009 Pt complained of dizziness, light he 9/20/2009 Patient experienced lightheadednes Swollen red hot left arm where flu sh 9/21/2009 (R) upper arm cellulitis - Itching and 9/21/2009 L Axillary lump noted in arm on 9-20 9/20/2009 Itching+ red blotches on arms + legs 9/20/2009 Itching and bright red blotches on b 9/18/2009 12:20pm 9/18/09 patient returned to 9/21/2009 Patient contacted clinic the 17th sta 9/16/2009 Erythema right upper arm. Warm no Approx. 1 hour after receiving vacci 9/18/2009 Started feeling tenderness, pain in h 9/21/2009 9/14 - going to bed extremely sore a 9/22/2009 Rash/swelling at inj site. 9/17/2009 A cluster of seven patients who all r Initial report received on 09 Septem 9/9/2009 Patient had arm being sore at end o 9/14/2009 Diaphoretic, felt faint, numbness in 9/18/2009 Pt complained of numbness in arm 9/14/2009 None 9/3/2009 Redness, induration at injection site 9/21/2009 Large red area on rt arm is inflamed
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9/22/2009 MO 9/22/2009 CA 9/22/2009 CA 9/22/2009 OH 9/22/2009 MI 9/22/2009 CA 9/22/2009 IN 9/22/2009 CO 9/22/2009 KS 9/22/2009 NH 9/22/2009 CA 9/22/2009 MA 9/22/2009 CA 9/22/2009 IL 9/22/2009 9/22/2009 CA 9/22/2009 CA 9/22/2009 NY 9/22/2009 VT 9/22/2009 CO 9/22/2009 FL 9/22/2009 OR 9/22/2009 CA 9/22/2009 NE 9/22/2009 CA 9/22/2009 FL 9/22/2009 IL 9/22/2009 WA 9/22/2009 NC 9/22/2009 ME 9/22/2009 IL 9/22/2009 ID 9/22/2009 AK 9/22/2009 MI 9/22/2009 IL 9/22/2009 CA 9/22/2009 NC 9/22/2009 NC 9/22/2009 MI 9/22/2009 PA 9/22/2009 NV 9/22/2009 IL 9/22/2009 IA 9/22/2009 MT 9/22/2009 IL 9/22/2009 FL 9/22/2009 IL 9/22/2009 IN 9/22/2009 CA 9/22/2009 MI 9/22/2009 NY
52 25 71 50 66 4 10 62 63 0.2 10 0.2 64 55 66 17 67 0.2 0.2 0.2 7 0.1 40 21 15 4 66 10 10 2 73 67 10 37 14 4 68 68 11 42 1.1 62 68 56 4 79 65 76 0.4 71 34
52 25 71 50 66 4 10 63 0 10 0 55 66 17 67 0 0 0 7 0 40 21 15 4 66 10 10 2 73 67 10 37 14 4 68 68 11 42 1 62 68 56 4 79 65 76 0 71 34
F F M F F M F F F 0.2 F M 0.2 M F M M F F 0.2 F 0.2 F 0.2 M M 0.1 F F F F M F F M 0.2 M F M F M M M M F F F 0.1 F F F F M F F F 0.4 M F M
9/14/2009 Arm erythema, painful to the touch, Pain between the spine and shoulde 9/21/2009 24 hrs after vaccination, pt's neck (b 9/14/2009 Headache, Fever, Arm Swollen, Arm 9/15/2009 Got shingles as a result of vaccine. 9/4/2009 Left arm erythema and induration no 9/14/2009 9-11-09 off @ 2:30p (showing swell 9/14/2009 Erythema, induration, fevers, myalg 9/15/2009 3 hrs after shot developed severe le 9/14/2009 Erythema Multiforme. 9/11/2009 Varicella shot given on 9/10/09 at 2 9/16/2009 Irritability: "Screaming" "inconsolabl 9/11/2009 Two days after shot, there was swe 9/14/2009 Rash on legs, knees & forearms. U 9/21/2009 Information has been received from 9/21/2009 Information has been received from 9/21/2009 Extreme case of cellulitis (according 14 mo girl w/ SCID s/p 1 dose ROTA 9/9/2009 Sustained tachycardia presenting a 9/14/2009 Within hours of receiving vaccines, 9/15/2009 Partial seizure - new onset 1 week a 9/17/2009 About 5 pm pt. was asleep in mom's 9/16/2009 On Sep 1 2009 pt received Inactiva 9/4/2009 Felt lightheaded about 5 minutes af 8/19/2009 Chest pain, trouble breathing, rapid 9/15/2009 Vaccines administered 9/11/09 LT A 9/16/2009 Pt states she hasn't been able to mo 9/15/2009 Confusion lasting < 24 hours 5 days 9/16/2009 Mild inflammation with erythema 8-1 9/16/2009 9.3 x 6.5 cm area of erythema with 9/17/2009 Gave flu shot, and pt started bleedin 8/17/2009 Client seen 7-29-09 for travel, was g 9/17/2009 Pt broke out in hives shortly after th 9/18/2009 Within 2 minutes of shot he felt light On 8/18/09 I took my son to his prim 9/15/2009 Allergic Reaction, left arm turned re Pain in the left shoulder and arm 8-1 9/18/2009 Pt broke out in hives on arms, neck 9/15/2009 Child woke today with low grade fev 8/31/2009 Complained of soreness L arm with 9/14/2009 5X3 cm Erythema, very itchy, red an 9/15/2009 Swelling, redness, and warmth in ar 9/16/2009 Flu vaccine given @ 0922 AM. Ons 9/18/2009 Patient received self limiting left side 9/17/2009 Red raised sandpaper appearance 9/17/2009 Pt reported arm swelling and "bruise 9/13/2009 Pt given PNEUMOVAX & FLUVIRU 9/11/2009 Following injection, patient reported 9/14/2009 Received vaccines 8/31/09. Fever 1 9/16/2009 Thursday- Sept. 10 6pm - vaccine; 1 9/17/2009 Shortness of breath, coughing, light
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9/22/2009 MO 9/22/2009 MA 9/22/2009 OH 9/22/2009 CA 9/22/2009 IL 9/22/2009 CA 9/22/2009 MT 9/22/2009 IL 9/22/2009 MO 9/22/2009 AZ 9/22/2009 NV 9/22/2009 IA 9/22/2009 ME 9/22/2009 NH 9/22/2009 WV 9/22/2009 VA 9/22/2009 MO 9/22/2009 NC 9/22/2009 MO 9/22/2009 MN 9/22/2009 OR 9/22/2009 NJ 9/22/2009 CA 9/22/2009 CA 9/22/2009 IL 9/22/2009 OH 9/22/2009 NY 9/22/2009 CA 9/22/2009 MI 9/22/2009 UT 9/22/2009 NV 9/22/2009 MS 9/22/2009 CA 9/22/2009 AZ 9/22/2009 GA 9/22/2009 MN 9/22/2009 PA 9/22/2009 GA 9/22/2009 VA 9/22/2009 NC 9/22/2009 WA 9/22/2009 IN 9/22/2009 AL 9/22/2009 CO 9/22/2009 WA 9/22/2009 NC 9/22/2009 GA 9/22/2009 CA 9/22/2009 AR 9/22/2009 WA 9/22/2009 SC
35 12 24 82 36 17 66 13 49 5 4 0.7 55 9 7 39 79 62 73 1.5 38 1.2 48 1.1 47 4 52 50 80 4 61 3 67 11 24 70 72 22 14 43 52 0.2 15 67 31 42 32 53 13 0.4 73
35 12 24 82 36 17 66 13 49 5 4 0 55 9 0 39 80 62 73 1 38 1 48 1 47 4 52 50 80 4 60 3 67 11 24 70 72 22 14 43 52 0 15 31 42 32 13 0 73
F M M F M F F M F F F 0.7 M M M 0.5 M F F F M 0.5 F F 0.2 M F 0.1 F M F F F M F M F F F F M M F F F F 0.2 F F U F F F F M 0.4 M F
9/17/2009 Shot was given in Lt arm. Patient re 9/18/2009 Mother called 9/18/09 @ 1:46p to re 9/17/2009 FLUVIRIN vaccine administered in R 9/18/2009 On 9/18/09 this volunteer for hospita 9/15/2009 Next day fever, headache - 30 degr 9/16/2009 Received tetanus shot 9-14-09. Tha 9/17/2009 Pt. given Tdap, she is over 64 yrs. o 9/15/2009 Mother stated child developed 2X3i 9/18/2009 Pt said lymph node swollen on left s 9/16/2009 Fever only up to 102 degrees 1 day 9/14/2009 Local reaction 3 - cm - Redness and 9/13/2009 Vomited several times bit. 7 & 10:30 9/3/2009 The pt reported fever, pain, redness 9/11/2009 RA swelling, erythema 8x6 cm, indu 9/22/2009 Flumist given on Thursday, Sept. 17 9/22/2009 RASH 2 HOURS POST VACCINE. 9/22/2009 she presented to the clinic with redn 9/22/2009 CLIENT RECEIVED PNEUMOVAX 9/22/2009 an hour and a half after getting a re 9/22/2009 Cellulitis on bilateral thighs where in 9/22/2009 ABOUT 10 MINUTES AFTER RECE 9/22/2009 On July 10, 2009 patient received o 9/22/2009 9/18/09 8am client called and retur 9/22/2009 HEP B NOT NEEDED 9/22/2009 Broke out in red flat rash on inner a 9/22/2009 R thigh started swelling on Sat.am 8 9/22/2009 Within 1/2 hour of vaccine administr 9/22/2009 I was injected with the flu vaccine o 9/22/2009 patient says muscle still tender after 9/22/2009 Patient put in car after receiving sho 9/22/2009 L arm severe pain 9/22/2009 rash began about 1 hour after shot 9/22/2009 shingles rash eruption 2 weeks afte 9/22/2009 Immediately following injections, pa 9/22/2009 Developed cough, throat/chest tight 9/22/2009 I experienced extreme dizziness aft 9/22/2009 Pt developed a red rash around the 9/22/2009 Pt presented with swollen, firm uppe 9/22/2009 Left arm injection site was warm, re 9/22/2009 STARTED FEELING WEAK ABOUT 9/22/2009 Within two hours of vaccination, the 9/22/2009 Patient hadYa high fever and scream 9/22/2009 9/17/09- Rec'd Tdap, varicella at He 9/22/2009 three days after injection patient rep 9/22/2009 Pt complained of itching, redness of 9/22/2009 12 hours after vaccine, general feel 9/22/2009 Developed chest/throat tightness, fl 9/22/2009 3 hours after receiving seasonal infl 9/22/2009 Pt had meningitis vaccine on 09/15/ 9/22/2009 Death of patient. Y 9/22/2009 Immediately after receiving flu vacci
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9/22/2009 OR 9/22/2009 VA 9/22/2009 MA 9/22/2009 NJ 9/22/2009 CA 9/22/2009 SC 9/22/2009 PA 9/22/2009 9/22/2009 OR 9/22/2009 IL 9/22/2009 IL 9/22/2009 NC 9/22/2009 CA 9/22/2009 IA 9/22/2009 IN 9/22/2009 WI 9/22/2009 AZ 9/22/2009 MA 9/22/2009 MI 9/22/2009 CA 9/22/2009 KY 9/22/2009 VA 9/22/2009 VA 9/22/2009 MI 9/22/2009 MI 9/22/2009 CA 9/22/2009 CA 9/22/2009 CA 9/22/2009 NY 9/22/2009 MI 9/22/2009 VA 9/22/2009 AZ 9/22/2009 NY 9/22/2009 TX 9/22/2009 VA 9/22/2009 OH 9/22/2009 CA 9/22/2009 NY 9/22/2009 FL 9/22/2009 TX 9/22/2009 FL 9/22/2009 OK 9/22/2009 OH
41 55 49 32 1.3 12 82 48 41 74 52 34 65 49 33 45 4 21 48 66
41 55 49 32 1 12 82 48 41 74 52 34 65 49 33 45 4 21 48 66
40 6 0.3 59 71 25 67 1 23 50 36 4 12 5 76 5 4 3 4 4 2 1.6
40 6 0 59 71 25 67 23 50 36 4 12 5 76 5 4 3
2
F F F F 0.3 F F F F F F F F F F F F M F M F F F F 0.3 F F M F M M M F F F F M M F M F M F 0.2 F M
9/22/2009 Rash and some itching appeared on 9/22/2009 Whole body itching, esp. of scalp an 9/22/2009 TIngling/numbness down arm and in 9/22/2009 Around 11 pm started coughing and 9/22/2009 Chicken pox rash 10 days after vac 9/22/2009 Shortly after taking the vaccine she 9/22/2009 Swollen right arm from elbow to fore 9/22/2009 Pt rcvd immunization on Friday and 9/22/2009 Swollen node left side of neck. 9/22/2009 The patient received a flu shot on W 9/22/2009 Pt called 9/20/09 and complained o 9/22/2009 Vanish Point retractable syringe 25G 9/22/2009 Approximately 1-2 hours afterwards 9/22/2009 Used 1 1/2 needle over 240 lbs not 9/21/2009 Patient said she was experiencing s 9/22/2009 Pt received FLUZONE on 9/15/09 a 9/18/2009 L arm swollen, warm. 5 cm long, 3 c 9/22/2009 Syncope episode, lightheaded, nau 9/22/2009 Patient was breathing very deeply. 9/21/2009 Had fever of >103 and projectile vom Fever M/V, soreness at site within 1 9/22/2009 Sx began 4 hours after vaccine adm 9/22/2009 A/P neck pain - right side of neck w 9/22/2009 Once arrived at home, from Dr office 9/22/2009 Breathing difficulties started about 3 9/21/2009 24 hrs after vaccination, pt's neck (b Pain between the spine and shoulde 9/22/2009 Patient experienced chest pain imm 9/22/2009 Mother reports swollen leg. Says shot did not hurt but 5-10 mins 9/22/2009 Seen in clinic 9/17/09 with L arm inj 9/10/2009 Pt states when vaccine was injected 9/4/2009 Within one hour after injections of p 9/15/2009 Given MENACTRA, GARDASIL, Inf 9/15/2009 Rash at injection AREA Erythema a 9/14/2009 -patient got flu & pneumo shots on W See copy of progress note. 9/10/2009 Developed wheezing & cyanosis aft 8/17/2009 A non-serious, spontaneous report 8/27/2009 A non-serious spontaneous report o 8/17/2009 A non-serious spontaneous report o 8/22/2009 A non serious spontaneous report o 8/21/2009 A non-serious spontaneous report o
DATEDIEDL_THREATER_VISIT HOSPITALHOSPDAYS X_STAY DISABLE RECOVD VAX_DATEONSET_DATE n has been received from a physician concerning a child who was vaccinated with a dose ofUROTATEQ. Subsequently, the patient had dev n has been received from a physician Y concerning an 8 week old female who on 17-DEC-2008 Y was vaccinated ### with the first ### dose of ROTAT n has been received from a certifiedYmedical assistant (C.M.A.), for the Pregnancy Registry Y for GARDASIL, concerning ### 2/18/2008 a 14 year old femal n has been received from a 62 yearYold male physician with environmental allergies, Y asthmaNand atopic 11/9/2008 dermatitis who on### 09-NOV-2008 w n has been received from a physician concerning Y a patient (age and0 gender not reported) who Y on an unspecified date was vaccinated with ction of redness, swelling, itching at injection site. Y 6/4/2008 6/5/2008 eruption, 3-4 lesions consistent withYVaricella lesions. Fever of 103 and febrile convulsions lasting Y approx. 1/24/2008 one minute. 2/8/2008 ed by patient, he began to complain Yof generalized itching, then nausea approximately 30 min. Y to 1 hr. after Hep ### B vaccine### administration. 02 within 24 hours of immunization,Ysmall pink lesions on trunk. Y 2/13/2008 2/14/2008 01 beginning within 24 hours of imm. Y Y 4/29/2008 4/30/2008 00.5 within 24 hours of immunization. No other illness symptoms. Y 5/27/2008 5/28/2008 ception area immediately after injection Y of Gardasil and fell to floor and had full body twitching Y for 5 to 10 seconds. 1/2/2009 Was 1/2/2009 not observed fallin given an adult Hep A dose instead of a pediactric dose. Y 4/3/2008 4/4/2008 A given to child instead of a pediactric dose. Y 1/2/2009 1/2/2009 ately 8 hours after receiving vaccines Y child spiked fever of 104 degrees(rectal) with vomiting Y and diarrhea. Twin### sister had ### fever spike as we vaccines along with twin sister and Y spiked a fever of 103 degrees (rectal) within 8 hours afterY administration. She ### wasn't having ### the vomitti with low-grade fever of 100.8 within 24 hours of immunizations. Y 6/10/2008 6/11/2008 m raised tender eryth around injection Y site, temperature of 99.8 Y 6/9/2008 6/11/2008 er, chills; local redness, swelling at site Y of imm. Symptoms developed 7 days after imm. Y 5/30/2008 6/5/2008 or seizure still being determined,events Y startedYin june of 08, she has 3Y experienced over 100 N syncope episodes 5/1/2008 since6/24/2008 that time, a month or s 12/11/08 Pt reports bumps on the back of hands bilaterally approx 1cm in diameter that spread N all over body. ### Pt repots the ###bumps are ver OUT W/ CHICKEN POX Y ### ### cal swelling, induration, erythema, warmth, Y and tenderness resulting in a physician office visit. Y ### ### U 1/2/2009 scribes reaction as increased tempYof 103F, Red hot swollen right arm, body aches and nausea. U Patient was seen ### at1/2/2009 ED and recieved Ben sting 1-5minutes. Fever 104+. Final Y Diagnosis: Febrile Convulsions. Additional: Acute Suppurative Y OM12/8/2008 w/o ruptured eardrum. ### Treatment on L arm located about 2-3 in away from affected area where shot was administered. There Y were a 2 rounded ### red areas and ###then several ospital 12/03/08 for swelling of rightYupper arm, treated with Bactrim, seen again 12/4/08 for Y flu area slightly 12/1/2008 bigger, 12/2/2008 sent to hospital redness, induration, warmth in posterior upper arm (triceps area); occurred one mo. after vaccine. Y ### ### d vaccines below and appeared well Y with no complaints. Upon exiting, pt collapsed in hallway. Y Pt unresponsive ###for a short ### time, with sligh ender supra clavicular lymphadenopathy. Y Also some milder adenopathy in brachial region. Y Both were in left arm, ### which had ###received DTA ot flu shot and needle insertion didn't hurt, but "it felt like the needle hit something". Reports N he had a "fireball" 11/3/2008 of pain when ### medicine inject ceived flu shot Nov 3 & ok until Nov.Y 22nd. Woke up and had #6 pain left arm (upper only) with N pain to left 11/3/2008 LUE distal to that. ### Still has som flu shot left deltoid on 11/3/08. No significant increased pain when administered flu shot as N compared with 11/3/2008 other years 11/3/2008 when got flu shot. C 008 rec'd flu shot pt sore for 1st couple Y of days. Ok until Nov. 15 pain (L) shoulder just belowNacromion #3. 11/3/2008 Nov 20 call Dr.### & used Alleve, T getting her shot 11/3/2008. Reports Y bowling that night and noticing sore arm. Reports on 11/13/08 N noticed 11/3/2008 she was dropping ### things. Hav 08, shot given Nov 4 & 5 sore arm, "went away". Nov 8 & 9 am sore arm around injection site. N Reports 11/3/2008 some tingling 11/8/2008 left arm shoulder to e m pain. Refusal RN interview. Therefore below is not completed. U 11/3/2008 ed his flu shot on Nov 3, 2008. States 1-2 days after the shot he had stiffness in his arm (left)... N "Can't lay11/3/2008 on it"...." have 11/5/2008 to move it around a eceived 11/3/08. States toward the end of November (approx. Nov 12th) he developed an achiness N in both 11/3/2008 shoulders rating ### it a #5. States e 3/08- W/E of Nov 8 & 9. -> sender couldn't hardly life her arm - was weak. On & off ever since. N 12/1/08 11/3/2008 left arm- had 11/9/2008 to hold arm close to h t rash after getting vaccine, 12 days after rash blister appeared, a few days after that blister N were gone but 12/5/2008 area still itchy and ### painful. Patie 2008 flu shot given left arm. Nov 4, noted tensed muscle feel- expected. 8-10 days later right N shoulder 11/3/2008 started hurting in ### rotator cuff-intens ection was blistered , raised , red and tender to touch. No fever. Plus irritability. Area aroundYsite was red x an ### elongated area ### appears "bur rts child with "severe" hip and joint pain. Complains of severe pain in legs, feels like she has the flu, mom feels### this is more ### than an averag itching one vaccine left arm administered area. Symptoms started 11/25/2008, Dx Arthrus reaction. Y Rx with ATARAX ### 12/2/2008 25 mg QID as neede 12/30/2008- Temp 101 degrees- redness and induration at left upper thigh. Y ### ### ceived Menactra vaccine on 12-31-2008. Rapidly developed redness and swelling at injection Y site only. Area of### redness was ###5 in x 5 in. Are veloped Shingles 3 days after vaccination. Patient had no prior history of Shingles, was notNill, had not been ill### for atleast ### 3 months prior to occurred immediately after the shot was administered. large raised red area approximately 6Yinches in circumference ### with ### itching and burnin
d area approximately 4 inches in diameter with a pink circular eurthmia approximately another Y 2 inches surrounding ### the outer ### portion of the nt complains of major swelling in the arm where the vaccine was administered. Swelling to the U point where1/2/2009 he could not 1/2/2009 lift his arm. He com as given Zostavax vaccine at approximately Y 12:30pm on 12/20/08 (subcutaneously per protocol) Y at Pharmacy. ### He had no problems ### at time he had itching at injection site beginning soon after Y vaccine given (given 2 12/19). Around midnight Y 12/21, pt awoke ###to get out ### of bed and had 9/29/2008 Y N 9/29/2008 9/29/2008 flu vaccine 12/8. On 12/10 developed fever andY seizures. Sepsis work 2 up negative, head CTYnegative. Dx: 12/8/2008 complex febrile### seizures. 3/3/09 ngestion-nasal,ears,head - vision and hearing. Severe headaches. Chills - cold sweatsY fever, N severe weakness, ###confusion###very, very bad er DTaP was given right thigh became erythematous and very edematous, no treatment necessary. Y 12/8/2008 ### gue, itching around face, neck, scalp, shoulders, ears. Flushing of face, also apparent. Started U itching again 1/2/2009 left arm1/2/2009 toward back. bumps on legs after shots. Y ### ### ports temp of 103 degrees vomiting,Ydiarrhea starting 12/29/08. Seen at hospital on 1/1/09 U ### ### and swelling around vaccination siteYwith warmth. Pt took BENADRYL 11/7/08 and IBUPROFEN Y X several 11/5/2008 days. Saw 11/6/2008 family practitioner. mber 26 at 10 am received the ZOSTAVAX vaccine; about 10pm had a terrible headache andU took 2 ADVIL. On### 27 at 2 am### woke up with ch owing Flu vax developed pain and tenderness LUE with decreased ROM persist Sx as of 12-29-08. N ### ### ain "10/10" in deltoid area rad. downYbiceps area also into shoulder/neck. This was flu shot #2 Y alt recall of first vaccine ### by manufacturer. ### eeks after the f/u shot, I experienced Y joint pain, in the foot, ankles, knees, neck, arm, elbow and hand. 2/10/09### Received PCP ### medical reco struggling before shot- held by father. Shot was administered to L arm. Child looked up at Y mom and "smiled" ### then became ###briefly limp, res ates she recieved Zostavax 12/10/08 Y and developed Zoster 12/13/08. Location of Zoster wasYon scalp ### ### mplains of generalized urticara withYtightness in chest. Swelling of the tonsils was observed,Uhowever patient 1/5/2009 denied1/5/2009 any prior illness. served having trouble breathing. Patient Y had altered mental status. Patient did not improveUafter epi-pen1/5/2009 administration. 1/5/2009 ost- MMR reactions; fine pink papular rash and fever onset 8 days after MMR vaccine administration. Y Fever 5/21/2008 of 103. 5/29/2008 MMR rash. Pt developed pink macular Y rash on 5/14; initially few spots on legs, then on trunk Y and arms. Afebrile. 5/5/2008 Acting 5/14/2008 well. No other sx. SEEN FOR WELL CHILD VISIT ON 12-29-2008,RECEIVED VARICELLA, HEPATITIS A, AND Y FLU VACCINES. ###PARENT ### CALLED ON 12 ness at vaccine site with low grade fever Y of 100.5 and crankiness since night before Y 4/8/2008 4/9/2008 heat, redness, and swelling at imm site (right thigh). Y 4/25/2008 4/26/2008 le, red skin at DTaP imm site. Y 2/13/2008 2/15/2008 ENTED TO ALLERGY/IMMUNIZATIONS CLINIC C/O A 5 DAY RASH OVER BOTH ARMS AND U INSIDE OF THIGHS. ### 1/1/2009 PT BELIEVES IT M rxn to DTaP- area of erythema, localized firm edema, and heat at DTaP site on arm Y 5/1/2008 5/2/2008 tous, maculopapular rash midly pruritic in the antecubital fossae bilaterally as well as dorsumNof the hands and ### on the1/1/2009 proximal legs bilatera , bruising at site of immunization Y Y 3/24/2008 3/27/2008 ubcutaneous swelling at immunization Y site, not red, not tender. No additional symptoms. Y 4/15/2008 4/22/2008 icella vaccine swollen to the size of a half dollar, red and hot. Tender to the touch. No Shortness Y of Breath 4/28/2008 4/29/2008 ceived the MMR & Varicella vaccines in the left anterior thigh. She had a large area of redness Y with an irregular 1/5/2009 border 1/5/2009 present over the are and swelling in left thigh where Varicella vaccine was given appeared 6 days after imm. Fever Y from 6/3 - 5/27/2008 6/5 (6-8 days 6/3/2008 after imm). ot on 12/2/08 and on 12/4/2008 hadYsevere pain and edema in ankle and foot and with in a week Y total joint 12/2/2008 involvement. 12/4/2008 MD visit follow wee Hives, trouble breathing / problems have Y continued since first injection / she breaks out in hives N when there 1/23/2008 is a change 3/25/2008 of temperature (outs s, pain in back, headache, chills, stiffness Y Y 1/2/2009 1/2/2009 ays developed ipsilateral upper arm numbness and pain and tingling into the L hand. WithinYa few days,10/3/2008 ipsilateral thigh had numbness and ceived vaccine on december 18, had Y fever of 102F on december 24 and first chicken pox were U noted on january ### 3. 1/3/2009 was ordered for the patient and Prevnar was given. Patient felt light headed after the shot and Y fully recovered. 11/6/2008 11/6/2008 rmation was received on 23 December Y 2008 from a health care professional. A one year old Nmale patient with a### runny nose at the time of v was reported by a lawyer and described the occurrence of joint pain in a female Y subject of unspecified U age 9/1/1999 who was vaccinated with LYME o hospital on 12/24/08 for intussusception; ROTATEQ Y vaccine was1given on 11/3/08. 1/21/09 Y Reviewed 11/3/2008 hospital medical### records of 12/23 STAVAX shot 6-16-08. Has had restricted range of motion in that arm. If she immobilizes Y arm U couple days 6/16/2008 the pain 6/16/2008 dissipates. Exercise ma reased muscle pain, fatigue, Y weakness, dysphagia, weight loss. Pt requiring Prednisone Y IVIGNevery q monthly. 8/7/2007 Methotrexate 9/1/2007headache, mu daughter received her 1st shot of 3 (to complete full dose) she started having problems Y soon after.- light headed, 3/12/2008 dizziness, 3/12/2008 fainting, fatigue, ches 2) Visual Change: felt like water was in her left eye 3) Neck pain 4) Total body myalgiasY5) BP 0f 140/100 ### ### ved flu shot and Pneumovax in different arms on 11/11/08 . Later that day she developed L arm Y soreness with ### fevers to 102 ###degrees F. Als as given PNEUMOVAX and Flu shot on 11/11/08 he developed chills and significant aches and Y fatigue later that ### day. Had ### a large red rash o clinic on 12/30/08. After leaving PCP's Y office (in clinic at approx. 5pm) - had tennis ball sized U area of inflammation, ### redness ### at left arm - a oped severe right arm pain a few hours Y after the shot. Had chills and continued arm pain. Developed Y a blotchy### red indurated ###rash on right d
was administered 12/15/08. Baby returned Y 12/16/08 with bloody diarrhea. Stool culture done-Ynegative for O and### P negative ### for salmonella, 08 Patient received PNEUMOVAX around 230. At midnight woke up left arm sore at injection Y site at 2am woke### up pain at### injection site radi eaction to vaccine 1-2 days after administration. Nauseous, dizziness, headache, ringing in the ears. Was 10/8/2008 exposed10/9/2008 to grand children just p ain (next morning) extending down arm to fingers - around left shoulder blade. Shortness ofYbreath - red (hives) ### fever. Pt called ### MD. Told t esents with stomach pain, watery red eyes, itching, sweaty, red, flushed face. Y ### ### d hypersensitivity reaction, warmth,Yredness and swelling locally. Patient reported hives bilaterally Y on arms, but### not observed ### on examinati er vaccine had slight rash at vaccine site (RA-VARIVAX) with itching. Following day had rash Y on face - more 2/12/2008 pronounced 2/14/2008 with itching. No diffuse maculo-papular rash on shoulder, Y back, upper thigh, neck, spots face, arms, no fever. Y non pruritic. ### 12/6/2008 r receiving Hep A vaccine pt developed sand papery rash, slight irritation. No fever, cough, sob, Y and no 7/21/2008 recent illness. 7/21/2008 U ### ### lled, daughter is very weak, cannot Y keep eyes open. Llips are pale. Weak. Told mother to take Y her to ER. Took### to ER -started ### feeling better derness, erythema left upper arm no fever- probable allergic reaction. Could not rule out cellulitis. U ### ### ted 12/27, started on face and is slowly spreading downwards. ### ### nch raised, erythematous area to right Y deltoid warm to touch. Vaccine given 12-22-08, reaction Y began on 12-23-08 ### around ### 1:00 pm. Reac Y ### ### tion was administered in left arm. Patient then passed out & was laid down. Pt was drooling, Y then her legs & arms ### extended ###outward (strai p B injection in gluteal region. Y ### ng, tingling and redness around corners of mouth. N ### ### r well child visit and had just finished 10 day course OMNICEF this am for bilat. ear infections. Y Developed1/5/2009 generalized 1/5/2009 hives couple hrs afte ea, light headed, dizziness at 13:20. B/P 136/85, P. 89 Denies respiratory problems. Face flushed, N diaphoretic. 1/5/2009 14:00 1/5/2009 continued c/o nause after getting immz on rt lg. Treatment cold compress. 1/2/2009 ed receipt IM Influenza age 16-17 (1997-98) Y with development red rash. Told not to take again....no Y documentation 1/1/1998 available. No other sy ught by mom for over 1 week h/o small "knot" right anterior thigh after vaccinations. No painYor discomfort. Small ### 1" diam. ### area of non ten t arm still sore. Hard to grasp or lift heavy objects. Vaccine given on 12-4-08. No treatmentUgiven at this 12/4/2008 time. 12/5/2008 red and swollen 12cm by 7cm tense and tender Y ### ### n: rash 10 days after SMPX, MEN, Y AVA vaccine. Believes due to SMPX vaccine. Symptom: Rash, diffuse3/3/2003 start: 03/10/2003 3/13/2003 Comment: 782 2/15/08, notes soreness, states no below waist eccythmosis, scattered lesion anterior and posterior trunk12/5/2008 and neck, reddened ### raised macul d suspected immune reaction. Patient has lost sleep. Arm has pain without swelling. PatientUhas seen doctor and ###has had### Medrol DP + Sle ection site x 2 days. On 3rd day radiated Y to L shoulder at deltoid. Constant throbbing pain, restricts N mobility. Severe ### enough ###to wake from s ears, jaw tightness, lightheadedness, Y chest tightness 20 after Engerix-B #1 U 1/5/2009 1/5/2009 d vaccine on Friday. Saturday night pt noticed site where he received the vaccine was itching U and he had developed ### 11/1/2008 a rash that was abou TWINRIX given. Blistery type scab 12/11/08, now has a scar barely visible and felt like had Yflu, muscle aches, 12/3/2008 tiredness, maybe ### a little feve on immunizations on 10-23-08- Broke out i rash (generalized) and periodic temp (101)- no temp today, but still### rash- irritable ###at first but not chool nurse office-phone call from RN- states "big wheel- she can put 4 fingers over to coverUdiameter-appears### red raised ### - slightly painful to mplains of swelling at site of injection. stomach cramping and headache. Swelling at site of injection Y approximately 10/6/2008 10/7/2008 the size of a nickel. lled and stated this (L) arm around injection Y is red and swollen and getting larger. States sheYhas been using 10/7/2008 cool compresses, 10/8/2008 no fever. Ad mplains of swelling at injection site on left arm. Swelling is approximately size of golf ball. Y 10/8/2008 10/9/2008 on 12/10/08 arm red from site of injection to elbow, took TYLENOL today in am, no relief as Uof yet (350pm) sleeping ### off and ###on all day due ours, patient experienced motor function impairment with her legs buckling underneath her, Y 10-12 times over the ###next 3 hours ### falling each t s given vaccines for Typhoid and Cholera. Y I was allergic to them. In less than 24 Y hrs I had difficulty Y moving2/1/1982 and was taken 2/1/1982 to ER at hospital 01 Dr. ran rapid strep -> negative continue Y to have ear and sinus trouble. 12/18 Dr. irrigated U (L) ear (perforated)### & did sinus ### x-rays. e within 15 min - 5 cm red spot painful Y - itchy- muscle weakness- slept 12hrs- went to urgent Y care on 12/28/08. ### No infection ### at vaccine siteadministered in L thigh on 12/18/08. On 12/26/08, 4 vesicles appeared @ injection site. Slight U firm mass underneath, ### some ###discomfort. ports that a rash began 3 days afterYthe vaccine on her hands. She described as bumps andNreported itching. Then ### rash progressed ### to her ately 1 wk following injection: large hives 4" to 6" (blister like) on both legs from knee to hip for N about 1 week- shooting ### pains ###in hands-follow acked out after receiving HPV vaccine. Y ### ### headache, increase menstrual periods (3 in 2 months). N ### aP on L deltoid very red, swollen, hot to touch, site of flu shot on R deltoid also very red, swollen Y and hot to touch. d area at vaccine site + about 1.5cm. Hardened area- circular. U 12/9/2008 12/9/2008 school teachers c/o S.O.B. & wheezing to school nurse - treated with Ibuprofen. Y ### ### TC on 12/31/08- c/o .5cm red area with 3 small bumps that appeared 2 days after Immunization. Y ### ###
houlder w/red itchy rash Y U ### ### 1520 client fainted 5-10 secs., did not fall, no injuries noted, B/P 90/60, R14, P60, no SOB noted, Y push/grips strong, ### perria### intact, skin u/d a arm just distal to shoulder, reddened Y area roughly 4cm in diameter with another 1cm borderUwhich is lightly reddened. ### The ### area is very wa n has been received from a Certified Y Medical Assistant for the Pregnancy Registry for GARDASIL Y concerning 6/30/2008 a 19 year 6/30/2008 old female with pen n has been received from a consumer, for the Pregnancy Registry for GARDASIL vaccine, concerning U his 25 year old wife general anesthe n has been received from a physician, for the pregnancy registry for GARDASIL, concerningUan 18 year 5/27/2008 old female 8/30/2008 with a history of 2 pregn n has been received from an office manager concerning Y a female who 4 Y in August 2007, was Y vaccinated with 8/15/2007 a dose 8/17/2007 of PNEUMOVAX 23 va n has been received from a physician Y concerning Y a 65 year old female 4 who was vaccinated Y with a second 0.5 ### ml dose of PNEUMOVAX ### 23 n has been received from a physician concerning his 71 year old wife with no known Y allergies N and no pertinent### medical history ### who on 19-D symptoms 4 weeks post Influenza vaccine, Y increased difficulty ambulating x 4 weeks myalgias, N neuropathies, 10/9/2008 evaluated 11/9/2008 by ER physician on swelling and induration anterior Right Y thigh at typical location of immunization -- MMR and DTaP Y adm on3/25/2008 right side x 2-3 4/4/2008 days. Afebrile. Tre d a seizure two hours after recieving Y the vaccine. She had no history of seizures and she did Y not have a fever### at the time### m, mild redness, progressing in severity Y and radiating dowm arm to wrist and up into shoulder U and neck, rash ### at injection ### site extending d ed that the evening after receiving her shot she had redness, swelling, and slight pain at siteYof injection. 1/5/2009 1/5/2009 ated that pt developed a mild URI and vomitingY3 days post immunization 3 and a fever of 102. Y Parents brought 12/3/2008 pt in12/6/2008 2 weeks post immuniza minutes of getting vaccines Left leg (injection site) broke out with whelps spreading to the abdomen. U Patient 1/5/2009 given 1/41/5/2009 tsp. of Benadryl po an ted with approx 5 cm area of redness, Y sl warmth but minimal swelling. Mildly tender. No streaking. Y Rx'd 3/19/2008 Tylenol or Motrin 3/20/2008 for discomfort. 01 -102, body aches, and fatique x 4 days. Y 1/2/2009 1/3/2009 RECIEVED VACCINE. 12/23/08 VISITED DOCTOR COMPLAINING OF UPPER RESPIRATORY U INFECTION/### EXACERBATION ### OF ASTH r (102.9F), SOB & rash 3 days afterYreceiving Pediarix, Y hib, Prevnar.4 Evaluated in ER 11/6/08 Y at Hospital. 11/3/2008 Patient admitted 11/6/2008 for 1 week due as given Hep B shot at 1Yminute of age. Y On theYsecond day of life patient 84 Y was having Y seizures N and could no longer ### drink from ### her bottle. O noted on right arm near site of varicella administration. U ### 1/3/2009 given in same arm 12/20/08. 12/22/08 Rt arm w/2" area of erythema, ver tender, induration N and tender distal deltoid, ### continue ### pain control, was given Tdap vaccination on 12/29/2008 Y for post exposure to Whooping cough. He followed Y up on 12/30/2008 ### c/o dizziness, ### chills, wea 0 hours after getting Tetanus booster I started having servere chills and body aches the entire U day. The night 1/3/2009 after that 1/4/2009 I had a fever of 102. was reported by a lawyer and described the occurrence of rheumatological symptoms in a female U subject3/1/1999 of unspecified 3/15/1999 age who was vacc spontaneous report of Bell's Palsy has been received from a Registered Nurse concerning aN52-year-old10/5/2008 female subsequent 10/5/2008to FLUMIST. M previously health 8-month-old Y boy with a 2-weekY history of runny nose 25 and cough without fever. Y Three days prior ### to admission ### he developed mber 10 pt received Flu vaccine. At 9:30 Y am. After Y the vaccine he went 1 to the dentist who prescribed U an antibiotic ###for the tooth ### infection. On ite hurt longer than any previous flu shot and muscle continues to hurt especially with movement N of arm, with some ### restriction ### of movemen sore for prolonged amount of time after receiving flu shot. Burning all the way down to the elbow Y for a few seconds, ### then ached ### for a month sore at site of injection for a prolonged Y amount of time immediately after injection. Y ### ### sore after receiving flu shot for a prolonged Y amount of time "joint pain"-not relieved by Ibuprofen. Y ### ### y-absence of muscular control of right Y facial muscles-upper, middle, lower face-Drooping eye N and mouth. 12/8/2008 ### t dizzy, was short of breath, and had Y a dry mouth 20 minutes after leaving the hospital, which Y lasted for 4/14/2008 2 hrs. In the 4/14/2008 evening the patient de ateral leg pain with cramping. Generalized muscle and joint pain, symptoms began around midnight U today. 1/5/2009 1/6/2009 hrs of vaccine. L arm at vaccine swollen, red and painful. Treated with BENADRYL. Also, had Y a fever. ### ### 6:00pm, Rash appeared on L arm and Y L side of face and chest. Pt. also had local reaction ofY warmth and redness, ### described ### "like the size swelling (L) lateral thigh. ### ### accine and after a few min. later had asthenia, numbness and tingling down (L) arm, dizzy, ringing N in ears, frontal headache, no SOB. Coug ### N ### ### h left elbow pain, progressed to right Y elbow, then to other joints. Peaked, with all over, achy N body and high 10/9/2008 fever. Patient has ###been slowly g flu clinic 17 mo was given FLUMIST approved for equal to or greater than 2 year olds. No reactions. U 11/6/2008 on the 11th with a horrendous headache. Lasted about 3 hrs. Woke up on the 12th with a bad Y headache and ### dizziness. ### Headache went a us case was received from a health professional on 27 December 2008. The patient was enrolled Y in a study 5/3/2006 for which Sanofi Pasteur was n ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/2/2006 a sponsor. A 32 ### year old female p ort received on 27 December 2008 from Y a physician. A 31-year-old pregnant female experienced Y oligohydramnios 5/4/2006approximately ### 193 days a ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/1/2006 a sponsor. A 28-year-old ### pregna ort received on 27 December 2008, Y from a physician, as part of a study for which is not a sponsor. Y A 38-year-old 5/4/2006 pregnant female experienc ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur Y is not 5/3/2006 a sponsor. A 28-year-old pregnan ort was received 27 December 2008Yfrom an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006 A 30 year old female
ort was received on 27 December 2008 Y from an investigator as part of a study for which Sanofi U Pasteur is 5/5/2006 not the sponsor. 1/10/2006 A 29 year old fem ort was received 27 December 2008 from an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006 A neonate male patie rmation was received on 20 OctoberY2008 from a health care professional. A 51 year old female Y patient received ### an intramuscular ### injection ts have given patient the not unexpected warmth and redness at the shot site. What is unusual U is that he subsequently ### developed hyper pi n has been received from a consumer concerning his 77 year old wife with depression, Penicillin N allergy, Sulfonamide ### allergy, ### LEVAQUIN a eared 3 days after immunization was given. Rash is located behind the left ear and has spread N onto the12/1/2008 neck. Rash 12/4/2008 is described as itchy. ast her 1 yr. shots she started running a 100,5 temp. she had vomiting and loose stools..sheYalso developed a ### rash 11/1/2008 all over..i was told the r eadache 48 hours after administration of Zostivax and pneumococcal vaccines. Redness to Y site of zoster 1/2/2009 vaccination.1/4/2009 veloped upper respiratory symptoms, Y cough, and fussiness one day following his 2 month immunizations. Y 7 days ###following### vaccination he d zziness lasting 6 - 8 hours. No other symptoms. Completely resolved in approximately 18 hours. Y ### ### ped a blister like rash on top of left hand about 2 hours after receiving the vaccine parents administered Y 2 1/6/2009 children's chewable 1/6/2009 Benadryl chil nauseous, ringing in the ears, paleness for about 10 minutes after the vaccine. Y 1/7/2009 1/7/2009 e in one day later with hives, treatedY with atarax. Y 1/6/2009 1/6/2009 esented to Immunization clinic on 01/06/09 for the second dose of HPV vaccine, having received N the first8/19/2008 dose on 08/19/08. 8/19/2008 During screeni mplained of severe pain, weaknessYin upper arm from site of injection to elbow onset immediately N post vaccine. 12/8/2008 Reported 12/8/2008 12/15/08, advise r vaccine administration, painful, red swelling of left upper arm U 1/5/2009 1/6/2009 ERED FROM HIVES, RASHES ANDY A MILD GRADE FEVER FOR 7 DAYS FOLLOWING VACCINATION. Y 12/1/2007 THE PT 12/2/2007 RECEIVED TX WITH P d area on arm warm and swollen. U 1/6/2009 1/7/2009 s and swelling to left upper arm x 4 Ydays s/p pneumococcal vaccination 28NOV08. Reports Y onset of symptoms### one12/2/2008 day following vaccinatio after receiving the first dose of the injectable flu vaccine, the patient developed red bumps. There Y were three larger ### bumps### near the injection d Gardasil shot and then Depo-Provera Y about 1 week later. 2 months later, this past Friday she passed a mass### of tissue 1/2/2009 vaginally that was t. Wed night to check up on anything and wife told me he was in bed. He noticed earlier thatYevening hive-like 1/3/2009 red bumps 1/7/2009 on arms, torso an was reported by a lawyer and described the occurrence Y of joint pain0 in a 45-year-old femaleNsubject who6/14/2000 was vaccinated with LYMERIX. A arm began itching. Got worse and 1 day later heat & redness began than increased until theYpatient took Benadryl. ### I1/2/2009 advised ice- good res sore after receiving flu shot for a prolonged Y amount of time initially felt burning 3 weeks following. Y Arm was painful ###and hard ### to lift. rmation was received on 02 December Y 2008 from a health care professional. A 40 year old female N patient with### a nut allergy ###received an int tis; red, warm, tender treated with Keflex and Septra Y ### ### ter received her second injection of YGARDASIL on December 22, 2008. On December 31, 2008 U she had a sudden ### and severe ### hives react ella-like rash - Rt upper arm 3 clustered vesicles erupting 1 wk ago, now crusted and 2 1-2 mm Y erythematous papules ### 1/1/2009 on ant. chest. + URI ction with itching, redness, and swelling on right thigh at the site of Flu vaccine. Y ### ### fever 106 degrees F, redness at injection Y site. N 1/5/2009 1/6/2009 ceived first dose of GARDASIL and may have been pregnant 7/31/08-LMP-5/15/08 receivedYGARDASIL6/19/2008 16-1608 within minutes of administration of vaccines. Y ### ### L administered 12/22/08, within hours patient noticed "tremors" (looks like she is having chills). Y Family and friends ### noticed### episodes too. Ep night, back pain, fever, headache, neck, Y stiffness, and arm pain. U 1/5/2009 1/6/2009 ort received from health authorities in Y a foreign country on 5 January 2009 under the authority Y reference number: 7/4/2008 PL-URPL-OCR-20081218 7/4/2008 N ort received on 05 January 2009 from Y an other manufacturer who had provided a copy of a litigation report. 3/27/2001 The report 3/27/2001 referenced a case. F 7th Monday: Nurse at medical center Y gave me Pneumonia shot on Right shoulder. The shotNwas high on the shoulder ### and### it pricked the Bo ped seizure activity < 12 hours. S/P YHep A vaccine Y #2. Admitted and3started on Anticonvulsants. U 3/3/09 MR 1/7/2009 received 1/7/2009 for DOS 1/7-10/2009 w ### N ### ### d with juvenile onset diabetes Y mellitus 17 days Y after live flu vaccine. 11/12/09-records Y receivedN for DOS 12/14-12/15/08-DC ### ### DX: New onset d 3:30 am Hives hospital ER. (10/18/08 Y 9:22 am city hospital ER cover in hives- extreme itching-skin Y turning black ### and blue ### from top to bottom 8pm- Body aches, fever/chills, postYnasal drip, sore throat. Evening of 10/23/08, had increased Y sinus congestion, ### body aches, ### fever/chills ministered flu vaccine; patient began to faint (vasovagal episode) occurred; vital signs taken. Y ### ### ness & swelling - started - by 4-5 pm on 1-5-09 - gotten progressively worse & longer. > 50 cent. U noted at office 1/5/2009 visit 1-7-09 1/5/2009 445pm. facial swelling hives body approximately 3 hours after receiving immunization contacted PCPY MD given ZYRTEC ### not seen ### by PCP. Mothe n left arm - net sore at first - but after 2 days very painful when lifting, putting on coat - etc. Lasted Y about 2 weeks. ###Daughter### was injected as Y Y ### ### le with left arm swelling from mid upper Y arm to mid lower arm. After speaking with provider possibly Y cellulitis not### associated. However starts ceived VARIVAX on 9/26/02 in the right thigh. She returns to clinic on 9/22/03 with a diagnosis of shingles. 9/26/2002 It is described 9/22/2003 in the medical re
ceived VARIVAX on 1/12/98 at another facility. Site of immunization is not recorded in records. U She came 1/12/1998 to our facility on### 11/26/99 with a d ceived VARIVAX on 5/7/07 in the right thigh. She returns to clinic on 10/09/08 with diagnosisUof shingles described 5/7/2007 in 10/9/2008 medical record as "loc ceived VARIVAX on 2/15/05 and 9/18/07. Both immunizations were administered in the left thigh. Patient 2/15/2005 returns to 3/2/2006 clinic on 3/2/06 with a ceived VARIVAX on 12/27/02 and returns to clinic on 6/2/04 with a diagnosis of shingles. She U received the VARIVAX ### 6/2/2004 in the right arm. The s alergica, ronchas, comez¢n, mano, problemas al tragar, se me hincho la cara, hasta la fecha U no se me quita el dolor de cabeza, me siento action, hives, itchiness, dizziness, problem swallowing, my face was swollen, to this day myUheadache doesn't go away, I feel very nervous n has been received from a physician concerning an 18 year old female with no relevant medical N history or allergies who in approximately 2 -Patient received Td on 9/26/2008 and started having soreness at beginning of November/08--started N having 9/26/2008 upper 11/1/2008 arm, neck pain (left side creased swelling on L arm from top of shoulder to mid-humerus, rednessover same area withNitching. Pt. also 1/6/2009 complains 1/7/2009 of pain upon move on arm and spreading. Hot to touch,Ychild could not move arm said it felt numb. Swollen Y ### 1/5/2009 nt received the Pneumovax injection in the Right arm and on 1/7/09 she had noticed increased Y pain in the1/6/2009 arm along 1/7/2009 with 2 areas of rednes out one minute of receiving Gardasil I immediately started throwing up, became dizzy, covered Y in sweat, 5/31/2007 shaking, and 5/31/2007 felt faint. I was requir ned 1/08/09 and stated that she had spoken with her friend who had a reaction to the Tetanus U vaccine, and 9/9/2008 she wanted to### report that she h acc,pt c/o dizzyness,when seen pt looked pale and sweaty,pulse 55,bp 88/54,pt put on tableYat trendlenberg 1/7/2009 position1/7/2009 felt better ,bp 99/69,p as administered at 11:00am on Monday. By 10:00pm Tuesday evening patient has an extremely running 1/5/2009 nose, coughing, 1/6/2009 low fever ~100, s rting 1 day after shot. Strong family history of allergy to flu shot, in mother and brother. Y 1/6/2009 1/7/2009 a call from patient above stating that she became very ill 4 days after the 2 vaccines were given. Y Pt. reported nausea, ### extreme ### fatigue, wh p after injection. Awoke limping with red, hot, tender swollen leg within 5 hours of IZ. Remained Y hot, became itchy, ### leg color ###uneven with do perienced acute leg weakness progressing Y to include arm weakness and overall body weakness N within a11/4/2008 two-week period. ### Saw family phy phone call received by health department Y nurse from patient's mother with complaints of patient Y having itching 1/6/2009 throat,1/6/2009 hives, and SOB, stat d female presented to Student Health Center at TAMU on 11/25/08 with complaint of right arm U pain ever since ### she got her### flu shot in mid o hree days later w/complaint of fever, chills for two days. Has large, warm, reddened area at site, U swelling. 1/5/2009 States began 1/6/2009 the day after injecti tingling and numbness/neuropathy-type symptoms in arm vaccine was administered (right). NShe also states 7/25/2008 some 7/26/2008 motor symptoms, mainl the shots on 10/23/2008 at 19:45 pm. Y After 24 hours developed itching and swelling of the forearm Y that extended ### to the entire ### arm. The ar n minutes after Td shot pt. had seizure Y in car with mother. Pt. reported dizziness, ears ringing, N confusion upon 1/6/2008 arousal. 1/6/2008 Pt. reporting body ac S FACE; NOSE; EYE NOT INVOLVED TREATED WITH ACYCLOVIR 800MG 5X/DAY Y ### ### rre Syndrome after receiving Y the flu Yshot. VeryYsevere case, currently 34 Yin intensive care at Hospital U 2/25/09-records ### received 1/1/2009 for DOS 1/5-2/ an MMR shot on December 19, 2008 as part of my registration requrements. As of today, there U remains a very ### tender area ###on my right arm of double pneumonia one Y week after Y vaccines were given. Treated w/ initial antibiotic shots,Ythen oral antibiotic 9/30/2008 Amoxicillin. 10/5/2008 This was her 2 12/4/2008 N ### 12/4/2008 bilious vomiting, abd. bloating, pain -YER admitted Y - multiple tests run2(x-rays, labs) - no etiology N - remains fussy, ### spitting 1/4/2009 more - mother feels s of upper lip < lower lip as well a little Y swelling. Sinus area feel dry, rash developed on legs,Yarms, and face. 1/7/2009 Swelling1/7/2009 of lower eye lids. uid-filled vesicles on red bases appeared on 1/2/09. VARIVAX done 12/15/08. Y ### 1/2/2009 o RUE to include erythema and edema 15cmx9cm. Warm to touch and pain. SXS started last U night. Pt tx'd1/7/2009 IV Abx and 1/7/2009 PO Abx. ction to ADACEL . Pt has redness, warmth, pain, induration measuring as 3"x5" around injection U site. 1/5/2009 1/5/2009 dness - Left deltoid - pt. did not use ice or take analgesic. She decided not to wait for Dr. - he U was seeing 1/6/2009 in-pts @ hospital. 1/7/2009Advised to use onsciousness approximately ten minutes after GARDASIL, episode lasting less than 30 seconds. Y 1/6/2009 1/6/2009 er vaccine, infant became extremely fussy, "stomach hurting" screamed with feelings- has only N gradually improved### on RANITIDE ### and Hypo n has been received regarding a case in litigation as reported in a newspaper article Y that theNauthor's normal 4 year old daughter was trans follow up information has been received Y from a licensed practical nurse (L.P.N.) for the Pregnancy Y Registry 1/23/2008 for GARDASIL 3/8/2008 concerning a 26 n has been received from a physician Y concerning a female patient with a history Y of mouth ulcers N who on8/18/2007 an unknown 8/18/2007 date was vaccinated n has been received from a consumer Y concerning Y her 16 year old daughter 4 with no medical N history or drug 12/6/2008 allergies12/7/2008 who on 06-DEC-2008 n has been received from a consumer, who is the mother of the patient, for the pregnancy registry Y for GARDASIL concerning 2/25/2008 an 18 year ol d soreness/pain complaints from site of injection diminishing over time but lasting 5 weeks. Complaints Y finally subsided ### 12/31/09. ### ates child developed swelling to the Yleft deltoid area approximately 8-12 hours after receivingYflu vaccine. Also he ###complained ###of itching at th ination patient appeared pale and weak. He was instructed to sit down. His head fell to the side Y and his eyes closed. ### He opened ### his eyes s ately ten minutes after his vaccination, patient was standing by the door and began to faint and Y slowly fall to floor. ### No injuries ### reported. He as mistakenly administered both DT & TDAP vaccines - no adverse reaction was observed subsequently Y ### ted with redness on his torso and reported having a fever the night after receiving influenza vaccine. Y Pt referred 1/3/2009 to primary 1/3/2009 care provider. cella and FLUZONE R arm 12/15/2008. Y Mother reports today an area " 3"x4", that is warm, U red, hard and rashy" ###at the injection ### site R arm and approximately 15-30 sec after injection. Was assisted to prone position. No respiratory effort for approximately ### 30 seconds. ### Color re
n has been received from a physician Y concerning a 77 year old female patient with Y VICODIN, N LYRICA and 10/5/2007 AMBIEN12/7/2008 allergies, diabetes me nstop day of vaccines unconsolable Y 12/5/2008 12/5/2008 d right deltoid IM injection of PNEUMOVAX Y and since then had local reaction, large, of pain,Uedema, a erythema ###slowly improving. ### oid soreness, dizziness and joint pain. U 1/2/2009 1/2/2009 ed vaccine on 12-10-08. 2. Itching around Y neck and back 7 day later. 3. Itching from head to N toe. Also rash inside ###mouth. ### ceived vaccines (PREVNAR, HAVRIX, VARIVAX and MMR II) on 10-16-08. Follow up with FNP Y on 10-20-08 d/t ### a rash that ### started on 10-1 al exam. Child received HIB and DTP on 7/15/08. Child was very limp, quiet the next day, and Y left leg where HIB was given was red and a with auras, nausea and headache. Y 1/5/2009 1/5/2009 n has been received from a Registered Y Nurse for the Pregnancy Registry for GARDASIL concerning U an 18 year ### old1/16/2008 female who on 11-OCT IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### Swelling 4 inches around injection site; observation U 1/7/2009 1/9/2009 sick the week before vaccine with aY'virus'. Day of vaccine was feeling ok, day following vaccine Y (11/21/08) thought ### she had ###burner her ton IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### D INFLUENZA IM VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANSASAL ROUTE Y ### left elbow to left shoulder with pain/deep ache all around the left shoulder, and Nausea. SheYstates the nausea 1/7/2009 started 1/7/2009 just shortly after rec cieved Flumist (lot 500570P) Y intranasal Y 13Nov08 Y as part of his military 17 Yunit vaccination Y program. N He developed### vague lower ###back pain app atient @ 11am. Started w/diarrhea after getting 1st Hep a/b combo.injection during the night(approx.12-14 U 1/8/2009 hours after 1/8/2009 shot). Morning is no fter injection, heat flush & abd cramping. Y 2) 10 Ymin after, itching & heat 3 @ injection site. 3) 15 N min after, itching### & hives over ###entire arm/sho d swelling to left upper arm @ 7pm Yon 12/4/08 but did't think much of it until swelling had increased Y the next 12/4/2008 morning. 12/4/2008 Child seen in health SERIES OF 3 GARDISIL VACCINES, Y HAVE BEEN EXPERIENCING PAIN IN FEET, HANDS, N THEN OTHER 8/2/2007 JOINTS, 9/2/2007 BEEN TO DOCTO 009 CHILD STARTED RUNNING A Y FEVER, 1O2.2 PARENTS WERE ADVISED TO TAKE TO Y ER. 2 DAYS PRIOR ### TO 1/1/2009 THIS CHILD WAS tdap in the afternoon of 1-06-09. At 6pm that evening noticed a rash around site (Left arm) that Y injection was 1/6/2009 given. Reported 1/9/2009 this on 1-09-0 WO DAYS OFIMMUNIZATION RASH APPEARED AT LOCAL SITE BECAME BIGGER THROUGH Y OUT DAY ### TO APPROX ###7 INCHES IN D ceived HPV vaccine on 10/23/07 Y and Y 12/31/07.Y On 2/25/08 patient 7presented with breathingYdifficulty and was### diagnosed 2/25/2008 with pulmonary e where dtap and polio was given is red and warm to touch. Not painful. Moving fine, no fever,Yno other s/s4/28/2008 illness 4/30/2008 patient called immunization clinic at 1:15pm today 01/09/2009 asking for nurse who administered U vaccination 1/8/2009 to her daughter. 1/9/2009 Mother claim 000-Patient calls this office and speaks to this nurse. States that @ approx. 0630 today sheYwoke up to itchy 1/6/2009 red bumps 1/7/2009 all over her (R) ar ry 6, 2009, 2.5 weeks after vaccine adminstration, Macular rash on chest neck and back, vesicular Y lesions on back, ### number 1/5/2009 less than 10. C NING OF PAIN AND TENDERNESS SINCE INJECTION, PAINFUL TO RAISE ARM OR LAY U ON ARM.STATES ###ARM WAS ###SWOLLEN AN ceived vaccine on 12/18/08. Contacted Y telephone helpline 12/19/08 to report arm is swollen,Yred, warm to the ### touch; temp### was 98. Patient C/O at about 5 - 6 PM started with chills and fever, highest temp 102.9, and headache. In morning Y noticed1/6/2009 both arms1/6/2009 red (from top of hands hat Sunday a.m. feeling very tired. YComplained of arms feeling heavy and a headache. Later Y that day complained 8/18/2008 8/31/2008 of numbness and tinglin accine at 4 in the afternoon, the pain at site woke me up at 3:30 am. Site was raised red andYhive like. Took 1/7/2009 benadryl 1/8/2009 and advil. Site size big was reported by a healthcare professional Y via sales representative and described the occurrence N of muscle 7/1/2008 wasting in an adult female sub was reported by a physician Y via a sales representative Y and described 0 the occurrence Y of abdominal U pain in a 2-month-old subject of unspec was reported by a physician Y via a sales representative Y and described the occurrence Y of abdominal U pain in a 2-month-old subject of unspec was reported by a physician and a Y sales representative and described the occurrence Y of Bell's N palsy in a 32-year-old ### 1/6/2009 female subject who w d 1/8/09 stating that he had receivedYthe Shingles vaccine the day before and was experiencing U facial numbness, 1/7/2009swollen 1/8/2009 tongue and droop ates child developed Temp 103.8 within 24 hours of vaccine administration with prolonged crying. Y Did not 11/5/2008 seen medical 11/6/2008 TR. Advised physi ation Provided U 5/23/2008 ported to facility with 5 1/2 cm x 8cm reddened and indurated area on left deltoid are. Area was Y warm to touch 1/6/2009 and patient 1/7/2009 reported feeling
ent received MENACTRA about 9:15 AM. V/S given and reviewed side effects. After gettingYhome, client1/2/2009 states having 1/2/2009 S.O.B. and tightnes r body started 1/8/09, worsened 1/9/09. Fever. U ### 1/8/2009 d area with erythema/ warmth. Y 1/6/2009 1/7/2009 ven GARDASIL- fainted after getting it, patient complained of headache prior to fainting. Y 1/8/2009 1/8/2009 theaded, tachycardia, intermittent tinnitus. Y Cramps not related to monthly cycle. Mood swings, N abnormal3/18/2008 pap smear.4/22/2008 er immunization complained of nausea, light headed, dizziness patient monitored. Symptoms Y resolved. Patient 1/9/2009 said she 1/9/2009 was better e. 2/18/09 Neurology consult received Y dated 1/15/09 with no definite dx: Impression: Transient U word finding difficulties ### 1/8/2009 (dysphasia) with R h cc IM right deltoid. With in 10 min after IM injection mother noted redness and bruise area 50 Y mm around1/9/2009 top of shoulder. 1/9/2009 veloped shingle along C3 within 1 week of ZOSTAVAX. Y ### ### veloped redness and pain at injection Y site. Evaluated by provider as cellulitis. Treated with CEPHALEXIN Y for 7### days.1/1/2009 Re- evaluated one we hrs of receiving 4 month vaccine (PEDIARIX; Act HIB; PREVNAR; ROTATEQ) child had sleep Y disturbance and### "high1/2/2009 pitched scream-supe U 1/8/2009 1/9/2009 nset of 104 degree fever. Parents administered Y TYLENOL alternating with MOTRIN. At 1:33pm Y parents called. 1/5/2009 Child1/6/2009 with 106 degree fever welling. Increase fever of 45ø C and with projectile vomiting 15-20 mins. after vaccine given symptoms Y started. 1/7/2009 Pt went 1/7/2009 to ER 11 pm 1/8/09 e fever, sore throat, swollen neck lymph nodes, runny nose, muscle aches and fatigue. Taking U ibuprofen. 1/8/2009 1/9/2009 son (a DMD) is visiting from out of time Y and noticed that his mother had a raised area on her U arm that he found 1/8/2009 out was 1/9/2009 the injection site. It broma at site (subcutaneous tissue on left arm) of Pneumovax injection. I first noticed a scab Y had formed 9/18/2008 on the site and was ### surprised. It and fever. Had Vaccine mid-afternoon Y on the 10th. Had a fever that evening and through theUnight. Early1/10/2009 morning complained 1/10/2009 of stomach a sly received two doses of Meningococcal vaccine Y 1/10/2009 00dF), which lasted several months.Y Cough, which lasted a couple months. Head cold, too.Y (Treatment10/9/2008 was with three 10/9/2008 sequential and diff n afternoon, shut van sliding door on my left hand. Went to ER due to severe pain, possibleNbroken hand.1/7/2009 Had a tetanus 1/8/2009 shot during ER tr erature, respiratory illness Y ,flu,running nose. 1/15/09-per vaccine provider phone call-patientNpresented to1/7/2009 office 4 days 1/9/2009 after vaccine C/O flu nflamation, pain at shot site...about 2 1/2 X 3 1/2 inches, lasted over 1 week. Now, 2 weeksUlater, site is visibly### pink; swelling, ### inflation and changes including fussiness towards bath water, speech regression to none and glossy eyedYstaring with 1/5/2009 lack of smiling 1/6/2009 and responsivenes n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y an 18 year### old female### who on 24-NOV n has been received from a physician concerning an 18 year old female who in May Y 2008 was U vaccinated5/1/2008 with the third dose of GARDASIL N n has been received from a physician Y concerning Y a 9 weeks old male, 5 who on 19-DEC-2008, Y was vaccinated with ### the "normal ### dose" of RO st PNEUMOVAX - 0 reachon 1-6-09Y2nd PNEUMOVAX - tenderness, redness from site to elbow Y (Lt), hardness 1/6/2009 @ site 1/6/2009 local RXN only - no nfection near injection site of upper Y left arm. N ### ### omiting, fatigue and hot flashes. Started 20 min after injection. Pt received at work and sent U home early 1/6/2009 1/6/2009 onsciousness sonorous breathing rigid Y extremities twitching extremities lasting approximately Y 15-20 minutes.### ### g total body urticaria. Treated with antihistamine/steroids. Y ed and reported a rash all over her body Y on 12/24/08. Went to ER on 12/29/08 - Urgent careY at medical center.### Rx with Methylprednisolon ### Y ### 1/6/2009 ness at injection site that lasted 4 days- 0 raised - some pain with palpation - itching on 3 of Y 4. ### ### ed unconsolable crying + Screaming >4hrs following immunizations U ### ### MMR + VARIVAX vaccine on 12/22/08 for an employment physical, experienced rash on abdomen U + fatigue. ### Reaction reported ### 1/5/09 ction redness, swelling for > 3days. U ### ### 102.4 evening following vaccine - mother Y took him to after hours pediatric clinic who told herNto watch him 12/9/2008 - saw his regular ### MD on Wednes ps all over face, neck, arms and legs U 7/31/2001 1/5/2009 redden area to (R) thigh & Rash noted to stomach + legs -, mom stated started with rash to Ysite the next am and ###rash started ### 12/19/08. redness 7.5cm x 3.5cm, tender and itchy for 2 days. Rx'd Benadryl. Y ### ### ure unknown. Symptoms include, wheezing, Y runny nose, difficulty breathing through nostrils,Ntime course9/30/2008 - ongoing following 10/3/2008administration omplains of sore right arm, 8 days after shot given. Sats has limited motion of arm without having U full ache in arm ###muscle.### No swelling or ra ection site for 2 months. Y N 11/6/2008 11/6/2008 11:30 am pt developed rash on face, neck, and chest. Dr checked pt. Administered 1 teaspoon Y BENADRYL and ### 1 teaspoon ### prednisolone m noticed swelling at injection site after 5:00PM , 0 fever; spoke with on call triage nurse; applied U cool compress; ###Rx Benadryl, ### Motrin 12/31 d varicella immunization on 7/30/08 He came into the office w/rash for 2 days on 1/6/09 & was Y diagianosed 7/30/2008 with chicken 1/5/2009 pox. Hx symptom d diffuse, maculopapular rash fever 108. Pt previously never vaccinated Y ### ### about 2-3 days after injection her arm Y felt red and warm, told to put ice on it & take TYLENOLY - 2 days later 10/2/2008 she went to ER### where they lanc
m swelling shoulder to elbow, painful. Y Painful to raise arm. Next day red patches same area. Y Took AMOXICILLIN ### 875 MG ### 2 X a day for fi eption. 2/23/09 Received hospital medical records Y of 1/8-1/9/2009. 2 FINAL DX: Intussusception Y Records reveal### patient 1/8/2009 experienced interm t hot, dizzy, lightheaded, hands were clammy, tight fisted, tingly and patient was breathing hard Y and fast 1/9/2009 1/9/2009 oid developed edema after 2 days. U ### 1/5/2009 swelling with in duration and elevated warmth at site of vaccination treated with ice. Y ### ### e had nausea and chest pain within Y30min. Then aching felt bad. Went to bed. Woke and went Y to toilet 4 hours### after vaccine. ###"Passed out" ceived a pneumococcal vaccine (in Y left thigh), an influenza vaccine (in left arm) and his 3rd hepatis Y A&B 11/3/2008 vaccine of the 11/3/2008 series (in left thigh) nterior cervical adenoopathy on left and few shotty nodes on right. Notable scattered faint erythematous Y papules ###on the face, ### trunk, and ar ported temp of 101.1 on evening of vaccines Y with swelling, redness, size of fifty cent piece next Y AM. Fever that### night 103.5### with site red, firm TDAP Vaccine on 1/7/2009. Came in to employee health on 1/9/2009 with left arm red, warm Y to touch, and 1/7/2009 stated the 1/9/2009 area was larger than s after vaccination, patient complained of sore arm, then started to complain of wobbly legs, Yblurred vision, 12/9/2008 and had12/9/2008 high fever, and lasted 2 t message on voicemail 01/09/2009 stating she had sore L jaw after receiving immunizationsYon day prior.1/8/2009 Call returned 1/9/2009 to client 01/12/200 rong immunization in wrong area. Y 1/7/2009 WITH MOTHER AND NOTIFIED HER OF ERROR AND ALSO NOTIFIED DR. AND MY PRACTICE Y MANAGER 1/7/2009 AND 1/7/2009 MEDICATION ERROR Rt arm swollen from elbow up 1 1/2 size. red spot spread to size of hand. approx 7-8 cm. wrsit Y redness, rt. 1/8/2009 ankle swollen 1/9/2009 ,Mom gave advil U 1/9/2009 1/9/2009 02F, VOMITING X1 DAY. RUNNY NOSE, Y COUGHING, FATIGUE X5 DAYS. N 1/6/2009 1/7/2009 nset 36-48 h after immunizations; chills and possible fever 42-54 h after initial immunization;Ydocumented 1/7/2009 afebrile Day 1/9/2009 3 after immunization FTER VACCINES PT DEVELOPEDY MILD URTICARIA TO CHIN AREA AS WELL AS MILDYSWELLING TO 1/9/2009 UPPER 1/12/2009 EARS; NO RESPIRA d two Hep B vaccines during hospital stay. Date and times are listed under # 10 and 11. Y ### ### s of upper right arm pain since vaccine administered. States is painful to raise arm when dressing. N No redness,### swelling, or### pain with palpat L OVER BODY N 5/27/2008 1/9/2009 gling at all sites from bottom of feet to scalp after first dose of rabies shot - ongoing. N 9/16/2008 Now new9/17/2008 onset progressive bila g difficulty, fever, body aches, tongue swelling, vomit, blood was showing as secondary issueYin the nasal 1/9/2009 airway area1/9/2009 and upper throat area oped a 3 inch diameter redness with hardened lump. The area felt as if it were a severe burn. Y Problem lasted### for 10 days. ### fter small pox and anthrax vaccination Y he noted onset of mildly symptomatic and diffuse papular Y rash, No systemic ### or ill symptoms. Impres izure - Had flu shot 11-14-08, 2nd flu Y shot 12-18-08, on same day of flu shot cough, fever, crying, Y decreased appetite ### called ###911. d Tdap injection LT arm on 12-28-08. Y C/o pain movement area below injection site, red swollen. Y PR saw PMD ### and was started ### on predniso nd listless, poor muscle tone AM following Y vaccination. Parent felt he had a seizure while sleeping. Y Was taken### to ER. Dx### with pneumonia, received 12/27/08. On 12/30/2008 Y began experiencing itching of nose, 101 f temperature; aching U of neck and ### back. Dad contacted ### PMD w ceived on Saturday, 12/27/08. On Tues. Y 12/30/08 began experiencing itching of nasal cavity, U nasal infection, nasal ### bleeding, ### 101 degrees adache from 12-17-08 time given till Dec 28, 2008 almost (2 wks) also hoarseness same time. Y Everything is ok### now. ### n has been received from a physician Y concerning an approximately 70 year old patient who Y on an unspecified date was vaccinated with a d was reported by a healthcare professional Y and described the occurrence of anemia in a female U subject of unspecified ### age### who was vaccin was reported by a consumer and described Y the occurrence of injection site burning in a 70-year-old N female 11/7/2008 subject 11/7/2008 who was vaccinated wi was reported by a pharmacist (alsoYthe subject) and described the occurrence of arm rash inU a female subject ### of unspecified ###age who was fever, Heat @ site. Y Y 1/5/2009 1/6/2009 of breath, bodyaches. Treated with Y TORADOL IM & ALBUTEROL NEBULIZER X 2. Symptoms Y started 1/9/2009 around 1800. 1/9/2009 menactra + Hep A vaccine within 5 mins of receiving the vaccine the patient was getting ready Y to leave and 1/12/2009 passed out 1/12/2009 in our waiting room. d shaking, shivering with pain around 1am after receiving flu shot at 6 pm night before. Symptoms Y lasted about 1/8/2009 3 hours. 1/9/2009 Pain was headache ed out info sheet stating he had fainted w/previous injection at Dr's office(date unknown, butYin 2008). He1/10/2009 came to get 1/10/2009 FLUVIRIN, TWINRIX n has been received from a female registered with ankylosing spondylitis. Who on 21-Nov-2008 N was vaccinated ### with a dose ###of ZOSTER va ### N ### ### d cold, cough, vomiting after Y Influenza vaccination, Y requiring hospitalization 48 for Pneumonia. N 1/26/2009 MR 12/9/2008 received for DOS ###12/15/2008-1/ mins of receiving HPV injection pt became pale, lightheaded, vision became black, diaphoretic. Y Had pt wheeled### to obs. room###monitored pt f With X 3days fever 99 , HA, myalgia on 11/12/08 Blood drawn for yellow fever IgG and Igm.YResults was11/7/2008 antibody low-unable ### to separate f er flu vaccine administered, developed diffuse eczematous rash that persisted months after vaccine U given. Rash ### comes and ### goes. 1-7-09 = lt leq red + swollen + warm Yto touch ordered- TYLENOL, Compresses, HC cream & U BENADRYL po-> 1/5/2009 RECK1/6/2009 1-8-09 -> (on AMOX f d a flu shot in October 2008. She felt immediate pain in shoulder, radiating down arm. SheYfelt the flu shot 10/1/2008 was given 10/1/2008 higher up on her sho eveloped a satellite pustule near vaccine Y site. Area appeared to have a generalized cellulitis Y around site. 12/8/2008 Member sent to### ER and was tre ch over upper body, extremities + bottoms of feet. Felt very "hyper" "wired". Difficulty sleeping Y that night, diarrhea, ###sweats,### swollen axillary l
Y Y 10/9/2008 ### Vaccinated at 9AM- Pain in left upper arm 4PM and continues. Shot was given top of arm at N shoulder in back. Saw ### family doctor, ### neurologis ours; woke up dizzy; then complained of a stomachache. Y ### ### nted 4 days after vaccination per mom's report: with HPV vaccine patient was getting up from Y sitting down on couch ### when### she fainted. Mo 20 x 20 over (L) arm PCV7 site. Y 1/6/2009 adache, brown spot in vision - 30 mins. Y - fever 102 degrees x 9hrs. Headache and dizzy afterY72hrs. 1/5/2009 1/5/2009 he side where HEPTAVAX was given with headache for a few hours. Y 1/7/2009 1/7/2009 with 11.5cm x 13cm area of erythema. Warm to touch, painful on palpation. Area blanchesYon palpation,1/5/2009 sl erythematous 1/7/2009 no clearly dema hema, pruritis and pain at site of VARICELLA Y injection within 24 hours vaccine. Seen at 48 hours. U ### ### ed body rash with mild edema,"patches" and hives. Y 12/4/2008 ### mage in right arm. I have peripheral Y neuropathy, blood clots, bone infection and blood veins infected N in right 10/1/2008 arm. n has been received from Y a nurse concerning Y aYmale who was vaccinated 0 with all three doses U of ROTATEQ 11/1/2008 at appropriate 11/1/2008 intervals. In Nov n has been received from a physician Y concerning a 63 year old female patient with Y upper respiratory N tract infection ### at the time ### of vaccinatio n has been received for the pregnancy registry for GARDASIL from a physician concerning aU 15 year old female ###who on 23-OCT-2008 ### was noted at injection site on left leg, without Y itching. Presented to the primary care provider the following Y day and 1/6/2009 received 1/7/2009 prescription for Augm wo HPV shots had muscle sorenessY and slight fever. After Shot #3 had severe whole body Y myalgias and1/6/2009 stiffness "I1/7/2009 can hardly move". Te s received two Varicella vaccinations. The first vaccination was given by our office (administer Y unknown)9/6/2006 on 8-19-02.1/9/2009 The second vaccina IVED GARDASIL, MENACTRA AND ADACEL IMMUNIZATIONS ON 01-12-09. AFTER INJECTIONS, Y PT 1/12/2009 GOT DIZZY 1/12/2009 AND PALE WHILE patient had a seizure at 7:00 pm. No fever was noted by his mom. Diastat 2.5 mg was given Y rectally times 1/9/2009 two doses 1/9/2009 and patient was fully ENTED TO OFFICE ON 12-24-08 WITH C/O SORE THROAT, COUGH AND FEVER. STREP Y SCREEN PERFORMED, ### RESULTS ### NEGAT e, malaise, myalgias began approximately 16 hours after receiving the vaccine. Approximately Y 24 hours later, 1/8/2009 they began 1/9/2009 to improve and ha owing vaccination patient developed Y fever to 102, irritability, rash, wheezing 1/6/2009 1/9/2009 omplaining with joint pain, backpain,Yheadache, and face red the day after the vaccine. Y 1/7/2009 1/8/2009 am - parent returned to health department; states infant difficult to arouse, sleeyp, only sipping Y at bottle. 1/7/2009 Had fever (100.1F 1/7/2009 rectal), 1/7, ar ter recived the first HPV guardasil shot Y on 9-16-2008. She received meningococcal vaccineUat the same9/16/2008 time. After9/17/2008 the first shot she had a seizure 7 hours after 2nd dose of flu vaccine; Patient Y went to Hospital 1 and was admitted. 3/5/09 Y MR received 1/12/2009 for DOS 1/12/2009 1/13/09 with D/C DX e on face and swelling of face. GivenY Benadryl 1cc per Dr. Y 1/13/2009 1/13/2009 within 24 hours of vaccination. No history of seizures Y prior to this episode. 5 None since. 1/19/09 Y Reviewed hospital ### medical### records of 01/01 SS; PAIN & NUMBNESS STARTING Y IN LOWER Y EXTREMITIES; RASH 5 LOWER EXTREMITIES (MILD, ERYTHEMATOUS; ### 1/2/2009NO VESCICL 1 PM-PT REPORTED FREQ NON-PRODUCTIVE Y COUGH AND BRONCHOCONSTRICTION Y (FELT LIKE CHILDHOOD ### ASTHMA, ### BUT NO oid slightly swollen, with warmth to touch and client complains of numbness. Y 1/9/2009 1/10/2009 of chills without fever, myalgias, starting 24 hours after injection. 1/8/2009 1/9/2009 , raised bump at the site, soreness from elbow to shoulder. Y 1/13/2009 1/13/2009 as a very happy and relaxed baby prior to getting vaccinated. He only cried when he was hungry Y or gassy and ### was very social ### with everyon 1am stiff neck, tight jaw muscles. 13:30 Y Left arm bottom itched, 1"x4" hard lump w. red edges N sprayed w/1/10/2009 bactine and 1/10/2009 took anti-histimine. 1 e minutes of vaccine administration the patient developed upper respiratory congestion and sneezing. Y Over 1/12/2009 the next1/12/2009 five to ten minutes he ped strong daily headaches. She reports a history of sever headaches in her past history. She U noticed daily 1/6/2009 headaches 1/8/2009 after 1st Gardasil v mildly painful, warm, red, slightly swollen beginning first day after injection and continues to be U on the 3rd1/10/2008 day following 1/11/2008 injection without wor veloped genital herpes primary episode 12/16/08. Treated with hydrontisone prior to culture Yresult. Resolved 7/12/2007 on own. Pt and ###her mother re lightheaded, tachycardia tinnitus since Y May 08. 2/24/09 MR received from PCP from 3/2008Uto 1/2009 for 3/18/2008 multiple visits 5/23/2008 with multiple c/o. P lightheaded, tachycardia tumoritis Y persisting since May! Patient c/o sf since May 23 (initiallyUseen 5/28/08 5/20/2008 for complaints). 5/23/2008 2/24/09 MR rec lightheaded, tachycardia, tinnitus since Y May 08. 2/24/09 MR received from PCP from 3/2008 U to 1/20095/20/2008 for multiple5/23/2008 visits with multiple c/o. rm- erythematous mac raised. Confluent rash surrounding. Approximately 4cmx2.5cm. LeftYupper arm in1/9/2009 area of Dtap 1/10/2009 injection site. of entire arm down to fingers. Erythema at site. Y 1/6/2009 d fever of 104 degrees following day Y 1/5/2009 1/8/2009 o LL at site of vaccine. Advised to use cool compresses to site and to call office if more concerns. U 1/7/2009 1/9/2009 w grade), rash of a vesicular inflamed Y type; located proximal to injection site, began 2 3 wks after Y injection, 12/5/2008 looking like a red ### bump that furth a where she got ADACEL is tight, hot, red, swollen (about size 4-6" wide and red from elbowUto shoulder). Hasn't ### taken any### otc. meds or us veloped low back pain that radiatedYafter 30 minutes to abdomen. Pain described as cramping Y / pressure. 11/4/2008 7 on pain11/5/2008 scale of 0-10 generaliz - x2Days, Motrin/Tylenol. Y Y 1/5/2009 1/6/2009 accines pt broke out in hives, lg itchy red welts --> both arm, back and chest. Benadryl givenUand change to Zyrtec. ### ###
ed child had congestion, sweats, tiredness and cough since given FLUMIST. Advised to use U asthma meds and### follow up w/ ### MD if symptoms ain since flu shot reported on 12/5/08. Y As of 12/16/08 saw MD, diagnosed with bursitis, RELAFEN U prescribed. 11/7/2008 May11/7/2008 need cortisone injectio his whole right arm was swollen, red & sore down to the elbow for 3 days following vaccination. Y Did not see 11/4/2008 MD. 11/5/2008 his whole right arm was swollen red & sore from shoulder to finger tips. Applied warm soaksYwith relief. Slight ### swelling & redness ### still noted Reported persistent pain after flu shot. Y Saw MD, was told injection "hit a nerve". 1/5/09 Pt reports N receiving cortisone ### shots ### for bursitis. No upper arm became red, warm & swollen. Y Injection site induration to size of 50 cent piece and Y was fury red. 1/5/2009 Cold compress 1/6/2009applied. On 1 m area of erythema and warmth to posterolateral upper R arm U ### t tetanus/pertussis vaccination-onset of reddness, edema, pruritits to injection site area 2-3 inch Y diametric1/6/2009 day 4-apply 1/9/2009 1 degree cortisone c RECOMBIVAX HB instead of Hep A. Discovered when putting in NCIR. Medication Error. Y ### ### of left deltoid following Influenza vaccination Y on 11/4/08. 11/5/08 increased soreness, fever and Y chills; 11/7/08 11/4/2008 went to 11/5/2008 primary care diagnos ess and swelling at injection site, (+)Yfever 1 day after injection; treated at student health services U 1/12/09 for 1/9/2009 severe 1/10/2009 local reaction vs cellulit s after injection - developed bilat. chest pain and around to back. Short of breath. Took Benadryl Y 50mg PO 11/6/2008 and felt 11/6/2008 better in 5-10 min. Also n has been received from a physician Y concerning Y a 15 month old child who on an unspecified Y date was vaccinated with a dose of 0.5ml of n has been received from a registered Y nurse concerning a 15 month old female child who onN01-MAY-2008 5/1/2008 was vaccinated 6/27/2008 SQ with 0.5ml n has been received from a physician concerning a child who on an unknown date was vaccinated U with a dose of PROQUAD (Oka/Merck u n has been received from a licensed practical nurse concerning a 4 month old male patient with N a milk allergy 7/22/2008 and no 7/22/2008 other medical history n has been received from a physician concerning a 15 month old male with a history of sepsis U treated at birth 8/7/2008 who on8/7/2008 07-AUG-2008 was va n has been received from a 61 year old female patient with osteoporosis, hypothyroidism and Y gastroparesis who ###on 24-OCT-2008 ### was vac ### N 1/14/2008 ### ### N ### ### hicken pox vaccine cause herpes one simplex encephalitis? Since my child was given a live strand of the virus### and 6/14/2004 it just so happen he ma & influenza given in left arm 12/1/08, returned to office 12/4/08, developed rash 12/3/08 which Y is expanding, 12/1/2008 area itchy, located medial left upper arm with 2 hours of vaccine did Y not radiate, stabbing, difficulty lift L arm up also 2 dayNhx of nausea, malaise ### ### r ZOSTAVAX vaccination; persisting through present - 1/12/2009-, and worsening -more; more places on body-; effectively ### treated with non d with rheumatoid arthritis on 01/08/2009 by a rheumatologist at a research center. I am 28 U years old, and first### noticed 1/8/2009 pain in feet about 1 es onset of pain at R shoulder vaccination site @ 12/11/08 PM. Exam c/w localized inflammatory reaction 12/4/2008 at lateral aspect of deltoid. No s patient called after hours with c/o fever, n/v/d since he received the flu shot on 12/18. He told the nurse he would ###go to a local ### hospital. I ca ythema Multiforme, Diarrhea, Nausea, Vomiting, chills. ### ### n has been received from a Licensed Practical Nurse concerning a 16 year old female who on Y 30-JUN-2008 1/5/2009 was vaccinated 1/5/2009with the first d n has been received from a nurse practitioner Y concerning Y a 17 year3old female with Y no medical Y history and drug ### allergies 1/2/2009 who on 31-DEC-2 n has been received from a physician Y concerning a 12 year old female who on 29-OCT-2008 Y Y was vaccinated with ### the third### dose of GARDA follow-up information has been received Y from aYphysician concerning 3 a 67 year old female patient Y with osteoporosis and seasonal ### allergy w VAX 23 given 12/2/08 between 1-3pm. On 12/3/08 am T 100 and soft ball sized warm, red area Y noted at12/2/2008 injection site 12/3/2008 (LD). MD called by right deltoid pain after Hepatitis B #2 Y vaccine over a year ago. N ### ### gan with cough and upper respiratory infectionYafter vaccine administered. 17 Patient began taking U over the counter ### meds and ###got worse. Pa 9 Increase Tempature/ 01/06/2009 Tempatrue, nausea, fatigue, headache. Y 1/5/2009 1/5/2009 1/2/2009 Y 1 N 1/4/2006 1/1/2009 EKS AFTER VACCINATION PATIENT Y MAY HAVE COME DOWN WITH A SLIGHT CASE OF Y SHINGLES. 11/7/2008 A RASH/SORES ### APPEARED O re than 24 hours I noticed a rash that started near her injection site on her thigh, on her buttocks, Y near the 1/12/2009 back of her 1/13/2009 neck on her back an er receiving Hepatitis A and DTap the pt presents with redness, swelling, localized fever, andUcontact dermatitis. 1/12/2009 1/14/2009 AFTER I ADMINISTERED VACCINE Y TO THE CHILD,THE MOTHER STATED THAT THE CHILD Y WOKE 1/12/2009 UP IN THE 1/13/2009 MORNING WITH SW er to 102. Had a large knot at the site of injection. U 1/12/2009 1/12/2009 m 7cm red/warm tender but non-indurated Y no streaking U 1/12/2009 1/13/2009 ped fever of 104.5 with irritability. Patient still with temp of 102 48 hours after vaccine administered Y 1/12/2009 1/13/2009 ven around 11AM? About 3 hours after flu shot-started coughing and had a "tickle" in my throat, Y cough became### more frequent, ### then heart r OLLEN LEFT DELTOID REGION, WARM AND SLIGHTLY TENDER. EXTENDS TO AXILLA, U CANNOT 1/12/2009 RULE OUT1/13/2009 SECONDARY CELLUL ng (site of innoculation), arthralgias in knees and ankles bilaterally 2/9/09-records received for U DOS 1/14/09-presented 1/13/2009 1/14/2009 with C/O reaction to ately 2 hours after received flu shot Y client starting sneezing and coughing. Eye lids began toYswell and had 12/5/2008 difficulty12/5/2008 breathing. ningococcal (MCV4) vaccine on 01/09/09 Y in left arm SC instead of IM. Pt was brought to Urgent Y Care on 1/9/2009 01/11/09 with 1/10/2009 pain, erythematous mach pains within 2 hours Y of shot. Y Hands then became tingly and had"pins and needles", throat Y then had 1/14/2009 same feeling. 1/14/2009 Then had feverish ministered 01/12/09, 01/13/09 morning red and swollen by evening small blister that increased in size to 1 inch diameter, blister broke am 1/1
en on 1/12/09 right arm, Had right arm Y swelling, redness, felt firm to touch, worsened over 2 days. U Seen in 1/12/2009 clinic on 1/14/09, 1/12/2009 had indurated e ter shot administered, felt chest pressure, heart pounding, congested chest & cough. Breathing Y problems1/9/2009 also which1/9/2009 lasted about 25 minu s after receiving the MMR vaccine he called by phone and said he felt like he was going to "black Y out" but did not. ### He also### complained of "t :30pm 12/30/08 Slight headache inYafternoon, Oral Typhoid stated that evening, 2 hours later Y became sick. Symptoms ### nausea ### and low gra ported having a fever, local myalgia and pharyngitis after having the TDAP vaccine. Definite Ytime course not known, ### but suspected ### to be wi hot was administered and three hours later I experienced... Poor co-ordination. Tripped getting Y out of a 1/13/2009 car and tripped 1/13/2009 again when I tried t me down with Shingles. Y Was treated with gabapentin and acyclovir. 01/21/2009 Office note received Y from5/1/2007 PCP DOS1/14/2009 1/14/09 with dx: Shing EIVED THE FLU SHOT IN MID-OCTOBER Y AND Y DISPLAYED A FEVER 7 DURING VETERAN'S U DAY WEEKEND ###WITH NO ### OTHER SYMP east 103, chills, fatigue, loss of appetite, diarrhea, vomiting; vomiting lasted at least 2 days (ongoing U but getting 1/12/2009 better) 1/12/2009 n: 47 y/o female AD SM reports theYonset of undocumented fever chills commencing 3 daysYafter BIOTHRAX. ### SM went 12/3/2007 on to develop coug nt states with every flu vaccination since 2000 he will have URI symptoms (post nasal drip, nasal congestion, 6/16/2000 rhinnorhea, 6/19/2000 dry cough, watery n c/o pain to L side of face from nose to L ear and L scalp - tender to touch. No lesions noted U except for small 1/6/2009 macule 1/12/2009 on L upper eyelid an hypersensitivity Rxn to vaccine & erythema/induration in L deltoid Y ### ### given on 01/13/09 in arm. Mom gaveYchild Tylenol after injection at home. At 4:00Am (1-14-09) Y mom noticed 1/13/2009 rash on1/14/2009 child all over body. See s been to 2 Doctors who say it is not related to the ZOSTAVAX injection. Rash is over trunk N but she feels it is spreading. d & swelled where VARIVAX was given Y Y 1/12/2009 1/13/2009 fever, headache, body aches and joint pain, lethargy x 6 days. N 1/6/2009 1/8/2009 6x7cm hard red patch on left leg atYinjection site. U 1/13/2009 1/14/2009 es swollen shut, itchy. BENADRYL 2 Tsp PO Q6 PRN. Y 1/13/2009 1/14/2009 atous areas distal to site of injection. Non tender, non indurated 1 cm in diameter. Y 1/12/2009 1/13/2009 dominal discomfort, onset 4 days after Y injection with nausea. Symptoms lasted X 5 days. Y ### 1/2/2009 nt was a 34 year old male Officer with no medical problems prior to receiving anthrax Y vaccination N #5 in Apr 4/15/1999 1999. In Aug 9/1/1999 and Sept of that ye eceived multiples doses of ENGERIX-B Y within aY one year time period, later diagnosed Y with MS. N Symptoms: 2/1/2006 Loss of vision 5/1/2007 (CN II), weaknes 9 received flu vaccine. Pt reports that evening feeling chilled, dizzy, weak, severe aching bit. Y Forearm and 1/5/2009 difficulty breathing, 1/5/2009pale, HR102,B ped cellulitis on the site of Pneumococcal Y vaccine with fever, vomiting 01/9/09. 11 1/2 hours after the shot1/9/2009 treated with 1/9/2009 Abx augmentin. ceived yellow fever and typhoid injections without incident. Approximately 15 mins later GARDASIL Y inj given. 1/6/2009 Within mins 1/6/2009 patient had synco hours-swelling 2"x3" raised 1/2-3/4 inch, hot, have been-icing/heat pack-5th day=still swollen, N very tender1/5/2009 and hot-very 1/6/2009 uncomfortable. was fine at first but overtime developed Y aching where vaccine was deposited inside arm to point Y of interfering with ###sleep. 11/1/2008 Also general arm w ght, fever, non-weight bearing 1/10/2009 1/10/2009 ection site, fever, non-weight bearing doses of GARDASIL I had all normal pap tests between the years 2004 to 12-1-20066. AfterU3 doses of GARDASIL ### I had### 2 abnormal pap shot of GARDASIL on 2-7-08 had dizziness, headache, missed school. Second shot 5-7-08 Y had dizziness2/7/2008 and severe2/7/2008 headache - missed s D AA male SM presents with 2-day history Y of SPV innoculation site concerns. Reports HA, malaise, Y chills, and ### myalgia. Chills, ### Headache, g ed his primary SPV on 11/27/07. Never Y developed Jennerian pustule. 3 weeks post inoculation, Y he developed### a small, red, raised lesion a one minute after receiving anthrax #1 and 2, she had very brief episodes of chest pain, lasting Y less than 21/8/2008 min that resolved without interve oped redness, swelling, pain approx 24 hrs after receipt of anthrax vaccine. Swelling Start: 12/16/2007; Y Erythema ### Start: 12/16/2007; Edem h on arm, redness into his armpit about 10 days after receipt of primary SPV Symptom: Edema U @ injection site### >120 mm not beyond elbow /o eczema that received SPV and had exacerbation of his eczema. His concern is more focused Y on his children ### at home, 2 of whom have redness, swelling around primary SPV site approx. 6 days after receiving vaccine. Symptom: Y Erythema Start: ### 12/10/2007 Symptom: Swell rge local reaction with his 3rd and 4th anthrax shots. Symptom: Edema @ injection site 50-120mm Start:6/1/2003 06/2003; Edema @ injection site he had large local reaction with his 3rd, 4th and 5th anthrax shots, including redness, swelling Y and pain at7/1/2003 injection site. Erythema Start: 07 d large local reaction to anthrax vaccine Erythema Start: 05/2007; Swelling Start: 05/2007; Pain Y Start: 05/2007 5/12/2007 o PCP for evaluation of HA, body aches, Y general malaise and diarrhea she developed after U being vaccinated 11/5/2007 with SPV, anthrax and typhoi n has been received from a physician concerning a male who was vaccinated with a dose ofUMMR II and was diagnosed with autism. The n has been received, for the Pregnancy Y Registry Y for GARDASIL, from 0 a nurse practitioner concerning Y a 16 6/3/2008 year old female 6/3/2008 with no pertinen n has been received from a physician's Y assistant Y (P.A.) concerning 3 a approximately 3 monthUold patient 12/4/2008 who was vaccinated 1/6/2009with a dose of was reported by a consumer and described Y the occurrence of psoriasis in a 56-year-old female N subject who was ###vaccinated ###with ENGERIX eption. First began with bloody Y diarrhea Y 1-10-09. Y Resolved 1-11-09.2Recurred 1-14-09. US 1-15-09. N Intussusception 1/7/2009 1/11/2009 at cecum. 1/29/09 Re , hard area approximately 2 1/2" in diam. at injection site. Sore and burning. Approximately 12 U days after injection, ### developed ### bumpy, itchy ported elevated temperatures of 104.0 degree F the morning after vaccines, also mentioned Yextreme fussiness 1/12/2009 and 1/13/2009 slight decreased appeti developed at injection site the day of administration. Complains of itching at site. Erythematous Y from top of1/7/2009 deltoid to 1/7/2009 4cm above elbow. Coo
mins after receiving vaccine pt stated that he felt dizzy & had blurry vision. He was placed in Y supine position 1/14/2009 with feet 1/14/2009 elevated v/s HR 100 ates that right wrist was swollen on 01/10/09 about 24 hours after MENACTRA and HAVRIX Ywas administered 1/9/2009 in right 1/10/2009 arm. m to touch rash at injection site. Y 1/7/2009 1/9/2009 ted blood in infant's stool one day after Y immunizations were given. Infant was fussy the evening U of vaccines, 1/9/2009 but has1/9/2009 been fine since. ed screaming for hours on end, severe irritability, lethargy Y 9/5/2008 9/6/2008 ports hives on back- upper torso U 1/14/2009 1/14/2009 ported raised red very painful spot at site of injection, which got better with time. Y 1/6/2009 lled and reported need to go to ER folllowing immunizations given 12/31/2008. She stated respirations Y became### labored 1/1/2009 and temperature 10 ays of receiving the 2nd round of the Y HPV vaccination, Y my daughter2began with severe painYin her arms, legs, ### and hips, difficulty ### walking w as accidently give Tdap instead of Td Y 1/15/2009 rs 102+, Nausea, Dizzy, lethargic, weak & tired U 1/14/2009 1/14/2009 1 x 7 cm reddened area noted this am. 1/13/2009 1/15/2009 per arm is very swollen and hard after receiving Shingle vaccine. Red circle approximately four N inches in1/12/2009 length is present. 1/12/2009 Some itchy. Ve 3rd hep B injection on 12/8/08. Within one day developed tender left axillar adenopathy lasting Y 2-3 days,12/8/2008 followed by 12/9/2008 swelling, erythema an fever, vomiting, dehydration, elevated Y heart rate N 1/12/2009 1/14/2009 mplained of persistent redness, edema, was febrile and noticed streaks down arm post vaccination. Y Treated 1/6/2009 by on-call 1/7/2009 physician with an a hemic stroke (basilar artery Y thrombus). Y Underwent Y mechanical thrombectomy 20 Y 11/25/08. Y 2/2/09 N Received11/5/2008 ER medical records ### of 11/19/200 receipt of vaccines in travel clinic client experienced syncope episode, i.e., lost consciousness, Y became 1/15/2009 pale, dyaphoretic. 1/15/2009 B/P 110/70; clie ceived vaccine 01/06/2009 and called pharmacy 01/14/2009 with complaint of a red rash at the U injection site 1/6/2009 approximately 1/14/2009 2 inches in diam B Vaccine series given at start of new Y job (1st dose 9/13/2006) because blood work Y showedNno immunity 2/14/2007 present from 8/23/2007 previous immunizat able screaming and fits of rage lasting for 15 minutes at a time, happening since an hour and U a half after1/13/2009 vaccination. 1/13/2009 At current time, symp eactive lymphadenopathy and swelling in left anterior cervical chain and supraclavicular areas on 1/15/09 1/12/2009 with torso1/15/2009 macularpapular rash d a febrile seizure with a temperature Y of 106.8 degrees and rising 7 days post MMRV shot. He'd Y had a double-ear ### infection 12/7/2007 as well at the tim ed patient "almost passed out" and patient stated he had headache. I observed the patient to Y be alert/ appropriately 1/14/2009 1/14/2009 responsive. d-mosquito bite size area where received vaccine, no fever, no other issues. No drainage, no Y bigger, not 1/8/2009 painful. 2 days 1/9/2009 later had lump the was brought to my office for the next set of vaccines, his parents described 8 hours of high - pitched Y screaming 7/7/2008 post the 7/7/2008 prev vaccines. No A given to 9 month old child. U 1/6/2009 1/6/2009 severe irritability, 4-6 hrs immunization for several days U ### ### Swelling, warmth redness U 1/5/2009 1/6/2009 2 area of redness with elevated temp and soreness at injection site. 12/25 redness and elevated Y temp resolved, ### quarter" sized ### knot at site arm - redness and swelling, mild rash redness used Benadryl 2t sp Q60 until redness gone.Y 1/7/2009 1/8/2009 headedness and inability to focus visually 5 minutes after 3rd rabies Vac. administered . VitalYsighs remained 1/9/2009 stable. Some 1/9/2009 nausea. All Sx s en Tdap - recommended for ages 11-64 only. ADACEL- lot # C3027AA in right deltoid. Y 9/22/2008 ed of pain radiating from injection site in left deltoid down to her hand diminished grip strength, U normal sensation. 1/14/2009No 1/14/2009 s/s inflammation. Ibu red circle around administration site that was hard to touch, 0 itching. Area was tender to touch. Y Began 2 days ### after administration ### and laste ed bandage over SPV site and approx. Y 3-4 days later develop a localized rash that becameYgeneralized over ### several days. SM received p Area swelled red raised. Very sore. Mom gave BENADRY & ice to area - still present 1/15/09Y 1/12/2009 1/12/2009 e to appointment for 4 mo WCC on YAmoxil started on 1-6-09. Appoint date 1-12-09. Had dry Y rash primarily 1/12/2009 on Abd.1/14/2009 & torso. Dr. instructed sounding cry, crying consistently, not Y consolable, after receiving immunization 0n 1/8/09. Had Y swelling at1/8/2009 injection site 1/8/2009 of DTAP for 1-2 day 9 per mother at 10:30 pm she felt infant Y & he was hot. She gave Tylenol and child had seizure. Y Child taken 1/14/2009 to ER 1/14/2009 by ambulance with temp U ours of vaccination Pt experienced generalized ache ness that lasted 3 days. Itching was significant Y enough 1/8/2009 to require 1/8/2009 antihistamines. No r back of neck began to itch in the PM. Then when woke up 11-15-09 legs and arms were itching resemoline 1/13/2009 hives, welts/redness 1/14/2009 on bilatera haking Chills myalgias for several hours. Resolved spontaneously. Fatigued the next day. Y 11/5/2008 11/5/2008 both parents for rash, Friday had a few spots on chest, has spread entire body and SaturdayY had fever to 102.### Received ### MMR 12/18/08, a eived DTAP, IPV, MMR,Volvox and flu 1/6/09 T100.3 1/7/09 0 fever 1/8/09 fever to 104 lasting Y 3 day associated 1/5/2009with1/8/2009 headache 1/11/09 bl ellulitis 24 hours after vaccination inYleft deltoid Y 1/8/2009 1/9/2009 njection 3:45p- woke up 9:45 pm same day-fever 102- aches all over body - had headache called Y doctor 10/2/2008 next day advised 10/2/2008 take 2 Tylenol an miting, Diarrhea Daily-No reason hospitalized Y for dehydration lost 30lbs. Continued to be sickN Colonoscopy, 8/22/2007 MRI problems 10/1/2007 with Blood sug hours of HPV dose given on 08/27/2008 - Had rash over trunk of body, Lasting 3 days did not Y seek medical 8/27/2008 attention. 8/28/2008 Within 24 hrs after 6/ 30 Pt. called to report that she had a rapid heart rate which started approximately 1/2 hr afterYreceiving the1/6/2009 vaccine and 1/6/2009 lasted for approxim
veloped a 1"x1 1/2" induration that is red and warm where an ADACEL injection was given. U 1/6/2009 ucousy stools after ROTATEQ vaccine x 2 weeks. U ### ### er UMM placed erythema, tenderness and warmth occurred- 9cm X 6 cm oral paten, resolving N after 2 more days. ###At visit 5### days later paten ived PEDIARIX/PREVNAR 1/09/2009 at 09:25 per / LPN- 1/10/2009 Mon report swelling, redness Y at site 1/9/2009 and thigh 1/10/2009 swollen 1/12/09 "doing 0-15 min after getting vaccines small white raised bumps. Lasted about 3 weeks itching 0 treatment Y 9/11/2008 9/11/2008 p- size of "grape" in arm - where shot administered for one week - then thereafter, remains aUlump "pea" size in### upper left ### arm. n has been received from a consumer Y concerning her 8 week old daughter who on 11-DEC-2007 N was vaccinated ###with a dose ### of COMVAX n has been received from a consumer concerning a friend of the family's child who on an unspecified U date was vaccinated with MMR II, and n was obtained on request by the Company from the agency via a Public Case Detail Form U and a Case 3/26/2008 Line Listing concerning an approxim n has been received from Y a physician Y concerning a 22 year old female patient with no pertinent Y medical history 1/7/2009 and no 1/7/2009 known drug allergy n has been received from a physician concerning a 15 year old female with no previous Y medical, N family, 12/7/2007 or social history 12/8/2007 who on 19-NOV-2 n has been received from a health professional concerning a 19 year old female patient whoYon 17-DEC-2008 ### was vaccinated ### with the first n has been received from a physician Y and a hospital Y medical librarian 1 concerning a 59 year N old female who on### 30-DEC-2008 1/1/2009 was vaccinate n has been received from a physician, for VARIVAX (Merck), a Pregnancy Registry product,Yconcerning a female who was vaccinated with minutes of vaccination to the left upper arm, patient felt weakness in right side (muscular and Y joint) from right hip ###to knee; ### weakness lasted nt presented with swelling and redness on upper arm approx 2 inches from injection site 1 day Y post-injection. Her ###upper arm ###was hot and p esented with cellulitis of right arm associated with swelling and axillary lymphadeopathy. Patient Y reported fever, ### chills at home. ### VERE PAIN AT THE SITE OF INJETION FROM 1/13/09(DAY OF VACCINATION) TO 1/14/09...MORE Y THAN 1/13/2009 36 HRS....WITH 1/13/2009 SITE (LEFT d a rash on the thighs and face. U 1/13/2009 l pain/stomach cramps for 2 hours. No treatment given. Y 1/6/2009 1/6/2009 iented, unable to answer questions Yappropriately for 45 minutes. Went to ER and was seen Y by triage nurse, 1/6/2009 then symptoms 1/6/2009resolved and p IVED EXPIRED FLUMIST LOT 500548P EXP DATE 12/18/2008. NO REPORTED ADVERSE U EVENTS TO DATE ### OF COMPLETING REP rash & periorbital swelling beginningY 11/6/08 - Adverse reaction reported to Employee Health Y on 11/7/0811/5/2008 - referred to 11/6/2008 Nurse Practitioner at ported burning and stinging in her hand starting several hours after she received the vaccineUon 12/30/2008. The ###next day### she said that the nced large local reaction as well asYa "rash all over" Y 12/6/2008 12/7/2008 me to clinic today and presented with a possible reaction to the flu vaccine. The flu shot wasUadministered 10/9/2008 on October 10/9/2008 9, 2008. The patient veloped watery diarrhea 1/2/09. The diarrhea lastd until 1/6/09. Patient also developed irritability Y and a decrease ###in appetite. 1/2/2009 me to Health Center at 12:06 pm on 1/16/09, 9 days after injections. Stated "prolonged hardUlump on my1/7/2009 right arm where 1/8/2009 I got the pneumo ng, tightness in chest, cough, swelling Y around his eyes and a bit of difficulty breathing. It was about 4 hours 1/13/2009 after the1/13/2009 shot. PV on November 4th, 2008. she stated she didn't know she was pregnant. Had a miscarrieage Y in December. 11/4/2008 (Came in today ### becase she d an afebrile seizure event lasting 2-3 minutes Ythe evening after receiving 1 influenza A and Hepatitis Y A vaccine 1/14/2009 at her 1/14/2009 PMDs on 1/14/09. Sh fever, body aches, chills, dizziness Y ### ### n has been received from a case inYlitigation from a 64 year old female who on 29-OCT-2008 N was vaccinated in ### the right arm with a dose o n has been received from a consumer Y concerning a 13 month old male with no medical history N or drug allergy 6/5/2006 who on 6/5/2006 05-JUN-2006 was va n has been received from a pharmacist Y concerning Y a 90 year old female 3 Y patient who was vaccinated Y with a dose ###of ZOSTAVAX ### (lot# not p n has been received from a registered nurse who Y reported that the one 0 Y of her patient's mother U reported that there was a female patient who was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a female patient who expe was reported by a lawyer and described the occurrence of arm pain in a 48-year-old Y male subject N who was 5/13/1999 vaccinated 6/1/1999 with LYMERIX (Gla was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age who was vaccinated with LYMER was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified Y age who ### was vaccinated 10/4/1999 with LYMER was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age2/23/2000 who was vaccinated with LYMER was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified N age who was vaccinated with LYME was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified 5/25/2000 age who was vaccinated with 1/10/2009 N 1/8/2009 1/10/2009 1/14/2009 N 1/13/2009 d hives/facial swelling, local Y itching within 5 minutes of vaccine. Required EpiPen administration. Y 1/8/2009 1/8/2009 varicella shot R arm. 11/5 developed redness & blisters on R arm below injection site- pt here Y 11/6/09 1/14/2009 1/15/2009 became red, swollen, warm the evening Y of 12/30/08. Symptoms worsened next day. She was seen at clinic on ### 11/1/09- They ### referred her LA- like rash Y Y ### 1/10/2009 er of 101.9, aches, stiffness - around 6:30 pm. Around 1 am next am0 headache, sweating,Ynightmares,1/12/2009 few hives on 1/12/2009 hands. Symptoms im oulder started pinching. The pain progressed to point of doctor visit. Am currently doing physical Y therapy for left ### shoulder.###
t ever given- hurt immediately and for approx 4 to 5 days after. Got really sick after for 4 days N - puking etc. Started ### noticing ###that arm aches induration, swelling on R thigh where Y Hib and PREVNAR were given. Later developed into Y a localized abcess. 4/1/2006 Had recurrence of similar s episode following GARDASIL administration. Held in clinic for 15 min following incident, withYBP initially 122/64 1/16/2009 and 1/16/2009 126/76 15 min later. G firm, warm to touch 6.0cm X4.5cm, chemical taste in mouth approximately 20min after administration Y patient 1/14/2009 normally 1/14/2009 has chemical taste w wollen, hot red to left thigh. Treatment CLENDA 75/5 1 top po tid x 10 days. U 1/14/2009 1/14/2009 olable, crying within 6 hrs. 2. Not having lower extremities 3. Hypersensitive below waste lineY 1/12/2009 1/12/2009 /blurriness/head pain/nausea. Another Y student at his school had immunizations yesterday also, and was1/13/2009 sent home1/14/2009 from school with simila oped redness, swelling and pain at injection site within 24 hrs of receiving his second ANTHRAX shot. 8/1/2007 d redness, pain and swelling at site of anthrax vaccine within a few hours after receiving the Y shot. 8/7/2007 d vaccine at our office on 1/5/09. On Y 1/6/09 pt started with redness, swelling, hot to touch with Y pain, some 1/5/2009 itching at 1/7/2009 the vaccine site. Wen given 1/14/09. Left arm swelling. Y U 1/14/2009 1/16/2009 veloped hives within 2 hrs of vaccines being given. Rx BENADRYL PO. No tongue/lip swelling/wheezing. Y 1/16/2009 1/16/2009 d rash over torso, about 30 lesions. No open areas, no s/s infection, no crusting. Y ### cified dates, the subjects received unspecified doses of HEPATITIS B vaccine (unknown). At U an unspecified time after vaccination with HE was reported by a sales representative and described the occurrence of decreased therapeutic U response in a subject of unspecified age an was reported by a healthcare professional Y and described the occurrence of hive in a 21-year-old U female subject ### who was ### vaccinated with E was reported by a healthcare professional and described the occurrence of not responding to N therapy in11/2/2006 a male subject of unspecified age was reported by a physician and described the occurrence of hearing deficit in a male subject U of unspecified age who was vaccinated with e was reported by a pharmacist and described the occurrence of not responding to therapy inUa subject of unspecified age and gender who was reported by a healthcare professional and described the occurrence of urticaria in a 10-year-old Y female 9/22/2000 subject9/23/2000 who was vaccinated w was reported by a healthcare professional and described the occurrence of arm weakness in Y a 39-year-old 9/16/2008 male subject 9/16/2008 who was vaccinat was reported by a physician (also the subject) via a sales representative and described the U occurrence of a young adult female subject of u was reported by a healthcare professional and described the occurrence of wrong route of administration N 10/1/2008 in a 38-year-old 10/1/2008 female subject w was reported by a consumer and described the occurrence of foot pain in a 8-year-old female U subject who was vaccinated with hepatitis B was reported by a healthcare professional and described the occurrence of a subject of unspecified U age and gender not responding to ther was reported by a physician and described the occurrence of hepatitis b antigen positive in an adult subject of unspecified 8/1/2008 gender who was was reported by a healthcare professional, who was also the vaccination subject, that described N the occurrence of not responding to thera was reported by a healthcare professional and described the occurrence of rash on trunk in a 35-year-old 8/21/2008 female subject 8/21/2008 who was vaccina was reported by a consumer and described the occurrence of injection site pain in an adult female N subject 8/19/2008 who was8/19/2008 vaccinated with ENGE was reported by a consumer and described the occurrence of injection site soreness in an adult Y female 7/19/2008 subject who7/19/2008 was vaccinated with E was reported by a pharmacist and described the occurrence of hepatitis B surface antigen positive N in a 2-month-old 7/28/2008 8/28/2008 male subject who was was reported by a healthcare professional and described the occurrence of hepatitis b antibody U negative1/16/1998 in a 49-year-old 8/1/2008 female subject w was reported by a health care professional and described the occurrence of swelling of knees Y in a 26-year-old 6/25/2008 male6/26/2008 subject who was vacci was reported by a pharmacist and described the occurrence of elevated liver enzymes in a 48-year-old N male 8/14/2008 subject 8/26/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of hives in an infant Y female subject who was vaccinated with hepa was reported by a physician via a nurse and described the occurrence of allergic reaction inUa subject of unspecified and and gender who w was reported by a consumer, who was also a GSK sales representative, that described thatNoccurrence 7/16/2008 of irritability 8/6/2008 in an adult male subje was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in8/1/2008 a 50-year-old 8/4/2008 male subject who w was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in8/1/2008 a 72-year-old 8/4/2008 male subject who w was reported by a healthcare professional and described the occurrence of hepatitis B antigen U positive 4/30/2008 in a 45-year-old 5/5/2008 male subject who was reported by a healthcare professional and described the occurrence of arm burning in an U adult female 7/1/2008 subject who was vaccinated wit was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008 subject who was vaccinated with was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008 subject who was vaccinated with was reported by a healthcare professional and described the occurrence of hives in a 3-year-old Y female subject ### who was ### vaccinated with E was reported by a nurse and described the occurrence of allergic reaction in an adult femaleUsubject of unspecified age who was vaccinate was reported by a healthcare professional and described the occurrence of swelling of knees Y in a 26-year-old 6/25/2008 male6/25/2008 subject who was vaccin was reported by a healthcare professional and described the occurrence of low hepatitis b antibody U level in a male subject of unspecified a was reported by a healthcare professional and described the occurrence of hepatitis b surface antigen positive 6/10/2008 in a6/11/2008 27-year-old female sub was reported by a physician and described the occurrence of fever in a female subject Y of unspecified Y age who was vaccinated with hepatit was reported by a pharmacist and described the occurrence of nausea in three subject of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccina was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccin
was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccin was reported by a healthcare professional and described the occurrence of a false positive hepatitis N test6/16/2008 in a male subject 6/19/2008 aged between 5 was reported by a pharmacist and described the occurrence of decreased therapeutic response U in an unspecified number of subjects of un was reported by a healthcare professional and described the occurrence of an adult male subject U (a dentist) not responding to therapy follo was reported by a pharmacist and described the occurrence of an adult male subject (a physician) U not responding to therapy following vac was reported by a pharmacist and described the occurrence of an adult male subject not responding U to therapy following vaccination with H was reported by a pharmacist, who was also the consumer, that described the occurrence ofY fever in a 22-year-old male subject who was v was reported by a healthcare professional and described the occurrence of Hepatitis B antibody U negative 1/22/2001 in a 23-year-old 6/12/2007 female patient w was reported a physician, via sales representative and described the occurrence of not responding U to therapy in a subject of unspecified ag ct was in clinic for day 180 on 03 October 20005. Pre-injection vitals were normal with blood pressure (BP) 10/3/2005 of 114/84. 10/3/2005 The subject did not h was reported by a physician via a representative and described the occurrence of HEPATITIS N B antibody negative in a 13-year-old subject was reported by a healthcare professional and described the occurrence of vaccination errorUin a subject4/14/2008 of unspecified 4/15/2008 age and gender wh was reported by a healthcare professional and described the occurrence of metallic taste in Ya 57-year-old4/4/2008 male subject 4/4/2008 who was vaccinate was reported by a healthcare professional and described the occurrence of possible HEPATITIS Y B in an elderly 3/1/2007 female subject who was va was reported by a physician and described the occurrence of not responding to therapy in aUmale subject of unspecified age who was vacc was reported by a healthcare professional and described the occurrence of low Hepatitis B antibody Y level1/1/2001 in an adult male subject who was was reported by a healthcare professional and described the occurrence of HEPATITIS B antibody U negative in### a 63-year-old 3/27/2008 male subject was reported by a healthcare professional and described the occurrence of a subject of unspecified U age and gender not responding to ther was reported by a healthcare professional Y and described the occurrence of rash in a femaleNsubject aged3/1/2008 between 20 and 29 years old wh was reported by healthcare professional and described the occurrence of hives on head in aY29-year-old2/26/2008 female subject 2/26/2008 who was vaccinate was reported by a physician and described the occurrence of a 43-year-old male subject notNresponding to therapy ### following vaccination w was reported by a consumer and described the occurrence of diarrhea in a 31-year-old female U subject who 3/23/2008 was vaccinated 3/23/2008 with ENGERIX was reported by a healthcare professional and described the occurrence of not responding to U therapy in an adult female subject who was v was reported by a healthcare professional and described the occurrence of hepatitis B antibody U negative in an adult female subject of unsp was reported by a physician from a blood center and described the occurrence of HEPATITIS U B surface antigen positive in a subject of uns was reported by a physician and described the occurrence of Hepatitis B surface antigen positive U in a subject of unspecified age and gend was reported by a healthcare professional at a dialysis unit and described the occurrence of HEPATITIS10/1/2006 B antigen positive in a 77-year-old was reported by a healthcare professional at a dialysis clinic and described the occurrence of U HEPATITIS 2/23/2008 B antigen2/26/2008 positive in a 52-year-o was reported by a healthcare professional and described the occurrence of non-seroconversion U in a subject 1/8/2008 of unknown age and gender w was reported by a healthcare professional and described the occurrence of strange taste in Ya 25-year-old 1/24/2008 male subject 1/24/2008 who was vaccinate was reported by a healthcare professional and described the occurrence of injection site redness N in a 23-year-old 2/22/2008 female 2/23/2008 subject who was was reported by a consumer and described the occurrence of flu like symptoms in a 32-year-old N female 2/15/2008 subject who 2/15/2008 was vaccinated with E was reported by a pharmacist and described the occurrence of not responding to therapy inUa 54-year-old female subject who was vaccina was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in2/9/2008 a 79-year-old 2/12/2008 male subject who w was reported by a physician and described the occurrence of HEPATITIS B surface antigenYin a male subject 1/1/2008 aged between 2/1/200830 and 40 yea was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in2/1/2008 a 78-year-old 2/6/2008 female subject who was reported by a healthcare professional and described the occurrence of Hepatitis B antigen Y positive in2/2/2008 a 76-year-old 7/2/2008 female subject wh was reported by a consumer and described the occurrence of bruise injection site in a 60-year-old U female 1/27/2008 subject who was vaccinated with was reported by a physician via a sales representative and described the occurrence of not U responding to therapy in a subject of unspecifie was reported by a physician and described Y the occurrence of hepatitis B surface antigen positive Y in a 48-year-old ### male subject ### who was va was reported by a pharmacist via a sales representative and described the occurrence of discomfort U at time of injection in an unspecified n was reported by a healthcare professional and described the occurrence of low hepatitis B antibody U level in a subject of unspecified age an was reported by a healthcare professional andYdescribed the occurrence of vaccination failure Y in a 53-year-old female 9/1/2007 subject who was vac was reported by a healthcare professional and described the occurrence of stomach pain inUa male subject 10/1/2007 of unspecified 10/1/2007 age who was va was reported by a healthcare professional and described the occurrence of not responding to U therapy in an unspecified number of adult su was reported by a physician and described the occurrence of decreased therapeutic response U in an adult male subject who was vaccinate was reported by a physician and described the occurrence of HEPATITIS B surface antigenUpositive in an 11/1/2007 adult female 11/1/2007 subject who was va was reported by a consumer and described Y the occurrence of hair loss in a 53-year-old maleN subject who6/2/2007 was vaccinated 9/1/2007 with ENGERIX B was reported by a healthcare professional Y via another manufacturer and described the occurrence U of not responding to therapy in an adult was reported by a physician and described Y the occurrence of pain in arm post vaccination inNa 29-year-old 11/8/2007 female subject 11/8/2007 who was vaccina was reported by a healthcare professional and described the occurrence of nausea in a 15-year-old Y male 10/1/2007 subject who 10/2/2007 was vaccinated with
was reported by a physician and described the occurrence of not responding to therapy in aUsubject of unspecified age and gender who wa was reported by a healthcare professional via Merck and described the occurrence of not responding U to therapy in an unknown number of was reported by a physician via sale representative and described the occurrence of alopecia Y in an infant male subject who was vaccinate was reported by a healthcare professional via sales representative and described the occurrence U of not responding to therapy in several su was reported by a pharmacist and described the occurrence of allergic reaction in a subjectUof unspecified age and gender who was vacci was reported by a healthcare professional and described the occurrence of hepatitis B surface Y antigen positive in a female subject of unsp ptember 2007 the subject received a birth dose of ENGERIX B (10 mcg, unknown). On September U 2007,9/18/2007 same day 9/18/2007 as the vaccination with was reported by a healthcare professional and described the occurrence of hepatitis B surface U antigen positive 8/7/2007 in an8/9/2007 infant male subject wh was reported by a healthcare professional and described the occurrence of inappropriate dose U of vaccine 6/27/2005 administered 6/27/2005 in a 21-year-old ma was reported by a healthcare professional and described the occurrence of hive-like rash over N the body9/22/2008 in a 6-month-old 9/23/2008 male subject who was reported by a healthcare professional Y and described the occurrence of swollen thigh (injection Y site) 8/20/2008 in a 5-year-old 8/21/2008 male subject who w was reported by a physician and described the occurrence of injection site reaction in a 2-year-old U male subject 5/1/2008 who5/1/2008 was vaccinated PEDI was reported by a healthcare professional and described the occurrence of fever in a 5-year-old Y female subject 8/6/2008 who 8/7/2008 was vaccinated with P was reported by a physician and described the occurrence of lethargy in a 2-month-old subject U of unspecified gender 7/10/2008 who vaccinated with was reported by a physician and described the occurrence of injection site hives in a 6-month-old Y female subject who was vaccinated with was reported by a pharmacist and described the occurrence of apnea in a subject of unspecified U age and gender who was vaccinated with was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w was reported by a healthcare professional, Y via a GSK sales representative, that described the Y occurrence 7/16/2008 of inconsolable 7/16/2008 crying in a 2-mon was reported by the mother of a consumer and described the occurrence of nausea in a 2-month-old N male 4/29/2004 subject who 4/30/2004 was vaccinated wit reported by a physician, via GSK representative, that described the occurrence of high fever in a 4-month-old subject of unspecified gende was reported by a physician, via a GSK representative, that described the occurrence of high U fever in a 4-month-old subject of unspecified was reported by a physician via a sales representative and described the occurrence of crying U uncontrollably 7/25/2008 in a 2-month-old 7/25/2008 female subje was reported by a physician and described Y the occurrence of hypotonia in a 2-month-old male Y subject who 7/21/2008 was vaccinated 7/21/2008 with PEDIARIX was reported by a physician and described the occurrence of wrong route of administration U in a subject of unspecified age and gender who was reported by a healthcare professional Y and described the occurrence of swelling at the injection N site 6/16/2008 in a 2-year-old 6/17/2008 male subject who w was reported by a physician and described the occurrence of a lump on leg at injection site N in a 7-month-old 4/15/2008 female5/12/2008 subject who was vacci was reported by a healthcare professional and described the occurrence of soreness in a 11-year-old U male 6/5/2008 subject who 6/5/2008 was vaccinated wi was reported by a consumer and described the occurrence of fever in a 13-month-old female N subject who was vaccinated with PEDIARIX. was reported by a physician and described the occurrence of a lump at the injection site in aN7-month-old 4/11/2008 male subject 4/14/2008 who was vaccinated was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 3/28/2008 screaming3/28/2008 in a 4-month-old subje was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 2/8/2008 screaming 2/8/2008 in a 2-month-old subje was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 3/14/2008 screaming3/14/2008 in a 2-month-old subje was reported by a physician and described the occurrence of generalized petechiae in an infant U subject who was vaccinated with PEDIARI was reported by a healthcare professional via a representative and described the occurrence Y of swollen lips in a child male subject who wa was reported by the mother of a consumer and described the occurrence of irritability in a 16-month-old N male 3/3/2008 subject3/3/2008 who was vaccinated was reported by a consumer and described the occurrence of high fever in a 17-month-old female N subject 1/24/2008 who was1/24/2008 vaccinated with PEDIA was reported by a healthcare professional Y and described the occurrence of swelling of legs Y in a 4-month-old female ### subject ###who was vacci was reported by a physician, via sales representative and described the occurrence of bulging U fontalle in a 4-month-old subject of unspecif was reported by a healthcare professional Y via a sales representative and described the occurrence Y of bulging 1/7/2008 Fontanelle 1/10/2008 in a 4-month-old was reported by a consumer, and subsequently confirmed by a physician, that described theY occurrence11/8/2007 of prolonged 11/8/2007 crying in a 2-monthwas reported by a healthcare professional and described the occurrence of crying in a 6 week-old Y male 5/18/2007 subject who5/18/2007 was vaccinated with P was reported by a physician to a sales representative and described the occurrence of feverUin a subject of unspecified age and gender wh was reported by a healthcare professional and described the occurrence of hepatitis B antibody U negative 9/23/2004 in a 60-year-old 6/12/2007 female subject w ious spontaneous report of administration to a seven-month-old has been received from a physician Y concerning 12/1/2008 a seven-month-old 12/1/2008 male w ious spontaneous report administered expired FLUMIST was received from a nurse concerning Y a four-year-old 12/2/2008 male. 12/2/2008 The patient received F eous non serious report of stuffy nose, fever, green mucus coming out of her nose and coughing U was received from12/2/2008 the patient's mother co ious report "given FLUMIST to 19-month-old" was received from a doctor's medical assistantYinvolving a 12/4/2008 19-month-old 12/4/2008 male. On 14-Dec-20 ous report of "gave FLUMIST to an 11-month-old" has been received from a registered nurse Y concerning an 11-month-old ### ### male. Medical h ious report of administration of expired product has been received from a registered nurse concerning Y a four-year-old ### male### who received FL ous, spontaneous report of administration of FLUMIST to a seventh month-old was receivedYfrom a nurse. There ###was no adverse ### event as accine used (Expired drug administered) A non serious, spontaneous report of gave expired YFLUMIST to a three-year-old ### ### female patient wa
ous spontaneous report of influenza A, fatigue, fever, sore throat, and stomach ache has been Y received from a### physician ### concerning a four ous report of a child under two years of age who received FLUMIST was received from a registered Y nurse concerning ### a 23-month-old ### fema ous report of administered expired FLUMIST was received from a registered nurse concerning Y a four-year-old ### female. Medical ### history and ous, spontaneous report of administration of expired product was received from a nurse concerning N a two year-old ### female### subsequent to F ious report of administration of expired product was received from a registered nurse concerning Y a 38-month-old ### female. Neither ### medical hi ious report of administered expired FLUMIST was received from a medical assistant concerning Y a 36-month-old ### female. FLUMIST, ### which e ious spontaneous report of expired FLUMIST given to this child was received from a certifiedYmedical assistant### in a physician's ### office conce was reported by a healthcare professional via sales representative and described the occurrence U of swelling arm in a subject of unspecifie swelling, itching, pain and tenderness and slight bruising at and around injection site on second N day after vaccination ### lasting ###about five day s history of seizures. She had been seizure free for over 3 months after switching drugs. She U had two seizures 1/7/2009 3 days 1/10/2009 after vaccination. bble 2 inches by 4 inches surrounded by a flame red 3 inch in circumfance rash. 1/17/2009,Y2 weeks after 1/3/2009 the injection, 1/3/2009 a flat redish brown x 10cm long, redness, warm to touch (L) upper arm. Y 1/15/2009 1/17/2009 was reported by a pharmacist (also the subject) and described the occurrence of feeling woozy Y in a 60-year-old 10/9/2008 male 10/9/2008 subject who was vac ffered Severe back pain, Tingling ofYlower extremities, Y Loss of sensation, 14 Y Band like Y feeling around N torsoe, Unable ###to stand,### resulted in perm ankle,and foot were swollen. Painful hives on ankle, and on top of foot. smaller hives across Ylower back,on back ### of neck,and ###top of head.th ctivity, lower paralysis, exhaustion, Y nausea Y andYvomiting, brain fog,15 difficulty Y concetrating, low N blood pressure, 8/24/2007 Painful 9/15/2007 periods and off cycle, ely after receiving shot,severe pain in Y injection arm.Had to rest for 10mins in office.BeginningYthe next day,1/6/2009 had a painful 1/7/2009 knot in back, pain i d crying spell for hours after vaccine. Has remained more fussy and easily cries for several days. U Wakes1/13/2009 at night more 1/13/2009 often. hy red rash area across belly Y ### ### Y 1/19/2009 1/19/2009 FELT LIKE HER HEART WAS RACING. SHE HAD A MINOR LOCAL REACTION TO NEOMYCIN Y IN THE 1/19/2009 PAST. BASCIALLY, 1/19/2009 WE CALM ported slight rash across back following a shingle vaccination. Y ### ### ately 6-8 hrs after taking third pill of Y Vivotif on 1/12/09, pt had generalized whelps/hives. Pt works Y in an ER, 1/8/2009 was seen 1/12/2009 by a fellow physician s after vaccine developed chills, progressed to numbness, tingling of lips and palate, increased Y BP and heart 1/19/2009 rate. 1/19/2009 d MMR on 1/10/09. On 1/18/09 at 2am, Y Pt noted with 103F temp at home, with tonic clonic U seizure and 1/10/2009 macular body 1/18/2009 rash. Taken to ER, et right hemisphere ischemic Y strokeYwithin 12 hours Y of vaccine administration. 6 3/11/2009 Y Received N vaccine 1/14/2009 records1/14/2009 & PCP medical record ped Myocardial infarctionYand MI a week Y after administration Y of Anthrax 1 Y vaccination enroute Y to Germany 4/21/2008 after leaving5/7/2008 Ft Hood Texas. Pt did 07, my son was treated in the Emergency Y Room at St. Claire's Hospital in New Jersey. Y He had N recently developed 4/4/2006 4/13/2006 a high fever (103. 2) alo ure 104.1, heavy chest congestion, Y wet hacking cough, chills, sweaty. 3:00 AM 5 ml Childrens Y tylenol 7:00 1/16/2009 AM temp1/17/2009 103.9 7.5 ml childrens was considered medically important. Information regarding PREVNAR was received from aUconsumer regarding a 6-year-old male patient ### N ### ### (+) Stool Guaiac, screaming with eating. Difficult Y to have BM. Intussusception 6 - admitted 1/11/09 Y after reduction ###with 1/15/2009 air enema. (+) recurre ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009 ates "eye lids swelling, and severe stomach cramps". Was not seen by physician in office after Y symptoms9/19/2008 occurred. 9/19/2008 d to office on 1/9/09 c/o "rash". 10 days post vaccination hospital + eruption consistent with H. ZOSTER RT TIV### Denmatine 1/7/2009 treated with AC z on 1/16/09 - started seizuring, eyes Y open wide, then shaking all over, then fell asleep for approximately Y 1/13/2009 1 hr. Had1/16/2009 2nd febrile episode sho redness, lump, tenderness at right thigh. Fever 99-102.6. Vomiting x 1 on 1/14/09. Irritable and Y cranky. Treated 1/13/2009 with1/14/2009 TYLENOL-MOTRIN. S ined of pain in muscle around site ofY injection within days of receiving vaccine. The pain hasNradiated up9/30/2008 and down10/1/2008 arm, has affected sleep pt to administer dose: Unable to get plunger down (resistance) so gave 1/2 dose same arm similar N area and 10/1/2008 was able 10/1/2008 to give dose. Pt state Y ### ### apprx 3" immediately after receiving V2V- wheel baded after 24 hrs after 24 hrs - 3 days after Y a red/blue1/15/2009 discoloration. 1/15/2009 l immediately after giving V2V 31/2"x4" - Wheal faded after 24 hrs- 3 days later and red/blueYdiscoloration 1/15/2009 remains. 1/15/2009 at eye of 50 cent piece pink for at 5-6" from there. 1/13/2009 1/16/2009 ew hours after immunization with influenza Y in the left arm the patient started to experience pain U to the slightest 1/8/2009 touch 1/8/2009 in the left arm between e in "forehead". Nausea - no vomiting. Onset 01/05/09 U 1/3/2009 1/5/2009 inistered R deltoid 1/16/08. Pt describes site becoming swollen & red up to 4 cm circumference Y with a burning 1/16/2009 sensation. 1/16/2009 She felt dizzy & w ours, injection site swelled, reddened, itched, hot to touch and was extremely sore in area covering Y 6 inches 1/15/2009 by 6 inches. 1/16/2009 Pharmacist recom en dose of adult hep A. Client was 2 - 3 mos pregnant at time dose given. Client has not reported U an adverse 1/13/2009 reaction. CAME INTO OFFICE ON 10-11-2008 DESCRIBING COMPLAINT OF COUGH, SLIGHT SWELLING Y AND DIFFICULTY ### SWALLOWING ### AF l changes, encephalopathy, change in eye contact, speech delays, social regression Y 3/17/09-records N received-evaluation 2/20/2007 2/20/2007 8/31/07-Impressi he symptoms started after the second Y dose. Delainey has been having fainting spells where Ushe gets dizzy 4/28/2008 and sees 5/15/2008 black with white spots
ministered vaccine Wed - SorenessYturning into acute muscle pain around injection site and U spreading through 1/6/2009 back and 1/7/2009 torso. Thur - breat mplains of excessive swelling and redness at injectio site, site all is hardened and feels hot to U the touch.1/14/2009 1/15/2009 me in on Friday 16 Jan 2009 complaining of excessive swelling at site of injection, redness, U hardness, and 1/14/2009 hot to the 1/15/2009 touch. me in complaining of excessive swelling, redness, hardness, and hot at site of injection. U 1/14/2009 1/15/2009 mplains of lump, hardness, and redness at injection site. U 1/14/2009 1/15/2009 mplaining of fever. U 1/14/2009 1/15/2009 LOPED ,MACULOPAPULAR RASHY1/19 ON FACE THAT SPREAD TO TRUNK AND ARMSUAND LEGS TODAY. ITCHY RECIEVED VACCINATION ON 01/15/09. HAD RED WELT AT INJECTION SITE APPROXIMATELY U 3 INCHES 1/15/2009IN1/16/2009 DIAMETER WITHIN 24 wollen and hot Y 1/19/2009 1/20/2009 STARTIED TO BREAK OUT IN HIVES ON FACE & CHEST UPON ARRIVAL AT HOME APPROX Y 30 MINS AFTER ### VACCINE. ### NO COUG OCALIZED HIVE REACTION AT THE PPD SITE IN 24HOURS. BY 36HRS DEVELOPED ITCHY Y RED BUMPS 1/13/2009 WITH 1/14/2009 HALO & SOME HIV en the slightest symptoms since the Ybegining of her chart. Consant sinus infections Y acompained N by a weeze 1/15/2009 and cough. 1/20/2009 She also is haveing ter I received my flu shot I fell ill with a severe flu?/viral infection? that took me six weeks to recover Y from.12/9/2008 Symptoms: On the ###first day, seve ceived 2 varicella vaccines (2/23/05, 1/28/08). Patient presented to the office on 1/14/09 withYscattered pox-lke 1/28/2008 lesions. 1/14/2009 Varicella titer obtai an 17th mom noticed welts & bruising Y on child'sYside. She took her to 2 the ER. Seen by MD + Y welts & bruising 1/8/2009 spread 1/17/2009 down body to ankles, izure (grand mal) lastingYover 3 hours. Y Life flighted and hospitalized for 5 days. Results-permanent Y N brain damage ###to the left ### hippocampus. X 2 1-5-09. First time seizures. 1/23/09 Y Reviewed Y hospital medical 1records of 1/5-1/6/2009.YFINAL DX: new onset ### seizures 1/5/2009 Records revea AP vaccine on 10/29/08, exhibited expected Y s/sx Y after injection "knot 1 at side, pain, fever, headache". U Two weeks ###later had### lymph node on c Contests Rash 1/12/2009 e out in lesions mostly on trunk. U 2/22/1999 1/19/2009 eg weakness / had to use crutches for Y weeks / had weakness, numbness / tingling in legs. Still U with some6/19/2008 symptoms. 9/1/2008 1/23/09 Received PC mmunization unable to maintain LUE advection above 90 Y 1/13/2009 1/14/2009 30 sec post injection, laid down that-ammonic inhalant. 15 min later again syncope episode Y ammonia, inhalants 1/20/2009 & crackers 1/20/2009 & juice given ffuse in location, reddish and fine papular, no skin thickening, induration or subcutaneous nodules Y , noted 1/15/2009 after the vaccines 1/16/2009were given. l from patient stating a possible reaction to shingles vaccine. Three days after arm had swelling, N huge welt, 1/14/2009 itchy, painful, 1/17/2009 no fever, lasted fo ceived 1st Tdap in L upper A, then MENACTRA in R upper Arm. I turned around for no moreYthan 6 seconds 1/19/2009 to throw 1/19/2009 needles away in shar old girl with one day history of emesis, Y starting on the morning following her first series of vaccines. Y 1/12/2009 1/13/2009 ve, unresponsive for NSR. Took 1 hr before could vagal episode - No LOC. Y 11/4/2008 11/4/2008 er ZOSTAVAX - developed herpes zoster L ant chest, near arm. N 1/12/2009 1/13/2009 induration, just below deltoid area L arm began 24 hrs after injections of influenza & pneumonia Y vaccine. Achey ###& aneretis ###at onset, + 48 fter GARDASIL #3 developed syncopal Y episodes- recurrent, over course of 6 mos. Neuro and Y cardio work2/4/2008 ups WNL. 2/28/2008 1/22/09 MR received se symptoms known-3rd MMR given. U 1/14/2009 - 2x2, Erythema - 5x3 left arm warm Y compressor. U 1/9/2009 1/9/2009 ceived call from mother she states that about 34 hours post vaccination hives appeared on arms, Y BENADRYL 1/10/2009 given1/11/2009 with relief. On 1/12/09 4/08 received flu shot 10pm 12/14/08 throat started feeling tight and full. Also had red, watery eyes and swelling ### of the eye### lids. Treatment, d fainted about 2-4 min post vaccination with GARDASIL and VARIVAX. As family signed out Y in waiting 1/15/2009 room. Regained 1/15/2009 consciousness, 5 veloped fever, irritability and rash on Y 12-31-08. Parent took child to ER. ER MD noted fever Y and maculopapular### rash diagnosed ### viral exanth x 2 approx 6-8 hours after receiving vaccines. Running 101 degree fever although parent states Y has given1/5/2009 fever reducer. 1/5/2009 Next morning no n /23/2007 pain at site of GARDASIL injection #2 5 week past GARDASIL. Myalgias, hip pain,Yelbow, wrist, 7/18/2007 hand, finger, 8/20/2007 knee, foot pain, fatig se reactions. Child was given influenza vaccine at 4 mo of age- though to be 7 mo when it was U given. Infant had### no ill effects. ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009 en in office today for seizure yesterday Y after vaccines; took child to ER for fever of 104.3 andY developed1/12/2009 seizure. 1/12/2009 U 1/7/2009 1/7/2009 as given Td vaccine and in about 4 to 5 minutes later he was given PNEUMOVAX. After PNEUMOVAX, U patient### stated that### he felt very hot, U mmunization at 11 am temp. started 4 or 5 pm. Cheeks red, eyes blood shot. 1-10 rash on face N and arms,1/9/2009 7 am left arm 1/9/2009 painful. Rash sprea n- fever, chills, abdominal pain, diarrhea Y lasting 3 days. Symptoms subsided-she then felt well. Y No reaction 5/29/2008 at site of 6/1/2008 injection. She was in c n has been received from a physician Y assistant concerning an 18 year old female who on unspecified U dates 2/29/2008 was vaccinated 2/29/2008with a first, sec n has been received from a physician concerning a female patient who was vaccinated with Uthe complete series of GARDASIL (lot not repo n has been received from a sonographer Y concerning her daughter, who an on unspecified date Y was vaccinated with the first dose of GARD n has been received from a nurse and Y later a physician concerning a 13 year old female patient U with asthma 11/3/2008 and allergies to codeine, and
n has been received from a physician Y and a medical assistant concerning a 14 year old female N with a history of### asthma 10/1/2008 and recurrent otitis n has been received from a physician Y concerning a 26 year old female who on 28-OCT-2008 Y was vaccinated with ### the first### dose of GARDA n has been received a consumer through Y a Merck pregnancy registry concerning herself, a 41 Y year old female 10/1/2007 with 10/1/2007 allergies to Sulfa and ir follow-up information has been received Y from a nurse practitioner concerning a 26 year old female Y patient 1/29/2008 with no pertinent 3/3/2008 medical history n has been received from a health care professional for GARDASIL regarding a 15 year old Yfemale who 2/29/2008 on 29-FEB-2008 2/29/2008 was vaccinated w rmation and follow up has been received from a pharmacist and nurse for the Pregnancy Registry U of GARDASIL ### concerning 3/11/2008a 24 year old f n has been received from a nurse practitioner (N.P.) concerning a 1 year old female who was U inadvertently vaccinated with a first dose of G n has been received for the Merck Pregnancy Y Registry for GARDASIL from a health department Y nurse and 5/30/2007 from a registered 1/30/2008nurse concern n has been received from a medical assistant and a nurse practitioner, for the pregnancy registry Y for GARDASIL, 11/8/2007concerning ###a 23 year old n has been received from a physician Y concerning an 18 year old female patient who on 11-DEC-2008 N was vaccinated ### with### the second dose n has been received from a registered Y nurse concerning a 19 year old female patient with asthma N and no known ###allergies### who on 11-DECn has been received from a nurse practitioner Y concerning a 19 year old female patient who 1.5 N year ago, 7/1/2007 approximately 8/1/2007 in July 2007, was v n has been received from a pharmacist, Y concerning a female patient with hyperlipidaemia and N no known drug reactions ### or### allergies, who on n has been received from a registered nurse concerning a 23 year old female patient with drug N hypersensitivity### who a month ###ago was vacc n has been received from a registered Y nurse concerning a 22 year old female with no medical N history and allergy to10/4/2008 KEFLEX, who on 02-O n has been received for the Merck Pregnancy Y Registry for GARDASIL from a Registered Nurse U concerning 12/5/2008 a 14 year 12/5/2008 old female patient wh n has been received from a physician concerning an approximately 15 year old female who Y in November11/1/2008 2008, was11/1/2008 vaccinated with a dose n has been received from a physician concerning a 24 year old female who "more than a year N ago" was vaccinated11/1/2008 with GARDASIL, 0.5 m n has been received from a physician concerning a 15 year old female patient, who was vaccinated N with the first dose of GARDASIL, ### 0.5m n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL concerning a 23 U year old female 10/6/2007 patient who on 06-APR-200 n has been received from a physician Y concerning Y a 13 year old female patient who was vaccinated N with 11/6/2008 the third dose 11/6/2008 of GARDADIL vaccin n has been received from a healthcare Y worker concerning a 20 year old female patient with N no pertinent4/28/2008 medical history and with allergic re n has been received from a physician concerning a 20 year old female who on 12-DEC-2008 N was vaccinated with ### a second ###dose of GARD n has been received from a nurse practitioner Y concerning a 16 year old female with no medical N history of12/9/2008 allergies, who on### 09-DEC-2008 w n has been received from a nurse practitioner Y concerning a 21 year old female with a penicillin allergy and no medical ### history ### who on 14-O n has been received from a healthcare Y worker concerning an 18 year old female with no medical U history and allergies, ### who ### on 18-JUN-200 n has been received from a physician concerning a male patient who on approximately 03-DEC-2008 U was 12/3/2008 vaccinated 12/3/2008 with 1 dose of GARD n has been received from a 16 yearYold female patient with no drug reactions/allergies, who N on 09-DEC-2008 12/9/2008 was vaccinated ### with the first n has been received from a registered nurse concerning a 19 year old female patient with idiopathic Y thrombocytopenia 5/29/2008 and no drug reactio n has been received from a physician Y concerning a 20 year old female patient who on 17-JUN-2008 N was6/17/2008 vaccinated6/17/2008 with the first dose of G n has been received from a physician Y concerning a 16 year old female patient who on 14-AUG-2008 U was 8/14/2008 vaccinated with the first dose of G n has been received from a physician Y concerning an 18 year old female patient who on 6-DEC-2007 N was4/9/2008 vaccinated4/9/2008 with the first dose of G n has been received from an office manager at the physician's office, concerning a female patient, N who was 4/7/2008 vaccinated with ###first, second a n has been received from a medicalYassistant concerning a 23 year old female with no medical Y history, allergies 1/11/2007 or drug reactions who on 1 n has been received from a registered Y nurse concerning a 14 year old female patient with seasonal N allergy 9/17/2008 and no known pertinent medica n has been received from a nurse concerning Y a 129 year old female patient who was vaccinated Y with the first dose of GARDASIL vaccine ( n has been received from a physician Y concerning a 14 year old female patient with no known Y drug reactions or allergies, who in 2008, "a fe n has been received from a physician concerning an adolescent female patient who on an unspecified U date, was vaccinated with GARDAS n has been received from a physician concerning an adolescent female patient who on an unspecified U date, was vaccinated with GARDAS n has been received from a registered Y nurse concerning a 26 year old female who on 25-SEP-2008 Y was vaccinated9/28/2008 with a first dose of GA n has been received from a physician Y concerning a 21 year old female patient with no pertinent U medical history and no drug reactions/allerg n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a dose of GARDASIL, (site, route n has been received from a medicalYassistant concerning a 25 year old female patient who in N approximately 9/1/2008 September 9/1/2008 2008, was vaccina n has been received from a registered nurse concerning of her 22 year old daughter with noNknown allergies and ###a history### of contact derma n has been received from a registered Y nurse concerning a 12 year old female patient with noNknown allergies and ###sickle cell ###anemia who 10 n has been received from a registered nurse concerning her 23 year old daughter who "about U one month11/1/2008 ago" was 11/1/2008 vaccinated with the first n has been received from a physician Y concerning a 15 year old female patient with no pertinent Y medical 7/17/2008 history, no drug 9/5/2008 reactions/allergies n has been received from a nurse concerning a female patient who was vaccinated with a dose U of GARDASIL (lot # not provided). Subseq n has been received from a physician concerning a 25 year old female with no pertinent medical N history or allergies ### who on ### 21-NOV-2008 w n has been received from a licensed Y practical nurse concerning a 11 year old female patientNwith no drug/reactions ### allergies, ###who on 17-DE n has been received from a physician Y concerning a 14-15 year old female. On an unknown Ydate, the patient was vaccinated with her first d
n has been received from a physician Y concerning an 18 year old female who on 14-AUG-2008 N was vaccinated 8/14/2008 with a second dose of GAR n has been received from a physician Y concerning a 12 year old female patient with no pertinent N medical history### who11/1/2008 in the end of October 2 n has been received from a patient's mother concerning her 7 month old son who was vaccinated U with a dose of GARDASIL instead of the n has been received from a registered Y nurse and the patient's mother concerning a 14 year N old female patient 3/23/2007 with no 5/1/2007 allergies and no pert n has been received from a nurse practitioner Y concerning an 18 year old female patient whoNon 10-OCT-2008 ### was vaccinated ### with first dos n has been received from a nurse practitioner concerning a 22 year old female patient with hypothyroidism Y 10/7/2008 and no know 10/8/2008 allergies who on 0 n has been received from a medical assistant concerning a 19 year old female patient for the Y pregnancy12/8/2008 Registry for GARDASIL ### with no kn n has been received from a medicalYassistant concerning a 19 year old female patient with no N pertinent medical 8/13/2008 history and ### a history of an n has been received from a physician Y concerning a 23 year old female patient with depression, N who on an unspecified ### date, was vaccinate n has been received from a healthcare Y worker concerning that "many patients complained ofUburning at the injection site whey ### they get a d n has been received from a nurse practitioner Y concerning a 16 year old female with asthma Y and no allergies who ###was vaccinated ### with the t n has been received from a physician concerning a patient who was vaccinated with GARDASIL U (dose, site and route not reported) on uns n has been received from a registered nurse concerning a 24 year old female patient with noUknown drug reactions/allergies ### ###or medical his n has been received from a registered Y nurse concerning a 13 year old female patient with noNprevious medical 11/8/2007 history reported who in 2007 n has been received from a physician Y for GARDASIL vaccine, concerning an 18 year old female U patient 11/5/2008 with no previous medical history re n has been received from a medical assistant concerning a 20 year old female patient with no Y pertinent medical 8/4/2008 history, 8/4/2008 no drug reactions/a n has been received from a healthcare Y worker concerning a 25 year old female patient who N received second dose ### of GARDASIL and was f n has been received from a medical assistant concerning a patient who may had received aUpartial dose of GARDASIL. The patient did not n has been received from a nurse practitioner Y concerning a 14 year old female who on 30-DEC-2008 Y was vaccinated ### with### the first dose of n has been received from a nurse concerning Y a 19 year old female with asthma, hirsutism and N polycystic ovarian ###syndrome ### and no known follow-up information has been received from a registered nurse and pediatrician concerningUa 7 month 12/9/2008 old male who 12/3/2008 on 09-DEC-2008 wa n has been received from a registered nurse concerning a 30 days old patient who on 04-NOV-2008, U was vaccinated ### with### a dose of rotavir n has been received from a registered nurse concerning a patient "greater than 32 weeks ofUage", who on an unknown date was vaccinate n has been received from a physician Y concerning a 9 month old male patient with a history of N birth weight 10/2/2008 low, who on 28-JUL-2008, ### was v n has been received from a registered nurse concerning a 4 month old patient, who on 16-OCT-2008, U was vaccinated ### with### the first dose of n has been received from a physician concerning a 13 month old female who on 02-DEC-2008 U was vaccinated 12/2/2008 with12/2/2008 ROTATEQ vaccine. co n has been received from a registered nurse concerning a 2 month old male patient with no U illness at time of vaccination ### who ### on 11-DEC-2 n has been received from a physician Y concerning an 8 week old patient who was vaccinatedYwith the first dose of ROTATEQ vaccine 2ml o n has been received from a MedicalYAssistant concerning a 16 week old female patient whoNon 21-NOV-2008 12/5/2008 was vaccinated 12/5/2008 with first dos n has been received from a physician concerning a patient who was vaccinated with ROTATEQ U vaccine, oral, (lot # not provided). The pati n has been received from a physician concerning a female who on 05-DEC-2008 was vaccinated U with her 12/5/2008 first dose12/5/2008 of ROTATEQ (lot# not n has been received from a physician concerning an "about 9 weeks old" female who in October Y 2008, was 10/1/2008 vaccinated 10/1/2008 orally with a 2 ml do medical records were received an reviewed concerning an 4 month old male baby patient with U a history of 8/28/2008 mild respiratory 9/1/2008 distress syndrom welling and pain. Took Cephalexin 500Mg Y 4x/day for 10days. Patient c/o pain periodically. Y 1/2/2009 1/4/2009 ouple hours of receiving the Tdap booster Y (following a routine physical in which my daughterUreceived an1/13/2009 excellent bill 1/13/2009 of health), she devel recieved comvax. Nurse was instructed to go give 1st hep b but instead gave comvax. No known U symptoms. 9/17/2008 mom never called stating her reaction because patient never returned or called stating she had a reaction to the immunization U that was given ### to her. She recieved a Dta m symptoms. She never called to say she is having a reaction to the immunization that was given. U Dr ordered to### give a Tdap but the nurse g fter infant was given Tdap instead of Dtap he was irritable. Y 1/16/2009 1/17/2009 IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ### COMPLETING REPORT. IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ### CMOMPLETING REPORT HPV vaccine on January 15. Aunt called on Jan. 16 and reported that her niece had swelling Y and redness 1/15/2009 from site of injection to her elbo ately 1100 1-20-08 given smallpox immunization w/o authorization by provider and with dx ofNeczema. 1/20/2009 plaining of post smallpox reaction 18 Apr 2008 (8 months) Pimple and nodule formation 2 wks U ago 7 Jan4/18/2008 09 around site 1/7/2009 of skin on abdomen and legs. Draining blister lesions on left side of back at beltline and LeftUleg blister lesions. 1/6/2009 From1/8/2009 Shingles vaccine by M arms were sore. 17 Jan 09 felt conjested. Y 18 Jan 09 more conjested 19 Jan 09 felt conjested and run down. 1/16/2009 20 Jan 1/19/2009 had conjestion fever w CAME IN OFFICE ON 1-7-09 WITHYCHICKENPOX Y ### 1/5/2009 veloped herpes zoster on 12.26.08. Patient presented with grouped blisters on the right posterior Y neck, right 7/1/2008 upper chest ### and right upper b ctions on upper Lt. arm, red area, hot to touch, with some swelling in the area noted. 1/9/2009 1/13/2009 ived the Flu vaccine between 9am & 10:30AM left the building with her mother and in the parking Y lot c/o1/20/2009 being itchy1/20/2009 and scratchy all over in D VARICELLA VACCINE ( SECOND DOSE) LOWER PART OF LEFT UPPER ARM 1/19/09. Y SEEN 1/21/09 1/19/2009 WITH 1/21/2009 9CM BY 7 CM AREA O
of 104.8, B/P 168/80, ache all over-lasted Y for 24 hrs. Y 1/13/2009 1/13/2009 FLUMIST GIVEN TO CHILD DURING WELL CHILD EXAM. NO REPORTED ADVERSE EVENTS U TO DATE ### OF COMPLETING VAERS. ned today 01/21/2009 @9:24am with c/o pt. was very tired last evening. She did well through the night. Mom 1/20/2009 states 1/21/2009 that today patient would ately 12 hours after vaccination; an onset of myoclonus Y seizures began. 3 During the first hour, N as many as 16. ### This continued ### from 10/15/0 ficulty breathing, lips swelling, red face. About 10 minutes after vaccines were give dad noticed Y above symptoms 1/21/2009patient 1/21/2009 was still in clinic. D e, Nausea, Vomiting, Diarrhea, Severe Y stomach ache, Chills, Body Aches. I was unable to perform Y usual 9/12/2008 activities and 9/13/2008 required medical atte weakness, fatigue, dizziness, severeYmood changes, anxiety, low grade fever, severe headaches, U chills 1/30/09 1/20/2009 Received 1/21/2009 PCP medical rec after shot. 6 hrs later site of injection was very painful. Next day it was so painful she could Y not get dressed, 1/19/2009 could not 1/19/2009 go to work. Not swo veloped large area of erythema and induration at 48 hrs, s/p booster dose of varivax (given U on 1-19-09).1/19/2009 Area measured 1/21/2009 7 cm x 4 cm and p orts noticing itching and soreness @Y right arm injection site and a "quarter-sized" area that felt Y hard and was 1/7/2009 yellowish 1/8/2009 in color @ 5PM on 1 ut immediately after HPV shot. Had stinging on right side above pelvic bone for a couple of days Y after. Had 1/5/2009 full body1/5/2009 muscle soreness for a 8/31/2007 N 1/3/2007 8/31/2007 seizures (repetitive head turning andYpossible salaam seizure) occuring Jan 14, 2009 over a Y 10-15 minute1/9/2009 time span.1/14/2009 No fever at that time, n, swelling, redness to right deltoid. No exudate. Dx: cellulitis Y 1/19/2009 1/20/2009 eloped; Right arm red, swollen, hot from upper deltoid to mid humerus- started KEFLUX & ROCEPLIN Y 2gm 1/7/2009 1mx 3 days 1/8/2009 -> improvement is ceived vaccine (Anthrax) in L arm. No pain or erythema. Pt woke up Jan 18 with inability toUleft arm and1/16/2009 paresthesia 1/18/2009 over the lateral aspec ported a lot of pain in left arm and couldn't even sleep on it. The next morning he thought heYwas blacking 1/20/2009 out. Left message 1/20/2009on patient's an ew hours of shots pt developed low grade fever. Subsequently the next day got profuse watery Y diarrhea1/16/2009 (only 1 episode 1/16/2009 of blood in stool). arm 6 inch by 9 inch erythemous plaque, firm,warm to touch with discrete? clusters of vesicles U in center1/19/2009 medial, lateral 1/20/2009 area of left deltoid a got swollen or red. Just very painful. Continues to throb, hurts to raise arm up above head after U few seconds gets ### a shooting ### pain from the iatric dose of HEP A was supposed to give adult dose. U 1/7/2009 ived PENTACEL, HEP B, PREVNAR, ROTAVIRUS & flu vaccines, instead of PEDIARIX, HIB, Y PREVNAR, 1/21/2009 ROTAVIRUS 1/21/2009 & flu vaccines. No d red rash around injection site on thigh within hours of vaccines (8 cm X 8 cm in doctors office) U man reported 1/21/2009 prior to 1/21/2009 arriving @ doctors of tly warm to touch, swelling right upper Y arm approx 8in x5in. Patient applied "anti-itch" cream.U 1/19/2009 1/20/2009 n has been received from a registered Y nurse concerning a 22 year old female with penicillin Y and amoxicillin 6/19/2008 allergy who 6/19/2008 on 19-JUN-2008 wa n has been received from a nurse practitioner Y and a certified nurse midwife, for the pregnancy Y registry for 2/15/2008 GARDASIL, 3/3/2008 concerning a 21 yea n has been received from a physician Y concerning a 11 year old female with no pertinent Y medical N history 9/12/2008 who on 12-SEP-2008 ### was vaccina n has been received from a physician concerning a 9 weeks old male who on 10-NOV-2008Ywas vaccinated oral ###with the ### first dose of ROT n has been received from a consumer concerning his daughter, a 6 year old female with no N medical history 7/1/2004 who "at 18 months of age" was n has been received from a consumer concerning her 20 month old son who was vaccinatedUwith MMR II. Secondary suspected vaccine in veloped erythematous papules on his low back (#12) and his face (#3) following the administration Y of VARICELLA 1/12/2009 vaccine 1/17/2009 s were swelling. Patient was going to call primary doctor. Patient called me on Sunday 1/18/2009 U in the afternoon. 1/14/2009 Patient 1/18/2009 did receive other ized erythema around injection siteYslightly warm no discharge. Y 1/7/2009 1/11/2009 and pruritis on forehead & neck some blistering Y 1/7/2009 1/15/2009 n has been received from a 61 yearYold femaleYpatient with no pertinent 4 Y medical history and Nno known drug 12/9/2008 allergies12/9/2008 who on 09-DEC-2008 ain. 2. Some time weaken of lower limbs. 3. Some time numbness of lower limbs. 4. Shoulder U pain once 6/23/2008 in a while. 7/23/2008 5. Body ache- 3 w d vaccination- shortly after the site Y became red and inflamed. The size increased following Y day and became 1/16/2009 warm 1/16/2009 to touch. Size approx 4 oy (WM) seen 1/9/2009 for 1 yr old health Y steps exam. Mild rhinorrhea reported and nose congested. Y Exam 1/19/2009 otherwise 1/19/2009 normal. Afebrile. 1x 1 reaction to VARIVAX given SC to Left upper arm 12/15/08- 2x3 cm area arm sl, red, sl warmYand swollen. Treatment: ### warm ###compress, OTC ceived 2nd dose of Rotateq on 10/27/08. Pt has diarrhea x 10 days, watery stool 3-4x/days. ### ### ea erythema, warm, tender, slightly hard, Left deltoid. 2 days s/p immunization with DTap, fluYIM and polio 12/3/2008 SC in left 12/4/2008 arm. n has been received from a pharmacy technician concerning a patient who on 14-JAN-2009 Y Nwas vaccinated 1/14/2009 with a 1/14/2009 dose of ZOSTAVAX (O n has been received from a physician Y concerning a 76 year old female patient who Y on 05-JAN-2009 N was 1/5/2009 vaccinated 1/9/2009 with ZOSTAVAX (Oka arm & shoulder; edema & warm with pain 6/10 with movement; itching; T 98.8 degree; tiredness; tender on palpation to underarm; motion on small pox, left shoulder, excess redness est. 70 x 55mm; gauze dressing placed recommend U air dry 30min 1/5/2009 at hs; 1/14/2009 TYLENOL. Seen 16 JA ng pain in upper arm, and shoulderYleft side. Onset 1 week after Tdap. Pain duration approx.Y 3 mo. Weakness 7/17/2008 of arm 7/24/2008 occurred approx. 2 w n has been received from a 26 year old female who on 13-DEC-2008 was vaccinated with aUdose of VARIVAX### (Oka/Merck). ###The reporter s econds: tingling & numbness down arm to fingers. Then, blurred vision, dilated pupils, wain Y skin, light headedness, shallowed breathing. A subject was enrolled in the study 110870 Y (MenACWY-TT-057). Y On 027 August 2008, 22 October N 2008 and 23 December ### 2008, ### he received gree rash on left arm surrounding smallpox vaccination site. Started 2 days ago 14 JAN 09, spread U to axilla 1/5/2009 area, swelling 1/14/2009 in axilla area, ten 03.5, lethargy with crying off and on. Y Tx - IV fluids Y and fever control1with TYLENOL, MOTRIN. Y 1/29//09-records 1/19/2009 received 1/20/2009 for DOS 1/20/09-p
as admitted to medical center. Y Abdominal Y CT was Y performed. Patient 2 diagnosed with intussusception. Y 1/29/09-records ### 1/11/2009 received for DOS 1 and 12/18 4-5 episodes where lips turned blueYand eyes seemed unfocused; 4 lasted 5-10 sec. U on 12/19 11:30 am ###turned blue, ### stopped brea ort received on 12 March 2008 from the patient's parent. A 17-year-old male patient, with no illness at the 3/10/2008 time of vaccination, 3/11/2008 had received n has been received from a representative Y as reported by a colleague concerning a 13 yearUold female who on an unspecified date was va n has been received from a physician concerning a 14 year old female who was vaccinated U with her first 0.5 7/1/2008 ml dose7/1/2008 of GARDASIL toward n has been received from Y a nurse practitioner concerning a 22 year old female who on 14-JAN-2009 N was 1/14/2009 vaccinated 1/14/2009 with a first and only d n has been received from a physician Y concerning a 19 year old female who in approximatelyU2009 was vaccinated with a 0.5 ml second do n has been received from a physician Y concerning a 70 year old male with hypertension Y who Non 05-JAN-2009 1/5/2009 was vaccinated 1/7/2009 with a dose o n has been received from a healthcare worker concerning a 34 year old female who on 02-MAY-2008 Y was 5/2/2008 vaccinated 5/2/2008 with the first dose of onset juvenile diabetes.YVaccine given Y 8/8/08 Ypt developed symptoms 4 consistent with diabetes N over the 8/8/2008 next few months. 12/2/2008 Presented with r Gardasil, pt developed fever, malaise, confusion. Y Admitted to hospital 4 and Dx'd with ADEMNvs. cerebral9/19/2008 vasculitis.9/25/2008 Has made nearly full r 2009 APPROXIMATELY @ 9:20 PM PATIENT RECEIVED A SHOT OF GARDASIL 0.5 ML IM. Y PATIENT 1/21/2009 WAS ADVISED 1/21/2009 TO STAY FOR 2 Y AFTER INJECTION, 2 SMALL RED/ RUFF DRY PATCH SHOWED UP ON HIS STOMACH, Y COUPLE1/15/2009 DAYS LATER 1/16/2009 ONE SHOWED UP se event, just diagnosed with Rotavirus Y after 3 doses Y of Rotateq...Vomiting 3 and diarrhea, stool Y positive for 5/16/2007 Rotavirus.1/27/09-records 1/15/2009 receive ite swelled about the size of an eggYwith redness x approximately 3 days. She developed itching Y all over her body ### day 2 after ### shot that las scribed area around vaccine as red,Y warm, and swollen on 1/21/09. I instructed her to see the physician1/19/2009 as soon as1/20/2009 possible. I followed u as vaccinated on 01/08/2009 with Zostavax Y (LOT 1553X) in the right tricep. On 01/14/09, theNpatient received 1/8/2009 a follow-up 1/16/2009 phone call and re hots (HepB, Rotavirus, Pneumococcal, Polio, Hib, Y DTaP) were given2 on 1/15/2009. On the morning N of 1/17/2009 1/15/2009(approximately 1/17/2009 9:30 AM), d pain in my Deltoid area the entire muscle since 11/05/09. I have had itching in that area asUwell as in the 11/5/2008 back of the 11/5/2008 shoulder.I have pain 2009, pt was administered the Influenza vaccine, Flulaval, instead of Afluria (approved for the U pregnant populaton). 1/15/2009 hts after the inject I was very uncomfortable Y and wakeful. The third day, I began noticing a soreness U in my left breast ### which### during the next nted miniutes after the injection was given. Pt came to and we monitored pt and rechecked blood Y pressure 1/22/2009 and heart 1/22/2009 rate. Patient stayed a ing/erythema at injection site U 12/1/2008 12/2/2008 hot flushing, sweating, blurry vision 5 minutes after vaccination. Pt did not pass out but did Y fall to ground. 1/22/2009 Pt felt better 1/22/2009 immediately upon b e event at this date and time. patients parent notified 1/22/2009 ately 10 minutes after receiving immunizations Y (listed below) the patient C/O difficulty breathing. Y Upon examination 1/16/2009 1/16/2009 patient was anxious an ella disease, less than 50 pox, with fever, Y diagnosed 01/22/09, started 01/20/09 by mother's U history. PO 1/12/2009 Benadryl prn 1/20/2009 itching nt became lightheaded then fainted several minutes after receiving immunizations. LOC approx Y 1 min. and color ### pale. Remained ### nauseous lling, erythema, warmth and tenderness. 1/20/2009 1/21/2009 ek following the vaccination, patient states he felt very tired. In the second week, he had a sore Y throat. In 11/5/2008 the third week 11/7/2008 he had a cough, n hrs after vaccines, mild dizziness, weakness, Y fever, pain @ injection site no treatment 1/15/2009 1/16/2009 iven 6 days ago Pt noticed soreness in shoulder to elbow area. Then spread to Flexor portion U of Forearm 1/15/2009 only describes as "Arthritic. like p 02, maculopapular rash on trunk, cranky. Y 1/8/2009 1/19/2009 mal, supple, no lymphadenopathy, no meningeal signs. Respiratory exam: normal, no intercostal Y retractions, 1/19/2009 movements 1/20/2009 symmetrical, no w eaking out 1/19. Itches - rash. No known exposure. No fever. DX: Varicella Y ### 1/19/2009 arm - hot and swollen, redness to injection site. Y 1/13/2009 1/15/2009 ceived VARIVAX (chicken pox) vaccine on 1/8/09 and came in 1/21/09 complaining of a rash. Y Dr diagnosed 1/8/2009 the rash1/21/2009 as chicken pox caused vaccine 1-16-09 - On 1-21-09 came to office c/o mild fever for 1 day- Friday not feeling well Y post injection1/16/2009 falling a lot1/16/2009 Generalized rash- d ceived ZOSTAVAX shot on 01/09/2009. Five days later, on January 14, 2009 she has noticed U a spreading 1/9/2009 rash at the 1/9/2009 sight of injection. Sh ped fever to 102 degree a chickenpox Y like rash Y 1/7/2009 1/15/2009 hing at site & next day arm red, swollen. Reactions in arm VARIVAX given. U 1/14/2009 1/15/2009 of 101-102 X 24 hours - se & eating otherwise Review of sy-neg. Y 1/20/2009 1/21/2009 in the hours after vaccine. Mother reports patient has typical reaction similar to other vaccination Y in past. 1/12/2009 arm feel affected. Cannot lift arm without pain. Pain goes up to neck. I waited to send this in N to see if pain10/6/2008 subsided.10/7/2008 It did not. I cannot lift m oblems with AVA #1 and # 2. He reported Y that 2 days following vaccination with AVA # 3 heYhad mild joint pain### that12/6/2008 persisted for one day. night that vaccines given. VaccinesYgiven 1-17-09 @ 3 hours am (approx. Seen at ED 1-12-09 Y @ 11pm1/12/2009 with 105 fever. 1/12/2009 n both wrist, itching on palms of hands and soles of feet. Welts on hip bones and on one breast. 1/5/2009 1/7/2009 a of erytheima & edema & pain (10 cm diameter) ice, BENADRYL, TYLENOL/ALLEVE for pain Y 1/21/2009 1/21/2009 (HEP A) vaccine/left office - went to wait for bus/reported by doctor that child suddenly turned Y pale (lasted 1/15/2009 few sec)1/15/2009 taken back to office/ch minutes of vaccination c/o not feelingYwell pallor observed, full body seizure with unresponsiveness Y to shake 1/8/2009 and shout. 1/8/2009 positive pulse but co fussiness X 24 hrs, vomiting, resolved Y after 24 hours. Y 1/14/2009 1/14/2009
ped temp to 106 degrees about 4 hrs Y after vaccines. Y 1/12/2009 1/12/2009 st ava #1 broke out in a rash in his axilliae. Y No itching, or pain. Photo's-confluent maculo-papular N light pink 11/8/2008 rash, with few### descrete distal le mplains of pain in left deltoid of site of influenza injection Y Y Y 1/16/2009 1/16/2009 fect, patient was fine. Y 12/3/2008 ule. 7 cm erythema + induration. R deltoid. Y 1/15/2009 1/16/2009 iving 3 shots, client became pale & "passed out in chair approx. 5 seconds. Assisted to floorYby nurse + 1/13/2009 father. Had1/13/2009 not eaten yet that day Y 1/9/2009 1/12/2009 10/31/08 said had blurring vision, earache, itching, & hives. in our conversation pt stated had. Y hives, & itching previous ### to ### shot. I attribute " 6 Patient noticed pain in her left arm/ shoulder that has not resolved since injection. on 1/21/09 N she saw Dr who ###has noticed ###inflammation n has been received from a physician Y concerning Y a 13 year old female 12 who was vaccinated N with the first dose ### of GARDASIL, 0.5ml. Subse n has been received from a physician Y concerning a 17 year old female with no drug Y allergiesYwho had recent 1/12/2009 urinary1/12/2009 tract infection and com n has been received from a physician Y concerning Y a 15 year old female 0 Y patient who Y on 15-DEC-2007 N was6/9/2008 vaccinated6/9/2008 with the first dose of G n has been received from a healthcare Y worker Y concerning a 9 week0old female with a historyNof "reflux" who 1/8/2009 on 08-JAN-2009 1/8/2009 was vaccinate n has been received from a physician and a nurse concerning a 10 weeks old female patientUwith a possible 1/8/2009 "reflux 1/11/2009 issue" prior to oral vacc n has been received from a 27 yearYold femaleYpatient with no known 0 allergies and no pertinent N medical history, who was vaccinated with t d angio edema of face, large wheal Y @ inj site of MMR @ 10 minutes. Uricaria over truck & limbs Y by 20 minutes### & some drooling ### -> im epin occurred evening of vaccination of left arm. Patient states it resolved in 2-3 days". Y 10/1/2008 ke up following morning with right ankle swollen so much he could hardly walk. Used heat, TYLENOL, U MOTRIN### with relief.### No recent injury of day HEB B# 3 received Pt developed hives on arms/face/stomach. No resp distress. Pt takes U allergy shots ### weekly. Pt has ### taken Benadr HBV #1 patient experienced a migraine Y HIA stabbing pain radiating from back of head through Y to the front. With ### chest pains ###and SOB ccurred on 7/16/08 and again 8/21/08 with 2 different nurses as vaccinations. 11/24/2008 - Y client reports8/31/2008 with 1st injection 8/31/2008 on left arm 4-5 h TDAP on 11/24/08 for travel to Brazil. Y Returned to clinic on 11/28/08 for an arthur-type reaction U left deltoid, 10### x 10 cm, warm ### tissue than s had significant vomiting day after HPV with all three administrations. 3/23/09 Received PCPY medical records 9/19/2007 of 9/19/079/20/2007 FINAL DX: viral g X 4" circular swelling red, no Cellulitis, Y past 2 days vaccine's. applied ice pack which minimized Y swelling. 1/5/2009 1/7/2009 s after TdAP in left deltoid, pt. developed swelling at site, fever, chills and lymph node enlargement, Y supraclavicular 1/16/2009 1/16/2009 area. Now is resolved. tions given (Hib in upper RVL, Prevnar in lower RVL) Injection sights were cleansed with alcohol Y and aspiration 1/8/2009 done1/8/2009 prior to injection of va iving immunizations the patient ate lunch and took a 1/2 hour nap. Awoke suddenly screaming Y terriby-lasted 1/13/2009 15 minutes, 1/13/2009 calmed down even day after MMR. Parent consulted primary Y care provider at pediatric clinic and was advised toUuse Benadryl. 1/20/2009 Presented 1/21/2009 to our facility on day iven in error. PCP ordered a Varicella vaccination and I administered a Zoster Vax. Error identified Y on 1/22/2009. 7/28/2008 7/30/2008 Patient returned for PPD RSE REACTIONS NOTED Y 1/23/2009 very pale, fainted getting out of theYbath father caught patient before he hit the floor. U 1/22/2009 1/23/2009 s of hand and legs, cough, dizziness, Y nausea, malaise, muscular pain, gastrointestinal disturbance, Y face an throat ### rash. ### ent came into the Immunizations clinic Y on the 12Jan09 to receive the MMR, Varicella, IPV, DTAP, N and the 1/12/2009 HEP A vaccine, 1/13/2009 waited 15 minute n itching sensation in the back of the right arm. PT was rubbing the site and noticed a red rash Y like reaction 1/23/2009 going from 1/23/2009 the shot site which w wollen and warm to touch, pink upper left arm. Benadryl Y ed rash noticed approximately 8 hours after receiving vaccine.lotion applied to rash at time noticed. U called1/22/2009 OMS on 1/23/09 1/22/2009 to report rash an 9 at the time of immunization, baby Ywas seen and diagnosed with URI/(L)otitis media. Afebrile. Y During night 1/21/2009 of 1/22 1/23/2009 developed fever of 102 over night (Dec 16th 2008), Y my baby Y wake up, Yfussy, did not wanna5eat, start vomiting yelowY liquid, got pale, went ### to doc.### and told us it cou ely following venipuncture pt said it hurt. Pt supported and encouraged to provide post-injection N pain relief methods. ### She said ###it still hurt whe MCV4, Hep.A, Varicella on 01/20/2009. On 01/21/2009 her lower L. arm (just above the elbow) Y became1/20/2009 swollen, red, 1/21/2009 very sore and warm e body and neck, has been running fever (around 100.5F) for 3 days already. U 1/13/2009 1/21/2009 arrhea, dehydration, 1 week Y following Y 2 month Y immunizations: DTAP, 30 YHIB, PCV7,YROTATEQ. Y (+) intracerebral 10/7/2008 bleeding with ###stroke and sei ved her immunizations on 1/16 and developed urticarial rash 1/21. Patient had 0 previous hxUof reactions1/16/2009 to vaccinations 1/21/2009 and had 0 previou ematous left upper arm, slightly warm and tender. 2 days s/p DTap, flu IM injection Left deltoid Y and Polio 12/3/2008 SC. after influenza and HAVRIX were given Y in the left thigh, patient developed a warm, red, firm, Ytender area surrounding 1/8/2009 1/9/2009 this site. It was measu both MENACTRA and BOOSTRIX 1/23/2009 Y in left deltoid approx 1 cm apart. Area becameYred, hot and 1/22/2009 indurated1/23/2009 after next day. No SOB oke out with a couple of red spots on back. Vaccine given on 1/16/09. Pt saw Dr on 01/17/09. Was diagnosed 1/6/2009 with1/17/2009 shingles. Treated wit opped by the clinic and stated since this flu shot on 11/24/08- He has had left sided neck pain U and left arm soreness. ### He denied any chest p erythema multiform. Y 1/22/2008 1/28/2008
hrs after giving immunization another noted maculo-papular rash all over the body. Follow up check up rash 1/21/2009 all over1/21/2009 the body. Given Bena .3 Febrile seizure X 5 min Y Y 1/21/2009 1/22/2009 orts shortly after the shot, it is hard to Y pinpoint when it started a knot came up on (L) arm where N the injection 10/2/2008 went in and had some swelling ks like measles. No fever kopeck spots. Y 1/12/2009 1/22/2009 GARDASIL shot series. It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008 a change in my v ort received from the patient's parentYon 12 November 2008. A 39-year-old male patient complained of weakness, ### loss of ### appetite, night sw ort was received 08 May/2008 from a Y health care professional. A five-year-old female patientUwith no known 5/2/2008 allergies, had received a subcu ort received on 02 September 2008 from a healthcare professional. A 68 year old male patient Y developed8/26/2008 wheezing8/29/2008 72 hours after had rece -old female patient experienced bilateral axillary rash and bilateral ear redness and itching within Y hours after 11/5/2008 receipt11/5/2008 of an intramuscular left ort was received from a health care provider on 09 January 2008. A 55-year-old male patientYwith no pre-existing ###medical ### history, had rece d rash within 24 hours of administration of her 2 month shots. Diagnosed by the pediatrician N as eczema. 12/6/2000 12/7/2000 ated pain began 4 hours after the immunization Y was administered on October 6, 2008, and has U never been 10/6/2008 the same 10/6/2008 since. She went to he ours, after the vaccines, Ymy daughter Y started making moving in a weird way I had never seen U before. I put 1/16/2009 her in her 1/16/2009 crib because she I tho o navy recruit that present after yellow Y fever vaccine. Y Pt noted sweating, 1 palpatations, weakness, Y dyspnea, 1/8/2009 and hives1/8/2009 immediately after yel lled to report reddened area on date of injection at injection site. Increased redness and lump Y at injection 1/8/2009 site noticed1/8/2009 on second day follow on thorax. Lasted for 5 days. No treatment necessary. Y 1/9/2009 1/20/2009 itis of arm. 3/3/09 MR received fromYreporter including vax rec (no lot #s). Pt presented 1/26/09 U with c/o increasing 1/15/2009 redness 1/24/2009 around SP vacc rmation received on 21 January 2009 Y from a health care professional. A 27 year old female patient N with a1/19/2009 history of 1/20/2009 tonsillectomy received A hronic resp. congestion, myalgia, skin lesions acute to chronic, headaches to migraine, Y neuropathy N pain, 2/6/2002 diarrhea, brown 2/6/2002 urine, chronic fati esday had sore throat, runny nose and developed into cough. fever of 100 degrees taking aspirin U helped. 1/21/2009 Today feeling 1/22/2009 the worst. history of shingles, but in the days following vaccination - vaccination on 12/20/08 - he developed pain on the back ### or his ### scalp in the right the vaccine ZOSTAVAX. I had all the side effects listed, except I had an outbreak on my arms like chickenpox. Was1/15/2009 this normal U 1/8/2009 pprox 16 hour after immunization. Fever increase recent. Y 1/15/2009 1/16/2009 ng in office for 15 minutes after receiving GARDASIL vaccine. Patient complain of left knee feeling Y hot, painful. 1/23/2009 I assessed 1/23/2009 left knee, knee w nt soreness let deltoid subsequent to vaccine. N s after I received the ZOSTAVAX injection , I broke out with a rash on my right arm. It was 2-3 Y cm wide, consisted ### of pruritic ###small red papu after injection developed red hard area Y no painful quarter size. Resolved without sequelae.U ### ### attached. Called patient 1/23/09 return Y call from patient. Swelling decreased still sore and itchy, U still taking 1/19/2009 BENADRYL 1/20/2009 and antibiotic. had an immediate reaction at the MMR injection site. With moderate erythema, warmth, in duration Y patient 1/6/2009 was stable 1/6/2009 and activity unchang jection site- plus erythema approx 2 cm with hard papula pustule next to each other. U 1/6/2009 1/20/2009 d hives 12 hrs after receiving vaccine. Y 1/21/2009 1/22/2009 eft thigh with redness around site ofYinjection. Rx BENADRYL swap 2 tsp q 6 hrs. PRN. Y 1/20/2009 1/23/2009 n has been received from a nurse and Y her 79 year old mother (the patient) who had Y a historyNof shingles on July ### 2008 with### the rash localize n has been received from a registered Y nurse and Y physician concerning 0 a 54 year old patientUwho on 14-JAN-2009 1/14/2009 was 1/16/2009 vaccinated with a in Health Department this am stating she had a reaction from her Pneumonia vaccine. Pt stated U that she has 1/23/2009 a "itchy, 1/23/2009 prickly" rash to both arm shots given,alert and oriented x 3 2:18pm - c/o "ears numb I can't hear", swaying in chair,alert Y x 1(person 1/23/2009 only), blowby 1/23/2009 oxygen given @10 ed, hot and swollen Pt. to take Advil and benadryl Y 1/20/2009 1/21/2009 vaccine at 9:30 am, stated feeling chilled approx 2.5 hours later. Then started to have dry cough and expiratory 1/23/2009 wheezes 1/23/2009 at night starting la ut with seizure like behavior. Y 1/26/2009 1/26/2009 of arm and itching one day after vaccine admin d his 1 yr well-baby check-up on Friday, Y January Y 16, 2009 and everything 1 checked out perfectly Y for him.1/16/2009 He was given 1/20/2009 his vaccinations of Developed severe case of Y pneumonia Y with fever - no cough or cold prior. Was sent to hospital N for chest 1/23/2007 x-ray. Was7/16/2007 given inhalation therap 9 pt received a Tdap inj booster in LYdeltoid in belly of the muscle. Several hours later she developed Y swelling 1/12/2009 and pain 1/12/2009 in the deltoid. No di eived Engerix B vaccine on 1/13/09. On 1/26/09, client reports symptoms of sweating, itchingYon upper extremities, 1/13/2009 pain 1/15/2009 in knees,and fatigu e fol shot. Woke up the next morning, couldn't move arm, "hives" at site, red, warm, swollen,Yvery painful,1/21/2009 pain at joint. 1/22/2009 Was instructed to co SED WITH SHINGLES 01/26/2009 PATIENT HAS ONLY RECEIVED ONE DOSE OF VARIVAX LISTED9/11/2000 ABOVE 1/26/2009 ed and diagnosed with Guillian-Barre Syndrome. Y Weakness in upper 16 extremities. 2/10/09 Received hospital medical ### 1/20/2009 records of 1/20-1/30/2 s started two days after recieving the Y vaccine. Experienced muscle pain, spasm,Yand weakness. N Have seen multiple ### doctors ### for treatment ports high fever (104.7, severe diarrhea, Y and shortness of breathe four hours after vaccines.YWas seen in local### ER was observed ### and given s after the vaccine the patient develop severe migraine headaches, accompanied by nausea. Y She was medicated 1/24/2009 with 1/24/2009 pain medication bef
lled to report swelling of right arm thirty six hours post injection. Patient stated hurt in muscleYand "itched like 1/8/2009 crazy".1/10/2009 She also reported vag ceived the Varivax on Saturday 1/24/2008. The following day she noticed the area was red and hard and1/24/2008 itchy. It continues 1/25/2008 today, she has iving vaccination at 11am on 1/21/09, pt went out to lunch and had a hamburger and a beer.YAround 1pm, 1/21/2009 developed 1/21/2009 Headache, nausea, a alling to report possible reaction to vaccines. Traveling abroad, yellow fever area. On 1/16 received U 5 vaccines. 1/16/2009 Tdap, 1/22/2009 Flu, HepA, HepB an after being vaccinated pt. began having Y SOB and Y then palpitations 5 with heart racing. Pt. taken Y to ER and1/7/2009 admitted with 1/7/2009 tachycardia and BB with erythema and edema. Mom brought baby in. Advised to ice x20' q hr. Motrin 5mg prn. Y 1/5/2009 1/5/2009 swelling, warmth to site fever (100.2), chills, fatigue, achy. Y 11/5/2007 11/6/2007 ately 24 hrs after injection, a hard reddish lump formed at injection site. it was painful to touch Y and very hot. ### ### hot. Red, sore. Bump 3 to 4 inch in diameter-lasting about 2wks and still have a bump aboutUdime size. NO pain ### , no redness. Hep B shot, warm, painful area 2"x4" around injection area. Y ot given-is red and warm to the touch and a little sore. Y 11/5/2007 11/6/2007 headache with fatigue approximately 16 hours after flu shot. Duration was approx. 24 hrs. I rarely Y have a headache. ### ### ng, hives, feverish. N 12/2/2008 12/4/2008 d. got shot. Thursday the 11th small nickel size red area and hard, warm to touch knot. VeryNsore to touch. Friday ###morning### golf ball size kno und, fever, swollen area, tender to touch right upper arm 24 hrs after shot given. Noted givenUposterior mid upper ###arm not deltoid. (severe vertigo) vomiting, nausea. Y Y ### ### nset right flank rash-itchy vesicular anterior and posterior. U 1/24/2009 1/24/2009 ythematous maculopapular on both cheeks and all over trunk and extremities. Swollen-nontender Y (R) thigh. 1/9/2009 1/20/2009 rned to clinic 2d after vaccination & Y voiced pt had been to ER for febrile seizure post vaccination. Y 1/26/2009 er back - few small red raised bumps. Left front chest 1 small / pinpoint raised red bump. Mom Y gave Benadryl P.O. ### after onset ### of symptoms d ADACEL RA upper deltoid, PNEUMOVAX RA lower deltoid. On 11/4/08 since vaccinations Y febrile, chilling. 11/4/2008 Has not 11/5/2008 felt well since. Nega eft shoulder, et with deep breath -dizziness assisted to lie down-ice bag applied to shoulder-skin Y w/d, BP11/7/2008 100/60 P-72 11/7/2008 regular. Encouraged e, chills, fatigue, fever (highest 103.2 F). These symptoms lasted 4-5 days. Still had headache Y 8/18/08. 8/12/2008 8/13/2008 with erythema, warmth + swelling - vaccines given 8-6-08, signs and symptoms started 8-7-08. Y Motrin, Benadryl 8/6/2008 icepacks. 8/7/2008 mediately began to feel tired. He also developed a headache and a low-grade fever (99.0F) Ywithin 2 hours 8/12/2008 of receiving 8/12/2008 immunization. Patie e, fever 101.0F, neck ached, slight sore throat, very tired. Hold not feel well for 2 days. Y 7/22/2008 7/24/2008 3/05-1445- after receiving immunizations on 7/21/08. C/o pain in LUE. Pts. LUE had an area Y of approx 7/21/2008 5 in x 3 in around 7/23/2008 injection site that ul - Hyperventilating - trembling before injection. Became faint approx 3 min after inj. Placed Yin shock position, 7/2/2008 color returned 7/2/2008slowly, got pa mother reported that child had a small bleed after needle was removed pressure and cotton ball U was applied by RN. The child removed ban ates developed muscle and joint aches Y the following day after receiving a Tetanus vaccine. Stated N by 4:001/5/2009 PM on 1/4/09 1/6/2009 his joints began to ates" child can not move her RUE at all: C/O RUE being very sore C/O nausea +HA. Temp 99 N f. Given children 7/9/2008 Ibuprofen. 7/10/2008 Mother states mi n HPV during her pregnancy she was apx 6wks gestation. She was also given varicella at hospital. U When9/25/2008 she was apx 9/25/2008 5 week gestation g MMR patient eyes rolled back, PtYslumped and became unresponsive and dusky. O2 put on U Pt after trying to### revive and### EMS called. B/P nation 10-27-2008. 10-29-08 arm started aching. 10-30-08, arm swollen clear down into handNand up thru shoulder ### into neck. ### e, weakness, decreased concentration, writing illegible, chills, stiffness lower extremities, muscle Y aching, fever 101 ### (although ###this was taken Tenderness, difficulty breathing. U 10/1/2008 10/1/2008 at swelling from top of knee up leg on next day. U 9/24/2008 9/25/2008 mmunization administered TRIHIBIT/DTAP/HIB given instead of ACTHIB HIB U 8/25/2008 8/25/2008 Rash immediately around MMR at varicella injection site. Y 7/31/2008 7/31/2008 lled clinic at 5:15 pm 7/8/08 stating child had temp 101F this am. She has given Motrin and YTylenol and now 7/7/2008 at 5:15 7/8/2008 Pt temp 101.2 even th s after administering vaccine patient c/o dizziness. H20 given and Pt jacket removed with recovery. Y 6/9/2008 6/9/2008 ministered 6 mo too soon per vaccination scheduling guild lines Y ### ticed last NOC right thigh to knee swollen + red. 0 hot to touch, but is tender child does walk,U but with slight limp. ###Advised ### to give Ibuprofen Temp- eyes matted - clear nasal discharge Y - cough - Sx lasted 2 days - to ER Fri, Amoxicillin, and cough med- Dr ###said ok to### proceed with ne se broke out in hives, w/2nd dose lips swelled as well as mouth. Y 6/27/2008 10/9/2008 tous Maculopapular rash appreciated Y in the L2-L3 distribution of the R leg. Largest patch 6cm U in diameter. 8/16/2007 DX shingles. 1/20/2009 TX Acyclovier 300m r abdomen, onset 1-22-09. Y 1/15/2009 and VARIVAX vaccine were administered. Y Pt c/o chest pain at home. Pt returned to office, BP U was taken 1/22/2009 and was monitored. 1/22/2009 c/o rash on b f 1-16-2009 noticed back pain, throughout that morning developed what felt like a mild fevers Y and generalized 1/5/2009 muscles 1/16/2009 aches "flu-like" feeli s about 2in erythema and slight swelling advice to apply ice pack patient denies any pain U 1/20/2009 1/21/2009 ceived pediatric dose of ADACEL. No adverse reaction. Y 12/8/2008
DPH and IPV. Reporting medication error. To date , no reported adverse reaction from IPV over U vaccination. Born ### 3wk's premature. up at 5pm with vomiting. Feels like she could faint. Complains of ears ringing and continued Y nausea.-1. 1/19/2009 1/20/2009 tching-blistering at injection site at about 12 hours after injection-warm compress. BENADRYL Y PRN. 1/8/2009 1/8/2009 en arm - about size of baseball, hot tender. Started 1day after shot and lasted 4-5 days. Y 12/9/2008 ### nausea, dizziness within 30 sec of vaccine administration (HPV) symptoms persisted for full 48hrs Y per Pt1/20/2009 symptoms 1/20/2009 were severe. Tdap in left upper arm-IM 12/15/08. Pt called Tues - achiness Monday night-on AM Tues-L arm Y red, warm, rash, ### swelling took BENADRYL vaccine was administered by the office nurse on the morning of 01/22/09. Exceptional itching, Y pain, tenderness, 1/22/2009 and1/24/2009 soreness at the sight o ort received on 13 January 2009 from Y another manufacturer, report number A0761372A. The N initial reporter 9/29/2008 to this manufacturer 9/29/2008 had been ort received on 15 January 2009 from Y a consumer. A 65-year-old patient, who had no concurrent U illnesses, but ### who has allergy ### to tree polle ort was received 16 January 2009 from Y another manufacturer; document number 927258. The Y other manufacturer ### received ### the report from n has been received from a physician Y concerning Y a 14 year old female 12 who on 17-NOV-2008 Y was vaccinated with ### the second ### 0.5 ml dose n has been received from a physician concerning a female patient who on 25-FEB-2008 wasUvaccinated2/25/2008 with the third 8/1/2008 dose of GARDASIL. n has been received from a physician Y concerning Y a patient who was 11vaccinated Y with a dose Uof ROTATEQ (Lot### not provided) ###although it wa Y N edema of the eye, distorted vision;Ypossible auto-inoculation Y 4 Y ### ### minutes after patient had the shot, we were standing at the receptionist's area and she faintedYand fell down. 1/26/2009 She remembers 1/26/2009getting very d wheezing, hives, dyspnea occured Yat 12 noon.Ytourniquet applied when 1 patient had first cough Y and saw1/27/2009 first hive on1/27/2009 arm. injected epinephr Hepatitis B #2 and TdaP. Developed Y rash on neck, right and left upper arm. Denied rash prior Y to injections. Denied ### itching, ###SOB, edema. tes after vaccine administered client was standing ready to leave, and client later reported felt Y extremities1/26/2009 getting numb. 1/26/2009 Client sat down in irst injection on 7/10/2008. Since my Y second injection (9/26/2008), I haven't had a regular menstrual N cycle, 7/10/2008 even while 9/26/2008 on birth control. I am mach, sore Muscles, joint pain Y 1/12/2009 1/16/2009 eived two vaccines after older sibling received vaccine. Client standing and awake and alert Y and putting on 1/26/2009 coat to leave 1/26/2009 facility when sibing arm pain that remains severe in mid Y upper arm where the injection was given on left since 10/20/2008 N flu shot. ### NSAIDs nto ###helpful. US ne itis and soreness in left arm, where vaccine administered. treated with Tylenol and cold packs. Y 1/21/2009 1/22/2009 minutes of receiving the Tdap immunization, patient had passed out on the floor and started seizureing. Y She 1/23/2009 convulsed 1/23/2009 for approximately 45 ately 6 minutes after receiving the Tdap vaccine in left arm, patient had difficulty breathing and Y felt dizzy,1/23/2009 nauseous,1/23/2009 and light headed. I laye MS TO HAVE FLU AFTER 3 DAYS OF RECEIVING VACCINE AND ABOUT AFTER 5 DAYSUSHE DEVELOPED 11/5/2008 TINNITUS ### AND PATIENT ed Anthrax vaccine 10 Dec 2008, # 3 of 6 shots. Pt found that she was pregnant on 13 Jan 2009. Pt had no reaction ### to the Vaccine. Repor swelling, heat, bruising & pain at injection Y site, along with headache. Patient also stated a red band from 1/21/2009 injection site 1/23/2009 down the back of he ately 3-6 wks after vaccination number Y 2 in september 2008. i had migraines, nausea, vomitting, U fatique with 9/20/2008 no probable cause ### that lasted inflamation at injection site, with increasing Y cellulitis 1/24/2009 1/24/2009 n area of redness + swelling +warm painful to touch on Rt med thigh esp where TETNUS / ADACEL Y was given 1/6/2009 GARDASIL 1/8/2009 suspect + TDAP d injury to left arm and came to clinic requesting a TD. U 1/22/2009 swelling at injection site; some itching in body. Recommended Benadryl and then pt to medical U center if1/23/2009 anything else. 1/24/2009 esented in Health Department one day after receiving Tdap. C/O back pain in Left deltoid. Slightly Y red at1/26/2009 injection site. 1/26/2009 No swelling noted. ministered 1-21-09 pt wife notified us that w/in a few days he had broke out in rash on trunk which Y then spread, 1/21/2009 treated w/OTC Benadryl. ver on arms and legs 1/21, woke upY1/22 with very bad rash on right lower leg. Seen by PCPY 1/22 treated 1/20/2009 with BENADRYL 1/22/2009 for rash and TY th redness on 01/23/09 and severe pain and redness which increased with time. Was very red, swollen and 1/22/2009 painful 1/23/2009 and spread to elbow 1/2 swollen area at injection site, hot toYtouch very itchy- 104 degrees-105 degrees Temp. Y 1/22/2009 1/23/2009 reaction to MMR & VARIVAX - Lo causing erythema onis Y 1/27/2009 1/27/2009 ction to Tdap U 1/20/2009 1/22/2009 fussy and very gassy for 2 days following vaccine. Day 3 brought diarrhea 10-15 times a day, Y watery, green, 1/15/2009 positive 1/18/2009 for occult blood, no f nflammation and pain at injection site extending 4" from site and half-way around arm. Pt told Y to apply cold 1/5/2009 compresses 1/7/2009 x1 day then warm c d 1/27/09 with Zoster L1 dermatome.Recieved Varivax 4/27/04 and ProQuad 11/14/06 1/27/2009 ella rash started 1/27/2009. Y Y 3/21/2005 1/27/2009 n has been received from a physician concerning a 79 year old white female patient who onY05-DEC-2007 12/5/2007 at 13:4510/7/2008 pm was vaccinated into n has been received from a physician concerning a 65 year old male who on 05-NOV-2008 Y was vaccinated 11/6/2008 with PNEUMOVAX ### 23 (Lot #66 n has been received from a physician concerning a 49 year old male with asthma and allergic Y rhinitis who 11/6/2008 on 06-NOV-2008 11/6/2008 was vaccinated n has been received from a pharmacist Y concerning Y a hospitalized patient 0 Y who on an unknown U date was vaccinated with a dose of PNEUMO n has been received through the Merck Pregnancy Registry from a healthcare worker concerning Y a female 4/15/2008 (age not4/15/2008 reported) who on 02-JU n has been received from a physician Y concerning an approximately 15 year old female patient N who was mentally handicapped who in 2007
was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified N age 1/1/2000 who was vaccinated with LYME was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified 5/25/2000 age who was vaccinated with was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age 6/2/1999 who was vaccinated with LYMER ho received flu and ZOSTAVAX Y vaccine Y on 11/6/08 Y began to notice12lethargy, myalgias, arthralgias Y that gradually 11/6/2008grew 11/9/2008 worse. Was seen in st vaccination: dizzy, dimming vision, Y nausea. Recovered Y in clinic: In1 P.M: Client experienced Y loss of vision, 1/22/2009 loss of 1/22/2009 muscle control, swelling with ESRD on HD, HTN, and Y DM presents to ER from HD center via ambulance after receiving N PNEUMOVAX 12/4/2008 and developing 12/4/2008sudden SOB. ccination 1/20/09, and 1/22/2009 c/o painful knot, erythema 2 1/4 in on Right Deltoid. U 1/20/2009 1/22/2009 ate that infant cried screaming episodes for 3 hours per episode, for 24 -36 hours after receiving Y immunizations. ### Increased ### T. Eyes and fac after the injection patient noticed a red wheal approximately 1" in diameter. It was itching andUburning. The 1/22/2009 rash increased 1/23/2009 in size to 3 1/2-2 FLUZONE 1/15/09. 1 week later noted pain in both forearms & later both legs. 1/22/09 Mainly U myalgias. 1/15/2009 Still being 1/22/2009 evaluaated. after administration, a 2 inch strip ofY hot, painful whelps developed on middle of the torso, on N the left side. 1/16/2009 The next1/21/2009 dayit spread to the fron TIS TO LT. DELTOID REGION. Y Y 1/20/2009 1/22/2009 2 of the 3 Gardisil shots. One on 10/16/07 andYone on 2/2/08. In April 4 2008 I had a virus thatUlasted for 4 2/6/2008 weeks and5/23/2008 was treated with antib cieved vaccines on 1/16/09 on both upper outerY thighs. On 1/17/09,2patient's father phoned Ydoctor on call, 1/16/2009 stating right 1/17/2009 thigh was swollen. perienced swollen, red, hot upper arm at side of injection, patient took benadryl to relieve theYsymptoms;1/21/2009 symptoms1/22/2009 were dissipating after a after 1st PCV, baby's thigh feels hard and small red area around injection site. Baby extremely Y irritable and 1/27/2009 drowsy 24 1/28/2009 hours after as well. ash; about 2 dozen lesions Y Y 5/14/2008 1/21/2009 ers of up to 103.2, body aches, malaise, Y cough,small pustules on skin Y 1/22/2009 1/24/2009 YTHEMATOUS LESIONS WITH VESICLES Y IN DIFFERENT STAGES. 2-3 LESIONS NEW TODAY. Y ERUPTIONS 1/6/2009 BEGAN 1/19/2009 ABOUT 72 HOU IPV GIVEN AT 12 MONTHS U 1/20/2009 1/20/2009 welling 10.5 cm x 9.5 cm, firm, and warm to touch with pain. Y 1/26/2009 1/28/2009 veloped a rash 7-10 days later. Rash has been diagnosed as pityriasis rosea. The dermatologist informed me### that PR may ###be associated inic with 5 yo with concerns about swelling/redness to R thigh. Received vacc 3d in bil thighs U and mom states 1/23/2009 R thigh had lump next d. with SHOT WAS GIVEN DIRECTLY IN TO Y MY LEFT SHOULDER, UP VERY HIGH, AND BEHIND. N I NOW HAVE A### TEAR ON### MY SUPRASPIN as on target with speech and gross motor skills approaching his first birthday. He Ysaid about N 10 words, knew 6/29/2007 the signs 7/6/2007 for cup, food, mom a g x 3 weeks. 2. Local pain where shot or injection was given. N ### ### es temp 102.2 F orally several hours after injection. Also complained of nausea and vomitingY but was also 1/26/2009 taking Flagyl 1/26/2009 for Vaginitis. c/o headache, nausea, vomiting, fever, rash on arms, neck, chest, abdomen and pain and swelling N at injection 1/26/2009 site.1/26/2009 neck muscles, onset 24 hours later. No other physical events to potentially cause this no fever U or constipation 1/23/2009 symptoms. 1/24/2009 Rx: muscle relaxa accine given. 1-22-09 at 6pm beganYvomiting. At 9:40pm c/o knees "killing me". Mom carriedYto bed 1-23-09 1/16/2009 and 1-24-09, 1/22/2009 child home playin d localized reaction with redness, swelling and itching. Y 1/26/2009 1/27/2009 o right upper arm swelling, localized to immunization site. Hot, painful. Patient seen in clinic, U states it feels 1/27/2009 much better, 1/27/2009 swelling decreased , Hyperemia and edema at injectionYsite R thigh and oral lesion measuring 10x7cm U 1/26/2009 1/27/2009 y Dr via telephone and advised to go Y to emergency room. Patient was triaged by Dr. Y 1/26/2009 1/26/2009 redness with the left shoulder/arm where shot was given. Y 1/21/2009 1/21/2009 as diagnosed with shingles. Y 1/7/2009 1/19/2009 , 2006 I went to the Hospital for my Y annual physical. Y When the Doctor 3 discovered that I had NAtrial Fibrillation 5/12/2006 and kept 5/12/2006 in the hospital for my le SM referred to hospital from ED for Y f/u evaluation of chest pain S/P primary SPV and AVAY#2 1/31/2008. 1/31/2008 Symptoms: 2/6/2008 Dyspnea, Diaphor ort received on 21 January 2009 from a health care Y professional. A 2-year-old 0 child, who hasUpast medical 10/1/2008 history of respiratory 1/1/2009 syncytial vir ort received on 15 January 2009 from a physician. Y A 7-month-old female 0 patient who had no N concurrent illnesses, ###pre-existing ### medical cond n has been received from an investigator Y concerning Y a 12 month old0 female with nasal congestion Y and a history ### of a recent ### cold and methic n has been received from a pharmacist concerning a female who in 2008 was vaccinated with Y a dose of GARDASIL. The patient experienc n has been received from a physician Y concerning Y a 24 year old female 6 Y who on 22-JAN-2009Uwas vaccinated 1/22/2009 with a1/22/2009 0.5 mL third dose of GA n has been received from a consumer concerning Y the 15 year old daughter 0 of her friend whoN"months an months ago" was vaccinated with vaccine given 12/31/2008. Onset of painful genital ulcerations- two total- on approximately 1/14. Evaluation in### office1/16/2009 revealed two isolated ported rash and itching around injection site starting a couple days after receiving the ZOSTAVAX injection. 1/19/2009 1/19/2009 eltoid region with redness, warmth and itching per patient, upon return to office on 1/22/2008,Ywhere ADACEL 1/19/2009 was given. 1/22/2009 Pneumonia Vaccine R arm Flu vaccine Y and 7 hours later, L arm pain so severe + decreased U mobility, went to the ### ER. ER Dr. ###was "uncaring ed on 1/15/08 at 11 am, states child's Y left arm red and swollen post vaccine. Was advised to Y go to PMD. 1/13/2009 On 1/19/08,1/15/2009 called MOC, states too veloped a facial palsy on right side Y that started on or around 12/23/2008. Patient was evaluated Y for Lyme which ###was negative. ### No other c
FLUSHOT 12/15/08 AND MOTHERYSPOKE WITH ON CALL PHYSICIAN 12/16/08 AND STATED Y SHORTLY AFTER ### FLUSHOT ### PATIENT Y 1/22/2009 1/22/2009 G AT INJECTION SITE Y 11/3/2008 11/3/2008 9 pt report n&v, confussion,HA,lip swelling Y & numbness. 2/23/09 MR received for several OVs U beginning 1/26/2009 1/8/09. Seen 1/28/2009 prior to vaccine for nations, including rotateg, received on 1/26/09 at 2mo. of age. mother called clinic to report that U baby had1/26/2009 8 episodes 1/29/2009 of diarrhea 1/28/09 an ith, I was never alergic to anything in my life until they adminestired that flu shot that they told N me I had to 3/13/2000 have to keep 3/13/2000 on working, althoug 09- received vaccination. 21 Jan 2009 Y had chills and weakness. 23 Jan 2009 had chest pains. Y Went to Aid 1/20/2009 Station was 1/20/2009 told he had gas. Co 9 after clinic visit, and @ 7:30p felt dizzy, Y faint, sensitive to light and mom states pt. got really U pale. Mom1/20/2009 gave tylenol 1/20/2009 and went to sleep. W ng for 12 hours. 10 days later subjective sx of swollen tongue and difficulty swallowing. Did not Y seek medical 1/13/2009 care for1/14/2009 condition. y 1 week after HPV #3 vaccine U 1/22/2009 1/28/2009 ours of receiving vaccine had fever greater than 102F, chills, sore throat, muscle aches, fatigue, Y and dee12/9/2008 non-productive 12/9/2008 cough. lasted 4 d eived HIB #1, Prevnar #1, Pediarix #1. Y Started to show sytmptoms of vasovagal response but Y then moved 1/28/2009 into very1/28/2009 shallow, slow respiratio ction, erythema, induration noted 2 days after vaccine administered U 1/27/2009 1/29/2009 post Injection patient experienced swelling,tenderness and warm to touch at injction site, leftYdeltoid. Symptoms 1/27/2009intensified 1/27/2009 for 48 hours af days after injection, 2 cm firm tender, non-erythematous soft tissue mass appeared appeared N at injection 1/15/2009 site. Lump 1/19/2009 enlarged and develop ter immunization, patient projectile vomited Y and stopped breathing. Went to children's Hosp.Y2/4/09-records received ### for DOS ### 11/17/08-pre m Reddened Raised area @ injection site Y 1/19/2009 1/21/2009 d neck pain/stiffness radiating up upward to right side of head. Started day after injection given N in right arm. Continues ### to date. Referred to dose of ROTATEQ pt. had vomited in the office and then contiued diarrhea at home. After 2nd Y and 3rd doses 4/4/2008 vomited 4/4/2008 the next day and the hat in 2004 she received the flu shot while on duty as an RN at the TriCare clinic. Within 15 minutes she had itching ### at the ### site that then sp ea of redness. Left shoulder at injection Y site. Warm to touch. U 1/21/2009 VARICELLA reaction - redness @ the site started 1-28-09 in evening. Y 1/19/2009 1/28/2009 mplaining of rash on right side chestY wall, some pain in his back through his anterior chest +Nin that same 1/13/2009 band of derma 1/17/2009 tone. Aching, irrita m eriphan with pain, itching developed at site of injection within 24 hours of administration. 1/27/2009 1/28/2009 rash on both thighs. No fever, vomit or any other complications. Patient to follow up with Dr in U 1 week. 1/26/2009 1/27/2009 d lump in R. arm circumference size of 2 silver dollars. Very red and sore. Y 1/26/2009 1/28/2009 red ZOSTAVAX IM instead of subcutaneous. No information regarding correct route found on U product vial 1/20/2009 nor in VIS1/20/2009 sheet. ministered IM instead of Sub Cu nothing indicated route route on product bottle nor on his sheet. U 1/21/2009 1/21/2009 was reported by a lawyer and described the occurrence of skin lesion(s) on multiple body sites N in a male subject aged between 50 and 59 ceived ROTATEQ on 1-27-09, Y developed intussusception Y on 1-28-09, 2 required surgical repair Y 1-28-09. 2/9/2009 1/27/2009 MR1/28/2009 received for DOS 1/28 eived FLUMIST in previous years. Received Y FLUMIST Y 1/15/09. Seen 20 in ER 1/17/09 for presumed N viral illness. 1/15/2009 Admitted 1/19/2009 to PICU 1/19/09 w ceived injection 6-9-08. Exposed to Yfamily with in last 1 month with severe chicken pox. Patient Y in our ED 6/9/2008 with other concerns. Presumed ch oped erythematous, pruritic lesions at Y site of primary SPV inoculation approximately 6 weeksYpost vaccination. 9/16/2008 Symptoms:### Dermatitis, foca 1/28/2009 N 1/27/2009 1/28/2009 lled our office approx 30 minutes after getting ZOSTAVAX injection. "on her way home stated Y she felt like 1/26/2009 on. she got 1/26/2009 a shot of morphine". U 1/8/2009 started in 1/14/09, had to be woken Y up for feedings. Fever 100.5. Symptoms subsided 11/5/09. Y Went to ER 1/14/2009 1/14/09 1/14/2009 because couldn't get hi Flu shot 10/14/08 Fry's. That nigh had hallucinations + feet extremely sweaty - wringing wet-Y2nd night same thing ### hallucinations ### not feeling ut, tremors, eyes rolling in the back of Y her head Client sent to ER via ambulance. Y 1/20/2009 1/20/2009 reaction. KINRIX accidentally administered instead of HEP B. Y 1/23/2009 she gets frequent breakouts of "shingles"-about 3X/yr for the last 6 yrs. MD recommended ZOSTAVAX. Y 1/14/2009 Pt was clear 1/26/2009 of any symptoms. Sh 08 increased temp 105.8 and febrile Y seizure. Y 12/8/2008 ### ely after the 2 vaccines admin., student said he was becoming faint. He fainted sitting in chair Y supported1/28/2009 by 2 staff and 1/28/2009 transfer to cot. Stud d VARIVAX vaccine on 09-22-01 at clinic & now is seen at other clinic & developed a rash that Y was cultured 9/22/2001 & positive 1/22/2009 for varicella zoster. Swelling, itching, warmness on left deltoid Y 1/28/2009 1/28/2009 swollen. Cold compress applied. U 1/28/2009 1/29/2009 rsday morning fever of 100 and leg was red, but is better now. Y 1/27/2009 1/30/2009 CONVULSIONS FOR A DURATION OF ABOUT 20 SECONDS; HE DOESN'T REMEMBER Y ANY OF THAT 1/29/2009 TIME; HE 1/29/2009 WAS EXTREMELY P ccured 1/2/09 mid-morning. Zostavax was situated in the freezer next to Varivax and unfortunately Y I mistakenly 1/2/2009 grabbed 1/2/2009 Zostavax instead hat the Last flu vaccine caused difficulty breathing and tighness in his chest for 3 days. He said that he did 10/1/2008 not go to10/1/2008 the doctors because th ours, patient began coughing and sneezing. Y Eyes and lungs began to hurt. Patient advisedYto contact personal ### physician### who prescribed
esented to BHC 237 with rash 24 hrs Y post multiple vaccinations. Patient presented with urticaria Y with large 1/20/2009 red blotches 1/21/2009 with flat raised are en 1/14/09 in L arm Patient states an initial 2-3 days of sore arm, 2 days of no symptoms, then U 1/20/09 awoke 1/14/2009 with excruiating 1/20/2009 pain in L arm .7 degrees, chills, body aches, swollen lymph glands, nausea, pain at injection, unable to lift/move N arm, 1/27/2009 headache, 1/28/2009 backache, burning sens REPORTED TO SICK CALL C/O NOSE Y BLEED Y X 2 DAYS, WITH RASH 8 AROUND HIS WAIST U LINE, CLINIC### ON 1/20/2009 BASE DID BLOOD TES d 1/21 morning. Rash to neck 1/22 evening, Y extending to chest and trunk, very itchy, rash worsened Y 1/231/21/2009 to almost 1/22/2009 entire body, went to ER 9 Pt. awoke with flu like symptoms, Ypain in arms and purpura-like rash on legs. Received prescription N for 1/2/2009 steroid pack 1/8/2009 (pt. could not be mo HAS IMMUNIZATIONS ON 1/23/2009. Y ON 1/24/2009, PARENTS WOKE UP TO CHILD HAVING Y DIFFICULTY 1/23/2009 BREATHING, 1/24/2009THEN PAREN perienced soreness at the site where the Pneumovax was given (left deltoid). Client reportsNchills, fatigue, and### fever of 103 ### degrees for ab ports fever of 100-103 for 3 days fllowing Y immmunization. afebrile today in clinic Y 1/26/2009 1/17/2009 tes post administration of DTaP and MMR, patient's arm began to swell at injection site. Patient Y also developed 1/30/2009 a hive 1/30/2009 like rash, redness a swelling, pain & redness 2 days after administration of vaccines U 1/28/2009 1/29/2009 ur office on 1/22/09 and reecieved 4Yyear old boosters. Woke up 1/23/09 with red and swollen Y left arm. Diagnosed 1/22/2009 with 1/23/2009 cellulitis left arm tre after administration of Varivax, dose #2, the patient developed a warm, itchy, red area on leftUthigh (site of1/27/2009 injection).1/28/2009 The patient was seen ING TO MOTHER, CHILD DEVELOPED Y CELLULITIS Y IN THE LEFT2ARM WITH A TEMPERATURE Y OF 1/22/2009 104.8 AND1/23/2009 NEEDED IV ANTIBIOT h extremely sore arm limiting movement Y 1/27/2009 1/28/2009 max 102F 2 days after shingles vaccine administration) and redness, warmth, tenderness at injection U site.1/26/2009 Fever deffervesced 1/28/2009day 3 after inj dministered around 11 June 2008 prior to deployment. Pregnancy diagnosed during deployment. Y Pt returned 6/11/2008 upon dx of pregnancy. No k all over the body, mostly in the torso regions. N 1/15/2009 1/22/2009 f 7/22/2008 child had a prolinged Y febrile Y convulsion. Y He was admitted 1 to Hospital around midnight Y 7/22/09. 7/22/2008 He was 7/22/2008 observed and did not ha n my upper left arm is something I'v never experienced before. It isn't like a sore muscle, it is worse. It is a disabling ### 1/8/2009 pain. For the past 3-4 was reported by a healthcare Y professional Y and described the occurrence of diarrhea Y in a 6-month-old U female 1/6/2009 subject1/6/2009 who was vaccinated w th lower back progressing into thighs and having difficulty walking a lot of joint pain. Started U next day and1/27/2009 also had rash 1/28/2009 on left thigh, contin ning after his shot, he developed a fever of 100 degrees. The next day, his fever was 101 degrees, Y he had 1/26/2009 a bad headache, 1/26/2009a stiff neck, an arge red, warm, painful area around injection site. Y 1/27/2009 1/28/2009 x15 cm. edema, erythema, induration. Y 1/19/2009 1/20/2009 2-23-08 for vaccines to travel Jan 9 or 10th, 2009 awoke with severe pain in "every" joint. Took N aspirin, pain gradually ### 1/9/2009 decreased. Felt much d area red, swollen, warm to touch 1-29-09. Child active, alert, good movement with arm. NoYfever marked 1/27/2009 redness 1/28/2009 with pen. Advised mom dness some swelling at site. Noted reddened area about 13 mm in diameter. Pt. started to Y feel itchiness 1/28/2009 on L arm 1/30/2009 in the evening after rece hea and aching approximately 2 hrs after Adacel shot given - symptom progressed with severe Y myalgias 1/14/2009 lasting approximately 1/14/2009 72 hrs. ceived TD vaccination on 1/8/08, approximately Y 3 hours after, the patient developed a low-grade Y fever of 100.7F. 1/8/2008Patient 1/8/2008 took TYLENOL fo nt received a routine booster shot with Td-170 on Friday, 02/01/2008. Immediately, she felt aUburning sensation, 2/1/2008 and 2/1/2008 then developed a large ceived TD-171 on 01/25/08. He developed Y flu-like symptoms, including cough, ear pain, pharyngitis, U and1/25/2008 muscle aches, 1/29/2008 and a local reactio ceived TD on 03/12/2008. Patient came Y back to the doctor's office on 03/14/08 with flu-like symptoms Y and 3/12/2008 redness,3/14/2008 tenderness and a nodu as vaccinated on 02/01/08 and the symptoms Y of the event started on 02/08/08. Patient experienced Y a variety 2/1/2008 of symptoms 2/8/2008 over a period of perienced a high fever of 101.3F, body aches, chills and headache after receiving TD booster Y shot. Called 6/9/2008 the physician's 6/10/2008 office and was a ceived TD vaccine on 6/12/08 as a routine Y booster. Later that day, the patient visited his cardiologist Y for6/12/2008 an unrelated 6/12/2008 reason and was not i tient received vaccine on 06/04/08 Y and on 06/08/08 patient went to ER, where he was diagnosed Y with cellulitis 6/4/2008 in the6/8/2008 area of injection site. patient received vaccine on 06/09/08 Y and on 06/13/08 she came to doctor's office with symptoms Y of cellulitis 6/9/2008 - swelling, 6/13/2008 redness, warmth an tient received vaccine on 6/11/08 and Y 6/13/08 patient come to doctor's office with complaintsY of fever, chills, 6/11/2008 muscle6/13/2008 aches, along with sym patient received vaccine on 06/11/08 Y and on 06/18/08 she came to doctor's office with symptoms Y of cellulitis 6/11/2008 - swelling, 6/18/2008 redness and a knot ved TD vaccine on 06/20/08 and started to experience pain on 06/21/08. C.K. described hisYreaction as6/20/2008 feeling a significant 6/21/2008amount of pain ceived TD vaccine on 06/20/08 and experienced pain at injection site and general achiness on Y 06/21/08.6/20/2008 Patient took 6/21/2008 TYLENOL for the ad ceived Td injection intradermally, instead Y of a PPD test, two to three years after receiving herNregular Td booster 6/9/2008 shot.6/9/2008 Patient was suppose tient came to doctor's office to receive TD and MENACTRA vaccinations for admission to college. Y Patient 7/14/2008 was administered 7/14/2008TD IM/left delt as administered TD vaccine on 06/25/08 Y and developed a local reaction of swelling, warmth Y and redness6/25/2008 at injection6/25/2008 site during the same d as administered Td vaccine on 7/30/08 Y and developed a local reaction of swelling, warmth and Y redness at 7/30/2008 injection site 7/30/2008 during the same day ceived TD injection on 04/15/08 andYdeveloped redness and hardness at the injection site. Patient Y was treated 4/15/2008 for cellulitis 4/15/2008 with AUGMENT ceived TD injection on 10/16/07 andYdeveloped cellulitis, redness and induration at injection Y site. Patient was treated ### with### BACTRIM for 10 08 TD was administered to the patient intradermally, in the left inner forearm, instead of a PPD Y test. The8/25/2008 patient immediately 8/25/2008 experienced p veloped induration at injection site, Ythe site was warm to the touch, as well as a swollen lip and Y swelling 7/15/2008 in the mid corner 7/15/2008 of eyes. Follow u ported not feeling good after Td injection Y and developed swelling at injection site. Follow up on Y 10/28/2008: 7/16/2008 As the patient 7/16/2008 did not return to
veloped induration and redness at injection Y site, and a headache. Follow up on 10/28/08: AsYthe patient did 7/7/2008 not return 7/8/2008 to the medical office ceived TD vaccine, lot TD-183 on 09/24/07 Y due to a scrape and developed an itchy rash on arms, Y abdomen, 9/24/2007 legs, face 9/24/2007 and scalp couple of weating, migraine headache, rapid heart Y beat, paresthsia in fingers and toes, localized swelling Y at injection site.### Patient was### examined by a was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional Y and described the occurrence of fever in a 15-month-old Y male11/4/2008 subject who 11/4/2008 was vaccinated with was reported by a physician and described Y the occurrence of pain radiating down arm in a 65-year-old N male subject ### who vaccinated ### with F was reported by a consumer and described Y the occurrence of erythema in an adult female subject N who was vaccinated ### with ###FLULAVAL (G was reported by a healthcare professional Y and described the occurrence of bilateral conjunctivitis U in an adult female ### subject ###who was vacc was reported by a healthcare professional Y and described the occurrence of leg rash in an adult Y female subject### who11/1/2008 was vaccinated with FL was reported by a healthcare professional Y describe the occurrence of leg rash in an adult female Y subject who ### was vaccinated 11/1/2008 with FLULAV was reported by a healthcare professional Y and described the occurrence of leg rash in an adult Y male subject who ###was 11/1/2008 vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of leg rash an adultY subject of unspecified ### gender ### who was vaccin was reported by a healthcare professional Y and described the occurrence of leg rash an adultY subject of unspecified ### 11/1/2008 gender who was vaccin was reported by a healthcare professional Y and described the occurrence of leg rash in an adult N subject of unspecified ### 11/1/2008 gender who was vac was reported by a healthcare professional and described the occurrence of shoulder bursitisNin a 37-year-old female ### subject who was vacc was reported by a physician and described Y the occurrence of generalized itchy rash in a 35-year-old N female 11/7/2008 subject11/7/2008 who was vaccinated w was reported by a healthcare professional Y and described the occurrence of pain in shoulderNjoint in a 30-year-old ###female subject who was was reported by a physician and described Y the occurrence of high fever in a 60-year-old female U subject who was vaccinated with FLULAVA was reported by a healthcare professional and described the occurrence of injection site pruritus Y in a 57-year-old ###female subject ### who was v was reported by a healthcare professional and described the occurrence of local reaction inUa subject of unspecified age and gender who w was reported by a pharmacist and described the occurrence of a product complaint in a subject U of unspecified### age and gender ### who was va was reported by a healthcare professional and described the occurrence of injection site pruritus U in a female 10/1/2008 subject10/1/2008 of unspecified age wh was reported by a healthcare professional and described the occurrence of injection site pruritus U in a female 10/1/2008 subject10/1/2008 of unspecified age wh was reported by a healthcare professional and described the occurrence of injection site pruritus N in a 82-year-old 10/1/2008female 10/1/2008 subject who was v was reported by a healthcare professional Y and described the occurrence of hives in a 69-year-old U female 9/24/2008 subject who was vaccinated with was reported by a physician and described the occurrence of diffuse itching in a 77-year-oldNfemale subject who ###was vaccinated ### with FLUL was reported by an allergy physician Y and described the occurrence of rash-pruritic in a 68-year-old Y female subject ### who was ###vaccinated with was reported by a healthcare professional and described the occurrence of swelling injection U site in a 29-year-old ### female subject who was was reported by a healthcare professional Y and described the occurrence of injection site pruritis U in a 68-year-old ###female subject ### who was v was reported by a consumer and described Y the occurrence of ears clogged in a 58-year-oldUfemale subject who ### was vaccinated ### with FLUL was reported by a physician and described the occurrence of low temperature in a 20-year-old N female subject ### who was vaccinated ### with FL was reported by a physician and described the occurrence of incorrect storage of drug in a 52-year-old U male subject ### who ### was vaccinated w reported by a healthcare professional via a inside sales representative and described the occurrence Y of black spot at injection ### site in a subje was reported by a healthcare professional and described the occurrence of injection site redness Y in a 65-year-old ### female ### subject who was was reported by a healthcare professional and described the occurrence of injection site redness N in a 21-year-old ### female ### subject who was was reported by a consumer and described the occurrence of nerve disturbance in a 64-year-old Y female subject ###who was### vaccinated with F was reported by a consumer and described Y the occurrence of injection site redness in a 34-year-old Y female subject ### who was ### vaccinated w was reported by a physician and described the occurrence of allergic reaction in a 62-year-old U female subject ### who was vaccinated ### with FLU was reported by a healthcare professional Y and described the occurrence of arm redness in a U 34- year- old female ### subject who was vaccina was reported by a healthcare professional Y and described the occurrence of high fever in a 37-year-old N female ### subject who### was vaccinated was reported by a healthcare professional Y and described the occurrence of injection site pain N in a 36-year-old ### male subject ### who was vaccin was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 8-year-old 10/8/2008 female 10/8/2008 subject who was v was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 13-year-old 10/8/2008male 10/8/2008 subject who was va was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 17-year-old 10/8/2008male 10/8/2008 who was vaccinate was reported by a healthcare professional (also the consumer) and described the occurrence N of chest rash 10/2/2008 in a 42-year-old 10/2/2008female subject was reported by a healthcare professional and described the occurrence of injection site redness in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness U in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness U in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness Y in a subject 10/1/2008 of unspecified 10/5/2008age and gend was reported by a healthcare professional and described the occurrence of injection site redness Y in a 33-year-old 10/1/2008 female 10/1/2008 subject who was
was reported by a healthcare professional that described the occurrence of injection site burning U in a subject of unspecified age and gende was reported by a healthcare professional that described the occurrence of injection site burning U in four to five subjects of unspecified ages was reported by a physician and described Y the occurrence of swelling arm in a female subject U of unspecified 10/2/2008 age who was vaccinated with was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult male subject who was vaccin was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult female subject who was vacc was reported by a healthcare professional Y and described the occurrence of lost consciousness Y in a 15-year-old 10/4/2008 female 10/4/2008 subject who was va was reported by a pharmacist and described the occurrence of radiating pain in the arm in aU39-year-old female ### subject who was vaccinate was reported by a pharmacist and described the occurrence of increase in migraine in a 25-year-old U female 12/1/2008 subject12/4/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of nausea in a female Y subject of unspecified ### age### who was vaccin was reported by a consumer and described the occurrence of red rash on stomach in a 39-year-old N female subject ### who was ###vaccinated wi was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified 11/6/2008age who was vaccinated was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified 11/6/2008age who was vaccinated was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec ry 8, 2009, patient recieved intranasal life attunated influenza vaccine. In about 3 days, he started Y having1/8/2009 flu symptoms 1/11/2009 including fever, bod E UPPER BODY MUSCLE ACHES, HEADACHE, NAUSEA,PHOTOPHOBIA,PAIN 8/10. TX: Y TYLENOL, 1/1/2009 PHENERGAN, 1/1/2009 BEDREST X 48 H ad a seizure the day after (11/11/08)Yhe had the yellow fever vaccine (11/10/08). It was during U nap time at school. ### He was### rushed to the em ceived the vaccine on 1/30/09. The next day, 1/31/09, he vomited twice. He also didn't eat very Y much that 1/30/2009 day, prompting 1/31/2009 me to think he d vleoped herpes zoster on the left side of the body, where vaccine was administered. U 1/28/2009 1/29/2009 2008 first shot experienced Y headaches, Y dizziness, Y back pain, soreness 15 Y at injection site (still feels U pain in arm 2/7/2008 today). April 2/7/2008 2008 after second rst HPV vaccine, and 1 hr later, I developed Y a fever Y of 102.0, was vomiting, 2 and had Y a severe N headache.9/20/2007 Ever since9/20/2007 9/20/07, I have had a c ed ZOSTAVAX IN; approx. 6 months ago at a local retail pharmacy (not at one facility). Pt presented to an ED with other problems, and on th PCV7 instead of Hept A vaccine. Hept A vaccine then administered. MTR notified of event. 1/23/2009 ed & warm spot just below injection site pt reports not painful U 1/27/2009 1/29/2009 ema, swelling L upper arm, pain, tenderness, low fever, hallucination at nights, belly ache- no vomiting or diarrhea. or redness 3x4 1/2 in elevated in duration Y 1 1/2in initial 0 dc 0 Adenopathy. U 1/26/2009 1/27/2009 ving RATATEQ by mouth, noticed that pt. started having redness around mouth, eyes, right Y ear & blotchy 1/26/2009 redness on 1/26/2009 scalp. Gloves were la ills, and cramps, vomiting Y 1/13/2009 1/13/2009 as given 0.5 ml pneumoccocal vaccine. Developed swelling at injection site. 11/3/2008 11/3/2008 atient received tetanus/diptheria injection. Returned 1/19/09 with complaint of injection site swelling - left12/1/2008 deltoid- Reported 1/17/2009 increased redde ort received on 07 October 2008 from Y a physician. A 41-year-old male patient, with no concurrent N illnesses, 4/19/2008 no known 4/23/2008 allergies, and no use n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL concerning Y a 2810/5/2007 year old female 4/19/2008 patient with no pe n has been received from a registered Y nurse concerning a 20 week old female patient who on U an unspecified date was vaccinated per oral n has been received from a physician Y concerning Y an approximately 15 Y month old female patient Y who on unspecified dates was vaccinated n has been received on Y request from the FDA Y under Freedom of Information 0 Act regarding aUreport from a physician ### concerning ### a 3 month next day after receiving injection herYdeltoid was swollen, hot to touch, knot @ injection site. NThe knot went away ###and the ### hot feeling. Swel swollen underarm muscle with pain traveling up and down to below the elbow and into the lymph Y nodes of 1/27/2009 the arm. 1/28/2009 welling, cold sweats, vomiting, fingerYnumbness, point tenderness at site of injection, severe fever Y for 5 days 1/8/2009 post injection; 1/9/2009 followed by 10 d FTER INJECTION, SHE DEVELOPED Y PAIN, REDNESS AND SWELLING AT INJECTION SITE. N ALSO1/30/2009 FEVER AND 1/31/2009 GENERALIZED RE es child had a seizure 1/31/09 around Y 5am, lasting approx 3 minutes (stiffness, then body shaking), U temp1/30/2009 99.8 F. Called 1/31/2009 911. Child taken to ER INJECTION-FEVER ACHES WHICH RESOLVED IN 24 HRS BUT DEVELOPED LARGEURED WHEEL 1/30/2009 AND INDURATION 1/31/2009 AT INJECT ps , throat and very itchy rash all over the body Y 1/30/2009 1/30/2009
e 6 hours after injection lasting 24 hours, pain, itching and redness at injection site starting 8 Y hours after injection 1/28/2009 and1/28/2009 continuing at this time ld in for immunizations. Began administration with oral RotaTeq. Infant had not even taken Ythe entire amount 2/2/2009 when 2/2/2009 she began vomitting. oss tonic seizure, mild rash Y 1/20/2009 1/29/2009 fever and dizziness. 8:00 p.m. vomiting chills and cough. 12:00 a.m. awoke with body achesYwhich lasted for 72 ### hours. It felt ###like an actual vaccines on 1-12-09. Symptoms started on Sunday, 1-25-09, with a fever, "just not feeling well" Y Took ibuprofen 1/12/2009and 1/25/2009 slept. On Monday, Ja ts to the emergency room on Sat 1/31/09 Y complaining of painful, itchy rash on torso. During Ureview of systems 1/22/2009 and 1/30/2009 physical exam, pt noted g WF received 0.5ml Pneuomvax injection Y IM in her left deltoid at 0930 1/27/09 with no complaints Y or complications. 1/27/2009 1/27/2009 This was her first expo ng the MMR, Hep A, and Varicella vaccines my daughter woke up the next morning with herYright eye looking 1/23/2009 red and 1/24/2009 half closed. It took 3 mately 6:00 pm on 1/24/09 He was unable to lift his right arm due to severe pain. Pain then moved to left 1/27/2009 shoulder 1/27/2009 then both knees began e fever (100-107 F) multiform rash on Y face only. No (grand or trunk) or est or surface. U 1/23/2009 2/1/2009 seen in office with redness, swelling 8 x 10cm with soreness to injection site. 2 x 2 cm ecchymotic Y right arm 1/30/2009 about inj. 1/30/2009 site. Encouraged res eived shots. 2:08pm- developed hives. Y EPINEPHRINE given at 2:10, BENADRYL given at Y 2:15. 2/2/2009 2/2/2009 -09 reported 1-30-09 L arm sore, itchy, warm to touch with erythema. After exam per doctorYno cellulitis.1/27/2009 Hx D.M. Tx 1/29/2009 with Cephalexin 500 m 2 X 48 degrees. Fever decreased with TYLENOL & IBUPROFEN. Q 4 degrees. Y 1/26/2009 1/26/2009 e received on 1/30/08 here in the office at 430 pm - over the past 3 days pt c/o R arm swelling N at site with 1/30/2009 redness 2-4 1/31/2009 cm non-puritic bump injection, in 24 hours, hot, red, swelling. These symptoms dissipated, then pain into arm toNwrist and under 1/15/2009 arm. TX: 1/15/2009 arm sling, cortisone n in upper outer arm where vaccine administered. Persisting from time of injection, on/off to 1/13/09 was12/9/2008 seen - note 12/9/2008 worse again. Hurts to w pustules on trunk (small vesicular lesions). Y 8/4/2004 1/31/2008 er following injection patient states she Y had erythema and slight burning of right upper arm where Y the ZOSTAVAX 1/13/2009vaccine 1/13/2009 was injected. Ery N 10/4/2008 1/4/2009 1/22/2009 Y Y Y N 1/21/2009 1/22/2009 RA + VARIVAX given on 1/19/09. On Y 1/20/09 seen Y in office for vertigo 1 feeling of weakness in N legs, headache, 1/19/2009 vomiting. 1/20/2009 Was seen in ER in hed) seizure - like episode. Y Y 1/27/2009 1/28/2009 6pm he received his two vaccines HAVRIX Y and FLUZONE. He was well and with his mother.YAt 4am that night### he woke up### in extreme pain er arm swollen and warm-tender to touch. MEDROL dose pak ordered per Dr. Encouraged patient Y to alternate 1/28/2009 heat 1/28/2009 and cool compresses to 4-6 hr > 24 hrs post vaccine red, warm, swollen 3 X 5 cm around shot site Y 1/27/2009 1/28/2009 rhea, mottled, decreased cap refill required. Suspect Y mild virus infection. 4 Note: stool sent to office Y for dsRNA 1/23/2009 rotavirus 1/26/2009 genome testing. 2/1 n has been received from a nurse practitioner Y concerning a 16 year old female patient who on Y 03-JUN-2008 6/3/2008 was vaccinated 6/3/2008with a dose of n has been received for the pregnancy Y registry for GARDASIL from a 20 year old female patient Y who was vaccinated with the first dose of G n has been received from a physician Y concerning Y a 10 year old female 3 Y patient with Y anterior and N posterior 5/8/2008 endometriosis 6/1/2008 and SYNAREL alle n has been received from a physician Y concerning Y a child who was vaccinated 0 with a dose ofUROTATEQ (lot# not available) orally. Child dev n has been received from a physician Y concerning Y a child who was vaccinated 0 with a dose ofUROTATEQ (lot# not available) orally. Child de n has been received from Y a physician concerning Y a patient who was5vaccinated Y with a "booster" U dose of PNEUMOVAX ### 23### (Lot # not provid orted in a published article, title as stated above that a 15 month old patient was vaccinated U with a first and second dose 1/1/2008 of PEDVAXHIB at n has been received from Y a registered Y nurse concerning a 22 week old female patient Y who on N 06-JAN-2009 1/6/2009 was orally 1/6/2009 vaccinated with the n has been received from an investigator Y concerning Y a 3 month old 0female Y who was vaccinated U with a first dose of ROTATEQ. This report n has been received from a licensed practical nurse for the pregnancy registry for GARDASIL Y concerning a pregnant female ###patient with he n has been received from a nurse and the patient's mother for the pregnancy registry for GARDASIL, Y concerning ###a 11/8/2008 15 year old female with n has been received from a registered nurse concerning Y a 14 year old 3 Yfemale patient who onY 16-OCT-2008 was ### vaccinated ### with the first do n has been received from a healthcare Y worker concerning a 17 year old female patient with N no known drug reactions/allergies ### ### and medical n has been received from the mother concerning Y her 13 year old daughter 0 who on 16-OCT-2008 N was vaccinated ###with a dose ### of GARDASIL was received on 27 November 2008 via a search Y of the VAERS database (VAERS Id Number: 317893). 5/8/2008 It was originally 5/8/2008 reported to VAER Y Y 2/2/2009 2/3/2009 very light headed, as though Y I was going to lose consciousness. My finger tips began to tingle, Y as though1/9/2009 they were 1/9/2009 asleep. Then my feet on was administered 11/5/2008, pt presented to the clinic on 11/14/2008 with a rash to the injection Y site that 11/5/2008 was diagnosed 11/7/2008 by Dr. as a loca ceived MMR vaccination on 1/16/09. 4-5 days later patient developed rash. Patient's HbA1c U is elevated but 1/16/2009 unsure if1/20/2009 patient was diagnosed disease, resulting with the Y tx of IVIG,Yafter 6-7 days Y of various invasive 7 testing to rule out other U illnesses. 2/28/2008 2/4/09 ER note 3/5/2008 received for DOS 3 oulder of same side as vaccine administration starting 24 hours after given. Exam consistent U with subdeltoid 1/30/2009 bursitis 1/31/2009 and rotator tendinitis. ed Zostavax on 01/06/2009. She developed Y an itchy painful rash on her neck and an itchy sensitive N area on 1/6/2009 right scapula 2/1/2009 and under her rig o the office on 01/31/09 for inconsolable crying. No cause for the crying found on exam. NoYredness or induration 1/29/2009 at1/30/2009 either injection site. N s later high fever. Next day more seriousY letahrgic, high fever despite several doses of Tylonol U and Motrin, 1/30/2009 vomiting,1/30/2009 listless, non communic
diagnosed 1/09 Y ### 1/22/2009 after administration - Fever, Chills, Swelling Y at Injection site, Aches, Diahreah for 6 days. DR.Yvisit then sent to ER ###for fluids### for dehydration. RSE EVENTS, SYMPTOMS, OR TREATMENT REQUIRED Y 1/26/2009 AY, JAN 30 PAT CALLED STATED YHE FELT ILL, DIZZY, ANXIOUS AND LOSING CONTROL Y OF HIS BLADDER. 1/29/2009 WE 1/30/2009 INSTRUCTED PAT after receiving the pneumonia vaccine Y he had redness appear on his left arm. There is minimal Y pruritus and no pain. The redness is at the s jection site after varicella vaccine in left thigh U 8/19/2008 8/19/2008 es symptoms started at 10 PM on 2/2/09 Y he was trembling, and muscle twitching. then aboutU5:30 AM on2/2/2009 2/3/09 woke 2/2/2009 up sick, dizzy, got up REPORTS CHILD DEVELOPED MIDABDOMINAL Y PAIN, DIARRHEA, AND VOMITED ONCE U STARTING 1/21/2009 1/23/09. 1/23/2009 IT BECAME INCREAS REPORTS TINGLING RIGHT ARM WITHIN 5 MINUTES OF ADMINISTRATION OF IMMUNIZATION Y BY2/2/2009 TIME PATIENT 2/2/2009 GOT HOME WIT Varicella shot given on 1/21/09. HeY had a very bad cold with congestion at the time of injection, U he developed 1/21/2009 an ear 2/2/2009 infection 3 days later hronic headaches that began very soon Y (within days) after first vaccination of Gardasil. Headaches N became progressively ### ### worse and curre n, severe swelling, hives. Told to iceY and take motrin. Still discolored, swollen and painful 2 weeks U later. 1/20/2009 I was offered 1/20/2009 the vacine in the hos ped vasculltic lesions on legs/feet with Y pain/swelling & polyarthralgia onset approximately 11Ndays following 1/8/2008 receipt of 1/21/2008 AVA# 3; diagnosed w broke out in welts. Entire body covered Y above hips, including groin, breast, scalp, ears, face, N back. Accompanied 1/21/2009 by 1/29/2009 intense burning and it ge cluster of pinpoint vesicles with clear fluid on right posterior trunk with surrounding erythema. Y DX: Herpes 11/5/2001 Zoster 1/7/2009 d used topical Neosporin 2 + times per year for many years for minor skin abrasions etc. Patient received9/1/2007 ZOSTAVAX 1/1/2008 9/07 and 1 month la n 12/23. Pt had ache front to back 12/30 and reported to MD. Rash break out under left breast Y 1-2-09, patient said ### all symptoms ### gone exce U ### NG SGT who noticed a single 4mm Yvesicular lesion on her left forearm one day following receipt U of ANTHRAX ### (AVA#4), influenza, ### & typhoi screaming x 48 hrs. Y ### ### staring spells vs sandifer's syndrome. Head tilt and head bowed and eyes rolling back in head U - lasts no more than ### 7-10 seconds. No sleep upper arm flu shot 46 X 44 mm left DTAP 65 X 39 mm right Y 1/7/2009 d a little red immediately after shotsYwere given, area gradually enlarged. By 1/15/09 (2 daysYafter shots)1/13/2009 the area covered 1/15/2009 her left thigh + h er the vaccine neck started to ache. Pain went away for 30 to 40 min. Then pain came back. until now. Pain 2/3/2009 located at 2/3/2009 site. Almost after th ort received on 23 January 2009 through Y literature that in 2008, one child aged 5 months hadYreceived two doses of 11/1/2008 ACTHIB (date of vaccin ort received 28 January 2009 from a consumer Y who is the patient's aunt. 0 A four-month-old patient U with a history of respiratory problems, had dates of adverse events were not recorded Y by me. they started in early December, Y 2007 after N a series of shot ### given12/1/2007 by his pediatrician. My e T 24 hours after shots. Y 1/29/2009 pain, fever, vomiting, perioral- rash, YItching (scalp) > -acetaminophen (rectal) - warm compresses U - ZYRTEC 2/3/2009 2/3/2009 n Tues eve (2/3) pat experienced itching Y woke up w/blistering rash on waist, under breast & U arm pits - itchy 2/2/2009 & red 2/3/2009 vaccine 1/23/09. Febrile seizure 1/30/09 Y Y 1/23/2009 1/23/2009 degree F the day after Tdap vaccination. No other symptoms. Y 1/22/2009 1/23/2009 ZOSTAVAX vaccine approx. 1pm 1/22/09 went to bed approx. 1030 pm that night-had bout Y of very fast,hard, 1/22/2009 heart 1/22/2009 palpitations lasting app adaches, rash prior to immunization documented by doctor at medical center. Not resulted from Y MENACTRA. 1/26/2009 Student 1/26/2009 did not report any s eginning w/; 24 hrs- fatigue. Panesthesia hands on 2/4/09. U 1/28/2009 1/29/2009 ient was given DTap at 10 years of age). 11/5/2008 tous maculopapular spots on torso, legs and arms. Not itchy. Occurred about 5 days after vaccination. Y Resolved ### without treatment. ### No feve p, Hep A at well child cheek 1/7. Screamed all night and again next night. No fever. No other Y source. 1/7/2009 1/7/2009 arrhea for 1 month. Y Y ### ### 30 p.m. I administered MMR and Varicella IM rather than sub q. There were no adverse reactions Y while1/23/2009 client here.1/23/2009 8/28/2008 N 8/27/2008 8/28/2008 p on arm at site of administration. Pt also diaphoretic and sweating all night Y 2/3/2009 2/4/2009 and crying for more than 3 hours. Y ### ### MMR and Varivax on 1/30/09. Came to the office on 2/3/09 with a flat pinkish rash on chest U and legs with 1/30/2009 a temperature 2/2/2009 of 103.8. ed headache, upper torso myalgia approx. 6 hours after vaccine. Symptoms lasted approx 48Y hours. 1/12/2009 1/12/2009 derwent surgical debridement of necrotizing Y faciitis Y at the site of immunizations. 7 Discharge to Y home today 1/27/2009 on oral antibiotics. 1/27/2009 d vomitting, diarrhea, and low gradeYtemp withiin 12 hours of vaccine Y 2/3/2009 2/4/2009 ve weakness and muscle atrophy in lower extremities, Y L>R with intermittent 4 parathesias. 3rdNvaccine given 9/9/2008 around 9/12/2008 Sept. 9 and unusaly gat eloped fever of 103 and vomiting on Wenesday 1-28-09 lasting until Thursday 1-29-09. Treated Y herself symptomatically 1/27/2009 1/28/2009 and did not seek m urned to clinic 1/29/09 with child. Noted edematous/reddened upper Right arm. Extremity freely Y mobile;child 1/27/2009 complained 1/28/2009 of pain & itching a ed of fever last night (2/3/09)and today complains of sore throat, red spots on neck,trunk andUarms. Acyclovir 1/26/2009 200mg 2/3/2009 every 4 hrs ordered. B
S A VACCINE WAS ADMINISTERED Y IN LEFT ARM, THEN GARDASIL VACCINE WAS ADMINISTERED Y 2/4/2009 IN RIGHT2/4/2009 ARM AND APPROXI pneumococcal vaccine trial, with severe COPD, Y was hospitalized with COPD exacerbation. YVaccination took 1/2/2008 place 1/15/2009 on 1/02/2008. Accordin NER L EAR AND CHEEK. LOCAL REACTION TO INJECTION SITE- REDNESS AND SWELLLING. TO TAKE 5CC OF BENDADRYL Q 6 H nted after vaccines Y 2/4/2009 2/4/2009 ordered pneumo vaccine. patient given varicella Lot # 0994X Exp: 11 July 2010 U 2/4/2009 2/4/2009 o 104 24 hours after vaccine administered. Y Also had runny nose and mild cough. No rash. U 2/2/2009 2/3/2009 er on the inside, left lower lip. No other adverse reaction noted approximately 24 hours postYinjection. 2/3/2009 VAX administered at 10:00a on 2/4/09 Y at Pharmacy to patient. Wife called at 3:30p and reported N husband 2/4/2009 is experiencing 2/4/2009 excruciating pain cine administered IM in right deltoid instead of SQ 2 calls made to pt 2/4/09 for f/u - no answer Merck contacted2/2/2009 indicated 2/2/2009 vaccine may be wheezing 01 hour after Influenza vaccine. Y 2/5/09-records received for 11/5/08-presented toYER with skin11/5/2008 rash. DX: 11/5/2008 acute allergic reaction t redness and swelling in Lt arm. Had Tdap & flu vaccine in same arm. Y 1/26/2009 1/26/2009 rts that patient had sudden onset ofYepisode of "stiffness" tonic state x 2-3 sec. Followed byYgeneralized1/27/2009 clonic-like1/27/2009 seizure activity of abou zed reaction Y 1/22/2009 1/22/2009 s after vaccine given (given 1/30/09). On 2/1/09 pt. developed "hot, itchy, burning flue rash U on thighs, abdomen 1/30/2009 & back 2/1/2009 of knees- Denies raised tender erythematous reaction at injection site. N 2/2/2009 2/3/2009 of blanchable erythema across left thigh Y spreading laterally to medially. Not tender no induration. Treated 1/29/2009 with antibiotics in ED- discontinu was reported by a healthcare professional and described the occurrence of intramuscular formulation U administered 1/23/2009 1/23/2009 by other route in a 2-m was reported by a physician via a sales representative and described the occurrence of injection Y site redness in a subject of unspecified ag was reported by a healthcare professional and described the occurrence of high erythema inY a child subject 1/1/2009 under the 1/3/2009 age of 6 years and o was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject 1/12/2009 under 1/13/2009 the age of 6 years and was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject 1/5/2009 under the 1/6/2009 age of 6 years and was reported by a pharmacist and described the occurrence of injection site redness in a 35-year-old Y female subject who was vaccinated w n has been received from a licensed Y practical nurse (L.P.N.) concerning a 24 month old premature Y born 12/5/2008 male (2 month 12/6/2008 early) with asthma w n has been received from a physician Y concerning a 42 year old female with multiple Y sclerosis N who on 29-JUL-2008 7/29/2008 was vaccinated with a d n has been received from a 19 yearYold female patient who on 27-JAN-2009 was vaccinatedYwith first dose 1/27/2009 of GARDASIL 1/27/2009 (Lot # not reporte ned in March of 1987 I was Y a healthy teenagerYwith records to prove it. SometimeY between March N and May 3/20/1987 of 19873/20/1987 I received several vacc eceived ADACEL vaccine Y on 11/20/2008 On 12/01/2008 Y he presented 6 with leg numbness Y and tingling which was ###progressive. ### Urgent refer me vaccine reaction. The injection triggered a flare up of pts underlying reflex sympathetic dystoptry. n, hoarse throat 3 hrs after AFLURIA administration. Y Treated with BENADRYL and SOLUMEDROL U and felt better. ### al reaction 10X18 cm around injection site. Area is red + indurated + warm to touch 1/28/2007 dness, swelling + warmth at the injection site (right upper arm) Y 2/3/2009 2/5/2009 ctivity at 3-4 minutes duration with eyes Y rolled back, not responsive to parents. Temperature Y104.2 F rectal 1/30/2009 at urgent1/30/2009 care center. No preced gic to eggs, and vaccine compoents.YSevere stomach cramping, vomiting, headache, dizziness Y which lasted for### 2-3 days ### oped rash bilaterally over both thighs According to mom and maternal grand mother the maculopapularv U 1/30/2009 rash started 1/30/2009 from the the sites =o dness and swelling in arm from injection Y site into elbow Y 1/28/2009 1/30/2009 nted to the family practice clinic on 1/27/09 withYcomplaints of fever x1 1 day. Infant was fussy and Y difficult to 12/1/2008 console, 1/27/2009 and was refusing breas rgic skin reaction. U 2/2/2009 2/3/2009 nset of lethargy and vomiting. Y Hospitalized Y for Y lethargy, to rule out sepsis. 3 Continued vomiting Y lead to diagnosis 1/29/2009of intussussception. 2/2/2009 Succ ports adolescent having hives on hands,knees and feet that began approximately 2-3 days past N receiving1/22/2009 vaccines on 1/24/2009 1/22/09. Also reports gan febrile episode on 1/31 with fever Y up to 102.4 F lasting 3 days. Patient was taken to physician U and 1/30/2009 upon examination 1/31/2009 no signs of infec arm erythema area on rt. arm extending from deltoid to elbow. no blisters. extends around arm. U Client has2/2/2009 red hair and 2/4/2009 very fair skin. h pt on Tuesday 2/3/09 she was administered the HPV vaccine about 4 hours later a rash devloped Y on her 2/3/2009 back that 2/3/2009 grew to cover the maj mplains of severe pain in left arm when lifts the arm, since first injection given N 12/8/2008 12/8/2008 ythematous tender reaction right arm Y 1/2 diameter. No complication Y 2/2/2009 2/3/2009 s administered Hep A in right deltoid and menactra right lateral arm and PPD implant right forearm Y at around 2/5/2009 4:55pm.Erythema 2/5/2009 and few pa e localized reaction at injection site including erythema, hives, itching. Given benadryl 25 mgYp.o. and ice 1/29/2009 to area. Reaction 1/29/2009resolving 25 m cieved HAV#2 on 2/3/09, went home Y and had aY3hr nap, mom woke1patient and noticed coughing Y and wheezing, 2/3/2009which 2/3/2009 continued through generalized seizures with fever. He Y had one seizure by report previous to the vaccination. This Y was a five-minute 1/29/2009 seizure. 2/3/2009 we had at least TERED IN LEFT DELTOID ON 2/4/2009; Y WITH IN 3-4 HOURS EXPERIENCED SEVERE PAIN IN DELTOID 2/4/2009 MUSCLE, 2/4/2009 JOINT OF LEFT S e client had within 24 hours: Fatigue, lethargy, loss of appetite and general weakness. Y 5/2/2008 5/3/2008 ble crying X 8 hours Y 12/2/2008
ver body. Got shot yesterday. RashY today. Y 2/3/2009 2/4/2009 warmth, swelling around site of 2 injections. Y Started 2 days after vaccines given. No fever. UPrescribed oral 2/2/2009 antibiotics, 2/4/2009 BENADRYL, MOTR nt dad who said skin was bumpy for a day or two but has gone away. No treatment. Y 1/13/2009 perienced a vasovagal response to HPV. Duration was 4-6 seconds. BP at 09:30 60/40 pulse-50, Y at 9:45 62/40 ### p-52, BP at ### 10:00 72/40 pox rash site 2/2/09 - No other symptoms. U 1/15/2008 2/2/2009 rm & chest with + urticarial patches Y+ 2 cm swelling @ injection site lungs clear- no wheezing Y Given SOLUMEDROL 2/2/2009 2/3/2009 125 mg IM. ALBUTE and lethargic and poor feeding. Hospitalized Y - Hydrated. Y 1/17/09 MR 2 received for DOS 1/29-30/2009 Y with 1/27/2009 D/C Dx: Sleepiness 1/27/2009 after immun se reactions known patient was sent a letter by mail. Patient has no working phone number. U 2/4/2009 ight eye to be a "little pink". Went toYstation and was prescribed VIROPTIC and ILOTYCIN drops. 01/26/2009 1/15/2009 the right 1/23/2009 eye was worse (sw veloped hundreds of vesicular and papular lesions, described as "itchy", on trunk and LE. U 1/27/2009 2/2/2009 3, hearing loss, sleep disorders, neurological Y problems, Y headaches,1muscle jointYpains, fatigue, N muscle spasms, recurring 7/2/2008 skin lesions, chil ent, hearing loss, scoliosis, sinus,high Y blood pressure, Y tinittus, rhinitis, 6 sleep disorder, Y headaches, N muscles 1/12/2003 joint pain, muscles spasm, recu n has been received from a physician concerning a male patient who is 20 months at present Y who received his first dose of ATTENUVAX, n has been received from registered nurse concerning a 42 year old female nurse who was U vaccinated with a second dose of ATTENUVAX n has been received from a pharmacy student concerning an adult female patient who was vaccinated U with four doses of ATTENUVAX vac n has been received from a physician concerning a 2 year old male who on 26-JUN-2008 was N vaccinated 6/26/2008 with ATTENUVAX 7/4/2008vaccine (Ende n has been recieved from a consumer concerning her 8 month old son who on 29-APR-2008Nwas vaccinated 4/29/2008 with a4/29/2008 dose of MMR II. Suspe n has been received from a 62-year-old female physician, with a history of hepatitis B and an U allergy to penicillin, 2/1/1997who 4/25/2008 in February 1997, wa n has been received from a registered nurse concerning a 24 year old female who was vaccinated Y with ATTENUVAX. The nurse mentione n has been received from a nurse concerning Y a 13 month old male with no pertinent medicalNhistory, drug4/4/2008 reactions or allergies who on 04n has been received from a nurse concerning Y a 16 month old male with no pertinent medicalUhistory and3/20/2008 a milk allergy 3/27/2008 who on 20-MAR-200 n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008 history or allergies, 3/29/2008who on19-MAR n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008 history or allergies, 3/29/2008who on 19-MA sy developed 17 DEC 08 2/17/09-records received Y for DOs 12/22/08-Released 6 form hospitalYafter exhaustive investigation ### ### into sudden left f n has been received from a Registered Y Nurse concerning her 22 year old daughter who on 27-OCT-2006 Y was ### vaccinated 3/2/2007 with first dose of n has been received from a doctor of Y pharmacy for the pregnancy registry of GARDASIL concerning U a female patient who on an unspecifie ### N ### ### swelling due to tetanus toxoid. Vaccine was not administered at this facility, so very little information can be reported. Patient just reports a got the vaccine I didn't have any pain Y or swelling. The next day (Saturday) I had a little soreness. Y As the1/30/2009 day progressed 1/31/2009 the pain got worse received a Tdap vaccine in the left deltoid muscle on 02/02/2009 at 1100. The next day sheU had an approx 2/2/2009 6" red, 2/3/2009 swollen, warm to touch hours after rec'ing the MMR shot our son began to run a low grade fever 99.7, vomiting, irritable U mood. We 2/5/2009 informed2/6/2009 the doctor's office and und alert but shaking in bed at a group Y living setting and then vomited. Evaluated by medical Y staff there and 2/4/2009 sent by2/4/2009 ambulance to local ER arted receiving Anthrax vaccinationsYin 2007 and has had a total of 4 shots. He has had jointUpain, in all joints, 3/1/2008 feeling "achy" after each inje accination site and over entire body. U 1/26/2009 1/26/2009 Vaccines on 2/3/2009, and rash started 2/6/2009 from neck down. Advised mom to give patient U Benadryl 2/3/2009 every 6 hours. 2/6/2009 f left thigh. Hospital admission IV antibiotics. 3/23/09 Y Received hospital 2 medical records of 2/4-2/5/2009. Y 2/3/2009 FINAL DX:2/4/2009 left thigh cellulitis Rec B vaccine administered. 0845 Client still in building came to my office stating her RT arm was Y breaking in2/6/2009 rash and itiching 2/6/2009 real bad. Denie noted to get red, swollen & splotchy in the evenings since Vaccine given - looks fine in the AM, Y when this 1/26/2009 is noted he 1/26/2009 states that entire thig up with patient around 2-3AM on 01/30/2009 Y and Y no problems. When 2 mom was up with patient Y around 1/29/2009 6-6:30AM, 1/30/2009 he had a fever of 103.5 d a hard time walking the day after Y her immunizations, Y she seemed3stiff and sore. Then again, U a week after 1/6/2009 her immunizations 1/12/2009 she had tro vaccine, left deltoid became red andYswollen. Tender and warm to touch. Over the next several U days signs 1/9/2009 and symptoms 1/10/2009 progressively w ented w. generalized hives on neck, chest and general body 3 days after immuniaztions Y 2/2/2009 2/5/2009 ven pneumovax shot (I.M. Right Deltoid) on 2/5/09 @ 1415 in his home. Pt. called clinic this morning and2/5/2009 left a voicemail 2/5/2009 reporting that he 0 MIN. AFTER SHOTS, BABY BECAME LETHARGIC WHILE BEING HELD IN DAD'S ARMS, Y HEAD DROOPING 1/21/2009 DOWN. 1/21/2009 sHE WAS LAID nted immediately after first shot. Has Y experienced Y extreme fatigue,memory 2 loss, trouble concentrating U and 8/20/2007 after the8/20/2007 third shot started exper me of Gardasil vaccine, but one year later adverse immunune system problems that included strep throat, 10/9/2007 urinary tract 6/1/2008 infections,treated fo fter my 2 month old son received the Y rotavirus vaccine with his other 2 month shots he has had N bright green 1/19/2009 diarhea1/20/2009 since, on a daily basis booster anthrax on 2/2/09. On 2/3/09 soldier presented with injection site erythema and itching. Y Treated with 2/2/2009 antihistimine. 2/2/2009 On 2/4/09, sym ped L sided seizures 24 hours after receiving PENTACEL, Y ROTATEQ 3 and PREVNAR. EEGUis abnormal, 2/4/2009 so likely not2/5/2009 vaccine related. Pt w arted to feel tingling sensations on back starting about 01/11/09. These symptoms Y continuedNto manifest until blotches ### 1/11/2009 appeared on the skin se events. Medication given PENTACEL and ACTHIB given at same time, reporting medication. 2/2/2009
l pain within 5 min after vaccine & urticaria 10-15 min after vaccine. Used BENADRYL withYrelief. 2/6/2009 2/6/2009 rted severe local reaction at R leg, very red and swollen x 7 days, would not wear clothing over Y it and very 7/16/2008 bothered7/18/2008 with discomfort x 1 we over. Hives. No respiratory problems. No other problems. 2/3/2009 2/4/2009 le pt. presents to clinic with "infection Y at primary SPV site." Pt. reports receiving primary SPV (left upper7/14/2008 arm) on 7/14/08, 7/23/2008 at same time wit irst Anthrax vaccine and a Typhoid immunization on 4 April 2008. That same night I noticedYa reddish, warm 4/4/2008 lump the 5/14/2008 size of my fist on the le with possible adverse reaction toYSmallpox Vaccine. 2/10/09 Office note received from reporting Y MD. Pt 9/24/2008 seen 10/6/08 9/29/2008 with c/o L arm pain nt is a 38 year old female. Source of patient information was patient. Source of patient information Y was 10/3/2007 medical records. ### Received second male with hx of hospitalization s/p AVA #6 for Y pericarditis/pericardial 5 effusion July 2004, concerned Y receiving 5/10/2004 further 7/1/2004 doses of AVA. PCP co male, spouse of retired SM presents to FBVHC with report of developing a rash "hives" on both Y arms and5/19/2008 legs within5/20/2008 24 hrs of receipt of Tda welling, discoloration, soreness, swelling would be three times the size of opposite shoulder. U 2/4/2009 2/4/2009 ceived ROTATEQ ON 1/12/09. She is breast fed. On 1/13/09 mucousy stools were noted. Y On 1/20/09 1/12/2009 stools were1/13/2009 dark, tarry and heme-p d emesis and cyanosis a few hours Y after flu vaccine. Valvar pulmonic stenosis with 50mm gradient. Y 1/22/2009 1/22/2009 ent phoned in and report he had a reaction Y to pneumonia injection given 2-5-09 here @ PCHD. U Instructed 2/5/2009 client to take 2/5/2009 BENADRYL OTC a e, fever 104, red, swollen injection siteY less than 24 hrs. Patient irritable + crying frequently. YInfluenza site: 2/3/2009 Normal. 2/3/2009 symptoms began on 1-27-09 With client experiencing flushed face, tired, external chills, weakness Y + sharp 1/26/2009 shooting 1/27/2009 aches + pains to all ext IVAX vaccine, developed varicella 20 days later. U 1/15/2009 2/5/2009 izures, temp 103.2 degrees. Y Y 2/2/2009 2/3/2009 rm "tingling", numbness & difficulty Y with any weight bearing L upper extremity. Symptoms started U approx 5-> 6### hrs after injection. ### patient developed fever 101 @ home Y around 10pm 1/31/09- given dose of TYLENOL- shortly Y after pt had 1/30/2009 jerking +1/31/2009 shaking, eyes rolled ba Y ### arm with 10x7 cm faint erythema surrounding 3x3 cm induration with control puncture mark.U Area is sensitive 2/3/2009 to touch. 2/4/2009 et of redness, pain, swelling an painY with movement of RUE. Prescriptions of MOTRIN, PREDNISONE, N DIPROSONE 2/3/2009 2/5/2009 CREAM, DARVOCE , indurated area left arm. BENADRYL, Y IBUPROFEN, ice Y 2/4/2009 2/5/2009 s, arm pain, warm to touch, and swelling 2/4/2009 2/4/2009 large hive appeared first on leg, then hives spread over legs and trunk. Concomitant fever Y lasting 5 days. 1/21/2009 1/29/2009 ately 5 minutes after immunization was Y administered, pt. stated that he felt lightheaded, fell back Y against wall, 2/6/2009 and exhibited 2/6/2009 seizure-like act ulitus requiring hospital admission for 1 1/2 days. Y r arm swelling beginning 2 48 hrs after administration, Y DTap 2/2/2009 and Var given 2/4/2009 in r arm. L arm w cus in mouth, wheezing,difficulty breathing, fever behavior changes. fever showed up day ofUshot. and other 2/5/2009 symptoms 2/6/2009 showed up the next t at least 25% of my hair. I have never Y experienced this type of hair loss before the shot, andNam not under 1/10/2008 any major stress. I had my last s rmation was received on 29 OctoberY2008 from a manufacturer whose initial reporter was a health care professional. A patient experienced rmation received on 29 January 2009 Y from a health care professional. A female patient with a history of diabetes, asthma, and an allergy to n has been received from a health professional concerning a 77 year old white female patient U with sulfonamide 3/1/2007 allergy 1/22/2009 who on 1-MAR-2007 n has been received from a physician concerning a 61 year old female with sulfonamide Y allergy N who on 1/29/2009 29-JAN-2009 1/30/2009 was vaccinated SC w n has been received from a pharmacist concerning Y a 71 year old female 0 Y with a history of shingles N 2 years6/9/2008 ago and no 1/25/2009 allergies, who on 09n has been received via a literature article regarding Y a case in litigation 0 Y concerning a male who U at 2 months of age was 3/30/1998 vaccinated with RE n has been received from a consumer Y concerning her 6 year old son with no medical historyNand drug allergies who was vaccinated with th n has been received from a consumer concerning a 7 year old male who was vaccinated with N a dose of MMR II on unspecified date. Soon n has been received from a consumer who was the relative of a male patient whoY "about 50Nor 60 years ago" was vaccinated with a dose o n has been received from a consumer concerning her relative who was now a 63 year old male N who was vaccinated with MMR II (mfr. unkn n has been received from a consumer concerning her relative 3 year old daughter with symptoms U of autism who was vaccinated at 1 year o n has been received from a physician's assistant concerning a 17 year old female Y who "within U the last month and ###a half", on approximately n has been received from a certifiedYmedical assistant concerning a 22 year old female Y allergic N reaction 1/11/2009 to LEVAQUIN 1/18/2009 who on 17-NOV-200 n has been received from a nurse and Y a physician for the pregnancy registry for GARDASILYconcerning 8/31/2007 a 15 year old4/9/2008 female student with n 0 the pt received HepB #1 and the Meningococcal Y Vaccination in preparation 1 for college entrance. U On 7/17/00 6/16/2000 the pt 7/17/2000 suffered a seizure and RDASIL shot series, It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008 a change in my vagin had second shot of GARDASIL and is having bad headaches, pain in the abdomen, nausea,Unight sweats, 2/3/2009 depression, 2/3/2009 lower back pain. H es, fever (>100 degrees), chills-onset 8 hrs. After administration of FLUZONE. Lasted over night, Y until next A.M.### Took Tylenol ### po. swollen, red, and hot to touch around Y area where VARICELLA was administered. Pt statesYpain has worsened. 2/2/2009Advised 2/4/2009 pt to go to doctor f vaccination developed rash on trunk. Parent thought possible hives. Advised BENADRYLYpo dose. No 1/19/2009 other symptoms. 1/19/2009Rash resolved es on both arms & trunk day after injection - resolving with use of OTC catesine cream Y 1/28/2009 1/29/2009 2008, family medicine--Got shingles vaccine around 2:00pm in my upper right arm; given by medical Y assistant II. ### She had ### taken my temper
r imm. child had fever 101, rash veryY red and much more prominent than usual. No vom or diarrhea. Y Took 1/27/2009 to doctors 1/28/2009 office at 11 AM. Doc complained of pain in her R arm with pain radiating from shoulder to hand the morning of 1/28/09. U This 1/26/2009 pain is still 1/28/2009 present > 1 week after v complained of pain in her entire R arm the afternoon of 1/28/09, approx 2 days after vaccination. U No radiating 1/26/2009 pain-just 1/28/2009 persistant pain in h ent to receive the 3rd shot of GARDASIL. Y The person who administered the shot squeezed patient's arm1/21/2009 and stuck 1/21/2009 the needle in her arm a 01 degrees F > Broke out in Hives > Pt. called into H. Dept 9/23 c/o of these symptoms did not U seek medical 9/22/2008 care- Never 9/23/2008 returned phone c swelling, pain. Y 1/20/2009 1/21/2009 Y Y 4/28/2008 1/22/2009 d dog bite in am and needed booster Y td was given tdap approx 10 am in rt delt im.pt states about U noon his2/6/2009 rt upper arm 2/6/2009 and rt shoulder star s soon as injection given then later that day large reddened area looked like a hive about theYsize of baseball 11/4/2008 which 11/4/2008 lasted several days. n Monday, February 2, 2009. Per patient: Y Tuesday night I could barely move. Sore all over, kinda Y like a flu2/2/2009 ache but much 2/3/2009 worse. Wednesd HROUGH CHICKENPOX FEBRUARY Y 2009. RECEIVED VARIVAX 8/1/2003 AND PROQUAD 8/18/2006. 8/18/2006 2/5/2009 d spread of smallpox due to drying self with towel that may have had possible contact with vaccination U area. 1/29/2009 2/10/09 Per 2/5/2009 reporter-pt was no d yellow fever vaccination 05 Feb09. Y After recieving the injection, pt experienced dizziness, confusion, N nausea, 2/5/2009 and blurred 2/5/2009 vision x 4 days. ed in and states that child has chicken pox despite receiving the vaccine on 05/24/2002 Y 5/24/2002 2/8/2009 er vaccination, varicella-zoster virus-like rash and symptoms. Y ### 1/28/2009 nced shoulder girdle pain for 3 days followd by arm weakness and serratus muscle paralysisNwhich has 11/4/2008 not resolved as of### today. Pt had a s started with "strangled cough" Y and Ybody aches. Y 12/12/2008 Had severe 6 vomiting and diarrheaN extremely weak ### and12/3/2008 barely could walk-no s per and lower extremity swelling and erythema when extemities are warm. Cyanosis of the swollen U extremities 2/5/2009 when2/7/2009 they are cool. Also fac r entire body that itches. Zyrtec 1/2Ytsp q12hrs. given to treat symptoms as needed to help with Y itching. 2/2/2009 2/8/2009 ntracted cellulitis in his left leg, afterYreceiving 3 vaccinations in that leg. He had to be treated U at the ER 38 2/4/2009 hours after 2/4/2009 receiving the vaccin headaches and numbness in left arm, Y fingers, chest and leg starting after HPV #1(7/8/08), which N were annoying 1/22/2009but 1/22/2009 tolerable. Now experie esented to clinic with mother (MOC)Yto receive 4 month vaccinations. During the screening process Y MOC stated ### that infant ### became extrem (48 hours later) Low-grade fever after Y treatment with Tylenol/Ibuprofen lasting at least 5 days, U Mild Rash, 2/3/2008 Lethargy, 11/5/2008 Listlessness, Fussine slightly swollen red rash (approx. 1.5 inches in diameter) was noticed on my upper arm at theYsite of the vaccination 2/2/2009 about 2/3/2009 24 hours after be ed rash at injection site, fever Y Y 1/29/2009 2/5/2009 U 2/9/2009 swollen, & rash around vaccine area notice on 2/6/09 taking bath, on 2/7/09 & 2/8/09. The rash U went away 2/6/2009 redness 2/6/2009 swollen 7cm x 6cm on 1/10/2009, red bumps appeared onY back of hands + face - total E2Y changed to - 5 pustules Y resolved after one ###week 1/10/2009 s noted to have Red spots first on arms, Y trunk and then legs. Rash lasted 5-6 client was taken to ER with1/22/2009 104. fever,1/22/2009 client TX for pneumoni elling, rash prescribed Orapred andYgiven Benadryl at ER Y 2/6/2009 2/6/2009 n 25-09 2-6-09 fever (elevated to 104.7 Y rectally - ER notes) lethargy > febrile seizure Y 2/5/2009 2/6/2009 ace, neck, groin area, back, and torso. Y Y 2/3/2009 2/3/2009 student came in with c/o R hand reddness at the nails. Started with 2-4 fingers then extended U to 4th + 5th 1/16/2009 fingers, 1/21/2009 slight edema, mild tend hills 5 hours after vaccine, lasted 4 days. Y 2/4/2009 2/4/2009 ays fever and runny nose. 12 days-rash-head, belly, arms and legs. Itching. Improvement atN15 days. 1/26/2009 1/30/2009 hargic 10 minutes after the infection chills immediately after injection. U 2/4/2009 2/4/2009 rs after vaccine pt broke out in hives all over hands and face on and off x 3 days. Given Benadryl Y with relief. 2/4/2009 2/7/2009 ministration the patient had a vasovagal response. She was sitting on an exam table was brought Y to a recombant 2/6/2009position 2/6/2009 and recovered w ed clinic on 2/6/09 (injection given on 02/4/09) stating after third HPV injection she experienced U mild swelling 2/4/2009 @ site 2/5/2009 with moderate pain an ates she had a S/E of right arm pain from upper arm down her arm which lasted 5 days, It was Y hard for her 1/15/2008 to lift her1/15/2008 right arm over her shou /09- Rx scarred immediately - dizziness, Y 1/31/09 Temp 103 redness- swelling and warmth. Decreased Y appetite. 1/30/2009 Dizziness 1/30/2009 relieved by antiv ted to ER c/o arm soreness radiating Y to head. Increased soreness over WE. Pt noted mobileYfirm module1/22/2009 (L) elest @1/26/2009 collar bone. MD's note ted to office with erythema & ederma @ below the sight of the injection, pt also developed fevers Y for 2 days 1/23/2009 post injection1/23/2009 treatment was B swelling at injection site. Y 1/14/2009 n has been received from a gynecologist, concerning a 21 year old female patient with history U of pollinosis 3/13/2008 who was3/28/2008 vaccinated with a third dy aches, anxiety, high Cholesterol, Y concentration difficulty, constipation, crampsYarms, depression, digestive problems, ### dry ### mouth, energy iving the vaccinations, the patient was hospitalized Y for six days. The6 patient's symptoms included Y vomiting, 1/23/2009 diarrhea, 1/25/2009 fever. 5/7/09 - Hosp r rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient N with no 8/24/2007 reported past 8/24/2007 medical history rec rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient U received 1/31/2009 MENACTRA 1/31/2009 (lot number U2824 n has been received from a physician Y concerning Y a female patient who 2 on unknown date was Y vaccinated8/16/2008 with the second ### dose of GARDAS n has been received from a nurse who reported Y that she received an 0 email from a former employee U of theirs, who stated in the email that "a
n has been received from a physician Y concerning a 14 year old female who was vaccinated Y with the first dose of GARDASIL. Subsequently n has been received from a consumer concerning her 5 year old daughter with penicillin allergy Y who was vaccinated with MMR II (lot numb n has been received from a nurse practitioner and a female consumer with drug hypersensitivity Y N (No otherwise 5/23/2008 specified) 6/30/2008 who on unspecifie 2/4/2009 2/4/2009 n: PENTACEL. persistent fever- 3 days of 100-102 degrees. Red blotch around shot site 3 inches in diameter and beginning to spread to th es child started becoming grouchy. Y Appetite decreased. Few days later noticed left side of face/jaw Y swollen. Went ### to1/23/2009 Doctor-who was sure 09 patient presented to Urgent Care with c/o crying, Y low grade fever, 7 vomiting, diarrhea. Was Y admitted to 1/20/2009 hospital with 1/26/2009 diagnosis of Gastroe es child was dizzy, nauseated and right Del red swollen, redness under arm as well and is painful. N 2/4/2009 2/5/2009 ceived KINRIX (DTap and IPV) to left medial thigh and Flu to left lateral thigh 2/6/09. MotherUnoticed itching, 2/6/2009 redness 2/8/2009 and swelling at media notability, poor feeding, lethargy and Y sev. min. of 1 y twitching. T 100.3 F in office on 10/19/05, Y and nl exam. Back ### to self### by 10/20/05 per eadache pain. 2/18/09MR received Y from PCP including vax rec and numerous consultations.NInitially c/o 8/30/2007 with visual changes 9/1/200710/3/07. PE (+ eadache, head congestion, chills. N 2/5/2009 2/5/2009 at sight and swelling of leg - right leg Y 2/6/2009 2/7/2009 I am having an adverse reaction to the Anthrax shot I received on Sunday (8Feb09). I haveUbeen experiencing itching 2/9/2009 from the spot where ccinated on Friday 2/6/2009 at 11:45am and then approx. 12 hours after vaccination at 1:30am, Y patient had 2/6/2009 102.5 temp 2/7/2009 with chills, sweats, ced redness around neck later in day Y after vaccinations.Pt has a pink-red collar-like ring around U neck. Given 2/9/2009 Benadryl2/9/2009 in office. stered on 01/29/09 left deltoid area.Returned to clinic 02/02/09 with complaint of left deltoid redness Y 6in/5in, 1/29/2009 erythema 1/29/2009 with warmth and sligh HAS A RASH ON HIS FACE, BOTH Y ARMS ON THE DELTOID AREA, AND A SMALL PATCH U ON HIS CHEST. 1/29/2009 2/8/2009 with 2 1/2" x 1 1/8" erythematous area, warm to touch. (+) pain when touched; (+) itching. Patient's Y mother 2/4/2009 noticed a2/5/2009 small erythematous a nt present with a Swollen and red upper left arm that felt hot to the touch. She denied having Y a fever but1/30/2009 stated her arm 2/2/2009 really hurt a lot. S ately 2 hours (10:00 AM) after receiving 2 immunizations (hepatitis b and Tdap) the back of Y her left leg began 2/9/2009 to have2/9/2009 a burning sensation. m firm cystic lesion on Rt leg at sight of injection Y ### 2/4/2009 event fifteen minutes after vaccine admin. Y 2/7/2009 2/7/2009 ry lymphadenopathy: swollen, tender. Y There was no source of infection, so I had mammogram Y plus ultrasound 1/28/2009 done. 2/6/2009 Multiple suspicious no gan having frequent UTI's after firstYHPV. Then after second got yeast infections every 2 weeks and tingling 1/17/2008 in fingers 1/17/2008 and toes. After third ates had problems with "legs Y giving Y out and weakness." Y Noticed symptoms 5 on 1/27/2009 and Y went to emergency 1/15/2009room. 1/27/2009 Patient states was ed 1 Jan 1992. Approximately Y 30 min Y after receiving Y Typhoid vaccine, 5 member developed severe Y headache, 1/11/1992 vomitted, 1/11/1992 and notable respirat ain after injection. Few minutes later severly dizzy and disoriented. Blurred, splotchy vision. UStill have pain 2/9/2009 in arm to 2/9/2009 which it was administe started on face 8 days after MMR shot, fever, runny nose. Rash spread to back and then next N day to the 1/29/2009 stomach. Today 2/6/2009 he has been claw hour of arriving home from the vaccines, Y patient went down for a nap. He woke up screaming. U As I tried 9/11/2008 to console him, 9/11/2008 give him tylenol, an h: The HPV vaccine Gardasil Y was administered Y Yon January 15, 2009. 10 Y Thirteen days later andYfor 3 days has 1/15/2009 vomit, dizziness 1/28/2009and cephalgia was reported by a law office and described Y the occurrence of shoulder pain in a Y male subject U of unspecified 6/23/2000 age who8/1/2000 was vaccinated with ately two hours after receiving Tdap right arm became numb from shoulder to the hand. No redness Y or swelling 2/10/2009 noted. 2/10/2009 ght child to office 4 days after 1 z given child L thigh was pale red over entire upper area (5"x5") Y stated wasn't 2/5/2009 hard but 2/7/2009 mom stated that be to right upper arm Y 2/6/2009 2/7/2009 shots on Feb 02, 2009 - namely PEDIARIX #3, YHIB #3, PREVNAR #3, 3 ROTAVIRUS #3 and Y FLU #1 - 3 days 2/2/2009 later with 2/6/2009 fever, resp. problem miting x 2 days, lethargic,Y poor PO. Y Seen in hospital Y ED 2/8/09. Admitted, 9 Y had diagnostic laparoscopy Y with1/6/2009 ileocecectomy. 2/8/2009 Dx with intussusc r headaches on 1/21/09 - Seen again Y on 2/7/09 when mother told dr she is concerned this isUrelated to the 7/11/2008 HPV vaccine. 11/1/2008 got related inform d to vomiting and diarrhea - But no fever. Y 2/9/2009 2/9/2009 area of ERYTHEMA U 2/9/2009 2/9/2009 trician who saw Pt in office on 2-5-09 Y - noted 4 cm round Erythematous area to upper (L) arm. Y No induration 2/3/2009 or pain with 2/5/2009 palpation- no crus U 2/6/2009 2/6/2009 hite male ADSM is referred for persisting Y lesion at initial SPV X6 months. Symptoms : Nodule, U subcutaneous, 8/13/2008 Erythema, 9/13/2008 Pain, Lesion, Pust after receiving DTaP, HIB and Influenza, Y patient had a febrile seizure. U 2/10/2009 2/10/2009 ped a pruritic rash starting the day after receiving 2nd GARDASIL vaccine. No work up done. Y Rash on torso 9/19/2008 area. 9/20/2008 Treated with TRIAMCIN dache for 2 days. -Welt at injection site, patient describes as 3 in long & 1 1/2 in deep, patient Y has taken BENADRYL 2/5/2009 2/6/2009 & the welt has decrea stration of vaccine. 2/10/2009 back to clinic with report of "some pain at (L) arm site" immediately after second injection + "around" U 2am 2/2/2009 this morning 2/3/2009 (2-3-09) - Pt c/o ons 007 Child received DTP #4 Polio #3 at Pediatrician's office- seen in our clinic today- Red rash, large welts2/4/2008 torso & extemities 2/5/2008& face- started suppose to receive MMR and received MENACTRA instead. This was done in error by the M.A. U Dr. has reported 2/4/2009this to our local health De dose Amox 2-5-09. C/o HA + nausea Y on 2/6/09 with some soreness and stiffness to (R) armU- 2/7/09 C/o 2/5/2009 tiredness +redness 2/6/2009+ warmth to (R
ic Reactions - Redness, swelling, possible Y development of blisters. U 2/6/2009 2/7/2009 ceived vaccines at approximately 1:45pm. Y Mother reports "Child got really quick in back seat of car, mom 2/2/2009 turned to check 2/2/2009 on him , his face er became very ill when we left the office. Y Complained of headache, stomache ache, had a fever, Y could not 1/26/2009 keep balance. 1/26/2009 Within 8 hrs I had n has been received from Y a physician Y with had hay fever who on 02-FEB-2009 vaccinated himself Y with a 2/2/2009 0.5 ml first dose 2/2/2009 of PNEUMOVAX n has been received from the patient's Y mother concerning her 12 month old female Y daughter, N who in 1999 was vaccinated with a dose of M n has been received from a nurse practitioner Y concerning Y a 22 year0old Y female patient with no N pertinent 8/13/2007 medical history 12/1/2007 and allergic reactio n has been received from a nurse concerning a female "born in 1983" with no pertinent medical U history who 5/29/2007 on 29-MAR-2007 7/1/2007 was vaccinat n has been received from Y a Certified Medical Assistant Y concerning13 an 18 year old female who N on 22-AUG-2007 8/22/2007 was12/1/2008 vaccinated with a first n has been received from a healthcare Y professional concerning her 20 year old daughter who U was vaccinated with all three doses of GARD n has been received from a medicalYassistant and a pediatrician concerning a 17 year old female Y patient for the ### pregnancy ### registry for GAR n has been received from a registered Y nurse (R.N.), for GARDASIL, a Pregnancy Registry product, Y concerning 4/22/2008 a 154/23/2008 year old female patien n has been received from a pharmacist Y concerning a 70 year old male with hypertension and Y allergic to morphine 2/4/2009and 2/4/2009 tramadol hydrochlori ic rash, vesicles, fever X 2days 2/3/09 - given vaccine 1/27/09 U 1/27/2009 Red swollen left arm painful. 2/10/09 = Reddened area on arm, spreading painful. 2/11/09 = cellulitis. U Pt has 2/5/2009 prior Hx staph 2/9/2009 infections. ain, vomiting, malaise, R/O sepsis-doubtful. Pt with prior diagnosis of staph infections Y 2/3/2009 2/4/2009 cm red, warm, swollen area left deltoid. Y 2/9/2009 2/10/2009 and swelling at site of injection U 2/9/2009 2/10/2009 es after receiving vaccine Pt. was getting Y ready to walk out the door with parent - and faintedY- Able to keep 2/9/2009 standing 2/9/2009 and assisted into chai after injection Y 2/9/2009 2/9/2009 ying/inconsolable and fussier X 2-3 Y days after vaccination. Y 1/26/2009 1/26/2009 1/2/2009 ed lesion Pt. had fever for 2 days of 101 F. Y 8/23/2007 2/9/2009 wsy and dazed lasting about 5 mins. Pt. was put back into the RM where Dr. check her andYbaby was doing 2/10/2009 better.2/10/2009 ed right arm (hyperimmune response). Y 2/10/2009 2/11/2009 ing, Rash spread all over body Y 1/29/2009 1/29/2009 greater than 5cm w/ erythema & pain. Y 1/30/2009 2/1/2009 h pain, Erythema, warmth and edema Y at and below site of vaccination within 24 hr of administration. Y 2/4/2009 2/5/2009 ticed a 4 in by 3 in area of redness, warmth and tenderness on site where vaccine was administered, Y 24 hrs 2/3/2009 after administration. 2/3/2009 Unchang itching, redness at site 2 days after. U 2/3/2009 2/5/2009 ted blotchy rash at PNEUMOVAX site starting 1 day after immunization and cleared on 2-3-09 U (said she 1/30/2009 is sensitive1/31/2009 to many things). Feels r shot she developed redness, swelling, itching and pain 5" X 3.5" around shot Y 2/4/2009 2/5/2009 ven 2/6/2009. patient states she noticed swelling. Today 2/11/2009 she reported it to the clinic. U She had2/6/2009 local swelling 2/7/2009 at the site measurin p at 1:00 am with chills, this continued till aprox 4-5:00 am. Pt denies fever and chills at this N time.Today pt 2/10/2009 is feeling2/11/2009 unusually tired and rep nt called the Dept of Health Services for guidance on the adverse event. She plans to self report U to VAERS soon. ### She is ### in good health, an CM SWOLLEN SPOT ON RIGHT ARM, Y NOT RED, NOT WARM, MIDLY TENDER U 2/9/2009 2/10/2009 as in office for routine visit. Pt was ordered HPV vaccine, menactra (meningococcal) vaccine, Y and adacel2/10/2009 (tdap) vaccine. 2/10/2009 Gave all three im 2-103, severe arm pain and injection site swelling, dizziness, sore throat, difficulty swallowing, Y cough, nasal 2/9/2009 congestion, 2/9/2009 nausea, constipatio ly had fever and redness tenderness and swelling of the left arm, site of administration the came U to involve 1/31/2009 the entire2/1/2009 circumference of the a MA APPROX. 4 CM IN SIZE TO LEFT Y SHOULDER AT INJECTION SITE. PRESCRIPTION FOR Y KEFLEX2/2/2009 250MG\5ML-1 2/3/2009 TSP BID X 7DAY in received 1st dose of JE vaccine. He presented to the office for his 2nd dose of japanese U encephalitis vaccine 2/4/2009at the 2/7/2009 1 week follow up int diarrhea 4 days after 1st dose of Rotateq, Y profuse, Y presented 12-24 5hours later with dehydration U (10%) 2/25/09-records 2/4/2009 2/8/2009 received for DOS 2/ ported increased swelling at injection site and increased redness "size of football". She stated Y that patient's 1/30/2009 father felt 1/31/2009 it might be "infected", h weakness in right side of face four days after de vaccionation.PE: Mouth corner deviated to U the right. Non 1/30/2009 blinking right 2/4/2009 eye.Prescibed: Pr d symptoms of severe headache, fatigue, dizziness, Y abnormal vision3and excessive sleepingYon about 5/2/2007, 3/28/2007 5 weeks 5/2/2007 after receiving HP ours of getting Pneumovax vaccine R arm began to hurt, became very painful, 9/10, swollen,Y red areas 5-6" 2/9/2009 long. Started 2/9/2009 2/9/09 PM and re ME BREATHING,NOT FEELING WELL Y WAS ADMITTED Y TO HOSPITAL 3 2/13/09-records received-for U DOS 2/4-2/7/09-DC ### 2/4/2009 DX: Influenza A and reported about 15 minutes after recieving Hepatis B immunization and Td, he had left side Y of head 2/10/2009 and face felt 2/10/2009 numb. This lasted for STOOD WITHIN A MINUTE OR TWO OF GETTING 4 SHOTS, TURNED VERY PALE, THEN Y FELL AGAINST 2/7/2009 HER 2/7/2009 MOTHER AND RN W at injection site. Y Y 2/9/2009 2/11/2009 accine given 1-6-2009. Had fever for Y 48 hours and fussiness after that vaccine. Had 2nd dose U of flu vaccine 1/6/2009 2-9-2009. 1/6/2009 Within an hour or d on 02.02.2009 with rash and fever: had MMR and Varicella immunizations on 1.26.09; on 1.28.09 Y onset1/26/2009 of fever up1/28/2009 over 103 F and then tr
swelling, warm Fever 104.0, chills, nausea, increased Lymphodempathy, decreased ROM ofY extremity, pain 1/30/2009 L shoulder/ 2/10/2009 arm/axilla ting on exam table after vaccine and she felt dizzy. She was assisted to lying position on table Y by mother. 2/11/2009 A few seconds 2/11/2009 later nurse arrive ste in mouth, feeling of swollen lips, blurry vision, lethargy, nausea, headache, body aches. Y Started in am2/6/2009 of day after2/7/2009 vaccine received - 2/ Spasms (they look like infantile Y spasm) But theyY have NO physical signs 1 of the typical Y infantile N spasm. They started ### after ONE ### month shot ap INSTEAD OF Tdap U 2/4/2009 2/4/2009 N HANDS< AND OVER FOURTY Y PERCENT OF BODY AFTER VACCINE>>NOW HAVE GUILLIAN N BARRE SYNDROME> ### 2/6/2007 12/13/09-office aP: Sanofi Pasture Limited: Lot Number: Y C2957AA Y Exp: 21May10 and 1 Hepatitis A: Glaxo Smith Y Kline Lot2/9/2009 Number: AHAVB320BA 2/11/2009 EXP: 25A n 1600(Sun) by 1100 next day(mon)Y1/2" lump on right arm also entire arm and hand swelled,fever N 99.5,weakness,extreme 2/8/2009 2/9/2009 headache. Feve ceived Merck's Gardasil Y vaccine 2 weeks Y ago and since has been experiencing a variety of symptoms, N headaches, 1/20/2009 seizures, 2/3/2009tingling, numb was reported by a physician and described theYoccurrence of aseptic 0 meningitis in a 16-year-old Y male subject ### who 1/10/2009 was vaccinated with HA .3 (r) for 2 days morning after vaccinations. Child later diagnosed with Autism, aphasia, Y developmental N coordination ### disorder. ### 2/24/09 Dev ble crying for 3 days after getting 1st set of vaccines at physician's office. Y ### ### 1-3 of ANTHRAX I felt hands burning and unable to write. From shot 4-6 felt burning at both N hands, arms, 2/3/2009 chest, face 2/4/2009 & back of head. pular rash over trunk, face & extremities. 2/9/2009 2/10/2009 n has been received from a physician concerning Y a 55 day old male0who on 20-JAN-2009 was N vaccinated 1/20/2009 orally with 1/26/2009 a 2 ml first dose of RO n has been received from a physician Y concerning a 10 year old female patient who was vaccinated U with a dose of GARDASIL (lot# not prov pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/30/2008 for COPD exacerbation. Y Vaccination ### took ### place on 12/11/ TER GETTING VARICELLA VACCINE Y SAID HIS THROAT HURT, COUGHING, ITCHING. IMMEDIATELY Y 1/29/2009 GIVEN 1/29/2009 ALBUTEROL, BENEDR ed and reported L arm "purple" all the Y way down and "itching all over" with tingling of L arm.YBegan approx 2/9/2009 30-45 minutes 2/9/2009 after vaccine--to ethargy after Hepatitis B vaccination that was administered at approximately 24 hours after delivery U of child. When ### performing ### metabolic te 08, @ 8-9AM, mom observed infantYto start to choke and exhibited redness all over his faceYand swelling observed ### by mom ### on tongue and ven 02/09/09. on 02/10/09 mother reported Y swelling and redness at injection site, RN advised Y mom to alternate 2/9/2009 cool2/10/2009 and warm compresses 9, two days after vaccine administration, the patient developed a rash on her left lower extremity N and was 1/14/2009 diagnosed 1/16/2009 with shingles. re 102 deg. - hives - severe pain at site and lymph nodes under arm - fatigue Y 2/3/2009 2/3/2009 rned to clinic 2/9/09 stating she noted Y small lump left tricep region appr. 10 days prior. reports U area getting 1/20/2009 progressively 1/31/2009 larger. area appr. hird dose my daughter got very pale, Y sweaty, aand dizzy. The nurse and I layed her back onUthe exam table. 7/15/2008 She became 7/15/2008 unresponsive fo es approximately ten days after receiving Zostavax vaccine, she had severe muscle crampsN5 to 10 times a day ### in the 1/8/2009 following areas of he nt developed diarrhea (10 watery stools Y per day, 2 days after to Rotavirus vaccine. He also developed Y diarrhea 2/4/2009 after 2/6/2009 the rotavirus vaccine g 5mm area of "bruising", erythema right upper outer arm (area of injection site). No systemic Y symptoms. 6/2/2008 6/4/2008 ATES "HAD FULL BODY RASH, NO FEVER." Y ash onset 5 days after vaccines ?rotavirus Y vac. Y 2/4/2009 2/8/2009 iven 2/20/08. On about 2/26 pt went into CHF, symptomatic. She recovered spontaneously Y by about 3/12/08. 2/20/2008 Background: 2/26/2008Severe mital r CALLED AND REPORTED HIVES STARTING 30 MINUTES AFTER DTAP WAS ADMINISTERED.BENADRYL Y 2/10/2009 WAS 2/10/2009 GIVEN. CONTINUE the TDAP vaccine on the morning of Y Jan. 26. That night, I was unable to sleep, felt very dry,Uand consumed 1/26/2009 a large1/27/2009 amount of water. The n ection sight up into shoulder, erythema, entire arm itching, face flushed. Y 12/2/2008 12/2/2008 , pain at injection sight up to shoulder and down arm, entire arm itching, flushing in face, vomitting, Y and fever. 2/11/2009 itching, 2/11/2009 pain, flushing started m area of erythema, induration, hot to the touch, and sharply demarcated. Patient complained U of pain... tender 2/9/2009 to touch.Patient 2/10/2009 had a low g 7:00 p.m. To E.R. by ambulance for Y sudden onset altered loss of consciousness. ObtainedUlabs, CT, lumbar 1/21/2009 puncture. 2/6/2009 Had been c/o inso es long by three inches wide swelling of injection site - 24-48 hours from injection. Red & hotUto the touch. 2/10/2009 Tylenol for 2/11/2009 discomfort. ed from a health care professional via the Medical Y Communication the 0 following information N on 30 JAN 2009: 1/27/2009 A 52-year-old 1/28/2009 male patient wa mom took patient to ER for Y nausea and Y vomiting. Y 12/19/08 mom took 230 Y patient to ER for shortness Y of breath. Diagnosed ### with### acute myeloid le nted within 2 minutes of vaccine administration. Patient obs x 45 minutes. BP checked after Y10min. BS checked-88. 2/12/2009 2/12/2009 Drank water. Walked o both sites - Erythema no fluctuance. (R) arm ~2-5cm; (L) arm ~8cm. TX - BENADRYL + TYLENOL. U 2/9/2009 2/10/2009 and neck turned red with a rash and itch - symptoms ongoing 1/26/2009 1/27/2009 vere bronchospasm and shortness of Y breath 40 minutes after vaccine. No EPi needed; Stable Y Bp and O22/11/2009 SAT, 911 2/11/2009 to ER -discharged hom arted temp 1:30 am 2/12/09. Mom gave MOTRIN temp was 100.8 at highest, no sore at injection Y site. 2/11/2009 2/12/2009 eft deltoid swollen and tender. 1st GARDASIL Y injection given 8/16/08 and no reaction. 2nd GARDASIL injection 2/4/2009given 2/5/2009 2/4/09 and above re ely after administering, Pt developed hives - no other s/s. Doctor ordered BENADRYL and save Y Rx for BENADRYL 2/10/2009 2/10/2009 other reports fever 102 degrees -onset evening after immunizations. 3" redness at site of PENTACEL (L) upper 2/3/2009 thigh-2/3/2009 warm to touch. 1/2 dollar sized red rash. Not hot to touch. Child fussy-more than with other shots. Giving TYLENOL Y and 2/5/2009 MOTRIN. 2/6/2009 d, warm to touch. Local reaction at site of injection. Y 2/10/2009 2/10/2009
ingles) developed # days after vaccine Y administration. red FLUMIST with expiration date 2/3/09 on 2/12/09. No apparent adverse event. red FLUMIST with expiration date of 2/3/09 on 2/12/09. No apparent adverse event.
Y U
1/29/2009 2/1/2009 2/12/2009 2/12/2009 Y 8/21/2007 hest, back, face, scalp, arms - few on legs U 1/12/1998 2/10/2009 ported within 7 minutes of receiving VARIVAX vaccine patient c/o hurting in chest and throatYarea and felt2/4/2009 sick to his stomach. 2/4/2009 No shortness B #2 administered at 11 am on 2/9/09 at noon cheeks became red and flushed then pale, severe Y headache.. 2/9/2009 Premedicated 2/9/2009at 7am with TY sis and upset stomach with 15m of VARIVAX, resolved within, 5-10m in office developed hives Y after vaccine 2/10/2009 2/10/2009 ports she got shingles from the vaccination Y (L) upper thigh near groin area. She saw her MDUwho confirmed it ### and treated 1/8/2009 her. Hives exten veloped rash on neck, face on 2/9. Y Also had some shortness of breath and "watery eyes" onY2/8. Rash on2/6/2009 inner arms, 2/7/2009 back, chest, per nur n has been received from a physician concerning a 24 year old patient with a history of papanicolaou N smear 4/20/2007 abnormal 8/1/2008 who on 20-FEB-200 was considered medically important. Information regarding PREVNAR was received from a U healthcare professional 11/6/2007 regarding a 24-monthreceived vaccines (Dtap, Fluzone).YNo allegeries Y or cold systems noted 1 or reported. 1/15/09Y- mother states 1/14/2009 noted 1/15/2009 "bumps" under patient's as vaccinated on 1/30/09 after fallingY on the ice. After the vaccine she called complaining of redness Y and1/30/2009 pain at the injection 2/6/2009site (rt arm). S RT RED, BURNING ABDOMINAL/CHEST RASH. TODAY PT OBSERVED TO HAVE SMALL N RED RASHES 2/3/2009 TO LEFT 2/5/2009 UPPER ABDOMEN en Varicella/DTaP 1530: call from parent that pt Y awoke from nap congested 1 & wheezing-advised Y to give2/10/2009 albuterol nebulizer 2/10/2009 per Dr. and if n the Gardasil vaccine and walked out of the room. As I exited I lost vision and hearing and collapsed, Y still2/11/2009 conscious2/11/2009 and very nauseated. D fever, chills, loss of appetite for 6 days Y 2/4/2009 2/5/2009 shrill cry for 45 minutes (non-stop crying) Y 12/2/2008 12/3/2008 male received 2nd doe of VZV on 02/10/09 at around 0830. Starting at 2100 on the same day U the child 2/10/2009 exhibited erythema, 2/10/2009edema in the l ction site reaction to the R upper extremity. Pt received pneumovax on day one and erythema, U edema started 2/11/2009 on day 2/12/2009 two and persisted thr hours of Jeff's first DPT Y shot, he had Y a grand mal Y seizure. We continued 2 to give Yhim the series N of shots and at age 5/18/1984 25, he continues to hav S HUSBAND PRESENTED TO PHARMACY ON 2/13/09 STATING THAT HIS WIFE HAD AYRED STREAK 2/5/2009 APPROX. 2/6/2009 4 INCHES LONG AN m pain upper arm, can't lift arm without Y significant pain. TD vaccine given 1/21/2009 10:30 AM. N Saw doctor 1/21/2009 following1/21/2009 week 1/28/2009. Pain -Back of L arm--upper area--above elbow and below arm pit swollen. Approx 70 mm long--warm Y to touch.2/4/2009 Redness 2/5/2009 noted at two injection s ates he started a fever@ 1PM Fri. 1/30/09& Y by 8PM it was 104 degrees. Dr's office suggested Y alternating1/29/2009 Motrin&Tylenol-it 1/30/2009 would go down received his second immunization with DTAP/HIB/IPB on February 9 at about 10 AM. He didYwell after the2/9/2009 vaccine unto 2/9/2009 about about 1:45 P sil vaccination on 2/19/08. Second YGardasil vaccination April 2008. 3 weeks later, on May 9, N she came4/15/2008 home from school 5/9/2008 complaining of s fter injection, child woke up with nausea and stomache ache. Arm very sore for 4 days, including Y his armpit. 12/2/2008 Complained 12/3/2008 that it hurt if he m patient was administered Rotatec. After immunization, patient had 10 days of watery diarrhea Y and vomiting. 2/11/2009 02/11/09 2/12/2009 - patient was admin ternoon began chest pain. By Thurs. Y AM pain unbearable so went to ER. EKG normal & sent Y home. Fri.1/13/2009 AM pain severe 1/14/2009 so went to ER. EK tate Epidemiologist stating that he had Y received a call from local provider stating possible measles Y case.1/12/2009 He spoke1/24/2009 with child's PCP and w ter shot - mild malaise developing, 7 hours after shot- fever and severe chills (chills and shaking Y was worse than ###the worst### malaria attack I ythematous papular eruption, itchy, Y on fore/arms/trunk/thighs. 2/5/2009 2/8/2009 swelling and erythema Y 2/10/2009 2/11/2009 fter vaccine admin., pt. walked backYinto the waiting room complaining of dizziness. AssistedY into a chair2/13/2009 with mother 2/13/2009 at side. Several attem ly pruritic chicken pox U 2/19/2002 2/11/2009 exam 11-25-08. GARDASIL #1, MENACTRA & ADACEL given to update imms- Pt has since learned that she ### was pregnant at time of va urs stated arm was the size of a football. Y Had pain, redness, warmth. Had no fever. Felt weak. < 24 hours 2/12/2009 after shot 2/12/2009 the arm was still 4.5 lled and notified that the day after injection Y her arm was twice the size an extremely painful."YBENEDRYL 1/28/2009 DM and started 1/29/2009 to feel better. Re nute seizure - tonic clonic associated Y with fever. No treatment except TYLENOL, MOTRIN for Y fever 1/29/2009 2/7/2009 m unsure of onset, but pt. had been seen in local ER 2/6/09 with no mention of rash she wasUtreated for croup 2/3/2009 2/6/092/7/2009 with decodnon to EPI ed to office at 4:00 pm- with red spotty rash on facial area. No c/o itching voiced. No rash noted Y on trunk 2/5/2009 at time of visit. 2/5/2009 VS obtained, norm Rec'd vaccines in AM and was fine Yall day. She went to a martial arts class in the pm and after Y class became 9/3/2008 faint and 9/3/2008 had seizure. She w ears 1 hour post injection - Return of Bells palsy, also " set off arthritis & joint pain". Has had Y flu shot every year ###with 0 reaction ### did not see swelling to site, itching. (Varicella). Y 2/4/2009 2/5/2009 ight of injection L arm became sore.Y 2/6/09 Severe pain to L arm. 2/7/09 increase temp, feltNbad. 2/8-9/09 2/5/2009 redness noted 2/5/2009 to L arm below s noticed next day- became worse over next 24 hrs then started to decrease on day 3 -> resolved. Y 2/2/2009 2/3/2009 a redness noted same evening. There was no sleep disturbance. Next day, hard & red thighYSeen 27 hr after 2/5/2009 the shot: 2/5/2009 large red area creat after shot began headache- for next 36-40 hours extreme nausea & headache (sinus & jaw) Y Routine chiropractic 2/8/2009 app't2/9/2009 & therapy helped & m raised papulovasicular lesions arms, wrist and back U 8/3/2007 2/13/2009
ter vaccination, at 7 pm developed fever (101.5F). Given MOTRIN by mother. Fever was 103F Y at 1 am,2/12/2009 102F at 5 2/12/2009 am, and 100 at 9 eoccurrence of Reitens Disease after Y 3rd TYPHOID pill - c/o S-1 pain resolved post backs required Y steroid 1/9/2008 use Last1/13/2008 episode of Reitens dis eizure 24 hours post vaccines 101 degree Y F otitis diagnosis at 24 hours as well Y 2/4/2009 2/5/2009 eeks after vaccines given developed fever and rash (which resolved in short period of time),Ubut rash faded 8/5/2008 and actually persisted until see 11/4/2008 N ### ### ven 1st dose of Gardasil Lot # 14484 Y on 2/4/08. Patient became ill with Severe Adominal Y Pain N and Nausea. 8/18/2008 Patient 9/3/2008 given 2nd dose of Gar avax injection, patient's arm from shoulder Y to injection site started aching (within 15 minutes). Y By the next 2/5/2009 day, the injection 2/5/2009 site was surroun op a fever, irrability, decrease in appetitie Y and diarrhea that I could not control at home which U resulted in an 2/9/2009 ER visit.2/14/2009 after receiving D/T immunization my arm at sight of injection starting hurting. I couldn't lift myYarm up above 2/12/2009 shoulder2/13/2009 level without alot of so arre requiring hospitalization, Y IV gammaglobulin Y Y and acute rehab. Symptoms 7 started 1 weekYafter vaccination 8/19/2008 2/23/09 8/28/2008 Received hospital m minutes after the shot I walked out of the doctors office and into the lobby, and all of a sudden I lost all energy in my body. Literally, I felt as t us case was received from a consumer Y on 06 February 2009. A female patient reported thatUshe received an injection of Tetanus/Diphteria er flu injection 9/29/08, pt became feverish, aching all over, nauseated for a few days, also states U he developed 9/29/2008 a huge 9/30/2008 cold sore on his nos h VARICELLA on 9-4-08 vesicles on face & trunk. fever of 103 degrees X 6 days Y 2/14/2000 9/4/2008 les over trunk x 4 days. Y Y ### ### CELLA - few vesicles on trunk fever Y 101 degrees -> HA -> X 5 days fatigue Y -> 8/16/2007 9/18/2008 les on trunk X 3 days Dx : VARICELLA Y Meds: ZOVIRAX Y ### 12/8/2008 PM feet starting itching. 2/03 2:00 AM Awoke & whole body itched "terrible"- Took < chewable Y BENADRYL 2/2/2009 (Total 25mg). 2/2/2009 2/03 6:00 AM Co vaccines 2/3/09, 2 days later, developed erythematous papules on face then over next few days, U progressed 2/3/2009 cephaolocauded 2/5/2009 to his whole ted 02/13/09, highest was 102.8F, parent noted redness, not wanting to use her right leg. Seen Y on 12/14/09, 2/12/2009 afebrile 2/13/2009 after ibuprofen, 1cm X e onset of erythema, pruritus and edema on right upper arm after receiving MMR vaccine. VSY - B/p-104/64, 2/11/2009 R-20, P-74, 2/11/2009 regular. Patient was es starting January 3rd. Nausea andYflu-like symptoms Y starting around 5 January 15th. Low back N pain started 1/2/2009 early January. 2/2/2009 February 2, patie d Influenza A U ### 2/15/2009 r vaccine administered patient developed Y joint pain, insomnia, numbness of certain areas onNright side of body 2/3/2009 (cheek, 2/3/2009 elbow, thumb, heel), RECIEVED A SUB-Q DOSE OF ZOSTAVAX IN HER RIGHT ARM ON 2/12/2009. THE PATIENT Y TOLERATED 2/12/2009 THE 2/14/2009 SHOT VERY WELL; ceived 1st dose of Gardasil vaccineYon 8/8/08 in Dr. office, since having the vaccine she hasNhad recurring8/8/2008 headaches, 9/28/2008 severe joint pain, ch ped burning, itching rash on both upper Y arms, chest and upper thighs over 3 day period postYvaccination; 1/29/2009 to Er on 1/29/2009 day 3 -received IV solu ziness & fast heart beat Y 2/13/2009 2/13/2009 ter received Gardisil vaccine today..Number 3, and she fainted about 8 minutes after the shot. Y She was2/16/2009 okay..nurse2/16/2009 kept us a few minutes periences severe flushing episodes,Ynausea, severe abdominal pain, back pain, difficulty breathing. N Several 12/1/2008 physicians and ###tests find noth as had chronic constipation with abdominal Y pain since administered the oral vaccine (Rotateq). He has not 2/16/2009 been able 2/16/2009 to have a bowl movem adache, nausea, joint pain, unusualYtiredness/weakness, aching muscles, muscle weakness,Nbad stomach2/6/2009 ache. 2/18/09 2/6/2009 Received vaccine n 1/21/09. Came in with swollen R side of face on 2/9/09 Y 1/21/2009 2/9/2009 was reported by a healthcare professional via another manufacturer and described the occurrence U of grand mal seizure in an adult female Y N 10/8/2008 12/1/2008 myalgia. Episode of tachycardia 24 hours after vaccine, lasted 5-6 minutes. Y 1/29/2009 1/30/2009 dominal pain after first dose. ChestYpain, difficulty breathing, shortness of breath, palpitations Y and cramping 1/29/2009 after second 1/29/2009 dose. No wheez en outside guidelines. Per MFG. No need to revaccinate. Y 2/15/2009 ls, weakness, RUQ pain and tenderness. 2/24/09 Y Mr received for DOS 7 1/30-2/7/09 with D/CYDX: Hypovolemic 1/26/2009 shock 1/30/2009 r/t profuse diarrhea a le on L Tricep Area with wheal of induration, ? early vesicle formation at center of papule. Scattered U papules 1/23/2009 on Trunk 2/10/2009 and extremities App some sinus congestion at the time Yof her vaccinations. Two days later she developed fever Yand cough. She 2/2/2009 was diagnosed 2/4/2009with pneumon ing dizzy after shot. Pt told to sit- down Y - given a cold compress. Pt LOL for under 1min with Y some jerking 2/16/2009 movements 2/16/2009 ammonia inhalant as given two tetanus injections (ADACEL) in 1 year. Denies pain. Edema problems after 4 days. Y 2/12/2009 elling pain @ injection site hives present both arms. U 2/11/2009 2/11/2009 ported pain and swelling at injectionYsite. Exam revealed erythema (approx 3 cm in diameter) Y warm to touch 2/15/2009 and tender 2/16/2009 to palpation. No fe n has been received from a Nurse Practitioner concerning a female who approximately 6 months U ago was8/1/2008 intramuscularly 8/1/2008 vaccinated with t n has been received from a Registered Y Nurse (R.N.) Y concerning a 17 2 year old female with no N family history 1/2/2008 of seizures 4/1/2008 or drug allergies wh n has been received from a consumer Y concerning Y her son, a 5 year1old male who allergic toNamoxicillin who was vaccinated with one dose n has been received from a registered Y nurse concerning Y a 71 year old 0 male patient with penicillin N allergy1/22/2009 and SULFONAMIDE 1/22/2009 allergy, who n has been received from a kindergarten Y teacher concerning her husband's relative's churchmember's U daughter's 8/5/2008 friend 9/1/2008 at school, a girl wh n has been received through the Merck pregnancy registry from a physician concerning a 17Yyear old female who ### on 16-NOV-2007 ### was va
n has been received from a Registered Y Nurse concerning her daughter (a 15 year old female) N who in August 4/16/2008 2008 was 10/1/2008 vaccinated with the n has been received from a physician concerning a female with penicillin and sulfa allergy and U a history of3/1/2008 knee surgery and tube placed in n has been received from Y a kindergarten teacher Y concerning her husband's 0 relative'S Y churchmember's N daughter, a 14 year ### old girl who on ceived the three doses of ROTATEQ - #1 doseYon 06/18/08, #2 dose 1 on 08/22/08, # 3 dose Y on 10/24/08. Diagnosed ### 1/27/2009 on 01/27/09 with rotav e, emesis. 2 ED visits. Y Y 1/27/2009 2/4/2009 and "pinging" when I tap thumb & pinkie Y + ring finger together ; (L) forearm feels irritated & achy N when resting it### on any sfc,### Face of shoulde U 2/9/2009 L injection given in left deltoid at 4:15 pm, client stated she was dizzy and felt hot at that time. Y Client lost consciousness 2/6/2009 2/6/2009 at 4:16 pm, was as 5X 8cm erythematous, indurated area Y 1/28/2009 1/29/2009 as seen at the Emergency Room because Y she was having seizures Y 2/10/2009 2/10/2009 fter had HEP A shot had bilat hand swelling and palms looked red, had been fussy during night. Y swelling1/27/2009 was gone 1/28/2009 by end of day, feet were ES GENERALIZED RASH AND ITCHING OF SKIN SINCE DAY AFTER hEP b VACCINE WAS U ADMINISTERED. 1/26/2009 pT. 1/27/2009 HAD RECEIVED tW weeks after getting 1st set Y of Gardasil, Y patient complained Y that she79 was Y weak and Y was having N a hard time 11/3/2008 speaking. On 11/29/08 ### patient ha d during pregnancy. Pregnancy resulted in Voluntary Interruption of Pregnancy at ~ 11+2 weeks 9/17/2008 10/6/2008 lled stated that child began with fever about 12 midnight Friday night (Feb. 13. She stated child Y convulsed 2/13/2009 3 times and 2/13/2009 threw up. When ask atigue, difficulty concentrating & sleeping following vaccinations N 9/5/2007 10/7/2007 ted shingles 8 months s/p vaccination Y U 6/4/2008 2/8/2009 es that 4 hours after immunization that Hannah complained of "butt & thighs are numb & chest Y feels jittery". 2/10/2009 Did not call 2/10/2009 physician and symp ### Y N ### ### en Left arm. Patient came back to clinic 1 day after receiving injection. Patient treated with N Prednisone 2/16/2009 taper, benadryl 2/17/2009 OTC, and intermitte injection given on 2/10/2009 in the right Y arm subcutaneous. On 2/17/2009 patient presentedUwith extensive 2/10/2009 erythematous 2/12/2009 rash extending fr large reddened area approximately 2.5x3 inches in circumference 3 days after vaccination. Y Area was swollen 2/12/2009 and hot 2/14/2009 to touch. Patient rep U 2/6/2009 2/15/2009 veloped vesicular rash in dermatomal distribution over thoracic area, c/o pain over this area.Y mother called 2/17/09 reporting, about Y 2 hours after receiving MENATRA injection c/o shooting N down left2/16/2009 arm and leg 2/16/2009 2/16/09. Today 2/17/0 on shoulders, back, (R) side family Dr. Y order BENADRYL. U 2/17/2009 2/17/2009 pain left index finger mcp onset 2/13/09 U 2/11/2009 2/13/2009 ious, spontaneous report of administered expired FLUMIST in a 30 month-old female patientYwas received 1/23/2009 from a nurse 1/23/2009 practitioner in the U ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/6/2009 a 38-month-old 1/6/2009 female who ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a four-year-old 1/5/2009 male who rec ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a four-year-old 1/5/2009 female subse ious spontaneous report of hives has been received from a physician concerning a 32-month-old U female, subsequently ### to ### FLUMIST. This c ious spontaneous report of administered of expired FLUMIST was received from a physicianY concerning 1/6/2009 a 58-month-old 1/6/2009 male. who receiv ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/12/2009 a 24-month-old 1/12/2009 female subs ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a 40-month-old 1/5/2009 female who ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a 38-month-old ### male who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a four-year-old ### male who rec ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 24-month-old ### female ### patient subsequ ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 28-month-old ### male ### patient subseque ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a 24-month-old 1/1/2009 patient1/1/2009 (gender unknown). Th ious, spontaneous report of administration of expired product, vomiting and diarrhea was received Y from a nurse### in concerning ### a 33-month-o ious, spontaneous report of administration of expired product, dehydrated, elevated white blood Y cell, vomiting, ### diarrhea and ### lethargic was re ious report of "six patients received expired FLUMIST "was received from a nurse concerning Y a four-year-old 1/1/2009 (unknown 1/1/2009 gender). The patien eous non-serious report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009concerning a c ious spontaneous report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009office concerni neous non-serious report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009office concern accine used Expired drug administered) A non-serious spontaneous report of administration Y of expired product### s received ### from a registered ious spontaneous report of administration of expired product was received from a registeredYnurses concerning### a 24-month-old ### female who ious report of "gave patient expired FLUMIST" was received from a nurse concerning a four Y year old male patient. ### On 30-Dec-2008, ### the pa nt to make f/u apt child not responding Y to parent Y when she call child's 1 name, PCR to parent Y to shake baby's 7/7/2008 arm and7/7/2008 PCR called nurse. Ba hat started several hours after receiving her booster flu shot. U 1/13/2009 1/13/2009
U ### ### oy passed out suddenly after receiving vaccines on 1/17/09 @ around 6 pm. I turned aroundYto dispose 1/17/2009 of the needle, 1/17/2009 when he suddenly w ours after receiving the vaccine had chills, fever, Y myalgias, vomiting 1and headache. Sxs were severe enough 5/18/2005 that she 5/18/2005 was admitted to the h ne-type disorder. Fever,Yjoint pain, diffuse swelling. 4/6/09 Received chiropractor medical records U of 11/14/2008. 6/1/2008FINAL DX: ###sciatica, DJD, tions given on 1/12/09 at approx. 4:00 PM. Mom Y called at 10:40 AM31/13/09 stating 2-3 inchYdiameter swollen 1/12/2009 red area 1/13/2009 on (L) arm. Appt wa s seen 11/12/08 for pulling ears x 1 week. He had no URI Sx or fever but mom reported oneYslightly loose stool### that am, sl.### decreased appe er shots had episode of vomiting and developedY seizure. Hospitalized 1 and started on Phenobarb. Y 3/9/091/12/2009 Received hospital 1/13/2009 medical records ns, Shaking, High Fever. Y N 7/11/2006 7/18/2006 iving the third series of Anthrax Y Vax.YBecame insulin Y dependent, shortly after. 2/23/09 Y OfficeYnote received 9/24/2003 for 1/23/08 for### Diabetes Mellitus eption - open reduction after failed enema Y reduction. Y Presenting sx: 1listlessness, decreased Y feedings (fluid1/6/2009 intake) increased 1/9/2009sleep. 3/3/09 nset arthralgias 12/29/08. Pain, swelling elbows, wrists, hands, fingers,knees, ankles low grade N temp initially. ### Seen by PCP ###& Rheumatolo elling to the right deltoid area. ### r Tdap I started having numbness Y inYfeet and (R) Y leg. This went on25 forYa month and Y 1/2 and I never put it together ###at that point. ### 12/12/08 Ha s, nausea, tiredness, confusion, off balance Y AM & PM, racing thoughts and actions in the AM. N 2/25/09 MR1/5/2009 received. 1/7/2009 HPV vax 12/2/08 and d Guillain Barre Syndrome after multiple vaccines Y in basic training. Service 7 member had pneumonia U prior 9/3/2008 to hospitalization 9/6/2008 for GBS, but num n began 4 days after primary smallpox Y vaccine. Service Member meets criteria for "Suspect"Ypericarditis according ### to CDC ### guidelines. Def GARDASIL vaccine about 15 minutes later. Pt had light headiness and dizzy, pale and nausea. Y 1/15/2009 1/15/2009 ng in lower part of body. Y Y 6 Y ### ### d to office about 1 hour post vaccination with c/o rash. Very faint bumpy rash starting on arms, Y progressed through ### day to### include trunk + l iously well except notedYto have poor Y weight gain. Y Appeared well at2visit. Vaccines administered Y approx1/19/2009 10:30 am. Noted 1/19/2009 at daycare to be e- intense Flu-like symptoms w/ feverY coughing- nasal congestion- ending in a visit to ER. Lung, N blood and 1/9/2009 urine samples 1/9/2009 seemed o.k. Cam ery severe local Rxn at site of pneumococcal vaccine. Two days laterYsuffered urinary retention Y and ARF. Vaccine ### was listed ### as one of ma d petechiae 1/30/09. Diagnosed withY I.T.P. 2/1/09 Y (Platelets 5,000). 2Responded to I.V.I.G. - Platelets Y 95,000, 1/8/2009 on 2/2.1/30/2009 Platelets 205,000 on 2 e call from parent - reports child c/o pain left arm + shoulder since vaccine on 1/13/2009 to day Y of call 1/16/09 1/16/2009 - Parent 1/16/2009 reports relief with Ty accine administered. 1/19/09 Y - Developed Y severe Y viral symptoms. 1/25/09 1 - Dx with DVT andUhospitalized; 1/16/2009 put on Heparin. 1/25/2009 1/27/09 - D/C on ived the Tdap shot in my left arm 12-15-08 Y at family practice which my arm became very sore N 12-16-08 & has ### been sore every since 1-15-0 episode following injection, approx 30 Y seconds Y following vaccination.1 Member not caught before Y hitting floor. 2/9/2009 Patient sat 2/9/2009 up at 2-3 mins later ### N 4/28/2008 ### 1/18/2009 N 1/14/2009 1/18/2009 e week after shot. Fever 101 degrees Y F 104 degrees F. Unknown rash (was told Y chickenpoxU& given Prednisone). 5/23/2006 Developed 5/30/2006 food aversion ation for numbness, pain, in hands and Y feet. IVIG, Y Narotin. 2/20/09-records 5 received Y for DOSN11/28/08-presented ###to ED with ###C/O hands an ER twice for abdominal pain, fever,Yvomiting. Diagnosed Y with intussusception. 5 Tried to reduce Y with barium 7/8/2008 enema several 9/25/2008 times but was no eption. Required partial colectomy. 2/24/09-records Y received for DOS 5 1/8-1/13/09-DC DX: Intussusception. Y 1/5/2009 Presented 1/8/2009 with 2 day history of M 1/15/09 - Right upper arm redness, Y pain and swelling to hand, red raised area noted surrounding U injection 1/14/2009 site, seen 1/15/2009 by attending, given cant 15 minutes after the shot. After 15 minutes when she get up + walk she fell little bit dizzy Y + palpitation 1/12/2009 few minutes. 1/12/2009 Notified provider a enduration, erythema & swelling extending Y area 10cm diameter. No treatment rendered. Y 12/8/2008 ### 08 pt. presented to office c/o pain LYdeltoid w/ radiation of pain to elbow. Area of erythema measured Y 1.5x2 cm. ###Normal remainder ### of exam sions (>250) on extremities, torso, face and bucal mucosa 8 days after receiving first varicella Y vaccine. Tx: Acyclovir ### 1/7/2009 800 mg every 6 hours 0min after injection while sitting in waiting area, c/o dizziness, lightheadedness. Attempted toYmove patient1/8/2009 to exam room 1/8/2009 but began to faint oximately 8 minutes after receiving 6 vaccinations, pt. c/o feeling faint. Pt. became unresponsive Y and began 1/12/2009 jerking1/12/2009 movement of her head hours after vaccine pt reports swelling Y and tenderness in left axilla. Also had tenderness at injection site.1/12/2009 Swelling progressively worsened ls, Diarrhea, Malaise following day hives day 4 U 1/8/2009 1/9/2009 2 degrees F), severe left arm pain at site of administration. Y 1/8/2009 1/10/2009 NTACEL, PCV7 and Rotavirus 1/12/2009 Y - developed fever to 106 1/11 per mom, Occ crying. Y Temp on and 1/12/2009 off throughout 1/13/2009 day 101-102 per hing & macular rash on thorax. Y 1/14/2009 1/14/2009 tions given on 1/8/09 at app. 4:30 pm Y - Call from mom on 1/9/09 @ 3:30 noting redness, soreness, Y & swelling 1/8/2009 of L thigh 1/9/2009 - PA notified mom office and c/o L upper arm still being sore 2 weeks after injection. Received GARDASIL 12/30/08- Called office### 1/14/09. ### STAVAX Received 12/25 itching rash started at site of injection Spread all over his body down Y legs and back ### Took BENADRYL ### R on 12/2 e very irritable Abd pain. Y ### ### n has been received from a 39 yearYold male patient Y who was in the0hospital for a hip replacement. U He had 3/1/2007 a chest x-ray 3/1/2007 and then received iting and diarrhea within 48 days after Y admin. of 2nd ROTAVIRUS vaccine at 4 mos well check Y on 11/07/08. 11/7/2008 Was 11/9/2008 tx at hospital ER, with IV
mplaints of wheezing at night and fells pressure on the chest and coughing starts about 2 weeks U after vaccination 10/8/2008 but reported ### to me on 1/ d crying - went to clinic. Sent home -Ydid well. Y 1/13/2009 1/13/2009 n has been received from a physician Y concerning a 22 year old female who was vaccinated U with the second 12/1/2008 0.5 ml 2/12/2009 dose of GARDASIL (lot TDAP vaccine 12/29/08 - felt overlyYfatigued on 12/30 & early. 12/31. Late morning 12/31 IYdeveloped abdominal ### cramping ###- severe- unab n has been received from a male concerning his 4 year old son who in January 2007, was vaccinated U with1/1/2007 PROQUAD. 1/1/2007 His son was diagno ven Influenza virus vaccine instead of Hepatitis B on 12-30-08. She was then given HepatitisYB on 01-2-09. ### n has been received regarding a case in litigation from a consumer, concerning her son whoNon an unspecified date was vaccinated with a ed my cell phone and left message stating she had symptoms of rapid heart rate & dizzinessYafter receiving 2/6/2009 vaccine Friday 2/6/2009 afternoon. I spo n has been received from a 74 year old female with arteriosclerosis, and diabetes and a history N of left eye 7/11/2008 twitching7/19/2008 before vaccination who ff and could not move right arm for Y 3 days. Then the soreness moved down arm and wake up N in middle of night. ###Went to### orthopedic speci me very swollen and red, itched, area about 2 1/2 X 2 1/2 inches. Lasted for 6 days. Then just Y swollen and 1/23/2009 started 1/24/2009 to go away. Had bump U 2/11/2003 2/7/2009 red HEP A into R deltoid. Then administered GARDASIL into R deltoid. 10-15 seconds later, Y patient lost2/9/2009 consciousness 2/9/2009 + fell backwards f ought back in office by guardian 2/2/09 with a c/o (R) BELLS Palsy noted after one day vaccines U for 5 y.o. 1/30/2009 given KINRIX, 1/31/2009 MMR, Varicella, In as given inj f/m PNEUMOVAX last Friday. Pt came in today with c/o high fever (103.8) severe Y pain in rt arm 1/30/2009 & nausea 1/30/2009 30Jan09 accines - on 1/16/09, low grade temp. Y suddenly became limp & unresponsive. Vomited & then Y responsive. 1/15/2009 911 brought 1/16/2009 to ER then he beca enza vaccine given approx. 3pm 1/21/09. Caregiver noted "hives" around injection site and torso Y approx.1/21/2009 6pm. No other 1/21/2009 sx other than hives macular rash extending medial upper arm down to antecubital fossa N ### ### RA was administered to 56 y.o. pt. - only licensed for up to 55 years of age. No adverse reactions Y were reported. 1/13/2009 der discomfort reported 11/13/08 Flu vax given 10/30/08 shoulder X-ray 11/24/08; MRI shoulder 12/4/08 Tx: Physical ### therapy ### ling in fingers, unable to lift arm over head. 3/18/2008 3/20/2008 local redness/swelling with some itching. U 1/29/2009 1/31/2009 .4 and red rash all over arms, trunk, legs, feet 24 hrs after administration. BENADRYL and tepid U bath administered. 1/14/2009 1/15/2009 1/16/09-Rash on face & arrhea after 1st ROTATEQ lasted x 3 months. Eventually resolved, used NUTRAMIGEN. Y 9/9/2008 ash c/w RUBELLA. Irritability, fever, poor po intake. U ### ### d PREVNAR vaccine 1-14-04. Pt had fever of 102 degrees rectally. Y 1/14/2008 1/15/2009 Y 1/2/2009 1/12/2009 104 X 3 days post vaccine Y 1/13/2009 1/13/2009 minutes of receiving GARDASIL, patient Y passed out, regained consciousness. Since that time U - 2 episodes 5/16/2008 of similar 5/16/2008 symptoms with loss o me into the clinic complaining about rash all over body. The Pt. stated that he had been abroad U the weekend 2/5/2009 prior. 2/12/2009 From what the note from 0 minutes after injections began ruritic Y episode with erythematous rash on inner arms, One area Y on chest1/12/2009 with slight1/12/2009 edema of eyes. Sent to eks of peripheral neuropathy - pain and sensitivity to left triceps and left pectoralis area/chestYwall. no weakness. 10/6/2008 saw 10/8/2008 a neurologist. to patient he was suffering from fever, headache, joint pains, nausea, rashes, and diarrhea Y on the 15 Feb2/6/2009 2009. Seen 2/15/2009 by Medical Provider en warm touch left arm 2/17/09 0600 treatment was given on 2/18/09 at 01000 Benadryl 12.5mg/5ml Y and 2/16/2009 Cleocin 75mg/5ml 2/17/2009 HPV Vaccine dose #3. Did fine in office. Fifteen minutes after leaving (while still in car) patient Y noticed that her hand was quite swollen an 9, patient called the health department to state that very soon after he had received the Zostavax U vaccine, he began ### noticing ###that he was b n was given an Adacell vaccine rather than the ordered hep B No adverse reaction Y ### symmetrical eruption of dull erythematous irregular patches to face upper/lower extremities U and anterior posterior 2/4/2009 trunk 2/6/2009 s taking oral Typhoid Fever vaccine for a trip. She took them correctly, one piull every other day. Y The first2/12/2009 day, no problem, 2/15/2009 2nd day, she fe en burned and very hard with itchy Y red bumps. Very large knot in arm. Treated by Hospital for Y Allergic reaction. 2/7/2009 2/8/2009 GIVEN AT 0915 LD IM WAITED 20YMIN IN THE LOBBY WITHOUT REACTIONS. LEFT AND Y WENT BACK 2/18/2009 TO SCHOOL 2/18/2009 AT 1120 SHE C 08 Mom called provider office an spoke Y with nurse Y complaining of left 3 leg swelling. 4/6/09-records Y received 12/1/2008 for DOS 12/6/2008 12/18-12/21/08-DC DX vaccine, developed fever in night, byY next day fever raised to 106 - went to emergency roomYfor tests, antibiotics ### in case it### was an infection shot was given I had mild tenderness Y in the shot area for a few days. It seemed to be gettingUbetter but then 2/12/2009 on the sixth 2/17/2009 day it began to get n right thigh, Hib given left thigh 8 days Y ago. Swelling and lump on right thigh about 3 cm with Y less swelling 2/10/2009 and lump 2/11/2009 on left thigh (1.5 cm pot about the size of a quarter that was tender and warm on friday 2/13/09 U 2/11/2009 2/13/2009 series of Guardasil on 7/24/2008. Y On Y 9/10/2008, patient went to emergency room in ambulance U due to 7/24/2008 rash and difficulty 9/10/2008 breathing, assum en 11/16/09 & given VARIVAX #1, PREVNAR Y #4 & HEP A #1. 1/17/2009 Developed a rashYon legs, face 1/16/2009 & arms. 1/17/2009 @ 8 pm 1/17/09 develo Tdap, influenza and PNEUMOVAX vaccines 01/06/09. Pt called clinic 01/13/09 to report thatYon 01/07/09,1/6/2009 she had experienced 1/7/2009 onset "sev veloped severe diarrhea after 1st ROTATEQ >10 stools per day x2 weeks. Resolved - needed Y Pregestemol. 2/29/2008 ed Varicella vaccine 1/12/09. RTC today Y 20 to reddened area 11X10 CM @ site of vaccine. U 1/12/2009
as vaccinated on 1/22/09 (fluid was Y noted in both ears at the time). His ears became inflamed Y and he was 1/22/2009 given amoxicillin 2/3/2009 (has previously 16 scattered red pin point papules w/ pin point scab Y 1/20/2009 1/20/2009 MMR#2 2/2/09 woke 2/3/09 with L shoulder, neck, upper arm pain/swelling ? and headache.Y Self treated2/2/2009 with IBUPROFEN 2/3/2009800 mg and TY ter having 3 vaccines (VARIVAX, MMR Y & PREVNAR), had hives on face - no other exposures U in interim Given 2/9/2009 (4mg)2/9/2009 1cc decadron Benadr and called for help Pt found sitting pale Y semi responsive. Very pale wiffed ammonia inhalate Y help arrive. Pt taken ### to urgent### care for observa m around 4:30PM. Went home, seemed X 2hrs. Around 8pm became very fussy temp 100.6.Y Didn't sleep 1/30/2009 well that 1/30/2009 nite. Next day was som Y 1/29/2009 1/31/2009 Y Y 1/9/2009 1/9/2009 Y Y 1/16/2009 1/25/2009 ed swollen - Hot to touch Y Y 1/6/2009 1/7/2009 04 and higher for seven days straight. Y Within 48 hours after vaccine U ### ### ort received on 02 June 2008 from aYhealth care professional. A 28-year-old patient, had received U a 0.5 mL 6/6/2008 intramuscular right deltoid inject d pain at injection general malaise, fatigue "out of it" Pt observed with no subsequent sx's. Y 1/6/2009 1/7/2009 10 min after receiving YF-VAX + ENGERIX-B. Y Pt had reaction of SOB and urticaria app. 15min Y after he left 2/18/2009 FLAS. Pt 2/18/2009 was treated with 50m -VAX given 2/10/09 (1cc given rightYdeltoid subQ) @ 1300-1400. On 2/13/09, while at daycare, Y the patient 2/10/2009 had hallucinations 2/13/2009 (tactile of bug GARDASIL 1/7/09 at routine health assessment Patient seen in the office on 2/5/09. Developed N lump in her 1/7/2009 neck on 2/2/2009 2/2/09. Diagnosed wit Flu and MENACTRA 10/31/07. By Thanksgiving Y he had foot droop of 3 left foot. Seen Y by primary in Feb. '08 for ankle ### pain. ### Referred to Ortho ost administration infant very fussy and immunization site with erythema & mild edema, tender Y at 7-8cm. 12/8/2008 12/8/2008 grandmother described staring spells which lasted 2 weeks after visit. She states they were Y "just like patient's mother's ### absence ### seizures c iven 1/2/09 symptoms began 01/03/09 included: dizziness, lasted 2 hrs. rash lasted 2 days nYwith vomiting 1/2/2009 1 X. Per 1/3/2009 the patient mother BEN an staring & jerking involuntarily. (Woke Y up crying at 12:15) We took her to the ER and by 1:30 Y a.m.. she was ### fine.) No other ### reactions. (N ng after receiving the vaccine, c/o fever 102 degrees F, vomiting x1 and muscle aches, joint Ypain2/10/2009 2/10/2009 swollen upper thigh to medial thigh. Y 1/9/2009 1/12/2009 ceived vaccines on 01/23/09; developed low grade fever + x 3 days 01/28 - 01/30; given Amoxil Y for purvulent 1/23/2009 rhinitis. 1/28/2009 Rash noted on 01/30/ l received from family member reporting that vaccine recipient has rash & severe nausea. No U mention of1/13/2009 fever. Vaccine 1/14/2009 was given 1-13-09 1/5/9 no problems. 1/6/9 - Circular welts Y with blisters- itching back, legs, arms, buttocks - worse Y on 1/7/9. 1/5/2009 Went to ER1/6/2009 1/7/9 - placed on BEN ceived PENTACEL injection by itself (IM) in right lateral thigh. 5 hours later mom called stating U his right leg 1/14/2009 was swollen and warm to touch n R upper arm - minutes later 5 cm diameter welt with raised erythematous center painful. Used U ice, TYLENOL, 1/14/2009educated 1/14/2009 pt's mom on brin ceived HEP B3 vaccine on 7/20/06. A few days later she had a severe nose bleed, blood pouring Y out of 7/20/2006 nose and mass 7/25/2006 coughing up blood ceived HEP B vaccine on 4/28/06 A few days later she had a severe nose bleed, blood pouring Y out of nose 4/28/2006 and mouth. 5/2/2006 Coughing up blood ithin 24 hrs. Started on legs-became Y generalized in 48 hrs. 2) Low temperature elevation (38-38.4) U > 481/2/2009 hrs. 3) Periods 1/2/2009 of extreme irritab ed lesions head to toe-not palms or Ysoles. On dorsum of hands and feet though. Y 1/12/2009 1/17/2009 and redness over (L) leg (thigh) 30 x 30. Y 1/19/2009 1/20/2009 nd swelling of right upper arm x 2d, treated w/KEFLEX Y 1/12/2009 1/13/2009 EL given right thigh in am 1/15/07 - Parents Y came back in due to pt crying non-stop 11:30 2:00, U vomiting 1/15/2009 X 2, not nursing 1/15/2009 pt calm at times, re nted after receiving vaccines- Menactra, Tdap, Hep A#2 Y 2/13/2009 2/13/2009 as given vaccine. Approximately 5-7Yminutes after patient's eyes rolled back. Upper body began Y to jerk. Called 2/13/2009 911. 2/13/2009 ght deltoid pain and swelling with vomiting x 1 and low grade fever. After 48 hours patient feltYmuch better. 2/12/2009 2/13/2009 nt fever and maculopapular rash of trunk. Y 2/4/2009 2/10/2009 d a PNEUMOVAX on 2/17/09 and noted Y a reaction on 2/18/09 arm swollen (raised) 7x7 red area with a 2/17/2009 small fine rash, 2/18/2009 Hot to touch and pa lling, itching, rash, warmth at site. Y 1/6/2009 1/6/2009 vaccine breakthrough. Diagnosed with varicella on 1-19-09. U 7/7/2005 1/15/2009 rs had 3" diameter cellulitis. Patient has a history of IgG2 deficiency. Treated with KEFLEX BACTROBAN. U 2/16/2009 Cellulitis 2/18/2009 at site of DPAT. started within 10-15 min after MMR and VARIVAX injection. Slight puffy lips and stable visual Y signs. POS 1/13/2009 decreased 1/13/2009 95% - CTA afterward ght by Mom, had vaccination on 1/20/09. Mom noticed swelling right thigh yesterday. No fever. U Groin - right 1/20/2009 thigh - mild swelling and erythe lymph swelling/tenderness with palpation Y (Jan 15 2009). Hives and itching on neck and extremities Y 12 Jan 1/9/2009 2009. Seen 1/12/2009 and treated with PR m lesion R thigh around shot sight. Red, Y hot, indurated, tender. Began around 1 day after shot. N 1/21/09 decreased 1/14/2009 to1/15/2009 2 1/2 x 2 1/2 cm. me size swelling and tenderness at DTaP Y site. Y 1/21/2009 1/22/2009 njection site, gave BENADRYL advised mom to give in 6 hours if hives came back or go to ER, Y call 911 if1/23/2009 any trouble 1/23/2009 breathing. ck like sensations in his (L) UE that radiate to his hand. At the time of onset, approximately 2Yweeks after the injection, ### the### pt said he did no ness area (4 1/2 inches x 4 inches) on left arm with swelling and soreness. N 1/27/2009 1/28/2009
hs old patient received vaccines (routine) PEDIARIX, Hib, PREVNAR, Rotavirus - 4/21/08. On N 4/22/08 mom 4/21/2008 noted bloody 4/22/2008 stools and cramp ory of rash prior to presentation. On exam, 12cm x 15 cm around erythematous rash lat/post.Y(L) arm warm to touch, ### multiple ###bullae laterally nization at 12:15 pm on Thurs 10-9-08 Y c/o headache starting at 11 pm that night; woke up w/headache Y -10/9/2008 severe at 4:30 10/9/2008 - headache describ -fell to the ground stomach upset on Dec 6, 2008 and on Dec 7, 2008 Y 12/6/2008 12/7/2008 diameter, slightly elevated, red, irregular skin area where injection given. Denies itching or pain. U Instructed 1/12/2009 to notify1/14/2009 primary physician. ame limp and unresponsive x 5 minutes. Y Y 1/26/2009 1/27/2009 d Ulcerative Colitis after ANTHRAX Y 1-4, sxs started 2 years after #4, diagnosis made 1 year N after # 4. Diagnosed 1/4/2000with narcolepsy in 2008, b s she was well at the time and took Y no medications. Approx 24 hours later SM reports she awakened Y with papular ### pruritic### rash on bilateral ration, pain on LT arm cold compress, Y OTC Benadryl U 1/21/2009 dministered on 1/23/09 - On 1/23/09 leg was hot, red, swollen, from hip to knee, painful to touch, Y fever and 1/23/2009 hives on1/23/2009 neck-chest - Pt instruc iven 1-12-09. Pt complained of severe pain at injection site on 01-16-09. It was not relievedYby ice or EXCEDRIN. 1/12/2009 1/16/2009 ADVIL provided minima R) deltoid, fever, swelling at injection Y site, body aches, chest tightness, headache. Pt seen by Y PA at Medical 1/20/2009 Clinic on 1/20/2009 1/22/09. Recommend bump on L legs. Shot 2 days ago. Y ### ### ash - generalized RX - BENADRYLY& PREDNISONE Y 1/19/2009 1/20/2009 hours after injection, pt c/o extreme Ymuscle pain in legs arms, back and abdomen. -No local Y reaction noted 1/15/2009 @ injection 1/15/2009 site. Pt also c/o H/A to pt several hrs after injection, the site became red, raised and warm to touch. Area was the N size of a 50c piece. ###Ice applied ### to area since g redness, itching + swelling at shot Ysite L upper arm starting approximately 24 hours after shot has 8x5cm 1/19/2009 are erythema 1/21/2009 + swelling + tende ccine given to a patient under 1 year of life by mistake. HEP B ordered and HEP A given. Discovered after 1/7/2009 injection. became very painful, unable to lift. Y 1/8/2009 1/8/2009 ouch of flu- woke up with headache took ALEVE. Feels extra tired. This happens some years Y when gets1/22/2009 flu vaccine1/22/2009 also. Arm is sore. Inje er receiving tetanus shot- Had severe pain & aching (deep) in right upper arm - It has been 4 months & although 9/4/2008 the9/12/2008 pain is less, is still very h that spread over body and face swelling 1 d after vaccines, followed by rhinorrhea and cough. Y On 1/12/09 1/9/2009 child was 1/10/2009 wheezing. Also taking redness and swelling. It ran base of neck on right down to right elbow. TYLENOL/BENADRYL U 1/20/2009 1/21/2009 1/7/2009 d Rheumatoid Arthritis-- Pain beganYwithin 5 days of last dose of GARDASIL vaccination. Severe N joint pain--unable ### to 1/2/2008 walk. 2/26/09 Recei ted approximately 5 min after vaccinations Y given. She reported feeling fine just after vaccines. U During check 2/6/2009 out she fainted. 2/6/2009Blood pressure with a full body rash and fever - pt taken Y to hosp. for urticaria. Also has with peanut butter. Y 10/6/2008 10/8/2008 ot 1/12/09. Also, exposed to many children with URI symptoms 1/12. On 1/13/09, had syncope related to1/12/2009 quick changed 1/13/2009 in position. Also n e fever, symmetric erythema, induration, Y slight increased warmth right upper thigh beginning about 20-241/21/2009 hours after1/22/2009 injection 10 1/2 cm dia eadache (Migraine) N 11/3/2008 oke in AM with redness size of baseball Y then increased to size of softball per dad. 1/23/09 seen Y in office 1/20/2009 induration centrally 1/21/2009 with 16x11 ery administered 1/21/2009 Rt arm. Redness Y and swelling next morning 1/22/09. School nurse Y measured redness 1/21/2009 - 9 cm. 1/22/2009 redness, inability to perform R.O.M. with affected arm. Diagnosis Brachial Neuritis post TD U for adults 2 days. 1/24/2009 Treatment 1/25/2009 per pcp Ibuprofen on STRATTERA. Mother reports changes on behavior. Child more opositional and inattentive Y after receiving 1/23/2009 vaccine 1/23/2009 e call from Pt's mother stating Pt has little red bumps/rash on chest and both arms. Instructed U mother to take 1/20/2009 her to 1/30/2009 MD for diagnosis. Mothe y 4/08 and 12/08 (Not certain vaccine related - Pt concerned and asked for it to be reported Y 1/15/2008 4/1/2008 d hives (urticaria) in underarms, waist Y and legs. Prescribed MEDROL DOSEPAK 4 mg and ZYRTEC. Y 11/1/2008 11/2/2008 ere bilateral knee pain, spreading toY proximal lower leg and distal anterior thighs. No benefitYfrom TORADOL 1/17/2009 30 mg1/24/2009 IM. Excellent relief with h 3 weeks after injection. Y ### 1/13/2009 lient called to report 1/15 am experienced Y tingling sensation R side rib cage area into back. By U 1/15/09 afternoon 1/13/2009pain 1/15/2009 R mid rib cage into b se reaction known Y ### ness, swelling, discomfort @ injection Y site within hours of administration. Symptoms persisted Y despite patient 1/30/2009 treating 1/30/2009 with TYLENOL ES, M after receiving injection patient had localized pain at site, aches, drowsy, muscle soreness especially U in back 1/20/2009 down to1/20/2009 middle lower back. C/ n usual, cold or pains after vaccine, got sick with Flu and other symptoms, such as weakness, Y fatigue, continual ### coughing,### mucus constant ng of the vaccines child started limping. Y Right leg from groin to knee swollen with redness and Y warmth present. 1/28/2009 Right 1/28/2009 thigh left above knee swelling and redness to injection site that occurred within minutes to hours of administrationUper mother.1/13/2009 On exam 2 days later, site w/swe veloped redness & swelling at injection Y site- 6.5 X 10 cm. Y 1/15/2009 1/21/2009 & swelling @ injection site in the evening post receiving imms. It now extends to entire upper Y arm- Instruction 1/20/2009 on cool 1/20/2009 compress, BENADR 3/3/09-records received-brief syncopal episode after immunizations, resolved without treatment. Y Seen on1/16/2009 1/19/09 for1/16/2009 PPD reading. Y 1/21/2009 1/21/2009 veloped itchy rash minutes after imms Y have given (DTaP + IPV) Y 1/9/2009 1/9/2009
screamed. 5 1/2 hrs. after vaccines Y cried hard, turned head & started jerking his head 5 seconds Y - foggy look 2/9/2009 on face2/9/2009 - no further episodes mial shingles left side T 3-6. Tx - Zovirax Y 200 mg/5 mL 3/4 tsp three times a day x 1 week. U 9/11/2007 1/18/2008 atigue chills fever - flu- like symptoms Y x 3 nights (night only) (highest 104.5) slight rash all over body, not much appetite, no breathing Y difficulty1/26/2009 2/2/2009 high fever, irritable beginning 2nd day Y after vaccine Temp up to 104 at home per mom. 102.1Yat office 1/10, 1/6/2009 102.3 1/12 1/8/2009 at office use of TYLE fter the immunization was administered, the patient developed a 7.5 cm x 5 cm area of cellulitis. U He was started 2/5/2009 on antibiotics 2/6/2009 (KEFLEX) af as diagnosed with rotavirus after receiving Y vaccination series. Y 9/8/2008 ### ours after immunization, had leg swelling and hives at (R) thigh at site of Hib vaccine associated Y with prolonged 1/9/2009 crying. 1/9/2009 Y U 2/5/2009 2/6/2009 e " temp 2/9/09 in PM. 2/10/09 no temp today but (Rt) leg where PCV given is little swollen. U Red hardened 2/9/2009 area size 2/9/2009 of dime. No excess cr comfort in (L) arm - 2/6/09 redness and swelling (L) arm N 1/30/2009 2/4/2009 lled 24 hours after immunization, stating injection site the size of a dime & was red & raised.UI told patient 2/7/2009 to take 2 BENADRYL 2/8/2009 & I would c tchy leaky rash on left side chest and shoulder. Soreness and shooting "pings" of pain. AchyNshoulder and 8/28/2008 neck. Hydrocodone 1/17/2009 for pain. nd influenza vaccine on 2/9/08-started with vomiting, high fever approx. 2 hours after vaccineY 2/9/2009 2/9/2009 redness and itching around the injection site after DTAP given symptoms began 24 hours after U vaccine given. 2/4/2009 No medications 2/5/2009 or treatment dache, fatigue, general full body aches and joint pain + felt "warm" with 24 hr of vax. Improvement Y within2/5/2009 48 hr but @ 2/6/2009 72 hr - all sx returned mperature of 100.0 degrees blurred vision lasting three days. Only lights out lying in bed gaveYme relief. 2/4/2009 2/5/2009 arms, legs, hands, &* feet. Looks likeY little blisters. Symptomatically treated with ANTHRAX, CLARITIN, Y & 1/4/2009 MOTRIN Vesiculopapular 1/20/2009 lesions s stated within 24 hrs. of the injection. Symptoms include fatigue, weakness in right arm, mildYfever, swollen 2/3/2009 lymph nodes 2/4/2009 involving the right asal congestion & pressure, headaches, muscle & joint aches, dizziness, nausea & light headedness Y for 10 days. ###Took TYLENOL ### & SUDA U 2/6/2008 shortly after the injection (about 0 minute) my head started to whirl - got lightheaded - felt like Y I was going2/3/2009 to pass out. 2/3/2009 Also it increased the njection site, raised, red, hot, multiple. ORAPRED given and BENADRYL cream. U 2/11/2009 2/11/2009 area, slightly raised, firm, not, itchy. Center of area appears to have vesicles 2/9/2009 n radiating to the neck. Pt. can barely Y lift arm. U 2/9/2009 2/9/2009 er vaccination c/o being light headed, dizzy, feeling like she was going to pass out. Slept 2-3 Y hours, R arm 8/14/2008 hurt, did8/14/2008 not seek medical atten problems -mucus spitting day nightY- choke on it about to lose breath mucus worse, eye dry Nskin keep peeling 5/11/2007 off. Weezing, arm hurt come , increased blood pressure-racing pulse, Y nauseous, bronchial spasms, difficulty breathing and Y speaking- Taken### to ER given ###BENADRYL an INRIX + TDAP given 9:35 - passedYout in lobby - unconscious 10 min sustained 1-1 1/2 inchY laceration to 2/10/2009 back of head 2/10/2009 in fall pt rec'd HPV-4. On 1/12/09 when nurse in contact with pt again. Pt reports injection site tingling N for 2 weeks 8/5/2008 then site 8/19/2008 went numb approx 2" umbness going down L arm with injection Y (in left arm). Numbness, tingling severe within 15 Y min-Startes within 2/4/2009 3 hours 2/4/2009 numbness @ L foot ately 24 hours after vaccines had episode Y of eye rolling, shaking and possible apnea lasting Y 2-3 min. No fevers.### Evaluated### in ER. Of interes ped symptoms of chickenpox after having received 2 doses of VARIVAX Y 10/4/2007 1/26/2009 she felt faint, nauseated, sweaty at work. Y Felt "throat tightening, difficulty breathing & only able Y to speak 12/5/2009 or 2 words2/5/2009 at a time". She said eloped varicella on 2/4/2009 - had Rec'd 2 doses of VARIVAX on 2/9/99 and 2/12/08 U 2/12/2008 2/4/2009 R 1/28 - Next AM, thigh visibly raised, pink, well defined, non, tender 21/2 X 3 cm area. No fever. Y 2/2/09 Swelling 1/28/2009gone, looks like a bruise. er DTaP and VARIVAX in R shoulder, 7x7 cm bright red area, with heat, 2x2 induration where Y DTaP given; 2/2/2009 No fever.2/4/2009 4 days later, less red ated she has had pain in her left shoulder and in her left lower arm since receiving the flu vaccine U 2/5/09. No 2/5/2009 redness,2/6/2009 swelling or induration swelled within hrs of receiving MMRY(SQ) and DTaP (IM) on 09Feb09. No erythema. Swelling U approx 1 in 2/9/2009 greater than 2/9/2009 R leg. Non-painful b d blurry vision within 24 hrs of above vaccinations seen by optho- optic neuritis, MRI was negative for mass, 1/21/2009 treated1/22/2009 with oral steroids. Was n itching in area of vaccine admin. right after injection. Later that day swelling began. On 01-30-09Y day after 1/29/2009 injection, 1/29/2009 outside of arm is red munization 2-3-09 and was fine withYinjection. On 2-4-09 mom states Pt had 101 degrees temp Y and pt leg2/3/2009 had swollen 2/4/2009 up the size of baseb rs of receiving MMR/VZV/ Hep A vaccine fever to 103 degrees persisting x 5 days. No local Y reaction. 1/26/2009 1/26/2009 DTaP at 2:30 pm. Per call to On callY doctor at 10:30 pm - vomited several times since 12 with Y possible mild 1/21/2009 temp. Asked 1/21/2009 to eat but not kee generally hot feeling well last night. Erythema 50cm sized. Afebrile. Took BENADRYL + IBUPROFEN. U 1/28/2009 1/29/2009 RIVAX immunization on 6-23-99 now Y has chickenpox Y 6/23/1999 1/19/2009 cal reaction with 15 cm area, painful swelling. Treated with antibiotics for possible Cellulitis. No Y fever. Improved rapidly. Also had superficial child had redness and area felt hot to the touch (around injection site/shoulder area) Advised Y to use cool1/27/2009 compresse 1/29/2009 - give TYLENOL for c st thigh with mild erythema, taut with some mild dimpling swelling (med). 3 puncture sites visible Y in 3-4 cm 1/13/2009 diameter area. 1/14/2009 atous rash cheek & peri orbital tissue, pruritic both wrists Y 1/23/2009 1/28/2009 m nap this p.m. screaming for 2 hours was noted to have erythema and swelling of left leg. Erythema Y & swelling 2/6/2009 has 2/6/2009 subsided at office visit
at site, size of apple swelling at site fever at site Ice applied to site, APAP administered PO oped varicella rash on trunk and extremeties 13 days post varicella vaccination. N 1/19/2009 2/4/2009 arter size area left ECU tender areaYwith left wrist deviation & painful motion. Occurred nightUafter taking1/26/2009 2nd dose of 1/26/2009 oral TYPHOID. Had r tion was received at 10:45 AM. When Y pt. arrived home 11:30-11:45 AM she felt a little strange Y but thought 2/9/2009 it was due2/9/2009 to not eating. Then a er vaccine developed fever & rash on Y back. 2/3/2009 2/5/2009 /swollen Rt injection site slightly redY U 2/9/2009 2/9/2009 came nauseous, lightheaded, and had momentary syncopal episode. Pt. was hypotensive @ Y 80/40 but2/11/2009 BP rebounded 2/11/2009 after pt. was laid on hrs had pain, swelling, low grade fever Y (99 degrees) and rash. Rash was 8X12 cm U 1/27/2009 1/28/2009 body aches, headache, fever, chills Y x 7d. Sl. ST decreased appetite positive weight loss 9 pounds Y in 8 days. 2/3/2009 2/4/2009 little light headed and sick to her stomach. Did not vomit. Recovered quickly. Y 1/9/2009 1/9/2009 IVAX. That night after shower, she had a generalized blotchy rash all over body not hives. 1/27 Y rash gone, 1/26/2009 developed 1/26/2009 swollen tender ill defi /o reaction to Varicella vaccine. Rash Y on Left arm and Back c/o itching. (1/19/09) Pt. given Rx Y for Prednisone 1/5/2009 50 mg1/19/2009 x 1 for 7 days. bq VARIVAX given Rt lower thigh. Parents notified stuff about 5 minutes after with large reddened Y area to 2/2/2009 Rt thigh Dr2/2/2009 notified and seen pati e fever - 2 hrs after shots given- no longer running one Rt. leg- swollen & red 1/27/2009 1/27/2009 Y 1/22/2009 0:00 AM - Fri morning - Had severalYblisters @ site of Vaccine on Lt arm - Midday Fri - Lt armYbecame tight 1/29/2009 and swollen 1/30/2009 by 7:30 pm Lips and ed his vaccines and when he woke up Y noticed a lump on his (R) thigh. When seen in office, the Y lump appeared 1/13/2009 red, 1/14/2009 itchy, and slightly larger ation site with vesicular lesions and circular erythematous tender and generalized erythematous N papular 1/26/2009 trunk, extremities. 1/26/2009 n has been received from a registered Y nurse, concerning a 9 weeks old male patient, with a U history of gastroesophageal ### reflux ### disease and n has been received from a Nurse Practitioner concerning an "about 2 month old" patient who Y in December 12/1/2008 2008, was 12/1/2008 vaccinated with the n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a first and second dose of ROTATEQ (lo n has been received from a nurse concerning a 23 month old female patient who was vaccinated U orally with the three series of ROTATEQ n has been received from a registered Y nurse concerning her 17 week old grandson with no pertinent Y medical history ### who on ###07-OCT-2008 n has been received from a physician concerning a 2 year old patient who on 08-JAN-2009 U was vaccinated 1/8/2009 oral with1/8/2009 his first dose of ROTA n has been received from a registered Y nurse concerning her granddaughter who on 29-DEC-2008 Y was vaccinated ### orally 1/2/2009 with 2 ml of the fir n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h n has been received from a registered nurse concerning a female patient with gastrooesophageal Y reflux1/19/2009 who on 19-JAN-2009 1/19/2009 was vaccina n has been received form a registered nurse concerning an approximately 16 week (4 month) Y male with 1/19/2009 a history of1/19/2009 gastroesophageal reflu n has been received from a physician concerning a 16 week old patient who on 09-JAN-2009 U was vaccinated 1/9/2009 with the 1/9/2009 first dose of ROTAT n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h n has been received from a registered Y nurse concerning a 62 day old female patient with noUpertinent medical 1/26/2009 history 1/26/2009 and no known drug a n has been received from a community pediatrician concerning a 32 weeks patient who wasUvaccinated with ROTATEQ (lot # not reported) n has been received from a physician concerning a patient who on 28-JAN-2009 was vaccinated U orally with 1/28/2009 a dose 1/28/2009 of ROTATEQ (lot numb n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da n has been received from a nurse practitioner concerning 2 patients at the practice who were U vaccinated with a dose of GARDASIL on uns n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da n hs been received from a registered nurse concerning a female with sulfanomide allergy who U was vaccinated with a dose of GARDASIL o n has been received from a receptionist in a physician's office concerning her daughter whoUon 28-JAN-2009 1/28/2009 was vaccinated 1/28/2009 with the fourt n has been received from a nurse practitioner and the mother concerning a 16 year old female Y with no medical 1/28/2009 history 1/28/2009 and drug allergies w n has been received from an office Y staff member concerning a female patient who in approximately U January 1/1/2009 2009 was 1/1/2009 vaccinated with the n has been received from a physician Y concerning an 11 year old female patient who in July 2008 U "6 months 7/1/2008 ago" was7/1/2008 vaccinated with the f n has been received from a physician concerning an 11 year old female patient with asthmaNwho on 25-NOV-2008 ### was vaccinated ### intramu n has been received from a medical assistant concerning 3 female patients who fainted afterYreceiving the first dose of GARDASIL. Medica n has been received from a nurse practitioner Y concerning a female patient who on an unspecified N date received 9/1/2008 the11/1/2008 first dose of GARDASI n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL and her n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL (Lot # not reported). After patie n has been received from a registered nurse concerning a 26 year old female with polycysticNovarian syndrome, 1/27/2009 a history 1/27/2009 of thoracic sympa n has been received from a physician concerning a 15 year old patient who on 13-MAY-2008 Y was vaccinated 7/14/2008 with first 7/14/2008 dose of GARDASIL n has been received from a physician concerning an 18 year old female with no medical history Y who on 30-DEC-2008 ### 1/4/2009 was vaccinated with n has been received from a physician concerning an unknown number of patients who wereUvaccinated with a dose of GARDASIL and exp n has been received from a Certified Y Medical Assistant concerning a 21 year old female withYa history of dysmenorrhea 2/8/2008 and pelvic pain as
n has been received from a physician concerning an approximately 14 year old female who Y was vaccinated 1/1/2009 with the 1/1/2009 first 0.5 ml dose of GA n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL (lot num n has been received from a nurse practitioner Y concerning a 15 year old female patient who in N November5/24/2007 2006, was10/1/2008 vaccinated with GARD n has been received from Merck Pregnancy Y Registry for GARDASIL vaccine from a Nurse practitioner U concerning 12/8/2008 an 12/8/2008 18 year old female wi n has been received from a physician Y concerning a 16 year old female patient who on 25-MAR-2008 Y was 5/27/2008 vaccinated 5/27/2008 with first dose of GAR n has been received from a physician concerning a 22 year old female who on 23-Jan-2009Uwas vaccinated 1/23/2009 in arm 1/24/2009 with the second dose o n has been received from a 22 yearYold female patient with yeast hypersensitivity, no drug/reactions N allergies 1/23/2009 who on 1/23/2008 23-JAN-2009 was va n has been received from a physician concerning a 17 year old female with drug hypersensitivity N and allergic reaction to AMOXICILLIN and n has been received from a nurse practitioner Y concerning a 23 year old female patient with no N pertinent medical ### history and no known drug n has been received from a registered Y nurse concerning a 28 year old female patient with asthma, N allergies an allergies to penicillin, CECL n has been received from a RN concerning a 16 year old female who was vaccinated with her U first dose of GARDASIL on an unspecified d n has been received from a registered Y nurse concerning an 18 year old female student with N a slight temperature 1/9/2009 at the 1/9/2009 time of vaccination ( n has been received from a respiratory Y therapist concerning a 11 year old female patient with U no pertinent 1/26/2009 medical history 1/26/2009 and no known dr n has been received from a physician Y concerning a 48 year old female licensed nurse practitioner N with sulfanomide 1/26/2009 allergy who was admin n has been received from a nurse concerning a 26 year old female who was vaccinated withUa first dose of GARDASIL, lot number not repo n has been received from a physician Y assistant concerning a female patient who "experienced Y a severe headache after her first dose of GA n has been received from a physician Y concerning a 14 year old female patient with attentionNdeficit disorder 10/1/2008 and depression 10/1/2008 who on 24-JUN n has been received from a registered Y nurse concerning an 18 year old female patient who on Y 05-APR-2007 9/4/2008 was vaccinated 9/4/2008with the first d n has been received from a registered Y nurse concerning a 15 year old female patient with noYpertinent medical 6/25/2008 history 6/26/2008 and no known drug a n has been received from nurse practitioner Y concerning a "high school age" female patient who Y on unspecified date was vaccinated with tw n has been received from a consumer concerning her daughter who on 18-Apr-2008 was vaccinated N with 4/18/2008 the first 0.5ml 7/16/2008 dose of GARDASIL n has been received from a nurse practitioner concerning an 18 year old female patient whoNon 26-NOV-2008 ### was vaccinated ### intramuscula n has been received from a consumer concerning her 14 year old female daughter who on 16-OCT-2008 N was ### vaccinated ### with the first dose n has been received from a physician Y concerning a 16 year old female patient who on unspecified Y dates was vaccinated with the first dose n has been received from a physician. Y The physician reported that "she heard from a friendUthat the female patient, who was not the physi n has been received from a Registered Y Nurse concerning a 14 year old female patient with Flu N vaccine allergy 1/23/2009 and 1/23/2009 gastroesophageal reflux n has been received from a clerk inYa physician's office concerning her 19 year old daughterYwho in approximately 6/1/2008 June 6/1/2008 2008 "Summer 200 n has been received from a nurse concerning Y a 23 year old female patient who on unspecified U dates was 1/22/2009 vaccinated 1/23/2009 with the first and the s n has been received from a physician Y concerning a female patient who on unspecified date Y was vaccinated with her second dose of GARD n has been received from a office manager Y concerning a 19 year old female patient with no Y known drug 1/16/2008 allergies/drug 6/2/2008 reactions who on 16 n has been received from a registered Y nurse concerning her 18 year old daughter who on 27-OCT-2006 Y was vaccinated ### with the first dose n has been received from a physician Y concerning a 13 year old female patient with a historyYof passing out 1/23/2009 every time 1/23/2009 she received an injec n has been received from a nurse at physician's office concerning a female patient who on 31-DEC-2008, U was### vaccinated 1/14/2009 with the third dos n has been received from a physician who on 01-DEC-2008 was vaccinated with a dose of GARDASIL U vaccine. 12/1/2008 The patient had an abnorm n has been received from a physician Y concerning his 12 year old daughter with no known medical N history 1/22/2009 and drug 1/22/2009 allergies, who on 22-JA n has been received from a nurse concerning Y a 13 year old female with no drug reactions orYallergies who 7/23/2008 on 23-JUL-2008 7/23/2008 was vaccinated n has been received from a consumer concerning his 15 year old daughter with acne, no known N allergies 1/20/2009 and no pertinent 1/21/2009 medical history, n has been received from a nurse concerning Y an 18 year old female patient who on 16-JAN-2009 Y was vaccinated 1/16/2009 intramuscularly 1/16/2009 with the f n has been received from a consumer Y concerning her 14 year old female daughter with no pertinent N medical history, 7/1/2008 no drug reactions/alle n has been received from a physician Y concerning a female patient who on 15-AUG-2008 was Y vaccinated8/15/2008 with the first 8/15/2008 0.5 mL dose of GAR n has been received from a physician concerning a 16 year old female patient who was vaccinated Y IM with the first dose of GARDASIL (lot n has been received from a nurse practitioner concerning a 20 year old female with no known Y drug reaction/allergies 1/12/2009 1/12/2009 and a history of exerc n has been received from a physician concerning a patient who on 20-JAN-2009 was vaccinated U with third 1/20/2009 dose of GARDASIL 1/20/2009 (Lot # not re n has been received from a nurse concerning Y a 18 year old female patient who was vaccinated U with first dose of GARDASIL (Lot # not repo n has been received from a physician concerning a 16 year old female patient who was vaccinated U with two doses GARDASIL. Subsequen n has been received from a Nurse Practitioner Y concerning a female who was vaccinated withU a first dose of GARDASIL vaccine, and devel n has been received from a physician Y concerning a 17 year old female patient who on 27-JUN-2008 N was vaccinated ### with first dose of GAR n has been received from a practiceYmanager concerning a 21 year old female with no pertinent N medical1/20/2009 history, drug 1/20/2009 reactions or allergies n has been received from an office Y manager (also reported as an emergency medical technician N concerning a ### 23 year old### female patient w n has been received from a registered Y nurse concerning a 12 year old female patient who onU11-OCT-2008 1/19/2009 was vaccinated 1/19/2009 with the first do n has been received from a nurse practitioner Y concerning a 14 year old female who "sometime Y this month" 1/1/2009 was vaccinated 1/1/2009 with the first do
n has been received from a physician concerning several females who on unknown date were U vaccinated with GARDASIL vaccine. On uns n has been received from physician concerning a 14 year old female who was vaccinated the U first dose of with GARDASIL on an unspecifie n has been received from a nurse practitioner concerning a 22 year old female who on 03-DEC-2008 U was 12/3/2008 vaccinated 12/3/2008 with the first dose of n has been received from a registered nurse concerning a 19 year old female who on 12-MAY-2008 Y was vaccinated ### intramuscularly ### in the n has been received from a pharmacist Y concerning her 9 year old daughter who in August 2008, N was vaccinated 10/1/2008with 10/1/2008 a first dose of GARDA n has been received from a nurse concerning a 25 year old female with no drug allergy whoYon 09-JAN-2009 1/9/2009 was vaccinated 1/9/2009 with the first d n has been received from a nurse practitioner concerning a female who was vaccinated withNthe first dose of GARDASIL. 1/1/2008 "Few months ago n has been received from a physician concerning a female who on was vaccinated in the deltoid Y with the1/19/2009 first and second 1/19/2009 dose of GARDAS n has been received from a healthcare worker concerning a 14 year old female with penicillin Y allergy and1/16/2009 drug hypersensitivity 1/16/2009 of DARVOC n has been received from a physician concerning a female with eczema who about 1 year ago, N was vaccinated 1/1/2008 with the 1/1/2008 first dose of GARD n has been received from a registered pharmacist concerning three female patients who on Y unknown dates were vaccinated with GARDAS n has been received from a consumer Y concerning her 18 year old daughter with asthma whoNin the summer 4/15/2008 of 2008,9/1/2008 was vaccinated with t n has been received from a consumer Y concerning her approximately 20 year old daughter with N no pertinent 11/1/2008 medical11/1/2008 history, who in Novem n has been received from a consumer for the pregnancy registry of GARDASIL vaccine concerning U his fiancee 6/1/2008 who has has two doses of G n has been received from a medical assistant and a registered nurse concerning a 15 monthYold patient who vaccinated with a dose of GAR n has been received from a medicalYassistant concerning a female patient who on 14-JAN-2009 N was vaccinated 1/14/2009 subcutaneously 1/24/2009 with the th n has been received from a patient's mother concerning her 12 year old daughter with no pertinent N medical 1/3/2009 history and 1/3/2009 no known drug aller n has been received from a nurse practitioner Y concerning a 13 year old female patient who on Y 15-JAN-2009 1/15/2009 was vaccinated 1/15/2009intramuscularl n has been received from a nurse practitioner Y concerning a 20 year old female patient with AZITHROMYCIN N allergy ### and a history of seizur n has been received from a Nurse Practitioner concerning a female patient who completed GARDASIL U vaccine (lot # not provided) series. n has been received from a doctor of pharmacy who spoke with a nurse in her facility and stated U that on an unspecified date another patien n has bee received from a 19 year old female patient for GARDASIL, concerning herself withNno pertinent 10/1/2008 medical history ### and no known dr n has been received from physician concerning a female patient who was vaccinated with a Y0.5 ml dose of GARDASIL vaccine. The patien n has been received from a physician concerning a 16 year old female who on 15-JAN-2009Nwas vaccinated 1/15/2009 with a1/15/2009 0.5 ml dose of GARDA n has been received from a 19 year old female with no drug allergy who in January 2008 was N vaccinated 1/1/2008 with the first 1/15/2009 dose of GARDASIL. n has been received from a physician concerning a female who was vaccinated with a third U dose of GARDASIL vaccine and experienced p n has been received from a registered nurse concerning a 20 year old female who on 09-OCT-2008 U was10/9/2008 vaccinated with the ###first 0.5 ml do n has been received from a nurse concerning a 19 year old female patient for the pregnancyUregistry for GARDASIL. 2/3/2008 6/27/2008 With allergy to BENAD n has been received from a doctor of pharmacy concerning her daughter who in October 2007 N was vaccinated 10/1/2007 with10/1/2007 the first dose of GARDA n has been received from a physician Y and her assistant concerning 23 year old female whoYon an unknown date was vaccinated ### with a firs n has been received from a Nurse Practitioner Y concerning a 22 year old female virgin patient with no pertinent ### medical 12/1/2008 history no drug reac n has been received from a registered nurse concerning a female, who was vaccinated withUthe second dose of GARDASIL, IM in upper de n has been received from a nurse practitioner Y concerning a 16 year old female patient with penicillin Y allergy, 1/14/2009 who on1/15/2009 14-JAN-2009 was vac n has been received from a consumer concerning her 15 year old female daughter with no pertinent Y medical 8/26/2008 history8/26/2008 and no drug reactions/ n has been received from a nurse concerning "almost every single patient" (approximately 237) U who was vaccinated with GARDASIL. Sub n has been received from a medical assistant concerning a 17 year old female with no pertinent N medical history 1/8/2009 who1/12/2009 on 30-OCT-2008 was n has been received from a nurse practitioner concerning a female who was vaccinated withUa dose of GARDASIL (lot # not reported). Sub n has been received from a Certified Medical Assistant concerning an approximately 14-year-old Y female12/1/2008 with no known 12/1/2008 drug allergies who n has been received from a nurse practitioner concerning her daughter who in October 2008, was vaccinated 10/1/2008 the first 10/1/2008 dose of GARDASIL. n has been received from a physician concerning a 15 year old female who was vaccinated U with a 0.5ml dose of GARDASIL (lot number no n has been received from a registered Y nurse concerning her 26 year old daughter who on 13-JAN-2000 Y 1/13/2009 was vaccinated 1/13/2009 with a second dose n has been received from a nurse concerning a 14 year old female student patient who on 12-JAN-2009 U 1/12/2009 was vaccinated 1/14/2009 with the third dose n has been received from a registered Y nurse concerning a 17 year old female patient with CODEINE Y allergy 8/26/2008 who on8/26/2008 19-JUN-2008 was vac n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL 1/5/2009 (Lot 1/14/2009 # was not available) n has been received from a nurse concerning a 25 year old female patient with no known drug Y reactions/allergies 1/7/2009and 1/7/2009 medical history who n has been received from a female patient, with no known drug reactions/allergies and no pertinent U medical history, who was vaccinated w n has been received from a licensed Y practical nurse concerning a 19 year old female patientUwith no known 8/20/2008 medical history; who on 20-AU n has been received from a nurse practitioner concerning a 19 year old female who on 08-Jan-2009 N was 1/8/2009 vaccinated 1/8/2009 with the first dose of G n has been received from a physician Y concerning a female patient who on vaccinated with the U three doses of GARDASIL. Shortly after the n has been received from a physician concerning a female patient who was vaccinated with Ua dose of GARDASIL 10/1/2008 last fall and said the vac n has been received from a licensed Y practical nurse concerning an 18 year old female patient N with no known 9/15/2008 medical 9/15/2008 history and drugs alle
n has been received from a nurse Concerning a female who was vaccinated with the third dose U of GARDASIL vaccine. The nurse reported n has been received from a physician concerning a female patient with unspecified psychiatric U problems12/1/2007 and restless1/1/2009 legs syndrome who in n has been received from a nurse practitioner Y concerning a 25 year year old female patient with N no pertinent medical history, ###not known dru n has been received from a physician assistant concerning a 15 or 16 year old female patient U who on unknown dates was vaccinated with n has been received from a registered nurse concerning her daughter who was vaccinated with U the third dose of GARDASIL. Four days af n has been received from a physician concerning a female who on unspecified date was vaccinated U with a first dose of GARDASIL and had n has been received from a physician concerning a 13 year old female patient, who on unspecified Y dates, was vaccinated 11/1/2008 with the second n has been received from a nurse concerning a female who was vaccinated with a first doseUof GARDASIL. The patient called the nurse 4 n has been received from a Nurse concerning Y a 20 year old female patient with no pertinentYmedical history 1/8/2009 and no drug 1/8/2009 reactions or allerg n has been received from a registered Y nurse concerning a 23 year old female patient with noYpertinent medical### history and### no known drug a n has been received from a nurse in the physician's office concerning a 43 year old female who U was vaccinated with three doses of GARDA n has been received from a physician's assistant concerning a 15 year old white female, 75.9 Y kg and 157cm 1/8/2009 in height, 1/8/2009 who on unspecified n has been received from a consumer concerning her daughter who was vaccinated with theUthird dose of GARDASIL. 1/1/2009 In January 2009 ("a n has been received from a physician concerning a 14 year old female who on 01-MAY-2008 N was vaccinated 5/1/2008 with the 5/22/2008 third dose of GARDA n has been received from a physician's assistant concerning a 13-15 year old female who onY 08-JAN-2009 1/8/2009 was vaccinated 1/8/2009 with the third do n has been received from a 21 year old female with attention deficit disorder and no medicalUhistory who was vaccinated with ### three doses o n has been received from a consumer concerning her 17 year old daughter with a history of N drug hypersensitivity 1/5/2009to MYNOCYCLINE 1/7/2009 who o n has been received from a physician concerning a female who was vaccinated with a first dose N of GARDASIL 1/8/2009 without any reactions and o n has been received from a registered nurse concerning a 21 year old patient who on 10-NOV-2008 N was vaccinated ### with a first dose of GA n has been received from a 19 year old female with no known drug allergies who on 05-JAN-2009 N was vaccinated 1/5/2009 with 1/8/2009 the third dose of GA n has been received from a nurse concerning a 16 year old female with no medical history ofY drug allergy 7/11/2008 who on 11-JUL-2008 7/11/2008 was vaccin n has been received from a nurse practitioner, for GARDASIL, a Pregnancy Registry product, U concerning7/3/2008 a 17 year12/1/2008 old female who on 03-J n has been received from a medical assistant concerning her daughter who was vaccinated Uwith the first dose of GARDASIL on an unspec n has been received from a physician concerning a female patient who was vaccinated with Uthree doses of GARDASIL vaccine (no lot num n has been received from a nurse practitioner concerning a 15 year female who in May 2008, Y was vaccinated 5/28/2008 with the 6/1/2008 first 0.5ml dose of G n has been received from a consumer concerning her 15 year old daughter with no medical N history and drug 7/1/2008 allergies, 12/1/2008 who in July 2008 wa n has been received from a nurse practitioner Y concerning an 18 year old female who was vaccinated Y with9/3/2008 the second9/4/2008 dose of GARDASIL in n has been received from a nurse practitioner concerning a 17 year old female who on 06-MAY-2008 N was5/6/2008 vaccinated with GARDASIL intra n has been received from a 45 year old female patient who was vaccinated with two doses of U GARDASIL vaccine (no lot number was prov n has been received from a registered nurse concerning a 22 year old female who on unspecified Y dates was vaccinated ### with ###the first and th n has been received from a medicalYassistant concerning a 13 year old female patient with no Y pertinent medical 7/16/2008 history 7/16/2008 and with allergic rea n has been received from a doctor of Y pharmacist concerning a 17 year old female patient with N no pertinent 10/1/2008 medical history and no known d n has been received from a registered nurse concerning a 10 year old female patient who onY 15-MAY-2008 was ### vaccinated ###with the first do n has been received from a physician Y concerning a 14 year old female who on 20-MAY-2008 Y was vaccinated 5/20/2008 with the 5/25/2008 first dose of GARDA n has been received from a consumer concerning her 19 year old daughter who on 09-APR-2007 U was vaccinated ### with 3/12/2008 the first dose of GAR n has been received from a 24 year old female patient, for GARDASIL vaccine, a PregnancyNRegistry product 9/1/2008 concerning 12/6/2008 herself with no p n has been received from a physician Y concerning a 16 year old female with no medical history Y or drug allergy 1/5/2009 who on1/5/2009 05-JAN-2009 was va n has been received from 2 nurses concerning a 17 year old female with a history of faintingYwho on 30-DEC-2008 ### was vaccinated ### with the n has been received from a physician assistant concerning an 18 year old female with reactions Y to vaccines who was vaccinated ### with a dos n has been received from a 24 year old female medical assistant who in December 2008, was U vaccinated 12/1/2008 with a second dose of GARDASI n has been received from a physician concerning an 17 year old female who on 02-JAN-2009 Y was vaccinated 1/2/2009 with the 1/2/2009 first dose of GARDA n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning U an 7/16/2007 18 year old female ### with urinary freq n has been received from a physician concerning an 11 year old female who in August 2007, Y was vaccinated 8/1/2007 with the8/1/2007 first dose of GARDA n has been received from a registered Y nurse, concerning a female patient, who on an unspecified U date was vaccinated with GARDASIL. Th n has been received from a registered Y nurse, concerning a female patient, who on an unspecified U date was vaccinated with GARDASIL ,0. n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 1/1/2008 12 months"1/1/2008 was vaccinated intram n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 1/1/2008 12 months"1/1/2008 was vaccinated intram n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 12 months" was vaccinated intram n has been received from a physician concerning a female with allergy to latex who was vaccinated U with GARDASIL. Concomitant therapy n has been received from a 27 year old female patient who on 08-OCT-2008 was vaccinatedY with a first 10/8/2008 dose of GARDASIL, when she was n has been received from a consumer Y concerning her 12 year old daughter with no known medical N history 6/10/2008 and allergies, 6/10/2008 who on 10-JUN-20
n has been received from a physician Y concerning a 12 year old female patient who on an unknown Y date was vaccinated with the first dose n has been received from a Registered Nurse concerning a 17 year old female patient with no Y pertinent 8/31/2008 medical history 9/2/2008 and no drug reactio n has been received from a consumer Y concerning her 21 year old daughter with no previousYmedical history reported ### who### on 06-APR-2007 n has been received from a licensed Y practical nurse for the Pregnancy Registry for GARDASIL, U concerning 10/8/2008 a 26 year old female ### patient wit n has been received from a consumer Y concerning her 16 year old daughter with no drug reactions Y or allergies 12/9/2008 who on 09-Dec-2008 ### was va n has been received from a registered Y nurse concerning a 16 year old female with no medical U history and allergies ### and 0 previous ### pregnan n has been received from a certified nurse midwife for the Pregnancy Registry for GARDASIL U vaccine, concerning 8/15/2008 a8/15/2008 19 year old female wh n has been received from a Registered Nurse regarding the Pregnancy registry for HPV concerning Y a 2411/4/2008 year-old female with penicillin and n has been received from a Registered Nurse, for the Pregnancy Registry for GARDASIL vaccine U concerning a### 24 year 2/26/2008 female with of asth n has been received from a nurse practitioner Y for the pregnancy registry for GARDASIL vaccine Y concerning 1/28/2008 a 27 year 2/11/2008 old female with a his follow up information has been received from a nurse, for the pregnancy for GARDASIL, concerning Y a black female with one previous preg n has been received through the Merck Y pregnancy registry from a female consumer, nurse practitioner Y and 2/22/2008 physician 2/22/2008 concerning female wi n has been received from Pregnancy Registry for GARDASIL vaccine from a Registered Nurse Y (R.N.) concerning 10/9/2007a10/9/2007 female patient who was n has been received through the Merck Y pregnancy registry from a physician concerning a 25Yyear old female with ###a history### of tonsillectomy fter vaccinations, he developed a rash all over body (mostly on face & neck). It was a red, blotchy Y rash with 1/26/2009 tiny raised 2/4/2009 bumps. Rash laste rtness of breath. Rx- BENADRYL 25mg Y IV, SOLUMEDROL 125mg IV; MEDROL DOSC Pack, Y BENADRYL PO###Symptoms ###resolved. ceived vaccine 01/19/09 (Monday) and Y report ear ache and cold sores on 01/23/09. Patient treated Y as such 1/19/2009 but returned 1/23/2009 to MD office and d ported - symptoms of Brachial neuritis Y - R arm deep ache, weakness, numbness. N 1/20/2009 1/26/2009 e fever, chills, body ache, dizziness lasted 36-48 hours Y 1/29/2009 1/30/2009 was given 1/30/09-same day Patient developed repetitive Head nodding 3-4 episodes per hour N per parents. 1/30/2009 Observed 1/30/2009 1 episode in clinic cm erythematous plaque, hot raised, at injection site, mild pruritis. Pt noted began after injection, U enlarging 1/22/2009 qd 1/22/2009 zed swelling @ injection site (upper quadrant of left thigh) 14 days post vaccination pain to the U touch, cranky 1/8/2009 child. Redness 1/22/2009present 4d. Po anus shot in my right arm. About 4Ydays later I noticed a lump on my right shoulder. I had an ultrasound + that### showed 1/4/2009 3 lumps. I had an 0 min of giving immunizations infant became limp 1 eyes appearing "vacant." No jerking motions/cyanosis Y 1/21/2009 - 1 Hr 150-O2 1/21/2009 100% monitored f d coldness, stiffness, chills, spasticity occurred 4 hrs after vaccine (flu). Episode lasted 5 minutes. Y 10/8/2008 10/8/2008 d hives approximately 12hr after PEDIARIX, Hib, PCV7, ROTATEQ. Y 1/13/2009 m fever, hot to touch, pain at injection Y site, shortness of breath, redness and swelling at injection U site. 1/21/2009 1/21/2009 AP instead of DTAP Y zure like activity Y Y 1/28/2009 1/29/2009 cines, pt. was nervous, I left the room so pt. could get dressed. MOP said pt. got up to change Y and pt. fell 1/28/2009 back. Pt.1/28/2009 was pale. We laid her ceived vaccines on 1-16-09- Hepatitis Y A, PREVNAR, influenza, and MMR. On 1-24-09 patient started with 1/16/2009 symptoms 1/24/2009 of rash, fever-rash sta m with erythema, length of deltoid positive Y warmth, positive swelling given 10 days KEFLEX 250 Y mg every 11/6/2008 12. 11/8/2008 103.5 degree F X 48 degree + MOTRIN/TYLENOL Y 1/26/2009 1/26/2009 mmatory reaction to right upper arm 2/10/2009 2/12/2009 onset of facial rash & rash @ sites Y of vaccines within minutes post VARIVAX @ 1205- refractions Y was noticed. 1/8/2009 1/1000 1/8/2009 EPI 0.1 ml given in ith fever - suspicious CT Y Y 1/20/2009 1/21/2009 rash on (R) side of face and on arm. Last for 3 days. Y 9/4/2008 9/5/2008 TX: BENADRYL TYLENOL Topical treatment of lesions N 12/5/2007 1/19/2009 red vaccine to patient. Patient older than eligible age. Product guidelines say age less than 65 Y yrs old is eligible. 1/9/2009 Client is 65 yrs old. ort received on 16 January 2009 from a health professional. A 58 year old female, with a history N of hypertension, ### Hypercholesterolemia ### and s in right thumb that rapidly spread to Y both hands and then into feet. Sense of tongue burning N followed by a sense ### of numbness ### about the f ef near syncopal episode when she got up from exam table, less than 2 minutes after injection. Y Completely 1/27/2009 resolved1/27/2009 in 10 minutes. Did not 2 since midnight. Fever to 102.2 with Y blurred vision short term. Headache. SOB from a few U hours after shot 1/29/2009 until midnight. 1/29/2009 (L) arm sorenes vaccine given to child less than 6 months of age. Y 1/30/2009 tous, tender to palpitation. Anterior aspect Y of left arm. Plaque about 4cm in diameter. U 1/28/2009 1/29/2009 ls, nausea, sore at inj site H/A, achy feeling. Y 1/26/2009 1/26/2009 ocal cellulitis (L) deltoid treated with antibiotics. Y 1/7/2009 1/14/2009 ZOSTAVAX 1/27/09. 1/30/09 presented Y to our office arm pain from elbow to arm pit, "feels on U fire" swollen, 1/27/2009 hard and 1/28/2009 red. Treated with OTC tenderness, and warmth @ site of injection possible infection --> pt. referred to PCP. U 1/30/2009 1/4/2009 munization red, swollen, tender with patient c/o arm, shoulder and neck pain - 1st local reaction U I've seen1/22/2009 with. 1/22/2009 eiving Tdap pt. had fever, vomiting and body aches for 3 days. Y 1/31/2009 1/31/2009
edema, itchiness @ site of injection, c/o general malaise. 1/28/2009 1/30/2009 - warm area 2 days and gradually subsiding. Y 1/1/2009 1/1/2009 izzy while walking , fainted. Y 1/29/2009 1/29/2009 ded, heart racing, palpitations. Y Y 1/15/2009 1/15/2009 ates the child had diarrhea x 7 days. Y 12/1/2008 12/1/2008 from client states "upper right arm has been hurting since she received the hepatitis A-B vaccine U on 1/12/09". 1/12/2009 She 1/12/2009 has applied cold and he th swelling, induration, warmth and ,mild erythema of left thigh. U 1/27/2009 1/28/2009 ncope within 3 min, fell to floor, hit head. Y Unresponsive for several minutes. VS were stable.Y Went to ER1/8/2009 for eval. Recovered, 1/8/2009 sent home. n has been received from a consumer concerning his child who on an unspecified date was U vaccinated with a dose of PROQUAD (lot num n has been received from a physician concerning a patient who on third week of December U 2008 was vaccinated ###with the### first dose of ROT PM Tongue "thick and hard". Y Difficulty breathing and swallowing. 2/3/09 12 Noon (L) arm sore. Y (L) hand/fingers 2/2/2009 tingling. 2/2/2009 2/3/09 Family calle ZOSTAVAX - on 9/17/08 in left upper Y deltoid. On 12/19/08, pain in left arm, left neck, left cheek Y occurred. 9/17/2008 Herpes lesions ### occurred - left no t on 12/3/08, Flu vaccine 11/17. 3/19/09 Y MR received from PCP which include neuro consults. N Pt seen 11/17/08 ###for12/3/2008 URI sx. Flu vax given. veloped sore right arm the day she received the vaccine. Bothers her most at night rolling over U in bed. Difficult 2/9/2009 to put2/9/2009 deodorant on. No feve ed ZOSTAVAX on 01/06/2009. She developed an itchy painful rash on her neck and on itchyUsensitive area 1/6/2009 right scapula 2/1/2009 and under her righ ped urticaria (Hives) within 24 hoursYof receiving vaccine (HEP B) U 2/12/2009 2/13/2009 @ approx 2 pm, slept for 6 hours (unusual) waking once to nurse and cry @ 6 pm and then back Y to sleep until 2/5/2009 8 pm. Upon 2/5/2009 waking went very as given Hepatitis A and VARIVAX; Y within minutes was syncopal and had tonic-clonic seizureY while still in2/16/2009 exam room. 2/16/2009 Pulse 70, B/P 104/62 ng 4 y/o shots, 1 day post getting them Y arm (right arm) blister, red, sore. Fussy all day 2 days U post shots2/11/2009 with red lacy 2/12/2009 rash, clammy, pale, area of vaccine MIN local reaction of Y about 1 inch around VACC site-has pooling reaction area Y under the2/10/2009 vaccine site 2/17/2009 of redness about 6 in ed Vaccinia characterized by headache nausea and generalized erythematous papules sparing face and 2/8/2009 neck 2/19/2009 s been running a fever up to 104, dizziness, Y shakes, muscle ache, headache, weakness, coughing, N flush 2/16/2009 and loss of 2/17/2009 energy. These sympto headaches, frequent illness Y includingY viral spinalY menengitis, numbness 9 and tingling in different U areas of the body. ###First 1/15/2009 shot 10/31/08, seco veloped temperature of 102F and headache on 2-18-2009 around 1:45pm. Parent reported U symptoms to2/17/2009 clinic at approximately 2/18/2009 4:30pm an 17 started to get a papular rash on both feet hands and arms with itching. Took over the counter Y Benadryl 2/11/2009 1 tablet February 2/17/2009 18 2009. The r om pt: sx's began 2-17-09 PM - painYL side only (arm, shoulder, breast). She went to work 2-18 Y and left early 2/17/2009 d/t sx's. 2/17/2009 Co-workers commente 02.5 one hour after the DTaP1/Hib/IVP Y shot administered. Also signs of severe distress, screaming U and5/9/2001 crying. He5/9/2001 continually grasped m ( 2/12/09) he was shivering, temp taken, was 94 degrees. At 2 am,his temp was 103. He had Y an uneasy2/12/2009 stomach for 2/12/2009 a few days. Nausea b s before Thanksgiving, mother Y saysYpatient had Y cold symptoms, coughing 4 and nasal congestion. N The week of ### Thanksgiving, ###Nov. 24, 2008 headache, right earache, left arm pain (same side as vaccination), vomiting x 1. Y 2/10/2009 2/11/2009 st his hair- all of it over the course of 3 months and became completly bald. He has not had any N new growth. 3/30/2007 4/30/2007 ain - stiff after receiving vaccination that has continued to be bothersome U 8/25/2008 8/26/2008 -Pt received Fluzone MDV 0.5ml, and should have received Fluzone 0.25ml. 1/29/2009 - Pt received Tdap instead of Dtap 1/30/2009 - Pt received Fluzone MDV 0.5ml instead of 0.25ml. 1/29/2009 lled and questioned soreness of vaccinated arm. Patient stated that it was warm to the touch U and approximately 2/16/20092" in diameter. It was also swollen and tender and hard after recieving DTaP but should of recieved dT booster insteadY 2/17/2009 2/18/2009 ticed onset of partial seizure like activity the night after vaccines were administered. Episodes U of shaking2/16/2009 the head and 2/16/2009 shaking one arm wi ay after receiving vaccines, lethargic, eyes droopy, woke up 2x only to feed for 8-10 min each U time 2/18/2009 2/18/2009 ed the following information from a nurse via the Y agency on 05 FEB 132009: A 68-year-old woman, Y born on 26 APR ### 1940, was ###vaccinated wi was reported by a lawyer and described the occurrence Y of arm pain0in a female subject of unspecified N age 5/8/2000 who was vaccinated with LYME was reported by a healthcare professional Y via a sales representative and described the occurrence U of vaccine 4/10/2008 exposure 4/10/2008 during pregnancy was reported by a healthcare professional Y via a sales representative and described the occurrence U of pregnancy 4/10/2008in4/10/2008 an adult female subjec abdomen and spread to back with itching, Y stinging and pain. Pain constant treated with VALTREX U 1g tid 10/9/2008 x 7 days and2/2/2009 NEUROTIN 500mg b 2/12/2009 and swelling at site, Dorsal portion of Left arm in subcutaneous area. 4 cm round. Y 2/17/2009 2/18/2009 r all over body 10 days after immunization pt examined 2/9/09 rash resolved Y 1/26/2009 2/4/2009 ve like. Swollen Rt leg - redness. Y Y 2/17/2009 2/18/2009 chicken pox disease on 2-19-09 9/22/2003 2/19/2009 veloped #3 1-2 mm papules red on right thigh 1 week after shots Y 1/29/2009 2/5/2009 ed. 7/7/09 Medical records received Y DOS 12/26/07 to 6/23/09. Assessment: Rash Patient presented Y with1/8/2009 erythematous 1/14/2009 maculopapular ras
9 donor reported a rash she developed following a Hep B injection she received on 2-17-09.YRash on 2-18-09 2/17/2009 stretched 2/17/2009 across abdomen a r reported by parent to be 105.6 degrees Y F. Office temperature within normal limits 97.2 degrees Y F without 2/11/2009 other symptoms. 2/11/2009 Lab work comp rythematous vesiculopapular eruptions Y over arms, hands, legs, heels, chest, upper back, upper trunk, onset 1/15/2009 17 days 2/1/2009 following receipt of SP ve 1 dose of MENACTRA that had expired 2 days before no problems. U 2/4/2009 t 2008 his mother brought him to immunizationsYto receive his 6 month 10 old shots and Synagis. Y Mom reported the ###child was### cranky having a d bilateral red eyes, itching, pain similar Y to 4/29/05 eye infection 2 hours after receiving both IM Y influenza10/1/2005 10/2005 and 10/1/2005 FLUMIST 10/2006. P 3 AVA vaccinations in 2007 and continued Y to experience cough, fatigue, myalgia, arthralgia, dizziness,and 2/28/2007 short term memory problems. n has been received from a physician Y concerning Y a 32 year old male 0 patient with Wilson's disease U and decreased immunoglobulin levels w n has been received from a female who on an unspecified date was vaccinated with the firstYdose of MMR II and "had a reaction like stop b n has been received from a physician Y concerning a female who on an unspecified date was Yintramuscularly vaccinated with the second dos 2/19/2009 N 2/18/2009 2/19/2009 - entire body - breathing on her own,Y difficulty swallowing, Y weakness3arm Y and legs at 2200 then U progressed 2/5/2009 this AM. 2/5/2009 2/27/09-records receiv o hospital 2/6/9 for intussusception. 3/9/09 Received Y hospital medical 2 records of 2/6-2/7/2009. Y FINAL DX: Ileocecal ### 2/6/2009 intussusception Recor Feb. 5, 2009 fever 102- C was the highest Y the fever and slight rash on face, no energy, red eyes Y not eating. 1/27/2009 Fr. Feb 6, 2/5/2009 2009 fever and rash ic rash encircling entire base of neck developed 48 hours after ZOSTAVAX administered without Y rash at injection site of R deltoid. Develop lls, muscle aches. Y Y 2/19/2009 2/19/2009 & warmth of left thigh where KINRIXYwas administered on 2/17/09 U 2/17/2009 2/18/2009 nner thighs and lower back positive pruritis. U 2/17/2009 2/19/2009 tight chest, hives, and difficulty breathing that lasted for three hours. Y 9/20/2008 9/20/2008 d, extremely cold chills, dizziness (these conditions lasted four days). Y in today for yellow fever and Hep AYvaccine for travel to Peru. Vaccine was given (yellow fever) Y SQ in left 2/16/2009 arm and Hep 2/16/2009 A IM in R deltoid at d FLUMIST on 10-8-08, but still tested Y positive for influenza B on 2-4-09. Y 10/8/2008 2/4/2009 d FLUMIST on 10-9-08, but still tested Y positive for influenza A on 1-31-09. Y 10/9/2008 1/31/2009 d FLUMIST on 10-8-08, but still tested Y positive for influenza A on 2-2-09. Y 10/8/2008 2/2/2009 ceived FLUMIST on 10-9-08, but still Y tested positive for A and B influenza on 12-7-08. Y 10/9/2008 12/7/2008 ot in Oct - (first shot ever for flu). By next am lips were swollen and remained for the day. ByYevening lips started ###getting dry ###and chapped a nconsolable crying, poor feeding Y 2/3/2009 2/3/2009 oid has 2cm annular red induration - Pt c/o nausea, vomiting, & fever of 101.4 F 2 days afterYinjection was2/5/2009 given. States 2/7/2009 she has never had cry after PENTACEL vaccine Y 2/13/2009 2/13/2009 after Vaccine given patient called with Y an intense PRURITIC Response - patient returned toYoffice for DEPO 2/9/2009 MEDROC 2/9/2009 Injection. n MMR & DTAP into left deltoid & VARICELLA & IPV in right PT got 10 X 10 area of erythema N on left deltoid 2/11/2009 & a headache 2/12/2009 lled the pharmacy with concern about Y red area excessive swelling and redness at the injection Y site (size2/11/2009 of a grapefruit). 2/12/2009 Patient was conce the shingles vaccine 7-07 and developed shingles exactly at the injection site and then spread N down my arm 7/1/2007 numerous 1/26/2009 lesions and tremen U 1/27/2009 2/9/2009 ot on Jan 7-09- my arm ached- the place were the shot was given it got red and swelled up bigger then a 1/7/2009 50 cent piece. The worst is my n ports child with facial swelling and vomiting Y started 2/6/09. Seen ER at medical center 2/6/09. N Mom reports 2/5/2009 "Dr said she 2/6/2009 had allergic reactio edness/warmth of (R) arm. Area of induration Y 7 cm x 8 cm. Treated with 3 d of Prednisone. U 2/6/2009 2/7/2009 15 min. Wait after Hep B injection, pt Y stated she felt tired. Helped to exam table where she started U having 2/19/2009 seizure like 2/19/2009 movements of arms. m area longer than palm size, tender notes to L auxilla, low grade temp + malaise 2/16/2009 2/16/2009 mplained of severe body ache's, fatigue, night sweats, + fever. Y 2/6/2009 2/6/2009 r injection, itching L deltoid at 48 hrs, 8 x 8 cm red indurated area 2/12/2009 2/13/2009 d raised, red area at injection site used ice with relief this am. C/O sever pain to right arm - no U pain medication 2/12/2009 taken2/12/2009 by RN advised to take r (103.6), sweats, chills, malaise. No treatment. Y 2/18/2009 2/18/2009 accine was administered at 11:30am Y on Wednesday, 2/18/2009. On the way home from herNCF appointment, 2/18/2009 I stopped 2/18/2009 at our Chiropracto ter the vaccine was given the patient Y noticed, redness, swelling, itching and pain of her rightUarm. Dizziness 2/16/2009 and sleepiness 2/17/2009notices as wel headache and achy, a few hours after receiving vaccines. Y 2/11/2009 2/11/2009 ates she had itchy, red spots all over arms, legs, trunk and scalp a few hours after receiving the Y vaccine (2/19) 2/19/2009 that lasted 2/19/2009 until 3am this mor as given 4 vaccines on 2/17/09 afternoon (menactra, varivax, gardasil, adacel). Late that evening note redness 2/17/2009 and2/17/2009 soreness to the back o observing redness and swelling at injection site the morning after the Tdap was administered. U Swelling and 2/17/2009 pain has2/18/2009 increased today (day t O of headache, swelling resulting inYleft arm numbness, swollen tongue and slurred speech.YPatient seen 2/19/2009 in ER and 2/19/2009 treated with Prednison D RASH ON UPPER TRUNK AND BOTH ARMS, TOOK BENEDRYL AT 6PM 2/19/09 AND 8AM N 2/20/09.2/18/2009 2/19/2009
her called and spoke with RN in clinic on 2/18/09 informing her patient had seizure on morning Y of 2/18/09, 2/17/2009 and wanted 2/18/2009 Dr Gold informed. P lling and erythema 2 days after injection with Tdap (ADACEL) and HPV4 at same site. Y 2/17/2009 2/19/2009 ately 10 minutes after immunizations, parent reported Y stiffening and 4eyes rolled. Patient wasUnot in office2/20/2009 at this time/was 2/20/2009 with parents. Bab ite swollen, red, itchy and painful for over 1 week. No treatment. Y 2/8/2009 2/9/2009 ceived Yellow Fever and Hepatitis BYVaccination and waited 10 minutes in the Aid Station before Y departing. 2/18/2009 15 minutes 2/18/2009 after departed he re alance, double vision, dizziness, nausea, Y abnormally high blood platelet count. 3/12/09 Received U ER medical records ### of 11/28/2008. ### FINAL d entire body rash with lesions, itching, elevated temp. lasted for 8 days. Parent states "looked Y like regular 1/8/2009 case of 1/19/2009 Chicken Pox". Child ad dministered 2/6/2009 on february 19, 2009 rash covering trunk and face no fever otherwise normal Y . rash 2/6/2009 pruritic blanching 2/19/2009 raised papule o ately 5 min after giving immunizations, Y pt became Y combative, c/o severe 1 abd pain, throat pain. Y Patient was 2/19/2009 sweating2/19/2009 and scratching skin. M PER ARM PAIN, SWELLING, AND WARM TO THE TOUCH MEASURING 5X5 CM. SYMPTOMS U STARTED 2/18/2009 ON 2/19/09 2/19/2009 AM. PT SEEN BY ack to clinic today to report a reaction to receiving the Pneumovax vaccine in our clinic two days Y prior. Pt 2/18/2009 states receiving 2/18/2009 the vaccine in th 2/20/2009 s post Varivax immunization ( 1st dose) Employee developed itching rash on arms & legs , tiny, Y raised " pimple### like"1/18/2009 ,fluid filled rash Emplo headache. Facial swelling w/rash. Lymphandopathy. Y Prednisone at tapering dose. Doxycycline. Y ### ### ssed out about 10 minutes after receiving 5 vaccinations at her 4 year old well check up. While Y under observation, 2/10/2005 she 2/20/2009 passed out in her m g Varicella vaccine, Tdap, then HPV, child's eyes rolled back, body slumped to right side, b/lYarms and legs 2/19/2008 waved/flapped 2/19/2008 side to side. No warmth, pain/soreness and itchiness since vaccine was administered at left upper arm Y 2/16/2009 2/16/2009 g Fever and stomach ache during the night. To 101.2 degrees Farenheit by 8am 02/19/2009.U Patient complained 2/18/2009 of2/19/2009 headache and nausea 08 pt received anthrax and typhoid vaccines. The following day pt c/o generalized tingling throughout U her body.### Nov. 17, seen ### by Dr. Cash a 1/24/2009 N 1/8/2009 1/24/2009 3/21/2009 Y Y 35 Y U 1/23/2009 2/13/2009 oth legs and arms with weakness. Muscle Y weakness Y (not working right 48 Y in func). Speech impairment. N 4/20/09 Received ### hospital ### & rehab me DTAP, IPR, MMR & VARIVAX IZ onY2-19-09. Came in 2-21-09 to clinic to have PPD read. U Left upper arm 2/19/2009 red, swollen, 2/20/2009 tender & hot to tou ower back bilateral 2 days after vaccine administration. Y 1/29/2009 iredness from 14:00pm - 14:30pm. 2/17/2009 headache @ 15:00pm, took two TYLENOL gel Y capsules @ 2/12/2009 15:00 pm,2/12/2009 Sx resolved by 15:15 e given 2-09-09 (Monday). Mom called Thursday 2-12-09, she reported following: Pt had slight Y fever and2/9/2009 didn't feel2/10/2009 great and some itching redden, hot to touch at injection siteYwith swelling, no fever, no rash, no difficulty breathing, reported Y 2/2/09 2/18/2009 TX. Benadryl 2/20/2009 ETix 120 mg 2.3 that she had a flu shot here in our clinic Y in early December 2007. Although there is no record Y of it being12/1/2007 administered here. Dime-sized ar l seizure. PMH negative. Y Y o developed pinpoint red rash (dots) on torso, legs and arms U 2/6/2009 2/6/2009 lling & itching. U 2/18/2009 2/20/2009 ents with pain in upper right arm. Outer Y aspect of upper arm is noted to be red, raised, increased U temp hard 2/11/2009 & 35 mm 2/12/2009 x 25 mm blistered w tching pain began 1 day post-vaccine Y 2/18/2009 2/19/2009 at vaccine site with 3X4 cm mild redness on LDT. Y 2/11/2009 2/11/2009 ce today 2/20/09 vaccine Tdap has reaction swollen and redness, - as per phone call with mom. U 2/19/2009 2/20/2009 0/09 mom saw arm swollen & red on area of DTAP vaccine area. Mom will apply ice on edutal U arm as per 2/19/2009 phone call 2/20/2009 with mom on 2/20/09 after vaccine administered pt developed a festering lesion about 1 in x 1/2 in under arm (R) that U did not itch 2/13/2009 or hurt. Also 2/16/2009 had numbness in u eddened thigh with 1 1/2 2-d of decreased interaction (per mom; "out of it" X 1-2 d) (did not bring Y in to this8/7/2008 MD for eval8/7/2008 subsequently fine) redness @ injection site- esp with VARICELLA. 0 Rx except for observation for 30 mins Pt.Yadvised to give 2/20/2009 BENADRYL 2/20/2009 @ home no sob, w ness @ injection site - (immediate) --> Hives developed after 5 mins. on chest - observed pt.Yfor 30 mins. 2/20/2009 Advised BENADRYL 2/20/2009 PO @ home ed of itching all over. Rash noted arms, face, inner legs and buttocks. BENADRYL 25mg given N PO. DECADRON 2/20/20094mg 2/20/2009 with Depomedral 40m approximately 5 minutes after receiving vaccinations. Y 2/20/2009 2/20/2009 month shots, my son developed some shrill, high-pitched screaming and alternated between Y screaming8/15/2008 and passing 8/15/2008 out for about 12 hour 00, chills, redness behow injection area, Y swollen around injection area, hot to the touch, hard, N very very painful, 2/17/2009 sweats, 2/17/2009 dizzy ediately developed fever, rash and Y discomfort. Within 2 weeks behavior changedYdramatically, N language4/18/2007 skills regressed, 4/18/2007 frequent fevers, s argic, not eating well, not as many wet diapers U 2/19/2009 2/20/2009 NCED ITCHING ,SHORTNESS OFYBREATH, HEAVINESS IN CHEST DIFFICULTY BREATHING, Y RASH 1/29/2009 ,REDDNESS 1/29/2009 SWELLING ALSO occurred at site of administration within hours, spreading over the next day to a total size of approximately Y 1/29/2009 3" by 5", 1/29/2009 accompanied by itching eving the vaccines at his 4 month appointment, my son demonstrated some jerking/shaking of Y his head while 10/7/2008 sleeping. 10/7/2008 This lasted for abou day as receiving the combo booster Y shot, his arm around the site got very warm, Hard to the U touch and 2/10/2009 he aid it hurt. 2/10/2009 It was a large red ra ontinuous non stop, nausea vomiting Y 1 today, 2 times yesterday, normal breathing, c/o warming, U no report 2/21/2009 of rash 140/92, 2/21/2009 74, 22R, No whe
on 5 hours post vaccination. 24 hours post vaccination: 1.5" hard, raised, hot, red area around Y injection sites 2/18/2009 on thighs. 2/19/2009 36 hours post vacc ely after the proquad and hep A vaccines, Y his appetite severley decreased. Less than a weekNlater, he had a fever ### of 102 to ### 105 for three da anfer from sharing towels/clothing with roomate vaccinated 27 Jan 2009. Developed lesions along jawline 17Feb 2009. 2/17/2009 ure of 102.6. Headache. Sore arm. Strange fluttery sensation in chest. Treatment: Bedrest. Y Aspirin. 2/20/2009 Fluids. 2/21/2009 uscle control in both arms, restless, high Y fever - 103.4 - 105.8 at one point, lethargic, lifeless, Ylimp, blue around 1/20/2009 mouth, 1/20/2009 fingernails and feet, l ch of shingles in C5 distribution 9 days Y after administration of Zostavax Y 1/23/2009 2/1/2009 n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 17 5/12/2008 year old female 5/12/2008 patient with atten n was viewed on the Internet concerning Y a 19 year Y old patient who in 0 approximately April 2008 N (10 months 4/1/2008 ago), was vaccinated with the fi n has been received from Y a physician Y concerning Y a 20 year old female 0 with respiratory allergies N who on 9/16/2008 21-FEB-2008, 11/4/2008 24-APR-2008 and 1 n has been received from a physician Y concerning a female patient who was vaccinated with Uon unspecified date with a dose of GARDASIL n has been received from a consumer Y via the Internet Y concerning her 0 daughter who in August U 2007, was 8/1/2007 vaccinated with GARDASIL. Sub n has been received from a healthcare Y worker concerning a 58 year old female with Y allergy to Y VICODIN 1/21/2009 and MINOCIN 1/21/2009 who on 21-JAN-200 n has been received from a healthcare Y worker concerning a 49 year old female with Y hypertension Y who on 28-OCT-2008 ### was ###vaccinated IM n has been received from a healthcare worker concerning a 38 year old female with Y no medical U history or 2/16/2009 drug reactions/allergies 2/16/2009 who on 1 n has been received from a physician Y concerning a 60 year old male patient with diabetes, hypertension U 12/1/2008 and dyslipidaemia 12/3/2008 who on the mor ter started to get restless in the legs and had many Y headaches. She was twitching and couldn't N stop from jerking movements 1/25/2009in head and le ceived her 1st GARDASIL shot on 1-16-09. Y She received no other shots and wasYon no medication. Y On 1/16/2009 1-20-09, patient 1/22/2009 woke up with flu-lik n the GARDASIL shot. A week after being injected I had a serious allergic reaction and broke out in a very itchy rash 1/27/2009 all over my fingers an ter had the vaccine GARDASIL andYnow her arm is bruising up looks really nasty and she saying U she's got 11/6/2008 numbness of the ###arm and Dr. do ped trunkle red micropapule rash 2 wks post MMR Y 2/6/2009 2/16/2009 ziness". Slumped in chair post immz given pupil dilated. Assisted to cot when appropriate. YApplied cool 2/7/2009 rag. Given2/7/2009 snack & juice when re e nonspecific rash. Described as hives by parents. Y 9/22/2008 9/23/2008 e non-specific rash described as hives by parents. Y 3/20/2007 5/1/2008 ing non stop x 1-2 hr. 2/18/09 - temp Y 101 this mother has cystic fibrosis - not breastfeeding. Y 2/17/2009 2/17/2009 to have stiff neck on (L) shoulder - progressed to stiffness bilaterally in her trapezius muscleYand base of 2/2/2009 skull. Feb. 10 2/4/2009 - symptoms intensif er receiving shots RT leg, sore, red,Ywarm and swollen about the size of mom's palm of hand. N Went to see2/7/2009 Dr on 2/10. 2/9/2009 Told was an allergic er shot injection site itched, became red and raised. Eventually the itching moved down arm Nand red rash8/3/2007 went away.8/5/2007 On 11/2007 she wen e and client dizzy evening after shot.Y Next morning left arm swollen and client began to shiver Y and low grade 1/27/2009 fever 100 1/27/2009 degrees F. Very re et of excruciating right shoulder andYupper arm pain following flu virus immunization. Pain intensity N very 10/1/2008 high (9+/10)10/2/2008 and maximal at onset. after imm Fever 101.1 Y 1/15/2009 1/15/2009 lled Health Dept @ 3:45pm reporting Y that child's lips were turning blue and swelling, she also Y reported child 2/17/2009 to E.R. 2/17/2009 because they were still as given vaccines on 2/13/2009. Patient came into office on 2/17/09 c/o nausea, diarrhea, wtYloss, fever, 2/13/2009 chills, stomach 2/14/2009 bloating and stoma ted 2 days after flu vaccine ? allergyY to eggs. Y 2/11/2009 2/14/2009 d varicella vaccine RA SQ on 2-4-09 Y and returned to office 2-16-09 with red/swollen (15 mm)Y in area around 2/4/2009 injection2/5/2009 site and reported are d she was pregnant 2 months after receiving GARDASIL vaccine. Pt miscarried at 2 1/2- 3 mos Y pregnant. ### ceived Tdap instead of DTap. No adverse reaction. Y ### mmunizations, about 3-4 min later fell to the right off chair, hit head on floor. I helped her up. YShe was twitching. 2/16/2009 Felt 2/16/2009 dizzy, blacked out. La w grade) starting five days after administration, following by rash to face/neck/torso on ninth day U after shots. 2/2/2009 2/6/2009 es erythema in shot area started dayYof injection, worsened through weekend. Presented to Clinic U 2/16 with 2/13/2009 large (about 2/13/2009 10 x 11 cm) erythe stered 2nd dose of ROTATEQ. Rec'd this dose prior to administration of IM vaccines due today. Pt had projectile 2/11/2009 vomiting 2/11/2009 immediately after stered 1st dose ROTATEQ, had projectile vomiting with copious emesis from mouth +nostrils. Y No other vaccine### had been given. ### Pt observe e - post immunization evening - continuing at time/date of call on 02/12/09. Given MOTRIN by U mother - Mother 2/11/2009 related 2/11/2009 - Some relief - but on ction - mild redness, soreness Y 2/9/2009 2/10/2009 r receiving the tetanus, influenza and meningococcal vaccines and having blood drawn, service Y member2/21/2009 complains 2/21/2009 of ringing in his ears, lig y gave DTAP #4 to 8 month old. Received DTAP #3 on 1/21/2009. Mistakenly gave ROTATEQ Y #4 same time. ROTATEQ #3 on 1/21/09 eport on 2/21/09 at 1 pm pt fever 102 degrees axillary. Gave acetaminophen and "fever wentYdown". Crying 2/13/2009 most of2/21/2009 the time. Temp did not tial syncope, nausea, lasting several minutes post injection. Was monitored for 20 min and was Y normal. 12/11/2009 week later2/11/2009 developed chest pain, GSK labels their pre-filled syringes of Hepatitis B Vaccine - ENGERIX-B for adults and children U with a yellow and olive band, respectively, to degrees within hours of injection. C/O severe pain to right leg, nearly intractable pain. Unable N to bear weight 2/16/2009 on leg2/16/2009 x 36 hrs. Post injection DTD on 2/7/09. Mom up pts feet dizzy after leaving clinic & laid down rest of day. Arm was Ysore that even. 2/7/2009 & by next2/7/2009 day was red & swolle urned 7 days after immunization withYlarge bruise on right upper arm, extending from deltoid (bottom Y edge)1/7/2009 to elbow,1/10/2009 approx 5" in width. Sta
Hepatitis A inoculation on 2/10/09 at approximately 11 am. At 10:30 pm experienced symptoms Y similar to 2/10/2009 attack of food 2/10/2009 poisoning. Vomited eadache day of vaccine, through evening. Recurring headaches, constant fatigue, joint pain prominent U in left 2/7/2009 arm where 2/7/2009 administered. Decr Y 3/1/2003 rted with rash, fever and HA. Seen Y on 2/11/09 counted 44 lesions (papules). Seen 2/12/09 vesicular N fluid1/21/2009 sample collected. 2/9/2009 Feels worse. t started around 2pm. Slight swelling. Hurts to move arm. Ibuprofen and ice the shoulder/arm. Y 2/13/09 doing 2/10/2009 much better. 2/10/2009 n has been received from a certifiedYnurse midwife concerning a 24 year old female patient with Y asthma, epilepsy ###and migraine ### headaches FAINTED IMMEDIATELY AFTER INJECTION OF GARDASIL. 5 SEC. OF COMPLETE UNCONSCIOUSNESS Y 2/20/2009 FOLLOWED 2/20/2009BY CONFUSI nausa, shakiness increasing since 4th dose of Imovax received 2/17/09. Recommended use U of aspirin 2/17/2009 on regular basis. 2/19/2009 iving 2 IM injections in left deltoid (Hep A #2, Menactra) while seated, patient stood up and had Y a syncopal 2/23/2009 event. No 2/23/2009 LOC, recovered within SECONDS AFTER VACCINE ADMINISTRATION Y THE GIRL COLLAPSED. SHE APPEARED Y PALE, FLACID ### AND COLD### TO THE TOUCH ite became red, swollen, sore, hot and itchy. Welt and itchiness lasted from 2/17 to 2/22. Only Y treatment 2/16/2009 was cortisone 2/17/2009 cream to ease itch REFERS THE CHILD SUFFERED Y A RASH ALL OVER THE BODY WITH RED BLISTERS.YSHE TOOK12/8/2008 HER TO THE 12/8/2008 DOCTOR'S OFFICE & swelling at injection sites.Low grade temp - 99.0. Fussy and irritable U 2/19/2009 2/20/2009 of child= developed high fever (states Y 104 degrees)the Y evening of 2/19/09 1 and had a seizure U and was taken 2/19/2009 to the 2/19/2009 hospital- time unknown vaccine child had generalized scarletina body rash with confluent 2 cm area left lower thigh and U 1 cm confluent 2/20/2009 right2/20/2009 thigh rash that started D SWELLING AT INJECTION SITE, NOT ABLE TO MOVE ARM, FEVER Y 2/16/2009 2/17/2009 vaccine administered in a local health Y department clinic on 2/18/09 in the morning to this adolescent U female. 2/18/2009 Patient2/22/2009 had history of undocum ness, rash (2"x1"), itching at injection site U 2/19/2009 2/21/2009 ness, rash (1"x1"), itching at injection site U 2/19/2009 2/21/2009 oke up the morning of 2/19/09 to find she had alot of itching on her left hip and discovered 5 N raised spots.2/12/2009 This was the 2/19/2009 same side she had S today to our Health Center with complaints of vomiting and fevers of 103.Today at 103.3R. Dr U Anees requesting 2/20/2009reporting 2/20/2009 for possible adve ame pale and complained of being nauseated and light-headed. RN assisted client in putting Y her in a supine 2/2/2009 position2/2/2009 with legs elevated. T soreness, and swelling at injection site, with mild, red, raised rash on stomach and back (some U itching). Swollen 2/9/2009 glands 2/23/2009 behind the ear/nec gan 4 days after receiving vaccines accompanied by fever for 2 days. Y 2/12/2009 2/16/2009 as running a fever on and off for twoYdays prior and on 2/15/09 around 8:30 pm she had a seizure Y that lasted 2/6/2009 almost2/15/2009 25 minutes and had to ates, awakened with fever 102.8 theYfollowing morning after receiving vaccine. Myalgia, arthralgia Y and continued 2/19/2009 episodes 2/20/2009 of fever over 72 ADACEL @ 10:30 am - within 10 hours Y child c/o severe H/A, dizziness and nausea, and chills. Y BP - orthostatic 2/20/2009 hypotension 2/20/2009- unable to sta @ 10:20 AM stating she had an upset Y stomach, nausea and shortness of breath this was herU3rd GARDASIL 2/23/2009 injections. 2/23/2009 2/26/09 Received since the vaccines pt. has had fevers, headaches Y & generalized weakness. 11 Just prior to admit. noted visual 1/13/2009 problems 1/14/2009 and gait problems. n on 2/18. C/o sitting soreness, muscle ache on 2/19. On afternoon of 2/19 & 2/20 had fever Y 38-38.9 degrees 2/18/2009 C, generalized 2/19/2009 body ache, i 1hr post immunization and had syncopal episode Y - No seizure activity. 1 3/11/09-records received Y for DOS2/17/2009 2/17/09-presented 2/17/2009with vomiting p was reported by a physician via a sales Y representative Y and described 1 the occurrence of itching U in a 4-year-old 2/19/2009 male2/19/2009 subject who was vacci was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age 3/20/2000 who was vaccinated with LYME d GARDASIL injection 1/21/09. Pt reported being pregnant 1/20/09. U 1/21/2009 1/30/2009 ash that resolved with oral diphenhydramine x 1. Y 2/20/2009 2/20/2009 patient and she states that she is feeling better. She is still weak, a little sleepy, not pain. No headache or 1/5/2009 sinus pain at this moment. No n has been received from a nurse concerning Y aY60 day old female 10 who on 05-DEC-2008 was N vaccinated12/5/2008 with one dose 12/8/2008 of ROTATEQ (lot n n has been received from a licensed Y practical nurse Y concerning a 79 0 year old female who onU10-FEB-2009 2/10/2009 was vaccinated 2/12/2009 SQ with a 0.65 n has been received from a physician Y concerning a patient who was vaccinated with a dose Nof ZOSTAVAX (Merck). After receiving ZOSTA n has been received from a consumer concerning his now 22 month old son who at 14-15 months U of age,6/1/2008 was vaccinated with PROQUAD follow-up information has been received through the Merck pregnancy registry through Y a 23Yyear old female consumer 10/2/2007 who was vaccinated n has been received from a Registered Nurse (R.N.) concerning a patient who was vaccinated U with the second dose of GARDASIL. The pa n has been received from a physician Y concerning a 19 year old female who in early Y September N 2008, was9/1/2008 vaccinated9/1/2008 with the first dose of n was viewed on the internet Y concerning Y a 14-year-old Y female patient, 0 who on anYunspecified N date was vaccinated with a dose (s) of GARD rmation received on 21 January 2009 Y from a health care professional. Upon receipt of follow-up information on 17 February ### 2009, it was de eakness in extremities, numbness, Y difficulty Y walking Y and climbing stairs. 9 Diagnosed Y with GBS, N later changed 5/28/2008 to CIPD6/10/2008 due to recurring symp was swollen from shoulder down to elbow, golf ball sized, red, hard knot at injection site + itching. Y 2/9/2009 2/9/2009 Y Y 1/8/2009 1/14/2009 mmediately following rotovirus 'drink'. On 2/12/09, pt. had fever (101.5) rectally, vomited for 3Yhrs. Was very, 2/11/2009 abnormally 2/11/2009 fussy and agitated me day, then stomach upset, dizziness, right sided "numbness". No muscle weakness on testing Y at visit on2/4/2009 2/17/09. All 2/4/2009 symptoms resolved i ADACEL, in Left delt and PNEUMOVAX in Right delt on 2/17/09- Called office 2/19/09 c/o swelling U &pain 2/17/2009 came in for 2/19/2009 eval 2/19/09- Right u
to patient he was seen by an ER Physician Y at hospital on 02/23/09. Diagnosed with Bell's Palsy. U Prescribed 1/23/2009 Prednisone 2/3/2009 and Acyclovir. Pt eared 2 days after shot lightly. Strong heavy rash at 10 days after shot continuing 5 more days. Y Fever 104.5 ### degrees X 72 ###hrs starting 9 d ed ZOSTAVAX 12/18/09; Saw Derm. on 1/7/09 for rash. Returned to medical center 1/10/09 Y + Dx'd zoster rash ### R thigh. Tx'd NEUROTIN facial paralysis began day after vaccinations Y were given. Went to ER on 2/1/09 where Bells NPalsy was diagnosed. 1/28/2009 Is 1/29/2009 improving but not yet er up to 103.3 degrees F, congestion, cough soreness in throat; U ### 2/18/2009 r of vaccines being given pt becameY irritable, facial flushing, hives diffusely esp on trunk/back Y but also on 2/17/2009 extremities. 2/17/2009 Mild swelling of eyel ble crying, pallor, & loss of consciousness, Y 8 hrs after being given immunization for the first time. Y 2/17/2009 2/17/2009 ace, stomach, back, legs started onY2-8-09. Pt. temp 98.5 degrees (2-9-09). 103 degrees Feb N 5 + 6, 2009 1/27/2009 cough, rhinorrhea 2/8/2009 started Feb 2 t vaccine admin. Pt c/o lightheaded,Yloss of appetite, nausea, cold chills, unable to move feet. U C/o vision2/18/2009 change. 12/18/2009 hour later pt c/o heada t one hour after recurring second shot of GARDASIL. Pt self report "3 white spots, on my face" U noticed after 2/17/2009 she left2/17/2009 the clinic. "a little itchy lands, (femoral), redness and swollen site, no fever, Hurt - make her cry. Rest made it betterY- iced +heat 2/6/2009 2/7/2009 Presented with 3 weeks nonproductive Y cough, treated with AZITHROMYCIN. Patient still with symptoms 1/10/2008 as of 02/15/2009. ### flu shot 2-16-09 came to office 2-18-09 left upper arm red & swollen & hard 5 cm no rash Y 2/16/2009 2/16/2009 er receiving MENACTRA developedYflushed face, clammy & weak legs, "feels well''. Y 2/17/2009 2/17/2009 g hot, HA, eyes burning then blacked out. Woke up on floor. Also w/ rash on abdomen and thigh. Y 2/17/2009 2/18/2009 warmth and firmness felt at injection site on upper left arm. 2 1/2 cm at area of induration felt there, no erythema 9/22/2008 9/23/2008 umps on stomach, legs & back. Sm Qtip size red raised bump on VARICELLA site right leg and Y PREVNAR 2/17/2009 site is a2/19/2009 bruise. Pt feels well. Pt V combo administered 2-10-09. Within 24 hrs developed swollen, red, painful arm at site - 2-11-09 U broke 2/10/2009 out in oral blisters 2/13/2009 on tongue, ante d Bells Palsy 8/12/08 received. N 5/16/2008 8/12/2008 HEP A (VAQTA) on 2/11/08 & 8/1/08 Today, mom reporting no local reaction. Y 2/16/2009 (L) arm 8X8 in redden- warm to touch - (R) arm 2X1 in redden - warmth to touch c/o pain. BENADRYL Y 2 tsp 2/5/2009 BID - Cool 2/6/2009 compresses r antibiotics + MMR. Face-trunk some spots on extremities. Y 2/6/2009 2/11/2009 & a lot of pain after receiving TD still having pain, arm weakness & numbness N ### ### er receiving the shingles vaccine in Y his R arm, patient developed a characteristic rash in the Yright C8 T1 1/21/2009 nerve root. 1/25/2009 He also had a neuralgia mentation on (L) arm (Linear appearance), non-raised, even distribution, cramping in hands (B) U on occasions 2/16/2009 injection site urthen 1 hr. Progressed to diffuse edema & erythema from elbow to distal deltoid. Y Some mild 2/16/2009 tenderness. 2/16/2009 Hard slightly numb muscle pain, edema to 3x regular size, Y rash, fever and general malaise. Y 2/13/2009 2/13/2009 munization given 2/15/09 (Booster). States no pain on 2/15/09. States in afternoon on 2/16/09 Y had dull headache 2/15/2009which 2/16/2009 lasted one hour. O ent for Hep-B vaccine. Prior to giving Y shot, assessed allergies to PCN, Sulfa, naproxen, zithromax Y and pineapple. 2/18/2009Denied 2/18/2009 wheat/yeast allerg Rxn. Redness, Swelling & injection site 9X8 cm. Systemic Rxn vertigo, mild headache, nausea. Chills, 2/17/2009 Bodyache. 2/17/2009 of her face red and swollen. Right eye Y swollen completely shut, trouble breathing, trouble sleeping, U fidgety, 1/16/2009 non responsive, 1/17/2009irritable, fever, N 2/19/2009 2/19/2009 perature 105 core. Y 2/12/2009 2/13/2009 lesions around left flank 2/5/2009 2/10/2009 gas, distended stomach. pain. Started within 4 hours of dose and continued for 8 hours (tookY sleeping pill) 2/23/2009 2/23/2009 a dull frontal headache since waking on 2/20/2009 after 1 day of Tdap and still present on 2/24/2009 U 2/19/2009 2/20/2009 after Tdap given had 101.7 temp. Y Y 2/19/2009 2/19/2009 ven two injections in the left arm on 2/23/09. She called the clinic on 2/24/09 and advised us Y that she woke 2/23/2009 at 0300 with 2/24/2009 pain in her left axilla after she received 2nd vaccine of gardasil she continues with a rash on her body.Saw PCP doctor N was then 6/16/2008 referred to dermatologist were o anterior and posterior trunk beginning Y approximately 2/21/09 progressing in intensity. No respiratory Y distress 2/19/2009 noted. 2/21/2009 Patient evaluated by ministered to Left deltoid and a large welt formed at injection site over next 24 hours. Site was Y hot to touch2/5/2009 and tissue2/5/2009 was hard underneath urting when given and never stopped Moved arm around during the rest of the day About 7 hours Y later when 2/17/2009 she went 2/18/2009 to bed, the pain got m ent started having feversYon the dayYof DTaP vaccination Y (2/19/09) up 1 to hospital admission Y(2/20/09). Mother 2/19/2009 reported 2/20/2009 temp of 101.9 on 2/ 1/12/2009 N 1/12/2009 1/12/2009 PED SIGNIFICANT ERYTHEMA IN Y THE SHOT SITE ON HER RIGHT THIGH APPROZ 4 TOY 5 CM IN DIAMETER 2/12/2009 2/13/2009 became erythematous, warm, slight induration. Temp 98.9 Keflex 250/5ml 1tsp TID X 10 days Y Compresses 2/9/2009 Benadryl 2/10/2009 12.5/5ml 1tsp q 6 hrs. d hives all over body few hours after immunizations we're given. Y 2/6/2009 2/6/2009 ter vaccination patient experienced palpitations, and lightheadedness for 45 minutes, A bruise Y 1 inch long 2/17/2009 and 1/2 inch 2/17/2009 wide appeared, a r swelling L arm Y 2/9/2009 2/10/2009 occal vaccination given on 2/22/09 @ 1000. The patient did not experience any symptoms until Y 2/23 when 2/22/2009 she noticed 2/23/2009 her Left Deltoid was d seizures and had to be rushed to Ythe Hospital Y where he stayed for one week. Patient Y has N curious mental 6/1/2006 delays; he 6/1/2006 cannot walk, talk, or
arent of error.Will call in Am to check on patient reaction.Will give HepB at 2 mo check. Y 2/24/2009 of face around eyes; no swelling. Per parents, occurred immediately after vaccine; did not call Y MD until several 2/23/2009 hours 2/23/2009 after immunized. Tre from mother: Pt was admitted to hospital 2-18-09 Y due to fever 104.6.3 Stated blood culture done Y in ER was 2/18/2009 (+) for bacterial 2/18/2009 infection. Repea Y U 2/23/2009 2/23/2009 post immunization with 2 skin lesions. 1) - follicular on neck, throat, (R) arm. - itchy. Pictures Usent to Dr., 2/12/2009 felt to be post-vaccinal 2/24/2009 non-viral pu Y 2/19/2009 2/20/2009 ed, swollen, warm to touch, thigh area, 4 cm in size, raised Y 1/8/2009 1/10/2009 shot given right arm 2/15. 2/17, soreness Y at site, lump at site of injection, warm to touch, swollen. Y Temp 99'. 2/15/2009 2/17/2009 given 2/14 2/17 - arm puffy, warm to touch, redness around site and trailed down arm Y 2/14/2009 2/17/2009 lls VHC x 3 in past week. "Just don't Y feel like myself; very tired, achy, constant HA, nodes on Y side of neck 2/11/2009 and under 2/13/2009 chin are enlarged." R was on 02/19. On 02/22 injection site became red, 2" circle. On 2/24 it is still a 2" around circle. U No heat or 2/19/2009 pain. Arm2/22/2009 is a little sore. Told her lled 6 days following vaccination forYa tip to Brazil. He reports facial swelling with sx. StartingUon Sunday2/17/2009 2/22/09 a 1300, 2/22/2009 which was 5 days ined to dentist about sores in her mouth. Dentist prescribed VALTREX and patient is concerned Y the ZOSTAVAX 1/27/2009caused 2/6/2009 the sores and the Local Reaction with continued erythema & induration at site. 2 Pruritic rash with small dark lesions on thighs 2/19/2009 on 2/21/09 2/19/2009 MMR & VARICELLA given. 2-11-09 PC from mom. States child "broke out" in rash at babysitters. U RN advised 2/10/2009 parent 2/11/2009 to take child to Dr. advi TAVAX injection 2-12-09. That evening arm was very tender. His wife is a nurse, redness noted Y from elbow 2/12/2009 to shoulder. 2/12/2009 States arm felt num tous nodule app 0.5 cm in diam bothY thighs. 2/23/2009 2/24/2009 MMR and VARIVAX on 1/30/09. Fever Y that night for 2 days. Atend of fever had prominent myoclonic Y jerks 1/30/2009 with sleep 1/30/2009 for one day then rec ld female who came for a routine physical exam and vaccines and developed a rash over the Y next 24 hours. 2/12/2009 The rash 2/13/2009 was of rapid progres of GARDASIL administered on 2/24/09. Pt experienced syncope, pt recovered well. WaitedY15 mins. Stated 2/24/2009 she felt 2/24/2009 better exited office. d fever < 12 alter shot swollen tonsil or lymph nodes & L facial swelling injection given SQ on left arm. No 2/21/2009 pain or swelling 2/21/2009 around injection e morning following the vaccinationYmy right shoulder was in severe immobilizing pain. I could U not move1/17/2009 it due to the 1/18/2009 pain. I attempted to t serious event was reported by a health Y care professional on 13 January 2009. Based upon additional Y information ###received on 13 February 2 n has been received from a registered nurse concerning a 71 year old female who was vaccinated U with a 0.65ml dose of ZOSTAVAX (Merc n has been received from a registered pharmacist concerning an adult male who, "many years U ago", was vaccinated with a "complete dose l pain, diahrrea, general ill feeling 12/07. Y Again 8/08 - Diagnosed Crohn's disease 10/08. 3/9/09 U Received 8/16/2007 PCP vaccine 12/1/2007 records & medical a BOOSTRIX vaccine (R) arm 10/30/08. Seen on 11/2/08 area red swollen, hot to touch ### 11/1/2008 hours, urticarial rash on chest, shortness of breath, and nausea Y ### ### ately 12 hrs after reaction, patient experienced Y localized bright red egg sized swollen area atYinjection site, 2/19/2009 itchy, soreness, 2/20/2009 and firm swollen t, Kitra Woodall, child had routine immunizations on 02/11/09. Infant jerked right leg slightly U at the time of 2/11/2009 getting the 2/21/2009 shot, and small bruise Y Y 2/24/2009 2/24/2009 ction and cellulitis at injection Y area.. Y .went to urgent Y treatment care and 4 was put on Keflex and U Prednisone...went 2/4/2009 to Emergency 2/5/2009 Room a we ollowing the vaccine, pt began Y to have Y pain andYprogressive weakness 5 of her left arm and leftY leg. SHe was 1/12/2009 evaluated 1/22/2009 at joe DImaggio Chil pisode which lasted for approximately 10 seconds after administering menactra vaccine.childYclaimed she2/25/2009 felt dizzy after 2/25/2009 the last injection. w ea immediately following Gardasil #1 injection. Sxs resolved spontaneously over course of next Y 30 minutes 2/25/2009 while being 2/25/2009 seen in clinic. hortly after administration of Gardisil. Out for 3-4 seconds. Observed for 45 minutes before going Y home. 2/25/2009 At home and 2/25/2009 still reports nausea a ng office c/o site where varicella given had a hard knot, warm to touch, whole back of arm swollen, painful to the point that it kept patient up hours of receiving vaccine - developed severe lower back pain, diffuse H/A, Shoulder joint pain Y and upon 2/14/2009 rising from2/15/2009 suppine position I wou wver, Polio and oraL 7/14/08 tYPOID Y ORAL -7/17/08eYHE AND LEG RASH AFTER TRAVEL N 5 WEEKS7/18/2008 LATER AND 7/18/2008 SWELLING OF THE 09 patient was taken to hospital for Yseizure activity. Y At hospital she was 3 intubated for respiratory Y failure. Mother### reported low ###grade fevers a lgia. pt received rabies vaccine ist dose on 01/27/09 and second dose on 02/03/09, and wasYscheduled for 2/3/2009 third dose 2/24/2009 02/23/09. When pt pr h fever, chills, severe myaligias and GI upset within 24 hours. Y 2/19/2009 2/20/2009 y patient reported pain on entire arm lasting for more than 3 weeks ### nd tenderness where shot given (pneumococcal conjugate); fever of 100.4 (pneumococcal conjugate); Y drowsy 2/23/2009 and 2/23/2009 loss of appetite (pneum as administered the Merck HPV vaccine - third dose, patient reported left hand tingling. Physician Y evaluated 2/25/2009 - patient2/25/2009 returned home. Physi 9 Pt presented with a temperature of Y 104.2(f) with no other signs. Drew blood cultures positive Y for Invasive 10/9/2008 Streptococcus Pneumoniae. Tr lled office today and reported patient had experienced redness and itching after YF immunization. Y Patient 2/17/2009 showed her 2/23/2009 the site on Monday m became red and indurated. Patents' mother describes purulent blisters approx. 1wk after administration Y 2/2/2009 2/9/2009 IVED ZOSTAVAX ON 2/23/09. ONY2/24/09, PT REPORTED NUMBNESS AND "A WEIRD FEELING" Y ON 2/23/2009 THE LEFT 2/24/2009 SIDE OF HIS FACE n has been received from a physician Y concerning an 18 or 19 year old female with a history Y of seizure "in the past during an IV administrati after the shot was administered, patient Y showed Y limpness in his left 17arm, lasting a little less than Y a minute. About ###2hours later ### more limpnes
k after 1st GARDASIL, my daughterYbegan having headaches, nausea and began passing out. N Began having 8/3/2007 trouble 8/10/2007 breathing. Pediatricia episode of syncope, sweating and clammy Y 2/24/2009 2/24/2009 t 9am Donor started having; headache (pounding), fever, chills, fatigue. Swollen lymphnodes Y under L arm. 2/23/2009 The L arm 2/24/2009 deltoid area where i Y 2/23/2009 2/23/2009 m (3 inch wide) round tender induration at VARIVAX injection site - developed ~ 24 hrs after the injection. 2/17/2009 2/18/2009 thema, hyperemia and pruritus measuring 12x8 cm Y 2/19/2009 2/21/2009 administered 10-17-08, on 10-23-08 pt seen by PA-C for wide spread hives on palms and soles. U Tenderness to area of injection, no swelling minutes of injection into right arm, pt began to have erythema around both injection sites - going Y up arm to 2/21/2009 neck, chest 2/21/2009 & shoulder. C/o puriti at injection site (L) thigh, hot, tender, approx 3" in diameter with fever. 2/23/2009 2/24/2009 olled eyes back of head ? seizure. Seen Y in office 2/25/2009 for this. Y 2/9/2009 2/24/2009 n 2/23/09. Complaining of Hx of itching Y started after given her MENACTRA,/Tdap/Varicella vaccine about2/19/2009 315pm 2/19/09 and at home 715p administered on 2-17-09 - says "3 to 4" days after receiving vaccines, client experienced symptoms Y of fever 2/17/2009 (102-103), 2/20/2009 chills, nausea - clien minutes patient experienced moderate swelling and mild erythema of left thigh extending to Y superior portion of### knee joint. ### The joint was not 02 degree at home the night of vaccine Y 2/24/09. Today in office 97.6 AX. Slightly swollen at Ysite RVL, warm 2/24/2009 to touch, 2/24/2009 no redness. Hives on U 1/2/2008 2/23/2008 0 min after while on elevator. Once off elevator still had symp. Dizziness-noted while still. NoYnausea. Comes 2/17/2009 to a point 2/17/2009 when must slow dow SQ swelling, local reaction with redness. Tender to touch. Treatment: cool compress and MOTRIN Y prn for2/24/2009 soreness. 2/25/2009 n received from patient's mother byYphone. Per mother Pt. began having body pain at 2:00AM N on 10-21-08, unresolved ### by### TYLENOL. No f usea, vomiting; patient received shot of KETOROLAC 60 mg/2ml today, 2/25/09. Also, patient U was prescribed 2/24/2009 PHENERGAN 2/25/200925 mg tabs, 1 Hepatitis B & MMR vaccinations. I have latex allergy. Nurse practitioner (2 of them) said disregard Y latex 6/1/2007 allergy pamphlet. 6/1/2007 I broke out in b swelling 5"X51/2" U 2/24/2009 2/26/2009 vaccines on 2-17-09 No bandaids applied & rash developed 3 days after. Mom stated that happened Y with 2/17/2009 2 mo shots 2/20/2009 also. mother informed clinic on 02/28/09 that daughter had received MCV4 vaccination prior to going U to college 8/4/2008 and has been experiencing swelli after receiving vaccines, approximately 15" after vaccines. Pt did not hit head; No seizure noted. Y Pt. recovered 2/18/2009with 2/18/2009 fluids (juice + water) ll from pt that she had acute joint pain during the night Jan 5, 09. Her doctor told her it was due U to the shingles 11/6/2008 shot. 1/5/2009 Was on 1/2 mg PRED lled 2-13-09 reporting ash of left arm day after HAVRIX injection. By 2-13 rash with itching allY over body. Mother 2/9/2009 did2/10/2009 not get child to ER as r month after vaccination developed fever to 101 degrees for 1 week. This was followed Y by "black N out spells". Within ###several ### days a facial tic s ceived a flu vaccine on 10/15/2008. That evening she felt ill and went to sleep. She awoke in the middle of the ### night to drink ### water and fai , edema around immunization site. Approximately 1 1/2 in. diameter. Y 2/24/2009 2/25/2009 & erythema of left upper arm very painful Y 2/12/2009 2/16/2009 headache for 11-13 days following vaccine - started within 8 hours of receiving vaccine OTC Ymedication ineffective ### - Advil ### Aleve, Aspirins, S max 104.8 oral per parent; 101 rectalY @ office fussy - resolved decreased appetite but takingUbottles. 2/19/2009 2/19/2009 nny nose, fuzziness and 2 lesions on Y back. 2/6/2009 2/6/2009 ausea and vomiting. Y 7/10/2008 7/10/2008 s: 1. Pain and swelling. U 2/3/2009 2/3/2009 ine given in left arm. On 2/14 arm became Y getting swollen and red from the arm to the wrist.YOn 2/15/Pt 2/13/2009 went to ER2/14/2009 were was prescribed w a pneumonia shot on Monday, February 16 around 9:00 a.m. By that evening I had chills and N body aches. 2/16/2009 The entire 2/16/2009 upper arm where th N VARICELLA VACCINE ON 12/31/08 PRESENTED TO OFFICE ON 01/20/09 WITH PAPULAR Y RACH EXTENDED ### 1/16/2009 FROM HEAD TO EXT ed with c/o pain and swelling at site.YVery limited arm movement. Fever above 102, and chills. Has had some 2/25/2009 tingling 2/25/2009 to arm that injection w and heat at injection site Y 2/23/2009 2/25/2009 vaccine he stated starring and his eyes Y would roll up. Didnt think anything was wrong and then U he started5/24/2006 jerking. Diagnosed 5/26/2006with epilepsy lling w/ warm to the touch on left arm. Seen by Dr. - given meds for comfort: Ibuprofen 800mg U T1 TID and Ultram 50mg T1 Q4-6hrs. nstered at work. A weekYafter shot, YI began to have Y difficulty swallowing. 23 Y The difficulty increased N and visited doctor ### 12/2/2008 on 12/1. On 12/2 was o .6 12:20 pm 2/26/09 2/25/2009 2/26/2009 dministered on 1/14/2009 Y and developed Y neurologic Y symptoms on14 or Y about 1/23/2009. He was U subsequently 1/14/2009 diagnosed 1/23/2009 with Guillian Barre mplained that baby vomiting from 02/24/09 Y to present, and fever fora day.tynelol given for fever ,fluids pedalite 2/23/2009 for vomiting. 2/24/2009 9 at about 9:30PM, his eyes rolled back Y and jerked Y some, call squad2 and taken to Hosp andYthen to Children's, 2/17/2009 temo 2/19/2009 102.9. Questioned se 9 at 6pm pt stated had nausea, lightheadedness and a fever up to 103 degrees. 2-26-2009 pt U came to clinic 2/24/2009 left deltoid 2/25/2009 red,itchy,swollen an er c/o diahrrea, decreased urination Ydespite adequate fluid intake, red buttocks and gluetal fold. U Also, consistant 2/24/2009 fever 2/24/2009 of 101 F . Referred eumonvax Immunization on 2-25-09. Pt c/o swelling, warm, rash 3 inches in diameter at injection Y site. Felt 2/25/2009 feverish but 2/26/2009 did not take temp. Sa eving the pentacel in his left arm at the health dept on monday 2/23/2009, he developed left Yarm significant 2/23/2009 swelling,2/26/2009 redness, and pain. Fa
ebilitating headaches, chronic Y diahrrea, Y severe back & abdominal pain, tingling inYhands and Nfeet,numbness in ### hands & feet, ###stabbing pain i after receiving the injection, a bump appeared at the injection site,lasting about a day. It disappeared Y and1/15/2009 then retrurned 1/16/2009 about 1 week later. hours after injection Pain at injection side, redness extending 7 inches by 4 inches; fever of 101 Y degrees2/24/2009 orally; chills; 2/25/2009 severe weakness in a ke activity, Loss of consciousness on 2/25/2009Ysee notes 4/27/09 Received 2 hospital medical Y records of2/23/2009 2/26-2/27/2009. 2/25/2009 FINAL DX: seizur ter receiving CODEINE child's tongue Y started swelling, vomited, HR increase, lips edematous, Y SOB, unresponsive 2/24/2008 EPI 2/25/2008 PEN given IM, O2 s s LUE arm, shoulder pain with rash at Y injection site. Left deltoid has localized cellulitic area 8Ucm L X 5.5 2/24/2009 cm W. temp2/26/2009 is 99.5. No other syste clinic reporting SOB, throat feels funny. Y Instructed to go to ER. At ER, patient did well and left Y with BENADRYL. ###There was ###some confusio ots - back abd, 12/26/09 started ZOVIRAX 200 mg 3 PO BID X 5 days. U 3/22/2007 2/26/2009 nyl & Pt sister PKU + mom strong on mercury free. Physician ordered wrong in Epic Y 1/5/2009 ed screaming started ~45' with shots, continued X 45' Pt slept X 48' then cycle repeated X 5Ydays 2/24/2009 2/24/2009 ing the clinic per mother, pt fainted, Dr responded, SPO2 100-98%. Pulse low. Oxygen given Y to pt after 10 min.### Pt able to### stand ambulate a l - Employee stated received an MMR on 1-16-09 and on 1-20-09 started itching in entire body Y and having 1/16/2009 facial swelling. 1/20/2009 ing, took BENADRYL 50mg followed by 25 mg Q6 hour. Y ### ### ction site with large reddened/warm site- Better today. Y 12/9/2008 ### ection hot to touch, red and swollen. Y ### ### MMR, VARIVAX, and PREVNAR onY 2/24. That night had episode where child stopped breathing Y for 15-20 2/24/2009 sec., eye 2/24/2009 rolled back, went limp is a 14 month old female whose mother called on 2/25 and spoke with RN, Mother advised child Y had "chickenpox" 2/12/2009 after 2/21/2009 vaccinations on 2/1 daches, severe @times (6/10) lasting Y for 10 days post immunization. During 1st 24hrs post Y vaccine, also2/18/2009 c/o lightheadedness 2/19/2009 / dizziness 24 hours after administration, she cried and screamed for more than 6 hours and continuedUto scream and cry### off and on ### for the next seve n has been received from a Certified Y Nurse Midwife, for the Pregnancy Registry for GARDASIL, Y concerning 8/1/2008 a 19 year8/1/2008 old female who in Au n has been received from a physician Y concerning a 23 year old female who was vaccinated Y with a first dose of GARDASIL 0.5ml IM. Subse n has been received from a physician Y concerning a 15 year old female with no medical Y history N and drug allergies who, on an unspecified da n has been received from a nurse concerning her 26 year old daughter who was Yintramuscularly Y vaccinated with the first and second 0.5 m n has been received from Y a registered Y nurse concerning Y a 15 year old 4 female patient Y with noNpertinent medical 9/24/2007 history 12/1/2007 and no known drug a n has been received from a nurse inY a physician's Y office concerning0a female who was vaccinated N with a dose of GARDASIL (lot # not repo n has been received from a physician Y concerning a 21 year old female who on 05-SEP-2008Uwas vaccinated with ### a first dose of GARDASI n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with a dose of MMR II. Subsequentl 009 Pt. talked with PHN + and she stated she had a "reaction" to her Flu shot-stated she had Y "a temperature +### chills, stated ###she could hard treme discomfort following inj. LOC after standing up- approx 10-15 min to fully recover- pt symptoms Y Hx 2/24/2009 of LOC with 2/24/2009 vaccine, but mother as administered diluent for ACT HIB vaccine only without reconstitution of HIB vaccine, but telephone Y call2/23/2009 to mother 2/23/2009 to advise of error. Moth ticed patch of red skin in area where vaccine was administered 7 days after vaccine was given. Y No itchiness, 2/3/2009 pain,2/10/2009 or heat noted at site. N advertently received Tdap and MENACTRA that was meant for older sibling. Therefore get MENACTRA Y and 2/5/2009 Tdap earlier than usual schedu vaccinations, Pt developed severe swelling, Y pain, redness and the area became hard. She initially Y had a2/11/2009 fever, but it2/12/2009 went away. The area(b s after the shots where administered to the patient, patient's mom notified one of the medicalY assistants2/19/2009 that the patient 2/19/2009 was developing a r d few itch spots on abd 4 days ago.YSpots increased over next few days. Y 8/24/2007 2/19/2009 ce member contacted the 24 hour vaccine Y call center to report reproducible flu-like symptoms Y of nausea, vomiting, ### low grade ###fever and diar lled to report pt c/o "loosing vision on Y both sides." Parent to take pt to primary care provider U (Dominican 2/17/2009 Health Clinic) 2/18/2009 for eval. Mother calle -like reaction. Hives - several days 1 Y week apart for 1 day. Y 1/19/2009 1/19/2009 hills, fever X 24 hrs. (X hrs) Y 2/19/2009 2/19/2009 fter shot employee experienced slight nausea & weakness & hand tremors. Symptoms lasted Y 2 days. No 2/20/2009 medical Tx 2/21/2009 sought. Symptoms r e, Flu- like symptoms, low grade fever sore throat, nasal congestion, SOB fatigue, aches, etc.N 7/5/2008 7/6/2008 oughout, injection site arm & neck, w/o resp. distress OTC BENADRYL Y 2/13/2009 ht - swelling redness- covering entire upper arm. Area marked with pen. If redness spreads start U antibiotic. 2/24/2009 2/25/2009 ess and weakness approx 45 mins Y after receiving vaccine. Lasted 4 1/2 hours. Seen at ER given Y Benadryl. 2/26/2009 No co/ rash, 2/26/2009 SOB. Injection site rted child got puffy around eyes the day after vaccination 2/19/09. It resolved 2/24/09. The evening Y of 2/23/09 2/19/2009 child 2/23/2009 presented with patch, r oreness and hand and fingers became Y tingling approx 1-2 hours after vaccine. Then tired and Y vomiting X2 2/26/2009 at about2/26/2009 2-3 hours with headach ness and vomiting (4-5X) approx 1-2Yhours after vaccination. After going to have lunch. Had slt Y headache2/26/2009 and arm and 2/26/2009 flank soreness. Seen V 2005 around noon, swollen Y lips and Y wheals under eyes. Took Claritin and wheals resolved, Y but lips swollen, 11/1/2005 so instructed 11/8/2005to take Benad ues following administration of the vaccine the patients left arm, where the vaccine was givenYbegan to turn 2/27/2009 red and 2/27/2009 develop whelps. Dr. Sp my identical twin sons were given a vaccine (they had the ones for RSV also), they Y got worse N and worse6/4/2003 until at 18 months of age, they we and spoke with RN on 2/19/09 with c/o Y tremors and high BP since vaccination on 11/4/08. She U reported 11/4/2008 that she did11/5/2008 not know side effects o
4/09 at 2pm due to rash over entire body which started 2/23/09. Received vaccines 2/6/09. U 2/6/2009 2/23/2009 n the Gardasil shot in December 2007. Y In January Y 2008, diagnosed with 1 Supraventricular Y Tachycardia N (SVT): Blacked ### 1/14/2008 out/lost consciousne ed joint/body ache, weakness, feverY(flu-like symptoms). The following day, patient reported Y pain (10/10) in left### shoulder and ###left leg, brough ection site, diffuse myalgia and 3 x 4 cm supraclavicular swelling adenopathy. U 2/3/2009 2/24/2009 Swollen on L deltoid upper. Mom just noticed today upper to side on L arm. 0 fever, child active. U Mom called 2/26/2009 today in2/27/2009 office to let us know. ccine on 2/24, called office on 2/25 reporting 'large read area' @ site of injection T99. 2/26 reports still red, 2/24/2009 hot, tender to touch. 2/27 Still r nced HA which was constant x2 wks after GARDASIL vaccine. Ordered DARVOCET & asked Y pt to be seen 1/20/2009 for evaluation 2/21/2009 and she did not LUQ pain, fatigue and weight loss Y since administration of first GARDASIL vaccination. Pt and U pt's mom 7/11/2008 did not report 7/11/2008 these symptoms. Pt e fever, dizziness, pain and swelling at site. N 2/24/2009 2/25/2009 uscle pain to the extent of having diffucult time using all muscles in body needed help gettingYout of bed 2/25/2009 or chair because 2/26/2009 muscles were we pain in upper left arm at injection site Y and tingling in pinky & ring finger of left hand. Dr. suggested N Rx therapy,### MRI and EMG. ### MRI showed ceived the MMR vaccine on 2/18/09.Y Patient had Y an atypically febrile 1 seizure on 2/25/09. AYhigh fever was 2/18/2009 NOT documented 2/25/2009 at the time o ainting loss of consciousness for about a minute while on examining table. Y 2/28/2009 2/28/2009 RST GARDASIL VACCINE Y (administered Y 9/13/06): Y experienced dizziness, 9Y light-headed, Y nauseous, N headaches, 3/13/2007 leg3/13/2007 cramps, and shooting algias, Arthus reaction Y 2/24/2009 2/24/2009 d Hives over entire body except face. Y Y 2/23/2009 2/24/2009 pneumoccal/flu vaccine 2 days priorYto presentation at ED. within 12 hrs developed painful, erythematous Y 9/30/2008 swelling at9/30/2008 the pneumocaccal inje Pt. stated did not feel shot "going in"Ywhen administered; felt a little faint approx 15min after shot, U but recovered. 1/29/2009 2/2/09--severe 2/2/2009 aching pain yesight startin at about two weeks after Y immunization. Y "Optic neuritis"4 Y3/3/09 MR received forUDOS 12/4-8/2008### with12/4/2008 D/C DX: Optic Neuritis ain swelling and redness at administration site. Malaise, headache, upset stomach, myalgias,Ysweats. 2/27/2009 2/28/2009 ge reddish purple area with rashed rash at injection site, didnt show up until 11 days after injection. Y 2/16/2008 2/27/2008 STATED VACCINES WERE ADMINISTERED Y ON WED ON SATURDAY MORNING CHILDYAWOKE WITH 2/25/2009 SWELLIN 2/28/2009 OF LEFT ARM AND s and two days after receiving the Varicella vaccine patient broke out the approximately 20 pox. Y They began 2/11/2009 on her2/27/2009 thigh. Pt ran a fever o white male presents with c/o having a flu and pneumonia injections 2 weeks ago and now has Y soreness, redness, ### and 11/9/2008 skin peeling. He sta ction with redness and swelling to Pentacel. Also, about 3 hours of inconsoleable crying. Fussiness Y over next 1/5/2009 three days. 1/5/2009 Site of other vacci ed** case of progressive vaccinia. smallpox vaccine Y administered127 on 23 Jan 09, patient was diagnosed with 1/13/2009 AML/neutropenic 1/25/2009 fevers on 28 ised and hot rash on torso. Raised hard Y bump at site of shot all occurred two weeks after shot. 2/16/2009 3/2/2009 n has been received from a physician Y and medical Y records concerning 3 an approximately 3 month Y old male with### rash12/1/2007 erythematous, bronch ort received on 17 February 2009 from another Y manufacturer as part 10of a study for which sanofi Y pasteur is not a### sponsor. The ###following is ve ort received on 17 February 2009 from another Y manufacturer as part8of a study for which Sanofi U Pasteur 10/3/2008 is not a sponsor. "The ### patient is a 1 n has been received from Y a physician Y via an email Y from a consumer 10concerning the Y consumer's Y 16 year5/20/2008 old daughter who on 20-MAY-2008 n has been received from a physician Y via an email Y concerning a female 0 who was vaccinatedUwith a dose of GARDASIL. The consumer rep n has been received from a consumer Y concerning Y a 12 or 13 year old 4 male who was vaccinated N with a dose of MMR II on an unspecified d 01005622-1 described "losing mental capacities" Y in a 43-year-old female 0 who received LYMERIX. U This report was received from the vaccin o left thigh where IPV and DTaP given Warm, Red, Induration. TX CEPHALEXIN 250/5ml/5ml U tid (three 2/26/2009 times a day) 2/26/2009 for 10 days 150ml. HA that started at back of his head then through whole head, got very pale and nauseous and Y then vomited 3/2/2009 x 2. Pt c/o 3/2/2009 not feel god and na Multiform Minor, etiology unclear but may be related to MMR and VARIVAX 2/10/2009. U 2/10/2009 2/26/2009 gic reaction. Redness some edema approx 4 1/2 cm diameter. Y 2/24/2009 2/27/2009 ndritis R side > 1wk. N 2/24/2009 2/25/2009 2/10/2009 N 1/14/2009 2/10/2009 eadache, chest pain, increased blood Y pressure,Yloss of consciousness. 4 Y ### ### Breakthrough by baby sister after 1st Var. He also had breakthrough disease (both < 50 each) Y after exposed to ### sister, Hx. Related to nurs und area of injection) swelling, redness, pain, and itching that has been worsening since 2/27/09 U (when 2/27/2009 given). 2/27/2009 iven 930 AM on 3/2/09: with 1 1/2 - 2 hours later cried, high pitch voice; lasted x 4 hours withY15 minutes cat 3/2/2009 naps. Child 3/2/2009 would woke up an ction to the R forearm. redness, itching swelling - numbness in the R arm. Reacted only to vaccine Y given intra 2/6/2009 dermal.2/7/2009 Vaccine was given IM 2/17/2009 2/26/2009 Y 1/4/2000 3/1/2009 ter office & receiving PNEUMOVAX, pt. noted fever on & off. Took TGC. Cold then woke up Y during night 12/2/2008 wet with sweats. 12/2/2008 24 hours after i en 2/18/09. MOC called 2/20/09. On Left arm at site of KINRIX, arm was red, firm, and tender. Y No drainage 2/18/2009 Blotchy red 2/18/2009 rash extended down her states rashes appears on child face 6 days after administration of vaccines. Also states U she uses new 1/26/2009 lotion on child's face and is not s are L upper arm BENADRYL 25mgYq 6 pm. DURIAF 500/s 1 tsp BID X 10days MOTRIN q Y6 hours. 2/20/2009 2/21/2009
mps - deltoid strength decreased 50% with (not inj site) - lower strength fastening clothing inUback; - adjusting seatbelt. ### ### swelling of R upper arm 4 cm in diameter. U 2/25/2009 2/27/2009 er 50 yo. and received the FLUMIST vaccine normally. Clinic notified 9/20/08 and advised toYwatch pt closely 9/20/2008 next 24 hours. On 9/21/08, pt ea of slight erythema and purple discoloration at site of injections. Not warm to touch. Not raised Y when seen 2/13/2009 in our office. 2/14/2009 e and excessive pain continuing for 3 wks; Followed by prolonged weakness in left arm for past N 4 months. ### ### 2cm area of erythema and firmness. Tender to touch. Treatment, cold compress. Y 2/3/2009 2/4/2009 esented to Employee Health Clinic and Y informed the RN that she had an allergic reaction to Y FLUZONE she 2/6/2009 had administered 2/6/2009through Empl rm just below axillae has warmth, redness, Y & edema on side & back of arm. U 2/23/2009 2/24/2009 lling, dizziness, nauseous evening of date shot given. Couldn't lay on right arm to sleep. ByYnext day at 12:00 2/6/2009 Noon 2/6/2009 bruised 50mm across ter received her 3rd injection of GARDASIL vaccine Y on Feb. 9th 2009. 0 She had severe headaches ever since. We took 2/9/2009 her to the emerge ter received GARDASIL vaccine from her doctor on 02/23/2009. Since having the injection she U has had 2/23/2009 a severe headache, 2/23/2009body aches, u started throwing up, couldn't get her to respond afterwards for about 10 min, just starred intoUspace (wasn't 1/22/2009 her normal 1/23/2009 self for another 3 da atient started with breathing problems Y - till her body was shaking. She got hives (slight) on the U arm where 2/23/2009 the shot was 2/24/2009 given. As of today s hrs of being given MMR pt developed erythema multiforme requiring treatment with oral. Y 2/20/2009 2/21/2009 lled advising pt's arm where the Dtap Y was given had gotten Red hot swollen and he complained Y of it itching. 2/25/2009 The swelling 2/27/2009 went all the way n has been received from a nurse practitioner, Y who was told by one of her own patients, concerning N a 156/30/2008 year old female 7/15/2008 patient who is not n has been received from a teenage Y female athlete Y (runner) via a news 0 report who in May 2008, N was vaccinated 5/1/2008with5/1/2008 GARDASIL. In May 2 n has been received from a medicalYassistant concerning a 15 year old female with no previous Y medical history### or drug 1/5/2009 allergies reported w n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### 1/24/2008 who was vaccinated wit n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### who 6/1/2008 was vaccinated wit N rmation received on 20 February 2009 Y from a consumer. A 65 year old male patient who at the Y age of 5 years 2/10/2009 suffered severe chest pain an ort received 19 February 2009 from Y a health care professional. A 14-year-old male patient with U a medical history ### of environmental 11/6/2008 allergies a rmation received on 18 February 2009 Y from a health care professional. A 49 year old male patient N received 8/1/2008 FLUZONE 8/3/2008 (lot number U2761A er shot- hives, pain shooting down arm Y and chest, nurse gave me BENADRYL. One Y week later N I was still having ### hives on ### my chest after ea m on 7/22/2008, fever started 99 degrees, Y in 1/2Y hour went up to 1017 degrees. Seizure started Y went to ER 7/14/2008 in Ambulance, 7/22/2008 seizure lasted 45 shot @ store. 10/29 flu-like sx: myalgia, Y sore throat Y 11/1 pain, tenderness 20 @ site. ER/admit 11/10 Y - 12/1 abscess ###L deltoid### --> staph aureus pain in chest approx 3 days after shot. Shortness Y of breath, fatigue,3 fever, night sweats, muscle Y soreness. 8/25/2008 Hospitalized 8/28/2008 after for 3 days due Varicella administered while she is pregnant. 16wks. EGA. U 2/19/2009 d itchy: topical skin reaction site of flu shot. Resolved with hypopigmented round area 12 mmUdiameter site 12/8/2008 injection. Not itching. ### Not sore. oday with sister who are getting vaccines. Client had vaccines administered on 2/18/09 and U started rash2/18/2009 on her chest 2/25/2009 today mom states cli induration L deltoid 6cm x 6cm. U 2/19/2009 2/20/2009 ter immunization started with lower Y leg itching which then included the abdomen/torso. Rash-full N body after 12/9/2008 @ 2 weeks with ### cont. itching, bu re today for Right thigh red area after shot on Friday, an on Left has softball size red rash where Y the immunizations 2/20/2009 were. Patient did not ha arrhea for 7-8 days on day after vaccine given. Y 1/26/2009 1/27/2009 nset of fever 103.9 with cough, headache, & congestion. U 10/7/2008 2/26/2009 al, redness, tender to touch per patient. Y Swelling and soreness. Y 2/23/2009 trial of ZYRTEC, and if worsening then antibiotics. U 2/19/2009 2/24/2009 - ZYRTEC/allergy med, antibiotics. U 2/20/2009 swelling, pain, itching at site of injection. Instructed pt. to use warm compresses, topical BENADRYL or2/24/2009 Calamine lotion, ADVIL or TYLEN 9- Rash all over, fever, cough x 2 days- Dx: Varicella + Bronchitis Treatment: ACYCLOVIR Y 200/5 1/2 tsp7/12/2007 QID x 5 days 2/23/2009 & BENADRYL 1/2 t ated red and swollen right arm aboutY 2/10/09 with fever 104 degrees and several sm "blisters". Y Took child 2/5/2009 to family doctor 2/10/2009 who DX "vaccine ed 7mm took Benadryl none in am, so not seen in office. Y 2/26/2009 2/26/2009 ash on left side of neck arm and side. Nometasone Furoate, Hydroxyzine HCL 25 mg, Prednisone. Y ### 1/3/2009 ely got left sided eye pain and nausea / an hour and a half later got chest tightness and pain,Ywhich lasted 1/13/2009 intermittently 1/13/2009 5 days. No reaction eived immunizations for travel on 12-17-09 and came into the office on 3-2-09 with rash on his U body. Rash 2/17/2009 appeared 2/27/2009 to be pin point pustule ustular, follicular eruption on the chest and back Y 2/17/2009 3/2/2009 ccine given outside age range Y 2/26/2009 2/26/2009 9 Right Deltoid Red, Swollen, hard induration, Y hot to touch, itchy, red streaks and painful to touch. U Pain with 2/25/2009 Range 2/26/2009 of motion but has full R wellimg at injection site, with rash. pain down left arm and on left shoulder blade. onset immediately N after 2/28/2008 immunization 2/28/2008 was administered t veloped sores on lip approximately 3-4 days after receiving the vaccine. She then developed Y sores on her 2/5/2009 nose as well 2/8/2009 as around here ey
ceived Menactra vaccine on February Y 25th and 24 hours later on February 26th he developed N fever 101.8, 2/25/2009 dizziness, 2/26/2009 nausea, headache, a Y Y 2/26/2009 2/26/2009 Y Y 2/18/2009 2/19/2009 swelling, warm and hard @ site 2.5 x .5 Y 2/27/2009 3/2/2009 d pain and swelling at injection site.YWas seen in the ED 3 days later Y 2/26/2009 ng and redness of the left lower thigh Y 2/25/2009 2/26/2009 ays of injection client passed out at school andYagain at hiome, no other 2 s/s of illness. Admitted Y to hosp.5/22/2007 for tests, all5/24/2007 neg. Has passed out 9 pisode within 5 minutes of administering #3 Gardasil and Varivax #2 Y 3/3/2009 3/3/2009 e anxiety - moody and irritable following flu vaccine - constant meltdowns. 2) Sensory issuesNregarding things ### touching her ### - sometimes un ven his 4 year old immunization on Feb 25, 2009. MMR was given on his right leg and mom stated Y pt developed 2/25/2009 rash 2/25/2009 around the site few ho spontaneous report of seizures and possible transient ischemic attacks has been received from N a parent who is ### also a nurse ###concerning a d shingles like rash that itched. Saw primary care doctor was treated and doing well. Y 2/11/2009 2/16/2009 ives BENADRYL. Observed 90 minutes, Y hives diminishing. Referred to allergist for testing. Y 3/3/2009 3/3/2009 cal erythema, swelling, stiffness with fever up to 102 degrees F. U 2/27/2009 2/28/2009 nt- She had a rash + fever @ time ofYER visit. On 3/3/09 zero rash zero fever-body-aches. Per Y patient. 2/27/2009 2/28/2009 of leg with a fine urticarial rash around injection site. Y 2/24/2009 2/25/2009 perienced a syncope episode Friday Y 2/27/09. Transported to emergency room via ambulance. Y Labs and 2/26/2009 CT of head 2/27/2009 negative. Most recen Tdap and meningitis vaccines. Several minutes later became pale, said he didn't feel well. Became Y unresponsive 1/14/2009for 1/14/2009 < 1 minute. Condition y injection site rash that spread. Became about 2 in x 2 in rash that developed blisters. Very U itchy, red and 2/27/2009 inflamed. No 3/1/2009 fever. No swelling o scle pain @ injection site, progressively getting worse after injection. Pain radiates to shoulder N trapezius muscle 2/9/2009 and neck. 2/9/2009 3 wks post inject reaction to vaccines. MOTRIN and apply cold compress. Y 2/25/2009 2/26/2009 nd vaccine became red. Y U 2/27/2009 3/2/2009 02, with R shoulder swelling and pain X 3d. Seen at ER and started on AbX. Currently afebrile U and improving 2/27/2009 recovering. 2/28/2009 swelling and warmth at injection siteY noted 2/20/08. Treated with CLARITIN 10 mg, 1xday for Y 2 days and2/18/2008 hydrocortisone 2/20/2008 cream to site for 2 a haircut on 4/15/08. At that time, he noticed a dime-sized area of hair loss on scalp, back ofNhead. 4/9/2008 contacted manufacturer indicating that Y the caller had received notification of an AE possible associated U with administration ### ### of BIOTHRAX va xperienced moderate (7x6cm) local reaction to 2nd BIOTHRAX vaccination on 12/1/08. AreaYwarm to touch. 12/1/2008 Malaise12/1/2008 12/2/08, feeling better ports that at approximately 5:00 pm on 10-8-08 he experienced general muscle aches, fatigue Y and fever.10/8/2008 He experienced 10/8/2008 two episodes of ports being tired on the first day after Y receiving the ANTHRAX vaccine. At 6:20 AM on the second Y day she 10/8/2008 noted chest 10/9/2008 pain and shortness d dry rash localized to the injection site (injection site rash). Subject is a military person who Yhad received 7/11/2008 4 previous7/12/2008 doses of Anthrax vacc at injection site at 24 hours after immunization. Y Redness, swelling, itching, tenderness and induration Y at injection 7/15/2008 site7/16/2008 at 48 hours after immu ports that approx 5 hours after immunization, she experienced malaise and fatigue. Her symptoms Y progressed 7/9/2008 to stomach 7/9/2008 pain and nausea ports that three days after receivingYthe ANTHRAX vaccine she felt chest pain and fainted for Y approximately 7/1/2008 30 seconds. 7/4/2008 Subject was take e-mail: Subject has a latex allergy and received the anthrax vaccine. Subject is requesting information U regarding whether the vaccine is mad of muscle, left leg, from mid-calf to behind the knee. Soreness caused limping. Subsequently Y within 3 days, 5/6/2008 pain lessened, 5/9/2008 no longer limpin ection site, itching at injection site, swelling at injection site, redness at injection site, warmthYat injection 4/22/2008 site, 5cm x 4/23/2008 7cm area. n has been received from a consumer Y concerning her 20 month old son with penicillin allergy N who on approximately ### November ### 2004 was v n has been received from a physician concerning a female patient who in August 2008, wasUvaccinated with 8/1/2008 a dose of 2/1/2009 GARDASIL (Lot not n has been received from a consumer Y concerning Y her 14 year old daughter 1 with purple cornflower N allergy 2/16/2009 and no pertinent 2/25/2009 medical history, n has been received from a physician Y assistant concerning a female patient who on an unknown N date was 11/4/2008 vaccinated with### the second dose ort received 23 February 2009 from a health care Y professional. A 4-year-old 2 female patient had Y received 12/4/2008 a third dose12/4/2008 intramuscular left delto ort received 23 February 2009 from Y a health care professional. An eight-year-old male patientY with no past medical ### history,### had received an ort received on 27 February 2009 from Y a physician. A 4-year-old female patient, whose past medical Y history was not provided, had received 2-08 was in hospital for syncopal episode. Y SheYhad normal EEG recording. 2 Was referred for Yevaluation of4/4/2008 a 2 months Hx of spells. First in 2 d spots that started on torso and spreading to her legs. 1/22/2002 2/26/2009 A AND VOMITING Y Y 2/25/2009 2/26/2009 n and swelling in L arm the next morning after receiving a Tdap in this arm. States lymph nodes Y swollen 2/20/2009 and just felt2/21/2009 ill with a bad taste in m pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 11/27/2008 for COPD exacerbation. Y 10/4/2007 Vaccination took ### place on 10/04/ pneumococcal vaccine trial, with severe COPD, Y was hospitalized for 1 chest pain-non cardiacYon 02/06/2009. 1/8/2007 Vaccination 2/6/2009 took place on 1/08 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 6 8/13/2008 for right hip Y fracture. Vaccination 11/7/2007took 8/13/2008 place on 11/07/2007 as vaccinated for meningitis, gardasil, Y and tetanus on 2/18/2009. On 2/19/2009 she could hardly N walk her 2/18/2009 legs were2/19/2009 numb and very weak a
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 1 11/06/2008 for left femYartery reocclusion. 1/9/2008 Vaccination 9/25/2008took place on 1 at-WATERY EYES-RUNNY NOSE-worn ousore right shoulder(shot was in left bicep)-Phlegm-hoarsenessN 2/27/2009 3/1/2009 and edema localized at injection site. slightly raised irregular borders approx. 2-3 in in diameter. N Symptoms 3/2/2009 appeared3/3/2009 24 hours after immun ed Gardisil in left arm then MenigitisYvaccine in right arm. Within a mintue of reciveing the second U shot she 3/3/2009 passed out, 3/3/2009 her body became ri lled and states she has had arm pain Y since receiving infuenza shot 10/16/2008. Has seen MD N X2. Was put on### NSAIDS TID ###X 1 week w/ n ess Administered Daptacel to adult patient. Y Patient should ### have received ### Adacel. Dap e reaction Administered Daptacel to adult patient. Patient should have received Adacel.YDaptacel box 12/4/2008 and vial not marked for pediatric ed 2 month vaccines in office, returned Y home with mother and then cried continuously for >4Yhours, with 2/27/2009 mother unable 2/27/2009 to soothe baby e event Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and vial### not marked for pediatric us t for 24 hours. Administered Daptacel to adult patient. Patient should have received Adacel. Y Daptacel box and ###vial not marked ### for pediat e events. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 1/30/2009 vial not marked for pediatric use e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box1/30/2009 and vial not marked for pediatric u ately 2 weeks after receiving the meningococcal Y Y vaccination and tetanus 5 vaccinations, patient Y developed optic ### neuritis.4/15/09-records 1/3/2009 rece lf reported sore arm for 3 weeks. Administered Daptacel to adult patient. Patient should have Y received Adacel. 5/16/2008 Daptacel box and vial not m e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 5/16/2008 vial not marked for pediatric use e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 6/5/2008 vial not marked for pediatric use ely following vaccination go light headed Y turned blue and fainted out for approximately 60 seconds Y immediately 2/1/2009 followed 2/16/2009 by a migrain heada ed of itchy throat, "patient stated throat Y closing and feeling very itch all body", abdominal pain, Y mouth numbness,facial 1/19/2009 1/19/2009 erythema, positive ra NJECTION WITH REDNESS,SWELLING,WARM Y TO TOUCH. Y 2/18/2009 2/19/2009 e local reaction. Painful with patient Y asking to be carried. Swelling of left quadricep with loss of U knee landmarks, 3/2/2009 erythema 3/4/2009 and warmth at inj was reported by a physician and described the occurrence of elevated gamma glutamyl transferase N in a 44-year-old ### 1/21/2009 female subject who w was reported by a lawyer Y and described Y the occurrence Y of skin blistering 0 and peeling in a female N child who 2/21/2007 was vaccinated with HAVRIX (G was reported by a physician via a sales representative and described the occurrence of cellulitis Y in a child (4 to 6 years of age) male subjec nced vomiting and 1 bloody stool. He Y was taken Y to ED where they found 1 he had intussusception. Y He was 12/8/2008 treated w/air 1/2/2009 enema. He was obs h began to get red and swell with 2 Y papules appearing in central lesion that had fluid but dried Y up. I saw today 2/18/2009 about2/19/2009 2 weeks post vaccines dness, soreness at injection site - approx Y 8 hrs later increase HR with some PVC'S, severe HA Y and backache, ### low grade fever ### 99.6 lt heade of Right thigh and vomiting. Went to Y emergency room on 2/26/09 follow up. In our office on 3/3/09 Y thigh looked 2/24/2009 normal 2/26/2009 child is fine. es X 3 inches round, red, warm to touch Y region left deltoid. Were HEP A given. Slight red rash Y around injection 3/3/2009 site 3/4/2009 and back. 18 hours po ped fever 101.7. 15 cm area of redness, Y tenderness, and swelling. Localized just to vaccine location. Y Treated 3/3/2009 with oral 3/4/2009 MOTRIN and BENAD achy at site of injection, tenderness and achy in back. Ibuprofen given - 2 hrs later: Pt felt better, Y decrease3/2/2009 fever, back3/3/2009 tenderness gone. Fev n tongue - Labored breathing - BENADRYL Y Y ### ### ons given - mom calling stating childs (L) leg was swollen from knee to groin and red. - No temp - n pain.3/2/2009 3/3/2009 Y 3/3/2009 3/3/2009 eadache-fever-dizziness. Doctor visit, Y bedrest, Toradol injection for headache-Hydrozodone for Y headache2/23/2009 2/23/2009 lled 2 days after immunizations listed were given. States child has Hx of eczema rash-mild, but Y noted some hive-like ### raised ### areas on skin o r receiving Tdap at 03/02/2009 . Temperature= 101 (Ty) control by Tylenol. Y 3/2/2009 3/2/2009 t injection site dx by CHOP. Admitted x 48 hours for IV antibiotics, nml, us, neg, cxs. Full recovery Y of mobility. Had HIB + pneumococcal sa d flu shot at clinic on 11/3/08. States Y she started with discomfort to left upper arm from flu shot N area to her 11/3/2008 elbow and 11/6/2008 states "it feels bruised VAX vaccine administered 2/24/09 Right upper arm. Two days afterward the patient called the N office questioning 2/24/2009if site 2/24/2009 reaction was norma of immunization, patient returned to the doctors office to report injection site was itchy. Site U was seen by 3/3/2009 Dr. Site was also red, slight swolle as 2.5 X 2.5 cm indurated erythematous area @ VARIVAX site. Y 3/2/2009 ame limp, unable to hold head up, Refused to bear weight on Lower extremities. Awake and Yalert but "out 2/16/2009 of it" according 2/16/2009 to father. This las ADACEL, MENACTRA, FLUZONE, Hep A, VARIVAX, and GARDASIL - just after receiving YGARDASIL she 3/3/2009 stiffened3/3/2009 up and eyes rolled ba and Dad; reporting to us today at well Y check visit that on 10/21/08 approx 1900 pt had fever Y of 104, responded### to treatment ### of TYLENOL, in ater had fever of 102.5 degrees, 103 Y degrees on the next day, controlled by TYLENOL/MOTRIN U every 42/23/2009 hours. Called 2/24/2009 doctor the first day b n has been received from a physician concerning an 85 year old female with a history of "lung Y cancer surgery" 2/8/2008 who on 2/2/2009 08-FEB-2008 was v n has been received from the patient's Y sister concerning Y her sister with 4 no pertinent medicalUhistory or drug 9/10/2007 reactions or allergies ### who on un was reported by a healthcare professional and described the occurrence of spitting up in a 6-month-old U subject of unspecified gender who was reported by a physician via another manufacturer and described the occurrence of pellet-like U stools in an infant subject of unspecified was reported by a physician Y and described theYoccurrence of intussusception 4 in a 3-month-old N female subject 1/20/2009 who 1/24/2009 was vaccinated with RO was reported by a healthcare professional via a sales representative and described the occurrence U of swelling of upper arm in a child subje
was reported by a healthcare professional via a sales representative and described the occurrence U of swelling of upper arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje 1st GARDASIL vaccination in Oct 2008 and ever Y since then I have been having high fevers, N between to 102-103.0. 10/1/2008 ### arre Syndrome with loss of sensation Y in hands/feet Y and proximal muscle 17 weakness onset onN12/08/08. No improvement ### 12/8/2008 as of yet 4 days of administered 2/05/09 in morning. Parents report Y mom picked up child 3 from crib for 9 p.m feeding. Y Child was 2/5/2009 unresponsive 2/5/2009 and limp. Father ately 4 days after immunization, pt had Y nausea Ythat went to fever, chills 14 and extreme diarrhea Y - went to urgent 11/3/2008 care about 11/7/2008 1 1/2 weeks also ropped off at Mall. At 5:30pm student Y called mother with Sx of SOB, grey lips, perspiration, pale N skin color, 2/25/2009 numbness 2/25/2009 of legs, slurred speec d ZOSTOVAX vaccine on 2/17/09 and three days later she developed shingles on right breast. 2/17/2009 d IZ on 2/18/2009, mother phoned 2/19/2009 Y fever 104 advised ER. Y 2/18/2009 2/19/2009 hed. Neurologist's assessment 2/20/09 Y - normal with coincidental viral infection with fever to N 102 on day 2/11/2009 of visit 2/20/09. 2/12/2009 fter vaccines given. Y 2/17/2009 2/17/2009 ots, pt complained of feeling "tired". This "feeling" lasted et mother reports had fever not measured Y via thermometer2/20/2009 2/20/2009 24 hours after injection after am shot, mom called to report itchy rash on left arm with some swelling. Patient complained Y of knee 2/18/2009 and elbow 2/18/2009 pain. st immunization pt. c/o wheezing with Y exhalation. The Monday following 11/10 she came down N with flu-like symptoms ### 11/3/2008 + fever 101 degrees ever, generalized aching 24 hour after vaccine given. Vomited 2 day after vaccine given. Y 2/13/2009 2/14/2009 VAX given IM Left deltoid on 2/18/09. Y On 2/19/09, pt returned to ofc with edema, pain and erythematous U 2/18/2009 streaking from 2/18/2009 injection site down broke out at 4:30 pm 11/08/08. Rash or blister like over left eye- on forehead + into scalp + hair. N Not to painful but very uncomfortable espec oday stating that the day after getting her shots she developed Blisters in her scalp and itchyYrash on her body.### She did not ### seek medical a ash across abdomen with urticaria started 24 hour after Hepatitis B vaccine administration. Self Y treated with 2/26/2009 BENADRYL 2/27/2009 OTC and topical h rge reddened area with raised rash at injection site. 11 days after injection. Y 2/16/2009 2/27/2009 h severe redness/swelling & induration. Y Worsened over several days pt treated with ABX forYpossible cellulitis 2/23/2009 & steroids/BENADRYL 2/24/2009 for al cellulitis. Treated with Omnicef 120/5/ml 3.5 ml twice daily for 7 days. U 2/18/2009 2/19/2009 gic purpura - developed 4-6 hrs after Y vaccine lasted 1 month - 2-3 developed nose bleed lasted N 2 months 10/1/2008 swelling ankles 10/1/2008 lasted 2wks - wh cal lymphadenitis. U 2/16/2009 2/23/2009 or the 1st of three Guardisil Y vaccinations. Y I had a recent previous pap smear that normal, no N HPV, no abnormal 4/27/2007 cells, 7/11/2007 nothing. After another d grouped papules and vesicles withYa red base on his left shoulder on 2/17/09. He was treated Y with Valtrex 2/3/2009 for 7 days. 2/17/2009 Papules, vesicles a minutes of injection, arms felt heavy and tingly, tongue was tingling, felt nautious and felt dizzy, Y collapsed in 3/5/2009 waiting area 3/5/2009 but did not loose co was given IM Pneumovax in left detoid Y on 3/2/09 at clinic visit for cough and sore throat. RNUreported using 3/2/2009 one inch3/3/2009 25 gauge needle and m swollen right bicep. treated with local care only, observation Y 3/3/2009 3/4/2009 D YELLOW FEVER VACCIN SQ, NOTICED REACTION SEVERAL DAYS LATER. REACTION Y CONSISTED 1/23/2009 OF URTICARIAL 1/25/2009 REACTION wheal (3 cm x 1 cm) and flare (5 cm x 6 cm). Started within 5 minutes of vaccination. At 10Yminutes was3/5/2009 still spreading 3/5/2009 without systemic s DEVELOPED REDNESS TO INJECTION SITE (RIGHT ARM) WITH INDURATION AND SENSITIVE Y TO3/2/2009 TOUCH 3/3/2009 ceived flu shot at unknown pharmacy Y 6 months ago. Felt immediate pain in Left lateral upper N arm, and pain has persisted to the present da d swelling of right eye with redness Y 1 hour after Immunizations, then developed swelling of left Y eye and approx 2/27/2009 2 hours 2/27/2009 later had hives on fa edness for two days at site of injection. Right thigh. U 3/3/2009 3/3/2009 lled and reported that patient was pregnant when she received her third Gardisil. Y 2/4/2009 heals around injection site, right shoulder area, and trunks. Hydrocortison cream and Loratadine U given. 3/3/2009 3/3/2009 as very anxious when given his immunizations Y at 11:30am. Immediately after he became pale Y and c/o nausea. 3/2/2009 Less3/2/2009 than 5 minutes after v m Red, Swollen, Hardness, warm to touch. Patient admitted to scratching the arm at the injection Y site. 3/3/2009 3/5/2009 he vaccine at 3pm, february 10, 2009. Suddenly became very dizzy at 4:30 pm. The extreme Y dizziness2/10/2009 slowly subsided 2/10/2009 and was gone by able crying for 6 hours after vaccine administration. No treatment. Y ### ### ceived pneumococcal vaccine on 11/17/2008 and 2 days later complained that his right upper Y arm was hot to the ###touch red, ### and swollen. P and swelling of L upper thigh measuring Y 8 x 7 cm oval. U 3/4/2009 3/5/2009 zure while sitting and eating, talkingYneck twisted and fell to the floor while @ grandmother'sNhouse lasted9/8/2006 2min. Multiple 6/5/2008 seizures since the at 7:30pm child had a seizure lastingY about 1.5 minutes. No fever. Complained of feeling tired Y before and 3/3/2009 after taken 3/4/2009 ER treated and has a ses of VARIVAX, developed 20-30 classic varicella lesions over axillary/trunk area, no cough,Ycoryza, URI 8/23/1999 symptoms,3/4/2009 otherwise well, lesion iving all ten shots - PENTACEL, ENGERIX and ROTATEQ. Pt noted to have significant erythematosis Y lower 2/26/2009 extremities 2/26/2009 that lasted few min ing and weakness in legs, feet, arms, Y hands and face; first noticed numbness in feet end of October, U 2008. Progressed ### to### legs, arms, hand er (after 3rd DTaP) leg from thigh toYknee swollen and red spotty spot on inner thigh not at injection U site but 3/2/2009 near it, no 3/4/2009 fever, warm, tender.
Y 3/3/2009 3/3/2009 d swelling and soreness to injection site. She also had about 6 inches of redness around site. U 2/25/2009 2/27/2009 over body, very large and raised. Benadryl worked somewhat. Zyrtec (20mg) stopped the reaction N almost totally. ### However, 1/15/2009 after about a we n has been received from a licensed Y practical nurse concerning a 26 year old female with noYknown medical history ### and 1/1/2009 drug allergies, who n has been received from a physician Y assistant and a licensed practical nurse, for GARDASIL, Y a Pregnancy 12/2/2008 Registry product, ### concerning a n has been received from a office manager Y concerning Y a 14 year old 0 female patient who on U 28-APR-2008 6/27/2008 was vaccinated 9/1/2008 with the first dos n has been received from an advanced registered nurse practitioner concerning a 23 year old Y female diagnosed 2/24/2009 with 2/25/2009 epilepsy 2 years ago n has been received from a physician Y concerning Y a female patient 31 who in July or August of 2008, N was vaccinated 8/8/2008with 9/1/2008 her second dose of G n has been received from a physician Y concerning Y an 18 week old male 2 patient with a historyYof reflux and umbilical ### infection ###when he was b edness. Malaise. Chills. Headache.YCough. 3/26/09 Y Received hospital 2 medical records of 10/7-10/8/2009. Y 10/3/2008 FINAL DX: 10/4/2008 Percutaneous coron ed chest heaviness, nausea, headache Y after administration of vaccine presented next day with U persistent2/9/2009 complaint. 2/9/2009 3/10/09 Received PC elling and redness at sight. Y 2/6/2009 2/6/2009 ceived shingles vaccine on 2/9/09 at that time she did not note on VAR that she was immunoUcompromised. 2/9/2009 On 3/2/09 2/16/2009 the home healthcar ed day after vaccines administered. Pt arm warm to touch. Pt complained of itchy & soreness. Y Cellulitis2/27/2009 of R arm- AMOXICILLIN. 2/28/2009 UMIST and came down with Influenza Y A anyway. Y ### 2/23/2009 nning one week after receiving MMR, Y Varicella + HepA vaccine. Rash on back and 5 total lesionsU a few2/20/2009 appearing2/27/2009 like typical chickenpox ven PEDIARIX at 4mo. WCC, HEP B was given too early, must re-vaccinate to insure immunization. U ### ven Hep A vaccination, not in child profile or EMR immunizations. Found later in chart note, Pt received third 2/11/2007 Hep A vaccination today, rece eceived HPV # 1 6-26-07. Patient returns 8/30/07 for HPV #2 and says that her legs were hurting Y - come6/26/2007 back 10/23/07 still c/o leg pain lab abbing head pain, 2/14/09 chest pressure, Y 2/15/09 back and neck pain, 2/16/09 all of above.N2/18/09 diagnosed 2/13/2009 with 2/13/2009 costiocondritis. umbness in left leg, moved up bodyYto left arm, then went to other side of body. Headache severe. U Heart 11/5/2008 palpitations. 11/6/2008 Cramping in hands ated generalized Rash in AM-deniesYSOB. Instructed Tx BENADRYL and/or MD or ER if worse. N Called mother 2/26/2009 3-2-09 2/27/2009 AM-she stated went t dizziness, dysautonomia, fatigue. Has been treated for possible Meniere's disease and for anxiety. N Recurrent 9/19/2007 MRSA9/19/2007 skin infections since 9/ ge 5 was given the MMR/Varicella (Chickenpox) Y shots on the same day, February 19th 2009.YOne shot in2/19/2009 each leg. 2/24/2009 On Tuesday February 2 in hives on 2/22/09. Worsened by Y office visit on 2/23/09. No known new products of foods Y treated with 2/20/2009 SOLUMEDROL 2/22/2009 dose pack and hy e fever, muscle aches, nausea and vomiting. Y Y ### ### ed hot left arm pain Tylenol and iceY Y ### ### o nausea immediately after MCV4. Became pale and stated "I feel nervous and like I may throw Y up". BP 90/60 3/3/2009 placed3/3/2009 on floor in supine pos e seizure. about 0300 -> ER had sz Ythere -> Home 0930 - another sz -> ER -> Home. (Dx: Otitis Y Media @ 2/19/2009 this ER visit 3/1/2009 & sent home w/AMO ood up after injection, walked to closed door, slumped forward & said he didn't feel well, thenYthrew his head 2/3/2009 back, went 2/3/2009 stiff & fell over unco ticed a blister at site of injection 8 am on 1-27-09. On 1-28-09 area became red, swollen & sore; Y Clt developed 1/26/2009 HA 1/27/2009 & head felt warm. No t shingles vaccine- ZOSTAVAX- Resulting in break out of shingles. 2/24/2009 Y
& swelling at injection site. Skin warm to the touch. Y 2/23/2009 2/23/2009 ngestion, cough, decreased appetite, temp 104 degree F lasting 3 days. Also diagnosed with Y acute Otitis 2/24/2009 Media on2/24/2009 day 3. Treated with AU ted to office on 2/28/09 with red, swollen area on thigh where DTAP was administered. ShotYwas given on 2/26/2009 2/26/09. 2/27/2009 Family noticed redden ing at site of injection Y 1/26/2009 1/27/2009 PREVNAR injection 2/23/2009. Late evening started having fever to 103 & fussy. Seen by Y Dr. 2/23/09 2/23/2009 - No orgin found 2/24/2009 for fever T-98.9 at t swelling, redness, erythema, pain of left upper arm to elbow - lasting 6 days. After resolution, Y depression 7/8/2008 remains 7/10/2008 in muscle of upper left a & induration 10 inches around injection site. Y 2/27/2009 2/28/2009 ction redness swelling 4 cm x 5 cm Left Y thigh DTAP. U 2/23/2009 2/24/2009 o sore arm on 2-28-09. Mom noted Yredness, inflammation & warmth. Dad took patient to walk-in Y clinic on 2/26/2009 2/28/09. 2/28/2009 Dr. put him on antibiotic ion right upper arm 2 - PNEUMOVAX RX: TYLENOL as needed ice to area as needed Y 2/24/2009 2/25/2009 l -> Per note from/by Dr. : "Patient suddenly Y awoke from her sleep at 2:30 am early Weds. morning U with 2/16/2009 shaking chills 2/18/2009 and "cold sweats" an Telephonce call from school nurse to report that child came to her office in the AM with c/o U severe itching, 3/4/2009 left upper3/5/2009 arm, after recieveing ately 24 hours after administration ofY vaccine patient states she woke in the night feeling "hot", Y and patient's 3/5/2009 cheeks apear 3/6/2009 flushed. Patient cine was administered on 2/13/09. As Y of 2/27/09 my son has had episodes of hives. Started Non lower extermities 2/13/2009and 2/27/2009 then moves to top (fa e, lymph node reacted and created a big bump under the same arm that had the vaccine. Fever, very weak 3/3/2009 legs and knees. 3/3/2009 I still do not hav 6 PM vacine given- headache that night & the next day, flu like symtoms(aching, chills and diarrhea) started. 3/2/2009 I still have 3/3/2009 them as of 3/6/09. a rash 2 days after administration. She describes it as raised and hard, a big red area about Ythe size of her 2/18/2009 palm. 22/20/2009 days later not as big or
eadache from back of neck up to head.Throbbing, general malaise. Sx began about 12 to 15Yhours later. Felt 2/3/2009 hot. 2/4/2009 RM AREA TO RIGHT ARM WHERE MENACTRA WAS GIVEN(03/04/2009).PATIENT WAS SEEN U BY DR.NAVE 3/4/2009 AND 3/6/2009 MOM WAS INSTRU ps all over body that started 9 days after Y vaccine was given. Y 2/2/2009 2/12/2009 RM AREA AROUND THE INJECTION SITE GIVEN IN THE RIGHT ARM. SEEN DR 09/06/2008 Y MOM WAS 9/4/2008 TOLD TO 9/6/2008 WATCH SITE AND A ceived 4 vaccinations on 02-18-09. YLater in that same day, patient complained of right arm pain. Y Per Mom, 2/18/2009 the deltoid 2/18/2009 site was erythemato D ZOSTER VAX. ON 1/29.09. HIS WIFE CALLED CLINIC CHARGE NURSE 2/23/09 TO REPORT Y PT. 1/29/2009 HAD DEVELOPED 2/16/2009 A BLISTER WI 11/6/2003 ceived Gardasil and Menactra Y vaccinations Y on Y Friday, Feb. 27th at about 2 2 pm. She also had Y completed2/27/2009 a course of3/2/2009 Zithromax, but had pr ng after receiving the Tdap, along with a trivalent flu shot, the patient reported jaw pain on the Y left side that "hurt ### like hell" ### and persisted for me swollen and red, several hours after Y administration of vaccine. Area became painful.There Y was quite 3/4/2009 a bit of swelling 3/4/2009 around the entire veloped fever and light sensitive headache after receiving vaccines Y 3/4/2009 3/4/2009 nset full body myalgia and fever 102 less than 24 hours after injections. U 3/5/2009 3/6/2009 effect at injection site (R arm): round, erythematous without pustular lesion 1.5 cm x 1.5 cmYand tenderness 1/8/2009 on Right 1/21/2009 arm. er administrating ROTATEQ baby developed redness on face - chest & back. Administered Y @ 11:50 am -3/6/2009 rash 12 pm3/6/2009 (on 3-6-09). ost vaccine child c/o pain (sharp) inYright hand (vaccine given in left arm) then later in day child U c/o pins &3/3/2009 needle parasthesia 3/4/2009 X 4 extremitie
hs, patient had rash at location of immunization. Y At 4 months with no alcohol or band aids used, U patient had 3/2/2009 rash on legs 3/3/2009 where shots were d #2 GARDASIL vaccine inj 2-17-09. 1st injection was given at another clinic. Pt called 2-25-09 Y & stated 2/17/2009 shortly after 2/17/2009 she got home felt an occurred after having vaccines. Vomiting lasted about 10 hours. Y 3/5/2009 3/5/2009 and low grade fever occurred after receiving vaccines, vomited X 1. Y 3/5/2009 3/6/2009 st yellow fever vaccination (SQ) member Y noted a small area of redness at the site of his vaccination. Y By2/24/2009 this afternoon 3/4/2009 the area of redness arm cellulitis - treated with SEPTRA Y Ds and NAPROSYN. Y 2/11/2009 2/19/2009 - severe, malaise- severe, fatigue severe, headache- moderate, swelling/induration, redness, Y diarrhea, chills-moderate, 1/29/2009 1/29/2009 pain-severe- took 5 d TDAP. He developed fever & headache x 4 days. Per mom they brought him to urgent care. Y Now he is better. hours after injection patient experienced redness and a hard area about the size of a fist. Swelling Y from injection 1/29/2009 site1/29/2009 to wrist. Warm to the t fever for several days then "chicken pox" rash which eventually spread over entire body, fatigue N - I (her 2/23/2009 mother) have3/2/2009 ended up with about sudamina rash developed on body trunk and upper extremities 30 min after administration. Vaccine Y is Trimovax 3/6/2009 of Sanofi 3/6/2009 Pasteur Lot No s very painful and swollen wrists, hands, and knee for duration of close to 2 weeks, appearingY2 weeks and2/4/2009 5 days after 2/24/2009 administration of vac ighly anxious after vaccines given. Reported tingling in mouth, numbness in feet, and diff. breathing. Y States 3/8/2009 couldn't3/8/2009 move legs. Epinephri n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a U 17 year old female 3/6/2008 who on 3/6/2008 06-MAR-2008 was n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 15 9/18/2008 year old female who on 18-SEPn has been received by a drug wholesaler Y representative Y concerning three patients who on 20-JAN-2009 Y 1/16/2009 were vaccinated 1/17/2009 with a dose of P n has been received from a Doctor of pharmacy Y concerning a 61 year old female patient who N on 22-DEC-2008### was vaccinated ### with a dose ort received 24 February 2009 from Y another manufacturer (document number 45214091), who received the report from a health care profes AP & VARIVAX 3/3 0900 AM. 3/3/09Y 2330 To ER via ambulance with high temp muscle tremor, Y arm pain.3/3/2009 3/5 seen in3/3/2009 office with cellulitis (R at site of injection- Soreness at site L arm and up into L neck. Temperature elevation up to 102 N degrees accompanied 2/9/2009 2/9/2009 by some nausea. d TDAP, HEP A, MENACTRA 1-20-09. Y Mom called this am 1-22-09 states he is out on townUon basketball 1/20/2009 trip and 1/21/2009 called c/o stiff neck, sta es onset of soreness + "Shooting pain " Left axilla last night, 2/26/09; 4/10 severity. (Also reports Y mild/moderate 2/25/2009injection 2/26/2009 site tenderness/ d flu shot and came down with influenza Y A anyway. Y ### 2/22/2009 d flu shot and came down with influenza Y A anyway. Y ### 2/25/2009 up to neck-soreness still sore-sometimes more than others times- When sick or after other shots N vaccines. 12/1/2008 12/1/2008 l headache, neck pain, body ache +Yvomited X 1 later same day and went to ER for evaluation. Y Received2/28/2009 IV fluids +2/28/2009 Toradol for pain Dx: V g pain, particularly in knees for 24 hours after vaccine administration. IBUPROFEN administered Y by parent, 3/3/2009 no further 3/3/2009 treatment. njection, pt. felt nauseated then proceeded to faint. Recovered after anonic inhalent used. Again Y c/o nausea, 2/26/2009 sleepiness. 2/26/2009 Was very pale a ely after 4th injection (HPV) Pt had stiffening of body, gluteral oral sound, fixed stare, then fainted. Y Vomited 2/26/2009 after recovery 2/26/2009 from faint. Was pa roximately 7 PM 1/23. About 2 hrs Y after onset fever/ vomited X1 Tylenol mother described seizure Y activity. 1/21/2009 Seen at1/23/2009 emergency clinic. The hest area pain and redness and swelling Y at site of injection of VARIVAX. Vomited once yesterday U morning. 2/23/2009 Today felt 2/24/2009 tightness in chest. se practitioner at clinic phoned to inquire Y about side effects of Hep A vaccine as pt had presented Y this AM 2/19/2009 with nausea, 2/20/2009 sinus congestion a U 11/3/1998 3/3/2009 dministered 0945 1/28/09 and patient Y was discharged Y 10:15. In the5evening hours at home,Ythe patient 1/28/2009 noticed onset 1/28/2009 of pain, swelling arou flu shot on Thursday. Friday--the vaccine Y site became red, hot to touch, and hard. Taken toYdoctor on Saturday ###as clinet ### began having co
ely flushed and hot with infection of Twinrix. That passed and client complained of nausea and U warm feeling 2/27/2009 for next2/27/2009 1 1/2 hours. ted on 2/11/09 and had a positive urine Y HCG. Pt received Anthrax, Typhoid, and Small Pox. U Error was identified 2/11/2009 on 2/11/2009 3/9/09 @ 0820. Pt had ed having a rash on face spread to rest of body. Varicella vaccine given the day before. Rash Y blistered9/23/2008 and scabbed 9/24/2008 over - some itching. . - swollen right thigh, reddened and hot, no fever; applied cold packs 10-14-08 - Unable to see Y doctor. Leg 10/8/2008 (r thigh) apears ### to have redden ceived vaccine on 3/3/09 in the afternoon patient then had fever of 102.7 at 3am on 3/4/09 was Y given tylenol. 3/3/2009 patient 3/4/2009 then had a seizure at 3 since 3-6-09; Bloody nose today 3-9-09, Cranky/fussy since 3-6-09; No rash, or fever. Referred Y patient to3/5/2009 physician for 3/5/2009 care. ling, erythema, itching, significant increase in circumference of upper outer thigh Y 3/3/2009 3/4/2009 DACHE AND GENERALIZED MUSCLE ACHES AFTER VACCINATION. ARM OF VACCINATION Y SORE. 3/5/2009 3/5/2009 dministered 3/5/2009 3 pm. Friday am 3/6/09 individual noted site to be tender only, no erythema, Y but by Friday 3/5/2009 evening 3/6/2009 was experiencing veloped high fever, erythema at injection Y site, and cellulitis which resulted in an office visit toYthe pediatrician 2/25/2009 as well 3/5/2009 as an ER visit and a c swelling,heat and firmness at site. Dark red for quarter-sized area around site and then lighter Y pink for an3/2/2009 area the size 3/3/2009 of a grapefruit. No t rts a blister, smaller than a dime, appeared to back of left arm the day after vaccination. A smaller Y blister 2/24/2009 appeared2/25/2009 in same area the next d hingles vaccine that my Dr said i should get. A few days after the shot every muscle in my body hurts so2/26/2009 bad i cant stand 3/1/2009 it. And exhauste d area swollen, tender and hot to palpation. Unable to move arm or flexion. Fever upt 10 103.0 U by history.3/7/2009 3/7/2009 ter DTAP given mom reports he had "inflamed blood vessels in legs and toes". Pt not seen by Y Doctor- when seen ###exam was ###normal. offer IPV given child has developed stuttering, slowly improving but not gone yet. U 1/21/2009 2/23/2009 given. 3/06- arm swelled to size of tennis ball at site. 3/07 itching, discomfort. 3/08 Broke out Y on torso with 3/5/2009 welts, rapid 3/6/2009 heart rate, discom ed R upper area > resolved w/ Benadryl and 1 1/2 days of Prednisolone. Seen at urgent care. Y 3/5/2009 L thigh around vaccine administration site. Resolved with antibiotics. Y 2/18/2009 2/19/2009 she saw Dr for "horrible blurred vision...and Y flashes on the left side of my left eye". Reports she Y also had12/3/2008 increased 12/3/2008 coughing (forceful) at th 0-15 minutes after injection given employee Y became cool/clammy, face flushed, Rt arm red blotchy Y areas appeared. 3/3/2009 Stated 3/3/2009 "he felt dizzy an induration and warmth at the injection site, measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009 induration and warmth at the injection Y site measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009 induration and warmth at the injection Y site measuring 5-6 cm in diameter. U small rash over left upper eyelid & fever Y 101 degrees approx. 20 hrs after vaccine. Next morning Y awoke2/24/2009 with eyelid2/25/2009 lid swelling & facial/bo eloped a tight cough and progressive Y respiratory distress beginning 3-5 min after vaccination.Y On initial exam 3/5/2009 he has 3/5/2009 tachypneic tachycardia ain, and pain in arm of ADACEL shot. Y 2/24/2009 ouch, redness 6 1/2cm X 5cm. U 3/6/2009 3/8/2009 e; 3/5 arm swelling redness dx "cellulitis" Y urgent care KEFLEX; 3/6 flushed cheeks arm swelling Y dx "vaccine 3/4/2009 reation" 3/5/2009 DC KEFLEX. ness, 2"/3" on Rt. thigh. Minimal induration itching. Y 2/27/2009 2/27/2009 /3/09 Pt. received HEP A #1 and VARIVAX Y #2 wt. 280.6#, temp. 99 T. No reaction noted at Y time. 3/4/09 pt. 3/3/2009 returned3/4/2009 with c/c: Rt lower arm ction to IMM. Left deltoid x 2 days. BENADRYL 1 1/4 tsp po q 4-6 hours prn. Y 3/3/2009 3/5/2009 d generalized pink maculo-papular rash on 3/8/09 about 24 hrs prior to being seen. No fever.UNo other symptons 2/24/2009 - completed 3/8/2009Augmentin fo m raised, red urticarial-appearing patch upper outer L arm at site of Tdap immunization mile excoriation Y at 9/22/2008 lower edge. 9/25/2008 BENADRYL 25mg @ nced pain, redness and swelling at injection site worsening after 2 days of flu & pneumo injection. U TYLENOL 10/6/2008 for pain. ked into clinic stating she thought she was having reaction to HEP B vaccine. Began havingUelevated Temp 9/23/2008 101 degree 9/24/2008 F 2am on the 24th Y ### ### th Baseball sized knot warm at touch and with redness x 1 month after vaccine was administered. U 2/24/2009 2/24/2009 ure has been normal, it is a red, heated rash located on right thigh. The injection was given on U Friday 3/6/09 3/6/2009 the rash3/8/2009 appeared on 3/8/09. T veloped rash to left chest. Left shoulder, and upper left arm. BENADRYL 25mg PO was given. Y 3/7/2009 3/7/2009 algias, N/V and arthralgias. U 3/5/2009 3/5/2009 days after his vaccine heYran a feverYof 102. I took Y him to the pediatrician 40 Y and heYbegan to have N a seizure. 10/2/2008 It lasted 45 minutes ### so he went n has been received from a certified nurse midwife concerning a female who was vaccinatedYwith a dose of GARDASIL. On an unspecified n has been received from a consumer concerning a child in her family who on an unknown date U was vaccinated with a dose of MMR II (dos n has been received from a 60 yearYold male pharmacist with no allergies and hypertension Y N and cholesterol 1/10/2009 who on1/14/2009 10-JAN-2009 was vacc weakness in legs and urinary difficulty, Y starting 2Yweeks after vaccinations. 4 Patient was hospitalized, Y supportive 1/28/2009 care, 2/12/2009 symptoms self-resolve t shot- fainting began, headaches. Y 10/2/08-2nd shot- fainting + headaches continue Y inabilityNto sleep or concentrate, 8/1/2008 inability to see or hav as given ZOSTAVAX vaccine in her Yleft arm and Pneumococcal -PPV-23 in her right arm. Approximately 15 3/6/2009 minutes after 3/6/2009 the vaccine admin minutes after vaccination child passed out, jerking motions of extremities were noted. B/P elevated Y to 158/98. 3/4/2009 Recovered 3/4/2009 quickly. Referred t adverse rxn, doctor did not do any treatment. Y 2/27/2009 istory of tic disorder in January 2009-exacerbation Y of tics. Parent concerned 1 - poss. R/T GARDASIL N administration. ### Persistent ### exacerbation
ode after 1st GARDASIL 8/18/08. Dizzy episode after 2nd GARDASIL 10/22/08. See attached. Y ### ### dness left deltoid & soft tissue swelling Y - onset 48 hrs after vaccinations. T-97.5 PO. Y 2/23/2009 2/25/2009 ike a fever of 102, became "unconsolable and rigid" within 2 hours after receiving vaccine. Also Y site of vaccine 3/4/2009 became 3/4/2009 "hard as a rock" an perienced nausea and itching starting the day after receiving the injection. Y 2/9/2009 2/10/2009 covering 5 inch Diameter Area Around Y injection site, Raised Lump At injection Site. U 3/3/2009 3/4/2009 U ### ### d and swollen x 4 days; better today but continues and now itchy. Used ice and Motrin. N 3/2/2009 d, swollen, itchy lump hurts when touched for 3 weeks. Size of a silver dollar. To date there isYa shadow similar 1/13/2009 to a fading 2/1/2009 bruise. ebruary of this year my daughter came up with a few ringworm's on her stomach and thigh. I U bought the over-the-counter 1/29/2009 3/3/2009 medication and wa cine on Tues. 3/2/09 about 10 am. No immediate reaction. Wed. am patient noticed itching. by Wed. afternoon, 3/2/2009 area of 3/2/2009 injection red, swolle ed 3/18/09-records received-office visit Y office visiti 12/5/08-positive ANA, fatigue and arthralgias. N October 10/3/2008 had asthma flare### that required ste e, nausea, vomiting, fatigue, chills and dizzy started about 48 hours after second dose and lasted Y about 24 hours. ### ### - child experienced occasional vomiting episodes on 2/14 & 2/15/09. There was also redness Y & swelling 2/13/2009 @ site of 2/14/2009 DTAP vaccination on th lowing vaccinations fingers of both hands became + 1 swollen and points of bending on hands Y itched as2/20/2009 well as both 2/21/2009 forearms. Day # 2 no & small vesicles on neck, back upper Y thighs. U 2/20/2009 2/24/2009 Y 3/3/2009 3/3/2009 and puffy red @ site and all below all way to elbow, and hot and sore. Stayed for 7 days. Y 1/28/2009 2/28/2009 ot to my 4 yr old within 8 hrs my daughters Y arm swelled & then she woke up with hives everywhere U on her2/24/2009 body. It is2/24/2009 10 days & they are stil edness only 1hr after shot - Overnight Y arm began to swell & is warm to touch - MD cannot rule U out cellulitis 3/4/2009 based on3/4/2009 exam. .5, myalgias, with redness / swellingY upper arm X 2 wks; skin subseq sloughed off. Tx with Prednisone Y X1/20/2009 7 days. 1/25/2009 Y 2/24/2009 2/25/2009 was reported by a lawyer and described the occurrence Y of joint pain0 in a male subject of unspecified N age12/1/2000 who was vaccinated with LYMER was reported by a lawyer and described Y the occurrence of joint pain in a female subject of unspecified N age 6/30/2000 who was vaccinated with LYME dministered as part of annual physical Y exam caused a severe allergic reaction in right nostrilNand eye. Paient 9/29/2008 started 9/30/2008 losing vision in right e aleness, weakness, dizziness, distortion of hearing, sweating, nausea, wretching and vomiting Y (small amount, 2/20/2009 no food) 2/20/2009 within about 5 minut was given as no history of tetanus was known for a long time. Client had received one on 01-22-2008. Y This 3/6/2009 was found 3/6/2009 when I went to ente REFERS DIZZINESS, PERSPIRATION AND PALENESS.LASTED FOR 20 MINUTES. RECOVERED Y AFTER 2/23/2009 LAYING 2/23/2009 DOWN. d 4cm red hive with central elevation. Given 12.5 mg benadryl. Observed for 1 hour. No SOA. Y Redness 3/10/2009 improved3/10/2009 to 2 cm and no longer r d shortness of breath, hives, itchingYall over approximately 30 minutes after being given PPD, Y Influenza vaccine, 1/27/2009 and1/27/2009 Tdap. Sent to ER; rec minute of receiving Menactra inj, became Y pale, slid to floor out of chair. RN lowered to floor. Stiffened Y body 2/26/2009 for approx 2/26/2009 15-30 secs, face redd ng the gardasil vaccine three weeks ago, my daughter has severe back pain, general muscleNaches, fatigue 2/17/2009 and terrible 2/9/2009 headaches. She al D 15 MONTH SHOTS 4 DAYS AGO- STARTED WITH SWELLING OF LEFT LEG. NO TEMPERATURE. U 3/6/2009 CAME TO 3/8/2009 OFFICE- 1" X 1.25" B arted jerking/seizure for about 1-3 seconds. Then Y had about a dozen 1 episode's of the jerking/seizures Y for 2/10/2009 about 3-52/11/2009 seconds. The patient w ite reaction: redness and soreness-next day and lasting 5+ days. Itching after several days. Y 3/5/2009 3/6/2009 pneumococcal vaccine trial, with severe COPD, was diagnosed with colon adenocarcinoma,Y metastatic.1/31/2008 Vaccination 6/27/2008 took place on 1/31/20 ### N 3/13/2008 ### usea and vometing, mental confusion.This is info taken from the patients mom. Stated pt recovered Y and2/20/2009 is now @ her travel destination. At bilateral profound bilateral brachial weakness approx. Y 6-weeks after 7having received the splitNinfluenza vaccination 1/8/2009 (injectable). 2/15/2009 Vaccine wa M child felt warm. Mother did not take temperture. At 8:15 or 8:20 PM child 's temperture 103.3. Y Child started 3/9/2009 to have 3/9/2009 a seizure. Ambulan 5 mins after Varivax given, pt developed erythema at and above injection site. Per drs orderYgave pt dose3/6/2009 of oral benedryl. 3/6/2009 esented to office with child (Melody) reported that Varicella was given 2/26/09. Papular rashUappeared on 2/26/2009 child 3/8/09. 3/8/2009 No fever was noted 2009 at approximately 2:45pm the above named pt. was in the clinic with her daughter who U was receiving 2/12/2009 services and 2/12/2009 the pt came to me a emely sore arm with mild warmth in the deltoid since day injection was given. He is on day 5 U of pain in that 3/6/2009 arm, which 3/6/2009 is longer than what n in health center on 03/04/09 with a rash that started on 03/03/09. Rash scattered throughtout U body: slightly 2/3/2009 raised 3/3/2009 or macular, erythemat zy a few minutes after HPV vaccine. Pt also felt her L arm turning different color. Pt has notYeaten whole2/18/2009 day prior to 2/18/2009 vaccination. Pt given nt received 0.4cc of Infants Tylenol. An hour later she received DTAP, IPV, Hepatitis B, Haemophilus Y Inf.1/26/2009 B, Prevnar1/26/2009 and Rotateq. The patie my first and only dose of Gardasil in late September, I beleive it was the 20th. I found out inUOctober that 9/20/2008 I was pregnant. 10/2/2008 My due date ba ely after vaccination, a few red hive-looking rash spots appeared on my son's face/neck/arm Y and knee. Also, 3/10/2009 difficult3/10/2009 to console crying a for hrs, had sore arm, legs, headache, fever of 101.3, tiredness, dizzy, lack of appetite. With Jr.UMotrin and cold 3/9/2009 compresses 3/10/2009 on arm and legs as given her first flu shot with Fluvirin on October 29, 2008. To date she still has muscle tenderness at the injection ### site. ### 0/09 2 red areas 1 to inner aspect of (L) arm 1 to back of (L) arm (slightly raised) swelling noted U to axillary3/9/2009 gland (L).3/10/2009
en 2/27/2009. (left deltoid) seen in office Y 3/4/09 for left delt was erythematous and tender. 4X4 U cm area, 2/27/2009 no lymphadenitis 2/28/2009 but slightly tende runk and local swelling, pain, itchingYat vaccination site. Antihistamines Prescribed. N ### ### 48 hours-entire leg 2x NL size feverYup to 104.2 degrees x > 2 day after vaccine. U 5/12/2008 5/13/2008 Rt shoulder tenderness, pain with motion, Y radiation of pain to wrist/hand - ACE wrap, ice or heat, N IBUPROFEN,### light12/4/2008 duty at work 12/29/08 Y U 2/23/2009 3/9/2009 redness and tenderness to site of injection. Y U 3/3/2009 3/4/2009 n has been received from a physician Y concerning Y a female patient "in her 80's" who Y "over a N year ago" was vaccinated with "single dose" of n has been received from a physician Y concerning Y a 22 week male who Y on 15-DEC-2007 (lotNnumber 657673/0904U), 3/14/2008 3/14/2008 14-MAR-2008 (65991 n has been received from a consumer who saw via video clip online last month concerning aNmale "little kid" who was vaccinated with MMR n has been received from a consumer concerning her 3 year old son with allergies to certainNepilepsy medication (unspecified which ones) n has been received from a physician Y concerning a female who was vaccinated with a 0.5mlYdose of GARDASIL. 3/25/2008On 3/30/2008 an unspecified date, a was reported by a healthcare professional andYdescribed the occurrence of cellulitis in a subject U of unspecified age and gender who was va was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a patient who developed a rmation was received on 26 November Y 2008 from a health care professional in the USA. A 55 N year old female 11/6/2008 patient 11/6/2008 received a right arm i by the hospital that I had no recourse, Y I workedYas a nurse for 1 yr before all of this, Y volunteered N as an instructor. ### ### o injection site, no redness or discharge noted. 3/4/2009 3/6/2009 ed: Had L) upper arm swelling starting 3/8, swollen lymph node under L) arm 3/9, Flu like sx Y chills, HA, neck 3/7/2009 ache 3/10, 3/8/2009 Inj site red, swollen ed area size of 1/2 dollar - vaccine give 2/26/09 - and 2/28/09 area turned red and hot to the Y touch and swollen. 2/26/2009 Cheeks 2/28/2009 had a red rash with le ADMS is referred to the FBVHC from Y WAMC Allergy department for persistent leucopeniaUsince receipt 1/27/2009 of multiple2/2/2009 vaccines. 3/18/09-rec minutes after vaccines administered, Y patient became flushed in face with some rash, drooling, Y runny nose, 3/10/2009 gagging,3/10/2009 and coughing. Sent to 3-9-09 with 101-102 degree fever for 5 days previous r. nose cough & 15 "spots" on torso. Mother U called 3/18/2008 3-10-09 to report 3/9/2009 at least 100 more V & MENACTRA @ 08:30 AM FeverY Pm - abd pain & facial hives - given BENADRYL - wentYER @ 6 PM. 3/10/2009 Given IV 3/10/2009 steroids & BENADRYL poor feeding for 7-10 days after vaccine, Y no fever, no seizures. Y 1/5/2004 1/6/2009 ection started to ache 3/5/09 pm. Unable to raise arm and fever. Recd. 1. Ibuprofen 600mg qY6-8 hours with 3/4/2009 food PRN 3/5/2009 discomfort 2. BENAD dministered 3-3-09, on 3-4-09 Pt experienced redness and pain around the injection. DeniesYitching, or fever. 3/3/2009 Redness 3/4/2009 is about size of 50 c inistering Tdap vaccine the patient fainted. TR, BP, WNL. Water given. Was all better <1 minute. Y 3/4/2009 area of erythema/tenderness (L) deltoid area (-) fever. Located above the area the injections were given. 3/4/2009 cellulitis secondary to immunization injection given 11/24/2009. Seen in clinic 12/8/08 placed Y on DURICEF 500mg ### BID 12/4/2008 x 10 days. (inconsolable) crying over 3 hours Y in next 24 hrs with fever to 103. Y 3/4/2009 3/4/2009 l syncope- twice, oral fluids, juice remain Y supine Trendelenberg. She was treated in our facility. Y 2/15/2008 2/15/2008 e itching/hiving @ site & lip tingling. YNo other symptoms BENADRYL by mouth given + sent Y to ER for further 3/9/2009 obs -> no 3/9/2009 further Rx needed. nd sweaty about 30 min after receiving Y vaccine stated "I feel- not like I can't swallow but my throat Y feels tight3/5/2009 like when 3/5/2009 I take MORPHINE a h of 104 degree F vomiting X 1. Y Y 3/5/2009 3/5/2009 Dtap + PREVNAR on 2-5-09 @ 16:30. 300/am 2-6-09 reported temp 104.7 continued running Y temp with 2/5/2009 no other symptoms 2/6/2009for 3 days. D ed scream, inconsolable for 3 days after vaccine administration per mother's report. Y ### ### chills started about 9 hours after vax admin. 3-3-09 was given TWINRIX and ADACEL. StillUfeverish 24 hours 3/3/2009 later but 3/3/2009 feels better. (R) arm Dizziness, body aches, fever, headache. Y 2/24/09- Headache, nausea, body aches. 2/25/09- Dizziness, Y neck 2/23/2009 and back 2/23/2009 pain, body aches, fev d VARICELLA lesions 9 days after receiving VARIVAX. Y 1/29/2009 2/7/2009 arms and torso consistent with mild VARICELLA vaccine on 3/2/09, onset of rash 3/7/09. NoUother symptoms. 3/3/2009 3/7/2009 hecks, forearms, hands similar to varicella but also with papulovesicular lump character. Vaccine U given 3/02/09, 3/3/2009 onset 3/7/2009 3/7/09. No other sys ought she had shingles, no visible outside Y rash, had pain all over her body. Contacted MD for U pain medicine. 2/27/2009 3/9/2009 onset 3 hrs after vaccine lasted 8hrs. Y 3/5/2009 3/5/2009 TDAP 3/6/09. Within 1-2 days developed fever of 102, body aches tender arm & hard bump Uthe size of a 3/6/2009 coin where injection given. ceived a 3rd dose of varicella vaccine in error. Y 2/4/2009 rash around injection site, approximately 24 hour post injection. No itching/pain. Normal sideUeffect. 3/3/2009 3/4/2009 nduration at site of KINRIX 36 hours following administration. No systemic symptoms. Resolved Y spontaneously. 3/5/2009 3/7/2009 Y 3/9/2009 eumonia vaccine was given in left arm. Pt on Tuesday 3/3 am, hurt on Tuesday pm, the armUswollen and 3/2/2009 red, warm to 3/3/2009 touch and was fever complains of dizziness approximately 15 minutes after receiving injections per employee report Y she got 3/10/2009 dizzy after 3/10/2009 smoking cigarette. Tem ports evening 3/05/09 Pt developed swelling and redness at L thigh. U 3/5/2009 3/5/2009 ulated self on Right index finger. Lesion Y developed. Also developed lesions in mounth and on Y Pharynx (stated 3/3/2009 she 3/10/2009 put finger in mouth) una
rts pt with hard red area 2 1/2 inch in diameter. Fever of 104.0. Advised to give benadryl andYtylenol along3/5/2009 with use of3/6/2009 warm compress at th 2007 - Back and Hip pain Winter, 2007/08 - addition of shoulder and elbow pain, ankle pain N and weakness, 8/2/2007 increase 11/1/2007 in back and hip p TO CHICKEN POX AT DAYCARE. WOKE UP ON 2/13 WITH A FEW SAMLL BUMPS ON HEAD Y AND UPPER 2/27/2008 CHEST, AS DAY WENT O ncussion and with the stitches they gave me a tetanus vaccine. My arm since has hurt a great N deal. I cannot 3/9/2009 move it. 3/9/2009 I have a very large lum ccinated with Flu vaccine on 10/29/08 Y and developed syncope on 10/30/09 and passed-out.YCT scan of head was ### negative, ###probably not a ling, redness, hotness, hardened area increasing over several days. started antibiotics on 3/6/09; Y symptoms 3/2/2009 resolved3/3/2009 by 3/8/09 ery patches and itchy without pain all below injection site of left arm. Y 2/19/2009 3/3/2009 Tdap vaccine patient developed "twitching "over the left index finger initially and then generalized U to the entire 3/4/2009 arm/arm 3/5/2009 also had become s oster rash 2 x 4 cm right thorax, pain right ribs, both for past 7 days. U 2/20/2009 3/4/2009 7/29/2008 N 7/22/2008 7/26/2008 TION SITE BECAME RED, HARD AND HOT TO THE TOUCH THE DAY AFTER BEING IMMUNIZED Y 3/9/2009 3/10/2009 , pt developed intermittent fussinessYand apparent abdominal pain (legs curling up). Worsened Y over next 2/16/2009 24 hours, then 3/7/2009 passed a bloody/m ately 7 hours after vaccination on 3/10/09, started feeling febrile (no temperature was taken),Ychills, sweating, 3/10/2009 weakness, 3/10/2009 full body muscle a given to this patient. No reaction or adverse effects noticed as yet. Y 3/11/2009 3/11/2009 d area of erythema (1 cm diameter) and induration (2 cm diameter) in area of vaccine administration U on right 3/9/2009 thigh 3/11/2009 CLAIMS THAT AS SOON AS SHE YWAS ADMINISTERED THE VACCINE (TETANUS BOOSTER) Y ON HER 3/1/2009 RIGHT ARM, 3/1/2009 AS SOON AS S old had INTUSSUSCEPTION, hadYpreviously Yhad 3 doses of Rotateq 1 at correct schedule, last Y dose on 10/20/08 ###10/20/08-office 3/8/2009 visit-well (9 MARCH 2009): EVENING - HEADACHE, CHILLS. LATE NIGHT - HEADACHE, MILD FEVER., N TUESDAY 3/9/2009 (10 MARCH 3/9/2009 2009): HEADAC st wanted to touch basis with Dr on Y some rough reactions to the Tdap injection pt received last U Thursday (3/5). 3/5/2009 Following the injection pt ret swelling at site 5" long X 2" wide. (2) Inj site red. (3) some dizziness. Y tous, edematous at vaccines site on right arm. BENADRYL, apply ice. Y 3/9/2009 3/9/2009 2/17/2009 lurred speech. 8-13-08 EquallibriumYoff. 3/18/09-records Y received for 4 DOS 8/21-8/25/08-DC U DX: Viral encephalitis. 7/14/2008 In8/9/2008 ED C/O dizziness, slu bling; Questionable seizure episodes Y 8 days after Y 6 month vaccines2administered on 2/5/2009. N 3/23/09-records 2/5/2009 received 2/13/2009 for DOS 3/2-3/4/0 Immunizations client sitting in waiting Y room reported "not feeling well". Head dropped to left U side, became 3/11/2009 pale, went 3/11/2009 into deep sleep-snorin Y 3/10/2009 ceived DTaP, IPV, MMR and VARIVAX Y on 3/9/2009. Pt developed blistery rash on 3/10/2009 U and temperature. 3/9/2009 Patient 3/10/2009 presented on 3/11/2 fussy 20 days after administration of vaccines. Rash on face, chest, back and arms. Erythematous U macular/papular 2/18/2009 rash 3/8/2009 with areas where ed rash similar to classic measles rash- (without oral lesions). U 2/23/2009 3/3/2009 t was received from a health professional on 09 May 2008. The patient is one of three patients U reported as part of a cluster. A child (exact a t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac ort was received 04 September 2008Y from a health care professional. A five-year-old patientYreceived an8/22/2008 injection of8/22/2008 DAPTACEL (lot numbe ort received on 15 September 2008 Y from a healthcare professional. A 5 year old male patient, Y with no medical 8/22/2008 history, 8/23/2008 no illness at the time rmation was received from a health Y care professional on 06 October 2008. A 19 month old male Y patient 10/2/2008 with no known 10/3/2008 allergies received a ort was received 17 October 2008 from Y a health care professional. A 2-year-old female patient N with no past 10/1/2008 medical10/1/2008 history, had received a was received from a consumer on 22 April 2008. A consumer reported that her four-year-old N daughter experienced 8/12/2004 "ongoing sicknesses s ort received on 22 September 2008 Y from a consumer, who is the patient's mother. A 26 yearUold female 9/18/2008 patient, with9/19/2008 no medical conditions -old female patient with a medical history of neurogenic bladder, reflux and spina bifida, had Ureceived an injection 9/9/2008of MENACTRA, lot numb ort was received 12 December 2008Yfrom a health care professional. A 14-year-old female pregnant U patient 12/5/2008 had received ### a left deltoid injec ort received from a physician on 29 October 2008. A female patient (age and date of birth unknown) U had received 7/1/2008 a dose 8/1/2008 of MENACTRA (l rmation was received on 14 OctoberY2008 from a health care professional. A 12 year old female U patient 8/20/2008 with a history of acne, ### bronchitis, a oe rash, respiratory distress, elevated Y temperature, Y (102 and higher),3 tachycardia. TreatmentUrequired three 3/10/2009 trips to 3/10/2009 the emergency room w n has been received from a licensed Y practical nurse Y concerning her374 year old mother with N contrast dye2/27/2009 allergy and 3/1/2009 a history of varicose v n has been received from a registered nurse concerning an unknown number of patients who U were vaccinated with a dose of MMR II (dose n has been received from Y a registered Y nurse concerning a 34 year old female with asthma and Y no drug allergies 1/19/2009 who 1/19/2009 was vaccinated with h n has been received from a consumer concerning her son with no medical history (APGAR scores N noted 6/7/2001 to be 9 at birth) 6/7/2001 or drug allergy wh 1/11/2009 N 1/5/2009 1/11/2009 volvement, nerve inflammation: Y numbness, Y tingling, burning, facial and head neuralgia, migraine-like N headaches 11/7/2008 (It began ### with nerve pain a U 5/7/1999 3/4/2009 er surface of skin. Small and hard. Y 3/4/2009 3/6/2009
redness and itching past normal. Advised to take BENADRYL and if not cleared see primary U care doctor.3/6/2009 Was getting 3/6/2009 better at the time. induration, warmth, erythema, & TTP - Treated for possible cellulitis. U 3/3/2009 anorexia, SOB on mild exertion, asthenia - arrhythmia (? PVC). Sx on day 1 and 2, began to Y decrease on2/25/2009 day 3 and 2/26/2009 by day 6 was nl. Starte ap given instead of DTap # 4 at 18 mos well child check. U 1/8/2008 gan noticing rash on chest, spreading to arms, flanks & legs. Reports that rash does itch. Patient U also stated 3/4/2009 that she 3/8/2009 has been utilizing ta administered to patient. Pt. left office well and happy. Twenty minutes later mom carried pt.Yin. She reports 3/9/2009 pt. started 3/9/2009 c/o chest hurting an e 99 degree-102.4 degree temps, watery eyes, loss of appetite, fatigue. Also, reddened, hard, U warm to touch 2/23/2009 3 "diameter 3/6/2009 circle around inje ports his daughter has had fever, up to 102.4, this morning. Ibuprofen takes fever down to 101.2. Y 3/5/2009 3/6/2009 d, swollen, firm, hot @ area of injection site for 48h after receiving Meningitis vaccine. Y 2/25/2009 2/25/2009 U 1/3/2007 3/6/2009 U 7/31/1997 3/5/2009 PREVNAR / VARIVAX administered 2-25-2009, Lt Leg induration and erythema started 3-06-2009. U 2/25/2009 3/6/2009 hr after receiving immunization, child Y developed hives over entire body, no respiratory symptoms. Y Mother3/6/2009 called clinic 3/6/2009 and was advised to mes in 3 days later. Her VARICELLAYvaccine Rt. Humerus caused a circular patch of blistersUto form along3/3/2009 with redness 3/5/2009 & warmth on the si 1 day; afebrile and fine the following day Y 3/11/2009 3/11/2009 ous swelling at the site of the DTaPYimmunization. slightly tender, has a boggy nontender feel. U approximately 3/10/2009 3x3 inches. 3/11/2009 first noticed 24 LLED STATING CHILD HAD SEIZURE THE FOLLOWING Y MORNING 3 ON 3/10/09. TAKEN TO U EMERGENCY 3/9/2009 ROOM 3/10/2009 AND HOSPITALIZED r state child had a fever, hives, and Y wheezing. Hives developed on 03/04/09 around neck and Y shoulder.Wheezing 3/2/2009start 3/4/2009 on Saturday 03/07/0 EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTACEL IS A Y RECONSTITUTED 3/5/2009INJECTION WITH IMMU th difficulty breathing, itching in throat, Y and hive like reaction to scalp. Patient never given fluYshot in our clinic 3/3/2009 but reported 3/3/2009 having it in prior on 3-10-09, right deltoid. Right arm is now sore with limited ROM in right shoulder. Right deltoid U swollen3/10/2009 and warm 3/12/2009 to touch; no redness. A tely 25 minutes after Stacey recieved Rabavert, she stated her ears (bilaterally) felt hot, andYthat radiated3/5/2009 to her jaws3/5/2009 and cheeks. When s 9 13:45 Immunization administered. 13:55 Injection site red, puffy/size of quarter, painful. Cool Y compresses 3/11/2009 applied3/11/2009 with no adverse sympto spitalized 4 months prior to service for Y Guillain Barre. Y 2. Denied Previous 3 Y hospitalizations onNentrance physical. 3/5/2009 3. Denied 3/5/2009 Previous diagno ed anthrax shot and one hour later he Y returned with visual changes. Pt states he blacked outY and when he 3/5/2009 woke he as 3/5/2009 seeing red. Pt state Shingles Vaccine Zostavax. By evening Y had flu symptoms, sore throat and bronchitis. Have Ybeen sick for 3/2/2009 10 since. Zostavax 3/2/2009is made by M d any types of warts. After the gardasil Y injections, I got a filiform wart on my eyebrow that had Y to be removed because it affected my visual hitis and flu like symptoms after getting Y the vaccine. Y 3/2/2009 3/5/2009 d with intussusception 8 days after 4 month vaccines. Y Neede surgery 6 and was discharged 2Ydays later, 3/16/09 3/2/2009 Received 3/10/2009 hospital medical EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTASEL IS A Y RECONSTITUTED 3/5/2009INJECTION WITH IMMUN 09, AN MMR AND A VARIVAX Y WERE Y ADMINISTERED Y TO THIS PATIENT 2 BY THE OFFICEYMEDICAL 2/24/2009 ASSISTANT. 3/10/2009 ON MARCH 10, MOM nd redness of left deltoid region 11cm x 4cm 3/11/2009 3/12/2009 d shingles 19 days following vaccination. Y 1/31/2009 2/19/2009 ATE FEW MINUTES AFTER VACCINE PT COMPLAIN Y OF PAIN LOWER 1 BACK RADIATINGU TO BOTH 3/11/2009 HIP AND LEGS 3/11/2009 THEN GOT WOR n at and around injection site. Pain through entire hand, shoulder and neck is accompied by nauisa U 3/10/2009 3/11/2009 questing VAERS done...one Y month after receiving MENACTRA & 1st GARDASIL on 9/10/08, Y Pt had blurred 9/10/2008 vision. 3 months ### later diagnos vere headache and was admitted toYhospital several Y occasions at ER 2 after not sure if relatedYto vaccination. 5/26/09 ### medical ###records receiv ction w/ erythematous rash. Admitted to hospital. Y IV Vanco --> BACTRIM. 1 4/8/09-for DOS 2/20-2/20/09-DC Y 2/17/2009 DX: Cellulitis-presented 2/18/2009 to ED w of VARIVAX (L) shoulder - 3-10-09 returned 3-12-09 - Erythema 8x8 cm2 Induration 3x3 cm2YHeat 3/10/2009 3/11/2009 e, joint aches/pains, chills - arms swelling/ Y redness. U 3/9/2009 3/9/2009 fever developed 1 week after MMRYseen in ER and diagnosed with measle-like flat rash mostly Y at the trunk 2/2/2009 and back. 2/12/2009 Lasted 2 days. ven Td & pneumonia vaccinations. 10 min later SOB and chest tightness with hives on local Yreaction. EPINEPHRINE 0.3mg 1:1000 and B len, hard, lump "the size of 2 Quarters" no c/o discomfort noted. U 3/11/2009 3/12/2009 tion, INFANRIX, given on 3-3-2009. Patient's mom noticed large, red swollen area on right upper N arm on 3/2/2009 3-5-2009. Patient 3/4/2009 seen today, 3/5 received @ bedtime T-101.0; pt woke Y parent up in am (3/10/09) with febrile Sz (temp in ER 102.7 Y (R)) tonic-clonic 3/9/2009 upper 3/10/2009 extremities stiffeni t in by aunt to have PPD read. No Tx needed. Aunt stated mom noted redness to left deltoidYarea no other3/6/2009 sx noted. 3/8/2009 1 1/2 cm X 7 1/2 cm sl her (L) arm has been sore ever since she had the BOOSTRIX. She has shooting pain with certain N movements,### for weeks 1/7/2009 she couldn't raise e, vertigo, tingling in arms, pain bothYaxilla. 3/17/09-records received for EDvisit 3/6/09-C/O headache N two 3/5/2009 epidsodes 3/6/2009 of syncope and body a d late on 3-9-09 a red swollen area to (R) arm - Today 3-12-09 Dad noted a rash around (R) arm to deltoid3/9/2009 region child 3/9/2009 had a fever 101 on 3 after injection c/o severe pain Lt arm-fever that afternoon - temp not checked -Fever with chills Y - Left school 12/1/2008 next day 12/1/2008 because of temp. after shot given swollen fore arm. Shots Y given in deltoid. N 3/10/2009 3/11/2009
Y 3/9/2009 3/11/2009 dverse RXN to PCV Pt. requested PCV. Pt. received .05 ml on 3/3/09 in (R) arm no RXN @ time of shot. Pt 3/3/2009 called on 3/4/2009 3/4/09 (advised to com with tingling in the heel surface of his feet (bilateral). No difficulty with ambulation or LE weakness. On 3/93/5/2009 pt noted additional 3/8/2009 tingling in his er ZOSTAVAX numbness (L) side of cheek - client very nervous about vaccine (Dental work 6 months) tingling 3/12/2009 in jaw 3/12/2009 up to eye. Hx HTN, B nutes of receiving HPV vaccines, became light headed pale, nauseated, weak, vomited, had Ymuscle weakness### until next day. ### Mother refuse er receiving PENTACEL, PREVNAR, HBV, ROTATEQ mother brought pt in for evaluation onN1) swelling of 3/6/2009 outer thigh 3/6/2009 involving area includ swelling at site of vaccination on Wed. following vaccine began itching and cotton mouth. Began U taking BENADRYL. 3/9/2009 3/11/2009 d area, red, swollen and warm to touch. Y U 3/10/2009 3/11/2009 VAX administered SQ R arm on 3/11/09. Y Developed edema, erythema, warmth from upper 1/3 U arm to elbow. 3/11/2009 Accompanied 3/11/2009by pain & stiffn haped 9 x 9 cm erythematic area cellulitis, cellulitic area. U 3/9/2009 3/10/2009 red KINRIX as "catch up" immunization to 8 year old. Y 3/10/2009 ped mild case of pyelonephritis whileY taking oral typhoid course. Y 3/4/2009 3/5/2009 n has been received from a physician concerning a female who was vaccinated with VAQTAUvaccine. Subsequently the patient experience follow up information has been received Y from a nurse concerning a 19 month old female infant Y with no pertinent ### medical 12/8/2006 history, drug react n has been Roche Pharmaceutical (manufacturer report # 540009) a 64 year old female reported U she was vaccinated with VAQTA and RE n has been received from a company representative concerning a 6 month old female who on U an unspecified date was vaccinated with PE ort received on 24 February 2009 from Y the patient's parent. A 16-year-old female patient hadYreceived a dose of MENACTRA on an unspec ort received 23 February 2009 from a health care professional. An 18-year-old male patient had N received a first### dose, 12/1/2008 left arm injection of A ort received 23 February 2009 from Y a consumer, who is the patient's parent. A 14-year-female U patient had 2/20/2009 received 2/20/2009 a first dose intramuscul serious case was received on 20 February Y 2009 from a health care professional. A 13 year old N female patient who ### inadvertently ### received a ort received on 11 February 2009 from Y a healthcare professional. A 17-year-old female patient, U with an allergy 2/10/2009 to penicillin, 2/10/2009 received a first l follow-up information has been received Y from a physician and a nurse concerning a 10 month N old male who had ###a history### of being born pre n has been received from a consumer Y concerning her 14 month old niece, with no medical history Y and no allergies, ### who on ### 10-DEC-2007 w n has been received from a consumer Y concerning her 13 month old son with no medical history and an allergy### to amoxicillin ###who on 10-NO n has been received from a Nurse Practitioner, Y (N.P.), concerning a 2 year old male patient Y who on 10-DEC-2007 ### was vaccinated ### IM i "left follow up information has been received Y from a registered nurse concerning a 3 year old female U with chronic ear infections and nasal cong follow-up information has been received from a physical therapist concerning a 5 year old female, N who on 26-OCT-2007 ### was vaccinated w n has been received from a physician Y concerning a 15 month old male with no illness at the Ytime of being 12/3/2007 vaccinated 12/3/2007 and no pre-existing ill n has been received from a physician and a medical assistant concerning an 18 month old female Y patient1/3/2008 with a peanut 1/9/2008 allergy, who on 03 n has been received from a consumer Y concerning his approximately 15 month old daughter N who on 12-DEC-2007 ### was vaccinated ### with a do n has been received from a physician Y concerning Y a 4 month old female patient who on 26-JAN-2008 Y was 1/26/2008 vaccinated 1/27/2008 IM with a dose of PED n has been received from a physician Y concerning a 7 month old female with no pertinent medical U history1/24/2008 and no drug 1/24/2008 reactions or allergies, n has been received from the fatherYof the patient (a "doctor") and a physician concerning the Y reporter's 2 month ###old son who ### on 17-NOV-2 n has been received from a consumer concerning her 12 month old son who on 28-NOV-2006 Y was vaccinated### with10/8/2007 the third dose of PEDV n has been received regarding a case in litigation from a lawyer via paralegal articles concerning U a 6 year1/1/2001 old female child with enterovirus n has been received from a mother concerning her 12 month old son with an unremarkable N medical history 2/14/2008 and no allergies, 2/14/2008who was vacc n has been received from a occupational therapist concerning her 5 year old daughter with pertinent Y medical history and drug reaction/aller n has been received for a case in litigation from information obtained from a published literature U article concerning 6/24/2002 a6/24/2002 4 month old female wh n has been received from a physician via medical records concerning a 16 week old female Y with no known 1/11/2008 drug allergies, 3/4/2008 a gastrointestina n has been received from a consumer Y concerning her 1 year old daughter with a murmur and N no drug reactions/allergies ### who ### on 15-NOV-2 n has been received from a physician concerning a 9 month old female infant with a possibleUallergy to CERON ### DM, a maternal ### grandmoth n has been received from pediatric medical records and a pediatrician concerning a 19 weekNold male patient 4/11/2008 with a4/18/2008 history of respiratory s n has been received from a physician Y in the form of pediatric medical records which were received U and reviewed 5/9/2008concerning 6/1/2008an approxima n has been received from a physician Y in the form of medical record concerning a white female U patient who 5/15/2008 on 18-MAR-2008 6/25/2008was vaccinate n has been received from a Licensed Practical Nurse concerning a female patient with allergic Y reaction to antibiotics cefaclor who was vacc n has been received from a physician Y concerning a 16 week old female with a history of nasal Y congestion 7/22/2008 and constipation 9/11/2008 who on 22-JULn has been received from a consumer concerning her 6 week old son with sensitivity to milkYprotein in formula 8/8/2008 and no8/9/2008 other allergies who w n has been received from a physician Y concerning a 23 week old male with a history jaundiceYand group 7/21/2008 b betahaemolytic 8/4/2008 streptococcal pos male (unknown age) took the first dose of VIVOTIF (Batch no. : unknown) on unknown date.U Within one day he experienced severe nause ort was received on 22. Jul.2008 from a physician. This 9-year old patient took first dose of VIVOTIF U (Batch 7/21/2008 no.: unknown) on 21.JUL.2008 was reported by a physician (also the Y father of the subject) and described the occurrence ofUencapsulation 3/2/2009 reaction in 3/3/2009 a 2-year-old male su
as given vaccines on 2/25/09, developed a red cluster of bumps on right leg where vaccine N was given on 2/25/2009 3/6/09, and3/6/2009 by 3/8/09 a full body ptoms was my left arm where flu shot was given, began to be very sore days later.Y ContinuedNthroughout the whole ### arm and ### my hand, wrist ther of child) called to clinic on 3/4/09. Info vax received today. Spoke to MOC, states child had Y reaction of3/2/2009 3" redness, muscle hard and itch me rash in palms and plantar feet, with right ankle swelling - 8 days after HEB B #4 and HEB Y A# 1 given. 2/23/2009 3/3/2009 around shot area. Tingling of lips. Y 2/6/2009 2/7/2009 d fever 101.8 with chills; red, raised rash on arm and legs within 24 hrs of vaccine. Symptoms Y resolved over 2/6/2009 4 days. 2/7/2009 and erythema 10X13 cm below area of vaccine site. U 2/7/2009 2/8/2009 n has been received from a 72 yearYold male patient Y with allergy to 0 several unspecified medications, N Parkinson's 9/1/2008disease, 10/1/2008 hypertension and n has been received from the mother Y concerning her 16 year old daughter with no medical history Y and no allergies ### reported, ###who on an uns n has been received from a medicalYassistant for the pregnancy registry for GARDASIL concerning Y a 15 year 3/4/2008 old female 3/4/2008 patient with type 1 rmation was received on 02 March 2009 from a health care professional. A 15 year old female U received an 8/16/2008 intramuscular 1/8/2009 left arm injection o HIGH BECAME RED, WARM TO TOUCH, Y AND SWOLLEN. WENT TO LOCAL ER, RECIEVED Y 10 DAY SUPPLY 3/9/2009 OF 3/10/2009 AUGMENTIN AND B RECIEVED ANTHRAX VACCINE ON 7 MAR 09. SWELLING AND DISCOLORATION A THE U SITE OF THE 3/7/2009 INJECTION. 3/8/2009 MEMBER STAT swelling, nausea, headache, low grade fever. U 3/10/2009 3/11/2009 ports the following: Child had normalY behavior throughout day until approximately 7 hours post Y vaccination, 3/10/2009 (7 PM) the 3/10/2009 child became letharg 5pm c/o sore right armpit, took ibuprofen 800mg,11/1/08 3pm injection site size of a quarter, Yfever & chills, temp ### 101 degree: ###11/2/08 injecti IA PRESENTED ITSELF ABOUT 5 HOURS AFTER ADMINISTRATION N 3/12/2009 3/12/2009 PED HERPES ZOSTER 5 MONTHS AFTER RECEIVING VARICELLA VACCINE. UNILATERAL Y VESICULAR 10/1/2008 RASH 3/11/2009 FROM MID ABDOME after immunization she noticed a raised, Y red area (slightly bigger than a silver dollar) on herYright deltoid. 2/6/2009 Broke out2/13/2009 in "little bumps" around EATION OF LEFT ARM. ARM IS SWOLLEN& RED FROM TOP OF LEFT SHOULDER TO ELBOW Y (18 3/10/2009 CM). CIRCUMFERENCE 3/11/2009 ABOVE perienced pain in R arm continually since receiving vaccine-worsens with exertion of extremity. N A "divit" at 10/9/2008 injection site 10/9/2008 1st appeared about ck, neck shoulder and head pain, Headache, Y and disorientation, could not concentrate, malaise, U weakness, 3/10/2009 tired. Went 3/11/2009 to my family doctor BROUGHT PATIENT IN WITH COMPLAINTS OF RIGHT UPPER ARM RED AND SWOLLEN U (WARM TO 3/11/2009 TOUCH). 3/12/2009 ONSET OF SYMPTO 3" long by 1&1/2" oval. It is red and inflamed. Not raised and no pain associated with it. WillUtake Tylenol 3/11/2009 or Advil if3/13/2009 it starts to hurt and will REDNESS ON VACCINATION SITE. REACCTION U 3/6/2009 3/6/2009 mall blisters in a circular pattern around the injection site approximately 2 inches in diameter.-not Y sure if exact vaccination ### ### date is correct with balance within an hour of vaccine. Fever 103 began that night, lasted several days. Child had episodes of twitching during fever. Child ated baby cried nonstop for eight hours Y straight.YMother stated no fever 1 or swelling around shot Y site. Mother 1/8/2009 stated took 1/9/2009 to ER, and the bab nduration approx 12 hrs after injected. No fever, HA respiratory symptoms, G1 symptoms. Y 3/9/2009 3/9/2009 given DAPTACEL on 3-5-09, on 3-6-09 her legYwas red about 1-2",1on 3-7-09 swelling and redness Y was about 3/5/2009 5-6 inches 3/6/2009 around, no fever ately 24 hours after admin, Pts arm Y developed sore, red, inflamed rash- diagnosed at ER as U allergic Rx. 2/28/2008 3/1/2009 njection site - repeated Benadryl X1. Y ody x 2 weeks. Pt got chicken pox. Y ### 3/5/2009 redness, swelling at site of DTaP injection. Y 3/4/2009 3/5/2009 redness, swelling at site of TDAP injection. Y 2/23/2009 2/25/2009 n eve., pt. noted onset "stiffness" right Y knee joint; next a.m. (3/12) awoke & noted stiffness w/swelling U @ 2/27/2009 left knees (R 3/11/2009 > L) & "stiffness" in m d HIB and DTAP into left thigh. Erythematous macular lacy area 13cm X 13 cm surroundingYinjection site. 3/11/2009 3/12/2009 al temp Friday eve 3/06/09 beginning around 7pm. Temp remained in that area with Tylenol +Y Motrin alternating. 3/6/2009 All day 3/6/2009 Saturday 3/7/09. Su ately 24 hours after receiving lZ's mmr & Dtap in Rt arm, pt. mom noticed pt. arm red, warm to Y touch & swollen 3/11/2009 in area 3/12/2009 where lZ's were give hematous hyperemic plaque covering Y lat aspect of L arm. U 3/10/2009 3/12/2009 es developed on right shoulder. C/oYwarm ear (right) 12:50 and itchy all over. ZYRTEC - given Y in office 3/13/2009 10 mg. orally. 3/13/2009 20 mins. later hives cular erruption with subsequent cellulitis Y of RLe + inguinal LAB. Tx: ORAPRED 15 mg qd xNsd; AUGMENTIN 250 mg bid x 10d. ed rash - hives on chest, back, arms & face. Started < 24 hrs after vaccines were administered. Treated3/12/2009 with diphenhydramine. 3/13/2009 ced he had hives / whelps to right cheek on his face, right arm/shoulder, and right leg. She put Y child in bathtub 3/11/2009 & called 3/11/2009 the doctor on call. ollen, hives (Lt arm), Lt arm red, hotYswollen pain in Lt arm no fever, no problems breathing. Y Will given Benadryl 3/4/2009 3-6-09 3/5/2009 (per doctor direction ADACEL 430 PM. 3/11 That night, developed vomiting and headache. On 3/12 developed N fever to 1023/11/2009 which responded 3/11/2009 to TYLENOL. V hrs after receiving ROTAVIRUS vaccine, pt. developed diarrhea, blood & mucous present atNtimes for next 2/25/2009 2 weeks.2/26/2009 Pt. was evaluated by RDASIL #3 Pt. c/o stomach pain after 2 days mother report her daughter is doing fine. ately 10 minutes following injections, pruritis and urticarial rash developed. Rx BENADRYL liquid Y 1 tsp. 3/12/2009 3/12/2009 Urticaria around (L) Deltoid area and both hands x 10 days. Patient given Allegra 180 mg # U 14 and told 2/18/2009 to F/U as needed 2/28/2009 for change in con unt of hives noted in groin area approx Y 5 hours after vaccination, rash next day much more U extensive involving 3/13/2009 entire 3/13/2009 trunk -hives with targ
and seizures. 4/16/09 MR Y received from PCP from 2/18/09 to 4/13/09. Pt presented on 2/18/09 N for 3rd Gardasil 2/18/2009 vaccine 3/14/2009 1757U. RTO for f/u tis 24 h after guardasil vaccination. Right temporal-occipital Y T2 flair 7on MRI with negative HSV PCR. 3/26/09 2/12/2009 Received 2/13/2009 hospital medical re dministered as part of routine PEx 2/18/2009. Y Pt Y seen on 2/23/20094with pain and redness inUthe vaccination 2/18/2009 site and3/5/2009 neck soreness. She w nistered Hep B vaccination at 3 days Y old, 4 hours Y later had a seizure. 4 Immediately after vaccination Y she became 1/3/2009sleepy 1/3/2009 and slept until she eving first round of Gardasil shot- three Y weeks later noted small red spoches on chest area( Sat N AM), Sun 2/2/2009 day felt weak, 3/7/2009 back cramps, and n d burning rash on arm 4in in diameter. Experiencing chest pains and joint pains.As well as cold U sweats. 3/12/2009 3/13/2009 igh with erythematous, tender nodule. U 3/13/2009 3/14/2009 ort received from another manufacturer Y (document number 45214356), who received the report U from a health care professional. A female p n has been received from a physician Y concerning an 84 year old male patient with Y diverticulitis N and a history 12/5/2008 of malaria 12/5/2008 who on 05-DEC-200 t was received from GlaxoSmithKline Y and was Y assigned manufacturer 0 report number A0769858A U for KINRIX. 2/19/2009 This 2/19/2009 case was originally repo n has been received from a consumer concerning her son who was vaccinated with all the doses U of MMR II on unspecified dates. Subsequ eeks s/p ROTATEQ vaccine, Y child had intussusception. Y Vaccine 12/29/09, 2 admitted for intussusception Y 1/15/09. ###3/26/09 1/15/2009 Received hospita tions given 2-26-09 had not been entered into system & mom did not bring immunization record. U 3/12/2009 5.5 - 6.5cm SL. red soft area - warm -> hot to touch. U 3/6/2009 3/9/2009 U 3/10/2009 9 sudden onset of knot in left neck Y area, swelling from left neck to left arm & left facial swelling N & twisting 2/5/2009 of face - 3/12/09 2/18/2009 cont. high BP & d urticarial lesions on back, face + extremities 5 days after MMR, varicella, Hepatitis A + influenza N vaccines 2/13/2009 were given. 2/18/2009 Pt had no other sym ed child cried 4-5 hours after having PENTACEL. Notified provider prior to next scheduled dose. Y Next dose not ### given of PENTACEL. ### Only H sode of a fainting spell/?seizure. PtYfell on ground and lifted arms in air 'stiff'. Pt then vomited. Y Vitals were 3/12/2009 w nl and pt 3/12/2009 was stable and was s 3/4/09 (MMR, VARIVAX, PCV, HepY A) had fever 3/7 (100-101) and 3/8, 3/9) developed rash U on back and3/4/2009 neck is cranky. 3/7/2009 Sat night 3/7 scr eft arm at 8am, around 9-10 am Left Y hot, swollen and red. T99.8. U 3/9/2009 3/10/2009 ates noticed L arm swollen 24hrs. after Imms. with redness. 48 Hrs later blisters appeared around Y Imms. area. 3/2/2009 Applied 3/4/2009 topical Benadryl and t arm pain started 24 hours after immunization with MENACTRA. Pt stated his arm was difficult Y to move and 3/5/2009 "felt heavy" 3/6/2009 for a day or so. Pt ebellar ataxia Y U 2/24/2009 3/3/2009 vere outbreak of herpes zoster. Patient received vaccine 1/0/08 then on 12/29/08 had a severe outbreak of 1/9/2008 herpes Zoster.### L injection, fever headache, nausea 3/12/2009 N UNEXPECTED GOOD EFFECT RATHER THAN AN ADVERSE EFFECT! Since I don not know where 1/24/2009 else to report 1/24/2009 this I am making th ely after receiving Hepatitis A, Flu, MMR, MCV4 and Varicella, the patient stated he didn't feel Y well. His color 3/10/2009 became 3/10/2009 pale and he passed o rea of shot. immobility - mild pain. Taking Y MOTRINE. N 3/10/2009 3/10/2009 oropharyngeal swelling. Vomiting, Y flushing and hives on whole body. Y 3/5/2009 3/5/2009 covering body. U ### 3/10/2009 erythema with induration at injection site. U monia vaccine was given in my left arm at around 10:30 A.M. on 03/06/2009. I began experiencing Y the usual 3/6/2009 pain and3/7/2009 fever at the injection after injection + returned to hotel room Y @ 12:30pm stated noticed itching @ injection site (left Y deltoid) and3/9/2009 she applied 3/9/2009 Hydrocortisone (1% U 2/18/2009 d an ileo-colic intussusception which presentedYto the ER 2 days after 2 vaccine administration. Y It was reduced 2/23/2009 with an 2/25/2009 air enema and patien r, hysterical laughing, nonsense speech, rash on legs especially right thigh has a bright red rash U area about 3/4/2009 two inches 3/13/2009 in diameter ild's mom reported fever, redness and hardness on left thigh today which began 3-2-09 p.m. The doctor's3/2/2009 office told 3/2/2009 her to check the temp hone call on 3/11/09 from client's mother Y stating she took ct to dr for rash and swollen lymphYnodes. Dr diagnosed 2/17/2009 her 2/25/2009 with reaction to MMR received 2 doses of Varicella vaccine per appropriate schedule. 08-23-04 dose 1 and 08-19-08 Y dose 2. Developed 8/23/2004 2/20/2009 rash consistent with chi to facility approximately one hour post injection c/o numbness in throat moving to back of tongue Y and roof 3/16/2009 of mouth 3/16/2009 given Benadryl po at 10 ported very hard, red, warm and swollen area to left upper arm and fever of >103 degrees F Ywithin 3 days 2/12/2009 after receiving 2/15/2009 the vaccines. She Boostrix in right arm on 03/05/09. Noted swelling, discomfort and pain at injection site on 03/11/09, Y 6 days3/5/2009 after vaccination. 3/11/2009Contacted fac d area cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009 d Cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009 cm induration, redness, itchiness at site of injection. Rx for Benadryl and hydrocortisone 1%Y 3/13/2009 3/14/2009 arp pain and swelling right arm focussed on injection site for Tdap. Pain into axilla, shootingUdown arm and 3/11/2009 into shoulder 3/13/2009 and neck. No dy llen left arm. Fever, nausea, headache. Symptoms developed 24 hours after injection and continued N for 3/12/2009 48 more hours. 3/13/2009 Patient was unable nued L upper arm pain and numbness down to elbow, cannot raise L arm above 90 degrees.UStates vaccine caused ### these symptoms. Has ES ONE WEEK AFTER VARICELLAY VACCINE ARM BECAME RED AND SWOLLEN. MILD,GENERALIZED 3/2/2009 RASH 3/9/2009 BEGAN TWELVE DAY d generalized diffuse macular rash, herpetiform vesicles on neck Y ### ###
PPV shot around 10:45 a.m. after aYyearly physical with Dr. I have asthma, therefore shouldUbenefit from3/12/2009 getting the3/12/2009 vaccination. I was feel and pain at axilla on left side. Was prescribed Y MEDRAL Pk, antihistamine and KEFLEX BID. Y 3/10/2009 3/11/2009 lling, redness at injection site. Headache, nausea, vomiting, fatigue, fever 24 hrs. Y 3/11/2009 3/12/2009 adaches, myalgias, sore throat about 6 days after immunization given. N 3/4/2009 3/11/2009 listless, not self for 1 wk post immunization. Y 1/12/2009 1/12/2009 e like 1 cm raised area 1 inch from injection site R arm where varicella was given SQ. Notified Y M.D. via phone. 3/9/2009 He ordered 3/9/2009 BENADRYL liqu ied us 48 hours after vaccines that child Y had had hives and increased temp 101 degrees F -Y102 degrees 3/11/2009 F 24 hrs after 3/12/2009 vaccine given. Her dness / itch on L mid arm upon D/C home size 4.5 cm and lump felt about a quarter size, HOUnotified /seen 3/14/2009 Pt. and instructed 3/16/2009 to apply warm ess on nape of neck @ HS on 3/12/09. Y Dx with hives by MD on 3/13/09 Hives prominent on N trunk, groin 3/12/2009 + axillary with 3/12/2009 intense itching. 0 min after immunizations the Pt fainted. No resp. arrest initial V/S BP 109/57 HR 97 RR 24 O2 Y Sat 98-100% 3/13/2009 Room 3/13/2009 Air, monitoring and nutr d they noticed redness on 3/16/09 (L) upper deltoid & swollen. Today I notice a little rednessYaround the 3/13/2009 vaccine area. 3/16/2009 No swollen no indura ped a large red swollen (10cm X 11cm) Y notice 24 hours post injection. Pt says site is painful Y and warm to3/14/2009 the touch. 3/14/2009 ted with 30-50 lesions on arms and Y trunk. Afebrile. Dx with Varicella. Y 6/11/2002 3/13/2009 est pains, heaviness on chest, shortY of breath, neck and shoulder pain in right side where injection Y was given. 3/4/2009 3/30/09 MR received from O ain, Fatigue, and nausea. Pain goes up into her neck. And dizziness. Y 2/20/2009 2/20/2009 lateral injection site. Y Y 3/2/2009 3/4/2009 ous after - then tired/fatigue- wheezing. Y Taken by ambulance (911) to ER. Released. ORAPRED, Y CAREDIN. 3/11/2009 3/11/2009 alsy 2 weeks after MCV4 vaccine. Treated Y with Prednisone, Acyclovir. 4/29/09 MR received U from PCP with 2/27/2009 DX: Bells 3/13/2009 Palsy. Pt presented i ed erythema multiforme exanthem dev. x 8 days after vaccination (was on amoxicillin). U 3/6/2009 3/14/2009 and swelling around injection site, three inches in diameter. Slight pain around site. No otherUsymptoms reported. 3/11/2009 3/13/2009 enopathy of R axillary nodes causingY significant swelling, mottled rash and pain in the R axilla. U Improving3/11/2009 slightly with 3/12/2009 ibuprofen on day 4. oint pain after immunization until 3/08. Y ### 2/13/2008 hematoma at injection site. No redness. N 2/6/2009 2/6/2009 n has been received from a physician concerning a 7 month old patient who was vaccinatedUwith the first dose of ROTATEQ (lot # not prov n has been received from a consumer concerning her son who, "as an infant", was vaccinated Y with a dose of ROTATEQ. Subsequently th n has been received from a physician concerning a 31 year old female nurse who on 17-FEB-2009 U while2/17/2009 she was orally 2/17/2009 administering a ch n has been received from a licensed Y practical nurse (L.P.R.) concerning a 9 month old patient U who on 17-FEB-2009 2/17/2009 2/17/2009 was inadvertently give n has been received from a registered Y nurse with medical records concerning a 12-month-old Y male patient 1/18/2008 with no medical 8/4/2008 history or allerg n has been received from a medical assistant concerning a male who on 01-AUG-2008, 01-OCT-2008 U and 2/10/2009 10-FEB-2009 2/10/2009 was vaccinated w n has been received from a nurse concerning Y a 13 month old patient who on 05-MAR-2008 U was vaccinated 3/5/2008 orally with the first dose of ROT n has been received from a healthcare worker concerning a 28 day old patient who on an unspecified U date was vaccinated orally with the fi n has been received from a physician concerning a 12 month old male who on 13-SEP-2007Ywas vaccinated 1/18/2008 with a 28/6/2008 mL first dose of ROT n has been received from a office manager Y concerning an 18 week old male patient who on Uan unspecified date was vaccinated with the fir n has been received from a physician concerning a "4 month old" male who was vaccinatedUwith a 2 ml second dose of ROTATEQ (lot # w n has been received from a consumer concerning his son who at age of 16 weeks was vaccinated N with the first dose of ROTATEQ and at 6 n has been received from a medical assistant concerning herself who got ROTATEQ (no lotU# provided) in her eye and on the skin around n has been received from a physician Y concerning a 2 month old male who was born at 29 weeks Y gestation, 2/2/2009 who on approximately 2/2/2009 02-FEBn has been received from a physician concerning a 4 month old male patient who in approximately Y 06-DEC-2008, 12/6/2008 was 12/6/2008 vaccinated with sec n has been received from a physician who reported that an extra dose of ROTATEQ (lot notUreported) may have been given at the same vi n has been received from a physician Y concerning a 23 weeks old patient who on 19-FEB-2009 U was vaccinated 2/19/2009 orally 2/19/2009 with the first 2 ml dos n has been received from a physician Y concerning a 7 month old patient who on 24-FEB-2009 U was inadvertently 2/24/2009 vaccinated 2/24/2009 orally with the f n has been received from a physician concerning a female who on 21-FEB-2009 was vaccinated N with first 2/21/2009 0.5mL dose 2/22/2009 of GARDASIL. Ther n has been received from a consumer concerning her daughter a 13 year old female who in NOctober 2008, was ### vaccinated 12/1/2008 with a third dos n has been received from a physician Y and medical assistant concerning a 18 year old female N who received 11/1/2007 all 3 doses 2/16/2009 of GARDASIL. The n has been received from a nurse concerning Y a 14 year old female who was vaccinated withNGARDASIL (Lot# not reported). After receivin n has been received from a registered nurse concerning an approximately 25 year old female Y who in November 1/21/2009 2008, 1/23/2009 was vaccinated with n has been received from a nurse concerning Y a 13 year old female patient who on 10-DEC-2008 U was vaccinated ###with her ### third dose of GAR n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe n has been received from a nurse concerning Y a female patient who on unspecified dates was Y vaccinated with the first and the second 0.5 m n has been received from a physician Y concerning a female patient who on an unspecified date U was vaccinated with a 0.5 ml dose of GARD n has been received from a MedicalYAssistant concerning a 17 year old female patient with no U pertinent 2/23/2009 medical history 2/24/2009 and no drug reactio
n has been received from a certified medical assistant concerning a 15 year old female with allergic rhinitis 1/26/2009 who on 1/26/2009 26-Jan-2009 was vaccin n has been received from a physician concerning a 21 year old female with Raynaud's syndrome N and hypertension 2/26/2009 2/26/2009 who on 26-FEB-2009, a n has been received from a physician Y concerning a female under 18 years old with no pertinent Y medical2/18/2009 history who2/20/2009 on 18-FEB-2009 was v n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL U (Lot# not reported). After receiving n has been received from a licensed Y practical nurse concerning a 20 year old female patient with no medical 2/26/2009 history2/26/2009 and drug reactions wh n has been received from a nurse practitioner concerning a female who was vaccinated withUthe second dose of GARDASIL 0.5 mL. Abou n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning Y an 3/24/2008 18 year old3/24/2008 female who on 14-JAN n has been received from a physician's Y assistant concerning an approximately 17 year old female U patient who was vaccinated with the first n has been received from a consumer concerning her 22 year old daughter, with no known drug N reaction/allergies and 2/19/2009 no pertinent medica n has been received from a consumer concerning her son with no pertinent medical history, U no drug reaction/allergies, who on unspecified n has been received from a 26 yearYold registered nurse, with no known medical history andYdrugs allergies, 2/12/2009 who two 2/12/2009 weeks ago was vacc n has been received initially from a registered pharmacist who reported the pharmacy technician's N daughter 10/1/2008 was given the third dose of GA n has been received from a consumer concerning a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR n has been received from a consumer concerning Y a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR n has been received from a physician concerning a female who was vaccinated with GARDASIL U (Lot # not reported). The patient experien n has been received from a health professional concerning a patient who on 18-FEB-2009 was U vaccinated 2/18/2009 with the first dose of GARDASIL n has been received from a physician Y concerning a 20 year old female patient with no pertinent Y medical history 1/8/2009 and no 1/8/2009 known drug allergie n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 19 year 9/18/2008 old multiracial 9/18/2008 female with no histo n has been received from a consumer concerning a 15 year old female patient who started therapy U in August 1/1/2009 2009 with 2/8/2009 the first dose of GA n has been received from a medicalYassistant concerning a 14 year old female who on unknown N date was vaccinated with two doses of GA n has been received from a nurse practitioner Y concerning a 15 year old female patient with endometriosis Y 8/13/2008 who on unspecified dates was va n has been received from a nurse concerning a 24 year old female patient who on 28-NOV-2008 Y was vaccinated ###with 12/3/2008 first dose of GARDA n has been received from a physician's Y assistant concerning her relative, a female who on an U unspecified date was vaccinated with GARDA n has been received from a registered nurse concerning a 14 year old female student with no U known medical 2/14/2009 history and drug allergies, wh n has been received from a physician concerning a female who was vaccinated with three doses U of GARDASIL (Lot # not reported). The pa n has been received from a consumer Y concerning her 16 year old daughter with allergy to AMOXICILLIN N 10/1/2008 who in August 11/1/2008 2008, was vaccina n has been received from a registered Y nurse concerning a 20 year old female patient with noNpertinent medical history and no known drug a n has been received from a nurse midwife Y concerning an unspecified number of patients who U were vaccinated IM with the second dose 0.5 n has been received from a physician concerning several hundred patient who on unspecified U dates were vaccinated with doses of GARDA n has been received form a physician concerning a female who was vaccinated with a 0.5 ml Y dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning a female patient who was vaccinated intramuscularly U with her first 0.5 ml dose of GARDASIL n has been received from a consumer concerning her daughter who became ill after received U her second dose of GARDASIL. The consum n has been received from a physician Y assistant student concerning a 16 year old female who N on 06-JAN-2009 1/6/2009 was 2/25/2009 vaccinated with first dos n has been received from a consumer Y concerning her 15 year old daughter with no known medical N history 6/26/2008 or drug allergies, 7/1/2008 who on 26-JUN n has been received form a 23 year old female patient, with no known drug reaction/allergiesNand no pertinent 1/1/2009 medical 2/12/2009 history, who in Janu n has been received from a consumer concerning her daughter (a 16 year old female) who in Y March 2008, 3/1/2008 was vaccinated 3/1/2008 with her first do n has been received from a nurse concerning Y her 20 year old daughter who was vaccinatedNwith her third 6/29/2007 dose of GARDASIL 8/31/2008 (lot # not ava n has been received from a physician Y concerning a 38 year old female with no medical history Y or drug allergies 8/7/2008 who was 8/7/2008 intramuscularly va n has been received from a pharmacist Y concerning a 17 year old female patient with no pertinent N medical 2/16/2009 history and 2/16/2009 no drug reactions or a n has been received from a registered nurse concerning a 15 year old female patient with noUpertinent medical 2/17/2009 history 2/17/2009 and no known drug a n has been received from a nurse practitioner Y concerning a 26 year old female patient with allergy Y to sulfa 10/9/2008 and asthma 10/9/2008 and a history of "bra n has been received from a physician concerning a 16 year old female with no pertinent medical Y history 2/20/2009 and no known 2/20/2009 drug allergies who o n has been received from a physician concerning a 23 year old female patient who was vaccinated U with a 0.5 ml IM dose of GARDASIL. Su n has been received from a consumer concerning her 16 year old grand daughter (patient) who Y on 08-JUN-2007 6/8/2007was6/8/2007 vaccinated with a firs n has been received from a physician concerning a health care provider's 20 year old son who Y was vaccinated with the 7/1/2008 second dose of GA n has been received from a nurse concerning a 17-year-old female with no known relevant medical Y history 2/10/2009 nor drug2/11/2009 allergy, who on 10-FEB n has been received from a physician Y concerning a 16-year-old white female student, with no U known relevant 1/15/2007 medical 2/26/2007 history nor drug aller n has been received from a Registered Nurse concerning a 14 year old female with a historyNof back pain2/4/2009 and pin in 2/4/2009 hip, and no drug react n has been received from a physician concerning a 14 year old female who was vaccinated U with the first dose 1/8/2009 of GARDASIL (lot# not repor n has been received from a company representative concerning a female who was vaccinated U with GARDASIL (LOT# not reported). After
n has been received from a 20 yearYold female healthcare student who on 6-FEB-2009 was Yvaccinated with 2/6/2009 a first dose 2/6/2009 of GARDASIL. On n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning U a 14 year 12/1/2008 old female 12/1/2008 with asthma and no n has been received from a female 21 years old who on 14-DEC-2007 was vaccinated with N the first doses 6/26/2008 of GARDASIL 6/26/2008 0.5 ml. On 12-FEB n has been received from a female consumer who on an unknown date, was vaccinated withUGARDASIL (lot # not reported). Subsequentl n has been received from a patient's Y mother concerning a 19 year old female who was vaccinated N with second of GARDASIL. The patient's n has been received from a physician Y concerning a 25 year old female who on 17-FEB-2009Ywas vaccinated 2/17/2009 with the 2/17/2009 first dose of GARDAS n has been received from a physician Y concerning a 17 year old female who on 02-DEC-2008 Y was vaccinated 12/2/2008 with the first### dose of GARDA n has been received from the immunization Y coordinator concerning a 20 year old female patient Y who in approximately 9/1/2008 9/1/2008 September 2008, wa n has been received from a physician Y concerning a female patient who on 26-OCT-2007 was N vaccinated with the ###first dose ### of GARDASIL ( n has been received from a Registered Y Nurse for the pregnancy registry for GARDASIL, concerning Y a 25 5/2/2008 year old female 5/2/2008 patient with anxie n has been received from a physician concerning a 38 year old male with hypertension who Non 13-FEB-2009 2/13/2009 was vaccinated 2/13/2009 with a dose o n has been received from a physician concerning a female who was vaccinated intramuscularly Y with a dose 9/3/2008 of GARDASIL 9/4/2008 (lot number not n has been received from a nurse practitioner Y concerning a 15 year old female who was vaccinated U with the second2/18/2009 dose of GARDASIL (lo n has been received from a registered nurse concerning a female patient with a history of jump U roping injury who was vaccinated with GAR n has been received from a consumer concerning her 28 year old daughter with no pertinentNmedical history, allergies ### 11/1/2008 or drug reactions, wh n has been received from a certified medical assistant concerning a female who on 13-FEB-2009 Y was vaccinated 2/13/2009with 2/13/2009 the first 0.5 ml dose n has been received from a physician Y concerning a 13 year old female who in July 2008, was N vaccinated7/29/2008 with the first1/1/2009 dose of GARDASIL. n has been received from a consumer via internet concerning a female who on an unspecified U date was vaccinated with GARDASIL (lot nu n has been received from a nurse concerning a 17 year old female with no medical history and Y drug allergy who ### on 26-NOV-2008 ### was vac n has been received from a physician concerning a 20 year old female patient who on an unspecified U date was vaccinated with the third do n has been received from a consumer Y concerning her 12 year old daughter with no medical N history and drug allergies1/1/2009 who was vaccinated n has been received from a physician Y for the Pregnancy Registry for GARDASIL, concerning a 17 year old 8/25/2008 female with 8/25/2008 no medical history a n has been received from a Medical Assistant concerning a 17 year old female who 12 weeks U ago was vaccinated ### with the first dose of GA n has been received from a registered Y nurse concerning a female who was vaccinated with Y GARDASIL. Awhile back the patient fainted aft n has been received from a physician concerning a 16 year old female who on 20-NOV-2008 Y was vaccinated with ### the first### dose of GARDA n has been received from a Registered Nurse (R.N.) concerning a 16 year old female with aNhistory of asthma 2/16/2009 and amoxicillin 2/16/2009 allergy who o n has been received from a medical assistant concerning her daughter with a history of RSV (respiratory syncytial virus infection) as a child n has been received from a physician Y concerning a female patient who on an unknown dateUwas vaccinated with GARDASIL 0.5 mL IM. S n has been received from a physician Y concerning Y a 15 year old female 0 who was vaccinated U with a 0.5 ml dose of GARDASIL about a year n has been received from a consumer concerning her 13 year old daughter with drug allergies N to codeine 10/9/2008 and IMITREX 1/17/2009 and no other pertin n has been received from a nurse concerning Y her daughter who on an unreported date was U vaccinated IM with the second dose of GARDA n has been received from a registered nurse concerning a 23 year old female patient with noYpertinent medical 2/4/2009 history, 2/9/2009 no drug reactions/a n has been received from a licensed Y visiting nurse concerning a 15 year old female patient with Y no pertinent 6/26/2008 medical history and no know d n has been received from a physician Y concerning his granddaughter (a 15 year old female) with Y a family history 1/1/2009 of allergies 1/1/2009 who was vaccin n has been received from a physician Y concerning his 22 year old daughter with no pertinent N medical history and no known### drug allergies w n has been received from a patient with positive history of papilloma viral (HPV) who on 22-SEP-2008 N and 9/22/2008 08-DEC-2008 was vaccinated w n has been received from a registered Y nurse concerning a 17 year old female who on 25-JAN-2009 N was1/25/2009 vaccinated with 2/1/2009 a first dose of GAR n has been received from a physician Y concerning a 21 year old female with attention deficit/hyperactivity N disorder 1/1/2007and2/1/2007 a history of depressio n has been received from a nurse concerning a female patient who in "August 2008" was vaccinated Y with8/1/2008 the second 10/1/2008 0.5 ml dose of GARD n has been received from a registered nurse (R.N.) concerning her daughter, a 14 year old female Y who was vaccinated with a second dose n has been received from a nurse practitioner Y concerning a 14 year old female with no pertinent Y medical History 2/2/2009 and 2/2/2009 no known drug reactio n has been received from a physician Y concerning a 24 year old female patient who on 04-FEB-2009 Y was 2/4/2009 vaccinated 2/5/2009 with the third 0.5 ml do n has been received from a consumer Y concerning Y her daughter who0on Y an unspecified date U was vaccinated with a dose of GARDASIL. Th n has been received from a physician Y concerning a 22 year old female patient who in approximately Y 2008 ("about a year ago") was vaccina n has been received from a physician concerning a 16 year old female with a history of irregular N periods who 8/1/2008 has not8/1/2008 had her period since n has been received from a consumer concerning his girlfriend with no medical history or drug Y allergy who 1/22/2009 on 22-JAN-2009 was vaccinated n has been received from a medical assistant concerning a female with AUGMENTIN allergyNwho on 22-JAN-2009 1/22/2009 was vaccinated with the n has been received from a Nurse Practitioner (N.P.) concerning a 31 year old female who on N 06-FEB-2009 2/6/2009 was vaccinated 2/6/2009intramuscularl n has been received from a case in litigation for WAES # 0902USA01678 from a consumer who U reported "her daughter's anemia became w n has been received from a nurse concerning Y a 20 year old female patient who on 08-JAN-2007 U was vaccinated with1/8/2007 the first dose of GAR n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (
n has been received from a Nurse practitioner (N.P.) concerning a 15 year old female who on Y 01-OCT-2008 10/1/2008 was vaccinated 10/1/2008with a 0.5 ml d n has been received from a female , for GARDASIL who in December 2008, was vaccinatedUwith GARDASIL 12/1/2008 (number 12/1/2008 in series not reporte n has been received from a health professional concerning a 15 year old female with no known Y medical history, ### who on 29-DEC-2008 ### was n has been received from a physician concerning a 17 year old female student (weight 134.8Y pounds, height 2/2/2009 65.5 inches) 2/2/2009 who on the aftern n has been received from a physician Y concerning a 15 year old patient who on 14-JAN-2009Uwas vaccinated 1/14/2009 with the 1/14/2009 first dose of GARDAS n has been received from a health professional concerning a 15 year old female with no allergies Y who on an unspecified date was vaccinat n has been received from a nurse practitioner concerning her sister who was vaccinated withY a first dose of GARDASIL in arm. On unknow n has been received from a 29 year old female consumer who in April 2008, was vaccinatedNwith the first 6/1/2008 dose of GARDASIL. On June 20 n has been received from a consumer Y concerning her 14 year old daughter with sulfa allergyNand with no previous ### medical### history reported n has been received from a certifiedYmedical assistant concerning a 17 year old female with asthma and4/28/2008 no known drug 12/1/2008 allergies who on 0 n has been received from a registered nurse concerning a 23 year old female patient with allergy Y to VICODIN 1/21/2009 who on 1/21/2009 21-JAN-2009 was va n has been received from a consumer concerning someone she saw on the television news,Ua female who was vaccinated with GARDASIL n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. The patient's relevant medical n has been received from a physician Y concerning a 11 years old female patient who on 02-FEB-2009 Y at afternoon 2/2/2009 was 2/2/2009 vaccinated with the n has been received from a nurse practitioner concerning a female who was vaccinated withYa first dose of GARDASIL in arm. On unknow n has been received from a physician concerning a 23 years old female with allergy to CIPRO Y and a history 2/2/2009 of mitral 2/2/2009 valve prolapse who on n has been received from a physician concerning a 23 year old female with a history of papanicolaou U smear 7/12/2007 abnormal 1/16/2009 in January 2006 but n has been received from a physician concerning a female patient who was vaccinated with Ua 0.5 ml dose of GARDASIL (lot # was not pro n has been received from a registered Y nurse concerning a 33 year old female who was vaccinated U with her 1/1/2009 first dose1/1/2009 of GARDASIL (lot num n has been received from a Nurse Practitioner Y concerning a 19 year old female who was vaccinated U intramuscularly 5/15/2007 with her first, second a n has been received from a consumer concerning her daughter who developed soreness onUher arm and neck after receiving a dose of GA n has been received from an immunization coordinator concerning a 24 year old female patient. Y "Sometime 1/29/2009 last week" 1/29/2009 the patient was vac n has been received from a physician Y concerning a female (approximately 24 year old) with U history of an abnormal 9/5/2007 Atypical squamous cells n has been received from a Nurse Practitioner (N.P.) concerning a 14 year old female with aNhistory of contact 1/22/2009 dermatitis 1/22/2009 who on 22-JAN-2 n has been received from a consumer concerning her daughter (a 21 year old female) with diabetes Y as well 2/4/2009 as allergies 2/5/2009 to heat and penicil n has been received from a physician Y concerning a 14 year old female who on 01-MAY-2008 N was vaccinated 8/2/2008 with the first dose of GARDA n has been received from a physician Y concerning an approximately 15 year old female patient Y who in December 12/1/20082008, 12/1/2008 was vaccinated with n has been received from a medical assistant concerning a female patient who in approximately N February2/1/2009 2009 finished 2/1/2009 the series of GARD n has been received from a 23 yearYold female patient with no pertinent medical history and Nno known drug 1/15/2009 allergies/drug reactions who on n has been received from a 29 yearYold female consumer who was vaccinated on an unspecified U date with the second dose of GARDASIL n has been received from a consumer Y concerning her 15 year old daughter with no pertinentNmedical history 1/17/2008 and no11/1/2008 drug reactions or allerg n has been received from a 37 year old female with no allergy and medical history who on 18-AUG-2008 Y was vaccinated ### 11/8/2008 with a first dose o n has been received from a nurse practitioner concerning a 15 year old female patient with aYhistory of appendectomy conducted in Decem n has been received from a consumer concerning her daughter who in December 2008, wasNvaccinated12/1/2008 with a first 0.5 ml dose of GARDAS n has been received from a physician Y concerning a female with a history of injection site reaction Y (vaccine 1/20/2009 unknown) 1/22/2009 who was vaccinated w n has been received from a healthcare Y worker concerning her daughter, a 15 year old female N with no pertinent### medical 1/5/2009 history and no know n has been received from a physician concerning a nurse's daughter who was vaccinated with U GARDASIL a year ago. Coincidentally, the p n has been received from an office manager concerning a female patient who in 2008 was vaccinated U with the first dose of GARDASIL (lot n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL concerning U an 18 12/2/2008 year old female 12/2/2008 patient who on 2 n has been received from a Nurse concerning Y a female patient who was vaccinated with theUfirst dose of GARDASIL (Lot # not reported). P n has been received from a consumer Y concerning her 14 year old daughter who on 26-NOV-2007 Y was vaccinated ### with a 0.5 ###ml dose of GA n has been received from a physician Y concerning a 12 year old female patient with no drug reactions U or 1/14/2009 allergy who1/15/2009 on 14-JAN-2009 was v n has been received from a physician Y concerning a 20 year old female patient with no pertinent N medical 4/29/2008 history and4/29/2008 no known allergies/dru n has been received from a nurse concerning a 11 year old female patient who on 04-DEC-2008 U was vaccinated 12/4/2008with 12/6/2008 GARDASIL (lot# 661 n has been received from a consumer concerning her daughter, a 21 year old female with no N medical history 1/16/2007 or drug9/1/2007 allergy who was vacc n has been received from a physician's assistant concerning a female patient who in October Y 2008 was 6/12/2008 vaccinated 6/13/2008 with the third dose of G n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL U and 9/19/2008 may have 10/1/2008 an unspecified reacti n has been received from a nurse practitioner concerning a 24 year old female who on unspecified Y dates was vaccinated with the first and n has been received from a consumer, concerning her daughter who in October 2008 and December N 2008, 12/1/2008 was vaccinated 12/1/2008 with her first an n has been received from a nurse practitioner Y concerning a female patient who was vaccinated N with three dose of GARDASIL. Subsequent n has been received from a physician Y concerning a 20 year old female patient with no drug reaction/allergies U 1/16/2009 history1/16/2009 who on 16-JAN-2009
n has been received from a nurse concerning Y a female with no medical history or allergy who N on 26-DEC-2008### was vaccinated with the firs n has been received from a physician concerning a 22 year old female who was vaccinated N with three dose 8/1/2007 of GARDASIL between Februa n has been received from a consumer concerning herself (a 24 year old female) with migraine N who received the first two doses of GARDAS n has been received from a 21 yearYold female with no pertinent medical history or drug allergy N who on 20-NOV-2008 1/15/2009 1/15/2009 was vaccinated with n has been received from a nurse practitioner concerning a female who was vaccinated withU3 doses of GARDASIL on unspecified dates. S n has been received from a registered nurse concerning her daughter who on an unknown date U was vaccinated with a dose of GARDASIL. n has been received from a registered nurse reporting that she received an e-mail from a woman U who stated that she received the complet n has been received from a medicalYassistant concerning an 18 year old female with asthma, Y bipolar disorder, 6/11/2008 LEXAPRO 6/11/2008 and PAXIL allerg n has been received from a Registered Y Nurse concerning a 22 year old female with psychiatric Y disorders1/29/2009 and a history of pyelonephritis wh n has been received from a certified medical assistant (C.M.A) concerning a 19 year old female Y with no medical 1/8/2009 history 1/8/2009 and no known aller n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning U her daughter 1/22/2009 an 18 year old female with n has been received from a registered Y nurse, for Y the Pregnancy Registry 0 for GARDASIL, concerning Y a 17 12/5/2007 year old female 3/20/2008 with no previous n has been received from the Merck Pregnancy Registry from a 22 year old female with no pertinent Y medical history ### who on ###17-DEC-2007 n has been received from a certified nurse midwife concerning a 23 year old pregnant female Y who is bipolar 1/9/2008 and has1/9/2008 a history of depressio follow up information has been received from a certified nurse midwife for the Pregnancy Registry Y for GARDASIL, 12/4/2007 concerning 2/15/2008 a 22 year old rmation and follow up has been received from a physician for the pregnancy registry for GARDASIL Y concerning 5/21/2008 a 24 year old female who o n has been received from a consumer and a nurse practitioner for the Pregnancy Registry for Y GARDASIL 4/29/2008 concerning 4/29/2008 herself, a 26 year old n has been received through the pregnancy Y Registry for GARDASIL from a nurse concerning Y a 20 year 5/29/2008 old female 5/29/2008 with no pertinent medic rmation has been received from an 18 Y year old female with no pertinent medical history or drug Y reactions11/1/2007 or allergies, 5/29/2008 for the Pregnancy Re follow-up information has been received Y from a nurse, for the Pregnancy Registry for GARDASIL, Y concerning 5/19/2008 a 23 5/19/2008 year old female smoker n has been received from a licensed Y practical nurse through the pregnancy registry for GARDASIL U concerning 6/2/2008 an 186/2/2008 year old female with a n has been received from a nurse practitioner concerning many patients that complain of pain U after receiving GARDASIL. The nurse practit n has been received from a Licensed Practical Nurse (L.P.N.) for GARDASIL, a Pregnancy Registry U product, 11/6/2008 concerning 11/6/2008 an 18 year old pre swelling, heat and hard spot at site of Y injection 24-72 hours after initial injection. Low grade fever U of approximately 3/10/2009100 3/11/2009 degrees farenheit 48 N N Y N n has been received from a 91 yearYold femaleYpatient with an unspecified 0 thyroid disorder, recent N diagnosis 3/26/2008 of hypertension, 4/26/2008 nitroglycerin a n has been received from a licensed Y practical nurse, concerning a 64 year old male patient with N no known drug### reactions/allergies ### and no p n has been received from Y a registered Y nurse concerning Y a 25 year21 old male with Y cystic fibrosis N and a history of renal transplant and 2 or 3 s n has been received from a consumer concerning two males who were vaccinated with a dose U of MMR II. The patients developed autism a n has been received from a consumer concerning her 5 year old son who "a couple years ago" N was vaccinated with a dose of MMR II (Lot n has been received from a consumer Y concerning Y her 18 month old2son with gastric issues, N reflux and no8/1/2005 known drugs 5/1/2006 allergies, who in ap -24 hours after vaccines. In ER. Oxygen, Y Acyclovir, Y Rocephin, propofol, 5 succinocholine, endotracheal Y tube. 3/5/2009 RSV negative, 3/6/2009 influenza = nega evening upper left arm was red, swollen, Y itchy. Y Following day, more 2swelling, hot to touch, very Y itchy. 4 a.m. 12/14, ### severe### swelling in knees mor" type incident "weird cry" X 20 min. Arms flailing, Y eye looking to2left - unfocused. T101.4Y gaze deviating 3/2/2009 rapid eye 3/2/2009 blinking. 3/18/09 R 03 for 72 hours, severe sore throat and cough lasting more than a week, nausea. U 3/8/2009 3/9/2009 her neuropathy symptoms and triggered a flare of her Trigeminal neuralgia. 3/2/2009 3/2/2009 se effects observed. Father instructed on after care. Look for fever, soreness in thighs. Possible Y mild case3/9/2009 of flu in next 2 weeks. her Rt arm has been hurting since injection 4 months ago. N ### ### d shots Monday afternoon. Tuesday Y morning mom noted redness and induration on right thigh N around injection 3/9/2009 site3/10/2009 and child complained o h erupted day post vaccination. -> treated Y with BENEDRYL. Y 3/6/2009 3/7/2009 3/13/2009 de in the deltoid region and lymphadenopathy Y in the left axillary region. Some erythema of the U injection site. 3/3/2009 3/15/2009 09. Severe welts (red, puffy) 2-23-09 to 2-25-09 (peak discomfort) 1 tablet BENEDRYL 2/25.Y Itch relief w/ 2/17/2009 AQUAFLOR 2/21/2009 topical area : Head of head left side bottom started aching Y within about 1hr later that day around noon. I started feeling flush 2/20/2009 10:00 am and 2/20/2009 my throat felt like it w miting approx 6-8 hr post injection - vomiting cont with dizziness, lightheadedness & soreness Y @ site of immunization 3/10/2009 3/11/2009 Sl. swelling, no redne s, Dizziness, Mild Nausea - 20 Mins after injection - feeling (mild) of throat closing VP (Briefly) Y 2/23/2009 2/23/2009 ite was warm/hot to touch, touch tender, pt. febrile and chills, oral temp 99.8 after chills. Fever Y started 29 3/5/2009 hours after 3/6/2009 injection - remained fe ely after shot, had onset of headache Y dizziness. Onset of fever 12:00am 3/3/09, temp 103.9.YReceived Advil, 3/2/2009 water, cold 3/2/2009 pack. Headache, n rhea, Pale, Lethargic, Weak, (Per mother) lasting 2 Days. Y 1/28/2009 1/28/2009
parent called and reported that the child had a lump on her right outside thigh area. It was not U red or sore. 2/23/2009 Lump under 3/2/2009 skin. There is a scr after vaccines were administered developed hives on injection site, right deltoid and scattered Y in the back. 3/10/2009 injection of MENACTRA. Patient developed palpitations, was dizzy, weak and pale. Symptoms Y resolved in3/9/2009 24 hours.3/10/2009 ulitis at site of injection resolving with Y AUGMENTIN. Y 3/5/2009 3/7/2009 as given 3 GARDASIL vaccines in 2008 by her PMD. PAP smear results on 3/4/09 shows LGSIL N with HPV changes. hed medical records. Y Y 2/24/2009 2/24/2009 en to a 7yr old will count as a valid dose, but requested VAERS form submitted. 2/24/2009 ash - maculopapular, fine, to chest, back, face & upper extremities no fever, chills, arthralgiasY 2/26/2009 3/10/2009 st to report accidental (unintentional) administration of 23-polyvalent (PNEUMOVAX ) vaccineY to a 2 1/2 hour 3/14/2009 old newborn. Infant doing clini GI upset, "flare of Ulcerative Colitis". Y Patient reports symptoms began within 1h of vaccine administration. Y 3/6/2009 Patient seen 3/6/2009 in acute care clinic , dizziness, stiff and sore everywhere starting approx 8-12 hours after receiving the Menactra Y vaccine 3/10/2009 3/11/2009 ormed nurse that he usually faints after receiving injections. Patient given one injections (Hepatitis Y A) while 3/16/2009 lying on3/16/2009 exam table. 10 minute veral days of her second shot - she was Y unable to walk without much pain to her feet. WithinN2 weeks she 7/28/2008 was diagnosed ### with RA and now ter patient was given the Flu Shot his Y right eye Y showed signs of not 4 moving properly. It looked U as if he were going ###crossed-eye. ### 24 hours la mber on Mobilization Orders. He received Y his 1st Anthrax Vaccine on 15 Mar 2009 in his leftYDeltoid Region. 3/15/2009 He reported 3/15/2009 to facility complai mber of the military. Vaccine was administered Y 15 Mar 2009, during Mobilization Orders activity. Y Vaccines 3/15/2009 were administered 3/15/2009 at the facility. PRESENTED WITH RED, PAPULAR Y LESIONS ON FACE,HEAD,TORSO,ARMS AND LEGS Y 2/23/2009 2/21/2009 Varivax, and Havrix administered on 11/6/08. Pt. noted abrubt onset of blurred vision in left N eye on 11/26/08. 11/6/2008 Seen by a neuro-ophthalmolo ### Yellow Fever vaccine 2/27/09. According to patient, started having itchy grouped rash on right Y arm area2/27/2009 and continues 3/6/2009 to spread to other a administration: myalgias, subjectiveYfever. Starting the second day after administration: muscle U soreness3/12/2009 in the forearms 3/13/2009 with weakness an neck, swelling and redness of eyelids, lips and ears Y 2/27/2009 2/27/2009 well appearing and presented to clinic Y for varicella vaccine. Patient received first varicella vaccine Y too early 3/13/2009 (before 3/13/2009 one years old)and recec tions given 3/16/09. Client returned to clinic 3/17/09 stating during the evening of 3/16 her left N arm was painful, 3/16/2009 w/pain 3/16/2009 radiating down to ha ber was examined in flight medicineYclinic on 04Feb09. Her symptoms The patient filled out SF Y 600 Small1/23/2009 Pox questionaire 2/3/2009 and responded ven #2 HPV and left area went to pharmacy, Y weYhad a Fire Drill pt walking 5 out to car and fainted. Y Hit head, 2/18/2009 LOC, was2/18/2009 taken to Hospital foun ### N 12/4/2008 ### ember was a basic trainee and received multiple Y vaccines at the end 10 of September 2008 and N then developed 9/29/2008 lower extremity ### weakness an Y 3/17/2009 3/17/2009 - immunization administered. 3/11/09 Y Am - increased redness, swelling at injection sites, iceYapplied, TYLENOL 3/10/2009 given. 3/11/2009 3/12/09 6pm - seen scess left thigh. Y 3/12/2009 3/15/2009 7/5/2009 Y 117 U 3/6/2009 3/11/2009 iltrate L anterior thigh: indurated, reddened, not tender. Y 3/4/2009 ately 30min after receiving MMR vaccine Y Pt's lips + face + ears started swelling, face + headYpruritic +mild 3/17/2009 difficulty swallowing. 3/17/2009 No resp. dis 3/17/2009 as given pneumococcal vaccine in L Deltoid on 3/14/09 @ 1722. Patient noted that her arm was U very sore. 3/14/2009 On 3/15/09 3/15/2009 @ 2038 RN noted th ports developing a pruritic rash on her Y face, fatigue and joint pain within 2 hours of vaccine administration. Y 3/9/2009 She subsequently 3/9/2009 developed pa izure - ER visit treated with MOTRIN Y and TYLENOL. Y 3/6/2009 3/15/2009 evere muscle aches all over body - sore muscles with touch. 3/20/09 Note received from PCP. U Pt has not been### seen at all### since DOV. TC f r - up to 103- March 13-14-2009 FullYbody rash- March 15-16-17-2009 MMR-given 3-02-09 U 3/2/2009 3/13/2009 Y ### 3/16/2009 was considered medically important. Information regarding DRYVAX was received from a literature U source regarding a participant enrolled n has been received from a consumer concerning her son, who received the routine vaccines N (names and5/1/2002 manufacturer 5/1/2002 unspecified) at five n has been received from a consumer concerning Y her 12 month old3son Y who on 21-AUG-2002 N was vaccinated 8/21/2002 with8/22/2002 an only first dose of MM n has been received from a consumer concerning her son who on 27-DEC-2001 was vaccinated N with the first dose ### of MMR II (Lot # 63870 orted in a published report, title stated above regarding a case in litigation concerning an approximately U 17 4/23/1998 month old male who on 23-APR n has been received from a nurse practitioner Y concerning a 23 year old female who on 09-JAN-2009 N and 3/9/2009 09-MAR-2009 was vaccinated wi n has been received from a registered Y nurse concerning Y a 14 year23 oldYfemale patient with noNpertinent medical### history, 1/10/2008 no drug reactions/a n has been received from a consumer Y concerning Y his 14 year old granddaughter 2 with a history N of migraine 9/1/2008 who in September 10/1/2008 2008, was va n has been received from a registered nurse concerning an adolescent female between 14 and U 17 who was vaccinated with GARDASIL. T es vaccine last week. Got shingles this week. 3/10/2009 3/16/2009 ead and neck 2 hours after vaccinesYwhich lasted about an hour, then went away. Father ofYbaby said 23/12/2009 small red dots 3/12/2009 appeared again sam
l from mom- stated when child wokeY up this AM- She was experiencing some facial edema,Ydifficulty opening 1/6/2009 her mouth, 1/7/2009 + difficulty swallo /4 hrs post pneumonia vaccine started Y having some problems with swallowing & felt bad. During Y that night had### problems swallowing, ### breat other, reports client had episode of Y dizziness and blacked out at school. Ambulance took him Y to hospital.2/13/2009 Reports he 2/17/2009 had mental confusion was reported by a physician Y and described theYoccurrence of convulsion 0 syndrome in a 5-month-old U female 2/27/2009 subject2/27/2009 who was vaccinated w was reported by a physician and described the occurrence of incorrect storage of drug in anUinfant subject of unspecified gender who was was reported in a literature article and described the occurrence of WELL's syndrome in a 7-year-old Y male subject who was vaccinated wit d TDAP instead of rec. TD. No reactions reported. Pt contacted of error. Rec. ACIP recommendation. 3/16/2009 r administer- flushed cheeks- then went Y home, nausea, urine retention and fever 102-103- condition Y persisted 2/23/2009 + Pt.2/24/2009 went to ER-fu evaluatio ith swelling / Erythema. U 3/3/2009 3/5/2009 as small bump on chest, back, and head / some painful to touch. Member was seen by Dr and U she stated3/7/2009 it was Type 3/15/2009 II hypersensitivity - s st vaccination, pt presented with 7cm Y area of redness on (L) deltoid with warmth/redness. Y 3/16/2009 3/17/2009 2 days. Red spots on face and body. Y N 3/4/2009 3/11/2009 Y 3/13/2009 3/13/2009 knot at injection site R upper leg. Y 3/10/2009 3/17/2009 le ADSM is referred by Research Nurse Y for inclusion in the Anthrax study. SM reports increased Y erythema, 5/11/2007 swelling, and ### pain after each of at 10:20 to Immunization clinic and stated Y she had broken out in hives and her throat was swelling Y up, pt3/18/2009 was then instructed 3/18/2009to call 112 (am aricella vaccine in error, should have been given zostavax. No adverse reaction noted. Zostavax Y will be 3/4/2009 given in 4 weeks, 3/4/2009 due to it being a omitting, headache, pain, 100.3 fever, pain at injection site U 3/17/2009 3/18/2009 ction. 40mm X 26mm area of erythema and itching at site. No systemic symptoms. Similar toYprevious reaction 2/9/2009 to MMR 2/11/2009 on 6/2/08. mplained of a itchy, painful rash begining the day after the injection was recieved U 3/12/2009 3/13/2009 Tdap vaccine. Approx. 18 hours later, felt a combination of chills, fever, body aches which lasted Y approximately 3/16/2009 2 full 3/17/2009 days. ately one hr. after receiving vaccinations c/o itching to left cheek then progressing to right cheek, Y chin and 2/17/2009 ankles. Red 2/17/2009 raised "pimple-like" ately three hours following vaccination c/o itching on neck, cheeks and chest areas. Also reports Y accompanied 2/17/2009 by red,raised 2/17/2009rash. Sympto ped a rash, resembling chicken pox, on both arms and both legs, starting the night after she Y received the3/13/2009 vaccines. 3/13/2009 Still evident 5 days late ot had a period after receiving her third Y vaccine. It's been ten months since she Y had a period.4/2/09-records N 5/27/2008 received 6/1/2008 for DOS 3/17/09-offic h where vaccine was administered was reddened, swollen and had a rash with raised vesicles Y similar to chickenpox. 3/5/2009 3/12/2009 Symptoms started 7 d cieved vaccines on 3/17/09 around 1600 Mom reports that infant woke up in the middle of the U night with 3/17/2009 102.5 fever.3/18/2009 Patient did recieve am rms red, raised rash. Warm to touch. N 3/16/2009 3/18/2009 at 7AM on 3/12/2009 with fever of 101, Y pain and redness at the administration site, pain all over Y including 3/11/2009 jaw, joints3/12/2009 and muscles. Pt also esented day after vaccination with redness and swelling to site of shot administration on rightYthigh (MMR 3/16/2009 injection site) 3/17/2009 Dr. prescribed Zyrt ately 1 week after shot was given, my Y son developed a large hive at the injection site, a measles U like rash, 3/10/2009 a high fever 3/17/2009 102.5, refusal to eat episode condition and vitals monitored Y 3/17/2009 3/17/2009 d to clinic 2 days after vaccine given with red raised wheal around injection site. Y 3/11/2009 3/13/2009 RNED TO CLINIC WITH RAised red wheal measuring 9cm by 7cm . Area was warm to touch Y. 2/24/2009 2/26/2009 vere abdominal pain; muscle aches,Ylethargic, has Y asthma now, also1developed skin indentions N (tissue break down ### up underneath ### the skin) 3/17/2009 N 3/13/2009 3/17/2009 d swollen and reddness noted approx. 3 inches over deltoid area. pt told to applt cold comperss U and to give 3/17/2009 tylenol or 3/18/2009 motrin according to we spontaneous report of status epilepticus, dehydration Y and fever was 0 received from a physician, Y concerning a 36-month-old ### ### male subseque orted of experiencing heavy chest, rashes swelling Y throat 1 1/2 hour1after vaccination, went to Y E.R and received 3/16/2009 BENADRYL/Epinephrine. 3/16/2009 R edness, pain, increased temp 101 degrees Y U 3/16/2009 3/17/2009 B # 3, DTaP # 4, PCV # 4 and MMRY# 1 on 12/4/08. At 8pm that night, pt had seizure with 104.2 Y temp. Went 12/4/2008 to medical 12/4/2008 center ER. TX with th cough 1900 15MAR09, progressed Y to headache, nausea, sore throat, tachycardia, fever (103 Y degrees3/15/2009 F), muscle3/15/2009 ache, general weakne after vax, jogged for 3 1/2 hours with 2-3lb weights. At 2p had lunch and became nauseous,Y dizzy and weak 10/1/2008 so went 10/1/2008 to sleep. Woke up at C to reporter who states patient experienced redness & pain at anthrax site right arm & had Ylimited mobility 3/15/2009 w/right arm, 3/15/2009 using left arm to lif tous induration area at the injection site on (R) thigh. Treated with BENEDRYL/ KEFLEX. U 3/16/2009 3/17/2009 ness and swelling 13 x 10 cm on the L thigh. Noted approximately 30 minutes after Imms. Given Y BENADRYL 3/11/2009 and warm 3/12/2009 compresses. Resol diagnosis of thrombocytopenia during routine physical. Menorrhagia (excessive menstrual bleeding) Start: 11/15/2004 ### and LOC x 30 sec, about 10 min after vaccination. Y 3/18/2009 3/18/2009 8, Pt was 7mo old and received a Tdap instead of DTaP. No known injury. Y 5/28/2008 /o feeling as though she were goingYto pass out as she was checking out with secretaries. Secretary Y called 2/5/2009 M.A. and2/5/2009 they assisted Pt to si study report of right lower lobe pneumonia wasY received from an investigator, 1 concerning a U four-year-old female ###subject number ### 1-08-0294
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 2/19/2009 a 34-month-old 2/19/2009 female who ious, spontaneous report of gave expired FLUMIST in a 33-month-old female patient was received Y from 2/11/2009 a nurse practitioner. 2/11/2009On 11-Feb-20 ious, spontaneous report of gave expired FLUMIST in a four-year-old male patient was received Y from a nurse 2/11/2009 practitioner. 2/11/2009 The patient's me ious spontaneous report of administration of expired product was received from a RegisteredYNurse concerning 1/24/2009 a child. 1/24/2009 FLUMIST was adm ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 male. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 36-month-old 1/6/2009 male. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y in the 1/6/2009 concerning1/6/2009 a 36-month-old femal ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 36-month-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a three-year-old 1/6/2009 male. The ious, spontaneous report of administration of full dose in one nostril was received from a nurse Y concerning a female ### child of ### unknown age s ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/22/2009 a four 1/22/2009 year-old male, which ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/29/2009 a 41-month-old 1/29/2009 female, who n has been received from a case in litigation via a case report concerning a 63 year old female U with pre-diagnosis and pre-vaccination med n has been received from a case in litigation via a case report concerning a 48 year old female U who on 12-NOV-1992, 5/25/1993 6/21/1993 18-DEC-1992 and 2 n has been received from a case inYlitigation via a case report concerning a female who on 29-MAR-1999 U 3/29/1999 was vaccinated 4/12/1999 with a dose of RE n has been received from a female who in 1994 or 1995 was vaccinated with RECOMBIVAXYHB (manufacturer unknown). In 1994 or 1995 n has been received from a registered Y nurse concerning a 21 year old female patient who onY an unspecified date as a child was vaccinated n has been received from a physician Y concerning a 12 weeks old female with no known drugNallergies and 8/17/2008 born with9/10/2008 vocal cord paralysis, h n has been received from a case inYlitigation via a case report concerning a male who in 1997, U received the usual infant 1/1/1998 vaccinations that y n has been received from a consumer Y concerning her approximately 5 year old son with no N known allergies or pertinent medical history wh n has been received from a physician concerning an 8 week old male with no known drug allergies U and a 5/29/2008 history of 6/30/2008 circumcision and family n has been received from Y a registered Y nurse concerning a female child who on an unspecified Y date was vaccinated with RECOMBIVAX HB n has been received from a physician concerning a 16 year old male with no pertinent medical U history who was vaccinated with a dose of R n has been received from a pharmacist Y concerning a 50 year old female with hypertension and N no history 10/1/2008 of drug reactions/allergies, 10/2/2008 who o n has been received from a pharmacist concerning a 1 day old male infant who on 19-NOV-2008 U was inadvertently ### vaccinated ### SQ with RE n had been received from a physician Y via pediatric medical records concerning a 40 day oldUfemale who7/30/2008 on 30-JUL-2008 9/8/2008 was vaccinated w n has been received from a physician Y assistant concerning a 30 year old female patient withUno pertinent medical ###history and ### no known dru n has been received from a physician concerning an adolescent patient (exact age not provided) U who on an unspecified date was vaccinat n has been received from a physician Y via medical records concerning a 51 day old white female Y infant with 8/22/2008 bottle feeding ### and a history of c n has been received from a physician via pediatric medical records concerning a 10 day old Yfemale with 6/13/2008 no known drug 6/16/2008 allergies who on 13 n has been received from a pharmacist, Y with no medical history of allergies, 43 year old female, Y who on 11-NOV-2008 ### was ### intramuscularly n has been received from a lawyer regarding a case in litigation concerning a 39 year old female U with variety of ailments (general symptom n has been received for a case in litigation from information obtained from a published articleUconcerning a female with acne who was vacc n has been received from a medical record via a pregnancy registry concerning a 6 month old Y female with 4/11/2008 bilateral feet 4/11/2008 inversion most likel n has been received from a medicalYrecords via of a health professional concerning a 1 day U old male who 4/27/2008 on 27-APR-2008 4/30/2008 was vaccinated n has been received from a physician Y concerning a 2 day old, 6 pound 12 ounce black infantUfemale. On 7/11/2008 11-JUL-2008 9/11/2008 she was vaccinated n has been received from a medical assistant concerning a 35 year old female with no pertinent N medical9/30/2008 history or drug 10/2/2008 reactions/allergies n has been received from a physician Y concerning a 25 year old female with PENICILLIN allergy N who on 9/25/2008 25-SEP-2008 9/28/2008 was vaccinated with n has been received from a physician Y through medical records concerning a 1 day old, 3345Ugram, white 7/2/2008 male who on 02-JUL-2008 was va n has been received from a nurse practitioner concerning a female who at the age of 13 (approximately U 1996) was vaccinated with a first d n has been received from pediatric Y medical records and a physician concerning a 15 week old U female with 6/30/2008 diaper rash 8/20/2008 who on RECOMBIV n has been received from a physician through medical records concerning a 1 day old, 3608Ygram, 21.56/12/2008 inch, white6/14/2008 male with a head circum n has been received from a certified medical assistant concerning a patient who "years ago"Ywas vaccinated with RECOMBIVAX HB (manu n has been received from a certified medical assistant concerning a 34 year old female patient Y who 20+ years ago (approximately 1988) wa follow up information has been received from a Registered Nurse (R.N.) concerning a 26 year Y old (also 9/29/2008 reported as10/1/2008 24 year old) female wit n has been received from a medical assistant concerning a 22 year old female who was vaccinated Y with a dose of RECOMBIVAX HB, on a n has been received from a lawyer from a case in litigation concerning a 43 year old patient Y who on 20-JUN-2003 6/20/2003 was vaccinated with a fir n has been received from a pharmacist concerning a patient (age and gender unspecified) who Y was vaccinated on an unspecified date with rmation has been received from a vaccine nurse and follow-up information was received fromY the physician, concerning a patient who in 20
n has been received from a nurse practitioner Y concerning Y an 11 year 0 old female who was vaccinated Y with RECOMBIVAX HB (manufacture n has been received from a registered Y nurse concerning a 32 year old male with sulfonamide Y and penicillin allergy ### who on### 12-NOV-2007 a n has been received from a physician concerning a 49 year old female with thyroid papillary N carcinoma, asthma 9/3/2008 and 9/3/2008 drug hypersensitivity to rmation has been received from theYphysician's office via medical records concerning a babyYgirl with a history 3/31/2008 of neonatal 5/1/2008 jaundice, mongo n has been received from a pediatrician concerning a 14 day old female baby with a history N of exposure to GARDASIL ### 12/4/2007 while in uterus (app n has been received from certified physician assistant (PAC) concerning a 3 day old, 7 pounds, 5 ounce, 4/9/2008 19.75 inch, 4/12/2008 female with a history o medical records were received and received Y concerning an 6 week old male with cleft lip andUa history of4/29/2008 jaundice, spitting 5/19/2008 up and blood bili n has been received from a female pharmacist concerning herself who in earlier 2008 was vaccinated N with a first and second dose of RECO n has been received from an office manager concerning a male who on unspecified dates was U vaccinated with three doses of RECOMBIVA n has been received from a nurse practitioner concerning a 34 year old, unemployed, femaleUpatient with7/10/2008 depression 7/31/2008 and a history of hepat follow up information has been received from a nurse practitioner concerning a 20 year old female U who on an unspecified date was vaccina n has been received from a registered nurse concerning a 46 year old female with a history Y of knee problems 8/12/2008 and an 8/13/2008 allergy to band aids, w follow-up information has been received regarding Y a case in litigation 0 from information obtained U from a published 1/9/2002article 1/12/2002 concerning a fema n has been received from a nurse practitioner via the patient's mother concerning her daughter Y with a history of bulimia who about 9 years n has been received from a medical assistant concerning a 20 year old female who was vaccinated Y with RECOMBIVAX HB. Concomitant n has been received from a nurse practitioner concerning a 14 year old female who was vaccinated Y with the first dose of RECOMBIVAX HB n has been received from a 50 yearYold female registered nurse with hypothyroidism and allergy N to non-steroidal 7/2/2008anti-inflammatory 7/13/2008 medicat n has been received from a registered Y nurse concerning her daughter who sometime in 1998 U was vaccinated with a dose of RECOMBIVAX n has been received from a nurse concerning a dialysis patient who was vaccinated with fiveUdoses RECOMBIVAX 2/19/2008 HB (dates of vaccinatio n has been received from a nurse practitioner who heard that a female who was vaccinated Ywith a dose of hepatitis B virus vaccine (manuf n has been received from a consumer concerning her friend's son who in 2008 (also reported Y as 2001) was vaccinated with one dose of RE n has been received from a physician concerning a patient who was vaccinated with RECOMBIVAX U HB. Subsequently the patient experien n has been received from a consumer concerning her daughter who in 1995 was vaccinatedUwith RECOMBIVAX HB. In 1995 the patient w n has been received from a registered Y nurse concerning a 32 year old female with a history Y of migraine headaches, 6/6/2008 PENICILLIN 6/6/2008 allergy, hy n has been received from a nurse practitioner Y concerning an approximate 35-year-old female N with a history of ### motor vehicle ###accident that r n has been received regarding a case in litigation from a physician concerning a 30-year-oldUpatient who was vaccinated with a second dos n has been received from a case inYlitigation via a case report concerning a 53-year-old maleN who on 04-NOV-2000 11/4/2000 was vaccinated ### with a n has been received from a health professional Y concerning a 21 year old female with no pertinent Y medical 1/14/2008 history, drug 1/15/2008 reactions or allergie n has been received from a registered Y nurse concerning a 22 year old female with no medical Y history or 1/15/2008 allergies who 1/16/2008 on 15-JAN-2008 was n has been received from a pharmacist concerning a 23 year old female with a history of unspecified N surgery and contemplated blood dona n has been received from a registered Y nurse concerning a female in approximately her mid 40's N with no allergy 2/6/2008 to yeast 2/7/2008 (any other allergies n has been received from a physician Y via medical records concerning a 4 week old female who Y on 30-JUN-2006 6/30/2006was 7/28/2006 vaccinated with a firs n has been received from a registered nurse concerning a Caucasian female with allergies to Y CODEINE,8/28/2007 METHANOL and### PENICILLIN wh n has been received from a nurse practitioner concerning a female who was vaccinated withYa nurse practitioner concerning a female who n has been received from a registered nurse concerning a 14 month old female patient with Y no pertinent medical history 2/28/2008 or drug allergies w n has been received from medical records Y concerning a female infant (full term normal babyUgirl weighing 9/17/2007 7 pounds9/28/2007 8.4 ounces with a lengt n has been received from a nurse practitioner Y concerning a 65 year old female with allergiesYto DEMEROL, codeine, and "DARVIN", and a n has been received from a physician Y concerning an 8 month old black female with no known U drug allergies, 8/2/2007 who on 02-AUG-2007 ### was vac n has been received from a physician, Y concerning a 1 day old Caucasian male infant (a normal U 9 lb 0.2 oz, male ###infant with ### no abnormalitie n has been received from medical records and a health professional concerning a 4 week old U female infant with ### small 11/1/2007 heart murmur and va n has been received from a case in litigation concerning a female physician who on 03-SEP-1996, U 11-NOV-1996 4/3/1997and 03-APR-1997 was va n has been received regarding a case Y in litigation which was reported in Litigation Report concerning U a 48 year### old female who in Novembe n has been received regarding a case Y in litigation concerning a 43 year old female with carpal U tunnel syndrome and numbness in hand (bo n has been received from a Nurse Practioner (N.P) concerning a 49 year old female patient N with sulfonamide 3/13/2008 allergy3/13/2008 who on 13-MAR-2008 n has been received from medical records Y concerning a 5 week old infant male who on 28-JUN-2007 Y was 6/28/2007 vaccinated8/1/2007 intramuscularly with w n has been received from a pharmacist concerning a 66 year old female patient who in 1997Uor 1998 was vaccinated with a dose of RECO n has been received from a patient who was vaccinated with a dose of RECOMBIVAX HB. U Subsequently, the patient reported that she fell n has been received from a mother concerning her daughter who in August 1993, was vaccinated U with a first 1/1/1994 dose of RECOMBIVAX HB (m n has been received from a registered nurse concerning a 21 year old male with a history ofNyeast of allergy who stated that he had an "alle follow up information has been received Y from a physician and from medical records concerning N a 27 year5/5/2006 old white male physician with gilb n has been received from a mother concerning her son who was vaccinated with a second dose U (date unspecified) of RECOMBIVAX HB (m
n has been received from a registered nurse concerning a patient (age and gender unknown), U who on 24-JUN-2008 6/24/2008 6/24/2008 was vaccinated with a n has been received from a 52 year old male physician who in 1998 was vaccinated IM withYa second 0.5 ml dose of RECOMBIVAX HB an n has been received from pharmacist concerning a patient who on unspecified date was vaccinated N with the third dose 7/2/2008 of RECOMBIVAX H was reported by a healthcare professional and described the occurrence of dizziness in a 28-year-old Y female 8/21/2007 subject 8/22/2007 who was vaccinated was reported by a healthcare professional Y and described the occurrence of near fainting in aY 13-year-old 2/2/2008 female subject 2/2/2008 who was vaccinat was reported by a healthcare professional Y and described the occurrence of rash in a 15-month-old Y male1/24/2008 subject who 1/26/2008 was vaccinated with H was reported by a healthcare professional and described the occurrence of high fever in an U adult male subject 2/5/2008 who was vaccinated with HA was reported by a healthcare professional and described the occurrence of night terrors in aY2-year-old 2/27/2008 male subject 2/27/2008 who was vaccinated w was reported by a physician via a sales represented and a health care professional and described Y the occurrence 5/14/2008 of rash in a 15-month-ol was reported by a consumer (also the subject) and described the occurrence of shooting pain U up the neck 5/6/2008 in a 18-year-old 5/6/2008 female subject was reported by a healthcare professional, via a sale representative, and described the occurrence N of swollen 4/30/2008 gland 5/3/2008 in a 41-year-old femal was reported by a healthcare professional Y and described the occurrence of injection site redness U in a 47-year-old 1/7/2008 male subject who was va was reported by a healthcare professional and described the occurrence of diarrhea in a 45-year-old N female 2/15/2008 subject who was vaccinated w was reported by a consumer and described Y the occurrence of dizziness in a 45-year-old female U subject who 2/8/2008 was vaccinated 2/8/2008with HAVRIX, was reported by a physician and described Y the occurrence of laboratory test interference in N a female subject in her late 20's who was vacc was reported by a consumer and described the occurrence of abnormal laboratory test value U in a 27-year-old 1/1/2008 female subject who was vacc was reported by a healthcare professional and described the occurrence of low grade fever U in a 1-year-old 3/19/2008 female subject 3/19/2008 who was vaccina was reported by a healthcare professional Y and described the occurrence of sweating in a 20-year-old Y female 3/20/2008 subject 3/20/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of pruritic papular rash Y in a 65-year-old 2/28/2008male 3/9/2008 subject who was vac was reported by a consumer and described the occurrence of tingling feet in an adult femaleUsubject who was vaccinated with HAVRIX (Gl was reported by a healthcare professional, via an agency sales representative, and described U the occurrence 5/1/2008 of injection 5/1/2008 site soreness in a was reported by a consumer and described the occurrence of a nonspecific reaction in a female U subject of 5/1/2006 unspecified age who was vaccin was reported by a healthcare professional and described the occurrence of arm pain in a subject U of unspecified age and gender who was v was reported by a healthcare professional and described the occurrence of burning in a female U subject of unspecified age who was vaccin was reported by a healthcare professional and described the occurrence of burning in a male U subject of unspecified age who was vaccinat was reported by a healthcare professional and described the occurrence of vaginal yeast infection N in an6/12/2008 adult female 6/18/2008 subject who was vacc was reported by a healthcare professional and described the occurrence of localized inflammatory Y reaction 6/27/2008 in a 10-year-old 6/27/2008male subject w was reported by a physician and described the occurrence of vaginal yeast infection in a 17-year-old N female 6/12/2008 subject6/13/2008 who was vaccinated w was reported by a healthcare professional Y and described the occurrence of injection site hives Y in a 3 year-old 6/10/2008 female 6/11/2008 subject who was vacc was reported by a healthcare professional (also the subject) and described the occurrence of Y injection site 5/1/2008 redness in5/1/2008 a 67-year-old female was reported by a healthcare professional, via a GSK sales representative, and described the U occurrence of injection site soreness in an u was reported by a healthcare professional via a sales representative and described the occurrence Y of hive 6/27/2008 in a 8-year-old 6/27/2008 male subject wh was reported by a healthcare professional via a sales representative and described the occurrence N of hives 6/27/2008 in a 3-year-old 6/27/2008 male subject wh was reported by a healthcare professional and described the occurrence of heart palpitation in a 25-year-old 4/2/2008 female 4/2/2008 subject who was vacc was reported by a healthcare professional and described the occurrence of accidental overdose Y in a 5-year-old 7/16/2008 female 7/16/2008 subject who was va was reported by a healthcare professional via a sales representative and described the occurrence U of an unspecified, severe event in a pe was reported by a healthcare professional via a sale representative and described the occurrence U of an unspecified, severe event in a ped was reported by a physician and described the occurrence of sweating in a 13-year-old maleY subject who8/2/2008 was vaccinated with HAVRIX (Gl was reported by a healthcare professional Y and described the occurrence of purpura in a 19-month-old Y male 8/12/2008 subject8/12/2008 who was vaccinated w was reported by a physician and described the occurrence of anaphylaxis in a 1-year-old subject U of unspecified gender who was vaccinate was reported by a healthcare professional and described the occurrence of an accidental overdose Y in a 2/20/2008 1-year-old female 2/20/2008 subject who was was reported by a physician and described the occurrence of fever in a 2-month-old male subject Y who was 7/3/2008 vaccinated 7/3/2008 with HAVRIX (Glaxo was reported by a healthcare professional and described the occurrence of bleeding from cut N in a 52-year-old ### female subject ### who was vac was reported by a physician and described Y the occurrence of fussiness in a 2-month-old male Y subject who 11/7/2008 was vaccinated 11/7/2008 with HAVRIX (G ct's medical history included high blood Y pressure and high cholesterol. Previous and/or concurrent Y vaccination 4/30/2008 included 5/3/2008 inactivated IPOL; u was reported by a healthcare professional and described the occurrence of vaccination complication U in a 6-year-old ### female ### subject who wa was reported by a consumer and described Y the occurrence of fever in a 10-month-old female Y subject who was### vaccinated### with HAVRIX, G was reported by a physician via a sales Y representative and described the occurrence of hives Y in a 22-year-old ### female subject ### who was vac was reported by a healthcare professional and described the occurrence of low grade fever Yin a 6-month-old male ### subject### who was vaccina was reported by a consumer and described the occurrence of colic in a neonate subject of unspecified gender 12/1/2006 who was exposed to HAVRI N
old child had received their two and four month YHib immunizations (manufacturer, 0 lot numberNand dates of administration not reported) and ort received on 13 March 2009 from Ya health care professional. A 20-month-old male patient U had received 3/4/2009 on 04 March 3/5/2009 2009 a fourth intram n has been received from a consumer concerning her son with no medical history or allergies N who on 20-SEP-2006 9/20/2006 was vaccinated with a n has been received from a pharmacist concerning Y a 54 year old male 5 Y with hypertension, Y obesity, U diabetes, 3/3/2009 atherosclerosis, 3/4/2009asthma and he n has been received from a nurse practitioner concerning her approximately 30 month old grandson U with a little autism prior to receiving the n has been received from a consumer Y concerning her 5 year old son with no medical historyNor allergies who 3/1/2006 was vaccinated with a dose o n has been received from a consumer concerning her 18 month old nephew with no medicalNhistory who in 1/1/2008 January 2008, was vaccinated n has been received from a consumer who reported that she has 3 friends whose children were U vaccinated with a dose of MMR II and deve n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y a 15 5/6/2008 year old female with attention def rmation has been received through the Merck Pregnancy Y Registry for 0 GARDASIL from a registered Y nurse 6/3/2008 concerning6/3/2008 a 20 year old female min. of vaccines pt. hadYcough, sneezing. Y Tongue Y and mouth pain. 1 Doctor found periorbital edema Y with 3/17/2009 wheals, no 3/17/2009 swelling of lip or tongue 9 pt. received 3rd dose of PENTACEL, Y HEP B, PREVNAR & ROTATEQ. Within 4 hours pt. Ydeveloped large 3/10/2009 area of3/10/2009 confluent erythema (s 24-28 after 12 pt. noted swelling redness & heat @ inj. site on left upper arm 4 cm X 2 cm area. Y Instructed 3/12/2009 to use compresses 3/14/2009 & TYLENOL gling in arms/legs, feeling weak, nauseated 10/13 - see doctor 1st time & twice more in OctNOct - tingling 10/6/2008 in arms/legs, feeling ### weak, nause d flu vaccine & got INFLUENZA B anyway. Y Y ### 3/10/2009 at 3:00 pm vaccines were given Within Y 5 minutes of vaccines, she was feeling nauseated and Y a numbness 2/2/2009 in right arm 2/2/2009 which started to sp somnolence and headache. Y Y 2/20/2009 3/2/2009 acular papular rash. Y U 2/24/2009 2/25/2009 a fast food restaurant after leaving Your office. Halfway there she got a pain in mid-sternal toYepigastric region. 2/26/2009 Then 2/26/2009 she felt very flushed, non-stop crying. Y ### ements of head to right Y Varicella and Hepatitis A vaccine in L arm on day prior to visit. This AM noted significant swelling U erythema 3/17/2009 @ injection 3/18/2009 site. Area of erythem as given HEPATITIS B vaccine on 2/25 @ 17:30. The second dose was given on 2/26 @ 02:00. Y 2/26/2009 en, painful (L) upper arm at area of Y injection. Mild erythema & cellulitis. PREDNISONE/CEPHALOXIN. Y 3/5/2009 3/5/2009 er the vaccine the site became red itchy swollen with scattered hives around the site & on trunk. Y 3/9/2009 .7 48 hrs after administration cellulitis Y left anterior thigh. 3-4 cm annular area erythema and Ywarmth. Tenderness 3/16/2009 to3/18/2009 touch. t 8:00PM on 3/18/09 Temp of 101 degrees. 3/19/09 Temp 102.9. To use Tylenol or Motrin. UTo take to ER 3/18/2009 if lethargic 3/18/2009 or not doing well. n has been received from a nurse practitioner Y concerning a 20 year old female with not drugYreactions or2/20/2009 allergies who 2/21/2009 on 20-FEB-2009 wa n has been received from an aunt concerning Y her 15 year old niece with asthma who in JulyN2008, completed 7/1/2008 her three 2/23/2009 doses GARDASIL. ving chills, achy joints, shoulder (left) and neck pain (left arm received vaccine) around 2200Non eve of vaccine. 3/16/2009 Began 3/16/2009 running fever of 100 PED ACHING/ FEVER ABOUT 24 HOURS AFTER ADMINISTRATION OF TDAP. TEMP 102 Y DEGREES,3/5/2009 48 HOURS 3/6/2009 LATER. BODAY AC HROUGH ROTAVIRUS DISPITE 3 DOSES Y OF ROTATEQ AT 2, 4, & 6 MTHS OF AGE Y 9/2/2008 3/6/2009 of 102, hurts to move,body achy all over, crying from pain, has not called MD, called at 10:30 this am. encouraged 3/18/2009 3/19/2009 to call MD. lling developed that has been increasing in size with time. It has not resolved as yet. My wifeUis now taking 3/16/2009 zyrtec, pepcid 3/17/2009 and Keflin 500 m n to patient in error, should have gotten HepB Y 3/4/2009 e administered at 10 a.m. when I was 34 weeks Y and 5 days pregnant. 4 This was a twin pregnancy Y with lots of monitoring ### (ultrasounds, ### etc.) Y 3/19/2009 3/19/2009 NOTED HIVES ONCE AGAIN, ONLY THIS TIME WORSE, MOTHER GAVE PATIENT BENEDRYL Y AND 2/11/2009 PUT SOME 2/11/2009 CREAM ON HIVES T ly immunized and pretty much on schedule Y but was still diagnosed with pertussis per PCR on Y 3/13/2009. Immunizations ### 2/10/2009 dates were 11/16/2 eloped hives 22 hours post immumizations Y on neck, trunk, and legs. No swelling of lips nor Y difficulty breathing. 3/12/2009 Consult 3/12/2009 to allergy clinic ew hours after receiving 4 vaccines, patient developed a rash over both upper arms that spread U to lower 3/17/2009 arms, back,3/17/2009 and face. He had no re ck dot on patient's left arm after administration of Varivax #2 using VanishPoint 5/8" syringe.U 1/13/2009 1/13/2009 d 5 minute tonic clonic seizure withYtemp 101 on evening shots were given. Patient had a history Y of prior3/17/2009 febrile seizures. 3/17/2009 Seen at Hospita ack dot on patient's right arm immediately after administration of MMR. U ### ### mplained of tightness and pain in his Y chest, went Y to the clinic at the 2Hospital on 15 Mar 09. Y The clinic then 3/4/2009 transferred 3/15/2009 him to another hosp cular lymphadenopathy on same shot was given for gardasil #1 and #2 U 3/12/2009 3/19/2009 ymptoms, frequent urination, burningY on urination beginning 11 days after initial dose, continuing U sporadically 6/11/2008 to present 6/23/2008 time, 9 months late 8/18/08; HPV #2, 10/20/08; HPV #3,Y3/3/09. Hospitalized Y within 2 weeks 25 of each vaccine for severe Y depression 3/3/2009 exacerbation. 3/10/2009 3/23/09 Rece ular, vesicular, asymptomatic chin, upper/lower Y extremities left ear very red, swollen 2/7/09 Y 2/4/2009 2/6/2009 ht thigh swollen, red, pain. 3/17/2009 3/18/2009 ted 03/16/09 and developed generalized rubelliform rash- continues to today though now defervesced. U 3/2/2009 3/16/2009
as given MMR vaccine on 3/16/09. Route IM the right lower thigh, Mom noticed reaction nextYday. Swollen. 3/16/2009 Warm to3/17/2009 touch. Large ring aroun ed with redness to right thigh at around Y 10am 3/18/09. Redness worse & area getting swollen N leg looks3/17/2009 more swollen. 3/18/2009 Child seen at 8am out" for a few seconds then felt dizzy. Y 3/19/2009 3/19/2009 and warmth to deltoid site. Y 3/16/2009 3/17/2009 en 03-16-09. Called by mom about red hot areas on arm. Came in for eval. No resp. problems. Y Relaxed and reading 3/17/2009 book. R arm (delto th local reaction, left upper thigh. Warmth and redness about 10x6 inches. U 3/17/2009 3/19/2009 8x10cm red oval. mild edema and tender to exam. U 3/18/2009 3/18/2009 ast 15 yrs, pt has had single spot zoster breakouts on her gluteal area approx every year. She N received ZOSTAVAX 11/7/2008 11-7-08. Since that tim eloped on entire torso 7 hrs after MMR #1 givenY 3/17/2009 3/17/2009 oe macular papular rash. Purplish face Y coloring, fussiness, fever, runny nose and swollen face. N 3/18/2009 3/19/2009 ameter erythematous lesion on the (R) Y upper arm. Site of varicella shot 24 hrs after injection. U 3/17/2009 3/18/2009 ox 3/18/09 after 2 vaccinations for VARIVAX 9/26/05 12/9/08. Y 12/9/2008 3/18/2009 Experienced diarrhea, vomiting and fever (102.0) for 24 hrs. Had same reaction to Hep B # 1Yof 3 on 11/17/2008. 3/13/2009 3/14/2009 n has been received from a manager Y concerning a 46 year old female hospital employee with Y allergy to 2/12/2009 LIPITOR, diabetes, 2/12/2009 hypertension, h rmation has been received through the Merck Pregnancy Registry from a medical assistant concerning Y a6/19/2008 19 year old6/19/2008 female with asthma wh n has been received from a consumer Y reported that "her former student's sibling was diagnosed N with autism after receiving MMR II the pati follow-up information has been received Y from a certified medical assistant for the pregnancyYregistry for 9/21/2007 GARDASIL concerning a 22 year o n has been received from a consumer concerning her 4 year old granddaughter who on an unspecified N date was vaccinated 9/1/2008with a dose of n has been received from a consumer Y concerning her approximately 26 month old daughterNwho in April 2000, 4/1/2000 was vaccinated 4/1/2000 with a dose n has been received from a consumer concerning her friend's son who on an unspecified date U was vaccinated with a dose of MMR II. It wa n has been received from a consumer concerning her 16 month old son with no pertinent medical N history 9/1/2005 and no allergies 9/1/2005 reported, who in n has been received from a consumer concerning her grandson who on an unknown date was U vaccinated with MMR2/1/2001 II. It was reported that n has been received from a consumer concerning her approximately 16 month old daughterNwith no pertinent 2/13/1995 medical 2/13/1995 history of drug reacti n has been received from a consumer concerning her now 5 year old daughter with no drug Nreactions/allergies 3/22/2004 who on 3/1/2005 22-MAR-2004 at the n has been received from a consumer concerning her now 22 year old son with an allergy toYyeast who in "1988" at approximately 12 mont n has been received from a consumer concerning her approximately 24 month old son who U on an unspecified date was vaccinated with the n has been received from a consumer concerning a male patient who was vaccinated with aNsingle dose of MMR II on an unspecified date. n has been received form a nurse concerning a 23 year old female who on 21-NOV-2008 was Y vaccinated injection ### with the ### first dose of GA was reported by a pharmacist and described the Y occurrence of tremor in a 11-year-old subject U of unspecified gender who was vaccinated w after 4 month vaccines given, pt withYfever, multiple Y episodes of emesis 1 and several cyanoticYspells. 1 spell 3/3/2009 lasted 30-60 3/4/2009 seconds - patient w serious case was received on 27 February 2009 from a health care professional. A child received PENTACEL (lot number not reported) on rregular area to left delt. Nt, slightly warm N 3/17/2009 3/18/2009 Y U 3/17/2009 3/18/2009 ever to 102, hives under bilat axilla,Ypain and redness at injection site, perceived wheezing and Y dry mouth 3/18/2009 with nausea. 3/19/2009 Patient went to ER 40 pm MA had just finished giving pt IZZ's, when pt's foster mother asked if it was normal for Y pt to be all red 3/17/2009 MA turned 3/17/2009 to see pt and he was ythema at injection site noted several hours after receipt of vaccine - lasted 3 days and no c/oY pain or discomfort. 3/11/2009 3/11/2009 nstop crying for 3 + hours Y 3/11/2009 3/16/2009 Lymphadenopathy, cervical, BIL. Y 1/14/2009 1/15/2009 oe rash and headache. Reported by parent, did not see rash. Referred to family doctor. Unable Y to reach client 3/6/2009 for follow3/11/2009 up information. Herpes Zoster Vaccine 5/8/2008 gotY rash on L eyebrow - forehead (slight) no blisters. Oct 11, U 2008 - went5/8/2008 to eye Dr - clear. ### Nov 23 2008 es, abdominal pain ( <5 min from getting Y shot). Within minutes, trouble breathing, emesis. PO Y BENADRYL 3/12/2009 given initially 3/12/2009 before resp distres local swelling including entire arm and Y proximal forearm with localized pain and urticaria. Y 1/23/2009 1/23/2009 after vaccinations pt. noticed back ofY left arm sore & redness around injection site. The redness Y continued3/9/2009 to spread, 3/10/2009 was not to the touch. es that eve after a shower noted area was red & swollen with a pinpoint flat rash that extended Y down from1/9/2009 injection site 1/9/2009 3 fingers width. C/o -103 degrees F wouldn't crawl or sleep or eat for 2 days very uncomfortable and just wantedUto be held. 4/13/1995 I get angry4/13/1995 because I could have g fever to 103 degrees. Fever was noted Y (rectal) 102.7 on admit to ER, uncontrollable vomiting. Y Dehydration. Neuro ### signs intact. ### Received IV orts that she had a softball size knot on left arm the day after her last TWINRIX on 2/11/09. ItY"had local fever 2/11/2009 and I itched 2/12/2009 and was very sor -sized redness @ site of injection yesterday after school. This morning pt c/o slight pain andYsite was itchy. 3/9/2009 Mom noticed 3/10/2009 that redness had ports approximately 40 min after receiving Y vaccine became lightheaded, pale, clammy & thenY became semi 3/5/2009 unresponsive. 3/5/2009 Co-workers call fter the vaccine was given, subject experienced tenderness, irritation, and swollenness in her Y left arm. Tenderness 3/17/2009 3/18/2009 and swelling has decre
d shot 12/30/08 - Raised red area around shot site is still red - not swollen just red - pt. is notYin pain just doesn't ### like mark on arm. mmatory reaction. 7x7 warm erythematous area assoc w/ persist fever. DX cellulitis, secondary Y to sterile3/17/2009 abscess from 3/18/2009 DTap vax. veloped raised red "bumps" all over (L) arm 2 days after shot. States area itching but betterYnow. Instructed 2/24/2009 to notify 2/26/2009 MD for further instruc ine VARICELLA. Y 8/8/2007 3/15/2009 iagnosis of chickenpox Received VARICELLA vaccine 3/1/02. Sibling had chickenpox - 2 wks U prior had not 3/1/2002 received 3/12/2009 VARICELLA vaccine d ZOSTER & TD BOOSTER vaccinations on 6Mar2009. Pt received vaccines on R deltoid.YZoster vaccine 3/6/2009 caused localized 3/7/2009 rxn to include Limited movement of right arm. Y N 8/12/2008 8/13/2008 9 pt. called to report "hive-like rash" appeared on face within 2-3 days of 1st Hep-B vaccine Y given on 3-03-09. 3/3/2009 Rash now 3/5/2009 itchy and spreadin on Rt thigh hard red lump, warm to touch, Y no fevers using BACTROBAN oint and warm compresses. Y 2/23/2009 3/3/2009 esented to the clinic on the 19th of March complaining of a rash across his back and chest as Y well as behind 3/8/2009 his ears 3/18/2009 and some on his legs veloped pain and redness at the injection site of Flu vaccine. His entire right shoulder turned Y purple. 1/17/2009 1/19/2009 nstop from 1am-8am. Shots were given at 3:20pm the day before. U 3/19/2009 3/20/2009 3/13/09 for 10 year old well child visit. Y Recieved varivax #2. On 3/15/09 developed large area Y of redness, 3/13/2009 pai, and warmth 3/15/2009 on left arm. See ries of Hepatitis B vaccine(6/10/08, 7/15/08, and 11/25/08), the post-vaccine surface antibody N on 3/10/2009 was negative. eveloped erythema swelling and lymphedema on the upper arm at the injection site. He had severe pruritis. 3/7/2009 Symptoms 3/11/2009 started on 11 Mar. ries of Hep B vaccine (4/20/07, 12/21/2007 and 02/15/2008) post-vaccine HBsab was negative Y (titer on 3/10/09). 03.4, muscle spasm, r thumb-treatedY with anti-pyretics, time U 3/19/2009 3/20/2009 d adacel vaccine on 3/18/09. TodayY3/20/09 noticed rash on left forearm that is itchy, raised, were 9 bumps 3/18/2009 initially,3/20/2009 now only 3. No other iving the second dose of the Gardasil vaccine, I had a large lump under the skin at the injection U site that 3/12/2009 felt almost 3/12/2009 like a marble. The skin w n at 0930am, developed erythematous wheal, 4 cm & warm, almost immeditely and small hives U down both 3/19/2009 arms and 3/19/2009 face. an ugly looking rash, which she describes as bright red and a lengthwise oval that is about 2-3" Y long. She 3/18/2009 notes that3/20/2009 it may be slightly raise a faint red rash around the injection site. It was about 1/2" X 1&1/2" in the shape of a lenthwise Y oval. It does 3/18/2009 not itch. 3/19/2009 ported to Health Dept. that pt. wokeYup on the morning of 3-19-09 complaining of being dizzyYand unable3/18/2009 to get out of 3/19/2009 bed. He followed up after receivng vaccines patient had temp (102F), n/v, chills and malaise. Mom treating with tylenol U and fluids. 3/19/2009 3/20/2009 EVED ANTHRAX VACCINATION AS A TUBERCULOSIS TEST ON HIS LEFT FOREARM. HE Y HAD THE 3/20/2009 NORMAL3/20/2009 SIDE EFFECTS OF TH eared on 3/19/09 and a vesicular rash around injection site. Treated with benadryl Y 3/12/2009 3/19/2009 soreness/tenderness in upper arm near site of injection. Mild sore throat and diarrhea. N 3/19/2009 3/20/2009 area of inderation at the site of the chicken pox injection. No rash in the area. I felt it was an uncommon reaction. 3/6/2009 3/19/2009 symptoms in Nov - Dec. Y Flu symptoms Y 1st Jan.YSaw P.C. 1/5/09, showed 60 Y signs of choking often, U called paramedics ### 1/18/2009 1/18/09 - could not stan after vaccines (and after dinner + dessert), Y developed Y hives, lip/tongue 1 swelling, throat and chest Y discomfort 2/26/2009 and dyspnea; 2/26/2009 then syncope. itching and shortness of breath. Y 3/18/2009 3/19/2009 arm swelling, redness and tenderness. N 3/18/2009 3/18/2009 minutes of receiving 3 vaccines - MENACTRA, ADACEL, and GARDASIL, pt developed a macular/papular Y 3/18/2009 rash L arm 3/18/2009 and trunk. BENADRY sion, Nausea. Vomiting 20-25 mins.Y Prior to EMS being called. Treated with a cold compress Y until EMS3/18/2009 arrived. 3/19/2009 d to have Erythema Multiforme 7 days after receiving vaccines. Also had mild URI, so E. Multiforme Y could 3/10/2009 be due to3/17/2009 viral etiology. ? Possib of swelling in legs, knees, elbows and hands. Mild pain in quads, sweating, sensation of dyspnea. U Treated 3/18/2009 2 weeks3/18/2009 prior for hives due to ib ollen around site. Y 3/18/2009 3/20/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP. Y 1/27/2009 nstead of TDAP. Y 1/27/2009 nstead of TDAP. Y 1/27/2009 = Legs and arms. No other symptoms. Occurred after shot. Disappeared after Benadryl. Y 3/19/2009 3/20/2009 @ site of injection. Post 12-12 hours later redness, hot to touch and swelling. U 3/19/2009 3/19/2009 ter had her 4yr old injections, she has Y always had a slight fever with each vaccination. This time N however3/19/2009 she hasn't3/19/2009 been producing much er first shot, daughter started having Y weakness/tingling in left arm. Also, dizziness. Within aNweek after second 3/9/2009 shot, 3/12/2009 she began to have mo nset of fever accompanied with febrile Y seizuresYapproxmitatly 9 days1 after vaccinations wereYrecieved. visited 3/10/2009 ER after 3/19/2009 first seizure on 3/19/ MINISTERED (L) DELTOID 3/6/9 @Y1045. PT NOTED HIVES & ITCH @ SITE 3/11/9. PT CONTACTED U 3/6/2009 DR 3/12/9 3/11/2009 & WAS BROUGHT IN atient started to loose muscle Y and in May 2003, was diagnosed with ALS. 4/22/09 Y MR received N from neuro 9/1/2001 2/7/05 to 9/1/2002 4/6/09 with DX: Proba
ceived both a pneumovax and influenza injection on 10/21/08, The influenza vaccination wasUgiven in patient's### right arm, and ### the pneumov e clinic and within 1-2 hours had 103-104 temp and is still having extremely high fever and chills U today. 3/19/2009 3/19/2009 ously healthy 22-month-old male had Y the following Y vaccinations on 1/20: 1 4th HIB, 1st hepatitis U A, and 1st1/20/2009 varicella. The 1/21/2009 following day, he de ebrile seizure (15-20 min of generalized Y T-C seizure Y but with eye deviation 1 to the right). Fever Y 39. Hoarseness. 3/2/2009 RSV3/21/2009 antigen positive. Rec'd N Y 0 N 5/20/1998 ort received 09 March 2009 from a health Y care professional which involved a cluster of two patients. U Two patients, 9/1/2008also 3/1/2009 reported as employe was received from a health care professional Y on 13 March 2009. A 17-year-old male patient,Nwith a one-week 3/11/2009 history 3/11/2009 of upper respiratory in ort received on 17 March 2009 from Ya literature collection. "An 8 month old female patient developed Y a left sixth nerve palsy 6 weeks after D n has been received from an office Y manager concerning a patient who on an unspecified date, Y was vaccinated 2/10/2009 with2/10/2009 PNEUMOVAX 23 (lot# n has been received from a doctor of Y pharmacy concerning a 77 year old male patient Y with arthritis N of wrist, enlarged ### prostate ### (benign), hyp n has been received from a consumer Y concerning her 15 year old daughter with no Y past medical N history 8/20/2008 and no drug 10/1/2008 reactions or allergies n has been received from a consumer Y concerning his daughter (a year old female) with no medical N history3/3/2006 or drug allergies who on 3-MARn has been received from a consumer concerning her son (a "43 year old" male) who "developed U autism after receiving a dose of MMR II". n has been received from a consumer concerning her daughter who became autistic after receiving U a dose of MMR II. Upon internal review n has been received from a consumer Y concerning her 36 month old son with gastrointestinalNissues who7/24/1998 on 24-JUL-1998 was vaccinated w n has been received from a consumer Y concerning his 9 year old daughter, who on an unspecified N date, was vaccinated with MMR II (Lot nu n has been received from a consumer Y concerning a her 4 year old son with allergy to metalsNand a history 2/10/2004 of high fever 2/11/2004 in approximately in n has been received from a consumer concerning her 8 year old grandson with no medical history N who in 2001 was vaccinated with a 0.5 m n has been received from a consumer concerning her grandson, a now 10 year old male, with N no known drug reaction/allergies and no per n has been received from a consumer her son, with no known drug reactions/allergies and no N pertinent medical history, who on unspecified 2/15/2009 N ### 2/13/2009 cal swollen, red , warm on lateral leftY arm. No fever. Y 3/2/2009 3/2/2009 a of erythema, fever to 101.5 degrees F 24 hours after injection of ADACEL left arm. Y 3/17/2009 3/10/2009 given 2/23/09. Patient monitored 30 minutes post vaccines. No problems or complaints reported. Y Patient 2/23/2009 returned2/24/2009 for visit 2/26/09 & repor 9 Pt presented here with vesicular like lesions to tip of nose and another vesicular like area with Y redness2/26/2009 to left side3/12/2009 of nose. Normal eye an ulopapules x 3 clustered on left upper anterior thigh at site of VCZ vaccine. U 3/6/2009 3/15/2009 izure seen at Hospital on 03-08-09.YNo activity since. Y 2/26/2009 3/8/2009 ped rash approx 10 days post SPV inoculation. Y Petechiae also noted. Pt also had a dental surgery Y the day2/9/2009 following2/19/2009 SPV inoculation and w red, hot and swollen x 6 days measured 10cm x 6cm. ZYRTEC given and started on 3/10. Y 3/10/2009 3/11/2009 and tenderness at injection site when seen one week later. U 08 patient presented as a new patient and I found she was under immunized needing one polio Y and two tetanus ### boosters.### I elected to give nted and hit her head, applied ice pack and examined by Dr. Waited in clinic for 1/2 hour after Y and was fine. 3/23/2009 Did have 3/23/2009 a bump on her forehe Y 1/26/2009 2/2/2009 hema with superficial swelling 5x6 cm over vacc site apparently on the next day. Adv Motrin,UOTC Benadryl, cold compress. ped papulovesicular lesions which developed into a rash along the T8 dermatome approximately Y Pt called 2/17/2009 back 2 days 2/21/2009 after ZOSTAVAX. th knee pain on 11-19-08 - Motrin, knee Y brace - C/o stickling knee with pain on 12-17-08; numbness U in toes-INDOCIN ### with### MRI (L) knee wit n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning N her daughter 9/2/2008 in law, 9/2/2008 an 18 year old fema n has been received from a 20 year old female with no medical history and drug allergies who Y in February2/1/2008 2008 was 2/1/2008 vaccinated with her fir ed disease of pericardium Y U 12/8/2008 ### raised area at injection site hot to touch and lump felt under the area Y 3/19/2009 3/19/2009 fic myocarditis Y U 1/12/2009 1/22/2009 carditis, unspecified Y U 12/9/2008 ### carditis, unspecified; Unspecified disease Y of pericardium. U ### ### ricular tachycardia, dizziness, chestYpain. Brought Y to emergency room 7 by ambulance and admitted N to a cardiac 1/21/2009 telemetry 1/28/2009 unit for 7 days. Nu iven IM to LD and MMR given on 03/18/09. Mom returned on 03/19/09 and child had edema Y at injection3/18/2009 site that started 3/18/2009 2 inches above in resented for follow up after recieving his small pox vaccine and anthrax on the 8th. On the 17th U he had erythema 3/8/2009and 3/20/2009 itching at the site. On ceived the zoster vaccine at the VA clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed Y a shingles 2/5/2009 rash approx 2/15/2009 10 days after the ccine was given on 3-6-09 @ 9:35 am. On 3-16-09 @ 2 pm patient developed a mild headache. N Between 3/16/2009 5:30 and3/18/2009 6 pm she developed g 09 BROKE OUT WITH 3-4 CHICKEN Y POX LIKE SORES WITH PINS & NEEDLES LIKE PAIN N AND CONTINUED 3/11/2009WITH 3/20/2009 BREAKOUTS UNT RM SWOLLEN FROM SHOULDER TO ELBOW AND WARM TOO TOUCH, STARTED ON SATURDAY U 3/17/2009 3/21/09 3/21/2009
nt received the Tdap immunization without complications on Friday, March 6, 2009. Pt stated Y she felt fine3/6/2009 with no problems 3/11/2009 until Wednesda M RED & SWOLLEN FROM SHOULDER TO ELBOW Y 1/20/2009 1/23/2009 9, approximately 24 hours after injection, left arm red, hard, swollen, hot and c/o itching. Over Y the next 33/19/2009 days, redness, 3/20/2009 swelling and itchin ped his initial symptoms of low back pain within a month of his 3rd anthrax vaccination. Y His N low back pain 12/3/2007 was later determined ### to be due t mmediately following injection of HPV vaccine. No fall or injury. Rapid recovery - regained consciousness Y 3/19/2009 when client 3/19/2009 placed in suppine po post vaccine patient developed feverY102 F. Mom was on her way to taking child to ED whenYchild had a3/18/2009 seizure in 3/19/2009 the car Shingles Vaccine and Tetanus, Diphtheria Y Pertussis (Tdap) Vaccine received from Dr. Reporting Y administered 2/12/2009 vaccines 2/23/2009 here rather than un c symptoms started in my left hand within 2-3 weeks of a vaccination in my left arm. Y It startedNwith lots of7/18/2008 tremors and8/3/2008 then certain fingers in 24 hours after Meningococcal Vaccine,the Y site of injection and surrounding area was red, painfull,swollen, U 3/19/2009 tender, and 3/20/2009 very hot to touch. H like exanthem 20 days post vaccination. Y 3/3/2009 3/21/2009 ash 2 weeks after admin of vaccine. 1/29/2009 2/19/2009 MMR on 2-2-09. Paperwork signed by pt & guardian that she is not currently pregnant, no possible way she 2/2/2009 is pregnant & understands shou wollen, red, hot to touch from shoulder Y to elbow. 3/20/2009 3/21/2009 ut of exam room after vaccinations and experienced syncope at check out desk. Event witnessed Y by/patient 3/20/2009 helped3/20/2009 down by nursing who d in arm for over a month - Stinging pain, unable to lift arm. N 2/6/2009 2/6/2009 arm cellulitis Deltoid area. Y Y 3/6/2009 3/6/2009 ays after receiving VARIVAX left Deltoid Y Pt developed erythematous papular left Deltoid which U have persisted 3/11/2009 about3/17/2009 1 week with minor loca veloped hives 2 dys after vaccines were given. Y 3/13/2009 3/15/2009 00 x 2 days. Rash x3 days - red circular Y hives. Right TM red - CEDAX, 1 tsp every day ORAPRED U 1 tsp 3/20/2009 po every day 3/20/2009 x 5 days. rythema on L thigh around Dtap & polio Y site with induration. Pt on AUGMENTIN. Y 3/18/2009 ection 3/17/09 - 1st 8 hours painful 3/19/09 rash behind knee. 3/20/09 rash to arms & legs, & N then surrounding 3/17/2009 area3/19/2009 of injection. Red papul important efect was today the Dr.toll me his LIVER get a little damage,the result from the laboratory Y give as this matter, he always have BIG upper left thigh started to swell within a day after receiving the shots. Area was warm to the touch, Y VERY2/27/2009 swollen, red, 2/27/2009 and I could feel a ha n has been received from a registered Y nurse concerning Y a 14 year old female patient with a Y history of pre-eclampsia 2/4/2009 2/4/2009 and BELL's palsy duri n has been received from a physician concerning Y a 21 year old female 21 ("who is a family friend Y of the physicians") who was vaccinated with n has been received from a physician Y concerning a patient was vaccinated with a dose of GARDASIL U on an unspecified date. Subsequentl n has been received from a physician concerning her newborn 3 month old baby who on an Yunspecified date was vaccinated orally with the n has been received from a consumer Y concerning her 18 month old son "generally sensitiveNto different ingredients" and with no pertinent m n has been received from a consumer concerning her son with no pertinent medical history and N penicillin allergy, who on an unspecified da n has been received from a consumer Y concerning her 12 months old son who on 13-DEC-2004 N was vaccinated ### with one dose of MMR II al n has been received from a consumer Y concerning her son who had been developmentally disabled N and who was vaccinated approximately n has been received from a physician Y concerning Y a 57 year old female Y hospitalized patient who N while hospitalized was vaccinated with PNE n has been received from a physician concerning Y an 83 year old female who on 17-FEB-2009 N was vaccinated 2/17/2009 with 3/10/2009 a dose of ZOSTAVAX ( ts of intussusception, each Y after given Y rotateq vaccine, Y the second episode 3 was 7 days afterYthe rotateq 3/13/2009 was administered. 3/20/2009 Was life flighted ately 8 days after administration, the site of administration became sore, then burning and painful U sensations 3/13/2009 began3/21/2009 on day 11 following adm ven varivax on 3/5/09. Within 10-15Ymins. of receiving vaccine pt. complains of flushed face,Ystinging at injection 3/5/2009 site 3/5/2009 and redness at site. P area on right arm with a darker center surrounded by an erythematous area around it. It measures U 4cm3/13/2009 by 4cm. warm 3/14/2009 to touch. No fever. linic on 03/24/2009 c/o severe painYat injection site. Unable to lift arm due to pain. Fever at injection U site3/19/2009 and erythema 3/19/2009 noted at injection sit t injection site, redness, swelling, hot to touch, tx w/ Y 3/19/2009 3/21/2009 pneumococcal vaccine trial, with severe COPD, Y was hospitalized for 2 worsening interstitial cystisis. Y Vaccination 7/28/2008 took place 3/3/2009 on 7/28/2008. Ac RSE REACTIONS Y ### ### d on the floor due to fainting. she stated Y she was dizzy and the floor was spinning. She did not Y eat breakfast. 3/21/2009 Approx3/21/2009 1/2" in length and 1/4" given on 3/12/09. She started having an erythemitous papular rash on 3/23/09. The rash began U on her3/12/2009 face and spread 3/23/2009 to her neck, ches lder swollen & extremely sensitive with severe pain for approx. 3 weeks. called office was told U to ice area. 9/24/2008 went to other 9/25/2008 office was told som veloped left-sided neck pain approximately Y 48 hours after receiving varicella vaccination. The Y neck pain3/16/2009 was related 3/18/2009 to any head movemen me to ER for 2nd injection of Hep B series on 3/10/09. The next am she noticed weakness in Y right hand3/10/2009 upon awakening.Patient 3/11/2009 was seen ceived her first shot 5/24/07 Y - she had Y sorenessYin her arm and headaches 26 Y but tollerated them. N On 10/1/2007 9/30/2008 patient 10/4/2008 was at basketball prac e, vomiting, lack of appetite, extremeYfussiness N 3/20/2009 3/21/2009 er vaccine got vesicular rash on face. Y U 3/9/2009 3/13/2009 d, Swollen, hot to touch - Afebrile TX- warm compress to site three times/day recheck in 24hrs. U 3/18/2009 3/19/2009 hours entire upper arm was erythematous, Y swollen and area around injection site was hard to Y palps - No3/12/2009 fever. By about 3/13/2009 36 hours erythem
d rash 8 days after receiving MMR and VARIVAX. Rash is diffuse on legs and trunk. There isYswelling of 2/27/2009 hands and feet. 3/7/2009 Dx'd with erythem multiforme- Itchy red rash all over body. Y Tx BENADRYL and cortisone ointment. U 3/10/2009 3/18/2009 rash on arms & forehead within 24 hrs of receiving TDaP vaccine recommended OTC BENADRYL Y & hydrocortisone 3/14/2009 3/15/2009 cream prn itching. No crying for 3 Hour for no reason Y 2/25/2009 2/25/2009 igue, itching, hands hard to make a fist. Slight chest pressure insomnia anxiety anorexia. Y 3/10/2009 3/11/2009 ation with 2x2 redness in center with small bumps and tenderness. Y 3/16/2009 3/17/2009 of injection was red and swollen - very light & hot to the touch. Sun. - redness covered all ofYupper arm 3/13/2009 - down to the 3/14/2009 elbow, pulsating & ho ure 104.2 within 12 hours of vaccine and stomach pains. U 3/16/2009 3/17/2009 was reported via a legal complaint, and described the occurrence of autism in a 4-year-old Y male U subject11/2/2004 who was vaccinated with INFANR continual ringing in left ear. Started Y 24-48 hours after receiving a .05 cc Tetanus/Diphtheria Y booster N injection. Still ###continual ### ringing today. N if he felt ok after I administered his Yshot and heY said yes, then said 2 he felt lightheaded and fainted. Y I had3/18/2009 my tech call 3/18/2009 911 and I administere s red, warm + swollen, painful T99.5. Doctor ordered Benadryl + Motrin. Area was cleared the Y next morning, 3/13/2009 but returned 3/13/2009 that evening so re dmin. 12/20/83, immediate adverse reaction, pt cried hysterically for next 6 months, Y dark black N appeared under### eyes, learning ### special ED c rts fever started 3/14/09. Rash started Y Sunday on chest & face. Itching. Swollen glands. Mucous N in throat. 3/6/2009 Seen 3/14/2009 at ER- Dx chick pox. S 3 days post VARIVAX. Seen by neurologist. Y 1/29/2008 2/11/2009 L given 3/17/2009. Patient got headache and vomiting on 3/19/2009 and 3/20/2009. Y 3/17/2009 3/19/2009 er arm completely swollen, warm but not tender, swelling was beyond elbow on 2/19/09. Recheck U if redness 2/18/2009 starts to 2/18/2009 extend rather than rec after shots given, swelling size of grapefruit, red and hot. Treatment, BENADRYL, TYLENOLYand cold packs. 3/18/2009 3/19/2009 after second dose of VARIVAX vaccine (first dose on 1/27/97) developed swollen red arm at Yinjection site, 3/16/2009 fevers, and 3/17/2009 severe myalgia. Also redness and induration distal to vaccination Y site with severe pain about 12 hrs after injection.YNext day redness 2/18/2009 increased 2/19/2009 in size with fever ed a 103 degrees fever for 2 days and Y cellulitis at the injection site. I also still have a lump inYmy arm. 3/5/2009 3/6/2009 dematous + erythematous at R upper arm surrounding injection site. BENADRYL, apply ice.Y 3/20/2009 3/20/2009 o itchy hives on Left deltoid appearing 5 days after injection. Y 2/16/2009 2/21/2009 post injection patient had large areaYof erythema >10 cm around point of injection. Y 3/9/2009 3/10/2009 se reaction reported - *Child mistakenly given Hep A 35 days prior to 1st Birthday. Y 2/10/2009 y care physician informed me on the use of GARDASIL and how it prevents cervical cancer.NAfter reading 10/1/2008 a small pamphlet 10/1/2008on the drug I a in hives on arm where injection was given and chest. Relieved w/ 2 Benadryl. Y 3/13/2009 3/13/2009 3-09 Body aches, fever, left arm swelling, red & warm to the touch. Pt given BENEDRYL & Y on 3/16/09. 3/12/2009 3/13/2009 U U ceived TDAP & PNEUMOCOCCAL on 3-16-09. Presented to office on 3-19-09 with a 4 1/4 Y X 2 1/2" red,3/16/2009 raw, hard 3/18/2009 area, painful. agnosed with chicken pox one month after receiving vaccine. U 1/19/2009 iving MENACTRA, in process of receiving GARDASIL, child became extremely pale and experienced Y LOC 3/12/2009 x about 15 3/12/2009 seconds, slumping in d arm rash lasting several days, treated Y with BENADRYL. Y 3/10/2009 3/11/2009 02/60; P 60 - R-12;- Pt feel lightheaded, skin tone change to pale. Saw spots, alteration in hearing Y (A:) Pt 3/19/2009 given Kool 3/19/2009 Aid to drink Patient lay ever 104.5, poor appetite, sleeping 21 Y hours/day. Fever controlled with TYLENOL and MOTRIN Y to 100-102 3/3/2009 degrees.3/10/2009 Afebrile 3/15/09, conti Y Y 6/11/2002 3/20/2009 swelling (half dollar sized) at injection site of VARIVAX vaccine 24 hours prior. U 3/17/2009 3/18/2009 PENTACEL on 03/10/09. On 03/11/09 which mom was changing diaper she noted L upper thigh U at injection 3/10/2009 site was 3/11/2009 swollen + red and see and induration (L) deltoid at site of injection - blanching erythema - local allergic rxn vs cellulitis. Treated3/12/2009 for both (AUGMENTIN 3/14/2009 and CLARI 3/18/2009 L dose #3 1/27/09 2/17/09 - DysuriaY with Lower Abdominal Pain UA - Large Blood, small leuks, Y Prot > 300 1/27/2009 mg/DL cx-neg 2/17/2009 symptoms lasted perienced a headache Tue evening of vaccine administration. Headache was "tolerable" and Y went away3/14/2009 by morning. 3/14/2009 given before age 1 no side effects reported. 3/16/2009 ported that injection site was red, itchy and sore since last night. Limited to round area around U injection site. 3/14/2009 3/16/2009 s were given, the patient was conversing Y with giver of immunization while drawing up 4th vaccine Y - Pt fell3/15/2009 out of chair, 3/15/2009 hit head and was seiz ng on legs. Slightly raised red rash on arms, legs, face, torso and back. 1 Temp 100.5. U 3/12/2009 3/13/2009 oke up the day after vaccinations with Y fever of 103 degrees. She was very fussy and had quarterY sized red 3/12/2009 lumps on 3/13/2009 each thigh where vacc day after vaccination. Y Y 3/9/2009 3/10/2009 ely after receiving HAV patient developed macular rash at site and upper back. Not hives, RxYwith BENADRYL. 3/16/2009 3/16/2009 s after injection - hive 3x4cm, (-) itching (-) shortness of breath --> ice pack, ZYRTEC PO, recheck Y 24 hours. 3/16/2009 3/17/093/16/2009 still with redness / (-)
HEP A dose 2 in our office mom called 1 hr later & stated child's eye lids are swelling has callUinto MD. Child 3/17/2009 has seasonal 3/17/2009 allergies. lled office 2 hrs after vaccinations were given. Child had hive- like rash on legs and abdomen. Y Instructed to 3/9/2009 give antihistamine. 3/9/2009 eared on neck 1 week after vaccineYpreceded by a headache and stiff neck. Rash is shingles-like. N Continued 2/25/2009 to spread 3/4/2009 down right arm, sho out in full body rash consisting of small, Y red, itchy dots 10 days after vaccine was administered. U Pt saw a3/13/2009 dermatologist 3/23/2009 who told him he had pprox. 11:15am shingles vaccine administered Y to L arm SQ, tolerated well. Approx. 11:30 am Y client complained 3/17/2009 of nausea 3/17/2009 VS taken B/P 13 rmation was received on 26 November 2008 from Y a health care professional. 5 A female patient Y received an 9/18/2008 injection 9/20/2008 of FLUZONE SV 2008n has been received from a physician who received a "health alert" from the state health department U concerning a 16 2/24/2009 week old patient who n has been received from a registered nurse and a nurse practitioner, for GARDASIL, a Pregnancy Y Registry 1/20/2009 product, 1/20/2009 concerning a 16 year n has been received from a consumer, Y who was the guardian of the patient, for the Pregnancy Y Registry for 4/8/2008 GARDASIL, 4/8/2008 concerning a 14 ye onset "bruising" dx: ITP.Y4-25-08 - GUILLAIN-BARRE Y Syndrome - 32 hosp Y 32 days. 4/1/09 MRY received for 11/8/2007 4 DOS- 11/27-29/07 ### with DX: Th ausea, vomiting, fever + joint pain. 6/19/09 Y Pt reports she never sought medical tx. Took Benadryl. N Case 3/17/2009 closed 3/17/2009 ced around 7:00 AM this morning that Y (R) upper arm was very red and very swollen. Redness N about 4 inches 2/25/2009 on diameter 2/26/2009 and arm is very s -warm to touch-rash over entire upper Y arm- shoulder pain and swelling radiating down arm- Referred Y to family 2/13/2009 doctor. 2/13/2009 Pt is 31, she got an M vacc 110708; presented to ER 110808 Y with itchy red rash over entire body face, extrem. Started Y with neck, 11/7/2008 broke out 11/7/2008 with all over rash next 3/17/2009 ) arm at inj site. redness, warmth, temp 100 deg. SEPTRA given for possible cellulitis. TYLENOL/MOTRIN Y 2/16/2009 for discomfort, 2/18/2009 apply cool compr 3/16/2007 ination, patient collapsed to floor - fainting lasted 5 seconds or less. BP 118/80, no dizzness, Y nausea, headache. 3/18/2009 Left 3/18/2009 with mother walked nced vasovagal reaction within one minute following injection of HPV # 3. She was sitting on Y the exam table 3/24/2009 during3/24/2009 vaccine administration ates client woke up from a nap around Y 4pm the same day of vaccination and his legs were stiff Y and he was 3/20/2009 screaming 3/20/2009 in pain. Mom states ately 4:00PM 12/7/08 Symptom: Headache Y ThisY came on suddenly. 4Pain level was a 5. Described as aching 12/4/2008 pain on 12/7/2008 back (upper) head. W presented to clinic 3/24/09 with c/o pins Y and needles and tingling in right arm x ~ 3.5 weeks. U Onset was weeks 2/9/2009 following 3/1/2009 02/09/2009 vaccin pain/muscle locking approximately Y five days after vaccine administered at left shoulder and U left elbow, tingling ### in left11/3/2008 hand 2. Prolong ccine administered in Lt Deltoid IM on 3/20/09. within 24 hiours patient reported left arm andYhand numb.3/20/2009 She experienced 3/21/2009 flu like symptom male flyer w/ no significant past medical Y history Y received smallpox vaccination 7 by scarification U on 10MAR09. 3/10/2009 Pt then 3/20/2009 deployed. On 20MAR ted a red, hot raised area on the child's left upper arm 2 days after receiving the vaccines. ItYwas 3 in in 3/17/2009 diameter and 3/19/2009 had a white area in th by Mother of client on 3/25/09 @ 08:30 Y a.m.): "Left leg is sore by her knee with swelling, redness N (in a big 3/23/2009 red circle3/24/2009 where vaccine given) administered Jan 27th, 2009. FeverYdevelopedYwithin 2-3 days of vaccine 10 administration, pt felt Y bad, experienced 1/27/2009body 1/29/2009 aches and weaknes Blood pressure, Face and eye swelling, Y shortness Y of breath and chest 4 pain went to the emergency N department 3/24/2009 and 3/24/2009 is currently admited at M red, swelling and itching, mom administered childrens benadryl ### ### ess, tightness in chest. S/s started 10 Y days after vaccination. Pt was given naproxen 500mgUtwice daily and 3/12/2009 zantac 3/22/2009 150mg twice daily. Con e reactions/symptoms. patient given extra dose of IPV (Polio) vaccine, FOC upset. 3/16/2009 ollen lump area. One lump to left deltoid 8.5x5.5mm. One lump to left arm sub-q 5 x 5mm. Lumps occurred 3/16/2009 one day 3/18/2009 after injection. ous vessicles at injection site, pain and burning 3/13/2009 3/25/2009 ve first dose of Rotateq after 15 weeks of age on 3/20/09. Infant has had no untoward affectsYwhen nurse3/20/2009 checked with the parent the next mitting this report per patient's primary Y care physician's request. Patient was hospitalized andUwas given Pneumovax 3/16/2009 3/18/2009 prior to discharge on 3/ rash broke out the night of the vaccination on elbows, moving the buttocks and then ankles. UFeet sweating profusely. ### Lasted ### about 3 week erythema, plaque lesion; mild tenderness; no fevers, no chills, no airway compromise; treated Y with ALTABAX; 3/16/2009 no other 3/18/2009 problems reported. by pt to show nurse reaction. Pt told nurse that 8:30 A.M. 3/18/2009 - area became hot to touch N & itchy. 3/17/2009 1:30 P.M. -3/18/2009 Pt went to see school n and swollen all around back of arm approximately 5 1/2 inches long. Pt. states site itches. Y 3/23/2009 3/24/2009 of throat with difficulty swallowing, fever, Y weakness, red and swollen arms Y 2/13/2009 2/16/2009 Tdap left deltoid, 3-22-09: arm sore, fatigue, 3-23-09: pain in arm with movement swollen left axillary lymph 3/20/2009 node, tender 3/23/2009 to touch, 3-24-09: aiting in line about 15 minutes after receiving iz and fainted, hitting head on wall and floor. Received Y immediate medical attention. VSS. nl ne on reported yet. Misadministration 2 hrs ago. 3/24/2009 d Acute L arm swelling + redness. Was Y seen on 3/18/09 + started on Keflex. Was seen againY on 3/20/093/16/2009 redness + 3/16/2009 swelling had improved. Thurs. night Temp 105 Friday with HA Y dizziness Temp lasting till seen Tuesday - 100.1 in clinic. Y 3/18/2009 3/19/2009 d a fever 103-104 F on Sat 3/21/09.YHe also C/O abdomen discomfort X vomited x1 and backache. U 3/19/2009 3/20/2009 ght after getting vaccines started with Y chills, low grade fever and headaches. I called doctors Noffice told it 3/23/2009 was normal. 3/23/2009 Today 3/25/2009 Son n has been received from a physician Y concerning Y an approximately 12 month old (reported as Y "1 year") male who within the last few weeks n has been received from a health professional Y Ythrough the Merck pregnancy 6 registry concerning Y a 17 year 1/22/2008 old female 1/22/2008 who on 22-JAN-200 n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 23 year 1/26/2009 old female 3/16/2009 who was vaccinated wit
n has been received from a physician Y assistantYconcerning a 16 year old female Y with no allergies Y who on3/12/2009 12-NOV-2008 3/13/2009 was vaccinated wit n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 24 year old 4/26/2008 female patient 4/26/2008 with no known dru n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 25 year old 6/30/2008 female patient 10/5/2008 with no known dru n has been received from a physician Y concerning Y a children patient who Y on an unspecified date Y was vaccinated with the third dose of ROT n has been received from a physician Y concerning a child who on an unspecified date was vaccinated Y with the third dose of ROTATEQ (Lot was received via an author of a newspaper Y article on 19 March 2009. It is part of a cluster involving U one identified eight-year-old 1/1/2009 male pati e, vomiting approximatelyY36 hrs after Y vaccine administration. Y Admitted 6 Yto SICU on 3/21/09 for U observation 3/18/2009 and close3/19/2009 monitoring for Intraven ain - whole body - muscles stiff - jawYmuscles sore sore throat - needed assistance Y dressing -Ngetting out of2/3/2009 bed - etc. 2/5/2009 Used wheel chair and stered PENTACEL, PREVNAR and Y ROTATEQ Y3/16/09. Pt had 5 generalized 3 seizures on 3/17/09. Y Temp3/16/2009 100.1 rectally. 3/17/2009 4/2/09 MR receive RA given left upper arm 3/18. Increased Y redness and swelling around site 3/20. 7"x7" warm, U firm with vesicular 3/18/2009 lesions 3/19/2009 in center, with crusti U 2/27/2009 2/27/2009 e significant pain in arm at injection site. Y Had some redness around site the next day as wellYas some joint 3/17/2009 discomfort 3/18/2009 in wrist/hand. ttered papules -> Probable chickenpox Y *Child rec'd 2 doses of VARIVAX dose #1 age 12 mos. Y dose #2 age 9/26/2007 6 yr. 3/24/2009 n, red circle about 4" in diameter at injection site. Sore to touch. 2) Slight headache and same Y feeling I get 3/10/2009 if I eat food 3/11/2009 with MSG, surprised yr old immunizations on 3/18 noted swelling & redness on right arm 3/19. Also c/o fainting feeling Y with h/a 3/19 for several hrs that subside Red rash size, 2 " in diameter started Sat. AM some soreness. 2 days later still bright red, rash Y itching. No 3/20/2009 swelling. 3/21/2009 Dx localized reaction. P 3/20/2009 cine given March 12 3:00 pm March 16 low grade fever, tired, March 18 broke out in hives. March Y 16 - 183/12/2009 low grade 3/16/2009 fever March 18 bad hiv t injection site noted after administration of vaccine. 1 tsp BENADRYL given start: 2 doses ofY steroid for 3/19/2009 HS and next 3/19/2009 day AM. izure-no treatment Y Y 3/16/2009 3/19/2009 old male subject presented to the Healthcare Y Center for evaluation of a progressively disabling Y fatigue-like 8/9/2004 syndrome that he believed was ceived varicella vaccine at ages 19 months and 10 years -on 5/12/08-. The vaccine was administered in5/12/2008 the left arm2/23/2009 at 10 years of age, loc er vaccine, he ran a fever of 100-102 Y degrees F on and off for 6 days. On the 7th day after vaccine, Y he broke 3/5/2009 out in severe 3/9/2009 full-body hives ox #2 given on 3/17/09 and came back on 3/19/09 with (R) arm posterior redness and swelling. Y Tx: Ice daily 3/17/2009 to affected 3/19/2009 area for 20 mins an t injection site noted after administration of vaccine. 1 tsp BENADRYL given STAT 2 doses with Y steroids3/19/2009 for HS and3/19/2009 in AM. immunization on 3/12/09. Parent of child noticed pain, swelling on 3/19/09 came into clinic on Y 3/20 with area 3/18/2009 of redness, 3/19/2009 swelling and pain & swelling at injection site. Y Y 3/18/2009 3/19/2009 itching, swelling, fever at injection site Y and rash extending from deltoid to elbow on (R) arm. U 3/25/2009 3/25/2009 itching, swelling and fever at injection Y site and rash extending from deltoid to elbow on left arm. U 3/24/2009 3/24/2009 n has been received from a 22 year old white female consumer (medical assistant), for the pregnancy Y registry 4/11/2008 for GARDASIL, 3/1/2008 who on 11-A n has been received through the Merck Y Pregnancy Registry via a physician concerning a 19Yyear old female 4/21/2008 with a 4/21/2008 history of tobacco abus n has been received from through the Y Merck Pregnancy Registry via a nurse, concerning a 19 U year old female 9/7/2007 with a9/7/2007 history of asthma, and ness, tingling, tightness right side ofYface, could hardly open mouth. given two 12.5 mg. childNBenadryl strips. 3/21/2009 taken3/21/2009 to Goshen General Ho ceived Tdap (Adacel) on 3-23-09 @Y3:20 pm. He awoke @ 8 am on 3-24-09 with joint aches, N chills (hot,3/23/2009 cold, sweats), 3/24/2009 malaise, weakness N TO HAVE SEIZURES AN HOURYAFTER THE VACCINATIONS. I TOOK HIM TO THE EMERGENCY Y ROOM. 2/2/2008 WHERE 2/2/2008 THEY SAID THA ceived vaccine and reports not feeling well a few hours later. Symptoms began as a headache Y and bodyaches, 3/25/2009 and3/25/2009 later progressed to swe gan about 2 hours after receiving vaccine. No local, injection site reaction. She took a Benedryl Y and was 3/25/2009 clinically stable 3/25/2009 when seen. in for labs and for a Gardasil vaccination. She was vaccinated, and then while having labs drawn, Y she became### lightheaded ### and fainted. M LASTING APPROX. 3 MINUTES TRANSPORTED Y BY EMS TO ER. Y 3/25/2009 3/25/2009 s post administration of Varicella vaccine, pt reports swelling at site. Upon inspection, erythema Y and swelling 3/26/2009 noted3/26/2009 to the site. Denies any eived second dose of pre-exposure Y Rabies vaccine on 2/3/2009, and telephoned health department Y on 2/10/2009 2/3/2009with 2/9/2009 concerns over vacci , very edematous, erythmatous, painful. able crying for more than 3 hours. Tylenol did not help. Kept on crying in her sleep Y 1/19/2009 1/19/2009 iving vaccine patient became light-headed and dizzy. Pt. admits that this has happened before. Y She said 3/19/2009 she's not 3/19/2009 surpised that this happe second dose in series of Hepatitis BYvaccine on 3/18/09. Reported that she started vomitingYon 3/19/09.3/18/2009 Was treated 3/19/2009 at an Urgent Care fa RENCE WITH LIMB MOVEMENT LEFT LOWER EXTREMITY. REFERRAL: NEUROLOGY Y 3/11/2009 3/19/2009 ect of left arm at Varicella vaccination site has several clear filled vesicles. Arm warm, red and U swollen from 3/24/2009 shoulder 3/25/2009 to elbow. 5 inch by 5 i ceived his Tdap vaccine first. It took us 10 minutes after administration of the Tdap to determine N he also3/23/2009 needed MCV. 3/23/2009 This was administe 03, nausea, vomiting approx 8-10 hours Y after vaccination Y 1/5/2009 1/5/2009 e weakness, lethargic, muscule painYin all extremities. Continued to remain ill for Ymonths with N dizziness, stomach 9/2/2008pains, 9/2/2008 diahrea, numbness ax was ordered and administered to a 2 month old patient. No adverse reaction has been reported. U 3/25/2009
was reported via medical records forwarded by a lawyer and described the occurrence of Lyme N disease in 6/4/1999 an adult female 6/4/1999 subject who wa was reported by a lawyer and described the occurrence of stiff neck in a male subject Y of unspecified N age 5/4/2000 who was vaccinated with LYMER &S inc. numbness/tingling in hands/feet. Y 12/3/08 Y ER for intense pain5 in Y joints = Dilaudid. 12/5/08 N medical11/5/2008 center = constipation/MAALOX. 12/2/2008 1 er called 2 days after immunizations was given,Ywith c/o non-wt bearing 1 and swelling at site,Ybrought pt to 3/16/2009 office 3 days 3/18/2009 after with redness, s min of getting the shot, pt had hives,Ychest pain,Y difficulty breathing, 1had called 911, pt admitted Y to hosp. 3/24/2009 4/6/09 Received 3/24/2009 hospital medical rts about 14 hours after shots, pt was seizing inY his bed. 911 was called 2 /ambulance son to hosp U and pt 1/30/2009 taken to medical 2/5/2009 center (then trans ng today to report that on 3/25/09 bright red lump appeared on left leg where she received vaccines U at 1yr3/6/2009 wcc 3/6/09. 3/25/2009 No warmth, dime siz ebrile Seizure Y Y 3/25/2009 3/26/2009 ted local reaction. Y 3/24/2009 3/25/2009 with swelling to R deltoid. U 3/24/2009 2/25/2009 r, achy all over body and nauseated. Discussed possible reaction versus onset of viral illness. U To treat fever 3/24/2009 and push 3/25/2009 fluids. If not better by ess. induration pain. Since he got the vaccine. 0 fever . given Cephalexin - Benadryl - cold compresses. Y 3/23/2009 3/24/2009 hest 3 days after administration. Rash was clustered only in this area. Y 2/5/2009 2/8/2009 swelling and warm to touch. 10x8cm. Advised to ice and apply warm compresses, observe area U of erythema 3/24/2009 circle 3/26/2009 with marker, advised, m elt woozy approx 5pm afternoon he received vaccine. Has had headache/nausea & vomiting. U Vomiting3/24/2009 occurred only 3/24/2009 on 3/26/09. r injection - Pt c/o rash, swelling, itching @ site. Y 3/17/2009 3/18/2009 delayed. Redness, warmth and swelling around injection site, 4x4cm. Given antihistamine and N hydrocortisone 3/19/2009 cream. 3/24/2009 Local Rx started sam swelling and pain after she received a MMR vaccine on 3/19/09 in Lt. upper arm. Y 3/19/2009 3/19/2009 was reconstituted with sterile water and was given as a injection to the Lt arm. Y 3/23/2009 d inflammatory reaction, right thigh from Y upper thigh almost to knee with warmth and tenderness. Y 10/6/2008 10/6/2008 he left upper arm 2cm/3cm red rash round noted left upper arm tender to touch. 3/25/2009 3/26/2009 + minimal swelling @ site. Y 3/9/2009 3/10/2009 per right arm and neck and swelling upper right chest since flu injection 2/25/09. Notices pain U in upper right 2/25/2009 arm when he lifts things. d Tdap + Typhoid 3/9/09 for pre-travel immunization. Within 10 min of receiving vaccine pt c/o Y pain + swelling 3/9/2009 L posterior 3/9/2009 deltoid. Pt. denie d 8x15cm local erythema, induration in thigh. 3/23/2009 3/23/2009 d up to ER 2/27/09 after receiving shot Y at Hospital with fever 39 + C + Febrile seizure. HIB inYFB #3 & PCV#3. 2/27/2009 2/27/2009 Y 3/24/2009 3/25/2009 ng all over started and headache 45 minutes after shot received, but able to still function. Took Y Tylenol 1000 3/25/2009 mg about 3/25/2009 3 hours later due to n has been received from a Certified Nurse Midwife concerning a female with a penicillin allergy Y who on 01-FEB-2008 2/1/2008 3/1/2008 was vaccinated IM w n has been received from an office manager and a physician, for the Pregnancy Registry forYGARDASIL, concerning ### a 23 year old female w n has been received from Y a nurse practitioner Y concerning a 16 year old female with history of Y mild reaction 3/5/2009 (itching) to 3/5/2009 orange who on 23-D n has been received from a medicalYassistant concerning Y a 15 year old female who in approximately U March 10/1/2008 2008 and in October 2008, was n has been received regarding a case in litigation concerning a 4 year old male who on 13-OCT-2000 N was 4/25/2001 given a multi-vial (first) dose of R ated that right arm was swelling, warm, Y red and firm to touch. States child c/o hurting and swelling Y seemed 3/12/2009 to be increasing. 3/14/2009 Parent took chi n has been received from a consumer concerning her son (a "6 year old" male) with history of U gastrointestinal 2/1/2004 dysbiosis and high yeast leve n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated N with one dose of MMR II on an unsp n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated N with one dose of MMR II on an unsp as accidentally administered PEDIARIX (instead of PENTACEL) et Hepatitis B resulting in anUextra dose 3/19/2009 of Hepatitis B given. Patient was c , fussiness and swollen glands. Y 3/12/2009 3/20/2009 sis and lightheadedness shortly after Tdap administration, resolved after 15 minutes. Fever 103 Y by history 3/20/2009 18 hours after 3/20/2009 injection, lasted 2 d r pt. received vaccine she started c/o feeling tired. Pt had several weeks of fatigue symptoms Y that continued until ###Feb. 11/5/2007 2008. Several differ back, chest, abdomen with itching. Resolved OTC antihistamines. Y 3/16/2008 3/18/2009 after receiving immunization, injection site red, hot & larger in size. On exam: Right anteriorY thigh injection 3/20/2009 site is firm, 3/22/2009 slightly warm, & ten ng & redness at injection site 3-20-09 Tx. cephalexin 125 mg PO TID X 10 days. Y 3/19/2009 3/20/2009 ven Tripedia U2397BA instead of Td with pertussis. No adverse event reaction. Adverse reporting Y notified. 3/20/2009 Physician states that re-vaccina ven Tripedia U2397BA instead of Td with pertussis. No adverse reaction. Adverse reporting notified. Y States 3/20/2009 that re-vaccination was not requ se problem- Pt was given DTAP Tripedia U2397BA instead of Td with pertusis- was told revaccination not3/20/2009 needed. om left thigh red, hot and swollen since Y vaccine given on 2/25/09. U 2/25/2009 2/25/2009 om left upper arm with erythema, hotYelevated rash 3"x 2 1/2 ". 2nd degree to vaccine area. U 3/18/2009 3/18/2009 d headache within 2-3 hours after Typhoid Y vaccine. Within 24-30 hr joint paint in hips,shoulders,elbows N and 2/23/2009 knees. Elevated 2/23/2009temp at 72 hou LATTER PART OF FEBRUARY Y PATIENT Y REPORTED Y TO LOCAL60 EMERGENCY ROOM WITH U COMPLAINT 12/3/2008 OF WEAKNESS 3/1/2009 AND LEG P
SSIC LESIONS, BUT HAS RECIEVED 2 VARIRAX AND THE DISTRIBUTION AND ITCHINESS U ARE C/W 6/19/2007 CHICKENPOX. 3/25/2009 es and Fatigue increasing in first 6 months Y after, leading up to dizzy and fainting spells, low blood N pressure, 4/24/2008 and Migraines. 4/24/2008 Still experiencin n to have TB test read 3/13/09 1300. Rt deltoid where Tdap injection had been given "circle slightly Y larger3/11/2009 than a quarter 3/13/2009 is red, warm to tou S ADMINISTERED IN AM ON 3/24/2009. T/C FROM MOC 3/27/09 AT 9:15 AM TO REPORT CHILD C/O 3/24/2009 HER LEFT 3/27/2009 ARM ITCHING. aRM DM, HTN, HLD, BPH p/w weakness that started Y yesterday midmorning. 18 He firstYfelt weak during N work, when ### he noticed ### that he could not PAIN LEFT SHOULDER SINCE INJECTION- POSITIVE RASH N 2/25/2009 3/1/2009 ved vaccine on Fri. She did not experience Y any adverse effects until waking up the next day.Y She was dizzy, 3/20/2009 had some 3/21/2009 episodes of rapid h 3rd 2009 my son recieved the Varicella vaccine along with the Hepatitis A and MMR vaccine. U Seven days3/3/2009 later he had 3/10/2009 a slight fever aroun headache from day after vaccine 4YMarch 2009 to 12 March 2009. Accompanied by fever (101 Y deg), chills, 3/3/2009 burning 3/4/2009 eyes, cough, sore thro ented to er on 3-20-09 with a full body rash andYfever of 105 F. Admitted 6 to hospital the nextYday. currently 3/16/2009 the rash3/21/2009 has faded, no temp., l e. After receiving Hepatitis A IM 0.5ml Y injection the nurse noted that the patient was not breathing Y with his3/20/2009 eyes rolled 3/20/2009 back and body had be nd shoulder very sore, swollen, difficult to move arm or shoulder. SiteYreddened, swollen raised, Y warm to3/24/2009 touch for several 3/25/2009 days. 4/28/09 R me red, inflamed, sore, patient developed fevers Y 3/5/2009 3/6/2009 inoculated with 6 separate vaccines at approximately 3:40 p.m. and after about 2 min., MomYnoticed that3/26/2009 child's face 3/26/2009 had broken out with h t started at the site of the pentacel injection and then extended to the length of the leg, the other Y leg, the3/26/2009 arms, the trunk, 3/26/2009 & the face; red/pin shot was given, her legs started teitching. Y TheYdoctor told me this 26 was normal. ItYkept up, got N worse where 12/9/1999 she would turn### blue, eyes bulge & induration on left arm measuring 3 1/2 X 5 1/2. Y 3/25/2009 3/26/2009 r, injection site pain, redness, swelling, Y pain in eyes Instructed to see physician Y 3/24/2009 3/25/2009 ed the following from a consumer via the agency on 12 MAR 2009: A 58-year-old female patient, N was vaccinated with FLUVIRIN i.m. in Oc d with 2 doses of 2 month immunizations < 28 days no adverse reaction reported @ 5 days.Y 3/23/2009 high and red area both size of a dime. No swelling of the leg. Applying cool pack and TYLENOL. N 3/24/2009 3/25/2009 d raised blister like lesions with erythema base at site of injection (clustered), then dried and Y became flesh 2/19/2007 colored. No 3/13/2009 fever, no other lesion F at 11 PM, following immunizations Y (PEDIARIX, HIB, PREVNAR, ROTATEQ) in the morning. Y 4/7/09 Received 3/26/2009 ER3/26/2009 medical records of 3/2 wollen @ injection site with mild painYinduration measured @ 4 X 4, mom was told to apply cool U compress 3/24/2009 to site. Admin. 3/26/2009 BENADRYL 1 tsp leg with large warm erythematous Y area tender small rash macular to same leg lateral side, two U days after 3/24/2009 vaccine. 3/24/2009 Treated with KEFLEX 1 der joint pain with occasional low grade fever at night. N 2/27/2009 2/27/2009 and swelling at injection site pain through shoulder, arm, 50 mm x 50ml L deltoid. U 3/23/2009 3/24/2009 eived IMOVAX IM on 3/26/09 on L deltoid. Reports severe pain and knot at injection site andYlimited range 3/26/2009 of motion3/27/2009 L arm at 9am on 3/27/ a of swelling & redness in deltoid area of left arm. Y 3/17/2009 3/20/2009 ent BOOSTRIX instead of HAVRIX along with IPOL, MMR, VARIVAX and DTap. Y 3/24/2009 fter GARDASIL (#2) Pt developed acute respiratory problems. "Lack of breath" after thanksgiving Y dinner. ### ### nausea, sweating - soon after injection - Pt put head between legs - pt felt better in 10-15 minutes. Y Offered 3/27/2009 pt. cold3/27/2009 water - pt said she wa ction - redness and induration on left deltoid. N 3/24/2009 3/26/2009 7/09 for "diffuse maculo - papular rash "from abdomen down -slight "scaly" feel to it - macular rash on bottom 3/26/2009 of feet.3/27/2009 MMR began screaming, writhing and Y complaining of arm pain (not at site of injection which Y was not inflammed) 3/25/2009 screamed 3/25/2009 x 3 hrs, had feve ought patient in stated that his R leg was swollen. Pt was given injection on 3/18/09 on his RUleg was his 3/18/2009 IPV and DTP. 3/20/2009 Dr look at Pt and inf tingly warm feeling in L fingers (1st and 2nd digits). U 3/27/2009 3/27/2009 at injection site, redness and swelling Y around elbow and an overall sick feeling. Y 2/25/2009 2/26/2009 Y Y 2/26/2009 02, irritable. S/S started pm 3/23/09. Redness, warm to touch right thigh edema. Left thigh edema Y and "knot" 3/23/2009 present 3/23/2009 treated with Tylenol. d HPV (GARDASIL) #2 in L deltoid. Here for TI DM follow-up, not acutely ill. Within < 1 min, Y pt c/o pain, 3/26/2009 and erythema 3/26/2009 noted. I was called in U 3/10/2009 3/21/2009 at injection site, redness and swelling Y around elbow and overall sick feeling. Y 2/26/2009 2/27/2009 s given but it was suppose to be a DTAP due to patients age. 3/19/2009 nausea, headache, slurred speech.Y 4/17/09 MR received from PCP from 3/25 to 3/27/2009. U Seen for PE 3/25/2009 and vax 3/26/2009 3/25/09. Seen 3/26/09 f receipt of FLUSHIELD Lot #4998274 Y in 1999 to her left deltoid. The next day she noted fine Ypruritic red spots 10/8/1999 to bilateral 10/9/1999 cheeks progressin nt reported receipt of IM influenza vaccination Y at NMCP while working the ER in 2002 or 2003. Y He denied 12/7/2007 any illness 12/8/2007 (URI) prior to this vac er injections, raised, red area around injection sites. Advised to apply cool compresses, and Yadministor 13/27/2009 tsp oral Benadryl 3/27/2009 every 6 hours a ZY AND LIGHTHEADED, FELT BETTER ONCE SHE LAID DOWN ON THE EXAM TABLE FOR Y ABOUT3/27/2009 20 MINS 3/27/2009 EPORTED TO PEDIATRICIAN Y ABOUT HIGH FEVER. Y TYLENOL NOT 53 Y WORKING. BY 2/28/09 U FEVER HIT 2/17/2009 103.7. TESTED 2/23/2009 POSITIVE FOR Flu vaccine on 3/12/09. Had R leg pain starting on 3/18 and fever on 3/17. Seen in the office U on 3/19 and 3/12/2009 noted to3/18/2009 be walking slowly on to
cinated with MCV4 (MENACTRA) 3/24/09, Y returned 3 days later with swelling and pruritus ofYinjection site. 3/24/2009 She was3/25/2009 treated with Benadryl. to severe hives, relieved by antihistamine; severe itching, redness and swelling at injection site Y for 24 hours. 3/27/2009 3/27/2009 ves on ankles and lower leg, relieved by antihistamine. Itching at injection site for 24 hours. Y 3/27/2009 3/27/2009 fever-102, chills, body aches, mild headache. Soreness in arm. Symptoms lasted 48hrs, although N fever 8/26/2008 lowered to 8/27/2008 100 on 2nd day.11/08-p ful, hot to the touch, egg sized knot @ injection site. Fever up to 100.8, chills, body aches,generalized Y weakness 3/25/2009headache,nausea, 3/26/2009 loss of ceived shots Dec. 29th, seizures Y started Y that weekend Y following, progressed 6 into Y5-10 daily, N mostly rt. sided jerking ### turning 1/4/2009 blue and eyes g 03.5 at 0130 in the AM on the day after Y the shot, that would not go down w/ Tylenol, Motrin U or tepid baths. 3/23/2009 Fever stayed 3/24/2009 around for 3 days ort received from a health care professional Y on 13 March 2009. The reporter stated that two of N his patients "got ### the Flu" 3/5/2009 after receiving FLUZ ort received on 19 March 2009 from Ya consumer who is the patient's parent. A male patient had received DTaP when he was an infant (man ort received on 19 March 2009 from Ya consumer who is the patient's aunt. A female patient had received a DTP vaccine (manufacturer, lot R upper arm injection site. Headache, nausea, myalgias, arm pain, itching. Prescription for hydrocodone Y 3/19/2009 and prednisone 3/20/2009 given. high red and swollen over entire lateral thigh from knee to hip. Treatment per Dr. > ice and Y watch for further 3/25/2009 developments 3/26/2009 3-30-09 I spoke d 3/9/09 - on 3/14/09 mother noted fine red rash on face, abdomen, neck trunk & upper legs,YNo treatment. 3/9/2009 3/14/2009 ought patient to the clinic on 3/23/09 to be evaluated by RN. Child was "covered" in pox. Some Y were still3/17/2009 in the vesicule 3/20/2009 stage, but most we and swelling LUD. Warm to touch. Soreness X2days. Mother states applied ice and gave TYLENOL Y for 3/3/2009 low-grade fever 3/4/2009 X1day. & swelling on arm - right side. Y 3/23/2009 3/28/2009 2 degrees) multiple muscle aches, mild Y nausea was seen and released from ER 3/25/09 stillUhas muscle3/23/2009 aches & erythema 3/25/2009 around injection lled 2 days after vaccine to say that vaccine site " reddened and raised" (erythema) starting Y about half dollar 3/18/2009 in size3/20/2009 and moving "to a much on, large area of redness and swelling at site. (baseball size) + pain+ itch + fever 102-103 degrees, Y 5x within 2/23/2009 6 hours 2/23/2009 of injection. Resolved fter immunizations, child had red, swollen Y left deltoid. Also c/o HA & burning throat & not feeling Y well. Parent 3/18/2009 took child 3/19/2009 to Dr. on Fri, 3-20rmation was received from a health Y care professional on 09 October 2008. A 35 year old pregnant female 9/22/2008 with no reported### obstetric history was received on 23 March 2009 from a health Ycare professional. A 4 month old female patient received 2/11/2009 ACT-HIB lot2/12/2009 number UF516AA (Sa n has been received from a consumer concerning his son, with no pertinent medical history N and no known2/1/1991 drug allergies, who in February 1 n has been received from a consumer Y concerning his 12 month old son with no pertinent medical U history and no drug reactions allergies wh n has been received from a consumer concerning her son with no medical historyY or drug allergies U who was vaccinated with the booster do n has been received from a registered nurse and the mother of a 9 month old male who on 10-DEC-2002, U 3/5/2003 05-MAR-2003 3/5/2003 and 10-JUN-2003 n has been received from a registered Y nurse and Y from a mother concerning Y her approximately U 35 months old son with oesophageal acid re n has been received from a physician for the pregnancy registry for GARDASIL concerning aY 14 year old 1/3/2008 female who1/3/2008 on 03-JAN-2008 was n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y15 year old female 6/9/2008 with no 6/9/2008 relevant medical his pain radiating from back to front 1 wk post vaccine. Denies rashes or other symptoms stateYwent to ER 2/25/2009 & was "ruled3/4/2009 out for heart problem 2mo shots on 3/9/09. Had seizure Y on 3/19/09. Febrile after seizure noted. Continued to beYfebrile X 2d. 3/9/2009 Fever broke, 3/19/2009 developed full body d with joint pain, & nausea vomited 1 time - joint pain worsened thru the day, difficulty walking. U Next day3/19/2009 less pain, still 3/20/2009 had nausea 3rd d. 1st immunizations 3/13/09 - PEDIARIX left thigh, HIB left thigh and PCV7 right thigh and RV5 N orally. Developed 3/13/2009 subjective 3/13/2009 temp few hours reports today that child is dizzy and has redness about size of a "fifty cent piece" some swelling U and warmth 3/3/2009 in area where 3/5/2009 TDAP was given h and hair loss. Y U 2/24/2009 2/25/2009 ZOSTAVAX 2-2-09, then developed rash to both lower extremities (below knees) on 2-7-09 U - Only fine red 2/2/2009 rash, no blisters 2/7/2009 - Describes ras with red patches and small white welts Y on upper torso and itching; within 5 mins of receivingUimmunizations. BENADRYL ### ### was given (1 1/2 ought child back to Health Dept due to redness, swelling and fever to right thigh. Client received Y immunization 3/16/2009 to area 3/17/2009 3/16/09. Mother appl received 3/16/09 5pm, Mother called Y Health Department 3/17/09 stated child broke out in hives Y on trunk,3/16/2009 back, "water 3/16/2009 blisters" under eyes. d redness, swelling, pain and welts on Y left arm from shoulder to elbow. Saw MD on 2-5-09. Given Y Z-Pak, NAPROSYN, 2/4/2009 2/4/2009 steroid and steroid c was reported by a lawyer and described the occurrence Y of arthralgias in a male subject of unspecified U age 7/13/2000 who was vaccinated with LYME ype rash on legs and arms, widespread and itchy. Y 3/25/2009 3/26/2009 Sore + tender - Hurt with movement 3-25-09 redness started on hours later but less tender 3-20-09 Y - still3/24/2009 red to arm,3/24/2009 warm to touch. 11.3 w. with redness, warm to touch, itchy to left upper arm. Instructed parent to apply BENADRYL Y oint. Cool 3/6/2009 compress 3/7/2009 2-3 times per day, T as given a second dose of Hep A vaccine Y and within seconds she fell backwards and hit her head. Her back 2/5/2009 remained2/5/2009 arched backward an gling in jaw and lips, very mild. 3/12/09, Y spasms in jaw and face itching. BENADRYL 25mg. U For one per day 3/6/2009 q6h prn 3/6/2009 itching. 3/18/09, office nd numb feeling in legs, itch associated Y with tingling. Also tight feeling in legs. U 3/25/2009 3/25/2009 s given a Tdap on 03/24/2009. When entering data on MCIR, imm clerk noted that Tdap wasYgiven per private 3/24/2009 provider 3/24/2009 on 11/08/2008. Th AS GIVEN HIB AND PCV7 ON 3/24/09. Y PT HAS A HISTORY OF SEIZURES. PT WAS CLEARED Y TO GET 3/24/2009 IMMUNIZATIONS. 3/25/2009 CHILD'S MO f injection site, low-grade temperature, muscle soreness, fatigue Y 3/27/2009 3/27/2009 clinic as walk-in with c/o non-productive Y cough with shortness of breath x 2w after the evening U after he 3/11/2009 got his Pneumovax. 3/11/2009He states he i
and bruising noted at injection site on March 27, 2009. Noted discomfort on March 29 to injection Y site around 3/24/2009 10, awoke 3/27/2009 client up, discomfo other call to Health Department on 03/30/09, Y received 1st HPV 07/29/08 at Health department, U no adverse 9/30/2008 reactions10/7/2008 after this vaccine. Rec AFTER RECEIVING THE ZOSTAVAX VACCINE THE PATIENT REPORTED PAINFUL RASH Y AT INJECTION 3/24/2009 SITE 3/25/2009 BUT ALSO BILATER swelling began left arm. 03/27/09 reddness and hot feeling occured with fever of 101.8. 03/28 N and 03/293/23/2009 swelling increased 3/26/2009with itching. De on Thursday, March 26, 2009. Initial itching within minutes. Friday, March 27 area around injection U site was 3/26/2009 swollen,3/26/2009 red and hot. Evening F and deep bone & body aches, site of shot swelling,(6 X5 inches) red and hot X 5 days so far. U Nausea X3/27/2009 4 days. Unable 3/28/2009 to sit up longer th Very fatigued, with severe swelling of arm from shoulder to elbow. Muscles in back of arm extremely Y tender. 3/24/2009 Ran fever 3/24/2009 alternating with ch aims "huge" bruise near elbow and quarter size bruise at injection site. Red in between bruises. Y Not painful, 2/13/2009 but states 3/16/2009 that she was on che pt of AVA # 1, TYPHOID, and SPV on 22 Jun 07, Y SM reported localized 5 soreness, low gradeY fever, muscle 7/25/2007 twitching and insomnia. ### Insomn h with significant swelling, urticaria 8x6cm area. Treated with BENADRYL 'X2 with improvement. Y 3/17/2009 3/18/2009 as given MMR and Varicella injection. Within 2 minutes of vaccine patient's legs swelled and Ya rash appeared. 3/30/2009 Was 3/30/2009 given 7.5 mg of BENAD about 3 hours, didn't want to be touched. Soft spot on head was hard. U 3/24/2009 3/24/2009 ction 3/18/09 left deltoid, 3/19/09 wife Y noticed red ring around injection site. Pt. didn't sleep all Y night due 3/18/2009 to left arm &3/19/2009 pain up in left side of n eaction at injection site 4 x 3 cm, + erythema + edema, TX BENADRYL, ice and CLARITAN.Y l over forward while sitting on the floor Y 4 hours after vaccination. Found to be breathing but blue Y lips and non-responsive. 3/9/2009 3/9/2009 Event lasted abou was given Mon 3/23/09 about 12:45PM Y Pt started with nausea, + diarrhea that evening 4PM. YSeen in ER3/23/2009 on (Th) 3/26/09 3/23/2009 Given 1 liter of IV d redness, swelling and pain at injection site on right arm. Y 3/28/2009 break - vaccinated 3/5/09. U 3/5/2009 3/28/2009 associated Varicella rash. Y ### 1/17/2009 ite reaction. Sore with in 12 hours, redness and increased pain by 24 hours mark, 2" x 3" redness, Y raised, 3/26/2009 warmth from 3/26/2009 the area. No fever. n at 32 weeks and 10 days (too late for 3rd dose to be given). U 3/27/2009 h swollen, red, warm to touch - consistent Y with cellulitis. Will treat with SEPTRA 1 1/2 tsp BIDUX 10 days 3/27/2009 and BACTROBAN 3/29/2009 topical TID x 10 t shingles around 3 days after the vaccine (March 20th is when she started having symptoms). U Patient got better after medications were giv ent received a pediatric dose of Hepatitis A, no adverse events, no treatments needed. Y 2/27/2009 n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 24 year ### old female ### with a history of n has been received from a physician Y concerning Y a 70 year old male 0 patient whoYon 11-MAR-2009 N was 3/11/2009 vaccinated with a dose of ZOSTAV n has been received from a consumer concerning Y his granddaughter 0 (a female patient of unknown U age) who experienced paralysis after ge n has been received from a physician Y concerning Y a 15 year old female 2 Y patient with atypical seizure N disorder 3/10/2009 (started3/13/2009 following an episode o n has been received from a nurse practitioner Y concerning a 25 year old female with no allergies Y who on 5/22/2007 22-MAY-2007 4/1/2008 was vaccinated IM w n has been received from a physician Y concerning Y an approximately 13 year old female, who on Y 29-JAN-2007 6/4/2007 was vaccinated 3/1/2009with the first d n has been received from a consumer Y concerning Y her approximately0 20 month old son with N no pertinent 5/11/2006 medical history 5/11/2006 and no known drug n has been received from a consumer concerning "three of her friend's sons" who were vaccinated U with MMR II (lot number, route and site n has been received from a consumer concerning a stranger's granddaughter who was vaccinated U with MMR II (lot number, route and site n has been received from a parent concerning her son via e-mail a male who was vaccinated U with MMR II and subsequently the child expe n has been received from a consumer reported "she knows several children (exact number is U unknown) who experienced a high fever and n has been received from the mother of her 12 year old son with a previous Pyloric StenosisUsurgery, who was vaccinated with a dose of M n has been received from a consumer Y via the internet concerning her 16 month old son whoNin January 2005, 1/1/2005 was vaccinated 1/1/2005 with a dose o n has been received from a consumer via the internet reporting that she knew of toddlers who U on an unspecified dates were vaccinated wit n has been received from a consumer concerning her daughter who on an unspecified date U was vaccinated with a dose of MERUVAX II. S ort received on 17 March 2009 from Ya literature collection. " A previously healthy 17 month old N boy was inoculated with FLUZONE SV '2005 us case was received on 26 March Y 2009 from another manufacturer. The initial reporter wasUthe consumer's spouse. A male patient receive states pain, erythema, and tenderness Y developed Y at sites of vaccines 2 given 3 days prior to ER U admission 3/25/2009 at hospital. 3/25/2009 Erythema & warmth s ruising and petechiae inYApril/May 2008. Y Petechiae Y on lower legs and 6 feet. 4/24/2009 MR received N for DOS 1/30/2008 2/17-19/2009 4/1/2008 WITH D/c dx: Im d chest pain, SOB and diaphoresis. YAdmitted toYclinic and diagnosed4 with MI. Troponins elevated, EKG normal, 1/30/2009 Cardiac 2/11/2009 cath primarily norm d 13 1/2 x 12 cm reddened swollen and warm to touch. Rub area 2 Hrs. and apply ice pack for U 15 min. for 3/26/2009 24 Hrs - then warm compress. reaction, red, warm to touch, raisedYarea 2 1/2 X 2 inches RT. Y 3/25/2009 3/26/2009 elling With mild erythema. Y Y 3/26/2009 3/27/2009 d a hot, red, swollen lump under skin where vaccine was given. Are marked with skin marker. U Patient advised 3/23/2009 to contact 3/26/2009 clinic if redness or around injection site. Low grade fever. Cool compress and TYLENOL prn. Y 3/24/2009 3/25/2009 r injection I got very hot and dizzy. I could not stand up. Health Dept had to lay me down. MyYblood pressure 1/16/2009 was very 1/16/2009 low, I was pale in col d rash on Both anterior thighs within 24 hours after vaccine slightly pink maculopapules on both thighs. 3/23/2009 3/23/2009
pain, swelling radiating up to neck and down to fingers.
N
2/19/2009 2/20/2009 3/18/2009 ately 48 hours after administration of Tdap + MCV4, Pt. had fever & didn't feel well. Could not Y pin point. 3/17/2009 16 hours later 3/19/2009 cried uncontrollably se event, dose given 3 weeks to soon. 3/20/2009 d low grade fever, arthralgias and red swollen area at injection site. Y 3/19/2009 3/19/2009 swelling and hot touch. 3/20/2009 3/21/2009 d in ED 3/11/09 with possible seizure. Per parent history lasted several seconds, child's eyesYrolled up, became 2/24/2009 stiff 3/11/2009 and poorly responsive. ction of pain, warmth, + erythema (7X 15cm) Y 3/18/2009 3/20/2009 arm red and swelling. Y U 3/17/2009 3/18/2009 len arm, bump, raised and hard. 3/24/2009 swelling of left arm. 48 hrs. after receiving Imm's. 0 temp. Y 3/25/2009 3/27/2009 Office visit - Dr. - Shingles on R forehead & scalp - mild - 2 wks. 12/23/08 - Office visit - Dr.Y- Pink eye 2/20/09 3/28/2007 - Office visit ###- Dr. - Shingles :40p seen for erythema 3.5 cm X 3.5 Y cm & sore. Right Axilla tenderness. R upper arm started Y 3-17-09 with 3/16/2009 pain in 3/18/2009 Axilla & progressed to i ale received DTAP, MMR, VAR, IPV, Y HEP A 3/27/09 no history of recent illness! h/o febrile seizures Y 3/28/09: 3/27/2009 pt sleeping, 3/28/2009 woke up @ 1AM hard knot. No fever or child. Did notYtreat with AX. Kept close eye on arm. Y 3/23/2009 3/25/2009 o left arm. Running temperature started Y evening after vaccine. Started on Ax on 3-20-09. Y 3/17/2009 3/17/2009 at injection site was warm to touch, red and very hard. Y 3/25/2009 3/25/2009 Y 3/12/2009 3/24/2009 l from mom got Imms (HIB and PVNR) Y 3-23-09. On 3-25 had a seizure in the car. He had been Y drinking 3/23/2009 a bottle, began 3/25/2009 shaking, and choki ately 15 minutes after receiving vaccine she started feeling shaky, clammy, itchy, KP 3-25-09Nnauseous, 3/25/2009 & became 3/25/2009 diaphoretic & light head ccine administration on 3-23-09 @ approximately 1645. She stated she was fine until 2200 that U night. She 3/23/2009 noticed hives 3/23/2009 on arms, legs, & a as given adult dosage of Hep A. 3/23/2009 le with generalized mildly pruritic maculopapulae Y eruption of the arms, sides, flanks/ lower back, Y legs, feet 2/18/2009 and hands3/5/2009 approx. 2 weeks after
Y 3/24/2009 3/24/2009 turned to office 3-23-09, after vaccine 3-20-09 with rash. Reviewed sx and hx with MD who U also saw patient. 3/20/2009 Diagnosed 3/21/2009 with viral EXANTH ceived Pneumovax 23 vaccine IM to right deltoid Y on 03/24/09. On 03/25/09 1 he presented with Y progressive 3/24/2009 painful swelling 3/24/2009 and erythema a mth and induraton at vaccine site. Tender aillary nodes. U 3/28/2009 3/29/2009 POL on 3/27/09 and developed hives Y within 24 hrs Y 3/27/2009 3/28/2009 inistration of GPV, patiient expressed feeling weak and nausea. Provider was notified and patient Y was taken 3/3/2009 to tx room. 3/3/2009 Initial BP was 104/6 ted to have a thigh mass one monthYafter administration of hib3 and flu vaccines. The massYcontinued to grow### and was removed ### on 12/23 CALL A DAY AFTER AND COMPLAINS Y OF DIFFICULTY IN BREATHING, HEAD PAINS, SWOLLEN Y TONGUE/THROAT, 3/24/2009 AND LEFT SID 9 Mom reports to IM clinic at 2nd shot Y visit, thatYpatient developed projectile 1 vomiting & abd.Ypain about 24 hours ###after his ### 1st set of shots. rm after Tdap vaccine given on 3/16/09. Small amount of redness noted after injection. About Y 3/19/09 employee 3/16/2009 noted 3/19/2009 increase redness, sw d a tactile fever for 3 days after the vaccine and then developed a blanching, macular rash on Y the face, torso, 3/24/2009 arms3/24/2009 5 days later. eloped localized eythema of injection site approx. 4-8 mm per Mother of client via phone call.Area U reported 3/23/2009 as triangular 3/23/2009 in shape with bruis IA/HIVES- TREATMENT ATARAX 10 MG PER 5 ML-1 TEASPOON EVERY SIX HOURS. BAKING Y SODA OR### OATMEAL### BATHS. wing was reported by the client: Vaccines Y given on 03-09-2009 in the morning with complaintsUof soreness3/9/2009 at the injection 3/9/2009 site and a mild he prox 5 min after vaccination received. Recovered quickly. Y 3/30/2009 3/30/2009 clinic and later seen on 3/30/09 forYan urgent visit for complaints of non-pruritic red rash onUleft side of trunk 3/24/2009 - Per PCP 3/27/2009 physical exam: ery r for three days (T. Max 103.7f Y 3/28/2009 3/29/2009 1/31/2009 Y Y Y 9 Y N 1/15/2009 1/30/2009 s began the same evening I received Y the influenza vaccination given at work site. Fever, body N aches, sore throat, ###weak, lightheaded, ### dizzin g warmth, redness injection site 2. Left axilla pain -> tender enlarged isolated 2.5 cm lymph node U 3. Non-tender, 3/26/2009 sl. irritated rash - both axill erythema rash, primarily to trunk and bilateral legs. Y 3/26/2009 3/30/2009 barky cough, hard time breathing red Y welt on L arm. Y 3/30/2009 3/31/2009 dministered on 3-20-09 in AM. By afternoon tips of fingers hurt. Played basketball after school. Y Noticed3/20/2009 tips of fingers 3/20/2009 had blisters. Some o body ache, weakness, pain in left arm, behind shoulder and left upper chest. Pain and discomfort N with ROM. thigh: No tx. Telephone advice given. Right thigh. Y 3/24/2009 3/26/2009 ger than a bean) tenderness, slight redness and warmth near L shoulder. U 3/27/2009 Y U 3/30/2009 3/31/2009
round mouth with swelling spreading Y over both cheeks over period of several days. Applied steroid Y cream 3/19/2009 which helped 3/19/2009 -> course last 5 da hrs after receiving 6mo vaccine hadYvomiting with associated limp/pale episode. No seizure activity. Y Returned 3/16/2009 to baseline 3/16/2009 within 60-90 min. ns on labia - lidocaine jelly, ACYCLOVIR 200 mg/ 2tsp TID 5cc TID. 2. Fever 100.2. 3. Coughing U for 3 days. 2/27/2009 4. Colitis 3/3/2009 x 3+ days. 5. Pharyng ve nodule. No sign of infection. U 3/18/2009 3/28/2009 minutes after administering HPV vaccine, patient fainted. No history of fainting in the past. Y 3/31/2009 3/31/2009 ought her daughter in @ 1630, with a nodule on left leg about the size of a quarter. I referredUher to PCM5/21/2008 as W/I. Patient 5/21/2008 didn't seem to hav spot, raised area, Lt upper arm where varicella was administered. Dr checked area on 3/31/09. Y 3/30/2009 3/31/2009 ic reaction, This case was reported by a healthcare professional via a sales representative and U described 3/12/2009 the occurrence 3/12/2009 of nonspecific rea ction, My daughter immediately put her head back and said I don't feel very good. I feel like I'm Y going to faint. 3/31/2009 The nurse 3/31/2009 was standing behin n has been received from a pediatric Y medical records and a physician concerning a 15 weekNold bottle fed female ### with 1/19/2009 no known drug aller n has been received from a registered nurse concerning her 1 year old son with milk Y allergy N and no other medical history who was vaccinat n has been received from a consumer concerning her 42 month old son with "gene mutations" N who "when 12/1/2006 he was 15 month old" in approxi n has been received from a consumer Y via the internet concerning her now 5 year old son who N on an unspecified date was vaccinated with n and follow up has been received from a physician for the Pregnancy Registry for GARDASIL Y concerning1/9/2008 a 18 year 1/9/2008 old female with sulfon n has been received from a nurse for Y GARDASIL, a Pregnancy Registry product, concerningUa 21 year old 1/15/2009 female with 1/15/2009 no medical history o n has been received from a medicalYassistant concerning a 16-year-old female with no medical Y history or3/25/2009 allergies who 3/25/2009 on 25-MAR-2009 w n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from someone concerning 2 n has been received from a physician concerning a 19 year old female who was vaccinated U with unknown how many doses of GARDASIL. aving severe stabbing ache in shoulder & upper arm approximately 2-3 days afterYvaccine. Began N having, numbness ### & tingling. ### Discolorat Cm red, raised, hot area c/o itching Yat the site starting the next day. TX: Ice, Benadryl and Hydrocortisone U 3/25/2009 cream. 3/26/2009 ceived PNEUMOVAX vaccine on 3/11/09. contacted outpatient primary care clinic on 3/30/09 N with the following 3/11/2009 - c/o3/30/2009 non-productive cough eloped ROTAVIRUS infection after receiving vaccination. Y 1/7/2009 1/13/2009 d to clinic the day after receiving vaccine. Y Per her report approximately 30 min after receivingY vaccine her 3/24/2009 arm started 3/24/2009 swelling, she felt feve possible mixed with IPV form submitted per CDC recommendations No Reaction per client's parent. 3/30/2009 Mom states light rash on face yesterday prior to vaccines (not mentioned or noticed prior to injection) this 3/31/2009 morning (4-1-09) 4/1/2009 child has fine ras heavily speckled line or band going up his arm from the injection site. U 3/12/2009 3/13/2009 ame dizzy after vaccination Y 3/30/2009 3/30/2009 vers a day, bad headaches with fever, sore throat, stopped up nose or runny, weak, upset stomach U and vomiting, 2/3/2009pale 2/9/2009 skin, cried because as given flu shot and pneumonia vaccine Y right before discharge. Patient reports that when he U got home 3/15/2009 he began experience 3/15/2009 generalized p d one-sided facial palsy with a significant Y droop that affected the eye early in February of 2009. Y Went to 1/13/2009 ER. Significant 2/10/2009 change in sensatio eloped fever and had febrile seizureYat home Temperature 102. Child is fine today. Fever was Y treated in3/23/2009 ER 3/31/2009 ular rash over chest, abdomen, and back within 15 minutes of injections. No treatment administered. U Still 3/31/2009 present early 3/31/2009 AM the following da LOST CONSCIOUSNESS AFTER RECEIVING THE LAST OF 5 VACCINES. CLIENT WASYSITTING IN3/31/2009 CHAIR AND 3/31/2009 HEAD FELL BACK. post-vaccine: egg-shaped area of rash on arm below shot site; @ 30 hrs post-vaccine: sudden Y onset of moderately 3/28/2009 3/29/2009 severe muscle/joint pai ver vaccination given on 3/27/2009 @ 10:20 a.m. Student returned to Clinic at 11:35 a.m. forYswelling of3/27/2009 lower lip, left 3/27/2009 lower lip to middle of ECAME DIZZY AFTER RECEVING THE LAST OF 3 VACCINES. CLIENT REMAINED IN CHAIR, Y FEET3/31/2009 ELEVATED. 3/31/2009 DIZZINESS ABATED after varicella vaccine #2 developedYredness and swelling at injection site. 48 hrs post vaccine Y developed 3/29/2009 increased3/30/2009 redness, swelling and E - REDDNESS AND ERYTHEMA LEFT Y ARM DISTAL TO THE INJECTION SITE AREA - C/O HEADACHE 3/30/2009 AND MUSCLE 3/31/2009 ACHES - SAYS emp up to 103 - today 102.6 - left arm hurts and slightly swollen - left hand pain "tingles" - fatique U - today3/31/2009 slight cough 3/31/2009 - eyes watery - no ap s:Shortness of Breath, Racing Heart, Y Anxiety, some Dizzyness, These symptoms got progressively N worse3/7/2009 over the course 3/8/2009 of 2 weeks. The iarix instead of DTaP. No adverse Symptoms and do not expect any. Y 3/24/2009 3/24/2009 to clinic one day after receiving vaccinations with Right upper arm reddened, swollen and warm U to touch.3/30/2009 Patient stated 3/31/2009 tenderness; denied lts under skin, muscle feels very tight even after constant massage. Also high fever of 102.9 Udegrees. High 3/31/2009 pain in legs 4/1/2009 - enough to prevent ceived Influenza vaccine (adult dose) instead of Hepatitis B vaccine. He is now 12 weeks of U age. To date, we have ### not experienced ### an adv ported redness for a few days. This progressed into pain and tingling in arm, like "ants crawling U on my arms". 2/11/2009 Still itching, 2/12/2009 but was told my M hot was given. Pain starting in arm of injection site, quickly moved to shoulders and neck. Within U two days 3/26/2009 it included 3/27/2009 the entire back and h spontaneous report of seizure, influenza, wheezing Y and fever was received from a physician Y concerning a 27-month-old ### 11/2/2008 female subsequen ven GARDASIL vaccine was informed would have to wait 20 minutes to be observed, pt wasYsitting on exam 3/27/2009 table after 3/27/2009 injection passed out become fussy, crying - had to console approx 2 hrs- 3 vaccines were given crying lasted forYapprox 9 hours3/18/2009 Mom had 3/18/2009 to hold Pt constantl Y 3/17/2009 3/22/2009 Y N 3/31/2009 4/1/2009
rea @ injection site. Y 3/23/2009 3/24/2009 etting a rash of small red bumps on my face on Friday 3-27-09. Saturday rash had spread to Yneck and chest. 3/13/2009 By Sunday it had spread to ar woke up the morning after the injection with "puffy face and L side of neck" which turned into U a rash. States 3/16/2009 also had 3/17/2009 some rash on stomac ain, induration warmth at injection site with redness at site and extending distal to injection site U to elbow. 3/25/2009 3/25/2009 accines 10:30 am, began with vomiting, uncontrollable crying and apnea 45 min-1 hr later. Heard Y pt on phone 3/19/2009 - screaming, 3/19/2009 high pitched cry immunization patient shaking, teeth chattering / cold - felt frozen under 3 blankets. Doesn't Y believe he had a fever. ### Achy. ### Fatigued X 12 ho after VARIVAX developed varicella lesions on arms, legs, mouth. Y 3/23/2009 3/25/2009 n has been received from a physician Y concerning a 16 year old female patient who completed Y GARDASIL series. The patient was HPV pos n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning a 20 year old female patient with n n has been received from a consumer regarding a case in litigation concerning his child whoUwas diagnosed with autism shortly after receiv n has been received from a parent concerning his 6 year old son who was vaccinated with MMR U II (Lot# not reported). The patient was on us case was received on 26 March Y 2009 from a consumer (patient's parent). A 23 year old male N patient with seasonal allergies received AD 74yo, Male, came to ER with - Had flu Y shot yesterday, this am developed rash right thigh, now U diffusely spread 12/3/2008 to both 12/4/2008 legs, chest arm. Eyes loss of control - 9-13-08. Hospitalized five days. Y Diagnosed virus syndrome. 4 Home doctor said U had Guillain 10/2/2008 Barre syndrome. 10/3/2008 4/8/09 Receiv seminated encephalomyelitis Y about Y 1 week after Y shot. Fever started. 27Extreme irritability and screaming. Y Altered 12/2/2008 state of consciousness ### 12 d ed rash over trunk, face & extremities Y with classic pox like vessels with erythematous bases. Y 3/20/2009 3/26/2009 m erythema and induration. Y veloped fever up to 103.2 F rectally on 3/26/2009 - and an erythematous papular rash - descendant - started 3/17/2009 on face on 3/27/09. Fever res 12 hours later. Headache, couldn't move Y arms and legs. Y 3/26/2009 3/27/2009 ent needle was in right deltoid, pt started to waver w/eyes rolling back. Pt began to wobble to N a fro. I helped 2/9/2009 him to his 2/9/2009 seat. Water was giv about 15:40. Approximately 17:30 became Y dizzy light headed, face tingled and broke out in aYsweat. Lasted 3/24/2009 about 303/24/2009 min. Later arms and le a of redness and induration on L upper arm approximately 12x10 cm. 3/18/2009 f PREVNAR were administered on the same day. Patient's Dr. notified @ 11:30am 3-25-09. Y 3/25/2009 adache, neck soreness, vomiting, nausea, Y dizziness and fatigue N 3/24/2009 3/25/2009 poor appetite, nausea/vomiting, left arm pain and soreness. Unable to attend school since 3-30-09. N Out of3/30/2009 character 3/30/2009 for this child. Arm pain ine hives for 15 min. Then resolved. Clear lung. Y 3/26/2009 3/26/2009 01 degrees, rubbing @ head, increased Y fussiness There is a question of secondary viral illness Y 3/31/2009 4/1/2009 n 3/18/2009 pt. awoke with temperature Y of 105.4 degrees @ 11 AM after waking up c/o entire Y body twitching, 3/17/2009 and increased 3/18/2009crankiness. 3 TDAP vaccine 3/19/09. Developed Y sore arm within 24 hrs became indurated, red, hot in injection area around 3/19/2009 48hrs, 3/21/2009 felt flu like (tired, achy ceived Tdap on 3/23/09. Came into office today 3/30/09 arm slightly red, small lump at site. Patient N states 3/23/2009 "it is much3/24/2009 better than it was. Arm
gan to develop around the injection site and spread to my chest, neck and back. Rash began approx. 4 days 3/8/2009 ago and 3/18/2009 has steadily worsene t B/P 106/60 Temp 98.4 Pulse 72 Resp. 20 - c/fired, dizzy. c/o feeling hot and sweating on & off. 1245 T3/27/2009 malise 1245 3/27/2009 T.C. to mother child ta breakthrough. Had 2 doses of VARIVAX (3-2-04 & 3-4-08). Diagnosed with varicella in our office U on 3-28-09. 3/4/2008 Had 30 3/24/2009 vesicles. No fever. rned pale a minute after receiving all 4 vaccines, then her lips turned blue 1/2 minute later, she Y had a seizure, 3/13/2009 with her 3/13/2009 eyes flipping upward eloped diarrhea evening of 3/6/09. Fever Y Sat-Mon & Tues. which mo. kept controlled with Tylenol & Advil. 3/5/2009 Caught runny 3/6/2009 nose developed ov TdaP 3/16/09 Developed symptoms 3-17-09. State fever 104.0 F orally, chills, muscle aches, Y arm deltoid 3/16/2009 red. Taking 3/17/2009 Tylenol. given (Rt) ar ed tightness in throat 30 min. after receiving vaccines - Took BENADRYL and felt better after Y 1 1/2 hours. tates he was in this office yesterday, received pneumonia vaccine in rt arm. Report this was Y he second pneumonia 3/25/2009 vaccine. 3/26/2009 States approx -103.8 and diarrhea. Y Y 3/31/2009 4/1/2009 ates he felt some numbness and tingling in my 3rd and 4th digits in lower left arm along ulnaUnerve. States 3/12/2009 he is experiencing 3/12/2009 mononeuritis U sy (R). Pt states a few hours after vaccine Y she noticed Y drooping on right 4 side of face - hospitalized. N Referral 3/23/2009 to neurologist. 3/23/2009 Not resolved at v al swelling @ site of KINRIX Y 3/30/2009 3/30/2009 diameter nodule, palpable. Y U 3/31/2009 4/2/2009 tal body itching for 1 1/2 months after Y the injections. Flushing of skin, resolved in ER, MD and Y allergy visits. ### ### erythematous rash and small vesicles around vaccine injection with out any treatment rash cleared Y in 3 days 3/25/2009 with out3/28/2009 any signs. er arm swollen, warm to touch, sore, mildly red. Treating with cool compresses and IBUPROFEN Y as needed. 3/13/2009 4/2/2009 TETANUS shot a week ago, then started having pain in the area of the injection, but then in the N last couple 3/23/2009 days or so 3/24/2009 has had pain, swellin 2/24/09 Fever by report from mom.Y2/27/09 Patient Y began experiencing 4 ankle pain. 2/28/09YAnkle began 2/20/2009 to swell with 2/22/2009 redness. 3/1/09 Pa RECEIVED 7 VACCINES ON THE 26 OF MARCH. CLIENT HAD POSITIVE PREGNANCY TEST U TODAY3/26/2009 IN OUR ADULT 4/2/2009 HEALTH CLINIC
and erythema (~4 inches red ring in diameter) appeared on 03/06/09, 2 days after receivingYthe vaccine. 3/4/2009 Patient also complained of swelllin in office for a 6 month physical on 9/09/08. Prior to adminsitering vaccinations black dots were U noticed on7/8/2008 the child's left thigh. It was noted ening of the shots, she developed low grade temp that increased the following day to 104F. U She also developed 3/31/2009 emesis 3/31/2009 (NBNB) x 3 with la ll on 4/2/09 stating that on Monday March 30 she received the Shingles vaccine. She did not U have any problems 3/30/2009for3/31/2009 greater than 24 hours gluteal pain starting four days after vaccination and lasting for four days. Pain relieved with anti-inflammatories. Y 2/25/2009 No other 3/1/2009 symptoms. Decli d a vaccination from an expired vial of Hep B. (exp date was 2-2-09). Parents were advised to revaccinate 3/12/2009 the child. No adverse reactions oral typhoid capsule as directed and within several hours had vomiting, diarrhea, fever and fatigue. Y Symptoms 3/6/2009 resolved 3/6/2009 by next day. Advis d full blown Shingles approximately Y 4 days following vaccination. Prescribed ACYCLOVIR, 800MG, ONE TABLET 3/5/2009 5 TIMES 3/9/2009 A DAY FOR 10 ived subcutaneous injections of MMR and Varivax on right and left thighs respectively usingUVanishPoint synringes. ### Black### dots noticed on b H PEDIARIX U ### ### ND ERYTHEMA TO RIGHT DELTOID Y 16.25 CM x 16.25 CM. ADVISED PARENT ON APPLICATION U OF 3/31/2009 COLD COMPRESSES, 4/2/2009 MED W\ arted to notice hives on the back of her neck, between legs and on wrist about 5 hours after U administration 3/31/2009 of the vaccine. 3/31/2009 Patient has been al reaction at the left deltoid - mild erythema, tenderness and edema. U 3/31/2009 4/2/2009 d about 5 hrs. after being vaccinated Y and still continues. He became very unresponsive at times. U He ended 3/26/2009 up getting 3/26/2009 dehydrated which ca U 3/18/2009 r of 106F, wheezing, upper right quadrant Y pain Y and lower right quadrant 1 pain. It lasted for 8 months. Y Treatments 8/29/2007 were 9/19/2007 antibioctics. 5/26/09 was reported by a consumer and described the occurrence of possible acute hepatitis in a female U subject of unspecified age who was vacc was reported by a pharmacist and described Y the occurrence of injection site soreness Y in a 29-year-old N female 2/11/2009 subject 2/11/2009 who was vaccinated was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age 6/1/1999 who was vaccinated 5/1/2000 with LYMER nding graduate school, this 40 year old member Y reported receipt of 7hepatitis A #1, influenza, and typhoid 8/5/1997 vaccinations 11/8/1997 on 11/7/1997. Medic d orange size lump/ swelling/ redness - sore to touch first 24h - used ice - advised use allergyYcrm & ice for4/1/2009 sx 4/1/2009 Y 3/26/2009 /2 inches red area with swelling, mild Y induration. U 3/26/2009 3/27/2009 ed ball under skin @ injection site that Y is painful DX: Cellulitis Y 3/31/2009 3/31/2009 5 min after GARDASIL Dizziness 30 min after vaccine still c/o dizziness, now on 4/2 , got vaccine Y on 3/31/09 3/31/2009 3/31/2009 izure. Temp. 105. TYLENOL. 4/30/09 Y scheduled for f/u MRI. Y 3/26/2009 3/27/2009 er gave child TYLENOL 0.4ml but did not take temp. 1pm Mom woke child for feeding. Mother Y stated he 3/26/2009 was upset, 3/26/2009 he could not decide if in joints, muscles - constant. Periodic nausea, periodic chest pain. N 3/20/2009 3/20/2009 bumps at injection site going down into underarm & side of back started date of injection & Y still present 3/19/2009 on 4-2-09 3/19/2009 itching at injection site right delt. PtYstates "feels like sunburn" U 3/28/2009 3/30/2009 redness and swelling of Rt triceps after Y DTAP. Moderately tender. This is a minor side effectU 3/31/2009 4/2/2009 right upper arm below injection site extending to medial arm. Warm to touch. Pt reported itching Y started3/31/2009 several hours 3/31/2009 later. Warmth note :00 PM - began experiencing rt. eyeYitching, burning, watery raw @ rt. corner of eye, later in N day blister appeared 3/25/2009corner 3/27/2009 of rt. eye went to D ection site, malaise, nausea, photosensitivity, headache, diarrhea and trouble sleeping. U 3/31/2009 4/1/2009 n has been received from a physician Y concerning Y a 72 year old male 0 patient with heart condition U who in August 8/1/2007 2007,2/1/2009 was vaccinated with n has been received from a consumer concerning her 4 year old son with no pertinent medical N history or drug 9/1/1995 reactions or allergies who in n has been received from a medicalYassistant concerning her 16 year old daughter who on 11-FEB-2008 Y 2/12/2008 was vaccinated 1/1/2009 the third dose of w n has been received from a physician Y concerning Y a 12 year old female 6 with allergies to Augmentin N who on 9/17/2008 10-OCT-2007, 3/27/2009 17-JAN-2008 and n problems, dizziness, near Y fainting,Y rapid heart Y beat, broke out in rash Y all immediately. Y Now: N MS, Graves 6/23/2008 Disease, 6/23/2008 Fibromyalgia, daily mig litis, pain, fever, tachycardia. Redness/pain at site Y w/ worse progression. 3 Vanc and Zosyn given Y upon presentation 3/16/2009 to 3/18/2009 ER. D/C home with p V on 3/6/09 and AVA on 3/11/09. On 3/17/09 pt Y describes feeling fatigued, 1 he had non positional U left sided 3/6/2009 chest pain 3/17/2009 (1-2/10), cp worse w rash on (L) arm, neck and face; rash Y appearedY3/27/09. No fever. Patient's 2 daughter received Y live attenuated 2/23/2009 varicella 3/27/2009 vaccine 3-4 weeks p 3 degrees), headache, body aches, dizziness, fatigue. U 3/26/2009 3/26/2009 lu shot experienced headache, dizziness + flu like symptoms. Y m pink area around where PNEUMOVAX given. Y 4/1/2009 4/3/2009 nted for a few seconds after that patient had major headache, in addition patient pain on upper Y right arm. 3/19/2009 3/19/2009 began 1 hr after injection. Today Right inner and anterior thigh- diffuse swelling from 1 1/2 above U knee to 3/16/2009 groin crease. 3/16/2009 er the vaccines, patient c/o feeling "bad". Y Had anorexia and nausea, was very pale. The nextYday also extremely 2/25/2009 pale, 2/25/2009 weak, couldn't eat, na Y 4/1/2009 er administration, nickel size redness. Y On 5th day after; hive looking rash appears. On 6th day Y after administered 3/18/2009vaccine 3/23/2009 entire deltoid red me in 3/31/09 stated that the day heY got vaccines 3/23/09 his legs both got swollen and purple. Y They took 3/23/2009 to urgent3/23/2009 care, advised them jus
feel nauseous, vomited x 3 in spaceYof 2 hours. Saw ER physician for meds which stopped emesis. Y 3/10/2009 3/10/2009 htheadedness within 15 minutes of ZOSTAVAX administration. Paramedic took vital signs +Ublood sugar3/27/2009 (all WNL). 3/27/2009 Pt refused work up at h sized swelling at site of VARIVAX reported by mom. 1-2 days after immunizations. Later pt developed Y vomiting /diarrhea illness, 2 d after i broke out in small blisters on abdomen 2 days after receiving varicella immunization. StatedYblisters itched 2/16/2009 but no fever 2/18/2009 noted. Today in clin + erythema + pruritis of Rt upper arm. U 3/24/2009 3/27/2009 ome: (Location) bilateral arm. Pt. mother Y describes it as painful. Relieving factors include: BENADRYL. Y Associated 3/27/2009 3/29/2009 symptoms include: pain ceived 6 wks immunization of 5 wks. Y 3/10/2009 ts today 4/1/09 with red area (about baseball - sized) + sl. raised + mild pain on right deltoid U - site of MENACTRA 3/31/2009I.M. 4/1/2009 injection given on 3/3 al reaction 9X6 cm local ice and Benadryl. Y 3/27/2009 3/28/2009 dministered to left thigh but bruisingYto left shin. Parents stated leg was swollen with bruisingYwent to ER.3/30/2009 3/31/2009 of Rt thigh area after vaccine. Swelling Y started morning after vaccine. Area also has some erythema. Y 4/2/2009 4/3/2009 soreness, swelling. Y 3/19/2009 veloped redness around back of arm about 5-6 inches long and also skin felt hot to touch and Y very itchy.3/30/2009 3/30/2009 9 Received Hep A at approx 2pm. Developed Y hives approx 8p. Took BENADRYL. 3-31-09 noYhives visible. 3/30/2009 C/O itching 3/30/2009 all over. SOLUMEDR s given at 9 months. 3/25/2009 ap/Hib/IPV and HebB/Hib- no sx 4/2/2009 SIZE DARK PINK RAISED AREA AT INJECTION SITE NO PAIN NO TREATMENT Y 4/2/2009 4/2/2009 oke out in shingles 6 days after vaccination Y was administered. Pat She is being treated by her N primary care 3/24/2009 physician 3/30/2009 accordingly. r, strong crying, for many hours, fine the next day. Y 4/2/2009 4/2/2009 ized knot on right arm. Red & warmYto touch. ER MD gave steriod dose pk. & Icc pack U 3/24/2009 3/29/2009 e adn hives were around shot area and on both thighs adn stomach, the areas were itching. YSo mom gave 3/27/2009 benedryl3/27/2009 and repeated it at 9 a.m n left deltoid where Tdap was given. Area hot, red. swollen. Smaller area of redness with heat on right deltoid 4/1/2009 where 4/2/2009 Menactra was given. adverse reaction. Patient received Dtap vaccine instead of the recommended Tdap vaccine.YPatient received 4/1/2009 adequate protection with Dtap d bilateral kidney area pain, increased thirst, increased urination approximately 20 hours after U Hep B #2 was 3/19/2009 given. 3/20/2009 No problems with vacc MOTHER PRESENTED TO HEALTH DEPARTMENT FOR CHILD'S VACCINES. MOTHERYREPORTED 7/17/2008 THAT CHILD 7/17/2008 HAD SWOLLEN RE o weeks after my daughter Y got the 1st Y Gardisil vaccine shot she started having seizures, sheNhas no family 9/3/2008 history of9/18/2008 seizures and has alwa d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate Y the 3/13/2009 child. No adverse reactions have d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate Y the 3/19/2009 child. No adverse reactions have ter developed a large red knot at injection Y site, was raised, size of a half dollar, warm and very Y tender. She 3/26/2009 also had a4/1/2009 severe runny nose. A 0 minutes of patient receiving TdaPYand gardasil, pt had a 30 second episode of stiffening and Y blank staring. 4/3/2009 Since that 4/3/2009 time she has had disease (rash, fever). U 3/23/2009 4/2/2009 TDaP and PNEUMOVAX L deltoid 3/31/09. Reaction of swelling, redness and immobility began U within 24 3/31/2009 hours of injection. 3/31/2009Slow resolution d by Clinic today to report that she developed L lateral arm pain, some numbness/tingling from Y shoulder 3/20/2009 -> fingertips, 3/21/2009 quite significant at tim ring rash in groin and hip area. U 3/27/2009 3/31/2009 x 100.5; redness, induration 2 cm x 2 cm. Y 3/30/2009 3/30/2009 -> redness + swelling at the site of injection - measures 4.5 inches + 4.5 inches. U 3/30/2009 3/31/2009 ea of redness on L thigh ice packs and Y Benadryl. Y 3/30/2009 4/1/2009 ea of redness, warmth and in duration Y on L thigh. Treated with ice packs and Benadryl. U 4/1/2009 4/2/2009 arthralgias / HA (L) shoulder pain with Y t ROM-->Bursitis Rx CALEBREX/NORCO/ROM exercises N 3/29/2009 ed varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 1/21/2008 3/30/2009 ed Varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 4/21/2008 4/2/2009 ort received on 20 January 2009 from a consumer, who is the patient's parent. A 5 month oldY male patient, 4/30/2008 with a history 4/30/2008 of environmental a ort received on 13 March 2008 from Yanother manufacturer, (a report number was not identified). N The initial reporter ### to this ### manufacturer had ort received from a manufacturer on 23 January 2009. The other manufacturer had received the original report from a health care professio ort received on 22 January 2009 from Y a health care professional. A seven-month-old femaleNpatient with no 1/6/2009 past medical 1/6/2009 history, had receiv rmation was received on 19 August Y 2008 from a consumer (patient's mother). A two and a half Y month old 8/11/2008 female patient 8/11/2008 with no reported m ort received on 08 August 2008 fromYa physician. A healthy 2-year-old male patient, had received on 04 August 8/4/2008 20088/4/2008 a fourth intramuscula was received from a health care professional on 09 June 2008. A five-year-old male patient with a history 6/17/2004 of asthma,5/1/2008 chronic ear infections was received from a health professional on 03 June 2008. A 36-year-old female patient wasY accidentally6/3/2008 exposed to6/3/2008 ACTHIB (lot number NG AFTER WAKING, CRANKY, LETHARGIC AND GROGGY X 2 WEEKS AFTER ADMINISTRATION. Y 3/11/2009 LEGS SWOLLEN 3/12/2009 UP TO 4 DAYS s- He had extremely sore legs and Y arms even though vaccines were given only in arms. HeYwas achey 2/19/2009 and felt flu 2/19/2009 like. Then had low grad
ceive.5cc pneumo-vac on 5/3/07 in their Y Right deltoid. On 5/29/07, pt had reported c/o rash on Y face, upper chest, and forerms. Pt was given Fever ~ 101 F, Malaise, Moderate Diarrhea, chills in evening, body aches, 4/3/2009 4/4/2009 08, pt was in clinic and C/O welts onY thigh; Shoulder reaction to flu shot; cough and sore throat. Y ONSET OF SYMPTOMS: ### ### Ongoing since fl as given scheduled vaccination doses Y of: Typhoid, Influenza, and Anthrax on 3/14/09. After about U a week3/14/2009 and a half3/24/2009 later, the patient notice , 4/3/09, I received two vaccines, a Y tdap in the left arm and a pneumococal polysaccharide vaccine N in the 4/3/2009 right arm. Within 4/3/2009 a few hours, I st ter hives around vaccination site later Y and to this date muscle aches, joint pain and skin hypersensitivity. N 3/8/2009 3/10/2009 A and Hep B shots on 4/4/09. Felt sick Y and nauseated at the time. Returned on 4/5/09 c/o inability U to remove 4/4/2009 R arm and 4/4/2009 nausea and vomiti Y Y 0 N serious case was received on 24 February Y 2009 from a health care professional. A nine yearUold patient received ###the2/24/2009 INFLUENZA vaccine ( n has been received from Y a medicalYassistant concerning Y a 49 year 1old female with diabetes, Y chronic obstructive 3/24/2009pulmonary 3/24/2009disease, coron n has been received from a consumer concerning her son with no medical history or drug allergy N who was vaccinated with a dose of MMR n has been received from a consumer concerning a male who, on an unknown date, was vaccinated U with MMR II (lot # not reported). There n has been received from a consumer concerning her 7 year old son who on unspecified date U was vaccinated with MMR II. The patient dev n has been received from a consumer reporting that her nephew now 30 month old male who N in approximately 2006 was vaccinated with M n has been received from a consumer, Y concerning her 17 year old son with a penicillin and CECLOR Y allergy, sulfonamide allergy, drug hyp n has been received from a physician Y concerning a patient who in approximately 2008 "about Y a year ago" was vaccinated 9/1/2008 subcutaneously d fever 3/26/09/ER visit for febrile seizure Y / URI. U 3/25/2009 3/27/2009 ter receiving DTAP, PREVNAR, ROTAVIRUS Y & HIB vaccines child experienced right facial droop involving 2/20/2009 eye, lower 2/20/2009 face & mouth. Symp hought to be febrile seizure, 2 days Y after receiving MMR. Was seen in ER. No labs or test were Y done. Ran 3/24/2009 fever x's 3/26/2009 24hrs. When fever subs 5 minutes after HPV (GARDASIL) vaccine Y lasted about 1 minute with L arm jerking X 3 sec pale Y looking 3/23/2009 referred to ER. 3/23/2009 BP 100/80, HR 78, ped erythematous rash, urticarial type with angiodema which began on 1/29/09 and persistedY throughout1/29/2009 2/13/09-see 1/29/2009 picture. There was s ient said arm slightly sore evening of immunization but next day fine. Patient was given TdapY by mistake since 4/1/2009 it is only recommended at a d hives within 15 minutes of receiving vaccinations. Gave 0.1 epinephrine IM in office. Y 3/27/2009 alized reaction started day after. Increase to redness, swelling. Spreading down R arm hot toUtouch. 3/5/2009 3/6/2009 ma around injection site, non tender induration of muscle about 7cm - L thigh. U 3/31/2009 3/31/2009 KINRIX (DTaP/IPV) Rt thigh on 4/1/09, red, sore, itchy indurated warm spreading rash developed. Y 14x10cm 4/1/2009 likely allergic, 4/3/2009 but AUGMENTI VARIVAX 3/26/09 mom noted a red area on L arm at injection site. Tender to touch, but notYsore with movement. 3/26/2009 73/27/2009 cm by 5 cm warm reac a USAFR female service member, and was on military status on 29 March 2009, when she received N a TDaP 3/29/2009 vaccination 3/29/2009 (0.5 mL, IM, L upp given 3-20-09 AM. Seen in office 3/23/09 Y with 3"x31/2" erythematous, swollen, warm induration U @ site of3/20/2009 Td injection. 3/22/2009 very painful every time I move it. U 2/25/2009 allergic reaction U 4/1/2009 4/2/2009 ak, muscle soreness for 3-4 days two weeks after administration of Hep A and Hep B vaccines. Y Advised3/12/2009 to see his healthcare 3/26/2009 provider. d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/20/2009 reported. 3/20/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/20/2009 reported. 3/20/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/17/2009 reported. 3/17/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/19/2009 reported. 3/19/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/19/2009 reported. 3/19/2009 clinic, c/o redness and blotching of the Y left upper arm with swelling. Area was warm to touchUand swollen 4/1/2009 from shoulder 4/3/2009 to the elbow. Pt als lled on 4-6-09 stating that patient had a fever of 103.6 for 48 hours. No other symptoms noted. Y 3/26/2009 3/28/2009 ed out as aching 1 hour after vaccination. Client states pain (Left Arm) was at it's worst 1 week U after vaccine 3/27/2009 (04-03-09) 3/27/2009 when she experien 9 the employee went to the ER around Y 10 pm due to swelling in neck, change in voice and difficutly Y speaking. 3/24/2009 States 3/27/2009 he did not have diffic ain of both knees. 4/13/09 MR and Y vax info received from PCP. In for 14 yr WCC with normal U exam 11/11/08. ### Vax given. ### Returned 12/22/ ately 24 hours after the vaccine was received the patient had severe chest pain. The chest pain Y began evening### and lasted### for over an hour ticed on 4/5/08 at 2:00AM, soreness, itching and a knot on left arm where Zostavax was administered. Y Patient 4/3/2009 applied 4/5/2009 alcohol to help with 9am- phone call from parent. Parent reports child right upper arm is red, swollen, & hot to the U touch. Symptoms 3/31/2009 began 4/1/2009 on 4/01/09 and is wo alized papules. No bullae or blisters around site of injection (left upper thigh) Possible folliculitis U but possible 4/3/2009 local varicella 4/4/2009 from vaccine. given 3/31/09 approx. 10:30am. Pt. Y noticed it was tender an swollen 4/01/09 approx. 6:30 pm. U 4/02/09 area 3/31/2009 red, raised, 4/1/2009 hot to touch & incre otavirus) vaccine given vinitial dose at 19 weeeks of age, after the recommended start age of Y 15 weeks,3/20/2009 by mistake.3/20/2009 No physical reaction to ived IPV and DTAP in Right thigh on 4/3/2009. Now has pink/red and hot area to site measuring U 3.5 x 4 inches. 4/3/2009 Painful 4/6/2009 to palpation. Place r shot pt had swollen, painful area at site, 1" red Y circle at site with rash 4 around it. Syncopal episode Y on 4/1. 3/31/2009 Transported 4/1/2009 to hospital by ambu ven Pneumovax vaccine as ordered.YLeft deltoid injection site wiped down with alcohol swab,Yand vaccine 3/2/2009 given. Site 3/3/2009 dabbed w/ cotton ball,
ed sudden and severe hair loss resulting Y in many visits to dermatologists over the last year and N a half. This 7/20/2007 has resulted 9/17/2007 in meds prescribe Clinic on 4-6-09 to report that she had experienced painful, red blotchy raised rash on left upper Y arm which4/1/2009 presented4/5/2009 on 4-5-09 at approxim -Hyporesponsive Episode, onset was about 2 hours after receiving DTaP vaccine, lasted approximately Y 3/14/2009 4 hours 3/14/2009 A TDAP SHOT ON FRIDAY(04-03-09) AND SAT. HE HAD BODY PAIN & CHILLS.LEFT ARM Y WARM AND 4/3/2009 TENDER 4/4/2009 TO THE TOUCH. TOD en, feverish arm where shot was administered. Headache, neck ache, weakness, general feeling Y of tiredness. 4/3/2009 4/5/2009 ome numbness and tingling across the upper back and neck and extending down into his arms Y bilaterally. 4/1/2009 This was resolving 4/1/2009when seen on was reported by a consumer and described Y the occurrence of feels like having a heart attack Y in a 60-year-old 10/1/2008 female 10/1/2008 subject who was vacc 9, pt presented w/ aboutY14 hr hx ofYfever, headache Y and vomiting and 7 20 min of purpuric rash. Y Pt directed 3/20/2009 to ER then 3/30/2009 Peds ICU. CSF incre dmother and mother report that this Y 6-month-oldYinfant has been a bit3 fussy and out of sorts since Y he received 3/17/2009 immunizations 3/19/2009two days ago ve Diarrhea, Vomiting, Back Pain, Body Y Aches,YHA. From 033009 --> 1 033109 To ER Admitted Y Observation. 3/30/2009 Discharged 3/30/2009 040109. To Scho a reddish purplish area on leg not acting sick otherwise. Recommended she watch it for a fewUdays and if3/24/2009 not better to4/6/2009 be seen. at injection site "burning" to left arm, both arms, now legs and eyes. No rash, no swelling and U no fever, VSS. 4/2/2009 Advise;4/4/2009 Monitor. e: onset: 3/10/09-present. OTC MOTRIN Y taken for symptoms. Lower back pain: onset:3/10/09 N x 1day. Fever: 3/9/2009 onset:3/10/09 3/10/2009 x 1day Reported and swelling L leg. Started the day after lZ. Worsened x 24 hours then improved, used ice only. Y 4/3/2009 4/4/2009 9 - School nurse phoned HD and stated Y that student's L upper arm was somewhat red with some U swelling. 3/31/2009 Client c/o4/1/2009 nausea and L arm pai with long periods of crying and inconsolability. Fever 101.8 rectal. Vomiting x 1. decreased oral Y intake. 4/2/2009 4/3/2009 red and swollen. Cellulitis - given antibiotics. Y Went to urgent care - Then follow up and officeU6/23/08. 6/20/2008 6/21/2008 n has been received from Y a Nurse Practitioner Y Y for the Pregnancy Registry for GARDASIL concerning Y an6/18/2008 18 year old female patient with no n has been received from a concerning Y a 50 year old nurse female who was alsoYa nurse was Y vaccinated with a dose of ZOSTAVAX (Oka/ n has been received from a physician Y concerning a patient with milk allergy who was vaccinated U with ROTATEQ vaccine. Upon return for a week after vaccinations - resolved Y after two days. Y Lethargic, irritable 22 Y2-3 weeks Y later for about N two weeks. One### month after ### immunizations, en thigh left - side left day #2 after vaccination. Y ER on 4-5-09 No tx. Y 4/2/2009 4/4/2009 o site with induration x 3-4 days. Left arm. Y 3/26/2009 3/28/2009 shingle shot. Asked nurse if it would hurt, no just like flu shot. It did hurt and burned. 03-19-09 4 AM Difficulties 3/18/2009 Breathing for 1 Hr. Noticed d petechial rash on inner thighs, abdomen, behind knees 5 days after vaccine give. No itch -YNo vesicles.3/17/2009 No rash at3/23/2009 injection site. Platelet c n so had ADACEL vaccine (administered off -site) 10 days later, presented to me with myalgias, arthralgias, headache, 3/7/2009 malaise. Ok to conta DISIL vaccine administered 7/8/08 pt report hives all over body within hours of injection lasting Y 3-4 days. 7/8/2008 Tx with BENADRYL. 7/8/2008 swelling & erythema of entire thigh > 72 hrs Discomfort & ambulation > 48 hrs. Y 11/1/2005 11/1/2005 cm red wheal appeared after 9 month immunizations given. No discomfort/problems noted, but N wheal has2/6/2009 persisted since 2/6/2009 shots (on right th ction right thigh with erythema and induration Y developed nine days after immunizations. AlsoUwith low grade 3/24/2008 temp. (99.9) 4/2/2009 d rash L side neck in dermatomal pattern consistent with VZV. 3/18/2009 3/25/2009 iven 3/19/09, fever developed 3/27/09. Y Rash erythematous macular papule with palms/soles & buccal urticaria 3/19/2009 developed 3/29/2009 3/29. Looks like Y ### ### ed 6 mo. well baby checkup on 2/23/09. Vaccines listed below given. Pt. came in to see MDYon 2/28/09.2/23/2009 Vomiting 2/25/2009 began on 2/25 with Dia lled, c/o erythema (L) upper arm at injection site, Sl. raised "welt" in appearance, "larger than Y half dollar"3/25/2009 in size. No3/26/2009 c/o discomfort, and dec se events recorded 8/2/2006 d to the office on 3/31/09 with c/o rash Y all over body since Sunday 3/29/09. Spreading rash not U itchy. No 3/19/2009 fever. Non vesicular, 3/29/2009maculopapula KINRIX 3/24/09 (R) deltoid. Seen 3/26/09 Y with swelling, erythema, warm to touch no tenderness Y no induration. 3/24/2009 Negative 3/25/2009 node. Ab after vac d headache 5/26/09 Received PCPYmedical records of 12/3/08-5/18/2009. FINAL DX:migraine Y HA; probable 12/3/2008 psychiatric 2/21/2009 illness Records rev maculo papular rash to face, neck, Yarms, chest, abdomen, back and groin blanching and non U vesicular. 3/17/2009 Not itchy, afebrile, 3/27/2009 No V, No D. Po ceived KINRIX as part of 4y.o. physical, in (L) deltoid 4/3/09 at approximately 9:AM; went to school Y after appt, 4/3/2009 picked 4/3/2009 up from school at 5PM ec. Yellow Fever Vaccine - woke upYwith itching mild noc, slight headache - In AM 3/31/09 noted Y rash (hives) 3/30/2009 chest,3/30/2009 neck, arms and legs. D ely following injection pt. became stiff, Y eyes rolled in back of head, bluish + orange around mouth, Y + pt. was 3/31/2009 having jerking 3/31/2009 motions of entire ed of itchy throat 40 minutes after receiving multiple vaccines (TYPHIM VI, HAVRIX and yellow Y fever YF-VAX). 3/25/2009 Administered 3/25/2009BENADYL 50 ness, swelling and firmness Rt 'upperarm' 3"x2 1/2". No fever or chills. Denies cp or SOB. NoYpruritus. ROCEPHIN 3/30/2009 gram 3/31/2009 + IM, KEFLEX 500 m notices red spots on back of neck Y and a lot on stomach. 1-16-09 8AM when woke up this AM, Y red spots 1/6/2009 were all over 1/15/2009 face, back, neck and o pneumonia vaccine given in the left arm (deltoid). Mild pain, redness and streaking from injection U site. 4/6/2009 4/6/2009 Hep B vaccines were given to 70 newborns because the GSK products requires 10 mcg dosage, but MERCK product 2/17/2009 required only 5 mcg f tates he was in his office yesterday, received Pneumonia vaccine in rt arm. Report this was he second pneumonia 3/26/2009 vaccine. 3/26/2009 States approx 3 tion given on 3/27/09 3 hours after going to bed woke up screaming for 5-10 min. did settle some Y fussy till 3/27/2009 TYLENOL 3/27/2009 kicked in temp 103 de d redness around upper arm 2 d after vaccine given-Itchy c/o nausea- Rx BENADRYL, MOTRIN Y -Lasted2/10/2009 3-4 days. 2/11/2009
an two days after shot was given (103F) Y mother gave Tylenol. Child taken to ER with c/o seizure. 3/18/2009 3/20/2009 tion site reaction with mild cellulitis Y 3/31/2009 4/2/2009 X 24 hr, injection site rash, urticaria Y Y 4/1/2009 heat, swelling left deltoid area. Hard in center of redness, approx. ping- pong ball sized Y 3/21/2009 3/23/2009 D with throat itching within 5 min of shot. Y Requiring BENADRYL 25 mg PO + Albuterol Nebulizer Y treatments 3/30/2009 X 2 given 3/30/2009 over 2 hours. ld with spots on body, started 3 days ago along with diarrhea; cough x 4 days temp 98 R 148-38 Y Stuffy 3/10/2009 nose, yellowish 3/23/2009 nasal drainage. A ain, left sided facial flushing, fevers up to 100.8 degrees orally after vaccine given. Also noted Y left supra3/18/2009 - clavicular3/18/2009 lymphadenopathy. Fu and swelling to left upper arm. Y U 4/1/2009 4/2/2009 noticed itching at site of vaccination. Mild tenderness, seen at clinic 3/27. 6X5 cm warm pinkYarea surrounding 3/25/2009 2.5 cm 3/26/2009 area darker pink + mi 5 cm X 5 cm; Swelling + Pallor 8X8 cm; tenderness. U 3/31/2009 Y 4/2/2009 4/2/2009 stomach,head hurt, feet felt prickly Y 3/28/2009 3/28/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 4/10/2008 4/21/2008 3rd dose of Gardasil on 3/31/09 On 4/2/09 she had an episode where she became very angry Y and agitated 3/31/2009 and had 4/2/2009 behavior not like her n d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 6/25/2008 7/8/2008 as given Adacel instead of Infanrix. I have told my superviser and his parents. Y 4/7/2009 sed appt for Well Child Clinic and coordinator Y MaryBeth Hayes RN called to remind parents. Y She spoke with 2/24/2009 dad and 3/1/2009 he said that child had Optic Neuropathy leading to severe loss Y of vision right eye. Treated with high dose Y IV steroids N with no benefit. ### 5/4/09 11/4/2008 Received Optho Clini INTED.ASSESSED MY MD Y 4/7/2009 4/7/2009 owing vaccination, pt. developed generalized Y itching and painful sores on her back. She went U to her doctor 3/30/2009 on the 3rd 4/1/2009 day post-vaccination fic myocarditis. This case was identified Y as part of the H-406-005 Enhanced Surveillance Study (5000005). 2/2/2009 2/18/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 4/29/2008 5/13/2008 ardial infarction (410.7), unspecifiedYsite (410.9). This case was identified as part of a study.U 1/30/2009 2/17/2009 Kinrix innoculations given on 3-17-09, on 3-28-09 (11 days post inocculations) Pt spiked a 102F U temperature, 3/17/2009 which3/28/2009 subsided over the nex ought child in today for assessment of oval shaped 3 inch by 6 inch reddened area on left posterior U lateral4/6/2009 upper arm,4/6/2009 site of VZV sc injectio s after her vaccine was given the following Y symptoms Y were noted: weakness 1 of mouth muscles Y with drooling 2/4/2009 and liquids 2/22/2009 running out of mou d with ACAM2000 during pregnancy. Pregnancy resulted in spontaneous abortion. 1/14/2009 2/2/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 5/16/2008 6/23/2008 ates he got his second injection on Friday and that his rash came back over the weekend and Y stating this3/5/2009 time the rash 3/9/2009 is worse. +Pruritis, d to toe. Not sleeping or eating. - Maculopapular Y rash, condense together in big patches, notUsick, no cough, 3/26/2009 no URI3/27/2009 c/o, measles-like rash. rash with blisters) on lower L back. Y U 3/25/2009 4/5/2009 1/13/2009 erythema L thigh day after immunizations. Continued to increase spread of erythema. MotherUhad given Benadryl 4/3/2009et had 4/4/2009 applied ice to site. 009@09-43 from pt. States he was in this office yesterday, received pneumonia vaccine in rt arm. Report3/25/2009 this was he 3/26/2009 second pneumonia va n has been received from a nurse for the pregnancy registry for HPV concerning a female with Y a history of2/4/2008 vulvar condyloma 2/4/2008with Trichloroa n has been received via an internet blog from a consumer concerning her daughter who wasUvaccinated with a dose of GARDASIL. In the m n has been received from via the physician of aYpatient whose mother 6 found the current case U online. The5/30/2007 current case concerns a female p d focal deficits temporallyY associated Y to receipt Yof the spv. See attached. 20 Diagnosis: Y CEREBELLAR N ATAXIA/menigoencephalitis. 1/5/2009 1/20/2009 Symptom n has been received from a physician concerning a 17 year old female who was vaccinated N with her second dose of GARDASIL, 0.5 mL, IM orts pain & burning sensation to right Y upper arm since flu vaccination. Severe pain started approximately11/4/2008 2 wks after administration. ### She re oid (arm) red and swollen, mother of patient stated that kid had a low grade temp. of 99.4 theYday after vaccine administered. ma & swelling of uvula. Y Y ### ### d swollen warm to touch. Are measures Y 8x6 cm. no pain. Temp 99. Y 3/30/2009 4/1/2009 shingle shot. Asked nurse if it would hurt. No, just like flu shot, it did hurt and burned. 03-19-09 4 AM difficulties 3/18/2009 breathing 3/18/2009 for 1 hr. Noticed ghtly raised, warm to touch pink area @ injec. site post getting VARICELLA vaccine on 3/30/09 U 14.5 cm3/30/2009 X 7cm. Reported 3/31/2009 by guardian on 4 area of blanching erythema around Yinjection site at L upper arm. Started a few hours after injectionU zero 4/1/2009 treatment included 4/2/2009with systemic n has been received from a nurse practitioner, Y for the Pregnancy Registry for GARDASIL, concerning Y a 15 year ### old female 3/1/2008 with iron deficie n has been received from a physician Y assistant concerning a 24 year old pregnant female with Y a history 2/12/2008 of penicillin2/12/2008 allergy who on 12-FEB on arm. Not sure if it was vaccine reaction Y or early cellulitis. U 7/11/2007 7/13/2007 d syncopal episode, shortness of breath, Y headache, throat felt "fuzzy" Injection site swollen,Ured, achy. 8/8/2007 8/9/2007 n has been received from a case in litigation via Litigation Reports concerning a 15 month old N male patient 3/14/2000 who on 14-MAR-2000 3/30/2000 was vacc
was received from a health professional Y on 26 March 2009, via another manufacturer (document number 45215838). A patient received Fl Y Y 2/6/2009 2/9/2009 eveloped. Got in waiting area she began to break out with a pruritic rash and had difficulty breathing. Y 62.53/4/2009 Solumedrol3/4/2009 IM given, 0.2 Epinep ASIL 1-30-09 - At 2nd appt for GARDASIL 4-2-09 pt. described symptoms from first IZ admin. Y stated had 1/30/2009 severe headache 1/30/2009 with vomiting a induration at left thigh elevated white Y blood cell count to 13.7 K Fever to 100.5 U 4/6/2009 4/7/2009 redness, itching and swelling of the upper arm for a week followed by a general feeling of tiredness, Y headaches### and general ###achiness lastin Y 4/2/2009 4/6/2009 lled stating that left arm is red, swollen, warm to touch, has a red splotchy rash and is the size U of a "grapefruit". 4/6/2009 Patient 4/7/2009 denies any pain, bu rned red and slightly raised the evening of the day the shot was given. Y 4/6/2009 4/6/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 5/24/2008 6/25/2008 the tongue and throat. No acute respiratory distress. complained of mild itching around eyesYand forehead. 4/8/2009 No erythema 4/8/2009 or rash noted in th EAMED ALL DAY RIGHT AFTER SHE RECIEVED THE IMZ. RUN 103 TEMP THE FIRST DAY Y AND 1014/2/2009 TEMP THE4/2/2009 NEXT TWO DAYS. C nt received Tdap vaccine (Adacel) and experienced muscle aches, chills, general malaise, nausea Y and axillary 3/19/2009 lymphadenopathy. 3/19/2009 Symptom U 4/1/2009 4/1/2009 nt received Tdap and experienced nausea, vomiting, chills, low grade temp and a rash beginning Y immediately 3/19/2009 after injection. 3/19/2009Symtoms subs s a Methicillin Sensitive Y Staph Aureus Y left septic Y hip and left abscess 5Y on ankle with presumed U osteomyelitis 3/16/2009 of femur. 3/20/2009 Patient's prenatal cou ite blanched and cool to touch, after the blanching, the injection site had a bluish-tinged appearance. Y Ice 3/30/2009 pack applied 3/30/2009 to injection site, mo nt received Tdap and experienced fever, bodyache and headaches. Symptoms subsided in 4Ydays. 3/19/2009 3/19/2009 nt received the Tdap vaccine and experienced nausea/vomiting, axillary lymphadenopathy, blotches, Y beginning 3/19/1968 8 hours 3/19/1968 after vaccine admin nt received Tdap and experienced chills, diarrhea and vomiting 1-2 hours after injection. TheYsymptoms subsided 3/19/2009in 3/19/2009 2 to 3 days. HPV vaccine Gardisil on March 31, 2009. Y The next day I was feeling soar and tired, but did not N think anything 3/31/2009 about 4/1/2009 it. By Friday evening ( Hep B shot 3-31-09 VLL. On 4-02-09, mom notice it was reddened, hot and hives were appearing Y as well 3/31/2009 as swelling 4/2/2009 on the upper left thig red DTAP instead of Tdap to 11 yr old, administrative error, no adverse event 3/23/2009 9@ 11:05AM, Injection site is red, swollen, Y warm to the touch, and pain in elbow.03/16/2009@ U 3:05Pm, No 3/9/2009 pain, no3/14/2009 warmth, but still swolle ately 48 hours after immunizations her Y left leg at injection site began swelling and turned reddish N purple, swelling 4/3/2009continued 4/5/2009 and covered he a 62 year old African American male Y and recieved Y the flu vaccine on 11 1/12/09. He reported a Uhistory of Diabetes. 1/12/2009 He2/24/2009 was recovering from a ons were received on 04/06/09 (received DTaP, MMR, VZV). On 04/08/09 developed swelling, U itching, redness 4/6/2009 in left 4/8/2009 arm at site just below had a rash on neck and chest. LipsYwere swollen. Itching at rash sites. Also complained of itching Y throat. 4/1/2009 Went to ER4/7/2009 administered Benedr d the months up to March Y there was no local orYsystemic reaction 21 to any Y of the Immunizations N given on 12/19/08. ###On 2/28/2009 March 3 patient came 8HRS DEVELOPED LOCALIZED REDNESS AND SWELLING IN RIGHT ARM, FEVER, MALAISE, U MYALGIAS. 4/6/2009REACTION 4/7/2009 OCCURED A minutes of receiving theYvaccines, patient Y developed Y hives on his head 3 and then experienced U shortness of 4/2/2009 breath, wheezing 4/2/2009and his lips tu er), child went to ER 2-13-09 with LLQ Y pain hadY CT- Showed ovarian 2 cyst was told by ER physicianY was8/25/2008 result of HPV 2/13/2009 immunizations. Lap d immunizations (FLUMIST, HepA/B, Meningococcal, Y MMR, Pneumococcal) 15 on 2/18/09. PerUthe pt he received 2/18/2009 these3/4/2009 vaccinations on 2/19 high-redness, 14x17 cm swelling and discomfort from upper thigh to knee area. Involved thigh Y 2.5cm larger 4/6/2009 in circumference 4/7/2009 - secondary e oday that he had a reaction to RECOMBIVAX HB #2 in October 20008. Y 10/1/2008 10/1/2008 d rash around belly button and on thighs- chicken pox looking rash with temp received varicella Y 2/26/09. 2/26/2009 4/6/2009 redness, 12 cmx8cm. Noticed 4/8/09 @ 0630. Vaccine 4/7/09 2130. Y 4/7/2009 4/8/2009 e began about 3 days after ZOSTAVAX injection. N 3/24/2009 3/27/2009 ticed red welt on site of injection theYfollowing day. In the afternoon around 3 pm. she experienced Y slight3/26/2009 itch on left3/27/2009 arm. The red welt on ri d red itchy mark ant injection site. U 4/7/2009 4/8/2009 ncopal episode after GARDASIL. Did not fall, guided to chair by me & aroused with ammonia Y & cold wet cloth. 4/8/2009 No seizure 4/8/2009 act. Pulse alwa n has been received from a healthcare Y worker concerning a 78 year old female who was vaccinated Y with8/30/2006 a dose of 1/26/2009 ZOSTAVAX (Merck). F n has been received from a nurse practitioner Y concerning a 77 year old female with SULFONAMIDE N allergy 3/1/2007 and no 1/22/2009 known medical history n has been received from a 74 year old female with no known medical history and drug allergies, N who two 1/12/2009 weeks ago 1/23/2009 was vaccinated with n has been received from a registered Y nurse concerning a 77 year old female patient with noNknown allergies 9/27/2007 and no pertinent medical hist n has been received from a registered Y nurse (also reported as certified medical assistant) concerning N a 71 1/20/2009 year old female patient with hiat n has been received from a licensed practical nurse concerning a 55 year old female paraeducator Y (weight 1/2/2009 242 pounds, 1/2/2009 height unknown) w n has been received from a physician Y concerning a female patient who on 23-JAN-2009 wasYvaccinated1/23/2009 with a 0.651/23/2009 ml dose of ZOSTER va n has been received from a Master Yof Science in Dentistry and a Physician concerning herself, Y a 61 year 1/9/2009 old female1/24/2009 patient with pre-osteop n has been received from a registered Y pharmacist concerning an 87 year old female patient U with recurrent1/9/2009 shingles (about every two month n has been received from a registered Y nurse concerning a 63 year old male patient with no pertinent U medical 1/12/2009 history1/15/2009 and no known drug all
n has been received from a physician Y concerning a 65 year old male patient who on 21-JAN-2009 N was vaccinated 1/21/2009 with 1/23/2009 ZOSTAVAX. On 23 n has been received from a physician Y concerning a 73 year old female patient with reflux, osteopenia Y and high### cholesterol 1/14/2009 who on 31-DEC n has been received from a physician Y concerning a 68 year old female patient who on 21-JAN-2009 U was1/21/2009 vaccinated with 0.65 ml of a dose n has been received from a registered Y pharmacist concerning a 69 year old female patient with N herpes simplex 3/5/2008 and1/26/2009 penicillin allergy who o n has been received from a 74 year old male physician with prostate cancer that was treatedUwith radiation 12/1/2007 who in approximately 1/1/2009 Decembe n has been received from a pharmacy Y student concerning an over 65 year old female who on U 28-JAN-2009 1/28/2009 was vaccinated 1/29/2009 with a dose of n has been received from a physician's Y assistant concerning a roughly 60 year old female who U on 20-JAN-2009 1/20/2009 was 1/20/2009 vaccinated with a dos n has been received from a physician's Y assistant concerning a 59 year old female with no drug N reactions or 1/2/2008 allergies 1/2/2008 and a history of breas n has been received from a physician concerning a 79 year old male who on 6-JAN-2009 was N vaccinated1/6/2009 injection with 1/20/2009 ZOSTAVAX (LOT # n has been received from a nurse concerning a 3 year old patient who on 19-JAN-2009 wasUvaccinated 1/19/2009 with a dose1/19/2009 of ZOSTAVAX instead n has been received from a pharmacist concerning a 67 year old female patient with an allergy N to something 1/22/2009 the dentist 1/22/2009 gave her (not furth n has been received from a pharmacy Y student concerning a 65 year old female patient with N hypertension,1/8/2009 hypercholesterolaemia, 1/16/2009 osteopor n has been received from a pharmacist concerning a 80 year old female patient with no known N allergies 1/19/2009 who on 19-JAN-2009 1/21/2009 was vaccina n has been received from a physician Y concerning a female patient who was over 65 year old, N who beginning 11/1/2008 November 12/1/2008 2008, was vaccina n has been received from a physician concerning a female in her 70's who on an unknown date U was vaccinated with ZOSTER vaccine, 0.6 n has been received from a registered Y burse concerning a 71 year old male who on 16-JAN-2009 Y was vaccinated 1/16/2009 with 1/21/2009 a dose of ZOSTAVA n has been received from a physician concerning a 67 year old female who was vaccinated Y with ZOSTER vaccine live (Oka/Merck), lot # n n has been received from a 63 year old male patient with headaches caused from some food N products (unspecified) 9/1/2008 and no known drug all n has been received from a 62 yearYold male patient who on 2-JAN-2009 was vaccinated with N a dose of ZOSTAVAX 1/2/2009 1/4/2009 (No Lot # provided) 0. n has been received from a nurse concerning a 4 year old female who on 23-JAN-2009 wasUvaccinated 1/23/2009 with ZOSTAVAX 1/23/2009 SQ, 0.65ml (lot # n has been received from a physician Y concerning a female patient with diabetes who in February N 2007, was 2/5/2007 vaccinated 1/1/2009 with a 0.65 ml dose n has been received from a 62 yearYold female registered nurse with no known drug allergy N and hypercholesterolaemia 1/13/2009 who on 13-JAN-20 n has been received form a consumer Y concerning his son in law who on unspecified date was U vaccinated with a dose of ZOSTAVAX. Five n has been received from a pharmacist concerning a 70 year old female who on 23-DEC-2008 U was vaccinated### with1/17/2009 a 0.65 ml dose of ZOS n has been received from a licensed Y visiting nurse concerning a 67 year old female with drug N hypersensitivity 1/14/2009 to codeine, 1/17/2009 PPD and ZYBAN n has been received from a doctor of pharmacy concerning a 60 year old male with cholesterol N and hypertension 1/8/2009who 1/18/2009 on 8-JAN-2009 was n was received from a 80 year old male Y patient with allergies to tetracycline; CIPRO; penicillin; N clindamycin; 11/5/2008 erythromycin;### tramadol; metop n has been received from a physician Y concerning a 74 year old female patient with a historyUof splenectomy 1/6/2009 who on1/20/2009 approximately 6-JAN-2 n has been received from a registered Y 35 years old female pharmacist who reported that she N thought her 1/14/2009 right eye could 1/14/2009 had inadvertently n has been received from a Physician Y Assistant concerning an 81 year old female patient with N hypertension, hyperlipidaemia, 1/15/2009 osteoporosis n has been received form a female patient who was vaccinated with ZOSTAVAX (Lot # not reported). U Patient called because she wanted to n has been received from a consumer concerning her 60 year old husband with no pertinentNmedical history 1/19/2009 and no1/19/2009 drug reactions or allerg n has been received from a physician Y concerning a female patient who had an outbreak of shingles U in July 12/1/2008 2008 and 1/15/2009 in December 2008 wa n has been received from a pharmacist concerning a female patient in her 60's who on 2-JAN-2009 U was vaccinated 1/2/2009 with a dose of ZOSTAV n has been received from a medical assistant concerning a 12 month old male patient who on U 13-JAN-2008 1/13/2008 was vaccinated 1/13/2009subcutaneous n has been received from a pharmacy tech concerning a female patient in her late 60s who U on approximately 01-JAN-2009, "approximately n has been received from a physician Y concerning a male patient who was vaccinated with a Udose of ZOSTAVAX (Oka/Merck) (lot # not pro n has been received from a licensed Y practical nurse concerning a 76 years old male patient N with cardiovascular 8/1/2008 disorder, hypertension and n has been received from a licensed Y practical nurse concerning an 87 year old male patient N with kidney 1/15/2009 stone, coronary 1/16/2009 artery disease, dem n has been received from a physician Y concerning a "young child" who was vaccinated with aYdose of PROQUAD ###(Merck).### Subsequently, w n has been received from an 81 year old female with diabetes and a history of nervous breakdown, N and 1/22/2009 no drug reactions 1/28/2009 who on 22-JANn has been received from a physician concerning a 77 year old female who on 05-JUN-2008Ywas vaccinated 6/5/2008 with 0.65 1/20/2009 ml dose of ZOSTER n has been received from a medicalYassistant concerning a 62 year old female patient with no Y known drug1/7/2009 allergies1/16/2009 and VARICELLA as a c n has been received from a registered nurse concerning a 62 year old patient who on 20-JAN-2009 N was1/20/2009 vaccinated1/21/2009 with ZOSTER vaccine n has been received from a certifiedYmedical assistant concerning a 62 year old male patientUwith no known 1/20/2009 drug reactions/allergies with ga n has been received from a pharmacist Y and a medical assistant concerning an 81 year old female N who on 12/8/2008 08-DEC-2008 1/25/2009 was vaccinated su n has been received from a nurse practitioner concerning a 68 year old female with hypertension, U arthritis 1/16/2009 and a history 1/27/2009 of genital herpes. T n has been received from a physician concerning a patient who was vaccinated with ZOSTER N vaccine live 3/10/2008 (Oka/Merck) 1/9/2009 0.65ml (lot number n has been received from a pharmacist concerning a 62 year old female with allergic reaction N to TETRACYCLINE 1/30/2009 and 1/31/2009 PHENOBARBITAL w n has been received from a licensed Y practical nurse concerning a 78 year old female with hypertension, N 2/25/2008 hyperlipidaemia 1/26/2009 and a history of pa n has been received from a physician Y concerning a 67 year old male with colitis ulcerative, gout N and metabolic syndrome 1/26/2009 whose wife was v
n has been received from a certified medical assistant concerning a 76 year old male with hypertension U 1/26/2009 and coronary2/3/2009 artery disease who o n has been received from a pharmacist concerning a 66 year old female with allergic reaction Y to antibiotics 1/29/2009 who at "some 2/1/2009 time last week" w n has been received from a female who on 23-JAN-2009 was vaccinated with ZOSTER vaccine N live (Oka/Merck) 1/23/2009(lot 1/31/2009 number, route and sit n has been received from a 64 yearYold female with no medical history and no drug allergiesNwho on 29-JAN-2009 1/29/2009 was 1/31/2009 vaccinated with a 0 n has been received from a physician Y concerning a 60 year old female with hypothyroidism, N hyperlipidaemia, 1/15/2009 sciatica 1/30/2009 and back problems w n has been received from a registered nurse (R.N.) concerning a 14 month old female with no U relevant medical 2/3/2009 history 2/3/2009 or past drug history n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a dose of ZOSTAVAX (Oka/M n has been received from a 66 yearYold female patient with penicillin allergy, no pertinent medical N history, 1/23/2009 who on 23-JAN-2009 1/30/2009 was vaccin n has been received from a 70 yearYold female patient with blood pressure high, no drug reactions N / allergies, 1/13/2009 who on 1/30/2009 13-JAN-2009 was va n has been received from a 66 yearYold female consumer with no known drug reactions/allergies N and breast 5/11/2008 cancer since 8/1/2008 January 2007, wh n has been received from a medicalYassistant concerning a 63 year old male with diabetes and N no drug allergies ###who 1/30/2009 on 15-NOV-2008 was n has been received from a medical assistant concerning a 14 month old patient who was vaccinated U inadvertently 2/5/2009 with a dose of ZOSTAV n has been received from a physician concerning a male who was vaccinated SQ with a 0.65 U ml dose of ZOSTAVAX (Oka/Merck) at a pha n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml (lot number, route an n has been received from a certifiedYmedical assistant concerning a 66 year old female patient with no known 1/29/2009 drug 1/31/2009 reactions/allergies and n has been received from a registered Y pharmacist concerning a 74 year old male patient with Y no drug reactions/allergies, 2/4/2009 2/5/2009 who on 04-FEB-2 n has been received from a registered nurse concerning a female patient who on an unspecified U date was vaccinated with one dose of ZOS n has been received from a registered Y pharmacist concerning a over 60 year old male with atrial N fibrillation and### a history of### chickenpox and n has been received from a registered Y nurse concerning a 63 year old female who on 25-JUN-2008 N was6/25/2008 vaccinated6/25/2008 SQ with a 0.65ml dose n has been received from a pharmacist concerning a 72 year old female with penicillin allergy N who on 19-JAN-2009 1/19/2009 was 2/2/2009 vaccinated with ZO n has been received from a medical assistant concerning a 77 year old female who on 03-FEB-2009 U was2/3/2009 vaccinated2/7/2009 with ZOSTAVAX (Oka n has been received from a physician concerning himself, a 70 year old male patient, with no pertinent medical history and no known drug n has been received from a healthcare Y student concerning a female who on 3-APR-2008 was U vaccinated4/3/2008 with ZOSTAVAX### (Oka/Merck) (lo n has been received from a physician concerning his father who on an unknown date, was vaccinated U with ZOSTAVAX (Oka/Merck) (lot # n has been received from a physician concerning a female who was vaccinated with a dose Uof ZOSTAVAX (Oka/Merck) (lot number, route n has been received from a physician concerning a patient who on an unknown date, was vaccinated U with ZOSTAVAX (Oka/Merck) SQ (lo n has been received from a physician Y and a nurse. It was reported that a 62 year old femaleNwith type II diabetes, 2/5/2009 hypertension, 2/8/2009 congenita n has been received from a physician Y concerning a male physician who was vaccinated withYa dose of ZOSTAVAX (Oka/Merck) (no lot # p n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub n has been received from a physician concerning a 62 year old female with several autoimmune U diseases, 1/1/2009 who about1/1/2009 a month ago approxi n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTAVAX n has been received from a physician Y concerning a patient who on 10-FEB-2009 was vaccinated with a 2/10/2009 dose of ZOSTAVAX 2/12/2009(Oka/Merck). n has been received from a licensed practical nurse concerning a 79 year old female who onN29-DEC-2008 was ### vaccinated 1/8/2009 with ZOSTAVA n has been received from a pharmacist Y concerning an 89 year old male with allergies to GUAIFENESIN, N 4/14/2008 PENICILLIN 2/13/2009 and SUDAFED, and n has been received from a medicalYassistant concerning an 80 year old female with diastolic N dysfunction, 2/10/2009 hypertension, systolic murmur, c n has been received from a 59 yearYold female with allergic PENICILLIN, SULFONAMIDE and N ERYTHROMYCIN, 1/7/2009 and 1/7/2009 no pertinent medica n has been received from a physician Y concerning a 77 year old female who on 12-FEB-2009Nwas vaccinated 2/12/2009 SQ with 2/13/2009 ZOSTAVAX (Oka/Me n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub n has been received from a physician Y assistant concerning a male with hypertension, osteoarthritis Y and no drug allergies 2/9/2009 whose wife in Dec n has been received from a 61 year old female with iodine (IVP dye) allergy and a history of Nheadaches 1/19/2009 while on therapy 1/20/2009 with DEMEROL a n has been received from a 67 yearYold female with allergic reaction to ERYTHROMYCIN, KEFLEX, N sulfa, FLAGYL, ### BUTALBITAL, ### aspirin n has been received from a physician concerning a patient who on an unspecified date was Yvaccinated with a dose of ZOSTAVAX (Merck) n has been received from a pharmacy technician concerning a 60 year old female patient who N on 17-FEB-2009 2/17/2009 was2/17/2009 vaccinated with a dose n has been received from a pharmacist Y concerning a 78 year old male patient with a previous N cause of shingles 2/16/2009 in October 2/18/2009 2008, who on 1 n has been received from a pharmacist Y concerning an adult female patient who was vaccinated Y with a dose of ZOSTAVAX 1/18/2009 (Oka/Merck) 0.5 n has been received from a pharmacist Y concerning a 70 year old female with allergies to alendronate N sodium 2/16/2009 (MSD)2/18/2009 WAES # 0902USA044 n has been received from a pharmacist concerning an 81 year old female patient with a history N of shingles1/8/2009 on her trunk 2/8/2009 and no known drug n has been received from a physician concerning an over 65 year old patient who on approximately U 20-DEC-2008, ### 2/20/2009 two months ago, was va n has been received from a physician concerning a male who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml2/18/2009 (lot # not reported). Aft n has been received from a nurse practitioner concerning an approximately 70 year old patient U with cardiac failure who was vaccinated SQ n has been received from a pharmacist concerning a female patient with sulfa allergy who on N 18-FEB-2009 2/18/2009 was vaccinated 2/19/2009 with ZOSTAVA
n has been received from a registered Y nurse concerning herself with a history of osteoporosis N and borderline 8/4/2008 elevated 9/1/2008 LDL who on 04-AUG n has been received from an office Y staff in physician office concerning a 63 year old female Y patient with a history of Fibro Myalgia who was n has been received from a nurse practitioner Y concerning a 73 year old female with osteoporosis N and hypertension 2/17/2009 2/19/2009 and no known drug alle n has been received from a 67 yearYold female with penicillin allergy and high blood pressure N who on 1-JUN-2007 6/1/2007 was 2/14/2009 vaccinated with a do n has been received from a consumer Y of 77 year old female with a history of high blood pressure N and drug 2/20/2009 reaction2/21/2009 to niacin and stent put n has been received from a physician concerning a 73 year old female who was vaccinated N with a dose 1/23/2009 of ZOSTAVAX (Oka/Merck) approx n has been received from a pharmacist Y concerning a patient who on 23-FEB-2009 was vaccinated N intradermally 2/23/2009 with 2/23/2009 a dose of ZOSTAVAX n has been received from a physician Y and a licensed practical nurse concerning an 86 year N old female patient ### with hypertension, 2/3/2009 coronary n has been received from a physician Y concerning himself, a 61 year old male patient with a history N of pain 2/16/2009 and vaccine 2/18/2009 reaction and no kno n has been received from a licensed Y practical nurse concerning a 61 year old male patient who U on 5-FEB-2009 2/5/2009 at 13:25 2/5/2009 was vaccinated wi n has been provided from a physician concerning a female patient who on 13-FEB-2009 was Y vaccinated2/13/2009 with a dose 2/23/2009 of ZOSTAVAX vaccin n has been received from a physician Y concerning an 83 year old female patient with osteoarthritis, N elevated 4/22/2008 cholesterol, 2/14/2009 degenerative joint n has been received from a nurse practitioner concerning a 72 year old female homemaker N with no history 2/1/2008 of HSV I or 2/1/2008 II and allergy to aspi n has been received from a registered Y nurse concerning an 79 year old male with type 2 diabetes N mellitus, 11/8/2007 coronary 2/5/2009 artery disease and pro n has been received from a 71 year old female with allergic reaction to FLAGYL who on 20-FEB-2009 U was 2/20/2009 vaccinated 2/20/2009 with a dose of ZOST n has been received from a physician Y concerning a patient who was vaccinated with a singleYdose of ZOSTAVAX 2/1/2008 (Oka/Merck). 1/12/2009 It was repo n has been received from a physician concerning a female in her 70s who "about a year ago" Y was vaccinated with ZOSTAVAX (Oka/Merck n has been received from a pharmacist concerning a 65 year old female who on 29-JAN-2009 U was vaccinated 1/29/2009 with 1/29/2009 a dose of ZOSTAVAX ( n has been received from a nurse practitioner concerning a male patient who at the "beginning Y of December 12/1/2008 2008" 12/1/2008 was vaccinated with ZO n has been received from a 72 yearYold female with diabetes, sulfonamide and a history of tetanus N who about one and 2/8/2009 a half to two years a n has been received from a 71 year old female patient with a history of shingles before receiving N the vaccine 10/2/2008 and blisters 10/9/2008 around her lips si n has been received from physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) on an unspecified date. Subse n has been received from a physician concerning a 61 year old female with diabetes who in N February 2008, 2/1/2008 was vaccinated 5/1/2008with ZOSTAVA n has been received from a pharmacist concerning a 65 year old female who on 21-FEB-2009 Y was vaccinated 2/21/2009 with 2/23/2009 one dose of ZOSTAVA n has been received from a female consumer who was vaccinated with ZOSTAVAX (Oka/Merck). Y The consumer reported my physician did n has been received from a medicalYassistant and a nurse practitioner (N.P.) concerning an N 81 year old female 2/9/2009 patient 2/11/2009 with hyperlipidaemia n has been received from a physician's assistant concerning a girl who on an unspecified date U was vaccinated 2/12/2009 with 2/12/2009 a first dose of VARIVAX n has been received from a 65 year old female with blood pressure and thyroid problem whoYwas vaccinated with a12/1/2008 dose of ZOSTAVAX (O n has been received from a 60 year old female with sulfonamide, morphine, DEMEROL andNCELEBREX 1/2/2009 allergy who1/3/2009 on 02-JAN-2009 was n has been received from a pharmacist concerning a 65 year old male who on 05-Jan-2009 N was vaccinated 1/5/2009 with ZOSTAVAX, 1/10/2009 subcutaneou n has been received from a 60 year old female receptionist who in December 2008, was vaccinated Y with12/1/2008 a dose of ZOSTAVAX 12/1/2008 (Oka/Merck n has been received from a pharmacist Y concerning a 66 year old female patient with no known N drug allergies, 1/12/2009 who on 1/14/2009 12-JAN-2009 was va n has been received from a pharmacy tech concerning a female patient in her late 60's who U on approximately 1/1/2009 01-Jan-2009, 1/1/2009"approximately n has been received from a nurse practitioner Y concerning a 60 year old male patient with a history N of Human 1/2/2009 immunodeficiency virus expos n has been received from a physician concerning a male patient who on an unspecified dateYwas vaccinated 6/30/2008 with a dose of ### ZOSTAVAX (O n has been received from a registered Y pharmacist concerning a 22 year old female employee Y who handles the intact1/1/2009 ZOSTAVAX vaccine ( n has been received from a 65 yearYold female registered nurse, who is the consumer, with Y hypersensitivity and ### allergic reaction ### to antibiot n has been received from a registered pharmacist concerning an 80 year old female with arthritis Y and sulfa 1/2/2009 allergy who 1/2/2009 on 02-JAN-2009 wa n has been received from a nurse concerning Y a 76 or 77 year old female patient who in MaryY 2008, was vaccinated 3/1/2008 12/1/2008 with ZOSTAVAX (Oka/ n has been received from a pharmacy student concerning a patient who about 1 month ago,Nwas vaccinated 12/1/2008 with a 12/1/2008 dose of ZOSTAVAX (O n has been received from an office Y manager concerning a 72 year old male who on 06-JAN-2009 Y was vaccinated 1/6/2009 with 1/6/2009 a dose of ZOSTAVA n has been received from a registered pharmacist concerning a 72 year old female patient who Y on an unspecified date was vaccinated with n has been received from a nurse practitioner Y concerning a male patient who in December 2008, N was vaccinated 12/1/2008with 1/5/2009 a dose of ZOSTAVA rmation has been received from a pharmacist concerning a 77 year old male who on 30-DEC-2008 N was vaccinated ### with 1/9/2009 ZOSTAVAX (Oka/M n has been received from a 68 yearYold female patient with sulfonamide allergy and a historyNof blood pressure high who in ### approximately 2 n has been received from an office Y manager concerning a 62 year old female who on 08-JAN-2009 Y was vaccinated 1/8/2009 with 1/8/2009 a dose of ZOSTAV n has been received from an office Y manager concerning a 66 year old female who on 08-Jan-2009 Y was vaccinated 1/8/2009 with 1/8/2009 a dose of ZOSTAV n has been received from a 68 yearYold female patient with breast cancer, atrial fibrillation, cardiac N valve11/1/2007 leak, neuropathy 11/1/2007 peripheral, sulfon n has been received from a medical assistant concerning a 69 year old female who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck n has been received from a pharmacist Y concerning a 91 year old female who on 12-DEC-2008 U was vaccinated### with a dose ### of ZOSTAVAX n has been received from a 74 year old female with Crohn's disease, penicillin and Keflex allergy N who on 1/8/2009 08-Jan-2009 1/8/2009 was vaccinated with
n has been received from a 62 yearYold female nurse with penicillin and PREDNISONE allergy, N hypercholesterolaemia 1/7/2009 1/8/2009 and osteopenia and n has been received from a pharmacist Y concerning a patient who on approximately 1-JAN-2009 U "last week" 1/1/2009 was vaccinated 1/1/2009with ZOSTAVA n has been received from a healthcare student concerning a male patient who on 07-JAN-2009 U was vaccinated 1/7/2009 with 1/7/2009 ZOSTAVAX (Oka/Mer n has been received from a pharmacist concerning a 62 year old female with PENICILLIN allergy N who on 1/5/2009 05-JAN-2009 1/5/2009 was vaccinated with n has been received from a pharmacist Y concerning a 65 year old female who on 06-JAN-2009 U was vaccinated 1/6/2009 with ZOSTAVAX 1/6/2009 (Oka/Merc n has been received from a nurse concerning a male who on an unknown date, was vaccinated N with ZOSTAVAX (Oka/Merck) (lot# not pro n has been received from an 82 year Y old female patient with no known drug reactions-allergies N and medical history, ### who on ### 16-DEC-2008 n has been received from a 75 year old female with allergic to sulfa who was vaccinated withNa 0.65 ml dose of### ZOSTAVAX 1/2/2009(Oka/Merck) (lo n has been received from an office manager concerning a female nurse with a history of shingles U who on 31-DEC-2008 ### was ###reconstituting n has been received from a physician concerning a patient who on approximately 24-DEC-2008 U was vaccinated ### with ZOSTAVAX (Oka/Me n has been received from a 60 year old nurse practitioner with no pertinent medical history reported Y and12/3/2008 no drug reaction/allergies, ### reportin n has been received from a registered nurse concerning a patient who was vaccinated with Y a dose of ZOSTAVAX ### (lot # not ### reported) by th n has been received from a 63 yearYold female consumer with penicillin allergy who reportedNthat she received 4/1/2008 a single 11/1/2008 dose of ZOSTAVAX n has been received from a nurse practitioner concerning a 66 year old female patient with no N known drug reactions/allergies ### ### and asthma w n has been received from a registered Y nurse concerning a female who on 19-DEC-2009 wasUvaccinated with "one ### dose" of ### ZOSTAVAX (O n has been received from a nurse concerning Y a 68 year old female patient with hypertensionYwho on 08-FEB-2008 2/8/2008 12/9/2008 was vaccinated in her le n has been received from a 61 year old female with an allergy to penicillin and no pertinent medical N history who ### on 19-DEC-2008 ### was vacc n has been received from a pharmacist Y concerning a 63 year old female patient, with no pertinent N medical history ###and no known ### drug react n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith ZOSTAVAX 12/1/2008 (Oka/Merck) 12/1/2008 about two week n has been received from an 81 year old female who in October 2008 was vaccinated with ZOSTAVAX U (Oka/Merck), 10/1/2008 10/1/2008 0.65ml/once, SC Sub n has been received from a pharmacist concerning a 74 year old male with a history of cold U sores, who one year ###ago was### diagnosed with N n has been received from a 62 year old male who "about 8 weeks ago" was vaccinated withUsingle dose of series ###of ZOSTAVAX ### (Oka/Merc n has been received from a male with a history of herpes simplex who was vaccinated with aNsingle dose of ZOSTAVAX ### (Oka/Merck) ### (lot # n has been received from a physician concerning a 15 year old female patient, who on an unspecified U date, was ### vaccinated ###with ZOSTAVA n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith single dose 6/1/2008 of ZOSTAVAX 6/1/2008about 6 month n has been received from a 62 year old female with "numerous reactions to other unspecified U medication" who### on 17-DEC-2008 ### was vacci n has been received from a 85 year old female patient, with codeine and sulfonamide allergy, N who on 15-DEC-2008 ### was vaccinated ### with a n has been received from a 61 yearYold female patient with allergic reactions to antibiotics (had N a reaction once to ERYTHROMYCIN), who n has been received from an 86 year Y old female with blood pressure and a history of shingles N in April 2006, 12/7/2007 who on 07-DEC-2007 ### was vac n has been received from a 71 yearYold female patient with hypertension and no known drugNreaction or allergies, ### who on### 20-NOV-2008, w n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA n has been received from a doctor of pharmacy concerning a patient on an unspecified dateUwas vaccinated with a dose of ZOSTAVAX (O n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA n has been received from a registered pharmacist concerning a 77 year old female patient who Y on 12-DEC-2008 ###was vaccinated ### subcutan n has been received from a registered pharmacist concerning an unknown number of patients U who were12/1/2008 vaccinated12/2/2008 with a dose of ZOSTA rmation has been received from an office Y coordinator and follow up information has been received N from a10/9/2007 physician 10/9/2007 concerning a 59 year ol n has been received from a registered nurse who on unspecified date developed shingles like U blisters from giving ZOSTAVAX to patients. S n has been received from a registered Y pharmacist concerning a 75 year old female patient who N on 23-JAN-2008 1/23/2008was 12/9/2008 vaccinated with a dos n has been received from a physician concerning a 71 year old male who on 09-DEC-2008 was U vaccinated 12/9/2008 with a 0.65 mL### dose of ZOSTA n has been received from a 56 year old male patient with dialysis and allergy to tetracycline N who on 11-DEC-2008 ### was vaccinated ### in the ar n has been received from a nurse practitioner concerning a 65 year old female patient with hypertension N and osteoporosis, ### ### who on 15-DEC n has been received from a medicalYassistant concerning a 60 year old female patient with drug N hypersensitivity 12/9/2008 to DEMEROL 12/9/2008 and no perti n has been received from a doctor of pharmacy concerning a 66 year old patient who on 16-Dec-2008 N was vaccinated ### with ### a dose of ZOST n has been received from a female who on an unknown date, was vaccinated with ZOSTAVAX U (Oka/Merck) (lot# not reported). Subsequen n has been received from a consumer Y concerning her 73 year old male husband with a pacemaker U and a1/2/2008 defibrillator, 11/1/2008 and a history of both n has been received from a female patient who on 26-Nov-2008 was vaccinated subcutaneously N with a dose of### ZOSTAVAX ###(Oka/Merck). O n has been received from a pharmacist concerning a 62 year old female patient with no drugNreactions/allergies, ### who on 12-DEC-2008 ### was n has been received from a nurse concerning a 75 year old male patient with a history of large Y cell lymphoma 11/2/2007 who on 12/5/2008 21-NOV-2007 was va follow-up information has been received Y from 62 year old female pharmacist prone to fever Y blister who on 12/5/2008 05-DEC-2008 12/5/2008 at 10:00 was vacc n has been received from a female physician who on 10-DEC-2008 was vaccinated with a dose N of ZOSTAVAX### (Oka/Merck). ###The physician n has been received from a 65 yearYold female with diabetes who in July or August 2008, was N vaccinated7/1/2008 with a dose 12/1/2008 of ZOSTAVAX (Oka/
n has been received from a physician Y concerning a 78 year old male patient with hypertension, N artery coronary 1/5/2007 disease 10/2/2008 and diabetes and a n has been received from a pharmacist concerning a patient who two to three days ago wasNvaccinated 12/8/2008 with a dose of ZOSTAVAX vaccine n has been received from a health professional concerning a 67 year old female with an allergy N to latex, who on ### 10-DEC-2008 was vaccina n has been received from a registered Y nurse concerning a 61 year old male with hypercholesterolemia Y who on### 10-DEC-2008 ### was subcutan n has been received from a nurse practitioner Y concerning a 13 month old female who inadvertently U on 09-DEC-2008 12/9/2008 12/9/2008 was vaccinated SQ w n has been received from a medicalYassistant concerning a 74 year old female patient who had U an episode 5/1/2008 of shingles prior to receiving ZO n has been received from a nurse practitioner Y concerning an 87 year old female patient withNhypertension, 12/1/2007 hyperlipidaemia 12/7/2008 and hypothyroid n has been received from a store manager concerning a female patient who on 12-NOV-2008 U was vaccinated ### with a dose of ZOSTAVAX ( n has been received from a physician Y concerning a 66 year old female patient with codeine N allergy, hypertension 10/1/2008and 10/1/2008 hypothyroidism who 2 n has been received from a female patient who on an unspecified date was vaccinated with U a dose of ZOSTAVAX (Oka/Merck). Subseque n has been received from a female consumer who on 25-NOV-2008 was vaccinated with a dose U of ZOSTAVAX ### (Oka/Merck). ### On 28-NOV-2 n has been received from a 46 year old male patient with history of drug hypersensitivity to penicillin N and12/3/2008 shellfish based 12/3/2008 medications such n has been received from a consumer concerning her sister, a female patient who accordingUto the consumer she had already had a very b n has been received from a physician concerning a 1 year old patient who on 24-NOV-2008Uwas vaccinated with ###a dose of### ZOSTAVAX (Ok n has been received from a nurse practitioner Y concerning a 67 year old male patient with sleep N apnoea and 9/12/2008 a history 9/12/2008 of head injury recover n has been received from a 64 year old male with high blood pressure and shingles with post U herpetic neuralgia 10/1/2007 (PHN) and ### a history of sten n has been received from a physician concerning a 60 year old female who, "in last week", on U approximately 24-Nov-2008 ### was vaccinated n has been received from a female patient, who in February 2008, was vaccinated with a dose Y of ZOSTAVAX 1/1/2008 vaccine 12/1/2008 (Oka/Merck) (Lot. # n has been received from a 73 yearYold male patient with history of prostatic disorder and noNknown drug11/1/2008 reactions/allergies, 11/3/2008who on appro n has been received from a physician Y concerning a 77 year old female patient who in February N 2007, was2/1/2007 vaccinated with### a dose of ZOST n has been received from a pharmacist concerning a patient who about a year ago was vaccinated N with a dose of ZOSTAVAX (Oka/Merck n has been received from an 88 year Y old female consumer with a blood pressure condition and N no pertinent medical ### history, ###who on 18-No n has been received from a registered Y nurse (R.N.) concerning her father, an 83 year old male N with a history 2/1/2008 of macular 11/1/2008 degeneration and " n has been received from a physician concerning a 74 year old male with hypertension, dyslipidaemia Y and penicillin ### allergy ### and a history of n has been received from a consumer Y concerning her 75 year old mother with leukemia, memory N loss and a history ### of two strokes, and "all n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck) (Lot n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Merck) (Lot not re n has been received from a 54 yearYold female with a history of shingles in right eye in Feb 1998 N and no drug allergies ### who ### was vaccinated n has been received from an 88 year old male with no pertinent medical history who on 15-DEC-2008 N was vaccinated ### 1/6/2009 subcutaneously with n has been received from a 61 yearYold female with sulfonamide allergy and no pertinent medical U history who 1/5/2009 on 05-Jan-2009 1/5/2009 was vaccina n has been received from a 74 year old female with sulfa allergy and allergic to an antibioticsU(unspecified) 1/6/2009 who on 6-JAN-2009 1/8/2009 was vaccin n has been received from a registered pharmacist concerning a patient who was vaccinatedYwith a dose of ZOSTAVAX (Merck) (Lot not re n has been received from a 66 year old male patient with high cholesterol and a history of quadruple N vessel 1/5/2009 bypass graft 1/6/2009 in 1990, shingles n has been received from pharmacist concerning a 73 year old female who on 03-JAN-2009Nwas vaccinated 1/3/2009 with a dose 1/3/2009 of ZOSTAVAX va follow-up information has been received from a registered pharmacist concerning a 75 year N old male patient 1/4/2009 with no 1/4/2009 known drug reaction/a n has been received from a physician Y concerning a female patient who on 05-DEC-2008 was U vaccinated12/5/2008 with a 0.65ml dose ###of ZOSTAVAX n has been received from a female Y Registered Nurse, who "5-6 weeks ago", was vaccinatedNwith ZOSTAVAX ### vaccine 12/8/2008 (Oka/Merck) subcuta n has been received from a 70 year old male with sulfonamide allergy who on 24-DEC-2008Ywas vaccinated with ###a 0.65 ml ### dose of ZOSTA n has been received from a pharmacist Y concerning a 67 year old female patient with hypothyroidism, N arthritis, diverticulitis ### ### and interstitial cy N n has been received from Y a physician Y concerning Y an approximately 030 months old female who Y received 3 doses of PEDVAXHIB 5/1/2008 (lot# not re n has been received from a Doctor Y of pharmacy Y concerning a 79 year 0 Yold male inpatient for N decompensate 4/2/2009 diabetes 4/2/2009 with hypertension, dia n has been received from a registered nurse, for VARIVAX vaccine (MERCK), a Pregnancy U Registry product 3/4/2009 concerning 3/4/2009 a 17 year old preg n has been received from a registered pharmacist concerning a now 66 year old female whoYin approximately 2003 "about 4 to 6 years ago rib cracked went to doctor. Y She prescribed pain pills, week later it went popped again. YearsNwent by without 10/1/2003 problems, breast cancer show a 16-year-old female who presents today with mother. Y The patient states 1 she was with her mom Y earlier getting 3/12/2009 her prom 3/13/2009 dress fitted when s vaccines on 3-16-09. The evening of vaccine she got a fever + slept poorly. In the morningYafter the vaccine 3/16/2009 was disoriented 3/16/2009 + needed he h swollen, red with blisters. Looks like Y a 2nd degree burn. Almost entire thigh swollen. Very tender U to touch. 4/1/2009 Swollen area 4/1/2009 very hard. Receiv dizziness, vomiting low grade fever resolved spontaneously. U 4/1/2009 4/1/2009 d bilateral pulmonary embolisms Y and Y moderateYto severe right ventrical 4 heart dysfunction. Misdiagnosed Y originally ### as "walking ### pneumonia", pain and swelling in arm. HeadacheYand temperature 100.2 degrees 24 hours after vaccine.Y5 cm swelling 3/27/2009 and erythema. 3/28/2009
e course on the vaccines, patient has Y developed debilitating abdominal pain. 4/15/09 MR received U 5/5/08 6/13/2008 to 4/13/09.8/1/2008 15 yr WCC 6/13/08 w at 10:45 am 3/26/09, shaking. PoorYsleep night of 3/25/09. Y 3/25/2009 3/26/2009 PE complete immunization given (DTAP Y IPV MMR Varicella) 415P child started cough. 4:20pm Y wheeze A-P 4/6/2009 lungs. Benadryl 4/6/2009 12.5mg / 5ml S ction lasting 4 days. Y Y 3/30/2009 3/30/2009 d PREVNAR vaccine @ thigh on 4/12/09 at 1021 AM. Awoke from nap approx 3PM & criedYas if in pain. 4/2/2009 Mom noticed 4/2/2009 R leg (thigh->toes) edness and swelling of left upper thigh, plus erythema approximately 12cm. U 4/1/2009 4/1/2009 ceived the Zoster vaccine at the clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed a shingles 2/5/2009 rash approx 2/15/2009 10 days after the vac njection of ZOSTAVAX on 03/25/2009 about six days later developed red spots on my right leg U on the inside 3/25/2009 between 3/30/2009 ankle and knee. The ped rash after vaccines were given. I'm sure of due to Varivax n MMR. 3/24/2009 me to pick up a sticker and she looked pale, lips were white. She said she was tired and laidYdown on the4/8/2009 floor. I picked 4/8/2009 up patient and carr eral scattered vesicles. Some already crusting over. Y 3/10/2009 4/4/2009 roke out on left thigh as soon as theY MMR was pushed. Patient was given BENADRYL 12/5mg Y and thigh 4/9/2009 was observed 4/9/2009 for 15 minutes. Th of redness to the right deltoid, muscle Y aches in right arm patient unable to lift arm above hisNright shoulder. 4/4/2009 Patient states 4/6/2009 " I just do not fee lled 4/9/09 AM to notify us approximately two hrs after vacc. She felt "weak and with headache"; U this morning 4/8/2009 after 154/8/2009 min run she c/o swea LA vaccine (along with TDAP & HEP A, and MENATRA) given 3/31/09 (1388 IM VERIVAX lot) onset (acute) 3/31/2009 Bell Palsy 4/4/2009 VII on 4/4/09. U 4/6/2009 iatric/adolescent dose of Hepatitis A instead of adult dose. Dr notified at 16:04, 3/31/09. Y 3/31/2009 as inadvertently given DTap instead of Tdap. Patient contacted today and has had no adverse Y events. 4/3/2009 elling - Pt reported fever to 101 x 2 days after 2 days on 4/3/09 redness- swelling inner L armY5"X3" - No fever 3/3/2009 - Tx BENADRYL 3/3/2009 and KEFLE Y 3/31/2009 3/31/2009 old female presents with fever starting Y 4 days after Y vaccination. Patient 2 continued to fever for Y 6 days with3/9/2009 102-104.7t 3/12/2009 with no other sympto he dept and left message. Pt was contacted at 2:15pm of 04/07/2009, stated"03/26/2009 gotYinjection in3/26/2009 clinic, started 3/27/2009 to act out on Friday munized with Varivax vaccine on 3/4/09. Over the next 48 hours, she developed redness and Y warmth at 3/3/2009 injection site, 3/3/2009 and surrounding are 1/30/2009 N 4/17/2008 1/30/2009 ar sized redness and warm to touch at administration site. Y 4/8/2009 4/9/2009 elt "woozy,dizzy" when got home. approx Y 1 1/2 hr later had some difficulty breathing along with Y burning sensation 3/18/2009of3/18/2009 face and eyes. did not 2/18/1998 Y Y Y 1 N 1/9/1998 1/19/1998 ent at 10:15am, pt. called 9:15pm complaining of right arm pain, not red, no fever, vomiting and Y stomach3/26/2009 ache; ate out. 3/26/2009 d Herpes Zoster (C5 distribution) 03/21/2009 Y 9/2/2008 3/21/2009 s a softball sized area at the site of administration. Area is painful, red, swollen, and warm toUtouch. Patient 4/8/2009 does not4/9/2009 have a fever or other ver 6 hours after injection. Tylenol given.Fussy. Appetite down and remains down. Awoke whimpering Y with 4/7/2009 high fever 4/7/2009 (10 pm) Temp Recta ceived #2 VZV, #1 HPV, and #1 Tdap (had 5 previous DTP vaccines) 4-1-09 at the HC. At the Y OV on 4-1-09 4/1/2009 patient also 4/4/2009 had a viral gastroe 4/9/2009 N 4/8/2009 4/9/2009 week field exercise, patient was administered anthrax and smallpox vaccine, 05MAR09. Patient Y did follow-up 3/5/2009 note on 3/23/2009 12MAR09 with no pro eved shots at health departmentY behind Y schedule.Received 6 vaccines. Around 8 hours later, Y dad found3/16/2009 child having 3/16/2009 seizure, limp, blue, dr came cranky cried her developed rash on her lower extrimities.Rash lasted for 1 hour patientY consolable 1 n 20 minutes after the administr hours after TD was given pt started Yto run a low grade temp and had swelling of the injection site along with 4/6/2009 a hive. Mom 4/7/2009 was told to use co ceived Kinrix (DTaP,IPV, MMR & Varicella 04/07/09. He was seen in the office this date dueYto pain, itching 4/7/2009 and swelling 4/8/2009 in left arm for 2 da o 102.5, rhinorrhea, and erythematous rash that began on cheeks and spread to neck, trunkNthen extremities. 3/26/2009 Further 3/28/2009 details can be obtain 3/12/2009 N 3/11/2009 3/11/2009 was reported by a physician (also the father of the subject) and described the occurrence ofUvaccine underdose 3/5/2009 in a 3/5/2009 31-year-old pregnant f ped acute abdominal pain - 2 hrs after injectionYof (1) GARDASIL; (2) 1 MENACTRA, (3) TDAP. Y Pt was evaluated 3/25/2009 in ER 3/25/2009 - diagnosis acute UT remic swelling on Rt upper arm at injection site 1"/1'/2" Y 3/19/2009 3/19/2009 9 at 1030 the pt received the TDAP and IPV in her right arm. The pt woke at about 2230 with the sensation 3/25/2009 that her3/25/2009 throat was swelling. T and rash reaction with angioedema. 4/1/2009 4/4/2009 ew minutes client turned pale, stiffened body, arched back, arms curled to chest, eyes rolled Yback, head jerked 4/8/2009 back and 4/8/2009 forth. Lowered clie weakness BP prior to event 114/62, S/P 96/58 pulse 60 normal breath sounds. Blood sugarY = 82. 4/2/2009 4/2/2009 s after receiving vaccine started to "hum" Y fell over backwards hit head on floor, unconsciousUapprox 10 seconds 4/8/2009 -> head 4/8/2009 twitching as in office to have meningococcal but was given a HIB injection instead. 3/30/2009 vaccination on 3/31/09: TDAP and TYPHOID right arm, FLUMIST and AVA #4 left arm. On 1 April 09 pt3/31/2009 noted a 3" 4/1/2009 circle of redness and s
ates she started having cold symptoms and a sore throat starting the day after the immunization. Y 2/21/2009 2/22/2009 ately 2 weeks after immunization, he states his muscles felt tight, and he states he felt more Y fatigued than 2/27/2009 normal. This 3/13/2009 lasted about 5 days mplaining of intermittent sharp mid to low back pain since last night. Pain occurs when getting up from laying down position and forceful ex er vaccine administered had swelling, redness, tender. To RTR- 2" by 2" - raised red & swelling Y to L deltoid4/7/2009 15mm by 4/9/2009 15mm diffuse red. me to our clinic on 4/9/09 at 10:05 accompanied by mother. Patient complains of body aces,Unausea no vomiting, 4/7/2009soreness 4/8/2009 in bilat. arms an rmation was received on 21 November 2008 from a health care professional. A cluster of approximately Y 20 cases of slight bleeding at the s ort was received on 08 December 2008 Y from a consumer (patient's mother). A 4-month-old male U with a history 10/7/2008 of being 10/7/2008 33 weeks premature n has been received from a health professional Y for GARDASIL, a Pregnancy Registry product, Y concerning 3/20/2008 a female3/20/2008 who became pregnant n has been received from a registered Y nurse for Y the pregnancy registry 0 for GARDASIL concerning Y a 17 years 6/1/2008 old female 6/16/2008 patient with no pe n has been received from a consumer Y concerning Y his 18 year old daughter 10 with no pertinentNmedical history 8/28/2008 or no known 9/8/2008 drug allergies, wh n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from a school staff member n has been received from a consumer concerning her now 11 year old nephew who on an unspecified U date was vaccinated with a dose of n has been received from a consumer concerning her now 12 year old nephew who on an unspecified U date was vaccinated with a dose of n has been received from a physician concerning Y a male who on 04-APR-2008 0Y was vaccinated N with a dose 4/4/2008 of ZOSTAVAX 3/1/2009 (Oka/Merck). In ort was received from another manufacturer Y (document number 45216582), who received theYreport from a health care professional, who is n has been received from an 82 year old female patient with no drug reaction/allergies, who Non 23-JAN-2009 1/23/2009 at about 1/24/2009 12:00, was vaccinate reporting disturbed sleep at night secondary to pain at injection site. She is reporting that she U experiences 4/3/2009 some numbness 4/4/2009from shoulder about 4-6 cm left deltoid. warm to touch. Y 4/1/2009 4/2/2009 d rash. She went to the doctor andYit was diagnosed as shingles. She had a fever and flu like U symptoms 3/20/2009 preceding the rash. The rash wa on all my neck for two days, I had fever yesterday, it last only one day and I still have the swelling N of glands 3/30/2009 starting 4/7/2009 yesterday. I haven't vi after receiving the shingles vaccine on April 3, 2009 I had flu like smyptoms. Headache, sleepless Y nights, 4/3/2009 chills, achy 4/6/2009 all over,very weak, f Dtap given, 04/01/09 Pt. had axillary temp of 103, 04/02/09 Pt. had 2-3cm redness at injection U site 3/31/2009 4/1/2009 ction to Dtap (given on 03/30/09), right Y arm swollen and red (4cm). Pt. came back to office onU04/01/09. 3/30/2009 3/31/2009 mins of injections, pain, stiffness, extreme Y fatigue, lethargic . Then experienced cont. Y pain and N soreness,3/23/2009 stiffness on3/23/2009 and off for next week X2 4/29/09 Received Hospital medical Y records Y for 2/8-2/9/2009 & 4/5-4/7/2009. 5 FINAL DX: new Y onset seizures 2/4/2009 Records 2/8/2009 reveal patient expe d area, size of half-dollar, left arm.Swelling Y arm/neck/shoulder. MD diagnosed cellulitis. U 8/18/2008 8/20/2008 ainful red swollen 4 X 3 1/2" area on left arm after vaccination Y 4/25/2008 4/26/2008 mm red raised area at site of injection generic benadryl given Y 4/8/2009 4/9/2009 te, fever, seizure Y N ### ### abdomen/chest/lumbar Y Y ### ### nt shooting pains in right arm, soreness at injection site, no redness or swelling at site U 11/5/2007 11/6/2007 red Tdap and Gardisil, pt.'s head dropped, was unresponsive, arms and legs drew up in seizure-like Y activity, 8/17/2007 pt. was8/17/2007 incontinent of urine, pt redness, warm to touch, itches Y U 8/3/2007 8/4/2007 and high pitched screaming two hours after vaccines given, lasted for 2 hours Y 5/16/2007 5/16/2007 inistration of all 4 vaccines, upon departure and standing, client reported feeling dizzy. Assisted Y client back 4/9/2009 to chair. 4/9/2009 Client fainted. Incohe er MMR vaccination our daughter developed Y a 101 degree fever. The the 6th day our daughter U had a febrile 3/30/2009 seizure due 4/3/2009 to a 104 fever. Sh d vomiting, dehydration and abdominal Y pains. 4/14/09 Y Received hospital 4 medical records of U 4/9-4/12/2009. 3/30/2009 FINAL DX: 4/2/2009 cyclic vomiting; abdo n 02-25-09. States she had pain, swelling and itching lasted 2 weeks after injection (given 11/3/08). Y She11/3/2008 didn't do anything then and about ped a rash on right arm shortly after vaccine administration N 3/9/2009 3/14/2009 redness, very hot, doubled in size on Y the evening of 04/06/09. Mother gave Benadryl and theYnext morning 4/6/2009 pt. woke up 4/6/2009 screaming of pain. M rea of induration over R deltoid with 13x10 cm of erythema, non-tender, no expressible d/c. Received U DAPTACEL 4/9/20094/9/09 4/10/2009 R deltoid 20, 2009 - developed severe headache. Y Seen by PMD on March 23, who diagnosed shingles. Y 3 lesions4/10/2008 on scalp - 3/20/2009 (L) side of head - culture h large erythematous edematous puritic Y patch around site of DTaP & varicella injections -> 5" wide x 4" long; 4/8/2009 To ER 4/8/2009 + office. hing, blinking, facial grimace beginning on day of administration of vaccine and has been ongoing. U Frequency 4/6/2009 about 4x/10 4/6/2009 minutes. itis day 13 after MMR. Y 3/26/2009 4/6/2009 tous discoloration with slight induration approximately 9-10 cm, no c/o pain. Y 4/7/2009 4/9/2009 rythema 15x16cm left thigh, not tender, + warmth and itch. Continue TYLENOL and IBUPROFEN; U BENADRYL 4/8/2009 for itching. 4/9/2009 after the shots, became pale around 5 sec no treatment needed. Y 4/7/2009 4/7/2009 e and pain in all of them, incontinence urinary, memory loss. N 2/10/2003 s and dizziness especially upon standing. Hot feeling in face and head - sweating on face and U head. Fasting 4/10/2009 blood 4/11/2009 sugar 131 (diabetic). Oc ven vaccine IV push instead of subcutaneously pt HR 130's but anxious and getting respiratory Y treatment. 4/11/2009 HR in 70's in 15 min.
as extremely exciteable when his cousin that he hadn't seen in over a year came to visit us, his U grandparents. 3/30/2009 The boys 4/9/2009 love each other, bu is red, no swelling noted, arm is warm, but so is other, painful to touch. Patient was advisedUto put ice on 1/14/2009 arm and alternate 1/16/2009with warm com left upper arm Y U ### 1/26/2009 augh,weak, breathing problems Y Y ### 11/6/2008 us case was received on 01 April 2009 from a health care professional. An approximately 3 week Y old patient (gender ### 6/7/2008 not specified) receive ort received 01 April 2009 from a health Y care professional, who is also the patient. AccordingUto the reporter, they developed the "flu" an uns us case was received on 01 April 2009 from a health Y care professional. 0 A 5 month old male U patient received 4/1/2009 PENTACEL 4/1/2009 (lot number C318 n has been received from a physician Y concerning a 24 year old female with allergies to tomatoes N and pollen, migraine, ### rhinitis ### seasonal, de n has been received from a nurse practitioner Y concerning a 24 year old female who Y on 18-FEB-2009 N was 2/18/2009 vaccinated 2/18/2009 with her second dose n has been received from a physician Y concerning a patient who was vaccinated with ROTATEQ Y (lot number not reported) oral. Subsequen n has been received from a physician Y concerning Y a 2-3 year old patient Y who was vaccinatedUwith ROTATEQ (lot number not reported) oral Full clonic/tonic 1 hr 45 minutes after receiving Y routine immunizations 2 - Family describes today's Y episode the 4/3/2009 same as4/3/2009 in the past (same sei ays after vaccine. Hospitalized 1 week Y after with Y erythema multiforme. 3 2 weeks after in ER with N transient3/17/2009 synovitis and fever. Hospital recor multiforme major possible KAWASAKI's Disease. Y 4/27/09 MR received 5 for DOS 3/24-28/2009 Y with D/C 3/16/2009 DX: Erythema 3/18/2009 multiforme major s/ pasms started on the 3rd day after vaccinations Y Yand progressed. Diagnosed 3 in January 2009, U being treated 10/1/2008 with medications 10/4/2008(TOPAMAX, B welling, induration + erythema at injection site - induration 4X5cm; erythema 12 X 8 1/2 cm with N some bruising 4/3/2009 onset at 4/4/2009 approximately 3hrs a swelling, redness and pain at site 9 hrs after shot. Also vomiting. Patient called MD on 3/25/09 Y regarding 3/20/2009 above instructed 3/20/2009 to take Ibuprofe rs of vaccination, Pt developed "big knot" at the injection site, and the site turned blue. Heart Y rate became2/2/2009 elevated. 2/2/2009 She had bad headach 27-09 with c/o dizziness, pain, racing heartbeat & fever. (did not know how high). Too dizzy Yto stand up.3/26/2009 Person suggested 3/27/2009they go to urge nto clinic after shots for immigration.Y She was given a Tdap and an MMR in left arm. Six days Y later she 3/20/2009 came back 3/26/2009 to clinic with a bruised a a swelling and rash at site of VARIVAX. Y Y 4/7/2009 4/7/2009 eceived PC from Pt states LA started Y itching and swelling this weekend. Tdap was given on Y 1-28-09 states 1/28/2009 applied 3/14/2009 soaks to LA area. On 3/ w/ redness & warmth x 40 hours: then pain in arm radiating to shoulder/neck & elbow -> referred Y to physical 2/6/2009 therapy2/8/2009 on 4-3-09. after receiving vaccine felt itchy, dry mouth, felt generally "bad" - low grade temp 99.1 - Following Y day temp 2/10/2009 is PM 102 2/10/2009 degrees - TYLENOL ed child had a tem up to 102 degrees within 24 hrs (off and on). Soreness, redness, and slight Y swelling to3/31/2009 area where4/1/2009 shot was given (L) Va runcal pruritis (primarily B/L breasts). Sx occurred 24-48 hours s/p vaccine (GARDASIL) # TYand lasted9/23/2008 approx. 4 wks. 9/24/2008 Denies rash/ fever ite - swollen, red, soreness, fever (at the injection site) left leg where DTAP + Polio were given. U 3/16/2009 3/17/2009 ceived ANTRAX and Typhoid on 12 Mar 09. Smallpox on 19 Mar 2009. Patient found out thisY month that3/12/2009 she was pregnant when she recei d with shingles along L4 - L5 distribution today. U 9/10/2008 3/31/2009 eddened, "hst to touch", swollen - taken Y to Urgent care by Mom - 4-1-09 - Placed on KEFLEX Y po tid - arm 3/30/2009 resolved 4-30-09 4/1/2009
ight sweats 3/12/09 + 3/13/09. Y 3/12/2009 3/12/2009 h was red & swollen with some oozing coming from area between both shots. Redness wasYapprox. 14-16 3/27/2009 cm X 14 3/28/2009 cm. Child given BENA erythema, swelling, heat, hardness possible cord. No vesicles. U 3/30/2009 4/1/2009 f 04-1-09 : "Restussness" Morning of 4-2-09: Hives U 4/1/2009 4/2/2009 d injection and by next morning felt Ypain/soreness to area of injection. 48 hours after injection U Pt. noticed3/20/2009 a swelling3/21/2009 an redness starting two advertently received BOOSTRIX instead of KINRIX. No adverse events were noted. MotherYwas notified 4/2/2009 of error ately 5 minutes post injection, Pt experienced syncopal episode lasting 10 seconds. BP 90/62 Y at episode. 4/6/2009 After orientation 4/6/2009 X 3 was re- esta d, hard area with streaking - Pt. dx. in Y ER with cellulitis - Parent reported (L) deltoid Y 4/6/2009 4/7/2009 ht shoulder and right deltoid, red, swollen, hard and warm to touch. Denies pain or fever at this U time. Began 4/10/2009 4/11/094/11/2009 and continues today 4 X6 inch area of redness 2 days after Y VARIVAX. Augmentin 875 mg -125mg - 1 tab Q 12 X 10d. U 4/8/2009 4/10/2009 ped hives at the IPV site. Y U 4/7/2009 4/7/2009 veloped erythema & puritis of left upper Y arm within hours of receiving injection there (10 inchYX 10 inch area 4/25/2008 of erythema 4/25/2008 & slight induration action left shoulder - Swelling, pain, redness, fatigue started day after ADACEL administration - Tx MEDROL, 4/6/2009 Ibuprofen 4/7/2009 d, warm to touch, swollen size of tennis ball. Y 4/6/2009 4/7/2009 Pt received Td & Hep B on both L Delt. Pt. states she has marble size knot under skin @ site. Y 3/11/2009 3/17/2009 erythema R upper arm with vesicles. U 3/18/2009 3/31/2009 red w swelling. Ice packs (treatment). U t itch, redness + swelling at vaccine site starting approximately 8 hours after administration associated Y with 3/30/2009 moderate 3/30/2009 headache persisting a tarted with rash neck + chest 3/20 face, arm leg c/o itching - approx 45 U 3/3/2009 3/19/2009 al body aches, nausea, fatigue, elevated B/P and tachycardia, epistaxis; Serum sickness. Y 4/2/2007 4/2/2009
ter rec vaccine, welts developed onYRt neck, between breasts + underneath breasts, Rt + LtYouter arm proximal 4/11/2009 to elbows. 4/11/2009 C/o headache, r s- erythema on right right arm with calor. There was no induration nor tenderness. Y 4/6/2009 4/6/2009 ash on face day following administration of GARDASIL. Also a cough. Y 3/20/2009 3/21/2009 eruptions treated with BENADRYL / CALAMINE Y 3/27/2009 4/5/2009 was reported by a healthcare professional and described the occurrence of vomiting in a 3-month-old U (almost 3/4/2009 4 month 3/4/2009 old) female subject was reported by a physician via a sales Y representative and described the occurrence of rashNin a 4-month-old 4/1/2009 male subject 4/1/2009 who was vaccin 09 with small induration and some redness. Advised to put cold compress + should resolve in U a few day by 4/7/2009 doctor. 4/8/2009 h with erythema and swelling 8cmx4cm Y are of pinpoint induration for 2 days. U 4/7/2009 4/8/2009 ped 8cm X 4.5 cm warm, erythematous raised lesion on upper arm 2 days after receiving VARIVAX. Y Itchy.4/6/2009 No fever. 4/8/2009 ports a rash - itching - developed 2 days after vaccine given 3/18/2009 - Reports used Neosporin with success 3/18/2009 - Referred 3/20/2009 to PMD or clinic f acting different, restless, low grade fever, crying, Y screaming with sucking, 2 poor appetite, restless Y x 2 days. 3/30/2009 Onset 4/2/09. 4/2/2009 Assessment: Pall was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age 4/1/1999 who was vaccinated with LYME was reported by a lawyer and described the occurrence of arthralgias in a male subject of unspecified U age 5/5/2000 who was vaccinated with LYME 99019267-1 describes joint and muscle pain inYa 58 year-old female0who received LYMERIX. N The vaccinee 6/1/1999 has no known allergies or med ability 8 days after vaccination. Fever lasted 3 days and ranged from 100.3 to 104.2 1 episode U of vommitting 4/4/2009 on day 4/10/2009 3. Treated fever with d 12 days ago with MMR. Had some arm soreness which has resolved. Then on Saturday Y 8 days after vaccine 3/5/2009 - he 3/15/2009 developed subjective after receiving the 1st MMR vaccination Y our daughter developed a fever (highest recorded was 101.3), had 4/3/2009 minor vomiting 4/12/2009 (4 episodes tota CALLED COMPLAINING OF HEADACHE WHEICH STARTED APPROXIMATELY TWO DAYS AFTER RECEIVEING 4/6/2009 4/8/2009 ZOSTAVAX. tHE P eported that son's developed arm blister, redness.local reaction 11 April 2009. Dr. made aware Y and advised 4/10/2009 pt to apply 4/11/2009 cold ice pack,and i ollen area 1" to 2" wide per mom. Y 4/7/2009 4/8/2009 an oval shaped, bright red rash on Saturday morning. As of Monday morning it was resolving. Y Denied pain 4/1/2009 at site or 4/4/2009 itching. ported child was not acting herself atYpreschool that morning, as reported by her teachers. Parent Y reported4/7/2009 paying special 4/8/2009 attention for a po icidal ideation, ever since vaccination was administered. This has continued to worsen. Before N being vaccinated, 3/25/2009 mental 3/26/2009 health was at the VER FACE AND NECK APPROX HOURS AFTER VACCINATION WITH 1ST OF PRE-EXPOSURE Y SERIES 4/7/2009 RABIES 4/7/2009 PCEC VACCINE d 4/8/09, The following day in the afternoon Y the client came to office w/his father and an examination Y of the 4/8/2009 arm was 4/9/2009 made. Red circular ar s in fingers/hands/feet approximately 3 weeks post Y flu shot. Diagnosed 30 with GBS. 4/27/09 Received U hospital medical ### records ### of 11/24-12/1 tion given on 3/31/2009. Child had Y tactile fever for one day on 4/9/2009 with onset of generalized body rash 3/31/2009 which is4/9/2009 still present at time of eved four vaccines on 4/2/09. The client Y parentYrequested all vaccine 4 be given in the same extremity Y due 4/2/2009 to a previous 4/4/2009 injury in the other ar ES HE REC'D PNEUMOVAX ON 4/7/09 AND THAT EVENING HE HAD FEVER FOR TWO DAYS Y AND SEVERE 4/7/2009BODY 4/7/2009 ACHES. PT STAT ld child received Hepatitis A # 1 at 6 months instead of 12 months, per standard, in error. In Y follow up with 3/16/2009 the parent, child has had no adv ticed Saturday night 4/11/2009 a red, Y raised area on left deltoid. seen today 4/13/2009 PM Y in office with4/10/2009 4X4cm area 4/11/2009 with redness and mil ry & Physical. This patient received a Pneumococcal Y vaccine probably 5 on 3-25-09 and we doY not know where. 3/25/2009 Patient 3/28/2009 came to agency on 3 ately 2" induration and redness of upper left arm where VARIVAX was given. Mom contactedYoffice and was 4/7/2009 given instructions 4/8/2009 to give BENA on arm at shot site. It's there a month. Almost gone away. Y 3/13/2009 3/13/2009 perienced a short, 5 second seizure Ylike episode five minutes after receiving the following vaccines Y (Meningococcal 4/6/2009 (Menactra) 4/6/2009 lot#, and PP ceived vaccination on 4-8-09 & called Y pharmacy on 4-11-09 to report that the site of injectionYhad a egg shaped 4/8/2009 lump 4/11/2009 that was red & itchy. the site of injection; next day after immunization, Mupirocin oint TID x 7 days. U 4/7/2009 4/8/2009 given L arm on 4/9/09, Pt returns on 4/11 with Lt arm about 50 cents size red area with some U bruising on4/9/2009 upper aspect 4/10/2009 at injection site, to f ain and edema localized at injection site. Unable to lift arm, unable to touch arm or put pressure Y on arm or 3/27/2009 sleep on left 3/27/2009 side x 72hrs. Gener 09 employee came in to clinic reporting right arm where tdap was adminstired for the last week Y was red, swollen,and 4/1/2009 4/1/2009 painful at site of inject ped erythrematous local swelling at injection site. Y 3/12/2009 3/13/2009 N 4/3/2009 4/12/2009 atigue for one week after vaccine administration. Seen in clinic on 04/14/09. Afebrile, WT 150#, Y BP 130/67. 4/9/2009 HEENT-negative, 4/10/2009 abdomen sof ness, swelling around injection site. U 3/10/2007 3/16/2007 Y Y 3/30/2009 4/7/2009 sodes on day after receiving Y vaccines Y requiringYtransport to PEDS ICU. 7 05/04/09 - Hospital U medical records 3/16/2007 for 03/17/2007 3/17/2007 to 03/23/2007. tarted after 12 weeks. 3/6/2007 Pt. developed red rash all over;itching;14x10 cm red macular rash at injection site on left leg;large U erythemous 3/23/2007 patches 3/28/2007 on chest, back and and hives at injection site within 30 minutes of vaccine administration. Y 6/6/2007 6/6/2007 09 pt. presented to the office with aYrash for 1 day.Exam reveiled approx. 100 vesicular lesions Y scattered6/19/2007 about, primarily 4/6/2009 on the torso. Mild ed, dizzy, especially when standing up, started within 30 min. of vaccination, lasted about 5 days Y 4/3/2009 4/3/2009
signs/symptoms approximately one hour following Tdap immunization. Patient experienced visual Y disturbances, 4/10/2009 including 4/10/2009 blurry vision, Eup D MD VISIT.2 DAYS S/P VACCINE ADMIN OF TDAP, PT SEEN FOR REDNESS/TENDERNESS, U GIVEN 4/8/2009 KEFLEX4/11/2009 RX. call from mom @ 1:29 stating "my son got shots at Southside yesterday now he has a rash all over his body 4/13/2009 and a fever." 4/14/2009 Mom asked wha re varicella (RA-SQ) became very reddened, Y tender and swollen to the size of a silver dollar.UParent was 4/2/2009 going to take 4/13/2009 child to MD for evalu episode about 5-10 minutes after receiving Menactra and Gardasil in L arm and TDaP in R. Y 4/14/2009 4/14/2009 L OVER THE BODY 2 HOURS AFTER Y VACCINE ADMINISTRATION. U 3/19/2009 3/19/2009 NED PREGNANCY Y 3/20/2009 3/25/2009 C URTICARIAL RASH A FEW HOURS Y AFTER PREVNAR AND PEDIARIX VACCINES. U 3/20/2009 3/20/2009 ndurated area on left deltoid at site of Administration approx 4 X 4 inches. Associated pruritis Y 4/13/2009 4/14/2009 REFERS HAVING A RASH ALL OVER Y THE BODY AND A RED EYE. Y ### 12/2/2008 ation site reaction. 2 inch raised welt, red, warm to the touch, painful. Began 12-18 hours after Y vaccination, 3/13/2009 slowly resolved 3/14/2009 on its own over d nausea and vomiting after leaving clinic. Resolved day following injection. Reported soreness Y at injection 12/3/2008 site. Red 12/3/2008 skin discoloration 4 x able crying for several hours continuously. Y 2/13/2009 2/13/2009 veloped Guillan Bare syndrome, 4 days after the Y vaccination. 4/22/09 20 Y MR received for DOSU10/29-11/17/2008### with D/C DX: ### Guillain-Barre perienced 5-6 bouts of diarrhea within 10 months of vaccination. After she was about 18 moUthe bouts of diarrhea ### seemed ### to stop. She wa clinical trial report of allergic reaction with bronchospasm Y has been received 2 from an investigator Y concerning 3/24/2009 a 39-year-old 3/26/2009 male, (subject n was reported by a physician via a sales representative and described the occurrence of hepatitis U A antibody negative3/1/2009 in an adult male subj ness and swelling at the injection site. Took BENADRYL and used ice packs. Y 4/9/2009 4/10/2009 U 4/9/2009 iven in Left deltoid. Redness, swelling, warm to touch. Y 3/4/2009 3/4/2009 redness/swelling/tender 4 hours after Y injection. TYLENOL/BENADRYL/cool compress resolved in a hour 4/10/2009 after TYLENOL/BENADRYL 4/10/2009 @ 11:10 A on 4-13-09 and reports. " I think I have shingles" describes as dime size water blisters U to R arm 3/30/2009 and under4/9/2009 R arm, painful. C/O a t, tender, swollen area right shoulder Y and fever. Seen 4/9 (2 days after) not on pain/fever meds. Y Pt returned 4/7/2009 for PPD reading so its not clea recurrent area on face, Y 9/15/2006 4/10/2009 4-9-09 04-11-09 2/3 of upper thigh Yaround injection site - was red, swollen and child refusedYto walk. Was4/9/2009 not itchy.4/11/2009 Was given BENDARY ash and slight numbness, no swelling of lips or tongues. Y 4/8/2009 4/9/2009 ed reaction on L thigh with warmth (no Y tenderness). Y 4/13/2009 4/14/2009 jection site (large lumps) itchiness all Y over body, headaches, could not lift arms, aches. U 4/9/2009 4/10/2009 rash & VARICELLA appearing rash. Y Y 4/8/2009 4/11/2009 h after receiving Rotavirus vaccine then went away and no distress. Y 4/8/2009 4/8/2009 lled 8 days after DTap was given in right thigh to c/o swollen, hot to touch area at site - unrelieved Y by TYLENOL 4/7/2009 for age 4/7/2009 referred to PCP. ter is 13 yrs old and has received the gardasil vaccine during which before receiving the 3rd vaccine I was notified that 4/1/2009 there would be som dose, there was a very sharp, deep pain at injection site. When I went to leave office I felt dizzy, N nauseous, 2/18/2009 and vision 2/18/2009 started blurring and tion at 2:33 pm on the date above, Rainbow began to experience, dizziness, fever, sore throat, N severe arm pain. Today, 4/10/2009 the next morning, N 2/1/2008 N 4/3/2009 Y N 3/31/2009 3/31/2009 n has been received from a medical assistant concerning Y a female who 0 on an unspecified date U was vaccinated with a dose of GARDASIL ( n has been received from a consumer concerning one of her cousins who was vaccinated with U MMR II. After receiving the vaccine, the pat n has been received from a consumer concerning her husband's uncle who was vaccinated U with a dose of MMR II. The reporter stated that n has been received from a physician Y concerning a 4 year old male who was vaccinated withY the second dose of MMR II "standard dose" ( n has been received from a consumer concerning a male patient who is a member of his wife's N family, who on an unspecified date was vac n has been received from a medicalYassistant, Y for the Pregnancy Registry 0 for GARDASIL, concerning U an 18 year old female ###with sulfa aller U 4/9/2009 t office after getting 4 vaccines. She was standing at window to make another appt. She asked Y for water then 4/9/2009 had a syncopal 4/9/2009 episode with len, warm, painful; he had fever lastY night) Cellulitis L lateral leg that developed 8 days afterNreceiving immunizations; it is immediately ove ea of redness & induration at injection site. 4/8/2009 4/8/2009 ver- Sat morning (3/28/09) all at once Y (10am). Seizure from fever (102.9) (at 1:45PM). (HepYA given on3/19/2009 3/19/09) (MOTRIN 3/28/2009 given even tod Y Y 3/30/2009 4/1/2009 ENADRYL Rash X 24 hours: StartedY 7 days after antibiotic/vaccine *Rash is worse on Right side (thigh) 3/27/2009 at injection site 4/6/2009 where MMR & VAR me in for MD visit 4/8/2009, with complaint Y of on and off neck pain. Patient and pt's mother U feels pain started 8/31/2007 after HPV 9/1/2007 vaccines, HPV vac
reports fever ranging from 100 degrees F - 103 degrees F and vomiting starting 4/3/09 through Y 4/4/09. Also 4/3/2009 reports4/3/2009 body aches. No treat d fever, high 103 degrees after IZS on 4/7/09. F/U in our office on 4/8/09 temp 100.9 taken TYLENOL. U Mom 4/7/2009 states household 4/7/2009 sick. ness & edema left deltoid within oneYwk injection. As redness & edema resolved pain radiated N to left shoulder 1/17/2009 neck right 2/1/2009 shoulder and down ouch and little swelling LD. Y 4/6/2009 4/6/2009 e same day lasted 3 days. Throwing up two days after. Y 3/31/2009 3/31/2009 U 4/9/2009 4/9/2009 served rash arms, hands, face and Y neck woke developing a redness that I first thought was N sun burn. Over 3/31/2009 the course 4/3/2009 of the next two days d shingles vaccine @ approx 9:30 am on 3/12/09. R arm. Pt called 3/17/09 @ 10:30 am to report Y R arm 3/12/2009 soreness and 3/12/2009 pain that wraps arou ash red indurated 1 1/2 inch round red mildly tender area 1/2 inch above injections ; injectionYsite. 3/26/2009 2" duration, warm to touch, swelling. 4/6/2009 4/7/2009 om, he was drinking juice, dropped cup Y & became unresponsive with a blank stare. Eyes rolled Y backward 4/1/2009 & he became 4/4/2009 very stiff. He had b t arm pain, fever, chills and palpitations lasting 24 hours. Y 4/8/2009 4/8/2009 & slight swelling posterior Rt upper arm Y 3/31/2009 4/1/2009 fever the evening of the immunizations Y admitted abdominal pain. As of 4/7/09, she had had Uthe fever 6 days. 4/2/2009 4/2/2009 ame very pale, lightheaded and felt like she was going to faint. Child was also slightly diaphoretic. Y Had child 4/3/2009 lay down4/3/2009 and gave water. multiform - treatment 5 days oral steroids Y 1/2 tsp one daily Y 3/12/2009 3/20/2009 ccine administered to child instead of varicella. No adverse symptoms noted at this time. Vaccine Y was administered 4/15/2009 4/15/2009 4/15/2009 at 10:45 am d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 6/30/2008 7/11/2008 ted Left upper arm was swollen, red, Y and warm to the touch 24 hours after shots received. Child U saw Dr 4/13/2009 4-15-09. Nurse 4/14/2009 noted redness and noted dime size erythemia at SQ injection site of the Varicella vaccine on Left upper arm. OnY04/09/09 at 1215, 4/8/2009 area 4/8/2009 measured 4 x 3 cm an esented to the emergency room 6 hours Y after shots with febrile seizures. Repeat episode of Y febrile seizure4/8/2009 24 hours after 4/8/2009 first episode. er, joint aches Right shoulder very swollen Y and painful Y 4/3/2009 4/3/2009 -hour of Pentacel injection, Y patient returned Y to office inconsolable, copious thick secretions, Y trouble breathing, 4/3/2009 worsening 4/3/2009 of his eczema. ga 9 mother reported child had seizureY1 hr after arriving home from getting vaccines on 12/16/08. U Skin was "very### hot." Child ### was taken to loca lled our office to inform us that she Y had "pumps all over her body and they itch really bad." She Y states that 4/14/2009 she woke4/15/2009 up with the pump and temperature 103.2 F U 4/14/2009 4/15/2009 REA DIRECTLY OVER LEFT DELTOID MUSCLE WHERE VACCINE GIVEN WAS BLISTERED, Y OPEN 4/13/2009 AND OOZING. 4/14/2009 LARGE SURROU HEA SINCE DECEMBER '08. PREGNANCY TEST NEG. MOTHER REPORTS NEVER HAD N A PROBLEM 1/8/2009 BEFORE 1/20/2009 GETTING THE GARD n a shot of PPV Pneumococcal Polysaccharide. Reaction: Runny nose, severe Arm Pain, fever U 99.2 next day from shot, temp 102 second with severe pain yesterday at right upper Y arm injection site. Mom called nurse and discussed. Temp 100.4/13/2009 Redness and 4/15/2009 tight area as big as ne shot on 4/13, 99.4 fever on 4/14, fever of 102 4/15, Stuffed up nose, cough, breathing impacted. U Muscle 4/13/2009 ache, sever 4/14/2009 are pain after shot 3 days after recieving 1st Gardasil dose in LD, she developed a red, dry, itchy skin rash to leftY arm, shoulder 1/20/2009 to knuckles. 1/22/2009 Also present on kn post-vaccination with JE-VAX, client's arm was swollen, red, and itchy from elbow to shoulderYand felt hard4/6/2009 to the touch. 4/7/2009 Topical benadryl du was reported by a healthcare professional and described the occurrence of brainYstroke in aN62-year-old1/12/2009 male subject 2/1/2009 who was vaccinated rash + bruising + oral bleeding 4/10. 4/11 ER - Ytransferred to hospital. 3 IVIG + Prednisone forUthrombocytopenic 3/26/2009 purpura. 4/10/2009 4/21 Link w/3442 01-102. (R) arm erythema and severe Y pain outYof proportion to exam 2 - R/O invasive strep. 4/27/09 Y Received 1/4/2008 hospital1/4/2008 medical records of 1/ p requiring prolonged IVYantibiotics and surgery. Y 5/4/09 Received 14 hospital medical records of Y 11/11/-11/25/20007. 11/9/2007 11/9/2007 FINAL DX: left hip septi ed vaccine 3/31/09. Presented with vomiting, lethargy Y on 4/14/09. Required 4 surgery for Intussusception. Y 3/31/2009 5/14/09 hospital 4/13/2009 discharge summa 04 - Patient received FLU, DTAP, COMVAX, MMR & PNEUM. conj after this did Y not talk, quiet, N sick, tired, fever### (HOT) 3-4### d. ibu. given did mitted to hospital for a bowel obstruction on 3-29-08. Y On 3/29/09 Lap 6 appendectomy performed. Y Pt had RUQ 3/2/2009 intussusception 3/27/2009 reduced usin ly raised sand paper type rash Right cheek, itching. Y 4/8/2009 4/11/2009 red raised itching welts periorbital, both eyes, raised red itching pustules back of both hands. Y Began 3 days 4/6/2009 after vaccine, 4/9/2009 presented to clin rm cellulitis at injection site. Y Y ### rm cellulitis at injection site. Y Y ### 11/1/2008 und neck, hairline and bilateral ears. Y 4/10/2009 4/14/2009 tous rash, swelling of hands, fever
mild - mod fever, nausea, severe pain Y at injection site evening of 3/16/09. Onset of itching + mild Y rash over 3/16/2009 body 3/17/2009. 3/17/2009 with swelling to R deltoid. Y 4/10/2009 4/11/2009 ith fever T 103.8. Y Y 4/13/2009 4/15/2009 hed chart note dated 4-15-09 Patient Y presents today for evaluation of reaction to VARICELLA Y vaccine given 4/13/2009 2 days4/14/2009 ago. Red swollen and e, fever muscle weakness. Y Y 4/9/2009 4/10/2009 n back and on face. U 4/1/2009 +4 HOURS AFTER WE NOTICED THE RIGHT LEG OF OUR BABY REALLY RED (AROUND U WHERE 4/15/2009 THE VACCINS 4/15/2009 WERE DONE). AB n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 19 year old female 1/27/2009 who on 21-AUGn has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 2/16/2009 and no2/16/2009 known drug allergies/d us case was received on 01 April 2008 Y from a health care professional. A 37 year old femaleUpatient with a history ### of2/28/2008 asthma, high blood pr E report received on 04 April 2009. This subjectYis a female infant with 2 no family history of seizures N experienced 8/28/2003 febrile 8/29/2003 seizures while enrolle ness, swelling, fever(101), headache, tiredness, chills, body aches, sore joints, 3" hard massUat injection site, 4/13/2009 sugar spiked 4/14/2009 to 286 (norm has ED LUMP WITH BLISTER L POSTERIOR Y UPPER ARM QUARTER SIZE DIAMETER. PAINFUL U TO TOUCH. 4/2/2009 3 SMALL 4/15/2009 BLISTERS AT L E eported blank stare and unrespoonsive after vaccine, lasting for 30 seconds. Parents never Y sought medical 1/14/2009 attention 1/14/2009 after episode. l pain, irritation, swelling, and decreased Y range of motion within 30 min. of the injection to theUleft arm. Within 4/14/2009 4 hours 4/15/2009 all of that pain radiate lar arthritis within 3days of vaccine administration. Y Infant was admitted 3 with lab samples taken Y from CSF,3/19/2009 blood and3/21/2009 urine. He was given pa pain from Lt shoulder eight hours after Y receiving the tdap boost in the Lt Deltoid muscle. Client U was seen3/30/2009 by her Pvt3/30/2009 MD and dx with tendon ed his vaccination on Monday April 13 Y around noon Y time. A fever began 2 within 6- 8 hours after U shots (102.5 4/13/2009 F), sleepy 4/13/2009 and very irritable thro orts that 3 weeks after receiving Hepatitis B vaccine #1 she developed lymphedema extending U from her left 3/4/2009 neck to 3/25/2009 hip, noticed her left hip er arm swelling, edema and pain. Event occurred within 24 hours of vaccination and resolving Y by 72 hours. 4/7/2009 Treated 4/8/2009 symptomatically with i A, Stiff Neck Temp 100 Y 4/2/2009 4/3/2009 1 minute after administering DTaP, Hep A and Hep B vaccines the patient had stiffening of his Y entire body 4/16/2009 with laryngospasm 4/16/2009 which lasted Anemia, low red and white Y blood cells Y NO FEVER...seizure Y disorder,8 anemia Y neutropenia .. checked U for 3/13/2009 childhood disease 3/23/2009 and disorders... ter vaccination, became overwhelmed with unexplained exhaustion. Had to go to sleep and Y slept for 12 hours 4/15/2009 straight. 4/15/2009 Also next morning h OTARIX AT 6 MONTHS OF AGE U 4/10/2009 4/10/2009 HAD A REACTION ON LEFT POSTERIOR THIGH WHERE VARICELLA VACCINE WAS GIVEN.PATIENT U 4/15/2009 HAS A 4/15/2009 RAISED REDENED AR ven in left thigh, brought back by mom Y two days later with swelling from top of thigh down toYthe knee. Advised 4/14/2009 warm 4/14/2009 soaks three times dai ED REACTION ON (R)UPPER DELTOID AREA PATIENT DENIES ANY DEVER, NO MALAISE; U REPORTS 4/8/2009 SORE ITCHING 4/8/2009 THAN PAIN. ot appeared on infant's right thigh after her shots at 6 month old well check up on 1/29/09. Staff U became 1/29/2009 aware of incident on 3/03/09. DTaP ERYTHEMA, PRURITIS, SWELLING OF ARM Y 3/17/2009 3/17/2009 st vaccination, patient had eruption Y of hives and developed extreme fatigue, arm and leg pain, U and muscle 3/12/2009 weakness, 3/15/2009 severe enough that s swollen size of dollar bill" 7x11 cm raised erythematous plaque on L anterior thigh. N 4/13/2009 4/14/2009 aised erythematous plaque at vaccination site in R arm after 24 hrs. Y 4/6/2009 4/8/2009 , headache, malaise during night time Y fever prolonged dream state grogginess. Resolved byYnext morning 4/14/2009 4/15/2009. 4/14/2009 X given R thigh 4-1-09 per mom. Pt developed fever and "shakes" that same evening - she called 911 - fever decreased 4/1/2009 to 98 - mom called as given the GARDASIL # 1 vaccination Y in her right deltoid muscle. Pt. was advice to sit for the Y injection but 4/16/2009 refused.4/16/2009 Very shortly after the d office 4/16/09 0900 to report a baseball sized, red, itchy but not raised area at left upper arm Y at injection 4/14/2009 site; no respiratory 4/15/2009 involvement, ted to PCP 1 wk after she received Y MMR and VARIVAX in R deltoid with 3-4 cm abscess. U 3/31/2009 4/4/2009 nny nose, itching started evening of Y 4-3-09 along with start of rash. Diagnosed with chicken pox Y on 4-6-094/2/2009 by family physician 4/3/2009 Rash mainly ation of ZOSTAVAX 4-7-09, development of vesiculated, burning, itching lesions of back 4-11-09 U 4/7/2009 4/10/2009 FLUZONE vaccine on 9/16/08. November (date unknown) patient developed abdominal cramps Y & vaginal 9/16/2008 bleeding. 11/1/2008 OB/GYN evaluation r vaccine: Headache, neck and shoulder pain at noon - chills at temp 101.7 at 1:00 o'clock associated Y to stomach 4/1/2009 discomfort. 4/1/2009 No chest pain ea of redness - right thigh cellulitis likely reaction to vaccine. Y 3/23/2009 3/25/2009 ccines were given at about 9:30am, pt woke from nap about 3pm with multiple large urticaria Yover back, lower 4/15/2009 extremities 4/15/2009 and abdomen (no d rash on forearms 7 days after receiving ZOSTAVAX. Y 3/24/2009 3/31/2009 iving shot in AM of 4-7-09 pt c/o shortness of breath in the afternoon at home with mother - *Nurse Y informed 4/7/2009 mom to 4/7/2009 watch patient closely f ZOSTAVAX 1500 on 4/8/09, morning of 4/10 pt awoke with hard, hot, red, itchy lump at injection Y site about 4/8/2009 the size4/10/2009 of a small egg. Pt calle cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009 -stop for at least an hour. Le were red/swollen no special rx given but pt given TYLENOL in office & advised 4/16/2009 to ice X 4/16/2009 24 hours erythema, warmth & induration at vaccine site area involved 12 1/2 cm X 12 cm in size. Received Y 2 vaccines 4/15/2009 in left 4/15/2009 deltoid HEP A #2 - MEN h hot, swollen and red at injection site. Y Y 4/13/2009 4/14/2009
n, slight shortness of breath. Amnesia during and half an hour after receiving vaccination. "Almost" Y passed 4/15/2009 out during 4/15/2009 vaccination. Flu like n has been received from a consumer concerning her first 6 year old child who was vaccinated N with his first dose of MMR II. Subsequently n has been received from an 18 year old female with migraine and no allergies for GARDASIL, Y a Pregnancy 4/1/2007 Registry4/1/2007 product, who in Febru n has been received from an office Y staff member Y concerning a patient 0 who on unspecified dates U was vaccinated with all three doses of RO rated local reaction. U 4/13/2009 4/15/2009 al reaction 10-12 cm, with pain, mildYpruritis. U 4/13/2009 4/14/2009 rning after vaccine T max 103.1. Y Y 4/13/2009 4/14/2009 a DTAP on 4/09/09. Benefits and risks explained - VIS info given. Mom noted fever at 11 PM U 4-9/09, redness 4/9/2009 at site4/10/2009 of injection noted in th ad GARDASIL #2 at approx. 4:15 pm. Y Took CLARITIN in AM for allergies. Also takes CONCERTA Y and ORTHO 3/20/2009 TRICYCLEN low dose. Use ute onset of severe vomiting and dizziness. Lasted into next day. Also began to have leg pain Y & perceived 3/17/2009 weakness, 3/17/2009 tingling. The leg sy Pox with HX of one dose of VARIVAX. U ### 4/13/2009 4/13/2009 ning arm soreness + swelling - ice applied Y 4/2/09 arm increased soreness, increased swelling, Y warmth, elevated 4/1/2009temp 4/1/2009 + not feeling well. To e, bodyache, some nausea. 4/10/09. Advised TYLENOL 500 mg 2 tabs P.O. Q6 PRN. U 4/9/2009 4/10/2009 eg starting swelling right after immunizations were received. Y 3/24/2009 3/24/2009 tomach, chest, genitals U 4/6/2009 swollen, red, and hot to the touch. YPatients arm also had a tight knot under skin. Dr. advised U on 4-11-094/9/2009 that patient4/9/2009 should take BENADR ed to me by ER physician:] After shots, Y went home, took nap about 1 hrs. Went awake, cried U inconsolably. 4/8/2009 Then had 4/8/2009 stiffening, jerking, & vomit, diarrhea, stomach pain. 04/10/09 Y fever (104.7) rash. No GI symptoms except anorexia. U 04/11/09 varicella 4/1/2009 - like4/9/2009 rash. veloped chills overnight after getting the vaccine. Site of injection was Y swollen and red. OnYMarch 29th,3/26/2009 the swelling 3/27/2009 and redness extende l from parent on 4/15/09 @ 10:15am. She reports child's left arm/shoulder is swollen aroundUinjection site. 4/14/2009 Area, red4/15/2009 per report. Mom states ue, headaches, muscle cramps, muscle pain, sound sensitivityafter 1st shot. Increased Y in severity N of all 7/12/2007 symptons. After 9/26/2007 3 rd shot signfican /2009, PT BROKE OUT ON FACE AND Y FOREHEAD Y WITH BLISTERS. 2 WAS DIAGNOSED N WITH HUTCHINSON 2/27/2009 VARIATION 4/12/2009 OF FACIAL nt received the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a Ybig, red, swollen 4/3/2009 area on4/5/2009 her upper arm. She r nt received the Zostavax vaccine on 4/10/2009. After administration of the vaccine, she reported Y a dollar4/10/2009 size red wheel 4/10/2009 around the injection pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 2/19/2009 with COPD Y exacerbation. 11/7/2007 Vaccination 2/15/2009 took place on 11/7/2 ted redness and swelling of Lt arm increasing Y 24 hrs after injection. Increasing at 48hours. No U fever. Marked 4/15/2009 erythema 4/16/2009 and induration of Lt d immunizations and about 5 minutes Y afterwards the school nurse brought pt in to where shots Y were being 4/16/2009 given stating 4/16/2009 that pt was having sized erythema to left thigh . 8 cm raised wheal, old compress was applied for 30 minutes and Y Benadryl 3/26/2009 1tsp given 3/27/2009 po . veloped red "Rash" according to mother on top of both legs on 4/13/2009 and was taken to U doctor on 4/16/2009 4/8/2009 4/13/2009 Tdap vaccination on 4/13/09 in upper left arm. Injection site is still painful on 4/17/09, but real U issue is pain 4/13/2009 caused by 4/15/2009 two pea sized nodule ed I large area around the injection that was fire red and hot to the touch. It was welped up rasied. U About4/15/2009 the size of 4/16/2009 1/2 dollar or little larger and swelling at injection site, by 4/13/09 Y fever of 102, sweats and chills, swelling in jaw, swelling U in R arm 4/9/2009 and joints,4/13/2009 significant drooling, ten adache ,feels warm ,no feverheadache improving headache ,not weak ,no numbness U 4/16/2009 4/17/2009 d some redness appear at the site of the injection >24 hours after recieving the vaccine. Not U raised, slightly 4/14/2009 warm, 4/16/2009 not hard and not itchy. immunizations fine Given four on 4/14/2009. Y Next day 4/15 some tenderness and on 4/16/09 Y noted sweling 4/14/2009 left deltoid 4/16/2009 down to elbow with ARM SWOLLEN AND WARM TO TOUCH. APPRX THE SIZE OF AN ORANGE. PT DENIES U INCREASED 4/16/2009 PAIN. 4/17/2009 NO FEVER. PT FEELS eption 4/29/09 ReceivedYhospital medical Y records Y of 4/13-4/15/2009. 2 FINAL DX: Intussusception, Y enema2/17/2009 reduced Records 4/12/2009 reveal patient e red and swollen and vomiting / 4th time this lot # has been reported Y 4/16/2009 4/17/2009 mmer of 2008, patient had Y many episodes Y of anxiety which she never had before, she also isUmore easily confused; ### 6/1/2008 9/30/08 Dr d with Pneumovax on 3/31/2009. Called office Y on 4/1/2009 stating arm 1 was red. sore and hot Y to touch. Advised 3/31/2009 to come 4/1/2009 in that day. Came hot swelling at injection site with pustules inside the swollen area on the first day of the injection. U Then outbreak 3/30/2009of3/30/2009 pustules scattered over RTS LOCALIZED (R) UPPER ARM PAIN EVENING OF 4-16-2009. REDNESS, SWELLINGUAND TENDERNESS 4/15/2009 TO 4/16/2009 TOUCH NOTED 4/7 on left arm (arm of injection). Appeared 3 days after vaccine administration. Was very red and U itchy however 4/13/2009 not quite 4/16/2009 so bad today. Spec dness and tenderness 6x13cm. Seen Y on 4/17/09, Cephalexin 500 mg PO given. Pt to f/u withUprovider next 4/14/2009 week. 4/16/2009 ea around injection site tender, red Y and warm. No streaking or adenopathy U 4/14/2009 4/17/2009 d = 4x5 cm area of erythema with subcutaneous Y induration at site of Tdap injection; no fluctuance; tender 4/13/2009 to palpation; 4/15/2009 no streaking; no ade vomiting, lethargic, breathing difficulties, Y sunken Y eyes, listless. Baby 1 was brought to hospital, Y they then transferred 12/5/2008 12/6/2008 her by ambulance to an tous, warm 7X7 cm. induration left lateral thigh. Y 4/15/2009 4/16/2009 hema + induration 3X2 cm on L - Deltoid arm. Complained L-arm pain. Plan warm compression. U 4/14/2009 4/14/2009 unization was given pt went to the waiting where she stated she was "feeling like she is going Y to throw up". 3/6/2009 Pt was given 3/6/2009 .30 Epi pen in left
reaction right upper arm + edema + red. No complaint of tenderness. Treated with BENADRYL Y & TYLENOL. 4/16/2009 4/17/2009 Y 4/9/2009 cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009 er followed by generalized seizure - Requiring intubation. 3 seizures back to back. Y called on 4/16/09 & said 4/15/09 pt had red welt size nickel at inj site and then on 4/16 was size Y of a quarter. 4/2/2009 Pts mom 4/15/2009 will give benedryl & arted on GARDASIL series 5/15/2007- 2nd given 7/16/2007. Mom noticed in fall of 2007 thatNabsence type 5/15/2007 seizures began. n has been received through the Merck pregnancy registry from a Physician's Assistant concerning N a female 1/22/2008 who is1/22/2008 social alcohol drinker a n has been received via the Merck pregnancy Y registry, from a registered nurse, concerning aY 15 year old 3/3/2008 female patient, 3/3/2008 who on 03-MAR-2 n and follow up information have been Y received from a nurse practitioner for the Pregnancy Y Registry for 2/15/2008 GARDASIL2/15/2008 concerning 23 year old n has been received from a certifiedYmedical assistant concerning a 16 year old female whoYon 27-FEB-2008 2/27/2008 was vaccinated 2/27/2008 with her first n has been received through the Merck pregnancy registry, for GARDASIL, concerning a 14Yyear old female 4/7/2008 patient with 4/7/2008 attention deficit di n has been received from a certified medical assistant for the Pregnancy Registry for GARDASIL Y concerning 3/26/2008 a female 4/18/2008 who on 26-MAR-200 n has been received from a medical assistant for the pregnancy registry for GARDASIL concerning Y an 18 year### old female ### with no known al follow-up information has been received from a nurse practitioner concerning her daughter aY14 year old female with scoliosis and no previ n has been received for the pregnancy registry for GARDASIL from a nurse practitioner concerning Y a 213/11/2008 year old female 6/2/2008 with no pertinent follow-up information has been received Y from a pediatrician, a physician and a registered nurse Y for the pregnancy 4/21/2008 registry 11/5/2008 for GARDASIL c n has been received from a certified nurse midwife, for the Pregnancy Registry for GARDASIL, Y concerning 6/3/2008 a 17 year6/3/2008 old female with asthm n has been received from a registered Y nurse (R.N.) for the pregnancy registry for GARDASILU concerning1/22/2009 a female patient ### who on an unspe n has been received from a nurse concerning a 9 year old female patient with a history of migraine Y headaches 2/24/2009 and 2/24/2009 no known drug allergies n has been received from a radiologist reported that a gastroenterologist said he had some patients U experience stomach pain after receivin n has been received from a consumer concerning her daughter an 18 year old female with allergy N to (unspecified 2/23/2009medication) 3/6/2009 who on 23-F n has been received from a nurse practitioner Y concerning a 27 year old female with allergy to N thimerosal and no medical 3/9/2009 history who on an n has been received from a physician concerning Y a young adult female 7 who was vaccinatedYwith the first dose of GARDASIL (lot number n n has been received from a nurse concerning a 25 year old female who on 20-MAR-2009 was U vaccinated 3/20/2009 with GARDASIL 3/20/2009 (lot number 659 n has been received from a physician Y concerning a 23 year old female patient with no pertinent Y medical history 8/8/2008 and no 8/8/2008 known drug allergie n has been received from a 21 year old female with hypersensitivity to yeast who on 3-MAR-2009 N was vaccinated 3/3/2009 with 3/17/2009 the first dose of GAR n has been received from a physician concerning a 14 year old female who on 27-MAR-2009 U was vaccinated 3/27/2009 with a first dose of GARDASI n has been received from a physician assistant concerning a "teenager" female who was vaccinated U with GARDASIL 0.5 ml. After getting G n has been received from an employee at a physician's office concerning a couple of patients U who was vaccinated with GARDASIL. The pa n has been received from an office administrator concerning a 19 year old female who on 12-JAN-2009 U 3/18/2009 and 18-MAR-2009 3/30/2009 was vaccinated n has been received from a physician concerning his 22 year old daughter who on Y 12-Mar-2009 Y was vaccinated 3/12/2009 with 3/12/2009 her first dose of GARD n has been received from a RN concerning Y a 15 year old female patient who on approximately N 16-MAR-2009 3/16/2009 was vaccinated 3/16/2009 with the first n has been received from a physician concerning a 15 year old female who on 06-MAR-2009 Y U was vaccinated 3/6/2009 with GARDASIL 3/6/2009 IM 0.5ml. C n has been received from a physician concerning a female who was vaccinated with the second U dose of GARDASIL (Lot not reported). Sub n has been received from an office Y nurse concerning Y a female who12on an unknown date, was U vaccinated with the ###third 4/28/2008 dose of GARDASIL n has been received from a physician Y concerning a female who in 2008, "within the past year", Y was vaccinated with a dose of GARDASIL ( n has been received from a Registered Y Nurse concerning Y a female patient who was vaccinated U with a dose of GARDASIL (Lot # not report n has been received from a physician concerning a 16 year old female who was Y vaccinated N intramuscularly with a 0.5 ml dose of GARDAS n has been received from a physician concerning a 17 year old female who was vaccinated Y with the second dose of GARDASIL (Lot # not n has been received from a nurse concerning Y an 18 year old female who on 20-JAN-2009 was Y vaccinated 1/20/2009 with her 1/22/2009 first dose of GARDASIL n has been received from a consumer concerning her 18 year old daughter with Nail-patellaUsyndrome who 2/23/2009 in 20082/23/2009 was vaccinated with th n has been received for the pregnancy registry for GARDASIL from a certified medical assistant U concerning 1/23/2009 a 15 year 1/23/2009 old female patient wh n has been received from a nurse concerning Y a female who on an unspecified date was vaccinated U with the second dose of GARDASIL. Th n has been received from a certified medical assistant concerning her 17 year old female friend N with no pertinent medical history who in 20 n has been received from a registered nurse concerning a 22 year old female with pertinent N medical history 3/9/2009 or drug allergies/reactions who n has been received from a nurse practitioner concerning an approximately 20 year old female Y with no relevant 3/11/2009 medical 3/12/2009 history, no relevan n has been received from a licensed Y visiting nurse concerning a 13 year old female patient who Y on 16-JUL-2007 3/13/2009was vaccinated ### with the fi n has been received from a nurse practitioner Y concerning a 16 year old female with not sexually Y active and a history ### 1/1/2009 of meningitis as a bab n has been received from a nurse practitioner Y concerning a 23 year old female who was vaccinated N with complete GARDASIL 2/13/2009 series. On 1 n hs been received from a physician concerning a female patient who was on unspecified dates U was vaccinated with1/1/2008 0.5 ml doses of GARD n has been received from a nurse concerning Y a female who patient who on an unspecified date Y was vaccinated IM with her second 0.5 ml
n has been received from a consumer concerning her daughter, a 11 year old female patient, N with no known drug allergies, joint pain and p n has been received from a licensed Y practical nurse concerning an 18 year old female patient N with no pertinent 3/5/2009 medical 3/6/2009 history and no know n has been received from a nurse practitioner Y (N.P.) concerning a 49 year old female with hypothyroidism N 3/2/2009 and gastroesophageal 3/2/2009 reflux dise n has been received from a registered nurse concerning her daughter with eczema and allergies N who in June 3/9/2009 2008 was 3/9/2009 vaccinated with the n has been received from a registered Y nurse for the pregnancy registry for GARDASIL concerning U a 23 year 1/21/2009 old female with ###asthma and no n has been received from a Registered Y Nurse (R.N) concerning her 16 year old daughter with N juvenile rheumatoid 11/1/2008 arthritis,### and allergies to n has been received from a consumer concerning her 22 year old niece who on approximately N 24-FEB-2009 2/24/2009 was vaccinated with a dose o n has been received from a registered nurse concerning a female patient who was vaccinated Y with her second dose of GARDSIL (lot # not n has been received from a registered nurse concerning a 19 year old female with no pertinent Y medical history 11/1/2008 or drug 11/1/2008 reactions/allergies w n has been received from a female who in June 2008 and August 2008 was vaccinated withYher first and 6/1/2008 second dose 6/1/2008 of GARDASIL (lot nu n has been received from a nurse practitioner Y concerning a female patient who on unspecified N dates in 2007 was vaccinated with the first t n has been received from a physician concerning a 14 year old female patient who in approximately Y September 9/1/2008 2008, 9/1/2008 "4-6 months ago" fro n has been received from a physician concerning an approximately 12 year old female who N on approximately 3/6/2009 6-MAR-2009, 3/6/2009 "about a week n has been received from a physician Y concerning a "16 years old" female who was vaccinated U with a third 0.5 ml dose of GARDASIL (lot # n has been received from a consumer concerning her daughter, a 14 year old female with a Nhistory of mononucleosis 3/1/2008 3/1/2008 and no drug reaction n has been received from an 18 year old female with no known drug allergies/reactions and U no pertinent medical history reported who on a n has been received from a healthcare Y worker concerning a 21 year old female with no medical N history and 3/11/2009 drug allergies 3/13/2009 who on 11-MARn has been received from a physician concerning a female with latex allergy who was vaccinated U with a dose of GARDASIL, IM, 0.5ml. Sub n has been received from a consumer Y concerning her 15 year old daughter with allergies to N penicillin and 1/26/2009 other antibiotic 1/26/2009 and no pertinent m n has been received from a nurse practitioner (N.P.) concerning a 24 year old female who on Y 16-MAR-2009 3/16/2009 was vaccinated 3/16/2009with a 0.5 ml d n has been received from a nurse concerning Y a female who was vaccinated intramuscularly N with the second 3/17/2009 0.5 ml 3/17/2009 dose of GARDASIL on n has been received from a 23 year old female with allergy to anything in the "cillin family" and N a history 11/5/2008 of cesarean2/16/2009 section and tuberculos n has been received from a certified medical assistant concerning a patient who in 2007 wasNvaccinated with a dose of GARDASIL. In 2009 n has been received from a healthcare worker concerning a female who experienced groin pain U and a lump in her groin after receiving a do n has been received from a registered Y nurse concerning her daughter, an 11 year old femaleY patient with no pertinent ### medical ### history and n n has been received from a physician Y concerning a female patient with a history of urinary tract U infection who 3/1/2009 in the last couple of weeks wa n has been received from a physician Y concerning a female patient who on an unknown dateUwas vaccinated with the first dose of GARDAS n has been received from a certifiedYmedical assistant, for the GARDASIL a Pregnancy Registry, U concerning 2/2/2009 a 14 year 2/2/2009 old female patient w n has been received from an emergency Y medical technician concerning a 15 year old femaleY with asthma who was vaccinated 9/1/2008 with the com n has been received from a physician Y concerning a registered nurse who was vaccinated with U her first dose of GARDASIL. 6 weeks after h n has been received from a nurse practitioner concerning a 15 year old female patient with no U pertinent 3/17/2009 medical history 3/17/2009 and no known drug n has been received from a physician concerning a female patient who was vaccinated with Ythe first 0.5 ml dose of 11/6/2007 GARDASIL. Subsequen n has been received from a registered nurse concerning an 11 year old female with no pertinent Y medical3/11/2009 history or drug 3/11/2009 reactions or allergi n has been received from a physician Y (OB/GYN) concerning a 21 year old female patient who U on an unspecified date was vaccinated with n has been received from a physician Y concerning a 16 year old female patient with no known Y drug allergies 1/19/2009 who on1/19/2009 19-JAN-2009 was vacc n has been received from a physician Y concerning a 24 year old female with no relevant medical Y history or 3/12/2009 drug allergy 3/12/2009 who was vaccinated n has been received from a registered nurse concerning a 23 year old female with Graves' disease, Y latex allergy ###and poppy ### seeds allergy w n has been received from a registered nurse concerning a patient who on unspecified datesUwas vaccinated with the first and second dose n has been received from a registered Y nurse concerning a female student in her twenties who U on an unspecified date was vaccinated with n has been received from a nurse practitioner concerning an 18 year old female patient withYseveral bug7/16/2008 bites who on 7/16/2008 18-MAR-2008 was v n has been received from a medicalYassistant concerning a female patient who on unspecified Y dates was vaccinated with the first and seco n has been received from a consumer concerning her daughter, who on 20-JAN-2009 was vaccinated U with 1/20/2009 her first 1/20/2009 dose of GARDASIL. Co n has been received from a 19 yearYold female patient with no pertinent medical history whoNa few months ago### received 3/18/2009 the first dose of GA n has been received from a medicalYassistant concerning a 23 year old female patient with no N pertinent medical history 3/20/2009 and no known drug n has been received from a registered nurse concerning an 11-18 year old female who was U vaccinated with her first dose of GARDASIL (lo n has been received from a health professional concerning a female patient between 11-18 U years who on an unspecified date was vaccina n has been received from a nurse practitioner concerning a female with a history of tension headache Y who was vaccinated 3/16/2009 with the third 0. n has been received from a health department nurse concerning a patient who on 04-MAR-2009 U was vaccinated 3/4/2009with3/4/2009 a dose of GARDASIL n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning1/12/2009 a 20 year old 1/12/2009 female with no know n has been received from a physician assistant concerning a 16 year old female on 20-MAR-2009 U was vaccinated 3/20/2009 with 3/21/2009 the first dose of GA n has been received from a physician concerning a 20 year old female with a history of human Y papillomavirus 2/19/2009 high risk. On 11-FEB-2009, t
n has been received from a certified medical assistant concerning a 21 year old female with N dysmenorrhea 9/23/2008 and no known 11/1/2008 drug allergies wh n has been received from a female who in September 2008, was vaccinated with her first dose N of GARDASIL. On an unspecified date, she n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL, 0.5 mL. The patient experience n has been received from a registered nurse concerning a 14 year old female patient with noNpertinent medical 2/6/2009 history 2/13/2009 and no known allerg n has been received from a 42 yearYold female who on 09-FEB-2009 was vaccinated with the N first 0.5 ml 2/9/2009 dose of GARDASIL. 2/9/2009 After vaccina n has been received from a physician assistant concerning a 21 year old female patient whoYon 08-JAN-2009 1/8/2009 was vaccinated 1/8/2009 with the first n has been received from a medical assistant concerning a 20 year old female with no medical N history or3/24/2009 drug allergy who on 24-MAR-2009 n has been received from a physician Y concerning a 12 year old female with no medical history Y or drug allergies### who was vaccinated ### with th n has been received from a physician Y concerning a female who was vaccinated with GARDASIL U (unspecified number of doses) may have n has been received from a physician Y concerning a female patient who on approximately 26-JAN-2009 N ("two 1/26/2009 months 3/16/2009 ago") was vaccinated n has been received from a physician Y concerning a 25 year old female who was received a first U dose of 3/20/2009 GARDASIL3/24/2009 (lot # not reported) in h n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 1/29/2009 a 26 year old female with pain in n has been received from a nurse practitioner Y for the pregnancy registry of GARDASIL, concerning U a 2612/4/2008 year old female 1/15/2009 patient with no pe n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5ml dose of GARDASIL n has been received from a 24 yearYold female, for the Pregnancy Registry for GARDASIL who Y on 16-DEC-2008 ###was 1/19/2009 vaccinated with a firs n has been received from a 25 year old female patient with penicillin allergy who on August N 2008, was vaccinated 8/1/2008 with the first dose of GAR n has been received from a registered Y nurse concerning a 27 year old female patient with noYpertinent medical 1/19/2009 history 1/19/2009 and no know drug al n has been received from a consumer concerning her daughter who was vaccinated with a third U dose of2/19/2009 GARDASIL (lot # not reported) 5 w n has been received from a registered nurse concerning a 19 year old female patient with a N history of mononucleosis 3/16/2009 3/16/2009 at age of 15 who on 1 n has been received from a medicalYassistant concerning her 13 year old daughter with no previous Y medical history ### reported ###who on 17-DE n has been received from a registered nurse concerning a 12 year old female patient with noUdrug allergies 3/9/2009 or medial3/9/2009 history who on 9-MAR n has been received from a physician Y concerning a 20 year old female with egg allergy who Non approximately 3/13/2009 13-MAR-2009, 3/13/2009 two weeks ag n has been received from a nurse concerning a 25 year old female with penicillin allergy whoNon 30-SEP-2008 3/24/2009 was 3/24/2009 vaccinated with her firs n has been received from a physician concerning a female patient who is also the receptionist N in the office 3/20/2009 and on 20-MAR-2009 was vacci n has been received from a physician Y concerning a female patient with no pertinent medicalYhistory and no known drug 3/24/2009 allergies/reactions n has been received from a consumer concerning her daughter who was vaccinated with theNsecond dose of GARDASIL two weeks after th n has been received from a physician concerning a female who in February 2009, was vaccinated U with the third dose of GARDASIL. Subse n has been received from a physician Y assistant concerning a 16 year old female with penicillin N allergy and6/5/2008 sulfonamide allergy who on 05-J n has been received from a Doctor Y of Pharmacy (Pharm. D.) student concerning a 27 year old N female with no medical 3/24/2009 history or drug allerg n has been received from a nurse concerning a 14 year old female who was vaccinated withYall 3 doses of GARDASIL. That after the patie n has been received from a 26 yearYold female who in December 2008 was vaccinated with N a first dose 3/17/2009 of GARDASIL. 3/21/2009 On 17-MAR-2009 w n has been received from a physician Y assistant concerning a 24 year old female with asthmaNand a history 3/25/2009 of urinary 3/25/2009 tract infection who on (3/8" x l-l/8") around injection site. Forgot to check the site of injection until just now. 12:15 PM Y 04/18/2009. 4/16/2009 Zostavax INJ adverently given expired dose of smallpox vaccine. Y 4/18/2009 4/18/2009 atigue (20 hours of sleep for five days)Extreme body ache, confusion, dizziness 4/20/09 Received PCP medical 4/13/2009 records 4/14/2009 of 4/13/2009. FINA d area induration 10- to 15cm with swelling Y and erythema, fine vesicles around the injection U site. po benadryl 4/16/2009 , Po Motrin 4/18/2009 for pain and ceph Y Y N n was received from an investigator for a study concerning a patient who on an unspecified U date was vaccinated with a dose of PNEUMOV n has been received from a consumer reporting that she knew some friends who had their children U vaccinated with a dose of MMR II and la n has been received from a consumer concerning a couple of her friend's children who wereUvaccinated with MMR II (lot# not provided) and n has been received from a 26 yearYold femaleYfor GARDASIL, a pregnancy 3 registry product,Y concerning 2/1/2008 herself with2/1/2008 no pertinent medical h n has been received from a nurse concerning Y a 11 year old female patient who on an unspecified Y date was 7/17/2008 vaccinated 2/9/2009 with the first dose o n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 1/11/2008 22 year old1/11/2008 female with no medical n has been received from a physician via agency concerning a patient who was enrolled in aUstudy. This report was part of a post-marketin n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unknown date, the patient wa n has been received from an investigator via agency concerning a patient with HIV infection Uwho was enrolled in a study. On an unspecified N n has been received from an investigator via agency concerning a child patient with HIV infection U who was enrolled in a study who was vac n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date, the patient n has been received from the agency concerning a patient who entered a study and was vaccinated U iwth a dose of PNEUMOVAX 23. This n has been received from an investigator concerning a patient who on an unspecified date was U enrolled in a study. This report was part of a
n has been received from an investigator concerning a patient who was enrolled in a study. U On an unspecified date, the patient was vaccin very slurred speech, lossYof appetite. Y Vaccine was Y given 7 weeks ago, 12 week by week condition U deteriorated, 2/11/2009 no diagnosis 2/12/2009 made. 7/7/09 Ho ash, left groin area, about 21 papules Y with deep red flat areas around papules alternate burning Y and itching. 4/2/2009 I noticed 4/6/2009 rash on 4/6/09 - 3 day p this am with redness to inj. site, warm to touch and states that area is tender. Y 3/31/2009 4/1/2009 itching to right arm 2d after injection came home from school and mom noticed redness andYswelling to right 4/7/2009 arm. TYLENOL, 4/9/2009 cold compres clinic today with chicken pox - 3/23/09 1st vaccine 7/3/8 2nd vaccine 2/24/9. U 2/24/2009 3/22/2009 states that pt c/o pain with some swelling @ injection site. Mom states following day worse, w/ Y redness, 3/30/2009 swelling and 3/30/2009 tender to touch. Still w e "notice bumps on body and itchy"Yon 4/14/09. Seen by ER physician and prescribed BENADRYL Y by mouth. 4/2/2009 Client4/14/2009 came to clinic today 4/ VAX given on 4/1/09 - had pain that day. Rash developed on 4/2/09 - Seen in our office 4/3/09 Y txd with MEDROL 4/1/2009dose 4/1/2009 pack (5 day tx) and om Pt swollen to Lt thigh. Y Y 4/13/2009 4/13/2009 veloped pain/tenderness to the injected area 8 hrs after the vaccination. The following day developed Y redness, 4/9/2009 swelling 4/9/2009 & nausea symptom sh that developed 10 days after imms Y given, skin rash all over body, 2-3 mm macular, papular Y eruption, non-peticheal 3/30/2009 4/9/2009 in nature, lasting 5 da DTaP noticed red welt on left arm where vaccine was administered about the size of a softball U got worse4/13/2009 (bigger) the4/14/2009 next day, tender, warm Mother brought pt to office w/ c/o redness Y + swelling in the 14cm x 8.5cm left leg at the injection Y site of DTaP. 4/13/2009 He was 4/13/2009 given BENADRYL in 5 doses of the Anthrax vaccine in 1998/1999. I began feeling chronic fatigue andYarthralgia/myalgia N in 2000 1/1/1998 and it has 1/1/2000 gotten increasingly w swelling of face and eyes. Treated Ywith benadryl. Y 4/16/2009 4/17/2009 s after being immunized, patient developed hives in patches all over his body. Y 3/6/2009 3/9/2009 nt stiffness-difficulty in getting out of bed post vaccination Saturday 18ARP2009;feverish;vomiting Y 4/17/2009 4/18/2009 as given Chicken Pox (Varicella) vaccine Y on 3/19/09. On 3/24/09 she developed a 104 degree Y fever, runny 3/19/2009 nose, cough, 3/24/2009 sore throat, lethar ash on left thigh, red patches around injection site about 1 inch around, non tender and no swelling. Y advised 3/10/2009 to give3/11/2009 benadryl q 6 hrs, hydro child reported that child had erythema bilateral arms. Erythem started on 4-17-09 and no longer Y present4/16/2009 on 4-19-09. 4/17/2009 Mother of child stated er after 48 hours of receiving the shot. Y Baby got an armpit reading of 102.5 and was feverishYfor 48 hours,4/2/2009 afterwards4/4/2009 did not eat/drink for 2 admin 01/08/09, pt started with feverY01/09/09 3:00am Y - Mom states3pt was "burning up" andYguessed fever 1/8/2009 at 100 (did 1/9/2009 not measure it). Gav lowgrade fever day of immunization (early evening)- Tylenol admin and effective. loose BM Y , greenish in color 4/1/2009 04/02 4/6/2009 - 04/05/09. Then on 04 hat twice since administration she experienced Y episodes where Left hand became numb and U cold and then 4/13/2009 turned red 4/14/2009 and blue. Upon pres ay after vaccinations, Face SwellingY2 days after, by day 3-4 rash on face Y 4/8/2009 4/9/2009 e of soreness in arm 4/18/09 while performing routine housework. Noticed red, swollen, warm Y 3 in X 3 in4/17/2009 area 3-4 inches 4/18/2009 below injection si eving vaccine, Mariah started Y havingYbouts of rectal Y bleeding and diareah. 36 Y In additin Y to this she N had a very 8/23/2007 loud barking 9/1/2007 "chronic" cough. Mo swelling at injection site. Red and warm Y to upper arm . Y 4/16/2009 4/16/2009 aints-screened Jan 13, 2009 denied being pregnant-Her informed choice HPV#1 and Menactra Y given, states 1/13/2009 due Hept A #2 due after 12 Fe facial redness, itching and swelling 1 day after vaccine administered into left deltoid. Also felt Y lightheaded4/6/2009 day of vaccine. 4/7/2009 3/27/2009 N 3/26/2009 3/27/2009 shingles vaccine on April 13, 2009. On Thursday I had a rash which got worse every day. I went to see Dr. 4/13/2009 Jones today. 4/16/2009 He diagnosed sh miting,malise, headache could not get Y out of bed for 2 weeks after 1st shot. Developed Y periphreal N neurapathy within ### 30 days ###of 1st shot. H 2 degrees F) lasting 36 hours. ChillsYon 4-11-09 pain in both deltoid muscles radiating into neck N area. Dr visit 4/9/2009 on 4-12-09 4/9/2009 given RX for ibupr ction at injection site, left deltoid. Area red, slightly swollen, warm to touch 31/2 x21/4 circumference Y of needle 4/9/2009 site. Area 4/10/2009 described as itchy and swelling at injection site. Fever Y of 101.2 with generalized aches. Injection site a dark reddish Y pink extending 4/8/2009 towards 4/10/2009 elbow, 5" in diame ed with erythematous macular rashY- descendant type at night on 4/11/09 - taken to ER nextYmorning -(not sure if case 4/11/2009 was reported). Child l episode Records recieved 05/06/09 for DOS 04/10/09. Office visit. Post anthrax vaccine c/o Y weakness,4/10/2009 pale, slow4/10/2009 to respond to verbal co at sight of injection. Y 3/30/2009 3/30/2009 ined of severe pain at site of injection, as well as redness and swelling. Also cried for 3 1/2 hours Y after receiving 3/31/2009 injection 3/31/2009 wollen to the knee. No pain has itching. Y 4/11/2009 4/12/2009 ok patient to walk-in vaccine clinic. Obtained Y #2 Hepatitis A dose, #4 Pneumococcal dose (each Y in left thigh), 4/1/2009 and Influenza 4/1/2009 Split virus dose pain, high fever due to mistake. My daughter was given vaccinations by mistake twice. Y 1/9/2009 r and swelling due to mistake, and my son was given vaccination twice by mistake. Y 1/9/2009 X given in (L) deltoid on 4-9-09. OnY4-12-09 swelling of deltoid noted, no redness - (+) tender. Y Swelling resolved 4/9/2009 by 4/12/2009 evening 4-13. Also had njection site within 24 h (as reported by mother) at the time of visit -vesicle 3mm at injection U site with excoriated 4/7/2009 area.4/8/2009 Monitor for infection. was reported via medical records forwarded byYa lawyer and described the occurrence of arthritis U aggravated 4/19/1999 in a 77-year-old 4/20/1999 male subject NAR administered on 4/13/09 instead of 1. Mother called at 11:30 PM on 4/13/09 and statedUhad fever 102. 4/13/2009 Instructed 4/13/2009 to give TYLENOL an s after shot: body aches- hives, no respiration distress. 4/13/2009 4/13/2009 e TDAP vaccine 10-29-08. Later that day after vaccine administration, patient complained of Y weakness, dizziness, ###chills and ### body aches. La
t. noon sudden onset with severe back Y pain & body ache like the flu. Diarrhea started - went Y to bed - 200 4/3/2009 went to ER. 4/4/2009 Received a bag of f of arm at injection site, diarrhea, vomiting, Y fever.YSymptoms began 24 10 hr after vaccine. Erythema, edema of 4/6/2009 Rt deltoid.4/8/2009 BP decreased. 6/24
swelling to the site. Mother states approx. 5X5". Red, hot to the touch. C/o itchy. Painful. Y 4/9/2009 4/10/2009 d 3 seizures following 6 mos vaccines lasting 1 Y 1/2-2 min. 1st was tonic 2 clonic. 2nd was clonic Y with staring. 4/15/2009 3rd was 4/16/2009 a staring spell witnesse er vaccination, patient had about 10 spots of urticaria (red, raised) scattered on wrists, arms Ytrunk & behind 4/15/2009 ear. Relieved 4/18/2009 after bath in the , rhinorrhea started the following day after vaccination, today 4/20/09 saw MD for treatment.Y 4/15/2009 4/16/2009 9 started with cold & cough, gave TYLENOL Y for fever. On 3/26/09 Baby was very irritable RYside of body3/18/2009 hand & leg 3/21/2009 would jerk simultaneo and ulcers over scrotum, trunk and scalp, Y >100 lesions. U 4/9/2009 4/16/2009 ollen feet + hands Y N 4/6/2009 4/17/2009 hours, he had an 11 cm sized area of redness at the injection site that was firm & warm & his U thigh was swollen. 4/7/2009The4/8/2009 area was non tender R) upper arm. Started on KEFLEX - 25x 10 1/2 cm Follow-up in 2 days 4/16/2009 4/17/2009 ox. Patient had vaccine on 11/14/00 N ### 4/15/2009 ction 4x5cm, induration and erythema within 24hrs at MMR site. Advised to apply warm or cold Y compresses, 4/13/2009 TYLENOL 4/14/2009 po, or BENADRY an perienced a seizure approximately minutes Y after vaccine administration. Was taken to emergency U room.4/20/2009 4/20/2009 tient on off dizziness since receiving vaccine on 4/17/09. But complaining on weekend fever U negative, vomiting 4/17/2009 negative 4/17/2009 shingle negative fo post GARDASIL and MENACTRA administration. Y Patient fractured nose during syncope event Y (hit office 4/17/2009 counter during 4/17/2009 fall). d fever approximately 8 hours after vaccine. (105 degrees F). Next AM, joint and muscle tenderness; Y "whole 4/16/2009 body"4/16/2009 5x responded to Ibupr ad fever 100.1 and chills. Student took Advil and an hour later felt fine. T.100.1 BP 130/80 P100 Y 0296904/16/2009 CNRA 4/16/2009 e, nausea after 1st shot, recovered in Y 2 days. Developed rash in a week after 2nd shot. Saw Y dr, dermatologist and allergist finally diagnosed ven VARICELLA & MENACTRA vaccinations and after he walked into lobby he passed out. YPatient set in 4/13/2009 wheelchair 4/13/2009 & assisted by Dr. . B congestion, swallowing freq. weak Y nausea - approx. a minute and half - called mom (parents) Y this AM - 4/17/2009 but was unable 4/17/2009 to get update. 9 Mother called and spoke to call center who then called our office. Child received MMR andYVARIVAX today, 4/16/2009 rash 4/16/2009 developed on face, and d SPV left arm on 4/4/09. On 4/9/09 the pt experienced about 60 min of central chest pressure (2/10). He 4/4/2009 states that 4/9/2009 he felt like his heart r tarted 48-72 hours after Hep A # 2 and no obvious trigger. CLARITIN 5mg/5ml qd prn. U 4/6/2009 4/9/2009 er thigh induration 10x9cm, mild tenderness to left upper thigh. Y 4/15/2009 4/16/2009 nutes of the DTAP, pt had reaction, Y wheezing, sob, tickling in the throat, appeared grayish inYmouth, 2 tsp4/17/2009 BENADRYL, 4/17/2009 alb nebs X 2, SOLU veloped shingles 4/15/09. U 8/7/2006 4/15/2009 er of Pt; Pt arms became tender + painful (@ injection site) approx 6-7 hrs after injections, the Y hands became 4/9/2009 swollen4/9/2009 itching next day Pt re ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/20/2009 female, 2/20/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a 15-month-old 2/23/2009 female 2/23/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious spontaneous report of expired FLUMIST given was received from a company sales representative Y concerning 2/23/2009 a 2/23/2009 47-month-old male. O n has been received from a registered nurse concerning a male who last week was vaccinated U with VARIVAX (Merck). Concomitant therap MENACTRA 4/8/09 at 4:15PM, close Y to that time. Checked the vial for how to administer, it didn't Y state, checked 4/8/2009refrigerator 4/9/2009(see attached) post vaccine -> felt dizzy, diaphoretic helped to sit down no syncope no loss of consciousness Y supine x 4/14/2009 10 min then4/14/2009 sat up received orang ted with Sx of allergic Rxn after shots. Y No food, drink or other exposure noted. Sx started about Y 1 hr after4/9/2009 shots. No4/9/2009 probs w/ previous sho htness of chest next day. Benadryl +Y steroids. Y 4/1/2009 4/2/2009 dasil #3 woke up with shoulder pain L now hands fingers hard to work. Tests for lupus & arthritis N - neg. Now 1/4/2008 very stiff joints hands & knees ace and trunk extremities. Intense itching. Y Y 4/15/2009 4/15/2009 ith vesicular rash on trunk 4/16/09 - rash appeared 4/14/09 on trunk. N 11/3/2000 4/14/2009 hysical with immunization 4/3/09 fever Y to 101 X 24 hrs, then 4/6/09 developed no fever. Developed cough, 3/30/2009 cranky, not 4/10/2009 sleeping seen by Dr n has been received from an investigator via agency concerning a patient who on an unspecified U date was enrolled in a study. This report w y concerning a patient who was enrolled in a study. This report was part of a post-marketingUsurveillance program. On an unknown date the n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. This report was part of a post-marke n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date the patient n has been received from an investigator via DAIDS concerning a patient who was enrolled U in a study. On an unspecified date the patient w n has been received from a registered nurse concerning a 20 year old female with no past drug Y history, 12/6/2008 who on 06-DEC-2008 12/6/2008 was vaccina ort received 07 April 2009 from a consumer Y who was the patient's mother-in-law. A male patient N (age not reported) with a history of sleep d ort received 09 April 2009 from a health care professional. Y A four-month-old 1 male patient withYa history of eczema 4/2/2009and4/2/2009 an egg allergy, had r
episode, fever - 102.7, partial absence Y spell or Yseizure which resulted 1 in some anoxia post ictal Y phase, sign 4/7/2009 tachycardia. 4/7/2009 4/29/09 Received ed child c/o pain, redness and swelling noted to (left) vastus lateralis approximately 3cm x 5 cm. Y 3/31/2009 4/1/2009 ately 15-20 minutes after vaccination Y child became unresponsive, no respiratory distress. Mother Y emergently 4/16/2009 brought 4/16/2009 infant back to office. I 0 min after vaccination given, the patient had a blank stare, turned gray, rapid breathing, gotYstiff eyes, eyes 4/15/2009 rolled back, 4/15/2009 arm and legs stiff a 02 degrees and diffuse urticaria. Began Y the AM after vaccine administered. Given antihistamine U as treatment. 4/15/2009 4/16/2009 4/10/09 left deltoid noted to have about 4" round increased redness, warmth and swelling. Instructed Y to use 4/8/2009 ice packs prn. ived vaccination on 3-27-2009 and came in office with chickenpox on 4-8-09. Y 3/27/2009 4/8/2009 d swelling and hardness at site (L) arm of inj, progressed down arm to below elbow. Described Y as hard, 3/13/2009 warm, very 3/13/2009 tender, entire circumfer hes over body, especially elbows, knees Y and hands with swelling and redness within 5 hrs ofYvaccination. 4/13/2009 4/13/2009 male received vaccines 4/10/09. 2hrs Y after vaccine started develop rash to body, which spread Y the following 4/10/2009 day with 4/10/2009 swelling. Seen in ER cella 4/7/09. At 3:30am on 4/9/09 woke up w / 104 Temp. Used fever control methods. Saw Y PCP at 9:30am 4/7/2009 on 4/9/09, 4/9/2009 temp at 99. Large, r d swelling and pain of injection site >5cm about 8 hours after injection. 12-18 hours after injection N developed 4/9/2009 dizziness, 4/9/2009 nausea and heada me down with shingles within days of receiving Zostavax. Y 3/19/2009 3/24/2009 veloped painful rash with vesicles at site of injection and mid back. Y 3/19/2009 3/24/2009 vaccine administered 04/15/2009; 36 Y hrs. later I had 3.5 cm indurated, red, sore, warm vaccination Y site w/surrounding 4/15/2009 4/16/2009 erythema accompani ived PPD and Flu vaccine 4-15-09.Next day he developed fever.Red rashes developed on forehead.Mom Y gave a dose of benadryl elixir 1 t s following injection of varicella and mmr to left thigh mom returned with child and wanted usUto see left thigh 4/21/2009 reddness 4/21/2009 and swelling. 2 3/4 nd 4/16 baby was cranky and crying, no fever. On 4/18/09 "baby's eyes started rolling back"Uone time. On 4/14/2009 4/20/09 "everytime 4/18/2009 MOB put bab tching and rash on arm where vaccines were given. Benadryl cream prescribed by MD. Y 4/13/2009 4/14/2009 en, hot area where vaccine given Y 4/17/2009 4/18/2009 days after getting Proquad VMMR vaccination Y and Pnem vaccination. My son ran 105 F fever U and I took him to the ER. His temperature w ed disease of the pericardium. 5-000007 Y 4/28/09 Received vaccine & clinic medical records of 3/20/09. FINAL 3/9/2009 DX: pericarditis 3/20/2009 Records rev en, hot area around where vaccine was given Y 4/17/2009 4/18/2009 administration, had flu-like symptoms including chills, aches, and vomited X1. Today (1 dayNafter vaccine 4/20/2009 administration) 4/20/2009 she has a runny n RSE EVENT-MD ORDERED & PATIENT RECEIVED DTaP. THIS VACCINE IS NOT RECOMMENDED Y FOR 9/3/2008 CHILDREN PAST 6 YEARS episode fainted Y 4/21/2009 d tdap and varicella and passed out. Hit forehead on wall and recieved a lacaration steri strips Y were applied 4/18/2009 Pt c/o dizziness 4/18/2009and pain. Pt st ceived a Tdap and 1st Hepatitis A and Y within 5 minutes, broke out in a rash and had trouble Y breathing and 4/13/2009 swallowing. 4/13/2009 Patient reported he following Twinrix vaccine on 4/15, client's Y upper lip began to swell. Swelling continued for several N days. 4/15/2009 Client visited 4/17/2009 primary care physicia rash starting on face and spreading. Tactile temp, fussy. Multiple papules, vesicles Y 2/18/2009 4/13/2009 y aches HA vomitng for 3 days Y U 4/18/2009 4/19/2009 V injection approx. 8:20 a.m., Immediately felt sick and dizzy, thought she was going to vomit. N There were 4/20/2009 two more4/20/2009 incidents during day on diagnosis to vaccine-Hypothyroidism, Y Hashimotos,Acid Y Reflux, Anxiety, 20 Y Depression, OCD and N had occassional 9/20/2007 eye 10/1/2007 tics. Exacerbation of pre was reported via medical records forwarded by a lawyer and described the occurrence of arthritis U in a male subject in his forties who was v was reported by a lawyer and described Y the occurrence of joint pain in a male subject of unspecified N age who ### was vaccinated with LYMER vaccines 4/2, on 4/9 developed Y fevers, sore throat Y - unresponsiveness 21 and encephalitis withNbrain edema4/2/2009 by 4/11. Suspect 4/9/2009 viral encephalit a fever up to 104 with last vaccines Y and screamed for ten hours nonstop. Y 1/28/2009 1/29/2009 ceived DTap and VARIVAX vaccines on 3/18/09 in right thigh. Patient returned to office 3/20/09 U with large 3/18/2009 red circular 3/20/2009 area around injection ceived DTap vaccine in left thigh on 3/16/09. Parent reported large red swollen area around Y injection site3/16/2009 1 day after3/18/2009 injection. Redness and at, difficulty swallowing, hoarsenessYand laryngitis. Told to stop VIVOTIF and use ADVIL. Throat U culture pending. 4/17/2009 4/18/2009 get lesion (7cm x 5 cm) with central clearing. Y Raised, red and warm, but no pain or itching. Y 4/15/2009 4/17/2009 d pain at left upper arm at previous injection site with redness and tenderness (2" x 5" of size). U Pt stated scratching 4/8/2009 area 4/12/2009 after 4 days of injec cold sweats and chills 4-20-09 that evening after the vaccine was administered. Pt also c/o difficult with4/20/2009 forward flexion 4/20/2009 of neck - "mild disc on L thigh with chicken pox lookingYlesions warm compresses + Augmentin x 5 days. Y 4/6/2009 4/17/2009 tous papular and plaque like lesions - very pruritic on extensor surface of upper and lower extremities. U This 4/7/2009 rash developed 4/18/2009 2 weeks after 2 smallpox 31 Mar 09 Lt upper arm, which Y was followed by swelling, redness, and increasing tenderness, Y 3/31/2009 no fever, Pt stated 4/1/2009 she was vaccin ollow-up to a previously submitted VAERS report this 47 year old patient received 4 BIOTHRAX U prior to and 1/11/2003 during his 1/13/2003 deployment in 2003. omiting and diarrhea, subjective fever Y and hematoma to site. Y 4/8/2009 4/9/2009 Y 4/15/2009 4/16/2009 creased appetite, rash, shaky, vomiting in the 24 hours to 48 hours with the vaccine administration N on 4/15/09 4/15/2009 4/16/2009 ines were given the patient hopped off the exam table (she was sitting on it) & fell to the floorY and became 3/16/2009 rigid and3/16/2009 looked blue and unresp
<15min) onset of facial swelling afterYvaccine delivery. Y 4/21/2009 4/21/2009 ely after vaccination, eyes rolled back, Y color became gray/green, leaned to left; mother supported U her - nurse 4/21/2009 attempted 4/21/2009 to assist her to put 08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis Y ofNSacroileitis,7/22/2008 pain Amplification 8/5/2008 syndrome. Pai 9 Patient brought by parents. About 12-18 days after vaccines developed hives on both cheeks N and few scattered on lower legs. uring swallowing; Febrile seizure. Y Y 4/8/2009 4/15/2009 ter immunization. Woke up next AM with severe swelling to face & eyes, very sleepy. Afebrile, Y no SOB 4/10/2009 or difficulty4/10/2009 swallowing. Took 50 m ely after receiving 2nd GARDASIL vaccine along with DTap vaccine, patient fainted. She wasYunconscious 4/17/2009 for 2-3 seconds. 4/17/2009 Awoke with sha is having tingling sensation up and down his left arm, and he stated that his shoulder is sore. U Asked him3/10/2008 is pain severe 4/9/2009 he said that it is eas as given Hep A 1st, then HPV. AfterYHPV was administered pt tensed up and began to looseYher color, she 4/17/2009 then began 4/17/2009 to lean backwards a dness where injection given area approx. 6in long & 4in with with warm areas + pain. Started Y around 12 hours after inj + worsening over 48 fter vaccine with smallpox, awoke with non painful non pruritic 10 cm red patch with multiple U 2-3 mm satellite 4/13/2009 papules 4/13/2009 around path extendin after injection erythematous confluent raised rash appeared on dependent surface of L upper Y arm. 1% Hydrocortisone 4/16/2009 4/17/2009 cream bid, extendin hezia, twice - Fussiness - Constipation Y Y 3/25/2009 4/1/2009 4/15/2009 N 4/15/2009 4/15/2009 erythema, induration at Iz site - VARICELLA Iz right thigh U 4/8/2009 4/9/2009 ne was mixed with sterile water diluent and not HIB diluent. 3/9/2009 n has been received from a 31 yearYold female licensed practical nurse with reaction/allergy Y Nto DEMEROL7/5/2007 and a history 7/5/2007 of function kidney additional information has been received Y from a nurse practitioner concerning a 14 Y year old Nfemale who on 17-OCT-2006 ### 2/1/2007 was vaccinated w n has been received from a physician assistant and a licensed practical nurse concerning a U female who was vaccinated with the first dose n has been received from a physician Y assistant concerning a 20 year old female Y with migraine, N penicillin8/15/2007 allergy and VICODIN 8/1/2008 allergy and a ports child woke up "Sunday night atY 1:30" (April 12) with c/o not feeling well, sore throat andYswollen glands 4/8/2009 on side4/12/2009 of neck. Reports c/o h veloped a skin infection at the site of Y the MMR vaccination. She had low grade fevers for days Y and was in 4/2/2009 discomfort. 4/11/2009 10 days on antibioti IVED DTAP INSTEAD OF TDAP. U 4/13/2009 4/13/2009 arm from just above elbow to shoulder Y joint. Had 4+ edema. Hot to touch, with deeper reddish Y black skin 4/15/2009 discoloration 4/16/2009 below where Kinrix d loss of consciousness after vaccination, associated with tonic clonic motions of extremities. Y Complete4/14/2009 recovery. 4/14/2009 No prior history of seizu ived 2 month vaccines as Pentacel, Prevnar and Rotateq. Vaccines given at 10:30 AM, Infant Y had inconsolable 4/21/2009 crying 4/21/2009 and mild fever (not ceived vaccinations and about 5.5 - 6 hours later experienced weakness, fatigue and fever ofU 102.5 axillary. 4/21/2009 No other 4/21/2009 symptoms other than ARICELLA VACCINE RECEIVED. PREVIOUS DOSES ON CHILD GIVEN ON THESE DATES: U 4/21/03,4/17/2009 04/18/20074/17/2009 rned pale and diphoretic after administration of first Gardasil vaccine. Patient complained of feeling Y like she 4/22/2009 was going 4/22/2009 to pass out. Patient w nderated at injection site. Heat and Y prednisalone Y 4/15/2009 4/16/2009 al reaction from left elbow to over left shoulder including underside of arm. Red, hot to touch,Uskin hard and 4/20/2009 swollen,4/21/2009 painful, no enlarged ax er receiving his 4 month booster vaccines Y patient Y started having seizures 1 Y which have Y resulted N in several9/26/2007 hospitalizations, 9/29/2007 numerous medica 4 HR OF VACCINES, PT GOT RAISED Y RASH ON BOTH ARMS. RX KEFLEX 250MG TID FOR 1 WK. CLARITIN 4/20/2009 RX, 4/21/2009 BENADRYL HS PR OID MACULAR RASH,MILD SWELLING, Y WARM TO TOUCH. CLARITIN RX/BENADRYL RX. RETURN 4/17/2009 IF NOT IMPROVED. 4/21/2009 d large local reaction at site of vaqricella Y vaccine Y 4/17/2009 4/18/2009 was reported by a lawyer and described Y the occurrence of joint pain in a female subject of unspecified U age 5/4/2000 who was vaccinated with LYME was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age 7/8/2002 who was vaccinated with LYMER came dizzy, pale, clammy & sweaty lethargic stated his very tired. Pulse droped into the 50's Y - oxygen @ 4/21/2009 3 liters had 4/21/2009 patient lie down chec telephone call from patient on 4-16-09 stating the she had slight nausea and slight swollen lymph node 4/14/2009 in (L) clavicle 4/15/2009 area. No fever. 4-21SM referred from aid station for left Y facial swelling in temporal association with the receipt ofYAVA and Typhoid 4/7/2009 vaccines. Symptoms: Swel
njection 02/13/2009 @ 4:00pm 36 later Pt states fever of 100, chills body ache L arm, headache. Y 2/13/2009 2/15/2009 n on 4/8/2009. Pt noted symptoms. Flu like achy onset 4/18/09. Stopped 4/21/09. Rash onset 4/21/09 - ongoing. 4/8/2009Rash 4/15/2009 on side of face, nec ccinated with Hepatitis A and Hepatitis B vaccines 15-20 seconds after vaccines administered Y patient fainted. 4/22/2009 Per guardian 4/22/2009 "patient has al large area redness/heat denies itching mildly painful area raised warm area breadth of thigh with central4/20/2009 clearing around 4/21/2009 vaccine site. Ben ng office, parents report baby turned blue, when strapped in her car seat lasted few secondsY-> pinked up on her own. Brought her right ba on 4/17 - Sore, red and itchy, and aYlittle swollen. Saturday swollen and warm.- little fever. Monday 4/20,4/17/2009 still sore and 4/18/2009 warm. Dr. prescribed eft thigh around on a or injection and fever of 100.2 U 4/16/2009 d hives 3 days after getting HPV vaccine for the 1st time. Y 4/16/2009 4/19/2009 n has been received from a nurse practitioner Y for the pregnancy registry for GARDASIL, concerning Y a 23 year old female 5/21/2008 with a history of 2 n has been received from a 22 year old medical assistant who was given the second dose ofNGARDASIL "subcutaneously instead of intram
n has been received from a Nurse Practitioner concerning a patient who on 13-FEB-2009 was U vaccinated 2/13/2009 with an inadequate 2/13/2009 dose of GAR n has been received from a physician concerning a 16 year old female who on 12-JAN-2009Uwas vaccinated 1/12/2009 with the second dose of GAR n has been received from a medical assistant concerning a 11 year old female with a historyYof pharyngitis 2/26/2009 streptococcal 2/26/2009 who on 26-FEB-2 n has been received from a Registered Nurse concerning a 16 year old female who was vaccinated U intramuscularly with her third dose of G n has been received from a physician Y concerning a 19 year old female with penicillin allergyUwho on 19-FEB-2009 2/19/2009 was 2/19/2009 vaccinated IM into t n has been received from a physician Y assistant concerning a 15 year old female who on 27-FEB-2009 U was 2/27/2009 vaccinated 2/27/2009 with a first dose of G n has been received from a 25 yearYold female who on 18-FEB-2009 was vaccinated with her N first dose 2/18/2009 of GARDASIL and the patient had n has been received from a nurse concerning Y a 13 year old female who on 26-AUG-2008 was N vaccinated 11/2/2008 with her first 12/1/2008 dose of GARDASIL n has been received from a physician concerning a 14 year old female patient with no pertinent N medical 2/12/2009 history and2/17/2009 no known drug allergie n has been received from a physician Y assistant concerning a female under 18 year old who Y on unspecified date was vaccinated with her th n has been received from a registered nurse concerning her 16 year old with no pertinent medical U history and no ###drug reactions/allergies ### w n has been received from a consumer concerning her daughter (approximately 17 year old) N with codeine allergy who9/1/2008 had been experiencin n has been received from a registered nurse concerning her 14 year old daughter with frequently Y injection site reaction after unspecified va n has been received from a 41 yearYold female patient with an allergy to "cloricidin" and a history U of bleeding 3/2/2009 during pregnancy 3/2/2009 who on 2-M n has been received from a female who was vaccinated with a first and second doses of GARDASIL U on an unspecified date, respectively. T n has been received from a nurse practitioner concerning a female patient who was vaccinated Y with a dose of GARDASIL. 3/2/2009 On 2-MAR-2009 n has been received from a registered Y nurse concerning a 24 year old female who in approximately Y February 2/1/2009 2009, about 2/1/2009 1 month ago, wa n has been received from a nurse practitioner Y concerning a 20 year old female with no pertinent U medical9/25/2007 history or drug 2/24/2009 reaction/allergies w n has been received from a physician concerning a 14 year old female who 25-FEB-20009 was U vaccinated 2/25/2009 with a dose 2/26/2009 of GARDASIL (lot # n has been received from a radiologist Y concerning her niece (a 14 year old female) who on 08-FEB-2008 Y 2/4/2008 was vaccinated 2/8/2008 with her first dose n has been received from a Nurse Practitioner (N.P.) concerning a female who was vaccinated N with 0.5 ml dose of GARDASIL. The patient n has been received from a registered Y nurse (R. N.) concerning a female patient at one of the U local schools who had an aluminum poisonin n has been received from a physician concerning a female patient who was vaccinated intramuscularly with 0.5 ml dose of GARDASIL. Co n has been received from a mother concerning her daughter who on unspecified dates was U vaccinated with all the three doses of GARDAS n has been received from a physician Y concerning a female teenager who on an unspecified Y date was vaccinated with the first dose of GAR n has been received from a nurse concerning Y a 17 year old female patient who on 28-FEB-2009 N was vaccinated 2/28/2009with 2/28/2009 the first dose of GAR n has been received from a physician concerning a 13 year old female who on 22-DEC-2008 Y was vaccinated with ### her 2/23/2009 first dose of GARDA n has been received from a physician Y concerning a 15 or 16 year old female who was vaccinated U with the second dose of GARDASIL. On n has been received from a registered Y nurse concerning an 18 year old female with an allergy U to naproxen 11/1/2008 who on 23-APR-2008 11/1/2008 was vacc n has been received from a consumer concerning her 23 year old daughter with no pertinentNmedical history 8/1/2008 and no known 8/1/2008 drug allergies o n has been received from a physician concerning a female who on an unspecified dates wasUvaccinated with first and second doses of GA n has been received from a school nurse (registered nurse concerning a high school aged female U who was 7/31/2007 vaccinated with a dose of GAR swelling ANT LT Thigh, delayed onset Y after immunizations 4/9 am, either soft tissue infection U (cellulitis) vs 4/9/2009 delayed and 4/9/2009 severe local reactio m red patch on L thigh 2 days with vaccine Y administration tender + hot no systemic signs or symptoms. U 4/16/2009 4/17/2009 was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a 5-year-old male patient eared over mid back and buttocks 7/30/08. Progressed to localized area over left thigh, clustered, mean spots,### very7/30/2008 pruritic. Area persisted mmunization clerical staff stating client Y had left phone message stating that she had blistersUat the site of 3/1/2009 her shingles shot. Said area was lled Pt. crying, unable to console X90 min. Tylenol given - phone call 4/17/09. Pt doing better, Y cried for 24/16/2009 1/2 hrs. and 4/16/2009 is fine today- had low iving a HEP A injection pt walked to front desk & ran into the exit door. She stated "every thing Y was purple 4/17/2009 because4/17/2009 the shot hurt so much. hema and edema extending 10 cm X 4 cm around injection site. Decreasing edema and erythema Y daily.4/13/2009 4/14/2009 Mom called re: 4 bumps to left thigh Y with redness. 3-13-09 mom brought child to MD with increased Y redness 3/11/2009 and selling. 3/12/2009 3-14-09 ED visit, la A (intense when moves head) aching all over and a slight cough.Tem.101.Advised to see PCP U if T. 102-103 4/21/2009 and if sxs 4/21/2009 not subsided in 48 h ates that a few hours after the patient Y received Y his shots she fed him1and put him down for aYnap. She states 4/20/2009 she went 4/20/2009 in to check on him a NURSE PHONED TO SAY RIGHT ARM RED,SWOLLEN,TENDER--REDNESS EXTENDS U 3CM BELOW 4/20/2009 ELBOW---ADVISED 4/22/2009 TO SEND T ng of 4/22/09, the day after vaccination, parents noted that left arm was swollen above the elbow, Y red and4/21/2009 hot to the 4/22/2009 touch. Child had not co e on 4/15/09 at which time vaccinesYadministered according to CDC recommended schedule. Y Parents report 4/15/2009 that on 4/16/2009 4/16/09 patient develo muscle pain in the deltoid area beginning Y withing days after the shot. It has been 9 months and N the pain 7/15/2008 is only slightly 7/17/2008 better. dose of oral typhoid in the morning of 4-21-09 and began to feel intestinal discomfort the in evening Y of the 4/20/2009 same date. 4/21/2009 Started with diarrhea inistration of a subcutaneous MMR vaccination using a VanishPoint syringe, a black dot appeared U on the site of ### injection. ### nausea w/o emesis and Crampy abdominal Y pain 30+ episdoes of watery diarrhea no blood inY24 hours. Orthostatic 4/22/2009 and 4/23/2009 fatigue. bcutaneous injection of the MMR vaccine using the VanishPoint syringe, a black dot appeared U on the child's left ### arm. ###
D T-DAP 4/1/09 AT BEGINNING OF 12 HOUR SHIFT (0700) AND HER SHIFT EXTENEDED Y UNTIL 0300 4/1/2009 THE NEXT 4/3/2009 DAY. ON THE NIG d severe pain at injection site and upper arm,prickly reddened area around site, dizziness, fever,, U nausea,lymph 4/20/2009 glands 4/21/2009 swollen in axilla minutes after second vaccine injection(HPV) client stated that she felt hot,then did not respond Y to verbal4/23/2009 stimuli, eyes 4/23/2009 open, and body beg 009, arm was sore and red at site ofYinjection. Redness gradually worsened. At time indicated N in number4/20/2009 11, patient4/22/2009 began to feel nauseate rm redness, swelling, fever, skin hot, red rash on arm, pain in arm for one week, egg sized lump. Y Symptoms 4/14/2009 resolved 4/14/2009 on own after one wee e shingles vaccine administered on the 21st of April at 10:00a.m., became very red, itchy andY swollen to 4/21/2009 three inches 4/22/2009 in diameter, 1/2 inch h was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age7/30/1999 who was vaccinated with LYMER was reported by a consumer and described Y theY occurrence of throat0 tingling in a 45-year-oldUfemale subject 9/17/2008 who was 9/17/2008 vaccinated with influe ng office Pt had a delayed fainting spell - Returned to office - No injury. Y 4/23/2009 4/23/2009 ter injection - pain at site -nausea-vomiting 9 hrs- Temp -101.4 - 12 hrs. See attached for detailed Y acct 4/14/2009 4/14/2009 ure starting within 24 hours of injections with lack of appetite & fatigue. Cough developed within 24 hours 3/25/2009 with positive 3/26/2009 strep (rapid test) 3/3 s red, swollen, itchy Y 4/21/2009 4/22/2009 degrees (rectal) on 4/23/09, redness Y and warmth to both thighs U 4/22/2009 4/23/2009 red area on LA last night 4/15/09. School nurse (called 4/16/09). 3/4" wheel - 2" flare -red-hot; Y dermis itching 4/14/2009 - no rash4/15/2009 no resp. problems after vaccines given mom stated pt vomited in bathroom. Once out of bathroom mom statedYpt feet "hot".4/17/2009 Temp was 4/17/2009 99.8 axillary 15 min la d redness, swelling, pain 5/10 and heat stating 4 days after injection. Erythematous and edematous Y area 4/6/2009 9 cm X 7.54/10/2009 cm at injection site. St 9, he was given MMR in right upper arm. Later that evening, he developed a red whelp and Y swelling of the 4/17/2009 right upper 4/17/2009 arm (deltoid area) No cm redness & swelling around site of Y immunization left and lateral thigh Y 4/21/2009 4/22/2009 appeared on arm in vicinity of vaccines - 4 days later on 04/6/09 and 4/20 severe rash on face - 4/21 severe 4/2/2009 generalized 4/6/2009 indurated pink pap eived varicella vaccine on 4/21/09. Y Developed edema of R arm extending from deltoid to mid forearm erythema 4/21/2009 over4/23/2009 deltoid. m to touch, inflammation instructed to give child, children's Motrin or Advil. U 4/21/2009 4/23/2009 r arm is red, hot to the touch and feels hard @ injection site. <- hist Dx Skin is mildly red-notY hard child 4/21/2009 not ill- playful4/22/2009 afebrile. egular shaped welts - No temp. - Itchy on parts of arm/legs and torso - Recommended BENADRYL U _ See 4/21/2009 Dr. if not 4/22/2009 better. iness symptomatic tx Y 4/22/2009 4/23/2009 ling, redness at site of injection (improving 4/21/09) fever & chills over night nausea. Y 4/20/2009 4/20/2009 swelling, heat (L) upper arm and developed several hrs after injection, Rx BENADRYL/VICODIN Y and cold 4/20/2009 packs. 4/21/2009 tching - burning - tired - achy Had emp. health physician check patient Y 4/21/2009 4/21/2009 post pt left boyfriend called back stating pt's tongue was starting to swell & have blisters on tongue. Y Told4/21/2009 boyfriend 4/21/2009 to return to clinic. Dr ex min child had cough, wheezing, difficulty Y breathing, pale Oxy 93-96% on room air then developed Y itchy rash 4/22/2009 all over4/22/2009 the body. Got XOPEN spot at injection site. Y 4/15/2009 4/16/2009 4/22/09 with rash. Y Y 5/30/2006 4/21/2009 ever and erythematous, blotchy rush all over - day after PENTACEL and ROTARIX Y 2/11/2009 2/12/2009 eport that after shots on 2-19-09, pt cried non stop greater than 3 hrs. Y 2/19/2009 2/19/2009 n has been received from a physician concerning Y a 12 month old patient 0 who on 20-JUN-2008, Y 06-AUG-2008 10/1/2008 and 01-OCT-2008 4/7/2009 was vacc n has been received from a physician concerning Y a 17 month old patient 0 who on 20-DEC-2007, Y 20-FEB-2008 4/17/2008 and 17-APR-2008 3/16/2009 was vacci rmation has been received from a physician Y and follow up information has been received from Y a registered 4/14/2009 nurse concerning 4/14/2009a 15 year old ort was received 17 April 2009 from Y a consumer, who is the patient's parent. An 11-year-old male Y patient (also 6/1/2008 reported 6/1/2008 as 12 years of age) ng of the vaccine swelling developed at injection site. The next day she developed a headache, Y chills, nausea 4/22/2009 and sweating. 4/22/2009Today (day 3) nt had a seizure on the Friday after Y getting the vaccine. Patient had a seizure w/u-extension,YLP/UDS. Patient 4/8/2009 had CT 4/17/2009 scan and EEG. The E nt received travel vaccines (yellow fever, Y meningococcal, typhoid) at an outpatient travel clinic Y 4/1/09. He4/1/2009 developed4/1/2009 a headache about 5 m pneumonia vaccine 4/20/09 in left arm. Y Stated it was immediately painful. Localized swellingUoccured over 4/20/2009 the next4/20/2009 6 hours. Swelling incre had slight swelling about 5cm, redness, itching, and pain Y 4/1/2009 4/3/2009 U 4/14/2009 4/14/2009 ceived her 4 month vaccines on approximately Y Y4/12/09 of this year (2 2 injections, 1 to the R thigh U and 1 to4/12/2009 the L thigh4/16/2009 presumably pentacel a s started exactly 2 months after her Y 2nd shot. Started Y with headaches, 1 nausea, vomiting, Y strep N throat and11/7/2008 body aches. 1/7/2009 Continues on with no as vaccinated 4/14. Presented for urgent care 4/23 with three patches of vesicles on left back. U 4/14/2009 4/22/2009 ere muscle pain in lower legs that continued for 7 days, and they are still sore, but not so severe Also after4/8/2009 3 days, I4/14/2009 started to have muscle 9/17/2008 N 9/2/2008 9/2/2008 d shortness of breath, wheezing, Y cold extremities, Y and hives within 5-15 2 minutes after receiving Y four immunizations 4/23/2009 and 4/23/2009 PPD. 5/14/09 hosp perienced two episodes of syncope after receiving vaccines on 4/21/09. First episode immediately Y after 4/21/2009 receiving vaccines, 4/21/2009 then 15 minute minutes of receiving her first Gardasil injection the patient blacked out. SHe was treated with Y smelling salts 4/17/2009 to try and 4/17/2009 rouse her and was p
hrs after receiving the immunizations Y listed below, patient's rt. arm began itching at the varicella Y site, then 3/23/2009 she noticed 3/24/2009 swelling and warmth ed this facility and stated that since she was administered her Td vaccination in the right deltoid on 3/27/09 3/27/2009 she has 3/27/2009 had "pain off and on in s after receiving MMR vaccine subcutaneously, Y developed a 1.5 cm wheal that itched and hurt Y at the site4/23/2009 of this vaccine 4/23/2009 administration. Tre vaccination on April 16th 2009 I noticed at the injection sight his arm was swollen, red and very N hot to the4/16/2009 touch. Everyone 4/16/2009 told me he was f was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age who was vaccinated with LYME 4/21/2009 N 4/16/2009 4/21/2009 eption, Bilious vomiting, Irritability, Listlessness. Y YIntermittent vomiting1 episodes starting on 4-12-09. Y Increased 4/7/2009 vomiting 4/12/2009 noted on 4-21-09. D cines emesis about 10 minutes afterYvaccines, developed Y facial and arm rash 20 minutes after Y vaccines, 4/15/2009 Pt sleepy. BENADRYL 4/15/2009 15 mg IM a eption, s/p surgical reduction. Y 4/28/09 Y MR received Y for DOS 4/16-19/2009 3 with D/C dx: Intussusception. Y 4/14/2009 Pt presented 4/15/2009 with vomiting, fussin ter received her second GARDASILYvaccine and had 2 30-45 second seizure 15 minutes after U the injection 4/21/2009 in the doctors 4/21/2009 office on the floor reviewed PROTCOL questions with patient, denied steroid use 4/24/09 - patient came to pharmacy U and4/23/2009 showed pharmacist 4/24/2009shingles-like ra headache, - flu-like symptoms, -nausea; -muscle pain Y 4/22/2009 4/23/2009 iving IM DTaP and IM PREVNAR onY 4/20/09 to (R) thigh, pt. developed red, warm area and Ytemp described 4/20/2009 as "hot"4/21/2009 per mom day after sho t was given a DTaP immunization Y 4/20/2009 swelling, redness, and warmth to immunization Y site (right posterior upper arm). 4/23/2009 4/23/2009 es, shortness of breath, very painfulYwith in 5 hours after injection, Pt states arm very painful Yunable to lift4/21/2009 on 4/22 + 4/21/2009 4/23 area near injection f the she c/o itching at the site - red area appeared 3 days later 15mm x 20 mm now. StartedUsmall welting 4/7/2009 after - no 4/7/2009 fever, no swelling in ar erebral Palsy, 1 seizure periodically Y 12/08, sees Neurologist, EEG 12/08 abnormal, on KEPPRA, U this episode 4/20/2009 = day 4/21/2009 after immunization mom r to elbow swollen twice the size & with erythema. Y 3/11/2009 3/13/2009 ived 2 chicken pox vaccines, chicken pox rash on 4/17/09 Y 6/20/2007 4/17/2009 d hives within 10 minutes of HIB / PREVNAR administration. BENEDRYL given in office. Monitored Y X 20-30 4/2/2009 min 4/2/2009 Y 4/20/2009 0PM Hep A #1 given LA. After injection, Y stated she was dizzy and tip of tongue numb. Color Ypink. 2:35PM 4/16/2009 HR 34 R 4/16/2009 20 BP 110/60 talking w U 2/11/2009 2/12/2009 vaccines - approx 30 mins later father Y returned to clinic stating child c/o "scratchy throat" - no Y SOB - vomited 4/7/2009 x3 - c/o4/7/2009 chest tightness EPI. 3 GARDASIL shot. Approx 3-5 min. later had several vials of blood drawn. After last vial pt. became Y "rigid",4/16/2009 had muscle 4/16/2009 contractions, eyes we by parent, Pt.'s R arm and shoulder Y at injection site became very swollen, child taken to ER.UParents thought 4/14/2009 needle was in arm. Arm X ra warm area without induration occurred 4/19 (2 days after vaccines given). U 4/17/2009 4/19/2009 red ROTATEQ orally before other vaccines - within 1 min of giving oral vaccine, infant mucous Y membranes 4/15/2009 of upper4/15/2009 and lower lips began to here for evaluation of dizziness andYsymptoms that she thinks may be related temporally to the injection 4/14/2009 of a TDAP 4/14/2009 that was given on 4/14/ ht arm within about 4" from injectionYsite bright red, swollen, hard and hot to touch on 3/19/09. Y 3/20/09 signs 3/18/2009 and symptoms 3/19/2009 persist with larg as brought back to office 25-30 minutes Y after injection given complaining that his chest hurt. Patient Y exhibiting 3/13/2009 welts,3/13/2009 wheezing, welt around jection site 2" x 1" redness w/ 2" raised Y areas w/i. No vesicle. No streaky redness. U 4/14/2009 4/24/2009 n in Rt. deltoid about 2-3 hours afterY receiving pneumonia vaccination. Pt could not move her U arm or fingers 3/18/2009 and went 3/18/2009 to the ER. Pt given a st 66, have always had a healthy, active Y lifestyle; have been energetic & chipper Y- hard to keep N me down, 6/10/2008 some favorite 6/11/2008 activities being aer was considered medically important. Information regarding PREVNAR was received from a U healthcare professional 8/3/2004 regarding a male patie was considered medically important. Information regarding PREVNAR was received from a U healthcare professional regarding a patient wh was considered medically important. Follow-up information provided recovery status. Information Y regarding PREVNAR ### was received form a was considered medically important. Information regarding PREVNAR was received from a U consumer regarding her granddaughter who su n regarding PREVENAR was received from a healthcare Y professional 0 regarding a 19-month-old Y male patient who experienced drug ineffec was considered medically important. Information regarding PREVNAR was received from consumer U regarding 4/9/2008 a 15-month-old male patien provided Quality Assurance Y Results. Information Y regarding PREVNAR was received from a N healthcare professional 8/28/2008 9/12/2008 regarding a 3-month-o received provided additional patient details, medical Y history, event details, 0 and test results. Information Y regarding 8/14/2008PREVNAR 10/1/2008was received n regarding PREVNAR was received form a consumer regarding a 5-month-old male patientUwho experienced### multiple seizures. ### The patien n regarding PREVNAR was received from a healthcare Y professional regarding a 12-month-old Y male patient who experienced 10/1/2008 drug ineffecti n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldY female patient who experienced a linear, raise n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldY male patient 9/24/2007 who experienced 11/5/2007injection site a information provided patient demographics, recovery status, concomitant vaccine, and doseYdetails including lot ### numbers.### Information reg n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU male patient 2/15/2008 who developed 2/26/2008 petechia 11 days n regarding PREVNAR was received from a healthcare professional regarding a patient whoUwas administered the vaccine that was stored n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU female patient 6/16/2008 who inadvertently 6/16/2008 was given a
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 6/30/2008 who experienced redness at th information was received that provided patient information and lot number. Information regarding U PREVNAR 7/28/2008 was received 7/28/2008 from a healthca n regarding PREVNAR was received from a healthcare professional regarding a patient who experienced low antibody titers. The patient re mation was received in dose details and source details. Information regarding PREVNAR was N received from a ### mother4/8/2008 and a physician rega n regarding PREVNAR was received from a healthcare professional regarding a 2-month-old patient who 8/14/2008 experienced 8/14/2008 administered improp n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldN male patient9/5/2008 who experienced 9/10/2008rash from head Information provided test results and a possible cause for the reported events. Information regarding N PREVNAR 9/22/2008was received from a healt n regarding PREVNAR was received from a healthcare professional regarding a patient who received PREVNAR that had been frozen on a n regarding PREVENAR was received from a company representative regarding a male patient who experienced decrease in babbling. Th n regarding PREVNAR was received from a consumer regarding a 4-month-old female patient U who experienced ### administered ### the 2nd dose n regarding PREVNAR was received from a patient's mother regarding her 4-month-old sonYwho experienced 4/1/2008 injection site swelling, body t n regarding PREVNAR was received from a healthcare professional regarding a 9-month-oldY patient who experienced facial rash. The pat n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced induration. The patient received t n regarding PREVNAR was received form a consumer regarding a 4-month-old male patientUwho experienced broke out all over with a rash n regarding PREVNAR was received from a pharmacist regarding a 4-month-old patient whoUexperienced5/6/2008 rash and fever. 5/6/2008 At 4 months of a n regarding PREVNAR was received from a pharmacist regarding a 15-month-old patient who U experienced 5/6/2008 fever of 103.9 5/6/2008 degrees. The pa n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient who experienced red swollen l information was received that provided medical confirmation of the events, and also included Y patient demographics, 7/9/2008 7/9/2008 and recovery status. I n regarding PREVNAR was received from a nurse regarding her grandson, a male patient (age U unknown), who experienced reaction on the n regarding PREVNAR was received from a mother regarding her 12-month-old female daughter N who experienced 9/2/2008 swelling 9/3/2008 and redness at n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient9/8/2008 who experienced 9/12/2008urticaria on bo n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient7/3/2008 who experienced 7/8/2008rash from head n regarding PREVNAR was received from a healthcare professional regarding a 13-month-old Y male patient 8/6/2008 who experienced 8/9/2008 hives, extens n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced 10/1/2008 decreased 10/1/2008 appetite and widespre n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced extreme pain when PREVNAR w n was received from a pediatrician regarding a 4-month-old patient who experienced diarrhea. The patient received a dose on an unspecifi n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who U experienced diarrhea. At 6 months of age, th n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who experienced diarrhea. At 6 months of age, th n regarding PREVNAR was received from a pediatrician regarding a 12-month-old patient who experienced diarrhea. At 12 months of age n was received from a healthcare professional regarding a 13-month-old male patient who experienced U injection 2/3/2009 site 2/4/2009 swelling and fever of 1 n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldU male patient2/3/2009 who experienced 2/4/2009injection site sw n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldN male patient 12/9/2008 who experienced 12/9/2008injection site h ped a sore throat and fever 2 days after receiving the vaccine. Fever resolved after 1 day, but U sore throat 4/20/2009 persisted 4/22/2009 for several days. injection site reaction. Softball sized slightly swollen and red injection site area in left arm inYsubcutaneous 4/16/2009 upper tricept 4/17/2009 area. Received in old me today at a sibling's visit that ~2 weeks after patient received her Varivax she developed Y a fever and 4/19/2004 what looked 5/2/2004 like chicken pox lesi edness, swelling, induration, & pain at injection site. unable to lift arm. Started taking TylenolN1000 mg per 4/23/2009 recommendations. 4/24/2009 weating, chills, fainting, pain deep in ears Y 4/24/2009 ours after the vaccine my upper arm began to swell. The injection site had a rash, my entire U upper arm looked 4/24/2009 like a4/24/2009 giant hive. It was very rhea, crying (insolable), stopped eating Y typical foods she liked, needed to be in constant Y motion N (baby jumper)to ### be happy,### didn't want to be (pneumococcal polysaccharide) my husband had swelling at the sight and red and very hot.The Y redness4/20/2009 and swelling 4/20/2009 went down the inside n has been received from a 45 year old female nurse who on 16-APR-2009 was subcutaneously N vaccinated 4/16/2009 with a dose 4/16/2009 of ZOSTAVAX (M n has been received from a consumer Y concerning his now 5 year old son with developmental N delays, who 10/1/2005 at the age 10/1/2005 of 18 months was vac n has been received from a consumer concerning her approximately 12 month old male withNfood allergies and no pertinent 6/1/2007medical history o small pox lot number VV04003a. Pt. Y Developed Rash Covering entire body 6 days after vacination. U poc4/19/2009 fully formed 4/25/2009 then reaction accured ENTS WIH SKIN IRRITATION AND RED SPOTWS ALL OVER BODY SINCE 25 APR 2009YPT SEEN PROVIDER 4/15/2009 ON 4/25/2009 26 SPR 2009. PT A d TD vaccination 18 April 09. C/O increased pain over right deltoid muscle on 19 April. Pt states U that pain 4/18/2009 has been4/19/2009 stable for the past wee es son ran high fever (102 to 103) starting Y "about an hour after the shots" for most of weekend. Y Developed 4/23/2009 severe headache 4/23/2009and "walked in ction at injection site. Redness, swelling heat and hardness extending from injection site at left U deltoid to4/24/2009 just aboce 4/25/2009 the elbow. Injection ad G RIGHT ARM FROM DELTOID AROUND UNDER ARM PIT DOWN TO WRIST, STARTEDY 4/24/09 4/23/2009 4/24/2009 GIVEN TDAP AND MENACTRA AND FAINTED FOR A 15 SEC AND VERBALIZED FEELING Y DIZZY. PT. 4/27/2009 LAID ON 4/27/2009 THE FLOOR AND COL e and fever reported on 4/3/09 via a phone call to the LPN working at the outpatient clinic. No Y treatment noted. 4/1/2009 4/3/2009
er, child started with fever of 103.7 degrees Y Fahrenheit on 4/11/09 and she gave him TylenolYand then temperature 4/7/2009 went 4/11/2009 to 104 degrees so d with severe arthus allergic Y reactionY and pulmonary distress. Treated with high and prolonged U dose of prednisone 3/30/2009 -4/10/2009 ongoing at present.5/4 ather reports elevated temp at home Y 4/23/2009, for which he did administer tylenol. States child Y woke up 4/23/2009 approximately 4/24/2009 5 am 04/24/2009 w eived the flu shot I developed severYnumbness on my extremities witihn 2-3 weeks. Y After thatNI developed severe ###weakness, 11/1/2007loss of motor p 04, not responding to infant Ibuprofen. Up to 1 1/2 days prior, child's personality was a bit off Y (fussy and4/14/2008 not eating 4/21/2008 as well), but no other h ely after receiving her second varivax in her L arm she began to have hives that would comeYand go. She4/25/2009 was given4/25/2009 2 tsp of diphenhydrami uth pain on right leg and itching the Y day after. Five days later gave shingles 4/22/2009 4/27/2009 at site starting at 4/23 increasing toYredness and swelling at the site on 4/24. Headache, diarrhea, U nausea, 4/23/2009 vomiting, 4/23/2009 anorexia beginning on d increased pain that evening and then had red stripe formed below injecttion site- still present U 2 days later. 4/20/2009 Lips became 4/20/2009 swollen for 2 day ne disease fibromyalgia,Yraynods, numbness, Y flushing/sweats, anxiety,headaches, Y exhaustion N to the point9/8/2008 where its12/1/2008 impossible to work, tot ort was received on 21 April 2009 byYanother manufacturer that received the report from a healthcare N professional 2/26/2009on 13 April 2009. A male ort received on 21 April 2009 from the Y patient's spouse. A male patient (demographics not provided), N who has autoimmune reactions to milk mptoms for two to three Yweeks. Numbness Y in feet Y - leg cramps - back 30 Ypain in spinal area - problem U walking (paralysis). ### Hospitalization ### - tes 9 pt came to my office - her VARICELLA vaccine site had a 3 inch circle that was red, hot, painful Y and hard. 4/18/2009 Call to 4/18/2009 mom, ice applied, BENE & swelling after inj. given & cont >4d after inj. while pt on AUGMENTIN for puncture injury 4/23/2009. Y 4/23/2009 4/23/2009 9 pt presented with classic herpes zoster outbreak (R) side torso (not crossing midline). U 10/6/2008 3/24/2009 anus shot in clinic on 4/21/09, seen in Y urgent care on 4/24/09, site of injection upper left arm,Uwarm, red, tender, 4/21/2009 reaction 4/22/2009 first noted by patie /2 hr after immunization given, pt noticed slight nausea. At 5:25 PM she became very nauseated U + vomited 3/26/2009 small amt. 3/26/2009 TPR 99 degrees F area with redness, warmth approximately 6cm X 4cm. No induration temperature 99.4 f (tympanic) U Rx: Apply 4/17/2009 cold compresses 4/19/2009 to site pm Ty called doctors office 4/16/09 @ 1424 Y and left message for doctors office that pt was in ER on Y 4/15/09 for 4/7/2009 seizure episode. 4/15/2009 Records receive -09-09 I started getting a 'burning - itchy' feeling on right (back) thigh - it was painful - itchy for Y about 9 days 3/13/2009 - (and red) 4/9/2009 it was now gone. Flu and PNEUMOVAX 3/24/09 one in each deltoid. Pain since - Limited range of motion, very Y painful. Referred 3/24/2009 to physical 3/24/2009 therapy - Given rent called, red puffy (R) leg - local imm. reaction - 1/15/09 Parent called, fever >101 on 1/14/09. Y Red bumps 1/5/2009 on face, 1/15/2009 neck, belly and arm injection erythema and pruiritis localized to site 1X2 L upper arm. Oral antihistamine and steroid Y cream prescribed 4/20/2009 after 4/21/2009 days with injection. swollen arm, hot tender Y 4/15/2009 4/15/2009 swelling of arm; Hot. 4/15/2009 4/15/2009 sh, few hives occurring after 15 minutes of MENACTRA Admom. Given 37.5 mg BENADRYL Y P.O. 5 minutes 4/16/2009 later c/o 4/16/2009 tight chest - given E d first GARDASIL injection 4/10/09. On 4/12/09, noted 1cm round tender axillary node. U 4/10/2009 4/12/2009 ankles, elbows, arms, and legs. C/o rash being itchy; 0 trouble breathing. U 3/30/2009 3/31/2009 loose stools, fever Tylenol. U 4/15/2009 4/15/2009 itching, Skin Inflammation topical Cortisone, Y Oral Prednisone Ultra violet light N 1/21/2008 ### 4 1/2 hours after patient got the vaccine Y she felt light headed + dizzy and then became unresponsive, Y eyes 4/17/2009 deviated4/17/2009 upwards, slight jerking utes after Pt received 2nd VARIVAX, she started to c/o of sore throat, PF; bilat. wheezing, no Y swelling of4/23/2009 lips; improved 4/23/2009 after Epinephrine 0 cella at VARIAX shot site 1 - 1/2" closed up vesicles on red base. Y 4/6/2009 4/18/2009 9 around 11:30 A.M. had vaccine within minutes felt light-headed and woozy, strong feeling Yabout 2 hrs,4/16/2009 then took 3hr 4/16/2009 nap and gone when omplained of itching at injection site within 5 mins. of administration. Red rash appeared at Y 10 mins Benadryl 4/22/2009 given4/22/2009 to member. vaccine 041409 fever low grade -> Y 101.8 from 041409 -> 042009. Anorexic, personality changes. U Fever4/14/2009 - no response 4/14/2009 to Tylenol or Motrin. eloped on back, abd, arms & leg. Redness Y & itching. 0 sob Symptoms began 4-21-09 p.m. Y 4/20/2009 4/21/2009 break along 2 T-11. Dermatome within 48hrs of receiving vaccine U 4/14/2009 4/15/2009 rted "dime" size swelling- redness at Y inj. site - "nickle" size swelling/redness itchy under injection Y site on 4/13/2009 4-14- Child4/14/2009 to ER R/T swelling/redn after vaccine administration, child felt sick, went to bed early. Awakened in AM with arm pain, swelling, redness 3/30/2009 increasing 3/31/2009 so much that cou vaccine on 4-21-2009. When awoke on 4/22 didn't notice rash. Got to school + noted rash> Y went to school 4/21/2009 nurse who 4/22/2009 stated she has' hives unable to bear weight on left leg). Per Y mom happened after given vaccine. N 4/8/2009 4/9/2009 7:50 PM Mother called to after hours triage and report states that Mom reported 'arm swollenYfrom shoulder 4/20/2009 to elbow, 4/21/2009 mild redness - no red pper arm: L red, warm, indurated. Slightly tender. Y 4/15/2009 4/15/2009 ollowing vaccinations, then labwork (Had vaccines, then labs, then syncope occurred - Nothing Y to eat today). 4/23/2009 4/23/2009 4 cm allergic skin reaction CLAITIN/ZARTAC U OSTAVAX vaccine 4/14/09. Pt developed Y painful case of shingles 4/27/09 requiring treatment U in the ER4/14/2009 (Valacyclovir, 4/27/2009 Vicodin) nd the area itchy, raised area from the Y base and warm to touch, she had Td 10 years ago butNno reaction. 4/17/2009 4/22/2009 hy. Knee pain. Fever. Rash. Y U 4/8/2009 4/12/2009 w hours - splotches noted on both hands Y - Inj given @ 5:15 pm 4/22/2008 1) Eye swollen 2) splotches Y - now 4/21/2009 hives on4/21/2009 chin / both ears/ rash
ved 4/20/09 - Pt states itching and feet swelling started next day - took BENADRYL - helped,Ubut is having 4/15/2009 itching and 4/16/2009 swelling in feet today tenderness & increased warmth at injection Y site. Y 1/19/2009 1/26/2009 n has been received from a consumer Y concerning a her daughter 21 year old with Y penicillin allergy N and no 6/17/2008 pertinent6/17/2008 medical history who in n has been received from a physician concerning Y a male patient who 0 was vaccinated, "within N the last few 4/18/2009 days", with 4/18/2009 ZOSTAVAX (Oka/Me ort received on 15 April 2009 from a pharmacist.Y A 42 year old female 1 patient, who has no known Y allergies,4/8/2009 a history4/11/2009 of hepatitis B infection, us case was received on 20 April 2009 Y from another manufacturer whose initial reporter wasUa consumer. A male patient (age not provided se effects. Received the Tdap vaccination and current age is 69 years. Y 4/27/2009 PED FEVER ON 4/23/09. TOTAL BODY Y RASH(MORBILIFORM) DEVELOPED ON OR ABOUT N 4/24/09.4/15/2009 4/23/2009 8 Client received both Pentacel (DTaP, IPV, HIB) and Pediarix (DTaP, IPV, Hep B) at the same U visit. 4/22/2009 4/22/2009 as very irritable and "not himself" for a duration of 3 days after administration of the second dose Y of Hep A 4/21/2009 vaccine. 4/21/2009 tient recieved four doses of Anthrax between the dates of 02-JUN-08 and 06-AUG-08. U 3/19/2009 3/19/2009 OT SLEEP AT ALL, JOINT PAIN, SWEATS, CHILLS, SWOLLEN ARM Y 4/27/2009 4/27/2009 profuse sweating, disoriented for 10 minutes Y 4/24/2009 4/24/2009 ours of Tdap and Varivax administration, Y patient experienced redness,itching,and swelling ofYLeft upper 4/24/2009 arm.Mom applied 4/24/2009 cool compresses minutes after IPV,Prevnar and Hep A given, child developed 3-4cm hive on right wrist and 2 Ysmaller hives 4/28/2009 on back and 4/28/2009 chest.Wheals noted ctivity taken by ambulance to hospital Y 18 hours after vaccine given. Patient has no previous U events of seizures### ever. 5/4/09 ### MR received fo HAD VACCINE ON 4/21/2009AM, CAME BACK ON 4/22/09PM AND WAS COMPLAINING U OF PAIN AROUND 4/21/2009 THE 4/22/2009 INJECTION SITE, LE ated on a chair in exam room one with mother and younger brother present. Patient given HPV, Y Tdap, and 4/20/2009 Menactra 4/20/2009 vaccines at 4 pm by R ### N ### ### s: hives, vasculitis, joint pain, swelling Y of feet, hands & eyes, extremity pain, fever up to 101. Ufor 3 days. Treatment: 4/15/2009 benadryl, 4/16/2009steroid pack, ped an egg shaped reddened, hot area on the upper back part of her right arm where she got Y her varicella 4/27/2009 shot yesterday. 4/28/2009 It was noted by VEN 4/22/09 IN AFTERNOON. LEFT Y UPPER ARMS SORE REST OF LAST WEEK. EMPLOYEE Y DESCRIBED 4/22/2009 A FIRM 4/27/2009 LUMP AT INJECTI oke out in hives all over her body, which was highly pruritic. Felt some throat swelling but not Y enough to 4/21/2009 constrict airway 4/21/2009 completely. This o ped hives after injection and was seen Y in the ems - f/u at pcp today 4/23/2009 eived the influenza, pneumococcal (PPV23), Tdap, MMR, Hepatitis A, Hepatitis B, and shingles U Vaccine 4/22/2009 at 10:10 a.m. 4/26/2009 at clinic. Client then d Tdap on 4-22-2009, IM in left deltoid swelling stated 3 days later. Redness from top of deltoid U to elbow4/22/2009 and area is4/25/2009 hard and warm to the ates arrived home @ about 11 am. YPt. began having reaction starting @ about 11:30 am. Began Y with swollen 4/24/2009 mouth, 4/24/2009 then right eye, then c C/O PAIN STARTING 8 HOURS AFTER Y SHOT WAS GIVEN. REDNESS ON ARMPIT AND LEFT DELTOID. 4/24/2009 4/24/2009 ived a 4th DTaP and IPV as well as a 5th Hep B when she was given a Pediarix vaccine 4/22/09 Y at less4/22/2009 than 12 mos 4/22/2009 old, 1 Pediarix not on ately 1 minute after receiving the vaccines the patient passed out without any warning - he had Y a mild tremor 4/28/2009 of the arms 4/28/2009 and legs that last tient was quite irritable and slept a lot, maybe for the first three days. The worst symptoms IUsuspect come 4/20/2009 from the4/20/2009 rotateq vaccine, since hange in feeding pattern and marked temporary loss/regression of social milestones approximately Y 1 week 7/20/2007 following7/27/2007 routine 2 month immun eloped bilateral buccal mucosa swelling Y 7 hours following MMR vaccine. swelling is non tender N and only 4/28/2009 from the inside. 4/28/2009 no visible external was reported by a lawyer and described the occurrence of arthralgia in a female subject of unspecified U age who was vaccinated with LYME was reported by a lawyer and described the occurrence Y of arthralgias 0 in a male subject of unspecified U age who was vaccinated with LYME was reported by a lawyer and described the occurrence Y of Guillain-Barre 0 Syndrome Y in an adult N male subject 12/1/1996 who was vaccinated with INFL eption reduced 5/04/09 Received vaccine & PCP Y medical records of1 4/13-4/27 as well as hospital Y d/c summary 4/13/2009 of 4/27-4/28/2009. 4/26/2009 FINAL Yellow fever immunization 3-18-09 prior to trip Y to a foreign country. 3 Developed flashing spells Y 3-29-09. Received 3/18/20093 L3/29/2009 IVF prior to departure. surfaces rash on elbows, knuckles, Y knees. SkinYbx: leukoclastic vasculitis 2 consistent with erythema Y elevatum 7/1/2008 diutinum. 7/26/2008 5/26/09 medical rec h screams for 3 days and for 10 days: Y lethargy (limp) Y - Non reactive - lack eye contact avoid communication Y 3/2/2009 - stopped3/2/2009 feeding - stopped lau Flu Vaccine on Oct. 10, 2008. 5 days Y later began fatigue which progressed to anaphylaxis, Y episode N 1 on October. ### Received ###corticoteroids. aricella #2 9/26/9 (1st dose was 5/03) within 24 hrs flat rash noted on chest, face & neck. Wo Y c/o rash to chest c/o itching on neck, face wit rm swelling red, tender, itchy after vaccines given 2 d ago- progressively worse 4/26/09 afterYpain but mostly 4/23/2009 itchy. 4/23/2009 L arm few small slightly oster type rash developing on R lower leg 6-7 days after vaccination examined today 4-27-09. N No other identifiable 4/13/2009 cause. 4/20/2009 th pain at the injection site 5 1/2 hrs after immunization, low grade fever 18 hrs after injection; Y 24 hrs after 4/24/2009 injection arm 4/24/2009 painful to touch, sw le of erythema on right side of (L) thigh. Y A bit of induration, but no underlying mass and no warmth." Y This4/21/2009 is MD's report. 4/22/2009 Also says "local rea of breath, tingling, sweating. Y 4/28/2009 4/28/2009 es, high fever. At night chills, sweating, sore joints. Symptoms continued until Friday. Sunday U slept late4/23/2009 still had sweating/chills. 4/23/2009 Right now 4/28/2009 nto office + reported vaccine site was red, raised + warm to touch. Presently abscent disappeared Y on its own. Zero intervention needed. s after getting vaccine, arm becameYred, swollen, and described itching at site of vaccine, pain Y to move. 4/24/2009 Applied ice4/24/2009 that evening. Mom stat
d to hospital 4/23/09 with reported edema - redness and tenderness of left deltoid. Treated with Y KEFLEX 4/20/2009 250 mg TidX7days. 4/23/20094/27/09 only s n at injection site beginning 4/13/09 in the evening. States she noticed inflammation, redness, Y and warmth 4/13/2009 at injection 4/13/2009 site on 4/15/09. Relie a of petechiea under right eye within 5 minutes of vaccine adm., approx 1/4" wide X 1/2" wide Y -was crying 4/22/2009 vigorously4/22/2009 prior and during vaccin shakes chills abdominal pain sore throat, headache started at 10 pm on 4/6/09. Y 4/6/2009 4/6/2009 orts rash to inner arms approx. 10 minutes after receiving vaccines on 04/09/09. Clients states Y she began4/9/2009 to experience 4/9/2009 pain in Rt shoulder ools, crying spells, abdominal pain crumps, Y decreased appetite, diarrhea. Per mom Y 2/24/2009 2/26/2009 loped rash behind ears, back of neck and on face then went to arms, torso and legs. Had running nose : raspy 4/6/2009 breathing. 4/19/2009 Saw on 4/23. ack into office. Per mother child had been crying since received vaccine. On examination swelling Y of the4/20/2009 upper R thigh 4/20/2009 warm to touch red a stered VARIVAX and DAPTACEL in (R) Thigh on 4/21/09. On 4/22/09 Pt developed quarter N size area of 4/21/2009 redness, swelling, 4/22/2009 with pruritus. Gi eneralized 2 days after immunizations Y Y 4/15/2009 4/17/2009 en instead of TDAP. Y 9/12/2008 of LA, tender, hot, itchy - 2nd patient with same reaction to same Immunization Y 4/21/2009 4/21/2009 er vaccine developed diarrhea, > 10 times per day initially, some mucus - straining noted, noYblood. No 2/25/2009 fever, no ill 2/28/2009 contacts. ness, itching & induration @ left thigh Y surrounding site of immunization within about 24 hrs. of U vaccines -4/20/2009 treated with 4/21/2009 BENADRYL 4/23/2009 er had bad stiffness on back of neck and then it went down both sides of torso. Called doctor U but said not 10/1/2008 related to vax. Pain on back sub t 8:45am patient was vaccinated at Y the Health Department with Hepatitis A vaccine at 8:47am Y patient fainted. 4/27/2009 Nurse4/27/2009 saw her unresponsive, 4/20/2009 rapid hair loss a month after administration of GARDASIL vaccine 8/1/2008 3/15/2009 eloped 2 days after shot - first on arm where shot was given then all over body. Headache today N - 4-28-09. 4/20/2009 4/22/2009 r HEP A with in 24 hr ATAVAX if needed. Y 4/8/2009 4/9/2009 ad at clinic c/o having reaction - redYrash noted on arms, legs, face - stomach and back approx U 2 min hard 4/28/2009 hot redness 4/28/2009 area noted at injecti dness, edema 3 d after vaccine. 4/21/2009 4/24/2009 Mom reports that client "walks strange, bobs head, hands shake, and coordination is off" afterNseries of hepatitis 7/1/2001 b vaccines 8/1/2001 in 2001-2002. swelling and pain at injection site. Tenderness and slight rash also noted. 4/14/2009 4/15/2009 vaccine on 4/13/09- symptoms began morning of 4/18/09, severe headache - 2 reddened areas N R shoulder; 4/13/2009 one just 4/18/2009 above acromion proce ction at injection site right thigh - warm, red & swollen Rx'd with MOTRIN & warm packs. resolving U 4/23/09 4/21/2009 4/22/2009 esented to clinic on 4/24/09 c/o right arm pain extending to neck and fever. Upon examination, U right arm 4/22/2009 edema from 4/24/2009 shoulder to elbow. Rig hoarse and hives - She lost her voice I was very scare so I took her to her doctor. Y 4/7/2009 unk and back that started about 4 days Y post smallpox VX. U 4/10/2009 4/16/2009 VAX administered right deltoid 4/21/09 after leaving office, pt started to develop pain in rightYupper arm. 4/21/2009 During rest4/21/2009 of day and night, pain i ped hives right after vaccinations and for 1 week has raspy voice - increased vomiting, crankiness Y and episodic 4/15/2009 hives. 4/15/2009 Was treated with 3 d hours, developed fever - 101.8 degree - Aching joints, headache. Treated with Ibuprofen. Duration Y - 12 hours. 4/17/2009 4/18/2009 er, with bulging fontanelle and CT scan Y with prominence of anterior CSF Spans over both frontal Y and temporal 4/6/2009 lobes 4/7/2009 - No hydrocephalic. Th d rash appox. 1 1/2 " X 1 1/2. Very itchy. Pt. observed for one hour post 25mg po Benadryl. Y 4/14/2009 4/15/2009 tous area surrounding injection site 5x5 cm diameter with mild tenderness to palpation no fluctuance. U Will try for possible infection. AUGME e pale after the vaccination, lost consciousness Y for 3 minutes - appeared to have a seizure vital Y signs stable. 4/18/2009 Paramedics 4/18/2009 came and pt. refu ceived BIOTHRAX in 2000. Over the last year his ankles, wrists and knees became inflamed. N He was diagnosed 6/3/2000with4/4/2008 autoimmune hepatiti n has been received from a health care Y professional Y concerning an 311 year old female patient Y who on an12/1/2008 unspecified 12/1/2008 date was vaccinated n has been received from a consumer concerning her now 5 year old son with OMNICEF allergy N and a history 10/1/2004 of bronchiolitis 10/1/2005 at 5 weeks of n has been received from a female Y patient, with iodine allergy and "severe food allergies", who Y on approximately 5/9/197709-MAY-1977, 5/9/1977 at the age n has been received from a consumer concerning her friends' boys who on an unspecified dates U were vaccinated with MMRII. "One week l t was received from a health care professional Yon 16 April 2009, and 1 refers to a serious adverse Y event experienced 11/3/2008 12/1/2008 by a subject participatin ort was received 28 January 2009 from Y a consumer, who is also the patient. A 59-year-old female N patient with 5/1/2007 history 7/1/2007 of a recent black wido ering entire body, swelling of joints, Y benadryl, oral steroids Y 3/9/2009 3/9/2009 min. post injection patient had mood change, redness, swelling at injection site along with legYpain. We watched 4/27/2009 patient 4/27/2009 for a while and then eived Tdap without any symptoms of concern. Then, immediately after HPV vaccine was given, Y the client4/29/2009 complained 4/29/2009 that her arm hurt. She o Tdap, muscle aches, headaches, fatigue. Worst was injection site allergic reaction to pertussus U vaccine. 4/24/2009 Arm was 4/25/2009 very red, swollen, ver a around the Shingles vaccine U 4/27/2009 4/29/2009 eports beginning to feel nauseous 6 hours after receiving vaccine. 18- 24 hours post vaccination Y member4/27/2009 reports nausea 4/27/2009 and 2 incidents of VER WITH NORMAL CBC,PARENT REPORTED 106 DEGREE FEVER THE NIGHT VACCINE Y WERE GIVEN 4/28/2009 4/28/2009
d MMR and Varicella vaccines and immedicately developed redness and swelling at both injection Y sites 4/17/2009 and hives on 4/17/2009 abdomen. No respira oid- 2 days sfter vaccine administration, the injection site is hard, red, warm to touch and tender upon palpation. 4/27/2009 4/28/2009 oster C34 dermatoma Greater than 20 vesicles U 4/1/2009 4/29/2009 igns begin with a pain in my right arm Y three-four Y days after my vaccine. 6 I was not able to raise N it above my head. ### The 11/2/2008 pain moved to my sh RASH THATS GETTING WORSE AND SPREADING U 2/15/2008 4/24/2009 njection in deltoid. developed over next 24 hours swelling, erythema, pain, and fever and general Y mailaise. 4/17/2009 this lasted 4/18/2009 for three days. m injection site a 15x15cm soft nodule appear while appling pressure to syringe with some resistence noted. 4/29/2009 Soft nodule 4/29/2009 with reddnes and n , facial swelling- in pts temples U 4/28/2009 4/29/2009 4/24/2009 N 4/21/2009 4/23/2009 le subject was enrolled in non-GSK study. Medical Y conditions at the0time of the event included U seizure disorder. 8/28/2003 Concomitant 8/29/2003medications i tient consult has been requested onYa 20 y/o WM Y ADSM hospitalized for severe thrombocytopenia U and ITP 4/16/2009 in association 4/23/2009 with the receipt o . Baby presented the day after receiving his immunizations Y with fever, 2 vomiting and diarrhea.Y Baby had been 4/21/2009 having4/22/2009 watery stools 2 to his patient came for a well child Y check, Y immunizations Y given at 9:30AM 3at around 1:30PM patient U woke up from 4/27/2009 sleep cried 4/27/2009 and turned limp, ca usea, HA, sore throat, rhinorrhea, + Ycough. Sx started hours after typhoid vaccine given. Given Y Augmentin 4/17/2009 875mg 4/17/2009 BID x 10d. ction on R upper arm (injection site) with erythema, warmth and mild tenderness. Keflex 500Ymg PO BID4/28/2009 x 7 days BENADRYL 4/29/2009 25 ml after 6 arm was sore for 3 days. Then in a week Y she started having spasms in her arm that continueNto happen at 10/8/2008 night still.10/9/2008 Has gotten a steroid s dministered on 4/23/09. Immediate Y bruising noted 1/2 dollar size. Bruising dissipated over weekend Y but Pt 4/23/2009 developed 4/23/2009 site of erythema, rais udent in nurses office or immunization clinic. Rec'd 5 vaccines - after several min of sitting looking Y @ stickers 4/29/2009 leaned4/29/2009 to (L) an fell out of cha U 4/27/2009 4/28/2009 3-4 lesions with cellulitic area on (L) Y thigh. Topical warm compress and PO Augmentin. Y 4/20/2009 4/28/2009 hematous rash under the skin on the anterior aspect of both lower legs, vaccine site normal. YRash was noticed 4/28/2009 right4/28/2009 after vaccination. Obse wollen and red about 10 cm X 6 cm Y within 1-2 hours after getting vaccine - given oral steroidsU and Antihistamine. 4/28/2009 4/28/2009 ADACEL on 4/16/09 and by 4/18/09 the right arm became entirely swollen and the injection Y site became4/16/2009 indurated, 4/18/2009 reddened, painful and s out in hives face to legs 1 1/2 hour after receiving MMR II vaccine. Parent went to daycare, did Y confirm hives 7/21/2008 with moderate 7/21/2008 wheezing. BEN iven 10:15 A and by 12:00 MN 102 Y deg and 4:00 increased 103.7 vomiting and fever. Seen Y by Dr later in4/20/2009 day 2 pm 4/20/2009 c/o pain (R) shoulder, r meter redness, and warm to touch area Y surrounding shot site. U 4/23/2009 4/24/2009 ed the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a big, red,Uand swollen4/3/2009 area on her4/3/2009 upper arm. She repo received the roto vaccine - by mouth - along with her other 2 month vaccinations - injections-. U She had blood in her4/22/2009 stool and extreme disc er DTAP, arm red & swollen & warmYdeltoid area. No fever. U 4/27/2009 4/28/2009 n has been received from Y a certifiedYmedical assistant concerning a 71 year old male Y who on Y 01-JUL-2008 7/1/2008 was vaccinated 7/7/2008 with PNEUMOV n regarding PREVNAR was received from a healthcare Y professional0regarding a 2-month-oldY female patient 4/27/2009 who experienced 4/27/2009 apneic episo was received from a health professional Y on 07 November 2008, and represents a cluster of Y 20 patients. Twenty ### patients, ### all employees of n has been received from a licensed Y visiting nurse, for the GARDASIL a Pregnancy RegistryYconcerning3/20/2009 a 23 year old 3/20/2009 female with hypothy n has been received from a nurse concerning Y a 36 month old male who on 07-MAR-2006 was N vaccinated4/4/2007 with a first 4/4/2007 dose of PEDVAXHIB n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y27 year old 7/22/2008 female with7/22/2008 cephalexin allergy and stered to patient. Less than 3 minutes Y later patient was leaving clinic and collapsed to floor. Y He did not have 4/29/2009 any trauma. 4/29/2009 He was cold and s udent mistook Menactra as the diluent for the varicella and injected it subcutaneously. No problems Y with4/29/2009 patient therefor 4/29/2009 no treatment need veloped maculopapular rash over entire Y body 14 days after vaccine administration. Patient seen Y 4/18 for 4/1/2009 this rash (by 4/14/2009 MD), and unclear if v ills, Bodyaches, Nausea, Vomitting,Yand local site reaction (redness, tenderness) U 4/27/2009 4/28/2009 9 PATIENT WAS ADMINISTERED THE SMALLPOX VACCINE AS A REQUIRED PROPHYLACTIC Y BEFORE 4/3/2009 DEPLOYMENT 4/20/2009 WITH HIS U ential swelling and redness to right upper Y arm/deltoid, especially near area of vaccine administration, Y +pruritis, 4/28/2009 w/in 4/28/2009 the first 24hrs of vaccine esented to the ER with R arm swelling Y with redness and puritus. Y 4/28/2009 4/28/2009 e severe pain in left arm, 'as though someone just broke it'; headache developed; 24 hours ofNjoint and muscle 2/23/2009 pain;2/23/2009 within weeks, sharp sta WAS GIVEN ALL THREE VACCINES HEP A#1 (RIGHT ARM), MCV4 AND HPV#1 (LEFT ARM) Y IN THAT 4/29/2009 ORDER,4/29/2009 WHEN I WAS APPLYI arm to the touch and red Y 4/27/2009 4/28/2009 aricella rash began 04/28/2009 treating with Y 4/7/2009 4/28/2009 lled me the day after the administration complaining of Headache, Fever, Chills, Loss of apetite. U I explained that she was experiencing a ra .3F and chills and Severe headache Y began at 2:30am. Pt came to health unit at 0830. Pt given Y Tylenol 650mg 4/28/2009 and 4/30/2009 slept. At 11:30 pt report ed today, stating she had just noticed a rash around the site of injection, also c/o itching fromUrash. NO fever 4/23/2009 or other 4/30/2009 symptoms. as seen by this physician three days after administration of Menactra. He was complaining ofU back pain,3/24/2009 shoulder pain, 3/24/2009 headache, lighthea ening, fussiness, constant crying, poor Y appetite, vomiting, skin rash (head, face, neck, ears, Ybehind ears,4/14/2009 abdomen,4/17/2009 back, legs, arms, feet),
4/27/2009 N 4/24/2009 4/27/2009 wn with Evans SyndromeY3/15/09. Seen Y for irritability Y 3/7/09. 5/4/09 19Received Y hospital medical U records of 3/4/2009 multiple admits. 3/15/2009 FINAL DX: throm d neck right arm pain immediately after Y head/neck trauma in Mar 2003; received AVA#4 Y oneNmonth later4/26/2003 with continued neck pain, intermitt veloped severe systemic rash, elevated Y temperature, continuous crying, inabilityYto sleep. ANmonth later patient### stopped smiling, ### and devel h stomach pains, rash on the top and Y bottom ofYboth feet. Stomach14pains were intermittent then Y became2/28/2008 constant. 13/10/2008 year later 2/09 diagno + swelling, heat @ site of injection erythema 130mm X 70 mm - slightly indurated. Y 4/29/2009 4/30/2009 ived above listed vaccines 11-20-08Y at routine WCC visit at 12 noon. Child developed tactileYtemp 11-21-08 around ### 1pm followed ### by pruritu mplained of headache, ringing in ears, + occasion blurred vision. Given a Medrol Dose pack.U 4/22/2009 4/22/2009 warmth to injection site - 4/28/09 @ 8 AM followed with itching, increased heat/swelling on same morning. 4/27/2009 By 9 PM4/28/2009 on 4/28/09, she had a l ports patient complaining of severe headache and (L) arm pain at school today (11 AM) -Become Y unruly 4/27/2009 and "violent" 4/28/2009 with staff at school. T d 12 month vaccinations on 4/18/09. Y She had zero reaction at first, but 1 week after shots pt. Y began having 4/8/2009 a fever.4/20/2009 This lasted 4 days off Hrs of vaccine, pt noted extreme tenderness, and swelling of upper arm. Sx worsened over next N 48 Hrs. 4/27/2009 4/27/2009 x 15 min & c/o HR. No sensitivity to light/sound, dizziness, lightheaded. Pt instructed to take U Tylenol & call 4/23/2009 if symptoms 4/23/2009 persist/worsen. d swollen with erythema over large area. (4" x 3") Y 4/28/2009 4/29/2009 er arm with redness, swelling & warm Y to touch qcm in size Dx with cellulitis. Y 4/21/2009 4/22/2009 wollen, hot, reddened (size of a softYball) hard lump - VARIVAX. Right arm same but the sizeNof an apple4/22/2009 - MENACTRA. 4/23/2009 face and back. Y 1/12/2009 4/25/2009 erythema & swelling extending 3 cmY inferior to lower shot & 1/2 cm above upper injection site Y - supportive 4/16/2009 care ZYRTEC 4/18/2009 1/2 tsp daily prn e slightly lightheaded immediately after receiving GARDASIL #3. She layed down but continued Y talking 4/17/2009 & said she 4/17/2009 felt fine. She walked ou eloped chicken pox disease - in clinic 4-24-09. U 10/2/2008 er injection: lip swelling, nausea, redYinjection site. 48 hrs after injection: larger area of redness Y with central 4/13/2009 bullous lesions. 4/15/2009 Treated for 1 1/2 es 2 days after vaccines patient's eyes Y rolled back in her head, she stiffened out and was "slobbering". Y Denies 4/1/2009 increased 4/3/2009 temperature. Calle miting + diarrhea 48 hours after vaccines Y given. Went on to develop URI sx's - v/d were <24Uhours. 4/22/2009 4/24/2009 use my arm/shoulder, extreme pain & tightness. Unable to work due to some of the requirements N of my3/18/2009 job. I had 3/18/2009 X-rays taken & have be s, odynophalgia, nausea, vomiting, decrease appetite, dizziness. Y 4/20/2009 4/20/2009 immunization site reaction 4cm X 6cm Y erythematous area on upper right arm. Warm, clearlyYdemarcated2/25/2009 area, tender 2/27/2009 to touch, no streakin pain, local reaction seen in office 2/25/09 T97.7 P75 R16 Erythema at injection site rest of exam U normal,2/18/2009 BP 124 / 76 2/18/2009 Wt 215 lbs, 4/7/09 sti was reported by a pharmacist and described the occurrence of injection site pain in a subject U of unspecified age and gender who was vacc was reported by a healthcare professional Y and described the occurrence of wrong route of administration N 1/7/2009 in a 19-year-old 1/7/2009 male subject wh was reported by a healthcare professional Y and described the occurrence of wrong route of administration N 1/7/2009 in a 19-year-old 1/7/2009 male subject wh was reported by a consumer and described Y the occurrence of watery eyes in a 58-year-old male N subject who was ### vaccinated ### with (FLULAV reported by a healthcare professional via a sales representative and described the occurrence U of injection site reaction in a subject of unsp was reported by a consumer and described Y the occurrence of itchy rash in a 75-year-old male N subject who 11/5/2008 was vaccinated 11/7/2008 with (FLULAVA : SM contacted VHC reporting receipt Y AVA #2 on 4/8/2009 (lot# unknown). The next day he U had numbness 4/8/2009 to right 4th/5th 4/9/2009 digits. 4/10/09 th ter was given all three doses Y of Gardasil Y on 8/28/08, Y then on 11/1/08, 3 and the last on 3/7/09.NOn April 11,3/7/2009 2009 my daughter 4/11/2009suffered with t BALL SIZE NODE IN ARMPIT OF SAME ARE ARM AS INJECTION SITE. MADE SLEEPINGUDIFFICULT4/20/2009 AND ARE4/30/2009 MOVEMENT PAINFUL 00.7F, body aches, HA, sore throat, fatigue, dizziness, sore arm Y 4/27/2009 4/28/2009 indegestion, lack of appetite, weightloss, Y dizziness, abdominal pain, fever, fainting, listlessness Y and nausea. 1/7/2009 This lasted 1/8/2009 from date of vacci erythema Left shoulder and axillaryYarea. Lymphadenopathy. Y 4/17/2009 4/27/2009 r chest, back, and arms. ITCHING,YNO DRAINAGE. Y 4/17/2009 4/27/2009 ports client with elevated temperature Y (average 101) following vaccinations,also reports moderate Y cough.4/24/2009 Temperature 4/24/2009 continued elevated ardened red area mid clavicular, leftYside, pea-sized. Vaccinatiion site, left deltoid, erythematous.Keflex Y 500 4/18/2009 mg 1 tab 4/18/2009 4Xday X10 dys mom stated symptoms of redness and Y swelling at injection site on left upper arm developed on Y 4/28/09 in4/27/2009 the evening. 4/28/2009 Arm felt hot to the to dministered on 04/28/2009. Within 24 hours swelling, fever at injection site, tenderness,and N increasing redness 4/28/2009 appeared. 4/28/2009 Within 48 hours stated sylmptoms of redness and swelling @ injection site of left deltoid on 4/29/09 in the morning. Y Arm4/27/2009 felt hot to the 4/29/2009 touch Dr. Knox at No hrs after DTaP pt had fever with seizure. Y He had had a febrile seizure the night before with diagnosis of4/29/2009 ear infection. 4/29/2009 nd Pain at injection site, increasing Y in size. Cramping in stomach with meals. Cellulitis LeftYArm. Keflex 4/18/2009 EQ 250mg 4/30/2009 4 times daily X10 day SEIZURE ON 28APRIL2009, MOTHER Y OF PATIENT CALLED 911 AND WAS TAKEN TO THE Y ER BY 4/20/2009 AMBULANCE 4/28/2009 Erythema Multiforme on back associated Y with puritis and uncomfortable. No respiratory distress. Y Epinphrine 4/16/2009 0.3mg4/30/2009 IM, Benadryl 50mg IM area at site of each injection. N 4/23/2009 4/24/2009 MATELY 3-5 MINUTES AFTER RECEIVING THE VACCINE THE PATIENT SUDDENLY PASSED Y OUT4/27/2009 - SHE HAD 4/27/2009 NO WARNING - SHE
after administration of MMR client noticed reddness the size of 50 cent coin. The following day Y (5/1/09) swelling 4/24/2009 had 4/30/2009 increased to 50mm in s Left legs had cellulitis, redness. DidYrequire IV Yantibiotics for 4 days.1 5/22/09 Received hospital Y medical4/27/2009 records of 4/28/2009 4/29-4/30/2009. FINAL N he day after receiving the vaccine) Y the patient returned to the provider's office with-3 spots ofU maculopapular 4/28/2009 rash on 4/29/2009 9, Pt came in for #2 GARDASIL. Pt had no adverse reaction to #1 dose. Pt had a vasovagalYepisode immediately 4/24/2009after 4/24/2009 vaccine given. Pt ha hours after admin of vaccines began Y vomiting Q 30 min- was taken to ED- called night clinic X2. 4/29/2009 4/29/2009 ea on right deltoid of erythema and induration, noted about 24-36 hours after vaccine. Ice applied. Y 4/29/2009 4/30/2009 ke a size of a baseball hot and red. Y 1/14/2009 1/15/2009 eaded with tunnel vision (compared to distorted vision experienced with ocular migraine headaches Y experienced). 5/1/2009Bp5/1/2009 156/90, pulse and res area red and swollen about half of back arm, hot to touch, hurts to touch and itching. Y 4/29/2009 4/29/2009 on (MD): Pt had dried like zoster rash Y to forehead X 3 days with mild fever only. Now has vesicular (urticaria) 4/16/2009 rash with 4/26/2009 sciatica without feve thy 4 mo. old admitted toY ER statusYepilepticusYand intubated upon 7 arrival. During hosp. hadYposs. aspiration 3/23/2009 pneumonia 4/13/2009 (+) culture Moroxe area right upper arm warm, pink sl. firm. Symptoms decrease today with papular at injectionYsite. No anaphylaxis 4/25/2009sx4/26/2009 - no encephalopathy s m Erythemic warm rash on Lt thigh. Mom putting salve on it. That is helping. Pt mom statesNgot whole body 4/24/2009 rash @ 2 months with vacc. open cut. used rubbing alcohol to clean at home. Has clear liquid at injection site after couple Y of days, then 12/2/2008 it scabbed 12/2/2008 over and got better. welling and redness of whole right upper arm for 3 weeks. Hives and welts everyday for several U months, stomach ### shut down for about 3 we Y Y 4/10/2009 Y U 4/29/2009 4/30/2009 ported severe injection site soreness. Y N 3/12/2009 3/12/2009 rm redness with swelling slight induration 10cm X 8cm. Y 4/22/2009 as given Pediarix vac. but was supposed to get a DTAP vac. 4/27/2009 d region w/ 7x7 cm round, well circumscribed Y erythema. Are defined by rash is tender & indurated. Y Dx cellulitis 3/6/2009 + abscess 3/6/2009 Keflex 500 mg o in a rash that evening. Rash is on the face, neck, both arms legs and abdomen. No temperature. Patient4/24/2009 stated her4/24/2009 Band Aid at home she neralized weakness + malaise. Y 4/20/2009 4/20/2009 vaccine was administered first. Then PENTACEL (IPV-DTAP-HIB) was administered IM in the U right thigh, 4/30/2009 then PCV75/1/2009 administered IM left ocalized redness + swelling, hot to touch, no pain or tenderness. Complaints of itchiness. No Y fever, patient 4/14/2009 took Benadryl 4/18/2009 for allergic reacti action - hives - severe wheezing, breathing, Y throat. U 4/28/2009 4/28/2009 as given HEP & DTAP vaccine in the (L) arm on 4/28/09, 1 day later was noted to have swelling, Y redness4/28/2009 itching on the (L) deltoid area, les ven MMR vaccine instead of MENACTRA. Y 4/27/2009 EP B & MMR given in (L) upper arm. Arm swollen with hive - like rash from elbow to deltoid on U 2/3 of arm4/27/2009 circumference. 4/28/2009 Cold compresses was given MMR & VAR pt started crying. Y When pt was given HEP A. pt started crying and gasping Y for air. 3/23/2009 Pt also sweating. 3/23/2009 multiforme - minor. U 4/17/2009 4/25/2009 r VARICELLA was given on 4-16-09 Pt developed a red swollen area located where vaccineYwas given. 4/16/2009 4/25/2009 s swollen, puffy and red with peelingYof skin and crusting. Y 4/27/2009 4/28/2009 lesion trunk with scabbing and diagnosis of herpes zoster. Y 8/30/2007 4/18/2009 ped a local rxn one day after vaccine DTAP was administered. Also papular lesion developedY on chest area. 4/29/2009 4/30/2009 hours, pain, swelling at injection site. Low grade temperature 99 degree to 100 degree. Myalgias, U malaise. 8/27/2008 At 48 hours 8/29/2008 with squamous eryth called stating child complains of seeing snakes. Anxiety and hallucinations. U 4/30/2009 5/1/2009 rs, ipsilateral axillary pain, fullness. Low grade (unmeasured) fever. Local tenderness, swelling Y at the injection 4/20/2009 site. 4/22/2009 was reported by a consumer, the subject's Y mother, and described the occurrence of swellingNin a 5-year-old 3/31/2009 male subject 3/31/2009 who was vaccina was reported by a healthcare professional Y and described the occurrence of injection site redness N in a 5-year-old 4/9/2009female 4/9/2009 subject who was v was reported by a healthcare professional Y and described the occurrence of erythema i a 4-year-old N female 4/10/2009 subject 4/12/2009 who was vaccinated wit was reported by a healthcare professional Y and described the occurrence of injection site redness U in a 4-year-old 4/13/2009male 4/15/2009 subject who was vac was reported by a physician via a GSK representative and described the occurrence of red N spot at injection 4/16/2009 site in a4/16/2009 4-year-old female sub was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci vaccination 10/30/07; returned to doctor Y with pain Y in left shoulder (same 3 as vaccinated Y arm) Nwithin two months;### began 1/2/2008 experiencing pain, n he, lethartic onset 48 hours after vaccination with guardisil Y 4/24/2009 4/26/2009 er, very tired and rash (skin raised, hot, not itchy, red) on upper left leg appeared. Shot put U in back of left 4/21/2009 arm. 4/27/2009 e rash all over legs and arms appeared 2 days following injection. Rash lasted 8 days and continued Y to leave 4/17/2009 darkened 4/19/2009 spots for over 2 ad
numb for approximately 30 minutes after receiving Anthrax vaccine, event has happened forYthe past 2 doses 4/30/2009 4/30/2009 mptoms, shaking, "bobblehead" mannerisms, Y "dizzy appearing" per parents starting 3 days after U vaccinations. 4/22/2009 Self-resolved 4/25/2009 by 6 days, but LITTLE OVER 24 HOURS. FIRST SIGNS, SEVERE SORE THROAT, NECK PAIN, ARM PAIN, U STOMACH 4/20/2009 PAIN,4/22/2009 A PINK EYE TYPE INF ide of cheeks. Y Y 4/28/2009 4/28/2009 rned to office - stated "my son passed out" - Found seat belted into passenger seat - eye opened Y responded 5/2/2009 by name. 5/2/2009 Asked what happen a tetanus shot for an infection, and received the tdap. I experienced a sort coughing spell within Y 10 hours, 4/30/2009 mild cold 4/30/2009 symptoms the next mor njection 5/1/09 yellow fever vaccine.Y Noted arthralgias, myalgias, swollen hands and fingersUand bilateral5/1/2009 lower leg red 5/2/2009 rash. Specific manu ustular rash extending from L shoulder Y near vaccination site, across back and upper chest, few U lesions on4/22/2009 thighs 5/28/09 5/2/2009 ED records receiv Vision,Blood restal,soryasis Y 6/8/09 Received medical records from 7/20/2006-6/4/2009. Records N reveal patient 4/23/2003 experienced: 6/20/2006exacerbation o n has been received from a TV news Y report and the patient's father concerning his 16 year old Y daughter who 3/1/2008 in March 3/1/2008 2008, was vaccinate n has been received from a consumer concerning her son, an 11 year old male who was born N prematurely and was diagnosed with cerebra n has been received from an 83 year Y old male with no pertinent medical history or no allergyYwho on 31-MAR-2009 3/31/2009 was 4/3/2009 vaccinated with ZO n has been received from a registered Y nurse concerning a 25 year old female with no medical N history or 3/13/2009 drug allergy3/24/2009 who on 13-MAR-2009 n has been received from a registered nurse, for the GARDASIL, concerning a 17 year old female Y patient 3/19/2009 with a history 3/19/2009 of pelvic inflammat us case was received on 21 April 2009 from a health Y care professional. 3 A 29 year old femaleYpatient received 1/26/2009 YF VAX 1/27/2009 (lot number UF428A ort received on 24 April 2009 from aYhealth care professional. A 35-year-old female patient, who U had a concurrent 4/20/2009urinary 4/20/2009 tract infection, had us case was received on 27 April 2009 Y from a health care professional. A female patient (age N not specified) 4/24/2009 with a history 4/24/2009 of high blood pre ated at approx. 0830 4/22/09. Mother Y reports that Y pt. had increased temp 2 starting at 1200 4/22/09. N Mother 4/22/2009 reports to4/22/2009 clinic 4/22/09 with child ven SQ left arm of VARICELLA vaccine #2. Soon after applying band aid pt complained of itching. Y I talked 4/10/2009 to M.D. and 4/10/2009 he ordered 50mg IM ter shot, fever, headaches, chills, body aches, nausea symptoms resolved completely- 4 pmY4/28/09 4/27/2009 4/27/2009 heet - mom reports infant spit up milk Y and some "white" stuff and declared it had to be due toYthe liquid medicine 2/20/2009 we2/21/2009 gave. Had 2 mos shots as given initial dose of ROTARIX @ 28 weeks. Then follow up dose 4 weeks later was given. Y However ROTATEQ 3/24/2009 was given at that point. nal chest tightness without wheezing - within 5 min of HAVRIX (Hepatitis A) & POLIO (IePV)Yvaccine Resolved 4/23/2009 in 204/23/2009 min after liquid BENAD darkened raised area on Pt's left upper arm over deltoid muscle that measures 8 MM X 5 MM. N Pt. C/o dull 5/13/2008 pain when 5/13/2008 spot is touched. Also ived 2 vaccines, MENACTRA and GARDASIL # #3, in opposite deltoids. Within 5 seconds after Y receiving 4/17/2009 the 2nd shot 4/17/2009 child had a seizure er vaccine was administered site was red and "bumpy". Y 4/23/2009 4/23/2009 llowing vaccine, swelling distal to vaccination site - specifically dorsum of hand & wrist (left arm Y only); pain 4/21/2009 and reddish 4/23/2009 (blanching) discolor ost vaccine rash "mini measles" all over Y trunk. Not ill. Y 4/13/2009 4/24/2009 3, start at 9pm & vomited x2. Y 4/27/2009 4/28/2009 d screaming/crying. Y 2/24/2009 2/24/2009 hours of shot fever,paleness, weakness, dizziness,tight chest, hard to breath.Patient remains N sick still after 4/28/2009 6 days with 4/29/2009 contiued fever, dizz nd swelling, painful at site of injection, approx 4 inches in diameter Y 4/28/2009 4/30/2009 pain and swelling at injection site Y 4/20/2009 4/23/2009 ports extreme pain at site of injection Y which began immediately and continues x 11 days. NoUfever, no local 4/23/2009 redness, 4/23/2009 swelling or induration er receiving the for about 4 weeks after the shot I experienced deep aching of my muscle and Y arm and couldnt 2/13/2009 move 2/15/2009 my arm without pain. nd pain at site of injection and medial arm. Redness approx 5-6 inches medial to injection site. Y 4/14/2009 4/20/2009 ceived Zostavax Vaccine on 4-29-09Y and had been warned about the localized red itchy weltUthat could occur 4/29/2009 at the injection 5/2/2009sight and it did the MMR vaccine on 4-20-09. I amYexclusivelyYbreastfeeding a 14 3 week old infant. On 4-29-09 Y she developed 4/20/2009 a fever 4/29/2009 of unknown origin. red yellow fever vaccination to rt deltoid. Y 20 minutes after vaccination, pt. left clinic and reportedly U walked 5/1/2009 to another 5/1/2009 building to complete th 2 HOURS: SEVERE DROWSINESS; Y 24 HOURS: Y VERTIGO, DIZZINESS; 2 36 HOURS: NUMBNESS N &4/30/2009 TINGLING LEFT 5/1/2009 ARM, SHORTNE ted thigh swelling at injection site two days after immunization. Patient was seen in office and Y examined: 4/22/2009 left thigh with 4/24/2009 10x6 cm indurated, ablity and rash about 9 days after the well visit on 04/14/09. Patient seen in office on 04/24/09 Y for rash-4/14/2009 five petechial 4/23/2009 on neck and chest. minutes post injection patient developed redness, swelling, 30 mm in size4 with warmth andYhardness at 5/4/2009 the injection5/4/2009 site. Dr. notified, and on was received on 4/28/2009 in LeftY Arm. Client was brought back in the HD on 05/01 with Y very red swollen 4/28/2009 LA, with 4/29/2009 a temperature of 100 , projectile vomiting, lethargic, dehydration, stopped Y breathing while4sleeping - we were ableYto resuscitate 5/27/2003 him, lips turned 6/1/2003 blue, eaction to right deltoid after Tdap administered Y "started two days after the shot was given." (Hep U B immunization 4/21/2009 was 4/23/2009 administered to patien 00-102 within 24 hours. Muscle spasms Y x5 days now. 4 inch area of swelling around injection U site. Pustule 5/1/2009 at injection 5/1/2009 site. Soreness limi scribed onset of large 'orange sized' hot lump in the area of administration, onset was approx Y 72 hours after 4/29/2009 admin. 5/2/2009 patient stated lump wa d regular vaccines at two months and began spitting up blood for the following 24 hours. AtY4 months we 4/30/2009 administered 4/30/2009 only one vacc/week awoke with severe pain and weakness in Right deltoid. Significant Pain and weakness continued N for 2-3 days.### Then the pain ### decresed to m cellulitis developed at immunizationYsite 2 days after immunization given. Pt initially treated with U Keflex and 5/1/2009 Bactrim but 5/3/2009 cellulitis worsened
9 patient started to develop red rash in which progressively increased in numbers and intensity. Y Rash was 4/16/2009 coalescent. 4/26/2009 Patient seen on 04 king across the leg from the site of Y injection, as well as a swollen, firm leg. She was given injections U today 5/4/2009 with Pentacel, 5/4/2009 HepB, and Prevn after injection - mom noted swelling tenderness and erythema - 36 hours after he has swelling 1.5 inches lareger 5/1/2009 on that 5/2/2009 arm with tendernes N 4/29/2009 sle like red, raised bumps all over body. Y Y 4/8/2009 4/20/2009 RSE EVENTS, SYMPTOMS, OR TREATMENT Y 4/2/2009 TIS LEFT LEG DIAGNOSED IN ER Y MAY 3, 2009. CELLULITIS BEING TREATED WITH SEPTRA ORAL 5/1/2009 ANTIBIOTIC. 5/1/2009 er administration of rotateq child developed fever to 102, and a few episodes of loose stool and Y vomiting-4/27/2009 report being 4/29/2009 filed at mom's reque honed clinic and left a message on 5-04-09. Y Her call was returned and the following information Y was received. 5/2/2009 29 hours 5/3/2009 after immunizations n R hand started 12-24 hours after injections. Y Dizziness - resolved.5/18/09 records received-office N visit 12/28/08 5/1/2009 C/O 5/2/2009 swollen glands, lethar out with 9 blisters on 5-3-09 Mom states looks like chickenpox. Blisters on back and neck. 4/27/2009 5/3/2009 ven 2nd dose of Hep B series at 2:00pm Y 4-13-09 - At 5:00pm noticed a rash around belt line Y - progressed4/13/2009 to entire body 4/13/2009 - He had also recei cellulitis at administration site - Started on OMNICEF. U 4/29/2009 4/30/2009 syncopal episode after taking 2 steps when she got off the exam table - 11 feet and hit headYagainst door frame. BP was low and remained ped shingles 7 days after ZOSTAVAX injection. N 3/25/2009 4/2/2009 ed from stating pt seems to be in severe Y pain; severe hard crying off and on since vaccines received today. 5/4/2009 Pt states5/4/2009 left thigh is slightly sw nted to GARDASIL clinic 7-22-08 to begin series. Completed series 4-17-09 after reporting LMP U 3-26-09.4/17/2009 Presented to health department fo & Lg redness at injection site Y 4/28/2009 4/30/2009 wollen from upper thigh to knee. 3 cm larger than (R) thigh. Area a little reddened. Afebrile. U 4/28/2009 4/29/2009 asting 15 seconds - returned to normal LOC. Y 5/4/2009 5/4/2009 R upper chest welt 3 cm raised macule + dermatographism benadryl given PO - will give benadryl Y + MMR -> #2. ed left upper arm approx size quarter. Pt able to use arm. Y 4/28/2009 4/30/2009 B #3 vaccine given on 4-29-09. Pt. c/o swelling and redness of (L) arm where injection givenYon 4-30-09.4/29/2009 Pt. stated on 4/30/2009 5-1-09 that redness w ld given Hep A vaccine instead of Hep B. No immediate adverse reaction. No treatment given. U 5/4/2009 r vaccine site (deltoid) was reddened, Y warm + itchy on 4/25-4/26 worsened @ 48 hrs after inj. U Patient went 4/24/2009 to ED to4/25/2009 have checked. Now re 0 min after vaccinations (HEP A #1,YVARIVAX #2) child started vomiting and became increasingly Y lethargic, 4/29/2009 No total4/29/2009 LOC. Non discrete urti rts eyes red, puffy & warm red area right upper arm Y 4/21/2009 4/22/2009 ed 6 mon vaccinations at 2 hrs after Yhe ran a Temp of 100.4 and large warm red lumps formed Y at inj sites. 4/27/2009 Tylenol and 4/28/2009 bath given with some rash trunk after 8 hrs. Temps are as high as 101. Maculopapular rash chest abdomen, legsYface. Rash became 4/6/2009cellulitis 4/11/2009 in 240 with contin 4/26 - Rt arm swollen, hot, red. Y 4/25/2009 4/26/2009 es reddened area around injection site Y that goes down arm to elbow. Also reports pain under Y arm sore.4/27/2009 Knot increased 4/28/2009 from under quarte patient returned to clinic 2 days after vaccination to have right arm evaluated. Raised reddened Y area 9 cm 4/27/2009 X 6 cm right 4/28/2009 upper posterolatera 4-17-09, 7 PM. On 4-18-09 upon awakening had eyes swollen shut, face incl tongue puffy and U red, eyes4/17/2009 were also red. 4/17/2009 Facial swelling/redn ash with pain and swelling; fever atYinjection site; cough, red throat; post-nasal drip; bruisingU- treated with 4/17/2009 ZITHROMAX 4/17/2009 antibiotic; cough s ort was received 05 June 2008 from a health care professional. A 54-year-old male patient had U received an 6/3/2008 intramuscular 6/4/2008 right deltoid inject of four cases of injection site swelling, heat and tenderness in addition to large nodule at injection Y site out6/30/2008 of an unknown number of patients ort received from a consumer on 08 August 2008. A 63-year-old female patient received a leftNdeltoid intramuscular 3/20/2008 injection of DECAVAC ( ort received form a health professional on 04 November 2008. A cluster of three cases of flu-like U symptoms 10/1/2008 and injection site tenderness ou old male patient with a history of back pain and previous eye injury received an intramuscular U left deltoid injection ### of11/1/2008 DECAVAC (lot numbe -old female patient, who has medical Y condition of hyperlipidemia for which she takes ZOCOR, Y had received 1/13/2009 a left deltoid 1/15/2009 booster dose of D -old male patient, who had medical Y condition of glaucoma and erectile dysfunction , had received Y a left deltoid ### booster dose ### of DECAVAC ( ort received 27 February 2009 from a health care professional. A 31-year-old female patient had received2/23/2009 an intramuscular right deltoid inje ort received from a health care professional on 23 April 2008. A 21 year old, male patient (with Y no medical 4/16/2008 history) reported 4/17/2008 having symptom ort was received 15 May 2008 from a Y health care provider. A 26-year-old patient had received Y an intramuscular 5/14/2008 left deltoid 5/14/2008 infection of DECA ort was received 20 May 2008 from a consumer, who is also the patient. Additional information Y was also 21 4/1/2008 May 20084/2/2008 from the patient's phy 1 mo after receiving vaccine that beginning night of vaccination nausea and vomiting persisting Y X 2 weeks, 3/20/2009 SOB 243/20/2009 hrs after vaccine, insom d Immunization on 4/22/09. Onset of symptoms on 4/23/09. Nausea, headache, Stiff neck,Narm weakness, 4/22/2009 flushing, 4/23/2009 dizziness, lethargic, fe lt dose of HEP A instead of Pediatric dose Y 4/24/2009 lt dose of Hep A instead of pediatric dose. Y zed inflammation to left upper extremity - no streaking noted. No fever - began morning afterUvaricella SC 4/29/2009 injection. 4/30/2009 s. High pitched crying x1 hour - inconsolable; slowly resolved over next hour - onset = 5 hours Y after injection 4/29/2009 - on follow 4/29/2009 up exam - family rec
accine 4/16/09 - Mother called with complaint of half dollar size of local swelling where shot given. Y Told 4/16/2009 to ice ibuprofen 4/17/2009 or TYLENOL ection site swollen and painful - o/v 24 hrs later. (2) glomerulonephritis (post strep) Dx'd 4/21/09. Y 4/6/2009 4/7/2009 m and itchy area over TRIPEDIA injection Y site. U 4/26/2009 4/29/2009 ameter area of erythema on LT deltoid around immunization site. Instructed to apply cool compresses U and 4/27/2009 call if area 4/28/2009 increases. nted, difficult to arouse (12 sec) utilized Y ammonia to arouse. Patient stopped breathing during Y fainting spell. 4/29/2009 Patient 4/29/2009 cold, pale and clammy ived Kinrix injection in R thigh on 4/27/2009. On 4/28/09 - child seen by doctor diagnosed with U (hives) reaction 4/27/2009 to Kinrix. 4/28/2009 Given Benadryl. 4/30/2009 today 4/29/09 at 12:10 PM to reportYbreaking out with rash around injection site on 4/26/09. Y States has other 4/23/2009 areas 4/26/2009 involved now (legs, face d vaccine on 4/24/09. She called on 4/27/09 to report that later 4/24/09 in the pm she brokeYout with a rash 4/24/2009 that looked 4/24/2009 liked chickenpox an n has been received from a consumer Y concerning her approximately 24 month old Y son with N no medical history 1/1/2006 or drug 1/1/2006 allergies who in Janu n has been received from a physician Y concerning Y a 15 year old female 0 Y who on 13-AUG-1998 U was vaccinated 8/13/1998 with the 4/22/2009 first and only dose o n has been received from a physician concerning a 22 year old female who on 23-APR-2009Nwas vaccinated 4/23/2009 with the 4/23/2009 second dose of GAR n has been received from a registered Y nurse concerning a 19 year old female with no medical Y history and2/5/2009 no known drug 2/5/2009 allergies who on rmation and follow up has been received Y from a nurse and consumer for the Pregnancy Registry Y for GARDASIL 8/22/2007 concerning 3/24/2008 a 17 year old fe site still itches. Recently blistered &Ykeloid. Pt c/o severe itching @ vaccination site. 5/26/09 Received clinic 9/9/2008 medical 10/1/2008 records of 9/3/2008-4 m area of redness 1" diameter No fever. Y 4/27/2009 njection site Benadryl 25 mg PO + triamcinolone cream to site. 1/13/2009 1/13/2009 en lump at injection site (R arm). Benadryl given by mother (day after injection) Y 4/2/2009 4/3/2009 over all of body, tongue + lips. Referred to Dr at Health office. U 4/29/2009 4/29/2009 esions eruption 4/27/09 AM U ### 4/27/2009 ceived both TWINRIX & TYPHOID before Y collapsing on the chair. Immidiately patient startedY to cease. 3/24/2009 Patient was3/24/2009 moved to the floor and came lightheaded, pale, and unresponsive for approx. 1 minute. BP 90/48. Placed on couchYw/ feet elevated. 5/5/2009 Given 5/5/2009 apple juice after alert & oncerned that vaccine (s) have caused Y chronic pain. Has had ulcers and cholecystectomy (abnormal N gallbladder 7/30/2008 scan), 8/26/2008 but persists with ab d Varicella vaccine on 4/30/09. On Y 5/1/09 pt's parent reporting approximately 1" swollen area U around injection 4/30/2009 site. Was 5/1/2009 seen in clinic on 5/ dness + swelling at injection site afebrile; Y no pain; warmth to touch Y 4/29/2009 4/30/2009 swelling @ upper arm - 8" length 5th" width Benadryl/Tylenol. 4/27/2009 4/28/2009 & fussiness 9 days after MMR vaccine given (along with PENTACEL). Patient's fever resolved Y by 48 hours 4/20/2009 and there 4/29/2009 were no other assoc ction swollen redness injection site left T size right to left 25 X 25 mm up and down sore andUhard. 4/21/2009 Rash on Rt leg above knee- both feet - rash is spotty and puffy, worse in AM - better in PM. Took Y Benadryl4/6/2009 4/09 rash 4/6/2009 still present -not as re experiencing rash/hive type symptoms on his arms + legs. This started on 4/25/09 and wasUstill present4/24/2009 on 5/1/09. 4/25/2009 Pt was advised to take ction right arm Y 4/27/2009 4/29/2007 .8 at 5:00 pm day following vaccine. Continued with fever 5/1/09 - sibling sick with otitis started Y on ZITHROMAX. 4/27/2009 4/28/2009 ction left arm Y 4/27/2009 4/28/2009 ur after vaccine administration c/o flushing of face with temp elevation to 99.6 F. Also reported U vomiting. Vomiting 5/4/2009 and 5/4/2009 facial flushing contin ured 9 days after administration of HPV, Y HepA and Varicella vaccines Y 4/22/2009 5/1/2009 on, some lost of vision 1/13/2004 S ADMINISTERED 4-13-09 ON 4-21-09 Y PATIENT DEVELOPED A FEVER AND HAD A SEIZURE Y LASTING 4/13/2009 2 MINUTES. 4/21/2009 TRANSPORTED with heat and edema surrounding injection Y site with erythema ring approx 3-4 cm surrounding Y pale area 4/24/2009 appearing 44/28/2009 days after vaccination ted for pre-travel vaccinations prior to Y travel. Vital signs at presentation were as follows; B/PY120/62, T 97.7, 5/4/2009 R 12 and 5/4/2009 HR 60. Cursory phy from pt. wife stating husband c/o sore throat and one side of his tongue is sore, being tired and Y that injection 4/17/2009 site is 4/18/2009 swollen and warm and i er vax on 2/4/09. Rcvd call from pt.Yon 4/24/09 10:16a. She reports the following: on 3/28, she U experienced 2/4/2009 pain in3/28/2009 scalp and jaw and blur CALLED AND STATED HE HAD SHOTS Y YESTERDAY, WHEN SHE GOT HOME WITH THE Y CHILD HIS5/4/2009 LEGS WERE 5/4/2009 VERY SWOLLEN, owing, swelling, itchiness and pain at site of injection increasing to giant hives on neck, trunkUand arm. Considerable 4/10/2009 4/11/2009 pain, throbbing and itc arre' Syndrom 6/8/09 Hospital Y records Y and DCYsummary received 14 DOS Y 4/03/09 to 4/17/09. Final Y Diagnosis: 3/13/2009 Guillain-Barre 3/28/2009 syndrome. Post ates that he developed diffculty breathing and chest Y pain on 3/18/09 10and went to the Emergency Y room where 3/6/2009 he was3/18/2009 admitted for a pulmon VAX .5 CC GIVEN R DELTOID IM APPROX 10 A.M.. PT STATES THAT EVENING ARM TENDER, Y SOME 4/30/2009 SWELLING, 4/30/2009 WARMNESS AT ived the MMR vaccine and varicellaYvaccine at one time. Developed measles from the vaccine. Y No treatment 4/17/2009 prescribed. 4/26/2009 Began with rash swelling of the site w/ redness and pain Y same day as vaccine. pain, swelling slowly resolved Y over few days. 4/29/2009 No respiratory 4/29/2009 complaints or dy came lightheaded and lost color in her skin. Patient also complained of ringing in the right ear. Y Symptoms5/5/2009 occured approximately 5/5/2009 1 minute ling, itching on back of arm and neck. Also has been vomiting. Y 5/4/2009 5/4/2009 ated area of injection had egg-size swelling the evening after injection. Over the next 2 days,Yswelling appeared 4/29/2009 to spread 4/29/2009 down to elbow ar
ately 4-5 hours after receiving the vaccine, I broke out in hives large about 5 in in diameter and Y raised. These 4/30/2009 were on 4/30/2009 my stomach. I had re was reported by a physician and described the occurrence of rectal bleeding in an infant male U subject of unspecified age who was vaccina was reported by a physician and described the occurrence of rectal bleeding in a 4-month-old Y male subject 4/13/2009 who was 4/13/2009 vaccinated with ROTA fever, 2 days of rash. Had CSF, blood & urine cultures Y & stool culture 3 obtained & viral panel.YGiven CEFTRIOXONE 4/28/2009 4/28/2009 X3 days. 5/18/09 ED mergency Rooms. 6 days Y Hospital Stay. Y 6 daysYIn House Rehab. 5/13/09 12 hospital records received N DOS11/5/2008 12/4/08-12/9/08.### FINAL DIAGNO redness & swelling @ sites of injection, Y diagnosed in ER on 4/30/09 with right thigh cellulitis,Y treated with 4/28/2009 KEFLEX 4/29/2009 & BACTRIM TYLENOL at home. Pt. received MENACTRA Y on R deltoid on 5/1/09. About 30 hours later on Y 5/2/09; mother 5/1/2009 noticed5/2/2009 redness, induration pa 24 after shot, erythema tender (swollen started 3 days after shot , all erythema approximately U 4cm disterl4/29/2009 to shot site. U 4/24/2009 5/1/2009 nd out pregnant 2 wks after receiving vaccinations. Due date of 9/01/09. Client gave permission on 5/1/09 to report ### to VARIVAX registry fo d been diagnosed with shingles on 04/29/2009 U 5/7/2008 4/29/2009 x 5 cm swelling and redness to RPUA. Y 4/22/2009 d swelling, redness, and itching at injection site week after injection. Pt stated sxs was resolving Y without 4/29/2009 tx. 4/30/2009 tion administered - child sitting in chair with mom at side. Approx. 10 min. passed and then finger Y stick hgb. 5/5/2009 done. Child 5/5/2009 uncomfortable with d combination vaccine of DTAP, HEPB, Y & POLIO on 4/24/09. Pt. had no fever or s/s of anyNillness @ time 4/24/2009 of vaccination. 4/27/2009 Pt. returned to c dness, swelling at injection site 9-10 days after vaccine. At time of visit, no fever, swelling subsided Y 4/23/2009 5/2/2009 child called Health Dept 5/1/09 withYcomplaints of redness and swelling in child's arm - childYhad Tdap inject. 4/30/2009 L delt. 4/30/09. 5/1/2009Mother was re child was in the ER last night. AfterYleaving our office @ 2:06 pm. Patient was fussy, throwing Y up, and swollen 4/15/2009 on 4/15/2009 the admin. site. h present on knees, elbows & buttocks. Bx of elbow Y lesion -> herpetiformis 2 dermatitis. Treatment U with DAPSONE 2/15/200825mg 9/29/2008 twice daily - revise e 2008, noticed large ecchymoses on Y left flank. On June 10, a CBC showed platelets to be 36, U 000 (normal 3/11/2008 140, 0006/10/2008 -250,000). Saw hema red 4:05pm. Reacted at 4:20pm with Y anaphylaxis - Left eye swelling, shallow breathing, no airway Y edema,5/5/2009 +tongue swelling. 5/5/2009Given Epineph , Tiredness and poor appetite, Non-Stop Y cry for more than 3 hours, complains of pain in the N nose, Difficulty 5/4/2009 breathing, 5/4/2009 wheezing, paleness, n has been received from a consumer concerning her husband who in approximately 1970, U was vaccinated with MMR II. The consumer rep n has been received from a female consumer who stated that her uncle received on an unspecified U date an unspecified MUMPSVAX (man n has been received from a physician Y assistant concerning a 61 year old female Y patient withNcodeine allergy, 4/20/2009 post menopausal, 4/21/2009 lipid and an n has been received from a nurse concerning a her great-niece 13 year old female with no known N allergies 4/28/2009 or medical 4/28/2009 history reported, who n has been received from a physician Y who reported that a patient's mother told him Y that her U 24 year old daughter, on an unspecified date w rned red, very sore, itchy.erythema Ymedial aspect left uppr arm, none at outer deltoid at sited Y of pneumovax 4/29/2009 injextion.Area 4/29/2009 tender, erythem A vaccine--became dizzy and was lowered to the ground. BP 80/50, color pale. Color returned Y quickly, BP 4/28/2009 110/70 twenty 4/28/2009 minutes later hot child had some congestion, but normal Y temperature. Shot received at 9AM. Fever first noticed Y at 2PM 4/15/2009 (approx. 4/15/2009 101-102 degrees). Tre PRESENTED WITH TEMP OF 104.1, Y STIFF NECK, Y & ELEVATED 2WBC COUNT ONE WEEK U AFTER ADMINISTRATION 4/30/2009 5/2/2009 OF IMMUNIZAT C/O BEING COLD, DIZZY, THEN MOUTH, Y ARMS, AND HANDS STARTING TWITCHING, ALONG Y WITH 5/6/2009 BIG TOE. AMBULANCE 5/6/2009 CALLED female had foot stuck with pin. Had cellulitis and susuptiple to Tetnus. Physician did not have any Td on4/23/2009 hand so administered Tdap off-lab ported to student health services 2 days Y after receiving his Varicella Vaccine (04/08/2009). He Y present with 4/6/2009 right upper 4/7/2009 arm mild swelling an ately 2 minutes after receiving 3rd HPV immunization, client fainted. Client was unconsciousYapproximately 5/6/2009 10 seconds, 5/6/2009 for 3-5 of those se shot in a.m. on Monday 4/29, symptoms started in the late afternoon: fatigue, pain in arm, sudden Y nausea, 4/27/2009 dizziness,4/27/2009 fever of 102 degrees, RTS DIFFICULTY BREATHING 2 HRS AFTER INJECTION. SHINGLES RASH ON HIPS WITHIN N 12 HRS 5/4/2009 OF INJECTION 5/5/2009AND CONTINU after vaccine pt. reports a "different rash at a different spot every morning and at night whenUI go to bed". 4/28/2009 "I have a4/30/2009 red ring and a big knot s after gardasil #1, patient reports left index and middle finger is mildly swollen and difficult toUbend. Vaccine 5/5/2009 was given 5/6/2009 in the same left arm H AROUND INJECTION SITE Y 5/4/2009 5/6/2009 NJECTION-LEFT ARM IS SWOLLEN, WARM TO TOUCH,ITCHES AND HURTS Y 5/4/2009 5/5/2009 ed vaccines listed below at 4:30pm. After receiving vaccines, pt. was walking in the waiting room Y and sat down 5/6/2009 in one5/6/2009 of the waiting room c ours of vaccine child had high fever, red bumps on her face, very lethargic when not screaming, U excessively 5/6/2009 tired. 5/6/2009 eceived TdaP and menactra and felt dizzy and like she was going to faint yesterday. Still feels Y "terrible"4/13/2009 today. Some 4/13/2009 headache but she a us case was received on 23 April 2009 Y from a consumer (patient's mother). A 13 year old female U patient4/20/2009 with a history 4/20/2009 of asthma and gastri ort received on 28 April 2009 from aYconsumer. A female patient (demographics not reported)Nhad received 7/3/2008 on 16 June 2008 a dose of Hep was considered medically important. Information regarding PREVNAR was received from a U healthcare professional ### regarding a male patie n/v fever, headaches 12-24 hours after every AVA Y vaccine, but had 32 episodes cp/sob after AVA #3/SMPX 6/28/2004 vac, wt loss, 6/28/2004 hungry, insomnia.. onsolable. Swelling of thigh (left) knee Y to hip, hot Y to touch. Shots given 1 at about 1040a. Still Y crying presently 5/6/2009 3pm.5/13/09-records 5/6/2009 received mins of receiving immunizations, left warm + nauseous. Stood up + opened door at which point Y fainted. I saw 5/4/2009 her + helped 5/4/2009 her to floor so no vaccine received 24MAR2009. Symptoms began 13APR2009 with lesions on arms, legs, face, Y and trunk 3/24/2009 with clear4/13/2009 discharge. Biopsy was
ely after receiving GARDASIL injection, Y pt passed out with her head on a desk. She quickly Y regained consciousness 5/4/2009 5/4/2009 & required sutures. Y 5/6/2009 cellulitis 5 cm X 5 cm red, warm U 5/4/2009 5/5/2009 cellulitis at administration site. Started on OMNICEF. 4/29/2009 4/30/2009 nch area of redness, warmth and induration Y treated with KEFLEX 500 mg BID x 7d 5/1/2009 5/2/2009 R on 4-29-09 c/o fever nausea and Ydiarrhea and pain left arm - Followed up @ doctors officeY 4-30-09 and 4/28/2009 5-6-09 4/29/2009 g joint pain, numbness (left leg/hand), Y leg coldness, and stroke after AVA #4: 06 Jan 2003 AVA N 1 w/o AE.1/6/2003 AVA2 was given ### 23 JAN 2003 w veloped itching on his back 3 days Y after receiving the vaccine; 1 day later, he developed swelling Y + 3 lesions 4/17/2009 on his4/20/2009 right jaw; 1 day later h Y 4/30/2009 eared at site of vaccination. It was warm Y to touch and slightly itchy. 2 small spots appeared next Y to it. Rash 4/17/2009 lasted 5 4/29/2009 days. after 24 hours and warmth after injection Zero fever. U 5/4/2009 5/5/2009 10ml around injection of chicken pox Vax. Y 5/4/2004 5/6/2009 ed, warm with pain -> treated with KELFEX -> seen next day on 5/5/9 with response to antibiotic Y 5/1/2009 njection site showed redness, warmth, swelling. Area was also tender to touch. Also startedYw/temp 99.35/4/2009 today 5/4/2009 al reaction redness & swelling down into elbow. Clarinex 5 mg Y 3/31/2009 4/1/2009 @ throbbing pain L arm + hand. Info given by son. Pt does not speak English. U 1/29/2009 nt developed shingles on left side back Y and lateral chest wall. Antiviral medication not given as U it was 1 week 4/21/2009 after onset 4/30/2009 of symptoms. The of the Rt upper arm, temp of 101 XY2 days, itching and pain and tender axillary Adenopathy.YPt given Keflex 4/24/2009 500mg4/25/2009 tby mouth QID on 04-2 lling, redness, large circle @ inj site.Y Taken to PCP & informed to switch from Ibuprofen to TYLENOL. U 5/4/2009 5/5/2009 given @ 4:30 pm- Pt C/0 itching @ approximately 7:00 pm. Noticed both legs and R arm hadYhives approximately 4/27/200910:00 4/27/2009 pm. Low grade tem ined of having dizziness, pain at injection site, fever with joint pain. Y 5/1/2009 5/2/2009 ght tricep area with induration, warmth, confluent fine papules Y 4/27/2009 4/28/2009 er erythema 1-2mm vesicle in center - has burst Y 4/27/2009 4/28/2009 n right arm post receiving VARICELLA vaccine. Swelling & reddness began 4/29/09. Tx'd with Y XYZAL 54/28/2009 mg daily. Was already on MINOC 0 minutes after vaccinations (Hep AY#1, VARIVAX #2) child started vomiting and became increasingly Y lethargic; 4/29/2009 no total 4/29/2009 LOC, non discrete -103, rash on face - dry cheeks. Vomited Y once resolved in 24 hour without further fever, rashY on new symptoms. 3/31/2009 4/4/2009 was received from a health professional. A 41-year-old female patient, with a history of asthma, N received3/31/2008 an intramuscular 3/31/2008 left deltoid third ort received from a health care professional in the USA on 23 April 2008. A 21 year old, maleYpatient (with 4/16/2008 no medical 4/17/2008 history) reported havi ar-old female patient, who was hospitalized from 18 July 2008 to 19 July 2008 because she became U confused 7/21/2007 and angry after receiving a fir -serious case received from a healthY care professional on 17 September 2008. A 40-year-old N female patient 9/3/2008 received 9/15/2008 the first three doses rmation was received on 01 December 2008 from a consumer. A 59 year old female patient U with an allergy 9/5/2008 to penicillin 9/1/2008 received an injection -serious case received from a patient Y on 05 August 2008. A 68-year-old female patient experienced N headache, 7/29/2008 forehead 7/29/2008 swelling, sleepless n has been received from a physician Y and a nurse concerning her 13 year old daughter Y withNasthma and4/22/2009 no known 4/22/2009 allergies who on 06-AU n has been received from a consumer concerning her friend's 15 year old daughter who wasUvaccinated with two doses of GARDASIL. Afte n has been received from a pharmacist concerning a 23 year old female who on 08-FEB-2008 Y was vaccinated 2/8/2008 with her second dose of GA n has been received from a consumer Y concerning Y her son with neutropenia, who when vaccinated U with any vaccine including RECOMBIVA ort received 29 April 2009Y from a health care professional. Y An 8-week-old female infant had received U a first 4/27/2009 dose of right 4/27/2009 thigh injection of PE us case was received on 30 April 2009 Y from a health care professional. A 57 year old (corrected U on 05 May 4/21/2009 2009) female 4/22/2009 patient with high was received on 01 May 2009, via another Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study. n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 1/15/2009 who vomited 1/15/2009 blood. The patien ever with chills - arm swollen 4/30 threw Y up. U 4/28/2009 4/28/2009 ere migraine headache unresponsive Y to prescription meds. Onset 10/08. Abdominal pain and N some dizziness. 7/14/2008 Treated 10/1/2008 by pediatrician and 9 Mom called on her son who had shots Y on 4/27/09. His left leg is sore, red and hot today. Y I told mom to 4/27/2009 put ice on4/28/2009 his leg and have him u er flu shot, I developed a rash. This rash was all over my body except my face. The dr's that U treated me10/6/2008 were dermatologist, ### family dr., Al rm was red/irritated no pain no fever didn't feel hot. Y 4/6/2009 4/21/2009 ATEQ vaccine 4-14-09. Developed vomiting on 4-17-09 - lasting 24 hours then had 4 days ofYwatery diarrhea. 4/14/2009 No fever. 4/17/2009 Sibling then develo ver body, swollen and hot. Y 4/20/2009 4/22/2009 102 for 3 days with mild posterior lymph Y node swelling and one left axilla, and neck tenseness gradually resolved. alls the day after immunization was given c/o fever low back and B/L hip pain. States "difficult Y to walk" due 4/28/2009 to pain. 4/28/2009 Symptoms occurred (o reaction 13x26mm induration with redness. Y 5/5/2009 5/6/2009 0 cm length width erythema, edema, Y tenderness, dryness to right arm Y 5/4/2009 5/5/2009
or 5 hours crying, given Tylenol with Y some relief. Y 5/6/2009 5/6/2009 er administration of TDAP vaccine in Y right deltoid, patient developed severe pain and bruising U at injection4/27/2009 site with report 4/29/2009 of chills, nausea. arm red, warm to touch, swollen, indurated Y Y 5/5/2009 5/5/2009 tired, muscle ache lasting 1 1/2 weeks. No treatment. Y 4/9/2009 4/11/2009 patient states patient received vaccine and then "slumped over in chair". Mother left room toYget addional 4/23/2009 help. When 4/23/2009 mother returned to ro Imm given in AM. The following day he woke at 6AM with bilateral eye pruritis. He notices eyelids N red and5/1/2009 whites of eye 5/2/2009 a little red. Pruritis E FUSSINESS AND 103 DEGREE FEVER 24 HOURS AFTER GIVEN. TREATED WITH MOTRIN. Y CBC 5/5/2009 WITHIN NORMAL 5/6/2009LIMITS AND N hest 104.6, hives off and on all over body Y 4/28/2009 5/1/2009 Telephone consult) rash on face andYback of neck, no respiratory distress per mother. AtaraxUq6 hours as4/27/2009 needed. Mother 4/29/2009 instructed to sche ely 28 hours after vaccination the patients Y Right forearm began to have hives on it. The following Y morning 4/30/2009 approximately 5/1/2009 42 hours after va d 5 pox blisters/spots 11 days after vaccination. No other symptoms i.e. fever. Site of injection Y is itchy as4/21/2009 of today. 5/2/2009 4 months and was given vaccine that was for 5yrs and up..... Y 5/1/2009 negative BHCG on 30Mar2009. SM received Anthrax and Smallpox on 2Apr2009. SM tested U positive BHCG 4/2/2009 on 4May2009. 5/4/2009 Last Menstru accines at 11a.m. and returned to clinic Y at 1p.m. due seizure like activity as witnessed by mom. Y Per mom 5/7/2009 pt began drooling, 5/7/2009clenched jaw l accines at 11a.m. and returned to clinic Y at 1p.m. w/ twin sibling. Upon examination pt was found Y to have temp 5/7/2009 of 104.3 5/7/2009 (rectally), content, im aP INSTEAD OF Tdap U 4/24/2009 4/24/2009 proximately 5-10 minutes of vaccineYadministration, pt. c/o momentary changes in vision, was U pale and diaphoretic 5/7/2009 and 5/7/2009 vomitted. VS as fol -umbilical follicultis on 2 May 09. No tx. required. U 4/30/2009 5/1/2009 ness and swelling 4 cm x5 cm Y 5/6/2009 5/6/2009 ncopal episode 15 min after administration of vaccines. Y 5/6/2009 5/6/2009 se event reported. RN gave Tdap instead of a Dtap. Y 5/5/2009 or after getting vaccines. Pt was paleY and staring straight ahead with 2 shakes of head. RN was U able to arouse 5/6/2009 pt and5/6/2009 handed pt to father. A muscle was extremely painful, pain also felt in L side of neck on day of administration. Approx Y 36 hours5/6/2009 later, L deltoid 5/7/2009 reddened, somew ctivity 3-4 hrs after receiving vaccine on 5/5/09,Yseen in ER - Head CT 2 and CBC WNL, admitted U to Hosp. Plans 5/5/2009 for o/c5/5/2009 5/7/09 - Temp in ER up blood, chest pain, and Y acute onset. Y Complete Y heart failure. Two10thrombi Y also Y noted in leftNventricle. Pt has defibrillator ### 1/6/2009 now on Chronic m 11 AM 4/28/09 - taken by ambulance Y to E.R. In-patient Y 2/28/09 - 4/29/09 1 - high fever. 4-30-09 U - Back to Dr. 4/27/2009 office, severe 4/28/2009 diarrhea. 5/18/09 s: 1. Rash 2. local swelling. SuspectY Drug #1 Dosing: one time vaccine dose. U 3/18/2009 3/18/2009 opted at about 7 m/o from a foreignYcountry. Her Y shot records weren't 2 available to us. With consultation, Y 10/1/2008 the recommendations 10/2/2008 was to immu and swelling at injection site/entire upper arm; Left swelling 2-3 times normal size of arm. Fever, U vomiting5/5/2009 5/5/2009 thigh - fever 101.7 given Rx KeflexY5/1/09. Seen in office 5/7/09 - given Rx for Omnicef. FluUoffice visit in 4/30/2009 1 week. 5/1/2009 AM shaking arm when reaching, falling Y over after waking in am by 3/16/09 condition in am + N pm - falling over, 3/9/2009 trouble 3/10/2009 balancing 3/19 - not a & swelling noted at injection site Y 5/4/2009 5/5/2009 degrees. Diarrhea. Vomiting. RashY/ red / swollen right arm. Antibiotics by PCP. Y 4/24/2009 4/25/2009 sicular rash over torso / proximal extremities and fever present x 2 days. U 4/27/2009 5/7/2009 9 - Injection given R shoulder. Client Y describes pain in R shoulder joint, trouble lifting arm. Pain U was immediate 4/29/2009 after4/29/2009 shot then next day, we seizure like episode and stopped breathing Y per mom. Pt was admitted to hospital for observation. Y 5/6/2009 5/6/2009 mo vaccines on 4/24/09. Initially had Y a knot (no reddness or drainage) at site of PCV + VZVYshots. She now has some redness of skin with cm area of erythema with slight induration, Y minimally tender. Y 4/28/2009 4/28/2009 rythema at injection site. Y 4/27/2009 5/4/2009 ccines (shots) for flu, polio, & yellow fever- She also started oral typhoid vaccine on 5/05/09. YShe awoke 5/06/09 5/5/2009@ 6am 5/6/2009 with nausea by 9a vaccination in left arm on April 14, 2009. Y On April 16th, noted tenderness on left hip which spread U to groin. 4/14/2009 Pain continued 4/16/2009 and days later a reas other various locations of diamond shape rash. C/o itching 0 SOB or other signs of distress. Y after vaccination given, patient passed out, lost consciousness for about 3 seconds, then spontaneously Y 4/28/2009 woke up. Patient was given water redness, and warmth. Y 5/4/2009 5/7/2009 - No initial local reaction until 4 day post injection, 0 fever 0 change in appetite, sleep or play.N 9 days post4/6/2009 injection 4/10/2009 site increased size, war ZOSTAVAX was given got warm, swollen & sore. It was the size of a half dollar Y 5/1/2009 5/1/2009 adache and feeling of inside of scull on fire - lasted 3 hr and lifted. Went to ER. Y 4/29/2009 4/28/2009
0 - vaccination administered 0933 - pt. stated "light - headed, clammy, body feels tense, "really Y hot" BP = 5/7/2009 120/80 P = 5/7/2009 76 RR = 20 0945 - "in t a lump on left arm after administration of vaccine, and evaluated 5/1/09. Returned 5/5/09 with U redness/4/20/2009 warmth at 4/20/2009 injection site and compl n has been received from a 24 yearYold femaleYwith citric allergy who 2 on an unspecified dateNwas vaccinated with a single dose of MMR II .
n has been received from a consumer concerning her brother who on an unspecified date was U vaccinated with MMR II and then developed n has been received from a 74 yearYold female registered nurse with no allergiesYand a history N of hip replacement, 6/18/2008 24/24/2009 TIA (transient ischaem was considered medically important. Information regarding PREVNAR was received from aUconsumer, the mother of a patient who experie was received on 01 May 2009, via another Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study. ort received from a health care professional Y on 15 August 2008. A 39 year old, female patient, U with a medical 7/31/2008 history1/23/2009 of no known allergies a er Mother walked into Center. Pt received immunizations 05/04/09. Pt now c/o of dizziness, headache U & chest 5/4/2009 discomfort. 5/5/2009 Follow-up phone rs, significant Local Reaction - Site erythematous, warm to touch - Softball size area. Y 5/5/2009 5/6/2009 9 Tetanus/Diptheria toxoid was given in the left arm along with influenza and pneumonia which Y were given 3/12/2009 in the right 3/12/2009 arm. That night the p sh back of both hands and both elbows since getting small pox 16 Apr 2009. U 4/16/2009 5/1/2009 emperature of 100 F within 24 hours Y of injection as well as tenderness; both were controlledUwith Tylenol.5/6/2009 After 24-hours 5/7/2009 warmth and swelli swelling upper arms 5/7/2009 5/7/2009 EK AFTER SHINGLES VACCINE CLIENT HAD DEVELOPED RASH ON ENTIRE BODY AND Y IT LASTED4/3/2009 FOR ONE 4/10/2009 MONTH. NO FEVER d with ACAM2000 during pregnancy Pregnancy resulted in full term healthy delivery 7/8/2008 7/22/2008 U 4/21/2009 4/21/2009 as given his 2 month routine Vaccines which included the Rotavirus. This was done on Wednesday May 6, 5/6/2009 2009 about 10:30am. On Friday p Lt upper arm at injection site noted Y soon after vaccination 4-3-09. Presented for care on 5-1-09 Y with 2d4/3/2009 history increasing 4/29/2009 size of lump an was reported by a healthcare professional Y and described the occurrence of injection site redness Y in a 4-year-old 4/13/2009male 4/14/2009 subject who was vac ived oral Rotavirus vaccine Y Jan 30 Y 2009. Had some Y nausea, vomiting, 3 fever for 24 Hrs then Yresolved but1/30/2009 5 1/2 wk later 3/5/2009 developed intussus d fever 3/14/09 - 3/18/09 with rash head Y to toe -Yrash eventually peeled. 1 Hospitalized after 2 ER Y visits - had3/4/2009 a/c for Kawasaki 3/14/2009 with cardiology ness pain, swelling at and around injection site. Y 3/20/2009 3/20/2009 circle around shot. Now white circle, swollen arm, 6 inches across red circle. N 4/28/2009 4/29/2009 alized erythema/ induration on left shoulder after vaccines placed Y 5/7/2009 appetite Tremors Loss of mobility Dizzy Y Weight loss. N 1/22/2009 1/29/2009 ven shots on 5-1-09. 45 mins after shots Y started fever, body aches, nausea, on sat started reaction Y around 5/1/2009 shot area5/1/2009 red, very itchy hot to t mpanying note. Y 4/29/2009 4/30/2009 controllably for 5 days after shots given. Y 11/4/2008 11/4/2008 vaccine breakthrough diagnosed by Dr in our office on 5-1-09. Had VARIVAX X 2. Sibling also U has varicella. ### 4/30/2009 Vaccine Breakthrough. Diagnosed in office by Dr. on 5-1-09. Had 30 lesions. VARIVAX X 2. U 11/5/2008 4/29/2009 change. Sleepy day after vaccines. A few days later, more resistant behavior in this easy going Y toddler- irritable, 3/3/2009clingy, 3/4/2009 decrease appetite ates pt has red, swollen, itchy area where shot was given. Left arm, 1/2 dollar size. U 5/6/2009 5/8/2009 eived immunizations (Preona #4 Hep Y A + VARIVAX) then developed raised red itchy rash 5/7/09. Y No fever, 4/29/2009 illness or5/5/2009 fussiness. as lethargic moaned and maintain a fever in excess of 103 degrees for six hours. Unable to U fully wake up. 9/18/2006 9/18/2006 him a shot by annual check up. AndYhe had UGI. 90 minutes later after shot he start havingYhives, itchy, slight 5/5/2009 dyspnea. 5/5/2009 We brought him b rgic reaction, rt arm redness, & swelling Y U sig. facial swelling Benadryl + Epinephrine Y given. Y 5/4/2009 5/4/2009 edness and hardness pt. denied any pain except when someone touches with hand. Mom noticed U 48 hours 5/5/2009 after immunizations 5/7/2009 treatment eived vaccinations @ approximatelyY2 PM 5/7/09 fussy @ 5 PM 8-9 Developed fever 104.0 FY even with TYLENOL 5/7/2009 every 5/7/2009 4 hrs @ 1 am fa g s red, swollen, hot to touch, tender.YRt thigh 2 hrs 6 x 10cm, Lt thigh 8 x 12 cm. Started with U redness + swelling 5/4/2009-> dramatically 5/5/2009 worsening ess-instructed to lay down waited for 15 min and sat up slowly. No further problems. Y 4/21/2009 4/21/2009 mph nodes @ neck, rapid heart rate dizziness, weakness, headache, shake, nervious feeling Y feeling, nausea, 2/9/2009 rash,2/10/2009 body aches, tiredness. after receiving MMR she broke into a rash all over body with hives. She was extremely fussyYand miserable 4/22/2009 for the next 4/24/2009 48 hrs No treatmen ted 6 days after vaccines - lasted 3 days; Temp 104.8 degrees no other symptoms but of above Y from mother 2/2/2009 2/11/2009 ver 102 degrees - 103 degrees axillary, Y cranky saw Dr (PMD) 5/01/09 Rash face, neck, chest, U underarms, 4/21/2009 abdomen 4/28/2009 & back - progressed t vaccine break through. Diagnosed in office by Dr with varicella on 4-28-09. Had 7 lesions. NoYfever. Had VARIVAX ### x4/26/2009 2. multiforme- started 5/2/09. ThoughtYto be hives- nuclear by E multiforme on 5/4/09. BENADRYL Y tried w/o 4/15/2009 relief. 5/2/2009 4/23/2009 4/23/2009 ort received on 02 April 2009 from aYphysician. A 16 year old female patient, with no medicalYhistory, received 3/6/2009 the following 3/8/2009 vaccines in the with Very sore arm (painful to touch in shot area), a general headache (which I normally do not U get), and achiness 5/8/2009 all5/9/2009 over. I had received th eizure lasted 60 seconds self-resolved,seen Y in ED dxed with Bilateral Otitis Media treated with Y Amoxicillin 5/1/2009 5/8/2009 tly serving my 4th deployment since 2003. I received Y 6 doses of the4 Anthrax vaccination between U December 2003 and April 1st, 2009. I n he day the first dose rabies vaccine Y was given symptoms included swolen lymph glands, soreness Y in left 4/20/2009 arm, dizziness, 4/20/2009 exaustion, headach
id with induration, mild erythema, slight itching. 5/8/2009 5/10/2009 swelled up to double its size and was Y very hot and painful. I couldn't lift my arm for two days.YThe day after5/6/2009 the vaccination 5/6/2009 I developed flu li n has been received from a consumer Y concerning her son who on an unspecified date was vaccinated N with the first dose 4/1/2008 of MMRII (lot not follow-up information has been received Y from a consumer concerning a 13 year old Y female with N no pertinent 9/26/2008 medical history and no drug re n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 21 10/2/2008 year old female 11/1/2008 with CECLOR al n has been received from Y a physician's wife concerning her daughter, an 15 year old femaleNwho was on unspecified dates vaccinated with n has been received from Y a physician's wife concerning her daughter, an 11 year old femaleNwho was on unspecified dates vaccinated with n has been received from a nurse practitioner Y through a pregnancy registry for GARDASIL, Y concerning a7/31/2008 20-year-old 7/31/2008 female, with prior hist n has been received from a licensed Y practical nurse through a Pregnancy registry concerning Y an 18 year 8/1/2007 old female who 3/5/2008 in June 2007 and n has been received from a physician Y concerning Y a 15 month old patient who was Y vaccinated U with a dose of ROTATEQ (lot number and ro n has been received from a physician Y concerning Y a 15 month old patient 0 who on YunspecifiedUdates was vaccinated with all three doses of R time of injections noted client flinched Y mildly. 5/6/09 Contacted client after receiving a phoneYcall from his 5/5/2009 employer of5/5/2009 an adverse reaction. ld received immunizations of DTap,Yhepatitis B, rotavirus, HIB, PCV, and IPV on 5/04/2009. YHad 5 minute5/4/2009 generalized 5/4/2009 seizure and when p d patient's father returned to clinic approximately Y three hours after Varicella vaccine administrered Y (administered 5/5/200905/05/09). 5/5/2009 Patient had de ARTED ON 5/10/2009 FROM FACEYCOVERED ALL LIMBS BY 5/11/2009 5/1/2009 5/10/2009 f injections got fussy, then had generalized Y fine shaking. Prior to shaking had episode whereYshe straightened 5/5/2009 out. Spell 5/5/2009 lasted less than 2 d fevers, malaise and headache within 24 of administration of Menactra. Now feeling somewhat better 4 days 5/7/2009 after administration. 5/8/2009 Previou h and/or Hives, swollen feet, hands, Y face and entire Y body. Extremely2itchy. went to the Emergency N room on 4/17/2009 4/20/09 and 4/17/2009 was kept overnight after the injection (5/2), developed injection Y site pain and swelling, shoulder pain. On 5/7 developed U rash4/30/2009 on upper back 5/2/2009 and increase in pa AR bill redness c some swelling and itching on Left Upper Arm subcutaneous Y 5/8/2009 5/9/2009 XN R>L THIGH W/IN MINUTES - BLOTHCY ERYTH. Y 5/8/2009 5/8/2009 administered in school setting on 4/30/09. Y Mother reports that arm appeared ok that night and Y next am.4/30/2009 Child began 5/1/2009 complaining of arm h XN R THIGH W/IN MINUTES WITH BLOTCHY ERYTH. Y 5/8/2009 5/8/2009 0 hours after receiving vaccine, patient developed nausea, vomiting, vertigo, abdominal cramps, Y and temp. 5/8/2009 of 102.5. 5/9/2009 Symptoms lasted appr ates that patient had on left arm- swelling, Y red streaks, knot, fever up to 101 degree after varicella Y injection 1/13/2009 in left arm. 1/14/2009 Went to Dr. Williams ht swelling of the left deltoid muscle with redness, itching and skin warm to touch. Mother verbalized Y that 5/8/2009 patient had5/8/2009 severe headache hou ovitis (L) hip. 6/24/09 Hospital records Y receivedYDOS 5/2/09 to 5/3/09. 1 Assessment: Toxic (Transient) Y synovitis 4/29/2009 of hip.5/3/2009 Patient presents with second dose of GARDASIL. Approximately 16 hours later developed dizziness and fooling fainted and nausea. 5/6/2009 Fever5/7/2009 weakness continued 5/8/2009 ns in left hip with weakness and nausea Y - developed rash on left side of back that radiates toNhip. Received 5/5/2009 ZOSTAVAX 5/7/2009 on Tues - 5/5/09. S ped a right upper extremity tremor sites Y after administration of vaccines persists at 48 hrs. No U other neurological 5/6/2009 findings. 5/6/2009 5/14/09 Receive ported C/o redness and soreness at injection site. Observed slight bruising / redness at injection Y site area 4/14/2009 on 4-30-09. 4/15/2009 s after 3rd dose of GARDASIL, Pt developed, headaches, dizziness, abdominal discomfort, N various aches 2/27/2008 / pain, dairy 6/15/2008 sensitivity, elevated redness, pain. Entire deltoid area was swollen + red warm compress, Benadryl and Ibuprofen Y given w/ good 5/5/2009 response 5/6/2009 decrease swelling. iven instead of VARIVAX (ZOSTAVAX) 5/11/2009 gan around 6pm on 4/28/09 started on her face, 4-29-09 in morning woke up with all over still N with hives4/28/2009 today 4-30-09 4/28/2009 has had 5 doses of er shot arm sore and some swelling. May 7 arm swollen and Erythema 4 inchs aprox. May 8 arm swollen5/6/2009 and " 4 inches 5/7/2009 aprox. May 11 ar ensation in right arm; arm is hot, red,Yswollen; Pt has "extreme fatigue" Blood pressure has been U elevated5/8/2009 about 1S5/11/2009 points has a rash on rig 9 Severe Seizures < 3 days Transported Y by ambulance to renown medical center. OngoingNseizures until 2/23/2009 under control 2/24/2009 with phenoborbitol ction, quarter sized erythema to arm. Blanches, non tender, not raised. Y 5/8/2009 5/10/2009 Swelling itching warm to touch > Onset later that right mom gave BENADRYL & ice over the Yweekend 5/8/2009 5/8/2009 d tender mildly pruritic erythematousYpapules over bilateral hands, dorsal > palmar surfaces,Yonset approximately 4/3/2009184/18/2009 days following receipt hrs following vaccinations c/o swelling, pain + warmth @ injection site Rt deltoid (MENACTRA). Y 5/7/2009 5/8/2009 gave oxygen and checked vitals. Y 5/11/2009 5/11/2009 m area of erythema with slight induration, Y minimally tender. Y 4/28/2009 4/28/2009 pular/macular erythematous rash and Y fever X 2days. U 4/22/2009 lling + tenderness at injection site. 4 days after Typhim developed soreness in arm, tenderness U (no swelling) 4/28/2009 in axilla,5/4/2009 Tingling in L fingers b acular erythematous rash Y U 4/28/2009 c 4:30 p 4/27. Pt went to school 4/28 Y - was fine then. 4/28 night developed red area, hot to touch, U 9x9 cm 4/27/2009 approx at4/28/2009 vacc site. Talked to on ours after shot developed generalized Y arthralgias, headache, hot touch but no fever, chills. Severe Y leg and 4/20/2009 arm pain.4/20/2009 Seen in ED @ hospita local. Myalgias. Arthralgias. Fever >Y 102. Palpitation. Onset hours > vaccine. Pt seen 2 d > vaccine U rx. NSAIDS 5/9/2009 / TYLENOL. 5/9/2009
RICELLA vaccine on 4/20/09 - On 5/9/09 Y developed some itchy spots on truck with eye pain and frontal 4/20/2009 headache - On 5/9/2009 5/11/09 Dx'd with c :10 AM Pt. c/o ears tingling, L side of shoulder, face (L side) feeling slightly numb - No c/o difficulty Y in breathing, 4/17/2009 No 4/17/2009 c/o throat tingling, No c episode - hit head. Y 5/1/2009 5/1/2009 ceived shots on 4-14-09. Returned to clinic on 4-17-09 with report of swelling in right arm and Y face and itching 4/14/2009 starting 4/14/2009 on Tuesday night. HONED 5/5 @ 1 pm. Reports that at 3am. Child awakened screaming & banging head. Head Y hot, no fever 5/4/2009 & remainder 5/5/2009 of body not warm was reported by a healthcare professional Y via a GSK representative and described the occurrence U of diarrhea in a 2-month-old 4/16/2009 male subje N ort received on 04 May 2009 from a Y health care professional. This patient, who is a 54-year-old U male is one 8/13/2008 of a cluster 8/14/2008 of five patients who ACEL, MENACTRA, varicella 3/11/09. Onset 3/20/09 Y - fever, headache, 14 Y lethargy; evaluationNat hospital: 3/11/2009 MRI, LP. Dx 3/20/2009 cerebritis. 5/12/09 VA n has been received from a consumer concerning her three friends' children, who were vaccinated U with MMR II and became autistic. Upon n has been received from a consumer concerning her currently 14 year old niece who as a toddler U was vaccinated with a dose of MMRII. C n has been received from a 21 yearYold femaleYconcerning herself with 7 no medical history orNdrug allergy 1/8/2008 who experienced 5/1/2008 seizures the nex within 1 week change in cognitive abilities & behavior. Within 1st 24-48 hours rash Y over upper N forequarter9/5/2008 resolved within 9/6/2008 2 more days (No n has been received from a nurse practitioner Y concerning Y a 22 week4 male who on 31-JAN-2007 Y was vaccinated 4/23/2007 with 4/23/2007 a first dose of ROTAT t injection site of varicella. ER vs 3xYFri-Sun. Adm Y hosp Sun 5-1-09 4pm through ER. Culture Ydone at injection 4/29/2009 site = staph. 5/1/2009 IV antibiotics wh d 5/1/09, c/o pain. "limping". Temp 103 degrees during the night, shaking, Temp 102 degrees Y am of 5/1/09 4/30/2009 c/o tummy 4/30/2009 ache, gagging, 0 vo 5/6/2009 4/29/2009 induration, fever, chills, myalgia, BP stable, No anaphylaxis. 5/4/2009 5/4/2009 n initially & then recurred with deep muscle pain U 4/23/2009 out in bumps all over his body, is in the nurses office @ school. Some are fluid filled. does not have PCP. 4/29/2009 Instructed 5/3/2009 to go to PCP. ash on R deltoid began 5/4/09 and today 5/6/09 erythema and in eye itchy spread to both forearms U in addition 4/18/2009 3-5m papule 5/4/2009 have appeared ness, fever, joint pains, headache w/in 24 hours of vaccine. Y 5/6/2009 ministration of L arm erythema & firmness 2-3 cm, Local reaction. Noted 5/7/09. U 5/5/2009 5/6/2009 24 hrs after injection site where administered extremely tender, unable to lift arm. 24 hrs after Y fever began 4/23/2009 at 99 degrees, 4/24/2009 extreme fatigue, male was administered VARIVAX onY5/4/09 at Health Unit . On 5/6/09 mother presented to health Y unit with5/4/2009 child to report 5/5/2009 vaccine reaction. eared 3 days after vaccine, with no Y associated signs or symptoms. Rash consistent with erythema Y multiforme. 4/30/2009 Coincided 5/3/2009 with day 7 of AM hours post vaccination: Fever/chills X 3 days; redness/swelling in large area over injection site, Y generalized 3/20/2009 arthrolgias; 3/21/2009 started to resolve r, painful. 3rd day reaction. Swelling at site of injection. Y 5/4/2009 5/6/2009 (2) SOB, (3) Throat swelling, (4) Stiffness Y of upper & lower extremities. Oxygen SAT decreased Y 94% on4/30/2009 RA. Rx: 6 lit 4/30/2009 oxygen, EKG, SOLUM warmth, induration - diffuse tightening Y + pain with touch. Treated with augmentin and will follow U up tomorrow 5/5/2009 05/08/09. 5/6/2009 iven 4/23/09 - Pt began having myoclonic Y jerk seizures about 5 hours later. Pt told to go to ER Y ASAP. LP, 4/23/2009 EEG, MRI, 4/23/2009 CT had all WNL. Curr U 4/14/2009 meter redness, warmth, swelling, with Y superficial oozing of serum. Y 5/1/2009 5/4/2009 eived Td. - Should have received dTap) 4/11/2009 tool noted 4-29-09 5 days after vaccine Y given. Y 4/24/2009 4/29/2009 t weak, lost balance, became pale, eyes rolled around, pulse and blood pressure went decreased. Y With rest, 5/6/2009 a drink,5/6/2009 and a snack patient s oid swelling, heat, pain. Large palpable nodule in right axilla. Rx: Augmentin E S 600mg 1 Y 1/2 tsp po BID 4/27/2009 x 10d. Warm 4/27/2009 compresses to af seizure activity, brief alteration of consciousness. Y Y 1/2/2009 1/9/2009 r followed by seizure 24 after vaccine Y Y 3/25/2009 3/26/2009 arm red, swollen and fevered. Mother Y stated used ice packs, ibuprofen and BENADRYL withUno improvement. 5/5/2009 Advised 5/5/2009 to go to ER or child 0-09) - site irritation only through Sunday 5-03-09 - Rash began Monday AM. Covering - Neck U to back of 4/30/2009 thighs. Covering 5/4/2009 torso. .7 Po since evening after TDAP given until seen in office on day 2. Fatigue + Myalgia X 2 days. U 5/4/2009 5/5/2009 4/29/2009 ling and pain at the site of injection. Y 4/28/2009 5/1/2009 ling & pain at the site of injection. Y 4/7/2009 4/24/2009 st administration child had redness up & down 22 mm left & right 20 mm right thigh upper & slightly Y warm. 4/28/2009 Mom advised 4/30/2009 to watch & use wa ver 11 days post vaccine 4/24/2009 5/4/2009 noticed behind ears, now on stomach, arms fine red rash behind ear papular rash scattered U on thorax + 4/29/2009 extremities - 5/5/2009 2 hours vaccine on 4/2 throat, difficulty swallowing, stiff neck am of 4/25; and R arm pain Sun am 4/26. Fever blisterYlip. Evaluated 4/24/2009 by Dr and 4/25/2009 started on NAPROSY tient received immunization at 11:00 and then developed hives that afternoon, no respiratoryYdistress, gave 5/1/2009 patient Benadryl. 5/1/2009Claritin, and O
ed & hot to the touch. Y 4/28/2009 FTER RECIEVING ANTHRAX VACCINE MEMBER HAD A RING OF RAISED BUMPS AROUND U INJECTION 5/1/2009 SITE THAT 5/4/2009 ITCHED. MEMB ed fever (102.0 degrees F) and soreness at injection site (left deltoid region) 24 hours after Y receiving injection. 4/29/2009 Had4/30/2009 stomach discomfort 2 rent says that patient only slept about an hour and a half last night after his immunizations. Says U that he5/11/2009 cried nonstop 5/11/2009 for 3 1/2 hours unco oticed rash on upper arm and redness size of 50 cent piece. Parents gave Benadryl 1 dose.Y 5/1/2009 5/2/2009 sore, low grade fever, felt tired. Parent unsure which arm was sore. Y 4/29/2009 4/30/2009 low grade fever, fatigue (parent not sure which arm was sore) Y 4/29/2009 4/30/2009 TELY AFTER GIVING MMR SQ ON LT THIGH PT THIGH BECAME RED, SWOLLEN AND Y BLANCHING 5/11/2009 WAS NOTED 5/11/2009 DR NOTIFIED AND and swelling at injection site. Fatigue. Y 5/8/2009 5/10/2009 the patient called the office to say that as of 1/7/09, her arm from the injection site to the elbow Y was red, warm, 1/5/2009 and swollen. 1/7/2009 ceived the vaccination on Monday 5/4/2009. Y Mother called office on 5/5/09 and stated that child's Y Right arm 5/4/2009 where he 5/5/2009 had received his Dta eaming in tantrums which would last 15minutes to one hour off an on. Flailing arms, legs, shaking N head. 5/1/2009 Diarhea, vomiting, 5/1/2009 no fever. Initia hysician varicella rash on back, stomach Y and arms with no fever Y 4/30/2009 5/12/2009 pneumococcal vaccine trial, with severe COPD, Y was admitted to the 10 hospital fro severe colitis Y on 11/8/2008. 9/10/2007 Vaccination 11/8/2008 took place on 9/1 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 8 11/18/2008 with CHF. Y Vaccination 9/10/2007 took place on 9/10/2007. ### Accordin d Tdap injection 3/17/09. 3/24/09 reported Y as walkin to PCP reporting that arm is red and swollen. Y Per NP 3/17/2009 note that3/24/2009 day "left deltoid area ha d no signs of complications Y after birth. Shortly after receiving hepatitis vaccination by the nurse U the baby 5/11/2009 began experiencing 5/11/2009 stopped bre ying, sore arms, couldn't move arms; Y temp 105 degrees F; mother gave Tylenol suppository;Ychild projectile 5/6/2009 vomiting.5/7/2009 Tylenol lowered fever LOPED SIGNS AND SYMPTOMS OF hERPES zOSTER OPHTHALMIC BRANCH OF 5TH YNERVE l SIDE 5/1/2009 4 days after 5/5/2009 receiving Zostavax d lump the size of a blueberry appeared Y behind his right ear (this was diagnosed as lymphadenitis U by Dr.4/28/2009 Chevez) the 4/29/2009 day after his vaccina esday May 13th I visited my primary care physician for a routine physical examination. He recommended Y 5/6/2009 that I receive 5/6/2009 both Tetanus and P ETWEEN 102.5 AND 103.7 FOR 50 HOURS; DIFFICULT TO CONTROL WITH MOTRIN AND Y UNRESPONSIVE 4/28/2009TO5/7/2009 TYLENOL // RASH: P halitis etiology unkonwn.YFive weeksY after administration Y pt experienced 100 Y stiffnessYof neck. Neck N pain, back 8/16/2007 pain, lethargy, 9/19/2007 no appetite fever m, I fainted, had possible seizure, unconscious Y for 1 hour, several months of testings, Y Dr's can't N find what's wrong, ###since vaccine ### have sever warmth & hardness at site, pain at site. Y Y 5/5/2009 5/6/2009 -> Lt scapular pain - gen OXYCONTIN 20mg. ? nerve root. 1/1/09 - shingles --> given FAMVIR N 500mg: PO Q8### hours. ### elling w/ slight tenderness 12 days after Merck vaccine. Lasted approximately 12-24 hours. YCould move 4/8/2009 neck freely; 4/10/2009 R swollen upper arm ion , tenderness left upper arm Tylenol or Ibuprofen cold pack to and comfort. U 5/5/2009 5/6/2009 ssible granuloma. Y U 3/19/2009 5/11/2009 nted after administration of yellow fever vaccine, also received IM vaccines for Havrix & Adacel. Y Lasted 5/11/2009 about 30 seconds 5/11/2009 recovered comp minutes after receiving immunizations Y had syncopal episode and fell onto concrete outside clinics, Y V/s normal, 5/6/2009 hadn't5/6/2009 eaten that day, Dad s child reports that child had redness, swelling and warmth at injection site within only a few minutes U (<30). 4/13/2009 Site remained 4/13/2009 tender to touch un ped urticaria (generalized) after receiving DTP/aP (TRIPEDIA), PREVNAR & HIB. Per mother Y rash quickly 4/24/2009 subsided4/24/2009 within 10 Min & comple into clinic at 10:00 am on 11-3-08. She reported 4-5 hrs after getting vaccines pt noted redness, Y warmth, soreness ### and itching ### on upper le ine give with expired date Lot 00114 Exp 21 Mar 09 - Saw date as 21 May 09. U 5/12/2009 ately 24 hrs post receiving vaccines, pt reported temp of 102 degrees F. Temp went down inYthe evening 5/5/2009 but next afternoon 5/6/2009(48 hrs later, te ite {erythema warm sensation pain} with in 4 hrs of shot; then in 24 hrs --> pruritis + (increased) Y redness4/24/2009 5 treatment4/24/2009 (resolved in 1 wk). ZOSTAVAX injection 5/28/09. Awakened this morning (5-1-09) with a raised, red rash over U "upper chest." 4/28/2009 States the5/1/2009 rash "itches and burn n, loss of eye sight for 2 weeks. Nerve Y pain. Experience - still being treated for nerve pain in U head. 7/9/2008 ### apules + pustuls on back + arms. Y ### 5/12/2009 me 1 1/2 hrs post vaccine & stated Y to faint (Dad is a Dr. (cardiologist) and called it a "near syncopal Y episode 5/11/2009 she also 5/11/2009 felt nauseous & tired. ain and swelling saw Dr 5/9/09 Y 5/6/2009 5/7/2009 tis left arm s/p Tdap placed on Keflex per clinic & now doing well. 5/8/2009 5/9/2009 developed cough and congestion in lungs, Dr prescribed antibiotic (Amox-clav 500 mg) 3 days N later they gave 4/7/2009 no relief 4/8/2009 or made any differen ministered @ thigh on 5-3-09. On 5-4-09 in office for eval -- leg pain & refusal to walk since vaccine Y administered. 5/3/2009 Are 5/3/2009 firm. Are on L thigh ma, pain, redness. Y 4/30/2009 4/30/2009 secondary transmission of vaccinia:YPatient is not vaccinee. VAERS filed on vaccinee. 26 year U old female 4/16/2009 patient whose 4/30/2009 boyfriend received n has been received from a pharmacist Y reported that a 25 year old female Y with no allergies received U PNEUMOVAX 1/31/2009 1/31/2009 (Lot# 662742/1117X), u s a PNA vaccine on 5-2-09 on her left deltoid. Develop a big red mark on the injection site c/o pain and feels 5/2/2009 swollen5/2/2009 then put a marking on around 2100 on 5/2/09; spoke with one RH to report that her (L) arm where they injected Pneumococcal vaccine 5/4/2009 started 5/5/2009 to get swollen. Pt w ingling and respiratory symptoms 4/15/2009
ates awoke to arm red swollen tender to touch. Noted hard spot near tender arm size of prune. Y Patient able 5/8/2009 to use arm 5/9/2009 c/o area itchy. Wil back itchy, especially on ABD. Trunk/Buttocks Y groups of vesicular/ papules/few tiny pustules U on erythem. base. 6/7/1999 Clinically - varicella (status ve hep B (peds) on 5-1-09 vac exp date 4-28-09 5/1/2009 dministered to pt on 4-1-09 after she Y denied any allergies about 6pm. Client states on 4-2-09 Y a red slightly 4/1/2009 raised rash 4/2/2009 developed on neck, length area of redness + local temp - started ? 2cm x 2 in and elevated to 5cm X 5cm overnight. Y Fever 4/29/2009 > 99.8 (A) m area of erythema + warmth -> L biceps. Y U 5/6/2009 5/7/2009 Y Y 4/13/2009 4/22/2009 on, some lost of vision. ### was reported by a lawyer and described the occurrence Y of joint pain0 in a male subject of unspecified N age 8/1/1999 who was vaccinated 11/1/1999 with LYMER o hve severe joint pain Y U 5/11/2009 5/11/2009 as given a Zostavax vaccine as opposed to a varicella vaccine. Contacted patient's mother. Patient is having 5/11/2009 no symptoms. hospital on May 11, 2009 Y with bilious Y emesis, Y and low grade fever. 2She was sent home with the diagnosis 4/3/2009 of acute5/10/2009 gastritis. The patient pr received 2nd dose of Hep A/B TwinRix Y on 5/11/09.She had no problems with 1st dose on 1/12/09. U Within 5/11/2009 an hour of 5/11/2009 receiving the shot, he tions administered at 12:40pm, 12:45pm face red, hives noted on face. Benadryl administered. Y 2:40pm face 5/11/2009 no longer 5/11/2009 red, hives gone. N AS THE VARICELLA AND MMR WAS GIVEN LOCAL REACTION OCCURRED IN THE FORM Y OF WHEAL, 5/13/2009 TWO5/13/2009 OF THEM AND SOME ped a raised red area on back of Left Y arm on Sunday, 4/26 after immunization on 4/16. AreaYwas hot and 4/16/2009 itchy when 4/26/2009 noticed. Presented @ that a couple of hours after taking 1st Y typhoid pill developed rash on wrists with swelling of one eye. No 5/8/2009 difficulty breathing. 5/9/2009 After taking ated she had received a MMR vaccine Y and later that night her jaw appeared swollen and painful. Y She stated 4/14/2009 that she 4/14/2009 felt feverish. She cam n a 102 fever, breathing very fast and Y red cheeks and a very congested nose. Pediatric emergency N number 5/8/2009 advised 5/8/2009 us to go the hospital w to clinic 4/21/2009 with swollen cheeks, Y upper lip and left periorbital areas. Hives on trunk and Y arms since4/6/2009 4/6/2009 when 4/7/2009 he had his vaccin S MOTHER REFERS RASH IN ARMS, LEGS, BACK AND IN THE BACK OF THE NECK. Y 3/9/2009 3/9/2009 s and swelling at site of Varivax and Hep A vaccine, persisting swelling at site for 2 weeks. Y 4/27/2009 4/27/2009 DEVELOPED ITCHY HIVES SIMILAR Y TO VARICELLA LESIONS ON HER FACE AND BODY. U 4/9/2009 5/9/2009 eveloping warts on inside of vagina which had never occured before. Three weeks later they N were still there 4/24/2009 and getting 4/28/2009 uncomfortable so i w CP on 2/4/09 for GYN/PAP and received #1 GARDASIL Y that day. Urine 2 HCG on 2/4/09 was negative. N Pt subsequently 2/4/2009 2/4/2009 had (+) pg test 2/16/0 on 1 week prior to abnormal labs, cough x 1 week, Y nasal congestion1 x 1 week, croup 2 months Y prior to admission 2/24/2009- 3/16/2009 3/16 plts 12,000 receive wing day, noted increased fever, increased rash to chest & arms (red pimples). 3-5Y days later,Ndecreased speech, 1/3/2008clumsiness, 1/4/2008 huge dilated by MD 5-12-09 in Dermatology - note enclosure. Y 4/10/2009 5/8/2009 uration with redness R lateral thigh Y 4/29/2009 5/1/2009 ook child across street to groc store. She was crying when suddenly went limp + eyes rolled Yback in her head. 5/8/2009 She had 5/8/2009 mild inflammation o onds after injection became diophoretic, lightheaded, passed out for 15-20 seconds. C/o swelling Y in throat 5/12/2009 and throat 5/12/2009 soreness, no SOB or days vomiting X 2 days U 5/5/2009 5/5/2009 ness approximately 10mm. Vesicles. U 5/12/2009 5/13/2009 d immediately to VAR + MMR with redness + swelling @ sites, generalized urticaria on legs, Y arms, + back5/13/2009 + abdomen. 5/13/2009 Given 0.2cc of Bena 30mm area of induration on L lateralYthigh. Y 5/1/2009 5/2/2009 se event of symptoms, wrong vaccine given. In clinic 1hr. Past injection with no problems. Y 5/13/2009 dache, fatigue, tremors, arm swelling, myalgias, weakness. U 5/11/2009 5/12/2009 h "milk protein allergy" atY1 month ofYage, developed Y diarrhea about 300 3Y weeks after getting only N dose of ROTATEQ. 10/8/2008 Found 11/5/2008 to have rotavirus hing pain in Rt arm, very tender to the Y touch, very red and very hot. Dr put her on antibiotics. U 4/26/2009 4/28/2009 plaint was neck arm stiffness of left side, Y which continued, confustion (goofy like she was drunk), N conti complaints 5/11/2009of5/11/2009 neck arm, then exhaus n has been received from a nurse practitioner Y concerning Y her 18 year 4 old daughter Y who on 29-AUG-2007 N 8/29/2007 was vaccinated 9/5/2007 with her first dos n has been received from a consumer concerning Y her approximately1 12 month old son with N allergic reaction to antibiotics who in 2001 was n has been received from a consumer concerning, the patient's mother, her son (a twin, whoYalso had the same experiences reported in W n has been received from a consumer, the patient's mother, concerning her son (a twin, whoUalso had the same experiences reported in W n has been received from a Registered Y Nurse concerning a 2 month old male who on 30-APR-2009 Y was4/30/2009 vaccinated 5/4/2009 orally with the first 2 m d with rotavirus on 4/30/09 at 6:38. Was taken to Y hospital by mother1after vomiting & diarrheaYfor 2 days. Was 7/2/2008 admitted 4/29/2009 to hosp & tested for ospitalization for IVIG - extreme weight Y loss. Tripping, Y falling, loss of5 muscle mass, inability to N walk without 11/5/2008 assistance. Now ### is in a wheelch ient seen for F/U s/p hospitalizationY4-5thMay09 Y @ hospital for Acute 2 Myopericarditis following Y receipt of4/22/2009 primary Smallpox 5/2/2009 and Anthrax #1 p with CP and SOB in the early morning Y hours Yon 1/22/09 and got tachycardic 1 and SOB trying Y to climb stairs 1/11/2009 later that 1/22/2009 day. Went to health e on lower lip within 48 hours of injection." Y Upper Y chest pain waking 2 pt. @ 0300 1 wk after injection. Y No cause 4/15/2009 or change 4/22/2009 of routine other tha d, slightly warm to touch, area was Y 1 1/2 inches wide x 3 inches in length. Y 5/5/2009 5/6/2009
o fever 102,less of appetite, and fussiness. Y Y 5/12/2009 5/12/2009 ven Rotarix vaccine. On first dose of Rotarix, my baby had symptoms of vomiting, blood in stools. N These 5/13/2009 symptoms 5/14/2009 stopped after giving ant 5/16/2009 Y Y Y 4 N 5/11/2009 5/12/2009 vaccination on Friday, by Saturday Y evening developed rash at site of injection. Two days later U reaction (rash, 5/1/2009 swelling) 5/3/2009 was appro 2" x 2". A d, hard 2.5 X 3 inch cellulitis, left upper deltoid with left arm pit lymph node involvement. Father U is a MD and 5/12/2009 put child5/13/2009 on Keflex. Child has fe 9 mom called and spoke to nurse, stated Y that son got imm on 5-6-09 and now has a swollenYarea on this 5/6/2009 left thigh that 5/10/2009 is the size of a tenn hours of taking the vaccine, headache,low Y body temperature.next morning, low blood pressure, N nausea, 5/11/2009 body ache, 5/11/2009 stiffness in right arm, th Varicella and Hepatitis A vaccines on Y 5/13/09 at 1500 hr. Around 1830 hr., developed urticaria, Y swelling 5/13/2009 on eyes and 5/13/2009 mouth. He began cou n 786.5 (5-000008) 5/19/09 medical records received Y DOS 1/27/09 to 2/5/09. FINAL DIAGNOSIS: U Atypical 1/6/2009 chest pain, 1/27/2009 Hypertension (Sys nistered Tdap, no previous allergy toY Td, was being Y worked up for allergy 13 - tested + seafood N and almond;4/15/2009 approx 154/15/2009 minutes after vaccine d m, red, bruised spot on the left arm at Y injection site. Prednisone given orally. Y 5/12/2009 5/13/2009 er arm redden and swollen. Child complains of pain. Mother Bendryl. Applied ice. Y 5/7/2009 5/7/2009 esented to the emergency department Y complaining of generalized rash and itching. Patient was Y treated with 4/6/2009 benadryl4/9/2009 and released home a ite red and swollen x 1 day, diagnosed with cellulitis at injection site, treated with Sulfatrim xU10 days 5/12/2009 5/13/2003 e series of 3 injections and after the Ypatient developed Y utis, uris, strep 3 throat 3 times, joint pains, N muscle weakness, ### numbness, ### insomnia, m ports that after receiving shot of gardasil abd menectra on 02/25/2009 she became very sleepy Y but not lethargic 5/13/2009 and5/13/2009 experienced a severe SEEMED TO HAVE PROFOUND HEARING LOSS FOR 2 DAYS AFTER HER VACCINATIONS. Y SHE DID 2/26/2009 NOT RESPOND 5/13/2009 TO HER NAM en hpv vaccine pt was then found to be pregnant Y 6/8/2007 was reported by a healthcare professional Y and described the occurrence of shoulder pain inNa 40-year-old 4/14/2009 female subject 4/19/2009 who was vaccina ations. - Fever, chills. - Local cellulitis. 5/15/09 Y Medical records received 2 (hosp discharge summary Y included) 4/29/2009 DOS 4/29 4/29/2009 and 5/1/09 to 5/3/0 nd decreased appetite started Y after he Y receivedY5/1 immunizations - developed night sweats,Ncold symptoms, 5/1/2009 bruising5/3/2009 - hospitalized 5/11/09 esented to hospital with 1-day history of bleeding, Y bruising and low platelets. 3 History includedY epistaxis, left 4/20/2009 elbow bruise 5/11/2009 and a platelet coun elling, redness within 48 of receivingYDTAP R deltoid. Y 5/9/2009 5/9/2009 d redness, swelling locally in Rt. deltoid Y where administered. Systemic chills without fever, myalgias. Y 5/6/2009 5/7/2009 d Varicella vaccine (lot #0336Y) SCYin L lateral thigh on 5/4/09, as well as Hep A vaccine IM.YSeparate areas 5/4/2009 of induration 5/4/2009 found on L thigh ed vaccines TDAP, Hep A + VARIVAX @ 2:30 pm, Pt waited 15 min after vaccines. Pt was fine. U It was around 5/13/2009 3:07 5/13/2009 pm when Pt came to Do redness, pain, warmth at injection site. Patient seen at clinic and back in primary physician'sYoffice. 5/11/2009 5/13/2009 1/4 inch upper arm redness, blanches, not warm, no streaking c/w immunization reaction Y 5/12/2009 5/14/2009 Erythematous Wheals all over bodyY+ itchiness TX: Benadryl 25mg to tabs PO 4-6 Hrs for itchiness. Y 5/11/2009 5/11/2009 d redness, heat and swelling yesterday. Area red hot, 0 induration noted, minimal swelling toYsite. Approx 5/11/2009 12cm across. 5/10/2009 No itching or pain. Mother noticed L arm red @ injection site. 5/4/09 blisters on L upper arm with redness + tenderness Y at the 4/21/2009 base. Mom 5/3/2009 called child's Dr + h gnant female, ADSM, reports receiving Flu Mist vaccine on 17 October 2008 despite being 38 U weeks gestation. ### The service ###member decid rgic reaction at site of injection. Y Y 4/25/2009 4/25/2009 female presents for walk-in appt, with "itchy, little red bumps that look like mosquito bites" on Y arms, chest, 3/10/2009 abdomen3/16/2009 and back 10-days s/p ale, ADSM, is referred to the Transition Y Unit for several day h/o nausea and vomiting associated U with his receipt ### of Flu Mist ### vaccine on 28 O linic (06May09) re 22 y/o AD WM SM Y w/ 10-12 tiny vesicular lesions surrounding primary SPV Y injection site 4/29/2009 RUE. SM5/6/2009 received primary SP h left arm, swelling, no fever or vomit. Pt was seen today Doctor 5-22-09. U 5/12/2009 5/13/2009 tchiness, redness at site of injection (L deltoid) 5 - 6 cm reaction - round - slightly erythematous U lesion. Slight 5/1/2009 induration, 5/3/2009 no fluctuance. s down on R side of face when crying or drinking. Began 1 week ago (approximately 4/30) ?Nmild Bells Palsy. 4/28/2009 4/30/2009 2" urticarial patch over injection sites on right thigh - started at the MMR site - enlarged to cover Y both sites. 4/24/2009 4/24/2009 ination on way home mom said lips got swollen and child broke out in fine whelps. Gave TYLENOL Y and BENADRYL. 5/7/2009 5/7/2009 On 5-7-09 left arm at swollen lymph nodes under jaw on April 30. N 4/21/2009 4/30/2009 ptoms 2 wk recovery complete physical breakdown felt as if hit by a truck" weak, chills, pain back Y + ribs; chills; 4/2/2009 nausea; 4/24/2009 loss of appetite; che d rash on 1 thigh, warm to touch Y 5/6/2009 5/7/2009 njection given - HEPA. HEPB & INFLUENZA given 0845 - Patient feeling weak, dizzy, chestYtightness, HR60 5/14/2009 blood5/14/2009 pressure 60/40 0850 vaccination: Next few days had increased swelling hardness, heat (hot) Redness cont to spread Y also itching 5/4/2009 + aching5/4/2009 + soreness - spoke w erythema - mom described as the size of a baseball tx with BENADRYL 5/13/2009 5/15/2009 Feverish, C/o "feeling sick" 5-15-09 Employee came to Employee health with pea sized knotYleft upper inner 5/11/2009 arm. lymph 5/12/2009 node also red blot tion (KINRIX) given on 5/12/2009; mom noticed and reported localized swelling of L arm on 5/14/09, U arm5/12/2009 swollen to 5/14/2009 twice the normal size fr hives occurred that pm or next am. Patient has DX of urticaria Dermatitis. HX of local reaction Y to latex band 4/29/2009 aids- only 4/29/2009 RX for this incidence Rt arm inflamed and swollen from shoulder Y to elbow - no pain, no fever - when picked up from U day care. 4/28/2009 4/30/09 - Arm 4/29/2009 unchanged - still no
blisters up both arms. Treated with BENADRYL 25mg x 2 doses and antibiotic cream to blisters. 4/30/2009 4/30/2009 treated with BENADRYL 6.25mg Q4hr prn. Y 5/6/2009 5/6/2009 reaction at IM injection site left deltoid. + redness, swelling and warm to touch. Treated with YTYLENOL, BENADRYL 5/8/2009 5/9/2009 and warm compresses e fever (101), diarrhea, mild irritability starting 48 hours after vaccination. Y 3/19/2009 ness and swelling in L arm 24 hours after injection at site of Sub Q injection of VARIVAX. Y 4/29/2009 4/30/2009 nset one hour after vaccination, at site. Treated with 25 mg Diphenhydramine P.O. . Y 4/29/2009 4/29/2009 Tdap around 9:00-9:30 am at school; Y felt drowsy all day afterwards. Later that evening felt tired, Y weak, dizzy, 5/5/2009 chills and 5/5/2009 fever of 102.6. com ministered 0.5 cc of Tdap to client. Expiration date was checked before administration of vaccine U but still was 5/4/2009 not realized til entered into gr IZ's 4.29.09 - 5-1-09 pale, fever by evening was in Reno all day that day. 5-1-09 Fever increasedY unknown temp as no thermometer. W ->72 hours : 5 x 7 cm erythematous raised area with small papules (no vesicles). RecoveredYwith Rx. Sl.4/27/2009 increased 4/28/2009 color. Afebrile. an at injection sites on right arm. Patient received Varicella and Hep A vaccines in right arm.YHives spread5/6/2009 to legs, groin 5/6/2009 and upper arms. N creased temperature. Seen in Hospital Y emergency room. Y 5/7/2009 - red and swollen with small hard lump. Y 5/5/2009 5/6/2009 ay 8- joint and muscle pain, fatigue Y and lymph node swelling. 2/28/09 Day 9- symptoms became severe,2/20/2009 site painful.2/28/2009 3/3/09 Day 12- evalua site red and swollen x 1 day, diagnosed with cellulitis. Treated with a 7 day course of amoxicillin U 5/12/2009 5/13/2003 brought in for office visit two days after Y immunizations d/t fever and localized rash to L thigh.YDescribed 4/13/2009 by NP as tennis 4/14/2009 ball sized, raised, brought in for an office visit six daysY after immunizations were given for localized rash of R arm Y around injection(s) 4/7/2009 site. 4/12/2009 Was treated for dia vaccine on may 12,2009 at 4:19pm. Later in evening developed body aches, chills and "fever in side". Left 5/12/2009 arm became 5/12/2009 swollen and red. esented to our office on 5/14/09 with a 2.5in circular swelling @ the injection site. She was diagnosed Y with 5/11/2009 either cellulitis 5/14/2009 of the injection si , swollen, hot area on left upper thigh, no discomfort and gait problems Y 5/12/2009 5/14/2009 d her first rabies vaccine on 3/25/09Yand 2 days later had flu-like symptoms, sore throat, "bad" N cough, fever, 3/25/2009 chills, excessive 3/27/2009 tiredness and er aspect of arm extending light redness 100mm radiating from injection site with darker redness N extending 5/13/2009 50mm from 5/15/2009 injection site radially d chest pain and palpations after second Y gardasil vaccine. Cardiac evaluation is underway. 5/26/09 N Medical records ### received ### DOS 12/30/0 ythamatous, tender lesion at injection Y site U 5/13/2009 5/14/2009 ollen and knot the size of a quarter Y at first on5/13/09 pm. Arm s/s increased and pt seen in Y ER and tx with 5/13/2009 Benadryl. 5/13/2009 Mom reported on 5/1 5 yo vaccines today, kinrix, MMR and Y var.ÿ Rash developed about 20 minutes after they leftYthe clinic.ÿ Very 5/14/2009 itchy.ÿ5/14/2009 Started on neck and w as given Gardisil instead of Menactra Y 5/12/2009 n (786.59) 5-000009 6/10/09 Medical records Yreceived DOS 1/21/09 to 2/3/09. CLINICAL IMPRESSION: U 1/13/2009 Palpitations 2/3/2009 resolved. Post vacci ew days of receiving Menactra vaccine, Dylan developed Y toe numbness 10 then headache, nausia, Y followed3/19/2009 by foot dragging, 3/20/2009 impaired joint po esented 24 hours later with redness about the size of a half dollar, with tenderness to the touch. U Recommended 5/14/2009 cool 5/15/2009 compresses and trea ELTS" ON LT ARM TOWARDS THE OUTSIDE-MENACTRA GIVEN IM ON OUTER ASPECT Y OF DELTOID 5/14/2009 MUSCLE 5/15/2009 & HEP A GIVEN TO month old male presents with c/o Skin Check: for 4 days had Immunizations on 4/17/09 and now Y has a red, 4/17/2009 hard, warm 4/19/2009 to touch area below ssion from E.R.,recieved Pneumovax in ER, c/o R tricep swelling, pain, itching, observed swelling, Y edema, 4/16/2009 warmth,redness, 4/16/2009notified Dr. Ea ame in to my office 5/15/09 1350 to report neck stiffness and head pressure that started 5/15/09 U PM. 5/13/2009 5/14/2009 as given MCV4 and Var #2 in her left arm. Mom stated that patient had a history of feeling light Y headed with 5/15/2009 any type 5/15/2009 of procedure/lab test. experienced a short duration of minor pain and redness at injection site each time the vaccine Y was administered. 5/8/2008I was 1/22/2009 pregnant during my lt with swelling and redness within 4-6 hours after immunization Y 5/12/2009 5/12/2009 arm injection site swelling but not painful, with some redness. Y 5/2/2009 5/15/2009 d erythematous rash at site of vaccine. Y 5/15/2009 5/15/2009 day after shot with a rash widespread over the body and some puffiness to her eyes. Urticaria. U 5/11/2009 5/12/2009 ss Criteria: Other- Medically Significant. Y Initial report received from another manufacturer Y (other manufacturer's 4/21/2009 control 4/22/2009 number: WAES 090 9 cm, warm, erythematous area @ previous injection site. Mom states area doubled since injection. N 5/11/2009 5/12/2009 d reaction right thigh. Y 5/5/2009 5/6/2009 was reported by a healthcare professional Y and described the occurrence of fainting in a 13-year-old Y female 5/12/2009 subject 5/12/2009 who was vaccinated wi ceived vaccine 5-8-09; noticed erythema, Y tenderness and warmth 5-9-09 (10x10 cm area at Y injection site).5/8/2009 Doctor visit 5/9/2009 5-11-09. Prescription ced redness @ swelling to right deltoid area this morning. Y 5/14/2009 5/15/2009 of inflammation occurred immediately after injection given at injection site. Red are had pin point Y areas and 5/13/2009 facial areas 5/13/2009 also flushed. MD n red skin in roughly rectangular shape over left anterior thigh surrounding the injection site. About Y 9cm x 5cm. 5/5/2009 Emerged 5/11/2009 6 days after vaccina mplaints of dizziness, Pt put head on desk. At 1:38 pt vomited small amt, color pale, clammy, Y alert oriented 5/15/2009 B/P 100/72 5/15/2009 - Pt states she is h urs after receiving injection size 2X2 inch in circumference pruritus, pain + Erythema Tx Benadryl Y + Cold compress. 5/8/2009 5/9/2009 d 4.5mm x 5mm areas + redness, swelling Y and tenderness at site of injection L upper thigh. No Y significant 5/13/2009 systemic 5/13/2009 reactions due to vaccine
ction Left deltoid; erythema/ edema Y and pain. U 5/13/2009 5/14/2009 red and swollen. Y 4/28/2009 4/29/2009 ves over entire body, headache, itchy throat. Y 5/15/2009 5/15/2009 ed vaccinia with diffuse rash, myalgias, Y fever, and robust take. Treatment with indocin and benadryl.. Y 4/29/2009 5/4/2009 y of the shot, the injection site had minamal Y swelling; however the following starting occuringUthe day after 5/11/2009 the shot, 5/12/2009 Severe swelling of lymp Mom reports body rash for 9-10 days and vomiting 1-2 times daily from 11-28-08 until 12-2-08; Y also "change of### attitude" screams ### loudly at t n has been received from a consumer Y concerning her 24 month old nephew who was vaccinated U with MMR II when he was 18 months old. n has been received from a consumer Y concerning her 2 years old son with a history of cross-eyes N operation 11/1/2005 who in November 4/1/2007 2005, was v n has been received from a registered Y nurse concerning Y a 16 month0 old male with Down's syndrome N and7/1/2008 cardiac issues, 5/8/2009 and a history of a n has been received from a registered nurse for the Pregnancy Registry for GARDASIL concerning Y a 2512/4/2006 year old female 8/30/2007 who is a Guillain B n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL concerning a 22 Y year old patient 9/20/2006 who 9/20/2006 on 20-SEP-2006 was v n has been received from a nurse concerning aY14 month old female 0 who was vaccinated with U all three doses of ROTATEQ (dates, route a n has been received from authors of a published Y literature article concerning Y an 11 year old N male patient who was vaccinated with PNEUM vaccines rec'd 10/18/07 and 11/20/07. Y 3 mos later Y developed Guillain-Barre 5 syndrome/was hospitalizsed Y for acute ### lower 2/5/2008 extr. weakness. 5 4/28/09 after sx has resolved. Stated that 12 hr after Td-had arm soreness, faint pain in knees, Y felt like fever, 4/24/2009 enlarged 4/24/2009 lymph node under (L ches erythematous area on left arm, Mildly elevated. Still present 72 hours after vaccination. U 5/15/2009 @ injection site edema pain. Y Y 5/11/2009 5/12/2009 c received HPV, MENACTRA, Hep A, Tdap - observed pt. 15 min. after vaccinations. Pt. later Y reported she 5/13/2009 couldn't 5/13/2009 quite hear several hour ceived VARIVAX immunization 5/11/09, mom noticed rash on arms, legs and trunk 5/13/09. Y 8-10 small slightly 5/11/2009 raised 5/13/2009 lesions on arm, leg an Y U 4/28/2009 5/15/2009 vaccination, (hours later) redness and Y swelling developed around injection site. At ER, patient U was given 5/13/2009 ibuprophen 5/13/2009 and benadryl. 2 day alergic reaction to left thigh Y 5/12/2009 5/15/2009 apular rash post auricular nodes U 4/24/2009 5/3/2009 esented to the Emergency Room approximately Y 27 hours post vaccination with injection site Ycellulitis. Symptoms 5/13/2009 included 5/14/2009 reddness, heat ven Menningicoccal vaccine at approx. 9 am. at 930 am she started to feel dizzy and was beginning U to get 5/18/2009 a headache. 5/18/2009 Her father was calle 9 Adriana returned to have a TST read. PHN observed right arm triceps area reddened, firmYand warm 5/12/2009 to touch in an 5/13/2009 area 3 1/2 by 2 inche plained swollen area about size baseball Y noted under left arm noticed soreness under arm to U chest area5/14/2009 . This was5/16/2009 first noted on 05162009 erated vaccine well, but upon leaving office (within 5 minutes) was "not feeling well" per mom. Y While in car, 5/14/2009 continued 5/14/2009 to complain of not fee E OUT WITH PIMPLES ON FACE. SLIGHT REDNESS Y 5/18/2009 5/18/2009 slight fever and flu like symptoms and a base ball size knot that was warm and tender and decreased Y ROM 5/8/2009 2 days 5/10/2009 post shot. When pt repo baby on 5/11/09. Got MMR while still Y in hospital on 5/13/09. 2 hours later c/o numbness of tongue. N Later5/13/2009 c/o pain and 5/13/2009 tingling of l neck and d localized swelling at injection site which lasted 48 hrs. Y 5/15/2009 5/16/2009 d hard bump in arm that grew in size. She felt itching in the arm of injection that spread over Yentire body.5/18/2009 She had the 5/18/2009 previous two hepatitis s administered vaccines, before giving Y vaccine client said he had taken some Benadryl recently Y for allergies. 5/14/2009 After receiving 5/14/2009 vaccines client as given Vaccines and 48 hours later began having Y fevers and resultant 3 febrile seizure. HadYan ear infection 5/13/2009 noted 5/16/2009 at the appointment whe 9 the patient was given the meningitis vaccine: Meningococcal (MENACTRA) Polysaccharide Y accination4/28/2009 injection given 4/29/2009 in the left deltoid b atigue, migraines, nose bleeds, muscle Y & joint pain, sensitivity to light, mood swings, irritable,Nbrain fog, dizzy 5/10/2007 spells,6/11/2007 trembles, numbness, b where the vaccine was adminstered, which is the left shoulder, has been extremely sore and N I am unable 4/25/2009 to lift my arm 4/28/2009 up over my head, ne hing began less tan 12 hours after first Y hepatitis B vaccine; no hives/blisters; mother treated Y today for poison 5/11/2009 ivy exposure 5/18/2009 eltoid from Prevnar administered on 05/13/2009. left deltoid 5x4 erythemetous lesion, not indurated, Y nontender. 5/13/2009 ice 5/14/2009 and 12.5mg benadryl tw e of vaccine(prevnar) left deltoid 7x7 indurated erythemetous tender macualar eruption Ice, benadryl Y and5/13/2009 motrin 5/14/2009 e weak and dizzy while walking outside to car. Pt had syncopal episode and fell on sidewalkYoutside clinic. 4/27/2009 Her sister 4/27/2009 reports seeing her st eived Zostavax in am on 05/14/2009. The visit was uneventful. On 05/15/2009 she came back Y to the HD 5/14/2009 stating her 5/15/2009 r. lower arm was sore 1.9), achiness, headache, throwing Y up the morning after the shots, feeling week Y 5/12/2009 5/12/2009 NDURATED AND ERYTHEMATOUS. AREA 5CM BY 10CM STARTING AT INJECTION SITE U AND EXTENDING 5/12/2009DISALY CINE WAS INJECTED ON HER UPPER LEFT LEG. THE AREA WHERE SHE HAD THE VACCINE Y GOT5/4/2009 INFECTED. 5/11/2009 IT WAS PURPLE AN ted 4/15/09, chicken pox. Elevated IGG 1550 on 4/16/09. Transmitted to 9 mon old sib whoUalso tested IGG 4/7/2000 positive. 4/15/2009 after vaccines Y 5/18/2009 5/18/2009 d raised, reddened, approx 4 1/4 in x 3 1/2 in area painful and warm to touch. Left arm Posterior Y subqutaneous 5/4/2009 area 5/7/2009 has reddened area ap ed in clinic Td and Pneumovax injection. Pt states that evening she was ambulanced to ER with U severe body 5/15/2009 aches,5/15/2009 chills, and diaphoresis sh all over body, no urticaria, feels sandpapery Y 5/18/2009
er her first shot patient started having Y episods of what we thought were panic attacks. She had N a hard time 6/11/2008 breathing, 6/12/2008 her heart would race ad dizziness, nausea and vomiting Y on and off since HPV was given 3/16/09, associated withUbody malaise. 3/16/2009 There was 4/2/2009 no reported fever. rst booster injection given (April 8, 2009 Y I think) I experienced left arm itchiness with small bumps U 1 week5/15/2009 post the injection. 5/16/2009 The injection si p at injection site. Sore arm. Achey muscles. Y 5/12/2009 hing, unresponsive. Fussiness, fever, Y decreased Y appetite. 6/3/09 Hospital 1 records receivedYDOS 5/15/09 5/15/2009 to 5/16/09. 5/15/2009 FINAL DIAGNOSIS: d swollen with redness and pain. Y 5/13/2009 5/13/2009 was reported by a pharmacist and described the Y occurrence of decreased 0 oxygen saturationY in a neonate4/6/2009 male subject 4/6/2009 who was inadverte -104 X 2 days Y 5/12/2009 5/14/2009 en/red 2 days after vaccine administered Y (left thigh). Y 5/15/2009 5/17/2009 A and Influenza shot on 4/14/09 and SPV 4/16/09. She returned to the Imm Clinic on 4/23/09 for evaluation 4/14/2009 of SPV4/23/2009 (major take); pt reques g of day of shots - She developed chills vertigo, nausea (still able to drink.) confined to bed - Y missed school 5/12/2009 next day.5/12/2009 Mom states " this sens given in R thigh- 48 hours later, thighY with edema + splotchy erythema. R thigh 33 cm diameter, Y L thigh 29 5/13/2009 cm. At 72 5/12/2009 hours, rash worsened S B #2 (accelerated schedule) given Y 4/15/09 - later on 4/14/09 pt called with "arm burning". YNo other symptoms 4/13/2009advised 4/14/2009 ADVIL/cold comp nflammation 3 cm Rx for Benadryl given. Y 4/21/2009 systemically see clinical data report.Y Y 5/5/2009 5/6/2009 swelling-hard and warm to touch . Left Y upper thigh 8"x5" (redness). Seen at hospital. DX: cellulitis. Y RX: BACTRIM. 5/8/2009 5/9/2009 5/11/2009 Y Y 5/8/2009 5/9/2009 tous, swollen, large local reaction greater then 30cm 1 week after vaccine for DTAP. Y 4/16/2009 4/21/2009 4/14/2009 h red, indurated 1 1/2 - 2" area Y 5/5/2009 5/6/2009 which began a couple of hours after receiving vaccine. U 5/12/2009 5/12/2009 per right arm appeared red, swollen and hard with a measurement of 60mm induration. Patient N denied any itching or difficulty breathing. called back 2 days after ER visit to notify Y us that patient was very weak + had drowsiness, a Y "knot on the4/15/2009 left arm". The 4/15/2009 was patient last dos was reported in a literature article and described the occurrence of hepatitis B antigenemia in Y a 111-day-old subject of unspecified gender me in for Flu vaccine, Right and TDAP, Left. Complaint of pain and swelling next day- c/o very painful. Called 5/1/2009 PMD today-appointment 5/2/2009 mad injection site, right arm. Erythema right Y arm. Taking BENADRYL about every 8 hours. Y 5/8/2009 5/9/2009 d 13X14 CM Swollen, Redness, warm Y to touch. Apply cold compress (ice) every 2 hrs for 15Umin. Then warm. 5/5/2009 5/5/2009 ould have received a Tdap patient was administered a DTaP. No adverse event reported. Patient Y notified 5/11/2009 of mistake. orts that after HPV vaccine given on 2/27/09 she went home, started feeling dizzy, had chestYpain, rapid 2/27/2009 heart rate and 2/27/2009 vomiting for 3-4 day en lump L thigh. Y 5/7/2009 5/7/2009 esicles at injection site, followed by patch Y of erythema & induration expanding to 8 X 10 cm by 5/13/09. Borders 4/28/2009 slightly 4/30/2009 raised, mildly tende ceived VARIVAX vaccine on 12/19/97 and 6/27/08. Exposed to chicken pox vaccine 2 weeksY ago. Developed 6/27/2008 chicken 5/10/2009 pox rash on 5/10/09. iven 5/1/09 pri 5/1 - 5/09 Redness + swelling at site 5/5 - 8/09 no fever/chills. No antibiotics Y given. 5/1/2009 5/1/2009 receiving vaccine, mild swelling and tenderness of left upper arm / L axilla. Y 5/6/2009 5/8/2009
generalized. Benadryl 6.25 BID X 5 days ; weak 2y in Y 5/6/2009 5/11/2009 M ADSM is referred from a study for evaluation of previous local reaction to AVA #2. Symptoms: Y Edema8/12/2007 @ injection8/12/2007 site 50-120mm, Pain, tion to the pertussis in DTAP #5. Became pale approx 15-30 minutes after imm in peds. Returned Y to peds5/5/2009 at Dr.'s direction. 5/5/2009 Place on exam 9 1150/AM.- MMR #2 given. 730/PM. Y Pt had seizure taken to ER s+s unknown. Y 4/28/2009 4/28/2009 received first GARDASIL shot in June 2008. She passed out and hit her head getting a concussion N -the Dr 6/1/2008 believed-. She had to stay in be y MD on 3/13/09. Pt c/o rash in dermatome pattern from right lower flank which extends down U and wraps2/20/2009 around to ant 3/6/2009 thigh. Sx started 7 d n has been received through the Merck pregnancy registry, from a registered nurse concerning Y an approximately 1/20/200818 year old female with n n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL, concerning N a 222/22/2008 year old female 2/22/2008 who on 22-FEB-2 n has been received from Merck Pregnancy Y Registry for GARDASIL from a health care worker Y concerning2/7/2008 a her 15 year 7/1/2008 old daughter with n has been received from a physician Y and a registered nurse concerning a 10 years old female Y patient who 3/6/2008 on 06-MAR-2008, was vaccina n has been received from a physician's nurse concerning a female who in 01 July 2008, wasYvaccinated with 7/1/2008 GARDASIL 7/1/2008 vaccine (Lot# and n has been received from a registered Y nurse and a 26 year old female with no pertinent medical N history and 2/17/2009 no history of known drug react n has been received from a 20 yearYold female patient with no relative medical history, drug N reactions or allergies 3/1/2009who 3/1/2009 was vaccinated with n has been received from a physician Y concerning a 21 year old female who on 18-MAR-2009 Y was vaccinated 3/18/2009 intramuscularly 3/18/2009 with a first do n has been received from a 28 yearYold female patient with irregular heartbeat and no allergies N who in June 9/1/2007 2007, was 10/1/2007 vaccinated with the
n hs been received from a physicianY concerning a 15 year old female who was vaccinated with U GARDASIL. The patient developed genital n has been received from a physician concerning a either 15 or 16 year old female who wasYvaccinated with a dose of GARDASIL (lot num n has been received from a nurse concerning a 9 year old female with sore throat on 23-FEB-2009 N who 2/23/2009 was vaccinated with her first dose n has been received from a 30 year old female with no medical history reported, who on 24-JAN-2009 N was 1/24/2009 vaccinated 1/24/2009 with a 0.5 mL dose o n has been received from a nurse concerning a 23 year old female with a penicillin allergy who Y on 02-APR-2009 4/2/2009was4/2/2009 vaccinated with GAR n has been received from a nurse practitioner concerning a 19 year old female patient with no Y previous medical 3/27/2009 history 3/27/2009 reported who on 27 n has been received from a physician Y concerning a 13 year old female with a history of cancer N who was vaccinated with a first and second n has been received from a mother concerning her 14 year old daughter, with inflammatory N bowel disease 9/29/2008 and not known drug reactions/al n has been received from a Nurse Practitioner (N.P) concerning a 20 year old female patientNwith no pertinent 3/16/2009 medical 3/26/2009 history and no know n has been received from a registered nurse concerning a female patient who on 30-JAN-2009 U was vaccinated 1/30/2009 with1/30/2009 the first dose of GARD n has been received from an office manager concerning a female who was vaccinated in theUphysician's office with a second dose of GARD n has been received from a consumer who in January 2008, was vaccinated first dose of with U GARDASIL1/1/2008 (dose, route 1/1/2009 and lot number not p n has been received from a registered nurse concerning a 16 year old female with no knownYdrug reaction/allergies 4/3/2009 and 4/3/2009 no pertinent medic n has been received from a nurse practitioner concerning a female patient with allergy to Ceclor, U who on3/31/2009 31-MAR-2009 4/1/2009 was vaccinated wit n has been received from a nurse practitioner Y concerning a 19 year old female patient with no Y pertinent medical 2/4/2009 history 2/7/2009 or no known drug a n has been received from a 27 yearYold female with sulfonamide allergy who "about a year ago", Y in approximately 1/1/2008 2008 1/1/2008 was vaccinated wit n has been received from a physician Y concerning a female who on 22-DEC-2008 was vaccinated Y with the 2/18/2009 first dose2/18/2009 of GARDASIL vaccine. n has been received from a physician concerning a 20 year old female who on 30-MAR-2009 N was vaccinated 3/30/2009 with her 4/3/2009 first dose of GARDA n has been received from a physician Y concerning a 21 year old female patient who on 25-SEP-2007 N was9/25/2007 vaccinated with ### the first dose of G n has been received from a physician concerning a 20 year old female who on 02-APR-2009, U was vaccinated 4/2/2009 intramuscularly 4/2/2009 with third 0.5 n has been received from a physician Y concerning a 19 year old female who on 13-NOV-2008 U was vaccinated with ### first dose of GARDASIL n has been received from a registered Y nurse, for the GARDASIL vaccine a Pregnancy Registry U concerning 3/30/2009 a 17 year old female with sulfa n has been received from a registered Y pharmacist concerning her 17 year old daughter with Nno pertinent4/29/2008 medical history, 5/5/2008 who on an unspe n has been received from a registered nurse concerning a female who on an unknown date,Uwas vaccinated with GARDASIL (lot # not repo n has been received from a licensed practical nurse concerning a female with no drug reaction/allergies Y who was vaccinated with the first 0 n has been received from a Pharm. T. concerning a 23 year old female with sulfonamide allergy N and a 3/16/2009 history of birth 3/21/2009 control who on 16-M n has been received from a female staff member in a physician's office but not healthcare professional U concerning 5/16/2008 her 14 year old daughte n has been received from a nurse concerning Y a 15 year old female patient with no relative medical N history, 3/25/2009 drug reactions 3/27/2009 or allergies who i n has been received from a consumer concerning her daughter, a female patient, who on anUunspecified date was vaccinated with a dose n has been received from a practiceYmanager concerning a 22 year old female patient who on Y 06-FEB-2009 2/6/2009 was vaccinated 2/6/2009with her first d n has been received from a bachelor Y of science in nursing concerning a female who on 03-APR-2009 Y was4/3/2009 vaccinated 4/3/2009 with the second dose n has been received from a registered nurse concerning a 19 year old female patient with anemia, Y herpes type### 1 since July ### 2005 and sulfa n has been received from a registered nurse concerning a 17 year old female who on an unknown N date, received her 3/31/2009 second dose of GAR n has been received from a licensed Y vocational nurse concerning a female who on 04-OCT-2007 N was vaccinated 10/4/2007intramuscularly 10/4/2007 with a firs n has been received from a physician Y concerning a female who was already being treated for U vulvar Condyloma (genital wart) and was vac n has been received from a Registered Nurse (R.N.) reported that in February 2009 an unknown U number 2/1/2009 of patient may 2/1/2009 had received a dos n has been received from a Registered Nurse (R.N.) concerning an 18 year old female who Y on 02-APR-2009 4/2/2009 was vaccinated 4/2/2009 intramuscular n has been received from a physician concerning an approximately 15 year old female patient Y who was vaccinated 3/1/2009 with 3/1/2009 her first dose of GA n was received from a nurse practitioner Y concerning a 22 year old with a needle phobia and Uadmitted to 3/21/2009 passing out3/21/2009 with piercings and tatto n has been received from a physician Y concerning a 26 year old female at a high risk to allergies, U with penicillin 3/23/2009 allergy 3/24/2009 and a history of hosp n has been received from a licensed Y visiting nurse concerning a female with no pertinent medical N history10/4/2007 or drug allergies 10/4/2007 who on 04-OCTn has been received from a physician concerning two 17 year old female who on an unspecified Y date were vaccinated with a 0.5 ml second n has been received from a consumer Y concerning her daughter, a 17 year old female patientYwith no relevant 3/27/2009 medical 3/27/2009 history, drug reaction n has been received from a pharmacist concerning a patient who was vaccinated with a second U and third4/8/2009 dose of GARDASIL 4/8/2009 (lot # not rep n has been received from a physician concerning an unknown number of female patients with U no pertinent medical history or drug allergies n has been received from a Registered Nurse concerning a female who on an unspecified date U was vaccinated with GARDASIL and exper n has been received from a 46 yearYold female with allergies to sulfa and ATARAX and no pertinent N medical 3/30/2009 history3/30/2009 who on 30-MAR-2009 n has been received from a physician concerning a 14 year old patient who on 05-MAR-2009 Y was vaccinated 3/5/2009 with the 3/5/2009 first dose of GARDA n has been received from a physician concerning a patient who experienced heavy menstrual U bleeding about a year ago after receiving a d n has been received from a physician Y concerning a 19 year old female with no medical history N and drugs 3/6/2008 allergies, who 3/21/2009 on 06-AUG-2007 w n has been received from a consumer concerning her daughter, a 15 year old patient with no N pertinent medical 4/7/2009 history 4/7/2009 and no known drug
n has been received from a consumer concerning his 22 year old female wife who on 16-APR-2008 N was vaccinated with the first 0.5 mL do n has been received from a medical assistant concerning her 12 year old daughter with no pertinent N medical 4/6/2009 history reported 4/6/2009and no known n hs been received from a physician concerning a patient who on an unspecified date was vaccinated U with a dose of GARDAIL (dose, route n has been received from a dentist concerning her 13 year old daughter who on 08-APR-2009 N was vaccinated 4/8/2009 with the 4/9/2009 first dose of GARDA n has been received from a physician Y concerning a 15 year old female patient with no known N drug allergies/drug 2/5/2009reactions 3/31/2009 who on 05-FEBn has been received from a nurse practitioner Y concerning a 17 year old female who on 13-AUG-2007 U was 8/20/2008 vaccinated 8/20/2008 with the first dose of n has been received from a healthcare Y worker concerning a 12 or 13 year old female patientYwith no relative 1/22/2009 medical 1/22/2009 history, drug reactions n has been received from a physician concerning a 25 year old female teacher with no knowNdrug allergy 4/1/2009 who on 01-APR-2009 4/5/2009 was vaccin n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 2/26/2009 her daughter, an approximately 1 n has been received from a physician Y and a registered nurse concerning a 19 years old female N patient who 1/7/2009 was vaccinated 3/1/2009 with a complete n has been received from a physician Y and a registered nurse concerning a 27 years old female Y patient who 6/13/2007 was vaccinated 12/5/2007 with a complete n has been received from a physician Y concerning a female patient who was vaccinated with Na complete series of GARDASIL. It was reporte n has been received from a 25 year old female with no medical history and drug allergy whoUwas vaccinated with her second dose of GARD n hs been received from a consumer concerning a 10 year old female who was vaccinated with U GARDASIL. Then the patient started to fee n has been received from a female patient who was a medical assistant and a physician concerning Y the 2/18/2009 patient who2/19/2009 was vaccinated with h n has been received from a registered Y nurse concerning her daughter who 02-FEB-2009 was N vaccinated10/3/2008 with her third dose ###of GARDASIL n has been received from a physician assistant concerning a 21 year old female with no medical N history 1/27/2009 or drug allergies 4/1/2009 who was vaccinat n has been received from a registered Y nurse concerning an 18 year old female with a historyNof cardiac murmur 4/7/2009 who 4/9/2009 on 07-APR-2009 was n has been received from a registered nurse concerning an 18 year old female with asthma Y and no known 4/13/2009 drug allergies 4/14/2009 who on 27-JUN-2 n has been received from a registered nurse concerning a 27 year old female who on an unspecified N dates was vaccinated with the three d n has been received from a nurse concerning a 17 year old female patient who in approximately Y January 2009 (reported as about 3 months n has been received from a pharmacist Y reported that he received a call from a mother concerning N a 14 female ### daughter who was vaccinate rmation was received from a physician, and follow up information from a nurse concerning a Y female patient who was vaccinated with her se n has been received from a Licensed Visiting Nurse concerning a 12 year old patient who onU03-APR-2009 8/6/2008 was vaccinated 8/6/2008 with the first do n has been received from a physician concerning a female patient who "last year" in 2008 was Y vaccinated with her second dose of GARDA n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 19 11/4/2008 year old female 11/4/2008 with no relevant n has been received from a physician assistant concerning a 16 year old female with negative Y medical history 4/13/2009 who on 4/13/2009 13-APR-2009 receiv n has been received from a physician Y assistant concerning a 29 year old female patient whoNon 13-APR-2009 4/14/2009 was vaccinated 4/15/2009 with GARDA n has been received from a registered Y nurse, for GARDASIL, a pregnancy registry product, Y concerning a 6/3/2008 16 year old 3/25/2009 female who on 03-JU n has been received from an office Y manager who stated that she received this report from the U patient's mother. The patient's mother had re n has been received from a physician Y assistant and nurse concerning a 17 year old female who Y on 25-DEC-2008 ###was vaccinated ### with the f n has been received from a nurse practitioner concerning a 24 year old female with KEFLEXYallergy and3/30/2009 irregular heartbeat 4/6/2009 who on 30-MA n has been received from consumerY concerning her 17 year old daughter who"2 or 3 months U ago" was 4/13/2009 vaccinated 4/14/2009 with the first dose of GA n has been received from a physician and his office manager concerning a 25 year old female N with a history 4/11/2009 of bladder 4/13/2009 repair in July 2007 d n has been received via medical record Y from a registered nurse concerning a 16 year old female Y with heavy 3/20/2009 menstrual 3/22/2009 periods (last menstr n has been received from an office assistant and a female patient who on 19-MAR-2009 was N vaccinated3/19/2009 the first dose 3/26/2009 of GARDASIL. Conc n has been received from a registered Y nurse and a licensed practical nurse from patient's report Y and emergency 2/16/2009 room 2/16/2009 (ER) records concer follow-up information has been received Y from a licensed nurse practitioner concerning a female U patient who on an unknown date was vacc n has been received from a physician Y and a licensed visiting nurse, concerning a 11 year oldNfemale patient, who ###on12/1/2008 13-AUG-2008 was va n has been received from a Allergy YTechnician concerning a 14 year old female patient with Nno pertinent medical ###history 12/5/2008 and no drug reacti n has been received from a medical assistant concerning an unknown number of patients whom U were vaccinated with a dose of GARDASI n has been received from a physician Y concerning a 16 year old female who was vaccinated Y with three doses of GARDASIL (Lot # not repo n has been received for the Merck pregnancy Y registry of GARDASIL from a 22 year old female N patient with 2/16/2009 iodine allergy 2/16/2009 and a history of "p n has been received from a physician concerning a female patient who on unspecified datesYwas vaccinated with the first, second and third n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5mL dose of GARDASIL n has been received from a medicalYcoordinator concerning an 18 year old female who on 25-MAR-2009 Y 3/25/2009 was vaccinated 3/25/2009 with the first dos follow-up information has been received from a physician and the physician's office manager Y concerning3/23/2009 a 19 year 3/23/2009 old female who on 23-M n has been received from a nurse practitioner concerning a 25 year old female who on an unspecified N date was vaccinated with first 0.5 mL n has been received from a physician concerning a female patient who was vaccinated with a dose of GARDASIL IM. On an unspecified da n has been received from a Registered Nurse concerning a 25 year old female who in 2006 Y("3 years ago") was vaccinated with her first an n has been received from a registered Y nurse, for the Pregnancy registry for GARDASIL, concerning U a 22 year old female 4/22/2008 with no pertinent
n has been received from a physician concerning an 18 year old female patient who on 22-JAN-2009 Y was vaccinated4/1/2009 with her first dose of n has been received from a physician Y concerning a 26 year old female with no drug reactions N or allergies who in 2008 4/21/2009 was vaccinated with n has been received from a physician concerning three patient who were vaccinated with GARDASIL U and tested positive for a high risk stra n hs been received from a nurse practitioner concerning a 14 year old female student with no Y pertinent medical 9/22/2008 history 9/23/2008 and no known drug n has been received from a physician Y concerning a 11 year old female with bronchospasm exercise Y induced 4/21/2009 who n 4/21/2009 21-APR-2009 was vacc n has been received from a registered Y nurse, concerning a female who was vaccinated withUGARDASIL that was stored improperly at 32 F n has been received from a registered Y nurse (R.N.) concerning a 19 year old sexually activeNfemale who from 10-JUL-2007 3/27/2009 was vaccinated n has been received from a consumer Y concerning her 17 year old daughter with no medical N history and allergies, 4/17/2009who 4/20/2009 on 17-APR-2009 wa n has been received from a physician concerning a patient who unspecified date was vaccinated U with GARDASIL (lot # not reported). On u n has been received from a nurse practitioner Y concerning a 24 year old female who vaccinated Y the first dose of GARDASIL 7/1/2008 on an unspecifi n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL and experienced a vasovagal re n has been received from a consumer concerning her daughter, a 16 year old female who on Y unspecified dates was vaccinated with a first n has been received from a physician Y concerning a 40 year old female who experienced pain U on her shoulders, knees and sometime in her n has been received from a physician Y concerning a 19-20 year old female who was vaccinated N with the first 0.5 ml dose of GARDASIL (no n has been received from a physician's assistant concerning a female patient who on unspecified U dates was vaccinated with the first, secon n has been received from a nurse practitioner concerning a female patient, who was vaccinated U with the3/18/2009 third dose 3/25/2009 of GARDASIL, 0.5ml. N n has been received from a consumer a 28 year old nurse with latex allergy and a history of Yparoxysmal supraventricular 2/23/2009 Tachycardia (PSV n has been received from a licensed Y practical nurse concerning a 22 year old female with a N medical history 3/26/2009 of knee operation 4/8/2009 in 2004 who n has been received from a the doctor's nurse concerning a 25 year old female who on 21-APR-2009, U was 4/21/2009 vaccinated 4/23/2009 intramuscularly with n has been received from a registered nurse concerning that her son's several female friends U developed muscle twitches and tingling sens n has been received from a consumer concerning her 18 year old daughter who was vaccinated U with the first dose of GARDASIL (lot#, rou n has been received from LicensedYPractical Nurse (LPN) concerning a 19 year old sexuallyNactive female 11/1/2008 who in April 4/9/2009 2008, an unspecifie n has been received from a medical assistant concerning a 17 year old female who on 26-FEB-2009 N was 2/26/2009 vaccinated3/5/2009 with the first dose of G n has been received from an office manager concerning a female who was vaccinated with the U first, the 5/11/2007 second and the third dose of GARD n has been received from a licensed practical nurse concerning a 16 year old female who inYSeptember 2/27/2008 2008, was 2/27/2008 vaccinated with GARDA n has been received from a physician Y concerning an 18 year old female who was vaccinatedNwith the first 7/19/2007 dose of GARDASIL 3/13/2009 on 12-JAN-2 n has been received from a physician Y concerning an 18 year old female who was vaccinatedUwith GARDASIL. 6/19/2007 The 9/19/2008 patient had a negative p n has been received from a physician Y concerning a 21 year old female who had a negative pap U smear test 1/15/2008 on 09-JAN-2006. 4/9/2009Patient then re n has been received from a registered nurse concerning a 33 year old female with on pertinent U medical history and no allergies who in app n has been received from a consumer concerning her 21 year old daughter who was vaccinated Y with the first dose of GARDASIL (lot #, rou n has been received from a registered Y nurse and a patient care coordinator concerning a 19Nyear old female 7/8/2008 who in June 2007, was vaccin n has been received from a certifiedYmedical assistant concerning a 21 year old female with N amoxicillin allergy and no 2/1/2009 pertinent medical his n has been received from certified medical Y assistant concerning a 3 year old female patient N with no drug reaction 7/1/2008or10/1/2008 allergies and no pertin n has been received from a nurse concerning Y an "about 20 year old" female who on an unspecified U date was vaccinated 2/1/2009 with third 0.5mL d n has been received from a physician concerning his daughter who on an unknown date was U vaccinated with a dose of GARDASIL and the n has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 2/10/2009 or no known 2/10/2009 drug/allergy reac n has been received from a consumer concerning her 15 year old daughter with no pertinentNmedical history and no known drug allergies/d n has been received from a physician Y concerning a 21 year old female with sulfonamide allergy who on 1/18/2008 18-JAN-2008 1/19/2008 was vaccinated intram n has been received from a physician concerning an 18 year old female who was vaccinatedUwith GARDASIL. The physician reported that rmation was received from a physician and follow up from a licensed practical nurse concerning Y a 20 year old female ### 11/1/2008 who was vaccinated w n has been received from a certified nurse practitioner concerning a female who on an unspecified U date was vaccinated with first dose of G n has been received from a nurse practitioner Y (N.P.), for the Pregnancy Registry for GARDASIL, Y concerning 4/30/2008 a 23 year 6/19/2008 old female with no p n has been received from a 52 yearYold licensed visiting nurse who was splashedYwhile she N was withdrawing 11/1/2008 a dose11/1/2008 of PNEUMOVAX 23 in n has been received from a 69 yearYold femaleYpatient who "2 or 3 years 0 ago" was vaccinated Y with a dose of PNEUMOVAX (manufacturer n has been received from a physician Y concerning his 54 year old wife with allergy to sulfa drugs Y like Bactrim 8/20/1998 and no8/20/1998 pertinent medical histo n has been received from a physician concerning Y an approximately 117 week old male who was U vaccinated 5/7/2009 orally with 5/11/2009 a 2 ml second dose o n has been received from a physician Y concerning Y a patient who on an 1 unspecified dates wasUvaccinated7/14/2008 orally with 5/11/2009 three doses of ROTATE n has been received from a physician Y concerning Y a 12 month old male 3 who on 07-JUL-2008Ywas vaccinated with ###the first dose of ROTATE solated IgA deficiency, administered pneumococcal Y vaccine. 4 days 2before admit she developed Y swelling, 4/20/2009 redness &4/20/2009 fever within 24 hrs of i ort received from a consumer on 08 May 2009, Y who is also the patient's 0 parent. A 37-year-oldUfemale patient 4/21/2009 with an unknown medical histo was received on 13 May 2009 fromYa consumer. A 41 year old female patient received ACAM2000 N (lot number 5/2/2009 unknown) 5/11/2009 in her left arm an
ped pain, swelling and redness at site of vaccine LD after receiving it. Y 5/8/2009 5/9/2009 ates pt received vaccine then had some blood work in office. After ten minutes pt complained Y of dizziness 7/14/2008 accompanied 7/14/2008 with numbness in ng by 8 cm wide erythema & warmth ant/lad @ thigh. 5/13/2009 5/13/2009 set (10-12 hours) post vaccine fever. Y 104 T max. Fever lasted 48 hours, then abruptly stopped, and a lacy 5/13/2009 red rash5/13/2009 appeared head to toe. ven Adacel, Menactra + PPD. Began feeling light headed, sat in chair and became faint. Y 4/20/2009 4/20/2009 er, I awoke with a 3 inch red, hot, itchy, swollen circular patch on my upper right arm. I called Y pharmacist 5/1/2009 and saw my5/4/2009 doctor. Benadryl pre ven MENACTRA 0.5 ml @ deltoid on 5/12/09. On 5/13/09 at approx 7pm pt & parent noted large Y localized 5/12/2009 reaction.5/13/2009 Redness & warmth 5x hours- Left arm (between elbow andY deltoid) became swollen 3x normal size at site of varicella Y vaccine. 5/12/2009 Within 48 hours 5/13/2009 red welted rash d ately 24 post Kinrix vaccination patient had marked non-pitting edema to his right upper leg with Y redness that extended from his right greate IVEN 4-14-09 AND PATIENT REPORTS ONSET OF SEVERE HEADACHE ON 4-15-09. Y 4/14/2009 4/15/2009 02 degrees Body aches.chills,fever, red swollen left arm. Applied ice to left arm, Tylenol Y 5/12/2009 5/12/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile Water. Patient does ceived MCV4 in Left deltoid and Tdap in Right deltoid on 5/12/09. She came in 5/18/09 c/o left Y upper arm 5/12/2009 itching for5/15/2009 a few days (approx sta cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/13/2009 in Sterile Water. Patient does ide effects include: diarrhea, stomach pain, discomfort, cranky behavior, problems with sleep, Y excessive5/14/2009 crying, but 5/15/2009 no fever. The adverse e Y 5/18/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/14/2009 in Sterile Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/12/2009 in Sterile Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile Water. Patient does d baseball size knot with redness, swelling and fever noted. Pt taking benadryl. Y 5/18/2009 5/18/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/12/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does y administered an expired Hep A vaccine to patient. She did not have any adverse symptomsYat the time.5/19/2009 No treatment 5/19/2009 given. cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does er second gardasil, pt went to ER for Y dizziness, ataxia and severe headache. Skull x ray, ct head Y and lab4/18/2008 work all negative. 4/18/2008 7/2/09 Receive ht immigration form from civil surgeon Y with need for Td, PPV, Varicella (due to neg blood titer) and Zoster. 5/13/2009 I said Zostavax 5/17/2009 not needed beca cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/13/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and U 0.25% phenol 5/13/2009 in Sterile Water. Patient does er receiving vaccines, he had left upper extremity Y swelling, redness,2and warmth. His left thumb U base was 5/13/2009 itching. There 5/18/2009 was left thumb pai ling of nausia. Sycope within minutes of the injections. Fell and hit head. Regained consciousness U within 5/19/2009 a few minutes 5/19/2009 under care of the PLAINING OF VOMITING AFTER VACCINES WERE ADMINISTERED. HE WAS SEEN BY U ANOTHER 5/19/2009 PROVIDER5/19/2009 LATER THE SAME EV pain in arm of injection, inability to move/lift Y arm, extreme stiffness and pain in neck, enlargedYand painful/tender 5/13/2009 touch 5/14/2009 glands in neck. Could hema, vesicular rash in dermatome Y distribution (L/arm). Rx : ACYCLOVIR 800 5x/d. LYRICAU50. tid and 5/13/2009 VICODIN. 5/17/2009 ely post immunizations baby became very pale & lethargic HR 100 initially - increased 120s with Y stimuli pulse 5/13/2009 0 X 965/13/2009 arousable but sleepy g turned 30 min after immunization with hives. Lungs CTA Heart Reg Benadryl 12.5mg given-Ypt observed5/13/2009 x 20 min still 5/13/2009 with hives but active. warmth, erythema approx 10 cm around Y injection site. Y 5/12/2009 5/14/2009 se effects noted per patients father - 5-13-09. Y 5/12/2009 stated that his "arm is sore." No other adverse effects noted, 5-13-09. Y 5/12/2009 ns were given at 2:30 pm; Pt waited in the room for 15 minutes. Waiting then to have lab drawn Y noticed5/12/2009 her right hand 5/12/2009 swelling on the dors was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and n muscles, joints. Felt hot all over, pressure Y in chest. Given IV fluids DILAUDID, ZOFRAN inY ER. 5/6/09 5/5/2009 6 am D/C with 5/6/2009 VICODIN for pain. .5 within 24 hrs of vaccine administration. 5/13/2009 5/14/2009 ack ache in mid + lower back muscles which woke me from sleep. Restlessness + achey thatY night. Gradually 3/30/2009 decreased 3/31/2009 over next 3 days. ruised at injection site - high fever - Paleness, Weak, dizzy - Sore throat, ear ache, sore eyesY - chills 3 days 2/27/2009 MOTRIN 2/27/2009 & TYLENOT given upper pain with 3" swelling, redness, Y heat, hardness. 5-12-09 Went to place @ 6-7 pm.- was Y told "reaction 5/11/2009 to tetanus 5/12/2009 but not bad enough swelling, 6" down arm, 3-4" wide, with heat. No fever. Pain in arm as well. Diagnosis cellulitis Y secondary 4/27/2009 to injection. 4/29/2009 Tx with AUGMENTI hargy, rash started 6 days following vaccination. Some rhinorrhea started 5/8/09 with slight cough Y Fever4/29/2009 > 104 degrees. 5/5/2009 ters branching out / popping up on nose Y area - 7 total so far, patient was contacting doctor. U 5/12/2009 5/15/2009
ped rash behind his leg, forearms and Y few spots on trunk. Describes as itchy, appears dry, Y Flat. Began4/29/2009 approx. 244/30/2009 hours post 2nd dose H y - few hrs. after Gardasil #3. Y 8/18/2008 8/18/2008 en and red at injection site. 5/13/2009 epared for older sister & accidently given to younger child. Y 5/14/2009 ess, malaise, swelling of lymph nodes Y day of injection. Involuntary muscle twitching seizureYon Saturday. 4/30/2009 5/2/2009 ceived Hep A on right arm and HPV on Left arm a few seconds later while nurse in room hadYdazed look5/18/2009 and feeling5/18/2009 a heavy feeling lay bac d Tdap, HPV and Menactra and then slumped over into mother's arms motionless, then jerked Y involuntarily 5/19/2009 and was5/19/2009 layed down with eyes as fatigued a few hours after the injection. About 6 hrs after injections, there was a small rash U around area. 5/14/2009 Fever started 5/14/2009 @ 10:pm, patien m swelling, leg and back - pain. Y Y 5/13/2009 5/13/2009 dizziness, pulse rate 100, low grade fever, sore arm w/hot to touch + tired. These symptomsUstarted about 4/30/2009 12 hrs after 4/30/2009 vaccine was given a nted about 10 minutes after the last shot, falling off the table. ? L.O.C for about 3 minutes. Y 5/18/2009 5/18/2009 t. Extreme fussiness trouble sleeping. only when carried. Y 5/11/2009 5/13/2009 len, warm, painful area to upper right Y thigh 24 hours post vaccination. Approx 24 cm X 19cm. U Also noted 5/12/2009 several fluid 5/13/2009 - filled vesicles at in d high fever to 104 with lethargy on day of vaccinations, after they were given. 2 days later she Y developed5/5/2009 hives that5/5/2009 lasted for 2-3 days. P STAVAX administered; pain at injection site 5/5/09 redness/hardness 3 inches wide & 6 inches U long extending 5/4/2009 from injection 5/5/2009site & down th 5/13/2009 reaction with redness & swelling @ injection site, radiating heat. check non-sotp crying > 3 hours (or more) 5/18/2009 post injection. 5/18/2009 esented shortly after receiving the vaccine Y with slight red rash to all body parts. Benadryl Administered. Y 5/18/2009 5/18/2009 d #2 Hep A vaccine. 3 min. later became dizzy & fell. ? loss of consciousness x few seconds. Y BP- 80/60 3/18/2009 Pulse- regular. 3/18/2009 Skin warm/dry. f 5-8-09. Mom noticed a rash on child. Child has had low grade fever. Decreased appetite U and fluid intake. 5/7/2009 Fussy more 5/8/2009 than usual. Pin h y weekend, use bandages slides off. Y Reaction occurs progressively starting around original vaccination U point 3/10/2009 to upper 4/25/2009 arm. Exam reveals c 5/9/2009 N 5/4/2009 5/9/2009 N vaccine 3/1/09, developed fever chills, Y rigor, malaise, Y pain @ injection 4 site, admitted to hospital Y for cellulitis 3/1/2009 at TD injection 3/2/2009 site. Treated wit ale presented to the office for routine follow up of chronic medical problems. She had a routine physical examination 5/1/2009 5/1/2009 on 8/8/08 at which tim ter - chills - increased pulse - about 15 next 2 days - fever, weakness, sweating. Also noticed Y lower blood 4/14/2009 pressure,4/14/2009 about 20 points. Only d with bruise @ site of immunization + swelling + erythema. Pt very fussy and difficult to console. Y 5/7/2009 5/7/2009 ct identified himself as a cardio-vascular surgeon, Y 22 years in Army.5He was deployed Y to a foreign N country in 1991, at which time he receive Herpes Zoster - began 5-3-09. Y U 11/4/2008 sh "hives" x 3 days; improving after 3 days per mother. Rash started 7 days after vaccinations U in same place 5/4/2009 as administered 5/11/2009VARIVAX. Mo n has been received from a registered Y nurse concerning an approximately 14 year old female U patient who3/7/2008 on 22-AUG-2007, 19-OCT-2007 n has been received from a physician concerning a 15 year old female patient who was vaccinated U with 1/26/2009 the first dose of GARDASIL IM, 0.5 n has been received from a physician concerning a 19 year old female Y with no known medical Y history, allergies 5/17/2007 or drug reactions ### who in Ma n has been received from a office manager Y concerning a 4 year old male patient with no pertinent N medical history ###and no known drug allerg Menactra on 5/13/09 and developed fever, myalgia, and headache on 5/14/09. Seen at office Y and instructed 5/13/2009 to take 5/14/2009 ibuprofen. ceived a Hepatitis B vaccine on May 18th @ 1:37 PM. She recieved a second dose of the vaccine Y on May 5/19/2009 18th @ 12:45 5/19/2009 AM. No known com ceived the HPV vaccine in the late afternoon Y of Wednesday, May 6, 2009. Early on ThursdayU morning she5/6/2009 woke up with 5/7/2009 pain in her right leg er receiving VZV#2, felt cold and had Y sore throat, day 8 or 9 post vaccination, noticed rash to back of neck 5/5/2009 with itching; 5/17/2009 15 days post vaccin ports they were awakened in the middle Y of the night with patient screaming. When they wentYto him, he was 5/19/2009 very hot, 5/20/2009 then he immediately s ported that child's entire left thigh was reddened, swollen, and warm to touch within 25 hoursYof receipt of4/22/2009 vaccines. 4/23/2009 Mom gave motrin and b oyee PE 11/10/08. Received flu vaccine, Y TB test and Hep B vaccine 11/10/08 during employee PE. Then was sent ### to health ###Dept. for Tdap P and IPV vaccines on 4/29/09, came in to office on 5/1/09 with R leg red, swollen, hot and painful Y to touch. 4/29/2009 Diagnosed with cellulitis and tr ection site, difficulty breathing and nausea. Y Y 5/17/2009 5/17/2009 ew months of the vaccination on 12/05/06, I became less stable on my feet, and experienced Y Nsymptoms 12/5/2006 of neuropathy 4/15/2007 including foot drop, l 11, 2009, I went in for aYcheck-up, Y and referralYfor neurological evaluation 1 and saw Dr. I hadYbeen previously 3/11/2008 ill since 3/14/2008 April 2005, and had b perienced chest pain and flushing. EKG was done. Pt felt better. Had subsequent ECHO and Y HOLTER and 4/23/2009 work up4/23/2009 by cardiology. as immunized with Yellow Fever vaccine and dose #2 of Twinrix (HepA/HepB) vaccine on 4/28/2009. U The 4/28/2009 patient reports 4/29/2009 that she develope red spot at injection site; size of baseball; Y red area is hard; Provided Motrin and Tylenol as has U had a fever 5/18/2009 since date 5/19/2009 of shot (Monday, Ma scribed a tightness in chest with difficulty breathing Y within 5 minutes2of getting the vaccine. U Patient was 5/18/2009 given an injection 5/19/2009 of epinephrine s rs after injection, patient developed red, inflamed, warm to the touch, 2" radius reaction at injection Y site. 48 hours after injection site not as Y ###
RM NUMBNESS AFTER RECEIVING VACCINATIONS, THEN 2.5 MINUTES AFTER C/O BECOMING Y LIGHTHEADED 5/20/2009 5/20/2009 AND DIZZY cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/20/2009 Water. Patient does B Vaccine, Dose 2 administered on 5/18/09 @ 3 PM. On 5/19/09 upon awakening in morning, Y patient describes 5/18/2009 itching 5/19/2009 hives over upper ch KIN;CC swelling and redness left upper arm;site of the pneumonia shot ;was given 11/12/08Yin clinic. The patient ###return here ###11/13/08 arm d herpes simplex in the eye, April, 2009. Was treated by Dr. for it. Y 1/14/2009 4/16/2009 ave no known allergies (especially neomycin Y or gelatin which are contraindications for Zostavax) Y patient 5/15/2009 had a significant 5/16/2009 reaction to shingle PED HIGH-PITCHED SCREAMING WHEN LAYED DOWN, ARCHING OF BACK TREMOR AND Y OPEN,1/23/2008 GLAZED EYES 1/23/2009 WITHIN AN HOU equiring 2 doses of IV medication. Y 6/29/09 Y Hospital Y ER records received 2 DOS 6/17/09. Assessment: Y Second 5/19/2009 afebrile5/19/2009 seizure. Patient presen jection administered. Immediately after PEDIARIX given body stiffened, eyes rolled back in head Y and stopped 5/19/2009 breathing 5/19/2009 x 2-3 seconds. Re d swollen, hard, hot & red where vaccine given. 6 cm / 5 1/2 cm. Circ. 23 cm. Y 5/12/2009 5/13/2009 lls, muscle aches. Y 5/14/2009 5/14/2009 5/18/2009 ace, trunk and extremities 5/18/2009 utes after vaccine administered Pt began Y c/o dizziness and weakness in upper extremities. Pt. U then began 5/19/2009 c/o weakness 5/19/2009 in lower extremitie (R) arm- swollen, unable to move. Numbness in fingers, swollen hand. Y 5/19/2009 5/19/2009 t after receiving ADACEL, MENACTRA and GARDASIL. She then became opisthotonic, began Y salivating, 5/19/2009 eyes rolled 5/19/2009 back. Episode lasted wollen, Eye lid, decreased appetite.Y Y 5/19/2009 5/19/2009 vaccinated with SPV around 09 AprY09, approx 24 Apr wife developed a lesion near her eye,Yher arm and4/9/2009 multiple lesions 4/24/2009 on vaginal area. in erythema edema and pruritic sx.Y5/10/09. U 5/18/2009 5/19/2009 accine onset redness @ vaccine site Y 5/11/2009 5/12/2009 R upper extremity treated with oral LEVAQUIN. Y Y 5/14/2009 5/15/2009 lness. - Generalized skin rash (topical Y chicken pox rash). - Bilateral Otitis Media. U 5/5/2009 5/10/2009 n: the day after receiving his first anthrax Y shot, SM developed hives and was seen at the local Y ER x2 because 9/30/2007 hives did not resolve despite panic male, PVT, ADSM reports eruption Y of skin skin rash some 3 weeks after his receipt of U primary SPV4/16/2009 and TYPHOID 5/7/2009 vaccines. Sympto 5 cm slightly tender red swelling on the left thigh. Y 5/19/2009 5/19/2009 Y 4/24/2009 4/24/2009 accine administered - no adverse event Y during 15 min wait. 5/6/09 -Courtesy call follow-up - Y Pt reports rash 5/1/2009 and bumps 5/6/2009 under right breast a red, warm, and swollen crying uncontrollably Y Y 5/20/2009 5/20/2009 me down with shingles anyway, diagnosed Y 5/19/09. Rash and blisters on face...lip and below lip and in eye. 1/14/2009 Spent 5/16/2009 $300.00 on vaccine and ine red rash on both her arms and thighs. Itchy. states started the next day after recieving Tdap. U 5/16/2009 5/17/2009 ped a rash thought to be Shingles approx Y 3 weeks s/p Zostavax administration. Pt treated with U valacyclovir. 2/9/2009 3/4/2009 s were administered to this chld. Immediately after the 5th vaccine, the pt. displayed mild seizure Y activity5/19/2009 lasting about 5/19/2009 5 seconds. She awo HAV and Depo Provera at doctor visit Y on a.m. In p.m. state symptoms of back pain, epigastric Y pain, temp. 2/26/2009 high 105 2/26/2009 degrees ache all over, ur office on 5/12/09 for 4 year old boosters. Y Two days later developed red, swollen left arm. YDiagnose with 5/12/2009 cellulits 5/14/2009 secondary to vaccine a eft deltoid to elbow redness and swelling-fever,headache,and Y aches all over especially legs-relief Y with tylenol-denies 5/15/2009 5/16/2009 rash,hives,shortness pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2 1/29/09 with enterococcal Y prostatitis. 4/14/2008 Vaccination 1/29/2009 took place on 4/14/0 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2/25/09 with Urinary tract Y infection 4/14/2008 - bacteremia. 2/25/2009 Vaccination took plac call from Mom 5/21/2009 R/T patients Left thigh. DTaP injection admininstered 5/18/2009.Red feverish area 5/18/2009 measuring 5/19/2009 7 1/2 x 4 1/2 on Le ped myocarditis. Symptoms developed Y on 27 April. Y Smallpox vaccination 8 given on 19 Apr 09 U 5/28/09 Medical 4/19/2009 records 4/27/2009 received DOS 4/27 red vaccines at 11:40; promptly fainted; Y as she fainted she fell from the chair to the floor; had Y approx 2-35/21/2009 second duration 5/21/2009 seizure with twitc Zoster- Appeared on patient's left arm Y extending linearly from the left clavicle to the left wristY two weeks4/22/2009 after vaccine 4/30/2009 administration. The v SHES, JOINT PAIN , MUSCLE PAIN, U 11/4/2003 11/5/2003 iving vaccinations, patient felt faint lightheaded Y 5/20/2009 5/20/2009 days after receiving Zostavax vaccination, client had painful blisters on her scalp and top of the Y head with 5/12/2009 severe headaches. 5/19/2009 Saw her HCP of rash and swollen on both thighs after MMR and Varicella vaccines. U 5/11/2009 5/11/2009 action - itching - immediate with hives and rash developing over a 3 day time period. Treated Y with 50mg q6h 5/8/2009 benadryl 5/8/2009 and 10mg claritin - r me in on 8/12/08 for Gardasil and Varivax. Patient Y was counseled for 8 pregnancy. Patient called Y on 5/21/09 8/12/2008 and stated 4/27/2009 that she had been turned to clinic two days post vaccination with a red, slightly swollen area to Right upper arm.U Area is circular 5/19/2009 in shape 5/21/2009 and the size of a ha rovider pt seen in ER 5/13/09 pm - 30hr Y after vaccine gen rash + 102 fever. 5/14/09 still has fever + gen 5/12/2009 rash. Given5/13/2009 antibiotics in ER 5/13/2 ated she had localized swelling in left upper arm (injection site) within 24 hours. Been on 5/15/09 U no redness. 5/11/2009 C/o pain 5/12/2009 from left shoulder to ever 101.8, eating ok, not acting sick, no rash, given TYLENOL for fever. Recommended if not Y better in a4/28/2009 few days or 5/21/2009 if worse to be seen
given at about 12:30pm. By 7PM, arm ached - pain in (L) elbow- Daily pain increase in all joints Y and pain 5/12/2009 has continued 5/12/2009 even now. multiforme 4 days after administration. N 5/14/2009 5/19/2009 and tenderness with local swelling at Y injection site; painful to raise arm. Tx'd with NSAIDS. Pt U reports had 5/18/2009 sweats &5/18/2009 chills the evening of im rash, hives around injection site not sure when it started per patient Y 5/11/2009 d (+) erythema and edema - warm Y to touch measuring 3 X 2 inch oval area. 5/18/2009 5/19/2009 Y 5/21/2009 nt fainted immediately (30 secs) after the vaccine, she twitched for 15-20 secs then staring forwards, U and5/18/2009 then started 5/18/2009 crying. PR = 72/min, DASIL injected into left deltoid. Pt became dizzy, visual disturbances, severe stomach crampsY and R hand 5/15/2009 cramped 5/15/2009 up and "felt dead" It too nt turned pale, felt tingling all over, pupil dilated and was blurring over. PR = 80 / mier Bp = 90/60. U 5/18/2009 5/18/2009 is red, swollen, tingling felt in hands and fingers. No fever. Also felt numbness sharp pain when U making 5/20/2009 a fist. No oozing 5/20/2009 or bleeding presen meter erythema/induration at site of VARIVAX - Treated with KEFLEX, ibuprofen Y 5/19/2009 5/21/2009 n (L) deltoid area began promptly, pain peaked at the 1-3 wk period gradually improved beginning Y in May3/20/2009 1 '09. 3/20/2009 ine number 1 given . Syncope 5 minutes Y after vaccine. Fell to floor hit head laceration required Y sutures broken 5/20/2009 incisor 5/20/2009 # 1 Rt upper. upper arm-hot to touch- VARIVAX given 5-13-09. Patient presented with symptoms 5-14-09. Y Treatment:5/13/2009 BENADRYL 5/14/2009 PRN. lled 2 1/2 hours after shot stating she has what look like broken blood vessels all over her body. U 5/15/2006 5/15/2005 a PNEUMOVAX shot on Monday afternoon 4/27 and was well until approx. midnight (8hrs after shot). I woke 4/27/2009 during4/27/2009 the night with a very p pells X 5 lasting approx 3 seconds, each. Y 5/18/2009 5/18/2009 ven varivax 5/8/9. On 5/14/2009 developed pain left lower extremity. On exam today findings U consistent with 5/8/2009 shingles 5/14/2009 in dermatomal distrib iven Approx 6pm on 5/12/09 on 5/13/09 Y L arm has area 3x3cm redness, swelling. 5/12/2009 5/13/2009 d our office on 5-21-09 to report that child received typhoid vaccine at health department 1-2Yminutes after 5/13/2009 vaccine given child fainted. Bec and induration (R) thigh. 5/19/2009 5/21/2009 Q oral vaccine administered. Approx 10 minutes later child's lips noted to be swollen as well as Y the soft tissue 5/21/2009 surrounding 5/21/2009 the lips. Oral muc n has been received from a pharmacist Y concerning a female in her "early 20s" who on an unspecified Y date was vaccinated with third dose o n has been received through a Merck Y Pregnancy registry from a 38-year-old female with no Y medical history 8/16/2004 or allergies 9/13/2004 who on 16-AUG-20 n has been received from a physician and a 35 year old female concerning herself with no pertinent Y medical 6/14/2007 history6/14/2007 and no known drug rea n has been received through the pregnancy Y registry for VARIVAX (Oka/Merck) from a physician's Y assistant 5/1/2007 concerning 5/1/2007 a 34 year old femal n has been received through the Merck Y pregnancy registry and from a male consumer concerning Y his 226/18/2007 year old wife 6/18/2007 with no known allerg n has been received through the Pregnancy Y registry from a registered nurse concerning a 16 U year old female 10/3/2007 with no6/1/2007 medical history or alle n has been received from a registered Y nurse concerning a 14-year-old female with no pertinent Y medical history 5/1/2001 and no drug reactions/allerg n has been received from a physician concerning a patient who on 17-MAR-2008 was inadvertently U vaccinated 3/17/2008 with3/17/2008 VARIVAX (Oka/Merck) n has been received from a physician Y concerning an 11 year old male who was vaccinated with U VARIVAX (Oka/Merck). The patient reporte n has been received from a physician concerning a 9 year old male who on 21-FEB-2008 was Y vaccinated 2/21/2008 (subcutaneous) 2/22/2008 with a second do n has been received from a health department registered nurse who was told by an unspecified U school nurse 4/14/2000 that a3/11/2008 9 year old male on the n has been received from the parent of an approximately 19 month old male patient with a history Y of seizure 3/13/2008 who on3/13/2008 13-MAR-2008 was vac follow-up information has been received from a registered nurse concerning a 11 year old female Y consumer with ###a history 2/22/2008 of asthma. Who n has been received from a pharmacist concerning a male who on approximately 14-MAR-2008 U (reported 3/14/2008 as on an 3/14/2008 unspecified date about n has been received from a physician's assistant concerning a male who was vaccinated with Y a first dose of VARIVAX (Oka/Merck). The pa n has been received from an 89 (also reported as 79 years old) year old retired physician. He U reported that 3/18/2008 he was 3/18/2008 vaccinated with VARIVA n has been received from a physician Y concerning a 36 month old male with an allergy to REGLAN Y who on 3/30/2007 30-MAR-2007 3/30/2007 was vaccinated w n has been received from a physician Y concerning a 21 month old male who, at 12 months ofUage, was vaccinated with a dose of VARIVAX n has been received from a registered Y pharmacist concerning a female who on 24-MAR-2008 U was vaccinated 3/24/2008 with a 3/24/2008 dose of VARIVAX (Ok n has been received from a motherYconcerning her 12 months old son with possibly allergy to N eggs and 5/16/2008 a history of 5/18/2008 febrile seizures and ear n has been received from a mother concerning her 11 year old daughter who"at the age of 1" Y (approximately 1997),3/10/2008 was vaccinated with V n has been received from a physician concerning a patient (age and gender unknown) who,Uon an unspecified date, was vaccinated with a n has been received from a physician Y concerning Y a patient who on an 0 unknown date was vaccinated U with a second dose of VARIVAX (Oka n has been received from a nurse concerning a female patient who was vaccinated with a dose Y of VARIVAX 3/7/2008 (Oka/Merck) 3/17/2008 (lot number, dose n has been received from a licensed Y practical nurse concerning her 8 year old son Y with no known Y allergies, diabetes, ### 4/23/2008 asthma and a history n has been received from a health professional Y concerning a 14 month old 20lb. 15oz. 29 in.Yfemale with 3/3/2008 no known 3/11/2008 pre-existing allergies, b n has been received from a consumer concerning her 9 year old granddaughter with Y no pertinent N medical history or drug 4/7/2008 allergies/reaction n has been received from a physician concerning Y a female between012 and 15 years of ageYwith a history of obesity 2/1/2008 who was vaccinated S n has been received from a physician concerning an 8 year old female who was vaccinated U with VARIVAX (Oka/Merck). The patient report
n has been received from a physician Y concerning a 12-month-old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) and ei n has been received from a physician Y concerning a 12 year old 104 lb. 55 in. female who onY03-Oct-1996 10/3/1996 at the age2/29/2008 of 12 months, was vac n has been received from a physician Y concerning a 12 month old male who on 26-Feb-2008Ywas vaccinated 2/26/2008 subcutaneously 3/14/2008with 0.5ml of n has been received from a nurse concerning a 45 year old, non-pregnant female physician U with probable 3/26/2008 recurrent exposures to wild type n has been received from a health department Y registered nurse who received information from U the patient's mother ### 3/17/2008 concerning a 7 year old n has been received from a physician Y concerning an approximately 5 year old female patientUwith no medical history who was vaccinated w n has been received from a licensed Y practical nurse concerning a 9 year old male child with N no known allergies### or pertinent 3/20/2008 medical history n has been received from a nurse concerning a 3 year old boy with no pertinent medical history N and no history 3/1/2006 of drug 3/20/2008 reactions or allergies n has been received from a consumer Y concerning her daughter with no known drug allergiesYor pertinent2/19/2008 medical history 2/21/2008 who "sometime du n has been received from a licensed Y vocational nurse concerning a 13 month old patient who N on 17-MAR-2008 3/17/2008 was3/25/2008 vaccinated with VARIV n has been received from a consumer concerning a 12 year old male with Penicillin allergy and N a history of chickenpox 3/14/2008 who on 11-March-2 n has been received from a nurse concerning a female who in 2002 was vaccinated with one U dose of VARIVAX (Merck). The patient's moth n has been received from a licensed vocational nurse concerning a 39 month old female who Y on 25-FEB-2008 2/25/2008 was3/11/2008 vaccinated with the firs n has been received from an advanced practice registered nurse concerning a 78 year old postmenopausal U 1/29/2008 female,1/29/2008 weight 142lb, height 59 n has been received from a physician concerning a 18 month old male who on 08-OCT-2007 N was vaccinated 10/8/2007 in right 4/23/2008 arm subcutaneously w n has been received from a physician concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX. Concomitan n has been received from a licensed practical nurse concerning a 9 year old female patient who N on 24-MAR-2008 3/24/2008 was 3/24/2008 vaccinated SQ with n has been received from a physician Y concerning a 17 month old female who two months ago, Y in March 2008, 3/1/2008 was vaccinated with VARIVA n has been received from a nurse concerning a 13 year old female who on 21-FEB-2008 was Y vaccinated2/21/2008 with the second 2/28/2008 dose of VARIVAX n has been received from a certifiedYmedical assistant (CMA) concerning a patient who on unspecified Y dates was vaccinated with two dose n has been received from a physician Y concerning a 12 month old female with no pertinent medical N history 3/16/2008 and no drug 3/26/2008 reactions/allergies, w n has been received from a consumer Y concerning her daughter, a 9 year old girl with no known N allergies4/25/2008 or pertinent 4/25/2008 medical history who w n has been received from a physician concerning a male who's son on 16-MAR-2008 was vaccinated U with a dose of VARIVAX (Merck). Th n has been received from a physician concerning a male patient who developed varicella and U secondary transmission from his son, who ha n has been received from a consumer concerning a 12 year old male with penicillin allergy and N a history3/11/2008 of chickenpox 3/11/2008 who on 11-MAR-20 n has been received from a nurse practitioner (N.P.) concerning a 5 year old male with a soyNallergy and no 5/8/2008 pertinent5/9/2008 medical history who o n has been received from a grandmother Y concerning her 21 month old grandson with eczema N who was vaccinated 5/10/2008 with a second dose of V n has been received from a physician concerning a 7 year old female who on approximatelyY14-MAR-2008 3/14/2008 was vaccinated 3/14/2008 with a second d n has been received from a registered nurse (R.N.) through a Merck pregnancy registry concerning Y a 31 year 5/5/2008 old female 5/5/2008 with no pertinent m n has been received from a health professional concerning a 16 year old female with asthmaUwho on 12-MAR-2008 3/12/2008 3/14/2008 was vaccinated subcut n has been received from a 34 yearYold female who was accidentally exposed to VARIVAX (Oka/Merck). N Concomitant 5/12/2008 therapy included al n has been received from a nurse practitioner Y concerning a male who was vaccinated with aUfirst dose of VARIVAX (Merck). The nurse rep n has been received from a physician Y concerning an approximately 5 year old female who was Y vaccinated with a dose a VARIVAX (Oka/M n has been received from a registered nurse concerning a 15 month old male with no pertinent N medical history 5/8/2008 or allergies 5/12/2008 who on 08-MAY n has been received from a registered nurse concerning a 12 month old female who in the morning Y of 17-FEB-2006 2/17/2006 3/22/2008 was vaccinated with th n has been received from a public health Y nurse concerning a 15 year old female child who inU1999 was vaccinated 10/1/2008 with 1/1/2009 her first dose of VA n has been received from a public health Y nurse concerning a 7 year old male child who in 2002 U was vaccinated 10/1/2008 with 1/1/2009 her first dose of VARIV n has been received from a public health Y nurse concerning a 5 year old female child who in U 2004 was vaccinated with 1/1/2009 her first dose of VAR n has been received from a Registered Nurse concerning a patient who was vaccinated withUVARIVAX (Merck) (Lot # not reported) instead n has been received from a registered nurse (R.N.) concerning a patient who on 30-JAN-2009 U was vaccinated 1/30/2009 with 1/30/2009 a dose of VARIVAX (M n has been received from a consumer concerning her son with reaction to all vaccines and medications Y he has received that contain gelatin n has been received from a physician Y concerning a 10 year old male with no medical historyUwho on 14-APR-2000 4/14/2000 was 1/28/2009 vaccinated with a fi n has been received from a doctor's front desk employee concerning a friend who had a reaction U to VARIVAX (Merck) (lot# not reported). I n has been received from a registered Y nurse concerning a 4 year old female with no known N medical history 9/8/2008 and drugs 2/4/2009 allergies, who on 08n has been received from a nurse practitioner Y concerning a 5 year old female patient, with no N known drug 1/28/2009 reactions/allergies 1/31/2009and no pertine n has been received from a 17 year old female, for the Pregnancy Registry for VARIVAX (Merck), U with asthma 1/23/2009 and 1/23/2009 no drug reaction who on n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX (Merck). "Wit n has been received from a medical assistant concerning a 72 year old patient who was inadvertently U vaccinated with VARIVAX (Merck) in n has been received from a female registered nurse (R.N.). It was reported that a drop of VARIVAX U (Oka/Merck) (lot 2/2/2009 # not reported) splash n has been received from a physician Y concerning a 11 year old female patient who on 27-AUG-2007 U was6/2/2008 vaccinated 1/19/2009 with her first dose of V n has been received from a physician concerning an 8 year old patient who on 11-AUG-2001 U was vaccinated 8/11/2001 with the 1/22/2009 first dose of VARIVA
n has been received from a registered nurse concerning a female junior volunteer who on 19-OCT-1995 U was vaccinated ### with a first dose o n has been received from a nurse practitioner (N.P.) concerning her 9 year old daughter withYno pertinent2/3/2009 medical history 2/7/2009 and drug allergie n has been received from a physician Y concerning an 8 year old female who on 31-MAY-2001 U was vaccinated 5/31/2001 with her 1/30/2009 first dose of VARIVA n has been received from a physician via in a published article, concerning a 11 year old patient Y with a seizure disorder and a history of mil n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wit n has been received from a registered Y nurse concerning a 46 month old female with no pertinent Y medical 6/19/2006 history and2/4/2009 no drug reactions/alle n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wi n has been received from a licensed practical nurse concerning a female who on an unspecified U date was 1/19/2009 vaccinated 1/19/2009 with the second dose n has been received from a pharmacist Y concerning a female who on 10-FEB-2009 was vaccinated N with her 2/10/2009 first dose 2/10/2009 of VARIVAX (Merck) n has been received from a consumer concerning her approximately 20 month old son with Y no pertinent 7/25/2008 medical history and no drug reactio n has been received from a registered Y nurse concerning a female who on approximately 30-JAN-2009, U "about 1/30/2009 two weeks 2/5/2009 ago" was vaccina n has been received from a physician Y concerning an approximately 12 year old female withUno medical history or allergy who on 11-SEP-1 n has been received from a physician assistant concerning a 13 month old female child whoNwas vaccinated with VARIVAX (Merck). The ch n has been received from a nurse concerning a 12 to 15 month old male who in 2009 was vaccinated U with a 0.5 ml dose 2/1/2009 of VARIVAX (Mer n has been received from a physician Y concerning a 4 year old male patient who on 11-FEB-2009 N was vaccinated 2/11/2009with 2/12/2009 the second 0.5ml do n has been received from a licensed Y visiting nurse concerning a 12 month old female patientYwith no known 2/10/2006 drug reactions/allergies 3/24/2006 and a n has been received from a physician Y concerning a 15 year old female with no pertinent medical Y history 7/28/2003 and no drug1/16/2009 reactions or allergies w n has been received from a licensed Y practical nurse concerning two patients who on 16-FEB-2009 N was vaccinated 2/16/2009 subcutaneously with the n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009 3 years ago", in approx n has been received from a physician Y assistant concerning a 13 year old male patient with no Y drug reactions/allergies 4/4/2007 2/15/2009 who was vaccinated n has been received from a consumer Y concerning her 13 month old daughter with no pertinent N medical history ### or drug 2/15/2009 reactions/allergies w n has been received from a registered Y nurse concerning a 14 year male with no relevant medical U history1/26/2009 reported and 2/2/2009 no allergies reported n has been received from a nurse concerning a 11 year old male patient with autoimmune disorder U who about 5 years ago, in approximate n has been received from a licensed Y practical nurse concerning a 13 year old female patientUwho on 16-FEB-2009 2/16/2009 was vaccinated subcuta n has been received from a consumer concerning her 24 month old granddaughter. The caller U reported that she had 1/23/2009 shingles about a mon n has been received from a consumer Y concerning her almost 15 month old daughter with noNknown medical 2/5/2009 history who on 05-FEB-2009 w n has been received from a registered Y nurse concerning 9 year old female patient with no previous N medical 8/21/2000 history and 2/23/2009 allergies reported, w n has been received from a health professional concerning a 10 year old female patient withYno allergies at 9/7/1999 time of vaccination and allergic n has been received from a physician concerning a patient who on 05-Mar-1997 was vaccinated Y with the 3/5/1997 first dose of1/5/2004 VARIVAX (Oka/Merc n has been received from a licensed Y practical nurse concerning a 12 year old female patientNwith no previous medical ### 2/23/2009 history and allergies n has been received from a Licensed Practical Nurse concerning a 4 year old male patient who U on 08-JUN-2005 6/8/2005was2/1/2009 vaccinated with first d n has been received from a registered Y nurse (school nurse) concerning a 7 year old male who N in approximately 2008, about 1 year ago, wa n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with the first dose of VARIVAX n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with a second dose of VARIVA n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009 3 years ago", in approx n has been received from a physician Y concerning a 29 year old female with no medical history N who in her teens, was vaccinated with two d n has been received from a pharm D. concerning a 46 year old male with HIV, penicillin allergy N and drug hypersensitivity 2/23/2009 to sulfa and a hist n has been received from a doctor of pharmacy concerning an over 60 year old male physician U with a history 2/25/2009 of chickenpox 2/25/2009 who on 25-FEB n has been received fro a nurse practitioner concerning a 6 year old male who on 15-SEP-2003 U was vaccinated 9/15/2003 with 1/31/2009 a dose of VARIVAX (O n has been received from a medicalYassistant concerning 38 year old female with no pertinent Y medical history 2/12/2009 and no 2/21/2009 known allergies, who n has been received from a physician Y concerning a 13 month old male with no medical history Y or drug allergy who ### on 1/16/2009 31-DEC-2008 was va n has been received from a consumer Y concerning her 25 month old son with allergy to eggsYand oatmeal, 1/21/2009 patient's 1/28/2009 mother with Sjoren's sy n has been received from a office secretary concerning 36 year old mother female who on 27-FEB-2009 U 2/27/2009 was splashed 2/27/2009 in the eye with VAR n has been received from a registered nurse concerning a patient with egg allergy and a history U of chickenpox who on an unspecified date n has been received from a nurse practitioner Y concerning a 47 month old (age estimated) female N who in July 7/1/2007 2007, was 2/1/2009 vaccinated with on n has been received from a physician concerning a 17 year old female who on 13-FEB-2009Ywas vaccinated 2/13/2009 with a 0.5mL dose of VARIVA n has been received from a physician concerning a female between 30 and 40 years old who Y on an unknown 2/11/2009 date was 2/20/2009 vaccinated with a 0 n has been received from a nurse practitioner concerning her 6 year old grand daughter whoNin Summer 2008 6/1/2008 (approximately 2/28/2009 June 2008), n has been received from a registered nurse concerning a female in her late 30's who four toY five weeks1/27/2009 ago was vaccinated 2/1/2009with the first d n has been received from a registered nurse concerning a patient who a couple years ago was U vaccinated with the first and second doses n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated Y with first and second dose of VARIVA
n has been received from a physician Y concerning a 5 year old male who was vaccinated withY a second dose of VARIVAX (Merck). The pat n has been received from a nurse practitioner concerning a number of patient who were vaccinated U with VARIVAX (Oka/Merck). The patien n has been received from a registered Y nurse concerning a 27 month old female with no pre-existing Y allergies, 2/21/2008 birth defects, 2/25/2009 medical conditio n has been received from a registered nurse concerning an 8 year old female who on an unspecified Y date was vaccinated with a second of n has been received from a physician concerning an approximately 17 year old female with Y penicillin allergy and clindamycin allergy who o n has been received from a registered nurse concerning a patient (gender not specified) who U on an unspecified date, was inadvertently vac n has been received from an immunization program officer, concerning an unknown numberYof patients who 7/8/2008 on an unspecified 7/8/2008 date, were v n has been received from a physician and other health professional concerning a 17 month Y old (previously 6/10/2008 reported9/14/2008 at 18) female patient w n has been received from a physician Y assistant concerning a 44 year old male who on 05-SEP-2008 N was9/5/2008 vaccinated9/7/2008 with a first dose of VA n has been received from a registered Y nurse concerning a 16 year old female with no previous N medical history 9/18/2008 reported 9/18/2008 and an allergic rea n has been received from a health care Y professional concerning a 14 year old female who on U 23-AUG-1999 9/19/2008 was vaccinated 9/20/2008with the first do n has been received from a pharmacist Y concerning a female physician who on an unspecified U date was vaccinated with VARIVAX (Oka/Me n has been received from a physician concerning a 11 year old patient with no pertinent medical Y history,11/7/2001 allergies or9/18/2008 drugs reactions, who o n has been received from a patient who on an unknown date was vaccinated with VARIVAXU(Oka/Merck). On an unknown date, the patien n has been received from a pharmacist concerning an adult patient who received the first dose U of VARIVAX (Oka/Merck). Subsequently the n has been received from a registered nurse concerning a 24 year old female who was vaccinated U with 2 doses of of VARIVAX (Oka/Merck n has been received from a physician concerning a 10 year old male with no pertinent medical Y history or9/11/2008 drug reactions/allergies, 9/11/2008 who on 1 n has been received from a health professional concerning a 12 month old male who at 11:00 U am, on 12-SEP-2008 9/12/2008 9/18/2008 was vaccinated SC wit n has been received from a physician Y and a health Y care worker concerning 2 a 16 year old male Y patient who 12/2/2008 on 02-DEC-2008 12/4/2008was vaccinate n has been received from a physician concerning a little over 12 month old patient who was Yvaccinated with a dose of VARIVAX (Oka/Merc n has been received from a health care worker concerning a 15 month old patient who was vaccinated U with a first dose of VARIVAX on an n has been received from a medicalYassistant concerning a three elementary school aged patient Y about the age of 8 or 9 who received the follow-up information has been received Y from aYphysician and a nurse 0 concerning a 5 year old N male patient, 11/3/2008 who on11/4/2008 03-NOV-2008 was vac n has been received from a medical assistant concerning three patients who between June U 2008 and August 6/1/2008 2008 were vaccinated with th n has been received from a physician concerning a 14 month old female with no drug allergies N or reactions a history ### of reactive ### airways an n has been received from Y a physician who heard that an adult female who was vaccinated with U VARIVAX (Oka/Merck) (route and site was follow-up information has been received Y from a registered nurse concerning a 41 year old female Y with no 9/23/2008 pertinent 9/24/2008 medical history and no n has been received from a physician Y concerning Y a newborn baby (DOB 20-Mar-2008) who Y was a sibling of a patient 4/15/2008 vaccinated with VARI n has been received from a registered nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck) subcutaneous n has been received from a physician and a medical assistant concerning a female who on an N unspecified date was vaccinated with a dose n has been received from a physician who was told by another physician, that a patient whoUin the past was vaccinated with VARIVAX (Ok n has been received from a physician Y concerning a 14 month old male with no relevant medical N history or 6/19/2008 allergies who 7/15/2008 on 19-JUN-2008 w n has been received from a licensed Y practical nurse concerning a 13 month old patient who N on 09-SEP-2008 9/9/2008 was vaccinated with VARIVA n has been received from a physician concerning a 24 year old male who on an unspecifiedYdate was vaccinated with VARIVAX. About ten n has been received from a 60 yearYold femaleYwith penicillin allergy0and Y sulfonamide allergyYand a history 8/1/2001 of liver transplant, 8/1/2001 arthritis and g n has been received from Y a physician Y concerning Y a male with positive 1 skin test for egg and soy Y (physician stated ###not a clinical ### allergy to so n has been received from a registered Y nurse concerning a 40 month old boy without medicalNhistory and1/23/2007 no allergy 9/20/2008 who on 23-JAN-2007 w n has been received from a nurse concerning Y a 7 year old female who on 03-MAR-2003 wasNvaccinated SC 3/3/2003 with VARIVAX 9/24/2008 (lot number 643 n has been received from an office Y manager concerning a 13 month old female with no medical N history or 9/23/2008 allergies who 10/1/2008 on 23-SEP-2008 w n has been received from a registered Y nurse concerning a patient who was vaccinated with U VARIVAX (Oka/Merck) instead of ZOSTAVAX n has been received from a physician concerning a 15 month old male with no pertinent medical Y history and 3/5/2009 no allergies 3/5/2009 who on 05-MAR-2 n has been received from a physician concerning a 15 month old female with no pertinent medical Y history3/5/2009 and no allergies 3/5/2009 who on 05-MAR n has been received from a physician concerning a 14 month old patient who on 02-MAR-2009 N was vaccinated 3/2/2009 with3/12/2009 a dose of VARIVAX (d n has been received from a registered pharmacist concerning a 21 year old patient who wasNvaccinated with one or two doses of VARIVAX n has been received from a consumer Y concerning a 72 year old male who was supposed to U received ZOSTAVAX 3/10/2009 (Oka/Merck) 3/10/2009 on 10-MAR n has been received from a pharmacist concerning a child who on an unspecified date was vaccinated U with a dose of VARIVAX (Oka/Merc n has been received from a bachelor of science in nursing concerning her 5 year old daughter Y who in 1995 was vaccinated with VARIVAX. n has been received from a physician Y concerning an 8 year old male with unknown drug reactions, Y asthma 3/12/2009 and a history 3/12/2009 of hives (develope n has been received from a bachelor of science in nursing concerning her 1 year old son who U in 1998 was vaccinated with VARIVAX (Merc n has been received from a physician Y concerning a 9 year old female who on 09-JUL-1999 was Y vaccinated with ### a first dose ### of VARIVAX (O n has been received from a physician concerning a 9 year old male who on 01-MAY-2000 was Y vaccinated 9/26/2008 with a first 9/27/2008 dose of VARIVAX. At
n has been received from a physician concerning a 9 year old male with rhinitis allergic whoYon 08-OCT-1999 6/30/2008 was vaccinated 7/1/2008 with a first do n has been received from a physician concerning a child (age unknown) who was vaccinated U with the first 9/28/2007 and second 6/13/2008 0.5 ml doses of VAR n has been received from a nurse practitioner concerning a female with allergy to "6MP" andUCHRON'S 10/2/2008 disease who on 02-OCT-2008 rece n has been received from consumer, for the Pregnancy Registry for VARIVAX (Oka/Merck), Yconcerning a2/1/2007 34 year old5/1/2007 female who in Janua n hs been received from a physician and a licensed practical nurse concerning a female patient Y who was recently vaccinated with the seco n hs been received from a physician and a licensed practical nurse, concerning a 14 year old Y female patient 9/18/2008 with no pertinent 9/9/2008 medical histo n has been received from a registered medical assistant concerning a 4 year old male who was Y vaccinated with VARIVAX (route not report n has been received from a registered nurse concerning a patient who on 16-OCT-2008 wasUvaccinated with VARIVAX ### (Merck) ### (LOT# 660 n has been received from a pharmacist concerning a 9 year old female who on an unspecified Y date was9/17/2008 vaccinated10/8/2008 with a dose of VARIVA follow-up Information has been received Y from a nurse practitioner, concerning a 15-month-old U male infant with### eczema, who ###on 20-OCT-20 follow up information has been received from a nurse concerning a 43 year old female with Y history of fever 8/15/2008 with previously 8/22/2008 vaccinations wit n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) (lot # not re n has been received from a nurse concerning a 24 month old patient with no pertinent medical Y history who 4/3/2007 on 03-APR-2007 9/30/2008was vaccinate n has been received from a physician Y concerning a 11 year old male with no past medical history N of immunocompromise ### or ### immunosuppre follow-up information have been received Y from a register nurse concerning a 7 year old female Y student with 5/17/2002 no allergies and ###no pertinent m n has been received from a registered Y nurse concerning a 9 year old female who was vaccinated N with VARIVAX (Oka/Merck) intradermally n has been received from a healthcare professional concerning her daughter who in 1996 was Y vaccinated with VARIVAX (Merck). The pati n has been received from a nurse concerning a male who on 07-MAR-2001 was vaccinatedUwith a first dose 7/7/2008 of VARIVAX ### (Merck) 0.5 mL s n has been received from a healthcare Y worker concerning a 12 year old male with no relevant Y medical history 6/28/2007 or allergies,### who on 22-APRn has been received from a allergistYconcerning a patient who in 2007. also reported as last U year, was vaccinated with a dose of VARIVAX n has been received from a healthcare professional concerning a 12 month old female who U on 16-OCT-2008 was ### vaccinated ### subcutaneou follow-up information has been received from a registered nurse and a physician concerningUa 73 year old 10/7/2008 female patient 10/7/2008 who on 05-SEP-2 n has been received from a caller concerning her 12 month daughter with food allergies andYno pertinent 5/1/2008 medical history, 5/1/2008 on 03-JUL-2007 n has been received from a nurse concerning Y a 22 month old male who on 06-MAY-2008 was N vaccinated5/6/2008 with a dose of VARIVAX ### (Merck) n has been received from a pharmacist and nurse midwife concerning an adult female who was U vaccinated with a dose of VARIVAX (Merc n has been received from a physician concerning a 33 year old female pregnant (17 weeks)Npatient with a history of VARICELLA ### at age of n has been received from a physician Y concerning a 7 year old male with hypersensitivity andUasthma and a history ### of eczema who on 11-O n has been received from a registered nurse concerning a female patient who in April 2007, Nwas vaccinated 4/1/2007 with a dose of VARIVAX (Merc n has been received from a licensed practical nurse concerning a 5 year old male patient, with U no known6/18/1997 pertinent medical 6/18/1997 history, or no kn n hs been received from a registered nurse concerning a 64 year old patient who on approximately U 01-NOV-2008 11/1/2008 was vaccinated with VAR n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with the first dose of VARIVAX (Ok n has been received from a registered Y school nurse concerning an 8 year old female patientNwith a history7/2/2001 of shingles (2006) ###and lesions o n has been received from a physician Y concerning a 7 year old female who on 03-NOV-2008Nwas vaccinated 11/3/2008 with the 11/4/2008 second dose of VARIV n has been received from a physician Y concerning a 16 year old male with no pertinent medical Y history who 11/3/2008 on 03-JUN-1998 11/4/2008was vaccinate n has not been received from a nurse Y concerning a 24 month old female who on 15-OCT-2007 N was vaccinated### with VARIVAX ### (Oka/Merck) n has been received regarding a case Y in litigation from a registered nurse concerning a 9 year N old female 9/25/2008 who on 25-SEP-2008 was vaccin n has been received concerning a 7 year old female with no concurrent conditions or pertinent U medical history ### who on 28-OCT-2008 ### receiv n has been received form a registered nurse concerning a 12 year old female with ZITHROMAX Y allergy 7/18/2008 (total body swelling) ###and no illness n has been received form a physician Y concerning a 14 year old male with a history of attention Y deficit/hyperactivity 10/7/2008 disorder 10/8/2008 and possibly ha n has been received from a registered nurse concerning a 39 month old female with no medical Y history, no known ### allergies ### who on 10-OCT n has been received from a registered pharmacist concerning a patient who on 07-OCT-2008 U was vaccinated 10/7/2008 subcutaneously 10/7/2008 with a 0.5 m n has been received from a registered Y pharmacist concerning of a 66 years old white femaleUwho on 10-Nov-2008 ### was vaccinated ### with VA n has been received from nurse concerning a patient who came into office to receive a doseUof ZOSTAVAX (Merck) (MSD) but was given a n has been received from a physician concerning a 3 year old male who at the age of 7 months U (in approximately 2005) was ###vaccinated wi n has been received from a pharmacist concerning a 16 year old female with penicillin allergy N and a history 4/8/2008 of Guillain-Barre 4/18/2008syndrome and n has been received from a Registered Nurse with no known drug reactions or allergies, whoN on 14-MAY-2008 6/16/2008 was vaccinated ### with first do n has been received from a physician concerning her 12 month old daughter who on an unspecified Y date was vaccinated subcutaneously w n has been received from a registered Y nurse (RN) concerning a 13 month old female with eczema Y who on 31-Oct-2008 ### 11/1/2008 was vaccinated sub n has been received from a physician concerning her 2 year and 9 month old daughter who U was "previously" vaccinated with a dose of VAR n has been received from a registered nurse concerning a 20 year old female patient with noYknow drug8/28/2008 allergies, no 8/29/2008 seasonal/environmen n has been received from a pharmacist concerning his granddaughter (14 month old female)Nwho at about8/1/2008 age 12 months 8/8/2008 (approximately A
n has been received from a nurse concerning a 5 year old female who received her first dose Y of VARIVAX 6/13/2007 (Oka/Merck) (lot# ###647719/1248N n has been received from a nurse concerning a patient who was vaccinated with VARIVAX (Oka/Merck) U instead of ZOSTAVAX (Oka/Merck n has been received from a medical assistant concerning a 68 year old male who on 15-OCT-2008 U was vaccinated ### with VARIVAX ### (Oka/Me n has been received from a licensed Y nurse concerning a 12 month old male patient with no known N pertinent medical ### history, and no known n has been received from a licensed Y nurse concerning a 12 month old male patient with no known N pertinent 10/8/2008 medical history, ###and no known n has been received from a physician concerning an adult patient who was vaccinated with VARIVAX U (Oka/Merck) instead of ZOSTAVAX ( n has been received from a licensed visiting nurse concerning a 4 year old female who on 23-OCT-2008 N was vaccinated ### with ### (lot # not rep w-up information has been receivedYfrom a physician concerning a 10 year old male studentYwith no pre-existing 8/5/2008allergies, 8/25/2008 birth defects or m n has been received from a physician Y concerning a boy who was vaccinated with VARIVAX Y(Oka/Merck) 0.5ml (therapy started date, route n has been received from a physician concerning his daughter, a 13 year old female who onN18-SEP-2008 4/18/1997 was vaccinated 4/18/1997 with the second n has been received from a physician and a licensed practical nurse concerning a female who Y was recently vaccinated with the second dos n has been received from a nurse concerning Y a patient who was vaccinated with VARIVAX (Oka/Merck) Y (therapy started date, route, site u n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with VARIVAX (Oka/Merck) when n has been received from a physician assistant concerning a male patient who on 17-NOV-2008 U was vaccinated ###with VARIVAX ### (Oka/Merc n has been received from a healthcare worker concerning a 63 year old male patient, who was U scheduled9/1/2008 to receive 9/1/2008 ZOSTAVAX (Oka/Mer n has been received from a nurse concerning Y a patient who was vaccinated with VARIVAX (Oka/Merck) Y (therapy started date, route, site u n has been received from a physician Y concerning a female patient who on 03-NOV-2008 was U vaccinated11/3/2008 with a 0.5 ml dose ###of VARIVAX (O n has been received from a nurse via a sales representative concerning an approximately 4 Nyear old male1/1/2005 who in 2005 10/6/2008 was vaccinated with n has been received from a 35 yearYold female pharmacist concerning herself with no pertinent N medical 8/15/2008 history who8/25/2008 on 15-AUG-2008 was n has been received from a patient who "a week ago" was vaccinated with VARIVAX (Oka/Merck). U The patient### reported that ###she went to a n has been received from a medicalYassistant concerning a three elementary school aged patient Y about the age of 8 or 9 who received the n has been received from a consumer concerning his daughter, a 5 year old female who in October U 2007 10/1/2007 was vaccinated with VARIVAX (M n has been received from a physician Y concerning her son who was vaccinated with VARIVAX Y vaccine (Oka/Merck) (lot # not provided). Sub n has been received from a certifiedYmedical assistant concerning a 26 month female with drug Y hypersensitivity 9/22/2007 to CEFTIN### and no illness a n has been received from a physician Y concerning a 10 year old female with asthma who on N 22-OCT-1999 9/17/2008 received 10/7/2008 her first dose of VARIV n has been received from a physician Y concerning a 24 month old female who on 23-MAY-2008 Y was vaccinated 5/23/2008 with11/6/2008 her first dose of 0.5 mL n has been received from a physician Y concerning a 11 year old female who on 24-JUN-1998Nreceived her 10/2/2008 first dose10/3/2008 of VARIVAX (Merck) (l n has been received from a registered Y nurse concerning an elementary school aged child patient U with medical history and allergy unspecifi n has been received from a patient's Y mother concerning her 3 year old son, with no pertinentYmedical history 5/16/2007 and no drug ### allergies / drug re n has been received from a physician concerning a 71 year old female with no pertinent medical U history and 5/1/2008 no drug 5/1/2008 reactions/allergies wh n has been received from a health professional concerning an 8 year old female who on 21-OCT-2008 U received ### the second ### dose of VARIV n has been received from a physician Y concerning a 28 month old male (child) who was vaccinated Y with VARIVAX (Merck). Subsequently th n has been received from a Registered Nurse concerning a 38 year old female patient with penicillin N allergy and ### medical history ### unknown, n has been received from a physician Y concerning a 37 year old male who on 10-SEP-2008 received Y the10/9/2008 first dose of VARIVAX ### vaccine (Ok n has been received from a license practical nurse concerning a 12 year old female who on Y 08-SEP-20089/8/2008 received the 9/9/2008 second dose of VAR n has been received from a physician Y concerning a 10 year old female who was vaccinated N with a dose of VARIVAX (lot #### not reported) wh n has been received from a registered nurse (R.N.) concerning a patient who on 28-OCT-2008 U was vaccinated### with a dose ### of VARIVAX (M n has been received from a registered Y nurse concerning a 22 month old male with no known allergies who on an unspecified ### date was vac n has been received from a physician Y concerning a 15 month old male who on 02-JUL-2008Nwas vaccinated 7/2/2008 subcutaneously ### with a first 0.5 follow-up information has been received from a physician concerning a 13 year old male patient Y who on5/22/2007 29-JUN-1998 3/1/2008 was vaccinated subc n has been received from a medicalYassistant concerning an elementary school aged patientYabout the age of 8 or 9 who received the seco n has been received from nurse practitioner Y concerning a 49 year old female patient with hypertension N who 9/11/2008 on 11-SEP-2008 9/11/2008was vaccinate n has been received from a physician Y concerning a 4 year old male patient (his nephew) who U in approximately 8/1/2008 August 11/1/2008 2008, was vaccinate n has been received from a physician Y concerning a female patient who at the age of 12 months Y (date unspecified) was vaccinated with a d n has been received from a Registered Y Nurse concerning an 18 year old female patient withUno pertinent 9/1/1998 medical history or drug reactions n has been received from a Registered Y Nurse concerning a 13 year old white male with unknown Y medical 1/22/1997 history and no known ### drug allerg n has been received from a certified medical assistant concerning a patient who on 12-DEC-2008 U was inadvertently ### vaccinated ### with a dose n has been received from a certified medical assistant concerning a patient who on 15-DEC-2008 U was inadvertently ### vaccinated ### with a dose n has been received from a registered nurse concerning a 4 year old male patient with asthma Y intermittent 4/3/2008 who on 13-APR-2008 ### was vacc n has been received from a physician Y concerning a patient who on an unknown date, received U 2 doses of VARIVAX (Oka/Merck) (lot # not n has been received from a physician Y concerning of his daughter a 25 year old who on an unspecified U date was vaccinated with a dose of V
n has been received from a physician Y concerning a patient (a friend at school of his nephew)Uwho on unspecified date was vaccinated with n has been received from a consumer Y concerning a 28 year old daughter who 13 years ago U(1993) was vaccinated 1/1/1998 with 1/1/2008 a dose of VARIVA n has been received from a female Y licensed practical nurse, with asthma, who on 18-Dec-2008, U splashed a VARIVAX ### (Oka/Merck) ### in her e n has been received from a nurse concerning her daughter with environmental allergy. In 1999-2001 Y when her daughter was 4-6 year old, n has been received from a nurse concerning a 24 month old female with a history of liver transplant Y who was vaccinated with a dose of VA n has been received from a pharmacist concerning a 75 year old patient who on 29-DEC-2008 U was vaccinated### with VARIVAX ### (Oka/Merck) n has been received from a physician concerning Y a 2 year old female with steroid therapy, absence U of corpus callosum ### and ### pan-hypopituita n has been received from a health professional concerning a 10 year old female student who U on 03-SEP-1999 9/3/1999 was 11/6/2008 vaccinated subcutaneo n has been received from a registered Y nurse concerning a 14 month old male patient with noUpertinent medical 10/1/2008 history and### known allergies n has been received from a nurse and Y a medical assistant concerning a 44 month old female N who on 03-MAY-2006 5/3/2006 was 1/1/2009 vaccinated with he n has been received from a nurse concerning a 12 year old female who on 09-JUN-1997 was N vaccination 12/1/2008 with the first 12/1/2008 dose of VARIVAX (O n has been received from a physician a 39 year old male with no drug reactions or allergies U who on 20-Nov-2008 ###was 12/1/2008 vaccinated subcutan n has been received from a registered Y nurse concerning a 43 year old female employee whoUon 01-DEC-2008 12/1/2008 was 12/3/2008 vaccinated with the firs n has been received from a 31 yearYold female patient for the pregnancy Registry for VARIVAX. Y Some time 2/1/2007 in February, 2/10/2007 2007 was vaccina follow-up information has been received Y from a registered nurse who while working part timeN at a high school heard12/3/2008 from an acquaintance n has been received from a physician Y and a nurse supervisor concerning an 7 year old female U with asthma, 4/15/2008 eczema and allergic ### rhinitis wh n has been received from a physician Y concerning an 8 year old female patient who on 03-Dec-2008 Y was12/3/2008 vaccinated12/5/2008 with the second dose o n has been received from a registered Y nurse concerning a 10 year old female patient who onN29-OCT-1999 was ### vaccinated 12/4/2008 with a dose of n has been received from a registered nurse concerning an employee who was vaccinated with U the first dose of VARIVAR (Oka/Merck). Th n has been received from a registered nurse concerning a female employee who was vaccinated U with her second dose of VARIVAX. The p n was been received from a medicalY assistant concerning an approximately 60 year old maleU patient who 12/8/2008 on 08-DEC-2008 12/8/2008 was vaccinated n has been received from a physician Y concerning a 6 year old female patient who either 2003 N or 2004 was vaccinated with the first dose of n has been received from an office manager concerning a 76 year old female who on 03-DEC-2008 U was12/3/2008 vaccinated12/3/2008 with a dose of VARIVA n has been received from a registered Y nurse concerning a 26 year old female patient with noNpertinent medical### history and### no known drug a n has been received from a licensed Y practical nurse (L.P.N.) concerning an 8 year old female Y who was vaccinated 7/14/2008 with 1/5/2009 a first and second d n has been received from a healthcare worker concerning a female patient, who on unspecified U dates, was vaccinated with two doses of VA n has been received from a physician Y and licensed practical nurse concerning a 5 year old female Y patient 3/25/2004 who on 25-MAR-2004 5/31/2008 was vacci n has been received from a licensed Y practical nurse concerning a 51 year old male patient with N Bacitracin and ### Sulfonamide 1/2/2009 allergy and no n has been received from a physician concerning a 7 year old female twin on 02-JAN-2009 was U vaccinated 1/2/2009 subcutaneously 1/2/2009with a 0.5ml do n has been received from a physician Y concerning a 24-month-old female who was vaccinated Y with a 0.5ml dose of VERIVAX (Oka/Merck) ( n has been received from a physician concerning a male child with no pertinent medical history N and no drug allergies ### 1/1/2009 who on 29-DEC-2008 n has been received from a nurse concerning Y another nurse who in 1990 was vaccinated with U VARIVAX (Oka/Merck) (unsure if 1 or 2 dose n has been received from a physician concerning a 8 year old female who on 02-JAN-2009 U was vaccinated 1/2/2009 subsequently 1/2/2009 with a 0.5ml dose n has been received from a physician concerning a 7 year old female twin who on 02-Jan-2009 U was vaccinated 1/2/2009 subcutaneously 1/2/2009 with a 0.5m n has been received from a physician Y and certified medical assistant concerning an 8 year old U patient who was vaccinated with two doses n has been received from a health educator Y concerning a male teenager who on 30-DEC-2008 N was vaccinated### with1/11/2009 VARIVAX (Oka/Merck n has been received from a registered nurse concerning a 43 month old male child who on 05-SEP-2006 Y 9/5/2006 was vaccinated 1/3/2009 subcutaneously i n has been received from a physician concerning an 10 year old patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck) (no lot# n has been received from a nurse concerning Y an 8 year old male with no medical history, noNknown drug9/18/2001 allergies who 1/11/2009 on 18-SEP-2001 wa n has been received from a nurse concerning Y a 28 year old female with no allergy who on 22-DEC-2008 Y was vaccinated ### with ### her first dose n has been received from a nurse practitioner concerning a female who was intended to receive U ZOSTAVAX 1/13/2009 (Oka/Merck), 1/13/2009 was inadvertent n has been received from a nurse concerning Y a 50 year old female who in 1995 was vaccinated U with one dose of VARIVAX (Oka/Merck) (lo n has been received from a nurse practitioner concerning an unspecified number of patientsUwho on an unspecified date were vaccinated w n has been received from a physician concerning an 88 year old male who on an unknown date, Y was vaccinated ###with1/5/2009 the first dose of VAR n has been received from a school registered nurse who heard of a case concerning a child Ywho was vaccinated with one dose of VARIVA n has been received from a nurse concerning Y a 12 month old female who on 22-DEC-2008 was Y vaccinated with ### a first dose ###of VARIVAX (O n has been received from a registered Y nurse concerning a 7 year old female patient with no Y previous medical 4/24/2007 history 4/27/2007 reported, who on 04-A n has been received from a licensed visiting nurse concerning a patient who on 10-MAR-1999 U was vaccinated 3/10/1999 with 3/14/1999 a dose of VARIVAX (Ok n has been received from a consumer Y concerning a her 12 month old son with no pertinent medical N history 9/11/2007 and known 9/15/2007 drug reactions or all n has been received from a bachelor of sciences in nursing concerning a patient who on an U unspecified date was inadvertently vaccinated n has been received from a physician concerning her ex-husband who was vaccinated IM with U VARIVAX (Oka/Merck) (Lot # 659722/1877U
n has been received from a physician assistant concerning a 27 year old male with amoxicillin Y allergy who on 13-NOV-2008 ### ###was vaccinate n has been received from a physician Y concerning a male patient under the age of four yearsYwho was vaccinated wit 1/19/2009 ha dose of VARIVAX n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck). It was n has been received from a certified medical assistant concerning a patient who "one week ago" U was vaccinated 1/16/2009with 1/16/2009 a dose of VARIVAX ( n has been received from a registered Y nurse concerning a 6 year old male patient with no known Y drug reaction/allergies 4/11/2008 1/21/2009 and no pertinent m n has been received from a physician concerning a patient who was intended to receive ZOSTAVAX U (Oka/Merck) (MSD), was inadvertently n has been received from a nurse practitioner concerning a male with no pertinent medical history, Y allergies 10/5/1998 or drug reactions who on 05-O n has been received from a nurse practitioner Y concerning a 13 year old male patient with noYpertinent medical 10/2/1996 history1/9/2009 and no known allergi n has been received from a health professional concerning a 5 year old female patient, who Non 18-OCT-2007 was ### vaccinated with a dose o n has been received from a nurse practitioner Y concerning an 8 year old male with food allergies Y including 7/21/2001 peanuts and no past medical hist n has been received from a nurse practitioner concerning a 4 year old female who on an unknown Y date was vaccinated with a dose of VAR n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof VARIVAX 1/8/2009 (Oka/Merck) 1/20/2009 (lot#661008/1317X). n has been received from a registered nurse concerning a 7 year old male patient with asthma N who on 19-AUG-2002 8/19/2002 1/24/2009 was vaccinated with o n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof VARIVAX (lot# 661008/1317X). Concomitan n has been received from a registered nurse concerning a 4 year old male patient who in approximately Y 2005 was vaccinated 1/1/2008 with the first n has been received from a public health Y nurse concerning a 16 year old female child who inU2004 was vaccinated 10/1/2008 with 1/1/2009 her first dose of VA n has been received from a registered Y nurse concerning a 43 year old male with no pertinentNmedical history 1/23/2009 and no1/25/2009 drug reactions/allergie n has been received from a physician concerning a 9 year old female who at few years ago N was vaccinated injection with VARIVAX (Merck n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the n has been received from a registered Y nurse concerning a 13 year old female with no knownNallergies or7/15/2008 medical history, 7/17/2008 who on 07-AUG-1 n has been received from a licensed practical nurse concerning a 9 year old white female who Y on 25-Aug-2004 8/26/2004 was vaccinated 6/8/2008 SQ with VA n has been received from a physician concerning a male patient, who was vaccinated with the N first dose of VARIVAX (Oka/Merck) on an un n has been received from a medicalYtechnician concerning her 18 month old female daughter, Y with no pertinent 7/16/2008 medical 7/17/2008 history and no drug n has been received from a registered Y nurse concerning a 13 month old male with no relevant N medical history 7/16/2008 and no 7/17/2008 drug allergy who on 1 n has been received from a physician concerning a 35 year old female who 15-Mar-2005 was N vaccinated 3/15/2005 with a first dose of VARIVAX (Ok n has been received from a healthcare worker concerning a 19 year old female with no pertinent N medical4/25/1996 history who on 25-APR-1996 was n has been received from a physician concerning a female teenage patient who on an unspecified U date was vaccinated with the second do n has been received from an office Y manager, in physician's office, concerning an office nurse's U child who on an unspecified date was vacci n has been received from a nurse concerning Y an 8 year old male who on 18-JUN-2008 was Yvaccinated with 6/18/2008 the second 6/19/2008 dose of VARIVAX n has been received from a physician concerning a female patient, who was vaccinated withNthe first dose of VARIVAX (Merck) on an unsp n has been received from a physician concerning an 18 year old female who on 19-JAN-1998 N was vaccinated 7/3/2008 with the 7/3/2008 first dose of VARIVA n has been received from a physician concerning a patient who on 23-Jul-2008 was vaccinated U with VARIVAX 7/23/2008 (Oka/Merck). 7/23/2008The physician n has been received from a licensed practical nurse concerning a 40 month old male, weightU29.5lb height 2/28/2006 35 inches, 6/23/2008 who on 28-Feb-2006 n has been received from a physician concerning an 8 year old male with no know allergies N who on 01-JUL-2008 7/1/2008at6/30/2008 2 PM was vaccinated s n has been received from a physician concerning a 9 year old female with no know drug allergies U who at6/24/2008 11 AM on 6/25/2008 24-JUN-2008 was vacc n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U 2/5/1999 with the second 0.5ml dose of VA n has been received from a physician concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician Y concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5ml dose of VA n has been received from a physician concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician Y assistant concerning her approximately 24 month old N son with no pertinent medical 7/23/2008 history nor drug a n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5 ml dose of V n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5 ml dose VAR n has been received from a physician concerning an 8 year old male who on 23-JUN-1998 was U vaccinated 6/23/1998 with a first 6/17/2005 dose of VARIVAX (O n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl n has been received from a medical assistant concerning a female who on 08-JUL-2008 was U vaccinated subcutaneously 7/8/2008 7/15/2008 with a 0.5 ml dose n has been received from a registered nurse concerning her daughter, a 3 year old female who Y in approximately 2006 (2 years ago) was va n has been received from a nurse practitioner concerning Y a 12 month old male with eczemaNand egg allergy 7/11/2008 who on7/13/2008 11-JUL-2008 was vacc n has been received from a certified medical assistant concerning a 14 month old female who Y on 29-JUN-2005 6/29/2005 was vaccinated 8/3/2005 with a first n has been received from a physician concerning his 4 year old son who "at age of 1", in 2005 N was vaccinated with a7/1/2008 dose of VARIVAX (O
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl n has been received from a medicalYassistant concerning a 5 year old patient who on 19-JUL-2004 Y was vaccinated 8/14/2006 with VARIVAX (Oka/Me n has been received from a physician concerning an about 7 year old male who on an unspecified U date was vaccinated with VARIVAX (Ok follow-up information has been received Y from a nurse concerning a 17 year old female with Y asthma and 7/17/2008 no allergy who 7/25/2008 on 17-JUL-2008 wa follow-up information has been received from a medical assistant concerning a 12 month oldY male with no 7/18/2008 relevant medical history or allerg n has been received from a consumer concerning her 12 year old daughter with sulfonamideNallergy who7/23/2008 on 23-JUL-2008 7/24/2008 was vaccinated w n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y female twin 8/6/2008 who on an8/7/2008 unspecified date was n has been received from a nurse practitioner concerning a 6 year old female patient who was Y vaccinated with a second dose of VARIVAX n has been received from a healthcare worker concerning an adult female who on 23-JUL-2008 U was vaccinated 7/23/2008 inadvertently 7/23/2008 with a dose o n has been received from a licensed practical nurse and a consumer concerning a 11 year old Y white female 8/6/2008 twin who8/7/2008 on 06-AUG-2008 was n has been received from a nurse concerning a 12 month old healthy patient who on 17-JUL-2008 Y was vaccinated 7/17/2008 with 7/23/2008 a first dose of VAR n has been received from a healthcare worker and the nurse concerning a 63 year old female U who on 02-AUG-2008 8/2/2008 8/2/2008 was vaccinated with a n has been received from a physician concerning a 7 year old female with allergic rhinitis and Y a history of 7/16/2008 "HAO" who 7/17/2008 on 16-JUL-2008 at 11 n has been received from a company representative concerning her daughter a 7 year old female Y with pollen 7/1/2007 allergy 7/1/2008 who in approximately follow-up information has been received from a nurse concerning a 10 year old male who onU13-AUG-2008 8/13/2008 was vaccinated 8/15/2008 subcutaneousl n has been received from a registered nurse concerning her daughter, a 14 year old female Ywho at 4:008/21/2007 pm on 21-AUG-2007 8/23/2007 was vaccinat n has been received from a registered Y nurse concerning a 4 year old female with no known U pertinent medical 8/13/2008 history 8/15/2008 or drug reactions/aller n has been received from a registered Y nurse, concerning her 5 year old son, who on 12-MAY-2004 N was 5/12/2004 vaccinated 8/20/2008 with VARIVAX (Oka/Me follow-up information has been received from a nurse concerning a 10 year old male with mold U allergy and 8/13/2008 reactive8/15/2008 airway disease who on n has been received from a physician concerning a 3 year old male who on 27-FEB-2006 was N vaccinated 2/27/2006 subcutaneously with one 0.5 ml d n has been received from a physician concerning a 15 year old female patient who on 16-AUG-2008, U was 8/16/2008 vaccinated 8/18/2008 subcutaneously into n has been received from a physician Y concerning a 15 year old female patient who on 24-MAR-2008, Y was 3/24/2008 vaccinated 3/24/2008 with a dose of VARIV n has been received from a nursing student concerning her 4 year old daughter who on 22-JUL-2005 Y was 8/21/2008 vaccinated 8/21/2008 subcutaneously with n has been received from a physician Y concerning a 5 year old female who on 07-AUG-2008,Nwas vaccinated 8/7/2008 with her8/9/2008 first dose of VARIVAX n has been received from a female who "last week" (on approximately 15-AUG-2008) was vaccinated U with 8/15/2008 one dose of VARIVAX (Merck) 0 n has been received from a registered Y nurse concerning a 5 year old female with no illnesses Y at the time8/11/2008 of vaccination, 8/11/2008 who on 04-FEB-20 n has been received from a nurse concerning Y a 14 year old patient with allergy to unspecified Y medication who ### on 12-DEC-1999 6/18/2008 was vaccin n has been received from a physician Y concerning a 16 year old male who in 1996 was vaccinated Y with VARIVAX 6/27/2008(Oka/Merck). 6/27/2008 On 27-JUN n has been received from a nurse concerning a 10 year old patient with allergy to unspecified Y medication who ### on 28-Dec-1999 7/1/2008 was vaccina n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA n has been received from a female who a year ago was suppose to get ZOSTAVAX (Merck),U but by mistake 8/1/2007 the prescription 8/1/2007was written fo n has been received from a consumer concerning a 10 year old male son with no previous medical N history 8/19/2008 reported,8/20/2008 who on 19-AUG-2008 n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me n has been received from a nurse concerning Y a 7 year (estimated, age unit was not provided) Y old patient with an ###allergy 7/1/2008 to unspecified med n has been received from a pharmacist concerning an adult patient who was vaccinated withUVARIVAX (Oka/Merck). Subsequently the pat n has been received from a pharmacist, concerning a 67 year old male patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) i n has been received from a registered Y nurse concerning a 14 year old male with no pertinentNmedical history 9/10/1997 who on 10-SEP-1997 was vac n has been received from a pharmacist Y concerning her son who was vaccinated with VARIVAX Y (Oka/Merck) a while ago. The patient deve n has been received from a physician Y concerning a 36 month old female with no pertinent medical N history 8/16/2006 who on 16-AUG-2006 8/25/2008 was vaccin follow-up information has been received from a registered nurse concerning her 18 year oldYdaughter with 8/13/2008 no known 8/13/2008 allergies or pertinent m n has been received from a registered nurse; concerning a friend of hers who developed shingles N 3 days after her children received a boos n has been received from a registered Y nurse (R.N.) concerning a 12 year old female who onN18-DEC-1998 was### vaccinated 8/21/2008 subcutaneously n has been received from a registered Y nurse (R.N.) concerning a 13 year old male who on 25-AUG-2008 U 8/25/2008 was vaccinated 8/25/2008 subcutaneously w n has been received from a nurse concerning a female grandmother of a child who receivedUthe second6/18/2008 dose of VARIVAX (Merck) (Lot # 6 n has been received from a physician concerning an "almost 5 years old" male who in November U 2007, 11/1/2007 was vaccinated 8/22/2008 with his second do n has been received from a nurse concerning Y a 13 year old female who was vaccinated withYa second dose 8/26/2008 of VARIVAX 8/26/2008 (Merck). One day n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Merck). Subsequently the patient developed n has been received from a consumer concerning her 6 year old son, who on 13-AUG-2008Nwas vaccinated 8/13/2008 with VARIVAX 8/23/2008 (Merck), 0.5 mL n has been received from a pharmacist, concerning a 67 year old female patient who was vaccinated U with a dose of VARIVAX (Oka/Merck n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Oka/Merck). Subsequently the patient devel n has been received from a nurse at the health care department who received a faxed reportUfrom a registered 12/3/2007 nurse, 8/20/2008 concerning a case of
n has been received from a physician Y concerning a patient who on an unspecified date was Yvaccinated with a first dose of VARIVAX (Merc n has been received from a physician concerning a patient who on an unspecified date, wasUvaccinated with a dose of VARIVAX (Merck). T follow-up information has been received Y from a nurse and a consumer concerning her 10 year Y old daughter 8/4/2008 who is a8/5/2008 student with an amox n has been received from a physician Y concerning a male who on 28-JUN-2008 was vaccinated U with a dose 6/28/2008 of VARIVAX 8/6/2008 (Oka/Merck) (Lot n n has been received from a physician concerning a male patient with Crohn's disease who on N an unspecified date was vaccinated with VAR follow up information has been received Y from a physician concerning a 9 year old male whoNin 1999, also re was vaccinated with a 0.5 ml d n has been received from a physician concerning a 10 year old female with no known allergies U who on 05-AUG-2008 8/5/2008 8/5/2008 was vaccinated with n has been received from a licensed practical nurse concerning an approximately 12 year old N male patient 8/11/1997 who on 11-AUG-1997 8/18/1997 was vacc n has been received from a physician Y concerning a 4 year old female patient who on 20-AUG-2005, N was8/23/2008 vaccinated8/25/2008 with the first dose of V n has been received from a physician Y concerning a 5 year old female who on 19-AUG-2004Nwas vaccinated 8/19/2008 with a first 8/21/2008 dose of VARIVAX ( n has been received from a registered nurse (R.N.) concerning two or three patients who were Y vaccinated8/8/2008 with VARIVAX 8/10/2008 (Merck) that was n has been received from a physician Y concerning a 12 month old female with no known pertinent U medical 8/16/2008 history or8/18/2008 drug reactions/allergies n has been received from a physician Y concerning an 8 year old female with no pertinent medical U history and no history 7/12/2008 of drug reactions or n has been received from a physician's assistant concerning a 4 year old female who on 20-DEC-2004 U was 8/4/2008 vaccinated 8/4/2008 with the first dose o n has been received from a registered nurse (R.N.) concerning a 9 year old male who on 14-FEB-2000 N was 2/14/2000 vaccinated 8/16/2008 subcutaneously wit follow-up information has been received Y from a physician concerning a female patient whose U son in 1999 was vaccinated 7/28/2008 with a dose of VA rmation has been received from a registered Y nurse concerning her 5 year old daughter who on N 27-AUG-2008 8/27/2008 was vaccinated 8/27/2008 with a dose o n has been received from a health professional Y concerning a 5 year old female with no allergies Y and no medical 2/7/2006 history 9/1/2006 reported, who on 0 n has been received from a pharmacist concerning a patient who an unspecified date was vaccinated with a dose of VARIVAX (Oka/Merck n has been received from a nurse concerning Y a 5 year old male with dextromethorphan hypersensitivity Y 10/8/1996 who on 08-OCT-1996 was vaccina n has been received from a physician concerning an 11-15 year old female who was vaccinated U with a second dose of VARIVAX (Oka/Mer n has been received from an allergist/ Y immunologist concerning a 7-9 year old male "sometime N in mid-July 7/15/2008 2008", on approximately 15-Julfollow-up information has been received Y from a physician concerning a 16 month old femaleNwith a history6/1/2008 of allergic6/1/2008 atopic dermatitis who n has been received from a licensed Y practical nurse (L.P.N.) concerning a 12 month old female Y with no pertinent 8/29/2008medical 9/1/2008 history or allergie follow-up information has been received Y from a physician concerning a 5 year old male patient Y (birth weight 9/8/2008 was 7 pounds, 9/9/2008 11 ounces) with n has been received from a physician concerning a 12 year old female who on an unspecified N date was vaccinated with a second dose of V follow-up information has been received Y from a nurse concerning a 16 year old male who onN22-JUL-1997 8/18/2008 was vaccinated 9/6/2008 with the first dos n has been received from a physician concerning an 11-15 year female who was vaccinatedUwith a second dose of VARIVAX (Oka/Merck). n has been received from a physician Y concerning a 6 year old female with a history of otitis media Y in February 2/7/2004 20048/11/2008 (treated with amoxicillin n has been received from a pharmacist Y concerning a 15 year old male patient with AMOXICILLIN U allergy 9/8/2008 who on 08-SEP-2008 9/10/2008 was vaccin follow-up information has been received Y from a physician concerning a 11 year old female who U on 20-AUG-2008 8/20/2008was 8/20/2008 vaccinated with the f n has been received from a physician Y concerning a 9 year old female who was vaccinated with Y VARIVAX vaccine (Oka/Merck) (route, lot n n has been received from a pharmacist Y concerning a 29 year old female who on 09-Sep-2008 U was vaccinated 9/9/2008 IM with 9/9/2008 VARIVAX (Oka/Merc n has been received form a physician's Y assistant student concerning an 11 year old male with N no known5/23/2007 allergies, who 9/4/2008 on 18-APR-2000 wa follow-up information has been received Y from a nurse practitioner concerning a 7 year old female Y with allergy 8/4/1998 to OMNICEF ### (rash) and no p n has been received from a physician Y concerning a 7 year old male patient who on 21-AUG-2008 U was vaccinated 8/21/2008 with 9/9/2008 a second dose of VA n has been received from a consumer her 12 months daughter with allergy to gelatin, who on N 04-Sep-2008 9/4/2008 was vaccinated 9/4/2008 with VARIVAX n has been received from a physician's Y assistant concerning a female patient who received U two doses two of VARIVAX 9/3/2008 (Merck) at unstated n has been received from a registered Y nurse concerning a 4 year old male with no pertinent N medical history 8/4/2008 and no history 8/6/2008 of drug reaction n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5ml dose o n has been received from a physician Y concerning a 5 year old patient who had been vaccinated Y with a dose of VARIVAX (Merck) in the pas follow-up information has been received from a nurse concerning her 6 year old male grandson U with no 8/16/2008 pertinent medical 9/6/2008 history and no dr n has been received from a Certified Y Medical Assistant concerning a 9 year old female who N on 10-SEP-2008 9/10/2008 was vaccinated 9/10/2008 with a booste n has been received from a nurse concerning Y a 9-year-old female patient who on 30-AUG-2008 N received8/30/2008 the second dose of 0.5ml VARIVA n has been received from a physician Y concerning a 16 month old female with no pertinent medical N history8/8/2008 and no drug 9/8/2008 reactions/allergies, w n has been received from a physician concerning an 8 year old male who on 23-JAN-2001 was vaccinated 1/23/2001 with the first 9/7/2008 dose of VARIVAX n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5 ml dose n has been received from a physician Y concerning a 11 year old male patient who on 21-AUG-2008 U was 8/21/2008 vaccinated with 9/9/2008 a second dose of V n has been received from a physician Y concerning a 9 year old male patient who on 21-AUG-2008 U was vaccinated 8/21/2008 with 9/9/2008 a second dose of VA n has been received from a physician Y concerning a 11 year old female patient who on 21-AUG-2008 U was 8/21/2008 vaccinated9/9/2008 with a second dose o follow-up information has been received from a nurse concerning a 67 year old female with U hypertension9/16/2008 who on 16-SEP-2008 9/16/2008 was vaccin
n has been received from a nurse concerning her 7 year old male grandson with no pertinent N medical history and no 9/6/2008 drug reactions/allergie follow-up information has been received from a nurse concerning a 68 year old male with hyperlipidemia U 9/16/2008 who on 16-Sep-2008 9/16/2008 was vaccina n has been received from a physician concerning an 11 year old female who on an unknownUdate was vaccinated with a second dose of V n has been received from a certifiedYmedical assistant (C.M.A) concerning a 20 year old female, Y weight 7/17/2008 168lb, height 7/18/2008 67 inches, with no pe n has been received via literature article regarding a case in litigation concerning a now 54 year U old female 3/7/2001 with common variable immunod n has been received from a physician concerning a 24 year old female who on was vaccinated U with two doses 4/1/2008 of VARIVAX (Merck) and fai n has been received from a registered nurse concerning an over 6 years old male who on approximately U 7/21/2008 21-JUL-2008 7/21/2008 was vaccinated with n has been received from a physician Y concerning a 12 month old male with no medical history Y or no drug allergies who was vaccinated with n has been received from a pharmacist concerning a male who was vaccinated with VARIVAX U (Oka/Merck). The patient failed to SEROCO n has been received from a physician Y concerning a 12 month old female who on 29-MAY-2008 N was a dose 5/29/2008 of vaccinated with VARIVAX (M n has been received from a pharmacist concerning a 70 year old male who on 14-MAY-2008Uwas vaccinated 5/14/2008 with VARIVAX 5/14/2008(Merck), 0.5 m n has been received from a physician concerning a 7 year old male who was vaccinated withU the second dose of VARIVAX (Merck). One y n has been received from a registered Y nurse concerning a 4 year old boy who on 06-JAN-2005 N was vaccinated 7/17/2007 subcutaneously 5/13/2008 into left arm n has been received from a physician concerning a 60 year old patient who on 30-JUL-2008Uwas inadvertently 7/30/2008 vaccinated 7/30/2008 with VARIVAX (O n has been received from a physician Y concerning an approximately 10 year old patient who N on an unspecified date was vaccinated with a d n has been received from a physician Y concerning a 13 month old female with no pertinent medical N history 4/30/2008 and no allergies 5/11/2008 who on 30-APR n has been received from a physician concerning a 16 month old female with no known allergies N or pertinent 4/21/2008 medical5/9/2008 history who on 21-AP n has been received from a nurse practitioner through a pregnancy registry concerning a 29Yyear old female 4/1/2008 with asthma 4/1/2008 and a possible Ty n has been received from a consumer's Y mother concerning her 24 month old daughter with no N pertinent medical ### history or### drug allergies wh n has been received from a physician Y concerning a 5 year old male who on 19-Jan-2008 was on 19-Jan-2008 1/19/2008 was vaccinated 7/21/2008 with a secon n has been received from a registered Y nurse (R.N.) concerning a 11 year old male with no pertinent Y medical 5/18/1998 history and 5/8/2008 no allergies who o n has been received from a physician concerning a male who's 5 year old son was vaccinated U with VARIVAX (Oka/Merck) on an unspecifie n has been received from a nurse concerning a 55 day old patient who on 16-MAY-2008 was U vaccinated5/16/2008 into the thigh 5/16/2008 with a dose of VARI n has been received from a physician concerning his 5 year old grandson with a history of eczema U (outgrew) 5/1/2008 and no 5/1/2008 known allergies who in n has been received from a consumer concerning her 5 year old grandson who was vaccinated U with at least one dose 4/9/2007 of VARIVAX (Merck) follow-up information has been received from a nursing student concerning a 19 month old male Y with no7/22/2003 known drug 7/24/2003 reaction/allergies or p n has been received from a healthcare worker concerning a 75 year old female who on 16-MAY-2008 U was 5/13/2008 vaccinated 5/16/2008 with a dose of VARIV n has been received from a medicalYassistant concerning a 5 year old male with no pertinentNmedical history 7/30/2008 or allergies 7/30/2008 who on 14-AUG-2 n has been received from a registered nurse (R.N.) concerning a 10 year old patient who was U vaccinated with a dose of VARIVAX (Merck) n has been received from a nurse practitioner concerning a 37 year old female who on 28-SEP-1998 U was vaccinated ### 8/16/2007 with the first dose of V n has been received from a registered nurse concerning an 8 year old patient who was vaccinated U with a dose of VARIVAX (Merck) (dose n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008 U was 7/21/2008 vaccinated 7/21/2008 with a second dose n has been received from a office manager Y concerning a 30 month old female who was vaccinated U with the first dose of VARIVAX (Merck) n has been received from a registered nurse concerning one to two female patients betweenNthe ages 15 to 18 months out of 20 who were n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008 U was 7/21/2008 vaccinated 7/21/2008 with a second dose n has been received from a physician Y and a medical assistant concerning a 5 year old boy with Y no pertinent 5/19/2008 medical5/19/2008 history and no history n has been received from a physician Y concerning a 10 year old female with no related medical Y history and 5/13/2008 drug allergy 5/14/2008 who was vaccinated n has been received from a physician Y concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX (Merck). At t n has been received from a medical assistant concerning a 11 year old male who "about oneY month ago", in April 2008, was vaccinated wit n has been received from medical assistant concerning a 7 year old patient who "about one Ymonth ago" in April 2008, was vaccinated with n has been received from a male dentist concerning his female friend who on 08-APR-2008 Uwas vaccinated 4/8/2008 with VARIVAX 4/8/2008 (MERCK) inste n has been received from a consumer concerning a 48 year old male with high blood pressure U whose 5-year-old son4/9/2007 developed bumps on n has been received from a nurse practitioner Y concerning an approximately 16 month old male Y with no known 1/8/2003 allergies 2/1/2003 or pertinent medica n has been received from a physician Y and a medical assistant concerning a 7 year old female, Y weight 46lb, 12/4/2006 who on 4/27/2008 19-JUL-2001 was vacc n has been received from a nurse concerning Y a 29 year old female who was vaccinated withUVARIVAX (Merck). The nurse reported that th n has been received from a physician's office staff member concerning her daughter, a 4 year Y old female5/16/2008 who on 16-MAY-2008 5/16/2008 was vaccin n has been received from a physician concerning a 12 month old patient who on an unspecified U date was vaccinated with a dose of VARIV n has been received from a physician's office staff member concerning a 4 year old boy whoYon 22-MAY-2008 5/22/2008 was 5/22/2008 vaccinated with the sec n has been received from a physician Y concerning an 8 year old female, weight 39lb, height 48.5 Y inches, 8/23/2007 who on 05-DEC-2000 4/25/2008 was vaccina n has been received from a physician and her first office staff member concerning a 4 year old Y patient who 5/22/2008 on 22-MAY-2008 5/22/2008was vaccinate n has been received from a physician and her office staff member concerning a 4 year old boy Y who on 22-MAY-2008 5/22/2008 5/22/2008 was vaccinated with t
n has been received through the pregnancy Y registry from a registered nurse for VARIVAX (Merck) U concerning 3/25/2008 a 20 3/25/2008 year old female with no n has been received from a registered nurse concerning a 14 year old male with no allergiesYand with Crohn's 4/28/2008 disease 4/29/2008 and who is immunoc n has been received from a registered Y nurse concerning a female in her 30's year old who on Y 19-MAY-2008 5/19/2008 was vaccinated 5/19/2008with a first dos n has been received from a registered nurse concerning one to two male patients between the N ages 15 to 18 months out of 20 who were v n has been received from a registered nurse concerning an 8 year old patient who was vaccinated U with a dose of VARIVAX (Merck) (dose n has been received from a physician Y concerning a 30 month old male with no other medicalNproblems who on an unspecified date had bee n has been received from a physician Y concerning a 13 year old male who was vaccinated with Y the second dose of VARIVAX (Merck) (lot# 6 n has been received from a medicalYassistant and physician concerning a 21 year old female Y with no pertinent 5/13/2008 medical 5/23/2008 history and no drug n has been received from a physician Y concerning a 13 month old male who on 05-MAY-2008 Y was vaccinated 5/5/2008 subcutaneous 5/19/2008with his first do n has been received from a registered nurse concerning a 57 year old female who on 27-MAY-2008 Y was5/27/2008 intended to 5/27/2008 receive ZOSTAVAX ( n has been received from a physician Y concerning an 8 year old boy who on 12-MAY-2008 was Y vaccinated 5/12/2008 with the second 5/26/2008 dose of VARIVA n has been received from a physician Y concerning a 12 year old male who was vaccinated with N a first dose of VARIVAX (Merck). The patien n has been received from a physician concerning a 12 month old female with no known allergies Y and a history 4/23/2008 of cellulitis 5/4/2008 in left leg at 6 mo n has been received from a health professional concerning a patient who was vaccinated with U a dose of VARIVAX (Merck) (lot number, inje n has been received from a physician concerning an 18 month old female who on 22-MAY-2008 Y was vaccinated 5/22/2008with 5/22/2008 VARIVAX (Merck). Th n has been received from a physician concerning a 5 year old male with seasonal allergies who N on 24-JUN-2004 5/14/2008was 5/14/2008 vaccinated subcutan n has been received from a physician concerning a 9 year old male who on 06-SEP-1995 was U vaccinated9/6/1995 with VARIVAX 9/1/2004 (Merck) (lot # not n has been received from a registered nurse, concerning her 13 year old daughter who on 14-JUL-1995 Y 7/14/1995 was vaccinated 5/28/2008 with the first dose n has been received from a physician Y assistant concerning a 30 year old white female with seasonal allergy, 8/1/2008 chronic8/13/2008 sinusitis and anaemia n has been received from a health professional concerning an 18 year old female who on 20-MAY-2008 U 5/20/2008 was vaccinated 5/22/2008 subcutaneously on n has been received from a medical assistant and physician concerning a 10 year old female N with no pertinent 8/11/2008 medical 8/11/2008 history and no allerg n has been received from a registered nurse concerning a 12 month old female who in approximately U 2007, about one year ago, was vacci n has been received from a registered nurse concerning an 8 year old female who on 02-MAR-2001 Y was9/12/2007 vaccinated 5/9/2008 subcutaneous with a f n has been received from a physician concerning an 82 year old female patient living in an assisted U living 8/15/2008 residence8/15/2008 who on 1:30PM, 15-AU n has been received from a licensed Y practical nurse concerning a 5 year old female with no U medical history 5/21/2008 or allergies who on 21-MAY-20 n has been received from a physician concerning a patient who was vaccinated with VARIVAX U vaccine (Merck). The physician reported tha n has been received from a physician concerning a child who was vaccinated with a dose ofUVARIVAX (Merck) in the 4/21/2008 past. Five or six week n has been received from a registered Y nurse concerning a 12 month old female who on 08-APR-2008 Y was 4/8/2008 vaccinated 4/17/2008 subcutaneously in th n has been received from a consumer concerning her daughter, a female who in approximately U 1998 (about 10 years ago) was vaccinated n has been received from a pharmacist concerning a 25 year old female employee of the hospital U who was vaccinated with two doses of VA n has been received from a registered pharmacist concerning her son, a 14 month old male Ywith no pertinent 7/1/2008 medical7/1/2008 history and no known n has been received from a medicalYassistant concerning a 9 year old female, weight 78lb, height Y 58 inches, 5/22/2008 with attention 6/2/2008 deficit/hyperacti n has been received from a physician Y concerning an 8 year old male who on 22-AUG-2000 N was vaccinated 9/1/2006 subcutaneously 5/26/2008with the first do n has been received from a medical assistant and a nurse concerning a 70 year old female who U on 18-AUG-2008 8/18/2008 was 8/18/2008 vaccinated with VAR n has been received from a physician concerning an 85 year old male who on 08-APR-2008Uwas vaccinated 4/8/2008 with a "regular 4/8/2008 dose" of VARIV n has been received from a physician concerning her 8.5 year old daughter who on 24-JUL-2007 U was vaccinated 7/24/2007in7/24/2007 the right arm with a do n has been received from a registered Y nurse concerning a 6 year old male with no drug allergies Y who on5/14/2003 14-MAY-2003 5/24/2008 was vaccinated with n has been received from a registered Y nurse (R.N.) concerning a patient who on 03-JUN-2008 U was inadvertently 6/3/2008vaccinated 6/3/2008subcutaneosly n has been received from a physician Y concerning a male in his 40's with a past medical history N significant5/1/2008 for a thyroid 5/1/2008 disorder treated with n has been received from a certified medical assistant concerning a 13 year old white femaleY with no pre-existing 8/7/2008allergies, 8/8/2008 birth defects, or n has been received from a vaccineYprovider concerning a 9 year old female minor with no pre-existing Y 5/28/2008 allergies, birth 5/29/2008 defects or medical c n has been received from a physician Y concerning a 10 year old male with allergy to OMNICEF Y who on 22-APR-1999 4/22/1999 8/10/2008 was vaccinated with a n has been received from a physician concerning a 4 year old female with no history of recent exposure to 6/5/2005 Chicken pox 6/4/2008 who on 05-JUN-20 n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male with8/12/2008 atopic dermatitis 8/13/2008 on leg behind kn n has been received from a registered nurse concerning a 68 year old female patient with noUpertinent medical history 8/8/2008 or known allergies o t was identified from a line listing obtained Y on request by the company from the FDA under the U Freedom of Information Act. A patient exper n has been received from a registered nurse (R.N.) concerning a 69 year old female who onU11-AUG-2008 8/11/2008 was vaccinated 8/11/2008 with a dose of V n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX vacc n has been received from a physician Y concerning a 9 year old male who in approximately 2000, N "8 years ago", was 8/12/2008 vaccinated subcutaneo n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male who 8/4/2008 on an unspecified 8/5/2008 date was vaccin
n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Oka n has been received from a registered Y nurse concerning a 19 year old female patient with asthma Y and penicillin 8/4/2008 allergy 8/13/2008 which caused breat n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Mer n has been received from a registered Y pharmacist concerning a patient who on 13-AUG-2008 U was vaccinated 8/13/2008 with a8/13/2008 dose of VARIVAX (Me n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Mer n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me n has been received from a physician Y concerning an adult male, without a reported history ofUchickenpox and who was VZV negative, who n has been received from a registered Y nurse concerning a 3 year old female with no known N drug allergies 7/28/2008 and no pertinent 8/10/2008 medical history, follow-up information has been received Y from a licensed practical nurse for the pregnancy registry Y for VARIVAX 3/7/2008 (Merck) 3/7/2008 concerning a 15 y n has been received from a physician concerning a male who was vaccinated with a dose ofUVARIVAX (Merck). Subsequently the patient e n has been received from a licensed practical nurse and a consumer concerning an 11 yearYold female who 6/13/2008 on 13-Aug-2008 8/14/2008was vaccinate n has been received from a nurse concerning a patient who on 04-AUG-2008 was vaccinated U with a dose8/4/2008 of VARIVAX (Merck) (lot # 66144 n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007 (Merck)10/1/2007 (lot no., route and site n has been received from a physician concerning a female who on an unspecified date was Yvaccinated with a second dose of VARIVAX (M follow-up information has been received from a nurse concerning an 11-12 year old female Y who was vaccinated 10/1/2007 with 10/1/2007 VARIVAX (Merck) (lo n has been received from a nurse cornering an 11-12 year old female who was vaccinated with Y VARIVAX 10/1/2007 (Merck) (lot 10/1/2007 no., route and site of n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007 (Merck)10/1/2007 (lot no., route and site n has been received from a physician Y concerning a 6 year old male who on an unspecified date U was vaccinated with a second dose of VAR n has been received from a physician's assistant (P.A.) concerning a approximately 23 month Y old white male 2/1/2008 with no3/1/2008 other medical history n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Sub n has been received from a health professional Y concerning a 12 year old male with a historyNof rash for 29/19/2003 days who 6/21/2008 on 19-SEP-2003 was v n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Subs n has been received from a physician Y concerning a patient, his child, who was vaccinated with U a dose of VARIVAX (Merck) (lot no., route a n has been received from a physician concerning a 10 year old male, weight 107.8lb height Y 52.5 inches, who 8/3/2005 on 03-AUG-2005 8/27/2007 was vaccina n has been received from a licensed Y practical nurse concerning a 10 year old male with no pertinent Y medical 6/4/2008 history 6/4/2008 and drug reactions/alle n has been received from a consumer concerning her son who on 19-JUN-2008 was vaccinated N with his6/19/2008 booster VARIVAX 6/19/2008 (Merck), 0.5 ml n has been received from a physician Y concerning a 11 year old male patient with no known allergies Y or pertinent 6/16/2008medical 6/16/2008 history who on 16 n has been received from a licensed Y practical nurse (L.P.N.) concerning a 14 month old male Y on 05-JUN-2008 6/5/2008 was vaccinated 6/5/2008 subcutaneo n has been received from a licensed Y practical nurse concerning a 14 month old male patientYwho on 05-JUN-2008 6/5/2008 was 6/5/2008 vaccinated with a d n has been received from a physician Y concerning a 11 year old female who in April 2008, was N vaccinated4/1/2008 with second dose of VARIVAX (M n has been received for a physicianYassistant concerning a 8 year old male patient who on 11-SEP-2001, Y 9/11/2001 was vaccinated 5/2/2008 with VARIVAX (M n has been received from a physician Y concerning a 9 year old male patient with a history of U seizures who was vaccinated with a dose of VA n has been received from a nurse concerning Y an approximately 8 year old male who "about Y 10 years ago" in approximately 1998 was vacc n has been received from a healthcare Y worker concerning an approximately 7 year old female Y with no known 5/16/2001 allergies 2/1/2007 and a history of strep n has been received from a physician concerning a 59 year old male patient who on 15-APR-2008 U was prescribed 4/15/2008 and 4/15/2008 vaccinated with a fir n has been received from a nurse concerning a patient who in 1998 was vaccinated with a dose Y of VARIVAX (Merck) (lot no., route and sit n has been received from a physician concerning a 5 year old female patient with no pertinent Y medical history 4/1/2007 and drug reactions/allergies n has been received from a physician Y assistant (P.A) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) years ago n has been received from a health professional Y concerning a 14 year old female with a history Y of dermatitis, 3/31/2008 rhinitis 3/31/2008 allergic and latex allerg n has been received from a 40 yearYold female with hypercholesterolaemia and a history of female Y genital9/4/2007 operation 9/4/2007 concerning on 04-SEP n has been received healthcare provider Y concerning a 9-year-old male who on 16-AUG-2002 Y was vaccinated 8/16/2002 with a dose 6/1/2008 of VARIVAX (Me n has been received from a licensed practical nurse concerning a 12 year old male who on an Y unspecified8/5/2008 date was vaccinated 8/5/2008 with her firs n has been received from a registered nurse (R.N.) concerning a patient who on 03-APR-2001, Y 4 day early 4/3/2001 prior to the 4/3/2001 patient's first year b n has been received from a health professional concerning an 11 year old male who on 05-JUN-2008 U was6/5/2008 vaccinated 6/6/2008 subcutaneously in le n has been received from a pharmacist Y concerning a 46 year old female with history of morphine N allergy who 6/9/2008 on 09-JUN-2008 6/10/2008 was vaccina n has been received from a medical assistant concerning a 63 year old patient who on 04-JUN-2008 U was6/4/2008 vaccinated6/4/2008 with a dose of VARIV n has been received from a consumer concerning her son a male patient who on 10-JUN-2008 N at 11:006/10/2008 was vaccinated 6/10/2008 with VARIVAX (Me n has been received from a consumer concerning her son who was vaccinated with VARIVAX U (Merck) (Injection site, dose/ frequency and n has been received from a registered Y nurse (R.N.) concerning that during the past few months Y a few patient 5/14/2008 who were 5/14/2008 vaccinated with a s n has been received from a registered nurse (R.N) concerning a patient who on 11-JUN-2008 U was inadvertently 6/11/2008 vaccinated 6/11/2008 with a dose of n has been received from a nurse concerning her child, 4 year old male, with a history of prior N immunizations 6/10/2008 (unspecified) 6/10/2008 who on 10-JUN
n has been received from a nurse concerning a 36 month old male who in approximately 2006 Y was vaccinated with a6/5/2008 single dose of VARIV n has been received from a certifiedYmedical assistant (C.M.A.) concerning a 12 year old female N with no6/26/2008 pertinent medical 6/27/2008 history or known n has been received from a pharmacist concerning a 65 year old patient who on 27-JUN-2008 U was inadvertently 6/27/2008vaccinated 6/27/2008with a single d n has been received from a registered nurse concerning a patient who on 30-Jan-2008 was U inadvertently 6/30/2008 vaccinated 6/30/2008 with a dose of VARIV n has been received from a registered nurse concerning a male with no known pertinent medical U history6/26/2008 who on 26-JUN-2008 was vaccina n has been received from a nurse concerning a 60 year old male who on approximately 30-MAY-2008 U was 5/30/2008 vaccinated 5/30/2008 with a dose of VARI n has been received from a licensed Y practical nurse (L.P.N.) concerning a 4 year old femaleNwith no medical 5/8/2008 history or 5/8/2008 drug allergies who o n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or U her) 70's with 7/1/2008 no pertinent 7/1/2008 medical history, dr n has been received from a veterinarian Y concerning his 24 year old pregnant daughter with aUhistory of chickenpox 6/12/2008 as infant. The patient's n has been received from a physician concerning her daughter who was vaccinated with a dose Y of VARIVAX (Merck). On an unspecified d n has been received from a nurse concerning her approximately 12 month old daughter withUallergies who8/1/2005 in August 2005 was vaccinated n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated U with the two doses of VARIVAX (Mer n has been received from a Merck employee Y concerning a 6 year old female who last week U (between 23-JUN-2008 6/25/2008 6/25/2008 to 29-JUN-2008) was v n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or U her) 70's with 7/1/2008 no pertinent 7/1/2008 medical history, dr n has been received from a licensed practical nurse concerning a 20 year old female patientUwith no pertinent 8/17/2007 medical history who on 17-M n has been received from a nurse concerning a 25 year old female with no pertinent medicalUhistory or history 4/1/2008 of drug4/1/2008 allergies or reaction w n has been received from a nurse concerning a 6 or 7 years old male who was vaccinated with U at least two doses of VARIVAX (Merck). Th n has been received from a licensed Y practical nurse (L.P.N.) concerning a 13 month old female U with no medical 5/30/2008 history 6/24/2008 or no drug allergies n has been received from a pharmacist concerning a patient who on 07-JUL-2008 was vaccinated U with "one 7/2/2008 vial" of VARIVAX 7/2/2008 (Merck) inste n has been received from a health professional concerning a 4 year old female with no pre-existing U allergies, 7/1/2008 birth defects 7/3/2008 or medical condi n has been received from a health care professional concerning an 8 year old female with no Y pre-existing 6/26/2008 allergies, birth defects or medica n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated U with the two doses of VARIVAX (Mer n has been received from a healthcare worker and a physician concerning an 11 year old white Y female with 8/14/2007 no pertinent 8/14/2007 medical history an n has been received from an office manager concerning a 63 year old female who on 08-JUL-2008 U was vaccinated 7/8/2008 in7/8/2008 her left arm with a do follow-up information has been received from a registered nurse concerning a 5 year old male U with no relevant 7/2/2008 medical 7/4/2008 history or allergies n has been received from a certified medical assistant (C.M.A.) concerning a 4 year old female N who on 01-JUL-2008 7/1/2008 7/1/2008 was vaccinated intram n has been received from a registered nurse concerning a 13 year old female with no pre-existing N drug allergies 4/10/1996 and6/27/2008 medical conditions wh n has been received from an office staff concerning a female who in June 2008, was vaccinated U with a dose 6/1/2008 of VARIVAX 6/1/2008 (Oka/Merck) (lot n has been received from a registered nurse concerning a 10 year old female patient who inYapproximately 8/1/1998 August 1998, 6/6/2008 when she was 12 n has been received from a licensed practical nurse concerning a 10 year old male who on 02-FEB-1997 Y 4/10/2007 was vaccinated with the first dose n has been received from a licensed practical nurse concerning an 8 year old female patientYwho on 17-JAN-2001, 4/10/2007 was 7/1/2008 vaccinated with the n has been received from a pediatrics office and a nurse concerning a 12 month old female Y who on 27-JUN-2008 6/27/2008at6/27/2008 1545 was subcutaneo n has been received from a Licensed Practitioner Nurse, concerning a 15 year old female patient, U whose5/27/2008 mother told the LPN that she had n has been received from a physician, Y concerning a male patient who received VARIVAX (Merck) Y (Lot #557099/0453U) 6/5/2007 7/11/2008 0.5 mL SQ on 05-J n has been received from a physician Y concerning a 13 year old female patient who on 24-Mar-2008, Y was3/24/2008 vaccinated3/24/2008 with a dose of VARIVA n has been received from a physician concerning a 12 year old female who on 24-Mar-2008Ywas vaccinated 3/24/2008 SC with 3/25/2008 a second 0.5ml dose n has been received from a physician and a registered nurse concerning a patient who overUthe last one or two weeks 6/1/2008 was vaccinated with n has been received from a medicalYassistant concerning a her 7 year old daughter with history Y of asthma and### no drug 3/13/2008 reactions/allergies, n has been received from a health professional Y concerning a patient who on an unspecified Y date, was vaccinated with a first dose of VARV n has been received from a physician concerning a female with a history of obesity who wasYvaccinated SC with a second 2/1/2008 dose of VARIVA n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity and another male 1/1/2008 (WAES#0804USA n has been received from a registered Y nurse concerning a 9 year old male who on 15-Mar-2000 Y was vaccinated 3/20/2008 into 7/2/2008 his leg with the first do n has been received from a nurse practitioner Y concerning a couple of patient 's who on an unspecified U date was vaccinated with the second n has been received from a nurse concerning a patient who on 10-July-2008 was vaccinatedNsubcutaneously 7/10/2008 with a7/15/2008 dose of VARIVAX (Me n has been received from a consumer concerning her daughter who was vaccinated with a dose U of VARIVAX (Merck). Subsequently the pa n has been received from a physician Y concerning an 8 year old male with no pertinent medical Y history or3/31/2008 drug allergies 4/1/2008 who on 31-MAR-20 n has been received from a health professional Y concerning a 12 year old male who on 22-SEP-1999 Y was 9/22/1999 vaccinated7/3/2008 with VARIVAX (Merck n has been received from a physician Y concerning a 10 year old female who in approximatelyN2007 was vaccinated SC with a second 0.5 m n has been received from a physician concerning his 17-month-old male who was vaccinated U at 12 months of age with a dose of VARIVAX n has been received from physician's office concerning a 7 year old boy with no pertinent medical N history 4/1/2008 who on 01-APR-2008 4/1/2008 was vaccin n has been received from a health professional concerning a 15-month-old female with no medical U history 3/12/2008 who at a 3/21/2008 well check up on 12-MA
n has been received from a physician concerning her 56 year old mother with mild intermittent Y asthma as medical history and no illness at t n has been received from a physician concerning a 7-year-old female with no pertinent medical Y history or 3/25/2008 drug reactions/allergies, 3/26/2008 who on 2 n has been received from a registered nurse concerning a 32 month old who on 25-AUG-2006 N was vaccinated 8/25/2006 with3/30/2008 0.5 ml of VARIVAX (Me n has been received from a physician Y concerning a child who was vaccinated with VARIVAXY(Merck). "In the past couple 3/1/2008 of weeks", in app n has been received from a physician concerning a female in her 70's who on approximatelyU26-FEB-2008 2/26/2008 was vaccinated 2/26/2008 with a dose of V n has been received from a consumer concerning her 11 year old son with a drug reaction/allergy U to soy and peanut,4/2/2008 who on 01-APR-2008 n has been received from a physician Y concerning a 17 year old female with no pertinent medical N history and 4/1/2008 no drug 4/2/2008 reaction / allergies, wh n has been received from a consumer Y concerning his 10 year old daughter who on 04-OCT-1998 N was vaccinated 4/3/2008with 4/4/2008 th first dose of VARI n has been received from a registered nurse concerning her 10 year old son who on an unspecified Y date3/21/2008 was vaccinated 3/28/2008 with the first dose n has been received from a registered Y nurse concerning an 8 year old male who on 03-Nov-2000 N was vaccinated 2/5/2007with 2/5/2007 the first dose of VAR n has been received from a registered nurse concerning a patient who on approximately 01-APR-2008 U was 4/1/2008 vaccinated with a dose of VAR n has been received from a nurse concerning Y a 4 to 6 year old male who on approximately 01-APR-2008 Y 4/1/2008 was vaccinated 4/1/2008 with VARIVAX (M n has been received from a physician concerning an 81 year old female who on 08-APR-2008 U was vaccinated 4/8/2008 with "regular 4/8/2008 dose" of VARIV n has been received from a physician Y concerning a 12 year old male who on the day before Nthe child's first birthday was vaccinated subcut n has been received from a physician Y concerning a 13 year old (previously reported as 11 year Y old) female with ### no pre-existing 4/6/2008 allergies, b n has been received from a physician Y concerning an approximately 36 month old female patient Y with no pertinent medical history who was n has been received from a physician Y assistant concerning a "7 or 8 years old" male who in U September 2007, 9/1/2007 was vaccinated with a secon n has been received from a physician concerning a 4 year old male with no pertinent medical Y history and no drug reactions/allergies, 3/25/2008 who w n has been received from a health professional Y concerning a a 13-year-old female with a history Y of rhinitis 10/2/1995 allergic and 4/1/2008 scoliosis who on 02n has been received from a licensed Y practical nurse (L.P.N.) concerning a 14-year-old female, Y weight 179 4/10/2008 pound, height 4/10/2008 67.5 inch, who on n has been received from a registered nurse concerning a patient who was vaccinated subcutaneous Y with a 0.5 ml second dose of VARIVA n has been received from a registered nurse concerning a 11-year-old female who on 05-JUN-1998 Y was vaccinated 6/5/1998 4/5/2008 SC with a 0.5 mL dose n has been received from a registered nurse concerning a 7 year old male who on 22-Jun-2001 Y was vaccinated 6/22/2001 with 3/23/2008 VARIVAX (Merck) (lot n has been received from a health professional concerning a patient who on 30-NOV-2005 was U vaccinated with ### a dose 4/1/2008 of VARIVAX (Merck n has been received from a registered nurse concerning a 14 year old male child who "withinUthe last two 4/1/2008 weeks" on approximately 01-APR n has been received from a registered nurse concerning a 9 year old patient with a history ofNpremature puberty 4/9/2008 and4/10/2008 asthma and a drug rea n has been received from a physician Y concerning a 4 year old male patient, who on 24-Feb-2005, Y was vaccinated 2/24/2005 with 4/1/2008 VARIVAX (Merck) ( n has been received from a physician Y concerning a 41 month old male with autism, speech delay U and encopresis 9/2/2005who 7/31/2007 on 02-SEP-2005 wa n has been received from a licensed practical nurse concerning a 14 year old female with amoxicillin U allergy who ###on 21-NOV-1997 4/7/2008 was vac n has been received from a registered Y nurse concerning a 15 year old male who was vaccinated U with a dose VARIVAX 4/9/2008 (Merck). On 09-Apr n has been received from a nursingYstudent concerning herself, a 42 year old female with noNhistory of drug reactions ### 3/1/2008 or allergies and poss n has been received from a nurse practitioner and consumer concerning a patient who in March U 2008, was 3/1/2008 vaccinated 3/1/2008 with a dose of VARI n has been received from a registered Y nurse concerning a 14 year old male with asthma andNseasonal allergies 1/15/1996 who4/15/2008 on 15-JAN-1996 was n has been received from a nurse concerning a patient who on 17-JUN-2008 was vaccinated U with VARIVAX 6/17/2008 (Merck). 6/17/2008 The nurse reported t n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity who in 2008 was vaccinated SC with n has been received from a certifiedYmedical assistant concerning a 10 year old female with N allergic reaction 4/14/2008 to ZITHROMAX who on 17-JU n has been received from a veterinarian Y concerning his 18 month old granddaughter with noYmedical history or allergies, who about a mont n has been received from a registered Y nurse concerning a 6 year old male with ringworm of U scalp who was 3/8/2007 vaccinated 4/17/2008 with first and second n has been received from a nurse concerning Y a 7 year old female who on 14-APR-2008 wasUvaccinated4/14/2008 with the second 4/14/2008 dose of VARIVAX n has been received from a nurse concerning Y a 12 month old female with a ear infection andYwith no pertinent 10/6/2003 medical history ### or drug react n has been received from a physician Y concerning a 15 month old male who on 15-APR-2008Y was vaccinated 4/15/2008 with a4/15/2008 dose of VARIVAX (Me n has been received from a registered Y nurse concerning a 12 month old boy with dilated cardiomyopathy, Y 4/9/2008 hypoxic ischemic encephalopath n has been received from a nurse practitioner concerning a 33 year old female who in approximately U June 2004, was vaccinated with VARI n has been received from a physician concerning a female patient who entered an unspecified U study and was vaccinated with VARIVAX (M n has been received from a medical assistant concerning a 75 year old male patient who at U 2 pm on 18-JUN-2008 6/18/2008 inadvertently 6/18/2008 received a n has been received from a physician concerning an approximately 6 year old male with epilepsy Y and seizure 3/26/2001 disorder, 4/1/2006 and no drug reactio n has been received from a company Y representative concerning her 11 year old son with noUpertinent medical 6/16/2008 history, 6/16/2008 drug reactions or alle n has been received from a health professional concerning a patient with reactive airways disease U and a8/25/2004 history of rhinitis 11/5/2005 allergic and otitis n has been received from an employee at a physician's office concerning a 4 year old male patient U with 8/10/2000 no pre-existing 1/25/2004 allergies, birth defec n has been received from a healthcare worker concerning a 12 year old male with no knownYallergies who 6/16/2008 on an unspecified 6/16/2008date was vacc n has been received from an office worker in a physician's office concerning a 8 year old male U with a history 1/5/2000 of adenotansillectomy 5/25/2007 (16-MAR
n has been received from a health professional concerning a 4 year old male with rhinitis allergic U and asthma 3/22/2005 and a history 3/5/2008 of otitis media w n has been received from a health professional concerning a 5 year old female who on 16-JUL-2001 U was 7/16/2001 vaccinated 8/29/2005 with VARIVAX (Oka/M follow-up information has been received Y from a healthcare worker concerning a 9 year old female N with no 6/16/2008 known allergies 6/16/2008 who on 17-OCTn has been received from a health professional concerning a 45 month old female patient with U a history of9/1/2004 premature6/6/2007 twin birth who on 01-S n has been received from a nurse concerning Y a 5 year old male who on 18-JUN-2008, today, U was inadvertently 6/18/2008 vaccinated 6/18/2008 with two doses n has been received from an employee at a physician's office concerning an 8 year old girl with U allergic rhinitis 8/26/1999 who on 4/6/2007 26-AUG-1999 was v n has been received concerning a 10 year old male with allergic rhinitis, asthma and allergy N to peanut butter 3/22/2001 who on3/13/2005 22-MAR-2001 was vac rmation has been received from a registered nurse and follow up information was received from Y the physician 6/9/2008 concerning 6/11/2008 a 12 month old fe n has been received from a medicalYassistant concerning an 18 year old female who on 02-JUN-2008 N was 6/2/2008 vaccinated 6/16/2008 with a first dose of V n has been received from a physician Y concerning a 4 year old male with hypersensitivity andNatopy who on 29-JAN-2004 6/18/2008 was vaccinated w n has been received form a physician Y concerning a 12 month old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) (lot num n has been received from a health professional concerning a 17 month old female with heartUdisease and 9/16/2003 asthma who on ### 16-SEP-2003 wa n has been received from a women from a pediatric office concerning an 11 year old femaleUwho on 02-JUN-2008 6/2/2008 was 6/2/2008 vaccinated subcuta n has been received from a male dentist with a history of being given 2 doses of pneumococcal U 23v polysaccharide 4/8/2008 vaccine 4/8/2008close together n has been received from a physician concerning a female who was vaccinated with a first dose U of VARIVAX (Oka/Merck) prior to pregnanc follow-up information has been received Y from registered nurse concerning an 8 year old male Y child with 4/16/2008 no known allergies 4/23/2008 who on 16-APR n has been received from a registered Y nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck). 4/9/2008 On 09-APR-2 n has been received from a registered Y nurse concerning a 7 year old female with exercise induced Y asthma 4/8/2008 and no known 4/26/2008 allergies, who on n has been received from a nurse concerning Y a 5 year old female with no history of allergiesY(including neomycin 4/29/2008or4/29/2008 gelatin) who on 29-APR n has been received from a physician concerning a 4 year old female who in the afternoon of U 19-APR-2007 4/19/2007 was vaccinated 4/19/2007 in the left arm w n has been received from a registered Y nurse concerning a 5 year old male with Amoxicillin allergy Y who on 6/15/2007 21-MAY-2003 4/2/2008 was vaccinated su n has been received from a healthcare Y worker concerning a 14 month old male with no pertinent U medical4/14/2008 history who 4/28/2008 on 14-APR-2008 was n has been received from a registered Y nurse concerning a 5 year old male with no pertinent N medical history 3/30/2004 who on4/11/2008 30-MAR-2004 was vac n has been received from a registered Y nurse concerning a 15 to 18 month old child patient out N of 20 who was vaccinated with VARIVAX (O n has been received from a physician concerning a 57 year old female patient who on 15-APR-2008 U was4/15/2008 prescribed4/15/2008 and vaccinated with a n has been received from a registered nurse concerning a 77 year old male who on 23-JAN-2008 U was vaccinated 4/29/2008 with ZOSTAVAX (Oka/M n has been received from a licensed Y practical nurse concerning an 8 year old female with allergy Y to pertussis 4/11/2008 vaccine 4/12/2008 (limplegs) and ZYRT n has been received from a consumer concerning her 18 month old daughter with no pertinent Y medical history 10/4/2005 or drug 10/4/2005 allergies who on 04n has been received from 2 nurses Y concerning a 6 year old boy, 66 pounds weight and 47 inches Y height,3/26/2003 with seasonal 4/29/2008 allergies who on 26 n has been received from a physician Y concerning a 30 month old male who on 21/NOV/2006Nwas vaccinated with ### a4/30/2008 single dose of VARIVA n has been received from a physician concerning a 9 year old boy with no history of drug reactions U or allergies 12/6/2006 who4/13/2008 on 30-MAR-2000 was v n has been received from a physician Y concerning a 12 year old female with no pertinent medical N history 10/1/2007 who on 10-JAN-2001 was vaccinat n has been received from a motherYand a physician concerning a 13 year old boy with asthma, N allergy to4/15/2008 penicillin and 4/15/2008 severe allergies to m n has been received from a dermatologist concerning a 20 month old male who on approximately U 10-APR-2008 4/10/2008 was vaccinated with a 0.5 n has been received from a registered Y nurse concerning a 4 year old male with no pertinent Ymedical history 8/28/2001 and no 8/28/2001 known drug reactions/a n has been received from a health professional concerning a 7 year old female child, with noYknown drug4/15/2008 allergies, 4/17/2008 who on 17-APR-2008, a n has been received from a registered Y nurse concerning a 12 month old female with no pertinent N medical4/8/2008 history of 4/28/2008 known allergies who on n has been received from a physician Y concerning a 14 year old female with no pertinent medical U history 7/10/2007 and no drug reactions/allergies wh n has been received from a company Y representative concerning his child's piano teacher's daughter N a 20 3/31/2008 month old4/26/2008 female who in the end n has been received from a physician who between 1996-1997 was vaccinated with her first,Usecond and third doses of VARIVAX (Oka/Me n has been received from a nurse concerning Y a 11 year old male with no medical history of drug Y allergies 6/17/2008 who on 17-JUN-2008 6/19/2008 was vaccin n has been received from a physician concerning a 4 year old male who on 13-MAR-2008 was Y vaccinated 3/13/2008 into the thigh 3/15/2008 with a second dos n has been received from a physician Y concerning a 4 year old male who on 22-APR-2008 was Y vaccinated 4/22/2008 into the thigh 4/22/2008 with a second dose n has been received from a licensed Y practical nurse concerning a 5 year old female with eczema Y on buttocks 5/2/2008 and no5/2/2008 known drug reactions n has been received from a physician Y concerning a male who on 24-APR-2008 was vaccinated Y with his 4/24/2008 second dose of VARIVAX (Oka/M n has been received from a registered Y nurse concerning her friend's child who was vaccinated U with VARIVAX (Oka/Merck) about 6 or 7 yea n has been received from a physician Y assistant concerning her son who was vaccinated with Y VARIVAX (Oka/Merck). The physician assista n has been received from a physician Y concerning a 9 year old patient who on an unspecifiedUdate was vaccinated with VARIVAX (Oka/Mer n has been received from a registered Y nurse concerning a 52 year old female with no pertinent Y medical history 4/4/2008 of allergies, 4/18/2008 who on 04-APR n haws been received from a physician assistant concerning a 19 year old patient who on 15-MAR-2008 N 9/27/1997 was vaccinated 2/7/2008 SQ with a second n has been received from a medicalYassistant concerning a 24 month old female with no known Y allergies who 6/4/2004 on 04-JUN-2004 6/4/2004 was vaccina
n has been received from a registered nurse (R.N.) concerning a 3 year old male who was vaccinated Y with 2/4/2008 the 2nd dose 2/4/2008 of VARIVAX (Oka follow-up information has been received from a physician concerning a 9 year old male withYno pertinent6/12/2008 medical history 6/12/2008 or history of drug n has been received from a certified medical assistant (C.M.A.) concerning a 60 year old patient U who was vaccinated subcutaneously with n has been received from a nurse practitioner Y concerning her 18 month old grandson with no N known relevant 5/28/2008 medical6/4/2008 history who on 28-MA n has been received from a physician concerning a 11 year old female with a history of attention N deficit disorder and no allergies who on 03 n has been received from a registered Y nurse concerning a 12 month old male (the doctor's son) N with no 6/10/2008 relevant medical 6/13/2008 history who on 10 n has been received from pharmacy student concerning a 60 year old patient who was vaccinated U with VARIVAX. The pharmacy student re he had vaccine on May 20. On May 21st - pt. c/o dizziness, joints aching, T. 102, SOB, "heart Y racing". Took 5/20/2009 2 acetaminophen, 5/21/2009 stayed in be n has been received from a physician Y concerning a patient who on an unknown date was vaccinated N with 4/30/2008 a second4/30/2008 dose of VARIVAX. On dm. 3/18/09 for 6 mos. well visit 3/19/09 Temp. 101 degrees per mom Temp. in office 99.7 Y (Ax) Dx: Vaccine 3/18/2009 reaction 3/18/2009 d starting 5/18 that Pt has a rash on arms + legs, no fever. Y 5/13/2009 5/18/2009 breaking out into rash on 5/14/09 around Y 7:00 pm. The rash is red round areas from head to toe. 0 blisters. 5/12/2009 Does not seem to be itching. ters breaking out/popping up on nose Y area - 7 total so far. Patient was consulting doctor U 5/12/2009 5/15/2009 e hypersensitivity reaction to MMR vacc. w/ spreading erythema and urticarial lesion at site ofYinjection. She 5/8/2009 was comfortable 5/8/2009& breathing ea oke out in a rash after ROTOVIRUSYimmunization given within 24 hours. Also had a temperature N of 101. 5/4/2009 Mother gave 5/5/2009 TYLENOL rash was stated - that after thigh vaccine (TDAP) he developed a high fever - and generalized rash. States Y took Benadryl 5/12/2009 + Tylenol 5/13/2009 helped symptoms of arm, redness, severe pain & inability to use arm for 3 days due to pain & swelling Y 5/7/2009 5/7/2009 lar rash appeared on forehead & spread to back of neck 30 min post vaccines given & lastedY48-72 hrs. n has been received from a nurse practitioner and a healthcare worker for GARDASIL, a Pregnancy Y Registry product, ### 3/1/2008 concerning a 23 yea Y 5/15/2009 n has been received from a physician Y concerning Y a 21 year old female with partial Y hearing loss N due to congenital 6/15/2007sensory 6/22/2007 nerve damage, ir n has been received from a physician concerning a 13 year old female with cerebral palsy, hydrocephalus U and shunt which has became oc n has been received from a female concerning her daughter, for a pregnancy registry for GARDASIL, Y who on an unspecified date was vacc vaccine failure. Pt presented 5/18/09 with typical herpes zoster skin lesions. U ### 5/8/2009 n has been received from Y a pharmacist Y concerning a 19 year old female with no pertinent medical Y history who was vaccinated with the sec d irregular breathing with gasping after Y shallow breathing approx 11 hrs after vaccines givenY. Temp was1/29/2009 104. Went1/29/2009 to ER then home and d to R thigh, area hard, red, hot to touch. Y n has been received from a consumer Y concerning her son with no known drug reactions/allergies N and medical 5/1/2002 history who "when about 18 n has been received from a nurse concerning Y a 67 year old female with a diabetes and a history Y of childhood 2/26/2008 chickenpox, 3/19/2009 who on 27-FEBn has been received from a medicalYreceptionist concerning a 76 year old female with no pertinent Y medical 1/13/2009 history and 1/15/2009 no drug reactions/a after vaccine redness & swelling at site. Y Seen at 72 hours after administration. 10 X 8 cm area Y of erythema 5/15/2009 with 2 X5/16/2009 2 cm area induration. n has been received from a 59 yearYold female registered nurse with latex allergy, unspecified N pain medication 9/30/2008 allergy 9/30/2008 and penicillin allergy fever of 102 degrees F orally -Nausea -Severe, violent vomiting -Tenderness/sensitivity of injection Y site. 4/22/2009 4/22/2009 a of severe swelling around the site of injection. Pain to touch and radiates heat Y 5/18/2009 5/18/2009 ation was being injected, became faint. Has not done this with other injections. Once patient Y sat for a few5/22/2009 minutse and 5/22/2009 sipped on Coke, felt umococcal vaccination was given instead of a 1st Hepatitis A. Incident occured 05/21/09 at 1545. 5/21/2009 ction with arm swelling Y 5/20/2009 5/20/2009 ervation: slight diffuse induration in the deltoid area of the right arm. Red and blotchy in the Y area noted. 4/30/2009 Not hot to touch 5/3/2009 and withoug tend administered in Right deltoid. ThreeYinch induration around injection site that is tender and warm U to the touch. 5/20/2009 5/21/2009 n in left arm after receiving her first dose of anthrax. The pain started one day after receivingYthe dose and 4/15/2009 lasted for4/16/2009 3 days. RECEIVED VACCINE ON 5/18/2009 ON THE LEFT ARM ONE INCH BELOW THE TDAP. SHE EXPERIENCED 5/19/2009 FEVER 5/19/2009 OF 102, CHILLS, ely after administering the vaccine, the Y patient experienced near-syncope: pallor, diaphoresis, U hypotension 5/22/2009 and bradycardia. 5/22/2009This lasted ov arted having reaction to vaccine twoYdays after delivery. Rash swelling and itching at injection Y sight. They 5/5/2009 thought patient 5/7/2009 was possibly getti led in on very hectic day wanting to get child with bone marrow transplant revaccinated. They Y were on their 5/18/2009 way home from doctor. Recep mplained of dizziness, nausea and dry heaves. The symptoms lasted approximately 8 hours. Y No treatment 5/20/2009 5/21/2009 ental status per MD Y 1/30/2009 1/30/2009 e and worsening myalgias upper extremities Y and torso. U 5/20/2009 5/21/2009 fter receiving smallpox and anthrax Yvaccine, patient developed fever and chills which resolved Y overnight.5/12/2009 Patient went 5/14/2009 running the next day ven Pneumovax on 5/11/09, pt called on 5/13/09 and spoke to triage nurse asking if the following Y symptoms 5/11/2009 are normal 5/13/2009 after recieving the p miting, eyes rolling to back of head, twitching Y for 1 hour, patient went to ER and then was seen Y folling day.5/19/2009 5/20/2009 d to cinic with herpes zoster rash on back and chest that started 5/19. No known chicken pox before vaccine 1/22/2009 or exposure 5/19/2009 to Zoster or chick
jection site and on the back of right arm. Y 5/19/2009 5/20/2009 ting in chair for injection. approximately 30 seconds after injection, observed color (pale) on face,patient Y 5/22/2009 lost consciousness 5/22/2009 for a moment a er DTAP vaccine his left upper arm began to swell. It got bright red,swollen, hot to touch andYhad a rash.5/15/2009 He was administered 5/15/2009 Qdryl(corn f iving Varicella vaccine on 4/16/09, pt was seen on 5/16/09 with a Dx of Varicella. Y 4/16/2009 5/16/2009 d Rotavirus vaccine on 4/06/09. Pt Y had ER visitYwith Dx intussusception 7 on 4/08/09. pt c/o vomiting/rectal Y 4/6/2009 bleeding, low 4/8/2009 grade fever. Moc + veloped three lesions at 2 days post injection, each approx 3-4" in diameter, within a 10" area U around the 5/19/2009 site of injection. 5/21/2009 Pt applied ice. A ped gradually worsening myalgias and muscle weakness after receiving the Zostavax on 12/22/08 Y and had elevated ### ESR### of 71 consistent brought in today by her mother. Mom reported to the doctor about SXs 30 days after her 1stYdose of ROTATEQ. 3/27/2009Intussusception 4/7/2009 per Dr. . R cal swelling and tenderness developing Y over 48 hours since vaccines given. U 5/19/2009 5/20/2009 d soft node to R/L anterior thigh region. Nurse Practitioner recommended to massage the affected U area5/12/2009 & to apply 5/12/2009 warm compresses PRN d shingles on forehead - red rash with Y discharge 1-2 wks post vaccine, VALTREX ordered U 5/13/2009 5/15/2009 rior arm - 1 area maculopapular 5 cm Y diam. erythema (MENACTRA) (B) Posterior arm - 1 area U maculopapular 5/21/2009 15 cm diam. (VARICELLA) th fever - 103 - last night + then started Y with fussiness @ 2p 5/22 + redness at site + painful Y- Rt thigh. 5/21/2009 5/22/2009 zy about 2-3 minutes after BOOSTRIX was given(MENACTRA given about 2 min earlier). Pt Ytried to lie down 5/22/2009 on exam 5/22/2009 bed but felt from bed per (L) arm: Pain radiates from deltoid to above elbow; to (L) side of neck. Inflammation minimal erythema 5/19/2009 minimal 5/19/2009 veloped firey red rash on both facial cheeks that feels hot to touch. This occurred on may 20. N She received 5/18/2009 an intra-articular 5/20/2009 steroid inject injection (L) arm was swollen, tender and red, T. 103. Loose stool and vomiting also. U 5/20/2009 5/21/2009 degree 6 days later - Chronic febrile Y seizure (Lasted less than 5 min - sent to ER via ambulance Y and recovered 5/15/2009 - Also 5/21/2009 diagnosed with B-O t rash on anterior R thigh, same leg/area Y given DTAP on 5/13/2009 - Rash appeared about 5/18/09 U per 5/13/2009 parent non 5/18/2009 - pruritic. Blanchable e ministered a TD vaccine when this vaccine should only be given to pts 11 yrs & older & the vaccine the pt. 6/24/2008 needed was 6/24/2008 DTAP. V combination given into LT thigh on 5/20/09. Today area is warm to touch. Swollen, reddened N approx 3" 5/20/2009 X 5" area5/21/2009 office for well child visit. Given adult dose (1ML) of HEPATITIS A (HAVRIX) vaccine in error.Y LMH staff 5/22/2009 notified. CDC 5/22/2009 & poison control con 5/19/2009 N 5/18/2009 5/19/2009 val red, raised area at site of injection left arm covered for possible cellulitis inf - Cephalexin Y500mg TID 5/21/2009 x 1 cd 5/22/2009 04 F and whole upper arm inflamed and swollen - ~ 20-24hrs. Y 5/14/2009 5/14/2009 ERS filed Feb 2003. This 33 year oldYreceived her first three ANTHRAX vaccination 02 Nov 1998, N 12 Nov11/2/1998 1998, & 28 Nov 1998. AVA #4 an urticarial plaque on left lateral arm Y 4/21/2009 4/22/2009 n on 5-20-09 Pt came back in on 5-22-09 Rt arm red and swollen within the area of the shot.U(foster child5/20/2009 missed this 5/22/2009 dose) wollen, reddened, tender and hot to touch R upper arm. Afebrile. Received vaccines 5/18/09 - Cellulitis R 5/18/2009 upper arm 5/21/2009 - 2 hours to injection Y 5/22/2009 vacc. approx 1500 5/20/09; approx.Y12-14 hours later woke up with severe muscle/joint pain and fever, seen 5/20/2009 in office 5/21/2009 @ 1530 05/21/09 still and swelling to left arm approximately Y 12-15 hours after injection, warm compress, Allgrax XY48 5/14/2009 5/15/2009 d, warm to touch, red, extremely swollen, Y hard to touch- treated after Keflex. U 5/18/2009 5/19/2009 d, slight swelling, light redness treated Y with Keflex. U 5/18/2009 5/19/2009 ed, swollen at sight of injection reports swelling under left arm since 5-20-09. 6 X 8 cm area;Yredness, heat 5/19/2009 to LUE @ 5/20/2009 injection site; pocket m erythematous indurated circular area. Left upper lateral arm. Patient reports myalgias and Y subjective fevers 5/18/2009 the next 5/19/2009 2 days after injection ed crying for at almost 12 hours interspersed with extreme sleepiness and difficulty rousing from Y sleep, fever 8/24/2007 of 102+, 8/24/2007 red, hot site of injectio ut a cubic inch of muscle, big indentation. No pain just atrophy. I researched and it looks like a side affect of 5/6/2009 the polio5/15/2009 vaccine? Please drop welling at injection site, site was hard, Y red and swollen for 6-7 days. Child had fever of 101 for N 3 days, and was covered in hives. Injection s tachycardia, myalgias, severe arm pain,arm bruising, headaches, lethargy. all symptoms lasted Y about 2.5 5/22/2009 days. worst 5/23/2009 being 24-36 hours a ENTED WITH COMPLAINTS OF CHILLS, BODY ACHES, JOINT PAIN, HEADACHES, VOMITTING Y X 35/21/2009 DAYS. PT5/22/2009 DIAGNOSED WITH UR med area 8 inches by 3 1/2 inches at Y L deltoid (injection site) Injection given on 5/23/09 U 5/23/2009 5/25/2009 uscle pain in shoulder where vaccine Y administered. Very painful to even move arm for 2 days Y and continued 5/18/2009 moderate-severe 5/18/2009 pain for 4 m ay 23rd) after vaccination on May 22nd, 2009, my son developed weakness. Day 3 (May 24, U2009) after 5/22/2009 vaccination,5/24/2009 my son had high fever was reported by a physician and described Y the occurrence of lupus like syndrome in a 42-year-old N female subject who was vaccinated with s syndrome. Received IVIG and ASA. Y 5/26/09 Received H&P w/report. FINAL DX: Kawasaki Y syndrome1/23/2009 Records reveal 1/31/2009 patient experience n has been received from a consumer Y concerning her best friend's son, a approximately 13 N months old male who in approximately 2003 wa n has been received from a consumer concerning a male family member, now 12 years old,Uwho experienced autism after receiving vaccin n SANOFI PASTEUR'S TDAP product before patient was 11 years old. Y 3/24/2009 a of erythema 5" x 5", left upper arm. No fever Y 5/18/2009 5/20/2009 ents with maculopapular pink rash on trunk, 7 extremities (measles-like) and low grade fever.Y 5/13/2009 5/15/2009
er nurse child was seen today by N.P. and had an "erythema , macular rash" on entire trunk Y(front & back)5/1/2009 and forehead. 5/13/2009 Rash started on 5 after receiving vaccines, patient began vomiting. Vomited several times over the next 9 hours. Y No fever; 5/12/2009 no rash. Patient 5/12/2009 seemed much imp reaction to PENTACEL vaccination.Y8x11cm erythematous area to right medial thigh slightlyYwarm to touch, 5/19/2009 erythema 5/19/2009 fades as infant calms nt received vaccines on 3/31/09. Mother called on 4-2-09 morning with adolescent having fever, Y rash all over 3/31/2009 the body. 4/2/2009 However no difficulty -serious case received from a consumer Y on 15 October 2008. A 63-year-old female patient with Y history of diabetes, ### asthma ### and allergies to iven 5/8/09. Fever to 101.5. Syncopal Y episode, pain and swelling of injected arm. SymptomsNbegan day after 5/8/2009 injection. 5/9/2009 Still present but reso wollen eyelid, decreased appetite Y N 5/19/2009 5/19/2009 arm with redness from shoulder down to wrist, also has red streaks to Rt side under arm, soreness U no fever. 5/20/2009 ely after vaccine administration patient briefly (about 3 sec) lost consciousness. Y 5/8/2009 5/8/2009 n has been received from a 62 yearYold femaleYpatient with an allergy 0 to VICODIN and no other N medical5/11/2009 history who5/12/2009 on 11-MAY-2009 was cal reaction 4 X 5 cm Erythema andYind Y 5/18/2009 5/20/2009 sing began to scratch ears & hair. Noticed Y rash all around neck, chin, back, belly. Hives roused U different5/13/2009 sizes, welt5/21/2009 on front, little dots in b Y Y 5/18/2009 5/23/2009 after receiving GARDASIL # 1, developed redness and itching both legs (thigh to ankle). Skin became more 3/16/2009 red with3/17/2009 NIVEA. No fever. Y 5/21/2009 d @12:30 am 5/22/2009 stating child have fever of 101 and body aches. Advised to go to ER. U 5/21/2009 5/24/2009 N 5/22/2009 th fever, irritability and crying for 4 days Y after vaccination. Patient returned solid and slept poorly Y for 5 nights. 5/6/2009 Per parents, 5/7/2009 patient didn't wish ut 12 hours after vaccination, rigor then Y edema. Patchy erythema. No respiratory, no color. Advised U massage, warm compresses, TYLENO ticed increased redness + swelling of L arm @ injection site on 5/21 (PM), worsened on 5/22Ywith increase 5/20/2009 swelling 5/21/2009 ("fist sized" are of swell patient reports almost immediately Yafter receiving vaccine nausea and dizziness, then in theYevening fever 5/7/2009 of 102.8, 5/7/2009 mom gave EXCEDRIN eeks (end of November)Yafter getting Y flu vaccine, Y client began experiencing 10 Y weakness Y in legs N with numbness in### feet and toes. ### He began w s following administration of vaccine, patient with complaints of pruritis, pain, and redness toYsite. Denied5/7/2009 breathing5/11/2009 difficulties. Six days fo lips and tongue 30 min after injection lasting 30 min Y ### ### REFERS THAT THE NEXT DAY OF VACCINE ADMINISTRATION THE CHILD DEVELOPED Y A RASH IN 5/8/2009 THE ENTIRE 5/9/2009 BODY WITH A SL AINTED AT A RESTURANT 30-1HOUR Y AFTER RECEIVING SHOT AND FEELS CHILLS ALL U OVER BODY 5/26/2009 . NOT5/26/2009 FEELING WELL n chest, back, and arms post small pox vaccination on 13 May 09. Followed up with NP on 26 U May 09. As 5/13/2009 of 26 May5/26/2009 09 still has lesions will as healthy at the time she received her Y shots. 10 days later (Friday) she appeared ill with a rash Y that would 6/10/2008 go away6/20/2008 and re-appear. She de Y Y 5/21/2009 5/25/2009 g enterocolitis, symptoms Y started 24Y hrs after Pentacel, Y Prevnar, Hep 10 YB and RotaTec vaccine Y administration, 5/20/2009 diagnosis 5/21/2009 made 3 days after v macules on trunk, extremeties and Y face, began on the morning of 5/26/09, worsened as dayYprogressed. 5/6/2009 No other 5/26/2009 cymptoms veloped mucosal wart inside lower lip 5 days after receiving second HPV vaccine. U 3/30/2009 4/4/2009 ken to facility on 5/21. Report statesYpatient presented Y with rash on 1face, trunk and extremities. U 6/9/09 Medical, 5/19/2009 hospital, 5/21/2009 DC summary rece iving last vaccine MMR noted childs lips pale, no cyanosis observed. Child awake and crying, Y noted child5/22/2009 urinated on 5/22/2009 self per father and wa d a swollen arm that subsided 4 days after ZOSTAVAX vaccine was administered. Pt saw PCP Y were said 5/18/2009 it may be5/19/2009 an allergy. Vaccine adm eveloped chickenpox rash - more than 100 lesions Y 7/16/2002 fter MMR, developed itch rash on face and trunk. 1 day of headache 8 days after (gone now). ately five hours after the vaccination my son was unconsolable for an hour and extremely fussy Y all night. He 1/9/2009 developed 1/9/2009 a rash at the injectio oss, achy muscles and joint pain. fatigue. Symptoms reflecting M.S. and chronic fatigue syndrome. N Symptoms 3/15/2003 are getting 1/1/2005 worse over time. 5/5/2009 N 4/29/2009 5/5/2009 ed. 9/9/09 Rheumatology consultant records received DOS 1/5/05 to 6/17/09. Assessment: Y Rheumatoid arthritis, ###uncontrolled anxiety. Patie 03; diarrhea; lethargy; decrease oral Y intake. Hospitalized Y x 2 days. 26/2/09 ED and inpatient Yrecords received DOS 5/14/09 to 5/16/09. FINA s and pain in arm. No fever, no redness or swelling at sight of injection but tender to the touch. Y Weakness 5/19/2009 and pain lasting 5/19/2009 2 days +. welling with hard middle, itchy, very warm, red and fever 99.5 (my temp. usually runs low). Had Y to go on antibiotics 5/6/2009 for5/8/2009 3 days. Gradually go ceived PEDIARIX, HIB and PREVNAR #2, RV5, hives occurred approximately 24 hours afterY administration. 8/4/2008 10-20-08, 8/5/2008 received PREVNAR eltoid with 100 cm of erythema, swelling & warmth zero damage + tender noted next day really Y increase5/18/2009 later that night. 5/19/2009 ort received on 13 May 2009 from a physician. Subject Y identification 3number: 1-08-06459. This U subject is11/3/2008 participating in a study. A 14-yearand left deltoid dark red, puffy is swollen like a sausage. Could not lift up arm for four days. N Hot to touch.4/29/2009 Size measured 4/30/2009 5-20-09 10 1/2cm ort received on 13 May 2009 from a physician. This Y subject is participating 3 in a non sponsored U Sanofi Pasteur study. ### 11/1/2008 This case involved a 1 en area on deltoid of right arm. Progressed over 48 hours, at exam, measured 1 1/2 inches circular raised 5/13/2009 erythema, 5/14/2009 warm to touch. No stre ort received on 13 May 2009 from a physician. This Y subject is participating 7 in a non sponsored U Sanofi Pasteur 11/4/2008 study. This case involves a 1
ine given, pt complained of tingling along anterior medial aspect L upper arm. Hurt to move Yarm. Also complained 5/14/2009 5/14/2009 of "tingling" going down a of erythema and swelling on arm at Y injection site - 4 1/2 X 6 cm - at 24 hrs post injection LUA. N 5/18/2009 5/19/2009 ess in chest & throat 20 mins after receiving vaccines and ERYTHROMYCIN. Has allergy to YCECLOR, was 5/4/2009 given BENADRYL 5/4/2009 returned to d ng of throat after receiving vaccine and Bicillin, no prior allergy history. Given BENADRYL and Y observation 5/13/2009 - return to 5/13/2009 division. 5/19/2009 ralized tonic - clonic seizure 8 hrs after Y vaccines. CT, labs EEG normal. Y 5/11/2009 5/11/2009 as administered SMALLPOX vaccine during 1st trimester. Currently in 2nd trimester after learning U of pregnancy. 1/12/2009 ports redness at injection site R arm, denies fever, chills. reports pain 3/0 . Right arm, deltoid U are with redness 5/18/2009 measuring 5/18/2009 130 cm length n ema and swelling on Rt deltoid site starting 3-31-09 3/30/2009 3/31/2009 om mom reporting child diagnosed Y with cellulitis (L) thigh @ Urgent Care on 5-14. Has an approx. 5 inch5/12/2009 in diameter 5/14/2009 area of redness & har 10 min. after leaving pharmacy. Y 5/16/2009 5/16/2009 ction - pain, erythema started 5/16 - MOTRIN and BENADRYL given. 5/15/2009 5/16/2009 and exhaustion started 1st week after vaccine and persist. May 1 started body aches, sore throat, temp 101.8 4/6/2009 deg, 4/11/2009 swollen glands in neck, C received from guardian that child complained of headache leg aches, vomiting x 3 and fever Y (felt hot to5/11/2009 touch) did5/11/2009 not check temp after re nt was accidently given HPV 5/11/2009 ped 2 cm erythema at local injection site and scattered rash on body consistent with VARICELLA. U 5/7/2009 5/18/2009 on belly 5-17-09 in AM, 101.7 fever on 5-17-09 at 8:00 AM TYLENOL was administered, fever N went down 4/27/2009 did not appear 5/17/2009 again. 7 chicken with redness, itchiness over 3/4 of entire Y surface upper left arm. Y 5/19/2009 5/20/2009 e attached encounter Y Y 3/13/2009 3/13/2009
sicles at site of injection of varicella #1 - Occurred ~ 2wks after inj.
U
4/9/2009 4/30/2009 5/21/2009 ped diffuse Myalgias approx 12hrs after Pt vaccination given. N 4/27/2009 4/27/2009 mall) of red flat rash in upper arm; tender to touch; started yesterday. U 5/18/2009 5/19/2009 VZV injection site on 5/12/09. No treatment needed. Y 5/12/2009 5/12/2009 ction on left and right anterior, upper thigh, 2 inch by 3 inch red, indurated area. Pain eliated U due to pt. crying 5/18/2009 upon touch. 5/19/2009 No fever. TYLENO lled the office at 230 PM on 5/20/09 to report that child broke out in hives all over 10 minutesYafter she left 5/19/2009 office yesterday 5/19/2009 AM She did not vaccine breakthrough. Had VARIVAX-2 doses. Diagnosed with varicella in our office on 5-19-09. U 6/18/2007 5/17/2009 5/19/2009 5/19/2009 as given twice, no adverse reaction noted. Y 5/26/2009 ports a gradual onset of edema and erythema, first to the vaccine site, then spreading to theYentire arm. 5/21/2009 She reports5/22/2009 the site was warm to th air loss (alopecia) around temples (around Y ear area, mainly in front) and some hair loss around N hair line and crown. Has happened the last d via EMS to Emergency Dept on theY morning of Y 08/11/2006 00:57 actively 1 seizing. Y Symptoms N began 308/10/2006 minutes prior 8/11/2006 to arrival to ED. No ceived the Typhoid Vaccine 0.5ml IM Left Deltoid at Approximately 8:15am. Left Health Center Y approx. 8:30am. 5/27/2009Health 5/27/2009 Center alerted at 9 dom twitches and involuntary muscle movement/spasms in my legs, calves, quads, ankles, feet, N and toes 11/1/2008 and sometimes 2/1/2008 in my fingers and tion red, hot and swollen and tender to touch U 5/27/2009 5/27/2009 ncing flu like symptoms with hot/cold, some sweating, nausea and dizziness. Legs hurting. Y 5/26/2009 5/27/2009 after vaccine administration he presented with widespread urticaria rash. Of note he also finished U a course 5/21/2009 of Bactrim 5/27/2009 the day before rash s First Anthrax vaccination was issued in my left arm. Two days later my arm started to swellYand became 5/4/2009 red at the injection 5/5/2009site. This adv s after experienced fever of 103, chills, Y body aches, chest pain and shortness of breath. U 5/21/2009 5/24/2009 n chest, shortness of breath, EXTREME fatigue, chronic joint pain, muscle fatigue. N 5/4/2008 5/14/2008 OF GRAVES DISEASE SINCE 2006. UNDER TREATMENT AND MEDICATION. NEEDED IMMUNIZATIONS Y 5/27/2009 TO OBTAIN 5/27/2009 JOB TO DO SO ZOSTAVAX 4/16/09. Developed herpes Y zoster 4/26/09 over T9 on right. Y 4/16/2009 4/26/2009 AX given to 5 year old without complications. Called patients mom on 5/23/09 & 5/26/09 Y 5/22/2009 max 103.8. Multiple tonic / clonic seizures Y in 1st 24hrs after vaccine admin. (currently 5). ER:UCT+LP. Still 5/26/2009 febrile lasts 5/26/2009 seizure 1030 am 5/2 n at ED on 5/11/09 for c/o scratchy Ythroat feeling as if was swollen.Had received vaccinations Y that am for HepA/B and meningococcal. Was ted to our clinic by patient's PCP: J.YDohemann MD (415)923-3447. 4 hours after receiving vaccines U pt reports 5/19/2009 fever5/19/2009 of 102 with rigors and after vaccine administration the patient reported experiencing some fever, chills, and muscleYpain at site 5/18/2009 of injection.5/21/2009 5/25 to report severe muscle pain in left arm with limited ROM. Pain started after 2nd dose of Y Twinrix 5/4/09 5/18/2009 but became 5/19/2009 worse after 3rd do ed varicella-like rash, greater than 50 lesions on face, neck, trunk, arms, buttocks, and legs U 5/22/2009 5/27/2009
nally gave expired Pneumovax dated 04/02/2009 Lot#0963U on 5/26/09 5/26/2009 d and forearm had slight swelling Y 5/27/2009 5/27/2009 ias of bilateral feet and lower legs, bilat forearms, R hand and inability to fully extend R indexNfinger; started 5/26/2009 the morning 5/27/2009 after the vaccine; s r 103 F 12 hours later lasting for 4 days with no appetite, listless and not very responsive, would U only take 5/21/2009 some water. 5/22/2009 Followed by 2 days ure 101-103 approximately 24 hrs. post vaccination and loose stools - presented in clinic - noUother symptoms. 5/26/2009 5/27/2009 en- immediately after patient received vaccine he fainted. Y 5/27/2009 5/27/2009 veloped hives about 22 hours after receiving 4yr boosters- DTap, IPV, MMR and VZV. No previous Y reaction, 5/18/2009 no respiratory 5/19/2009 or GI symptoms ceived DTAP, HIB + HEP A ~ 5-11-09. Patient noticed redness + swelling at injection site ~ 24 Y hours after 5/11/2009 vaccination 5/12/2009 (5-12-09). Left thigh me to office 5-26-09 + reported sheYhad warmth + redness to injection site 5-20-2009 which Uresolved; then 5/18/2009 on 5-22-2009 5/20/2009 she began to hav vaccination 2/20/09 - only 2 mo - Between 1st and 2nd dose -should be 6 mo. 4/24/2009 o itching at the site, 5min later started Y coughing. Mom stated he was having an asthma attack, Y but did not 5/26/2009 have inhaler. 5/26/2009 Dr. notified and neb jection site right deltoid (1) day after injection was given. Seen by Dr. 2 day after c/o rash and Y itching BENADRYL 5/18/2009 was 5/19/2009 prescribed by Dr. se event. Mis administration of TDAP. Rt is 9 yrs old - should of been TD. ### was reported by a healthcare professional Y and described the occurrence of joint pain in an adult U female 4/29/2009 subject who 5/1/2009 was vaccinated with B VARICELLA vaccine given into (R) arm 4x4 cm area of erythema and 9x7 cm area of erythema Y surrounding 5/20/2009 injection 5/21/2009 site to: Septra EL and VARIVAX vaccines given into (L) leg. 8 x 11 cm area of erythema and warmth on anterior Y (L) thigh. 5/20/2009 Septra. 5/21/2009 arm next day, took BENADRYL heart flutter was noticed on Thursday (2 days later). By Friday Y arm was swelled 5/19/2009 went5/20/2009 down by Sunday. n has been received from a registered Y nurse (R.N.) concerning a female patient who received U two doses of GARDASIL. The patient had no n has been received from a certifiedYmedical assistant concerning a 17 year old female whoNon 17-MAR-2009 3/17/2009 was intramuscular 4/28/2009 vaccinate n has been received from a physician concerning a 22 year old female with no medical Y history U who was 3/19/2008 vaccinated with 5/4/2009 her first (lot# 6582 n has been received from a nurse practitioner Y concerning a 19 year old female who experienced Y fever a5/13/2009 few hours after 5/13/2009 receiving the first d n has been received from an investigator concerning a 35 year old female with no known drug N allergies, 1/12/2009 with HIV and5/4/2009 alcohol use who ente n has been received from a consumer concerning a male family member, now 8 years old, who U experienced autism after receiving vaccine n has been received from a consumer concerning a male family member, now 10 years old,Uwho experienced autism after receiving vaccin n has been received from a nurse practitioner Y for the Pregnancy Registry for VARIVAX (Oka/Merck) Y concerning 9/26/2008 a 26 year### old female with a n has been received from a pharmacist Y concerning a 62 year old hospitalized Y female with pneumonia, Y urinary 5/19/2009 tract infection, 5/20/2009diabetes, hype n has been received from a licensed Y practical nurse for GARDASIL and MMR II, Pregnancy YRegistry products, 2/11/2009 concerning 2/11/2009 a female patient Y 5/28/2009 5/28/2009 Hives neck back, abdomen arms and leg started 5/21/09 in the evening. Treated with ZyrtecYX 7 days. 5/20/2009 5/21/2009 PD" testing using ANTHRAX Vaccine - 5m experienced area of erythema 3' X 2 1/2: with 1 cm Y central induration. 5/12/2009Tender, 5/13/2009 not hot - Resolve V vaccine ordered by physician and nurse administered it. The child was 5 yrs old and the vaccine Y should 5/26/2009 not have been given, as it is indic aised) rash in crops over the antero-medical aspect of left thigh no erythema. Y 3/26/2009 5/1/2009 at Inj site. Red itchy rash. U 5/20/2009 5/22/2009 ous patch over the vaccine site left upper arm - lateral posterior aspect no warmth; no tenderness; Y full range 5/12/2009 of motion 5/13/2009 nsider this a vaccine failure for him to Y be fully immunized and get pertussis at age 7 Y 5/23/2007 5/1/2009 was administered to left deltoid on Tuesday May 26, 2009. Came to office today to show me Yhis left arm 5/26/2009 which was reddened 5/26/2009around the en zed area of enduration 2-4 inches above right elbow. Nickel-sized area of enduration 2-4 inches Y above 5/13/2009 left elbow. 5/15/2009 Slight erythema to both ad small pox vaccine on the 17th of May. He returned for follow up on the 26th. His skin reaction Y showed 5/17/2009 local redness 5/27/2009 and white blister. H ld probably be considered a vaccineYfailure since the child was fully immunized and was diagnosed Y with 7/18/2007 pertussis at age 6. e fever (not even 100) 5/26 in the evening followed by redness and swelling at the site on 5/27. Y Fever gone 5/26/2009 5/28 although 5/26/2009 redness & swellin ced swelling and redness at injection site 5/27/2009. Prescribed keflex and benadryl. U 5/19/2009 5/27/2009 ONE CALL FROM MOTHER STATING CHILD HAD RASH ON BODY WHICH APPEAR 45 MINS POST 5/28/2009 IMMUNIZATION. 5/28/2009 CLIENT RETURN fter receiving TdaP imm., pt. was sitting Y sewing at approx. 10:30am and had magnified circles Y in front of 5/12/2009 both eyes. 5/14/2009 Vision was not affected reased sensation and decreased strength in the Y left arm. 7/7/09 Hospital 4 records received DOS 5/11/092/12/2009 to 5/15/09. Assessment: Disturbed d rash c/ second injection, but thought it was due to starting a new OTC product. 3rd immunization Y given, 1/22/2009 and rash reappeared. 2/5/2009 numbness, pain, limited ROM and inability Y to perform many normal activities of daily living. Diagnosed N with 4/15/2009 axillary nerve 4/15/2009 dysfunction... put o cines given to pt, Lt leg Varicella was administered, Rt leg MMR and Kinrix administered. Lt leg area 35cm/25cm 5/27/2009red 5/28/2009 and swelling. Rt leg eloped 48 hours after immunization. Low grade temp. U this second HB shot during a 9:30 am appointment on 5-20-09. The first HB shot I receivedYwas from the 5/20/2009 same physician 5/22/2009 a month earlier o d stated Pt had started getting a rash Y to both legs, mom informed to bring back to clinic, then Y mom called 4/24/2009 and stated 4/24/2009 he was getting swolle th reddened raised area at site of VARIVAX injection. Approximately 1/2 hour after injection-Yseen by MD5/28/2009 recommended 5/28/2009 ice and BENADRY
ble crying with head twitching - lasted for about 30 minutes - low grade fever 1st 24 after shots. 5/27/2009 5/27/2009 arm, legs + face. Y 5/26/2009 5/26/2009 ody aches, arm pain. Approx 1 in redness Y @ injection site. - Recommended IBUPROFEN 600 Y mg q 6 hrs5/26/2009 prn. - Went 5/26/2009 to ER - 5-27-09 mplained of "high" fever several hours after injection (although did not have a thermometer).YSweating, could 1/14/2009 not sleep, 1/14/2009 numbness and ting 1; eyes and lips became swollen and Y puffy after leaving office. Returned 30 minutes later; pulse Y 98%, BP 5/27/2009 112/68. BENADRYL 5/27/2009 1tsp po give painful - swelling (L) thigh - 3cm X Y4 cm 1day post vaccination Y 5/26/2009 5/27/2009 4/9/2009 5/26/2009 st 1st dose pt noted flashes in visualY field and fatigue. Inc in flashes after 2nd dose. Reported Y dec in visual 2/23/2005 field 2-3 days post 3rd dose, In Y 4/16/2008 5/27/2009 ed rash developed within past 3 days Y 5/25/09. Blisters - vesicles with fluid - fatigue. Y 5/4/2009 5/25/2009 uscle pain and swelling. Supra clavicular adenopathy Y 5/26/2009 5/26/2009 veloped myalgias in the neck and back within 24 hours of administration of Td booster. AlsoYhad some nausea 5/26/2009 and5/27/2009 some wheezing startin n has been received from a nurse practitioner Y concerning a 22 year old female with unspecified N drug reactions/allergies 4/6/2009 4/30/2009 and medical history n has been received from a pharmacist Y concerning Y an 81 year old male 0 with hypertension, cancer, U diabetes 10/8/2008 and a history 5/5/2009 of heart attack w n has been received from a physician concerning a 9 week old male with no pertinent medical N history reported 5/13/2009 who 5/22/2009 on 13-MAY-2009 was v ed from a consumer the following information on 14 May 2009: A female patient was vaccinated N with Influenza 11/1/2007 virus11/1/2007 vaccine (batch no. or m red ZOSTAVAX vaccine 5/20/09 at 9:30am. Reported she awoke next am with generalized hives N over body 5/20/2009 including 5/21/2009 buttocks and scalp. N nt to ED with swelling to right leg. Red Y and warm to touch. Y 5/7/2009 5/9/2009 firm area on Rt deltoid approx 2minYwide running 1/2 to elbow. Parent reports started 1 afterNadministration 3/31/2009 vaccine.3/31/2009 Mother plans PMD visi back, abdomen, arms, face after vaccine Y (24 hours) no high fever. Mother plans PMD visit due N to current 3/31/2009 ear infection4/1/2009 also. mplaint (1/1): This 12 month old female Y presents today for evaluation of a rash. Rash-Associated Y Signs and 5/22/2009 Symptoms: 5/23/2009 The following chara ed after vaccination and bumped head on floor. Monitored for 50 minutes. Sent home with mom Y to monitor 5/26/2009 s/s concussion. 5/26/2009 BP 94/60, P 72 ax- rash and pain. Treated with BACRIM DS initially and changed to Acyclovir treated x 1 week. Y Treatment 3/30/2009 started 4/094/1/2009 4/24/09. Folliculitu ight thorax returned after 2nd Hep. B vaccine - came to clinic on 5/7/09 - 'Shingles'. Treated U with ACYCLOVIR 5/4/2009 X 3 weeks5/7/2009 5/22/09 still symp VARIVAX 5-21-09, seen in office 5/23/09 arm, red, warm to touch for 2 days. 15 x 14 cm erythemas Y with5/21/2009 4 x 6 cm central 5/21/2009 induration and 59 given VARIVAX, developed erythema with 3 mm central papule vesicle seen on 5/21/09. Y 5/18/2009 5/18/2009 Y U 5/27/2009 5/29/2009 ate 4 minutes after receiving vaccines; I started getting dizzy, nauseated, cold sweat, and a headache. Y There 5/4/2009 was a 5/4/2009 burning in my arm goin ular redness with warmth. no s/s infection. supportive care : compresses and motrin prn. Y 5/27/2009 5/28/2009 ates that he had vaccinations administered on Tuesday and wednesday afternoon around 1:30 Y p.m. he began 5/26/2009 having 5/27/2009 fever and chills. He a ate 2 minutes after receiving vaccines: Y I passed out. Right after I woke up I started throwingYup and the Rn 5/5/2009 clinic was5/5/2009 unable to stop it and utes after i got the 1st shot, body felt warm and tingly. then i had a small seizure according toYthe tech, but did not lose consciousness. the ter given approx 10 am on 5/27/09 r del im. spoke with pt on 5/29 and she reports on 5/28/09 Y she awoke5/27/2009 with headache 5/28/2009 and chills took tem LN,VOMITING,URI.sYMPTOMS STARTED Y IN THE PM AFTER SHOTS. Y 5/28/2009 5/28/2009 y AM 5/19/09 with frequent vomiting and fever. Frequent vomiting lasted until 0700, then final, Y isolated emesis 5/18/2009 at 1700. 5/19/2009 Temp max 103. F her called and reported that Kahlyndra Y c/o not feeling well approximately 2 hours after vaccine Y administration. 5/27/2009 Following 5/27/2009 am c/o nausea, an a pharmacy clinic to receive Zostavax. Pt is s/p renal transplant and on chronic immunosuppression. N Screening 5/1/2009questionnaire used was d ap administered R deltoid. 1-9-09 Soreness reported to Employee Health Nurse. 2-27-09 - Appointment U scheduled 1/2/2009 due 1/9/2009 to report of persiste hrs after vaccination, arm became red, swollen,Yand painful. admitted 2 to hospital 48 hrs afterYvaccine receive, 5/11/2009 and treated 5/12/2009 for cellulitis of arm adm. 2:30pm,Fri.22 May 2009. 3 days later 2am woke up with difficulty breathing, productive N cough with5/22/2009 green phlegm, 5/25/2009 no fever. All day ( eaction distal to injection site(whihcYwas on right deltoid) extending about 6 cm with induration Y to inner bicep. 5/28/2009 Has minimal 5/28/2009 warmth, not too , generalized body aches and chills. Reports that they do not have a thermometer so have not U been able5/28/2009 to take a temperature. 5/29/2009 Some loca , 1991. "Hold up four fingers. That's right, you're four years old!" On patient's birthday Y he was N coming down 8/19/1991 with a cold. 9/20/1991 August 19, 1991. O ted 13 days s/p vaccination of MMR, TDaP & Varicella w/ rubella type rash; pink macular papular U rash involving 5/16/2009 face, 5/28/2009 UE's & torso; Pt also rash on trunk 26 days after Immunization administration, rash non tender, pre eval. Y 5/1/2009 5/27/2009 ceived vaccines at 12:00 at 14:45 became Y hoarse and felt like he was having difficulty breathing, Y also mild 5/28/2009 cough. Developed 5/28/2009 flat, red rash en lethargic, decreased appetite. Bright red rash on cheeks and face. Rash on legs, had slight U rash prior5/26/2009 to administration 5/26/2009 on legs now mor MMR and VARIVAX vaccine 4/3/09. Missed period 4/17/09, did not know was pregnant at time. 4/3/2009 d area on arm; Warm to touch. Swollen Y (1.5X10 cms). Placed on MEDROL DOS-PAK. Dx:YLocalized allergic 5/12/2009 reaction. 5/13/2009 er, redness 2-3 " down arm, warm to Y touch. Ached. 0 Fever. 3rd day stinging, less redness. Y 5/26/2009 5/28/2009 on. mild edema, tenderness, slight erythema. Y 5/28/2009 5/29/2009
ch area around injection site is warm, swollen and red with nodule. Painful. Difficulty raising arm U and lifting 5/27/2009 arm. Recommended 5/27/2009 medical eva as given initial dose of Gardasil vaccine in (R) deltoid. Almost immediately after vaccine wasYgiven she c/o 5/19/2009 dizziness5/19/2009 & then lost consciousn swelling, warmth, bruising with a few hours of administration. Patient + presented with aboveUsymptoms 5/26/2009 in office 725/26/2009 hours later. Temp 96.9 was reported via a statement of injuries received via a lawyer and described the occurrenceUof joint pain in 8/1/2000 an adult male subject who was me in clinic stating that she could no longer move her left arm. Patient had had some Y swelling N in left arm12/4/2007 after a Td 12/4/2007 vaccine on 12/04/07. It on 5/26/09 c/o feeling nervousness. States that it started ~ 3 days after receiving Adacel inj. N which he is still 5/13/2009 having the 5/16/2009 SX. as of appt on 5/ ed-macular rash to left thigh. Warm to touch, swollen. U 5/27/2009 5/28/2009 cine given, Patient with h/o fainting with shots, became weak, laid down, had episode of emesis, Y VSS, patient 5/28/2009 treated 5/28/2009 and recovered, mothe ceived Subcutaneous dose of ZOSTAVAX 5/26/09. Patient returned to pharmacy 5/29/09 with N questions5/26/2009 about localized 5/29/2009 reaction to injectio 0 mm after immunizations were given (Hep A - Varicella - Meningococcal). Pt developed throat Y tingling sensation 5/20/2009and 5/20/2009 dizziness, then collap 5 min after 1 mms given, child dev. hives near injection site, L leg. variable hives on trunk back Y & face. Pt5/21/2009 given diphenhydramine 5/21/2009 10 mg in .7 degrees F, vomiting, irritability, pallor, Y poor feeding, sleepy presented to ED approximately Y 7:30pm on5/22/2009 5/25/2009.5/25/2009 05/18/2009 pt told mom left upper arm Y hurts. Mom noticed left arm red, swollen warm to touch. Mom called 5/18/2009 Dr, she5/18/2009 told mom to put heat o was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v was reported by a healthcare professional and described the occurrence of arm swelling (injection N site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a physician and described the occurrence of bruise injection site in a 4-year-old Y female subject 4/9/2009 who4/9/2009 was vaccinated with c was reported by a physician via a GSK Y representative and described the occurrence of armUswollen in a child subject of unspecified gende was reported by a physician and described Y the occurrence of injection site blisters in a 4-year-old U male subject 5/6/2009 who was 5/7/2009 vaccinated with KI was reported by a physician and described the occurrence of rash in a subject of unspecified U age and gender who was vaccinated with KIN ash at vaccine site and on upper extremity Y Y 5/27/2009 5/30/2009 hot;It was not until 3rd day of the Shot . The area of the vaccination became very hot, achedYand red.(Felt 5/25/2009 inflamed)5/25/2009 Two days later the pro 02.7; Headache; Fatigue; Was given tylenol 480 mg every 4-6 hours for 16 hours; slept mostYof the day; drank 5/27/2009 liquids 5/28/2009 but did not eat; no oth a of induration at injection site with swelling Y and pain. Y 5/28/2009 5/29/2009 d gunk in her eyes real bad Y the morning Y of theY10th. She had a fever 14 of 104.9 when we tookUher to the emergency 5/8/2009 5/10/2009 room where they gave as vaccinated with Smallpox on his left arm on 20 May 2009. Pt's Smallpox blister 'popped' in U his sleep the 5/20/2009 night of 30 6/1/2009 May. He noted that rm swelled up to the wrist and is hot to the touch. 5/27/2009 5/28/2009 body aches - Patients relates having fever with pertussis as a child. Y 5/5/2009 for immunizations on 5/28/2009. Child received DTAP, HPAC, IPV & MMR. Mother telephoned Y this morning 5/28/2009 & stated 5/28/2009 that child began to br lled, client had high temperature 103.9. Y Went into convulsions. Sent to ER, diagnosed with UTI. Y Took her 4/22/2009 to pediatrician, 4/24/2009 stated no diagnos rate, fever, vomiting, diarrhea. U 5/22/2009 5/28/2009 d 4/29/09. Mother noticed small "pimple Y like" lesion at site of VARIVAX injection (Left thigh) Y on 5/1/09. Small 4/29/2009 cold sore 5/10/2009 like blister on mouth Typhoid cap appropriately --> 6 hrs. later had dizziness, light-headed followed by nausea andY vomiting assoc. 5/20/2009 with movement. 5/20/2009 Hx of 2 episo swelling pruritus in place of injection. Y 5/15/2009 5/17/2009 14 hours after vaccines administered Y (102 degrees F). Y 5/26/2009 5/27/2009 bout 12:00 patient became weak, pale, Y collapsed to floor, febrile, tachycardia. Patient seen inY ER, monitored, 5/26/2009 labs (CBC, 5/27/2009 BASIC chemistry a area of redness over the skin at the site of injection 7 1/2 x 4 cm. No further reported problems U as of 5/26/09. 5/5/2009 5/5/2009 severe hives. Y Y ### ### mplain of muscle pain in left deltoid muscle. Pain persists one month after injection. N 4/28/2009 4/29/2009 is not to be started after 12 wks of age this pt. is 6 mons old. Y 3/9/2009 3/9/2009 n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with the second dose of GA n has been received via a literature article regarding a case in litigation concerning a male who U in November 11/1/2004 2004, 11/1/2004 was vaccinated with a d turned to clinic on 5-13-09. Lft arm injection site with 4-5 cm area of swelling. Area red and non U tender to5/11/2009 touch. Patient 5/12/2009 reports itching to ar n has been received from a case in litigation from a lawyer concerning a patient who on 19-SEP-2003 U was 9/19/2003 vaccinated with a dose of Hep B d spinning, stomach sore, throat hurt for short time. Patient presents to clinic 4/24/09 at 8:50am, Y report "stomach 4/23/2009still 4/23/2009 hurts" to lower abdom ed redness and swelling began around Y 1500 on 5/20. She applied cool compress around 1700 U applied ice 5/18/2009 pack, at 2000 5/20/2009 applied lotion "aloe x 2 1/2 cm indurated, increased warmth. Fever 39 degrees C. Prescribed Keflex. 5/28/2009 5/29/2009
lling, redness, heat, and rash at injection site. Y 5/20/2009 5/25/2009 nto office and never was immunized. She was going to camp and needed imms. Dr. Asked nurses Y to work 5/29/2009 on seeing5/29/2009 what imms could be g as administered the DTaP vaccine instead of the Tdap vaccine. There has been no known orYreported adverse 5/15/2009 reaction 5/15/2009 to the patient. In the er dose of Rota vaccine given patient developed Y intussuception requiring 3 surgery for repair. Y6/2/09 ER records 3/30/2009 received 4/3/2009 DOS 4/3/09. FINA atient was given the MCV vaccine early. The recommended age to administer is between ages Y 11-12, it 5/29/2009 is approved5/29/2009 for ages 2-55. He was d a 12 year old female who was alert Y and oriented but appeared nervous, comfort measuresYwere taken.5/20/2009 I proceded5/20/2009 to administer the vacc ceived MMR and Varicella vaccine'sYon May 21, 2009 from Merck and Co. Came into office today with rash 5/21/2009 on face 5/31/2009 and chest patient has n elling in lympyh node on side of chest. Site swollen, warm to the touch. Lasted approx. 5 days. Y Doctors perplexed ### at the ### location of the sw photographs the patient developed right sided ptosis and an enlarged pupil between Y September N 1st and 7th. 9/4/2008 The parents 9/7/2008 noticed abnorma e up the night of vaccination (5/26)with Y pain. The Y next morning the mother 1Y noticed a red, round, N hard area 5/26/2009 approximately 5/27/2009 4-5 inches. The c der soft tissue infection with tender Yindurated area central eschar surrounding cellulitis. Treateed with Zithromax and 5/23/2009 Bactrim.Cultured are Tenderness at surrounding injection site (Left Deltoid) U 5/31/2009 5/31/2009 l Saturday 05/30/2009 with headache, stomachache. Also injection site of menactra (r arm) Yred and swollen 5/29/2009 approx.5/30/2009 1cm. wing administration of vaccine the patient developed stomache ache, fever, and headache. Highest U fever5/29/2009 was 101. 5/30/2009 iven on 5/26/09. Day after arm hurt, administration site, red, swollen,firm to touch and warm.YWorsened on 5/26/2009 Thursday. 5/27/2009 Saw Employee Healt post vaccine 2 days ago, no fever, no previous vaccine reaction. Recieved DTaP IM and VZV SQ but reaction 5/27/2009 started 5/27/2009 around DTaP area, p nic Seizure acttivity lasting 2 minutes. Y 6/29/09 Y Hospital records received 2 DOS 5/19/09 to 5/21/09. Y Assessment: 5/18/2009 Acute 5/19/2009 onset seizure second ace torso arms and legs onset 05-29-09. Pt. c/o itching. Parent is giving Benadryl. Possible Fifth Y Disease5/29/2009 5/29/2009 vaccine was administered, the patient Y complained of pain in the right arm, started crying, became U diaphoretic, 6/1/2009 ashen,6/1/2009 and lost consciousnes aculopapular rash on face, exerting,Ytrunk, back starting on 29 May 2009. U 5/21/2009 5/29/2009 over injection site - X 2 days - cool compresses. Y 5/13/2009 at injection site x 2 days. Treatment cool compresses. Y 5/13/2009 5/14/2009 ely following injection patient had syncopal episode for 15 seconds. She had Flailing of arms/YLegs when5/29/2009 she was unconscious, 5/29/2009 as nurse wa on 5/29/09, raised, itchy, painful x 2dY seen in the office 5/29/09: T: 98.2. Exam: dry papules upper Y forearms, 6/26/2007 back, trunk, scattered = 6 = blis at site of injection up to 15 cm. Peak with underlying induration almost entire extent of quad.Y(right). 5/29/2009 5/30/2009 s receipt of third AVA vaccine on 5/2/2009 Y (AVA #1 8/2/05, #2 8/17/05). He reported no problems Y for 2 days. 5/2/2009 5/4-7/2009 5/2/2009 he c/o: 1) a roun ceived Tdap IM R arm on 4-8-09. Right Y arm red and swollen; warm to touch. Good ROM. Pt.Ustate she took 4/8/2009 pain medication 4/12/2009 for discomfort. sented in clinic on 4/3/09 @ 10:45 AM c/o swelling and redness of left arm. Client denies difficulty U breathing 4/1/2009 and negative 4/1/2009 for rashes. Client e and vomiting within a few hours following vaccine administration. Client had a fever and had Y a racing pulse 1/28/2009 the evening 1/28/2009 following vaccine tion were given at 5:25pm. Bil Redness of upper arms noticed at 5:35pm 6:50 redness receding. Chest - 4/8/2009 CTA ; No SOB, 4/8/2009 A&O x 3, NAD, 18 eralized itching right shoulder increased back + legs, welts noted above RD site + upper back Y - Benadryl4/13/2009 12.5 mg 15ml 4/13/2009 PO Given @ 1640. eived Immunization on 3/26/09 (DTAP Y and MMR). Mom states, "Started on TYLENOL and MOTRIN, Y but3/26/2009 spiked temperature 3/28/2009104 on 3/28/09 witnessed seizure on 5/21/09. H/O probable Y seizure Y activity in the past 4 6 wks. After seizure, Y pt has had complaint 5/20/2009of5/21/2009 headache, dizziness, w l cord, right vocal cord, polyps Y cancer. Y Lost of voice. Y Rash in skin complete 5Y body.YPain to joints N complete11/4/2003 body. Gallbladder 11/5/2004 removal with, m 4/14/09, diarrhea, diaper Y rash - rash Y - face, scrotum Y bruised w/infection. 8 7/13/09 Hospital DC summary3/24/2009 received DOS 4/14/2009 4/15/09 to 4/22/09. s in face, body, hands, feet Y BELL's Palsy Y in face. Y Losing ability to walk. 14 Y Low blood pressure readings. Y Kidney (not ###normal 11/1/2008 readings). MRI's ( brile seizure; Negative workup at Hospital. Y 6/22/09 Y Medical records2DC summary received DOS Y 5/20/095/19/2009 - 5/22/09. 5/20/2009 Assessment: Seizure w eloped poor appetite with associatedY vomiting, Y sudden in onset, worsening 1 over a few hours.YChild evaluated 5/13/2009 at office 5/22/2009 exam consistent with U ollen, itchy & hot to touch. Y Y 5/26/2009 5/27/2009 vaccine breakthrough. Diagnosed in office with varicella on 5-26-09. Had over 100 lesions noUfever. 2/11/2009 5/24/2009 + redness at injection site. N 5/20/2009 5/20/2009 n left arm, jaw, left leg for two weeks after vaccination. U 5/15/2009 5/15/2009 veloped an erythematous patch in right Y thigh hours after shot was given. It got indented andYbigger, with some 5/7/2009 induration, 5/18/2009 measures: 3x 1 c veloped furuncle abscess site of vaccine Y about 1 wk after shot given. It is probably unlikely this Y was secondary 5/6/2009 to shot. 5/13/2009 Furuncle was in upp erythema and induration around vaccination site. Reaction probable cause from VARIVAX. Y 5/27/2009 5/27/2009 days after inj pt was seen in ER forYrash that was felt to be eczema. Y 4/28/2009 n has been received from a physician concerning Y a 24 year old female 1 patient who on 26-AUG-2008 U was 5/21/2009 vaccinated 5/21/2009 with the first dose of G was received from a consumer via Y Sanofi Aventis on 20 May 2009. A female patient, with a history of Type II diabetes, Hashimoto's thyroid ately two minutes after injection of vaccines Mom noticed and questioned to nurse about bilateral Y lower extremity 5/21/2009redness. 5/21/2009 Nurse called Dr. 009 24 hours after immunizations were given L upper arm started to swell & redden. They were advised5/26/2009 to use Tylenol 5/27/2009 + cold packs by clin
t a Tdap 5/14/09 and developed cellulitis Y on the (L) upper arm site of the injection. Then was seen at the5/14/2009 doctors office on 5/21/09. d ADACEL 4/27/09- And developedYcellulitis on site of injection. She was seen at ER. Y 4/27/2009 4/29/2009 9 Patient received DTaP #5 and Varicella #2 to the (R) Deltoid by RN and IPV #4 and MMRYII #2 to (L) Deltoid. 4/16/2009 Family 4/17/2009 brought pt to clinic a Y 5/28/2009 5/28/2009 d PENTACEL 3/3/09 @ 2mo. well-child on 3/16/09 called nurse line - (mom) stating child non Y stop screaming. 3/3/2009 This 3/3/2009 office called back 3/9 as given Tdap in error as this has only been studied to age 64 and recommended for ages 11-64. U Patient5/22/2009 having no adverse symptoms per vaccine breakthrough. Diagnosed with Varicella on 5-26-09. Had over 200 lesions. No fever.U 6/7/2007 5/23/2009 and bruising at site with pain. SterileYabscess Lt. leg. Y 5/22/2009 5/23/2009 ingles of L chest and arm 7 monthsYafter vaccine. Zoster/Shingles. Y ### 5/25/2009 5/27/2009 d area developed erythema and edematous swelling 5 1/2 6 1/2 cm. There is also warmth to the area though 5/27/2009 no induration 5/28/2009 or fluctuance of en, hard to touch, painful with bruising Y large lesion 5" X 5" sterile abscess. Y 5/22/2009 5/23/2009 d diarrhea for 3 weeks, fever, speech and motor regression, has been evaluated for autism by N specialist,11/5/2008 results inconclusive. 11/8/2008 MRI and EE Y 11/5/2008 ### e right deltoid since injection. also with small lump. parathesia intermittently radiating down to U right elbow, 5/29/2009 with loss 5/29/2009 of strength to right arm. e and dizziness s/p Tdap and HPV #3. Y Immunization given at 1515, gradual onset of headache U over course 6/1/2009 of the day. 6/1/2009 Patient to ED at 220 ng ataxia with onset approximately 11/08. Y Severe gross motor and fine motor impairment noted. N 6/15/09 Received ### PCP 11/1/2008 medical records fo oss of felling in left arm, hand afterward Y and left arm had chills.There ia a golf ball size swelling Y to the upper 5/28/2009 left arm.5/28/2009 ceived dose #4 of DTAP IM on 5/26/09. Parents report they noted large reddened area with Y mild swelling5/26/2009 at site on 5/27/2009 5/27/09. Client without administered instead of MMR as requested by parents. No adverse event noted. Y 5/29/2009 nt recevied 3rd dose of Rotateq Y on May Y 15, 2009. Y She developed intussusception 1 on May 25,Y 2009. 7/14/09 5/15/2009 Hospital 5/25/2009 records received DOS was administered on 5/26/09. Client had reaction to vaccines on 6/01/09. Came in clinic today Y 6/02/09, 5/26/2009 left deltoit sligtly 6/1/2009 redness and swell oke up the next day with raised, itchy rash all over body except on face, chest and upper trunk. U Took OTC 12/9/2008 medicines and ### rash lasted 3 wee turned to clinic 3 days post vaccination with right thigh erythemic, slightly swollen and warm to Y touch. Mother 5/26/2009 states5/27/2009 that symptoms started d fever 103 with diffuse sweats x 24 hrs, irritability x 48 hrs, 7 days after vaccinations. Rash Y broke out about 5/7/2009 24 hrs 5/14/2009 after fever broke - macu MA, EDEMA AND INDURATION 1.25"X Y 1" TO RIGHT DELTOID. ICE PACKS, IBUPROFEN YAND TYLENOL 5/28/2009 FOR AGE 5/29/2009 PRN. ter fainted and was taken to the ERYto be monitored, after going home she began with a fever... U this is the6/1/2009 day after receiving 6/2/2009 her rd HPV sh was reported by a healthcare professional Y (also Y the subject's mother) 0 and described the occurrence N of cyanosis 9/27/2006 in a9/27/2006 2-month-old male sub izures - 5-20 minutes of seizures - VALIUM Y 2 milligrams Y given - tachypneic 1 spell 5-10 seconds Y recovered 5/18/2009 without ventilation. 5/19/2009 6/12/09 Hosp ccines given Pt c/o dizziness, fan on pt - cool cloth on forehead - B/P checked, decreased 88/46 Y -head of5/18/2009 bed down5/18/2009 - foot of bed elevated. 20/09 Spoke to Dad - baby doing well, no ill effects. Child here for visit, received overdue imms Y / MICR was 5/18/2009 "down" - Child had these imms munizations Thurs. PM 5/21/09, but didn't notice swelling & erythema until Saturday 5/23. Pt Y reports "extreme 5/21/2009 pain" Sat/Sunday 5/23/2009 but feels be idmorning patient developed a fever and sweats (soaked clothes), dizziness and felt like sheYwould blackout 5/20/2009 if stood5/21/2009 up. Also started mens ution-Progressive swelling, tenderness, erythema at a site 5/20/2009 5/21/2009 ped petechiae of lower extremities below knees. (R) greater than (L). These areas appearedYwithin 48 hours 5/19/2009 of vaccinations. 5/21/2009No squeezing ted Saturday 5/23/09 102.2- gave MOTRIN and TYLENOL to help bring fever down. Rash started N on Sunday-was 5/13/2009 flat 5/23/2009 and then red pimple chicken pox lesions- head, trunk, and scalp extremities. Friend broke out 5 days ago. U 5/17/2000 5/24/2009 ed urticarial rash at site L arm Y U 5/21/2009 5/24/2009 Tdap to right deltoid 5/22; developed Y chills and fever and headache that evening. Seen in UC Y 5/24; right5/22/2009 UE was not 5/22/2009 red, warm or tender. O e, too warm, flushing and nausea. Y U 6/2/2009 6/2/2009 HPV she was weak, T.100, decreased eating, hives runny nose & sneezing. Y 6/1/2009 6/2/2009 d muscle and tender pain sustained since TWINRIX injection 05/04/09. U 5/4/2009 5/4/2009 en, shortness of breath. Mom statedYallergic to VARIVAX event though she got MMRV. 5/19/2009 5/21/2009 redness, and soreness left upper arm. 13cm by 14cm. Y 5/19/2009 5/20/2009 ately 3 weeks post ZOSTAVAX, developed 8 lesions, dime sized, left upper arm. A couple ofYweeks later,3/23/2009 developed 4/1/2009 sever, debilitating kne len, cellulitis (TYLENOL). Y 5/18/2009 5/21/2009 and edema, warm to touch, measuring 6x7 cm oval on right deltoid. 5/28/2009 ted 1 day after receiving vaccine. Pt vomited x 1, was lethargic for about 48'. Slight sore throat Y 2 days later. 5/19/2009 5/20/2009 eck, Day 7, c/o some nausea, 2 episodes Y of vomiting. Told to go to hospital ER if couldn't keep Y fluids down 5/22/2009 over weekend. 5/31/2009 Nausea & vomiti tomach", shaky, jittery, chills/hot + "feeling Y just different, not myself" No diff. breathing, swelling U or rash. Patient 5/7/2009 vomited 5/7/2009 while talking with h d bump at the injection site; small red dots from injection site spread to arms, also on torso and Y back 5/11/2009 5/20/2009
adiating to her jaw, shoulder and neck. Y Stiffness lower back painful and stiff making it difficultYto walk. Went 5/7/2009 to PMD on 5/8/2009 Fri 5-8-09. c/o " ever mother at approx. 9 pm on 5/13/09. Pt c/o- H.A.; No relief with ADVIL; 5/14/09 at 11am - Pt. still Y experiencing 5/13/2009 H.A. and 5/13/2009 given 1 TYLENOL by rts child vomited on Thursday pm. Friday Y developed red, raised rash on buttocks which spread U to entire 5/28/2009 body by Sunday, 5/29/2009 MD appointment 5/19, 20 c/o pain lt side of chest & shoulder back c/o bad H/A 5/19 LT deltoid upper arm swollen (9 cm 5/18/2009 10 cm) warm 5/19/2009 to touch. c/o could n s after 3 17-09 injections (not sure which day) noticed decreased mobility of R shoulder and N"lightening bolts" 3/17/2009 down3/20/2009 arm to fingertips. Patien th c/o rash on chest and bilateral arms. Y generalized itching. Y 5/22/2009 5/23/2009 MMR shot on 1/16/09. Diagnosed with Y measles on 1/15/09. Broke out entire body with red bump. Y Fever up 1/6/2009 to 105. Irritable. 1/15/2009 Rash and symp turned to the pharmacy complaining of itching within 10 mins the area was slightly raised, red, Y and hot to5/23/2009 the touch -5/23/2009 it extended about 3" di cal swelling and erythema. Local and distant urtitaria. @ 3rd p shot. N 5/26/2009 5/27/2009 n 5/28/09 patient noticed next day some Y redness then next day redness increased and swelling Y up to 6 inches 5/28/2009 pain 5/29/2009 in area. Itched all over w theaded & thinks she may have fainted (briefly) while sitting in chair 3-4 min. after HPV #3 inject. Y 6/1/2009 6/1/2009 Tdap to R Deltoid 5/22; developed Ychills + fever and headache that evening. Seen in UC 5/24, Y (R) UE was 5/22/2009 not red,5/22/2009 warm or tender. On 5 5 AM on 5/27/09 T 102 Crying unconsolable Y - vomited X T - ate only 5 grapes - Temp 102.6 U ax in office at 5/26/2009 11:30 AM5/27/2009 on 5/27/09. Physical e Y Y 5/19/2009 5/30/2009 ven a TB vaccine while he had a fever Y of 104 and a case of Strep throat. He began to have neurological Y problems ### about 24 ### hours later. (Tro 9 - pt had swelling & redness of the (L) thigh. Pt instructed to Ice area & admin APAP. Pt was U seen in ofc. 5/13/2009 5/15/09. Was 5/14/2009 given XY2al 2.5 m arm became very red, warm to touch, Y tender. Limited ROM with inflammation. TX= P.O. Antibiotics, Y pain 5/13/2009 meds, subsequent 5/15/2009IV antibiotics. n has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning Y a female patient who was vaccinated with n has been received from a registered nurse who heard from another contact concerning a 22 U year old female patient who was vaccinated hile at home developed 104 temp and seziure. Presented Y to hospital4for treatment. Y 5/19/2009 5/19/2009 ENTED WITH COMPLAINTS OF N/V AND ABD PAIN X 2hrs POST VACCINATION. PT TREATED N WITH 5/22/2009 PHENERGAN, 5/22/2009 1 LITER NS, SIQ to clinic 5/29/09 with 1 day of body, joint aches, radiating up from legs, associated with low grade U fever. 5/27/2009 5/28/2009 rs of receiving vaccines pt developed Y localized cellulitis with red dermatitis of fluid filled blisters. Y This occured 5/19/2009 in the5/19/2009 area where the DTaP v d chest pain and was admitted for myocarditis Y on Y 25 May 2009. Admitted 1 to medical center. N Received call 5/14/2009 through call 5/25/2009 center reporting post mitted to hospital with paralysis below the neck. History of GARDASIL vaccination; Y Last dose U 04/17/2008. 4/17/2008 No definite 3/10/2009 diagnosis. Described above is simply the most recent event, one of many Y throughout the past 9 months. This dateUreflects the 8/20/2008 diagnosis given 5/20/2009 by a neurologist o with erythema, mildly inflamed with induration, per pt. it already subsided. Y 5/27/2009 5/28/2009 mmunizations administered at an exam. Y 5/31/09 Fever 100-101 degrees. No or rash. 6/1/09 Fever Y and malaise - no other localizing signs. 6 rash Tylenol given as needed Fever 102 degrees F Diarrhea 11-12 days after vaccinations Y 5/18/2009 5/29/2009 ain in left arm w/tingling sensation inYleft fingers 5/6/2009 5/9/2009 omiting, fatigue. Y 6/1/2009 6/1/2009 daughter to a physician she had never Y been to before. While we were there the nurse suggested my daughter 5/18/2009 get the 5/18/2009 GARDASIL injection. ccinated on 5/28/09, went to schoolYon 5/29/09 and upon return home from school mother noticed Y swelling 5/28/2009 and redness 5/29/2009 on right arm. Patie ng our office, the patient passed outYwith increase tone. Taken to the ER for evaluation of possible Y seizure 6/3/2009 activity. CTScan 6/3/2009 & blood work a er receiving the MMR vaccine, Evan came down with 103 degree fever. The following day (8U days after 5/26/2009 vaccine), his6/2/2009 fever is 104 degrees. d approx 1530 on 6/3/09 stating "my son got shots there yesterday now he is having an allergic reaction."6/2/2009 Mom questioned 6/3/2009 as to what kind fort in abdomen, like cramping or feeling of gas. began approx 8 hours after injection ( 4:30 PM Y ) and lasted 6/1/2009 through the 6/1/2009 night. 2. aching in a RED BUMP FIRST SHOWED ON WEDNESDAY, Y 27 MAY, THEN AS THE DAYS PROGRESSED U THE 5/26/2009 BUMP STAYED 5/27/2009 BUT THE REDNE f right arm where vaccine was given. Y Antibiotics and antihistamines given. U 6/1/2009 6/2/2009 se headaches and fainted and had a seizure. Y 5/29/2009 5/29/2009 ours after receiving the third of three injections of GARDASIL, I began to experience intense muscular pain and headache 5/23/2009 which continued months after being given the GARDASIL Y vaccine. I had a ct scan done, which showed that my lymph nodes 5/7/2007 were enlarged. ###A little over a ay arm (R) became painful - swollen and red. Pt took TYLENOL all day. On Wed 6/309 Pt begins N with "spinal 6/1/2009 pain" body 6/2/2009 aches, headaches edema erythema hyperemia measuring 15X12 cm oval. 6/1/2009 6/2/2009 pprox. 10:45 AM - Pt fainted outsideYclinic in the front passenger side of her car. Revived when Y her arm was 5/29/2009 shook by 5/29/2009 nurse. Ambulance w 5/21/09 LDT - RTC 5/27/09 and large red warm localized reaction to Td. Y 5/21/2009 5/27/2009 hematous, macular rash on her back, trunk. No fever. U 6/2/2009 eral 5 inches x 2 inches tender, erythematous swelling. Y 6/1/2009 6/2/2009 e red rash raised bumps (hive-like) 1 patient sat for 1/2 hr gave Benadryl 12.5 melt tablets (1)Y+ 1 to take home 6/3/2009 (2prn)6/3/2009 = 4 tablets (iced rash ed Health center on 6/3/09 2:20 PM to report flushing, palpitations. Had 2-3 episodes of palpitations U and flushing. 6/2/2009Vaccination 6/3/2009 for Typhoid g wollen arm. was seen a ER & followed Y up with us 5 days after initial shot 3 days after ER vistis. Y 5/28/2009 5/30/2009
ven Pneumovax on 5-26-09. He states Y that he became nauseated within a few minutes, then vomitted. 5/26/2009 The following 5/26/2009 day, he developed b ARICELLA vaccine given all following info received from clinic 5-6 DEPO PROVERA shot - 5-11 U " Lump 4/30/2009 on arm" - Pain 5/11/2009 shoulder to elbow" iving immunizations and walking to office to be checked out he became "light headed" fainted hitting desk.6/1/2009 Small abrasion 6/1/2009 R eye brow + bo 103 for 3 days, loss of apetite, body aches, fast breething, fussiness Y 5/28/2009 5/29/2009 utes of receiving the 1st does of gardisil she was dizzy, pale, light headed, saying that she couldn't Y breathe. 6/3/2009 it sounded 6/3/2009 like she was gaspin F 101.8, ACHY ALL OVER WITH SHOOTING PAINS DOWN ARMS AND LEGS OCCASIONALLY. Y PATIENT 6/2/2009 ALSO6/3/2009 FELT PAIN IN MIDDL minutes cheeks were red and swollen with urticaria Y 5/20/2009 5/20/2009 n has been received from Y a pharmacist regarding a case in litigation concerning a young female Y relative (exact age unknown) of a healthca n has been received from a registered Y nurse concerning Y a child male 0 patient who on approximately Y 27-MAY-2009 5/27/2009 was 5/30/2009 vaccinated with the rmation has been received from a nurse and follow up information from a medicalYassistant who U reported4/21/2009 that a 49 year 4/21/2009 old female was on 2 n has been received from a pharmacist reported Y that a patient was believed 0 to received a dose U of PNEUMOVAX 4/1/2009235/29/2009 in April 2009 but no do ness, swelling and itchy @ site 3cm x 2cm raised rash R upper arm with Sl blistering . Benadryl Y + Ibuprofen 5/26/2009 PRN, cold 5/28/2009 compresses to area ed nodular papular rash 6/3/1996 5/29/2009 swelling, heat @injection site Y 5/3/2009 5/3/2009 on the area of injection 5x8 cm with 2x3 cm of - induration. U 5/27/2009 5/27/2009 vaccine break through. Diagnosed with varicella on 5-29-09 U 2/2/2007 5/22/2009 g motor paralysis 6/9/09 Hospital ER Y records received DOS 5/28/09. Post immunization patient Y c/o shoulder 5/27/2009 pain, knee 5/28/2009 pain, generalized a 5/29/2009 me to the clinic 6-1-09. Stating sheYhad a red area on left thigh. States the red area startedYon Sat and5/29/2009 has gotten 5/30/2009 larger. Band aids are s of chest tightness within 5 min after immunization with HEPA, HPV, TDAP. PPD test done also Y at same5/28/2009 time. Symptoms 5/28/2009 persisted for 3 da being preg. 12/31/08. Had US on Feb'2009 and was informed baby had problems and abortion Y done 3/18/09 ### at OB. 3/18/2009 9 MILD Other - Fatigue, Some dizziness U 6/3/2009 6/4/2009 vaccine 5/27/2009 and seen 5/29/2009 with red very swollen arm treated with BENADRYL, Y ice, Hydrocortisone 5/27/2009 1% 5/28/2009 cream for itching. mildly itching rash, 10 cm, over injection site U 5/27/2009 5/28/2009 Neuropathy. 3-6mo after vaccine. Tests, Y pain medication. Y N ### 1/1/2003 owing vaccination, child developed erythema Y and edema of lower, lateral aspect of upper right U arm, in region 6/1/2009 of subcutaneous 6/2/2009 varicella vacc D TDAP, GARDISIL, MENINGOCOCCAL Y INJECTION, Y TOLERATED 1 WELL, WALKED OUTUOF EXAM ROOM 6/3/2009 AND 6/3/2009 PASSED OUT (5 -7 M HAD PNEUMOVAX ON RIGHT DELTOID Y AREA ON 3/30/09 .ON 3/31/09 HE HAD MUSCLE Y ACHES AND 3/30/2009 ON 4/1/09 3/31/2009 DEVELOPED FEVE STATED THAT SHE EXPERIENCED Y DEEP THROBBING PAIN AT THE SITE OF INOCULATION Y ON 5/20/2009. 5/15/2009 SHE 5/20/2009 SOUGHT MEDICA munization clinic 6/04/09 at 12:30 PM, C/O headache on 6/03/09 (the evening of taking the vaccines.) Headache 6/3/2009worse 6/3/2009 6/04/09 with Naus with rash and fever of 102 on 05/30/2009 and continued with pruritic rash that developed into U red oval shaped 2/2/2006 areas 5/30/2009 with vesicular lesion o d vaccines on 6/2/09. On 6/3/09 after Y pt got home from school, mom called office stating arms N were now6/2/2009 both red at6/3/2009 injection sites and sor ess, swelling at site, started 2 days after injection. Y 6/1/2009 6/3/2009 lling morning after vaccine, no fever, no treatment needed Y 6/3/2009 6/4/2009 symptoms appears one week after receiving Y vaccine. U 5/26/2009 6/1/2009 min after receiving immz, pt appeared Y to have a seizure; loss of consciousness <45 seconds, Y jerky movements, 6/1/2009 urinated 6/1/2009 on self. Ammonia baby check-up and vaccination Y on 4-20-09, Y visited Y physician on 4-23-09 41 Y with N/VYand lethargy. N By that 4/20/2009 evening, she 4/23/2009 was taken to the ED w ding in line 5-10 minutes after the injection Y making an appointment when she lost conciousness Y and suffered 5/29/2009 tonic clonic 5/29/2009 movements for 30 GARDASIL on 5/27/2009 - swelling/ redness started within 24 hours - seen 5/29/09 - treatedY with MOTRIN, 5/27/2009 BENADRYL. 5/28/2009 No previous Rxn fter receiving MMR, patient developed Y measles like rash. Y 5/20/2009 5/30/2009 Y 5/28/2009 5/29/2009 ast PM (about 5-6 hours after injection) very fatigued then this AM 6/4/09 dizzy, nauseated. Now Y slightly better. 6/3/2009 No rash 6/3/2009 - No difficulty breath rash on chest, abdomen, and eyes 6/4/2009 6/4/2009 nced (L) arm pn @ injection site with approximately 1 cm surrounding ecchymosis, arm has U erythema/induration 6/1/2009heat6/2/2009 approximately 115x1 eloped one month after the vaccine Ywas given. Rash is red, bumps, painful on arms and legs. Y Was seen by 2/4/2009 PCP and3/1/2009 given PREDNISONE. d, papular to trunk & limbs 3 days after vaccine - lasted one week - No treatment Y 3/4/2009 3/7/2009 vomiting approximately 8-9 hours after Y vaccines given - administered @ ~1500 on 06/03/09 U Started vomiting 6/3/2009 ~ 0100 6/4/2009 - 0200 06-/04 /09 d immunization 9:05 AM, pt went out to smoke a cigarette, 15 mins later started feeling dizzyYand sweating. 6/4/2009 Pt went inside 6/4/2009 to sit, started to had c/o nausea with emesis after injection by another nurse earlier that day. He was told toYcheck with this 2/5/2009 nurse before 2/5/2009 leaving his shift. EDIARIX given simultaneously Y 5/28/2009 5/28/2009 was reported by a healthcare professional Y and described the occurrence of rash in a 58-year-old U female4/27/2009 subject who5/7/2009 was vaccinated with B
was reported by a physician via a GSK representative, and described the occurrence of a rash Y in an adult 3/30/2009 subject of3/31/2009 unspecified gender wh nduration (R) arm 4/29/2009 4/30/2009 n VYANESE doses after vaccines. YA couple of hours later hyperactive behavior had escalated U more than6/3/2009 normal. Called 6/3/2009 pediatrician but d d shot Fri - Pt brought in Monday to be seen. Noted markedly erythematous area that measures Y probably 5/29/2009 3 x 2 cm.5/31/2009 around that faint redne was reported by the mother of a consumer and described the occurrence of swelling at the injection U site3/25/2008 in a 5-year-old male subject who w was reported by an other manufacturer Y via a nurse and described the occurrence of nauseaYin a female subject who was vaccinated with ( was reported by a physician via a sales representative and described the occurrence of swelling N in a subject 4/2/2008 of unspecified 4/3/2008 age and gende was reported by a physician via a sales representative and described the occurrence of swelling N in a subject 3/19/2008 of unspecified 3/19/2008 age and gende was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende was reported by a physician via a sales representative and described the occurrence of extensive Y swelling 3/18/2008 of vaccinated 3/20/2008 limb in a subject o was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who was reported by a physician and described the occurrence of swollen buttocks in a 4-year-old U male subject 3/25/2008 who was 3/26/2008 vaccinated with INFAN was reported by a healthcare professional Y and described the occurrence of swollen axillary N nodes in a 5-year-old 5/7/2008male 5/8/2008 subject who was va was reported by a physician via a representative and described the occurrence of erythemaUin a child subject of unspecified gender who w was reported by a physician via a representative and described the occurrence of swelling inY legs in a subject of unspecified age and gend was reported by a healthcare professional via a sales representative and described the occurrence U of nonspecific reaction in a subject of u was reported by the mother of a consumer and described the occurrence of nausea in a 4-year-old N male 8/5/2008 subject who8/6/2008 was vaccinated with was reported by a healthcare professional and described the occurrence of injection site reaction U in a subject of unspecified age and gend was reported by a physician, via a GSK sales representative, that described the occurrenceUof swelling at the injection site in an unspecifie was reported by a healthcare professional and described the occurrence of swelling injection Y site in an 18-month-old 8/19/2008 8/19/2008 female subject who w was reported by a healthcare professional and described the occurrence of swelling of injection Y site in a8/19/2008 5-year-old 8/19/2008 female subject who was was reported by a healthcare professional and described the occurrence of swelling injection Y site in a 5-year-old 8/20/2008male 8/22/2008 subject who was vac was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w was reported by a healthcare professional and described the occurrence of crying in a 4-month-old U male subject who was vaccinated with was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe vaccine administered, mother reports Y fever of 99.5, Y then began having 2 myoclonic jerks of arms, Y legs and5/14/2009 head. No 5/14/2009 decrease in level of aro o BPH, intra-cranial hemorrhage 10yrs ago admitted Y on 5/25 with a 41 Ywk h/o HA, fevers, rigors and progressively 5/7/2009worsened 5/13/2009 weakness, with Y N 6/28/2008 0.5 degrees F, achy joints/neck, HAYeyes sensitive to light, numbness in feet/hands. 5/21/09.Y5/27/2009 Follow 5/15/2009 up with 5/20/2009 parent. Parent state KINREX + MMR on R deltoid on 5/29/2009 - came into office 06/02/09 necessary with cellulitis Y + reddened 5/29/2009 @ site. 5/30/2009 minutes after injection Pt became rigid all over, very stiff, and fell down to table. After severalYminutes then6/2/2009 began to arise 6/2/2009 but was very grog degree F fever, body aches, joint pain: Rash at injection site. Symptoms began to subsideYafter 36-48 5/24/2009 hours. 5/25/2009 ected with 2nd GARDASIL inj. About Y 30 seconds later pt fainted fell head first off of bed. Pt hit Y right forehead 5/29/2009 on floor 5/29/2009 and ice was applied. P 30 papules on trunk and groin - No vesicles - very itchy 4/11/2007 5/29/2009 m red whelp to (R) deltoid, not tender to touch, cellulitis. Treatment - BACTRIM DS U 5/27/2009 5/29/2009 ed pt came home form Daycare on Thursday 5-28-09 and c/o pain in (L) arm, Mom also stated Y it was itchy. 5/27/2009 Area was 5/28/2009 reddened, itchy and s rs after receiving vaccines became irritable, crying & inconsolable for 1 1/2 hrs. Left leg hadYnickle sized3/31/2009 bruise at injection 3/31/2009 site. Left thigh l redness, heat, bruising after 3 days. Pt was Pt used cold packs and warm packs Y 5/27/2009 5/28/2009 Q site redness, heat. Pt saw physician Y who prescribed "Steroid Inj and BENADRYL OD Y 5/19/2009 5/20/2009 n arms / legs about 1 hour after receiving,MENACTRA, HPV #1, HEP A #1, on 5/27/09 no other complaint. 5/27/2009 5/27/2009 n has been received from a physician Y concerning Y a female with unspecified 0Y reported drug reactions/allergies U 4/30/2009 with Behcet's Syndrome and a orted in a news magazine article that a male who on an unspecified date was vaccinated with U a dose of MMR II. Subsequently the patient d n has been received from a physician Y concerning Y either 15 or 16 years 0 old male patient whoUon an unspecified date was vaccinated with a n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL ( xperienced swelling in the lymph node of the left armpit. 5/25/09 chills, generalized malaise,YTemp 99.8 5/15/2009 5/26/09 Malaise 5/24/2009 continued, fever a ema and induration at arm injection site. Y 5/26/2009 5/27/2009
thigh red/warm swollen with itching within 24 hours of vaccines given. Y 5/29/2009 5/30/2009 ven dose #2 of GARDASIL, seems to Y tolerate well. No c/o offered - fainted upon preparing to leave facility, 5/13/2009 hitting back 5/13/2009 of head hard on doo and erythema at Lt site of immunization Y 10 days after immunization. No signs of injection - NoY treatment given 5/14/2009 - Local 5/24/2009 reaction presumed to with erythema and purpura skin in large circular area 8cm - no adjacent to but not symptom surrounding U needle 5/29/2009 insertion 5/30/2009 site from vaccinatio
substantial swelling of injection armYfrom shoulder to elbow, skin sensitivity, stiffness - joint pain Y (ankles,4/30/2009 knees, elbows, 5/1/2009 wrists, neck) - feve Multiforme rash started on 5-22-09 started in groin area spread allover started on BENADRYL Y change to5/15/2009 ZYRTEC 5/22/2009 on 5-26-09 PRELONE swelling of R deltoid area. ErythemaYand induration surrounding injection site. Y 5/26/2009 min of receiving JE vaccination, client had a seizure lasting 1-2 min. Alert & oriented after, though Y very pale 6/4/2009 and unsteady. 6/4/2009 BP 122/80 No s ss on neck, arms, legs, about 10 minutes after shots were given, no difficulty breathing, nor Y swallowing, no 6/4/2009 rash noted. 6/4/2009 BENADRYL 25 mg e swollen warm to touch. Swelling from Y knee to hip Y 6/3/2009 6/3/2009 was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 9/4/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/21/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/14/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/20/2008 in four child subjec was reported by a healthcare professional Y via a sales representative and described the occurrence U of erythema 9/15/2008 in a9/16/2008 5-year-old male subje was reported by a healthcare professional and described the occurrence of swollen thigh (injection Y site) 8/22/2008 in a 5-year-old female subject who was reported by a physician, via another health care provider, and described the occurrenceYof injection site hot to 8/29/2008 touch in a 3 year old fem was reported by a healthcare professional Y and described the occurrence of floppy in a 6-month-old Y female subject ### who was ###vaccinated wit was reported by a consumer, the subject's grandmother, and described the occurrence of seizure Y in an infant female 11/1/2008 subject who was vacc was reported by the grandmother of a consumer and described the occurrence of hyporesponsive U reaction (unspecified) in a 4-month-old f was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a was reported by a healthcare professional Y and described the occurrence of swelling injection Y site in a 4-year-old 3/16/2009female 3/16/2009 subject who was v nd swelling in a 6x6 are to Right thigh where MMR vaccine was administered, swollen area was Y hot to touch 6/2/2009 and painful 6/3/2009 d shot Tues afternoon; minor discomfort at injection site. - Started to feel extreme fatigue Weds. Y afternoon6/2/2009 (approx 1300hrs) 6/3/2009quickly followe n 2 days following the injections. It began as a ring about an inch from every injection and onU the next day6/1/2009 had covered 6/3/2009 her whole body exc of malaize approximately 12 hours after Y injection. 36 hours later, muscle pain in the upper inside N of calf of 5/21/2009 lower left5/22/2009 leg. Pain in upper bod rts child developed night terrors and feels it is due to DtaP. Had first night terror night vaccine U given, has5/29/2009 had one again 5/29/2009 2 other times when @9:16am MOC t.c. c/o mild dizziness 1 hours post vaccinations then severed ha, lbp and dizziness U with falling 6/4/2009 this morning 6/4/2009on ambulation d urticaria all over body 3 days after receiving vaccinations. Also on a new med - flonase, and U has tried a 6/1/2009 new food - 6/4/2009 cherries, so etiology u ent had 3 vaccines administered on Y 5/26/09 @ approximately 12:00 pm. Client called @ approx Y 1:25 and5/26/2009 stated "I'm5/26/2009 having trouble breathin , Swelling, Tenderness, fevers, Elevated Y white Y blood cell count. 6/26/2009 3Y MR received for DOS U 6/4-7/2009 6/3/2008 with D/C6/4/2008 DX: Cellulitis. Pt pres MOTHER REQUESTING LIST OFYIMMUNIZATIONS GIVEN AT LAST VISIT ON 05.27.2009 U (MOTHER 5/27/2009 WAS GIVEN 6/4/2009 RECORD THE DAY ived rotateq on 4/3/09 and was admitted to theYhospital for intussusception 4 on 4/9/09. 7/24/09 Y Hospital records 4/3/2009 received 4/9/2009 DOS 4/9/09 to 4/2 n left arm wth mild erythema on the site not likely cellulitis. U 6/4/2009 6/5/2009 mother calls to report that about 3 hours after immunizations received client began feeling "lethargic" U and then 6/3/2009 later in6/3/2009 the evening develope ed Hib and DTP/DTap vaccinations on 04/Jun/2009 and developed pain and sore at the injection N site. He6/4/2009 cried when6/4/2009 I was holding him up, LA FROM VACCINE Y 5/28/2009 6/3/2009 rts child had 1st seizure 6-3-09 at 2030 Y lasting approx. 1 min. taken directly to hospital ER. CT Y of head and 6/3/2009 CXR done. 6/3/2009 Ativan and Tylenol OF DIARRHEA (5 TIMES DAILY), VERY ODOROUS Y 1/5/2008 5/25/2009 days after Hepatitis B vaccine my thumb Y and pointer finger on right hand were numb and i went N to my family 5/16/2007 doctor 5/20/2007 and within the next wee vomiting, headaches, pain in joints,Y backache, aches in the arm that was injected. Bad mood U and sleepnessness. 5/26/2009 5/27/2009 rienced generalized macular papular rash over body with "strawberry toungue" beginning 06/03/09 U afebrile 5/20/2009 6/2/2009 d vaccine on 6-2-09. on 6-5-09 patient still complains of injection site redness, warmth and itch. U i advised 6/2/2009 pt to take some 6/3/2009 ibuprofen for the ak out in hive after MMR and Varirex, the right thigh swell up and swollen where MMR was administered. U Gave 6/5/2009 Benadryl 6/5/2009 2.5 ml po x1 , no re ain in deltoid area, swelling and slight fever. Pain for 3 days. 6/2/2009 6/2/2009 ion site became itchy within 1 hour & Y became very red that evening. 6/4: Site became painful, U swollen, tneder, 6/3/2009 redness 6/3/2009 spread, and she be
U 6/5/2009 6/5/2009 e evening on the day of injection the patient developed a egg sized lump on the back of the right Y arm. When 5/28/2009 the arm5/28/2009 was reassessed in the bed itching during the night and small red dots over her body. She took Benadryl during the am Y and now (6-5-09,1:00pm) 6/4/2009 6/5/2009 reports no S/S. NOTICED ON 06/04/2009 2 SMALL WHITE SPOTS ON ROOF OF MOUTH. NO FEVER, DID U HAVE DAY 6/1/2009 OF IMMUNIZATIONS. 6/4/2009 ANOTH ion site was found to be swollen, firm, red, and hot to touch. Patient temp of 99.00 in the afteroon Y after the 5/25/2009 injection 5/25/2009 resolved by 2300 that s for evaluation of red swollen right thigh. Y Warm to touch. Sore. Treatment advised: supportiveYmeasures. Cool 6/3/2009 compresses 6/5/2009 and Tylenol. ater of administration of the vaccine Pt called the pharmacy complaining of numbness and tingling sensation. 6/3/2009 From the 6/3/2009 talk to Doctor at offi ing, erythema (10 x 10 cm area) itching, Y mild induration directly under injection site (2 x 2 cmUarea). 6/2/2009 6/3/2009 .5 cm erythema around injection site. Warm non tender. U 6/3/2009 6/4/2009 welling, tenderness, redness and warmth Y over right deltoid appeared 2 days after injection. Mild U erythema 6/2/2009 without warmth 6/4/2009 left upper arm. of left arm with edema and erythema. U 6/2/2009 6/3/2009 reaction. Sore and swelling. Y 5/26/2009 5/29/2009 d severe localized reaction to this immunization. N 6/2/2009 6/4/2009 was reported by a healthcare professional Y (also the subject) and described the occurrence Y of U injection site 5/12/2009 pain in a5/12/2009 45-year-old female sub ented to clinic 6-4-09 w. cc "crying a lot", 7 cm reddened swollen LAT at site of 4th INFANRIX. Y Mom advised 6/2/2009 to warm6/3/2009 packs, return to clinic was reported by a consumer (also the subject)Yand described the occurrence 6 of pneumonia Yin a 81-year-old male subject 2/24/2009 who was vaccina of breath and dizziness Y 6/4/2009 6/5/2009 mitted to clinic with warm red areasYon bilateral upper extremities. Pt rec'd vaccines on 6/3/09. MENACTRA 6/3/2009 in (R) arm 6/4/2009 and Tdap in (L) arm meter induration with 2 in wheal on LA surrounding VARIVAX adm site. Normal pulses. bilat.Y 6/3/2009 6/5/2009 2 days after vaccine T. 102 + moreYjerky movements after 3 days of vaccination as per mom less of balance 6/1/2009 and frequent falling lethargy, pain, swelling left arm onset day after Y rec'd VARICELLA vaccine in left arm. Low grade fe. Y T 99.2. 10 X 6/3/2009 6 cm red tender 6/4/2009 lesion below inj s chest & back rash red, bumps mild itching Y x 1 1/2 hrs without fever, general malaise saw MD 5/23/09. 6/1/09 5/21/2009 Blood work 5/23/2009 showed low white ted skin under bandage around vaccination site. Individual, isolated rash clusters under arm & across chest 5/22/2009 and abdomen. 6/1/2009 ped intussusception requiring Y surgical reduction. Y Also had symptoms4 of resolving virus + viralYexanthem 5/28/2009 c/w parvovirus 5/30/2009 (fifth's disease) on t e fever, overall "joint aching" + head "feels too big for her body" 6/3/2009 6/4/2009 scle spasms to arm x 24hrs. Nickel sized area "bullseyes" at injection site. Unable to do promY because pain. 6/4/2009 6/4/2009 oid with erythema and swelling. Y N 6/4/2009 6/5/2009 excessive of arm, shoulder & neck involving Y throat. U 5/31/2009 6/1/2009 and swelling after 6 hours on date ofYvaccine. Then rash that became larger the next day. The Y next she mad 5/29/2009 an observation, 5/29/2009was on 6/3/09 et of wheezing approx 10 minutes post Y vaccine administered nebulized albuterol given. Y 5/22/2009 5/22/2009 d received the Typhoid vaccine first.Y Then she was administered the Hep. A. As soon as theYHep, A was5/21/2009 removed the 5/21/2009 nurse, patient slump Tetanus booster and Hep B shot at 4:30pm on Thursday June 4th. Woke up at 5:30 June 5th Y very dizzy.6/4/2009 Called Dr.6/5/2009 He said to wait it out IN TO RECIEVE ANTHRAX AND SMALLPOX Y VACCINES AT 141 MDG WA ANG. PT RECIEVED Y INITIAL 6/6/2009 ANTHRAX 6/6/2009 VACCINE. HE WA echiae & edema - transient & self resolving. Y 6/2/2009 6/3/2009 in all muscle groups, Fatigue, rectal bleeding. (On initial series 6 doses bleeding remained for Y several months) 6/6/2009 Concurrent 6/7/2009 doses 1-2 week t from a typically developing boy, to full regression in to Autism within one week of Y his MMR N shots. He also 7/18/2000 recieved7/18/2000 the Varicella vaccine o in hives (10/19/07). Developed a allergy Y to peanuts which had not been presentYprior to theNimmunization. Long ### term adverse ### affect PDD thigh was red, warm, swollen Y & itchy shortly after the injections. He was in pain & wanted to U be carried because 6/1/2009his6/1/2009 legs were weak. Arou s after the vaccination, I'm getting weaker and Y weaker. Have cold symptom 6 like. Went to dinner. U After 103/24/2004 minutes, experience 4/6/2004 hiccup. My c ke a huge hive 2 x 3 1/2 inches. It was red and hot and lasted 5 days. (It was on the injection Y site). 5/15/2009 5/15/2009 , swelling and warmth to site whereYvarivax was administered. 5/28/2009 5/29/2009 h rabies vaccine, had progressively worse Y headaches, sweats/chills, facial redness, muscle fatigue, general fatigue, ### uncoordinated, ### confusio mom, states she tried to feed her in the AM and she vomited. Vomiting x 3 from 7:30 Am - 12UN. Refuses to 5/6/2009 eat or drink. 5/7/2009 No fever or diarrhe red swollen area at one injection site (believes to be varicella) running fever. (Right arm siteYof injection). 5/26/2009 5/27/2009 immunizations @ 9AM - broke out in Y rash starting @ 12 N 1 place under eye (looked like blisterY went away5/26/2009 2 under 5/26/2009 neck @ 1:30 they wen ely following administration of GARDASIL she was sitting on exam table, felt lightheaded andYfainted. falling 6/3/2009 to floor. 6/3/2009 Mother in room reporte 2/20/09 ----> mom reports LA (left arm) Y injection sit on 03/03/09 became red, raised, warm toYtouch physician 2/20/2009 diagnosed 3/3/2009 as cellulitis. Paren all area of urticaria @ flexor surface of (R) arm on day of vaccination, but four days later, she Y developed urticaria 5/4/2009over 5/4/2009 entire upper body & n has been received from a medicalYassistant concerning a 17 year old female with a historyYof convulsions 5/28/2009 and under 5/28/2009 the care of an unspe ped severe urticaria over entire bodyY several hrs after administration of several vaccines. This Y resolved with 5/8/2009 BENADRYL 5/8/2009 & PREDNISONE n has been received from a 17 yearYold femaleYwith no medical history or drug allergy who was N vaccinated 12/1/2007 with 1st,12/1/2007 2nd and 3rd doses of G
and induration at injection sites. Pain to touch at injection site. 5/27/2009 5/29/2009 n has been received from a pharmacist concerning a female who "one or two years ago" on Uunspecified dates was vaccinated with the first n has been received from the author of a literature article, title stated above concerning a healthy Y 16 old male who more than 8 years after n has been received from an office Y manager concerning Y a 12 year old 0 female who on 19-MAY-2009 Y was5/19/2009 vaccinated5/19/2009 with a dose of VARIVA m rash 24-36 degrees after immunizations 5X care - tylenol and/or motrin. U 6/2/2009 6/3/2009 RIVAX + PCV given. 5/15/09 Dx Ataxia DM T 100.5. 5/29/09 Ataxia persists. 6/5/09 Child back Y to normal 5/7/2009 no signs of 5/15/2009 ataxia. d, raised, tender, warm to touch area approx 2" x 3" at Varicella injection site. T. 99.3. C/o slight Y nausea, seen 6/3/2009 in our Public 6/4/2009 Health Office at om brought child in, Dr saw a red, hot to touch area to (L) deltoid, measured 5in by 5in in diameter. Y 6/4/2009 6/5/2009 ated 18 hrs after vaccine child was sitting in cart at Kmart and fell over and was very pale andYappeared to3/4/2009 have fainted. 3/5/2009 This lasted 15 min diarrhea, vomiting, fatique, temperature of 100, left work, did not see a doctor Y 5/29/2009 5/29/2009 and itching palms on evening of June Y 1. Some itching Y during the week, 1 with bad hives on evening Y of Friday, 6/1/2009 June 5. Visited 6/5/2009 urgent care clin ollowing vaccination with Anthrax, Smallpox, Y Typhoid (18 May). Pt. with pruritic papular lesions U which started 5/18/2009 on distal6/5/2009 extremities (wrists/an occal vaccine given at 0907 IM prior to discharging. Pt. had no knownYallergies and not allergic Y to eggs. At 5/17/2009 1015 pt c/o 5/17/2009 back and rt flank pai e and diplopia accompanying Y a cerebellar Y hemorrhage occurring within about 24 hrs of an influenza Y vaccination. ### 7/31/09 Hospital ### records r zure lasted 1 min about 2 mon after Ygiving the 0.5 ml IM shot of DT.Tdiphteria-tetanus) Y 6/8/2009 6/8/2009 SED A 12 YEAR OLD FEMALE WHO WAS ALERT AND ORIENTED. THE MOTHER STATED Y THAT THE6/5/2009 CHILD WAS 6/5/2009 DUE HER LAST HP al congestion, lost voice, body aches, rash at injection site Y 5/20/2009 5/20/2009 hours: Significant swelling at injection Y site and redness, 101 - 102 Fever, Chills, Muscle pain.U After 30 hours: 5/29/2009 Wet Cough 5/30/2009 (diagmosed as br administered on Tuesday,6/2/09. On Thursday a 2.5 inch x 2 inch erythematous, raised, tender, Y area noted 6/2/2009 around injection 6/4/2009 site. This area / 6 days post vaccine noticed warmYto touch /redness / swelling / itchy at around injection site Y on left arm. 5/26/2009 6/2/2009 oke up with a very sore arm. The site of the injection was swollen and tender. He complainedYof feeling overall 5/27/2009 weak5/28/2009 and achy. He was runn ely after having vaccines, patient had a seizure that lasted a few seconds. Dr. did a neurologic Y exam 5 minutes 6/8/2009 and 30 6/8/2009 minutes after episod ceived injection on 5/26/09 and was fine until the evening of 5/27 when she had a red spot the Y size of a quarter 5/26/2009 at the 5/27/2009 injection site. The are head ache, nausea, bloating and diarrhea 2 days after taking last of four live virus oral typhoid U vaccine capsules. 5/27/2009 Treatment 6/4/2009 not sought. Imp RECORD OF FEVER x48 HOURS AFTER VACCINATION; "RASH" FIRST APPEARING AROUND Y NECK, 6/2/2009 THEN TRUNK 6/4/2009 TO UPPER AND side of injection swelled significantly, with hard raised lumps, lasting 5 days Y 6/2/2009 6/3/2009 s her arm was very swollen. She had a temp. of 104 degrees and she was in bed for 4 days.Y She did not 2/10/2009 call our office 2/10/2009 or report this to any d a large local reaction at site of DTaP 3 days after the injection. Resolved with ATARAX. Y 6/3/2009 6/6/2009 4 hours, body ache and sore arms x 48 hours. Welts to left arm- (1) anthrax, (1) Tdap >x 5 days. Y 6/1/2009 6/2/2009 hot was given on Friday, June 5th appointment was at 9:15 for a physical. Left arm hurt immediately N after6/5/2009 and began6/6/2009 to swell and was very n has been received from a consumer Y concerning Y his 24 years old fiancee 1 who on 25-MAY-2009 N received 5/25/2009 the first dose 5/25/2009 (0.5ml) of GARDA n has been received from a physician Y concerning Y a 15 year old female 3 patient who Y on 14-NOV-2006, N 16-JAN-2007 6/12/2007 and 3/1/2009 on 12-JUN-2007 w n has been received from a consumer concerning Y his son with general 0 sensitivity to all vaccines U (no specific vaccine or manufacturer given n has been received from a medical assistant concerning a 55 year old female with Y a historyNof chronic obstructive 5/5/2009 pulmonary 5/5/2009 disease and .7, Myoclonic movements, joint pain,Y given ibuprofen, Y TYLENOL, IV 4 ROCEPHIN: adverse reaction U began 5/28/2009 within 1 hour 5/28/2009 of vaccine adminis L vaccine - neuritis (LUE) - thoracic outlet syndrome - no strength (L) arm/(R) arm (decrease U strength)- 4/16/2008 decrease vasc 4/16/2008 (L) arm (with elevat in arms & shoulders. Evaluated by Geneticist & Rheumatologist. 6/9/2008 7/14/2008 n in LDMIM. 30 minutes after shot client upper arm had some swelling, heat to touch and reddened Y raised6/4/2009 area L- 3inch 6/4/2009 W 3inch. Light rash and induration at site injection (L) Deltoid 6x7 cm. Area pruritic. Y 5/27/2009 5/28/2009 ports pain at site, fever, sore throat for 2 days post injection following sores at site, left shoulder U pain and4/15/2009 decreased4/15/2009 strength and range of y urticaria, agitation about 1 hr following Y MMR/VARIVAX increase RR increase HR also, chills. Y BENADRYL, 6/4/2009 EPI, ORAPRED 6/4/2009administered and warmth to left thigh area. About Y 10x10 cm area. Y 6/2/2009 6/4/2009 action to KINRIX DTAP-POLIO- Friday 4-17-09 child had small knot. Saturday 4-18-09 childYhad knot 6 4/16/2009 inches in diameter, 4/18/2009 hot to touch. ceived PENTACEL vaccine on 6/1/09. Leg became red and large amount of swelling on thigh. Y Very fussy,6/1/2009 cried for over an hour. 6/3/09 she noticed onset of itching, redness, Y and that area was (hard). Pt states 12-15 hoursUafter injection6/2/2009 Sx began6/3/2009 to appear. She denies and low grade temperature. Y 4/4/2009 4/4/2009 e temperature and lethargic. Y 6/2/2009 6/3/2009 ven PENTACIL at 9:00 am on 6/1/09. He went to daycare and when mom picked him up in Y afternoon noticed 6/1/2009 area around 6/1/2009 shot on anterior arm swollen below injection site 10 Y by 15 cm. Also complained of chest pain: NL EKG; NL enzymes. Y 5/1/2009 5/3/2009 t states: Left upper extremity is difusely Y reddened, starting around glenohumeral area extending Y towards5/27/2009 elbow. Covers 5/28/2009 area of superior & rash at injection site. Rash is 2-3" long and 2" wide. Patient sought medical attention but only U a hot compress 6/1/2009 was recommended. 6/2/2009
inconsolable crying. DTaP/IPV/HIB/PREVNAR Y and ROTATEQ given at 9:45 am 6/1/09. Crying Y began 9:00 6/1/2009 pm, stopped 6/1/2009 9:00am 6/2/09. e swelling approximately 15 minutes after vaccines. BENADRYL PO given upon return to clinic. Y 6/3/2009 6/3/2009 diarrhea 12-15 x 1 day. Lasting > 2 weeks. All stool studies normal. Y 4/16/2009 4/26/2009 diarrhea 12-15 x 1 day lasting > 2 weeks All stool studies normal. Y 4/16/2009 4/26/2009 nt legs broke out in hives evening of injection 6/1/09. Woke up next AM & hives on arms & legs. Y Patient took 6/1/2009 25 mg BENADRYL 6/1/2009 8 AM on 0 s, fatigue, rapid HR, abd pain, numb legs- sx's intermittent since then and continue. 7/2/09 Medical N records received ### 1/15/2008 DOS 11/11/08 to 6/12 other states that pt was a little feverish the morning following her vaccines and that she had some U redness6/1/2009 at the DTAP 6/2/2009 vaccine site. Yester cry for 4 hrs - hard to console 6/2/2009 6/2/2009 thigh, redness, some pain and getting bigger. Can walk normally. Started later the night of shots. U Treatment, 5/26/2009 warm5/26/2009 compress for swelling a ced hives on torso, no fever and injection site look ok per patient mom. U 6/1/2009 6/1/2009 accines and approximately 4 minutes later skin turned lace like pink and blotchy resembling Y hives. Dr. notified 6/1/2009 eval pt6/1/2009 and given 10 mg Ben ool IZ's 5/26/09, when child came back fur PPD reading father states child's leg had some redness Y we examined 5/26/2009it and 5/27/2009 measured it. Y 5/26/2009 5/26/2009 5 min after 3rd GARDASIL injection - Had received injection then walked on to waiting area Y to get father. 6/2/2009 Fainted after 6/2/2009 return to exam soon -102 rash on 6-3-09 seen in office. Y Y 6/1/2009 6/3/2009 ed rash. Started on 5/30/09 after a fever. Y 5/21/2009 helps, cellulitis treated with BACTRIM. U 5/27/2009 5/29/2009 d to toe entire body on 5/27/09. Started with fever 104 @ 2-3 days prior then rash. ReceivedNMMR immunization 5/14/2009 of 5/27/2009 5/14/09. er arm red, swollen, and warm to touch. Y Measures about 7 inches in length. Mom took child N see APN. APN 5/18/2009 is treating 5/20/2009 area with butt paste, er, T: 99 - 101 degree F from the evening to next day, then started having cough - o/e: Chest: Y some wheezes 5/21/2009 and crackles 5/21/2009 (rales) on base reaction to INFANRIX vaccine in (L) thigh" (MD) Parent "(L) Leg swollen. Onset was Tues. after Y vaccines." 5/26/2009 Rectal temp 5/27/2009 101.5, Tylenol give vaccine break through. Diagnosed in office on 6/2/09 with varicella. Had about 20 pox. U 4/29/2008 6/1/2009 ven HIB that was expired. Y edness pain at injection site x 4-5 days - better slowly over 3 wks but left with residual brachial Y neuritis. 3/26/2009 3/26/2009 6/4/2009 d ENGERIX B vaccine IM in both RYand L deltoids on 5/4/09. At approx 2:30 PM 5/6. Pt wake Y from ncp and 5/4/2009 noted her 5/6/2009 right arm was numbredness, and swelling extending over Y entire upper left arm and shoulder. Began 1 day after N injection. Prescribed 5/27/2009KEFLEX 5/28/2009 x 7 days, Predni dvertently received ZOSTAVAX instead of Chickenpox varicella, CDC called no further f/u. Parent Y informed 6/8/2009 of local reaction to look for. Sup ut after received shot with brief tonic/clonic activity of upper extremities lasted 3-5 seconds. No Y loss of bladder 5/21/2009 control. 5/21/2009 ceived #2 GARDASIL on 5-12-09 and called 5-15-2009 reporting c/o itching / have several hours Y after she 5/12/2009 had GARDASIL 5/12/2009 5-12-09. Pt took thematous indurated lesion on thigh, developed 24-48 after immunization (L thigh). U 6/6/2009 stomach felt queasy; sat down; says her vision was fuzzy; became pale; fainted; assisted toYa lying position 6/8/2009 et fanned; 6/8/2009 regained conscious Y Y 6/1/2009 given 5th HEP B today within 10 min of injection being given in (R)D. Employee noted backNteeth became 6/8/2009 numb on both 6/8/2009 sides upper & low e named patient was seen in my office on February 7th, 2009 with a complaint, which I witnessed one bump on### her shoulder area. Two day cess @ site of injection. Negative Gram Y stain Negative Culture. Y 1/3/2009 2/5/2009 es high temp starting 1 hour after administration Y around 101.3 degrees F. Mom gave motrin Yand temp came 6/5/2009 down to6/5/2009 normal soon after dos NKA, PMH: Dementia, Hypertension, CVA,OA/DJD, hyperlipidemia Patient also has h/o stroke. Y Patient was 2/19/2009 admitted 2/19/2009 for fracture following m d not know she was pregnant at the time of vaccination and was vaccinated with Anthrax andUHPV 6/2/2009 6/2/2009 d meningitic like illness while Y out of Y state. Ultimate Y diagnosis is Acute 7 Disseminated Encephalomyelitis U (ADEM). 5/18/2009 Had5/29/2009 ataxic gait, stiff neck w es after receiving Pediarix on Left thigh.Entire leg became red/purple per mom- bled small amt Y at site. stopped 6/9/2009 with bandaid 6/9/2009-then blotchy/v with 2nd gardasil vaccination, beenYhaving myriad of symptoms. Initial symptoms included N headaches that 12/1/2008 started12/1/2008 after the first vaccinatio s sister also received an immunization and was discussing other shots she'd received in theYarmed forces. 6/9/2009 Client stated 6/9/2009 she felt dizzy. I ha <5 min. after admin of vaccines. From a sitting position while assuming standing position, she Y fell to floor. 6/4/2009 Syncope duration 6/4/2009 <5 sec. First aid Y DEVELOPED HIGH FEVERS 101.5-103 FOR 2 DAYS THAT STARTED 10 DAYS AFTERYSHOTS WERE 5/29/2009 ADMINISTERED. 6/7/2009 OTHER TH s of L facial drooping since 730 am Y this morning. Episodes last about 30 seconds, pt gets glazed over look 6/8/2009 in eyes and 6/9/2009 becomes lethargic. Y 6/8/2009 #1 (1423X) given in right arm on 4/23/09. Y Adverse reactions symptoms began 4/24/09 exhibited N by: dizziness, 4/23/2009 headache, 4/24/2009 stomach pain, nau ness, swelling of about 3 inches. Slight itchiness. Slightly sore. Y 6/8/2009 6/9/2009 re, drooling, swelling of injection site. Y SOB, passed out completely. No response X 10 min. This Y occurred 6/8/2009 several hours 6/8/2009 after the injection w sh on arms and hives + joint pain, left Y arm. Y
hours of vaccine c/o sore throat - light headiness U 6/8/2009 6/8/2009 n with TYLENOL, fussiness, decreased eating U 6/8/2009 6/8/2009 degrees about 12 hours after immunizations Y 6/8/2009 6/9/2009 en 2X NL size, Red, hot vesicules around Y injection site had given Benadryl in ER. Y 6/5/2009 6/6/2009 - large hives at site of injection - myalgias and arthralgias Y 6/2/2009 6/2/2009 r the immunization, child developedY~ 2" red raised tender area surrounding VARIVAX site - Yno vesicules5/30/2009 - now it brown 5/31/2009 skin surrounding s tous swelling, right deltoid area. DayYafter shot was given. Y 6/5/2009 6/6/2009 old male patient received a first time dose of MENACTRA (lot number U2816AA) intramuscularly N in the right 5/5/2009 deltoid on 5/6/2009 05 May 2009. On 0 serious case was received on 08 May 2009 from a health care professional. A 12 year old female Y patient 5/7/2009 received a second 5/8/2009dose of ADAC ted on (L) ear - Spread down face and Y trunk with a fine, flat, red rash that continued down hisY body - No 5/27/2009 fevers noted.6/8/2009 d syncope episode immediately after MENACTRA vaccine + HGB blood draw. Pt was sitting Y on exam table 6/5/2009 and stated. 6/5/2009 I didn't feel good, I Y 11/6/2008 11/6/2008 ours, fever (up to 101 deg. F) headache, bodyaches, redness and soreness at site. Bodyaches, Y fever and 5/29/2009 headache 5/29/2009 intermittent for 2 1/2 m and small purpuric areas on R lower Y leg. Y 5/29/2009 5/29/2009 4-36 hours after vaccine (R) deltoid. Swelling at injection site according to mother- 3 1/2 in high Y 2 1/2 in wide. 5/28/2009 Described 5/29/2009 red firm- like 2 go n has been received from a staff member in a physician's office concerning a 46 Y year old female U who on4/13/2009 13-APR-2009, 4/13/2009 at 9:40, was vaccin n has been received from a consumer concerning two of her friend's children who on an unknown U date were vaccinated with MMR II and d ort received on 29 May 2009 from a Y health care professional. A 58 year old male patient received U DECAVAC 4/28/2009 intramuscularly in the left delto ort received on 05 June 2009 from a health careYprofessional. A 47 year old female patient who N delivered twins 6/3/2009 vaginally on 02 June 2009 r MMR II and HAVRIX vaccine on (R) thigh, and Dtap, VARIVAX and IPV on (L) thigh. Noted N large area of 6/8/2009 swelling and redness on (R) thigh ceived DT on 6/1/09. Started feeling ill 6/2/09; l.g. -HA, fatigue, red sore arm. On 6/3/09 had Ysignificant episode 6/1/2009 of dyspnea 6/2/2009 with headache given 5/26/2009. Left leg appeared red, warm to touch and painful when touched. Mom noticed Y this on 5/26/2009 6/9/09. Subsequent 6/5/2009appt. 6/6/09. all" sized area around injection site. YDr Wright believes it is a shingles lesion. Being treated with Y Acyclovir.6/5/2009 6/6/2009 w fever, broke out in tiny hives (scalp, tummy, back, not legs). Hives light not raised, itchy. Fatigue, Y diarrhea, 6/8/2009 very thirsty. 6/8/2009 Now only has a c e within 2 hours. Had fasting blood test on 6/1/09. Arm was swollen at injection site, lump, fever Y 102, nausea, 5/29/2009 stomach 5/29/2009 ache, vomiting, swol d severe vaso response and faintedYat check out window approximately 8 minutes after receiving Y vaccine.6/8/2009 She fell hard 6/8/2009 and hit the floor w er extremity cellulitis. Swollen, red, warm to touch. Painful to patient at administration site. U 6/1/2009 6/3/2009 ceived Tdap vaccine during school Tdap clinic on 5/13/09. On 5/18/09 PHN received phoneYcall from school 5/13/2009 nurse.5/18/2009 She reports patient's a o right thigh 5 cm around and warm to the touch and redness. Mom stated child had fever as Y high as 1026/8/2009 F - temp today 6/9/2009 98.5. d Hep B #2 dose on 06/08/09. She Y had a little redness at the site and went to bed. She woke N in the middle 6/8/2009 of the night 6/8/2009 with neck pain. The and diarrhea, dehydration. Vaccine given at another Y facility. do not have 2 lot information. 6/18/09 Y ER records 6/1/2009 received6/6/2009 DOS 6/10/09 to 6/11/ led clinic approximately 2 hours after Y receiving Menactra Vaccine stating client complaining Y of headache 6/8/2009 and shaking. 6/8/2009 Advised to follow up 5/28/2009 N 5/26/2009 5/28/2009 s given an adolescent dose of Hep B in lieu of the adult dose. U 6/10/2009 mother reported patient had fevers and Y headache pain since immunizations on 12/15/2008. Patient Y had high fever ### and also ### seemed to be h was given shots 05/06/09. On 5/11/09 Y the mother noticed a rash on her face which she bestY describes as 5/6/2009 looking like 5/11/2009 heat rash. On 5/13/ ed papules. Red base withe yelllowish vesicles. Rash noticed 48 hours ago. Mom was usingYcortisone cream. 5/26/2009 Per Drs 6/8/2009 order patient was to GIVEN ON THURSDAY, JUNE 4, 2009. SUNDAY A.M. WHEN I AWAKENED MY BODY WAS Y HURTING 6/4/2009 ALL OVER, 6/7/2009 AND MY SKIN HUR ERYTHEMA 1"X 2" TO RIGHT DELTOID. Y TX-ICE PACK PRN PAIN AND BENADRYL FOR AGE U PRN ITCH. 5/21/2009 5/22/2009 xis (w/in 30 min, irritability, Y vomiting,Yhives, wheezing). EPI SQ x1, albuterol/atrovent neb, decadron Y IM, prednisolone 6/10/2009 6/10/2009 x5 days. 6/12/09 Me received DTaP and Prevnar vaccine in January at age 16 months, parents state child was often Y quiet, less 1/8/2009 active than 1/8/2009 usual, and often sta given 5/20/09. Vomited starting 5/28. Y Temp to 104.6 Y starting 5/29. Mild 2 rash, cough also. Developed Y severe 5/20/2009 red rash 5/28/2009 5/29 - eventually spre nning on bilateral arms. On and off Yx 1 wk. Rash Y down bilateral legs1and cont. on arms x 3-4Ndays. Began 4/21/2009 with rash4/23/2009 to face and neck 6-8-0 ools 24 hours after administration ofYROTOVIRUS - continuous for 6 d N 6/3/2009 6/3/2009 vaccine on 1-23-09. Since that date until present date pt c/o pain in rt deltoid area- no swelling, U edema or 1/23/2009 temperature 1/23/2009 noted. Juvenile Rheumatoid Arthritis-> seen at medical center. Tx Prednisone, Methotrexate, LEUCOVORIN. N 1/09 started ### 1/14/2009 having back pain, unila owing inj - inj site slowly turned red and swollen "looked like a spider bite" x 1wk- Cont. to get Y red and turned 4/30/2009 into a calloused 5/7/2009 blister appea 0 minutes after receiving vaccine, child Y broke out in rash. It started above his eye lids, and inYthe anticubital 6/9/2009 fossa of both 6/9/2009 arms, then progre ion, redness and tenderness to left Y shoulder area measuring 5cm by 5cm. Pt treated oral Antibiotics. U 6/8/2009 6/10/2009 mins after rec'vg all imm. appeared fine; started to stand then fainted x 20-30 secs. Revived w/cool Y water 6/10/2009 compress &6/10/2009 light stimulation. Rema started (L) thigh increased on 24 hr and worsened in 48 hr, gotten better, no trouble. Y 6/8/2009 6/9/2009
5/13/2009 DIARIX but didn't need a dose of DTaP or IPV. Y 5/19/2009 5/19/2009 -"Kiwi size"- approx. 3-4 in diameter. Swelling - 1/4 in -raised, painful Afebrile. U 6/8/2009 6/8/2009 inic 1 week after vaccine 6-9-09. According to dad 1 day after receiving the vaccine her attitude N changed 6/1/2009 she became 6/9/2009 compulsive, says she next day with increased redness and knot under site. Tx with ice. 6/10/09 Pt was seen in office Y today with6/5/2009 pain left arm, 6/6/2009 firm nodule at injec n: 11/10/98. Received anthrax vaccine Y #1- denies problems. 11/24/98. Received anthrax vaccine N #2- denies 1/8/1999 problems. 12/11/98. Received medical conditions diagnosed since starting Y ANTHRAX Y vaccine series, including fatigue, Y reproducible N arthralgias 1/22/1999 / myalgias, and obstructive Dermatitis, focal Start: 01/2004 Comment: Y Tinea capis. Symptom: Lymphadenopathy, axillary N Start: 09/2004 ###Comment: bilat axillary a ceived FLUMIST and ADACEL vaccines Y on 10/31. She developed severe arm pain and swelling Y in the left shoulder ### and arm a few hours af ceived Tdap into the left shoulder onY 10/31, the arm developed pain, swelling, heat, and itching at the site since### then. Fever start: 10/31/2006 - Comment: Undocumented, no temperature taken. Symptom: Chills Start: 10/31/2003### - Comment: Have occurred n: 37 y/o female developed severe Y right shoulder and arm pain and swelling a few hours after Y receiving ADACEL ###vaccination. Symptom: P old female received DTaP on 12/12/2006 Y at the clinic. Mother noticed child developed a large U erythematous and ###indurated area on the left 11/4/2001 N 6/6/2000 11/1/2001 U 4/19/2009 n has been received from a consumer Y concerning her approximately 36 month old son with N no pertinent medical 4/9/2007history or drug reactions o n has been received from a nurse concerning Y a 23 year old female who on 29-MAY-2009 was U vaccinated 5/29/2009 with the first 5/29/2009 dose of GARDASIL, n has been received from a consumer, for the Pregnancy Registry for GARDASIL concerning Y herself, a 2/12/2008 26 year old 2/12/2008 female, who on 12-FEB n has been received from a physician Y concerning Y a 16-year-old female 2 patient with Y no medical N history who 5/18/2009 was vaccinated 5/28/2009 with the second Y 5/4/2009 5/7/2009 DACEL and MENACTRA 05-12-09 pm., Y Wed pm 5-13-09 adolescent woke up with "baseballYsize knot" -5/12/2009 "hard to touch 5/13/2009 and large red whelp degree and rigor 12 hours after injection - Resolved 12 hours later without treatment. Y 10/3/2008 10/3/2008 ed Urticaria Patient treated with Prednisone Y Y 5/29/2009 5/29/2009 was given to me months ago in my left arm. It was understood that it was result in some soreness N for a while. 2/23/2009 But there is a numbness and m to touch 2x2 circumference. 6/3/2009 6/5/2009 vaccine breakthrough. Diagnosed with varicella in office today. U ### 6/2/2009 r vaccine. Severe local reaction: swelling, erythema, warmth, itching. Given Loratidine. 6/4/09- patient states 3/10/2009 after seeing 3/13/2009 Dr and taking the on 6/5/09 c/o pain in (L) arm with swelling and pain radiating to upper scapulae area. This occurred U when he awoke. T-102 in am. Seen at c er arm area of induration and erythema 156 mm X 75mm. Right upper arm circumference 7Y1/8 "and left is 6/1/2009 6 1/2". T-99.9 6/2/2009 area hot to touch hed side effects which have been checked. Abdomen cramps; ache: joints; aches: whole body; bowels:9/27/2007 irritable, cellulitis; chills, chills feve ceived PNEUMOVAX 23 vaccine in her left deltoid muscle at her place of employment on 04/09/2007. Y She 4/9/2007 experienced 4/9/2007 swelling and pain in n the clinic on 5/20. Mom states that on 5/19/09 pt had fever 105 and rash. Today rash is worst but no fever. 5/18/2009 Red bump 5/19/2009 raised pink on abdo ction with marked erythema, warmth,Y and pain at injection site within 12hrs of administration.USize of affected 5/27/2009 area 12cm 5/28/2009 X 10 cm Treated w on neck after 1st shot (4-5 days later) thought it was from something else, itching also. After Y2nd shot rash 4/24/2009 widespread 4/28/2009 on trunk, neck, arms n after injection (s/s) Pt got hot, very moist feeling, felt nauseated, dizzy. After she sat for about Y 5-10 min 6/9/2009 and had drank 6/9/2009 of H20 she felt bet swelling from shoulder to elbow - MOTRIN - rest- elevation Y 6/9/2009 6/10/2009 red, swollen, bruised, warm to touch. U 6/4/2009 6/6/2009 ven ADACEL instead of DAPTACEL at age 4 yrs 10 mths. No adverse reaction. All other vaccines given in6/2/2009 another state. omiting 24 degrees after vaccines. Advised pedia lyte (5m. am'ts) Then gradually elevated toYformula. Same 6/9/2009 symptoms 6/10/2009 after 1st series of v tchy, warm, sore, rash 6" long x 4" wide went to my doctor, prescribed KEFLEX generic cephalexin Y 500 mg 6/5/2009 twice daily 6/6/2009 for 7 days. was reported via medical records that were forwarded by lawyers and described Ythe occurrence U of polyarthralgia 7/27/1999in an adult male subject w d Tdap vaccine in the ED. The vaccine is to be given to patients between 11-64 years of age.Pt Y reported5/27/2009 to our office6/2/2009 on 6/8/09 that 6 days sician note: "her right arm shows an inflammation, some redness and mild induration at the Y site of her recent 6/6/2009 injection 6/7/2009 when she got her pn r to 101F responded to NSAID's, nausea, sattelite lesions, marked inflammation of shoulder Y with bilateral5/24/2009 swelling of 6/3/2009 axillary and cervical ly eived vaccines MMR, and Hep. B. on Monday 06/08/2009. Called today.Stated on Tues nightYtongue became 6/8/2009 sore and 6/9/2009 swollen. Still sore an erythema, swelling 3-4" in diameter 24 hours after receiving shot. Warm compresses and Benedryl Y advised. 6/9/2009 6/10/2009 ug reaction of head chest back armsY and legs. U 6/9/2009 6/11/2009 ely after vaccine was given, the patient developed pallor and was dizzy. Y 4/6/2009 4/6/2009 HE, DIZZINESS, PROBLEMS WITH SPEECH, NAUSEA, STOMACH ACHE, SLEEPINESS,NNO APPETITE. 5/29/2009 6/12/09 5/29/2009 Medical records rece pular, red in color, blanching, generalized in arrangement U 5/29/2009 6/10/2009 unk and forearms presented after second pill administered. Y
unk and back with some itching. Y 6/9/2009 6/10/2009 e long seizure associated with feverY2 hours after administration of Dtap and Prevnar Y 6/8/2009 6/8/2009 et 6/7/09, duration of 3 days; Eye sensitivity Y to light: onset 6/8/09, duration 1 day; Runny Nose: Y onset 6/7, 5/28/2009 duration still 6/7/2009 ongoing as of 6/11/0 perienced yesterday (6/10/09) on the body from face to upper thigh, fever. Mom gave TylenolU steaspoonsful 6/4/2009 and applied 6/10/2009 Calamine lotion. mm area of induration, warm to touch, erythematous Y 6/9/2009 6/10/2009 nduration, pain, itching, warmth, 14cm x 11.5 cm area surrounding injection site. Local cellulitis Y 6/2/2009 6/9/2009 : Pt. had conjunctivitis in both eyes Yand was tx'd with antibiotic gtts x5 days. 8 May 09: Annual Y physical exam 5/29/2009 was normal. 5/29/2009 Conjunctivitis ha ose of Hepatitis A given by error too early from first dose.CDC called and verified that this dose Y would not 6/11/2009 be valid and 6/11/2009 should be repeated 0 seconds after the first injection myYdaughter became faint and passed out, she then began U having a seizure, 6/11/2009 the entire 6/11/2009 episode lasted app tly, but want to report now. 3 Influenza vac, with identical reactions each time of visual change Y (marked) 11/1/2004 & headache. 11/1/2004 Recovered all 3 times Molluscum after previous dose of PROQUAD. Y 7/31/2006 6/9/2009 rom a nap around 5pm on 6/9/09 and Y noticed (L) arm was red, swollen, and warm to touch. Y Gave TYLENOL 6/9/2009 d/t LG fever 6/9/2009 of 99 per mother, ts with red, raised area on outer Lt thigh + tender to touch, about size of a baseball -SX began this a.m. 6/11/096/10/2009 Area 6/11/2009 is site of KINRIX inj. ter Tdap, Menactra , Varicella vaccines administered - Vital taken rest, fluids, EKG. Y 6/11/2009 6/11/2009 ash within 6 H of administration of PREVENAR Lt - MMR, VARIVAX, HAV 6/11/2009 6/11/2009 eaction. Injection site, swelling, red Y and hot Fever treated with Motrin and Benadryl. Y 6/8/2009 6/10/2009 2 cm red, cellulitic area were INFANRIX given - x2 days - warm compresses-PO AUGMENTIN, Y 400 POBID 6/8/2009 6/10/2009 Y 8/14/2008 5/5/2009 syndrome, headache + fever treatedYwith Keflex 500mg - PO TID X 10 days. Y 6/9/2009 6/9/2009 with blisters on mouth. Y Y 6/7/2009 of the eyelids, dizziness, feel sick. top center of head tender to touch, hurts. "This feeling" will N not go away! 1/9/2009 I called1/10/2009 the Doctors Office the 01) 24 hours after immunizations - red rash on trunk 10 days after immunization U 5/25/2008 6/5/2009 nger rash, erythematous nodules well demarcated. N 5/20/2009 6/3/2009 meter redness no induration or tenderness Y - no cellulitis - no treatment necessary Y 6/5/2009 6/7/2009 ther of the client reported the following Y events occurred after vaccination of client for Yellow U Fever and Typhoid 5/27/2009 VI at5/28/2009 clinic on 5/27/09. 5/28 y swollen upper left arm shoulder toYelbow. No fever good movement in shoulder, elbow, and wrist prescribed 6/4/2009 Keflex6/7/2009 for cellulitis. e out in hives within 24 hrs. Y 6/4/2009 6/4/2009 veloped rash about 1 1/2" in diameter at injection site. White in center. U 6/2/2009 6/4/2009 er vaccine administration, approximately Y 15-25 minutes child had syncopal episode that wasYprolonged with 6/5/2009 noticeable 6/5/2009 pallor, and fluctuan ped redness, swelling & induration of R thigh approximately 48 hrs after receiving vaccines. YMinimally tender, 6/3/2009 no fever 6/5/2009 or other systemic sy MMR, varicella, PREVNAR with Hep A 6/8/09. Began with erythematous rash that night thatYbecame a generalized 6/8/2009 urticarial 6/8/2009RXN the next d spots located on her scalp, forehead and face Lt is bilaterally. Spots itchy. no blistering -Treatment Y - acyclovir 5/15/2009 X 7 5/28/2009 days icellaform rash on chest, back, abdomen, Y buttocks, upper thighs. Treated with diflorasone diacetate N ointment 5/14/2009 for itching. 5/22/2009 Y 6/1/2009 6/1/2009 inistration of GARDASIL patient got dizzy + started perspiring. Y 6/8/2009 6/8/2009 n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning Y a 15 year old### female with ### no medical hist n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Yconcerning6/26/2008 a 17 year old 8/6/2008 female patient with n n has been received from a physician concerning Y a 16 year old female 7 patient who is a tampon U user and who on an unknown date was vac n has been received from a pharmacist Y concerning Y a 69 year old female 0 patient who Y on 11-MAR-2009 N was 3/11/2009 vaccinated 3/15/2009 SQ with 0.65 mL of d vaccines 6/10/09. Had High fever (TMAX 104.1) (6/11/09), given TYLENOL/MORIN; No vomiting, Y no seizures. 6/10/2009Also 6/11/2009 with runny nose, mild and warmth at the site of injection the Y size of a golf ball. Entire thigh was swollen. U 6/10/2009 6/11/2009 ection site. Low grade fever; back pain started 6/4 in pm; lethargic; aches; cough; weaknessYin limbs, decreased 6/3/2009PO6/4/2009 all lasted 2 days. No l on- Red, itchy, warm 2 1/2 U 6/8/2009 6/10/2009 er patient received shots child began Y to run a high fever of 104 - 105 degrees, and developed Y a cough. Stated 6/9/2009 also had 6/9/2009 decrease in appeti VAQTA and MENACTRA. After MENACTRA (approx 1 min) Pt slumped to side and fainted. Recovered Y immediately 6/12/2009 6/12/2009 c/o dizziness and head d vaccines approx. at 2:30 pm on 6-11-09 mom states at 8:00 pm that night pt began with redness Y and itching 6/11/2009 to palms 6/11/2009 of hands. Hands ha tvaccinial lymphadenitis beginning post-vaccine Y day 5, involving left axillary, supraclavicular U and cervical nodes, 6/1/2009 non-suppurative, 6/5/2009 no system 9 developed headaches that progressed to lethargy, Y slurred speech22and imbalanced gait. HeUwas hospitalized 5/6/2009 6/2/09 5/23/2009 (and remains hospital Patients Mother called office and reported Y that Left arm at site where daughter received vaccine U is red, hot 6/9/2009 and swollen. 6/10/2009 Provider Dr. mad cine administered pt became flushed,tachycardia,thick Y tongue.tingleing in lips and throughYout body. Pt 6/10/2009 evaluated6/10/2009 in Occ Health. Remai ted for a few seconds. I held her in chair until she came to and then we got her on the examYtable and let 6/12/2009 her rest for 6/12/2009 about 15 minutes. S
4 hours from the vaccination time patient stated that she had a raised reddened area aroundUthe injection 6/9/2009 site(left deltoid)and 6/10/2009she started ex d sensation in left arm, left arm weakness, and cold left hand U 6/5/2009 6/6/2009 ately 24 hrs after vaccination. Noted left arm swelling and c/o numbness from shoulder to wrist. U After 48 6/10/2009 hrs remains6/11/2009 swollen but no erythem periencing itchy palms and Y also had pressure in his ears. Pt was red and flushed. Pt also had Y itching on the 6/8/2009 back of his 6/8/2009 head. Epi was adm ounding vaccine site was red 2-3 inches Y in diameter in right arm, no induration,no heat present U 6/3/2009 6/3/2009 28 year old male with complaints of hives that started showing up within the first week of getting N home from 5/16/2008 deployment. 5/25/2008 He reports it was immunizations began having neck pain with radiation down back; right arm discomfort and then N later in week 6/4/2009 right knee 6/5/2009 lateral discomfort a developed a maculopapular rash at the varivax injection site, on 5/25/2009. Y 5/15/2009 5/25/2009 ash and swelling noted in left deltoid. Received 2 vaccines on 06/11/09, noticed soreness inULeft arm 146/11/2009 hours later.6/12/2009 Awakened next morni d muscle red/swollen and warm to touch 1 and 2 days after administration. Size of tennis ball. Y Improving 6/10/2009 today on day 6/11/2009 2. ECEIVED VACCINE ON 06/09/09 AT MARYMOUNT PRIMARY CARE AROUND 4PM WENT HOME AND6/9/2009 HOUR LATER 6/9/2009 ARM BECAME S was reported via a statement of injuries received via a lawyer and described the occurrenceUof flu-like symptoms in an adult male subject w ain at injection site (~ 3" inch diameter), oval shape rash /redness. U 6/10/2009 6/11/2009 n with what looked like bug bites - Mom Y stated they appeared with VARCELLA shot + gettingYworse - Mom 5/27/2009 took child5/29/2009 to hospital - trans. Pt t with swelling to right arm. Y 6/10/2009 6/10/2009 hematous rxn to both legs, 6 x 6". Y 6/8/2009 rm and tender indurated area at site of VARIVAX- 7x9cm. Y 6/10/2009 6/11/2009 NACTRA injection. Child had brief syncopal episode. Lasted about 30 seconds, then alert, normal Y neurologically. 6/12/2009 6/12/2009 confluent smooth area L deltoid. Local Rx. Y 6/10/2009 6/11/2009 09 after receiving immunizations the child had Y rhythmic movements1of arms and legs followed Y by lethargic 5/26/2009 periods where 5/26/2009 baby was unresp mplains of headache after 1 hour ofYHep A shot, muscle cramps on the left arm, tingling of the U left fingers. 6/12/2009 6/12/2009 tes she has muscle cramps over both Y shoulders, back neck, these symptoms appeared 15 minutes U after6/12/2009 shot, nausea, 6/12/2009 sweating. 3 hours a reaction at site of VARIVAX. Slightly tender. 6x6 cm. Y 6/10/2009 6/11/2009 esented to office with redness, hot to touch, knot at injection site, and treated with VERIPRED Y 20mg. 6/9/2009 6/11/2009 d ZOSTAVAX vaccine on 6/10/09 - RTC on 6/12/09 C/o pain, red, warm to touch at injectionUsite. Advised 6/10/2009 warm compresses. 6/11/2009 Given RX for elling and redness at injection site. Ice pack applied. BENADRYL given one per day. Y 6/11/2009 6/11/2009 and redness at injection site 1 week Y after administration. Y 6/4/2009 6/11/2009 oid pain with radiating to neck and forearm. Y Paraesthesia in right arm following Tdap immunization. N 6/8/2009 6/8/2009 ad to toe rash. Blisters mostly on chest. 6/12/09 Rash almost gone. 0 blisters. Y 6/3/2009 6/7/2009 , in chest, pale, warm, nauseated. Cold packs were applied, she denied any difficulties breathing Y and recovered 6/12/2009 completely 6/12/2009within a few m f 5/27. arm pain On 5/28. abdominal pain, leg pain; tingling backs of legs & feet. Light headed, Y passed out 5/27/2009 in shower. 5/27/2009 Temp 100.8. at daycare. He took a longer than average Y afternoon nap and woke up a little warm. He wasYstanding at the 6/3/2009 window6/11/2009 with his caregiver whe nization on 5/26/09, had episodic spells Y of rhythmic movements of arms and legs followed by Y lethargic episodes. 5/26/2009Baby 5/26/2009 felt cold to mother d eloped Abnormal Seborrheic dermatitis after vaccination, Y also Failure 6 to Thrive. N 6/7/2007 6/8/2007 MR 10 days post vaccine Y 6/2/2009 6/12/2009 days after my 2nd vaccine, my was swollen and extremely red above the injection site. Soon N after, I developed 6/1/2009 a rash 6/3/2009 (starting on my back d vaccine in the hospital. Approximately 1.5 days after administration RN noticed moderate swelling U and6/13/2009 redness of6/14/2009 right upper extremity w Y 0 N ort was received 04 June 2009 fromYa consumer, who is also the patient. A 67-year-old female U patient with1/1/2008 a history of1/2/2008 penicillin, seafood an ort received on 08 June 2009 from another Y manufacturer whose initial reporter was a health care U professional. A 24 year old female patient n has been received from a physician Y for the Pregnancy Registry for GARDASIL regarding an Y 18 year old female ###with 6/1/2008 depression and a his n has been received from a physician concerning an approximately 80 years old Y female whoNwas vaccinated 8/2/2007 with a 0.65ml 8/2/2007 dose of ZOSTA n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y an 18 year6/13/2008 old female who on 13-JUN-2008 n has been received from a physician concerning a 29 year old female who on 14-MAY-2009 Y was vaccinated 5/14/2009 with VARIVAX 5/14/2009(Oka/Merck) ( n has been received from a nurse, for the pregnancy registry for GARDASIL, concerning a female Y with no7/1/2007 known allergies 5/24/2008 and no pertinent n has been received from Y a physician Y concerning Y a 10 month old female 0 with a history Y of wheezing Y who was vaccinated 12/1/2006 with 3 doses of RE n has been received from a consumer Y concerning Y his 15 year old daughter 0 who was vaccinated U with GARDASIL. After the patient received arted sneezing approx. 20 minutes after gettingYimmunization. Left eye 1 swelling and pt. c/o itching Y - rash 6/10/2009 on thigh. BENADRYL 6/10/2009 40 mg given s (not just in shoulders with shots - though it is worst there), sore lymph nodes (at back of neck), N sore throat, 6/5/2009 aching ears, 6/5/2009 loss of appetite (n AY, JUNE 4TH, RIGHT SIDE OF FACE Y STARTED Y SWELLING. PARENT 5 TOOK HER INTO Y EMERGENCY 6/4/2009 ROOM. BY 6/4/2009 THE TIME THE M.D and briefly passed out a few minutes after vaccines administered. Client laid on exam table and Y given juice. 6/15/2009 6/15/2009
RECEIVED ALL THE VACCINES LISTED Y IN ITEM NUMBER 13 ON 06/10/2009 SHE STATED N HAD AN 6/10/2009 OUTBREAK 6/11/2009 OF HIVES THE FOLL ection patient complained of left arm pain rest of day. Next day had headache, chills, body aches, Y and hives 6/12/2009 to arms6/12/2009 and torso. 2 days late ching under armpits 10/30 red and Y itchy under arms, down side of breasts, on stomach and Y down to the pelvic### area. 10/31### went to stat care anthrax vaccination, member states she had 5 menstration flows in a 6 week period. This reaction Y has never 8/15/2007 happened 8/22/2007 to her prior to vacc ped zoster rash within 24hrs of receiving Y vaccine. Pt was seen in office 6/15/09 and started on U Famciclovir6/9/2009 and Prednisone. 6/9/2009 on given at 9:20 a.m. Patient showed signs of excessive tiredness at 7:45 p.m. Vomiting occured Y beginning 6/12/2009 at 4:00 a.m. 6/12/2009 er receiving DTaP #4 and Hepatitis Y A #1, patient presented to ER with c/o redness and swelling Y at injection 6/9/2009 site. Today 6/13/2009 (6/15/09)mom repo e given on 5/20/09. Shot site got swollen, Y hot and erythematous. Was adv to try ice and Benadryl Y initially. 5/20/2009 Came into 5/21/2009 offc on 5/22/09 & wa w fever INJECTION ON 6/10/09 DEVELOPED A 4 INCH RED BLOTCH ( NO FILLED) ON LEFT Y BACK 6/10/2009 OF ARM AND 6/11/2009 FELT MALAISE x 1 d zoster pain 48 hours after administration Y and classic rash 6 days after vaccine. U 6/8/2009 6/10/2009 extreme swelling to injection site per mom. Witnessed by Dr. at home visit. Y 6/10/2009 6/11/2009 d vaccinations on 6/9/09. He was up most of the night after vaccine with pain in his left thight. U On 6/10/09,6/9/2009 thigh was 6/9/2009 red & still painful. Also pells started in January 2009. They Yoccurred multiple times per day and continued for over 2Nmonths. She 11/4/2008 also experienced 1/9/2009 nausea, dizzin ng, redness, irritation at injection site with little blister bubbles at site. Y 6/11/2009 6/12/2009 ike rash developed 3 days after given Zostavax Y 6/10/2009 6/13/2009 en dots around injection site. Hives on upper deltoid to elbow. Pt to take BENADRYL q 6 hours Y prn call if5/18/2009 worse. 15cm 5/19/2009 hive around injection n site approximately equal to 2 X 2" red swollen, hot to the touch, raised area. The next day injection has 6/12/2009 gotten approximately 6/13/2009 1 " bigger t ddenly fell to the floor about 1 minute after. Y 6/8/2009 6/8/2009 ateral lower extremity edema. Assoc Y with pain that makes walking difficult. Also assoc with malaise Y and 4/17/2009 fatigue. Occurred 4/23/2009 both times she w d erythema multiforme w/in 96' of DTaP, Y Hep A, PREVNAR and MOTRIN. Y 6/3/2009 6/7/2009 was reported by a healthcare professional Y and described the occurrence of labial swelling inYa 16-Year-old 1/22/2009 female subject 1/23/2009 who was vaccin rts she noticed hives on baby's back; Buttocks at 8 PM on 5/27/09 - approximately 4 hours after Y injection5/27/2009 - and a fever 5/27/2009 of 99.9 gone by noo een on 6/9/09 for pap smear - during course of visit she advised provider that she refused any Y further GARDASIL. Stated that apx 3 hours a in waiting area. Y 6/11/2009 6/11/2009 11/11/08 - 1st sore on outer vaginalYarea/left side. 11/12/08 - fever 101. 11/14-18/08 - more Y sores-outer 11/7/2008 left vaginal area. 11/20/08 ### DR. take s red rash, left side of forehead and surrounding Lt eye, consistent with shingles. N 6/2/2009 6/4/2009 .T. Congestion; 6/2/09 Fever, leg pain; Y 6/6/09 headache, Y vomiting;12 6/10/09 - broad-based gait, facial weakness/? 5/13/2009asymmetry. 5/31/2009 7/21/09 Hosp pain, erythema in (whole upper right) arm of injections. Symptoms started within 24hrs. At 4 U days starting6/11/2009 to improve. e on 6/5/09 mother noticed left arm was red and swollen from shoulder to elbow. Afebrile. Cold Y compress 6/4/2009 applied. 6/5/2009 erve palsy "Bell's palsy" Y U 6/11/2009 6/12/2009 cines 6/3/09, started with fevers to 104-105 on 6/4/09, seen in clinic 6/5/09 with fever to 104.4, Y no S/S URI, 6/3/2009 UA dip (-). 6/4/2009 F/U call 6/6/09 fever 9-4AM started vomiting/diarrhea, 11:00AM Y Fever 100.7. By 7:00 PM fever 102.8. ContinuedYto vomit, went 5/28/2009 to emergency 5/29/2009 room. Received I s in wrist, elbow and shoulder of arm ADACEL was administered, began within a few minutes Y of injection. 5/21/2009 Numbness 5/21/2009 was in (R) arm. Full ra ped body aches, myalgias on 5/29/09. Y The next day, she was much better. Y 5/28/2009 5/29/2009 ling R Deltoid Y 6/4/2009 6/8/2009 d rash on hands, chin 6/12 taken to Medical Center Rx for Prednisone 20 mg Qd II tabs 6/15Yspoke with 6/11/2009 mother, patient 6/12/2009 is doing well today. n waiting room. Fell and hit her head on chair in waiting room ~ 5 min after receiving vaccines. Y Possibly 6/15/2009 hit head on6/15/2009 seat cushion or possibl th large area of erythema, warm to touch Y 6/10/2009 6/11/2009 deltoid ~ 3 cm oval shaped area erythema, edema + warmth + induration 0 fluctuation + tender U to palpation. 6/10/2009 given Bactrim 6/11/2009 DS #14, T by mo vaccine adm. on 6/10/09. Mother noted "small red bump" at site yesterday. Larger red round Nspot today. 6/10/2009 (Left triceps6/11/2009 area) (6cm diameter) S ceived her vaccine on 4/20/09 am and began screaming at 4/23/09. She was seen in the ERYafter 2018 on 4/25/09, when abdominal x ray, e headache and swelling RT arm - Aspirin Y TYLENOL. Ice pack initially. (2) Repetition of above U q 2 weeks2/27/2009 with shooting 2/28/2009 pains RT side body he had swelling and pain at injection site. Y 6/4/2009 9 Pt saw Doctor reports received TdYBooster at Hospital on 5/19/09. Left arm erythema induration Y 2 degrees. 5/19/2009 DX: Local 5/21/2009 allergic reaction to within 4 hours, cellulitis picture 48 Y hours later. U 6/9/2009 6/10/2009 d MENACTRA) Tdap 8/407. Head ache /st over time developed fatigue (sleep up to whole day) N and headache 9/19/2007 (1st 10/8/2007 concerning Reaction). ( A on 10/29/08 HA started that he did not have at time of apt & vaccine. Seen 10/31/08 for abd N pain & HA. ### ### red 5/22/09; on Sunday, 5/24/09 Pt developed papular rash on upper back and chest, with itching. Y Both 5/22/2009 itch and rash 5/24/2009 diminished over next n has been received from a physician concerning a patient who on unspecified date was vaccinated U with a dose of GARDASIL (LOT# not r n has been received from a physician Y concerning Y a 19 year old female 0 with sulfonamide allergy, Y allergy to2/2/2007 PEDIAZOLE 2/2/2007 and AUGMENTIN, n has been received from a nurse concerning Y aYfemale with no allergies 0 who on 20-JUL-2007 Y and on 24-SEP-2007 1/25/2008 1/25/2008 was vaccinated IM 0.5
n has been received from a nurse practitioner concerning 3 children who was vaccinated with U GARDASIL. The nurse practitioner reported n has been received from a physician Y concerning a teenage female who within the last two years Y (approximately 2007) was vaccinated IM n has been received for the Merck pregnancy Y registry, from a nurse concerning a female patient, Y who was 9/28/2006 vaccinated with### two doses of GA n has been received from a registered nurse, for the pregnancy registry for GARDASIL concerning Y a 21 1/16/2008 year old female 1/16/2008 with a history of la n has been received from a physician for the Pregnancy Registry for GARDASIL, concerningY a 17 year old female ### with 2/12/2008 no known allergies n has been received from a Nurse Practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 19 5/9/2008 year old 5/9/2008 female with thrombocy n has been received through the Merck Y pregnancy registry from a registered nurse concerning Y a 21 year 4/3/2008 old female with 6/5/2008 no pertinent medic n has been received from a physician concerning four female patient's who were vaccinatedYwith dose of GARDASIL. Subsequently the pa n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 21 year 2/20/2009 old white female with no significant n has been received from a registered Y nurse concerning an 11 year old female who on 11-MAR-2009 U was 3/11/2009 vaccinated 3/11/2009 with GARDASIL (lot n has been received from a registered nurse concerning a 11 year old female who on 24-MAR-2009 U was3/23/2009 vaccinated3/23/2009 with the first dose of G n has been received from a registered nurse for the pregnancy registry for GARDASIL concerning Y a 16 year 5/19/2008 old female, 5/19/2008 who on 26-FEB-20 n has been received from a registered Y nurse, for the GARDASIL a Pregnancy Registry product U concerning 3/20/2009 a 14 year 3/20/2009 old female patient wh Client received MMR and Varicella vaccines. Y Mom was instructed to observe carefully for fever Y 5-12 days5/28/2009 after vaccine 6/3/2009 administration and to Y n has been received from a medicalYassistant concerning a female who was vaccinate with on U unspecified3/3/2008 dates (doses and LOT# were no n has been received from a caller concerning her daughter a 17 year old who became very ill U after receiving 5/1/2008 injection5/1/2008 the first dose of GAR n has been received from a 20 year old female patient with parakeratotic cells evidenced in N previous PAP 4/28/2009 test, who4/29/2009 on 20-APR-2009 was v n has been received from a consumer concerning herself with no previous pregnancies and Nno reported past 5/1/2009 drug history 5/1/2009 who on 01-MAYn has been received from a physician concerning a 17 year old female with no pertinent medical Y history 4/15/2009 reported and 4/16/2009 no known drug allerg n has been received from a nurse practitioner Y concerning a 15 year old female who on 27-Feb-2009 Y was2/27/2009 vaccinated2/27/2009 intramuscularly. 0.5ml n has been received from a nurse practitioner concerning a 16 year old female patient with aNhistory of epstein-barr 5/1/2009 virus 5/2/2009 infection and lymp n has been received from a physician concerning a teenager female who was vaccinated with N the first dose of GARDASIL in April 2007 and n has been received from a physician Y concerning a 15 year old female with PENICILLIN allergy N and no pertinent 11/5/2008medical 1/1/2009 history who was v n has been received from a registered Y nurse (RN) concerning a 17 year old female who on 24-JUL-2008 U 7/24/2008 was vaccinated 12/9/2008 with the first dose n has been received from a mother concerning a her daughter who on 3-JUN-2008 was vaccinated U with her 6/3/2008 first dose of GARDASIL (dose n has been received from a physician concerning a female patient who on 04-MAY-2009 was Y vaccinated 5/4/2009 with the first5/4/2009 dose of GARDASIL ( n has been received from a physician Y concerning a female patient who was vaccinated with YGARDASIL and experienced syncope, the pati n has been received from a consumer concerning her 12 year old daughter who on an unspecified U date was vaccinated with her first dose n has been received from a doctor of Y osteopathic medicine (D.O.) concerning a female who Yon an unspecified date was vaccinated with the n has been received from a registered nurse concerning a 21 year old female with no pertinent U medical history 5/1/2009 or drug 5/1/2009 reactions/allergies w n has been received from a medicalYassistant and the patient's mother, for GARDASIL, a Pregnancy N Registry 4/21/2009 product, 4/21/2009 concerning an 17 ye n has been received from a licensed Y practical nurse, for the Pregnancy Registry for GARDASIL Y (Lot # 659184/0843X), 8/21/2008 8/21/2008 concerning a 25 yea n has been received from a 25 year old female certified medical assistant concerning herselfYthat she was vaccinated IM with the third 0.5 m n has been received from a Certified Y Medical Assistant concerning a 14 year old female withNno pertinent 4/7/2009 medical history 4/24/2009 who on 07-APR-2 n has been received from a healthcare worker concerning her 18 year old daughter who wasUvaccinated11/9/2007 with the third 11/9/2007 dose of GARDASIL a n has been received from a 23 year old female who on 04-MAR-2009 was vaccinated with with N second dose 3/4/2009 of GARDASIL. 5/4/2009The patient ha n has been received from a consumer Y concerning her daughter a 23 year old female with a history N of eczema and Dairy allergies (cause of n has been received from a physician Y concerning a 15 year old female who on 06-MAY-2009 Y was intramuscular 5/6/2009 vaccinated 5/6/2009 with her 05ml d n has been received from a pharmacist who heard from a nurse (mother of the patient) concerning U the female patient who on unspecified d n has been received from a 23 yearYold female with no medical history or drug allergy who on N 01-May-2009 5/1/2009 was vaccinated 5/1/2009with the first do follow up information has been received from a registered nurse concerning a 27 year old female Y with penicillin 3/9/2009 allergy 3/9/2009 and no pertinent me n has been received from a physician Y concerning a female patient about 20 years old who on N an unspecified date was vaccinated with a do n has been received from a nurse practitioner Y concerning a female who in October 2007, was N vaccinated 10/1/2008 with the first 10/1/2008 dose of GARDASIL. n has been received from a nurse manager Y concerning a 25 year old female who on 08-MAR-2009 Y was vaccinated 3/8/2009 with 3/8/2009 GARDASIL. There n has been received from a physician Y concerning a 14 year old female who on an unspecified U date was intramuscular vaccinated with GAR n has been received from a licensed practical nurse concerning her 16 year old daughter with Y DURICET allergy 8/3/2007 and no pertinent medical h n has been received from a female who in 2006 was vaccinated orally with GARDASIL and U just recently had been diagnosed with human p n has been received from a consumer Y concerning her 16 year old daughter with lactose intolerance N and4/22/2009 not other drug 5/9/2009 reactions or allergie n has been received from a physician, Y a consumer and a secretary concerning a 15 year oldNfemale patient 5/8/2009 with no history 5/8/2009 of allergies who n has been received from a medical assistant concerning a 21 year old female with no allergies Y or medical 4/23/2009 history who 4/25/2009 was vaccinated intra
n has been received form a physician Y concerning his 33 year old daughter who had been vaccinated Y with GARDASIL series. During one of n has been received from a physician Y concerning a 17 year old female patient who on 27-Feb-2009 Y was2/27/2009 vaccinated with 3/1/2009 the first dose of G n has been received from a physician concerning a patient who was vaccinated with GARDASIL. U Subsequently the patient experienced co n has been received from a physician concerning a 21 years old female with no pertinent medical Y history 5/6/2009 who was vaccinated 5/6/2009 with GARDA n has been received from a registered Y nurse in a physician's office and a registered nurse inUa county health 2/5/2009 department, 2/5/2009 for the Pregnancy n has been received from a medicalYassistant concerning a 26 year old female who on 08-MAY-2009 Y was5/8/2009 vaccinated5/8/2009 with her first dose of n has been received from a physician's assistant who reports an office had several patients U faint after receiving GARDASIL. It was unknow n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry Product, Y concerning5/4/2009 a 17 year old 5/9/2009 female who was va n has been received from a nurse concerning a 24 year old female who on 11-MAY-2009 was U vaccinated 5/11/2009 with a 0.5 mL first dose of GARD n has been received from a certified medical assistant concerning a 14 year old female with Yno pertinent5/14/2009 medical history 5/14/2009 who on 14-May-20 n has been received from a nurse practitioner Y concerning a female patient who in 2008 started N the series of GARDASIL. Concomitant thera n has been received from a receptionist Y concerning her daughter who on an unknown date was U vaccinated with a dose of GARDASIL (lot n n has been received from a certifiedYmedical assistant concerning a 25 year old female patient N who on 17-APR-2009 4/17/2009 4/17/2009 received the first dose n has been received from a nurse concerning Y a female who on an unknown date, was vaccinated Y IM with the first dose of GARDASIL 0.5m n has been received from a physician Y concerning a 15 year old female with a history of headaches Y who on unspecified dates were vaccina n has been received from a physician and a registered nurse concerning an 18 year old female Y who on 18-Mar-2009 3/18/2009 3/18/2009 was vaccinated with t n has been received from a nurse practitioner concerning a 25 year old female who on 20-OCT-2008 U was 4/16/2009 vaccinated 4/16/2009 with the first dose of n has been received from a licensed practical nurse concerning her 25 year old female friend N who on 18-MAY-2009 5/18/2009 5/19/2009 was vaccinated with he n has been received from a nurse practitioner Y concerning a 16 year old female who was vaccinated U with10/2/2007 the first dose 11/1/2007 of GARDASIL on 02 n has been received from a physician Y Assistant and a Licensed Practical Nurse concerning N a 16 and half 1/9/2009 years old 1/14/2009 female with familial risk n has been received from a physician Y concerning a female who was born on 09-Jun-1988 was U vaccinated8/7/2007 the first dose of GARDASIL (Me n has been received from a Nurse Practitioner concerning a 17-year-old female patient who Yon 07-AUG-2007 7/24/2008 was vaccinated 7/24/2008 with the first n has been received from a physician Y concerning an 11 year old female with no illness at time Y of vaccination 4/8/2009 or pre-existing, 4/8/2009birth defects o n has been received from a licensed practical nurse concerning a female who was vaccinated U with a dose of GARDASIL. Subsequently, th n has been received from a physician Y concerning a 20 years old female who was vaccinatedUwith GARDASIL 4/8/2008 three times: 5/8/2009 1st dose given o n has been received from representative reported experience as reported by a nurse concerning Y a female 5/18/2009 patient who 5/18/2009 on 18-MAY-2009 wa n has been received from a nurse concerning Y a female who was vaccinated with a first doseUof GARDASIL. Subsequently the patient expe n has been received from an office manager concerning a 15 year old female who on 11-NOV-2008 U was vaccinated 5/1/2009 with the first dose of G n has been received from a Registered Nurse (R.N) concerning a female patient who on an U unspecified date was vaccinated with a dose o n has been received from a medical assistant concerning a 23 year old female with not reported Y drug reactions/allergies 3/10/2009 3/11/2009 and medical histor n has been received from a physician Y concerning a teenage female who within the last two years Y (approximately 2007) was vaccinated IM n has been received from a certifiedYmedical assistant concerning a 12 year old female patient U with cystic 5/13/2009 fibrosis, no 5/20/2009 drug reactions/allergi n has been received from a 34 year old patient registered nurse with allergies to IMITREX, COMPAZINE, U 5/21/2009 MACROBID, 5/21/2009 for the Pregnancy R n has been received from a physician concerning a teenage female who within the last year Uwas vaccinated 1/1/2008 with a dose of GARDASIL vac n has been received from a consumer Y for the pregnancy registry for GARDASIL concerning U his 17 year 4/21/2009 old girlfriend4/21/2009 with anemia, irregular n has been received from a physician Y concerning a 16 year old female patient who "a coupleUof months ago" was vaccinated with the first a n has been received from a physician concerning a 25 year old female with a history of miscarriage N before 5/12/2009 the vaccination 5/19/2009 who on 12-MAY n has been received from a physician Y concerning an 11 year old female who on 19-MAY-2009 Y was vaccinated 5/19/2009 with5/19/2009 the second dose of GA n has been received from a mother concerning her daughter who on 31-MAR-2008 was vaccinated N with3/31/2008 first dose of3/31/2008 GARDASIL (Lot # 659 n has been received from a nurse practitioner for GARDASIL, a Pregnancy Registry product,Y concerning a 23 year old 3/3/2008 female with allergies n has been received from a physician concerning a 15 year old female student with no medical U history and 2/25/2009 no known 2/25/2009 drug allergy who on 2 n has been received from a Certified Medical Assistant (C.M.A.) concerning a 24 year old female N patient who 5/1/2009 on 13-MAR-2009 5/27/2009 was vaccin n has been received from a consumer concerning his 16 year old daughter with "brachial plexus" N of her 10/1/2008 right arm which 10/1/2008 was diagnosed a fe n has been received from a Registered Y Nurse concerning a 25 year old female patient with no Y pertinent 5/15/2009 medical history 5/16/2009 and no drug reactio n has been received from a physician concerning a "14 year" old female patient who was hospitalized Y couple days for "Helicobacter pylori" n has been received from an emergency Y medical technician concerning a 15 year old femaleNpatient with5/21/2009 no drug reactions 5/21/2009 or allergies who n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. One or two months after the GA n has been received from a physician concerning a female patient who on an unspecified date N was vaccinated with5/22/2009 the first dose of GARDA n has been received from a nurse concerning Y a 23 year old female patient who on 20-MAY-2009 N was vaccinated 5/20/2009with 5/26/2009 a second dose of GA n has been received from a consumer, Y for the Pregnancy Registry for GARDASIL, concerning Y her 15 year old ### daughter with ###seasonal aller n has been received from a registered Y nurse (R.N.) concerning a female who on 27-MAY-2009 U was vaccinated with a dose of GARDASIL (
n has been received from another physician Y (not the patient's physician) concerning a female U who was vaccinated with a dose of GARDAS n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL vaccine. Subsequen n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa n has been received from a nurse through a representative concerning a female patient whoYwas vaccinated with the first dose of GARDAS n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa n has been received from a nurse practitioner concerning a 11 year old female who on 19-MAY-2009 U was 5/19/2009 vaccinated 5/28/2009 with her first dose of n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a dose of GARDASIL (LOT# n n has been received from a Nurse Practitioner Y concerning a female about 14 years old who Y was vaccinated 5/29/2008 with the5/29/2008 first 0.5 mL dose of GA n has been received from a physician Y concerning an approximately 25 year old female who U on "20-MAY-2009" 5/20/2009 was vaccinated, 0.5 ml, with n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and fainted A ROUTINE PHYSICAL, I WAS GIVEN Y A TETANUS Y AND GARDASIL 2 VACCINE SHOT. APPROXIMATELY Y 6/10/2009 FIFTEEN 6/11/2009 AND A HALF HOUR n has been received from Y a medicalYassistant concerning Y a 9 weeks2old female patient with Y no pertinent5/28/2009 medical history 6/3/2009 and not known alle n has been received from a physician Y concerning Y a 7 months old female 0 with unknown drugYallergies and 4/16/2009 unknown 5/26/2009 medical history who on n has been received from a hospice nurse concerning a 16 years old female withYunknown drug N allergies and unknown medical history who n has been received from a health professional for the pregnancy registry for GARDASIL concerning Y a female 10/7/2007 with a history of atrial septal d Alopecia Areata Universalis beginning three days after receiving third GARDASIL booster, Tetanus with 10/1/2008 Pertussis injection, and Flu vacci the vaccine and a month later was diagnosed with Grovers disease which is a rash Y on the back and chest. 12/1/2007 Seems to me it### very coincidenta en 6/8/09 for 5 year WCC and received MMR, VZV, PV, DTaP, Hib and Hep A. He woke up this a.m. c/o itchy 6/8/2009 red rash 6/9/2009 on (L) upper thigh w ce visit: Red, warm area on left thigh, painful (to touch), Y 6/1/2009 6/3/2009 dedness, dizziness since vaccine series completed one year ago. Fainted 6/4/09. U 4/1/2008 4/1/2008 Y 5/8/2009 5/8/2009 numbness of the Rt fingers & right Y arm & nose 2 weeks seen by 5.26.09. No symptoms after Y 6-12-09 4/24/2009 5/12/2009 ely after receiving vaccine, right armYbecame very sore. Redness developed at 11:00 PM. Warm Y to touch. 6/10/2009 Area is 6/10/2009 very swollen. ain at the injection, Limited movement. Fever, chills, body aches for 2 days. Y nderness and swelling at site. Lasted for 2 weeks. Required medication for several days - ADVIL Y 5/20/2009 me in for office visit - Urticaria on Rt thigh, warm to touch, non-tender. Y 6/1/2009 6/3/2009 fice visit- firm, red, tender, warm area on (L) thigh. Y 6/8/2009 6/9/2009 action rash, swollen area around injection site. Itchy hand etc. Rash is 40mm in length. 6/10/2009 6/10/2009 TIVE ERYTHRODERMA - required Y hospitalization Y due to dehydration. 1 Treated with steroids U for over 2 wks. 5/11/2009 6/17/095/13/2009 Medical record receive cribed area on (R) leg is approximately 1 inch from injection site. 3 inches wide and 2 inches U tall and red and 6/4/2009 hot to touch. Per mom spoke w iven on 6/5/09. On 6/7/09 area on left leg - raised, warm, measuring at 6 x 8 cm. Y 6/5/2009 6/7/2009 s a quarter-sized red area at the injection site that is warm to touch. There is also significantYbruising in a 6/5/2009 3-4 inch area 6/6/2009 surrounding the red PCV-7 in (R) thigh and PENTACEL (DTaP-IPV-Hib) in (L) thigh on June 5 in PM. Increased Y sleepiness rest 6/5/2009 of June 5, 6/6/2009 2009. On 6-6-09 not a 6cm x 3cm erythematous rash on her (R) upper anterior thigh Laterally & anteriorly is the injection U site. 6/2/2009 6/4/2009 woke during night with chills, painful skin irritation. Full body aches, light-headedness, exhaustion, N lack of focus, 6/6/2009 periods 6/7/2009 of mild confusion, re 7cm x 5 1/2 cm warm to touch. 6/3/2009 6/8/2009 g, redness, pain 4/23/2009 5/1/2009 hr. - hives and swelling throat, took BENADRYL - 50 mg, then another 25 mg 6 hrs. later. Ok Y next day. 4/21/2009 4/21/2009 d and swollen 35 mm X 35 mm Y 6/4/2009 6/5/2009 ived PENTACEL, PREVENAR, GENHEVAC B, and ROTATEQ on 5/4/09. On 5/5/09 child dev'd Y factile fever 5/4/2009 and red5/5/2009 maculopapular rash o oid, red, warm to touch. Swollen, raised, Y 6cm x 3cm. Y 6/9/2009 6/10/2009 adache "head pounding" chest tightness and some shortness of breath (although speaking Y normally) and6/8/2009 "feeling cold" 6/8/2009 - visibly shivering. v d Immunisation and then in about 2Yhrs developed so many hives on face, neck, arm, abdomenY had swollen 6/2/2009 upper lip. 6/2/2009 Was seen at emerg ven MENACTRA - Vaccine given 5/28/09 Y redness 5/29 then seen 5/31 in ER Hosp. for right arm Y swelling5/28/2009 shoulder to5/29/2009 hand - Numb/tingling h ed shingles like rash in left T8-9 dermatoma, Y 2 days after receiving the vaccine. 6/11/2009 6/13/2009 days post vaccination seen in office Y for rash. ATARAX Rx. U 6/3/2009 6/13/2009 vd MMR SubQ @ Health Dept. 6-11-09 Y Pt. returned to HD. Exhibits approx 10 mm by 15 mm Y reddened6/2/2009 & inflamed6/5/2009 area upper outer aspe lls, headache, sore throat achy arms and legs. Y 6/1/2009 6/1/2009 Y 7/1/2008 7/2/2008
irritability with green/mucus colored stool with presence of blood, which was Hemacult + andY in office, pt 6/4/2009 improving. 6/6/2009 at 2 AM on 6/9/09 with temp of 101.4 & feeling dizzy. As of 8 am was feeling better, temp gone. Y 6/8/2009 6/9/2009 urred 5 to 7 days after shingles vaccine on sides of neck and other places shingles would appear. N Was 3/13/2009 taking NITROFURANTOIN 3/18/2009 MACRO vaccines 4/21/09. That night he had chills and temp of 100 degrees. Stayed home from school Y on 4/22 AM. 4/21/2009 Had been 4/22/2009 treated with MOTRIN 6/8/2009 m red area with 3x4 cm raised x 6cm area. No drainage - warm to touch. Doctor advised Benadryl cream to 6/2/2009 area with6/3/2009 ice packs. If no better itching, erythema, and swelling about Y 2 days after injection. Improved with BENADRYL administration, Y no 6/9/2009 pain/tenderness. 6/11/2009 ss, swelling, erythema. No treatment necessary. Y 6/11/2009 6/11/2009 m neck back, chills fever sweating. Dizzy, Y nausea, fatigue, muscle weakness. U 5/27/2009 5/29/2009 6/10/2009 /9/09, on 6/11/09 MOC called, stated pt. had red area back of rt. arm, size 1"x2", hurts a little, U not itchy 6/9/2009 6/11/2009 6/9/2009 se reactions previously d fever and a seizure afterwards. Was Y taken to the ER at medical center. Y 6/4/2009 6/5/2009 n and stated that 2 months after ZOSTAVAX, she was dx with shingles. Pt had never had shingles Y disease 3/24/2009 before. 6/1/2009 dema, tenderness, fatigue onset 15 hours after injection. Felt arm pain with movement 15 hours after injection. 6/8/2009 Unable 6/9/2009 to move arm withou
ite is reddened and raised. Circumference is approx. 2 inches in diameter. tenderness, nausea Y
U Y
6/9/2009 6/5/2009
6/6/1999
ough. Chicken pox 6-8-09 Lesions- neck- face. hands + arms. Y 5/28/2009 ng at menactra injection site within Y hours of administration. later same evening pt c/o heat swelling Y redness 6/12/2009 at site pt 6/12/2009 taken to care now dx was given Typhoid at 0915 on 06/06/2009. Y He had onset of localized pain and discomfort at site. Y Approximately 6/6/2009 1 hour 6/6/2009 later his pain spread pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 10/28/2008 with Pneumonia. Y Vaccination 9/22/2008 took place ### on 9/22/2008. Ac pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/21/2008 with atrial fibrillation. Y Vaccination 9/22/2008 took place ### on 9/22/2008 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2 3/26/2009 with vertigo Y and small bowel 6/13/2007 obstruction. 3/26/2009 Vaccination took th and 13th day after receiving the MMR, Client experienced fever (She didn't take her temperature),chils, Y 5/11/2009 sore throat 5/23/2009 and tiredness. These h after injection the patient woke upYwith loss of function in her left arm. Went to ER and for therapy. Y She 6/5/2008 was told it was 7/4/2008 nerve damage, un Was hospitalized with meningococcal meningitis Y and bacteremia. 6/24/09 3 Hospital ER records Y received DOS### 3/29/09. 3/28/2009 Assessment: Menin p given, employee experienced nausea, vomiting, dizziness, palpitations, pain @site. No swelling. Y 5/14/2009 5/14/2009 d smallpox vaccination on June 6, 2009, Y a Saturday. On the following Tuesday, his right armUstarted to hurt 6/6/2009 and gradually 6/9/2009 worsened. On Fr 10 p.m. - phone call from cl reporting he woke up at 3 a.m. this morning with severe muscle and joint pain6/2/2009 in shoulders, 6/3/2009 elbows and hips. E N 6/4/2009 6/5/2009 ollowing 1st gardasil injection patient reports muscle weakness or pain, non-progressing. Also N c/o fatigue. 3/25/2009 Medical records 4/27/2009 received DOS 5 len, Painful, warm to touch. Symptoms started one hr after administration and continued for Y 7 days. 6/10/2009 6/10/2009 as given Hepatitis A vaccine instead of Hepatitis B vaccine Y 6/16/2009 6/16/2009 am: Two days after vaccination, patient reported that site of injection was red, swollen and warm Y to the touch. 6/10/2009 Pt reported 6/12/2009 that size of area o l asleep on the car ride home (very unusual at that time of day). He then became feverish and Y fell asleep6/10/2009 for the night 6/10/2009 at 7:00--two hours af ot his vaccinations on Thursday Y morning. Y Then Y on Saturday night he2was sleeping, started vomiting, U when 5/21/2009 I went to 5/23/2009 clean him up he was sta reddened, swollen and painful some Y itchy. Mother stated notice swelling last evening 6/16/09 Y at about 8.00pm. 6/15/2009 Mother 6/15/2009 did not massage ar ccines on 6-5-09, and on 6-14-09 child began to have a rash that looked like clots on back, Y no drainage or 6/5/2009 raised areas. 6/14/2009 It is now everywhe es child has been seizure free sinceY8/08. Has had 10 seizures since start of rabies vaccine Y series - Has5/28/2009 2 doses left.6/1/2009 1st dose given here o en around 11am 6-12-09. Mom called Y around 2pm- patient crying, unable to console. Eft egYinjection site 6/12/2009 swollen, red. 6/12/2009 Advised to apply he a to injection site- Rt. leg (upper) started 9 days after vaccines. U 6/5/2009 6/13/2009 n has been received from a 63 year old female patient who was on 17-DEC-2008 vaccinatedNwith the first 2/18/2009 dose of GARDASIL 0.5 ML on bu n has been received from a 36 yearYold female patient who in 2006 was vaccinated with the Nthree doses4/25/2007 of GARDASIL. The patient was no n has been received from a nurse concerning her daughter a 14 year old female with amoxicillin Y allergy and 3/6/2008 no other3/6/2008 medical history who in G AND REDNESS ON RIGHT THIGH,LATERAL ASPECT MEASURING 55cm X 70cm. Y 6/10/2009 6/11/2009 Y Y N er had a seizure with vomiting. Date immunization Y given rash on back 1 and abdomen. No prior Y fever. 8/26/09 6/8/2009 Hospital 6/10/2009 records received DO 5/29/2009 N 5/27/2009 5/29/2009
### N ### ### mbness, tingling, burningYof feet, progressing Y toYcalves and near knees. 8 8 days hospitalization. Y N Immunoglobulin 10/1/2008 - 5 days. 12/6/2008 7/13/09 Hospital ep shot on 4-22-09. it was put in my right arm. still today it still hurts and has pain in it. neverUhad a problem 4/22/2009 until i got 4/23/2009 the shot. ng gardasil shots my daughter has complained of frequent headaches, hair loss, and joint pain. ous chills and pain in the left arm with Y swelling and muscle aches. Low grade fever. Large 4x6" U round, raised, 6/8/2009 indurated, 6/11/2009 red warm area aro as sore for the remainder of the day after receiving his 2 shots on 6/12/09. He refused to allow Y me to look, 6/12/2009 and thinking 6/13/2009 he was only sore (a urs after immunizations patient developed Y severe headache. At bedtime patient's mouth wasYdistorted to right 6/4/2009 and was 6/4/2009 numb and tingling. as administered vaccine. Patient then began to have a vasovagal syncope reaction. Patient was Y immediately 6/16/2009 given oxygen. 6/16/2009 Patient was lay after vaccine was given, onset of temperature Y to 102 axillary and diarrhea. Illness resolved inY3 days total. ### ### breath, extreme shortness Y of breath.Has Y never experienced this before. Rash on upper torso. U Patient crawled 3/26/2009 to front 3/28/2009 door and opened do ceived approx 8 hrslater edema andYitching at site. Returned to clinic approx 18 hrs later withY 3.5 x 3.5 cm 6/16/2009 warm, red, 6/16/2009 indurated itchy rather 4) reduced with acetaminophen, but resumed, red/warm/pain at injection site, arm is swollenYand slightly6/12/2009 hard/firm to6/12/2009 the touch. Left brachial neuritis after HPV/Gardasil vaccinations..History of Illness: 1/20/2009 Y - Presented N for initial 8/28/2008 evaluation by 8/31/2008 hand surgeon. By his GIVEN VACCINES BECAME DIZZY AFTERWARD FEET ELEVATED AND GIVEN COOKIE.YDIZZINESS6/17/2009 ABATED AFTER 6/17/2009 FIVE MINUTES veloped bacteremia without focus and tested positive Y for Neisseria meningitidis 2 from her blood. Y 6/24/092/13/2008 Hospital records 3/25/2009 received DOS 3/2 my Zostavax DS PWD #1 ON jANUARY 12, 2009. I feel fine 95% of the time. The other 5% U my shingles 1/12/2009 are on fire.2/1/2009 Kind of like a hot pok r, greater than 103F, axillary. Gave Tylenol Y and Advil with temp remaining elevated next dayUwhen grandparent 6/15/2009 placed 6/15/2009 call to vaccine admin d to wait immediately after vacine. Felt Y ok for a minute or so, got onto the elevator started toYfeel dizzy and 6/17/2009 blacked 6/17/2009 out and face planted in n: Had febrile illness within 24 hours for both vaccines. 1st episode required hospitalization.NDeveloped chronic ### headaches after 2000 dos n: diffuse puritic rash 2 days post anthrax, HBV, and meningococcal vaccines. Comment: Initial VAERS 5/25/2003 completed Oct 03. Symptom: Le n: Diffuse maculopapular rash of both Y UE/LE and trunk within 48 hours of anthrax #2 and yellow fever vaccines. 3/11/1999Symptom: Joint Pain, mu mpetent w/ past - MMR rash. Decreased Y WBC count 1.7, ANC700. Resolved within 1wk. Y 5/29/2009 5/31/2009 received spv, yellow fever, typhoid, and flu vaccines. Y On that day 29 after Y the vaccinations, gradually started to feel ###"exhausted ### and weak" - h n on 06-11-09. Began having an elevated temperature on 06-12-09. Also c/o headache, stomach Y ache,6/11/2009 + diarrhea.6/12/2009 Highest temperature w redness and swelling from injection site to approx. 1 inch of elbow. Client not c/o pain or discomfort. Y 6/15/2009 6/16/2009 and red reaction with induration approx. 10 cm in size less than 30 minutes following vaccination. Y These reactions 6/16/2009noted 6/16/2009 at VARIVAX vaccin a phone call from patient 6-9-09 stating c/o fever, headaches, generalized body aches and nausea hours after receiving Tdap on 6-8-09. d rash on face and upper body. Over in 3 days. Terribly itchy, hives, swelling right side eye-chin-collar Y bone. 6/10/2009 lethargic. 6/11/2009 Took benadryl on 9 grandmother presented to Health YUnit and reported that health care professional went to pediatrician Y today 6/9/2009 & was6/10/2009 sent to E.R. for "high f Y Y 6/15/2009 6/15/2009 accine #1, #2, #3- no problems. 10/06/03- received Y anthrax #4- along 10 with Hep A #2 and Hep U B #2- few 10/6/2003 weeks later ("by the ###end of Octobe seizure that evening after receiving vaccines in office. Dad report stiffening & shaking episode Y < 1 min while 2/17/2009 in highchair 2/17/2009 at restaurant. The Kinrix on 6/11/09, IM/L arm. Mom noted redness + swelling on 6/12/09, arm warm to touch Y in the upper6/11/2009 deltoid area; 6/12/2009 good ROM. Mom re Kinrix on 6/10/09 IM/Larm; mom noted redness + swelling on 6/11/09. No impaired ROM, c/o sore to touch; 6/10/2009 arm red, 6/11/2009 warm swollen from e received ANTHRAX vaccine #1 - no problems 2/27/04 Y - deployed to7foreign country 4/21/04 - received ANTHRAX 4/21/2004vaccine 4/22/2004 #2 and HEP B va e, fever, right hand swelling, arm, leg Y pain. N 6/12/2009 6/13/2009 n: 1/21/05- received primary FLUMIST- no problems. Y 1/23/05- "felt run 2 down". 1/24/05- c/o n/v, U diarrhea,1/21/2005 fever (temp 1/23/2005 not taken), chills and n not around injection site. Rxd Benadryl 25mg 1-2 a day LORATADINE 10mg 1 a day. Y 6/15/2009 6/16/2009 on site erythema, induration, tenderness lasting more than 1 month; worsening after each anthrax vaccination. Right sided axillary adenopa administered 06/10/09 at about 11am. By 2pm child began to scream uncontrollable until about Y 7pm. No6/10/2009 treatment necessary. 6/10/2009 Was adminis oke out on forehead, face and neck. Benadryl 12.5mg/ml given (PO). Y 6/17/2009 6/17/2009 , reproducible arthralgias after each anthrax vaccination. Currently stationed in Qatar. Joint Pain, multiple joints### Start: 5/22/2004 comment: received smallpox vaccine on his left upper arm Y (3 jabs)- denies any 2 problems. 08/27/04 - onset U 0600 while 8/27/2004 sleeping - bilat chest pain ("du tous, non-fluctuant, indurated area. Warm to touch, no exudate or focus of fluctuance or purulence. Y 6/15/2009 6/15/2009 urated, mildly erythematous lesion over deltoid Y 6/15/2009 6/16/2009 ction to vaccine Y 6/15/2009 6/17/2009 d - swollen, red AMOXICILLIN RX started w/DTAP. 6/15/2009 area of erythema/swelling (L) biceps, 2 by 2 cm area of erythema/swelling (R) bicep low grade Y fever x 24 6/15/2009 hours. 6/15/2009 , induration, swelling, itching left deltoid! - treated for cellulitis with Keflex. U 6/15/2009 6/15/2009 hly circular red/warm/itching raised Y patch surrounding injection site. Few clear vesicles (central ) noted started 6/15/2009 less 6/16/2009 than 24 hrs after injectio received anthrax vaccine #1 along with SPV- about a week later, noticed rash on left inner thigh- c/o moderate 1/31/2003 pruritus2/7/2003 was dx'ed with "poi
received from patient on 11/2/04 No problems with first three ANTHRAX vaccines 10/09/03 - received anthrax 11/1/2003 vaccine #4 (foreign country)ve L arm / shoulder pain with weakness. Medical records requested. Symptoms: Joint Pain, isolated start: 6/12/2003 6/12/2003 comment: left shoulde n: 2/3/05- received SPV (3 pokes, left upper arm) along with flu vaccine (right upper arm)- states U was "getting 2/8/2005 over a cold" (only sx= nasal c n: SM developed, N&V, HA, diarrhea about 72 hrs post anthrax vaccination #1, which recurred U with second 7/8/2007 anthrax in Sept. Symptom: Fati le, ADSM, presents as a referral from Y clinic for chest pain after smallpox vaccine. Symptoms:Y Chest pain,5/28/2009 fever, headache, 6/5/2009 general. n : progressive fatigue, cognitive loss, anhedonia, myalgias, arthralgias after each anthrax vaccine Comment: ### med records requested Sym n: This patient reports back pain, knee pain, headache, fatigue, memory loss, sleep disturbance, and hair 3/22/2003 loss since starting ANTHRAX vac n: Headache, arthralgias, memory loss, fatigue, visual change, fever after anthrax vaccine #2. Symptom: Head,### general; Symptom: Joint P ve, persistent bilateral shoulder pain, bilateral UE, numbness / fatigue, diffuse headaches failing to improve with ### NSAID'S muscle relaxants, n: Headache, Myalgias, UE/LE paresthesias worsening after each anthrax vaccine; SX beyond Y 30 days. Symptom: 2/2/2003 Headache, general star n has been received from a medical assistant (MA) concerning a 41-day-old patient who on U 08-Apr-2008 4/8/2008 was inadvertently 4/8/2008 vaccinated with n has been received from a health professional Y concerning a 3 year old male who on 29 OCT U 2007 was vaccinated ### with 0.5 ###ml, a second d n has been received from a physician Y concerning a male with obsessive-compulsive disorder N diagnosed7/23/2007 prior to vaccination on 23-JUL-200 n has been received from a registered nurse concerning a 1 week old infant who on 21-MAY-2008 U was vaccinated 5/21/2008 at 5/21/2008 the pediatrician's offic n has been received from a physician concerning a 11 year old male with no pertinent medical Y history or drug 7/1/2007 allergies who in July 2007, w n has been received from a consumer who is the mother of the patient, reported that her sonUwent in for his 2 month immunization shots an n has been received from a physician concerning a 2 year old male who on 24-JUN-2008 was N vaccinated 6/24/2008 with VAQTA 6/24/2008 vaccine, 0.5 ml, IM n has been received from a nurse concerning a male who was vaccinated with VAQTA. It was U reported that the patient developed hepatitis n has been received from a registered nurse concerning a 36 year old female patient who onU28-FEB-2008 2/28/2008 was vaccinated 2/28/2008 with an 0.5 mL n has been received from a consumer Y concerning Y a approximately 15 1 months old male with Y egg allergy,10/1/2007 peanut allergy 10/1/2007 and beef allergy wh n has been received from a nurse concerning Y a female with allergy to nuts who on 06-JAN-2006 Y was vaccinated 1/6/2006with1/6/2006 the first dose of VAQ n has been received from an office manager concerning a female who on 06-AUG-2008 wasUvaccinated with 8/6/2008 a dose 8/6/2008 of VAQTA. On 06-AUG n has been received from a registered Y nurse with no allergies or medical history who on 26-JUL-2004 U and 1/31/2005 on 31-JAN-2005 8/27/2008 was vaccinated n has been received from a physician concerning a 6 day old patient who was intended to receive U RECOBIVAX 10/3/2008 HB,10/3/2008 was inadvertently adm n has been received from a nurse practitioner concerning a female patient who was vaccinated U with a dose of VAQT. The patient showed n has been received from a physician Y concerning a patient who on 04-NOV-2008 was vaccinated N with VAQTA 11/4/2008 vaccine. Subsequently the p n has been received from a physician concerning a 14 year old female who on 19-JAN-2009Nwas vaccinated 1/19/2009 intramuscularly 1/19/2009with a first dos n has been received regarding a case Y in litigation concerning a 49 year old female who on 19-Nov-2007 N was vaccinated ### with ### first dose of h n has been received from a registered nurse concerning a patient's uncle who on an unspecified U date was vaccinated with MMR II. Subseq n has been received from a physician concerning Y a "very old" female 0 who was vaccinated with U MMR II. The patient recently received MMR n has been received from a physician Y concerning a 14-year-old male with type 1 Ydiabetes mellitus, Y no known 8/5/2008 drug allergies, 8/6/2008and a family hi n has been received from a physician concerning Y a 4 year old male 0with egg allergy and a history U of asthma 8/8/2008 who on 8/8/2008 08-AUG-2008 was vac n has been received from a consumer concerning Y her 32 year old daughter 0 who recently received U a booster dose for MMR II. It was reporte n has been received from a physician concerning a 5 year old female who received her first Y dose of MMR II at 15 months of age (approxim n has been received from Y a physician concerning Y his wife, who as a0child Y was vaccinated Y with Y MMR II. Subsequently the patient experienc n has been received from a consumer concerning her now 6 year old son with "family genetic N history (predisposition) 8/1/2003 8/1/2003 of motor skill problem n has been received from a medical assistant concerning an adult male who was vaccinatedUwith a dose of MMR II as a child. The patient h n has been received from a healthcare worker concerning a nurse regarding MMR II. The nurse U was cut on shattered vials of vaccine recei n has been received from a nurse practitioner concerning a 32 year old male who on 09-DEC2008 N was vaccinated 12/9/2008 with MMR ### II SQ, 0.5ml. n has been received from a consumer concerning her 12 month old son who was vaccinatedYwith a dose of MMR II (lot# not provided) 0.5m n has been received from a physician Y concerning a female with DEMEROL allergy, arthritis, Uosteoporosis,4/3/2006 hyperlipidaemia### and hypothyroid rmation has been received from a pharmacist and follow-up information was received from aUregistered nurse 3/12/2007 concerning 3/25/2008 a 34-year-old fem n has been received from a consumer Y concerning her daughter with no pertinent medical history N or drug8/10/2005 allergies who 3/29/2008 on 01-MAR-2001 an n has been received from a registered nurse concerning a 22 year female health worker withUno pertinent medical ### history 3/28/2008 who, on 16-Sep-1 n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a nurse practitioner (NP) concerning a 19 year old female, with noUprior medical conditions, who was vaccinated n has been received from a PharmD. Y concerning a 5-year-old male with an allergy to porcineY and bovine gelatin who in approximately 2006 n has been received from a pharmacist Y concerning a 19 year old female with a history of convulsions N in childhood ### who on### 19-NOV-2007 w n has been received from a 47 year old female pharmacist reporting on herself with an unknown N medical history and unknown drug allergie n has been received from a physician Y concerning a 1-year-old male with a history of stroke and N heart problems 4/10/2008 who4/10/2008 on 10-APR-2008 was n has been received from a physician Y concerning an approximately 28-year-old female with no medical history or allergies who as a child w
n has been received from a physician concerning a white male who, on an undisclosed date,Nwas vaccinated 8/17/2004 with a10/1/2004 second dose of MMR I n has been received from a physician Y concerning a 15 month old female no pertinent medical N history, drug 4/3/2008 reactions 4/15/2008 or allergies who on 03 n has been received from a registered nurse concerning a now 25 year old male medical student U who on 8/3/1995 10-Apr-2008 8/3/1995 was vaccinated with n has been received from a physician Y concerning a 12 month old male with no pertinent medical Y history, drug 4/3/2008 reactions 4/3/2008 or allergies who on n has been received from a registered nurse concerning a male with no pertinent medical history and no8/24/1999 drug reactions/allergies 4/1/2008 who on 09 n has been received from a physician concerning a 12 month old female who was vaccinated U with MMR II. Concomitant therapy included V n has been received from a physician Y concerning a 14 month old female with a history of urinary U tract infection 4/16/2008 and 4/22/2008 no known drug reaction n has been received from a health professional concerning an adult patient who was vaccinated U with MMR II as a child and had a negative n has been received from a health professional Y concerning a 15 month old female with a penicillin Y allergy 1/31/2008 who on 31-JAN-2008 2/11/2008 was vaccin n has been received from a physician Y concerning a patient who was vaccinated with 2 dosesUof MMR II. Subsequently, 9/2/2003 3/7/2008 the patient develop n has been received from a registered nurse concerning a female allergic to porcine who "atU5 years of age", in approximately 2001, was va n has been received from a pharmacist concerning a female who in the past was vaccinatedUwith a dose of MMR II. Subsequently the patie n has been received from a physician Y concerning a 12 month old male who, in February 2008, Y was vaccinated 2/1/2008 with MMR 2/1/2008 II. Concomitant th n has been received from a physician concerning a patient who on 01-MAY-2008 was vaccinated U with a second 5/1/2008 dose5/1/2008 of MMR II. Concomit n has been received from a registered nurse concerning an approximately 27 year old male N consumer with no known allergies or pertinent n has been received from a consumer concerning a 12-month-old male who, on an unknownNdate, was vaccinated subcutaneous with 0.5 m n has been received from a health professional Y concerning a 5 year old female on 06-MAY-2008 U was vaccinated 5/6/2008with5/6/2008 MMR II (lot number 6 n has been received from a physician Y concerning a 4 year old female, with no pertinent medical N history, 4/25/2008 drug reactions 5/4/2008 or allergies who on n has been received from a pharmacist concerning an approximately 30 year old female whoU was vaccinated with her second dose of MMR n has been received from a physician concerning a 24 month old female who was vaccinated U with MMR. Concomitant therapy included VA n has been received from a physician concerning a 5 year old female who was vaccinated with U MMR II. Suspect therapy included VARIVAX n has been received from a licensed Y practical nurse concerning a 5 year old female with no U pertinent medical 4/25/2008 history or drug allergies who, n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a physician Y concerning a 12 month old female who, in February 2008, Y was vaccinated 2/1/2008with2/1/2008 MMR II. Concomitant n has been received from a consumer concerning her male son with allergies to eggs, soy, wheat, U mustard, peaches, maple syrup, milk, sh n has been received from a health professional Y concerning a 51 year old female with drug allergies N to penicillin, 2/11/2008 iodine 4/23/2008 and Acetaminophen n has been received from a NP concerning Y a male with no known medical history or allergiesU who on 07-MAY-2008 5/7/2008 5/20/2008 was vaccinated sc with n has been received from a physician concerning a 9 year old male patient who in 2003 wasUvaccinated with 1/1/2003 a second 5/22/2008 dose of MMR II (Me n has been received from a nurse practitioner concerning a 13 month old female with no pertinent N medical 4/28/2008 history or4/28/2008 drug allergies who on n has been received from a pharmacist concerning a patient (age, gender unspecified) who U thought the patient was vaccinated with a dose n has been received from a physician Y concerning a 4 year old male child who on 25-FEB-2008 U was vaccinated 2/25/2008 with4/12/2008 a second dose of MMR n has been received from a physician concerning an "approximately 12 or 13 month old" male Y child with egg 5/1/2008 allergy, 5/1/2008 "very allergic and atop n has been received from a health professional Y concerning a 9 year old male who sometimeUin 2000 was 6/9/2008 vaccinated6/9/2008 with his first dose of M n has been received from a physician concerning a 26 month old female patient who was vaccinated U with a dose of MMR II vaccine and th n has been received from a physician Y concerning her "approximately 2 year old" son who onUan unspecified date was vaccinated with MMR n has been received from a licensed Y practical nurse concerning a male patient with sulfa eyeNdrop hypersensitivity 8/1/1991 and 6/2/2008 a history of migraine n has been received from a health professional concerning an adult patient who was vaccinated U with MMR 1/1/2007 II as a child 1/1/2007 and had a negative n has been received from a health professional concerning an adult patient who was vaccinated U with MMR 1/1/2007 II vaccine1/1/2007 as a child and had a n n has been received from a registered nurse concerning a patient who on 17-JUN-2008 wasUvaccinated IM 6/1/2008 instead 6/16/2008 of SC with a dose of MM n has been received from a physician Y concerning a 4 year old female patient who was vaccinated U with a dose 7/3/2005 of MMR II at 16 months of ag n has been received from a medicalYassistant concerning a 21 month old female child with no Y known allergies, 6/10/2008 or pertinent 6/23/2008 medical history n has been received from an office Y manager concerning a 12 month old male child with no known Y allergies, 6/10/2008 benign 6/14/2008 heart murmur and ecze ported that her daughter experienced fever about 7 days after vaccination with her first doseYof MMR II, injection, when the child was 3 and n has been received from a physician concerning a 19 year old female with penicillin allergyNand AUGMENTIN allergy who had two doses o n has been received from a physician concerning a 13 month old female old female with portNwine naevus 6/23/2008 and sensitivity 6/23/2008 to OMNICEF who n has been received from a nurse practitioner concerning a 4 year old female with a history U of eczema who 9/4/2004 on 04-SEP-2004 was vaccinate n has been received from a health professional Y and healthcare worker concerning a 21 yearUold female who 11/1/1996 on 01-NOV-1996 was vaccina n has been received from a physician Y concerning a female patient with an "autoimmune disease" Y who on 1/5/1998 an unspecified 2/1/2008 date was vaccinat n has been received from a registered Y nurse concerning a 50 year old female employee withYpenicillin and 6/6/2008 codeine allergies 6/8/2008and an unspec n has been received from a physician concerning a 15 month old male patient who in approximately Y July 7/1/2003 2003, was vaccinated 7/1/2003 with a first d
n has been received from a registered Y nurse concerning a 42 year old female patient who onUan unspecified date was vaccinated with MMR n has been received from a medical assistant concerning a female who (on an unreported date) U was vaccinated with7/1/2008 MMR II (Lot # not rep n has been received from a licensed practical nurse concerning a male patient with no known U allergies or pertinent medical history who on n has been received from a pharmacist concerning a patient who received her primary series U received a third dose of MMR II about four ye follow-up information has been received Y from a physician concerning a 4 year old female patient Y with a protease 7/23/2008sensitivity 7/24/2008 and no pertinen n has been received from a CMA and physician's assistant concerning a 38 year old female Nsmoker with6/17/2008 hypertension, penicillin allergy, co n has been received from a pharmacist concerning a pregnant female who is "due any day now" N that was vaccinated with MMR II and is te n has been received from a physician Y concerning a female patient in her "mid 40's" with no allergies N or pertinent 7/7/2008 medical 7/19/2008 history who on 07 n has been received from a consumer Y concerning his adult wife, who was undergoing fertilityUtreatments, whom he believes was vaccinated n has been received from a physician Y concerning a female who has negative titers for Rubella U after she was already given 2 doses of MMR n has been received from a physician concerning a 33 year old male, affiliated with another U unspecified 7/29/2008 practice, who 7/29/2008 on 29-JUL-2008 was n has been received from a pharmacist Y concerning a 46 year old female who on approximately N 19-JUL-2008, 7/19/2008 "about 7/19/2008 3 weeks ago" was vac n has been received from a physician concerning a 5 year old male patient with congenital heart Y disease who was vaccinated at an unspec n has been received from a physician Y concerning a 55 year old female with a history of breast N cancer who 7/29/2008 on approximately 8/7/200829-JUL-2008 w n has been received from a healthcare worker concerning a 1 year old female who, on 06-JUL-2008, U was6/6/2008 vaccinated with MMR II (lot numb n has been received from a certifiedYmedical assistant concerning a 22 year old male who on U an unspecified date ###was 7/1/2008 vaccinated with a fir n has been received from a registered nurse concerning a 45 year old male who on 31-JUL-2008 N was vaccinated 7/31/2008SQ8/3/2008 with the first dose of n has been received from a physician concerning a 4 year old female with no medical historyUwho, in 2004, 7/23/2008 was vaccinated 7/31/2008 with a first dose n has been received from a pharmacist concerning a "post menopausal" female volunteer atUher facility who was vaccinated as a child with follow up information has been received from a mother concerning her son with a history of N premature birth 10/8/2007 who on 08-OCT-2007 ### was vac n has been received from a female Y consumer with penicillin, naproxen and ezetimibe (MSD)Nallergies who "14 years ago" in 1994 was vacc n has been received from a 30 year old female with a history of adhesions in 1997 who on 17-JUL-2008 N 7/17/2008 was vaccinated 7/17/2008 with MMR II (lot# n n has been received from a medial Y assistant concerning a 4 year old male who received theNsecond dose8/4/2008 of MMR II 8/6/2008 (rHA) (Lot # 655380/13 n has been received from a medicalYassistant concerning a 5 year old male patient with no known Y allergies 8/12/2008 or pertinent 8/14/2008 medical history who n has been received from a physician Y concerning a 12 month old female with no medical history N or allergies, 8/5/2008 who on8/15/2008 05-AUG-2008 was va n has been received from a patient's mother concerning a 5 year old female with peanut oil allergy U who in approximately 2006 was vaccina n has been received from a certifiedYmedical assistant concerning an 18 month old male, who Y is otherwise 7/23/2008 healthy, 7/30/2008 who on 23-JUL-2008 at n has been received from a female nursing student who was vaccinated in the past (unsure U of how many doses she was given) with MMR n has been received from a registered Y nurse concerning a 36 year old female with drug reaction U to NORGESIC 8/4/2008 FORTE 7/30/2008 which causes naus n has been received from a consumer concerning a female child who was vaccinated with aUdose of MMR II on an unspecified date. Subse n has been received from a consumer concerning a male child who was vaccinated with a dose U of MMR II on an unspecified date. Subsequ n has been received from a consumer via the internet concerning her healthy toddler child who U on an unspecified date was vaccinated with n has been received from a physician Y concerning Y a now 29 year old female Y patient, who in 1980, Y at age one 1/1/1980 was vaccinated 1/1/1980with the first d n has been received from a physician Y concerning an approximately 5 year old female who inUNovember 11/1/2007 2007 (when 6/1/2008 she was 4 years old), n has been received from a physician concerning a male who on 26-AUG-2008 was vaccinated U with the8/26/2008 first dose of8/26/2008 MMR II. Suspect thera n has been received from a physician concerning a male who was vaccinated with MMR II. The Y patient developed erythema after getting M n has been received from a nurse atY a health department concerning a 39 year old male, who Y on 17-JUL-2008, 7/17/2008 was8/10/2008 vaccinated with MMR n has been received from a nurse concerning Y a male with no known allergies and reported no U pertinent medical history who was vaccinate n has been received from a physician concerning a 23 year old male with no known allergiesUor medical history who 6/6/2006 in approximately 1986 n has been received from a consumer Y concerning a 14 year old female who was vaccinatedYwith a dose of MMR II when the patient was a n has been received from a physician concerning a 12 month old male with a history of kidney Y transplant7/30/2008 waiting list, 7/31/2008 feeding tube, congeni n has been received from a patient's mother concerning her 7.5 year old daughter with no allergies U or pertinent 9/26/2005 medical 8/1/2008 history who was va n has been received from a nurse concerning Y an adult female who on 29-AUG-2008 was vaccinated N with 8/29/2008 a booster9/10/2008 dose of MMR II. On 10 n has been received from a nurse concerning a 42 year old male with allergy to Prozac whoNreceived dose 1/2/2008 1 of MMR 8/18/2008 II as a child tested ne n has been received from a registered Y nurse (RN) concerning a 30 year old female with no allergies U or medical history 9/5/2008 who was vaccinated n has been received from a pharmacy student concerning a 48 year old female with drug reactions/allergies N 6/1/2008 to NSAIDS, lidocaine, morphin n has been received from a consumer concerning her 35 year old son who received MMR IIUwhen he was a young child. It was reported tha n has been received from a registered nurse concerning a 36 year old female who has received U two doses 9/18/2008 of MMR9/18/2008 II in the past (date not r n has been received from a consumer, who is a nurse, concerning her 15 month old male son Y with no medical 9/9/2008 history 9/10/2008 or allergies who on 0 n has been received from a certified medical assistant (CMA) concerning a 5 year old male who N around the 8/1/2008 second9/25/2008 or third week of August n has been received from a physician concerning a 19.5 year old female patient with penicillin N and AUGMENTIN allergy who had two dose
n has been received from a pharmacy Y student concerning a 4 year old male who on 23-SEP-2008 U was vaccinated 9/23/2008 with 9/23/2008 MMR II (lot # 66179 n has been received from a consumer Y concerning her 3 year old son with no pertinent medical Y history or8/27/2008 allergies who 9/3/2008 on 27-AUG-2008 wa n has been received from a licensed practical nurse concerning a 34 year old pregnant female U with seasonal 7/30/2008 allergy8/15/2008 and thyroid disorder b n has been received from a physician concerning a male patient with no medical history andUno drug reactions/allergies who on an unspeci n has been received from a nurse at a physician's office that a "12 month old" patient with noU medical history, 10/3/2008 received a dose ### of MMR II, in n has been received from a physician Y concerning a 12-month-old female who in September N 2008, was vaccinated 9/1/2008 with 9/1/2008 MMR II, Hep A (ma n has been received from a pharmacist concerning a patient who was vaccinated with MMRUII. It was reported that the patient was given M n has been received from a consumer concerning her older son who on an unspecified dateUwas vaccinated with a dose of MMR II (lot num n has been received from a 31 year old female licensed practical nurse with no medical history N or allergies who on an unspecified date whe n has been received from a consumer Y concerning a 1 year old female who on 10-OCT-2008Nwas vaccinated via ### injection with ### MMR II. Seco n has been received from a consumer concerning his son who was vaccinated with a dose of U MMR II. Subsequently the patient developed n has been received from a nurse concerning Y a male who was vaccinated with both doses ofY MMR II and 4/13/2006 subsequently, the ###patient develop n has been received from a patient who was vaccinated with MMR II (route and site not reported). U The patient had a previous experience w n has been received from a patient's Y mother concerning her 15 month old son with hypersensitivity Y to Amoxicillin 1/31/2006who 2/15/2006 on 31-JAN-2006 was n has been received from a nurse concerning Y a patient who in 2007 was vaccinated with a dose U of MMR II, RECOMBIVAX HB (MSD) (lot # n has been received from a nurse practitioner Y concerning a 31 year old female student with Y depression and 9/26/2008 no drug10/7/2008 reaction or allergy who n has been received from a nurse concerning Y a female patient who on 24-DEC-1999 was vaccinated N with a dose ###of MMR II (lot #625634/0 n has been received from a registered Y nurse concerning a male adult patient who on 20-NOV-2007 U was vaccinated ### subcutaneously with a n has been received from a Doctor Y of pharmacy concerning an adult female patient who in September N 2008 9/1/2008 was vaccinated with a dose of n has been received from a registered nurse concerning a 4 year old female with no medicalNhistory who on 10-NOV-2008 ### ### was vaccinated n has been received from a consumer concerning her child with a history of anaphylactic reaction U to latex who on an unspecified date was n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof MMR II "years ago". It was reported that the n has been received from a certified medical assistant concerning an unidentified patient who U on unspecified date in the past "may" have b n has been received from a physician Y concerning a 5 year old "healthy" female with a historyYof skin irritation at### injection site ###(onset 24-OCT n has been received from a pharmacist concerning a patient who was vaccinated with MMRII. U The pharmacist reported that the patient exp n has been received from a caller concerning a 14 year old male patient with allergy to GEODON N and a 12/3/2008 history of slight 12/3/2008 emotional difficultie n has been received from an adult female Y consumer who in her childhood was vaccinated with U a dose MMR II. In approximately 1/1/2009 January 20 n has been received from a consumer concerning her a 36 month old son who, "probable when Y he was 18 7/1/2007 months to 2 1/2 years old", was n has been received from a consumer concerning her son, a 12 month old male with allergies Y to formaldehyde 1/10/2006 and 1/11/2006 fragrance mix and histo n has been received from an office Y manager concerning a 14 month old female who on 13-JAN-2009 Y was 1/13/2009 vaccinated 1/13/2009 with a dose of MMR n has been received from a registered nurse who on 14-JAN-2009 was administering MMR N II and some vaccine splashed 1/14/2009 into her eyes. Th n has been received from a physician Y concerning a patient who "several months ago" was vaccinated Y with a dose of MMR II (lot# not provi n has been received from a registered Y nurse concerning a 30 year old male patient with no pertinent U medical history and no drug reactions n has been received from a consumer concerning her son with reaction to all vaccines and medications Y he 5/7/2001 has received 5/7/2001 that contain gelatin n has been received from a medical assistant concerning an 18 year old female who in approximately U 1991, "when ### she was 1 year of age" n has been received from a physician concerning a 5 year old male with drug reaction to flu Y shot a year ago who on12/1/2008 unspecified date was v n has been received from a nurse practitioner concerning a now adult male who was, on unspecified U date, vaccinated with 2 doses of MMR n has been received from a nurse practitioner Y concerning a now 36 years old male who on unspecified U dates was vaccinated with two dose n has been received from a consumer concerning his 9 year old son with attention deficit disorder U (ADD) diagnosed when he was very you n has been received from a consumer concerning her 4 year old daughter with no medical history Y and drug 1/19/2009 allergies1/26/2009 who on 19-JAN-2009 n has been received from a nurse concerning an approximately 28 year old male student who U was possibly vaccinated with MMR II and ha n has been received from a physician concerning a 5 year old patient who on an unknown date U was vaccinated with the second dose of MM n has been received from a registered Y nurse concerning a 35 year old female with problemsUwith fertility11/5/2008 and a miscarriage### in July 2007 and n has been received from a consumer concerning her son who was vaccinated with MMR II.USubsequently the patient experienced severe n has been received from a consumer concerning his daughter who was vaccinated with MMR U II. The consumer reported that the patient h n has been received from a Registered Y Nurse concerning a patient who was vaccinated withUall three doses of MMR II. The patient's antibo n has been received from a consumer concerning her four and a half year old son with no pertinent Y medical 8/1/2005 history and no known allergies n has been received from a consumer whose husband on an unspecified date was vaccinated U with MMR II and had reactions like fever and n has been received from a physician Y concerning an approximately 12 month old (reported as U "1 year of age") 2/6/2009 patient who on approximate n has been received from a licensed visiting nurse concerning a 30 month old male patient with Y a history2/13/2009 of jaundice2/13/2009 at 3 weeks old who on n has been viewed on the internet concerning a 15 month old female who was vaccinated with U a dose of MMR II. Concomitant vaccination
n has been received from a registered Y nurse concerning a 27 year old female who in 1981 was U vaccinated 9/10/1981 with a first dose of MMR II, in 19 n has been received from a consumer concerning her now a 5 years old son who in approximately Y 2005 ("when he was 1 year old") was va n has been received from a healthcare Y worker concerning a 30 year old male who was vaccinated U with a dose of MMR II when he was a ch n has been received from a registered Y nurse (R.N.) concerning an 8 year old male with 1 sibling Y who on 6/29/2001 29-JUN-2001 2/2/2009 was vaccinated subc n has been received from a consumer concerning his 6 year old son who on an unknown dates U was vaccinated with both doses of MMR II. n has been received from a consumer, Y who is the uncle of the approximately 24 months old N male patient with no previous medical history w n has been receive from a registered Y nurse concerning of himself a 27 year old male with sulfonamide U allergy 8/9/1982 who in 1983 was vaccinated umer reported that 10 years ago, in 1999 her son had a very severe reaction. He experienced Y a seizure and a high fever. The consumer sta n has been received from a health care worker concerning himself. It was reported that in 1947 U the patient was vaccinated with 2 doses of n has been received from a consumer concerning her 8 year old son who was vaccinated with U a dose of MMR II. It was reported that the pa n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with MMR II. It was reported that he n has been received from a registered nurse concerning her daughter with frequently injection Y site reaction after unspecified vaccination wh n has been received from a licensed practical nurse concerning a female with no medical history U or drug allergies 9/1/1983who was vaccinated with n has been received from a nurse practitioner concerning a 12 month old female who on 19-FEB-2009 N was 2/19/2009 vaccinated 2/23/2009 with a dose of MMR n has been received from a nurse practitioner concerning a female infant with allergies to seafood Y and shellfish who was vaccinated with a n has been received from a physician Y and a nurse concerning a 13 month old female who on N 23-FEB-2009 2/23/2009 was vaccinated 3/4/2009 with MMR II. Th n has been received from a consumer concerning her now 4 year old son with an intolerance N to gluten and 1/1/2006 a history 1/1/2006 of "GI Issues" who "wh n has been received from a nurse practitioner concerning a female who on an unspecified date U was vaccinated with a dose of MMR II (dos n has been received from a patient concerning his wife who on an unspecified date, was vaccinated U with a dose of MMR II vaccine. The re n has been received from a consumer concerning her now 15 year old daughter who was vaccinated Y with "one dose" of a MMR II "when sh n has been received from a case inYlitigation for WAES #0610USA022225 from a physician U via medical records concerning a 55 year old fe n has been received from a consumer concerning her 12 month old daughter with no pertinent Y medical history 12/1/2008 or drug 12/1/2008 reactions or allergies n has been received from a consumer concerning her 10 year old son who on an unspecified Y date was vaccinated with a dose of MMR II (L n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with a dose of MMR II. It was report n has been received form a consumer concerning her 5 year old daughter with no pertinent Y medical history 8/1/2005 and no drug 8/1/2005 reactions or allergi n has been received from a physician Y concerning a 12 month old male with no pertinent medical N history 2/25/2009 and no drug3/13/2009 reactions or allergies w n has been received from a consumer concerning her 12 month old son who was vaccinatedNwith a dose of MMR II. Concomitant therapy i n has been received from a consumer concerning her daughter 4 years old who at 15 months U old (2005) was vaccinated with a dose of MM n has been received from a consumer Y concerning her 6 year old son who on an unknown date N was vaccinated with the first dose of MMR I n has been received from a consumer concerning herself (a "37 year old" female) with food N allergies who received MMR II series as a child n has been received from a physician concerning a male patient with unknown drug reactions U and asthma who was vaccinated with a seco n has been received from a pharmacist concerning a patient who was vaccinated with a dose U of MMR II on an unspecified date. Subseque n has been received from a Physician Assistant concerning an 8 week old patient who on 20-MAR-2009 U 3/20/2009 was vaccinated 3/20/2009 with MMR II due t n has been received from a consumer concerning her approximate 14 month old daughter with N no drug allergy 3/31/1999 who on 31-MAR-1999 was v n has been received from a consumer Y concerning a friend's 19 month old daughter "who went Y to the emergency room 1/1/2009 with a 105 degree fe n has been received from medical assistant Y concerning a 35 year old female with asthma, seasonal N allergy 8/28/2008 and tetracycline 3/16/2009 and erythromy n has been received form a consumer via e-mail, who was vaccinated with a dose of MMR IIU(lot# not reported), on 5 different occasions an n has been received from a Registered Nurse concerning a 47 year old male with benign prostatic U hyperplasia 2/20/2009 and no drug allergies who o n has been received from a consumer concerning a male who on an unspecified date was vaccinated U with a dose of MMR II (dose, route a n has been received from a Registered Y Nurse (R.N) concerning her 4 year old son with no pertinent N medical 2/1/2006 history and 2/1/2006 no known drug alle n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. It was repor n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. it was repor n has been received from parents via e-mail concerning their son who was vaccinated with aUdose of MMR II on an unspecified date. The p n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with MMR II. The consumer reporte n has been received from a medical assistant concerning a 13 month old male who on 17-MAR-2009 Y was 3/17/2009 vaccinated 3/17/2009 with MMR II (lot # 66 n has been received from a female consumer who was vaccinated with a dose of MMR II (HSA) U over 20 years ago. Over 20 years ago the n has been received from Y a physician Y concerning a female patient who was vaccinated Y with NGARDASIL. The patient received the first dose n has been received from Y a registered Y nurse (R.N.) Y concerning her daughter nowY18 year old, Y with drug hypersensitivity 6/1/1998 7/1/2008 to PHENERGAN w was received on 09-June-2009 from Y a consumer. A male patient of unknown age received the N following vaccination 6/1/2009 on 6/9/2009 01-June-2009: sma ort was received 11 June 2009 fromYa health care professional. A 35-year-old female patient with a history of chronic hepatitis B had receiv ENTED TO MEDICAL C/O RASH AND SWELLING X 1 DAY. PT STATES THAT RASH STARTED Y APPROXIMATELY 3/18/2009 3/18/2009 5 HRS AFTER HE R
Y 6/16/2009 6/17/2009 oke out with shingles in his eye and Yon scalp 102 weeks after receiving vaccine. Y 6/5/2007 4/22/2009 ceived pneumococcal vaccine on 5/13/09. Y On 5/14/09, developed pain, redness, warmth, erythema Y at injection 5/13/2009 site.5/14/2009 WBC elevated at 11.8 Fainting episodes x2 after vaccinesYgiven. Recovered x1 after glass of water given. Second Y time it was6/17/2009 difficult to 6/17/2009 wake her, shallow breat 6/17/2009 6/18/2009 d vaccine 9/11/08 and became pregnant Y in 2/09. She then had a fetus that "was not thriving"Y and she had 9/11/2008 a D&C done 5/26/2009 5/26/09. Please no ted to our office on 6/18/09 with left Ysided rash. Rash began one day after varivax was administered in the6/9/2009 left arm. 6/10/2009 Rash is present on the after vaccine patient complained to parents Y that her R arm was hot and redness and swellingNwere noted.6/15/2009 She was given 6/16/2009 Ibuprofen and col accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 6/4/2009 hroat 10 minutes after the injection Y got dry and felt like an object was in it, and his left arm atYthe shoulder 6/18/2009 felt like it 6/18/2009 was numb. Had a little h d papule rash and itching face,upper and lower body. I took the vaccine 2/24/09, but since then N as a RN I2/24/2009 have administered 6/17/2009at least 30-40 accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/1/2009 No harm 6/1/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/1/2009 No harm 6/1/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. No harm done to patient. ng of continued pain and soreness in the muscle of the left arm in the deltoid region. Pain with deep palpation 6/7/2009 of the6/18/2009 lymph nodes under the sters on lt arm where varicella vaccine Y was placed. Pt also has erythema/induration of 4cm xY5cm surrounding 6/16/2009 area6/16/2009 where varicella vaccine have the following symptoms about 3 hours following the shot: high Fever, Hallucinations, soreness, Y joint 7/20/2006 pain, aches 7/20/2006 and fatigue. Once th alled stating that he was running a fever up to 101 on day 10 of small pox vaccine and was complaining Y of6/7/2009 discomfort 6/17/2009 under the arms from mergency room twenty-four hours after Y vaccinesY were administered with 1 apenic spells and cyanotic U episodes, 5/22/2009 along 5/23/2009 with fever. 7/7/09 Hosp accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. as entered into the electronic medical record as a female. The nurse gave the patient an HPV Y as indicated 5/4/2009 for female patients. Upon return lls, muscle aches, sore joints, swollen glands, headache, fatigue all started the day after the Yvaccines were 6/16/2009 given. Patient 6/17/2009 had to leave work , body aches, blotchy redness, and severe swelling Y to right upper arm 2 especially near & surrounding N PPSV 6/15/2009 injection6/17/2009 site. 7/2/09 Hospital r walk 5 hours after shot was given. Limped Y on leg where shot was given. Gave tylenol and was Y able to walk 6/17/2009 again after 6/18/2009 2 hours. Expected th dministered, vaccine 2 weeks out of date; No adverse event observed in patient. 6/16/2009 sted that these side-effects be reported. DTAP given at Left Deltoid (IM). Mother reported Left Y arm red, sore, 6/15/2009 had hard 6/17/2009 knot, and warm to to ollen, red, + bump Dxper Dr L leg cellulitis Y vaccine Rxn. Y 6/16/2009 6/17/2009 igh with induration, red 4x4 cm. U 6/16/2009 6/17/2009 OC onset about 10 minutes post injection with 10-15 seconds tonic posturing. Patient recovered Y consciousness 6/18/2009 in less 6/18/2009 than 30 seconds - B arm pain and swelling. Noted arm, area red slight swelling confined to injection site, size of U .50 cents piece. 6/15/2009 Able to6/16/2009 move extremity well. S Y Y 9/23/2008 10/7/2008 and swelling onset 1 day after immunization given. 2/24/2009 2/28/2009 given left Deltoid on 2-7-09 On 2-9-09 pt had small welt at site. On 2-10-09 it had increasedUin size to 4.5"2/7/2009 X 3" with warmth 2/9/2009& swelling at th 01 degrees, - fever at 5:00 p.m day of vaccine given 2/11/09. Next morning 2/12/09 arm very Y sore at site2/11/2009 and hand 2/11/2009 swollen. Had rings cute as in her car seat, after grandparents Y had come out of the grocery store. Grandparents noted Y child was twitching. 12/3/2008 Unresponsive ### & had som n has been received from parents, aY physician Yand a medical assistant 2 concerning a 19 yearUold female 2/20/2009 with anxiety, 2/20/2009 depression, asthma, t ay of vaccine 17 hr HA and arm hurt at injection. Took EXCEDRIN - no relief. No redness at injection U site.6/10/2009 Pain L arm 6/10/2009 with movement at inje and ZOSTAVAX on 5/4/09. Y He started experiencing Y numbness/tingling Y (R) feet and hand with U weakness 5/4/2009 one week5/15/2009 later which has been p nutes of injections, pt became acutely droopy, nauseated and vomited profusely. He was flushed Y and sweating. 6/17/2009 3x4 6/17/2009 cm. Wheal at site of VA ns (seizures) approx. 1 day after shots. 6/26/09 Y Received hospital medical 1 records for 6/18-6/19/2009 U admit. 6/15/2009 FINAL6/16/2009 DX: seizure-like spells ching and drooling Y N 6/3/2009 6/15/2009 ter injection. No adverse affects. Y 5/28/2009 5/28/2009 d, swollen red lesion on Rt, posterior Y upper arm. U 6/16/2009 6/17/2009 er 4 month shots, developed raisedYrash all over body. Change in personality -> lethargic, decrease N in babbling 3/12/2009 and3/14/2009 cooing, screaming, dec LA complications: None - mild illness with rash, no fever 6/19/2002 6/10/2009 aria. ZYRTEC. N 5/6/2009 5/8/2009 d Tdap @ 9:30 am on 6/10/09. At 12 00 pm on 6/11/09 pt developed nausea. Had to lie down Y for 15 hrs6/10/2009 and fell asleep. 6/11/2009 Woke up 3am on 6 oid where Tdap administered on 6/6/09 became indurated, erythematous, swollen, warm, painful. Y On Monday 6/6/2009 6/8 patient 6/6/2009 seen in office and nt received DTaP vaccine IM in left thigh on 6/10/09. Patient was seen in the office on 06/12/09 U with a 3 6/10/2009 cm x 3 cm irregular 6/11/2009 area of redness ticed the injection site was red and swollen Y on 6/16/09, mother marked the swelling with a pen U and over 6/15/2009 the course of 2 days it was increas nting episodes with 1st dose of GARDASIL on 4/7/09. With this 2nd GARDASIL & within seconds Y pt. got6/15/2009 pale, as she 6/15/2009 was laying down her
Y Y 5/22/2009 5/23/2009 me to IMMs complaining of redness rash, itching and soreness under arm of ACAM2000 vaccination site.5/5/2009 me to IMMS complaining of rash, redness, and itching at and around ACAM2000 vaccination site. 5/5/2009 eported "it looked like hives all over"Y - Rash-1wk- after MMR II, VARIVAX, HAVRIX given. Red Y itchy papules 3/18/2009 2mm-1cm 3/28/2009 varying site and loc 7, 2009, I noticed a rash on my back Y (right side). Two days later, the rash was spreading with U blisters and 3/5/2009 itching. Saw 3/7/2009 doctor, confirmed ES EVERY TIME HE RECEIVES ANTHRAX VACCINE SINCE 1999, HE SUFFERS TEMPORARY Y MEMORY 7/11/2008 LOSS. 7/12/2008 HE RECEIVED 5 SER given at about 12:15 PM June 16. Headache began immediately upon leaving the clinic. At 10:00 Y PM her 6/16/2009 R arm began 6/16/2009 significant muscle tw n has been received from a nurse practitioner, for the pregnancy Registry for VARIVAX (Merck), U concerning 7/3/2008 a 25 year 7/3/2008 old female with a his n has been received from a nurse concerning Y a 31 year old male with anaemia macrocytic, Y aNhistory of immune 6/8/2009 thrombocytopenic 6/9/2009 purpura n has been received from a pharmacist Y concerning a 48 year old female who on 08-JUN-2009 Y was vaccinated 6/8/2009 with a6/9/2009 dose of PNEUMOVA n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e n has been received from a consumer concerning his 5 year old son who on 01-JUN-2009 was Y vaccinated 6/1/2009 with a second 6/8/2009 dose of MMR II 0 n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e n has been received from a physician Y for the Pregnancy Registry for GARDASIL concerningYa 22 year old 11/8/2007 female who 11/8/2007 on 06-SEP-2007 wa n has been received through the Merck pregnancy registry for GARDASIL from a registeredYnurse concerning ### a female 2/1/2009 patient who on 17-J n has been received from a physician who heard from the mother of one of his patients that U she was told by a pediatric rheumatologist that n has been received from a 25 yearYold femaleYwith a history of overgrowth 0 bacterial and "ZIPORO" N (therapy 3/1/2009 unspecified) 3/1/2009 allergy who in Ma n has been received from a Registered Pharmacist Y (R. Ph.) concerning 0 a 96 year old femaleUwho was vaccinated subcutaneously with a 0. n has been received from Y a medicalYassistant concerning a 11 week old male patient with oxygen Y therapy 6/12/2009 since birth 6/12/2009 and a history of prem ving client home. Client c/o not feeling well, became hot, eyes rolled back and head went down. Y Mother6/18/2009 called the6/18/2009 EMS. When the squad accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. her called clinic on 6/19/09 after child received third dose of the HPV vaccine on 6/17/09. Per U Grandma,6/17/2009 the child had 6/18/2009 no immediate proble o upper right arm noted that evening . Continued to spread and covered entire upper arm. TxY cool cloths, 6/15/2009 tylenol for 6/15/2009 discomfort. At presen nd swelling at site of vaccination in right arm that started on the day of vaccination. U 6/16/2009 6/16/2009 ness and swelling on site. Tender and Y hard subcutaneous tissue. No other symptoms. Prescribed U Motrin 6/15/2009 and told to 6/15/2009 soak area in warm wate ability, muscle/joint aches, headache, diarrhea X4 days U 6/15/2009 6/16/2009 U 6/16/2009 6/16/2009 welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients within U one week6/16/2009 with reaction 6/16/2009 to Varivax. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. njection site, Left upper arm erythema and edema surrounding and below immunization injection Y site (13.5/10cm) 6/17/2009 6/18/2009 welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients seenUwithin one 6/17/2009 week with reaction 6/17/2009 to varivax accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. dministered 6/16 @ 10am then on 6/17 in late afternoon, pt noticed L head tenderness in hair Y and tender 6/16/2009 glands in 6/17/2009 neck on L side. This oc accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. EACTION TO VACCINE U 6/16/2009 6/18/2009 veloped Shingles on 1st branch right Y trigeminal. Patient has pain, swelling, itching, redness N to right side 6/11/2009 of face and6/14/2009 forehead. Temp 99.0. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. 7 pm on 6/17/09, client had small bruise on R deltoid where 1 of the vaccines was administered. On 6/18/09, 6/17/2009 redness 6/17/2009 was noted to R delto ceived Pneumo vaccine right deltoid mm post alcohol swABBING. c/o small amount reddness Y - @ 1 " in 6/15/2009 area with a6/17/2009 small 1"" track towards accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. ODE ENLARGED ON L INGUNAL REGION ABOUT 1CM IN DIAMETER MMR GIVEN SQ IN L THIGH 6/2/2009 6/19/2009 e of the flu shot there is a 5cm areA of macular erythema with multiple confluent vesicles . Across Y the mid 12/9/2008 chest large patches ### of macular e ollowing administration of Hepatitis A, Meningococccal and HPV vaccine, 6-18-09, patient ran Y a fever of 100.6 6/17/2009 degrees 6/18/2009 F and complained o eceived Havrix (Peds Hep A) vaccine Y on 6/16/2009. Developed fevers to 101+ farenheit thatYevening. Had 6/16/2009 acute mental 6/17/2009 status changes th d varivax on 11-21-1997, pt presented in our office on 6-17-2009 with scattered 10-15 nacular U lesions some sl ### papular 6/15/2009 without vesicles 2 da 6/15/2009 6/19/2009
ed the prescription for the Oral Typhoid vaccine from the Health Dept on 6/15/09. Ct started U the capsules6/16/2009 on Tuesday, 6/19/2009 6/16/09. Ct took her orts back on 6-18-2009, one day after Y receiving dose #3 of HPV, that she now has Knots on back of head 6/17/2009 that are tender 6/18/2009 to touch. No prob IVED VARIVAX ON 1-14-2002 AND 3-3-2009. PT PRESENTED IN THE OFFICE ON 6-17-2009 U WITH 25-30 3/3/2009 SCATTERED 6/15/2009 MACULAR LES R on 6/11/09. Kristin states had bumps on face and right knee 6/15/09 about the size a dimeYwith a little head 6/11/2009 in center. 6/15/2009 Exam on 6/19/09 fe veloped afebrile Seizures Y on 05.23.2008, was Y diagnosed with Infantile 11 Y Spasm. Now Y has Seizure N disorder 5/17/2008 and global 5/23/2008 developmental delay. shot was uneventful. After scab fell off while overseas wound started to heal up. Wound didYnot heal like 8/23/2007 everyone else. 4/1/2008 Scar did not hard came faint, diaphoretic and was eased onto the floor. Her VS stayed normal, she was givenYO2 and within 6/16/2009 1 minute 6/16/2009 was conscious and or vaccine 6/16/09, each day following the site of injection became increasingly redder, more painful U and swollen. 6/16/2009 By 6/18/2009 6/19/09, began itching, rsistent low grade pain since time. No Y functional ROM deficits, pain 1-2 of 10 in nature. Clinical Y exam normal 9/19/2008 w/palpation 4/3/2009 of deltoid. No palp @ 2:30 pm immunization given. 6.17.09 @ ~ 5:30 pm --> fever (1m 104) - Hives @ 11:00 pm.UNo facial swelling 6/17/2009 or difficulty 6/17/2009 breathing. Histor 9 patient felt generalized joint pain. Noticed swelling both ankles. Reported as non-pitting. Denise Y treatment. 6/9/2009 Joint pain 6/10/2009 resolved by 6/11/09 swelling at injection site (lower deltoid at left arm). Recommended Diphenhydramine 25mg and U Ibuprofen. 6/16/2009 6/17/2009 at site of injection - 6/17/09 2hrs. Body ache and joint pains 6/18/09. High fever. Y 6/17/2009 6/17/2009 redness and edema around the injection site, significant swelling of leg even 2 days, later, warm Y to touch 6/17/2009 advised parents 6/12/2009 to put warm com was reported by a physician, Y via a GSK representative Y and described 4 the occurrence Y of intussusception Y 5/27/2009 in a 4-month-old 6/4/2009 male subject who d zoster PCR confirmed. Y Y 9/28/2005 4/9/2009 htness in throat, pale, wheezing Y andYcollapsed Y in clinic lobby. Mom took 1 him right to ER. He Y had anaphylaxis 6/2/2009 to vaccines. 6/2/2009 Received Epinep - 04-24-09 = left arm, shoulder, Y neckY and rib pain Y with muscle spasms. 2 No treatment. 04-27-09 N - severe pain 4/20/2009 in left side 4/27/2009 of my back, more p 6/7/2007 t pain in her back on 6/10/09. Patient Y didn't realize that she had a rash till 6/14/09. The rash U was approx.5/22/2009 6" in diameter 6/10/2009 in a circular pattern VRIX in prefilled syringe in the left thigh with 1" needle. After immunization given, realized that Y it was an adult 6/9/2009 dose. Evaluated child for 20 m swelling at site of injection. Red, swollen, warm to touch. Ranging 3 in by 1 in by 1 in. Encouraged U mother 6/18/2009 to place 6/19/2009 ice pack, give appropria t 6.18.09 Acute URI 4 mo check-up vaccines given see below- Return visit 6.19.09. Fever within 24 hrs of 6/18/2009 vaccine administration 6/19/2009 probably v d 1/2 dollar size hive around area of injection - c/o pain & itching. Y 6/18/2009 6/18/2009 ped localized redness and swelling over (L) Vastus Lateralis sites within 24 hrs. Now 2 wks later Y has an erythematous 6/4/2009 6/4/2009 ring about 10 cm with soon after immunization followed by vomiting some hours later symptoms resolved within 48 Yhours never had 3/4/2009 fever. 3/4/2009 and swelling at injection sites. Fever 99.3. Y 6/9/2009 6/10/2009 hemic area approx 3cm diameter, LYdeltoid. Y 6/17/2009 6/19/2009 d with C. difficile on 2/27/09 and 4/21/09 Y 2/6/2009 2/15/2009 6/11/2009 , Redness around injection site right thigh area, warm to touch. Tx-Infant TYLENOL liquid, Hydrocortizone Y 6/16/2009 0.5% 2x 6/17/2009 a day for few days cough.. mother brought child to car - before leaving child c/o itching all over and turned brightYred. Brought 6/10/2009 back into6/10/2009 office c/o cough sweati welling/redness, pain and blister at the injection site. U 6/17/2009 6/19/2009 ven a DTaP rather than a Tdap. He had no adverse reactions. 5/20/2009 4/29/2009 hargy began 24 hrs after shots. The entire upper R arm swollen, red, hot, tender not localized Y abscess. 6/16/2009 6/17/2009 ular raised red area at (R) thigh. Y 6/17/2009 6/18/2009 opal reaction minutes after vaccination. Hypotensive + bradycardia immediately after near syncopal Y episode 6/17/2009 and cool, 6/17/2009 pale, diaphoretic. La s, started 11 hours after the injection. Fever 101 deg; shaking chills; no localized reaction; noYparathesias.6/8/2009 Severe headache. 6/8/2009 ema (notable lips & (L) eye), SOB. BENADRYL Y & SOLUMEDROL given. Y 6/9/2009 6/11/2009 receiving Pneumovax & Zostavax, pt began having head fullness/pressure, ears tingling, walk Y fatigued. 5/28/2009 Some lightheadness. 5/28/2009 1 wk later st iven 6/4/09. Pt developed within 24 Yhours fever, swelling, chills and generalized hives. She was U seen on 6/9/09 6/4/2009 when6/5/2009 a large erythematous on LUE with YF Vax 2:30pm 6/15/09Yafter screening. At approx. 2:35 pt c/o redness, swellingYand itching6/15/2009 at injection6/15/2009 site- 25 mg BENADRY redness at site one day after vaccine administered. Knot under (L) arm two days after. U 6/12/2009 6/14/2009 swollen to shoulder & down to end of deltoid muscle observed in office. Dad reported red swollen Y - req. Abx. 6/10/2009 therapy. 6/11/2009 at Gyn which came back positive forY high risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 N after receiving 6/18/2007 3 dose 6/5/2009 GARDASIL 8/11/06, 1 6/9/2009 ame lethargic, flushed, diphoretic and vomited. A 3x4 cm eccentric wheal developed at the left Y arm site, followed 6/19/2009 by 6/19/2009 a wheal at the right arm ur hours after the PPV vaccine (administered at 2:00 PM Thursday, 6/18 PCT)or Friday, 6/19Y around 5:00 6/18/2009 PM my temperature 6/19/2009 dropped per ; Severe and continuing headache;YUnusual and continuing sleepiness; Unusual tiredness, Yweakness (sudden 6/18/2009 and6/19/2009 severe); Severe and co e, chills, unwell, slightly swollen glands.
ministered the Anthrax Vaccine Y by the on 2 October 2006 due to the fact I was an Y active duty N service member 10/2/2006 assigned 10/4/2006 to a foreign country. redess within 1 hour of vaccine. Within 2 hours of vaccine, headache and fever of 103 degrees N F. Fever 6/19/2009 and headache 6/19/2009 reduced by Motrin eal hipertension after 1.5 months after Y the secon Y dosis and finally results 8 in neuropatic painY( 1 week after 3/9/2009 the first symptons) 5/25/2009 gerated reaction at site of injection.YRed, swelling, temp. 99.9, painful 6/19/2009 6/20/2009 RECEIVED HEP B, POLIO, PNEUMOCOCCAL DISEAS, DTAP, AND HIB. THE INJECTIONS Y WERE GIVEN 6/18/2009 AT 4 PM 6/19/2009 ON 6-18-2009, WIT ad his 4th dose of DTAP and his 3rd of Polio on June 18,2009 at appr. 3:30pm. He was fine Ybefore the shots 6/18/2009 and the 6/19/2009 evening after. First th n has been received from a pediatrician Y concerning a 15 month old male patient who on 14-APR-2008 N was 4/14/2008 vaccinated 4/22/2008 with a dose of MMR n has been received from a physician concerning a 1 year old female who on 02-OCT-2008 Nwas vaccinated 10/2/2008 with the10/2/2008 first dose of MMRII. S n has been received from a consumer concerning her 6 year old daughter who was vaccinated N with a dose of MMRII (lot number not provid Y Y Y N 12/9/2008 was received from a health professional Y on 09 June 2009. A 49-year-old male patient, with aNhistory of seasonal ###allergies,### received an inje was received from a health care professional Y on 09 June 2009. A female patient received anUinjection of FLUZONE ### SV '2005-'2006 USP (l n has been received from a physician Y concerning Y a 6 month old male 8 patient who on 06-JAN-2009 Y was vaccinated 1/6/2009 with 1/6/2009 one dose of ROTA n has been received from a 17 yearYold female, for the pregnancy registry for GARDASIL, with Y asthma and 3/21/2008 VICODIN 3/21/2008 allergy, who in Janua n has been received through the pregnancy registry for GARDASIL from a registered nurse Y concerning a8/18/2008 14 year old 8/18/2008 female with no pertine n has been received from a consumer Y concerning her approximately 17 year old Ydaughter with N no medical 3/31/2008 history or 9/1/2008 allergies who was vac ng after receiving the vaccine (06/18/2009) she woke up with severe body aches, felt like the Y flu, and Rt.6/17/2009 deltoid warm 6/18/2009 and tender to the tou for doctor's visit and was ordered Gardasil Y vaccination. Patient received vaccination and wasY instructed 6/19/2009 to remain in6/19/2009 waiting are for 20 minu ately 2 to 4 days after 2nd rabies vaccine, pt developed widespread, wheal-like rash to lowerUarms, lower6/15/2009 legs, back6/17/2009 of neck, & upper chest me in 6/22/09 stating that child has been fussy, running a low grade fever and unwilling to take U a bottle since 6/19/2009 vaccines 6/19/2009 given. No fever toda 6/11/2009 N 5/21/2009 6/11/2009 ng of lesions on right wrist, hand, and Y genital region 8 days after small pox inoculation. Instructions U on keeping 6/12/2009 lesions 6/20/2009 convered, good han esented with red, swollen, painful area on arm where vaccine was administered approximately Y 72 hours after 6/8/2009 shot was 6/9/2009 given. We told her to ely after Pt received second vaccine: Twinrix, Her head went forward towards knees. Pt wasYreturned to 6/18/2009 sitting position 6/18/2009 and regained aware amined - tender, urticarial type reaction distal to injection site. Large tender, raised urticaria,Uwith central6/19/2009 dusky discoloration 6/19/2009on forearm, w out 3-4 hours I had a tight chest and nagging cough when I took a deep breath. Little dizzy on N day 2 and6/19/2009 blood spot6/19/2009 in my eye (never had t n 4/07/09- she developed a rash onYtrunk 6 days Y later on 4/13/09-it 2was scattered over her upper trunk area4/7/2009 she called 4/13/2009 Employee Health o a (from knee to buttock) of redness and swelling. Warm to touch. Starte >36 hours after injection Y 6/15/2009 6/17/2009 ved HPV and had fingerstick for hemoglobin. Y left exam room and was sitting alone in conference Y room began 6/22/2009 to feel 6/22/2009 light headed and was 2009, ONE DAY AFTER RECIEVING DTAP, MOTHER REPORTED MODERATE TO LARGE Y AMT. OF SWELLING 6/16/2009 6/17/2009 AT INJECTION SITE. R & throbbing headache Y 6/22/2009 6/22/2009 derness and swelling over posterior Y aspect of left upper arm on 5/28/09 @16:53. Treatment: Y Ice to area 3-4 5/14/2009 times daily, 5/14/2009 Medrol dose pack, tified office approx 45 minutes to 1 hour after vaccination that patient was having chills and was Y shaking.6/15/2009 Denies pain 6/15/2009 in arm. Instructed m pneumococcal vaccine trial, with severe COPD, was hospitalized on 02/23/2009 with COPDYExacerbation. Vaccination ### 2/23/2009 took place on 10/1 ax 23 was given 6/17/09. Within 24 Y hours, he began to feel some discomfort in that arm and Ydeveloped a6/17/2009 macular red 6/20/2009 rash around the injec WAS GIVEN ALONE IN DELTOID YAREA. NEXT DAY PT RETURNED WITH SWELLING, PRURITUS Y OVER 6/15/2009 WHOLE 6/16/2009 DELTOID AREA. as given a HPV injection and within Y seconds she fell over with loss of consciousness and jerking Y movements. 6/9/2009 Fell off6/9/2009 of exam table. Pt. wa o Pneumovax with the sweeling, induration,erythema, Y warthm and pain in the R arm and forearm Y 5/20/2009 d with Win. 9/29/09. Hospital records receivedYDOS 4/8/09 to 4/9/09. Assessment: Idiopathic Y Thrombocytopenic 3/28/2009Purpura. 4/8/2009 Child presents w ned she had warm facial cheeks and red rash on facial cheeks - both facial cheeks - warm toYtouch. Received 6/15/2009 vaccine 6/19/2009 on 06-15-09. MR given Left arm. 2nd in series #/MMR 5/14/09. 6/20/09 Noticed bruising, swelling, tender. 6 inch oblong 6/19/2009 area of redness 6/19/2009 and warm to tou ncopal event after administration of 4 vaccines (see below). Was caught before fell to floor, Ywas sat on chair, 6/16/2009 as soon 6/16/2009 as sat, her eyes ope tavax was administered in the R deltoid area, Ms. Cubelic has had intermittent intense itching in the right arm distal ### to the ### injection site. Th easles vaccination rash. Red, raised areas over all of body. Low Grade temp. Y 1/20/2009 1/29/2009 lling of from deltoid to just above elbow Y with redness and increased heat to palpitation. plus increased Y bleeding 4/3/2009 at injection 4/5/2009 site with subseq 2 days post injection. Left deltoid area became swollen and inflamed with a 1/2 dollar red lump Y that was6/12/2009 painful and6/14/2009 warm. Generalized mu h rash (small red dots) in diaper area 06/19/09) on 06/20 and 06/21/09 had red checks, low N grade temp.6/18/2009 slow progression 6/20/2009 of rash up abd to feeling well. Generalized weakness. Cold hands and goose bumps noted. V/S HR 88/minute Y RR 20; B.6/15/2009 P 90/60. Placed 6/15/2009 in supine position ing dizzy. V/S - HR 100/minute, RR 20, BP 100/60. Pt placed in supine position with feet elevated. Y Observed 4/13/2009 for other 4/13/2009 reactions. Pt reporte ed pain and swelling of 3" x 3" in L tricep Y area. Site showed no redness, duration x 2 days, character U is constant, 6/17/2009alleviating 6/17/2009 factors: nothing came faint for about 15 seconds then woke up fine. Was checked (provider) then discharged. Y Was watched 6/15/2009 for 30-45 6/15/2009 minutes. Pt had clon
se events reported by patient. Y 6/9/2009 cm, overlying cellulitis. U 6/14/2009 6/14/2009 eived MMR and Hep A on 4-10-08,Yat age 2. - Mom noticed increase bruising 1 wk prior to office N visit for4/10/2008 the same. 5/20/2008 She was seen on 5-20n has been received from a healthcare worker who worked with 15 patients with no medical U history who were vaccinated with a dose of MM 3.8) and febrile seizure 12 hours after vaccines administered. Y 6/8/2009 6/9/2009 ult diphtheria/tetanus vaccine on 06/16/2009. The following day experienced headache, muscle and joint6/16/2009 aching, flushing 6/17/2009 of skin, and mala sized red area back of right arm. U 6/9/2009 13 1/2 cm x 17 1/2 cm, swelling at left deltoid, upper arm Y 6/8/2009 6/10/2009 eltoid 10 cm bruise. Warm/Induration, Rash. Y 6/9/2009 6/11/2009 pt states she developed a hive on her face approx 48 hrs after receiving vaccines. Then 12Nhrs later developed 6/12/2009 hive-like 6/14/2009 rash on arms, but 's left deltoid was red + swollen. Redness measured 4cm, swelling measured 3-4 cm. Y 5/28/2009 5/28/2009 8/09. Vaccines were administered and the patient remained in the exam room in a supine position Y for 15 5/28/2009 minutes, with 5/28/2009 an additional 10 minu ys ago. No pain or fever. Itching @ site - no one else has had reaction very large redness & U swelling right 6/15/2009 ant thigh6/16/2009 10.5 cm X 9 cm DASIL given 5/11/09. She called my office on 6/17/09 to say she had itching in her fingers and Y water blisters 5/11/2009 after inj. 5/11/2009 She gets same rxn w his am with shot area painful - per mother. Y U 6/17/2009 6/18/2009 ed LPN to give Hep A and PREVNAR. Y PENTACEL given by LPN instead of PREVNAR. Patient Y recalled 6/15/2009 same day /6/15/2009 stable / no adverse effe ARICELLA left deltoid on 6/15/09 approximately Y 9:30 am, child noticed redness, induration and Y hard bump 6/15/2009 36 hr later 6/16/2009 as he showered, deni 5-8/day) for 2 weeks following the vaccine. Finally changed from Soy to Alimentum and so far Y is better. 6/5/2009 6/5/2009 o 103.3 within 24 hours of 2nd set of immunizations Y 6/16/2009 6/16/2009 he day of the vaccine, had diarrhea for the week after reported to me 6/22/09 Y 4/20/2009 4/20/2009 lands on left side of neck. 6/18/2009 6/22/2009 check-out area stating "i just don't feel right". Skin clammy patient escorted to exam room, had Y her lay down, 6/19/2009 lower 6/19/2009 extremities raised. Oran after PPD placement and GARDASIL Y < 10 second witnessed ?generalized tonic/clonic seizure. Y No post ictal 6/19/2009 no incontinence. 6/19/2009 with dizziness and SOB Y 6/22/2009 6/22/2009 a hospital. I was informed about the meningitis vaccine which is a series of 3 shots. It was suggested that I3/8/1989 have the vaccines. 3/8/1989 After the first as given ZOSTAVAX on May 22, 2009. Developed Zoster from neck to wrist on June 8, 2009. 5/22/2009 6/9/2009 ema erythema hyperemia from elbow extending to shoulder. 6/19/2009 6/20/2009 en; red and 3 in x 4 in area- warm to touch. Today blisters on leg. Using MOTRIN and ice onUleg. 6/19/2009 6/20/2009 er called 6-19-09 reporting redness, swelling and warmth to touch at injection site on right arm. Y She stated 6/17/2009 not sure how 6/19/2009 long, but patient jus B vaccine booster administered @ 3:45 PM. At approx. 8PM, health care worker (HCW) began Y to experience 5/20/2009 numbness, 5/20/2009 tingling @ injectio left arm red and swollen. Treatment - Benadryl 1/2 tsp TID U 6/10/2009 ecking out after check-up appointment Y and fell to the floor, white and pale. After 5 minutes, pt's Y color is good 6/17/2009 and pt6/17/2009 is A and O. Pt's vs norm d rash c/w very mild VARICELLA Y 5/14/2009 5/19/2009 lla given, supposed to be HAV. No reaction seen. 6/22/2009 m red area (L) Thigh. DTaP and Varicella given on 6-19-09. Y 6/19/2009 6/19/2009 d redness/swelling, fatigue 2 days after Y PNEUMOVAX injection. U 6/15/2009 6/15/2009 orted a rash that developed on back, neck and arms. Rash cleared up the same day. Y 6/11/2009 6/12/2009 cine 6/3/09. Fever 101 degrees 6/4/09. 101 degrees-103 degrees 6/5/09. Pain at vaccine site. Y 6/3/2009 6/4/2009 ess starting 6/11/2009. R arm 8cm x 9cm redness, warmth, slight indurated area, faint bruise Y under erythema 6/10/2004 able6/11/2009 to move arm. Ice/tylen dasil 1st dose on Aug 23, 2007, 2nd dose on Oct 23, 2007. I got pregnant in JanY2008. MyNunborn baby then ### diagnosed 1/22/2008 with ring chromos ort was received 10 June 2009 from a newspaper Y article: A female college freshman student had received an unspecified meningococcal va ort was received 10 June 2009 fromYa newspaper article: Two college students (one identified Y as a male and the other unidentified), had rec n has been received from a 21 yearYold female patient with a history of previous miscarriageYand anaemia2/1/2009 who in February 2/1/2009 2009, was vacc n has been received from a physician concerning a 15 year old female with depression who Uin November5/1/2008 2007 was vaccinated 8/1/2008 with her firs n has been received from a pharmacist Y concerning his friend's daughter who on unspecifiedNdate was vaccinated with a dose of GARDASI n has been received from a pharmacist concerning two patients who within the last 30 days U were vaccinated 5/9/2009 with ZOSTAVAX 5/9/2009 (Merck) (sub 103 degrees - diarrhea -Yloss of appetite Y - severe Y stomach pain - weight 3 loss - weak/pale - lasted Y over 75/11/2009 days. Hospital 5/14/2009 stay was 3 days, tre Pt c/o pain in feet; 112508 pain cont, Y now can'tYpick up objects with44 hands; 112608 Y requires Y assist to walk 11/7/2008 into ER; 112708### is now bedboun ceived ZOSTAVAX vaccine on 5/26/09 and began having adverse reactions on 5/28/09 of body U aches, headache 5/26/2009and 5/28/2009 fever. (Dtap) whole arm swollen noticed 6/16/09 received imm on 6/15/09 4pm gave Rx Dermatop Y- watch give6/15/2009 tylenol Benadryl 6/16/2009 as needed. urticarial lesion w/o any systemic symptoms. Non pruritic papular lesion surrounds the punctum U where MMR 6/16/2009 was given. 6/16/2009
eddened, feverish knot with redness going to axillary area. Itchy 3 1/2X2 " knot redness 7 1/2" U X 4 1/2" no 6/16/2009 streaking down arm (bubbly look dministered 6/17. Arm turned pink immediately following, then cleared. Several hours later arm N turned red 6/17/2009 and slightly 6/17/2009 swollen in a 3" diame iven to early per manufacturer. 5/22/2009 TDAP on 6/9/09 noticed hives to injection site and just below injection site to anterior upper Y arm. Had swelling 6/9/2009 blotchiness 6/11/2009 to areas and mu der swelling. U 6/15/2009 6/16/2009 ed and swollen. Y 6/10/2009 d swollen, warm, red and hard to touch-client Y mother encouraged to seek help at MD or ER. No U drainage noted 6/9/2009 at injection 6/9/2009 site. c/o L upper arm redness Y 4/29/2009 5/2/2009 OUR OFFICE FOR 4 YEAR OLD WELL Y CHILD VISIT. RECEIVED 4 YEAR OLD BOOSTERS: Y Dtap, MMR, 6/17/2009 IPV, AND 6/19/2009 Varivax ON 6/17/09. nt is a 46-year-old man who had Pneumovax Y vaccine here on June 17. Within 1 or 2 days, he Y developed6/17/2009 localized redness 6/20/2009 and irritation tha days after receiving MMR, Prevnar Yand Varivax vaccinations. U 5/13/2009 5/22/2009 ceived the shingles vaccine on Monday, and she came back today on 6/11/09 due to allergic reaction. She 6/8/2009 was told6/11/2009 if she had any problem other reports 3 to 4 hours after reciving Y immunizations yesterday, child started running fever U ranging from6/22/2009 99 to 101,6/22/2009 Child very fussy and cr er called pt complained of soreness Y at the site and feeling cold. The next day she c/o her heart Y racing and 6/17/2009 feeling some 6/18/2009 discomfort in her ch by Father, stated school nurse called Y that daughter face was swollen. Father instructed to take U daughter 6/22/2009 to ER. 6/23/2009 a Shingles vaccination at 2:30 PM last Friday (06/19/09) and am STILL experiencing headaches N today, Tuesday 6/19/2009(06/23/09). 6/20/2009 I was told at t e vaccine around 9:00 am, became tired, and went to sleep from 5 to 7pm, then back to bed Y later that night. 6/18/2009 Complained 6/18/2009 of excessive night ble crying, would not nurse or drink. Seen by physician within 4 hours of onset of symptoms.Y Eposide lasting 6/19/2009 24 hours. 6/19/2009 Physican dx pertu dap immunization yesterday. At 1100 Y pm she developed onset of HA/dizziness/chills/ nauseated. Y She also 6/22/2009 reported6/22/2009 to her mom some lowe N OF REDNESS, WARMTH, AND SWELLING TO RIGHT ARM 1 DAY AFTER RECEIVINGYVACCINES. 6/17/2009 REDNESS 6/18/2009 COMPLETELY AROU 2/21/2009 N 2/19/2009 2/21/2009 eloped a few small, raised, red dots on the face and in the hair line area. U 6/23/2009 6/23/2009 er and Grandmother after receiving second series of vaccinations "child will not play as before". U 4/1/2009 4/15/2009 earing Loss and balance problems 5 days after injection. MRI and MRA normal. ETN Y doctors N (started week 5/7/2009 folowing5/12/2009 SHL) put me on sterio /1:32pm-Anthrax vax rec'd IM L. Delt. 13 Jun 09/2:00am-Sore throat/fever/chills/flu-like symptoms Y noticed. 6/12/2009 Went to6/13/2009 ER later in the day wh e fever, polymorphous rash, bilateral bulbar conjunctivitis, cervical lymphadenopathy, erythematous U palms 4/30/2009 and soles, 6/21/2009 swelling of hands and of both ankles, purple/red color on heals. Y Extreme pain in left ankle/ achillies tenden/ lower leg. N Began December 11/6/200808-12/1/2008 Present. Can not stan d the initial left bicep muscle aches to Y a common reaction to injections; however deep throbbing U and aching 9/8/2006 in left bicep 9/8/2006 continued; and eve d a headache shortly after receiving vaccine 3/10/09. He also experience throbbing of the head Y and near 3/16/2009 his left eye 4/12/2009 thereafter. On 04/12 omplains of "severe itching" from head Y to toe. Member given Benadryl + Clairton by Doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" from head Y to toe. Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given Benadryl and Clartin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe" itching head-to-toe. Y Member given BENADRYL & CLARITIN by doctor.Y 6/22/2009 6/22/2009 omplains of "serve itching" from head-to-toe. Y Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" head-to-toe. Y Member given BENADRYL and CLARITIN by doctor. Y 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given BENADRYL and CLARITIN byYdoctor. 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given BENADRYL & CLARITIN by doctor. Y 6/22/2009 6/22/2009 935 Upon rising client stated "feeling dizzy, laid client down B/P 108/80 P64, R14, skin w/d appropriate Y for 6/23/2009 race, c/o 6/23/2009 legs feeling week", able d c/o pain + swelling (LD) area. Observed Y redness, swelling at area warm to touch. Y 6/17/2009 6/17/2009 hours post administration of HPV 1st seizure - no other risk factors. 7/9/09 Hospital ED records Y received6/15/2009 DOS 6/15/09. 6/15/2009 Assessment: New t- MENACTRA 5/21/2009 ot- MENACTRA 5/11/2009 the typhoid vaccine on 26 May 1982. He was seen Y in the clinic the50 following day Y for a reaction N to typhoid5/26/1982 with a temperature 5/27/1982of 100.6; diagn ot-MENACTRA 5/12/2009 as shaking violently for less Y than 20 seconds accompanied by pallor & diaphoresis. No loss of Y consciousness. 6/23/2009 7/14/09 6/23/2009 Records rec'd from P ately equal to 2 hours after eye and cheek swelling. No dyspnea, no vomiting. Y 6/12/2009 6/12/2009 doses of varicella on 2-17-04 and 2-19-08. Pt dx today with chickenpox. Y 2/19/2008 6/23/2009 tes that after the receipt of all three AVA vaccinations she experienced a "knot" at the injection site the day of the ###vaccination. ### Additionally t induration, redness, tenderness atYinjection site (13 cm), fever 102. Y 6/9/2009 6/10/2000 vaccinations 6/8/2009, developed quarter-sized Y reaction at injection site. Progressed to about Y grapefruit sized 6/8/2009 reaction, 6/8/2009 took BENADRYL a ven at the site of redness and swelling. Y 6/18/2009 6/19/2009
e she received Tdap is red, swollen and warm to touch on Wed 6-17-09. 6/16/2009 6/17/2009 ports an itching bump at site of injection. She says that she didn't notice it until 3 days after U receiving vaccine. 6/18/2009 I advised 6/21/2009 her to use Benadr , 2009 12:04 PM After pt was given TDAP and MENACTRA vaccines he jumped off the bedYand sat next 6/19/2009 to his mother, 6/19/2009 while his brother re other, patient c/o headache on 6/6/09 Y - spent 6/7/09 in bed with nausea, h/a - diarrhea beganYon 6/8 - 6/10. 6/5/2009 Seen in hosp 6/6/2009 on 6/10 - dehydra ntly gave PEDIARIX at same visit as PENTACEL. Infant's mother aware - informed of possible Y increase local 6/18/2009 reaction per CPC, and to repo X given inadvertently @ same visit as PENTACEL. Infant's mother aware. Spoke to her 6/22, Y reports no6/18/2009 adverse reactions, no site redness ogressive body aches. Then weakness + dyspnea. ER visit x1 MD x3. Y 6/16/2009 6/17/2009 t swelling involving the whole L deltoid where vaccine was injected. Y 5/12/2009 5/13/2009 adaches - Given medication for headaches, Y bed rest. Y 6/15/2009 6/17/2009 episode after MMR vaccine and TBYskin test. While checking out of clinic with parent struck tile floor resulting 6/22/2009 in laceration 6/22/2009 to head and 10 ocal erythema of skin approx 10 cm in diameter, no induration. Y 4/1/2009 4/1/2009 elling from elbow to neck. TX - BACTRIM Y 4 tsp po BID. Y 6/17/2009 6/19/2009 , given & explanation of possible Rx. Took infant home & 2 hours post shots started crying almost Y non stop. 6/22/2009 Brought 6/22/2009 back to clinic & right h ~ 2" diameter with corresponding Y axillary lymphadenopathy. Y 6/1/2009 6/2/2009 ollowing vaccine pt - had swelling and Y redness @ injection site with itching. Saw MD. ? cellulitis Y - no tx other 6/17/2009 than cold/hot 6/18/2009 packs, resolved w , deltoid region : 4x6 cm indurated. Pink, non-tender, itchy. 6/16/2009 6/17/2009 ke up screaming @ 2am. Patient had raise red spots over body. They called ER- Couldn't say Y without seeing 6/15/2009 her. They 6/16/2009 put her in Aveno ba utes after intramuscular; injections of PEDIARIX and PREVNAR vaccines to anterior and latYsides of left6/15/2009 thigh, patient's 6/15/2009 left thigh became w ceived VARIVAX 5/21/09 patient had Y rash 6/17/09 was seen in office 6/18/09. 5/21/2009 6/17/2009 econds after vaccines given. Started on L leg extending to Abd (Very mild). Benadryl 12.5 1/2 Y tsp given &6/4/2009 rash resolved 6/4/2009 after 45min period tous circular area around site of injection on (L) deltoid. This rash showed the day after shot Y was given. No 6/9/2009 fevers. 6/10/2009 d lump at injection site. Y 5/11/2009 5/11/2009 macular rash trunk, limbs and face. U 6/19/2009 6/23/2009 ite pain after 20 mins. 2 weeks laterYdevelopedYsevere headaches, treated 1 with percocet. Y gained N 40lbs in1/28/2000 the months 1/28/2000 that followed. extreme ave two knot very swollen and red around the shot site in his two arms and fever 100.7 for two U days. It wont 6/21/2009 go away 6/21/2009 wit tylenol or motrin .w was received from a physician on 18 Y June 2009. A 14-year-old female patient, with no reported U medical3/26/2009 history, received 4/26/2009 the following vacc n has been received from a certifiedYmedical assistant, for the pregnancy registry for GARDASIL, Y concerning a### 20 year 3/31/2009 old female with a hi n has been received from a lawyer Y concerning Yher approximately 6 0year old grand daughter Uwho on an unspecified date was vaccinated wi n has been received from Y a nurse concerning Y aY4 month old female 1who on 15-APR-2009 was Y vaccinated 4/17/2009 with a first6/4/2009 dose of ROTATEQ (L n has been received from a physician Y concerning Y an approximately1514-week-old male patient N who was vaccinated 4/1/2009 with 5/1/2009 the first dose of RO he felt sinus congruent with sore throat, muscle aches allover, Temp, congestion (sinus), general Y malaise6/16/2009 swollen lymph 6/16/2009 Glands @ neck. s legs + arms heaviness arm R where shot administered nausea + dizziness. N 10/4/2007 10/6/2007 o injection site 3x3 round raised. Orapred + Altabax Y 6/11/2009 6/11/2009 ame pale and lightheaded at clinic, Ybut recovered on own. Mother called in this AM to reportYtaking client 6/19/2009 to ER on 6/19/2009 06/19/09 PM near midn warmth and swelling at administration site. Y 6/17/2009 6/17/2009 d with ACAM 2000 (lot VV04-003A)Yvaccinia live virus vaccine on June 12 2009. Normal take U documented 6/12/2009 on June6/22/2009 18, 2009. No adverse s reamed inconsolably for 3.5 hours. Y He also apparently went limp for a few seconds, but did not Y turn blue.3/23/2009 He had a 3/23/2009 fine pinpoint rash and s nt inadvertantly received a Hepatitis A vaccine instead of the appropriate Hepatitis B #1 vaccine Y at 3 months 6/16/2009 of age.6/16/2009 The patient had no ad ceived 4 immunizations in the officeYat approx. Y 3:15 PM. Mother called 1 after hours at7:23 to Yreport the child 5/21/2009 was grey/pale 5/21/2009 and limp. No re en 1st varicella on 06/12/2009 pt returned to the office 6/24/2009 with the c/o spots on belly,Yfever, vomiting. 6/12/2009 Pt was6/24/2009 dx with chicken pox. ceived Rabies Post Exposure Vaccine (Imovax)Yfor Dose #2/Day 3, 6on 6/18/2009 at 10:00 a.m. U At 1:35 am, 6/18/2009 patient 6/19/2009 was transported to hos ght parotid gland without fever. chills, malaise, myalgias or fatigue. Y 6/3/2009 6/18/2009 fter administration of zostavax patient stated she had redness at injection site about the size of a quarter, 6/22/2009 3rd day after 6/24/2009 injection, site is red, edness and swelling approximately 4 inches in diameter. Warm to touch, fever 2 days post vaccination. Y Dr. 6/22/2009 saw pt. Advised 6/23/2009 parents to ice a r i recieved the vaccination i did not Yfeel well and slept all afternoon i recieved the shot in theYmorning. I was 6/18/2009 vomitting, 6/19/2009 almost fainted, swea ng of immunizations he threw up 2 times, Y became chilled, spiked a fever, and began having U breathing difficulty 6/22/2008 similar 6/23/2008 to the reaction at 2 m site the day after immunization. Warm Y red rash extending 5-7 cm around site 6 days after immunization. U 6/17/2009 No fever, 6/18/2009 chills, drainage. Seen i immunizations on 06.16.09. Fever and Y vomitingY started on 6.17.09. 3Ataxia started on 6.20.09. N Hospitalized 6/16/2009 from 6.20.09 6/17/2009 - 6.22.09. Post inf ed Pt developed hearing loss to both ears Dec 07 shortly after completing GARDASIL Y series.UDose #1 1/23/07 8/6/2007 - Dose#2 12/1/2007 3/29/07 - Dose#3 8 009 center was notified by hospital Y of a vaccineY adverse event following 3 involving this patient. Y The event4/29/2009 occurred in5/11/2009 May 2009. Review of r ed Tdap and then GARDASIL. she was sitting on end of exam table talking. She stopped talking Y fell forward 6/24/2009 into my6/24/2009 arms and I laid her bac
ates "bumpy rash" to both arms & legs Y 1 day after vaccine. Followed up with pediatrician & dermatologist N 5/13/2009 who Rx cream 5/14/2009 & rash subsided te male who presented as walk-in to clinic Y reporting development of itchy red rash over bilateral Y hands evening 6/7/2009 of 6/16/2009; 6/16/2009 possibly spreadin . Soreness at site (L arm). Hives/rash - legs & ankles. Stable no other SX. Y 6/23/2009 6/24/2009 3PM increased fussiness & strangeY eye movement. "Out of it" & fever started. 6/20/09 - Tired Y & diarrhea. 6/19/2009 6/21/09 - "Very out of it". Limited rts that approximately 7 hours after vaccine was administered, infant became very irritable and Y cried inconsolably. 6/22/2009 Infant 6/22/2009 only slept 1 1/2 ho n upper arm swelling, warm to touchYwith some induration. Pt c/o some itching, denies pain. Advised Y to use 6/16/2009 cold compress 6/16/2009 and take BENAD PNEUMOVAX (L) deltoid 6/23/09. PtYhad pain later same day (+) redness of skin. Rash spread U (+) tender6/23/2009 (-) drainage 6/23/2009 (+) felt warm (-) chills ash involving mainly the axilla and groin area appearing 48 hrs after vaccine. No associated U fevers. BENADRYL 6/22/2009 3/46/24/2009 Tsp every 4-6 hours. RN at Dr's office called stating pt had Y a Hepatitis B shot at our clinic and now was having a Y reaction. Complains 6/22/2009 of 6/22/2009 nausea, "feeling woozy ened skin from elbow to shoulder onYL UE. Benadryl if needed. Y 6/19/2009 6/21/2009 ed "low grade fever" the evening of 6/19/09 Y -> reported warmth pain and redness at site of the Y PNEUMOVAX 6/18/2009 vaccination 6/19/2009 on 6/20/09. Repo rmth eryth and 1 vesicle just inferiorYto injection site. Itchy, no fever, no malaise. Y 6/23/2009 6/24/2009 ing of day she received vaccines, developed fever, left deltoid redness, swelling and warm to touch and 6/22/2009 soreness. 6/22/2009 vaccine at 830 AM and by 1030 AM left deltoid swollen, hard to touch and soreness. 6/24/2009 6/24/2009 ythematous plaque to L deltoid posterior to injection site. No heat, no streaking, no tenderness, no s/s of6/17/2009 infection. Pt 6/23/2009 denies pain, has FRO pprox 2 pm ZOSTAVAX given approx 1:30 am. Pt experienced rapid pulse of 80-93; BP 146/84, Y went down 6/11/2009 to normal 6/12/2009 after 2 hours, reporte n has been received through the Merck pregnancy registry from a physician concerning a 23Yyear old female 9/10/2007 who on 12-JUL-2007 ### was vac n has been received from a 16 year old female consumer for the Pregnancy Registry for GARDASIL Y concerning 3/19/2008 herself 3/19/2008 who on 19-MAR-20 n has been received from a medical assistant concerning a female in her 20's, who in December Y 2008, was 12/1/2008 vaccinated 12/1/2008 with the first dose o n has been received from a nurse practitioner Y concerning her 13 year old daughter who on 16-JUN-2009 Y 6/16/2009 was vaccinated 6/16/2009 with the first dose oke-like symptoms such Yas muscle Y weakness on Y one side, slurred speech, 3 confusion, Y sent toN Emergency Room ### - Brain scan ###- no stroke, se ven a flu shot on Monday. Y On Thursday, Y pt experienced Y muscle weakness 4 on oneYside, slurred N speech, confusion, 11/3/2008 trouble 11/6/2008 swallowing. He w PNEUMOVAX 0.5 ml IM 6/5/09. Seen Y @ ER 5/7/09. Y DX: cellulitis (R) 3 upper arm. Treated in Y hospital till 6/10/09. 6/5/2009 Discharge 6/7/2009 6/10/09. 7/2/09 o hospital for routine medical check Yup. 14 y/o female no past medical hx. Pt rec'd three immunizations U GARDASIL-Merck 6/19/2009 6/19/2009 Lot 0389U Exp 2 given in high left shoulder 6-8-09. (Patient is 65 and should have received plain DT.) Patient developed general 6/8/2009pain & stiffness in left sho y, cranky, clingy, sl. decreased appetite Y and developed rash on abdomen, neck, legs overall U scattered on6/20/2009 body incl. 6/21/2009 hands/feet consistent w swelling, warm to touch at injection site. Pt also has low grade temps. Y 6/15/2009 6/18/2009 econds after injection, patient became pale, diaphoretic and fainted. LOC about 10-15 seconds. Y Responded 6/22/2009 to stimuli 6/22/2009 and had no other pro h erythema, swelling, warmth to touch Y area of erythema 9x9 inches. 6/18/2009 6/20/2009 and redness, tenderness in area of shots Y on (R) Leg/thigh very large approx. 10x12 cm redness. Y Went to ER-placed 5/7/2009 on 5/8/2009 antibiotics. d patient reports that patient felt depressed about two weeks after receiving GARDASIL. Also N reports that 6/10/2008 she had mood 6/1/2008 swings. Did not se leg pain and refusal to walk 48 hrs after 5 yr vaccines given in legs. Lasted several hours without Y parents 1/16/2009 being able1/18/2009 to see redness, tende akness, SOB on exertion (mild) left arm felt tingling & cold however felt warm to provider, no U edema. 6/17/2009 6/18/2009 d on 5-27 and stated child developed Y rash and fever several days after imm - mom states rash Y was very5/12/2009 bad and on 5/20/2009 May 23 they took him n 6-10-09 c/o headache then at 01:00 Y c/o "whole body shaking" last 1/2 hour then c/o "heaviness Y in the legs 6/9/2009 ". Ran 6/10/2009 low grade fever x 4days exam table - gave MENACTRA im to LD then HPV im RD. A few second later patient feels dizzy Y and passed 6/17/2009 out and 6/17/2009 lying on exam table, f the shingles vaccine hoping it would help me - I have had 2 episodes a year for about 5 years, after the vaccine that accelerated to 5 episo Y 6/11/2009 Y 6/17/2009 Y 6/11/2009 esented with Bell's Palsy on 4/28/09. Symptoms. Symptosm began on the 27th with right sided Y facial paralysis, 4/16/2009 blurred 4/27/2009 vision, excessive te eumococcal vaccine in the ER on 6/18/09 in the Lt posterior arm. Left posterior arm noted with Y red raised 6/18/2009 erthema, swollen and very warm Y 6/15/2009 Y 6/17/2009 d temp 100.3, unable to work, numbness Y of hands & feet pupils dilated, moaning. BP 120/70Y RR rapid 40, 6/17/2009 headache 6/18/2009 (+) Blood sugar 70. P 3/23/2009 N 3/13/2009 3/23/2009 njection site, feels tender and is somewhat reddened but not warm or infected feeling. U 6/2/2009 atient felt some pain in her upper left arm and felt a small bump.Seen at this office 6/25/09. She U has a 1 cm 5/19/2009 soft cyst-like 6/19/2009 nodule which is in 3, 2009, client returned to health department for PPD reading. During visit, she c/o redness and Y warmth in6/1/2009 her left arm. Visual inspection o N RED PATCH ON RIGHT DELTOID. U 6/23/2009 6/24/2009 a 61 year old MALE who presents to Y clinic with a 4 day history of R upper arm pain/swelling Y which started6/8/2009 after he received 6/10/2009 the Zostavax o
ever of 102, vomiting, and congestion. Y Was seen in emergency room 6/18/09 because symptoms Y persisted, 6/15/2009 diagnosed 6/15/2009 with pneumonia.Pat ven VFC DTAP. No adverse reaction. Y 6/15/2009 6/15/2009 recieved 4 vaccines, Hep B, Td, MMR, Y and PPD. 30mins after, she came back complainingYof dizziness6/22/2009 and light headedness. 6/22/2009 Employee red 2 doses of hepatitis B vaccine on the same date of service Y 6/25/2009 6/25/2009 ceived Hep A and Tdap vaccinations. Y Approximately 1 minute later patient complained of nausea U and she 6/25/2009 was pale. 6/25/2009 Patient lost conscious e myalgias after injection. On 6/24/09 Y (6 d after inj). Woke up itchy, indurated, local injection site 4 x 8cm.6/18/2009 (B) wrist edema. 6/24/2009 Hurt with arthralg es listed given at 29 days old. 5/1/2009 KINRIX on 6.22.09. Per mom, noticed Y swelling, increase - after 24 hours - 6.23.09, went to ER Y around 11 6/22/2009 pm. Thought 6/23/2009 insect bite caused s lled @ 10 am 6/24/09 to say pt had large reddened area on R upper arm ~ about 4" in triangular U shape -6/22/2009 indurated and 6/23/2009 sensitive to touch. C asovagal reaction abut 5 mins. after administration. Pt responded immediately to verbal commands. Y She6/16/2009 was oriented 6/16/2009 - kept pt until her mo 6/23/2009 6/24/2009 by T-99. Red, swollen at site. Advised TYLENOL, cool compresses. Y 6/23/2009 6/24/2009 ould present himself off & on with anger outbursts, mood swings & getting in his "zone" whichUwas like he4/22/2009 couldn't process what I said until a of right thigh and bruising. U 6/17/2009 6/18/2009 dness, heat, tender, firm area 5" horiz Y and 3" vert just below site of injection in (L) upper arm....2 U days after 6/9/2009 injection6/10/2009 - (started itching 1 day macular rash started 2 days after vaccine Y was given & a fever of ? degree was reported by U his mother. He had no fever when seen 6/19/09 ve decreased motor skills LE >> VE Dxd - " transverse Y myelitis". 7/2/09 5 Hospital records received U DOS 5/29/09 5/4/2009 to 6/2/09. 5/28/2009 Assessment: Tra ontacted by pt mid-Jun 2009 & reported Y recurrent headache, dizziness, nausea, blurred vision, N & fatigue 3/31/2009 which developed 4/13/2009 about 2 weeks fo after administration of vaccine, patient developed erythema, pain, vesicle at site of innoculation/fever Y of 102 6/16/2009 degrees6/18/2009 approximately 48 hrs a f injection: Chills, Nausea, Diarrhea & fatigue. 2nd day vomiting & fatigue persists. Y 6/10/2009 6/10/2009 Y 6/11/2009 Y 6/15/2009 Y 6/17/2009 lar rash at injection site - (R) SQ-thigh. Y U 6/15/2009 6/24/2009 d AM of 6/25/09 L upper arm redness, induration, swelling, and increase warmth. Suspect cellulitis. N Tx with 6/23/2009 KEFLEX6/25/2009 250/5ml one tsp TID x ceived from a physician on 23-APR-2009 (via a sales representative). The reporter is also the patient. A 3/25/2009 male patient3/27/2009 (initials: EF, age unkn Migraine with loss of central vision. Y Felt sickly. Diarrhea. Slight headache. Fatigue. Chills. Aches. Y Report received ###from a consumer ### on 05-N ceived from a nurse on 03-11-2008. An 80 year-old male patient received AFLURIA 0.5 ml pre-filled U syringe on### 14-Oct-2008. ### Concomitant ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like ### symptoms 11/1/2008 (nasal congestion ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four patients experienced U flu-like symptoms ### 11/1/2008 (nasal congestion, ch ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like### symptoms 11/1/2008 (nasal congestion ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like ### symptoms 11/1/2008 (nasal congestion ite pain lasting 3 months U ### ### n has been received from a consumer Y concerning her cousin's 15 year old son who was vaccinated N with MMR II (lot number not available) n has been received from a physician Y for the pregnancy registry for GARDASIL concerning aY 22 year old 8/5/2008 female with 8/12/2008 a history of papanicol n has been received from a Physician Y Assistant (P.A) concerning a 15 year old female Y patient Y who on 13-JUN-2009 6/13/2009 6/13/2009 was vaccinated with th information received from the healthcare provider upgraded the case to serious. It also provided U additional 5/18/2007 concomitant 4/9/2009 vaccines, test resu given MMR and Varicella. Y Whelps atY 5 mins after given. Benadryl given, whelps smaller. Sleeps Y no wheeze, 6/18/2009 cry when 6/18/2009 woke 30 minutes afte rying baby in severe pain- can't calm down, mom can't put baby down. Y 6/22/2009 6/22/2009 me to health dept today and reported Y the following: Client left building where she received IZY"body went6/19/2009 stiff, eyes 6/19/2009 were open x 2-3 minute Y 4/22/2009 child spiked temp of 101.4 tues. 6/16/09 after vaccinations received Mon. 6/15/09. Fever broke tues afternoon. 6/15/2009 Symptoms 6/16/2009 include runny no Bright red blood in stool - size: about Y a quarter occurred twice in the evening on the day sheY received her2/9/2009 2 months 2/9/2009 vaccinations. I took he nd throat swelling, chest pain 1 1/2-2 Y hours after vaccine was given IV BENADRYL and PEPCID Y given in6/17/2009 ER. 6/17/2009 phenhydramine N ever, went to ED -> Dx with otitis media. Y Y 5/19/2009 5/20/2009 d elbow and knee burning joint pain. One month after vaccination had Parvovirus infection. Pain Y continues, 2/21/2008 no other3/30/2008 rheumatologic disease pain in left arm after receiving flu shot. U 10/9/2008 ### r reported to me that 3 days ago he started with some numbness to left axilla and lateral upper arm. 6/17/09 5/18/2009 50% better. 6/12/2009 6/22/09 90% bett nny nose, coughing Dx 6/1/09 with pneumonia Y Rx AMOXICILLIN. Y 5/29/2009 5/30/2009 fussy, screaming, inconsolable for 2 days. Mom could not put baby down. Y 6/12/2009 6/12/2009
@ injection site Y 6/17/2009 6/18/2009 ely after varicella vaccine, which was given last, client c/o nausea & dizziness. BP 100/60 x2.YJuice was given. 6/23/2009 Remained 6/23/2009 seated for 15 min unization client developed hives thatYitched until she scratched and drew blood. They covered N neck to toe6/10/2009 of her body. 6/12/2009 fter shot, arm swell up, turn red, working down to forearm, painful ! 6-13-09 Medical office provider: Y PA =6/11/2009 Fexofenadine 60mg = Benadryl = , pt. called & left a message that following having received VARIVAX, she developed a rash Yon her arm.5/21/2009 The message was misplaced, but ted about 6 to 8 hours after HIB and Prevnar vaccine. Temperature 103 degrees. ContinuedYfever 101 to 6/5/2009 103 for 3 additional 6/5/2009 days. Evaluat 6-3-09. Severe pain in arm,shoulders,knees,back Y and fever of 103.7 6-4-09. ER on 6-5-09 was N given Levaquin, 6/3/2009 Vicoden,Ultram. 6/3/2009 6-6-09 pa d symptoms of dizziness with near Y syncope, sensation of throat constriction with tightness atYthe base of6/20/2009 his neck. 6/21/2009 This was then accompa ht hours after vaccine administration, Y at about 4:00 AM, patient experienced sensation of throat Y constriction 6/24/2009 and inability 6/25/2009 to breathe deeply. d nausea and vomiting, insomnia and mild fever approx. 10 hours after vaccine administration. Y Vomited repeatedly 6/23/2009 during 6/24/2009 night. Able to eat esents to clinic at approximately 1745 Y on 6/25/09 for MMR immunization - enrolled in medical Y assistant program 6/25/2009 at local 6/25/2009 school, cannot find s given a Dtap/Polio IM injection in the left deltoid on Wednesday 6/24/2009. Client and mother U returned 6/24/2009 to clinic at 9:00AM 6/24/2009 on Friday 6/26/2 HAD KINRIX ON 06-23-2009.DEVELOPED RED RAISED SWELLING AT INJECTION SITEUON 06-24-2009.SEEN 6/23/2009 6/24/2009 BY DR.KALIL ON 06-2 welt, larger then usual Y 6/25/2009 6/26/2009 a of erythema with a slight hemorrhagic Y appearance, encompassing almost entire L thigh U 6/23/2009 6/23/2009 hy, hard, swollen around the injection site. 4-inch diameter around the injection site. Localized U 6/24/2009 6/26/2009 d swollen area approx 4x4 inches bendryl taken Y 6/19/2009 6/25/2009 ours after receiving Oral RotaRix vaccine, Y 2 month old baby developed fever (100.9-101.2) for U four days,6/22/2009 acute onset 6/22/2009 copious watery non-b hours after the vaccination, I felt my head starting to ache. Then later I felt like there was anNelephant on6/24/2009 my chest. 6/24/2009 I was having difficulty b was swollen all the way down to elbow. It is really sore and she had very back headache and joint pain 6/23/2009 6/23/2009 accine administered inadvertantly. Y 4/17/2009 6/26/2009 accine administered inadvertantly. Y 6/24/2009 6/26/2009 ceived Menactra and varivax injection. Patient fainted 3-5 minutes after injection was given Y while in the elevator. 6/26/2009 6/26/2009 ely following vaccine, patient Y began Y to complainYof mild symptoms (my 5 shoulder hurts, Y my wrist N hurts, look at these ### spots on ### my leg. On the WINRIX 1ml, Tdap 0.5 ml, IPV 0.5 ml, Y MMR 0.5 ml and PPD 0.05 ml. Pt passed out in 1 minute Y and was 4/8/2009 given smelling 4/8/2009 salt and recovered as given an MMR by agency while was 5 weeks pregnant. 6/9/2009 sweats, dizziness. Y 6/24/2009 6/24/2009 ticaria that started about 12-24h after vaccine administration. Treated with diphenhydramine.U 6/22/2009 6/22/2009 ng - 1 1/2 cm circumferential difference, irritable. Shoulder --> wrist, dorsum of hand slight edema. Y 6/23/2009 6/23/2009 er of child: See attachment telephone Y conversation 6/25/09 3:30 PM. Y 5/20/2009 5/20/2009 en 6/24/09. 6/26/09 woke with painful, red and swollen arm. Y 6/24/2009 6/26/2009 s after receiving GARDASIL vaccineY Pt. developed dyspnea, dysphagia, stabbing, sharp pain Y (R) arm and 6/12/2009 hip, neck6/12/2009 pain. Dx: Allergic react minutes of MMR + Varicella vaccines administration child's right thigh became red and indurated. Y 6/25/2009 6/25/2009 3hr prolonged crying episode. Started roughly 3hrs after getting vaccines. Resolved with warm Y compresses 6/23/2009 to the thighs. 6/23/2009 imms. 6/9/09. On 6/10/09 was achy and 102 degrees fever. On 6/13/09 pt again at clinic c/oYnausea, abd6/9/2009 cramping,6/10/2009 and fever. with warmth ~ 6-7 cm diameter no induration. 6/24/2009 6/25/2009 24,2009 received injection of Zostavax Y and byYApril 8th, experienced 15 Yextreame anxiety, inability N to sleep, 3/24/2009 and by May4/8/2009 7th was hospitalized s of appetite, fever as high as 102.9 after having pneumococal conjugate and hepA vaccinesUon 6/23/08.6/23/2009 6/27/2009 thma attack, no fever, sinus infection. Y pt treated with iv decadron followed by po taper of prednisone Y 5/29/2009 6/5/2009 STARTED WITH A FEVER 6/27 ON THE MORNING OF 6/28 BROKE OUT WITH A RASH U WHICH CONSISTED 6/18/2009 OF 6/27/2009 ABOUT 10-20 ERYT n has been received from a healthcare professional through a Pregnancy Registry for GARDASIL Y concerning 4/21/2008 a 17 year 4/21/2008 old female with dep n has been received from a physician concerning an 18 year old female who on 18-JUN-2009 Y was vaccinated 6/18/2009 IM, 0.5 6/18/2009 ml with the first dose n has been received from Y a healthcare Y student concerning a 19-year-old female patient whoYwas vaccinated 4/20/2009 with the 4/20/2009 first dose of GARDAS n has been received from a consumer Y concerning Y his fiancee who on 0 22-JUN-2009 was vaccinated U with6/22/2009 the first dose 6/22/2009 of GARDASIL. Subs perienced two episodes of debilitating inflammatory arthritis after the second andYthird rounds Y of Hepatitis 8/29/2008 B vaccination. The ### interval of ons s, pt experience moderate intense muscle tightness and aching and a sense of limps feeling Ylimp. This interfered 2/9/2009with2/9/2009 her ability to play spo ed Merck first to report adverse effects. Merck faxed notification to agency and nurse calledYto follow up4/28/2009 with pt. Pt had reported to Merck ives...They were first noticed around mid January 2009. We first saw our pediatrician who thought N it was6/11/2008 viral. Then 1/15/2009 we went to see an All pt called to report GI sxs: nausea, upset stomach. Day later, she reported swollen lymph node Y in armpit 6/23/2009 of left arm where 6/24/2009 she got vaccine 7 TO 100.8 FOR 2 DAYS, INCREASE ON SLEEP, INCREASE SPIT UP, RUNNY DIARRHEA/STOOL U 6/25/2009 6/26/2009 started getting red over 24 hrs with lump Y forming underneath skin. By 36 hrs, arm swollen toNsize of tennis 6/25/2009 ball with 6/26/2009 red color & warmth at to
ection site, R leg "hundred-ish tiny bumps with white pink tips"; later rash appeared on face and U neck; T 6/18/2009 max 102 F;6/20/2009 diarrhea. the night of 6 t 4 days after vaccine (2nd) dose...vaginal Y lesions, Y nausea,vomitting, 3 headache -E.R visit diagnosed Y with1/24/2009 herpes, all1/28/2009 subsequent tests nega DTaP, MMR, IPV, Varivax on 6-17-2009. Y Had Yhad brief joint pain and 2 mild rash approx 5 days Y prior and6/17/2009 only faint pinpoint 6/18/2009 macular rash on eived Menactra, Gardisil, Adacel, and, and Havrix. She became pale and nauseated. Her skin Y was cool and 6/29/2009 clammy. 6/29/2009 Her head went down a 2009 CLIENT NOTICED THAT LEFT ARM WAS SORE AND WARM TO TOUCH ALSO REDYAND SWOLLEN, 6/25/2009 INSTRUCTED 6/27/2009 TO TAKE BE hes in joints, especially injected arm. Began severe headache, nausea, vomiting. Body wasUquivering, jaw 6/23/2009 quivering 6/26/2009 bad pretty bad. Did no able crying, arching back and restless Y no sleeping, High fever N 6/25/2009 6/25/2009 ed that she developed hives on both arms and had a headache approximately 1 hour after receiving Y the6/22/2009 vaccine. She 6/22/2009 called her doctor's o HY BUMPS ON BADY NOW SPREADING U 6/30/1999 6/29/2009 ceived Zostavax vaccine on 6/17/09. Y States symptoms of pain in upper thighs began on 6/19/09, U pain then 6/17/2009 elevated6/19/2009 to lower back. Visited er vaccination temp. - sore throat, cough. This lasted 2 1/2 weeks. Then on the 30th of May N I awoke to a5/14/2009 painful left 5/30/2009 knee. This got worse o Right hand swollen, numb - its mainly in my pointer finger, middle finger & thumb now. I've had N my left arm 5/14/2009 go numb5/27/2009 & hurt & ache & feel li by mother: 5/8 Right arm swollen, Y followed by 7 days of hives, swollen knee joints, fever offYand on, puffy5/7/2009 feet". Treated 5/8/2009 by hospital, and p ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in g 2 doses of VIVOTIF, deep pink colored Y rash to face, neck noted. Eyes swollen almost shut, Y c/o pruritic. 5/13/2009 Referred to PCP. Placed on stero mediately suffered syncope episode after injection of GARDASIL. She was pale, clammy to touch Y and non-responsive 6/10/2009 6/10/2009 for approx 1 minute. B ENTACEL, HVB, PCV7, Rota) resulted Y in wheezing, SOB, irregular breathing, fever 104 degrees; Y seen in 6/12/2009 ER. 2nd set 6/12/2009 (PENTACEL, Rota) r ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf minutes after receiving vaccines became Y dizzy. Passed out. Mom states it looked like he was Y having a seizure. 6/9/2009C/o6/9/2009 weakness & being tir ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf d swollen lymph nodes to neck andYburning behind ear drums. 3 days after ADACEL/MMR IINinjection. Pt 5/1/2009 has been to5/1/2009 ER (on 2/22/09 and w ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf nced arm pain and shoulder pain after injection - near inj site. Started days after inj; con't forN~ 2 months. It cleared ### but shortly ### thereafter pt ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an in es, irritation, lack of sweat doing exercise, insomnia, redness in all parts of body, numbness left N lower foot, tingling sensation, weakness: in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf sh/pustules, RX with NSAIDS/observation Y for possible reaction U 5/27/2009 ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf n instead of DTaP, no reaction to the Tdap. 6/18/2009 6/15/2009 N 6/15/2009 6/15/2009 , swelling, tenderness (all continued after 2 months) 4/6/2009 4/6/2009 dache, the began c/o sensitivity to light. Y On 1/22/09 went to have eyes checked retinas Y inflamed. U Went to 1/20/2009 ophthalmologist 1/20/2009 retinas being tre A, myalgias, back pain, LE pain/neck Y pain, paresthesias, Y N&V, diarrhea. 1 7/23/09 Hospital records N received 6/19/2009 DOS 6/21/09 6/20/2009 to 6/22/09. Asses bout 2 - 3min after receiving vaccine with seizure like activity (probably secondary to fainting)Ypale, nauseous, shaky, low BP. Seemed to re accidently given PCV-7 instead of MENACTRA. 0 adverse reaction Y 6/23/2009 with 4/3" reddened area. Warm to touch. 6/23/2009 6/23/2009 since day after vaccine up to 10x daily for (currently) 18 days. Negative stool studies. U 6/11/2009 6/11/2009 ven dose of TDAP, MENACTRA, VARICELLA, double dose. 1st 6/10/08, MENACTRA, 2nd 6/15/09, Y VARICELLA. 6/15/20091st 6/13/07, 2nd 6/15/09, ven 2 doses of TDAP and Varicella. 1st dose - 6/10/08, 2nd dose - 6/15/09. Y 6/15/2009 on with the Vaccine Healthcare Center Y (VHC) was initiated on 5/23/2008 following reports ofYPt with myopericarditis 5/13/2008 5/20/2008 day 6 post ACAMBIS S n @ ER 3/6/09 Y U 2/27/2009 3/6/2009 mp > 103 degrees F @ 2A 6/21/09 post Y experiencing fever rigors. Temp did not decrease with Y TYLENOL. 6/20/2009 High temp 6/21/2009 X 36 hrs. Fever rigo & swelling size - began 50 cent size - painful, itching enlarged - redness area warm to touch Yabout 2 days 6/22/2009 - decreased 6/24/2009 grade fever aching -
bdominal cramping & pain for 48 hours. Severe vomiting & diarrhea for several hours. No specific Y treatment 1/30/2009 2/3/2009 ite swollen, red, itchy - Pt visited PCP on 6/26/09; MD told Pt the reaction would go away in Y 2-3 days. 6/24/2009 6/25/2009 swelling localized to injection site 3" in diameter. U 6/24/2009 6/25/2009 pt called office 6/25/09 sts. small redY area to vaccine site. Adv. Dad to watch area and if areaY spread and/or 6/24/2009 become6/25/2009 redder, hot or hard to Pt came in today c/o redness on left deltoid had fever X 2d. Used alcohol on area. Redness N & swelling6/24/2009 warmed to 6/24/2009 touch 6" X 4 1/2" U 6/9/2009 6/14/2009 edness of entire circumference of arm. Given IM steroids. 6/22/2009 6/22/2009 persistent pain and mild tenderness to palpation, onset with pneumococcal vaccine to L deltoid N 4/27/09. 4/27/2009 4/27/2009 veloped 10 vesicular rash scattered on his chest, neck, back & scalp on 6/19/09 Y 6/8/2009 6/19/2009 swelling, and a hard lump after receiving the diptheria, pertussis, tetanus shot at my OB-GYN's office. n has been received from a health professional for the Pregnancy Registry for GARDASIL, concerning Y a2/18/2008 16 year old2/18/2008 female with no known n has been received from a consumer Y for the Pregnancy Registry for GARDASIL concerningYher daughter 4/14/2008 a 14 year old female with no kno n has been received from a physician concerning Y a 14 year old female 0 patient who on an unknown N date was vaccinated with the first dose n has been received from a health care Y worker concerning a 15 year old female patient whoYon 12-JUN-2009 6/12/2009 was vaccinated 6/12/2009 with the third n has been received from Y a registered Y nurse concerning Y herself, an080 year old female Y with Y asthma and allergies to codeine 1/1/2009and sulfa who was received from a health care professional Y in country on 18 June 2009. A six-month-old female N patient, 6/18/2009 with no reported 6/18/2009 medical history, ort received 19 June 2009 from a health Y care professional. A 17-year-old female patient with U no known drug 1/2/2009 allergies, had received a first do was retrieved from a newspaper article Y on 22 June 2009. An 11-year-old patient received anUinjection of DTaP (manufacturer, date of adm ped onset of paresthesias (tingling)Yin B/L hands, Y neck stiffness, occas. 8 hand numbness, hipYpain, & feeling 11/4/2008 flushed on eve ### of 11/17/08. Flu en for annual physical 5/14/09 & found Y to be well Y on exam. No labs 3needed. ADACEL Y vaccine N done. 3-45/14/2009 days later 5/20/2009 some symptoms of vagu / h/o recurrent cough w/ wheeze, who Y receivedY1st MMR, VAR & HAV 1 on 6/11/09. Child wasYhealthy that6/11/2009 day. Day after 6/12/2009 woke up w/ face ed called arm red & swollen (? which) home care 2. 6/24/09 Erythema Multi form no explanation Y not sure if6/11/2009 due to vaccines 6/24/2009 tis of the left arm at the site of injection. Y --> Treated with KEFLEX antibiotic for infection. 6/24/2009 6/24/2009 d vaccine on 06/18/2009, by 06/20/09 she was feeling very dizzy and it has been happeningUon and off since. 6/18/2009 6/20/2009 e fever w/ knot in left thigh, erythema to thigh 3cm X 8cm, itch, warmth. Y 6/19/2007 6/19/2007 r arm weak & numb x 6 days from deltoid to elbow. Reoccured with Gardasil #2 - (RT) arm, Y marked pain6/18/2009 + weakness 6/18/2009 - RT upper arm - 5 da VAX given @ 0900 on 6/23/09. At 1530 on 6/23/09, pt. seen in office for increased swelling U and erythema 6/23/2009 to site. Circular 6/23/2009 edema 5" width, Vaccine given. 6/12/ - 6/14 - Sore arm. Itching started 6/13 on arm 6/15 Itchy wrists 6/16 - U headache, dry 6/11/2009 heaves, 6/15/2009 rash developed on tors ately 24 hours after vaccines pt started with crying and that has lasted for 2 more days. He has N also has 6/18/2009 a temp to 101 6/19/2009 degrees F and mild sed syncope vs possible seizure. Found down with ?shaking, ? apnea. Reportedly with someYconfusion briefly 6/18/2009 afterwards 6/19/2009 and then fully rec ed red papular rash every- where on body except face and palms. U 6/22/2009 6/23/2009 a to right thigh. Size smaller than a pea, no redness or swelling. Treatment: warm compresses Y and massage. 6/22/2009 6/22/2009 - Hot flush - 5-28 - red raised welt egg shape/size - hot - 5-29 - still warm -ache shoulder - elbow Y - swelling 5/27/2009 gone - no 5/28/2009 energy - 6-8 - arm sh d 20cm X 25cm area of redness after administration of DTAP + itching. Treating with cool compresses + 6/22/2009 Benadryl. 6/23/2009 d 105 cm x 70 cm area of redness at site of MMR, & itching. Treating with cold compresses & BENADRYL. 6/22/2009 6/24/2009 n Lt deltoid 6/20/09 - no previous reaction reported - over 10 yrs on tetanus. Called 6/24/09 -YPt reports lightheadedness, 6/20/2009 6/21/2009 fever x2 days - up dacel - recommended for ages 17-64. LOT# C3098AA EXP 9/1/2011 L deltoid Y 6/24/2009 n area of injection site. Lasted about 5-6 days. Y 6/4/2009 6/5/2009 N was in box labeled PPD therefore. 1cc was given ID in pt left arm. Dime sized slightly reddened U area noted 6/12/2009 at injection 6/12/2009 site. r after immunization (10:30 am) recipient Y c/o headache, nausea, shortness of breath. Tx with Y Tylenol. Nausea subsided - other Sx continu d c/o pain and swelling (LD) area. Observed Y redness, swelling and area warm to touch. Y 6/17/2009 6/17/2009 9 received Hep A and MCV-4 in L arm Y and HPV in R arm. Overnight pain and redness @ injection Y site. Increased 6/23/2009 pain 6/24/2009 and redness on 6-2 arm, red tender and hot. Measures 90x80 millimeters - Area involved is slightly below the injection Y site 6/22/2009 6/23/2009 rm, redness, hardness pain. Y 5/13/2009 5/14/2009 rted fever 103 + irritability all night. Offered an appt by myself and Doctor. Mom refused apptUX 2. 6/24/2009 6/24/2009 t local reaction on L arm, red and swollen 6 cm in size encompassing the whole arm. Y 6/23/2009 6/23/2009 local to inject - fussy and fever - Treated Y with tx Y 6/22/2009 6/24/2009 n, joint pain, diarrhea, high blood pressure, Y rash. Prostate cancer we do not receive, never adverse U reaction 2/17/2003 of this vaccine when administer tender, sore, red, warm to touch x 3days. Keflex 500mg 1 tab Po TID X 7 days. N 6/17/2009 mp, itching, hot to the touch. - Warm compress, gentle massage, BENADRYL if needed for itching. Y 6/3/2009 6/9/2009 ulder pain for a couple of weeks now, no injury or trauma. Pain and pressure to the area andUwith overhead 6/1/2009 activities. 6/15/2009 Right shoulder bother
white and became sick/feel nauseated after getting Hep A and Yellow fever , which came onY several minutes 6/25/2009 after 6/25/2009 YF given then she fainte e, nausea, fatigue U 6/26/2009 6/27/2009 t local reaction. - *see attached. - Y Y 6/22/2009 6/23/2009 was reported by a physician and described Y the occurrence of difficulty breathing Yin a male subject Y of unspecified age6/1/2009 who was vaccinated acks out - low blood pressure. Extreme Y pain in Ylegs and body. Body7jerks Y no concentration Y brain N fog. Rashes, joint ### pain 11/1/2007 Fatigue, constipatio Y 6/5/2008 n w/ rash all over body on 6/19/09, pt Y also had low grade fever x 2 days. Y 6/5/2009 6/19/2009 t leg, high fever, refused to walk a.m. after injection given U 6/25/2009 6/26/2009 aving bloody noses at approx 1 am 6/26; Y has had 8 between then and 7:15 am 6/30. He hasNnot had bloody 6/26/2009 noses before, 6/26/2009 and he has not b ic with mom approx 5 minutes after Y being seen in clinic ear pain at 2:30 pm and also received Y four immunizations 6/29/2009including 6/29/2009 HPV (Gardasil), office to report approx 12 hours following vaccine administration she developed widespread, Yintense muscle 6/29/2009 spasms, 6/29/2009 vomitting, hands and dministered 6-22-09, 2nd dose of Hepatitis A vacccine. That evening headache, myalgias, chills, U low grade 6/22/2009 fever 99.3. 6/25/2009 Evening of 6-25-09, , edema, hives, lymphadenopathy, treated with prednisone Y rash onset 6/28/2009 and was seen in office. pt had varicella vaccine 6/18/2009. Y 6/18/2009 6/28/2009 mediatley with slight jerking motion. B/P 80/40, pulse 60. Woke a couple seconds later veryYcold, shaky, 6/30/2009 80/50. Very 6/30/2009 diaphoretic, pale, we d vaccines ~ 1230 pm. Pt. toleratedYwell. Received Tdap, MMR, Varicella, and ppd. Asked pt. Y if I could procede 6/29/2009 with 6/29/2009 obtaining blood - at w ates that Right arm became swollen and painful, then began to hurt deep inside the muscle from N the injection 5/12/2009 site to5/22/2009 the wrist, patient still ha ssed out in the hallway about 3 minutes Y after receiving vaccines. Mother was with him at theUtime. She reports 6/30/2009 that 6/30/2009 he fell face first and hit nt experienced hives 1 week after receiving Y the Zostavax vaccine on 5/1/2009. She went to urgent N care and 5/1/2009 had her rings 5/7/2009 cut off because o ceived Rotateq 6-12-09, on 06-15-09 Y mom called Y and state pt was unconsolable, 2 crying, pushing Y away from 6/12/2009 mom and 6/15/2009 had vomited x 3. Ad ure elevation 104 degrees F Y 6/29/2009 6/30/2009 se reaction noted. Verified with patient and mother. 6/2/2009 administered around 4:15 June 29th. Y Pt woke up at 6 a.m. the following day crying in pain, headache rated 6/30/2009 10 on scale 6/30/2009 of 1-10. She had a ziness", stomach pain within seconds of administration. Pt closed eyes at this time. Pt placed Y in supine 6/30/2009 position with 6/30/2009 knees raised to chest close right eye, facial numbness, drooling from right side of mouth Dx: Bells Palsy Y 2/11/2009 6/4/2009 ceived Varivax, Gardasil, and PPD. Within in minutes she fainted. Y 6/30/2009 6/30/2009 iven on 6-18-09 & patient Y had to undergo Y surgery Y for intussusception 5 on 6-22-09. 9/8/09 Hospital Y records 6/18/2009 received 6/21/2009 DOS 6/21/09 to 6/25/09 d swelling of the eye's, lip's and ear's. Also had an episode of vomiting. some difficulty breathing.Patient Y 6/30/2009 was given 6/30/2009 vaccines and had left th ceived two vaccinations, Hib and HepB. He did not need either one of those shot. I found out U when I compared 6/30/2009 the6/30/2009 shot record that they ga evaluated on 6/30/09 and noted to have confirmed case of diffuse varicella. Child's rash involved U dozens of varicella ### 6/27/2009 lesions on trunk, back developed bright red macule about 3 in. diameter at the site which was itchy and also developed Y generalized 6/25/2009 hives. 6/28/2009 Both noted about 3 day ours after vaccine administration, patient's wife called and reported the patient experiencing Y dizziness, nausea, 6/19/2009 and6/19/2009 slight fever. I spoke wi r,lethargic,shakes,chills,no appetite Y Y 6/29/2009 6/29/2009 n, myocarditis treated with IVIG. 7/31/09 Y Hospital Y records received DOS 3 6/28/09 to 7/1/09. Assessment: U 6/24/2009 Myocarditis. 6/27/2009 Patient presents with excellent health prior to service entry in May 2009. Y 13 May 2009 - Pt7 received multiple vaccines N - See Vaccine 5/13/2009 History. 6/2/2009 The total number of er shot 2 areas of large blisters, 2" long (reported by mom) - arm hot, swollen - bright red - client Y denies 6/19/2009 fever or pain 6/20/2009 and redness of right arm. Y 6/22/2009 6/24/2009 brasion/ shield ulcer follow up OD- pt Y states no pain, feels it is resolved, using e-mycin ohs, VIROPTIC Y q2h, 6/19/2009 and VIGAMOX 6/25/2009 qid. minutes after vaccination became pale, unresponsive lasted 3-5 minutes. See enclosed note. Y Pt is in today 6/25/2009 for her pre-kindergarten 6/25/2009 physic Started with multiple small vesiclesYon bottom. 6/26/09- Seen in office had started on trunk Y as well, some 6/18/2009 vesicles "blistered" 6/25/2009 culture done. ew hours of receiving TDAP. Pt c/o hourly diarrhea X 10 or 12. Denies fever, bloody stools,Yrash, nor v, or 6/5/2009 other sx. 6/5/2009 Stomach was "sensitiv p in arm swelling & pain Y ### ### was reported by a physician and described Y the occurrence of injection site cellulitis in a 5-year-old N male subject 6/1/2009 who 6/4/2009 was vaccinated with c eak/ shakey. Chest was tight and felt a warm sensation going thru body like a dye from a cat-scan. U Bad6/30/2007 headache.6/30/2007 stridor, cough and shortness of breath. Y 8/3/09 Y ER records received 1DOS 6/23/09 Assessment: Y Allergic reaction, 6/23/2009vaccine 6/23/2009 adverse reaction, owing ROTATEQ vaccines. Developed fever & diarrhea U 6/18/2009 6/24/2009 n, mood swings, change in menstrual cycle ( increase to 2X monthly), cramping, loss of hearing, U infection 2/14/2008 eye + ear.9/15/2008 Redness, Soreness 6cm X 6cm. Y N 6/22/2009 6/23/2009 lls, cold hands, pain in legs, weak, headache, Y stomachache, shortness of breathe Y 6/3/2009 6/4/2009 ort was received 25 June 2009 fromYanother manufacturer (document number 45220797), who received the report from a health care profes n has been received from a Certified Medical Assistant (C.M.A.), for the Pregnancy RegistryYfor GARDASIL, 6/17/2008 concerning 8/26/2008 a 26 year old fema
ort received 25 June 2009 from another Y manufacturer (document number 45220198), who received Y the report from a consumer, who is the n has been received from a registered Y pharmacist concerning a 53 year old female on chemotherapy Y who6/5/2009 on 05-JUN-2009 6/6/2009 was vaccinated ent's Hepatitis A immunization, Y she began Y languishing Y and eventually 1 turned jaundiced. AfterNa liver biopsy, 6/28/2007 she was 9/1/2007 diagnosed with autoim as given inital dose of Tdap on 06/04/09 and was give a 2nd dose on 06/29/09. Y 6/29/2009 6/29/2009 d syncope immediately following injection of Tdap. Patient sitting, depressed head between knees, Y passed 6/29/2009 ammonia6/29/2009 inhalant briefly under h vaccine breakthrough. Diagnosed in our office on 6/29/09 with Varicella. Had over 100 lesions. U No fever. 1/10/2008 6/26/2009 Pt presented to the emergency room for a cat bite. Y Patient recieved 11a tetanus diptheria toxoid U because hers 6/12/2009 was out 6/16/2009 of date. 6/17/09 - Pt p d breathing and had a cardiac arrest. Y CPR required. 7/23/09 Hospital records received DOSY7/1/09 to 7/2/09. 7/1/2009 Assessment: 7/1/2009 Syncope vasov 09 pt received Tdap.That same evening pt noticed her upper left arm at the location the immunization Y was 6/19/2009 given became 6/19/2009 red, painful and s MT REPORTS CHILD FELT HOT, COMPLAINED OF HEADACHE & PAINFUL LEFT ARM. ARM SWOLLEN 6/29/2009 &HOT6/30/2009 6/30 & WORSE 07/01/ EACTION TO L UPPER ARM--SWELLING (FIRM INDURATION) AND WARMTH OF L UPPER U ARM FROM 6/29/2009 SHOULDER 6/30/2009 TO JUST ABOVE OSE OF HEPATITIS B WAS GIVEN TWICE. NO ADVERSE REACTIONS AT THIS TIME. Y 6/15/2009 min after Varivax vaccine was administered Y patient began with throat itching, hives, lower lip Y swelling and7/1/2009 throat tightening. 7/1/2009No audible wh ENT PAIN IN LEFT DELTOID. NO LUMP, REDNESS OR SWELLING. FIRST SOUGHT TREATMENT U 5/26/2009. 5/11/2009 RECOMMENDED 5/16/2009 HEAT vax on 5/29/09. Reports she developed generalized papulovesicular rash on 6/17/09 @ 1600. Y On 6/19/09 5/29/2009 States 10 6/17/2009 "bumps on face, 2 on rea (1 3/4"x1 1/4") of mild erythema to posterior right arm with smaller central area of erythema. U Warm to 6/29/2009 touch. Developed 6/30/2009 on the night of g last injection (which was gardasil) she said she felt like she was going to pass out then slumps Y into my arms. 7/1/2009 She 7/1/2009 opened her eyes again of swelling/induration around injection Y site with associated pruritus. Y 6/30/2009 7/1/2009 watery diarrhea, nausea, stomach ache. U 6/22/2009 6/23/2009 anges after AVA 1 and 2. AVA 1 had Y black vision X 3-6 sec with needle injection. 1 hr later c/o U difficult focusing 4/3/2009 on letters/numbers 4/3/2009 being u #2 dose of VARICELLA on 6/23/09Yin right thigh on 6/25/09 mom noticed bruise and red swelling Y -> saw 6/23/2009 MD 6/25 and 6/25/2009 MD circled induratio immunizations 6/29/2009 AM. On morning of 6/30/2009 noted red hard spot on Right thigh 7/1/09 U Exam6/29/2009 11 x 20 mm 6/30/2009 area of erythema indu skin reaction. Red raised irregular border 10cm x 8cm. Fading center/clearing. Y 6/23/2009 6/26/2009 :45 pm pt. c/o tingling in arms after injections Y of MENACTRA and HPV. Pt also given Tdap. Pt Y asked to wait 6/30/2009 twenty 6/30/2009 minutes to make sure s ve episode - pallor & unresponsiveness Y 4 hrs after 1st set of immun on 2/5/09 - labs normal,YBP low, fine 2/4/2009 after. 2/4/2009 6/29/2009 n, redness and swelling. Y 6/29/2009 6/30/2009 rted to -us on 6-30-09 that 24 hours after receiving vaccines pt had a fever of 104 for 48 hours. Y 6/25/2009 6/26/2009 ed around March 12 and to this date the illness persists. The reaction is the loss of sensitivity N in the thumb 3/12/2009 and later3/12/2009 in the index finger. It l mix the DTaP IPV solution with the Hib Powder for the PENTACEL vaccination. Gave the DTaP Y IPV part 6/29/2009 of the PENTACEL pt's mother notif S GIVEN GARDASIL 1 ST DOSE ON 16/6/2009 AND SHE HAS THYOID SWELLING WHICH IS PATCHY 6/16/2009 BY DOPPLER 7/1/2009 CONFIRMATION so given T-DAP- MENACTRA, HEP YA Pt was given GARASIL (LA), within 30 sec. Pt becameYpale. unresponsive 6/29/2009 arms 6/29/2009 & legs became rigid, re if the lateral neuropathy of my daughters left leg is related to the GARDASIL vaccine, Y but N after reading7/29/2008 reports of numbness I feel obligat oid area of redness, heat, and induration. Y MOTRIN, ice, Benadryl advised Y 6/3/2005 6/4/2005 4/9/2009 6/27/2009 blisters on hand. Tender to touch on 6/28/09. Tx: VALTREX 1GM take 1 tablet 3x day # 15 ORF. U 6/24/2009 6/28/2009 around site and down media aspect of leg; no edema or induration or other rash. Developed day of immunization 6/22/2009to6/22/2009 next day. Reevaluated ely following immunization child lost Yconsciousness and experienced tonic-clonic movementsYof arms, upper 6/30/2009 body and 6/30/2009 neck movements. Pla as been hurting since injection 1 week Y ago. Today (7/2/09) patient woke up in tears and hurts U really bad6/25/2009 into her shoulder 7/2/2009 and has hard tim prior to 11:30 AM 7/1/2009. Represented Y in office with rash at 6:00pm Y 7/1/2009 7/1/2009 light headed, fever, nausea, vomiting, joint pain, headache. Y 6/23/2009 6/24/2009 len. Hard lump at injection site radiating into shoulder (Right). Mother was giving TYLENOL and Y BENADRYL 6/26/2009 and applying 6/28/2009 ice to site. d pain, swelling and decrease ROM in both wrists one week after receiving Typhoid injection.NShe was told 4/20/2009 at a Sports 4/27/2009 Medicine facility that N n has been received from a physician concerning a female "in her 70s" who was vaccinatedUwith a dose of PNEUMOVAX 23. The patient u was reported by a healthcare professional Y and described the occurrence of seizure in a 5-year-old Y male6/24/2009 subject who 6/24/2009 was vaccinated with H ater in the day, respiratory problems,Y chest pain and severe headache-slept all day 4/21/09 and Y condition4/20/2009 worsened.4/20/2009 4/23/09 taken to emer as given Immunizations on 6-22-2009 (Pentacel, Y Engerix-B, Prevnar,2 & Rotarix). He was hospitalized Y on6/22/2009 6-25-20096/22/2009 when mom reported at riencing itchiness--Thumb side of both arms; top of both thighs; back of neck; scalp; lower belly. U I do not 7/1/2009 see any rash 7/2/2009 (more than 3 weeks) mucous in stools; persistent Y belly pain; required 2 hospitalization of 2 days; Y diagnosed 1/23/2008 with COLITIS; 1/28/2008 could no longer b ported temperature of 104.8 the morning Y of 7/1/09. Low grade temperature the evening of the Y immunization. 6/30/2009 Treated 6/30/2009 with Motrin every 6 h
an 6-4-09 with small red area per Mom. Increased reddness 6-5-09. 10cm x 12cm red, hot, tender, Y swollen 6/3/2009 deltoid area. 6/4/2009 No ecchymosis. A ying, hard to console, on awakeningYthis morning Y 6/30/2009 7/2/2009 ain in upper arm at site of injection for 6 days. Swelling and inability to lift arm overhead. PainYwent down 6/26/2009 both arms and 6/26/2009 across shoulders. T e rash - chicken pox lesions, severeYitching, it's been 3 month since symptoms began and still ongoing 4/8/2009 4/10/2009 d rash at injection site developed 24 hr after injection. Treated with ice bag and TYLENOL. Subsided Y after 6/24/2009 another 24 6/26/2009 hrs. or Adagio visit, HPV # 3 due. Pt. states at this time she had reaction to HPV vaccine # 2, and Y didn't want # 3. ### Pt. reports she ### developed fe U 6/29/2009 6/30/2009 t. to clinic to receive HPV #2. Pt described symptoms after receiving first GARDASIL IZ within Y 2 hours after 4/9/2009 injection experienced 4/9/2009 fever, gas n the whole length of the Rt upper arm L elbow + use referred KINRIX and VARIVAX on thisYarm. 6/30/2009 7/1/2009 as received last AVA, noted sharp,Ystabbing, burning Y type pain (not like Y pain r/t inguinal hernia) N ?doubled 9/18/2003 over, couldn't 9/18/2003 sleep. Sought eva here he received MENACTRA is red & swollen 3-4" in diameter. Itchy, hard. U 7/1/2009 7/1/2009 ministered, then MCV - 4 given & second Y after this injection Pt. stated "I'm dizzy". Pt be came Y weak & pale. 7/2/2009 Checked7/2/2009 blood pressure & was ed vaccines Monday 6/29/09 and mom notice swelling and redness Wednesday morning on U 7/1/09. Pt. not 6/29/2009 complaining 7/1/2009 about arm, he said d bumps- Red on arm and legs. Itching Y and spreading, no fevers. Cramping two weeks ago.YDx Erythema 6/19/2009 Multiforme. , edema, tenderness at injection site, sm area of induration. Y 6/24/2009 6/26/2009 & redness left arm @ site of VARICELLA -> cellulitis Y 6/22/2009 6/24/2009 inistration of albuterol nebule, hepatitis a and varicella vaccines, patient developed rash on body Y and tingling 6/10/2009 in the 6/10/2009 back of her throat 06/10 ved dtap on 7\2\2009 was seen in office 7/3/2009 for site that was red, warm to touch, swollen, Y and painful. 7/2/2009 7/3/2009 ately 45 minutes after the DTaP shop was given to my daughter we arrived home from the doctor Y and she 6/25/2009 was floppy 6/25/2009 in my arms, would on ed HPV vaccine for 1st time on 6-17-09 at approximately 16:35 as part of P.E. (Pt. had received Y PPD in other 6/17/2009 forearm 6/17/2009 5 min. prior). At 16:4 and redness at injection site. Y 6/30/2009 oster involving the left side of face. Y U 6/30/2009 7/3/2009 etanus shot and was diagnosed with Y cellulitis 2 days later, being treated with cephalexin 500mg Y 3x a day 7/1/2009 for 5 days 7/3/2009 as unusually sleepy the day of and the Y day after the vaccinations; I noticed twitching in arms Yand legs, esp. 7/2/2009 hands; she 7/2/2009 moved wrists up and Y 6/24/2009 7/4/2009 per arm, where the injection was given, became very hot, achey, and swollen. The entire area N became red 7/3/2009 and extremely 7/3/2009 sensitive to touc nt received gardisil #1, Tdap and meningococcal Y conjugate vaccine 3 (ACYW-135) on 01June N 2009 -- administered 6/1/2009at6/23/2009 Pediatrics in facility. O n has been received from a 23 years old female for the Pregnancy Registry for GARDASIL who N on 16-MAY-2008 5/16/2008was 5/16/2008 vaccinated intramus n has been received from a registered Y nurse through the Merck Pregnancy Registry concerning Y a 16 year 3/28/2008 old female 3/28/2008 patient who on 28-MA follow-up information has been received from a Nurse Practitioner for the pregnancy registryYfor GARDASIL 8/18/2008 From a8/18/2008 nurse practitioner conc n has been received from a physician Y concerning a 22 year old female with no pertinent medical N history who 6/9/2009 on 06-APR-2009 6/13/2009 was vaccina n has been received from a physician Y assistant concerning a 15 year old female who on an U unspecified date was vaccinated with the first 0 n has been received from Y a physician Y and her Y office manager concerning a 19 years Y old female Y with no drug 7/1/2007 reactions 7/1/2008 and a history of ane n has been received from a physician Y concerning a 14 year old female patient with seasonalYallergies who 6/11/2008 on 11-JUN-2008 6/11/2008 was vaccinated n has been received from a study for Y ROTATEQ Y concerning a 17 week 0 old male who was vaccinated U with a second dose of ROTATEQ. Ei n has been received from a study for ROTATEQ Y concerning a 17 week 3 old male who was vaccinated U with a second dose of ROTATEQ. Th n has been received from a physician concerning a now 29 year old female patient who wasYdiagnosed with Bell's palsy 2 days after receiv veloped fevers about 2-3 days postYvaccination. Y 7/1/2009 7/4/2009 6/30/09 FOR 16 YEAR OLD WELLYCHECK. RECIEVED VARIVAX # 2. ON 7/1/09 WOKEYUP WITH RED, 6/30/2009 SWOLLEN 7/1/2009 TO TOUCH, WAR orts on Sat., July 4, 09, she noted aYmild rash at site of injection. Denies itching at this time and N had no other 6/29/2009 complaints. 7/4/2009 Reports that she diaphoresis, early analphylaxis, given Y diphenhydramine and epinephrine. observed in emergency Y room 7/2/2009 7/2/2009 ter recieving immunizations.Turned pale. Fell to the floor. Patient passed out for 10 seconds.YStated that she 7/6/2009 felt dizzy 7/6/2009 when she came to. after infection, by 7:00 p.m. 6/17/09, Y had high fever chills, muscle aches, pain down spine. YSevere muscle 6/16/2009 aches, 6/17/2009 child sobbing. Took to cieved shots, walked out of room feeling fine. Walked over to the check out desk after standing Y there for a7/6/2009 few seconds 7/6/2009 knees gave out and DEVELOPED ATRIAL FLUTTER/FIBRILLATION Y IN JUNE 2009, AND 3 WAS CONCERNED Y THAT IT MAY 2/24/2009 HAVE BEEN 6/12/2009 CAUSED BY VAC iving both vaccines, patient complained of the following symptoms later in the evening;EntireYmouth and lips 2/3/2009 were swollen 2/3/2009 and blistered, Pa and swelling at injection site left deltoid. Y 7/1/2009 7/2/2009 site approx 3 hours post injection. Approx. 9cm by 4cm. Pt crying and retracting RIGHT legYwhen leg touched. 7/2/2009Was7/2/2009 taken to the doctor a sh developed by 7/1/09. rash got worse Y by 7/2- rash was on hands, between fingers and on arms N and feet. 6/29/2009 right hand7/1/2009 was swollen and puff COMPLAINS OF SWELLING AND PAIN IN LEFT ARM ON 7/3/09 AFTER GETTING IMMUNIZATIONS U ON 7/2/2009 7/2/09. STATES 7/3/2009 SHE FELT H 50 mg prednisone x 3 days, angiodema with admission Y to hospital 6/19/2009, 2 benadry,discharged Y on 6/21/2009 5/27/2009 with6/16/2009 hydroxizene 25 mg 3/d
03 degrees started at 6pm, rash started at 5pm and crying from 10pm - 2am Y 7/2/2009 7/2/2009 ts to the clinic with 3 day hx of headache, joint pain, low grade fever, nausea, aphtous stomatitis. U Tx with 7/2/2009 SoluMedrol7/3/2009 125mg IM injection an to inform PHN that approx 24 hrs after receiving Tdap, Hep A and Hep B. Pt L arm where Tdap Y was given 5/29/2009 was tender 5/31/2009 for 24 hrs. Pt c/o upp warmth, tenderness to left upper thigh Y began approx. 24 hours after injection. Erythema measuring 10.56/29/2009 cm in diameter. 6/30/2009 Advised to apply c d flared urticaria scattered throughout her body. Pt seen today in office for rash for 4 days. Treated U with BENADRYL 7/2/2009 at 7/3/2009 home and prescribe e here today with Aunt (who has legal custody of child.) to show nurse Rt arm - Local reaction Y back of Rt6/30/2009 arm red, raised, 6/30/2009 swollen area mea ed up after it was given. Required BENADRYL for about two days. Y 7/5/2007 7/5/2007 area of erythema but no induration, Y (R) thigh Y 6/23/2008 6/23/2008 d office 9:10 am 6/29/09 regarding Hepatitis A shot received in office on 6/26/09 - States child Y developed 6/26/2009 fever- 1026/28/2009 degrees Saturday 6/27 9, we have this 20-month old her 4th DTAP, her 4th H flu, and her second Hepatitis A. 10 days U later she6/11/2009 developed a L nerve palsy in her L identally received RUBELLA vaccine in addition to HEPATITIS B vaccine Y 7/3/2009 identally received Rubella vaccine in addition to Hepatitis B vaccine Y 7/3/2009 e fever, nausea, headache Prior medical diagnoses: Hyperlipidemia dysmetabolic syndrome, Y diabetes, 6/23/2009 hypertension 6/23/2009 AP vaccine 6/29/09 @ Lt thigh and developed redness, swelling, and hardness 7/1/09 per Pts. N mother 6/29/2009 7/1/2009 swollen, warm to touch at site of injection. Y 7/3/2009 7/4/2009 p X 2 days 1 1/2 dollar size. Itchy/ rash U 6/29/2009 6/29/2009 ed area to right upper arm. There was Y some soreness to the arm as well. Patient developed worse Y URI s/s 6/17/2009 on 6/30/09 6/30/2009 as well. was reported by a physician and described Y the occurrence of vasovagal response in a 15-year-old U female 6/25/2009 subject who 6/25/2009 was vaccinated with 9 mother put infant to sleep on his back Y at 8:30Ypm. She then checked 1 him at 9:00 pm and found Y him face 6/19/2009 down and 6/21/2009 not breathing. Grandp bear full weight. Fever, R thigh erythematous swelling Y --> Dx: R thigh 1 myositis at site of injection, Y ultimate 6/24/2009 rebound with 6/24/2009 supportive cares. 9 L. Redness, swelling area hard around vaccine. Had open heart surgery 6/27/09.YSuffered brain U injury. Lactic 6/20/2008 acids6/20/2009 raised to brain, abnorm one week later sleepiness, Y weakness. Y By 2 wkYafter the vaccination 200she Y developed bilat legNweakness and could ###no longer ### walk. She was n has been received from a certifiedYmedical assistant concerning a 7 year old female patient N who on 25-JAN-2003 6/29/2009 6/29/2009 was vaccinated with the n has been received from a certifiedYmedical assistant concerning a 9 year old female patient Y who on 16-Jun-2001 6/29/2009 was 6/29/2009 vaccinated with the n has been received from a physician Y concerning a 72 year old female patient who on 10-JUN-2009 N was6/10/2009 vaccinated6/24/2009 with ZOSTAVAX (Mer n has been received from a pharmacist concerning two patients who within the last 30 days Y were vaccinated 5/1/2009 with ZOSTAVAX (Merck) (sub n has been received from a 24 year old female, for the Pregnancy Registry for GARDASIL, concerning Y the 2/4/2008 24 year 5/21/2008 old female who in Dece rmation has been received from a physician Y concerning a 14 year old female patient Y who received Y the second 9/4/2008 dose of GARDASIL and expe n has been received from a female patient who on an unknown date was vaccinated with GARDASIL. U "15 months from the completion of th n has been received from a licensed Y practical nurse, Y for GARDASIL,0 a pregnancy registry product, Y concerning 6/4/2007 a 243/18/2008 years old female patien orted in a newspaper article that an 18 year old female who was vaccinated with GARDASILU(dose, route and lot numbers 3/1/2008 unspecified). On n has been received from a physician Y concerning Y a female patient with 0 asthma who Y on an unknown N date, was vaccinated 2/1/2009 with the first dose ort received on 24 June 2009 from aYhealth care professional. An 11 year old patient receivedY a first time6/24/2009 dose of DECAVAC 6/24/2009(lot number U2 es infant started having diarrhea, vomiting, fever Y up to 102 on 4-15-09. 2 Was put in hospital on Y 6-19-09 for4/13/2009 dehydration. 4/15/2009 Received IV fluids an mitted to hospital on 4/13/09 for intussusception Y Y after receiving vaccines 2 on 3/23. 7/7/09 Received Y vaccine 3/23/2009 & PCP 4/12/2009 records which include E d GARDASIL Injection and was diagnosed Y with Ytransverse myelitis and is being treated with steroids. U Pt has 6/24/2009 LE weakness. 6/25/2009 7/17/09 Medica Y 6/29/2009 6/29/2009 came very fussy and developed fever Y to 102 after the immunizations. Patient did not want toYeat and fussiness 6/29/2009 lasted 6/29/2009 more than 3hours. F ue reaction Left arm and Right arm. VARIVAX and MMR SQ x 2. 6/24/09 at 10:00AM. Treatment Y ice and6/24/2009 TYLENOL.6/24/2009 No temperature. (Reco injection had raised, red, hard blotch at injection site. Slightly itchy. No temp. per pt. 5 days later Y pt reports 6/24/2009 all sx almost 6/25/2009 resolved. Feels fine whole body maculopapular rash with some areas of confluence and papa measure 2-13 mm N in size. One6/13/2009 large patch6/22/2009 34 cm on post (L) arm iven 1st GARDASIL shot today. Pt. passed out after feeling faint and sick to stomach. Pt. was Y pale but opened 6/29/2009 eyes6/29/2009 and was alert after Am uration over entire left outer thigh with central clearing with slight fluish like. U 6/25/2009 6/26/2009 ministering vaccines MMR and Varicella, Y patient began immediately having redness start @ injection Y site 6/29/2009 and spread6/29/2009 to about a 50% area a that the next day. After the shot in the Y late afternoon she started itching on her right arm in the area of the 6/23/2009 shot. States 6/24/2009 noted a rash with a tous blanchable rash on trunk, neck, face and head several hours after PENTACEL and PREVNAR Y injections. 6/30/2009 6/30/2009 ced pain in (L) hip on 6/23/09 - thenYstarted with egg sized red area with heat - progressed to U 11 X 5 cm6/22/2009 area - upper: 6/23/2009 illiac crest - Pt prese eadache, itching, rash, chest discomfort, Y tongue swelling, difficulty breathing. 8/14/09 MR received N from3/12/2009 pcp for DOS 4/21/2009 3/12/09. HPV#1 give er administration of vaccine. Pt hadYtight sided upper back pain which then radiated to her shoulder, N neck 6/15/2009 + head. Also 6/18/2009 developed erythema f 6/23 pt whole body turned red, arms & legs had red spots. Pt had 101 fever - Mother gave Y child TYLENOL. 6/23/2009 Pt was6/23/2009 taken to ER - temp the dness, swelling, warmth, soreness Y below sight of varicella immu Dx "Mild Superficial Cellulitis". Y Rx KEFLEX 6/23/2009 500 mg6/24/2009 po BID x 10d. 6/25/09
veloped bruising at injection site after withdrawal of needle, after 15 minutes had a small hematoma Y that6/22/2009 improved with 6/22/2009 direct pressure for 1 ash typical of rubella. Y Y 6/19/2009 6/26/2009 pm pt. felt dizzy (6/30/09) and cont to Y do so. 4:30 AM 7/1/09 oral temp of 101 degrees F. TYLENOL administered. 6/30/2009Incoherent 6/30/2009and fatigued a d a area - 10 cm- area of indurationYwith erythema and pain. Central area of erythema with surrounding Y 6/23/2009 area of lighter 6/24/2009 erythema. ythema and induration at site of injection 8.5cm x 6cm left arm. Y 6/23/2009 6/24/2009 fter vaccination postular rash on hands/feet Y No systemic signs/symptoms, vaccine site healed Y normally. 6/10/2009 Treated with 6/24/2009 ANTIHISTAMINE. 3 cm area of tan/lt. brown pigmentation of thigh where shot administered U 5/29/2009 6/1/2009 uption of pustules on erythematous base Y diffusely (out scattered), worse around head. Lesions U were in different 6/5/2009 stage 6/23/2009 of healing. Atypical fo en, painful, hard felling (solid) area around injection site. 1 and 1/2 inch in diameter. Recommended Y cold6/26/2009 compress,6/27/2009 instructed to call MD or and induration Y 6/30/2009 7/1/2009 ceived HPV #2 @ 4 pm 6/29/09. Developed Y generalized urticarial rash 6/30/09 @ 8 pm. 6/29/2009 6/30/2009 veloped a red raised area around injection Y site. It itches, is about 1" x 3". It developed between Y an hour 6/23/2009 or two after6/23/2009 injection. Patient waite d that immediately after the PENTACEL shot, child had 3 raised scratch areas. Then received Y PREVNAR. 6/22/2009 Developed 6/22/2009 erythema multiforme er 102-103, body aches, swelling atYinjection site , headache starting ~ 6 hours after injection of vaccine.6/26/2009 Took NSAIDS 6/26/2009 + Benadryl. Fever m erythematous induration area on upper arm. Received DTaP A/ DTap reaction Y 6/22/2009 6/23/2009 tous, swelling at site of injection no fever Y no systemic symptoms. No other sign. N 6/27/2009 6/28/2009 ceived the varicella vaccine on 06/26/09 (2nd dose). On 06/28/09 the parent notified the office Y that patient 6/26/2009 developed 6/28/2009 a three inch welt at th nted, went white, no treatment patient recovered fine with no ADR reported Y 6/3/2009 6/3/2009 vere HA, myalgias followed by hyperventilation & paresthesias, no fever or focal neurologic changes Y on exam 6/22/2009 * improved 6/23/2009 with MOTRIN. sized area of redness over (L) lateral Y thigh with mild warmth to touch, now tender, no fluctuance Y noted. 7/1/2009 7/3/2009 swollen & hot to touch 7/3/09 at injection site. Tender, painful. Pt would not put pressure x2d. Y Resolving today 7/3/2009 7/6/097/3/2009 swelling decreased (+ 2/09, Redness, fever, nausea, vomiting, Y swelling, pain. AUGMENTIN; BACTRIM DS, VICODIN, N IBUPROFEN. 6/20/2009 16 x14 6/20/2009 cm erythematous wa ew hours of vaccination the pt experienced pruritus at the injection site (VZV). Within one day Y she had developed 6/26/2009an itchy, red, swollen left Y 6/29/2009 Hep B dose # 2 of 3 at approx 11:30 AM 6/30/09 w/o incident mom called at about 16:40 reporting Y that his 6/30/2009 ears turned 6/30/2009 bright red and swoll ted at site of injection within 24 hrs & Y spread to bilat upper ext's. Macula/papular/ erythematous. N Most intense 6/25/2009 at inj. 6/26/2009 site w/bumpy, almost co d ACAM2000 on 6/25/09. Experienced Y robust take - 15mm. noted on 7/2/09. On 7/4/09, pt called with c/o 6/25/2009 of chest pain, 7/4/2009 SOB, pain in arm a mation at deltoid but very stiff neck & torticollis within 24h. Lasted 72 hour left trapezius & subscapular Y pain. 5/20/2009 5/21/2009 d ZOSTAVAX vaccine administered on Thursday, July 2nd. States that since then has beenUsore and arching 7/2/2009 from the 7/2/2009 waist down especia s after receiving DTaP, developed cough, wheezing, SOB followed by red flush and hives. Resolved Y with 7/7/2009 DECADRON, 7/7/2009 epinephrine IM, ora d vaccine on 6/26/09. On 6/28/09 ptYc/o chest tightness, shortness of breath, chest congestion Y & tightness. 6/26/2009 DX with6/28/2009 asthma flare per ER M tous swelling at site of injection (-) fever Y (-) systemic symptoms. No other signs. N 6/27/2009 6/28/2009 DTaP on 6/30/09. c/o pain at injection Y site approx 4-5PM. Redness began approx 6-7P 6/30/09. U Seen in6/30/2009 office on 7/1/09 6/30/2009 approx 11AM - sw s after receiving started with hives, they last one day and went away. Pt left with a reddenedYone inch around 7/2/2009 hard spot. 7/5/2009 Advised to use wa and swelling of arm. Y 6/17/2009 6/19/2009 notified of dose given outside of recommended guidelines. 0 reactions reported. Y 6/25/2009 Vaccination (itch, no fever); 5/16/09 - 1 spot (arm); 5/18/09 - 5 spots (arm, hip, leg); 5/19/09 = Y 10-20 (arm, 5/14/2009 hip, leg, back); 5/16/2009 5/20/09 - 30-40 s mp, reddened ongoing after 5 days. No pain. U 7/2/2009 7/2/2009 came extremely pale, lightheaded, experienced "bloody" taste in mouth immediately after having Y MCV4 administered. 7/6/2009 7/6/2009 Patient was monitore icella injection site became red, warm to touch, and raised the day after injection. Diameter Ysize as big as7/2/2009 approx. 3 7/3/2009 inches. came to work at 7am with temp over the next three hours of 99.8 to 99.9. At 11am fever became N 100.2 and 7/2/2009 employee 7/4/2009 was sent home from ates has red spots with a white center Y on left shoulder, left side of back of neck, on her lowerUscalp and 36/29/2009 spots under7/5/2009 her left armpit. Paren one conversation w/ grandmother on Y 6/12/09. Patient had swelling to left arm w/blisters (<50). U w/fever. Intended 6/10/2009 to seek medical attention w vaccine breakthrough. Had varivax x2. Diagnosed in our office on 6/30/09 with varicella. Had U over 100 6/27/2007 lesions. 6/28/2009 Dr. reported that patient had syncope Y x 2, tiredness, dizziness, swollen/rash on face on 7/1/09 Y at 1630. Pt. 7/1/2009 passed out 7/3/2009 and injured self. Dr ates at 7 pm infant began an unusual, Y ugrent screaming. Y Her breathing 1 became shallow, bluish Y color noted 5/5/2009 around mouth. 5/5/2009 Infant taken to H minutes after vaccines were given patient Y developed hives, right facial swelling, and gurgly resperations. Y 5/5/2009 Pt's mother5/5/2009 called into clinic, was extremity swelling from the knee to the thigh, warm to touch, temperaure to 102, upset stomach Y 4/23/2009 4/24/2009 nced swelling and redness at the site. Y This worsend into itching and then pain. pt went to theYER and had7/1/2009 a follow up7/1/2009 appt with us the next and swelling of left arm two days following Y getting vaccinations.RX of Sulfamethoxazole-Trimethoprim Y 200mg-40mg/5ml 6/24/2009 6/26/2009 oral suspension. 5 adache, Syncope Y Y 7/2/2009 7/3/2009
ion was given on May 1, 2009. Approximately 1 week after receiving the patient's third injection, N the patient 5/1/2009 developed 5/7/2009 small warts on her h vaccine break through. Had 2 doses of varicella vaccine. Diagnosed with varicella in office onU6-25-09. 8/13/2008 6/21/2009 c-clonic seizure with left facial, eye twitching Y lasting Y 2 minutes. Seizure 3 began the evening onY the day when 6/30/2009 vaccines 6/30/2009 were given, Patient ta n with headache, pain in lower back, hands and feet where tingly. Could not feel face. Pt was U complaining7/6/2009 of headache 7/7/2009 2 days prior of vacc d 2 chickenpox like rashes. 1 on lower left arm and other below neck Y 6/30/2009 7/2/2009 MMR where given on 06/29/09 in right thigh. On 07/02/09 pt accompanied mother.Complained U of red raised 6/29/2009 spot on6/30/2009 right thigh 9cm x 8cm. shots app 11 days ago now with redness to right thigh at site of shot and child with low grade Y fever and 6/25/2009 fussiness today 7/6/2009 mom noted small ng at injection site - red from shoulder to elbow warm to touch. Y 6/17/2009 6/19/2009 nd weakness days before menstrualYcycle begins since first dose on 5/14/08. Seizure on 07/07/09. U Has never 3/31/2009 had a seizure 7/7/2009before. Is not o g required doses of the Anthrax Vaccine -NUNK- myself and a majority of Soldiers I have spoken U with have 7/20/2004 described 7/20/2004 decreased ability to ter was encouraged to have the Vaccination GARDASIL at our local doctors surgery. She had U the first injection, with4/26/2009 no side effects, after th The patient had a mild fever the day after injection then developed a few vesicles on his back. U Symptoms:. 5/19/2009 1. Mild fever 5/20/2009 and a few vesicles note on 5/11/09- Patient here today as walk in to clinic complaint of reaction to shingles injection. States he has been 5/11/2009 symptomatic with scr ort received on 30 June 2009 from aYhealth care professional. A 47-year-old female patient, who U has a history 6/30/2009 of migraine 6/30/2009 headaches and a N N n has been received from a physician concerning a female who was vaccinated with the firstYand second dose of GARDASIL on unspecifie se events or treatment needed--adult dose given. Per CDC no further action required 6/29/2009 S Zostavax and within an hour the area of the inocculation on the right arm, was sensitive toUtouch and ached. 2/23/2009 By the 2/23/2009 next day the area wa d Hepatitis A & typhoid @ 1:30pm her Y mom called @ 3pm stated her daughter was having aYreaction c/o 7/7/2009 sob,headache 7/7/2009 dizziness, nausea Y Y 6/10/2009 6/18/2009 veloped jerking movements of armsYthe evening following administration of vaccine and the U jerking episodes 7/1/2009 persisted 7/1/2009 at least 5 days. Als y paralysis. 7/9/09 Hospital records Yreceived DOS Y 5/29/09 to 6/1/09.3Discharge Diagnosis: Lower Y extremity 5/29/2009 weakness, 5/29/2009 probable Guillain-Ba ving inj. pt sat down and passed outYin waiting room. Out for approx 45sec, pt taken to treatment Y room here 7/8/2009 in clinic and 7/8/2009 seen by attending ceived TDaP injection to left deltoid Y6/9/09. On Y6/11/09 patient called4 clinic to complain of n/vYduring the 24h 6/9/2009 following 6/10/2009 immunization and de accine given inadvertantly. Y 5/11/2009 7/8/2009 outer and anterior upper arm which has confluent erythema, induration, and tenderness overU12x6cm extending 7/6/2009 down 7/6/2009 to lower portion of bi as given Boostrix instead of Tripedia No further treatment required Y 7/8/2009 7/8/2009 cieved vaccinations at the health department Y on Monday. Patient came into our office todayYwith a fever, 7/6/2009 reddened, warm 7/7/2009 to touch, swollen as looking at wheni was calling his name and he stop talking 8-year-old intern in biostatistics who is here with left upper extremity pain, post a TDAP shotYthat she got 5/5/2009 on May 5. She 5/8/2009 had just arrived, w other called stating that she took her Y daughter to her doctor on 07/01/2009 after her arm developed Y a hard 6/30/2009 red area where 7/1/2009 she got her vacc amed and cried for two full days without sleep and then slept for two full days. When doctor Y was contacted 9/16/2006 and said9/16/2006 as long he isn't seizing eaction five days after injection. Large Y red rash covering entire deltoid area. Rash was hot, Yitchy and bright red with a white/yellow lump in 8 PM (Less than 24 hours after vaccine) developed red, itchy, swelling at IPV injection site, since then has 7/6/2009 had red itchy 7/7/2009 papules appear on cination given IM route. U 7/7/2009 zure. Febrile seizure- evaluated at hospital Y 4/8/09. Y 4/7/2009 4/8/2009 ceived ZOSTAVAX vaccine on 6/10/2009. Y Reported shingles-like symptoms on 6/13/2009 and went to her 6/10/2009 physician. 6/13/2009 Pt received medicatio ain at injection site. Y Y 7/6/2009 7/6/2009 6/26/2009 Varicella 7/1/09, 7/6/09 noted develop few rash on face / trunk / neck 2 mm--> 6 mm diameter U of papule vesicle 7/1/2009 lesions. 7/6/2009 hest, back and legs. Y Y 5/13/2009 5/13/2009 umbness. TX: CT of head. Blood work; Y no medicine. N 5/21/2009 5/27/2009 isters at various stages of healing on arms, legs and face, some excoriated. U 6/29/2009 7/1/2009 ted to office one day after receiving Yinjection with left arm hurting and rash on arm about sizeYof baseball. 7/1/2009 Pt then went 7/1/2009 to urgent care on 7er arm, redness, swollen, warm to touch. Y 6/29/2009 7/1/2009 was reported by a physician and described Y the occurrence of injection site cellulitis in a 5-year-old N male subject 6/1/2009 who 6/4/2009 was vaccinated with K n has been received from a consumer Y concerning her 12 year old student daughter Y with no known N drug allergies 8/8/2007who9/1/2007 on 09-MAY-2007 wa n has been received from a consumer concerning her son, a 15 month old male patient whoNon 04-NOV-2005 11/4/2005 was vaccinated 11/7/2005 with a 0.5ml n has been received from a 62 year old male with no pertinent medical history reported and N no known drug 2/21/2009 allergies, 4/15/2009 who on 21-FEB-2009 n has been received from a paper and poster presented at the Conference on Vaccine Research. U Four real-time polymerase chain reaction
ort was received 01 July 2009 from aY health care professional. A 14-year-old female patient U with a history 6/30/2009 of vomiting 6/30/2009 following a prior vacci ort received on 02 July 2009 from a Y nurse. A 63-year-old female patient, who hasYa current medical N history 6/18/2009 of lupus, 6/24/2009 had received an intram n over 2 weeks since my last guardasil shot and my left arm is still sore at the injection site. Feels Y like a 6/19/2009 sore muscle. 6/19/2009 Y 7/8/2009 7/8/2009 DISCHARGE AT INJECTION SITE,YSWOLLEN GLANDS, HEAVY NOSE BLEED, LARGE BLOOD U CLOTS 7/2/2009 inistration of vaccines. Client complained of lightheadedness. Nurse observed client to be pale, Y cold,clammy 7/8/2009 with buccal 7/8/2009 cyanosis client nev week, develops water filled blister which then pops. Several lesions on arms, trunk Y 6/24/2009 7/1/2009 ted after receiving immuizations as follows: IPV, Tdap,MMR,Hep A, Hep B. The temperatureYoutside was 7/2/2009 103degrees, 7/2/2009 the client stated she ely 15 minutes after vaccine administration client c/o, tingling of her upper lip and a hive forming Y above her 7/8/2009 left eyebrow. 7/8/2009 Shortly there after hours of immuniation Child called to Mom and was found in a crawling position able to talk but Y unable to move. 7/6/2009 His mother 7/6/2009 picked him up a redness and warmth at injection site. Approximately 2-3 inches in diameter. Hard knot at sight. Y Used ice7/7/2009 to injection7/7/2009 site. S/S X 2 days. d Tdap 0.5ml Im in left deltoid on 6/30/09. Y She called that evening to complain of pain at injection U site. Used 6/30/2009 ice and6/30/2009 took ibuprofen with so d HPV vaccine on 14 Apr 09. Pt went Y to urgent care clinic on 24 Apr 09 complaining that herNright hand had 4/14/2009 been numb 4/18/2009 for the past 6 days a call from son-in-law of patient stating that patient has two small fluid filled spots on patient Nforehead and7/6/2009 that his eyes 7/7/2009 are puffy. He state vaccine given at 1:35PM. At 1:45PMYitching, facial swelling, difficult breathing, signs of shockYbegan. Taken 6/25/2009 to Beverly 6/25/2009 hospital emergency r iven in Right deltoid. Next day hot to Y touch, redness, and swelling measuring 40 X 19 cm Y 7/7/2009 7/7/2009 onset of pain in joints on injection side arm immediatly after injection, this progressed to joint N pains in wrists 6/3/2009 bilaterally6/4/2009 x 6 weeks since injec 10cm x 10cm Flat with raised middle, reddened and warm to touch. Advised pt to apply cool compress and 7/7/2009 massage7/9/2009 every 20 minutes doses of DTap and IPV were given on 12/8/08 to this patient due to confusion re contents ofUnew combination 12/8/2008 vaccine 12/8/2008 being used at Clinic atigue (sleeping 20-22 hours per day). In Jan. Y she started to throw up, 2 on 1/19 she had a migraine N symptom 12/2/2008 that was 12/7/2008 painful and affected , trouble breathing, loss of Y voice, malaise, Y crying, headache, chest discomfort, pain Y at injection N site with swelling, 6/14/2007dizziness, 6/14/2007 abdominal pain welling, induration, pain and fever locally. 7/7/2009 7/8/2009 ss than a minute after vaccines, Y heYcomplained of lightheadedness followed by unresponsiveness, Y pallor 7/7/2009 and rolling 7/7/2009 of eyes, lasting for abo around injection site "hardness" warmth Y to touch. Injections given on Wednesday. Father didYnot notice symptoms 6/24/2009 until 6/26/2009 Friday morning. Fat dministered on Wed. 2. Thursday - dizzy - low fever by evening, very cold. 3. Friday am feverU- dizzy - feeling 6/24/2009 faint. Friday 6/26/2009 by 12:00 very cold h (injection site) with 4 in x 7 in red, Y indurated, warm to touch, antibiotic (po. given to tx cellulitis. 6/29/2009 6/30/2009 AX was administered on 6/9/09. Pt got Y a fever on 6/10 and then a shingles rash on 6/21. She U was diagnosed 6/9/2009 with shingles 6/10/2009 on 6/24/09. and erythema. Y 6/16/2009 6/17/2009 , nausea and vomiting - patient wasYsent to ER. Y 6/11/2009 6/12/2009 ceived GARDASIL and DTaP in left arm. Patient had allergic reaction to GARDASIL, come inY on 7-29-096/30/2009 to report. small 7/2/2009 red rash and soren ped Varicella infection; < 50 lesions Yall over body, oral lesions, with fever; but crop of 10-15 vesicles U grouped 6/18/2009 around6/21/2009 vaccine site in thigh. cm swollen right upper arm and 2 by 2 cm lower right arm lateral aspect. Y 7/2/2009 7/3/2009 yellow fever vaccine on 7/1/09 no complications. 7/4/09 c/o: nausea, vomiting, severe stomach Y ache, diarrhea, 7/1/2009 low grade 7/4/2009 fever and flat ras swelling R arm deltoid. N 7/7/2009 7/8/2009 redness and pruritus. Marked induration/erythema entire left upper arm. 7/7/2009 7/8/2009 esical 2" X 1" surrounded by hot, red Y area 6" X 8" (injection site left arm) itching, painful. Symptoms began 7/6/2009 24 hours7/7/2009 after receiving vaccin ived vaccination 7-7-09; child awoke Y 7-8-09 with redness and pain on right thigh area of vaccine Y administration, 7/7/2009 mom7/8/2009 took child to MD offic ed MMR and VARIVAX subcutaneous to right upper leg. Within 5 minutes developed large red Y hive to area 7/7/2009 of injection. 7/7/2009 Pt was given oral B a of erythema at deltoid area, no fever, non-tender, no cellulitis. Y 7/7/2009 7/9/2009 erile abscess with 5 X 3 cm redness and 2 cm non tender subcutaneous knot. N 7/7/2009 7/7/2009 erythema ~2 1/2 inches oval with warmth Y about 24 hrs after imm. 48 hrs-72 hrs later the redness N increased 7/3/2009 to 17 x 13 7/4/2009 cm oval on (R) uppe eg, knee pain. 7-3-09 - Numbness, Y low grade temp, chills - saw MD - labs done - tested negYfor strep/flu 6/30/2009 - sore throat.7/2/2009 7-4-09 - No strength 15 mos vaccines. Developed swelling and erythema, first noticed by mom the following day Y at 11:00AM.6/30/2009 Approx 5x9 7/1/2009 cm swelling and eryth swelling at site of injection (thighs) with refusal to walk 2 days later day. Pt seen & was able to Y bear weight 6/24/2009 but refused 6/26/2009 to walk next morning Y Y 7/7/2009 7/7/2009 ed, swollen, tender to touch in small area. U 7/6/2009 7/7/2009 rm swelling, temp and pain. On day Y2 after immunization given. U 6/16/2009 ately 12 hours after administration of hepatitis A vaccine, pt developed hives over entire body. Y No other known 7/6/2009 cause7/6/2009 for hives. ort received on 02 June 2009 from a health care professional. A 16 year old female patient with U allergies 5/28/2009 to Augmentin 5/29/2009 and Ampicillin receiv ella vaccination administered to the patient has resulted in chickenpox. At this time, I could not U determine 7/1/2009 how severe7/8/2009 the effect on a one ye izure 3:38 am after vaccine admin previous Y day. Y 6/30/2009 7/1/2009
n has been received from a nurse concerning a "12 year old" female who was vaccinated with U her 1st dose of GARDASIL, 0.5ml, IM. The n has been received from a 72 year old female,Ywho on an unspecified 0 Y date "couple of months N ago", was vaccinated with a single dose of Z n has been received from a physician Y concerning a 65 year old male patient withYdiabetes, gastrooesophageal N 6/23/2009 reflux7/4/2009 disease (GERD), alle n has been received from an 89 year Y old female patient with arthritis who was vaccinated Y with N ZOSTAVAX 7/1/2008 (Merck) one 1/6/2009 year ago approxim xis - Vaccine given @ 1:45 Y pt went home Y started @ 5:00 pm with hives then 7:00 pm chest tightness, U SOB7/8/2009 then went7/8/2009 to ER. Pt went home tions followed about 4-5 hours by fever Y and febrile Y sz witnessed lasting about 10 10 min. Pt also Y with (L) otitis 7/8/2009 media. No sequelae. 10/20/0 veloped approx 12 raised blistered. very puritic. no treatment necessary. Y 6/17/2009 6/19/2009 tion given on 6/30/09. Parent called 7/01/09 to report child had no problems on 6/30/09 but when Y he awakened 6/30/2009 on 7/01/09 7/1/2009 he complained o eling nausea and dry heaves in beginning, then dizzy and diaphoretic. Mat brought in and patient Y assisted 7/10/2009 to floor and 7/10/2009 blood pressure taken veloped a bright red, irregular shaped, Y warm, slightly itchy, bumpy, firm and slightly raised area U around her 7/6/2009 second Varicella 7/8/2009vaccine, abou urning & itching, extensive swellingYelbow to neck, pounding headache, muscle pain, joint pain, N low fever,7/2/2009 nauseous.7/2/2009 Treatment: tylenol, b redness and swelling left arm ~ 12 hrs after receiving pneumovax taking Motrin with effectY 7/8/2009 7/9/2009 SS AND SWELLING, SLIGHT REDNESS LEFT ARM FROM ELBOW TO SHOULDER ~12 HRS Y AFTER RECEIVING 7/8/2009 7/9/2009 PNEUMOVAX I ine administration the pt was standing waiting w.his mohter for the vaccine record, he fall backward Y hit the7/9/2009 wall w.his 7/9/2009 head and slide down t c'd vaccines 7/8/09 and on 7/9/09 had Y an event that starting with high pitched scream then patient Y went stiff 7/8/2009 and eyes7/9/2009 rolled back and rema usculostreleted pain and weakness.YSkin desquamation Y @ fingers;20 Dermatitus Y @ head. 7/23/09 N Received6/6/2009 hospital 6/15/2009 medical records for 7/418 y.o w/m administered a Tdap IM:(lt)Deltoid Y (Boostrix)Glaxo-Smith-Kline:lot Number AC52B039BA Y Immediately 7/10/2009 after 7/10/2009 injection pt. became h Mother who has noticed no difference in the childs behavior or in the injection site. Informed U mom of error 7/9/2009 and told her that she might noti n around the smallpox site. With a diameter of 8cm. With No fever, No chills, No chest pain, Y No nausea, No 7/2/2009 vomting, 7/10/2009 No night sweats, No h 4 days after Rotateq (6/26/09). Change Y in formula before vaccine to Prosobee. Seen for gastritis U 6/30/09-diarrea 6/22/2009 x 3d. 6/26/2009 esented with redness, warmth, swelling and pain of right arm surrounding injection site in area U measuring 7/7/2009 12 cm x 7 cm. 7/9/2009 Treated for possib nd evening after patient received the Varicella vaccine, my husband called me at work to tell U me patient told 7/8/2009 him to look 7/9/2009 at his arm because AVA #3 and Tdap on 6/29/09 as routine Y vac update. (He denied any recent or current URI symptoms.) Y That 6/29/2009 evening6/29/2009 he noted onset of fatig se event/pregnancy outcome report of vaccines inadvertently administered during pregnancy AVA and TYPHOID 8/14/2008VICPs administered on 14 2m vaccination with oral Rotavirus on 6/30/09. Aphthous ulcer - onset 5 days after ROTATEQ. Y 6/30/2009 7/5/2009 ter receiving vaccine pt c/o H/A dizziness and nausea that lasted 5 hours. Y 6/11/2009 6/11/2009 r GARDASIL developed fever, myalgias, swollen eyes; diagnosed with "mono". Monospot (+) Y however EBV 6/26/2008 titers all6/27/2008 negative. Never felt co h after vaccination, child developed 11cm diam red tender indurated lesion on right deltoid centered Y at varicella 7/9/2009 injection 7/10/2009 site. By 48h, increa slight), looks reddish (as if hit by tennis ball on left arm. U 7/9/2009 7/11/2009 ed patch ~ 1cm above MMR injection site in right arm, occurred almost immediately after injection. Y Child observed 7/9/2009for7/9/2009 ~20min. Rash enlarge O x3. HPV given L deltoid. Pt passed out 1-2 secs after vaccine given. Pt arousable. A and OY x 3. Vital signs 7/9/2009 stable. Pt 7/9/2009 tearful and pale. Pt s ness and swelling 4 days after vaccines R arm- TDAP 5 1/2 - 6cm. L arm- MENACTRA 4x4 5cm. Y 7/6/2009 blistering of arm. 6/18/2009 6/20/2009 e and Anaphylactic reaction reaction 10 minutes after vaccination patient presents, generalized Y swelling, erythema, 7/8/2009 cough, 7/8/2009 shortness of bre PNEUMOVAX in left deltoid. Skin gotYred, hot, erythematous. Pain in arm started within 2 hrsYof getting shot. 7/8/2009 Using ice7/8/2009 prn, otc Benadryl 25m dministration error HIB vaccine mixed with Merck DILUENT for MMR DILUENT Lot # 4060XYExp Dec 2010 6/8/2009 veloped a 3cm erythematous, warm, circular area at site of injection the morning after she received U it. Treatment 7/9/2009- Benadryl 7/10/2009PO prn, Motrin started burning itchy area on site area Y that night and next day Rtc - got more down arm - saidY took BENADRYL 6/17/2009 2 days 6/17/2009 that helped - so didn oreness, tenderness, knot @ site, no redness. U 7/9/2009 7/10/2009 ter given, sudden onset head ache stomach pressure and nausea, last 2 hours with suddenYrelief. Also during 7/9/2009 this time 7/9/2009 family noted Pt had arm is red, swollen from deltoid to elbow warm & tender to touch. Referred to PMD. & this office to follow7/8/2009 up with mother 7/9/2009 on Monday 7-13 at injection site, left deltoid, measuring approximately 4cm. long, 3cm. wide. Warm to touch, no pain, knot 7/7/2009 approximately 7/9/2009 2cm. round, itching X WAS GIVEN AS PPD. 0.1 ANTHRAX GIVEN INSTEAD OF TST. U 7/11/2009 MEMBER GIVEN ATHRAX 0.1 ML INSTEAD OF TST. U 7/11/2009 head have hurt enough to prevent sleep. Some 30 hours after innoculation chills and fever were U experienced 7/9/2009 for about 7/10/2009 an hour. 30PM on 7/10/09 and at 8:30am while asleep. 8/5/09 Primary care provider medical recordsYreceived DOS 7/7/2009 6/17/097/10/2009 to 7/14/09. Includes po ustules at site of inoculation spreading to Pt's neck, chest and arms. Sore throat with minimalUexudate on 7/1/2009 (R) tonsil, 7/11/2009 difficulty swallowing, mi ALSY(RIGHT SIDE) DAY AFTER ADMINISTRATION NO OTHER COMPLAINT REFERD BY U PT. NO FEVER 7/7/2009 GENERAL 7/8/2009 MALAISE OR HE 7th my 5 week old daughter was given a Hepatitis A vaccine by a medical assistant in my doctors Y office. She 7/7/2009 was supposed to get the seco hird vaccine of GARDISIL i stoped getting my period, now if i dont take birth controls i wont get U my period. 10/1/2007 1/1/2008 at 0200 with pounding headache, and Y took excedrine. Came into clinic this morning for followYup after receiving 7/11/2009 2 vaccines 7/12/2009 yesterday. Pulse
algias, headache all started aroundY11pm last night. Also had a "few drinks" last evening. Chief Y complaint 7/11/2009 today: headache, 7/11/2009aches. Denies fter Tdap vaccine, awakened with painful, hands and feet, malaise, fatigue. Initially would occur N as frequent 3/13/2007 episodes. 4/5/2007 Pain was symetrical n has been received from a physician concerning a 63 year old female with no known Y drug allergies N and2/20/2009 who was first 2/27/2009 diagnosed with herp n has been received from a registered nurse concerning Y a female who 0 on an unspecified date U was vaccinated with a dose of GARDASIL (d n has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 8/1/2007 and no known 8/1/2007 drug allergies/d ort received on 06 July 2009 from a Y physician. A 57-year-old female patient, who has allergy U to bee stings7/2/2009 and pesticides, 7/2/2009 but no known dru was reported by a healthcare professional Y via sales representative and described the occurrence U of cellulitis 5/19/2009 in a 5-year-old 5/21/2009male subject w was reported by a healthcare professional via sales representative and described the occurrence U of cellulitis 5/19/2009 in a 5-year-old 5/21/2009female subject ven Mon., 7/6/09 at 3:30 pm. 7/7/09-around Y 4 am headache started; by 4 pm vomiting and hot. Y 5:30 pm fever 7/6/2009 104ø. Took 7/7/2009 to ER at 6 pm. Tx Vaccine breakthrough. Had varivax on 3/10/05 and 4/8/08. Diagnosed in our office on 7/6/09 Y with varicella. 4/8/2008 Fever for 6/30/2009 72 hrs starting on 6/3 mplaining of dizziness and nausea the date of injection with a knot and redness at the injection U site that has 7/8/2009 increased 7/8/2009 to a size of a baseb COMPLAINED OF AN ITCHY RASH ALL OVER HER BODY. THE RASH BEGAN SEVERAL Y HOURS AFTER 7/2/2009 THE VACCINE 7/2/2009 WAS ADMIN th fever >102.0 less than 12 hrs after receiving immunization. Patient resolved in 48 hrs without Y specific intervention. 7/8/2009 7/8/2009 hts sweats, weight loss, Yaches, pneumonia Y 7/16/09 ICD-9 Codes: 486 (pneumonia unspecified U organism, 515### (postinflammatory 12/1/2008 pulmonar ED ON MONDAY (7/13/09) MORNING Y AND SAID THAT SHE AWOKE ON SUNDAY (7/12/09) U WITH A "BREAKOUT" 7/8/2009 7/12/2009 ON HER STOMACH ess of R arm, mild swelling near injection site, chills, sweats, body aches, nausea, mild erythema Y at injection 7/7/2009 site. Seen 7/7/2009 in clinic 7/9, vac adm d red, hot, raised, itchy blotch under the left arm (shot injected into left arm) and also left upper U chest above 7/8/2009 nipple area. 7/9/2009 Patient took Bena S WITH EDEMA AROUND INJECTION Y SITE IS LEFT DELTOID APRROX. 5X4 INCHES IN YSIZE. CHILD7/8/2009 WAS EVALUATED 7/9/2009 AND TREAT ear-old female was brought Y in by ambulance Y with Y a one-day history11 of Ytrouble eating Y that sheNdescribed as difficulty ### chewing food secondary 01, redness, raised bump, and severe soreness at injection site. U 7/10/2009 7/10/2009 ports having an MMR vaccine 90 days before conception of pregancy. No complications from Y the vaccine were reported. 6/30/2009 Fetal sonogram d dose Varicella, 48hrs later injection site red & swollen, then painful red welts on entire body.YPatient also6/2/2009 experienced 6/4/2009 nausea and dizzines with a rash on buttovk, sides, thighs, Y sow spreading, was told it is granuloma annulare. Appeared N after vaccine. 5/27/2008 Stil5/30/2008 having shingles, not as vaccine without incident at 1630 on 7/8/09, on following day [7/9/09] child almost passed outYabout 1100 hours 7/8/2009 in am.7/9/2009 Reportedly child sat nduration (+) erythema, warm to touch. Rx for tylenol/benadryl given. Y on site indurated, erythematous 99.2 Temp. Body aches. Y 6/20/2009 6/21/2009 oke up this morning (7-13-09) w/small lesions (rash) approximately 12 lesions between breasts, U slightly oozing 7/10/2009 0, size. 7/13/2009 efore injection. Syncopal episode after injection recovered after lying down. Mom reports nausea Y for few hours 6/26/2009 after.6/26/2009 07/11/09 Swelling & cellulitis from left Y elbow up to his neck including entire upper arm - with multiple Y blisters 7/8/2009 at injection 7/10/2009 site seen 7/11/09 R es Fevers- per pt. None while seen Y at the office. N 6/18/2009 6/19/2009 irregular rash on upper L arm - erythematous swollen area with mild tenderness. N 6/29/2009 7/1/2009 ear old male reported receipt of ANTHRAX Y vaccine 8/26/1998 while stationed at AFB, as an N airfield management 8/26/1998journeyman. 1/1/2007 He reported alaise, weakness, low grade fever, headache Y - Painful rash across left breast. Y 7/8/2009 7/9/2009 rash - additional sores. Pt with erythema 8cm diameter around wound / small pustule (3mm)Yon opposite6/24/2009 R lat. elbow, questionable lesion o P/Menactra in (L) Deltoid on Wed 7/1/09, on 7/2/09 had headache, on 7/3/09 headache goneYbut had rash, 7/1/2009 redness, 7/3/2009 swelling & hot to touch iving MMR shot at age 1, patient lost her words. About 1 month later, she startedYmaking eeee U sounds. At 4/9/2007 18 mo, she 4/9/2007 had 2nd HEP A sho pain, swelling localized to injection site that started one day after injection given. Treated with Y AUGMENTIN 6/18/2009 with complete 6/19/2009 resolution. with rash 5/26/09. Mild fever began 5/27/09. Denies any other problems. Denies difficulty breathing, Y swelling 5/14/2009 around 5/26/2009 lips/throat or hives. Ra 5 immunizations. After receiving last immunization c/o not feeling well, passed out + hit head Y on floor. 6/5/2009 6/5/2009 hed Notes. See back. Client in today for immunization and PPD. Client very apprehensive Y upon entering 6/19/2009 immunization 6/19/2009 room. MENACTR 6-19-09 spoke with RN c/o having reverse reactions to vaccines given 6-16-09. Pt. stated she was told to 6/16/2009 call back Monday 6/19/2009 6-22-09 if she d ceive injection - next day began developing local reaction - red, hot, painful R deltoid. That night developed7/8/2009 flu - like Sx 7/9/2009 - exhausted, body a ely after the 2 vaccines were given, patient complained of not feeling good. Pallor and sweating Y noted; also 7/13/2009 complaints 7/13/2009 of nausea- then vom h over abdomen and extremities. Y 7/7/2009 7/9/2009 eport change of affect of patient -> seems "lethargic" per parent. Also c/o pain in left leg where U he received7/9/2009 vaccination. 7/10/2009 O/E patient had lim welling/induration of deltoid region persisting 5 days after immunization. Y 7/8/2009 o rash on arms torso chest for 4 days after getting VARICELLA #2 vaccine given 4 days priorUto rash. 6/29/2009 e fever since immunizations. On 7/8/09 Y at app. 5 AM temp increased 102 and pt had seizure. EMS called 7/6/2009 to home. Pt7/8/2009 evaluated by pediatric r vaccines, right thigh grossly swollen, Y indurated, red lacey rash over anterior thigh. Pt with decreased Y range 7/7/2009 of knee 7/7/2009 motion. Received DEC Y 7/2/2009 sating pain in shoulder radiating to back Y 6 hrs post vaccine. No redness or swelling. UnableYto sleep 2 hour 6/18/2009 pain. Much 6/18/2009 better post 24 hou
n has been received from a physician concerning an 84 year old female with allergic to medications Y who1/20/2009 on 20-JAN-2009 1/24/2009 was vaccinated w n has been received from a registered nurse concerning a 57 year old female patient with bipolar N disorder, 2/23/2009 hypothyroidism, 2/23/2009 penicillin allergy n has been received from a pharmacist concerning a 79 year old female patient, who on 20-FEB-2009, N was 2/20/2009 vaccinated 2/23/2009 with ZOSTAVAX (M n has been received from a physician concerning a 66 year old female who in 2008, "a few months U ago", was vaccinated subcutaneously w n has been received from a registered Y nurse concerning an 87 year old male who was vaccinated Y with a dose 3/1/2007 of ZOSTAVAX 3/1/2007 (Merck) on an n has been received from an office manager concerning a 76 year old female who on 10-FEB-2009 Y was subcutaneously 2/2/2009 2/2/2009 vaccinated with a n has been received from a medicalYassistant concerning a 63 year old female patient with allergy Y to tetanus 1/1/2009 shot and 2/1/2009 a history of bowel irr n has been received from a physician concerning himself over 60 year old who was vaccinated Y with a dose 2/12/2009 of ZOSTAVAX 2/15/2009 (Merck) (specific n has been received from a certifiedYmedical assistant concerning a male with hypertension N and sleep apnea 2/23/2009 and no 2/24/2009 allergies reported who n has been received from a physician concerning a 71 year old female who on 24-FEB-2009, Y was vaccinated 2/24/2009 with a2/25/2009 dose of ZOSTAVAX (M n has been received from a registered pharmacist concerning a female patient "over 60 years Y of age", who was vaccinated with a dose of Z n has been received from a Nurse Practitioner Y (N.P.) concerning a 73 year old female patient Y who "last year" was vaccinated 2/23/2009 with a 0.65 m n has been received from a registered pharmacist concerning a male patient who on 25-FEB-2009 U was 2/25/2009 vaccinated 2/26/2009 with a dose of ZOSTAV n has been received from a physician Y concerning a 75 year old female who in May 2008, was N vaccinated 5/1/2008 with ZOSTAVAX 5/1/2008 (Merck) (lot no. n has been received from a nurse practitioner Y concerning an "over 60" year old female patient Y with hypertension 1/9/2009and 1/23/2009 cholesterol high, who n has been received from a Licensed Y Practical Nurse concerning a 64 year old male patient Uwho on 16-JAN-2009 1/16/2009 was 1/21/2009 vaccinated with a do n has been received from a physician Y concerning a 67 year old male with a hypertension and Y hypothyroidism 2/27/2009 and a history 3/2/2009 of multiple nonn has been received from a registered Y pharmacist concerning a 66 year old female with allergies N to Ibuprofen 2/26/2009 and CEFTIN 2/28/2009 who on 26-FEB n has been received from a registered pharmacist concerning a 72 year old female patient with Y a history1/25/2009 of hypertension 1/25/2009 who on 25-JAN-20 n has been received from a pharmacist Y concerning an approximately 60 year old female whoN on 25-Feb-2009 2/25/2009 was vaccinated with ZOSTA n has been received from a pharmacist concerning a 71 year old female with allergic reaction N to ZITHROMAX 3/2/2009 who on 3/3/2009 02-MAR-2009 was v n has been received from a physician concerning a 60 year old female banker with a historyUof type II diabetes 1/21/2009 mellitus 2/25/2009 and no acute illness n has been received from a licensed Y practical nurse concerning a patient with no known drug N reaction/allergies; who on an unspecified date n has been received from a consumer Y concerning her 86 year old husband with diabetes and N hypertension and### a history of brain tumor. No n has been received from a pharmacist concerning a 42 year old female patient with chronicYshoulder pain, asthma ### and unspecified ### allergie n has been received from a registered Y pharmacist concerning a 63 year old female patient with U penicillin, 3/2/2009 sulfonamide, 3/3/2009 codeine, MOTRIN, a n has been received from a physician concerning a female who was vaccinated with a 0.65 N ml dose of ZOSTAVAX (Merck) on an unspecif n has been received from a Doctor of pharmacy concerning a 67 year old female patient with N no drug reactions/allergies 2/18/2009 2/19/2009 and hypercholeste n has been received from a pharmacist concerning a 67 year old female with no drug allergies N who on 03-MAR-2009 3/3/2009 3/3/2009 was subcutaneously n has been received from a pharmacist concerning a 65 year old male patient who on 03-MAR-2009 N was 3/3/2009 vaccinated3/3/2009 with ZOSTAVAX (Mer n has been received from a physician concerning a 71 year old male patient who on 27-FEB-2009 U was vaccinated 2/27/2009 with 3/5/2009 one dose of ZOSTA n has been received from a pharmacist concerning a 73 year old female with penicillin allergy, U sulfa allergy, 12/1/2008 allergy codeine, fish allergy and n has been received from a 71 yearYold female who on 05 -JAN-2009 or 06 -JAN-2009 was N vaccinated with 1/5/2009 a dose of1/5/2009 ZOSTAVAX (Merck) n has been received from a registered nurse with no known medical history and drugs allergies, Y who on 03-May-2009 3/3/2009 3/3/2009 was vaccinated with n has been received from a physician concerning a 70 year old female who was subcutaneously U vaccinated with a 0.65 ml dose of ZOSTA n has been received from a consumer concerning a 62 year old female who on 03-MAR-2009 U was vaccinated 3/3/2009 with a 3/4/2009 dose of ZOSTAVAX ( n has been received from a pharmacist concerning a 79 year old female patient with allergicNreaction to neomycin 3/3/2009 who 3/3/2009 on 03-MAR-2009 w n has been received from a pharmacist concerning a 74 year old male patient who on 03-MAR-2009 N was 3/3/2009 vaccinated3/3/2009 with ZOSTAVAX (Mer n has been received from a consumer concerning her husband, a 75 year old male patient, with N no known 2/24/2009 drug reaction/allergies 3/3/2009 and with n has been received from a 78 yearYold female consumer with PENICILLIN allergy who in approximately N January 2009, was vaccinated wit n has been received from a physician concerning a 65 year old female patient who on unspecified Y date was vaccinated with a dose of ZOS n has been received from a pharmacy student who heard second hand that a patient was vaccinated U with a dose of ZOSTAVAX (Merck). C n has been received from a registered pharmacist concerning an "over 65 year" old female patient N who on3/4/2009 04-MAR-2009 3/6/2009 was vaccinated w n has been received from a registered nurse concerning a 67 year old female patient who "3Nmonths ago" 12/1/2008 in approximately 12/1/2008 December 2008 n has been received from a Nurse Practitioner Y (N.P.) concerning a 71 year old female with hypertension N and 2/5/2008 no drug 3/10/2009 allergies who on 05-F n has been received from a consumer concerning herself who on 10-MAR-2009 was vaccinated N with a dose 3/10/2009 of ZOSTAVAX 3/11/2009 (Merck). On 11 n has been received from a medical assistant concerning her mother (a 63 year old female) Y with diabetes who had a shingles outbreak "un n has been received from a registered pharmacist concerning a female patient who on an unspecified U date was vaccinated with ZOSTAVA n has been received from a 67 year old female patient with no drug reactions and "shingles N 10 years ago"3/5/2009 "1 week ago" 3/5/2009 on approximately 0 n has been received from a veterinarian concerning her mother, a female in her eighties, who U in December 12/1/2008 2008 was 12/1/2008 vaccinated with ZOS n has been received from a physician concerning a female who was vaccinated with ZOSTAVAX Y (Merck) 0.65ml. The patient had herpes a
n has been received from a nurse practitioner Y concerning a 50 year old nurse female who experienced N eye and face3/13/2009 exposure to ZOSTAVA n has been received from a 70 year old female patient with sulfa allergy who on 31-JUL-2008 Y was vaccinated 7/31/2008 with a7/31/2008 single dose of ZOSTA n has been received from a physician Y concerning an approximately 64 year old female who Y in May 2008,5/27/2008 was vaccinated 3/10/2009 with a dose of ZO n has been received from a physician Y concerning an approximated 75 year old female with no Y known drugs 2/24/2009 allergies 2/24/2009 and medical history, w was reported by a healthcare professional and described the occurrence of cut hand in a 56-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated w n has been received from a 82 female Y with sulfa allergy and antifungal drugs allergy who onY30-DEC-2008 was### vaccinated 3/15/2009 SQ with 0.65 m n has been received from a physician concerning a 61 year old female with hypertension, arthritis, N imbedded 7/11/2008 rose thorn 10/1/2008 removed from left a n has been received from a physician Y concerning a female patient who on 02-MAR-2009 was U vaccinated 3/2/2009 with a dose3/2/2009 of ZOSTAVAX (Merc n has been received from a physician concerning a 70 male with no reported allergies, who Y on 20-JUN-2008 6/20/2008 was vaccinated 6/20/2008with a 0.65mL n has been received from a consumer Y concerning her 66 year old husband with no known drug N reactions/allergies 1/8/2008 with 2/25/2009 hypercholesterolem n has been received from an 91 year Y old female with atrial fibrillation, diabetes and drug reaction/allergies Y with### cortisone shot, ### who " 3 mon n has been received from a female physician with no pertinent medical history or drug reactions N or allergies 3/17/2009 and was 3/17/2009 not pregnant concern n has been received from a physician concerning another physician's patient who was vaccinated U with a dose of ZOSTAVAX (Merck) on an n has been received from a Nurse Practitioner Y (N.P.) concerning a 63 year old female with hypertension, N 3/11/2009 acid reflux and osteoporosis as w n has been received from a registered Y pharmacist concerning a 64 year old male patient who U on 06-MAR-2009 3/6/2009 was vaccinated 3/8/2009 with a 0.65 n has been received from a registered pharmacist concerning a 64 year old female with no medical Y history 3/16/2009 or a drug3/18/2009 allergy who on 16-Mar n has been received from a 57 yearYold female with a history of shingles and drug allergies to N penicillin, 3/16/2009 erythromycin 3/16/2009 and "vycodine" who o n has been received from a female Y consumer who on 23-FEB-2009 was vaccinated with a 0.65 U ml dose2/23/2009 of ZOSTAVAX 2/25/2009 (Merck). Lot# was n n has been received from a pharmacy Y technician concerning a female patient who on 20-MAR-2009 U was3/20/2009 vaccinated with ZOSTAVAX (Mer n has been received from a 68 yearYold female consumer with penicillin and erythromycin allergy N who in12/1/2008 December 3/18/2009 2008, was vaccinated w n has been received from a physician Y concerning a 61 year old male who six days ago, on approximately N 3/14/2009 14-MAR-2009 3/14/2009 was vaccinated wi n has been received from a registered Y nurse concerning a 69 year old female patient with asthma N and allergic 2/17/2009 reaction 3/30/2009 to antibiotics (CIPR n has been received from a physician Y concerning a male patient who in 2006 was vaccinated Y with a dose of ZOSTAVAX 9/1/2008 (Merck) (lot not re n has been received from a physician Y concerning an 85 year old female, who on 27-FEB-2007 Y was vaccinated 2/27/2007 with ZOSTAVAX 2/5/2009 (Merck). O n has been received from a physician Y concerning an 82 year old male patient who on 26-SEP-2007 Y was9/26/2007 vaccinated with 2/4/2009 a dose of ZOSTAV n has been received from a pharmacist Y concerning a 59 year old female with latex allergy and U no pertinent 3/20/2009 medical history, 3/1/2009 who on 20-MAR n has been received from a nurse concerning an approximately in her 70's who on 17-MAR-2009 Y was vaccinated 3/17/2009with 3/18/2009 ZOSTAVAX (Merck) n has been received from a pharmacist Y concerning a 70 year old female patient with penicillin N allergy who 3/20/2009 on 20-MAR-2009 3/1/2009was vaccinated n has been received from a physician Y concerning a 73 year female who in November 2006, U was vaccinated 11/1/2006 subcutaneously 3/20/2008with 0.65 ml o n has been received from a 64 yearYold female consumer with high blood pressure and highNcholesterol 2/19/2009 who on 19-FEB-2009 2/26/2009 was vaccina n has been received from a nurse concerning Y a 70 year old female with blood pressure high,Ndepression1/14/2009 and history3/23/2009 of shingles (unspecifie n has been received from a Registered Nurse (R.N) concerning herself with no pertinent medical N history3/17/2009 and no known 3/17/2009 drug allergies/drug n has been received from a pharmacist concerning a male "over 60" year old who on an unspecified U date was vaccinated SQ with a 0.65m n has been received from registered pharmacist concerning a female patient who on an unknown Y date was vaccinated with a dose of ZOST n has been received from a 75 year old female patient with drug reaction to CELEBREX whoNon 16-MAR-2009 3/16/2009 was3/25/2009 vaccinated with single n has been received from a 66 year old female patient with "allergy to sulfa drugs" who on 24-MAR-2009 N 3/24/2009 was vaccinated 3/24/2009 with "one dose" o n has been received from a physician concerning a 74 year old female patient who "1 week N ago" on approximately 3/18/2009 18-MAR-2009 was vacc n has been received from a 77 year old male patient with no pertinent medical history or drug N reaction or 5/1/2008 allergies who 2/1/2009 in May 2008, was va n has been received from a 75 yearYold female consumer with hypertension, who was also the N patient, who 3/5/2009 on 05-MAR-2009 3/12/2009 was vaccinat n has been received from an 83 year old female who in approximately 2008 was vaccinatedNwith ZOSTAVAX vaccine 3/18/2009 (Merck). Concomitan n has been received from a pharmacist concerning a 78 year old female with no drug reactions N or allergies 3/4/2009 who on 04-Mar-2009 3/4/2009 was vacci n has been received from a nurse practitioner (N.P.) concerning a female who on an unspecified U date was vaccinated with a dose of ZOST n has been received from a physician Y concerning a 66 year old male who in June 2007, wasUvaccinated with 6/1/2007 the first2/1/2009 0.65 ml dose of ZOST n has been received from a physician concerning a 61 year old female with hypertension and N hyperlipidaemia 3/26/2009 and no 3/26/2009 drug reactions or alle n has been received from a 65 yearYold female with high blood pressure and allergic to sulfaNwho 0n 11-MAR-2009 3/11/2009 3/19/2009 was vaccinated with a d n has been received from a consumer concerning her 76 year old husband who on an unspecified U date was vaccinated with a dose of ZOS n has been received from a licensed Y practical nurse concerning a male with no medical history Y or drug allergy 1/15/2009 who on 15-JAN-2009 was va n has been received from a physician concerning a 70 year old female who on 12-MAR-2008 U was vaccinated 3/12/2008 SC with 3/9/2009 a 0.65 ml dose of ZO n has been received from a female Y patient with no drug allergies/reactions and arthritis who N on 18-MAR-2009 3/18/2009 was vaccinated 3/18/2009 with ZOSTAV n has been received from a registered pharmacist concerning a female patient who on 18-FEB-2009 N was 2/18/2009 vaccinated with ZOSTAVAX (Me n has been received from a patient Yvia of a letter who was vaccinated with a dose of ZOSTAVAX N (Merck) on an unspecified 2/15/2009date. On 15-F
n has been received from a nurse practitioner Y concerning a 62 year old female with morphine Y allergy and 3/26/2009 medical history 3/26/2009 of breast cancer w n has been received from a female with a medical history of Shingles, high Cholesterol and N high blood pressure 1/1/2009 who2/1/2009 was vaccinated with a n has been received from a medical assistant concerning a patient who was vaccinated withYZOSTAVAX (Merck). The patient developed a n has been received from a pharmacist concerning a patient who was vaccinated with ZOSTAVAX U (Merck). The patient experienced a mus n has been received from a Registered Pharmacist (R. Ph.) concerning a 60 year old femaleNwho on 09-MAR-2009 3/9/2009 3/16/2009 was vaccinated subcut n has been received from a registered pharmacist concerning a 60 year old female with "being U sensitive3/30/2009 to things" but 4/1/2009 no allergy to gelatin n has been received from a consumer concerning "friend of a friend" who was vaccinated with U ZOSTAVAX (Merck) a long while ago. The p n has been received from a consumer concerning "friend of a friend" who was vaccinated with U ZOSTAVAX (Merck). On an unknown date t n has been received from a registered Y pharmacist concerning a female who on approximately N 12-MAR-2009 3/12/2009 was vaccinated with a 0.65 m n has been received from a physician Y concerning a 55 year old male patient with abnormal aneurysm, N hypothyroidism, 1/1/2009 1/1/2009 undefined anemia a n has been received from an advance registered nurse practitioner concerning a male patient N who on 03-MAR-2009 3/3/2009 3/24/2009 was vaccinated SQ wi n has been received from a nurse concerning Y a "over 60 year old" male who was vaccinatedUwith ZOSTAVAX (Merck). In 2008 the patient n has been received from a 66 year old female with reaction to BENEDRYL and reaction to N cisplatin (+) 3/31/2009 doxorubicin (+) 4/1/2009 etoposide (+) vincri n has been received from a medical assistant concerning a 38 year old male patient who was U inadvertently vaccinated with ZOSTAVAX (M n has been received from a 90 year old female consumer with no pertinent medical history and U no known 3/13/2009 drug allergies, 4/1/2009 who on 17-MAR-2 n has been received from a Medical Assistant concerning a female patient who on 02-APR-2009 U was accidentally 4/2/2009 vaccinated 4/2/2009 with ZOSTAV n has been received from a physician concerning a 78 year old male patient who in JanuaryN2008, was vaccinated 1/1/2008 with 3/1/2009 a dose of 0.65 ml Z n has been received from a female patient with no known drug reactions/allergies and no pertinent N medical history, ### who 1/1/2009 on 18 18-DEC-200 n has been received from a 73 yearYold female nurse practitioner with penicillin, codeine andNMOTRIN allergies 3/27/2009 who 4/1/2009 on 27-MAR-2009 were n has been received from a female patient who was vaccinated with a dose of ZOSTAVAX (Merck) U (Lot# not provided). Subsequently the p n has been received from an 81 year old female patient with no pertinent medical history and N no known 3/31/2009 drug allergies, who on approximate n has been received from a 67 year old female with no pertinent medical history and no known Y drug allergies, 3/30/2009 who on4/2/2009 30-MAR-2009 was v n has been received from a medicalYassistant concerning a 51 year old female patient with osteoporosis N and 4/1/2009 sulfonamide 4/2/2009 allergy, who on 0 n has been received from a Registered Y Pharmacist concerning a "over age of 65" female who N on approximately 3/27/2009 27-MAR-2009, 3/28/2009 " about 1 w n has been received from a physician Y concerning a female in her 60's who was vaccinated with N a dose of ZOSTAVAX (Merck) (Lot number n has been received from a Certified Medical Assistant (C.M.A) concerning a 64 year old male N with gastroesophageal 4/6/2009 4/6/2009 reflux disease and n n has been received from a Nurse Practitioner Y (N.P.) concerning a 70 year old female who inU February 2009 2/1/2009 was vaccinated 2/1/2009with a dose of n has been received from a Nurse Practitioner Y (N.P.) concerning a 62 year old female who on N 03-APR-2009 4/3/2009 was vaccinated subcutaneous n has been received from a physician Y assistant concerning a female patient with fibrocystic breast Y and without 3/2/2009 drug allergy 3/3/2009 who was subcu n has been received from a physician with allergy to penicillin who on 06-APR-2009 was administered U ZOSTAVAX 4/6/2009 (Merck) 4/6/2009 (lot # not availa n has been received from a pharmacist Y concerning a 65 year old female with blood pressureNhigh who on 3/20/2009 20-MAR-2009 3/20/2009 was vaccinated wi n has been received from a registered pharmacist concerning a 67 year old female patient with Y hypertension, 4/2/2009 hypercholesterolemia 4/6/2009 and no n has been received from a physician concerning a 64 year old male consumer who got the N ZOSTERVAX4/3/2009 (Merck), unknown 4/5/2009dose and freq n has been received from a 59 year old female with a history of perforated ulcer and no known N drug allergies, 2/18/2009 who on 2/18/2009 18-FEB-2009 was va n has been received from medical assistant concerning a female patient who on an unspecified N date was vaccinated with a dose of ZOSTA n has been received from a Registered Y Nurse (R.N.) concerning a 62 year old male who on N 19-FEB-2009 2/19/2009 was vaccinated 4/9/2009 subcutaneously n has been received from a physician Y concerning a 63 year old female patient who on 25-MAR-2009 N was 3/25/2009 vaccinated 3/23/2009 with ZOSTAVAX (Me n has been received from a nurse concerning Y a patient with unknown history of shingles prior N to receiving4/2/2009 ZOSTAVAX 4/9/2009 (Merck) who was va n has been received from a Nurse Practitioner (N.P.) concerning a 68 year old patient who U on 03-APR-2009 4/3/2009 was vaccinated 4/13/2009 with a dose o n has been received from a health care professional concerning a 63 year old male patient who U on an unspecified date experienced a poss n has been received from a physician Y concerning a patient who on 18-MAR-2009 was vaccinated U with ZOSTAVAX 3/18/2009 3/20/2009 (Merck). The physician n has been received from a consumer Y and a Registered Pharmacist (R.Ph) concerning a 77Nyear old male 1/26/2009 patient with 2/15/2009 a history of "Dental n has been received from a 67 year old female patient allergic to aspirin and sulfa drugs, and N with thyroid disorder ### who 4/8/2009 on 16-DEC-2008 w n has been received from a physician concerning a 65 year old female with no known drug reactions/allergies, Y 1/5/2009 who 1/19/2009 on 05-JAN-2009 was v n has been received from a medical assistant concerning a 16 year old patient who "last week" U was accidentally 4/8/2009 vaccinated 4/8/2009with ZOSTAVA n has been received from a medical assistant concerning a 60 year old male patient who about U 2 weeks ago 4/2/2009 was vaccinated with ZOSTAV n has been received from a medicalYassistant concerning a female who on 31-MAR-2009 was N vaccinated 3/31/2009 with a dose 4/10/2009 of ZOSTAVAX (Merc n has been received from a 73 year old female patient who was vaccinated with a 0.65 ml dose N of ZOSTAVAX (Merck) 4/9/2009 (lot# was not provid n has been received from a doctor of pharmacy concerning a 65 year old female with blood Y pressure high2/1/2009 and a previous 3/1/2009 small pox vaccina n has been received from a nurse (at the physician's office) concerning a patient who was vaccinated U with ZOSTAVAX (Merck). The patien n has been received from a healthcare worker concerning a 25 year old patient who on 16-APR-2009 Y was4/1/2009 vaccinated4/1/2009 with ZOSTAVAX vac
n has been received from a physician concerning a patient who was subcutaneously vaccinated U with a 0.65 3/31/2009 ml dose of ZOSTAVAX (Merck n has been received from a physician Y concerning a 66 year old male with no pertinent medical N history and4/2/2009 no known 4/10/2009 drug allergies/drug rea n has been received from a 61 year old female consumer with no pertinent medical history and N no known 4/15/2009 drug allergies, 4/16/2009 who on 15-APR-2 n has been received from a registered nurse concerning a 63 year old male who on 05-JAN-2009 U was vaccinated 1/5/2009 with 1/5/2009 a dose of ZOSTAVA n has been received from a nurse practitioner concerning a 70 year old female who on 13-APR-2009 N was 4/13/2009 subcutaneously 4/15/2009 vaccinated with n has been received from a 65 year old female registered nurse with no pertinent medical history Y or drug4/17/2009 reactions or 4/17/2009 allergies reporting he n has with allergies to PENICILLIN, CEPHALOSPORIN, non-steroidal anti-inflammatory drugs N and silver 8/7/2007 containing4/13/2009 compounds who on 07 n has been received from a pharmacist Y concerning a greater than 70 year old female who on N 11-JUN-2008, 6/11/2008 "last summer", 4/10/2009 was vaccinated n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX Y (Merck). On approximately 4/6/200906-APR-2009 n has been received from a 76 yearYold female, with no known drug reactions/allergies and no N pertinent medical history, 4/1/2009 who in approximat n has been received from a consumer Y concerning himself who on 20-JUN-2008 was vaccinated N with a dose 6/20/2008 of ZOSTAVAX 6/22/2008 (Merck). Two d n has been received from a medicalYtechnologist concerning her 65 year old husband with idiopathic N thrombocytopenic 4/13/2009 4/15/2009 purpura and no dru n has been received from a registered pharmacist concerning a 77 year old female patient with N no medical 4/16/2009 history or 4/17/2009 allergies who had 2 p n has been received from a physician Y concerning a 72 year old patient with diabetes who onU28-JAN-2008 1/28/2009 was vaccinated 4/22/2009 with a dose of Z n has been received from a physician Y concerning an 85 year old female who was vaccinatedNwith a dose 4/3/2008 of ZOSTAVAX 12/1/2008 vaccine (Merck) 0 n has been received from a physician Y concerning her 65 year old mother who was vaccinated N with a 0.65 10/1/2008 ml dose of 10/1/2008 ZOSTAVAX (Merck) ( n has been received from a physician Y concerning a 63 year old male who on 16-APR-2009 was Y vaccinated 4/16/2009 with a 0.65mL 4/21/2009 dose of ZOSTAV n has been received from a pharmacist concerning a 68 year old female with sulfonamide allergy N and a 4/21/2009 history of uterine 4/23/2009 cancer, cervical c n has been received from a physician Y and a Licensed Visiting Nurse concerning an 83 year N old male patient 4/20/2009 who on4/20/2009 20-APR-2009 was vac n has been received from a registered Y pharmacist concerning a 67 year old female patient who N on 19-APR-2009 4/19/2009was 4/24/2009 vaccinated with ZOS n has been received from a consumer Y concerning herself (a 61 year old female) with no medical N history 4/21/2009 and drug allergies 4/22/2009 who on 21-APR n has been received from a 67 year old female with arthritis, osteopenia, high cholesterol, high N blood pressure 10/1/2008 as well 4/20/2009 as allergy reaction to n has been received from a physician concerning a "74 year old" female who in April 2007, was U vaccinated 4/1/2007 with a single 4/10/2009 dose of ZOSTAVA n has been received from a pharmacist (from a drug information center) concerning a male patient U who received 4/19/2009approximately on 19-APR n has been received from a physician Y concerning a 64 year old male patient with type 2 diabetes N mellitus, 4/24/2009 hyperlipidaemia, 4/25/2009 hepatitis C antib n has been received from a Licensed Y Practical Nurse (LPN), a 69 year old female concerning N herself, she was### vaccinated 4/20/2009 in the arm with o n has been received from a physician concerning a 63 year old female who on 17-APR-2009Nwas vaccinated 4/17/2009 with ZOSTAVAX (Merck) (lot# n has been received from a registered Y nurse concerning a 70 year old male with a history ofNherpes simplex 4/22/2009 treated4/24/2009 with VALTREX and ac n has been received from a 69 yearYold female patient with hypertension, arthritis, drug hypersensitivity Y to 12/7/2007 "NASOTEC", Prednisone, ### Pipera n has been received from a consumer's husband concerning his wife with no pertinent medical N history and 3/1/2009 no allergies 3/1/2009 who in approximate n has been received from a pharmacist concerning a 67 year old female with no known allergies N or medical 4/24/2009 history reported, who on 24-AP n has been received from a pharmacist Y concerning a 60 year old female with liver disorder and N no known allergies, ### who on 18-DEC-2008 w n has been received from a pharmacist concerning the pharmacist's 66 year old mother withYno pertinent 3/5/2008 medical history who on 05-MAR-2 n has been received from a physician Y concerning a 78 year old female who on 03-MAR-2009 Y (also reported 3/3/2009 as 30-MAR-2009) 3/7/2009 was subcuta n has been received from a physician concerning a 62 year old male who on 25-FEB-2009 was Y subcutaneously 2/25/2009 vaccinated 3/2/2009 with a 0.65 ml d n has been received from a Registered Y Nurse (R.N.) concerning a 61 year old female with migraines, U hypercholesterolaemia 4/14/2009 4/15/2009and allergy to n has been received from a Registered (R.N.) concerning a female with a history of 2 cases N of childhood chickenpox who was vaccinated w n has been received from a nurse practitioner (N.P.) concerning a male who on an unspecified N date was vaccinated ### 4/13/2009 SC with a 0.65 ml dose n has been received from a 71 year old female patient with history of shingles before vaccination Y and no known 1/1/2009 drug2/1/2009 allergies/drug reaction n has been received from a physician concerning his 80 year old mother in law, who was vaccinated N with a dose of 2/22/2009 ZOSTAVAX (Merck). A n has been received from a pharmacist concerning two patients who on an unknown date were U vaccinated 4/21/2009 with a dose of ZOSTAVAX (Mer n has been received from a 63 yearYold male consumer with no pertinent medical history reported N who on 8/23/2007 23-AUG-2007 4/27/2009 was vaccinated w n has been received from a nurse practitioner Y concerning a female who was vaccinated withUa dose of ZOSTAVAX (Merck). The patient de n has been received from a 66 yearYold female with no pertinent medical history and no drugNreactions or 4/17/2009 allergies won 4/17/2009 on 17-APR-2009 w n has been received from a nurse concerning Y a 82 old female patient with unspecified drug reactions/allergies Y and medical history who was n has been received from a pharmacist concerning a 60 year old male with chest pain, obesity, N gastrooesophageal 4/13/2009 4/25/2009 reflux disease, vitamin n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTER v n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTAVA n has been received from a pharmacist concerning a 65 year old female who is the mother of U an other healthcase 4/22/2009 professional 4/22/2009 in the same n has been received from a retired 72 Y year old female registered nurse with no medical history N and drug allergy 7/1/2007 who4/22/2009 in July 2007 was vacc n has been received from a registered nurse concerning a 65 year old (also reported as 64 year N old) female 4/27/2009 with hypertension, 5/1/2009 gastrooesop
n has been received from a registered pharmacist concerning a 63 year old female who wasUvaccinated with ZOSTAVAX (Merck) and expe n has been received from a physician who was vaccinated with a dose of ZOSTAVAX vaccine Y (Merck). Two weeks later after receiving the n has been received from a physician concerning himself who on 30-APR-2009 was vaccinated N with ZOSTAVAX 4/30/2009(Merck) 4/30/2009 by the intramuscu n has been received from a 73 year old female patient with sulfa allergy who in July 2008, was N vaccinated7/1/2008 with a dose 4/25/2009 of ZOSTAVAX (Mer n has been received from a licensed Y practical nurse concerning a 72 year old male patient with N chronic obstructive 3/30/2009 pulmonary 4/20/2009 disease, arth n has been received from a registered nurse concerning a 57 year old patient who on 04-MAY-2009 U inadvertently 5/4/2009 received 5/4/2009 ZOSTAVAX (M n has been received from a 67 year old female with allergies to estrogen, and FLUORENOL, post herpetic neuralgia and arthritis and a his n has been received from the doctor's nurse concerning a 61 year old female who on 01-MAY-2009 N was vaccinated 5/1/2009 5/1/2009 subcutaneous injection n has been received from a nurse practitioner concerning a 15 month old male who on 05-MAY-2009 Y was5/5/2009 inadvertently 5/5/2009 vaccinated with a d n has been received from a physician Y concerning a 74 year old female patient with no pertinent N medical 4/22/2009 history and no drug reactions or al n has been received from a doctor of pharmacy concerning a 64 year old female who in January N 2009 was 1/1/2009 vaccinated 1/1/2009 with a 0.65ml dose o n has been received from a 90 year old male who on 05-MAR-2007 was vaccinated with a dose N of ZOSTAVAX 3/5/2007 (Merck). 4/29/2009 There was no con n has been received from a registered nurse concerning a medical assistant who had been administering U ZOSTAVAX (Merck) for the past n has been received from a 58 yearYold female physician concerning herself with history of shingles N while in her 20's4/10/2009 who following her hus n has been received from a medical assistant concerning herself, a 24 year old female with N a history of chickenpox at5/4/2009 her 5 years old who o follow-up information has been received from a physician concerning a 68 year old female patient N with hypertension, 4/30/2009 5/1/2009 osteoporosis and DEM n has been received from a Registered Pharmacist (R.Ph) concerning a 66 year old female patient N who used 5/4/2009 KENALOG 5/5/2009 about 1 to 2 week n has been received from a pharmacist Y concerning a 65 year old male with type 2 diabetes, N other unspecified 5/1/2009 medical 5/1/2009 conditions and a mil n has been received from a 65 year old female registered nurse concerning of herself with hypertension, N hypercholesterolaemia, 5/5/2009 5/6/2009 allergic re n has been received from a registered Y nurse concerning a 89 year old male with chronic obstructive N pulmonary 4/28/2009 disease, 5/3/2009 hypertension, ana n has been received from a physician concerning an approximately 55 to 70 year old year old Y male with rheumatoid arthritis who on 2008 w n has been received from a pharmacist concerning two patients who on an unknown date were U vaccinated 4/21/2009 with a dose of ZOSTAVAX (Mer n has been received from a physician Y concerning a patient who was vaccinated with a dose Yof ZOSTAVAX 4/28/2007 (Merck).4/29/2009 The patient developed n has been received from a 62 year old female with cholesterol high and breast cancer diagnosed N in June 4/30/2009 2006 who 5/7/2009 on 30-APR-2009 was n has been received from a pharmacist concerning an approximately 74 year old female whoN on 06-MAY-2009 5/6/2009 was vaccinated with ZOSTA n has been received from the doctor's Y employee concerning an over 60 year old male who "recently" U was4/1/2009 vaccinated4/1/2009 with ZOSTAVAX (Me n has been received from a pharmacist concerning his 68 year old wife who unspecified date N was vaccinated SQ with ZOSTAVAX (Merck) n has been received from a Licensed Y Vocational nurse concerning a 52 year old female withUallergies to4/14/2009 codeine and 4/15/2009 DEMEROL and histo n has been received from a doctor of pharmacy concerning a 62 year old male patient with diabetes N and4/24/2009 no known 4/28/2009 drug allergies /drug rea n has been received from a nurse practitioner Y concerning a 71 year old female patient with no N known drug 2/20/2008 allergies, 5/4/2009 hypertension, hyperlip n has been received from a medicalYassistant concerning an 86 year old male with unspecified N drug reactions 9/1/2007 / allergies 5/7/2009 and medical histor n has been received from a physician Y concerning a 79 year old male with a history of chickenpox U (when was 5/5/2009 child) who 5/7/2009 on 05-May-2009 w n has been received from a physician concerning a 60 year old female with unspecified allergy Y who in May 5/1/2009 2009 (last5/1/2009 week, date unspecifie n has been received from a licensed practical nurse concerning an 82 year old male patient N with chronic obstructive ### 5/11/2009 pulmonary disease, hy n has been received from a physician Y concerning a 72 year old male patient with no pertinent N medical history 5/5/2009 and with 5/7/2009 seasonal allergies w n has been received from a pharmacist Y concerning a female who on 04-MAY-2009 was vaccinated Y subcutaneously 5/4/2009 with 5/8/2009 a 0.65 ml dose of n has been received from a pharmacist concerning a 65 year old female who on 11-FEB-2009 U was vaccinated 2/11/2009 with 2/15/2009 a 0.65 ml dose of ZOST n has been received from a nurse concerning Y a 60 year old male with hypothyroidism and hyperlipidemia N 4/29/2009 as well as4/30/2009 no drug allergies who o n has been received from an Adult Nurse Practitioner (A.N.P) concerning an 86 year old female N patient with 5/12/2009 hypertension 5/13/2009 and sulfonamide n has been received from a 60 year old female consumer with 'allergies to some chemicals in N perfumes'5/13/2009 and a history 5/14/2009 of shingles in March n has been received from a female patient who on 15-MAY-2009 was vaccinated with a dose U of ZOSTAVAX 5/15/2009 (Merck). 5/16/2009 On 16-MAY-2009 the n has been received from a pharmacist concerning a female patient in "late sixties" with no allergies N or medical 5/11/2009 history who "last week" on a n has been received from a registered pharmacist concerning a approximately 65 years oldNmale who on 2/13/2009 13-FEB-2009 2/15/2009 was vaccinated wit n has been received from a physician Y concerning a female who on an unspecified date was N vaccinated with a dose of ZOSTAVAX (Merck) n has been received from a consumer concerning her husband a 91 year old male who on unspecified U dates was vaccinated subcutaneous n has been received from a registered nurse concerning a 14 month old patient who on 19-MAY-2009 U was 5/19/2009 vaccinated 5/19/2009 with ZOSTAVAX (M n has been received from a certifiedYmedical assistant concerning a 69 year old female patient N with allergic 5/4/2009 reaction to 5/5/2009 CECLOR and AUGM n has been received from a physician's Y assistant concerning an 88 year old male patient with N hypertension, 2/14/2008 hyperlipidemia, 5/20/2009 arthritis, aortic n has been received from a pharmacist concerning a female with blood pressure high and "some N kind of eye 1/1/2007 disease" who "1 or 2 years ag n has been received from a medicalYassistant concerning an 84 year old male with ischaemic N cardiomyopathy 4/20/2009 and diabetes 5/16/2009 and a history o n has been received from a pharmacist concerning a 66 year old female with unknown drug Nallergies and 5/13/2009 unknown 5/15/2009 medical history who "la
n has been received from a physician concerning an over 60-year old female who on an unspecified N date was vaccinated with a 0.65mL do n has been received from a consumer concerning her husband a 62 year old male with neuralgia N from phantom 5/18/2009 limb 5/19/2009 pain who on 19-MAYn has been received from a consumer Y concerning her sister, a 63 year old female who in May N 2007, was 5/1/2007 vaccinated 3/1/2008 with ZOSTAVAX (Mer n has been received from a physician concerning a female patient in her early 60s with unspecified N drug allergies and 5/13/2009 no pertinent medical n has been received from a 58 yearYold female consumer with no known drug allergies and a U history of genital 2/1/2008 herpes 2/1/2008 who in February 200 n has been received from a pharmacist Y concerning a patient with unknown drug allergies and U unknown medical 4/30/2009 history who "about 3 weeks n has been received from a 61 year old female patient with hypothyroidism and no drug reactions N or allergies 5/20/2009 who on 5/21/2009 20-MAY-2009 was va n has been received from a Nurse Practitioner (N.P.) concerning herself with no pertinent medical Y history and with penicillin allergy who on n has been received from a physician concerning a 60 year old female patient who on 22-MAY-2009 N was 5/22/2009 vaccinated 5/22/2009 with a dose of ZOSTA n has been received from a 68 year old female with early heart beat; arthritis and thrush from N an antibiotic3/6/2009 who on 06-MAR-2009 3/27/2009 was vacci rmation received from a health careYprofessional on 31 July 2008. An 18-year-old male patient Y with a history 7/30/2008 of seasonal 7/31/2008 allergies received , shortness of breath edema of eyelids, Y erythema, tachycardia. Y 7/9/2009 7/9/2009 n Thursday - 6/18/09 approx. 9:30 AM. Y Mother Yreports Friday 6/19/09 4 AM - had increase temp Y of 100.8 -6/18/2009 never went6/19/2009 higher then that - gave eption requiring surgical Y reduction. Y Y 3 Y 5/28/2009 6/15/2009 has adverse reaction to Gardasil, she has had continuous fever 104 07/10/09 nausea Dr thought might be strep, however 7/2/2009 strep test negativ hild was given her 1st dose of ROTATEQ. She immediately vomited. It was repeated within minutes, + she vomited5/4/2009 again. Today, she wa n has been received from a certifiedYmedical assistant concerning a 17 year old female patient Y who on 18-JUN-2009 6/18/2009 6/18/2009 was vaccinated with 0 rday, swollen knot on right wrist Monday - painful. Swollen clavicular node and cervical nodes U Wednesday6/13/2009 painful (Right). 6/15/2009 Swollen tissue in well child visit, pt. was given Live Oral ROTAVIRUS vaccine & she vomited soon thereafter. Y It was repeated 7/10/2009 within minutes, 7/10/2009 & she again vo egion of erythema and edema, on left buttock began only 60-90 minutes after vaccine administered, Y BENADRYL, 7/9/2009ice,7/9/2009 CORTAID cream. n has been received from a nurse concerning Y aY63 year old female nurse 3 with borderline hypertension N and 4/22/2009 hypersensitivity 5/21/2009 to DILANTIN, "P 009 MMR, Varicella, PCV7, and Hep A given on 6/22/2009 pt seen in office Dx with herpes simplex Y without 6/12/2009 mention6/22/2009 of complication. Then Y 6/29/2009 7/9/2009 aricella given in (L) upper/outer thigh. 19th +- cm raised, red + hot to touch area around w/ bruising Y injection 6/26/2009 sights 2-3 6/27/2009 days after receiving 30 minutes after vaccine, felt numbness and pain in Lt arm. Stated after vaccine also felt numbness U from 6/11/2009 Lt shoulder 6/11/2009 to hip. 2 weeks follow mmunization pt had fever 102- 103 and screaming x 2 hrs increased x 2 days. Parents very Yconcerned. 5/11/2009 No tx was given 5/12/2009 by our office. iven 5-26- AM. Symptoms noticed 5-27-AM after taking shower. Left upper arm became reddened Y from5/26/2009 shoulder to5/27/2009 elbow. Skin had a bu ms at inj. site - warm to touch. T. 98.3 Rx with pain mid - ice. Y 6/29/2009 6/30/2009 had an episode of dizziness after receiving GARDASIL and VARIVAX #2 fainted for <1 minute Y (20 seconds) 7/3/2009 but recovered well right away. was reported by a healthcare professional Y and described the occurrence of cellulitis in a 4-year-old Y male6/19/2009 subject who 6/21/2009 was vaccinated with ER Hospital for elevated temp/ generalized Y rash, Y cathed urine negative/chest 2 x-ray negative/YInfluenza A6/16/2009 negative. 6/23/096/22/2009 MD's office. vom e light headed. Blood pressure 70/40 but elevated to 90/60 within 15 minutes. No other adverse Y effects observed. 7/6/2009Remained 7/6/2009alert and orien esented today to emergency department Y approx 12 hours after her Day 3 RabAvert dose complaining Y mostly 7/10/2009 of feeling 7/10/2009 anxious, having sub s after receiving vaccine client experienced headache. She took ibuprofen but didn't receiveNany relief until 7/13/2009 second 7/13/2009 dose taken 4 hours late at injection site and severe fatigue lasting two days post vaccine. Y 6/30/2009 7/1/2009 ness, bumpy, warm, itching area around injection site Y 7/10/2007 7/11/2007 ed that she experienced chest tightnes Y accompanied Y by shortness of 2 breath and acelerated heart rate on6/8/2009 Tuesday morning 6/9/2009 6/09/09. She re patient received Prevnar, Hib, Varicella, Y and MMR vaccinations. On 7/10/09 patient motherUreported that7/8/2009 the child 7/10/2009 has been taken to the E D WITH A RASH ALL OVER BODY,YIT SWELLED, HE HAD WHELPS ON FACE, BRUISING, U AND A PURPLISH 7/10/2009RASH. 7/12/2009 WAS SEEN AT U GENERALIZED RASH AND URTICARIAL Y REACTION INVOLVING FACE WITH PRURITUSN 7/9/2009 7/9/2009 Mom noticed rash upon awakening on the 14th of July after vaccine administered on the 13thYof July. Pt. 7/13/2009 given Prelone 7/14/2009 x 3 days and Zyrtec ash and spots on chest; increased in 24 hours; resolved without treatment Y 6/18/2009 6/29/2009 vaccination 7/1/09; 7/2/09 the patient reports fever, chills, muscle aches, then red tender sore arm at injection 7/1/2009 site. 7/2/2009 WAS ADMINISTERED AT 6 MONTHS OLD. Y 5/28/2009 5/28/2009 rm previously healthy female received Y her 6 month Y shots on 06/02/09 3 exactly 12 weeks afterYher 4month 6/2/2009 rota vaccine. 7/6/2009 On 07/6/09 the pati adache,soreness in arms nausea. U 7/14/2009 7/14/2009 min of vaccines being given, patient presented with bilateral erythema with single urticarial lesion U at sites of7/2/2009 injection. 7/2/2009 Dose of BENADRYL g enderness (L) Deltoid, warm + Red + Tender, firmness also noted. (L) arm circumference 31.5 cm (R) arm 6/25/2009 circumference 31 cm. Given Hy m to touch, red area stated by mom left thigh. d headache p.m. of 7/2/09 - 7/6/09 with Y relief from ADVIL. Awakened during sleep on 7/6/09 with continued 7/2/2009 headache, 7/2/2009 lightheaded + little d dministered 7-10-09, pt reported swelling the size of a grapefruit and pain on 7-11-09 in pm.YPt did not seek 7/10/2009 treatment. 7/11/2009
dministered 9/10/08 and noticed swelling Y of face, neck, nose and lips next day. Reports thatYshe had difficulty 9/10/2008 breathing. 9/11/2008 Reports that she w ed that she took client to PMD because Y her arm was red and swollen. Dr stopped client fromYtaking TYLENOL. 4/28/2009 Continue 5/1/2009 to use cold packs ven MMR II, RECOMBIVAX HB, BOOSTRIX, MENACTRA injections. Pt was talking with nurse Y and mother 4/25/2009 when he4/25/2009 slumped over to the lef 7/7/2009 , crying, fussy, red rash over entire body - Maculopapular rash. 7/7/2009 swelling, tenderness on left thigh atYsite of vaccine that was noticed 2 days after receiving vaccine. U 7/7/2009 7/9/2009 5-10 min after vax bright red + hot both legs top to foot - lasted 1/2 to sevl hrs. Y 7/14/2009 7/14/2009 dma- patient got a "pimple like" mark on arm where Tdap was given. Patient was swimming Y in a pool and 7/7/2009 at the beach. 7/7/2009 Bump gone 2 days seconds after administering HPV in R delt pt felt "dizzy" pulse 58 and BP 98/52 w/anxiety and Y orthostatic7/13/2009 hypotension. 7/13/2009 After 30 min pt felt m d red knot on arm and leg on 7-1-9 Y- C/o sore, hot to touch and can't walk good - Warm compress Y tid, BENADRYL, 6/30/2009 ELOCON 7/1/2009 cream ite was red, tender, itchy. Had high temperature, some diarrhea. Little rash around site. S/S Ypersisted about 6/23/2009 1-2 hrs,6/24/2009 resolved. t. presented to doctor with (R)axillary swelling. Area felt boggy. No warmth or redness. Y 7/9/2009 7/9/2009 d child, new to area, no vaccinationYrecords. Parent - non language speaking but Pt is fluent.UPt reports that 7/7/2009 about 1 hour 7/7/2009 after receiving va assed out, in the lobby on their way out home. Became pale, non responsive, US taken & showed Y for few7/13/2009 minutes as 7/13/2009 inquiry noted. MD not ain and inability to lift arm headache, stomachache, nausea pale, dizzy, weak, dry mouth & throat. N This lasted 7/9/2009 3 days,7/9/2009 missed (1) day of wo wollen, red right arm. Y Y 7/1/2009 7/2/2009 eling sluggish on 6/27/09, then got a migraine on 6/29/09 pain still on right side. started having N right ear 6/26/2009 pain on 6/30/09 7/2/2009 and woke up on 7/ DTAP, HIB and PREVNAR on 6/29/09. Fever occurred several hours later - sleepy that dayU& fussy that6/29/2009 evening. 3 6/29/2009 loose stools & 1 emes r up to 104.8 (R) for 3 days till seen. Y 7/2/2009 7/3/2009 d reddish area at site of injection - No induration. No pain. Y 6/30/2009 7/1/2009 and induration. Y 5/28/2009 5/29/2009 m red mildly tender area around theYinjection site. U 7/4/2009 ite red, itchy, hot to touch, approx 1 1/2 inch swelling. Y rritated, itchy Injection site. Swelling of entire upper arm, painful. Y ling with 5cm induration/swelling tx with antibiotic KEFLEX. Y 4/14/2009 4/14/2009 miting, fussiness/irritability began several Y hours after vaccine, resolved in 48 hrs. Y 7/8/2009 7/8/2009 Y Y 6/18/2009 6/23/2009 n has been received from a nurse concerning a patient who was vaccinated with a 0.65ml dose U of ZOSTAVAX (Merck) instead of VARIVAX n has been received from a pharmacist concerning a patient who was vaccinated with ZOSTAVAX U vaccine (Merck). The pharmacist report -old female patient had received a left Y deltoid intramuscular injection of ADACEL, lot numberYC2965AA and 5/14/2008 one day5/15/2008 later, she developed a ort was received 29 May 2008 from a Y health care provider. A 74-year-old female patient with N a history of 5/22/2008 shingles (March 5/27/2008 2008) and diverticu serious case was received from a health professional on 11 June 2008. A 29-year-old femaleNpatient, with 4/21/2008 a history of 4/21/2008 sulfa drug allergy and ort received on 24 June 2008 from a health care professional. A 20-year-old female patient whose U past medical 4/15/2008 history includes the current ort received on 07 July 2008 from a Y health care professional. A 57-year-old female patient, who Y has a past 6/17/2008 medical history 6/19/2008 of "blood clotting -serious case received from a Healthcare Y Professional on 21 July 2008. A 58-year-old female Y patient developed 7/16/2008 a general 7/17/2008 feeling of not fee ort received from a health care professional on 01 December 2008. A 43-year-old female patient Y who had stepped ### on a nail ### and who had a serious case was received from a physician on 08 December 2008. A 60-year-old male patient, Y with no reported 12/4/2008 medical history, received a ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular ort received from a healthcare professional on 08 December 2008. an adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular d ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular rmation was received on 16 December Y 2008 from a health care professional. A 38 year old female Y patient with### no known ### allergies received ort received on 05 February 2009 from a health care professional. A cluster of 10 to 15 patients Y out of an unspecified number of vaccines h ort received 19 February 2009 from Y a health care professional. A 31-year-old female patient with U known allergies 2/6/2009 to Penicillin 2/6/2009and Cephalos serious case was received on 24 February 2009 from VAERS (reference number 331469) viaY a search of the agency ### database. ### A 58 year o was extracted from the VAERS database via QSCAN on 24 February 2009 (reference number U 332974).11/5/2008 A 42-year-old 11/5/2008 female patient recei serious case was received on 24 February 2009 from VAERS (reference number 334283) viaY a search of11/5/2008 the QSCAN 11/5/2008 database. A 34 year was extracted from the VAERS database via OSCAN on 24 February 2009 (reference numbers 336106 and 335552). ### A 26-year-old female serious case was received on 04 March Y 2009 from a health care professional. A 74 year oldNfemale with2/27/2009 a history of rheumatoid arthritis, hy of 3 patients who received ADACELY(lot number C3068AA), and developed injection site reactions. Y Initial2/27/2009 report received 3/12/2009 on 17 March 2009 ort received on 20 March 2009 from a health professional. A 42 year old female patient, with Y no medical history 3/20/2009 other3/20/2009 than seasonal allergie
serious case was received on 01 April 2009 from a health care professional. A 40 year old female Y patient3/24/2009 received ADACEL 3/28/2009 (lot number UF serious case was received on 06 April 2009 from a health care professional. A 28 year old female U patient3/30/2009 received ADACEL 4/6/2009 (lot number C3 old female patient with a history of migraines received an initial dose of Adacel (lot number C3097AA) N intramuscular 4/24/2009 4/25/2009 in the left Gluteal and was received from a consumer on 11 Y June 2008. A 58-year-old patient, with a history of Lyme N Disease, reported 6/5/2008that6/6/2008 she received in intram ort received on 22 September 2008 Y from a consumer, who is the patient. A 54 year old female, N with no medical 9/16/2008 history, 9/17/2008 received on 16 Sept serious case was received on 03 March Y 2009 from a consumer. A 49 year old female patientNreceived a first 1/1/2009 time dose of ADACEL (lot not t was received from a consumer on 09 March 2009. A 47-year-old female patient received an N injection of 3/5/2009 ADACEL (lot 3/6/2009 number not reported rmation was received from a health care professional on 07 August 2008. An 11 year old female patient with 5/4/2007 no reported 5/7/2007 past medical histo old male patient, with no medical history, Y received on 23 September 2008 a 0.5 ml right deltoid N injection9/23/2008 of IPOL (lot9/23/2008 number "A0273"), a 0. eived from a healthcare professional on 26 September 2008 under the local reference number Y 08-0447. This 9/23/2008 case deals 9/24/2008 with a cluster of 5 m of 2 adult patients who received TUBERSOL, lot number C2910AA, and developed injection Ysite redness9/16/2008 and induration 9/22/2008 four days after the -old female patient who was known Yto be pregnant at the time, had received a 0.5 mL intramuscular Y left deltoid 8/21/2008 injection 9/29/2008 of ADACEL (Lot# C -serious case received from a healthcare Y professional on 16 October 2008. A 61-year-old female U patient developed ### a 7.5cm ###by 9cm area o rmation was received on 27 OctoberY2008 from a health care professional. A 54 year old female Y received an intramuscular ### ### left deltoid inject ort received from a health care professional on 29 October 2008. A 37-year-old pregnant female Y patient had 8/11/2008 received a left deltoid intramus G, REDNESS AND WARMTH ON THIGH. Y 7/8/2009 7/11/2009 ausea; weight loss over 20 Y lbs; dizziness; Y balance Y problems; impaired concentration; vertigo;Ninflammation of esophagus; ### 1/5/2009 abdominal pain, e n was extracted from his discharge Ysummary on Y 8/31/08: "7 month13 old boy, previously Y healthy N who had diarrheal 6/27/2008illness 8/27/2008 1 week ago...found veloped small lump at site of injection Y which persisted unchanged for 2-3 mo. Then during the Y month of 3/10/2009 June. Lump6/20/2009 elevated in size. Pt wa days ago. Cellulitis 6.5 cm surrounding Y blister. Doxycycline 100mg 2X a day. Y 6/25/2009 7/3/2009 econdary to smallpox vaccination. Y 6/17/2009 6/21/2009 & swelling at site. Mostly resolved before Y pt back to office. Crying a lot, but consolable. Y 7/9/2009 7/9/2009 N 3/22/2006 ed 2 vaccines @ approximately 9:20am. Had fainting episode @ 9:30am fell off exam table. Y Mother had 911 7/7/2009 called- did 7/7/2009 not transport to ER. n has been received from a health professional Y Yconcerning a 15 years 0 old female who was vaccinated N with 7/1/2009 GARDASIL 7/1/2009 last week, approxim redness, warmth of right upper arm + shoulder began eve 7/8/09. Decreased but persistent am U 7/9/09. 7/8/2009 7/8/2009 mps, severe weakness, decreased urine output the first day despite drinking lots of H2O. C/o Y "contractions 6/26/2009 inside" 6/26/2009 vagina similar to contra n has been received from a physician Y concerning a 23 year old female patient who on an unknown U date was vaccinated with a dose of GA developed hives within 48 hours of her first HPV. She had no other obvious cause for her hives. Y 6/26/2009 n has been received from Y a Physician Y AssistantY concerning a 12 year old femaleYpatient withNpertinent medical 7/15/2008 history 3/1/2009 reported as none an 6/22/2009 6/22/2009 n has been received from a physician Y concerning Y a male patient who 0 was approximately fiveYyears old was vaccinated with MMR II a few m o 106 degrees and irritability following Y vaccines, brought to ER by parents approx 12 hours following immunizations. 7/7/2009 7/8/2009 Was observed and tre elling > 2 in width & length, red, hard, hot to the touch & days after vaccine given. Ice compress U tx. 7/7/2009 7/8/2009 n has been received from a registered Y nurse concerning a 45 year old female with sulfa andYDEMEROL 5/29/2009 allergies who 6/15/2009 on 29-MAY-2009 wa thur reaction at right deltoid injection Y site N 7/13/2009 7/14/2009 cine reaction. Left arm extensive. Y 7/7/2009 7/9/2009 ing at injection site. No sign of systemic reaction. Y 6/1/2009 6/3/2009 se reaction. MMR II given 1wk after VARIVAX (3/23/09). Y 3/30/2009 ny symptoms-soreness, fever etc. Y 7/6/2009 ion of optical, nerves + muscles weight loss, excessive urinating and thirst, tiredness, rash, blurry vision. See 3/9/2009 attached letter! Swelling at site of injection and distally approx. 7 inches. U 6/30/2009 7/4/2009 er admin of ZOSTAVAX pt noted asymmetric, tenderness over (L) scalp/neck. When seen 7/7/09 Red rash (not vesicular noted) posterior s s "severe pain" in muscles, knee joints, ankle joints, extreme fatigue, feeling feverish ((no confirmed Y fever6/12/2009 per pt). Severe 6/16/2009 shaking beginning miting x 2 in waiting room- 20 min after Y receiving HBV, + with acute onset LLQ pain. Pt diaphoretic, U pale.6/12/2009 B/P 122/82. 6/12/2009 Pt laid down in exam 7/2/09 stating he became "achy with over all achyness & mostly back aching 5 days after receiving Y vaccinations. 6/25/2009 He6/30/2009 had a fever of 100 Deg able crying/screaming x 3-6 hours. Fever of 101 x 24 degrees. Rash on (Rt) leg and torso < than Y 24 degrees. 4/24/2009 4/24/2009 after receiving vaccine patient developed Y swelling at site, diffuse urticaria, and noisy breathing. Y He was given 7/8/2009 ATARAX 7/8/2009 then EPI PEN whic ed, round- approx. 2 inches in diameter area on pt's L thigh. Home care - included ice to area + Motrin, continued 6/24/2009home 6/25/2009 care >cold compres ed pruritus. Fatigue. Myalgias. U 7/2/2009 7/4/2009
ema 4cm X 6cm at injection site on L thigh, tenderness, normal gait. Rec: ice, ibuprofen. Matthew's Y mother 7/9/2009 wanted this 7/10/2009 reaction reported to ately 42 hours post Zostavax vaccination I began to have itching, redness, soreness and swelling Y at the injection 7/6/2009 site 7/8/2009 (about 2 inches in diam male brought in by his mother with Yacute onset of vomiting and fever to 104 @ 4am 7/14/09.U Recieved Hepatitis 7/13/2009A 7/14/2009 vaccine 7/13/09. Has ha our of administration patient became Y nauseated, fatigued and light headed. Nausea increased Y to vomiting7/9/2009 & inability 7/9/2009 to keep food or liquid varivax booster on Monday July 13,2009 and yesterday he felt sore. His R arm is swollen, red N and sore. 7/13/2009 He is c/o HA 7/14/2009 and backaches too. H eveloped generalized vaccinia U 7/8/2009 7/9/2009 veloped a burning sensation in rightYarmpit within an hour after receiving vaccine. Two hoursUlater developed 7/13/2009 a lump7/13/2009 in the same area. By t ater: dizziness, malaise followed byYrapid atrialYfibrillation at day 3 requiring 2 overnight stay inYthe hospital6/29/2009 10/16/20096/30/2009 received records from immunization, experienced deltoid pain and headache. Deltoid pain experienced for 72 hours Y and had 7/10/2009 poor range 7/10/2009 of motion causing a dis given a double dose of Varicella vaccine. Y Once when he was 15 months old, then again when N he was 57/13/2009 years old (7/13/09). 7/13/2009 On his left le 0cm Circular, swollen leasion on lt upper thigh. Red, hard, and tender Y 7/13/2009 7/14/2009 hest pain, asthsma, diarrhea. 7/17/09 Medical records received DOS 7/13/09 to 7/17/09. PAP U test and Gardasil 7/13/2009 administered. 7/13/2009 Next day pat me swollen down to elbow.hard......red.....hot to touch..........DR verified more than normal reaction Y to vaccination;took 6/16/2009 6/16/2009 course of Doxycyclin (Rabies vaccine)#1 given 6/24/09. Pt. Y had no reaction. Rabavert #2 given 7/1/09. On 7/2/09Yclient had sweating, 7/1/2009chills (T97.9), muscle/join S AND SWELLING AROUND SITE Y Y 7/8/2009 7/9/2009 e tender to touch where vaccines were Y given. No lumps, just erythema. Y 7/14/2009 7/15/2009 , child developed raised pink areas on face, legs, arms, torso which increased by 7-7-09. Denies Y fever or6/25/2009 swelling; continues 7/5/2009to eat and urin ped local reaction to vaccine. pt had warmth & erythema at vaccine site measuring 12x7cm. no U pain/ fever. 7/13/2009 7/14/2009 er receiving her Gardasil, patient felt Y a little bit tachycardic (did not report this until later). She Y walked up7/10/2009 to the desk7/10/2009 at the nurse's station to with head ache, slight nausea, feeling exhausted. Felt as if heart was pounding/racing. Pt feeling Y fine by 6/30/2009 Thursday 7/1/09. 7/1/2009 Both pt and spou e felt poorly last night. He felt as though Y he had a fever and was being stung by bees. He also Y felt dizzy7/14/2009 and SOB. 7/15/2009 He has hx of COPD an month vaccines including Pediarix, Prevnar, Y oral Rotavirus, and ACT-Hib. 4 hours later she was Y lethargic,5/18/2009 was felt to5/18/2009 be hot to touch, was se er taken at 2:15 a.m. on 4/20; 1 tsp Motrin Y immediately administered; drove to emergency room; N 1 dose of 4/17/2009 Tylenol given 4/20/2009 at 3:00 a.m.; fever was reported by a lawyer and described the occurrence of chronic inflammatory demyelinating U polyneuropathy 5/17/1999 in an adult### female subject w at 10pm father noticed eye lids swollen Y + red. Taken to ER - Benadryl liquid given. Y 7/2/2009 7/2/2009 s of Bells Palsy returned. This included facial droop and pain in L side of face. Is taking Prednisone N for symptoms. 7/13/2009 7/14/2009 pule, erythema at site of VARICELLA Y vaccination, Approx 3cm X 4 cm. Y 7/13/2009 7/14/2009 up with chest pain that got worse asYthe day wore on, 8/10. Went to the ER at 2100 that night Y and had normal 6/24/2009 EKG per 7/3/2009 SM. Was told his ch oped chest pain that lasted approx one Y day and resolved without treatment. Approx 10 days Y later c/o of SOB 6/17/2009 when laying 6/20/2009 down at night. coughing, wheezing, lethargic, increased heart rate & pale 5 minutes after shot. ALBUTROLY breathing treatment/ 7/14/2009 Nebs. 7/14/2009 Epi jr. pen injectio ea red and swollen, hot to touch. Area Y of redness covers most of upper thigh and 3/4 of circumference. N TX: 7/13/2009 antibiotics 7/15/2009 and BENADRYL for i tender swelling at site of injection. Left lateral arm. N 7/9/2009 7/13/2009 aricella red + swollen + itching 18mm x 40mm. Y 6/3/2009 6/5/2009 and induration in right thigh 2 days after administration, measuring 3.5 x 3.0 cms. No tenderness. Y Patient c/o 7/2/2009 some itching. 7/4/2009 BENADRYL has , child complained of rt cheek/jaw hurting, Y small amt. of swelling below rt ear/jaw. Called CDC Y to see if mumps 5/26/2009 was 6/20/2009 a possibility - CDC conf usea, diarrhea, itchy Skin/Hives. Joint pain, Myalgia. Trouble Swallowing. N 5/20/2009 6/20/2009 AX administered 7/7/09. Pt called on 7/9/09 reporting redness, swelling, itching at injection site. Y Described7/7/2009 site as oblong 7/8/2009 red red spot -silver an 24 hours after vaccination pt developed Y urticarial lesions diffusely over body- oral antihistamines/ N He blockers 7/2/2009 / cool 7/3/2009 compresses. Still wit called on 6/2/09 to let us know that his mother has been recently diagnosed with A.D.E.M atU Hospital, possibly 4/8/2009 related 5/1/2009 to exposure to child nt cyclical crying/ screaming with knees drawn up to chest about a few mins. X about 3 hours Y post ROTATEQ 5/11/2009 given5/11/2009 hing of arms & legs for a few seconds Y at a time Yrepeatedly through evening. 1 Seen by RN in ED Y - concern for 6/5/2009 infantile 6/5/2009 spasms. Admitted ove partial seizure, head nodding, eyes blinking slowly, not responding for 20 seconds or so. Fifteen Y minutes -7/1/2009 hour of abnormal 7/6/2009 behavior. Five ately 10-15 min after vaccine given. Patient called and c/o tingling in her fingers of the arm that U she received 7/13/2009 her vaccine 7/13/2009 the use of her muscles, Yblood pressure Y unstable, Y could not control44 eye Y movement or controlYbody temp. My 4/2/2009 child could 5/1/2009 not breathe on her dy tremor/spasmed (seizure) starting with arms and legs with head nodding. Afterwards, screaming U more, 6/26/2009 low grade6/29/2009 continuous grunting ins d moderate swelling R deltoid, TTP. LT prescribed BENADRYL 25mg q6hrs for TX. 7/6/2009 7/7/2009 began on LFT side (where vaccination was administered) 5 days after vaccination. The painYtraveled to6/13/2009 LFT shoulder 6/17/2009 and upper arm, then ted 10 d. after vaccines with >3cm smallpox lesion, mild to moderate erythema, subj. c/o SOB N on exertion, 6/26/2009 fatigue, malaise, 7/4/2009 intermittent che mited at home x 3 and had diarrhea x 3 1/2 wks - parents feel it is from the Rotavirus vaccine.Y 3/27/2009 3/27/2009 c'd Hep A and VZV #2 on 7/6/09. She was fine until 24 hrs later when she noted a red rash on U L arm. 7/6/2009 7/7/2009 00. Received call from pts mother stating that child began with red, raised, maculopapular rash Y covering entire 7/2/2009 body 7/2/2009 approx. 30 min post re
ost bumped in the door as she left the office after the 1st GARDASIL and felt dizzy but got betters Y quick. Today 7/9/2009 after 7/9/2009 the 2nd GARDASIL - s temp of 104.3 degrees F, headache, weakness onset this evening. Also c/o SOB + wheezing. Y Treatment 7/7/2009 - Ventolin.7/7/2009 No acetominophen o d varivax vaccine sc in left arm. Patient Y was seen in Emergency Room on 07/10/09 for redness Y at site on7/9/2009 left arm. Treated 7/9/2009with Keflex. S ed child had a rash to both arms andYhas complaining of itching. Subjective data. Mom stated child had a7/9/2009 fever. Mom 7/11/2009 called children's hea slight elevation. Y 7/6/2009 7/7/2009 skin rash, diarrhea, soreness @ inj.Ysite, headache, back pain, myalgia. Y 6/22/2009 6/23/2009 n has been received from a consumer concerning her nephew who was vaccinated with MMR U II (therapy date, dose, route and lot# not rep was reported by a pharmacist and described the occurrence of fainting in a 30-year-old maleY subject who 6/12/2009 was vaccinated 6/12/2009 with TWINRIX (G was reported by a pharmacist and described the occurrence of fainting in a 30-year-old maleY subject who 7/13/2009 was vaccinated 7/13/2009 with TWINRIX (G was reported by a physician and described the occurrence of facial palsy in a 18-year-old male U subject who 7/7/2009 was vaccinated 7/8/2009with BOOSTR et of 9:00pm on 7/14/09, by 3:00pm on 7/15 temp was 101.7 oral and patient called HD. Patient U also c/o7/14/2009 body aches, 7/14/2009 tired and dizziness. swelling, redness and itching U 5/19/2009 5/27/2009 ter receiving IPV vaccine, patient developed Y fever Y above 102 and uncontrolled 2 vomitting thatYled to dehydration 6/17/2009 and6/17/2009 necessary hospitalizat ear old received the following vaccines on 5/6/2009. HPV Lot # 1129X, HAV Lot # 0932X, and Y Varivax Lot5/6/2009 # 0050Y. 5/6/2009 The primary medical d sented to clinic 2 days after receiving Zostavax injection with an approx 40x48mm red raisedNindurated area 6/23/2009 at the injection 6/24/2009 site, it felt mildly es that pt had a nose bleed 4 days post gardisil #1. States pt has never had nose bleed int the Y past "It gushed 7/3/2009 and woke 7/7/2009 her up-we got it to ter received the HPV Vaccine Gardasil on Tuesday, July 14th at 6pm. On Wednesday July Y 15th she woke 7/14/2009 up with pain 7/15/2009 at the injection site er, patient experienced an all over body rash 2 1/2 hours after vaccination of VZV and Hepatitis U A on 07/14/2009. 7/14/2009Denied 7/14/2009 fever. Denied itc 09 Patient came home with Y chills and Y fever; started Y vomiting during night. 5 Fever was up to 103.5. Y Also had7/7/2009 lower back7/8/2009 pain and headache. V ng, redness, pain, itching Y 7/14/2009 7/15/2009 reddened area on left arm. C/O itching 7/14/2009 7/15/2009 swollen at sight of injection with redness and pain U 7/14/2009 7/15/2009 VE REEDNESS AND PAIN BEGINNING THE DAY AFTER THE SHO PERSISTING OVER HEREE Y WEEKS. 6/24/2009 iTCHING 6/25/2009 BEGAN 5 OR 6 DA Varivax and had a local reaction at the site approximately 11.5 cm wide by 12.5 cm high Seen Y by pcp 7/14/2009 no treatment 7/15/2009 except for Tylenol for treaks from scratching irritation from adhesive bandaide Y 7/14/2009 7/14/2009 patient received following vaccinations: Y L leg - IPV and Varicella. R leg - MMR and DTaP.UGrandma reported 7/8/2009 that 7/8/2009 the evening after vacc Varivax on 7/13/09 on 7/14 at injection site a mild erythemia appeared as approximately 4cm Y circle. no7/13/2009 treatment needed 7/14/2009 lled office at 8:30 am on 7-15-09 reported Y that her daughter had fever of 104 F that morningY(approx 24 7/14/2009 hours after 7/15/2009 vaccines). Mother gave as vaccinated on July 14, 2009, Developed reaction with in 12 hours of vaccines given, Meningococcal U IM 7/14/2009 left deltoid7/15/2009 muscle and Varicella S er came back too low on 5/27/09.6/12/09 I received the first of a two-part series MMR vacination. Y 6/15/097/14/2009 I noticed a7/15/2009 raised,red,hard,warm, minutes after pneumococcal vaccine at 1125 a.m., pt c/o dizziness. Pt's face turned red. Pt c/o Y chest tightness 7/16/2009 and back 7/16/2009 pain 11/10. Doctor s, shakiness, nausea, joing pain, overall teirdness/feeling of sickness Y 7/14/2009 7/15/2009 and profuse sweating for approximately 20 minutes Y d vaccine on Mon 7/13/09. Pt called on 7/16 saying that Tues afternoon after playing golf she Y noticed her 7/13/2009 arm was swollen, 7/14/2009 red, itchy, , had d GARDASIL #2 on 7/10/09. No complaints Y at visit. Phone call to clinic Mon 7/13/09 08:10am. N Pt reported 7/10/2009 to RN pains 7/11/2009 swelling and unab onset of fever and child complaining Y of pain taken to doctors. June 20th taken to ER for high U fever 103.76/11/2009 and examined. 6/16/2009 Illness continued. ounding injection site reddened, tender Y to touch and slight swelling Y 7/13/2009 7/14/2009 7/10/2009 "startle reflex" every few seconds X 30 min sticking tongue out and increased salivation. Fussy Y and pale.7/1/2009 Refusing to7/1/2009 eat. As reported by p ught child to clinic 7 days after shots she had viral exanthem & hives. Present to allergist for Yfinal dx & recommendation. 6/9/2009 6/17/2009 le ADSM is referred from a researchYsite with c/o recent diarrhea, decreased appetite, dehydration U and chest 7/9/2009 pain. Symptoms: 7/13/2009 Dizziness, c acular rash on trunk - antihistamine - steroid injection 40mg DEPOMEDROL - 2mg DECADRON Y IM 7/14/2009 7/14/2009 n the shingles vaccination as part of my physical examination - recommended. It was administered Y along5/22/2009 with the pneumonia 5/22/2009 vaccination ven TDAP and VARIVAX vaccines on 6/26/09. Reports that on 6/27/09, she began to have body aches, low 6/26/2009 grade temp 6/27/2009 up to 99.8 and nec ely after giving vaccines - VARIVAX, in right arm subcutaneously deltoid area, patient developed Y urticaria7/15/2009 at injection7/15/2009 site, had itching. Bena er injection outer aspect of (R) arm from deltoid to just above elbow red, warm and swollen Y 7/14/2009 7/16/2009 ollen at injection site. Ice packs & ibuprofen as treatment. Y 7/1/2009 7/3/2009 es hot, red and painful induration larger than the "palm of her hand" Y 7/14/2009 7/15/2009 on 7/16/09 self reported event. Stated she thinks she had a reaction to the PNEUMOVAX vaccine. U she had 7/13/2009 swelling7/14/2009 under her arm, sorene sode of nausea then vomiting about 10 - 15min after receiving HAVRIX Y 7/15/2009 7/15/2009 around injection sight, erythema andYhives just distal to shot sight. U 7/14/2009 7/16/2009
and redness of left upper arm and elbow. Y 7/14/2009 7/14/2009 er injection arm became extremely swollen Y & painful. Saturday was started on PREONISONE. U Monday swelling 7/2/2009decreasing 7/3/2009also taking NA -old male, with no illness at the time of vaccination, Y received a first dose of YF-VAX (Lot number Y UF30AA;7/8/2008 route/site7/12/2008 of administration not re rmation was received on 03 December Y 2008 from a health care professional. A 22 year old male Y patient received ###a right arm ###subcutaneous ort was received 03 December 2008Yfrom a health care professional. A 56-year-old male patient Y with no known### allergies and no past medica was received from a health care professional Y on 09 March 2009. A 29-year-old patient received U a subcutaneous 3/6/2009left arm injection of YF-Va serious case was received on 27 March 2009 from a health care professional. A 21 year oldUmale patient3/16/2009 received IPOL 3/23/2009 (lot number B0476 serious case was received on 24 April 2009 from a health care professional. A 22 year old female Y patient4/21/2009 received IPOL 4/22/2009 intramuscularly in t lasted 2 days straight. Even with children's Y motrin and tylenol, fever reached 104.8 at 4 am Ytwo days after 7/14/2009 shots were 7/15/2009 received. The fifth sh - Reported to the ER with headache Y pain (10/10) Y and fever (max 102.8). 4 Admitted to hospital Y for 6 days6/15/2009 (discharged 6/24/2009 30 June 2009). During and swelling up to 5" in place of injection. Pain, fever 100.4. N 7/6/2009 7/7/2009 abdominal, face, legs, and arms X 2 days later probably viral reaction Y 7/7/2009 7/9/2009 HPV vaccine 5 days later pt experienced Y swelling (lump) and hotness at injection site. ReccUcold compresses 7/8/2009 7/13/2009 -old male patient received vaccination with smallpox Y vaccine on an unknown 1 date. The manufacturer U and lot number of the vaccine were no t clinic was reported by mom to be "acting drunk" unsteady gait, saying inappropriate things.YWas then sleepy. 6/16/2009 Episode 6/16/2009 lasted about 4 hour m (upper) was reported as red and swollen. Rx BENADRYL and warm compresses. 7/12 - redness Y spread 7/10/2009 to wrist but 7/10/2009 swelling decreased an ours after shot - swelling redness lump under tissue 1.5cm. Cont x 4 days came in - Tx ice toYarea (5 minutes 7/7/2009 intervals! 7/8/2009 and BENADRYL 25 aised, red, hot area around injection site. ort was received 14 July 2009 from a consumer,Ywho is also the patient. 56 A 36-year-old femaleNpatient with3/25/2009 no medical5/6/2009 history and no concur hild received 4 immunizations at Dr Y office. 7-15-09 site of MMR was red, hot and raised, no fever, Y no malaise, 7/13/2009 child acting 7/15/2009 normally. Went to n has been received for the pregnancy Y registry for GARDASIL from a master of science in nursing Y concerning 5/19/2008 a 26 year 7/1/2008 old female with no arm below injection site is red\swollen\hard\hot. Approximately 11cm in length and 9 1/4 cmYacross. Given 7/15/2009 BENADRYL 7/16/2009 and tx with antibio d at injection site red\swollen\itchy area approximately 1" across and 4" down. No rash or anaphylactic Y reaction 7/13/2009 noted. 7/14/2009 Instructed to give BE n has been received from a consumer Y concerning her 19 year old daughter with no medical Y history and drug 5/28/2009 allergies, 6/25/2009 who in approximatel er arm swollen, warm to touch, pinkish color. Y 7/15/2009 7/16/2009 dose of Hep B given to adult on 7/6/09, followed by adult dose given on 7/9/09. No adverse s/s. Y 7/6/2009 ssure both lower legs (calf) and behind knees: helped by resting (in recliner). Makes worse: walking. 3/9/2009 3/14/2009 ooster given on: DECAVAC - 1-26-07 - correct Booster as last Booster was 1997. DECAVAC Y - 1-8-08. DECAVAC - 1-9-09. No adverse sym . 2 Red papules L thigh, surrounding redness, one with pustule no streaks. U 7/3/2009 7/7/2009 r, chills, diarrhea, weakness, dizziness. Supportive care, Tylenol. Y 6/26/2009 6/26/2009 scribed dizziness, vision disturbance, shortness of breath and severe fatigue. Onset of symptoms U about7/13/2009 3 hrs after 7/13/2009 vaccination. Pt. stated s n and swelling to R arm several hours Y after admin. PNEUMOVAX. Pt returned to clinic 7/16/09 U for eval. Pt 7/14/2009 still had redness 7/14/2009 to injection site was reported by a healthcare professional Y andYdescribed the occurrence 0 of itchyYhands andNfeet in a female 6/5/2009 subject 6/6/2009 of unspecified age wh d four shots right arm (Meningococcal, Y TDaP, MMR, and Varicella). Had Hyperimmune response Y with shaking, 7/10/2009 chills, 7/10/2009 and temp of 100.6. P ever 103 and nausea 6-27-09 Tingling Y and numbness of all extremities and shortness of breath Y 6/22/2009 6/24/2009 nt pain, headache, nausea, stomach pains, low grade fever. Treated with appropriate fever lowering Y agent 7/16/2009 7/16/2009 ing and redness at the injection site.YRequired topical treatment and Tylenol. Y 7/14/2009 7/16/2009 CAME TO HEALTH DEPARTMENTY FOR COLLEGE IMMUNIZATIONS. NERVOUS ABOUTNSHOTS. DETERMINED 7/17/2009 7/17/2009 NEEDED Tdap(FOR ction, red, swollen, hurts, no temp. Shots on Tuesday, reaction gone on Friday. Did not see Y doctor. Used 6/23/2009 cold compress 6/24/2009 at sight. ction, red, swollen, hurts, no temp. Shots on Tuesday reaction gone on Friday. Did not see Y a doctor. Used 6/23/2009 cold compress 6/24/2009 at injection site. nt received a Dtap in the left arm, and about 36-48 hours later, had onset of induration, swelling, U warmth,7/15/2009 and erythema, 7/17/2009 resembling celluliti ay is declining 3rd Gardasil Still having shoulder pain from 2nd inj. Day of 1st inj and after no N sx. 2nd inj: 3/30/2009 day of inj3/30/2009 headache ,nausea, so m, raised area at vaccine site for one week. 2.5cm in length. Denies fever, pain, or other symptoms. Y Treatment 7/12/2009 given, 7/13/2009 tylenol and benedryl. L HOURS AFTER RECEIVING THE VARICELLA VACCINE, THE PATIENT EXPERIENCEDYBLISTERS 7/14/2009 ON HER BODY. 7/14/2009 THE BLISTERS R welling of joints(knees and elbows). High fever, rash all over back and abdomen. Motrin andNTylenol given 1/19/2009 for the pain 1/27/2009 and inflamation. E 24 hours after vaccinations were administered Y patient had redness around both eyes with facial Y swelling. 7/15/2009 7/16/2009 an on 7/16/2009, 8 days after MMR vaccine. Fever up to 102.5 on 7/17/2009. Eating and drinking U well, playing 7/8/2009 and7/16/2009 responsive to parents.T erythema, warmth to touch, tenderness Y at injection site. Pt. reported fever developed the day U after vaccine 7/13/2009 was administered. 7/14/2009 Pt. was seen M CALLED TODAY TO REPORT THAT PT HAD RXN TO TDAP VACCINE RECIEVED YESTERDAY. Y REPORTS 7/16/2009HEADACHE, 7/17/2009 NECK/JAW vaccines 7/16/2009. Reports that at 11:30 this am (7/17/09) she started with lower facial tingling U and family 7/16/2009 member 7/17/2009 says that when the c redness surrounding vaccine site. Itchy and a little sore. Started about 24hrs after vaccine. U 7/15/2009 7/16/2009
ped acute arm pain at the site of injection & the following day spread to both arms & legs; diffuse N muscle 5/1/2009 pain throughout 5/2/2009 developed over 1 vaccine resulted in a case of shingles. Y U 7/13/2009 7/13/2009 after injection with chills, malaise, warm, Y red urea at site. Woke next am with pruritic rash onUlegs. 7/15/2009 7/16/2009 wny edema area on right upper arm.Y Y 7/14/2009 7/16/2009 m noticed swelling adn redness at inj. site. In clinic 7-17-09 upper arm red with hard knot and Y swelling of7/16/2009 right arm at 7/17/2009 inj. site.Area of 2 1/2 4 hours after vaccination, injection area began swelling, ultimately to the size of a large orange; Y erythema, 7/10/2009 pruritis, tenderness, 7/11/2009 very hard an ceived Zostavax vaccineYfor shingles Y on 2-2-2009. Patient lost hearing in right ear, Y developed N swollen neck 2/20/2009 glands and 2/20/2009 growth in nasophary fever, hoarseness, paleness, weakness, and dizziness. started 9:30 pm on July 14, 2009, and U ended 1:30 6/14/2009 am July6/14/2009 17, 2009. treatment:ibp d male received MMR #1, Varicella #1 Y on 6/15/09. Presented with c/o rash all over body, seen Y at ER, Measles 6/15/2009 IgM, IgG 7/8/2009 titers sent from ER, a on back of left arm. Red, swollen, Y and warm. Y 7/15/2009 7/16/2009 eltoid swollen noticed 7.16.09 unsure fever, felt hot mom gave 1 dose of TYLENOL induration U 8 cm x 7 cm 7/15/2009 Red & Hard 7/16/2009 as per mom the ind @ vaccine sites 0 anaphylaxis, 0 emesis, 0 resp distress, supportive care only. Y 7/16/2009 7/16/2009 njection, 2 hours later L arm red and worn from site down to L hand. U 7/16/2009 PV given in lower mid Lt thigh where Y bled after injection VARIVAX then swelled and becameYred / Lt posterior 7/14/2009 arm was 7/14/2009 in injected 3x / keep crying with loss of appetite since administration of vaccines (PENTACEL, Hep B, PREVNAR U & ROTATEQ) 7/14/2009 on 7/14/09. 7/14/2009 d stools with bloody mucus, foul odor Y 5 days after ROTATEQ given - ? anal fissure (not clearly seen). No 7/7/2009 elevated stool frequency irritability en 6 shots on 7-14-09. Received call today stating she is 6 months pregnant. Will see physician U on 7-21-09. 7/14/2009 n has been received from a consumer for the Pregnancy Registry for GARDASIL concerningYher 18 year3/24/2008 old daughter who on 24-MAR-200 n has been received from the pregnancy registry for GARDASIL vaccine from an 18 year oldYfemale consumer, 5/1/2008 who 7/7/2008 started therapy with G n has been received from the pregnancy Y registry for GARDASIL via a nurse practitioner, concerning U a 22 4/25/2008 year old female 4/25/2008 with a history of a n has been received from a physician, Y for the Pregnancy Registry of GARDASIL, concerningYa 24 year old female ### with 1/7/2008 anxiety and depress n has been received through the Merck pregnancy registry for GARDASIL vaccine from a registered N nurse 5/19/2008 concerning 7/1/2008 a 20 year old female n has been received from a physician for the Pregnancy registry for GARDASIL, concerningYa 25 year old 7/16/2008 female with 8/6/2008 no drug allergies and n has been received from a medical assistant through the Pregnancy registry for GARDASILYconcerning9/17/2008 a 17 year old female with no previ n has been received from a physician for the Pregnancy Registry for GARDASIL, concerningY a 15 year old 9/17/2008 female with bicornuate uterus a n has been received from a healthcare worker concerning a 20 year old female with no known drug reactions/allergies 4/25/2008 8/20/2008 and no pertinent me n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a female ### who in1/1/2007 approximately 2007 w n has been received from a registered Y pharmacist concerning a "teenager" female who in February U 2008, was vaccinated with the First dos n has been received from a patient's Y mother concerning an 18 year old female with no allergies Y who on 08-JUN-2009 6/8/2009 6/8/2009 was vaccinated with n has been received from a physician Y concerning a 25 year old female patient with a historyUof vaginosis bacterial 6/2/2008 on 19-MAR-2009 who on n has been received from a physician concerning a female who was vaccinated with a 0.5 mL U dose of GARDASIL, intramuscularly. 5/1/2009 A mont n has been received from a licensed Y practical nurse concerning a 23 year old female with noNmedical history 5/1/2009 and drugs 5/28/2009 allergies, who in No n has been received from a physician concerning a female patient. It was reported that in January U 2007 12/1/2008 the patient's5/9/2009 pap smear was norma n has been received from a nurse concerning Y a 11-year-11-month- old female patient who was N vaccinated 5/27/2009 with the first dose of GARDASIL n has been received from a physician Y concerning her daughter, an 18-year-old female, who Yin July 2008 was vaccinated 7/1/2008 with the first dose n has been received from a physician who has heard of a couple of female patient's who were U vaccinated with dose of GARDASIL. The pa n has been received from a consumer Y concerning her "teen" daughter who was vaccinated with N three doses 3/1/2009 of GARDASIL 3/1/2009 as follows: 1st i n has been received from a 72 year old female consumer with blood pressure high, cholesterol U and Oesophageal 6/6/2009Reflux 6/6/2009 acid reflux concer n has been received from a consumer concerning her 12 year old daughter with seasonal allergy N who in October 2/1/20092008 2/1/2009 was vaccinated with n has been received from a registered nurse concerning a 23 year old female patient Y with noNpertinent medical 3/26/2009 history 3/26/2009 or allergies who on 2 rmation has been received from a nurse practitioner, for GARDASIL, a pregnancy Registry product, Y concerning 10/8/2008 a 1710/8/2008 year old female with as n has been received from a registered Y pharmacist concerning a 14 year old female with no medical N history 5/6/2009 and no allergies who on 06-MAY n has been received from a physician concerning a 22 years old female with unknown medical U history who 6/9/2009 on 09-JUN-2009 6/10/2009mid morning w n has been received from a registered Y nurse concerning a 22 year old female who on 25-MAR-2009 N was 6/2/2009 vaccinated 6/2/2009 with the first dose of G n has been received from a physician Y concerning a female who was vaccinated with a dose Uof GARDASIL. Subsequently the patient exper n has been received from a registered nurse concerning a 19 year old female who on an unspecified Y date was vaccinated with third dose o n has been received from a physician concerning a 19 year old female who about a year ago Y (in approximately 2008) was vaccinated with n has been received from a physician concerning his 24 year old daughter with no Y pertinent Ymedical history 5/4/2009 reported5/4/2009 and no known drug al n has been received from a physician's assistant concerning a 15 year old female who on 14-APR-2009 Y 4/14/2009 was vaccinated 4/14/2009 with second dose n has been received from a 22 yearYold female patient who on 20-FEB-2009 was vaccinatedYwith the first 2/20/2009 0.5 mL dose 2/20/2009 of GARDASIL. Ther n has been received from a physician concerning her daughter, a 26 year old female who onN11-JUN-2009 6/11/2009 was vaccinated 6/12/2009 with the first do
n has been received from an office Y manager concerning a 17 year old female patient who onU15-JUN-2009 6/15/2009 was vaccinated 6/15/2009 IM with a dose n has been received from a registered Y nurse concerning a female patient who "3 weeks ago"Y on approximately 5/12/2009 26-MAY-2009, 5/12/2009 was vaccina n has been received from a pharmacist concerning a female with unspecified drug reactions/allergies Y and4/1/2009 medical history, 4/1/2009 who "a couple m n has been received concerning a 23 year old female with latex allergy and no pertinent medical Y history 5/20/2009 who on 03-DEC-2008 5/21/2009 was vaccina n has been received from a pharmacist Y concerning a female who in June 2009, was vaccinated U with a dose 6/1/2009 of GARDASIL (lot number, rou n has been received from a nurse practitioner concerning a 17 year old female with no pertinent Y medical6/13/2009 history who 6/13/2009 on 13-JUN-2009 was n has been received from a certified medical assistant concerning a 26 year old female patient Y with penicillin, 3/27/2009 amoxicillin 3/28/2009 allergy and (PERC n has been received from a 24 year old female with no pertinent medical history and no drugNreactions/allergies 6/11/2009 who6/12/2009 on 11-June-2009 was n has been received from a health professional concerning a 11 year old female patient whoYon 23-APR-2008 6/12/2009 was 6/12/2009 vaccinated IM with the f n has been received from a nurse practitioner concerning a 22 year old female with no drug N reactions or5/22/2009 allergies who on 22-May-2009 wa n has been received from a physician Y concerning an "around 12 year old" female with unknown U allergies and unknown medical history who n has been received from a physician Y concerning a female patient who about a week and a Y half ago approximately 6/1/2009 June 6/1/2009 2009, was vaccina n has been received from a physician Y and company representatives concerning a 14 year old N female who8/1/2008 in approximately 9/1/2008 August 2008, w n has been received from a physician concerning a female who was vaccinated with her second N dose of GARDASIL (site and route of adm n has been sent from a consumer concerning her daughter who on unspecified date was vaccinated U with the second dose of GARDASIL (l n has bee received from a physicianY concerning a female who was vaccinated with a dose of U GARDASIL. Subsequently the patient was tak n has been received from a nurse practitioner concerning a female who was vaccinated withUGARDASIL. Subsequently the patient went co n has been received from a physician concerning a female who was vaccinated with the firstUdose of GARDASIL. The patient developed ra n has been received from a 21 year old female with no medical history who about 2 months N ago in approximately April 2009, was vaccinate n has been received from a licensed practical nurse concerning a 13 year old female who onY03-AUG-2007 8/3/2007 was vaccinated 8/4/2007 with a dose of n has been received from a consumer concerning a 15 year old female who on 13-JUN-2009 N was vaccinated 6/13/2009 with the 6/14/2009 first dose of GARDA n has been received from a physician Y concerning a female patient who on a unspecified date Y was vaccinated with a dose of GARDASIL (lo n has been received from a nurse practitioner concerning a 22 year old female with a historyYof vasovagal 6/16/2009 responses, 6/16/2009 but not as a reaction n has been received from the mother Y of the patient concerning a 14 year old female who onYan unspecified day in February 2007 was vacc n has been received from a physician concerning a 14 year old female patient who on an unknown Y date was vaccinated with the second do n has been received from a nurse practitioner Y concerning a 17 year old female patient with aYbroken toe6/17/2009 who on 17-JUN-2009 6/17/2009 was vaccina n has been received from a nurse concerning a 17 year old female patient who "has a history Y of passing6/17/2009 out, even if6/17/2009 you just draw blood". O n has been received from a physician concerning a female with unknown medical history and U unknown drug allergies who received all thre n has been received from a registered Y nurse concerning a 22 years old female with unknown Y medical history 6/16/2009 and unknown 6/16/2009 drug allergies w n has been received from a physician Y assistant concerning a female patient who on unspecified U dates was vaccinated with all three 0.5 ml n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL. Subsequently the patien n has been received from a physician concerning a female patient who in September 2008 and U November4/2/2009 2009 was6/7/2009 vaccinated with the fir n has been received from a nurse practitioner Y concerning a female patient who was vaccinated Y with GARDASIL. Subsequently the patient n has been received from a 32 year old female consumer with sulfa and shellfish allergies and N a history 6/16/2009 of endometriosis 6/19/2009 who on 16-JUN-2 n has been received from a nurse concerning Y a 19 year old female with a history of a "severe N reaction to6/12/2009 an unspecified 6/18/2009 meningitis vaccine n has been received from a certified nurse practitioner concerning a 22 year old female withUoveractive bladder 5/22/2009 and5/26/2009 allergies and no illness n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning Y a 25 year old with a history of asthma female N who on 18-JUN-2009 6/18/2009was 6/19/2009 vaccinated intramus n has been received from a physician concerning a 13 year old female who at time of vaccination N with unspecified sickness was vaccinated n has been received from a pharmacy Y technician concerning a female with a history of premature U who in January 2009, 1/1/2009 was inadvertently v n has been received from a consumer concerning his 22-year-old daughter who was vaccinated N with all three 7/1/2007 doses6/15/2009 of GARDASIL (dose, r n has been received from a consumer concerning her 16-year-old daughter with no medical N history nor drug 4/1/2009 reactions/allergies 4/1/2009 who was va n has been received from a consumer concerning her daughter who on 22-JUN-2009 was vaccinated U with 6/22/2009 the first dose 6/22/2009 of GARDASIL. On n has been received from a physician Y concerning an 18 year old female with no pertinent medical U history5/27/2009 and no drug 5/27/2009 reactions or allergies orted in an internet article, concerning a female who was vaccinated with GARDASIL (date, U dose, route not reported). The author of the ar n has been received from a consumer concerning her daughter, a 15 year old female who on U 04-APR-2009 4/4/2009 was vaccinated 6/6/2009with the first do n has been received from a registered pharmacist concerning a 17 year old female patient who U on an unspecified 6/17/2009 date had been vaccinate n has been received from a registered Y nurse concerning a 26 year old female with penicillin Y allergy and sulfonamide 6/23/2009 6/23/2009 allergy and a history o n has been received from a health professional concerning an 18 year old female with prophylaxis U who on 15-NOV-2006 was ### vaccinated w n has been received from a registered nurse concerning a 13 year old female who on an unspecified Y date was vaccinated with second dos n has been received from a certified nurse midwife concerning a female patient with sulfonamide Y allergy who on an unknown date was vac
n has been received from a Registered Nurse concerning a 16 year old female patient who on U 23-MAR-2009 5/28/2009 was vaccinated 6/16/2009 with a first do n has been received from a physician's assistant Y who reported that 0a patient came into the office U and reported that a friend of hers, who wa n has been received from a consumer mother concerning her daughter with no pertinent medical N history and no known drug allergies who i n has been received from a licenseYpractical nurse concerning her 19 year old daughter withNno pertinent1/20/2009 medical history who on 20-JAN-2 n has been received from a nurse practitioner concerning a female patient who on an unspecified Y date was vaccinated with GARDASIL (lot n has been received from a physician concerning a 12 year old female who on 24-JUN-2009Ywas vaccinated 6/14/2009 intramuscularly 6/24/2009with the 0.5 m n has bee received from a consumer concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (d n has been received from a physician concerning a 17 year old female who on an unspecified U date was vaccinated with a dose of GARDAS n has been received from a registered nurse concerning 3 female patient who were vaccinated U with a 0.5 mL third dose of GARDASIL, intr n has been received from a licensed practical nurse concerning her daughter with no medical N history of allergies, who in October 2008, wa n has been received from a Physician Assistant concerning a 9 years old female who on 22-JUN-2009 U was 6/22/2009 vaccinated 6/23/2009 with the first 0.5mL n has been received from a nurse practitioner Y concerning her 15 year old daughter who wasNadministered 11/2/2007 all three dose 12/9/2008 of GARDASIL, and n has been received from a nurse practitioner student concerning a 12 year old female with U allergy to ROCEPHIN 6/23/2009 and 6/23/2009 no past medical hist n has been received from a physician Y concerning a 23 year old female with no known pertinent Y medical 6/19/2009 history, who6/19/2009 on 19-JUN-2009 was n has been received from a nurse concerning a 19 year old female who received all 3 dosesUof GARDASIL 7/12/2007 (on 27-DEC-2006 was vaccinat n has been received from a office assistant Y concerning a 14 year old female with unspecifiedY drug reactions/allergies ### 8/1/2008 and medical history, w n has been received from a physician Y concerning a 22 year old female who "four months ago" Y in approximately 2/1/2009 February 2/1/2009 2009, was vaccin n has been received from a nurse concerning a 21 year old female who on 11-MAY-2009 was U vaccinated 5/11/2009 with the first dose of GARDASIL n has been received from a physician Y concerning an 11 year old female who on 18-JUN-2009 U was vaccinated 6/18/2009 with 6/23/2009 the first dose of GARDA n has been received from a nurse concerning a female who on an unspecified date was vaccinated U intramuscularly with a 0.5mL dose of G n has been received from a physician concerning a female who was vaccinated IM, 0.5 ml, with Y a dose of GARDASIL and then fainted. The n has been received from a registered nurse concerning a 26 year old female who on 25-JUN-2009 N was6/25/2009 vaccinated6/25/2009 with the first dose of G n has been received from a nurse concerning Y a 22 year old female who in April 2009, was vaccinated U with4/1/2009 her first dose 5/1/2009 of GARDASIL inje n has been received from a medical assistant concerning a 15 years old female who on 10-JUN-2009 Y was 6/10/2009 vaccinated 6/10/2009 intramuscular admin n has been received from an 18 year old female patient with a history of fainting but no drugUreactions or allergies 6/8/2009 who 6/8/2009 on 08-JUN-2009 wa n has been received from a physician concerning a 14 year old female with a history of passing U out from5/26/2009 other shots5/26/2009 (name manufacturer u n has been received from a physician Y concerning a 11 year old female patient with no pertinent U medical 6/17/2009 history and6/20/2009 no drug reactions or al n has been received from a Nurse Practitioner (N.P.) concerning a 16 year old female patient N who "about 6/22/2009 one week6/22/2009 ago" (on approximately n has been received from a physician concerning a 45 years old female with no medical history N and drug11/1/2006 allergy who 11/1/2006 in November 2006, w n has been received from a registered nurse concerning a female who two months ago was Nvaccinated with 4/29/2009 the first 5/1/2009 dose of GARDASIL. A n has been received from a registered nurse concerning an 18 year old female with no pertinent Y medical6/22/2009 history or allergies 6/22/2009 who on 22-JUN n has been received from a physician concerning a female patient who was vaccinated with Ua dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning Y a 23 year old female who on 09-UN-2009 wasUvaccinated with 6/9/2009 the first6/9/2009 dose of GARDASIL (6 n has been received from a nurse concerning a 13 year old female with AMOXICILLIN allergy Y who on 05-JUL-2009 7/5/2007 was 7/5/2007 vaccinated with th n has been received from a Licensed Practical Nurse concerning a female patient who on anUunspecified date was vaccinated with a first d n has been received from a nurse concerning Y a 16 year old female patient who on 29-JUN-2009 Y was vaccinated 6/29/2009with 6/29/2009 a dose of GARDASIL n has been received from a physician Y concerning a female patient in her mid teens with a fear U of needles6/8/2009 who on approximately 6/8/2009 08-JUN-20 n has been received from a physician Y concerning a female patient who was reported to be "14-16" Y year old who on an unspecified date wa n has been received from a physician concerning a 20 year old female patient who on unspecified Y date was vaccinated with a second dose n has been received from a nurse concerning a 16 year old female with no medical history or Y drugs allergies, 9/1/2008 who in 9/1/2008 September 2008, was n has been received from a physician's assistant concerning a 23 year old female patient with U hallucinations 6/22/2009 induced 6/28/2009 by steroids who on 22 n has been received from a nurse concerning an approximately 14 to 15 year old female who U was vaccinated with what the nurse thought w n has been received from a physician concerning his 11 year old son with a history of numerous N unspecified unimmunisations who was pos n has been received from a nurse practitioner concerning a 24 year old female with no pertinent Y medical6/27/2008 history reported 6/27/2008 and no known dru n has been received from a physician concerning a 24 year old female with no pertinent medical Y history reported and no known drug allerg orted in an internet article, concerning a female who was vaccinated with GARDASIL vaccine U (date, dose, route not reported). The author o n has been received from a physician concerning a female patient who on an unspecified date Y was vaccinated with the first dose of GARDA n has been received from a physician concerning a patient who was vaccinated with GARDASIL. U After getting the vaccination the patient e orted from an article, published Y on 29-JUN-2009 that there were "hundreds" of life-threatening U reactions said to be associated with GARDA n has been received from a physician concerning a 13 year old female patient with no pertinent Y medical 2/28/2008 history who2/28/2008 on 28-FEB-2008 was v edness swollen and tender to touch. U 7/16/2009 7/16/2009
m I had the 3rd gardasil shot and about 10 minutes later I was feeling sick, nausea,diarriah, stomache U pains, 7/17/2009 insomnia, 7/17/2009 heart palpatations,fe njection 7-6-09 at 5 pm. Beginning the next day, pt had severe headache and temperature ofN100 degrees, 7/6/2009 extreme fatigue, 7/6/2009 and severe pai of gardasil administered in check inYroom in left upper arm. Allowed to go, walked around the U corner to check 7/16/2009 out and 7/16/2009 my daughter's eyes Abdominal pain, nausea, Yvommiting,Yprolonged Y weekness, dizziness,3low Y bp, tachycardia,required N 911 call7/7/2009 on side of7/11/2009 highway, in Woodbury n has been received from a registered nurse for the pregnancy registry for GARDASIL concerning Y a 16 year 9/24/2008 old female 9/24/2008 who on 24-SEP-20 n has been received from a physician Y concerning Y a 14 year old female 4 who on 25-JUL-2007 Y Nwas vaccinated 6/4/2009 with the6/4/2009 first dose of GARDAS n has been received from a nurse practitioner. Y The nurse practitioner reported that Y "she wasNsent an email 7/23/2008 by one of 7/25/2008 her patient's mothers n has been received from a consumer Y concerning her 15 month old son with no pertinent medical U history 9/1/2002 and drug allergies 9/1/2002 who in Septem n has been received from a registered pharmacist concerning a 61 year old male with no medical N history7/10/2009 who on 10-JUL-2009 7/11/2009 was vaccina n has been received from a physician Y assistantYconcerning a 6 month 2 old male patient who on Y 25-FEB-2009 4/24/2009 was vaccinated 7/2/2009with a first dos ort received on 08 July 2009 from a Y health care professional. A 29-year-old male patient, whoYhad no concurrent 7/7/2009 illnesses, 7/7/2009 but who has med ye contact, words, repetitive odd behaviors, Y crying, sick, diarrhea. Pt was given 18Y vaccines until U 18 months. 11/3/2006 Pt was 11/3/2006 born with a twin-his sist d GUILLAIN BARRE Syndrome - MILLER FISHER Y Syndrome after multiple 3 vaccinations in Basic N Training. 2/25/2009 Symptoms: 3/27/2009 Neuropathy, Weakn 8/10/2007 Y 12 N 7/23/2007 7/28/2007 en area measuring 4 1/4 " x 3" wide. warm to the touch. Y 7/16/2009 7/17/2009 an to have emesis around 6/2/08 and progressed neurologically to vent. curd ICU for a time.NDr diagnosed 3/17/2008 with acute6/2/2008 demyelinating enceph rted blister at injection site on left leg. States slightly red. states fever 99.9 on 7/7/09. No fever or other symptoms 7/7/2009this7/8/2009 am. Giving TYLENO area of redness at vaccination site 15 minutes after vaccine (L arm). 15 mg ATARAX given. Y 7/14/2009 7/14/2009 was reported by a healthcare professional Y and described the occurrence of urticaria in a 29-year-old N female 7/6/2009 subject who 7/6/2009 was vaccinated w ogist - gave Valtrex 16m + clobetasol Y ointment. Headache, rash, blisters open with liquid coming out . 3 day fever to 101.9 . Left ear - canno d severe headache on 7/12/09 that Y resolved with Motrin 200mg + sleep. Mild headache off and N on Monday 7/8/2009 - Wed. Uneven 7/12/2009 pupils size 7/13 nausea, episode of fainting the following Y day, 7/14/09. Y 7/13/2009 7/14/2009 ation site became red & swollen 7 days after administration (area apx 60 mm X 120 mm) U 7/7/2009 7/14/2009 len, clear runny nose. Swollen nasal Y mucosa. Y 7/14/2009 7/14/2009 13/2009- Seizure activity- fever 102.3 at OHI- at home- seizure lasted 3-4 min. Mother brought Y baby to clinic 7/8/2009 2:43 pm. 7/13/2009 120mg acetaminoph ying inconsolable the day that Pt received vaccines and does this everyday lasting 20-30 min even it Pt's5/27/2009 sleep 5/27/2009 LEG RED AND SWOLLEN/ QUICKLY INCREASE SWELLING WITH WARMTH/ ABLE TO U BEAR WEIGHT 7/14/2009 BUT STIFF 7/15/2009 LEG WITH WALK vaccine July 10, 2009 with no adverse Y reactions in left upper arm. Pt called our facility July U 20 to report 7/10/2009 that in the AM 7/19/2009 July 19 started to fe ostrix on 7/17/09; reports vomiting, hives, arms feel heavy, wheezing, back burning, swelling Y at site on 7/20/09 7/17/2009 Advised 7/17/2009 benedryl Y ### 7/10/2009 ay his leg was blistered, really red and Y hot dont know if it was from shots or the broken needle Y i found in7/14/2009 his leg 7/15/2009 9 noted lethargy, headache when moves around too much. No elevated temperature, no vomiting. U Encouraged 7/13/2009to 7/19/2009 give Tylenol or Ibuprop ped marked thrombocytopenia 4 weeks Y after receiving MMR, varivax, and Hep A. Pt was given IVIG in emergency 6/17/2009 department 7/17/2009 on 7/17. ands, elbows, and chest. contact dermititis Y at site of injection U 6/30/2009 7/15/2009 ceived Pentacel, Prevnar, & Rotateq on 7/13/09. Within minutes, patient developed 2 small Y hives on feet7/13/2009 & legs. No 7/13/2009 breathing dificulties o Y 5/7/2009 Y 6/4/2009 of vessicular rash in L5/S1 distribution Y - burning pain with rash consistent with zoster. Occured U at non-vaccination 7/16/2009 site 7/17/2009 1 day after zoster va scribes receiving Tetanus/Pertussis shot on 7/10/09 in left arm. On 7/11/09 around 2 pm, started Y to feel7/10/2009 weak, lightheaded 7/11/2009 and body ache reported that approximately one week after she recieved the vaccine that she noticed a redYarea around 7/1/2009 the injection7/6/2009 site that "itched". Sh her 1st Varivax 7/6/09 in her left thigh. It started to become red that day and became the size Y of a nickle.7/6/2009 The site was 7/6/2009 red, no tenderness rash, itching, left upper underarm 11X12cm Y red, warm, 4cm area of blisters, oricedyre: 2 blisters Y opened 7/14/2009 for Zoster7/15/2009 culture and lg blister po eived a Menactra on 7/20/2009. She had a previous meningitis vaccine (type/ brand unknown) Y on 8/23/2007 7/20/2009 in another 7/20/2009 county. virus vaccine was ordered due to a non immune varicella titer result. the pharmacy dispensedY a Zostavax7/16/2009 vial in a ziplock bag that was labe ion site began to itch, turned hot and Y grew to about 5 inches or more in diameter within 24 hours, Y and has 7/17/2009 remained7/18/2009 for 3 days. Benadryl d pneumococcal vaccine trial, with severe COPD, was diagnosed with stage 3A carcinomia of the right lung 6/25/2007 that as of5/15/2009 June 2009 has spread tender erythmatous area at immunization Y site. Y 7/13/2009 7/14/2009 ediatric dose of Hep B instead of the adult dose. The patient did not suffer any adverse reactions. Y I contacted 7/20/2009 the patient 7/20/2009 and reported my Y 6/15/2009 7/12/2009 dministered Friday afternoon, July 17, by physician. Saturday afternoon had uncomfortable Yskin soreness 7/17/2009 on left shoulder. 7/18/2009 Examined to fin who works in Dental school received MMR vaccinatioin on 5/20/2009. Screening questions U asked regarding 5/20/2009 pregnancy 7/17/2009 or plans to become
7/2/2009 N 7/2/2009 7/2/2009 days c/o headache, nausea, emesis - persistent c/o anorexia and mild nausea for 2 - 3 wks.Y 6/30/2009 temperature 105 degrees/ seizure Y activity. Fever started day of vaccine 6/26/2009 seizure started Y 6/27/2009. 6/26/2009 6/26/2009 noted severe redness, erythema, tenderness & swelling Recommended ice packs to area &YMOTRIN 7/14/2009 7/15/2009 ceived VARIVAX IM instead of Sub-Q. Y 7/15/2009 insect bite like sensations on arms/legs/back & will have appointment w/ MD to examine perUcase in case 6/26/2009 he is developing 7/15/2009 shingles. re for physical with foster mom (her aunt). Denied sexual activity; LMP 6/20/09. Office protocol is to do a preg 7/7/2009 test if receiving HPV. HepA, :35 AM - Patient received MENACTRA and ADACEL vaccine. Patient is placed in chair to beYobserved for 7/14/2009 15min. Patient 7/14/2009 fainted and fell ou and swelling on the left arm around the deltoid area - Prescribed/ advised to take BENADRYL U and ibuprofen. 7/8/2009 Reaction 7/8/2009 on the arm then got ills, body aches began 2 hours after TDAP administration and lasted 4 days" Y swelling, warmth & streaking of redness Y to left arm. Pt denies fever. Is going to urgent care. Y SWM contacted 7/10/2009 & notified. 7/13/2009 Pt given copy of at injection site, knot in arm, pain, Pt. c/o not being able to move his arm. Rash around injection N site 7/15/2009 7/16/2009 24 hrs, acute onset, on back & some Y on face her anterior & extremities "too many to count" NRecommended 8/11/2003 TYLENOL 7/19/2009 & topical BENADR min after vaccines administered patient became pale, diaphoretic, and complained of abdominal Y discomfort. 7/20/2009 Also complained 7/20/2009of being light h ven Adult dose of Hep A - no Adverse Reactions. U 7/16/2009 an to have emesis around 6/2/08 with progressive to vent / trach and diagnosis of acute disseminating N encephalomyelitis. 5/16/2008 6/2/2008 Still being treated mplained of pain in injection site and when examined in the office her left upper arm had approximately Y a7/16/2009 10cm x12cm 7/17/2009 red circular area wit ted on shoulders and then spread all over. Started 7/7/09 same evening received shots hives Y continued to7/7/2009 AM, mom7/7/2009 notified MD of hives. R erythematous, hot, 3/12 cm. TX: KEFLEX, BENADRYL. Cool compresses. Y 7/7/2009 7/8/2009 ent's upper arm, where vaccine was administered, became red and swollen. Remained so for Y 4-5 days. 6/29/2009 ustule on right thigh. Y 7/6/2009 7/15/2009 urated - pruritic 12 X 6 cm swelling of Y leg just inferiorly to DTAP injection one day after administration 7/9/2009 7/10/2009 Y U 7/13/2009 7/13/2009 vaccine 6/29 - developed reddened, tender area where vaccine was given that night. Area is larger, still6/29/2009 tender 7/11/09. 6/29/2009 Given rx for Cefad n has been received from a physician concerning a female in her "mid 60's" who in 2008 (reported Y as "6 months to one year ago"), was vac ort received on 16 September 2008 Y from a healthcare professional. A 31 year old female, with Y no medical9/11/2008 history and 9/11/2008 who was using Nuvar 7/2/2009 Y Y N 5/8/2009 6/22/2009 n has been received from Y a consumer Y concerning Y a 14 years old female 5 with a history Y of tubes N in ears when little ###and 12/7/2007 adenoids removed at n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL (dose, ro n has been received from a physician Y and a certified Y medical assistant 6 concerning a approximately Y 18 week old ### male2/1/2009 with dermatitis from 0 n has been received from a registered Y nurse concerning Y a male with0 no patient medical Y history N who on approximately 7/7/2009 7/13/2009 07-JUL-2009 "one w r the first few weeks, panic attacks,Ylow body temperature, difficulty swallowing, unable Y to digest N food properly, 7/13/2007 regurgitation, 8/6/2007circadian rhyth e received pneumococcal vaccine in left deltoidYon 7/7/09. Later that2evening he called the medical U center 7/7/2009 complaining 7/7/2009 of pain, warmth, and minutes of giving KINRIX, VZV and MMR, the child Y developed coughing, hives and swelling ofYthe lips. 7/8/2009 7/8/2009 Reports crying x 2/2 hrs after vaccine Y administration. G. mom "thinks child not breathing normal". Y Examined 7/2/2009 in office 7/2/2009 5 hr > administration o ythematous somewhat confluent papules that covered anterior upper chest only-itchy. OTC steroid Y cream.7/8/2009 7/9/2009 patient started running a fever, thatYnight ok on 7/4. The fever stopped. On 7/5 patient brokeY out with "spots". 6/22/2009 She had 7/3/2009 several - all over "th Y 7/16/2009 redness, pain and itching at site of TRIPEDIA injection- (RIE suggested). Dr. stated to mom-mild reaction. 7/15/2009 Called 7/17/09 7/16/2009 12N Mom says sl m - Received care from MD's office Y stating, pt. there with c/o "redness and knot" in right deltoid Y area - child 7/14/2009 had school 7/15/2009 booster at Health De at the site of injection. Measuring 15L mm x 12mm w. Redness around the site 30mm x 15mm. Y Excess crying 7/16/2009 x 1 hr.7/16/2009 ceived Zostavax vaccine on 07/10/2009. Y She returned to the office today with a rash on herNback and left 7/10/2009 side, painful 7/15/2009 for six days. Shingle red adult dose of Hep B vaccine to client in error vs. adolescent dose. No adverse event noted Y at time of7/20/2009 administration of vaccine. two doses of Tdap. First dose 6/11/2009 and second dose today, 7/21/2009. No adverse reactions at this 7/21/2009 time. mplained of right swollen arm and slight temp of 99. She also complained of a headache. This Y was initially 7/17/2009 relieved7/18/2009 with aspirin and Benad vaccine given 7-18-09 in Left arm subcutaneous. Sat 10 minutes in office, no problmes at that Y time. Mother 7/18/2009 states child 7/18/2009 had a small red circ he night of immunization he felt shaky all night. next day he was pale, elevated heart rate, weakness, Y difficulty 7/10/2009 breathing. 7/10/2009 After taking Bena ately seven hours after receiving immunizations, Y patient had 7-10 minute episode of unresponsiveness Y and 7/13/2009 being "limp". 7/13/2009 Episode followed p G REDNESS AND EXTREME SWOLLEN. Y WENT TO ER. EVER SINCE THE SHOT SHE HAS Y HAD PAIN. WAS GIVEN BENADRYL ORIGI deltoid starting the day after injection. Today which is six days after injection she has quarter-sized Y area7/15/2009 of redness7/16/2009 over injection site with ived IM on 7/16/09. Employee states Y symptoms of nausea, vomiting, diarrhea, chills, hives, Y abdominal pain 7/16/2009 (10, low7/18/2009 grade temp started on
ports fever last evening. Marked swelling of left upper arm with redness and several bumps Y on the skin. 7/20/2009 Area is warm 7/20/2009 to touch. Area outline th history of cluster headaches. Recently started on topamax. Headaches controlled. Approximately Y three 7/21/2009 minutes7/21/2009 after administration of h at site, swelling at site, diarrhea, generalized joint pain Y 7/16/2009 7/20/2009 inflammatory irritation with proximal radial to shoulder perceived redness and warmth. Well circumscribed Y 7/20/2009 and mild 7/20/2009 palpable fever over late U 7/21/2009 7/21/2009 ely after administration of HPV patient fainted. Dr. reassessed patient for injury and reaction.YAfterwhich patient 7/14/2009 was7/14/2009 o.k. arm rash/pain starting 1 day after vaccine. Y Y 7/14/2009 7/16/2009 ED FACIAL SWELLING, TONGUE SWELLING, SLURRED SPEECH, DYSPHAGIA, ARM AND U FEET TINGLING, 7/6/2009 HEADACHE, 7/6/2009 NAUSEA. at 6:00 pt c/o soreness. On the next Y am noted redness, paiful to touch, warmth and edemaYrt arm. Applied 7/13/2009 ice packs 7/13/2009 and OTC Benadryl g GIVEN ON THE 10 OF JULY, CAME BACK ON JULY 20TH OF 2009 FOR A POSSIBLE REACTION U TO 7/10/2009 AMOX AND 7/20/2009 DR. KING ALSO SU vaccines at 2:30 pm office visit on 5-13-09. Y By 8:30 pm child had facial swelling and eyelid swelling. Y Poor 5/13/2009 feeding, swelling 5/13/2009 of injection site. dministration, dizziness for 30minutes (rapid heart). Itching and soreness and redness. Chief complaint redness 7/13/2009 increasing 7/13/2009 in size. ped chills Monday evening with Temp 102.4 that night. Parent treated temp with Ibuprofen alternated Y with 7/13/2009 TYLENOL. 7/13/2009 Child slept a lot 7/14/ mmunization began having brief (about Y 30 mins) periods of dizziness and nausea. EpisodesUare self - limited. 7/14/2009 Exam 7/16/2009 is normal. fter child received rotavirus vaccine, she developed Y bloody diarrhea.2 Initial blood culture wasUpositive but 7/8/2009 repeat neg.7/9/2009 Even several days lat ble crying last evening (7-15-09) x 4 to 5 hours. Would not walk at that time. Y 7/15/2009 7/15/2009 received rotavirus vaccine, she was difficult toYfeed, felt cold. The next 1 day she had BMs with U frank blood.7/8/2009 She was admitted 7/8/2009 overnight, BM 04, body aches, nausea. Y 6/25/2009 weakness, had to stop usual activities at school and went home. Was pale and clammy when Y the mother 5/27/2009 picked him 5/28/2009 up from school, the s erienced dizziness, fainting, vision disturbances, Y and fatigue beginning the morning after vaccination. U Pt was 7/9/2009 advised 7/10/2009 to go to doctor immed ely after shots were given Pt became Y unresponsive. Had small seizure lasting only few seconds. We opened 7/5/2009 airway 7/15/2009 and laid her flat. She ca ea red-warm-swollen-tender to touch. (varicella like) raised area about size of silver dollar-red U area about7/15/2009 3" wide and 7/16/2009 4 1/2-5" long- Recom d hives after KINRIX immunization. Came into office 7/16/09. Put on BENADRYL 1 1/2 tsp TID Y and PERIACTIN 7/14/2009 1 tsp 7/15/2009 TID, no fever or distr vaccine given subcutaneous left upper Y arm 7-9-09. Developed erythema, tenderness, swelling, U and warmth 7/9/2009 at injection 7/10/2009 site on 7-10-09. Sa ainful, papular rash of hands, spreadinig Y to arms, then legs. U 7/1/2009 7/4/2009 xis: Child presented with hives, itching and redness on face, also c/o feet itching at 1456 hrsY- 7 minutes7/14/2009 after receiving 7/14/2009 immunizations. He large amount of swelling at injection Y site. Y 7/10/2009 7/11/2009 en on 7/10/09 Pt in to U.C on 7/12/09. Left thigh swollen (1/2 of thigh) redness approx 3 inches U in diameter. 7/10/2009 Tender7/12/2009 to touch. Gait normal nic seizures, 3 hours after vaccinations 7/10/09.Y 7/22/09 MR received 3 for DOS 7/9-13/2009 with Y D/C DX:7/10/2009 Seizure Disorder. 7/10/2009 Pt presented se stated that pt developed flat round disc shaped lesion 6 days post MMR & Hib adm. Lesions U nickel sized 6/17/2009 on hand +6/23/2009 leg. as given Tdap immunization on 7/1/09. Y Returned to our clinic on 7/8/09 c/o redness & itchingY around injection 7/1/2009 site. Large 7/8/2009 reddened, hot ar ven GARDASIL vaccine upon checkout Y Pt fainted. Lost consciousness for ~ 5 sec. Fell and hit N head on floor. 6/26/2009 Sent to6/26/2009 ER for CT scan, IV. lled 7-6-09 c/o (L) arm stiffness from Y ADACEL. Advised to use ice and ibuprofen. Saw PCP on 7-7-09 advised 7/2/2009 to continue 7/6/2009 ibuprofen - Note elirious - severe headache - memoryY loss - couldn't speak certain words - couldn't rememberYwords he was 7/20/2009 trying to7/20/2009 say - "kind of out of it". dness & swelling to injection site right arm advised to give BENADRYL & MOTRIN & apply cool Y compresses. 7/20/2009 7/21/2009 m rash - generalized - Rx calamine - BENADRYL. Y 7/6/2009 7/16/2009 + itching at site, has persisted for several days. After 8 days after immunizationn rash and itching U is dissipating, 7/13/2009 approx 7/14/2009 size 1inch by 1inch, d urticaria, angio edema, throat itching Y Y 7/21/2009 7/21/2009 (erythematous & edematous at vaccine site) upper arm. Apply ice, BENADRYL. Y 7/20/2009 7/20/2009 redness, severe itching at site of vaccine beginning day of vaccine, worsening for 3 days, then Y improving. 7/13/2009 7/13/2009 TDAP before age 11 yrs. Y 6/19/2009 with Pt blurring of vision after GARDASIL. Few minutes later. She was short of breath > Briefly. Y 7/21/2009 7/21/2009 iefly after immunization: in this order Y 1 MENACTRA, 2 ADACEL, 3 GARDASIL. Referred to ER Y because7/21/2009 of continued 7/21/2009 dizziness. as given GARDASIL on 7/20/09 at 1430 and seconds later patient stated she was not feelingYwell and asked 7/20/2009 for water. 7/20/2009 Patient then turned p ghtheaded and nauseous after receiving vaccine and walking to play room; sat in chair, still Y lightheaded,7/21/2009 BP low, pulse 7/21/2009 weak and laid pt. do Sleep & H/A 7-19-09 - H/A & hallucination (while awake) -> was taking food from ref. & thought Y it was falling 7/17/2009 on her.7/19/2009 About 2 PM (took me es about 4o after shot his arm got red Y and swollen, warm to touch and hurt when he moved U it. He stated7/15/2009 he had temp 7/15/2009 of 100.8. Went to ER injection site - egg size, red swollen; tender area on left mid-arm, hives in area with itching and N pain. Advised 7/17/2009 BENADRYL 7/18/2009 1 teaspoon ever rsistent left arm pain since TD injection. No signs of infection U 5/9/2009 5/9/2009 ed, red rash, itchy, ice 15 mins on 15 mins off 2 days, headache, felt sick tired, took antihistamine Y 4 to 6 hrs 3 days 1cm red area surrounding injection site. Minimal warmth, no blisters, no hives on L thigh. 7/14/2009 7/15/2009
ever, began vomiting, & shaking. Feet Y turned blue & turned gray around mouth for over halfYan hour. 7/13/2009 7/13/2009 n has been received from a physician Y concerning a female patient who was vaccinated with Ythe first and only dose of GARDASIL when she nt had what were described as low-grade Y fevers (up to 101) the night after receiving her immunizations. Y 7/20/2009 The parent7/21/2009 witnessed a generalize ow 11 wks old received 2 Y mos vaccinations and one day later experienced apnea, brady's, desats U resulting 7/16/2009 in intubation. 7/17/2009 spots to back, arms,chest, torso with a fever. N 7/8/2009 7/16/2009 eived the ZOSTAVAX vaccine. The next day I had redness, pain, itching, warmth and swelling at the injection 7/1/2009 site. My 7/2/2009 arm had a red swolle rash 3 x 7 cm at injection site that lasted more than 4 weeks. No vesicle, or bulla. Non tender. Y No Rx - This 7/10/2009 was at ZOSTAVAX 7/10/2009 site. was reported by a pharmacist and described the occurrence of vaccination adverse reactionYin a female subject 5/8/2009 of unspecified age who wa Slurred speech, Dizziness, muffled Y hearing, blurred vision, involuntary joint movement, Y easily N frustrated,3/30/2007 muscle spasms, 7/13/2007 taste and memory seminated encephalomyelitis (ADEM): Y leg weakness; Y left face, arm, 5and leg sensory symptoms; U no fever or 7/1/2009 other viral7/8/2009 illness symptoms; inc mpy, itchy rash at injection site about 4 in diameter with a few stray bumps around the elbowYstarting a few 7/15/2009 hours after 7/15/2009 vaccination. Bumps RTS WAKING WITH HEAD ACHE, NAUSEA, FEELING EXHAUSTED. THURSDAY 7/2 PT Y REPORTS FEELING 6/30/2009OF7/1/2009 HEART POUNDING, ates child c/o right arm pain Sunday 07/19/2009. Parent states right upper arm was red, swollen U and warm 7/17/2009 to touch. 7/19/2009 Parent applied cold pac nt secure message (email) to primary care physician: "I had a rather (for me) severe reactionYto the PNEUMOCOCCAL 7/17/2009 7/17/2009 vaccine I was given perienced change in sense of tasteYand change Y in facial sensation within 2 12 hours of his 6thUAnthrax and 6/10/2009 3rd Typhoid 6/10/2009 vaccination. The sym ceived a gardasil vaccine injection. Appeared fine, walked to front office to check out. Was Y speaking with 7/16/2009 the check-out 7/16/2009 person and withou esents with redness and warmth at site of zoster vaccination recieved 06/25/09. Y 6/25/2009 6/27/2009 ection red, swollen, with pain for 2 days U 7/20/2009 7/21/2009 7/22/2009 N 7/17/2009 7/22/2009 arm wheal measured at 5cm x 6cm; erythematous & warm to touch. Puncture site noted atUcenter of inflammation. 7/20/2009 7/22/2009 Slight induration note ceived telephone call from mother, Y pt. had received vaccines-Hep A #1;MMR #2 & VaricellaY#2 on 5/11/09. 5/18/2009 On 5/18/09 5/19/2009 pt. received Td boo LASTED 10-30 SECONDS; WENTYTO ER; NO TREATMENT INITIATED. AFTER BLINKING Y EYELIDS7/13/2009 BUT RETURNED 7/13/2009 TO NORMAL A swelling, redness, and warmth Rt. deltoid U 7/21/2009 7/22/2009 ports vaccination site with red mark "rash" for 12 days past vaccination concern for extremityUachiness day 7/10/2009 3-12 post 7/13/2009 vaccination 9 pt received varicella and hep. a #1 Y injection while in the office. In late afternoon on the 14th Y noted redness, 7/14/2009 edema, 7/14/2009 pain, and warm to tou ER on 6/26/09. Pt states he woke up and felt like Y he was drunk. Pt 5had dizziness, confusion, Y trouble with6/9/2009 gait. Pt c/o 6/26/2009 muscle spasm on left Rash entire body. Fever to 102 degrees on day 13 post MMR. With possible insect bite day N of rash. 7/7/2009 7/20/2009 ported erythema swelling + temp of Y104F. 7/20/2009 7/22/2009 f vaccines, pt developed rash on extremities Y -hands, feet throat felt funny - next day rash cont Y - today rash 7/20/2009 is just to7/20/2009 biceps no temp - no loc 7/22/2009 swelling, erythema <48 hours after vaccine Y administration. Seen in ER for I & D, cultures obtained Y and (-).7/6/2009 Placed on 7/8/2009 P(o) ABTx x2 for 7 day ately 4 days after vaccination, patient reported increase pain, swelling and redness at site of Yinjection. Seen 7/9/2009 by Infectious 7/14/2009 Disease MD. No a eats, nausea, vomiting & shortness of breath within a few hours after injection & seen the next Y AM 20 hours 7/20/2009 post injection 7/20/2009 with no fever, GS n on 20 Jul 09 to receive VARIVAX. Pt mom stated Monday nite. Patient became itchy, swollen, Y and warm 7/20/2009 to the touch 7/20/2009 at site of injection. 2 arm over Tricep with 3x4cm redness with mild swelling, mild warmth shin with redness. Y 7/7/2009 7/7/2009 post injection, site of VARIVAX vaccine was red and firm, with residual bruising. Y 7/1/2009 7/8/2009 after injection, at site of VARIVAX vaccine, red, hard, tender lumps had developed. Y 7/2/2009 7/10/2009 e, dizziness AP 89 reg R-20 BP 104/64. Rested flat recovered after 15 minutes. Y 7/21/2009 7/21/2009 ack to clinic after 15 min c/o tightness in her chest, she had audible wheezing. She was treated Y with 50mg 7/21/2009 BENADRYL 7/21/2009 (IM), albuterol via N dministered on 6/22/2009 Left leg redness left leg pain, fever on 6/23/09. Continued rednessUleft leg on 6/24/09 6/22/2009 decreased 6/23/2009 pain, decreased n has been received from a nurse concerning a female patient who on unspecified date wasUvaccinated with the first dose of GARDASIL va ed of feeling faint, lightheaded 2 minutes Y after receiving 1st dose of vaccine. She sat down in Y chair, nearly 7/13/2009 fainted, then 7/13/2009 threw up. She felt n has been received from a physician Y concerning a male smoker patient with chronic Y obstructive U pulmonary disease who in 2008 was vacc n has been received from a consumer who was the mother of the patient. The mother reported U that her son stopped talking after receiving was received from a health professional Y on 10 July 2009, and involves a subject enrolled in an investigator-sponsored ### study. ### Subject ID: 1 ined of thirst after receiving vaccines, fainted , clammy, pupils dilated, double vision, After about Y 15 min.7/21/2009 pt recovered. 7/21/2009 ter injections-pt became moody-cried all evening- didn't know why he was crying-seems quiet Y and ok the7/21/2009 next day. 7/21/2009 d said she wanted it documented that pt had a reaction after the GARDASIL site was sore also Y came out 7/13/2009 in hives underarm 7/15/2009gave BENEDR t# 0171U, exp 6/29/09 was given to pt. on 7/2/09. This vaccine was expired by 3days. SinceYthis was first7/2/2009 immunization, and will receive #2 HPV # 3 on 7/15/2009. This vaccine expired on 6/29/09. Parents contacted. Will receive on Y additional 7/15/2009 HPV vaccine in 4 hrs to insure effic HPV #3 on 7/15/09. This vaccine expired on 6/29/09. Parents contacted. Pt will receive an additional Y HPV7/5/2009 vaccine in 4 months to insure eff
HPV #2 7/21/09. This vaccine expired on 6/29/09. Parents contacted. Pt will receive an additional Y HPV vaccine 7/21/2009 4 months after she receives area of redness and edema. First noticed on 7-19-09. - itching. 7/20/09 7 X 3 1/2 cm. Redness Y noted 7/15/2009 ice packs, BENADRYL 7/17/2009 rm swelled up and appeared cellulitic Y 24 hrs after receiving KINRIX in right deltoid arm. Y 6/15/2009 6/16/2009 oor post GARDASIL vaccine #2, 10 minutes post vaccine. Alert, responsive, pale. BP 70/50 Y- 78/60 - 86/60 7/17/2009 - 92/70 7/17/2009 - 98/70 - (Bumped L he in severe rash left side neck, upper shoulder back & front. Went to doctor - prescribed PREDNISONE. Y 6/16/2009 Rash subsided 7/8/2009 after 2 days. Sore ports child began having rash 7/15/09 which progressed to include neck, back, shoulders, abdomen, Y (R)7/13/2009 hip to (R) leg 7/15/2009 and calf, both feet. P deltoid area reddened, swollen, warm to touch, sore Y 7/16/2009 7/17/2009 ness over body, -Rash, -Itchy bumps, -Stuffy nose Y 7/6/2009 7/7/2009 m, swollen "2x2 " tender cold compresses applied left arm. 7/15/2009 7/15/2009 itching, and induration around injection site. Warm to touch. 7/16/2009 7/16/2009 swelling, and pain surrounding injection site. Redness from right shoulder to right elbow and warm to touch. 7/15/2009 7/16/2009 NACTRA, TDAP, vaccination, HEP AYgiven 2min, Pt looked dazed, then arched neck and body, Y hands and 9/23/2009 arms curled 9/23/2009 in. 7/23/09 - came to clinic to report pt got rash on arms, thigh after receiving vaccines. Pt took N BENADRYL,7/10/2009 used topical 7/10/2009 lotion for poison Ivy ike activity noted on 7-22-09 -> patient Y taken to ED. CT done patient had received VARIVAX Y and HAVRIX 7/20/2009 vaccines7/22/2009 on 7-20-09 rived at ED 17 Jul 2009 @ 2300 with Y left sided facial swelling. Onset was 3 hours prior to arrival. Y She was 7/16/2009 given Benadryl 7/17/2009 25 mg orally @ 0 papular rash 1 day after vaccine. Y U 7/21/2009 7/22/2009 hema, induration, warmth, and tenderness Y to L upper arm from shoulder to elbow. U 7/21/2009 7/22/2009 ox like rash/hive like, occuring mostly Y at nite. treated with anithistamine, may need steroid.. N 7/15/2009 7/16/2009 welt at site of vaccine. Pain at site. U 7/22/2009 7/23/2009 to left tricep area started day after varivax vaccine administered on 7/20/09. Bactrim prescribed Y x10days. 7/20/2009 7/21/2009 er shots, had joint aches and muscle Y soreness. Lasted 2 weeks. Also, injection site L arm was Y hot, red and 6/2/2009 swollen.6/5/2009 Went to MD on 6/24/0 2/14/2009 N ### 2/14/2009 er arm with large red, indurated area that is tender to touch and palpitation x 2 days. Used Benadryl Y and7/13/2009 cold packs7/15/2009 e with nausea and vomiting that started 3 days post vaccination with Zostivax. Symptoms resolved N after6/17/2009 24 hours 6/22/2009 vacccine: first and second days, just some swelling. But on the third day I spent time in the sun Y with ths ite6/6/2009 exposed. The 6/9/2009 site became very r RTED FEVER AND PAIN,SWELLING AND REDNESS AT INJECTION SITE Y 7/10/2009 7/10/2009 ceived 2nd Varivax on 7/21/09. Site became red, painful and hard. Came in to the office forYphysician to7/21/2009 see. Prescribed 7/21/2009 an ABX to start i able crying for 3 and 1/2 hours. Very high pitched scream type cry in an infant that normally Y does not scream 7/22/2009 when 7/22/2009 crying. 1 cm red, warm, localized reaction from vaccine. Y 7/20/2009 7/22/2009 turned to District Health Office 48 hours post vaccination with swollen, reddened area 60mmYby 50mm on 7/21/2009 back of right 7/23/2009 arm. RETURNED TO CLINIC FOR SKIN TEST READING AND SHOWED PHN SITE OF VARICELLA Y VACCINATION. 7/21/200980X60 7/23/2009 MM AREA OF ER sh to arms and legs, seen by dermatologist Y who determined rash was probably Giannoti Crosti caused by 7/15/2009 Hep B vaccinee. 7/20/2009 ported experiencing wide-spread redness and tenderness over entire upper left arm shortly after U immunization. 7/16/2009 She7/16/2009 presented to pharmac N ARM, FEELING LOTS OF PAIN Y U 7/22/2009 7/22/2009 a transverse myelitis which resulted Y in temporary Y paralysis of legs and 9 on-going loss of sensation N of body10/3/2008 from above the nipple-line ### to the b es after receiving immunizations, patient got up from sitting on exam table to standing. Fainted Y after taking 7/22/2009 2 - 3 steps 7/22/2009 towards the door to l ed, swollen with heat. Warm moist compress 4x a day. Y 7/21/2009 7/23/2009 ncopal episode post receiving VARIVAX Y 7/22/2009 7/22/2009 redness with 3 cm x 2 cm red area L post 1 cat aspect Y 7/21/2009 7/22/2009 was initially reported by a nurse on 16.Jul.2009. The female patient was vaccinated with oralUVIVOTIF (Batch 7/16/2009 no.: UNKNOWN) 7/16/2009 on 16.Jul.2 n has been received from consumers concerning their "teenager" daughter who started to receive Y GARDASIL series over a year ago. The d progressive lower extremity weakness/numbness Y requiring intubation 33 6/30 for respiratory failure. U EMG/MRI 6/9/2009 consistent 6/27/2009 with GUILLAIN-BA verse event, but I have had a 5 personal zoster outbreaks in people previously immunized persons and know of 2 others in our community nic attack (shortness of breath, confusion) 20 minutes after administration of meds. No hives Yon swelling 7/11/2008 noted. 7/11/2008 ale, white - bluish lip - one minute event in a very warm store (2) "Fainting" duration 5 minutes Y with in 5 hrs. 3/18/2009 of vaccine 3/18/2009 en in left arm 7-13-2009. Pt states arm became red, hot, swollen, tender to touch. Pt started Y taking Tylenol 7/13/2009 on 7-14-09. 7/15/2009 Pt went to ER on 7Y Y 7/10/2009 7/10/2009 se events. I gave a Hepatitis A inj instead of DTAP. Y 7/7/2009 len left deltoid, warm to touch 5" X 4.5". Y Mom advised ice 30 minutes QID/ TYLENOL and MOTRIN Y for pain 7/13/2009 7/14/2009 all dark bump around right ribcage. Y 7/2 - Bumps became overlapping welts. - Saw Dr. - SaidNit looked like6/24/2009 shingles. 7/10 6/30/2009 - Saw Dr. began ag cm erythema, red, tender warm to touch Y Y 7/15/2009 7/16/2009
er injection, vomited bilious materialYand had abdominal / cramp. Y 7/6/2009 7/10/2009 ceived MMR vaccine on 7/6/09. Pt did not know if she was pregnant. She stated there couldUbe a chance 7/6/2009 of her being7/9/2009 pregnant. Pt was retu ent received SUB-Q injection, patient began to stiffen his body while collapsing to the floor. Skilled Y nurse 7/14/2009 assisted him 7/14/2009 to the floor with no inc 9 per parent, client got out of bed atY9:00 Am, without eating or drinking went to use bathroom. Y Client felt6/18/2009 dizzy (told6/20/2009 this to Dad), then pass 2007 client had his first convulsive seizure Y following immunizations. Mother reported 1 hr. 15 Y min. post vaccines ###(HIB, MMRV ### and Pediatric t lightheaded immediately following vaccinations. Sat Pt down, used smelling salt, gave pt sips Y of ice tea, 7/23/2009 had pt sit 7/23/2009 an additional 20 minute s after taking pill # 1 - back & stomach Y cramps & diarrhea. @ two hours later, client went to hospital E.R.7/16/2009 with "severe 7/16/2009 "stomach pain (ULQ Y 6/23/2009 puffiness + warm to touch @ injection site above 30mm of redness. Site is tender to touch @ Y site of Varicella 7/15/2009 injection. 7/16/2009 redness < 24 hrs after administration Y of HEP A vaccine right upper arm/ warm compresses TYLENOL Y PRN 7/14/2009 7/15/2009 lo-vesicular rashes all over trunk and buttocks, some are extra-pruritic since yesterday; someY of the lesions 2/10/2009 are now7/21/2009 crusted. Supportive me tchy and a lump at the site. Y 7/14/2009 7/15/2009 wallowing began 15 minutes after injection was administered Pt. was given BENADRYL. Patient's Y condition 7/23/2009 has improved 7/23/2009 d with Health Dept today, 7-24-09 at 10:30 am, with very red, raised, swollen, hot and tenderYarea approx7/22/2009 13cm in diameter, 7/23/2009 around VZV inj and redness/induration (R) upper arm at site of inj measuring 7cmX7cm. 7/21/2009 7/22/2009 nted directly after administration of HPV. Mom and nurse slid her to floor where she regained Y consciousness. 7/23/2009 (This 7/23/2009 was 3rd of 4th shots giv erated the HPV vaccine injection well. However 5 minutes after the vaccine was given she fell Y to the floor 7/24/2009 she was awake 7/24/2009 and alert and aw kin, right sided chest pain, headache, Y nausea, dizziness Y 7/23/2009 7/23/2009 S AND SWELLING 3CM BY 3CM AT SITE OF INJECTION TREATED WITH MOTRIN BENEDRYL U AND7/22/2009 KEFLEX RECOMMENDED 7/23/2009 APPL a flu shot at this clinic on Nov 9, 2007 Y and 2 weeks Y later my hands23 started becoming numb,Uthen my arms 11/9/2007 and by the next### morning my legs ction at injection sites, redness and swelling. Swelling of tongue and complaints of tongue "itching". Y Patient 7/22/2009 seen in7/23/2009 office 24 hours after ad d large, swollen, firey red and hot localized Y reaction around injection site. Patient was reffered Y to urgent7/14/2009 care where7/16/2009 cellulitis was ruled out nt's mother, baby had 4 days of "not being herself, staring off into space. We thought she just Y had become 4/27/2009 autistic, but 4/27/2009 then it went away an ite swollen to softball size, hard, redYand warm to touch. Went to ER and was discharged toYhome with prescriptions 7/21/2009 7/21/2009 for Crphalexin 500 mg ely after receiving Tdap, Menactra, and HPV at 3:15 pm patient reported feeling dizzy, weak.Y Pale, sweating, 7/23/2009 no loss 7/23/2009 of contiousness, pt. p lands around neck, breast and armpit Y area where injection was adminstered. The area was very N tender. 7/17/2009 7/19/2009 Given vaccines. Started with rash on right thigh that mom says is slowly getting bigger. No N fever or no other 7/21/2009 symptoms 7/21/2009 d 2 episodes of seizure-like activity,Ysecond episode Y lasting 20 minutes. 3 patient went to ER U and had full7/20/2009 sepsis workup 7/21/2009 over 4 days, CSF, u Patient received Hep a, Menactra approx. Y at 3PM. Mother reports trip to ER around 5:30 due N to hives and 7/9/2009 itching. States 7/9/2009 received Benad administered on 7/22/09. Noticed red/bumpy silver dollar sized @ site. 7/24/09 came to HD measured 6cm/8cm 7/22/2009 red/bumpy/warm. 7/23/2009 tient had a red, swollen, warm to the touch area where the varicella was given in the back ofNher left arm, 7/2/2009 that lasted 7/7/2009 about a week. Starting 7/17/2009 ated at ER for steam burn and received Y a Td shot. Later that day, arm swelling, general malaise, Y diarrhea, 7/15/2009 nausea, chills, 7/15/2009 fever onset. The ED SHAPE RED RASH(PATCH)slightly rasied 10.5cm in width and 13.5cm in height on rightYthigh; patient 7/22/2009 reports itching 7/23/2009 and feeling warm uiac stool 1 day after rotavirus vaccine given Y 7/23/2009 7/24/2009 ater started continuous shaking in legs, had chills, and felt feverish. Symptoms lasted another N day. Today 7/22/2009 still very7/22/2009 spacy, feverish, and w redness at site and upper arm day after injection;No fever but felt warm day after,No fever no Y chills 2 days 7/21/2009 after injection 7/22/2009 WAS GIVEN 2 DAYS AGO. PT CAME TODAY TO CHECK ON A PPD BUT ALSO HAD REDNESS Y AND 7/22/2009 INDURATION, 7/24/2009 PRURITUS, HEA 102.1 FOR TWO DAYS. STARTEDY 5 HOURS AFTER VACCINE ADMIN. OFFICE VISIT NEXT Y DAY SHOWED 7/16/2009 NO7/17/2009 OTHER SOURCE OF ed redness at site and low grade fever Y lethargy next am, edema of left arm and red blotchy rash U kind of 7/21/2009 like hives but 7/22/2009 not raised in the left u eport (at 4 mo visit) excessive crying after 2 mo shots. Stopping breathing and eyes rolling. Paramedics Y were 5/11/2009 called, baby 5/1/2009 was not transport of thigh, development of erythema 14cm wide. U 7/20/2009 7/21/2009 veloped a debilitating headache requiring 0 days bedrest. Patient stated headache was veryYsevere. 7/22/2009 7/22/2009 poor feeding, fever to 103.5 - Given TYLENOL. Rapid recovery this AM. Y 7/22/2009 7/22/2009 d, warm to touch, red rash covering deltoid down to halfway mark of upper arm. 7/22/2009 7/24/2009 ing while receiving vaccinations, upon administering MENACTRA to PD; client became quiteYupon assessment 7/24/2009 client 7/24/2009 flaccid B/P 70/40; imm 300 client became pale, L head, wk, eyes rolled, shook 10-15 secs., SZ, laid client down - raised Y legs, P56 7/24/2009 66, B/P 102/60, 7/24/2009 1222, client ans mmediately after MENACTRA. This was the third vaccine given. Patient lied flat and recovered Y completely 7/25/2009 within 20 7/25/2009 minutes. ceived ZOSTAVAX on 7-13-2009. He reported to his family physician with shingles on 7-21-2009. U Patient 7/13/2009 did not mention 7/21/2009 a current shingle ythema around injection site L leg. Positive Y tenderness, warmth, edema. U 7/21/2009 7/23/2009 d Inflammatory Diarrhea with 24 hours of vaccine. No fever. Now has chronic Diarrhea for 8 weeks. 8/24/09 5/26/2009 Medical5/30/2009 records received DOS
t was given Hep B vaccine at his 10:15 Y AM visit. Y Began twitching of 1left leg and arm upon arriving Y at home. 7/17/2009 Parents 7/17/2009 called Rescue Squad a rythematous, slightly warm localizedYreaction to right SQ right arm. Erythema 2.5 inches in diameter. U 7/22/2009 7/23/2009 s after injection pt started with redness, Y swelling & knot at injection site. Seen in office 48 hrs Y after injection 7/21/2009 Dx'd with 7/21/2009 mild cellulitis. Pt pres on to vaccine in left deltoid approx 24-48 hrs after administration. Y 7/21/2009 7/22/2009 was reported by a pharmacist and described the occurrence of jaundice in an infant male subject U whose11/5/2008 mother was vaccinated with FLUA was reported by a healthcare professional and described the occurrence of vaccine exposure U during pregnancy 6/4/2009 in a 32-year-old female su swelled that the shot was received in; I put cold compress on 10 minutes of every hour for the Y entire day 7/22/2009 after the shot; 7/23/2009 the 2nd day, I put c hour of the shot (took place on Wed 7/22), very cranky. For next 48 hrs would not sleep more N than 40min7/22/2009 an hour 7/22/2009 at a time for naps, and njection site, lasted 4 wks(tiny nodule still present today), swelling at injection site, extremelyYcranky, unable 6/24/2009 to sleep, 6/24/2009 awoke many times du (14cm X 15cm), itchiness, tender, hot to touch, induration (6cm X 6cm), blistery beginning on 7/23/09. Treated 7/22/2009 with7/23/2009 warm packs, Keflex, & ing at injection site immedicately after administration, left upper outer arm. Within a few hours Y the site was 7/17/2009 still itching, 7/17/2009 also slightly painful a and itching at injection site at time of injection. Twenty four hours later all signs of redness & Yitching disappeared. 7/23/2009Day 7/23/2009 2 Redness and itchin post shingles vaccine, I began to feel multiple pain issues - sharp pain at bottom of buttock/top N of thigh, 12/6/2007 burning in both 5/20/2008 shins, tingling in on vomiting, abdominal pain, joint pain, Y numbness Y & tingling in hands 2 & feet, fatigue, weight loss. N Unable to 6/9/2008 eat certain6/22/2008 foods. Developed alle arre Syndrome developed Y 8 days after Y receiving Y the vaccine, resulting 203 Yin 2 months Y ventilation, N 7 months hospitalisation, ### subsequent ### hetero iefly after - body was shaking - Immunization Y in this order: (1) MENACTRA - (2) ADACEL - (3) Y GARDASIL 7/21/2009 7/22/2009 ped red lesions with itching itching 24 Y hours after immunization, lesions started an ankles legs Y then both 7/16/2009 wrists and lower face. ports,7/17/09 Pt. had redness, swelling, tingling of left arm approximately from elbow to slightly Y below shoulder, 7/16/2009 area was very hot. Pt. was d high pitched screaming and crying (unconsolable) day following immunization Y 7/20/2009 7/21/2009 TDAP 4/21/09. At 7/7/09 visit c/o achy left shoulder to fore arm with increased pain with movement U since 4/21/2009 injection. 4/21/2009 Stated when she was a spots to back, arms, chest, torso with a fever. 7/8/2009 7/16/2009 ving painful needle like pricks in nerve endings in various parts of my body. After a couple ofNdays of this,5/22/2009 the feeling5/29/2009 continued mostly in my ld, chills, achy, arm pain T 99.4. By Y7/16/09 progressive loss of strength both arms T increase Y 100.4. Saw 7/14/2009 MD 7/17/09 7/14/2009 sent pt to ER for tes perienced severe adverse reaction Y to PENTACEL given 7-17-09 left arm. Had swelling, pain, Y huge bullae 7/17/2009 which when 7/19/2009 pressed caused ves ash 4 x 4 cm surrounding injection site. Myalgias B/L posterior neck pain, ache 7/10, non radiating. Y HA developed 7/2/200912 7/3/2009 hrs post injection, reso ne was to prevent further outbreaks of shingles. I have now had two outbreaks of shingles since Y the vaccine 1/8/2009 and Dr. suggested I let your d mild fever X 2 days started 15July2009 1 day after the shot. Pt was advised to see provider,Ypt called for7/14/2009 telephone7/15/2009 consults. m X 4 cm patch of erythema posterior upper LEFT arm were varicella vacc. was given. Mild warmth Y - Tenderness 7/14/2009to 7/15/2009 palpation, no sign of inf n has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning Y a 25 year 3/1/2009 old female patient with no perti n has been received from a consumer concerning Y her 19 or 20 year0old niece with no knownNdrug reactions/allergies and no pertinent med n has been received from a registered Y nurse concerning a female patient who on an unknown U date was vaccinated IM "either with the first d with Idiopathic thrombocytopenic purpura on Y 7/24/09; platelet count 5 = 0. 8/17/09 Hospital records received 7/15/2009 DOS 7/24/09 7/23/2009 to 7/29/09. Asse all outbreak of pox with fever of 103 degrees. Y 6/22/2009 7/16/2009 d - MENACTRA - large swollen red area from shoulder to mid upper arm - felt feverish and hot Y to touch - 7/23/2009 painful. (L) 7/24/2009 deltoid - BOOSTRIX - s given 7/20/09 right deltoid; Pt states Y"later that eve" site with redness edema pn. Sxs cont'd and U increased. 7/20/2009 Pt presented 7/20/2009 to clinic 7-23-08 f ds head & hands shaking. Y 5/11/2009 5/11/2009 02 degrees F nausea, vomiting -> (severe) Y dizziness, rapid heartbeat, rash, aches/pain in legs, Y knees, ankles, 7/21/2009 weakness/ 7/21/2009 extreme fatigue. ems, sleep difficulties, physical ailments. 3/1/2003 Q given 12/17/07. 12/19/07 infant had blood flecks in stool on & off for 3 days, in about 1/2 of Y BM's. He is breast ###fed and has ### about 19 stoo immunization 9/11/08- PEDIARIX, HIB, PCV7,ROTATEQ. On 9/18/08 baby had diarrhea and Y blood in stool 9/11/2008 x 4. Day9/18/2008 before had increased (R) 2 days after immunization. Required Y ER visit. Y 7/17/2009 7/19/2009 eceived VARIVAX and TDAP and MENACTRA on 7/9/09 - developed Zoster lesions 7/11/09Y 7/9/2009 7/11/2009 ness, swelling, blanching, pain, itching, migratory pleuritic type chest pain. Y 7/22/2009 7/24/2009 n 7/20/09 - Developed, 2 days later Y a 3X3.5 cm area of light pink induration with surroundingYblanching. 5x7cm area of mod. erythema no VARIVAX #2 on 7/22/09, developedYa 2x2.5 inch, firm, erythematous, warm area at injectionYsite. (Lot# 0694Y) 7/22/2009 7/24/2009 t started hurting right away and continued to hurt over next 2 days. On the night of the 23rd.YPt began to7/21/2009 look red + 7/21/2009 felt warm. No fever. Pt c s hands shaking w/ head shaking Y 7/23/2009 7/23/2009 5 to right arm, around injection site. Warm to touch with slight edema. Y 7/24/2009 7/25/2009 emperature with diminished responsiveness within 24 hours of vaccines. Y 7/1/2009 7/1/2009 , heat, mild edema, pain Y 7/9/2009 7/9/2009 cheeks, chest, arms & legs Y Y 6/30/2009 6/30/2009
n has been received from a Nurse Practitioner Y concerning a 17 year old female with a history Y of neuro- surgery 7/22/2009 in 2001 7/22/2009 for malformation an n has been received from a registered nurse concerning a 19 year old female who on 04-APR-2007 U was vaccinated 4/4/2007 with first dose of GARD Dose 07.15.09 Throbbing behind ear. Post second dose 07.17.09 Hives all over body swollen Y hands & feet. 7/15/2009 7/17/2009 3 d"; cried for more than 3 hrs straight without sleep or feedings per mom's report. Y 3/2/2009 3/3/2009 highs BENADRYL and Aloe Vera N 2/17/2009 2/17/2009 n has been received from a registered nurse concerning a now 24 months old male Y who in October U 2008, 10/1/2008 at the age 10/1/2008 of "15 months old" wa n has been received from a registered nurse concerning a 13 year old patient who was believed U to be vaccinated with MMR II and was beli ort was received 20 July 2009 from aY consumer in the country, who is also the patient. A 50-year-old U female 7/11/2009 patient with 7/11/2009 a history of a stray n has been received from a nurse concerning Y a 22 year old female patient with penicillin Y allergy Y who on 7/13/2009 07-JAN-2009 7/13/2009 was vaccinated with n has been received from Y a physician concerning a 26 year old female with no known allergies Y or reported 1/7/2009 medical history 4/8/2009 who on 07-JANates she had fatique, weak and nausiated. Had diarrhea over the weekend following administration. Y Patient 7/13/2009 followed 7/14/2009 up with PCP 1 week a swollen, nodule, tender to touch left thigh injection site of Dtap vaccination on 7/15/09 back Y in office for reevaluation 7/15/2009 7/16/2009 on 7/17/09 and treatm after immunization, Left arm red,swollen Y and is painful and itchy. Left upper arm redness andYinduration(7cm). 7/22/2009 Slightly 7/23/2009 tender. Treatment: co HONE CALL WE MADE TO CHECK PATIENT STATUS ON 10/18/2005 PATIENT MOTHER YSTATED THAT THE ###PATIENT WAS DOING F d on 7/15/09, on 7/16/09 at 3 a.m. adolescent Y began to c/o of numbness and tingling along with Y weakness 7/15/2009 in both upper 7/16/2009 extremities elbows 4th vaccine was given (menangitis), my son almost fainted. His vision became tunnel vision and Y he said his 7/21/2009 ears felt7/21/2009 plugged...his arms wer EA OF ERYTHEMA, WARMTH, AND TENDERNESS AT THE SITE OF VACCINATION. SYMPTOMS Y WERE 7/22/2009 CONSISTENT 7/24/2009WITH CELLU IVEN TWICE U 7/24/2009 7/24/2009 esented to the ER the following dayYwith signs of malaise, joint pain, redness at injection site,Y nausea, vomitting, 7/6/2009 fever 7/8/2009 and chills of the right arm where the Varicella was administered has some edema which is approximately Y the size of 7/24/2009 a ping pong 7/25/2009 ball. The area has s oyee of the hospital received her TDaP Y (right) and Hep B (left) vaccines on 7/21/09 around 1530. Y Awoke7/21/2009 in the middle 7/22/2009 of the night with feve ted swollen lymph nodes in groin and Y neck. 7/23/2009 7/26/2009 3 inch indurated area with nodularity under the injection site approximately 3 cm by 3 cm. Very Y TTP, with7/23/2009 Rubor 7/23/2009 atient came in with 4 x 5 inch area of erythema surrounding injection site. On 7/26/09 patientUreturned 5 7/23/2009 x 5 inch, dr.7/25/2009 diagnosed cellulitis ately 30 minutes after Tdap immunization employee reported by phone that both hands wereYswelling by7/24/2009 base of thumbs. 7/24/2009 No airway involve after injection developed a welp. Within Y 48 hours arm swelled up to size of "grapefruit" per patient. See 7/23/2009 at UTC 72 hours 7/24/2009 after and given m L OVER BODY Y 8/21/2002 7/27/2009 the Shingles vaccination on May 26,Y 2009. Onset of Shingles on July 6, 2009. It was strongly U recommended 5/26/2009 that I take 7/6/2009 the shot, so I finally , hot and itchy patch or 4" to 5" diameter at the injection site Y 7/24/2009 7/25/2009 ne in series was given on 6/12/09. Patient felt light-headed after receiving Twinrix and typhoid Y injectable6/12/2009 shots. The 6/12/2009 patient rested and dra se #2 given on 7/13/09. Patient experienced another episode of light headedness and briefYsyncope (for 7/13/2009 a few seconds) 7/13/2009 within 5 minutes o perienced problems breathing deeply, had definite wheezing per her mother and then lips started Y to tingle. 7/23/2009 Mother said 7/23/2009 the event probably copal episode in the parking lot. Received Y HPV, Hep A and TDAP. Told mom that she hadYringing in the 7/23/2009 ears and 7/23/2009 felt dizzy leaving the off h ~ 2 inches in length and 1 inch in width down back of arm at injection site. Patient said thatUis appeared 7/21/2009 slightly red 7/27/2009 shortly after injection, emities became stiff immediately after receiving DTaP/IPV/MMR II/VARIVAX fainted within 2Ymins of first7/23/2009 injection lips 7/23/2009 cyanotic. No drooling red and raised Y 7/23/2009 7/25/2009 LA - redness / swelling 7/10/09 GARDASIL Y - Dizziness, light headed - almost fainted, fever X Y 48 - 72 hours 7/9/2009 7/9/2009 hives, erythema, itchy within 5 min Y of injection. BENADRYL 25 mg IM given - symptoms relieved Y within 7/23/2009 15 min of BENADRYL. 7/23/2009 t MMR #1, VARICELLA #1, DTAP#4 , PRENVAR#4 + HIB#4. after 10 minutes, mom noted redness Y ~ the 7/15/2009 night of the 7/15/2009 MMR, a few minutes er DTaP Imm. infant sleepy for 24 hrs Y with taking only few oz. of formula - Afebrile developedUerythematous 7/23/2009 rash on 7/27/2009 thigh surrounding shot , firm erythematous mild ascending Yweakness to legs & arms neck pain back pain nausea HA. Y 7/21/2009 7/22/2009 ection given on Monday. Wednesday morning noted rash to arms. Late evening it spread to Y legs. Rash is7/20/2009 red blotchy 7/22/2009 and itches. Rash on a ped enlarged left inguinal node on same Y side that vaccine was given. Y 6/22/2009 - Soreness proximal to injection site.Y 7/23/2009 7/23/2009 edema, warmth entire right upper arm urticaria over entire body. No breathing distress and fever 100.4. Y U 7/20/2009 7/21/2009 was reported by a healthcare professional and described the occurrence of cut hand in a 56-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated w was reported by a physician and described Y the occurrence of swelling injection site in a 77-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated wit ine started having severe shin pain (B), sternal painU 7/14/2009 7/15/2009 ed / or passed out after vaccination 2) Vomiting (x1) afterwards. Y 7/21/2009 7/21/2009 izure the night after immunizations given. Y Y 7/21/2009 7/21/2009
ministering vaccine patient asked to lay down for shots for fear of needles. After giving vaccines Y patient sat 7/22/2009 up looked 7/22/2009 i felt fine, stood up an minutes of administration, had syncope or possibly an akinetic seizure witnessed by MD. Collapsed, Y somewhat 7/22/2009tonic, 7/22/2009 prolonged recovery. on 7/19/09. - Acyclonir Y U ### 7/19/2009 and heat at vaccine sites. Silver dollars sized area of redness per mom @ VARIVAX site. Slight U redness,7/21/2009 hot and sore 7/22/2009 - smaller area to R I r 102 degrees F, sleepy, lethargic, diarrhea X 3 da. MOTRIN alternating with TYLENOL 9 4Y- 6 9m. 7/17/2009 7/21/2009 ated RA swelled and reddened, area measured 3"x6" with said red streak in it." Took child toYER observed 6/11/2009 + reminded 6/11/2009 to not get Varicella # accinated on Monday 7/20/09 with ADACEL by LPN. Returned Tuesday 7/22/09 with redness & swollen 7/20/2009 on the injection 7/22/2009 site. Notified docto eft forearm and trunk, Sat & Sunday itched, red vesicles Y 7/16/2009 7/17/2009 ped shingles like rash across left cheek Y of face approximately 6 days after receiving vaccine.UPt received6/30/2009 2 Rx's from7/6/2009 Dr. VALTREX and V ter GARDASIL (HPV) vaccine, awoke Y with leg pain, numbness, Tachycardia, orthopnea & nausea. Y Developed 7/16/2009 shortness 7/17/2009 of breath. Labs n rxn with redness, warmth and swelling (about the size of golf ball). We never saw rxn. Spoke Y to mom on 7/13/2009 phone. Instructed 7/14/2009her to do warm ever, fussy x 1 day. c/o swelling- symptoms began last night. U 7/21/2009 7/21/2009 d office and stated child was given immunizations in left thigh, stated leg swollen hip to knee, Y warm to touch. 7/17/2009 7/18/2009 entire upper arm) edematous, warmYto touch, Blotchy red patches- pt took BENADRYL. Y 7/21/2009 7/22/2009 . Swollen cheeks, hot and red cheeks - Peeling, itching cheeks on face. Shingles shot. Y 3/2/2009 3/4/2009 allergic to AVELOX. Developed sinus infection 2 days after vaccine administration, started 2N- pack. The 7/15/2009 next day she 7/18/2009 noticed her arm wa er ZOSTAVAX - began with low grade Y fever. 7/9 - backache & blisters on shoulder blade. Blistering Y & pain 6/29/2009 continued 7/9/2009 with blisters moving malaise began day 1 followed by fever > 102 degrees F / Headache/ myalgnas & chest discomfort Y all day7/21/2009 7-22-09 - Took 7/21/2009 Ibuprofen 600 mg rted posterior right arm, 1 1/2 inch diameter, red, hard and itchy after receiving vaccines 7-15-09. Y Onset7/15/2009 of symptoms; 7/16/2009 7/16/09. Still with s d area, long, around injection site, somewhat itchy. Y 7/1/2009 7/2/2009 2 mo vaccines at 11 AM on 7/22/09. Returned to clinic at 6:15 PM stating "(R) leg swollen &Ypainful when 7/22/2009 touched".7/22/2009 Examined by NP who a vaccines (Tdap, MMR, HEP B & A). blood drawn for lab work. Loss consciousness for 8-10Yseconds. Pt7/20/2009 pale & clammy. 7/20/2009 Pt to take deep br 1.2 B.P. elevated @ 160/98 H.R. elevated 125 skin site warm to touch, red, slightly swollen. Y 7/15/2009 7/16/2009 Left leg where vaccine was given redness on area, reaction on same day as vaccine was given, Y pt will put 7/22/2009 cold compresses 7/23/2009 for 10 min. 3-4 r 102 degrees, about 3 days. Vomited, about 11 PM. Shot was 3:00 ish. Body ws inflamed w/ U redness about 3 days, eyes sunkin in. ief (< 1 minute) syncopal episode after receiving GARDASIL. Had been given HEP A & HEP Y B prior to GARDASIL. 7/17/2009 7/17/2009 ort received on 07 July 2009 from a Y health care professional in the country. A 10 year old female Y patient received 7/7/2009ADACEL 7/7/2009 (lot number C30 n has been received from a physician who attended a program. The reporting physician stated U that during the process of the discussion an n has been received from a pharmacist concerning a 73 year old male who on 11-JUN-2009Nwas vaccinated 6/11/2009 with a 6/13/2009 first dose of ZOSTAVA KINRIX on 7/23/09, grandparent noted localized reaction 24 hrs later. Came into the office on 7/26 for unrelated 7/23/2009 issue 7/24/2009 & showed us her arm KINRIX on 7/21/09, parent noted localized reaction 24 hrs later. Called to office 7/23/09 to report that arm 7/21/2009 was red,7/22/2009 swollen, warm to touch ncing erythema, warmth, and tenderness Y at injection site - R arm where varicella vaccinationUgiven. Sx x7/13/2009 3days not 7/13/2009 improving. + varicella given wed. 7-22-09, + over Y course of the day patient presented to clinic on 7-24-09 Y with itching, 7/22/2009 swelling,7/23/2009 + redness on both del ely after shot pt felt light headed and dizzy when walking sat in chair and had a 5-10 sec longYtonic seizure, 7/27/2009 afterwards 7/27/2009 pt was hypofebrile an gan having swelling pain, bruising, Y and redness to right arm 3 days after TDAP given. Bruising Y occurred 7/2/2009 July 6. No 7/5/2009 fever. Went to MD pre on on 07/24/09. On 07/24/09 swelled. On 07/25/09 severe HA, chills, site hot, nausea, hard Y lump size 7/24/2009 of tennis ball. 7/24/2009 On 07/26/09 contin o health dept. by Dr. for yellow feverY and typhoid vaccines. Stated after receiving typhoid shot Y on 7/20/09 7/20/2009 she broke 7/20/2009 out in hives. She boo n for five days following vaccine. Patient unable to raise arm above shoulder level due to pain. U Headache 7/22/2009 not responsive 7/22/2009 to conservative m was given a Dtap instead of a Tdap. This vaccine was given in the afternoon on 7/27/09. The Y child was given the vaccine for preventative nd redness right leg dtap #5 was given and ipv #4 on right leg/ varicella mmr on left leg. vacccines N GIVEN 7/20/2009 ON: 07.20.2009 7/21/2009 pt f/u on 7.22 veloped fever, seizure, Left Y arm weakness Y the Yfollowing morning and 30 was hospitalized. MRIYshowed Right6/5/2009 Middle Cerebral 6/6/2009 artery infarct. P sh to abdomen. treatment Acycolvair, Y Valtrex Y 6/22/2009 7/16/2009 lling at site of injection on Rt. upper Yarm, lethargy, nausea , fever,body aches and pains, vomiting, Y loss of7/20/2009 appetite,headache. 7/20/2009 t to Left Arm Constant pain for over 2 weeks. Pain still there but not as intense. Patient believes nerve was hit during reciept of shot. swelling and tenderness 12x11cm on LD assessed by RN.Patient advised to place ice pack and motrin for 7/23/2009 pain. 7/25/2009 icella, MCV4, & Gardasil were completely Y administered at approximately 1:50 p.m. on 7/28/09; Y When the7/28/2009 family was7/28/2009 checking out at the cle nts mom, patient complained of Headache Y 10 mins postvaccination. Developed Bilateral armYredness, sore 7/20/2009 and warm 7/20/2009 to touch getting large injection site (left upper arm). No treatment. Y 3/2/2009 3/3/2009 allergic reaction to vaccine administration Y site approximately 10-12 hours after administration, Y impressive 7/27/2009 swelling, redness, 7/27/2009warm and pain pper extremity with ~ 4 cm area of blanching erythema with smaller area firmness palpated subcutaneously Y directly ### below.### ped systemic hives, pruritis, and throat Y numbness. Pt was seen in the ER. Y 7/27/2009 7/27/2009
t site of injection; c/o left sided facial numbness approximately 20 minutes after injection, stillUwith some numbness 7/26/2009 left 7/26/2009 upper lip and left sid elated varicella (skin rash) Y 7/13/2009 7/20/2009 fever for 2 weeks (intermittent), had fever 4 days Y before his one year 4 immunizations June 29, Y 2009. Developed 6/29/2009 petechiae (July 11) on legs Y 5/14/2009 m though no fever. Edema in handsY / feet skin all over body was sensitive to touch. Steroids N started 7/28/09 7/27/2009 and ZANTAC. 7/27/20099/1/09 PCP re iven: 7/21/09 - Fever day (1) 101.7 Y - MOTRIN q 6-8 hrs given - Child c/o soreness to arm - Headache, Y nausea, 7/20/2009 stomach 7/21/2009 aches and pain, di vomiting irritability Clingy. Y Y 7/1/2009 7/2/2009 25-09 with "mild achy". Worsened on 7/27/09 -> fever (subjective), body aches, nasal congestion U cough 7/23/2009 & chest congestion, 7/25/2009arms & legs a en instead of TD. No adverse reaction. 7/13/2009 eruption at injection site diagnosed cellulitis. U 7/22/2009 7/23/2009 ort received from a consumer on 29 March 2009 via the ACAM2000 Hotline. A male military service Y member 3/19/2009 who received 3/28/2009 smallpox vaccine was received on 05 May 2009 from a consumer/patient. A 41 year old male patient receivedNthe following 4/27/2009 vaccinations 5/2/2009 on 27 April 2009: A ions at 11:20 am on 7-27-09. FeverYof 103.5, rapid heart rate, body aches, hallucinations, rapid U speech in 7/27/2009 a high pitched 7/28/2009 voice, vomiting, an 09 I received ZOSTAVAX -Merck # 971651. No immediate side-effects except mild erythema at site. On3/20/2009 5/28/09 I had 5/28/2009 attack of severe vert ntracted Chicken Pox disease. Y U 7/14/2009 7/18/2009 les vaccine injected on 7-8-09 at 1:30 P.M, had a couple of spots on my stomach that night (thought that 7/8/2009 were bites) 7/9/2009 - Thurs A. M. (7-9-09) AX vaccine injection side effect. Approximately 3 inches in diameter red, swollen, warm, tender U area surrounding 7/21/2009 the7/22/2009 injection site on arm. S after - can't lift arm (left) - headaches - fever - aches (whole body) - nausea - mental sluggishness Y + fogginess 6/3/2009 [ A extra 6/4/2009 strength Tylenol + A st MMR/VARIVAX administration child Y developed a fever. Went to ER same day and received Y AMOX for5/21/2009 OM. 2d after 5/27/2009 ER visit developed r o lightheadedness, "feeling faint" directly after vaccination (had no c/o after 1st shot) Pt. became Y diaphoretic, 7/21/2009 pale-reclined 7/21/2009 with feet up, coo 009 right arm became swollen, red Y and warm and symptoms have progressed. Mom gave children's Y TYLENOL 7/21/2009 from7/22/2009 7/22/2009-7/24/2009. n has been received from a registered Y pharmacist Y concerning a 78 year 0 old maleYwith no pertinent Y medical 5/30/2009 history who 6/5/2009 on 30-MAY-2009 w n has been received from a physician Y concerning Y the physician's daughter 2Y with not reportedNdrug reactions/allergies 6/8/2009 and medical history wh n has been received from a nurse practitioner Y concerning a 20 year old nurse practitioner female Y (her daughter in law) with no reported dru just after 9 AM. Left office Y 930. Eyes Y itchy, throat scratchy 10-1030. She called office. Reported Y face swelling. 7/22/2009 Got to 7/22/2009 ER 1147 and treated rectal temp of 101.4 F and episodeYof going limp, Y eyes rolled back for 1 < 1 minute. Child taken Y to hospital7/15/2009 in post-ictal 7/16/2009 state, then transferred 0 minutes after receiving vaccines mom noted blanching small red macules on dorsum of feet; Y child otherwise 7/2/2009 well; given 7/2/2009 8 mg of BENADR VARIVAX #2 on 7/27/09 - erythema, Y pruritis, sl. tenderness, 4-5cm diameter elevated area. Y 7/27/2009 7/28/2009 three weeks of moderately severe diarrhea (occult blood pos) after 2 month vaccines. Y 4/22/2009 5/1/2009 waiting area after administration of Hepatitis Y A vaccine. Vasovagal syncopal episode with tonic/clonic Y movement 7/16/2009 x 10 seconds at approx. 3 d fainting episode shortly after the shot. Y She fell and hit her R shoulder and R ear--she was Y placed lying7/27/2009 down on exam 7/27/2009 table. Given water physical this year 7/22/07, Uncle and patient reported that 1 week after her first HPV VaccineYwas administered 7/21/2008 on 7/21/08, 7/28/2008 she began havi ports she noted large red warm induration measuring 10 cm across left deltoid at the injection U site and temperature 7/27/2009 7/28/2009 of 100.8 degrees Fahre ceived Varivax on 7/27/09. Mother called the office the next afternoon stating that were the child Y received 7/27/2009 the injection 7/28/2009 was raised and abo eption. 8/24/09 Hospital records received DOS Y7/21/09 to 7/24/09 Assessment: 3 Dehydration,Yviral gastroenteritis. 7/6/2009Ileocolic 7/21/2009 intussusception. ceived 2nd Varivax on 7/27/09. Within a 24 hour period the injection site became red and swollen Y to the7/27/2009 size of approximately 7/28/2009 a half dollar. MA, WARMTH AND TENDERNESS SURROUNDING INJECTION SITE, STARTING DATE OF Y VACCINATION. 7/27/2009 7/27/2009 oke up with several large and swollen Y bruises as Y well as smaller bruises 3 on parts of her body:Y her right foot, 6/29/2009 left and right shins, right flank, c ess without ill contacts, GI symptoms. 3 cm circular erythematous patch with slight papulovesicular Y surface 7/16/2009 at/near7/26/2009 varucekka vaccune sig ceived vaccine at pharmacy with no side effect/reaction even after 30 minutes post administration. U Mild 7/25/2009 skin reaction 7/26/2009 (approx 1.5 inches x 1 HPV #3 on 7/22/09. About 1 week later Y developed swelling of lateral part of lower lip. No skin U rashes 7/22/2009 7/28/2009 (0561Y/4131x)administered on Tuesday, 7/21/09 to LA without incident. Pt. called office on U 7/27/09 reporting 7/21/2009 sore & 7/25/2009 swollen Lt shoulder jo minutes following meningococcal immunization, client had syncopal episode with mild seizure Y activity for 7/22/2009 a few moments. 7/22/2009 Recovered with to the school to lift weights the nextYday after receiving the Tdap vaccine. His eye started swelling Y shut, his 7/23/2009 lips got swollen. 7/24/2009 He was wheez ea of swelling, hard, red, hot to touch at injection site. First appeared within 24 hours of injection. Y Course 7/23/2009 of 4 days.7/24/2009 Treated with ice packs Y 3/5/2009 3/6/2009 WAS ADMINISTERED A SECOND DOSE OF ROTOTEQ AT 11 MONTHS OF AGE U 7/29/2009 WAS GIVEN SECOND DOSE OF ROTOTEQ AT 11 MONTHS OF AGE U 7/29/2009 - silver dollar size - at administration site 2 days after shot which went down after a few moreNdays, then 7/21/2009 7 days after7/23/2009 shot patient woke up s sized rash and swelling at injection site. Patient was told to report back if it hasn't improved Uin one week. 7/21/2009 7/23/2009 evere pain in arm from shoulder to wrist. Mostly centered at elbow with swelling of site of injection, N elbow7/22/2009 and wrist. Raised 7/24/2009 bump at injection
.9, chills, body aches, mild headacheY started 10:30pm. on 7/28/2009. Called Dr. at 11:15pm. U Gave motrin 7/28/2009 and tylenol 7/28/2009 overnight. Hives -st dministered day 0, 1000. Low fever and headache, beginning day 1 1600 lasting through day Y 2 2200. Treated 7/27/2009 with NSAIDs. 7/28/2009Skin sloughing zure (new onset) 19 AprY2009. AfterYextensive Y work-up there is no indication 3 for an underlying U cause. Pt concerned ### 4/19/2009 that seizure developed was reported by a healthcare professional Y and described the occurrence of passed out in a Y 16-year-old 7/14/2009 male subject 7/14/2009 who was vaccinated B was reported by a healthcare professional Y and described the occurrence of passed out in a U 10-year-old 7/23/2009 female subject 7/23/2009 who was vaccinated was reported by a healthcare professional and described the occurrence of passed out or vomiting U in approximately 7 to 8 subjects of unsp d vaccine - at above clinic on 7/9/09Y- - 7/20/09 start with H/A sore throat - - to high fever - around U 102. Rash 7/9/2009 - to blister 7/20/2009 covering body. 9 presented with rash on face then spread to entire body. Had a high temp 7/25/09 seen at E. R. 7/21/2009 7/25/2009 t dizzy, 30-60 minutes after school while out shopping. Felt unsteady, mother gave her OTCYprevacid, Gatorade 5/11/2009 and 5/11/2009 sugar. She denies be at site with swelling and skin was hot to the touch pt also had a fever of 99.8. U 7/27/2009 7/28/2009 high swollen and erythematous - no Y c/o pain and able to ambulate without difficulty. Y 7/24/2009 7/25/2009 ed back to clinic after receiving vaccines with bilateral swelling in eyes. Y 7/29/2009 7/29/2009 R vastus lateralis Y U 7/28/2009 7/29/2009 ceived HPV vaccine (3rd dose) in series on 7/22/09. A few minutes after receiving vaccine she Y felt dizzy 7/22/2009 and drop in7/22/2009 BP to 81/46 from 106/7 r injection #1 Gardasil. 1 1/2 hr after given vaccine- hives developed- pt has hlo hives and they Y did resolve 6/22/2009 after 2 6/22/2009 doses of Benadryl. inistering vaccines listed below, patient continued to sit in chair and after approximately 2 minutes Y patient7/28/2009 stated she7/28/2009 felt dizzy. After about ds after immunizations administered child became unconscious and fell back on the exam bed. Y Her respirations 7/29/2009 were 7/29/2009 22/sec HR was 88 BP swollen area (approx 31/2"0 left thigh. Pt. was advised to continue cold pack and BENADRYL. If condition 7/17/2009 worsens to 7/18/2009 to E.R. ports that he spent Sat. night 7/25/09 Y (afebrile) with gmo. No rash noted Sat. night but Sun. AM Y (9:00AM) 7/23/2009 child woke7/26/2009 up with red "bumps" o ayed 3 days after 2nd dose and 6 days after 3rd dose. Parent requested this be reported. Y 7/16/2009 .7, febrile seizure, eyes running. Y Y 7/23/2009 7/23/2009 m, rash, redness & from prior area irritates her. Y 7/21/2009 7/24/2009 posterior area red; very swollen warm to touch, very tender to touch, some pain with movement. Y 7/27/2009 7/28/2009 d 7/24/09. 7/25/09 evening (5pm) started Y w/ shortness of breath, chest tightness, palpitations. Y Went to 7/24/2009 ER on Sunday 7/25/2009 7/26/09 around 9:30 legs - Bumpy rash with fever vaccines given 7/27/09 reaction 7/28/09. 7/27/2009 7/28/2009 n has been received from a physician Y concerning a female who was vaccinated with Y a dose Nof ZOSTAVAX 9/25/2007 (Merck).10/4/2008 On an unknown date, n has been received from a registered nurse who was also the patient's mother concerning aY 44 day old3/25/2009 male patient 3/26/2009 who on 25-MAR-2009 007 couldn't walk right - Ytook him toYER they admitted Y him to hospital 240 at that time.Yhis condition N kept getting 3/16/2007 worse - 5/26/2007 May 28, 07 he went Co iving the new shingles vaccine, ZOSTAVAX, I had an outbreak of herpes, type 1. I had not had an incident 7/15/2009 of an outbreak 7/20/2009 of herpes, type 1
e fever, muscle aches, site erythema and tenderness, increase resp mucus. Pos - vax adverse Y reaction, 7/23/2009 pos mild URI 7/23/2009 and premenstrual con d rash on neck, legs, arms "looks like chicken pox!" Y 7/16/2009 7/19/2009 ed, warm 31/2X4cm area on Rt. upper Y arm, where DTaP was given. 7/20/2009 7/21/2009 ed, hot, tender to touch. Left upper arm. Y Y 7/24/2009 7/25/2009 welling at injection site day after cellulitis. 8/10/09 Y ER records received 2 DOS 7/25/09. Assessment: U Cellulitis 7/24/2009 surrounding 7/25/2009 injection site. Patie ure 102 - 103 x 2 days 4 hours after vaccine. Crying non stop x 4 day. Talked to PediatricianYDr. Continued 5/13/2009 TYLENOL, 5/13/2009 no office visit. Pedia d some chest discomfort on the night Y of the 20th Y and thought it was only indigestion. Went toY bed and woke 7/10/2009 up a few 7/20/2009 hrs later with severe c s after immunizations, pt. developedYa vomiting episode. He became very pale and his breathing Y slowed.7/15/2009 He passed7/15/2009 out. Mom called an am RIX on 7/22/09 in left upper arm. On 7/24/09 came into office with redness on left upper arm. U Warm to touch. 7/22/2009 7/24/2009 veloped an unexplainedYon 07-20-09, Y followedYby a generalized seizure 3 and respiratory failure Y & RUL collapse. 7/7/2009 Baby 7/20/2009 was mechanically ve ain felt sick on Sat. and Sun. Mon woke Y up with cluster of blisters on hands + feet. Tues. Chicken Y pox started. 6/24/2009 Legs,6/27/2009 arm, back, saw dermat ld was given pediatric HEPATITIS A vaccine. Y 7/24/2009 fainted - ice pack, counseling Y 7/27/2009 7/27/2009 er receiving vaccine, while sitting on table she became ashes in color, used ammonia inhaler Y but she passed 7/24/2009 out to7/24/2009 lying down position on eloped to the medical area of left deltoid. Began this am area is the size of 1/2 dollar, warm to touch. Painful. 7/23/2009 No swelling. 7/24/2009 Will treat with BE ther reports that approx. 13 hours after Y receiving Y vaccines that the patient 1 developed a feverYof 105. She 7/27/2009 was evaluated 7/27/2009 by the ER, No tre rm: (cm) 11x9 erythematous slight raised Y macule. Y 7/22/2009 7/24/2009 dministered to upper L arm on 7-16-09 area 7" X 5". Became hot, dark red, swollen with 1 pustule U in center. 7/16/2009 Pain level 7/16/2009 7 by evening of 7-1 s given a TDAP and should have received DTPLAP. Y 7/27/2009 eived VARIVAX 17 days after MMR and the interval should have been 28 days. Y 7/6/2009 lips and tongue Dr. prescribed Mycostatin Y (7/14) 2ml 4x day. He is improving. (never had thrush before!)7/8/2009 7/10/2009
was recieving a routine series of vaccinations while on a military deployment. A corpsman administered Y a7/25/2009 0.5 cc dose of anthrax vaccine, bu sting thirty seconds, followed by unresponsiveness Y lasting for thirty seconds. He was also hypotensive Y for 7/29/2009 about five 7/29/2009 minutes. He was trea RETURNED TO ADULT CLINIC FOR PPD READ ON 7/30/09 (IMPLANTED ON 7/28/09) WITH N C/O OF ROUND 7/15/2009 MACULAR 7/18/2009PAPULAR RA swelling, itching, hardness U 7/27/2009 7/28/2009 ely following administration of vaccines, client became pale, hot, and dizzy. BP 74/40. Had client Y place head 7/24/2009 between 7/24/2009 knees, cold pack app ite pain to the point where he refuses to walk or move at all without being held. He wouldn'tUeven sleep 7/29/2009 by himself, 7/29/2009 he had to sleep on my or Gardisil #3. Layed down before shot administered to right arm. After 5 mins patient experienced Y syncope 7/27/2009 episode7/27/2009 while laying on table. F cedived vaccines. While patient was leaving the building she fainted. Patient quickly awakened, Y but was7/21/2009 confused 7/21/2009 for a short time. Patien cieved DTaP, MMR, IPV in the left deltoid on 7/28/09 and developed redness, swelling and tenderness U from 7/28/2009 the AC7/29/2009 joint to the area just pro o knee pain x 1 week then went to ER Y and dx w/ ataxia at Medical Center. Seen by Peds ID.U 6/19/2009 7/22/2009 yncope x 2 events. Syncopal events separated by ~5 minutes. Pt. complained of severe dizziness Y for ~40 7/27/2009 minutes 7/27/2009 after immunizations. was given Tdap by me (MN, RN) on 07/22/2009. At the time of vaccine administration, I did not realize 7/22/2009 that he was beyond the age recom ceived her 2nd Varivax on 7/27/09. Mother call on 7/29/09 to report that a red area the size Y of a ping pong 7/27/2009 ball had 7/28/2009 developed. Tx was for RETURNED TO CLINIC FOR PPD READ (IMPLANT ON 7/28/09) WITH C/O OF LDT PAINFUL N SWOLLEN 7/28/2009 MESURING 7/30/2009 50MM DIAMETER; RECEIVED VZV ON 7-21-09 AND Y DISCOVERED SHE WAS PREGNANT ON 7-30-09. U 7/21/2009 7/30/2009 ECEIVING MMR INJECTION ON 7/17/09, Y PT DEVELOPED REDNESS,SWELLING, PAIN AT U AND AROUND 7/17/2009 THE 7/24/2009 INJECTION SITE 7 DA not state on the screening tool that she was asthmatic was immunized with Zoster and Pneuomococcal Y 7/30/2009 -23 and left7/30/2009 the clinic for about five d wheezing, swelling of lips, albuterol Y nebs, epinephrine 1:1000 0.15 cc, and decadron 6 mgYIM given, patient 7/20/2009 transported 7/20/2009 to hospital in sta area of erythema of about 37mm presented Y with in 15 min of administration. Three seperate U raised areas 7/16/2009 were noted 7/18/2009 with in the area of e 8 hours later right leg itching, burning and pain U 7/29/2009 7/29/2009 M SWOLLEN, REDDNESS AND COPLAINS OF PAIN. PATIENT WAS TREATED WITH ANTIBIOTICS U 7/27/2009 CLINDAYCIN 7/28/2009 150 MG. ported to our facility on 4/6/09 that she has been experiencing pain to Right Upper ExtremityNsince Zostavax 1/30/2009 injection4/6/2009 given on 1/30/09. Pat ministered Tdap and Menactra in left deltoid with separate syringes on 7/29/09 without apparent U difficulty. 7/29/2009 Pt returned 7/29/2009 to Clinic on 7/30/09 D PHONE CALL FROM PATIENT. PATIENT COMPLAINED OF FEVER AND NAUSEA 6 DAYS Y AFTER7/22/2009 VACCINATION. 7/30/2009 PT ALSO, COMP ent into his Primary Care Physician the Y day after the vaccines were adminstered when the Nurse Y Practioner 7/27/2009 was told7/28/2009 by the parent about th eaction,cellulitis L arm, pt. treated with Keflex Y 7/28/2009 7/28/2009 02.7, extreme weakness to the point Y of barely being able to walk or talk. Extreme Swelling & U pain on a scale 7/23/2009 1-10 at 7/24/2009 10 on the arm of the i minutes of administration pt has itching of faceYand neck and dry cough. 1 Whelps on body with Y hive reaction 7/29/2009 (2 on neck 7/29/2009 and 4 on body) Give ve vesicular eruptions on trunk and abdomen. Y 7/23/2009 7/30/2009 len, itchy, hot to touch. Lt deltoid. 7/30 only minimal tenderness, no itch. Y 7/21/2009 7/22/2009 ness, raised semi solid knot X 1 week. Area 10mm rechecked 7/30/09. Much improved LE pain Y 7/22/2009 7/23/2009 al nodule, pain L axilla x 3-4 days. 7/30 no edema, no redness, slight tender when palpated. Y 7/21/2009 7/22/2009 o doctors office on 7/25/09 with a 2 inch X 2 inch area of red, raised and warm area @ site ofY VARICELLA 7/23/2009 vaccine -7/24/2009 posterior upper right ar fter injection, chronic urticaria. For date... one year, 8 mo. N 11/6/2007 ### , began to become red/swollen. Slight itch, 2 1/2 round swollen area. Y 7/28/2009 aised red area. Pt treated with Diphenhydramine 25mg Hydrocortisone 1% cream. Y 7/23/2009 RA given from Lot #U2867AA Exp 3-5-10. Doctor notified no new orders. Local Health Dept staff Y notified.7/27/2009 Follow up call made to parent at 1 most fainted. Y 7/29/2009 7/29/2009 ine given, no adverse events but patient returned for 2nd injection & said was pregnant when Y got 1st dose 4/22/2009 upper chest. BENADRYL a few times Y 7/22/2009 7/23/2009 given on 07/23/09 at clinic - Pt was seen in office for WCC on 7/29/09 and told us about the Y reaction. Pt's 7/23/2009 (R) arm was swollen from should male, developed unexplained bruising Y over medial right forearm & right lateral elbow, paresthesia N from right 7/20/2009 elbow to7/20/2009 fingertips right hand, m swelling, warmth, tenderness onset 7-29-09 applied warm compress TYLENOL given - tenderness, Y warmth. 7/28/2009 Worsened 7/29/2009 7-30-09 gave BEN ates when client woke up 7/29/09 @ 8:30 AM, the back of her (L) arm was red with rash + swollen U the size 7/28/2009 of 1/2 dollar. 7/29/2009 Reports putting co welling and redness at injection site,Ycellulitis. The day after injection given. Y 7/22/2009 7/24/2009 oped HA approx 4 hrs after receiving a booster dose of anthrax on 7/13/09. Went to bed withY the HA and7/13/2009 woke up with 7/13/2009 the HA. No N&V or hrs after receiving his most recent AVA vaccine, SM developed a HA, unlike any other HA he's ever had.7/13/2009 On the date 7/13/2009 of his phone intervie oped redness, swelling, pain, induration at site of ANTHRAX injection. Symptoms resolved within 72 hrs.9/20/2006 Symptoms: 9/20/2006 Erythema, Edema @ ed skin color, loss of motor coordination, feeling of drunkness Y 5/12/2009 5/12/2009 9. Large local reaction lasting 2 weeks, Y sick 2 1/2 weeks with N+V, temp 99-100.8, Y terrible H/A, Y back pain. 1/14/2009 This was1/14/2009 followed by polyneural wing day my throat was swollen making it hard to speak, breath, and eat. My speech was a little Y slurred and 7/24/2009 I felt sick 7/25/2009 to my stomach. I thre
ver body x 6 days. Fever off and on.Y Treatment - Benadryl for rash / itching. Supportive careYTylenol / Motrin 7/13/2009 for fever. 7/19/2009 und injection site - size of 50 cent piece, itching of arms + lower legs for days. Arms had goose Y bumps, raised 6/30/2009 patches. 6/30/2009 It seems 3 weeks no d Tdap in Rt deltoid on 7/24/09. I received a call from his mom on 7/27/09 stating that over the Y weekend7/24/2009 around the7/25/2009 inj. site it became red, 7/14/2009 ess and slight swelling on both arms (deltoid area). U 7/23/2009 veloped multiple pruritic erythematous 1-2mm papules on (R) lateral thigh 1 day after immunizations. Y Seen 6/12/2009 by MD and 6/13/2009 prescribed hydrocor d female became dizzy and fainted Yafter administering GARDASIL vaccine was taken to theYhospital where 7/14/2009 she got7/14/2009 staples on her head. tous Edematous and firm area on left upper arm from shoulder to lower 1/3 of humerus, warm U to touch. 7/28/2009 7/29/2009 , warm sore area on Lt. deltoid (upper arm). Swollen, tender. Y 7/17/2009 7/18/2009 omiting, dizziness. Y 7/24/2009 7/24/2009 L) arm 6 d ago. Next AM noted disc (L) axillary this AM with discomfort about medical episode/ U (L) elbow.4/14/2009 No erythema 4/19/2009 - No fever - No syste on neck and legs. Y 7/23/2009 7/26/2009 Y N n to have fever 8 days after - Imm ofYMMR II fever was 104.5 rectal - irritable Y 7/15/2009 7/23/2009 N and redness from elbow to shoulder of arm in which vaccines were administered; DTaP and PCV7 Y were administered 7/22/2009 7/23/2009 to left deltoid which is 8, redness at the site of immunization shot given anterolateral thigh. Y 7/20/2009 7/21/2009 er - 7/25/09 A.M. had fever 101 withYjerky movements in sleep, breathing labored. Clenched Y teeth when trying 7/24/2009 to give 7/25/2009 TYLENOL, crying, eye n has been received from a medical assistant concerning a female patient who was vaccinated N with GARDASIL (vaccination date, dose nu circle where vaccine was given. Severe itching. U 7/29/2009 7/31/2009 9 PATIENT RCD VARICELLA IMMUNIZATION. Y 24 HOURS LATER HE BEGAN TO BREAKU OUT IN A 7/20/2009 RASH. AFTER 7/21/2009 7 DAYS OF NOT C pain, lack of back range motion; treatment, Y PT which didn't work; seeking further medical treatment. Y Have had### this pain since ### Dec. 2008 low grade fever yesterday, but it has gone up since then. Fever is now about 102. Has been U on Motrin,7/29/2009 but fever went 7/30/2009 up even on the Mot 09 patient was brought in my mother with lower extremities on left thigh with palpable mass with U 1.5 cm erythema 7/27/2009on7/28/2009 the higher injection sit dministered Varicella vaccine to left arm subcutaneous on 7/28/2009, without adverse event.UClt returned 7/28/2009 to facility on 7/29/2009 7/29/2009 with onse ccured 7-30-09. After administration of HPV and Varicella vaccine,client was escorted to a chair Y to be obserbed 7/30/2009 for 7/30/2009 15 min. While seated in linic for kindergarten immunizationsYwith DTAP #5 administered to right deltoid. Mother reports Y no symptoms 7/7/2009 or complaints 7/9/2009 to site till 2 day given 7/22/09. Child developed erythemic, Y annular rash day after shots were given, 7/23/09.YMother reports 7/22/2009 child had 7/23/2009 low-grade fever. Exac AL RASH, AS WELL AS RASH ONYLEGS, & WAIST - DESCRIBED AS A ALLERGIC REACTION. Y NO BRUISING 7/23/2009 OR 7/23/2009 PAIN, JUST ITCHIN ceived hpv vaccine on 7/29/09 on right Y arm. Reaction on 7/30/09 about 24 hours after vaccine U was administered. 7/29/2009 Area 7/30/2009 has swelling, is red in hives all over her body around 7:45pm Y the day of the shot given..about 4 hours after...took N patient to ER 7/30/2009 around 7/30/2009 9:15 pm due to being a ceived Gardasil immunization at approximately 12:15 pm. Stayed at doctor's office for 20 minutes Y following 7/31/2009 the immunization. 7/31/2009 At approxima the injections in my left arm and hadY symptoms for over 3 months after the injection. I could Y not lift my left 1/10/2009 arm above 1/10/2009 my shoulder, had num swelling, warm to touch, pain at leftYupper arm. Ice put on site, tylenol, mortin.Pt seen in office U told to do7/29/2009 warm compress, 7/30/2009 benadryl and call ythema muscle hot to touch x 2 days after vaccine injection. U 7/27/2009 7/28/2009 ately 5-10 minutes after injection, pt.Yfelt weak, faint, had syncopal episode in car in parking lot. Y Returned7/31/2009 to exam room 7/31/2009 and monitored for > Y Y 2 Y 7/24/2009 7/30/2009 pular rash erupted 6/17/09 after receiving varicella vaccination on 5/29/09. No fever. All areas Y crusted over 5/29/2009 by 6/25/09. 6/18/2009 me down with Varicella 8 days afterYreceiving Varivax. U 7/23/2009 7/30/2009 after vaccination pt noticed that area around vaccination site became red, swollen, hard and Y itchy. This spread 7/16/2009 down 7/17/2009 her arm to her wrist a d not have any initial problems following Y vaccine administration. Two days following the vaccine U administration 7/28/2009 patient 7/30/2009 presented to pharma ceived 12 mo vaccinations on 7/20/2009, Y at site of vaccine patient with 4 cm area of erythema, U induration, 7/20/2009 pain, and7/21/2009 warmth on right upper ven the following injections: Adacel (Tdap), Gardasil (HPV), and Hep B. She c/o's feeling suddenly Y light-headed/dizzy/nauseated. 7/31/2009 7/31/2009 She was RM HAS A 13CM RED IRRIATION & SWOLLEN. 4CM HAS WATER BUBBLES & DRAINAGE U CLEAR. CENTER 7/29/2009OF 7/30/2009 BUMP MEASURES 1 THER STATED THAT ABOUT 24HRS AFTER ADMINISTRATION OF VACCINE, SHE NOTICED Y REDNESS 7/30/2009 AND SWELLING 7/31/2009 AT VACCIN mesis (x7) 24 - 30 hours following DPT. Y Unclear if could have been unrelated event such as Y gastroenteritis. 7/29/2009 Partner not ill. Patient fully r day after vaccines given, pt's mother reported high fever and talking to herself as if delirious Y for approx 57/24/2009 hours. Called 7/25/2009 on call physician, b ld male had had upper extremity Y movements Y 2-3 Y wks prior. He received 2 vaccines 7-21-09 inYAM. He had7/21/2009 a generalized 7/22/2009 seizure 16-20 hrs a given at 2:40 pm. 2 hives right ant thigh at 2:44 pm - Gave 3/4 tsp. BENADRYL. Hives resolved Y - never reoccurred. 7/22/2009 7/22/2009 o clinic 2 days after receiving MMR, area with erythema, swelling, warmth, and tender to palpation. U Pt diagnosed 7/20/2009 with 7/22/2009 cellulitis, treated with 7/28/2009 7/29/2009
r 2 sec. - Paleness in face * Treatment -> lay down with elevated legs Y 7/20/2009 eadaches evening of vaccine, emesis (4) next day, fatigue + malaise, normal exam. U 7/30/2009 7/30/2009 d golf ball size swelling at site, tenderness X8 days. Evaluated 7/31/09 unremarkable, no pain, Y no redness, 7/21/2009 no swelling. 7/22/2009 given 29JUL2009. Mom reported swelling/redness at bilateral deltoid areas AM of 31JUL09.URt deltoid area 7/30/2009 worse. Pt. 7/31/2009 evaluated by Dr. and ved her vaccines 1 week ago, 7/22. YHas been seen now 3 times for sx's fatigue, fever, nausea, headaches, 7/22/2009 swollen7/23/2009 glands, body aches an d shot on Wed 7/29/9. On Thurs. called to say redness, swelling & itching at injection site. Counseled U on7/29/2009 proper procedure 7/30/2009 (BENADRYL/TY accine admin after approp. screening. Y 7-29-09 Pt. arm sore. Red & warm to touch. Minimal swelling. Y 7-30-09 7/28/2009 Called7/29/2009 HD. Arms swelling. En and headache. U 7/22/2009 7/22/2009 oday for TBST reading C0838. Nurse noted that pt's (L) deltoid area 2 1/4" x 2 1/2" slightly firm U swelling reddened 7/28/2009 areas 7/28/2009 with injection site n ted to clinic 2 days after injection. Site red, swollen and hot. Pt was diagnosed with cellulitis and U given KEFLEX 7/29/2009 500mg 7/31/2009 QID x ten days. nt received a 1st Hep-B vaccine on 8/1/2009 10am without any difficulty at the time however,Uthe patient reported 8/1/2009N/V, 8/1/2009 abnormal pain with b starting - few hours after vaccination. Persisted for 2 wks. Evaluated by EMT. Y ter vaccination of HAVRIX #1 c/o dizziness, weakness - GI distress - cold, clammy, B/P 80/60 Y P. 60 R. 28, 7/31/2009 administered 7/31/2009 epi 0.5 ml + 50 mg s at 10:30. Fell asleep, woke approx 3am screaming and crying, face looked like a balloon, very Y irritable,7/29/2009 screamed7/30/2009 at the touch of the shot d VZV and Hep A immunizations on 07/29/09. Mom called to office on 07/31/09 stating had Y swelling at injection 7/29/2009 site.7/30/2009 Pt brought into office a was reported by a healthcare professional and described the occurrence of adverse reactionUin a subject of unspecified age and gender wh was reported by a healthcare professional via sales representative and described the occurrence Y of injection 7/1/2009 site reaction 7/3/2009 in a 5-year-old m was reported by a healthcare professional via sales representative and described the occurrence Y of injection 6/9/2009 site reaction 6/11/2009 in a 5-year-old fe was reported by a healthcare professional Y via sales representative and described the occurrence Y of injection 5/21/2009 site reaction 5/23/2009 in a 5-year-old m was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a physician via sales representatives and described the occurrence of injection U site reaction in a subject of unspecified ag was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a healthcare professional Y and described the occurrence of swelling injection N site in a 5-year-old 7/20/2009male 7/20/2009 subject who was vac was reported by a physician, via a GSK representative and described the occurrence of fever U in a subject of unspecified age and gender w hours of receiving vaccine developed low grade fever 100. Cold like symptoms runny, stuffyUnose. 72 hrs7/28/2009 began dry7/30/2009 cough. mark at injection site U 7/28/2009 7/30/2009 ped large area of firmness, pain andYswelling of left arm and shoulder 1 days after receiving vaccines U 7/31/2009 8/1/2009 urs, Jonah became lethargic, sickly, pale, fever. After the fever subsided 4 days later, Y my son N was then displaying 7/3/2008 autistic 7/3/2008 symptoms like lo gardasil shot on 03/27/08 my symptoms Y included: Pain in my arm, dizziness, acute pharyngitis, N sore joints 3/27/2008 and mucles. 3/27/2008 After my 2nd Garda Y 7/28/2009 7/28/2009 d-low eye contact, unresponsive to name being called, head-banging, stims like arm Y flapping, U lining up objects, 6/29/2006 inappropriate 6/30/2006play with toys mergency room, transferred Y 60 miles Y to ICU in Y a bigger hospital. 3 days 4 in ICU, 7 units of blood Y given in transfusion. ### Total ### 4 days in hospita welling on 7/24/09 - site of 2 immunizations andYa bug bite, swelling 2increased became hard Y and hot to touch 7/23/2009 called 7/24/2009 PMD on 7/26. Went to E eption, diarrhea, vomiting, dehydration. 8/17/09YHospital records received 1 DOS 7/30/09 - 7/31/09. U Assessment: 7/24/2009 Ileocolic 7/30/2009 intussusception. P d out, 1 day laid back on table shook and sat up direct. Pt. was laid back. Dr notified Dr. visited Y with pt and 7/31/2009 pt mom was 7/31/2009 given soda and rest ately 5 minutes after being vaccinated the patient started feeling lightheaded and nauseated,Yshe then had8/3/2009 a syncopal 8/3/2009 episode. When she r ed this morning by mother - first noted Y on left thigh spreading to trunk, forearms and head getting Y more spots 7/30/2009 as day7/31/2009 goes on. Child fussy, w ng in chair while vaccines administered within 2-3 minutes, while still sitting, client rolled his eyes Y back, stiffened 7/6/2009 arms7/6/2009 and fell back in chair d fever to 101-102. Pt reported arm swollen at site of injection. Y 7/28/2009 7/29/2009 d no adverse event. Patient received VARIVAX 7-15-09 and that evening developed temp 99-100 and fine 7/15/2009 bumpy 7/15/2009 rash and she continues d left arm swelling, redness, itching below injection site around (L) bicep - Given BENADRYLU25 mg tablet 7/22/2009 every 6 hrs 7/22/2009 prn and HC 1% crea id rash both legs @ immunization sites. Y U 7/23/2009 7/26/2009 ing and red patch of skin bilateral thighs at injection site and swelling. Right thigh: Red areaU13 X 12 cm.7/20/2009 left thigh 10 7/22/2009 X 8.5 cm red area. degrees --> 12 hr. after vaccine administration. Emesis multiple times at night (2-8 hr later).U 7/27/2009 7/27/2009 n has been received from a Registered Nurse (R.N) Y and a Physician0 for the pregnancy registry Y for GARDASIL 3/1/2008 concerning 9/10/2008 a 17 year old fem n has been received from a registered Y nurse concerning a 16 year old female patient with a Y history of acne 7/27/2009 and no known 7/27/2009 drug allergies wh n has been received from a physician Y concerning an 82 year old male patient (180 pounds and U 67 inches), 7/14/2009 who on 14-JUL-2009 was vacci Y Y 7/15/2009 7/16/2009 d the menactra vaccine on 7-29-09.Her Y arm was very sore,on 8-1-09 at approx 6 pm she complained U of 7/29/2009 sore lymph nodes 8/1/2009 in her neck radia ately 24 hours after pneumonia vaccine, Y my husband's arm swelled significantly, became very Y red from the 7/30/2009 shoulder7/31/2009 to the elbow, and there
ch sized red/hot painful swollen area at site varicella vaccine starting on 8/1/09. Ice was applied Y intermitently 7/31/2009 and by8/1/2009 8/3/09 area was no lo accine administered to Right arm 7/16/2009. Parent noted red swollen area on right arm 07/26/2009. U To 7/16/2009 clinic 7/29/2009 7/25/2009 - area red and war Y Y 3/23/2009 3/23/2009 ter got her MMR and Varicella vaccination Y on 7/17/09 and started with symptoms on 7/26/09Nwhere she 7/17/2009 developed 7/26/2009 a rash with raised bump Y Y 6/30/2009 ed local health department on 7/31/09 and reported that after she received the Td booster onY 7/28, she left 7/28/2009 the clinic7/28/2009 and when she arrived lation with the following skin reactions: blanching Y erythroderma on 10 back and chest that is drying U and flaking 7/22/2009 with extension 8/1/2009 in a lacey fashio occurred 5 minutes after immunizations. C/O nausea, dizziness. B/P 138/60. Pulse 88. Oxygen Y saturation8/3/2009 96% room8/3/2009 air. veloped a 4 inch are of redness and inflammation on her right arm (site of administration). The U vaccine 7/31/2009 was administered 8/2/2009 on Friday 7-31, t episode occurred 2 minutes after immunization. Assited to supine position with legs elevated. Y B/P 84/60. HR 8/3/2009 64. Oxygen 8/3/2009 saturation 98%. C re with mother for ppd reading,mother showed Left arm,noticed tenderness,redness and swelling Y on LD.mother 7/30/2009 advised 8/1/2009 to place ice pack a wo after his vaccination for shingles my father began experiencing periods of dizziness and vertigo Y when7/28/2009 he stood from 7/30/2009 a sitting position or veloped hives after second Hep A vaccination. Y The patient was treated in our office with RxYfor Benadryl. 7/24/2009 7/24/2009 THER REPORTS CT VOMITING 4 HOURS AFTER RECEIVING VACCINE ON 7/31/09 FOLLOWED Y BY7/31/2009 REDNESS,7/31/2009 SWELLING, FEVER ( mplained of jaw pain, dizziness and nausea with emesis X's 1 of bile looking substance. Patient Y also complained 7/29/2009of7/29/2009 sweating, heart poundi a rash on arms and joint pain in wrists and knee. U 7/20/2009 8/1/2009 veloped a large red and swollen area at the vaccination site approximately 4" x 7" in size U 7/28/2009 7/28/2009 f imm. (07/23)developed redness, soreness and swelling right arm from elbow to shoulder. Worsened Y the 7/27/2009 next day7/27/2009 (07/24) and also c/o fee ports no known drug allergies. patient called on 8/3/09 to report the following effects following Y vaccination: 7/31/2009 raises whelps 8/1/2009 & itching at the ad ports no drug allergies. patient called on 8/3/09 to report the following side effects after administration Y of 7/27/2009 vaccine: raised 7/28/2009 whelps and itching ped cellulitis in his right upper arm the Y day after receiving 4 year old vaccinations. He was treated Y with antibiotics. 7/31/2009 8/1/2009 after administration of Vaccine Y 1/7/09, Y Patient Y was discharged and14 upon Y arriving at home became Y incoherent 1/5/2009 and unresponsive 1/7/2009 to verbal c to Dr. Lee's report, "VACCINE REACTION: Within 10 minutes of receiving vaccines, patientYdeveloped erythematous 8/1/2009 8/1/2009 macules and patche very shortly after injection. Fell forward Y off table & broke her nose. 7/23/2009 7/23/2009 orso told to leave t-call with PCM. Y 7/13/2009 7/13/2009 min after injections, became pale, nauseated, dizzy, + felt "hot". Vital signs stable. After 15" Y up to chair.7/28/2009 Denied nausea 7/28/2009 or dizziness, colo s after vaccination, pt developed hives on (R) wrist, and her tongue became swollen, over the Y next day; 6/26/2009 Hives spread 6/26/2009 to both arms from wr e up during the night from a really bad Y sharp pain in chest. She barely touched it and the sharp N pain would return ###same 1/1/2009 with shoulders. 7/22 ite visible. Redness is 8-9 cm below site and is irregular. Redness extends from outer to inner Y aspect of 7/28/2009 arm and ends 7/29/2009 in a hive approx 3-4 ported symptoms began in the evening the day of injection. She developed chills and fever up Y to 104 degrees 7/16/2009 that night. 7/16/2009 Swelling of arm t Y 6/23/2009 omiting, diarrhea, fever. Mom states she had same reaction after first dose Hep A. Y 7/23/2009 7/23/2009 d his 3rd AVA booster on 27 MarchY2009. Within Y 8 hours of vaccine4receipt, pt noted rhinorrhea. N He denies 3/27/2009 any itching 3/27/2009 eyes, hives or rashe d Tdap, MCV, & Varicella 7/30/09. Developed Temp 101.7 the evening of vaccines. Also c/oYskin feeling7/30/2009 sensitive at7/30/2009 injection site. Mom rep r report taken, pt. had c/o cellulitis on R. upper arm which was tender, hot to touch, itchy andYfirm to touch. 6/30/2009 Area affected 7/1/2009 was 4-5 in diamete and redness of rt arm. Tx cold compress. 1 1/2 tsp. BENADRYL. U 8/3/2009 8/3/2009 mother of client on 6/30/09. Pt received Y shots 6/29/09 and hasn't slept much - cat naps off and Y on. Can't get 6/29/2009 fever under 6/30/2009 control. Mom called Y Y 7/30/2009 arden area, 7cm x 7cm red, warm toY touch, redness has been decreasing. 7/28/2009 7/29/2009 r upper torso and fever Rash - macular, red and warm - No treatment except TYLENOL for fever. Y 7/24/2009 7/29/2009 .4 7-29-09.7-28-09- Seen in ER 103.0. Y Fever 101.9 -7-30-09 Y 7/28/2009 7/28/2009 immunization was given instead of the DTaP to a 18month old boy in error. U 8/3/2009 noted on arm same day after vaccineY administration. Patient was seen in ER on 7/31/2009 and Y was admitted 7/29/2009 at hospital 7/29/2009 for possible celluliti ceived a 4th dose of DTP when he was Y 6 years old. His mother related that he had an abscess Y and fever7/28/2009 from it and7/29/2009 was hospitalized for 2 vaccinations approx. 345pm. Approx Y 650pm baby woke up screaming, high pitched scream Yfor several hours 7/27/2009 (until 7/27/2009 approx 10pm). Nothing two welt sites one aprox. 4 cm & improving 2nd site 6 cm & warm to touch & red. with discomfort Y lasting 7/27/2009 2 days - improving 7/28/2009 with MOTRIN n on 07/31/09 for vaccines. Discussed med hx of seizures. Father stated that his son has seizures Y with stress 7/31/2009 or fevers. 7/31/2009 He stated that last throat & some mild swelling in glands and low grade fever for 24 hours. Y 7/30/2009 7/30/2009 , edema, induration at injection site Y >4 cm. No response to BENADRYL/ice. Response to AUGMENTIN. Y 7/11/2009 7/12/2009 vaccine admin 7-30-09. Family report Y that blister appeared either the next day 7-31-09 or 8-1-09. Y To Dr. 8/2/09. 7/30/2009 Dx with 7/31/2009 bacterial infection & Y 8/3/2009
Y 7/23/2009 7/25/2009 eft thigh big red welt at site size of softball & 7/31 looks smaller. Mom advised to give BENADRYL Y & to call 7/29/2009 us back7/30/2009 if redness worsens or s throat nasal congestion cough with mid epigastric pain - pain for 2 days - sore throat 2 days N - nasal congestion 7/28/2009 cough 7/29/2009 persist. give a little history on this patient. She Y was a cheerleader, majorette, and was in a weight lifting N class. She 7/14/2009 was very active 1/1/2009 and athletic. I did ool reported she was very weak - 03/09 Y leg weakness/tired 03/09 pain started. Please see attached. N Patient continuity ### 1/8/2009 codes to 353037 an Hep#2 only 4 months after HepA#1. U 7/28/2009 pain, swelling, itching, and heat radiating Y around the injection site, over the next several days U swelling and 7/31/2009 redness grew 8/1/2009 into the whole upp g fine after first after first Yshot, received Y 2nd series Y and next day went 2 to dr. from school Y complaining N of blurred 1/2/2009 vision, 3/11/2009 sick to stomach, and n has been received from a physician Y concerning Y a "6 month old" female 0 who in "July 2009",Uwas vaccinated 7/1/2009 (oral administration) 7/1/2009 with the t follow-up information has been received Y from a nurse, for GARDASIL, a Pregnancy RegistryYproduct, concerning 6/12/2008a 8/15/2008 23 year old female who n has been received from a physician Y concerning Y a female who in January 2 2009, was vaccinated N IM with the second ### 0.5ml ### dose of GARDA n has been received from a physician Y and a certified Y medical assistant, 0 for GARDASIL, a Pregnancy N Registry 5/21/2008 Product, 5/21/2008 concerning her 17 y n has been received from a 23 year old femaleYpatient with no pertinent 0 medical history and Usulfonamide11/6/2008 allergy who 11/6/2008 on 06-NOV-2008 was eption 4 mo after completing 3 doses ROTATEQ. Y 9/23/09 Medical records 2 received for date Y of service 7/22/09 2/10/2009 to 7/23/09. 7/22/2009 DX Intussuscepti was reported by a consumer and described the occurrence of autism in a 1-day-old male subject U who was 6/26/2003 vaccinated 6/26/2003 with ENGERIX B, (G arted night after vaccine. Fever lasted 16 days.YParainfluenza type 15 B sputum. Lt lower lobe pneumonia Y with 5/6/2009 positive rise 5/6/2009 in mycoplasma ant smallpox vaccination on 7/21/09. Subsequently Y Yhad blisters all over3his back and chest. He was Y taken to7/21/2009 Emergency8/2/2009 Room and admitted fo dness, itchy and painful for 1 wk. Y 7/15/2009 7/16/2009 Y 7/14/2009 7/15/2009 d swollen X 2 days; tender - Fever Y increase 101.0. - Will treat KEFLEX 500mg #30 T po tid for 10 days.7/27/2009 7/29/2009 was given IM rather than Subq. 7/27/2009 following immunization. Pt was sitting in chair during administration & fainted following 4th vaccine. Y Pt was 7/30/2009 still in chair 7/30/2009 when he fainted. P ands and feet (blisters) sores in mouth. Y Treated with ZYRTEC and BENADRYL mouth washYmixture. 7/20/2009 7/24/2009 y 09 child received 3rd HPV vaccineYin left arm. On 28 July 09 a lump was seen over injection Y area. Was7/27/2009 seen on 297/28/2009 July for a check up ag ke up on 7-11-09 and her eyes were puffy both the top + bottom lids. No itching or burning. N Eye eyes are 7/10/2009 still puffy 7/11/2009 2 wks later. ches pm. 7/7 Body aches, Temp low grade, chills. Y 7/6/2009 7/7/2009 ness, Headache, Extreme sweating, chest pain, diff. Breathing, and feeling faint. Y 7/24/2009 7/25/2009 :00 PM Mom called to report daughter's Y (R) arm was red, swollen and real sore. She also couldn't Y pick up 7/24/2009 her arm very 7/27/2009 high. Mom called ba turned to clinic after 30 min from receiving vaccines reporting an allergic reaction. Patient presented Y with7/30/2009 macular papular 7/30/2009 rash on left cheek 0 Syncope, diaphoretic with within normal vs: BP 116/76, HR:84, RR:18. Treated for Vasovagal Y symptoms 7/29/2009 and monitored 7/29/2009 vitals. after MMR/Varicella developed full blown Y TIP w/ platelets down to 4K! Referred to Hematologist. U 7/2/2009 7/22/2009 to parents woke up next day with leg Y pain then had trouble breathing - taken to hospital ERU- Dx Hyperventilation 7/23/2009 according 7/24/2009to MD. ar redness-itchy and painful to touch for 1 week. Y 7/15/2009 7/16/2009 mmunization mac/pap rash of face and neck with some swelling of face with erythema and itching. Y Resolved 1/26/2009 in 2 weeks 1/26/2009 time with Zyrtec. No dministered to pregnant female approximated 3 weeks gestation. Report LMP 5/5/09, deniedUsexual activity. 5/27/2009 EDC 2/4/10. secondary innoculation to genital area. Y Mutiple vesicles with crusting to penis. 7/16/2009 8/4/2009 w hours the injected arm upper muscles Y ached when lifting or raised. Following day flu-like symptoms Y - achy, 7/27/2009 slight fever. 7/27/2009 Next day fine...on S SHOT WAS GIVEN ON LEFT ARM, UPPER LEFT SIDE OF PATIENT'S LIP STARTED TOUSWELL.BY 8/3/2009 10 PM HIS 8/3/2009 ENTIRE UPPER LIP W ther called at 9:30am this morning reporting that the child had nausea and vomiting during the U night. She 8/3/2009 stated child8/3/2009 vomited once during esented 8/3/2009 concerned and with a larger than expected rash and warm, palpable, approximately U 2 7/30/2009 to 3 cm nodule 8/2/2009 at the area of admi after vaccine, arm had slight itching and faint redness (0.75" x 1.0" oval) where vaccine was Y administered. 7/27/2009 Itching and 7/28/2009 redness have gone a episode 2 minutes after immunizations. Fell to floor. B/P 98/64; Pulse 83; Oxygen sat 98%. YLegs elevated. 8/4/2009 Recovered 8/4/2009 without incident; d swellling and induration over the Left Y upper arm from the shoulder to mid-upper arm. Tender U to palpation. 7/30/2009 No fluctuance 8/2/2009 ately 1 week prior patient was admitted Y into theYhospital after a 2-story 2 fall that subsequentlyUrequired her 8/1/2009 to undergo 8/1/2009 a splenectomy on 7/27 ombo vaccine of Dtap/IPV. Pt contacted. No adverse s/s reported by pt. Y 8/3/2009 ately 1 month after receiving the second Y dose of Y the Gardasil vaccine 6 (manufactured Y by Merck N - I am unable 8/31/2007 to load that in### the information s eizure 2:00 a.m. the following morning. Y Went to Crestwood Hospital Emergency room for evaluationY phone 7/24/2009 256-429-5177. 7/25/2009Did not require aches and muscle cramps day after recieving anthrax. The cramping continued for 3 days after. U 7/27/2009 7/28/2009 oster Rash on trunk on the Right side in Dermatomal Distribution.Seen at clinic for rash and diagnosed N on 6/13/2009 07/29/09.As 7/26/2009 of 8/3/09 per telepho d second Hep A vaccine about 4pmYin pediatrician's Y office without immediate 1 effect. The next Y day at about 7/20/2009 6 pm (26 7/21/2009 hrs later) pt had a gen e minute after shot Kayla became dizzy. She told me numerous times that something was wrong Y and and7/31/2009 that she did 7/31/2009 not feel good. She tu
6 month shots at 11:00am. There was no food given besides formula after shots. At 18:30 rapid U rash developed 7/23/2009 over 7/23/2009 the baby. Starting on ministered at 2:30 p.m. appointment which include TD and Meningococcal. Patient felt fine going U into appointment 8/4/2009for 8/4/2009 vacines. Later at 9:00 eption 7/20/09 - symptoms Y began. Required surgical Y reduction 7/22/09. 8 8/31/09 Hospital records Y received7/9/2009 DOS 7/20/09 7/20/2009 to 7/28/09. Assess OOSTRIX given -> mild soreness/ swelling post injection Lt arm. A "few days later" developed U " electrical 6/23/2009 sensation" 6/25/2009 in arm -> Palm of han tory of seizures. Has C.P. She developed grand mal seizures the day after BOOSTRIX given. Y 7/15/2009 7/16/2009 dizzy, nausea, rash on face, neck. U 8/3/2009 8/4/2009 F x 2 days of markedly swollen (L) arm, shoulder and elbow x 4 days. C/O decreased appetite Y and lethargy 7/30/2009 x 2 days. 7/31/2009 03.1 a few hrs after getting vaccines. Given Ibuprofen by his mother. N 8/3/2009 8/3/2009 ction left upper arm 7/23-7/30/2009.YOn 7/31/09 patient developed skin lesion right ankle andUlower leg; clustered 7/23/2009vesicles 7/31/2009 in annular shape redness, swelling, tenderness at site of vaccine approx. 24 hours after receiving. Pt had slight Y itching at7/31/2009 site, redness 8/1/2009 approx. 2" across. ling "off", dizziness, red local reaction, Y tender to touch (L arm). Y 7/15/2009 7/16/2009 coughing and hives within 3 minutesYafter shot given BENADRYL PO and EPI 0.1mg given SQ. Y Began having 7/13/2009 decreased 7/13/2009 (88%) and O2 app min of receiving HPV #3 in a semi-lying Y down position she started having some tremors and passed Y out. B/P 7/31/2009 at that time 7/31/2009 was 102/59 with a arm on right side, swollen and red. U 7/29/2009 patient came to our office on 7-29-09. Y He stated that patient was given a vaccine in our officeY on 7-1-09 and 7/1/2009 he had to be taken to the emer n 2/+ pain in L elbow on 8-4-09. Pt Y relates she had pain and swelling at injection site on 7-21-09 U and now 7/20/2009 the pain and 7/21/2009 swelling at injection swelling and pain in R arm where vaccine Y was administered. Flu like symptoms w/o fever orYchills. 8/3/2009 8/3/2009 at injection site, pain at injection site, achy and Y tender to touch/hot to touch at injection site, itching/no Y fever 7/29/2009 or chills 7/30/2009 Y 7/28/2009 7/28/2009 9 MODERATE Other INDURATION 3CMX 5CM/NO CELLULITIS ssy after the vaccines were given. Y Y 8/3/2009 8/3/2009 9 MODERATE Other. FATIGUE RASH Y STARTING ON L EAR. CONTINUING TO BE ON FACE AND MIDSECTION 7/20/2009 7/23/2009 SAW PHYSICIAN ON eceived vaccinations. 7/15/09 c/o aches/pains, dizziness, H/A bruise arm. No fever went to chiropractor N 7/10/2009 3 X after last 7/15/2009 3 wks. 7/29/09 - Calle arm was slightly swollen & pink surrounding site of injection (yellow fever). C/o itching over Y body but no7/30/2009 hives (Reported 7/30/2009 7/31/09 - advised nted after administration of Tdap (ADACEL) shot. Y 8/3/2009 8/3/2009 U 7/30/2009 welts on inside portion of left upper arm, away from the injection site. U 7/27/2009 7/29/2009 tch developed and got worse not resolved Y with BENADRY tabs/cream. Unable to go to MD.U7/1/09 Dr. - 6/8/2009 evaluated.6/23/2009 7/1/09 - Itching and h vere erythema localized & developed hives. No respiratory difficulty. Y 7/22/2009 7/23/2009 d VARICELLA Disease (chicken pox) Pox to left arm, stomach & legs. rest, fluids, TYLENOL. Y 7/13/2009 7/26/2009 warm, 7 cm X 7 cm U 7/27/2009 7/29/2009 red and warm to touch. Y 7/24/2009 7/26/2009 with immediate itching and soon to follow Y redness, swelling & warmth. BENADRYL given & Ibuprofen. U Seen 7/31/2009 in office 7/31/2009 on 8/3/09 for eval. Mo parents reported increased screaming; Y fever 102 degrees with diff. reading temp.; shaking;Ytaken to Hospital 4/14/2009 Dx vaccine 4/14/2009 reaction. n has been received from the husband Y of a 63 Yyear old female with 0"heart condition" who was U vaccinated with a dose of PNEUMOVAX 23 n has been received from a registered Y nurse (R.N.), for the Pregnancy Registry for GARDASIL, Y concerning 4/28/2008 a 22 year6/5/2008 old female who was i n has been received from a consumer concerning his 25 year old god-daughter who, 4 or 5 N months ago, in 2/1/2009 approximately 2/1/2009 February 2009, w n has been received from a consumer concerning one of her co workers who was vaccinated U with a dose of GARDASIL (date, route and si n has been received from a physician concerning his 76 year old wife with Crohn's disease and N a history of 7/7/2009 pancreatitis 7/23/2009 with the use of PUR n has been received from a physician Y and a nurse Y concerning a 61 0year old male patient who U on 08-JUL-2009 7/8/2009 was 7/14/2009 vaccinated SQ with a 0 izure. 8/21/09 ERrecords received for Y DOS 7/17/09 Y with dx: Acute fever 1 and seizures recurrent. Y Generalized 7/17/2009 tonic-clonic 7/17/2009 seizures following ort was received 27 July 2009 from another Y manufacturer (reference number WAES 0906USA04755), Y who 5/11/2009 received5/11/2009 the report from a health ort received on 27 July 2009 from another Y manufacturer whose initial reporter was a consumer. U A unidentified male patient received INFLUE ort was received from another manufacturer Y (document number 45221964) who received the report from a health care professional. A fema an anthrax shot at 0830 on 01AUG09. Y As lunch time drew near, I began getting a terrible headache. Y I ate 8/1/2009 lunch and8/1/2009 the headache persist on administered in left deltoid. Left axillary pain and fever one day following vaccination. Large Y bruise developed 7/22/2009one 7/22/2008 day later. Left forear ESS OF BREATH, CHEST PRESSURE, HIVES, AND SORES Y 7/28/2009 7/28/2009 mplained of rash, redness at injection site and itchy all over. Mild rash noted on patient's chest Y as well. 7/22/2009 7/24/2009 ely after receiving vaccines patient had Y full body seizure. Did not void. Remained unconscious U over five minutes, 8/5/2009 until8/5/2009 revived with ammonia en at site of injection U 8/3/2009 8/4/2009 were given at about 1030am 8/5/09. Patient was without symptoms when she left the office. YFamily stopped 8/5/2009 at a fast 8/5/2009 food restaurant after l
vaccines on 7/13/09. Family contacted Y health department on 8/3/09 stating that child had a rash U that began 7/13/2009 early am 7/30/2009 on 8/3/09 after severa ely after Hepatitis B vaccination only on 6-30-09 dose 1 and 8-30-09 dose 2 pt was pale, dizzy Y and lightheaded. 8/3/2009 Observed 8/3/2009 patient both time blister, scab forming after U 7/30/2009 7/31/2009 s, body aches, joint pain, headaches, fatigue, overall feeling of being out of it and in a lot of pain. N So far, 7/24/2009 this has lasted 7/29/2009 12 days and is not g iving MCV4, while seated, client moved forward, passed out, slipped to the floor. Patient was Y lying prone7/31/2009 on floor, arms 7/31/2009 at sides, with jerkin e, Nausea, Vomiting, Chills, body aches, tiredness, Y difficulty breathing, 1 paleness, weakness, N dizziness, redness 8/3/2009 and tenderness 8/4/2009 at injection ought child to HD office 8/3/09 PM to report that child's arm became tender, with redness over Y deltoid spreading 7/31/2009 to just 7/31/2009 aboeve the elbow P after the vacination of Gardasil, I has Y a reaction.Y My legs swelled and 2 I had small red bumps N all over my legs. 9/9/2008 I couldn't 9/13/2008 walk because of the week, I had begun to experience severe Y left sided pain in my face. I was treated for different causes N (all wrong) 6/8/2009 when6/15/2009 finally on Aug 2nd, I w stating that 7days after vaccine was given child has "throat spasms", dizziness for 4days,right side pain 7/22/2009 in shoulder,eye,foot. 7/29/2009Also stating b ter received a DTAP vaccination on 7/31/09. She experienced significant swelling, redness,Upain, and heat 7/31/2009 at the injection 8/1/2009 site in an area a fingers feeling numb. Body hurts. Head hurts. Nausea, vomited x2. Fatigued. Lethargic. N Loss of appetite. 8/3/2009 Chest 8/4/2009 pain across top of che and pain at injection site for 3 days. Improved now. Some swelling present.Now has muscleYaches, shaking, 7/16/2009 weakness, 7/19/2009 lightheadness, and ema and warm to touch - adecel over right deltoid on 7/30 - developed erthema today morning, U slightly larger 7/30/2009 over time 8/5/2009 - 8x8 cm area of in diarrhea, fever of 102 x 2 days Y 7/27/2009 7/28/2009 edness/swelling/warmth at site starting two-three days after injection. Denies fevers, chills. Ibuprofen U relieves 7/21/2009 pain around 7/23/2009 site. Area by shot ceived Pentacel vaccine component DTaP IPV and second dose IPV during routine 4 yr-old Y immunizations. 8/5/2009 Mom was made aware of incide EEN IN EMERGENCY ROOM FOR Y FACIAL SWELLING AND WHEEZING. VACCINE APPOINTMENT Y AT8/5/2009 1:45 PM VACCINE 8/5/2009 GIVEN APRO ax administered at approx 1100. Pt called at 1500 to report severe pain in her shoulder. I examined U her on 7/29/2009 8/3/09. At 7/29/2009 that time she was una red, warm , tender, inflammed 20 cm oval around right posterior upper arm 2 days s/p injection Y with single8/3/2009 dose of "tetanus 8/5/2009 and pertussis" omach pain and weakness. Very tired and barely able to get out of bed. Kidney pain. 7/30/2009 7/30/2009 d vestibular neuritis 12 days after receiving the shingles vaccination. ### 1/11/2009 ciousness with skin pallor, abnormal extremity movement & incontinence of bladder. EpisodeYlasted approximately 7/22/2009 <30 7/22/2009 seconds. out size of baseball) Lt thigh red & hard area around injection site. Area improved over the wk. Y 6/19/2009 6/19/2009 w days of the initial vaccine, red bumps, itching & weakness in my left hand & arm occurred. Y Now, 1 year & 3/5/2008 5 months3/10/2008 later the site still is red radiation to skin years ago for mycosis fungoides, was given ZOSTAVAX in right arm -sq- 7/24/2009. U Two 7/24/2009 days later 7/26/2009 she complained of pa (PENTACEL, PREVNAR & ROTATEQ) were given on 7/28/09. Baby developed moderate fever Y (up to 102 7/28/2009 degrees)7/28/2009 & intermittent mild rash y of the vaccine was given, the patient developed chills, lightheadedness, dizziness, weakness Y and body6/30/2009 aches. She 6/30/2009 also complained of sh ven GARDASIL vaccine about 4:00 PM. At about 4:10 PM patient states throat swelling, unable Y to breath,8/4/2009 nausea. Patient 8/4/2009 out in supine po 07, SM received AVA (2), TYPHOIDY (VICPS), and TWINRIX vaccines. He recalls increasedNtenderness at vaccination ### 1/1/2008 sites lasting < 48 ho er of 102.5, left arm red, swollen and warm. U 7/24/2009 7/24/2009 s 8/4 L thigh swollen red + warm to touch,cover front of thigh + hurts to walk. U 8/3/2009 8/4/2009 ported fever, left arm pain, swelling and redness, nausea, vomiting approximately 2 days after Y vaccination 7/29/2009 with ADACEL 7/31/2009 & PNEUMOVAX. up from exam table fell forward, brushed head on wall and was caught by staff. Laid down, vitals U stable, woke up and was able to drink flui , hot, fever, blister pustules poppingY- oozing liquid. U 8/4/2009 8/4/2009 ine given mom then tells RN patientYhad the chicken pox. RN explained he may have someYreaction to vaccine 7/16/2009 and7/17/2009 if she had told RN or D ed vaccines. Mom stated pt. had seizure in car. PMC staff did not witness any seizure activity. Y Pt. walked 8/4/2009 back to bus8/4/2009 with mom. vs stable/o arm, shoulder pain, swelling and redness to vaccine site, few small blisters to area; 4 1/2 inYdiameter of7/30/2009 redness. Treatment 8/1/2009consisted of ib N 7/9/2009 8/3/2009 ash on her wrist, arm, chest and back, mostly on her right side. She got the vaccine in her leftUarm. The rash 7/24/2009 on her back: 7/30/2009 looks like chicken o upper arm fever 102 degrees-103.9 for 3 days pain in upper arm. Took TYLENOL and BENADRYL. Y 7/27/2009 7/28/2009 redness, swelling, warmth and induration noted by patient the following day after vaccination.Y Treated with 3/19/2009 KEFLEX3/20/2009 and Hydroxyzine. xis ~ 1/2 in after receipt of IPV and Y DTAP Y 8/5/2009 8/5/2009 presented to clinic at 4:05 pm stating Y began feeling tingling over all of body, difficulty speaking, chills, pain8/5/2009 to bilateral8/5/2009 hands since 3:00pm. 9 received a T booster F and first Hepatitis B vaccine- 3 days later hot red itchy urticarial rash Y - this spread 7/20/2009 from torso 7/23/2009 out to limbs. No othe ular pruritic rash around site on upper Y arm. Began the day after admin, peaked 5 days after.U 7/29/2009 7/30/2009 g weakness all over, unable to sit up Y in bed. Once on edge of bed & assisted standing legs Y would not / could 8/3/2009 not step. 8/3/2009 As if would not liste without systemic symptoms occurring 3 days after the vaccination. With intense pruritis initially. Y Begining 7/16/2009 with the shoulder 7/20/2009 then to trunk, gro 3rd, I received a shingles vaccine at the local pharmacy. Early morning, March 5, I had chills, N a fever of no 3/3/2009 more than 3/5/2009 100 and urine urgen d a reaction to VARIVAX immunization on 6/20/09 which was erythema but no induration or pain measuring 6/19/2009 12.5 x 6/21/2009 8 cm outer area and 5x given at top of left shoulder Y causing Y electric shock type jolt down left arm while needle Y was U being forced in by ### nurse. Symptoms ### progresse
ter had serious problems with her period had toYbe put on birth control, 0 and now she is in theUhospital with depression 7/30/2009 at 14 years old she n ceived Immunizations, went Y to the parking Y lot - and returned with facial swelling, vomiting, coughing, Y wheezing, 8/5/2009 SOB.8/5/2009 BENADRYL 25 mg po xis - instant hives - lip swelling, Y itching, Y throat closing, nasal congestion within 5-10 minutes of Y administration. 7/30/2009 Treatment: 7/30/2009 BENADRYL, Epin warm redness to vaccine site, swelling. 7/28/2009 7/29/2009 was received from a health care professional on Y 30 July 2009. A 72-year-old 18 male patient, with U a history4/22/2009 of codeine allergy, 5/1/2009 received an int e week of vaccination the client had a sore swollen arm and also developed hives along bothYlabias and swollen, 5/4/2009 tender 5/10/2009 inguinal lymph glan vaccines, episode of syncope followed by brief seizure 2-3 seconds. Recovered fully withoutYmeds. 7/23/2009 7/23/2009 ation, hives. Went to ER, BENADRYL, Y Steroids. Y 7/23/2009 7/23/2009 ness 103.5 Bronchiolitis possible. Y 7/22/2009 7/27/2009 d shingles 3 days after vaccination same Y side of body, different site. Treated with acyclovir. Y 7/24/2009 7/27/2009 n has been received from a MedicalYAssistant coworker concerning a 60 year old female with N a drug reaction 2/5/2009 to PERCOCET, 2/12/2009 that produce 8/1 (2 days later) with swelling erythema, tenderness & warmth at left triceps area where VARIVAX was placed. 7/30/2009 8/1 7/31/2009 Rx - PREDNISODONE n has been received from a 76 yearYold female with chronic UTI, blood pressure high, drug hypersensitivity N 3/24/2009 and penicillin 5/1/2009 allergy who on 24 n has been received from a physician Y concerning a female in her eighties who was Y vaccinated U with a dose of ZOSTAVAX (Merck) (0.65ml, n has been received from a consumer concerning her 16 year old daughter allergy Y to cinnamon N and with 8/1/2007 a history of 8/1/2007 an allergic reaction (e scle weakness, body aches, fever, soreness Y at injection site, headache and nausea reportedUby patient.7/23/2009 Onset of S/S 7/24/2009 24 hours after admin with 5 X 5 cm erythema distal to injection Y site, 0 tx at this time. U 7/29/2009 7/31/2009 ea of pruritic angioedema surrounding site of Tdap. Y 7/27/2009 7/29/2009 tigue and soreness. U 6/10/2009 t to ZOSTAVAX, bright red around injection, pain, itching, swelling, very hot, went from injection site to elbow. 7/30/2009 7/30/2009 NTACEL given (never had this combo before) and within 2-3 minutes area red & swollen, 30 X 45 mm no SOB, wheezing ice applied on & ceived 3 vaccines MENACTRA, ADACEL and VARICELLA. When she stood to leave she had Y a syncope 8/5/2009 episode and 8/5/2009 was lowered to the fl per outer arm red, warm 40 x 40 mm, slightly raised no pain, itching. 8/6/09 Area red, warm not Y raised slight 8/4/2009 itching 50 8/5/2009 x 60 mm. d, swollen and painful. Fever 102, 10cm Y circle of raised erythema, edema and warmth with central Y punctate 7/30/2009 eschar.7/31/2009 Evaluated by provider by lab confirmed rabid fox - had traveled Y out of state. Pt reported to ER in other state for tx.Y Rcvd RABAVERT 7/31/2009 #1 &8/3/2009 2 ml HRIG on 7-31-09 ction with swelling of thigh muscles. U 7/31/2009 d Hep A local erythema induration (-) (-) drainage. 7/28/2009 7/29/2009 client became nauseated and fainted aproximately 5 minutes after receiving vaccines. AfterYthe incident patient 8/5/2009 rested 8/5/2009 in the clinic for 30 m patient came by clinic at 8pm 8/5/09, patient is not with her. She reported that patient had headache Y and8/4/2009 fatigue all day 8/5/2009 requiring him to ta red a pediatric Hepatitis A to a 19 y.o. Y 8/5/2009 e up three days after vaccines were given with swelling on the forehead spreading, spreading Y over the left 7/31/2009 eyelid to left 8/3/2009 ear. Worsened a da was administered to the left arm sq. YThe child's mother called on the 14th of july and stated pt Y running fever 7/13/2009 >101. and 7/14/2009 the arm was red and e on 7/31/09 for 15 month Well Child Check and was given DTAP, HIB and Prevnar vaccinesUthat were due. 7/31/2009 Pt developed 7/31/2009 fevers on evenin rabies pre-exposure #3 on 8/5/09 atY1030. Around 1930, she had fever to 105.3 and felt chills. Y Took tylenol 8/5/2009 and cool 8/5/2009 bath. Was seen in ER ents to clinic with a 4cm x 4cm round, red, area to left upper arm, that is warm to touch. No pain U to area when 8/4/2009 touched. 8/5/2009 Informed pt to apply ceived vaccination of Tdap on 08/04/2009 Y and had local redness and swelling to left deltoid.YParent stated8/4/2009 that patient 8/4/2009 had fever ranging fro STATED AREA WHERE VARICELLA Y WAS GIVEN WAS SWOLLEN, RED AND TENDER TO TOUCH SINCE 8/4/2009 WEDNESDAY 8/5/2009 MORNING. MATELY 2 MINUTES AFTER RECEIVING IMMUNIZATION PT BE CAME WEAK AND DIZZY. Y ACCORDING 8/6/2009 TO FATHER 8/6/2009 PT "SLUMPED rash and swelling at injection site on left leg. Y 7/29/2009 7/30/2009 ame in to HD c/o side effects since vaccination. Symptoms: dizziness (7/16/09), vomitting (7/22/09), U passed 7/16/2009 out (7/23/09), 7/16/2009 hives on chest, r omitting at noon 8/4/09 and again at 8pm. Had fever 99 degress off and on 8/4/09. C/o body Y aches 8/4-8/5. 8/4/2009 Tylenol given 8/4/2009 at 12pm 8/4/09 an 8/6/2009 N 8/5/2009 hurday a.m., 7/30/09, with scatteredYred itchy rash all over body. Pt. taken to clinic and givenYa steroid shot 7/29/2009 for allergic 7/30/2009 reaction to something HER PHONED OFFICE STATED Y PT. HAD REACTION FROM VARICELLA VACCINE. INSTRUCTED U MOTHER 8/4/2009 TO RETURN 8/5/2009 TO OFFICE, ays after vaccination, rash, red cracked bleeding Y lips, bright red feet5and hands, swollen hands Y and feet,7/17/2009 blood shot 7/19/2009 eyes, crying. Fever las 08, pt went about her day as normal, Y but became very tired quite suddenly around 5:00 in the U evening. She went ###to bed to ### rest (something after Tdap, client had pain and swelling Y at injection site which increased to Baseball size red,Nhard painful 8/3/2009 area with radiating 8/4/2009pain to left sid uit on day 24 of his training was brought in for syncope. Was told he passed. States Y he has N been having6/17/2009 F/C, night 6/28/2009 sweats, coughing up blo Pneumovax 23) was administered on Y 8/5/09, and several hours later patient reported pain atUsite with associated 8/5/2009weakness 8/5/2009 of arm, nausea aP given to client who is a close contact Y to confirmed Pertussis case in this County. First prophy-dose Y of Z-Pak 8/4/2009 taken8/5/2009 @ 6:30 pm. Client wa was reported by a consumer (also the Y subject)Yand described the occurrence 0 of swelling at injection N site in a 31-year-old ### male subject who
was reported by a healthcare professional via sales representative and described the occurrence Y of injection 7/1/2009 site reaction 7/3/2009 in a 5-year-old m on (MMR & DTaP) 8/3/09 24 hrs later parent noted redness 48 later child c/o pain at injectionUsite w/noted 8/3/2009 spreading erythema 8/4/2009 no assoc fev ffect fever 100.8, myalgias, redness @ injection site after administered. 6x8 cm area. U 8/4/2009 8/4/2009 cm area of induration, warmth, erythema Y at the (R) deltoid area, Non-tender to touch. Treatment prescribed: 8/4/2009 ATARAX8/5/2009 10mg tid x 4 days Ora ale 5 min after injection. Legs elevated. Fainted in chair. Eased down to floor by staff x 2. Easily Y aroused,8/6/2009 oriented. BP 8/6/2009 107/62. Skin warm, an a few hours after immunizations-Yreached 104. 1. Y 8/4/2009 8/4/2009 e, (leg, neck, and back pain) fever 103, Y tachycardic, Redness and Swelling in Right upper arm Y around injection 8/3/2009 site. 8/3/2009 ceived vaccines- KINRIX, MMR, Varicella. On 7/28/09 morning: Developed red rash on the left Y cheek same 7/28/2009 day in the 7/28/2009 afternoon (approx. 1 eezing & swelling of face within one hour of receiving vaccination. C/o nasal congestion and rhinorrhea, pt. 8/4/2009 has remote 8/4/2009 h/o asthma- and w m, pt was at a restaurant, felt lightheaded, Y and was trembling. She stood and passed out. Upon Y awakening 8/5/2009 pt kept repeating 8/5/2009herself over a multiforme minor Y 7/29/2009 8/4/2009 sh to face, torso, buttocks. U 8/5/2009 8/5/2009 ollen, hot touch. Onset Aug 4th 2009. Tx-apply ice prn. Y 8/3/2009 8/4/2009 with 12cm macule, warm to touch Y 7/31/2009 8/1/2009 DTAP shot (5th shot) on 8-3-09. On 8-4-09, arm was very swollen about 4 inches long with red U and white8/3/2009 in the middle. 8/4/2009 No drainage, tende vaccination Pt. experienced rednessY and swelling at site of injection, the following day the redness extended 6/1/2009 to her right 6/2/2009 elbow with swelling d to urgent care clinic with shortnessYof breath, pale, lightheadedness, labs drawn, IV normalUsaline 500ml.8/6/2009 8/6/2009 n has been received from a physician Y concerning a 76 year old female patient with Y food allergy N to mango and no other medical history who n has been received from a nurse concerning Y a 66 year old female with no pertinent Y medicalNhistory and no known ### drug allergies ### who on 1 n has been received from a physician Y concerning a 97 year old female patient with Y no pertinent N medical history who was vaccinated with a n has been received from a physician Y concerning Y a 19 year old male 0 patient with rheumatoidUarthritis who on 17-OCT-2008 ### ### was vaccinated n has been received from a 49 yearYold male a ph. D. with an allergy to clindamycin Y and penicillin N and asthma ### who on 10-OCT-2008 ### was v n has been received from Y a physician Y concerning a male who was vaccinated with a first dose Y of PNEUMOVAX 0.5 mL. Concomitant vacc n has been received from a pharmacist concerning Y an 81 year old female 0 Y inpatient (acute ischemic Y MI) with 10/1/2008 diabetes, 10/2/2008 hypertension and hyp n has been received from a certifiedYmedical assistant Y concerning a261 year old male patientUwith coronary 10/7/2008 artery disease, 10/8/2008 hypertension, de follow up information has been receiving Y from a healthcare worker concerning a Y 27 year oldYfemale patient 11/1/2008 with a hypothyroid 11/3/2008 and a history n has been received from a healthcare worker Y concerning a patient 0(gender not specified) who N on an unspecified date was vaccinated with n has been received from a pharmacist Y concerning Y a 79 year old female 0 who on 03-NOV-2008 N was vaccinated 11/3/2008 with11/4/2008 PNEUMOVAX, Lot num n has been received from a pharmacist Y concerning Y an 85 year old male 0 who on 04-NOV-2008 N was vaccinated 11/4/2008 with 11/5/2008 PNEUMOVAX Lot no. 6 follow-up information has been received Y from aYphysician concerning 2 a 70 year old female with Y no known 11/4/2008 allergies or 11/6/2008 drug reactions and no follow up information has been received Y from a healthcare worker concerning a 36 Y year old Y female patient who### on 30-OCT-2008 11/3/2008 at 09:55 w n has been received from a registered Y nurse concerning a 49 year old female patient Y with cancer Y and no11/3/2008 drug reactions 11/3/2008 or allergies who on n has been received from an office Y manager concerning Y a female who 3 on 26-NOV-2008 wasYvaccinated with a### dose of PNEUMOVAX ### 23 (l n has been received from Y a physician Y and a licensed Y practical nurse0 (L.P.N.) concerning a 71 N year old male 1/2/2009 with hypertension, 1/2/2009 diabetes an n has been received from a pharmacist Y concerning Y a 41 year old female 0 with breast cancer U and morphine 1/30/2009 allergy who 1/30/2009 on 30-JAN-2009 was n has been received from a consumer Y concerning Y a patient who was 0 vaccinated with a doseUof PNEUMOVAX 23 (lot #662018/1332X). Sub n has been received from a registered Y pharmacist Y concerning a 46 year 4 old male with penicillin Y allergy. On 3/8/2009 07-MAR-2009 3/8/2009 the patient was h n has been received from a pharmacist Y concerning a 66 year old female Y who on 24-JUL-2008 Y was vaccinated 7/24/2008 with 7/24/2008 a dose of PNEUMOVAX follow-up information has been received from a certified medical assistant concerning a 1 year U old male 2/15/2008 patient, who 2/15/2008 on 15-FEB-2008 at 11 follow up information has been received Y from a physician and a licensed practical nurse concerning Y a 685/28/2008 year old female 5/29/2008 patient with drug n has been received from a pharmacist concerning a 67 year old male with adverse drug reaction/allergy N 6/3/2008 to ADVIL, who 6/4/2008 was hospitalised fo n has been received concerning a patient who on an unspecified date was vaccinated with PNEUMOVAX U 23 (lot# not provided). Subseque follow up information has been received from a registered nurse concerning a 70 to 80 yearUold male patient 6/11/2008 who on 6/11/2008 11-JUN-2008, was va follow up information has been received Y from a nurse concerning a "70 - 80 year old" femaleNwho is a patient 6/11/2008 in a rehabilitation 6/11/2008 hospital, wh n has been received from a physician Y concerning a 70 year old female who on 12-JUN-2008Uwas vaccinated 6/12/2008 with a6/13/2008 dose of PNEUMOVAX n has been received from a physician Y concerning a 64 year old female who on 16-JUN-2008Uwas vaccinated 6/16/2008 with a6/18/2008 dose of PNEUMOVAX n has been received from a pharmacist concerning a related who was vaccinated with a dose Y of PNEUMOVAX 23. Subsequently, the patie follow-up information has been received from a physician concerning a 69 year old female with Y a history5/21/2007 of vaccination 5/21/2007 with BCG in the left n has been received from a pharmacist Y concerning a 71 year old female with an allergy to lipstick, N heart 6/19/2008 disease congenital, 6/20/2008high blood pre follow-up information has been received Y from a physician, concerning his 61 year old, female Y retired wife 6/26/2008 with gastrooesophageal 6/26/2008 reflux dis follow up information has been received from a registered nurse concerning a 71 year old white N female with 6/26/2008 hypertension, 6/27/2008 dyslipidemia, se
n has been received from a pharmacist Y concerning a female who on 04-MAY-2009 was vaccinated N subcutaneously 5/4/2009 with 5/8/2009 a 0.65 ml dose of n has been received from a licensed practical nurse concerning a 60 year old female who was U vaccinated 6/27/2008 with PNEUMOVAX 6/27/2008 (date not rep d follow up information has been received from a licensed practical nurse and a physician concerning Y a 78 5/13/2008 year old 5/13/2008 male patient with hyper follow up information has been received from a certified medical assistant concerning an 87Yyear old female 6/25/2008 with no6/27/2008 medical history and no follow up information has been received from a physician and from a health professional and Y concerning6/24/2008 a 35 year 6/24/2008 old male with no known n has been received from a pharmacist concerning an adult female who a long time ago wasUvaccinated with PNEUMOVAX (lot # not repo n has been received from a health professional concerning a 72 year old male with no known Y drug allergies 6/24/2008 and no 6/24/2008 previous medical histor follow up information has been received from a physician concerning a 65 year old female patient Y who on 6/26/2008 26-JUN-2008 6/26/2008 at 10:00 AM was v n has been received from a physician Y concerning a 68 year old female who on unspecified date N was vaccinated into shoulder of the arm (u follow up information has been received from a registered nurse concerning a healthy female Y infant who7/17/2008 on 17-JUL-2008 was inadvertently n has been received from a 60 year old female consumer with hurting joints, non-specific connective N tissue disorder and THIMEROSAL alle n has been received from a physician Y concerning a 69 year old female with no drug reactions Y or allergies 7/9/2008 and depression, 7/9/2009 asthma and a hi follow-up formation has been received Y from a physician concerning a 35 year old female patient N with allergies 7/18/2008 (unspecified), 7/18/2008but no known n has been received from a physician Y concerning a 66 year old male patient with no known drug U allergies 7/14/2008 who on 14-JUL-2008 7/14/2008 was vaccin n has been received from a female consumer (age unknown) who on an unspecified date was U vaccinated (route unknown) with a dose of P follow up information has been received from a physician and a certified medical assistant concerning Y a 65 5/5/2008 year old female 5/7/2008 patient who on n has been received from a licensed practical nurse Y (L.P.N.) concerning 0 a 94 year Y old female Y who on 16-JUL-2008 7/16/2008 7/16/2008 was vaccinated with a d n has been received from a licensed practical nurse concerning a 55 year old male who on 16-JUL-2008 Y 7/16/2008 was vaccinated 7/16/2008 with PNEUMOVA n has been received from a registered Y nurse concerning a patient (age and gender not reported), N with concomitant 7/22/2008 medications, pertinent m n has been received from a pharmacist concerning a patient who on 27-Jul-2008 was vaccinated N with PNEUMOVAX 7/27/2008 7/27/2008 23 (lot# 662042/0622 n has been received from a pharmacist concerning a patient who on 27-JUL-2008 was vaccinated N with PNEUMOVAX 7/27/2008 7/27/2008 (Lot # 662042/0622X n has been received from medical records Y regarding a case in ligation with rofecoxib (WAES# N 0590USA03739)### concerning ### a male patient ( n has been received from a consumer concerning her 84 year old mother who received PNEUMOVAX U (lot # not reported) while she was in n has been received from a physician and a nurse practitioner concerning a patient who about U a month ago, July 2008, was inadvertently v n has been received from a licensed Y practical nurse concerning a female (age not reported) Ywith drug reactions/allergy 12/1/2004 12/3/2004 to RELAFEN and S follow up information has been received from a pharmacist concerning a retired male patientYwith no known 8/10/2008 allergies 8/10/2008 and status post hip re n has been received from a certifiedYmedical assistant concerning a 57 year old female with N unknown allergies 8/7/2008 who8/12/2008 on 07-AUG-2008 was v n has been received from a physician's Y assistant concerning a 62 year old female with a history U of immunodeficiency 4/1/2006 who in approximately n has been received from a medicalYassistant (MA) concerning a 76 year old male patient with Y no known7/29/2008 drug allergies, 7/30/2008 hypertension and a n has been received from a physician concerning a female in her 50's with diabetes who "one Y year ago", was vaccinated with her first dose n has been received from a medicalYassistant concerning a 72 year old female with hypertension Y and sulfonamide 7/22/2008 allergy 7/23/2008 who on 22-JUL-2 follow up information has been received from a 60 year old male physician concerning Y himself, Y who in September 9/16/2003 2002 9/16/2003 and 16-SEP-2003 n has been received from a registered nurse concerning a 6 month old male who on 18-AUG-2008 N was 8/18/2008 vaccinated 8/18/2008 with a dose of PNEUMO n has been received from a physician Y concerning a 65 year old female (weight 150#, height Y63") with drug 8/15/2008 allergies8/15/2008 to MIACALCIN, NAPRO n has been received from an approximately 61 year old female consumer with no allergies/drug Y reactions and no pertinent medical history n has been received from a registered nurse concerning an approximately 38 year old female N who on 25-AUG-2008 8/25/2008 8/25/2008 was vaccinated intram n has been received from a pharmacist concerning a 76 year old patient who on an unspecified U date was vaccinated with PREVNAR instea n has been received from a registered Y respiratory therapist concerning a 58 year old femaleYwith drug reaction/allergy 7/23/2008 7/24/2008 to flu vaccination, wh n has been received from a registered Y respiratory therapist concerning a 56 year old male with N no drug reactions 8/1/2008or allergies who in 2002 w n has been received from an office manager concerning a 60 year old female with hyperlipidaemia, U hypothyroidism 8/26/2008 8/26/2008 and drug hypersensitivi follow-up information has been received from an office manager concerning a 44 year old female with seizure disorder, severe mental reta n has been received from a health professional concerning a 13 year old female patient whoYon 18-AUG-2008 8/18/2008 was 8/19/2008 vaccinated intramuscula n has been received from a healthcare worker (office manager) concerning a 5 year old female N with no allergies/drug 8/27/2008 8/28/2008 reactions and no pert n has been received from a 67 year old female consumer with a sulfonamide allergy, who onY28-AUG-2008 8/28/2008 was vaccinated 8/28/2008 with a first dos n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX. Subsequently the patie n has been received from a pharmacist concerning a 28 year old female patient with diabetes, N osteomyelitis 9/2/2008 and anxiety 9/2/2008 disorder who on 0 n has been received from a physician and the Clinical operations manager concerning a 4 month U old female 9/3/2008 who on 9/3/2008 03-SEP-2008 (also rep n has been received from a registered nurse concerning a 48 year old male with no drug reactions/allergies N 9/5/2008 who on 05-SEP-2008 9/6/2008 was intra n has been received from a physician concerning a female patient who was vaccinated with Ya dose of PNEUMOVAX 23. Subsequently the n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified U date was vaccinated with a dose of n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified N date was vaccinated with a dose of
n has been received from a consumer concerning her 4 year old daughter with down's syndrome, N drug reactions/allergy 9/15/2008 to KEFLEX and str n has been received from a female consumer (age unknown), who, on an unspecified date, U was vaccinated with a dose of PNEUMOVAX ( n has been received from a pharmacist and an assistant director of nursing concerning a male N nursing home patient who was vaccinated b follow up information has been received from a physician concerning a 47 year old female xYray technician 9/9/2008 who on 09?-SEP-2008 9/9/2008 was vac n has been received from a 63 year old female registered nurse with drug hypersensitivity toYCECLOR, high 9/18/2008 cholesterol 9/18/2008 and osteoporosis w n has been received from a physician concerning an approximately 32 year old female who U on 17-SEP-2008 9/17/2008 was vaccinated 9/17/2008 intradermally n has been received from a pharmacist and an assistant director of nursing concerning a male N nursing home patient who was vaccinated b n has been received from a pharmacist and an assistant director of nursing concerning an approximately N 97 year old female nursing home n has been received from a female 72 year old retired registered nurse (R.N.) with drug hypersensitivity Y to9/1/2007 PRAVASTATIN 9/1/2007 sodium, AMOXI n has been received from a physician concerning a patient (gender not specified) who was vaccinated Y with a dose of PNEUMOVAX. The p n has been received from a pharmacist concerning a 74 year old patient who on an unspecified U date was vaccinated with PREVNAR instea n has been received from a registered Y nurse concerning a male who on 20-June-2008 was vaccinated Y via 6/20/2008 subcutaneous 6/20/2008 route with a first d n has been received from a registered Y nurse concerning a 86 year old male who on 26-AUG-2008 Y was vaccinated 8/26/2008 via 8/27/2008 subcutaneous route n has been received from an approximately Y 69 year old female who reported that approximately Y "9 or 10" years ago, she was vaccinated w n has been received from a physician Y and an advanced practice nurse concerning a male over Y 50 years9/10/2008 old with diabetes, 9/10/2008 who on approxim n has been received from a Licensed Practical Nurse 1 concerning a male patient who was U vaccinated With a dose of PNEUMOVAX. Conc n has been received from a consumer concerning her 65 year old husband with an allergic reaction N to sulfa 9/8/2008 drugs and 9/9/2008 no pertinent medical n has been received from a registered Y nurse concerning a patient (age and gender unknown) Y who in June 8/26/2008 2008, was 8/27/2008 vaccinated SQ with a n has been received from a registered nurse and a health professional concerning a 44 yearYold female 9/18/2008 with allergic9/18/2008 reaction to antibiotics ( n has been received from a nurse practitioner Y concerning a 46 year old female with chronic N obstructive pulmonary 9/22/2008 disease 9/22/2008 and a sulfonam n has been received from a physician concerning a 31 year old female with asthma who on U approximately4/1/2008 01-APR-2008 was vaccinated w follow-up information has been received Y from a certified medical assistant concerning a 69 year Y old female 9/15/2008 with penicillin 9/15/2008 allergy and allerg n has been received from a nurse practitioner student concerning her 61 year old father whoYin July 2008,7/1/2008 while hospitalized 7/1/2008for another co n has been received from a registered pharmacist concerning a female who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a registered nurse concerning a patient who on 26-SEP-2008 were N vaccinated9/26/2008 with PNEUMOVAX 9/26/2008(lot # 659487/ n has been received from a registered Y nurse concerning a 65 year old female with penicillin,Ycodeine, sulfa, 9/30/2008 DARVON, 10/4/2008 DEMEROL, morphin n has been received from a nurse concerning Y a 56 year old male with glaucoma, headache,Udepression 9/30/2008 and diabetes who in 2003 was vac n has been received from a registered nurse concerning a 66 year old female with chronic fatigue Y syndrome, 10/3/2008 hyperthyroidism, 10/3/2008 arthritis, stre n has been received from a nurse concerning Y a 60 year old male with gout, thalamic syndrome, N gastroesophageal 10/3/2008 reflux 10/6/2008 disease, benign p n has been received from a nurse concerning Y a 64 year old male with diabetes, low back pain, Y knee pain and hypertension and no allergies n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified Y date was vaccinated with a dose of n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified U date was vaccinated with a dose of n has been received from a physician an approximately 66 year old female who on an unspecified N date was vaccinated at the health depar n has been received from a certifiedYmedical assistant concerning a 49 year old female with N PENICILLIN10/8/2008 and SULFONAMIDE ### allergies and n has been received from a registered nurse concerning a 65 year old female with no major U medical history, 3/1/2008 who in March 2008, was vacci n has been received from a medical assistant concerning a 65 year old female with hypertension N and no10/8/2008 allergies who 10/9/2008 on "08-OCT-2008" w n has been received from a registered pharmacist concerning a patient who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a medicalYassistant concerning a 66 year old female patient with arthritis, Y chronic 9/30/2008 back pain, 10/2/2008 hyperthyroidism and n has been received from a registered pharmacist concerning a patient who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a physician concerning himself, a 60 year old male with no pertinent N medical history 9/26/2008 and no 9/26/2008 drug reactions or alle n has been received from a healthcare Y worker concerning a female who on 26-SEP-2008 was N vaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 23 (lot #6580 follow-up information has been received Y from a registered nurse concerning a 23 year old female U patient9/26/2008 who on 26-SEP-2008 9/26/2008 was vaccin n has been received from a registered Y nurse concerning a 29 year old female patient who onU26-SEP-2008 9/26/2008 was vaccinated 9/26/2008 with a dose of P n has been received from a medicalYassistant concerning a 6 month old patient who on 29-SEP-2008 U was 9/29/2008 inadvertently 9/29/2008 vaccinated with PN n has been received from a nurse concerning an adult in 50s, who in October 2008 ("past week") Y received 10/1/2008 a first dose 10/1/2008 of 0.5 ml PNEUMOV n has been received from a physician Y concerning an approximately 52 year old female patient U with asthma who during the past few months n has been received from a Registered Nurse (R.N) concerning a patient (gender not specified) U who was vaccinated 8/1/2008 with a dose of PNEUM n has been received from a Registered Nurse (R.N.) and a Registered Pharmacist (R.Ph) concerning U a 71 year old female patient who was n has been received from a registered Y pharmacist and a registered nurse concerning an approximately U 66 year old female patient with no p n has been received from a registered Y nurse and the child's mother, concerning an approximately N 2 year old male child with heart abnorma n has been received from a nurse concerning an adult in 50s, who in October 2008 ("past week") Y received 10/1/2008 a first dose 10/1/2008 of 0.5 ml PNEUMOV
n has been received from a pharmacist and a nurse concerning a 65 year old female patientNwith allergic reaction to10/1/2008 penicillin, erythromycin follow-up information has been received from a pharmacist concerning a 65 year old femaleYwho on 10-OCT-2008 ### was vaccinated ### with the n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX. The physician reporte n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX nine months prior. The n has been received from a 66 years old female patient who with sulfonamide allergy concerning Y that in 2007 she received the vaccine for n has been received from a physician concerning a male who was vaccinated with PNEUMOVAX U and a day later he experienced body ach n has been received from an office Y manager concerning a 64 year old male who on 14-OCT-2008 N was vaccinated ### with a dose ### of 0.5 mL PN n has been received from a 63 year old female who in October 2007, was vaccinated with PNEUMOVAX N 23 (lot ### # not provided) ### 0.5ml. On n has been received from a physician concerning a 65 year old male with no drug allergies who Y on 06-Oct-2008, 10/6/2008was 10/8/2008 vaccinated with PNE n has been received from a pharmacist Y concerning a 66 year old male with a history of kneeNreplacement 2 months ### ago who ###on 14-OCT-20 n has been received from a physician Y concerning a male who was vaccinated with a dose ofUPNEUMOVAX vaccine (route not reported). A n has been received from a physician Y concerning a 49 year old female with a history of asthma N who on 30-SEP-2008 9/30/2008 10/1/2008 was given a 0.5ml do n has been received from a registered nurse concerning an 11 week old child who was vaccinated U with one dose of PNEUMOVAX (lot # no n has been received from an unknown source concerning a 36 year old male who on 30-SEP-2008 U was9/30/2008 vaccinated9/30/2008 intradermally with PNE follow-up information has been received Y from a physician concerning a 73 year old male who Y on 26-SEP-2008 9/26/2008 was9/26/2008 vaccinated with PNEUM n has been received from a healthcare Y worker concerning a male who on 26-SEP-2008 wasNvaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 (lot #658074/0 n has been received from a nurse concerning an 82 year old retired female with high blood pressure, Y thyroid 10/3/2008 issues10/3/2008 and possible hydrochlo follow-up information has been received Y from a healthcare worker concerning a 26 year oldNfemale who10/1/2008 on 01-OCT-2008 10/3/2008 (previously repo n has been received from a registered nurse concerning a 4 month old male who on 08-OCT-2008 U at about 10/8/2008 12:00 was 10/8/2008 vaccinated with a do n has been received from a nurse concerning Y a male adult over 50 years old, who in October Y ("past week") 10/1/2008 received10/1/2008 a first dose of 0.5 ml P n has been received from a registered Y nurse concerning a 66 year old female with allergy toN"sulfa" and penicillin ###who on 14-OCT-2008 ### wa n has been received from a registered Y nurse concerning a female patient who in 2003 was vaccinated Y with 9/11/2008 a dose of 9/12/2008 PNEUMOVAX and ha n has been received from a registered nurse concerning a 56 year old female who on 09-OCT-2008 Y was10/9/2008 vaccinated with PNEUMOVAX ### 23 n has been received from a registered Y nurse concerning a 66 year old female who on 08-OCT-2008 Y was10/8/2008 vaccinated with PNEUMOVAX ### va n has been received from a pharmacist Y concerning a 60 year old male with penicillin allergy N and allergic reaction ###to antibiotics ### who on 13-O n has been received from a nurse concerning an 88 year old female patient with hypertension N and reflux and no ### known drug ###allergies who n has been received from a physician concerning a 53 year old female with rheumatoid arthritis Y who on 22-AUG-2008 8/22/2008 was vaccinated with n has been received from a health professional Y concerning a 64 year old female received a Y dose of PNEUMOVAX 23 vaccine (lot # 662020 n has been received from a laboratory technician concerning a female patient who was subcutaneously N 10/7/2008 vaccinated with a### standard dose of n has been received from a certifiedYmedical assistant and a healthcare worker, concerning N a 63 year old female ###patient who ### in October 20 n has been received from a registered nurse concerning a 52 year old female co-worker withNno known allergies ### or pertinent ###medical histor n has been received from a 43 year old female with allergic reaction to tetracycline who in the N fall of 2003 was ### vaccinated ### with the first dose n has been received from a retired 70 Y year old nurse with no medical history and drug reactions/allergies N who ### on 15-OCT-2008 was vaccin n has been received from a health professional concerning a 57 year old female who on 26-SEP-2008 U was 9/26/2008 vaccinated 9/26/2008 with PNEUMOVAX, n has been received from a laboratory technician concerning a female patient who was subcutaneously U vaccinated ### with a### dose of PNEUMO n has been received from a pharmacist Y concerning a female with shellfish allergy and latex allergy Y who on unspecified dates was vaccinate n has been received from a physician Y concerning an 87 year old female who on "on Friday",U17-OCT-2008, was ### vaccinated ### with PNEUMOV n has been received from a physician and a nurse practitioner concerning a 85 year old female Y retired without ### illness at time ###of vaccination n has been received from a pharmacist Y concerning a 70 year old female patient with niacin, Y cephalosporin and CODEINE allergies, who ab n has been received from a physician Y concerning a 50 year old female who on 26-SEP-2008Uwas vaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 (lot # 659 n has been received from a health professional Y concerning a 36 year old female who at 11:00 U am on 26-SEP-2008 9/26/2008 9/26/2008 was vaccinated mistake n has been received from an health care worker in a physician's office concerning a 57 yearUold female patient 9/26/2008 who9/26/2008 on 11AM of 26-SEP-20 n has been received from a nurse concerning a 70 year old female with a history of hypertension, N coronary artery ###disease, osteoarthritis an n has been received from a certified medical assistant concerning one adult female patient who Y on an unknown ### date was vaccinated with a n has been received from a registered Y nurse concerning a 43 year old female who at 11:00 AM U on 26-SEP-2008 9/26/2008was 9/26/2008 vaccinated with PNE n has been received from a physician Y concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a certifiedYmedical assistant and a health care worker concerning Y an 82 year old 10/8/2008 female who 10/9/2008 in October 2003, wa n has been received from a certified medical assistant and a health care worker concerning N a 61 year old 10/8/2008 male patient who on 08-OCT-200 follow-up information has been received from a 63 year old female with allergic reaction to antibiotics, N SULFONAMIDE ### and ### "others unspec n has been received from a healthcare worker concerning a female who on 22-OCT-2008, "yesterday", N was vaccinated ### with ###a dose of PNE n has been received from a physician concerning a 64 year old female patient who on 22-OCT-2008 Y was vaccinated ### intramuscularly ### with a
n has been received from a healthcare worker concerning a male who on 22-Oct-2008 was N vaccinated subcutaneously ### with ###the first dose o n has been received from a registered nurse (R.N.) concerning a 48 year old male who on 21-Oct-2008 N was vaccinated ### with ###a dose of PNE n has been received from a medicalYassistant concerning a 66 year old female who on 13-Oct-2008 U was vaccinated ### with PNEUMOVAX ### va n has been received from a medicalYassistant concerning a 61 year old female who on 14-OCT-2008 U was vaccinated ### with### PNEUMOVAX 2 n has been received from a medical assistant concerning a 67 year old female who on 08-OCT-2008 U was 10/8/2008 vaccinated 10/9/2008 with PNEUMOVAX 2 n has been received from a medical assistant concerning a 65 year old female who on 20-OCT-2008 U was vaccinated ### with### PNEUMOVAX (L n has been received from a physician concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a physician concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a certified medical assistant concerning an adult female patient who N on an unknown 9/29/2008 date was vaccinated with a n has been received from a certified medical assistant concerning an adult female patient who N on an unknown### date was vaccinated with a n has been received from a physician concerning one patient who was vaccinated with PNEUMOVAX Y (Lot#1295X, therapy date, route, site n has been received from a physician Y concerning a 66-year-old female with a history of hypertension, U heart conditions, ### anxiety ### and bleedin n has been received from a physician Y concerning a patient who was vaccinated with PNEUMOVAX U vaccine (dose and route ###not reported). n has been received from an office manager concerning a 55 year old male who on 22-OCT-2008, Y "Wednesday ### of last week", ### was vaccina n has been received from a 65 year old female with allergy to sulfonamide and "gluten" whoNon 17-OCT-2008 was ### vaccinated ### with PNEUM n has been received from a nurse concerning Y a female who on 21-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot # 660717/02 n has been received from a nurse concerning Y a female who on 13-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot # 660717/02 n has been received from a physician concerning a female who on 19-OCT-2008, "10 days ago", U was vaccinated ###with a dose ### of PNEUMOV n has been received from a female who in November 2002, was vaccinated with a 0.5 mL dose U of PNEUMOVAX 11/1/200223. 12/1/2007 In December 2007, th n has been received from a physician Y concerning a 66 year old female with diabetes, hypertension, N lipids high ### and drug allergy ### to CIPRO, W n has been received from a medicalYassistant concerning a female who on 28-OCT-2008 was Y vaccinated with ### PNEUMOVAX ### 23 (dose and n has been received from a physician concerning a 74 year old female who on approximately Y 12-OCT-2008 was ###vaccinated ###with PNEUMO n has been received from an adult female certified medical assistant who on an unknown date N was vaccinated### with a dose of PNEUMOVA n has been received from a consumer concerning a co-worker who on 13-OCT-2008, the patient N was revaccinated ### with PNEUMOVAX. ### Co n has been received from a physician and a nurse concerning a female who on 17-OCT-2008 N was vaccinated ### with PNEUMOVAX (lot #660 n has been received from a physician, Y concerning a 60-year-old female patient with chronic Y cervical radiculopathy, ### lumber### radiculopathy, d n has been received from a physician, Y concerning a 51-year-old female patient with sinusitis,Y hyperlipidemia and ###no known ### drug allergies, w n has been received from a physician concerning a 70 year old male with no medical historyYwho on 27-OCT-2008 ### was vaccinated ### with PN n has been received from a nurse concerning Y a 53-year-old female patient who on 27-OCT-2008 N was administered ### a dose of PNEUMOVA n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot # 6606 n has been received from a physician Y concerning a 69 year old female with drug hypersensitivity Y to IMURAN (caused ### by diffuse ### swelling), l n has been received from a physician concerning a 69 year old female who at 9:26 am on 22-OCT-2008 Y with a### first dose of ### PNEUMOVAX n has been received from a pharmacist concerning a 20-year-old female patient, who on 28-OCT-2008 U was vaccinated ### with a dose of PNE n has been received from a physician Y concerning a female patient over 60 years of age whoUin October 2008 was ### vaccinated ### with PNEUM n has been received from a physician concerning a female patient over 60 years of age whoUin October 10/1/2008 2008 was vaccinated with (Lot #66 n has been received from a physician concerning Y a female who on 27-OCT-2008 was vaccinated N with (lot #660685/0619X). ### In October 200 n has been received from a medicalYassistant concerning a male patient with no known drugUreactions/allergies, 11/3/2008 who 11/3/2008 on 03-NOV-2008, wa n has been received from a registered pharmacist concerning a female patient who is also her U student with an allergy to eggs who was vac n has been received from a physician concerning a female who on 29-OCT-2008 was vaccinated N with PNEUMOVAX ### vaccine ### (lot #660685 n has been received from a medical assistant concerning a patient who was vaccinated withUa dose of PNEUMOVAX (lot # 659148/1382U) n has been received from a nurse concerning a female who on 30-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot #662599/107 follow up information has been received Y from a physician concerning a female patient who no U 03-NOV-2008 11/3/2008 (1:30 PM) 11/3/2008 was vaccinated wit n has been received from a physician Y concerning a 76 year old male with heart disease, elevated N cholesterol, 11/4/2008 atrial11/4/2008 fibrillation, enlarged pro n has been received from a pharmacist and a hospital employee who was the brother of a female U patient who on an unknown date was vac n has been received from a female with penicillin allergy, sulfonamide allergy and LEVAQUIN Y and certain1/1/2005 drops allergy 1/1/2005 who in 2000 was va n has been received from a nurse concerning a male who on 30-OCT-2008 was vaccinated N with PNEUMOVAX### (Lot #62599/1076X), ### 0.5ml n has been received from a physician Y concerning an under 65 year old female with diabetesNwho was vaccinated with PNEUMOVAX vacci n has been received from a nurse concerning a 50 year old female who on 05-NOV-2008 was U vaccinated with dose of PNEUMOVAX (lot n n has been received from a physician concerning a female who was vaccinated with PNEUMOVAX U (lot # not provided). Secondary suspec n has been received from a registered Y nurse concerning a female patient who on an unspecified Y date was vaccinated with a dose of PNEU follow-up information has been received Y from a nurse concerning a 63-year-old female patient Y with asthma, 11/3/2008 arthritis, 11/4/2008 and drug allergies we
n has been received from a womanYat a medical clinic concerning a 63 year old female who Yon 26-SEP-2008 9/26/2008 was vaccinated 9/26/2008 with a first do n has been received from a 76 yearYold female with a rapid heart beat and allergic reaction to N erythromycin 11/4/2008 and tetracycline 11/4/2008 who on 04-NO n has been received from a pharmacist concerning herself, a 59 year old female with latex, iodine, N HIBICLENS 11/3/2008 and11/3/2008 Neomycin allergies, wh n has been received from an inventory Y manager concerning a female nurse who on 03-NOV-2008 U was vaccinated 11/3/2008 with 11/3/2008 PNEUMOVAX 23. O n has been received from a healthcare worker concerning a 52 year old female with allergy to Y soy products, sulfa, ### BACTRIM, 11/1/2008 CIPRO and L n has been received from a nurse concerning a 63 year old female with cholesterol high, blood Y pressure high, 1/1/1999 lupus,1/1/1999 arthritis, seizures and n has been received from an adult female who was vaccinated with PNEUMOVAX 23 (routeNnot reported) in her left arm 1 week after recei n has been received from a pharmacist concerning a 67 year old female who on approximately N 03-NOV-2008 11/3/2008 was vaccinated with PNEUM follow-up information has been received Y from a physician concerning a 65 year old female with Y hypertension and ###joint discomfort ### who in De follow-up information has been received Y from a physician concerning a 70 year old female patient Y with reflux and ###hypertension ### who on 17n has been received from a physician concerning a female who on an unknown date was vaccinated U with PNEUMOVAX 23 (Lot # 660685/ n has been received from a nurse practitioner concerning a 65 year old female who in 2000 Y was vaccinated with the first dose of PNEUMO n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX 23 in the past. S n has been received from a registered Y nurse concerning a 53 year old female patient with a N medical history of ### cancer and### no known drug re n has been received from a pharmacist, Y an adult female with a history of splenectomy at 28 N years of age resulted from a car accident, who n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX 23 (lot#662100 n has been received from a medicalYassistant concerning a 73 year old female patient who on Y 03-NOV-2008 11/3/2008 was vaccinated 11/3/2008with PNEUMO n has been received from a licensed Y practitioner nurse concerning a 72 year old female patient N with diabetes, allergies ### to ### prednisone, cortis n has been received from a registered nurse concerning a 13 year old male with asthma andYallergies to amoxicillin ### and CEFZIL ### who on 23 n has been received from a medical assistant concerning a 2 month old infant who on 11-NOV-2008 U was vaccinated ### with PNEUMOVAX 23 n has been received from a registered Y pharmacist concerning a 60 to 65 year old male patient, N with no known 11/7/2008 allergies, who ###on 07-NOV-20 rmation has been received from a healthcare worker and follow-up information was receivedYfrom a physician concerning ### a 46 year old fem n has been received from a physician concerning her father who on 10-NOV-2008 was vaccinated N with a dose### of PNEUMOVAC. ### Later that n has been received from a registered nurse concerning an approximately 81 year old male N with sulfonamide allergy ### and history ### of cardiov n has been received from a physician Y concerning a 64 year old female patient who on 04-NOV-2008 U at 10:00, 11/4/2008 was 11/4/2008 vaccinated with a dose n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX (lot # 662100/0 n has been received from a pharmacist and a registered nurse concerning a patient who on N an unspecified date was vaccinated with PNEU n has been received from a pharmacist and a registered nurse concerning a patient who on Yan unspecified date was vaccinated with PNEU n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot #6606 n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot # 6606 n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX. Lot numb n has been received from a pharm D. concerning a 59 year old female who in approximatelyY2006 "about 2 years ago" was vaccinated with n has been received from a registered nurse (R.N.) concerning a 71 year old female with noNmedical history or### allergies who ###on 13-NOV-20 n has been received from a medicalYassistant /office manager concerning a 6 month old female U who on 14-NOV-2008 ### was### inadvertently va n has been received from a nurse concerning a 53 year old female with DARVOCET allergyNhistory and no medical ### history### who on 13-NOV n has been received from a nurse concerning a 35 year old female with allergy to nortriptyline N and no pertinent 11/3/2008 medical 11/3/2008 history who on 03-N n has been received from a nurse concerning Y a 62 year old female with sulfonamide allergy,Nallergy to tetanus 11/4/2008 toxoid and no pertinent med follow-up information has been received from a pharmacist concerning a 70 year old femaleYwho on 20-OCT-2008 ### was vaccinated ### IM with n has been received from a pharmacist Y concerning a patient who was vaccinated with PNEUMOVAX. U A nurse told the pharmacist that the n has been received from a consumer concerning his 30 year old wife with asthma and seasonal N allergies who### on 14-NOV-2008 ### was vacci n has been received from a physician Y concerning a 65 year old female with hypertension, lipids N increased, osteoporosis ### and ###penicillin allerg rmation has been received from a healthcare worker and follow-up information was receivedYfrom a physician concerning ### a 84 year old fem n has been received from a registered nurse concerning a mid thirties old female patient withU no pertinent medical ### history ### and no known all n has been received from an office Y manager concerning a 7-year-old female patient with no Yrelevant medical 11/5/2008 history nor drug allergies, who n has been received from an office Y manager concerning a 6 year old female patient with asthma, Y no drug reactions/allergies, ### ### not immunoco n has been received from a registered nurse concerning two patients who on an unspecifiedUdate were vaccinated with a dose of PNEUMO n has been received from a certified medical assistant concerning a 67 year old male patientNwith hypertension, Raynaud's syndrome, arthr n has been received from a physician Y concerning a male patient in his late 40's to late 50's with Y asthma and chronic obstructive pulmonary t was received from Sanofi Aventis concerning a patient who on an unknown date was vaccinated U with PNEUMOVAX (site and route of ad n has been received from a physician Y concerning a male patient in his late 40's to late 50's who Y was vaccinated with PNEUMOVAX (lot # 6 n has been received from a licensed Y practical nurse concerning a female patient with asthma Y and graves'9/1/2008 disease and 9/1/2008 no known drug aller
n has been received from a physician assistant concerning a 67 year old female patient whoUon an unspecified date was vaccinated with a n has been received from a nurse concerning Y a 49 year old female patient with immunosupression U who on 11-NOV-2008 ### ### was vaccinated w n has been received from a licensed practical nurse concerning an unidentified patient with asthma U who was vaccinated with a dose of PNE n has been received from an office manager concerning a 73 year old female patient with hypertension U and hypercholesterolaemia ### ### and a h n has been received from a registered Y nurse concerning a female patient who on an unspecified N date was vaccinated with a 0.5 ml single d n has been received from a licensed Y practical nurse concerning a 17 year old female patientUwho in November 11/1/2008 200811/1/2008 ("this week") was vacc n has been received from a consumer concerning a "72 year old" female patient with penicillin N allergy and codeine ### allergy and a history of " n has been received from a registered nurse concerning an 80 year old female with allergiesYto PENICILLIN, iodine ### and CODEINE ### and a h n has been received from a nurse concerning a 60-year-old patient who on 18-NOV-2008 was U vaccinated with### a dose of 0.5 ###ml PNEUMOV n has been received from a pharmacy Y student concerning a 6 month old patient who was vaccinated Y with a dose of PNEUMOVAX. The pa n has been received from a healthcare Y worker concerning a 69 year old female patient who Y had experienced an unspecified ###allergic reactio n has been received from a nurse concerning Y a 61 year old male patient with an allergy to LIPITOR, N cholesterol 12/1/2008 high, 12/1/2008 peptic ulcer disease, n has been received from a licensed Y practical nurse concerning that two patients developedNlocalized reactions### after received ### PNEUMOVA n has been received from a pharmacist Y concerning a 67 year old female with penicillin and quinolones N allergies, ### who on 17-NOV-2008 ### was n has been received from "mid to late Y fifties" year old male who, "in early November 2008", on Y approximately 01-NOV-2008 ### ### was vaccinated n has been received from a pharmacy Y student concerning a male on 10-NOV-2008 was vaccinated U with PNEUMOVAX ### (lot ### number 662662 n has been received from a healthcare worker concerning a 70 year old female patient who Y on 24-NOV-2008 was ### vaccinated ### intramuscula n has been received from a healthcare Y worker concerning a 77 year old female with hypertension, Y cholesterol,### thyroid disorder, ### sulfonamid n has been received from a licensed Y practical nurse concerning an approximately 50 year old N female with drug### hypersensitivity to thimerosa n has been received from a medicalYassistant concerning a 69 year old female patient who on Y 01-OCT-2008 10/1/2008 was vaccinated 10/2/2008with the first d n has been received from a medical assistant concerning a 3 year old female who on 24-NOV-2008 U was mistakenly ### vaccinated ### IM with PN n has been received from a registered Y nurse concerning a male patient who on unspecified N date was vaccinated with a 0.5 ml single dose o n has been received from a medicalYassistant concerning a 62 year old male patient who onN01-DEC-2008 12/1/2008 was vaccinated 12/1/2008 intramuscularly n has been received from a health care Y professional concerning a 65 year old male patient with Y no known drug### reactions/allergies, ### cardiac n has been received from a registered Y pharmacist concerning a 42 year old male who on 31-OCT-2008 Y (also reported ### as "31-DEC-2008") w n has been received from a registered Y pharmacist concerning a 31 year old female who on 30-OCT-2008 Y was ### vaccinated ### with PNEUMOVA n has been received from a registered Y nurse concerning a female patient who was vaccinated U with a dose of PNEUMOVAX (lot number no n has been received from a nurse concerning an unidentified patient who was vaccinated with U a dose of PNEUMOVAX. It was reported tha n has been received from a doctor of Y pharmacy concerning a female patient who on approximately N 04-NOV-2008 11/4/2008was vaccinated intramus n has been received from a pharmacist concerning himself who was given a second dose ofNPNEUMOVAX on### 25-NOV-2008 ### and on 26-NO n has been received from a certified medical assistant concerning a 73 year old female patient Y with hyperlipidaemia, 9/9/2008 9/10/2008 hypertension and AVE n has been received from a nurse concerning a 56-year-old patient who on 17-NOV-2008 was Y vaccinated with### a dose of 0.5 ###ml PNEUMOV n has been received from a certifiedYmedical assistant concerning a 53 year old female patient Y with diabetes, 9/8/2008 seizure disorder, chronic fatig n has been received from a healthcare worker concerning a 50 year old female patient with N hypercholesterolaemia, 12/4/2008 12/4/2008 hypothyroidism, CODE n has been received from a Registered Y Nurse concerning a female patient in her 70's who on Y approximately 14-NOV-2008 ### ### was vaccinated n has been received from a pharm D Y that a medical assistant stated that a 17 year old female Y patient who on 21-NOV-2008 ### ###was vaccinated n has been received from a medicalYoffice coordinator, concerning a 17 year old female patient U who was vaccinated with a dose of PNEUM n has been received from a registered nurse concerning a patient who was vaccinated with Y a dose of PNEUMOVAX 11/4/2008 11/4/2008 23 on an unspecified d n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of PNEUMOVAX on an unspecified date n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of PNEUMOVAX on an unspecified date n has been received from a physician concerning a 50 year old healthy male patient who received U PNEUMOVAX at age of 50 and also rec n has been received from a registered Y nurse (R.N.) concerning a 64 year old female with thyroid N disorder and antihistamine ### ### allergy who wa n has been received from a doctor of Y pharmacy concerning a male patient who on approximately U 04-NOV-2008 11/4/2008 was vaccinated intramuscu n has been received from a Licensed Vocational Nurse concerning a 24 month old patient who U on 10-DEC-2008 ###was vaccinated ### with both n has been received from a doctor of Y pharmacy concerning a female patient who on approximately Y 04-NOV-2008 11/4/2008was vaccinated intramus n has been received from a medical assistant concerning a male patient who on an unspecified U date was vaccinated with a dose of PNEUM n has been received from a 56 year old physician reporting herself with a history of asthma who N in the AM 12/5/2008 of 05-DEC-2008 12/5/2008 was vaccinated n has been received from a medicalYoffice coordinator concerning a 71 year old male patient, U who on unspecified date was vaccinated with n has been received from a healthcare Y worker concerning a 65 year old male patient who had Y experienced an unspecified### allergic reaction n has been received from a healthcare Y worker concerning a 66 year old female patient who Y had experienced 9/30/2008 an unspecified 10/2/2008allergic reactio n has been received from a pharm D Y that a medical assistant stated that a 71 year old male Npatient who on 21-NOV-2008 ### ### was vaccinated w
n has been received from a medicalYassistant concerning a 70 year old female with penicillinYallergy who on 17-NOV-2008 ### ### was vaccinated n has been received from a certifiedYmedical assistant, concerning a 52 year old male with no U medical history 12/7/2008 or allergies, 12/9/2008 who on 07-DECn has been received from a healthcare professional concerning a female patient who on 16-Dec-2008 was vaccinated ### intramuscularly ### with follow-up information has been received Y from a registered pharmacist concerning a 53 year N old female patient### who on 15-DEC-2008 ### was v n has been received from an office manager concerning a 52 year old female patient who onY 10-DEC-2008 was ### vaccinated with PNEUMO n has been received from a physician Y concerning a 52 year old female patient with fibromyalgia U who on 12/1/1999 approximately 12/1/1999 December 1999, 9 y n has been received from a registered Y nurse concerning a 43 year old female who on 17-December N was vaccinated ### IM with the second do n has been received from a registered Y nurse concerning a 57 year old female who was vaccinated U with the first### dose of PNEUMOVAX ### (LO n has been received from a 74 year old female with a previous reaction to Tetanus shot andUallergy to egg whites, yeast who recently was n has been received from a physician concerning a his mother who on 15-DEC-2008 was vaccinated N with a dose ###of PNEUMOVAX ### (manufa follow-up information has been received Y from a registered pharmacist concerning a 55 year U old male patient who ###on 15-DEC-2008 was vac n has been received from a nurse concerning a 75 year old female with hypertension, hypercholesterolaemia, U ### osteoporosis ### and no allergy n has been received from a nurse concerning a 71 year old female with hypercholesterolaemia, U coronary artery ### disease, aortic ### valve steno n has been received from a physician Y concerning two patients in their 50 who on approximately Y 09-DEC-2008 12/1/2008 ("last12/1/2008 week") were vaccinate n has been received from a physician concerning a 58 year old white female patient with allergic Y reaction to KEFLEX ### and ### sulfonamide aller follow-up information has been received from a registered pharmacist concerning a 51 year N old female patient### who on 15-DEC-2008 was v n has been received from a certified medical assistant concerning a male patient who on anUunspecified date was vaccinated with a dose o n has been received from a certified medical assistant concerning a female patient who on an U unspecified date was vaccinated with a dose n has been received from a certified medical assistant concerning a male patient who on unspecified U date was vaccinated with a dose of P n has been received from a healthcare worker concerning a 12 month old patient who on 15-DEC-2008 U was vaccinated ### with ###a dose of PNE n has been received from an office manager concerning a 66 year old male patient who on 12-NOV-2008 Y was### vaccinated with PNEUMOVA n has been received from a registered nurse concerning a patient who on an unspecified date, U was vaccinated with PNEUMOVAX, intrade n has been received from a 66 yearYold female, 188 pounds and 66 inches in height, with allergic N reaction 12/5/2008 to ACE inhibitors, 12/5/2008who on 05-DE n has been received from a physician Y concerning an 83 year old female patient with chronicNobstructive pulmonary ### disease and arthritis an n has been received from a physician Y concerning two patients in their 50 who on approximately Y 09-DEC-2008 12/9/2008 ( " last 12/9/2008 week") were vaccinat n has been received from a 71 year old female healthcare worker with hypertension, hypothyroidism, Y tinnitus, latex ### allergy, ### iodine allergy a n has been received from a healthcare Y worker concerning a male patient who on 11-DEC-2008 U was vaccinated ### intramuscularly ### with a 0.5 m n has been received from a physician Y concerning a 12 month old female with a history of bronchiolitis N at 3 month ###of age, reactive ### airway iss n has been received from a nurse and a 55 year old male physician who on 02-JAN-2009 was N vaccinated1/2/2009 with a dose 1/3/2009 of PNEUMOVAX (Lo n has been received from a physician and a licensed practical nurse concerning a 62 year old N female patient with ###ibuprofen ### and penicillin a n has been received from a physician concerning a female who was vaccinated with a dose Yof PNEUMOVAX. Subsequently, the patient de n has been received from a physician's Y assistant (P.A) concerning a 24 months old male patient N with no known 1/9/2009 drug 1/9/2009 reactions/allergies and n has been received from a licensed Y practical nurse (LPN) concerning a patient who was vaccinated Y with PNEUMOVAX ### (lot # not provided n has been received from a physician Y assistant (P.A.) concerning a 24 months old female patient N with no 1/9/2009 known drug1/9/2009 reactions/allergies an n has been received from a licensed Y practical nurse (LPN) concerning a patient who in November Y 2008, was vaccinated ### with PNEUMOVAX n has been received from a licensed Y practical nurse concerning a patient who on 12-JAN-2009 U was vaccinated 1/12/2009 with PNEUMOVAX (lot num n has been received from a licensed Y practical nurse concerning a patient who on 23-DEC-2008 Y was vaccinated 1/8/2009 with PNEUMOVAX (lot num n has been received from a licensed practical nurse (LPN) concerning a patient who on 08-JAN-2009 Y was 1/12/2009 vaccinated with PNEUMOVAX ( n has been received from a nurse concerning an 81 year old female who on an unknown date, Y was vaccinated with PNEUMOVAX (lot# no n has been received from a nurse concerning a 53 year old female who on an unknown date, Y was vaccinated with PNEUMOVAX (lot # no n has been received from a nurse concerning Y a "over 65" year old female who in December Y2008, was vaccinated 12/1/2008 with 12/1/2008 a dose of PNEUMO n has been received from a physician Y and a nurse practitioner concerning an 80 year old female U who on1/12/2009 12-JAN-2009 1/13/2009 was vaccinated with n has been received from an office Y manager concerning a 79 year old female patient with asthma Y and allergic 1/14/2009 to morphine, penicillin and su n has been received from a nurse and a medical assistant concerning a female patient who Y in December12/1/2008 2008, was12/1/2008 vaccinated with a dose n has been received concerning a 69 Y year old female patient, who weights 210 pounds and Y is 64 1/4 inches tall, ### and has no ###pertinent medi n has been received by a drug wholesaler Y representative concerning a patient who on 20-JAN-2009 Y was1/20/2009 vaccinated1/20/2009 with a dose of PNEUM n has been received from a medicalYassistant concerning a 75 year old female with allergic reaction Y to penicillin 1/9/2009 and1/10/2009 LEVAQUIN and aspirin n has been received from a medicalYassistant concerning a 32 year old female patient with no Y pertinent medical 1/20/2009 history, 1/21/2009 who on 20-JAN-20 n has been received from a medicalYassistant concerning a 65 year old female patient with no Y pertinent medical 1/16/2009 history 1/16/2009 and no known drug n has been received from a medicalYassistant concerning a male patient who was vaccinated N with PNEUMOVAX 23 (Lot # 661529/0868X) n has been received from a medicalYassistant concerning a patient who in January 2009, was U vaccinated 1/1/2009 with a dose1/1/2009 of PNEUMOVAX (65
n has been received from an immunization coordinator concerning a female patient with rheumatoid N arthritis 1/23/2009 who on1/23/2009 23-JAN-2009 was vac n has been received concerning a 58 year old male patient with mixed hyperlipidaemia, diabetes Y mellitus, 1/12/2009 gout and 1/12/2009 hypertension who on 12 n has been received from a medicalYassistant concerning three patient who in January 2009,Uwere vaccinated 1/1/2009 with a 1/1/2009 dose of PNEUMOVAX n has been received from a consumer concerning herself (a 72 year old female) with fibromyalgia, N short 1/26/2009 gut syndrome, 1/26/2009 history of diarrhea, n has been received from a physician Y concerning a 50 year old female with PENICILLIN allergy Y and "a lot of medications" ### ### allergies and a h n has been received from a physician concerning an 85 year old female with heart and lung Yproblems, arthritis, 10/7/2008 penicillin allergy, ### sulfa allerg n has been received from a physician Y concerning a 78 year old female with type 2 diabetes,Ychronic obstructive ### pulmonary### disease and hyp n has been received from a physician Y concerning an 83 year old male with chronic obstructive Y pulmonary 7/28/2008 disease heart 7/29/2008 problems and no k n has been received from a consumer concerning his 84 year old sister who was vaccinatedUwith her first 1/1/2009 dose of PNEUMOVAX 1/1/2009 vaccine w n has been received from a physician Y concerning an 84 year old male patient with iodine and N NEOSPORIN 1/26/2009 allergy,1/28/2009 osteoporosis and osteo n has been received from a physician Y concerning a 65 year old female patient with allergic reaction N to AUGMENTIN 1/27/2009 1/28/2009 and clindamycin and o n has been received from an office Y manager concerning a 32 year old male who on 04-EC-2008 Y was vaccinated 12/4/2008with 12/4/2008 a dose of PNEUMOV n has been received from a health professional Y concerning an 81 year old female with rheumatoid Y arthritis, 1/19/2009 allergic reaction 1/21/2009 to vancomycin, n has been received from a medicalYtechnologist concerning a 43 year old female with a sulfonamide N allergy and ###a history### of arthralgias, al n has been received from a office manager Y and a physician assistant concerning a 36 year old U female who 1/21/2009 on 21-JAN-2009 1/21/2009was vaccinate n has been received from an office manager concerning a 32 year old male who on 01-DEC-2008 Y was vaccinated 12/1/2008 with PNEUMOVAX 23 (l n has been received from an office Y manager concerning a 65 year old female who on 19-NOV-2008 Y was vaccinated ### with a### dose of PNEUM n has been received from a 65 yearYold female with SULFONAMIDE allergy who on 26-JAN-2009 Y was vaccinated 1/26/2009 with 1/26/2009 a 0.5 ml dose of PN n has been received from a pharmacist Y concerning a female inpatient at his hospital who was U given a dose 1/31/2009 of PNEUMOVAX 1/31/200923 intravenou n has been received from a semi-retired Y physician concerning his 67 year old wife with asthma N and CODEINE 1/13/2009 allergy 1/16/2009 and a history of atopi n has been received from a physician Y concerning a male patient who on an unspecified dateYwas vaccinated with ###a dose of ### PNEUMOVAX n has been received from a physician Y concerning a patient who on unspecified date was vaccinated U with a dose ### of PNEUMOVAX. ### Subseq n has been received from a physician Y concerning a male who in approximately October 2008 U was vaccinated 10/1/2008 with a10/1/2008 dose of PNEUMOVAX n has been received from a 57 yearYold male physician who on 03-FEB-2009 was vaccinated Y IM with a dose 2/3/2009 of PNEUMOVAX 2/3/2009 23. On 03-F n has been received from a medical assistant concerning a female who was vaccinated withYa dose of PNEUMOVAX 23. Subsequently the n has been received from a physician concerning an approximately 60 year old female who Y was vaccinated 2/5/2009 with a dose 2/5/2009 of PNEUMOVAX 2 n has been received from a physician concerning an approximately 50 year old male who was Y vaccinated with a dose of PNEUMOVAX vac n has been received from a physician Y concerning a 4 year old female who was vaccinated with Y a dose of PNEUMOVAX 23 in her thigh. La n has been received from an office manager concerning a patient who on an unknown date,Uwas vaccinated with PNEUMOVAX 23 (lot# no n has been received from a registered pharmacist concerning an 8 month old female child who N on 11-FEB-2009 2/9/2009 was 2/11/2009 vaccinated with PNEU n has been received from a medical assistant concerning a 36 year old female patient with BACTRIM Y and 2/10/2009 BIAXIN allergy 2/10/2009 and no known me n has been received from a retired registered nurse concerning her 43 year old daughter with N "MELOXOCAM" 2/9/2009 allergy 2/10/2009 and arthritis and sco n has been received from a physician Y concerning unspecified number of patients who "aboutUa year ago" were vaccinated with PNEUMOV n has been received concerning a male physician who on 13-FEB-2009 was vaccinated withUPNEUMOVAX 2/13/2009 vaccine 0.5ML (lot# 659922/16 n has been received from a registered Y nurse concerning a 67 year old female with mitral valve Y prolapse,2/16/2009 elevated lipids, 2/16/2009 diverticulitis, irritab n has been received from a nurse concerning Y an 81 year old male who on 13-FEB-2009 wasY vaccinated2/13/2009 SQ with a 2/13/2009 dose of PNEUMOVAX n has been received from a nurse and Y a certified medical assistant concerning a 12 month old U male, who 2/23/2009 on an unknown 2/23/2009 date was vaccina n has been received from a healthcare worker concerning a 46 year old female patient, withNno known drug 2/19/2009 reactions/allergies 2/20/2009 and with a h n has been received from a physician Y concerning a 75 year old patient with hypothyroidism, Nno known drug 10/1/2008 allergies2/16/2009 and a history of depre n has been received from a pharmacist concerning a female who on 25-FEB-2009 was inadvertently U vaccinated 2/25/2009 with 2/25/2009 one dose of (PREVEN n has been received from a nurse concerning a male physician with hypercholesterolemia who N in approximately 2/24/2009 2002, 2/24/2009 "about 7 years ago" n has been received from a registered Y nurse concerning a female office receptionist who onN24-FEB-2009 2/24/2009 was vaccinated 2/24/2009 IM with the seco n has been received from a registered Y nurse concerning a female office medical assistant who N on 24-FEB-2009 2/24/2009 was 2/24/2009 vaccinated IM with the n has been received from a physician concerning a 69 year old female who on 21-JAN-2009Ywas vaccinated 1/21/2009 with a1/22/2009 0.5mL dose of PNEUM n has been received via Novartis (manufacturer control # S2009US02845), from a female that Y received a dose of PNEUMOVAX (manufact n has been received from a registered Y nurse concerning a 77 year old female patient with ULTRAM N and2/24/2009 PENICILLIN 2/24/2009 allergy, who in 1998 w n has been received from a pharmacist concerning a 65 year old male who on 26-FEB-2009Nwas vaccinated 2/26/2009 with the 2/26/2009 first dose of PNEUMO n has been received from a physician Y assistant concerning a male over 60 year old who on U an unknown date was vaccinate with an unspe n has been received from a physician Y and via medical records. A 45 year old male with gastroesophageal N 2/5/2009 reflux disease, 2/5/2009 irritable bowel syn n has been received from a registered Y nurse (R.N.) concerning a female who was vaccinated Y with a dose of PNEUMOVAX (lot # not report n has been received from a medicalYassistant concerning a 6 year old male with no pertinentYmedical history 3/4/2009 and no 3/7/2009 reported allergies, who
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with PNEUMOVAX (lot # not provid n has been received from an office Y manager concerning an 18 month old female who was vaccinated Y with PNEUMOVAX vaccine, instead n has been received from an office Y manager concerning a 71 year old female with drug hypersensitivity Y 2/27/2009 of lisinopril 2/27/2009 and AUGMENTIN, oeso n has been received from a healthcare worker concerning a 67 year old female patient with Y diabetes; hypertension; 3/10/2009 3/11/2009 hypercholesterolaemia n has been received from a manager Y and physician concerning a 65 year old Caucasian female Y worker 2/12/2009 with diabetes; 2/12/2009 hyperlipidaemia and n has been received from a registered nurse concerning a 2 month old female who on 16-MAR-2009 U was 3/16/2009 vaccinated 3/16/2009 with a 0.5 mL dose of n has been received from a physician concerning a male who on 23-JAN-2009 was vaccinated N with "one1/23/2009 dose" on PNEUMOVAX 1/27/2009 23 (lot nu n has been received from a nurse practitioner Y concerning an 81 year old male patient with arthritis who in 3/10/2009 1998 was3/10/2009 vaccinated with a dose n has been received from a licensed practical nurse, concerning a 72 year old female with hypertension, N chronic 3/3/2009obstructive 3/4/2009pulmonary dis n has been received from a pharmacist concerning a female nurse who was vaccinated withUPNEUMOVAX 3/18/2009 23 (Lot 3/18/2009 number 0980X). The ph n has been received from a physician Y concerning a patient who was vaccinated IM with the Y second 0.5ml dose of PNEUMOVAX. After gett n has been received from a pharmacist concerning a male physician who was vaccinated with Y a dose of PNEUMOVAX (662663/0980X). It n has been received from a pharmacist concerning a male physician who was vaccinated with Y a dose of PNEUMOVAX (lot # 662041/0612 n has been received from a pharm.YD. concerning a 62 year old male who was vaccinated IM U with a 0.5 3/10/2009 ml dose of 3/10/2009 PNEUMOVAX 23 (lot # n has been received from a Pharm.YD. concerning a 60 year old female who on 04-MAR-2009 U was vaccinated 3/4/2009 IM with 3/4/2009 a 0.5 ml PNEUMOV n has been received from an office manager concerning 8 patients who were vaccinated with U PNEUMOVAX (lot # 662599/1076X). It was u n has been received form an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX (lot # 662599/1076X). It was u n has been received from an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX ( lot # 662599/1076X). It was u n has been received from an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX (662599/1076X). It was unspe n has been received from a licensed Y practical nurse concerning a female patient, who on 11-MAR-2009 N 3/11/2009 was vaccinated 3/13/2009 with the first dose n has been received from a licensed Y practical nurse concerning a patient, who on 18-MAR-2009 N was vaccinated 3/18/2009with 3/20/2009 the first dose of PNEU n has been received form an office Y worker concerning a 19 year old female with allergies to N bees, FLEXERIL 3/25/2009 and CECLOR 3/26/2009 who on 25-MA n has been received from a registered pharmacist concerning a 75 year old female with penicillin Y and KEFLEX allergy and no pertinent me n has been received from a physician Y assistant concerning a 48 year old female with common Y variable immunodeficiency 5/6/2008 5/6/2008 and sulfonamide n has been received from a physician Y assistant concerning a 33 year old female with niacin Y allergy 01-Jan-2009 2/4/2009 who2/8/2009 on 04-FEB-2009 was n has been received from a physician concerning a 26 month old male patient, with no known Y drug reactions/allergies 4/2/2009 4/2/2009 and no pertinent med n has been received from a 59 yearYold female with asthma, high blood pressure, migraines,Nheart problem 4/6/2009 and penicillin, 4/6/2009 tetracycline, cont n has been received from a Doctor of Pharmacy concerning a 40 year old (also reported as N 44 year old)4/11/2009 female with4/11/2009 diabetes who on 11-A n has been received from a physician Y and a health professional concerning a 71 year old male Y patient (weight 2/26/2009 224 pounds, 2/27/2009 height 70 inche n has been received form a medicalYassistant concerning a 67 year old female who on 03-APR-2009 N was4/3/2009 vaccinated4/3/2009 with her second dose n has been received from a case in litigation (WAES#0610USA13557) from a physician via medical U records concerning a male who on uns n has been received from a medicalYassistant concerning a patient who was vaccinated withYa dose of PNEUMOVAX 4/13/2009 4/13/2009 (lot number 662785/1 n has been received from a medicalYassistant concerning a patient who was vaccinated withUa dose of PNEUMOVAX 4/2/2009 4/2/2009 (lot number 662785/1 n has been received from a registered nurse concerning a 51 year old female who on 15-APR-2009 U was4/14/2009 vaccinated4/14/2009 with a single dose of P n has been received from a doctor of pharmacy concerning a patient who was vaccinated with U a dose of PNEUMOVAX. The patient experi n has been received from a MedicalYAssistant (M.A.) concerning a 17 year old male patient with N migraine4/16/2009 and sinus4/17/2009 infection who on 16-AP n has been received from a physician Y assistant concerning a 64 year old female with low immunoglobulin, Y 8/6/2008 diabetes, hypercholesterolaemia 8/6/2008 n has been received from a consumer Y concerning his 73 year old wife with no previous medical N history reported ### who on 26-DEC-2008 ### was n has been received from a healthcare Y worker concerning an approximately 56 year old male N with no pertinent 4/1/2009 medical history who in early n has been received from a physician Y concerning a patient who on an unspecified date was N vaccinated with PNEUMOVAX (lot # not report n has been received from a registered nurse who in approximately 2008, about one year ago, Y was vaccinated with the second dose of PNE n has been received from a physician concerning a 27 year old male patient with diabetes who N on 22-APR-2009 4/22/2009was 4/22/2009 vaccinated with a dos n has been received from a nurse concerning Y a 65 year old female who on 20-APR-2009 was N vaccinated 4/20/2009 with a 0.54/24/2009 ml dose of PNEUMOV n has been received from a 65 yearYold female consumer with ALLEGRA, household cleaning N products,4/24/2009 kiwi, nuts, and 4/24/2009 preservatives in eye n has been received from a physician and the office manager concerning 19 patients who were U vaccinated 1/23/2009 with PNEUMOVAX 1/23/2009 instead of (P n has been received from a medicalYcare administrator concerning her 60 year old mother (physician), N with 4/26/2009 a rheumatoid 4/26/2009 arthritis with sulfa n has been received from a 47 year old male consumer with allergy to water pills who in MayN2008, was vaccinated 5/1/2008 in 5/1/2008 the left arm with first n has been received from a physician concerning a patient who on 24-APR-2009 was vaccinated Y with a 4/25/2009 dose of PNEUMOVAX 4/26/2009 (lot number n has been received from a physician Y concerning a 29 year old female patient with no pertinent N medical 4/28/2009 history an no 4/28/2009 known drug allergies n has been received from an immunization Y coordinator concerning a 72 year old female withYdepression4/30/2008 who in 20015/1/2008 was vaccinated with t n has been received from a licensed practical nurse concerning an 18 month old male with aYhistory of immunization 5/2/2009 5/1/2009 who on 02-MAY-2009
n has been received from a Registered Nurse concerning a 21 year old male student who onY 01-APR-2009 4/1/2009 at 8:30 at4/1/2009 a well visit was vacci n has been received from a physician concerning a patient who on an unspecified date was Yvaccinated with 4/29/2009 a dose4/30/2009 of PNEUMOVAX vacci n has been received from a physician Y assistant concerning a 74 year old male patient with diabetes N and4/30/2009 aspirin allergy 4/30/2009 who on 30-APR-200 n has been received from a female nurse concerning herself who "recently" in approximatelyYMay 2009, 4/30/2009 was vaccinated 4/30/2009 with a dose of PNE n has been received from an office manager concerning a 54 year old female patient with noYpertinent medical### history and### no known drug a n has been received from a nurse concerning Y a 33 year old female patient with rhinitis allergic, N recurrent upper### respiratory### tract infection, d n has been received from a physician and the office manager concerning an 18 week old male U patient who 3/27/2009 on 27-MAR-2009, 3/27/2009 was vaccinat n has been received from a physician and the office manager concerning a 7 month old female U patient who 1/22/2009 on 22-JAN-2009, 1/22/2009 was vaccinat n has been received from a physician and the office manager concerning a 12 month old male U patient who 3/19/2009 on 19-MAR-2009, 3/19/2009 was vaccinat n has been received from a physician and the office manager concerning a 9 week old maleUpatient who on 4/3/2009 03-APR-2009, 4/3/2009 was vaccinated n has been received from a physician and the office manager concerning an 8 week old female U patient who 3/19/2009 on 19-MAR-2009, 3/19/2009 was vaccina n has been received from a physician and the office manager concerning a 19 week old female U patient who 3/17/2009 on 17-MAR-2009, 3/17/2009 was vaccina n has been received from a physician Y concerning a female of chronic cougher who on 04-MAY-2009 Y was5/4/2009 vaccinated5/6/2009 with the first dose of P n has been received from a physician and the office manager concerning a 6 month old female U patient who 3/12/2009 on 12-MAR-2009, 3/12/2009 was vaccina n has been received from a pharmacist Y concerning a female who on 05-MAY-2009 was vaccinated N intramuscularly 5/5/2009 with 5/5/2009 a dose of PNEUMO n has been received from a physician and the office manager concerning a 12 month old male U patient who 4/1/2009 on 01-APR-2009, 4/1/2009 was vaccinate n has been received from a medical assistant concerning a female who on 07-MAY-2009 was N vaccinated5/7/2009 with a dose5/8/2009 of PNEUMOVAX (Lo n has been received from a pharmacist concerning an approximately 82 year old patient who Y was vaccinated with a dose of PNEUMOVAX n has been received from a physician and the office manager concerning an 8 month old male U patient who 3/30/2009 on 30-MAR-2009, 3/30/2009 was vaccinat n has been received from a physician and the office manager concerning a 12 month old female U patient 3/12/2009 who on 12-MAR-2009 3/12/2009 was vaccina n has been received from a Registered Y Nurse (R.N) concerning a female patient with latex allergy Y who "three years ago" was vaccinated w n has been received from a pharmacist concerning an approximately 58 year old patient who Y was vaccinated with a dose of PNEUMOVAX n has been received from a Certified Y Medical Assistant concerning a 78 year old female patient N with no known 5/11/2009 drug5/11/2009 allergies/drug reactions n has been received from a physician and the office manager concerning a 58 day old female U patient who 3/24/2009 on 24-MAR-2009, 3/24/2009was vaccinate n has been received from a certified medical assistant concerning a 64 year old female whoNwas vaccinated IM with a dose of PNEUMOVA n has been received from a pharmacist intern concerning a 24 hours old male who on 14-MAY-2009, U was 5/14/2009 vaccinated 5/14/2009 with PNEUMOVAX (d n has been received from a consumer concerning her father-in-law who on 18-MAY-2009 was U vaccinated 5/18/2009 with PNEUMOVAX. 5/18/2009 It was report n has been received from a physician and the office manager concerning a 61 day old female U patient who 3/27/2009 on 27-MAR-2009, 3/27/2009was vaccinate n has been received from a Nurse Practitioner Y (N.P.) concerning a 64 year old female with sulfa, N penicillin 5/26/2009 and food5/28/2009 allergies who on 26-MA n has been received from a 71 year old male patient with a history of an "unspecified cardiology-related U 5/28/2009 surgery recently" 5/29/2009 who on 28-MAYn has been received from a licensed Y practical nurse concerning a 49 years old female with asthma N and colitis 4/1/2009 who on4/2/2009 01-Apr-2009 was vac n has been received from a physician and the office manager concerning a 6 month old male U patient who 3/10/2009 on 10-MAR-2009, 3/10/2009was vaccinate n has been received from a female who was vaccinated with PNEUMOVAX. The patient reported U that when the pharmacist was taking air o n has been received from a physician and the office manager concerning a 9 week old female U patient who 3/25/2009 on 25-MAR-2009, 3/25/2009 was vaccinate n has been received from a physician and the office manager concerning a 12 month old female U patient who 3/5/2009 on 05-MAR-2009, 3/5/2009 was vaccin n has been received from a physician and the office manager concerning an 18 weeks old female U patient 3/10/2009 who on 10-MAR-2009, 3/10/2009 was vacci n has been received from a physician and the office manager concerning a 6 month old male U patient who4/2/2009 on 02-APR-2009, 4/2/2009 was vaccinated n has been received from a physician and the office manager concerning a 61 day old male Upatient who on 4/1/2009 01-APR-2009, 4/1/2009 was vaccination n has been received from a Registered Nurse (R.N) concerning a 4 month old female patientUwho on 25-NOV-2008 ### was vaccinated ### with a n has been received from a nursingYsupervisor concerning a male in his middle 50's who on Uapproximately 4/15/2009 15-APR-2009, 4/15/2009 two to three wee n has been received from a consumer concerning her son who on an unspecified date was vaccinated N with a dose of MMR II. It was report n has been received from a physician concerning a female with a history of experiencing aura Y of blindness 7/6/2009 and prevaccination 7/6/2009 anxiety after ember reports that in Jan '86 he developed severe pain, numbness and weakness Y in the leftNshoulder, arm, 3/1/1999 and hand4/1/1999 that lasted for weeks n the 10th, Left thigh into knee swollen and sore Y on 11th, Right knee3 down to mid top foot swollen, N red and 7/10/2009 feverish7/11/2009 on the 12th (pt. could n AX administered 2/18/08. Hearing loss in Rt ear approximately 10 days later. 8/11/09 Y Otolaryngology N consult 2/18/2008 records 2/26/2008 received DOS 2/05/0 Y 7/24/2009 d seizure. Disoriented. Difficulty talking Y ~5 minutes. Y 7/21/2009 7/29/2009 ven zoster vaccine 7/10/09. She presented 7/23 w/ bilateral blisters on 1st & 2nd digit of hand. U She was 7/10/2009 referred to derm. Will be seeing 8/1 all dots on neck U 7/30/2009 8/1/2009 hingle shot - 4 days later broke out with chicken pox - all over body - arms - legs - vagina. Back corner of 7/14/2009 eye. I was 7/17/2009 a mess - headache - f arm red warm to touch. BENADRYL, HC ointment U 8/3/2009 8/4/2009
AP vaccination in the (L) arm 7/29/09. Y Following morning she had swelling and a hard lump Yin the (L) upper 7/29/2009 arm. The 7/30/2009 site was itchy and pa h 6d after ZOSTAVAX injection - arm, abd, leg-Rt. Y 7/7/2009 7/12/2009 d immunizations at 0800 at 2100 developed restlessness and extreme aching pain from head U to toe. Took 7/29/2009 2 ASA and 7/29/2009 3 hr later took 2 ibup er the night of injection, headache, nausea, slight redness at injection site. Y 8/6/2009 8/6/2009 7/19/2009 N 7/15/2009 7/19/2009 was reported by a physician via a GSK Y representative, and described the occurrence of cellulitis U in a child 7/17/2009 female subject 7/17/2009 of appropriate ag ng erythema and swelling upper L delt R arm 39cm L arm 42.5 19x16cm L deltoid. Y 8/5/2009 8/7/2009 given 8/5/09 - 48hrs later, seen in office Y with 3-4cm circular cellulitic rash at injection site. Y 8/5/2009 8/7/2009 thigh dime size red swollen warm area noted. Approx 2 1/2 cm x 2 cm. Y 8/6/2009 8/7/2009 ZOSTAVAX on Friday, July 31. When Y she removed bandage later that day she noted a hardYlump about7/31/2009 2" by 1" at7/31/2009 the injection site over n eloped day of immunisation- Monday 8-3-09. Felt ill on Tuesday. Swelling deltoid, redness and Y warmth decreased 8/3/2009 on8/3/2009 Fri. Here in office Frid at the site of injection. Antihistamine and Hydrocortisone ointment. Y ort received on 14 July 2009 from a consumer. A 19 year old female patient with an allergy toNfish and beans 7/7/2009 received7/9/2009 MENACTRA (lot num aches all day long. N 7/14/2009 7/15/2009 d bronchospasm gave Racemic Epi 1/2 vial in 2cc NS via nebulizer. Pt responded well- No stridor Y after tx.8/7/2009 8/8/2009 d some arm swelling that she stated was about the size of a lemon. Patient returned to pharmacy Y on 8/8/09 8/1/2009 and swelling 8/2/2009 had gone down. face, trouble breathing 3 PM vomited Y denies diarrhea. Given PREDNISONE at RCH per mom. U Gave Dehydration 8/6/2009 Protocol 8/7/2009 this AM. after receiving BOOSTRIX and VARIVAX vaccines. LOC < 30 sec. Y 8/5/2009 8/5/2009 ne administered less than one month apart. Y ### t was received from a health care professional on 28 July 2009. A 13 year old female patient N received MENACTRA 7/27/2009 7/28/2009 (lot number U2926AA) and poor feeding in the 1st 12 hours, Y late very irritable, high pitched, nonconsolable crying. Septic Y work up8/3/2009 done. after vaccines (8/4/09), teen developed pruritus all over body at about 1pm. Five days after Yvaccines, teen 7/31/2009 developed 8/4/2009 red, itchy, warm, swo ss, inflammation, runny nose, sl. temp. Itching x3 days. Y 7/16/2009 7/16/2009 to L deltoid with edema no induration, tender to palpation placed on Orapred and Benadryl. U 8/4/2009 8/6/2009 eft arm- inflammation and tender still sore and swollen 2 days later. Pain in arm started on way home from8/5/2009 clinic after 8/5/2009 Varicella given. d cough and shortness of breath. No Y cyanosis. No use of accessory muscles of respiration. Y On exam RR8/6/2009 24/min, O28/6/2009 sat 99% in room air, B 4 inch erythematous on (L) arm. Y 8/4/2009 8/5/2009 l thigh SC with 3 inch in diameter indurated, erythematous, warm circular reaction site. U 7/29/2009 7/30/2009 rge masses of lymph nodes over skull. 8/3/2009 8/5/2009 redness and swelling at injection site Y with hives and itching. Y 8/3/2009 8/4/2009 pper medial side swollen, tender, red, painful. U 8/5/2009 8/6/2009 Hepatitis A #1 vaccine on 8/5/09 in L arm around 7PM complains of tingling in R hand. Woke U on 8/6/09 with 8/5/2009 red rash8/6/2009 on face that extended have maculopapular rash 1 day after Hep B administration on L deltoid area. itis B administered 7 weeks after 2nd dose Y ### nes administered less than a month apart. Y 9/17/2004 erythema at site of VARIVAX Palp heat Y 8/3/2009 8/4/2009 VARIVAX instead of ZOSTAVAX given IM instead of SQ Y 8/5/2009 hema at site of VARIVAX Palp heat Y 8/3/2009 8/4/2009 reaction with warmth, discomfort and induration. Y 8/6/2009 8/6/2009 in area vaccinated not warm to touch, feels well TYLENOL PRN, warm compress. Prn. U 8/4/2009 pe, Hypotension, diaphoresis Y 8/3/2009 8/3/2009 d staff physician, active duty and in Ygenerally excellent health, predeployment, who finished Y the 4-dose oral 7/9/2009 typhoid7/14/2009 vaccine (starting 9 Jul 0 n has been received from a nurse concerning Y a "70 - 80 year old" female with "unknown allergies" U and is6/13/2008 a patient in a rehabilitation hospita ound red spot size of a baseball on her Y arm. Middle was hard to the touch and very warm. This Y was in her 7/30/2009 left arm in 7/31/2009 the area of Chicken P seen @ urgent care) 2" diameter ofYredness around a knot - hard area decreases toward knee Y area with7/31/2009 egg size lump 8/1/2009 per parent. veloped redness and swelling of L thigh Y 24-48 hours after administration of vaccine. Pt. gotYhis 2nd Hep7/22/2009 A vaccine too early. (4 months af iven 8/4/09; Seen on 8/6/09 with 12cmx9cm Y localized reaction- red, swollen, warm with central urticaria. 8/4/2009 8/5/2009 sed erythema on L thigh, slightly tender to palpation. No fever, otherwise acting normal. Y 8/3/2009 8/4/2009 ECEIVING VACCINES, CLIENT FELT DIZZY. PATIENT OFFERED WATER AND HAD HERYHEAD DOWN 8/7/2009 BETWEEN 8/7/2009 HER LEGS AND C rash on trunk, shest, and upper back Y Y 4/28/2009 5/16/2009 d syncope ~ 10 min after receiving the vaccine. At the same time was watching her sibling having Y blood7/28/2009 drawn. 7/28/2009
DaP placed in Travel Clinic. Approx. 4 hrs later client began to feel "ache-y" and inj. site begab Y to swell and 7/29/2009 become7/29/2009 painful. Temp. 101 deg ceived Tdap on 07-31-09. Presented first on 08/03/2009 with fever 99.8 and local site erythema, N induration 7/31/2009 and mild soft 8/3/2009 tissue swelling. Fe ported that she received Zoster vaccine Y and developed redness around the site of injection. UShe reported7/6/2009 that three7/27/2009 weeks after receiving ion of Engerix B: 04/17/02. SecondYinjection: 05/16/02. Y Demyelinating 2 event:07/04. Y Emergency N room visit. 4/17/2002 CT scan and 7/7/2004 MRI with contrast. ived Menactra 8/6/2009am. At 2am on 8/7/2009 became suddenly ill with a high fever, chills,Yrapid breathing, 8/6/2009 and bad 8/7/2009 nausea. Family gave ness and diarrhea. Later, chills, rapid heart beat, fever, aches and pains. On the 6th, diarrhea, Y head ache. 8/4/2009 On 7th diarrhea 8/5/2009feeling better. pneumococcal vaccine trial, with severe COPD, Y was hospitalized for thoracic spine compression Y fracture 1/2/2008 (T8). Vaccination 1/15/2009 took place on 1 pneumococcal vaccine trial, with severe COPD, Y was hospitalized for left leg fracture. Vaccination Y took place 1/2/2008 1/2/2008. 5/10/2009 According to the ph pneumococcal vaccine trial, with severe COPD, Y was hospitalized for COPD exacerbation. Vaccination Y took 3/31/2008 place on 7/12/2009 3/31/2008. According pneumococcal vaccine trial, with severe COPDY was hospitalized for pneumonia. Vaccination Y took place on 10/13/2008. ### 6/1/2009 According to the p 6 mo immunizations on 7/28/09, mother called on 7/29/09 due to temp of 100.9 and red areaY on right thigh 7/28/2009 at site of7/29/2009 injection. pneumococcal vaccine trial, with severe COPDY was hospitalized for community-acquired pneumonia. Y Vaccination 1/15/2009 took 4/15/2009 place on 1/15/2009 Prevnar on 7/28/09, on 7/30/09 was seen in this office due to erythema around injection site,Yarea continuuing 7/28/2009 to spread 7/30/2009 and is hot and ten pneumococcal vaccine trial, with severe COPDY was hospitalized for community-acquired pneumonia. Y Vaccination 4/14/2009 took 5/29/2009 place 4/14/2009. A pneumococcal vaccine trial, with severe COPDY was hospitalized for small bowel obstructionYwith perforated cecum and peritonitis/Ventilato r ranging from 101.5-104 degrees fahrenheit, Y mild rash across back and neck and at point ofYinjection sight, 7/22/2009 decreased 7/29/2009 appetite, severe dro ceived Tdap. Approximately 5-8 minutes after receiving the vaccine, patient told mother sheYcould not see8/7/2009 or hear and 8/7/2009 she was dizzy. She after injection, arm became extremely painful, pt unable to move arm due to pain. Achy fromYhead to toe. 8/3/2009 Fever. These 8/4/2009 symptoms began to 0cm erythematous induration on leftYlateral thigh, non-tender to touch slightly warm. TreatedNwith clindamycin. 8/5/2009 Recheck 8/6/2009 in three days. after receiving Tdap client developed body aches, chills, fever of 102.2, headache, diarrhea. YSymptoms lasted 8/4/2009 about8/5/2009 9 hrs. round injection site. Hives day after injection. Y 8/4/2009 8/5/2009 .5, headache, chills, nausea, body aches, joint pain, fatigue, 2 days Y 8/4/2009 8/4/2009 e had a reaction, it was the size of aYgolf ball at the site of inj. and the size of grapefruit with big U whelps outside 7/29/2009 the inj. point. She said it wa leaving clinic after receiving Gardasil and varicella- event happened in clinic Y 8/6/2009 8/6/2009 follow-up information has been received Y from a medical assistant and medical records concerning N a 67 5/20/2008 year old female 5/20/2008 with arthritis in the n has been received from a certified medical assistant concerning an adult female patient who Y on an unknown### date was vaccinated ### with a n has been received from a registered Y nurse concerning a 67 year old female with asthma, cholesterol Y high, type ###2 diabetes ###mellitus, arthri n has been received from an RN concerning 70 year old female who on 16-Oct-2008 was vaccinated Y with a first ### dose of PNEUMOVAX ### 23 was reported by a healthcare professional andYdescribed the occurrence 1 of intussusception Nin a 2-month-old 7/8/2009 female7/15/2009 subject who was vacc was reported by a physician and described the occurrence of fussy in a 4-month-old femaleNsubject who was 7/2/2009 vaccinated 7/2/2009 with ROTARIX, (G was reported by a physician and described the occurrence of diarrhea in a 2-month-old female N subject who 6/26/2009 was vaccinated 6/27/2009with ROTARIX was reported by a physician, via a GSK representative and described the occurrence of vomiting U in a 3-month-old female subject who was was reported by a consumer and described the occurrence of diarrhea in a 2-month-old female U subject who was vaccinated with live attenu was reported by a consumer and described the occurrence of diarrhea in a 2-month-old female U subject who was vaccinated with ROTARIX was reported by a healthcare professional and described the occurrence of vomiting in a 4-month-old U male 7/20/2009 subject 7/20/2009 who was vaccinated wi ad fevers of 102 for 3 days. a rash on both legs and stoamic. stoamic pain. weakness, hoarse.and Y a little7/10/2009 wheezing. 8/3/2009 hurt, body red and itchy, mouth itchy, Y throat felt constricted. Reacted within 15 minutes after Y injection. Treated 7/31/2009 in ER7/31/2009 with epinephrine, Bena rritability several hours after administration, accompanied by pallor and clammy skin, poor feeding Y and sleeping. 8/3/2009This 8/3/2009 lasted for at least 48 d vaccination on a friday and had a Yhigh fever from Y friday until Monday 2 morning. He was staring Y into space 7/31/2009 body limp 7/31/2009 no reaction.doctor co chills, headache, head Ycongestion,Yblurry vision, Y dizziness, chest 12 pain, Y heart palpitations, Y congestive N heart 11/1/2006 failure, 11/2/2006 tinnitus, postural tachyc avoring right leg. Limitation at flexion Y and rotation of right hip due to pain. Y 8/4/2009 8/7/2009 nd numbness in both hands and feet for over 12 hours. Soreness at the injection site continues. Y 8/3/2009 8/4/2009 IENT'S FAMILY, PATIENT C/O TINGLING Y ON LOWER EXTREMITIES AND BEING VERY WEAK. N FAMILY 4/4/2009 CALLED DOCTOR OFFICE T Y Y vaccination (Hepatitis B) - Colic, sleeplessness, irritability. Same following next several Y vaccinations, N followed by ### cognitive### skill delays, spee t 6, 2009 my son recieved the Pneumococcal Vaccine. Four hours later he devolped a fever Y which lasted8/6/2009 for 2 days8/6/2009 and ranged from 101 eived 1st GARDASIL and 2nd VARIVAX Y vaccines afternoon of 8/5/09, experienced swelling Y of face, eyes,8/5/2009 throat, itchy 8/6/2009 and tingling in mouth rvous prior to receiving vaccinations and after 5th immunization pt stated "I feel weak". ColorYfrom lips went 8/6/2009 pale. Gave 8/6/2009 pt orange juice. Pt's eveloped hives all over her Y body. Her legs and hands are swallon. The hives are slowly spreading U to her face. 8/5/2009 Temperature 8/8/2009 since 08/08/08 n has been received from a physician concerning a 19 female patient who on 12-JUN-2009 U was vaccinated 6/12/2009 with the second 0.5ml dose of n have been received from the register Y nurse and Y a hospital central 15service technician, for GARDASIL, N a6/23/2009 Pregnancy7/22/2009 Registry product, conc
n has been received from a focus group researcher concerning a 17 year old female who was N vaccinated with GARDASIL. 4/1/2009 In April 2009, th n has been received from a physician Y concerning Y an approximately 17 year old female who N in 2007 was vaccinated ### IM with ### the first 0.5 ml n has been received from a consumer Y concerning her 18 year old daughter with no drug reactions/allergies N 6/16/2008 who was 10/1/2008 vaccinated with the fir n has been received from a Registered Y Nurse (R.N.) concerning herself (a 62 year Y old female) N with hypothyroidism 6/29/2009 7/10/2009 and no drug allergies w n has been received from a 73 year old femaleYpatient with blood pressure 0 high and sulfonamide N allergy10/1/2007 who in October 3/1/2008 2007, was vaccina n has been received from a 73 yearYold male patient with gastrooesophageal reflux disease N who on 24-JUN-2009 6/24/2009 was 7/23/2009 vaccinated with ZOS n has been received from a female registered nurse with reflex sympathetic dystrophy, Y cystitis N interstitial, allergic reaction to cefaclor and s n has been received for the Merck Pregnancy Y Registry from a physician for VARIVAX (Merck) U concerning 2/22/2008 a 33 year old 4/1/2008 female with cardiac ort received on 29 July 2009 from a Y health care professional. A cluster of two five year old patients U with a7/27/2009 history of speech 7/27/2009 delay and autism ort received on 29 July 2009 from a Y health care professional. A cluster of two five year old patients U with a7/27/2009 history of speech 7/27/2009 delay and autism administration of DTaP-IPV vaccines Y patient developed Y agitation and 1 difficulty breathing. She Y had been 7/30/2009 extremely combative 7/30/2009 during the im swelling 3 hour after Immun. Gave BENADRYL - No further swelling within next 1 hour. No Yrespiratory distress. 5/22/2009 5/22/2009 7/21/2009 unization, patient developed paresthesia Y of all limbs. 8/19/09 Neuro consults received dated N12/15/2008 with dx: ###Paresthesias ### of the hands & off X 4 days, rash on back and neck Y X 1 wk and spreading. Y 1/13/2009 7/27/2009 d 35 days post vaccination that sheYhad been diagnosed with chickenpox. Zosters cover body, Y concentrated 6/26/2009 on trunk, 7/31/2009 non-febrile. Treating ale fainted for seconds and fell back post vaccine admin. - head hit floor when fell - RequiredYlying in exam 8/4/2009 room until8/4/2009 able to get up withou LA lesions erupted 8/3/09. U 9/12/2000 8/3/2009 multiforme skin RXN. Y N 7/30/2009 8/2/2009 ther phoned at approx. 3:50 PM - States that after arriving home, patient was pale - "White as Y a ghost" & 8/3/2009 clammy. No 8/4/2009 hives, no problems b e - Induration at site of injection 5cm X 2cm - Erythema, tissue edema total area 10 cm X 10 U cm at injection 8/3/2009 site. 8/4/2009 ports pain at injection site and tight muscle since 7/25/09. No redness, no warmth, no swelling. U Patient advised 7/25/2009 to return 7/25/2009 to clinic or see PCP e, neck, back pain, nausea, fever, starting Y 12 hours after vaccine. U 8/4/2009 8/5/2009 eddened warm to touch, & with pain; swelling Pt stated "I am feeling better". "I did have a fever". U T 97.0. 7/30/2009 7/30/2009 welling, left arm bumps. Y 8/1/2009 eived MCV4 on 8/4/09 in left deltoid. On 8/5/09 client's left deltoid is sore, swollen and warm to touch. 8/4/2009 8/4/2009 nted and fell to the floor, soon after receiving immunizations. Y 2/13/2009 2/13/2009 d ZOSTAVAX on 7/16/09. Within seven days, she states she developed a blistery rash on both Y sides of7/16/2009 her face. Pt 7/24/2009 did not seek medical given on Aug. 4, 2009, went home started to have bilateral Jaw pain. Pain behind his eyes, zoning out per 8/4/2009 mom. 8/4/2009 followed by tingling in the arm/ hand. She then developed numbness/ tingling on some side Yface. Resolved 8/4/2009 overnight. 8/4/2009 len upper/forearm, warmth of arm of right arm lasted for 3 days - Swelling and redness started Y treatment7/31/2009 20 hours after 8/1/2009 immunization: cool es 7/27 went to ER CXR NL U/A - CxY negative - Went to clinic u/c 7/27 sent to another clinicY seen by doctor 7/24/2009 7-29-09 7/27/2009 - Hives under neck, d ea of redness, warm to touch right deltoid Y area at Tdap injection site, redness just noted today Y 8/7/09. Area 8/5/2009 of 11.5 mm 8/6/2009 x 12 mm area of re with assistance to floor. Posterior head was struck on fridge. Pupils dilated approx 7mm - ptYwas not following 8/4/2009 commands 8/4/2009 to squeeze hand ter received her 1st dose of GARDASIL IM. We then went to check out at the receptionist's window. My daughter fainted 8/4/2009 or had a stiffening chy muscles, fever warmth, a general feeling of weakness. Some fuzziness in my head. Drinking water and 8/4/2009 taking ADVIL. 8/4/2009 d/ raised area. Warm to touch with tenderness - ADVIL given by caretaker - Warm compressYapplied - reaction 8/5/2009 appeared 8/6/2009 8-6-09 to left arm. ped nausea, paleness, diaphoresis @ time of injection of VARICELLA #2. developed redness, Y swelling, warmth 8/5/2009 with tenderness 8/7/2009 and severe mild itchy scattered pruritic macules progressive increased until day of eval on 7/30/09 R armUinjection site7/7/2009 redness/includes 7/10/2009 multiple scatter ite red and swollen - Advised this is nl. U 8/3/2009 8/5/2009 d diffuse macular rash and chest pain. Positive cardiac enzymes along with normal ECG thought U developed 7/31/2009 myocarditis. 8/2/2009 Treatment was pa AFTER VACCINES- FATIGUE,FEVER,CHILLS, SLEEPING 12 HRS A DAY X 2 WKS, DOUBLE Y VISION 24/6/2009 WKS LATER, 4/7/2009 (R) PERIPHERAL rts that Friday (8/7/09)evening patient Y began itching her feet. She didn't make much of it and Y went to a friends 8/7/2009 to swim. 8/7/2009 She spent the follo d just received Tdap, Hep A, MCV4, MMR, & Varicella vaccines. He was sitting down waiting Y while his sister 8/6/2009 sat on the 8/6/2009 exam table waiting ts to HD 08/10/09 @ 800am with c/o of redness and itching, burning at site of varicella vacination Y to LPUA8/7/2009 SQ site from 8/7/2009 shot given 08/07/09 indications to vaccine on screening. Client give Tdap vaccination with father present and immediately Y reported 8/10/2009 dizziness. 8/10/2009 Her color was pi eft arm-deltoid area-was seen in ERYon Sunday, Aug 9th. Mother states was hughe yesterday. Y No c/o fever. 8/7/2009 Full ROM 8/7/2009 of proximal and dist N IPV AND MMR RIGHT ARM ON 08/05/209, Y RETURN BACK 8/06/20009 C/O TENDERNESS U AND WARM 8/5/2009 TO THE8/7/2009 LEFT ARM. BENADR high pitched crying x 3 days Y 6/10/2009 6/10/2009 swelling measuring 3.5 inches in diameter Y on left thigh. Y 8/5/2009 8/5/2009 redness measuring 6.5 in x 5.5 in, tenderness, Y and mild swelling. Y 7/28/2009 7/28/2009
-14 hours after immunization on 8-7-09; she experienced redness and inflammation at injection Y site, pain from 8/7/2009 ear down 8/8/2009 to wrist,fever,nause aised red welt formed the day after the shot, now gone down a bit but spread to 3X6 inches, N "almost elbow8/7/2009 to shoulder". 8/8/2009 Still a little warm to inutes after shots were given, client began to complain of "feeling funny with ringing in his ears Y and headache, 7/31/2009 diaphoretic 7/31/2009 and pale. Cool c days after the vaccine was administered the patient reports that she broke out in hives, all over Y her body6/22/2009 but consentrated 6/24/2009 on the abdomen Gardasil dose #2. Walked to waiting room and fainted. BP 118/60. Given ginger ale to sip.Y Denied dizziness. 8/10/2009 BP8/10/2009 recheck 5 minutes late vaccination Zostevax received Fri, 11AM, 8/7/09. Evening of injection, slight fever, muscle ache U down arm8/7/2009 to hand and 8/7/2009 up neck behind ear dministered May22, 2009. LMP June 14, 2009. Confirmed Pregnancy August 5, 2009 - 7.5Yweeks gestation. 5/22/2009 8/5/2009 crying for more than 4 hours non consolable Y and Swelling + erythema at the site of injection Y for PEDIARIX. 6/8/2009 iness, difficulty breathing, severe weakness, Y sleepiness, tremors all over the body, trembling, U electricity-like 7/17/2009 motions7/17/2009 all over the body, swo vaccine administered on 7/23/2009. First chicken-pox noticed on 8/07/2009. Subsequent chicken-pox Y developed 7/23/2009over 8/7/2009 the next 4 days on t ely following HPV#2 and Varivax #2 (10:45 am) patient fainted and fell forward off of the exam Y table and 8/10/2009 hit her Left 8/10/2009 cheek, ear and knee on d papular rash over entire body later on 08-06-09. No itching with rash. No redness, swelling N or inflammation 8/6/2009 noted at 8/6/2009 injection sites. Bena with mild erythema, 3cm with slight induration, Y non-tender. Y 7/20/2009 7/21/2009 vaccines on 07/29/09, Varicella on Y the right arm. 07/31/09 right arm is red, hot, swollen and Y painful, patient 7/29/2009 vomited,7/31/2009 dizzy and started to fa or 3 days left side around rib area, did drain some last PM. There has been some slight extension Y of lesions 7/30/2009 toward the 8/7/2009 back over the last c was reported by a lawyer via a statement of injuries and described the occurrence of neck pain U in a female subject of unspecified age who ythema, warmth, tenderness, slightly Y raised- "like Y skin was burning off", 2 Fever. 8/27/08 Hospital Y records7/31/2009 received DOS 8/1/2009 8/5/09 8/6/09. Asse rm, armpit, down side from armpit. 0 swelling. 0 fever. Pain started in arm - spread over the last couple 8/7/2009 of days. 8/8/2009 male ADSM/Specialist is referred toY FBVHC by SRC physician for smallpox vaccine inoculation Y site concerns. 7/31/2009 R/O satellite 8/6/2009lesions versus 9 Mild, other. Redness. 3 inch diameter, tender to touch. U 8/7/2009 8/9/2009 p R thigh covered by bandaid, red area (also raised) 39mm x 23mm @ widest point above and Y medial to7/27/2009 inject. site.7/28/2009 Inj. site sl. red (11x11 m Bradycardia - pulse < 40. Given oxygen. Y 7/27/2009 7/27/2009 given 7/20 including ROTAVIRUS. On 7/21 called about blood in the stool. Seemed well otherwise. Y 7/20/2009 pt rec'd KINRIX on L arm and VAX/MMR R side SQ, pt RTC for PPD reading 8/7/09 motherYshowed me L8/5/2009 arm stated8/6/2009 "It was worse, startin al notes: 19 y/o male who developedYmildly pruritic skin lesions over bilateral hands, primarilyYknuckles &1/29/2009 right palm, 2/14/2009 & bilateral elbows appr onset of LE and buttock purpura on Y8/5/09. Pt has developed subsequent hematuria. Pt hs been U diagnosed 7/27/2009 with HENOCH 8/5/2009 SCHONLEIN Pu accine in R DM. approximately 5 mins Y later pts inj. site turned red and had a dime size induration. Y Pt was 8/10/2009 then seen 8/10/2009 by Dr. me sized induration, quarter sized redness Y to R arm injection site, no dyspnea no SOB or swelling Y to other 8/10/2009 sites. 8/10/2009 indurated area @ site of vaccinationYleft thigh. Hives/ urticaria on 8/6/09. U 8/4/2009 8/5/2009 ost vaccine increase itchy rash red. No evidence infection 30 cm diameter circular. No rash Y other area. 6/29/2009 No joint pain. 7/9/2009 scribed red swollen extremity in R leg where vaccines were administered, pt had 4th DTaP and Y Hep A #27/1/2009 in R LE. Mother 7/6/2009 first reported to p m, swollen extremity where 4th dtap given, also fever and a hoarse cough (per mother) for one Y night. The7/1/2009 redness, swelling 7/6/2009 lasted several w nd was nauseated 7/29 eve. Continued with HA 7/30 and not feeling well. Pt had 2" red, swollen Y area at 7/27/2009 injection site 7/29/2009 with itching and vesic pneumococcal vaccine in office on 5/15/09. Y Calls office on 5/17/09 and is seen in Urgent Care. U Experiencing 5/15/2009 redness 5/17/2009 Lt deltoid, warmth rep t 5 PM lips started swelling. Called Y hospital at 5:30 had to leave message. 6:10 PM. Hospital Y nurse called 6/10/2009 treatments. 6/10/2009 Take 1.50 mg BEN icaria, and extreme erythema full body Y 1 day after Hep A immunization. Pt had no other abnlYpo intake. 8/3/2009 8/4/2009 rts swelling & redness in right shoulder within an hour. HEP A given there. Had low grade fever, Y next day 7/28/2009 102, went 7/28/2009 to school, come in 2 d X 14 cm red, warm to touch rash developed Y 24 hrs after injection to HIB & DTAP. Y 8/3/2009 8/4/2009 vaccine administered with 5/8" needle to left upper arm @ approx 11:10 AM. Pt left exam room Y @ approx 8/4/2009 11:20 AM and 8/4/2009 used bathroom. Pt d nasal swelling, throat clearing, pruritus Y Y 7/22/2009 7/22/2009 ul. States on 7/2 her Lt. arm (deltoid) was twice as large as other arm, very red, very itchy. Came Y to Employee 7/1/2009 Health7/2/2009 7/3 - we were closed hours the pt. developed erythema at the site of injection- (R) tigh. The erythema increased inUsize to 12x10cm 8/3/2009 with small 8/4/2009 area of induration redness, warmth @ site of VARICELLA - pt denies tenderness - warm compress applied perYmom 8/5/2009 8/6/2009 n has been received from a consumer Y regarding a case in litigation concerning herself (a female N patient of unknown age) with no drug aller n has been received from a physician Y via medical Y records concerning 0 a 20 week old premature U (WAES #0707USA01443) 11/7/2007 1/1/2008 male with a histo 8/3/2009 N 7/28/2009 8/3/2009 - admitted 7/31/09 for 24 hour ear infection. Y Treated Y with oxygen, albuterol, 1 atrovent, steroids Y and amoxicillin. 7/25/2009 9/8/09 7/31/2009 Hospital records rec MR given with Hep A, Hib, DTaP, PCV-7, VZV - 5/28/09 - Rash after fever - 6/02/09 - Vaccine Y reaction noted 5/15/2009 with rash, 5/15/2009 fever. en an MMR vaccine 2 days prior to being administered Yellow Fever. No adverse s/s. Will do U Yellow Fever 6/17/2009 titer in 30 days (one month) wh slightly red and tender. 8/4/2009 8/5/2009 shaking chills X 16-17 hrs after vaccinations Y given. Y 7/31/2009 8/1/2009
ccine on 7/31/09 in late afternoon. Pt. Y then started Y with fever and had 2 febrile seizure early 8/1/2009. Y 9/4/09 7/31/2009 Received 8/1/2009 ER records of 8/1/20 wollen, tight 24 hours. Y 8/4/2009 8/5/2009 Y 8/3/2009 8/3/2009 s post immunizations pt.'s face and Yeyes began swelling. Hives on chest. Taken to ER. Given Y IV fluids. 8/3/2009 Prescribed8/3/2009 PREDNISONE & BEN eft hip pain at injection site which restricted ability to walk for 4 days then moderated. Chills, Y hot flashes for 7/26/2009 7 days. 7/27/2009 Did not experience feve area (4 cm X 6 cm) below needle site Y (left upper arm) - Slight bruising (1 X2 cm) beneath needle U site warm 8/1/2009 to touch, 8/3/2009 slight swelling of red a and slight swelling below area of injection (not warm to touch) "slightly painful", says Pt. 8/1/2009 8/4/2009 Sick call with headache after Small Pox Y Vaccine 4 wks ago and papular rash all over body x 6Udays. No fever 7/2/2009 / chills.7/26/2009 Ibuprofen for headache h department, in car-driven by sister and their way home. Pt stated didn't feel good, sister noted Y body stiffened 8/3/2009 - muscle 8/3/2009 became tight and s ithin 2-3 minutes after given vaccine, Y observed here for 60 minutes the sent to E.R. 8/6/2009 8/6/2009 09 approx 10:10 AM vaccines administered Y tolerated well - nurse assisted client and motherYto supply room 8/4/2009 to receive 8/4/2009 health information m d "tiny red bumps" on arms, legs - None Y on back or stomach - itching - Unknown fever - to ER Y 7-25-09 - Rx 7/17/2009 Amox. 500mg 7/22/2009 tid x 21d. vomiting, grey skin tone. Syncope lasted Y ~20 sec, patient came to and combative, then began Y vomiting intermittently 7/29/2009 7/29/2009 and skin tone grey X 01 degrees F, myalgias, chills, headache, Y and arthralgias N 8/4/2009 8/5/2009 hrs after receiving vaccine (R) upper arm became swollen, warm, red, and itchy. It continuedYto progress7/30/2009 and pt returned 7/31/2009 to MD to evaluate algias, rash 24 hours post injection. Tx'd with PREDNISONE - developed fever & myalgias - Y After 1 wk resolved 7/27/2009 except 7/30/2009 left wrist pain. ped marked redness and swelling at injection site (about 10cm X 5 cm) Y 8/4/2009 8/5/2009 es, fatigue, blisters inside mouth, swollen Y glands, sores on lips and gums, swollen lips. 8/4/2009 8/5/2009 ollen, red, hot over entire arm; developed within 24 hours after vaccine. Y 8/7/2009 8/8/2009 MENACTRA 7/24/09. Felt bad the next Y A.M, with headache. -Progressing to HA - with feverY103.0 degrees 7/24/2009 F orally.7/25/2009 Went to ER on 7/26/09 arrhea w/in 48 hrs. of 3rd vaccine, vomiting, Y chronic fatigue, headache, abdominal pain, heart N palpitations, 6/25/2009 sensitivity6/27/2009 to light & noise. All ex d HEP A & VARIVAX on 7-29-09. On Y 7-30-09 Pt went to ER for a 5 X 2 cm wheal where VARIVAX Y was7/29/2009 given. Pt was 7/30/2009 afebrile. It resolved ying episode lasting > one hr, refusal to feed X 4-5 hrs. Pain - type cry, no coloration changes Y (occurred7/30/2009 4 hrs post 7/30/2009 vaccines). TYLENOL a 9, Pt. was administered tetanus tox. 0.5ml to (R) deltoid tolerate well. Pt. RTZ on 8-3-09 withYc/o inj. site 7/27/2009 was swollen,8/3/2009 red, tender. Noted 9c mild erythema of injection site left upper arm (6 cm X 6 cm). No fever. Very tender. Suspect Y edema closer 7/14/2009 to injection 7/15/2009 site of DTAP. ted to clinic today one day post PPD plant and varicella vaccine, with multiple large area of edema Y that appeared 8/5/2009to be 8/6/2009 mosquito bites, pos ped large red area around injection site -MOC describes as the size of a tennis ball. U 8/4/2009 8/4/2009 loped fever 103.4 given AX TYLENOL Y + a bath + noticed jerking spell x 2 lasting 2-3 seconds. Y Taken to 5/4/2009 ER w/ temp 5/24/2009 103.4 in ER had a se swelling, redness, itching in arm. Just above injection site to the elbow, inside of arm is veryNitchy. Mild fever 8/1/2009 & very8/1/2009 tired. Slept for 12 hou around injection site. Swelling. Probable Y cellulitis. Rx: KEFLEX 250 /5ml one tsp po TID #105. Y 7/30/2009 7/31/2009 , Pt was brought in by her mother. Pt had a red & swollen arm. L arm. She had her immunizations U on 8/4/09. 8/4/2009 8/5/2009 ediately c/o light headedness and tingling of both hands. Became semi responsive. BP 70/50, Y O2 applied, 7/27/2009 clammy and 7/27/2009 pale. 1135 was to w accine administered Friday, July 31st, 2009 normal burning sensation, discomfort experienced immediately. 7/31/2009 Next day,8/1/2009 Saturday AUG 1st, n 15 minutes after receiving vaccines child told mother, thet had already left the clinic, that herYthroat huet 8/10/2009 and she was 8/10/2009 having trouble breath deltoid, 7x7" distal, increase heat at injection site, central area large. Tx: Benadryl spray, claritin U 10 mg oral, 8/3/2009 ice to area 8/5/2009 hot and red on anterior left thigh approx. Y 5" x 3" in diameter. Seen at ER, given Benadryl andUBactrim. 8/4/2009 8/4/2009 ted redness, swelling, and itching of child's right upper arm a day after receiving vaccinations. Y Called MD.8/8/2009 Instucted to 8/9/2009 put ice on area and as given vaccines in AM and later inYevening developed fever to 104.9. Also had some abnormal Y "twitching" 8/10/2009 of body8/11/2009 that was able to be su sodes of numbness and tingling of left arm and leg unrelated to the site of administration. thisYshot was given 8/7/2009 in the right 8/9/2009 arm. It was her 4 t 2Pm Shots. Fever - mid. of night (not Y extreme acc. to Mom). Total of 4 doses tylenol from shots Y til morning 7/29/2009 of 7/30/09. 7/30/2009 Then did not need 03, tachycardia, flushing of face within Y 1 hour of vaccine administration. No hives, wheezing, Y angioedema, 8/11/2009 vomiting, 8/11/2009 or hypotension. Trea g on arms and legs. Fine red rash seen on tops of arms. Y 8/11/2009 8/11/2009 ed body aches, elevated temp of 102 Y to 102.5 began @ 2am after receiving tdap; 1 gm Tylenol U initially brought 8/10/2009 temp8/11/2009 down to 101.0; pt then and erythema at the injection site beginning Y within 24 hours after the injection and subsidingU 4 days after8/7/2009 the injection, 8/8/2009 though still present. 104.8 starting ~36 hours after vaccine Y administration, febrile seizure ~48 hours after vaccineYadministration. 8/7/2009 8/9/2009 patient. States had pain right away from Y TDap vaccine. Awoke next day with swollen lymph nodes. U Now 88/3/2009 days later pain 8/4/2009 is worse in arm. C d HPV4 vaccine injection on 8/7/09 at about 4:30pm. She developed a 4-5 inch diameter area Y if hives around 8/7/2009 the injection 8/7/2009 site at about 9pm ven kindergarden immunizations, ( did not even cry) we talkesd about what she was going to do now . I left 8/11/2009 the room8/11/2009 as I was finished. fathe odes of malaise, headache, nausea,Yfever, joint pain starting about 8 hours after vaccine administration. N 8/10/2009 Second vaccine 8/10/2009 was given with Be and very warm to touch. small amount Y of swelling. Fever of 101 degrees F. Girl just wantsUto lay on couch 8/10/2009 states8/11/2009 mother. Rapid Heart Rate, Excessive Sweating, Y Shortness Y of breath. Dehydration. 1 Had to go to hospital and have 11/3/2008 my baby11/7/2008 montored as I was pre
hepatitis B vaccine at employee health Y and 15 minutes later developed urticaria. Was treated Y at the ED which 7/22/2009 is adjacent 7/22/2009 to employee heal h day after shot patient ran fever during Y the day and very high fever during the night. 10th day U after shot7/31/2009 she began to 8/8/2009 have a rash along w 3-4 MIN AFTER ADMINISTRATIONYPT STATED SHE WAS DIZZY THEN SLUMPED OVERY HER CHAIR 8/11/2009 FOR 5-10 8/11/2009 SEC. SAT BACK UP Bile stained. AbdominalY pain. Anorexia. Y Air contrast Y enema + Abd.1X ray + Abd ultra-sound.Y 8/24/09 Hospital 7/31/2009 records 8/6/2009 received DOS 8/6/0 of hours after 1st shot, my left knee (which I've had 9 surgeries on, synvisc injection, and is arthritic) Y swelled 7/27/2009 up very7/27/2009 large far 5 days straigh cm left arm swollen with redness - ice arm every 2 hours per provider - RX given (TYLENOL). U 8/8/2009 8/10/2009 ter vaccination pt developed a feverYand her tongue and throat began to swell." TX: "Prednisone, Y cimetadine". 8/3/2009 - Pt tx8/5/2009 in ER. - Pt reported th ately 24 hours after receiving both TDAP and MENACTRA in left arm patient presented to clinic U with 8 cm 7/28/2009 X 8 cm area 7/29/2009 of induration, warmt ite reaction- 1/2 dollar sized, warm to touch, itchy. U 8/3/2009 8/5/2009 ite reaction - 2.5 inch diameter, hot, itchy, red. U 8/4/2009 8/6/2009 ythema of head, chest, arms and swelling of lips within 10min of receiving vaccine. He was given Y 20mg BENDRYL 8/10/2009 p.o. 8/10/2009 and EPI-PEN JR 0.1 15 min's developed hives at the injection sites. Resolved with ice and BENADRYL. Y 8/10/2009 8/10/2009 pper lat leg - VARIVAX - 4 d ago. Redness- serpentigenous. U 8/7/2009 8/8/2009 erythema/induration w/ spread. Y 7/29/2009 7/30/2009 7/31/09- R. arm hives that spread to back and around down legs. Sat and Sunday felt nauseous Y and feverish. 7/31/2009 No documented 7/31/2009 fever. Mond tous, indurated are 4.5 x 4.5" on R arm with no tenderness. No fluctuence. Y 7/29/2009 7/30/2009 arted coughing, wheezing, had facial swelling, hives. Pulse 0X 93%. Given 1 1/2 Tap BENADRYL, Y ORAPRED 7/31/2009 2 TAP 7/31/2009 X1, EPINEPHRINE hematous swelling of the left arm. Y Y 7/27/2009 7/28/2009 redness at injection site. Fever X one day and body aches. Y 7/13/2009 7/15/2009 edema/erythema. Y 8/5/2009 oped swelling of and erythema around injection site on right thigh. Swelling at maximum ~ 5 Y inches by 4 inches 8/5/2009 on 8-7-09. 8/6/1999 Erythema began ately 5 minutes after vaccines were Y given, child collapsed to the floor. She took a hard blow Yto the back 7/23/2009 of her head.7/23/2009 Regained consciousn vaccines on left arm (DTAP, IPV, VARICELLA) 7/28/09. Mom reported one day later adverse reaction. 7/28/2009 Nurse practitioner 7/29/2009 examined and n ain at injection sight in left arm. Arm Y red hot to the touch. This occured after 36 + hours after initial N injection 8/10/2009 of vaccine(s). 8/10/2009 Nausea and contin vaccine on 10-18-26 onYthe adviseYof my Doctor. Y I noticed no adverse 40 Y effects until 01-17-2007, U when my wife### discovered 1/17/2007 me down on the ised splotches appeared on babie's chest and abdomen exactly one hour or so after the vaccine Y injection 8/10/2009 on babie's8/10/2009 left front thigh. The sp but pain from the shoulder joint to wrist of the arm the inj. was given. difficult to lift coffee cupUthe next morning. 8/11/2009 pain8/12/2009 is a 7 on a scale of 1-1 LTOID 6 X 8 CM OF ERYTHEMA, WARMTH, IRRITATION (PRURITIC), AND INDURATIONYSURROUNDING 8/3/2009 TDAP 8/5/2009 INJECTION SITE. PT Varicella vaccine on June 22, 2009. Was diagnosed with Shingles on August 7, 2009. U 6/22/2009 8/4/2009 utes after injection client experienced itching at injection site. After about 2 hours had itching Y all over and8/3/2009 had rash on 8/3/2009 cheeks. Took bath i n has been received from a physician Y concerning Y a 14 year old female 1 with no pertinent Y medical N history 1/10/2009 and no known 5/4/2009 drug allergies (NKD n has been received from a nurse concerning Y a child with asthma who on 06-AUG-2009 wasUvaccinated with 8/6/2009 a dose 8/6/2009 of VARIVAX (Merck) ( , dizzy, nausea weak next day. 8/5/2009 8/6/2009 ted to clinic on 8/11/09 with history of Y blisters X 2 d. Fever 100 - 101 AX. Exam revealed approx. U 80 - 100 2/19/2009 vesicles primarily 8/9/2009on the torso. use swelling/redness of (L) arm within Y 24-48 h after vaccines. Seen in ED for evaluation. Y 8/6/2009 8/7/2009 eadache and low grade temp lasted approximately 24 hours. Sx started about 12 -15 h after shot Y 7/30/2009 7/31/2009 imately 2.5 + 2.0 erythematous indurated Y area around injection site from evening of injectionUat site of PREVNAR 8/4/2009administration. 8/6/2009 2) 48 hou n before realizing patient had one on 8-18-08. Y 8/6/2009 ven 4 go shots (DTAP, IPV, MMR, VZV KINREX) 2 days ago L arm developed redness and induration Y with 8/3/2009 elevated warming 8/4/2009with mild tend o injection sites 2 1/2 cm. Increased T. Y 7/30/2009 7/31/2009 ye doctor = pt thought she had another stye, but eye doctor told her he thought it was shingles Y because 7/24/2009 it was past the crease in her eye fo swollen, warm to touch. Skin very tight. U 8/4/2008 8/5/2009 swelling thigh - 10 cm swelling to (L) thigh - 20 cm swelling to (R) thigh - BENADRYL susp. 3/4 Y tsp PO - SOLUMEDROL 7/30/2009 7/31/2009 0.38cc IM of four patients (patient identifiers were not provided) received ADACEL (lot number UF452AA) Y on an unspecified 8/13/2008date. 8/14/2008 All patients develop of four patients (patient identifiers were not provided) received ADACEL (lot number UP452AA) Y on an unspecified 8/15/2008date. All patients develop serious case was received on 30 April Y 2009 from a health care professional. A cluster of fourYpatients (patient 8/14/2008 identifiers 8/15/2008 were not provided) serious case was received on 30 April 2009 from a health care professional. A cluster of fourYpatients (patients 8/11/2008 identifiers 8/12/2008 were not provided veloped severe and longlasting yeast infections after first and second dose of Gardasil. Doses Y were given 8/11/2008 2 months8/26/2008 apart. Gardasil #1 08/ vaccines were given, pt was taken to hospital for seizures. Hospital states that they do not believe Y that the 6/18/2009 seizures6/19/2009 are related to the vacc d Zostavax on 08/10/09 at 9:30am. She noticed area of injection site was red and itchy on 08/11/09 U in AM. 8/10/2009 Today (08/12/09) 8/11/2009she has eryth ates the child had "vomiting, slight fever, and alot of bleeding". Grandmother called in on 8/11/09 to report. 8/10/2009 Grandmother 8/10/2009 not sure if she will
to parents child had decreased babbling after admin of PCV7 vaccine. Resolved on its own.YNot witnessed 4/24/2009 by anyone 4/24/2009 in this office th symptoms c/w partial seizure vs. hypotonia, Y hyporesponsiveness.1 Almost immediately after Y recieving her 8/7/2009 6 mo immunizations, 8/7/2009 episode w c'd 6 immunizations here in clinic. After standing waiting about 4 min. she felt dizzy, sat down, Y rested, wet8/6/2009 paper towels 8/6/2009 on face and neck. R immunizations. Waiting for the 15 minutes with his sister. He saw her get dizzy as nurse sat Yher into chair,8/6/2009 then he fainted, 8/6/2009 bumped his hea arms, trunk, back, neck U 8/3/2009 8/4/2009 swelling at injection site, exteding 2 inch diameter. Mild tenderness U 8/10/2009 8/10/2009 ven Zostavax to LUE on 08/06/2009Yand presented to office 6 days later on 08/12/2009 w/ possible U shingles 8/6/2009 lesions8/12/2009 to RUE. Pt presented a ow-grade fever (100.2 orally) that night, Y then thigh pain the next day, then rash and swelling Ythe day after8/10/2009 that. I examined 8/11/2009 him 8/12/09 and 00.0,joint pain, body aches Y 8/10/2009 8/11/2009 as sent to the nurses station to receive Y a Gardasil, Menactra, and Tetanus shot. She received Y all three, and 8/12/2009 was asked 8/12/2009 if she felt okay, rep ssed out about 5 minutes after receiving both Gardisil #3 and Hep B #2 immunizations. Came Y to rather quickly 8/5/2009 after cold 8/5/2009 compresses were perienced vomitting approximately 10 mins after recieving vaccines. Vaccines were administered Y at approximately 8/12/2009 8/12/2009 12:30 pm. WOKE UP LAST NIGHT, 08/11/2009, TEMP OF 104.0 C/O HEAD, NECK AND MUSCLE PAIN 8/11/2009 8/11/2009 GIVEN AN EXTRA IPV NAD TDAP BEFORE DUE Y 8/6/2009 er receiving Zostavax patient came to the pharmacy with 3 shingles at the injection site and U 1 shingle on her 8/7/2009 belly. 8/10/2009 Patient said they aren't e shaky and nauseuos within a few minutes. She got 3 hives. BP 125/65 pulse 93, No wheezing Y or trouble 8/12/2009 breathing. 8/12/2009 25 mg of benadryl w eizure 8-11-09 Seen in ER and air lifted Y to Hosp. Y 8/28/09 MR received 2 for DOS 8/12-13/2009Uwith D/C DX: 8/10/2009 Convulsions 8/11/2009 NEC. Neurologist d ed 2 days post vaccination for ppd reading with erythema, edema, heat and site pain. advised U cold compress 8/10/2009 for 10m 8/10/2009 on and 10m off x4 h s very red and swollen. It is also under Y the area. Two areas are effected. This happend the last U time he got 8/10/2009 shots. It8/10/2009 is also painful. It felt lik was reported by a physician, via another Y manufacturer Y (Amgen, # KDL345560) 0 and described U the occurrence ### of bone 4/23/2009 marrow failure in a 2 te abdominal pain then syncope with decreased Y body temp (95). In 4ER, LP and bloodwork concerning Y for shock, ###no infection ###found. Stayed pain at site of vaccine 8/6/09 - Seen 8/11/09 - (L) anterior thorax- diffuse erythema with vesicles. U 8/4/2009 8/6/2009 iving 4 mos. vaccines child developed hives - Mom gave 1/2 tsp BENADRYL x 1 dose hives Ydisappeared8/11/2009 came in for 8/11/2009 office visit on 8/12/09 er, called this RN at 12:15pm and stated Y that daughter's left arm from shoulder to elbow is red, swollen,hot 8/10/2009 to the touch 8/12/2009 and the skin looked dness; Itching and warmth around MMR vaccination site. N 8/10/2009 8/11/2009 icaria appears 2 days after completion of oral typhoid vaccine. Patient started oral vaccine or U at home on7/22/2009 8/1/09. 8/10/2009 njection site with vesicles, warmth redness. 8/10/2009 8/11/2009 @ injection site by day 2 after administered Y HEP A & VARIVAX on same thigh developed redness, Y welt's, 7/30/2009 itching; developed 7/31/2009into cellulitis b administered R upper arm, after a few Y minutes later client slumped over, non responsive, body, Y arms became 7/31/2009 rigid, hand 7/31/2009 fisted with some tr lump to site fever 103.4. Rash all over left leg. 8/10/2009 8/11/2009 d DTaP left deltoid at hosp on 8/9/09 Y c/o redness 3in x 3in with swelling at site of injection. Assessed U by PA, 8/9/2009 local allergic 8/9/2009 reaction. Treatme n has been received from a nurse and Y the patient's mother concerning a 24 year old female Ywith migraine 6/29/2009 & depression, 7/30/2009 no known drug all n has been received from a consumer Y concerning Y her 14 year old daughter 4 who was in the remission N of rheumatoid 6/9/2009 arthritis, 6/9/2009with allergies n has been received from a physician concerning a 22 year old female patient who was vaccinated U with the series of GARDASIL, 0.5 ml an n has been received from a physician concerning a 23 year old female patient who was vaccinated U with the series of GARDASIL, 0.5 ml an was received from a health professional Y on 31 July 2009. SERIOUSNESS CRITERIA: OTHER-MEDICALLY Y 7/18/2009 SIGNIFICANT. 7/19/2009A 37-year-old ort received on 07 August 2009 fromYanother manufacturer who received the original information Y from a consumer through their call-in cente eption. Vaccine give 7/22/09, 8/3/09Y- decreased Y p.o intake, vomiting, 2 temp 99.8. 8/5/09 - persistent Y vomiting, 7/22/2009 no stool8/3/2009 --> to Emergency Ro was administered, patientYbecame dizzy 30 seconds after shot. Patient was pale, diaphoretic Y & nauseous. 8/4/2009 Symptoms 8/4/2009 lasted about 45 min ately 20 seconds after the GARDASIL with no warning she passed out and became unresponsive Y for 10 seconds. She was very pale, diap d out in lobby after receiving vaccine, Y pt. said hit head on floor. Sent to ER for treatment. Y 7/30/2009 7/30/2009 d PCR positive for pertussis 7/28/2009 Y 10/2/2007 7/28/2009 quired pertussis (positive PCR on 7/16/2009) Y 4/25/2007 7/16/2009 ped pertussis (PCR positive) on 7/23/2009) 7/2/2008 7/23/2009 quired pertussis and was PCR positive on 08/10/2009. Y 1/5/2009 8/10/2009 ately 5 minutes after injection, pt began Y complaining Y of shortness of 2breath Y and her throat closing U up. She 8/12/2009 was brought 8/12/2009 back to the exam ro d pertussis and was PCR positive on 08/10/2009 Y 9/11/2006 8/10/2009 quired PCR positive pertussis on 8/6/2009 Y 5/11/2006 8/6/2009 ately 5 minutes after receiving injection, Y patientYbegan complaining of 2 shortness of breath and Y that her throat 8/12/2009 was closing 8/12/2009 up. She was brou t site of injection (right shoulder): 2- or 3-inch diameter raised area of redness, soreness, tenderness. Y 7/21/2009 7/23/2009 patient reported some swelling afterYfirst day, which progressed to the left upper arm down to Y mid forearm 8/10/2009 swelling 8/11/2009 with edema. Pt was see
ped shingles 8/12/09. N 3/10/2009 8/12/2009 ported to us on 8/5/09. She had a seizure Y 2 mins after 2nd GARDASIL Injection. Y 8/13/2007 11/1/2007 e of injection became hard, swollenYand very hot to touch. Rash all over body with high fever. Y 4/10/2009 4/12/2009 d 8/5/09. Projectile vomiting 8/6/09. Listless behavior 8/7/09. U 8/5/2009 8/6/2009 ed area on left upper thigh tender to Ytouch, warm. 8/5/2009 8/5/2009 er admin - diffuse trunk papular rash - no vesicle no itchy; pt opted for antihistamine Rx alone Y - no steroids. 7/31/2009 8/6/2009 perienced dizziness and nausea appox: 5 minutes after vaccination. Patient was placed on Yback w/legs7/23/2009 raised for 15 7/23/2009 minutes. Nausea an high fever (104 Rectal), headache, Y pt seemed "out of it" per mother. Started through the night Y 7/14 to 7/15/09. 7/14/2009 Went to ER for Eval on 7/15 Tdap & Varicella L arm 7/29/09. Developed Y pain & swelling to the size of a baseball per mom Y seen in ER 7/29/2009 with diagnosis 7/29/2009 cellulitis. Put on C diameter erythema with minimal edema feels hot. Suggested TYLENOL every 4 hours prn Y & cold compresses. 8/5/2009Mom does not want to use . Mother called Health Dept. today to Y report that child had been checked at hospital after calling Y nurse hotline 8/6/2009 after hours. 8/6/2009 Evening of vaccin tions listed below given in the afternoon Y of 8/5/09. The next morning child reported a headache, Y stomach8/5/2009 ache, was 8/6/2009 febrile (mother did not me in on 7/27/09 c/o soreness left arm, neck and back. She said swelling, muscle soreness,Yfatigue, low7/24/2009 grade fever, 7/25/2009 no energy. I looked a m red papules with surrounding erythema scattered in a 3 cm patch on right upper thigh; itching. Y 7/24/2009 7/31/2009 ZOSTAVAX injection at a pharmacy. In a few hours, I got a terrific headache that lasted until 8/7/2009. The 7/27/2009 right top7/27/2009 of my head felt extreme the ZOSTAVAX on April 18, 2008. Two months ago, I started feeling a burning sensation in the skin on 8/18/2008 the left side of 4/3/2009 my back. It progress hours after DTaP + IPU given in leftYarm, it became swollen, red, hot, indurated approximately Y 13 x 13 cm.5/1/2006 No fever.5/2/2006 adace and stomache slef resolving after 24 hours Y 8/10/2009 8/10/2009 ceived 4 immunizations on 8/7/98. Mother called after hours nurse on 8/8 to report her daughter Y had developed 8/7/2009 a reaction 8/8/2009 on her right leg. Tmax of 103, soft tissue swelling, erythema, and warmth of overlying skin at site of vaccine administration. Y 8/11/2009 +Fatigue.8/11/2009 ed feeling lousy, muscle aches, andYtemp of 102.3 10 days post vaccination. On day 11, presented Y to immunization 7/30/2009 8/9/2009 clinic with temp of 100 sh and swelling, similar to a hive, silver-dollar sized...appeared at least within 48 hrs of immunization U 8/11/2009 8/13/2009 swelling, cool compress. Y 7/20/2009 7/23/2009 & swelling of arm. Cool compress 7/20/2009 7/23/2009 d a 4x4 in erythematous, warm area with vesicles noted centrally no fever. 8/10/2009 8/11/2009 of HEP A gave pt. "severe stomach cramps and diarrhea". Symptoms lasted 2 days per mother. Y 2nd dose 8/5/2009 gave patient 8/5/2009 the same stomach vaccine given @ 12 months, and PCV7 #5 given @ 15 month of age. (Accidental extra PCV7 Y administration). 7/17/2009 r, accelerated heart rate, muscle aches over whole body, swelling under arm, vomiting, headache, Y some diarrhea. 8/5/2009 Felt 8/5/2009 better after 3 1/2 day came very dizzy, nauseous immediately Y after vaccines given, eyes fluttering back. Her syncope Y lasted >15 8/11/2009 min; EMS 8/11/2009 called transported to called health center on 8-11-09 stating child had reaction to immunization. Red with swellingNper provider 8/10/2009 informed 8/10/2009 pt mother to apply ice to ite reaction- erythema, warmth and swelling 3cm induration, non tender to palpation and notUpruritic. 8/12/2009 8/13/2009 vaccine given in left arm and Hep A given in left deltoid IM on 6/15/09. Presented 5 days laterY with itchy bumps/ 6/15/2009 vesicles 6/20/2009 starting on arms, th mmunization and within five minutes had localized swelling and redness. Had provider examine U pt ordered 8/10/2009 Ice to arm 8/10/2009 applied x20 minutes. ness right upper arm. Y 8/11/2009 8/12/2009 hroat scratchiness Y 8/8/2009 8/8/2009 k was done as a routine physical one Y year after vaccine was distributed and the patients blood U platelet count 7/27/2007 was at1/12/2009 a low of 90 (normal ran ceived third dose of series for RabAvert vaccine due to rabies exposure. Patient had no reactions Y to first8/10/2009 two doses.8/10/2009 On third dose, patient of lesions on body 7/24/2009 8/7/2009 the following vaccinations today (at approximately 1545)including Tdap, MCV4, HepA, Varivax Y and HPV.8/13/2009 The patient 8/13/2009 stood up from exam t 9 Caregiver noted a red area on R arm Y when doing morning cares this am. Presented to HDUwith reddened 8/6/2009 area with 8/13/2009 irregualr borders betw ven Smallpox vaccine and Anthrax vaccine. Pt did not know that she was pregnat at time of vaccine Y 7/15/2009 8/7/2009 er 1-09 4 month shots of DTaP(with Hib/IPV/Prevnar/Rotatec) had about 48 hours of neurologic Y symptoms 1/8/2009 (namely poorly 1/9/2009 responsive, no s rm, Muscle Aches, 100 F Temperature, restless sleep. Y 8/12/2009 8/12/2009 swollen & red. U 8/11/2009 8/11/2009 s swollen & red. U 8/11/2009 8/11/2009 d office child screaming (uncontrollable) High pitched cry. Y 8/11/2009 8/11/2009 Swelling of left arm where shot was given: local inflammatory reaction to DTAP #4, r/ ocelliclitis. U 8/10/2009 8/12/2009 ew seconds body stiffened face flushed. Y 7/13/2009 7/13/2009 ight arm, right leg and abdomen. 2 days after vaccine given, given BENADRYL by mother, hives Y confirmed 8/10/2009 by their 8/12/2009 specialist. Not seen by theaded and was pale. Y 8/13/2009 8/13/2009 ed, Warm, Size -->1.5 in diameter Y 8/12/2009 8/13/2009
ction: swelling, redness, warm to touch; Y 5 cm in diameter - left arm. Y 8/10/2009 8/11/2009 low grade temp and red spots, treated with Zovirax ointment. Y 3/27/2007 8/13/2009 PM- vomited - (crying since receiving vaccines). 3:45 PM- redness around mouth. 3:50 PM- Ybreathing S.O.B. 8/12/2009 4:40 PM8/12/2009 lips swollen. 7:15 P Y 7/22/2009 ived immunization 1 on 8-11-09 & mother reports on 8-12-09 in AM (L) thigh became red & inflamed Y a injection 8/11/2009 site.8/12/2009 Child would not move r (trapezius muscle) enlargement. Y U 8/11/2009 8/13/2009 ely following HPV injection, pt. experienced syncope. Pt. was seated, fell to the to the right side, Y and struck 7/29/2009 the right 7/29/2009 side of her head on the ought pt into clinic on 7/24/09 (9 days Y after vaccines were administered) c/o bruise and lumpUon R upper 7/16/2009 leg down to back of knee. Dr and n swollen & red. U 8/11/2009 8/11/2009 me in with ~24 hr history of rash, starting Y at L abd, then increased and spread central to extremities. U Pt : multiple vesicles (>200), primarily ound injection site swelling onset day Y after injection. Y 7/30/2009 7/31/2009 Pt returned with reddened nodes allYover the body. Seen at ER. Please. see accompanying ER Y records. 8/11/2009 Per Dad, Pt8/11/2009 is getting better nodes ear old USAF services member reported Y receiving five Anthrax (AVA) vaccinations in 1999 with Y no remembered 5/13/1999 adverse 11/1/2000 events. He reporte d with R OM 7/22/09, put on Amoxicillin. Had Hib and Hep A boosters 8/3/09. Developed redYrash, hives 8/5/09, 8/3/2009 progressed 8/5/2009 to petechiae an ious spontaneous report of wheezing and fever has been received from a nurse concerning U a four-year-old 9/3/2008 male subsequent 9/3/2008to FLUMIST. ious spontaneous report of vomiting has been received from a registered nurse concerning aUfour-year old patient ###subsequent ### to FLUMIST labeled spontaneous report of fever, headacheYand non-serious body 1 aches, cough and vomiting Y has been received ### from ### a nurse for a nine ious report of expired dose of vaccine administered was received from a physician concerning Y a five-year-old 2/5/2008 female.2/5/2008 No medical history o ious spontaneous report of stuffy nose, headache, sneezing, and malaise has been receivedUfrom a consumer, 8/8/2008 concerning 8/9/2008 a 14-year-old fe ious spontaneous report of accidental exposure while administering drug and asthma attack Uhas been received from8/20/2008 a nurse concerning a 3 ious spontaneous report of NOSE BLEED was received from a physician concerning a seven-year-old U male 8/12/2008 subsequent 8/17/2008 to FLUMIST. The ious spontaneous report of shaking, nasal passage irritation, sweating, chills, headache, andUnausea has8/22/2008 been received 8/22/2008 from a consumer c ious spontaneous report of GENERLIZED RASH as been received from a nurse concerning N a 13-year-old 8/21/2008 male subsequent 8/21/2008to FLUMIST. N ious spontaneous report of shaking, fever, muscular chest and back pain, chills, headache, cough Y and fatigue 9/2/2008 has been 9/2/2008 received from a co ious spontaneous report of FLUMIST inadvertently given to a 52-year old male was receivedYfrom a pharmacist. 9/29/2008The 9/29/2008 patient's medical histo ious spontaneous report of viral syndrome, flu symptoms, gastroenteritis, myalgias, and neckY pain has been 8/19/2008 received 8/26/2008 from a nurse in a phy ious spontaneous report of expired FLUMIST inadvertently administered was received from a Y registered 9/11/2008 nurse concerning 9/11/2008 a seven-year-old ious spontaneous report of pneumonia, sleeping a lot, fever, asthma and coughing was received U from a mother 8/1/2008 concerning 8/1/2008 a six year-old fe erious spontaneous report of administered two doses of vaccine in two day period has been Y received from 8/27/2008 a nurse concerning 8/29/2008 a 5-year old ious spontaneous case of inadvertent administration of FLUMIST to an asthmatic and coughYhas been received 9/11/2008 from 9/11/2008 a nurse in a 12-year-o ous spontaneous report of headache, nausea, vomiting, and diarrhea has been received from Y a consumer 9/13/2008 concerning 9/15/2008 a 40-year old male s ious spontaneous report of headache, nausea, vomiting, and diarrhea has been received from Y a consumer 9/13/2008 concerning 9/13/2008 a five-year old male ious spontaneous report of rash and whelps was received from an office manager of a doctor's Y clinic concerning 9/17/2008 a 31-year-old 9/19/2008 female healt ious spontaneous report of swelling under left eye, flat red itchy rash, and hives has been received Y from 9/19/2008 a nurse and9/19/2008 a physician concernin ious spontaneous report of wheezing was received from a physician concerning an 11-year-old U male subsequent 9/24/2008to9/24/2008 FLUMIST. The patient ious spontaneous report of nose bleed was received by an employee in a pediatric office, concerning Y a five-year old female subsequent to ious spontaneous report of swelling of right lower eyelid was received from a father concerning N his 5-year-old 9/23/2008 male child 9/24/2008 subsequent to FLU ious report of administration of FLUMIST to a nine-year-old male on daily ASPIRIN was received Y from a 9/26/2008 consumer. 9/26/2008 The patient's medical hi ious, spontaneous report of aching, hot then cold, headache, nausea, sinus infection and stomachache Y was 9/24/2008 received 9/24/2008 from a consumer con report of vomiting, diarrhea, and abdominal Y pain has been received from a physician and a consumer U (patient's 9/8/2008 mother) 9/9/2008 concerning a nineious unlabeled spontaneous case of impetigo with redness and irritation under the nose hasYbeen received 9/26/2008 from a physician 9/26/2008for a five-year ious spontaneous report of accidental exposure and headache has been received from a female Y medical assistant (date of birth 01-May-19 ious spontaneous report of hives has been received from a registered nurse concerning a 7.5-year N old male 10/6/2008 patient 10/6/2008 subsequent to FLUMIS ious report of administration of expired FLUMIST was received from a health care professional Y concerning 10/6/2008 a 19-year-old 10/6/2008 male. The patient ious report of administration of expired FLUMIST was received from a military non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional an ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FluMist was received from an Air Force non-commissioned Y officer10/6/2008 and a health 10/6/2008 care professional in ious report of administration of expired FLUMIST was received from a healthcare professional Y concerning 10/6/2008 a 21-year-old 10/6/2008 male. The patient' ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious, spontaneous report of sore throat, fever, body ache, runny nose and congestion was received N from9/29/2008 a consumer, 9/30/2008 concerning a five ye ious labeled, spontaneous report of sneezing has been received from a nurse for a seven-year-old Y female, 10/6/2008 subsequent 10/6/2008 to receiving FLUMIS
ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from a military non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional con ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 concerning 10/6/2008 a 22-year-old male. ious report of administration of expired FluMist was received from a non-commissioned officer Y and a health 10/6/2008 care professional 10/6/2008concerning a ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received for a health care professionalYconcerning10/6/2008 a 20-year-old 10/6/2008 male. The patient's ious, spontaneous report of pleurisy, chest pain, shortness of breath and fever was receivedYfrom a pharmacist 10/1/2008 concerning 10/6/2008 a 24 year-old fe ious spontaneous report of administered expired FLUMIST was received from a consumer concerning Y a 10/2/2008 female greater 10/2/2008 than five-years-old. ious spontaneous report of administered expired FLUMIST was received from a consumer concerning Y a 10/2/2008 female greater 10/2/2008 than five-years-old. enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev enty-one cases: A nonserious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non - serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The e enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev ate dose of vaccine administered. One of twenty-one cases: A non-serious, spontaneous event Y of a half10/3/2008 dose of FLUMIST 10/3/2008 administered wa enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of half dose of FLUMIST administered was Y received 10/3/2008 from a registered 10/3/2008 nurse. The event enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 fro ma registered 10/3/2008nurse. The ev enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose to FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious spontaneous event of a half dose of FLUMIST administered was Y received10/3/2008 from a registered 10/3/2008 nurse. The even ious spontaneous report of inadvertent administration to an 85-year old was received from aYphysician concerning 10/9/2008 an 10/9/2008 85 year old female pa ious, spontaneous report of positive for type A influenza virus, productive cough, sore throat,Urunny nose,9/29/2008 chills, body 10/5/2008 ache and malaise wa ious spontaneous report of post-nasal drip taste, bad cold, sneezing, and running nose has been U received from a female patient of unknow ious, spontaneous report of "dosage to left nostril never misted/sprayed" was received from Y a consumer,10/9/2008 concerning10/9/2008 a 48 year-old male pa ious Spontaneous report of partial dose was received from a nurse practitioner concerning aY45 year old female. ### On 13-Oct-2008, ### the patie ious, spontaneous report of "gave half of vaccine" was received from a nurse concerning a 28 Y year-old female ### subsequent### to FLUMIST. Th ious, spontaneous report of sore and stiffness in back, neck and shoulders was received from N a consumer, concerning ### a 43 ### year-old female ious spontaneous report of "gave half of vaccine" was received from a nurse concerning a seven-year-old Y male. ### The nurse### forgot to remove ious spontaneous report of received FLUMIST vaccine via parental (IM) injection has been received Y from a physician ### and ### a combat medic c ious spontaneous report of received FLUMIST vaccine via parenteral (IM) injection has beenYreceived from a physician ### and ### a combat medi ious, spontaneous report of FLUMIST sprayed in the eye was received from a nurse, concerning Y an eight-year-old ### male patient ### while recei ious, spontaneous report of asthmatic patient given FLUMIST was received from a physicianYassistant concerning ### a seven### year-old female ious, spontaneous report of vaccination of 52-year-old was received from a consumer, involving Y a 52-year-old 10/6/2008 male 10/6/2008 patient subsequent to F ious, spontaneous report of administered FLUMIST to an adult greater in age than 49, was received Y from10/1/2008 a physician, 10/1/2008 involving a a 69-year ious report of inadvertently given FLUMIST has been received from a health department representative N concerning ### a 16-year-old ### female, s ious spontaneous report of "FLUMIST should not have been given" was received from a registered nurse concerning ### a 56-year ### old male pa ious, spontaneous report of secondary transmission of flu, muscle cramps, headache and chills U has been 10/9/2008 received from a consumer conce
ious, spontaneous report of administered FLUMIST to adult greater in age than 49, from a physician Y involving 10/1/2008 a 76 year-old 10/1/2008 patient subseq ious, spontaneous report of gave 62-year old female FLUMIST, was received from a health professional, Y subsequent ### to FLUMIST. ### There w ious, spontaneous report of vomiting was received from a Registered Nurse concerning a seven U year-old male### patient, subsequent ### to FLUM ious report of Henoch Schonlein Purpura, abdominal pain, joint pain, and rash below the waist N line has been 9/27/2008 received 9/27/2008 from a nurse concern ious, spontaneous report of FLUMIST misted into eye of male child between six and twelve years Y of age was received ### from ### a nurse. There ious report of runny nose and fever was received from a consumer concerning a five-year-old Y female. No medical ###history or ### concomitant me ious spontaneous report of received FLUMIST vaccine via parenteral (IM) injection has beenYreceived from a physician ### (patient's ### father) an ious, spontaneous report of administration to asthmatic was received from a pharmacist, concerning Y a ten year-old ### female### patient, subsequ ious, spontaneous report of full dose of FLUMIST in one nostril was received from a consumer, Y concerning a nine ###year-old### patient. The pha ious spontaneous report of generalized hives has been received from a Registered Nurse concerning U a 12-year-old ### female, ### subsequent to ious spontaneous report of severe headache has been received from a nurse concerning a 13-year-old Y female,### subsequent ### to FLUMIST. N ious spontaneous report of a 50-year-old male patient who experienced arthralgia and malaise Y subsequent 9/18/2008 to FLUMIST 9/18/2008 has been received ious spontaneous report of "patient received only half a dose" was received from a registered Y nurse concerning### a 34-year ### old male patient. ious spontaneous report of a second dose of FLUMIST given two weeks after first dose wasYreceived from a registered ### nurse ### concerning a ious, spontaneous report of inflammation of the face iwth swelling and itching was received from U a nurse, concerning ### an eight ### year-old male spontaneous report of paralysis on the right side of his face was received from the mother ofNthe patient concerning ### a 13 year-old ### male sub ious spontaneous report of administered expired FLUMIST was received from a health care Y worker concerning### an eight year ###old child. No m ious spontaneous report of received half dose of FLUMIST was received from a Registered Nurse Y concerning a### 34 year-old ### male. The divid ious, spontaneous report of rash was received from a pharmacist/consumer concerning a 37Nyear-old female subsequent ### ### to FLUMIST. Neit ious report of swelling of the glands has been received from a certified medical assistant (CMA) U concerning a six-year ### old ### male patient, sub ious spontaneous report of secondary transmission, fever, chills and malaise was received from Y a 35-year-old female physician ### concerning ious, spontaneous report of should not have gotten two doses this season, in a nine year-oldYmale patient was### received from ###a health profe ious spontaneous report of FLUMIST was administered to a 50-year-old was received from aYregistered nurse ### concerning ### a 59-year-old ma ious, spontaneous report of fever, congestion, muscle aches and sore throat was received from N a consumer, concerning ### an ### adult female su ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to a 58 year-old female was received from a Registered Y Nurse concerning a 58 year-old patient. ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of aches, fever and sore throat was received from a consumer concerning U a 30 year-old ###female subsequent ### to FL ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of croup and cough was received from a physician concerning a five-year-old U male, subsequent to ### FLUMIST. No m ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to pregnant female was received from a Registered U Nurse concerning ### an adult female. ### The patie ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of fever and vomiting has been received from a consumer concerning Y an 8-year-old male, ### subsequent 11/2/2008 to FLUMIST ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of fever of 104, aches and pain was received from a physician, concerning Y a five-year-old ### 11/1/2008 female subsequent to F ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco
ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of fever of 104 and hives was received from a consumer, concerning Y a six year-old female ### 11/1/2008 subsequent to FLUMIS ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FluMist administered was received from a physician concerning an adult Y patient. Neither medical history nor concomi ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ed report of expired FluMist administered was received from a patient. Neither medical history Y nor concomitant medication have been repor ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to a pregnant female was received from a nurse practitioner U concerning ### a 24-year ###old female. Th
ious, spontaneous report of achiness and joint pain was received from a physician concerning N a 27 year-old female ### subsequent ### to FLUMIS ious spontaneous report of accidental exposure, influenza, fever exhaustion, coughing, headache U and sneezing was received from a femal ious, spontaneous report of pain in leg, stomach pain, fever and nausea was received from aY nurse, concerning 11/4/2008 an 11/4/2008 11 year-old female subs ious spontaneous report of migraine headaches and abdominal pain was received from a medical N assistant 11/3/2008 in a physician's 11/3/2008 office concernin ious spontaneous report of FLUMIST syringe portion broke and caused town cuts on finger was Y received from a Registered 11/4/2008 Nurse in conce ious spontaneous report of itchy rash has been received from a certified medical assistant concerning Y an11/5/2008 eight-year11/5/2008 old male patient subse ious, spontaneous report of rash on forehead and upper half of face was received from a pharmacist, U concerning 11/5/2008a 11/6/2008 seven-year-old female, ious spontaneous report of administration to a 54 year-old was received from a 54 year-old female Y consumer subsequent to FLUMIST. The ious, spontaneous report of fever blister on the lip, "felt bad" and runny nose was received from U a nurse concerning ### an adult ###female, subseq ious, spontaneous report of hives all over her body was received from a nurse, a 41 year-oldYfemale subsequent 11/4/2008 to 11/4/2008 FluMist. The patient's p ious spontaneous report of sore throat, body aches and low grade temperature has been received U from a11/5/2008 consumer11/5/2008 concerning a 43 year-o ious spontaneous report of fever has been received from the mother of the patient concerning Y a seven year-old 11/7/2008 male, 11/7/2008 subsequent to FLUM ious spontaneous report of headache, chills, and stomach upset has been received from a Doctor Y of Pharmacy 11/8/2008 concerning### a 17-year-old fe ious spontaneous report of half the total dose of FLUMIST was received from a physician concerning Y a female 11/6/2008 child,11/6/2008 subsequent to FLUMIS ious spontaneous report of half the total dose of FLUMIST was received from a physician concerning Y a female 11/6/2008 child11/6/2008 subsequent to FLUMIS ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ate dose of vaccine administered (Incorrect dose administered). A non-serious spontaneousYreport gave11/6/2008 half the total 11/6/2008 dose of FLUMIST wa ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUIST was received form a physicianYconcerning11/6/2008 a male child, 11/6/2008 subsequent to FLUM ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUIST was received form a physicianYconcerning11/6/2008 a male child, 11/6/2008 subsequent to FLUM ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of runny nose and sneezing was received from the consumer concerning U an eight year-old ### female, ### subsequent to ious spontaneous report of expired FLUMIST administered was received from a nurse concerning Y a six-year-old ### female. No ### medical history ious spontaneous report of "administration to a 57 year old" was received from a pharmacistYconcerning a 57-year-old ### female. ### The pharma ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a ten-year-old 12/2/2008 female. 12/2/2008 The patient receiv ious report of administration of half dose of FLUMIST was received from a consumer concerning Y a 31-year-old### female. No ### medical history ious, spontaneous report of root canal, ear infection, sinus infection and nasal congestion was Y received from a### nurse/parent, ###concerning a 1 eous non-serious report of burning the nostril, hurting and administered of half dose has been Y received from a### nurse practitioner ### concernin ious spontaneous report of arthralgia has been received from a health care worker concerning Y a 10 year-old female, ### subsequent ### to receivin ious unlabeled spontaneous report of right arm pain has been received from a health care worker Y concerning a### nine-year-old ###female, subse ious spontaneous report of full dose of FLUMIST in one nostril has been received from a registered Y nurse 12/2/2008 concerning 12/2/2008 a seven year-old mal ious spontaneous report of was received from a nurse concerning a 52-year old female. Information Y on FLUMIST use in ages 50 to 64 year eous non-serious report of pregnancy was received from a nurse practitioner concerning a 34 U year old female ### patient. The ### mother of one o
ious, spontaneous report of vomiting and diarrhea was received from a consumer, concerning Y a 35 year-old female ### subsequent ### to FLUMIS ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a12/4/2008 12-year- old 12/4/2008 female. The patient's eous non-serious report of inadvertently administered FLUMIST to a 55 year old male has been Y received 12/5/2008 from a nurse. 12/5/2008 Medical history an ious report of fever, vomiting, chills, sore throat, and runny nose has been received from a nurse U concerning a ### 10-year-old### female, subsequ ious spontaneous report of bright red rash has been received from a nurse concerning a 48 Y year old female, subsequent ### to ### receiving FLUM ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a 46-year-old ### of unknown ### gender. N ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU levant medical history nor concomitant medications were reported for this patient. The patient Y received FLUMIST ###on 28-Nov-2008, ### intranas ious, spontaneous, report of vomiting, nausea and diarrhea was received from a consumer, Y concerning a nine-year-old ### female ### subsequent ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a12/5/2008 42-year old 12/5/2008 male. The patient's m eous non-serious report of scabies was received form a nurse concerning a six year old female N patient subsequent ### to FLUMIST. ### Medical h eous non-serious report of scabies was received from a nurse concerning a nine year old male Y patient subsequent ### to FLUMIST. ### Medical h ious spontaneous report of Henoch-Schoenlein purpura and upper respiratory infection was Y received from a physician ### 12/1/2008 concerning a 6 yearious spontaneous report of vomiting was received from a consumer concerning a nine year-old U (gender not reported), ### subsequent ### to FLUM ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a seven-year-old ### male ious, spontaneous report of gave FLUMIST to a 54 year-old was received from a pharmacist,Y concerning a 54 ### year-old female ### subsequent eous non-serious report of coughing and hives has been received from a patient's father concerning N a five year old female patient subsequ ious spontaneous report of FLUMIST given to a pregnant female has been received from a Registered Y Nurse 10/2/2008 concerning 10/2/2008 a 26-year-old fem ious spontaneous report of expired FLUMIST given was received from a registered nurse concerning Y a 49 year-old ### female, ### It was discovere eous non-serious report of administration to pregnant female, fever and stomach ache has been U received 12/5/2008 from a nurse concerning ### a 14 ye eous non-serious report of "glassy looking eyes, red eyes, eye discharge and nasal congestion Y has been received ### from a ### consumer conce ious spontaneous report of FLUMIST sprayed in the eye was received from a registered pharmacist Y concerning### a 22-year-old ### female. Med xposure during pregnancy. A spontaneous non-serious report of administration to pregnant female U was received 9/30/2008from 9/30/2008 a nurse concerning a ious, spontaneous report of administration of expired product was received from a registeredYnurse concerning### a 6-year 11### month old male ious spontaneous report of hives, red blotchy skin/redness, both hands swelled and 55-year-old Y administered 10/8/2008 FLUMIST 10/8/2008 has been received ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a 6 year ### old female w ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of administration to a pregnant female was received from a consumer U concerning a 24-year-old ### female. ### The patien eous non-serious report of administration of extra dose has been received from a nurse practitioner Y concerning### a five year### old male patient eous non-serious report of administration to pregnant female has been received from a health U care professional 11/7/2008 concerning 11/7/200828 year old fem ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of expired FLUMIST given to this patient was received from a certified Y medical assistant ###concerning ###a six-year-old ious spontaneous report of administration of expired product to a 52-year-old was received from Y a Nurse concerning ### a 52-year-old ### female. ious spontaneous report of administered expired FLUMIST was received from a Registered Nurse Y concerning a ### 14 year-old-male. ### FLUMIS ious spontaneous report of gave expired FLUMIST to an 11-year old was received from a Nurse Y Manager concerning ### a 11-year-old ### male. T ious report of administered expired FLUMIST was received from a Registered Nurse concerning Y a seven-year-old ###male. Medical ### history an ious, spontaneous report of "gave expired FLUMIST" was received from a registered nurse concerning Y a nine-year-old ### male ###subsequent to eous non-serious report of administration of expired product has been received from a nurseYpractitioner concerning ### a 14 ### year old male pa ious spontaneous report of administration of expired FLUMIST was received from a registered Y nurse concerning ### a 15-year-old ### male. Neithe ious spontaneous report of administration of one-half dose of expired product was received from Y a certified medical ### assistant ###concerning a ious spontaneous report of expired FLUMIST administered was received from a registered nurse Y concerning a### 13-year-old### female. The chil ious report of expired FLUMIST administered was received from a registered nurse concerning Y a 17-year-old female. ### Neither ###history nor co eous non-serious report of hives, itching, leg pain, bruising and attention deficit/hyperactivityUdisorder (ADHD) 9/24/2008 has been 9/24/2008 received from man ious spontaneous report of "29 patients ( 26 children & 3 adults) received expired FLUMIST Y "was received1/6/2009 from a physician 1/6/2009 concerning a 1 ious report of expired FLUMIST given was received from a registered nurse concerning a 29-year-old Y male. 12/4/2008 On 04-Dec-2008, 12/4/2008 the patient w ious report of administration of expired FLUMIST to two patients was received from a pharmacist Y concerning 1/6/2009 a 43-year-old 1/6/2009 female. The pat ious report of administration of expired product has been received from a Registered Nurse concerning Y a 1/8/2009 22-year-old1/8/2009 female who received ious, spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/7/2009 a five1/7/2009 year-old male subseq ious, spontaneous report of administration of expired product was received from a nurse concerning Y a five1/7/2009 year-old female 1/7/2009 subsequent to F ious, spontaneous report of administration of expired product was received from a nurse concerning an eight 1/7/2009 year-old1/7/2009 female subsequent to
eous non-serious report of administration of expired product was received from a nurse concerning Y a twelve 1/7/2009 year-old1/7/2009 male subsequent to F ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a five-year-old 1/1/2009 patient (gender 1/1/2009unknown). Th ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a 10-year-old 1/1/2009 patient (gender 1/1/2009 unknown). The ious spontaneous report of administration of expired product has been received form a Registered Y Nurse concerning ### a 15### year old male wh ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a five-year-old 1/1/2009 patient (gender 1/1/2009unknown). Th ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### an 18 ### year old female ious spontaneous report of administration of expired product was received from a registeredYpharmacist concerning two patients (patients' d eous non-serious report of "six patients received expired FLUMIST" was received from a nurse Y concerning 1/1/2009 a six-year-old 1/1/2009 patient (gender u ious, spontaneous report of administration of expired product was received from a registeredYpharmacist concerning 1/5/2009 1/5/2009 an adult (sex unknown ious spontaneous report of expired FLUMIST administered was received from a healthcare professional Y concerning ### a five ### year-old female. ious, spontaneous report of administration of expired product was received from a nurse concerning Y a ten year-old ### female### subsequent to F ous, spontaneous report of administration of expired product was received from a nurse concerning Y an 11 year### old female### patient subseque ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a five-year-old ### female who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a five-year-old ### male who rec ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/2/2009 a five-year-old 1/2/2009 female who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/2/2009 a five-year-old 1/2/2009 female who re ous spontaneous report of administration of expired product was received from a registered Ynurse concerning 1/2/2009 a seven-year-old 1/2/2009 male subse ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a six-year-old 1/5/2009female who re ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/6/2009 a 9-year-old 1/6/2009female subseq eous non-serious report of administration to a pregnant female was received from a physician U concerning a 26### year old female ### patient. On ious spontaneous report of cold like symptoms has been received from a consumer concerning U a 12-year-old 1/6/2009 female, 1/13/2009 subsequent to FLUM ious spontaneous report of administration of expired FLUMIST to two patients was received Y from a pharmacist 1/6/2009 concerning 1/6/2009 a nine-year-old f ious spontaneous report of asthma attack and accidental exposure has been received from aY Registered Nurse concerning a 33-year-old fe ious spontaneous report of fever, fatigue, nasal congestion, and sneezing has been receivedYfrom a nurse 1/14/2009 concerning a 20-year-old female ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a 13-year-old 1/5/2009male who rece ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009male. The pat ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 male. The pa ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 40-year-old 1/6/2009female. The p ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a seven-year-old 1/5/2009 male who r ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician concerning 1/6/2009 a 16-year-old 1/6/2009female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 female. Th ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 female. Th ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 male. The ious spontaneous report of FLUMIST administration to pregnant female was received from aNphysician concerning ### a 27-year-old ### female pa ious spontaneous report of administration of expired product was received from a consumer Yconcerning a1/7/2009 13-year-old1/7/2009 female. There was n neous, non-serious report of GERD and ulcer has been received from a mother concerning aUnine-year-old 1/19/2009 male patient 1/26/2009 subsequent to FLU ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a six-year-old 1/6/2009female. The p eous, non-serious report of FLUMIST given to 59-year-old was received from a nurse. ThereYwas no adverse event ### associated ### with this me ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a five-year-old 2/2/2009male. 2/2/2009 The patient's conco ious spontaneous report of "29 patients received expired FLUMIS" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a eight-year-old 1/6/2009 female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 35-year-old 1/6/2009female. The pa ious spontaneous report of administration to pregnant female was received from a physicianUconcerning a2/2/2009 30-year-old 2/2/2009 female who received eous, non-serious report of dizziness, lightheadedness, ear infection, sinus infection, stomach N ache, fever, body ### aches, sore ###throat, conges eous, non-serious report of administration of expired product was received from a nurse concerning Y an adult 1/20/2009 female1/20/2009 patient. On 20-Jan-20 ious, spontaneous report of administration or expired product was received from a nurse concerning Y a 36 2/3/2009 year-old female 2/3/2009 subsequent to FL ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a six-year-old 2/5/2009 female. 2/5/2009 FLUMIST that exp
ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 11-year-old 1/6/2009male. The pati ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 male. The pa ious spontaneous report of "23 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009female. The p ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009male. The pat ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of erythema multiforme, blisters on both legs and a few on arms and Y sore in right 10/9/2008 nostril and upper lip has both leg ious spontaneous report of positive influenza A test was received from a physician concerning U a 14 year-old 10/1/2008 male, subsequent 2/9/2009 to FLUMIST ious spontaneous report of administration of extra dose was received from a physician concerning Y a 10-year-old male 2/11/2009 who received FLUMI ious, spontaneous report of administration of expired FLUMIST to a 65 year old was received Y form a nurse 1/19/2009 practitioner 1/19/2009 concerning a 65-yea ious, spontaneous report of administration of expired FLUMIST was received from a nurse practitioner Y concerning 1/17/2009 a1/17/2009 42 year-old female su ious spontaneous report of "gave expired FLUMIST" was received from a nurse concerning a Y eight-year-old 2/19/2009 male. No 2/19/2009 medical history was r ious, spontaneous report of sore throat and fever was received from a physician, concerningYan 11 year-old male ###subsequent ### to FLUMIST. ious spontaneous report of "gave expired FLUMIST" was received from a nurse concerning an Y eight-year-old 2/19/2009 male. 2/19/2009 No medical history was ious, spontaneous report of administered expired product was received from a nurse concerning Y a 24-year-old 2/17/2009 female, 2/17/2009 subsequent to FLUM ious spontaneous report of "gave expired FLUMIST" was received form a nurse concerning an Y eight-year-old 2/19/2009 male. 2/19/2009 No medical history was ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a seven-year-old 2/20/2009 male, 2/20/2009 subsequent to FLU ious spontaneous report of eye pain, headaches, body ache, muscle ache, and sinus pain has N been received 1/1/2009 from a 1/1/2009 parent concerning her ious, spontaneous report of administered expired product was received from a nurse concerning Y a nine-year-old 2/20/2009 male, 2/20/2009 subsequent to FLUM ious, spontaneous report of snoring and nasal congestion was received from a consumer concerning N a five-year-old 1/27/2009 2/24/2009 female subsequent to ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 1/1/2009 male. 1/1/2009 Neither medical h ious, spontaneous report of administered expired products was received from a nurse concerning Y a six-year-old 2/20/2009 female. 2/20/2009 Subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a six-year-old 2/20/2009 male, 2/20/2009 subsequent to FLUMI ious, spontaneous report of administered expired product was received form a nurse concerning Y an eight-year-old 2/26/2009 male, 2/26/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a six-year-old 2/26/2009 male, 2/26/2009 subsequent to FLUMI eous, non-serious report of administration of expired product has been received from a certified Y medical3/13/2009 assistant concerning 3/13/2009 an 11-year-o ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/1/2009 male. 2/1/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 41-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 22-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 2/2/2009 female. 2/2/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40 2/5/2009 year old male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40-year-old 2/5/2009 male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 39-year-old 2/5/2009 male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/5/2009 female. 2/5/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40-year-old 2/6/2009 female. 2/6/2009Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y an adult 2/9/2009 male. 2/9/2009 Neither medical histor ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y an adult 2/9/2009 male. 2/9/2009 Neither medical histor
accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a2/9/2009 nurse in the 2/9/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 2/9/2009 female. 2/9/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 2/9/2009 female. 2/9/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 2/9/2009 male. 2/9/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 2/9/2009 male. 2/9/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/23/2009 2/23/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 48-year-old 2/1/2009 male. 2/1/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 22-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 2/24/2009 2/24/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/24/2009 a nurse in 2/24/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/24/2009 2/24/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/26/2009 a nurse in 1/26/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 31-year-old 2/24/2009 2/24/2009 female. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/24/2009 a nurse in 2/24/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 2/25/2009 2/25/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/25/2009 a nurse in 2/25/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 29-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 25-year-old 1/12/2009 1/12/2009 male. Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/10/2009 of unknown 2/10/2009 age. Neither med accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/10/2009 of unknown 2/10/2009 age. Neither med ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 43-year-old 3/2/2009 male. 3/2/2009 Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 49-year-old 3/2/2009 male. 3/2/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 3/2/2009 male. 3/2/2009 Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/12/2009 1/12/2009 female. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 40-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 43-year-old 3/2/2009 female. 3/2/2009 Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 1/12/2009 1/12/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning
ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 2/11/2009 2/11/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 1/26/2009 1/26/2009 male. Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/17/2009 of unknown 2/17/2009 age. Neither med erious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a1/26/2009 23-year-old 1/26/2009 male. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/26/2009 a nurse in the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse report Y of administration 2/17/2009of2/17/2009 expired FLUMIST was ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 2/1/2009 female. 2/1/2009 Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a nurse in the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 35-year-old 2/1/2009 female. 2/1/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse inYthe military 1/26/2009 concerning1/26/2009 a 20-year-old female. N ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse inYthe military 2/17/2009 concerning2/17/2009 a 26-year-old male. Ne ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 35-year-old 2/20/2009 2/20/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/20/2009 2/20/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/23/2009 a nurse in 2/23/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 46-year-old 2/23/2009 2/23/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/17/2009 2/17/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 30-year-old. 2/17/2009 2/17/2009 Neither medical history ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male. 2/18/2009 Neither 2/18/2009 medical history nor c ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/18/2009 2/18/2009 male. Neither medical h ious report of positive influenza A test has been received from a registered nurse concerningUan eight-year-old 10/1/2008 female 5/19/2009 subsequent to FLUM n has been received from a physician's Y assistant concerning a 26 year old female with no past Y history of6/26/2009 seizure and 7/10/2009 no drug allergies, who n has been received from a licensed Y visiting nurse Y concerning a female 0 who was vaccinatedYwith a dose of GARDASIL (dose, route and lo n has been received from a lawyer Y concerning a minor male patient who on 30-DEC-2003 Y was U vaccinated with### a dose of MMR II. The lawy n has been received from a 64 year old femaleYwith thyroid disorder,0 a history of shingles two N years ago 10/1/2008 and no allergies/drug 12/1/2008 reactions wh n has been received from Y a licensed Y practical nurse concerning a 79 year old male patient with U no known drug reactions/allergies and with ted on 14 Aug 2009 for clinic visit for adverse reaction to immunization. Right thigh from hip Yto just above 8/12/2009 knee red,8/13/2009 swollen, and hot to tou post Pneumococcal Vaccination, patient developed pain and swelling at injection site. Area was Y 16 cm x 8/12/2009 12 cm and 8/13/2009 warm to the touch. War s of muscle soreness at injection site today which is over a month after receiving TDAp B. There U is no redness 7/10/2009 or muscle 7/14/2009 induration. Comp d a fever with rash on face/arms/chest- Mom notes small raised red lesions, no blisters. -Recommended TYLENOL 8/4/2009 8/13/2009 for fever, BENADRYL f d shots stayed in office for appx 20mins Y after. Pt left and returned about 45 mins later. EyesYblack, face swollen, 8/5/2009 hard8/5/2009 to breathe and swea eadache 2-3d after vaccine and erythema, swelling, tenderness at left leg injection site. Y 8/9/2007 8/9/2007 (T max 103.2) began within 13 hours of receiving the vaccines (Tdap X MENACTRA). (2) R U arm sore. No8/11/2009 treatment.8/12/2009 PREVNAR given, child within seconds had a seizure lasting no more than 15 seconds. He had Y another 7/14/2009 seizure several 7/14/2009 hours later and with ure of 104.5 R. Y 8/6/2009 8/6/2009 surrounding injection site starting 12 hours after. At 72 hours site is 11x7cm right thigh. U 8/7/2009 8/9/2009 ccine given IM L deltoid. Red flushing Y occurred across back and L ear and chest. No hives - Y No SOB. No8/12/2009 coughing. 8/12/2009 No swelling. No wheezi ive 8-13-2009 approx. 11:00 am. byYevening, pt arm too sore to lift, red, swollen, painful. came U in to office 8/13/2009 8-14-09. 8/13/2009 approx 4" swollen, raise pain, swelling, unable to move right arm for 24 hours. Took Tylenol, aspirin and Soma at different Y intervals, 8/12/2009 drank liquids 8/12/2009 and applied heatin
of erythema, warm to touch, and firm of 5cm x 6 cm on upper left arm where Hepatitis A and Y Varivax injections 8/13/2009 were 8/14/2009 given r on day after shots was given on 08/06/09 but was told by nurse to refer to the VIS sheet forYchickenpox 8/6/2009 for reaction 8/13/2009 and to treat with Tylen S AND SWELLING AT INJECTION SITE ON RIGHT ARM MEASURING 110MM OUTSIDE RING U AND INSIDE 8/12/2009 RING 8/13/2009 40MM. BENEDRYL veloped fever to 102 per mother approximately Y 11 hours after vaccine given, vomited once, Y and had seizure 7/27/2009 about 7/28/2009 9 hours after fever note lled stating son had Tdap injection Monday, Y 7/27/09 and today (7/29/09) has a hard quarter U to golf ball size 7/27/2009 knot with 7/27/2009 redness and pain. as diagnosed in our office with Erythema Multiforma on 7/20/09. Rash started 7/18/09 on leftYdeltoid where 7/13/2009 DTaP has 7/18/2009 been given on 7/13/0 on 8/13/09 with a temp of 103 degrees F. Parents have given Motrin and fever has gone down. U Grandmother 8/12/2009 calls at 8/13/2009 5:15 pm on 8/13/09 a ved from mom 8/13/09, states pt has swelling/hardness the size of a "drink coaster @ the site of the injection 8/12/2009 on right 8/13/2009 arm with rash @ site. ft arm that began as soon as injected. Felt med burn when injected. Pain has continued x 18 U days. Has7/27/2009 slightly improved. 7/27/2009 Middle of uppe s: Circular swelling 3"x3", redness, vomit, itchy. Treatment: Rocephin Inj. 500mg. Instructions Y to parent:8/10/2009 Warm compresses 8/11/2009to area. ped high fever one day after immunization Y andYthen developed prolonged 4Y seizure after two days. Y Pt. then 8/12/2009 needed Anti-Seizure 8/13/2009 medicines erythema/edema affecting Y left upper Y extremity and axilla beginning 24-48h after vaccine administration. Y Progressed 8/5/2009 to 8/7/2009 lip/tongue angioede es that pt had cracked lips 4 days after Y vaccination. The whole lips became swollen and hadUblisters which 8/3/2009 peeled. They 8/7/2009 saw their physicia 03 axcillary with 2 minutes of stiffening, Y erythimical jerking of arms, legs during sleep withoutYrespiratory6/18/2009 problems. Seizures 6/18/2009with fever. Fev of leftside of lower lip occured approx. 15 min. after receiving Tdap vaccine. Pt. had already left Y clinic took6/30/2009 25 mg. of 6/30/2009 Benadryl at home. Retu Grace had a seizure that lasted under Y 10 seconds. Her head and torso "shivered" and she was Y non-responsive. 8/5/2009 8/5/2009 ates that the child began to have sorness Y at the area of vaccination about an hour after she received U the8/13/2009 vaccines. The 8/14/2009 following morning th redness, warm and slightly tender. Y Y 8/12/2009 8/14/2009 r for 6 days, Full body rash, itching, lethargy, lack of appetite, drowsiness. Treated with tylenol, Y cold compresses, 7/22/2009rest,8/7/2009 luke warm baths. ater, fever, headache, neck pain, chest pain, shortness of breathe, abdominal pain. Y 8/13/2009 8/14/2009 o vaccine site, tenderness and swelling. Y Patient complain of pain and itching to area. Y 8/11/2009 8/14/2009 OD NOTICE SWELLING, REDNESS, WARN TO TOUCH ON 8/11/09 EVENING. GAVE IBUPROFEN Y BEGAN 8/10/2009 ITCHING 8/11/2009 ON 8/12 GAVE BE accine (varicella #2). 8/12/09: L arm Y swollen, not feeling well overall, some neck & upper back Y discomfort. 8/11/2009 8/13/09:8/12/2009 arm swelling increased and swelling to vaccine site. Warm Y to the touch. Y 7/20/2009 7/21/2009 S AND SWELLING AT INJECTION SITE OF KINRIX (LD IM) PATIENT COMPLAINED OFUPAIN WHEN 8/12/2009 PARENT8/13/2009 TOUCHED ARM. SIT and swelling to vaccine site. Pain toYarea. Y 7/31/2009 8/1/2009 n erythematous raised lesion 8mm in Y diameter at the right temple area. Asymptomatic( no pain, N no itching). 8/3/2009 Started 2-3 8/6/2009 days after Shingles EIVED HPV AND VARICELLA IMMUNIZATIONS. UPON LEAVING, WHILE WALKING IN HALLWAY, Y MOTHER 8/14/2009 STATES 8/14/2009 THAT PT. LOOKE redness, edema, and itching at injection site. (4x4cm) Y 8/13/2009 8/14/2009 ped a red circular rash on the 13th, Y his rash was hot to the touch and his arm was sore. On the U 14th, the8/12/2009 rash had doubled 8/13/2009 in size was still h area reddness and swelling L upper Y arm 36 hours after injection Y 8/12/2009 8/14/2009 iving gaurdicil, lauren fainted while walking out of the doctors office. Completely blacked out,Y head hit the8/6/2009 floor, fainted. Now (I am an RN) er receiving vaccines patient Y became Y diaphoretic with grunting, nasal closing and retractions. Y Poor air exchange, 8/14/2009Sats 8/14/2009 89%, Pulses thready after taking the Tdap I had a fever of 103.8, I started Y getting migraines, 0 and my back by my U kidneys hurt extremely 8/3/2009 bad, 8/3/2009 it got worse throug ar size redness - Site is warm to touch but doesn't bother her. Her PCP rec. ice pack @ site Y and ZYRTEC 8/11/2009 for the response, 8/13/2009 but she used a d HR 100, temp. 100 degrees F, redY blotchy rash around eyes, pale face, sore throat @ 0800 on 8/14. Pt. 8/13/2009 reported8/13/2009 to provider 8/14 @ 2:3 Left herpes zoster ophthalmicus without Y involvement of The globe. U 8/3/2009 8/5/2009 thema, slight warmth, slight induration R thigh. Y 8/13/2009 8/14/2009 at hospital on 8/4/09 for Intussusception, Y was discharged the same night after reduction. 9/14/09 Y ER/Hospital 7/13/2009 Records 8/4/2009 received DOS 8/4/ ately 15 minutes after immunizationsY child c/o breathing difficulty. Mother took child home and Y gave her a8/12/2009 breathing 8/12/2009 tx and BENADRYL. The am after injection Pt started with cough, chest pain, swollen eyes. Was given 1.5 SC Epinephrine, Y BENADRYL 8/14/2009 25 P.O. 8/14/2009 10 minutes after bro o left deltoid at injection site encircles entire upper arm. Mom described as red, hot touch, and Y hard. Area 8/4/2009 the size of 8/5/2009 baseball. Swollen Warm to touch } injection site. Treatment: Amox. POT CLAVULANATE take 8ml BID U for 10 days 8/12/2009 400-57 mg/5ml 8/13/2009 Susp. Received s inadvertently given a Tdap along with MENACTRA. Was already given Tdap on 4/26/06. Spoke Y to VFC8/14/2009 and talked to parent about high ris ates "At 6:30 pm pt c/o numbness. Weakness tingling on side of body where vaccine was given. Y Face (side) 8/13/2009 and lip 8/13/2009 tingling, numb and droo Reading on GARDSIL and thinks childs Y Medical problems may be related to GARDASIL. Last U GARDASIL 4-16-07. ### Back 12/1/2006 pain started Dec-2 er MENACTRA L deltoid of pt developed itching erythema of site. Pt seen 8/12/09 noted ~ 8Ycm area of 8/10/2009 erythema no 8/12/2009 warmth. d hives 24 hours after MMR , Hepatitis Y A. Seen at an urgent care, no change 30m after BENADRYL. Y Sent 8/10/2009 to ER for 8/11/2009 observation. Discharge ambulance. Got epi pen by paramedic. Y Given steroids at ER. Discharged on prednisone. Y 8/12/2009 8/12/2009 ied 7:02 (Numbness in tongue) reported Y to staff by Pt. VS taken BP 07124/80 P- 86 O2 98. 07:04 Y Pt now8/13/2009 complains8/13/2009 of numbness in upper her reports scattered hives on abd & legs. Child was given BENADRYL & hives resolved over Y next 24 hours. 7/21/2009 7/23/2009
ate child became very listless after Y leaving office and getting home. Y 8/10/2009 8/10/2009 papules on erythematous base and surrounding pallor on arms, shoulder and neck pain on U side of injection, 8/12/2009 arm "tingling" 8/12/2009 on side of inject ight cheek and both upper thighs were vaccines were administered Y 8/11/2009 8/12/2009 p a rash consistent with erythema multiforme Y minor approximately five days after receiving his Y two month7/10/2009 immunizations. 7/15/2009 opathy, severe malnutrition and hairloss, ADD, ADHD, vitamin deficiency, memory Y loss, concentration N problems, 5/4/2007 burning 5/4/2007 in head, acute "ele ccine administered @ inappropriate initiation. Y ast shot in early November 07, been sick sense. November 20 Fainted in store multiple times. N Perfectly 11/1/2007 normal healthy happy ### teenager bef e week of receiving the first shot (10/24/2007), I experienced flu-like symptoms, fever, and such N severe vaginal 3/17/2008 discomfort 3/17/2008 that I went to the g well two hours after vaccine. Threw up about 3 hours after. Threw up after dinner. Dry heaves Y and temp 8/14/2009 up to 103.7 8/14/2009 during night. temp cellulitis following ADACEL - minor Y- tx: BIAXIN 500mg 1 POBID X 10d. U 8/14/2009 8/14/2009 n has been received from a registered Y nurse concerning a 16 year old female who was vaccinated Y with the 7/27/2009 "first dose" 7/27/2009 of GARDASIL (injec n has been received from a consumer Y concerning Y her 14 year old daughter 8 with no pertinentYmedical history and ###no1/15/2007 known drug allergies w n has been received from a head nurse Y concerning Y a 12 month old 0 female who on 17-JUN-2009 N was vaccinated 6/17/2009with 6/17/2009 a dose of MMR II (lot n has been received from a physician Y via medical records concerning a 14 week old inpatient N baby girl with anaemia ### 1/13/2009 of prematurity, chronic n has been received from a consumer concerning her 36 month old son with no pertinent medical N history 3/1/2007 reported and 8/1/2007 no known drug aller n has been received from an approximately Y 73Yyears old female patient 0 with unspecified medical N history, who "about6/1/2009 one or one and a half n has been received from a consumer Y concerning her 77 year old husband with neuromuscular Y N disorder and 4/1/2009 no known 5/1/2009 drug allergies who i was reported by a healthcare Y professional Y and described the occurrence of difficulty breathing Y in a 5-year-old 7/28/2009 female subject who was vacc was reported by a healthcare professional Y andYdescribed the occurrence 0 of pneumonia in a U child subject of unspecified age and gender wh chronic flu like symptoms, Y progressive fatigue, joint & muscle pain-severe pain throughout Y bodyN headaches 5/11/2000 & throbbing, 5/11/2000 brain fog, body t nted to clinic Aug. 04/09 - Symptoms had started 2 days prior - fever, chills, cough. PE - (+) Left Y lower lobe 7/30/2009 rales - treated 8/2/2009 with BIAXIN XL, A iving Tdap, VZV, MENACTRA (in this order), client immed. lost consciousness, color very pale, Y had posturing 7/28/2009 of upper 7/28/2009 extremities followed ze lump R. leg sm Lump on L Leg. Temp. 101.8 very cranky. Y 8/13/2009 8/13/2009 d TDAP 8/4/09 @ 3:50 PM. On 8/6/09 flu like symptoms (dizzy, fever 101). Symptoms cleared Y same day. 8/4/2009 Similar reaction in past (per mo eling dizzy, ears felt plugged, then started with headache, + started having breathing difficulty. Y EPIPEN 8/12/2009 given 0.3 ml 8/12/2009 @ 1:44 PM vitals P-10 daughter back today. Patient (R) arm red, swollen, hot, hard to touch. Mother states patient U has allergies 8/3/2009 to NEOSPORIN 8/4/2009 down latex? 100 arm swollen, redness, warm, mainly on underside, but on outer aspect as well - elbow to shoulder; N somewhat 8/10/2009 hardened 8/11/2009 to touch - compar 5 cm X 4.5 cm Red Raised area Right arm deltoid area noted 8/11/09 12:30 PM - Ibuprofen as U needed for 8/10/2009 pain - Cool 8/10/2009 compresses as need Reddened with lump under skin. Bruise in center. Fever of 100. Y 8/11/2009 8/12/2009 bed dots upper R arm. Y 8/10/2009 8/13/2009 vaccine 2/1/8 but developed shingles Y 7/8/9 anyway. Y 2/1/2008 7/8/2009 story hives like rash, fever, watery blisters Y mostly above waist & watery blisters down throat.YSeen in ER 6/3/2009 6/12/09 flu6/12/2009 & strep negative. g pain, limping, unsteady gait - refusing to walk. N 7/17/2009 7/17/2009 warm. TX: KEFLEX, BENADRYL, cool compress. Y 7/10/2009 7/11/2009 ver 6 hours after vaccines of over 105 Y degrees & was seizing. Parents took child to E.R. where Y fever & seizures ### were controlled ### & child wa o clinic today, 8/3/09, c/o (L) upper arm swelling and heat. Upon assessment, (L) upper armYswollen, hot7/31/2009 to touch, and 8/1/2009 client c/o pain only w orts left arm started swelling and turning red 1 day (7/21/09) after MCV4 and VARICELLA administered. Y 7/20/2009 Reports slight 7/21/2009 pain to left arm. Ca oted 2 days prior to visit - described as different crops of lesions at one time from papular and Y urticaria - 5/28/2008 like to vesicles, 8/12/2009 some popped out a o developed rashes with different lesions at the same time from papular, to vesicle to crusts Y it pock lesions. 5/10/2006 runny nose 8/13/2009 & sore throat also n lesions together w/crusted over and new papular and some urticaria-like lesions all over trunk, Y few on neck, 4/4/2007 and all 8/11/2009 over leg X 6 days now. ated 8-5-09. Onset 8-6-09 with headaches Y sore throat, nausea and congestion. On 8-11-09Useen at local8/5/2009 walk-n clinic 8/6/2009 now complaining of Fever, unable to swallow or breatheY for a minute or two. 28th July, Unable to swallow/breathe U for a minute 6/18/2009 or two after 7/19/2009 lying down. Coughin er I got the chills (6pm) by 8pm I had a fever. About 3 AM came the upset stomach- The fever Y lasted until 7/30/2009 8:30 AM 7/31/2009 of the 1st of August. A great deal of swelling (right arm looked as if a had a huge tumor hanging off it!!), (lasted approx. Y 4 days).7/20/2009 I took a BENADRYL 7/21/2009 1 tablet each d swelling in same side upper body to include neck shoulder with enlarged glands within 24 U hrs after IZ, worse 8/7/2009 at 48 8/7/2009 hours after IZ. Seen 72 adverse reaction. Tdap administered along with MMR, Varicella, Hep A, PCV7, to soon forUvaccines. 8/4/2009 s after injection patient got warm, vision blurred, then nausea. Pt was laid down with cool wash Y cloth + 8/10/2009 given juice.8/10/2009 Pt was slowly sat up a diarrhea - watery. X 2/ 8-10. X 3 + 8-11. Anorexic. Y 8/7/2009 8/9/2009 o redness. Swelling and sore are left lower arm 8/8/09. Area on left lower arm red and raisedY3 inches in length 8/6/2009 and 18/7/2009 1/2 inches wide. Calle vaccine administered 8/7/09. That evening had fever/chills - slight redness at site. Over next 48-72 hours redness 8/7/2009at site 8/7/2009 increased, swelling WHOOPING COUGH LIKE SYMPTOMS),HEADACHE,HOARSENESS FOR HALF A DAY,COUGHING N MORE,LITTLE 8/12/2009 8/13/2009 SMALL BUMPS AR
ash, erythemaos, macular, papular,raised,urticarialand Y fever 101.3F. Onset occurred acutely U 08/12/2009.7/24/2009 9/14/09 ICD-9 8/12/2009 Codes: 782.1 Rash e ordered and TDAP give in errorl Y 8/17/2009 8/17/2009 came light headed, dizzy w/ nauseaY& vomiting. Shock-like reactionl. Light pulse w/ blood pressure U 98/66. 8/17/2009 8/17/2009 02. Body aches. Both starting around midnight. Treatment - alternating Tylenol and Advil every Y 2 hours until 8/10/2009 fever resolves. 8/11/2009 pletion of vaccinations patient slumped Y on exam table, and then began to convulse with eyesUrolling in the 8/17/2009 back of his 8/17/2009 head. His arms raise area in SQ tissue on back of upper arm from below deltoid to elbow, firm, raised, red and very Y warm to touvh. 8/9/2009 Also tender 8/11/2009 to touch. with wrong solution. No adverse reaction. DOB was listed on hardcopy form as 07/10/1980 Y for a child with 7/23/2009 a patient age of 2 years. mately 2100, Pt complained of pain to his left arm where he stated he received a Pneumonia Y Vaccination 7/21/2009 during the7/22/2009 previous shift. His nur eloped fever with 24 hours of vaccine. Two days Y after vaccine developed 4 ataxia. Was admitted Y to hospital 7/16/2008 for ataxia 7/20/2009 and had multiple febri t skin reaction at site of injection. Started 24 to 36 hours after receiving injection. 3 inch circumference Y site 8/13/2009 with raised 8/14/2009 hardened red skin. A chest pain intermittently since the vaccine administration consistent with costochodritis, patient U has a mvp7/18/2009 that appears 7/18/2009 to have worsened w - Red, swelling, warmth to touch, 3"Ydiameter R thigh, 1" L thigh - Treatment 12.5 mg Benedryl Y 8/12/2009 8/14/2009 s a reddened area at injection site that is slightly itchy. U 8/14/2009 8/14/2009 veloped rash approximately two inches in are on right deltoid one day after receiving the Anthrax U immunization. 8/12/2009 Patient 8/13/2009 stated that are was ates that she suffered from posterior headaches describes as heaviness, nausea, diarrhea, and N fatigue. 8/13/2009 Thinks she 8/13/2009 may have had a low gra iving 2nd injection (MMR) the client Yslumped over in the chair, his eyes rolled in the back of his Y head, he8/17/2009 started to shake 8/17/2009 similar to a seizur painful hard lump with Pneumovax. Fever of 101.8. Vomiting Y 8/15/2009 8/15/2009 ECEIVING 1ST GARDASIL VACCINE, PT AND MOTHER RETURNED TO CHECK-OUT WINDOW Y AND8/17/2009 STATED THE 8/17/2009 PT "COULDN'T SE veloped a fever, headache, stomach ache, lethargy and loss of appetite approx. 40 hours after Y receiving 8/6/2009 vaccination.8/8/2009 The fever lasted for IAL LESIONS ON FACE, EXTREMETIES Y (+)PRURITUS ON SET OF RASH < 24 HOURS WITH Y VACCINE 8/5/2009 ADMINISTRATIO. 8/5/2009 NO HISTOR l thigh was swollen, red, firm to touch Y and painful area 9cm x 7.5cm in size. Fever up to 102F Y the evening 8/12/2009 after injection 8/13/2009 8/12/09 and the n 9 about 6:00pm child developed fever Y and was taken to ER where parents were told his fever U was 104.5 8/13/2009 degrees fahrenheit. 8/15/2009 Child was tes inflammatory reaction of skin. No systemic manifestations. Y 8/5/2009 8/16/2009 Y 8/14/2009 ter receiving Zostavax, onset of erythemic maculopapular lesions and erythemic patches to left N neck, bilateral 7/27/2009 lower chest, 8/3/2009 right lower abd, ENT PRESENTED WITH DIARRHEA Y ON AUGY11, 2209. BECAUSE 3 OF PERSITENT DIARRHEA, Y PATIENT 7/30/2009 WENT 8/11/2009 TO ER AT HOSPITAL x 6.0 cm wider. U 8/15/2009 8/16/2009 d blotchy rash at site of injection. 8/10/2009 8/17/2009 nd red left arm. U 8/12/2009 8/12/2009 n 8-7-09. 8-10-09 elevated temp 104, Y nausea, vomiting (x1) severe nausea sore. No diarrhea. Y No local reaction. 8/7/2009 Swollen 8/10/2009 glands. BRAT die given GARDASIL, had 20- second ser. tonic - clonic sz with mild postictal phase > 10m after. Y 8/17/2009 8/17/2009 ot swollen up and pt had a red spot in the bottom of both eyes. 8/13/2009 8/14/2009 02 or above and headache x3 days after. U 8/14/2009 8/15/2009 ter immunization of HPV given, patient Y swayed back + then fell to Rt side. Mother + myself called Y her name 8/11/2009 with no8/11/2009 response for @ 3 seco fter receiving vaccines awoke with c/o a headache 'in the back of her head' - headache persisted Y for 2 days, 8/3/2009 better with 8/4/2009 TYLENOL/MOTRIN d. 8/18/09 spoke w/pt says had swelling under left armpit to include chest, triceps and a red spotty rash across 6/26/2009 chest,7/6/2009 symptoms went away 0 min after administration pt states felt "hot" returned to Hospital at 4:05. Noted face slightly Y flushed, B/P 104/64. 8/7/2009States 8/7/2009 legs weak. 4:20pm tion given IM in R deltoid. Immediately Y after pt c/o pain at site. 2 minutes after injection pt was Y sitting in 8/11/2009 chair. Unresponsive 8/11/2009 to verbal stim ely became pale and fainted - revived in at 15 seconds but couldn't remember what happened. Y 8/12/2009 8/12/2009 hard tricep, inflamed large area. 4/23/2009 4/23/2009 eft leg is swollen, red, and warm to touch. Y 7/29/2009 7/31/2009 Nausea / emesis shaking headache BP 110/78 sent to ER Home and feeling was hot seen atYER. was taking 8/7/2009 to long. 8/7/2009 24 hours post imm started with armYpain on R. Nausea, vomiting. Achyness all over and fever Y 1st to 101 8/3/2009 --> TYLENOL 8/4/2009 --> 103.4 seen in o both cheeks, chin and forehead and under right arm with redness, itching and slight swellingUthe next day 7/24/2009 after vaccines 7/25/2009 were administered ived DTAP, VARAIVAX vaccine 8-11-09 Y (L) deltoid. At scheduled visit 8-13-09 to primary care. U Injection8/11/2009 site was warm, 8/13/2009 red and tender. Tre o R deltoid area. 8/14/2009 8/16/2009 received MMR vaccine 5/18/09. Presented Y with rash trunk and extremities. Referred for evalY and trt positive 5/8/2009 pruritis.5/21/2009 Treated with BENADR f tremors X approx. 30 sec and c/o light headedness, Immediately subsided when placed in Y Trendelenburg. 7/13/2009 Then got 7/13/2009 up in chair smiling an U 8/14/2009 8/15/2009 PER ARM REDNESS WIHT SLIGHTY INCREASED WARMTH. Y 8/5/2009 8/6/2009 mom 9:00 am- completely recovered per mom- Mom left clinic without having pt scheduled. Y Pt rec'd Varicella 8/14/2009 to (R) 8/14/2009 arm. Immediate wheal
U 8/17/2009 action from the chicken pox booster. Hives that were burning hot down my daughter's arm. UThis lasted 8/15/2009 all day and8/16/2009 through the night. She izure on evening. Y Y 8/4/2009 8/5/2009 bruise on leg Rt red Y 8/7/2009 8/10/2009 reaction large 12cm x 9cm, swollen hard, nodule formed near/around injection site. Pt instructed Y to use 8/10/2009 ice, TYLENOL, 8/10/2009 and BENADRYL if breakouts hives, rashes, red spots. Small little bumps. Arms, stomach, back, face, legs. And Y where he7/23/2009 got his shots. ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical n has been received from a dentist concerning his 62 year old wife with macular Y degeneration N and penicillin 8/5/2009 allergy who 8/8/2009 on 05-AUG-2009 w n has been received from Y a 70 year old female patient with no prior history of cancer Y who onUan unspecified date was vaccinated with one n has been received from a nurse practitioner, Y for the Pregnancy Registry for VARIVAX (Merck), Y concerning 2/19/2009 a 17 year old### female with no p n has been received from a physician Y concerning Y a 27 day old male4with a history of premature, N respiratory 1/15/2009 distress,2/10/2009 bruising of face, jaund n has been received from a physician Y concerning a "17-18 years old" female who "about twoYweeks ago"7/27/2009 (approximately 7/27/2009 28-JUL-2009) was n has been received from a physician Y concerning a 17 year old female with childhood seizures N from age 5-11 8/5/2009 years old 8/5/2009 and had been seizu n has been received from a physician concerning a 16 year old female who in approximatelyYJuly 2009 (about 7/1/2009 1 month 7/1/2009 ago), was vaccinate ort was received on 07 August 2009 from an attorney Y who is representing 0 the patient's parents. N A female2/21/2007 patient had 3/3/2007 received an injection o ffice visit vomiting, diarrhea. 2-24-09 dehydration, Y vomiting, diarrhea. Hemocult (-) Rota (+), Y C-diff (+). ### 2/23/2009 er receiving Hepatitis A Y and Tdap vaccines Y had dyspnea and coughing along with redness of Y neck and tingling 8/12/2009 tongue 8/12/2009 - used ALBUTEROL eadaches, belly pain, bilateral feet-legs Y tingling Y numbness, legs aching 14 while walking, weakness N in upper5/11/2009 and lower extremities 5/25/2009 - happened d vaccine site swollen, erythematous, Y warm to touch. Evaluated 8/14/09. Area nontender now. Recommend 8/12/2009 warm compress. 8/13/2009 Localize vacc cribes child as "limp" "weak" just did not feel "solid" when she held him almost immediately after Y shots and 8/11/2009 through the 8/11/2009 evening - cried incon ausea x 2 days - vomiting - headache - oral rehydration and MOTRIN for treatment. U 8/8/2009 8/8/2009 m RN Supervisor received t/c from patients Y spouse. Reports Patient went to ER had difficultyU breathing and 8/11/2009 chest pain. 8/12/2009 Had EKG, Labs an n site of administration 18mm W X 15mmL. Redness around Hive. Y 8/11/2009 8/11/2009 DaP < 10 yrs of age. No adverse reactions noted or reported. No treatment indicated. 8/5/2009 soreness, swelling and itching in arm from site of injection toward the elbow covered area about Y 1 1/2 inches 8/5/2009 by 3 inches. 8/6/2009 Period of dizzine edness, soreness -swelling - itching - Resolved within a few days-. Patient wanted to report Y it. 7/24/2009 area, swelling, 8/13/09 8:00 AM. Treatment diphenhydramine 1/2 tsp TID. 8/11/2009 8/13/2009 min after receiving the below 3 immunizations, pt. slumped fwd from sitting position on exam table, Y losing 8/11/2009 consciousness. 8/11/2009 M.D. caught upper given 6-26-2009 - Also given TDAP and Varicella Booster on 6.26.09. Mother states that evening Y he developed 6/26/2009 redness 6/26/2009 on R deltoid. Feve 8-11-2009 vomited, upset stomach, Ydizzy, tired, cough. Thought would get better continues to Y have symptoms. 8/11/2009 8/11/2009 Client called Health Department at approximately Y 3:40 with complaints of severe abdominal pain Y and "white 7/29/2009 foam coming 7/29/2009 from her mouth, a njection- large area of erythema and Y swelling, multiple vesicles @ site and pt c/o pruritus (L U arm varicella 8/4/2009 site) 8/10/2009 hours after HPV & HEP A she had red glassy eyes, fever to 102 for 2 days, weakness, (generalized), Y arms 7/31/2009 weak & thighs, 8/1/2009 decreased appe ived MMR and VARIVAX on 8-5-09. 8-11-09. Child started with a rash on 8-12-09 child wasNbrought into Health 8/6/2009 Dept 8/11/2009 with rash on face, he 3 3/4 red raised area at site of injection with small blisters through out area - No itching - burning Y etc - Temp 8/4/2009 97.8. 8/10/2009 er, called this RN at 12:15pm and stated Y that daughter's left arm from shoulder to elbow is red and swollen 8/10/2009 and "Hot8/12/2009 to touch" Instructed he er called RN at 12:15 pm and statedYthat daughter's left arm from shoulder to elbow is red, swollen, hot to8/10/2009 the touch 8/12/2009 and the skin looked "str eruption c/u varicella Zoster - S/p ZOSTAVAX. Y 6/30/2009 7/1/2009 orso- anterior ! Posterior ! Itching. Referred to PCP for assessment. Client given Benadryl and Y PCP office. 8/11/2009 SX resolved 8/11/2009 by the next morning matoma approximately 2 in diameter rash - demarcated erythema approximately 5 in diameter. Y 8/7/2009 8/8/2009 came light headed and momentarily fainted 15 minutes after receiving TDAP injection. An ammonia Y capsule 8/12/2009 was used 8/12/2009 and she immediatel VRIX #1 in (L) arm and patient said she felt light headed and started to fall, I lowered her to chair. Y 8/12/2009 8/12/2009 ollowing day awoke with bad headache. 8:00 am felt faint, sore muscles in arms and legs, (ADVIL) Y hurt to 7/29/2009 open eyes. 7/30/2009 Shot site slightly red. on's football game pt started to have Y low grade temp chest feels tight, joint swelling, tongue swelling, fever 8/11/2009 102.8. Pt 8/11/2009 advised to go to neare @ approximately 3:15 pm patient had vaccinations by 5:00 pm developed fever, aches, nausea, N tired. At 8/10/2009 6:15 throat 8/10/2009 felt sore. 8/11/09 - at r area is erythematous, mild swollenY& not Tender skin feels hot to Touch. Y 8/10/2009 8/12/2009 GARDASIL 6/4/2007, 7/31/2007, 12/28/2007 - Normal PAP 6/13/2006, 6/14/2007, 3/26/2008 U - ASCUS HPV 6/4/2007 + 8/3/2009. elling to vaccine site. ABX given from Y ER seen at PCP site. U 8/15/2009 8/15/2009 t red rash around injection site and bruising he following day with c/o fever >102, Y body aches, chilling and cough, encouraged Tylenol around Y the clock 8/11/2009 for the next 8/12/2009 24 hours and push ven a DTaP on August 6th at 1430.YOn 08/18/09 his mother called the clinic. She stated that Y his arm was8/6/2009 swollen from 8/6/2009 the injection site to
Vaccine received 08/13/2008 and 09/16/2008. Five days post second administration I developed N neuropthay 9/16/2008 including 9/21/2009 tingling with pins and 03 for 28 hours, with continued redness Y of injection sight, 48 hours later started wheezing, gasping U for breath 8/14/2009 and coughing 8/14/2009 continued for 36 following vaccination, patient notedYbody aches, chills and progressive left deltoid pain. By the Y following8/12/2009 morning the 8/12/2009 patient was noted to hours of the vaccination had debilitating Y stabbing pain (occipital, cervico, brachial)crescendoNepisode lasting 1 ### hour 40 minutes. ### On a scale h on arms and chest 24 hours after Yreceiving MMR Booster. Treated with Triamcinalone 0.5% Y cream and 8/12/2009 Benadryl.8/13/2009 Prescription given for ceived MMR and Varivax boosters. Y10 minutes later he vomited 3-4 times, had a bowel movement Y (on the 8/18/2009 toilet), and 8/18/2009 had a near syncopal here because he had his shots Friday and that evening he developed a huge red area in the Y vicinity of the 7/17/2009 shots. It7/17/2009 was itchy and his thigh episode following Tdap vaccine. Incontinent of urine. Y 8/18/2009 8/18/2009 seconds of vaccine, I got tunnel vision, and i leaned over in my chair to allow the blood to return U to my head. 8/18/2009 I black8/18/2009 out completely, and so D 4 MO SHOTS 1PM @ HEALTH DEPT. Y 2 HOURS LATER NOTICED "HIVES" BOTH LEGS. Y ER LAST8/17/2009 PM. GIVEN 8/17/2009 BENADRYL 1/4TSP d varicella vaccine 08/17/09 to RPUA SQ. Pt presents to PCHD today with 25w X 30l erthythematous raised 8/17/2009 area to 8/18/2009 site of vaccination sta t generalized tonic-clonic seizures the Y next day. Had full workup, including CBC, electrolytes,Y lumbar puncture, 8/13/2009 head8/14/2009 CT, EEG, all negative ter had been suffering from Y extremeYfull body Uticaria Y for three years Y and had been Y treated with U benadryl,3/4/2008 allergy medications, 4/15/2008 hydrocortiso of 100 degrees F.; headache; severe Y body aches and loss of energy; U 8/9/2009 8/15/2009 as found walking outside relative's house at 4:30 AM. She was found by police. Per mom, patient Y "seemed 8/13/2009 out of it" 8/14/2009 and "didn't want to answ a of erythema at site of MENACTRA injection. Y 8/14/2009 ction to left shoulder/deltoid with erythema, warmth and tenderness. No systemic symptoms.Y 8/12/2009 8/13/2009 arm redness and swelling. 8/17/2009 8/18/2009 ports 7pm Pt C/o throat discomfort, heat, itchy leg- swelling and induration at injection site started Y in AM soon 8/17/2009 after injection 8/17/2009 per mother 1x 2 ndurated, erythematous, swollen, hot and painful. Child more fussy than visual! exacerbationYof asthma x1 8/14/2009 day. Treated 8/15/2009 with Ibuprofen. Now fever to 103.5 headache "both arms hurt" redness at injection site and frequent cleaning of throat. U Encouraged 8/17/2009 to increased 8/18/2009po fluids, TYL upper arm c/erythema - lasting more than 72hrs. Y 8/12/2009 8/12/2009 vaccines, woke up feeling weak andYfaint. Sat down, and passed out. He had generalized seizure Y activity8/14/2009 > 20-30 sec. 8/15/2009 He was tired but not degrees & some delirium the day after Y vaccination small red area Rt deltoid at injection site,Ytender painful 7/27/2009 - Pain is mild moderate. Const away react w/ hives. U 8/13/2009 8/13/2009 accine @ 11am - went home - at 1 PM Y developed hives & itching (generalized) & shortness Y of breath - Mother 7/31/2009 gave7/31/2009 child BENDRYL oral & t. given Tdap injection during an OV to be seen due to a cat bite. 5/7/09 Pt. returned to officeUwith symptoms 4/29/2009 of left upper 5/5/2009 arm pain which be sterically. Lips and hands turn blue. YShaking, fever 103.7 2 days after shots. Y 1/12/2009 1/14/2009 e on Tuesday August 11, 2009, mother reports lump on L leg near injection site, still presentYtoday. 8/11/2009 8/12/2009 of warmth and itching on R thigh on day # 2 after shots. Y 8/7/2009 8/10/2009 after the Hib vaccine my son had high Y fever fluctuating Between 101.6 to 100.7 for the next 5Ndays. He became 7/20/2009 lethargic 7/25/2009 at night developed hot and red to the touch. And arm muscles felt jiggly." X 2 days. Y 8/6/2009 8/7/2009 minute after inj. patient stated inj site Y was itching. Area was slightly red, irregular in shape approx Y 10mm8/12/2009 in size and8/12/2009 warm to touch. 0817 c elling, erythema and bruising after injection. Erythema was approximately 10 inches area, small Y bruise about 8/4/2009 2 cm (18/6/2009 inch). - of neck, trunk, arms. Y Y 7/30/2009 7/31/2009 at injection site, red with fever. Y 3/16/2009 3/26/2009 er, bellyache, tired with MOTRIN temp Y came down, bellyache resolved Y 8/18/2009 8/18/2009 n after receiving Hep A vaccine, patient passed out. Quickly recovered and was awake and Y alert within seconds. 8/17/2009 8/17/2009 was reported by a healthcare professional Y and described the occurrence of injection site redness Y in a 22-year-old 5/19/2009 female 5/21/2009 subject who was the 1st round of Gardasil Y July 7, 2008. Towards the end of August 2009 a lesion formed on N my tongue. I 7/7/2008 have been8/16/2008 diagnosed with Oral C omiting, low grade fever x 2-3 days reported by mother (no office visit). Gave pain reliever, sx Y resolved. 5/5/2008 5/5/2008 6/23/2009 Y Y 2 N 5/30/2009 6/1/2009 was received from a health care professional Y via another manufacturer (case ID number 2009S1013958), on 13 August 2009. A 14-year-o n has been received from a medicalYassistant concerning a 79 year old male with a history ofY stroke, anaemia, 6/12/2009 dementia, 6/19/2009 hypersomnia, alz n has been received from a nurse concerning Y a 20 year old female who on 13-AUG-2007 was Y vaccinated 8/13/2007 intramuscularly 11/1/2007 on her left deltoid es and temp. 99 started 8/7 red, hard, swollen area at injection site (approx 10 cm in circumference and down 8/6/2009 arm form 8/7/2009 inj site - started to s ensation and pain in shoulder, lower legs and feet started morning of 8/11 and increased in intensity Y as day 8/10/2009 progressed. 8/11/2009 Lasted until 1 AM 8 ht headed & weak at 01:00 on 8-8-09 Y - went to Hospital ER & stayed until 05:00 on 8/8/09. Low Y grade temp 8/7/2009 - 99.7 (o)8/8/2009 Had IV fluids & dose o flu vaccine Nov. 2008 - within weeks Y of injection, noticed changes in movement of arm (left) N - positive stiffness 11/7/2008 with limited range of motion. R arm soreness, immed. after shot. Hep A + Typhoid Increase T=100 to the 8th- 101 to theY8th 08.18.09 8/17/2009 @ 8 am. 8/17/2009 en, itching in arm, warm to touch at 2:30 PM. Around 5:30 PM face was itching and arm wasY itching. Arm 7/20/2009 swollen in 7/20/2009 4" diameter. Nausea
were given, pt tolerated well. The following morning pt found quarter sized area of redness with Y a whelp at 8/4/2009 area of injection 8/5/2009 site - area is red as given PNEUMOVAX morning approximately equal to 10 AM 8/4/09, by that afternoon armYbecame sore8/4/2009 with diminished 8/4/2009 R.O.M. following a site of injection - dime size SubQ Y mass. Y 7/30/2009 7/31/2009 report of lymphadenitis has been received fromYa study investigator2concerning a female child U participating in a### post-marketing ### study for FL report of septic arthritis has been received fromYa study investigator3concerning a 39-month-old U female participating ### in a post-marketing ### stu report of hearing loss/deafness has been received Y from a study investigator 1 concerning a four-year-old U male 11/8/2008 participating 12/5/2008 in a post-marketi report of trauma has been received from a study Y investigator concerning 1 a four-year-old female U participating 12/4/2008 in a post-marketing ### study for F report of urinary tract infection and bacteremia Yhas been received from 2 a study investigator concerning U a12/1/2008 44-month-old male ###participating in report of trauma has been received from a study Y investigator concerning 1 a four-year-old male U participating 9/26/2008 in a post-marketing ### study for FL report of nail disorder has been received from aY study investigator concerning 1 a 44-month-old U female participating 12/7/2008 in a post-marketing ### stud report of trauma has been received from a study Y investigator concerning 1 a 41-month-old male U participating in a### post-marketing 11/7/2008 study for FL report of sleep apnea and tonsillitis has been received Y from a study 1investigator concerning U a 43-month-old 1/9/2009 female 1/16/2009 subject participating in a report of congenital anomaly has been received Y from a study investigator 1 concerning a 37-month-old U male 12/2/2008 (subject number ### 29395693) par report of sleep apnea and pneumonia has been Y received from a study 3 investigator concerning U a four-year-old 11/4/2008 female 12/4/2008 participating in a post report of encopresis has been received from a Ystudy investigator concerning 2 a four-year-old U male participating 1/8/2009 in a post-marketing 1/30/2009 study fo report of congenital anomaly has been received Y from a study investigator 5 concerning a four-year-old U female 11/7/2008 participating 11/9/2008 in a post-marketin report of abscess and postsurgical state/complication Y has been received 1 from a study investigator U concerning 11/7/2008 a four-year-old ### female partic report of congenital anomaly and epilepsy has Ybeen received from a1 study investigator concerning U a 26-month-old 11/4/2008 female### subject participa report of abdominal pain and vomiting has been Y received from a study 1 investigator concerning U a 30-month-old ### male participating ### in a post-m report of trauma has been received from a study Y investigator concerning 1 a 36-month-old female U participating in### a post-marketing ### study for F as in waiting room about 10 to 15 minutes after vaccination and was waiting to leave the building Y when patient 8/10/2009 began 8/10/2009 to complain of 'feeling izure like activity after the vaccination, this was her third dose, she had no adverse reactionsYwith the previous 8/18/2009 two. 8/18/2009 She remembers feeling ion of Garadsil was given to my daughter Y on July 21, 2009. A few weeks later her hair has begun N to fall7/21/2009 out severely.8/8/2009 She has not had any ting Heart rate 52 pale poor cap refill, dizzy and nausea. 8/17/2009 8/17/2009 7, DTaP vaccine was given instead of TDaP. U 7/18/2007 d edematous area at site of injection, measuring 6 cm. in width and 5.5 cm. in lenght. Left upper Y arm. 8/18/2009 8/19/2009 nt came in to see the doctor with a case Y of the shingles. Patient was advised to apply cold compresses U 4 times### a day 8/14/2009 for 20 minutes to relie S MOTHER STATES THAT CHILD HAS HAD DIARRHEA ALL DAY, FEVER OF 101, AND U SWOLLEN ARMS 8/17/2009 8/18/2009 hours after receiving vaccine patientYhad a generalized seizure lasting under 5 minutes. TheYseizure was8/5/2009 witnessed by 8/5/2009 his mother and siste pathic autoimmune hemolytic Y anemia Y accompanied Y by high fever, fainting, 7 jaundice, irregularYheartbeat. 6/18/1998 8/21/09 Hospital 7/1/1998 records received ry skin, extreme fatigue, light headed, Y headache, increased menstrual cramps, Raynaud's Y disease, N weight6/3/2008 loss, hair6/21/2008 loss, joint pain, facial r ng, earlobe swelling and eyelids, vomited. Y SomeY drop in BP. Seizure1- post-ictal. 8/31/09 ERY/ hospital records 8/17/2009 received 8/17/2009 DOS 8/17/09 to 8/1 d sudden onset of rolling of eyes, unable to hold Y head, and unresponsive 1 10 minutes after vaccination. Y Pt 8/17/2009 was at home 8/17/2009 and went to ER; fro Y Y 8/17/2009 8/19/2009 upperarm onset redness 1 day after imm. Y 8/13/2009 eported intermittent hives since first HPV vaccine. N 5/27/2009 d ocular viral, herpes infection right Y eye. N 8/1/2009 8/18/2009 ated she received the ZOSTAVAX on 8/14/09 and on Sunday 8/16/09 the injection site started Y to itch and8/14/2009 noticed a 8/16/2009 blister near injection site ated first vesicle rash on arm - also had fever. Pt's fever was in control, but developed more vesicle N rash 7/28/2009 on head, body 8/15/2009 and extremities abo ed following inj./ After 15 minutes pt appeared to be having seizure activity. Observed until able Y to leave 8/18/2009 with grandmother 8/18/2009 of her own accor , slight tenderness @ injection site 1 day after immunization; OTC Ibuprofen for pain and edema; U warm compresses. 7/20/2009 7/22/2009 d female complains of facial skin rash Y and pruiritis after AVA and Typhoid vaccines. Symptoms: Y Swelling, 8/17/2009 Rash, focal, 8/17/2009 Pruritus. x -Mod/Severe local with opportunistic Y bat. infection - SEPTRA susp 2 tsp PO Q12 hrs x 10days - Redness 8/17/2009 13 cm length 8/18/2009 12 cm with 2 cm x erythematous, indurated area of local Y reaction 13cm diameter. 8/13/2009 8/14/2009 e temp (<105 degrees F), erythropoiesis Y became papules all over next day. U 8/17/2009 8/18/2009 after injection and had probable vaso vagal response with full body tremor, lips turned pale, eyes Y rolled back, 8/17/2009 assisted 8/17/2009 to exam table tremor re 7/25/09. Had Mri & Ct scan & blood Y work. In August diagnosed with Hashimoto ThyroiditisN& compensated 4/21/2008 hypothyroidism. 7/25/2009 10/6/09 PCP ter is going into junior high and received Y her tetanus shot along with the first shot of 3 for Gardasil. U That 7/28/2009 was three weeks 8/18/2009 ago. Yesterday m eadaches that come on suddenly (side Y and front of brain). Have witnessed joints, bones that U hurt to the point 8/14/2009 that the8/14/2009 child can not walk, com sore, headache, fever/chills, leg aches Y 8/17/2009 8/18/2009 fter receiving her MMR vaccine, Y the patient developed Y fever, rash and 20 convulsions, requiringUadmission to 6/10/2008 the pediatric 6/20/2008 ICU. Her developm
ed that she felt a tingling funny sensation on her left cheek about two hours after the vaccine.She N had visible 8/18/2009 swelling 8/18/2009 of left cheek and face ALSY DIAGNOSED BY PERSONALY PHYSICIAN. U 8/18/2009 8/19/2009 llowing vaccine administration pt developed Y fever, myalgias, anorexia for approximately 36 hours. Y Temp8/18/2009 to 104.4. Also 8/18/2009 developed localized hot was given, pt. has had severe headaches Y and acute nosebleeds. She has received two N does, and will 5/19/2009 not receive 5/19/2009 a third. I was never m Fever, Seizure. 8/25/09 Hospital records Y received Y service dates 8/18/09 2 to 8/21/09. Assessment: Y Fever,8/18/2009 febrile seizure, 8/19/2009 vomiting. Baby wok red four vaccines during immunization clinic visit. Within five minutes of injection, client became Y very pale, 8/18/2009 c/o of dizziness 8/18/2009 and lightheaded s all over body appeared day after vaccination and continued for 3 days. Mom treated day 1Ywith benadryl 8/12/2009 then oral8/13/2009 steroids when didn't re chin, arms, legs, caps of shoulders Y U 8/14/2009 8/14/2009 her reported that the fever that developed Y post vaccination was as a result of vaccines given.Y Prior to vaccine 8/17/2009 administration, 8/18/2009father stated t le pain, severe headache, bad bone pains, neck pains, exhaustion, runny nose, stuffy nose, sore irritated 8/17/2009 throat, This 8/18/2009 has lasted now for 2 LAINED THAT INJECTION SITE WAS Y BOTHERING HER ON 20 AUG 09. REDDENED AREA Y MEASUROING 8/17/2009 30MM 8/19/2009 X 65MM ON MEDIA d the Gardasil series of Y shots on July 20, 2007, Sept. 26,2007 and Feb. 20, 2008. In Jan. 2009, N she told2/20/2008 me (her mother) 1/29/2009 about a large lum UG 09, PT COMPLAINED TO MOTHER Y THAT INJESCTION SITE HURT AND ITCHED. REDDENED Y WITH 8/17/2009 INDURATION 8/19/2009 NOTED ON LEF n has been received from a physician, for VARIVAX (Merck), a Pregnancy Registry product,Yconcerning a4/1/2008 female who 4/1/2008 in the first week of A diagnosed Sensory Guillain Barre - YJan 08 IVIG relapse May 2008 IVIG relapse June Y 2008 high N dose of PREDNISONE ### 12/1/2007 tapering down rela miting, bloody diarrhea. Seen in ER.YSeemed toYbe in pain - bright red 2 blood in diaper, massYpalpable in abdomen. 8/6/2009 Ultrasound 8/13/2009 suspicious fo xis, admitted to hospital. YBegan 10 min Y after admin Y of meds. Received epinephrine, BENADRYL Y and steroids. 8/4/2009 8/4/2009 1/2 weeks after receiving, patients pupils became unequal. Evaluation by pediatric ophthalmologist N revealed 10/5/2007 no other pathological ### findings h, swelling of most of arm where injection Y was given, seen in ER next day given Rx for ORAPRED. Y 8/17/2009 8/18/2009 HPV vaccine 2/10/09; starting 3/24 begin with itchy rash over feet which spread to much of torso. N By 4/09 2/10/2009 developed 3/14/2009 muscle weakness & m theaded/dizzy - No LOC, no nausea - Pt remained in supine position, then sitting position over 20 min. 8/17/2009 8/17/2009 day of injections, got low grade fever 24 hours later and very tired. By 5 pm did not want to walk Y or eat and 8/3/2009 fever 102. 8/4/2009 Fever came down 48 rea with redness - 3X3 center with light Y purple area, no tenderness or warmth. No treatment just observe.8/13/2009 8/17/2009 firm-warm to touch Rx for Augmentin Tsp BID x 10days. U 8/10/2009 8/11/2009 d warm, red, swollen, painful, 7 cm Y X 8 cm. Y 8/11/2009 8/11/2009 hour post injection, pt. came back with red, firm, warm knot approx. 2 1/2 in X 2 1/2 in. Denies Y any other symptoms ### @ this ### time. No tx @ esented to our ER with an injection injury. Y Received a Tdap. According to pt arm swelled upYsize of basketball, 6/8/2009 red, blotchy, fever. Seen in vaccine given in right arm- Redness, Y warm to touch, swelling where shot was given 8.0 cm X Y 8.5 cm in size. 8/13/2009 8/14/2009 rly morning with shallow breathing, fever of 102 degrees & rapid heart beat. After nursing, breathing Y remained 5/4/2009 shallow 5/5/2009 & heartbeat became ate DTAP given (extra) and HEP A given at inappropriate interval. (3 months instead of 6). Y 8/4/2009 es pt felt tired yesterday, light headed dizziness, fell out & lost conciosness for 30 seconds today! Y 8/12/2009 8/14/2009 of hours after first shot, my left knee (which I've had 9 surgeries on, synvisk injection, and is arthritic) U swelled 7/27/2009 up very7/27/2009 large and constantly fo hree daughters to their doctors for the GARDASIL shot. One daughter was fine, no reaction.UThe youngest 7/11/2009 daughter7/11/2009 -11 years old- felt nau other called clinic stating child developed Y "upper respiratory infection 1 week after administration Y of vaccine" 8/4/2009 was treated 8/10/2009 with antibiotics as EACTION, FEVER, CHILLS, MYALGIAS, NAUSEA, Y VOMITING, PNEUMONIA. 1 8/25/09 Received Y ER records 8/7/2009 of 8/16/2009 8/15/2009 to 8/25/09. FIN ministering MMR vaccine patient flinched arm and needle came out a little and some of the medication Y got 8/18/2009 into the right 8/18/2009 eye of the administr ss of hair. Then dizziness and nausea Y with vomiting and severe abdominal pain. After 20 months N of multiple 5/21/2007 doctor 6/15/2007 visits, Nina was diagnos ction within 24hrs. But lasted for nearly a full week. Red, firm, about 6-7cm in diameter, withYsome surface 8/7/2009 vesiculation. 8/8/2009 Initially given Kefle weeks after I received the MMR vaccine Y on July 20, 2009 I developed a low grade headache, Y nausea and 7/20/2009 diarrhea. 8/6/2009 The night of August 5 arted vomiting and having diarrhea at 4:30 p.m. on 08/19/2009. She reports visualizing blood U in her stool8/19/2009 on 08/20/2009 8/19/2009 at 6:00 a.m. ation was on 07/15/08, she began having Y muscle Y cramps primarily in 4 legs. 2nd vaccination was N 10/8/08 10/8/2008 and muscle cramps ###extended throu eloped fever of 100, vomiting and red spots on chest (Size of a fist)the evening of immunizations. U Rash disappered 8/19/2009 8/19/2009 by the next morning, ho to back of left arm the size of mom'sYfist with a rash going down the arm towards the elbow, Y warm to the touch. 8/6/2009 8/8/2009 AREA LARGE SWELLING, REDNESS, TENDER, AND WARM TO TOUCH. Y 8/10/2009 8/11/2009 ernight after receiving vaccine, did not sleep well. Next morning mom noticed area of blanching U red macules 8/18/2009 and papules 8/19/2009 on right knee. T d Vaccinations at 8 am with no symptoms Y or complaints denied any allergy except benadryl.At U 1053am 8/20/2009 patient came 8/20/2009 back to clinic complai temperature leading to seizure. Temp Y 104.1 at Y Hospital Emergency 2 Room. Transferred viaYambulance8/17/2009 to another 8/18/2009 Hospital. 9/1/09 ER rec th a fever on 8/13/09 rash started 8/16/09 mostly on his truck and right side of his face BIG RED SPOTS..8/5/2009 He now sores 8/13/2009 in his mouth, red d first Gardisil injection at her pediatric clinic without complications approximately 1 year ago. Y Gave 2nd Gardisil 8/7/20090.5ml 8/7/2009 injection in L Deltoid ROTATEQ 06/25/2009 AND PRESENTED Y TO OFFICE 7/10/09 WITH COMPLAINTS OF BLOODY U STOOL. 8/13/2009 AT THAT 8/20/2009 TIME WAS THOUG 24 hours after vaccine admin. pt had stiff neck, fever to 100F and body aches. U 8/17/2009 8/18/2009
hours after DtaP vaccination patient was observed to have 3 seconds of staring and trembling Y of whole body 8/17/2009 including 8/20/2009 arms and head. Per ed having "seizures" or "staring episodes" Y and her Y eyes started getting 3 blurry or double Y visionNat times in 1/16/2008 June 2008.3/27/2008 She was so sick she w mited and then became lethargic for 5 minutes. Did not lose conciousness. Y 8/20/2009 8/20/2009 tenderness at the injection site and scattered vesicles. Advised cool compresses to area andUTylenol for 8/13/2009 discomfort.8/19/2009 itchy read rash on face, arms, legs, chest and back. Started 2-3 hours after injections of : Depo N Provera, 7/29/2009 TD and Hepatitis 7/29/2009 A/B (Twinrix). varicella, TDAP, MCV4 on 081809. Returns to clinic 082009 with edema, inflammation,hot to U touch, pain 8/18/2009 at varicella 8/19/2009 injection site on right F 105 ON 8/8/09 WENT TO ER, CXR, Y BLOOD TEST NEGATIVE. THEN FEVER ON 8/10/09 102.2-TYLENOL 8/7/2009 & MOTRIN 8/10/2009 FOR FEVER, IN d itchy scattered vesicles 7 days after receiving Varicella vaccine U 8/13/2009 8/19/2009 1 had shot. On July 26 passed out Y4 times at the fair. August 3 blacked out but she said didn't N pass out7/21/2009 all the way.7/26/2009 Aug 10 not feeling we veloped a hive appearance rash on 1 side of the face approx. 2 hrs. after receiving her 1st dose Y of gardasil. 8/13/2009 The following day rash deeper G, DIZZYNESS HEADACHE , STARTED Y THESE FAINTING SPELLS AFTER THE 2ND SHOT U THAT WAS 1/22/2009 IN 6/09 7/15/2009 HAS FAINTED 6 TIMES minutes post-vaccination: syncope, racing pulse, uncontrollable crying Y 8/19/2009 8/19/2009 e syncope 5min post vaccination. Mother reported child shaking, however, when nurse arrived Y child was8/14/2009 awake and8/14/2009 talking to mother. Moth s given Tdap, Hep A, Menactra, and HPV. Syncope episode 10 min after vaccine adm. Child Y was assisted 8/17/2009 to the floor. 8/17/2009 Was responsive as Y 8/18/2009 8/19/2009 lu-like symptoms ~4 hours after reciept of vaccine (e.g., myalgia, malaise, fatigue). Onset ofUbilateral red8/19/2009 eyes with 8/19/2009 some pruititis, sore thro AREA LOA, APPROX.70MM X 70MM . NO OTHER SYMPTOMS. U 8/12/2009 8/12/2009 with diarrhea (day 0 only); variable low grade fever (day 2-10 ); cold-like symptoms (day 2-7):Yclear runny1/30/2009 nose, sneezing, 2/8/2009 watery eyes; whin al reaction noted 2 days after vaccination Y in the L deltoid. Erythema, induration, pain at the site. Y 8/18/2009 8/19/2009 redness X 1 day Y 8/12/2009 8/13/2009 er receiving third dose of immunization, my daughter began to demostrate unusual psychological N behavior. Atmosphere 10/1/2008 of self-destructive conds of receiving vaccine, I felt likeYI was going to pass out, nurse instructed me to lie downYon table, she left and ### I passed ### out. This occur seizures to reappeared. Hadn't had any seizures for months until vaccinnation was administered. Y Seizures 8/11/2009 lasted for 8/11/2009 most of the week. Se t might have been reported by doctor as requested by patient. Patient received a yellow fever N vaccine VF-Vax-uf081AA 10/9/2007 10/9/2007 on Oct. 9, 2007 an he same reaction to GARDASIL on both shots. The first shot I initially forgot about, on account of I was injected 8/15/2009 with8/15/2009 three vaccines at once. fter the vaccination, she developed Yshaking chills and soreness at the injection site + fever to U 100, two days 8/17/2009 after vaccination 8/18/2009 (today), has H oster, R side breast (under) to approx Y T10. Acyclovir 800mg with 4hrs x 10 days. Y 8/18/2009 8/19/2009 esented with vesicular lesions to Rt side of Rt leg at VARIVAX injection site. Y 8/17/2009 8/18/2009 d swelling & redness. 3 X 4 cm mildY induration. Y 8/18/2009 8/19/2009 8, 2009, patient came for a well child check and she was given DAPTACEL as catch up - last U imm given8/18/2009 at 15 m/o. 8/18/2009 d Hep B #1 in her left arm at 1500 on 6/23/09. The pt waited in the clinic 15 min (felt fine) and drove home 6/23/2009 (which is very close to the clinic eloped herpes zoster in T3 dermatome. He has no history of varicella disease. He received VARIVAX Y at 12 months7/24/2009 and 12yrs of age. elled/ made swallowing difficult/ food & drink would not go down. Y 8/11/2009 8/11/2009 ived varicella vaccination 7/31/2009. 1 week later, she developed a swollen, red area at the injection site. 7/31/2009 2 weeks after 7/31/2009 the vaccination, sh 7/16/09, Date of event 7/21/09, Severe generalized Rash - entire Body steroid given medial dose pacal.7/16/2009 7/21/2009 rm significant edema, redness, heat, Y mild pain + itching R lateral neck moderate redness + edema. Y 8/17/2009 8/18/2009 aches, Right arm numbness, R arm severe pain, nausea, agitated, hurts to swallow, emotional Y after HPV8/19/2009 vaccine. 8/19/2009 en left deltoid about 11:30 AM. 1:00 PM developed blotchy, itchy rash left side of chest and Y left shoulder. 8/20/2009 No respiratory 8/20/2009 involvement. Had administered (L) deltoid 8/17. Intense Y (L) upper deltoid pain 8/18 - current. 8/17/2009 8/20/2009 ver 99.0 - C/o SA last night, vomited x 2. Vomiting has stopped @ 4:00am 8/20/09. U 8/19/2009 8/20/2009 spreading into armpit/breast with soreness Y + hard area/cellulitis U 8/17/2009 8/18/2009 nset left sided chest pain and pleurisy Y like symptoms approximately 4 hrs after vaccine. Y 8/19/2009 8/19/2009 welling one day after vaccine - improved Y by day of doctors visit on 8/19/09 left arm is 4 cm greater Y diameter. 8/17/2009 Received 8/18/2009 two, immunizations s - not noticed until visit 4:00 pm following Y day Red, swollen, hard (cellulitis) pt jerked duringNinjection (needle 8/18/2009 reinported) 8/19/2009 8.20.09 still red s 8/18/09 left arm red swollen with heat and "rash" at injection site with itching at site of injection. Y Mom denies 8/17/2009 other symptoms 8/18/2009 and symptom ination mom reports the pt was veryYlethargic. Arm was swollen and had a white spot whereYvaccine was8/18/2009 given. Eyes 8/18/2009 were sensitive to ligh esented to Doctor 8/20/2009 complaining/existing hives. U 8/9/2009 8/11/2009 20 X 18 cm swelling / warmth / itching. 2 cm increase in left thigh circumference. U 8/18/2009 8/18/2009 9 Other Red raised rash. U 8/10/2009 8/20/2009 erythematous wheal U 8/11/2009 8/11/2009 ction site left deltoid. Area is raised & red with heat. Approx size of golf ball. Advised symptomatic tx with 8/18/2009 MOTRIN. 8/19/2009
tool no Tx given. 1 wk post Rotateq. Pt well at time of exam. Y 8/12/2009 8/20/2009 rash, Dx: chickenpox . Y U 8/31/2007 8/18/2009 lands on side shot administered only Y . Tonsil on side shot administered was swollen, bleeding Y and piece of 8/8/2009 flesh were8/9/2009 falling off the tonsil. F U 8/17/2009 8/18/2009 at the injection site. Lumps, welt, & rash at site. Y 8/18/2009 8/19/2009 p to 101 x 72 degrees - Swelling of leg - Swelling & erythema 3cm in area of shot. U 8/17/2009 8/18/2009 lled stating son broke out in hives all over body. Day after getting HIB. No new foods or dye, U No impaired 7/30/2009 airway. 7/31/2009 Rx'c BENADRYL - told n has been received from a consumer Y concerning her 24 month old son who on approximately N 17-APR-2006 4/17/2006 (reported as### when he was 18 n has been received from a physician concerning a 25 year old female who on 07-AUG-2009 Y N was vaccinated 8/7/2009 with a dose 8/7/2009 of GARDASIL (lo n has been received from a nurse practitioner Y and Y a nurse concerning 0 Yone of her patient's friends N who on unknown date was vaccinated wi n has been received from Y a registered nurse and a certified medical assistant concerning a 16 Y year old female 7/27/2009 with 7/28/2009 migraine headaches an n has been received from a physician concerning a 63 year old female patient who on 11-JUN-2009 U was6/11/2009 vaccinated6/11/2009 with a single 0.5ml do n has been received from a registered Y nurse concerning an 81 year old female patient Y already N deaf in left 7/28/2009 ear with hypertension, 8/8/2009 diabetes, ort received on 17 August 2009 fromYa health care professional. A 46-year-old female patientYwho had metal 6/8/2009 in her eye, 6/15/2009 had received an int ave Pentacel inadvertently when I should have given Hib. The parent was notified of mistake U by Dr. 8/6/2009 fter varicella vaccine developed defused smaller varicella papule some with vesicles trunk + N head shortly 8/3/2009 after fever8/17/2009 to 103-104. e up on left leg swollen. Allergic reaction Y to vaccine - polio shot. Y 8/10/2009 8/11/2009 o thigh quarter sz. 8/13/09. Warm compresses. 8/14/09 site not as red per mom. Y 8/12/2009 8/13/2009 minutes of receiving vaccine, Pt c/oYabrupt severe H/A 0 SOB 0 hives 0 local reaction. Y 8/14/2009 8/14/2009 U 8/14/2009 8/15/2009 ceived MMR injection left deltoid onY8/14/2009. States she developed a rash starting at the injection site 8/14/2009 which was 8/14/2009 covered by a band aid. r, nausea, stiff neck 103 degree fever according to mother. Did not go to ER, treated at home. Y 8/12/2009 8/13/2009 r rec GARDASIL, HAVRIX & VARIVAX inj - pt became pale, lightheaded - nausea ringing in Years - pt laid8/17/2009 on exam table 8/17/2009 recovered. mostly on chest - arm and head. This lasted 3 weeks small bumps and uneven skin. Y 7/15/2009 7/16/2009 right eyelid swollen. No other symptoms. Instructed by MD to monitor. Y 8/12/2009 8/12/2009 edness, warmth of left arm from shoulder to elbow. Swelling also present. Mother stated leftY arm looked8/14/2009 much better 8/15/2009 than it had on 08/15/ ite swollen and warm to touch redness Y about 2 inches in diameter. Y 8/18/2009 8/18/2009 adache, increased heart rate. Y Y 8/17/2009 8/18/2009 est and along shoulder blade on left side, red & warm to the touch. Y 8/19/2009 8/20/2009 l syncope w/in 2 minutes of GARDASIL administration. Y 8/12/2009 8/17/2009 nd eye vomiting, nausea; paresthesia of right fingertips, aching in thighs; No treatment. Y 8/14/2009 8/14/2009 as crying for about 6hrs; Right thigh was red and warm. Y d area noted to LT injection site Y 7/29/2009 7/30/2009 Y 8/14/2009 8/14/2009 lump - tennis ball size at site of injection. Site red, hot and itchy. U 8/13/2009 8/14/2009 d PPV23 in his right arm on 08/17/09 at 2:40 p.m. On 08/18/09, pt was complaining of redness, Y pain, and 8/17/2009 swelling to 8/18/2009 right arm where vacci ted a history of eczema on the screening form. The provider reviewed medical records bothYhard copy and 8/13/2009 digital and found no documenta of wide spread urticarial eruption, very pruitic,covering her torso and upper thighs and upperYextremities. 6/3/2009 Treated with 6/5/2009 oral anti-histamine a my fourth rabies booster shot, I developed a large red lump in the same arm later that day. N It was sore, but 8/6/2009 did not itch. 8/6/2009 It was further dow ad urticarial pruitic rash. No respiratory difficulties or systemic symptoms. Y 5/27/2009 6/3/2009 re 3 days after vaccines given Y Y 7/16/2009 7/19/2009 E SATELLITE LESIONS OVER BACK Y & FACE & ARM 3 WEEKS AFTER VACCINATION 7/30/2009 8/19/2009 ery dizzy immediately after vacinne. Nurse had to catch her and help me put her in chair. She Y sat there for 7/1/2009 awhile. Then 7/1/2009 I took her into the ap and varicella shots 6/1/09. Pt's mom reported to me yesterday that pt had bad diarrhea the U day after the 6/1/2009 vaccines6/2/2009 were given. Had see mother reports that at 2:00 AM on 8/19/2009, patient had what appeared to her to be a possible Y seizure. Mother 8/17/2009 called 8/19/2009 our office around 8:3 t with severe left arm induration and erythema extending from elbow to left shoulder with painful Y ROM. Tx'd 8/15/2009 with Medrol 8/15/2009 dose pack and Be tially vaccinated for smallpox on 08 Jul 09. he had an equivocal take so he was revaccinated on 12 Aug8/12/2009 09. pt presented to the clinic 20 A med child was on Zithromax day immunization Y given. Deferred kindergarden shots but gave Y HIB. Thought 8/19/2009 4th Hib needed 8/20/2009 as only 3 doses e Tdap and varicella vaccines administered reported to have a reddened, hard, warm, soft-ball sized lump 8/17/2009 at site of 8/18/2009 Tdap injection. Also re Pt. came to medical center presenting with a rash on his face, torso, back, and legs. Raised,Ured, itchy rash 8/13/2009 noted. 8/20/2009 Preceded by 2 days of t beat,weakness of the left arm and leg,troubleYbreathing,severe chest 3 pain, pain in the arm Y and leg, large 8/13/2009 red welts8/14/2009 on left side of neck and
GIVEN THIRD HEP B TO SOON. OTHER VACCINES WERE ADMINISTERED AT THIS VISIT ALSO. MOM 8/20/2009 WAS CONCERNED BECAUS d swelling, pain, erythema; hypotension Y with fever to 102F. Y 8/17/2009 8/19/2009 nausea, vomiting starting 4-5 hrs after Y shot and lasting for several days. On 8/21/09, orthostatic hypotension 8/18/2009 noted, 8/18/2009 temp 99.2. Viral illne vaccines at 4:30 pm. At 11:00 pm she rolled over in bed and head felt heavy. At 5:30 am she Y woke up dizzy 8/19/2009 and the8/19/2009 room was spinning. W ven the vaccine at 4:00 PM on 7/30/2009. Y He returned to the clinic on 8/1/2009 with a localized Y area of 7/30/2009 errythema and 8/1/2009 edema at the injecti ng from elbow to shoulder, skin redness, Y itching and fluid-filled blisters at injection site. Y 8/10/2009 8/12/2009 ay after Shingles shot, I developed stiffness and pain on movement of my left shoulder which has persisted 5/22/2009 from 5/23/09 5/23/2009 to the present. P ded, dizzy, and nauseous immediately Y after vaccination. Since vaccination: headache, Y severe N fatigue, numbness/tingling 7/24/2007 7/24/2007 in extremities, sha and swelling from site of injection past elbow. Started approx 24 hours after injection given and U has progressed. 8/19/2009 Denies 8/20/2009 any temp. was reported by a healthcare professional and described the occurrence of group b streptococcus U in an infant### male subject who was vacci was reported and described the occurrence of mild ulcerative colitis in a 52-year-old female Ysubject who was vaccinated with influenza viru was reported in a literature article and described Y the occurrence of 0 severe exacerbation of ulcerative Y colitis in a 52-year-old female subject le subject was enrolled in Y a prophylactic open study. Y On 26 June 2009, she received the dose N of MENINGOCOCCAL-TETANUS 6/26/2009 8/12/2009 TOXIOD. hen went to bed last night redness and small bruise. Came to clinic and FNP noted small amount U induration, 8/20/2009 erythema 8/21/2009 and small contusion oid area was a little pale 8/21/2009, elevated intensity/swelling 8/22/09, cool compress, Cephalexin Y 250/5 8/20/2009 mg's i tsp8/22/2009 QID. port soreness to right deltoid and right arm swollen. Y 8/13/2007 or - pale, fainted. V/S taken 430p 94/68 P 64 R 18. 435p 98/70 64 - 18. Y 8/20/2009 8/20/2009 ed (1) Tdap in (L) arm then MENACTRA Y and VZV Rt arm. Then immediately had projectile vomiting. Y Pt. then 8/21/2009 fainted8/21/2009 and vomited again whi ction (L) upper arm/tricep area. 4 cm x 4 cm mildly erythema, swollen, no TTP. BENADRYL is Y given by mouth. 8/20/2009 8/21/2009 vaccine reaction started 24 hours after Y receiving Varicella on 8/19/09. Pt reported itching prior Y to swelling8/19/2009 and tenderness. 8/20/2009 Induration area 5 accine about 11 o'clock, Ate lunch about noon. At approx 1 PM reported, diarrhea X 2, severe Y nausea, feeling 8/21/2009 faint.8/21/2009 Placed in recliner IV flu ) arm 1 1/2 inch circle. Y 8/20/2009 8/20/2009 client called reporting that arm site where Y VARICELLA vaccine was given become swollen &Yhad hive like 8/17/2009 reaction. 8/18/2009 Client was seen by PM S 8-20-09, began wheezing by 10 pYthat eve - worsening by am 8-21-09. Arrived for tx / received U DUONEBXL 8/20/2009 plus 8/20/2009 5 mg ALBUTEROL with V #1 12-16-08- No reaction. HPV #2 2-16-09- 2 wks after- severe abd pain, decreased facialYswelling, lips and extremities swollen, no resp m pt developed swelling slight left arm Y redness advised to apply ice and take BENADRYL. AtY8:30 pm pt 8/18/2009 became very 8/18/2009 shaky & diaphoretic red swollen warm to touch around injection site. Keflex ZSO/5. 5ml PO BID; possible cellulitis. U 8/19/2009 8/20/2009 d fever, pain, redness & swelling at Y area of injection site day after immunization - treated withUMOTRIN &8/18/2009 antibiotic. 8/19/2009 Y Y 8/17/2009 8/18/2009 time of vaccination until about a month Y after, I experienced moderate pain in my left arm at the N injection site 8/23/2008 and in the 8/23/2008 entire arm and had p Y Y 8/19/2009 8/21/2009 s after the shot, he started to wake in the night crying as if in pain and he was inconsolable. Y NHe has always 5/14/2009 been a 5/16/2009 good sleeper and had p nd received the vaccinations Y while standing Y was Y asked how he was 3feeling he said ok was then U sent to the 8/19/2009 hallway 8/19/2009 of the emergency room hours after the shots my son became Y lethargic complaining of severe body aches, throbbingY headache,8/21/2009 pain at injection 8/21/2009 sites, blurred visio ven shot on 08/18/09 in Left deltoid IM. Y He was sitting in a chair. Approx 1-2 minutes after injection Y his left 8/18/2009 arm was flexed 8/18/2009 toward body his l ter shot: Tremors,vertigo,hot flushing, Y pallor, nausea,headache,lower back pain,fatigue & dehydration. Y Pulse 8/10/2009 and respiration 8/10/2009 was high, blo 03, complaint of headache almost immediately, Y sore/dry throat, very irritable, soreness at sight, N feet twitching, 8/18/2009 vomiting 8/18/2009 the next morning af ness never went away after vaccination. Y At first could not raise left arm straight up to to side without N pain.1/19/2009 Range of motion 1/19/2009 gradually decrea ven vaccin afternoon of 8/21/09. She bgan itching "everywhere" abou 8pm that evening. At 9pm she began 8/21/2009 to notice8/21/2009 a generalized rash. Ab ves, itching, wheezing with Y prolonged Y reaction resulting in "flare ups" for weeks with anylphylaxis. N Recently 6/26/2009 escalated 6/27/2009 to a systemic reaction zziness cuasing inability to walk without Y assistance occurred approximately 4 hours post administration N of 8/19/2009 vaccination. 8/19/2009 Dizziness so severe red just prior to discharge Y from hospital Y on 4/1/08. Y Immediate pain10 at site of injection. In theYearly hours of 4/1/2008 the morning 4/1/2008 of 4/2/08 blood pre ever of 102.7 F taken under arm at 11 pm, Saturday, August 22. The highest temperature ofU103.6F was8/20/2009 taken under 8/22/2009 arm at 2 am, Sunday @ 2130--urticaria bilat hands, elbows et knees approx. 0015 (08/23/09). Macular rash bilat upper Y extremites 8/22/2009 with edema 8/23/2009 present approx. 01 d with Type 1 Diabetes Mellitus Y 10 days Y after receiving Y 3rd dose of GARDASIL 2 vaccine Y made N by Merck. 8/25/09 ###PCP records ### rec'd. WCC rain injury after a possible Y averted SIDS Y event.YFive hours (approx.). 60 Receiving Y second Y series of vaccines. 4/17/2009 9/9/09 Hospital 4/17/2009 records received ived both vaccines in right thigh at the Y same time. Within 48 hrs. site became large, red, andYwarm. No signs 8/4/2009 of systemic 8/5/2009 reaction. Treated Shingles Vaccine ZOSTAVAX 7/21/09. After 48hrs, had rash on chest and under breasts. Returned N to doctor 7/21/2009 8/4/09. 7/23/2009 No diagnosis. Given f of shingles Post Vaccine Rash, painYR jaw. Saw MD Tx Famvir 500mg TID x 7 days. N 6/19/2008 7/29/2009 for well check up at 09:30. He had history Y of mild Y cough and normal1exam. He had vaccinesYand went home. 8/19/2009 He took 8/19/2009 a nap and awoke wit ely following vaccine (about 4 mins) Ypatient passed out - hit her head on a table then concrete Y floor. health 7/28/2009 Unit called 7/28/2009 emergency and she w
der pain, decrease ROM after injection Y of vaccine. Pain on palpation of shoulder 3 days later. U 8/14/2009 8/15/2009 ness - firm - Golf ball size tender to touch- greater than 48 hours later. Y 8/5/2009 8/6/2009 had no feeling/wd not support weight. Y Dizzy/Light Headed. Blacked out. U 6/29/2009 8/15/2009 pprox Received Pentacel vaccine. By three hours later, the leg was red, swollen, very tender Y to touch. 8/18/2009 Redness and 8/19/2009 swelling disappeared x 6" width. Redness, with heat at injection site. Rec' pt use ibuprofen for pain 6-8 hours. Up to U 800mg, ice8/19/2009 packets for 8/19/2009 comfort. nd dizzy 1 hour after shot given. Y n has been received from a nurse practitioner concerning a 56 day old breast fed male who N on 08-JUN-2009 6/8/2009 was vaccinated 6/8/2009 with the first d n has been received from an office manager concerning Y a male physician 0 who on 11-AUG-2008 N was vaccinated 8/11/2008intramuscularly 8/12/2009 into the le n has been received from a consumer concerning a "3.5 year old" male patient with no pertinent N medical history and no drug allergies, who n has been received from a physician Y and an other medical professional concerning a 13 year Y old female 6/18/2009 with no pertinent 6/18/2009 medical history n has been received from a medicalYassistant concerning her 15 year old sister with no known N drug reactions/allergies 8/8/2009 8/8/2009 and no known pertin n has been received from a respiratory therapist concerning a herself who on an unspecifiedYdate was vaccinated with a dose of GARDASI severe fatigue, lethargy, chills, heart Y racing. Y 8/11/2009 8/12/2009 injection site with large X erythematous reaction. Slight tenderness, positive blanching of body Y skin color. 7/29/2009 Flu-like sxs with body aches, feve reaction to left thigh. Y 8/17/2009 8/18/2009 given on 8/11/09 (Tdap, MCV4 & Varicella). Y Mother called on 8/12/09 to report swelling, increased U (abnormal) 8/11/2009 discomfort 8/12/2009 to back of left arm ates he developed a rash to lower legs Y on 8/8/2009, intermittent itching. Pt went to foreign country Y from 7/14/2009 July 29 through 8/8/2009 August 8, 2009. H t. returns with c/o malaise, pallor, diaphoretic, hypotensive with no Sxs of SOB or resp. distress. Y V/S: B/P8/13/2009 96/. 10:458/13/2009 EKG performed; read se reaction noted to extra dose of ROTARIX given one month after 2nd. Y 8/19/2009 ng into nursing school, received varicella Y vaccine 8-4-09. On 8.15 and 16 took home pregnancy U test which8/4/2009 confirmed pregnancy. She had s ess t max 103. Severe myalgias. Redness Y at site. Y 8/13/2009 8/15/2009 duration & erythema at site of DTaP/IPV on (L) deltoid. Y 8/18/2009 8/19/2009 & swollen where immunization was given. Y 8/17/2009 8/19/2009 ction: red, swollen, hard to touch. Went Y to Dr. Dx with early cellulitis - put on antibiotics 8/19/09. U 8/17/2009 8/18/2009 tes child began favoring leg yesterday. Y Today, child's leg has 3 1/2 x 2 1/4" area of redness,Uswelling and 8/18/2009 warmth. MOTRIN 8/19/2009given. d syncopal episode & fell to ground in office after immunizations with VARIVAX. BP decreased Y pulse decreased 8/22/2009 not8/22/2009 cyanotic or pale had h arm 2in x 2in reddened hard area warm to touch. Denies pain c/o. Y 8/17/2009 8/20/2009 was reported by a healthcare professional and described the occurrence of arm Y swollen in aN11-year-old8/18/2009 male subject 8/19/2009 who was vaccinated was reported by a healthcare professional Y and described the occurrence of intussusception Nin a 6-month-old 7/17/2009 male subject 8/18/2009 who was vaccin ll erythema for 2 days, resolved. subsequent Y cellulitic erythema at site and proximal/distal began 5 days8/14/2009 post vaccination. 8/19/2009 given antibiotics vaccinations around 12:30 p.m. andYstarted feeling ill around 8:30 p.m. Fever of 103, stiff neck Y and neck8/21/2009 pain, back8/21/2009 pain, headache and bo Left Deltoid swelling, erythema, warmth. Y Onset day after immunizations (Tdap, MMR in left Uarm). Treated 8/19/2009 with ice,8/20/2009 anti-inflammitories, ant utside of FDA approved age limits. Pt is 9 and youngest limit is 11. No reported adverse reaction Y or illness 8/24/2009 reported 8/24/2009 by patient or family. P dministered 08/20/2009. Client had nausea and vomiting on 08/21/2009. Client had rash to YL arm accompanied 8/20/2009 by8/21/2009 fever of 101.5 and fatig ent received the immunizations (Kinrix, MMR, Varicella, Hep A) he left the building with his mom Y and sister. 8/19/2009 After they 8/19/2009 got in the car, his siste 1/25/2009 N 1/25/2009 1/25/2009 p, difficulty breathing, tired, pain in arm upset stomach Y 8/18/2009 8/21/2009 ports fatigue and complaints of chest pain, abdominal pain. Y 7/31/2009 8/1/2009 4 year vaccines on 8-20-09. Mom noticed Y L arm swollen on 8-22-09 and on 8-23-09 patientYarm was swollen, 8/20/2009 she complained 8/22/2009 of itching an ew days of the vaccination, pt. began to throw temper tantrums every day screaming at the top N of her lungs. 5/14/2009 She will 5/16/2009 not listen. She starts first hep b shot and IPV shot on the morning of August 20, 2009. By 11pm had high fever that Y lasted until 8/20/2009 August 22. 8/20/2009 Also had muscle ach cines to pt while she was lying flat on the exam table. Approximately 30 seconds later, she passed Y out and 8/21/2009 had several 8/21/2009 jerky upper body m given on 08/20. Approx 3" in diameter red rash. Rash was hot, tender and swollen as presented Y on 08/22. 8/20/2009 No other 8/21/2009 signs or symptoms. N e dizzy 20 min. after first Gardasil injection. Y 8/24/2009 8/24/2009 with rash all over extremities, trunk, face, bottom of feet 8/12/09. Has had fever of 100, lethargic, U lossof7/16/2009 appetitie. 8/12/2009 On 8-14-09 some spots all of left foot extremely sore, painful and remained sore, red painful as of 8-17-09 but improving Y 8/14/2009 8/14/2009 TES AFTER RECEIVING H. ZOSTER VACCINE EXPERIENCED WEAKNESS, LIGHT HEADEDNESS, Y FATIGUE, 8/23/2009 DIZZINESS, 8/23/2009 CONFUSIO mplained of continued muscle soreness and pain in left deltoid area 8 days after receipt of Hepatitis U A/B8/13/2009 vaccine. Physician 8/21/2009examined. No eceived phone call from pt reporting red, warm area on (L) deltoid. States started about 3-4 hrs after receiving 8/19/2009 the vaccine 8/19/2009 on 8/19/09. Instr omplaining of muscle fatigue ever since the immunization. He lacks energy. He had itching N that is now resolved. 7/2/2009He7/3/2009 had headaches that a d an increased heart rate of 118 with an average of 90. Pulse rate prior to receiving Adacel was U 60-70 beats 8/16/2009 per minute. 8/18/2009 Symptoms began
G AND REDNESS TO LEFT ARM U 8/21/2009 8/23/2009 m chronic nausea, chronic abdominal pain, face Yrash, anxiety, fatigue, 1 depression, weight loss, N loss of appetite, ### tremors, 5/20/2009 foaming of mouth... ng headaches, chronic fatigue, dizziness and light headedness. Received symptoms shortlyUafter receiving 7/23/2009 first Anthrax 8/6/2009 vaccine on 23 July petite & 102 degree fever; treated with tylenol U 8/17/2009 8/24/2009 y.o. Received immunization Booster at medicalYcenter. Returned 8/12/09 3 for mild irritation vs cellulitis (L) arm 8/7/2009 at site8/12/2009 for varicella. AUGMEN redness, and itching of the right deltoid after receiving TDAP vaccine. Y 8/19/2009 8/19/2009 8 he developed a tremor and stopped Y walking. Tremor persisted through 8/24/09 10/01/09 U PCP medical 9/22/2008 records, consults 9/28/2008 received DOS 9 Rash (small) on the tummy. Went to Y clinic 8/13 was tested for mono: negative. 8/22/09 got worse: U increased 8/4/2009 rash, increased 8/10/2009 fever, headach n 8/19/09 -Weds- Onset of soreness/hot to the touch-FRIDAY-SATURDAY-8/21-22. Saw patientY 8/24/098/19/2009 Monday-Small 8/21/2009 knot in muscle-sl parent of "nodule" developing months after injection (at general vaccine site) - developed sensitivity U & darkening. 8/18/2008See 12/1/2008 copy of parent's lette er HPV #3 and MENACTRA leg pain Y - left upper only - more muscular than bony, increased U CRP difficulty 8/10/2009 walking, 8/17/2009 missed day of school. 9 eloped 8 days after vaccination papular/morbilliform rash- developed 8 days after vaccination. Y 8/12/2009 8/20/2009 d reddened - size 8cm x 4cm slight reddish pink mild induration pain on touch. Y 8/22/2009 8/24/2009 nset left sided chest pain and pleurisy Y like symptoms approximately 4 hrs after vaccine. Y 8/19/2009 8/19/2009 h true urticarial rash on 8/19/09. Then Y developed joint swelling over entire body. BENADRYLYwas given 8/18/2009 every 4 hours. 8/19/2009 ed, hard, hot. U 8/18/2009 8/19/2009 s following shot pt became pale sweaty, not feeling well. Weak & tired on exam she was pale, Y sweaty, pulse 8/18/2009 rapid BP 8/18/2009 OK. Pt was given wa h and soreness developed on 8/22/09 Y AM went to the ER in evening as it was spreading - Was Y put on LEVAQUIN, 8/20/2009 Prednisone 8/22/2009 and ATARA loped swelling of face/hands/feet. Lab work consistent with (illegible)/nephritis. 10/2/09 Hospital N records,8/13/2009 allergy/immunology and neurolog urated dark red. 6cm total - lighter pink surrounding area. Itchy. Y 8/18/2009 8/20/2009 1/2 cm x 3 cm area of redness R upper Y arm. 8/19/2009 8/21/2009 circumferentially 2/3, length is 1/3 - Induration 5 cm on left upper arm. U 8/18/2009 8/19/2009 d VARIVAX and HAV; left office andYthen returned with difficulty breathing shortness of breath, Y cough, Red 8/24/2009 itchy palms 8/24/2009 given EPINEPHRIN Y 8/12/2009 eeling bad" about an hour after the shot. Had breakout of "blisters" starting on 8/22/2009 + more on 8/23/09, 8/20/2009 located mostly on chest, abdo ccine given at 11 am - 8/14 - Late afternoon felt "ill", headache, tired, no fever, noted rednessUand swelling 8/13/2009 at site - 8/15 8/14/2009 - No energy, arm w e temp (100 degrees F) and eryth raised Y blanching papules all over next day. U 8/17/2009 8/18/2009 upper thigh. Red and raised warm toYtouch. Per chuck speed pt given 1 tsp Benedryl. Y 8/21/2009 8/24/2009 d #2 varicella on 7/28/09. Developed clinical varicella on 8/07/09. Y 7/28/2009 8/7/2009 isters above sight where Immunization Y was Given. Y 8/18/2009 8/18/2009 egs. One leg shape of a triangle. Having HA's and abdominal cramping, fatigue. N 8/11/2009 8/12/2009 booster dose of AVA 18 Aug in rt arm. Y He premedicated 30 min prior with ADVIL 600 mg and Y BENADRYL 8/18/2009 50 mg. He 8/19/2009 took one dose of ADV 8/14/2009 N 8/11/2009 er my son received MMR and Hep A on 10/28/08 he had high fever, inconsolable, Y listless, lethargic U for two weeks. ### He is now ###receiving ther ely after vaccines started to cough, wheeze Y - got Y hives. 9/8/09 Hospital 1 records received DOS Y 8/20/09 to8/20/2009 8/21/09. Assessment: 8/20/2009 Anaphylacti eption 2 wks after receiving 2nd ROTATEQ. Y 9/1/09 Y Hospital records1 received DOS 6/28/09 Y to 6/29/09. Assessment: 6/12/2009 6/28/2009 Intussusception. Patie seeing black shapes, said it was trying Y to kill her, Y refused to go to sleep, 7 said if she did she wouldn't U wake8/17/2007 up, she was 7/29/2009 put in hospital for 7 d nt has been diagnosed with PDD-NOS, Mood disorder Y (depression/anxiety), 0 ADHD, is s/p neuroblastoma U 3/23/2009 in 2001 and 3/24/2009 has issues with obes was given two injectionsYof GARDASIL and shortly Y after was diagnosed 5 with auto immune disease N MG which 5/28/2008 means9/1/2008 grave muscle. She ha my daughter and two of my nieces received theYGARDASIL vaccine. All three have in the past U two months been hospitalized 8/18/2009 with seizure l n has been received from a nurse concerning Y her approximately 14 year old granddaughter Y N with no pertinent medical ### 1/1/2008 history and no known n has been received from a physician concerning a female who a couple of years ago was vaccinated U with 0.5 ml of GARDASIL (Lot # was n has been received from a registered pharmacist concerning a 63 year old male physician with N diabetes 8/3/2009 and hypertension and a history of n has been received from a registered Y pharmacist Y concerning a 69 year 0 old female with sulfonamide N allergy 4/20/2009 and a history of mild anxiety w n has been received from a 71 yearYold femaleYwith allergy to morphine 0 and a history of previous Y stroke 6/19/2009 who in December 6/19/2009 2008, and on 19 en area (Lt) thigh, no fever. Y 8/18/2009 8/19/2009 ately 38 hrs after administration of MENACTRA and HPV vacc, pt developed and was wokenYby "severe"8/15/2009 headache,8/17/2009 T 102 degrees, jaw/ha ons given on 8-10-09, screening questionnaire without "yes" answers. On 8-17-09 phone call received to8/10/2009 this office from mom regarding con et hives about 40-44 hrs after vaccines, generalized including fever with mild puffiness around Y eyes/lips 8/11/2009 no respiratory 8/13/2009 difficulty. (+) itching, ZOSTAVAX (shingles vaccine) on 8/13/09 at 4PM, noticed rash to (L) shoulder, (L) neck area U on 8/18/098/13/2009 with head8/18/2009 & eye sensitivity. Pt ca sized" lump at injection site starting 8-20-09. Bright red in color, no pain, only slight itch. Pharm N recc. ice.8/18/2009 Pt icing. 8/20/2009
ness in mouth, unable to eat without gagging, Dysguesia. N 8/17/2009 8/18/2009 nset pain, redness swelling over 3 days Y since Tdap administration. Day 2 with subjective fever, N malaise8/17/2009 Dx: Cellulitis 8/19/2009 Tx: Rocephin 1G 1M ure of 103 F and fever like symptoms 8/5/09. Telephone call from patients spouse stating temp U now 101 F. Nausea followed by emesis of p njection site - difficulty breathing - vomiting. Given Epi-OK after about 15 min. Y 8/17/2009 8/17/2009 induration right deltoid. Myalgias. N 8/11/2009 8/12/2009 ined of "mild" shortness of breath and Y dizziness. Went to E.R. was given BENADRYL and discharged Y to8/19/2009 home. F/u 8/19/2009 next day pt states comp d varicella vaccination on 8-19-09. Ypt presented to office on 8-20-09 with 7cm x 7cm RA wheal. Y Site was 8/19/2009 raised, warm 8/19/2009 to touch, red and fi d varicella vaccine sub-Q in left armYon 8/20/09. Pt presented to office on 8/24/09 with history U of redness8/20/2009 on 8/21/098/21/2009 and s/s getting worse ned to clinic 2 days after vaccinationY with erythema of upper left arm (where vaccine was given), Y tenderness 2/4/2009 and inablity 2/4/2009 to sleep on left sid shing, back pain, shortness of breath, and elevated blood pressure. Y 8/10/2009 8/10/2009 started on July 31 - had some wheezing, tachycardia, temp 103.6, severe myalgia, difficulty sleeping Y due7/30/2009 to agitation7/31/2009 despite taking zolpide m began to swell x 3 days after vaccination, Y reported to our worker's comp advisor. At that time, N she went 8/14/2009 to ER and8/15/2009 dx as bursitis and slin al temperature, Headache, Nauseous, Y abdominal discomfort, loose bowels, dizzyness/lightheadedness. U 8/21/2009 ER Visit per8/23/2009 primary physican. Fev er getting vaccine, arm became swollen, red, very tender, had difficulty raising arm. Had sweats U today. Had 8/22/2009 some mild 8/24/2009 itching until he took TIS, BUTTOCKS AT INJECTION SITE, ABX THERAPY Y STARTED ON 3 ADMISSIN 8/23/09 9/30/09 Y MR received 8/21/2009 for 8/23/2009 DOS 8/23-26/09 with d ceived Menactra vaccine in early afternoon Y and left with her family. Her color was pink and she Y was walking 8/24/2009 and talking 8/24/2009 without difficulty. I after client received5 vaccinations she became diaphoretic, pale, nauseated, faint, this continued Y for about 8/24/2009 15 minutes, 8/24/2009 kept for observatio vaccine received on 08/11/09. Lesion Y appeared on 08/18/09. Diagnosed as shingles on 08/24/09. U 8/11/2009 8/18/2009 4/1/2009 N 3/25/2009 3/31/2009 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 2/14/2009 for COPD exacerbation. Vaccination ### 2/14/2009 took place on 12/11/2 r vaccinations, she had 2 shots, stood up so her brother could sit and get his when she vomited Y X 3, pale, 8/24/2009 diaphroetic, 8/24/2009 comfort measures w th moderate to severe pain, swelling, and warmth in arm w/in 24 hours after receiving Pneumovax. U Am treating 8/24/2009 with8/24/2009 Keflex, ice (alternating vaccine on 9/5/08. On 10/29 I wokeY up numb on Y right side of abdomen. 4 Thinking it was a pinched N nerve 9/5/2008 I allowed it to go### on for several da mother on 8/25/09. States "pt. had a reaction to his vaccines." Relates that on 8/19/09 around Y 8 pm (bath 8/18/2009 time) she 8/19/2009 noticed his left arm was ed her Adacel booster and 1st doseYof Gardasil on Wednesday August 19, 2009 @ the Health Y Department. 8/19/2009 She began 8/21/2009 to ran a temp of 10 ed on 8/24/09 that she has blisters with white dots under her tongue and her lips that she had Y the same 8/21/2009 outbreak two 8/23/2009 to three days after sh male received the Oral Rotavirus Vaccine on 8/18/2009 under FDA IND #13843. Patient tolerated U vaccine 8/8/2009 well. Patient 8/22/2009 had follow-up clini swelling and tenderness of the left deltoid N 8/24/2009 8/24/2009 astritis, weakness, wt. loss.Nausea,Yvomitting ,diarreha, Y anal spasms, 2 vagal reflex responses, Y & paleness. 6/27/2007 9/17/09 GI 7/26/2007 Consult records DOS sneezing, and eyes got very wateryYand red, he started coughing a lot, and then the face got Y all swollen.8/17/2009 8/18/09 Pt8/17/2009 came in for F/U and he vaccine 08-24 PM. C/O dizzy, faint, & headache 08/25. Improved by late afternoon, but still resting. Y 8/24/2009 8/25/2009 d generally healthy male who received Y DTaP and Varicella vaccines at PCP's office (Health Y Center) today 8/25/2009 and developed 8/25/2009 "sternal pain" and rash on inner upper thigh of Left leg stated that it was itichy and had a tingle feeling just likeUwhen she had 8/18/2009 shingles before post injection, high fever (mom did not check temp) lethargy, abd pain, achy, looked sick for Y 3 days. sibling 8/19/2009 with same 8/20/2009 symptoms but only fo after injection had fever really high(temp not taken) lethargic, nauseous, for 24 hours.mom felt Y it was due8/19/2009 to the mercury 8/20/2009 in the shots. dness, warmth and swelling. Y 8/12/2009 8/13/2009 ocal reaction - red firm area size of egg - Proceeded w/ peripheral redness for 6" around the Y bump, itchy,8/13/2009 hot. Onset8/14/2009 in <24 hr - treated with minutes of injection of ZOSTAVAX pt experienced dizziness and tingling of her lips/bad taste Yin mouth. 8/19/2009 8/19/2009 action after giving HPV vac. Pt complain of having headaches, dizziness, numbness on L arm U and weakness 8/11/2009 on both 8/18/2009 legs. Pt was seen by D ouple of minutes of giving vaccines pt developed swelling and redness around injection site.YThere was8/17/2009 also visible8/17/2009 swelling and redness d Y 8/13/2009 iving MENACTRA and Hep A injection. Pt c/o light headed, faint, nausea- Pale. Pt laid downY- elevated feet 8/18/2009 - recovered 8/18/2009 - did fine. wollen and red from elbow to shoulder - No other sign of illness. BENADRYL and Ibuprofen. Y 8/14/2009 8/15/2009 vaccination for the shingles, but it came back. The only difference was the lack of pain post-herpatic Y pain. 6/1/2009 I also had6/10/2009 more shingles erupt. I give IM in the dorsogluteal, should be given in the deltoid. 1st dose must be repeated. Y 8/13/2009 8/13/2009 and around injection site and a hive off to the side of injection site - after running in place forY5 minutes. 8/19/2009 8/19/2009 ion at injection site - Eye ache, headache Y 8/5/2009 8/12/2009 d hives 2 days after shot that turned her skin white and caused her skin to sag. Y 7/22/2009 7/24/2009 d shingles L facial (V- 1 nerve root)Yfew days after ZOSTAVAX. Y 7/30/2009 7/31/2009 tient - 2hrs after vaccines - developed Y numbness in arms, hands, felt lightheaded and heart rate U speeding. 8/11/2009 Rescue was 8/11/2009 called and taken to call from mother. Says about 1/2 hr. after shot he was nauseated \ dizzy. These have gone but Y has HA. 8/25/2009 now. Taking 8/25/2009 him home from schoo
ccine - shortly after got light headed, flushed, nausea - not feeling well prior to shot. P.E. neg, Y U.S. nml. 8/20/2009 8/20/2009 ates after receiving vaccine was covered in hives, felt warm, chest pain and lip swelling. Given Y BENADRYL, 8/21/2009 came back to office and exam generalized non-febrile seizure 5-1/2 Y days after getting MENACTRA and ADACEL vaccine. U No etiolology8/7/2009 found for 8/13/2009 seizure. en on 8-11-09 Hives on 8-13-09 Benadryl + Zyrtec. U 8/11/2009 8/13/2009 night noticed a red/pink knot at site of injection. No itching, a little sore, no fever. Did not takeUanything or8/23/2009 put anything 8/24/2009 on. ed red rash at site of injection - intensely itchy - suggested hydrocortisone of BENADRYL to Yapplied 8/10/2009 8/11/2009 TWINRIX #3) Administered 6-2-09 (other doses= (1)5-28-08, (2) 11-17-08) Pt complained of N sore muscle in 6/2/2009 left deltoid 6/2/2009 since administration. d a lump Rt upper arm. It has continued Y to grow, is red, warm to touch with an mild induration U about 4-5 8/17/2009 cm in diameter 8/18/2009 - Advised to use ice d blister link rash over both thighs and Y had fever. This all happened approximately equal to 24 Y hours after 8/14/2009 receiving 8/15/2009 6 shots. Y Y 2/10/2009 2/11/2009 facility on 8-15-07. Rash erupted 8-17-09 - Presented in office with rash/pox's on 8-25-09. Y ticed stinging during injection. Stinging progressed to pain and around 5 PM he noticed redness, U swelling, 8/18/2009 fever. Left 8/18/2009 deltoid. As of today, s minutes of injection of all 3 vaccines, Y pt returned wheezing (mild) and facial hives. WheezingYreversed with 8/24/2009 Albuterol. 8/24/2009 ed to office approximately 30 min after Y injection of all three (3) vaccines with periorbital edema, Y urticaria and 8/19/2009 wheezing. 8/19/2009 Received BENADRY Hepatitis B vaccination (ENGERIX B) on 7-14-09. Returned for dose #2 Hep B today 8-14-09. U That's when 7/14/2009 the patient showed nurse a pap e pale approx 1/2 min after injection. Asked if he was OK and he did not answer. Assisted toYexam table 6/10/2009 to lie down.6/10/2009 Gave cool compress. P Y 8/19/2009 8/22/2009 n has been received from a mother concerning her son with seasonal allergies and no otherUpertinent medical history who vaccinated with Y 8/25/2009 8/25/2009 perienced fainting, and nausea. Y 8/25/2009 8/25/2009 blanching rash with pruiritis lower extremity. U d red, swollen and painful. Y 8/12/2009 8/14/2009 multiforme, seen on 8/24/2009 for Urticarial rash pharyngitis, treated with Loratadine and epipen Y given. 8/20/2009 8/24/2009 s after shot pt. complained site being itchy, swelling felt very hot. Y 8/24/2009 8/24/2009 hot Sat 830A. Returns at 930A with urticaria all over body, no difficulty breathing. Given 1/2cc Y CELESTONA 8/20/2009 IM and8/20/2009 1tsp BENADRYL PO. 1 vaccination, pt. and his mother walked to the front desk. Child walked towards exit door to lobby and knees 8/10/2009 buckled8/10/2009 and child fell forward. F warmth, firmness to upper left arm for 2 days. N ema ("puffy eyelids"). Increased blood Y pressure. Y 8/20/2009 8/20/2009 er vaccines patient developed fever to 101 degrees, arthralgias, and localized reaction at shot U sites, red,8/20/2009 warm about 8/23/2009 6 am. DTaP, IPV in left arm 8/5/09. Was brought Y to office on 8/7/09, noted redness 10 cmx8 cm inUleft upper arm 8/5/2009 with warmth 8/7/2009 and tenderness in DTaP given, patient recovered 5 am large induration with localized redness @ injection site. Y 8/18/2009 8/21/2009 an a few hours after vaccine. Had a seizure about 36 hrs after vaccine. Y 8/19/2009 8/19/2009 eous non-serious report of FLUMIST squirted into a child's eye has been received from the patient's Y mother who ###is a nurse ### concerning a 6 e out on her body - Hyperactive andYplaying. N ry alway clearing her nose, in the hot Y weather she get sexual acting. Can learn but do it veryNslow. Shrinking 3/6/2001 eyes. mptoms every time. Folded bowel movement. Y Very hard for him to breath. U 8/30/2005 8/30/2005 diarrhea, rocking back and forward. Skin flare up picky, pulling out the hair, very fusses. Needed N BENADRYL. 3/7/2006 3/7/2006 wel movement, vomiting and diarrhea picky skin, dry up hair needed BENADRYL. N mptoms, picky skin, thinning of the Y hair, very fussy. Need BENADRYL. N ### ### ### Y Y Y 17 Y Y N 9/9/2008 10/1/2008 er vaccinated: broke out of cold sores in places on the face where 2 had before had a cold sore. Y Have had 3 outbreaks in nostrils (nose). mors; upset agitated; not quite awake. 1-2x/night. N 8/17/2009 8/17/2009 ated smallpox 8/8/09; left arm. Pt referred Y to clinic with POS erythema and rash with circumfererencial Y distribution 8/3/2009to8/16/2009 torso, arms, thighs and of arm at injection site with warmth and Y erythema. Injected arm 7.5 cm larger than non injected U arm 18.5 8/18/2009 cm vs 25 cm 8/19/2009 arm circumference. for 1st 2 sets of shots for 48 hrs including his single PREVNAR vaccine #3. With last set #4Yhe ran fever 7/29/2009 for 7 days7/29/2009 102 & greater. He did left thigh red, sore, fever. Y 8/19/2009 8/21/2009 hours: High fever, irritability, drowsiness, Y loss of appetite, rash (Fever 102.3 Tmax). For 72 hours: Y Interference 7/16/2009 with 7/16/2009 limb movement (shaky ite is warm to touch, red & swollen -Yright arm. Y 8/24/2009 8/24/2009 m rash of trunk. Y 8/11/2009 8/22/2009 out after receiving vaccines- 15minYafter vaccines given. Put in sapine position, gave OJ + Y crackers, responded, 8/25/2009sat 8/25/2009 up and then again be min post vaccine became nauseated. 10 min later, requested to go to restroom. Stated he felt Y faint. Was 7/21/2009 assisted 7/21/2009 to floor, eyes closed. W
g with TETNUS shot, fever of 103.5, he 'acted strangely'; did not recognize his mother, upsetYcrying & disoriented. 8/10/2009 8/12/2009 ort received on 13 August 2009 fromYa physician. A 33 year old female patient, who had no concurrent U illnesses, 10/1/2008 but who has allergy to NEO ort received on 14 August 2009 fromYanother manufacturer (document number 45222761) who U had received the original report from pharma n has been received from a physician Y concerning a 17 year old female patient who Y on 05-AUG-2009 N was8/5/2009 vaccinated8/6/2009 intramuscular with the n has been received from a consumer concerning Y her 19 year old daughter who Y in Summer N 2007 was vaccinated 11/6/2007with 7/31/2009 the first dose of 0.5m n has been received from a Nurse Practitioner Y (N.P) concerning a teenager female patient who U on an unspecified date was vaccinated with UT IN OOZING SENSITIVE RASH ON FACE, SWELLING IN LEFT ARM AND LYMPH NODES, U INCREASE 8/25/2009 HEART8/25/2009 RATE, SWELLING OF ped swelling and itching at injection site after administration of Tdap Y 8/22/2009 8/22/2009 Seizures starting at 10pm Y on 08-24-09. Y They lasted Y about 45sec. He was having a seizure every U 2 hours, 8/24/2009 But they 8/24/2009 have been every for ho dual received the flu shot in the am of 8/24/09. About 1 hour later, he developed sneezing, aYrunny nose,8/24/2009 and a sore8/24/2009 throat. The following d riticariae Shoulders. Raised red area Y to back and shoulders. Y 8/25/2009 8/26/2009 e pale,weak c/o dizziness and began Y vomiting after anthrax vaccination. Y 8/26/2009 8/26/2009 vent onset was 8-08-09 - Client noticed Y a knot and soreness at injection site on (L) arm. By U the next day, 8/7/2009 soreness, swelling, 8/8/2009hardness, and ew days I became ill withYa sore throat and fever, then a cough and wheezing. MyYcough became N worse,9/13/2005 I began to 9/16/2005 have heart burn, sores pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 11 6/29/2009 for pneumonia Y with small cell lung ### cancer. 6/29/2009 Vaccination took n the night of his immunizations he started to get redness and swelling, progressively gotten Uworse, he has 8/24/2009 been receiving 8/24/2009 Tylenol at regula mcir the night before didn't look at it that day ,look in the chart they need the shots but after looking at mcir 8/20/2009 noticed that they recieved the sh er vaccination I experienced fatigue and muscle aches. There was no fever or injection site Y swelling or pain. 8/21/2009 8/25/2009 ceived Rotarix oral vaccine on 08/20/09.Taken Y Yto East Tn Children's3Hospital ER on 08/24/09 U with vomiting. 8/20/2009 Diagnosed 8/24/2009 with intussusceptio r syncopal episode at time of vaccination Y on 7/30/09. Approximatley 8/11/09, she began to have N intermittent 7/30/2009 problems 8/11/2009 with easy bruising, t eadaches/migraines which cause sleeplessness, Y Y stomache aches, painful 1 menstrual periods,Nnausea, always 9/4/2007 tired and feels ### like sleeping al mp 101, febrile sz, seen by pmd, dxYwith viral illness. 2nd sz 7/31, still fever, seen in ED, noYworkup, dx 7/20/2009 viral, sent home. 7/30/2009 d client report at this vist (today) that approx. 2 days after the last vaccination (6/4/09), clientYdeveloped "a6/4/2009 bump" with 6/6/2009 "water" to left arm, p d dizziness, high-fever (103), and headache approximately 19 hours after administration of Menactra U and8/25/2009 Adacel. We 8/26/2009 treated the patient w d swelling in the back of the left upper arm and left deltoid. The back of the left upper arm appeared U red8/25/2009 and raised8/26/2009 (approximately the size en on Humira and methotrexate since Y at least 10/2006 6/6/2008 - Herpes zoster vaccine given U Rash started 6/6/2008 late August/early 9/1/2008 September 9 w minutes patient lost consciousness; hit head on Y table ; unable to rouse; 2 phoned 9-1-1 for EMS transport 8/25/2009 to Hospital;patient 8/25/2009remains hospi ction to LT posterior upper arm; Redness, swelling & warmth. Moderate relief noted with Motrin Y and ice pack. 8/21/2009 8/23/2009 ated 7/31/09, His mother, broke outYin a fine raised rash on her right index finger about 1 to U 1.5 weeks later. 7/31/2009 Pt. never had a rash or otherw minutes of vaccination, pt complained of trouble breathing and an itchy throat. within a few more Y minutes 8/26/2009 the patient 8/26/2009 was completely cover nt received the Tdap vaccine on 1/7/09. Y It had been 11 years since she last received the TdYvaccine. However, 1/7/2009 prior1/7/2009 to her last Td vaccine e schizophrenic episode (disorentation Y and hallucinations)occurred 3 days Y after HPV Y vaccination. N Required 4/7/2009 hospitalization 4/10/2009 and continues to veloped 2 inch red circle around injection site. Did not look to be a rash, although patient reported U irritation 8/24/2009 and minor 8/25/2009 itching. vaccine administered to right arm 8/24 Y 09. Mom reports that his rt arm was painful that entireUday. They8/24/2009 noticed swelling 8/24/2009 of the arm with inc d vaccine on 8/24/09. Pt started c/oYof itching, reddness and swelling at injection site on 8/25/09. Y 18X12cm 8/24/2009 wheel noted 8/25/2009 to left posterior arm RECEIVED THIS VACCINATION DURING Y A NEW HIRE HEALTH EXAM. SHE CONTACTED U ME 1 WEEK 8/11/2009 LATER8/26/2009 TO REPORT THAT SH ved the flu vaccine on 8-12-09, and Ythat pm felt very sore and swollen at injection site, soreness U increased 8/12/2009 and she 8/12/2009 stated she could not sle and swelling, the size of golfball withYpain at vaccine Y site. Temperature 2 as high as 104 with vomiting. U 9/17/09 8/22/2009 Hospital 8/23/2009 records received DO local reaction U 8/25/2009 8/26/2009 ne at approx 9:30am felt slightly feverish the entire day.. (Not concerned)However the following U morning,8/25/2009 woke at 5am 8/26/2009 after about 1/2 hr I w and swollen area around the site of injection. Patient reported it was painful and itchy. U 8/18/2009 8/20/2009 nt c/o nuasea after vaccine MCV4; stated "I need to throw up"; BP was 70/40. Placed in a supine Y position 8/18/2009 with feet 8/18/2009 elevated; BP 110/80; si d shingles in nose the next day which Y got progressively worse. The doctor thought that I hadYa staph infection 8/14/2009 until 8/15/2009 the culture came back a uscle weakness. Pain in deltoid muscle Y 7/10=best. Swelling and joint stiffness in right hand, N wrist, fingers. 8/24/2009 Muscle8/24/2009 spasm in neck and sho fter primary Varicella vaccination, pt.Y (age 2) developed URI symptoms with nasal congestion Y and mild fever 7/30/2009 (99.5). 8/20/2009 The next day he devel RA shot given in LD Wednesday afternoon - that night arm was red & swollen & also still Thursday Y morning. 8/19/2009 Thursday 8/20/2009 night she felt nausea with swelling to R Deltoid. U 8/24/2009 8/26/2009 dness, warmth, swelling. U 8/24/2009 8/25/2009 prolonged crying, redness/swelling of left thigh, patient was brought back to doctors office later Y in the afternoon, 6/18/2009given 6/18/2009 Tylenol, and sympto ne- When I called to his home- per family member that speak a little english. U 7/28/2009 ne - when I called to his home - per family member that speak a little English. U 7/28/2009
ash that resembles Rubella. U 8/18/2009 8/24/2009 ays after vaccine with progressively enlarging red, blanching rash 5 x 6 cm mildly tender, 1 x U 1 1/2 cm induration 8/17/2009 @ site 8/17/2009 of injection. No othe orted by parent". Y 8/20/2009 erior thigh) 10 x 10 cm erythematous warm plaque with blanching. U 8/20/2009 8/21/2009 es, swelling around eye. No respiratory distress. Y 8/25/2009 8/25/2009 d shot 8pm on 8/24/09. Awoke at 6:30am on 8/25/09 with headache that lasted 3 hrs. Y 8/24/2009 8/25/2009 len X 4 days. U e. Momentarily passed out (opened her eyes and talked once laid down from slouching after Y covering shot 8/21/2009 with bandaid). 8/21/2009 Vomit, sweat said swollen to (L) deltoid. Y 8/24/2009 8/25/2009 & mild pain at site of DTaP injection. Y 8/24/2009 8/25/2009 Y Y 8/21/2009 8/21/2009 ort received on 21 August 2008 from a health care professional. A 2 months old male patientYreceived on6/19/2008 19 June 2008 6/19/2008 at 11:30 hours the f serious case was received from a health professional on 22 October 2008. A 28-year-old male Y patient received 6/2/2008 a booster 6/2/2008 of IPOL (lot numb ort received from a health professional on 03 December 2008. A 61-year-old female patient received Y a dose of ### FLUZONE ### (lot number U275 serious case was received on 06 February 2009 from a non health care professional. A 5 year Y old female2/4/2009 patient received 2/5/2009 DAPTACEL (lot nked with case 2009-00558. Y 2/7/2009 2/7/2009 t was received from a health care professional on 19 February 2009. A four-year-old female,Uwith a history 2/16/2009 of asthma 2/16/2009 and thrombocytopenia serious case was received on 06 April Y 2009 from a health care professional. A 4 and a half year Y old female4/2/2009 patient received 4/4/2009 DAPTACEL (lo ort was received 16 June 2009 fromYa health care professional. An 18-month old patient had Yreceived an injection of DAPTACEL and an inje was received from a health professional on 18 June 2009. A four-year-old male patient, withUno reported 6/5/2009 medical history, 6/9/2009 received the follo ort was received 18 July 2008 from a health care professional. A 28-year-old female patient had Y received7/17/2008 a subcutaneous 7/17/2008 left forearm inject ort received on 25 August 2008 from a health care professional. A 4 year old female patient, Y with no medical 8/21/2008 history,8/22/2008 received on 21 August was received from a health professional on 03 September 2008. This case represents on inYa cluster of 8/29/2008 two patients.9/1/2008 A four-year-old male was received from a health professional Y on 03 September 2008. This case represents one in Y a cluster of8/26/2008 two patients. 8/27/2008 A two-month-old fem rmation was received from a health Y care professional on 16 September 2008. A four month old U female patient 9/5/2008 with no9/9/2008 reported past medica rmation was received from a health Y professional on 16 September 2008. A two month old female U patient with 7/3/2008 no reported 7/8/2008 past medical histo -serious report received from a health Y care professional on 06 November 2008. A four-year-old N female patient 9/30/2008 received a left deltoid intramu ort was received 19 November 2008 from a health care professional. A six-month old male patient Y had received 2/6/2006 a dose of FLUZONE SV an ort was received 17 December 2008 from a health care professional. A five-year-old male patient Y had received 8/25/2008 an injection of IPOL, lot num was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/29/2009 patients;4/30/2009 the other two patients' was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/28/2009 patients; the other two patients' was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/28/2009 patients,4/30/2009 the other two patients' ths old male patient received on 30 January 2009 at 15:00 the third dose of ACTHIB (lot# UF578AB, Y corresponding 1/30/2009 to lot# B0395-1) and th ent after incident. 1550- Became pale, lightheaded - became unresponsive immediately following Y injection 8/18/2009 . Assisted 8/18/2009 with lowering head to N n has been received from a cardiac surgeon concerning a female who was vaccinated Y with aUdose of GARDASIL (lot #660618/0572X). Sub n has been received from a pharmacist Y concerning a 17 year old female with unspecified Y drug N reactions/allergies 7/1/2009and medical history, who follow-up information was received from a physician and a cardiac surgeon concerning Y his 15 N year old daughter 12/3/2008 with2/1/2009 no known drug allergi n has been received from a healthcare Y worker concerning a male who in 2003 was vaccinated U with PNEUMOVAX and developed what wa ort received on 17 August 2009 fromYa consumer. A 54-year-old female patient, who has history Y of allergy10/1/2007 to latex, thimerosal, PCN and sul ort received on 21 August 2009 from a health care Y professional. A 13-year-old 4 female patient,Uwith unknown 8/11/2009 medical8/12/2009 history, had received a d Hodgkins lymphoma. We Y diagnosed Y patient'sYcancer in August, 2008, 20 Y and she is continuing U chemotherapy. 5/15/2008 She will8/1/2008 have a stem cell tran hours after vaccine administration, patient developed several large about 5 X 6 cm confluent, Y pruritic erythematous 8/13/2009 8/13/2009 papular plagues on upp area 5x5cm red in duration. Y 8/5/2009 8/7/2009 ss, redness, warm to the touch. Y 8/20/2009 8/20/2009 muscle ache throughout entire body, extreme left arm pain; generalized joint pain & fatigue. UNote: Had 8/18/2009 previous dose 8/19/2009 of Tdap 3/5/2009 (p ain at injection site & arm (left) feels like hot pokers in muscle & joints. Last two fingers in left N hand are numb. 8/14/2009 Fever,8/14/2009 some dizziness. Canno erythema & swelling of Dermis & sub Y dermal skin at site where VERICELLA & MMR Imm. were Y given. No 8/12/2009 fever or size discomfort. after injection, pt developed redness, swelling, hot to touch on Rt arm. Seen in office on 8-19-09, Y recommend 8/17/2009 apply8/18/2009 ice, use BENADRYL. soft tissue abscess. Y 8/5/2009 8/12/2009 p at 4:30 AM with my Rt jaw swollenYon the inside & my Rt. ear is killing me. I have only a wisdom U tooth 7/15/2009 on that side.7/23/2009 I don't think it's the to
cal reaction (L) arm (2) C/o mild swelling Y of bottom lip, redness and swelling noted at site of U injection and7/27/2009 arm warm7/28/2009 to touch - (3) Mom stat 1st GARDASIL 8/13/09; mom reports 8/15/09 c/o headache lasting 2 days & vomiting. Had fluids Y & rest,8/13/2009 no ER or follow-up 8/15/2009 visit. Family his tes after shots, patient had a brief syncopal episode lasting 30-45 seconds; complete recovery. Y 8/25/2009 8/25/2009 lump as large as a baseball, red, hot, and painful. Advised pt to see her primary care physician. U 8/17/2009 8/18/2009 9, day following vaccinations, redness, warmth, tenderness both anterior thighs today, 8/19/09, Y just right8/17/2009 thigh has redness, 8/18/2009 warmth, tender warm\pink\non-tender; 2x3cm induration centrally (R arm) Y 8/19/2009 8/21/2009 er shot-BOOSTRIX mom returned to office with patient. She said he got nauseated in the car, Y became pale, 8/24/2009 flailed with 8/24/2009 his arms & passed o d Tdap and GARDASIL then stood up. Was helping sister get shots then felt lightheaded and Y fainted. 8/21/2009 8/21/2009 arted to experience warmth, pain and Y redness at injection site. Also erythematous area measuring U 7.5 cm 8/18/2009 X 6 cm. 8/20/2009 Given CEPHALEXIN 50 veloped tenderness, redness at injection Y site. Induration measuring 3cm by 3cm. AmoxicillinUgiven 12ml8/13/2009 BID 400mg/5ml. 8/14/2009 ite shows a swollen lump 1 1/2" in diameter tender, itchy. Arm is weak, child fatigued. U 8/17/2009 8/19/2009 swelling, and tenderness at injection Y site. Slight induration to area. Given CEPHALEXIN 500 mg three times 8/3/2009 a day. 8/4/2009 eceived varicella vaccine. 8-11-09 Site became red and swollen and stayed that way. Area involved U in oval 8/10/2009 shape-approx 8/11/2009 1 1/2 x 2 1/2 inch ately 20 hrs after administration of DT pt felt fuzzy & according to grandmother who witnessed Y the following 8/19/2009 pt c/o lightheadedness 8/20/2009 felt dizzy arm at vaccine site that did not disappear. Y N 4/5/2008 6/1/2008 22 yr old Female, inprocessing received Y a G6PD blood draw with no complications. Pt. received U a TwinRix 8/27/2009 # 3 vaccination 8/27/2009 to the R-Bicep, i Vaccine administered on 21 AugustY2009, on 26 August 09, mother of baby reported blood in Y baby's stool, 8/21/2009 returned8/27/2009 to clinic, occult blood p e to be discharged after Yundergoing cardiac catherization. Per chart, pt became restless and Y nonverbal 5-10 minutes ### after### receiving pneum Y 8/10/2009 8/11/2009 REFERS THE PATIENT PRESENTED Y WITH VOMITING, ITCHING AND RASH IN SKIN WHICH U GOT WORSE. 4/9/2009THE 4/11/2009 DERMATOLOGIST 20 SECONDS AFTER RECVING HPV VACCINE #2 & HEPA #1 CHILD REPORTED FEELING Y NAUSEA 8/27/2009 & DIZZINESS, 8/27/2009 BECAME PALE eloped on face and neck within approximately 18 to 20 hours following administration of the N injection. Treating 8/25/2009 with8/26/2009 Benedryl. Loss Consciousness with tonic/clonic Y episode; Temp 96.1 Y 8/18/2009 8/18/2009 along with IPV was administered today Y 8/27/2009 8/27/2009 N 8/26/2009 8/26/2009 t clinic after vaccinations and had a mild nose bleed while walking to car. Parents brought child Y back into8/26/2009 clinic immediately 8/26/2009 and nosebleed hardness & swelling, mildly unconfortable left deltoid - mother describing as on side of arm not posterior aspect 8/25/2009 - mother 8/27/2009 will apply ice pack. COMPLAINING OF PAIN AT INJECTION Y SITE, LEFT UPPER ARM. REDNESS AND SIGNIFICANT U SWELLING 8/5/2009TO 8/6/2009 LEFT UPPER ARM. D zed erythema 7 X 5.5 cm with central more erythematous area about 3 cm Y 8/17/2009 8/18/2009 ORE, TENDER, ITCHING, WARM TO TOUCH Y 8/24/2009 8/25/2009 U VACCINE @9AM. @ 10:30AM SAME DAY BEGAN TO BREAK OUT IN HIVES [5] ON THE Y SAME ARM 8/27/2009 AS VACCINE 8/27/2009 WAS ADMINIST swollen, red, hot,itchy and Axillary Y lymphadenitis. U 8/25/2009 8/26/2009 d fever 101 degrees 12 hrs following vaccine without other symptoms. Resolved 24 hrs. Y 8/24/2009 8/24/2009 administered on 8/10/2009 without difficulty. Y On 8/14 broke out with herpes zoster severe involvment Y on8/10/2009 left side T5-T9 8/14/2009 dermatomal patter ARM (DELTOID AREA) BUT ENTIRE UPPER ARM HAD GENERALIZED SWELLING, REDUAND WARM 8/25/2009 TO THE TOUCH. 8/25/2009 THE PATIENT s had moderate to severe headaches Y and nausea ,as well neck and upper back pain since N her second 7/22/2009 injection.Patients 7/24/2009 father is a physic izure, temp 104.3(temporal). Skin rash Y on trunk. Y Y 8/13/2009 8/26/2009 r (102.2) and Fever Seizure 7 days post Y MMR and Chicken Pox vaccine. Spotted rash underYeyes and accross 8/17/2009 bridge 8/24/2009 of nose 10 days post ut 10 minutes after receiving the injection Y my arm got hot and very itchy. Shortly after that I started Y to get8/25/2009 itchy and flushed 8/25/2009 on my face and h LED BACK REPORTING PAIN ANDYSWELLING IN ARM WHERE SHE GOT INJECTION. SHE Y SAID PAIN 8/17/2009 WAS 10/10 8/17/2009 YESTERDAY AND nted to clinic for second MMR on 08-18-2009. Reported pregnancy with EDC 12-18-2009 Y 7/10/2009 D ITCHING COVERING WHOLE BODY Y LASTING UNTIL THE NEXT DAY. Y 8/26/2009 8/26/2009 male/employee who presented todayYdue to two 1cm eythematous macule in thr right shoulder/deltoid/axillary Y 8/19/2009 area.It8/20/2009 appeared last night aft ing tender, warm and slightly swollen R shoulder. Afebrile, no erythema, signs of infection, severe Y allergy8/3/2009 symptoms.8/3/2009 He had Pneumovax HIGH RED, SWOLLEN ANT-LAT. 12CM X 16CM. INDURATED NOT TENDER, WARM Y 8/25/2009 8/26/2009 s of atrial fibrillation (newYonset) theYweek after vaccine administration, one episode required ER visit. 9/14/09 8/20/2009 ER records 8/21/2009 received 8/21/09 e: 11/28/08; Rash on hands appeared soon after, seen by Dr. on 12/7/09 for rash; 2nd vaccine: N 2/7/09; 3rd vaccine: ### 5/1/09 ### followed by extr G AND REDNESS WITH INDURATION AT INJECTION SITE Y , hips, neck weakness, muscle pain. N 7/20/2009 7/27/2009 upper thigh 13x13 cm, light eryth/purple circle rash with central sl darker purple area with pinpoint Y noted8/24/2009 centrally. Mild 8/25/2009 warmth to touch. (-) s a rash at rt side T5 & T11 area. T5 Y area started on 8/22/2009, T11 area started on 8/24/09. U Shingles in7/24/2009 Rt T5 & T11 8/22/2009 distribution. VALTRE
d ADACEL vaccine on 8/25/09: Lot #C3248AA Sanofi Pasteur. The pt called on today 8/27/09 Y to report headaches 8/25/2009 8/25/2009 since receiving vaccine m redness, swelling & discomf. Ibuprofen & BENADRYL topical admin. U 8/25/2009 8/26/2009 arm red swollen, itchy area size of baseball. Told mom to administer BENADRYL PO and ice-pack U to area. 8/25/2009 8/26/2009 red erythema. Decreased at this moment. U 8/25/2009 8/26/2009 of 1 cm diameter at site of injection (induration still present 3 wks later). N 7/31/2009 8/1/2009 , swelling, pain to site of injection. Advice to tx with warm compress and BENADRYL. Y 8/24/2006 8/26/2009 3 minutes after shots were given, patient felt nauseous, became weak and fainted on the exam Y table. She 8/25/2009 responded 8/25/2009 immediately to ammo subsequent headache dizziness for Y 1 week (+). N 8/18/2009 8/18/2009 8/12/2009 ceived MENACTRA and VARIVAX on Y 8/12/09, at 12 year check-up. Had no problems after getting Y shots8/12/2009 in office. Seen 8/26/2009 at ER 8/26/09 for s slight swelling, hot to touch around injection site (right arm). U 8/24/2009 8/26/2009 Y U 8/25/2009 8/26/2009 Was shaking and off balance "dizzy" Y after shots. Noted all the way to bedtime - didn't stop - Then Y 8/26/098/25/2009 had febrile8/25/2009 symptoms - Went to ER mmunization; pt developed erythema & edema to right upper arm at injection site. Y 8/24/2009 8/25/2009 local redness and pruritis. Encouraged to use ice at site and BENADRYL po. U 8/24/2009 8/25/2009 slight swelling, hot to touch around injection site (right arm). U 8/24/2009 8/24/2009 red DTAP instead of intended TD. Patient notified and states no adverse effects. Y 8/25/2009 ecreased O2 saturation, Y 70's. Copious frothy trach secres, oral secres. Rx - suction, increased Y FiO2 (4:558/26/2009 - 6:20 pm8/26/2009 - back to room air). No ve type rash widespread. Y Y 7/14/2009 ht warm area to left leg. Y U 8/24/2009 8/26/2009 ceived MENACTRA & TDAP. Became faint after. Diaphoretic & pale. Had client sit with head Y down till color 8/13/2009 returned. 8/13/2009 About 15 min. Left ceived Tdap and MENACTRA. Shortly after he became diaphoretic, pale and had a syncopalYepisode. Helped 8/13/2009 client8/13/2009 to seated position, hea was 103.5, Vomiting, Rash U 8/17/2008 8/26/2008 n has been received from a physician concerning Y a 6 months old male 9 who on 04-AUG-2009 U was vaccinated 8/4/2009 with the 8/10/2009 third dose of ROTAT n has been received from Y a medicalYassistant concerning Y an 8 weeks 2 Yold male patient who on Y 25-JUN-2009 6/25/2009 was vaccinated 8/5/2009with a first dos n has been received from a physician Y and a licensed practical nurse concerning an 18 year Y old female who 8/18/2009 on 11-OCT-2006, 8/18/2009 21-FEB-2007 n has been received from a Nurse Practitioner Y concerning a 26 year old female patient Y with Y no pertinent6/12/2009 medical history 6/21/2009 and no known drug n has been received from a physician Y concerning an unspecified age female who in "JUN-2007", U in "AUG-2007" 9/1/2008 and9/1/2008 in "SEP-2008" was va n has been received from a physician concerning a patient who was vaccinated with Y GARDASIL. U Subsequently the patient experienced at .8 later on day of vaccine. About 48Yhr after shot Y developed cyanotic 0 apneic episode. Seen at Y ED then transferred 8/11/2009 for 8/13/2009 obs at another hospit breathing & getting air" R ear & neckYtenderness. Received IV BENADRYL in ambulance with Y relief. Observed 8/26/2009 - E.R. 8/26/2009 X 2 1/2 hours. Takin th hives on wrist, itching all over body; Y swelling right arm @ Y.F. vaccine site; tenderness R Y side of face,8/26/2009 neck, ear. 8/26/2009 BENADRYL PO & ZAN ose of GARDASIL given to left deltoid Y muscle along with PPD to forearm. About 5-10 min after Y shot, became 8/21/2009 pale fell 8/21/2009 forward, hit floor, 3 c episode after receiving TDAP, MENACTRA, FLUMIST, HEP A. Regained consciousness after Y few seconds. 8/25/2009 8/25/2009 ound 1:30pm after I gave pt GARDASIL injection, noticed that she wasn't feeling well. I asked Y if she had8/24/2009 had lunch 8/24/2009 and she said no. I went h on left upper arm, warm to the touch. Triamcinlone 40mg IM, antihistamine 8/24/2009 Pt was given Tdap, HPV, & Meningococcal Y Vaccine while sitting on exam table. Pt stated she Y felt "lightheaded" 8/21/2009 following 8/21/2009 injections and was ceived FLu Mist on 25Aug09. Before administering vaccine patient submitted a negative pregnancy Y test.8/25/2009 28Aug09 patient 8/28/2009 took a second tes veloped fever later in the day following vaccinations, which continued daily ranging from 101-103. Y Patient8/10/2009 also experienced 8/14/2009 decreased appe lled stating child had red swollen area and increased soreness to 2" below injection. MotherYwas advised 8/10/2009 to take child 8/11/2009 to PMD. Was presc Associate reports cold sx , no fever.Y7/17/2009YAssociate received14 Tdap Y vaccine. 8/26/2009NAssociate reported: 7/17/20098/1/2009 8/1/2009 onset of hands called and says that expierenced pain and some swelling at site of injection as well as feverU(?), headache, 8/26/2009 tiredness, 8/26/2009 chills, body aches an ted to clinic 2 days after administration Y of Tdap. Pt complains of redness in Left arm, swelling and pain. 8/26/2009 Patiens arm8/26/2009 has visible erythema w eats, body aches, light-headedness, nausea Y 8/27/2009 8/27/2009 pneumovax at about 10am. started Yfeeling chills and possibly low grade temp and sweats 10pm. U subsequently 8/26/2009 developed 8/26/2009 swelling and incr veloped hives and itching all over body 30 minutes after HPV vaccine given. Patient called Y our office and 8/24/2009 reported 8/24/2009 this 1-2 hours after hive se events noted to date. Y 8/26/2009 ed at present. But client got 2 doses of Hepatitis B pediatric vaccine on this day, one dose in YPediarix, and 8/28/2009 another with 8/28/2009 Hep. B pedi given s se Events to date. Y 8/26/2009 epy after vaccines. 2 am - child's fever Y at 104F - awoke from sleep with jerking, vomiting. Mom Y gave Motrin 8/25/2009 alternating 8/26/2009 with Tylenol. Arous esented on 8/27/09 with redness and Y blisteringYover left upper arm. 1Mom reports the redness Y began on 8/25/2009 8/26 and began 8/26/2009 to spread, the blist
RSE EVENTS TO DATE Y 8/26/2009 t the office and came immediately back Y in complaining of a burning throat and eyes,a racingUheart and feet 8/27/2009 that were 8/27/2009 itching. He immediate of Left arm & shoulder and very hot to touch. Areas itching for 48 hours - elevated temp (101F) U for 72 hours. 8/11/2009 Child sleeping 8/12/2009 more than 12 h eved Pnuemovax 23 Rt arm on 10/27/2009 Y at 1035 am. reports that afternoon she began having arm discomfort 8/28/2009and 8/28/2009 swelling at site of inje ok 2nd dose of Vivotif on empty stomach. Y Went to exercise class. After exercise class felt dizzy, U headache, 8/26/2009 and loss8/27/2009 of balance. Called clini n and off for about 20 minutes. Had difficulty moving hands at one point. Got client on a bed Y to lay down, 8/28/2009 applied cold 8/28/2009 compress, and enco noticed itching, 3:00 noticed hive, 4:30 Y hive bigger called dr, 6:00 seen and given Hydroxyzide Y 8/20 8/19/2009 arm still swelling, 8/19/2009 9:00 went to ER a NUTES AFTER RECEIVING KINDERGARTEN VACCINES CHILD C/O L ARM BURNING.ARM Y BECAME 8/11/2009 RED AND 8/11/2009 BEGAN TO WHELP tructure on the arm where the zostavax was given. Lasted 3 days and was a little painful. Generalized Y nerve 7/31/2009 pain randomly 7/31/2009throughout he U 8/24/2009 mvax vaccine was administered IV instead of IM by mistake at approximately 0830. The patient Y became 8/28/2009 febrile (from 8/28/2009 37.1 C prior to vaccine ss, pruitic, macular rash at injection site (right arm). Y 8/26/2009 8/28/2009 ination parent and child left the clinic. Y Mom and child returned shortly afterward and mom stated Y that pt.8/26/2009 had a seizure 8/26/2009 in the car. She stat ed EIPHD on 8/27/09 reporting symptoms of fever, body aches, redness and tenderness at site Y of injection. 8/25/2009 Visited 8/26/2009 EIPHD on 8/28/09 statin : VZV#2 given SQ to Right Arm. Patient c/o pain and soreness that night. On 8/26/2009 Patient U went to 8/25/2009 school and 8/26/2009 started to feel pain to ri eft leg pain withing hours after having the injection (in her arm) and her quadriceps were soreU the next day 8/25/2009 she felt 8/25/2009 complete weakness and shot 2 and 3 started having chest pains Y and racing heart. Went to ER. After shot 3 started having N daily headaches 6/2/2007and blackouts. Mis-diago nt was seen 2 days after the immunization Y Daptacel Dtap R thigh. His right thigh was swollen U and tender8/21/2009 and there 8/22/2009 was a rash noted aroun d migrane headache Y Y 8/26/2009 8/26/2009 ministered Hep A and VZV Y to (L) arm at an IZ only visit. 1610 pt. left clinic. 1650 pt. returned to Y clinic with 8/27/2009 extensive urticaria 8/27/2009 on entire skin su Pt seen in office for vomiting and abd. Y distention Y - sent to ER for eval4 R/O intussusception orYbowel obst-9/12/2008 transferred to hospital ### for admit to ed by grandmother; states pt has a red swollen mark - on upper arm and a quarter sized bruise. U Instructions 8/24/2009 given to8/27/2009 monitor area/pt. Warm veloped ASCUS PAP and high risk HPV detected following 3 GARDASIL vaccines given 2008/2009. N 1/27/2009 e out with pox-like rash a few hours (about 4 hrs) after MENACTRA, Tdap and chickenpox vaccine. U Pox-like 8/26/2009 spots covered 8/26/2009 back of thigh, m as given ADACEL first without incident pt was then given GARDASIL vaccine and immediately Y lost consciousness 8/18/2009 for 8/18/2009 2-3 minutes, followed noon- pt received vaccines evening-Ysent by nurse to ER with severe joint pain, nausea and U lethargy. 8/25 8/24/2009 Pt still in8/24/2009 pain and vaccine sites d low grade fever and headache for 2 days following injections. Patients symptoms cleared Y on the third day. 8/25/2009 8/26/2009 t measuring 4x3 on back of right upper Y arm where VARIVAX shot administered. Y 8/17/2009 8/18/2009 ling to include digits, knees, elbows.Y Y 8/21/2009 8/23/2009 d woke up next morning after getting Tdap & HPV vaccines afternoon before she felt itching Yon her neck, 6/5/2009 both sides.6/6/2009 Glands felt swollen pe e night of 25 Aug 09 she developed redness, swelling and some pain in posterior left upper and Y now redness 8/25/2009 is also8/25/2009 going down the medial rythematous w/ clearing patches esp. Y on lateral aspect. Borders are not well demarcated. Interval Y clearing 8/19/2009 (+) point8/22/2009 of entry. (-) tender to pa asal flu mist. Fell back in waiting room Y ? Fainted. Y Hit back of head on1floor. Sent to ER by ambulance, Y then 8/27/2009 to another 8/27/2009 hospital. 9/8/09 Hosp ceived MENACTRA 0.5cc in LD then Tdap 0.5cc in RD. Immediately after receiving Tdap, ptYfainted for 68/28/2009 seconds and 8/28/2009 awoke with a convu area of well demarcated erythema Y over R deltoid area. Warm to touch. Small papules on the N surface- Treated 8/26/2009 with8/27/2009 KEFLEX. d swelling, red, hot touch. Y 8/25/2009 8/25/2009 rs following vaccine he awoke with severe Y dizziness. He was still dizzy at 6 am that AM. He went Y to ER and 8/24/2009 was given 8/25/2009 VALIUM and Rx Mec case of Zost 2 wks after - amin of vaccine. o- (L) letal trunk. U 8/12/2009 8/23/2009 inistration GARDASIL pt was kept for Y 15 minutes we then proceeded to our check-out desk. YShe then had 8/17/2009 a syncopal 8/17/2009 episode and hit her h red on 5/2/09 and was administered on 5/6/09. 5/6/2009 red 5/2/09 and was administered on 5/6/09. 5/6/2009 red on 5/2/09 and was administered on 5/4/09. 5/4/2009 rpes zoster outbreak. U 8/12/2009 mph nodes under right arm pit. Injection site tender. U 8/26/2009 8/27/2009 vaccines on 8/24/2009; came down Ywith rash 2 days later just on upper thighs where shots given- non vesicular, 8/24/2009 pinpoint, 8/26/2009 papules, itchy welling and redness down arm of where flu shot given. BENADRYL. U 8/26/2009 8/28/2009 ne sore. Bump on left side of neck. C/o of pain with intensity x 2 days. Y 8/17/2009 8/18/2009 swelling next AM redness, hot to touch. Y Went to ER. Swelling continued then getting larger. N Seen @ office, 8/19/2009 continued 8/20/2009 thru afternoon. W ved vaccines in office. When in parking lot, fainted. Mother able to hold up. No injuries noted!YResponded8/27/2009 immediately. 8/27/2009 rythema, swelling at site. Temp 100.1, left thigh 4.5" x 3.75" raised erythematous macule, warm Y to touch.8/17/2009 8-19-09 increased 8/18/2009in size, no itch after vaccination the patient developed reddness, swelling and itching at the vaccine site. Y 8/25/2009 8/26/2009
ained that he wasn't feeling well at approximately 12 pm 8-26-2009. He started shaking and was Y dizzy. He 8/25/2009 stated that 8/26/2009 his right arm, chest a ceived the vaccine today at 9:30 am at 7 pm the patient called the pharmacy and stated thatUthey had broken 8/29/2009 out in8/29/2009 a rash at the bottom of Y Y 8/28/2009 8/29/2009 inting, dizziness and seizures starting Y in 10/08 and lasting until seizure were under control inU3/09 while taking 7/22/2008 trileptal. 10/8/2008 There were a few fa thigh swollen to softball size hard, red, Y & warm to touch. No itching no pain. Y 8/17/2009 8/18/2009 tingling in right hand. Redness and swelling of arm down to the elbow. Low grade temperature U for first 128/19/2009 hours. Temperature 8/19/2009 of 103 to 104 ceived Dexamethasone IM and Benadryl po. Y 8/26/2009 8/26/2009 NOv. 24th did not have energy, Y tired.YWeek of Dec. Y 8th. had weird feelings 7 in hands and toes.(felt Y like I had 11/1/2008 needles in my ### hands and feet.) was given on a Wednesday. On Thursday Y left eyebrow felt itchy. By Friday I noticed a few hairs N had fallen.5/6/2009 By Saturday 5/7/2009 half of my eyebrow d 8/28/09 about 4 p.m. First hematuria observed on Sunday, 3/30/09 at home in late morning U urination. 8/28/2009 BP+ 120/808/30/2009 Afternoon, hematuria accine used (expired drug administered) A non-serious spontaneous report of administrationYof expired FluMist 2/26/2009 was 2/26/2009 received from a nurse c accine used (Expired drug administered). A non-serious spontaneous report of administrationY of expired 1/12/2009 FLUMIST was 1/12/2009 received from a nurs was received from a health care professional Y on 28 July 2009. A 70-year-old female patient,Nwith a history5/7/2009 of Bell's Palsy 7/1/2009 one year ago, rec ort received on 18 August 2009 fromYanother manufacturer (report number WAES 0907USA05484, U document number 45223472) who had rmation received on 19 August 2009Yfrom another manufacturer whose initial reporter was a health care professional. A male patient receiv ort was received 19 August 2009 from another manufacturer Y (doc number 0 45223759), who received the report from a health care profession ort was received 24 August 2009 from Y another manufacturer (document number 45223857) who U received 8/5/2009 the report from 8/5/2009 a health care prof n has been received via internet concerning a 16 year old female who on unspecified dates U was vaccinated with the first two doses of GAR n has been received from a consumer Y concerning Y her daughter (a 15 2 year old female) with food U allergy and 4/16/2007 asthma "who received all three mittent headaches, fatigue, lethargy. Y Hospitalized Y 07-1-09 thru 07-6-09. 6 Y IV TORADOL/COMPAZINE/BENADRYL U 5/11/2009with 5/26/2009 no relief. Currently b vaccines and left office to go to car Yin parking lot. Y Began c/o shortness 1 of breath, throat tightness. Y Came6/15/2009 back inside6/15/2009 office. Vomited thick, w ter had the series of GARDASIL vaccination onY10/3/2007, 12/14/2007 and 4/25/2008. Starting in October, 4/25/2008 2008 she 10/1/2008 started having pain in ter received all three injections Y of GARDASIL. YSince receiving the last injection, Yshe has been U hospitalized 6/19/2008 with severe 4/21/2009 kidney infections a s of pt's record 7/31/09. Y8/20/09 Spoke Y by phone Y to mother of patient 60 Ysays that patient received Y #1 HPV7/10/2009 on 9-19-08.7/24/2009 On Oct/2008 patient w ness & swelling at injection site day after injection, aches. Day #2 - Dramatic redness & swelling U (11 X 12 8/24/2009 cm) headache, 8/25/2009 nausea. ays after shot around site received PO Benadryl then rash to L thigh site injection of VARIVAX Y went down. 8/13/2009 8/18/2009 e started shortly after injection given - Medium headache persists yet today 8/27/09. During 1st night after 8/24/2009 injection, 8/24/2009 woke up during night pe to swell on (LF) leg. Y 8/25/2009 8/27/2009 eived MCV4 and TDAP. Approx. 1-2 minutes after became pale - had client sit down - had syncopal Y episode 8/26/2009 that lasted 8/26/2009 < 1 min. Client did 50 + hrs after injection with Erythema multiform (minor) rash primarily within 6 inches from injection Y sites - anterior thighs & few lesions left nt TD by mistake. Should have given client DTAP. Client called on 8/28/09 and message left. Have not8/18/2009 heard from client since the family l d fever of 100 last night and had left sided abd pain on Wednesday. 8/26/09. Woke up this U AM 8/27/09 8/24/2009 with rash on 8/26/2009 back of legs and wais d "rash on abd and groin area that is itchy". U 8/14/2009 8/15/2009 Rx BENADRYL 25 mg P.O. Y 8/21/2009 8/21/2009 n R thigh, redness - tenderness. Involves Y entire thigh. U 8/25/2009 8/26/2009 Barre syndrome. Respiratory Y problems. Y Weakness Y and fatigue. Therapy. 7Y U 12/2/2008 ### pruritic and painful papular lesions on Y hands and fingers 12 days post vaccination followed 2Ydays later by 6/30/2009 the appearance 7/13/2009 of lesions on rt e a of erythema and blisters covering Y thigh Hep A vaccine given. Y 8/26/2009 8/28/2009 esented in the office on 8/27/09 three Y days post-administration of Menactra and her first Gardasil U with myalgia. 8/24/2009 She 8/27/2009 was brought in after ex hematous edematous patch surrounding the smallpox vaccine site,with slightly pustular plaque Y representing 7/1/2009 the vaccine 7/30/2009 site itself. Multiple e, Fever, Facial Swelling, HematuriaY N 8/27/2009 8/28/2009 ion a few days after vaccination. Diagnosed with Y vasculitis. Hospitalized 2 for two days with pelvic N and joint 7/9/2009 pain. Blister 8/15/2009 on abdomen. Bilat. s with orange peel texture, swelling, induration >6 inches, itching, pain at site and left extremity. U Headache,8/27/2009 extreme tiredness, 8/28/2009and fever of 1 ed left arm. hot sensation with pain U 8/28/2009 8/30/2009 0 minutes after receiving Tdap injection, client became pale, and felt like he was going to "pass Y out" . Client 8/28/2009 lied down 8/28/2009 with feet elevated. B/ g reaction; Severe dehydration, vommitting, Y diarhea, stomach cramps, muscle cramps, difficulty Y breathing. 8/20/2009 Symptoms 8/20/2009 lasted for 4 days. numbness in arm 8 hours after vaccination, Y lasting 3 days. Sore throat, body aches, headache Y and mild 8/27/2009 fever 24 hours 8/27/2009 after vaccination las ame lightheaded, pale and lost consciousness for 30-60 seconds while sitting on the examination Y table. 8/31/2009 Client was 8/31/2009 layed flat for approx 5 m ceived vaccination at primary care appt. Y 7/14/09, was called with lab f/u on 7/15/09 when theYpatient reported 7/14/2009 her arm 7/14/2009 was swollen from abo eaction to Shingles vaccine-(Zostavax) -10 pk. As soon as injection, started gradually and intensified U to feel 8/27/2009 tingling,8/27/2009 burning, itching in right started 45 minutes after Tdap given. Started itching and scratching, broke out in hives, worse Y on legs and 8/24/2009 buttocks.8/24/2009 Took Benadryl and co
S AFTER SHOTS SHE BROKE OUT Y IN HIVES. GAVE BENADRYL EVERY 4 HOURS WITHOUT U IMPROVEMENT 8/26/2009 8/27/2009 SO WENT TO ER ON after vaccination patient developed HA, weakness, body aches which lasted 1-2 days. Developed N redness, 8/24/2009 swelling,8/25/2009 warmth and pain at in hour after receiving immunization child broke out in rash that covered his trunk and extremeties. Y Was given 8/28/2009 benadryl 8/28/2009 and rash began to cle er vaccines were given patient had Y a feverile seizure. Lasted nearly 5 minutes....temp went Y extremely high. 8/6/2009 Was take 8/12/2009 by Ambulance to Me eceived 08/24/09 @ 10:30 a.m. Sore Y throat developed that evening @ approx. 8:30 p.m. Developed Y headache, 8/24/2009 body 8/24/2009 aches, and low-grade er receivcing vaccinations, patient went Y to stand up and states that he felt a "little woozy" and Y sat back down. 8/27/2009 Patient 8/27/2009 then started complain f lower lip, soreness of throat, and itching on Left forearm and left bicep U 8/29/2009 8/29/2009 heat, swelling and discomfort within 24 hrs. Severe local reaction. Y 8/27/2009 8/28/2009 ceived vaccine on 8/17/09. According to parent: pt started vomiting on 8/25/09 at school andYsent home;8/17/2009 developed8/25/2009 rash on right side of bo TIS RIGHT THIGH. KEFLEX 250 MG Y 8/26/2009 8/27/2009 t the site of injection. the redness area is 2" X 1". It is also a pink area srounding that which is U 4" X 2.5". 8/29/2009 the area is 8/30/2009 warm. But no fever at th pular rash of trunk and extremities with some vessicles. Vessicles painful if broken. NoticedYabout two weeks 7/22/2009 after vaccine 8/6/2009 - clearing by fo ash 5 minutes following Prevnar, Rotavirus, Pentacel Y 8/19/2009 8/19/2009 apules on trunk, not itchy, otherwise normal exam Y 8/20/2009 8/30/2009 Y 8/21/2009 8/21/2009 REPORTED CHILD HAD ONSET OF Y MIGRANE HEADACHES, LEFT ARM NUMBNESS AND U SOME BLURRED 7/29/2009 VISION. 7/30/2009 ONSET OCCU mplains of severe pain in arm the injection was given. Shootin pain all the way down her arm Y to fingertips. 8/31/2009 8/31/2009 ats, body ache, difficulty sleeping Y 8/27/2009 8/28/2009 iving vaccine daughter c/o pain to injection Y site for days. c/o headache, dizziness, "stomache U ache", fatigue 7/18/2009 and general 7/18/2009 malaise. Intermitt h, dizzy, HA, backache, chills fever 102 degrees, Pt. just started monthly menstruation. Water, Y ice one head, 8/26/2009 ibuprofen. 8/27/2009 e, tiredness, nausea, diarrhea, body aches, joints aching. Y 8/17/2009 8/19/2009 nd injection site red & bumpy on R/th where varicella given. BENADRYL prn. Y 8/17/2009 8/18/2009 mother phoned, client ok evening of 8/27, woke up 8/28 feeling "poorly", high fever. Friday evening Y with quarter 8/27/2009 size round 8/28/2009 reddened areas yalgia - fatigue - started 8/22/09. Y Y 8/10/2009 8/22/2009 d vaccine on 8-26-09 on 8-27-09 onset redness, edema L upper arm, site of vaccine. Y 8/26/2009 8/28/2009 03 F with shaking chills day after vaccination. Also warmed patch (10cm) anterolateral arm that Y has not 8/28/2009 resolved. 8/29/2009 Y 8/26/2009 8/27/2009 eloped edema, redness/purple discoloration to lower exts. As well as a few red patches to back. Y No resp. 8/28/2009 distress.8/28/2009 Clear lung sounds. Cr administered 8/28/09 to Rt arm. Saturday, Pt woke with baseball size redness to vaccine site. Y C/o small8/28/2009 amount of 8/29/2009 itching and mild rednes swelling & induration at injection site, Y 14cm long x 9.5cm wide. Questionable secondary cellulitis. U No fever 8/26/2009 or other 8/27/2009 systemic s/s. Injection s ite reaction (redness; about size of a quarter) developed about 48 hours after injection. Patient U states it isn't 8/24/2009 as red 8/27/2009 or as large as it was. ately 36 hours after vax admin, parent noted child to have large, reddened, swollen area at DTaP Y injection 8/12/2009 site. 8/14/2009 having rash on leg administered. Rash Y spreading. Pt mom told to give BENADRYL & TYLENOL. U 8/25/2009 8/26/2009 e, fatigue. Local swelling, redness, & pain to site of injection. Y 8/27/2009 8/28/2009 ed to clinic 20 minutes after vaccineYwith vomiting, abdominal pain, and urticaria. Lung sounds Y clear. Continuing 8/21/2009 discomfort 8/21/2009 & worsening. Ad Y Y 8/18/2009 8/20/2009 .4, chills, H/A, swollen lips, pains & tingling in arms/legs. Treated with BENADRYL 25 mg PO Y and TYLENOL 8/24/2009 1000 8/25/2009 mg PO. ine fever. Temperature elevation began Y 4-5 h after vaccine administration. Duration approx. Y 30 h. Tmax 8/20/2009 104 F (rectal). 8/20/2009 Appetite decreased, mother, pt. started experiencing extreme fatigue/weakness and some nausea in morning on 08/21/2009. U Pt. 8/17/2009 was taken 8/21/2009 to PCP and Hgb che en and instructed to use cold packs to site if soreness, redness, or inflammation occur. Pt. stopped Y by health 8/20/2009 dept. on 8/21/2009 8/26 c/o pain in neck, of chicken pox. Y N nge sized, red, hard, warm area around injection site 24 hours after shot. 8/4/09. Reluctant to U walk due to8/3/2009 pain. On AM 8/4/2009 of 8/5/09 mom note Hematocrit leading to severe diaperYdermatitis. N 8/11/2009 8/14/2009 d TDAP (BOOSTRIX) on 16 JUN 09 developed rash on 17 JUN 09 was evaluated by provider Y on 24 JUN 6/16/2009 09 + Txed6/17/2009 with ZANTAC + PRED lled our office 4 hours after receiving vaccine with c/o severe headache. 8/25/2009 8/25/2009 haking, "locked up" (2 minutes) unresponsive, Y hypotension. 911 called ER Dx: Syncope vasovagal. Y 8/11/2009 8/11/2009 09 around 3:30 pm there was an approximately Y 3" X 5" area on the L upper forearm that wasNred, raised8/20/2009 and swollen 8/21/2009 and warm to touch. P o 105 degrees duration 2 days - Rash. Y 8/19/2009 8/19/2009 PV, Hep A, & Verasella. Symptoms were dizzyness, nausea, hot flash, blurry eyes & tinglingYears, pt layed 8/24/2009 down for8/24/2009 15 min w/ ice pack. of LA, red, hot. Y 8/25/2009 d to office with rash - Began on chest Y spreads to arms -8/27/ rash began. Y ### 8/27/2009
& swelling upper arm (16 cm) - to arms Y elbow. Circumference 23 cm vs 20 cm other arm. Pt reports chest 8/25/2009 pain X 38/25/2009 days after injection. & swelling 6x7 cm. Requires BENADRYL Y one tsp q 6 hours PRN. U 8/26/2009 8/27/2009 VAX 8/17/09 developed high fever that night with shaking chills vomiting the next day right arm was also8/17/2009 very red and 8/17/2009 sore left arm fine. Fe d Hep A vaccine on 8/25/09. Mother reported generalized red itchy rash first noticied 8/25/09 U in the evening, 8/25/2009 and swollen 8/25/2009 eyes 8/26/09 in A d suddenly around 21 May 08 profound Y fatigue, and sleeping 12-14 hours at a time and awakening N unrefreshed. 4/25/2008 Also 5/21/2008 had increase in HAs, inch erythematous area. Occurred/started 8/21/09 and continued to be red & swollen still today U 8/24/098/20/2009 with a measurement 8/21/2009 of 5.5cm x 6c miting. 5 cm swelling and erythema Y at injection site, right thigh. Y 8/7/2009 8/13/2009 miting, diarrhea, and fussiness. 3 cm Y of swelling and erythema at injection site. - Right thigh.Y 8/7/2009 8/13/2009 elling and redness to injection site. Y Y 8/24/2009 8/25/2009 grade fever, fatigue, headache lossYof appetite. VARIVAX given 8/17/09. Symptoms started Y 1 week later. 8/17/2009 Came into 8/24/2009 clinic. Quick strep n degrees. Lt thigh swollen. Y Y 8/18/2009 8/20/2009 ter flu like symptoms, lethargy, feverY to 100, initial insomnia for 4 days, tired, arthralgias, andNheadache. 6/25/2009 Week 2 had 6/28/2009 had swollen node in b inistration of GARDASIL vaccine patient felt like she was going to pass out. Her blood pressure Y dropped8/10/2009 to 90/52 and 8/10/2009 pulse dropped to 48 yed redness at the site of injections, several minutes after administration. Provider monitoredY pt. for any 8/18/2009 other adverse 8/18/2009 reaction after admin ollowing vaccination pt developed fevers, Y chills, sweats, fatigue, decreased appetite, & 2 similar Y pox lesions 8/11/2009 on the right 8/19/2009 cheek. Appear to b Y 8/6/2009 8/11/2009 Pt in for HEP B #3 - Reports "I had a reaction to the TETANUS". TDAP given 04/01/09 rightYarm IM. Pt states 4/1/2009 initially 4/2/2009 had some "redness" ven MENACTRA before he was at the recommended age to receive MENACTRA. Pt age 10,Y 2 1/2 months 8/13/2009 early per CDC recommendation gh pain within 24 hrs after vaccination. N 8/23/2009 8/24/2009 N 6/15/2009 7/1/2009 ported increased swelling in the (L) arm, both upper & lower 2 days after a DTaP & Hep B (DAPTACEL Y &8/18/2009 ENGERIX8/20/2009 B). It improved after 2 d Vaccine on Left arm: 1st day no problem. Y 2nd day 1" red area; sore, warm to touch. 3rd day 2"hard Y red area 8/26/2009 with 2" 8/27/2009 red welt around; hurt, h n. 8/21/09. Noticed reaction 8/22/09Yin evening 8:30pm. Rt thigh swollen increase to hip area Y down to ankle 8/2/2009 0 hard 8/22/2009 warm to touch - taken to became red and swollen one day after Y DTaP. Worse on second day . Plus warmth plus edema. No induration 8/25/2009 no tenderness. 8/26/2009 after vaccine broke out in rash - dime size red bumps. Itchy throat and extremities. Treatment: Y BEANDRYL, 8/10/2009 ice, cold8/11/2009 bath, MEDROL dose p d, raised - to chest, back, stomach, inner thighs. Mom treated with BEANDRYL 1 X 4 days. Mom Y states this 8/3/2009 happens 8/3/2009 every time with immun Y 6/3/2009 6/5/2009 taneous case was received from a health Y care professional on 26 August 2009. A 48-year-old N female patient, 8/20/2009 with a8/21/2009 history of asthma and a n has been received from Y a physician Y concerning a 9 year old female with latex allergy Y and histories Y of congenital 8/24/2009 disorder, 8/24/2009 clubfoot, myelo n (L) arm - site of where vaccine was Y placed; (+) swelling; (+) tenderness; (-) warmth; (-) induration; U erythema. 8/24/2009 8/28/2009 n has been received from a consumer Y concerning her 6 year old son with no pertinent medical N history and no known drug allergies who wa 10:00pm on day of immunization patient stated had headache and nausea. Drank SPRITE, laid N down and 8/14/2009 symptoms 8/14/2009 resolved about 2 hou ines administered in same arm (notYstated if L or R deltoid). Upper arm became warm, red &Y painful. Steroid 8/3/2009 administered 8/3/2009 @ clinic on 8/4. d to clinic 4/30/07 with 2d menorrhagia. Orthostatic Y with HCT 28.5. Admitted 5 to hospital. Required Y D&C to4/23/2007 stop bleeding, 4/28/2007 IV estrogen didn't w ates patient ran a fever of 104 degrees for 8 hours and developed hives fever and hives resolved Y after 8 8/20/2009 hours, but patient 8/20/2009 continued to be n has been received from a pediatric resident physician Y concerning 0an approximately 6 month U old patient who on an unspecified date was ping nights, fever, irritability, very fussy. Y SleepyYbut would not sleep21 but 4 a min his Y cry changed. N Seizures3/5/2009 (But we did 3/24/2009 not realize what they 7/31/2009 d Varicella vaccination about 3:30 pm. Y His mother Y drove him to football 15 Y practice. About 5:00UPM he took8/19/2009 a very hard8/19/2009 hit. 15-30 minutes late n has been received from a physician Y concerning a 19 year old female patient who at the time Y of vaccination 12/2/2008 was with 12/2/2008 fever and congestion Hep A VFC, instead of Hep B, VFC. She had already received 2 Hep A 's. Y 8/26/2009 d vaccine on 8/14/09. Pt developedYfever (101-102) on 8/23/09 with generalized tonic clonicYseizure. 8/14/2009 8/23/2009 out in a rash, swelling, vomiting, lethargic. Y Pt. was administered BENADRYL, EPI-PEN JR. and Y escorted8/25/2009 to Emergency 8/25/2009 Dept. Anaphylaxis 02, night of GARDASIL #2, Varicella #2, and MENACTRA - reduced with TYLENOL, no other Y symptoms.7/7/2009 7/7/2009 02, night of GARDASIL and 2 Varicella 2 MENACTRA., resolved with Tylenol, no other symptoms. Y 7/7/2009 7/7/2009 8/25/2009 Y 6/23/2009 d hep A (L deltoid) and ADACEL (RYdeltoid) on 8/25 @ about 10 AM. By 8/26 @ about 2000 pt had marked 8/25/2009 swelling8/25/2009 of L deltoid with erythe and swelling of injection site. BENADRYL and anti inflammatories given. N 8/21/2009 8/21/2009 s between shoulders and elbows "whole Y back muscle swollen" : T increase. Returned to clinicY on 8/4. Oral8/3/2009 steroid administered 8/3/2009 and 'cream' the shingles vaccine on 22 Aug 07. I was diagnosed with shingles on 2 Jul 09. I had hurt and had breakouts 8/22/2007 for several 7/2/2009 weeks prior to susp
accinated with GARDASIL. Shortly after she developed Colitis, inflammatory bowel disease, an autoimmune 8/17/2008 disease. 10/1/2008 d with ZOSTAVAX for shingles prevention in upper arm under flesh. Developed extreme swelling U & fever8/28/2009 at the area. 8/28/2009 This morning, aching eeling hot. Placed patient on floor, resp, pulse were normal limits. Pt recovered quickly, keepYlying down 8/17/2009 for 15 minutes. 8/17/2009 No adverse affects ADACEL 8/27/09 - 8/28/09, seen atYED for site of vaccine, (L) arm swelling with pain, 3/10, pain Y level (x'd 8/27/2009 I.V. Vancomycin, 8/28/2009 stopped due to 9 - 7 pm client taken to ER by ambulance Y c/o difficulty breathing. Temp 103 degrees. Tx 1000 Y cc NS IV -8/10/2009 ROCEPHIN 8/10/2009 1 gram IV piggy back ril 2009 he received AVA #2 to left deltoid. Y He again experienced site burning and soreness.YWithin 6-8 hours he ### was 4/27/2009 awakened from sleep ear old AD US Navy officer received an annual FLUMIST administration on 05 October 2006. (DEERs records 10/5/2006 receipt of both ### IM and nasal se symptoms noted. Y 8/31/2009 edness pain warmth of left shoulder.Y Y 8/28/2009 8/28/2009 our child developed angry outburstsYand increase in self abusive behavior which has grown U progressively6/1/2009 worse. We6/1/2009 consulted a neuro ps ped chills, fever, SOB after ADACEL administration on 8/24/09 - Evaluated on 8/26/09 - Tx OTC Y TYLENOL. 8/24/2009 8/24/2009 e call from parent reporting trip to urgent Y care on evening of 8-24-09 because pt was "sick." Parent Y stated8/24/2009 H.C.P instructed 8/24/2009 mom to call pub after receiving vaccine, began to feel bad. Muscle ached. Large red rash appeared and is still N visible 5 days 8/21/2009 later, although 8/22/2009 it seems to be and inflammation onset appr 24 hours after injection; at 48 hours post injection - (L) anteriorUthigh with 11x15.5 8/21/2009 cm 8/25/2009 area of erythema, warm min - 1 hr after vaccines pt began toYdevelop rash and whelps all over body. Also c/o itching.Y Pts mom gave 8/11/2009 him BENADRYL, 8/11/2009 but it did no ut. Stomach pain. Y 8/27/2009 8/27/2009 ope - some chest pain & dizziness nausea. 2nd episode 19th/8/09 (same SX). 9/3/09-records Y recived-date 8/18/2009 of service 8/18/2009 8/25/09-2 episodes stiffness, myalgias and pain. U 8/20/2009 8/22/2009 d <12 erythematous papular lesions. 2-3 were at injection site. Others widely distributed. Developed Y from8/11/2009 2-17 days8/11/2009 after vaccination. No ac se #3 given at age 8 wks but should be given at 24 wks. Y 8/27/2009 nflammation, bruising, warm to touch. Lt arm bruising/ pale halo ring around site - IM site 13Ucm X 8.5 cm 8/25/2009 - Sub Q site. 8/27/2009 warmth, slight bruising to the right thigh. Y Y 8/24/2009 8/24/2009 d area redness, itching within 4-5 hrs about 4x8cm. Y 8/25/2009 8/25/2009 ut. Stomach pain. Y 8/27/2009 8/27/2009 ersensitivity reaction to MMR. Right leg at site of vaccine began with swelling, redness (borders U ill - defined) 8/26/2009 within minutes 8/26/2009 of administratio ox developed on right foot 09 Aug 09, likely focal auto inoculation (vs localized vaccine). Y 7/27/2009 8/9/2009 eadache with fever 100 degrees F on 7/23/09. Y 7/16/2009 7/22/2009 /19/09. Next day large red area around site small pimples within red area. Pain, swollen & very Y itchy. Had 8/19/2009 shingles8/20/2009 - 10 yrs ago after deat was reported by a healthcare professional Y and described the occurrence of passing Y out in aY20-year-old6/25/2009 female subject 6/25/2009 who was vaccinate ceived HPV #3 on 07/13/09. No immediate Y adverse Y events noted. Patient 3 presented to ER on Y 08/01/09 with 7/13/2009 syncope8/1/2009 and again on 08/24/0 (within 10 minutes of FLU vaccine admin.). Y Fainted (between 10-15 minutes of administration). Y Paramedics 9/1/2009 said that 9/1/2009 the patient had an e multiforme within 24 hours of receiving Y shots. N 8/31/2009 9/1/2009 hours after vaccines L side of patient's Y face became swollen & lip on L side is real swollen. Pt Y states he 8/31/2009 became a little 8/31/2009 mucosy & coughed urse gave vaccines to young patient. Vaccines were meant to be given to a 4yr old child. The Y student got 8/21/2009 confused. She thought that she atigue- persistent, preceded by respiratory viral symptoms started 2 weeks after MENACTRA. N 6/29/2009 7/15/2009 sh, itching, 12 days after vaccination. Y TYLENOL, antihistamine as needed. U 8/19/2009 8/31/2009 ported high fever and frontal headache the night of receiving the listed vaccines. Mother reported Y fever resolved 8/31/2009 but headache 9/1/2009 remained th 0-20 minutes after receiving MMR &Yvaricella vaccines pt started coughing. He was auscultated Y & found8/31/2009 to be wheezing. 8/31/2009 Pulse ox 97% on pain; numbness in injection site and weakness distal to site, 1 month s/p immunization. N 7/31/2009 7/31/2009 s of feeling overheated, tachycardiaYand shortness of breath began approximately one hour after Y receiving 8/31/2009 vaccine. 8/31/2009 Emergency room admin iving her shots pt c/o shortness of breath. She recovered on her own before paramedics arrived. Y 8/31/2009 8/31/2009 days of receiveing menactra vaccine he had little pus filled bumps all over the top of his head Y in his hair. The vaccine is the only thing I ca nt and mother, Shad felt "funny" laterYin the day after receiving varivax. Noted dizziness and wheezing U when 8/20/2009 running8/20/2009 at football and had to s pounds, 7 oz; 31 inches) had his 12 month checkup on 28-AUG-2009 at 9:30am and received N 4 vaccinations8/28/2009 MMRII, 8/28/2009 hep B, Prevnar and a eption. Failed reduction. Required surgical resection. Y 9/14/09 Hospital 4 records received DOS Y 8/27/09 to 8/14/2009 8/31/09. Assessment: 8/27/2009 Intussuscep d high fever spikes of 104 and 103 Y degrees F. He also had sever muscle pain in the leg of the Y injection. 8/26/2009 The injection 8/26/2009 site was WITHOUT r ee days had head to toe rash, itching, Y no temp, no known exposure to disease. Given Tylenol Y prn 8/25/2009 8/28/2009 to mom approximately 5-6 hrs after recieving her Hep A and Varicella vaccines the pt. c/o her Y stomach 8/25/2009 hurting and8/25/2009 she started throwing-up d hives around injection site less than 24 hours after given. U 8/31/2009 9/1/2009 and MMR vaccines given on 8-18-09. Child developed mild redness at site of Varicella vaccine Y only on 8-19-09, 8/18/2009 called 8/19/2009 our office about it on daughter's 4mo check up and shots Y she remained more calm (as if sedated) than usual with spouts N of screams 5/5/2009 here and 5/5/2009 there. I assumed i
vaccineson 8/4/09. On 8/6/09 she was Y lethargic, runny nose and diarrhea. On 8/8/09 she wasU listless with 8/4/2009 the other symptoms 8/6/2009 too. No fever y (unilateral). 9/2/09 Consultant record received Y DOS 8/31/09. Assessment: 1 Bell's Palsy. Patient U presents 8/22/2009 with sudden 8/22/2009 onset (L) facial pals nted and fell to floor hitting head onYexam stool. LOC was approximatedly 10 seconds, BP 90/60, Y P 56, arms 8/12/2009 jerking, 8/12/2009 laceration on left side Hep A and Flumist, left room and pt.Y became diaphoretic, fell at hit front of head, seized andUwas transported 9/1/2009 to ER. 9/1/2009 ived TD, IPV,HEP A,MMR and VARICELLA on 8/31/2009. Within 5 mins. of receiving vaccines U client got8/31/2009 up and loss 8/31/2009 consciousness and fe occured about 2 min after administration of 3 IM vaccines -- MCV4, Hep A, and Tdap. Child Yc/o headache 8/31/2009 and dizziness, 8/31/2009 and a couple of s pneumococcal vaccine trial, with severe COPDY was hospitalized for3 Unicompartmental RT Knee Y Replacement. 8/5/2008 Vaccination 6/23/2009took place on 8 g cramps in the calves U 8/31/2009 9/1/2009 ports a rash, fever and headache that started on Friday and continued until Sunday. The fever Y and headache 8/28/2009 were8/28/2009 relieved with acetamino h with blisters over some parts of body. Temp. of 101 degrees on Friday night. Then rash over Y body. Mom 7/29/2009 gave tylenol 8/21/2009 for fever,gave baths me to clinic on 8-17-09 complaining of rash on body. Was examined by attending Dr. who isYan infectious8/6/2009 disease doctor 8/17/2009 and it was determ 9 Mother reported child had extreme dizziness- Felt dizzy a short time after vaccine and during Y day and 4/14/2008 night had difficulty 4/14/2008 standing due to .5cm mild erythema left arm. Nontender, no discharge and no cellulitis. Y 8/17/2009 8/19/2009 owing varicella administration patient noted to have red, non tender puritic area Y 8/26/2009 8/27/2009 twinrix vaccine (3rd dose) lot #AHABB131AB administered to left deltoid at approx. 2:30 pmYon 8/31/09.8/31/2009 She states 8/31/2009 that about 4 hours lat hematous oval shaped area over left tricep. No pain. Y 8/10/2009 8/12/2009 ministered Hep A and HPV vaccine.Y Sat in clinic room 10-15 minutes. Stated felt fine, color good. U released 8/26/2009 to check8/26/2009 out. stood 1-2 minutes ately 10-12 hours after receiving the vaccine, I developed flu like symptoms-fever, chills, nausea, Y muscle8/31/2009 and joint pain. 9/1/2009 I also developed s ellite lesions 1/2 an inch to the left and Y right of the original vaccination site. All three lesion were healing8/21/2009 well with scabbing. 9/1/2009Pt woke up th and aching muscles, chest pain, racing Y heart, aching Y leg (both), aching 2 arm (both), shortness N of breath, 8/13/2009 dizziness, nausea, 8/28/2009 rash, seizure-lik VER 102.4, HEADACHE Y Y 8/31/2009 9/1/2009 d flu shot on left arm,and pneumovax ,and decavac on the right arm at 11 am on 8/28/09.theYnext day,she 8/28/2009 called ,and 8/28/2009 complained that she arm(on which vaccine was administered) Y was inflammed and swollen and she developed a Yrash within 1-2 8/24/2009 days. She 8/25/2009 also had a mild temp hours after receiving MMR and Chickenpox Y vaccine child developed a rash all over chest, back, U arms, diaper 8/12/2009 area and 8/12/2009 face. Was given Be nd stomach cramps beginning ~24 hours after injection and lasting for ~2 hours. Second boutNof vertigo ~72 8/29/2009 hours after 8/30/2009 injection, which is s l skin reaction occurred the day after administration of vaccine (PENTACEL). 0 treatment. Y 8/28/2009 8/29/2009 Y N 8/20/2009 8/27/2009 did physical & came out the room, handle me the chart, I look at the chart & saw the #2 underY age and assumed 8/24/2009 pt was 2 mths & needed 2 spontaneous report of medication error, bronchospasm Y and exacerbation 0 of asthma has been Y received 8/10/2009 from a physician 8/11/2009 concerning a two ed area - Warm & itchy rt upper arm. N 8/24/2009 n has been received from a physician Y concerning a 72 year old female patient who Y on 28-JAN-2008 N was1/28/2008 vaccinated1/28/2008 with a dose of ZOSTA n has been received from a physician Y and an office manager concerning a 12 year old female Y patient with 8/26/2009 amoxicillin 8/26/2009 allergy (AMOXILIN) w 2 of the 3 HEPATITIS BYVaccines after Y the first mild achiness after the 2nd my Rt Y leg & armNwent numb 7/11/2008 - vision disturbances. 7/28/2008 Can't see we n, seizures, rapid heart rate, Y brain damage, Y weakness, Y no sleep, 123 changing Y skin color Y & textures, N pain, numbness. 6/5/2007 9/14/09 7/22/2007 Hospital records and erythema to site; extended to allYarm - Hot to palpation - Dx: Cellulitis to (L) arm. 8/25/2009 8/26/2009 iving immunizations at office visit, while ambulating in hall reported dizziness, then had a brief Y loss of consciousness 8/28/2009 8/28/2009 and was lowered to th Y 8/26/2009 8/26/2009 ent to ER 8/13/09 with complaint of swelling Y in arm, redness and fever. ER visit 8/13/09 temperature Y = 100.1, 8/10/2009 BP 106/74, 8/11/2009 patient was placed dia, arrythmias, heart block, syncope, Y chest pains. Y Taking 3 kinds of medicine daily. Has plenty N of follow ups 6/3/2008 with cardiologists, ### possibly put normal bleeding at time of injection (pt. not on blood thinners etc.) 5-10 min. after injection, Y arm felt "asleep". 8/28/2009 About8/28/2009 30 minutes post-injecti ma 8 cm on right posterior arm. S/S started following the vaccination. Y 8/5/2009 8/6/2009 ma noted in right posterior arm. Y 8/4/2009 8/5/2009 on right arm - posterior 3 X 5 cm area red, raised, & warm to the touch. Y 8/19/2009 8/20/2009 ll, muscle pain all over, bone (hip) pain 3-4 days. 3rd after immunization redness around injection Y site spread 8/18/2009 wide to 8/21/2009 elbow: red, hot, ache. air loss. Headaches. 10/14/09 PC note servce dates 12/18/09 to 8/6/09. Patient's hair is falling U out. ### 5/1/2009 in rash on 8/18/09, seen in ER withYincreased rash, T - 102 degrees on 8/19/09. Started onUPREDNISIONE. 8/14/2009 Phone 8/18/2009 call from mom on 8-2 ped chickenpox 10 days after vaccine. Y Y 8/7/2009 8/14/2009 len, eyes swollen, itching all over body. Y N 8/1/2009 8/1/2009 ccine administration, patient had episode Y of going limp, eyes rolling back & difficulty breathing. Y Patient w/fever 8/21/2009 100.4 8/21/2009 at the time. Patient re reaction at site of injection. Cellulitis. (right thigh). Y 8/24/2009 8/26/2009 2 hrs after HEP B vaccine, parents reported episode of head twitching. Not seizure. Brief, lasting U seconds, 8/19/2009 alert. No 8/19/2009 further episodes that
general malaise - Temp up to 102 degrees. Y Didn't feel good, shaky, anxious, palpitations, frequent urination, fecal evacuation. Y changes with in 1-2 days. Aggressive, combative, argumentative with friends, staring off intoYspace, enough 7/9/2008 that it bothered 7/10/2008 mom. Lasted 1 HING, REDNESS AND SWELLING AT SITE OF INJECTION. ALSO EXPERIENCED DIZZINESS, Y NAUSEA, 8/27/2009 WEAKNESS, 8/29/2009 DIARRHEA AN hours of flu shot injection the injection site was red, swollen, and heated. After 24 hours, theUentire upper 8/28/2009 arm and shoulder 8/29/2009were affected omiting, throat tightness within 24 hours Y of vaccine administration. patient seen by Interbal medicine Y practive, 8/27/2009 subsequently 8/28/2009 sent to ER for e of the vaccination, she felt a burning sensation down to her wrist, daily pain with radiation of U pain down8/12/2009 back and neck. 8/12/2009 Site never got red evening of vaccination. Woke up 4am, vomiting, chills, fever. Lasted 12 hours and symptomsY subsided. No 8/31/2009 treatment9/1/2009 neccessary developed large welped, reddenedYarea from top of left deltoid extending down to mid-biceps Y area and 8/31/2009 around back9/1/2009 of arm but not circumf fter vaccine was administered she developed itching and buring around eyes and some edema. U She took 8/31/2009 2 benadryl9/1/2009 at around 17:30 and ed tonic clonic seizure as per parents Y which lasted Y 45 to 50 sec. Temperature 1 was 99.3 deg YF. Outpatient 7/20/2009 was seen7/22/2009 by neurology and exam shot in clinic around 2:00 p.m. Around 4:00 p.m. my eyes started burning and felt like I had Y sand in them9/1/2009 - by the time 9/1/2009 I got home at 5:30 p perienced wheezing and chest tightness Y 2 hours after receiving the flu vaccine 8/31/09. She has not felt8/31/2009 well since 8/31/2009 this episode began and red PENTACEL vaccine in error, Patient was supposed to receive KINRIX. No adverse reaction Y noted. Patients 9/1/2009 last Hib vaccine was 2006 Soreness of Right upper arm, 8/9/2009 Y Injection site sore with redness, 8/11/2009 increasingYredness and8/5/2009 soreness, 8/9/2009 went to Urgent Care a NJECTION IS SWOLLEN WITH REDNESS AND PAIN ALSO THE ARM FEELS HOT. Y 8/31/2009 9/1/2009 advertantly innoculated spouse 4 weeks status post vaccination. Patient admits scratching off U scab at week 7/28/2009 3 due to8/28/2009 pruritis at vaccine site. Tdap in L deltoid on 08/29/09. SheYnoted swelling at injection site on 08/29/09. Reported toYEmployee Health 8/29/2009 on 08/31/09 8/29/2009 via phone. She and redness/swelling in area where injection given. Warm to touch.Arm sore above and below Y area where 9/1/2009 injection given. 9/1/2009 ticaria after receiving DTaP and Hib vaccines. Recieved diphenhydramine prn, and urticariaYresolved after8/4/2009 one day. 8/4/2009 th pustular lesions on erythematous base beginning on lower legs and spreading below kneeUas well as few 8/6/2009 lesion on 8/29/2009 back and chest 3 wee uffered severe reactions the night he received his 9 month shots. He spiked a 103-104 Y fever N that lasted6/15/2006 3 days with6/15/2006 explosive diahrea that minutes after receiving Gardasil, patient Y syncopized Y with tonic-clonic 1movements, described an Y aura and had 8/31/2009 a brief post-ictal 8/31/2009period. She w of pruritic small papules on thighs, trunk, arms, face, beginning about two days after Varicella Y vaccine; no 8/24/2009 fever or malaise 8/26/2009 were given and we left Dr office and placed baby in car and drove away. At that time baby had Y no symptoms. 8/25/2009 When8/25/2009 we got to our destinatio ports that she had a Shingles Vaccination. Y Within Y a day, she experienced 4 suprapubic pain. YThen her diverticulosis 8/7/2009 got 8/8/2009 worse. She was ho d "headache,chills, fever of 102.7,vommitting," "light red rash on arms, chest", described as "sunburn Y like". 8/31/2009 symptoms 8/31/2009 have not completely r ped 5 painful, fever blisters on skin between nose and lips approximately 24 hrs after Zostavax Y injection.8/25/2009 She reports8/26/2009 history of herpes simp d pneumovax 9 am on 8/28/09, began Y feeling achy by 1 pm, warm in evening. By the morning N of 8/29 his 8/28/2009 temperature 8/28/2009 was 101, going to 1 veloped fever of 104 in the eveningYon 8/26/09.Y Was seen in office on 3 8/27/09 for fever. Admitted Y to hospital 8/26/2009 on 8/28/09 8/26/2009 for paleness and u veloped abdominal distension & increased frequency of apneic & bradycardic Y events requiring Y vigorous 8/11/2009 stimulation.8/11/2009 Abdominal xrays were number of apneic and bradycardic events requiring intervention (stimulation Y for same PPV xY2), increased 8/13/2009 work of breathing 8/14/2009and baseline O & redness in right arm. Y as given 0.5 mL of flu vaccine on 8-31-09. On the afternoon of 9-1-09, patient came to me with Y a red, hot to 8/3/2009 touch spot 9/1/2009 on left arm. Area is 3 u shot (told to hang around store for approximately equal to 10 minutes for signs or symptoms Y of allergic reaction). 9/2/2009 Patient 9/2/2009 and her mother veloped large rash that she described as hard, warm, slight itch and somewhat painful. Reported N to us on 8/26/2009 8/31. Patient 8/27/2009 was instructed to ta 1/09 vaccines administered. Fatigue & listlessness ensued & increased within few hours. Late Y that day &8/3/2009 into night8/31/2009 vomiting & headache 2 warmth in shoulder and spreading across Y upper torso. Also implied that she was diagnosed Uwith pneumonia 8/31/2009 as a result of vaccinations. swollen tender to touch. Y 8/28/2009 8/29/2009 usea & vomiting after GARDASIL vaccine. U 8/31/2009 red, swollen. U 8/31/2009 9/1/2009 RDASIL # 3 given as injection; approximately 5 mins later stood up; was walking out of roomYand fainted. 9/1/2009 Pt also had9/1/2009 blood drawn as well a , edema, hyperemia measuring 10 xY12 cm on deltoid area. 8/1/2009 8/1/2009 nny nose congestion sneezing feverYoff and on x 3wks. Albuterol solution 0.083%. Y 8/15/2009 8/16/2009 ay- Saturday had fever 102, headache, swelling at MENACTRA injection site with pain shoulder Y to elbow,8/28/2009 fatigue. Fever 8/29/2009 resolved Monday. NSET 9/1 at 9PM,CHILLS, THROAT Y PAIN, VOMITING TODAY 9/2. General Malaise. U 8/29/2009 9/1/2009 able since 7/01/09 noc ; decrease appetite did TYLENOL. 7 /09 2nd day after vaccine fussyYand decrease 6/30/2009 po 3rd day7/2/2009 OK 4th day after vac ministered PCV, Hep A, and DTaP on 9/1/09. Within a few hours patient noted to have hive Ylike rash on body. 9/1/2009 By 9/2/09, 9/1/2009 rash all over body es, tongue swelling, itching. Y 9/1/2009 9/1/2009 ately 1/2 hr. after receiving vaccine pt. Y developed hives. Pt. put on RONITIDINE & BENADRYL. Y 9/1/2009 9/1/2009 and swollen right arm. AUGMENTIN 87mg one twice a day, BENADRYL 25 mg one every 6 Y hrs. 8/24/2009 8/26/2009
le, US Army AD PFC, developed papular Y lesions single & in small plaques over bilateral hands U (dorsal>palmar 7/13/2009 surfaces), 8/1/2009 bilateral elbows, k ted. Was given TDAP. When nurse gave MMR she inadvertently reconstituted MMR with the Y meningococcal 8/14/2009 vaccine. Pt was checked on of joints. Stiffness of extremities. Tx: Y Steroid, anti-inflammatory. Y 8/17/2009 8/19/2009 Y 8/21/2009 8/31/2009 , vomiting, diarrhea. Negative fever. Y 8/26/2009 8/26/2009 Hep B vaccine IM @ 08:30 7/28/09Y- Presented to ED @ noon with rash, SOB, pressure to chest Y and diaphoresis. 7/28/2009 TX: 7/28/2009 BENADRYL and SO nt was febrile to 102.1 with otherwise normal vital Y signs. He had 24 2hrs of myalgia, fever, and U vauge lower 8/28/2009 abdominal9/2/2009 pain prior to presenta lips, red eyes, hives on arms, back Yof head, chest tightness. Patient took BENADRYL. Rx for prednisone8/27/2009 taper. 8/27/2009 n has been received from Y a consumer Y concerning Y a his father, a 72 0year Y old maleY patient who N "one month 7/28/2009 ago" (approximately 8/14/2009 28-JUL-200 n has been received from a physician Y and the medical assistant concerning a 19Yyear old female Y with no 8/7/2009 known drug8/7/2009 allergies who "two we n has been received from an approximately Y 25Yyear old female patient with "cysts in the ovaries N that were not a### problem",### papilloma viral in n has been received from a health care Y professional concerning a 19 year old female patientUwho on an unspecified date was vaccinated w was received from a health care professional, via another manufacturer (reference Y number WAES N 0906USA00846), 3/3/2009 3/22/2009 on 25 August 2009. T 8/9/2009 N 7/15/2009 8/9/2009 ETURNED WITH MOTHER ON 9-2-09 DUE TO C/O OF HEART BEATING FAST, DIFFICULTY Y BREATHING, 9/1/2009 TURNED 9/1/2009 GRAY IN THE FAC Influenza and PPV23 vaccines on 08-31-2009. Began to have swelling and redness at injection U site of PPV23 8/31/2009 vaccine 9/1/2009 initially and then red menactra on june 24 2009. She hadYseizure during the night bit tongue severely. Went to doctor N next day, 6/24/2009 said to watch 6/24/2009 her. She had anoth ing the child became congested and had a fever. Continued to have worsening "cold" symptoms, U but fever 8/28/2009 stopped.8/28/2009 4 days later fever of 99 iving Hepatitis A vaccine patient fainted and had some seizure activity, including eyes twitching, Y tonic-clonic 9/2/2009 movements 9/2/2009 of arms and legs a veloping symptoms approx. 4 hrs. following administration of flu vaccine. Began coughing,&Yhaving chest9/2/2009 tightness. 9/2/2009 Developed 101 tempe ed and very hot at site of shot for three Y days and very cranky, followed by abdominal pains, then U fever and 8/28/2009 felt sick to8/29/2009 her stomach on the 4t in throat, radiating to chest, coughing, Y high blood pressure (173/109). Symptons began at 4:20pm Y and continued 9/2/2009until 9/2/2009 steroid were adminis aims that she felt lightheaded after standing for 10 mins and she had to be assisted with walking. Y She also 8/13/2009 claims that 8/14/2009 after feeling lighthead was administered the Anthrax vaccine on 24 Aug at approximately 0930 am in the Left upperYarm (IM). She 8/24/2009 experienced 8/24/2009 the normal burning ticed a small red rash around the injection site on Wednesday morning 9/2/09 two days afterYshingles shot 8/31/2009 was given. 9/2/2009 The rash was red an Y Y 9/2/2009 9/3/2009 und erythromatous indurated area around injection site. U 9/1/2009 9/3/2009 nt received the flu shot on 09/01/09 Y at 1450 and withtin 15-20 minutes she started having symptoms. U The9/1/2009 patient complained 9/1/2009 of dizziness, ng on exam table. While lying on exam table she fainted and arms flailed up. Nurse called patients Y name8/31/2009 and she immediatley 8/31/2009 opened her e SWOLLEN, WARM TO TOUCH RIGHT Y DELTOID. MYALGIAS, STIFF, PAINFUL NECK AND U SHOULDERS. 9/2/2009 HEADACHE, 9/2/2009 FATIGUE AND ME PALE, WEAK AND DIZZY AFTER ADMINISTERING HPV VACCINE. PT REPORTED FEELING Y COLD 9/3/2009 AFTER ADMINISTRATION. 9/3/2009 PT ed and hot at the site, cried continuously Y for an hour or more, 4 days latter, she started throwing N up out of1/2/2009 nowhere then 1/2/2009 that night she star ceived Pneumovax injection. Had immediate swelling/pain upon arriving home. Used ice, heat, N massage, 8/12/2009 NSAID's8/12/2009 for the past 3 weeks wi edness, pain at site of vaccination. YGeneralized malaise, fatigue, body aches and pains (quite Y severe). 8/31/2009 Fevers. 9/1/2009 ME PALE, WEAK AND DIZZY AFTER ADMINISTERING HPV VACCINE. PT WAS SITTINGYAT TIME ON9/2/2009 INNOCULATION. 9/2/2009PT REPORTE Jonathan experienced a rash on his trunk and extremities with some itching. 09/02/2009 HeYstarted coughing, 8/31/2009 wheezing 9/1/2009 and has nasal con ped rash on whole body, itchy, cranky, Y and low grade fever on 8-20-2009. Saw family physician U on 8-25-2009 8/17/2009 Dx MMR 8/20/2009 vaccine reaction a re aporx 1 month after having the 2nd Y hpv vaccine. since then have been suffering from dizziness, N sometimes 7/1/2009 sore achy 9/8/2009 left arm. Weaknes patient's mother (temp not actually taken; was 97.2 orally on 8/31/09), generalized rash, lossY of appetite,8/17/2009 lethargy. 8/29/2009 Mother noticed these s/ eeks after vaccine administered, theY patient developed severe joint pain and myalgias. MostUaffected joints 7/28/2009 were knees, 8/13/2009 elbows and hands swelling warmth to L thigh, almost to knee measuring about 6x4" irregular bordered, no drainage. U Pt triaged 9/1/2009 with RN9/2/2009 appt. Enc cool paks swollen warm "band" posterior to lateral arm measuring about 3x5". No drainage. No fever,U no other s/s 8/26/2009 of illness 8/28/2009 t tricep 1 hour following shot-over the Y course of 12 hours increasing severe muscle aches inNjoints, back,8/31/2009 feet, shoulders, 9/1/2009 head,chest pains. old female came in to the clinic to and stated that has some discomfort to right arm where she Y was given8/26/2009 a shot. Also9/3/2009 stated she noticed br nt developed a headache and a swelling of the face 1.75 hours after vacc. administration (in U addition to soreness 9/3/2009of the 9/3/2009 arm). The swelling administered to left Deltoid 9/1/09, upper Y arm became swollen/red very tight and painful. Taken Y to Emergency 9/1/2009 Room 9/1/2009 by mother 9/2/09 (as c te of injection swollen red and painful per patient. Swelling extends inot axilla, U 9/1/2009 9/2/2009 7/9/2009 N 7/7/2009 7/9/2009 started within 2hrs after vaccination. Also became Y pale and lethargic0about the same time. Poor U appetite throughout 9/2/2009 the 9/2/2009 night. Brought to cl & swelling around site of injection after 24 hours 6 centimeters. VARICELLA vac only. Y 8/31/2009 9/1/2009 lls, aches, hard to move, headache. U 9/2/2009 9/2/2009
day. Itching, vomiting x 1. 7.5 cm x Y 5.0 cm mild erythema and mild induration on left arm. N 8/31/2009 9/2/2009 VARIVAX # 2 on 08/31/09, injectionYarea has become red, swollen, painful, area of erythema, Y well circumscribed, 8/31/2009 slightly 9/2/2009 warm, mild pain & h Erythemic rash with few vesicles initial and put on KEFLEX 250mg for 10 days. Y 8/24/2009 8/26/2009 esented to office on 9/1/09 at aboutY10:00 am with c/o SA; "shaking", fever. T- 102.6 ear noted., Y V x 1 in8/31/2009 office, injection 9/1/2009 sites- clear, none r soreness to left deltoid on 9/2/09, fever 101 degrees, child was very weak, tired, HA on 9/2/09, redness am 9/1/2009 of 9/3/09.9/2/2009 Area 5 1/2 cm x 5 cm d reaction to shots give on 8/31/09. KINRIX 6x9 1/2 cm red and feverish whelp in right thigh no pain. VAIRIVAX 8/31/2009 4x6cm 9/1/2009 left subq red feveris h at injection site, radiating warmth about 8 inches in diameter. Muscle weakness in legs, from U hip down.8/28/2009 Patient also 8/29/2009 had headache. /27/09 8/29/09 Urticaria swollen eyes, nose, lips. Given EPINEPHRINE 0.15 mg IM and BENADRYL U 12.5 8/27/2009 mg orally. 8/29/2009 ze hive at site of VARIVAX. No other signs or symptoms. BENADRYL given. 9/3/2009 9/3/2009 ze hive @ site of Varicella vaccine. No other signs or symptoms. BENADRYL given. 9/3/2009 9/3/2009 h all body with no SOB or wheezing pulse OX 100% BENADRYL PO every six months. Y 9/3/2009 9/3/2009 on left side of neck and then when she turned neck she developed numbness on neck that is still present.9/3/2009 9/3/2009 d syncopal episode after receiving vaccine Y and was unresponsive and hypotensive for 5 mins. Y Patient improved 9/3/2009 after9/3/2009 rest and juice. hurts, patient says can't lift arm above the shoulder. Arm throbs, no swelling. After 2 hours post U injection no 9/3/2009 swelling 9/3/2009 or redness of site - jus ed, hot area - hard to move upper arm. U 8/25/2009 8/25/2009 e seizure on 9/12/2009. Lasted approximately Y 2 minutes per mom. Eyes rolled back. ArmsYand legs jerk 8/24/2009 9/2/2009 03 degrees, stomach-ache, muscle aches. U 9/1/2009 9/3/2009 phone call from mother, concerned Ybecause son had broken out in a rash all over body about Y five hours8/31/2009 after injections 8/31/2009 received. Child aler eneralized reaction at injection site redness, Y swelling & inflammation. Pt also experienced fever, U malaise.8/28/2009 Followed up 8/30/2009 with doctor visit. Even onset of fever, chills & all-over body aches on 8/30/09, injection was given 8/28/09. Y 8/28/2009 8/30/2009 e today complaining of swelling, redness, Y pain, and itching over bilateral upper arms, where Y immunization 8/31/2009 shots were 8/31/2009 given yesterday. Pt s tions were given 8-28-09. Child presented Y on 9-1-09 with fever (104.2 Rectal), nasal congestion, Y cough 8/28/2009 and restlessness. 8/31/2009 Y 6/17/2009 orted feeling weak and unable to feel her body. Afterwards client began to fall backwards onto Y the exam table 7/1/2009 and was 7/1/2009 limp for approx. 2-3 swollen, red, and warm to touch. Y 7/27/2009 7/28/2009 n in left deltoid at approximately 11:30 Y am. Client left with no complaint after shot & went to restaurant. 4/14/2009 Mom then states 4/14/2009 child complained ction with varicella vaccine redness/blisters Y to arm. Y 8/28/2009 8/29/2009 10 mm X 8 mm red, inflamed, warm to touch. 8/31/2009 8/31/2009 e fever started last night rectal temp today was 100 given Tylenol today. Left upper thigh is 3/4 an inch diameter 9/1/2009 larger 9/1/2009 than right thigh. 5/D y or two of vaccine started having "muscle spasms almost like vibrating" seemed to notice especially Y as he 6/24/2009 would fall6/25/2009 asleep; just not himse round the injection site. Pain at injection site. Y ed area where varicella vaccine was given. Warm to the touch & tender. U 8/11/2009 8/13/2009 9- morning Pt noticed a swollen area on her left deltoid measuring 2 1/2 diameter. Y 8/28/2009 8/29/2009 m turned black/blue first night - pain Y woke me up all night worse second day - third day 7/30 upper Y arm covered 7/28/2009 w/ hives 7/28/2009 - large and in a circ erythema warmth around site of injection Y extending 4cm. 3 days later with T 100 and erythema U extending8/24/2009 distally about 6cm. -105 w/in 24hrs of receiving Y immunizations Y - fever Y above 101 for 5 days 3 unconsolable crying, U pain, diarrhea, 6/5/2009 about 56/5/2009 days. 9/14/09 Receiv e myelitis of acute onset on 8/29/09.Y VaccinesYgiven 8/12/09. DC'd from Y hospital 9/25/2009,UDC DX 323.52 8/12/2009 Myelitis8/29/2009 following immunization hrs I had a red rash at the injection site which increased in size for 7 days ending up being about Y 2" x 4".8/17/2009 2 days post 8/18/2009 injection I was placed d MMR vaccine on 8/19/09 and began Y to fill pressure, pain and developed pain behind ears.U Pt also with 8/19/2009 nodules at8/27/2009 site of pain. oid swollen, red, warm to touch (61/2 Y cm x 7 1/2 cm). Reminded father to apply ice pack Q2Uhrs for 15 min. 8/25/2009 Then warm 8/26/2009 compress @ 24 hr ening. Child had redness, pain and swelling at injection site. The next day pt had fever to 103. Y Chills, sore 8/6/2009 neck & body 8/6/2009 aches. By 818 fev ed. 9/15/09 PCP Medical records received DOS 8/12/09 to 9/8/09. Assessment: Muscle pain/Myalgia. Y Patient 8/12/2009 c/o decreased 8/25/2009movement left ema, redness to (L) lateral/posterior forearm. No fever, no SOB, received ZOSTAVAX 8/27/09. U 8/27/2009 8/28/2009 our of receiving the injection, the patient Y complained of painful arm. Within a few hours, the Yarm was swollen, 8/18/2009 more8/18/2009 painful and patient com out while in hall after receiving vaccines. Y Hit back of head- small 1/4 " laceration. Given juice Y to drink &8/31/2009 allowed to8/31/2009 recover with feet up. S sed with shingles 9-1-09. Rash left Y upper thigh. Crusted over vesicles, painful. W/L/Q & LLNback pain. ### 8/13/2009 r vaccines petechial rash neck and shoulders - resolving in 24 hr. Y 8/31/2009 8/31/2009 d redness and itching at the injection site for days following immunization and reported it to me Y 8/29/09. 8/21/2009 8/22/2009 ash beginning 2 days after ADACEL injection, treated with oral PREDNISONE and BENADRYL U 8/31/09.8/21/2009 8/23/2009 ported hive-like eruption around neck, at injection site, on thighs immediately following injection. Y Child also 8/14/2009 stated some 8/14/2009 difficulty breathing of upper arm & few vesicles at the site Y of VARIVAX administration. U 8/31/2009 9/1/2009
slight shortness of breath. Y Y 8/6/2007 on 8/28/09 along with PPD. Came into office 8/31 for reading PPD. C/o area of Td: (+) red (+) Y hot (+) hard 8/28/2009 area extending 8/29/2009 from deltoid to ba rash - 17 days post vaccination consistent Y with varicella. Y 8/10/2009 8/26/2009 12 month immunizations on 8/28/09. Y Next day Y presented to ER with4temp 103.2 and seizures. Y Was hospitalized 8/28/2009 in PICU. 8/29/2009 Treated with ATIV 8-19-09 pt c/o eye lids being swollen. 8-15-09 - 8-19-09 pt c/o tension like headache. Pt tookYTYLENOL 8/14/2009 and BENADRYL. 8/14/2009 Talked to pt on 8 a of redness surrounding injection site approx 2 inches in diameter, warm to touch, mildly sore Y & raised, 8/25/2009 no other symptoms - occurred with ss, diarrhea - 24 hours after vx given. Y 8/21/2009 8/22/2009 ccine. 8/3 = swollen lymph nodes. 8/13-8/15 Y = headaches/body aches. 8/6 = changed bandage. Y 8/7 = lesions 7/27/2009 in genital 8/3/2009 area. 8/10 = swab a n has been received from a lawyer regarding a case in litigation, which was reported in a published U article, 11/7/1996 title as stated above, concerning eived Intranasal Influenza Vaccine at approximately 3:15 PM on 9/3/2009. By approximatelyU6:00 PM on 9/3/2009. 9/3/2009 Travis' 9/3/2009 complained of hi perienced a deep aching pain in leftYarm, bad taste in mouth, body ache, fatigue on the nightUof the injection. 8/25/2009 The pain 8/25/2009 has become severe iving the Hepatitis A vaccine he left Y our clinic and was in the bathroom of the hospital. He reported Y he felt 8/28/2009 dizzy then8/28/2009 awoke on the floor fee PPER THIGH ERYTHEMA, BLOTCHY, BLANCHING RASH. NO HARDNESS, TENDERNESS Y OR WARMTH 8/31/2009 9/1/2009 ported a 2 inch area surrounding injection that is pink and slightly swollen. "Like a small raised Y knot". She9/2/2009 reports it is9/3/2009 sore and slightly war as given Day 14 HDCV 1cc IM into right Y deltoid on 8/30/09. Reports of localized redness and swelling to 8/30/2009 area. Evaluated 8/31/2009 by MD on 9/2/09 a E ONSET WAS ON 9/2/2009, CLIENT NOTED SOME REDNESS AT INJECTION SITE VERY U LITTLE SWELLING 9/1/2009 NOTED 9/2/2009 ON RIGHT DEL ceived Day 14 HDCV 1cc IM to RT deltoid Y 8/31/09. Area became red and itchy. Seen by PA Yat the Lifetime 8/31/2009 health AfterHours 9/1/2009 on 9/3/09 for lled on 09/04/09 to report moderate swelling redness with red streak from injection site to elbow U RT arm.8/31/2009 Advised patient 9/1/2009 to apply cool cloth d Shingles about 9 months after receiving Zostavax vaccine. SX: (3) 2" shingles Ylesions - pain 10/9/2007 at sites - 7/15/2008 Duration: Appx 2 mon m very swollen, red and hot to touch. So swollen ithe bandage left an indentation and a blister U came. 9/1/2009 9/1/2009 lled this am c/o pain and redness at injection site late last night after recieveing Pneumococcal Y vaccine 8/25/09@ 8/25/20091130 8/25/2009 am. after the injection my son had a tempature of 102 and we could not get it down. He was veryNmiserable and 3/12/2009 fussy and 3/13/2009 would not eat or slee white areas on fingertips and between fingers, some raised others flat, all fluid filled. Areas open N on their8/13/2009 own, drain 8/20/2009 clear fluid then dry up. A ceived Gardasil HPV vaccine. After Y receiving vaccine patient was standing and waiting to sign U in for blood9/4/2009 work when9/4/2009 she passed out, fallin vaccine at primary care physicians Y office on 9/02/09. Y Presented to 6 Hospital on 9/04/09 with Ufever and leukocytosis. 9/2/2009 9/3/2009 Infectious disease phy Tdap on 8/28/09. Reports the areaYwhere the vaccine was administered was red, swollen, and U warm to 8/28/2009 touch all weekend. 8/29/2009He also compl ng following FLUMIST (Flumist not Y an option as a vaccination in #13). Y 9/3/2009 9/3/2009 Tdap and Hepatitis A vaccination on Y 8/27/09, patient started losing his auditory processing ability. U He answered 8/27/2009all8/27/2009 questions with a standa d pustules/papules different sizes, stages on head, chest, arms, legs, trunk and diaper area. Y 5/27/2009 8/31/2009 6 times a day for 2 weeks Y 6/25/2009 6/27/2009 #1, Hep A #1, Menactra and flu given Y 10/5/07. Patient seen 5/12/08 and reported vomiting several N times10/5/2007 a week since thanksgiving ### (about N 2.5-3 INCH DIAMETER, REDNESS AT SITE, ITCHING SUBSIDED AFTER 9/3, STILL REDNESS N AND 9/2/2009 HARD "BUMP" 9/3/2009 AT SITE tes that his daughter became ill theYnext day after vaccination. Within 24 hours he was nauseated U and dizzy. 9/1/2009 She has 9/1/2009 what is called migrat ceived Flulaval Vaccine IM on 9-3-09. Pt experienced soreness at injection and a "knot" developed U almost9/3/2009 immediately. 9/3/2009 24 hours later, pt. r dministered 8/19/09 at 09:05am. Patient reported back to nurse approximately 10-15 minutes Y later complaining 8/19/2009 of feeling 8/19/2009 hot and red. The a vaccine received this morning has made me very sick. The pain at the injection site is severe and similar 9/4/2009 to the pain 9/4/2009 I had when receiving arted to feel numbness in arm down to her hands approximately 2 hours after recieving vaccine U in her left8/31/2009 arm which8/31/2009 lasted for few hours. A 8/19/2009 N 6/22/2009 6/23/2009 was reported by a physician and described Y the occurrence of joint pain in a 39-year-old female Y subject who 8/17/2009 was vaccinated 8/18/2009with BOOSTR turned to office on 9/2/09 at 2:52pm.Y Swelling around injection site and previous surgery scars. Y Pt. also complained 9/2/2009 of9/2/2009 itching on hands and me in to office on 9/2/09. Patient received Y DTaP and Varicella in right thigh and MMR and Polio Y in left thigh. 9/2/2009 On 9/3/09 9/3/2009 patient returned to o local), pain, fever. Husband is a physician. Monitored condition. Lasted 3 days. Y 7/23/2009 7/23/2009 ction (R) arm, red, swollen & itchy. Slight fever x2 days. Tx: Ice, TYLENOL and BENADRYL. YF/u in office8/29/2009 PRN. 8/29/2009 at 3AM on 9/2/09 & felt very weak then Y developed fever up to 101.5, bad headache, vomiting, Y light sensitivity, 9/1/2009 4-5 hours 9/2/2009 later. R arm pain a n 8/25/09. Taken to ER on 9/2/09 with Y high fever (103.5) and febrile seizure. Child had convulsions, Y stopped 8/25/2009 breathing 9/2/2009 and turned blue. t reports pt fainted while at band practice at school approx. 3 1/2 hrs after immunizations were Y given. 9/3/2009 9/3/2009 ains of pain and swelling in hands and feet. Both vaccination sites still warm to touch. 9/9/09 USpoke with pt9/1/2009 who did not 9/3/2009 see any treating MD ved vaccine on Friday 9-4-2009. Injection site became swollen and dark, came back to pharmacy U to have 9/4/2009 other family9/4/2009 member to get immu lled in. Itchy rash to upper back & shoulders. States no SUA or any other sx. Rash does not go past mid back 9/6/2009 or above 9/7/2009 shoulders or on arm ceived vaccines (FLUVIRIN & PNEUMOVAX) on 9/3/09 at 130pm. FLUVIRIN in right arm, and U PNEUMOVAX 9/3/2009 in left arm. 9/3/2009 I advised her that er FLUVIRIN administered patient complained Y of dizziness, shaking & pallor. BP taken at 87/59. U Patient informed 9/4/2009us9/4/2009 at this point of previou
after receiving PNEUMOVAX and FLUVIRIN, pt. complained of hotness all over & tingling on Y her tongue.9/1/2009 EMS were9/1/2009 dispatched. BP & puls f soreness in the whole arm but mostly from elbow to the wrist, slightly itchy, looks like sunburn Y but not hives. 9/4/2009 Advised9/4/2009 to use cold compress o pharmacy states she woke up today Y with rash on the body (trunk). Consult pt to take 2 BENADRYL U and9/4/2009 contact or seek 9/6/2009 medical attention had vaccine injected was swollen & painful. Pt. had fever and some heavy breathing. Pt took Y some TYLENOL 9/2/2009 and BENADRYL 9/2/2009 and got be n receive influenza, pneumococcal Y vaccine. 9/3 nauseated, achy. Thursday pm - redness (L)Uupper arm. 9/5 9/2/2009 seen here 9/3/2009 large cellulitis. ed rash now itching at injection site. Y 9/1/2009 9/3/2009 at injection site - swelling from injection site, down arm almost to elbow, arm is tender & hot to U the touch. Patient 9/3/2009 advised 9/5/2009 to seek medical ca warm. Aches - all over especially neck, Y jaw. U 9/4/2009 9/4/2009 ped chicken pox after having 2 varicella vaccines. U 12/5/2006 9/4/2009 peared okay after flu vaccine was administered. Y About 10 minutes after vaccine administered, U he complained 9/4/2009 of pain9/4/2009 in the arm, abdomen red vaccine at 1:15pm on 9-3-09. Symptoms were reported at 6:00pm. Red face going downUneck splotchy 9/3/2009 rash, flushed 9/3/2009 feeling. Skin hot to eceived vaccines shortly after got nauseated, Y warm. Dizzy - laid in supine position. Ice to back Y of neck. BP 9/3/2009 (L) arm sitting 9/3/2009 104/60 pulse 60 s r vaccine had area at site of vaccine administration that measured 5cm in diameter and wasYred, raised, warm 9/2/2009 and painful. 9/3/2009 & eyes after vaccine - sneezed for hrs. eye swollen. No wheezing. U 8/31/2009 9/1/2009 ARIVAX was given (subcutaneous) was Y hot to touch, swollen, red, and itchy. She was put onYXYZAL every 8/31/2009 day. 9/1/2009 ted with large red area surrounding Y injection site. Varicella vaccine given 9/1/2009 in (L) deltoid. U No fever.9/1/2009 Other vitals9/2/2009 stable. Pt started on Y U 9/1/2009 9/1/2009 d vaccines on 8/31/09. Patient returned Y to office on 9/2/09. Patient's right arm swollen and tender Y to touch. 8/31/2009 Feverish 9/2/2009 around injection site. "dent" on his upper arm - the area where Y he was shot with vaccine. The skin has discoloration. U The affected 6/25/2009 area is 7/19/2009 about 2 inches long. He d immunization 8/27, 8/30 started to swell at mid/upper thigh swollen, blotchy, warm to touchYto (R) upper 8/27/2009 knee. Size 8/30/2009 of swelling is almost d e fever. Multiple bumps bilateral legs & arms. Y ### 9/3/2009 8 hours ago - got 3 shots GARDASIL, VARICELLA, MENACTRA. 9/3/2009 9/4/2009 r induration 2-3 cm X 3-4 days comfort measure. Advil - resolution of symptoms. Y 9/1/2004 9/3/2009 hat was very sore on 9-3-09 (day after administration). The muscle under the site of injectionY on (L) arm is9/2/2009 the size of9/3/2009 a baseball with swelli as ordered to get meningococcal on 8/14/09 and nurse gave pneumococcal. Y 8/14/2009 Y 9/2/2009 9/2/2009 eving the Gardasil vaccine, about 3-4 Y ours later she had severe abdominal pain that did not stop. Y I gave her 8/4/2008 motrin but 8/4/2008 it didnt help. After sh rom ankles to knees, worse at 12 hours post injection, now improved but still an issue for patient. U 9/2/2009 9/3/2009 mately 9:00 pm, my left arm began to ache. I went to bed about 10:30 pm and awoke aboutY12:00 am with 9/1/2009 my left arm, 9/1/2009 left shoulder and le Administered 08/26/09. He started having Y high fever on 09/01/09. He began to become extremely U fussy 8/26/2009 and some nausea. 9/1/2009 Fever continued ritability for 6 days. chronic low grade Y fever continues at this time. N 8/27/2009 8/27/2009 ollen,stiff and really red at the injection site 9/4/2009 9/4/2009 er redness and now has a bump the size of a dime on her right arm. U 8/28/2009 8/29/2009 or injection became inflamed and swolen within an area of 2.5 inches in circumfernce. The area Y was noticably 9/3/2009 re and 9/3/2009 enlarged. The injectio ter was adminstered GARDASIL (I cannot find it in your list of vaccines below/ Ch.-B.: Y NE51780, N NE51790, 1/14/2008 NF56940) 7/15/2008 on May 5, 2007, July after receiving Zostavax vaccine I had swelling and fever in my arm at injection site. 6 days after Y receiving 8/31/2009 it my chest9/1/2009 broke out in little bum a shot given while patient at osu. site Y where shot given hot red painfull and very swollen. Growing bigger every 9/3/2009 day. On 9/4/2009 3rd day body aches 4 HOURS PATIENT DEVELOPED Y SEVERE EMESIS AND DIARRHEA WITH A HIGH GRADE U FEVER OVER 9/1/2009 105F.9/2/2009 PATIENT WENT TO D reathing. Rapid Heart Rate. Y 9/9/09 Y ER records received DOS 9/4/09. Assessment: Atrial flutter Y with rapid 9/1/2009 ventricular 9/3/2009 rate and cardioversion pneumovax and influenza at 11:40am on Sept 5. By 9pm had sore arm. Next day, awoke with U redness spreading 9/5/2009over 9/5/2009 entire deltoid area o A AND FEVER BEGINNING 48 HOURS AFTER VACCINATIONS AND CONTINUING FORUMORE THAN9/2/2009 72 HOURS; 9/4/2009 pain, extreme swelling & bruising atYinjection site. Headache, fatigue, chills & sweats on 8/30/09. Y By that8/29/2009 evening and 8/30/2009 into 8/31/09, fast hea red 8/11/09 for pre-employment. Last Td vaccine received 2005. First time receiving Tdap. Approximately Y 8/11/2009 6 cm x 4 8/12/2009 cm red area at injection oned the pharmacy to complain of injection site reaction on 09/06/2009. I was not in so the U pharmacist on 9/3/2009 duty instructed 9/6/2009 the patient to ca accinations administered @ 4:30 p.m. Y 9/2/2009, was taken by ambulance to Hospital, @ 7:00 Y am on 29/3/2009. 9/2/2009Diagnoses, 9/3/2009 seizure. 10/7/ us behavior, tantrums, regression incontinence when previously potty trained,bowel pain,lossNof functional5/5/2008 language, 5/5/2008 ic pain (tingling, numbness, shooting pain in arms, hands, legs, and feet; some facial nerve U sensations);8/31/2009 started with 9/2/2009 numbness in feet on 9 n has been received from a physician Y via medical Y records concerning 5 a 7 day old male who N on 06-NOV-2008 11/6/2008 was vaccinated 11/7/2008 with a first do n has been received from an 18 year old healthy female who on 13-OCT-2008 was vaccinated Y with the first 10/7/2008 dose of10/7/2008 GARDASIL (Lot # 6603 n has been received from a nurse inY the physician's office concerning a female patient who on U 14-JUL-2009 7/14/2009 was vaccinated 8/31/2009with the secon n has been received from a 24 yearYold femaleYwith family history of1blood clots, her grandmother Y and mother 6/1/2009 were factor 7/6/2009 5, and no drug re
n has been received from a office nurse concerning a 15 year old female. The nurse reported U that the patient who was not a patient of the n has been received from Y a health professional Y Yconcerning an 18 year 1 old female patient who U in January 1/1/2009 2009, was vaccinated 4/1/2009 with a dose n has been received from a case inYlitigation concerning an approximately 6 month old female U who on 26-MAR-2001 3/26/2001 3/28/2001 was vaccinated with a n has been received from a consumer Y concerning Y her son with allergies 0 to wheat, dairy, eggs Y and nuts who was vaccinated with the secon n has been received from a registered nurse concerning a physician who in 2001 was vaccinated U with VARIVAX (Merck) (Lot number was urting and then swelling. Pain is deep in arm and hurts from shoulder to elbow. 9/1/2009 9/2/2009 chest pain, SOB, cough -Y2/09. CT chest Y 2/11/09 Y - R pulmonary artery 6 occlusion secondary to N massive PE. 2/11/2008 2/12/09 R 2/11/2009 atriotomy removal of R U tness - monitored a little lightheaded. Y 9/8/2009 9/8/2009 swelling, redness and induration of the entire leg (upper) in which vaccine was given, Right U leg. 9/1/2009 9/2/2009 d severe and prolonged allergic rash/hives Y required multiple office visits/medication. Y 8/28/2009 9/1/2009 d Cellulitis after MENACTRA vaccineY administration (at injection site). 8/31/2009 9/1/2009 Y Y 9/3/2009 9/3/2009 dministered 8/27/2009, On 9/7, developed calf pain, refusal to walk, and then rash. Seen in U clinic with typical 8/27/2009 rash of Henoch Schonlein Pu tion 9-1-09 and on 9-2-09 mother noted non-vesicular rash on neck and itching. Left arm andYshoulder are9/1/2009 red and warm 9/2/2009 to touch today (9ed swelling to L thigh from injection Y site to knee. Skin warm; mottled ant. thigh, back of thigh nl. 9/3/2009 9/3/2009 aneous nodule noted approx 4cm x 4cm sl. erythema. Y 8/18/2009 8/21/2009 mplained of dizziness, lightheadedness, blurred vision and numbness of face 20 minutes following Y immunization. 9/1/2009 Patient 9/1/2009 sat down with he ated that on Saturday (8-29-09) sheYfelt fever, chills, swelling and pain from her left arm to her U left arm pit, 8/28/2009 seen by doctor 8/29/2009 - Cephalexin 500m ven GARDASIL and ADACEL 100m /office approximately 10 minutes after injection, was found Y outside the9/1/2009 building by9/1/2009 police. Had syncope. en on 8-10-09. Mom noticed redness Y down to elbow on left deltoid and swelling beginning inYam, increasing 8/10/2009 swelling8/11/2009 through out the day. edema induration is warmth X 3 days after vaccines - OTC SX relief. Y 8/28/2009 8/29/2009 pt arms and legs retracted, unable to Y stand pupils dilated, rapid breathing, pulse 92 @ 12:55Ypm. Started 8/10/2009 he was having 8/10/2009 difficulty breathing or arm reddened. Y 9 on right arm injection site developed a rectangular red, slightly raised area 1" X 2". The area U itches and 8/12/2009 is warm to 8/17/2009 touch. Advised to con h started on lower buttock and spread to belly and back and by 8/12/09 was also on both legs U thigh area7/29/2009 both legs. Today 8/9/2009 8/14/09 rash rem eyes and lips, and all over the body.YAnd can walk. And it come and go. On this day is starting. N 1/31/2008 2/7/2008 agreed to receive the HEPATITIS B vaccine in HEPATIITIS B Vaccination Program. 7/10/2009 Y 10:00 am 7/10/2009 Employee 7/10/2009 received the HEPATI p 9/1 - clingy, didn't eat, listless, spacey, low grade temp. Knew sister's name but couldn't remember Y her8/31/2009 brother's name 9/1/2009 morning & afterno d type 1 diabetes. 9/16/09 MR received from PCP. Initially presented 2/1/08 withYc/o increased N thrist and8/19/2003 elevated BS. 1/1/2008 DX: Latent autoimm vaccination, arm sore, muscles sore. Y Next morning felt warm, fatigue, nausea, headache. Y Took Motrin. 9/2/2009 Taken to ER 9/2/2009 in evening. Flu test es after varicella vaccine was administered Y patient broke out in total body hives, had severe Y itching and mild 8/6/2009 expiratory 8/6/2009 wheezes but in no r RSE EVENTS NOTED AT TIME OF COMPLETING THIS FORM. Patient was given 0.5ml ofY Fluzone on 9/2/2009 26-Aug-2009 and then again on 0 warmth, swelling, left deltoid. Streaking noted approximately 2 inches from site, extending 1Uinch. 9/3/2009 9/3/2009 c'd T/C from MGM, advised client developed enlarged node Left side of her neck,close to the N clavicle on8/11/2009 8-21-09. States 8/21/2009 client has been ve ed vaccine on 8/17/09 11:28. Pt. returned to clinic (where she received vaccine) @ 7:30pm 8/17/09. Y THe 8/17/2009 following 8/17/2009 is note left in chart by F and itchiness at injection site. Within 48 hours, swelling and redness had grown to a 3" diameter Y and patient 9/2/2009 became 9/4/2009 achy and sick feeling. , difficulty breathing, chest and throat Y tightness, Y 9/2/2009 9/2/2009 p 3days post flu mist administrationYwith Pells Palsy. Left side of face was affected. Received Y treatment with steroid ### through ###civilian provide as administered Pneumovax on 9/2/09. On 9/4/09, patient presented to the pharmacy with cellulitis Y around 9/2/2009 the site of9/4/2009 injection. She had vi reddened area left anterior thigh, afebrile, Y Orapred 3tsp. in officethen 11/2tsp. daily for 4 days. Y Recommend 8/21/2009 cool compresses 8/22/2009 and Motrin f ported low grade fever, aching all over, "just like I was getting flu" about 24 h after admin lasting Y for 12-16h9/6/2009 relieved with 9/7/2009 ibuprofen d rash 3 days after recieving MMR vaccine Y 9/1/2009 9/4/2009 m at inj. site became swollen, red, itchy. Pt. also had hives on his face & neck, (about 20). U 9/4/2009 9/5/2009 t vaccine site. Seen at ER. Given 10 Y days of Keflex. Y 9/4/2009 9/5/2009 CHING, BLEEDING AT INJECTION SITE. Y 8/25/2009 8/25/2009 ted to facility after recieving the Pneumovax Vaccine at the medical clinic, prescribed by Dr. with U pain, redness, 9/4/2009 swelling 9/6/2009 at injection site. Dr sodes on significant crying and apnea. Y Pt also Yexperienced difficulty1 feeding so he was admitted Y for observation 9/1/2009 overnight. 9/1/2009 9/25/09 Medica dministered about 5:30 PM. Phone call at 7 PM stating edema in left arm from elbow to fingers. U Some mild 9/8/2009 pain in fingers 9/8/2009 (had to remove scribed "pain in arm with striations."YPatient was diagnosed with Pneumonia on 9/07/09. U 9/5/2009 9/8/2009 e, dizziness and shortness of breathYfollowing vaccine, then left sided numbness to ear, face,Uhand and arm 8/31/2009 x 1 week. 8/31/2009
ma-like" attack, body aches, chills, "violent Y coughing", says lungs felt like they were on fire. Y 9/3/2009 9/3/2009 nced "heart racing" followed by "jittery/nervous felling". Pt took alprazolam, which helped calmed Y her and9/7/2009 heart. Symptoms 9/7/2009 returned next m cm raised erythematous dermatitis over right deltoid. Treatment: BANADRYL elixir. Y 8/31/2009 9/1/2009 muscle joint pain, fatigue, nausea. States Y reaction 4-5 days post vaccine x 5 years. Onset within Y hours after 8/24/2009 flu vaccine. 8/25/2009 ived vaccine on 9/1/09. At 1:30 am 9/2/09 child had "throat closing, audible wheezing and difficulty Y breathing. 9/1/2009 Benadryl 9/2/2009 given & symptoms ported sharp pain in left arm 30 min after injection. She took OTC pain tabs and used an ice Y pack. Pain started 9/7/2009 to go 9/7/2009 away 15 to 20 min. lat and pain in upper deltoid area upper Y arm above elbow and trunk. 8/31/2009 9/3/2009 s after patient received injection she stated that the area where she was injected itched a little Y bit. We had 9/8/2009 her wait another 9/8/2009 5 minutes or so ss of appetite, fatigue, vague weakness Y of joints, anxiety. U 8/26/2009 8/29/2009 ss, wheezing, weakness, difficulty breathing. Y Sent employee to medical center for evaluation. Y TX with steroids. 9/4/2009 9/4/2009 ped hives 1 day later on inner elbows of both arms. They are currently fading. Pt did not seek Y medical tx & took no medications. aised silver-dollar sized area aroundYinjection site with 2 finger size striations on arm + 1 into N side of neck. 9/2/2009 Sore to the9/3/2009 touch. d serum sickness with hives, fever. Y 8/17/2009 8/20/2009 m area of redness & swelling at site of injection of VARIVAX. Y visit on 1/23/09, child had single words and could point to indicate wants. No animal Y names or N noises. Rec. 1/23/2009 increased 2/23/2009 reading to child. MMR ort was received 10 August 2009 from Y a health care professional. A 14-year-old male patientYhad received8/6/2009 a first dose8/8/2009 right arm injection of adache, injection site pain 8/13/2009 8/14/2009 rmation received on 18 August 2009Yfrom health care professional. A 17 to 18 years old female N patient received 8/14/2009 MENACTRA 8/15/2009(lot number u ort was received 20 August 2009 from Y a health care professional, who is also the patient's parent. A 17-year-old 8/18/2009 female 8/19/2009 patient with no conc ate schedule of vaccine administered. Initial information received on 25 August 2009 from aNhealth care8/19/2009 professional. A male patient with was reported by a healthcare professional and described the occurrence of vomiting in a 2-month-old Y male 5/20/2009 subject 5/21/2009 who was vaccinated wi was reported by a healthcare professional and described the occurrence of vomiting in a 4-month-old U male 8/27/2009 subject 8/27/2009 (reported as less than 2 ported that he had not receive Pneumo vaccine in the past. Patient received Flu vaccine (left Y arm) and Pneumo 9/4/2009 vaccine 9/4/2009 (right arm) on Frid 9/2/2009 9/4/2009 eared within 6 hours of vaccine admin. Responded to BENADRYL liquid but continued to recur Y for 48-72h. 9/4/2009 1 episode 9/4/2009 of tightness in chest n has been received from a physician Y concerning a 64 year old male anesthesiologist who on Y an unspecified 9/17/2008 date was 9/17/2008 vaccinated with a do n has been received from a health professional Y concerning a 5 year old male student with a U delayed delivery 8/22/2009 who on 8/27/2009 27-AUG-2009 at 10:0 n has been received from a physician Y concerning a 65 year old male with no significant Y medical N history who 8/8/2009 on 08-AUG-2009 8/9/2009 was vaccinat n has been received from a physician Y concerning Y a patient "who just0 came out of hospital received U series of three PNEUMOVAX vaccines n has been received from a registered nurse certificated concerning a 22 year old female patient Y with no9/19/2008 significant past medical ### history an n has been received from a physician concerning a 17 year old female who was Y vaccinated N with a dose of3/6/2008 GARDASIL. Two years ago, the n has been received from a health professionalYconcerning a 28 year old female who on 28-AUG-2007 U was 2/25/2008 vaccinated with the first dose o had scratchy throat, coughing, Y the symptoms Y went Y to thrush, fever, high 6 blood pressure, loss/slurred U speech, loss ###of appetite, ### fatigue. I saw ts given PENTACEL, MMR, PREVNAR, Y Hep A,YHep B, Varicella. 1915 1 parent stated child, limp, Y rash, convulsions, 9/2/2009 low 9/2/2009 temperature. 2000 c after 4 month check, presented to office with unusual Y movements for 4 several days. Y Quickly U recognized 9/19/2008 as infantile 9/19/2008 spasms in the office. Ad and bruising at injection site. Pt was shaking. Y 9/2/2009 9/2/2009 his AM for flu vaccination. Approximately Y 2 hrs later (12 noon), pt developed persistent coughing, U no wheezy, 8/28/2009 dyspnea, 8/28/2009 truritis, mucose sw p day after injections with small red nodule at site of injection, was sent to school and when Y arrived home, 8/27/2009 area had8/28/2009 gotten bigger with mult ght in 2 children for vaccines - baskets/containers were side by side - 5 yr old was kicking & Yfighting - grabbed 9/1/2009 the wrong 9/1/2009 basket & administ P fever 101.7 temp. TYLENOL alt. after Ibuprofen per Dr. 9-2-09 no fever. Y 9/1/2009 9/1/2009 30 PM fever 100.9 temp - very quiet - decreased activity - TYLENOL alt. with Ibuprofen per Dr. Y 9-2-09 no 9/1/2009 fever - Sx's9/1/2009 resolved. ed urticaria 6 days after receiving vaccines Y Tx - BENADRYL 25-50mg every 6 hours prn. U 8/26/2009 9/1/2009 after administration of ZOSTAVAX, I developed burning sensations in skin on left side of back N extending4/18/2008 into left breast, 5/15/2009 including sharp bu rted hives over entire body on 8-28-09 which lasted until 9-2-09. No fever. States child seemed Y more tired 8/18/2009 then usual 8/28/2009 on day before hives MMR administered approx 48 hrs ago. 24 hrs ago upper left arm red & swollen now 2x2 inch erythema, Y no 8/24/2009 fever child8/25/2009 active & playful. 2-3 days (102.0). - Alternate TYLENOL/MOTRIN. - Swelling to injection site. - Push fluids. -Headache Y x 28/25/2009 days. - Vomiting 8/26/2009 x 1-2 days. U 8/24/2009 seizures and developmental delays. Onset Feb. -12, 2001 9 months after vaccine.Y 10/6/09 PCP N medical records, 5/2/2000neurology 2/12/2001 consult, service nd swelling up left arm, itchy / redness of eyes. Pt given Benadryl 25mg Po 9/3/09 at 1430. Y 9/2/2009 9/3/2009 came in this morning c/o hard, red Yswelling on arm at the site of injection from 2 days ago. Pt Y says it started 8/25/2009 yesterday 8/26/2009 morning, getting wo ates fever of 101 degrees X 3 days beginning 09-01-09. Also states woke up 2 X on 09-01-09 Y stating "can't 9/1/2009 breathe".9/1/2009 Did not take to PMD
Tues evening using ice packs. Worse on Wed swelling. Same on Thurs. Redness worse andNpuffing on Fri. 9/1/2009 Y 8/17/2009 8/17/2009 on received his booster shot for chicken Y pox, within 6 months he had got shingles. He also ran Y a high temp. 3/12/2009 with the 7/6/2009 shingles..... and inflammation at the injection site. Itching patient is going to apply ice and take antihistamine. U 8/29/2009 8/30/2009 @ 7:30 pm - lower right thigh red - dime Y size, upper right thigh slightly red, low grade fever, pain 9-1-09 PREVENAR 8/31/2009 8/31/2009 @ 7 am - red, nickel siz Syncope immediately following vaccine. Y Recurred again within 24 hrs. Flushed, nausea, dizzyY when standing 9/2/2009 with orthostatic 9/3/2009BP changes. N d fever to 103. Painful swelling of arm. The vaccine was given in H.A., arthralgias, nausea. UNo rash no oropharyngeal 9/1/2009 9/1/2009 swelling. No dyspn nted after administering HPV vaccine for about 1-2 mins. Vital sysm. stable. Mom witnessed Y some arching 9/1/2009 moves. 9/1/2009 Blood pressure WNL w , red, swollen, warm to the touch area Y on L upper arm. Advised BENADRYL, warm compresses N and monitoring. 9/1/2009 9/1/2009 veloped dizziness after administration of GARDASIL (2nd dose). Y 9/2/2009 9/2/2009 allergic reaction. Y Y 9/3/2009 9/3/2009 breathing, rash development, dizziness. Y U 9/2/2009 9/3/2009 ined of left arm swelling / red/ warmYto touch at injection site that measured 18cm x 12cm onY8/26/09. Pt8/24/2009 given Benadryl, 8/26/2009 Motrin and ice. Y 7/27/2009 7/27/2009 mins of receiving flu shot, patient experienced nausea and dizziness. Symptoms lasted a fewYminutes & Patient 9/2/2009 was able 9/2/2009 to walk out. 3/3/2009 3/5/2009 Mild Fever). 8-30-09 & 8-31-09-(Chills & Fever oF 102.5 on & oFF). 9-01-09-Redness on armNcovered all8/29/2009 of arm above 8/29/2009 elbow-9-1-09 saw D episode immediately following vaccine administration. Patient was seated, no fall sustained.YBlood pressure 9/1/2009 dropped9/1/2009 to 76/48, recovered to chronic headaches 21/2 month following HPV #2 Diagnostic w/u (-). N ### scles are sore. My back hurts. I feel "stiff" all over. N 8/27/2009 8/27/2009 ain @ injection site within 2-3 hours of injection lasting 16-18 hrs. Followed by all over body ache Y & extreme 8/27/2009 fatigue.8/27/2009 & Redness 8-6-09 R arm. Y Y 8/5/2009 8/6/2009 Wed 8/26/09 fever next day. Friday - rash, splotches 3-4" across, worse, chills spreading. Saturday Y & Sunday 8/26/2009 - hives 8/28/2009 upset stomach Satur the face, swelling of lips; then 25mg diphenhydramine IV was administered. When no relief,Yand additional 8/28/2009 itching of 8/28/2009 throat, famotidine 20m fter administration of Gardisil, patient Y developed severe chickenpox. 1 week of fever, 3 weeks Y of rash. Patient 7/9/2009 still 7/23/2009 has severe scarring of f er MMR shot, Patient stopped sleeping Y and complained of sore stomach. First week, Y major behavior N change. 8/21/2009 On day 8/22/2009 10, patient's eyes got d welts around injection site. Approx 1x2cm in size. Y 9/2/2009 9/3/2009 at about 3:50pm at the waiting area after blood drawn and vaccination, she felt dizzy then passed Y out for 9/5/2009 less than 19/5/2009 min. Code blue was c lling, lump on arm at injection site. Y Y 8/27/2009 8/27/2009 N NOTED POST VACCINATION HANDS RED AND ITCHING Y 9/2/2009 9/2/2009 iving vaccine, pt states her entire upper arm swelled and she was not able to move arm all weekend. Y The 9/4/2009 under arm region also broke out i ported 1 day following vaccination (8/12/09), child's arm (from Shoulder and to just above elbow) Y increased 8/12/2009 redness, warmth to touch, and h reported progressively worsening throat Y tightness after receiving flu vaccine. Vaccine received Y at approximately 9/8/200912:30pm 9/8/2009 on 9/8/09. Soug ed a few days after receiving Tdap &Y Varicella in the left arm and MMR and Hep B in the right Y arm two lymph 4/14/2009 nodes in the left side of her ne arm was very swollen, red rash, appearance Y of cellulitis, and required medical attention. Pt Ywas given vaccine 7/29/2009 on day 7/30/2009 of discharge (7/29). ERYTHEMA ON UPPER LEFT ARM APPROX. 3 CM IN DIAMETER WITH MILD INDURATION. Y NO PUSTULE. 8/31/2009MOM 9/2/2009 NOTICED AREA O Tdap & MCV4 9/8/2009 @ approx 1500. Per mother child "Went to bed @ approx 2130 withY c/o sore arms. 9/8/2009 Woke up 9/9/2009 @ approx 0200-030 minutes of vaccination, Pt c/o dizziness. Dropped to the ground and tapped head on side of plastic Y chair. Instantly 9/5/2009recovered. 9/5/2009Drank water & welling- inflammation around site- 5" long. Right arm- 4" wide and 3" long swelling and inflammation Y and8/26/2009 tenderness. 8/27/2009 ent's mother, he started complaining that his left arm was in pain from the moment he received U the shots,8/26/2009 and that he 8/26/2009 could not move it bec the seasonal flu shot around 4 p.m. I woke up the next morning very itchy and developed hives Y all over my 9/4/2009 body. I took 9/5/2009 Benadryl every 4 vere crying and localized Redness toY the left thigh. Reaction lasted several hours. Pt was given Y Zyrtec and9/8/2009 Decadron 9/8/2009 IM. site when arm moved up high U 8/29/2009 8/29/2009 alized swelling, urticaria (generalized) Y within two or three minutes of vaccine. 1 tsp children'sYbenedryl given 9/1/2009 at the time, 9/1/2009 patient was monito e was no pain when shot was given, the next day there was a lot of pain in the arm at the injection U location. 9/8/2009 9/9/2009 d fever 103 2 days after vaccination . resolved without any sequelae Y 9/4/2009 9/6/2009 redness(softball size), swollen, itchy, Y warm to the touch, sore started on 9-5-09. Pt used benadryl U and calamine 9/3/2009lotion 9/5/2009 starting on 9-6-09 er receiving his scheduled 2 month Y shots, DTaP, Y Hep B, Hib, Polio, 8and Prevnar, patient began U having seizures. 7/25/2006After 7/27/2006 numerous tests, blo LAINED OF HER THROAT FEELING LIKE IT IS ON "FIRE". 9/9/2009 9/9/2009 ndrome. Autoimmune hemolitic Y anemia Y + idiopathic Y thrombocytopenic 10 Ypurpura. Coombs positive U (warm Ab). 3/17/2008 Hb=6 & plts. 20,000. ### Differenti ax 100.6 within 12 hrs of administration responding to tylenol diarrhea, vomiting within 24hrsU 9/8/2009 9/9/2009
Difficulty, body ache, chills apprx 36 hours. U 9/1/2009 9/2/2009 ild redness on Saturday. Each day Y noted progression down arm further, no fever, redness noticed Y on inside 9/2/2009 of bicep 9/5/2009 down to elbow area, w D, SWOLLEN AREA FROM SHOULDER Y TO BELOW DELTOID MUSCLE. SEEN BY PHYSICIAN Y 9/9/09.9/8/2009 ENCOURAGED 9/8/2009TO DO ICE CO fter vaccination pt. developed 5 red Ypatches on chest and back. Maximum size 3 cm. MD noted Y central7/15/2009 flat erythemtous 8/9/2009 area surrounded b , induration and warmth over right deltoid area, approximately 6cm diameter. U 9/2/2009 9/4/2009 ntense myalgias, fever, diarrhea Y 8/10/2009 8/19/2009 ite red & hot inflammation grew in size over 6 days to 9cm x 6cm, and is still present. We took N digital photos 9/3/2009 in case you 9/3/2009 want sent for stud ed the expected redness, swelling, etc. About four days later, as swelling was subsiding, the deltoid muscle 8/31/2009 in the upper 9/1/2009 arm began to exp d KINRIX IM and Varicella Subq in R arm and MMR in L arm. Was sitting in childrens chair waiting Y while sibling 9/8/2009 got shots. 9/8/2009 Pat fall to floor a d w/ juvenile rheumatoid arthritis 1/09. Symptoms have been progressive since 2007. Also has U asthma, scoliosis 3/13/2008 and5/3/2008 migraine HA. 9/25/09 e numbness *Sx's gone @ 2pm L arm numbness/tingling in fingertips tongue- numbness. Going Y away after 9/8/2009 20 min of9/8/2009 report. RICELLA vesicles symptoms started 8/29/09. Treatment supportive - over the counter medications. Y 8/19/2009 8/29/2009 ensation heavily on tongue and face, Y also all over body. Body feels warm, with no sweating.Y Metal taste8/31/2009 in mouth. 8/31/2009 almost immediately became fussy and then had a fever for 24 hrs reaching 104. I had called Y the clinic they8/4/2009 suggest ER 8/4/2009 but I knew to alterna st inj pt had large localized inflammation Y redness, swelling, heat. Spread to elbow. Day 5 pt went Y to urgent8/8/2009 care; suspected 8/10/2009 infection howev U 8/24/2009 8/24/2009 cold" with intermittent congestion, sinus drains age, head aching beginning 7/13; on 7/25 "stayed in bed all 6/8/2009 day "and frequent diarrhea, sam Lethargic after 5 minutes following Y the administration of flu shot. Paramedics arrived 15 minutes Y later. Checked 9/2/2009 the BP 9/2/2009 it was 9?/6?. Was r after immunization (flu) c/o itching all over body. 11:30 am self-medicated - Benadryl 50 mg. Y Symptoms subsided. 9/9/2009 9/9/2009 esented with swollen, inflamed (L) arm down to elbow - and low grad fever T99.5. (R) arm 3cc Y inflammation 9/1/2009 9-3-09. CBC 9/2/2009 and IM Decadron ministered 09/04. Reports pruritic rashY diffuse on 09/08. 9/4/2009 9/8/2009 cm x 3.5 cm red, raised, hot oval. Lt arm 5 cm x 5.5 cm red,raised hard hot oval (Both were given Y with an injection 9/2/2009gun). 9/3/2009 Pain when touched s and paresthesias in arm and leg on same side of site of injection. N 9/3/2009 9/4/2009 ost vaccine, reported red blotchy rash Y ant. abdomen, upper and lower arms bilaterally and mild Y itchy throat. 9/9/2009 Benadryl 9/9/2009 50mg po and Albutero several seconds after HPV shot, recovered after several minutes (out X approximately 30 sec) Y took approximately 8/19/200910 8/19/2009 min to feel better. of entire left arm. Pressure and pain, red, and warm. Treatment by ice and Benadryl 25 mg qN6 h. 9/8/2009 9/8/2009 given @ 1635 on 9-1-09. At approxY2000 that evening that evening notice swelling in bilat hands U and ankles. 9/1/2009 Seen in 9/1/2009 clinic 9-2-09 at 1525 upper arm very sore 8/26/09 - 8/28/09 Y without swelling or redness. 8/29/09 Had migraine HA. Developed8/26/2009 hives 8/30/09. 8/29/2009 (L) arm feels numb ver legs and arms 9/2/2009 vaccine 9/3/09 and called the next day with c/o rash on scalp, arms with itching to rash areaUand ears. No9/3/2009 other s/sx. Advised to take Bena ure following vaccine < 1 minute. NoY fever. No sequelae. Y 8/24/2009 8/24/2009 iphtheria vaccine given 5/01/09 to patient with poorly controlled Parkinson's disease. She called N office 5/11/09 5/1/2009 with twisting 5/2/2009 sensation in leg s a 5 in. x 4 in. raised, red, hot reaction around the injection site. He was given the injectionYof varicella vaccine 9/2/2009 in his 9/3/2009 Lt arm SQ at 1000/A 2 hrs after receiving vaccine patient Y c/o dizziness blurred vision. Also nausea, vomiting x2- local Y reaction8/17/2009 at site to include 8/18/2009 redness, swelling sh surrounding polio and hib vaccine Y sites, also rash to trunk, legs, arms, immunization givenY 24 hours previously. 8/18/2009 8/19/2009 1 degrees), myalgias, redness @ injection Y site. U 8/19/2009 8/20/2009 tetanus injection on 8/28/09 in E.D.YReturned on 8/30/09 c/o arm/neck pain. Dr diagnosed ptUwith acute 8/28/2009 allergic reaction to tetanus injection d rash on L arm & body cluster on abd. Y Red pimples 8-27-09. Y 8/26/2009 8/27/2009 ed home - made bagel and began to "hurt" "bottom stomach". "Ate bagel" - mom suggested to Y go to bathroom 9/5/2009 - no improvement. 9/5/2009 Returned ely after receiving varicella vaccine large red knot. Localized allergic reaction. Y 9/9/2009 9/9/2009 all red papulopustules. Y 1/29/2001 9/9/2009 d AVA in his right arm on 21Aug09 in the am. At the time he had burning at the injection siteUand his arm8/21/2009 was sore--nothing 8/22/2009 unusual for get r followed by rash. Platelets & WBCYdropped to a dangerous level, then went extremely high.Y Six weeks 7/31/2009 following vaccination, 8/14/2009 WBC & plate ed varicella-like eruption which subsequently led to scarring. Y 7/30/2009 8/6/2009 R. Voice hoarse, throat swelling, difficulty Y breathing within 5 minutes of vaccine administration. Y Neb treatment 9/8/2009 with Racemic 9/8/2009 Epi; BENADRY was reported by a physician and described the occurrence of aggression in a 4-year-old Y male N subject who 8/18/2009 was vaccinated 8/20/2009 with KINRIX (Gl ory reaction to DTaP in Rt deltoid. Redness and swelling. No pain or tenderness. Reaction started U within 6 9/1/2009 hours of vaccine 9/1/2009 per mom. Repo rash in S2 dermatome - R leg. Started a day after receiving varicella vaccine in left leg. Y 9/2/2009 9/3/2009 reaction to flu shot. 5:25PM 9/9/09. Swelling at site. Applied ice and observed. Pt had no pain U no dizziness 9/9/2009 no S.O.B.9/9/2009 Observed 45 minutes ceived influenza vaccination on 9/3/2009. On 9/4/2009 arm was red, warm to touch at site. No Y hardness felt 9/3/2009 itchy to patient 9/4/2009 took BENADRY e arm, swelling, itching was the last thing. Headache, fainting, nausea, diarrhea, chills, very sleepy. Y These 8/20/2009 symptoms 8/27/2009 were very strong the f
n has been received from a physician concerning an approximately 14 year old female who Y on 31-AUG-2009 8/31/2009 was vaccinated 8/31/2009 intramuscula ort was received 26 August 2009 from Y a health care professional, who is also the patient. A 46-year-old U female 8/21/2009 patient with a history of asth es. 9/27/09 Hospital records received DOS 8/31/09 Y to 9/2/09. Assessment: 2 Headache. Patient Y presents 8/25/2009 with headache. 8/25/2009 Normal neurologica MENACTRA & Tdap on 6/3/09. HadY a seizure on 6/12/09. Eyes rolled back, she stiffened and U turned blue6/3/2009 around the 6/12/2009 lips. Vomited & unres rs of receiving AFLURIA 0.5ml IM vaccine, patient reports she had several areas of large flatYblotchy areas on her face and neck. Also repo 13-09 - Groups of raised red areas with white edges. Fever - 100 on 8-12-09 - Fever resolvedU 8-12-09. Fatigue/malaise 8/11/2009 8/12/2009 on 8-12-09. Resolve ld given inactivated flu vaccine 0.25ml (for 6 months - 36 months age range). Correct dosingYbut 2 month 9/3/2009 early. Weight at time of visit = 12 ight of day of injection. Face swollen next morning. U 9/2/2009 9/2/2009 yalgias, fatigue, nausea, sweating for approximately 36 hours, with onset approx. 5-10 hoursUafter receiving 3/14/2009 vaccines. 8/15/2009 Rash developed 8/17 eadache and dizziness after Gardasil Shot! 9/29/09 Medical records received from dates of service U 2/2/09 2/1/2009 to 8/24/09 PCP, 2/1/2009 Allergist, ENT, N unwitnessed). Date. Several wks after vaccine. Y 8/24/2009 8/31/2009 ports feeling nauseated approx 2-3 hrs after flu vaccine. Vomited from 3AM 9/3 - 6AM. Also Y complained of9/2/2009 headache.9/3/2009 Self resolved no furth opal episode at home. Fell - stoppedYbreathing x20 seconds. Then was "postictal" x20 seconds Y - ? primary9/9/2009 seizure vs9/9/2009 breath-holding episod mp 102.3, fussy-given steroids & BENADRYL, Y 9-10-09 pt had diarrhea, doing well on 9-10-09. Y 9/9/2009 9/9/2009 minutes developed wheezing and itching. Y Gave patient nebulizer tx and 2 IV BENADRYL. Symptoms Y resolved. 9/3/2009 9/3/2009 ne at 6p, dry cough and headache by 9p, chest tight/sore throat,chills, sweating and fever ofY102 degrees9/9/2009 all night, woke 9/9/2009 with nasal conges ated child's Left arm very red, swollen Y and tender to touch. Stated child never complianed until Y mother touched 9/3/2009 his arm. 9/4/2009 ely after receiving Gardasil#3 injection, patient fainted, loosing consciousness for approximately Y 30 seconds. 9/9/2009 Easily revived 9/9/2009 with changing o s rt upper arm and upper back, bilateral forearms (back side) and bilateral upper legs/thighs Y 9/9/2009 9/9/2009 a flu shot from walk-in facility. TheyYgave me Fluzone. I have never before had a reaction toUflu vaccines,9/9/2009 but the flu vaccines 9/9/2009 that I had we grade temp (99F) treated with tylenol within 3 hours of injections. Within 10 hours, high tempYof 103. Extreme 9/9/2009 restlessness, 9/10/2009 rapid breathing ter has passed out TWICE since receiving these injections and experiences increased headaches U while 7/10/2007 the finishing 9/29/2007 up the series. She has ation was given to me on Sept 1st. YOn Sept. 7th, I became extremely dizzy and nauseated.UThe symptoms 9/1/2009 contined9/7/2009 until Sept 9th. I mad mplained of pain and tingling between shoulder blades. U 9/4/2009 9/9/2009 to clinic 9-9-09 with a red raised vesicles rash in dermatomal distribution on left lower back radiating around 9/2/2009 to center9/7/2009 of lower abdomen. O alized swelling to left deltoid; stiff and limited ROM from left shoulder to left elbow. Y 9/4/2009 9/5/2009 ven double dose of flu vaccine. NextYmorning complained of arm pain radiating into breast area. Y Sent to Occupational 9/9/2009 9/9/2009 Health facility for follo ouble dose of flu vaccine-no adverse reaction. Y 9/9/2009 9/9/2009 ouble dose of flu vaccine-no adverse reaction. Y 9/9/2009 9/9/2009 8 HOURS FEVER OF 105 DEG. F. YCollapse and shock. Persistant Crying lasting for 4 hours Y w/in 48 hours. 2/1/2006 Prolonged 2/1/2006 seizures 2 weeks ollen,red,hard and hot to touch. ?cellulitis started on septra U 9/9/2009 9/10/2009 9/12/2008 N 7/21/2008 9/12/2008 atus changes starting 7 days Y after immunization Y Ywith fever, headache, 5 lethargy, inability to walk, N discoordination, 5/27/2009 signs 6/4/2009 of autonomic instabil n fever of 100-102 for 3 days. Treated successfully with Tylenol. Moderate rash appeared onNday 5 after8/26/2009 onset of initial 9/6/2009 fever. Rash covered 0 minutes after injection, felt "wave" of dizziness which then lead to extreme blurriness, some Y difficulty breathing, 9/10/2009clammy 9/10/2009 skin all over. Ext ately 4 hours after vaccine administered Y patient reported:Visual changes including letters appearing Y in different 9/9/2009 sizes,9/9/2009 unsteady gait, muscle as sitting receiving vaccinations - immunizations for Typhoid Fever, Yellow Fever, and Hepatitis Y A on September 9/8/2009 8, 2009 9/8/2009 when he fainted a s and chest. No hives or bumps.Benadryl 25 mg, PO given. Y 9/10/2009 9/10/2009 d TDaP and varicella in L arm on Tuesday Y 9/8. Pt reports significant HA and low-grade feverUthat night; itching 9/8/2009 started 9/9/2009 on morning of 9/9 an shot was received at 3:25 pm. Around Y 5:30, a cough began. Around 6:30 hoarseness and aY "funny feeling" 9/9/2009 began in9/9/2009 the throat. By 7:30 w and soreness at site Y 9/9/2009 9/10/2009 nausea, diarehha, chills, body aches, Y headaches within four hours of receiving vaccine Y 9/9/2009 9/9/2009 s began with hair loss two Y months after first shot, progressed to stomach problems, indigestion, N bloating, menstrual ### 12/1/2006 irregularities, PMS Sym was reported by a pharmacist and described the occurrence of elevated liver enzymes in a subject U of unspecified 8/31/2009 age 9/3/2009 and gender who was as given 0.5ml of Influenza vaccine, IM @ 1405 in L deltoid. Patient was starting to leave clinic Y and said she 9/10/2009 felt "lightheaded 9/10/2009and dizzy", @ after administering FLUENZA patient loss (1:00pm) consciousness for approximately 3 minutes. Y She was 9/6/2009 non responsive 9/6/2009 for 1 minute and n ed, warm to touch bilateral arm injection sites. Size of 'Golf ball'. 9/8/2009 9/9/2009 esented child for flu vaccination. Mother reports that she takes flu shot annually, with no previous reaction.9/9/2009 Vaccine administered. 9/9/2009 Child beg d region became erythematous, warm & induration following immunization. Systemic fatigue. Y Began to improve 9/1/2009 48 hours 9/1/2009 later. Pt believes ain 2 days after injection- neck & leftYside of upper body down arm into elbow, symptoms/painUare continuing 9/8/2009 to increase 9/10/2009 & travel down arm. with 3 areas of raised pink sersiginous raiser border and flat center and left buttock with larger Y 2 inch confluent 9/8/2009 raised pink module; smaller
ythema at injection site left arm. No temperature, swelling at injection site. Y 9/9/2009 9/10/2009 swelling, soreness bilateral upper areas & slight itching (L) upper arm. Swelling started 9/8/09 Y pm & has 9/8/2009 increased. 9/8/2009 Taking MOTRIN PRN ve shot, his arm immediately swelled up, local irritation + redness w/ minimal bleeding. Pt. did Y not feel dizzy 9/10/2009 or have9/10/2009 any other adverse effe m had a fever 103. Diagnosed with Ycellulitis. Gave antibiotics in IV and was given LEVAQUIN Y and Doxycycline 9/7/2009 is recovering. 9/7/2009Also had swo tes in approx. 2005 while working on the postpartum ward as an RN she received a FLUMIST vaccination. 1/3/2005 Initially, the 1/3/2005 pt reported that she at, swollen tonsils, T 100.2, body aches Y and cough, Txed with PREDNISONE and TAMIFLU. 9/3/2009 9/6/2009 d area silver dollar size hot to touch. Y 9/9/2009 9/9/2009 both arms within 5 minutes. Resolved with BENADRYL. Y 9/9/2009 9/9/2009 d 9/2/09. States child had positive adverse Rxn 3 days after vaccination on 8/28/09. Client with Y rash had spike - no fever 99 to 101 mtn. Re n has been received from a published article. A 4 year old child was vaccinated with VARIVAX U (Merck) (lot number, route and site not repo n has been received from a certifiedYmedical assistant concerning a 4 year old male patient N with a history9/2/2009 of surgery 9/2/2009 (unspecified) and no k n has been received from a nurse for Y GARDASIL, a pregnancy registry product, concerning U an 18 year old 4/1/2008 female patient who in April 2008 n has been received from a physician Y concerning Y a 19 year old female 8 Y patient with no pertinent Y medical history 1/1/2009 and no 5/1/2009 known drug allergy n has been received from a physician Y concerning an 11 year old female who was vaccinatedYwith the second 5/8/2009 dose of8/3/2009 GARDASIL (dose, ro n has been received from a pharmacist Y concerning a female patient with a history of "aversion" U to the needles 8/29/2009 who 8/29/2009 was vaccinated with the ng, eyes swollen shut, red itching eyes, stomach aches, body aches, cough hoarness, sore throat, U runnning 9/10/1966 nose. 9/10/1966 concentrate, cognitive difficulty, malaise Y 9/8/2009 9/9/2009 ed rash and puritis developed approximately Y 90 minutes after recieving a dose of FluMist. Y 9/10/2009 9/10/2009 cieved Gardasil on 12/19/07, secondY dose on 2/20/08, and last dose on 6/23/2008. Extremely U tired and at 6/23/2008 times seemed 9/1/2009 slow to respond.O ceived vaccine on 8/25/09 Y and 2 days Y later sheYpresented to the ED6with emesis and currantYjelly stools.8/25/2009 She was found 8/26/2009 to have an intusse ce, vomit x1 on the way home. Mom reports she was pale and complaints of nausea and then Y vomit x1. 9/9/2009 9/9/2009 veloped redness, swelling, pain at injection site. Was seen and diagnosed with cellulitis andUwas treated with 9/8/2009 antibiotics. 9/9/2009 arm was swollen whole bicep about a 1/4 inch around. It was sl red and warm as well, after swelling Y went down 9/3/2009 entire9/3/2009 area was bruised. Pt M RED,WARM TO TOUCH AND SWOLLEN U 9/9/2009 9/11/2009 hat her left arm started hurting to the point she couldn't move it. The night of injection she 'felt Y like she had 8/20/2009 been hit 8/20/2009 by a truck' she ached a loss of appetite. Body chills and aches. Headache and significant fever. Beginning six hoursYafter shot administered 9/10/2009 9/10/2009 and worsening over ne 6 PM started screaming and grabbing Y at rt. leg, at 12:30 AM noticed swelling of fist size on rt.Uleg from above 9/8/2009 shot to 9/8/2009 below knee. 9/9/09 no st experienced headache and posterior Y neck pain that lasted approximately 48 hours. Following Y that he developed 9/3/2009 severe 9/3/2009 cervical neck pa meter redness, slight swelling and warmth at site Y 9/9/2009 9/11/2009 d Flu vaccine and pneumovax in right Y arm. Not sure which site was which vaccine. The lower U injection site 9/9/2009 has a reddened 9/9/2009slightly raised, (inside bicep) was slightly swollen and red, approx 2 inches in diameter. No itching. Patient U could not move 9/9/2009 arm past 9/10/2009 shoulder height. Pain is diagnosed after second vacc.(8/10)Was Y seen by PCP on 7/29/09 for general malaise, dizziness, Y nausea. 6/30/2009 Seen also 7/23/2009 on 8/10, 8/19&20 fo ad fever 99.1 degree last night after received the flu shot. I gave him Tylenol around 9pm. InNthe midnight, 9/10/2009 he developed 9/10/2009 fever again. I gav have any reaction to the vaccine he was just given a third menningitis vaccination. Has received Y one every year since 9/2/2009 2007. I was instruc welling and fever at injection site on left leg, as well as bruising. The swelling and fever wereYimmediate. Within 7/2/2009 a day, 7/2/2009 he broke out in rash S,SWELLING, INDURATION 10MM,YNECK AND L SHOULDER PAIN 6/10, BODY ACHES. NORMAL TEMP 9/9/2009 98.6.SENT 9/10/2009 TO URGENT CAR n Right arm from deltoid to hand lasting for 2 days. Y 9/9/2009 9/9/2009 was considered medically important. Information regarding PREVNAR was received from a U physician regarding an 18-month-old male pati rmation received on 31 August 2009Yfrom a health care professional. A three year old male patient U received either DAPTACEL or TRIPEDIA taneous case was received from a consumer Y on 03 September 2009. A 29-year-old female patient, U with 8/13/2009 no reported8/31/2009 medical history and no nted to E.R. on 7/27/09 after falling at Y home - was Y admitted - EEG was 2 positive for seizure, neurologist Y believes 6/30/2009 Tdap 7/27/2009 could have caused se arre Syndrome - LE Weakness, visual disturbance. Y 6 Y N ### ### izure 7 days after HIB and FLUMIST. Y Y 9/1/2009 9/3/2009 ella given accidentally. Previous dose, #1 not properly recorded, discovered previous count 3Ygiven. shot around 2pm 9/2. Approximately 6pm experienced numbness in mouth & throat for approx. Y 3 hrs. Also, 9/2/2009 then developed 9/2/2009 runny nose, so ack on 9/3 (1 day later) with rash throughout Y body. Pt also complained of warmness thru the Y night of 9/2.9/2/2009 Pt went to9/2/2009 clinic on 9/3 & was gi AP in R thigh. 9-3-09 mom noted red Y raised area R thigh. 9-4-09 MD appt. Tx with ice + TYLENOL. U 9/1/2009 9/3/2009 welling, hives, itching, flushing. Y 9/3/2009 9/3/2009 "rash" on trunk that spread to both legs in one week. Patient had about 30 "scabby" rash. Slightly Y itchy.1/19/2004 8/27/2009 low - fluid went into tissue. Red, itching & raised. Pt went to doctor - doctor stated vaccine given Y too low - 9/1/2009 pt will recover 9/2/2009 and is immunized. day 102 & increasing. Localized rash size of 1/2 dollar coin. Redness & warm to the touch. Y 8/14/2009 8/15/2009
9 Patient received TDAP vaccine. The patient circled no for pregnancy on the screening form. Y On 7-30-09 7/28/2009 the patient reported and stated pneumonia shot at 3:30 pm on September 1, 2009 on right arm. About 6 pm arm started to get Y red and swell 9/1/2009 and hurt. 9/1/2009 Patient cannot lift ar & Warmth 2-3 hours after injection Y 8/19/2009 8/21/2009 swelling (quarter size), redness warm to the touch fever x 2days 101 increase. 8/24/2009 8/26/2009 g dysfxn and annuciation difficulties, for 3-5 days post INFLUENZA vaccination. Y 9/5/2009 9/6/2009 ZOSTAVAX vaccine 8/28/09 per her Y request - 9/3 developed a "rash" along left rib and backYarea - Saw8/28/2009 Dr. in clinic on 9/3/2009 9/4 with large area te developed 28 hours spread to other areas 48-96 hours after vaccine. Y 8/21/2009 8/22/2009 y- inconsolable through most of night. U 9/9/2009 9/10/2009 ensation of (L) arm lasted approximately 21/2 - 3 hours after flu vaccine was given. Y 9/2/2009 9/2/2009 Y Y 9/9/2009 9/9/2009 and swelling of entire (R) thigh, Tx with Y BENADRYL and TYLENOL; increased warmth of extremity. Y 9/1/2009 veloped urticaria/lesions following administration of varicella vaccine. U 8/13/2009 8/31/2009 ormer 28 wk gest infant was Y on peds floor prior to discharge. He had been Y fed 45 min beforeNevent. Monitor 9/2/2009 alarm for9/3/2009 bradycardia HR 78. R soriented and dizzy within about 2 hours. Severe swelling at vaccination site within 12 hours,Ywith skin very 7/15/2009 hot to touch 7/15/2009 for about one week pneumococcal vaccine trial, with severe COPDY was hospitalized for4 Gastroenteritis, viral. Vaccination Y took 1/16/2008 place 1/16/2008. 8/24/2009According to t re throat, extreme red eyes, body aches, temp of 101.1, headache, chills, dry cough, hoarseness. U Took holistic cold?flu medication and we ccine was given after strong encouragement Y from MD. The next day my finger, hand and knees Y bilaterally 7/23/2009 were swollen, 7/24/2009 stiff. and uncomfo RIENCED PAIN,REDNESS AND SWELLING AT INJECTION SITE AND ITCHING.REDNESS U MEASURES 9/9/2009 APPROX. 9/9/2009 6 CENTIMETERS. W m,William came in with a red raised patchy and papular rash of axilla bilat. and wrists bilat. Very Y itchy.Also 8/31/2009 throat felt8/31/2009 swollen and hoarse, lip ports feeling "fine" after injections. Around Y 11 AM she became dizzy and lightheaded while driving. Y She 9/10/2009 hit a light pole 9/10/2009 as a result of mome swelling, and warmth at site, site is painful to palpation Y 9/9/2009 9/10/2009 STATES CHILD "NOT ACTING THE SAME" AS USUAL, WHEN ASKED TO CLARIFY, MOM N STATED 9/10/2009 SHE IS "NOT 9/10/2009 ACTING RIGHT." cH swollen area on right arm. Red area Y is hard and warm to the touch. First seen by mother on N Thursday 9/10/2009. 9/9/2009 9/10/2009 Went to urgent care ev weakness and tingling in Left arm 24Yhous after receiving flu vaccine. The vaccine was administered U in the 9/4/2006 Left arm. 9/5/2009 The weakness occurr ely after receiving the Td vaccine I began to feel the vaccine course through my body, affecting U my joints/muscles. 9/10/2009 Feeling 9/10/2009 stiffness, pain a eeling dizzy right after administration but it passed. Next day (during the night or within 12 hours Y of administration) 9/2/2009felt9/3/2009 chills, sore throat des e of administrtion, patient stated," My god, this hurts a real lot" She states she made that statment Y as the vaccine 9/2/2009was9/2/2009 being administered. perience swelling/warmness on the injection arm NOT at the injection site, swelling and redness U occurred 9/10/2009 lower on the 9/10/2009 arm than where the pruritis in the area 9/10/09, redness and tenderness noted soon afterwards. No history of other U injury to the 9/9/2009 area. Exam 9/10/2009 reveals 70mm X 8 . Troubles breathing. Sweating. t feeling well after receiving vaccine. Y Patient advised to sit down and RPH tended to patient.Y911 was called. 9/11/2009 EMS came 9/11/2009 and monitored pat n face and legs and generalized itching, patient took BENADRYL 25mg Tablets - 1 tab q 4-6Yhr. prn : Recovered 9/8/2009 in two 9/9/2009 days. orming a ring approximately 4 inches below site of injection on left arm. No fever, no difficulty N breathing. 9/9/2009 L arm is swollen 9/9/2009 & itches. Recom aims her blood pressure has elevated Y since the flu shot and she first reported this to me 7 days U after the shot. 9/3/2009 9/10/2009 n 8/13/09 rash on lower torso 8/20/09 - Pain. Saw Dr. on 8/21/09 received Acyclovir and PERCOCET. Y Missed 8/13/2009 vacation 8/20/2009 - Better now 9-10-0 ported diaphoresis, tachycardia, and tingling bilaterally in arms about 5 minutes after vaccineYadministration. 9/12/2009 We monitored 9/12/2009 B.P. and within 3PM - Patient received inactivated a 0.5 ml FLUZONE in L arm right after that Pt c/o of swelling Y and redness. 9/13/2009 Pt complaint 9/3/2009 of arm being hea ness, warmth & tenderness at injection site approximately 1 1/2 cm diam by 2 days after injection. 9/9/2009 9/10/2009 s a localized reaction also right lower Y thigh red-slightly raised 1 & 1/2 cm with satellite lighterYpink/red one 8/29/2009 measured 9/7/2009 1.4x1cm. Patient was edness and swelling developed within 2 days of vaccine (3x5 cm in diameter). Went away and U 10 days later 8/26/2009 recurred8/28/2009 with vesicles suggestiv wing immunization, not uticarial. Y 9/10/2009 9/10/2009 ceived FLUVIRIN flu shot on 9-8-09 and had no adverse reaction. He became swelling on next Y day 9-9-09. 9/8/2009 He went to 9/9/2009 ER & was given PRE wing immunization, patient's sister reported Y pain, mass, and erythema at site of injection. That U evening symptoms 9/11/2009spreading 9/12/2009and pt went to ection site followed with achy arm, rash on trunk, legs and neck. Patient says he has never had Y a reaction9/3/2009 to a flu shot. erythema, pruritus (L) deltoid - BENADRYL and CEPHALEXIN X 1week 9/10/2009 9/11/2009 eeling of coldness and weakness. Same reaction on 02/12/2009 but vaccine was given with other four. 9/10/2009 9/11/2009 dministered 09/01/09; On 09/07/09 pt. noticed red patches on hands + thighs which felt itchy N + "tight", pt 9/1/2009 seen 09/10/09. 9/7/2009 n face, legs, torso - improved w/ BENADRYL in 24hrs. Y 9/9/2009 9/9/2009 d hotflush, passed out and became unconscious, when patient came to, felt nauseated, wasYclammy to 9/11/2009 touch and hot. 9/11/2009 Pt was given water u shot in the pharmacy at 6:45 PM on Y 09/10/09 and had no symptoms of allergy. When pt got Y home and 9/10/2009 took Lisinopril 9/10/2009 at 10AM on the sam Y 9/8/2009 9/10/2009
tion on 9/9/09. Mom noted quarter-sized erythema and warmth on 9/10/09. On 9/11/09, 9cmUx 10cm area9/9/2009 of warmth9/10/2009 and erythema on R thi got some itchy hives developed 2 hours Y later, and it got worse overnight. He took BENADRYL Y for 2 days9/4/2009 then he went 9/4/2009 to his primary care ge Pt was not aware she was pregnant Y at time of vaccine Pt was 5-6 wks pregnant at time of vaccine. H/o 7/23/2009 prior miscarriage 9/3/2009 about 1 yr ago. elling in L upper arm. Y Y 9/9/2009 9/10/2009 o pneumonia vaccine -arm red - hot - hard - scabbed - client ran fever - achy - felt poorly - started Y within 24 9/1/2009 hours of 9/2/2009 receiving vaccine - mis VARIVAX injection subcutaneously in Y left arm. When she returned to office area 3cm x 3 1/2cm Y red, blistering, 9/1/2009 hot to touch. 9/2/2009 fter vaccine admin. pt c/o dizzy --> sat down c/o ears ringing, blurred vision & seeing spots, nauseous Y & diaphoretic 9/9/2009 --> 9/9/2009 lasted approx 10 m er pt. experienced hallucinations, diaphoresis Y and vomiting late afternoon on date of receiving Y Tdap immunization. 9/9/2009 9/9/2009 ry apprehensive re flu vaccine. ToldYto wait 15 min since it was 1st time to get shot. LPN noticed Y pt. starting 9/9/2009 to slump9/9/2009 in chair. RN came to a ng, face red, no breathing difficulty. Mom gave a dose of BENADRYL + advised to observe. U 9/2/2009 9/2/2009 t about 30 minutes after she received Y a TDAP has been unable to move arm well. Good movement to fingers. 9/9/2009 Arm and 9/9/2009 fingers has tingling d all over, tenderness + pain at the injection site- lasted for 2 hours. Now still c/o redness, swelling N + pain. 9/10/2009 9/10/2009 .9, no appetite. Y Y 9/8/2009 9/9/2009 ceived PNEUMOVAX on 9/11/09 developed Y swollen lymphnodes on her right arm (injection U site), arm severely 9/11/2009 hurt,9/12/2009 fever of 100.7 degrees Y 8/28/2009 8/29/2009 - injection site red and swollen. Y 9/9/2009 9/10/2009 redness, tenderness, to left upper arm, measures -approx, - 50x22 cms. Symptoms appeared 9/5/09. Redness 9/4/2009 - measured 9/5/2009 approx - 50x42c to Dr's office on 9-4 arm was inflamed, Y swollen + warm. Dr stated localized topical reaction.YTx w/ BENADRYL 9/2/2009 - O.T.C Follow up on 9-8 r d immunizations (FLUMIST, HepA/B, Meningococcal, Y MMR, and Pneumococcal) on 7/1/09. N He denied any 7/1/2009 local reaction. 7/20/2009 The pt was seen warmth, soreness at swelling site about 2-3 inches across. U 9/10/2009 9/11/2009 t irritability, back pain, muscle aches, difficult toYconsole - started morning 1 after vaccine administration, Y required 9/10/2009 office 9/11/2009 visit, ER visit, hospita n under the arm, odd spot to begin with...the arwa surrounding the injection site has grown toUa welt the size 9/10/2009 of 3" by9/10/2009 2" and is red, itchy and s and tingling in arm where injection given, dizziness, lightheadedness. 9/12/2009 9/12/2009 ps on upper left chest and back. Few Y other similar bumps located on lower arms and right shoulder. U 8/31/2009 9/10/2009 as given vaccination at about 1:55PM Y with no problem. Husband told me following morning around Y 5:00am 9/11/2009 she experienced 9/12/2009 nausea, feet sw ed numbness in arm where he received vaccine from shoulder to elbow about 20 minutes after U receiving9/12/2009 vaccine 9/12/2009 ed, swollen, and hot from top of shoulder to elbow extending halfway around the arm. Pt is also Y complaining 9/11/2009 of a slight 9/12/2009 wheeze approximat ness after first shot on 5/11/2009. My Y daughter had mild dizziness and headaches on and offNafter shot but 5/11/2009 the first week 7/1/2009 of July she had se hter received the "MIST" in the nose for seasonal influenza. Live, Intranasal Influenza Vaccine Y immediate8/17/2009 clear runny 8/17/2009 nose, fever of 102 wit at 1:00 pm on thursday sept 10th 2009 at pharmacy by pharmacist. 30 minutes after shot started profuse9/11/2009 sweating and 9/11/2009 feeling like my stom nd joint pain all over, fatigue and general weakness. U 9/12/2009 9/13/2009 feel dizzy and light headed. Went to bathroom and for almost 10 minutes my body went intoYa full sweat.9/13/2009 I was soaking 9/13/2009 wet feeling either l er vaccine administered; 8/27 a pock Y sore on L forehead; 8/28 L forehead & cheek tingling &Yslightly numb; 8/21/2009 8/29 tingling/numbness 8/27/2009 spread d sore, (R) arm mild-moderate edema. Y Fever at 100-101 deg. F, inappetence, HA, dry mouth,Ygeneralized 9/8/2009 discomfort.9/9/2009 Breathing not affected ed the following information from the literature article on 02 SEP 2009: A female adult patient Y had suffered from exacerbation of ulcerative ed the following information from a literature article Y on 02 SEP 2009: 0 A female adult Y patient N with ulcerative colitis had been managed with 6 ort received on 02 September 2009 from a nurse. Y The nurse had received the information from N a friend of8/21/2009 the patient. 8/31/2009 A 44 year old male pa n has been received from Y a licensed Y practical nurse concerning a 62 year old male patient with N no medical 9/8/2009 history or9/8/2009 allergies who on 08-S n has been received from a consumer concerning her 5 year old son with no drug allergies who Y on 11-JAN-2005 1/11/2005was2/1/2005 vaccinated with a 0.5 n has been received from a 22 year old female consumer with no pertinent medical history or Y drug reactions 9/17/2008 or allergies, for ###the Pregnancy n has been received from a nurse concerning Y aY20 year old female with 0 no drug allergies and U no pertinent1/1/2006 medical history 1/1/2008 who in 2006-200 n has been received from a nurse practitioner Y concerning a 21 year old female with no known Y drug allergies 8/27/2009 or pertinent 8/27/2009 medical history wh immunization clinic. Besides giving unusual vaccines, it was first day opened to public for flu shots. I grabbed TDAP and gave to 18 mont R 6/17/09 0200 for chills, fever, bodyaches, Y chest pain, dizziness, nausea. Asthma type s/s Y starting <12 6/16/2009 hrs after Tdap. 6/17/2009 -No rash-. Reports ped redness and itching at vaccine site. Initially resolved after 3-4 days then recurred in 1 wkUafter vaccine 8/27/2009 was administered. 9/5/2009(R) thigh. as injected with Fluvirin instead of Afluria. Patient is Pregnant. U 9/3/2009 n (Lt) lower back. While driving home had received flu vaccine prior to pain also noted staring N in abd. and8/31/2009 numbness8/31/2009 lower (Lt) abd and left warmth and pruritus at injection siteY(right deltoid). Y 8/31/2009 9/1/2009 n Influenza on 8/31/009, stated left arm from shoulder to elbow painful for a few days. StatesYhad small reddened 8/31/2009area 8/31/2009 at site of injection no e given (Lt) upper arm , noted pain and burning sensation down arm and joint pain wrist, (Lt)Ythumb and8/24/2009 elbow. Tender 8/25/2009 to touch unable to e cm raised erythematous dermatitis over right deltoid. Treatment: BENADRYL elixir. Y 8/13/2009 9/1/2009
s, patient returned within a few minutes with hives on face, and small papules and swelling ofY cheeks and9/9/2009 lips. No swelling 9/9/2009 of tongue. Occ VARICELLA vaccine 8/17/09. On 8/28/09 broke out in VARICELLA -like- rash (spots, 0 vesicles). U 8/17/2009 8/28/2009 d 9/2/09. States child had possible adverse RXN 3 days after vaccination on 8/28/09. Client Y# 972517, had 8/28/2009 spike a 8/31/2009 fever 99 to 101 . Relie ycliver 200 1/2 tp to qil 45D. ### 9/8/2009 L vaccine was noted at temperature that was out of normal range. Y 4/15/2009 L vaccine was stored at temperature that was out of normal range. Y 6/15/2009 L vaccine was noted at temperature that was out of normal range. Y 6/18/2009 L vaccine was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was not stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was out of normal range. Y accine was stored at temperature that was out of normal range. Y 6/16/2009 L vaccine was stored at temperature that was out of normal. Y 6/19/2000 accine was stored at temperature that was out of normal range. Y 6/15/2009 accine was stored at temperature that was out of normal range. Y 6/10/2009 accine was stored at temperature that was out of normal. Y 6/8/2009 L vaccine was stored at temperature that was out of normal range. Y 6/8/2009 L vaccine was stored at temperature that was out of range 6/8/2009 L vaccine was stored at temperature that was out of normal range. Y 6/5/2009 L vaccine was stored at a temperature that was out of range. 6/5/2009 L vaccine was stored at temperature that was out of normal range. Y 6/5/2009 accine was store at temperature that was out of normal range. Y 5/18/2009 L vaccine was stored at temperature that was out of normal range. Y 3/18/2009 L vaccine was stored at temperature that was out of normal range. Y 5/19/2009 L vaccine was stored at temperature that was out of normal range. Y 5/19/2009 L vaccine was stored at temperature that was out of normal range. Y 5/20/2009 L vaccine was stored at temperature that was out of normal range. Y 5/27/2009 accine was stored at temperature that was out of normal range. Y 5/27/2009 L vaccine was stored at temperature that was out of normal range. Y 5/27/2007 accine was stored at temperature that was out of normal range. Y 5/27/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 OULDER AND DELTOID 3" IRREGULAR TENDER FROM MIDDLE RED. LOCAL REACTION U TO VACCINE 9/11/2009 9/14/2009 o 4 mm rash inceased, progress to Y groin, back, and chest. Was seen yesterday 9/13/09 andUgiven Zyrtec, 8/31/2009 today 9/14/09 9/10/2009 follow up with PA. rts pt developed jaundice on Thursday am by Aunt who is a nurse. Pt's sclera was visibly jaundiced. U That 9/8/2009 was the 9/10/2009 only symptom. Mom de ecame very red and swollen the next day after the DTaP injection there U 9/9/2009 9/10/2009 ntacted the health dept this morning. Reports onset of symptoms 9/9/09 with swelling and redness at injection 9/8/2009 site. Warm 9/9/2009 to touch. Has bee ceived Tdap instead of Dtap for age 4yr. old on 09/12/2009 U 9/12/2009 9/14/2009 er vaccine administration, Y she developed a fever Y to 103.7 and subsequently 8 diffuse rash. Worse at site of9/5/2009 injection with 9/7/2009 large patch. Admitte esented 24 hours following vaccine Yadministration with fever of 102.8. Patient denied any symptoms Y other 9/9/2009 than malaise 9/10/2009 which she attribute Yellow Fever Vaccine (Lot UF 583 AA EXP 15 APR 10) around 4:15 pm on Monday August Y24, 2009. Around 8/24/2009 8:458/24/2009 pm that evening my thr icella vaccine, within 2 hrs of vaccine, he developed fever. About 13-14 hrs after vaccine had N developed9/11/2009 pox. Mother 9/11/2009 reports child has over t dizzy 30 minutes after the chot was given. She sat for 20 minutes then left. Y 9/14/2009 9/14/2009 d injection on the 11th, she states she came down with a migraine that pm. She also c/o joint Y pain and generalized 9/11/2009 9/11/2009 body aches. She had husband described: within 2 hrs developed itching, burning of skin at site of vaccine. Continued Y with redness, 9/8/2009 burning9/8/2009 for 5 days. Symptoms gan complaining of sore throat from the Flu Mist, immediately. Saturday and Sunday had loss U of appetite9/11/2009 and abdominal 9/12/2009 pain. Monday beg nning fever, almost immediately. Continued running fever of 100.6 - 101.3 for next two days. Y 9/11/2009 9/11/2009 NING AND REDNESS LEFT THIGH, Y GOT IMMUNIZATIONS THURS 9-10-09.FRIDAY CHILD Y LIMPING9/10/2009 AND LEG LOOKED 9/11/2009PURPLE AND
@ 1400 client called me and notified me of the following information...9/3/09 @0630 client states Y woke up9/2/2009 with tingling 9/3/2009 pain in bilateral lowe accine was stored at at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 accine was store at temperature that was out of normal range. Y 6/3/2009 chiness at site and into joint area 9/10/2009 9/11/2009 orted 4" X 11/2" area of induration that started near the injection site and spread distal the site. Y Reported 9/9/2009 area was 9/10/2009 red. Denied itching. To fter receiving the Pneumovax vaccine, Y red & splotchy rash on upper arm away from injectionYsite, pain, tenderness, 9/1/2009 warm 9/2/2009 skin. Next day re grape-sized nodule above collarbone. Painful and swollen. Y 9/8/2009 9/9/2009 er (104 degrees), dizziness, loss of appetite, moderate lethargy. Fever developed within 6 hours Y of vaccinations. 9/8/2009Fever 9/8/2009 and symptoms did after nasal flu mist vaccination-became ill with severe headache, fever of 102.5 under armpitYand continued 8/29/2009 for 4 days 8/31/2009 (missed 4 days of sc whole body was shaking.YHe would Y not sleep. He was gasping for air. He wouldn't eat and when Y he did he6/8/2009 spit it back 6/19/2009 up. When I went back N,REDNESS ON VACCINE SITE U 7/31/2009 7/31/2009 oulder pain beginning ~2 hrs after vaccination. Y YProgressed to cause 4 immobility of shoulder U joint with excruciating 8/27/2009pain 8/27/2009 on any range of mot vomitted 4 hours after receiving influenza vaccination Y 9/14/2009 9/14/2009 L vaccine was stored at temperature that was out of normal range. Y 6/3/2009 accine was stored at temperature that was out of normal range. Y 6/3/2009 NEUMOVAX vaccine (SC) on his left upper arm. After 2-3 days, mom called here and told heUgot swelling8/30/2009 (L) arm and diagnosed with celluli ver, feels warm all over Benadryl 20 mg PO @ 9:45 self administered. Y 9/14/2009 9/14/2009 osing" - itching, hives - Lot# 092040D exp02/2011 Westward epinephrine 5.3 cc SC @ 10:30 Y AM (R) forearm9/14/2009 11:15 9/14/2009 AM spoke to Doctor's s given vaccines. Cried, and then became very pale and limp about 60 seconds later, lethargic. Y Color improved 9/14/2009 over9/14/2009 10 minutes. Infant rem nt developed erosive lesions that oozed 48 hours after the receipt of 4yo immunizations (including U VARIVAX). 9/2/2009 Initially9/4/2009 began on the nose an flu shot and Hep A. 3 minutes laterYstanding at check out counter, fell backwards onto floor.Y Hit back of head 9/9/2009 on ground. 9/9/2009 Some twitching ash all over body. U 9/9/2009 9/10/2009 4.5cm x 4.5 cm, erythema, warmth at injection site. Y 8/19/2009 8/20/2009 erythema, warmth at injection site 7x6 cm size. Y 8/19/2009 8/20/2009 inutes after vaccine patients arms and legs went stiff and patient passed out. Patient recovered Y shortly after. 9/14/2009 9/14/2009 ter immunization, left deltoid red, hard Y and egg shaped lump. Told pt to ice and use APAP call Y if worse. Patient 9/3/2009 went to ER next day - Dr. s aspect of arm swollen with about 50mm by 50mm of protrusion. U 9/12/2009 9/12/2009 U 9/12/2009 9/12/2009 n, 20 minutes. Y f apparent limpness, lethargy occurring during car ride home after vaccinations, lasting several Y minutes. 9/10/2009 Normal exam 9/10/2009 when subsequently r flu shot on 9/1/09 by 1200 on 9/2/09 right deltoid developed a silver dollar welt it was red, hard Y and painful. 9/1/2009 She took9/2/2009 Benadryl, Tylenol and g a nickel size welt appeared at injection site. It was red, swollen, and hard. Plan: Watch. Gone: Y By Friday 9/1/2009 Sept. 4,9/1/2009 2009. ter size welts on left deltoid. Welt is red, hard. Treatment: Watched until it was gone Friday 9/4/09. Y 9/1/2009 9/2/2009 size welt on (L) deltoid. Welt was red, tender and hard. Treatment: watched until gone - Gone Y by Friday 9/4/09. 9/1/2009 9/2/2009 toid burned on injection and keep burning". It became hard to move by the next morning it was Y swollen and 9/1/2009 red. Treatment9/1/2009 watch applied h course of 2 days developed rednessYand swelling on left arm that itched and was blotchy. OnY9/3/09 went 9/1/2009 to Clinic to 9/2/2009 see physician. She sta d redness and started to itch on 9/3/09. Y Continued to get worse want to Dr. on pt had hives down Y left arm.9/2/2009 Plan-CLARITIN 9/3/2009 x 30 days. PRED the flu shot on 9/2/09 at 08AM. By Y 21:00 on 9/2/09 she noticed hives on left arm and bilateral Y thighs. The 9/2/2009 hives were 9/2/2009 red, raised, and whit in the evening face and ears began to itch, overnight the itching got worse. Nothing seen. PtY takes CLARITIN 9/2/2009 for seasonal 9/3/2009 allergies, so too id shortly after vaccination had following sx: 1. Blurry vision, 2. Numbing forearm, 3. Numbing Y arm and leg 9/14/2009 (left) vision 9/14/2009 got better shortly afte ceived Boostrix one month prior to 10th birthday. 9/14/2009 eeling well prior to shot (nauseated). 2hrs after shot, vomiting and sweating a drop in temp. (96.1F) Y continued 9/8/2009 for 3-4 9/8/2009 days. Patient feels this approx 18 hours after vaccination with Y (R) upper arm (elbow to over shoulder area) red and Y hot. Pt did not9/8/2009 complain to 9/9/2009 father other than pru d on 09-12-09 at 9:30 AM noted raised, warm area on (L) arm where was vaccine given. Stated Y as day progressed 9/11/2009 9/12/2009 noted itching under skin ost vaccination 5 episodes of dizziness followed by nausea lasting about 2 minutes. Patient noticed N reaction 9/4/2009 on 9-4-09. 9/4/2009 These episodes con munized in am, a few hours later, patient presented with rash all over body, mom called concerned U patient 8/12/2009 has no problems 8/12/2009breathing, gav
began 7/30 with swelling on R deltoid. Ibuprofen has been used - Patient states it seems to have Y helped 7/29/2009 with ice. Current 7/30/2009 7/31: 5 - 6" vertica ccinated 8-4-09, pt presented with rash Y on chest, cheek, foot on 8/11/09 along with fever, given Y instructions 8/4/2009 for IBU/TYL 8/11/2009 alternating. 8/16/2009 welling of entire L thigh to knee. Blotchy Y erythema. Y 8/12/2009 8/14/2009 swelling, not itching, very sore, ripple around red area. Y 9/11/2009 9/11/2009 e throat. Aches & pains in joints whole Y body. Started with symptoms with in 1 1/2 to 2 hoursYafter vaccine. 9/2/2009 Took TYLENOL 9/2/2009(symptoms las vaccine @ 08:40, @ 10:00 becameYdizzy with elevated blood pressure. Y 9/4/2009 9/4/2009 ng home from a friends house and lost sight in my right eye. It just went black. This was about Y 4 or 5 hours 9/11/2009 after I got 9/11/2009 my flu shot & my sig ng, large red streak, itching. Y Y 9/10/2009 9/10/2009 o itchiness after taking 3rd oral typhoid capsule, no rash noted at that time. After taking 4 dose Y on 9/9/09, 8/28/2009 again became 9/4/2009 itchy & noticed ras hour experienced numbness of the entire arm where he received the vaccine. The numbness Y went away in few hours. er vacinnation with Gardasil, patientYdeveloped Demographia, an auto-immune disorder for Y which she takes 7/3/2007 prescription 9/10/2007 meds, and has be ours after vaccine was given I began to vomit intractably for 2 1/2 hours. Also had mod abdominal Y pain at9/8/2009 the same time. 9/8/2009 I have continued Samllpox vaccine along with Anthrax and Hep Y B vaccine on 8/25/096and 2 days later had node Y under rt.8/25/2009 arm, 7 days 8/26/2009 later had flu like symp on back of left arm. Cool pack and BENADRYL. Y Y 8/31/2009 9/2/2009 itching, swelling @ site (RA. SQ.). N 8/17/2007 8/17/2007 ck of Lt arm red, > than golf ball in size, Y hot to touch & feels swollen inside. Per Dr. Ok to give Y BENADRYL 9/2/2009 & cool compress 9/3/2009if tender or imp s post vaccination, swelling of eyes and Left hive rash (urticaria). Y 9/4/2009 9/4/2009 M rash developed/itching on both arms from arm pit to elbow, interior arm started 7:30 A advised U patient 9/14/2009 to notify MD 9/15/2009 and take antihistamin red FLULAVAL 0.5ml to him by im (FLULAVAL is for age equal to or greater than 18). Y 9/9/2009 days after varicella immunization client and mother reports she had a red, swollen, welted area Y approx. 6/10/2009 4-5 inches that 6/13/2009 was itchy. 4-5 days n has been received from a consumer Y concerning Y her mother, an 850 year Y old female patientNwith lymphoma 7/2/2009 since 2005 7/2/2009 and last radiation o n has been received from a physician Y concerning a 6 year old female with erythromycin Y ethylsuccinate Y (+) 7/21/1997 sulfisoxazole 10/7/1998 acetyl allergy and r n has been received from a nurse for Y GARDASIL, a pregnancy Registry Product, concerningYa 19 year old 2/29/2008 female who 2/29/2008 on 29-FEB-2008 wa e licensed for 18 yrs and up was given to an 8 year old. No signs of symptoms noted. Y 9/4/2009 9/4/2009 ers, sweating, severe pain R arm (4"x 7") w/ swelling, redness, pt. couldn't use R arm, systemic Y deep muscle 8/25/2009 pain, rapid 8/26/2009 temperature shifts d DTaP 9/1/09 came into clinic on 9/3/09 c/o redness,swelling, warm to touch on injection site. 9/1/2009 9/2/2009 9/9/2009 apular rash starting on face spreading Y to trunk extremities, started day following vaccine administration Y and 9/9/2009 itching. No 9/10/2009 other systemic symp nt received the flu shot R deltoid, became pale, emesis x1, no loss of consciousness. Able to Y ambulate. 9/9/2009 9/9/2009 nt became lightheaded about 5 minutes post injection. No acute breathing distress or hivesY@ 1040. 9/9/2009 9/9/2009 nt received a flu vaccination walked back to chair in the waiting area and fainted in her chair.Y Immediately9/9/2009 arrousable9/9/2009 with spirits of ammon erpes infection Y U 8/2/2009 9/3/2009 w grade fever, vomiting, nausea flu shot given 9/2/09. 9/2/2009 9/3/2009 me back to our pharmacy 2 days after administering of flu vaccine and complaint Tuesday her U arm was sore. 9/8/2009 I examined 9/10/2009 her arm and note toid - injection of PNEUMOVAX vaccination - Localized edema / no pain/ no systemic symptoms. Y 9/8/2009 9/8/2009 d FLUMIST at about 14:25. No history of egg allergy. Pt then went to soccer practice. No Hx Y of trauma9/10/2009 per parent.9/10/2009 At 1930 pt's mom call area of injection down to elbow on left arm with hives/rash upset stomach 9/8/09. U 8/31/2009 9/2/2009 lled 9-15, reported itching, redness about 4 inches appearing one evening at the injection site U after receiving 9/11/2009 the ZOSTAVAX 9/11/2009 given 9-11-09 l febrile Seizure. Y Y 9/11/2009 9/11/2009 swollen throat and face swollen busted, Y lips, tongue swollen. Y GARDASIL left deltoid on 9/27/09. On 9/8/09 Pt developed numbness under left upper arm/axilla. N Exam8/27/2009 normal except 9/8/2009 paresthesia under l red GSK to < 18 yr old. Y 9/14/2009 red GSK to < 18 yr old c/o stomach upset, vomiting 7 hours after vaccine no fever. Y 9/14/2009 9/14/2009 e from injection site to top of head (48 Hrs). Headache (24 Hrs). Slight memory loss/cognitiveYability (2 wks). 8/19/2009 8/20/2009
apular blanching pink rash on trunk more Y than extremities & face. Post occipital nodes. No distress. N No8/28/2009 fever. 8/30/2009 cm wheal. 25mg BENADRYL given & ice applied. Y 9/10/2009 9/10/2009 all around site of shot pronounced/pain veins in my left leg burning/painful & continues to be.U Veins in my 8/20/2009 arm are normal 8/23/2009 again at this time e up crying with a headache, a flushed face. Mother gave TYLENOL by mouth at 7:00 AM. YTemp 1 hr after 8/26/2009 TYLENOL 8/27/2009 100.8. ection 1100 am. 2-Tylenol at 100 pm - arm tender 300pm- tightness in chest - unease 310pm Y - Diarrhea 9/8/2009 /ABN Cramp/ 9/8/2009 Nausea -vomit dizzi
ile seizure 11 days after MMR and VARIVAX given Y at well visit. Also8had otitis media. Was intubated Y overnight 9/3/2009 and 9/14/2009 very unresponsive - goo er skin at site of injection - (patient remained on premises for 20 min.) Called patient @ 1:15 YPM & she said 9/15/2009 her arm9/15/2009 was fine and knot had n flu shot, patient immediately explained Y a soreness in neck & swelling in throat, "swollen glands". U Asked 9/11/2009 pt to take 9/11/2009 slow deep breaths, she approx. 4 inches in diam. on Lt. upper arm. Sl. swelling. Y 9/9/2009 9/11/2009 rom elbow upwards, mild pain, red, itchy & puffy arm. Reaction happened the next day after Y the shot. Pt.8/28/2009 was itchy & itched hard with her fin oted malaise, headache, sore throat?, decreased appetite. Y 9/1/2009 9/1/2009 and cellulitis at sight. Y 9/2/2009 9/4/2009 rea around injection site. Tender, warm 10cm x 4cm. U 9/2/2009 9/5/2009 2 hours after ZOSTAVAX vaccination, patient developed 103.7 degree F temp, chills, myalgias, Y headache, 8/31/2009 prostration, 9/1/2009 and heavy sweats, la ke on 9/4/09. Aphasia. Hemiplegic. Y N 8/27/2009 9/4/2009 inflammation, hardening of inj. site, feverish. Y 9/2/2009 9/3/2009 elling, nose & eyes, 12 hrs after mist. Y Y 9/8/2009 9/9/2009 le who had a syncope spell about a mt after receiving HPV #2. Y 8/31/2009 8/31/2009 e in mouth that happened immediately & subsided in 1/2 hr. Lightheadedness/dizziness, slightly Y nauseous. 9/4/2009 9/4/2009 rm was in pain the evening of administration Y and then in extreme pain to where she couldn't move it. The 9/1/2009 following day 9/1/2009 she saw PCP who d rnoon the day the vaccine- client became dizzy, throwing up ran a fever of 101. It lasted approx Y 1 1/2 days. 7/19/2009 Client used 7/20/2009 TYLENOL. of Blistering Hives" to L arm. Recommended Y Benadryl and Urgent Care Visit. Urgent Care Treated Y and Steroidal 8/24/2009 Medication. 8/27/2009Next Day Still stinging, itching, at and above site (injection Y given at 45 degree angle downward) she asked Y me to palpate 8/27/2009 a lump (which I could not discern muscle pain on L side arm, up into neck, jaw & shoulder blade. Ran a fever of 101. Severe HA, Y sensitive8/28/2009 to light. Upset 8/30/2009 stomach lasted thr els like she has a cold coming on. Patient said she was going to take some over the counterUTYLENOL. 9/1/2009 9/2/2009 ported redness, swelling, hives, itching in right arm (opposite arm from vaccine administration). N Symptoms 9/2/2009 presented9/5/2009 3 days after vaccine our after receiving flu shot, patient'sYthroat started swelling. She felt sick. About 2 hour she Y reported itchy 8/31/2009 throat, cough, 8/31/2009 but no shortness o eats, headache, swollen/red L arm 3 days. Y 9/8/2009 9/9/2009 ps in AM after - Treated w/BENADRYL. Y 9/3/2009 t in lung on 4-12-2009 and Y will haveYto be on blood Y thinners rest of her 5 life. She is Y currently N on 15mg of warifin 8/21/2007 daily4/12/2009 to keep her blood thinn red immunization to patient @ 3:30. At 3:40, patient c/o itching and scratching on face, arms, Y legs and trunk. 8/17/2009 Welts8/17/2009 around mouth and on ain, reddness and swelling of injections site. Reports area of edema as 50 cent piece sized U one day after 9/11/2009 injection with 9/12/2009 pain level of 6/10. that she didn't feel well after vaccines were given. Nurse had her lay her head down on desk. She then9/14/2009 said she was 9/14/2009 feeling worse, she d on September 12th, 2009 onset of fever Y continued Y until 4:10 a.m. September 2 13th when child Y became unresponsive 9/2/2009 9/12/2009 and stiff with shaking s given a Tdap on 2/6/09 and 9/14/09 Y 9/14/2009 9/14/2009 d Pneumovax 0.5mL IM R deltoid on Y August 26. She presented to clinic on August 27 with R Y upper arm8/26/2009 red, warm,8/27/2009 swollen, and tender to wo vaccines were no extreme signs,...just Y some minor ones like light headed, but after the 3rdNvaccine the 9/7/2007 problems 10/1/2007 started within the follow -swollen, red, sore, nausea, loss ofYappetite. Y 9/10/2009 9/11/2009 swelling, warm to the touch at injection site. 9/10/2009 9/12/2009 ceived yellow fever vaccine on Monday Y 8/24 just prior to departure on 8/25. He became ill with N high fever8/24/2009 (104.5) and 8/29/2009 myalgia, (more specif her/guardian reports headache every Y day for 4 days after 1st HPV dose on 04/01/2008. Menactra U also given 4/1/2008 that day. Then frequent head Hypotension,Blurred Vison,Quickly Recovered Y 9/14/2009 9/14/2009 t flu vaccine, pain in leg - Received Y benadryl and ibuprofen Y 9/11/2009 9/11/2009 ceived an subcutaneous injection of yellow fever vaccine for a trip, on 9/2/09. On 9/8/09 he Y states that he9/2/2009 started to experience 9/8/2009 fatigue, ma d the 1st shot of Gardasil Y on 3/17/2008, Y she had Y the 2nd shot of Gardasil 2 on 5/19/2008. Y SheNdid not have 3/17/2008 the 3rd shot. She stated having t mother reported to staff on 9.8.09 that Y pt seen in ER on 9/5/09 for L thigh redness & swelling.Y 9/2/2009 9/5/2009 htness, chest congestion , chest pressure. Y Y 9/4/2009 9/4/2009 ately 2 hours after receiving the vaccine the patient reported tingling down her arm. Md told U her the tingling 9/1/2009 was probably 9/1/2009 from her tensing given 8/24/09 - red swollen, area developed on upper right arm the next day. Y ER SAID A KNOT DEVELOPED ON LT THIGH A DAY AFTER THE VACCINATIONS WERE Y DONE . IT WAS 9/2/2009 LARGE 9/3/2009 SWOLLEN AND HO xillary lymphadneopathy 4+ nodes Y 9/8/2009 9/10/2009 minutes of shot, became dizzy with Y nausea and headache. left arm, hand and both feet wentN numb. nausea 9/15/2009 and headache 9/15/2009ended within fe king, approximately every 5 minutesYlasting hours at a time. Mother stated, "it looks as if he is U trying to shake 8/24/2009 off a bug". 9/4/2009 Mother also reports about dosage. Child given .5cc of FLULAVAL Adult vaccine in the office. Concerned about reactions Y for9/15/2009 the patient.9/15/2009 Concerned about adje events reported. Concerned about dosage. Child given .5 cc of FLULAVAL Adult vaccine inYoffce. Concerned 9/15/2009 about9/15/2009 reactions for the patie caria) from head to toe appeared onY June 11, within two weeks of patient's tdap vaccination.Y It started on 5/29/2009 a small area 6/11/2009 of his neck and then
g given a Hep A vaccination Y and the Tetanus Shot patient had a grand mal seizure. Has been U very tired post 9/15/2009 seizure9/15/2009 but no other symptoms d cheeks, forehead, nose and especially upper lip within 5 minutes of recieving MMR, Varicella Y and Hep 9/14/2009 B. Was given 9/14/2009 Benadryl 12.5mg via on arm, soreness of arm, fever up toY101.4. Became red and sore 2 days after the shot, called Y the Dr on 8/26/2009 Friday and 8/28/2009 told nurse arm was red 8 patient given GARDASIL #2 and MENACTRA. Y Within 5 min. experienced joint pains. No arthritis Y developed, 12/1/2008 but arthralgia 12/1/2008persisted x 3 m tion patient started turning pale, then complained she didn't feel well, then passed out. Pharmacist Y caught9/8/2009 her before9/8/2009 she fell and called he -21-09 nausea, headache not feeling well began vomiting 12:45 am which continued throughout Y the night 8/21/2009 given ondansetron 8/21/2009 ODT 4 mg tab Y Y 2 Y 8/27/2009 9/13/2009 ed, warm, and swollen the size of a 50 cents piece coin. Child complains and exhibits signs of Y trouble walking, 9/1/2009 cries that 9/2/2009 it hurts to be touch Y 9/1/2009 9/1/2009 ulitis-Rx Keflex 500 QiD< 10 days # 40 no refills 9/11/2009 ported CHill, panic, Racing, Heart at ~2am on 09/10/2009. Pt said she talked to Hospital ER Yand was told 9/9/2009 told to take9/9/2009 Benadryl. Pt got bette Y Y 9/4/2009 9/4/2009 Y U 9/15/2009 9/15/2009 weakness 10 minutes after injection.YChecked BP 30 minutes after injection 120/75. Pt. still felt U weak/tired. 9/8/2009 Rash Began 9/8/2009 to develop 1 Hr Afte mplaint of nose bleeding and felt like drunk the next day when she woke up in the morning. YHowever, after 9/14/2009 talked to 9/15/2009 Ms at 5pm on 09/15/0 turned three days after vaccination complaining Y of fatigue, rash on back. Presentation similarYto shingles. 9/1/2009 Recommended 9/4/2009 she see doctor. P jection site area - Erythema and induration at 10 cm X 10 cm at the (L) deltoid area. WarmthYand mild tender 9/8/2009 to touch. 9/10/2009 t. had 0.5ml of FLUVIRIN in left deltoid. Pt had swelling at injection site. Pt had no asthma symptoms. Y Contacted 9/15/2009 Dr9/15/2009 and follow up with patie V given 2 months after 4th dose. DTAP (TRIHIBIT given 12-6-08) Y 2/23/2009 2/23/2009 @ injection site [redness] body aches, fever. U 9/13/2009 9/13/2009 oke out all over red, raised areas, no blisters, itches. U 6/18/2009 9/11/2009 VAR and said he had previously had a flu shot. Gave pt flu shot, and within about a minute pt. Y said he was 9/12/2009 light headed. 9/12/2009 I told him to rema en on injected (L) arm, beginning with 2 hours. Next morning, headache, slight fever, site hotNand swollen 9/8/2009 to touch and 9/8/2009 episodes of syncope DIARIX, MMR, Chickenpox, PCV7. Inappropriately wrong sister, wrong age appropriate vaccine. Y 9/15/09 9/14/2009 Called mom, states no unusual r 3rd dose HPV vaccine in office this Yam, then went to school and within 1 hour developed severe Y HA. Then 9/15/2009 complained 9/15/2009 could not see out o ined of right forearm tenderness, redness, Y swelling with below elbow circumference 26.5 cm on (R) arm.9/10/2009 Left arm below 9/11/2009 elbow circumferen car a few minutes after shot, returned to office. Recovered with rest and crackers. Hadn't eaten Y all day.9/14/2009 9/14/2009 aised bump at the injection site, Temp, and fussy. Pt is also teething. Y 9/1/2009 9/1/2009 n throat & cough for approximately 2 hours post vaccine. Resolved without medical therapy. Y 8/31/2009 8/31/2009 ery swollen, red, hot to touch. Weak, feverish, severe headache, diarrhea. Missed afternoonYof 8/14, 8/17-8/21, 8/14/2009 tried 8/14/2009 to return to work 8/24 ame swollen & warm & painful 1 day 5 Kinrix. Pt. Rx'd Amoxil po, Motrin & cold compresses.U 9/1/2009 y of allergy to getatin of Neomycin. Patient called said had 24 hour fever 2 days post injectionY and 6 inch diameter 9/3/2009redness 9/5/2009 & swelling at inje njection (IM) on 7-7-09 & received call 7-8-09 from pts mom c/o area Lg red & painful. "Can't Y raise his arm". 7/7/2009 I made Appt 7/8/2009 today with PA-C. veloped a bump with redness measuring 2"Length 2 1/2" width on the left thigh. N 9/10/2009 9/10/2009 ticed numbness below elbow on day of receiving vaccine. It is slowing improving but not completely U resolved. 9/3/2009 9/3/2009 en 9-1-09. On 9-2-09 at 2:30 AM woke up & headache. Headache not relieved & Tylenol or Ibuprofen U as reported 9/1/2009to me 9/2/2009 9/3/09 TC to suppo shingles vaccination 7/15/09. Have Yhad itching and burning on parts of my body. Mostly on stomach N and7/15/2009 on side of 8/10/2009 the torso with sometime azed appearance for 4 hrs from 7-11 PM. Slept 11 PM - 3 AM, whining/crying just wanted to Ybe held from4/13/2009 3-7 AM. (Completely 4/13/2009 NL from 8 A ot shingles vaccine. On 8-30-09 Developed marked pain right breast . Three days later developed N brilliant 7/29/2009 red blotches. 8/30/2009 Two days after that ame red & sore, face red, breast sore Y (L). Wheezing, tightness in chest, pain inside & upper back. Y 2 hours9/8/2009 after receiving 9/8/2009 flu vaccine. Pt too o 103.4 & Headache x 4 days. Tylenol & Alka-Seltzer. Y 9/8/2009 9/8/2009 hours after receiving TDAP pt c/o red, swollen and itchy eyes. Lasted Rest of day. Appt hereY @ office was 9/3/2009 around 9:23 9/3/2009 AM. Pt called 9/4/0 nurse administered the vaccine and left the room, I turned to my daughter to see if she was ready Y to go. The 8/12/2009 look on8/12/2009 her face was very stran nted after receiving flu vaccine. RPh called 911, patient then woke 30 minutes later. 911 emergency Y was 9/4/2009 cancelled patient 9/4/2009 was fine. vaccine same time as husband. No eating or drinking in between shot and problems. Had severe Y diarrhea 9/12/2009 about 459/12/2009 minutes after receiving pper extremity numbness and weakness Y started 9/11/09 At 11:00am. O/E : decrease sensation Y in L thumb 9/10/2009 and tremor 9/11/2009 of L hand. Rx with AT s of blurry vision, R knee pain, fatigue. Started after 1st HPV vaccine 3-10-09. HPV# 2 5/12/09. U HPV#3 9-15-09. Not seen by MD until 9/24 dvertently given KINRIX for 4th DTAP and 4th POLIO. 9/14/2009 9/14/2009 swelling and itching of R arm and legs, Y (-) SOB, syncopy (-) wheezing warm now spreading down N her arm.9/9/2009 9/9/2009 follow-up information has been received from a physician's assistant concerning a patient's U family member who on an unspecified date wa arm local reaction with erythema, swelling, Y low grade fever, malaise. Erythematous area measures Y 8.5 x9/9/2009 15cm on 9-11-09 9/10/2009 T 99 orally.
t received 3rd GARDASIL vaccination approximately Y equal to 1:10pm. Approx. 4 hours later,Ybegan to "feel 9/9/2009 funny" and 9/9/2009 was making "non-lu r shot felt nauseate pale for a few hours. Y 9/8/2009 9/9/2009 and tenderness to left upper arm. DTAP, Y HEP B given on 9/8/09. Erythema . Symptoms resolved Y in 48 hours. 9/8/2009 9/8/2009 ped oval rash adjacent to site of vaccine. Believed there is not a causal relationship but informed Y parents8/19/2009 would report. 8/23/2009 ves and pruiritis- onset 2hrs after vaccination. Duration, 48hrs Tx'd with Benadryl and Hydrocortisone Y cream 9/3/2009 with good 9/3/2009 results. given Rt arm SQ on 9/14/09. Onset: 9/15/09 4.5 cm long by 4 cm width with reddeness, warm Y to touch. SM. 9/14/2009 amount9/15/2009 swelling noted. d pain, redness and blister to left deltoid at injection site. Pt reported itching all over body. PtUadvised to take 9/4/2009 BENADRYL 9/5/2009 for symptoms. nstriction, stomach pains & diarhea, Shaking chills, Extreme exhaustion, Red eyes, itching, rash Y on forearms, 9/15/2009 confusion 9/15/2009 enza & Pneumoccal shot at same time. Take Influenz every year with no reaction ever. I became Y aware 9/14/2009 things were9/14/2009 not right aboput five ho tchy eyes, upper back pain, sore throat, Y fever. U 9/15/2009 9/15/2009 called my office to report symptoms after receiving the Flumist 9/9/2009. States on 9/11/2009 Y she developed 9/9/2009 flu-like 9/11/2009 symptoms including h flu shot at 0900 am September 15, 2009. At 8 pm that night started getting a bad headache.YAt 9 pm felt9/15/2009 as if I had 9/15/2009 fever and chills. Severe , JOINT PAIN, NUMBNESS IN EXTREMITIES, Y FEVER OF 103. ONSET 2 DAYS AFTER VACCINE U ADMINISTRATION. 9/10/2009 9/12/2009 SEEN IN OFFICE G BECAME SWOLLEN AND RED, ITCH, BLOTCHY VERY UNCOMFORTABLE Y 9/14/2009 9/16/2009 ated that she had fever, chills achiness Y all over and muscle type pain in her throat when she Ytried to swallow, 8/25/2009 similar8/30/2009 to a muscle spasm for D VACCINES AT APPROX 1430 ON Y 09/09/09 APPROX 11 HOURS LATER PATIENT SENT Y TO ER FOR 9/9/2009 POSSIBLE 9/10/2009 SIEZURES. NO PR minutes of immunization, patient noted palpitations that lasted approximately 40 minutes. TheYpatient noted 9/15/2009 arm soreness, 9/15/2009 but no swelling, d MATELY 40HRS AFTER Y RECIEVING Y FLUMIST VACCINATION, PATIENT WOKE UP WITH YSORE THROAT 9/11/2009 AND SWOLLEN 9/13/2009 TONGUE. A states that after 2 hours of getting the Flu Vaccine she had blurred vision which lasted for aYfew minutes. 8/28/2009 8/28/2009 iving the seasonal flu shot on 9-14-2009 That evening, night and all the next day I had arthritis Y like pain in 9/14/2009 all the joints 9/14/2009 in the arm of the vac ported a hive-like rash to arms 1 hour after receiving 2nd Guardasil Vaccine on 09.15.09. Rash Y lasted 10 9/15/2009 minutes &9/15/2009 resolved without treatm the flu shot around 4:30-5:00 on 9/15/09. Y Around 9-9:30 that night, I started experiencing adverse Y symptoms 9/15/2009 that included: 9/15/2009 coughing, whee nted and was assisted to the floor by parent & Vaccine Administrator. Ammonia inhalent wasY used & she8/14/2009 responded8/14/2009 approxiamtely 1 minut alf an hour, I began to sweat profusely and feel lightheaded/dizzy followed by a headache. I felt disoriented. 9/15/2009 By several 9/15/2009 hours later, my ar dministered 9/14/09 at 2:00 p.m. School Y nurse reported that patient had a dime size red round U reaction 9/14/2009 yesterday (9/15/09). 9/16/2009 Today has a t VZV/Tdap/MCV 4, and was sittingYon bench for about 5 minutes for observation. on gettingUup, he experienced 9/16/2009syncopal 9/16/2009 episode, hit the nfluenza vaccine 9/14/2009 @1200 L deltoid . developed redness, tenderness , itching at site U within 24 hours. 9/14/2009 Symptoms 9/15/2009 subsiding at time atigue, tingling of left arm (especially ring & pinky fingers treated with Aleve Y 9/15/2009 9/15/2009 esented with rash 1 month after admin of zostavax Patient declined treatment rash is resolving. Y 8/6/2009 9/10/2009 tarted soon after the shot on 9/14/09. Y Arm is itchy and sore. 9/16 arm is very itchy and sore, U it feels like9/14/2009 it's in her shoulder. 9/14/2009She feels hot shot on Sept 14 at 1:30PM in left arm. Y A few hours later arm was sore. The next morning, entire N arm& hand 9/14/2009 felt like9/14/2009 it fell asleep. The armp receive Gardasil #1, Fluvirin, and Menactra. She did receive Gardasil and Fluvirin but was given U Prevnar9/10/2009 in error. Had 9/11/2009 soreness of both arm er receiving her 2nd varcilla vaccination, Y patient developed a small erythematous papule on U her abdomen.9/8/2009 Over subsequent 9/13/2009several days mplained of agitation, tremors of hands and headache. Required a quiet place to sit. Determined U this was 9/16/2009 not her usual 9/16/2009 behavior. Provide veloped redness, warmth, tenderness at injection site Y 9/15/2009 9/16/2009 nt developed high fever >102 the night Y of vaccination 9/11/09. The patient, over the course ofY 72hrs, developed 9/11/2009 cellulitis 9/11/2009 at site of injection s after shot she developed the worst headache Yof her life 10/10, swollen 4 glands in her neck, N malase, significant 8/12/2009 hypersensitivity 9/5/2009 to touch, my er, pt awoke on Saturday, 7/18/09, with Y pain in right arm and neck with lumph node swollen like Y cyst. Per7/16/2009 mother, pain 7/18/2009 pt had shooting pain ccasions in the two years since the vaccine, Y pt has developed severe burning, pruritus and PHN N type symptoms 7/17/2007 in the 8/16/2009 shoulders, especially , swelling, redness and raised temperature Y at injection site (left leg) developed to 4" by 3" area U less than9/10/2009 24 hours after 9/11/2009 injection. No treatm INJECTION SITE CONSISTENT WITH SIZE OF BANDAGE;MOVEMENT OF LIMBS (ARMS U & LEGS) CAUSES 9/15/2009PAIN; 9/15/2009 PELVIC AREA PA the injection around 10 am and within an hour felt feverish- sweating, dizzy, blurred vision, fatigue. Y When 10/7/2007 I got home 10/7/2007 about 5 pm I was runn 9/15/09 at 6 or 7 PM EST patient reported hurting in her back and stomach. Chills and a fever N (100 degrees 9/14/2009 F), vomiting, 9/15/2009 diarrhea at 5AM mplained feeling slight faint and thirsty; Y withheld fluids to monitor. Patient later complained ofY tickle in throat 9/16/2009 but said9/16/2009 no problems breathing a call from a patient requesting to speak with NP. Pt c/o of vaccine reaction after receiving Td Y vaccine. 9/15/2009 States symptoms 9/15/2009 started 8pm 09/1 r vaccine administered bled a small amount and then swelled to a small hard lump. Pt waitedUin store for9/16/2009 35-40 minutes 9/16/2009 and looked to have injection 10:30am within one hour nausea, aching, burning cough. 7:00 returned to clinic with Y symptoms.9/14/2009 Conferred9/14/2009 with Dr, Motrin 400mg welling of upper arm, shoulder and right Y abdomen. Limited mobility of right arm. U 9/15/2009 9/16/2009 ling at injection site. lasting 4-5 days dizziness for 1 clay. Y 9/9/2009 9/12/2009 0-40 min after receiving a influenza vaccine, the patient's mother noticed bilat swelling aroundY eyes. No other 9/16/2009 hives 9/16/2009 noted. No redness or s ceived vaccine 9/14/09 & developed left arm/chest T2/T4 distribution shingles like syndromeUs/p injection9/14/2009 in left arm.9/15/2009 He received vaccine a
& swelling to site. Doctor visit. Dx cellulitis Y approximately Tx AMOXIL 500 T TID X 7 days. Y 9/9/2009 9/10/2009 d our office later in the day today to report that pt has hives. The only thing mom reported that Y is different 9/15/2009 today is that 9/15/2009 he received his 4thY 9/10/2009 UZONE vaccine injection on 9-4-09; family came in to clinic on 9-10-09 and received flu vaccine Y injection9/10/2009 again a 2nd time. dizziness (Patient received a dose of GARDASIL 1st dose on 3/22/09, 2nd dose on 7/31/09 similar N symptoms 7/31/2009 after each 8/3/2009 of these doses). d 9-12-2009 @ 3:15PM. Sat 9/12 patient reports "he slept lousy". Sun 9/13 didn't feel right. Kind of a sore 9/12/2009 throat. Mon 9/12/2009 - Wed 9/14-9/16 snif ined of severe arm pain. Stated thatYthe vaccine was given very high by shoulder. Pain unrelieved N by pain 9/10/2009 med. MD9/10/2009 wants to see her. M (4 hrs after injections/ pt went to ER Y with SOB, pain and inflammation (RT) arm. F/u with primary Y on Friday 9/1/2009 9/14/09.9/1/2009 Pt forgot he had pneu nced unusual swelling and muscle pain/ache. Refused to go to hospital, but MD was contacted Y by patient. 9/15/2009 Left deltoid 9/15/2009 experienced swelling ness & swelling at site, R arm swelling Y of lips. Developed blisters in mouth at time of visit, esophageal Y restriction, 9/12/2009dysphasia, fatigue, tachyc 1/2 - 3 hours after injection, faint like s/sx; felt throat "closing". EMS called - VSS, BB 245, patient Y wanted transport to ER. Was told she w ped redness of about 3 1/2 inches in length and 2 inches wide. Site was hard, hot to touch, and Y also very 9/14/2009 painful. 9/15/2009 scess and cellulitis on upper L thighY4x4cm 11x15cm. U 9/14/2009 9/15/2009 nd vomiting s/p flu vaccination, afebrile (a 1 hour duration, 2-3 hours s/p injection). Rest and Ufluid recommended 9/9/2009 treatment, 9/9/2009 call back if sxs w ceived FLUZONE shot - about 15 minutes Y later, patient & her mother returned to pharmacy because Y patient 9/15/2009 felt dizzy. 9/15/2009 Patient turned pale a EL, PREVNAR and ROTATEQ administered Y at approximately 1000 on 9/1/09. Mother noted Y transient mottling 9/1/2009 flushing, 9/1/2009 mottling and red hiv flu shot patient relied complaining of numbness in her left side and hoarseness in her throat.YI referred her 9/11/2009 to ER since 9/11/2009 the phone # on VIS 9-14-09; patient experienced erythema, Y at site. Pain, fever 9-15-09 - reported 9-16-09. Examined Y by Dr.9/14/2009 - no treatment 9/15/2009 indicated other tha 9 pt developed nausea, then hives to left back in the evening. Pt also reported itching all over Y on 9-15-09. 9/14/2009 On 9-16-09, 9/15/2009 all symptoms resolv ful shot ever gotten, walked home afterwards arrived by noon and started shaking all over chills. U Put blanket 9/14/2009 on, could 9/14/2009 not life glass of wate Hep A and Flu Mist on 12/11. Next Y day ( 12/12 noticed involuntary hand jerking a few times Y during day. Noticed ### again following ### day 12/13. al reaction, 3x4 cm wheal, developed within 18 hours of vaccine adminsitration. No systemicYor airway symptoms. 9/16/2009 Treated 9/17/2009 with Benadryl a congestion for 2-3 days prior to imms. Y Then the Y night after the imms 2 developed fever and rapid Y breathing 9/11/2009 and was 9/12/2009 assessed in the ER and n has been received from a registered Y nurse concerning her daughter who had been Y vaccinated N with three 8/14/2007 doses of10/1/2007 GARDASIL and after t rmation from a consumer with follow up information from a secretary at a physician's office, concerning U a8/24/2008 24 year old female with warts and n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning N a 16 year 6/15/2009 old female 7/1/2009 with no pertinent me n has been received from a physician Y assistant concerning several "30's" female patients who U were vaccinated with GARDASIL series on u n has been received from a physician's Y assistant concerning a 14 year old female with a history Y of a seizure 8/21/2009 when she 8/21/2009 was 10 years old wh rmation was received on 04 September Y 2009 from a consumer. A female patient with no reported U past medical history received an influenza ort received on 08 September 2009 Y from another manufacturer, report # WAES0908USA04708 N whose initial 8/26/2009 reporter8/26/2009 was a health care prof ort received on 10 September 2009 Y from a consumer. A 3 year old female patient finished her fourth dose of DAPTACEL (lot number, route ceived Varicella Vaccine on 9/2/09 and Y came down with low grade temp and numerous bumps Y on 9/12/09.Went 9/2/2009 to Dr. 9/12/2009 and diagnosed as C d stuffy nose lasting more than two weeks so far; fever of 102.4, severe headache U perienced nausea and runny nose within 24 hours of vaccine administration. Y 9/14/2009 9/15/2009 STATES THAT ON 9-14-09 AT ABOUT 8PM HER RIGHT ARM BECAME SORE AT INJECTION N SITE, 9/14/2009 THE FOLLOWING 9/14/2009 DAY SHE STAT -101.4 developed approx. 18 hours after vaccine. Had the fever for 2 days. Muscle and joint aches for 29/11/2009 days. Slept9/12/2009 an unusual amount for with erythema and edema and itching Y from deltoid to wrist, began within 48 hours of KinRix adminsitration Y 8/24/2009 to left deltoid. 8/26/2009 Treated as allergic ined 3 days post influenza vaccine, demonstrated neutropenia (ANC 650) and mild thrombocytopenia U (plt 9/11/2009 150). Patient 9/14/2009 otherwise well and a 2:30 p.m. Inluenza injection given. Y Approx. 3:30 p.m. client reports began feeling short of breath. Y Approx. 9/16/2009 4 p.m. client 9/16/2009 returned to our offic ped Graves Disease an autoimmune disorder (rare for pt's age group) that was not diagnosed N officially until 4/20/2007 Spring of 5/18/2009 2009. 9/28/09 PCP m after vaccines given child felt light-headed, sat down on front steps.When I was notified child was in back 9/17/2009 seat of cab 9/17/2009 and back to normal c ately 2 minutes after receiving Tdap, MCV4 and HPV, client was observed with an unsteady Y gait. Client 9/16/2009 hit the side 9/16/2009 of a hallway wall with ri pneumonia vaccine 9/14/09. Returned to clinic 9/16/09. Arm sl swollen. c/o soreness. No Y redness at injection 9/14/2009 site, 9/15/2009 however, a 2 inch wid at injection site which got worse on 9/16/09 then better on 9/17/09. Also itching around the injection Y site. 9/14/2009 9/14/2009 Fatigue, Nausea, migratory joint pain, Y joint swelling, abnormal TSH,T3,T4, headaches U 8/10/2007 9/13/2007 vaccine administered at 7:30 am. By Y 10:00 am developed sore throoat, cough, progressed toY chest tightness 9/16/2009 difficulty 9/16/2009 swallowing by 11:30 04 degree noted by school nurse. Y 9/10/2009 9/11/2009 g/clawing at eyes crying 9/16/2009 9/16/2009 zziness, nausea, vomiting, hot sweats. Occurred a little over 20 hrs & lasted 24 - 48 hrs. NoYfever. min after vaccination, pt c/o dizziness, feeling like he was "blacking out". Pt was able to lay down Y with feet9/11/2009 elevated. BP 9/11/2009 was taken. Felt bette l changes, agitation, obsessive compulsive Y behavior starting within 2-3 days of receiving DAPTACEL N #5,8/20/2009 MMR II #2, 8/23/2009 IPOL #4, Varivax #2.
t crying for 3 hrs, with fever". "Also short of breath & irritability". Child had previous immunizations Y in another 9/2/2009 country 9/2/2009 but did not have reco len, heat in area, hard knot. Erythemic flap 2 inch from clavicle to elbow. Painful, itching withYvesicles -->9/10/2009 3cm diameter. 9/10/2009 ning: red blister/rash 1" long rt shldr. Next 5 days: burning, very red at injection site (injection Ysite was back 8/20/2009 of left arm) 8/21/2009 2" diameter welt at in ellulitis on vaccine site. U 9/9/2009 9/11/2009 at injection site approx 19-20 hours after PNEUMOVAX injection. About 2" around site. Warm U to touch. 9/14/2009 Dr's office 9/14/2009 contacted patient told to h to under knee of left leg swollen 2x's normal size-warm to touch. Y 9/10/2009 9/11/2009 all over. Fever coughing runny nose. Y 4/30/2009 9/12/2009 9/8/2009 9/9/2009 d Shot Thur and reported "some reaction Sat. to MD. Dr. Keith reassured patient. School nurse and mom9/3/2009 report the side 9/5/2009 polio was received d mother report - after HPV #1 patient skip one period. After HPV #2 skipped 2 periods and now menstrual 8/28/2008 cycle irregular. er stated swelling, red and hot on the Y area vaccine was given. Y 9/9/2009 9/9/2009 after receiving the guardisil shot in her left arm she awoke with a painful lump above her leftNclavicle. Ten 8/13/2009 days after 8/18/2009 the lump, she saw the ternational student from China. Was given her 1st of 2 reguired doses of MMR on 09/14/09 UsubQ in her9/14/2009 left arm. A9/15/2009 mantoux test was also njection on tuesday here in her R arm. Y she noted some reaction that started a little that nightYand then more 9/8/2009 on wednesday 9/11/2009 wiht redness an T/C from Carole Chiv. States received Flu vaccine on Monday, September 14, 2009 in left deltoid. Y States 9/14/2009 immediately 9/14/2009 felt a pain in her lef hin, abdomen, and both arms. Lips Y began to swell. patient took 2 doses of benadryl liquid. Y swelling of lips 9/11/2009 did not decrease, 9/11/2009so she went t got Zostavax shot. By the time she Ygot home, she noticed her feet and ankles swollen. SheYcalled us to9/16/2009 report the 9/16/2009 side effects and called h after recieving vaccine, client passed out and hit his head on counter. Loss of conciseness for Y appox 1 minute. 9/17/2009 Client 9/17/2009 did recover, alert and 2 hrs after vaccine I started shaking uncontrollablly, and was extremely cold, I could not warm Y up. Temp.9/10/2009 was 98.6. Put 9/10/2009 8 heavy blankets on h and low fever. Y 9/8/2008 9/10/2008 oke out in hives/rash within minutes of administration. No respiratory distress or edema noted Y by physician, 9/14/2009 no other9/14/2009 complaints of symptom ng at the site of injection immediatatley Y after injection. 1 hour later: c/o headache, numbing at Y mouth/lips, 9/11/2009 pale progress 9/11/2009 to thighness in che ft Shoulder where vaccine was given. Soreness, red, swelling at injection site (hive). Pain lasting Y two days 9/14/2009 and counting. 9/14/2009 Notes JOSEPH LURIO 9/16/09 01:56 Y PM Signed Billie A Bernard is a 4 year old female brought N by father 9/10/2009 presenting 9/12/2009 with drug reaction. O and swelling from the shoulder to the elbow U 9/16/2009 9/16/2009 er anthrax vaccination to the right deltoid, patient reported 2 episodes of right arm carpal spasms Y that lasted 9/15/2009 for several 9/17/2009 minutes. Denies an eived HPV, HAv, MCV4. Advised to stay seated. Stated she wanted to go to lobby and went.Family Y started 9/17/2009 to walk9/17/2009 to WIC clinic. Started f ibed by employee as "swollen 3-4 inches Y below injection site, red and warm to touch" Y 9/15/2009 9/17/2009 subject is a 13-year-old female withYa history of reactive airway disease and nasal allergies U who received 8/28/2009 Fluzone through 8/28/2009 our school-base monia (fever 101-102 x 3 days, started Y 3 days after vaccination; productive cough). PNA diagnosed U by PCP 9/8/2009 6 days9/11/2009 after vaccination after C ticarial reaction N 9/15/2009 9/16/2009 after recieving smallpox vaccine to right arm, patient noted numbness of left tricep area. Over the next few 8/28/2009 days he experienced 9/5/2009 pruritis of mid clavical to upper arm and warmth in Deltoid began 24 hours after injection, with crescendo Y for 24 hrs, 9/10/2009 then gradually 9/11/2009 decreased pain. dministered without any noted problems or concerns. 9/16/09 soreness noted. By 9/17/09 noted swelling9/15/2009 ~2" diameter, 9/16/2009 redness, heat over d itchy rash all over body about 8 hours after vaccine. Responded to Benadryl. No egg or other Y vaccine reactions 8/28/2009have 8/28/2009 been noted prior to veloped chest tightness/pain with associated shortness of breath and bilateral lower leg numbness U on 9/10/09. 9/4/2009 Symptoms 9/10/2009 persisting but n 9/8/2009 N 9/1/2009 9/8/2009 o patient reported onset of a stomach Y ache withY5-6 hours of crampy2abdominal pain mid May Y 2009 w/o any 5/8/2008 associated 5/20/2009 symptoms (fever, di not clear. Suggested pt. contact physician. Y N 9/11/2009 9/12/2009 eceiving PNEUMOVAX, pt had rashYon injection site w/c progressively increased in size prompting Y ER consult. 9/8/2009 Rx CEPHALEXAN 9/8/2009 and PRE und mouth, and on angle of mouth where vaccine drip down, vomiting, diarrhea. Retaining. Irritability, Y diaper 7/9/2009 rash. After 7/10/2009 ROTATEQ. rec'd flu vac 9/1/09. 4:00 pm LA aches, pain, 8:15 pm redness, fever 101 degrees. Pain up into neck. Pt.9/16/2009 took TYLENOL 9/16/2009 9/16/09 then agai ale received MMR, IPV in right deltoid. About 5 hours later she developed significant abdominal pain and8/26/2009 achiness of8/26/2009 her arms and legs. 36 ately 10 minutes after vaccine administered, pt felt nauseated and hot and had syncopal episode. Y Pt "woke 9/11/2009 Up" drenched 9/11/2009 in sweat. Y 7/20/2009 7/20/2009 cellulitis at site of injection starting on Y day of injection 9/15/09, patient given BACTRIM DS TBID Y X 7 days 9/15/2009 and DECADRON 1cc. iven on 9-16-09 @ 245/PM. Pt. developed "severe headache & vomiting overnight" (per mother) 9/16/2009 9/16/2009 given 9/11/09 on 9/17/09 pt reported arm was red near injection site and slightly raise where vaccine was9/11/2009 given. Patient 9/13/2009 also states she got e, nausea, achy, numbness in fingers, clammy. U 9/16/2009 9/16/2009 e received @ 10:30-within 15 minutes Y became itchy-rash began to developed and progressed Y seen in ER~12 9/16/2009 and received 9/16/2009 IV Benadryl & weak, tired, feeling cold. 9/15/2009 9/16/2009
crying, irritability. Resulted in return Y to MD office and referred to E.D. Abdominal X-rays (R/O Y intussuscaption) 9/16/2009 and9/16/2009 urinalysis done (R/O U puffed or swollen, abut size of a baseball, Y soreness, difficulty swalling, glands in the neck swollen, almost 9/15/2009 Blacked out, continued dizziness s & tingling of hands & extremities immediately Y following injection. Shortness of breath shortly Y after but had 9/15/2009 continued 9/15/2009 to notice increased s noticed red rash on left arm (10x7) Ywent to clinic gave shot of DEPO-MEDROL and ZYZAL.YEither allergic9/7/2009 to flu or Pneumonia 9/7/2009 shot. ollowing administration of varicella vaccine Y a 3.n. diameter of redness + swelling was noticedNby pt. on the9/9/2009 adminis. 9/10/2009 area. Mother of pt. took Y 9/11/2009 9/14/2009 flu shot 9/10/09 @ mid morning (AM). 10:00 PM: Itching of arms & legs -> hives, raised all Y over body shortly 9/10/2009 thereafter. 9/10/2009 Heart racing. Pul ceived shot at approximately 3pm 9/10/09 and started feeling ill in the evening. He has suffered Y chills and 9/10/2009 numbing 9/10/2009 of the lips, and has also Heat radiation aft swelling of vaccination site. Y 9/10/2009 9/10/2009 tes after FLUVIRIN injection, pt felt dizziness, skin itchy and slight difficulty breathing. Pt used Y personal Proair 9/12/2009 HFA 9/12/2009 inhaler and felt better w r, vomiting, SPLITTING headache and slept a lot. Thank the lord. U 8/29/2009 9/3/2009 e and red, firm warm area 60 mm round noted on left deltoid. Used ice. Advised to follow-up Y with PMD. 9/9/2009 9/9/2009 n left arm in area of injection -sore -Not feeling well; fever on 9/8/09 U 9/2/2009 9/5/2009 IPV administered in R thigh on 9-9-09 Mom noted redness, swelling and pain around injection Y site R thigh 9/9/2009 on 9-11-09. 9/11/2009 KEFLEX 250/5 2 ts n & swelling following immunization from injection site to hand. 15 weeks post administrationNleft hand continues 5/28/2009 to 5/28/2009 swell, loses grip with gr lling, lungs filling up, swollen feet, fever Y within 5 mins. Within 24 hours. wollen area entire upper arm with temperature of 102 F. Y 9/8/2009 9/8/2009 scribed extreme achiness in his muscles & joints. Most prominent in hips and both biceps, beginning N a few 9/3/2009 days after 9/6/2009 his flu shot. No resp one call 9/14/09, pt received HPV #2Yon 6/12/09. Went to ER 6/13/09 for fatigue & body aches, Y unable to6/12/2009 hold 3 mo6/13/2009 old son. Per pt. given ded, itchy eyes, red eyes, throat felt Ytight, difficulty swallowing (not severe). Seen in ED givenYPrednisone9/15/2009 60 mg po,9/15/2009 prescribed Prednisone red and swollen around injection site. Y Patient was Rx-KEFLEX and Prednisone. Y 8/25/2009 8/26/2009 h swollen, red area around injectionYsite. Hives followed 3-5 days later. 8/28/2009 9/10/2009 s next day, swelling started 9/15/09 and has gotten worse 9/16/09, red, hard, measuring 3 1/2 Y length 4" 9/14/2009 wide, tiredness, 9/15/2009 fussy. Y 9/16/2009 hat within 8 hrs of receiving the FLULAVAL vaccine she developed "inflammation" and erythema Y to L upper 9/3/2009 arm, along 9/3/2009 with thoracic back sp per arm - Red, warm, slight enduration no treatment. U 9/14/2009 9/15/2009 a shot given Sept 14, 2009 at 11:30. Wed morning noted bright red, feverish, hard, terrible achy Y feeling,9/14/2009 hurt all over, 9/16/2009 difficulty moving arm e evening of the vaccine temp wentYup, fever, chills, weakness, also nausea. When he cameY to ER 8-22-09, 8/20/2009 temp was 8/20/2009 101.9, fever, chills, ain developed locally at injection siteYabout 6 hours after injection lasting about 72 hours. cine Wed 9/2/09 and had soreness at injection site. Thurs next day onset of nausea, diarrhea, Y fever, itchiness, 9/2/2009 headache 9/3/2009 and malaise. n has been received from a female Y registered nurse with no pertinent medical history Y who onN 03-SEP-2009, 9/3/2009 was vaccinated 9/3/2009with the secon n has been received from a physician Y concerning a 73 year old male patient withYdiabetes and N no known6/12/2009 drug reactions/allergies 6/16/2009 who on a d pneumonia vaccine 9/16-called 9/18 to report big red blotches - swelling, soreness painfulYto touch - shoulder and front of forearm- advise shot on 9-11-09 approx 11:00. At 17:00 her temp was 101.4. No sore arm at that time. By 19:00 U R arm was 9/11/2009 swollen.9/11/2009 By the next morning R U 9/11/2009 9/11/2009 hours of receiving varicella vaccine in R arm, pt. developed erythematous, pruritic, hard induration Y approx.9/9/2009 10 cm x9/10/2009 10 cm. Prescribed LO nutes of the administration of the vaccines pt became pale and felt lightheaded. She began c/o Y numbness 7/21/2009 in her hands 7/21/2009 with her hands feeli ates that she was not able to form her words or speak the day after vaccination. She states Y that the event 9/15/2009 eventually 9/16/2009 subsided and she did ated -migraine starting about 6 hours Y after vaccination, low grade temperature - swollen lymph U nodes under 9/8/2009 arm, neck, 9/8/2009 groin area. Terrible on left and right hand- Itching, dry skin, tightening of skin at both wrists - For four days - Took Y antihistamine, 9/1/2009 used CLARITIN 9/3/2009tablets. was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age4/14/2000 who was vaccinated with LYMEri er receiving VARIVAX and IPV on (L) Y arm, patient Y developed induration and vesicles, spreading N all the way 9/15/2009 below (L) 9/17/2009 elbow, required IV an ythematous, hot, edematous from shoulder to elbow. (+) nausea and low grade fever. U 9/19/2009 9/19/2009 Severe swelling and redness at site. Y Extends to approximately 4 inch circular diameter surrounding U injection 9/16/2009 site. Painful 9/16/2009 when using. Tigh after receiving my vaccination, I started breaking out in hives around my neck, shoulders andNa couple on9/16/2008 my right hand 9/17/2008 (shot was administ 009 patient called me to report injection site causing discomfort and pain in her (L) shoulder.YStated, "I feel 9/9/2009 the injection 9/10/2009 was given too high at site on right arm, down to midarm. Site swollen, red, hard warm to touch for 2 days. Symptoms Y decreasing 9/16/2009 on the 9/16/2009 third day. more than usual shotsSOB x 1 1/2 days HA, muscle aches, swelling and redness at site x 3 days Y 9/5/2009 9/5/2009 at onset; SOB, muscle aches, HA lasting 1 1/2 days; swelling and redness at site lasting 3days Y 9/5/2009 9/5/2009 nted 24hrs post immunization with an Y approx. 6cm in diameter red, blotchy urtsicarial region surrounding Y 9/16/2009 area of admin. 9/17/2009 in L thigh. Raisedm with some itching appeared on hands, arms, and legs (about 25-30 raised bumps). NoticedUthis two days 9/14/2009 after Flu shot. 9/16/2009
CALLED THIS AM TO REPORT THAT LAST EVENING CHILD'S LIPS AND LEFT SIDE OFYFACE STARTED 9/17/2009 TO SWELL. 9/17/2009THE LEFT DE , unconsolable crying all night, fever x 24 hours Y 7/20/2009 7/20/2009 ght rash, and facial flushing approximately 4 hours after influenza vaccine received. She took Y po Benadryl 9/17/2009 which provided 9/17/2009 some relief of itc 10 cm swelling and induration on L Y arm surronding the Kinrix injection site U 9/16/2009 9/17/2009 ves, headache, sore throat, nasal stuffiness after receiving LAIV. She took some Benadryl. UHives are gone, 9/17/2009 but itching 9/17/2009 still present as of 9 ODE SWELLING AND PAIN IN AXILLARY REGION OF ARM THAT VACCINE WAS ADMINISTERED Y 9/10/2009 9/12/2009 Sep 09. Pt states the left side of her face was numb, drooping, and drooling. It resolve spontaneously Y by 9/16/2009 0530 on 17 9/16/2009 Sep 09. swelling to left deltoid area. Left upper Y arm tricep/bicep area with redness and swelling. Spoke Y with patient 9/14/2009 today she 9/15/2009 states that her arm is STATES INSIDE ARM AND COLLAR BONE AREA INFLAMMED AND REAL SORE. RECIEVED Y FLUVIRIN 9/16/2009 AND PNEUMOCOCCAL 9/17/2009 VAC the Flu shot on 15 Sep 2009. Ibegan Y breaking out with a severe rash all over my body., This Y first began 9/15/2009 to appear9/17/2009 on September 17th,...W administered at 11am 11 Sept 09. By Y that evening I started experiencing severe heart rhythmn N problems, 9/11/2009 irregular 9/11/2009 heartbeats, skipping be EAR LEFT ELBOW 45 MINUTES AFTER RECEIVING VACCINATION. Y 9/14/2009 9/14/2009 when vaccine was injected she experienced dizziness "metallic taste in mouth" H.A. mid on forehead U - States 9/10/2009 was also 9/10/2009 seen black spots in ematous - "hive like" - area distal to injection site - (2 cm lower) area is sl warm to touch - approx Y 6 cm X 9/17/2009 3 cm - Otherwise no other untowar day 2 after KINRIX (DTaP/IPV) given Y with 9 cm length X 7 cm width area of inflammation/erythema, U slight 9/15/2009 central swelling 9/17/2009 and warmth to to izure 9 hours p shots. Y Y 9/9/2009 vesicular rash/eruption at vaccine injection site, calamine lotion topically, no further treatment Y warranted.9/16/2009 9/18/2009 t lightheaded and needed to sit down. Paramedics called, patient evaluated. Y 9/18/2009 9/18/2009 hours of administration, mom notesYredness and swelling of eyes-eyes swollen shut. U 9/16/2009 9/17/2009 increasing redness and swelling onYR arm beginning 9-17-09. Warm to touch. Mild sorenessY noted. 9/16/2009 9/17/2009 edness at HIB vaccine site of flu vaccine Y site. U 9/16/2009 9/17/2009 local reaction, redness, mostly, mild tender to R lateral thigh, likely site of TRIPEDIA injection. U 9/9/2009 9/10/2009 red, tender area around injection site. Pain up to shoulder, symptoms first noted 9/16/09. U 9/15/2009 9/16/2009 ovartis FLUVIRIN vaccine (UT97840P1, Y exp 5/10) in Rt arm. Pt immediately complained of dizziness, U then 9/18/2009 dry throat 9/18/2009 and cold feeling/tingli ured capillary immediately after injection. Y Seen by Dr. He said blood pressure was fine, no issues Y breathing. 9/17/2009 Patient9/17/2009 told him she has issue ldly raised erythematous papules with clear halo surrounding them. U 9/14/2009 9/15/2009 wk of vaccination rash began on fingers, hands, toes and feet. Bumpy rash, itchy. Did not seek medical treatment. 8/6/2009Is8/12/2009 resolving and areas are swollen. No redness or warmth to the touch. Y 9/15/2009 9/15/2009 ven JE-VAX yesterday at a facility/clinic at Kings Bay. He woke up today with swelling around eyelids and9/17/2009 urticarial rash 9/18/2009 to arms and hips. N Y Y 9/16/2009 9/18/2009 erythemic, pruritic, round and oval plaques,lesions approximately 4 inches x 3 inches appeared Y on inside 9/17/2009 of upper right 9/17/2009 arm extending from the vaccine at 12, about 15 minutes after the injection began to have itching eyes, face hot, Y bil ear pain and 9/18/2009 throat and 9/18/2009 chest tightness was red,swollen, and warm to touch. Patient complained of arm itching and pain. U 9/17/2009 n in clinic for routine Tdap referred from prework physical. Denied any immunizations in last Y10 years. Wehn 9/10/2009 Tdap put 9/10/2009 into MCIR, it shows c ates she had pain, redness at site of injection, hives, fever, joint pain-occurred same day of injection. Y 9/15/2009 9/15/2009 warmth- left arm. Y 9/9/2009 9/10/2009 eaction occured at about 1:30 pm. Pt Y felt light headed, experienced pain on both sides of abdomen, U and9/18/2009 began experiencing 9/18/2009trouble breath rm above elbow to below elbow volar red tender and warm to touch. 9/15/2009 9/16/2009 urs after receiving immunization started to have body aches and chills, Temp rose to 101 F, developed Y profound 9/16/2009 sense 9/16/2009 of exhaustion and d after second Varivax she developedYa 3 1/2 x 3 1/2 red hot warm papule on her right arm that U was swollen 9/14/2009 and puritic. 9/15/2009 Parents were afraid 630 patient was in her usual Y state of health when Y she received the 14 flu vaccine from the ClinicUlocated inside 9/16/2009 a supermarket. 9/16/2009 Approximately H DTAP TO A 2YR OLD U 8/24/2009 8/24/2009 Tdap and Varicella and Menactra on 8/14. Started with soreness in Left shoulder soon after.U Soreness 8/14/2009 and pain with 8/14/2009 movement continued ed Pnueovax in right deltoid area SQ: the area was red, warm to touch, with about 2+ edemaYat site. 9/17/2009 9/18/2009 vaccine 9/1/09 at 6:44pm. Symptoms Y began 9/2 at 8:00am and I still have them. Periods of N severe vertigo 9/1/2009 where entire 9/2/2009 room is spinning. ight upper arm became very sore later that evening and then became red, hot and swollen. The N entire upper 9/16/2009 arm was 9/16/2009 swollen. She also ex ter had the flu shot given to her on 9-16-09 at 4:45 pm, she had severe pain in the arm and at U 8:00 pm she 9/16/2009 developed 9/16/2009 a low grade 100.3 fe . Bilat. upper extremity weakness, achiness Y all over (muscle). 9/15/09 T 101-102 degrees F, U tightness in 9/14/2009 throat. 9/169/14/2009 MD visit decreased joi cine after lunch. Since she receivedYthe injection she felt bad. Swelling of her tongue, tenderness Y in neck. 9/17/2009 Took BENADRYL 9/17/2009then came to over body, neck and face, itching. Y Y 9/16/2009 9/16/2009 ter shot arm pain. 24 hours fever, body Y aches. 72 hours still fever, arm red, welts, warm to touch. Y This arm 9/14/2009 received9/14/2009 PNEUMOVAX.
udent given a second MENACTRA vaccine. 1st MENACTRA given 4/24/08 9/18/2009 ds occurring spontaneously-began one weeks p vaccination-occur several times a week-lasting few minutes-has 9/4/2009 not9/11/2009 needed to seek medic me to pharmacy for Pneumovax vaccine. Y Vaccine was administered in left deltoid. Patient called U back to9/10/2009 pharmacy 9/10/2009 7 hrs later with complai IPV given at 3:15 pm. Pt c/o chest & Y back pain, then started to become nauseated at 3:20 pm, pt expectorated 9/18/2009 clear 9/18/2009 phlegm. Feet started break-through Varicella infection. Y 9/3/2009 9/14/2009 ore. By 9pm felt nauseated, both shoulders and upper arm began to hurt as the night progressed U pain moved 9/17/2009 down9/17/2009 his back and hips. Nau ng shortness of breath, weak, dizzy,Y and felt like passing out and vomiting. My hands became Y tingly and9/16/2009 sweaty, I was 9/17/2009 taken to the emerge arditis treated with NSAIDs. PatientYis currently located and was vaccinated abroad. BP 133/85, HR 63,9/10/2009 RR 12, temp 9/19/2009 98.2, O2 99% on roo mmunization generalized malaise and Y myalgias and pain and 4 cm swelling at injection site,Unausea and9/18/2009 vomiting and 9/19/2009 mild reported vertigo omiting, fever of 101 degrees, pain Yat injection site, swelling at injection site, diarrhea, stomach Y ache, headache 9/16/2009 9/16/2009 xacerbation: wheezing, difficulty breathing. Y Epinephrine (1:1000 1 mg/ml) 0.5 mg sq given, 8Umg Decadron 9/19/2009 IM, albuterol/atrovent 9/19/2009 respiratory ceived the rotavirus vaccine on 9-11-09 approx. 4pm. The next morning he developed a fever U and it became 9/11/2009 high (103.5 9/12/2009 degrees F)and th vaccine given on same day as, or close to time of, receiving other vaccines such as hep B and Y other travel5/1/2006 vaccines -5/7/2006 maybe typhoid. Seve ed body itching, progressed to hives and low grade temp (100.3) over a period of approx 10Yhours. Took 9/17/2009 2 over the9/18/2009 counter Benedryl for th 9 when making a follow-up call to patient, the patient reported: Approx. 6 hours after receiving N vaccine, 9/17/2009 she felt "bronchitis-type" 9/17/2009 symptoms ORTY HOURS AFTER THE SHOT SHE DEVELOPED A FEVER THAT LAST ABOUT THREE U HOURS<9/14/2009 SHE THEN 9/16/2009 DEVELOPED A SPO iving the flu vaccine at work, I started coughing about 2 hrs afterward. At approximately 6 hrsNafter the vaccine 9/17/2009 my left 9/17/2009 hand and especially a flu vaccination around 10:00Am on Thursday 17 September by 4:30 PM I was experiencing Y dizziness9/17/2009 and muscle 9/17/2009 aches. By 6:00 pm I w nza vaccine approx 1:30 pm. About thre hours later, eyes began to swell, red and itching. Approx Y 1/2 hr 9/18/2009 later lungs9/18/2009 felt congested, face flu ot at 6pm. 10 pm felt throat itchy & Ywoke up at midnight with swollen lower lip & tongue, some Y wheezing9/16/2009 and loose 9/16/2009 BM. Took two motrin. S pain at injection site, unable to move arm. Extreme flu like symptoms, all muscles in pain, migraine U that won't 9/18/2009 go away, 9/18/2009 chills, vomiting, fever ccine was given intranasally to apparently healthy Y child on 8.17.09. 0Approximately 48 hoursUlater, developed 9/17/2009 fever,9/19/2009 sore throat, nasal cong as administered LAIV even though patient Y was contraindicated due to aspirin therapy. LAIV Y administered9/17/2009 on 09/17/2009; 9/20/2009 on 09/20/2009, at fever (100.5F), diarrhea initially normal color and explosive, turning to green and chunky within N 24 hours. 9/15/2009 9/15/2009 symptoms within a few hours: aches,Y chills, fever (to 103F), foggy thought processes (troubleUarticulating9/20/2009 thoughts), 9/20/2009 flushed face, minor cou across chest. U 9/19/2009 9/20/2009 d swelling and itching at site of injection. Parent reported no breathing problems and was told Y to apply a9/19/2009 cold compress 9/19/2009 to site. at the injection site. U 9/20/2009 9/20/2009 came light headed, dizzy, pale and complained of trouble breathing, 911 was called and EMT's Y arrived. 9/18/2009 Symptoms 9/18/2009 resolved and patient did ven PNEUMOVAX on 9/14/09 at 12:00 in left deltoid. Y Patient called 9/16/09 11:35 - fever 102.4 - c/o headache 9/14/2009 and 9/15/2009 chills- left arm pain. 9/1 eived Hepatitis B vaccine following birth on 7/30. Resident ordered Hepatitis vaccine again on 8/4/09 at 09:35, 7/30/2009 RN requested 8/9/2009Hepatitis vacc male vaccinated with ROTATEQ-R- vaccine on 8/18/09 under FDA IND #13843. Patient tolerated Y vaccine. 8/18/2009 On 8/25/09 8/21/2009 follow-up visit, moth 4-29-09: Dry hives - headaches - tightness in chest - 05-13-09 Dr. Nausea/headaches- spleen pain/swollen4/27/2009 weakness/fatigue 4/27/2009 - Dr - 6-16-0 sted DPT vaccine but received DPT + Polio Vaccine -KINRIX-. Patient did not receive the vaccine as the RN double8/29/2009 checked the drug conte after immunization, child developed redness and swelling of R deltoid are. Came to office andUwas prescribed 9/9/2009 ZURTEC 9/10/2009 prn and Cephalexin apular rash on Bilat upper and lower extremities. Pruritic and bright red about 12 days from vaccine. Y 9/2/2009 9/14/2009 d 5 1/2 cm wide to 4 1/2 cm long red, raised knot. Itching. Mom described 0 pain. (Warm toYtouch). Mom 9/15/2009 informed9/16/2009 to apply warm compre oose, mucousy stools x 10, some blood- probable fissure. 10/9/2009 MR from PCP for visit 9/18/2009. Y Patient 9/17/2009 received 9/17/2009 vaccine 9/17/2009, 9/15/2009 mplained of tingling in left arm, spreading Y to side of body. Lips maybe felt funny. Y 9/15/2009 9/15/2009 t 4 yo imms in May in another state. 9/14/09 We did physical and had no data gave again. Y 9/14/2009 eft pupil dilated 60" after injection. Went Y to ophth - resolved with PILOCORPINE & sent to ED Y for neuro work 9/4/2009 up CT, CTA 9/4/2009 work up was inco d 9-9-09 PM. Lt. leg a little red & sore Y on 9-10. On 9-11 Lt. leg red & swollen, hot to touch. YChild wouldn't 9/9/2009 walk. Lt.9/11/2009 leg swollen & red to kn e fever noted @ "bed time" 9/3/09. Temp 102 degrees F @ 7:15am 9/4/09. Child had been given Y TYLENOL: 9/3/2009 Ibuprofen 9/4/2009 night before and in m eft arm red, hot, tender no increase Yin size on 9/2/09. Rx: ORAPRED, BENADRYL, cool compresses. Y Rev 9/1/2009 9/3/09 - Resolving 9/2/2009 local Rxn . de a phone call to clinic on 8-31-09. States she received HBV #2 & TDAP vaccine on FridayY8-28-09. Last 8/28/2009 night, 8-30-09, 8/30/2009 developed a ras 9 clients aunt called clinic @ approx 16:30 stated client was c/o "abd. pain & discomfort." Stated "she was 9/15/2009 feeling "pukey". 9/16/2009Denied fever. ceived all 5 doses of Rabies vaccination series at one time. Y 9/13/2009 was a little over 1yr old he received 4 shots- one in each extremity. He stopped saying "MD" and "DA" did it and saying words again until 3 y n has been received from a physician's Y assistant concerning an approximately 1 Yyear old female N patient who 4/8/1999 on 08-APR-1999 ### was vaccina d her second injection of the Gardasil Y Shot in June 2009 and since then she has lost most ofNher hair. She 6/2/2009 is also getting 7/21/2009 scabs on her hea
eveloped a low grade fever from 99.5-100. degrees. He had chills, a severe pounding headacheN where he 9/16/2009 was grabbing 9/17/2009 his head in pain w d 6 days after immunizations to sayYthat child's face was swollen and that he had hives. Started Y on Friday, 9/8/2009 Septmeber 9/11/2009 11, 2009. Instructe ven 3 immunizations and was being Yinstructed by MA to remain seated when pt had an episode Y of vasovagal 8/11/2009 syncope 8/11/2009 and fell off exam tabl ven pre-kindergarten immunizationsYwhile seen for well child exam on 09/08/09. Pt then returned Y 09/10/099/8/2009 and was seen 9/10/2009 by Dr. with c/o ind atient in the hospital for a cellulitis onYmy left leg and was on Bancomyacin IV. I was given theUpneumonia9/14/2009 vaccine in9/15/2009 my right outer thigh wh operly screened and identified, at 1120 Y AM anthrax #2 was administered IM to the left deltoid. Y Within 209/21/2009 seconds the 9/21/2009 patient began to feel ys of receiving Fluvirin patient experienced Y sore arms, difficulty raising arms and bruising. HeNreceived a 9/12/2009 fluvirin injection 9/12/2009 in each arm in erro atigue, mono, chronic strep throat, Hashimoto's, Y extreme face and body swelling, aching muscles. N Got first 7/10/2008 vaccine 7/10/09### Lot 0072X in co ot was administered via injection into Y left upper arm. Immediately my face began to burn myYears turned bright### red, I got dizzy ### and sick to m hours of the vaccination, I noticed hives on the inside of both of my thighs. I had the vaccineNon 9/18 and9/18/2009 today is 9/21 9/18/2009 and the hives are st cieved flu shot at approximately 6am on 9/15/09. Approximately 2-3 hours later (per the patient) Y both arms 9/15/2009 became9/15/2009 red and blotchy from e was reported by a physician via sales Y representative and described the occurrence of injection U site redness in an unknown number of subj was reported by a healthcare Y professional Y and described the occurrence of anaphylaxis Y in aU23-year-old9/17/2009 female subject 9/17/2009 who was vaccinate at night with hot flashes, stomach abdominal pain, Y nausea, fever. Taken 1 to ER 8/15 discharged with heat stroke 8/6/2009 diagnosis, 8/15/2009 given Motrin. 9/1 len about 4-5 inches below injectionYsite. FeverY100 degrees C for 14day. Problems mainly arm; Y unable to 9/15/2009 lift. MD prescribed 9/15/2009BACTRIM and ter vaccination she was not lucid and spiked a Y high fever. Admitted4to hospital. White bloodYcount 0. Liver 9/15/2009 function9/15/2009 affected. Diagnosis an went to ER. Received 4 doses of ATIVAN and 1 Y dose of DILANTIN. 1Admitted to PICU. Y 9/16/2009 9/17/2009 after vaccine administration patient was Y seen in urgent care w/Dx of arm pain, and referred to U or the further 9/10/2009 evaluation. 9/12/2009 Patient complained m hurts from shoulder to wrist. U 9/21/2009 9/21/2009 te after receiving vaccine pt. claim to Y feel sick in stomach, started to breath heavily then became Y dosing 9/21/2009 off and not 9/21/2009 responsive. Gave 0.3m mptoms, chest congestion Y 9/17/2009 9/18/2009 of breath, lightheadedness, chills, later Y tingling of fingers, hands, arms, and tingling on legsYfrom knees 9/19/2009 down. Patient 9/19/2009 went to ER, vital sig x with Celadrin 4mg, antihistamine and Y Orapred. U 9/17/2009 9/20/2009 ates she had a rash 2 days after vaccination lasting 2 days. She reportedly applied a cold compress Y to alleviate 9/14/2009 the 9/16/2009 itching. The raised rash at injection site with little red (2-3 inch around) bumps around it, itching. Y 9/18/2009 9/19/2009 a couple of hour after receiving the shot she experienced pain. Each day it has increased. Now at 10 days. 9/11/2009 She fells9/11/2009 it under her arm - trave of bottom lip with repetitive licking (possibly Y due to itching). 9/18/2009 9/18/2009 given a VARIVAX and MENACTRA on L arm. Medical assistant left the room and within secYmom called9/17/2009 for help when 9/17/2009 the physician return ccination- No symptoms. 2nd day -edema, redness, hardening at site. 3rd day- All symptomsYintensified.8/24/2009 4th day all 8/25/2009 symptoms intensified. 5 ined of dizziness, light headiness, became pale, sweaty, fainting hot 15 minutes after vaccine Y administered. 9/21/2009 9/21/099/21/2009 pt placed in supine po perienced lightheadedness and decrease Y in blood pressure (76/53) after vaccination with FLUVIRIN. Y 9/20/2009 9/20/2009 ed hot left arm where flu shot was given (from shoulder almost to elbow). N 8/16/2009 8/17/2009 arm cellulitis - Itching and stinging the Y day after immunization 9/17/09. Y 9/16/2009 9/17/2009 lump noted in arm on 9-20-09. ThenYdeveloped fatigue, lethargy, HA, nausea. Seen at urgent U care @ 830PM 9/18/2009 ON 9-20-09. 9/20/2009 Woke at 3AM on ed blotches on arms + legs on Thurs. afternoon. Patient was at the beach earlier in the day.Y Small, red9/16/2009 bumps on the 9/17/2009 arms + legs. Patien d bright red blotches on both arms + legs starting Friday morning. Has not fully resolved yetNas of Sunday 9/16/2009 afternoon. Patient was in the su 9/18/09 patient returned to pharmacy to report deltoid muscle pain after 9/4/09 has not diminished. U Hurts to 9/4/2009 move right arm especially painfu ntacted clinic the 17th stating she developed small hives and redness and itching 2 1/2 hrs after Y vaccine9/16/2009 given. Stated 9/16/2009 she applied HC crea right upper arm. Warm non tender. 9/14/2009 9/16/2009 hour after receiving vaccine, mom noted Y patient to be unresponsive in back seat of car. Patient's Y eyes rolled 9/19/2009 back in9/19/2009 head, tongue was han eling tenderness, pain in hands, arms, Y low grade fever muscle weakness in upper extremities; general muscle 9/12/2009 weakness 9/13/2009 all over. Follow up ng to bed extremely sore arm. 9/15Y- 5 AM to urgent care Rx pain MED. 9/15 - Small amount Y of redness9/14/2009 - pencil eraser 9/14/2009 size. 9/16 - silver d lling at inj site. Y 9/16/2009 9/18/2009 of seven patients who all received FLUZONE Y SV 2009-2010 (lot number U3186AA): One patient Y experienced 9/4/2009 blurry vision, 9/4/2009 ringing in ears, a ort received on 09 September 2009 Y a nurse practitioner. A 33 year old female patient with a history Y of asthma, 9/1/2009 allergies 9/1/2009 to penicillin, sulfa, la d arm being sore at end of day. Cannot raise arm above shoulder today. Patient complainsUtoday of nausea 9/8/2009 but not9/8/2009 sure if attributed to he ic, felt faint, numbness in R arm. Y U 9/14/2009 9/14/2009 ined of numbness in arm down to tips of fingers from vaccine site immediately after administered. U 9/18/2009 9/18/2009 9/14/2009 induration at injection site with edema. Y 8/17/2009 8/18/2009 area on rt arm is inflamed and hot. Pt reports feeling feverish and generally ill two days later. U Today is9/15/2009 improving but 9/15/2009 area is still getting la
ema, painful to the touch, sob, hoarseness, Y aches, pain, palpitations. U 9/11/2009 9/13/2009 een the spine and shoulder muscle stiffness on left side - neck down to the shoulder. From rate 1-10 (Pt9/18/2009 says 8-9) experienced 9/19/2009 pain after 3 er vaccination, pt's neck (both front & back) start to swell and it last about 48 hrs after recovered Y there is no 9/4/2009 residual effect. 9/5/2009 e, Fever, Arm Swollen, Arm Pain, Rash. Y 9/10/2009 9/11/2009 es as a result of vaccine. Diagnosed with on 9-11-09. Received VALTREX 1GM- 21 Pills on 9-11-09. 9/4/2009 9/9/2009 rythema and induration noted on the Y day after the DTAP administration involving the lower 1/2 Y of the left8/12/2009 upper arm. Full normal range of m ff @ 2:30p (showing swelling/reddness) Y tired + in pain @ location. At midnight fever/hives. Visited Y ER @ 9/10/2009 9:30AM 9-12-09. 9/11/2009 Tx with KEFLE , induration, fevers, myalgias, cellulitis, red - orange urine. Y shot developed severe left shoulder pain & used Ibuprofen lasted 20-30 min site ok - used ice Y pack. 9/14/2009 9/14/2009 Y U 9/3/2009 9/7/2009 shot given on 9/10/09 at 2:30p woke up on 9/4/09 10 am broke out with spot on L upper arm Y30x40 mins.9/10/2009 Given BENADRYL, 9/11/2009 TYLENOL, C "Screaming" "inconsolable" X3 hrs Y (starting approx. 1-2hrs after vaccination) vomiting X1 approx Y 4 hrs after 9/9/2009 vaccination. 9/9/2009 after shot, there was swelling redness at shot sight. After about 5 days the red area was about Y 1 1/2 X 3 9/1/2009 or 4 inches.9/3/2009 There was a pink ar egs, knees & forearms. Used BENADRYL gel. Y 9/9/2009 9/11/2009 n has been received from a pharmacist Y concerning Y a 66 year old male 0 patient with Y no pertinent N medical 9/15/2009 history and9/15/2009 no known drug allergie n has been received from Y a medicalYassistant concerning a 17 year old female with no medical Y history or9/15/2009 drugs allergies, 9/15/2009 who on 02-JUL-20 ase of cellulitis (according to Dr) that Y required an Y E.R. visit on Thursday 0 or Friday 9/17 or 9/18 U that progressed 9/15/2009 to require 9/16/2009 hospitalization. Pt w/ SCID s/p 1 dose ROTATEQ at 2 months of age admitted to hospital Y for failure to thrive 10/08 N transferred 7/28/2008 to another hospital in 11/08. F tachycardia presenting as poor feeding and decreased Y responsiveness. 2 10/5/09 Hospital records, Y DC summary, 7/1/2009received 7/1/2009 DOS 7/2/09 to 7 urs of receiving vaccines,Ypatient crying, Y weak, Y low grade fever (99.41rectal), and hypotensiveY (65/31) with 9/10/2009 pale episode 9/10/2009 (pallor). Another ch zure - new onset 1 week after varicella vaccine.Y 5 Y 9/2/2009 9/4/2009 m pt. was asleep in mom's arms 20-30 Y minutesYafter a normal feeding. 1 Made a strange, quietY cry, lost color 9/15/2009 and tone, 9/15/2009 unresponsive. No unu 2009 pt received Inactivated INFLUENZA on left deltoid IM. Pt came 9/16/09 and stated sheYstill had a dull 9/2/2009 pain, or soreness 9/2/2009 in her arm. Th eaded about 5 minutes after vaccination. She laid down and passed out for about 5 seconds. Y Rescue squad 9/4/2009 checked9/4/2009 her over and she left n, trouble breathing, rapid heart beat, Y abdominal pain, numbness in leg, numbness in jaw, sweating, N paleness, 8/7/2009 headaches, numbness in ar administered 9/11/09 LT Anterior thigh. Mother reported swelling and redness of LT AnteriorYthigh 9/14/09. 9/11/2009 Evaluated 9/14/2009 9/14/09 12 x 12 cm a she hasn't been able to move her arm since receiving the vaccine. U 9/15/2009 9/15/2009 lasting < 24 hours 5 days after vaccination, Y no fever but felt warm. Now back to normal. No Yother s/s illness. 9/3/2009 9/8/2009 mmation with erythema 8-10cm now spreading down upper arm from site of vaccination (gradual U increase9/14/2009 erythema 9/14/2009 spread over 2 days sinc cm area of erythema with a 6.5 x 5 cm area of induration around punctures sites on R upper U outer arm, mild 9/14/2009 tenderness 9/15/2009 to touch, warm to to hot, and pt started bleeding. Then almost immediately, hard, big lump at injection site formed. U Gave pt ice 9/17/2009 pack! 9/17/2009 n 7-29-09 for travel, was given oral Y Typhoid, 1st dose TWINRIX. On 7-30-09 wife called stating Y the previous 7/29/2009 evening, 7/29/2009 day of immunizations out in hives shortly after the vaccine was administered. Pt mom gave her BENADRYL and it Y went away. 9/14/2009 9/15/2009 minutes of shot he felt lightheaded & dizzy, sat down and almost passed out. Also felt "numbness" Y all over, 9/18/2009 sat for 10 9/18/2009 minutes, still felt numb 9 I took my son to his primary Y care doctor Y for the Y following symptoms: 7 fever, headache, weakness, Y pain in8/4/2009 arms and8/18/2009 legs, loss of appetite, n eaction, left arm turned red. That same day in the evening was prescribed Tylenol for pain and Y to apply cold 8/6/2009 compress. 8/6/2009 e left shoulder and arm 8-19-09 - Blister on middle finger and palm of left hand 8-22-09 - Blisters N on palm8/13/2009 left hand -8/19/2009 painful 8-24-09 - also r out in hives on arms, neck, chest, and Y abdomen. Pt reported to PCP who prescribed a MEDROL U dose pack 9/16/2009 & topical 9/17/2009 BENADRYL. e today with low grade fever 100 degrees and red/raised rash on her truck (back, shoulder blades, Y abd). 9/3/2009 Rash is itchy. 9/4/2009 Mom treating with T ed of soreness L arm with touch and movement. Has persisted x 2 weeks lasted longer thanYexpected. 8/18/2009 rythema, very itchy, red and raised around injection. Lesion continued to increase in size. Rechecked Y 249/10/2009 hour later, 9/11/2009 put on KEFLEX. 2 days redness, and warmth in arm several hours after receiving PNEUMOVAX. BENADRYL was given U to the patient. 9/14/2009 9/14/2009 e given @ 0922 AM. Onset of chills (shaking) followed by fever to 102 degrees. C/O nausea, Y diarrhea and 9/15/2009 muscle9/15/2009 aches. Also c/o fingers ceived self limiting left sided facial edema, with no shortness of breath, rash, LOC, etc. The reaction Y occurred 9/11/2009 several 9/11/2009 hours after administra d sandpaper appearance to rash. Itch to site of KINRIX (DTAP/IVP) right deltoid. Y 9/8/2009 9/9/2009 d arm swelling and "bruise" where she received influenza vaccination (at 3:58 PM 9/16/09). YFirm swelling 9/15/2009 1" diameter) 9/15/2009 surrounding arm site PNEUMOVAX & FLUVIRUI in same arm at same time b/c pt s/p mastectomy and no lymph nodes Y in right9/11/2009 arm. Pt experienced 9/11/2009 3" X 3" in fla injection, patient reported redness and Y swelling of arm around injection site. Throughout day, Y worsened and 9/2/2009 pt went9/2/2009 to emergency room w vaccines 8/31/09. Fever 101 9/3/09.YFussy, cranky, poor eye contact. 9/4/09 listless, T 103+,Ulethargic, bad 8/31/2009 rash (mac. 9/3/2009 pap. L leg & trunk) t Sept. 10 6pm - vaccine; 11 pm - stomach discomfort; 3 am- vomiting - 3 times; Fri - Sun - dull Y headache, 9/10/2009 severe diarrhea, 9/10/2009 unable to do an of breath, coughing, lightheaded, nausea. Y Running nose. Y 9/17/2009 9/17/2009
given in Lt arm. Patient reported tingling & itching running up it. Arm to Lt side of face. Welting Y observed. 9/17/2009 Throat also 9/17/2009 tingling. FNP calle lled 9/18/09 @ 1:46p to report symptoms of: sore throat, sneezing, cough, headache, fever, Uachy, no appetite. 9/15/2009 Mom9/18/2009 states "He gets this ev N vaccine administered in Rt arm 9/16/09 Y @ 3:30pm and overnight developed swollen, red, hardened U left9/16/2009 side of neck. 9/17/2009 Came back to pharm 9 this volunteer for hospital presented with erythema and "tenderness" to her right deltoid, which U progressed 9/16/2009 since receiving 9/16/2009seasonal flu va ever, headache - 30 degrees C - took TYLENOL - Fever lasted one day - Headache lasted 2days. Y 9/4/2009 9/5/2009 tetanus shot 9-14-09. That night had chills, dizziness, shortness of breath and chest tightness. Y Had fever9/14/2009 101 in am.9/14/2009 No caryza, cough, sor Tdap, she is over 64 yrs. of age. Y 9/15/2009 ated child developed 2X3inch red area on deltoid, where vaccine was administered. No otherYsymptoms 9/11/2009 were noted.9/12/2009 On 9/15, redness 50% mph node swollen on left side the next day. U 9/17/2009 9/18/2009 y up to 102 degrees 1 day later. The patient came today at 5 years of age with complaint of Y elevated temperature 9/10/2009 for 2 days it has resolve ction 3 - cm - Redness and tenderness no fever. 9/10/2009 9/12/2009 everal times bit. 7 & 10:30 PM on 8-20, vomited 1X during noc., once AM of 8-21 & once eve. Y of 8-21, +8/20/2009 once on 8-22. 8/20/2009 Was "hyper" + laug ported fever, pain, redness and heat to his right biceps 48 hours after injection. N 8/31/2009 9/2/2009 ng, erythema 8x6 cm, induration 3 1/2 Y x 4 cm. 9/8/2009 9/9/2009 ven on Thursday, Sept. 17, 2009. Symptoms started Saturday with sore throat and a little drainage. U By 9/17/2009 Monday, Sept. 9/19/2009 21, low grade fever HOURS POST VACCINE. LATER, SAME Y DAY RASH ON FACE. NEXT DAY, RASH FROM HEAD Y TO FEET 9/19/2009 AND FACIAL 9/19/2009 EDEMA. WENT nted to the clinic with redness and swelling Y in left arm. swelling extended down into elbow, red U and warm9/15/2009 to touch. dr 9/18/2009 fears ordered bactrim RECEIVED PNEUMOVAX VACCINEYON 09/15/2009 AND REPORTS EXPERIENCING LOW-GRADE Y FEVER, 9/15/2009 REDNESS, 9/16/2009 ITCHING, TEND nd a half after getting a regular flu shot(1040am) my heart rate suddenly increased and my blood Y pressure 9/17/2009 dropped (1210pm). about 4:00p n bilateral thighs where injections were Y given-patient taken to ER-given Keflex po x 7-10 days Y 9/14/2009 9/18/2009 0 MINUTES AFTER RECEIVING THE SEASONAL FLU VACCINE, VICTIM NOTICED SHE Y WAS SLIGHTLY 9/17/2009 DIZZY9/17/2009 AND THAT SHE HAD 0, 2009 patient received only one vaccine: Y Chickenpox. Y On July 22,52009 he was rushed to Y the hospital 7/10/2009 with high fever 7/21/2009 and Seizure. At the am client called and returned to clinic to have RN check "vaccine reaction". Left anterior deltoid Y visibly red, 9/17/2009 with swelling 9/18/2009 around injection s OT NEEDED U 9/16/2009 9/16/2009 in red flat rash on inner aspect of upper Y arms within minutes of receiving vaccines. Flushed, Y no shortness 9/21/2009 of breath. 9/21/2009 Given Epinephrine IM arted swelling on Sat.am 8/15/09 - blisters Y started Sat pm. Sun.am 8/16/09 R thigh was red,Yswollen, hot8/14/2009 and painful. 8/15/2009 Taken to ER, started hour of vaccine administration c/o pins Y and needles in fingers and arms and had difficulty breathing Y seen 9/22/2009 by Dr in Medical 9/22/2009 clinic recieved 5 cted with the flu vaccine Y on Friday, September Y 18, 2009 at approximately 2:30 pm. I woke upUon Sunday9/18/2009 morning with 9/20/2009 a big bump on my to ys muscle still tender after 1 week. pt tried an aspirin and an aleve tablet. pt applied topical theragesic N cream...still 9/16/2009 sore. 9/17/2009 Arm does not feel w t in car after receiving shot Y at Dr's office. Y Fell asleep Y in car on the way 3 home & making odd U motion with 9/21/2009 mouth. Left9/21/2009 in car for a few minute Y Y 9/16/2009 9/22/2009 n about 1 hour after shot given- whelp Y type rash to trunk/extremities with swelling of eyes/face; Y benadryl9/21/2009 given; c/o abdominal 9/21/2009 pain & low gr ash eruption 2 weeks after vaccine administration Y U 8/25/2009 9/17/2009 ely following injections, patient "passed out", arms and legs became stiff. Eyes rolled back and Y patient lost 9/11/2009 bladder control. 9/11/2009 Immediate Docto d cough, throat/chest tightness, itchy Y eyes 2-4 hours after administration of flu vaccine. Sent Yfor treatment 9/22/2009 to urgent 9/22/2009 care facility. ced extreme dizziness after the vaccination. Y 9/18/2009 9/20/2009 ped a red rash around the injection site that measure 1&1/2 inches in length. No pain or irritation Y noted. 9/16/2009 9/19/2009 ted with swollen, firm upper arm withY a red splotchy rash. Pt reported pain when moving arm.U Pt developed 9/17/2009 first day9/18/2009 post shot followed by t njection site was warm, red and very swollen Y 9/15/2009 9/17/2009 D FEELING WEAK ABOUT 10 MINUTES AFTER SHOT; FELT WARM; HAD A DULL ACHE YIN HER HEAD; 9/22/2009 WAS SHAKY 9/22/2009 WHEN SHE WA o hours of vaccination, the left arm had begun swelling, with associated pain, and fever. ThisUwas post work 9/14/2009 hours, and 9/14/2009 had already gone h 7/17/2009 N 7/7/2009 7/7/2009 Rec'd Tdap, varicella at Health Dept. 9/18/09- c/o arm, hand spasms, mild difficulty breathing,Ygeneral malaise. 9/17/2009 Injection 9/17/2009 site; no redness, sw s after injection patient reported 2 inch red circle painful to touch U ined of itching, redness of both arms and feeling that the tongue is thick. Felt light headed but Y no SOB. Pt 9/21/2009 got the new 9/21/2009 Flu shot Afluria 1 ho after vaccine, general feeling of malaise, weakness. Progressed over next 12 hours to headache, U neck ache, 9/21/2009 myalgia 9/21/2009 ( generalized ) and ge d chest/throat tightness, flushing, low Y grade fever, cough within 3-4 hours of receipt of seasonal U influenza9/22/2009 vaccine. To 9/22/2009 ER, albuterol nebuliz ter receiving seasonal influenza vaccine developed sharp and throbbing pain at the injectionYsite which radiated to the outer elbow, 6-8/10. eningitis vaccine on 09/15/2009 Pt father called on 09/16/2009 b/c pts arm/shoulder area wasY red, painful9/15/2009 and swollen 9/16/2009 at the injection site. S 9/19/2009 N 9/14/2009 9/19/2009 ely after receiving flu vaccine, Y patient Y complained Y that she felt "funny" 1 and that her tongue feltY tingly. She9/16/2009 stated that9/16/2009 she did this sometime
some itching appeared on trunk and left arm (admin arm) on 9/18/09 around 3 hours after injection. Y Treatment 9/18/2009 antihistamine. 9/18/2009 dy itching, esp. of scalp and legs with raised red bumps on legs (serous fluid with crusting) developed Y 2-3 9/17/2009 hours after 9/17/2009 vaccination received. umbness down arm and in hands immediately. Apply ice pack this diminished. Then proceeded U to weekness 9/22/2009 in knees 9/22/2009 and tingling on brid 1 pm started coughing and wheezing it stopped after I inhaled Flovent. The next event happened N around9/21/2009 1:30 am I woke 9/21/2009 up with shivers, he ox rash 10 days after vaccine administered. Y U 9/11/2009 9/21/2009 er taking the vaccine she developed type I juvenile diabetes and also later had toYhave her gall N bladder removed 5/14/2008because 2/9/2009 it was not functio ght arm from elbow to forearem U 9/18/2009 9/19/2009 munization on Friday and developed macular-papular rash of arms, legs, torso on third day accompanied N 9/18/2009 by itching.9/21/2009 No change in persona ode left side of neck. U 9/16/2009 9/18/2009 nt received a flu shot on Wed 9/16 and came back for the pneumonia vaccine since she can Yonly have shots 9/17/2009 in one arm. There were multip 9/20/09 and complained of being in pain from Friday (9/18/09). Ever since she received the flu Y vaccine she 9/18/2009 has been9/18/2009 feeling "Pins and Need oint retractable syringe 25G x 1" used. The needle retracted with the first push (bypassed theYmedication9/22/2009 administration) 9/22/2009 and the full dose d ately 1-2 hours afterwards, the patient Y went to ER due to swelling/ redness at the injection site Y & flu like symptoms. 9/16/2009 9/16/2009 Per patient WBC count 2 needle over 240 lbs noticed resistance. Y Pulled Back & injected. Felt some resistance Pt. U reported some 9/21/2009 discomfort, 9/21/2009 said she had some id she was experiencing swelling in the back of the throat and difficulty swallowing. Y 9/21/2009 9/21/2009 d FLUZONE on 9/15/09 at 15:00. She began to feel ill by 21:00 that same day. She c/o chills, Y body aches 9/15/2009 x 24 hours. 9/15/2009 On 9/18/09 she awok ollen, warm. 5 cm long, 3 cm wide. BENADRYL otc. Y 9/16/2009 9/18/2009 episode, lightheaded, nausea, dizzy, seeing black fuzzy spots, flu-like symptoms (sweaty, chills). Y Pt rest 9/18/2009 for 15 mins.9/18/2009 and got better. as breathing very deeply. Patient was very sweaty. Did not respond to my voice or shaking.YContinued 9/22/2009 to shake the 9/22/2009 patient and he came t of >103 and projectile vomiting. Y 9/15/2009 9/16/2009 V, soreness at site within 15 min. after Y vacc. U 9/21/2009 9/21/2009 4 hours after vaccine admin. 1. Significant Y pain in L arm. 2. Arm weak & not able to lift it. 3. Y Severe Diarrhea, 9/20/2009 body 9/20/2009 cramping. 4. Swolle pain - right side of neck with muscle fullness. Questionable reaction to HeP A. Motrin every 6Uhours today. 9/21/2009 9/22/2009 ved at home, from Dr office, having diarrhea, Y vomiting and temp 101. Took to ER. Diagnosed with "stomach 9/21/2009 virus" per 9/21/2009 mom. Giving TYLENO difficulties started about 3 hrs. post flu vaccine, severe coughing, headache, sinus pressure,Yeye drainage, 9/21/2009 weakness 9/21/2009 in right hand, throat f er vaccination, pt's neck (both front & back) start to swell and it last about 48 hrs after recovered Y there is no 9/4/2009 residual effect. 9/5/2009 een the spine and shoulder, muscle stiffness on left side - neck down to the shoulder. From rate 1-10 (Pt9/18/2009 says 8-9) -9/19/2009 Experienced pain after perienced chest pain immediately after receiving vaccine. Chest pain lasted about 2 hrs. Vaccine Y left a9/14/2009 large bruise9/14/2009 on right deltoid about ports swollen leg. Y did not hurt but 5-10 mins later he said Y he felt dizzy and his arm started to hurt (the arm which Y he received 9/10/2009 the injection 9/10/2009 in). His blood press inic 9/17/09 with L arm injection site swollen, red, hot, 25 x 50 mm. C/o pain radiating to postUneck and jaws 9/15/2009 bilaterally 9/17/2009 increasing with hand when vaccine was injected she experienced dizziness "metallic taste in mouth" N.A. mid forehead. U States9/10/2009 was also 9/10/2009 seeing black spots in e e hour after injections of polio, MMR and chickenpox, child's face was swollen, purplish spotsYunder eyes. 9/4/2009 9/4/2009 NACTRA, GARDASIL, Influenza Vaccines. Y Approximately one minute after administration, adolescent, Y while 9/14/2009 sitting9/14/2009 down, had syncopal ep jection AREA Erythema and induration @ 10 cm x 10 cm at the L deltoid area. Warmth and Y mild tenderness 9/8/2009 to touch. 9/10/2009 ot flu & pneumo shots on Wed 9-9-09 Y at flu shot/vaccination clinic at Kroger Pharmacy #825 Y-2 days later 9/9/2009 (on 9-11-09), 9/11/2009 patient's wife noted of progress note. Y Y 9/11/2009 9/11/2009 d wheezing & cyanosis after receiving immunization Y chest - markedly diminished breath sounds Y with wheezing. 8/27/2009 HR8/27/2009 120/min. EPINEPHRIN ious, spontaneous report of fever was received from a consumer concerning a 47-month-oldYfemale patient 8/17/2009 subsequent 8/17/2009 to FLUMIST. This c ious spontaneous report of eye exposure to FLUMIST was received from a registered nurse Yconcerning 8/27/2009 a four-year-old 8/27/2009 male. The patient's ious spontaneous report of fever has been received from a consumer in the United States concerning N a four 8/17/2009 year-old 8/17/2009 female. This case is s ous spontaneous report of spaces out; not sleeping well; cranky; whiney; fever and decreased U appetite 8/17/2009 has been received 8/17/2009 from a parent c ious spontaneous report of "inadvertent administration" and Fever has been received from aUnurse concerning 8/18/2009 a 19-month-old 8/18/2009 male, subse
NUMDAYSLAB_DATAV_ADMINBY V_FUNDBYOTHER_MEDS CUR_ILL HISTORY PRIOR_VAX SPLTTYPE Unknown OTH OTH Unknown Unknown WAES0812USA04456 0 Unknown OTH OTH Unknown Unknown WAES0812USA04542 126 Ultrasound,OTH 07/14/08, with OTHnormalVitamins limits; Serum (unspecified) alpha-fetoprotein, Atypical squamous 06/23/08, cells negative WAES0808USA02610 of undetermined significance 15 Erythrocyte,OTH normal; Serum OTH C-reactive, ADVAIR; normal; SINGULAIR Environmental Serum rubella Dermatitis allergy; IgM, atopic normal Asthma WAES0812USA04870 OTH OTH Unknown Unknown WAES0812USA05315 1 PVT UNK None None None 15 PVT UNK None None Allergic to wheat, peanuts, eggs, peas. Hx of Dermitits - Ec 0 UNK PVT 1 PVT UNK None None None 1 PVT UNK PULMICORT None 0.25 MG/2 POLYDACTYLY, ML NEB SUSPENSION extra thumb ; AMOXICILLIN 250 MG/5 ML O 1 PVT UNK None None Non 0 PUB PUB Taking BirthNone Contol Pills NKA; anemia when younger 1 PUB PVT 0 PUB PVT 1 PUB PUB none None. Information none in #14 entered in error. No vaccinations given wit 1 PUB PUB None None NOne 1 PVT UNK None None MACROCEPHALY 2 PVT UNK None None Hypotonia, underweight, developmental disorder (mixed) 6 PVT UNK ALBUTEROL None 90 MCG/ACTUATION DYSMENORRHEA, AEROSOL Possible INHALER allergyEPIPEN to avocado 0.3 MG/0.3 M 54 ekg, eeg, cat UNK scan, mri,UNK blood tests. Labs andnone Diagnostics: none EKG PMH: WNL. frontal EEGH/A. WNL. Low Normal back pain imaging x 1 yr. studies. Brain M 1 UNK PVT Prilosec, multi-vit None 10 PVT PUB NONE NONE 1 PVT UNK None PUB UNK none none none none~ ()~NULL~~In Patient 2 UNK UNK None Previous heart attack (coronary artery disease) 10 PVT PUB Febrile Seizure 0 None PUB PUB Lorazepam;None Levothyroxine; Allergic Famotidine; to PHENERGAN. PRILOSEC; daily vitamins 1 OTH PUB None Asthma 31 PUB UNK No No 0 PUB PUB None None None 4 PVT PVT None NKDA; DM; HTN; Increase lipids 26 OTH OTH Insulin No Diabetic; no allergies 19 ER 11/29/08/. OTH Not seenOTH by MD. None No No No~ ()~~0~In Sibling|No~ ()~~0~In Patient 0 None OTH PVT PO: Calcium Nowith D; vitB12; Naprosyn. BCG (latex None~ treatments allergy ()~~0~In forruled blood Patient|None~ outcancer: 2008 by OCT-> dr ()~~0~In notes NOV->DEC per Sibling tes 13 3 x-ray; CT;OTH Lab tests; OTH IV None None None 10 None OTH OTH ALEVE; TRISPRINTEC None None 5 None OTH UNK None No Sulfa & Amoxicillin Allergies OTH OTH 2 None OTH OTH None (Tylenol) No allergies (polyps on sinus surgery) 9 OTH OTH None None None 6 None OTH OTH ADVIL prn None None 13 PVT PVT 9 None OTH OTH No Allergy to PCN NONE~ ()~~0~In Patient|NONE~ ()~~0~In Sibl 6 None PVT PUB COLOSTRUM; NYASTATIN; Pilonidal multivitamin; dimple; Jaundice MIRILAX 1 PVT PVT None None 7 None PVT PVT Lisinopril Hetz None , L-Thyroxine None 1 None PVT PVT None None None 0 n/a PVT PVT n/a; Had allergic History rhinitis/viral of Asthma/Allergic syndromeRhinitis on 12-02-2008 3 Visual verification UNK of Shingles PVT lession. n/a Shingles none started on none side and went around the torso following a typical patern 0 PVT UNK he is allergic to all childhood antibiotics, watermellon.
0 PVT UNK 0 UNK UNK None None 0 UNK UNK Coreg Cr 20mg, Benazepril Intermittant 20mg, AWarfarin Fib 5mg, Zetia 10mg, Lipitor 20mg 3 WBC, 12.4 OTH on admit; Troponin, PVT WNL; ATENOLOL CK-MB,None WNL; 50mg blood daily; Organic Lipitor cultures, heart 10mg NGdisease,s/p, daily; x2 days; GLYBURIDE urine CABG; culture, Hypertension;Hyperlipid 5mg<1000 PO BID; colonies/nl NORVAS L 0 1/7/09-records PVTreceived-Chest PVT x-ray LEVAQUIN; infiltrate No atLOPRESSOR; left acute lungillness base Pernicious and NEURONTIN; possible anemia;infiltrate CAD; ELAVIL MI; right Lumbar upperdisc lobe.disease; Periph 2 EEG; LP; CT PUB scan; Blood PUBculture -None all negative None 3/3/09-records None received-Head CT normal. 1 PUB UNK PROTONIX; BP meds 2 PUB PUB No No No 0 OTH PVT None None None 2 PVT PVT 6 PUB PUB 1 OTH PVT Unknown None Asthma 0 None OTH UNK COREG; VYTORIN; None ALTACE; Cholesterol; vitamins high and blood supplements pressure; and a weak heart due to 3 PVT UNK No No 1 PVT PVT None None 33 lab work done PVTLABS: ANA UNKneg. RA Nofactor <20(N). No CRP No 1.8(H). ESR 31 (H). WBC 11.5(H), lymphs 17%(L). 0 None PUB PUB None Cochlear implant 3 PVT PVT synthroid None 0 MIL MIL Unknown Patient denys None prior Known illness 0 MIL MIL Unknown No illness reported No alergies/prior medical conditions reported 8 PVT UNK None None None 9 PVT UNK None None None 1 N/A PVT PUB NONE NONE NONE 1 PVT UNK None None Non 1 PVT UNK None None None 2 PVT UNK None None None 16 NONE - OBSERVATION MIL MILAT THISNONE TIME NONE NONE NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 PVT UNK None None Non 16 MIL MIL none none none 3 PVT UNK NONE None Premature infant; 33 weeks 7 PVT UNK None None HEMANGIOMA - SKIN 1 PVT UNK None None MOLLUSCUM CONTAGIOSUM 0 PVT PUB none none none 7 PVT UNK None None Colic 2 Rule out Lupus. PUB PUB None Fiber Myalgia, Diabetes 62 UNK UNK None None HPV #2 given 3/24/08, lot # 1446U, LA. 0 CBC BMP Urinalysis PVT PVT Metadate None Attention Deficit Disorder none PVT PVT lisinopril and noaspirin HTN 16 PVT PVT allergic to milk, seizures~DTaP eggs, peanuts; (no developed brand name)~3~1~In seizures from Patie D 0 PVT PVT Not reported. PVT PVT The patientThe had patient a runnyhad nose a runny at the nose time ### of at vaccination. the time of vaccination wi Diagnostic results: OTH 05 May OTH2000: B. burgdorferi Diverticulosis; Ab (IgG and Broken Gastroesophageal IgM)nose; by Western Cat scratch Blot Reflux A0759678A negative. fever, Disease; Ex-smoker; B. burgdorferi HiatalThe Hernia subject Ab scree sm 50 Barium enema PVTshowedPVT intussusception, BIAXINnon given surgical Vomiting on 12/15/08 reduction and None blood forfor intussusception, left in chronic otitis diarrhea illness on PMH: 12/24/08 ear infection LABS:12/15 abdominal treated x-r 0 OTH PVT Blood pressure PMH: HTN.~Tetanus anxiety. Toxoid Depression. (no brand Allergies name)~UN~0~In to PCN, sulfa, P 25 muscle biopsy; PVTMRI separate. PVT Dx clinical myositis None Iron-deficiency anemia 0 UNK UNK Seasonal allergies; Patient was very healthy before this sh 2 None PUB PUB None TYLENOL 0 WBC, 16.3;PVT AST, 48; ALT, PVT 75; CRP, 73; SED,No 37 Asthma, GERD, has Sulfa Allergy 0 No testing done. PVT PVT None HTN; DM; Gout; Bladder Cancer; Carotid Stenosis 0 None OTH OTH CARDOZE None 190mg daily; Hypertension ISOSORBID 60mg; METOPROLOL 25mg daily. 0 PVT PVT No Asthma; Migraines; Anxiety
1 1 1 9 0 1 None 2 None 12 None 0 4 0 1 None 10 1 None 1 None 0 None 7 0 None 0 None
OTH UNK None Prematurity PUB PUB None None None OTH PUB None None None PVT UNK BUMEX 2mg PUB PUB None None PVT PUB None Allergic to Nuts PVT PVT PAXIL None None PVT PUB MIL MIL None None None MIL MIL PUB PUB None None Known PVT PVT NAPROXEN; None Multivitamin; Breast flu cancer; shot allergy to LETROZOLE PVT PVT Zantac, Sodium NoneFluoride, Ge Prevacid Reflux, Pre mature 34 1/7wks. PUB PUB KALETRA; No BUSPAR; TRUVACH HIV positive PVT PUB None None None PVT PVT FLUOXITINE None Anxiety Disorder PUB PUB Unknown None Unknown OTH OTH PVT PVT completed OMNICEF RecoveringAMOXICILLIN; this AM Stomach cramps; Hives OTH OTH None None Asthma- no meds; Sleep apnea PVT UNK 12/3/07: A/IPVT note: DueOTH to the patient's denied clinical symptomsseasonal after receiving allergies the flu shot I would recommend that the pa 5 MIL MIL None AMOXICILLIN 1 OTH PVT Unknown None Unknown 2 PVT UNK 10 7/2004: spongiotic MIL psoriasiform MIL chronic dermatitis Denied per MD Denied notes family (actualhx bxasthma results unavailable). 10 MIL MIL Patient denies 1 None at ourOTH facility OTH None 1 X-ray of shoulder; OTH MRIOTH No None now 0 None PVT PVT SULFA; PCN; Seafood 1 PUB PUB GA08088 8 No. Consulted PUBDR, continue PVT with series, METOLPROLOL; notify if reaction CYMBALTA; Allergy worse. toHCTZ; sulfa; HBP; MARZIDE; Depression; GA08090 PREVACID; Ulcer;VALTREX; HSV; ADD DEPO 1 PUB PUB GA08091 1 None PUB UNK None None None GA08092 1 PUB PVT SYNTHROID Diabetes; hypothyroidism GA08093 1 PUB PUB None None None GA08095 1 PUB PVT GA08096 0 UNK UNK GA08097 0 UNK UNK None None No allergies diagnosed yet by doctor prior to immunization 0 RH Arthritis;PVT Lupus PVT 2 My physician PVT did no testing. PVT LIBRA X TID None prn->ID ; Allergy VALTREX to: Sulfa; Never 500 mg Erythromycin; had daily; a problem LISINOPRIL Morphine; with vaccines~ 10 mg Biaxin daily; ()~~0~In ADVAIP 0 OTH PVT 8 None PVT PUB None None None 3 PUB PVT None HTN 6 PUB UNK None Penicillin 0 BPS, 8:10 92/54 PUB P60, PUB 8:15 98/72 P64, 8:18 None 96/64 sitting None P72, 8:20 112/68 P64 PVT PUB Sinus/congestion None PVT PUB QVAR; XOPENEX; None CLARITIN None known 0 None OTH PUB ROCEPHIN; Cat PERCOCET; scratch;RAD; cellulitis fluticasone; HSV; Tinnitus; salmeterol; Septra AUGMENTIN; flunisolide; ALB 0 PVT PVT 2 OTH OTH
0 MIL MIL PPD; manufacturer None Sanofi Photo Pasteur; Sensitivity lot number C2912AA; route/site left forearm, 0 PUB UNK None None None 2 None PVT UNK METOPROLOL; Not reported aspirin; Known simethicone; intolerable venlafaxine to Penicillin and ceftriaxone 0 None OTH OTH None Pregnancy NOS (LMP = 9/19/2008); WAES0811USA03496 Penicillin allergy Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0812USA05190 Drug hypersensitivity 95 Unknown OTH OTH None Termination of pregnancy WAES0812USA05011 - elective 2 computed axial, PVT within OTH normal limits; Unknown WBC count, over; blood Unknown culture, negative WAES0812USA00348 0 diagnostic laboratory, PVT negative PVT blood albuterol; examinations aspirin; Chronic ADVAIR; obstructive ULTRAVATE; pulmonary hydrochlorothiazide; disease; WAES0811USA02209 Penicillin allergy; ZESTORETIC; Allergic reac pr 3 None OTH OTH CRESTOR None WAES0812USA05099 31 LP, lab work, UNK venous doppler UNK L LE, MVI, Xray prenatal LLE None LABS: Vitamin, CBC Codeine, Vit&Echemistry Valium, WNL. Sodium Left leg Pentathol, x-ray WNL. Sulfa, PCN, metal alle 10 UNK UNK None None None 0 PVT PUB MultivitaminNone with fluoride allergic and Loratadine rhinitis PRN 4 UNK PVT crestor 10 mg. none daily : asa none 81mg 0 PUB PUB advaiar, Synvastatin, None Levothyroxine, Hypertension, Amitriptyline, hypothyroidism, Zoloft, mildCorig, asthma, OTC GERD. heartburn Know m 3 Pt had an LP, UNK MRI, Chem UNKpanel, CBC Acidofolis Sed rate, None CRP, 1/7/09-records TSH None and1/7/09-records a chest received-Viral NA~x-ray. ()~~0~In received-Constipation Guillainillness Patient Baree' with fever waswith r/o. from vomiting Labs birthwere with 2-3 0 N/A PVT PVT Tylenol, Nystatin Diaperointment rashNONE on buttocks 1 UNK UNK OMEPRAZOLE Chronic 20 MG vomiting Allergic CAP,assoc DELAYED to pollen, with history chronic RELEASE ofvomiting. esophageal SOLIA 0.15 dilatation. MG-30 MCG TA 1 PVT UNK Symbicort dry cough xCeliac 3 months, Sprue hospitalized doctor prescribed with fever Symbicort of 105~Measles + Mump 7 UNK PUB COUMIDIN,NONE OTHERS UNKNOWN 3 unknown. Labs UNKand Diagnostics: UNK Rotavirus Ag none (+). Urine, reflux, stoollactose and blood intolerance. cx (-). VA09:001 UAPMH: (+) forGERD 15 ketones, samll blood 1 (see 1500+UNK pages of medical UNK records) Labs and newborn Diagnostics: PMH: Direct IUGR.Coombs Maternal (+). smoking CBC, blood cx and lytes all WNL 12 PVT PVT 2 N/A PVT PVT 1 PUB UNK None. None. 1 UNK UNK Inderal, Ativan, Prevacid, Septo-Optic Ventolin inhaler Dysplasia, Asthma, GERD 14 AntinuclearOTH antibody, 16Mar1999, OTH negative; Antinuclear Unknown antibody, Allergies; 17Jul1999, Arthritis; Asthma; negative; A0730257A Depression; Antinuclear Fatigue; antibody, Gastroes 06Oc 0 OTH OTH Concomitant drug (s) not reported MEDI0007688 33 1/9/09-records PVTreceived-Urine PUB culture None negative. None Lumbar 1/6/09-records puncture Crytorehism increased received-two (rt) protein ME00109 week of history 317, increased of rhinorrhea opening andpres cou 1 Many labs and PVTtests. Labs UNKand Diagnostics: TOPROL extended CT None scansrelease; (-). High EKG blood NORVASZ; abnormal. pressure DIOVAN; CBC . PMH: withAmiloride; WBC HTN, 10.9, A-fib, LEXAPRO; RBC Sleepand apnea-on Hct Aspirin sl loC 0 OTH PVT OMEPRAZOLE; No D allergy, Asthma; SINGULAIR; environmental kidney CYMABALTA; failure~Vaccine allergies; calcium laryngeal not specified + D; reflux; multi-vitamin (no depress brand 0 PVT UNK no no 0 CXR showed PVT inflammation UNK 0 No PVT UNK no no 3 No lab data;PUB MD performed PUB - neurological THYROXINE; tests None toParoxetine rule outHypothyroidism other causes. 0 PUB PVT COMBIVENT Fingers inhaler injury 1 PVT PVT BACTRIM DS; DayTYLENOL prior with None food poisoning x 1day 1 01/05/2009PVT Pt seen inUNK office for L deltoid submandibular None noted Lymphadenopathy 1 None PUB OTH Birth control; NoVitamin B-12 None 0 PVT UNK Fever Chest x-ray;OTH Sinus serves PUBordeal, Muscinex 1/5/09 Asthma Tinritus; NKDA 1 State examiner PVT case pending. PUB Pt seen 12/27/08 Prematurity with c/o 34 spitting wks. PMH: up blood 34 week and sneezing. premie Dx with thru 7 Patient stated OTH that his doctors PVT believe Unknown this to believe None an autoimmune Unknown response to the vaccine. PUB PUB None None None 1 OTH PVT EVISTA; PRILOSEC; None AMPICILLIN SYNTHROID; DAYPRO; PROZAC; LIPITOR Chorionic villi UNK sampling:UNK 31/Mar/2006; COMBIVENT; Serologies:PULMICORT; 15/Feb/2006: Past medical Prenatal Blood history Type Vitamin A+; included antibody ### asthma, negative; obesity rubella (BMIimmune 40), va 204 03 November OTH 2005, 02OTH May 2006:Prenatal B+, antibody Vitamins negative,No HBsAg history- Negative, of tobaccoHIV-negative, or drug ### use. BMIRubella 23.7, Immune, 2 ETOHSyph drin 193 The patientUNK had a normal UNK alpha feto ALBUTEROL; protein test on prenatal 07 June Regarding vitamins 2006 and thenormal currentserology pregnancy, ### testing the on date 03ofMay the 2006 patient's with 234 Alpha Feto UNK Protein: 31/May/2006 UNK -AUGMENTIN; normal; Serology: ALBUTEROL; 16/May/2006 The patient FLOVENT; - had A+; antibody a history Prenatal -ofnegative; Vitamins body ### mass Rubindex - immune; (BMI) -Gr/Ch 24, a The patientUNK had serology UNK testing on VICODIN; 23 May 2005 PEPCID; and 05 Prenatal The September patient Vitamins has 2005 history that were of severe normal ### chronic with O+, lowRubella back pain, Imm, ga 03/Jan/2006: UNK Genetic screening UNK - Prenatal CF gene Vitamins mutation negative. The patient Serology had- aAB history (+), antibody of body ### mass - negative; indexRub (BMI) - immun - 19.7, 86 16 March 2006, OTH all normal OTHserology LABETALOL; testing showed, prenatal Parvovirus The vitamins patient IgG, had 5.7, a Parvovirus history of IgM, hypertension(controlled ###negative, A+, Rubella with IM, L
-115 13/Dec/2005, OTH normal serologies, OTH O+, Prenatal antibody,neg; vitamin, SYNTHROID HBsAg, Patient neg;had Syph a history IgG, neg; of humeral Gc/Chlam, ###muscular neg, HIV-NR; dystrophy 4/Jan/20 "auto 86 16/Mar/2006: OTH parvovirus OTH IgG 5.7, parvovirus Labetalol; Prenatal IgM negative; vitamins None Rubella Imm, NBsAg-NR, HIV-NR, ### antibody-negative. 0 1 None reported. UNK UNK The patient had no past medical ###history or use of other me PVT UNK 3 Diagnostic Laboratory OTH OTH Analgesic (unspecified); Depression,Thyroid Penicillin Aspirin; operation; Lipitor; allergy;Restasis; Sulfonamide Thyroid WAES0812USA05247 cancer Nexium; allergy; Lunesta; Allergic Synthroid; reaction B to 3 None MIL MIL PCN 9 PUB PVT none none 2 PUB PVT herbal remedies none and vitamins fibromyalgia, for fibromyalgia allergies tosymptoms. codeine, PCN, Novacaine, E-myc 1 Negative blood PVTcx's. Negative UNK CXR. None Normal white Nonecount, None mild anemia, negative strep and RSV. 0 UNK PVT lisinopril 30None mg po qd 1.seasonal HCTZ 25 pollens mg po 2.hives qd with symvasatin unknown etilogy 10 mg po qd 0 PVT PVT none none pertussis allergy 0 UNK UNK 0 PVT PUB none none nkda 0 UNK UNK 0 UNK UNK none reported none reported none reported none~ ()~~0~In Patient 1 none PVT PUB Albuterol MDI none and Flovent asthma MDI 1 NONE UNK UNK VALTREX, NO CLARITIN, ACUTESTEVEN-JOHNSON AVAREX ILLNESS. DEVELOPED SYNDROME STEVEN-JOHNSON SYNDROM 1 None PVT PUB Vyvanse None ADHD and obesity 4 CBC W/Auto MIL Diff Site/Specimen MIL allergra Monocytes D S/P BLOOD lesion biopsy Iodine 0.70 (H) on allergy, Right cell(s)/mcL depression forearm (0.11-0.59) and joint pain 1 PUB PUB None None None 48 UNK UNK None none 4 UNK PVT Diagnostic tests: OTH 16 February OTH 1998: MagneticBrain resonance lesion; Ankle imaging Carpal Fracture; tunnel of brainsyndrome; Carpal showed A0761134A tunnel no closed evidence release, headCheilitis; ofinjury; acoustic Corneal Deviated neurom dys S 3 PVT PVT Codeine; Prednisone; Avelox; ASA; sulfa 0 Had CXR PVT UNK no no 4 None reported. PVT PVT MultivitaminNone The patient had a nut allergy. ### 1 PUB UNK None None 9 4/14/09-records UNK received-CT UNK scan brain normal. 4/28/09-records 4/14/09-records receivedreceivedRapid strep Allergies:amoxicillin. negative. Assessment: Obstructive Acu 13 None OTH PUB None None None 1 PVT UNK 1 OTH PVT XOPENEX Ibuprofen + USN ON PVT 7-31-08 with OTH 10W4d on 8-11-08-patient None had increased AMOXICILLIN risk downs/on ULTRACET, patient chose termina 0 None PVT UNK 0 None PVT PVT None None 1 Patient wasPVT sent to ERUNK for observation and treatment None if needed. 0 UNK UNK Not reported. ### Not reported UNK UNK Not reported ### 0 Not reported UNK UNK The patient was healthy prior ### to January 2001 when she b 0 PVT UNK Month B-4 Have None aPMH: pace DM2, makerhyperlipdemia, installed obesity, anxiety, angina 0 CT (-); CSFPVT (-) initial studies. PUB Labs and Diagnostics: None Head PMH: CT WNL. recentCXR fall abnormal. EEG WNL. CBC with WBC 1 1 PUB PUB None None, healthy Extra digit both hands at birth - tied; H/O drugs use in, chil 16 1/12/09-records PVT receivedPUBGlucoseNone 486. Glucose urine 4+. Had neonatal hepatitis at 7 wks, recovered, born at 36 wks 1 PVT PVT 2 None OTH PUB None None Allergic to cats and dust 0 MIL MIL 0 PVT PVT None None 0 PUB UNK ENALAPRIL; Renal Folicfailure; acid; Iron; Peritoneal calcium; dialysis EPOGEN; since AR0845 NORVASC;SYNVISC 2 months ago, cause unknown 2 PUB PUB None None 0 Swollen leftUNK arm, pain UNK Cellulitis MIL MIL PROSCAR;None NEURONTIN; Large CELEBREX; prostate; H/O PROTONIX tumor in bioduct (benign) 361 None UNK UNK None
3971 None UNK UNK 521 Lab culture UNK ordered, but UNK unfortunately an HSV culture was performed rather than VZV culture. The HSV culture wa 380 None UNK UNK None 523 None UNK UNK PUB UNK UNK UNK cervix HPV OTH DNA assayOTH - positive None None WAES0811USA00270 36 none PUB PUB Depo Provera none Allergic to sulfa, black cherries, SC0827 PeptoBismol 1 None performed. UNK MIL Diphenhydramine, None Naproxen Aspirin Swelling~Anthrax (Biothrax)~5~40~In Patient 6 PVT PUB 1 None PVT PVT No illness atPatient time ofisvaccination allergic to Penicillin 0 PVT PVT None None 45 PUB PUB Librax, Vytorin, hyperlipidemia, MicardisHCT colon polyps none reported~ ()~NULL~~In Patient 0 PUB PUB 1 UNK UNK None None 1 PUB UNK None at time Constipation Constipation 4 Pt. stated aPVT visit to her UNK PCP the day followingNone the stated reported possible None reported vaccine reaction by patient. 0 PVT PVT Asthma - stable, no current meds 14 Monoscreen: UNK negative,UNK CRP & thyroid Lisinopril/HCTZ screen:None. within 10/12.5 normal Allergies: mg, limits. Zetia codeine, 10 mg (discontinued Medical conditions: 12/8), hypertension, Amitriptyline 75 hype mg 0 PUB PUB none nonr unknown VA09:002 0 None done UNK yet. UNK Ortho Tri-Cyclen No. Lo oral None. contraceptives. 1 CBC drawnPVT PVT Synthroid 100mg In for annual Zocor Hypercholesteremia, PE 40 mg Baby ASA ASHD 1 LABS: MRI UNK c-spine c/wUNK disc protrusion, Wellbutrin spinalXL None stenosis, neural Penicillin foraminal allergynarrowing, PMH: head facet trauma, arthrosis. hypercholesterolemi 1 PUB PUB None She is allergic None~ to Amoxcillin ()~NULL~~In but she Patient|None~ outgrew it ()~NULL~~ 0 PUB UNK none no none 12 SEEN BY ENT; MIL DERMATOLOGY MIL ALENDRONATE AND OPTHAMOLOGY NONE70MGGERD NO WEEKLY C&S OSTEOPOROSIS OR ALLOPURINOL LAB OR SEROLOGY PROSTATE 300MG DAY CANCER NIASPAN HYPER 750 M 62 2/25/09-records UNK receivedUNKLumbar puncture elevated none 2/25/09-records protein 2/25/09-records 76, normal receivedglucose received-PMH:Coronary Viral 77, gastroenteritis 29 red blood with cells, artery abdominal 75,000 disease. whi di h 6 PUB PVT none Penicillin; asthma 5 x-ray on 10-07-08 UNK LABS: UNK CXR revealed None significant None. bilateral Eczema. pneumonia PMH: Temp. w/right hospitalized 101 for pleural 2 days~Measles for effusion. significant CBC bilateral + of Mumps 10/22 pneum +plts Rub 4 16 PVT PVT None None except Pre-maturity runny nose 11 UGI; small bowel PVT follow, PUB then, multiple NoneKUB- see None hosp records, None LT, LP, Urine, LAB 1/14/09-records received-Upper 0 OTH OTH Benzoate 200 None mg, Paxil Penicillin, CR 25mg, codeine, Nasonex, highLotrel, bloodHCTZ pressure 25mg 18 PVT PVT 0 PVT PVT HCTZ; Verapamil; Appt forBupropion nevi HTN; Hypothyroidism; HRT Depression 0 None PUB PVT 1 PVT UNK 0 PVT PVT None 0 Stool heme,PVT negative PVT None None None Whole blood OTH lead test, OTH inordinate level; Unknown Serum mercury test, Noneinordinate level WAES0901USA00094 45 Beta-humanOTH chorionic,OTH positive folic acid; vitamins (unspecified) Drug hypersensitivity WAES0805USA00247 0 Diagnostic laboratory, PVT STD OTH testingUnknown LABS: pathergy Vulval ulceration; test neg. MouthESR West ulceration; 32(H), Nile viral CRP Canker infection WAES0812USA02633 10.5(H). sores oral; CBC,Viral chemistry, infection LFTs PMH: WN 1 Diagnostic laboratory, OTH 12/12/08, OTH enzyme None levels over 800 None LABS:PMH: CT scan Foreign & UStravel WAES0901USA00056 abdomen 7/08. abnormal Family hx: w/pancreatic IBS. & Urine beta-human, OTH 04/02?/08, OTH positive; Unknown Erythrocyte Pregnancy ABOLoop NOS antigen, electrosurgical (LMP AB=positive; 2/25/2008); excision Serum WAES0804USA02244 Epilepsy hepatitis procedure; B, Negative; Gastroesophagea Rapid p 1 None UNK UNK None 0 OTH PUB None None None 0 MIL PUB 0 PUB PUB NA NA NA OTH PUB None None 0 MIL UNK No No 3 PUB PUB None None None 0 None PVT PVT Yasmin No
429 Unknown OTH OTH Unknown Hypertension; Obesity; Diabetes mellitus; WAES0812USA02385 Drug hypersensitivity 0 None PVT PUB None None 0 None PVT PVT BUSPAR; ASMAVET; No GERD; PATENOL allergies; central serous retinopathy 0 PVT PUB None 8 PVT UNK 1 None PVT PUB None None PVT PVT None None 0 OTH OTH NADOLOL;None AVIANE Heart palpitations 97 Ultrasound,OTH 06/02/08, within OTH normal None limits; Colposcopy, Pregnancy03/13/08, NOS (LMP cervicitis, = 1/16/2008) focal WAES0803USA00533 HPV changes; Cervical smear, 02 MIL MIL 2 PVT PVT 1 PUB PVT Insulin One week before IDDM - had a 'virus' 1005 MIL MIL MIL MIL MIL MIL UNK UNK MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL 0 None UNK PUB Old med: "birth nonecontrol depression pills" New Meds: "generic Prozac and Ambien for 6 week 28 Numerous laboratory, UNK radiologic UNK and None other at time tests None ofofvaccination. patient, None as he Several continues none~ since ()~~0~In tothis be in time very Patient|none~ related serious to condition ongoing ()~~0~In medical inSibling our ICc 0 PUB PVT None none 0 Arterial Blood UNK Gas / Chest UNKXRay (findings None unknown). None Labs None. and PMH: Diagnostics: C4-C5CXR fusion. WNL. hiatal CKhernia 46 WNL. repair. CKMB NKDA. 1.9. La 0 Soft TissuePUB Infection/Cellulitis PUB None None None MS132008 31 BLOOD WORK, UNK XRAYS UNK AT UVA, FONTAINENONE RESEARCH NONE. CENTER. PMH: Labs 30 lband wt loss Diagnostics: 2' to stress Anti-CCP (+), CRP 1 22 BLOOD CULTURE PVT 01/03 PVTGREW POSS. NONE HAEMOPHILUS NONE NONE BETA LACTAMASE NEGATIVE IDENTIFICATION TO F 3 UNK UNK No illness noted 2 UNK PVT METOPROLOL,CRESTOR NONE NKA 125 LABS: EKGUNK abnormal w/biatrial UNK enlargement Orthotricyclen no w/RV prescribed strain.PMH: Troponin 10/23/07 BCP since 2.13(H). 10/07. Chest Preemie CT scan w/NICU c/w large & intubation. bilateral PE IT 2 PVT UNK None None None 1 Unknown UNK UNK Unknown None NKA, Last Menstrual Cycle :"12/22/2008" per mom and cli 1 none...did not UNK seek clinical UNKevaluation by primary care physician 17 PUB PUB Asthma 0 PUB PUB TYLENOL AS NONE NEEDED NONE 1 MIL MIL gabapentin,see omeprazole, above prostatitis, oxycodone, chronic rosuvastatin, neck pain,docusate hyperlipidemia 0 Pending Immunologist UNK UNK appt. none none 04/07 milk allergy, N/A~ ()~~0~In 10/08 GERD Patient|N/A~ ()~~0~In Sibling 13 UNK UNK Nuvaring 1 PUB UNK slight cold celiac Unk PVT PVT Unknown Concomitant medications A0762584A and relevant medical history wer Unknown PVT PVT Unknown A0762713A UNK PVT PVT Unknown A0762719A 20 UNK OTH PUB No concurrent Unknown medication The subject has no relevant A0762729A medical history and no history 1 Labs and Diagnostics: PUB OTH EKG (+) for Quinapril; IRBBB. LIPITOR; None MetforminHypertension; Pt's meds No allergies. PMH: HTN, High cholesterol. 1 N/A - Per telephone PVT RD PUB advised avoiding None Tetanus None until 4-6 None y.o. PVT PUB Nothing 1 PVT OTH AVELOX; CYMBALTA; NeuropathyAnxiety; DIFLUCAN; Depression; FLONASE; Diabetes; gabapentin; Dysphagia; LISINOPRIL; Gastrointestina METFO
0 None PUB PVT None None Seasonal allergies-hay fever 9 None PVT PUB AMOXIL Otitis None 1 PVT PUB Abdominal pain(viral illness) 0 PVT PUB PROZAC; NUVARING None AMOXICILLIN 35 PVT OTH None None None 0 None OTH OTH None None None 10 Labs and Diagnostics: PVT PVT CT brain scan Epi-Pen, WNL2except pak,0.3mg1; None evidence Eczema Albuterol of old inC6 childhood; 90mcg/inh cervical wrist 2 fx.puff(s), CTA fracture, WNL. QID 12/04; prn; MRI FLOVENT, (+)allergic for mild rhinitis, HFA, paran 0 PUB UNK 3 PVT PVT METFORMIN; None LIPITOR; Heart lanolin; disease; PROTONIX; gout; HTN; LOPRESTOR; Hyperlipidemia; ALLOPUNRIL; sarcoidosisCOU 3 PVT PUB allergic rhinitis; obesity 3 PVT UNK None None 1 PVT OTH 1 PVT PVT None None 0 PUB PUB Ear infection a week before vaccine (1/7/09) 1 PVT PVT Seasonale,None zoloft 50mgNone 1 UNK PVT The patientPer did patient, mentionUnknown she some was medications not sick at but timethey of vaccination. are not on file at our pharmac 73 PVT PVT Two or three dermatofibromas on legs 0 PUB PVT none none none fever~Influenza (no brand name)~UN~2~In Pat None MIL MIL None None Seasonal allergies 0 Yes. Received UNK2008 flu UNK vaccine atNone. Hospital in. None Youknown. can Allergic find manufacturer/lot to the erythromycin there. family (Previously of anti-biotics. have received Recently flu v 1 X-ray of hand PVT 7 Jan 09UNK Lotril, Effexor None SR, Ambien, Depression, Metformin, Type Wellbutrin, II diabetes Synthroid, Zocor, Zyrtec 2 normal result. UNK Labs andUNK Diagnostics: noneFlu (-) pain in the arm none. ,then PMH: a sever noneflu start after one day from getting the sh 0 UNK PVT None None 1 PVT UNK none perfectly healthy 0 Blood pressure, OTH 54/30.OTH Labs and Diagnostics: Unknown Pregnancy CBC, Chem PMH: NOS and (LMP none EKG=all 10/21/2008) WNL. Serum WAES0901USA00339 B-HCG (-). Unknown OTH OTH Unknown Unknown WAES0901USA00354 body temp, OTH high fever OTH Unknown Upper respiratory Unknown tract infection WAES0901USA00096 4 diagnostic laboratory, OTH rotavirus OTH test: positive Unknown WAES0901USA00389 0 PVT PVT No Allergy; Asthma; Hypertension; Obesity; BPH 07/27/04; Sp 1 MIL MIL ZANTAC; Folic NoneAcid; FLONASE; 12 weeks pregnant Multi vitamin 0 OTH PVT NORCO; SOMA 2 days ago Allergies over Strep to throat PNC; degenerative disc disease. 0 PUB PUB PVT PVT Solodyne None None 1 PUB UNK None None that we are aware of. 392 PVT PUB 0 None OTH OTH Avalide, Synthroid, MVIAllergy Calcium, to Sulfa, Atenol,Macrodantin ASA, Welbutron 0 PVT PUB None None None 8 Rubeola Titer, PUB12/17/08PVT 0.82; Equival ULTRAM; Varicella SOMA; None Titer,20 12/17/08, LOFT Chronic0.90, backNegative pain; Osteoarthritis 1 PVT PUB 6 None PUB PUB None At PE appt had small rash anteriorTN08042 hand R arm - 15 mm site 2715 PVT UNK None None 2 PVT UNK None Eczema-Atopic LA090101 1 None PUB PUB TB Test PPD None JHP Pharm. None 85857 ID/L Forearm 3 No Lab testPVT have beenUNK performed None or suggested. None None 0 OTH PVT FLUVIRIN left None arm; EVISTA None in; ELAVIL in 0 PVT PVT None None 0 PUB OTH Herpes Simplex Virus (oral) 1 PVT OTH None None None 159 N/A PVT PVT None 10 PVT PVT CONCERTA Stepped onADHD nail (no illness) 11 PVT PVT
0 PVT UNK 29 Abdominal PVT series LABS: PVT Stool guiaic None neg. abd x-ray & US GERD abnormal. PMH: recent BMP WNL. OM. 0 BP: 130/84 PUB P:80 PUB None Hyperglycemia, depression, allergies 5 PVT PVT GERD/IBS/Allergic Rhinitis 0 PVT PVT MACROBID, EMYCIN,Patient PABA, has DEMEROL, several allergiesCATAPRES, sulfa,TEQUIN, vibromycin, CELEBRE 0 Chest X-ray; PVT Cardiac Enz; PVTSMA 22; Triad/ PTT/INR; HCTZNone CBC; 37.5 Qday; U/A None - no Estradiol significant Faint~Influenza 1mgfindings Qday; fluoxetine (no brand 20mg name)~UN~0~In - one Qday. Pat 0 WBC 15,000 UNK on 11/5/08, UNK neutrophils citalopram 10.1 on 80 None 11/5/08, mg daily, mono no mirtazapine previous 1.3 on 11/5/08, allergies. 15 mgrest qhs, PMH ofgabapentin CBC includes WNL.mood 800 Temperature mg disorder, q6h, metform 98.9 hypero 14 White countUNK 3000 with UNK differential showing 40% segs, 12% monos, 45% lymphs. Sodioum 139, Potassium 3.7, chl 1 PUB PUB none cough allergy to unknown antibiotic SC0901 2 n/a PUB PVT N/A NONE NONE 0 none PUB PVT headache, high fever, loss of apetite, vomiting~ 1 PUB PVT OCP none reported Seizure hx - no current therapy PVT UNK none none none 0 UNK UNK 1 PVT PVT no no continuous supressed WBC. now normal .Immune dysfunc 0 PVT UNK none none 1 NONE MIL MIL NO ILLNESS NONE 2 PVT PVT Remeron DepressionDepression (treated, stable) 3 MIL MIL 1 n/a PUB UNK unknown unknown unknown. n/a~ ()~NULL~~In Patient 0 PUB PUB Multivitamin, None Aspirin 81mg Seasonal allergies None~ ()~NULL~~In Patient 227 SHINGLESUNK 053.9 UNK N/A 1 None performed PUB UNK Valtrex 500None mg bid; Activella NA 0 Rapid Physical MIL exam/ Oxygen MIL via None facemask /None benedryl given Noneat urgent care facility. Nothing more given due to pati 1 UNK UNK NOne None MIL MIL None None None 0 CXR-normal; PUB CT scan,PUB n/non contest Augementin except for 1yr 200mg; ethmoid 9mo Bid None sinitis x 10 days 1 PUB PVT PPD SanofiNone C2901BCNone left arm 1 CBC; ChestPUB X Ray PUB PHENOBARBITOL Cold Sx;daily Dx Seizure Pneumonia Disorder next day 3 Nasal swabOTH and blood PVT drawn; Swab None was positive No None 3 Nasal swabOTH rapid for flu PVT + None No None 0 PUB PVT TESRETOI;byPEROCET; PM had headache DEXYCY; PREMARIN; CADUET; ELAVIT; FOLIC ACID Unknown OTH OTH Unknown Unknown WAES0811USA03767 0 Unk OTH OTH Unknown A0763055A 0 UNK OTH PUB Thyroxine sodium; Acid reflux; Indapamide; The Arthritis; subject Hypertension; Omeprazole; had previously A0763069A Potassium Hypothyroidism received chloride influenza vaccinations 2 Blood work PVT performed PVT on an unspecified No concurrent dateUnknown was medication normal. The subject has not previously A0763072A received flu shots and has 1 PUB UNK No No 0 PVT UNK TRAMADOL None & SOMA Allergies: PENICILLIN; brother~Diphtheria SULFA;Toxoids ERYTHROMYCIN; (no brand name)~U MORP 0 PVT PVT None None None 1 OTH PVT Excedrin Penicillin, Ibuprofen 0 OTH PVT Previously fainted fainting~Vaccine after receiving not specified vaccinations (no brand name) 0 Unknown OTH OTH Unknown Ankylosing spondylitis WAES0811USA03927 1 Autopsy - report PVT not available. PVT None None 33 week premature twin PMH: 33 week preemie twin, NIC 1 Labs and Diagnostics: PVT UNK CXR (+) for likely atelectasis. None CT Cutis chestLaxa; (+) forcongenital marked volume disorder loss of LGlycosylation. lung. pH probe PMH: (+) for Aum 0 None PVT PUB No No No 4 12/12/08 Lab PUB showed low PVTyellow fever Unknown antibody None titer. Unable to separate IgG and Igm. 0 PVT PVT None Reactive Airway Cleft lip/palate Exacerbation; URI 1 PVT PUB None None 0 None PVT PVT ORTHOCYCLIN None None 10 None MIL MIL None None 0 PVT PVT Trazodone;None Methacarbenol Injectable iron; Celiac Disease; Fibromyalgia
4 PVT OTH Hx of breast (L) CA not same arm. 0 MRI, 11/29/08; PUBEMG, 12/10/08 PUB Levothyroxine; None Restasis; Low Dicyclomine Thyroid 1 PVT OTH 4 PVT PVT FEXOFENADINE None 180 Recurrent mg daily urinary Fainting~HPV tract infections. (no brand name)~2~18~In Patie None PVT PUB None Eczema None 0 OTH PVT None None 0 PVT PVT 2 PVT UNK None None 1 None PVT PVT ZYRTEC None None 7 OTH OTH None CT Contrast dye X-rays; EKG PUB UNK None None 0 Unknown OTH OTH Unknown Unknown WAES0901USA00781 2 diagnostic procedure, OTH balancing OTH testing Tylenol; Amoxicillin; Upper respiratory Diazepam; tract Xalatan; infection; Prinivil; Hypertension; WAES0901USA00809 Aleve Glaucoma 0 ultrasound, OTH 12/08/08, Pregnant. OTH 22Unknown weeks, 1 day Pregnancy NOS (LMP = 8/1/2008)WAES0901USA00452 1 None PVT UNK eczema, tonsillar Eczema hypertrophy (not infected) 1 Mild elevation PVT of CK toUNK 257. none Allergies to Fish and Shellfish 856 PVT PUB None known. None. 0 UNK UNK BENADRYLPT PRESENTED ALLERGIC TO OFFICE NA~ RHINITIS, ()~~0~In FOR ALLERGY-INDUCED APatient|NA~ PHYSICAL.()~~0~In PT C/O ASTHMA Sibling|NA BEING "T 0 none UNK UNK Phenobarb Upper 10 ml once Respiratory Epilepsy a day, Diastat Infection Seizure~DTaP 2.5 - went mg rectally to Dr. + HepB and prn was for + IPV seizures, diagnosed (Pediarix)~2~0~In 3/4after tsp mo bei 2 UNK UNK NONE NONE. PTECZEMA SEEN FORNA~ ROUTINE ()~~0~In PHYSICAL. Patient|NA~ ()~~0~In Sibling|NA 1 None UNK PUB None None none 3 PVT UNK None None None Fever, wheezing, irritability~DTaP + HepB + IP 1 PVT PVT metformin none 0 NA PUB PUB tylenon <0.4none ccs 2 times none on 1/7/09; 1 timeon 1/8/09 VA09:003 1 contact me UNK in a week and UNKI'll let you know Labs none and Diagnostics: Allergic toInsulin many none~ (H) things ()~~0~Patient 35.3. so much C-peptide that 4.5. the tests otherwise continue WNL. to c 0 Pending perUNK hospital. Labs UNK and diagnostics: Tox contact screen dermatitis none. (-). Chemistry PMH: none unremarkable. EEG WNL. 0 UNK UNK tYLENOL NONE NONE ~Pneumo (Prevnar)~~0~In Sibling|FACE FLUS 1 EEG - negative. UNK CT of UNK head - readReglan, as negative. Zantac, LABS: Topical skeletal GERD, Nystatin survey Upper Respiratory WNL. CT ofInfection head revealed at (afebrile) bilateral at time mastoid of 2 CSF: 57 wbc: UNK 66% LYMPHS; UNK CSF GLUCOSENONE 114; CSF MED PROTEIN ALLERGIES: 115 3/3/09-records CIPRO, ZOCOR, receivedZESTRIL, Electromyography LOTENSIN 0 NONE UNK UNK ESTROGEN, NONE TESTOSTERONE ALL: SULFA CREAM, (ANAPHYLAXIS); VOLTAREN,GENTAMICIN, CALCIUM, GLUCOSAMI TETRACYC 1 N/A PUB PUB Bentyl 20 mg None IM x 2 days No prior in Right Dlt to vaccine. 1 UNK UNK citlopram, felodipine,hctz, none none diovan, lovastatin 0 PVT PUB NA na 1 N/A PVT UNK None None 0 I called the PVT afterhours nurse UNK hotline Pamelor and told 50. her None Effexor my symptoms XR Allergy 150. and Prevacid to sulfa, she said Type 30. Corgard toIIget Diabetes, to 120. ER now. Chronic Glucophage I asked migraines, what XR 2000. they Chro co V 0 n/a PVT PVT n/a n/a n/a 2 None PVT PVT Minocycline,none celexa, Nuvaring none Headaches~HPV (Gardasil)~1~18~In Patient 1 n/a PVT UNK None None. Given None as part of treatment for fall/blunt trauma. No VIS given to 523 12/16/08, Positive PVT HSVPUB culture genitalia Cephalexin;None Allergy Augmentin fainted~Tdap (no brand name)~6~14~In Patien 66 Labs and Diagnostics: PVT UNK PAP smear (+) for ASCUS None and HPV. NoneCT PMH: brain none scan WNL. Pelvic US . ECG reported as no 3 CBC; Hytes; PVT Glucose;UNK TSH; Calcium, normal;None CT head PMH: 6/08; EKG, none 8/08; Holter 10/08 Labs and Diagnostics: PAP 3 Labs and Diagnostics: UNK UNK PAP smear (+) for ASCUS and HPV. PMH:CT none brain scan WNL. Pelvic US . ECG reported as no 1 None UNK PVT None Allergic to AMOXICILLIN (medicine) PVT PVT Allergies PCN; Cortisone; Tetanus per pt. 3 Strep test (-); PVT RSV (-);PVT flu A+B (-);PULMICORT; CBC None ZYRTEC RAD; AP 2 None PVT PVT None None None 12 None PUB UNK None No Cow milk allergy. 2 PUB PUB NC09005 1 All WNL perPUB pt PUB NUVARING 2005 - Anemia Hx: of Ovarian NC09003 and breast Cyst 1 PVT UNK None None 1 None PVT PVT None None None
0 None PVT PVT None Controlled asthma 0 PUB PVT No 1 PUB PVT No 0 PUB PVT No 0 PUB PVT No 1 PUB PUB LIPITOR, FOSAMAX, None ATENOLOL, Seasonal Allergies; Sore LEVOTHYROXINE, Arm~Influenza Hypothyroid(no Ca+ brand name)~1~73~In None OTH UNK Vitorin; BENICAR; None Known ZOLOFT Allergy to NIACIN 3 PVT PVT 0 PUB PUB None NC09002 1 Ultrasound;PUB WBC PUB None None None NC09001 1 PVT PVT Hx Asthma 0 None PUB PVT HCTZ 25mgNone qd; LipitorAllergies: 10mg oneMorphine qd. Unknown OTH OTH Unknown Unknown WAES0806USA02506 57 Body temp,OTH 6/27/2008,OTH 102.7, F Unknown WAES0807USA00576 Unknown OTH OTH Unknown Unknown WAES0807USA02893 0 None OTH OTH Milk allergy WAES0807USA04603 0 Unknown OTH OTH Sepsis WAES0808USA01657 1 Unknown OTH OTH Aspirin; calcium Osteoporosis; (unspecified) Hypothyroidism; (+); domperidone; Gastroparesis WAES0810USA05385 SYNTHROID; ACIPHEX; FORTE 306 1/29/09-records UNK received-COD-undetermined. UNK krk 6/23/09-pathology No medical problems-report received: no allergies autopsy -- No tissues drug without use, alcoho evide 5 See attached. PVTLabs and PUB Diagnostics: Tylenol CBC with None 43K WBCs None. withPMH: 20% none. atypical lymphs. CT brain scan (+) cerebral e -190 UNK UNK HSV encephalitis. Seizure. PVT PVT None None, Well None Visit 0 None PUB OTH None None None I don't knowUNK Positive PPD UNK No allergies; No history of hives; non-smoker; limited alcoh 414 UNK UNK UNK UNK 0 Allergic rx toUNK Pneumovax UNK 0 UNK UNK 0 blood pressure, PVT 01/05/09, PUB102/60;Unknown total heartbeat count, 01/05/09, Unknown OK WAES0901USA00898 2 Unknown 2/2/09-records OTH OTH received-Renal Unknown ultrasound 2/2/09-records normal. None receivedLabs 2/2/09-records WNL. Dysuria, MRI brain receivedWAES0901USA00986 left normal. flankPMH: pain times GTC 5 seizure days. After at 8 yea fir 27 X-ray, negative; OTH WBC count, OTH negative Unknown WAES0901USA01014 blood pressure, OTH 11/28/08, OTHsystolic Unknown around 89;Osteoporosis; computed axial, Watery Seasonal showed diarrhoea allergy no evidence WAES0812USA03732 of different abscess formation; 1 PUB PUB None 0 1/7/09 RightPVT humerus X-ray PVT AP and Lateral No None Known 34 U/A, CXR, CBC, UNK CMP,UNK Head CT-done Dayquil, in the Nyquil, ER none 12/29. Benadryl, 1/15/09-records 1/15/09-records noneTylenol 1/21/09 receivedrecords receivedCough received-PMH: MRI times negative. week. Kidney CT Patient normal. stone. wasDiverti Urine diagn 0 PUB PUB dilantin/ritalin/steroids. none Seizure disorder/chronic hepatitis C 1093 We do not have UNK data. UNK She died at Hosptial. According to1/21/09-records the State healthreceived-PMH: dept, the case mononucleosis was meningitis 2serogroup months a 14 SAW 2 DOCTORS UNK BECUASE PVT THOUGHT IT CANCER WAS A TOOTHACHE. REMISSION DENTIST SENT HER ON TO ANOTHER DOC 1 MIL MIL n/a NONE Swelling leg~DTP (no brand name)~1~1~In Sib 2 PVT PVT NONE CONTACT DERMATITIS~Hep A (Havrix)~1~4~ 1 NONE PUB PUB NONE NONE NONE 0 PVT PVT none none None 1 n/a PVT PVT advair 500/50, none allegra60-120mg nkda 1 PVT PUB Ranitidine GER fever~DTaP + HepB + IPV (Pediarix)~2~0~In P 0 none PUB PVT Loestrin 24-one nonedaily, Nexium acid reflux, 40mg-one pvc's, migraines, daily viral meningitis 3 weeks prior 1 PVT PUB NONE NONE NONE 1 Pending labs UNK currently UNK are CBCPD, Bactrim COMP, forCRP, no ingrown 2/9/09-records c3, c4, toenail no UA2/9/09-records 2/9/09-records received-Currently Measels~Measles receivedreceived-CRP onMeasles Bactrim + Mumps increased after for+ingrown Rubella first.9,MMR. lymphocte toenail. (MMR II 0 UNK PVT no Client states he takes allergy medication for environmenta 1 UNK UNK Motrin 800 None mg TID, Lamictal Allergy100 to Ceclor. mg BID Dx with Cerebral Palsy and followed by 0 UNK UNK none penicillin-all siblings have had reaction, told to avoid by ph meter, blister broke am 1/14/09 no fever, PUB no headache, PUB nonone problems with noneany other hypertension anaphylaticand type hypercholestalema reaction. Requested that if fever deve
0 none PUB PUB no no allergic to Amoxycillin 0 PUB PVT none none none 0 none PVT PVT none reports multiple allergies when skin tested at local allergist 0 None PUB PVT none none 0 none PVT PVT Cutivate 0.05% none1 app 4x per day prn Temovate 0.05% 1 app NovoLog Penfill 1 0 UNK UNK Diovan HCT 80/12.5 - tab once daily, levothyroxin tab50 mcg - once daily, simvas 624 Physician made UNK diagnosis UNK 26 NERVE CONDUCTION, UNK UNK MRI, BARIUM SWALLOW NONE TEST, NONE 1/16/09-records received-CSF: protein 77, glucose 52.N 0 PVT PVT 3 12/24/07 LABS, MIL CBC, normal; MIL Comprehensive No daily script None Metabolic Meds prior Allergies: profile, to vaccination. normal; To PCN; Epstein Sulfa;Barr Benadryl; virus studies: Tetracycline; Positive NoIgG chron te 3 None known UNK UNK None None None 6 PVT UNK Hypothyroidism; HTN 0 OTH PUB No No 1 PVT PVT Tylenol given Just after gotinjection over a cold and mild diaper rash. None PUB PVT TEGRETOLNone Unknown 1 None UNK UNK None None 2 PUB OTH None None None 1 PVT PUB None large lump on thigh~Measles + Mumps + Rube 1 PUB UNK Well check 1 PVT PUB None None 4 PVT PVT Mononessa 28's; Naprosyn Mild GERD; Dysmenorrhea 139 Gastric emptying MIL studyMIL positive forNone gastroparesis; Nonetestosterone, None 178; free testosterone, 16.1 454 MRI/MRA ofMIL brain, 1/19/08, MIL Abnormal Nonewith and None without contrast, None PMH: with findings hospitalized that w/food are of concern poisoning for2001. primary or sec 0 PVT PVT Glucophage, None Lotrel, Caltrate Diabetes 2 , HTN, HLD 0 None PVT PVT None No Diabetic 0 OTH PVT Patient stated she was allergic to CECLOR 1 OTH UNK None 1 OTH PVT None None 0 None PUB PUB PPV 23, Merck; Nonelot # 0981X; None Route/Site LVL; No. Previous Doses, 1 None PUB PUB None None None 41 PAP tests after UNKGARDASIL: UNK 11-20-07 = ASCUS; 5-21-08No = Known ASCUS; 12-3-08 = Normal 0 PVT OTH Allergic to most Noneanti biotic Allergic to most Dizziness~Varicella anti biotics (no brand name)~1~5~In P 7 None MIL MIL 12/20/2007 Adverse effect caused in therapeutic use, sma MIL MIL childhood h/o allergies to dust, pollen, pet dander EKGMIL MIL SINGULAR; ZYRTEC; RAD; PRN ALBUTEROL seasonal allergies inhaler MIL MIL MIL MIL h/o allergies which were skin when he was younger MIL MIL eczema MIL MIL MIL MIL MIL MIL none MIL MIL none none MIL MIL anthrax and typhoid given on same day as SPV Unknown OTH OTH Unknown Unknown WAES0901USA01153 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA00384 33 Unknown. Labs OTH and Diagnostics: OTH Unknown Abd US (+) for IS. Barium Unknown. enemaPMH: (+) fornoneWAES0901USA00993 IS 47 UNK PVT OTH Tuberculosis Unknown vaccine; Unknown; No relevantBlood medical pressure history. A0763485A medication No adverse events were repo 4 US LABS: PVT air contrastPVT BE unsuccessful as reducing No IS. Stool c/s neg. 0 OTH OTH Unknown 1 PVT PVT 0 PVT PVT None
0 PUB PUB None History of malarial yes~Hep infection A (no brand 11/08name)~1~0~In Patient 1 None PUB UNK Contraceptive None patch None 2 UNK UNK 0 CBC normal; PVT Lamictal PVT level pending, TYLENOL; as mother None PRN takes thisNone medication and is breastfeediing 1 PVT PUB 0 PUB PUB UNK UNK no 1 PUB PUB 4 blood work,UNK nerve conduction UNK study. Lyrica, LabsAmytriptyline, andNone. Diagnostics: Entocort, Idiopathic CBCBirth with Anaphylaxis, control WBC 13,940, pill,Fibromyalgia, Ultram RBC 5.28,GERD. Hgb 15.4. PMH: HctNKA. 46.1. UNK UNK none hypertension, none hyperthyroidism, noted.~ ()~NULL~~In osteoarthritis Patient 0 PVT UNK none none 2 MIL UNK none 0 none UNK UNK Zoloft None sensitivity to Erythromycin and Bactrim and Iodine dye 1 None UNK MIL none None hayfever 2 PVT UNK none none 1 UNK UNK Flovent, Albuterol, new patient Zovia, Allergies: appt Zyrtec, in practice Epinephrine Xanax, Ibuterol (heart palpitations), Lexapro + Kiwi 12 LABS: WBCUNK 20.9, ANCUNK 17.8(H), lymphs 10.3%(l). Creatinine PMH:0.3(L), URI s/s ALK x 1 150(L), mo. Recurrent AST 58(H). OM & CTear brain tube abnormal. insertion.P 0 PUB PVT No acute orN/A chronic illnesses 8 N/A UNK PVT levothyroxine,dyazide,arimidex, oro-labial Herpes, mild clonazepam,vitamin D, verapamil 190 start of vaccine UNKseries 09/13/2006,2nd UNK dose 10/18/2006 none and hypothyroidism, 3rd and finalmigraine dose 2/14/2006 headaches. Blood PMH: workthyroid drawn 5/10/2 proble 0 None PVT UNK Prevacid 15None mg. twice Ulcer, a day GERD siezure like symptoms, projectile vomiting, arch 3 PVT UNK None Laceration of finger 737 unknown PVT PVT none at thepossibly time double-ear none infection and earlier that month had sinusitis 0 BP, 100/60;PVT Pulse 0X, PUB 100%; HR, None 90's; RR, 26 None None 1 None PVT PUB None None None 0 None PVT PUB Mycology cream Diaper rashHx single umbilical artery 0 PVT PUB Well child checkNone up 0 None PVT PVT None 1 PUB PVT None 2 PUB PVT Benicar, Flonase None Ragweed, HTN 1 PUB PUB None None Over weight 0 V.S stable PVT PVT Unknown None Known None Known PUB PUB None None 0 None PVT PVT PROZAC 20 None mg; VYVANSE ADHD,30 insomnia, mg allergic rhinitis, major depression 2 OTH PVT MIL MIL 0 None PVT PVT None None depressive disorder, obesity 2 Taking BENADRYL, PVT using UNKhydrocortisone UDRecovering AROM 0 PVT PUB Abnormal newborn screening; Hgb electrophoresis; refer t 0 BMP creatinine PUB0.3 mg/dl; PUBHgb 12.1 g/dl; Hct None 36.7%; CXR None = WNL; UA-bacteria moderate; CBC - WBC 12.7 x/cmm; PVT UNK Exposure to rabies 0 PUB PUB Oral contraceptives, None Celexa Asthma, xanax, Anxiety, Ambien, Depression, Singular,OCD Pulmicort, Zephanal 1 PUB PUB None None None 0 PVT UNK No No 8 PVT PVT Sinusitis 3 PVT PVT Tylenol, Motrin None Keratosis plans low fever~ ()~UN~0~In Patient 1 PVT PVT 1 None Developmental Delay 315.9 0 PUB PUB 40 LABS: Blood PVT work 1/20/09: PVT ESR 32(H). YASMINE CRPNone <0.5. CBCNone & chemistry PMH: UTIs, WNL.HA, ANA dehydration, neg. IgA 73, contraception IgG 1532, igM irregula 105 1 None PUB PUB None None None 0 PUB PUB None Penicillin and buckwheat per patient
PVT UNK Attached with allergiesAttached 6 Stool culture, PVT negative PVT None None 3 PVT PVT 1 UNK PVT None None 0 None PUB PVT None No 1 PUB PVT lacerated upper Penicillin lip 0 Unknown OTH OTH Unknown Unknown WAES0712USA08098 Unknown OTH OTH Unknown Unknown WAES0901USA01220 Unknown UNK UNK PAROVEN; garlic Unknown WAES0901AUS00036 0 None OTH OTH Hormonal contraceptives None WAES0901USA01109 1 plasma creatine OTH kinase, OTH elevated 2/17/09-records Unknown received-MRI None brain normal, MRI WAES0901USA01201 cervical spine minimal bulge at C 0 Unknown PVT OTH Unknown WAES0901USA01203 2 VZV strain, OTH 01/??/09, positive OTH for VARICELLA Unknown zoster virus Unknown 2/3/09-records 2/3/09-records received-MRI WAES0901USA01139 received-PMH:subarachnoid brain normal, Lumbar punc intra Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA00290 0 n/a PVT UNK 0 n/a PVT UNK 0 n/a PVT UNK 0 PVT UNK RECEIVEDNONE PPD TESTNONE WITH VACCINE ON SAME HAND PUB UNK 0 None PVT PUB None None None 0 PVT PUB NONE ORDERED, PUB HOWEVER PUB CONTACTED PT RECEIVED VIRAL MEDIMMUNE PPD INFECTION TEST 784.7DURING FOR EPISTAXIS, 079.99 STABILITY N/A~ SAME ()~NULL~~In V40.3 WELL STUDIES BEHAVIORAL CHILD Patient|N/A~ AND VISIT. ADDITIONAL PROBLEMS ()~NULL~~In INFOR NEC S 1 1/5/09 Patch UNK tests performed UNK wereNone negative. Nasal Telephone congestion Sulfa, interview Td without -conducted told 8 days fever not of to soreness 1/16/09. take Td unless to arm~ she ()~UN~0~In had an injury. Patien De 0 UNK UNK NONE NONE NONE 1 UNK UNK N/A N/A N/A 0 PUB PVT allergic to PCN 4 none PUB PUB 1 Diagnostic X-Ray UNK doneUNK at Medical Center 11/07/2008 Vaginitis positive Augmentin, for acute Morphine, pneumonia. Percocet Chest X-Ray 1/7/2009 done at 0 PUB UNK 41 N/A PUB PUB None None None AZ0901 0 CBC - normal, UNKMRI - normal, UNK initialNone bicarb at15 time but Mild ofthis vaccination upper resolved respiratory None to 20 infection, on recheck, no UA sorenegative, throat Utox negative 2/17/0 0 PUB UNK none none none Unknown OTH OTH Vaccination adverse reaction; WAES0901USA00619 Stroke; Generalised raised r 0 None OTH OTH Unknown None WAES0901USA01342 9 Unknown PVT OTH Unknown Ulcer WAES0812USA05078 Unknown OTH OTH Unknown Unknown WAES0901USA01615 Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH07600409 was not provided. 19 UNK OTH OTH Unknown Cartilage tear in knee A0763805A UNK OTH OTH Unknown The subject's medical history, A0605304A concurrent conditions and co -24 A lyme titerOTH dated 20 May OTH2000 was 163. Alcohol abuse The subject's medical history, A0603918A concurrent conditions and co Diagnostic results: OTH 05 February OTH 2003, Lyme disease Hypercholesterolemia; screen, Bursitis 2.59elbow; LIV, Hypertension; positive; Gout; Gouty A0603038A Lyme synovitis arthritis disease IgG and IgM Western UNK OTH OTH Unknown The subject's medical history, A0600456A concurrent conditions and co UNK OTH OTH Unknown The subject's medical history, A0599980A concurrent conditions and co 2 Autopsy pending PVT PUB None None Heart murmur PUB OTH None Unknown 0 will be seeing PVT allergist UNK No Neurofibromatosis - type 2 1 None PVT PUB UTI; Rx Septra suspension 1 PUB UNK 23 VZV, real time, PVTPCR, positive PVT ATACAND; CELEBREX; PRINVIL furosemide; LANOXIN; PREVACID; synthroid; TOPROL 0 None PVT UNK Tubersol skin None test; Manufacturer, Allergic rhinitis/asthma Sanofi Pasteur; lot # C2908AA; Route/site ID, L 35 PUB UNK None Allergic to Penicillin & Sulfa
1 None OTH OTH High blood None pressure meds; Amoxycillian stomach/Penicillin/ meds Stomach Stufflon (medication); Hig 10 May 2006 MIL 1110; Collect_Sample: MIL Abscess; Bacteriology Results: Light growth of Coagulase negative; Staphylo 0 PVT PVT None None Allergic ICN, Augmentin 0 OTH OTH None 0 None PUB PUB None Eczema; insect Nonebites 0 PVT PVT None 1 CBC normal; PVT UA normal PVT Chronic eczema MIL MIL None Seasonal allergies MIL MIL 2 (Local reaction PVTvs cellulitis) PVT None No No 2 PVT PVT None None 0 None PVT OTH None None None PVT PVT Rash OTH OTH Concomitant medications A0754685A were unknown. It was unknown Hepatitis B OTH antibody, 7000mIU OTH Unknown Concomitant medications A0754688A were unknown. It was unknown 2 UNK PUB PUB Unknown No concomitant medications A0755872A or relevant medical history. N Hepatitis B OTH antibody, Jan2008, PVT negative; ATENOLOL; Hepatitis Unknown PENOFIBRATE; B antibody, No adverse Oct2008, ESOMEPRAZOLE events negative were A0757769A reported with previous vaccinatio UNK OTH OTH Unknown A0753558A UNK OTH OTH OBESE A0753422A 1 PVT OTH Unknown A0752850A 0 OTH PVT Unknown Ear infection; The subject A0752481A drinks two to three drinks per we UNK OTH OTH Unknown A0751461A 0 UNK PUB PUB Epoetin alfa; Dialysis; VENOFER; Hypertension TheEsomeprazole; subject has noAmitriptyline; history A0751452A of adverse Calcium events acetate following pre UNK OTH OTH Unknown A0750849A is the same A0750849A subject as Havrix report A073350 The subject's OTH hepatitis OTH B titer was negative Unknown A0749315A Hepatitis B OTH surface antigen OTH Aug2008 positive Unknown Polymerase Bite;chain The subject's reaction medical Aug2008 A0748855A history, low positive history of adverse even Hepatitis A PUB antibody, 2008, OTH negative; Multivitamin Hepatitis Unknown B antibody, The1998, subject negative; had a non-cancerous Hepatitis A0748000A B antibody, abnormal 2008, papnegative smear 10 0 Unk OTH PVT Unknown The subject had no medical A0747300A history, nor any history of adv 0 UNK OTH OTH Unknown A07466B1B is a suffix A0746681B case. Please reference report A074 0 OTH OTH Unknown A0746681A has a suffix A0746681A case. Please reference report A0 31 Hepatitis A PUB IgM, 28Aug2008, OTH negative; Hepatitis Premature B antibody infant The negative, subject was 28Aug2008, premature A0746640A negative; infant, who Hepatitis had been B surface hospitaliz a 3850 Hepatitis B OTH Aug2008 Negative OTH Unknown The subject's medical history A0746630A and concomitant medications 1 Unk PUB OTH Obesity, Possible The subject Arthritis, hadSuspected a history A0746159A ofTendonitis alcohol use, but no history of 12 Alanine aminotransferase MIL MIL 26Aug2008 Multivitamin; 390unknown VIRAL Ibuprofen HEPATITIS The Alanine subject C aminotransferase had a history A0745772A of substance 28Aug2008 abuse 462unknown and viral he OTH OTH Unknown This report was received A0744258A when the subject, now 11 years o Body temperature OTH 102F OTH Unknown The subjectA0744039A developed malaise and frequent di 21 PVT PVT Unknown The subject had no medical A0743134A history, nor any history of adve 3 Hepatitis B PVT antigen, 04Aug2008, PVT positive; Hepatitis Hemodialysis; B antigen The Hypertension; subject 18Aug2008, had a history negative Renal A0742679A failure of renal failure, hypertension, an 3 Hepatitis B PVT antigen 04Aug2008 PVT positive Hepatitis HEMODIALYSIS, B antigen The subject Type 18Aug2008 had 2 diabetes typenegative 2A0742674A diabetes and was on hemodialysis 5 Hepatitis B PVT antigen, 28Apr2008, PUB negative; EPOGEN;Hepatitis ZEMPLAR; Diabetes; B antigen, Renal The CYMBALTA; subject failure 05May2008, isNEXIUM; hoping Positive. to A0742525A LYRICA; receive The aREQUIP subject kidney transplant was and negative RENAGEL becau for UNK OTH OTH No concurrent Unknown medication The subject has no relevant A0741415A medical history. OTH OTH No concurrent Unknown medication The subject has no relevant A0741414A medical history. OTH OTH No concurrent Unknown medication The subject has no relevant A0741411A medical history 1 PVT PVT TOBRAMYCIN; Unknown MUPIROCIN Allergy; At the same appointment, A0740993A the subject presented w Body temperature OTH 102 OTH F Unknown The subjectA0740779A developed malaise and frequent di 0 UNK PUB OTH Unknown A0740560A Hepatitis B PVT antibody, negative; OTH Hepatitis B antibody, Unknown <9 A0740177A 1 Hepatitis B PVT surface antigen PVT po, 11Jun2008, Positive. UnknownThe The subject subject hadhad a Hepatitis no medical A0739438A B surface history,antigen nor anytest history performed of adve Unk OTH OTH Unknown The subject had no medical A0738699A history. The physician reporte 0 PVT PVT Unknown A0738217A was one ofA0738217A three cases reported by the same 0 UNK PVT PVT Unknown A0738216A was one ofA0738216A three cases reported by the same
0 UNK PVT PVT Unknown A0738213A was one ofA0738213A three cases reported by the same 3 A hepatitis B OTH screen performed OTH onHemodialysis the subjectRenal 02 June failure 2008 was negative. On A0737058A 19 June 2008, the hepatitis screeni Unknown OTH OTH Unknown A0736984A HEPATITISOTH B antibodyOTH June2008 negative Unknown The subjectA0735030A completed a three dose series of H UNK OTH OTH Unknown This event occurred in A0734385A two subjects (two physicians) with c Unknown OTH OTH Unknown This event occurred in A0734383A two subjects with this case, A07348 UNK PUB OTH Unknown The subject had no medical A0728389A history, nor any history of adve 2332 Hepatitis B OTH antibody, 12June2007, OTH Unknown negative A0728370A was one ofA0728370A three cases reported by the same UNK OTH OTH Unknown Concomitant medications A0726130A and relevant medical history wer 0 Blood glucose, OTH03Oct2005, OTH 94mg/dL, MULTIVITAMIN, 74, 106;Unknown Blood IBUPROFEN pressure, 03Oct2005, 140/100; A0725646A Blood pressure, 03Oct2005, B Hepatitis B PVT antibody, negative OTH Unknown The subject's mother isA0725392A HBV positive. 1 UNK OTH OTH Unknown The reporter was not aware A0725103A of any adverse events followin 0 UNK PVT PVT Unknown Subject was healthy and A0724678A was receiving no concurrent med HEPATITISOTH B surface antigen OTH 08Apr2008 positive DIALYSIS, HEPATITIS Subject RENAL takes B surface FAILURE alot of antigen concurrent A0724634A 15Apr2008 medications negative; by the Lab nurse work Did not develop OTH a positive OTHtiter to be considered Unknown a responder to the series. A0724370A Hepatitis B OTH antibody 12500 OTH ; Hepatitis B antibody Unknown <5; The subject recently tested A0724182A and had Hepatitis B antibody leve 149 Hepatitis B OTH antibody 27MAR2008 PUB negative Unknown A0722946A UNK OTH OTH Unknown A0722933A Blood drawn PVT for unknown PVTreason Unknown No known adverse events A0721988A following previous vaccinations. 0 Unknown UNK UNK Inhaler Unknown The subject had a history A0721445A of allergy to seafood. Concomita Hepatitis B PVT antibody Mar2008 PVT negative Obese The subjectThe hassubject no history A0721436A hadofcompleted adverse events a vaccination following series pre 0 Unk OTH OTH Unknown A0719021A UNK OTH OTH Unknown A0718735A A titer was drawn PVT following PVT the second No concurrent dose of Unknown ENGERIX medication The B. The subject titerhad wasno negative. relevant A0718733A medical history and experienc HEPATITISOTH B surface antigen OTH positive Unknown Concurrent medications A0718131A and relevant medical history was Hepatitis B OTH surface antigen OTH positive Dialysis A0717408A HEPATITISOTH B antigen OTH positive Unknown The nurse also reported A0715568A another subject who experienced 3 Hepatitis B OTH antigen 26Feb2008 OTH positive Unknown The reporter also reported A0715564A another subject that experience Unk OTH OTH Unknown A0714402A 0 Unk OTH OTH No concurrent Unknown medication The subject has no relevant A0714361A medical history and no history 1 Unknown PVT OTH Ortho Tri-Cyclen, Unknown Ethinyloestradiol No relevant medical + Norgestimate history A0712781A + Oral contraceptive place b 0 PVT OTH Cyanocobalamin; Unknown Multivitamin Gastric Bypass A0712779A UNK OTH OTH Thyroxine sodium; Unknown Blood Gastric pressure bypass; medication; Pedal A0712491A edema; Ascorbic Tummy acid; tuck; Calcium History: salt; small Thyro 3 Hepatitis B OTH antigen 12 OTH Feb 2008 Positive; Epoetin Hepatitis Alfa, Bladder Paracetamol, B Cancer, antigen Bypass Warfarin 18 Colon Surgery FebCancer 2008 sodium negative. Hemodialysis, Allopurinol A0712014A The subject Omeprazole, Hypertension, testedVitamin, negative Pacemak Alp fo 31 HEPATITISOTH B surface antigen OTH Feb2008 positive; Unknown The subject The subject was HEPATITIS traveled toA0712004A BCambodia core antibody after negative receiving"the his first entire d 5 Hepatitis B OTH surface antigen OTH 06Feb2008 PYRIDOXINE positive; Unknown hydrochloride Hepatitis B surface +; Nicotinic antigen acid15Feb2008 A0710599A +; Thiaminenegative; hydrochloride A hepatitis +; Ribofla Ba 151 Hepatitis B PVT surface antigen PVT 07 Feb(Prilocaine 2008 positive, Unknown Hydrochloride+Ligncaine) Hepatitis B surface antigen Metoprolol 21 A0710597A Feb Flurazepam 2008; A Hepatitis Hydralazine B antigen Fexofe te UNK OTH OTH Hepatitis B Unknown immunoglobulin The subject decclined to A0708836A provide medical history, concomit Results: Reporter OTH did not OTH know what type of testing Unknown was done Concurrent or anymedications quantitative A0708165A and values medical for thehistory subject's waslevels. unknown Re 2 Hepatitis B PVT surface antigen, OTH 11/30/2007, positive; Unknown Hepatitis Reflux B surface symptoms antigen, (NOS) negative; A0706423A Hepatitis B surface antigen UNK OTH PVT Unknown A0706119A UNK OTH OTH Unknown A0704397A UNK PUB PUB Unknown A0703420A 0 UNK OTH OTH Unknown A0702463A Results: hepatitis OTH B antibody OTH titers show no immunity Unknown to hepatitis ReporterB. is at an academic A0702226A health center and report's that Seroprotective OTHtiter of anti-hepatitis OTH B surfaceUnknown antigen antibody Unknown in December 2007 A0700837A showed inadequate protection. 0 HEPATITISOTH B surface antigen OTH ne Nov2007 neg Unknown Relevant medical history A0700836A and concomitant medications we 91 UNK PVT PVT Unknown A0700825A Laboratory OTH diagnostic study OTH performed and titer Unknown was negative. IMMUNOCOMPROMISED A0700017A 0 Unk OTH OTH CLARITIN-D Unknown Allergy, Penicillin Allergy, A0699078A Smoker, Social Alcohol Drinker 1 UNK OTH PUB Unknown No relevant medical history A0698379A and no concurrent medications
UNK OTH OTH Unknown The healthcare professional A0698375A reported a previous case, see UNK OTH OTH Unknown The reporter also reported A0698191A "one-third" of her hepatitis C pa UNK OTH OTH Unknown Unknown A0697307A Six weeks after OTHcompleting OTH the ENGERIX B series, Unknown the subjects Unknown had titers drawn A0697086A which showed no antibodies. Unknown OTH OTH Unknown At the time of reporting,A0697027A the subject's relevant medical hist Unk PVT PUB Unknown HEMODIALYSIS, RENAL A0696124A FAILURE 0 UNK OTH OTH Unknown The subject was born to A0696084A a hepatitis B surface antigen nega 2 OTH OTH Unknown The subject was born to A0696035A a hepatitis B surface antigen nega 0 Hepatitis B PVT surface antigen, PVT 19Nov21007, >1000 Unknown Healthy adult. A0695425A 1 Unknown PVT PVT None Unknown None A0751468A 1 UNK PVT PVT Unknown The subject had no medical A0750456A history and no history of adver 0 UNK OTH OTH Unknown The subject was reportedly A0749271A healthy. 1 UNK OTH OTH No concurrent Unknown medication The subject has a history A0748018A of seizure which occurred this pa UNK PVT PVT Unknown A0747988A UNK PVT PVT Unknown A0747109A UNK OTH OTH Unknown A0746432A UNK OTH OTH Unknown A0746367A 0 Unknown PVT PUB Unknown None A0744305A 1 UNK PVT OTH Unknown The subject at two months A0742470A of age had no history of advers bject of unspecified gender Body who temperature wasPVT vaccinated 103 PUB degreeFahre with PEDIARIX. ; White Concurrent blood Unknown cell vaccinations count A0742011A abnorma given was onone the of same A0742011A threedate cases as PEDIARIX reported byincluded the same A Body temperature PVT 103 PVT Degrees Fahrenheit ; White Unknown bloodThe cell subjects count abnormal were allUnknown treated A0742010A with at least one dose of RO 0 UNK PVT PVT Unknown A0741213A 0 In the emergency PVT room, PVT the subject Nowas concurrent evaluated Unknown medication with EEG, The subject EKG and haschest no relevant x-ray, A0739957A all medical of which history the physician and no history repor Unk PVT OTH Unknown A0738514A 1 UNK PVT PVT No concurrent PENICILLIN medication The Allergy subject has a history A0735433A of allergy to penicillin. The subje 27 UNK PVT PVT Unknown The subject had no medical A0735392A history, nor any history of adve 0 Unk OTH OTH CYSTIC FIBROSIS The subject's medical history A0733440A included cystic fibrosis. The s Unk OTH OTH Unknown The subject had a history A0731257A of fever, screaming, and fussine 3 Unk OTH OTH Unknown No adverse events were A0725174A noted following previous vaccinat 0 Body temperature, PVT 28Mar2008, PVT 102-103degrees MontelukastAllergic sodium; F; Body Rhinitis Ranitidine Gastroesophageal temperature, hydrochloride 29Mar2008, reflux. A0723471A A0723471A 102-103degrees was one F; Body of three tempe ca 0 Unknown PVT PVT GASTROESOPHAGEAL A0723470A was REFLUX one ofA0723470A three cases reported by the same 0 Unknown PVT PVT NASAL CONGESTION None A0723466A Unk OTH OTH Unknown A0722898A UNK OTH OTH Unknown A0721428A 0 Unk PVT OTH MultivitaminUnknown The subject has not previously A0717381A received any flu shots. No 0 Body temperature PVT increased, OTH 103 Unknown The subject has a history A0707255A of an occasional fever. 0 UNK PVT PVT Unknown Relevant medical history A0705229A and concomitant medications we Body temperature, OTH >103.0 OTH Unknown A0703677A 3 PUB PUB Unknown A0702795A 0 Unknown PVT PVT Unknown dietary and dermatological A0701309A sensitivities 0 Unk PVT OTH Unknown No relevant medical history A0694582A and no adverse events followin UNK OTH OTH Unknown A0691523A 992 Hepatitis B PVT antibody 6/12/2007, PVT negative Unknown A0728351A was one ofA0728351A three cases reported by the same 0 OTH OTH Concomitant drug(s) not reported MEDI0007575 0 OTH OTH Concomitant drug(s) not reported MEDI0007579 UNK UNK 2007: Patient had similar MEDI0007590 reaction when the mother's room 0 PVT OTH MEDI0007604 0 OTH OTH MEDI0007613 0 OTH OTH MEDI0007614 0 OTH OTH MEDI0007622 0 OTH OTH MEDI0007637
53 Influenza A,PVT B, 12/15/08, PVT influenza A, positive; Rapid Strep Enterovirus, test, 12/15/08, 11/04,negative; (unreported MEDI0007658 Urinalysis,12/15/08, year) Large Ket 0 OTH OTH MEDI0007660 0 OTH OTH MEDI0007662 0 PVT OTH MEDI0007667 0 OTH OTH MEDI0007674 0 PVT OTH MEDI0007683 0 OTH OTH MEDI0007685 Unk OTH OTH Unknown A0759842A 2 UNK PVT 3 UNK UNK Epilepsy 0 None done UNK - I did not go PVT to the doctor Atenolol, but will Methotrexate, None show her the Penicllin, premarin, scaredKeflex area celebrex at myhydrocholorothiazide, next appointment in February. valtrex 2 PUB UNK None None None 0 UNK OTH OTH Unknown In follow-up, it was reported A0752844A by the subject that he received 27 Labs and Diagnostics: UNK UNK Head CT (-). Paxil, ANA Kolonipin (+).None. CSF cell 2/18/09 count Anxiety. OV WNL from PMH: except 11/22/05 Anxiety/? (+) RBCs. received depression. CSF from glucose PCP. L breast Pt 133. reportedly cyst-remove Blood gluc "do 2 none PUB UNK None None none~ ()~NULL~~In Patient 22 PCOS LABS: UNK video EEG, UNKMRI brain & spine none WNL. CPKAllergy WNL. Alk penicillin phos severe 51(L). PMH: fatigue~HPV Asthma, PAP smear (Gardasil)~1~16~In strepWNL. throat. Patien 1 A blood testUNK was done UNK at the urgent yazcare birthoffice control none for any abnormality none and results were okay. 0 PVT PVT Tylenol mild nasal congestion none crying spell~DTaP + HepB + IPV (Pediarix)~1~ 2 UNK PVT 0 PVT UNK 0 N/A UNK PVT NO IBUPROFEN, SULFA, CODEINE, MACRODANTIN, MILD 2 UNK PVT 4 none PVT UNK Yasmin none nkda 0 PUB UNK none none none fever, chills, SOB, pallor~Smallpox (no brand n 8 PVT PVT none none none 0 MRI showed UNK R hemisphere UNK ischemic None stroke LABS: None MRI None brain abnormal w/right hemisphere ischemic stroke & brain 16 Pt had mid UNK LAD lesion UNK on coronaryNone catherization None requiring None mid Left anterior descending TAXIS(drug eluting) stent p 9 Diagnosed UNK with AutismUNK at the YaleInfant ChildTylenol Study NoCenter's illnesses, Developemental None, no fever developingDisabilities normally Clinic using Mullen Scales of E 1 UNK UNK none none omnicef, peanuts, birth mark left forward(dime size), Medic Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH07625309 was not provided. 7 Labs and Diagnostics: PVT PUB CXR (+) forNone R pneumpthorax, None - normal pneumomediastinum, ? slight allergy 6-10-08; and probable Hx otitis media L pneumothorax. . PMH: PCP record 58 Ultrasound PVT (+) intussusception UNK with recurrence None and surgical None reduction. Secondary Payers patches. 1/21/09-records PVT PUB None None 0 PVT PUB None None NKA 25 PUB OTH SYNTHROID 500mg daily Allergy to Cipro, Pyridium (HYPOTHYROID past) 3 None PVT UNK None None 1 None PVT PUB None None None 1 OTH PVT None listedUnknown; Penicillin; Sulfa; Allergic to bees 0 Dr doing MRI OTH of deltoidPVT to see cause Albuterol, of painADVAIR, and weakness. Spiriva, Asthma; Furosemide, hypertension Alprazolam 6 ESR-22; neutrophils PUB (low) PVT METFORMIN Diabetes 500mg qd Diabetes 0 PVT PVT 0 None PVT PVT None 3 OTH OTH No None 0 CT scan leftMIL upper armMIL 11 days after HCTZ, vaccination lisinopril, None was zocor negative HTN, DM, HLP 2 N/A PUB PUB Vitamin, generic none Zyrtec, seasonal oral contraceptives allergies MO-2009-01 0 None UNK UNK None None None 1 Had two minor UNKoutbreaks PVT of shingles None in 2008,None so dermatologist None recommended vaccine even though I'm not 60. PUB PUB prenatal vitamins client pregnant 0 PVT PVT NONE ZOCOR (MYALGIA), LISINOPRIL (DIZZY), LORATIDINE 0 Development UNK Pediatrican UNK diagnosed encephalopathy None 3/17/09-records none 3/17/09-records received-EEG received-PMH: normal except mild GE for reflux, slow waves exce 17 Her pediatrician UNK has checked UNK her vital Motrin signs, as needed sent noneher for none blood work, did an ultrasound on her heart, and a CT scan
1 Labs and Diagnostics: UNK UNK CT of Chest-no orthocyclenno PE, Hgb 8.3 (L), Hct PMH: 26.2 Obesity, (L).n/a~ WBC hypertension, ()~~0.00~Patient 12.6 (H), 17.0 congestive (H), 16.8 heart (H), failure, 16.0(H), asth RD 1 MIL MIL Unknown None Unknown 1 N/A MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown NONE UNK UNK I HAVE NO OTHER INFORMATION ABOUT THIS PATIENT OR THE 1 N/A UNK PVT UNKNOWNNO 1 Not Applicable PVT PVT NA NA NA 0 NONE PVT PVT TOPICORTECZEMA HX OF UTIs 1 NONE PVT PVT PROZAC NONE NONE KNOWN 5 Chest x-ray,UNK Breathing UNK not normalAlso acts listed similaraSmall to Rocephin asthma? sinusYes 11/17/2008 passages.Asthmatic she has Maliea and hadalso alot Mainaaupo~Hib at symtoms. of birth difficulty an epidural breathing. (no brand with She name)~4~1~ Duramax. may have Ne 9 none UNK UNK none none none 352 Varicella Zoster UNK virus IgG UNK = 2.49 Pos Varicella Zoster virus IgM = <0.91 Neg 9 LABS: CBC: PUB WBC 13.5, PUB ALC 5500, ANC 6400. NoH/H 13/48, Noplts Family 287,000. Hx: Mom CMP, w/several ESR, ANA, MRSA(+) CRP, RA abscesses WNL. 28 CT scan; EEGs PUB (3); MRIs PUB(3); spinal tap 2/19/09-neurdiagnostic Slight cold report received-abnormal III awake and asleep ele 7 CT Brain, OK MILLABS: CPK OTH1085(H). CK-MB 2.7(N). None LFTs None WNL. Magnesium 2.1. CT head WNL. MRI brain revea 1 Lab - ANA; PVT CBC; Sed rate; OTH X Rays as follows...CXR None + Ultra Chronic sound, sinus Cervical spine AR0901 + Lt shoulder. PVT PVT None 3619 PVT PVT None Eczema 74 PVT PVT PPD Tuber None Sol C2803AA None right PMH: lowerpneumonia, arm 0 doses, bilateral Ferrous forearm Sulfate fractures, varice 1 PVT PVT None None None 0 PVT PVT TAZ NO 1 None PVT PUB None None None None~ ()~~0~In Patient 3 PVT PVT Hypothyroid; chronic pain; fibromyalgia; N; S; fatigue 0 None PVT PVT None None None 1 None PUB PUB None 0 None PVT UNK 1 None PVT UNK None COPD; Hx CVA; Seizure 0 PVT UNK SECLIST CholesterolNone Check up only 24 Labs and Diagnostics: PVT PVT CT scan (-). BIAXIN EKG WNL. Sinusitis Echo WNL. PMH: EEG kidney WNL.reflux MRI/MRA as toddler. of brain T&A WNL. ageGlucose 4. Ovarian tolerance cyst. m OTH PUB ADHD; neuro fibromatosis, type I 0 PVT PUB None No None known 1 PVT PVT OTC for eczema Eczema 0 None PVT PVT None 0 None PVT PVT None None None; previous fainting on blood w/u 9 None PUB PUB None 0 PUB UNK LA090102 33 ANA, ASO,PVT CRP, 3.5; RFU, UNK negative; VaU, negative; None CGB Laryngitis dip, negative; cough,CMR, 4/07 negative; PMH: Mononucleosis. ESR, negativefamily LABS: hx:CB a OTH PUB PVT PUB None None 0 CT of head,PUB WNL; CBC; UNK CMP; X-ray, WNL None None 0 Tx lyme began PVT1/20/09;PVT mono 1/16/09 None None None ~Varicella (Varivax)~2~7~In Patient 0 UNK UNK MIL MIL ASA 0 PVT PVT 3 None PUB UNK Birth controlNone None 0 Unknown. Labs OTH and Diagnostics: OTH Unknown Stress test -no evidence Unknown for EIA PMH: or cardiac Mono disease, WAES0812USA02570 12/07. but tonsillectomy borderline 6/08. VE and Allergy VC O2 to Pap test, abnormal. OTH The OTH patient has Unknown HPV Unknown WAES0812USA02379 Unknown OTH OTH Unknown Unknown WAES0812USA02368 Unknown OTH OTH Zyrtec; Advair; DrugSingular hypersensitivity; Fish allergy;WAES0812USA02360 Shellfish allergy
-12 diagnostic laboratory OTH 12/03/08 OTH - complete DEPO-PROVERA metabolic Asthma;mg panel Otitis media plasma recurrent; TSH 12/03/08 Allergic WAES0812USA02344 -reaction complete toblood antibiotics; cell 12/03/08 Drug hy 0 Unknown OTH OTH Unknown Unknown WAES0812USA02177 0 Ultrasound OTH normal - Prenatal OTH testing Repliva including 21/7, Pregnancy ultrasound Zofran, Vitamins Surgery NOS has been (LMP= normal. 1/27/2008) Diagnostic WAES0810USA05371 Drug hypersensitivity: laboratory 04/11/08 Crohn's - norma dis 34 Ultrasound,OTH 04/23/08, Routine OTH test-Within normal Pregnancy limits; Ultrasound, NOS (LMP=07/07/08, 2/9/2008Routine WAES0809USA01795 test. Within normal limits; Ur 0 Ultrasound,OTH 5/2/08 OTH Unknown Pregnancy NOS (LMP= 11/21/2007) WAES0805USA00593 75 ultrasound, OTH 9/12/08, within OTHnormalMETHYLDOPA limit; ultrasound, Pregnancy mg; 07/28/08, PROTONIX NOS within (LMPmg = normal 3/11/3008) limitWAES0804USA04002 Hypertension; Dyspepsia None PVT PUB None WAES0804USA00010 245 Ultrasound,OTH BiophysicalOTH profile, within Allegera-D; normal Pregnancy limits; Meclizine; Ultrasound, Smoker Vitamins Nos (LMP 10/14/2008, = 1/30/2008); within WAES0803USA00972 Asthma; normal Sulfonamide limits, small for allergy; dates,Sea P 40 Diagnostic laboratory, OTH pre OTHnatal care Unknown panel; Ultrasound, Pregnancy Cholecystectomy; 02/07/08, NOS (LMP5 =week 12/18/2007); 6/7 Smoker; day; WAES0802USA04664 Amniocentesis, Asthma Glioblastoma multiforme 04/25/08, 17 w 0 None OTH OTH Unknown Unknown WAES0812USA03380 0 None OTH OTH Asthma WAES0812USA03339 31 Unknown OTH OTH Unknown Unknown WAES0812USA03231 21 None OTH OTH WAES0812USA03225 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0812USA02823 None OTH OTH None Drug hypersensitivity WAES0812USA02818 0 body temp -OTH fever of 102.6F OTH Pregnancy NOS (LMP = Unknown) WAES0812USA02787 0 Unknown OTH OTH Unknown Unknown WAES0812USA02632 diagnostic laboratory OTH -OTH DNA negative NUVARING for HPV diagnosticNone laboratory - 11/??/08WAES0812USA02627 - HPV test positive Pap test - no Unknown OTH OTH Unknown Unknown WAES0812USA02624 Pap test 10/01/08 OTH - abnormal; OTH Pap Unknown test - 2ndPregnancy pap smearNOS results (LMP are=pending Unknown) WAES0812USA02612 0 Unknown Labs UNKand Diagnostics: UNK CBC WNL. CRP (-). LPUnknown. with normal PMH: cell noneWAES0812USA02603 count, protein and glucose. CSF cx (-). M Unknown OTH OTH YAZ Allergic reaction to antibiotics WAES0812USA02593 0 Unknown OTH OTH Unknown Unknown WAES0812USA04118 8 None OTH OTH None None WAES0812USA04111 0 None OTH OTH None Penicillin allergy WAES0812USA04110 0 None OTH OTH None None WAES0812USA04104 0 Unknown OTH OTH Unknown Unknown WAES0812USA03784 6 None OTH OTH None None WAES0812USA03782 None OTH OTH None Idiopathic thrombocytopenia WAES0812USA03779 0 EndoscopyOTH OTH Hormonal contraceptives. Unknown WAES0812USA03770 Unknown OTH OTH Unknown Unknown WAES0812USA03750 0 Colposcopy, OTH 12/03/08,OTH results showed Unknown high risk HPV Unknown WAES0812USA03738 233 Unknown 2/4/09-records OTH OTH receivedUnknown HA. Holter monitor normal Unknown EEG normal withWAES0812USA03713 mild swelling of background. Chem None OTH OTH Hormonal contraceptives. None WAES0812USA03685 Urine beta-human, OTH Negat OTH Clindesse Seasonal allergy WAES0812USA03609 Unknown OTH OTH Unknown WAES0812USA03414 None OTH OTH None Unknown WAES0612USA03385 Unknown OTH OTH Unknown Unknown WAES0812USA04585 Unknown OTH OTH Unknown Unknown WAES0812USA04584 Unknown OTH OTH OMEGA-3, vitamins (unspecified) Unknown WAES0812USA04554 None OTH OTH None None WAES0812USA04543 Unknown OTH OTH Unknown Unknown WAES0812USA04513 0 Unknown OTH OTH Unknown Unknown WAES0812USA04291 4 Unknown OTH OTH Hormonal Contraceptives Dermatitis contact WAES0812USA04284 0 Complete blood OTH cell OTH Influenza virus Sickle vaccine cell anemia WAES0812USA04280 0 Unknown OTH OTH Unknown Unknown WAES0812USA04272 50 Magnetic resonance; OTH diagnostic OTH laboratory, None blood tests; electroencephalography; None WAES0812USA04270 cerebrospinal fluid Unknown OTH OTH Unknown Unknown WAES0812USA04263 0 None OTH OTH Unknown None WAES0812USA04143 0 blood pressure OTH- was low OTH None WAES0812USA04134 Unknown OTH OTH Unknown Unknown WAES0812USA04131
Unknown OTH OTH Unknown Unknown WAES0812USA04119 1 OTH OTH None None WAES0812USA05232 Unknown OTH OTH Unknown Unknown WAES0812USA05223 39 Unknown. Labs: OTH StrepOTH test (-). CBC Vitamins and Chem (unspecified) unremarkable. TSH normal at 2.13. WAES0812USA05222 AM Cortisol low at 7.1. Lyme (0 None OTH OTH Unknown Unknown WAES0812USA05150 1 None OTH OTH Thyroid Hypothyroidism WAES0812USA05125 15 Serum beta-human, OTH 12/??/08, OTH Positive None Papanicolaou smear abnormal WAES0812USA05115 106 Magnetic resonance, OTH ?/?/08, OTH negative results; computed Penicillin axial, ?/?/08, allergy negative PMH:WAES0812USA05114 constipation. Yaz contraception. A Unknown OTH OTH CLONAZEPAM; Depression YASMIN; METHYLPHENIDATE; WAES0812USA05103 TRAZODONE HYDROCHLOR None OTH OTH None None WAES0812USA05034 0 None OTH OTH ALBUTEROL; Asthma ADVAIR WAES0812USA04902 Unknown OTH OTH Unknown Unknown WAES0812USA04828 1 None OTH OTH LEXAPRO None WAES0812USA04823 None LABS: OTH MRI & US OTH of bilateralNone breasts c/w right cystNone PMH: Asthma inWAES0812USA04815 childhood, appy, umb. hernia repai Beta-humanOTH chorionic,OTH 12/04/08, positive, Unknownhome Pregnancy, pregnancy NOS (LMP= unknown)WAES0812USA04777 0 None OTH OTH None None WAES0901USA00023 Unknown OTH OTH Unknown Unknown WAES0901USA00012 Unknown OTH OTH Unknown Unknown WAES0812USA05266 0 None OTH OTH Unknown Unknown WAES0812USA05263 0 None OTH OTH Ocella Asthma; Hirsutism; Polycystic WAES0812USA05239 ovarian syndrome -6 Unknown OTH OTH Unknown Unknown WAES0901USA00735 0 Unknown OTH OTH Unknown WAES0812USA04863 Unknown OTH OTH Unknown Unknown WAES0812USA04847 79 diagnostic laboratory OTH - OTH ClostridiumUnknown difficile test; negative;Birth diagnostic weightlaboratory low -WAES0812USA04810 Rotavirus test: positive for rotavirus 0 Unknown OTH OTH Unknown Unknown WAES0812USA04738 0 Unknown OTH OTH Unknown WAES0812USA02697 0 physical examination, PVT well PVTchild Unknown Unknown WAES0812USA02608 Unknown OTH OTH Unknown Unknown WAES0812USA02152 0 Unknown OTH OTH Unknown WAES0812USA02054 stool analysis OTH - Rotavirus OTH was detected Unknown Unknown WAES0812USA02028 0 Unknown OTH OTH Unknown Unknown WAES0812USA01781 0 Unknown OTH OTH Unknown None WAES0812USA01749 4 Unknown OTH OTH Respiratory distress; Apgar WAES0812USA01223 score low; Hyperbilirubinaemia 2 N/A PVT UNK N/A None None 0 UNK UNK Including: some cross-pollen allergies to food thought to be PVT PVT PVT PVT PVT PVT 1 PVT PVT NONE ORDERED, PUB HOWEVER PUB CONTACTED PRESCRIBED VIRAL MANUFACTURER DURING INFECTION DENIES VIST SALINE 079.99 FOR N/A~ STABILITY NASAL ()~NULL~~In SOLUTION STUDIES Patient|N/A~ 0.65%, AND ADDITIONAL ()~NULL~~In NASALLY, TIN S NONE ORDERED. PUB HOWEVER, PUB CONTACTED CHILDREN'S OTITIS MEDIMMUNE TYLENOL MEDIA DENIES 160/5ML 382.9; FOR N/A~ GENU STABILITY ()~NULL~~In VALGUM STUDIES 736.41 Patient|N/A~ AND ADDITIONAL ()~NULL~~In INFO S PUB PUB None MIL MIL active eczema back of neck 264 n/a MIL MIL None No illness just N/Anormal reaction to smallpox 2 UNK UNK Meds Stan NONE Takes: Flomax High 0.4mg blood pressure, one daily.benign Benicar prostate, HCT 20/12.5 high cholesterol. one daily. Ge 3 MIL MIL NO NO PCN 2624 NONE PVT PUB NONE NONE 178 PVT UNK unknown none none 4 PVT PVT Iron supplement 0 PUB PVT No No None No~ ()~NULL~~In Patient 2 NONE PVT PUB NONE NONE NONE
0
PUB PVT Ursodiol 300mg none PO reported tidfatty liver allergic-Ceclor NONE ORDERED, PUB HOWEVER, PUB CONTACTED N/A n/aMEDIMMUNE ventricular MFR.sept n/a~ FORdefect ()~NULL~~In ADDITIONAL 745.4 Patient|n/a~ INFORMATION ()~NULL~~In ON STAB S 1 EEG, CBC/diff/CA/Magnesium/Neurology PVT PVT Zantac 15/1 appt. none 0.9ml tid Gastroesophageal Reflux 0 myoclous seizures; UNK CTUNK scans, MRI, full body X-ray, None eeg; None nerve 2/6/09-records conduction None~ test ()~~0~In received-PMH: (pending Patient 1/23/08) fibromyalgia, 2/6/09-records hyperlip re 0 PVT UNK zyrtec, topamax No Dubowitz Syndrome,developmental delay, seizure disorde 1 PVT UNK None None 1 LABS: WBCUNK 13.1(H). ESR UNK 4(N). none none allergy to Bactrum Lindseyand D Hawkins~HPV Ceclor PMH: (Gardasil)~2~25~In bronchitis, pneumoniP 0 None PVT PVT 2 PVT PVT n/a n/a n/a 1 none UNK UNK none asthma SC0902 0 PVT PVT None No None 240 4/7/09-pathUNK report received-multiple UNK Nasonex tissues (Pseudovent with Went extensive in for Seasonal sinisitus, 400 autolysis substituted and allergies. none~ and had bacterial for()~~0~Patient|none~ aEntex sore Nonethroat. overgrowth. 400 other. 120 She capsule),Claritan, had Molecular ()~~0~Sibling bad sinus evidence allergie Triam 5 None yet -- PVT EEG ordered PVT None None Possible previous milk allergy. Pre-auricular skin tag. 1 none PVT PUB dysuria none vaginitis - refused exam 1 CBC; WBCPVT 19.7 PVT Allergy ZITHROMAX UR1 - Allergic given 1/7 rhinitis. FORURX 2 Referred toMIL neurology for MILevaluation. None None None 0 OTH PVT HYTRIN; MOBIC; Inflammation; MEDROL; None HTN(p/u at time of vacc) 0 PUB PVT None 1 PVT PVT None RAD (seasonal) 0 PVT PVT PVT UNK 0 PVT PUB None None NKDA 0 PVT PUB None None known None Known 1 PVT PVT Physical DKA?; Hypothyroid; fibromyalgia; erythromycin; penicillin; 0 Ultrasound,OTH 07/31/08, 10 OTH week 5 day Adderall gestational tablets; Pregnancy age Hormonal fetus NOS with contraceptives (LMP positive = 5/15/2008); cardiacWAES0901USA01598 activity; Penicillin Diagnostic allergy laboratory, 07/3 17 Beta-humanOTH chorionic,OTH 04/15/08, positive None Pregnancy NOS (LMP = 3/3/2008)WAES0804USA03264 67 Stool Giardia OTH lamblia, 12/23/08, OTH negative; None WBC count, 12/18/08, None. PMH: 7.3 thou; noneRed WAES0901USA01174 blood cell count, 12/18/08, 4.73 mill 2 Unknown OTH OTH Unknown WAES0901USA01835 Unknown OTH OTH None None WAES0901USA01603 unknown OTH OTH Unknown Unknown WAES0901USA01746 5 None PVT PVT Iron None Anemia 4 OTH OTH MARLME; ZPAK; CHERUTUSSIN 4 None PVT PUB Allergies 8 PVT PVT None KNDA, HTn 0 diagnostic laboratory, OTH showed OTH a small Noneblood clot None WAES0901USA01749 30 CBC with diff, PUB ESR all pending. PUB 2-EPIPEN; ANA; AntiKRH; DNA; None PENICILLIN; CPK; Allergy Chem screening Penicillin; Allergy Bee Bee LABS: Allopry sting; all WNL Asthma out grew PMH:multip 0 PVT OTH LIPITOR; ACCUPRIL; HTN; PREVACID; GERD;ASA GLUCOSE intolerant; TB exposure; PT conv 0 Febrile seizure; OTHURI, day PUB of immunization URI, minor 0 None PVT PUB None None 1 None PUB UNK None None None 1 PVT UNK None None 0 Unknown OTH OTH Unknown Unknown WAES0901USA01755 4 Unknown OTH OTH Unknown Unknown WAES0901USA01301 ation to underarm; motion was abnormal OTH seen at MIL TMC by medical PPD; Sanofi provider None Pasteur; 16 Jan C2912AA; 09- Rx BENADRYL Right Forearm; & Ibuprofen 13 Jul 2000; 5 Jan 2009 9 T, 98.8 degrees, OTH oral MIL 7 X-rays, normal PVT PVT None None 0 beta-humanOTH chorionic, OTH positive Unknown Pregnancy NOS (LMP = 12/1/2008) WAES0901USA00165 OTH OTH LAMOTRIGINL; NoneCONEPRAZOLE; None None LITHIOM; prior to L-THYROXINE; now~ ()~~0~InTOPOLINAX Patient 61 UNK OTH OTH Unknown R0001587A 9 OTH MIL None NKDA 1 CBC, WNL;PUB Blood C+S, PUB Pending; TYLENOL; BMP, WNLNo MOTRIN 1/29/09-records None received-RSV negative. Influenza A and B negative.
12 Abdominal PVT X-rays; blood PUB count; blood NoneculturesNone (Emergency Congenital Room). talipes 1/29/09-records equinovarus ME00209 received-CT 1/29/09-records scan demonstrat received-P 2 2/5/09-records PVTreceived-EEG PUB positive Nonefor abnormal Dry cough left temporal 2/5/09-records None 2/5/09-records partial UTI~Vaccine received-Rhinorrhea, seizurereceived-PMH: activity. not specified MRI brain congestion UTI (noand normal. brand seen for name)~1~ CBC in 1 day ED WB fo a 1 UNK UNK The patient had surgery to remove ### cysts (location not spec Unknown OTH OTH Unknown Unknown WAES0901USA02129 0 Unknown OTH OTH Unknown Unknown WAES0901USA02073 0 None OTH OTH None None WAES0901USA01962 Unknown OTH OTH Unknown Unknown WAES0901USA01834 2 None OTH OTH HYDRODIURIL; Hypertension PRINIVIL WAES0901USA02001 0 Unknown OTH OTH None Pregnancy NOS (LMP = 3/24/2008) WAES0901USA01992 116 LABS: pH 6.8(L), PVT CO2 UNK 5(L), K 5.3(H), glucoseNone 487, CT head NoneWNL. PMH: URI, allergic rhinitis, impetigo. 6 MRI showed UNK numerousUNK small white Cymbalta matter T2 - uncertain lesions. ANA dates History positive, and ofdoses depression. elevated D-dimer, PMH: RAD. normal Seasonal CSF. Labs allergies. and Diag de 0 UNK UNK NONE NONE NONE 1 PUB PUB NO 610 Stool 1/27/09-records UNK received-Blood UNK culture negative. Fecal leukocytes positive with some bloody yeast cells.Stoo 1 none PVT PVT Current medications:Ultram,Allegra none D 1 UNK PVT 8 None performed. UNK UNK Simvastatin,Minor Fosamax, cold with Hyperlipidemia, Lisinopril, nasal congestion multiple hypertension, vitamin, calcium osteoporosis with vitamin D 2 As listed above, UNK all tests UNK returned Infant's negative. acetaminophen Allergist None performed None given no after tests. immunizations. Tri-Vitamin (Rugby), given onl 0 PUB PUB None No Illness at NONE time of Vaccination NONE~ ()~NULL~~In no illness prior Patient to Vaccination. No pre None MIL MIL Pt is pregnant- 33+3 weeks 0 Went to family UNKchiropractor UNK for adjustment and also to ob/gyn for breast exam 0 monitored blood UNK pressure UNKand heart none rate and none monitored behavior none 1 UNK PUB 0 PVT PUB none. PVT PUB Tylenol .3mlnone PO Child under age of , received wrong vaccine sh 0 Chest X-rayMIL MIL None Common cold-afebrile No previous allergies 8 none PVT PUB none none none 0 PUB PUB 1 PVT PVT 2 none PUB PUB none SC0903 1 PVT PVT 0 None None None PVT PVT LEXAPRO;Otalgia LODRANE-D allergies Depression; Amoxicillin Allergy 11 PVT UNK 1 None PUB UNK Zantac None 3371 PVT PVT 2 None PVT PUB CLARITIN; None ALBUTEROL None 13 PVT PUB None NKA 0 Reaction toPVT MMR vs. viral PVTillness None None None 0 None UNK UNK None 8 PVT PUB Recurrent fevers 1 PVT PUB Fluoride None h/o bronchospasm in the past but no recent flares. 1 URI- No labs PVT PVT Cough & URI - 12-23-08 otherwise neg. None PVT PVT None None None 1 OTH PVT None Thyroid, allergies to grass, high blood pressure 11 MIL MIL Denies 0 Cx oral Trach PVTsecretions PUB where green stain Mg No (mixed flura Gotticweb only). + Tractu story 2 PVT PVT None MINOCYCLINE (rash) 0 PVT PVT None, Routine None 0 PVT PVT None None 0 CAT scan; ER PVT PVT None Stress overSeizure last several disorder; months migraines, non in 15 years; multiple med 0 PVT PVT None
0 CBC; Bld CX; PVT UA; UCX; PVT CXR 3 MIL MIL denies denies None OTH OTH ZOLOFT; FLEXERIL; None CONESTA; None REFLEN 0 12.4; 3.5; 40.2; PVT 353; 76,s; UNK22,L; 2,M BACTRIM Infected ankle left leg swelling~DTaP (no brand name)~5~5~I PVT PVT 1 PUB PUB None None 0 PUB PUB None None None OR200901 None PVT PVT None None None PVT PVT None None None 1 OTH PVT None notedNone known 1 OTH PVT Unknown LABS: OTH H/H 11.8/32.7(L). OTH Unknown Chemistry WNL. Prolactin Unknown 37.46(H). PMH: Family VideoWAES0901USA01809 EEG hx: seizures. WNL. 0 Diagnostic laboratory, OTH 01/15?/09, OTH rapid Ciprofloxacin influenza Urinary test tract negative; infection Diagnostic laboratory, WAES0901USA02024 01/15?/09, mononucleosis te 0 Unknown OTH OTH Unknown Unknown WAES0901USA02577 0 Stool culture, OTH 01/08?/09, OTH positive for rotavirus Gastrooesophageal reflux WAES0901USA01952 disease 3 Stool occultOTH blood, positive; OTH Stool rotavirus antigen, positive Unknown WAES0901USA02002 Spinal tap, OTH ?/?/97, diagnosed OTH withUnknown multiple sclerosis; serum None measles Ab, ?/?/97,WAES0901USA02731 negative; serum mumps Ab, ?/?/9 0 EpinephrinePVT given IM @ PUB 1615 Hx milk prior-allergy None~ ()~~0~Patient asID08048 infant resolved. Lx ALTR cano w/r PUB PUB None Redness, Swelling~Measles ID08041 + Mumps + Rubel 1 None PUB PVT PDD, Sanofi None Pasteur, C2908AA, None ID, LMF, 0 ID08042 0 PUB PUB None Enviro. allergies / diabetic D08043 0 EKG done- PUB No abnormal UNK results reported to patient Denies Later ID08044 0 PUB UNK None None ID08046 1 N/A PUB PVT CRESTOR None None 1D08047 1 None PUB OTH None None None PMH: left axillary abscess, resolved; left ankle swelli 2 OTH PUB None 0 PVT PVT None None except codeine. 0 CBC, Pt, PTT PVT labs ordered PVT to check None for platelets None & clotting. None See attached lab report. 0 PVT PVT Prevacid 15mg None1 pkg oral Gastric bid Ulcer Hospitalization~Hep - GERD - Failure toBThrive (no brand name)~NULL 1 none UNK UNK None None None 2 UNK UNK Oral birth control-not None. specified. NKDA. Lyme Dz at age 16. No residual effects at time of PVT PUB NONE 1 UNK UNK 0 PVT UNK none none PR-09-01 1 n/a UNK MIL None None None 0 UNK UNK N/A N/A None none PVT PVT none none none 0 PVT PVT none none none 2 RIFA-neg. pulse PVT ox 98% PUB none URI/left otitis preemie media 57 surgery for UNK intussusception UNK LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS. 0 PUB PVT Vitamins only:Time-released None Pt saysMultiple she hasVitamin, a condition D3, Niacin, she refers Glucosamine, to as a compromise Calcium 1 None UNK UNK None None reported NKA None reported~ ()~~0~In Patient 8 PVT UNK no 4 See recordsPUB from hospital UNKLABS: None Initial: sodium Well171(H), infant Prematurity BUN/creatinine PMH: 86/1.4(H), 36 weekPT/INR preemie, 21.9/2.4. no prenatal ABGcare. abnorm Fa 5 PVT UNK None None None PVT UNK None None 1 PVT PUB 1 None PUB UNK FLUOXETINE,10mg; TRAZADONE, NKDA 50mg 11 not known OTH PVT None None OTH OTH None 6 None PVT UNK ADHD, Asbeyer's, Edema
0 None 1 None 10
PVT PUB None None None PVT PUB Zithromax, Zantac GERD, Febrile Seizures PUB OTH None (except None vitamins)Diagnosed with Lupus about 10 years ago PVT PVT None None UNK UNK 1 The patientUNK reported a UNK shift in WBC (white blood cell) count. The patient had received a typhoid ### shot eight months ago. Not reported UNK UNK The patient had no known history ### and had not been ill at th 3 None UNK UNK COUMADIN; Lisinopril;No TOPROL Known XL; allergies. ZETIA; History TRICOR; of### atrial simvastatin; fibrillation;and hyperchole Sertralin 0 Not reported PUB PVT LOVASTATIN; ACTONEL; The patient MVI; Calcium had a medical supplement history ### of hyperlipidemia, osteop 1 None OTH OTH The patient had not been taking ###any concomitant medicati 1 No tests where PVTdone atUNK the time. no no no 0 Patient states UNK no tests PVT or labs done. Metoprolol er None 50 mg High blood Hydrochlorothiazide pressure 12.5mg 0 CAT scan -UNK Neg. UrineUNK - neg Numerous different N/A blood tests Milk allergy done inand both acid ERreflux. and doctor's PMH: GERD. office - Cow's negative milkFlu sens te 0 Labs: CBCUNK with WBC UNK 13.4-89% neutros. Glucose 167. AST PMH:55. none Alk phos 155. CPK 1119. 0 NA PUB PVT Unknown No Unknown 11 No test done. PUB UNK Tricor, Lipitor none none 9 UNK UNK none none 1 Not reported OTH OTH History of tonsillectomy. ### 0 See enclosed PUB labs andPVT MD report None None Allergies: MSG, aluminum hydroxide, PCN, ASA, Sulfa, Eg 1 MIL MIL Insulin; multivitamin; No ZOCOR Flu shot & pneumonia Extreme fever shot; almost diabetes; hospitalized~Influenza high BP & Cholester (n 11 UNK UNK Patient has a history of non-Hodgkins Lymphoma, but it wa UNK UNK Had the shingles vaccine-ZOSTAVAX-around 1/7/2009-had outbreak on arms ch PVT PVT 1 None PVT PVT None None None 0 PVT PUB None PMH: allergy to Flu vax. PUB PVT AVANDAMET 3 PVT PVT LOVAZA; ZETIA; None BENICAR High Cholesterol; HTZ Triglycerides, High Blood pressure; MS, 11 PVT PVT None None 1 None PVT UNK Allergic rhinitis; Diabetes; HTN; esophageal reflux 0 PVT PVT None Chronic Otitis Contact MediaDermatitis + Esophageal Reflux 14 PVT PVT 1 PVT PUB 3 PVT PVT None None 0 None PVT PVT Aspirin; atenolol; Knee osteoarthritis; CELEBREX; Pulmonary VYTORIN; atrial toxicity fibrillation; THYROXIN; WAES0812USA00347 paroxysmal COUMADIN atrial tachycardia 2 Unknown OTH OTH Atenolol; ADVIL; NASONEX; Unknown TRAZODONE hydrochloride WAES0901USA02460 0 None PUB PVT Anti-Itch Cream None Itchy Rash~Pneumo (Pneumovax)~2~69~In Pa 0 Refused PUB PUB none no none 1 PVT PVT none none 0 UNK PVT None No PMH: None ALGS: PCN, SULFA, Keflex 0 PVT PUB UNK PVT None 4 EEG, ChestUNK X-Ray, Blood UNKpanel, urine all normal None 3/3/09-records None received- Bicarb 17, labs WNL, chest x-ray norma 174 chest x-raysUNK and cbc LABS: UNK CXR abnormal &n/a c/w LLL consolidation. amoxycillin and Blood augmentin c/s neg.PMH: pneumonia x 2. last one 0 None UNK PUB None None NKDA Heart murmur and asthma dx 2007 2 PUB PVT 1 PVT PVT 3059 NONE PVT PVT NONE NONE NONE 27 LABS: CSF:WBC UNK 1, glucose UNK 76, protein unknown 52(H), no c/s known neg.illness CBC: lymphs unknown PMH: 100%. HTN.CT PUD, chest/abd/pelvis esophageal stricture, abnormal. empyem Stoo 2 Labs and Diagnostics: UNK UNK NCS?EMG WNL. urine toxic metals PMH: WNL. Pineal Urine tumor. Mg++ B12 high Deficiency. at 230 andHypothyroidism. 307. allergy tests Fatig ( 0 Was told it was PUBprobably PUB due to Rotateq none reports none na 0 PVT PVT Pulmicort 2None puffs Inhaled Asthma, one hour Atopic before dermatitis, vaccination. sinusitis, Claritin migraine readitabs headaches 1 hour bh
2 None PUB PVT Unknown None known Unknow 1 UNK UNK sore throat, afebrile, Strep test negative. 0 UNK PVT 6 Referred toUNK her Personal UNK Physician HCTZ, Omeprazole Mild uri allergy to Sulfa, Hypertension 0 EKG in ERUNK showed IRBBB UNK and tachycardia. None at theNone Echocardiogram time of vaccination. None. and PMH: CXR EIA. negative. T&A. allergic Labs and to beestings. Diagnostics: EP study 0 None/2009PVT PVT None None None 1 PVT UNK None 1 MIL OTH Synthroid, Sera Vent, Singular, Asthma Metformin PVT PVT None PVT UNK None 1 None PUB UNK None None 1 None PVT UNK None None 2 None PUB PUB None None 1 None PUB OTH None None None None PUB PVT None None 0 CAT scan and PUBMRI, negative UNK None 0 None PVT PVT None None 11 None PVT PVT None Rad, Pneumonia, Constipation PUB PUB TB skin test; Aventis; C2679AC; Jaundice of L Fore newborn/Anemia Arm, 1 Dose.S/P I & D at age 8m 0 PUB PVT None Seen by physician - possibility KS200825 of egg allergy VS viral illnes 1 None PVT PVT Advil 800 TID; Recovering LISINOPRIL NKDA from10 leftmg rotator QD; cuff Simvastatin surg. KS200823 40 mg QD; METFORMIN 500 0 PUB PVT None None KS200822 1 None PUB UNK None Allergic to Penicillin KS200816 1 PVT PVT None None KS200815 0 None PUB PVT None None None KS200814 2 None PUB PVT None None None KS200813 2 PUB PUB No other medications None None KS200811 0 PUB PVT fainting Fainting at sight of blood K5200810 None PVT PVT None None None 1 Pt states basic OTHlab test,OTH viral load and Synthroid; thyroidLexapro Puncture evaluationwound by Allergies: Dr.(R) foot Levaquin; due to PMHX: a fishingHypothyroid; hook 2 daysAnxiety prior 1 PVT PUB None None Allergy to Codeine - both KS200809 Birth defects - medication 0 November 15th PUB 2008 (+) OTH Pregnancy Dec test 1 2008 (1st test) KS200826 0 PUB PUB None None KS200824 3 None PUB PVT Lipitor 1/2 TAB None None KS200821 0 None; BP, 109/66; PUB P, 56 PUB KS200820 0 PUB PUB KS200819 1 PUB PUB None KS200818 0 PUB PUB None None KS200817 0 PUB PUB None None KS200812 1 UNK PUB KS200808 0 PUB PVT None None KS200807 PUB PUB None None KS200806 1 PUB PVT None None None KS200901 0 Chest X rayPUB - RSV- Neg PUB Marked No KS200902 104 None PVT PVT OrthocyclinNone None 523 PVT PUB None None None None PUB PUB None None None 0 PVT PVT None None 11 OTH PVT No No No 1 PVT PVT None PVT PVT
PVT PVT None GERD 1 PUB PUB None None Fainting~HPV IA090001 (no brand name)~1~15~In Patie 0 PUB UNK Mantoux, Sanofi HIV+ Pasteur, HIV+ C2920AB, L forearm, no previous doses; MOTRIN, PR 1 OTH PVT None 0 PVT PVT None None None PVT PVT Multivit; Calcium None & D; Fish NKDA oil 2 PVT UNK synthroid, verapamil, Hypothyroidism lisinopril no physician as a result diagnose of a thyroidectomy, allergies; thyroidectomy high blood pressure. in the early 0 Unknown PVT PVT ENALAPRIL It was unknown if the subject had ### any illness at the time of 7 MRI, CAT scan OTHand "numerous OTH testing PRILOSEC procedures"; however The patient no results hadwere no concurrent provided.### illnesses LABS: MRI at the head/orbits time of vacc do 0 Oxygen SatPVT 98% on room PUBair. The patient had no illness at the ###time of vaccination and no 5 Unknown LABS: OTH CT brain OTHc/w cerebral edema. MRI brain Unknown abnormal & c/w ADEM. WAES0901USA02427 MRA head & neck & MRI of spi 158 LE cell, positive OTH for lupus OTH Unknown Unknown WAES0901USA03131 5 Unknown 2/9/09-records OTH OTH received-Laboratory Unknown tests WNLUnknown except for2/9/09-records potassium elevated. WAES0901USA03143 received-History Fecal leukocyte of formula stainintole nega diagnostic laboratory, OTH elevated OTH deoxyadenosine Unknown ADA nucleotides deficiency Recurrent and homozygosity respiratory tract WAES0901USA02676 for the infections; Leu 107>Pro Oral candidiasis mutation inrecu AD 8 CT head, slit MIL lamp evaluations, MIL fluorosein advair, albuterol, staining none prestiq asthma 0 UNK UNK 0 3.6 wbc, 12.8 UNK hg, 38.8 UNK hct, 383 platelets, alt 18, ast 35. hypospadias, ambiguous genitalia. PMH: hypospadias. c 0 PUB PUB 0 PUB PUB none listed none listed Mom reports sibling SulfaElizabeth~Tdap allergy (Adacel)~1~16~In Siblin 78 Bloodwork in UNK October and UNKDecember Armour 2008Thyroid, and n/aJanuary Yasmin, Hypothyroidism 2009 Nuvaring by Dr. Records Familyreceived hx: DM.05/07/09 HPV #2 -Lot LABS: # 0570X, Thyroglo giv 4 PVT PVT 0 PUB PUB none listed none listed Mom reports sibling-Kathryn~Meningococcal history of Sulfa allergy from childhood (Menactra)~1~ 0 PVT UNK zoloft, metformin, no diovan 1. Type II diabetes mellitus 2. Dyslipidemia 3. Osteoarthriti 1 None UNK PUB Aspirin 81mg., nasal Oscongestion. Cal Allergies: 500mg. every Aricept, day,CardizemCD Azulfidine, Past 120mg.every history of Gluten day, Lexapro Sensiti 0 UNK UNK none none none 0 UNK UNK none none none 5 UNK UNK Positive for MIL PregnancyMIL Nuvaring, Sertraline NONE HCL Allergies of Restoril, and wellbutrin. History of Depression 2 UNK UNK no Known no known no known 22 quit taking all PVT other medications PVT and adderall symptoms 20 none mg still xr persisted. and femcon none labfework was done to draw igE levels to diagnosis sh 0 PVT UNK Not the administrator none ofnone~ the vaccine. ()~NULL~~In May have Patient been reported by the v 2 None PVT PVT Toprimal Cariva NoneBCP None NC09008 PUB UNK 1 None OTH PVT None None None 0 PUB UNK None PVT OTH 2 None PUB UNK None None None 1 None PVT PVT None None AMOXYCILLIN 1 CBC, Normal; PVTStrep, Negative UNK None 0 None PVT UNK None None 2 PVT PUB NO NO 3 Stool was negative PVT for PVT salmonella, shigella, rotavirus, campylobacter, and e. coli 2 UNK PUB None UNK UNK 1408 none PVT PUB none none knownnone 307 Unknown PVT OTH Unknown Unknown WAES0901USA03149 10 magnetic resonance, PVT Left OTH shoulder; suggested Drug degenerative hypersensitivity; changes Diabetes mellitus; WAES0811USA02650 Asthma; Hypolipidaemia; Go 0 Unknown OTH OTH Unknown Rhinitis allergic; Asthma WAES0811USA02652 Unknown OTH OTH Unknown Hospitalisation WAES0901USA03112 0 Serum beta-human, OTH positive OTH CLARITIN, Pregnancy 10 mg NOS (LMP = 4/8/2008)WAES0807USA01140 Pap test, ?/?/08, OTH abnormal OTH Unknown Mental handicap NOS WAES0901USA03330
13 October OTH 2000: BrainOTH MRI ATTNVenlafaxine IAC's withUnknown and hydrochloride; withoutAnxiety; contrast: Alprazolam; Automobile Revealed Clonazepam accident; noA0599585A gross Depression; abnormality within Whiplash the injury IAC/C CBC, 21Jun2000, OTH normal; OTHCBC, 25Jun2004, Unknown normal; CBC, The28Jun2005, subject's medical normal;history, A0599980A Chemistry concurrent NOS, 25Jun2004, conditions and norm co CBC, 28Jun2004, OTH normal; OTHDiagnostic Venlafaxine Results:Depression; hydrochloride; 31 July 2001, Rheumatic Fatigue; CT ADDERALL of Sinus the fever; abdomen problems The subject's A0602347A and CTmedical of the pelvis, history, Negative concurren stu 3 Glucose SERUM, MIL 156 MIL mg/dL; Urea VYTORIN; Nitrogen SERUM, ATENOLOL; None 13Hypercholesteremia; mg/dL; FLECAINIDE; CreatinineASA; SERUM, CHF; MAXIDE; HTN; 0.8, mg/dL; LISINOPRIL; COPD; Sodium Obesity; LASIX; SERUM, DM;KC 0 Unknown PUB PUB None known None known Unknown 0 UNK UNK 2 OTH OTH Seroquel, Lexa Fatigue pro, Xanax PCN et met for min, Spiractin 0 PVT PVT 1 None OTH PUB Levothyroxine; None acyclovir; NKDA; furosemide; DX, fibromyalgia; warfarin; gabapentin; hypothyroidism; TRAZODONE; intermittentULTR pulm 7 PVT UNK None None 5 Shingles UNK UNK no 2 NONE PVT PVT METFORMIN, NONE RAMIPRIL NKA 107 MRI, blood UNK work and spinal UNK tap 3/4/09-records Ortho Tri Sprintec Virus receivedthat lasted n/a MRI2/17/09-records brain, for 4 weeks cervical then spine received:horse theshow onsetmultiple of MS. allergy-anaphylaxis. white matter lesion m 1 2/11/09-records UNK received-WBC UNK 14.0. None None None 1 UNK PVT premarin vaginal none creamnone known 1 UNK UNK reflux none PVT PUB none none none PVT PVT None None 2 MIL MIL none morphine same,but no rash~Anthrax (no brand name)~1~ 13 NONE PVT PUB POLY-VI-SOL NONE ANEMIA 0 UNKNOWNPUB PUB NONE NONE NONE 2 PVT PUB NONE NONE 8 Seen by SFGH PUBDermatologist PUB whoClonidine made diagnosis none none PVT PVT Possible early herpes lesion to anterior lip 0 MRI, XRAYS, MILAND PATIENT MIL FILES. NONE NONE 7 Hearing Tests, UNKSpeechUNK Evaluation, Behavior Evaluation, ear infection, PMH: blood cold wok Colds testing sincegenetics, birth. Earurinalysis, tubes occupational therap 0 Hematoma PVT on left arm PVT @ injection site. None None 0 None PVT PVT Flagyl 500mg None bidX7d None 0 None OTH PVT None None None 1 Physical Exam PVT PVT None Hypothyroidism on RX 6 Some lab work PUBdrawn at PVT hospital ER, None showedNone increased None WBC, states mother 1 PVT PUB Tinea capitis 0 PVT UNK See attached No known allergies; DX emphysema, 786.09,786.05 1 PVT PVT None None 0 PVT PVT Lobster claw hand, (left) 0 PVT PUB None None None 12 OTH PUB Heart bypass; kidney cancer 0 2/13/09-records MIL received-MRI UNK of head and c spine Atrial Fibrillation no abnormalities. 2/13/09-records Routine received-PMH:atrial blood work appeared fibrillation, normal. sleep Hospita apen 6 See above MIL comment. MIL See above comment. Labs 2004and Hypertension, Diagnostics: 02/08/2008 Essential ESR Pain,30. Chest NOS CK(Active) NEC 185-232. (In remission); CKMB 3.13. Allergy Troponin to PC T 92 Flu test positive UNK for influenza UNK B (date not provided) It was not reported whether the ### patient had any concurren 5 Unknown PVT PVT The patient had no concurrent### illnesses, pre-existing medi 8 blood pressure, OTH 12/18/08, OTH115/6; electrocardiogram, HIBICLENS; Nasal CLEOCIN; congestion 12/18/08, Methicillin-resistant hydrocortisone; norma; bodymupirocin; temp, staphylococcal WAES0901USA03219 12/18/08, SULFATRIM aureus 102.1 F, infection; 2-3 hours cold; follo Unknown OTH OTH Unknown Unknown WAES0901USA03646 0 Unknown. Labs OTH and diagnostics: OTH CT Unknown abdomen (+) for ? liver Unknown. bilomas. PMH: Transvaginal Congenital WAES0901USA03508 US malformation (+) for dilated andL lack Fallopian of rotat Tu Unknown OTH OTH Unknown None WAES0901USA02709 16 Clinical exam UNK only, no UNK serologic testing, no cultures Hyperchol.; Reflux; Osteopenis. No alcohol or drug use. 0 None UNK UNK None 3 PVT PVT None None None 0 Unknown PVT UNK Voltaren, Hydrocodone, 3 WKS Post-op High Niacin, R Bp, knee High Synthroid, Arthroscopy Chol, Norvasc, Hypothyroid Citalopram 2 Unknown PUB PUB None None 54 Lyme titers UNK negative UNK Luride 0.25None mg po qhsGERD, Croup, Hypertonia as infant resolved
0 NONE UNK UNK NONE VIRAL UPPER ALLERGIES: RESPIRATORY NUTS GIVES INFECTION PATIENT ANDHIVES PHARYNGITIS 0 PVT PUB NONE NONE 0 MIL MIL 2 cbc,cmp,tsh,glucose UNK finger UNK stick,CT lamictal, scan. synthryoid, Labs none and Diagnostics: zyrtec epilepsy, hypothyroid Head CT WNL. , allergic CBCrhinitisis. & CMP unremarkable. PMH: remote Gra hx 3 seen in clinic PUB todday 1/30/09. PUB stool sent for culture. none none 0 PUB UNK None None None 0 EKG, Urinalysis, UNK BloodUNK test performed. N/A LABS: N/A WBC 3.9,N/A Chemistry, CPK, CKMB, Troponin, CXR & EKG all WNL. 0 UNK UNK Acid Reflux AL0901 1 n/A UNK PUB none none none known 6 PVT PVT none peanuts 0 MIL PVT none none none MO-2009-02 0 MOC reported PUBlast night PUB to this RNnone that reported an EKG none hadreported been Born done, however premature, pulsechild ox not and is being sure otherhow treated tests. early. for No orthopedic Small definite fordiagnosis....m age, condition club fe 2 PUB PUB None None None 0 None UNK PVT Robitussin PRN COPD Depression Allergies Bees, Weeds,Ivory Soap,Wool 4 PVT UNK 0 none none 0 2/4/09-records PVTreceived-CXR PVT mild bronchial thickening, otherwise 2/4/09-records negative. received-History WBC 23.9. Urine of spitting culture up.no growth. 2 PVT PVT None None Referral to neurologist PVT UNK None NKDA 0 PVT PVT 0 UNK UNK None None None PVT PVT VIAGRA; ALBUTEROL; Bronchitis HTN; ADVIL; Gout; ?; Psoriasis SOLITANE; ?; ATENOLOL; NORVASC 9 None PVT PVT None None None 4 PVT PVT Baby ASA, None Lipitor, Finasteride, NKDA, Increased Flomax, Flaxseed, lipids, Embolic CA, CQ10, CVA, BPH, Selenium, ED, Tubular GlucosaA 1 PVT PVT Levoxyl; Nulev; NoneFemring; Provera 1 PUB UNK None 2 PVT PUB Alb MDI; PRILOSEC None Asthma; GERD 0 PVT PVT 0 PVT PVT It was notedOTH that the subject OTH underwent Anti-inflammatory; bloodBack tests,pain x-rays, Unknown; TheEMG subject Aspirin; studies, hasNaproxen anerve history A0765709A conduction sodium of a calcium studies deposit andon MRIs his elbow to ev 1 Labs and Diagnostics: PVT PUB Abd U/S (+) for IS. Abd None X-ray abnormal. None. PMH: BE abnormal. none 4 Bact'l cultures PUB (-). ViralPUB panel (-). DFA (-). MRI c/w acute None disseminated PMH: hypocalcemia encephalomyelitis resolved; LABS:WBC fever requiring 7.9(N),hospit lymph OTH UNK Unknown 45 MIL MIL MVI None PCN allergy PMH: acne, contact dermatitis 10/2008, chick 1 Autopsy is being PVT performed PVT None None None 0 PUB PUB None Allergic, PCN; HX, anemia PUB PUB Depo Provera None 150mg IM + PPD 10mm 9/8/08 Chest X-ray Negative 0 PVT PUB 0 PVT PVT None None None 0 PUB PVT None None None PVT PUB None None NKA 12 1/29- Pt's blisters OTH werePVT cultured- results None Known not back None yet. None Known 11 PVT UNK Cough; diaper PCN rash allergy 0 OTH OTH None None reported None reported or documented by parent 2679 Lesion cultured PVT to test UNK for varicella zoster 0 None PVT PVT Tylenol None None 1 PUB PUB 3 None PVT PVT None None None 0 MONITORED UNK BLOOD UNK PRESSURE NONE AND EKGNONE - WELL ALLERGY CHECKTO NONE~ PHYSICAL SUPRAX; ()~~0~In NO Patient|NONE~ OTHER HEALTH ()~~0~In ISSUES Sibl 0 UNK UNK ND0901 0 none MIL MIL na vaccine withheld none noted today 0 PUB PUB
1 None required MIL MIL None None None 6 per PMD UNK UNK none none none known 1 PVT PVT sinus infection asthma, allergies (dust, dogs) 41 BLOOD TEST UNKSHOWED UNK HE HADMEMBER A CRITICALLY GOT NONE #2 LOW DOSE NONE PLATELET OF HEP PMH: COUNT BGERD, ON 1-10-2009 OF CVA, 2000, skinAFTER cancerTHAT surgery, THEY cardiac ADVIS ca 1 none PUB PUB None None None 6 Blood test which UNK showed UNK indication Simvastatin of rheumatoid None 40 mgs. arthritis. qdHypercholesterolemia Pt. did not know name PMH: of test. sinusLABS: & colon RApolyps, factor (+), mitral ANv 1 CBC, CMP,UNK BLOOD CULTURE. UNK TYLENOL ABNORMAL ERVALUESDX WITH NO MCVRIGHT 69.9L, OTITIS MCHC-L, MEDIAGLUCOSE 146- H, SODIUM 134 0 None UNK UNK Diovan 320None mg 1 PO daily; Allergy Zetia to Codeine 10 mg 1 (reaction: PO daily, rash), Simvastatin Hypertension, 20 mg PO Type daily, II D -9 None PUB PUB URI Asthma 0 PVT PUB None Rocephin 1 UNK PVT ambien no no 1 PVT PVT URI Asthma 1 None PUB PUB None None 1 Labs: CBCUNK with WBC UNK 16.7. Blood cx (-). PMH: newborn jaundice 1 UNK PVT 2 none MIL MIL HCTZ, loratadine, none nexium, hypothyroidism, tylenol, zocor, vit asa, D deficiency, atenolol hyperlipidemia, DM, GER UNK UNK Pregnancy pregnant at time of vaccination. LMP 20 May 2008, vaccin 7 PVT PVT none 0 Normal Ct of UNK brain, normal UNKchest film and normal no LP and normal CBC and blood cultures were negative LABS: CT 9 PVT UNK Avapro Glipizide none Metotopol diabetes L. type Thyroxine(synthroid) 2 Began taking insulin Lipitorjust Fortamet 1 weekJanumet ago. 0 Body temperature, PVT 101.6 OTH Unknown No relevant medical history A0765333A was reported. The subject had 1 OTH PVT ZOLPIDEM, 5mg; ropinorole 0.25mg 0 PVT PVT None ADHD 1 PVT PUB None Allergy to Amoxicillin + Erythromycin 1 NIT PVT PUB 17 None PUB UNK For high cholesterol; None HBP; NoneMETHYLIN, for narcolepsy 1 PUB PUB 2 None PUB PVT None None NKA, None 0 None PVT PVT None Smashed finger None 0 none OTH OTH KEFLEX (for puncture puncture wound None wound) AE0801 0 None OTH OTH None None - Routine NoneBooster AE0802 4 Unknown OTH OTH none routine booster. no drug allergies AE0803 2 unknown OTH OTH PAXIL, SYNTHROID, routine booster. BENICAR hypertension, anxiety, AE0804 depression, hypothyroidism; h/o cilli 7 MRI; EEG; OTH Ultrasound;OTH Carotid Studies unknown chronic limeChronic diseaselime disease; no AE0805 allergies 1 none OTH OTH none none hay fever, recurrent sinusitis AE0807 0 unknown OTH OTH Unknown Persistent cough Unknown past 2 to 3 wks &AE0808 malaise 4 unk OTH OTH NAPROXAN injury and to HYDROCODONE leftnone hand AE0809 4 unk OTH OTH ADVIL Injury from none a needle AE0810 2 OTH OTH Ciprofloxacin; Fracture Clindamycin; injury Diabetic; toPROXEN his no right allergies hand AE0811 7 OTH OTH an antibioticbooster none AE0812 1 unk OTH OTH none none none AE0813 1 unk OTH OTH none none none AE0814 0 X-rays, PPD OTH test OTH Blood pressure Chest medication pain;Arthritis Cough; Congestion; AE0815 Diffic. breathing 0 none OTH OTH none none none AE0816 0 OTH OTH none none none AE0817 0 OTH OTH None None None AE0818 0 OTH OTH none unknown none AE0819 3 unk OTH OTH none unknown none AE0820 0 unknown PVT OTH TB, lot # C2908AA, none PPD/right Allergy to arm, antibiotics unknown AE0821 0 unknown OTH OTH unknown none unknown AE0822 0 Unknown OTH OTH Unknown None Unknown AE0823
1 unknown OTH OTH unknown unknown unknown AE0824 0 unknown OTH OTH unknown none none AE0826 0 Unk OTH OTH BENADRYLNone Migraines, mitral none~valve ()~~0~In AE0827 prolapse, Patient|UNK~ No ACL in ()~~0~In left knee, Sibling tumo 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759188A medical history. The subject h 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759183A medical history. The subject h 0 Body temperature, OTH 100.3 OTH Unknown No concomitant medications. A0759008A The subject had no relevant 0 An MRI wasPVT conductedPUB approximately OMEPRAZOLE, two weeks ANXIETY, following BUPROPION GASTROESOPHAGEAL SHOULDER the onset HYDROCHLORIDE, of DISLOCATION, the event A0757991A (date REFLUX CLONAZEPAM, The not subject provided) DISEASE haswhich previously QUETIPINE showed re 0 UNK PVT OTH LETROZOLE, Unknown ATORVASTATIN BREAST CANCER, CALCIUM,HIGH THYROXINE A0757768A CHOLESTEROL, SODIUM,THYROID ANTHIHISTA PR 1 UNK PVT OTH Unknown No relevant medical history. A0757735A The subject had previously re 2 UNK OTH OTH Unknown The subject has previously A0757719A received flu shots with no repo 2 UNK OTH OTH Unknown The subject has previously A0757718A received flu shots with no repo 2 UNK OTH OTH Unknown The subject has previously A0757717A received flu shots with no repo 0 UNK OTH OTH Unknown The subject has previously A0757716A received flu shots with no repo 2 UNK OTH OTH Unknown The subject previouslyA0757715A received flu shots with no reported 2 UNK OTH OTH Unknown The subject has previously A0757694A received flu shots with no repo UNK PVT PVT Ibuprofen Unknown The subject has no relevant A0757689A history and has not previously 0 UNK OTH OTH Unknown The subject had previously A0757324A received influenza vaccinations UNK OTH OTH Unknown A0757298A UNK OTH OTH Unknown A0757118A 0 UNK OTH PVT Unknown Concomitant medications A0756602A were unknown. No relevant med UNK OTH OTH Unknown A0756589A 0 UNK OTH OTH Unknown A0756078A 0 UNK OTH PVT Unknown A0755869A 0 UNK OTH PVT Unknown A0755868A 0 17 December OTH 2008, Skin PVT allergy test, Atenolol; glutaraldehyde Lovastatin Hyperlipidemia; (glutaral Shoulder Hypertension - testreplacement; score 5), kathon A0755860A The subject (test score has17), no relevant neomycin medica (test The subjectMIL underwentMIL a biopsy on Efalizumab; an unspecified Hypertension; Crinorectic date to The (Hydrochlorothiazide determine Psoriasis subject has in the norash history A0755844A +was Enalapril ofcaused adverse maleate) byevents bacteria, following virus or pre fu 2 UNK PVT PVT Latex allergy; Sore throat A0755289A 1 UNK PVT PVT Unknown The subject had previously A0754849A received influenza vaccinations UNK PVT PVT Unknown No concomitant medications A0754696A or relevant medical history. T 0 UNK PVT PVT Unknown No concomitant medications A0754693A or relevant medical history. T 0 UNK PVT OTH Esomeprazole; Asthma; HYZAAR; Food Theallergy (Hydrochlorothiazide+Losartan subject has a history A0754692A of numerous potassium+potassium food allergies. It was 0 Body temperature, PVT 10/19/2008, PVT 95LEXAPRO; degrees, FUnknown Tretinoin; Diphenhydramine Acne; depression;HCl TheA0754502A subject had no adverse events follo 0 UNK PVT PVT No concurrent Unknown medication No relevant medical history. A0754333A UNK PVT OTH Unknown Linked cases include: A0752107A, A0754297A A0752229A, A0752230 1 UNK PVT PVT Metoprolol succinate; Unknown Atorvastatin Allergy to BIAXIN; calcium; cholesterol; Aspirin A0754167A hypertension The subject h 1 UNK PVT PVT Unknown No allergies. The subject A0754164A uses alcohol socially and no toba 1 UNK PVT OTH Diltiazem hydrochloride; Unknown Reaction Metoprolol to preservatives. succinateA0753586A This subject had no adverse ev 0 UNK PVT OTH Thyroxine sodium; Unknown Gabapentin No relevant medical history. A0753954A The subject had no adverse e 0 UNK PVT PVT Warfarin sodium; Abdominal Atorvastatin Allergies: pain; urinary calcium; water tract pill ATENOLO; infection; caused A0753917A aAlprazolam; rash in past.Ciprofloxacin The subject had HC UNK OTH OTH Unknown A0753779A 2 UNK PVT PVT NSAID Chronic back The pain subject has chronic A0753700A back pain is under the care of pain 0 UNK OTH PUB Bee allergy;No Erythromycin concomitantallergy; medications. A0753594A unknown Thereaction, subject had Peanut not allergy previous 0 UNK OTH OTH No concurrent Unknown medication The subject has no relevant A0753417A medical history. 0 UNK OTH OTH Unknown A0753416A 0 UNK OTH OTH Unknown A0753411A 0 UNK PVT PVT Topiramate;Unknown Propranolol The hydrochloride; subject has previously Pantoprazole; A0752929A received Atorvastatin flu shotscalcium with no histo UNK PVT PVT Unknown The reporter stated thatA0752837A this event occurred in three additio UNK PVT PVT Unknown The reporter stated thatA0752836A this event occurred in three additio UNK PVT PVT Unknown The reporter stated thatA0752835A this event occurred in three additio 4 UNK PVT PVT Unknown The reporter stated thatA0752833A this event occurred in three additio 0 UNK PUB OTH No concurrent Unknown medication The subject had no relevant A0752564A medical history and no known
UNK UNK UNK UNK UNK UNK UNK UNK UNK
OTH OTH Unknown A0752498A was one ofA0752498A two cases reported by the same h OTH OTH Unknown A0752492A was one ofA0752492A two cases reported by the same h OTH OTH Unknown The subject has no history A0752279A of allergies. PVT OTH Unknown Five additional subjectsA0752233A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752232A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752231A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752230A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752229A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752107A experienced similar events. Linked PVT PVT Unknown The subject has received A0751413A flu vaccine previously with no rea PVT PVT Unknown The subject has received A0751412A flu vaccine previously with no rea 0 UNK OTH PVT No concurrent Unknown medications The subject has no relevant A0751369A medical history. UNK PVT PVT Thyroxine sodium; Unknown Spironolactone; The subject has Desonide; no relevant A0760091A Clindamycin; medical history. LEXAPRO; She Zolpidem has prev 3 UNK PUB OTH SumatriptanMigraine succinate The + Naproxen subject has previously A0760086A received flu vaccine and exper 0 UNK OTH OTH Unknown A0759673A 0 UNK OTH OTH Birth controlDrug allergyThe subject reported that A0759372A she is allergic to sulfa (rash all o UNK PVT PVT Unknown A0759350A UNK PVT PVT Unknown A0759349A UNK PVT PVT Unknown A0759348A UNK PVT PVT Unknown A0759347A UNK PVT PVT Unknown A0759344A 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759190A medical history. The subject h 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759189A medical history. The subject h 3 UNK UNK None known none known 0 MIL MIL NONE NONE NONE 1 UNK UNK None None Known Seizure~Yellow PMH: Family fever hx: childhood (no brand seizures. name)~1~5~In 1 UNK UNK Patient waschest takingcongestionAmoxicillan none wheezing-taking for ear infectionAlbuterol (Dr. checked as needed ear and stated ear in 1 PVT PVT simvastatinNone 20 mg, lisinopril NKDA, 10mg hypertension, hyperlipidemia 0 Spinal Tap UNK protein 159UNK very high. Labs none and at time Diagnostics: none of vaccinaion (never Never CSF been protein been ill) very ~HPV illincreased, healthy (Gardasil)~2~0~In until thenGARDISL repeat Patient CSF WNL. Anti-thyro 0 Several tests, PVT includingUNK extensive At blood the work; time,None just Cat oral Scan; contraceptives None MRI; and Lumbar 2/17/09-records puncture. 2/17/09-records received-Current received-CSF medication h other problems, and on assessment UNK appeared UNK to have chicken pox. Had been exposed to family member w/ severe case of chicken pox PUB UNK None LA090103 2 PVT UNK None PVT PVT None None 1 PVT PVT Singular Asthma 0 PVT PUB Slightly congested 0 PVT PVT Began 5 hour None after injcetion 0 UNK UNK 47 UNK UNK 4 The patient's PVT neurological OTHexam was SERTRALINE; normal, therefore XANAX noThe neurological patient hastests no known were performed. allergies, ### and Thehad patient no illnesses had an X o 197 Unknown OTH OTH None Pregnancy NOS (LMP = 4/19/2008) WAES0901USA03970 Unknown OTH OTH Unknown Unknown WAES0901USA03979 Diagnostic laboratory, OTH rotavirus OTH test Unknown came back negative Unknown WAES0901USA03957 5 X-ray, Sigmoid UNKdilatation, UNK no gas on None rectum, "Champagne Diarrhoea cup" WAES0901MEX00007 1 UNK UNK insulin none diabetic pain in arm/neck~Influenza (Fluzone)~3~53~In 1 PVT PVT cialis, avapro, none avodart, purosemide, allopurinol, prilosec, cartia, flomax, viagra, ci 1 n/a PVT PVT none none Ezcema, Penecillin, Exercise Induced Asthma 1 ALLERGIC UNK REACTIONUNK TO VARICELLA VACCINE NONE NONE 1 none UNK UNK None None None None~ ()~~0~In Patient|None~ ()~~0~In Sibling 1 PVT UNK 0 PVT UNK none codine
0 PVT PVT none none heart murmur 0 n/a PUB PUB mom denied none any illness 9 none PVT PVT n/a early URI 0 None UNK PVT None None None None~ ()~NULL~~In Patient 13 Blood test drawn PUB by MD. PVTClient has NONE not heardHealthy from DR. on NONE results. Reported 8 MIL PUB - HYDROCORTISONE/PRAMOXINE None, routine Hyperlipidemia annual f/u exam 1% COPD rect for hx -Anemia IPRATROPIUM of elevated Elevated BP,BROMIDE hyperlipidemia, BP readings 17MC NiC 0 PVT UNK Insulin pump; Yasmin; Type Frova.1 DM, Phenergan endometriosis, 25 mg every migraine 4 to headache, 6 hours as IUP, needed 70kg fo 1 PVT PVT 0 None PUB PUB None None 9 None PUB PUB None None None 0 PVT PUB None No Asthma, (mild persist.) 0 PUB PUB 2 PVT PVT None Drug allergy - Oxycontin 0 PVT PUB None None None 1 None PVT PVT Pneumococcal None vaccineNone 0 None PVT PVT None None None 0 Evaluated by OTH orthopedist PVT to get physical therapy. URI Alopecia 1275 PUB PUB 0 PVT PVT Levothyroxine; None FLOMAX; NKDA; ALAVERT neuropathy; hypothyroidism's; nephrolithiasis; Pitui 92 All neg - c/wOTH Bell's UNK Cold High chol; MI 1 UNK. Labs:PVT Tox screen PUB (-). Blood cx (+) for Strep Unknown salivarius No concomitant (contaminant). medications Lower A0766166A respiratory were noted cx in (+)chart for moderate by parent 1 LABS and DIAGNOSTICS: PVT PVT CT scan of Head No with Contrast. NKA 1 None PVT PUB None None Benign murmur 0 See attached PVT OTH FOCALIN XR, None 20mg Bipolar disorder 0 None PVT PVT 1 None PVT PVT 3 (+) Rotavirus PVT antigen test PVTLABS: CBC, chemistry None& UA WNL. CXR c/w bronchiolitis. Stool analysis (+) rotavirus. 0 Unknown OTH OTH Pregnancy NOS (LMP = Unknown) WAES0901USA03921 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA03924 24 Colonoscopy; OTH Computed OTH axial; Ultrasound; LUPRON Laparoscopy, DEPOT Endometriosis; Laparoscopic 09/??/08; Drug hypersensitivity Complete surgeryblood WAES0901USA03994 PMH:cell anxiety, LABS: gastric CT & band US neg. surgery Unknown OTH OTH Unknown Unknown WAES0901USA04190 Unknown OTH OTH Unknown Unknown WAES0901USA04478 2 Unknown PVT PUB Unknown WAES0812USA02105 Unknown OTH OTH Unknown Unknown WAES0901USA03562 0 Unknown OTH OTH Unknown Unknown WAES0901USA03312 Unknown OTH OTH Unknown Unknown WAES0901USA03564 Unknown OTH OTH VALTREX, Pregnancy mg; Vitamins NOS (unspecified) (LMP = 2/18/2008); WAES0901USA03679 Herpes simplex type II; Pregnan 18 beta-humanOTH chorionic, OTH positive Pregnancy NOS (LMP = 11/8/2008); WAES0901USA01798 Penicillin allergy; Psoriasis 4 Unknown LABS: OTH Abdominal OTH US neg. Unknown CT abdomen c/w pneumonia. Unknown PMH: KUBT&A. revealed WAES0901USA03674 Tension constipation. HAs. Allergy: Upper PCN, endoscop rash. F 7 computed axial, OTH normal; OTH electrocardiogram, None normal; electroencephalography, None normal; WAES0901USA03680 stool occult blood, positive 0 Unknown OTH OTH Unknown Unknown cardiac disorder~HPV WAES0901USA03777 (Gardasil)~1~14~In Sibli 0 UNK UNK Not reported ### 1 MIL MIL 0 None that I UNK know of, noUNK blood taken, or other Itests came perfomed. to the none ERI to filled have in a type smallofhair vaccine removed in item from 13my in order eye. to subm 2 n/a UNK UNK Bactrim once n/aa day Vescouretal Reflux, GE reflux, possible milk allergy 4 UNK UNK 6 Labs and Diagnostics: UNK UNK CRP 16.2 down to 0.7none by d/c. Fecal prematurity. occult blood PMH: (+).Premie-31 WBCs 17.4. wks. H&H 45 day downNICU to Hgb stay. 9.9NKD an 1 PVT PVT AndroGel none none 26 none ordered UNK UNK dilantin, gabpentin, none atenolol allergies: asa,HCTZ, Simvastain, crestor Chronic health probl 1 None PVT PUB Zantac GE Reflux None 0 PVT UNK
825 none 2
PVT PUB none none none PVT PVT none none Celiac Disease PVT PVT MULTIVITAMIN, NONE, GLUCOSAMINE, WAS HTN, IN FOR BPHWELL HERBAL VISIT/HEALTH PROSTATE MAINTENANCE SUPPLEMENT 1 PT WENT TO PVT ER FORPVT EVALUATION OF ABOVE HX OF STATED HTN, NKDA, DIABETES-NO SYMPTOMS, NO BIRTHFEVER IT DEFECTS, WAS OR DETERMINED COLD HX OF HTN, BYDIABETES THE ER PHY PVT PUB LEVOTHYROXIN 0 N/A PUB UNK n/a n/a nkda 0 LABS: CT head UNK WNL. UNK WBC 10.8(N), neutros 76%(H), lymphs 13%(L). Alk phos 339(H), total bilirubin 1.5(H), BUN 2 LAB WORK, UNK AND URINE UNKTESTS UNKNOWN LABS: CBC, NONE BMP & UA NONE WNL.PMH: Abdominal SAME anxiety SYMPTOMS~HPV x-ray c/w constipation. (Gardasil)~1~12~In CT abdomen/ 0 PUB UNK N/A UNKNOWN 12 PVT UNK tylenol infant upper drops respitory, dr did 0 not think it was important so she didnt even tak 4 Vision screening, UNK CT Scan, UNK MRI, blood Minocycline tests. none Labs and Diagnostics: none PMH: none MRI/MRA brain WNL. EKG abnormal-borderli 0 I visited theUNK Health Center UNKand they hydrocodone, advised that Lacerated stool my reaction softner,concerta kidney asthma was severe andand singular should be reported. 13 Jan 2008: elevated MIL ASO MILtiter (1:4NAPROXEN; or 800 IU/ML), None FLEXERIL; mild anemia NoneAMBIEN; with normal TRAZADONE; platelet count, OTC; mildProtein proteinuria supplements initially w 8 PVT PVT None Hypertension; Hyperlipidemia; NKA until now 2620 None UNK OTH None None Allergy: PCN 122 None UNK UNK No prior allergies 7 OTH UNK High cholesterol PUB PUB 1 Unknown UNK UNK None known None known None known 0 PVT PUB ZANTAC None None NC09009 None (EEGPVT pending) PVT None None None None MIL MIL None Allergic to TETVACYCLINE. 2 None PUB PUB None None None 0 UNK UNK Not reported UNK UNK Not reported ### Not reported PVT OTH The patient had a history of respiratory ### problems. 4 EEG; Speech PVTtherapy;OTH Occupational NonetherapyNone evaluationUndescended testes UNK PUB URI 0 CBC, normal, PVT 2-4-09 PVT FLOVENT Food allergies, apples, peas, milk; mild asthma 1 OTH PVT 0 + Flu test inPVT ER on 1/30/09 PUB Constipation History anemia 1 PUB PUB 0 PUB PUB Ibuprofen; ATENOLOL; None High LASIX; blood DIOVAN; pressureK+ CHL; PREVACID; DELLADENNA 0 URI - not needed OTH diagnostic PUB test None soon Seasonal at time allergies; NoCT200901 allergies or medical conditions. 1 None OTH PVT No Bee sting allergy Seizure~Pertussis (no brand name)~UN~0~In S PUB PUB None None 5 None PVT UNK None NKDA 0 PVT PVT FLUXRIDENone Systolic murmur 2 Stool cultures PVT done by PVT primary care Zantac physician. for GI None Gastroenterologist reflux GI reflux repeated as well as lactoferrin stool 0 PUB PUB n/a n/a n/a MO-2009-3 1 Autopsy found UNKno otherUNK cause of death. febrile seizures in past 2/17/09-records received-history of 1 none MIL PVT Chest Pain codiene MI and morphine 0 none PVT PVT none none PR-09-02 3 none PVT PVT None None none 0 None PUB UNK NKDA 0 Wound andUNK blood cultures PUB- no growth. omeprazole, Elevated none albuterol, WBC identified (14.5). migraine, ASA, alendronate, seizure disorder, mirtazapinte, anxiety, levetiracetam, alcohol/tobacco topiramate use, d 1 PVT PUB 3 EMG showed UNK asymmetric UNKmotor>>sensory None axonal>demyelinating None None known neuropathy. 2/23/09-records CPK 620. received-PMH: CSF proteinasthma, 62, otherwis atten 1 NOne PUB PUB Denies None 1 N/A PUB PUB N/A NO N/A N/A~ ()~NULL~~In Patient|N/A~ ()~NULL~~In S 8 PVT PVT unknown None indicated None
0 PATIENT HAD PVTPREVIOUS PVT SEIZURE/VASOVAGAL INCIDENT H/O EXERCISE DURING INDUCED DENTAL PROCEDURE, ASTHMA WE ARE REFER 379 UNK UNK COPD CC OF BENDADRYL Q 6 HRS ANDUNK F/U TOMMOROW. PUB IF WORSE SWELLING RUNNY NOSE KNDA ER, NO CONSIDER TEMP STEROID 0 PVT PVT None none none 0 UNK UNK none none 1 PVT PVT no no reccurent otitis media in the past None-observation PVT by clinician PVT andNone-children's parents Otitisvitamins Media-very None early none~ and mild ()~NULL~~In Patient|none known~ ()~N 0 OTH UNK Unknown 0 None OTH UNK None None None 0 None PVT UNK Insulin; CARDURA None cream; Diabetes; lovastatin Hypertension; Hyperlipidemia 0 PVT PUB NKDA; Asthma; Allergic Rhinitis 0 Pending UNK PVT Anterior epistaxis 0 None PUB PUB ZYRTEC Runny nose; HXunproductive heart murmur mild cough local reaction~Varicella (no brand name)~ 2 None at thisOTH time OTH Oral contraceptive; None Multi-vit None 1 None PVT PUB None ADHD on Concerta PVT PUB 0 UNK PVT PVT Unknown A0765349A UNK PVT OTH Unknown A0763996A 2 Unknown PVT PVT Unknown The subject was reportedly A0762590A healthy. Linked cases include A 1 UNK PVT PVT Unknown The subject was reportedly A0762589A healthy. Linked cases include A 1 UNK PVT PVT Unknown The subject was reportedly A0762587A healthy. Linked cases include UNK OTH PVT Unknown The subject has previously A0760407A received flu shots with no react 1 chest X-ray,OTH no active disease; PUB body temp, 12/06/08, Reactive103 airways Premature F; nasopharyngeal disease; birthSeasonal RSV, WAES0812USA01983 allergy; negative Asthma None OTH OTH Effexor Multiple sclerosis WAES0902USA00048 0 Unknown OTH OTH Unknown Unknown WAES0901USA04400 0 I have a positive UNK bloodUNK test from the Unknown labs for March cytolysis, 1987 high Itohave May rh and never 1987 sedsmoked rates, and or drank a falsealcohol. positiveIfor have Hepatitis never been C. I fi 8 EMG/NCV consistent UNK with UNKGBS 2/6/09-records received-CSF protein 386, RBC 43. CSF gram stain and culture no PUB UNK EKG - WNLUNK UNK Prior allergies: AMPICILLIN None UNK UNK Mentally handicapped 2 PVT UNK 0 PVT UNK None None None 0 MIL MIL none notednone reported Eggs Allergy 0 PUB PUB No No 2 PVT PVT Given PPD none in same arm none - at patients request - at same visit 57 Mild leukocytosis UNK with left UNK shift, blood None cx-neg, None influenza panel-neg, None PMH: strep breastfeeding. screen-neg, RSV-neg, BMP-norm, UA-nor 1 PUB UNK 4 Ultrasound UNK and contrast UNK enema showed iliocolic intussusception, PMH: newborn complete jaundice. small bowel wt loss. obstruction, recent URI ascites. Labs a 2 NONE PUB PUB NONE NONE NONE PERNONE~ PARENT ()~NULL~~In Patient 1 PUB PUB none knownnone None known 2 UNK UNK None Reported None 0 per pt the rash PVTis getting PVT better. Flonase, Synthroid, no Yasmin NO 0 PVT PVT Desogen 1 UNK PVT yearly physical arthritis,lower back pain 0 none PUB PUB none none 0 UNK UNK 0 Chest Xray,UNK pulse ox, UNK none none none, patient adopted no birth information available. 5 CBC: WBCPVT 7.6 (18S, 2B, PUB 63L, 17M, None "many atypical Intermittent lymphs). None. fever ESR over Had6.several mild Comprehensive plagiocephaly. days but no metabolic fever forprofile 2 days negative. (per paren UA 0 PVT UNK C/O UTI; BACK PAIN, AND CYST ON RIGHT SHOULDER 1 OTH PVT None PVT PUB None None
1 2
PVT PUB None NKDA MIL MIL None None None PVT PUB Asthma 0 None PVT PUB None None NH0815 384 None PVT PUB None Impetigo None 1 PVT PVT YAZ; SYNTHROID; Laceration PAXIL left Treximet, hand Hypothyroidism 0 CSF culture; PVT Blood culture; PUB Urine culture; None CT None Head and Shunt Hydrocephalus Series; Allwith normal. VP shunt. Labs and PMH: Diagnostics: CongenitalCT Hydrocep head W PVT UNK NONE Asthma 8 1/28/09 Viral UNK culture ofUNK conjunctiva (OD) and skin Unknown lesin positive Unknown for Poxvirus. 6 Referred toOTH primary care PVT provider.Coumadin, None Cozaar, known Lipitor, HTN,and highZetia cholesterol, CAD 2/17/09-records MIL received-UGI MIL 7/2/08-large sliding Nonehiatal hernia None 2/17/09-records without significant received-PMH: gastroesophageal chronic reflux. back pain. MIL OTH None None None OTH OTH None None WAES0811USA01317 Measles tire, OTH neagtive.OTH Unknown Unknown WAES0807USA05579 Measles titers: OTHSeronegative OTH Unknown Unknown WAES0807USA01777 8 Unknown OTH OTH Unknown Unknown WAES0807USA01095 0 Body temp,OTH 04/29?/08,OTH fever Vaccination adverse reaction; WAES0805USA00246 Fever 4101 Serum measles OTH Ab, 04/25/08, OTH Negative Unknown Penicillin allergy Hepatitis B WAES0805USA00144 Unknown OTH OTH Unknown Unknown WAES0801USA03341 None OTH OTH None None WAES0804USA02904 7 None UNK UNK None Milk allergy WAES0804USA02907 10 None UNK OTH None None WAES0804USA02908 10 None OTH OTH None None WAES0804USA04868 48 2/17/09-records UNK received-Negative UNK tests except for mild hypokalemia. 126 diagnostic laboratory, PVT Blood OTH test; neurological, VICKS NYQUIL Cold; Blood SINUS; Colitis testPMH: ulcerative; LABS: hormonal ulcerative CBC, contraceptives Scoliosis CMP, colitis. CRP WAES0901USA03519 contraception, & UA WNL. HA. Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA00303 7 UNK UNK URI rted. Patient just reports a historicalUNK allergy. UNK 1 NA UNK UNK Birth Control None Chronic Gastritis 1 None PVT PVT Crestor Lovaza None NKA 1 None PVT PVT Zyrtec, Nasonex None None ~ ()~0~~In Patient 0 unknown UNK PUB Unknown history of anxiety and depression, no known allergies Blood work UNK done but inconclusive UNK Zyrtec as he was - prnNone not in a flareNegram up at the (Nalidixic time. Last Acid) shot was Mar 08 and blood work do 0 none PUB PUB none none none 3 PVT PUB 1 LABS: Blood UNK c/s neg. UNK WBC 18.5(H), H/H 9.8/28.6(L). ESR 10. CRP 9.4(H). x-ray thigh WNL. US doppler of thigh 0 N/A UNK UNK Celexa, depakote, none trazodone NKA 0 none done PVT PVT Triaminic Chest Rhinitis Congestion - clear Medical nasalHistory: d/c the child was born at about 37 weeks ges 1 CAT Scan,spinal UNK tap, blood UNK cultures None and bloodwork. None --EEG, NoneMRI, PMH: andc-section bloodwork. dueLABS: to breech CBCpresentation, WNL. Chemistry 36 wkab p 6 She was given UNKand MRI UNK both types, none CT scan,no EEG, bloodnowas taken and a urine sample. All tests came back norm 1 PUB PUB none reported none SC0904 3 n/a PUB PUB 0 UNK PUB Type 2 DM, GERD, BPS, s/p surgery, depression, hx. of c 0 PVT PUB NONE UPPER RESPIRATORY UNDERWEIGHT--WT/HT,3%, NONE~ INFECTION, ()~NULL~~In COUGH MILD Patient FOR ANEMIA--HGB 3 WEEKS 10.0, 0 MRI, CAt scans, UNK ambulatory UNK EEG,birth thyroid control tests,blood nons pills lexapro tests. PMH: Labs Anxiety and seizures~HPV Diagnostics: & depression/ (Gardasil)~3~22~In Ambulatory Bipolar d/o. EEG EIA.(+) T&A. Patient for frontote Ear tub 236 LABS: CBCUNK done 7/9/08: UNK WBC 20.8, Birth bands control, 25%(H), none acne medication lymphs none15%(L). Monospot neg. 1 PVT UNK none none none 0 n/a MIL MIL none none none erythema~Anthrax (Biothrax)~7~22~In Patient 1 EEG - spikes PVT in R topical UNK area LABS: NoneCT head None WNL. MRI None head abnormal w/several ependymal nodules & multiple 13 OTH PVT HYZAAR; Glucosamine/chon; None No medical ASAconditions OTH PUB None None
0 None PVT UNK None None 2 None PVT PVT None None Healthy 1 PVT PUB None No No 9 None MIL MIL None None 07/28/2008 Dermatitis, contact secondary to clear, occlusi 40 MIL MIL Hyoscyamine None 0.125 1-2 05/14/2008 tabs qd SLRedness/Swelling prn; IBS flares 50-120mm - Not extending 5 None MIL MIL None None Allergies: No known allergies. No birth defects. Medical c 8 CXR: pneumonia MIL MIL Multivitamins None None 52 CT Abd/Pelvis MIL(29 JulyMIL 2004) withFLONASE small bilateral nasal None effusions, spray05/16/2008, (pm splenomegaly, Spring for Rhinitis, Seasonal mildallergic retroperitoneal Allergic NOS,Rhinnitis) (Assumed & bilateral inactive); groin ade 07 1 PPD read as MIL "0mm" onMIL 5-23-08. Pt. ORTHO-TRICYCLEN received None annual PPDs 28 05/23/2008 and neverRash, has experienced oth nonspecific a local skinreaction eruptionor(Resolved) a rash. 0 MIL MIL MUCINEX Cold 1 Hemoglobin, PVT normal; Abdominal PVT ultrasound, None normal; Stool None culture, no growth 0 None PVT PVT Pulmonic stenosis; Eczema;aUmbilical cyanotic hernia 0 PUB UNK 0 PVT PUB 1 None PVT PVT Has not taken No it - Treximet Allergic , 1-26-2009 to Codeine ; Omeprazole-; + Ampicillin ASA; Maxalt-MLT; Celexa 21 PVT PUB None No No 1 PVT PVT No Febrile Seizures 0 EMG; MRI PVT L Humerus/shoulder. PVT Allegra Referred D toInOrthopedist for well-adult Seasonal checkAllergies up 1 None PUB PUB AMOXICILLIN L Otitis media None MIL MIL None None 1 Vaccine reaction PVT OTH CONCERTA; None Lithium Carbonate; No allergies RISPERIDONE; previously; Psychiatric MOXAIR dx Autohale 2 PUB PUB Mononucleosis 1 PVT PVT EFFEXOR NO XE FOCALIN ADHD, RAD 0 localized reaction, PVT cellulitus UNK None ~Pneumo (no brand name)~1~69~In Patient 8 n/a PVT UNK none none none 0 PVT PVT None None ADHD, Raynaud's None~ ()~NULL~~In Syndrome Patient 2 CBC normalUNK UNK none none allergy to cephalexin - rash 1 MIL MIL none Had a normal UNK blood test UNK before shot, Yasmin, and after albuteral, none shot tested singular Asthma, for immune allergies deficiencies. (not to food LABS: or medications) CT head WNL., ANA 1: Not reported. UNK UNK Not reported. ### not reported. OTH OTH Patient has a history of diabetes, ### asthma, and an allergy to 693 physical examination PVT PVT Calcium; PREMARIN; Sulfonamide SYNTHROID; allergy ACIPHEX; WAES0902USA00378 COUMADIN 1 None OTH OTH Unknown Sulfonamide allergy WAES0902USA00259 230 blood pressure, OTH 212/1 OTH HYZAAR; levothyroxine Shingles sodium; lisinopril; omeprazole WAES0901USA04389 spinal tap, 12/11?/97, OTH bloody OTH spinal Unknown fluid, evidence of a possible Unknown cerebral hemorrhage WAES0902USA00158 None OTH OTH None None WAES0902USA00475 Unknown OTH OTH Unknown Unknown WAES0902USA00481 Unknown OTH OTH Unknown Unknown WAES0902USA00103 Unknown OTH OTH Unknown Unknown WAES0902USA00026 Unknown OTH OTH Unknown Autism WAES0901USA03633 Unknown OTH OTH Unknown Unknown WAES0902usa00465 7 None OTH OTH None Allergic reaction to antibiotics WAES0902USA00416 222 ultrasound, PUB 10/02/08, normal PUB 19.6Vitamins weeks; urine (unspecified) Pregnancy beta-human, NOSpregnancy; (LMP= 4/9/2008)WAES0809USA02697 serum alpha-fetoprotein, 11/25/08; fetal d 31 Allergic/immunologic UNK symptoms UNK RAST Nonetest 12None Jan 09 equivocal None result to soybean otherwise neg. 7/17/00: CT: Hea UNK UNK 0 None UNK UNK Smokes 5-7 cigarettes a day. PMH: smoker 0 OTH PVT ZOCOR qdNone NM0209001 2 None PUB PUB None None None 0 None PVT PVT None No No 1 MIL OTH None None 0 PVT UNK OSCAL 500; None BAYER 81mg; AllergicLISINOPRIL to fire ants (have 2.5mgreceived injection monthly for 28
1 None PUB PUB None Very dry skin Had and seen rash. derm for skin rash and to see again after 1 year 2 PUB PUB Recently completed None antibiotics None for01/28/2009~HPV strep throat. (Gardasil)~2~11~In Sibling 2 PUB PUB None None None 01/28/2009~HPV (Gardasil)~2~17~In Sibling 0 PUB OTH None Aches in joints None 1 PUB PVT OR200904 1 None OTH UNK None Iodine; Sulfa; adhesives 269 PVT PVT 0 UNK PUB none none 0 none PVT PVT no augmentum,bactrim, titanium 1 UNK UNK Insulin none Diabetes 902 PVT PVT 7 NONE UNK UNK NK NONE NONE KNOWN 0 EKG, HCG,UNK CBC Labs:UNK CBC WNL. Yasmine HCG (-). none Neuro exam none WNL. PMH: none 2452 PVT PVT none asthma 460 Examination PVT by physician, PVTclassic lisinpril shingles symptoms. none borderline hypertension n/a~ ()~NULL~~In Patient 20 Pt was evaluated PVT by Physician PVT none none none Lerch, Fred~Influenza (Fluarix)~0~48~In Patien 42 rpr=non-reative,lyme UNK disease=negative, UNK Synthroid CSfQD, studies none Diovan as well QD hypertension, as serum protein and hypothyroidism, electrophoresis chronic unremarlable back pain other s/p th m 2 None yet.. will PVTobtain inPUB 48 hours ifoccuflox not improved eye conjunctivitis drops none 6 n/a PVT PVT n/a n/a n/a no know reaction~ ()~NULL~~In Patient 0 None were UNK taken. UNK NONE NONE 0 Chest xray UNK & Head CTUNK WNL 2/7/09. CBC w/ diff none & CMP WNL Penicillin 2/7/09. allergies. Tingling TSH reflex Lumbar & Numbness~HPV andpain Vit after D serum motor-vehicle (Gardasil)~1~18~In tests from accide 2/9/09 1 UNK UNK NA None specified Nonebyspecified MOC or by noted MOC onor immunization noted on immunization record. record. 276 PVT UNK 1 UNK PVT None Shingles, recurrent every year or two. 7 PVT PVT extreme prematurity PVT PUB PRN TYLENOL None None 0 PVT PUB 17 None PVT OTH Lisinopril None Dust allergy; HTN 0 PUB PUB None Runny nose, None cough 0 PVT PVT None 1 CBC, CMP,PVT CT Brain Scan PVT all normal None History of GE reflux 0 None PUB PUB Unknown None Unknown 5 CBC; CMP OTH + Lipid panel PVT done on None 1/26/09 None Allergies to Penicillins 0 MONS screening PVT (-); Strep UNK Cx (-); 13.1 12/35Denied 265; 44P; by pt; PRENOTOL 18B; suspect 24L; 10M; drug1RL; exposure 2G; alche 20 x AL7 36 4 None donePUB PUB (very sensitive skin); hives occasionally 0 PVT PVT 3 None PVT PUB None None None 0 None PVT PVT None None 1 PVT OTH LEVORA; Fluoxetine; None DEMEROL 0 none PVT UNK BCP (Trinessa None 28 0.035 None mg ) 0 Saw in office PVT 2/2/09 forPVT Rx. to be reseen Dyazble; of Ater; continues Celexz; to grow. Omeprozole; Lidoderm; Parate; Solsate; Zocor; Altac 4 CXR negative OTH OTH ALBUTEROR ADVAIRNeosporin INHALER,- NAPROXEN, causes rash, Asthma, PRILOSEC DJD - knees, Anemia, L 0 None PVT PVT None NP dye allergy; DDD L spine; work up pending for RUB p PVT PVT None None 15 Abdominal OTH ultrasound, OTH 09/??/08, without Unknown pathologies; Pollinosisdiagnostic laboratory 09/??/08, WAES0902USA01054 without pathologies 8 Labs and Diagnostics: MIL MIL Echo with TYLENOL mild mild mitral, Fevertricuspid, - chest pain and -pulmonary anxious regurg. Audiology test (+) for conductiv 2 Stool culture OTH taken during OTHhospitalization None wasNone positive forNone ROTAVIRUS. PMH: 34 wk LABS: preemie, CO2 foster low, Kcare, 5.2, CL maternal 124, repeat drug ab CO 0 MRI completed: PVT resultsPUB pending. Labs and Diagnostics: Not MRIreported. brain WNL. PMH: none noted ### 0 Ct scan, 31/Jan/2009: OTH OTH normal, CBC: normal, metabolic panel: Patient normal, has a BC history pending. of environmental ### allergies. 106 Electroencephalography, OTH OTH negative;Unknown Computed axial, negative; Unknown. Neurological, 9/11/09 Hospital negative WAES0902USA00587 records 3/16/09-records received DOS received-EKG 8/27/09 Unknown OTH OTH Unknown Unknown WAES0902USA00564
Unknown OTH OTH Unknown Unknown WAES0902USA00449 Temperature OTH measurement, OTH ?/?/06, None 104 Penicillin allergy WAES0902USA00464 38 physical examination, PVT classic PVT herpes None zoster by Hypertension; visual exam Chickenpox right osteopenia; t 10-11 rhinitis distribution WAES0812USA00471 allergic; asthma; chronic back pain 0 UNK UNK beginning to spread to the Thisinside child has ofUNK the recovered child'sUNK leg. from abnormal the PENTACEL flu and shape, common similar - 2/3/09 cold/ear to 4:30 the infinity infection pm shape. 3 weeks shotprior site came to receiving to a head the and shot.was Child warm wasto 24 PVT UNK Intermittent 6 01-27-09 Rotavirus PVT detected PVT by EIA (enzymeNone immunooscopy), PMH: 34-wk UGI (-),preemie. Barium enema (-) LABS: Stool c/s (+) for ro 1 PVT UNK CONCERTA Psoriasis; ADHD 2 PUB PUB None None 1 PVT OTH None No Milk - protein sensitivity 2 CT; MRI. Labs PVTand Diagnostics: OTH CT PROZAC; scan (+)Doxycycline; None for sinus disease. Seasonal ASTELIN; MRI allergies. NASONEX; brain WNL. PMH:CLARINEX ADD. Asthma. Seasonal allerg 0 OTH PVT (Birth control) IMPLANON Grass, trees, outside molds 1 Cerucal PVT PVT Singular 4 mg No P.O. Illness Tabs Cough~DTaP (no brand name)~5~54~In Patien N/A UNK UNK N/A N/A 1 daughter diagnosed PUB onPUB Monday Feb. 9th withnone Influenza known A. 0 none PVT PUB zantac none none extreme fussiness~DTaP + HepB + IPV (Pedia 0 PUB PUB 10 MIL MIL N/A N/A N/A 1 N/A PUB UNK Amoxil 400 Resolving mg/5 ml Oral ear None Suspension: infection 2 tsps PO BID x 10 days 3 PUB PVT Benadryl None None 0 MIL MIL dapsone, predisone no (for not 2 sure, weeksstill lastbeing part evaluated of december for first a form partofoflupus. january). 51 none PVT PUB none none none 0 PVT PVT 9 pathology including UNK flow UNK cytometrydoxycycline of LNs were none 40mg negative. PO q none 3/11/09-records day received-pathology report no abnormality 0 Work-up in UNK progress. Labs UNKand diagnostics: albuterol and UC flovent (+) for Group Amoxicillin. B strepPMH: and Easthma, coli. GCbladder (-). Chlamydia infections. (-).Allergies UA abnorm to 12 Not sure. Diagnostics UNK and UNKother labs Lamictal done at None hospital. reported 2/11/09-records Codeine allergy, received-CT epilepsy 2/11/09-records head normal, MRI received-History spine negati 0 Per Allergy-Immunology UNK UNK Services,None skin test done None once member None released from acute care. Recommendation made 0 PVT UNK Synthroid, Buspar n/a 8 n/a PVT PVT slight runnyonly nosehas and one congestion, ear canal.dr said it was ok to have shot. 0 Still have not UNK received UNK any orders for testing. None He has symptoms GERD of seizure Drowsiness~DTaP still - especially (Acel-Imune)~2~0~In at night - and I worry Patien tha 13 Nerve conduction UNK studies UNK compatible NO with GBS NO Allergy to Ampicillin Sulbactam 39 12 April 199: OTH Thoracic OTH spine showed Esomeprazole; osteophytosis Alcoholic; Clopidogrel and Ulcer mild Fractured kyphosis. (unspecified) bisulphate; collar 02bone; Atenolol; May 2000: A0767211A Fractured Celecoxib; Radiology Hand; LEXAPRO; exam Sinus of problems; the Alfuzosin left sho To 0 PUB PUB None Slight cold None 2 None PVT PUB Vulvoraginitis NKDA 1 PVT UNK Cough 4 RSV (+).' Labs PVTand Diagnostics: PUB RSV Ag (+).Loss CBCofWNL. appetite; PMH: Globulin nausea viral low rash. Xat12.1. dayAlk Phos 203. AST 36. Total protein 33 Unknown - PVT Done through PVT ED LABS: None US of abd None c/w IS. Attempted None BE x 2 failed. Surgical pathology: 2 perforations 113 Head CT Scheduled PVT for PVT 2/13/09 None None 0 None PVT PVT None None None 0 PVT PUB None 2 None PVT PUB None Allergies: Erythromycin 0 PVT PUB 31 None. The service MIL member MIL is currently None pending None a dermatology Allergies: appointment. CEFTIN (rash); No history of congenital defects; 0 PUB PUB Zyrtec 1 mLURI daily - no fever None 1 None PVT PVT None None History of allergies, Celiac disorder 1 OTH OTH SIMVASTATIN; None VERAPAMIL Hypertension, hyperlipidemia PVT UNK None None 1 PUB PUB None None 1 Note: ChildPVT wil FU withOTH Pediatrician None PUB PVT None premature, cerebral palsy, developmental delay, V-P shun 1 PUB PUB Orthotrycycline NoneLow None
1 Physician Examination OTH OTH None Allergies to EBYTHROMYCIN 0 UA; CBC; CMP. PUB See attached PUB lab results. None None Known 0 Dr. done throat UNKcultures. UNK Hospital done blood None work and said None she has mono. (No one else in house got sick) 0 Temperature OTH measurement, OTH 102.5None F, for 3 days Hay fever WAES0902USA01032 Diagnostic laboratory, OTH several OTH unspecified Unknowntests None WAES0902USA01057 110 Serum Al OTH OTH LOESTRINAllergic 24 FE reaction to antibiotics; sulfonamide WAES0902USA01069 allergy 33 Unknown OTH OTH ORTHO TRI-CYCLEN None LO WAES0902USA01095 467 Unknown LABS: OTH WBCOTH 12.6, H/H decreased. Unknown Glucose 200 None (H).PMH: HgA1c BCP. 7.1(H). Amblyopia WAES0902USA00873 CSF: WBC in childhood. 8 & RBC 06/06/2008 3540(H), prote Re Unknown OTH OTH Unknown Unknown WAES0902USA00919 0 ultrasound, OTH normal; ultrasound, OTH normal; diagnostic laboratory, Urinary 06/27/08, tract infection; byophysical WAES0901USA00170 Infectious profile mononucleosis 1 ultrasound, OTH 06/25/08, possible OTH brachycephaly; Unknown Pregnancy amniocentesis, Varicella NOS (LMP=Unknown); 08/27/08, no brachycephaly, WAES0804USA05621 Behaviour disorder beta-human chorionic, 0 Unknown OTH OTH FOSAMAX;Hypertension; atenolol; PRINIVIL Drug hypersensitivity WAES0902USA00860 Seeing ophthalmologist; PVT PVT check titers 4 CBC with 14k PVT wbc & neutrophila PVT + Blood culture Bilat. Heel pain 1 CBC and CMP, PVT WNL PVT Fatigue; Post back surgery 1 none PUB PUB none~ ()~~0~In Patient|none~ ()~~0~In Sibling 1 None PVT PUB None None None 0 NP exam, repeated PVT vitals, PVTno studies. None 0 OTH PUB ADVAIR; Albuterol Asthma; Allergic Asthma; rhinitis Allergic rhinitis 0 PVT PVT None None GERD PVT PUB None none none 536 UNK OTH EPIPEN for food allergies; AllergiesAsthma; shellfish MAXAIR; and Albuterol strawberries 0 none PVT PVT none OCC cough, none sneezing 1 None PVT PUB None None None 0 PVT PVT Seen for follow-up Allergy to of ISONIAIDE Hypertension, none~ ()~~0~In Diabetes Patient& Hyperlipidemia 2 None PVT PVT None No No 1 PVT PVT Amitriptyline; CELEBREX; Adenocarcinoma; VALTREX; OXYCONTIN; LymphnodesELOXATIN dissection (R) 0 PVT OTH None No Asthma; Allergic; Rhinitis 2 PVT OTH 1 2/10/09 - PtUNK wearing Holter PVT Monitor. DIOVAN; Will have NEXIUM; None clinical test TRICOR; Allergic Mon and ZOCOR; to PCN; Tues -heart ALLEGRA; injectstent isotopes. in Multi 2000 Has Vits; it closed premature Ca; Fish 6 months Oil but Drlate do 1 None PVT PVT None 1 none UNK UNK Depo-provera no injections none q 3 months 1 PUB PVT none no no 1 Done at physician's UNK office UNKto exclude arthritis.None Results unknown Patient said to me ~Measles that except she is for + "healthy" Mumps report that + Rubella they were (no brand "negative." name) 1 PVT PVT NONE NONE 0 n/a UNK UNK none none no known allergies, no documentation of any birth defects 0 PVT UNK none none none none~ ()~NULL~~In Patient 1 PVT UNK 1 N\A PVT PUB N\A NONE NKDA- SPEECH DISORDER 3 PVT MIL none epilepsy controlled on Depakote 4 Rotazyme negative, UNK stool UNK culturesNone pending5/09 None 2/25/09- None WBC increased 18.4, hematocrit 28 MCV 82 showing ane 1 PVT PVT Just over "stomach flu" and cold. 5 none PVT PVT avandamet,altace, none lipitor, Diabetes Humulin mellitus 70/30and BIDHyperlipidemia 35 MRI of brainUNK consistentUNK with A.D.E.M. 4/24/09-records None received-MRI Adjustment reaction abnormalwith signal depressed in brainstem moodwithout 2/24/09-records regional 0 PVT PVT 77 487.1 2/13/09-records UNK UNK received-Chest x-ray showed bronchiolitis 2/13/09-records with superimposed received-PMH:Developmental left lower lobe pneumonia. delay. PPS RS 0 none UNK PVT None Known None none known 0 NONE UNK UNK NONE NONE ALLERGY TO AMOXICILLIN 2 PVT PUB 0 UNK UNK cold symptoms noneat time of 2nd flu shot 2 UNK UNK none Diaper rashNone
11 MIL MIL Allergy to PCN Reaction 2 None days later 0 immediatelyPVT after episode: PVTBP 112/48, noneHR 91,none O2 98% 5renal min glucosuria after episode: fainting~Varicella BP 104/52, (Varivax)~2~13~In HR 90, O2 99% Sibling1 1 none PUB PUB none none penicillin 0 We have had UNK 2 E.E.G's, UNK a MRI, an EKG, an echocardiography NONE NONEof the heart, an Upper G.I with Contrast, tons of bloo 0 NONE PUB PUB NONE NONE NONE 77 BLOOD WORK UNK AND PHYSICAL UNK OBSERVATION None NONE 2/13/09-records NONE received-CBC normal. 2 Elevated glucose UNK on Chem-16, UNK likely NONE secondary ? fever to seizure, representative none Negativeoffluother screen, illness negative or secondary RSV screen, to vaccination, normal CBC sus 1 none MIL UNK None, routine None requirednone everyever~ 10 years ()~NULL~~In in military.Patient had td shot in 1999 14 Elevated lymphocytes, UNK UNK an elevatedNone ANA, andNone, an abnormal prophylactic None antibody response. EEG and Rheumatology consult ar 10 The subjectPVT had abnormal PVTcerebrospinal fluidUnknown (CSF) laboratory The subject valueshad indicative no concomitant A0767750A of meningitis. medications, All cultures relevant were med neg 1 Speech language PVT assessment UNK None Healthy temp None. 99.1PMH: (R) none. 0 PVT PVT None (Hx ofNone Reglan) GERD; Eczema; 1 MIL UNK Hypothyroidism; Cervicalgia 1 UNK UNK Mild cold symptoms None 6 stool rotavirus OTH RNA, 01/26/2009, OTH positive Unknown WAES0902USA01092 Unknown OTH OTH Unknown Unknown WAES0902USA01085 19 Labs: BS 195. UNK ABGs UNK abnormal. CBC with WBCs COPD 10.9. CXR PMH:(+) COPD. for LLLemphysema, infiltrate andhypercholesterolemia, atelectasis. EKG WNL.L colon Phos 0 PVT PUB NONE NONE NONE 0 UNK UNK none none PCN and erythromycinSC0905 and states history--Tsf causing "ba 0 PUB PVT 1 PUB PUB Zantac (generic) none mom reports hx of acidSC0906 reflux 1 referral for allergy PVT testing PVT to determine Flovent, possible Singulair sore egg throat, and allergy Allegra asthma cough but but afebrile no none allergy to eggs 2 Blood drawn PVT for testing. UNK No HTN, hyperpipidemia 0 PVT PVT synthryoid - simvistatinseasonal - multivitamin allerigies - glucosomine - diverticulitis - zantac - hyatil - biotin hernia - hypothyro 11 PUB PUB none none none 0 LABS: EKGUNK & Holter monitor UNK WNLConcerta 27mg, NoneFexofenadine seasonal30mg, allergies, Flonase ADD PMH: acne, irregular heavy mens 10 None UNK UNK FurosemideClient 40 mg. denies daily, Hx.being Pantoprazole of hypertension ill 40 and mg. diabetes BID, Metformin 500 mg. one BID, 2 stool culturePVT and rotavirus PVTwere negative. Zantac Gastroesophagel None refluxdiarrhea~Rotavirus (Rotateq)~2~0~In Patient 2 N/A PUB PUB Birth controlNone pills None known PVT PVT AMOXICILLIN OTTITIS 400MG/5ML MEDIA 1 TSPSMALL BID X10 RASH~Influenza DAYS STARTED (Fluzone)~1~1~In ON 11/24/2008 Pa MO 4 PVT PVT none no 6 Cardiac echo UNK after recovery: UNK No change Aspirin,from atenolol, prior.Flonase, Vestibular FLovent, dysfunction glucosamine/chondroitin, Mitral valve prolapse/mitral lisinopril, loratidine, regu 0 UNK UNK 1 All bloodwork PVT normal; heart PVT rhythmFish normal; oil, calcium, echocardiogram None trazadone, Lownormal; thyroid; aspirin,brain PCN levothyroxin, scan allergy. normal; niacin. urinalysis I was on normal. a low-carb Adrenal diet 0 PUB UNK 0 PUB UNK NONE 1 UNK PUB none None NKA 16 CSF - neg. UNK CBC - WNL UNK UA -1.WNL, Amitriptyline + fornone Tricyclics 10 mg.scoliosis, 1CT/head pill p.o. headaches, -night no acute before muscle intracranial event.spasms 2.abnormality. Flexeril in lumbar 10 mg. Labs area. q8and hrs. PMH Dp 1 PVT PVT none none none same irritation to DTap~DTaP (no brand name) 1 PUB OTH No other medications Unknown MA20090232 1 LABS: CXROTH w/infiltrates. PUB WBC 170,000, CLONIDINE; HgbNone 4.1(L), ALBUTEROL; reported pltsAsthma; 10K (L). MONTELUKAST ADHD; Potassium MR (H), PMH: Uric intrauterine acid 10.5(H). growth Creatinine retardation, 1.3 0 PVT PUB Here for c/o HA's 1 None PVT PVT Albuterol; BENADRYL; None None TYLENOL 1 UNK PVT 0 None PVT UNK None None H/o exercise induced asthma; Congenital abnl kidney - rem 1 PVT PUB No; 2/12/09,Asthma; Bronchitis Allergic rhinitis 1 2/11/09 - CBC, PVTNormalUNK None 0 PUB PUB None Abnormal gait. 0 PVT PUB None 1 PUB PUB 0 PVT OTH None None None
3
PUB PUB Albuterol MDI URIassymptoms needed Asthma, Allergic rhinitis PUB PUB None None PUB PUB None None PVT PVT 4047 None PVT PVT None None 0 PVT PVT FLEETS enema Nonedaily Imperforate anus 0 PVT OTH None Previous reaction similar when reaction~Hep given FLUVIRIN B (no brand and name)~1~0~I Hepatitis B 0 PVT PVT 10 Hives OTH OTH HYDROCHLOROTHIAZIDE None None 25 mg; VALTREX; Gabapentin 100 mg; LIDODERM 1 PVT UNK None None 469 Colposcopy, OTH high grade OTH squamousUnknown epithelial lesions; Cervical PMH:smear, anorexia-past. High ascus grade pap hernia WAES0902USA01061 squamous; smear. repair Labs: Papilloma PAP (+) viral for infection ASCUS On 22-Nov-2008 OTH test results OTH were:Concomitant antibody test The medications (results: patient'sReported concurrent were not byreported. illnesses physicianUSWYEH08126209 include -Serotype ear 14 infections - 1.26, child (recurrent showed prio 1 General Chemistry, UNK Comprehensive UNK None MetobolicNone Profile, CRP, None. General PMH: Hemotology, none UA, Viral Culture, Aerobic Cultur 7 UNK UNK Zyrtec, Proair, none Cymbalta Mild intermittent asthma 2 PUB PUB AMLODIPINE,CRESTOR,FLOMAX, HYPERTENSION, TEMAZEPAM HERPES QQ10,FISH ZOSTER. OIL, VITAMINS. 0 none UNK UNK None noted but recent episode of croup and bilateral OM which was r 0 UNK UNK Birth controlNone (depo provera) none 1 urinalysis showed PUB onlyPVT concentrated lisinopril urine lovastatin none hypertension none~ hypercholesterolemia ()~NULL~~In Patient 1 none PUB PUB Tylenol none none 0 UNK UNK Asthma 1 PUB PUB ALL to Cipro Labs and diagnostics: UNK CSF UNK WNL. CSF cx (-).None CBC unremarkable. None PMH:seizures~DTP none. Fam hx (no of brand febrilename)~~1~Patient sz in mom 1 UNK UNK 0 PVT UNK no none~ ()~NULL~~In Patient 1 PUB PUB Tylenol prnnone none SC0907 1 UNK UNK None None None 0 N/A UNK UNK None None 24 MRIs, BoneUNK Scan, X-Rays, UNK Echocardiogram, NONE NONE Bloodwork.NONE. Labs: CRP, PMH:ESR, noneANA, noted. RF,allergy mono,toComplement PCN C3 and C 1 PVT PVT fluoride multivitamins none none high fever (104 )~Influenza (no brand name)~N 1 BMP PVT PVT none none none diarrhea/vomiting 10 days~Rotavirus (Rotateq) 1 EKG x3 andUNK Chest x-ray UNK x2 None None None None~ ()~~0~In Patient|None~ ()~~0~In Sibling 12 Per epidemiologist UNK blood UNK test showed positivePer IgM. screening questionnaire stated that child had no fever, but did hav 0 none UNK UNK none none none. no previous reaction to flu shots 3 none PVT UNK URI No allergies; Migraine headaches 1 PVT UNK 0 PVT PUB 2549 PVT OTH Unknown PVT UNK SINGULAER 10 mg daily Asthma; Heart murmur 0 PVT UNK ENALAPRIL MALEATEDiabetes 5 MG ormellitus tabs; METFORMIN type 2; nondependent HCL 850 MG alcohol or tabs; abuse; GLYB tob 1 None PVT PVT Multiple Consult for PROCHLORPERAZINE, pain management AVELOX, TORADOL, PNU-IMUN 9 Neg - Throat PVT Culture PVT IBUPROFEN URI-cold FEBRILE SEIZURE 1/14/09 4 None PVT PVT TYLENOL None None 0 PVT PVT B/P medicine None known None known 0 PUB PUB None OR200904 0 West Nile virus PUBtesting-PVT Fall 2008 positive test April/May Bells 2004palsy actualRT illness West Nile OR200903 Virus 1 None PVT PUB None 0 PUB PUB MOTRIN, PRN None None felt bad~Td Adsorbed (no brand name)~UN~0~ 1 PVT PUB CT200902 0 PVT PUB CT200903 1 None OTH OTH synthamch,None niacia, VALUIM, Macrdintin HYPTOMIDONOSE, Bactrim CALCIUM, SENSELIFT, EVIS 560 PVT PVT
0 PVT PVT None None None 4 MRI pin pt PUB PVT denies denies Reitens disease 1 PVT PUB None otitis media None PVT PVT ALBUTEROL Noprn VSD, ECZEMA, RAD, recurrent URI, sinusitis/som 0 autopsy was UNK performed, UNK SIDS wasNone listed as cause Very healthy of death. None 4 month LABS: Birthold Micro Hx:baby uncomplicated & tox boy.screensc-section. all neg. 16 Large battery UNK of tests performed UNK by Medical Center None. .Seen Labs None 2/4/08 and PMH: diagnostics: for c/o none congestion, Duodenal H/A, bxfever (-). Stomach and abd bx pain. (+)Asses for ch 0 Dr doing bloodwork, UNK noPVT results yet none Heart disease, Fever~Td hypertension, Adsorbed hypercholesterolemia (no brand name)~UN~~In 5 UNK UNK None None Clubfoot 1 UNK UNK None None 9 LABS: EMG/NCS UNK abnormal. UNK CSF: protein (N). none MRI brain, none c-spine &none~ l-spine()~~0~In WNL. Patient|none~ ()~~0~In Sibling y body. Literally, I felt as though if I UNK were to take UNK one more step I would collapse. I did not have the energy to put my hand up and ask the c UNK UNK ### 1 UNK UNK Migraine, unspecified, without mention of intractable migra 3125 PVT PVT 2929 PVT PVT 399 PUB PUB 392 PVT PVT 0 PUB UNK None None Grass; Trees; Dogs; Cats; Dust mites 2 PVT PUB 1 None PVT PVT As stated No No 0 None PVT PVT Advair, Singulair, Atenolol, Hx tachycardia, Ativan prn aortic valve dz post rheumatic fever, Hx as 31 EEG, EKG,UNK CT Scan, MRI, UNK X-ray of Oral back, contraceptives extensive blood Allergic and urine to Penicillin. work-up.Seasonal Video x24allergies. hours with 2/27/09-records EEG. 2/27/09-r re 127 Rapid Influenza PVT Test PVT nonoe none spina bifida occulta 0 CBC, CMP UNK - ALT=85, glucose=337, UNK Metformin MRI ordered. NoneLabs and Diabetes Diagnostics: mellitis, CBC bicuspid WNL. AV&AI, bloodreports glucose 'cold' 337.1-2 ALT weeks 85. 2 N/A UNK PVT FISH OIL, ECOTRIN, N/A DIGOXIN, IRRITABLE ALLEGRA, BOWEL SYNDROME, CENTRUM SILVER, DIVERTICULITIS, FOLIC ACID LYM 51 flu test, CBC, UNK Chem profile. UNK Labs and Synthroid Diagnostics: 50 none mg CXR Penicillin, WNL. T4 Advil high at PMH: 15.4.OCs. CBC WNL. 0 PVT PVT None N/A NKA 0 PVT PVT 0 UNK UNK 28 LABS: UA, UNK US abd WNL. UNKAbdominal x-ray c/w None constipation. PMH: Food partial allergy seizures testssince neg. 2 yo, remission since 10/06;m 0 U/S - normal; PVT UNK 0 Urine sample. UNK UNK Zovia NA NA PMH: abnormal pap smear; LEEP/LEETZ; bilat breast 19 CBC; Mumps; PVTIgG; IgM MILAntibodyNone Panel None None ~Mumps (no brand name)~UN~0~In Patient UNK OTH OTH Hepatitis C;ItSeizure was reported disorder Seizure~Hep that theA0768715A subject's B (Engerix-B)~1~0~In seizures can be Patient stress in 54 NCV/EMG; PVT MRI PVT Bronchitis 1 PVT PVT 0 None UNK OTH Unknown Unknown Unknown PVT PUB 4 Labs and Diagnostics: PUB PUB CXR (-). CT METOPROLOL; abd initially (-) Allopurinol; then (+) HTN; forglaucoma; ASA; diverticulitis. MVT gout; ECG skin (+)Ca. for PMH: atrial fibrillation. gout. HTN. CBC hyperlip with 18 None PVT PVT None None 2 PVT PUB 0 Temp 97.8;PVT BS 93; Pulse UNKOX 96% DDAUP None Enuresis None PVT PVT SPRINTECNone None 0 None PVT UNK ORTH TRI CYCLEN No No 1 None. MIL MIL 0 Unknown OTH OTH Unknown Unknown WAES0902USA01640 90 electorencephalography, OTH OTH abnormalNone LABS: CBC WNL, plts None 423(H). PMH: CO2 chronic 14(L),HAs, total WAES0902USA01693 shaking/jerking protein 5.7(L) episode EEG abnormal. 4/08, AD None OTH OTH Unknown PENICILLIN allergy asthma~Measles WAES0902USA01522 (no brand name)~UN~~In Sib 0 Computed axial, PVT myofascial PVT swelling Alprazolam;Penicillin Fluoxetine; Allergy; Omeprazole; Sulfonamide FLOMAX; allergy WAES0901USA03436 Tramadol hydrochloride 27 Unknown OTH OTH Unknown Unknown WAES0902USA02156 0 Beta-humanOTH chorionic,OTH positive Pregnancy NOS (LMP = 10/19/2007) WAES0711USA06688
168 Electroencephalography, OTH OTH 10/??/08, Aviane negative; Electromyography, None PMH: 10/??/08, aching, forcramping,numbness, lower WAES0902USA01700 extremities: negative; tingling Magneti of LEs w Unknown OTH OTH Unknown Penicillin allergy; Joint disorder; Drug hypersensitivity Ear disorder WAES0902USA01836 plasma ironOTH assay, extremely OTH highUnknown Unknown WAES0902USA01121 95 White countPVT 21.9, H H PUB 13.8/38, platelets 364, 23 segs, 45PMH: lymph's, none 10 monos, Chemistries sodium 139, potassium 8 PUB UNK No No 0 PUB OTH None Allergies: animal dander; dust mites; codeine; MEPERGAN PUB PUB TB test, SP,Hepatitis C29078A. C None Known 0 None PUB PUB Allergic to sulfa 1 PVT UNK None None NM020902 0 PVT PUB none none 1 NONE PVT PVT None None None 1 PUB PUB CARDIAZEM NONE NKA/ HYPERTENSION 26 MRI,Spinal UNK Tap,CT scan, UNK EEG, Echo N/A gram, EKG Noneand multiple None other PMH:Encephalitis~HPV tests. Family She hx:has epilepsy been (Gardasil)~1~14~Patient hospitalized. LABS: CBC 19 MIL MIL unknown 0 PUB PVT 32 MIL MIL NONE NONE KNOWN 249 UNK PVT 0 PUB PUB 4 UNK UNK Tylenol none none none~Hep B (no brand name)~1~0~Patient|non 1 PUB PUB PREDNISONE 20 MG PO TAB 10 0 2/17/2009 Class: Print 2 none PVT UNK Patient was seen for physical/no illness 2 UNK UNK 9 None PVT PVT AMOXICILLIN Ear infection PVT UNK allergic to PCN, Sulfa, NORVASC 0 Patient coming PVTin todayPVT 2/17/09 atLAMICTAL; 4:45pm forNo TOPAMAX office visit.Partial seizures; headaches 0 PUB PUB TRILEPTAL"cold" 300 mg runny dly Epilepsy nose (2.5ml BID) 2 None PUB PVT None None 0 PUB OTH Unknown None MEDI0007813 0 PVT PVT Concomitant drug (s) Not Reported MEDI0007801 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007798 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007796 1 OTH OTH Concomitant Drug (s) Not Reported MEDI0007795 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007788 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007766 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007760 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007756 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007755 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007750 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007749 0 PUB PUB Concomitant Drug (s) Not Second Reported vaccination with MEDI0007740 FLUMIST 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007734 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007733 0 PUB PUB concomitant Drug(s) Not Second Reported vaccination of MEDI0007724 FLUMIST 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007723 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007722 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007721 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007711 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007710 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007701 0 Kept child for PUB 24 hr observation PUB in None hosp LABS: None head US None WNL. 0 None- suspect PVTgastroenteritis UNK (seeing ZANTAC many15 patients None mg/cc today .9 cc GERD tid with vomiting & diarrhea)
1 UNK UNK Oral contraceptives; Acne Allergies: topicalragweed & oral & oak trees 0 None PVT UNK None None Two prior events of brief fainting after blood draws in 2005 0 None UNK UNK None None None PMH:latex induced dermatitis. 136 Increased ANA; PUB 6/15/09 OTH Received vaccine & PCP medical None records Medical of 7/16-11/8/2008. records received LABS: 4/6/09 Endocrine PMH: acne, Labs allergie Abno 1 LABS: LUEPVT US c/w edema. PVT No Insulin Resistance and Polycystic Ovary Syndrome PMH: 1 Stool Cx, rotavirus PVT Ag orderedUNK results AMOXICILLIN never Right received stated otitissame mediaday 1 EEG nl per PVT report LABS: PVThead CTPoly scanVisol WNL. with None CSF: Fe, MYLICON WBC Benign 2, RBC extra 1, protein axial fluid 18,collections glucose 68, of gram childhood. stain neg. PMH:Bloo lacr 7 Diagnosed PVT with AutismPVT on 08/31/2007, None Age 2y, None 4 month None 818 Labs: BloodMIL glucose 122 MIL Upset Stomach 3 Labs and Diagnostics: PVT PVT Abd X-ray (+) for obstruction. None BENone. (+) forPMH: IS. none 14 Has seen PCPPVT Rheumatologist UNK per LEVOXYL work up. PVT PVT 53 EMG; CT scan; PUB MRI; Chest PVT x-ray; None Abd. x-ray.None Labs and Diagnostics: Flu vaccinesore Allergy Head on CT mouth~Influenza . PMH: WNL.migraines. LP WNL. (noMRI anxiety. brand spine name)~UN c-sec. (-). EMG Alle 2 Labs and diagnostics: MIL MRI MIL brain (-). None X-ray at the spine None time (+) for dextroscoliosis. Depression. PMH: KneeLupus. X-ray (+) Mild forcognitive ? quadreiceps impairment. tendinosis Tin 3 elevated protein UNK in spinal UNK fluid; positive None EMG/NCV. None Labs None and Diagnostics: . PMH: noneCXR (+) for R lung apex consolidation. E 4 Cardiac enzymes PVT and ECG PVT neg/normal. None LabsNone and diagnostics: None Troponin 0.04. EKG WNL. Echo WNL. 0 PVT UNK 7 OTH UNK None None 0 PVT PVT No No 0 Labs and Diagnostics: PUB OTH UGI (+) for Gastroesophagela None reflux Possible and mild failure pylorospasm. to thrive (poor CBCweight with platelets gain). PMH: 605K.poor WBC wt1 0 All in ER UNK PVT HYDROXYUREA Thombocytosis 500 mg; -GEMFIBROZIL blood disorder;600 Emphysema mg; RANITDINE 150 mg 0 attached. Labs: PVT Hgb 8.9. PVTHct 27.8. Sodium BUN chloride; 20 Post by d/c. Cardioversion Diphenhydramine Creatinine PMH: Wolff-Parkinson-White 6.1 down hcl; to lorazepam; 1.9. INR 2.2. Midazolam paroxysmalhcl; atrial Morphine arrhythmia sulf 22 See above.PVT CBC otherwise PUB normal. None 2/27/09 records No received-Platelet None count 5000 and other cell lines normal. 0 None PUB PUB None None None 9 Ultrasound;PVT numerous PVT blood tests.Yaz Doppler (1st pack) ultrasound 2/26/09-Last demonstrated 2/26/09-records week C/O sore 2/26/09-records receivedthroat, cervical Recently received-Left lymphadenopathy, started lower oral contracept extremity excess Radiology interface; PUB XPUB rays on leftNone arm. Stiff left arm & neck 0 CT Scan - NCNS; MIL Diagnosis: MIL Sympathetic vasovagal None episode. None 4/6/09-records received-EEG vast majority normal, i 181 3/9/09-records PVTreceived-WBC PVT 17.3. 5/7/09-records Bloodclot~HPV received-5/7/09-records (Gardasil)~3~13~Patient received-office visi 4 PVT PVT None None None 7 4/2/09-records PVTreceived-Sweat OTH chloride test normal. Chronic ear infections 4/2/09-records received-lactose into 12 MRI; EMG;PUB Blood tests PVT 2/20/09-records received-EKG None normal, Penicillin; CAT Low scan thyroid; of head Elevated no evidence cholesterol of intracranial 2/26/09-record hem 79 3/27/09-records PVT receibed-Barium PUB enema None unsuccessful None inNone reducing intussusception. 3 KUB/Abdominal PVT ultrasound UNK 2/24/09-records None received-pneumatic None None 2/24/09-meconium enema reduction aspiration. unsuccessful. Head CT normal. C 1 None PVT OTH None None None 0 MIL UNK 2 None PVT PVT See list See list 2 EMG-neg PUB PVT None No 8 PVT PVT None R knee instability, positive ANA, hypermobility 0 PVT PVT Lo Ovral No Pt has Hx of fainting with injection 0 OTH OTH None None PVT UNK No 1 PVT PVT INDERAL, PAXIL Mild sore throat Percocet + Postnasal -> urny. dip migraines, hyperlipdemia 2 PVT PVT 1 PVT PUB None None None 0 PVT PVT None Thick nasalNone d/c 1 None PVT OTH None None Under birth wt baby - NKDA - Delayed speech 0 PVT OTH YAZ ? antibiotic Nonefor URI 2 OTH PVT retention end 0 PVT PUB None None None 0 Unknown OTH OTH Unknown Hip replacement; Hospitalisation WAES0902USA02357 2 PVT PVT NONE NONE
75 OTH OTH None None Disclosed 0 None MIL MIL None None 73 Unknown LABS:CBC OTH & OTH CMP WNL. Unknown CT head reported as Unknown WNL, noPMH: reportirregular available. WAES0902USA02190 menses, dysmenorrhea, genital 2 Kt level = 2.9 PUB (potassium) UNK SYNTHROID, None ZYRTEC, NKASINGULAIR, hypothyroidism ALBUTEROL, - asthmaFIOVENT 0 Unknown OTH OTH Unknown Unknown WAES0902USA01791 PUB OTH Newborn None Unknown OTH OTH Unknown Unknown WAES0902USA02174 0 PUB PUB Taking CLINDAMYCIN Tooth infection NKA for tooth /12/08infection. Kidney & Spleen removed due to cancer. 8 Unknown OTH OTH Unknown Arteriosclerosis; EyelidDiabetes twitching WAES0902USA02257 1 X-ray OTH PVT None None Ovarian Cancer-2001 (cured) 1 PVT OTH NEXIUM, CELEBREX None None 2188 PVT PVT None None 0 None PVT PVT NKDA 1 None PVT UNK None None None 0 MIL MIL Hypertension no and known ch pain allergies 1 PVT UNK None None 0 PUB PUB None None None known 7 Referred toPVT Dermatology PUB None None None PUB PVT None 14 PVT PVT None 2 MIL MIL 2 None PVT PVT None None Cefdinir 1 PUB UNK None None Stool culture PVT (-) bacterial UNK pathogen. 8 PVT PUB None None Amoxicillin Allergy (no recent exposure) 367 PVT PVT None None None 10 None PVT PVT NONE fever and rash NONE 0 PVT PUB None None 0 Cardiology PVT consult LABS: PVTEKG WNL. Tilt table test. None 7 UNK UNK 0 Pt. with typePUB II diabetes. PUB Novalog Insulin Anxious, 70/30 nomix Diabetes illness 48 units type 9AMII, PinsinHips Metaformin AL0902 2003 100mg at HS Reg. insulin p 2 normal tsh, PVT cbc, cmp UNK hctz, lipitor,gerd, nexium bph, htn. nonehad other a minor than gerd, dog bite bph, to htn R wrist 2d prior 9 No laboratory MILtest. MIL None None 1 na PUB PUB na well none na~ ()~NULL~~In Sibling2|na~ ()~NULL~~In Pa PVT PVT None 3 Unknown UNK UNK None statedunknown none MIL MIL none none none 2 none MIL MIL none none none 3 PUB PUB No Client had an eye infection a few weeks before. Was on E1 MIL MIL none none 0 NONE UNK UNK NONE NONE NONE 5 4/6/09-records UNKreceived-WBC UNK 27.53. Ultrasonography no illnessshowed documented none well defined heterogeneous collection in subcutaneo 1 PVT PVT 5 PUB UNK PROAIR HFA N/A90 MCG/ACTUATION Iodine INHL QVAR 80 MCG/ACTUATION INHL AE 1 None PVT PVT None Rash None 2 none UNK PVT UNKNOWNNO ALLERGY TO oxycontin 48 allergist hasUNK performedUNK general bloodwork 4/13/09-records none none received-Skin 4/13/09-records testing receivedpositive.PMH:seasonal allergies. 1 PVT UNK Was tx 1/9/09 None with Known Amox 400 mg/5 ML; T tsp PO BID X 10 days for O 1 PVT UNK Multiple Maintenance Meds Multiple Sclerosis; Denies~Atrial ()~~0~In Fibrillation; PatientHypothyroidism; HTN occult bloodPVT (-) UNK PVT PVT None None
12 None PVT OTH PRILOSEC;None PULMICORT Acid Reflux 0 PVT UNK 1 Mumps titerPVT (-) 10/08; PVT Rubella, Rubeola titersNone (+) 10/08 0 PVT PVT Mild URI Atopic Derm 0 MIL MIL None None 0 PVT PVT Children's Tylenol None None 2 CBC diff, pltPVT 322, 12.4/35.7 PVT 9.1, 77 None S, 16 L, 7URI M, Chemistries Sx Umbilical normal hernia 0 PVT PUB vein of Galson anomaly & Chiari malformation Type 1, VP 9 PVT PVT None None None 1 PVT UNK None None None 3 PVT PVT No Hernia Diagnostic tests/labs PVT related UNK to swelling ADVAIR; at the ZANTAC; ADACEL Prenatal injection The patient Vitamins; site:denied "None TUBERSOL any needed. illnesses Swelling ###at thelasted time of 1 day." the vaccina Prena 1 UNK UNK Antibiotic Vaginal Inft on ATB's 0 MIL MIL Similar reaction in bootcamp, after vaccinations 3 chem panel;MIL CBC; glucose; MIL tox screen none known asthma, controlled; 26 Free T4, 1.04; PVTT3, 109.8; PVT TSH, 2.16; Thyroglobulin none Ab, neg; noneThyroperoxidase AB, neg; 21 EMG/NCV: PVT Possible CIDP; PVT Spinal Fluid increased Noneat 58. None. Labs and PMH: Diagnostics: mild cold sx EMG/NCS abnormal. MRI brain an 0 PVT PVT None None 0 EEG scheduled PVT PUB No Sl oeformity of thums 1 PVT UNK No Ceclor Med. 1 None takenPVT OTH None 0 None OTH OTH None Only pilonickl None cyst 3 PVT PVT Amoxil 400mg L otitis BIDmedia 5 CBC, ESR,PVT EBV titer, PUB Herpes virus SYNAGIS, 6 -> all WNL No 01/05/09; measles Levoxyl, Down IgM 80; syndrome, Reglan, IgG 622 Zantac, hypothyroidism, Amoxil, Albuterol, BPD, GERD; Pulmicort 1 UNK UNK Tuberculin Parkdale 45270 Intra dermal left inner arm 1 None DonePUB PUB None None None PVT PUB Hospitalized for fever/Resp distress with mild jaundice 11/1 0 PVT PUB No No 5 PVT UNK None None Allergic - augmentin Bleeding~Hep B (no brand name)~2~6~In Pati 4 PVT UNK NONE NO Allergic Augmentin Swelling~DTaP (no brand name)~4~5~In Patie 0 PVT UNK None None None rash~ ()~~0~In Patient 5 None OTH PUB None None None 1 None PVT PVT None None None 1 OTH PUB None None amoxicillin (rash) 0 PVT PUB 0 None PVT PVT None epistaxis 0 PVT PUB AMOX 1 PVT OTH No None 6 PVT PUB 1 Pt told to take PVT BENADRYL PVT 25mg every 6 hrs None and apply ice. 0 OTH OTH Lisinopril; insulin; Niacin; ASA; saw palmetto; Multivitamin; Coenzyme Q-10 1288 PVT PVT AUGMENTIN resolving otitis None media 2 PVT PVT 0 None PVT PUB PRILOSEC;Allergies ATARAX Asthma PVT UNK None Allergic - Penicillin 3 MIL MIL None None 1 None PVT PUB None None 1 PVT PVT None H/O Galactosemia 0 None PVT PUB None No 4 None OTH PVT None None None 1 PUB PUB
1 stool culturePVT (-); GiardiaUNK (-); CBC OK; (+) blood None in stool 4/28/09-records None received-Stool culture negative. 1 PVT PVT PPD mild wheezing Allergy-ASA 0 OTH PVT None None PCN, Suprax; None~ mild()~~0~In heart murmar Patient 1 OTH OTH None None 2 No PUB PVT 1 PVT PVT ulcerative colitis; MIL narcolepsy MIL None None None 1 none MIL MIL No chronic None meds, noneAtopic at time dermatitis, of vaccination. chronic bronchitis, seasonal allergies, an PUB UNK 0 PVT PUB None None NKDA 4 PVT OTH LANTUS; HUMALOG; Allergy: SYNTHROID; Chocolate CORTEF; flavoring; FLUVINEF Med cond: Type I Diabetes, A 0 None PUB PVT None None PCN allergy 2 PVT PVT 1 PVT PVT 0 PVT OTH None 0 None UNK UNK LOTREL; LIPITOR None 10 elevated mg po D,blood diuretic reaction pressure, to meds~Vaccine elevated cholesterol not specified (no bra 2 None PVT PVT TAPAZOLE; None PRAVASTATIN Hyperthyroidism; Hyperlipidemia None PVT PVT Polyvisal without med congestion iron Foliate Hemoglobin E- Pothal 0 PVT PVT HTN; COPD; NKDA; Back Hypothyroidism; and hip pain COPD; HTN 0 PVT PVT Synthroid None Codeine Allergy FLU (extra lethargic)~Influenza (no brand name 8 PUB UNK ~Tetanus Toxoid (no brand name)~UN~49~In P 1 OTH PUB amoxicillin otitis medianone incl. no previous wheezing 1 PUB PVT None Neck Cancer PUB UNK None None 5 2/18/08 Anachoice PVT screen; OTH Ferritin; At timeRheumatoid None NoneFactor; Healthy None Creactive PMH:protein; Family hx: CBC; juvenile PIT; idiopathic Differential; polyarthritis. Chest x-ray. 0 BP 50/80, 98/60 PUB when PUB leaving No No No 2 PVT OTH None None None 1 None PVT PVT None None None 1 PVT UNK PVT PVT FLONASE nasal None allergic rhinitis 1 None PVT PUB None None None 1 None PVT PUB None Healthy None 12/20/08~Varicella (Varivax)~2~14~In Sibling 1 None OTH PVT None Recent laceration None (Seasonal of finger Allergies) 0 None PVT PUB STRATTERA; None AlbuterolADHD; Allergic rhinitis; Asthma 10 None PUB PUB Unknown None Unknown 77 PVT PVT PEPCID; EXCEDRIN; None None OSCAL 1 MIL MIL 7 Normal: BMP, PVTCBC, CK, PVT ESR, Strep Fluvoxamine screen, ASO OCD; maleate; Titer; AcneOCD; RA; Benzaclin ANA; Acne HS-CRP, LYME; Antibody, Mono Screen, CMP, 28 PVT PVT EFLEXOR XR; VALTREX, Allergies SEASONIQUE - Benzol Peroxide 2 None PUB UNK None None None PVT PVT None None 0 None PVT UNK YASMIN; PAXIL; None ALLEGRA Intolerant PM;AUGMENTIN; TYLENOL ES;depression MOTRIM; TYLENOL PM 0 None PVT PVT None None 15 PVT PVT PLAVIX; METOPROLOL; Had Heart attack Heart ZOCOR; attack 9/18/08LISINOPRIL 0 None PUB PUB 1/29/09 KEFLEX None and Prednisone Asthma prescribed None PVT PVT None None 6 PVT PVT LISINOPRIL, ASA, MVIinterstial SIMVASTATIN, fibrosis redness/swelling~Pneumo lung, CATincreased VIT D chol, HTN, (no brand Osteopenia name)~1~ 0 PUB PUB None None 0 PVT UNK 0 PVT UNK 0 PVT PVT None None None
0 CSF culture; PVT CBC; urinalysis; PUB chem None 7; viral PCR/unremarkable None Premature labor, 3 weeks early 129 None PVT PUB None None None PVT UNK ADDERAEL; None RESPERDAL ADHD, Anxiety 7 PVT PUB Unknown none known 2 child examined PVT1/10/09PUB & 1/12/09 None - finding of None acute tonsillitis None1/12 rapid No~strep ()~~0~In test negative Patient|No~ ()~~0~In Sibling 1 None PVT PUB Hydrochlorothiazide None milk/wheat 73 Rotazyme PVT OTH None Sun 0 PVT UNK None Double ureter (L); Hx: UTI x1 / VCUR gr 3 (L) 1 MIL MIL 0 None PUB PUB None None None 5 None PUB OTH None Environmental 1 OTH PVT None Patient has history of double mastectomy. 142 PVT PVT ACTONEL;None WELLBUTRIN; Clorazepate; SOMA; IMITREX; AMBIEN 0 None PUB UNK None None 1 PVT UNK 1 None PUB PVT None None "Lives with chronic fatigue" 1 see reverseOTH OTH Metmorphin; Magnesium oxide; Potassium; Omeprazole; Oxybutynin; Furosemid 16 MIL MIL None Non-Contributary 1 None PVT PVT None None None 1 None MIL MIL ZOLOFT; TRAZODONE None Depression/PMDD PVT PUB None None 0 OTH PVT Lorazepam;None ALTACE; Heart PRAVACHOL; problemsBETAPACE; - 2 stents; irregular PLAVIX; heart CEREFOLIN; beat; High BENT blood 0 None PVT PUB Multi Vitamin with Iron. UNK PVT EVISTA Penicillin allergy 0 PVT OTH None None Diabetes; Hyperlipidemia. 0 None PUB UNK None None Seasonal allergies; Morphine UNK UNK 0 Allergic reaction PUB causing OTH anxiety reaction None Allergic to yellow dye, antibiotics, sodium phosphate 0 PUB PUB Hx syncope with vaccination 14 None OTH OTH 0 EMG-WNL OTH PVT No None 1 PVT PUB diarrhea(mild) Laryngomalacie/GERD 480 PVT PVT None None None 2007~Varicella (Varivax)~1~0~In Sibling 0 MIL PVT 358 PVT PVT SULFA None PVT PVT None 2 None PVT PVT None None None 1 PUB PUB Unknown None Unknown 0 None5AA MIL UNK None None 1 PVT PVT None None 0 PUB UNK None None 1 None PUB PUB None Just over skin None staff infection 0 PVT PUB None None None 0 Blood sugarPVT normal @UNK ER Febrile seizures 1 PUB PUB PRILOSEC;None TENEX; AUGMENTIN; BUSPAR; MIRALAX; CECLOR; ONDANSETRON; Dx OSA; Asthma; ZYRTEC; Constipation; ADD 3498 None PVT PVT None None None done PVT for reaction.UNK Had (-) UA none and Chronic; culture None for AUGMENTIN non-specific ASD; Chronic as abdominal above Abdominal pain pain 2 OTH PUB None 1 OTH PUB 5 PVT PUB Allergic-PENICILLIN, diabetes, increased cholesterol 0 PVT PUB ZANTAC 15mg/ml nasal congestion GERD
UNK UNK 16 PVT PVT None None 0 CBC-sed Rate PVT& Uric Acid PVT- within normal, Blood culture - neg. 0 PVT PVT TRIVORA; None ZETIA IBUPROFEN; NAPROSYN; ASA; Theodore/Hyperlipidem 2 02-12-09 CMP; PUB ALK PHOS PVT 147; CXR: Viral Pneumonia;Type CBC1 Diabetes normal; Rapid FUL-neg.; HybAIC-normal 0 PUB PUB None None None 0 NA PUB PUB None None None 1 None PVT PUB URI Asthma; allergies. 1 Positive pneumonia PVT onPVT CXR; increased None total bili None 2/11; 2.8, None 2/12/09 0 OTH OTH Mild Crohns disease 0 None PVT PVT 14 MIL MIL None Known Allergies: Aspirin; Pollen; Mold. 0 Possible Allergy PVT Testing PVT MOTRIN, Poly None VIFLORNKA 0 PUB PUB lead PVT UNK None N/A 1 None PUB PUB None None None 1 None PVT PVT None None None 0 PVT OTH AUGMENTIN Otitis MediaNone 0 Diagnostic urinalysis, OTH within OTH normal PREVACID; limits. REGLAN;Gastrocesophageal ZANTAC reflux WAES0901USA00323 disease; Respiratory syncytial v 0 Unknown OTH OTH Unknown WAES0901USA00324 Unknown OTH OTH Unknown Unknown WAES0901USA01206 Stool analysis, OTHpositiveOTH for rotavirus. Unknown Unknown WAES0901USA01951 1 None OTH OTH None None WAES0901USA01953 0 OTH OTH Unknown Unknown WAES0901USA01966 4 Unknown OTH OTH Unknown Unknown WAES0901USA02430 Unknown OTH OTH Unknown Unknown WAES0901USA02433 0 None OTH OTH ZANTAC Gastrooesophageal reflux WAES0901USA02724 0 None OTH OTH PREVACID Gastroesophageal reflux WAES0901USA02746 0 Unknown OTH OTH Unknown Unknown WAES0901USA03061 Unknown OTH OTH Unknown Unknown WAES0901USA03138 0 None OTH OTH None None WAES0901USA03733 Unknown OTH OTH Unknown Unknown WAES0901USA03797 0 Unknown OTH OTH Unknown Unknown WAES0901USA04170 Unknown OTH OTH Unknown Unknown WAES0902USA00407 Unknown OTH OTH Unknown Unknown WAES0902USA00406 Unknown OTH OTH Unknown Unknown WAES0902USA00083 Unknown OTH OTH Unknown Sulfonamide allergy WAES0902USA00068 0 Unknown OTH OTH Unknown unknown Unknown WAES0902USA00031 0 None OTH OTH None WAES0902USA00020 0 Unknown OTH OTH Unknown Unknown WAES0901USA04442 0 Unknown OTH OTH Unknown Unknown WAES0902USA04426 0 Unknown OTH OTH ALBUTEROL; Asthma SINGULAIR WAES0901USA04422 Unknown OTH OTH Unknown Unknown WAES0901USA04407 61 Unknown OTH OTH Unknown Unknown WAES0901USA04393 Unknown OTH OTH Unknown Unknown WAES0901USA04391 Unknown OTH OTH Unknown Unknown WAES0901USA04385 0 temperatureOTH measurement, OTH 98.4 degrees MIRCETTE; F 4/9/09-records Polycystic vitamins (unspecified) ovarian Excessive received-CBC syndrome sweating WNL. 4/8/09-records WAES0901USA04376 received-PMH: T2-T4 s 0 Unknown OTH OTH Unknown Unknown WAES0901USA04368 5 None OTH OTH None None WAES0901USA04367 Unknown OTH OTH Unknown Unknown WAES0901USA04253 None OTH OTH None Dysmenorrhea: Pelvic WAES0901USA04188 pain
0 Unknown OTH OTH Unknown Unknown WAES0901USA04169 Unknown OTH OTH Unknown Unknown WAES0901USA04124 496 head computed OTH axial, negative; OTH diagnostic Unknownlaboratory, metabolic Unknown panel, PMH: negative; reflux.Wcomplete AES0901USA03986 blood cell, negative; Lym 0 ultrasound -OTH To confirmOTH pregnancyZOFRAN Pregnancy NOS (LMP = 11/13/2008) WAES0901USA03895 Allergic reaction to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0901USA03981 1 None OTH OTH Unknown Unknown WAES0901USA03962 -366 None OTH OTH HORMONAL Hypersensitivity CONTRACEPTIVESNo Relevant WAES0901USA03954 Data~ ()~~0~In Patient None OTH OTH None Drug hypersensitivity; Allergic reaction WAES0901USA03943 to antibiotics None OTH OTH None None No Relevant WAES0901USA03940 Data~ ()~~0~In Patient None OTH OTH Albuterol; BACTRIM Asthma; hypersensitivity; penicillinWAES0901USA03934 allergy; allergic reaction to antibioti Unknown OTH OTH Unknown Unknown WAES0901USA03906 0 Body temp,PVT 99.9 F PVT DIFFERIN; Fever DORYX; FEMCON Unknown FE WAES0901USA03830 0 None OTH OTH CLARITIN None WAES0901USA03709 None OTH OTH None Sulfonamide allergy WAES0901USA03695 Unknown OTH OTH Unknown Unknown WAES0901USA03688 Unknown OTH OTH Unknown Unknown WAES0901USA03572 0 Unknown OTH OTH Unknown Attention deficit disorder; Depression WAES0901USA03670 0 None OTH OTH None None WAES0901USA03669 1 None OTH OTH None None WAES0901USA03655 Unknown OTH OTH Unknown Unknown WAES0901USA03654 89 Unknown. 6/19/09 OTH Medical OTHrecordsUnknown received DOS 4/4/08Unknown. to 5/08/09.6/19/09 LABS and Medical WAES0901USA03641 Diagnostics: records received Spirometry. DOS CBC 4/4/08 - WN to 0 Serum tissue, OTH 01/26/08, OTH positive; Unknown Serum tissue, 01/07/09, Unknown positive; Western blot WAES0901USA03640 HIV-1, 01/07/09, indeterminate; W 0 Unknown OTH OTH Unknown Unknown WAES0901USA03550 Unknown OTH OTH Unknown Unknown WAES0901USA03543 Unknown OTH OTH Unknown Unknown WAES0901USA03541 0 None OTH OTH Unknown Allergy to vaccine; Gastroesophageal WAES0901USA03523 reflux disease 0 Unknown OTH OTH Unknown Unknown WAES0901USA03516 1 None OTH OTH None Unknown WAES0901USA03509 Unknown OTH OTH Unknown Unknown WAES0901USA03506 138 Cervical smear, OTH 01/14/09, OTHhigh riskNone HPV. None WAES0901USA03501 Unknown OTH OTH INFLUENZA VIRUS VACCINE Unknown WAES0901USA03498 0 Unknown OTH OTH HAVRIX, FLUMIST Passed outNo Relevant WAES0901USA03494 Data~ ()~~0~In Patient 14 Unknown OTH OTH Unknown Unknown WAES0901USA03441 Pap test, abnormal OTH OTH Unknown Unknown WAES0901USA03440 0 None OTH OTH PREVACID None WAES0901USA03437 0 None OTH OTH Unknown Unknown WAES0901USA03348 1 None OTH OTH None Acne WAES0901USA03315 0 Tuberculin purified OTH protein. OTH Unknown WAES0901USA03292 diagnostic laboratory OTH - OTH specified they None took test but did notNone provide what type of test WAES0901USA03289 0 Unknown OTH OTH Unknown WAES0901USA03288 Unknown OTH OTH Unknown Unknown WAES0901USA03159 0 None OTH OTH Unknown WAES0901USA03127 0 Unknown OTH OTH Unknown Unknown WAES0901USA03113 Unknown OTH OTH Unknown Unknown WAES0901USA03100 Unknown OTH OTH Unknown Unknown WAES0901USA03098 Unknown OTH OTH Unknown Unknown WAES0901USA03097 Unknown OTH OTH Unknown Unknown WAES0901USA03093 0 None OTH OTH YAZ None WAES0901USA03077 0 None OTH OTH Lexa pro ; Seasonale Graves disease WAES0901USA03066 0 Unknown OTH OTH Unknown Unknown WAES0901USA03059 0 Unknown OTH OTH Unknown Unknown WAES0901USA03056
Unknown OTH OTH Unknown Unknown WAES0901USA03051 Unknown OTH OTH Unknown Unknown WAES0901USA02938 0 None OTH OTH None Unknown WAES0901USA02772 0 None OTH OTH Unknown None WAES0901USA02752 0 None OTH OTH None None WAES0901USA02751 0 None OTH OTH DEPO-PROVERA None WAES0901USA02738 Unknown OTH OTH Unknown Unknown WAES0901USA02737 0 Unknown OTH LABS: EKGOTH WNL. Unknown Unknown PMH: cholelithiasis, WAES0901USA02713 wheezing, UTI. Allergy: se 0 None OTH OTH None Penicillin allergy; Drug hypersensitivity WAES0901USA02707 0 None OTH OTH Unknown None WAES0901USA02700 Unknown OTH OTH Unknown Unknown WAES0901USA02699 139 hematology,OTH for auto immune OTH disorder, ADVAIR vitamin Asthma deficiency, PMH: Lyme asthma, diseaseHep C WAES0901USA02690 0 Allergy testMIL OTH None Allergy to vaccine WAES0901USA02575 None OTH OTH Unknown Pregnancy NOS (LMP No = Unknown) Relevant WAES0901USA02567 Data~ ()~~0~In Patient Unknown OTH OTH Unknown Unknown WAES0901USA02535 10 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02502 Data~ ()~~0~In Patient 0 None OTH OTH None None WAES0901USA02494 0 Unknown OTH OTH Unknown No Relevant WAES0901USA02463 Data~ ()~~0~In Patient Ultrasound OTH - subcutaneous OTH small bruise YASMIN / postDrug inflammatory hypersensitivity Convulsion; change No Family Relevant history WAES0901USA02390 Data~ of cancer ()~~0~In Patient Cervix HPVOTH DNA assay, OTH Positive None WAES0901USA02385 Unknown OTH OTH Unknown Unknown WAES0901USA02384 50 Unknown OTH OTH None Pregnancy NOS (LMP=11/20/2008) WAES0901USA02133 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02114 Data~ ()~~0~In Patient 0 unknown OTH OTH Unknown Unknown WAES0901USA02093 380 Unknown OTH OTH Unknown Unknown WAES0901USA02043 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02042 Data~ ()~~0~In Patient 7 Unknown OTH OTH None Unknown WAES0901USA02018 145 Diagnostic Laboratory OTH OTH - Syphilis negative; Vitamins Diagnostic Pregnancy Laboratory NOS (LMP=6/27/2008) - prenatal screen WAES0901USA02008 Drug ; Serum hypersensitivity HIV-1 and/ or 2 10/08 0 Unknown OTH OTH Unknown Unknown WAES0901USA01986 Unknown OTH OTH KLONOPIN;Contraception; FEMCON FE Anxiety disorder; Histrionic WAES0901USA01979 personality 367 Pap test, 12/??/08, OTH - Abnormal; OTH Cervix HORMONAL HPV DNA CONTRACEPTIVES assay, None 12/??/08, -No wasRelevant positive WAES0901USA01978 Data~ for high ()~~0~In risk HPV Patient Unknown OTH OTH Unknown Unknown WAES0901USA01971 1 None PVT PVT Unknown Penicillin allergy Rash WAES0901USA01963 0 None OTH OTH None None WAES0901USA01947 Unknown OTH OTH Unknown Unknown WAES0901USA01860 4 None OTH OTH None None WAES0901USA01832 Unknown OTH OTH Unknown Unknown WAES0901USA01823 0 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA01820 Data~ ()~~0~In Patient 0 Unknown OTH OTH Unknown WAES0901USA01813 Unknown OTH OTH Unknown Unknown WAES0901USA01810 0 None OTH OTH None Unknown WAES0901USA01808 2 None OTH OTH CIPRODEX tablets Unknown WAES0901USA01796 0 Unknown OTH OTH Drug hypersensitivity No Relevant WAES0901USA01793 Data~ ()~~0~In Patient 9 Unknown OTH OTH Unknown Unknown WAES0901USA01766 0 None OTH OTH LEVORA None WAES0901USA01758 None OTH OTH None None WAES0901USA01741 Unknown OTH OTH None None WAES0901USA01731 0 LABS: Pap OTH smeal 6/08OTH WNL. UA YAZ neg for pregnancy, c/s(+) None e. coli. WAES0901USA01652 biopsy OTH OTH Unknown Unknown WAES0901USA01631 Unknown OTH OTH Unknown Unknown WAES0901USA01626 0 None OTH OTH None None WAES0901USA01623
Unknown OTH OTH Unknown Unknown WAES0901USA01616 397 Unknown OTH OTH Unknown Psychiatric disorder NOS; No Relevant Restless WAES0901USA01610 Data~ legs syndrome ()~~0~In Patient None OTH OTH None None WAES0901USA01588 Unknown OTH OTH Unknown Unknown WAES0901USA01517 Unknown OTH OTH Unknown Unknown WAES0901USA01508 Unknown OTH OTH Unknown Unknown WAES0901USA01340 Unknown OTH OTH Unknown Rash Insect bite NOS WAES0901USA01321 Unknown OTH OTH Unknown Unknown WAES0901USA01318 0 None OTH OTH LO/OVRAL None No Relevant WAES0901USA01310 Data~ ()~~0~In Patient 0 Blood pressure, OTH 12/24/08, OTH100/5; Electrocardiogram, Calcium (unspecified); 12/24/08, None DESOGEN; normal. vitamins Laboratory (unspecified) WAES0901USA01304 results - Blood glucose, 12/24/0 Unknown OTH OTH Unknown Unknown WAES0901USA01294 0 Unknown OTH PVT Unknown Laryngitis; Sinusitis Unknown WAES0901USA01258 Unknown OTH OTH Unknown Unknown WAES0901USA01227 21 Unknown OTH OTH Unknown Unknown WAES0901USA01221 0 Unknown OTH OTH Unknown Unknown WAES0901USA01181 Cervical smear, OTH 12/30/08, OTHpositiveYAZ; CONCERTA Attention deficit disorder WAES0901USA01176 2 None OTH OTH BENADRYL; Drug YASMIN hypersensitivity WAES0901USA01148 Unknown OTH OTH Plan B Unknown WAES0901USA01143 Unknown OTH UNK Unknown Unknown WAES0901USA01142 3 None OTH OTH None Drug hypersensitivity No Relevant WAES0901USA01138 Data~ ()~~0~In Patient 0 None OTH OTH Hormonal contraceptives Unknown WAES0901USA01134 151 Unknown OTH OTH Unknown Pregnancy NOS (LMP WAES0901USA01128 = 12/5/2008) Unknown OTH OTH Unknown Unknown WAES0901USA01027 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA01024 Data~ ()~~0~In Patient 4 Unknown OTH OTH YASMIN WAES0901USA01020 153 None OTH OTH None None WAES0901USA01008 1 Head computed OTH axial OTH None Unknown WAES0901USA01005 Unknown OTH OTH Unknown None WAES0901USA00984 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA00872 Data~ ()~~0~In Patient 0 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA00856 Data~ ()~~0~In Patient 0 None OTH OTH None Allergic reaction to antibiotics. WAES0901USA00808 diagnostic laboratory OTH - OTH negative; head hormonal computed contraceptives, axial - negative; None vitamins PMH: magnetic No (unspecified) Overweight, Relevant resonance WAES0901USA00803 Data~ appendectomy - ()~~0~Patient negative & LABS: cholecystectom Echocardi 0 Unknown OTH OTH Unknown Unknown WAES0901USA00802 5 Diagnostic microbiology, OTH OTH 05/??/08.Unknown Culture lesion confirmed Unknown Varicella Zoster virus WAES0901USA00796 149 Pat test, 03/12/08, OTH abnormal; OTH PapHormonal test, 09/16/08, contraceptives; normal.Unknown ALDACTONE tablets WAES0901USA00457 96 None OTH OTH Pregnancy NOS (LMP No = 12/6/2008) Relevant WAES0901USA00375 Data~ ()~~0~In Patient 0 None OTH OTH None None WAES0901USA00366 0 Unknown OTH OTH Unknown Syncope WAES0901USA00365 Unknown OTH OTH Unknown Vaccination adverse reaction WAES0901USA00353 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 11/1/2008) WAES0901USA00352 0 Unknown OTH OTH Unknown Unknown WAES0901USA00349 525 urinalysis - OTH positive for OTH protein; urine YASMIN beta-human Pregnancy 12/22/08 Tonsillitis NOS - negative; (LMP = Unknown) urine beta-human WAES0901USA00342 Urinary 12/29/08 frequency; - positive Obesity; Hyper 0 Unknown OTH OTH Unknown Unknown WAES0901USA00341 Unknown OTH OTH Unknown Unknown WAES0901USA00318 OTH OTH Unknown Flu Unknown WAES0901USA00315 0 Unknown OTH OTH Unknown Unknown WAES0901USA00309 0 Unknown OTH OTH Unknown Unknown WAES0901USA00308 Unknown OTH OTH Unknown Unknown WAES0901USA00307 Unknown OTH OTH penicillin (unspecified) Latex allergy WAES0901USA00289 Unknown OTH OTH Unknown Unknown WAES0901USA00200 0 body temp 06/10/08 OTH - 102 OTHbody temp None - 103 Labs None. and Diagnostics: 7/27/09 Medical EKG WAES0901USA00188 records WNL. received, CPK 44. including Troponin cardiolo I 0. 7/27
Unknown OTH OTH Unknown Unknown WAES0901USA00173 2 None OTH OTH None None WAES0901USA00154 10 Pap test, 10/20/07, OTH ASCUS; OTH Pap test, hormonal 05/21/08, contraceptives ASCUS;None Pap test, 23/03/08, normal WAES0901USA00061 5 beta-humanOTH chorionic, OTH 10/08/08, urine pregnancy Pregnancy test: negative; Pregnancy; NOS (LMP Pap=Delivery; test, 10/14/2008); 10/13/08, Pregnancy WAES0901USA00052 Asthma ASCUS: termination positive, HRHPV 7 Diagnostic Laboratory OTH OTH 12/23/08 - Mononucleosis None Unknown WAES0901USA00041 19 diagnostic laboratory, OTH 12/23/08, OTH -; ALESSE, ultrasound, INFLUENZA Pregnancy 01/07/09, -NOS VIRUS FHR(LMP 135; vaccine, No 1= weeks 11/18/2008) Relevant MENACTRA 0 days; WAES0812USA04853 Data~ Hiccups urine ()~~0~In beta-human, Patient12/18/08 0 None OTH OTH None Pregnancy NOS (LMP=8/5/2008) WAES0811USA02352 ultrasound, OTH 11/24/08, IUP OTHat 6w 2d, Unknown pelvic pain, Pregnancy rupturedPapanicolaou NOS corpus (LMP luteal = 10/9/2008); cyst smear abnormal WAES0811USA02127 Penicillin allergy; Hypersensitivity 76 Ultrasound,PVT 04/07/2008, PVT SLIUP SN VENTOLIN 4d. US due Pregnancy (ALBUTEROL); to bleeding/EDC Motor NOS PROZAC; (LMP=2/28/2008); vehicle 04-DEC-2008; accident; ADVAIR; WAES0810USA02628 Diagnostic Arm Asthma; ironfracture; (unspecified); Penicillin laboratory, Renalallergy; injury; ZOLOFT; 05/27/08, Splenec Anxiety vita 12 14 diagnostic laboratory, OTH 03/10/08, OTH - routine pregnancy Pregnancy workNOS up; ultrasound, (LMP = 2/11/2008) 03/31/08, WAES0810USA00870 - 1st trimester routine within no Ultrasound OTH 05/14/2008OTH - EDC 12/11/08; None routine Pregnancy dating 9W6D NCS (LMP = 3/4/2008)WAES0806USA02226 0 Diagnostic Laboratory OTH OTH 04/16/08 - cystic Vitamins fibrosis negative;Cesarean Ultrasound section; 06/12/08 Papanicolaou -WAES0802USA06329 CWO normal smear anatomy; abnormal; Beta-huma Ex-toba 0 ultrasound 01/14/08 OTH - within OTH normal allergenic limits; ultrasound extract Pregnancy 03/24/08 NOS (LMP - within = 11/13/2007 normal limits; WAES0802USA00364 Hypersensitivity Apgar score 8/9 0 diagnostic hematology OTH OTH 11/29/07 - None Tonsillectomy WAES0712USA00292 9 PVT PVT None None 0 None MIL MIL Sinus infection 4 OTH OTH Hydrochlorothiazide; Patient stated Diclofenac highpossible blood pressure; cold no allergies 6 PVT PVT EFFEXOR depression Hives, with anxiety arthralgia.~Measles + Mumps + Rubella 1 PVT PVT TUBERSOL, None SANOFI PASTEUR, Similar~Td C3026AA, Adsorbed INTRA DERMAL (no brand R FOREARM, name)~UN~27 01/ 0 None-Awaiting PUBneurology OTH referral Zinc oxide ointment; Diaper Dermatitis NYSTATIN None ointment 0 None PVT PVT None None None 14 PVT OTH 6 Ultrasound,PVT MRI UNK None None 0 PVT PVT No 0 None PVT PVT None cimetadine; CECLOR none PVT PUB none none 0 None performed. PVT Pt referred PVT to ER. None None MIL PUB None 1 PVT PVT 0 PVT PUB None None 8 None donePVT OTH None None None 2 cellulitis OTH OTH None None None 0 Neg RST PVT PVT None None 2 PVT PVT None None 0 PVT PUB Immediate outbreak Hives~Pneumo of facial (Prevnar)~3~1~In hives after ROTATEQ, PatientPEDIA 1 CT - Lab work PVT- UA PUB NKA 1 None PUB PUB None None None 411 PVT PUB none none none PUB PUB unk None Known denied allergies to meds or food 0 UNK UNK LIPITOR; LOTRIL History of hypertension and hypercholesterolemia. ### Has ha 48 MRI/MRA; EMG, PVT labs: PVT B12; ANA; Levothyroxine; ESR; HCG No ORTHOHx, NOVUM metastatic papillary cancer of thyroid s/p thyroidectom 0 PUB PVT 0 PVT PVT None None Atrial Septal Defect; Scoliosis PVT PUB 1 None OTH PVT FLAX seed;calcium; No magnesium; No vitamin B complex; Niacin; Omega 3; COENZY 0 PUB UNK 7 Cellulitis USPVT L arm PVT SYNTHROID; None QUESTRA; HTN;BENICAR hypothyroidism; hyperlipidemia 1 PVT PVT ACTOS; ALTACE; EFFEXOR; Diabetes;GLUCOVANCE; Obesity; HTN DARVOCET -26 OTH PVT Psoriasis 0 None PVT PVT SINGULAIRNone 0 PVT PVT Lisinopril; Amlodipine; Sertraline; IMITREX 1-31-09~Tdap (Adacel)~1~51~In Patient
2 PUB PUB 0 PVT OTH gastronitis None 0 MIL MIL Montelukast; None Atomoxetine; Asthma ADVAIR 0 PVT PVT ADDERALLNone XR 20mg;ADHD TQD 0 PVT PUB 0 PUB PVT Recovering from fx heel since 4/08 1 PVT PUB No Allergy to chicken pox vaccine 0 CMP; CBC;PVT UA; CT of PUB head None None None Unknown OTH OTH Unknown Unknown WAES0902USA02263 1 Unknown OTH OTH Unknown Unknown WAES0902USA01655 0 HB screen drawn PUB (L) antecubital PUB just None prior to HB No vaccine illness None dose given. 93 OTH PVT Multivitamin; None PREMARIN Drug allergy - PERCODAN; Menopause; uterine fibroids 16 Labs and Diagnostics: PVT PVT Brain MRI (+) for ventriculomegaly URI s/pand NEC; prior25 grade weekII premie. hemorrhage, PMH: repeat 25 wk (-) premie. for brainstem o 0 PUB PUB 26 None UNK UNK DILANTIN; gabapentin;seizures; atenolol;HTN; ASA hyperlipidemia; R carotid stenosis; bronchi 1 None PVT PVT LURIDE, TRI-Y-SOL Otiti - MediaNone - Amox 2/1 - 2/11/09 0 PVT PUB None None None 0 PVT PVT None None Seizure~Influenza (Fluzone)~1~6~In Patient 1 Temp 98.9 UNK - arms equal UNK size 7 None MIL MIL Depo shotsPt denies Pt denies 11 cbc bmp sed MIL rate rpr MIL none None nkda sm has back acne 1 Tests done PVT blood work,UNK xrays and flu swab. INone believe oneAsthma of the test was for mono, which came back negative, xra 15 Labs and diagnostics: UNK LP UNK with WBCs Yaz122-100% none monos, none. CSF protein PMH: OCs 109, glucose 57. HSV PCR (-). EEG abnorma 1 n/a PUB PUB none no none 6 MIL MIL Took KeflexNone and Percocet Allergic 02-15-09 to penicillin till 02-17-09 ,Ampicillin, after Paracetamol cosmetic surgery 2-05-09 0 PUB PUB None PCN, Tylenol, "Heart Meds", Steroids. Pt. denied allergy t 0 the DTaP was PVTfrom Glaxo UNKSmith exp None date 8/03, None the Hib was None from Aventis autism~DTaP exp date+11/02, HepB the + IPV IVP(Pediarix)~4~0~In was from Connau 0 PUB PUB no NKA 5 Chest X-ray, UNK venous blood UNKdraws,Levenox, CAT Scan, two Mother Nuclear injections says contrast Hx. daily two ofweeks anxiety for test,three and before and weeks many four Thanksgiving, other then yearsdiscontinued, tests ago but diagnosed patient mother Coumadin hadcan having cold not sympto Throm daily, reme 1 MIL MIL none HTN, HLD, GERD, OA, DM; allergy - metronidazole (urtica 31 TSH 0.50 1/2008 UNK PVT none hypertension, xerosis, eczema,hypothyroid, 1 MIL UNK None None PVT PUB PVT PUB PVT PUB Eczema UNK PVT 1 None PVT PUB None None None 0 After extensive PVTphysical PVT exam, referred None to neurology None for eval Noneand EEG. Likely benign rolandic epilepsy. Still waitin 0 PVT PVT Rota given none Po and Manufacturer none for Pentacel is Sanofi unable to enter above 4 OTH OTH No other medications Unknown MA20090270 UNK OTH OTH Thyroxine sodium; Unknown Fluvoxamine Hysterectomy; maleate; kneeRosuvastatin pain; A0769208A the subject calcium; under Chromium went twosalt; surgT 0 Unk PVT PVT Ofloxacin Unk It was reported that it was A0724362B unknown if the mother was preg 0 UNK PVT PVT Ofloxacin Unknown Pink Eye; The reporterA0724362A stated that the subject was very ea 116 OTH OTH Healthy PVT UNK None None 1 None PVT PVT None None None 9 None PUB PUB None None 1 Seen in ERPUB doctor- BENADRYL PUB given per mother None None 1977 OTH OTH Pan Hypopituitarism 7 PVT PUB Started 2-17-09 Augmentin 65 600mg/ 5 cc 3.5 cl po BID for 10 days 6 Parvovirus PVT and Measles PVT titers. 7/7/09 MedicalNone records received None DOS 12/26/07 to 6/23/09. LABS and DIAGNOSTIC
0 UNK OTH PVT 0 CBC; Platelets PVTand AutPVT Diff No Known Medications 17 2-4-2009: skin PVTlesion Giemsa PVT stain, DUAC, negative; RETIN-A pt Tzanck reported smear, Mild onsetnegative; facial of recurrent acnevesical single base HSV HSV lesion Ag DFA, lowernegative; lip on same vesica day OTH PUB None Allergy to CECLOR 0 multiple ABG UNK (hypoxic);MIL chem; CBC; ASA, CXR dig;(atelectisis LASIX; URI SYNTHROID; RUL, This consolidation), 9 month Polivisol old male etc.; vit; TYLENOL was negative born RSV; by emergency infl A/B Ag; c-section C3 low aa 0 OTH OTH TYAESON SUPERFICIAL PUNCTATE KERATITIS EKG NSR w/arrhythmia, MIL MIL inverted T waves, CK HBP, 179 prostate (55-170),problems Troponin I <0.38 (0-0.08, CKMB 2.43 (0-2.37), chem, diagnostic laboratory, OTH negative OTH pneumococcal penicillamine Wilson's antibodydisease; titer; immunoglobulin Immunoglobulins GWAES0902USA02409 index, decreased decreased body temp, OTH 104 degr OTH Unknown Unknown WAES0902USA02177 Unknown OTH OTH Unknown Unknown WAES0902USA02440 1 PVT PUB SYNAGIS, Not MedImmune, ill at time 35of 08A624, wkvaccines preemie; upper Twin; rightReflux thigh, (GERD); 2 previous NBdoses hearing screen ( 0 UA -trace bacteria; PUB WBC, PUB 16.9; Hgb, Depo 15.5; Provera Drug None screen (+) NKDA; Cannabis. Hx of abdominal See attached AR0903 gun- labs shot 2/27/09-records at age 9. 2/27/09-record received 46 LABS: Abdominal PVT x-rayPVT & KUB abnormal. Segs None 47%(H),None plts 457(H). PMH: Currently Creatinine w/OM 8(L),&albumin being tx5.0(H), w/oral globulin antibiotics. 2.1( 9 PVT PUB developmental delay None, but primary OTH carePVT physician evaluated Genfibrozil; &None HCTZ no Tx. Hypertension; Hyperlipidemia 0 UPT - neg PVT PVT ORTHO EVRA None Patch reported NKDA 1 UNK PUB SINGULAIREczema 10 mg, ATORAX Cat, dogs, 1 1/2 dust tsp(NKDA) Eczema, Ocular albinism, Hx of P 2 PVT PVT 0 None PUB PUB LYRICA, ULTRACET, None None ONNORRIS, SASTLINE OTH OTH None Asthma 0 Glucose, finger PUBstick, 102 PVT None None None severe reaction~Yellow fever (no brand name)~ 119 Influenza Test, MIL positiveMIL 114 Influenza Test MIL- Positive MIL 117 Influenza Test MIL- Positive MIL 59 Influenza Test, MIL positiveMIL 0 PUB PVT None None 0 PVT PVT None None None 2 None PVT UNK None None known 0 PVT PVT No Ceolliouprath decreased tone UE 0 PVT PVT Quinapril; HCTZ; None EFFEXOR SIMVASTATJN XR; NIASPAN > URTICARIA, DX: HTN, Depression, and 1 None PVT UNK No No 1 OTH PVT Unknown CHF, arthritis/ All: PCN, Sulfa, TOLECTIN, TCN, ZOLOFT 575 Diagnosed MIL as ShinglesMIL on 2-10-2009 No No 13 MIL OTH UNK UNK 1 PUB UNK None None None AR0905 1 PVT PVT SYNTHROID; CutPAXIL; DAYPRO; None AMBIEN; DARVOCET; Lorazepam; AUGMENT 0 OTH PVT AX and other NounknownNeurocardiogenic meds. syncope; seizures 0 PVT OTH FLOVENT HFA; Possible ATROVENT; pneumonia asthma DELTASONE; AMOXICILLIN; VICODIN; STNTHR 0 MIL MIL 1 PVT UNK None sensorineurial hearing loss 0 PUB PUB PAXIL, BUSPAR, None IMITREX Migraines, eggs, Vomiting~Influenza milk, PCN - Depression (no brand name)~1~32~In 0 none PUB UNK None None None 0 UNK UNK Patient hasPatient Cystic Fibrosis. has Cystic Fibrosis. 1 None PVT PUB Penicillin allergies 0 PUB PUB 0 none PUB PUB none none asthma none~ ()~NULL~~In Patient 0 PVT PVT Hx Eczema 1 None PUB UNK Atenolol, HCTZ, NoneOcella, IBS Zyrtec, and allergies Primrose None~to()~NULL~~In oil, dust, Vit E, mold, Multivitamin, and Sibling1|None~ Sulfa Zifaxan, ()~NULL~ Erythroc 0 none UNK UNK none none none PMH:Arm ear pain~HPV ache & tonsillitis. (Gardasil)~2~16~In Patient 1 NONE PUB PVT PREDNISONE NONE 5MG BID; RHEUMATOID IBUGESIC 400MG ARTHRITIS
1 EEG scheduled UNK 2/25/09 UNK prior to event Prevacid per Dr 3mg/ml no note on - 1.5 2/17/09. Wolf-Hirschhorn ml BID, Hydrochlorothiazide Syndrome / 10mg/ Sickle ml Cell- 5Trait mg /BID, Chronic Tri-Vi-S Ren 2 UNK UNK none no none 0 Labs and Diagnostics: UNK UNK Holter monitor None with frequent None -PVCs. wellHx baby CXR blocked exam WNL.lacrimal Echo WNL duct,for Dxage withwith Failure small toPFO gain noted weight, with va 1 PVT PVT None None None 0 2 MIL MIL Similar reaction Shortness in bootcamp of breath~Vaccine after mass vacination not specified and(no ca 2 Brain CT scan, UNKbrain MRI, UNKFactor 5 blood test,none FISH blood none test,PMH: lyme disease, migraine CBC, HA x 3 Evoked yrs. Vertigo. potential Factor test. VLABS: LeidenP 11 None PVT UNK None None None no~ ()~NULL~~In Patient 13 PVT PVT none none 0 UNK UNK NONE none NKA, Rt. eye ptosis, recet meatal stenosis correction 1 UNK UNK NONE NONE 0 MIL MIL UNK UNK 19 UNK UNK none none none 0 PUB PVT -0unk 1471 PVT UNK None VonWillebrands 0 PVT PUB no none 0 PVT PUB 1 UNK UNK NONE NONE mild asthma 1 None MIL MIL Lessina Optic Neuritis HSV 16 PVT PUB Atopic dermatitis History of congestion and runny nose, Atopic dermatitis 21 Staph Aureus; PVTInfl B positive; PUB X ray chest diffuse None pneumonia NoneLABS: Admit labs: WBC 0.9(L), plts 41K(L) CRP 26.6 29 MRTs and CTs; OTH multiple OTH lab test; Spinal tap LABS: No MRI PMH: brain 12/31/08 PSVT, HTN, abnormal. hypertensive MRI c-spine cardiovascular abnormaldisease. w/multile 1 PUB PUB PPD, ID, 1, 2-19-09 UNK UNK 0 OTH PVT TYLENOL 1 PUB OTH unknown Reported no allergies 2 OTH PUB none none Skin biopsyUNK done, pathology UNK -> 10/30/2008 shows none squamous knownHypertension, cell CA. diabetes, hyperlipidemia MRI/CT negative. PVT Blood UNK Work negative for any None neurological None indications/infections/ cardiovascular disease". 0 PUB PUB None 10/08 surgical excision of staph infection lower abd. 2 PUB UNK SYNTHROID; None PREMPRO Hypothyroidism 1 Unknown - PUB Pt sent for M.D. PUB evaluation Noneon 2-13-09. Mom reports None - mild dry cough 1 None PVT UNK None CAD, DMII, HTN, glaucoma 0 None PUB PUB Well Child NKA 1 PVT PUB 1 PVT PUB 3 OTH PVT None None 0 Allergist no PVT allergy testing PVT None None None 0 None PVT PUB None NKDA 0 None PVT PVT None None; NKDA 0 PVT PVT None None reported None 0 PVT PVT none none none 0 None PVT UNK He was given None some known children's None. tylenol (I think?) immediately prior to his vaccinatio 0 the doctor that PVTI saw two PVT days latertri-cyclen, (2-19-09)and red Dr.cephalexin(given bumps/rash Castro is none calling itteh ansame allergic day reaction as the border two vaccinations) line infection 0 Encephalitis, UNK Autism, Roseola UNK Roseola with high fever 3 months prior. PMH: eczema 1 PVT PUB NONE CYSTIC HYGROMA L SIDE OF NECK 0 MIL UNK N/A SULFA DRUGS 0 none UNK PVT n/a none allergy to codeine 0 none PVT UNK infant tylenol None aprox. 30None minutes prior to injections. 0 PVT UNK eczema 0 MIL MIL MOTRIN 800, States PO none QD allergic PCN, Taenia
1 UNK UNK none none 2 Any test were UNK not doneUNK until almost TBthree test months (PPD-mantoux)10/31/2007 noneafter shots. noneEarly PMH:intervention fever c-section 102~Measles w/nuchal program+cord, diagnosed Mumps decreased + Rubella him with heart +aVaric 7rate mo UNK UNK 1 PVT UNK none high blood pressure. no other 0 CHEST XRAY, PVTCBC, RSV UNKSWAB,Zantac, STREPReglan TEST runny noseacid reflux 9 PVT PVT Amlodipine,Diabetes, Levemir, Hypertension, Glucophage, None Glucotrol, Hyperlipidemia, ASA, HCTZ, Obesity, Zocor, Perforated Lotensin, nasal Byett se 0 None OTH OTH Concerta Pregnancy NOS (LMP = 5/19/2008); WAES0901USA03717 Penicillin allergy; Attention defici Unknown OTH OTH Unknown WAES0902USA02626 49 diagnostic laboratory, OTH 11/15/08, OTH unspecified Zyrtec; Allegra lab Allergic tests respiratory symptom WAES0902USA02661 Unknown OTH OTH Unknown Unknown WAES0902USA02666 Unknown OTH OTH Unknown Unknown WAES0902USA02698 0 None OTH OTH ACIDOPHILUS; Drug VENTOLIN hypersensitivity (ALBUTEROL); SYMBICORT; WAES0902USA02926 PREMARIN; CENTRU 1 Unknown OTH OTH Lisinopril Hypertension Immunisation WAES0902USA02933 0 Unknown OTH OTH Unknown Unknown WAES0902USA02939 2 Unknown PVT PUB LIPITOR; FLEXERIL; Diabetes; Hypertension; AVAPRO; CALAN Dyslipidaemia SR WAES0902USA02882 UNK UNK 6 EKG, normal; PVT Chest X-ray, PVT showed not bronchitis at time of None 3/16/09-records vaccination allergicreceived-WBC to Amoxicillin 3.2, Hgb 14.9, neutrophils elevated 7 UNK UNK I've never had an allergic reaction to any medicine in previ 49 LABS: Blood UNK c/s, CRP,UNK PT/PTT all WNL. She does have allergies PMH: asthma, seasonal allergies 10 None PUB PUB TYLENOL; None MOTRIN, PRN None 0 None PUB PUB none stateddenied OR200905 1 None PVT UNK None Right sided plagrociphely > treated & resolved 408 None PVT UNK None 0 - Physical exam PVT - normal, PUBon day of None shot (2/17/09) Cradle and captoday only (2/18/2009) 2 None PUB PVT None None None OR200906 2 PUB PUB OR200908 2 Allergy elimination, PUB so PVT far not allergic to gelatin Noor neomycin No 0 TSH, CBC PUB PVT None None None 1 Neuropathy,OTH abnormal PUB EMG and nerve NORVASC, conduction No NEXIUM, illness studyTOPROL, Arrhythmia, 2/09/2009.SYNTHROID, Physical migraines, therapy, hypothyroidism, BENICAR, blood labs, ALDACTONE, hypertension, (CBC), (ANA) PREMA dege ord 0 None PVT UNK None 0 Not Preformed PUB PUB None 1 None PVT PVT multiple meds None Heart attack x 2; type 2 diabetes; penile cancer 3 None PUB PUB None None None 1 PUB PUB MIL MIL BC (OCP) None PVT PVT None None None 0 PVT PVT None Known 4 None MIL MIL None None None 0 None PVT PUB Sinusitis; allergic All: INVEGA; rhinitis crab meat; med; conditions: ADHD; Bipolar d 0 None PVT PUB None Dermatitis None ~Rotavirus (Rotateq)~1~2~In Patient 0 None PVT PUB None Nasal Congestion None copious drainage 0 PUB OTH None Known or indicated on IMZ record 1 None PUB OTH None None None 0 Service member MIL has had UNK tetanus and influenza None vaccines in the past w/no adverse events. He had not had meningo PVT OTH State Vaccine No None 8 None PUB PUB None None Using Soy milk, regular causes diarrhea 0 CT chest, neg PVTfor P. E.PUB None No Benign Murmur UNK UNK 0 No test done PVT related toPVT this event.Multivitamin; None, FLOVENT s/p TAllergy and MDI;AAUGMENTIN; to 4 days CEFZIL; possible PREVACID, immune 15mg, disorder; BID reactive airw 0 PUB PUB None OR200907 3 PUB PVT None Known None
0 0
PUB PVT No No MIL UNK ACIPHEX, 20mg; None HCTZ NKA MIL MIL Allergies 19 VZV strain discrimination PVT OTH None None None 0 PVT PUB Cough slight swelling and soreness~Pneumo (no bran 6 None PVT PVT SYNTHROID; Asthma; TOPAMAX Epilepsy; Migraine WAES0902USA03903 0 PVT PVT 2 PUB PVT aspirin 0 PVT UNK Kidney-wellURI per Mom Proteinuria 0 NONE UNK PUB NONE NONE NONE PR 09 03 1 PVT UNK none none 0 NONE UNK UNK COMMON COLD AND RASH IN THE PR0904 FACE 1 UNK UNK 0 UNK UNK None None None 0 none PVT PVT Pulmocort, none albuterol bonchiolitis in past 1 NONE UNK UNK 4 PUB PUB Not applicable Amoxicillin 2 UNK PVT error on previous report...should have been reported as Zoster and no 2 UNK PVT 7 NONE UNK UNK Caduet None Had Shingles approx July 2008 0 PUB PUB none none 0 PUB PUB none no PCN same~HPV (Gardasil)~2~15~In Patient 14 None at thisPUB time - Client UNK referred None to private MD None for evaluation. None 4 PUB PUB Tylenol none 9 2/17/2009 EEG UNK at Hospital, UNK Neurologist none appt.none 2/18/2009stroke in-utero, seizures first 3 days of life from high fevers 1 PVT PVT None HTN 0 None PVT PVT 0 None - pt went PVTto hospital PVTemergency None room None None PMH: bipolar, asthma, anxiety, suicidal ideation hist 1 MRI->ADEM UNK LABS: MRI UNK brain abnormal. Neutros None 65.6%(H), known PMH: to us lymphs strep throat 26.2%(L). 12/08CRP & recurred 0.07(N). 1/09. ESR 33(H). CSF: p 1 OTH PVT Unknown None Unknown 0 3/11/09-records PVT received-white PUB count of 13,000 and urine3/11/09-records revealed white receivedcells and red Allergy cells. to Augmentin reaction w 0 UNK PUB PUB Asthma The subject had no adverse A0769858A events following previous vac UNK OTH OTH Zolpidem tartrate Hand tremor; High Insomnia; Cholesterol Osteopenia A0605302A 9 PUB OTH NUVARING 0 PVT OTH Fluoride drops None ex - 34 week preemie PVT UNK see note None 3 ultrasound, OTH abnormal; urinalysis, OTH 12/15/08, negative; urine None. culture, PMH: 12/15/08, NICU for negative; WAES0902USA02413 TTN. nasopharyngeal RSV, 12/15 2 diagnostic microbiology, OTH OTH 02/16/09,aspirin; lesion culture: LIPITOR; result calcium; pending Unknown PREVACID; DILANTIN; WAES0902USA02932 ACTONEL Unknown OTH OTH Unknown Unknown WAES0902USA02974 Unknown OTH OTH Unknown Unknown WAES0902USA03097 diagnostic laboratory, OTH CF OTH profile negative; REGLAN; diagnostic ZOFRAN; Pregnancy laboratory, vitamins NOS (LMP (unspecified) 1st trimester = 10/2/2007) usWAES0711USA01322 screening within range Unknown OTH OTH Unknown Unknown WAES0902USA01674 0 clinical immunology, OTH multiple OTH sclerosis Unknown negative; Lyme disease Unknown assay, negative WAES0902USA03098 Unknown OTH OTH Unknown Unknown WAES0902USA02699 Sed rate, CRP, OTHRheumatoid OTH factor, ANA, liver function panel, Patient all had normal a history findings; of IGA Lyme, deficiency ### Monospot, andASO, allergies all negativ to am 13 Lumbar puncture. PVT LabsPVT and Diagnostics: MESTINON CXR WNL. EKG Myasthenia WNL. Spinal Gravis tap(since with normal 1968). CSF PMH:glucose Myasthenia and protein Gravis 0 OTH MIL 6 Pavoo Vn and PVTMcarda PVT titra None None None 0 PVT PVT None None None 0 None PVT PVT None None None seizure~ ()~~2~In Sibling 2 PVT PVT CELEXA, ALBUTEROL, None Emphysina FLOVENT, - Breast DIAZEPAM Cancer - Anxiety
11 9
PUB PVT PVT UNK None Cough None PVT PVT Annual physical HTN; Hyperlipidemia; Sulfa allergy 1 OTH PVT None None 112 Flu A + PVT PVT None None 0 Seeing allergist PVT in TWLPVT no testing done yet. No Cleft palate 0 Ordered EEG MIL MIL None None None/ Healthy No previous Baby adverse event~ ()~~0~In Patient 12 Rubeola lgG PVT lgM; lgM OTH rubeola positive None None NKDA; Hx sinusitis; Otitis Media 0 LABS: EKGPVT WNL. H.pylori PVT (-). TRINESA; OMEPRAZOLE Possible stomach None ulcer 0 PVT PUB NUVARINGNone Allergy: Chocolate 1 None PUB PUB None None 352 + Pertussis PVT serology 01/26/09 UNK Physical exam 0 None PVT OTH No None 0 EKG: Normal OTH sinus rhythm. OTH Ectopic None beats. Premature No atrial Nonecontractions. Normal pulse. Normal QRS complex. N 1 PVT PUB 1 PVT PUB Digoxin; ALLEGRA; Cervical spinal LEXAPRO Ibuprofen stenosis - CHF (C2-C7); Cardiac Dysrhythmia (scheduled for 2 No PVT PVT No No Mild varicella~Varicella (no brand name)~UN~1 3 UNK UNK 88 PUB UNK No PVT PVT Cold temp 99.9 NKMA deg F 1 PVT PUB BENADRYL 5 None PUB PUB ERYTHROMYCIN Congestionophth None Conjuntivitis oint TID; AMOXIL 400 BID 0 Referred toPVT NeurologistPVT NASONEX None PROTONIXNone - CLANTIN 4 Not applicable PVT PVT HCTZ, FELODIPINE, No ASA hypertension,high cholesterol, elevated PSA, sulfa allergy None PVT UNK None None 0 None PVT PVT None IBUPROFEN -> itch 0 PVT OTH SYNTHROID; Pancreatitis, ATIVANIVP R/O Dye, MI shellfish; Papillary stenosis; emphysema 1 OTH PVT None None None 0 Addendum:PUB Appt to seePUB allergist today TamoxofenNone statedHx CA; Allergies: Naproxen; PCN; Sulfa; Zithromax; Pinea 0 OTH PVT Increased Chol; Dyslipademia; mild headache murviogenpic occasional hemotursa 1 PVT OTH None None 0 PVT PVT 1 Clinic follow-up PVT with physician PVT for monitoring 5 PVT UNK none none none 0 PVT PVT Lotrel, Zoloft, None Xanax High Blood Pressure, depression due to daughter's suicide 1 N/A PVT PVT NONE NONE NONE 0 UNK PUB none none none 1 PVT PVT Robaxin, Veramyst, NA Miacalcin, Allergy toFluocinonide Sulfamethazole Solution, Prempro, Carpal Fosamax, TunnelCelebr Syndr PVT UNK 2 N/A UNK UNK "cough med" cough none known 0 none PVT UNK none none 1 nonw PVT PVT Aspirin 81 mg none by mouth Dyslipidemia Daily Take an aspirin Hypertension daily for 21 daysAcute to reduce Coronary the risk Sy 1 Home temperature UNK on UNK day prior toTYLENOL hospital admission PRN NoneFEVERS of 101.9 nkda, previously degrees F.hospitalized ER admit temperature x3 days in was Sept100 2008 with for afeve pe 0 Autopsy done UNK - LABS:UNK 12/18/08: CBC, Tylenol-was BMP,Chronic CXR told to WNL. take bronchitis Premature 1/12/09: prior to per vaccinations LABS: infant, pathologist WBC 3 oldper who 30.3, healing MD did segs the rib 9.97% fractures autopsy lymphs found16.9%. at autop 1 N/A PVT PUB 1 PVT PUB 0 PVT PUB None. Patient None was here for wcc 0 none UNK PVT NONE NONE 1 PVT PVT NONE 1 PUB UNK Ventral Hernia Allergy repair to Abilify on 2/3/09, - dysphagia, discharged hand 2/6/09. tremors. Presented back to 0 LABS: EEG, UNK MRI brain,UNK spinal x-ray None WNL. Genetic None testsHernia WNL. at eight weeks old PMH: mild language & motor de
PVT PUB none none 0 None MIL MIL Singulair, Flonase None Egg allergy; asthma; Peanut allergy; shellfish allergy 0 1/10/09 WBC's PUBincreased UNK 23.5 k/ulAlbuterol per PCP.Nebulizer; Labs: WBC Hx12-30-08 taking 17.9, 26% ZANTAC DXlymphs, with RSV; 59.9% 7-20-08 neutros. DX with Flu (-). GERD; Strep1/10/09 (-). CXR A 0 PUB PUB None None 12 Pending complement MIL studies MIL None Hypothyroid; cervical dysplasia 1 Stool Culture PVT PVT None None 2 PUB OTH 2 PUB PUB DARVOCET; MOTRIN, PO; COLACE; TYLENOL 3 3 PUB PUB COLACE, MOTRIN, VICODAN 2 CBC with Diff; MILESR; TSH-sensitive; MIL Ibuprofen CMP; HIV-1 800 None mg AB; po RPR tid NKDA. with food; Patient EXCEDRIN had recent prn (10FEB09) for HA's; OTC Allergy Super work-up, B-Comp whi 3 OTH PVT 5 PUB PVT None None None 10 OTH PVT No 0 CBC TO BEPVT DONE PVT 1 None known PUB PUB No No 0 PVT UNK LIPITOR; DIOVAN; None ATENOLOL; None CARDIZEM; FLOMAX ASA 1 PVT PUB 0 None PVT PVT None None None 1 None PVT PUB None None None 0 PVT OTH 0 PVT UNK None None None 1 MIL UNK None None X-ray of leftPVT arm: negative PVT The patient had a history of a ### pulled muscle in the left arm Unknown OTH OTH Unknown Unknown WAES0902USA03575 Serum hepatitis OTH B, low OTH Unknown Unknown WAES0902USA03396 107 PUB PVT None None HPV #2 given 10/17/07, LA, 0469U; HPV #3 given 2 2 PVT PVT None 1 None MIL MIL none none none 1 none performed UNK PVT nexium none allergic to fentanyl. has acid reflux 10 PUB PUB none, per parent none, per parent none, per parent 0 EEG scheduled PVT PVT none none 1 CT, MRV, confirming UNK Transverse UNK Sinus Ortho Venous Triclyclin none Thrombosis....UTC Lo andNKDA, multivitamin none records none~ only 3/9/09-records ()~~0~In of beingSibling|none~ placed received-PMH:migraines. on Keflex ()~~0~In and Predniso Sibling| Ora 10 MRI Brain and UNKSpine: areas UNK of demyelination none none of cervical spine none 3/16/09-records and brain. CSF received-Allergic studies negative for to penicillin. infection, autoim 0 PUB PUB Albuterol inhaler child in good Hx. health of asthma 0 None MIL MIL None None None 0 PVT PVT none n/a point that it kept patient up at night. Told PVT mom to PVT do cold compresses none none and motrin none call if symptoms worsen. 1 PUB UNK Traumatic injury - stepped on nails in board. 0 Blood woork-3 PVTdirrfert test, UNKallegery none skin test,,C1 none functionional none test, hormone none~ ()~NULL~~In test,cbc -blood,c4,serum Patient|none sister~ trytose,swolle ()~NU 2 She was given UNKfosphenytoin UNK and started on maintenance Patient hadUnderlying congestion IV fluids. Head medical and CT rhinorrhea conditions was done fiveand including days noted prior. congenital as3/6/09-records stable. CMV, Blood m c 21 Unknown PUB UNK Unknown Unknown Unknown 1 PVT PVT None GI upset, fever, myaligias less severe~Td Adso UNK PVT Coumadin, Synthroid 0 PVT UNK None. None. None. I would like to see CDC mandate that drug manufa 0 none PVT PVT none notedsulfa allergy none knownPVT UNK Unknown None known 6 UNK UNK None none No PMH/PSH 7 PUB PUB 1 NONE KNOWN PUB PUB NONE REPORTED NONE REPORTED NONE REPORTED Magnetic resonance, OTH normal; OTH computed Unknown axial, normal; electroencephalography, Convulsion WAES0902USA02176 normal 2 3/5/09-records PVTreceived-EEG OTH abnormal, subtle None focalknown cerebral None of dysfunction. known at time, CTpossible showed reoccurring subdural hematoma brain bleed withfrom mi
7 3/9/09-records PUBreceived-Electrocardiogram PUB None at time normal. None of vaccine 2D echo None with 3/9/09-records color flow and received-PMH:bronchitis Doppler normal with trace andtricuspid whoopi 0 PUB PUB None None 1 OTH PVT None None 0 PVT PUB None None apricots caused rash 1 PVT PVT Eczema, asthma 2 PVT PVT None OTH OTH 0 None PVT PUB None None 1 PVT UNK 15 PVT PVT None None PVT OTH 3 None done PVT here - (vaccine PVT clinic for, CLARATIN; international diabetic Vitamins; travelers - says ALLEGRA; Diabetic controlled - says ZOLOFT; controlled albuterol; and able to travel 1 PVT PVT Pulmicort, Albuterol, Swallowed Tylenol Reactive foreign body Airway in alimentary Disease tract 0 PVT PUB ATARAX 52 UNK PUB None None HSM 12/07 -1/08 0 PUB PVT No illness Seasonal allergies 1 PVT PUB none none 1 All "negative" PUB per Mother. PVT1-22-09None EKG; CATNone Scan; multiple Allergies: bloodBrazil tests;nuts Urine (Anaphylaxis tests. 1-23-09 in 1987); TestingPecans, for Lupus; Waln "a 1 TSH= 0.01 PVT on 2/18/09 PVT SYNTHROID, None 50mcg Hypothyroidism NOS; Hyperlipidemia; elevated LDH 0 OTH OTH Latex; Gluten; Cotton; Parbein; Oris root. 2 PVT PVT None None 3 None PVT OTH Mom to giveNo BENADRYL No before next immunization PUB PUB Unknown None None 0 PUB PUB None No No 60 PUB PUB PREDNISONE 1/2 mg Arthritis qod OR200909 1 PUB UNK 31 EEG; Sleeping PUBEEG; Holter PUB monitor x 1 month; thyroid panel; Arthritis; Blood heart unresponsive~DTP sugar; murmur Braincaused scan; MRI from (no brand . Lyme Labs:name)~1~0~Sibl disease. CBC andPMH: Chem 2 UNK UNK Perimenopausal, otherwise no significant medical history. 1 None PUB PUB None Allergic rhinitis; Mild intermittent asthma 4 PVT PVT B6, B12, CAL, PhySt John's NKA Wart 0 MIL MIL None Allergies - Ty lox, Darvocet, Tagament 0 PVT PUB None 0 PVT PVT None None None 0 PVT OTH nausea and severe vomiting 0 UNK UNK 1 None PVT UNK Did not want None to reveal med None 0 PVT UNK none 16 NONE PVT PVT NONE NONE NONE 0 Client was on PUB Bactrim DS PVTfor sinusBactrim infection. DSDx He with was sinus given none infection a 10 day and dose, onhe 10has dayone regime day of left2xofday 10 day Bactrim, dose.with o 2 UNK PVT 2 eeg PVT UNK none none None UNK UNK given ibuprofen swelling, 800mg warm No and -tonormal ultram the touch, 50mg reaction pain onper 26 Dr. Feb 09 by Dr. 13 Spinal taps,UNK CT scans,UNK MRI's, Numerous prevestatin blood None 40work mg ups,None ECG's, PMH: tests none~ hyperlipidemia, for Guillain ()~~0~Patient Barre, jaw myasthenia movement disorder, gravis, HIV, shing L 1 PUB PUB None unknown 9 LABS: MRI UNK spine WNL.UNK CSF: RBC none 2, WBC 5,none protein 77(H), Penicillin glucose allergic 69, c/s neg. 1 PUB UNK 2 At ChildrenUNK Labs and Diganostics: UNK CSF WNL. CSF cx (-). PMH: HSVnone PCR (-). RSV/Flu (-). CBC and Chem WNL. Head 1 None PUB UNK Pt was not currently None onSeasonal any otherand medications none~ dairy ()~NULL~~In allergies. at time of Patient|none~ vaccinations.()~NULL~~I Patient als 0 PUB PUB none none 1 None PVT UNK HCTZ 25 mg None1/2 tab Seen inHTN the for welcome am/Asa81tomg Medicare one daily/Vit examD 400 mg one daily/Calciu 3 none PUB UNK none none
1 ESR, ASO,UNK FT4, TSH, UNK ANA TITER, none ANTI-DS-DNA, none EBV none AB PROFILE PMH: acute ACTpharyngitis, WKST: FANA, HA,STOOL, acute sinusitis, URINE,cough, CARD 1 none PUB PUB none none none 1 none PVT UNK Ziac, lisinopril, none asa 2 CBC; DIFF;MIL UA; Chemistry; MIL AdmitConjugated to hospital None estrogen LABS: EEG, cream None MRI BID PMH: brain36 WNL. wk fraternal twin A, SVD, vertex. Preterm 1 PUB PUB None Known No known No 2 PUB PVT Chlorphenir;Upper MIDRIN; respiratory TESSALON Smoker; infection. Migraine PERLES headaches. 0 PVT PVT Allergies- Morphine, adhesive tape, HCTZ, Verapamil 707 PVT PVT PVT PUB RITALIN 10None mg daily started Amblyopia 1-5-2009 OD 0 PVT PVT 0 PVT PUB None None Exercise-induced None~asthma ()~~0~In CA080024 Patient|Unknown~ ()~~0~In Si 4 None PVT OTH Estradiol; Spironolactone; None PMH Albuterol low platelet count 0 None PVT UNK None Kiwi 1 None PUB PVT None No None 1 PVT PVT 0 PVT PVT None None 4/6/09-records received-Has held breath before. 9 None PUB PUB None None None 1 No adversePVT reactions after PVT receiving Concerta HPV #1. 54mg None PI for Motrin ADACEL ADHD. prn - headache states PMH:the premie-34 study reports wks. RAD, headache T&A.inStrep somepharyngit for 14 da 1 PVT PVT 0 ultrasound, OTH 10/14/08, 27 OTH weeks gestation Unknown RCA; Pregnancy cervical smear, NOS (LMP ASCUS = 4/7/2008) HPV +;W beta-human AES0810USA02517 chorionic, 10/14/08, p Unknown OTH OTH Unknown Unknown WAES0902USA03537 Unknown OTH OTH None None WAES0902USA03735 Unknown OTH OTH Unknown Unknown WAES0902USA03764 68 neurological, OTH normal LABS: OTH CBC,None CMP, UA, BNP & urine None drug HPV screen #2 all given WNL. 12/6/07, WAES0902USA03784 Prolactin28.27(H). Lot # 0928U, IM/RA; Potassium HPV3.3 #3 Unknown OTH OTH Unknown Unknown WAES0902USA04026 Unknown OTH OTH Unknown Unknown WAES0902USA04035 Unknown OTH OTH Unknown Unknown Diarrheoea~Rotavirus WAES0902USA03761 (no brand name)~UN~0~ 0 PUB PVT None None 0 PUB PUB No No No 0 PVT PUB None None 7 None OTH PVT METOPROLOL 100MG, Diabetes PO, Daily; Mellitus SPIROLACTONE type II; Hyperlipidemia; 25 mg, PO,HTN; Daily;Rosacea ZOCOR PVT PUB None None None 1 PUB OTH None None None 0 PVT PVT None 545 None PVT PVT None None Asthma; Pyloric Stenosis @ 16 days old 6 None MIL MIL None None Seasonal allergies 1 Unknown PUB PUB Unknown none hx of headaches 0 PVT UNK Anxiety None 0 PVT PVT NKDA, 6 wks post partum 1 OTH PVT PROZAC; TRAZADONE-SINTHROID; None Depression, anxiety, CLONIPIN; GravesCARBIDOPA disease, asthma 1 PUB PVT Asthma Allergy Flu like soreAspirin, throat, Penicillin, nasal congestion Sulfur PVT PVT head laceration NKA 1 PVT PVT None None None 0 MIL MIL NONE Cold x 2-3 months. Congestion off and on. 4 none PUB PUB none NKA 0 MIL MIL NONe Cold X 1 mo, Cough rhinitis 0 MIL MIL NONE RecoveringAmoxicillin from respiratory Shellfish infection X 3weeks. 7 Available onMIL request. MIL Birth controlNone (pill or Nuvaring), Seasonal Claritin allergic asrhinitis needed 0 PVT PVT Singulair, Symbicort, none and Patient Albuterol has a history of environmental allergies and asthm It has been UNK so long I don't UNKknow if They anyone hadcan allI must help "required" me. give Icredit; vaccines was told refused thethere from doctor a birth was copy would to nothing of18 the not months. boys vaccinate wrong records. with I then if they my saw children. ill,what but did was PMH dur go 1 TSH "normal" UNK UNK Enalapril 20none mg po daily Allergy: "tranquilizers" diagnosis: hypertension
17 PVT PUB none 31 None Atypical UNK chest pain UNK with tranthoracic Ortho Tri-Cyclin echocardiogram NoneLo Allergy-Minocyclin; unremarkable. None~ ()~~0~Patient|None~ Exercise Induced Asthma; ()~~0~Sibling Lyme Disea 0 MIL UNK 21 2/26/09 CT PVT of UE/thorax OTH with high supraclavicular LAD/cellulitis. 1 PVT PUB Pt had shingles PVT after receiving PVT 1stNone VARIVAX @ None age 1 yr.Scoliosis; Alcohol prep pads 32 No PVT PVT No None 0 CT of abdomen PVT (neg); PVT CBC; CMP; amylase; lipase. Labsamoxicillin. and Diagnostics: 7/11/08~HPV PMH: Allergies Monospot (Gardasil)~1~13~Patient to (+). Pertussis, CBC WNL. Amox. CMP, L ankle amyla pi 1 none PVT PVT MAXAIL; ALLEGRA; none NEXIUM; PCN; Mold; PULMICORT; Sulfa; ZITHROMAX-Allergies; SINGULAIR; MVI Asthma; GERD 1 PVT PVT None None None 0 MRI showed UNK tenosynnovitis. UNK EMGAllegra normal.60 mg, None Flonase, Seasonal Orthotrycyclen allergies 7 1. Urinalysis: UNK negativeUNK for all tested Nexium 2. 20mg CBC none granules, w/lites: 3/16/09-records born normal Poly-Vi-Sol at 303.weeks, receivedCT with scan: iron eosinophilic URI normal 2mL symptoms esophagitis, 4. times EEG:1normal severe week 5. acid Tem ref 0 PVT PVT None None 0 Diagnosed UNK with: Thrombocytopenia, UNK none Pancytopenia, none Ammenorrhea, none 3/18/09-records Hypothyroidism, received-Recurrent Anemia, low blood sinusitis, pressure, statusA 0 none PVT PVT Synthroid 175mcg, None daily; Prozac, Prinzide hyper none~ 20/12.5mg, feeling ()~NULL~~In daily; Aspirin Patient 81mg, daily; Hydroco 1 PUB PVT Augemntin, Clindamycin 2/09 Client recently hopitalized for facial abcess. 0 UNK PUB azithromycin 4 none PUB UNK none no hx neck surgery, secondary AZ0902 to bone spurs; trigeminal nerv 20 Labs and Diagnostics: UNK UNK MRI (+) optic neuritis. NONE CSF with 10 ASTHMA, WBCs, glucose PMH: asthma. 111, normal epistaxis. protein NKDA 28. CSF cx (-). 1,25 1 PVT UNK Lamictal, amiloride. None amlodipine, Bipolar, Hypertension, prilosec, simvastatin, hypercholesterolemia, hectorol. lithium-induc 11 PVT PVT GERD 3 PUB PUB NONE NOTED 16 None PUB PUB None No None 11 MIL MIL 0 none PVT PUB none none none 12 neutropenicUNK since admission UNK currently onpatient vancomycin, felt well no meropenem, pre-existing at the time conditions. ofacyclovir, the headache flagyl, AML diagnosed caspofungin 5 days after va 14 PVT PVT 5 Chest x-ray,OTH 12/24/07, OTH considering technical factors Rash erythematous; chestNervous is unremarkable; system Bronchiolitis; disorder; Chest WAES0902USA04226 Upper x-ray, Brain respiratory 01/10/08, malformation; tract no radiographic infection Cardiac mu 34 15/Nov/2008: UNK Lumbar puncture; UNK CPR undetectable; Sed The rate patient (17); Gentamicin suffered trauma therapy to### was her left stopped knee/leg due while to subseq wres 40 none OTH OTH Concerta; Clonidine; Risperdal; Patient has Zoloft a history of asthma ### and ADHD (attention defic cardiac monitoring, OTH heart OTH rate is inUnknown the 30 range Unknown WAES0902USA03436 Unknown OTH OTH Unknown Unknown WAES0902USA03722 Unknown OTH OTH Unknown Unknown WAES0902USA04183 19 March 1999: OTH Chest:OTH No focal infiltrate or evidence Unknown of acute Allergies, cardiopulmonary medical The vaccinee history, A0344260A disease.; "noticed and concomitant 03some September pain" medications (site 1999: notLym spe we 0 PUB PUB None None 0 PVT PUB Autism; sensory integration problems 16 PVT PVT Resolving URI NKDA or medical conditions 3 None PVT PVT None Cough 1 None PVT PVT None None 27 PVT PUB None None None 15 PVT PVT None None PUB PUB UNK None None 0 PUB OTH Estradiol; Armour None Thyroid Hypothyroid 0 None PVT PVT None None None 1 Vaccine route MILgiven intra MILdermal IPPD C2910AA , ID , 2None , 20 Jan 09. 9 Throat culture PVTto lab today UNK3/2/09 3344 Clinical observation PVT PUB none none none 0 None PVT UNK None known allergic to my mycins. 0 PUB PUB none no fever~DTaP (no brand name)~1~0~In Sibling None PUB PUB Denies by Grandmother None None 1 PVT PVT No No Developmental delay- hypotonia
21 Pending PTOTH visit to 1 hour OTH Tretinoin 0.1% cream since Sulfa - 8/27/08 2 PVT OTH MIL MIL Unknown 1 PVT PVT none none none 0 None PVT PVT None None 1 PVT PUB None none known 0 PVT PVT none reported Bee stings 1 PUB PUB None 0 None PUB PUB None None None MI2009001 UNK UNK Feb 13, 2009 emergency None room treatment 0 UNK UNK None 1 EEG and saw PVT neurologist OTH 1 None PVT OTH None Codeine; penicillin ; generic drops; egg 1 None PVT PVT None None history of febrile seizures; mild asthma 2 PUB PUB None None 15 Unknown OTH OTH Unknown Unknown WAES0902USA04059 0 Unknown OTH OTH Unknown Unknown WAES0902USA04441 19 Unknown OTH OTH Unknown Unknown WAES0902USA04580 26 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA04384 155 Unknown OTH OTH Unknown Miscarriage WAES0902USA04455 None. OTH OTH None ### none OTH OTH At the age of 5yrs the patient suffered ### severe chest pain a 8 Unknown 3/12/09-records UNK UNKreceived-Labs ZYRTEC; WNL. TETRACYCLINE; CT scan The abdomen patient MULTIVITAMIN; and hadpelvis a past normal. history TYLENOL; ### of environmental ALLERGY SHOTS allergies a 2 none OTH OTH ### 0 PVT PVT Birth controlNone pills Child hood food allergies- was treated & outgrew them. PM 8 Allergen level PVT high 3/18/09-records OTH none received-Septic none workup none negative. CT scan normal. EEG normal. ANC 450. Blo 1 80 cc tan, thick OTHfluid- gm PVT (+) cocci No chronic illness; no known drug allergies 3 Widened pulse MIL pressure OTH of 177/82, Allergy pulse TABS92, None non-specific Loratadine None. changes PMH: onseasonal ECG. Diagnosed allergies with acute pericarditis with Level II ultrasound PUB planned PUB at hospital high risk Pregnancy, clinic None non complicated 2 OTH PVT SINGULAIR; Stable Albuterol asthma Amoxicillin as rescue allergy 7 PUB PUB None 1 None OTH OTH None None None 7 Lab works: PVT blood draws OTH & skin biopsy by Drs.None NKDA; HTN; Increase Cholesterol & HRT. Had positive PUB influenza UNK nasal swab with next visit 1 PVT PVT Cold Sx None 142 PVT PVT None None PVT PVT No 5 PVT UNK PVT OTH PVT OTH LORAZEPAN; NoneLEVOXYL; SEPTRA; PRAVASTATIN; ZOLOFT; PAXIL; Fish oil;EFFEXON; CLOMIPRAMONE; WELLBETRIN; ASPIR 592 PVT PVT None Known None Known RSV + as infant- PE tubes 4/07- Numerous ear infections 5 PUB PUB none knownnone known 0 None PVT PVT None None None 11 PVT PVT 0 No MIL MIL IBUPROFEN NoAND FLEXERIL None 10 None PUB PVT Unknown Unknown History of prostate cancer 13 none MIL MIL none none none 0 PUB PVT metoprolol, none omeprazole, learning advair,disability, rhinocort,HTN, sertraline, depression, hydrochlorothiazide asthma, rhinitis, rena 1 NOne. Antibotic PUB given PVT to patient from Prozac, family Maxide, physician. none birth control, Hypertension over the counter motrin as needed 0 PUB PUB synthroid 75mg n/a q1 graves disease, thyroid removed 3 PUB PVT Patient does have a history of herpes simplex around her m
1 Chest XrayUNK UNK NONE Patient has seasonal allergies and h/o asthma 0 PVT PUB nONE None 1 PVT PUB None 3 PVT PVT None PUB PUB vertigo GERD 1 none PVT UNK none none 2 3/2/09 tilt table UNKtest. Mother UNK statesStarte all other Fludrocortisone tests None neg., butNone 1mg unsure QD PMH: whatHA, tests appendectomy, done. LABS:asthma. ECG WNL. Family Echocardiog hx: CAD 0 PVT PVT 1 PVT PVT 0 MIL MIL NONE NONE 3 Chemistry, PUB 02/09/09, Pending; PUB Echoencephalogram, Concomitant Drug(s)02/09/09, Not Reported. Pending; EEG,MEDI0007972 01/12/09, Abnormal activity on left 5 OTH PVT none 0 PVT PUB None 1 PUB PUB None None 1 Prior VZV Titer PUB2/26/09UNK Equivocal. None Fx Coccyx - Bulging Disc 1 none PVT PVT none none none 1 3/18/09-records PVT receivedPVTEKG sinus ORTHOTRICYCLEN tach otherwise None normal. LO Acne; CTHistory brain negative. of depression Lymph 5/07 % low 9.0, gran % increase 0 PUB PUB none WV0901 2 OTH OTH 0 PVT PVT none knownScarlet fever Reaction?~Smallpox as child age 5 (no brand name)~UN~20~ 1 PUB PUB None No None 3 PVT PVT LOVASTATIN; ZETIA; Hyperlipidemia; DIOVAN; HCT HTN; Osteopenia; NKA 1 Stated on antibiotics PVT after PVTseen in None ER None None 2 Lab work (blood); OTH ANA,PVT Negative No other medications None Systemic lupus erythematosus; 08AV00126SP Von Willebrand's disease None OTH PVT SINGULAIR, None Nasal Spray 08AV00285SP 2 Unknown MIL OTH Unknown Unknown Unknown 08AV00718SP 0 None OTH PVT No other medications None None 08AV00691SP 0 None OTH PVT No other medications None Allergy to grass,Allergy08AV00597SP to plants; Allergies to PCN, ASA, D 1 10/10/2008,OTH Chest x-ray PVT Normal, Normal Topamax, per Anaprox ER None physician Migraine to patient; headaches; 10/10/2008, Drug 08AV00596SP EKG, hypersensitivity, Normal, Normal allergy pertoER Amo ph 1 OTH OTH No other medications None 1 History of Psoriasis or 08AV00447SP eczema like condition until age 10 1 None OTH PVT Prilosec None GERD Gastrooesophageal 08AV00436SP reflux disease; Allergies to: PC 0 None OTH PVT Claritin, Diazide, None Nexium, Allergies Enalapril, hypersensitivity; Pulmacort08AV00396SP inhaler Asthma; High blood pressure Hy 3 EKG,Negative; OTHChest X-Ray, PVT Negative; Oral Contraceptive UrineNone PregnancyNone Test, Negative; Blood 08AV00395SP test, Negative Unknown OTH OTH Unknown Unknown Latex allergy 08AV00332SP 3 None OTH PVT No other medications None Environmental fever~Measles Allergies 08AV00331SP Hypersensitivity; + Mumps + Rubella Heart(no murmur brandas n 1 None OTH PVT Centrum, Lutera None None 08AV00286SP 0 Unknown OTH OTH Unknown Penicillin allergy WAES0902USA04394 184 Unknown OTH OTH Unknown Unknown WAES0902USA04440 9 HematologyOTH OTH Hormonal contraceptives Hypersensitivity WAES0902USA04545 6 Unknown. Labs OTH and Diagnostics: OTH Unknown MRI (+) for increased signal Unknown on T2. PMH: EEGfxWNL. ankle. WAES0902USA04564 Echo asthma WNL. MRI/MRA WNL. MCV 0 Not reported PVT PVT The patientSyncope~Influenza had no past medical ### (Fluzone)~~8~In history and had Sibling|Sy not been 0 Not reported UNK UNK The patientSyncope~Influenza had no past medical ### (Fluzone)~UN~9~In history. The patientSibling had o Not reported UNK UNK Not reported ### Child has exercise PVT induced OTH Asthma- Symptoms None above noted Syncopal prior to Episodes HPV inj 4/14/09-records received-Normal cran 2592 PVT UNK 1 PVT PUB 1 N/A PUB PUB allergic to penicillin andSC0908 erythromycin 420 3/11/09-records UNK received-. UNKChest x-ray no acute COPD abnormality. 3/11/09-records Sputum culture receivednonrevealing. PMH: COPD-lung WBC 17,900. reduction Neutroph sur 760 3/11/09-records UNK receivedUNKECG abnormal butCOPD stable. Enzymes 3/11/09-records normal. Adenosine received-PMH:coronary sestamibi scanartery negative bypass for isch gra 280 LABS: CT head UNK WNL. UNK EKG abnormal w/inverted COPD T-waves. PMH: T-cell lymphoma, CAD, CHF, COPD oxygen depend 1 UNK UNK
260 3/11/09-records UNK received-ECG UNK normal. Arteriogram COPD with 3/11/09-records angioplasty to right received-PMH:breast lower extremity. cancer status post r 2 PUB PVT none 1 NONE MIL MIL NONE NONE NONE 0 EEG, CT Scan UNK, x-raysUNK all performed Topamax the same 25 Left mg day eaar daily, to eveluate infection Pineal Imitrexinjuries Cyst, 50 mg Venous from as needed, the Angioma fall.Depo 3/9/09-records 3/9/09-records Prevera Injection received-X-ray received-PM every 3 1 PUB PVT 1 None PVT PVT Unknown None Unknown None PVT PVT Unknown None None 0 PVT PUB None Mild URI GERD None PVT PVT Birth controlNone pills (unknown Nonebrand) 1 None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown 17 4/15/09-records UNK received-MRI UNK consistent withPatient bilateralrecently optic Allergy-induced neuritis. had strep MRA throatand normal. sometimes about MRI a week brain exercise-induced and priorspine to vaccinations. normal. asthma Neg None PVT PVT Birth controlNone pills (brand None unknown) None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown 15 was administered UNK compazine UNK and birth benedryl control byNA oral iv None 3/6/09-records received-PMH:long history of migrain 0 Blood work UNK on 12/18/08 PVT revelead Mumps AlbuterolVirus Treatment None AB (IGG)NKA, 0.97 History L. Presense of Asthma, or Absence S-section of Mumps in yr 2005. IgG AB can notb 1 PVT PVT 2 None PVT PVT None None None 40 GGT, 21Jan2009, PVT 120;OTH GGT, 12Feb2009, Aspirin 268; Unknown HepatitisThe viralsubject test, Nov2008, was reportedly negative; A0771189A healthy Hepatitis with viral a history test, of 21Jan20 unspe White bloodOTH cell count,OTH Mar2007, low. Septra Diagnostic DS; Bump Sulpha; results: onIVIG the15 thigh, February Pseudomonas 2007: A culture A0771378A Infection was taken from the bump on UNK PVT OTH Unknown A0771383A 25 Ultrasound,PUB stool culture PUB 3/11/09-records received-US None demonstrated None intussusception and x-ray with air enema redu 1 None PVT PVT XOPENEX Wheezing Neb Tx Mastocytosis 0 None PVT PVT None None 2 nothing done PVT in our office UNK none none none 1 NA PVT OTH TYLENOL, None BENADRY,Allergy PRN to OMNICEF. Also has Dx allergies and eczema 1 None PVT PUB None None Develop Mental Delayment 1 PVT UNK None None 0 None OTH PVT Lisinopril 20None mg qd; AMBIEN High blood 10mg pressure; pHS Allergies - penicillin; Cephalosporins; 1 None PVT PUB None None None 0 None PVT PUB none none none 0 Monospot, negative; PVT CBC UNKw/differential None negative/normal None Allergies: Penicillin; KEFLEX; OMNICEF; AUGMENTIN 2 None PVT UNK Eczema Eczema; NKDA 0 none PUB UNK None None Heart Murmur UC; CXS PVT PVT Mild cold symptoms immune disorder; dev delays nec 3 12/29/08 Xray OTH (L) shoulder; OTH BloodTYLENOL work. MRI PM None (L) shoulder/arm Pr; Calcium; "D" (inVitamins; and "SELDANE" neck;GERITOL; hadora "CLARITIN-D" procedure Folic acid; to "deaden ASA makes 81mg; heart nerve" LIPITOR flutter); 0 PVT PVT HCL tabs PVT PVT No known drug allergies PVT OTH None 0 PVT PVT 0 PVT UNK None None 0 PVT PVT TYLENOL for fever 1 PVT PVT CLARITAN as neededSeasonal allergies 360 Unknown PVT PVT LIPITOR; NORITATE; Rosacea Lung PRILOSEC operation; Lung neoplasm WAES0902USA01641 malignant; Chickenpox 62 Unknown. Labs OTH and diagnostics: OTH 11/11/07None MRI T-spine None. WNL. PMH: MRI brain obesity. (+) for scoliosis. WAES0903USA00102 CSF attenuation folliculitis. in L mild cerebellopon SAR/RAR UNK OTH OTH Unknown A0769209A UNK OTH OTH Unknown A0768721A 4 UNK. Labs PVT and Diagnostics: PVT Abd The X-ray subject (+) for Unknown had dilated no concomitant bowel The loops. subject medications. BE had (+)no forconcomitant persistant A0767773A filling medications, defect. Abd relevant US c/w med I UNK PVT PUB Unknown Linked cases include A0770472A, A0770476A A0770473A, A077047A
UNK PVT PUB Unknown Linked cases include A0770473A, A0770472A A0770474A, A0770475 0 UNK PVT PUB Unknown Linked cases include A0770472A, A0770475A A0770473A, A0770474 0 UNK PVT PVT Unknown Linked cases include A0770472A; A0770474A A0770473A; A0770475 0 UNK PVT PUB Unknown Linked cases include A0770472A; A0770473A A0770474A; A0770475 12 The first GARDASIL UNK injection UNK was in OCT 2008, the 2nd None was in Dec. 2008. I have not received the third vaccination 48 Elevated protein PVT in CSF; PVT Demyelinating DEPAKOTE; pattern None LIPITOR; on NCS/EMG Migraines; LEXAPRO LABS: asthma; Allergic~Influenza EMG/NCS osteoarthritis; abnormal (no brand hyperlipidemia & c/wname)~1~23~Pati acute polyneurop PMH: IB 0 CBC; glucose; PVTLytes; LFT's; PVT Ca 2/12/09 PREVACID; normal None Polyvisol except KPrematurity 6.1; Cl 107;(30 Lytes weeks). normal Prolonged 2/13/09 (K hospitalization 5.6, Cl 106). for (K cons apne 4 Labs and Diagnostics: PUB PVT CXR (+). CT LIPITOR scan (+) and None forVESTRAL lung fibrosis/bilateral cholesterol. PMH: pneumonitis. HTN. Hyperlipidemia Cocci IgM (+), IgG (-). Mycopla 0 None OTH PUB None None None UNK UNK only allergy is VICODEN 1 none PVT PUB none none none 1 See attached PVT PVT None None 0 PUB UNK Autism OR200914 0 Mother withPUB similar Sx PUB beginning 48-72 None hoursNone before patient; Nonemother - per report received no OR200912 immunizaitons. 0 PUB UNK OR200913 3 OTH UNK None reported None reported 1 CBC, CMP PVT both normalUNK None Family ill prior None to patient given vaccine 0 none PVT UNK none none none MIL OTH None 1 UNK PUB None None None 1 PVT PVT None None Vertigo~Influenza (no brand name)~UN~32~In 11 None PVT PVT Unknown Unknown Unknown In Daughter Varicella~Varicella (no brand name 1 PVT PVT 1 None PVT PUB None None None 0 L. Leg venous PVTdoppler UNK lower extremity arterialAllergic dopplesRhinitis - ANCA Benignscreen, HTN, Hypelipidemia Sedrate Immuno Globulin A - proteinase -3 7 PUB PUB None None 75 echocardiogram UNK UNK none none none PMH: smoker. 14 TZANCK Prep: UNKpositivePUB for viropathic Duoneb, changes Cardizem No ofacute multinucleated CD, illness. seizures, Lasix, Boniva, giant COPD, cells.Herpes Synthroid, parkinsonism, zoster. Coumadin, osteoarthritis, Vitamin osteoporosi D, Protonix, 0 N/A PUB UNK Children's Motrin None None 1 PVT UNK 1. Albuterol, cold, twocoughHTN, puffs everyasthma, 4-6 hours HL, asSeasonal needed for rhinitis, wheezing. depression, 2. Bupropion degenera s 1 none MIL PUB no non 2 MIL MIL OCP (LEVLEN) NONE NONE 0 PVT PUB none otitis medianone 1 PUB PUB UNK UNK HCTZ 25 mg Nothing 1 qd; Atenelol acute 50 mg 1 qd; Simvastatin 40 mg qd 0 PUB PUB 0 PUB PUB Otitis media and URI UNK UNK None reported unknown 0 None PVT PUB None None History of reactive airway disease 0 PUB PUB None None 2 PVT PVT None None 0 UNK PVT fosamax, lipitor, none 81 mgosteopenia aspirin, calcium, multiviramin 0 None PUB PUB None No 2 MIL UNK 1 PVT OTH 636 CT scan w/o PVT contrast inPVT ER; EKG,None Labs in ER; None MRI headNone w/o and with contrast referred to Neurologist. Labs and D 1 PVT PUB none none none 3481 PVT PVT none well child check 0 None PVT PUB None None 16 Ultrasound,PVT negative; 2UNK MRIs; blood none work; spinal nonetap showed allergic elevated to penicillin. proteinPMH: level;Osteoarthritis. nerve conductivity Hip surgery. test. Labs Alle a 2 PVT PVT
0 PVT PVT 2 OTH PVT SYNTHROID, none 88 mcg NKA q day 20 UNK PUB Mild Asthma, hypertension 20 Serum beta-human, OTH negative OTH None Pregnancy NOS (LMP = 1/18/2009) WAES0902USA03994 29 urine beta-human, OTH 02/16/09, OTH negative; Albuterol serumPregnancy beta-human, NOS 01/26/09, (LMP Vaccine =16; Unknown); serum exposure WAES0902USA04266 beta-human, Asthma during;02/03/09, Cramp~HPV <5; beta-hu (Gardas 66 Diagnostic laboratory, OTH 01/??/09, OTH blood Unknown work: no leukemia; Unknown Diagnostic laboratory,WAES0903USA00062 09/??/08, positive for mononucleo 1 Unknown OTH OTH Lamictal Epilepsy 3/19/09-records received-PMH: WAES0903USA00104 Epilespy on Lamictal. 24 Unknown LABS: OTH EEG OTH abnormal. Unknown MRI WNL. Repeat LPUnknown done 10/3:PMH: wbc chronic 42(H),WAES0903USA00467 protein sinusitis, & glucose strep throat, (N), c/s IBS, neg. encop Ini 3 Unknown Labs OTH and diagnostics: OTH Abd PRILOSEC US (+) for ileocolicGastrooesophageal IS. Abd X-ray (+) for reflux; WAES0903USA00374 SBO.Omphalitis Air enema. (+) PMH: for IS. lingual WBCfrenu 18 1 LABS: coronary PVT angiogram PVT abnormal PMH: recent negative cardiac stress test, DM, hypercholes 0 EKG; CBC;PVT LMP; TSH PVT LABS: EKG None WNL. CBC, NoneTSH, CMP Bicuspid no results Aortic Valve available. 0 PVT UNK PPD C2805AA 3/2/6 (RATD) upper area 7 Unknown OTH PVT Unknown Unknown 1 PVT UNK AMOXICILLIN; Sinusitis ALBUTEROL Neb Solution; BUDESONIDE Inhalants 95 Influenza AMIL positive MIL 7 None PVT PVT None Mild head cold Mild eczema PVT PUB PVT PUB CBC; RF; CPK; PVT C3-C4;UNK ANA; ESR All normal; X-ray of spine Nonenormal 0 Diagnosed PVT by Dr. UNK KARIVA none none 1 EmergencyPVT room bloodPVT gas test & EKG 1 None known PUB PUB Allergy, morphine 0 Normal CBC. PVT T4 Potassium, PVT BMPTOPAMAX Negative mono Dizziness screen. Amblyopia, Mild intolerance Migraines, to tiltdizziness, table test.patellofemoral LABS: rapid strep syndrome neg. 5 PVT PVT none none congenital diaphragmatic hernia - surgery @ 2 days - fine 2 None PVT PVT Albuterol HFA Coughing, diarrhea obesity, hypertension, high cholesterol 0 PVT PVT 2 PVT PVT 0 PUB UNK 10 None PVT PVT ALBUTEROL 2/12 Q4O RSV PRN 0 Allergies, 29-30 wk gestation. 0 BP - 100/70; PVT Pulse 76 PVT None None None 1 PUB PVT None None None UNK UNK Surgical pathology UNK report UNK confirmed rubella antibodies None UNK UNK 0 PVT PUB OMNICEF Productive AMOXICILLIN cough, nasal drainage 0 PVT PVT BIAXIN; ROLEPHIN; Chronic serous AUGMENTIN Dacryostenosis; Otitis GERD; Sleep disturbance; Otitis Media; C 1 PVT PVT None None 1 PVT UNK None None 1 Strep screen PVT - results neg. PVT None None 2 PVT UNK BETOPTIE;None CELEBREX; PCN; CALCIUM; RA; Glaucoma; NEXIUM; Sarcoidosis MVI 1 PVT UNK None tetanus toxoid 1 PVT OTH 2 PUB PUB 1 PVT UNK NKDA 2 Followed upPVT at her homeOTHunknown Aspirin low None dose 81 mgLactose tablet enteric Intolerance coated 1 tablet by mouth; Calcium Citrate + 1 PUB PUB hx of asthma, uses no meds. Allergic to shell fish 1 None MIL MIL PrescriptionNone Claritin Dog Allergies 14 PVT UNK none none none skin rash/fever~Measles + Mumps + Rubella (M 0 UNK UNK non non ~Meningococcal (Menomune)~~0~In Patient 1 UNK UNK 2 none UNK PVT unknown None noted
1 PUB PVT None None PCN, Sulfa, Cipro, Iodine, Compazine, adhesives, fish 2 PVT PVT NONE SISTER~Meningococcal (Menactra)~1~11~In S 10 Doctor diagnosed PVT rashPUB as measlesn/a n/a n/a 2 UNK UNK NONE 0 No testing was UNKcompleted. UNK This was None a clinicalNone diagnosis Allergic by a Nurse to Sulfa Practitioner 18 N/A PUB PVT COZAR, PREDNISONE N/A HTN, (18 S/P MG/D), MI, ASA, TEMPORAL BETA BLOCKER ARTERITIS(WIFE UNABLE TO HIGH GLUCOSSA, UNK HIGH UNKCHOLESTEROL. NONE SHORT NONE RANGE MEMORY RECALL ( NOT TESTED PER PHYSICIA 3 3/4 CBC (0100) UNK WNL with UNKslightly Zithromax elevated neutro (previously Sinus@ infection 7.6,received No segs significant (receiving of 288, courses) lymphs PMH Zithromax) and PMH: of 12; unknown seasonal BMP WNL antihistamine allergies. beside glucose NICU with multip x elev 2w 1 N/A UNK UNK Migraine headaches none controlled on topamax 0 UNK PVT none unknown 0 none PVT PUB NONE NO NONE 1 rapid flu-negative PUB monospot PUB negative CBC none absence seizures no medications 13 None PVT UNK HTN; Diabetes; HTN;high DM;Cholesterol; High cholesterol; osteoporosis Osteoporosis 0 None PVT PUB None None None 1 None PVT OTH No No PVT PUB Given wrong age group vaccine 1 PVT UNK Cold rash on lg~DTaP + IPV + Hib (Pentacel)~2~0~I 0 None PVT PVT WELLBUTRIN None None 0 PVT PVT None None None 1 PVT PVT OMNICEF R Otitis Media None 8 None MIL MIL None None None 8 None MIL MIL BLP None None 0 None PUB PUB None None OTH UNK None None 0 None PUB PVT None None 12/01/2008 DX with pneumonia. TX with antibiotics 7 UNK UNK Advil None None 0 CBC:Hb13.0g% PUB Hct 38% UNK WBC13,400 Chlorpheniramine PMN68% L20% Eo10% Mo1% atypical lymphocyte 1% Plt. 301,000/mm3 20 Blood test done PVT checking PVTfor LimeNone Disease, Lupus, None PorvoNone Virus, and Rhumatoid Arthristis: all negative 0 OTH OTH None Allergy to PCN 0 ultrasound, OTH 02/08/08, posit; OTH beta-human chorionic, Pregnancy posit NOS (LMP = 9/29/2007) WAES0803USA03327 diagnostic laboratory, OTH fetus OTH had spinal Nonebifida Pregnancy NOS (LMP = Unknown) WAES0903USA00423 1 Physical examination, PVT 01/20/09, PVT see FOSAMAX; narrative;Osteopenia; NEXIUM; Physical examination, ZOCOR Gastrooesophageal 01/20/09,relux WAES0901USA03522 Neuromuscular disease; Dyslipidaemia examination, see n 1 Unknown PVT PUB Unknown Unknown WAES0812USA05084 Not reported UNK UNK Not reported ### 0 None LABS: PVT CBC, metabolic UNK panel, UA, CPKNone all WNL. None PMH: leg length discrepancy; tonsillar hypertrophy. 0 PUB PUB ORTHOCYCLEN None Febrile seizures as a child. TN09002 1 PUB PUB None None None TN09001 1 None PUB UNK 2/25/09 CRESTOR; No Received NKA; Hypercholesterolemia TB skin test left MI2009002 arm. 53 Influenza AMIL positive MIL 97 Influenza A,MIL positive MIL 0 PVT UNK Soreness shoulders/neck 0 Labs: CBC,PVT CMP, CRPPVT Advil 200mg NoPRN None 0 PVT PVT CLARITIN; None IBUPROFEN Obesity; Environmental allergies 0 None PUB OTH None None None 0 None PUB OTH None None Allergic :PCN Syncope~HPV "hives" per mom (no brand name)~1~11~In Siblin 2 EEG 1/29/09 PVT (-) UNK TYLENOL; None PRN for fever 1 PVT UNK No None 1 none done PUB at clinic PUB Took SINGULAIR 2/19/09 allergic, in AM dust for mites; sinus congestion dogs, TN09003 no medical conditions per mom 3773 PVT UNK 0 WBC 24.6 with UNK78% neutrophils UNK and Plavix, 7% bands, Zocor, chest temp Levothroid, pain 101.7, with Allergies: Lexapro, abnormal BP 98/50. erythromycin Aspirin, stress Labs: test WBCs multivitamin, (rash) 24.6K-78% Intolerance: Wellbutrin, neutrophils, codeine Prempro, (nause 7%By ba 1 PUB PUB none none SC0909
0 PUB PUB Synthroid 100 Other mcg family daily, PCN members client Recent reported have newbeen hot DX flashes Hypothyroidism MO-2009-04 ill with with GI (vomiting/diarrhea) RX 48 hou 0 Positive Urine UNK HCG UNK n/a Pt was pregnant 1 PUB PUB no no MO-2009-05 2 PUB PUB MO-2009-06 1 patient will be PVT seen by PVT neurology and albuterol have nebulizer anpatient eeg inwas solution thege near seen reflux pulmicort future by treated dr wheeler nebulizer with(pulmonologist) prevacid solution plastic zithromax on bronchitis 2/19/09 prophalaxis no 1/09 current previ pre 0 PUB UNK None None Aortic Stenosis and allergy to milk products 1 PUB PUB NONE NONE NKDA, NONE 0 UNK PUB 1 None PUB PVT Synthroid 10 Sinusitismcg QD, onSulfa HCTZ day allergy, 525 of mg treatment Hypothryoidism, QD, Centrum with Augmentin 1 tab HTN, QD,hearing Calcium impaired supplemen 8 PVT PVT none no no vomitting, irratibility~Rotavirus (Rotarix)~1~0~In 1 PVT PUB None None None 1 PUB PUB NONE NONE NONE 3 UNK PVT Elmiron fibromyalgia, fibromyalgia, intersticial cystitis, IBS. interstitial IBS cystitis 0 Concurrent PUB with Viral Syndrome PUB Astham, Viral Asthma Syndrome 7 None PVT PVT None None None 33 Suggested PVT he be seenPVT by a neurologist None None None inflammed blood vessels~DTaP (Daptacel)~2~ 1 None MIL MIL None None None None DonePVT PVT None 1 None PVT PUB Tinea corporis None 0 Did blood work PUBup 5 significant OTH findings. None Everysick test3-4 returned days None before as normal. got fluEKG shot.done. Bronchitis like symptoms/ cough/no 0 none writer OTH aware of. UNK none NKA nor any pre- existing conditions 3 PUB PUB None 3 PUB PUB PUB PUB 1 Pending food PVT RAST panel. PUB Unknown Unknown None 0 PVT PVT None Serous otitis Milk leftallergy ear. None PVT UNK elevated temp None 2 UNK PVT None None 1 None PVT UNK None None 0 None PVT PVT None 1 PVT PUB TYLENOL 2 PVT PVT None No None 12 None PVT PUB None R otitis media Vesico-ureteral reflux 3 None PVT PVT ARICEPT, 10 Nomg; BENADRYL, No 25 mg; FOSAMAX, 70 mg; Hydrochlorothiazid None OTH PVT 1 None donePUB PVT Singular; Levothyroxine; none Asthma albuterol Measal rash after receipt of MMR~Measles + M 10 None PVT PVT None None None 0 None PVT PVT None None None 2 PVT PUB none none 0 None PVT PVT Finger laceration 0 Negative, flu PVT PVT CELEBREX; LOTREL;HTN; LIPITOR High cholesterol 14 Lumbar puncture(s), UNK CT UNK scan(s), MRI(s) 3/25/09-records none none received3/16/09-records EEG demonstrated received-Similar epileptiform episodes activityoccurred in right f Unknown OTH OTH Unknown Unknown WAES0903USA00787 Unknown OTH OTH Unknown Unknown WAES0903USA00750 4 None OTH OTH aspirin; CARDIZEM Hypertension; CD; COZAAR; cholesterol simvastatin WAES0903USA00745 15 ESR 72 mm/hr. PVT Labs and PUB Diagnostics: None UA WNL. upper UC respiratory (-). None CK 70. PMH: infection. CRP none. 0.16. URIAlk at Phos time of 240. vaccinations Total protein 9.0. Albumi MRI; EEG;PVT Heart monitor; PUB BloodNone work.5/18/09 5/18/09 None medical hospitalAsthma records recordsreceived receivedDOS DOS12/1/08 3/5/09 to 4/8/09. 3/6/09. benzaclin, LABS and albute DIAGN 0 BP 130/80; UNK pulse 70 LABS: UNK CBC, TSH & cardiac enzymes Do WNL. not have Potassium this information 3.3(L), calcium PMH:hypothyroidism, 8.4(L), BUN 25(H). anxiety 0 none PUB PUB unknown none none None PUB PUB None None None 22 Labs: CBC PVT WNL. Chem UNK WNL. Drug LEXAPRO; screen (-).NEXIUM PMH: Tourrette's syndrome. GERD. Depression. Allergy
0 PVT PVT 2 Neg PVT PVT No GERD 0 PUB PUB None same~DTaP + HepB + IPV (Pediarix)~2~1~In P 1 PVT PVT CHANTIX; ASA; None Folic Acid; Hyperlipidemia; MELOXICAM; Sinusitis; TRICOR; fatigue; METHOTREXATE RA; onychomycosis 1 Received Iontophoresis OTH PVT on 3-4-09;HCTZ; GivenZOCOR; By Occupational NoneFEMARA; Breast Therapist Lisinopril; Cancer SYNTHROID survivor 0 OTH PVT No OTH OTH 19 Physician told OTH ice compresses PVT 33 UNK UNK 0 UNK UNK Allergies; PCN, Sulfa, Codeine Motrin, Compazine. Can ta 8 PVT PVT SINGULAIR; ADVAIR; Asthma; ZEBETA;ZOFRAN BCP allergy 2 PVT PVT EMBREL; METHOTREXATE; FEMCON 1 PVT PVT 1 None PUB PUB None None None 4 MIL MIL NYSTATIN;Diaper Zinc oxide rash 0 OTH PVT None No No 31 None PVT PVT None Diabetic 0 None PVT PVT None None None 0 PVT PVT DMII, HTN, COPD, DYSPNEA, ANEMIA, LE VARIX, LE E 5 None PVT PVT None Codeine / Flexeril 1 PVT UNK No No UNK OTH OTH Blood clot inFibula eye; fracture; Eyelid disorder; Fractured A0600639A Pressure finger; in Motor groin. vehicle accident; UNK OTH OTH Bilateral Hearing Ankle Loss; fracture; Carpal Carpal Tunnel Tunnel A0600143A Syndrome; Syndrome; Chronic The subject Rhinitis;unde De 1 Two MRIs of UNK the brain UNK - Visual field None test - EEG None - follow-up None with Neurologist PMH: condyloma, scheduled actinic 26keratosis, March. LABS: hyperlipidemia, WBC 21.6 0 PVT UNK none none none same~Hep A (no brand name)~1~9~In Patient 0 UNK UNK hypo thyroidhypothyroid, and client states allergy to eggs. 0 NONE PUB UNK NONE NONE PR-09-04 0 PVT PUB none none none 0 PUB PVT none unknown 0 UNK PUB passed out~HPV (Gardasil)~NULL~~In Patient -8 Currently being UNKtreatedUNK by Dr. at our family physician's none 4/1/09-records office. none 4/1/09-records received-Began none~ ()~~0~Patient|none~ received-Allergies:amoxicillin. 2 months ago()~~0~Sibling|none followed by cough 2 PVT PVT NONE NONE NONE 1 Patient hadUNK an EEG and UNK CT scan None all results were Nonenormal.None 3/16/09-records received-EEG normal. 1 NA UNK UNK 148 UNK UNK COPD 232 UNK UNK COPD PMH: COPD, HTN, CAD, MI, palpitations, stroke, coronary PVT UNK None None 38 20-Feb-09: UNK WBC 10,700; UNK Granulocytes/100 Not knownWBC Not known 26.8 (Low); Not known. Lymphocytes/100 PMH: noneWBC 60.8 (High); Monocytes/100 0 UNK UNK None 0 PVT PUB 10 none PUB PUB none 0 None UNK UNK Ibuprofen none knownnone known 0 none needed PVT PVT none None--stepped noneon nail the day before, which preempted the vaccine. 28 None PUB PUB None None known 0 PVT PUB 0 PVT PVT INFANTS TYLENOL SEIZURE~DTP (no brand name)~1~0~In Siblin 12 PVT PVT Multi Vitamin None None 0 PVT PVT Trivasol infant no vitaminsno red hive-like rash~ ()~1~0~In Patient 1 PVT MIL None 1 None PVT PVT None None None 1 PUB PUB None Breast Ca (R) 16 yrs ago, DEMEROL allergy
1 CBC, normal; PVT pt advised UNK no pertussis in future 1 OTH PVT None Known Pt allergic to Bovine Serum 1 PVT PUB None None None 7 Ultrasound PUB - Slightly hypoechoic OTH region VALTREX apparently prn None withinNone deltoid 14 PVT PVT Varicella~Varicella (Varivax)~1~16~In Patient 1 PVT PVT LIPITOR; PREMARIN; Cough Osteoarthritis; EVISLA; TUMS; Pure Aspirin; hypercholesterolem Multivitamin; Fish oil; RESTASIS Unknown OTH OTH Unknown Unknown WAES0903USA00963 0 Unknown OTH OTH Unknown Unknown WAES0903USA00563 Unknown OTH OTH Unknown Unknown WAES0903USA00757 Unknown OTH OTH Unknown Drug hypersensitivity WAES0903USA00933 5 Computed axial, OTH 03/30/08, OTHnormal;Unknown Diagnostic laboratory,Unknown. 03/30/08,7/31/09 normal;Neurology Electrocardiogram, WAES0903USA00740 consultantnormal; recordsMagnetic receivedre UNK PUB OTH Unknown Linked cases include A0772419A A0772416Aand A0772420A. Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH08449409 was not provided. 0 On 11 December PVT 2008OTH the patient went to the neurologistNot who reported. ordered a cervical MRI ### (Magnetic resonance imagin 0 MRI's MIL OTH PREMARINNone 0.625 None swollen arm~Typhoid Vi Polysaccharide (no br 2 None PVT PVT None Asthma 1 PUB OTH No illness; 3/6/09 normal vag delivery 2 PUB PUB 81 mg ASA;None Vitamins; Cholesterol B12; CINACOR 6 COMPLETEMIL BLOOD COUNTS: MIL 2/18/09: None WBC NONE 4.0, HGB/HCT REPORTED ALLERGIES: 14.1/41.6, +SULFA PLT 191k; (HIVES), 3/6/09: NOWBC BIRTH/CONGENTIAL 3.9, HGB/HCT 13 0 none PVT PUB none none no known allergies; Hx, heart murmur; cleft lip; cleft 356 Tested for Influenza PVT & PVT Strep throat in office - all healthy negative. 0 Did strep which PVT was Negative; PUB CBC; No MP; urine No& mono Allergy to milk & soy 1828 None PVT PVT ZANTAC gerd Parent severe fever~DTaP (no brand name)~1 1 PVT PVT 1 PVT PVT Pulmacort No Asthma / RAD PVT UNK PVT PUB MOTRIN 10 None PUB UNK Cellulitis None 0 None PUB OTH ZANTAC No GERD - on meds (ZANTAC) 0 PVT UNK RespiratoryNone Infection 0 None PVT PVT QVAR; PROAIR None Asthma allergic rhinitis 0 None OTH PVT Enlarged heart; S/P Angioplasty 2 yrs ago; High Choleste 0 None UNK PUB Suprax (R) OM NONE 1 None PVT PUB None None None 0 PVT PUB None No None NC09010 0 PUB PUB Interferon and HepRIBASPHERE C being Hep Tx C illness NC09011 0 CAT Scan; OTH blood urineMIL test BP medication; NoneHCTZ 25m Allergy, morphine; hypertension 9 None PVT PUB Bronchiolitis 4 PVT UNK Singulair; Loratidine; None Miralax; AsthmaProair; spots~Varicella Albuterol neb. (no brand name)~2~7~In Patie 4 PVT UNK TOPAMAX;None MIRALAX Med dx- epilepsy Sister spots~Varicella (no brand name)~2~7~In 10 OTH PVT Diabetes; Hypertension; Thyroid disorder 0 PVT PVT ZANTAC None Failure to thrive PVT UNK No No PUB PUB None Acne 1 OTH PVT Penicillin; sulfonamide; NEOSPORIN (topical) 2 None PVT UNK None None PUB OTH None 1 None PVT PVT HCTZ; TOPROL; None Naproxen; Allergies, PREVACID; Hydrocodone; CENTUM Cervical SILVER radiculopathy; tabs; Vitamin Neck C;pain Zinc 0 None OTH OTH None None None 0 PVT PVT Rash on abd, None not listed new per provider; born by C- Section d/t placental a 7 UNK UNK None None
1 none PVT PVT none none none 91 calcium ionized, UNK CPK, UNK total, gammaglobulin, none lyme nonedisease none AB,3/19/09-records Tissue transglutamin, received-environmental Gliadin Antibody, 25-OH allergies. Vitam NOT SEN IN UNK DOSTORS UNK OFFICE NOR ED, SUPPORTIVE 0 PUB UNK 1 CT scan of PUB head negative, PUBdiastolic none blood pressure none = 40 asthma mmHg. 1 n/a MIL MIL n/a n/a n/a 12 PUB UNK zoloft, diovan, albuterol, norvasc, protonik, allopurinol ND-09-02 1 UNK PVT 12 None PVT PVT No HTN, hypothyroid 4 UNK UNK none none none none~ ()~~0~Patient 1 UNK UNK NONE NONE 19 Barium enema UNK- negative UNK for intussusception None None 3/31/09-records Nonereceived-Barium enema demonstrated retained feces 0 UNK UNK none no no 0 none PVT PUB 2 PVT UNK none none h/o Right inguinal none~ abscess ()~NULL~~In 2/09 Patient 0 NONE UNK UNK 139 4/2/09-records UNKreceived-Unremarkable UNK no CMP, no normal white nocount, low hemoglobin 10.5, unremarkable differential. B 0 NONE MIL MIL NONE NONE NONE PVT UNK OTH OTH None 0 PVT PUB PUB PVT 26 3/18/09-records PVT receivedPVTMRI of head negative. UTI,Spinal culture, tap Penicillin; negative showing LORTAB 3/18/09-records elevated3/18/09-records leukocytes, received-Right mostly received-Allergic lymphocytes inner ear infecti to butPe a 8 Referred toPVT neurologist:PVT MRI & EEG PEPCID video completed No @ GER medical 3/23/09-records center 3/23/09-records received-PMH:hypoxic received- Brain episode scan norm at bi 0 Labs: CBC PUB WNL. BS 126. UNKECG WNL. No None PMH: GERD. MIL OTH none no allergies; no medical conditions 1 none PVT PVT none none none 18 PVT PUB Occasional cough 8 None donePVT PVT None None UNK UNK ### of a cluster. A child (exact age not reported) UNK experienced UNK itching and redness at the injection site after receiving ### an intramuscular injection of a cluster. A child (exact age not reported) UNK experienced UNK itching and redness at the injection site after receiving ### an intramuscular injection 0 Not reported PVT UNK Not reported ### 1 PVT PVT No known allergies. No medical ###history, no concomitant m 1 None PVT UNK No known allergies or past medical ### history. 0 None PVT UNK The patient had no concurrent### illness, no concomitant med UNK UNK ### 1 PUB OTH VITEX No medical conditions. Allergic ### to : gluten, DIMOTIL, HYC None PVT UNK The patient had a history of neurogenic ### bladder, reflux, an 5 Pregnancy UNK Test: positive UNK The patient's medical and obstetric ### history were unknown 31 Workup in progress UNK UNK The following were reported to### be unknown: concomitant 55 None UNK UNK DIFFERIN The patient had a history of acne, ### bronchitis, and pneumon 0 Chest radiography, UNK numerous UNK laboratory testing No including other illness None. CBC, atPMH: the ESR. time. None~ tachycardia. Labs: Information ()~~0~Patient|None~ WBCsIntersticial 20K. regarding Bicrbcystitis. 19. manufacturer, ()~~0~Sibling|Non Phosphorus Smoker lot0.9 nu 2 Ultrasound;OTH ComputedOTH axial; Magnetic FOSAMAX; resonance; Contrast LASIX; Electrocardiogram media Potassium Varicose allergy vein; (unspecified) Spinal fracture WAES0903USA01427 Unknown OTH OTH Unknown Unknown WAES0903USA00564 0 RespiratoryOTH rate, 01/19/09, OTH 14; Total Albuterol heartbeat Asthma count, 01/19/09, 90 WAES0903USA00934 0 Hearing test, OTH fine; Diagnostic OTH laboratory, None vision test was fine; NoneDiagnostic laboratory, WAES0903USA00921 seizure test was fine 6 PVT PVT None notedNone notedTreated for ear infection 12/23/08 amoxicillin x 10 days. 12 Blood Panel/other OTH Blood PVT tests: TSH/Vit. LEVOTHYROXIN B-12/Vit. NoneD; 75mg Brain allergy: Scan/MRI; 1Xd; penicillin/med. SIMVASTATIN Physical Exam.; condition: 20mg Lung 1Xdmitral X-ray; valve (Sedimentation prolapse; hypB 3589 OTH OTH Unknown Unknown 2 PVT PVT
0 None
OTH PVT MIL MIL 1 None PVT OTH None None None OTH OTH 4 PUB PUB ALEVE qd -None has taken None for approximately 2 wks. 0 Rast to Eggs PVT (negative)PVT FLUORIDENone 0.25 mg daily None Hives~Influenza (no brand name)~4~2~In Patie 11 PVT OTH No No No 1 None PUB PUB None 0 None PVT PVT None None None 793 PVT OTH 4235 OTH UNK 9 PVT PVT None None None 0 PUB UNK None None 2 PVT UNK None No 0 PVT PVT None 1 none PUB PUB asthma, allergic rhinitis 1 As per attending UNK physcian UNKat hospital: PPD HEAD PLANTED CAME CT SCAN ON INRIGHT FOR -NORMAL; WELL PHYSICAL FOREARM. CHILD. MRIPMH: EXAM. - NORMAL MANUFACTUERnone Labs andSANOFI Diagnostics: PASTEUR; EEG aL 2 PUB PUB None Known NO illness None known NO ADVERSE UNKEVENTUNK COUGH AND NKA CHEST CONGESTION 0 CXR- NEGATIVE UNK UNK None Bronchitis and None Asthma known. No food allergies known. 2 None UNK PVT MultivitaminNone known. Allergy to Darvocet. No other medical conditions. 0 none PUB PVT none denies denies 0 N/A PUB PUB None None None N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In 0 absent DTR's UNK progressing UNKmuscle weakness and Nonefatigue.Guillain Labs and Barre. Diagnostics: PMH: GBS LDH (?).(L) knee at 191. surgery CBC unremarkab 0 Optometry Evaluation/Referal MIL MIL None None 0 UNK PVT None None PVT PVT Synthroid, Prilosec, Wellbutrin, Asthma, Deplin, chronic Singulair, sinusitis, anemia, Paxil, Tofranial depression, hypothyroid 3 UNK PVT None Allergic to Pennicilin 8 LABS: US abdomen UNK x UNK 2 (+) IS. Stool OB (-). mild BE unsuccessful. diarrhea None for 2 days NO ADVERSE PVTEVENTPUB WELL CHILD NKA VISIT NONE GIVEN 14 CBC, SED UNK RATE, PT AND UNK PTT - OF SIGNIFICANCE UPPER RESPIRATORY WAS A PLATELET INFECTION COUNT OF 6,000. LABS: plt ct 6K. 1 PUB PUB 19 Examination UNK by physician UNK on 3/5/09. None Chronic bronchitis 0 3/18/09-records UNK receivedUNKBUN/creat ratio increased COUGH28.0. 3/18/09-records 3/18/09-records received-Mild received-PMH:abdominal upper respiratory pain, symptoms H. pylori,al 1 PVT PVT Suture's needed for cut hand 30 Labs: Fasting PVTglucosePUB 247. UA (+) None for glucose None andnotedNone. mod ketones. PMH: Hgbacne. A1C 11.1%. 1 Hosp notesPVT enclosed. UNK 5/26/09 medical records None received Acne - multiple ED visits DOS 11/5/08 to 11/28/08. LABS and D 1 CBC -> 9.3,PVT 33.4 < 371; PUB ESR, 15; CRP, 24.4 No hx of febrile SZPMH: 4/8/09-records received- febrile seizu 1 None PVT PUB None None None 0 PVT PVT None Hyperlipidemia; Gerd; Menopausal syndrome; Obesity; Co 10 PVT PUB None None PVT PVT ASA; LORATADINE; None TYLENOL Obesity; HTN; Hyperlipidemia; Hypothyroid; Tetracycline 1 None PVT PUB None Eczema Recent ring worm 3/05/2009 2 None PVT PVT None None None 1 PVT PUB None developed viral illness 2 days later 2 None PVT PVT None None 7 PVT PUB 1 None 3/17/09-records PVT UNK received- EKG normal.None None 0 PVT PVT None 0 PVT PUB 1 PVT PVT None None Exercise induced asthma; allergies (seasonal)
2 PVT UNK 1 UNK UNK 3 09 Mar 2009; UNK Sodium WHOLE UNK BLOOD, None VENOUS, None 141 mmol/L; None Potassium WHOLE BLOOD, VENOUS, 4.3 mmol/L 0 PVT PVT Metoprolol; None Lisinopril; EVISTA Allergy -Iodine - alcohol 0 None PUB PVT None 0 Done on 3/11/09, PVT CBC,UNK CRP, IgE None - pending None None 2 UNK PVT NONE 1 PUB PUB 0 PVT PVT None Diabetes mellitus 1 PVT PUB None - wellNone child PVT PVT None None 1 nl CBC; abnl PVT urinalysisPVT Estrostep None None Unknown OTH OTH Unknown Unknown WAES0903USA00835 10 None OTH OTH Unknown None WAES0712USA08457 OTH OTH Unknown WAES0801USA05057 Unknown OTH OTH Unknown Unknown WAES0801USA01143 Not reported UNK UNK Not reported ### 38 None reported PVT OTH PRILOSEC No known allergies and no reported ### illness at the time of v 0 None PVT UNK BICILLIN The patient had a history of mitral ### valve prolapse. Concom 0 Lab work was OTH completed, OTH no further details provided. not reported ### 0 PVT OTH Penicillin allergy. No medical ### conditions, no concomitant d 0 None PVT PVT Premature baby: Hyperbilirubinaemia; WAES0712USA08565 Fever; Injection site 0 None OTH OTH None WAES0712USA04824 2 Diagnostic laboratory, OTH blood OTH work;Unknown chest X-ray; Drug urinalysis hypersensitivity WAES0712USA08834 2 WBC count,OTH 12/12/07, OTH elevated; Erythrocyte, Unknown 12/12/07, elevated; Unknown Serum immunoglobulin WAES0712USA09091 M, 12/12/07, negative fo Serum Hib OTH PRP antibody, OTH.96 Unknown Ear infection; Nasal congestion WAES0801USA00319 Unknown OTH OTH Unknown Unknown WAES0801USA00333 0 Unknown PVT PVT Unknown Unknown WAES0801USA00950 6 Unknown PVT PVT Peanut allergy WAES0801USA01636 0 Unknown OTH OTH AUGMENTIN Cold; Ear infection Unknown WAES0801USA02463 1 Body temp,OTH 01/27/2008, OTH 102F None None WAES0801USA05671 0 None OTH OTH None None WAES0801USA05750 1 Ultrasound,PVT 11/??/07, no PUB results reported; X-ray, 11/??/07, Unknown no results reported;WAES0801USA05767 Body temp, 11/17?/07, 104.7F. 314 Unknown OTH OTH Unknown Unknown WAES0802USA04639 Unknown OTH OTH Unknown Enterovirus infection WAES0802USA05318 0 None OTH OTH None None WAES0803USA01282 OTH OTH Unknown WAES0804USA01172 0 OTH OTH Unknown WAES0804USA01932 53 Monocyte count, PVT 03/05/08, OTH17%; WBC TYLENOL; count,Gastrooesophageal ZANTAC 03/05/08, Congenital 5.7 K/uL;reflux Body genital disease temp, malformation 03/05/08, WAES0804USA05095 female; 102.9; Body Stenosis temp, of03/05 nasol 0 None OTH OTH Murmur functional WAES0805USA00195 -46 body temp 03/17/08 OTH 98.7; OTHbody temp 03/10/08 Pregnancy 99 ; bodyNOS temp(LMP 01/04/08 = Unknown); 97.7 WAES0806USA02567 Drug hypersensitivity 7 Renal ultrasound, PVT 06/05/08, OTH follow up renal ultrasound; Ear infection; Nasopharyngeal Respiratory Nasal congestion. syncytial RSV,virus WAES0808USA04750 04/22/08, infection; posit;Hospitalisation; Body temp, 04/22/0 Weig 23 Unknown OTH OTH Unknown Plagiocephaly; Upper Cadidiasis respiratory tract WAES0809USA01524 infection; Constipation. 41 Unknown OTH OTH Unknown WAES0809USA03003 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0809USA04523 51 Unknown PVT OTH Nasal congestion; Constipation WAES0811USA00853 1 None OTH OTH Protein allergy Premature birth WAES0811USA02934 14 None OTH OTH PREVNAR Jaundice; Group B betahaemolytic WAES0812USA02271 streptococcal , positive OTH OTH BERNA20080106 OTH OTH BERNA20080226 1 UNK PVT OTH No concurrent Unknown medication The subject has no relevant A0772597A medical history. It was indicate
9 PVT UNK None None None 17 LABS: ESRUNK 48(H), CRP UNK 2.1(H), ANA 6/9/09 1:320 Medical homogeneous None records6/9/09 recieved pattern, Medical DOS RF neg, records 12/21/07 DS-DNA recieved to 2/26/09. neg.DOS Serum Synthroid, 12/21/07 proteinto Flexeril, electropho 2/26/09. V None PUB OTH None per MOC None per MOC 8 2-5-09 HEPPVT B S Ag - NR, PVTHEP B SNone Ab <5 nonNo immune &No HEP B core Ab - NR 1 None OTH PVT None 1 PVT UNK None None 1 PVT UNK None Cat scratchNone of eye 30 None OTH OTH Unknown Parkinson'sCataract; disease; Anaemia Hypertension; WAES0903USA00952 Gastrooesophageal reflux disease 0 hematology,OTH blood work OTH vitamins (unspecified) Pregnancy NOS (LMP = 12/6/2007) WAES0802USA00806 0 urine beta-human, OTH 04/17/08, OTH positInsulin Pregnancy NOS (LMP = 12/7/2007); WAES0804USA04091 Type 1 diabetes mellitus; Sulfona 145 Not reported OTH OTH None ### 1 NONE PVT PVT NONE NONE NONE 1 MIL MIL NONE NONE 1 PUB PUB 0 None PUB PUB None No Congenital cleft lip and palate 0 PUB PUB NONE NO NONE 0 NONE PVT PUB NONE NONE 161 VIRAL CULTURE PVT PENDING PUB NONE NONE NONE 7 PUB PVT None None known 1 NONE PUB PUB NONE NO NONE 0 Evaluated by PVT Pediatrician, PVTreferredYaz-oral to and evaluated conceptive None by dermatologist. Migraines;Tonsillar hypertrophy 1 Blood work UNK done and showed UNK that I had a lowWBC. none what I hadso none been evertotally healthy before I was asked o take the flu sho 1 UNK UNK 2 UNK PVT None noted 0 NONE PUB PUB NONE NONE NONE 1 PVT PVT ventolin inhaler None Allergy to aleve and contact solution preservative. tching during fever. Child was difficult PVT to keep awake UNK for 2 days. Significantly None decreased None appetite for 1 month. 1 LABS: WBCPVT 12/3(H), H/H PUB11.3/33.3(L), ZANTAC plts 635(H), None UA WNL, GERDBMP WNL, RSV neg. 0 PVT UNK None 1 None PVT PUB None None None 367 OTH UNK NKA None OTH PVT 442 PUB UNK 1 None PUB PUB None None None 2 None PUB PVT None None None 12 -> None yetPVT pt. to seekPVT medical evaluation ibuprofen3/13/09 1 None PVT UNK None None None 0 None PUB PUB No None Similar situation with 1st doses of same vaccina 1 None PVT PUB None None None 2 PVT PVT 0 No wheezing. PVTPeak flow PVT 400. PVT PUB OTC; Vitamin None C None 1 PUB OTH None None None 0 PVT PVT Heart Murmur 1 PUB UNK Ortho Tricyclen No Allergy to pertussis crying, red~Pertussis vaccine - Born(no w/out brand spleen name)~UN~0~ 0 None PVT UNK No Mild thoracic back pain 1 None PUB PUB None None PVT UNK No No 0 PUB PUB None Mother states 04/10/2008~Varicella fish & peanut allergies (Varivax)~2~3~Patient 10 MIL MIL NONE NONE NONE 0 none PVT PVT given tylenol none or Motrin penicillin, in anticipation possible of shot animal dander
24 Labs and Diagnostics: UNK UNK Head CT (+) for paranasal none sinus mucosal none. PMH: disease, Asthma. otherwise Trigger WNL. finger EEG release WNL-except symm 1 HSV PCR (-) UNK Right temporal-occipital UNK T2 flair on MRI LABS: PMH: Pap HA,smear TMJ, c/w factor HGSIL. V Leiden Vagdeficiency, c/s (+)candida. GERD, Abdomin asthma 15 On hospitalUNK admission UNK MRI of the Levoxyl T-Spine 50mcg, revealed NoneVitamin abnormality Hypothyroidism D 1000 from IU,T5 Tamadol to (controlled), T10 50mg consistent Obesity, PRN,with Bactrim Vitamin myelitis DS, Dbut Zyrtec Deficiency not diag 10m 0 labs and Diagnostics: UNK UNK Pneumocardiogram (+)none for mild GER. nonepH probe (+). blood and urine cx (-). head CT (-). EEG 33 pityriasis PVT PVT genertic yaznone (birth control none pills) 1 UNK PVT unsure None inactive rhuematoid arthritis, hblood pressure 1 PVT UNK None Seasonal allergies; Eczema Not reported UNK UNK The patient had a history of penicillin ### allergy. 0 chest x-ray,PVT 12/15/08, No PVTacute cardiopulmonary ECOTRIN; Diverticulitis TENORMIN; processMalaria identified; LANOXIN;absolute ZOCOR;neutrophil, WAES0812USA03381 COUMADIN 12/15/08, 13% low; lymph 0 Unknown PUB PUB Unknown Asthma WAES0903USA00854 Unknown OTH OTH Unknown Unknown WAES0903USA01644 17 1/15/09 LABS: PVTabdominal PUBx-ray neg. ZANTAC US abdomen forNone GERD (+)2IS. None; Air contrast except GERD barium2enema PMH: unsuccessful. RSV bronchiolitis None PUB PUB None RH Baby per mom's report 3 None PVT PVT None None None PUB PUB 13 PUB PUB took EXCEDRINE Hyperlipidaemia migraine PCN,@ SULFA Doctors prior to NC09012 onset 5 None PVT PUB None urticarial lesions None 5 days later 0 PVT PUB None 0 ER diagnostics PVTwill follow. PVT In office: None pulse ox=98; NoneBP = 110/70; None and blood glucose = 103 3 PUB PUB 1 PVT PVT Poly Vi Vitamins Slight nasalChronic congestion rhinitis T99.2 2 PUB PUB None None None 1 None PVT PUB None Healthy None 7 CBC, WNL;PVT CPK, WNL; PVT ESR, 21; None CRP, 2.86 None None 355 UNK UNK None UNK UNK 0 UNK UNK 0 PUB UNK None None None 0 None PVT UNK None None None 0 PVT UNK none None transposition hives~ of great ()~UN~0~Patient vessels; ASD; VSD; previous rxn to i 501 PVT PVT Congestion, cough, fever PVT PVT 1 PVT UNK None High blood pressure, Diabetes, seasonal allergies 0 CBC, Metabolic PVT panel done PVT prior to Singular injection 10mg; 3/9/09. NoneSimvastatin Borderline 20mg;Thyroid; CaltrateOsteopenia; with / D; VIT.D No known 400 IU;allergies VITC 500MG; to me MIL MIL 2 labs and Diagnostics: UNK UNK CBC with WBCs None 26K. Stool None hemeIn (+). utero KUB HIV(+) exposure for bowel - patient dilitationc/w on AZT SBO. for 6US weeks (+) for and IS.ha 9 PVT PUB no no no 0 PUB PUB MO-2009-07 8 none knownPUB PUB none no none 1642 none PVT UNK unknown unknown unknown 0 none UNK UNK Singulair prn none none 3 PUB PUB Unknown None per screening None known questionnaire 6 None UNK UNK Fluoxetine None Allergy to Sulfa 9 MIL MIL None 9 MIL MIL None 1 PUB UNK None None Allergic Rhinitis 2 PVT PVT Effexor XR-75mg, Gastritis/GERD Protonix Shellfish, 40mgIodine 1 None PUB PUB Atenolol, Lisonopril, None and Hypertension, Lipitor, Aspirin hypercholesterolemia 11. AdversePVT event onset: PVT unknown when pain and numbness Unknown began 7 PUB UNK UNKNOWNNONE UNKNOWN 1 PVT PVT Eucerin (topical) None Mild eczema
0 N/A UNK UNK FLONASE, NONE AZMACORT, ASTHMA PATADAY, RELATED CLARITIN,PRILOSEC, TO SEASONAL ALLERGIES IBUPROFEN FOR P 1 None PVT UNK 1 PUB PUB None 7 CBC; CMP;OTH throat CX, OTH neg ORTHOTRICYCLEN none LO NKDA; no birth defects; or medical conditions 0 PVT PVT none none 0 PUB PUB mild cough allergic sneeze to before Beesinjections per mother 1 No vaccinesPUB and URI- PUB ear and throat virus circulating in our asthma; community. uses rescue Our M.inhaler D. local only health office also notified. 2 None Ordered PUB OTH NKDA 0 PUB PUB None None 0 CBC; CMP;PUB UA PUB None None heart murmur 3 PVT PVT None 0 None PVT OTH None None None 2467 OTH OTH PVT UNK LOESTRINNo FE; Steroids Allergy, latex, Betadine. PMH: Allergies: Betadine, latex. 0 none PVT UNK no GERD 2 None PVT PUB Allergic reaction None 0 PVT PUB Egg and milk allergy; Asthma 14 CT - Head negative. PVT Labs PVTand Diagnostics: ZOLOFT; ATIVAN Head CT WNL. Hyperlipidemia, MRI head WNL. G.A.D.; Panic Disorder. PMH: hyperlipide 8 none PVT PVT Was on amoxicillin Upper resp, at time none illness/cough of reaction 2 PVT PUB 1 PVT PVT None None None 92 Positive, ANA PVT UNK None 0 None PUB OTH None None None Unknown OTH OTH Unknown Unknown WAES0902USA04090 Unknown OTH OTH Unknown Unknown WAES0902USA03978 0 Unknown OTH OTH Unknown Unknown WAES0902USA03082 0 Unknown OTH OTH Unknown Unknown WAES0902USA02902 199 stool rotavirus OTH antigen OTH 08/06/08 - positive; None stool culture 08/06/08 None - heavy entericWAES0902USA02647 flora, no white blood cells 0 Unknown OTH OTH Unknown Unknown WAES0902USA02385 diagnostic laboratory OTH - OTH tested positive Unknown for rotavirus Unknown WAES0902USA02251 Unknown OTH OTH Unknown Unknown WAES0902USA02243 201 stool rotavirus OTH antigen OTH - rotavirus positive Unknown Unknown WAES0902USA02170 Unknown OTH OTH Unknown Unknown WAES0902USA01794 Unknown OTH OTH Unknown Unknown WAES0902USA01704 Unknown OTH OTH Unknown Unknown WAES0902USA01652 Unknown OTH OTH Unknown Unknown WAES0902USA01525 0 Unknown OTH OTH Premature birth WAES0902USA01491 0 Temperature OTH measurement, OTH 12?/??/08, Unknown 103 degrees. Unknown WAES0902USA01091 Unknown OTH OTH Unknown Unknown WAES0903USA00060 0 Unknown OTH OTH Unknown Unknown WAES0903USA00014 0 Unknown OTH OTH Unknown Unknown WAES0902USA04196 1 Unknown OTH OTH None Unknown WAES0902USA04614 35 None OTH OTH None None WAES0902USA04623 473 diagnostic laboratory OTH 12/??/07 OTH - HPV None Test normal; diagnostic Nonelaboratory 02/16/09 WAES0902USA04624 - Positive for high and low risk HP Unknown OTH OTH Unknown Unknown WAES0903USA00004 2 Unknown OTH OTH Unknown Unknown WAES0903USA00009 0 None OTH OTH Unknown Unknown WAES0903USA00013 Unknown OTH OTH Unknown Unknown WAES0903USA00033 Unknown OTH OTH Unknown Unknown WAES0903USA00052 Unknown OTH OTH Unknown Unknown WAES0903USA00057 1 None OTH OTH None None WAES0903USA00076
0 Body temp OTH 01/26/09 101.5 OTHNASONEX Rhinitis Allergic WAES0903USA00096 0 Unknown OTH OTH albuterol; ALLEGRA; Raynaud'sDIFLUCAN syndrome; Hypertension WAES0903USA00106 2 Unknown OTH OTH None None WAES0903USA00120 Unknown OTH OTH Unknown Unknown WAES0903USA00502 Unknown OTH OTH unknown Unknown WAES0903USA00274 0 Diagnostic laboratory, OTH 02/26/09, OTH neurological None exam: negative None for findings. WAES0903USA00134 Unknown OTH OTH Unknown Unknown WAES0902USA04579 0 Unknown OTH OTH NUVARINGPregnancy NOS (LMP = Unknown) WAES0902USA04576 Unknown OTH OTH Unknown Unknown WAES0902USA04551 None LABS: OTH PAP smear OTH WNL. None None PMH: PUD, depo-provera WAES0902USA04538 contraception. OTH OTH None None WAES0902USA04537 0 None OTH OTH None None WAES0902USA04531 Unknown OTH OTH Unknown Unknown WAES0902USA04526 Unknown OTH OTH Unknown Unknown WAES0902USA04519 Unknown OTH OTH Unknown Unknown WAES0902USA04518 Unknown OTH OTH Unknown Unknown WAES0902USA04517 Unknown OTH OTH Unknown Unknown WAES0902USA04500 0 blood pressure OTH01/08/09 OTH 114/6 - ; None neurological examination None 01/08/09 - within normal WAES0902USA04481 limits; total heartbeat count 01 0 ultrasound 02/10/09 OTH - dw, OTH 22 week, Unknown EDC 6/12/09 Pregnancy NOS (LMP = 9/5/2008)WAES0902USA04477 38 None OTH OTH Unknown Unknown WAES0902USA04453 Unknown OTH OTH Unknown Unknown WAES0902USA04362 Medical records OTH received OTH w/LABS:None EGD 12/08Endometriosis (+) gastritis. 9/4/09 ESRMedical 9, ANArecords 1:80 speckled. WAES0902USA04356 receivedRF w/PMH: neg. Allergy: amoxicill 5 None OTH OTH Unknown Unknown WAES0902USA04044 Unknown OTH UNK Unknown Unknown WAES0902USA04071 None PVT PVT Unknown None WAES0902USA04072 Unknown OTH OTH Unknown Unknown WAES0902USA04176 31 Magnetic resonance, OTH everything OTH was fine. PENICILLIN allergy WAES0902USA04180 None OTH OTH hormonal contraceptives None WAES0902USA04190 Unknown OTH OTH Unknown Unknown WAES0902USA04195 Unknown OTH OTH Unknown Unknown WAES0902USA04198 Unknown OTH OTH Unknown Unknown WAES0902USA04249 Unknown OTH OTH Unknown Unknown WAES0902USA04250 Unknown OTH OTH Unknown Unknown WAES0902USA04252 50 Unknown OTH OTH None None WAES0902USA04343 5 None OTH OTH Unknown None WAES0902USA04346 42 None OTH OTH Vitamins (unspecified) None WAES0902USA04350 0 None OTH OTH None None WAES0902USA04032 429 Unknown. 6/17/09 OTH ER OTH records received Unknown DOS 11/22/07. LABS Unknown and DIAGNOSTICS: Medical records WAES0902USA04019 Beta received Hemolytic 6/19/09 Strepptococci PMH: works C a 0 Herpes simplex OTH virus, negative OTH Unknown None WAES0902USA04004 0 Unknown OTH OTH None None WAES0902USA04000 0 None PVT PVT None None WAES0902USA03917 0 None OTH OTH albuterol; ZYRTEC; Asthma; Sulfonamide VERAMYST; Brachial plexus allergy ADVAIR; injuryhormonal WAES0902USA03801 contraceptives; SINGULAIR 0 None OTH OTH None WAES0902USA03797 Unknown OTH OTH Unknown Unknown WAES0902USA03770 0 None OTH OTH None None WAES0902USA03739 None OTH OTH Unknown Unknown WAES0902USA03734 1 None OTH OTH None None WAES0902USA03713 42 Body temp,OTH 02/27/07, OTH 101; Erythrocyte, ASTELIN; 02/27/07, RHINOCORT; negat;None Body ALESSE temp, 03/26/07, WAES0902USA03633 101.5; Complete blood cell, 2/27/ 0 None OTH OTH None Back pain; Pain in hip WAES0902USA03603 Unknown OTH OTH Unknown Unknown WAES0902USA03589 Unknown OTH OTH Unknown Unknown WAES0902USA03555
0 None OTH OTH Unknown Unknown WAES0902USA03553 0 Diagnostic laboratory, OTH pregnancy. OTH ALBUTEROL; Pregnancy XOPENEX; NOS SINGULAR (LMP = 8/1/2008); WAES0902USA03545 Asthma 0 Cervical smear, OTH abnormal OTH Hormonal contraceptives Unknown WAES0902USA03544 Unknown OTH OTH Unknown Unknown WAES0902USA03536 Unknown OTH OTH Unknown Unknown WAES0902USA03528 0 Unknown OTH OTH Unknown Unknown WAES0902USA03115 10 Unknown OTH OTH Unknown WAES0902USA03112 0 None OTH OTH Unknown Unknown WAES0902USA03108 0 Unknown. Labs OTH and diagnostics: OTH Brain YAZ MRI (-). Sinus CTUnknown. (-). Head CT PMH: (-). heavy CT abd WAES0902USA03107 periods, (+) for possible sinusitis, gastroenteritis. H/A P 0 Unknown OTH OTH LEXAPRO;Pregnancy PREVACIDPapanicolaou NOS (LMP = Unknown); smear abnormal; WAES0902USA03106 AnxietyLoop disorder electrosurgical excis 0 urinalysis 02/16/09 OTH - revealed OTH the Unknown presence ofHypertension protein. WAES0902USA03105 1 None OTH OTH Unknown Unknown WAES0902USA03094 None OTH OTH SUDAFED Unknown WAES0902USA03093 Unknown OTH OTH Unknown Injury WAES0902USA02975 344 Unknown OTH OTH None Cervical dysplasia WAES0902USA02682 0 Unknown OTH OTH Unknown WAES0902USA02694 156 Unknown. OTH 5/27/09 medical OTH records PROVENTIL; LABS: BUN/creat FLONASE. ratio Unknown. 24(H). 5/29/09X-ray 5/27/09 Neurological of right medical WAES0902USA02704 wrist consult records WNL. records 5/29/09 PMH:recieved tension Neurological vascular DOS 1/2 co Unknown OTH OTH Unknown Unknown WAES0902USA02705 0 None OTH OTH None WAES0902USA02709 Pap test - inflammation OTH OTH Unknown Unknown WAES0902USA02879 None OTH OTH None None WAES0902USA02904 0 Ultrasound,OTH possible unspecified OTH fetal None abnormalities. Pregnancy NOS (LMP = 8/18/2008) WAES0902USA02914 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA02929 None OTH OTH Unknown Unknown WAES0902USA02935 0 None OTH OTH None None WAES0902USA02937 0 None OTH OTH None Penicillin allergy Asthma WAES0902USA02962 l virus infection) as a child who wasUNK vaccinatedUNK with the first 0.5 ml dose of GARDASIL. Respiratory Subsequently syncytial virus the WAES0902USA02969 patient infection experienced asthma. On Unknown OTH OTH Unknown Unknown WAES0902USA02669 Unknown OTH OTH Unknown Unknown WAES0902USA02388 100 None OTH OTH None Drug hypersensitivity HPV #3 2/11/2009, lot WAES0902USA02175 # 1311X Unknown OTH OTH Unknown Unknown WAES0902USA02184 5 None OTH OTH None None WAES0902USA02194 None OTH OTH None None WAES0902USA02197 0 Unknown OTH OTH None Hypersensitivity WAES0902USA02212 Pap test, 12/19/08, OTH mild OTH cervical dysplasia; Hormonal Pap contraceptives test, 05/22/06, None negative. WAES0902USA02237 Unknown OTH OTH Unknown Papilloma viral infection; Cervical WAES0902USA02269 pap smear abnormal; Genital wart. 7 Unknown OTH OTH Unknown Unknown WAES0902USA02274 31 Serum TSH,OTH normal; Serum OTH ANA,ADDERALL normal; Erythrocyte, Attention tablets; deficit/hyperactivity CELEXA Depression normal; Completedisorder blood WAES0902USA02276 cell, normal; Laboratory test, com 61 Unknown OTH OTH Unknown Unknown WAES0902USA02390 Unknown OTH OTH Unknown Unknown WAES0902USA02426 0 None OTH OTH Unknown None WAES0902USA02649 1 body temp 02/05/09 OTH 101 OTH Unknown Unknown WAES0902USA02167 Unknown OTH OTH Unknown Unknown WAES0902USA02030 Unknown OTH OTH Unknown Unknown WAES0902USA01667 0 Unknown OTH OTH Unknown Irregular periods WAES0902USA01676 None OTH OTH None None WAES0902USA01682 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0902USA01699 0 Unknown OTH OTH aspirin; WELLBUTRIN;Unknown YASMIN; ALLI; TOPAMAX; WAES0902USA01707 vitamins (unspecified) Unknown OTH OTH Unknown Anaemia WAES0902USA01775 None OTH OTH Unknown Unknown WAES0902USA01813 Unknown OTH OTH Unknown Unknown WAES0902USA01815
0 Unknown OTH OTH Unknown Unknown WAES0902USA01871 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP= unknown)WAES0902USA01879 0 Blood pressure, PVT 12/29/08, PVTlow None WAES0902USA02003 0 Unknown PVT PVT Unknown WAES0902USA01614 0 serum immunoglobulin OTH OTH E - significant Unknown elevated level of IGE Unknown WAES0902USA01435 None OTH OTH Unknown Unknown WAES0902USA01468 Unknown OTH OTH Unknown Unknown WAES0902USA01470 None OTH OTH Unknown Unknown WAES0902USA01481 0 Unknown. 7/7/09 OTH PCP OTH MR received. LEVOTHYROXINE Labs andSulfonamide Diagnostics: SODIUM Acne allergy Culture 7/23/09 of Medical papular records lesion WAES0902USA01500 (-). received X-ray RDOS foot,6/20/08 B ankles, to wr 6/2 217 Diagnostic laboratory; OTH OTH "hormones"LOESTRIN normal; Thyroid Asthma 1.5/30 function test, normal; Serum WAES0902USA01507 prolactin test, normal. 0 None OTH OTH NECON Drug hypersensitivity WAES0902USA01517 Unknown OTH OTH Unknown Unknown WAES0902USA01531 Unknown OTH OTH Unknown Unknown WAES0902USA01588 0 Blood pressure, PVT result PUB not provided; Unknown Total heartbeat count, Unknown result not provided. WAES0902USA01615 Unknown OTH OTH Unknown Unknown WAES0902USA01625 0 None OTH OTH hormonal contraceptives Allergic reaction Mitralto valve antibiotics prolapse WAES0902USA01635 554 Pap test, 01/16/09, OTH abnormal OTH without ORTHO HPV TRI-CYCLEN test; Papanicolaou Pap test, 01/??/06, smear abnormal abnormal which WAES0902USA01636 was positive for high risk HPV cervix HPV OTH DNA assayOTH - negative;Unknown cervix HPV DNA assay Unknown - positive WAES0902USA01653 0 None OTH OTH None None WAES0902USA00928 Unknown OTH OTH Unknown Unknown WAES0902USA00931 Unknown OTH OTH Unknown Unknown WAES0902USA00934 0 Unknown OTH OTH Unknown Unknown WAES0902USA00935 Cervical smear, OTH ?/?/06,OTH abnormal Unknown ASCUS PAP smear; Cervical Atypicalsmear, squamous ?/?/07, cells ASCUS; WAES0902USA00938 of undetermined Cervical smear, significance 11/??/07, h 0 None OTH OTH None Dermatitis contact WAES0902USA00942 1 None OTH OTH ATARAX; ADDERALL Diabetes; Heat tablets; sensitivity; NEXIUM; Penicillin insulin WAES0902USA00951 allergy Unknown OTH OTH hormonal contraceptives Unknown WAES0902USA01036 0 Unknown OTH OTH Unknown Unknown WAES0902USA01062 0 Unknown OTH OTH hormonal contraceptives Unknown WAES0902USA01064 Allergen skin OTH test OTH Hormonal contraceptives None WAES0902USA01080 Unknown OTH OTH Unknown Unknown WAES0902USA01104 289 None. 6/8/09 OTH Rheumatology OTH records MINOCYCLINE. received DOS6/8/09 2/7/09 None. Rheumatology to 3/30/09. 6/8/09 LABS Rheumatology records and WAES0902USA01115 DIAGNOSTICS: received records DOS received 2/7/09 UrineDOS to- cloudy, 3/30/09. 2/7/09 RM 17 None OTH OTH OCELLA No WAES0902USA01120 Unknown OTH OTH Unknown Appendicectomy; Cholecystectomy WAES0902USA00924 Unknown OTH OTH Unknown Unknown WAES0902USA00894 2 PVT OTH YAZ; ALDARA Allergic reaction Injection to antibiotics; site reaction Penicillin WAES0902USA00485 allergy 40 None OTH OTH None None WAES0902USA00488 Unknown OTH OTH Unknown Unknown WAES0902USA00535 Unknown OTH OTH Unknown Unknown WAES0902USA00570 0 Ultrasound OTH 02/02/09 - 31 OTH weeks pregnant; UnknownUrinalysis Pregnancy 02/02/09 Nos (LMP - positive = 7/1/2008)WAES0902USA00575 Unknown OTH OTH Unknown Unknown WAES0902USA00579 1 Unknown OTH OTH Unknown WAES0902USA00589 1 Unknown OTH OTH Unknown Unknown WAES0902USA00619 0 Unknown OTH OTH Minocycline None WAES0902USA00628 2 Unknown OTH OTH Unknown WAES0902USA00849 228 diagnostic laboratory OTH - OTH Cushing's disease None test: normal; serum Nonebiotin test - a littleWAES0902USA00858 low on Biotin; thyroid function test 1 None PVT PVT Unknown Unknown WAES0902USA00881 12 Unknown OTH OTH Unknown Unknown WAES0902USA00883 Unknown OTH OTH Unknown Unknown WAES0902USA00476 0 Unknown OTH OTH Unknown Unknown WAES0902USA00470 Pap test OTH OTH Unknown Unknown WAES0902USA00462 0 serum prostatic OTHacid - abnormal OTH PAP-low Unknown grade Squamous Unknown Intraepitheliel Lesion WAES0902USA00461
None OTH OTH None None WAES0902USA00455 Pap test, ?/?/09, OTH HPV positive OTH Unknown Unknown WAES0902USA00450 None OTH OTH Unknown Migraine WAES0902USA00427 0 Cervical smear, OTH 01/15/09, OTHpositiveHormonal contraceptives; NoneVitamins (unspecified) WAES0902USA00426 Unknown OTH OTH Unknown Unknown WAES0902USA00425 OTH OTH Unknown Unknown WAES0902USA00287 Unknown OTH OTH Unknown Unknown WAES0902USA00281 0 Unknown OTH OTH ADDERALLAsthma; tablets; Bipolar PROZAC; Obesity; disorder; Varicella; LAMICTAL; Sulfonamide Bulimia WAES0902USA00256 LITHIUM; allergy; SEROQUEL; Drug hypersensitivity RESTORIL urinalysis, presence OTH of OTH leukocyte, None protein, butPsychiatric no blood; urine Pyelonephritis disorder culture, NOSnegative WAES0902USA00221 0 PVT PVT None Private Doctor Private / Hospital Funds WAES0902USA00215 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 12/2/2008); WAES0902USA00185 Sexually transmitted disease; Inf 106 ultrasound, OTH 08/20/2008, OTH sonographic None markersPregnancy for trisomy;NOS ultrasound, (LMP = 12/18/08, 3/20/2008) WAES0805USA03343 normal; beta-human chorionic, 05/1 0 None OTH OTH ZOLOFT Pregnancy NOS (LMP = 11/19/2007) WAES0712USA08122 0 ultrasound, OTH 03/05/08 - OTH INP; urine beta-human Unknown Pregnancy - positive; serum Depression; NOS (LMP alpha-fetoprotein, =Anxiety; 1/10/2008) Papanicolaou WAES0804USA01176 05/01/08 Bipolar disorder; - smear within Smoker normal abnormal; limits Loop 73 Ultrasound,OTH 04/02/2008, OTH 6.4 weeksABILIFY; IUP; Beta-human WELLBUTRIN Pregnancy chorionic, NOS SR;(LMP SEROQUEL 03/24/2008, = 2/15/2008) positive WAES0805USA02898 Bipolar disorder; Allergic reaction Chromosomal OTH analysisOTH ?/?/08 posit Tylenol, - Down's Multivit syndrome; Pregnancy Platelet NOS (LMP count = 4/28/2008) ?/?/08 - Decreased WAES0805USA05753 Hypertension; Smoker 0 ultrasound, OTH 7/15/08, 12W OTH 4D; serum ZITHROMAX, alpha-fetoprotein, vitamins 08/13/08, Papanicolacu (unspecified) negative; smear abnormal; WAES0805USA05935 Smoker 0 Ultrasound OTH 07/07/08 - Within OTH normal doxycycline limits; Beta-human Pregnancy 100 mg chorionic Early NOS (LMP=5/7/2008) onset - positive of delivery WAES0806USA03410 Chlamydial infection 210 Ultrasound,OTH 08/25/08, normal OTH twins; None serum alpha-fetoprotein Papanicolaou 09/15/08,smear normal. abnormal WAES0807USA01851 0 ultrasound, OTH 06/18/08, normal OTH embryo vitamins (unspecified) Pregnancy Premature NOS (LMP labor; = 5/2/2008); Premature WAES0807USA03262 Smoker rupture of membranes 0 ultrasound, OTH 06/19/08, 10.1 OTHweeks vitamins gestation;(unspecified); ultrasound, Pregnancy 08/22/08, NOS vitamins (LMP (unspecified) routine: = 4/9/2008); No problems WAES0807USA04636 Asthma; seen Penicillin allergy Unknown OTH OTH Unknown Unknown WAES0901USA03966 0 ultrasound 11/??/08 OTH - 5OTH weeks andLEXAPRO 6 days gestation Pregnancy at time Depression NOS of (LMP vaccine; = 10/5/2008) ultrasound WAES0901USA04179 Smoker 11/16/08 - 7 weeks gestation; se 1 PVT UNK none none Unknown OTH OTH Unknown Unknown WAES0903USA02000 Unknown OTH OTH Unknown Unknown WAES0903USA01794 Unknown OTH OTH Unknown Unknown WAES0903USA01668 31 Erythrocyte,OTH 34; SerumOTH cyclic citrulline, Prinivil; 250 Mevacor Thyroid disorder; Glaucoma Sulfonamide allergy; WAES0903USA01845 Drug hypersensitivity; Hyperten 1 None OTH OTH None WAES0811USA00715 Unknown OTH OTH Cystic fibrosis Renal transplant; Shoulder WAES0903USA02039 operation Unknown OTH OTH Unknown Unknown WAES0903USA01841 Unknown OTH OTH None None WAES0903USA02062 273 diagnostic laboratory, OTH 08??/06, OTH diagnosed Unknownwith Gastric autismdisorder; Reflux gastritis WAES0903USA02038 1 Chest X-ray; PVT CT of head; PUB Blood work; Lumbar puncture; 34 Urine week culture. preemie 4/6/09-records 4/6/09-PMH:former received-Infectious 34 week preterm workupinfa n 1 Serum Sickness PVT LABS:WBC OTH 15.85(H), amoxicillin, lymphs Cough Day 22.0(L), 10(lingering) neutros none PMH: ("sinusitis") 72.4(H). recent ESR sinusitis 5(N), & CRP<0.5(N). on amoxicillin Complement at admit. Hive C3 0 EEG; CT Head; PVT Neurology PVT consult; None Spinal tap; Well Cultures; Visit hx Blood RSVwork PMH: LABS: RSVCBC: infection, WBCintubation, 24(H), hematocrit NICU x 130.4(L), wk. Re 1 UNK UNK 0 UNK UNK None MIL MIL None None 0 PVT PVT No No 1 none PVT PUB None Egg & yeast allergies, sickle cell trait, Incontinentia pigmen 1 None PVT PUB UNK UNK 12 None PVT PVT ZOCOR None None None~ ()~~0~Patient 4 UNK UNK NIL NIL 0 PUB OTH None High Blood pressure; Seizure medicine; central sleep apne 1 PVT PVT 0 None needed PVT PUB None None Except new onset HTN 1 Former HODGKINS; OTH had PVT splenectomy WELLBUTRIN; Levothyroxine; Former HODGKINS; Vit Red D; Low hot dose nodule~Tetanus Allergic ASAto cats Diphtheria (no brand 0 Influenza test PUB negative;PUB Strep test None negative None Allergies - Amoxicillin, Grasses; Adenoids removed for slee 0 None MIL MIL slight fever decreased 101~ ()~~0~In Sibling
7
PUB PUB No PVT PUB 1 PVT PVT Birth controlnone pills none 2 PVT PUB None None PVT PVT None None 0 MIL MIL None PVT PUB none none 12 OTH PVT None None None Not applicable. PVT OTH none 0 MIL MIL None reported Ulcerative Colitis GI upset~Tetanus Diphtheria (no brand name)~ 1 PVT PVT none none 0 Physician inPUB clinic areaPUB examined patient 108 MRIs Labs UNK and Diagnsotics: UNK HLA B27 (+). Alk phos (L) none 34. Lyme PMH: (-).none. RF (-). ANA (-). 19 EKG, ChestUNK X-ray, CT UNK Scan, MRI,Flouride, Lymes Disease, Poly None Vit-Sol and (Iron Chromosomes NoneVitamin) PMH: recurrent were all bilateral analyzedAOM. and showed Left middle normal earresul effus 0 NONE UNK UNK NONE NONE REPORTED NONE KNOWN 0 none UNK UNK NONE NONE ALLERGIES: PCN, SULFA, SILVADENE -2 NONE PVT PUB NONE ECZEMA NONE~ ()~NULL~~In Patient 20 PVT PVT None 7 PVT PVT NONE NONE NONE KNOWN 1 Abnormal nerve PVT conduction UNK velocities Crestor : 3/16/09 5mg. None Equivocal RhinocortAvelox 1MRI spray/ findings - drug nostril/ eruption. :3/16/09 qd. Fish Oil capsules. MVI. asa 325mg. 0 PUB PUB 0 UNK UNK none PCN 0 PUB PUB Unknown meds statespatient headaches hx brought of menorrhea with her from Burma/Thailand for allergies and m 11 Pregnancy UNK test was negative UNK Nuva-ring (birth None, control) manufacturer back ache, of bursitis, the vaccine tendonitis. is Baxter PMH: Healthcare eczema. Corporation. 0 Labs and Diagnostics: UNK UNK Head CT (+) for subarachnoid none bleed. none X-ray PMH: Repeat none CT (+) for evolution of frontal parenchym 16 See autopsy PVT report opinion OTH and clinical See clinical records None report; fromKnown clinic. simvastatin; see medical metformin; records ASP; - If I recall COZAAR she did have other medica 31 06 Nov 2008, MILSERUM,MIL Creatine Kinase, None 565 None (H*) IU/L; 08 NKDA, Nov 2008, no history SERUM, of chronic Proteinconditions Electrophoresis; Albumin, 4. 0 None PVT PVT None None AR (Allergic Rhinitis) 1 None PVT PVT none none none 3 OTH OTH None 5 5/21/09-records PVT received-Echo PVT abnormal. REGLANUltrasound none diagnosis Down's of Syndrome; intussusception.. AV canal;LABS Reflux and (G-E); DIAGNOSTICS; Myeloproliferat Th PVT PVT Furadantin None 25mg/5ml Grade I vu reflux R; Grade 3 L vu reflux 0 PVT PUB None LAR Cleft lip+palate UNK UNK 1 PUB PVT DIGOXIN; FOLIC Anemia; ACID; CHF Promethazine; Levothyroxine; Mechanical Lorazepam; valves: Morphine; Pulmonic; ADVAIR; Tricuspid; SPIRIVA Mi 0 PVT UNK Recent "allergy" Hypertension, symptomsDM, to unknown hyperlipidemia, allergen fibromyalgia, cervical C 9 chest x-ray PVT - bronchial PVT inflammation 0 PVT PVT Takes Claritin None redi - tabs None 11 Negative strep PVTtest 3-17-09 UNK Left otitis media - Afebrile 3741 PVT OTH Troponin (results: OTH revealed OTH significant Relevant troponin-1 medical Unknown level history elevation) Concomitant was not was provided. done medications on an USWYEH08499209 unspecified were not reported. date. 0 hematologyOTH OTH None General physical health deterioration WAES0903USA02047 1 Unknown OTH OTH Unknown WAES0903USA02042 Unknown OTH OTH Unknown Unknown WAES0903USA01872 Unknown OTH OTH Unknown Unknown WAES0903USA01804 None OTH OTH NUVARING None WAES0903USA02071 91 Unknown 3/27/09-records OTH OTHreceivedNone EGD, colonscopy and None capsule 3/21/09-records study showed received-PMH: WAES0903USA02043 chronic ileitisasthma and esophageal and GERD. ca 30 Unknown OTH OTH Unknown Migraine WAES0903USA01837 Unknown OTH OTH Unknown Unknown WAES0903USA01470 6 UNK UNK Healthy individual. 0 PUB PUB None NKDA
1 PUB PUB None None GA09001 0 PUB PUB PRILOSECNone 20 mg 48 units; Allergic HIOMULIN to DEMEROL; 70/30GA09002 CODEINE; 25 units; ZOCOR GLUCOPHAGE; 20 mg daily; NEUR ZOL 4 CT Scan; EKG; PUB Labs PVT None None None GA09004 0 Cerebrospinal OTH fluid testOTH results (date not specified) Unknown indicated It was clear reported aspect, that density theA0773653A young 0.005,subject ph of 8, was glucose the result 55, prote of a h UNK OTH OTH No concurrent Unknown medication A0773852A Body temperature, OTH low;OTH Eosinophils, 59%; White Unknown blood cell count, 23.7x10^9/l B0564949A PUB PVT None None 1 PVT UNK None None BACTRIM; Angioedema 2 PVT UNK None None 8 MIL MIL None None None 1 None PVT PVT BACTRIM DS; RashTAC on thighs Cream None 0.1% 7 PVT OTH TYLENOL None Prematurity(fever, - smallredspots baby on face + body~Measles + Mu 0 None yet. PVT UNK None Allergy: CODINE (anaphylaxis); No known birth defects. 7 None PVT PUB 197 None MIL MIL ADDERALLNone None 0 N/A MIL MIL N/A NONE ADHESIVEALLERGIC AND ANTHRAX REACTION~Anthrax VAAINE AND HEPATITIS (Biothrax)~1~ BV 0 N/A PVT PVT N/A N/A N/A N/A~ ()~NULL~~In Patient 1 PUB PVT 2 N/A PUB PUB Birth Control None Pills None known Erythema, itching, bruising~Measles + Mumps 1 PVT PVT None None Migraine Headaches with Aura 1 PVT UNK None None 0 PUB PUB not physician diagnosed allergy to dial soap 0 PUB PUB 0 PUB PUB none 5 Premature menopause UNK UNK 4/2/09-records nonereceived-Pelvic none ultrasound none 4/2/09-menarche WNL. DHEA 154 began normal.Estradiol at age 11 and23, everyother LH 32.3 m an 7 PUB PUB None None None 1 none at thisUNK time. UNK diagnosed with OM on 3-6-09 and only recieved amoxicillin that was s 2 PVT PVT Norvasc, Celexa, No Metformin, AllergicArin to Sulfa drugs. Currently diagnosed with HTN and 1 none UNK UNK none none 1 UNK UNK None None None 7 Was seen by PVT pediatrician UNK 3/18/2009 None No milk allergynone in prior~ ()~NULL~~In Patient|n/a~ ()~NU 0 PVT PVT no 2 vital signs taken PUB and allUNK stable .Mother instructed noneto give zyrtec 1/2 tsp daily and re-check in one day. 2 vitals takenPUB and all wnl.PUB Mother was instrctednone to give 1/2none tsp Zyrtec and return to clinic for re check on following day 0 several biopsies; UNK performed UNK by twothe dermatologist doctors all office of(specialist); the is showing side none; effects regular my twodaughter started other dermatologist; shots at was theTd time very Adult plus of healthy the lot#c2775ap regular vaccination anddoctor athletic; its and visits; hard sothe to health and rea skiu 4 none UNK UNK none none none 1 PVT PVT none 2 Unknown date: OTHRoutineOTH sequenceConcomitant analysis: type Cerebral Drug(s) B influenza palsy; Not Neuromuscular Reported virus Seizure; (FLUMIST Microcephaly disorder; strains); MEDI0008055 Taking NI, anti-epileptic NI, NI medication 0 PUB PUB PPD None Allergic to: PCN family; Hydrocodone; Flexeril; Ibuprofen; L 1 None PVT UNK None None 0 PVT PUB none no, healthyNKA; HX, HSV infection, cutaneous only; HSV meningitis, 0 chest x-ray,MIL normal; CBC, MIL normal;None Chem-7, normal None None 0 PVT PVT Vitamin D; ZINC; no calcium possible chew;ulcer; vitamin colitis; chewmultiple sclerosis 0 MIL MIL None None 1 None PVT PUB cough - viralNone illness 1 None OTH UNK None URI None Diagnostic Test: UNK pelvicUNK u/s (12/04)TRI-LEVLEN mult. leiomata TRIPHASIC max 2.8cm; metromenorrhagia endometrial biopsy; Labs: plts(1/02)-271K' plts(10/04 0 PVT PUB Allergic rhinitis NKA PUB PUB ALBUTEROL NebulizerAsthma; Eczema; Sickle Cell trait 0 PVT UNK 39 22-Nov-2008, OTH Rapid fluOTH test, Negative; Concomitant Blood culture, Drug (s) 11/??/08, Not TheReported subject Sterile; has Chest a history X-ray, MEDI0007935 of 11/18/08, fever and Consistent cough for approxima with right
0 0 0 0 0 0 0 0 0 0 0 0 0 0
OTH OTH Concomitant Drug (s) Not Reported MEDI0008002 PVT PUB Concomitant Drug(s) not Past Reported Disease: Ear infection; MEDI0007971 Ear tube insertion PVT PUB MIRALAX Constipation; Tubes Ear infection in ears due to ear MEDI0007922 infections OTH OTH Concomitant Drug(s) Not Reported MEDI0007907 MIL OTH Concomitant Drug (s) Not Reported MEDI0007901 MIL OTH Concomitant Drug (s) Not Reported MEDI0007891 MIL OTH Concomitant Drug(s) Not Reported MEDI0007884 MIL OTH Concomitant Drug(s) Not Reported MEDI0007881 MIL OTH Concomitant Drug(s) Not Reported MEDI0007879 MIL OTH Concomitant Drug(s) Not Reported MEDI0007874 MIL OTH Concomitant Drug(s) Not Reported MEDI0007872 OTH OTH Not Reported MEDI0007857 OTH PVT Concomitant Drug(s) Not Reported MEDI0007856 OTH PVT Concomitant Drug(s) Not Reported MEDI0007855 magnetic resonance, OTH ?/?/94, OTH multiUnknown - brain MRI General Symptom WAES0901USA00098 27 magnetic resonance, OTH 10/14/93, OTH abnor, Unknown Brain-see narrative Unknown WAES0812USA03330 14 Unknown OTH OTH Unknown Back injury WAES0812USA03312 Unknown OTH OTH Unknown Unknown WAES0901USA00317 Unknown OTH OTH Unknown Unknown WAES0812USA04898 24 Unknown OTH OTH Vocal cord Tracheostomy paralysis; Hypotonia; Laryngomalcia; WAES0812USA03569 Lung disorder; Malai Unknown OTH OTH Unknown Unknown WAES0812USA03314 None OTH OTH None None WAES0812USA02004 32 Physical examination, OTH 06/30/08 OTH , normal Unknown Circumcision; Family history WAES0812USA01523 of cancer Unknown OTH OTH Unknown Unknown WAES0812USA00544 Unknown OTH OTH Unknown None Injection site WAES0812USA00480 erythema, pruritus, rash, swelling, 1 Skin biopsy,OTH "possible drug UNK reaction" Furosemide; Hypertension ATIVAN; BENICAR WAES0812USA00053 0 Unknown OTH OTH Unknown Unknown WAES0811USA03029 40 Unknown OTH OTH Unknown WAES0811USA02988 4 None OTH OTH None None WAES0811USA02844 Unknown OTH OTH Unknown Unknown WAES0811USA02841 50 Unknown OTH OTH Unknown Hospitalisation WAES0811USA02798 3 Diagnostic radiology, OTH 07/22/08, OTH gastroesophageal reflux;Unknown Total serum bilirubin, 06/16/08, WAES0811USA02544 1.7 mg/dL, high; Serum di 1 None OTH OTH vitamins (unspecified) None WAES0811USA02179 Unknown OTH OTH Unknown General symptom WAES0811USA01659 Diagnostic laboratory, OTH 8/??/1997, OTH abnormal Unknown liver Acne WAES0811USA01658 0 Ultrasound,08/07/08, OTH abdominal OTH - no evidence Pregnancy of hypertrophic NOS (LMP pyloric= stenosis, Unknown); WAES0811USA00783 pedialyte Talipespasses smoothly through 3 Unknown OTH OTH Unknown WAES0811USA00635 62 OTH OTH Unknown WAES0811USA00563 2 None OTH OTH None None WAES0801USA03990 3 None OTH OTH Hormonal contraceptives PENICILLIN allergy WAES0810USA03139 hearing testPUB - passed; body OTH weightNone measurement 08/27/08 None 11.8 pound -; body weight WAES0810USA03070 measurement 07/08/08 7.4 p Unknown OTH OTH Unknown Unknown WAES0810USA02502 51 vital sign 08/20/08 PVT - Temp OTH- 99.8, pulse 145, respiration's Diaper rash 28; WBC count 08/20/08 WAES0810USA02436 14.20 - ; hemoglobin 08/20/08 1 2 hearing testPVT 06/14/08 -OTH left ear - pass; AQUAMEPHYTON, hearingProphylaxis test 06/13/08 IM, 0; -Erythromycin right ear - pass; Ophthalmic Apgar WAES0810USA02427 score 06/12/08 - 9 and 9; body Unknown OTH OTH Unknown Unknown WAES0810USA01821 Unknown OTH OTH Unknown Unknown WAES0810USA00820 2 Unknown OTH OTH Digoxin Paroxysmal supraventricular tachycardia WAES0810USA00425 OTH OTH Unknown Unknown WAES0810USA00194 OTH OTH Unknown Unknown WAES0810USA00177 OTH OTH Unknown Unknown WAES0801USA00075 Unknown OTH OTH Unknown Unknown WAES0810USA00002
Unknown OTH OTH Unknown Unknown WAES0808USA05347 0 None OTH PVT None SULFONAMIDE allergy; PENICILLIN WAES0808USA03602 allergy 0 None OTH OTH WELLBUTRIN; Thyroid ADVAIR papillary Renal DISKUS; carcinoma; cyst LEVOTHYROXINE Asthma; WAES0809USA04880 Drug SODIUM hypersensitivity 31 ultrasound 07/12/07 OTH - pregnancy; OTH diagnostic laboratory Mongolian03/13/08 spot; Jaundice Torticollis - neonatal newborn screen WAES0809USA04315 - negative; venipuncture 03/13/0 14 Unknown OTH OTH Jaundice neonatal WAES0809USA03422 3 diagnostic laboratory OTH 04/23/08 OTH - endocrine None disorders - normal; Jaundice diagnostic laboratory WAES0809USA03006 04/23/08 - hemoglobinopathies 20 Unknown OTH OTH Cleft lip Jaundice; Blood bilirubin WAES0809USA01661 abnormal; Infantile spitting up Unknown OTH OTH Unknown Unknown WAES0809USA01605 Unknown OTH OTH Unknown Unknown WAES0809USA00797 21 diagnostic laboratory PUB - OTH full rheumatologic Unknown workup DepressionHepatitis negative C WAES0808USA05345 Unknown OTH OTH Unknown Unknown WAES0808USA04151 1 None PUB PUB PERCOCET; LEXAPRO; Hypersensitivity ALEVE WAES0808USA03995 3 hepatic function OTH tests, 03/17?/02, OTH Unknown liver enzymes were fiveUnknown to six times the normal WAES0807USA05660 limit; hepatic function tests, 01/12 Unknown OTH OTH Unknown Bulimia WAES0807USA05790 None OTH OTH Unknown None WAES0808USA03092 Unknown OTH OTH Unknown Unknown WAES0808USA02804 11 Unknown OTH OTH SYNTHROID; TAPAZOLE Hypothyroidism; Drug hypersensitivity WAES0807USA05683 Unknown OTH OTH Unknown Unknown WAES0807USA05549 Unknown OTH OTH Unknown Dialysis WAES0807USA04094 Unknown OTH OTH Unknown Unknown WAES0807USA04037 Unknown OTH OTH Unknown Unknown WAES0808USA04836 Unknown OTH OTH Unknown Unknown WAES0807USA02498 Unknown OTH OTH Unknown Unknown WAES0807USA01576 0 None OTH OTH KLONOPIN;Migraine; RELPAXPENICILLIN allergy; Hypersensitivity; WAES0807USA01112 SULFONAMIDE alle 3 Computed axial; OTH 01/07/2008, OTH negative; Unknown Diagnostic laboratory, Motor 01/07/08, vehicle accident; negative WAES0810USA01573 Back injury Unknown OTH OTH Unknown Unknown WAES0801USA02974 26 Unknown OTH OTH Unknown Upper respiratory Unknown tract infection WAES0802USA05298 1 None OTH OTH None None WAES0801USA03311 1 body temp, OTH 01/16/08, 102 OTHF, feverNone None WAES0801USA04102 Serum Hepatitis OTH B coreOTH ?/?/95 posit Unknown - ; Serum Hepatitis BSurgery; core 12/??/07 Blood donor WAES0801USA04436 1 diagnostic laboratory, OTH failed OTH to seroconvert Unknown Unknown WAES0802USA02695 28 Unknown OTH OTH Unknown Unknown Febrile convulsion~Varicella WAES0802USA03013 (Varivax)~1~1~Pa 64 diagnostic laboratory PVT 10/31/07 OTH - Negative LIPITORtiter mg; Drug for fexofenadine RECOMBIVAX hypersensitivity Lipidshydrochloride; increased HB; diagnostic fluticasone WAES0802USA03149 laboratory propionate; 12/??/07PATANOL - Negative tite Unknown OTH OTH Unknown Unknown WAES0803USA01725 None PVT PVT None No adverseWAES0803USA03063 event~Hep B (Recombivax HB)~2~ 11 Unknown PVT OTH Unknown WAES0903USA04159 Unknown OTH OTH Unknown Drug hypersensitivity Coeliac disease WAES0804USA00190 81 hematocrit 10/22/07 OTH 16.5 OTH -; body height measurement 10/22/07 Unknown 24.25 -; body temp WAES0804USA00205 10/22/07 98 -; body weight mea 11 None PVT OTH None NONE WAES0804USA02481 9 Unknown OTH OTH Cardiac murmur; Varicella WAES0804USA03139 OTH OTH Unknown Unknown WAES0807USA00728 OTH OTH Unknown Unknown WAES0805USA00046 OTH OTH Unknown Carpal tunnel syndrome; Numbness WAES0805USA00042 in hand 0 Unknown OTH OTH DEPAKOTESulfonamide allergy WAES0804USA03842 34 body temp, PVT 08/24/07, 98.7, OTH -; bodyERYTHROMYCIN; temp, 10/07/07, 96.8, PHYTONADIONE None -; vital sign 10/07/07, mg 144, WAES0805USA00927 -, heart rate; vital sign, 10/07/0 Unknown OTH UNK Unknown Unknown WAES0805USA04759 Unknown OTH OTH Unknown Unknown WAES0805USA04852 Unknown OTH OTH Unknown Unknown WAES0806USA00720 Unknown UNK OTH Unknown Hypersensitivity WAES0806USA00825 magnetic resonance PVT 05/07/08 OTH - Tear aspirin of anterior 81 mg; Hypertension; talofibular LISINOPRIL Allergy ligament Hyperuricaemia; 10tomg; vaccine; and LISINOPRIL associated Hyperuricaemia Hypercholesterolaemia; WAES0806USA02494 20 ankle mg; effusion; omega-3blood marine Hepatic pressure triglycer steat0 Unknown OTH OTH Unknown Unknown WAES0806USA03414
0 Unknown OTH OTH Unknown Unknown WAES0806USA08376 None OTH OTH None None WAES0807USA00061 OTH OTH Unknown Unknown WAES0807USA00802 1 An EKG was PVT performed PVT on an unspecified Oral contraceptives date Unknown (followingThe thesubject subject's has episode a history A0717385A of dizziness) of irregularwas heartbeat negative. with negati 0 Blood pressure, PVT 02Feb2008, PVT low; CBC, 11Feb2008, Unknown normal; MRSA CTInfection. scan, 11Feb2008, History: A0709448A MRSA normal; infection Chest x-ray, of the 11Feb2008 skin. No kn 2 A physical examination PVT PUB performedAmoxicillin by an allergist Otitisonmedia 28 March 2008 was normal. A0708192A The event of rash was resolved w OTH OTH Unknown A0713347A 0 Body temperature, PVT 27Feb2008, PVT 103.6degrees AZITHROMYCIN Unknown F Allergic Rhinitis; Allergy A0717375A to AMOXICILLIN; Asthma; Reac Body temperature PVT increased PVT 89.1 No concurrent Unknown medication The subject had no relevant A0729978A medical history 0 PUB PVT Unknown The subject has no relevant A0728841A medical history. 3 UNK OTH PVT Unknown The subject had no medical A0728382A history and was not taking any OTH PVT Unknown No allergies and occasional A0724174A motion sickness. No history o UNK PVT OTH Unknown The subject's medical history, A0722972A history of adverse events fol 0 PVT OTH No concurrent Unknown medication The subject has a history A0722966A of sinus issues every now and th PVT PVT Unknown The subject's relevant A0719018A medical history, concurrent medicat The subjectOTH recently took OTH an HIV test which "came Unknown up inconclusive". A0718748A 0 PUB PUB No concurrent Unknown medication The subject had no relevant A0718377A medical history and no advers 0 UNK OTH OTH Unknown No known drug allergies. A0718132A No adverse events following prev 10 UNK PVT PVT Atenolol; Atorvastatin Gastroesophageal calcium; Allergy to reflux Pantoprazole Morphine. disease; The A0717934A High subject bloodhas pressure; had tetanus High vaccine choleste Unk OTH OTH No concurrent Unknown medication A0717658A 0 UNK PVT PUB Unknown A nurse reported, via an A0730977A agency sales representative, that UNK OTH OTH Unknown A0732272A UNK OTH OTH Unknown These events occurredA0732515A in a number of different subjects fro UNK OTH OTH Unknown These events occurredA0732528A in a number of different subjects fro OTH OTH Unknown These events occurredA0732533A in a number of different subjects fro 6 PUB OTH Unknown No relevant medical history A0735235A was reported for this subject a 0 UNK PVT PVT SalbutamolUnknown sulphate The subject has no relevant A0735402A medical history. Follow-up info 1 UNK PVT PUB LANSOPRAZOLE Borderline Diabetes; The subject's Gastroesophageal medical history A0735410A Reflux included Disease borderline diabetes 1 UNK PVT PVT Unknown The subject has medical A0735415A history of not gaining weight very 0 PVT OTH Blood pressure Highmedication Blood The Pressure subject had a history A0735441A of high blood pressure and no hi UNK PVT PVT Unknown A nurse reported, Via aA0736316A GSK sales representative, that an 0 PVT PVT No concurrent Private medication Funds The subject has no relevant A0737561A medical history, no history of r 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0737565A medical history, no history of r 0 Heart rate, PVT 4/2/2008, 150's PVT Oral contraceptives Upper respiratory The subject infection had no history A0738496A of adverse events following pre 0 PVT PVT Unknown The subject had no medical A0739138A history and was not taking any UNK MIL MIL Unknown The reporter expressedA0741172A concern over the quality of the vac UNK MIL MIL Unknown The reporter expressedA0741173A concern over the quality of the vac The subject's PVT blood pressure PVT remained No concurrent withinUnknown 90/50 medications (his The normal subject is 110/55). has noAfter relevant A0742501A 20 minutes medicalhe history felt better and no and history was 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0742657A medical history and no history UNK OTH OTH EGG Allergy, Peanut Allergy A0744953A 0 UNK PVT OTH Unknown The subject has a possible A0746398A history of seasonal allergies an 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0749650A medical history and no history 0 UNK PVT PVT Thyroxine sodium Unknown The subject had a bad A0755886A reaction to Codeine which resulted 0 UNK PVT PVT Unknown No concomitant medications A0757320A or relevant medical history. N 3 UNK PVT PVT Unknown Unknown High blood pressure; High A0758194A cholesterol; No adverse events 0 UNK PVT OTH Unknown No concomitant mediations A0758584A or relevant medical history. No 0 Unknown PVT PVT Unknown No concomitant medications A0758810A or relevant medical history. N 0 UNK PVT PVT Unknown It was reported that theA0758842A subject is prone to allergies, but sp 0 UNK PVT PUB Unknown Allergic rhinitis; reflux unspecified; A0759192A No known drug allergies UNK OTH OTH Unknown A0762179A Unknown OTH OTH Unknown Unknown WAES0903USA02330
Not reported UNK UNK Not reported ### 1 05/Mar/2009: PVT "spinal catheterization" OTH and blood cultures The that patient were negative. has no family 06 March history ### 2009: of epilepsy, A urine test andrevealed had no c" Unknown OTH OTH Unknown None WAES0903USA02361 1 Echocardiography, OTH 03/06/09, OTH normal Tylenol; left ventricular Albuterol; Hypertension; systolic Proair HFA; Obesity; function; Aspirin; Diabetes; Magnetic Zyrtec; resonance, Atherosclerosis; WAES0903USA02096 Vytorin; Fluticasone; 03/07/09, Asthma; left Ibuprofen; shoulder Cardiac In min Unknown OTH OTH Unknown Autism WAES0903USA02102 Unknown OTH OTH Unknown Unknown WAES0903USA02288 Unknown OTH OTH Unknown None WAES0903USA02340 Unknown OTH OTH Unknown None WAES0903USA02644 Beta-humanUNK chorionic,UNK 05/27/08, positive Pregnancy NOS (LMP = 4/23/2008); WAES0806USA01608 Attention deficit/hyperactivity dis 0 ultrasound, OTH 08/06/08, looks OTH okay vitamins (unspecified) Pregnancy NOS (LMP = 5/1/2008); WAES0807USA00388 Penicillin allergy; Attention deficit/ 0 PVT PUB ELOCON 0.1% 5yr PE prnvisitNKA 3/20/09-records received- PMH:eczema. 0 No tests performed. PVT PVT 2 None PVT PVT PPD; SanofiNone Pasteur; C2921AA; None Left forearm; ID 6 Lab work - lymes PVT / thyroid PVT/ anemia; ETC NEG None / MRI'S 4 to date w/ lesions not causing this but to be repeated in Ap 77 INFLUENZA MIL B PositiveMIL 0 When takenMIL to hospitalUNK on Feb-3-09 Nodoctor took None blood waswork very No and healthy stated None and there happy other were than until allthis vaccines the one~ electrolism was ()~~0~In given found, Patient which w 10 MIL MIL FINASTERIDE; None CRESTOR; Allergy HCTZ. to PCN. 1 None UNK PUB None None None 0 Had full setPVT of labs, echo-cardiogram, OTH & stressNone test, urinalysis ALPHAGAN Solu, Iodine Solu, Shellfish PVT PVT None None None PVT PVT None None 1 None PVT PVT none none seasonal allergies; CEFZIL PUB PVT 0 None PVT OTH SIMVASTATIN None None None PVT PUB 2 PVT PVT None None Possible allergy to bees - never tested 0 None PVT PVT None None None 11/07/2008~Varicella (Varivax)~1~1~Patient|11 1 Unknown UNK UNK hormonal contraceptives Unknown (unspecified); MerckWAES0903USA00042 Sharp & Dohme; lot number 66055 237 Pap test, 02/23?/09, OTH Positive. OTH None Asthma WAES0903USA00043 0 none done UNK UNK Lasix, Labetalol, Lotrel,Allergy Baby ASA, to compazine-tardive Omega 3, Zrytecdykenisia; Pt has hx of HTN, 1 PUB PVT NONE NONE NONE FEVER~DTaP ND-09-03 (no brand name)~4~5~In Patien 185 ROTAVIRUS PVT AG, EIA PVT TESTED POSITIVE STOOL CULTURES NEGATIVE AND FECAL WBCS NEGATIVE 1 PUB PUB 1 PVT MIL toperol, lilitor none High blood pressure, high cholesterol PVT PUB na na 0 No cause for UNK development UNKof atrialprenatal flutter was vitamins, none found.vitamin Normal twinD, echocardiograms, pregnancy zantac, none~ colace ()~~0~Patient|none~ normal blood cultures, ()~~0~Sibling|none normal EKG 0 PVT PUB None Speech Delay/ADHD 0 NONE PUB PUB NONE NONE NONE 1182 Pertussis DNA PUB(PCR) positive PUB on 3/13/2009 Received HIB, IVP, MMR,Varicella,Prevnar, Hepatitis A, Hepatitis B 0 None MIL MIL None slight runnyNone nose 0 PVT UNK None None None 0 None PVT UNK None noted.Unknown. 0 none UNK UNK R otitis media febrile andsz afebrile 0 None. PVT UNK None noted.Unknown. 11 ASAP TROPONIN UNK I, 6.14 UNK H; CK, 450 noneH; MMB, none 14.9 H*; GLUCOSE, none PMH: 96; Allergy: UREA PCN, NITROGEN, anaphylactic 10;reaction. CREAT, 1.3; BUN 7 n/a PVT PVT none none supraclavicular lymphadenopathy~HPV (Garda 12 Blood, urine, PVT MRI, CT scan PVT all normal. generic Paportho-tri-cyclen test none taken sixnone months after none~ initial()~NULL~~In dose revealed Patient|none~ abnormal cells ()~NULL~~I in mode 7 None LABS: PVT all WNL. PVT 9/5/08 Urine LEXAPRO; c/s (+). Drug DepressionDepression ABILIFY; screen WELLBUTRIN; neg. KLONOPIN 2 Received TYL PVTalso 0 reaction PVT None 1 PVT PUB 14 PVT UNK Diarrhea
1 None performed PVT PVT Amoxicillin;Earache; LORATADINE; OM NKDA SINGULAIR 1 None PVT PUB None None Possible Allergy to AMOXICILLEN. 0 OTH UNK ALBUTEROL None MD1 (Pollen; Trees; Roaches; Dust); DX, Asthma 1 PUB PUB None Questionable asthma PUB PUB TYLENOL; None FLUORIDENone 2 UNK PUB No No 0 None PVT UNK canidal regression; neurogenic bladder; malrotation; club f OTH PVT Unknown 0 PVT UNK Cough; URIAtopic dermatitis; Milk allergy (red spots on mouth) 1 PUB PUB 1 PVT PUB 99 PVT PVT OME; URI Hx takes x 2; speech delays; OME 1 None PUB OTH None None 0 Unknown PVT PVT Unknown Drug hypersensitivity; Diabetes; Hypertension; WAES0903USA02427 Hyperlipidaemia; Obes 0 Ultrasound,OTH normal; Ultrasound, OTH normal; QVAR;Ultrasound, fluticasone; Pregnancy normal; SINGULAIR Hospitalisation NOSUltrasound, (LMP = 4/28/2008); normal WAES0807USA00609 Asthma; Hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA02931 ultrasound, OTH normal; beta-human OTH chorionic, 12/05/07, Pregnancy positive; NOS serum (LMP =alpha-fetoprotein, 8/10/2007); WAES0801USA00529 Nausea normal Unknown OTH OTH Unknown Unknown WAES0903USA02626 0 None OTH OTH Unknown None WAES0903USA02913 Unknown OTH OTH Unknown Unknown WAES0903USA02548 0 None OTH OTH None None WAES0903USA02604 Unknown OTH OTH Unknown Unknown WAES0903USA02370 0 Unknown OTH OTH None WAES0903USA02366 344 Unknown OTH OTH Unknown None WAES0903USA02364 None OTH OTH None Hypersensitivity WAES0903USA02363 Unknown OTH OTH Unknown Unknown WAES0903USA02306 Unknown OTH OTH Unknown Unknown WAES0903USA02292 1 None OTH OTH Unknown Unknown WAES0902USA03560 UNK OTH OTH Unknown A0774199A 1 Abdominal PVT X-ray series, PVT normal; CBC, nonenormalnone none. PMH:none t number not reported) on notanreported unspecified OTH date.OTH 24 hours post vaccination the patient experienced a temperature ###of 100 degrees Fahrenhe 1 None OTH OTH None None None 1 CBC. BloodPVT and urine cultures PUB None Few red papular None scattered on chest 1 PVT PVT 0 OTH OTH Resolving URI None 0 PUB PVT Same~Pneumo (Pneumovax)~1~0~Patient PVT PUB Slight Cough PUB UNK TOPOMAX; SEASONALE Allergy to ASPIRIN; Chiari malformation 1 PVT UNK Same~HPV (Gardasil)~UN~16~In Patient 5 Testing by private PUB physician PUB unknown Unknown None Unknown 156 PVT PVT Lisinopril; TOPROL; none Pravastatin; Penicillin; Sulfa Vit; Calcium allergies; High BP; Epilepsy 0 PVT PVT SINGULAIRNo Demerol; CEFZIL; Hives~Measles MMR #2+vaccination; Mumps + Rubella (MMR vacc (MMRper II)~2 M 0 None PVT PVT Zyrtec None Environmental allergies & foods also 1 None PVT PVT Allegra None None 0 None PVT PVT PCN allergy, rash~Varicella gold sodium thiosulfate (Varivax)~2~10~Patient 0 PUB PVT No reactions prior or since but we switched to D 0 CBC; CMP PVT PUB None "stuffy nose" GE Reflux 1 PUB PVT ID09002 1 None PVT PUB None None PCN IDO9003 0 Blood & urine OTH tests were PUB "negative"; DAQUIL Positive forstrep Sore cold throat, throat (sore AUGMENTIN throat) 2Cough X 3/7/09 causes rash ID09004 1 PVT PVT ERRIN .35 mg tablet; CLARITIN; FLONASE; ASTELIN; IBUPROFEN
OTH PVT PCN allergy 1 PVT PVT none none 2 None PUB PUB None None None 585 PVT PVT 2568 PVT UNK 1 MIL MIL HETHATREX; rheumatoid COMADINE; Arthritis PREDNISONE; PLAQUINIL; FOLICACID 1 PVT UNK 2 Referred toPUB PMD and/or PVT Allergist for PPD; eval. On "allergy shots" Mult. environmental allergies: Incl. "Molds and dust" 8 None PVT PUB None 10 Viral cultures MIL for small MIL pox were sent none by myself nofor the health seasonal department allergies 2 PUB PVT Ear surgery 1 PUB UNK dimetap, half cold recommended none dose of tylenol 2 PVT PVT Flovent NONE Asthma/allergies Hep B surface PUBAb on 3/10/2009 PUB was Unknown "negative" No Unknown 4 none MIL MIL None Not previous NKDA to the vaccine Hep B surface PUBantibodyPUB (post-vaccine) Unknown drawnNo on 3/10/2009 Unknown was "negative" 1 UNK UNK none uri 2 none PVT PVT none none none 0 PVT UNK penicillin allergy 0 PVT PUB 2 UNK PVT Slight cold Sulfa, Zithromax, Keflex 1 UNK PVT Tramadol, HCTZ, None notedPenicillin Trazodone, Simvastatin, and Sulfa allergies Minocycline, Gabapentin, Meloxicam 1 NA PUB PUB None None NKDA 1 UNK UNK None None 0 N/A MIL MIL N/A N/A 7 PVT PUB No No 1 MIL MIL None. None. None. None.~ ()~NULL~~In Patient 13 PVT PVT none minor cold or none cough 88 Spinal tap, OTH 21 or 22; No OTH reflexes in feet and legs None 20th. Labs Lowand back Diagnostics: surgery 10/2006; LP with High normal blood cell pressure; count, glucose Gout. PM an 0 PVT PVT None None allergy to azithromycin - vomiting PMH: hives approx 6 mo 1 PVT PUB Vitamin D deficiency; CA breast; CA colon 0 none PUB OTH Rash on body none 0 PVT PVT none none 1 Migraine released OTH fromPVT ER at 7:45pm None None 7 None PVT OTH None 0 none PVT UNK TYLENOL 3; none BENADRYL Sulfa; NSAIDS; food allergies 2 PVT PUB PUB PUB No Allergic to PCN, Erythromycin PUB PUB No PUB PUB No PUB PVT No No PUB PVT No Seasonal Allergies PUB PVT no PUB PVT No Allergic to CECLOR, CLARITIN; AUGMENTIN 1 PVT PVT None None None 0 None. PVT OTH pancreatic pseudocyst 0 blood test showed PVT no sign PUBof any kidney None problems None None 3 EmergencyUNK Room visitUNK on March 20, 2009. Blood Nonework and None CTPMH: scan were GC &performed. chlamydia vaginal All testsinfections came back 11/08. inconclu Fa 9 LABS: segsUNK 67%(H), urine UNK pH 5.0(L), BUN 19(H), none Bloodnone c/s neg, PMH: throat recurrent c/s neg, earinfluenza infections. c/s neg. CXR WNL. 5 N/A UNK UNK SIMVASTATIN NO -10MG ANNUAL QD, DYSLIPIDEMIA PHYSICAL OTC ASA 81MG QD, MULTIVITS, OTC CALCIUM 365 Labs and Diagnostics: UNK UNK EMG/NCS c/w motor neuron none disease. none MRI PMH: abnormal. ALS~Hep none noted B (no brand name)~3~35~Patient
0 none, as patient PUB only recently UNK reported unknown this. was none notnotedunknown assessed at theleft time. arm pain~Pneumo (Pneumovax)~1~58~In P 0 Called the nurse UNK this morning UNK andtakes statedno there medications none was nothing pt. had theynone couldofdo. these I asked about blood work and stated tha 1 CT, MRI negative UNK LABS: UNK WBC 10.7(N), None MCVNone 61.5(L), MCH None 20.1(L), PMH:RDW anemia. 19.0(H), plts 467(H), polys 33%(L)L. To 19 RSV Ag positive. UNK Influenza UNK A/B AgNone negative. CBC NoneWBC 21.9k. None PMH: Electrolytes none and Calcium normal. UA normal. Head Unknown OTH OTH Unknown Unknown WAES0903USA01874 Magnetic resonance, OTH 01/25/99, OTH MRI None of brain showed negative, None abnormal signal WAES0903USA01790 in upper cervical spinal cord 181 Tenzyme Test: UNKone patient UNK confirmed as Type B. Not reported ### 0 UNK UNK Fioricet No known allergies, no medical ### conditions. Had an upper r none OTH OTH ### 0 Unknown PVT PVT Unknown Hypertension; Overweight; Hypothyroidism WAES0903USA02848 0 X-ray, 12/19/08, OTH unremarkable OTH None Arthritis; Enlarged prostate (benign); WAES0903USA02914 Hypertension; Hyperlipidaemia; p 42 diagnostic laboratory, OTH Stomach OTH empty Nonetest - No results available; None. PMH: computed none.axial, NKDA WAES0903USA02570 No results available; diagnostic la Unknown OTH OTH None WAES0903USA02249 Unknown OTH OTH Unknown Immunisation; Fever; Swelling WAES0903USA02300 Unknown OTH OTH Unknown Unknown WAES0903USA02305 magnetic resonance, OTH 01/??/00, OTH results not reported; Gastrointestinal electroencephalography, disorder 01/??/00, WAES0903USA02329 results not reported; diagno Unknown OTH OTH None None WAES0903USA02563 1 Unknown OTH OTH Allergy to metals Fever WAES0903USA02567 Unknown OTH OTH None None WAES0903USA02860 Unknown OTH OTH None None WAES0903USA03197 Unknown OTH OTH None None WAES0903USA03220 126 Flu A cultured; PVTIVP, brain, UNKheart 5/20/09-records None received-CXR Ventral negative. Septal Defect 5/20/09-records received-Clinical his 0 none PVT PUB none none none -7 None PVT PVT None None None 1 OTH UNK None reported None None known 14 1) Herpes lesion PUB rapid OTH culture w/typing None2) Herpes No lesion typing (3) wound culture 9 None PVT PVT None None known None known 10 PVT PVT None known. 10 24 Feb 2009 MIL WBC BLOOD, MIL 11.4 (H) x 10(3)/mcL;RBC Pt had dental BLOOD, none surgery 5.20 one X10(6)/mcL; day after receiving Hemoglobin the SPV. BLOOD, Was15.8 treated g/dL;w 1 PVT PVT None None None None PVT PVT Iron None None 0 PVT PVT None None 0 PVT UNK 7 PVT PVT None Breast CA; gallstone None PVT UNK Concerta, Clomidine, None Albuterol, ADHD, Asthma, Flovent,Psoriasis Alclometasone 4 specimen sent PVTto lab for PVT PCR analysis LOPRESSOR, of lesions. DYNZINE, AODM, METFORMIN, HTN, ASHD, CAPOTEN, Hypercholesteremia AVANDIA, LIPITOR, K + m 22 See MRI reports OTH #7. Hepatic PUB function PERCOGESIC; test andNone CBCINDOCIN on 11-10-08; ReactiveCMP PPD on 2-17-09; CBC with diff. on 12-5-08; B-12 0 Ultrasound,OTH first came OTH back normal. Pregnancy NOS (LMP = 8/25/2008); WAES0902USA01705 Yeast infection. 0 None OTH OTH Hormonal contraceptives None WAES0902USA01848 14 ECG performed MIL 02/10/09--Normal MIL 5000001 0 PVT PVT Trazadone, NSAID, Darvacet-N-100, ASA, Celebrex, Ultra 10 ECG performed MIL 01-22-09, MIL abnormal results; Troponin I performed 01-22-09, abnormal 5000002 result. 13 Troponin I performed MIL 12/19/08; MIL ECG performed 12/19/08; MRI performed 12/22/08 5000003 11 Troponin I preformed. MIL MIL ECG performed. Shortness of Breath 5000004 7 Diagnosed UNK with Postural UNK Tachycardia noneSyndrome noneLABS: PMH: electroMVP, physiology SVT, herniated study abnormal disc. Allergy: w/atrial latex. tachycardia & a 0 None PUB PUB NONE Child not ill NONE but younger sibling had been diagnosed with pertusis and 12 member was MIL given a prescription MIL for allegra 180 mg daily 10 None UNK PUB Allopurinol 100mg None bid, NKDA. gemfibrozil Problem 600mg listbid, includes: lisinopril hypertension, 40mg daily, hyperlipidemia metolazone 2 2 No testing. PUB PVT Synthroid, Zoloft, None. Voltran. Hypothyroidism, depression, arthritis in shoulders and han 9 PHYSICAL UNK EXAM BY MD PVT XALATAN OPHTH SCIATICA DROPS NERVE GLAUCOMA AND PAIN COSOPT AND SCIATICA OPHTH DROPS, NERVE LEFT ETODOLAC LEG OCCA 4 N/A PUB UNK NONE N/A NKDA
5 None PVT PVT Pt was not ill DM, at time Sarcoidosis of vaccination 3 PUB UNK N/A none NKDA 1 PUB PUB none none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 27 Liver PanelUNK ALT+Alk Phos+Albumin+TBili+AST+GGT UNK None at theNone time Site/Specimen None 22 Jul 2008 0757 Units Ref Rng Alanine Ami 0 PUB PUB none known Nausea/Vomiting~HPV (Gardasil)~1~18~In Pa 1 PUB PUB none none none 11 UNK UNK Altace, Coreg None. CR, Lipitor, Heart Plavix, attack Synthroid. in 2006 resulting in 2 stents implanted in LAD 16 Neurologic PUB Examination; PVT Labs including heavy metal, vitamin allergic deftoand penicillin; auto immune; I have endometriosis, MRI brain scan. All test were n 1 PVT UNK None Lyme 18 PVT PVT Heart mm; patent foramen ovale vs atrial septal defect 21 UNK UNK None Pregnancy OTH test was positive OTH per Dr. None None reported. 1 PVT PUB Exercise induced asthma; Anemia. 0 PVT PVT None 0 MRI - Pending. MIL MIL None None 0 None PVT PUB None None None 6 None PVT PUB None None None 2 PVT UNK Dog bite. 0 PVT PUB None None PVT PVT None None None 2 PUB UNK No Antibiotics & occ eczema the laboratory UNK said his UNK LIVER get little damage 0 PUB MIL None. None. None. 0 Diagnostic laboratory, OTH 02/??/09; OTH Beta-human Unknown chorionic, 02/??/09, Pre-eclampsia; positive Bell's palsy WAES0902USA00596 Unknown OTH OTH Unknown Unknown WAES0903USA02949 Unknown OTH OTH Unknown Unknown WAES0903USA03341 Unknown OTH OTH Unknown Unknown WAES0903USA03254 Unknown OTH OTH Unknown Hypersensitivity WAES0903USA02086 Unknown OTH OTH Unknown Penicillin allergy WAES0903USA02561 Unknown OTH OTH Unknown Unknown WAES0903USA02926 Unknown OTH OTH Unknown Developmental delay WAES0903USA02954 Unknown OTH OTH Unknown Hospitalisation WAES0903USA03241 21 Unknown OTH OTH Aspirin; Lipitor; Calcium Unknown (unspecified); Iron (unspecified); WAES0903USA02618 Synthroid; Prilosec; Dio 7 LABS: KUBUNK revealed dilated UNK central Prevacid bowel loops Yes,&URI paucity GERD of gasPMH: in LLQ. constipation. Abdominal US (+) IS in LLQ. Air contras 8 UNK PVT furosemide 40mg, metoprolol 25mg 0 no lab test obtained PVT onPUB 3/5/09. Pt.none had positive tinea strep corposis testnone on 3/23/09. 1 none UNK PUB none none allergy to PCN 0 PUB PUB Synthroid None 2 PVT PVT Zyrtec, flovent, n/a advair seasonal allergies, asthma 218 UNK UNK COPD PMH: COPD, interstitial cystitis, HTN, diverticulosis, fibrom 0 NONE PVT PVT NONE NONE NONE 0 UNK PUB 11 Clinical diagnosis PVT PVT Prenatal vitamin none None 1 PVT PVT pantoprazole rash niacin,PCN 2 CBC normal. PVT EBV serologies UNK normal. NoneChest None x-ray and neck Noneultrasound exams were normal. 1 PVT UNK None NO 4 Extensive Blood UNK work up, UNK LactoseFoclin intolerance XR20Ittest, -isdiscontinued hard Allergy to ADHD tell testing, which November - beginning CT vaccine scans 2008 was 2006 ofdue abdomen the 5/7/09-records do most paindamaging and medicine pelvis, received-PMH: but (no Upper I school canGI, tell3atte AD yo E 1 PVT UNK none no no 4 none PVT UNK Candidal diaper rash; contact dermatitis 1 PVT PVT None Allergy- Sulfa, Bactrim 1 None PVT PUB None None None
8 PVT PVT None None NKDA 8 PVT PUB 1 None MIL UNK None Pt discontinued allergy shots one month ago. 0 PVT PVT None None Esophageal3 Reflux, hours Crying~DTaP URI (no brand name)~1~0~P 1 none UNK UNK None None 1 OTH OTH Dermatitis, back of neck 1 None OTH PVT ALLEGRA; None HCTZ; SINGULAIR; Asthma; Hay ATARAX; None~ fever()~~0~Sibling|None~ Fishoil; Calcium; Vitamin ()~~0~Patient 1 none PVT PVT none no PFAPA syndrome UNK OTH OTH Unknown The subject's medical history, A0774872A concurrent medical condition 2 MRI of IAC's PVT with gad. PVT neg for Acoustic neuroma None or otherHigh tumor blood or abnormality; pressure; High Hearing cholesterol, test - nocontrolled significant with hearing med 0 CT Scan (2), OTH OK; LabsPVT showed decrease None K+ None which Dr. said None wasPMH: due to Recent an underlying bronchitiscondition & was on they oralare antibiotics monitoring wh 0 None donePVT PVT None None None 0 PVT PVT None None 8 PVT PVT NC09013 379 EEG; occipital PVTspike and PVT wave, started Noneon DEPAKOTE URI; Headache None 2 PVT PVT 0 PVT PVT 1 None PVT PUB none none 1 Normal CBC, PVT diff. ; 2 FTS, PUBmuscleNone enzymes; ESR None16; monospot Allergic to and peanuts strep cultures and treenegative. nuts. 1 None PVT PVT None None 1 PUB OTH Vesicare; need Foodtopoisoning check Drug w/hospital Allergies- Penicillin & Sulfa 0 PVT PUB None None None 5 PVT PVT 1 PVT PUB None PVT PUB None None 0 My MD opted UNK not to test UNK me for any adverse reactions since I falsely she says tested"It's positive been for a month, HPV two I just years don'tprior seeto it."receiving 0 None OTH OTH Estrogen Patch None None 1 PVT OTH None 1986~Influenza (no brand name)~1~32~Patien UNK UNK UNK UNK 2 PVT PVT Diovan, Fultron, NoneSimvastatin, HTN, Hypothyroidism, Celebrex, Metoprolol, Hyperlipidemia, HCTZ, Calcium Obesity None PVT PVT none 0 none OTH PUB none mother stated "it's happened before", non spec 1 PVT UNK None None 0 PUB PUB BENADRYLNone night before; Hx of vitamins lightheadness with BM last summer; hx of of hives 7 PVT PUB Torticollis at birth, 1 week premie, secondary to preaclamp 2474 PVT UNK 1 PVT PVT None ~DTaP + Hib (no brand name)~4~1~Patient 1 Developed PVT Cellulitis L thigh PVT Tx with None antibiotic None - Duricet None 2 PVT PVT None UNK UNK 21 LABS: Urine PVT c/s of 2/17PVT no growth. UA 2/24 WNL. 0 OTH OTH PVT PUB Diaper Rash None 2 OTH OTH 0 MIL MIL 1 PVT PUB Scalp hematoma 1 NONE PVT PUB ZANTAC, 1ml NONE BID; REGLAN, NONE 1ml QID 1 PVT PVT None None None 0 No PVT PVT none none none 0 None PVT PVT ZPACK S/p otitis media Ragweed/dust "swelling/itching"~HPV mites/cats- Hyposensitization (Gardasil)~1~20~Patien Tx.
0 PUB PUB Seasonal allergies Heart Murmur (Infant) 0 none PVT PVT SINGULAIRnone Asthma; Eczema 7 PVT OTH PRILOSEC;None KEPPRA; Acid FEMARA; reflux;FOSOMAX; brain aneurysm; ZOCOR; remission AMBIEN breast cancer; oste 10 unknown UNK PVT Non reported Non onreported VAR on VAR 0 None PUB PUB SIMVASTATIN None Allergy to PENICILLIN; Cholesterol 2 None reported. PVT OTH Not reported. ### diagnostic laboratory, OTH H. OTH influenzae Unknown was isolated form blood Early with onset serogroup of delivery; B WAES0903USA02034 Bronchopulmonary dysplasia 0 diagnostic laboratory, OTH results OTH pending; Unknown urine beta-human, Pregnancy NOS 02/03/09, (LMP positive = 1/4/2009)WAES0902USA00936 0 None OTH OTH Calcium (unspecified); Pregnancy NOS Iron (unspecified); (LMP = 12/28/2007) Vitamins WAES0809USA04651 (unspecified) 12 Labs and Diagnostics: PUB PUB US spleen WNL. Bone None marrow bx None c/w PMH: plateletmigraine, destruction. AR0909 hysterectomy Flow cytometry with bladder with non-specif suspens 0 Pt was seenPVT in ER PUB O yaz Oc's None Allergy to Antihistamines 1 None PUB PUB None None None AR0910 0 None PUB PUB None None None AR0907 0 OTH OTH None None None UNK UNK 2 None PVT PUB None Hypertension; Hypercholesterolemia; Allergic; Amitriptyline PVT PVT None None 0 PUB PUB MO-2009-08 0 PVT PVT Vyvanse None None 0 PUB PUB history of fluAutism type A 2-3 weeks prior to vaccination 3 MRI (1/20/09)UNKpineal cyst UNK- neurosurgeon N/A validated None this was No pre-existing not impacting diagnosed any vessels issues which 3/26/09-records would cause received headac 20 UNK UNK Current meds: none 1. Toprol PMH: XL 200 DMII, mgHL, po HTN, daily 2. CAD, Aspirin Gout, 81Status mg po post dailymultiple 3. Plavixlacu 75 5 PUB PUB Yaz birth control None None None~ ()~NULL~~In Patient 1 UNK PVT None None Multi allergies - patient does not 10 24MAR09, UNK WBC, 9.0; NA, UNK140; BUN, Motrin 12;-CA, seenone 8.5; #7 HBG, 13.2; none K, 4.1; C CR, 0.9; MG, 1.5; HCT, 39.2; CL, 97; GLU, 2 UNK UNK NONE NONE NONE 1 Physician's UNK visit 3/25/09. UNK Client's mother nonestated notedshe none andreceived mother noted and denies oralmother Tylenol any.denies after the any.immunizations were giv 2 4/13/09-records UNK received-WBC UNK 11,400. Aspirin, Cultures Nexium, No negative. Carafate, Allergies: Stool Plavix, forCodeine, Clostridium Amiodarone, amoxicillin, difficile Metoprolol, negative. vancomycin, Furosemide, Verelan, Diovan, Altac 0 4/29/09-records UNK received-CXR-large UNK toprol mediastinal none mass with allergic tracheal to penicillin. displacement patient associated has history in of past high with blood retrogoite press 1 PVT PUB 10 6/18/09 Hospital UNK and outpatient UNK records received None DOS 3/23/09 6/18/09toHospital 5/4/09. LABS and outpatient and DIAGNOSTICS: records received Echocardiogra DOS 3/2 not applicable PVT PVT none none none 2 PVT UNK 12 PVT UNK cerebral palsey, environmental allergies, PTSD, multiple m PUB PUB none at clinic. None Parent reported None giving acetaminophen prior to visit. Dose not know 2 Positive ANA UNK - 3/23/09.UNK Cardiac procedure. 0 MRI of thoracic, UNK cervical UNK and lumbar Lisinopril spine. 5MRI No, mg of but Completed brain. getting High Blood over Bactrim blood tests sinus pressure for for infection sinus Lyme,infection thyroid, two Vit Dweeks deficiency, prior and comp 2 PVT PUB rash on hands Penicillin 1 None PUB PUB none none seasonal allergies NJ200901 1 PUB PUB 3 PUB PUB None H/O metal allergies 3 CBC-resultsPVT pending OTH UTI Allergies to penicillin and intravein dye, dx: myalgia in 2008 PUB PUB None None PVT PVT AMLOCLIPINE; None BENAZEPRIL; HTN; Hyperlipidemia; ATENOLOL; Depression; ALLOPURINOL; Colonic FENOFIBRATE Polyps; Hear 0 PVT PUB None None Lazy Eye L 1 CBC 12,000; PVT Sed rate PVT 70 1 See attached UNK PVT No known illness NKA 0 PVT OTH On Singulair Son 5mg was QDnot Asperger's, sick prior Asthma , Seasonal Allergies Unknown OTH OTH Unknown Unknown WAES0903USA03963 0 OTH OTH Unknown Pregnancy NOS (LMP = 12/31/2007); WAES0803USA04511 Foster care 49 ultrasound, OTH 03/16/09, blighted OTH ovum Unknown and no gestational Pregnancysack NOS (LMP = Unknown) WAES0903USA00408
1 Blood pressure, OTH 03/01?/09, OTH 94/54 RECLIPSEN; LEXAPRO Unknown WAES0903USA02617 0 Unknown OTH OTH None Pregnancy NOS (LMP = 4/8/2008)WAES0903USA03061 97 Unknown OTH OTH None Termination of pregnancy WAES0903USA04267 - elective Unknown OTH OTH Unknown Unknown WAES0903USA03605 Unknown OTH OTH Unknown Unknown WAES0903USA03764 UNK UNK Not reported. ### 1 MRI; MRA; PVT CT 4/8/09-records PVT received-WBC None None increased 11.4, Nonehemoglobin decreased 11.1 and hematocrit decrease 2 Blood work MIL LABS: BUN UNK 24(H). HBA1C 6.0(H). Flat feet-Mallet Hightoe blood pressure; Right wrist destroyed cartilage; Chro 1 LB - Lumbar PVT puncture all PVT tests nl; EEG None- WNL;None MRI brainNone. - nl; CBC, PMH:Blood recent Culture, fall without Urine apparent - nl Labs:injury LP WNL. Head 1 PVT PVT NKDA 0 PUB UNK 1 None - Allergy PVTto Questran UNK ALLEGRA; None SINGULAIR; WELLBUTRIN; YASMIN; AMBIEN; ALBUTEROL INH. 545 PVT PVT None None None 1 PVT PVT LIPITOR None None PVT PUB None NKA, Short stature 1 PVT PVT LIPITOR; SYNTHROID; None ASA; VOLTAREN UNK UNK 4 PVT UNK None 0 PUB OTH Albuterol 0.083%; Otitis media Nebulizer Tx 3 None PVT UNK None Ears-PE tubes placed for frequent ear infections All labs WNL MIL and testing MILWNL None None None 287 No labs performed UNK UNK None noted 4 Doctor's office PVTadvisedPVT none wereFinished availableatocourse None him. of AMOXICILLIN None 2 weeks prior to vaccination 2 PUB OTH AMOXIL; ZYRTEC; (R) earache PREVACID; NKDA Vitamins; Albuterol 0 PUB OTH ALBUTEROL Otitis nebulizer Media 1 PVT UNK 1 None PVT PVT None 0 None MIL MIL None None None 0 None MIL MIL None None None -41 ultrasound 7/28/08 OTH - normal, OTH second Unknown trimesterPregnancy NOS (LMP - 3/11/2008) WAES0804USA02884 0 Diagnostic Laboratory OTH OTH 04/04/08 - routine Vitamins prenatal Pregnancy tests WNL; Cannabis NOSDiagnostic (LMPabuse; = 2/20/2008); Laboratory Papanicolaou WAES0805USA01280 Tobacco 07/22/2008 smear abuse; abnormal - routine Nicotine prenatal depend t 0 diagnostic laboratory OTH - OTH prenatal screening test: WNL; diagnostic Asthmalaboratory - QUAD WAES0805USA02022 screen test: WNL; ultrasound 0 UNK UNK 4/1/09-records Lidocaine, received-Cough Fish 4/1/09-records prior to vaccine. received-PMH: food allergie 1 None. PUB PUB 1) Glucosamine Nonechondroitin reported. 1) Knee POpain BID,(client 2) Cymbalta runs 4560 - 50 mgmiles/week). PO QD. 2) Anxiety a 0 PUB UNK NONE 0 N/A MIL MIL Diazepam 5mg N/A daily, Atorvastatin Hypertension, 10 Hypercholesterolemia, mg daily allergic to adhesive t 0 PVT UNK None None 0 PVT PVT methylphenidate, Excessive daytime none sleepiness 0 UNK UNK SINGULAIR 0 UNK UNK MultivitaminNone General allergies 6 None PUB UNK None statedNone stated, None however, noted.client had received a very large tattoo (solid bl PUB PVT Levemir, novolog, substance asa abuse, 81 mg,diabetes lsinoprl, metformin type 2, hepetitis C, GERD 0 UNK UNK Reflux (GERD) None Crying~DTaP (no brand name)~NULL~~In Sibl 0 PUB UNK Premarin none Diabetes controlled by diet 1 Labs at ED UNK visit showed UNK slighty elevated Xanax as WBC needed, Had count...remaining rash Flovent over asthma, forearms Rotadisk labs, depression vomiting~Hep and inhaler including backasof liver needed, neck B (Recombivax function of Serevent unknown panelHB)~1~34~In Diskus were originnormal. prior inhaler toPa re La 8 SEEN BY NEUROLOGY PVT PUB PHYSICIAN MOTRIN AND NOTED THAT PATIENT HAS SIGNIFICANT IMPROVEMENT HAS BE 1 Saw MD, unknown UNK UNK None Known None Known 0 UNK UNK None known None None known 0 None MIL MIL None No None 0 Diagnosed PVT with TMJ. Full PVTblood work-up shows signs of Epstein Barre none PVT PUB
0 26 March 2001: PVT MRI ofPVT cervical spine showed HEART moderate MURMUR, AUTOMOBILE cervical MIGRAINE, spondylosis ACCIDENT, PALPITATION, more A0756654A prominent CARPALTENSION TUNNEL to the left HEADACH RELEASE of midline 23 October PVT 2001: LymeOTH Elisa TiterGarlic; IgG: less Fishthan Back oil; Cod-liver 80; Pain Lyme Hernia oil; Western Calcium Blotsalt IgG and A0765787A IgM were negative; MarDx Weste 27 MRI and Lumbar PUB puncture PUBon 12/7/08 Aspirin at hospital. 81mg's No daily Medical 5/22/09 Flat center-Lyme Feet Hospital 5/22/09 titre, records Hospital Influenza MA0903 received records testing DOS received 5/22/09 12/7/08 DOS Hospital - 12/12/08. 12/7/08 rec2 4/17/09-records PVT received-Westergren PVT sed rateNone increasedNone 28, C-reactive protein increased 4.9. 0 LABS: CXRPVT WNL. EKG UNK w/incomplete right BBB. No Cardiac Diabetes; enzymesHypertension; neg. CMP WNL. Chronic WBC airway 10.5 obstruction PMH: 6 LABS: CSF: PVT WBC 4(N), PVT RBC 267(H), NoneproteinPossible 36(N), glucose start Brain of 104(H), cold anomaly perneutros mom left hemisphere; 27%(L), lymphs ASD; 13%(L)bands Hypotonia; Intrauteri 47%(H 19 PVT PUB Fluoride (+) BOM nkda 1 CBC + CXRPVT PUB Cough None 1 None PVT PVT None None Intravenous drug abuse; Seasonal affective disorder; Depr -27 None PVT PUB None None 1 none PVT PVT Multivitamins; none calcium;ADHD ST JOHNS WORT 1 None PVT PUB None None None 3 none-all perPVT pt PVT CLARITIN; none PANTOPRAZOLE; Osteopenia; ESTRIVG; hx ovarian Vitamin neoplasm D + calcium 2 PVT OTH Autism 0 PUB OTH Pt states none. No NK 1 PVT OTH None HTN / Dermatitis 5 OTH PVT ATENOLOL; RELPAX 0 PUB OTH MOTRIN 600 mg Allergic to tetanus, DM, HTN PVT PVT None None None 0 none PVT PVT none none 1 UNK UNK TENEX 1mg None OD; RISPERAL ADD; ADHD 25 mg 1 BID 1 PVT PVT Rt Otitis Media NKMA PVT OTH HTN; Triglycerides; reflux; myopathy; pelvic pain 0 UNK UNK None None 0 PVT UNK None None 0 Unsure of ER PUB reportedUNK this event None 1 None MIL MIL None. None. None. 0 PUB UNK none none 29 Pap test; Cervix OTH HPV DNA OTHassay, Unknown positive Pregnancy NOS (LMP = 1/14/2008); WAES0803USA00457 Penicillin allergy beta-humanOTH chorionic, OTH 01/??/08, positive None Pregnancy NOS (LMP = 1/15/2008) WAES0803USA03393 0 Pulse Oximetry OTH03/05/09, OTH 78 ; Pulse Unknown OximetryHypersensitivity 03/05/09, 92-93 WAES0903USA03647 Unknown OTH OTH Unknown Unknown WAES0903USA04016 Unknown OTH OTH Unknown Unknown WAES0903USA03176 2 PUB UNK Pickles (allergy) LA090301 None OTH OTH Unknown Disbacteriosis; Penicillin allergy; General WAES0903USA03666 symptoms Unknown OTH OTH Unknown Unknown WAES0903USA03958 Unknown OTH OTH Unknown Unknown WAES0903USA04509 PUB UNK LA090302 8 PVT PUB 0 None OTH PUB Tubersol, Sanofi none Pasteur, none C2921AA, R forearm, 1 previous dose 13 None PVT OTH None None None 367 PVT PVT None PCN 2 None PVT OTH None Allergic Rhinitis injection site redness + swelling~DTaP (no bran 1 PVT OTH None Heart Murmur Injection site reddness, swelling~DTaP (no bra UNK UNK None None UNK UNK None None was reported PVT via phonePUB 3-23-09 to adverse reporting. 0 None PVT PVT None URI; Fever None 0 None PVT PUB None Tinea Corporis None 0 Rapid streptMIL Positive 3-2-09, MIL ESR-Zyrtec 51, C reactive proteinPenicillin 73.9, Flu A&B negative, myoglobin 81, CBC WBC 12,100 88 Guillain Barre UNKLABS: ESR UNK13, CRP 03/05/2009 0.76. Sodium NONE lEVAQUIN 129, chloride NONE 750, IBUPROFEN TO 96(L), MY NONE~ creatinine KNOWLEDGE 800 ()~~0~Patient|UNKNOWN 02/27/2009 0.5(L).PMH: Liver MIRAPEX, back enzymes pain,TO FLUTICAS depression WNL. ME~CS ()~
645 NONE PVT PUB NONE NONE NONE 0 EKG, MRI, UNK Bloodwork,UNK Urine Analysis. OrthoTriCyclin Labs and No Diagnostics: Lo. I have Allergic been Head to onNuts, Health CT it since (-). Latex,Cats Problems Cerebral August 2005 MRA and including Seasonal and (-). MRI never Fainting~HPV brain Plants. experienced (+)PMH: for(Gard L ma pr L 2 PVT PVT none Dep-Provera, adhesive tape, endometriosis, migraines 3 PUB PUB UNKNOWNNONE NONE 28 LABS: CBCUNK WNL. Sodium UNK 127(L).rosuvastatin, CSF: protein none cyclobenzaprine, 130 (H),diabetes, glucosenaproxen, hypertension, 78(H), WBC doxazosin, 33(H), hyperlipidemia, lymphs finasteride 26%, degenerative neutros 73%, jointR 4 NONE PVT PVT NONE PUNCTUE PCN,LATEX,CODEINE WOUND TO FINGER 1 UNK PVT no allergies: penicillin, swelling codeine, in hands morphine, and face; flu-like cefoxitin, sickness~Te tetanus, m 7 PVT UNK none no none 1 CT Scan, blood MIL work, chest MIL x-ray. None None 5 LABS: WBCUNK 29.3, segsUNK 42%(H), monos none 11%(H), no plts 118(L). none LDH 1394(H), Triglycerides 242(H), HDL 17(L), AST 0 None ordered UNK at that time UNK None None No known allergies. None~ ()~~0~In Ear infections PatientJan 2009. 1 LABS: CT abd/pelvis UNK abnormal UNK c/w diverticulitis diverticulitisallergy & possible abscess to aspirin and Tolectin PMH: HTN, hyperlipidemia, 1 MIL UNK no allergies 0 N/A UNK UNK none none Hx: febrile seizure. Allergies: PCN and Amoxicillin 0 PUB PUB unknown unknown unknown 1 Blood tests,UNK spinal taps, UNK EEG's and others. Labs none and Diagnostics: EEGs abnormal. MRI brain WNL. Holter WNL. U 1 PUB PUB None None Redness~Varicella (no brand name)~1~1~Patie 1 None PUB PUB None Not known OTH OTH Phenobarbital, Allergy Tenor to chemicals; Min, Blood Lisinopril, arsenic Weight Avinza, increased decreased; Simvastatin. MA20090648 metal poisoning; pain; Distur None PVT PUB None 1 None PUB PUB Asthma 753 None OTH OTH None; afebrile NKDA; questionable Asthma hx 0 CBC; SMA;PVT U CX; Blood UNK culture LABS: TYLENOL CBC,None metabolic Sp tests recent & UApyloric WNL. stenosis Blood c/s repair. neg. PMH: GERDs/p pyloric s 2 No test done PVT PVT No known illness NKA 0 None PUB PUB None None None 0 PVT PVT PREM Pro 2 ? degree mcg; PERCOCET partial Codeine thickness Sensitivity 5/325 burn mg -> leftTachycardia foot 1 PVT UNK Albuterol, HFA No inhaler Asthma, Carisoprodol HBP350mg, Menest 0.625 1 PUB PVT No None Stated None Stated 3 PVT PVT None None None PUB PUB NONE NONE Allergies 10 None PVT PUB None None None 0 OTH OTH FOSAMOX;None LOVASTATIN None 2 PVT UNK 1 PVT PUB SYNAGIS, MedImmune, 31301723 4/11, IM, Rt thigh, 2; Polyvisol 0 PUB PUB None None 2 PUB UNK PPD Sanofi,None C3036AA, R-LT 0.1CC 0 PUB PVT No known illness NKA 1 OTH PVT None None OTH PVT None 0 PVT PVT None None None 0 PVT PUB LANTUS; NOVOLOG; none TI insulins DM; no known Urticaria~Influenza allergies but positive (no brand eosinophils name)~2~7~Patie 11 None OTH UNK MOTRIN; TYLENOL None Dermatitis 1 OTH PVT none PVT UNK None 1 CBC; CMP;PVT ESR; CPK;PVT UA Labs: CK 456, otherwise WNL. ADD PMH: ADHD 1 Labs; 05FEB2009; PVT Egg, PVT white 703Unknown 0/I; Egg, yolk denied 451 neg;seasonal Egg, whole and Hives/rash~Hep 604 food0/I; allergies GelatinB (Bovine) (no brand 237, name)~1~0~Patie neg; Latex 487 1 Unknown MIL MIL denied denied 0 N/A UNK PUB N/A No illness atNo time known of vaccination. pre-existing diagnoses or medical conditions. 0 PVT PUB UNKNOWNNONE N/A DIZZINESS~HPV (Gardasil)~2~15~In Patient 6 3/4/09 TRADITIONAL UNK BLOOD UNK WORKUPS NONE. 6/4/09 FOUND NONE Hospital ELEVATED 6/4/09 records Hospital LIVER received NONE~ ENZYMES, records DOS ()~~0~Patient 3/20/09 received ANEMIA,ELEVATED toDOS 5/9/09. 3/20/09 Several to BLOODP 5/9/09. antibioti P 6 see above -PVT ESR 7, WBC PUB7.0 withpulmicort 2 Bands, and 36 none SEGS or albuterol and Asthma 43 lymphnone~ and 14()~NULL~~In MONO. HgbPatient 12.9
1 none PVT PUB 0 UNK UNK None Allergic to cats and history of asthma 0 UNK UNK None Cronic hay fever 1 Tsh <0.005,PVT tt4 and tt3-nl, UNKthyroglobulin none antibodies-elevated none none at 26. Thyroid us-nl, RAIU-markedly low. 1 UNK UNK none htn, chf, hypothyroid, hypoglycemic, arthritis, anemia,gerd. 6 Labs and Diagnostics: UNK UNK EEG 2/3/09 WNL withnone bacgroundnone slowing. PMH:EEG none3/4-5/09 abnormal (+) seizures. MRI brain 1 UNK UNK Possible viral Clubfoot infection (R).(clear nasal drainage, didn't feel well, nothing s 140 09/Mar/2009: PVT InfluenzaPVT virus A&B IgG, IgM and IgA ABS,Not Influenza reported. A: From IgG, (4.94), information IgM### (1.09), received IgA17 (1.4); March Influenza 2009, th B Not reported UNK UNK The reporter's niece experienced ### serious seizures followin Not reported UNK UNK The reporter's son experienced ### a seizure following DTP va 1 OTH OTH PHENERGAN; nonetopiramate; hypothyroid; SEASONALE; depression/social ROBAXIN; anxiety B12 injections; disorder;EPI insulin PEN;res P 1 MIL PUB none none NC09023 5 None PVT UNK None 3 Had first dose PUB of varicella PUB before first birthdayBrother (7-9-97)(age 10) had outbreak of varicella 2wks prior to patients outbr 1 UNK UNK PPD, SanofiNone Pasteur, C2908AA, None Intradermal L forearm 5 PUB PUB 2 None donePVT PVT Unstable angina CAD; HTN; ASCVD S/P; STENTS; CHRONIC DEPRESSI 2 PUB PVT 0 PVT UNK No No 1 PUB OTH None None None~ ()~~0~Patient 22 Unknown OTH OTH Unknown ### 1 CT Scan (Computed OTH tomography), OTH EEG (electrocardiogram) NKAwere normal. ### None OTH OTH None None WAES0903USA04260 Hematology, OTH results not OTH reported Unknown None WAES0903USA04265 diagnostic laboratory, OTH ?/?/07, OTH rubella Unknown titers was very highNone WAES0903USA04534 0 Unknown OTH OTH Unknown WAES0903USA04681 Unknown OTH OTH Unknown Oesophageal acid reflux; Autism; Penicillin WAES0903USA03608 allergy; Environmental alle 0 ultrasound, OTH 04/29/08 OTH Vitamins (unspecified) Pregnancy NOS (LMP = 12/10/2007) WAES0805USA01355 0 Unknown OTH OTH None Pregnancy NOS (LMP = 5/17/2008); WAES0808USA02136 Anaemia 7 PUB PVT 10 OTH PUB Otitis Media 1 None PVT PUB 0 DATE OF0VACCINE illness seasonal ml allergies 0 None PVT PUB None Mild gastroesophageal reflux symptoms - not treated 2 PUB PUB GA09011 1 PUB PUB none reported GA09010 5 PUB PVT Denies None GA09009 0 PUB PUB GA09008 1 PUB PUB NO NO NO GA09007 0 PUB PUB none none allergic, yellow dye GA09006 0 NONE PUB PVT ATENOLOL; NoBP pill; Lisinopril Hypertension; high cholesterol GA09005 Diagnostic Results: OTH 09 OTH August 1999: Lyme ABUnknown IgM Interp., Lyme EIADisease. was positive; The subject's Lyme A0605475A IgGmedical and IgM history, Western concurrent Blot werec 1 none PVT PVT no no no 0 PVT UNK Atenolol, Isosorbide, H+P R hand Cal PCN, Ulner withDarvon, Vit nerve D, vit (Numbness) Demerol; B12, ASA, CAD, MVI, HTN, Prilosec hyperlipidemia 1 None PUB PUB None 0 PUB PUB none knownUnknown Unknown, MD checking MI2009003 for underlying conditions. 0 None PVT PVT None Laceration ,Drug left hand allergies, codeine, Hydrocodone, mycins, sulfa 0 Normal PVT PVT 0 PUB PVT none none none 1 UNK UNK NONE 0 UNK UNK NONE None Gardisal was the vaccine given on 3/27/09. It wasn't listed 0 UNK UNK METOPROLOL NoneSUCCINATE Allergies 100MG - NKDA; SAPast TABMedical - ONE-HALF History TAB - osteoarthrithis, DAILY; NAPRO hy
3 PUB PUB Lanisporil HCT none Borderline High-Blood Pressure 7 Unknown 4/2/09-records UNK UNK received-Labs Unknown WNL.Unknown Unknown 1 NONE NEEDED PVT PVT ESTROGEN, NONE MULTIVITAMINS, HEALTHYCALCIUM WOMAN NONE~ ()~NULL~~In Patient 3 PUB PUB None None 0 PVT UNK Levothyroxine None Hashimoto's; ulceritive colitis 1 PVT UNK 81 mg aspirin, none vitoryin, diovan, multi vit, vit c 0 PVT UNK prilosec None mild hay fever, mild asthma, irritable bowel, stomach ulcer 31 UNK PVT 81 Source undetectable MIL through MIL imaging Denies studies.Denies 4/13/09-records Deniesreceived- CSF opening pressure low. MRI demonst 1 PVT PUB None None None 0 None PVT PVT None None 0 PVT PUB 1 ESR; CBC;PVT Troponin;PVT Creatine Kinase copy enclosed (copyHere attached) for physical Problem list enclosed PVT OTH Edema; Redness 0 PVT PVT OCUFLOX mild eye drops upper respiratory none infection; conjunctivitis 0 PVT PVT NKA PUB UNK 23 PVT OTH 18 Confirmed to OTH be vaccine, PUB associated rash via None culture/sequencing Profound mental retardation; CT200906 seizures; cerebral palsy; scol 0 OTH OTH ACTONEL; CA+ Supplement; HRT; Glucosamine PVT OTH 2 PVT PUB TYLENOL UNK UNK N/V; shingles PVT PVT AURAGLAN, Left ear otitis drops media 12 ultrasound, OTH 01/31/08, 7w5d, OTH reason Unknown for test: Dates; diagnostic Lactose laboratory, intolerance 01/31/08, WAES0803USA01775 routine laboratory tests for preg Surgery, 3/19/09; OTH Temperature OTH measurement, Unknown 3/??/09 Unknown WAES0903USA04013 Unknown OTH OTH Unknown Unknown WAES0903USA04572 3 Electroencephalography, OTH OTH came back 6/4/09 normal; DC and Convulsion Computed hospital6/4/09 axial, disorder records came DCreceived and back hospital normal; DOSWAES0903USA04669 records 3/28/09/ Magnetic received to 3/29/09. resonance, DOS Depo-Provera 3/28/09/ negative;toC3 315 Unknown. LABS OTH and DIAGNOSTICS: OTH Unknown PAP Smear - Negative Unknown for Intraepithelial WAES0903USA04692 Lesion or Malignancy. Gen probes f 636 diagnostic laboratory, OTH Rotavirus OTH test: Unknown positive Unknown WAES0903USA04586 0 hematologyOTH OTH None WAES0903USA03246 Unknown OTH OTH Unknown Unknown WAES0903USA03954 Unknown OTH OTH Unknown Unknown WAES0903USA04221 Unknown OTH OTH Unknown Unknown WAES0903USA04679 Unknown OTH OTH Unknown Unknown WAES0903USA04682 Unknown OTH OTH Unknown Pyloromyotomy WAES0903USA04714 0 Unknown OTH OTH Unknown WAES0903USA04713 Unknown OTH OTH Unknown Unknown WAES0903USA04843 Unknown OTH OTH Unknown Unknown WAES0903USA03663 Magnetic resonance OTH imaging OTH (MRI) was performed, including The patient T1, T2 had fluidno attenuation history of inversion antecedent ### recovery febrile (FLAIR), illness, tra a Not reported OTH OTH Not reported ### 0 WBC: 14.2;PVT Hb: 10.9; Platelets: OTH 249; Segs: 61; None Lymph:30; Asthma; Eos:2; Chronic Sed rate:constipation. 27; Sodium:PMH: 140; Potassium: asthma. constipation 3.2; CP: 1 62 Misdiagnosed PUB as foot fungus PVT in May 2008. Misdiagnosed None PMH: in Oct.borderline 2008. Diagnosed HTN. ITP in Feb. 2009. Labs: Platele 12 Troponin: records MIL say MIL 'elevated' but LISINOPRIL awaitingNexact one reading HTNfrom PMH: civilian HTN, records; shoulderCardiac surgery. Cath: Family 12 Feb hx: CAD 09 "small OTH OTH Unknown No per mother Unknown 1 Pt diagnosed PVT with the Flu PVTA positive Singulair on 3-28-09 5mg, Zyrtec, Asthma, Pulmicort,allergies Xopenex (seasonal) eczema. 1 None PVT PUB OMNICEF ABD. Pain None 3 PVT PVT GLUCOSAMINE Unknown Hirsuitism 1 PVT PVT 0 PUB PVT None none none 0 PVT UNK Upper Respiratory No Injection
1 X-ray, right PVT shoulder; CBC PVT none PVT PVT none none 2 None PVT PVT None None Allergic to AUGMENTIN PVT PVT 0 None OTH PVT None 1 PVT PVT none 15 EKG; CMP;PVT CT; MRI; (Results UNK pending). diarrhea 2 PVT PVT Glucophage, None Accuretic,NKDA Zetia, Amaryl, Aspirin & Nexium 1 PVT OTH None None PVT PVT None None None 2 PVT PUB 605 11/10/06 VARICELLA OTH ZOSTER PVT IGG ACTONEL test -> negative None 35 mg. 1/wk.; Horse CELEBREX derived products; 100mg. 2/Day; Paper COSAMIN tape; Lactose .05 intolerance; 2/day; CRESO 2 PVT PVT FLEXERILL; None FENOFIBRATE; Ace inhibitors ODOCET; DYAZIDE; K-DUR; ATENOLOL; CITALE 1 UNK UNK None febrile seizures 2 PVT UNK MAKIDE; VYTORIN; none ASA none; prostate ca; CAD; HTN 0 PVT UNK none none COPD; Mitral valve prolapse 0 None PVT PVT NONE NONE 12 None PVT PUB None Expressive language disorder, 315-31 2 See attached PVT PVT None None None 0 NI KP 3/25/09 OTH PVT FLEXERIL N/A 10 TID, KP 3-25-09 INDERAL migraines, 40 mg pinched BID, PROMETHAZINE nerve in back, allergic 25 mg to PRN, AMOXICILLIN AMITRI 0 NI KP 3-25-09 OTH PVT Birth controlNone pills allergic - PCN - AMOXICILLIN - BACTRIUM MIL MIL 15 MIL MIL OTH UNK None 0 PVT PVT 1 None PVT PUB POLY-VIT-FLUOR None 0.25 Milk mgDigestaut allergy 0 Hospital records UNK pending, UNKexpected gabapentin, to includeAcute lisinopril, culture exacerbation and Nexium, Coronary sensitivity simvastatin, ofartery chronic datadisease bronchitis metoprolol, s/p PTCA, Plavix, COPD, Azmacort, hypertension, Zetia, Ac 1 None PVT PVT Levothyroxine, Zyrtek 1 office visit confirmed PVT urticarial PVT rash on trunk and neck 0 none PUB PUB N/A None None N/A~ ()~NULL~~In AZ0903 Patient 34 an ultrasound UNK and MRIUNK were obtained noneprior tono surgery eczema, perinatal HIV exposure NO PVT PVT NO KNOWN NO MEDICATION ILLNESS ALLERIC TO PENICILLIN AND SULFUR ABOUT THE AG 1 None Available UNK4/10/09-records UNK received-Abdominal None Known None known ultrasound None known negative for intussusception. Stool guaiac negative 3 None PVT PVT NONE PMH: Allergy to PCN, Hereditary Hypertension 0 PVT PVT 0 No known tests/lab PUB data. PUB Asthmanex,No Nasonex, known illness Asthma.Allery Singulair, Albuterol to Penecillan inhaler and Cefzil. 1 NO TESTSPVT DONE. PVT NONE NO ILLNESS CHICKEN-POX ON 1/4/07 ALLERGY TO AMOXICILLIN 3 0 Blood drawn UNK on 03-31-2009. UNK Tests None ordered unknown.MRI None known Reports of head eczema on 04-01-2009 and icthyosis. 4/6/09-records Allergies received-TSH, to nuts, crab, and CB 0 PVT PVT None known None known 3 UNK PUB 1) ESCITALOPRAM 5mg Problems: 2) EZETIMIBE Depression 10MG/SIMVASTATIN Hearing Loss Valvular 40MG Heart 3) FENO Disea 1 none PVT PUB Tylenol None None 15 See Above....Toxicology UNK UNK test wereVisad, deniedAminophylline, by See DR. that Above help 2Anemic, ortypes 3we positions will Thrush head be Stopped happy in was medication, care Dolicephellic, to Breathing ofapprove child Am and and realese Had this Poor blood was ofFeeding~Hep entire a transfusion, conflict medical of inte BSe h (n 1 abdominal scan UNK reveals PVT several enlarged None lymph None. nodes. Wassecond None in very scan goodtaken healthtwo months later, reveals lymph nodes PVT OTH None None Eczema 4 None PVT PUB PPD Pasteur None C2920ABNKDA; L forearm None 1 1 PVT PUB None None None 0 OTH PUB None PUB UNK None None None 2 None PVT PVT PVT OTH Calcium; Iron; FLONASE; Celiac LEVORA; dis.; Allergies; Loratadine Pollen; Chocolate; alcohol; talcum po 1 PVT PUB None None
0 OTH OTH PCN - hives 0 None PVT UNK None - Healthy baby 4 CBC - CRPPVT - mono - negative; PVT H simplex; urine none culture; strep for A; labia cx - negative 5/21/09 Medical records rec 10 PUB OTH none none 0 PVT PVT None URI 0 None MIL MIL None 1 None PVT PVT 0 UNK UNK UNK Unknown A0774690A 0 UNK UNK NO NO NO 28 body weightOTH measurement, OTH 10/09/08, 4.6 IB; body Bottleweight feeding; Diaper measurement, Colic rash; Head 10/07/08, discomfort; WAES0903USA04224 5 LBNasal 12 ounce congestion; Runny no None OTH OTH None Milk allergy WAES0903USA04860 Unknown OTH OTH Unknown Gene mutation WAES0903USA04869 Unknown OTH OTH Unknown Unknown WAES0903USA04886 0 Ultrasound,OTH 03/20/08, dating; OTH Beta-human Vitamins chorionic, (unspecified) Pregnancy positive Low NOSgrade (LMP squamous = 2/4/2008); intraepithelial WAES0803USA01840 Sulfonamidelesion allergy 0 ultrasound, OTH 02/03/09, 6OTH weeks 3 days Noneintrauterine Pregnancy gestation NOS (LMP = 11/12/2008) WAES0901USA02732 0 None OTH OTH MOTRIN None WAES0903USA04863 Unknown OTH OTH Unknown Unknown WAES0903USA04907 Serum prostatic OTH acid, positive OTH Unknown Unknown WAES0903USA04916 1 4 MRI's & EMG OTH4/13/09-records OTH received-EMG None demonstrated None presesence of devervation in deltoid muscle. MRI of 1 None PUB PUB None None Seizures as infant - up to age of two; traumatic birth. 19 None UNK UNK METROPROLOL SUCCINATE PMH significant 100MGforSAHistory TAB; NAPROXEN of MI - 2years 500MG ago with TAB; 1 stent SIM 6 Rotavirus - PVT Stool positive PVT 1/14/09 0 None OTH OTH FluconazoleNone start 3/25;DILANTIN; HCTZ; Simvastatin HTN; Chronic ; PSA;back Pantoprazole; pain; Obesity; GERD None PUB UNK None NKDA 1 PUB PUB None Rash on face Mom states last month treated at hospital for rash on thigh 1 Went to Walk-in OTH ClinicPUB today - Dr Metoprolol said reaction 50; Rash with Digoxin; going his COUMADIN up Warfarin arm 0 PUB PUB NONE NONE 6 UNK UNK vitamins none none fever,headach,vomiting, upset stomach,sore th 0 PVT PVT Metoprolol XL Chest 50 mg painQD, Sulfa NOS Hyzaar drugs100 mg QD, Crestor 10 mg QD 28 MD tested for UNK Lyme disease UNK and other NonevectorNo diseases--all None negative. Had CT scan that ruled out any tumors. MD 8 PUB PUB NO NONE NO~ ()~NULL~~In Patient 0 PUB PUB Cough 0 NONE PUB PUB NONE NONE NONE DIZZINESS~ ()~NULL~13~In Sibling1 1 N/A PUB PVT Triamterene, None allergy serum Allergies shots to1Xweek, Rash/itching/joint trees, grasses, multivitamins, weeds pain~Zoster in supplements SE LA; (nomild brand hyperten name) 0 no diagnoticUNK tests UNK Albuterol MDI No inhaler acute illness NKDA, Exercise induced asthma 0 NONE PUB PUB NONE NONE NONE FAINTING~ ()~NULL~12~In Sibling1 1 Cellulitis UNK UNK 1 PVT PVT NONE OSTEOPENIA; LUNG CANCER NEARLY 5 YEARS AGO; 0 none PVT PVT NO LEFT EAR DEFORMITY 1 PUB PVT Hypertension 0 None PUB PUB 1 PUB PUB None None known. PDA closure 04/09/2006 1 PVT PVT n/a n/a Less mobility - major bumps in legs~DTaP + IP 0 PVT UNK Vitamin K Injection, None Erythromycin Unknown Eye Ointment 1 UNK UNK HCTZ, amlodipine, unknown/none levothyroxine, Pt had lumpectomy alendronate 3 years ago. 1 UNK UNK 3 2-Nov-2008, OTH CT scan head, OTH normal; Concomitant Platelet count, Seizures; Drug(s) 11/02/08, Febrile Not Abnormal Reported 271; seizure WBC, development: 11/02/08, MEDI0008057 at 11.2 2 years had developmental leve 0 8/5/09 Medical PVTrecordsPVT received DOS 3/27/09. None LABS and8/5/09 DIAGNOSTICS: Medical records CT Brain received w/o Contrast DOS 3/27/09. - Moderate Asthma, ethmo ex 0 PVT PVT None None None 5 PVT OTH 1 PVT PVT
1
PVT UNK None None PUB PUB Steroids drops - eye surg 1 None PVT PVT LOESTRINNone 24 Known NKDA 0 CBC; NL WBC PVT UNK ESTRADERM Recent PATCH; pneumonia Hypothyroid; SYNTHON; with relapse. Fibromialgia; LYRICA: LEXAPRO: HTN; DMII; HCTZ; Sciatica; TYL #3; Neuropath LISINE; 0 PVT PVT None No None 0 None PVT PVT None No None 2 Viral culturePVT - POS varicella PUB / Zoster Antigen None None Pap test, positive OTH for carcinoma OTH inUnknown situ; PAP test, Papilloma clear viral infection; Sexually WAES0903USA04905 active Pap test; cervix OTHC.; urine OTH beta-human None Pregnancy NOS (LMP = 2/12/2009) WAES0903USA03214 Unknown OTH OTH Unknown Unknown WAES0903USA04710 Unknown OTH OTH Unknown Unknown WAES0903USA04678 Unknown OTH OTH Patient has a history of seasonal ###allergies. 1 UNK UNK Methylprednisolone; Loratadine Allergies-IOVERSOL; IODINATED INTRAVASC CONTRA 1 CommunityPVT Hospital - virus UNK syndrome NoneLABS:None Neutros 83.5%, None lymphs PMH: HTN, 9.1%.CKD, H/H pneumonia, 13.0/28.1(L).chronic BMP, BNP, SDH s/p troponi hea 12 5/11/09 hospital MIL records MIL received None for DOS 12/14/08-1/6/09. None None LABS and DIAGNOSTICS: On admission: Normal WBC 6 PUB UNK none none PVT PUB None None PVT PUB None None Allergic Rhinitis/one episode of RAD. 1 None PVT PUB No No 0 PUB PVT Pt stated that he was sick after receiving shot. 0 None PVT PVT ALLEGRA D No known PVT PVT None None None PUB PUB None None 1 PUB PVT None None 0 None PVT PUB None None Seasonal allergic rhinitis 0 None PVT PVT None None None 1 PVT PUB none none 1 CBC; Blood PVT Culture; C-reactive PUB protein None None 2 OTH PVT DEPO-PROVERA None Hx shingles age 8 1 PVT PVT MELOXICAM; IMITREX Allergies, PCN; CEDON; LODINE; BEXTRA None PVT PUB None None None 10 MIL UNK None None Allergic to PENICILLIN 0 PUB PUB 385 PVT PVT none no no 0 EEG Pending PVT PUB 1 strep, flu (both PUBnegative) PUB none reported TN09004 1 None donePUB OTH metformin 500mg; complaining Levacor Naproxen;Diabetic of nausea/diarrheatypeTN09005 II;Osteopenia none PVT PVT PPD Strept throat - on Amoxicillin 1 MIL UNK 1 CRP; CBC,PVT pending PUB 0 none OTH PVT none none none stated UNK UNK 0 MRI; Bloodwork PVT LABS:PVT Lymphocytes 46.2%(H). NoneAnion gap None 5.0(L). Family CThx: head stroke WNL. & DM. 0 None MIL UNK TB test THBESOL, None Sanofi RADPasteur, (Asthma), C2909AA, esoph reflux, Left Venous DARROSTENOSIS forearm, 0, 17MAR09 2 PVT PVT 2 numerous labs PVTwere done. UNK Sulfa; Demerol; no medical conditions 3 PVT PVT 20 PVT PVT None None None 1 PVT PVT DILTIAZEM ER; TOPROL Superficial XL; LISINOPRIL; phlebitis; HX COUMADIN; of syncope;FUROSONIDE; Diabetes, HTN,MECL Hype 2 Doppler U/SUNK normal. X-rays UNK of legsBenzaclin normal. topical 3/2/09 None gel WBCAcne 13.0 (N80,L14,M5,E1, CRP 154.8 mg/L, ESR 70 mm/1hr 7 PUB PUB NONE NONE
PUB PVT HCTZ, Xanax, Irregular Valiam, heart Aspirin, Metoprolol, rythm, Eggs hypothyroidism, Fexofenadine, (diarrhea, cramps) vertigo, Synthroid, Sesonal Scopolamine allergy transd None. PVT UNK None noted.None noted. 0 PVT PUB Flonase; zyrtec nasal allergies PDD, nasal allergies, constipation 1 None PUB PVT Unknown None Allergy to CAT Scan dye: flushing and swelling; General a 4 PVT PVT DeAllergy no tetanus had reaction to tetanus and was told never to g PVT UNK none prematurity, apnea of prematurity, hyperbilirubinemia 0 PVT PVT DeAllergy No Tetanus Had reaction to tetanus and was told never to g 4 UNK UNK None 0 None. PVT UNK Unknown. Unknown. 0 GAVE 4TH UNK PEDIARIX PUB NONE NONE 2 PUB PUB NONE NONE UNDERWEIGHT AT BIRTH-6LB 13OZ 0 UNK PVT n/a 2 None. MIL MIL None Local reaction. None. Local reaction to anthrax.~Anthrax (Biothrax)~2 0 An influenza UNK swab wasUNK done results none came back none negative.none 4 vials of blood was drawn all of which came back negati UNK UNK N/A N/A 21 Normal upper UNK GI, normal UNK colonscopy, None. normal 5/26/09 None upper Hospital endoscopy, None. records 5/26/09 negative received highHospital fever, red EDblood and abdominal records inpatient count, received pain, normal DOS dizziness, ED 9/18/07 blood andwork. inpatient to pale~HP 11/19/ 5/26 UNK OTH OTH Unknown A0776700A 0 UNK OTH OTH PINDOLOLHigh Blood The Pressure subject had no allergies. A0776466A The subject had no adverse 335 UNK OTH OTH Ibuprofen; Fexofenadine Unknown Allergies; hydrochloride; Tonsillectomy; Mometasone A0599605A Varicocele; furoate; The Arthrotec; subject reported Triamcin 95 Unknown no UNK data available UNK None None PMH: HTN, GERD, high cholesterol. Allergy: latex. 0 PVT PVT METOPROLOL; 3/9/09LEVOTHYROXINE; - bronchitis hypertension LISINOPRIL; SIMVASTATIN PVT OTH none none none 1 PVT PUB 0 PVT PUB None None Asthma, ear infections 0 PVT PUB none none none 1 PUB PUB 0 None PUB PUB TYLENOL None None 0 PVT OTH respiratory infection 0 PVT PUB Anemia Asthma 2 Injection reaction PVT PVT LEVOTHYROXINE; URI FLUOXETINE Allergic to PHENERGAN 2 none PVT PVT 0 PUB PUB ATENOLOL; SIMVASTIN; HTN;BUPROPION; HIGH CHOLESTEROL HYDROCHLOROTHIRZIDC 2 PUB PUB Allegra, 180mg., no one qd; NKDA Nasocort, Astilin, Ipratorium Bromide All Nasal Sprays; 1 MIL OTH BUSPRINE; LEXAPRO; CELEBREX; SINGULAIR; Qvar prn; PROAR prn; Ortho 550 Unknown OTH OTH Cardiac disorder WAES0903USA05210 None OTH OTH Unknown None WAES0903USA05205 324 rectal biopsy, PVT 03/05/09,PUB condylomaUnknown Unknown WAES0903USA01463 191 Unknown OTH OTH None Drug hypersensitivity WAES0903USA05483 0 MRI; CT; X-rays; OTH BloodPVT tests; Lumbar Too puncture. many to None list Labs: VZV Type IgGI Diabetes c/w immunity. PMH: VZV diabetes. IgM (-). VZV PCR (-) for both w 2 None WBCMIL increased MIL CLOBETASOL, Lupus; HYDROXYZINE Nephritis Lupus; Nephritis HCL, ZOLPIDEM, PMH: ESRD. HYDROCORTISONE, Lupus nephritis. renal SIMVA tran 11 3/19/D Dimer UNK 532(H) (ref:>230ng/ml UNK None H); 3/19/09 None 1903:Trop None I 0.31H, CK 151 (range 30-200 IU/L); 3/20/09 0155: Tro 32 Varicella Zoster PVT Virus IgA; OTHVZV IgM Albuterol 4/10/09-records MDI Asthma 2 puff received-Chest exacerbation Q6hr Asthma; prn asthma x-rayexacerbation/ increase interstitial bronchitis markings at time suggestive of vesicul 0 PUB PUB None None Sinus bradycardia UNK UNK 2 PVT OTH None-well visit None 0 None PVT PVT None None 0 OTH PUB None known None known None 0 Xray, forearm PVT PVT None None None MIL UNK none none 5 no PVT PUB LOZARTANnone 50mg Hypertension redness, hot, hard~Measles + Mumps + Rubell 0 PVT UNK No No No
0 none PVT PVT none none none 0 OTH PVT 15 minutes Fluctuating from vaccination BP per Pt None PVT PUB 2 PUB OTH LA090303 3 PVT PVT Xanax, citalopram Cellulitis of toe 2 None; *Please PUBrecommend OTH course of action for Scabies * future 11 None y.o. Tdap. None PVT UNK Poor weightNone gain 1 PVT PUB None None None 1 None PVT PVT No No 1 PVT PVT none None None 1 PVT PUB PVT UNK None CAD; Diabetes 0 PUB PUB 0 PVT OTH EFFEXOR NONE XR; YAZ; ABILIFY Amoxicillin; Naproxen PVT PVT None None PUB PUB none 0 PUB PUB NONE NONE ECZEMA 6 n/a UNK PVT Unknown except Mild cough. no cortisone, None Patientprednisone, completed ZPak steroids treatment or anti-cancer 1 day prior drugs. to vaccinat 0 None PVT PVT None None Fever and fussiness~DT+IPV+Hib+HepB (no b 5 PUB PUB Chron's Chron's allergic to benadryl AL0903 0 none PUB PUB none none seasonal allergies onlyMO-2009-09 1 PVT PVT Urinary Incontenance None UNK UNK None notedAsthma 1 UNK UNK Benicar 20 none mg daily, Lopid hypertension, daily elevated cholesterol 0 PUB PUB UNKNOWNNONE NOTED UNKNOWN 15 My daughter UNK has received UNKcat scans.EEG's and Labs andPMH: Diagnostics: 36 wk premie. EEG abnormal Family hxxof 2.seizures Brain MRI in WNL. paternal Head aun na PVT PUB Hydrocortisone noneCreamnone 1% none PVT PUB Acetaminophen none neo-natal jaundice 6 PVT UNK none 0 PVT UNK 10 OTH PUB No No 0 PVT PVT Supplements only. 1 None OTH OTH COUMADIN; None DARVOCET Allergies; N 100;Skin ESTRACE; cancer; Menopause; LIPITOR; TRICOR; High cholesterol; WELLBUTRIN; Anxi 4 none PVT PVT ASA; Simvastatin; none Atenolol; Cardiac Sulfasalazine cath 0 PVT PVT 1 None PVT PVT None Allergy to OMNICEF, AUGMENTIN; allergic rhinitis; obesit 2 No PVT PVT No None 1 PVT UNK Albuterol, Singulair None Peanut allergy None OTH OTH TRAMADOL/CELEBREX/LIPITOR None Arthritis/Seasonal Allergies/Hyperlipidemia 434 PVT PVT ZYRTEC None Peanut Allergy, Varicella~Varicella Eczema, Allergic (Varivax)~2~8~Sibling Rhinitis 346 PVT PVT ZYRTEC None Asthma, Allergic ~Varicella Rhinitis, (Varivax)~2~11~Sibling Eczema 0 PVT OTH Environmental and food allergies. ### No known drug allergie 1 UNK UNK Concomitant medication was none. ### Past medical history w om a health care professional HAEMOPHILUS who had UNK called INFLUENZA their UNKnational TYPE service B titercenter. of 0.96 A (range three-year-old The 1.00 patient and greater). female had medical patient, condition who ### hasofchronic chronicear earinfections infectionsa 0 Unknown PVT PVT The patient had no illness at the ###time of vaccination and sh 0 None reported. PVT PVT No past medical history was reported. ### 0 None PVT PVT None The patient had no illnesses, pre-existing ### medical conditio 1414 01/May/2008: PVT titer lessOTH than 0.15 ALBUTEROL; FLOVENT; History VERAMIST; of asthma, Anitbody SINGULAIR; chronic test~Hib ear### (ActHIB)~3~0~Patient STEROIDS infections, sinus infections, 0 None reported. PVT PUB ADVIL None reported. ### 1 PVT PUB NONE NONE 0 Swabbed for PVT flu which UNK was negative
PUB PUB ALBUTEROL Osteoarthritis, 90/IPRATROPIUM, NKA hypertension, CITALOPRAM, obesity, depression, DILTIAZEM, smoking, ETODOLAC, and transi FUR 1 None UNK PVT Synthroid 114 None mcg 3 PUB PUB HYDROCHLOROTHIAZIDE, HYPERLIPIDEMIA, NKA SIMVASTATIN, DJD, Erectile Dysfunction, IBUPROFEN,Obesity, LYSINEHypertension 10 UNK UNK None None None 0 PUB PVT Lopressor, None amlodipine,Diabetes, Ranexa, Singulair, asthma, hypertension, Asmanex, Xopenex, cardiac aspirin, syndrome ranitidine X, mul 2 MIL MIL 0 MIL MIL CLARITIN D None BENADRYL; HTN Unknown OTH OTH Unknown Unknown WAES0903USA05627 96 Not reported. PVT From information PUB received 24 March 2009,Not a rapid reported. flu testFrom was information performed### in received the doctor's 24 March office.2009, th 0 OTH OTH Albuterol; Proair Diabetes; HFA;Chronic Aspirin;obstructive Docusate sodium; pulmonary WAES0903USA04882 Vasotec; disease; Fluoxetine; CoronaryAdvair; artery dis Me None OTH OTH Unknown None WAES0903USA05206 None OTH OTH None None WAES0903USA05533 Unknown OTH OTH Unknown Unknown WAES0903USA05489 Unknown OTH OTH Unknown Unknown WAES0903USA05181 allergen skin OTH test, 11/15/07, MIL flaredZYRTEC up Penicillin allergy; Anaphylactic Sulfonamide reaction allergy; WAES0801USA05565 Latex allergy; Allergic reaction None OTH OTH Unknown Unknown WAES0901USA02454 2 PVT PUB No 0 PVT PVT 2 none PVT PUB none none 0 EKG-WNL, PVT AccucheckPVT 99. ER Labs: CBC Normal, BMP normal except glucose 192 0 (+) increasePVT AST 90; Increase UNK ALT None 56; Increase NoneLDH 1,045; FAAZ(-) Heterozygous food allergy panel; A/B-thal-Anexies CRP (-); IgE 8.9g/dl 4,92(11/26/08) ng/ml ; U/A none PUB PUB none exceptnone aspirin (patient daily none had stepped on nail 3/31/09) None. PVT PVT See 3/24/09Possible for hivesfood allergy 1 MIL MIL 0 None PVT PUB TYLENOL None None 2 PVT PVT 1 PVT PVT None None 0 Not available MIL at this time MIL None Prednisone 2 PVT UNK None None None PVT OTH None 1 PVT UNK no none 14 PUB PUB None NKA 0 none PVT PUB Nystatin ointment, none Albuterol Wheezing - Albuterol 0 none PVT PUB Nystatin Suspension Thrush none 0 none PVT PUB Zantac, Prevacid none GERD 0 none PVT PUB none none none 0 PVT PUB Nystatin Thrush none 2 NA UNK UNK Metformin and None Apri notedAllergic for birth control to penicillin 2 UNK UNK None 0 none PUB PUB Centrum Multivitamin denies with undiagnosed iron seasonal allergies 3 4/2/09 Mumps UNKIGG >5.00 UNKMumpsLisinopril, IGM <1.10 minoxidil, None amlodipine, Hypertension, Vit. Dkidney failure with dialysis. 7 CBC, diff, sed UNK rate, ANA UNK ASO RF Advair, Lyme allAlbuterol normal. Asthma, Singulair Labs: Foot PMH: Rapid injury asthma. strep (-).foot Fluinjury (-) CXR WNL. MCV 29.3 (H). RF (1 PUB PVT none none none 2 none PUB PVT 1 PUB PUB none per parent none per parent none~ ()~NULL~~In AL0904 Sibling1|none~ ()~NULL~~ 1 PVT PUB history of prior skin infections 1 PUB PUB none none AL0905 0 None done.PUB No adverse PUB reaction occurred NA to Healthy the infant following None the Adverse Event. 3 PVT PVT albuterol, pulmicort Asthma 1 LABS: WBC UNK 20.0(H), neutros UNK 17.7(H), Pt hadUS taken rightPrednisone arm abnormal ASA 50mg - w/significant breathing x3 on 3/24 difficulties soft as a tissue prep PMH: edema for an HTN, MRI. asthma. Family hx 1 PUB PUB PPD also placed at same visit, on lower left arm.
59 ContinuousUNK and ongoing UNK lab/bloodClobex work toand determine None luxiq foam cause Hives for hair of when fatigue, loss.taking Ifmono-like no meds results, illnesses containing the nextand step redextreme dye. is cortisone PMH: hair loss. Plante shotsL 4 None UNK PVT None None None 0 PVT PUB 1 ADVERSE PVT SKIN REACTION PVT NONE NONE NONE 2 PUB PVT Aciphex 20 COPD mg x1 Hydrochlorothizide COPD 12 « mg Allegra 150 Mg. x 1 a.m 0 None PVT PVT none epistaxis bony occipital lump 0 UNK PUB OTH LISINOPRIL Allergy (NOS); TheHigh subject blood hadpressure no reaction A0776925A after her first flu shot and had 10 Blood and CSF PVT Cx's neg; PVTPCR on blood and CSF None(+) done None for PMH: serotype none (B) N. meningitides Labs: CBC with WBCs 2 EEG and CT PVT scan (head) PUB normal Multivitamins LABS: Oxygenation None with Fl;95% Desonide Eczema on RA. cream PMH: CBC: URI. WBC C-section, 31.1(H), neutros uncomplicated. 71.7%(H), lymphs 0 See Attached PUB 4/15/09-records PUB received-Influenza Unknown NoneA and B None negative. known 4/15/09-records received-PMH: seasonal alle 13 none PVT PUB none Otitis media, none with effusion 2 PVT PVT MIRALAX 1 None PUB PUB None Denied Denied Convulsion~Polio CA090001 Virus, Inact. (no brand name 1 PVT OTH None None None 1 PUB PUB None None Known None Known 1 None PVT UNK None 1 UNK UNK ZYRTEC - over WCC; the anxiety counter NKA disorder cervical smear, OTH07/??/08, OTH normal None Pregnancy NOS (LMP = Unknown) WAES0904USA00158 OTH OTH Unknown Unknown WAES0904USA00372 OTH OTH Unknown Milk allergy WAES0904USA00334 7 MRI; MRV; PVT CT Scan; Spinal UNK Tap. Labs and diagnostics: Cold virus MRI Nonespine PMH:WNL. noneCBC with WBCs up to 19.8. RBCs 3.44. H 2 PUB PUB Asthma 2 none PUB PUB none none UNK UNK Pat allergies: SULFA DRUGS (SULFONAMIDES) 6 Platelet count UNK 3/23/09:UNK 273 Aspirin; enalapril; NEXIUM; OtherFish allergies oil; Vitamin - Contrast D. (CT Scan) - Ate crab 3 days prio None UNK UNK Fibromyalgia; allergic rhinitis/asthma; IBS 0 PVT UNK None None 0 PVT UNK None None 0 PUB PUB 374 None PVT OTH PREDNISONE None 0.25 mg/kg Resolving hypereosinophilia 7 Varicella Zoster PUB HSV & OTH VZV-PCRCOZAAR; Dermal - DNA CRESTOR; No detected. HTN; NORVASC; Hyperchol; CLARITIN; Osteoporosis FOSAMAX 10 PVT PUB None None 0 PUB UNK None 2 None PVT PVT None NKA/ heart murmur dx'd 9/3/08. 1 None OTH PVT None None known OTH PUB None None Esotopia, intoeing, foster care 10 PVT PUB None None None 1 PVT PUB None None None 80 Neg: CBC; PVT metabolic profile; PVT Lyme antibody LABS: None MRI,PMH: MRA migraine & MRV brain HA. WNL. FamilyEBV, hx: MS. CRP WNL. ANA done 4/6 10 None PVT PUB None None None 0 None PVT PVT LURIDE 0.5(L) mg, acute chewable otitis None media tablet 0 None DonePUB PVT None None None 0 Blood Sugar PUB 108/Pt. toPVT local ER for Claritin precautionary check.Hay Fever 0 None UNK UNK None None Seasonal allergies 1 None OTH PVT PRILOSECNone OTC; FLONASE; Reflux esophagitis; Loratadine; Albuterol ExercisedInh. induced asthma-stable/cont 9 PVT OTH ORAJEL; Camilia None teething Protein relief allergy drops(as infant); Azithromycin (Feb 2009) 0 None PVT PVT TYLENOL no None None UNK UNK None None 0 UNK UNK 0 None PVT PVT None None teething 1 None PVT PVT Penicillin prophylaxis None (s/p Eczema; APR) allergies (dust, cat, dog, pollen) S/P acute rheum
2 CT Brain WO PVT ContrastPUB None 2 None PVT PUB None No None 4/13/09-records PVT receivedPUB SMXTMP None - Well visit 2 PVT PVT Suicidal Sulfa 0 Prior lateralPVT RAST (-) PUB DETROL LA; None NURALAX Spondylo costal Rash~Measles dysplasia; +RAD Mumps + Rubella (no brand n 13 None PUB PUB None Known Not known No 0 PVT OTH Claritin PRNNone rhinitis None 1 CBC PVT PVT none none none 1 0 Lab (was PVT on AUGMENTIN PUB 500mg for cat bite) None (on antibiotics No knownfor allergies cat bite) PVT UNK Temp 98.9 0 n/a PUB UNK n/a none none 0 UNK UNK 11 MIL MIL none unknown 2 PVT PVT Brevoxyl and None Duac None 13 UNK MIL none unknown none PVT UNK none none none~DTaP (Tripedia)~5~~In Patient 5 PUB PUB none reported none 4 5/11/09 Received UNK OPHUNK office records Effexor DOS 11/4/08-12/1/09. None Anxiety/depression LABS: TemporalMedical artery biopsy records WNL. stateMRI PMH: brain allergic WNL.rh 0 PVT UNK 2 PUB PVT Detrol La, prevacol, prilosec, calcium, niacin, fish oil, baby asa 16 Troponin I drawn MIL 02-12-09/abnormal. MIL ECG performed 2-18-09/Abnormal. 5000005 14 MIL MIL none unknown 18 Troponin I drawn UNK 02/11/09-Abnormal UNK High blood pressure; Psychiatric 5000006illness 11 ALSO INOCCULATED PVT UNK WITH KINRIX ON SAME DAY, YOU DONT' lathargic SHOW Afor LISTING 8 days~FOR ()~~1~Patient THIS. 0 PUB PUB none none knownnone 18 Labs and Diagnostics: UNK UNK CBC WNL.Flonase, EKG Sinus Fosamax, No. rhythmFexofenadine with NKA. PACs, Cerebral Head HCL, Palsy, CT Hexavitamins, (-).spastic Carotidquadriplegia, DuplexOscal, Colace, no significant multiple Vitamin joint steno D, co 19 MIL MIL none unknown 38 MIL MIL none unknown 4 MIL UNK ferrous sulfate, Dysphagia, calcium/vitamin sulfa-drugs Bilateral D, cataracts, aspirin, senna, Remission, docusate, Carcinoma, polyvinyl Basal alcohol/NaC cell, se 1 None PVT PUB AUGMENTIN; L ear NASONEX; infection NoneMOTRIN; TYLENOL 11 PUB PUB OTH UNK None None 1 None PUB OTH None None None 1 UNK UNK 0 Ultrasound,OTH 03/17/08, normal; OTH Ultrasound PRENATE; 07/22/08, Pregnancy phytonadione normal; Kidney NOSultrasound, (LMP stone = Unknown); 09/19/08, WAES0810USA00442 Vulval normal; wart; Chest Prenatal X-ray,care; 10/04?/08 Can Unknown OTH OTH Unknown Unknown WAES0904USA00519 Unknown. OTH 06/04/09 Neurology OTH received Unknown. DOS 06/04/09 7/24/09Neurology toUnknown 9/18/07.received LABS and DOS DIAGNOSTICS: WAES0904USA00310 7/24/09 to 9/18/07. NerveFerrous Conduction sulfate, St 15 Elevated WBC MIL and protein MIL in CSF-None see attached. NoneOther None normal/negative: serum O&P; Plasmodium antigen; Prot Unknown OTH OTH Unknown Unknown WAES0904USA00203 14 None OTH PUB Ibuprofen 800 None mg prn; Hypertension; DILTIAZEN 249 Hxmg of Rheumatic approximately fever; X day allergic PO; to TRIAMT/HC SULFA X None PVT UNK None None Allergies 2 Etiology of allergic OTH reaction OTH unclear. Vit B-12 injection Environmental allergies 2 PUB PUB None None None 0 UNK UNK Pt allergies: Sulfonamides 1 PVT PUB 1 PVT PUB 95 Serum beta-human, OTH 05/16/08, OTH pregnant None Pregnancy NOS (LMP = 3/1/2008); WAES0805USA03810 Iron deficiency anaemia 0 Urine beta-human, OTH 02/26/08, OTH positive; vitamins Glucose (unspecified) tolerancePENICILLIN test, 08/01/08, allergy; 83mg/d depression; WAES0803USA00673 Endoscopy; Ex-smoker 2 OTH OTH None 1 PVT OTH Bronchitis 16 magnetic resonance, OTH most OTHconsistent Unknown with demyelinatingUnknown process of immune etiology WAES0904USA00488
UNK UNK ### 3 OTH PVT None as answered None None 0 PUB PUB None At age 1 open heart surgery 0 OTH OTH None 1 CBC with diff PVT PUB No No 1 none MIL MIL None None None 4 None PVT PVT Unknown None None 1 UNK UNK 0 PUB PUB No 32 MIL MIL none unknown 0 PUB PVT None No None Reported 0 PUB PUB NONE NONE 0 None PUB UNK none none 0 NONE PUB PUB NONE NONE NONE 0 PUB UNK none 4 Methicillin sensitive UNK staph UNK aureus septic hip and ankle with presumed osteomyelitis (radiological diagnosis pending 0 PVT PUB Runny noseAsthma x 1 week 0 MIL UNK none 0 PUB UNK 0 PVT UNK none 1 Pelvic examUNK noramal, UNK palpation ofI take swollen lo estrin glands, No 24 labds daily,Seasonal including No other allergies, daily a cbc-home results have medications, not been back, reciebing pelvic No other allergy sonogrammedications shots norma weew 2 PUB PUB No Allergy to Augmentin MO-2009-10 PUB UNK none none none MO-2009-11 5 UNK UNK None Diabetes 2 PVT PVT None None 43 Labs and diagnostics: UNK UNK MRI brain (+) for infarct. mild Head coldCTDiabetes (+) for infarct, PMH:ALT HTN, 90,DM2, glucose GERD, 176,high carotid cholesterol dopplers (-) fo 2 N/A PUB PUB none none unknown 6 PUB PVT Considerations: Patient had also started taking Oral Typho 71 May fax if needed UNK copies UNK of labs and none reports 4/16/09-records No Nonereceived-Transaminases known elevated. Needle biospy sh 1 PVT PVT NONE PHENERGAN, MORPHINE 0 Blood, results UNK not all inUNK yet. FutureNone skin/scratch None tests. 4/20/09-records None 4/20/09-records received-WBC received-PMH: 14.6, 26 neutrophils, eczema. 63 lymph 172 CT LABS:WBC PVT 15.0(H). PUB CT scan abdomen/pelvis None abnormal. PMH: kidney reflux w/2 ureters on left. 14 13 Mar 2009 UNK 2221, Mycoplasma UNK sp. None Ab IgG, 3.07 None(H); Mycoplasma Environmental sp. Ab allergies IgM, 166; Family Streptococcus hx: bipolar. pneumoniae Ag 1 None PUB OTH None 0 Hep titer ordered PUB 4/8/09. PUB None known None 39 PVT PUB Eczema present Eczema 1 PVT OTH LANOXIN; CHF KDUR; PLAVIX; Allergic:LASIX; ASA, Hx COREG; gastritisCAPOTEN AMBIEN, CORDAX. 3 None UNK UNK Back pain Autoimmune hepatitis 1 OTH OTH 1 OTH OTH 0 PVT PVT OCP None Has history of fainting 880 VZV strain, OTH VZV WILD OTH TYPE STRAIN. Unknown PENICILLINChickenpox allergy WAES0901USA03661 693 None OTH OTH calcium (unspecified); SULFONAMIDE estrogens allergy (unspecified); WAES0901USA03665 SYNTHROID; COUMADIN 11 None OTH OTH XANAX None WAES0901USA03667 None OTH OTH None None WAES0901USA03668 Unknown OTH OTH aspirin 81 mg; Arthritis; calcium Drug Helicobacter (unspecified) hypersensitivity; pylori (+); chondroitin infection; Glaucoma; WAES0901USA03677 Breath sulfate Hiatus shortness sodium hernia;(+); Hyperlipidae NEXIUM 0 Unknown PVT PVT Unknown Penicillin allergy WAES0901USA03836 0 Unknown OTH OTH Unknown Unknown WAES0901USA03902 15 None OTH OTH EVISTA; vitamins Osteopenia; (unspecified) Chickenpox Cholesterol WAES0901USA03955 Unknown OTH OTH Unknown Shingles WAES0901USA03956 3 complete blood OTHcell OTH niacin None WAES0901USA03965
2 Unknown OTH OTH Unknown Unknown WAES0901USA04130 14 Unknown UNK UNK PREMARIN; Oesophageal CRESTOR reflux; Osteopenia; Cholesterol WAES0901USA04150 high Unknown OTH OTH Unknown Unknown WAES0901USA04153 327 Unknown OTH OTH Unknown Penicillin allergy; Herpes simplex WAES0901USA04173 397 Unknown OTH OTH Unknown Prostate Cancer Radiotherapy WAES0901USA04306 1 blood glucose OTH 01/29/09OTH 400 Unknown Unknown WAES0901USA04404 0 Unknown OTH OTH Unknown Unknown WAES0901USA04396 0 Unknown OTH OTH None Breast cancer WAES0901USA04370 14 Unknown OTH OTH Unknown Unknown WAES0901USA03135 0 Unknown OTH OTH Unknown Unknown WAES0901USA03157 0 None OTH OTH None Hypersensitivity Thyroidectomy WAES0901USA03303 8 Unknown OTH OTH FOSAMAX;Hypertension; CALCIUM(UNSPECIFIED) Hypercholesterolaemia; (+); LISINOPRIL; WAES0901USA03307 Osteoporosis; SIMASTATIN; Sulfonamide VITAMIN alle 2 None UNK UNK VALTREX Shingles WAES0901USA03329 30 Unknown OTH OTH Unknown Unknown WAES0901USA03333 Unknown OTH OTH Unknown Unknown WAES0901USA03341 5 temperatureOTH measurement, OTH 97.2; temperature ICAPS; OSTEO-BI-FLEX; measurement,aspirin; 97.3; VZV diclofenac; strain, VZV WAES0901USA03446 VYTORIN; WILD TYPE hydroxyzine STRAIN hydrochlori Unknown OTH OTH Unknown Unknown WAES0901USA03447 None OTH OTH PRILOSECHeadache; Food allergy WAES0901USA03463 2 None OTH OTH AVODART None WAES0901USA03466 0 Unknown OTH OTH Unknown Unknown WAES0901USA03540 696 Unknown OTH OTH insulin; interferon Diabetes; (unspecified); Multiple Chickenpox sclerosis COZAAR; TOPROL WAES0901USA03649 XL tablets; ACTONEL; SAN None OTH OTH calcium (unspecified); Hypercholesterolaemia PEMPRO; VYTORIN; FLAGYL WAES0901USA03095 Unknown OTH OTH Unknown Unknown WAES0901USA02961 25 Unknown OTH OTH CIPRO Unknown WAES0901USA02833 3 Unknown OTH OTH Unknown Drug hypersensitivity WAES0901USA02800 10 None OTH OTH amlodipine,5 Cholesterol; mg; VYTORIN, Hypertension 10-20 mg;hydrochlorothiazide WAES0901USA02715 (+), 12.5-2 mg; metfo 5 None OTH OTH Lisinopril; FLOMAX Allergic reaction (MORINFLUMATE); Shingles; to antibiotics; Skin reactionWAES0901USA02708 PRAVACHOL Sulfanomide allergy; Drug hypersensiti 14 Unknown OTH OTH Unknown Splenectomy WAES0901USA02698 0 None OTH OTH None None WAES0901USA02650 None OTH OTH aspirin; LIPITOR; Hypertension; PLAVIX;Hyperlipidaemia; LOPRESSOR; PRILOSEC; Osteoporosis; WAES0901USA02589 ACCUPRIL; Gastroesophageal ACTONEL reflu Unknown OTH OTH Unknown Unknown WAES0901USA02579 0 None OTH UNK None None WAES0901USA02573 45 Unknown OTH OTH Unknown Shingles WAES0901USA02537 Unknown OTH OTH Unknown Unknown WAES0901USA02505 366 Unknown OTH OTH Unknown Unknown WAES0901USA02101 Unknown OTH OTH Unknown Unknown WAES0901USA02381 Unknown OTH OTH Unknown Unknown WAES0901USA02397 Unknown OTH OTH LIPITOR; colchicine; Cardiovascular LASIXdisorder; (FUROSEMIDE); Hypertension; WAES0901USA02403 TOPROL Gout XL TABLETS; ZOCOR; 1 None OTH OTH FOSAMAX,Kidney ECOTRIN, stone; LIPITOR, Coronary NEUROTONIN, artery disease; WAES0901USA02404 RAZADYNE, Dementia; Renal NAMENDA, disorder;CEN Hy 1 Unknown OTH OTH Unknown WAES0803USA02373 6 None OTH OTH Diabetes Nervous breakdown; Shingles WAES0901USA04418 229 Unknown OTH OTH BONIVA Unknown WAES0901USA04420 9 Unknown OTH OTH VAGIFEM VARICELLA; CHICKENPOX WAES0901USA04430 1 Unknown PVT PVT Unknown Drug hypersensitivity; Cervical cancer; Seasonal Hepatitis; allergic WAES0902USA00018 Osteopenia rhinitis; Darier's disease None OTH OTH DEPAKOTE; Arthritis; CARDURA; Depression; NEXIUM; Diabetes; METFORMIN; Diverticulitis; WAES0902USA00136 NABUMETONE; Gastrooesophageal ZOLOFT;reflu ZO 48 VZV strain 01/28/09 OTH - NEGATIVE OTH NORVASC;Drug HYDRODIURIL; hypersensitivity; LEVOTHYROXINE Drug hypersensitivity; WAES0902USA00195 SODIUM; Penicillin COZAAR allergy 11 None OTH OTH VALTREX; Hypertension; DIOVAN; AMBIEN Genital Arthritis; herpes Drug hypersensitivity; WAES0902USA00207 Allergic reaction to antib 305 Unknown OTH OTH Unknown Chickenpox WAES0902USA00208 1 None OTH OTH DICYCLOMINE Allergic HYDROCHLORIDE; reaction to antibiotics; METHADONE Drug WAES0902USA00225 hypersensitivity HYDROCHLORIDE 336 None OTH OTH Unknown Hypertension; Palpitations hyperlipidaemia WAES0902USA00269 None OTH OTH BalsalazideColitis disodium; ulcerative; OMEPRAZOLE; Gout; Metabolic PAROXETINE WAES0902USA00292 syndrome
8 Unknown OTH OTH Unknown Hypertension; Coronary artery disease WAES0902USA00421 3 None OTH OTH None Allergic reaction to antibiotics WAES0902USA00435 8 Unknown OTH OTH ALVESCO Unknown WAES0902USA00443 2 None OTH OTH FLOVENT; hormones (unspecified); None vitamins WAES0902USA00474 (unspecified) 15 diagnostic laboratory OTH - OTH RA: normal;statin diagnostic (unspecified) Hypothyroidism; laboratory - HLB27: Hyperlipidaemia; normal; serum WAES0902USA00486 Back creatine disorder kinase 1020 - ; serum as 0 Unknown OTH OTH None WAES0902USA00505 Unknown OTH OTH Unknown Unknown WAES0902USA00546 7 None OTH OTH LIPITOR; COUMADIN Penicillin allergy WAES0902USA00561 17 None OTH OTH Unknown Blood pressure high WAES0902USA00562 82 diagnostic laboratory OTH - OTH came backUnknown fine; biopsyBreast - negative cancer Arm discomfort; Swelling WAES0902USA00594 arm; Pustule 76 complete blood OTHcell - normal; OTH rapid Streptococcus Diabetes - negative WAES0902USA00857 Unknown OTH OTH Lactose intolerance WAES0902USA00947 Unknown OTH OTH Unknown Unknown WAES0902USA00952 Unknown OTH OTH Unknown Unknown WAES0902USA01008 2 blood pressure PVT02/10/09 PVT 134/7 -; total ALBUTEROL; heartbeat Asthma; count ALBUTEROL Hiatus 02/10/09 Upper hernia; SULFATE respiratory - regular; Sinusitis; DOSE; body tractNasal WAES0902USA01029 temp infection; AZITHROMYCIN congestion; 02/10/09 Chest98.8 pain; Cough; 250 F Diarrhoea - oral; mg Hypersen tab; respira AZ infe 1 None OTH OTH None Unknown WAES0902USA01040 Unknown OTH OTH Unknown Unknown WAES0902USA01078 0 tuberculin skin OTHtest 11/21/08 OTH None Atrial fibrillation Chickenpox; Shingles WAES0902USA01108 0 Unknown OTH OTH Unknown Unknown WAES0902USA01461 14 None OTH OTH ginkgo; hydrochlorothiazide Penicillin allergy (+); levothyroxineWAES0902USA01473 sodium 4 Unknown OTH OTH Unknown Unknown WAES0902USA01476 story and no known drug allergies, UNK who in "Spring UNKof 2008"ASPIRINE; was vaccinated VYTORIN with aNone dose of ZOSTAVAX (Oka/Merck) WAES0902USA01488 subcutaneously. Conc 255 Unknown OTH OTH Unknown Unknown WAES0902USA01627 Unknown OTH OTH Unknown Unknown WAES0902USA01630 Unknown OTH OTH Unknown Unknown WAES0902USA01656 Unknown OTH OTH Unknown Unknown WAES0902USA01663 3 VZV strain -OTH VZV WILDOTH TYPE STRAIN Unknown Unknown WAES0902USA01665 diagnostic laboratory, OTH lesion OTH test negative Unknown form Varicella Unknown zoster virus WAES0902USA01744 Unknown OTH OTH Unknown Unknown WAES0902USA02379 0 Unknown OTH OTH own Autoimmune disorder WAES0902USA02384 Unknown OTH OTH Unknown Unknown WAES0902USA02441 2 laboratory test, OTH2/16/09, OTH positive VZV Unknown Unknown WAES0902USA02652 10 Unknown OTH OTH alendronate sodium; ALTACE; None ZOCOR; sotalol WAES0902USA02660 hydrochloride 305 Unknown OTH OTH Unknown Drug hypersensitivity; Penicillin allergy; WAES0902USA02679 Drug hypersensitivity. None OTH OTH ALBUTEROL; Diastolic ASPIRIN; dysfunction; LIPITOR; Hypertension; OPTIVAR WAES0902USA02680 OPHTHALMIC Systolic murmur; SOLUTION; Cholesterol CLONI high 0 None OTH OTH PENICILLIN allergy; SULFONAMIDE WAES0902USA02684 allergy; Allergy reaction to anti 1 Unknown OTH OTH Unknown None WAES0902USA02713 Unknown OTH OTH Unknown Unknown WAES0902USA02787 Body temp,OTH 02/09?/09,OTH 99, maximum. OMEGA-3; Hypertension; PRILOSEC; Chickenpox TIMOPTIC; Osteoarthritis DIOVAN; WAES0902USA02901 vitamin b complex; vitamin d (u 1 None OTH OTH ASPIRIN; Iodine BUMEX; allergy Calcium (unspecified); LEXAPRO; WAES0902USA02954 NEXIUM; BYETTA; G 1 None OTH OTH Unknown Allergic reaction Shingles; to antibiotics; Gastric disorder Sulfonamide WAES0902USA02966 allergy; Drug hypersensiti Unknown OTH OTH Unknown Unknown WAES0902USA03055 0 Unknown OTH OTH Unknown Unknown WAES0902USA03099 2 Unknown OTH OTH Unknown Shingles WAES0902USA03124 None OTH OTH Unknown Unknown WAES0902USA03186 2 Unknown OTH OTH Unknown Drug hypersensitivity; Penicillin allergy WAES0902USA03535 31 None OTH OTH CYMBALTA Shingles WAES0902USA03564 62 Unknown OTH OTH Unknown Unknown WAES0902USA03736 Unknown OTH OTH Unknown Unknown WAES0902USA03747 Unknown OTH OTH Unknown Cardiac failure WAES0902USA03762 1 Unknown OTH OTH Unknown Sulfonamide allergy WAES0902USA03787
28 magnetic resonance UNK - normal UNK withFOSAMAX; "ptosis" listed; LIPITOR electronystagmography Osteoporosis; Low density WAES0902USA03808 lipoprotein increased Unknown OTH OTH Unknown Fibromyalgia WAES0902USA03809 2 None OTH OTH FOSAMAX;Osteoporosis; aspirin; calcium, Hypertension (unspecified); EVISTA; WAES0902USA03811 triamterene; vitamins, (unsp 624 Unknown OTH UNK hydrochlorothiazide; Penicillin allergy; RAMIPRIL High blood pressure WAES0902USA04034 1 None OTH OTH ASPIRIN; METOPROLOL; Blood pressure Stenthigh ZOCOR; placement VitaminsWAES0902USA03984 (unspecified) Unknown OTH OTH Unknown Unknown WAES0902USA03991 0 Unknown OTH OTH Unknown Unknown WAES0902USA04015 810 Temperature OTH measurement, OTH 96.9 AmitriptylineHypertension; hydrochloride;Coronary NORVASC; arteryLIPITOR; disease; WAES0902USA04081 METOPROLOL Hyperlipidemia; Drug hyper 2 diagnostic laboratory OTH - OTH FLOMAX (MORNIFLUMATE) Pain; Vaccination SIMVASTATIN adverse WAES0902USA04091 reaction 0 Unknown OTH PVT Unknown Unknown WAES0902USA04093 10 Unknown OTH OTH NEXIUM; PLENDIL; SYNTHROID Unknown WAES0902USA04102 298 None OTH UNK Unknown Osteoarthritis; Cholesterol levels raised; WAES0902USA04107 Degenerative joint disease; H 0 None PVT PVT HYOSCYAMINE; Drug hypersensitivity; PRILOSEC; ACTONEL Osteoporosis; WAES0902USA04109 Irritable bowel syndrome; Gastro 455 None OTH OTH aspirin; ATENOLOL; Type 2 diabetes LIPITOR; mellitus; CYANOCOBALAMIN; CoronaryWAES0902USA01793 artery disease; AVODART; Prostate VASOTEC; cancerGL 0 None OTH OTH TEKTURNA; Allergic AMLODIPINE; reaction to ASPIRIN; antibiotics NEXIUM; WAES0902USA04181 TRICOR; COZAAR; METOPRO 346 diagnostic laboratory, OTH negative OTH varicella Unknown zoster HASHIMOTO's virus; diagnostic thyroiditis; laboratory, Autoimmune positive WAES0902USA01812 todisorder herpes zoster virus Unknown OTH OTH Unknown Unknown WAES0902USA04193 0 Unknown OTH OTH Unknown Unknown WAES0902USA01851 0 Unknown OTH OTH Unknown Unknown WAES0902USA04217 Unknown OTH OTH Lantus; Metformin Diabetes; Sulfonamide allergy; Penicillin WAES0902USA02162 allergy; Allergy to vaccine 7 Unknown OTH OTH None Shingles; Blister WAES0902USA02166 serum herpes OTH simplex,OTH positive; serum Unknown herpes simplex, positive Unknown WAES0902USA02178 90 allergy test,OTH multiple tests: OTHresults Unknown negative Diabetes WAES0902USA04397 2 Unknown OTH OTH Unknown Unknown WAES0902USA04401 Unknown OTH OTH Unknown Unknown WAES0902USA04516 2 None OTH OTH FOSAMAX Hyperlipidaemia; PLUS D; CELEXA; Osteoporosis; DYAZIDE; ZOCOR; Hypertension; WAES0902USA02189 SULINDAC Osteoarthritis; Drug hy 0 Unknown OTH OTH Unknown Unknown WAES0902USA02244 None OTH OTH Unknown Blood pressure Swelling abnormal; arm ThyroidWAES0902USA02253 disorder 1 Unknown OTH OTH PLAVIX; fluconazole; Sulfonamide DIAZIDE; Shingles allergy; omeprazole; Drug hypersensitivity WAES0901USA01764 PRILOSEC; simvastatin; VALTREX 5 None OTH OTH None None WAES0901USA01762 0 None OTH OTH Unknown Unknown WAES0901USA01761 2 None OTH OTH Unknown Unknown WAES0901USA01750 0 Unknown OTH OTH Unknown Unknown WAES0901USA01748 None OTH OTH Acyclovir Human immunodeficiency WAES0901USA01737 virus exposure 141 viral culture,OTH culture of OTH vesicular culture influenza negative virus for vaccineNone virus and bacteria; WAES0901USA01730 Unknown OTH OTH Unknown Unknown WAES0901USA01717 0 None OTH OTH glucosamine Hypersensitivity; sulfate Flu Allergic reaction to WAES0901USA01639 antibiotics 0 None OTH OTH None Arthritis; Sulfonamide allergy WAES0901USA01575 275 Unknown OTH OTH lovastatin; vitamins (unspecified) Unknown WAES0901USA01561 0 None OTH OTH Unknown Unknown WAES0901USA01560 0 None OTH OTH Unknown None WAES0901USA01471 Unknown OTH OTH Unknown Unknown WAES0901USA01366 35 Unknown OTH OTH MEDROL DOSEPAK Unknown WAES0901USA01337 10 Unknown OTH OTH Unknown Unknown WAES0901USA01333 Unknown OTH OTH Unknown Sulfonamide Blood allergy pressure high WAES0901USA01302 0 None OTH OTH Unknown None WAES0901USA01470 0 None OTH OTH Unknown None WAES0901USA01289 0 echocardiography, OTH results OTHnot reported None Breast cancer; Shingles Atrial fibrillation; Cardiac WAES0901USA01288 valve leak; Drug hypersensitiv Unknown OTH OTH Unknown Unknown WAES0901USA01231 13 None OTH OTH Unknown Unknown WAES0901USA01219 0 Unknown OTH OTH PLAVIX, Pramipexole Crohn's disease; dihydrochloride, Penicillin allergy; ZOLOFT, WAES0901USA01207 Allergic AMBIEN reaction to antibiotics
1 Unknown PVT OTH LIPITOR; LEXAPRO; Hypercholesterolaemia; ZETIA; Shingles BONIVA Osteopenia; WAES0901USA01184 Penicillin allergy; Drug hypersen 0 Unknown OTH OTH Unknown Unknown WAES0901USA01183 0 Unknown OTH OTH Unknown Unknown WAES0901USA01182 0 Unknown UNK UNK PENICILLIN allergy WAES0901USA01161 0 Unknown OTH OTH Unknown Unknown WAES0901USA01154 Unknown OTH OTH Unknown Unknown WAES0901USA01151 14 None OTH OTH SYNTHROID; TOPROL None XL tablets WAES0901USA00075 4 Unknown OTH OTH LIPITOR Sulfonamide allergy WAES0901USA00062 0 Unknown OTH OTH Unknown Shingles WAES0901USA00038 Unknown OTH OTH Unknown Unknown WAES0901USA00028 11 None OTH OTH calcium (unspecified); vitamin None D (unspecified)WAES0812USA05244 0 Unknown PVT PVT Unknown Articulation problem WAES0812USA05241 214 Unknown OTH OTH NEXIUM Penicillin allergy Welts; Gastroesophageal WAES0812USA05203 reflux disease 7 None OTH OTH ADVAIR Asthma WAES0812USA04879 3 Unknown OTH OTH Unknown Unknown WAES0812USA04852 305 body temp, OTH 97.5 F OTH aspirin; hydrochlorothiazide; Hypertension Chickenpox lisinopril WAES0812USA04849 0 None OTH OTH LIPITOR Penicillin allergy WAES0812USA04830 0 Unknown PVT PVT None None WAES0812USA04714 0 Unknown OTH OTH Unknown Unknown WAES0812USA04643 0 Unknown OTH OTH Unknown Unknown WAES0812USA04568 1 Unknown OTH OTH Unknown Non-Hodgkins lymphoma; WAES0812USA04555 Cold sores 61 Unknown OTH OTH Unknown Unknown WAES0812USA04552 0 Unknown OTH OTH acyclovir Herpes simplex WAES0812USA04530 0 Unknown PVT PVT None WAES0812USA04509 0 Unknown OTH OTH Unknown Unknown WAES0812USA04273 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0812USA04260 1 Unknown OTH OTH Unknown Drug hypersensitivity; SulfonamideWAES0812USA04142 allergy None OTH OTH None Allergic reaction to antibiotics WAES0812USA04112 375 diagnostic procedure, OTH 12/16/08 OTH - diagnosed DIOVAN with Blood neuropathy pressure Shingles in her legs and feetWAES0812USA04103 1 None OTH OTH aspirin; LEVOXYL; Hypertension lisinopril; WAL-ITIN; EFFEXOR WAES0812USA04087 XR Unknown OTH OTH Unknown Unknown WAES0812USA04037 Unknown OTH OTH Unknown Unknown WAES0812USA04036 Unknown OTH OTH Unknown Unknown Unknown WAES0812USA04035 3 Unknown UNK UNK WAES0812USA03774 1 Unknown OTH OTH Unknown Left inguinal hernia; Surgery WAES0812USA03763 0 VZV strain, OTH 12/19/08, VZV OTHWILD TYPE CHANTIX STRAIN Hypothyroidism; Hormone replacement WAES0812USA03704 therapy; Sulfonamide allergy; Unknown OTH OTH Unknown Unknown WAES0812USA03607 321 Unknown OTH OTH Unknown Unknown WAES0812USA03603 6 Unknown OTH OTH Unknown WAES0812USA03597 0 None OTH OTH Unknown Dialysis; Allergic reaction to antibiotics WAES0812USA03386 1 None OTH OTH FOSAMAX;Hypertension; CYMBALTA; PRINZIDE Osteoporosis WAES0812USA03374 0 None PVT OTH calcium (unspecified); Chickenpoxvitamin Drug hypersensitivity d (unspecified)WAES0812USA03371 0 Unknown OTH OTH Unknown Unknown WAES0812USA03349 Unknown OTH OTH Unknown Unknown WAES0812USA03315 304 Unknown OTH OTH Knee arthroplasty; Hip WAES0812USA03240 replacement; Cardiac pacemaker in 0 OTH OTH Unknown WAES0812USA03215 1 None OTH OTH Unknown Unknown WAES0812USA03191 399 None OTH OTH NORVASC,Hypertension; LIPITOR, PRILOSEC, Disseminated Drug hypersensitivity; PAXIL, large cell MYSOLINE; WAES0812USA02814 lymphoma; Sulfonamide vitamins Anemia allergy; (unspecified) Gastroesop 0 None PVT PVT LIPITOR; ZOLOFT; Fever blister COUMADIN WAES0812USA02780 0 Unknown OTH OTH Unknown Unknown WAES0812USA02628 153 Unknown OTH OTH LIPITOR; ACTOS Diabetes WAES0812USA02621
636 Unknown OTH OTH Unknown Hypertension; Chickenpox; Diabetes; Lipids Coronary increased WAES0812USA02617 artery disease Unknown OTH OTH unknown Unknown WAES0812USA02596 Unknown OTH OTH Unknown Latex allergy WAES0812USA02350 0 blood pressure, PVT 12/10/08, PVT120/8; blood (therapy pressure, unspecified) Hypercholesterolemia 12/10/08, 120/8; vital sign, 12/10/08, WAES0812USA02325 normal; total heartbeat coun 0 None PUB PUB None WAES0812USA02200 Unknown OTH OTH Unknown Shingles WAES0812USA02144 372 None OTH OTH SYNTHROID; Hypertension; ACTONEL Hyperlipidaemia; hypothyroidism WAES0812USA02139 Unknown OTH OTH Unknown Unknown WAES0812USA02115 0 None OTH OTH None Hypertension; Hypothyroidism; Drug WAES0812USA02032 hypersensitivity Unknown OTH OTH Unknown Unknown WAES0812USA02055 3 body temp, OTH 100.4 degrees OTH Unknown Unknown WAES0812USA01823 0 None OTH OTH None Drug hypersensitivity WAES0812USA01782 Unknown OTH OTH Unknown Shingles WAES0812USA01775 0 Unknown OTH OTH Unknown Unknown WAES0812USA01655 0 erythrocyte OTH - was initially OTH 77 and later LIPITOR 7 Sleep apnoea Head injury WAES0812USA01630 50 None OTH UNK NORVASC;Blood PLAVIX pressure Stenthigh; placement Shingles; Post WAES0812USA01604 herpetic neuralgia Unknown OTH OTH Unknown Unknown WAES0812USA01189 335 Unknown OTH OTH Unknown Chickenpox. WAES0812USA00539 2 None OTH OTH (therapy unspecified) Prostatic disorder WAES0812USA00393 660 None OTH OTH Unknown None WAES0810USA00373 Unknown OTH OTH Unknown Unknown WAES0812USA00362 7 HematologyOTH - came outOTH OK Therapy unspecified Blood pressure abnormal WAES0812USA00358 274 Unknown OTH OTH COUMADIN Neuropathy; Macular degeneration WAES0812USA00054 4 Unknown OTH OTH Aspirin; FENOFIBRATE; Hypertension; Chickenpox QUINAPRIL Dyslipidaemia; hydrochloride; Penicillin WAES0812USA00050 allergy ZOCOR; vitamins (unspecifi None OTH OTH COUMADIN; Leukaemia; PAXIL; VALIUM Stroke Memory loss; Sulfonamide WAES0812USA00009 Allergy; Immunosuppression Unknown OTH OTH Unknown Unknown WAES0901USA01076 Unknown OTH OTH Unknown Unknown WAES0901USA01075 0 None OTH OTH Unknown Shingles WAES0901USA01009 22 Unknown OTH OTH Unknown None WAES0901USA01004 0 Unknown UNK UNK FOSAMAX mg; Calcium (unspecified) mg; Chondroitin WAES0901USA01001 sulfate sodium +; Vitamins 2 Unknown OTH OTH Unknown Sulfonamide allergy; Allergic reaction WAES0901USA00990 to antibiotics Unknown OTH OTH Unknown Unknown WAES0901USA00804 1 Unknown OTH OTH LIPITOR; ENALAPRIL CholesterolQuadruple MALEATE; high vessel ZETIA; bypass METOPROLOL WAES0901USA00790 graft; Shingles; TARTRATE Adverse drug rea 0 Unknown OTH OTH ACTONEL Unknown WAES0901USA00787 0 None OTH OTH Unknown Unknown WAES0901USA00333 7 Unknown OTH OTH Unknown Unknown WAES0901USA00314 14 Unknown OTH OTH Unknown Unknown WAES0901USA00196 0 diagnostic laboratory, UNK results UNK unknown simvastatinSulfonamide allergy WAES0901USA00135 1 Unknown UNK UNK BUFFERIN;Hypothyroidism; BIOTIN; SYNTHROID; Arthritis;potassium Diverticulitis; WAES0901USA00132 (unspecified) Cystitis interstitial Unknown OTH OTH Unknown Unknown WAES0904USA00201 Unknown OTH OTH Unknown Unknown WAES0904USA00198 0 Unknown OTH OTH NORVASC;Diabetes; GLUCOTROL; Hypertension; insulin; PRINIVIL; Hypercholesterolaemia; WAES0904USA00475 GLUCOPHAGE; Hospitalisation ZOCOR 0 Unknown OTH OTH None Pregnancy NOS (LMP = 2/13/2009) WAES0903USA03642 Unknown OTH OTH Unknown Unknown WAES0904USA00186 Test CT-CTPVT abdomen Oct. PVT 17-2006 AVAPRO; w/wo LABS:breast Insulin; crackedEXTRADIOL; rib Brice biopsy happen Windsor c/w after ALLEGRA ~Influenza cancer four PMH: or five DIDDM, (nodays brand asthma, later name)~UN~0~Patient URI, ganglion cyst, d 1 EKG-Normal PUB limits. Labs PUB and Diagnostics: UnknownHead None CT WNL. None. CBCPMH: WNL.Febrile Chem seizures. WNL except On CO2 OCs low at 20.2. EKG W 0 None OTH PVT TYLENOL No No 0 PUB PUB Bactrim Resolved UTI None 0 PVT UNK Minor syncopal event with vaccination GARDASIL 10/18/0 7 DNA test; CT PVT Scan; Echocardiogram; PVT BirthBlood control tests; None pills X-ray;PMH:anorexia, Positive Factorwt V Leiden stable x LABS: 2 yrs. Protein OCP since C functional 11/08. Allerg 166% 1 PVT PVT none Asthma; Allergies; Swelling~Tdap Eczema(no brand name)~5~11~Patient
49 ULS, CT scan, PVTblood work PVTall normal. Labs and Diagnostics: PMH:KUB Mono-LLQ (+) (+) for tenderness scybala. 5/5/08 UC (+)with for 100K liver and colonies. spleenCo p 1 CBC PVT UNK VENTOLINNone HFA Exercise- Induced Bronchospasm 0 640 pm- t/cOTH to ER indicated UNK child stable PPD planted None R forearmNone 0 PVT PVT 0 CBC -> WBC PVT 12,200 H/H PVT11.0/33.7 None plt 472 None None 0 PVT PVT Baby ASA daily Well child Atrial septal defect, (ASD) repair 2/09 10 None UNK UNK ALLOPURINOL 100mghypertension, bid, GEMFIBROZIL hyperlipidemia, 600 mg bid, gout,LISINOPRIL PVD, CAD, 40 diabetes mg daily 5 UNK UNK PVT UNK 0 OTH PUB 25 PVT PVT AMOXIL-Dx-OM Othis Media 0 PVT PVT None None None 2 None MIL MIL FLONASE; None ALLEGRA NKDA 0 PUB PUB Mefloquine None Allergies, Eggs, wheat, corn (starches) 4 Exam consistent PVT was Bell PUBPalsy. None None None PUB UNK PUB PUB Exposure toNone Hep A patient none PUB PUB none none none 0 PVT PVT Metformin; Glipizide; Unknown Simvastatin; Unknown Lisinopril. MIL MIL 0 UNK UNK 3 Blood and CSF UNKcultureUNK NEGATIVE. None. HSV 1/2None. DNA CSF <80 Exceptionally copies/ml healthy, NEGATIVE; no illnesses. wbc 9.0 (45 Currently gran, 36 breast lymph) feedin >8 1 N/A PUB PUB 0 PUB PVT unknown None Allergic to Demerol ~ ()~3~~In Patient 288 UNK UNK COPD 1 N?A atthis time PUB PVT None No Spleen removed in 1998 0 "DR at ER told PUBme I was PUB allergic to Flu vaccine"tx NONE with prednisone Per vaccinee:allergy and pepsid-to"found codiene, allergic Morphine,oxycodone,sulfa to pepsid" see allergi 10 Autopsy was UNK done UNK no No premature, no~ "hole" ()~~0.00~Patient|no~ in heart that was healed ()~~0.00~Sibling|no~ PMH: preemie, 0 none UNK UNK none acne none 200 Zoster as above. PVT PainPVT requiring tylenol none with codeine none none 1 PUB UNK acute pancreatitis 0 PVT PVT teething topFever tooth and fussy see #19~ x 3 days ()~NULL~~In with 4 month Patient injections. Fussy a 3 none UNK UNK Afebrile, gastroenteritis No known allergies 1 Newborn Screen UNK - normal UNK Mild congestion/ none cold symptoms 18 UNK UNK Benadryl. None. Patient had chickenpox approximately 4-6 years of age. 0 CXR, UA, bloodwork UNK LABS: UNK WBCnone 14.2(N), neutros none 51.9%(H), Premature, lymphs low 43.1%(L). birth weight, Creatinine born at 0.24(L), 30 weeks BUN/creat gestationratP None PVT PUB None None None 1 PVT PVT claritin, multivitamin, none known epipen lots ofas food needed allergy's, on all peanut meds allergy's, penicillin 1 none PVT PUB NO None none~ ()~NULL~~In Patient 2 UNK UNK none none none 0 Neg PVT UNK Lipitor; Altace; Flomax;CAD; Coreg; COPD; Spironolactone HTN; Hyperlipidemia; CHF 0 UNK PVT OTH No concurrent Unknown medication A0774135A 0 Increased CBC; PVT UA; Blood PVT cultures None negative None 6/15/09 - well Received H.O. exambenign that hospital day brain medical tumor records (resected for2007); 3/27-3/28/2009 peritoneal&shunt ER r 0 PVT UNK 0 None UNK UNK No No None 3 PVT PVT 0 PUB PUB None statedNone reported None noted 0 PVT UNK Well child 0 Pending OTH OTH None None None PVT UNK NKDA 1 none UNK UNK ALLOPURINOL None gout; bilateral shoulder bursitis
1 OTH PVT 14 OTH PVT wn position and forceful exertion. PUB PUB None 2 None doneUNK PUB None None Hx of seizures as school aged child. 1 None performed PUB PUB Mother denies None reported PVT OTH Not reported ### 0 None reported. PVT OTH The patient had a history of milk ###protein intolerance and w 0 diagnostic laboratory, OTH 03/20?/08, OTH posit -; ultrasound, Pregnancy 03/26/08 NOS (LMP - pending; = 1/10/2008) urine betaWAES0804USA01379 human, 03/20?/08 posit - eryth 15 ultrasound, OTH 02/02/09, revealed OTH a normal None pregnancy Chlamydial infection WAES0902USA01068 11 hematologyOTH LABS: WBC OTH 1.5(L), ANC None 400, H/H 4.7/13.2, None plts 3,000. PMH:Bone asthma, marrow pneumonia WAES0904USA00618 biopsy. xStrep 2 2006 && mono 2008, c/soral neg. co Unknown OTH OTH Unknown Unknown WAES0904USA01122 Unknown OTH OTH Unknown Unknown Autism~Measles WAES0904USA00236 (no brand name)~UN~0~Sibli Unknown OTH OTH Unknown Unknown Autism~Measles WAES0904USA00813 + Mumps + Rubella (no brand 331 Unknown OTH OTH Unknown Unknown WAES0904USA00610 Not reported UNK UNK The patient had a known pertussis ### exposure. 1 None OTH OTH aspirin; buspirone hydrochloride Unknown mg; ZETIA mg; WAES0901USA03627 LOVOTHROID mg; TOPROL XL 1 UNK PUB not known no not known 1 PUB PUB Pulmicort BID Wheezing (slight) Asthma allergy to mulberry MO-2009-12 UNK UNK none. diabetes 8 PUB PVT none none I am allergicnone~ to sea()~NULL~~In food and penicilline. Patient 3 UNK UNK 1 PVT PUB 1 PVT PVT none none none 0 Tests done UNK on 4-8-09, UNK show high SED rate and none lowalso blood received PMH: iron levels. Irregular TBALl test/neg LABS: major menses. H/H reactions Juvenile 9.7/29.0(L). to first osteoporosis. two ESRpertussis, 30(H).Heart CMP, then muTs 4 ABG, CBC,UNK CMP, CXR,UNK head CT, none brain MRI,right EEG, conjuctivitis, LABS: none CT PMH: rhinitis head,V/D, CXR,fever, BMPcongestion, WNL. 24-hour Family EEGhx: abnormal. childhoodM 2 PUB PVT NTG,Zetia,Loustation,Atenolol,Glucophage,Bentyl,Lexapro,HCTZ,Sancatana,Adv Allergies:Keflex,Iodine,Cipro,Ancef, Biaxin,Amoxicillin HX: 1 PUB PUB none 1 This is the second PUB report PUB this week with reaction from same lot number 1 MTI, EEG PVT UNK none none laryngomalacia-resolved 0 none PUB PVT none nasal congestion none 1 PUB PUB 0 PUB PUB none none sulfa allergy 1 PVT PUB none none none 0 PUB UNK none none none 0 none PUB PUB none none Born with heart murmurSC0910 4 PediatricianPVT has confirmed PVT that symptoms areNone from MMRNone vaccination. 3 CBC; CMP;PVT U/A; Abdominal PVT X-rays None and CT Scan Noneall WNLHistory LABS:ofWBC abdominal 13.9(H), migraines plts 524(H), PMH: neutros cyclic 73.0%(H), vomiting & lym ab OTH PUB None None 5 PVT PVT None None 0 PVT PUB Ibuprofen, Tylenol, Getting over Benadryl None a cold 1 PVT UNK None Bronchiolitis; Ear infections 344 PUB OTH None Allergies, feathers, dust; Osteoarthritis, knee replacement; 0 PVT PUB 0 None PVT PVT None none none 11 PVT PUB None None None fever~DTaP (no brand name)~2~0~Patient 2 PVT PVT none none 1 None PVT PVT None None NKDA 0 None PVT PVT None None None Laboratory UNK from hospital, UNK reveal low Sulindac testosterone 200mg Noneinand the Tramadol patient. unknown Head 50 hcl50 Dr. continuous mg tab with treatment, and still lookin 1 PUB PVT Cymbalta, Lisinopril, None but Prilosec recently AllergicOTC recovering to Prednizone (3 weeks) and Nizoral from unknown GI infection tha Chest x-rayPVT negative UNK LOVENOX;Asthma VICODIN; exacerbation Asthma PRILOSEC; SOLMEDROL; ADVAIR; XOPENEX;SINGUL
10 I know of noUNK tests, the UNK recommendation for ADD none was - Ifmade this Colds, isn't by his the tonsilitis teacher. correct Aggressive venue behavior to report towards this, please mother~ let me ()~UN~8 know 2 UNK UNK allergies: Zocor, Crestor, Lopid, fire ants 93 UNK UNK none 16 X ray, CT Scan, UNK Lab, Bronoscpy UNK 205 none reported OTH OTH not reported ### No testing had UNKbeen performed. UNK Not reported ### 0 none reported PVT OTH PREVACID NKA ### 0 Serum C-reactive, OTH 01/??/09, OTH slightly Antimicrobial elevated Food 5/26/09 (unspecified); allergy; Received Gastrooesophageal Pollen ORTHO rheumatology allergy; TRI-CYCLEN; Nasal reflux consult WAES0903USA04563 septum disease; ADVIL DOS deviation; 1/13/09. WisdomProphylaxis; LABS teeth remova and DIA A 0 X-ray, ?/?/09, OTH negative;OTH magnetic resonance, Unknown ?/?/09, reabsorption Unknown.inPMH: the humeral condylomata WAES0904USA00862 head and acuminatum. a tiny partial Lumbar thickness disc Unknown OTH OTH Unknown Unknown WAES0904USA00866 Unknown OTH OTH Unknown Unknown WAES0904USA00886 0 LABS: H/H PVT 8.8/28.4(L),PUB plts 574(H). Was CTon head Phenobarbital severe WNL. developmental Developmental 30 mg TID delay up until delay (from 3 wks and birth); ago seizures seizures (ran out (epilepsy); of - beginning med)severe at age men2 CBC & ESRPVT LABS: WBC PVT13.6(N),Amoxicillin segs 79.4%(H), No lymphs PMH: 18.3(L), urticaria H/Hx14.1/42.3(H), 3 wks prior, unknown plts 497(H). cause. Sodium RAST 131(L), testin 2 Labs: EchoPVT WNl. CBCPUB with normal WBCs Hgb No8.5-9.4. Hct No 26.6-29.3. PMH: noneMCV 57 (L). MCH 18 (L). Platelets 502. UC 3 abnormal EEG. PVT Labs and PVTDiagnostics: Brain None MRI with ? None. lack ofPMH: gray-white none matter noted differentiation in temporal lobe an 1 PVT PVT ZOCOR 10 Q day; NASONEX PCN, Sulfa, 2 Q Hypercholesterolemia AM; Pseudophedrine 30 2 Q AM; VISINE dry 0 PUB PUB no OR200916 0 PUB PVT VERAPAMIZ No ATRIAL FIBKnot at injection OR200915 site common after vaccines~ ( 1 PUB PUB No No No OR200917 6 None PUB PUB None None 0 PVT PVT None OMNICEF; PCN 45 None donePUB UNK None Penn; Sulfa 2 UNK OTH No No 0 None OTH OTH None None Allergy to Sulfa drugs 1 PVT OTH None 1 PVT PVT KEPPRA 500 None mg one BID Seizure Disorder/NKDA 1 PVT OTH None None Positive Pregnancy MIL Test MIL ALLEGRA None None 202 PVT PVT None None None 2 None OTH PUB None None None UNK UNK 0 OTH PVT None None None 1 None MIL MIL None 2 PVT PVT Atenolol; Aurlide; None Detrol None 1 PVT PVT None Otitis Media - Started AMOX X 10 days on 3-20-09. Histor 1 None PVT PVT None None None PVT PUB None None None (Pt. is in the process of behavioral / eval. 0 Syncopal episode PVT 90/62 PVT (BP reading) None : Discharged No from None clinic 96/64 1 PUB PUB None Known None None Known 1 None PVT PVT 2 None PVT PVT 0 PVT PVT None 0 OTH OTH METOPROLOL; NORVASC; Osteoarthritis; LISINOPRIL; HTN; NAPROXEN; diabetes; obesity; OXYCODONE/APARSU sleep apnea; hyper 1 OTH PVT CHANTIX; EFFEXOR; None None LIPITOR; MIRAPEX 1 PVT PVT No 6 PVT PVT None None 13 None PVT OTH RSV Broncholitis PVT UNK 0 None PVT PVT None None None Flu like~Tdap (no brand name)~UN~11~Patien 16 PUB UNK AR0911 731 None PVT PVT BACTROBAN; NoneBENICAR/HCTZ; Type II Diabetes; ~Tdap DIFLUCAN; HTN; (Adacel)~1~50~Patient Elevated SIMVASTATIN; Lipids; TAC; Obesity; Vitamin GERD D
0 PUB UNK None None Hypertension / Possible allergy to PCN 0 PVT PUB 1 OTH UNK 9 PVT PVT ZANTAC None Ex 28 wk preemie / well child 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0773093A medical history and no history 0 UNK PVT OTH No concurrent Unknown medication The subject has no relevant A0777610A medical history and no history 1 OTH PUB None No None 1 None PUB OTH None 2 PVT PUB 2 None at thisPUB time PUB None None None 3 LP, 0 cells; PVT Glucose, 34; PUB Pr 4; CRP < 0.2; WBC, None 9; Lym, None 6.8; ESR, PMH: 15;nasolacrimal RSV, Neg duct LABS: stenosis; CSF WNL. spitting Segs up 22%(L) & form AntinuclearOTH antibody, 31Jan2000, OTH Thyroxine negative; Erythrocyte sodium; Anxiety;Venlafaxine Back sedimentation Rotator pain; cuff Depression; hydrochloride; tendinitis; rate, 31Jan200, Hypothyroidism Shoulder A0600422A Anxiolytic; 111mm/hr; dislocation; Progesterone Hematocrit, Shoulder impi 31J Diagnostic tests: OTH 12 March OTH2002: HLA-DR4 DIGOXIN;present. Warfarin Allergy Lyme tosodium; red Atrial disease dye; fibrillation; OMEPRAZOLE Cardiac screen valve Hand 1 31disease; A0605477A surgery; LIV (positive). Lumbar Fatty liver Lyme spinal disease fracture; IgGTho an AntinuclearPVT antibody, Aug1999, PVT negative; Multivitamin Erythrocyte Herpes Simplex sedimentation Mitral1;valve Hyperlipidemia; prolapse. rate, Aug1999, The A0308640A Immunologic vaccinee 44mm/hr; has findings; Rheumatoid no known Macular allergie factor, DeA 6 PVT UNK none 10 34256 - MEASLES PVT ANTIBODY, PVT (IGM) noneTest Name no Resultnone Flag(s) Reference Range Reported Date Footnote MEAS 9 Daughter was UNK taken toUNK Hospital onInfant 4/12/09 Motrin after None. orthe Infant rashTylenol None. became Daughter (aspronounced needed was during examined and teething started onspreading. episodes). 4/3/09 andDr. Rarely was diagnose deeme more 2 UNK PVT NONE LISTED NONE ALLERGY TO DOXYCYCLINE AND SULFA 1 None UNK UNK PPD None Healthy 1 None PVT PVT Flovent None 3 UNK PVT none notedLevaquin, Sulfa, PCN 1 Had CT scan PUB done in ER PUB on 4-8-09. N/A N/A None known 1 UNK UNK lamotrigine 0 N/A UNK PVT RABIES VACCINE NONE DILUENT NONE NOVARTIS LOT 802011 1 UNK UNK Nasal Drainage: clear 21 LABS: CSF:UNK WBC 1, RBC UNK2, protein 37.5, glucose unknown 63. Potassium NKDA PMH: 3.2(L), DDD sodium c-spine. 133(L). Endometriosis ANA(+), SSA w/surgery. 193(H). Fam W 9 None donePVT PUB Amoxicillin upper respiratory none infection 2 Blood work UNK and a spinal UNK tap were None performed Known. in None the hospital. None Labs Known and PMH: Diagnostics: ChronicMRI H/Abrain x 9 months. WNL except Bellsmaxillar Palsy 7 0 UNK PUB NONE DM II,HTN, DYSLIPIDEMIA, LOW BACK PAI-L2 FX, ALLE None PUB PUB Eucerin cream Cough or Aquaphor None; History of delayed immunizations 1 PVT PVT 3 LABS: WBCUNK 3.2(L). PotassiumUS UNK of right arm c/w edema PMH: vs cellulitis dermatomyositis, w/o abscess. interstitial CXR abnormal. lung disease, X-ray pulmonary right hu 1 None PVT PVT None none GERD as an infant 0 OTH PVT 0 OTH PUB PPD SanofiNone Pasteur C2912AA None ID/RA 3 OTH PVT PRAVOSTATIN None40mg NKA 1 PVT PUB VFC (Vaccine None for children) Asthma. 1 PVT PVT 0 PUB MIL advair, singulair, None zyrtecAsthma, Latex sensitivity 0 None UNK UNK NUVA RING N/A HEP A IN 1991, TB test positive due to adminstration to BC 1 N/A PVT UNK 9 MIL MIL NONE NONE NONE 1 TSH, CBC, PVT BHCG, mono PVTspot depo provera diarrhea sulfa 6 PVT UNK none 8 PUB PUB none none no~ ()~NULL~~In Patient 1 LABS: Blood UNK tests WNL. UNK MRI WNL. none EEG abnormal. none premature birth PUB UNK Synergist RSV 5 CBC, rapid PVT strep test (negative) UNK clarinex started allergic dayrhinitis of asthma vaccinations 0 PVT PUB none none 657 none PVT PUB Fever100-101.Headache none 0 PVT PVT
0 None PVT PVT Lamictal Denied. Allergy to Dilantin, Cipro, Benadryl. Pt. has history of epile 3 PUB PUB 1 PUB PUB n/a n/a n/a 11 PUB PUB N/A N/A N/A 0 none PVT PUB none none none 0 PUB PUB GENERAL NONE RASH PR-09-05 5 POS PREGPVT TEST 03/25/09 PUB NONE KNOWN NONE 0 NONE PVT UNK NO PR-09-06 1 none ice bag PUB PVT vertigo 4 NONE PUB PVT NONE 1 none PVT UNK none none none 0 PVT PVT Nexium, toprol XL, benicar BenadrylHCT, insomnia, combiventhypertension, inhaler. ND-09-04 GERD 0 PVT UNK Tri-Vi-Sol reactive lymphadenopathy, None. cephalohematoma(birth injury) 3 Paatient with UNK lymphoma, UNK had radioation Fluxoetine on 10/3, 20mg; left arm lastdexameethsone dose wasAllergic weak of a 26 torqadiation PCN 4mgPMH: course. non-Hodgkin diagnostic lymphoma work upleft 10/28, axillainc 2 736 PUB PUB 2 26-Mar-2009 UNK CT angiogram UNK of chest: Percocet; no evidence Tylenol Smoker; of pulmonary Back Pastpain Disease: embolism; Tooth right ache; MEDI0008275 lower Ruptured lobe lung diverticulum; nodule not Colosto visualiz UNK OTH OTH Unknown The subject was reported A0775224A to be "considerably large". 1 None PVT PVT ALEADRONATE-SODIUM; None Hypertension SIMUASTATIN - Hyperlipidemia - Osteoporosis PVT OTH None WNL None WNL 0 None PVT PVT ADDERALLNone XR ADD 0 PVT PVT 10 PUB PUB Prednisone; unknown compute Emphysema - O2 dependent. none PUB PUB PPD none none of significance - pityriasis alba; Asthma; Obesity 938 PVT PVT None None 2 none PUB PUB Loratadine none allergic rhinitis 1 None PVT PVT ORTHO EVRA None None 1 None PVT PVT Allegra, Tylenol, None Nasonex None 1 OTH PVT ATENOLOLNo 50 mg; HCTZ No 25mg; NITEDIAC 30mg ER tabs 3 N/A warm compress PVT & PVT PO KEFLEX 0 PVT UNK 0 PUB PUB UNK UNK 0 UNK UNK UNK UNK Unknown OTH OTH Unknown Unknown WAES0904USA00644 Unknown OTH OTH Unknown Unknown WAES0904USA00515 0 diagnostic laboratory, OTH aOTH group A strep in the blood sore throat was found. PMH: 4/24/09 Labs foot PCP 4/1/09: swelling. records CBC Sickle-cell received WAES0904USA01011 with WBCs which trait. 11.1 reveal 73% 11yr segs, WCC 13.1% 3/3 Unknown OTH OTH Unknown Unknown WAES0904USA00594 Unknown OTH OTH Unknown Unknown WAES0903USA00682 Unknown OTH OTH Unknown Unknown WAES0904USA01136 Unknown OTH OTH Unknown Unknown WAES0904USA01186 Unknown OTH OTH Unknown Unknown WAES0904USA01349 Unknown OTH OTH LORATADINE Pregnancy NOS (LMP = 11/29/2008); WAES0904USA01164 Sulfonamide allergy PVT PVT 0 UNK PUB DEXAMETHASONE 4mg, PROMETHAZINE 23 mg PO antibiotics PVT+ warm UNK compresses. None None 0 PVT PVT ACTOS 45mg tablet; Freestyle test invt strip; METFORMIN 500 mg oral tablet; 9 Bloodwork; PVT Xray of chest; OTHFlu & strep; Urine None None 2 PVT UNK None None 10 None PVT UNK AMOXICILLIN Otitis MediaNKA or problems 1 12/28/2007PVT x-ray cervical OTH spine done. None1/3/2008 None MRI cervical None.spine 5/26/09 done. Medical Neurology records consult received done, DOS seen 2/3/07 12/31/200 to 5/7
0 OTH PVT LISINOPRIL; None SULFAMETH-TRIMETH; Strawberries; None~ Chronic TOPROL; ()~~0~Patient bladder APRIM; infections; MOTRIN hypertension; pu 0 PVT PUB TYLENOL after Cough; 12 Congestion NKDA 15 CBC; CK; LYMES; PVT ANA; UNK RHF; EMG LIDOCAINE; 4/8/09 positive Dog CLINDAMYCIN; bite muscle PCN damage BACTRIM 0 PVT PUB 0 None OTH PVT None Headache~HPV (Gardasil)~1~0~Patient 0 PVT OTH 3 Red & Itching OTH Rash onOTH Both Forearms, BENICAR/HCT hands,None Face, - 40/25, Neck Allergic SIMVASTATIN to pollens,- 40, grass, TRILIPIX etc., Sulfa, - 130LISINOPRIL 0 PVT OTH Epigastric Pain Basal Cell Ca, hyperlipidemia, hypertension, osteoarthritis None PVT UNK None None 1 PVT PVT SINGULAIRNo No 3 PVT PVT TRIVIFLORNone-but fell None and hit head on floor -> no LOC at home 0 PVT PVT No No 1 PVT PVT Obesity Obesity 0 Sent urine culture PVT and PUB throat culture (urine dipNone + rapid strep (-)). 0 PVT PVT None None 8 None Performed PVT UNK AMOXICILLIN 3-9-09 3-9-09 Sinus to Reflux 3/19/09; infection PREVACID started AMOXICILLIN FN 10 days 0 PUB PVT 11 MIL MIL none unknown 1 None UNK UNK None None None 0 None PUB UNK Levothyroxin, None Advair, Ibprofen, Allergies:Cloratab Percocet, Edema, itching, Ultram, erythemia~Influenza Augmentin; Asthma,(no Hypothy brand 0 UNK PUB amoxicillin Bronchitis 0 PUB PVT None None None 0 Medical records UNK state: UNK LABS: RAST atarax, testing zantac, (+) No. formiralax. milk, wheat, Eczema, prn: topical egg, moderate-severe peanut steroids & dog for eczema dander. MedicalSkin records test for reveal: soy allergy PMH: 0 PUB PVT None known 1 NONE UNK UNK NONE NONE NONE 1 PUB UNK No. No. No. 1 PVT PVT 12 PREG TEST PUB - NEG PUB NONE NONE PVT PVT Advair, pro None Air Asthma ~ ()~1~~In Patient Unknown 2 UNK UNK Has cold with Chronic no fever sinus None~ infections ()~~0~Patient|None~ stopped after T ()~~0~Sibling and A. Underdeve 1 None PVT PVT Advair, Singular None Asthma Fever, Muscle Ache, Head ache, stuffy nose~P 2 N/A UNK UNK lutera none N/A 1 N/A PVT PVT Zoloft None Allergic to sulfa and bee stings - has current prescription fo 20 UNK PVT PUB Cold; Diabetes No other vaccines wereA0778584A given on 12 January 2009. The su 15 Platelet count, PVT3000 LABS: PVT Head CT WNL. Mild FinalURI plt ct None 26K(L).PMH: evaluation 3 mo prior for macrocephaly WNL. 0 Bld Cx, NG;PVT ESR, 25; Plt, PVT188; HgB, KEFLEX 13.0; HCT, 500 Nomg 38.0; tid WBC, None 10.2; PMH: P, 71; allergies, L, 22; s/p M, 3; T&A. E, 4 Family LABS:hx: Segs allergies. 71%(H), lym 0 unknown - treated PVT at hospital. PVT LABS: ZYRTEC WBC 31.7(H), No bands ZITHROMAX 22%(H), segs allergy 57%(H), PMH:lymphs tracheomalacia, 11%(L). ESR pneumonia, 47(H). CR b 13 Abdominal PVT series; UGI;PVT air contrast None enema; exploratory None surgery Hospitalized 5/14/09 2/13/09; hospital RSV; discharge Bronchiolitis summary recieved DO 0 PUB PUB None None - URINone just done PMH: fever & cold s/s; viral syndrome w/rash; recur 25 u/s at hospital PVTLABS: plts PVT514(H), bands 14%(H), NonelymphsNone 32%(L), monos 19%(H). Abdominal US (+) x 2 for IS in R 3 Pt receivedPUB vaccine because UNK he was a case contact None None 3 Pt receivedPUB vaccine because UNK he was a case contact. None None PVT PUB SINGULAIR; NoCLARITIN; Asthma ADVAIR 1 PVT PUB VYVANSE No ADHD; Allergies (Environmental) 4 MIL MIL None None 3 PVT PVT PVT PUB None None 0 PUB PUB PPD SanofiNone Pasteur LFA 0 5 Instructed client PUB to seePVT Allergist - prior to another None dose ofKEFLEX Hepatitis: B. Sun Given phone IA090003 number of only Allergist in area. 0 PVT PUB 2 No flu like symptoms; OTH Lymph UNK node normal
1 1 None 2 1 1
PUB PUB Hydrochlorothiazide None Allergic to flu Rash~Influenza vaccine containing (no brand Thimerisol name)~UN~0~Patie PVT PVT None None PVT PVT Tylenol Upper respiratory None infection PVT PUB ALBUTERAL Wrist PRN; fracture QVAIR Asthma Inhaled daily; FLONASE inhaled daily PUB PUB None OTH OTH 0 PVT UNK NONE NONE Beta-humanOTH chorionic,OTH ?/?/09, pregnant Unknown Pregnancy NOS (LMP = 1/27/2009) WAES0903USA02289 0 Unknown OTH OTH Unknown WAES0904USA01356 105 Results were UNK not provided UNKfor the following: TYLENOL;12 At Pre November the natal timevitamins; Patient of2007: vaccination has glucose Essential a history the tolerance fatty patient ofacids asthma, was test,### self 06 high December treating bloodwith pressure 2007 Tylenol alpha-f (both for 1 29 August 2003: OTH CBC;OTH urinalysis; chem Phenobarbital; 7; dilantin; DilantinHistory and phenobarbital of congenital were normal seizures.### 1 PVT UNK MetphorminDiabetic None 13 UNK UNK STUFFY NOSE FOR 4 DAYS WITH SLIGHT COUGH 0 None MIL MIL none none none 1 PVT UNK Cenestin 1.25 None, mg otherwise PO daily Allergy healthy to sulfa and pen V-K. No birth defects. Had endom 2 normal CRP, UNK ESR, complement UNK and none rheumatoid None factor LABS: None CBC, FamilyRF hx:WNL. parentCSF: w/DM. glucose 50, protein 32 (both 0 none PUB PUB THYROID MEDICATON no Tendonitis AND MULTI dx NA~ ofVIT. ()~NULL~~In Rt elbow in 2007 Patient following tx with cipro by 0 No sign of viral UNKor bacterial UNKinfections. No other TestsMeds as Noofillness Thursday as none a noon matter are of inconclusive. fact they checked 5/14/2009 him before hospital theyrecords gave the rece s 21 PUB PUB None Currently. No ClientClient had ahad PPDa administered Right radical mastectomy 2/4/09. in 2003 which includ 1 none PVT UNK 1 PUB PUB Benyaclin gel to face B/D 0 None PVT PUB None NONE No previously diagnosed seizure disorder, but parent state 10 03/24/2009UNK Hgb 5.9, MCV UNK82.8, Retic none0.1, ANC none 1.39 glucose, none.Urinalysis, PMH: neonatal Spinal jaundice Tap, CT Brain, Xray chest, MRI, EE 0 UNK PVT none none none 0 NONE PUB PUB NONE NONE NONE 0 THIS IS THE PUB THIRD REACTION(DOSE) PUB NONE (SAME NO SYMPTOMS-SIGNS) FROM THE SAME LOT NUMBER (18 DOS 0 examined by PVT physicianPUB none 0 NONE PUB UNK NONE NONE NONE None. PVT UNK None. None. None. 0 MIL MIL 3 CBC, CK-muscle, UNK ESR,UNK ANA pending N/A Labs: WBC N/A 4.2. CK History 91 (WNL). of thyroid ANA nodule; (-). (no ESR Raynaud's done) syndrome. PMH: H/A 1 PVT OTH 2 PVT OTH 0 PVT PUB None Asthma 4/9/09, WBC, UNK 20.60; SGOT, UNK 113; SGPT, 121; P/T, 569; Blood culture, negative; U/A, positive leuk; positive blood; B 0 None PVT PVT ACYCLOVIR None 400mg None None~ ()~~0~Patient 1 None PVT PVT None None None 4 Wound cx negative OTH OTH None None 1 None PUB PVT PROZAC; ATIVAN None None 3 PVT UNK Darvocet Novacaine Preservative in locals. 46 OTH PVT None Clinical None Research Trial 0 MIL MIL No No 2 PVT PUB NC09014 0 none PVT PVT none eczema 7 PVT PVT None 0 PVT PVT Gastroesophageal None told. Reflux (GER) 2 OTH PVT 1 None PVT PVT 0 PUB PUB 0 PVT PVT TYLENOL; None CLARITIN None 1 PVT UNK none none
0
PVT PVT None None Allergies: AMOXICILLIN; hx: Asthma and seasonal allergie Unknown OTH OTH Unknown Unknown WAES0904USA01876 0 Beta-humanOTH chorionic,OTH ?/?/07, pregnant Vitamins (unspecified) Pregnancy NOS (LMP = 5/9/2007); WAES0904USA01551 Migraine Unknown OTH OTH Unknown Unknown WAES0904USA01347 2 PVT PUB none 1 PVT PUB None Eczema; Amoxicillin; Sulfa allergy 1 PVT PUB None mild cold ??None 1 PVT PUB PUB PUB CONCERTA; CLARITIN; ORTHO TRICYCLEN low dose 0 None PVT UNK None None 3076 OTH OTH None Unknown None Chicken pox~Vaccine not specified (no brand n PUB UNK 0 Blood cultures OTHneg. WBC PVT11.7 Cymbalta; BP. None Med; Phenobarb; Allergy - grass, diazide;Synthroid; mold; seizureanti disorder; inflamma hypothyroidism; ele 1 None PUB PUB None None 2004 Hodgkins Lymphoma 0 UNK UNK PVT PVT Leg pain Herpes 0 PVT PUB BENZOXL PEROXIDE Rash gel 0 PVT PVT 0 fever sl fine No(viral) exanthen 8 PVT PUB None None None 1 6/17/09 Hospital UNK records UNK and DC summary loratadine,received dalteparin, none - in DOS hospital indomethacin, no3/25/09 allergies, for to aortica 3/30/09. birth lisinopril, valve defects, LABS disorder. insulin orand medical aspart, DIAGNOSTICS: conditions. acetaminophen, Echocard 6/17/09 hep H 1 none PUB PUB none none none none~ ()~NULL~~In AL0906 Patient|none~ ()~NULL~~I 76 Positive sacroilitis UNK 10-08.MRI UNK 12-08 Mircette,multi Diagnosed Seasonal migrains, vitamin,allergies, zantac. acne, chronic GERD, 6/1/09 acne fatigue, Allergic Rheumatology depression ceftin, 4-09 dioxicillian. records 5/27/09 DOS 6/1/09 Rheumatology 2/18/09 Rheumatol to 5/27r 44 HERPES SWAB UNK SENTUNK TO MAYOVERAPAMIL, LABS 04/16/2009 NONE BENICAR, AND NO IS LEVOTHYROXINE, KNOWN PENDING. ALLERGIES. HSV (-). LOVASTATIN HX HYPOTHROIDISM, HYPER 2 UNK UNK 0 UNK UNK 466 UNK UNK COPD PMH: severe COPD, on home O2 & in hospice care since 1 MIL MIL NONE NONE 0 None PUB PUB NONE UNKNOWN 1 PUB UNK none none 5 Doctor submitted UNK note UNK to school stating Insulin"Patient (Hemolog) None hasknown a skin Juvenile rash on Diabetes his legs called Granuloma Annulare. It is not co 2 PVT PVT N/A N/A N/A 1 None yet I showed PVT ladyPUB at clinic and Keppra, told her Neurontin, Ino wouls fill Ultram, out Allergy this Enablex,Topamax form. to Sulfa drugs and benedryl. Epilepsy 4 unk at this time PUB UNK crestor none unk 1 na PVT PVT no no no na~ ()~NULL~~In Patient|na~ ()~NULL~~In Sib 2 UNK PVT Unknown, patient No has never Unknown had medications filled here. 2 none UNK UNK none none none 1 PVT UNK 0 0 0 54 Air Enema UNK UNK None None 1 PUB PUB none none 226 elevated liver UNK enzymes,UNK elevated wbc, decreased no rbc, lowered seasonal hct,allergies 16.8 rdw,PMH: lowered chickenpox, segs, raised seasonal lymphs, allergic raisedrhim 1 labs and Diagnostics: UNK UNK EKG NSR. Nexium, Venous dopplers Cardizem, Afib, cyst (-)Lasix, for onAfib, DVT. back, Atenolol, DM, ESR DM HTN, 19. Warfarin, COPD, Glucose ASA CVA. 1138. PMH: BUNHTN, 33. Creatinine A-fib, ovarian 1.4. CA A 0 PVT PVT poison ivy on Allergic elbowto penecillin 1 NONE PUB UNK NONE NONE NONE 3 UNK PVT patient has No only this vaccine Unknown on her profile at giant eagle pharmacy 2 UNK UNK Allergic to Ciprofloxacin 3 UNK UNK CephalexinGERD, 500mg,pantoprazole Obesity No known Ec allergies 40 mg, Fluoxetine 10 mg 2 UNK UNK loradine 10 environmental mg,albuterol, No fluticasone,benedryl known allergies, medication obesity allergies 25 mg,sertraline 50 mg,premarin 0 1 chest x ray UNK Labs: CBCUNK with WBCs 22.1-77%segs, cold 17% lymphs. none PMH: Platelets none 671. UA (+) for mod blood, (+) nitrites, M 1 PVT PUB TMPS 5 MLSerous B.I.D. Otitis Media 0 PVT PUB None None 0 MIL MIL None UNK
1 None
PVT PVT None None None MIL MIL none none none (CPAP; nebulizer at birth to 3 months) 1 None PVT PVT All cultures PVT were negative PUBBld CSFNone throat, CTNone scan normal, None FHD seizure cultures 13 None PVT PUB None None None CBC & Chem PVT 7, nl; EEG, PVT 9/08, nl for ADDERALL age but 1-2 XRspike-wave 25 mgADHD d/c that suggest predisposition to seizures 0 None OTH OTH None Pregnancy NOS (LMP = 12/1/2007); WAES0802USA04952 Social alcohol drinker; Smoker 0 hearing test, OTH 06/05/08,OTH failed right albuterol; hearing test; FLOVENT Pregnancy hearing test, Bacterial NOS06/06/08, (LMP infection = Unknown); faileddue right WAES0803USA00880 to Eczema; hearing streptococcus, test; Asthma; hearing group Congenital test, B; Vaginal 02/24/2 club 0 ultrasound, OTH 03/06/08, wnl; OTHultrasound; PRENATE beta-human Pregnancy ELITEchorionic, NOSpositive (LMP = 1/19/2008) WAES0803USA01292 0 beta-humanOTH chorionic -OTH positive ZITHROMAX Pregnancy 1 gm; DOXYCYCLINE; NOS (LMP = 1/25/2008) ORTHOWAES0803USA01406 TRI-CYCLEN Cervical dysplasia 0 ultrasound, OTH 06/02/08, normal; OTH diagnostic RITALIN laboratory, Pregnancy 11/05/08, NOS (LMP normal; = 2/6/2008); beta-human WAES0805USA04750 Attention chorionic, deficit results disorder not reported 23 diagnostic laboratory, OTH group OTH B strep None positive (baby); Pregnancy beta-human Normal NOS (LMP delivery; chorionic, = 4/18/2008); Vaginal 06/10/08, WAES0806USA02242 disorder; Asthma; positive; Disease Anxiety Apgarcomplication score, 8/9, ba 0 fetal monitoring OTHtests, normal OTH anatomy Nonesurvey:Pregnancy 20 weeks NOS EGA;(LPM urine=beta-human, 10/1/2007) WAES0807USA03038 01/18/08, positive; urinalysis, GB Apgar score, OTH 9/9 OTH Pregnancy NOS (LMP = Unknown); WAES0807USA03843 Scoliosis 83 None OTH OTH PHENERGAN; Pregnancy vitaminsNOS (unspecified) (LMP = 6/2/2008); WAES0808USA04369 Nausea 198 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 1/25/2008 WAES0808USA04377 0 Diagnostic laboratory, OTH prenatal OTH labs; Albuterol; Diagnostic Nasalcrom Pregnancy laboratory, NOS 12/??/08, (LMP =CT 3/30/2008); cultureWAES0809USA01360 positive Asthma; Hypersensitivity; Obesit -41 Ultrasound,OTH 03/09/09; Blood OTH pressure, DTP 102/58Pregnancy Chickenpox NOS (LMP = 12/12/2008); WAES0902USA01505 Cramp; Allergic to dogs; Allergi 0 Unknown PVT OTH Unknown Migraine WAES0902USA04263 Unknown OTH OTH Unknown Unknown WAES0903USA01086 11 None OTH OTH Drug hypersensitivity WAES0903USA01403 Unknown OTH OTH None Drug hypersensitivity WAES0903USA05482 Unknown OTH OTH Unknown Unknown WAES0903USA05497 0 None OTH OTH XANAX Unknown WAES0903USA05499 0 None OTH OTH None None WAES0903USA05512 14 None OTH OTH Hypersensitivity WAES0903USA05548 Unknown OTH OTH Unknown WAES0903USA05559 Unknown OTH OTH Unknown Unknown WAES0903USA05566 Unknown OTH OTH Unknown Unknown WAES0904USA00004 12 Unknown OTH OTH Unknown Unknown WAES0904USA00014 0 None OTH OTH None None WAES0903USA02293 0 None OTH OTH Unknown Unknown WAES0904USA00051 0 Unknown OTH OTH Unknown WAES0903USA02323 Unknown OTH OTH Unknown Unknown WAES0904USA00085 130 Unknown Labs OTH and Diagnostics: OTH Unknown alk phos (H) at 137. AST Unknown 112. ALT PMH: 131.ADHD MRI Wbrain AES0903USA02643 WNL. ANA (+). CSF WNL. Unknown OTH OTH Unknown Unknown WAES0904USA00089 Unknown OTH OTH Unknown Unknown WAES0903USA03984 Unknown OTH OTH Unknown Unknown WAES0903USA04598 Unknown OTH OTH Unknown Unknown WAES0903USA01645 2 OTH OTH Unknown Unknown WAES0904USA00097 0 Unknown OTH OTH hormonal contraceptives Pregnancy NOS (LMP-1/19/2009)WAES0903USA01677 Nail-patella syndrome 0 Unknown OTH OTH Vitamins (unspecified) Pregnancy NOS (LMP = 12/27/2008) WAES0903USA01999 Unknown OTH UNK Unknown Unknown WAES0903USA02061 None OTH OTH None Unknown WAES0903USA02101 None OTH OTH None None WAES0903USA02285 1 Unknown OTH OTH Unknown Unknown WAES0903USA02333 -150 Unknown OTH OTH Unknown Unknown WAES0903USA02337 73 Unknown OTH OTH None Not sexuallyMeningitis active WAES0903USA01421 cervical smear, OTH02/13/09, OTH HPV positive, Unknown had atypical cellsNone WAES0903USA01423 Unknown OTH OTH Unknown Unknown WAES0903USA01428 Unknown OTH OTH Unknown Unknown WAES0903USA01434
Unknown OTH OTH None Arthralgia; Bone disorder WAES0903USA01443 1 None OTH OTH YAZ None WAES0903USA01445 0 None OTH OTH SYNTHROID; Hypothyroidism; PRILOSEC; vitamins Gastroesophageal (unspecified) WAES0903USA01457 reflux disease 0 None OTH OTH CLARITIN Eczema; Hypersensitivity WAES0903USA01595 -89 ultrasound, OTH 03/06/09, Bicornuate OTH Uterus albuterol and fluid Pregnancy filled cyst; NOSbeta-human (LMP = 10/24/2008); chorionic, WAES0903USA01609 positive Asthma; Cervical dysplasia 60 Unknown OTH OTH None Sulfonamide allergy; Allergic reaction WAES0903USA01611 to antibiotics; Potato allergy; All beta-humanOTH chorionic, OTH was positive Unknown Pregnancy NOS (LMP= unknown)WAES0903USA01628 Unknown OTH OTH Unknown Unknown WAES0903USA01631 0 None OTH OTH None None WAES0903USA01637 0 Unknown OTH OTH Unknown Unknown WAES0903USA01639 None OTH OTH Unknown Unknown WAES0903USA02345 0 Unknown OTH OTH Unknown WAES0903USA02346 0 Unknown OTH OTH Unknown WAES0903USA02349 Unknown OTH OTH Unknown Unknown WAES0903USA02354 0 Unknown OTH OTH LOESTRIN FE Infectious mononucleosis WAES0903USA02374 None OTH OTH None None WAES0903USA02555 2 Unknown OTH OTH None None WAES0903USA02593 Unknown OTH OTH Unknown Latex allergy WAES0903USA02852 0 Unknown 5/13/09 OTH medical OTHrecordsNone received DOS Penicillin 1/26/09 allergy; 5/13/09 to 3/31/09. Allergic medical LABS reaction records andWAES0903USA02886 toDIAGNOSTICS: received antibiotics DOS 5/13/09 1/26/09 CBC medical - to MPV 3/31/09. record 7.1 fL 0 Unknown OTH OTH Unknown Unknown WAES0903USA02903 0 Unknown OTH OTH Unknown Unknown WAES0903USA02907 103 beta-humanOTH chorionic, OTH positive; Mantoux isoniazid; test, pyridoxine Pregnancy positive Cesarean NOS (LMPsection; = 2/16/2009); TB exposure WAES0903USA02927 Penicillin allergy; PPD skin test p pap test, ?/?/08, OTH normal; OTH pap test, Unknown ?/?/09, abnormal Unknown WAES0903USA02993 Unknown OTH OTH Unknown Unknown WAES0903USA03188 0 None OTH OTH None None WAES0903USA03192 Unknown OTH OTH Unknown Urinary tract infection WAES0903USA03221 Unknown OTH OTH HAVRIX Viral infection WAES0903USA03230 0 urine beta-human, OTH pregnant OTH Pregnancy NOS (LMP = 1/1/2009)WAES0903USA03231 Unknown OTH OTH Unknown Asthma WAES0903USA03237 computed axial OTH OTH Unknown Unknown WAES0903USA03242 0 None OTH OTH ORTHO-CYCLEN None WAES0903USA03245 Unknown OTH OTH Unknown Unknown WAES0903USA03247 0 None OTH OTH None None WAES0903USA03252 Unknown OTH OTH Unknown Unknown WAES0903USA03626 0 Unknown PVT PVT Unknown Unknown WAES0903USA03643 0 Unknown OTH OTH Unknown None WAES0903USA03665 0 Unknown OTH OTH Unknown Graves' disease; Latex allergy; Food WAES0903USA03945 allergy Unknown OTH OTH Unknown Unknown WAES0903USA03970 Unknown OTH OTH Unknown Unknown WAES0903USA03974 0 None OTH OTH None Arthropod bite WAES0903USA03975 Unknown OTH OTH Unknown Unknown WAES0903USA03979 0 Unknown 5/15/09 OTH Medical OTHrecords received DOS 1/19/09Unknown to 1/20/09. LABS andWAES0903USA03982 DIAGNOSTICS: None 149 cervical smear, OTH03/18/09, OTH positive None for hpv None WAES0903USA03986 Unknown OTH OTH None None WAES0903USA04004 Unknown OTH OTH Unknown Unknown WAES0903USA04033 Unknown OTH OTH Unknown Unknown WAES0903USA04036 Unknown OTH OTH Unknown Tension headache WAES0903USA04255 0 Unknown OTH OTH Unknown Unknown WAES0903USA04259 0 None OTH OTH None Pregnancy NOS (LMP = 1/7/2009)WAES0903USA04271 1 Unknown OTH OTH YAZ Unknown WAES0903USA04275 Unknown OTH OTH azithromycin Infection susceptibility Upper respiratory increased tract WAES0903USA04281 infection
39 None 5/13/09 OTH medicalOTH records received YAZ; FAMVIR DOSDysmenorrhea 2/3/05 to 3/26/09 HPV #2LABS givenand 11/24/2008, DIAGNOSTICS: WAES0903USA04302 Lot # 0571X CHEMHPV - ALT/SGPT #3 given 1/2 8U None OTH OTH Unknown Unknown WAES0903USA04310 Unknown OTH OTH Unknown Unknown WAES0903USA04317 7 None OTH OTH None None WAES0903USA04511 0 Unknown OTH OTH Unknown Unknown WAES0903USA04517 0 Unknown OTH OTH Unknown Unknown WAES0903USA04527 None OTH OTH None WAES0903USA04889 10 None OTH OTH None WAES0903USA04897 diagnostic laboratory, OTH 1-2 OTH HIV false Unknown positive Unknown WAES0903USA04899 49 Unknown OTH OTH Unknown Unknown WAES0903USA04903 4 Unknown OTH OTH Unknown Unknown WAES0903USA04909 beta-humanOTH chorionic, OTH 3/26/09, pregnant NAPROXEN; Pregnancy ranitidinePapanicolaou NOS (LMP= unknown); smear abnormal WAES0903USA04915 Shoulder pain; Gastroesophageal 42 diagnostic laboratory, OTH 2/23/09 OTH Pregnancy NOS (LMP= 1/15/2009) WAES0903USA04528 Unknown OTH OTH Unknown Unknown WAES0903USA04536 34 ultrasound, OTH everything OTH looked normal Unknown Pregnancy NOS (LMP= 1/19/2009) WAES0903USA04922 hematologyOTH OTH None Penicillin allergy WAES0903USA04544 0 None OTH OTH None None WAES0903USA04924 Unknown OTH OTH Unknown Unknown WAES0903USA04933 0 Unknown OTH OTH ZOVIA Pain menstrual Infectious mononucleosis WAES0903USA04982 0 None OTH OTH None WAES0903USA05175 0 Unknown 5/15/09 OTH Medical OTHrecordsDIFFERIN received DOS 5/15/09 5/15/09 3/9/09 Medical Medical Unknown to 5/5/9. records records LABS 5/15/09 received received andMedical DIAGNOSTICS: DOS WAES0903USA05202 DOSrecords 3/9/09 3/9/09 to to received None 5/5/9. 5/5/9. vaginal Monostat, DOS 3/9/09 discha Ben to 0 body temp, OTH 3/??/09, 101F OTH Unknown Egg allergy WAES0903USA05288 0 None OTH OTH Unknown Penicillin allergy WAES0903USA04553 Unknown OTH OTH Unknown Unknown WAES0903USA05321 None OTH OTH None None WAES0903USA04559 Unknown OTH OTH Unknown Unknown WAES0903USA05328 Pap test, positive OTH for high OTH risk HPVUnknown Unknown WAES0903USA04582 Unknown OTH OTH None Penicillin allergy; Infectious Sulfonamide mononucleosis allergy WAES0903USA04594 None OTH OTH None None WAES0903USA04609 OTH OTH Unknown Unknown WAES0903USA04725 4 None OTH OTH None None WAES0903USA04851 0 Unknown OTH OTH Unknown Asthma Urinary tract infection WAES0903USA04853 UNK UNK None 0 None MIL MIL NONE NONE NONE 1 LABS: intestinal UNK biopsy. UNK CBC WNL. Lipid profile(H). Amylase/lipase PMH: depression/anxiety. WNL. US of abdomen WNL. 2 none PVT UNK Expressive language disorder Unknown OTH OTH Unknown Unknown WAES0904USA02014 Unknown OTH OTH Unknown Unknown WAES0904USA02004 Unknown OTH OTH Unknown Unknown WAES0904USA02281 Unknown OTH OTH Unknown Unknown WAES0904USA02052 0 ultrasound, OTH ?/?/08, normal; OTH beta-human None chorionic, Pregnancy 03?/??/08, NOS positive (LMP = Unknown) WAES0904USA01867 207 Unknown OTH OTH Unknown Unknown WAES0904USA02046 0 Apgar score, OTH 09/14?/08, OTH 9&10 (BABY); None body weight Pregnancy measurement, NOS (LMP09/14?/08, = 12/24/2007) 2785 WAES0801USA05068 gram (BABY) OTH OTH Unknown Unknown WAES0904USA02013 OTH OTH Unknown Unknown WAES0904USA02011 Unknown OTH OTH Unknown HIV infection WAES0904USA02010 OTH OTH Warfarin Unknown PMH: on warfarin MA20090925 Unknown OTH OTH Unknown HIV infection WAES0904USA02003 Unknown OTH OTH Unknown Unknown WAES0904USA01998 Unknown OTH OTH Unknown Unknown WAES0904USA01997 Unknown OTH OTH Unknown HIV infection WAES0904USA01993
Unknown OTH OTH Unknown HIV infection WAES0904USA01992 1 Blood tests;PVT Ct scan; PUB MRI; Spinal tap; EEG.Fell 7/7/09 and Hospital cutHigh handB.P.; records COPD; received Bi-polar; DOSEmphysema. 3/25/09 to 4/4/09. 7/7/09LABS Hospital andr 4 None PUB OTH None None 1 None PVT PUB None None None NKDA ID09005 2 None PVT PUB None None NKA 26 PVT PUB None noted None noted ID09007 0 None PVT PUB None No None ID09009 12 PUB OTH No None 0 None PVT OTH None None No pre existing allergy 0 None PVT PVT Tuberculosis URI test, Pasteur, NoneC2920AB, LA, 0 0 None PVT PVT Physical appt/HTN PCN AR 10 PVT UNK None None NKA; Prenatal hydronephrosis, eczema 1 PVT PUB 0 PVT PVT None None None Swelling, redness, hard lump x2-3 mos~DTaP 730 None yet UNK UNK None No 1 PVT PVT NOne None 3 None PVT UNK None No None 1 None MIL MIL None None Lyme Disease age 16, Ixodes Scapularis, tx Amoxicillin 50 5 UNK UNK none None healthy None Typically very healthy 1 PVT PUB 1 PUB PUB 2 Blood and urine PVT test were PVTdone - test confirmed a virus and a white blood High Fever~DTaP cell count that (Daptacel)~1~0~In indicated he was Patient fighting i 1 Labs: UC (+) UNK for mixedUNK growth. UA unknown (+) for blood, noneRBCs, reported none 2-4 WBCs, reported many PMH: bacteria, RAD trace ketones and 30 protein. B 5 PUB PUB none reported none reported none reported 1 PUB PUB 1 PVT PVT Zyrtec Prn Seasonal allergies 1 N/A PUB PUB Ibuprofen 400 mg BID Allergies: Latex, Vibramycin, Bananas, Strawberries, Nect 9 Labs: Hgb UNK 9.7. KUB WNL. UNK WBC 19.8. ESR none and CRP elevated. none PMH: Platelets Env allergies. 583. CT (+) PCN. for Tonsillectomy. bowel obstruction. US GB 0 PVT PVT none none none none here UNK UNK none knownnone knownnone known-screening all NO 1 PVT UNK citalopram, none implanon depression 1 UNK UNK Synagis Given NA 03/26/2009 Left Leg IM Lot#31301568 Manufacturer MedImmune 3 PVT PVT septra D, amoxicillin, Illness~Smallpox codeine.(no adhesive brand name)~1~5~In tape. Arthritis ,Pat lob 0 EKG, HolterUNK Monitor, EEG, UNK Sleep lo-ogesterl, Studies, Heavy hypoglycemia, vitamins, Metalmetanx, test, mold, PCOS, CBC, cockroaches, glucophase, Urinalysis, depression smoke, prozac, Upper dust, GI, trazadone, Stool dustsample, mites, spironlactone trees, Hepatitis grass,p tes 0 none PUB PVT AVAPRO; ATENOLOL none Defective heart valve, surgically corrected 1 None OTH PUB SEPTRA DS Left BID; toeTRAZADONE; infection none SEROQUEL; REFAMPIN; RISPERDAL; REME 2 NONE PUB PVT None None None None PVT PUB Amoxicillin 250 (R) Otitis mg/5ml media None - taking 6ml po BID X 10d for Otitis 0 MIL MIL 0 PVT PUB None None None 0 PVT OTH Wheezing at Anxiety Night- D/O; Cough Depression; Palpitations. 1 None PVT PUB None None 0 None MIL MIL None None None PVT PVT Fever, pain, swelling PVT PUB Pain; fever; swelling 3 None PVT PVT None None None 1 None PVT PVT None None None 1 Diagnostic results: OTH 20 April OTH1999: X-ray Enalapril showed maleate Arthritis; degenerative Cervical Laminectomy; changes Spondylosis; of family theHypertension; lumbosacral history A0779397A of arthritis spine Lumbar (mother). withStenosis significant deg 0 None PVT PVT None None 0 PVT PVT None None PCN allergy; RAD; SUT 0 None PVT PVT LEXAPRO depression None
1 CXR - Normal; PVTEKG - normal; UNK D - Dimer SYNTHROID - Normal; No112 BP miqrogramms elevated, Hashimota's was daily; retching disease EVISTA; CBC, --> Thyroidectomy, MVI, electrolytes, FISHOIL,K-3 BABY Non-Hodgkins ASP, CALC lym 2 X-rays - tissue PUBedema,UNK and also CT tissue edema; Laceration Lactate, of None left 4.0hand 6/24/09 Hospital ER record DOS 4/6/09 and Inpatie UNK UNK 1 PUB PUB No No Red swelling itchy~DTaP (no brand name)~2~2 1 MRI (-); LPPVT (-); CBC (-); PVTEEG after. LABS: CBC, None BMP, None CSF WNL. PMH: Blood, MSPI(milk urinesoy c/sprotein neg. CXR intolerance). initially thought Familytohx 3 OTH PUB None 1 OTH UNK Minor Hay fever 3 PUB UNK None None None 7 PVT PVT CLEOCIN, rash 11 PVT UNK None None None 1 None OTH UNK Runny nose; Conjunctivitis; Diarrhea 1 PVT UNK HA and Onychomucosis 3074 OTH OTH 1 PVT PVT Nothing Known No Nothing known 0 PVT PVT 0 None can'tPVT read next OTH until NKA None 0 Xray of nasal PVT bones PUB none 0 PVT PVT MOTRIN 600mg Sinus Headache NKDA muscle + joint CT200907 tenderness~Tdap (no brand nam 0 PVT PVT None None Thyromegaly Biopsy, diagnosed PUB withPVT Lichen Planus CENESTIN; PROMETRIUM, Mint hrt 0 None PVT UNK STRATLERA None 80 mg ADHD 0 PVT OTH 0 PVT PVT None None None 5 4/13/09: D Dimer: UNK <200ng.ml UNK (<230); None Troponin None I <0.010ng.ml; None CK 40IU/L (30-200); CK-MB 0.3ng/ml (0-6.6); 4/13/09 3 708.9 Urticaria PVT PVT Well child None 1 PVT PVT Reaction, shot 0 PVT PVT 5 yr well child Food exam allergies - cows milk, egg, peanut, shellfish, fish, tree 982 PVT PVT 0 PUB PUB None None reported None CA090002 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008077 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008075 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008073 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008072 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008036 OTH OTH Unknown WAES0904USA02081 1 PVT UNK None 0 None PUB PUB None None None 0 PUB PUB None Allergic reaction None 1 PUB PUB No No None PVT PVT None None None 0 No testing only PVTinjections PUB given DEPO MEDROL, none 40mgNKDA; IM at 12:25pm; H/O hay fever; DECADRON, asthma; seasonal 4mg, DM allergies at 12:25pm; ALB 3084 None PVT PVT None Unknown None 11 PVT PUB None Unknown OTH OTH Unknown HIV infection WAES0904USA02000 OTH OTH Unknown Unknown WAES0904USA02001 Unknown OTH OTH Unknown Unknown WAES0904USA02002 Unknown OTH OTH Unknown WAES0904USA02009 Unknown OTH OTH Unknown Unknown WAES0904USA02012 0 None OTH OTH None Pregnancy NOS (LMP = 1/1/2009)WAES0904USA01725 EEG-withinPVT normal limits; PVT CT Scan of head - normal The patient had a history of sleep ### disorder. The patient ha 0 Unknown UNK UNK The patientPast had a medical concurrent history condition included of### eczema eczemaand at the egg time allergy. of vacci
0 Chest X-ray; PVT CBC; Chem PVT7; RSV; None influenza Records received 5/6/09 - ED DOS 4/7/09 LAB: Strep Screen +, RSV 1 NONE PVT OTH None 0 EEG ordered PVT PUB None None Family History of seizure disorder 0 PVT PVT ADDERALL, 30mg, po, QD 1 none PVT PVT none upper respiratory none infection PVT PVT 12 PVT PUB None None None 0 OTH PVT Birth control; None B12 q/od Allergies: in (L) arm;Codeine;PHENERGAN None~ PAXIL 10 ()~~0~Patient mg qd po. 0 PVT PVT none none 0 None OTH OTH None None None 2 UA & CBC -PUB Results normal. PUB Had a Mantoux No TB testNo W / in 4 weeks 0 none PVT PVT none none none 5 PVT PVT None 5 UNK UNK None 1 PVT PVT Benicar, simvastatin, None Lotemax Allergieseye to ingested drops, Cosopt, or injected Restasis, iodine,Optivar latex, morphine, Al none PUB PUB no no 0 visual examPUB done PUB none none 4 None UNK UNK Tri Vi Sol None None 1 PVT PVT None Penicillin allergy (Rash) 1 PVT PUB UNK UNK 11 Troponin 1 UNK 19 March 2009 UNKAbnormal PMH: smoker. 5000007 1 PVT PVT 0 None PVT PVT Oral contraceptives None None PVT PVT none PUB PUB None None None 0 PVT PVT vitamins none was here NKDA forno well past child medical visit history 0 n/a PVT PVT Albuterol inhaler, None Epi Pen Milk(as allergy needed), Triamcinolone Cream, Benadryl (as need 2 Will meet with PVT allergist PVT on 4/28/09 client is taking none diovan for none high listed blood pressure 54 PVT PVT none none 1 PVT PVT finger laceration none 0 This is the second PUB day UNK so there have Seasonique not been No (sp)? any tests. A birth Penicillin, control no medicine birth defects. Multiple ear infections, tubes in 11 Brain MRI, UNK EEG-normal; UNK bloodwork Synthroid, done 5/13/09 Zoloft, no Received Nexium Hypothyroidim, at hospital time ofdischarge vaccine Acid Reflux, summary Hashimotos, DOS 1/22/08-2/8/08. Anxiety, Depress LAB Diagnostic results: OTH 15 November OTH 2001: Magnetic Arrhythmia; resonance InDiabetes 1993, imaging the Mellitus subject (MRI) Type offell lumbar A0779693A eight 2; Hyperlipidemia; spine feet from showed a tree Hypertension; mild anddegenerat hit his bu S AntinuclearOTH antibody, 31Dec2007, OTH negative; Erythrocyte Coronary artery Angioplasty; sedimentation disease;degenerative Increased rate, 17Oct2002, A0603034A cholesterol disc disease; 6mm/hr;Heart Erythrocyte problems; sedim m 7 6/10/09 Hospital OTH records OTH and DC summary received DOSNo. 4/10/09 6/10/09 toFever, 4/12/09. Hospital yelling~DTaP LABS recordsand andDIAGNOSTICS: (no DCbrand summary name)~2~0~Pa received CSF - To D 1 CBC PVT PVT Down Syndrome 2 PVT PUB Allergy, amoxicillin (rash); sickle cell trait 2 PVT PUB NKA; Prematurity 1 Strep cx, inPVT office, negative; PVT throatADDERALL cx, pending None XR; ADDERALL Penicillin, rash; ADHD 2 None PVT PVT 4 None PUB OTH None NKDA 0 None PUB UNK None None 11 PVT PUB 11 Skin biopsy:PVT 12/3/09 Spongiotic UNK dermatitis with eosinophils None - done after Skinfirst rash~HPV rash/2nd(Gardasil)~2~12~Patient HPV vaccine 1 MIL MIL Negative Negative 2 MIL MIL none denied knee problems, elev triglyceride 1 PVT UNK none none 1 None PVT PUB None None 1 None PUB PUB None None None 0 PVT UNK None None
0 PVT PVT None Cleft lip 0 mother tookPUB to urgent care PUBand was Prozac referred 10; to None Dexedrine hospital ED; None had MRI which was "clear"; was told that it was seizure 14 Negative HLA-B27; PVT 9-11-08 PVT Hg 12.5, FOLIC Wbc5 ACID; 100; None METHOTREXATE; Normal H/O LFTS; "Burning" U/A;PREVACID; IgG, sensation A, ME,TRAUIADOL; C3 of feet C4; ANA; 5/19/08-records ENBRIL DNAA; RF receivedASO; Au None PVT PUB None None None 7 PVT PVT 0 None PVT PVT ADALATE None Allergic to bee stings- Iodine-Shell fish-mushrooms-molds0 PVT PUB 395 OTH PVT None None None 0 EKG; O2 Saturation; PVT BP; OTH Blood sugar None None PVT PUB Allergies-cough 0 None MIL MIL WELLBUTRIN None None 1 None UNK UNK COPD; Pneumonia NKDA 7 Hemoccult PVT positive X3 PVT on 4/6/09 My Kidz Iron None None 0 Unknown OTH OTH None WAES0904USA02836 1 PVT PUB PVT UNK 0 magnetic resonance, OTH 07/12/07, OTH 2 cm None hematoma Drug in hypersensitivity the bone Function marrow kidney decreased WAES0904USA02298 107 serum ANAOTH protein, 04/18/07, OTH 1/80; ZYRTEC serum rheumatoid factor, Unknown. 04/24/07, 6/19/09 24.7; Rheumatology serum WAES0904USA02303 C-reactive, consultant 04/24/07, medical 2.7;recor seru Unknown OTH OTH Unknown Unknown WAES0904USA02789 352 Unknown 5/19/09 OTH medical OTHrecordsascorbic receivedacid; 4/9/07 Migraine; vitamin to 4/16/09. Penicillin E; Pneumonia vitamins LABS allergy; (unspecified) and 5/19/09 Drug DIAGNOSTICS: medical hypersensitivity WAES0904USA02794 5/19/09 records medical None. received records 4/9/07 received to 4/ 4 4/13/09--negative UNK strepUNK test; 4/14/2009 Singular Negative forNone Asthma Mono test Asthma and Negative Mumps 9 Physical examination PVT by UNK doctor none none 0 NO TEST WAS PUB ORDERED PUB PPD SKIN TEST N/A ORDERED CHRONIC ABDOMINAL PAIN/CONSTIPATION 1 None PUB PUB None None None none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 None required PUB PUB None None None 0 none PVT PUB none none 0 none PUB PUB Tubersol PPD none skin reported. mantoux nonemom known givendenies in right that forearm. patient was previously ill 0 NONE ORDERED PUB PUB n/a n/a well child n/a~ ()~NULL~~In Patient 0 PVT PVT nuvaring na previously has had syncopal episodes with injections and u 1 PVT PVT 1 None UNK UNK MultivitaminNone None 3 EEG's, MRI's, UNK bloodwork UNK 05/8/09 ED N/Arecords None received forJaundice DOS 10/1/07-10//2/07 at birth LABS & DIAGNOSTICS: CBC - pl 1 PUB PUB 4 PUB PUB 1 PVT PVT none none none Diagnostic Results: OTH 21 OTH September 1999: Lyme Chronic IgM IFA Neck negative. Cervical Pain; Lymphadenopathy; Lyme Clinical Western depression; A0599614A Blot Congenital IgG Hypertension; non-confirmatory. Kidney Hypothyroidi Anomaly; 30 SepC Diagnostic results: OTH 04 November OTH 2003: LymeHyperlipidemia; IGG Western BENIGN Blot Nodular was PROSTATE positive prostateand HYPERTROPHY A0600454A Lyme IgM Western Blot was equi 0 PVT UNK NKDA 1 PUB PVT None None MIL MIL None URI symptoms Allergies: None; Medical conditions: None; Birth defects PVT UNK 2 PVT PVT None 7 None OTH OTH No None 0 PUB PUB NONE NONE NONE 1 PVT PVT None None Pulse ox = 97-98 UNK % PVT Vit D None None significant 1 CholesterolOTH UNK Glimepiride; Gabapentin; Omeprazole; Clonazepam; Metaproterenol PVT UNK None None 3 PVT PUB Medroxyprogesterone Amenorrhea ultrasound, OTH 07/22/08, confirm OTH dating; serum alpha-fetoprotein, Pregnancy Terminations NOS (LMP 09/18/08, = 5/21/2008); of within pregnancy WAES0807USA04419 normal Asthma - elective limits; Apgar score, Baby: 8/ Unknown OTH OTH Unknown Unknown WAES0901USA03372
0 Unknown OTH OTH Unknown Unknown WAES0902USA02446 Unknown OTH OTH Unknown Unknown WAES0903USA00415 0 Unknown OTH OTH Unknown Pharyngitis streptococcal WAES0903USA00427 None OTH OTH Unknown Unknown WAES0903USA00454 0 None OTH OTH Unknown Penicillin allergy WAES0903USA00457 0 Unknown OTH OTH Unknown Unknown WAES0903USA00536 beta-humanOTH chorionic, OTH Negative Unknown Unknown WAES0903USA00539 29 urine beta-human, OTH 3/3/09, OTHnegative; None serum beta-human, None 3/3/09, pending WAES0903USA00547 5 None OTH OTH None None WAES0903USA00572 Unknown OTH OTH Unknown Unknown WAES0903USA00589 0 None OTH UNK None None WAES0903USA00747 None OTH OTH None Drug hypersensitivity WAES0903USA00761 Unknown OTH OTH Unknown Injection site reaction WAES0903USA00774 0 Unknown OTH OTH levothyroxine Pregnancy sodium Hemorrhage NOS (LMP=12/22/2008); in pregnancy WAES0903USA00792 Hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA00860 Unknown OTH OTH Unknown Unknown WAES0903USA00891 0 Unknown OTH OTH Unknown Unknown WAES0903USA00901 518 diagnostic laboratory, OTH 2/24/09, OTH positive NoneHPV test None WAES0903USA00904 1 Unknown OTH OTH Unknown Unknown WAES0903USA00914 4 Unknown 5/21/09-ultrasound OTH OTH of abdomen None. 6/4/09 2/19/09-impression:bulky Consultant Unknown. records received 6/4/09 prominence Consultant DOS WAES0903USA00926 of2/12/09. pancreatic records Prilosec, received head. Claritan, 4/8/09-impress DOS 2/12/0 Yaz, B Unknown OTH OTH Unknown Unknown WAES0903USA00928 Unknown OTH OTH Unknown Unknown WAES0903USA00936 ml dose of GARDASIL. Concomitant Unknown OTH therapy included OTH HAVRIX. The patient developed Unknown a fever 2 days after WAES0903USA00937 she received the vaccine. The fe Unknown OTH OTH Unknown Unknown WAES0903USA00956 Unknown OTH OTH Unknown Unknown WAES0903USA00962 0 None OTH OTH Unknown Unknown WAES0903USA00966 63 Unknown OTH OTH None None WAES0903USA01098 Unknown OTH OTH Unknown Unknown WAES0903USA01124 0 magnetic resonance, OTH negative; OTH chest NUVARING X-ray, negative; Drug hypersensitivity electrocardiogram, negative; WAES0903USA01138 metabolic marker test, normal; e 0 None OTH OTH None None WAES0903USA01155 Unknown OTH OTH Unknown Unknown WAES0903USA01367 Unknown LABS: OTH CBC,OTH CMP & USUnknown of abdomen WNL. Strep Unknown ID test (+). WAES0903USA01378 0 PUB OTH None (Ibuprofen None after immunizations) None 1 None PVT PUB None None Antibody test OTH (results: no OTH antibodies Concomitant from vaccine) The medications patient's was done concurrent were on 10-Apr-2009. not reported. illnesses USWYEH08942909 included asthma and seasonal aller 253 Skin biopsy.PVT PVT None None None known PUB PVT None known Allergic SULFA; PERCODAN; ATARAX; CODIENE; DE 0 PVT PUB None None None 0 PVT UNK None 1 None PUB UNK FB in foot None 1 CBC PUB PUB No Asthma 0 PUB PUB none Allergic to Sulfa 0 4/28/09-records UNK received-CXR UNK normal. Cold like symptoms None 4/28/09-records 4/28/09-records received-Family received-Possible history bronchitis of asthma prioa 2 UNK PUB NONE NONE KNOWN NONE KNOWN 1 n/a PUB PUB None Slight cold symptoms None - runny nose, cough 1 None. UNK UNK None. None None 2 Dr. visit PVT PVT Lopressor, None zoloft, prilosec None 1 None PUB PVT Claritin None Allergy to ceclor 0 None. PVT UNK Unknown. Unknown. Unknown. 1 MIL MIL OCP None None 0 None. PVT UNK Unknown. Unknown. Unknown.
2 MIL UNK NONE 1 PVT PVT ASA, MVI,B12, UTI ATENOLOL, CARDIOLYTE, TAZADONE, AUGMENTIN FLAX SEED, FEM RING, TRAMADOL 0 PUB PUB none 2 none. Though PVT this information PVT is singulair, not requested, foradil, nonemy asmanex, maternal asthma trilevlin, grandmother and environmental synthroid, also loratidine hadallergies cellulitis(pets, after apollen, pneumonia molds); va 0 None PVT PVT ASA, Coumadin, none Diltiazem, A fib/flutter, Metoprolol, HTN,Simvastatin hyperlipidemia, ASD repair, psoriasis, br 1 PUB PVT toprol xl, sythroid, none-good zocor-all codene health, three except alergy taken high daily. bp Diagnostic tests: OTH 06 March OTH2000: Electromyography Aspirin; Atorvastatin Elevated showed calcium; Blood The evidence subject Pressure; Risedronic has ofHyperlipidemia; a acid; history mixed A0601415A Metformin sensory/motor of basal Type cell hydrochloride; 2removal Diabetes peripheral in Azithrom the polyneu 1970 0 Blood glucose, PVT17Oct2008, MIL 77; Electrocardiogram, Metformin hydrochloride; Unknown 17Oct2008, Gestational Cenestin; normal; Diabetes; Thyroxine On unspecified Restless A0768930A sodium;dates Legs Aspirin; Syndrome; theCo-careldopa; subject Shingles; had anHR EK 0 PVT UNK 0 PVT UNK None - Annual exam 1 Positive strep PUB test UNK No Hx of RSV & pneumonia 1 None PVT PUB None None None 1 None PUB PUB None Ibuprofen-rash 1 None OTH PUB None None None known 0 UNK PUB None 4 PVT UNK ADVAIR; VitAsthma D; Multivits exacerbation; NKDA; Asthma; coughFDC; Osteopenia 0 PVT UNK had viral URI gets butwhelps afebrileif 98.0 gets poison ivy per custodial guard 1 PVT PVT 4 PVT OTH None None 2 PVT PVT 2 PVT PVT None 1 PVT UNK None 1 None OTH PVT 1 CBC PVT UNK None None 0 PVT PVT SINGULAIR; LIPITOR Fibromyalgia, DM Type II 1 PVT UNK 0 OTH OTH None PCN-SULFA-Strawberries 0 Pt examined PVT by Dr PVT MANTOUX,None Pasteur, C3026AA, None right intradermal, 0 0 PVT PUB PULMICORT; Allergic XOPENEX; rhinitis; RashSINGULAIR; Stable -BENADRYL ringworm CLARINEX; (per Mom);ACIPHEX house dust; per allergist. 1 None PUB UNK None None None 1057 PVT PUB None None None 1 None UNK UNK None Rash with eggs 0 PVT PVT No No 188 Unknown OTH OTH Unknown Unknown WAES0904USA03237 333 Unknown OTH OTH Unknown Unknown WAES0904USA03291 0 diagnostic laboratory, OTH 04/14/09, OTH blood Nonedrawn None WAES0904USA02392 0 Allergy testing PVT PVT Tuberculin PPD The patient had a history of milk, ###egg and dairy allergies. T 0 PUB UNK None None 9 Patient hadUNK CT scan, an UNK EEG, and is to have None an MRI that and we None follow knowup of.with Dr. 0 PVT PVT 0 PVT UNK None Unknown 2 dr evaluated PVT arm PVT Prevacid, lipitor,paxil none none 0 NONE PUB PUB NONE NONE NONE 4 R thigh ultrasound UNK negative UNK for abscess/loculation. none Blood none culture pending on 4/24. 7/24/09 Hospital records receiv 61 blood work,UNK head CT scan, UNK lumbarNone CT scan, 5/20/09 chest None EDx-ray, records None head received MRI, PMH:None~ spinal multiple Family tap ()~~0~Patient hx: DOS 5/18/09 depression 1/7/09 Received to&1/12. manic-depression. Hospital Phenergan, LABS Ativ of 8 None PVT PVT Diovan (VALSARTAN) None Hypertension 40 MG (40MGElevated TABLETcholesterol Take 0.5) PO Hypothyroidism BID Ecasa (ASPIR ocula 6 PVT PVT 0 labs on 9/16/08: UNK Hb/HCT UNK9.7/29, ocygen, WBC 6.42, ? chronic platelets lung355, Chronic disease sodium lung on oxygen disease 140, potassium on oxygen 4.2,therapy, chlorideretinoopathy 101, CO2 31, of B p 0 No radiographs UNKdone. UNK Received dexamethasone, QVAR (beclomethasone), None.epinephrine, Previously albuterol aerosolized seen MDIbyfor albuterol, anasthma; allergist and history ondiphenhydramine 9/16/2005 of EpiPen and atdiagnose home with IV (fo 0 PUB PUB NO NO Allergic to mold and history of asthma.Patient is not taking 0 PVT PVT
1 UNK UNK Paxil daily None Allergy to erythromycin; dx of fibromyalgia & depression 0 PUB PVT stated "no" stated "no" 0 None, but allergy PVT testing PVT is pending None None Large local reaction to mosquito bites,mild eczema 0 PUB UNK none none none Diagnostic Results: OTH 16July OTH1996: MRI SUMATRIPTAN of the Head: Migraine; SUCCINATE; No evidence Uveitis The subject ofOESTRADIOL; multiple was in sclerosis a motor A0600424A SPIRONOLACTONE; vehicle plaques. accident Small area in 1970 MINOCYC of enhanc and w 5 PUB UNK None None AR0912 5 Abdominal PVT US & X-ray;PUB XR enemaNone for intussusception Runny nose LABS: None x 1 day abdominal PMH: 37 wk x-ray gestation, & US abnormal. no complications. GERD. 0 6/1/09 Hospital PVTrecordsUNK received DOS PPD;4/16/09 ATARAX None to 5/6/09. 6/1/09 Hospital Allergy LABS and referral records DIAGNOSTICS: r/oreceived rash related DOS None dairy; 4/16/09 documented. eczema. to 5/6/09. 6/1/09 benydry Hosp 1 Labs and Diagnostics: PVT PVT Abd US (+) IS. BE (+)None for IS. AbdNone. X-rayPMH: (+) for GERD. paucity air. Perianal CBC abscess./ WNL. 0 A neurologist UNK had received UNK her results today I have to goShe see is him learning in the office disabled, to find sheout haswhere apraxia, we go sensory from here. integraW 1 OTH PVT 1 OTH PVT Azithromycin; MALARONE; Acetazolamide 1 PVT PUB TYLENOL prn; allergic ZYRTEC rhinitis None prn with nasopharyngitis None PVT PUB None None Known 0 PVT PUB No No 0 None PUB PUB None None None 0 red area near PUB KINRIX site PUB- 1 cm from needleNone puncture fish allergy 1 No additional PVT EEG at this PVTtime KEPPRA Cerebral Palsy; one seizure 12/08 2 None PVT PVT CARNATOR; FOCALIN; Allergy: B-COMPLEX; eggs/milk/peanuts; COENZYME Mitochondrial Q10 disorder; RAD; 667 Chicken pox PVT rash + 50PVT lesions 0 PVT PUB ZANTAC PVT OTH 0 OTH PUB None None None yes~HPV (no brand name)~1~12~Patient 1 - ESR = 22.PVT Rest normal. PVT None None 0 PVT PVT None Nocturnal Enuresis 1/9/07 - resolved 0 PVT PUB " X ray neg"PUB PUB Unknown Cough NKA 2 None PVT PVT None None Overweight; allergic rhinitis 0 PVT PVT 0 None donePVT PVT 1 PUB PUB ASPERGER SyndromeLA090402 - diagnosed Sept 2008; Synesthes 0 no labs done PVT PUB none none Congenital hydrocephalus with VP shunt 10 PVT PVT ~Varicella (no brand name)~1~1~Patient 0 MIL MIL SYNTHROID; None ZOCOR;NKDA FOSAMAX; Pentoxifylline 1 Please see PVT the attached PVT lab reports. LIPITOR LABS:- Lupus currently None anticoagulant suspended; High Cholesterol (+), vitamins ANA PMH: (+), RF childhood (-), Coombs epilepsy, (+), ASO LBP.(+), Extensiv cardio Blood test (results: UNK TheUNK 14 serotype Concomitant blood workmedications showed inadequate Relevant were not medical immune reported. history response USWYEH03073208 was not withprovided. antibody concentrations None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH03548808 was not provided. On 23-Feb-2008 UNK test results UNK were:Concomitant antibody testmedications (results:Relevant Serotype were not medical 1 (1) reported. <0.2 history Serotype USWYEH03681408 was not 3 (3) provided. 0.6 : Serotype 4 (4) 2.3 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04296708 was not provided. None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04528208 was not provided. Laboratory UNK test (results: UNK bacterial pneumonia) The patient was was not done taking Relevant in 2008. any concomitant medical history medications. USWYEH05814408 was not provided. 15 Physical examination UNK (results: UNK head Concomitant circumference: therapy 39.8included Patient cm) waswas PENTACEL, done a full on term, 28-Aug-2008. ROTATEQ, USWYEH06016808 previously On and healthy 13-Sep-2008 H-B-VAX. baby. test resu 48 Oxygen saturation UNK (results: UNK 80's) was Concomitant done inThe Oct-2008. therapy patient's included Culture The concurrent patient (results: PREVACID. has illnesses anasal past swab: USWYEH06837608 include historyresistant of rhinitis premature allergic, pneumococcal) baby bronchial (bornwas at hy3 2 None provided. UNK UNK Concomitant The medications patient's Past concurrent were history not of reported. illness urinary includes tract USWYEH07924509 infection upper respiratory (requiring hospitalizat tract infecti Blood culture UNK (results: pneumococcal UNK Concomitant bacteremia) medications was done Relevant were in Oct-2008. not medical reported. history USWYEH08151809 was not provided. None Provided. UNK UNK Unknown USWYEH02943808 42 Culture wound, UNKnegative, UNK it was done on an unspecified Nasopharyngitis. date USWYEH03187808 21 Bacterial culture UNK (results: UNK no organisms Concomitant found) Injection medications was done siteinabscess were Dec-2007. not (LLT: reported. Injection USWYEH03233908 site abscess) 11 UNK UNK Concomitant medications Normal werebirth; not reported. no familyUSWYEH03505308 history of hematologic disorders None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04031908 was not provided. 0 None provided. UNK UNK The patient is a healthyUSWYEH04518208 child.
None Provided. UNK UNK Concomitant The therapy patient's included concurrent TYLENOL. illness includes USWYEH04931508 gastroesophageal reflux dise 0 No relevantUNK tests performed. UNK None. None. Past therapies included USWYEH05291208 PREVNAR at 2 and 4 mont ibody titers. The patient received a UNK dose on anUNK unspecifiedConcomitant date. The patient medications experienced Relevant were not low medical reported. antibody history USWYEH05671008 titers. wasThe not patient's provided.outcome is unkn 1560 On 08-Apr-2008 UNK test results UNK were:Concomitant blood immunoglobulin The therapy patient's included Aconcurrent (results: HEPless B/HIB. illnesses than 7 USWYEH05768608 include LN); blood coaliac immunoglobulin disease, hypersensi E (resu 0 None provided. UNK UNK Relevant medical history USWYEH05845108 was not provided. 5 None Provided. UNK UNK Concomitant medications Thewere patient nothas reported. a past USWYEH06087008 history of rash after being administe Physical examination UNK (results: UNK normal Concomitant (Language/Speech, medication Relevant Emotional/Social, were not medical re history Fine/Gross USWYEH06142508 was not Motor provided. Skills, Cognitive thin that had been frozen on an unspecified UNK date. On UNK an unspecified Concomitant date, the medications patientRelevant received were not medical a dose reported. history of PREVNAR USWYEH06525108 was notthat provided. had been frozen (med decrease in babbling. The None patient Provided. received UNK theUNK second dose Concomitant on an unspecified medications date. Relevant were Afternot medical receiving reported. history theUSWYEH07048708 second was not dose provided. of PREVENAR thera 0 Body temperature UNK (results: UNK102.5 deg. Concomitant F) and white medications bloodRelevant cells were urine not medical (results: reported. history elevated) USWYEH07245708 was not were provided. done in Dec-2008. Bo None provided. UNK UNK Concomitant The medications patient's concurrent were not reported. illness includes USWYEH07792109 hypersensitivity (multiple alle None provided UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH03223308 was not provided. None Provided. UNK UNK Concomitant medications Thewere patient notpreviously reported. USWYEH03552408 experienced injection site induration None provided UNK UNK Concomitant The medications patient's Noconcurrent were reaction not after reported. illness theincludes first USWYEH03902108 dosehypersensitivity of PREVNAR at (toage "everythin 2 mon 0 None provided UNK UNK None Unknown USWYEH04143508 0 Body temperature UNK (results: UNK 103.9 Concomitant degrees) wasmedications done onRelevant 06-May-2008. were not medical reported. history USWYEH04145908 was not provided. Body temperature UNK (LLT: UNK Body temperature), Concomitant 102therapy deg. F.included None Polio Vaccine "Pasteur" USWYEH04201308 (poliomyelitis vaccine inac 0 Body temperature UNK (results: UNK(7PM) Concomitant 100 degrees medications Fahrenheit) Relevant and werebody not medical reported. temperature history USWYEH05005108 was (results: not provided. (At night) 103.0 degrees None provided UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH05293308 was not provided. 1 None provided. UNK UNK None None USWYEH05941708 4 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06035908 was not provided. 5 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06036008 was not provided. 3 Physical examination UNK (results: UNK head circumference - 34 cm, Relevant lengthmedical - 53.5 cm, history Normal USWYEH06290608 was milestones, not provided. normal physical g 0 None provided UNK UNK None reported None provided USWYEH06552508 UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06660208 was not provided. ed a dose on an unspecified Nonedate. provided. The UNKpatient experienced UNK None diarrhea. No additional None information was available USWYEH07067108 at the time of this report. See Not provided UNK UNK Relevant medical history USWYEH07073908 was not provided. ea. At 6 months of age, the None patient provided. received UNK a dose UNK on an None unspecified date. The patient None experienced diarrhea. USWYEH07074008 No additional information wa hea. At 12 months of age, None theProvided patient UNK receivedUNK a dose on Concomitant an unspecified medications date. The Relevant were patient not medical experienced reported. history USWYEH07074108 No diarrhea. was other notvaccine provided No additional was administered information 1 UNK UNK Tuberculin PPD (manufacturer None unknown), 03-Feb-2009 USWYEH08110709 1 Body temperature, UNK 103UNK deg. F., 04-Feb-2009. None None USWYEH08120209 0 None provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH08336009 was not provided. 2 UNK UNK 1 UNK UNK unknown none none 13 None UNK UNK Fluoride None None 1 UNK PVT Yasmin birth None control pills, Environmental Allegra, sudafed allergies PVT UNK 0 PVT PVT None Graves disease. Restless leg syndrome 0 UNK UNK N/A NO N/A FEVER~Varicella (no brand name)~UN~1~Pat 0 MIL MIL none sulpha 0 None OTH OTH ARIMIDEX;Immune calcium system (unspecified); Breast disorder cancer; ZOCOR; Chemotherapy; vitamin WAES0904USA03213 D Herpes (unspecified) zoster exposure 0 temperatureOTH measurement, OTH 104 degr None Developmental delay WAES0904USA03207 Unknown OTH OTH Food allergy WAES0904USA02827 6 lab tests running MIL at thisMIL time amoicilian. sinus infection 10 MIL MIL 1 None MIL MIL N/A None 0 mom statesPUB all labworkPUB and lumbar puncture done none in known ER none were known negative 1 none UNK UNK Unknown None Diabetes 1 NONE PUB UNK NONE NONE NONE REACTION TO PERTUSSIS~DTaP (Acel-Imun 0 NONE PUB PUB NONE NONE NONE 2 None UNK UNK ADRs to macrolides. Sjogren's syndrome, PTSD, asthma,
4 Bloodwork, UNK including white UNKblood cells Nonewhich mother None states Allergic was normal. to penicillin Chest x-ray & strep screen which mother a 11 IgE, Liver &UNK Kidney Panels, UNK Glucose Simvastatin, & Chem,Allerted RA, Xyzal, Sed to Singulair, Rate, alergies Asthma, etcVentolin, 5/4/09-records allergiesAdvair, to foodreceived Nasonex and in environment Asthma control test 20 an 1 Temp in ERUNK was 100.4UNK axillary None None to knowledge None. Family of administrator. reports child's Was grandmother later informed andby aunt child's having ca 15 Lumbar puncture UNK 2 times UNK within 9 omeprazole months interval Hyperlipidemia , Simvastatin. was negative Medical 5/28/09 , GERD for records possible Medical received MS records panel. DOS received Four 3/11/08 more DOS toBrain 2/2/09. 3/11/08 MRIs Orchidec towere 2/2/ 7 None PVT PVT None None 0 PVT PUB none none Patient Penicillin was seen -hives for pre-op Codeine-stomach clearance for bloating tonsillectomy and ade 5 None UNK UNK None Diabetes Type none~ #2 ()~NULL~~In Hyperlipiglcerdemia, Patient hepatitis C Antibod 0 Clinic visit on PVT 4/25:Elevated PVT WBC Wal-Zyr, 15,000, Sed Ethinyl NONE rateestradiol/levonorgestrel 46. ER Medication visit on 4/26:WBC allergies: Ceftin, 12,000,Penicillin Sed rate 48. Return to clinic 0 PUB PUB none knownNKDA 84 positive antiUNK nuclear antibody UNK blood pentoxifllyne, test. Labs: ANA 1:640. PMH: RF scoliosis. (-). Anti-DNA tonsillectomy (-). Echo WNL. CXR WNL. US R LE ( MIL UNK ### No reportedUNK UNK Autoimmune reactions to milk.### 68 Hospitalization PUBand Tests OTH 1-21-09 4/29/09-records None received-UA 4/29/09-records None 4/29/09-records glucose received-recent 1000 and receivedmore viral than respiratory PMH:testicular 80 ketones tractcancer. and illness 100m 2-3 Ch 0 UNK UNK None notedNone noted 0 PVT PVT On AUGMENTIN see # 7 on ABx Nonefor punctures 169 PVT PUB None 1 PVT PUB No No 0 None OTH PVT None None None 2 PVT PUB Fluoride Cheealsles None None 8 Brain CT/MRI/LABS PVT Records PVT recieved 05/06/09 - LAB: WNL. Dust/pollens/molds ECG, EEG, WNL. Records received 05/06/09 PMH: Rece 27 None PVT OTH None None allergic to Penicillin; Codeine; Sulfur 0 PUB PUB RisperidoneHTN 2mg; HYLO Liquid #3 Iodine (X-ray contrast) 10 None PVT PVT None None None 1 PUB PUB None 0 Immunization PVT ReactionPUB Keflex 250 None mg/ 5 ml 1 1/2 NKDA tsp 0Bio X ~DTaP 7 days(no brand name)~1~5~Patient 0 Reaction toPVT Immunization. PUB Given KEFLEX Cough 250mg/5ml x 2 days NKDA 1 None 1/2 PO ~DTaP B/D (no x 7 days. brand name)~1~4~Patient 0 None PVT PVT None ADHD 2 None OTH PVT Depo Provera None Beta Blockers, asthma, migraine with auva 1 PVT OTH SIMVASTATIN Physical Drug allergy: PCN 0 PVT PUB None Penicillin 297 Biopsy - of OTH skin = lichen PUB planus Lipitor, Omeprazole None , Lelexa 0 Ct Scan head, PVTCXR, EKG, PVT Labs- normal BCP- YAZ Labs None and Diagnostics: Being worked Glucose Temp up 166. for 104~HPV Neurofibromatosis ALT 29 (no(L). brand Head name)~1~0~Patient . CT PMH: (-). none Drug noted scree 0 None PVT PUB None None None 12 PVT PVT transient neutropenia at birth, resolved 0 Info I overate OTH thinking blood OTH sugarNot lowyet butthat it was None morning becauseNiacin; of vaccine. Diabetic (take pills) 0 PVT PVT None None 0 Doctor notified PUBby RN PUB 1 PVT OTH 1 Visual diagnosis, PVT Dermatologist PVT consult to confirm 1 PUB UNK None None 1 PVT PVT None None Von-Willebrand's Prolonged (Dx on pain~HPV 4/2001) (Gardasil)~1~0~Sibling 1 PVT PVT Albuterol HEA None MDI PRN Mild Asthma 1 ER Done XUNK Ray (not sure UNK reason) Per mom not Wheezing able to bear of Infancy. weight 1 PVT PVT SINGULAIRNone PRN or ALLEGRA Torticolis;PRN PE tubes; asthma; allergic rhinitis 0 none. PVT OTH 0 OTH PUB None UNK UNK B-12, American Regant, 8796, IM Right deltoid, 0, 4-14-09 13 PVT OTH ASA 81 mgNone daily None 5 PVT OTH None Pt. physical 4 CBC - normal PUB plts. OTH Levothyroxine Sodium hypothyroidism 0.75 mg daily; PREMARIN 0.3 mg oral daily 0 Pt @ ER with PUB IV: Benadryl OTH/ Prednisone @ home PO Benadryl 25mg 1g + new X 2days Prednisone 50 mg 1 X 1 da
1 PUB PVT 7 PVT PVT URI CODEINE; MORPHINE; CHLOROMYCET; XANAX; OIL O 0 Diagnostic laboratory, PVT Blood PVT test checked in her Penicillin stomach allergy; 6/8/09-records and her Menstruation gall bladder; received irregular; Chest WAES0901USA00777 for DOS X-ray, Cyst; 8/12/06 Bowel 03/03/09, only. discomfort; slight Seenhyperin inDiarr offi 0 Unknown OTH OTH Unknown Unknown WAES0904USA03453 3 CAT scan of PVT head without OTHcontrastZOCOR; and of the Belladonna; abdomen,Levothyroxine; The chestpatient x-ray, has blood/urine ZANTAC; no known cultures, Ciprofloxacin; allergies ### urinalysis (NKDA), Cephalexin and Sjogren's lumbarsyn pu not reported. UNK UNK not reported ### PVT UNK None None 8 UNK PUB XOPENEX NO NEBU KNOWN 0.63MG/3ML ABNORMAL ILLNESS ATAT 10AM WEIGHT TIME BEFORE OF LOSS VACCINATION. COMING AS OF 4/15/09. INTO DOCTOR small for ges VI 0 unknown PUB PUB Albuterol asnone needed forAsthma asthma s/s 0 PVT UNK 0 None MIL UNK none none none 0 PVT UNK SIMVASTATIN NO NO 0 PUB PVT no no no excessive crying~DTP (no brand name)~NULL 0 PVT PUB none Left foot pain NKDA 0 PVT PVT no known illness Amoxicillin/Augmentin 1 eeg, cat scans, UNKmri of brain. UNK To have noneeeg repeated none at vanderbilt none. PMH: university diarrhea in xJune 1 week. LabsAppy. and diagnostics: On birth control CBC an 1 STILL WAITING UNK FOR RESULTS UNK FROM N/A NEUROLOGIST NONE 1. ANXIETY/DEPRESSION N/A 2. BRONCHIAL ASTHMA 3. O 0 UNK UNK None None 1 Coroner's report UNK conludes UNKhe diedLamictal as the result - 100 none ofmg/day artherosclerotic artherosclerosis, as of 9/14/07; and hypersensitive-type Zocor obesity, 20 mg/day; mild epilespy, also cardiovascular onCAD Vytorin with10/20 disease, mildlyp.o el 1 UNK PUB none none none 1 none PUB PUB NONE TIREDNESS REACTIVE AIRWAY DISEASE 5 PUB UNK ANNUAL TST NONE GIVEN THAT PENICILLIN SAME DAY IN RIGHT FOREARM 0 MIL MIL None None PVT PVT Claritin torticollis ALL in remission 4 UNK UNK N/A N/A 1991 client N/A~ had an ()~~0~Patient|N/A~ allergic reaction to()~~0~Sibling|N/A~ codeine; gave client () 3 none PVT PVT celexa, synthroid, Cat bitesingulair none none~ ()~NULL~~In Patient 0 NA UNK UNK no no no VA09004 0 PUB PVT NONE NONE 0 UNK UNK None None 0 UNK PUB ALLERGIC RHINITIS 0 UNK UNK Nystatin oral, thrush infant mylicon 7 None. Neurology PVT consult UNK obtained.None at time None of vaccines. Hydronephrosis, grade 2. Resolved without intervention. 0 none PVT UNK none Right Eye Cataract 04 September OTH 1998: EKG OTHwas normal; 07 December Unknown 1999: The subject's Dexa Bone medical Density history, A0600400A Study: concurrent There was conditions evidenceand of os co Diagnostic results: OTH 26 June OTH 2000: Lumbar Spine Unknown MRI: 1. The Minor subject's multilevel medical degenerative history, A0602351A concurrent changes theconditions discs lumbosac and co UNK OTH OTH Unknown The subject's medical history, A0780839A concurrent medical condition 13 Abdominal PVT ultrasound; PVT XR fluoro air None enema. 6/8/09 None Hospital Nonerecords DC summary received DOS 4/27/09 to 4/28/0 11 None Labs PUB and diagnostics PVT (as reported None by pt) None WBCs 12K. None EKG PMH: WNL.none Echo noted WNL. CXR-? fluid. No LP was done. 25 Skin bx 5/26/09 MIL medical UNK records recieved DOS 5/26/09 5/8/09.medical skin biopsy records 6/15/09 recieved medical DOSrecords 5/8/09. received urinary orLABS: chlamydial Biopsyin 0 Normal PVT UNK ZANTAC; REGLAN Just a little light cold GERD 20 FBC; TestsUNK for Autoimmune UNK disease; in all 37 tests from October 30 - January 5th 2009 5/8/09 - Medical records re PUB PUB None None 0 PVT PUB Well visit. 7 None PVT PVT LEVOTHYROXIN; No Calcium Sulfa supplement. allergy; Hypothyroid; Allergic rhinitis. 0 None PVT PVT None None None 1 None PVT PUB None None None 0 PVT PVT None None 0 PVT PVT JANUMET;Rash LIPITOR; in scalp TRIPIUX diabetes, high cholesterol. PVT UNK None None PVT PVT Routine FUNKDA; COPD; Asbestosis. 0 None PVT PVT ADDERALL, XR 20mg.ADD
3 PUB PUB None Known 0 PUB PUB NC09016 0 PVT UNK None Allergy to MUCINEX 0 CBC Strep PUB flu mono negative UNK - all None None Renal reflux NC09017 0 None performed PUB at Graham PUB County None Dep. of public NoneHealth by report Allergy to PCN / Dilaudid NC09015 per client 2 PVT PVT None None None 13 PUB PUB None Premature 9 weeks, body cardia 0 PVT PUB None 1 PVT UNK None None - Anxiety to immunizations deferred till now. 2 PVT PUB None PUB PUB None None None 0 PVT PUB None None None ~DTaP (Daptacel)~1~4~Patient 3 None PVT PVT None None 1 PVT PVT ZYRTEC 5 mg every day Seasonal allergies UNK UNK PVT PUB Cintrold, redNo yeast rice.Hernia in stomach. Flu like symptoms~Influenza Allergic to VICODEN;(no TAXOL; brand name)~ TALWIN 0 PUB UNK Allergy Med. None ZYRTEC;Seizure NASALCROM. right after she was born UNK UNK 226 Normal physical UNK examination UNK 03/01/2009. None 2 PUB PVT None None None 1 PVT PUB URI week earlier esotropia - corrected 0 None PUB PUB Unknown None None 3 PUB UNK 31 MRI & EEGUNK per mom (unable UNK to locate ALBUTEROL EEG) Asthma M.D. records "Cerebral attached. palsy; Pervasive SC0911 Dev Delay; Asthma" per mom 1 PVT MIL None None 5 OTH PVT None None Hx of asthma - no s/s since 2007; NKA ; recently changed 1 PVT PVT Lactulose pin; None ALBUTUAL NoneNEB PIN local reaction~Pneumo (Prevnar)~2~0~Patient 2 PUB PUB ORTHO TRICYCLEN none. lo ovarian cyst. PUB UNK 6 None MIL MIL None None None 0 PVT OTH HCTZ 25 mg None daily Recent bout of vertigo - one month ago 0 UNK PVT None Pt developed None hives 1 PVT PVT PPD, Sanofi, None C2803AA, None SQ forearm, no previous doses, 3/20/09 1 LP -CSF normal; PVT HeadUNK CT 1 Rash, Urticaria PVT OTH PPD sanofi,None C3060AA,None ID leftknown Foreman, PVT PVT None 0 PVT PVT Oral contraceptive None None Pt. later says she sometimes "faints" with shots 2862 03/12/2009,MIL Absolute Lymphs, OTH 0.59, LIPITOR; Low; 01/23/2009, Multivitamins; None ADDS, Myalgias; Minerals 432,Felt positive, nauseated; greater 09AV00058SP Hypotension than 200 strong positive; Alani 0 Unknown OTH OTH Unknown Unknown WAES0904USA03689 365 None OTH OTH Vitamins (unspecified) Allergic reaction Bronchiolitis to antibiotics WAES0904USA03576 0 Unknown OTH OTH None Iodine allergy; Food allergy WAES0904USA03788 Unknown OTH OTH Unknown Unknown WAES0904USA03416 28 02/Dec/2008: UNK CT of theUNK abdomen revealed a normal proximal Previously appendix; healthy. the distal portion ###of the appendix could no 61 Unknown PVT OTH Patient had a spider bite in May ###2007 and a long history of 0 PVT PVT none none 0 PVT PVT none Strawberries 0 PUB UNK Given Acetaminophen None known A 650 llergic mgstoatPollens 10:58 a.m. (hayfever-like symptoms) and Tomatoes 1 PVT UNK A deep dogsee scratch 18 sent me to clinic for booster of tetanus. I have ch 2 MIL UNK 0 MIL MIL Mirena- IUDSore ThroatSeasonal 0 CBC PVT PUB
0 none PUB PUB amoxicillin, R erythromycin otitis media none eye and ointment,acetominophen, bacterial conjunctivitis saline nasal drops 1 PVT PUB 4/13/09- amoxicillin 4/13/09- acute 250mg nonepharyngitis chewnone~ tabs ()~NULL~~In Sibling1|none~ ()~NULL~~ 28 None performed PUB PUB None at vaccination none time 4 Mono Test UNK negative; Completed UNK allNone blood tests, None Lyme Disease Asthma Negative; from None~ 5-13 Heavy years ()~~0~Patient Metal of age. Negative, AllergicHIV to penicillin, Negative,solum Bra 434 PVT PUB COUGH,RUNNYNOSE,RASH ON LEGS 1 PVT PVT synthroid none bee sting allergy, severe. carries epi pen 0 PUB PUB none none 1 PUB UNK none none none 2 5/11/09-records PVT received-H&H UNK 8.6 and 26.7, Na Wheezing 133, K 10.8, 5/11/09-records Gastroesophageal ABG 6.6. CXR received-Seen reflux; severe Croup; bilateral in Dehydration ED airspace and PCPdisease 5/11/09-rec office multip wor 1 UNK OTH OTH Phenobarbitone; Seizure Phenytoin Disorder B0571719A 7 Platelet counts: MIL 4/26/09: MIL 1K; 4/27/09: None 16K; 4/28/09: None 34K.None; 7/14/09 NKDA. Hospital 7/14/09 records Hospital received records DOS received 4/27/09DOS to 7/8/09 4/27 1 Stool spec -OTH neg for Rotavirus PUB 5/18/09 Hospital records received 5/18/09 Hospital DOS 4/22/09 records to received 4/24/09. LABS DOS 4/22/09 and DIAGNOSTIC to 4/24/09 0 CSF c/s negative PVT to date; PVTBlood c/s negative Rhinitis to date 5/13/09 Nonehospital records received DOS 4/27/09 to 4/30/09 LA 0 PVT PVT None None None 1 PVT PVT 1 OTH PVT 0 PVT PUB 0 None OTH PUB None Known None None Known 1 None PVT UNK 8 None PVT PVT 0 Advised skin PVT testing prior PVT to futureNone doses. None None 0 PVT PVT SYNTHROID; Seasonal ALEVE:allergies HTN; HCTZHypothyroidism 2 OTH PVT Received PPD None same day, Allergic was to: negative. Artificial sweeteners and was fit tested that day 0 Documented PVT moderatePUB "allergy to egg Resolving URI Egg allergy; Eczema 0 CBC and Strep OTHperformed, PUB test WNL. No None No Swelling arm~Vaccine not specified (no brand n 1 PVT PVT 0 UNK UNK UNK UNK 1 PVT PVT 6 chest X-ray,PVT 07/28/08, PVT see narrative; amlodipine chest X-ray, Rhinitis; besylate, 08/05/08, Upper 10 mg; see respiratory atenolol, narrative; 50 tract chest mg; infection; WAES0809USA04176 LIPITOR, X-ray, Coronary 08/11/08, 40 mg; artery see HYDRODIURIL, narrative; disease;com Ao1 0 Unknown PVT OTH concomitantUnknown medications Nowere history notofreported. allergies.USWYEH09133809 0 Not reported PVT PVT PEPCID; Prednisone The patient had received a flu### vaccine (trade name, manuf 0 ultrasound, OTH 04/06/09, IUP OTHearly vsLevothyroxine MAB. Reason: Pregnancy sodium, spotting; Ectopic NOS microgm ultrasound, (LMP pregnancy = 3/3/2009); 04/09/09, WAES0904USA03645 Hypothyroidism Result: Cardiac activity. Reason: 0 Unknown OTH OTH Unknown Unknown WAES0904USA03992 0 urine beta-human, OTH 07/26/08, OTH pregnant LEXAPRO,Pregnancy 10 mg; ACIPHEX NOS (LMP = 6/18/2008); WAES0808USA00962 Allergic reaction to antibiotics; D 0 UNK UNK lorazepam 0.5 None mg at night Insomnia, (1/2 nights GERD per week), Prilosec OTC 20mg PRN gastric 0 none PVT PUB none none none 13 None. UNK UNK None until started none known on amoxicillin Hospitalized for for earrule infection out sepsis on 4/8/09. 8/08 and for bronchiolitis 1 1 MIL MIL Hydrocortisone NoneCream,HTN, Lisinopril, Hyperlipidemia Local Atorvastatin site Reaction~Anthrax (Biothrax)~2~27~I 17 Bacterial Wound MIL Culture MIL 4-28-09 Viral WoundNONE Culture 4-28-09 N/A CBC 4-28-09 Full Layer Punch Biopsy (2mm) 4-28-0 0 n/a MIL MIL n/a None None, except patient has a hx of +reaction to TST (PPD) in 0 N/A MIL MIL N/A NONE NONE 0 Hyda Scan UNK for suspected UNK gall bladder Focalin, issues, 10mg/day; had no problems just aciphex, recovered Acid noted; Reflux 10mg/day; from MRA diagnosed the is 12 scheduled hour in stomach August, for May 2009; flu13th which medication forshe suspected hadhelped on Fe MA 0 NONE UNK UNK NONE NONE ALLERGIC RHINNITIS (SEASONAL ALLERGIES) MOM S 1 PVT PVT none 21 PVT PUB n/a n/a Will discussUNK with physician PVT after her visit today. None known. None known. 2 Quick Vue Influenza PVT rapid PVTtest completed. NOne Negative None results. NKDA 7 PUB PUB Client had pierced finger with fork, trying to take apart froz 0 CBC and CMP UNKtests were UNKbasically None normal. None reported Documented history of depression and ADD, no allergies o 3 None PVT UNK Zantac GERD GERD, Ezcema, Eosinophilic Esophagitis
3 PVT PUB None None 11 Multiple including PVT thrombocytopenia PUB None LABS 3/15/09: No initial None plts 5K. Family Coombs hx: Parent (+) LABS w/ulcerative 4/10/09:colitis, Plts <5K, migraines US of abd cervical x-rays; MIL C-spineMIL MRI; brain MRI/MRA;none thermogram; knownprior bone neck scan injuries 1982, 1993, Mar 2003 1 Lab test showing PVT viral encephalopathy, OTH None chronic Child colitis, sick;mercury 9/12/06-Hep No poisoning ~DTP B given + IPV + Act-Hib (no brand name)~1~0~P 11 Crohn's disease; PVT Upper/lower PVT US;None Endoscopy/colonoscopy; at theNone time of theNone vaccine Abdominal abdominal CT Scan pain~HPV LABS: abdominal (Gardasil)~2~15~Patient US w/right ova 1 PUB PUB 1 CBC, 11-20-08, PVT WBC, PUB 4.9, RBC, 4.31, EPIVIR; plate, KALETRA; 203K, HIV-VLR50; Hb,ZERIT; 11.3, HIV-Perinatal; CD4Hct, TMP/SMZ Abs35.8, 1221 Neonatal Lymph, 68.8%, drug exposure; Mono, 3%, NKA N, 13.9%, E, 52 0 PVT PVT None None 1 None PVT PUB T tsp BENADRYL None q night Seasonal allergies, Asthma, severe Bilateral Kidney Reflux 1 PUB PUB Unknown None Psychological problems 12 None PVT PVT None None 0 PVT PVT None None None CT200908 0 No PVT OTH 1 PVT PUB history of febrile seizure 1 PVT PVT ADVIL 200mg 1 PVT PVT MultivitaminNone None 103 PVT UNK None None 2 PVT PUB None 0 PVT OTH LOESTRINNo 24; FLORINEF None PUB PUB None None Failure to thrive 2 Viral and bacterial PVT cultures PVT negative ZOLOFT 100mg None OD None except depression NOS 2 PUB PUB none none none 2 PVT PVT None None None 0 4/20/09- Had PVT to see a specialist PVT & he confirmed None my pain None is from the vaccination. 0 None PVT PVT Birth controlNone pill. None dizziness~HPV (Gardasil)~1~18~Patient 2 PUB PUB Proteinuria Obesity 0 None done PVT at this timePVT None UNK OTH OTH Unknown A0768956A 0 Unknown PUB PUB Drug allergy; The Smoker subject has knownA0763053A allergies to amoxicillin, penicillin an 0 UNK PUB PUB No concurrent Unknown medication The subject has no documented A0763059A history of adverse events 2 According to PUB the reporter, PUBall diagnostic tests Unknown so far haveThe been subject negative; has no hadglaucoma fluA0765124A vaccinations and no in blocked the past, tearbut ducts. is uns UNK OTH OTH Unknown Medical history and if there A0765338A were any adverse events follow 2 UNK PVT PVT Aspirin; Lisinopril; High blood Lovastatin; Pneumonia; pressure; Doxycycline High It was cholesterol reported A0777619A by the subject that he has had 1 pending, MRI MILbeing arranged MIL by PCP denied. at home none hx shoulder/neck pain with normal x-rays otherwise none 35 Cat, MRI, EEG, UNK Blood UNK work 6/17/09 None Hospital ED None records None received DOS 4/23/09. LABS and DIAGNOSTICS: EEG 10 UNK UNK 1 PUB PUB Unknown None None 1 Ultrasound,UNK Endoscopy, UNK Blood tests None and stoolNone sample 5/5/05 Lactose Records intolerance, received nocternal DOS 1/7/09 enuresis, to 3/7/09. hypothyroidism LABS: MCV 10 Seen by infectious UNK disease UNK specialist None None 10 MIL MIL No None 0 PUB PUB none 0 MIL MIL None None 1 PUB PUB none local reaction SC0912 diagnosed as cellulitis~DTaP (Inf 0 N/A UNK PVT Benicar HCT None 40mg/12.5mg High Blood none~ Pressure ()~NULL~~In Patient 2 PUB PUB local reaction SC0913 with dx of cellulitis~DTaP (Infanri 0 PVT PUB otitis media 12 MIL MIL Np None 8 NONE MIL MIL RUNNY NOSE NONE ONLY 14 MIL MIL No None 1 None PUB UNK Trivisol None 0 UNK PUB DYSMENORRHEA
6 n/a PUB PUB none none 1 Unknown UNK UNK N/A None N/A Allergy: cephalosporins, septra. Unknown OTH OTH Unknown None WAES0904USA03499 1 None PVT PUB On AMOXICILLIN Mild pneumonia since None 4/16/09 0 None PVT PVT None None Environmental allergies 0 PVT PUB None None 1 PVT PUB NASONEX;NO TYLENOLNone 1 PVT PUB None PPD - Hep A 0 PVT PVT Rabies IG 4/24 None 0 PUB PUB 10 PVT PVT PREVACID;None LIPITOR Throat Ca 2005 without tx last 4 yrs; well 2006-200 21 EEG x3; LPPUB x3; MRI head; PUBEchocardiogram; None. 6/1/09 Encephalopathy Hospital records Nonesecondary receivedunknown DOS 4/13/09 etiology. to 4/20/09. 6/1/09 Phenobarbital, Hospital recordd 1 PVT PVT OMNICEF 300mg None q. 12h ? Tdap for ? (MENACTRA sl. cellulitis ~DTaP (no sxheld brand by name)~4~2~Patient Dr) PUB PUB Entire body rash~Pneumo (Prevnar)~1~0~Patie 0 UNK PVT None None PVT UNK PVT PVT None 1 PVT PUB None Peanuts, Eggs - had anaphylaxis once but now eats them 0 PVT PVT Birth controlNone None None PVT PUB None None PVT UNK 0 PVT PVT VENTOLINNone HFA; OMEGA-3 Asthma350 mg capsule 0 PVT UNK sore throat Phenergan; codeine 0 PVT PVT None None 1 PVT PUB Mild URI 4 PVT PVT Stepped on nail 0 PVT UNK None Asthma PUB UNK PVT UNK 1 None OTH PUB None None 0 PVT UNK 8 PVT OTH None 9 PVT PVT 1 BMP- 139/39/107/19/CO2; PVT PUB CBC 9.8, None 12.2, 36.4, None 433 Eczema, Allergic Rhinitis 597 None PVT PVT None None 1 None PVT PVT Healthy Child None 2 None PVT PVT VOLTAREN(R) hip lateral Notear drug allergies 1 PVT PVT none No None 2 None PVT PVT Clonazepam; Pain Fluticasone and swelling No known nasal; SINGULAIR; drug allergies; ZYRTEC; PMHx Allergic MEXAR rhinitis; anxiety. 0 PVT PVT CORTISONE; Unknown DIPHENHYDRAMINE The subject had HC1; no relevant Ibuprofen A0777867A medical history or any advers 0 UNK PVT PUB No concurrent Unknown mediations There was no relevant A0779458A medical history. The subject had no 2 UNK PVT PUB No concurrent Unknown medications Hearing loss; Otitis Media; A0779487A The subject had not experience 2 UNK PVT PVT Penicillin allergy A0780206A 0 UNK PVT PVT Unknown A0780790A UNK OTH OTH Unknown A0780793A UNK OTH OTH Unknown A0780845A UNK OTH OTH Unknown A0780846A 64 MRI, Blood UNK Work, CT Scans, UNK Lumbar Puncture, Heel Neurological Pain Seasonal examinations. allergies 5/14/09 Hospital records received DOS 2 PVT PVT None None 6 UNK UNK 2 PVT PVT rash, fever~Varicella (no brand name)~1~2~In
0 MIL MIL None None None See Above~ ()~4~23~In Patient 3 None PVT UNK None Questionable None mild cold symptoms in the week prior; none noted on da 2 PUB PUB 0 PVT PVT none noAll allergic reaction to amoxicillin 0 None OTH OTH None Known None None 0 UNK UNK 1 none PVT PVT none none 10 CBC and HIV UNK test pending UNK 5/28/09 none. ED records 5/28/09 no received ED records patellofemoral DOS received 5/3/09.DOS LABS syndrome, 5/3/09.Allegra, and DIAGNOSTICS: seasonal doxcycline, allergic CBC rhinitis fluomethelon - Pending. H 1154 UNK UNK medical records state PMH: psoriasis, low back pain 0 Unknown OTH OTH Unknown Unknown WAES0904USA04339 Unknown OTH OTH Cerebral palsy Premature baby WAES0904USA04222 3 Unknown OTH OTH Terazosin hydrochloride None WAES0904USA04218 11 None OTH OTH None WAES0903USA04872 0 Urine beta-human, OTH 03/19/09, OTH positive Unknown Pregnancy Pelvic NOS (LMP inflammatory = Unknown); disease WAES0903USA03976 Oligomenorrhoea 1 EKG, labs, PVT 2 D echocardiogram UNK all normal. None ### 0 CBC - Lymphocytes PVT 50.8% OTH DIFLUCAN;AtLORTAB the time 5The of vaccination patient hasonallergy 20 April to penicillin 2009 ### the that patient causes had a concurre rash. She 0 not reportedUNK UNK Flonase; Loratidine; Benzopril; History ofZoloft; high blood Hydrochlorothiazide pressure### and no known allergies. 0 Mother reports PUBdx of secondary PUB staph None R/T immunizations. None None. 6/29/09 6/29/09 Hospital Hospital ER AR0914 records ER records received received DOSDOS 4/24/09 4/24/09 to 4/ 0 PVT OTH No No No 0 PUB UNK None None Dust - pollen - smoke 1 PUB PUB none AR0913 None PVT PVT SYNAGIS None 0 None PVT PVT ALLEGRA; None WELLBUTRIN; Allergy TRAZADONE; to oak pollenBENADRYL-PRN and honey 0 PUB PUB PPD, C2806AA, None ID/LA,DARVOCET no previous and doses PERCOCET on file; HCTZ; allergy; ZOCOR; Has sarcoidosis PRILOSEC 0 None doneOTH PUB Headache- likely tension 0 PVT PVT 2 None PVT PVT None None 11 None PVT PUB None 1 see attached PUB PVT None None Premature 34 wk 0 None PVT PVT None None 1 UNK UNK 2 PVT PVT given PPD none at same time 3 PVT PVT no no 0 N/A PUB PUB Ogen and HCTZ None reported hypertension 2 PUB PUB I had just had none a c-section diabetic 6 PVT PVT no 3 Dr. appt. UNK UNK Citalopram none 40mg;known Zolpidem medication at time 5mg; of vaccination allergies listed:PCN, Sulfa, Opioid 9 CBC , UA/UC, UNKbloodculture, UNK CRP none all normal--none these testsnone were done on my breastfed infant LABS: CBC wnl excep 0 5/15/09 EDUNK records received UNK DOSNONE 5/1/09 LABS NO.and DIAGNOSTICS: NONE ECG - WNL 1 ALL TESTSUNK AND LABS UNK WNL. 6/2/09 NONE HospitalNONE records received 6/2/09 Hospital DOS 5/2/09 records to 5/3/09. received LABS DOS and 5/2/09 DIAGNOSTICS: to 5/3/09. Kid C 2 NONE PVT PUB ALUBUTEROL NONE ASTHMA; NO KNOWN ALLERGIES 9 PVT PVT 0 UNK UNK azythromycin None for otitis and NoneURI 1 Mother wasPUB unsure what PUB test was None run, she didNone not see notedNone a culture done, or any blood work drawn. 5 UNK UNK cold asthma - diagnosed right after 6 months shots. Breathing p 2 Last Td administered UNK 08/20/1999; UNK Patient no adverse reported None reactions takingreported. Allergies no other to medications animal dander. on 06/13/2008 Patient also reported, "I had an 0 PUB UNK Zoloft None Polycystic Ovarian MedicineSyndrome, solidified in Endometriosis arm requiring surgical rem 3 UNK PVT none none 0 None PVT PUB None None None 1 none UNK PUB Seasoniquenone - birth control Metatarsis Maxalt adductis - bilaterally 2 PVT MIL none none none
10 0 1 none
PVT PVT PUB PUB none no Previous non-displaced skull fracture with associated subd PVT PVT pulmicort and none veramystasthma, allergies PUB PVT 12 N/A PVT PUB N/A N/A N/A N/A~ ()~NULL~~In Patient PVT PVT NONE NONE NONE 0 PVT PUB NONE NONE NONE 2 na PVT PVT none none 1 UNK UNK unknown none unknown 1 5/18/09-records PVT received PVT Epstein Barr virus BCA None IgM 1.42, EBV-Mono IgG 2.841/18/09 6 PVT UNK 0 None known PUB PVT Tb test, Sanofi None Pasteur,KEFLEX; C3060AA, Contrast L Forearm dye; IODINE; VOLTAREN; ? Anti-inflam 1 None PVT PVT - BP 102/60PVT lying; 80/70 PUB sitting. Albuterol prn none asthma 8 UNK PVT 0 None PUB PUB None None None None PUB PUB None None None 2 P/A PUB PVT 1 None PVT PUB None None None 0 None PVT UNK None Well child visit No PVT PUB None None 2 None PUB UNK Generic DrugsNoneAllergyAllergies OTC; ALEVE OTC 1 OTH PVT None None None None. PVT PVT None None None 1 None PUB OTH ATIVAN H/S; None LEVOTHYROXINE None 0 PVT UNK None None 1 PVT PVT Shellfish 1 None PUB PUB None None None 5 PVT PVT None None 1 None PVT PVT Clonidine. None None 1 PUB UNK 1 None PUB OTH None None reported 0 Quick viral strep OTH (-); U/A PUB dipstick; SC, MOTRIN 1015;on ph None. 4-17-09; 6; TrTleuk; 98.3 4-19-09; Blisters Tr protein; on 4-20-09; soles Smallof 4-21-09 blood feet 2' running (mild) 0 Rapid strepPVT screen - negative PVT None None None 1 OTH OTH The patientno had pre-existing no illness medical conditions ### and had not been taking Unknown PVT UNK It was unknown if the patients### were taking concomitant me None PVT PVT The patientThe had patient no illness hadatathe history timeofofseasonal vaccination ### allergies, allergies to None UNK UNK Unknown ### 2 None. Per follow-up PVT information, PVT CBC/ESR/CMP OXYCONTIN and UAPatient performed had on a history 03 December of back pain 2008 ### and were a previous normal. eye injur 2 None PVT PVT ZOCOR; ibuprofen; None BENADRYL The patient has a medical condition ### of hyperlipidemia for w 1 None PVT PVT Cialis, Eye Drops The patient had medical conditions ### of glaucoma (uses eye Not reported PVT OTH She had not received any other ### vaccines within four weeks 1 PVT PVT None ### 0 None PVT PVT The patient had no concurrent### illness, no pre-existing med 1 HbA1C in April PVT2008: 11.5 OTH LANTUS No illness atThe time patient to vaccination. has a history of hypertension, ### diabetes and ha 0 Being followed PUBat clinicPUB LEVORA oral None contraceptive None 1 CBC; Sed-rate PVT WNL OTH None Asthma; Allergic rhinnitis. None PVT PUB AUGMENTIN None UNK UNK 1 PVT PVT None None 0 PVT PVT PREVACID Reflux same as above~DTaP + IPV + Hib (Pentacel)~
1 None 1 3 None 1 0 1
PUB PUB None None None PVT PVT None None PVT PUB None None PVT UNK Well visit PUB PUB None None None Known PVT PVT None UNK UNK 3 PUB PUB None None None 0 None PUB PUB None None None 0 diagnostic laboratory, OTH was OTHdiagnosed Unknown with autistic spectrum None WAES0904USA04467 3905 VZV strain, OTH 04/??/09, positive OTH for varicella Unknownzoster virus; Enterovirus Unknown PCR, 04/??/09, WAES0904USA04614 negative. 0 Unknown OTH OTH Unknown Unknown WAES0904USA03962 0 ultrasound, OTH 03/26/09, 7OTH weeks OB;FLINTSTONES ultrasound, Pregnancy 04/08/09, MULTIVITAMIN Caesarean NOS confirmed (LMP SAB section; = 1/25/2009); Early WAES0903USA05524 Smoker; onset of delivery Papilloma viral infection 215 urine beta-human, OTH positive OTH Unknown Premature baby WAES0805USA06266 22 MIL MIL PROSCARNo PMH: acrochordon, gingivitis, muscle spasms, alopecia. F None PVT PVT No No 0 PVT PUB 1 PVT PUB 0 None PUB PUB None Known 920 PVT PVT None None None 0 MIL MIL 0 None PUB PUB None None None 27 CMP; CBC;PVT TSH; CRP;PVT ANA; RA normal. Albuterol;LABS: Enalapril; had been Chest Zyrtec having CT wasscan s/p some surgery WNL. chest TSH forpain endometriosis 0.033(L). ER cxr PMH: & ekg, Asthma, Holter allergic monito 1 PUB PUB None allergy to AMOXICILLIN 1 PVT PVT No None 1 PUB UNK None NKDA 9 PVT PVT AMOXICILLIN Right acuteotitis media UNK UNK PPD, Paredule; 84833;` intradermal left forearm; 0 PVT PVT Lamactil - Increased dose Anxiety fromattacks 50 mg only. to 75 No mgallergies. 1 PVT OTH BACITRACIN Burn to faceNone -729 PUB UNK None None 1 PVT PVT None None None 1 PVT OTH 0 PUB PVT Denied illness Penicillin, at the time Typeof2vaccinations. DM, IBS Reports contact with some 9 visual diagnosis PVT PUB minocin acne vulgaris acne vulgaris MIL UNK none at time none of vaccination 8 PVT PVT NONE NONE NONE 4 PUB PUB 0 None accomplished UNK in UNK emergencyNone room. None Prior hx of infantile febrile seizure and PCN allergy. Pt oth 1 not applicable UNK PVT none reported no prior hx of shingles; PMH: stent placement; cardiac "pro 52 unspecifiedUNK blood testsPVT reported as was "normal" placedunknown on prednisone PMH:Prior then cortisone Shinglesointment x2; polyps; headaches; skin lesions 0 NONE UNK UNK NONE NONE NONE 1 PVT PVT lisinopril 10mg None Aspirin, Penicillin, Poison Ivy, Fire Ants, Polyurethane 15 unknown (done UNK in Westchester UNK Medical 6/8/09Ctr). Hospital none 6/8/09 records Hospital fibromyalgia. andrecords DC summary and 6/8/09 DC received Hospital summary DOS records received 4/03/09 andDOS DC to 4/17/09. summary 4/03/09 Lyric torec 4 12 5/18/09 Hospital UNK records UNK received Protonix DOS 3/18/09 None to 3/20/09. GERD, LABSPhlebitis and DIAGNOSTICS: 5/18/09 Hospital EKG records - nonspecific received T-wave DOS 3c 0 NONE UNK PVT NONE 9 n/a PVT UNK none none peanut allergy 0 none PUB PUB carvedilol, enalapril, none furosemide, afib, chf, lumbar simvastatin, radiculapathy, amlodipine, htn,methocarbamol, hyperlipidemia tramad 0 PVT PVT Wellbutrin SR, not Triphasal applicable not applicable 0 PVT PUB none 0 She received UNK blood testUNK to rule out infection and test was negative. No infection found.
0
UNK UNK Triameterene, Constipation Levothyroxine, Gabapentin UNK OTH OTH Unknown A0781881A 0 UNK OTH OTH No concurrent Unknown medication The subject was reported A0782027A to have no relevant medical histo 0 CSF culturePVT (-), Blood Cx UNK (-), UCX:None contaminate, None VRP (-),None stool Cx - pending 5/18/09 ED records received DOS 4/2 13 5/13/09 hospital PVT records OTH received DOS 12/4/08-12/9/08. Ear fullness, High LABS sinus blood and pressure DIAGNOSTICS: pressure 5/13/09 LPhospital - glucose records 76 mg/dL received (H), DO CS 1 PVT PVT Asthma & cough Asthma 1 None PVT PUB None Per mother; maybe at age 4 y/o, similar reactio None performed PVT PVT None Hyperthyroid 7 None PVT PVT Mild URI symptoms None PUB PVT None None 357 MIL MIL Unknown Osteoporosis, Dyslipidema ; cut b diffciency; DJO. PVT PVT Demerol 1 OTH PVT CLEMASTINE Unknown 0 None PVT PVT 3 Appointment PVT made withOTH immunologist None Allergic Rhinitis None 9 None PVT PUB None None 1 None UNK PUB None None Known 0 HemoglobinPVT = 11.4 / Lead UNK= 1.5 Diaper Rash/Swelling R Thigh 227 Elbow Bx, 9/29/08, UNK strongly UNK positive HCTZ; transaminases KCL; Folic >100; acid;8/7/09 Vit Endoscopy D2;Hospital CLIMARA Bx,records 12/19/08, patches received strongly DOS positive inpatient transaminases 11/25/08 to 91 CBC valuesUNK for Platelets: UNK DEC. 2007 Lisinopril - 242, 20 000mg/day; / uL; JUNE Metoprolol, Pre-existing 10, 2008 50Hx - mg/day; 34, Hypertension; 000 LIPITOR, / uL; JUNE Angioplasty 10mg/day; 12, 2008with -Finasteride, 37,stent 000 (DEC / uL; 5m 0 PVT PUB None. None. None. 0 PVT UNK Childrens Claritin none & Childrens seasonal Sudafed. allergies. Unknown OTH OTH Unknown Unknown WAES0904USA04537 Unknown OTH OTH Unknown Unknown WAES0901USA00303 1 None OTH OTH BUSPAR; ESTRATEST Postmenopause; H.S;Lipids ZOCOR abnormal;WAES0904USA04464 Anxiety disorder; Drug hypersensit 0 None OTH OTH None None WAES0904USA04459 muscular biopsy, OTH muscle OTH contain aluminum Unknown Unknown WAES0904USA04521 0 PUB PUB hctz/lisinopril, none metoprolol, htn,terazosin, gerds, gilbert's lanzoprazole disease, sarcoidosis 0 none PUB PUB none knownnone none none~ ()~NULL~~In AZ0904 Patient 0 A chest x-ray PVT and flu swab PVT were conducted None and Some were nasal negative. Penicillin congestion. No diagnosed illness or temperature. 2 SPINAL TAP UNK & BLOODWORK. UNK 6/15/09 Hospital NONE records DC summary received DOS 5/5/09 to 5/7/09. LABS and D 0 5/8/09 ED records UNK received UNK DOS 5/5/09 LEXAPRO, LABSRESIPRODRO & DIAGNOSTICS CYSTIC -FIBROSIS, None reported. DEPRESSION AND ASTHMA PVT PUB 1 UNK UNK None No Giant Uticaria onset 06/01/1995, GI reflux onset 04/01/200 0 PUB PUB Client had been NonetakingNone, Yaz fordenied the last a history year. of seizures, mom stated client pass 0 PVT UNK 1 NONE REPORTED PUB TOPVT HD UNKNOWNRECOVERED NONE RECENTLY LISTED FROM SHINGLES 2 None PUB PVT Paxil, Metoprolol, None Orthoestrin,Simvistatin None Protonics? 1 no testing done, PVT advisePVT NSAIDs/ice/rest prn. At none thisnotednone time, patient noted understood instructions and did not feel finger pai 2 PVT PUB 1 PVT PUB 0 Random blood UNKsugar from PUBglucoseNone. analyzer -None. 100 None. 0 PVT UNK none none none lethargy, excessive crying~Hib (OmniHIB)~1~0 0 UNK UNK URI 0 None reported. PVT OTH Albuterol inhaler Patient has a history of asthma ### and gastric reflux. Not reported UNK UNK Not reported ### Antibody test OTH (results: Pneumococcal OTH Concomitant serotype Unknown levels: medications serotype Relevant were 1--0.2, not medical reported. 12S--0.2, history USWYEH09094309 7s--0.2, was not14--0.9, provided. 3--0.2, 8--0.2, 18C 0 not available MIL5/8/09 medical UNK records None recievedDenied DOS 10/2003-2006. Denied LABS and DIAGNOSTICS: Initial thyroid labs: 0 5/13/09-records PVT receivedPVTNeutrophil % increased None54.4. urine Noneculture 5/13/09-records no growth.received-PMH: heart murmur since 0 None PVT PUB None None None 20 Punch skin MIL biopsy fromMIL R arm - "Highly suggestive of orthopox virus/ vaccinia infection."
0
PVT PVT PVT UNK 1 PVT PUB 1 PVT PVT 1 PVT UNK FLONASE; Allergic CLARITIN rhinitis NKDA-seasonal allergies 1 PUB PVT None 653 7/10/1991: MIL EKG NSR; OTH 12/21/2004:See Homocysteine note Chronic 9.9 DDD, (4-12);LBP, 5/16/05-7/13/2005: radiculopathy left Homocysteine leg total: 7.3 (4-12), An 3 OTH OTH None Allergy > Codeine; Diabetes; COPD; HTN; Hypothyroidis None donePVT PVT ESTRNCE;None ASA; Multiple Chlopropamide vitamins; LEVEXYL; NOVALAG; LEITHIN 12 Visited doctor PUB to rule out PUB chicken pox. NoneNo lab None work done Penicillin 1 None PVT OTH None 1828 None PVT OTH None PUB PUB 0 None PUB PVT diarrhea 1 CBC - eos 0.5; PVTSed rate PVT - 42 ASA 81 mgNone - 1 qt, Flomax 0.47mg - 1qt PUB PUB Iron Pill, VitParkinson'sNo D + Calcium, Baking Soda 9 PVT PVT Zolpidem; ZOCOR; None lisinopril; Penicillin ESTRACE; allergy LEXAPRO 1 Red area from PVTshoulder PVT to elbow. Maxalt 10mg None PRN, Yasmin None3mg TQD 1 PUB OTH No No 0 PVT PUB Wellbutrin Pt denies Celebrex, Cefzil , Cipro, Bees 1 PUB UNK None None 1 None PVT PVT None None 1 PVT PVT Jan 06 head injury with complete loss of memory - continu PVT PVT MINOCYCLINE; SINGULAIR; ZOLOFT 0 PVT OTH None None 4 None PVT PUB None None 0 UNK UNK Asthma No adverse effect~Rabies ### (no brand name)~1~ 1 PVT PVT None ### PVT OTH Unknown Unknown Confused~Rabies ### (no brand name)~1~18~Pati 12 17/Sep/2008: PUB Temp 97.1 OTH F (oral); pulse 72; respirations The 14; BP patient #1 162/100; had a history and BP of high #2 ### 150/110. blood pressure. The pati -4 On 19 November PVT 2008,PVT the patientDiazepam; went to the Gabapentin; doctor's and The Fish had patient oil; a thyroid Vitamin; had atest penicillin Calcimate completed, allergy. ###results were Ft4 1.17 and 0 None PVT UNK ASA Finger infection; The patient ear infection; palpitations~Rabies had a history Sinus infection of allergies ### (no brand to cephalosporins name)~~0~Patie an 0 diagnostic laboratory, OTH 04/24/09, OTH kidney ADVAIR; profile PATANASE Asthma normal; diagnostic PMH: EIA. laboratory, 04/24/09, WAES0904USA03995 liver function test normal; dia Unknown OTH OTH Unknown Unknown WAES0905USA00040 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0802USA03044 Unknown OTH OTH Unknown Neutropenia WAES0904USA04193 0 Blood culture PVT and sensitivity, PVT negative; CSF culture Rhinitisand sensitivity, No past medical negative history. The patient ### had not received any 1 None reported PUB UNK TUBERSOL; TOPROLThe XL patient has a history of the ### high blood pressure. UNK UNK Not reported. ### 0 Unknown PVT PVT Concomitant None therapy included RelevantPEDIARIX medical history andUSWYEH09225809 Haemophilus was not provided. B Conjugate Vaccine 0 PUB UNK Pulmicort, Albuterol None Cardiac arrest X 2 @ birth 79 Brain MRI, PVT abdominal scan, PVT and sinus Nonescan. None All clear. Labs: None.Lyme PMH:(-).Strep MRI pharyngitis, brain WNL. mild MRAasthma. WNL. MRV Family WNL. hx of CTm 1 None PUB PUB None No No 5 (Reaction toOTH preservative PUB in flu shot. LUMIGAN THIMEROSAL) (FLU NoneGLAYCOMA) Dermatopathology report log # 08: 044052 medical labs. 11-2 15 None UNK UNK None Pt. allergic to SULFA/ BACATRACIN 3 PVT PVT No No None 2 None UNK UNK NWDA PVT PVT None None None 0 Advised herPUB to see physician. PUB On flu about 5 None hoursApparent later,Allergypt. states BENADRYL she called a pharmacy hotline & was told this w 1 PUB PUB 1 PVT PVT Cough Asthma
0 None PVT PUB None 32 Weeks Premature 2 CPK, Serum PUB creatinine,PVT CBC Pending Dysthymia 0 PVT PUB NC09018 2 PVT UNK ALENDRONATE; None, wellness ASPIRIN; AUGMENTIN; visit Fish oil;ZYBAN; AMBIEN; Collagenous Multivitamins. colitis; Osteoporosis; 0 None. PVT PUB Haldol, Depo-Provera None Shot No Known Allergies 1 Bilateral eyelid UNKrednessPVT with fine scaling. Atenolol, NoHCTZ, edema. Hypertension Amlodipine, Conjunctiva Lisinopril injected bilateral. Palpebral conjunctive does have 1 COMPLETEPVT BLOOD CELL PUB COUNT AND URINALYSIS SLIGHT COUGH DUE TO PROBABLE ALLERGIES 3 nothing PVT PVT none none none 2 MIL MIL contact dermatitis, Eczema, Congenital ear deformity, hea 1 None PUB PVT Lyvothyroxine No Vasotec,None Vytorin, Aleve, Multi Vitamin 11 PVT PVT Yaz none none PVT PUB NA 32 As noted above MIL MIL Prenatal Vitamins NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In S 0 CBC done in UNK office prior UNK to vaccinenone admin. Results no illness WNLsymptoms twin birth w/ prematurity (34 6/7wks) 0 CBC done in PVT office prior PUB to vaccinenone admin. - results no illness WNL sxtwin, noted premature birth 34 6/7wks 0 NONE PUB PUB NONE NONE NONE 0 PUB PUB Denied Reported by patient's parent: PCN allergy 1 none MIL UNK unknown no no 0 PVT PVT None 0 Blood Glucose-98; UNK Vital UNK signs stable none none UNK UNK NONE NONE NONE 0 unknown UNK UNK UNKNOWNNONE UNKNOWN 1 PVT UNK Sinus condition with post nasal drip 0 CBC; HeadPUB CT. Labs and PUBdiagnostics: Labs unremarkable. PMH: CBC none. with WBC 12.7. Head CT (-). 9 Echo; Cardiac MILCath; BNP; MIL CT Scan MOBIC 5/26/09 15mg Hospital None QD 6/2/09 records Right Hospital received shoulder inpatient DOS pain 5/26/09 1/12/09 records Hospital to received 1/22/09. records DOS LABS 1/11/09 received and DIAGNO 1/21/0 DOS 1 CT scan - baby PVT had seizure; PVT BloodNone test; ChestWell-Baby X-Ray. 5/18/09 Check None (None) HospitalCheck records upreceived good DOS 4/28/09 to 4/29/09. 0 UNK UNK 1 Essential nlPVT MRI as reported PUB by Peds Fluoride Neuro. drop None CT (+) for calcification Positional plagiocephaly (L) medial Lt occipital/parietal 5/7/09-records received-Adopted region - neuro ha 0 PUB UNK Possible immune Multiple problems medical issues. Chronic ear inf; sleep apnea; FF 1 PVT PVT Runny Nose 1 MRI head - PVT normal urine PUB test/ creatinine + 3 catecholamines - normal 200909 1 OTH PUB 1 PUB UNK None BPD; Gastroesophageal Reflux; Graves Disease 10 PVT PUB None None 0 None PUB PVT None No Allergic SUPREX 0 None Available PUB PUB None None None None PVT PUB None None NKDA 0 PVT UNK No 7 None PVT PVT FOSAMAX; Calcium; ASA; Osteopenia; MVT H/O Fibroids; Hyperlipidemia 1 PUB UNK None None 2 OTH UNK None Sulfa; Allergy None PVT PVT None No known Allergies PVT UNK 3 PUB PVT None 4 Ultrasound PVT of left thighPUB - no mass lesion None notedNone None 0 OTH PVT -1 PUB PVT None None None UNK UNK 0 BP 132/86, UNK P = 76 UNK DEPAKOT,None PAXIL, HCTZ Hx of hypertension & seizures (no seizures for 12 years) 0 PVT UNK Synthroid, HCTZ, No Atenolol, HTN Elmivoin, hypothyroidism, Citalopram Fibromyalgia, Hyperlipidemia, allergi diagnostic laboratory, OTH upper OTH and lower Unknown GI tests: Hypersensitivity Crohn's disease WAES0904USA04566
Unknown OTH OTH Unknown Unknown WAES0905USA00320 310 None OTH OTH ASPIRIN; LIPITOR; Calcium Hip replacement; (unspecified); Transient WAES0905USA00386 PLAVIX; ischaemic Cranberry; attack; BENICAR; Chickenpo Vi Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH09242809 was not provided. UNK UNK Not reported. ### 176 Pregnancy UNK test: 14 August UNK2008 - positive No known allergies. Gestational ###diabetes. 1 BP-90/60 P-90 PUBR-20 T-98.6 UNK Denies Denies Denies 1 PUB PVT None None None 0 UNK UNK 15 none-Bx pending MIL MIL NONE NONE NONE 1 None that this UNK reporterUNK is aware ofDesogen, or reported MTV, None fromAlberterol patient. None prn, Flexiril prn 0 none UNK PUB 7 NONE PUB PVT ZOCOR/BENICAR MILD UPPER HYPERTENSION RESPIRATORY INFECTION 14 MIL MIL none unknown 0 NONE PUB PVT NONE NONE NONE PVT PVT None None None 26 None yet UNK PUB Synthroid and None Lamisil NKDA, has hypothyroidism and onychomycosis 1 UNK PVT PVT Penicillin Allergy There were no concomitant A0780206A vaccinations or medications. T 34 5/21/09 ERPUB medical records UNK LABS:None UA abnormal w/protein None & ketones. 5/21/09CMP medical WNL. records WBCPMH: 20.8(H), ear plts infection 532(H), 1/09. neu 10 CBC; ECHO; PVT pictures; PUB BMP labs and None Diagnostics: (L) otitis EKG None, WNL. CBC PMH:WNL. none.CRP and ASO (-). No echo done. 0 None PVT PVT None 1 OTH PVT Actonel, HCT2 None Lipitor, Hypertension, Nasone, Trazodone Hyperlipidemia, Osteopenia PVT PUB No No None 7 MRI of neckPVT down; CatOTH scan; Test COUMADIN; for blood clotNORVASC; in legs;Allergic X rayt LANOXIN of to back aspirin Shingles~ & chest. ()~1~70~Patient Lots of blood work. 0 PUB PVT None No PENICILLIN 1 PUB PUB Healthy OR200918 0 PVT PUB Cold Symptoms Similar to above only reported after this event.~ 188 PVT PVT No No None 175 PVT PVT no no no 1 None PVT PUB No No 2 PUB OTH None None 6 PVT PUB None 0 None PVT UNK None known None of known 0 Allergic reaction PVT to ADACEL. PVT PVT PVT 0 PVT PVT None None None 2 None PVT PUB None 0 PUB PUB None Reactive Airway Disease 1 None PVT PUB None No No 0 PVT UNK 12/23/2008~HPV (Gardasil)~1~15~Patient 1 PVT PVT None None None 2 PVT PUB Mild Congestion No 9 PVT PVT FEVER~ ()~UN~1~Patient 7 PUB PUB 1983 PVT PVT SINGULAIR; noRYNATAN; asthma ALBUTEROL 17 None PVT PVT None Corn allergy; food protein induced proto colitis 0 PVT UNK 2 Viral and throat OTHcultures: OTH Negative; Blood work-up: Within No normal medicallimits. history, concomitant ###medications, or illness at 1 PVT PVT 7 PVT PVT None None Failure-to thrive ESR/Sed Rate: UNK1st=47,UNK 2nd=68 I'm being medevaced None this None week, May 13-15, 2009 0 Phenobarbital UNK levels were PVTwithin aPhenobarbital, good theraputic nonenexium range.Mild and controllable epilepsy since age nine. Acid reflux.
2 0
PVT PVT none UNK PUB Atenolol, ramipril, None lipitorAllergic to codeine, sulfa and the horse serum in the tetanu electroencephalography OTH OTH Unknown Unknown WAES0905USA00584 Unknown 5/18/09 OTH PCPOTH medical records AMITRIPTYLIN LABS: CBC, mg; CMP, ibuprofen None TSH, 5/18/09 6/1/09 T4, EBV, PCP Neurology med monospot, WAES0905USA00372 records consultation IgG HPV all #1 WNL. records given BE received 3/13/08, swallow, DO Loa 30 amniocentesis, OTH02/19/09, OTH trisomy 18; None diagnostic Pregnancy procedure, NOS 3.1(LMP cm, No = 11/1/2008); Cul test:WAES0905USA00360 suggested Allergic reaction a congenital to antibiotics anomaly Unknown OTH OTH Unknown Unknown Cyanosis; Dizziness; WAES0905USA00344 Headache; Haemorrhagic Unknown OTH OTH Unknown Unknown Cyanosis; Dizziness; WAES0905USA00188 Headache; Haemorrhagic 0 ultrasound, OTH 10/02/08, 12"/ OTH7W.; ultrasound, YAZ 12/11/08, Pregnancy 22"/NOS 17W. (LMP = 7/12/2008); WAES0809USA03554 PPD skin test positive 217 Ultrasound,OTH 04/28/08, Viable OTH fetusUnknown with and EDD Pregnancy of 02-DEC-2008; NOS (LMPUltrasound, = 3/5/2008)W 11/12/08, AES0712USA08104 Male baby weighing 6 po Unknown OTH OTH Unknown Unknown WAES0905USA00497 Unknown OTH OTH Unknown Unknown WAES0905USA00367 0 UNK UNK 5/6/09 Client reported having major surgery on his right sh 0 CBC with WBC PUBcount of PUB 8,900. RP of 1.2. Had Mild blood URIand None urineknown culture performed, which were both negative. 0 UNK UNK None. None reported. 9 PUB PUB INFANT TYLENOL DIAPER,RASH HYDROCORTISONE ALLERGY TO PENICILLIN CREAM 0 PVT PVT 1 None PUB PUB none None 0 5/26/09 Hospital UNK records UNK received 5/26/09 DOS 4/23/09 Hospital NONE to 4/25/09. records CHOLELITHIASIS received LABS and DOS DIAGNOSTICS: 4/23/09 FATTYtoLIVER, 4/25/09. Ultrasound OBESITY benadryl, Abdomen (BMI solu-medro MORE - gallsT 2 UNK UNK Parmarin .3mg nonedaily, ASA allergic 81 mg to PCN Vits Beestings. BBlockers cause asthma sympt 1 adverse reactions MIL locally MILon left upper Will submit arm.Meds upon given request. for Attapulgite, itching Zyrtec Kaopectate 10mg TID or as needed 0 N/A PVT PVT N/A N/A N/A SISTER~Polio Virus, Inact. (Ipol)~3~4~In Siblin 1 None UNK UNK no none VA09005 0 N/A PVT PVT N/A N/A N/A BROTHER~DTaP (Daptacel)~4~4~In Sibling1| 1 none UNK UNK seasoniquenone oral contraceptive reported PCOS and pillschildhood asthma 1 titer PUB PUB none none AL0907 0 N/A PUB PUB N/A N/A Borderline Diabetes 4 Hip ultrasound/xray/bloodwork. PVT PVT 6/24/09 None Hospital None records (R) received Inguinal DOS Hernia. 5/2/09 6/24/09 to 5/3/09. Hospital LABSrecords and DIAGNOSTICS received DO 1 UNK UNK Allergic to PENICILLIN in the past, since young age. UNK UNK 2 OTH OTH ACTONEL; NEXIUM, NORVASC; Sulfa / PCNOmeprazole, ZOCAR; ASA; ANTIVERT 0 PVT PVT None None 1 PUB PUB None None reported 109 Rheumatology PUBtest negative PUB MRI negative. No. 5/21/09 5/20/09 No medical medical records No.records 5/20/09 received ~Pertussis (consultation) medical DOS records 8/6/08. (no IA090004 received brand Pepcid, (consultation) name)~1~0~Patient DOS Midrin, 9/9/08 received Beconase, LABSDOS and Na9 1 PVT UNK PVT PVT None None None 0 PVT PUB Allergic; Rhinitis/eczema ME00509 1 PVT PVT Multivitamins; Sinus SINGULAIR; infection Sulfa FEMART; CRESTOR; Vit D 4000u; MUCINEX D; 3 OTH UNK Unknown No 1 MRI 5-2-09PUB Negative; EEG, PUB EKG 3-7-09 normal, Recovering Repeat EEG's from a normal minor Seizures~DTP cold- onset 0+were Hib (no before brand - no name)~3~1~Sib fever 2 None required. PVT PVT VYVANSE;None FOCALIN ADHD 0 PVT PVT No No 15 4/23/2009 tissue MIL bx dorsal MIL surfaceMultiple hand: SUPERFICIAL Vitamin None None PERIVASCULAR LYMPHOCYTIC INFILTRATE WITH EO 1 None PVT PVT None None Penicillin 0 PVT PVT None None 0 PVT UNK No PVT PVT 6 None PVT PVT Celebrex, Neurontin None - Has , Clonazepram, Pain depression syndromeCymbalter in R leg following traumatic fracture. Rosac PVT PVT None h/o asthma lexzene 1 None PUB PUB 0 See ED report PVT PVT PRILOSECnone none 0 PVT UNK allergic rhinitis; migraines
19 PVT PVT 0 OTH UNK Thyroid; Lisinopril; No reported PAXIL History illness.of Low Thyroid disease; HTN; and taking PAXIL fo 0 PVT UNK 0 PUB PUB 1 None PUB PUB None None None UNK OTH OTH Unknown A0780644A Unknown OTH OTH Unknown Unknown WAES0905USA00539 1 Not reported UNK UNK Not reported ### 9 See hospital PVT summary.PVT 6/4/09 Hospital 6/4/09records Hospital None received recordsADD. DOS received 6/4/09 3/23/09 DOS Meningoencephalitis~DTP Hospital to3/23/09 4/6/09. records to LABS 4/6/09. received andDaytrana. DIAGNOSTICS: (no DOS brand 3/23/09 Acyclovir, name)~5~ CBC to dox 4/6Unknown OTH OTH Unknown Unknown WAES0905USA00506 Unknown OTH OTH Unknown Unknown WAES0905USA00582 114 Unknown 6/10/09 OTH Hospital OTH medical YASMIN records LABS:EEG Contraception abnormal. 6/10/09 Hospital MRI, CT medical scan, WAES0905USA00550 records MRA/MRV PMH:allergic all neg. 5/15/09 rhinitis,Med BC 1 PVT OTH None None. 6/9/09 Medical records DOS 7/10/06 to 3/10/09. Hy 0 Unknown. 7/13/09 OTH Hospital OTH records received DOS 4/20/09 Unknown to 4/23/09. LABS and WAES0905USA00526 DIAGNOSTICS: Ultrasound Abdo 2 culture 5/13/09 PUBhospitalPUB records received None DOS 5/2/09 to 5/6/09. None known LABS and DIAGNOSTICS: CBC - MCHC 35.5 G/D 0 PVT PUB Several URI's Fevers with immunization~ ()~UN~0~Sibling UNK UNK UNK UNK 0 Flu screen negative. PVT PVT Diabetes Mellitus, obesity (morbid) PVT PVT 4 PUB PUB Zero meds No None 16 None MIL MIL None None NKDA, Conditions None PVT PVT HYDROCORTISONE 1% Sulfa PULMICORT; allergy; Asthma, SULFAIR Keratosis 2%; pilaris; PROVENTIL Acne;Inhaler. Convulsion 1 None OTH PVT ALLEGRA Puncture Wound None 1 none PVT PVT metformin; hydrochlorothiazide; Diabetes;lisinopril hypertension 1 None PUB PUB BENADRYL; None MOTRIN reported Allergy to shellfish/iodine 3 PVT UNK AMOXICILLIN Otitis mediaNone 1 PVT PVT DIOVAN; LIPIDOR; LISINOPRIL; METOPROLOL; B12 upper right arm 12 pervio 2 PVT PVT SIMVASTATIN; ESTRADIOL; PCN; CODIENE; LEVOXYLSULFA; MORPHINE; ACETAMINOPHEN 0 Checked EKG, PUBTransferred UNK to ER (1) DM - II NKOA 1 None PVT UNK 4 Yo well child None exam 0 LP, CT, MRI, PVT EEG, blood OTH work WNL. None None UNK PUB 1 Zoloft ; 2 MVI nutrition; 3 Claritin 3 PVT PVT Speech delay, obesity None PUB UNK F (splinters PCN in foot) - Rash; Ear tubes; Seasonal allergies/Asthma. 5 Stool + for blood PVT & Rotavirus. PVT None Cough & Congestion None since birth 0 Does not apply PVT PVT none none 0 None PVT PUB None None None 7 EEG, normal; PVTMRI, normal PVT No No 1 None PVT PUB None No No 0 PUB PUB 4 PVT PVT Meloxicam;2SINGULAIR; days no rash; Sulfa Tamoxifen; Bladder drugs; Red infection ADVAIR; shellfish; CIPRO BONIVA; prednisone; taken LUNESTA; before BENADRYL noELAVIL; reaction CLA 1 Rapid flu test PVT A+B on 5-6-09 PVT Ibuprofen, Vita, BurnLovazu, to Lt arm NKDA Lisinopril Hypertension + Hyperglyceridemia UNK UNK 3 PVT PVT 17 PVT PVT 2 UNK UNK PPD, JHP Pharmaceuticals; No lot number 84833; route L F/A; 0 pervious doses; da 10 Exam only PVT UNK 6 PVT PVT 1 OTH PUB None None Known None 0 None PVT PUB None Otitis MediaAllergy withouttofever Amoxil
OTH UNK 3 MIL MIL NO NO HAYFEVER 1 None PUB PVT None No known illness Allergies related to asthma 0 UNK UNK none none - had none a well baby exam after immunizations that day 1 PVT PVT 1 UNK UNK NONE No No 1 UNK UNK NONE No NONE 0 NONE UNK UNK MILD URI WITH H/O IUDE RHINORRHEA NEONATAL ABSTINENCE SYNDROME, OM, C 2 UNK UNK Trisprintec None 2 none PVT PVT avalide 320/25, nonelopressor acuteallergies 100 mg, to unknown~Influenza sulfa, hydroxyzine ct dye, 25 fiorinal, mg,(no actigall flu brand shot300mg, name)~NULL~~I medical conditi 1 UNK UNK 0 PVT PVT none none 12 PUB PUB none none 425 UNK UNK COPD PMH: COPD, HTN, ex-smoker. 435 LABS: Echocardiogram UNK UNK abnormal & c/w. Cardiac COPD cath c/w PMH: 3-vessel recentdisease; bowel obstruction, depressed LV resection function; & colostomy; pulmonary CO HT 7 UNK UNK ALLOPURINOL 100MG/day; htn gout AMLODIPINE T4 ASIA A paraplegia 10mg/day;Chronic ATENOLOL Stage50MG IV decubitus bid; FE 0 Abnormal CT UNK scan revealed UNK Pt has been placed no known on Anticonvulsant. illness none. atNB theadmission Labs time and of vaccination Diagnostics: shows mec stained Head CT fluidWNL. present MRI atbr d 1 n/a PUB PUB none none normal seasonal allergies AZ0904 4 PVT PVT 1 n/a PVT UNK n/a no n/a 0 N/A PVT PVT Atarax for the Crohn's event, Conmeds only seasonal included allergies Asacol for Crohn's and Remeron for inso 9 PVT PVT NONE NONE 34 During hospitalization PVT complete PVT workup None performed: 5/20/09 None EDLabs, and None hospital spinal5/13/09-records infections records Sept '07~HPV received disease, received-PMH: (Gardasil)~2~12~Patient DOS genetic 9/22/07 Hx ITP. etc.. to 4/12/09 5/13/09-record Keppra 1 Blood work;PVT urine tests;OTH CT scan; MRIs; None echocardiogram; None asthma; Stress test; 2 herniated EKG; EEG discs(electroencephalogram) in lumbar spine L4, L5-S1. LabsPMH and 1 OTH UNK No No 10 12/31/08, Chest OTH X-ray OTH - no intrapleural pred lesion ?QD for how longRheum Arthritis/osteoarthritis 2 None PVT PVT None No None 1 PVT PVT 53 PUB PUB 0 None OTH PVT None Latex allergy 0 Blood Sugar MIL 120mg/dl MIL after event None None None 0 He saw PCP PUB on 5/5/09OTH None None Allergic to cinnamon Irritable didn't spiceeat as well possible bacteria infe 0 PUB PUB (L) acute otitis NSAwedie NC09019 0 PVT PVT OTH PUB None 1 PVT PVT None PCN; sulfa; Red dye 0 None PVT PVT CRESTOR TRICOR CA Allergy , METOPROLOL, = CECLOR; HTN; LISINOPRIL, hyperlipidemia/osteopenia 3 PUB PVT Ct. states she none takes reported nonone medications. or reported documented or documented 134 Positive PVT OTH None None None 3126 Clinical observation OTH OTH Conjunctivitis None 0 PVT PVT None None None 1 PVT PVT 1 PVT PVT 1 PVT OTH None None 0 PVT PVT ZYRTEC No Allergic rhinitis 0 PUB PVT Levothyroxine; DoxepinPCN; Sulfa; PERCODAN 14 HSV cultureMIL - negative;MIL PCR and cultures Vaccinee: forNo Unknown vaccinia meds; -Contact/PT: positive Vaccinee: 6/4/09 Review BCPs. ER6/4/09 of records available ERreceived records records DOS received on 5/5/09. vaccinee DOS LABS 5/5/09. onlyan -n 0 Unknown PUB PUB CHROMAGEN DrugCAPSULES; hypersensitivity; Surgery COLACE; Hospitalisation DILAUDID; WAES0902USA00071 TORADOL; PHENERGAN (P 0 UNK UNK 1 None UNK UNK Skin CA; CHF; C-diff; CAD. A flutter; Allergies: Antibiotics ( Admitted toUNK ER then unit UNK and discharged next day. History of Asthma; Allergy history of almonds, shampoo, g
1
PUB UNK None None This isn't anPVT adverse current UNK vaccine event but rather a vaccine X 2 failure. PUB PUB 1 PUB PUB No No No 12.2/ 12.9 /PVT 38.9 / 523 OTH Gr- 52% LmNone 48% None Constipation 1 PVT PVT No No 9 PVT PVT None None None MIL UNK 92 AntinuclearOTH antibody, 08May1999, OTH Warfarin negative;sodium Erythrocyte Cardiac Valvular Anxiety; sedimentation Defect Aortic rate, valve08May1999, replacement; A0599591A 4mm/hr; Back injury; Rheumatoid Cervicalfac sp 0 PVT PVT PVT PVT 37 6/15/09 Hospital UNK records UNK received no DOS 5/12/09. no LABS and newborn DIAGNOSTICS: jaundice Reduction of intussusception with air c 0 UNK UNK MultivitaminNone Allergic to Cipro eye drops and seasonal allergies. 0 PUB UNK hypospadias 0 NONE PVT PUB NONE NONE NONE NONE~ ()~NULL~~In Sibling2|NONE~ ()~NULL 10 PUB PUB none none none SC0914 1 UNK PVT None None None 0 UNK UNK Nexium and Prilosec 0 none availbale PVT UNK none none 1 UNK UNK None 0 PUB PUB ALLERGIC TO SOY. PR-09-08 0 PVT PUB URI Sm intervening weeks after vaccination 30 NONE PUB UNK NONE NONE NONE 4 PVT PVT lexapro, birth nocontrol 0 PVT PVT None None None 20 platelet counts MIL 3/16, 12,000; OTH 3/17,Unknown 24,000; 3/24, unknown 367,000;KNA, 4/28,not 235,000 known5/26/09-records 5/26/09-recordsreceivedreceived-Ear WBCinfection 16.04, pla 1w 1 Labs showing PVT encephalopathy, PVT gastric dysbiosis, No 7/24/09 and mercury Allergic MR received poisoning. to PCN. increased from 8/4/09 8/4/09 PCP. temp/rash, Medical Medical On date records records diarrhea~Measles of vaccine received received 1/3/08 DOS DOS +noted Mum 6/2 6/2 28 Pending VARICELLA PVT &PVT Herpes cultures CLL/SLL CLL Allergy Norvasc 2 OTH PUB 0 PVT PUB No 0 None PVT PVT Yez 3 - 0.02mg Nonepo daily Zero allergies previously/history of anxiety 0 PVT PVT 1 PVT PVT No No 0 PUB UNK 1 OTH PUB None PUB PUB None None 1 None OTH UNK None No 28 Rotavirus strain PVT is identical PUB to WC3 None strain of bovine-human Milk protein7/10/09 allergy rotavirus better Hospital found with records inNUTRAMIGEN ROTATEQ received (publication DOS 11/10/08 pending). to 2/24/0 7/10 2 PVT PVT Dirt bike wreck ~Td Adsorbed (no brand name)~1~4~Patient 0 Came out fine, UNKshe is still UNK displaying generic symptoms raglan none 2 for days nausea/headaches after mvp, vacinnations. viral mennigitis prescibed Hadatto5leave or by6ER. yrs work and of and age. motrin/ibrophren school 5/15/09 due medical to chill by d r 7 Unknown OTH OTH MENACTRA Unknown WAES0905USA01139 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0905USA01070 None OTH OTH None Penicillin allergy WAES0905USA01035 diagnostic laboratory, OTH genetic OTH blood None work Penicillin allergy WAES0905USA01034 4 Unknown OTH OTH Unknown Unknown WAES0905USA00720 301 See attached. PVT8/3/09 Hospital UNK records No received NoDOS 4/29/09 None.to8/3/09 4/30/09. Hospital LABS records and DIAGNOSTICS: received DOSUrinalysis 4/29/09 to- Ke 4/3 40 Lowered bilateral PUB muscle PUB tone, acute Diabetic inflammatory medicine Diabetes andIIdemyelinating Only diabetes ~Influenza polyradicular 6/9/09-records (Seasonal) neuropathy received(no brand and PMH: Guillain name)~UN~57 DM type Barre-s II, 10 5/18/09 Hospital MIL records MIL received None DOS 5/4/09None to 5/5/09. None LABS5/18/09 and DIAGNOSTICS: Hospital records Cardiac received Enzymes DOS 5/4/09 - troponin to 5/5 1. 11 1/22/09, CPK, MIL426; CPKMB, MIL 21; Troponin, 5/26/09 medical 8.6; none negative records 5/26/09 CXR received 5/18/09 medical DOS ED records 1/22/09 and hospital received to 2/3/09. records DOS Indocin. 1/22/09 receivedtoDOS 2/3/09. 1/22 U 7 Full cardiacMIL work up/ Records MIL not ZOCOR; yet available SYNTHROID; None for hospital Allergy Lisinopril 5/26/09-records to PCN 5/26/09-records received-CXR received-PMH:hepatitis negative, EKG normalA, si 1 PUB OTH none none
0 CBC PVT UNK None None 1 Stool Test -PVT Routine UNK Antibiotics -Blood Flox (Norflox); in stools, Taxim-o loose motions after taking milk 1 8/14/09 Hospital UNK records UNK received DOS 5/12/09 - 5/16/09. 8/14/09 LABS Hospital and DIAGNOSTICS: records received EEG DOS flat and 5/12/09 consistant - 5/16/09. with 2 none ordered PUB by hospital PUB none Cerebal palsy 1 None PUB PUB 4 UNK UNK 0 no tests performed, PUB went PUB to see a doctor, wasno asked illness to take nonepainkiller. 0 None PVT PVT None Allergic colitis in newborn period, Atopic Dermatitis 21 Troponin I UNK 27-Jan-09 UNK normal 5/19/09 medical ECG 26-Jan-09 records Hypertension received normalDOS 5/19/09 5/19/09 1/27/09 medical medical 5000008 to 2/5/09. records records ibuprofen, received received guaifenesin DOS DOS1/27/0 1/27/ 0 LABS: ANAUNK 1:640 w/diffuse UNK pattern. prn asthmalong historyallergy asthmarecently dx almond and seafood PMH: asthma, SV 1 Pt given Prednisone PVT UNK PrednisoneSore 10 mg throat.none Symptoms include runny nose, sore throat, pain with swa 0 PUB PUB 3 G6PD WNLMIL MIL Prenatal vitamins, None reported acyclovir. NKDA, Review Noneofknown~ systems()~NULL~~In normal. Lab Patient|Unknown~ test on 11 May 200 -2191 PVT PVT None None 6 Head Mri-normal, UNK Cat scan UNK body-normal none except Mono for mild diagnosed degenerative none. 5/2006 7/21/09disc -Medical shot disease given records of 12/2006 thereceived thoracolumbar at pediatrician's DOS 1/24/08 junction,ly urging to 4/ 0 PVT PVT Enlarged right kidney dx at birth, Hearing loss to right ear, 76 NONE PVT PUB NONE NONE NONE NONE~DTaP + IPV + Hib (Pentacel)~NULL~~I UNK UNK 5 CBC, 17Apr2009, OTH highPVT norm; Erythrocyte Salbutamol sedimentation Unknown sulphate; Calcium Asthma; rate, 17Apr2009, salt; Graves' Multivitamin Disease; high norm; A0780611A SAD; An ultrasound The subjectofhad the not left recei shou 0 WBC, 12.5;PVT NML Electrolytes; PVT (-) blood BONIVA cx Q 5/15/09 None month;Medical ASAOsteoporosis; 81records mg QD; received MVT GerdQD; (hosp 5/15/09 Ca++ discharge Medical with vit D summary records QD 5/21/09 received included) Hospita (hoD 2 WBC, 388,000; PVT (+) blasts; PVTHg, 11.3; None plts, 42,000 None None PMH: probable developmental delays. 21 Platelet count: PVT5/12 - 5,000; OTH 5/13, 35,000; 5/14 None - 49,000. URI, 8/3/09 earHospital infection, records bumpreceived on head.DOS 5/12/09 to 5/14/09. 0 None PVT PVT None None None 1 None PVT PVT Aspirin 81 mg None daily; METROPOTOL Valvular heart 05/07/2009~Pneumo 12.5 disease, mg BID Ventricular (Pneumovax)~1~65~Pati septal defect 0 OTH PUB 0 PUB PUB None Overweight, Vision Problem 2 None PVT PVT No None 2 PVT PUB 0 None OTH OTH None None None -1 None PVT PUB 12 None PUB PUB Motrin + Tylenol Cold SxS (infant 0None fever dose) 0 None MIL MIL None None Normal pregnancy @ 38 weeks gestation Allergies: NKDA 0 OTH PUB 6 None MIL MIL Ambien None Asthma a child /exercise induced - uses Albuterol inhaler p 6 Normal CBC, MIL Chemistry, MILUrinalysis, Nexium, Pancreatic Phenergan, None Functioning, Allegra, No birth andFish defects; negative oil capsules, No three known way Zocor, drug, abdominal Naproxen, food, or series medication Rozerem, X-Rays.Melo allerg 7 MIL MIL ALBUTEROL None SULFATE Exercised 90mcg (PROVENTIL induced bronchospasm; HFA), Inhaler allergy 2 PFtoQID insects; PRN Lyme exerc 1 PVT PVT None 2 PVT PVT 2 PVT PUB None Chronic congestion 0 PVT OTH 0 PUB PUB None None None 9 PUB PVT Not aware of Seasonal any allergies 22 PUB PUB Please call None for med. List None if needed 1 None/076/200 PVT PVT None None None 0 MIL UNK No Aspirin 0 OTH OTH Fosamax None None 2 PVT PVT NKA 1 PVT PVT None 2 none PVT PVT none none history RAD; eczema; febrile seizure 2008 0 OTH OTH BACTRIM; CLARITIN Rx Urticaria Dermatitis; Southern IL dermatitis 1 PUB PUB None None
0 0 1 none
OTH OTH PVT OTH PVT PUB none none PVT PVT none none none 1 PUB OTH None None 0 PUB OTH None None Sulfa 0 Influenza A/B, OTH AG, EIA;OTH urine dip stick No micro; No Influenza; negative; ZANTAC;UA, Amoxicillin positive protein PUB PUB None None None PUB UNK None Pre term 6-5-08~Rotavirus (Rotateq)~1~0~Patient 1 PVT PVT 0 PVT UNK PUB PUB LEVAQUIN;Sinusitis ZOCOR; QUINIPRIL HTN; increased lipids; ED; recurrent sinusitis; allergic rhini 1 NONE PVT PVT NONE NONE 8 PVT OTH None None None 7/1/09 ER medical records received PMH: back pa -2191 PVT PUB 1 PVT PVT 5 PVT PVT 34 wk twin 0 PUB UNK Denies useNone Denies 3 UNK UNK Claritin None Allergy to pollen and cats 2 none PVT PVT zyrtec eczema andnone seasaon rhinitis 2 PUB PUB 2 Minor cellulitis PVT PUB Amoxicillin and tunafish 10 chest xray, UNK cardiac echo, UNK holter moniter, none ekg none 5/26/09 Medical none. records 5/26/09 received Medical records DOS 12/30/08 received - 5/13/09 DOS 12/30/08 LABS and - 5/ 1 none PVT PVT Zyrtec none none 0 UNK UNK none none 0 UNK UNK none mild uri sx none PUB PUB no meds chronic abdominal persistant pain strep nonepharngitis known~ ()~NULL~~In -scheduled tonsillectomy Patient|known 6-2-09 know 21 Troponin I UNK 15-Jan-09 UNK normal 6/10/09ECG Medical 15-Jan-09 records UNK. abnormal received 6/10/09 DOS 6/10/09 Medical 1/21/09 Medical records 5000009 to 2/2/09. records received received DOS 1/21/09 DOS 1/21/0 to 2/ 1 MRI normalUNK CSF: Protein UNK222 WBC none 13 Elevated noneintracranial none pressure. (Paternal uncle 7/1/09has Hospital MS) records received DOS 4/30 1 UNK PUB none sulfa, penicillin and codeine allergies 1 PUB PUB NONE 2 PVT PVT none None Medical History: born at term via vaginal delivery. no signif 0 MIL PVT Left Leg weakness 1 PUB PUB OCPs 0 none PVT PVT none 259 PUB PVT ValacyclovirNone hcl(valtrexPatient 500MGdx: Tab) Hitnal Hernia, Thyroid Nodular Goiter, and aller 0 PVT PVT none Impetigo seasonal allergies 13 None PUB PUB None None 0 None at present PVT PVT none known 1 none PVT PVT 1 "unknown" UNK UNK SYNTHROID; Diabetes; NOVOLOG; hypothyroidism; LANTUS sulfonamide allergy; ### penicillin allergy. 1 Zyrtec, Benadryl PVT oral, Topical PVT Benadryl None creamNo None 1 PVT PVT SINGULAIRNone @ H.S. Hx asthma 0 UNK PVT PVT Unknown A0784405A 1 OTH OTH None 1 PVT PUB Pt is allergicMom to eggs, stated peanuts, sibblingZhad throamax, a reaction erythromycin did not repo 0 PUB UNK Per mother possible diagnosed allergies and asthma. 6 PVT PVT 0 PUB PUB None 1 Erythema PVT PVT Prilosec, Pravachol, None MVI NKDA, Fosamax, Hyperlipidemia, Vesicane Osteoporosis Citracal Gerd, varicose veins 0 PVT PUB Augmentin,1Flonase, SinusitisSingulair 2Multi Immune + eggdeficiency allergy
1 none PVT PVT 1 PVT PVT Penicillin 0 PUB PVT Veramyst, claritin none and albuteral Sinusitis,as GERD, needed mild asthma 5 ECG and cardiac MIL enzymes MIL were normal. None PA/lat None CXR was Nonormal. past medical CBC none~ showed history, ()~NULL~~In elevated no known Patient|none~ lymphocyte allergies. count ()~NULL~~I 1 bloodwork came UNK back normal, UNK BUN and Iron level a little allergies, on the lowasthma, side. Also, migraines had chest x-ray which came back no 1 UNK UNK none none 8-08 bilateral ear tubes Unknown OTH OTH Unknown Unknown WAES0905USA01427 516 electroencephalography, OTH OTH abnormal; vitamins magnetic (unspecified) resonance,Strabotomy; inconclusive; Surgery urine Al,WAES0905USA00689 2/7/09, 140 311 Unknown OTH OTH PEPCID; REGLAN Down's syndrome; Atrial septal cardiac defect; disorder Ventricular WAES0905USA01449 septal defect 269 ultrasound, OTH 02/08/07, unengaged; OTH vitamins serum alpha-fetoprotein, (unspecified) Pregnancy NOS 03/06/07, (LMP = negative 11/22/2006); WAES0905USA00483 Guillain-Barre syndrome 0 Fetal nonstress OTHtest, history OTH of renal Irondisease; (unspecified); Pregnancy Apgar Vitamins score, NOS 06/05?/07, (LMP (unspecified) Vaccine = 9/10/2005; 9/9 exposure WAES0707USA01442 Renal during~HPV disorder (Gardasil)~2~25 Unknown OTH OTH Unknown Unknown WAES0905USA01250 Magnetic resonance, OTH left OTH hand showed Unknown diffuseSickle edema celland SCmild disease heterogeneous WAES0905USA00574 enhancement of the left first metaca 77 MRI Brain/Spine, PVT EEG PUB NL 5/19/095/19/09 hospital hospital records PARONYCHIA records received Developmental received &DOS CERUMEN 2/13/08 DOSD/O-Hearing; 2/13/08 IMP to 2/18/08. to 2/18/08. ?'s LABS 2 mos-screen and Amoxicillin DIAGNOSTICS: passed; No C 0 None PUB PUB CLARINEX; PREVACID; Allergies; SKELAXIN; Asthma; Clavicular YASMIN; HBP; lymph Migraine; SINGULAIR; nodes~Influenza Chiari ADVAIR; malformation; (noVERAPAM brandsin na PVT OTH ALBUTEROL; CETRIZINE Environmental and red dye allergies 1 None PVT PVT None None None 0 None PUB PUB No Similar experience with TYLENOL 2 PVT PVT 17 MIL MIL none 0 None PVT UNK none none spherocytosis, amoxicillin allergy 3 PVT UNK none none Augmentin 9 PVT PUB 1 n/a PVT PVT Upper respiratory COPD infection 0 PVT PVT Minocyclene none ACNE 1 PUB PVT Wellbutrin none Depression 2 PUB PUB none none known 0 none PVT PVT none no, well check History up of syncope. evaluated by cardiology and neurology 0 MIL MIL ERYTHROMYCIN 2 N/A PUB UNK Vicodin, Ibuprofen, None, preventive Vitamin Hepatitis care C,appt. depression. NKDA. 0 PVT UNK Motrin Post partumAllergic to Reglan (itching) 1 MIL MIL none Penicillins, Lovofloxacin, Sulfa Drugs 0 PVT PVT metformin and metoprolol hypertension and diabetes type II 0 PUB PVT Benadryl none none 3 EEG, EKG UNK within normal UNK limits 5/21/09 5/21/09 Hospital Hospital Otitis records records Mediareceived received DOS DOS 5/16/09 5/16/09 to to 5/18/09. 5/18/09. LABS Tylenol, and Versed, DIAGNOSTI Omn 1 5/2/09: WBC PVT 14.9, segPVT 84%, bandnone 4%, lymphnone 3%, mono allergy 9%; SGOT to over 41,the SGPT counter 66; mono triple antibiotic spot negative ointment 5/4/09 listed - CXin 32 EEG's, CT scan, PVT Utrasounds, PVT GI problems, none none 3 PUB UNK 7 none PUB PUB none poison ivy exposure none treated 5 May 09; trichomonas vaginitis treated 9 1 PVT PUB none none Rash left arm~Pneumo (Prevnar)~3~3~In Siblin 1 PVT PUB bilateral mild/mod rash leftsensineural arm~DTaPhearing (Daptacel)~NULL~4~In loss. Sib 0 None UNK UNK None Healthy None 1 none UNK UNK none no s/s of illness allergy to Penicillin and sulfa 0 Influenza APUB and B bothPVT negative albuterol Strep inhaler None screen p.r.n. stated. negative Allergic to Penicillin. Possible history of asthma. PVT PVT 7 NONE PVT UNK 2 HEART MURMURS.THE ARE GONE BY NOW. 3295 PVT PUB 0 PVT PVT 3 UNK PUB Abilify, Lithium None 0 UNK UNK pt states she was not feeling well none PVT UNK
1 6/25/09 Hospital UNK records UNK and DC summary received none DOSnone. 6/4/09 6/25/09 to 6/9/09. seizures~HPV Hospital LABSrecords and (Gardasil)~~15~Patient DIAGNOSTICS: and DC summary Total received Protein 17 7/3/09 ER records UNK received UNK DOS 5/15/09. LABS Sheand hadDIAGNOSTICS: a sore 7/3/09 throat ER records noAll fever. labs received rapid normal. strep DOS Throat assay 5/15/09. cx was (-)Seasonal negative and Allerg so 1 PUB UNK None Latex, Lactose N/A MIL MIL None None None 0 None. FINAL PVT DIAGNOSIS: PUB Inconsolability None. 6/3/09 after None Hospital immunizations. records None. LABS 6/3/09 received and Hospital DOS DIAGNOSTICS: 5/15/09 records to received 5/16/09. Limited DOS Prevacid, Abdominal 5/15/09 Zanta Ultra to 5/ 0 PVT UNK None 0 UNK PVT PUB Unknown There were no concomitant A0784617A medications or relevant medic 2 None PVT PVT Proventil HFA None Pulmonary disease from pre maternity 2 PVT PVT 9 Pregnancy OTH Test Qual 23 UNK Apr 2009None 1038; hCGNone SERUM POSITIVE None (H); Chlamydia + Gonococcus DNA Panel NAAT 0 OTH PUB None Known None Reported None Reported -1 PVT PVT None 1 PVT PVT None No None PVT OTH AMOX 11 (L) Otitis media None 1 PUB PUB None None AR0915 1 Blood culture, PVT pending;PVT CBC with diff; increased WBC, 13.3 UNK UNK 1 PVT PVT none none none 5 PVT PVT None None None PVT PVT 1 PVT PUB 0 PVT PUB Conjunctivitis None PVT UNK No sx of an illness, unknown 0 PUB PUB Weakness "knot" to Lt arm LA090502 Hepatitis B OTH surface antibody, OTH Negative; Hepatitis Multiple B surface blood antigen, transfusions; Negative; Prematurity Hepatitis B0573907A B surface antigen, Positive 1 PVT PUB None None LA090503 1 PVT PVT No None 0 None PVT OTH Unknown Unknown PUB PUB See med list None None OR200920 0 None PUB PVT None None Allergy to Penicillin OR200919 0 PVT PUB 2 None PVT PVT None None None Arm swelling~DTaP (no brand name)~5~5~Pat 317 PVT PVT 0 None PVT PVT None None 2 None PVT PVT None None Mild Asthima UNK UNK TB; Pharmceticals; 84835; Neg; 0.1 mL 5 PVT PVT 0 None MIL MIL None None NKDA; No medical conditions; No birth effects. 0 None PVT PVT PPD None Peanut, egg 0 PUB PUB None None Seizure disorder; ~DTaPAllergic (no TN09008 brand to cats name)~2~1~Patient I will report UNK back in oneUNK week once we receive test results. NONE. Perfectly healthy before this! 14 UNK UNK Capsaicin; Flunisolide;Calculus HCTZ 50/Triamthrene; of kidney s/p (L) Hydroxyzine open partialpamoate; nephrectomy; Lisinopril; Anxie M Urine beta-human OTH OTH Pregnancy NOS (LMP = 12/22/2007) WAES0803USA00777 0 None OTH OTH None Pregnancy NOS (LMP = 1/28/2008) WAES0803USA02222 145 Apgar scoreOTH - 8/9 OTH NAPROSYN Pregnancy 500 mg; vitamins Hip NOSsurgery (LMP (unspecified) = Unknown) WAES0903USA03226 Hip dysplasia Pap test, 03/06/08, OTH atypical OTH squamous Unknown changes, HPV positive; Unknown Pap test, 09/??/08, WAES0904USA00156 atypical squamous changes, HP 0 Unknown OTH OTH Unknown Unknown WAES0904USA00174 Unknown OTH OTH Unknown Unknown WAES0904USA00178 0 None OTH OTH OCELLA None WAES0904USA00185 0 Unknown OTH OTH Unknown Unknown WAES0904USA00225 30 None OTH OTH None Heart rate irregular WAES0904USA00234
Unknown OTH OTH Unknown Unknown WAES0904USA00246 Unknown OTH OTH Unknown Unknown WAES0904USA00248 Rapid streptococcus, OTH 02/23/09, OTH negative Unknown Sore throatUnknown WAES0904USA00267 0 None OTH OTH None None. 7/23/09 Past Medical WAES0904USA00325 Records received DOS 8/17/2 0 OTH OTH XANAX; LAMICTAL; Penicillin allergy GEODON WAES0904USA00379 0 None PVT PVT YAZ Acute lymphocytic leukemia WAES0904USA00380 with a reaction to chemothera Unknown OTH OTH unknown Cancer WAES0904USA00409 diagnostic laboratory OTH - OTH Inflammatory ALBUTEROL; markers Inflammatory were NASONEX abnormal bowel disease WAES0904USA00429 10 None OTH OTH None None WAES0904USA00456 0 Unknown OTH OTH Unknown Unknown WAES0904USA00469 OTH OTH Unknown Unknown WAES0904USA00480 366 Unknown OTH OTH Unknown Unknown WAES0904USA00484 0 None OTH OTH None None WAES0904USA00575 1 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0904USA00581 3 None OTH OTH None None WAES0904USA00584 0 None OTH OTH ADVAIR; EFFEXOR Sulfonamide allergy WAES0904USA00585 0 Unknown OTH OTH Unknown Unknown WAES0904USA00586 4 OTH OTH Unknown WAES0904USA00590 30 Unknown OTH OTH Unknown Unknown WAES0904USA00591 0 Unknown OTH OTH Unknown Unknown WAES0904USA00592 Unknown OTH OTH Unknown Unknown WAES0904USA00596 Unknown OTH OTH Antimicrobial Pregnancy (unspecified); NOS(LMP CLARITIN = Unknown); WAES0904USA00604 Sulfonamide allergy. 6 Unknown . OTH Labs and Diagnostics: OTH None EKG 5/26/09 abnormal Unknown (5/2008 WNL, PMH: 6/7/08 Von Willebrand's WAES0904USA00606 EKG borderline Disease, abnormal OCs but may Unknown OTH OTH Unknown Unknown WAES0904USA00630 Unknown OTH OTH Unknown Unknown WAES0904USA00631 5 None OTH OTH YAZ Sulfonamide Contraception allergy WAES0904USA00634 Unknown OTH OTH Unknown Unknown WAES0904USA00852 2 None OTH OTH None None WAES0904USA00874 Unknown OTH OTH Unknown Unknown WAES0904USA00883 0 Unknown OTH OTH Unknown Unknown WAES0904USA00972 0 Unknown OTH OTH Unknown Unknown WAES0904USA00982 61 Unknown OTH OTH hormonal contraceptives; Anaemia; Herpes VALTREX simplex type I; Sulfonamide WAES0904USA01003 allergy None OTH OTH Unknown Unknown WAES0904USA01004 0 Unknown OTH OTH Unknown Unknown WAES0904USA01016 Unknown OTH OTH Unknown Genital wart WAES0904USA01018 0 Unknown OTH OTH Unknown Unknown WAES0904USA01025 0 None OTH OTH Unknown WAES0904USA01030 0 None OTH OTH None Unknown WAES0904USA01032 0 Unknown OTH OTH Unknown Phobia WAES0904USA01113 1 Unknown OTH OTH Unknown Penicillin allergy; Hospitalization Sulfonamide allergy; WAES0904USA01121 Highly allergic 0 None OTH OTH None None WAES0904USA01123 Unknown OTH OTH Unknown Unknown WAES0904USA01148 0 Unknown OTH OTH None None WAES0904USA01149 0 Unknown OTH OTH Unknown Unknown WAES0904USA01169 Unknown OTH OTH Unknown None WAES0904USA01183 Unknown OTH OTH Unknown Unknown WAES0904USA01198 0 None OTH OTH None Sulfonamide allergy; Drug hypersensitivity WAES0904USA01201 0 Unknown OTH OTH Unknown Unknown WAES0904USA01260 OTH OTH Unknown Unknown WAES0904USA01342 380 diagnostic laboratory OTH test, OTHreflex HPV NUVARING testing and DNA HPV None probe positive; PapWAES0904USA01354 test, positive 0 None OTH OTH None None WAES0904USA01367
None OTH OTH None None WAES0904USA01427 0 None OTH OTH None WAES0904USA01436 Unknown OTH OTH Unknown Unknown WAES0904USA01437 1 Unknown OTH OTH Unknown Unknown WAES0904USA01514 54 Unknown OTH OTH Unknown WAES0904USA01519 0 Unknown OTH OTH hormonal contraceptives Unknown WAES0904USA01528 0 None OTH OTH None None WAES0904USA01902 4 OTH OTH Unknown Unknown WAES0904USA01837 Diagnostic Laboratory, OTH OTH ?/?/09, pregnancy; Zithromax; Beta-human Cough, cold, Pregnancy chrorionic, Sexually NOS and(LMP flu transmitted therapies ?/?09, = 1/26/2009); pregnancy disease WAES0904USA01907 Headache; Penicillin allergy 53 Pap test, 3/??/09, OTH atypical OTHsquamous Unknown changes/HPV positive; Unknown Pap test, 04/??/08, WAES0904USA01849 negative 175 Pap test, 12/05/07, OTH lowOTH grade atypical Unknown squamous changes. Unknown A lesion may have been WAES0904USA01850 present; Pap test, 12/06/06, ne Pap test, atypical OTH squamous OTH changes/HPV Unknown positive Unknown WAES0904USA01851 Unknown OTH OTH None None WAES0904USA01864 Unknown OTH OTH Unknown Unknown WAES0904USA01868 1 Unknown OTH OTH None Penicillin allergy WAES0904USA01952 14 Ultrasound,OTH 10/17/08, aOTH few cysts Allegra; on the ovaries Hormonal but contraceptives nothing Noneelse; Vaginal ultrasound, WAES0904USA01877 02/02/09, negative; Compute 64 None OTH OTH hormonal contraceptives None WAES0904USA01895 2 Rapid plasma OTH reagin 04/07/09 OTH - syphilis None was positive; serum Cardiac TPPA murmur 04/07/09 - positive WAES0904USA01986 with an assigned titer level o 1 None OTH OTH WAES0904USA02036 None OTH OTH Unknown Unknown WAES0904USA02039 None OTH OTH Unknown Anxiety WAES0904USA02071 Magnetic resonance, OTH C-spine PVT andUnknown brain: Normal; Diagnostic Unknown laboratory, PMH:Diagnostic migraines, WAES0904USA02076 laboratory, daily HA since Lyme5/07, disease palpitation testeUnknown OTH OTH Unknown Unknown WAES0904USA02301 0 Unknown OTH OTH Unknown Unknown WAES0904USA02305 Unknown OTH OTH Unknown Unknown WAES0904USA02308 0 Unknown OTH OTH Pregnancy NOS (LMP = 6/7/2008WAES0904USA02324 0 None OTH OTH None None WAES0904USA02753 1 Unknown OTH OTH Unknown Unknown WAES0904USA02326 295 Blood pressure, OTH 03/25/09, OTH157/1; Blood Unknown pressure, Pregnancy 03/25/09, NOS 146/9; (LMPBody = Unknown) weightWAES0904USA02771 measurement, 06/03/08, 256 poun Unknown OTH OTH Unknown Unknown WAES0904USA02777 0 Unknown PVT PUB Unknown Unknown WAES0904USA02792 7 Unknown OTH OTH Unknown Allergic reaction to antibiotics; Heart WAES0904USA02800 rate irregular 1 Unknown PVT PVT None tonsillectomy; adenoidectomy WAES0904USA02904 2 Unknown OTH OTH None Bladder repair; Blood transfusion; WAES0904USA02972 Breast cosmetic surgery 2 blood pressure, OTH 03/22/09, OTH110/6; blood Unknown pressure, Bleeding 03/22/09, menstrual Osteomyelitis 120/7;heavy respiratory rate, WAES0904USA03132 03/22/09, 18; total heartbeat co 7 cervix biopsy, OTH 03/02/09OTH - clear; pap LEXAPRO test, 03/31/09 - genital Unknown herpes; pap test, 01/13/09 WAES0904USA03214 - Pt. at high risk for HPV 0 computed axial, OTH 02/16/09, OTHCT of the None head wasAllergic normalreaction to antibiotics WAES0904USA02907 OTH OTH Unknown Unknown WAES0904USA03407 35 Unknown OTH OTH Unknown WAES0904USA02911 21 diagnostic laboratory, OTH 01/09/09, OTH 3.2, Lymphatic number. None Was High; diagnostic laboratory, WAES0904USA02916 01/09/09, 47.2%, Lympha Unknown OTH OTH Unknown Unknown WAES0904USA03412 Unknown OTH OTH Unknown Unknown WAES0904USA03414 0 Urine beta-human, PVT positive OTH Unknown Pregnancy Uterine NOS (LMP disorder = Unknown); WAES0904USA03419 Iodine allergy Unknown OTH OTH Unknown Unknown WAES0904USA02944 Unknown OTH OTH Unknown Unknown WAES0904USA03425 0 Unknown OTH OTH Unknown Unknown WAES0904USA03434 0 None OTH OTH hormonal contraceptives None WAES0904USA02949 Unknown OTH OTH Unknown Unknown WAES0904USA02953 L IM. On an unspecified gynecological, date the patient OTH"dysplasias" had a OTH pelvic examUnknown and it showed that theUnknown patient developed "dysplasias". WAES0904USA03612 It was unknown if this wa None OTH OTH None None WAES0904USA03620 Ultrasound OTH ?/?/09 - Pregnancy OTH was normal toPlan dateB;with vitamins marginal (unspecified) placenta previa. ; Pregnancy WAES0904USA03626 NOS (LMP= 1/2/2009)
Unknown OTH OTH Unknown Unknown WAES0904USA03644 diagnostic laboratory, OTH positive OTH for high Nonerisk strain Cervical of HPV; dysplasia colposcopy with biopsies. WAES0904USA03444 Waiting for results. diagnostic laboratory, OTH positive OTH for aUnknown high risk strain of HPV Unknown WAES0904USA03729 1 None PUB PUB Unknown None WAES0904USA03746 0 Vital signs, OTH 4/21/09, normal OTH Bronchospasm WAES0904USA03456 Unknown OTH OTH Unknown Unknown WAES0904USA03790 cervical smear, OTH04/09, OTH high risk Unknown Sexually active WAES0904USA03798 3 None OTH OTH None None WAES0904USA03458 Unknown OTH OTH Unknown Unknown WAES0904USA03523 hormonal contraceptives OTH OTH hormonal contraceptives Unknown WAES0904USA03811 Unknown OTH OTH Unknown Unknown WAES0904USA03815 Unknown OTH OTH Unknown Unknown WAES0904USA03556 Unknown OTH OTH Unknown Unknown WAES0904USA03816 Unknown OTH OTH Unknown Unknown WAES0904USA03824 Unknown OTH OTH Unknown Unknown WAES0904USA03927 7 Unknown OTH OTH YAZ Acne WAES0904USA03959 OTH OTH CYMBALTAParoxysmal supraventricular Tachycardia; WAES0904USA03961 Latex allergy 13 Unknown OTH OTH hormonal contraceptives Knee operation WAES0904USA03985 2 None OTH OTH Unknown Unknown WAES0904USA03990 Unknown OTH OTH Unknown Unknown WAES0904USA04012 Unknown UNK UNK Unknown Unknown WAES0904USA04212 159 Unknown OTH OTH ORTHO TRI-CYCLEN Sexually active WAES0904USA04242 7 Unknown OTH OTH Unknown Unknown WAES0904USA04245 Unknown OTH OTH Unknown Unknown WAES0904USA04370 0 Unknown OTH OTH Unknown WAES0904USA04423 603 diagnostic laboratory, OTH 03/13/09, OTH positive Unknown high risk HPV; diagnostic Unknown laboratory, 03/07/08, WAES0904USA04430 HPV negative; diagnostic la 458 Diagnostic laboratory, OTH 06/22/07, OTH negative Unknown HPV test; Diagnostic Unknown laboratory, 09/19/08, WAES0904USA04435 positive high risk HPV; Diagno 450 diagnostic laboratory OTH 08/21/07, OTH negative Unknown HPV test; diagnostic Unknown laboratory, 04/22/08, WAES0904USA04437 negative HPV test; diagnostic la Diagnostic laboratory, OTH 03/??/09 OTH - positive; None Pap test, 03/??09 None - negative WAES0904USA04458 Unknown UNK UNK Unknown Unknown WAES0904USA04514 None OTH OTH Hormonal contraceptives; None CLARITIN WAES0904USA04522 colposcopy,OTH 04/28/09, OTH endocervical None curettage;Penicillin Pap test,allergy 01/01/09, atypical cellsWAES0904USA04530 of undetermined significance 92 None OTH OTH None None WAES0904USA04552 Unknown OTH OTH Unknown Unknown WAES0904USA04573 Unknown OTH OTH Unknown Unknown WAES0904USA04574 0 None 6/5/09-records OTH received-urinalysis OTH None 3/17/09 2+ ketones None and 6/10/09-records trace leukocytes, WAES0905USA00001 received-PMH:ashtma. urine culture no growth. Allergy 6/10/09 to c None OTH OTH None None WAES0905USA00009 1 OTH OTH APRI Sulfonamide allergy WAES0905USA00054 Cervical smear OTH- positive OTH Unknown Unknown WAES0905USA00061 344 Unknown OTH OTH DIFFERIN; Acne; ORTHO Contraception TRI-CYCLEN; minocycline WAES0905USA00065 Unknown OTH OTH Unknown Unknown WAES0905USA00074 50 urine beta-human, OTH 08/05/08, OTH positive None Pregnancy NOS (LMP = 6/19/2008) WAES0808USA00976 0 diagnostic laboratory, OTH valley OTH fever;WELLBUTRIN; chest X-ray, Sinusitis clear hydrochlorothiazide WAES0904USA00481 Unknown OTH OTH Unknown Unknown WAES0905USA01285 0 None OTH OTH Zyrtec; Premarin Sulfonamide allergy WAES0905USA01663 4 Unknown. OTH 6/12/09 Hospital OTH records Unknown and DC summary received Unknown. DOS 6/12/09 5/11/09 Hospital t0WAES0905USA01445 5/12/09. records LABS andand DCDIAGNOSTICS summary rece 301 Unknown LABS: OTH KUB OTH abnormal. Unknown. Air contrast 6/4/09 enema Hospital reduced Unknown records IS. 6/4/09 11/12/08 received Hospital received DOS WAES0905USA01453 records 5/11/09. flu vaccine, received Motrin. SPDOS lot #5/11/09. UT2782C L diagnostic laboratory, OTH rotavirus OTH (+)Unknown Unknown WAES0905USA01673 0 WBC, 13.5;PVT neutrophils, UNK 58; band, 13; lymph, 3; monos, 16; IgA platelets, deficiency6/5/09-records 351 6/5/09-records receivedreceivedPMH:IgA WBC 13.5, deficiency neu MRI - "didn'tUNK show anything" UNK Unknown ### 9 MIL MIL ###
1 PVT UNK None Allergy: Sulfa, Amox, Codeine; elevated chol, HTN, Ostepa 0 EKG; EEG;PVT Cardiology PUB evaluation RITALIN LANone 20mg 1 gdADHD 0 PVT UNK None None None ~DTaP (no brand name)~4~2~Patient 0 CBC PVT PVT Ingrown toenail. None 0 PVT UNK PPD SanofiNone C3060AA None LFA 3 None UNK OTH LANTUS; LIPITOR; Multiple sclerosis, LYRICA; Pronated LOZAUR; diabetes, flat hives~ feet,Arthritis, METFORMLIA; ()~1~0~Patient hay fever, Acid penicillin Reflux, GLYBURIDE; high blood METROPO pressure 1 PVT PVT None 1 PVT UNK none none none N/A PVT PUB CHILDRENS NONE IBUPROFEN MILD ANEMIA NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 MIGRAIN PUB PUB MIDRIN DENIED COMPLAINTS MIGRAINS OF ILLNESS 0 PVT PVT None Site check 6-10 MIL days after MIL administration to see viability of vaccine 3 none UNK PUB none none Site check 6-10 MIL days after MIL administration to see n/aviability of vaccine 1 no PVT UNK no no no None PUB PUB None known None None known Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 0 UNK UNK none 7 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 8 Site check 6-10 MIL days after MIL administration to see A/Aviability of vaccine 0 none UNK PUB none None Per patient: allergy to Sulfa medicines 8 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 0 ct head, skull UNK xray, cbc,UNK chem 12, none ua, urine tox none, all negative healthy none check Medical Medical at records thatrecords timereceived with received normal LABS: PMH: vision, CBC, frequent hearing CMPHA, WNL. andthigh urine Dru a 4 Unknown UNK UNK None reported No None reported 8 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 8 Site check 6-10 MIL days after PUBadministration to see N/Aviability of vaccine 6 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Patient is deployed MIL andMIL was unable to check n/A Site at 6-10 days after administration to see viability of vaccine 5 5/19 wbc count UNK12.6, BUN UNK10 Creaibuporfen, 1.04. LUEbc. none Venous 6/2/09 ultrasound: ED hypertension. and inpatient slow6/2/09 flow hospital atED confluence records and inpatient received of lefthospital IJDOS and left records 5/19/09 subclav rec to 0 PVT UNK NONE NONE Allergy to Sulfa 0 PUB PUB NONE NONE 1 Went back PVT to see on-call UNK nurse who BCP, stated Levothroxine she None did not know Hypothyroid if it was an adverse reaction to vaccine or not... later c 4 OTH OTH 0 PVT PUB None GER 0 None PVT PVT None None 2 None PVT PUB None None UNK PVT None UNK PVT None None None 0 None PVT UNK Sinusitis GERD; Allergic Rhinitis; NKDA Bicarbonate, PUB 11-12 PUB Unknown Cow milk protein allergy A0784664A Bicarbonate, PUB 11-12 PUB Unknown Bloody diarrhea; Cow milk A0784664B protein allergy; The subject had 1 CBC/diff; CK; PVT urine; FLU PVT A & B; - all GUAIFONESIN; neg. URI, HA, ALBUTEROL cough Cephalosporin, inhaler; bees, FLONEST pineapple inhaler 1 None PVT PVT None 1 OTH OTH SYNTHROID 10 Hypothyroid 0 PVT PVT None None None 1 None PVT PVT None None None 2 None OTH PUB None No Asthma NC09021 6 PVT PUB 3 OTH PVT None that I am aware
1 0 Lyme (-)
PVT OTH None None None PVT UNK None None PUB UNK None PUB PVT 2 Phenobarbital OTH level - Normal PVT EEG-NEXIUM; unchanged PHENOBARB Epilepsy no seizures Epilepsy in 15 years. 0 None PVT UNK None Cough; Nasal None congestion 0 Accucheck PVT - 131 PVT None None 0 None PVT PVT None None Asthma 0 PVT PVT See list See list / physical NKA before this 0 PUB PVT None No illness atNone time 0 none PVT PVT None None None 2 None PVT UNK None None 1 PVT PUB None None None 0 PVT PVT none none 1 OTH PVT UNK UNK 0 PUB PUB None None 0 PVT PVT NKA swollen arm~Td Adsorbed (no brand name)~UN 0 PUB PUB None None WV04 1 PUB PVT PREDNISOL None 15 mg once daily X 10 days was done 5-6-09. 46 None MIL MIL None 5 Not reported PUB UNK Imogam Rabies-HT; At the time lotThe of# vaccination, 26nc8x1 patient had 9/1/09 illness no ER known was records allergies reported ### received and as "bitten he DOS had by 5/4/09. not a bat". been Admta Unknown OTH OTH Unknown Unknown WAES0905USA01825 1 LABS: CXR, PVT UA, CPK,PVT blood & urine c/w WNL. EKG w/nonspecific PMH: HTN,Twave hyperlipidemia, changes. impaired 7/13/09 fasting Hospitalglucose,mono records rece 0 None UNK UNK SURGERY: ILEAL RESECTION, TONSILLECTOMY AS C 0 None PVT OTH Took blood None pressure pill Allergic AMLOD/BENAZEPRIL to PENICILLIN 5/20 0 PVT PUB Tylenol 0 None None NM0509017 03/12/2009,MIL Brain CATMIL Scan, normal; No other 03/24/2009, medications None Brain None MRI, Abnormal, Diarrhea, abnormal, peripheral 09AV00176SP MRI edema~Anthrax shows scattered (Biothrax) small foc Varicella-zoster OTH virus IGG OTHAB, 3.67 7 None at thisPVT time OTH L conjunctival w/ohemorrhage craniotomy s/p epidural hematoma; skull fx Unknown OTH OTH diphtheria toxoid (+); MENACTRA Unknown WAES0905USA01925 Unknown. 7/21/09 OTH Medical OTHrecords received DOS 5/31/08 None. to 6/27/09. Strep throat LABS pharyngitis. andWAES0905USA01680 DIAGNOSTICS: CBC - WBC 3.4 x 209 None OTH OTH None Pregnancy NOS (LMP = 4/1/2007)WAES0812USA03680 Unknown OTH OTH Unknown None WAES0905USA01298 1 PVT PUB NO NONE NONE 0 N/A PUB PUB N/A N/A N/A 1 Normal Ultrasound UNK of the UNK bilateral 6/4/09 lower extremity Hospital records venous6/4/09 received system. Hospital Normal DOS records 5/7/2009 comprehensive received and 5/18/09. DOS metabolic 5/7/2009 Motrin. panel, Tylenol. andnormal 5/18/0 Sev 12 PVT PVT Ampicillin 1 Labs were drawn UNK at ER, UNK but all tests Parents were administered negative none (CXR Tylenol none negative prior fortopneumonia, vaccine, then strep Ibuprofen and flu after swabs the were vaccine. negati 1 none PUB PUB none none none 7 CBC, Sed rate PUB(NL), done UNK1/09/2009 at Blessing no Hospital. no5/02/09 Sed rate elevated @ 25, ANA Positive, ANA tite PVT PVT None None MRSA (leg abscess) 3/08, Kabuki Syndrome 0 MIL MIL Birth Control None (Yaz 28) None 131 On observation, UNK I haveUNK disturbing gait skelaxin, abnormalities nexium, none lunesta, with nausea difficulty arthrotec, when with none~ heel taking metroprolol, ()~~0~Patient|none~ and codeine toe cyclobenzaprine, walking. related Received medications ()~~0~Sibling arthrotec, an MRI on flex1 3 6/4/09-records UNKreceived-Abnormal UNK electrocardiogram Recovering prolonged Tested from unknown positive QT interval immune for Gluten and ST deficiency &segment Wheatsymptoms. Allergy. depression 6/4/09-records suggestiv 0 UNK PUB sinemet and exelon - delirium and feeling irritable. 1 None were PUB ordered at this PVTtime Malarone prescribed No knownfor illness Nothis known international allergiestravel or medical episode. conditions. 1 PVT PVT None. Daughter No allergies. was healthy. No birth defects. No pre-existing medical co 1 6/4/09 Hospital UNKrecordsUNK received DOS Paxil5/18/09 20 mg, cough to Benicar 5/21/09. non20 productive hyperlipidemia, LABS mg, Tricor and DIAGNOSTICS: 145mg, hypertension, Plavix 75Diphtheria peripheral mg, Lovaza, Ab vascular Valium IgG 0.03 disease, 10IU/mL mg, UNK PVT na PVT PUB na slight nasalpremature crusting, possibly newbornviral with transient tachypnea and jaundice
0 PVT PVT NASAL SPARY N/A AND QV4 N/A 9 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 1 UNK UNK Zyrtec Seasonal pollen Seasonal allergies pollen allergies. 1 PVT UNK None reported. No know Had heart allergies stent previously placement before 7/2008,hypertension,CAD the pneumovax. 92 UNK UNK Altace None Hypertension, Prostate Cancer 1 UNK PVT No daily maintenance none notednone meds noted taken.by Uses patient; sumitriptan no chronic 100mg illnesses tabs as perneeded patientfor m 366 PVT PVT 0 EEG PVT UNK None None. 6/29/09 Hospital ER records received DOS 6/17/09. 0 PVT PUB None Known 1 Circ returned PVT to 18 cm PUB Bilat. ND swelling ZYRTECor redness None Dev. delay, Speech delay, A.R. 0 I think he developed PVT a PVT sinus infection unrelated None to TDap.Deviated septum; allergic rhinitis PVT OTH PVT PUB None NKDA or any other allergies/conditions 0 5/26/09 EDOTH records received OTH DOS 5/19/09. LABS and DIAGNOSTICS: WOLFE-PARKINSON-WHITE None syndrome6/5/09-records rec 0 None PUB UNK None None None 0 Pt to have EEG PVT PUB None ~Meningococcal CT200910 (Menactra)~1~0.00~Sibling|~H 0 Glucose fingerstick PVT 73,PVT 02 Sat Rd None = 98% RR=14 None BD 128/None 80 HR= 64 15 Vaccinia PCR+ MIL MIL Unk Unk Unk 1 UNK UNK 1 None OTH PUB None None 1 ED - visit, antibiotic PVT treatment OTH None None 5 Disseminated PVT chicken PUB pox MIL MIL none none 21 None MIL MIL MultivitaminNone No birth defects; No allergies; No chronic medical conditio 0 None PVT PVT None None None 0 None PVT OTH 5 OTH PVT No immunosupressant None reported meds by pt. 0 PVT PUB None None 122 PVT PVT PENECILLLIN, BEE STINGS 1 PUB PUB 23 PUB PUB Dicyclomine, None loratadine, notedNKDA. omeprazole. IBS, GERD. 0 PUB PUB 0 strep and mono UNK UNK Depo givennot 2/26/09, knownother (denies) NA not known nausea, dizziness~HPV AL0908 (Gardasil)~1~15~Patie 2 NONE PVT PVT 1 u/a done byPUB PMD-clientPUB says negative-no rx'shealth and recommended history allergy negative tono tetracycline furthur immunizations by PMD 290 8/7/09 Clinical UNK Research/Hospital UNK records received COPDDOS 8/7/09 2/25/09Clinical to 2/27/09. Research/Hospital LABS and DIAGNOSTICS: records received Hematocrit DOS 2 317 UNK UNK COPD 1 PVT PVT NONE 8 EKG, treponin:0.97 UNK (increased),cbc: UNK 5/28/09 CreatMedical 1.6, noCK illness records 445.noted CL Noreceived 96, previous cardiac DOS illnesses panel: 4/27/09 ckmb noted. to 15.3, 5/21/09. 5/28/09 myogl Naproxen, Medical 228, chem records omeprazol 10,rece ech 0 Primary care UNK provider will UNK follow upNone with parent NoregardingHeadaches; status/appt seasonal allergies; 8 none PVT PVT none none none n/a~ ()~NULL~~In Patient|n/a~ ()~NULL~~In S 1 UNK MIL SICK, RASHES, JOINTSICK, PAINRASHES, , MUSCLE JOINT PAIN PAIN , MUSCLE PAIN 0 PUB PUB No No No 7 None - MD PUB diagnosis PVT Lipitor 10 mg None qd, Timolol None 0.5% 1 gtt None~ each ()~NULL~~In eye qd, Actonel Patient|None~ 150 mg qd each ()~NULL~~ month 0 UNK PUB TYLENOL INFANTS 80 MG/0.8ML SUSP (ACETAMINOPHEN), Benadryl 4 cc 0 MIL PUB fibroneurolgia, no previous depression know allergies 258 UNK UNK None Denies anyClient illnessstates at time she of has vaccination. an allergy to Ibuprofen but no other m 2 PUB PUB 1 PUB PUB 1 PVT UNK ALEVE Rheumatoid arthritis 23 None PVT PVT None None None
0 None 5 None 0
OTH PVT None None None PVT PVT None None PVT PUB PVT OTH Allegra; Nasonex 1 UNK UNK PUB UNK No No 0 PUB OTH 0 PVT PVT Yes None Penicillin Allergy 0 PUB OTH 0 None PUB UNK BENADRYL; NONE TYLENOL NONE 2 None PVT PVT None None 0 ProthrombinPUB time was 15.8; PVT Chemistries and Hct Urosepsis remained normal; INR 1.6 day of vaccination 0 glucose finger PVTstick, 80+; PVT None 1 PVT PUB No NONE -365 Advise patient PVTto go to UNK ER or follow up with primary NONE care physician. 0 UNK UNK I do have allergies to dust, pollen, etc. No food allergies. 0 PVT PUB None None 6 None doneUNK UNK History of type 2 DM, HTN, high cholesterol. Not on immu 1 None PUB OTH None None None None PUB OTH None None PCN; Cat; peanut and seasonal allergies 2 PVT UNK Dermatitis bilat None axilla 0 PVT PVT Swollen lips Unknown OTH OTH Unknown Unknown WAES0904USA02063 28 ultrasound, OTH 12/07/04, normal; OTH serum MICRONOR alpha-fetoprotein Pregnancy NOS (LMP = 8/12/2004); WAES0409USA01336 Rhesus antibodies positive 0 None OTH OTH None Pregnancy NOS (LMP = 5/20/2007) WAES0706USA04214 0 serum immunoglobulin OTH OTH M, 1.12, elevated Unknown Pregnancy NOS (LMP= unknown)WAES0708USA01924 0 ultrasound, OTH 03?/??/08,OTH oligohydramnios; vitamins urine (unspecified) Pregnancy beta-human, NOS posit (LMP = Unknown) WAES0708USA02965 -124 Ultrasound,OTH 10/12/07, Normal OTH fetalCalcium development; (unspecified); Pregnancy Beta-human NOS Iron (unspecified); (LMP chorionic, = 6/1/2007) 10/03/07, Vitamins WAES0710USA05607 Positive; (unspecified) Serum alph-fetoprotein Unknown OTH OTH None None WAES0803USA03034 0 Unknown OTH OTH Unknown Unknown WAES0803USA03040 Unknown OTH OTH Unknown Unknown WAES0803USA03056 1 Unknown OTH MIL Unknown Unknown WAES0803USA03075 2888 Unknown PUB OTH Unknown Unknown WAES0803USA03503 0 None OTH OTH (therapy unspecified) Convulsion WAES0803USA03627 90 temperaturePVT measurement, PUB 02/22/08 Unknown - results low grade Asthma fever 99 WAES0803USA03170 0 None OTH OTH Unknown Unknown WAES0803USA03645 Unknown OTH OTH Unknown Unknown WAES0803USA03699 0 Unknown OTH OTH Unknown Unknown WAES0803USA03716 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0803USA03316 Unknown OTH OTH Unknown Unknown WAES0803USA03806 0 Unknown OTH OTH Unknown Unknown WAES0803USA03909 2 None OTH OTH ZANTAC; BACTRIM Egg allergyFebrile convulsion; EarWAES0805USA04042 infection Unknown OTH OTH Unknown Unknown WAES0803USA03335 Unknown OTH OTH Unknown Unknown WAES0803USA04047 Unknown OTH OTH Unknown Unknown WAES0805USA03728 10 None PVT PVT None WAES0803USA04131 2736 VZV strain, OTH 05/06/08, VACCI OTH albuterol; FLOVENT; Asthma; Diabetes ADVAIR; Upper respiratory mellitus insulin insulin-dependent tract WAES0805USA00361 infection; Viral infection 8 Unknown PVT PVT Unknown None WAES0803USA03372 diagnostic laboratory, OTH 04/09/08, OTH it None is clear None WAES0804USA02505 Unknown OTH OTH Obesity WAES0804USA00432 Unknown OTH OTH Unknown Unknown WAES0803USA04185
Unknown OTH OTH Unknown Developmental disturbance WAES0804USA00234 4166 Unknown PVT PVT Unknown Unknown WAES0803USA03375 17 Unknown OTH OTH Unknown Unknown WAES0803USA04192 Unknown OTH OTH None Chickenpox; ExposureWAES0803USA04437 to communicable disease 2313 None PUB OTH None None WAES0803USA03502 Unknown OTH OTH None WAES0803USA04442 3045 None OTH OTH None None WAES0803USA04497 750 None OTH OTH None None Rash erythematous~Varicella WAES0803USA04509 (Varivax)~1~0~S 2 None OTH OTH None None WAES0803USA04513 8 Unknown OTH OTH Unknown Unknown WAES0803USA04643 None OTH OTH diphtheria toxoid Immune (-) system pertussis disorder MENACTRA WAES0805USA01178 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0805USA01256 (Varivax)~1~3~Sibling 15 Unknown OTH OTH Unknown Ear infection Unknown WAES0803USA04691 0 Unknown PVT PUB (Therapy unspecified); Osteoarthritis; Aspirin Postmenopause; mg; LIPITORHearing WAES0803USA04699 mg; ZESTORETIC decreased; mg; Hypertension; OXYBUTY 198 Unknown OTH OTH None WAES0805USA01387 Unknown OTH OTH Unknown WAES0805USA01692 0 None PVT PVT Unknown Unknown WAES0803USA04721 Unknown OTH OTH Unknown Unknown WAES0805USA01842 7 Unknown OTH OTH Unknown Seasonal allergy WAES0803USA04722 Unknown OTH OTH Unknown Unknown WAES0805USA01972 10 None OTH OTH None None WAES0803USA04954 0 Unknown OTH OTH None None WAES0850USA01975 Unknown OTH OTH Unknown Unknown WAES0803USA04973 Unknown OTH OTH Unknown Unknown WAES0805USA02046 0 None OTH OTH Penicillin allergy Chickenpox WAES0803USA05043 1 None OTH OTH None Hypersensitivity WAES0805USA02125 Unknown OTH OTH Unknown Eczema WAES0805USA02311 0 Unknown OTH OTH Unknown Unknown WAES0803USA05062 0 beta-humanPVT chorionic, OTH 05/11/08, positive None Pregnancy NOS (LMP = 4/1/2008)WAES0805USA02345 2 None PVT PVT Unknown Asthma WAES0804USA00134 None OTH OTH (therapy unspecified) None WAES0805USA02351 Unknown OTH OTH Unknown Unknown WAES0804USA00167 Unknown OTH OTH Unknown Unknown WAES0805USA02862 4 Unknown OTH OTH Unknown None WAES0805USA02918 764 Unknown PUB OTH Unknown Unknown WAES0804USA00214 92 Unknown OTH OTH Unknown Unknown WAES0902USA00004 92 Unknown OTH OTH Unknown Unknown WAES0902USA00005 Unknown OTH OTH Unknown Unknown WAES0902USA00006 Unknown OTH OTH Unknown Unknown WAES0902USA00010 0 Unknown OTH OTH Unknown Unknown WAES0902USA00021 Unknown OTH OTH Unknown Hypersensitivity WAES0902USA00178 3211 Unknown OTH OTH Unknown Unknown Unknown Chickenpox~Varicella WAES0902USA00932 (Varivax)~1~8~Sibling Unknown OTH OTH Unknown Unknown WAES0902USA00937 149 None OTH OTH None None WAES0902USA01026 3 None OTH OTH None None WAES0902USA01058 0 Unknown OTH OTH None Pregnancy NOS (LMP = 12/1/2008); WAES0902USA00203 Asthma Unknown OTH OTH Unknown Unknown WAES0902USA00246 Unknown OTH OTH Unknown Unknown WAES0902USA01103 Unknown OTH OTH Unknown Unknown WAES0902USA00298 231 Unknown OTH OTH Unknown Unknown WAES0902USA00420 2721 Unknown OTH OTH Unknown Unknown WAES0902USA00423
Unknown OTH OTH Unknown Unknown WAES0902USA00601 4 None PVT PVT None None WAES0902USA01524 2801 Unknown OTH OTH Unknown WAES0902USA00865 Visual acuity OTH test, 20/30 OTH OD, and 20/20 Levetiracetam OS; Ophthalmological Convulsion Eczema disorder exam, corneal sensation WAES0902USA01617 was normal in both eyes; In Unknown OTH OTH Unknown Unknown WAES0902USA01622 961 None PVT PVT Unknown None WAES0902USA01929 Unknown OTH OTH Unknown Unknown WAES0902USA01623 0 Unknown PVT PVT Unknown Unknown WAES0902USA01660 0 None OTH OTH None None WAES0902USA01711 None OTH OTH None WAES0902USA02200 6 Unknown OTH OTH Unknown Unknown WAES0902USA02265 serum varicella OTHzoster,OTH <0.90 None None WAES0902USA01828 Unknown OTH OTH Unknown Unknown WAES0902USA01864 Unknown OTH OTH Unknown WAES0902USA02333 1 None OTH OTH Unknown Unknown WAES0902USA02410 42 None OTH OTH None Eczema WAES0902USA02447 1999 None OTH OTH None None WAES0902USA02690 Unknown OTH OTH Unknown Unknown WAES0902USA03691 None OTH OTH Unknown Birth twin Chickenpox~Varicella WAES0902USA03715 (Varivax)~1~4~Sibling 683 VZV strain, OTH 02/21/09, VZV OTHWILD TYPE Unknown STRAIN Seasonal allergy; Seasonal allergic WAES0902USA02913 rhinitis; Acne 48 None OTH OTH None None WAES0902USA03795 7 None OTH OTH None None WAES0902USA03986 Unknown OTH OTH Unknown Autoimmune disorder WAES0902USA03109 Unknown OTH OTH Unknown Unknown WAES0902USA03137 Unknown OTH OTH Unknown Unknown WAES0902USA03989 Unknown OTH OTH Vitamins (unspecified) None WAES0902USA03138 3108 Unknown OTH OTH Acyclovir; Augmentin WAES0902USA04049 Unknown PUB PUB Unknown Allergic reaction Hivesto antibiotics WAES0902USA03509 2497 Temperature OTH measurement OTH 100 f Unknown Unknown WAES0902USA03510 4120 None OTH OTH None None WAES0902USA04063 1334 Unknown PVT PUB Unknown Unknown WAES0902USA03512 Unknown OTH OTH Unknown Unknown WAES0902USA03573 Unknown OTH OTH Unknown Unknown WAES0902USA04096 Unknown OTH OTH Unknown Unknown WAES0902USA04099 None OTH OTH Unknown Birth twin chickenpox~Varicella WAES0902USA04167 (no brand name)~1~4~Si Serum varicella OTH zoster,OTH negative Unknown None WAES0902USA04172 None OTH OTH SUSTIVA, lamivudine, HIV infection; Herpes COMBIVIR, Penicillin zoster allergy; and ZANAFLEX Sulfonamide WAES0902USA04213 allergy 0 None OTH OTH Unknown Chickenpox WAES0902USA04374 1965 Unknown OTH OTH Unknown Unknown WAES0902USA04533 9 None OTH OTH None None WAES0902USA04540 34 None PVT PVT None WAES0902USA04599 7 Unknown OTH OTH Unknown Egg allergy;Hot Food flushes allergy facial; Limping; WAES0903USA00002 Urine output decreased; Loo 0 None OTH OTH None None WAES0903USA00050 Unknown OTH OTH Unknown Egg allergyChickenpox WAES0903USA00130 581 None OTH OTH None None WAES0903USA00325 Unknown OTH OTH Unknown Unknown WAES0903USA00365 9 None PVT PVT Unknown Unknown WAES0903USA00401 272 Unknown OTH OTH Unknown Unknown WAES0903USA00419 5 laboratory test, OTHAntibody OTH titers. NoUnknown results available Unknown WAES0903USA00571 serum varicella OTHzoster,OTH negative Unknown Unknown WAES0903USA00610 Unknown OTH OTH Unknown Unknown WAES0903USA00789
Unknown OTH OTH Unknown Unknown WAES0903USA00790 Unknown OTH OTH Unknown Unknown WAES0903USA00893 370 None PVT PVT Unknown None WAES0903USA01183 Unknown OTH OTH Unknown WAES0890USA02671 Unknown OTH OTH Penicillin allergy; Allergic reaction WAES0809USA02688 to antibiotics Unknown OTH OTH Unknown Unknown WAES0809USA03225 0 Unknown PVT PVT Penicillin allergy; Sulfonamide allergy WAES0809USA03272 96 None PVT PVT Unknown None WAES0809USA03440 2 Unknown OTH OTH Unknown Unknown WAES0809USA03452 0 None OTH OTH None Allergic reaction to bee sting WAES0809USA03499 1 None OTH OTH None None WAES0809USA03816 Unknown OTH OTH Unknown Unknown WAES0809USA03869 2507 Unknown OTH OTH Unknown None WAES0809USA03897 Unknown OTH OTH Unknown Unknown WAES0809USA03909 Unknown OTH OTH Unknown Unknown WAES0809USA03920 VZV strain, OTH low antibody OTH titers; serum Unknown hepatitis B, negative Unknown WAES0809USA03925 0 None PVT PVT None WAES0809USA04059 6 Unknown PVT PUB Unknown WAES0809USA04165 2 Unknown PVT PVT Unknown Penicillin allergy WAES0812USA01769 Unknown OTH OTH Unknown Unknown WAES0809USA04304 Unknown OTH OTH Unknown Unknown WAES0809USA04569 Unknown OTH OTH Unknown Unknown WAES0809USA04612 1 wound culture, OTHnegative OTH for a reaction Unknown to varicella Unknown WAES0811USA00877 Unknown OTH OTH Unknown Unknown WAES0809USA04621 1 Chest X-ray, OTH 10/22/08,OTH negative; Diagnostic laboratory, 10/22/08, Reactive negative; airways disease; Complete WAES0810USA05270 Rhinitis blood cell, 10/22/08, negative Unknown OTH OTH Unknown Unknown WAES0810USA02178 1 None PUB PUB None WAES0809USA04626 Unknown OTH OTH Unknown Varicella~Varicella WAES0810USA02126 (no brand name)~UN~2~Sib Unknown OTH OTH Unknown Unknown WAES0809USA04655 Unknown OTH OTH Unknown Unknown WAES0809USA04657 Unknown OTH OTH Unknown Unknown WAES0810USA00203 26 laboratory test, OTHlow immune OTH levels with low levels of hepatitis None WAES0807USA05344 Unknown OTH OTH Unknown WAES0810USA00210 Unknown OTH OTH Unknown Unknown WAES0801USA00386 0 diagnostic laboratory OTH OTH (therapy unspecified) PENICILLINLiver allergy; transplant; SULFONAMIDE Arthritis; WAES0807USA02635 Gastrectomy allergy 0 Allergen Skin OTH test, positive OTHto eggs; Unknown Blood pressure, Egg allergyCleft 50s palate WAES0806USA07544 606 None OTH OTH None None WAES0810USA00430 2032 Unknown OTH OTH Unknown WAES0810USA00436 8 Unknown OTH OTH Unknown None WAES0810USA00472 Unknown OTH OTH Unknown Unknown WAES0903USA01626 0 None OTH OTH None None WAES0903USA01816 0 None OTH OTH None None WAES0903USA01817 10 Unknown OTH OTH Unknown Unknown WAES0903USA02317 serum varicella OTHzoster,OTH negative antibody Unknown titers Unknown WAES0903USA02365 0 OTH OTH Unknown Unknown WAES0903USA02553 Unknown OTH OTH Unknown Unknown WAES0903USA02592 Unknown OTH OTH Unknown Unknown WAES0903USA02948 0 Unknown OTH OTH SINGULAIRDrug hypersensitivity; Hives Asthma Hives~Measles WAES0903USA03185 (no brand name)~2~0~Patient Unknown OTH OTH Unknown Unknown WAES0903USA03573 1 Unknown PVT PVT Unknown WAES0810USA02135 1 Unknown PVT PVT Furuncle; Insect Unknown bite NOS WAES0810USA02142
1 Unknown PVT PVT CLARITIN Rhinitis allergic; Cough WAES0810USA02144 259 Unknown OTH OTH Unknown Unknown WAES0810USA02460 UNK UNK CIPRO CHROHN'S disease; Drug hypersensitivity WAES0801USA02468 89 diagnostic laboratory, OTH 0.474, OTH ADIGG, None not detectible Pregnancy (titer NOS test to(LMP= check5/1/2007)WAES0810USA02478 immunity) Unknown OTH OTH Unknown Unknown WAES0810USA02490 -9 None PVT OTH Unknown None WAES0810USA02491 Unknown OTH OTH Unknown Unknown WAES0810USA02775 0 Unknown OTH OTH Unknown Unknown WAES0810USA03250 21 VZV strain, OTH 10/31/08, inadequate OTH specimen, None negative forNone B-globin, no strain identification WAES0810USA05257 10 None OTH OTH Eczema WAES0810USA05259 7 None OTH PUB Fever; Vaccination adverse WAES0810USA03306 reaction serum VZV-specific, OTH negative OTH Unknown Unknown WAES0810USA05327 546 None OTH OTH None None WAES0810USA03346 1 None OTH OTH None WAES0810USA03365 2358 None PVT OTH None WAES0811USA00032 Unknown OTH OTH Unknown Unknown WAES0811USA00045 Unknown OTH OTH Unknown Unknown WAES0811USA00196 100 Unknown OTH OTH Unknown Unknown WAES0810USA03366 488 diagnostic laboratory, PVT Culture: PVT lightNone growth staphylococcus None WAES0811USA00209 allergy test OTH OTH Unknown Unknown WAES0811USA00253 14 Unknown PVT PVT Unknown Unknown WAES0811USA00275 0 Unknown PVT PVT Unknown Unknown WAES0811USA00279 0 None OTH OTH Unknown Food allergy WAES0810USA03381 177 viral cultureOTH OTH Unknown Unknown WAES0811USA00282 Unknown OTH OTH Unknown Unknown WAES0811USA00520 biopsy - Don't OTH seem to OTH be characteristic Unknown of anything; biopsy VARICELLA - giant cells, not multinicleated, WAES0811USA00620 Herpes simplex virus - N serum VZV-specific, OTH confirmed OTH seroconvert (therapy unspecified); Hypersensitivity; cough, Eczema Asthma cold, and flu therapies; WAES0810USA03753 inhaled corticosteroid None OTH OTH Unknown Unknown WAES0810USA03770 0 Serum varicella PVT zoster,PVT 11/10/08, 6.58, None positive. None WAES0811USA00674 Unknown OTH OTH Unknown Unknown WAES0811USA00711 Unknown OTH OTH Unknown Unknown WAES0811USA00736 2661 Unknown PVT OTH Unknown Shingles WAES0810USA03910 1 Unknown OTH OTH Unknown WAES0811USA00878 1 Unknown PVT PVT None Allergy to vaccine~Hep WAES0811USA00949 B (no brand name)~UN 366 None OTH OTH None Unknown None WAES0810USA03915 Unknown OTH OTH Unknown Unknown WAES0810USA03963 3 Unknown OTH OTH Unknown Unknown WAES0811USA00986 101 Unknown PVT OTH Unknown Drug hypersensitivity ZITHROMAX allergy, total WAES0811USA01187 body swelling 1 Unknown PVT PVT MOTRIN; TYLENOL; codeine Attention deficit disorder WAES0810USA03983 742 None PVT PUB Unknown None WAES0811USA01304 0 Unknown OTH OTH Unknown Unknown WAES0811USA01326 0 Unknown PVT PVT Unknown Unknown WAES0811USA01329 OTH OTH Unknown Unknown WAES0810USA03995 Unknown OTH OTH Unknown Unknown WAES0811USA01618 10 Unknown PVT OTH CELEXA; gabapentin; Autism; Penicillin Guillain-Barre MOTRIN; allergy; ZANTAC; Acute syndrome RISPERDAL inflammatory WAES0810USA04022 demyelinating polyradic 147 Serum VARICELLA OTH ZOSTER OTH 11/10/08 XANAX; negat PREMARIN; LASIX Unknown (FUROSEMIDE); WAES0811USA01815 ZOLOFT; TRAZODONE HYDROC Unknown OTH OTH Unknown Chickenpox~Varicella WAES0811USA02164 (no brand name)~UN~3~ 1 None PVT PVT Tylenol Eczema WAES0811USA02212 Unknown OTH OTH Unknown Unknown Rash~Varicella WAES0811USA02274 (no brand name)~UN~1~Sibling 1 serum varicella OTHzoster,OTH positive immunity Unknown (1.3) Unknown WAES0810USA04025 7 OTH OTH Unknown Unknown WAES0810USA04135
497 None
PVT PVT None None WAES0810USA04137 OTH OTH Unknown Unknown WAES0810USA04155 0 Unknown OTH OTH Unknown Unknown WAES0810USA04174 None OTH OTH None WAES0810USA04356 9 None OTH OTH None WAES0810USA04357 Unknown OTH OTH Unknown Unknown WAES0810USA04483 0 None OTH OTH Unknown WAES0810USA04487 20 Unknown PVT PVT Unknown Unknown WAES0810USA04509 Unknown OTH OTH Unknown Unknown WAES0810USA00546 0 Unknown OTH OTH Unknown WAES0810USA04513 Unknown OTH OTH Unknown Unknown WAES0801USA00557 Unknown OTH OTH Unknown Unknown WAES0810USA00560 Unknown OTH OTH Unknown Unknown WAES0810USA00824 0 OTH OTH Unknown Unknown WAES0811USA02843 0 OTH OTH Unknown Unknown WAES0811USA02852 Unknown OTH OTH Unknown Unknown WAES0810USA01021 11 Unknown OTH OTH Unknown Unknown WAES0811USA03030 1374 Unknown OTH OTH Unknown Unknown WAES0810USA01157 10 Unknown OTH OTH None None WAES0810USA01158 0 Unknown OTH OTH Unknown Unknown WAES0811USA04005 Unknown OTH OTH Unknown Unknown WAES0810USA04557 Unknown OTH OTH Unknown Unknown WAES0810USA01539 Unknown OTH OTH Unknown Unknown WAES0810USA01665 399 body temp, PVT 99F PVT Drug hypersensitivity WAES0810USA04738 20 None OTH OTH None Asthma WAES0810USA01668 167 Unknown OTH OTH Unknown Unknown WAES0811USA04023 1 None OTH OTH None None WAES0810USA01701 Unknown OTH OTH Unknown Unknown WAES0810USA01718 558 None PVT PVT Unknown None WAES0811USA04139 0 None OTH OTH LEXAPRO None WAES0810USA01841 0 Unknown OTH OTH Unknown Unknown WAES0810USA04869 Unknown OTH OTH Unknown Unknown WAES0810USA01850 10 None OTH OTH FEMCON FE Penicillin allergy WAES0811USA04150 17 None PVT PVT None None WAES0810USA04909 1 Unknown PVT PVT None WAES0810USA02115 Unknown OTH OTH Unknown Unknown WAES0810USA04948 0 Unknown OTH OTH Unknown Unknown WAES0810USA04953 Unknown OTH OTH Unknown None WAES0812USA00343 112 Unknown OTH OTH Unknown WAES0810USA05081 284 None PVT PVT Unknown Unknown WAES0812USA00513 Unknown OTH OTH Unknown Unknown WAES0810USA05179 0 complete blood PVT cell 11/07/08 OTH - within Unknown normal limit; Hypertension blood chemistry 11/07/08 - within WAES0812USA00536 normal limit; serum C-reactive p 92 Unknown OTH OTH Unknown Unknown WAES0812USA00568 Unknown OTH OTH Unknown Unknown WAES0812USA00579 serum VZV-specific OTH - low OTH titer None WAES0812USA03195 4317 Unknown PVT PUB Unknown None WAES0812USA03263 0 Unknown OTH OTH Unknown Unknown WAES0812USA03384 0 Unknown OTH OTH Unknown Unknown WAES0812USA03602 251 None PVT PUB Unknown Asthma WAES0812USA04027 serum VARICELLA OTH ZOSTER OTH - negative Unknown Unknown WAES0812USA04091 Unknown OTH OTH Unknown Unknown WAES0812USA01179
Unknown OTH OTH Unknown Unknown WAES0812USA01180 3652 serum VARICELLA OTH ZOSTER OTH ?/?/08 Unknown - not have Pregnancy immunity NOS to VARICELLA ( LMP = Unknown) WAES0812USA04107 0 Unknown OTH OTH Unknown Asthma WAES0812USA04116 None OTH OTH Unknown Environmental allergy WAES0812USA04526 Unknown OTH OTH RAPAMUNE Liver transplant WAES0812USA04560 0 Unknown OTH OTH Unknown Unknown WAES0812USA05110 18 Serum VARICELLA OTH ZOSTER OTH 11/11/08 (therapy - positive; unspecified) Fever; VZV Hypernatraemia; strain mg; TYLENOL; 11/13/08Sodium - LOTRIMIN; VACCINE increased; WAES0812USA05278 STRAIN hydrocortisone Steroid therapy; mg; pyridoxine Corpus c 3352 Unknown PVT PVT Unknown WAES0901USA00086 86 None OTH OTH PREVNAR None WAES0901USA00142 974 Unknown OTH OTH Unknown Unknown WAES0901USA00325 0 None OTH OTH None None WAES0812USA01212 11 None OTH OTH Therapy unspecified Unknown WAES0812USA01225 2 None OTH OTH None None WAES0812USA01586 9 Serum varicella PVT zoster,OTH ?/?/06, negative Vitamins (unspecified) Pregnancy NOS (LMP = 2/10/2007) WAES0812USA01614 Unknown OTH OTH Unknown Unknown WAES0812USA01644 229 None OTH OTH ALBUTEROL; Asthma; ZYRTEC; Eczema; FLOVENT; RhinitisCLARITIN; allergic WAES0812USA01656 SINGULAIR 2 None PVT PVT Unknown None WAES0812USA01784 3324 None OTH OTH None None WAES0812USA02011 Unknown OTH OTH Unknown Unknown WAES0812USA02022 Unknown OTH OTH Unknown Unknown WAES0812USA02023 0 Unknown OTH OTH Unknown Unknown WAES0812USA02159 None OTH OTH Unknown WAES0812USA02785 0 Unknown OTH OTH Unknown Unknown WAES0812USA02789 1 None OTH OTH None None WAES0812USA03185 175 Unknown PVT PVT Unknown Unknown WAES0901USA00326 Unknown OTH OTH Unknown Unknown WAES0901USA00337 1528 None PVT PVT None WAES0901USA00774 23 None OTH OTH None Sulfonamide allergy : Hypersensitivity WAES0901USA00798 0 Unknown OTH OTH None Birth twin Dizziness~Varicella WAES0901USA01025 (Varivax)~UN~7~Sibling|In Unknown OTH OTH Unknown Unknown WAES0901USA01040 3 Unknown OTH OTH Unknown None WAES0901USA01048 serum antistreptolysin OTH OTH O, negativeUnknown Unknown WAES0901USA01127 0 Unknown OTH OTH None Unknown WAES0901USA01283 0 Unknown OTH OTH None Birth twin dizziness~Varicella WAES0901USA01284 (no brand name)~UN~7~Si Clinical serology OTH test - OTH negative forUnknown chicken pox Unknown WAES0901USA01303 12 Unknown OTH OTH Unknown WAES0901USA01324 851 Unknown PVT PVT Unknown Unknown WAES0901USA01525 clinical serology OTH test, negative OTH for Unknown chicken pox Unknown WAES0901USA01552 2672 None OTH OTH None None WAES0901USA01596 9 None PUB OTH Unknown Unknown WAES0901USA01608 0 Unknown OTH OTH Unknown Unknown WAES0901USA01625 serum varicella OTHzoster,OTH negative Unknown Unknown WAES0901USA01722 Unknown OTH OTH Unknown Unknown WAES0901USA01763 21 skin biopsy,PVT positive forOTH chickenpox Unknown ; serum varicella zoster, Unknown showed that he had WAES0901USA01975 never had chickenpox Unknown OTH OTH Unknown Unknown WAES0901USA01993 0 None PVT PVT None WAES0901USA02045 3 Temperature OTH measurement, PUB 01/16/09, None97.6F, Tympanic None WAES0901USA02473 4 Unknown OTH OTH Unknown Unknown WAES0901USA02496 4 bone marrow OTH biopsy, normal; OTH WBC count, low; erythrocyte, None high; neutrophil count, WAES0901USA02572 very low; serum granulocyte, po Unknown OTH OTH Unknown Unknown WAES0901USA02711 Unknown OTH OTH Unknown Unknown WAES0901USA02740
3 None PVT PVT Unknown Penicillin allergy WAES0901USA03087 serum immunoglobulin OTH OTH M - zero; serum Unknown immunoglobulin G Unknown - zero WAES0901USA03310 Unknown OTH OTH Unknown Unknown WAES0901USA03332 0 Unknown PVT OTH Unknown Acute alcoholic hepatitis; DiabetesWAES0901USA03381 mellitus; Gastritis; Duodenitis; Hyp 285 None PUB OTH None None WAES0901USA03444 Unknown OTH OTH Unknown Unknown WAES0901USA03477 None OTH OTH None None WAES0901USA03497 4482 None OTH OTH None WAES0901USA03507 Unknown PVT OTH Unknown Unknown WAES0901USA03656 None OTH OTH Unknown Peanut allergy; Food allergy WAES0901USA03678 Unknown OTH OTH Unknown Unknown WAES0901USA03712 12 Unknown PUB OTH Unknown Penicillin Allergy WAES0901USA03751 2350 Unknown OTH OTH Unknown Asthma WAES0901USA03923 Unknown OTH OTH Unknown Unknown WAES0901USA04117 Unknown OTH OTH Unknown Unknown WAES0901USA04155 92 Unknown OTH OTH Unknown Unknown WAES0901USA04409 2 Serum varicella OTH zoster,OTH showed noNone immunity None WAES0901USA04419 Unknown OTH OTH Unknown Unknown WAES0901USA04421 Unknown OTH OTH Unknown Unknown WAES0807USA03549 Unknown OTH OTH Unknown Unknown WAES0807USA03550 2 None OTH OTH None None WAES0807USA03577 1382 Unknown PVT OTH Unknown Unknown WAES0807USA03721 None OTH OTH Unknown Unknown WAES0807USA03815 1 None OTH OTH None None WAES0807USA03817 1 None PVT PVT tuberculin purified protein None WAES0807USA03862 Unknown OTH OTH Unknown Unknown WAES0807USA04012 serum varicella OTHzoster,OTH negative hormonal contraceptives None WAES0807USA04064 Unknown OTH OTH Unknown Unknown WAES0807USA04317 Unknown OTH OTH Unknown Unknown WAES0807USA04320 1 Unknown OTH OTH Unknown Unknown WAES0807USA04417 None OTH OTH Unknown Unknown WAES0807USA04481 0 None PVT OTH MIRALAX Unknown WAES0807USA04575 0 Unknown OTH OTH Unknown Unknown WAES0807USA04602 846 Unknown OTH PUB Unknown Public Funds WAES0807USA03035 -1 Unknown PVT OTH Unknown None WAES0807USA03059 1 None PVT OTH Unknown None WAES0807USA03067 Unknown PVT PVT Scoliosis; Hypersensitivity WAES0807USA03136 Unknown OTH OTH Unknown Unknown WAES0807USA04794 Unknown MIL OTH Unknown Unknown WAES0807USA04949 Unknown OTH OTH Unknown Unknown WAES0807USA03137 Unknown OTH OTH Unknown Unknown WAES0807USA04950 None OTH OTH None None WAES0807USA05051 Unknown OTH OTH Unknown Unknown WAES0807USA03138 Unknown OTH OTH Unknown Unknown WAES0807USA03139 2551 Unknown OTH OTH Unknown Unknown WAES0807USA03193 Unknown OTH OTH Unknown Unknown WAES0807USA03201 7 Unknown OTH OTH Unknown Unknown WAES0807USA03258 Unknown OTH OTH Unknown Unknown WAES0807USA05129 2 Unknown OTH OTH Eczema; Egg allergy WAES0807USA03325 35 Unknown OTH OTH Unknown Unknown WAES0807USA05163 Unknown OTH OTH Unknown Unknown WAES0807USA03367
Unknown OTH OTH Unknown Unknown WAES0807USA03548 Unknown OTH OTH Unknown None WAES0807USA05182 Unknown OTH OTH Unknown Unknown WAES0807USA05202 8 diagnostic laboratory, PUB lesion PVT culture- no growth Asthma WAES0807USA05281 body temp, PVT 99-100 PVT None WAES0807USA05354 1 Unknown OTH OTH Sulfonamide allergy WAES0807USA05376 1 Unknown PVT PVT Unknown WAES0808USA03476 Unknown OTH OTH Unknown Unknown WAES0807USA05521 0 Unknown OTH OTH Unknown Unknown WAES0807USA05538 1 Unknown/2008 PVT PVT Unknown Injection site WAES0808USA03477 erythema, pruritus, swelling~Varic 6 physical examination, PUB 07/28?/08; OTH body temp, 07/28?/08, Unknown 102 degrees F; body temp, WAES0808USA00277 07/31?/08, 99.4 degrees F 0 Unknown PVT OTH Unknown Unknown WAES0808USA00495 1 None PVT PVT None Rhinitis allergic General physical condition WAES0808USA00964 366 None OTH OTH Unknown Pollen allergy WAES0808USA03615 2 None OTH PUB Tuberculin purified protein None WAES0808USA03651 2 Unknown UNK UNK Drug hypersensitivity WAES0808USA04116 2 None OTH PUB none WAES0808USA03664 1561 Unknown OTH OTH Unknown Unknown WAES0808USA04170 2 None OTH PUB tuberculin purified Mycoticprotein allergy; Reactive Injection airways site WAES0808USA03770 disease erythema; Injection site pruritus; In Unknown OTH OTH Unknown Unknown WAES0808USA04209 2 Unknown PVT OTH Unknown Unknown WAES0808USA03954 0 Unknown OTH OTH ADVIL None WAES0808USA03964 0 None OTH OTH None WAES0808USA04357 2 Unknown OTH OTH Unknown WAES0808USA03968 Unknown OTH OTH Unknown Unknown WAES0808USA04359 0 PVT PVT Unknown Unknown WAES0808USA03987 3094 None OTH OTH Unknown Drug hypersensitivity WAES0808USA04413 0 OTH OTH HAVRIX Unknown WAES0808USA04011 3108 None OTH OTH Unknown WAES0808USA04415 Unknown OTH OTH Unknown Unknown WAES0808USA04419 0 Unknown OTH OTH Unknown Unknown WAES0808USA04038 1 None OTH OTH None None WAES0808USA04423 Unknown OTH OTH Unknown Unknown WAES0808USA04427 2405 None OTH OTH Unknown Drug hypersensitivity WAES0808USA04442 Unknown OTH OTH Unknown Unknown WAES0808USA04450 Unknown OTH OTH Unknown Unknown WAES0808USA04634 Unknown OTH OTH Unknown None WAES0808USA04849 OTH OTH Unknown Unknown WAES0808USA05003 740 Total heartbeat OTHcount, OTH 08/26/08, 128; acyclovir Body temp, 08/26/08, Otitis 97.7 media F; RespiratoryWAES0808USA04850 rate, 08/26/08, 18; VZV strain, 08/2 0 Unknown PVT PVT None WAES0808USA05051 urine bloodOTH OTH Unknown Unknown WAES0808USA05052 3534 None PVT PUB Unknown Unknown WAES0808USA05234 0 Unknown OTH OTH Unknown Unknown WAES0808USA05326 Unknown OTH OTH Unknown Unknown WAES0808USA05342 295 Unknown OTH OTH Unknown Unknown WAES0808USA05343 0 None PVT PVT None Allergic reaction to antibiotics WAES0808USA05355 VZV strain, OTH confirmed recombination OTH Unknown of vaccine strain and Unknown wild type varicella zoster WAES0808USA05366 virus 10 None OTH OTH None None WAES0808USA05407 Unknown OTH OTH Unknown Unknown WAES0809USA00001 VZV strain -OTH confirmed OTH recombination of vaccine strain and Unknown wild type VARICELLA WAES0809USA00002 ZOSTER virus 261 Unknown OTH OTH Unknown Unknown WAES0809USA00004
Unknown OTH OTH Unknown Unknown WAES0809USA00022 Unknown OTH OTH Unknown Unknown WAES0809USA00025 1 None PVT PVT Astelin, Zyrtec, Asthma; Advair, Penicillin Singulair allergy WAES0808USA01202 39 Unknown OTH OTH Unknown Unknown WAES0808USA01282 Diagnostic laboratory, OTH 0.43 OTH Immunotherapy Crohn's (unspecified) disease WAES0809USA00050 Unknown OTH OTH Unknown Unknown WAES0808USA01309 0 None OTH OTH None None WAES0808USA01368 7 None OTH OTH None WAES0809USA00313 2 Unknown OTH OTH Unknown Unknown WAES0809USA00328 2 None OTH OTH None WAES0809USA00335 2 None PVT OTH None WAES0809USA01407 2 None OTH OTH None None WAES0809USA00352 None OTH OTH None WAES0808USA01378 0 Unknown OTH OTH Unknown Unknown WAES0808USA01388 3106 None PVT OTH Unknown Unknown WAES0809USA01418 Unknown OTH OTH Unknown Unknown WAES0808USA01647 0 Unknown OTH OTH Unknown WAES0809USA00367 206 None OTH OTH None None WAES0809USA01435 e of VARIVAX (Oka/Merck) Serum (lot number, varicella OTHinjection ZosterOTH - negative site and route Unknown not reported). TheUnknown Pharmacist reported that WAES0808USA01650 a physician called and reported None OTH OTH Drug hypersensitivity WAES0809USA01455 Unknown OTH OTH Unknown Unknown WAES0809USA01502 Unknown OTH OTH Unknown Unknown WAES0809USA01549 0 None PVT OTH Unknown Dermatitis allergic WAES0809USA00471 3 None PVT PVT Unknown None WAES0808USA01573 1 None PVT PVT Penicillin allergy WAES0809USA01575 Unknown OTH OTH Unknown Unknown WAES0809USA00528 19 Unknown PVT PVT Unknown WAES0809USA01579 Unknown OTH OTH Unknown Unknown WAES0809USA01648 1647 None OTH OTH Otitis media WAES0809USA00743 2 Unknown OTH OTH None Penicillin allergy WAES0809USA01745 0 Unknown OTH OTH Unknown Unknown WAES0809USA00753 Unknown OTH OTH Unknown Unknown WAES0809USA01778 0 None OTH OTH Unknown WAES0809USA01790 470 None OTH OTH None Unknown WAES0809USA00773 2329 body temp, UNK 12/21?/04,UNK 102.9 Allergic reaction Rash to antibiotics WAES0809USA00867 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA01837 (Varivax)~2~11~Sibling 0 None OTH OTH Unknown Food Allergy WAES0809USA01223 Unknown OTH OTH Unknown Unknown WAES0809USA01951 2 None OTH OTH None None WAES0808USA01671 Unknown OTH OTH Unknown Unknown WAES0809USA01380 None OTH OTH Unknown Unknown WAES0809USA01975 21 None OTH OTH None None WAES0809USA01980 0 Unknown OTH OTH Unknown Unknown WAES0809USA02014 None OTH OTH None None WAES0809USA02162 31 None OTH OTH None WAES0809USA02177 2784 VZV strain, PVT 09/08/08, no PVT virus isolated Unknown Unknown WAES0809USA02297 Unknown OTH OTH Unknown Unknown WAES0809USA02316 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA02379 (Varivax)~2~7~Sibling 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA02380 (Varivax)~2~11~Sibling 19 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0809USA02381 (no brand name)~2~9~S 0 Unknown PVT PVT aspirin; DYAZIDE; Hypertension vitamins (unspecified) WAES0809USA02483
None OTH OTH None None WAES0809USA02576 0 Unknown PVT PVT Aspirin; Lipitor; Hyperlipidaemia Vitamins (unspecified) WAES0809USA02598 Unknown OTH OTH Unknown Unknown WAES0809USA02664 1 None PVT PVT [Therapy unspecified] None WAES0807USA05568 Unknown OTH PVT Unknown Immunodeficiency Diarrheacommon functional variable (due WAES0807USA05664 to spastic colon) Unknown OTH OTH Unknown Unknown WAES0807USA05694 0 None OTH OTH Unknown WAES0807USA05699 None OTH OTH Unknown None WAES0807USA05735 serum VARICELLA OTH ZOSTER OTH - negative Unknown Unknown WAES0805USA02934 Unknown OTH OTH Unknown Unknown WAES0807USA05738 0 None OTH OTH Unknown None WAES0805USA03403 Unknown OTH OTH Unknown Unknown WAES0807USA05739 301 None OTH OTH None None WAES0805USA03488 0 Unknown OTH OTH Unknown Unknown WAES0807USA05754 Unknown OTH OTH Unknown Unknown WAES0805USA03651 11 None OTH OTH None WAES0805USA03659 18 Unknown OTH OTH None None WAES0805USA03797 0 Glucose tolerance OTH test,OTH 3 degrees,Advair; within normal Mucinex Pregnancy limits; Ultrasound, NOS (LMP 06/24/08, = 4/1/2008); within WAES0808USA00063 Asthma; normal Drug limits; hypersensitivity Ultrasound, 07/3 7 None OTH OTH None None WAES0805USA04502 184 Unknown OTH OTH Unknown WAES0808USA00081 3643 VZV strain 05/19/08 PVT - positive OTH None WAES0805USA04544 Unknown OTH OTH Unknown Unknown WAES0808USA00094 0 Unknown OTH OTH Unknown Unknown WAES0805USA03823 0 None OTH OTH None Eczema (outgrew) WAES0805USA03860 Unknown OTH OTH Singular Asthma WAES0805USA04691 2 None PVT PVT None None WAES0808USA00101 3 None PVT OTH Unknown None WAES0805USA04055 0 None OTH OTH Unknown None WAES0808USA00147 Unknown OTH OTH Unknown Unknown WAES0805USA04395 3211 Serum varicella OTH zoster,OTH 08/16/07, less Unknown than 0.91 Unknown WAES0805USA04744 Unknown OTH OTH Unknown Unknown WAES0805USA04396 0 Unknown OTH OTH Unknown Unknown WAES0808USA00206 Unknown OTH OTH Unknown Unknown WAES0805USA04785 Unknown OTH OTH Unknown Unknown WAES0805USA04398 0 Unknown OTH OTH Unknown WAES0808USA00207 0 None OTH OTH None None WAES0805USA04786 1 Unknown OTH OTH Unknown None WAES0805USA04400 Unknown OTH OTH Unknown WAES0805USA04838 Unknown OTH OTH Unknown Unknown WAES0805USA04489 Unknown OTH OTH Unknown Unknown WAES0805USA04874 0 Unknown OTH OTH Unknown Unknown WAES0805USA04876 Unknown OTH OTH Blood pressure high WAES0805USA04930 24 None OTH OTH None None WAES0805USA04967 510 Unknown PVT PVT Unknown Chickenpox~Varicella WAES0805USA05060 (Varivax)~~8~Sibling|Ch OTH OTH Unknown Unknown WAES0805USA04998 0 Unknown OTH OTH Unknown WAES0805USA05068 Unknown OTH OTH Unknown WAES0805USA05058 0 Unknown OTH OTH Unknown Unknown WAES0805USA05071 246 Unknown PVT PVT Unknown Chickenpox~Varicella WAES0805USA05059 (no brand name)~1~7~S 0 Unknown OTH OTH Unknown Unknown WAES0805USA05072 0 Unknown OTH OTH Unknown Unknown WAES0805USA05073
0 urine beta-human, OTH 03/25/08, OTH negative ORTHO TRI-CYCLEN Pregnancy NOS LO (LMP = 2/29/2008) WAES0805USA05105 1 None PVT PVT mercaptopurine Crohn's disease; Immunosuppression WAES0805USA05122 0 None OTH OTH Unknown Unknown WAES0805USA05128 Unknown OTH OTH Unknown Unknown WAES0805USA05445 Unknown OTH OTH Unknown Unknown WAES0805USA05499 None OTH OTH Unknown None WAES0805USA05592 None OTH OTH None Unknown WAES0805USA05615 10 WBC countPVT 05/23/08 7.8 PVT None None WAES0805USA05620 14 None OTH OTH Unknown Unknown WAES0805USA05622 0 Unknown OTH OTH Unknown Unknown WAES0805USA05644 14 OTH OTH None Unknown WAES0805USA05627 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0805USA05950 (Varivax)~2~11~Sibling 11 Unknown PVT OTH Cellulitis of leg WAES0805USA05955 Unknown OTH OTH Unknown Unknown WAES0808USA02799 0 Unknown OTH OTH Unknown Unknown WAES0805USA05977 0 None OTH OTH CLARITIN Seasonal allergy WAES0806USA00627 3283 Unknown OTH OTH Unknown Unknown WAES0808USA02801 4702 None OTH OTH None None WAES0805USA06174 12 Serum VARICELLA PVT ZOSTER PVT - IgG iron equivocal; (unspecified); Seasonal serumCLARITIN VARICELLA allergy; Anaemia; ZOSTER Chronic 9/12/08 WAES0808USA02808 sinusitis - IgG equivocal 2 Unknown PVT PVT Unknown Unknown WAES0805USA06432 0 None OTH OTH None None WAES0808USA02844 Unknown OTH OTH Unknown Unknown WAES0806USA00003 240 Unknown OTH OTH Unknown Unknown WAES0806USA00008 0 Unknown OTH OTH Unknown Unknown WAES0808USA02857 None OTH OTH None None WAES0806USA00648 Unknown OTH OTH Unknown Unknown WAES0806USA00077 Unknown OTH OTH Unknown Unknown WAES0806USA00316 9 None PVT PUB Unknown Feeling of warmth Unknown WAES0806USA00650 diagnostic laboratory, OTH 08?, OTHdid notUnknown have any immunity Unknown WAES0808USA03096 Unknown OTH OTH Unknown Unknown WAES0806USA00326 0 None OTH OTH None None WAES0808USA03110 11 body temp, PVT 06/02/08, 99.4 PUBF CONCERTA Attention deficit/hyperactivity disorder WAES0806USA00672 633 Unknown OTH OTH Unknown Unknown WAES0806USA00699 0 Unknown PVT OTH Unknown Unknown WAES0808USA03124 0 Unknown OTH OTH Unknown Unknown WAES0806USA00991 0 Unknown OTH OTH Unknown Unknown WAES0806USA00616 1837 None OTH OTH Unknown Unknown WAES0806USA01000 0 Unknown OTH OTH Unknown Unknown WAES0806USA00625 0 Biopsy 08/15/08 OTH - fixedOTH drug reaction Thyroid Thyroid disorder WAES0808USA03213 1 None PVT PUB None None WAES0808USA03225 1 None PVT PVT None WAES0806USA01006 3398 Unknown OTH OTH Unknown Drug hypersensitivity WAES0808USA03245 1095 body temp 98.5 OTH OTH Unknown WAES0806USA01035 1 Unknown PVT PVT Unknown Asthma; Hypersensitivity; EczemaWAES0808USA03473 Unknown OTH OTH Unknown Unknown WAES0808USA01959 Diagnostic laboratory OTH -OTH the test result Unknown of the whole batch Unknown test was unknown. WAES0808USA02047 0 Unknown OTH OTH Unknown Unknown WAES0808USA02146 Unknown OTH OTH Unknown Unknown WAES0808USA02179 VZV strain PCR, OTH positive OTH for vaccine Unknown strain VZV None WAES0806USA01077 Diagnostic laboratory OTH -OTH swabbed the Unknown rash Unknown WAES0808USA02181 1 Unknown PVT PVT Unknown Unknown WAES0808USA03474
VZV strain, OTH positive forOTH vaccine strain Unknown VZV None WAES0806USA01078 9 None PUB OTH None Asthma; Penicillin Hives; Breath allergy shortness WAES0808USA02427 VZV strain, OTH positive forOTH vaccine strain Unknown VZV None WAES0806USA01079 0 Unknown OTH OTH Unknown Unknown WAES0808USA02457 Unknown OTH OTH Unknown None WAES0806USA01090 Unknown OTH OTH Unknown Unknown WAES0808USA02461 VZV strain, OTH positive forOTH vaccine strain Unknown VZV; VZV strain, negative None WAES0806USA01091 13 None OTH OTH None None WAES0808USA02475 0 ultrasound, PUB 08/13/08, no OTH problems;None ultrasound, Pregnancy 09/17/08,NOS no problems (LMP = 01/03/2008) WAES0808USA02606 Unknown OTH OTH Unknown Unknown WAES0808USA02627 62 None PVT PVT Unknown None WAES0808USA02671 None OTH OTH None WAES0808USA02721 0 Unknown OTH OTH Unknown Unknown WAES0806USA08049 Unknown OTH OTH Unknown Unknown WAES0806USA08138 0 Unknown OTH OTH Unknown Unknown WAES0806USA08305 0 Unknown OTH OTH Unknown Unknown WAES0806USA08306 0 Unknown OTH OTH Unknown Unknown WAES0806USA08307 Unknown OTH OTH None Unknown WAES0806USA08331 29 None PVT OTH None None WAES0806USA08400 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0806USA08402 (no brand name)~1~0~S 1737 Unknown PVT PUB Unknown Rash WAES0806USA08695 Unknown OTH OTH Unknown Unknown WAES0806USA08741 Unknown OTH OTH Unknown Unknown WAES0806USA08832 754 None PVT PVT None None WAES0806USA08878 0 None PVT PVT None None WAES0806USA01092 0 None PVT PVT None WAES0806USA08935 0 None PVT PVT Seasonal allergy WAES0806USA08942 0 None OTH OTH Unknown WAES0806USA01107 0 None OTH OTH Unknown WAES0806USA01151 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0806USA01251 (Varivax)~1~12~Sibling 2425 Body temp OTH 97.7 degrees OTH F - ; VZVDIGITEK; strain - nopropranolol amplified VZV hydrochloride None DNA; inadequate lesion, WAES0806USA01287 negative for B - globin, no stra Unknown OTH OTH Unknown Convulsion WAES0806USA01294 Unknown OTH OTH Unknown Unknown WAES0806USA01300 2087 None OTH OTH None Streptococcal infectionWAES0806USA01311 0 Unknown PVT PVT Unknown Unknown WAES0806USA01497 Unknown OTH OTH Unknown Unknown WAES0806USA01502 None OTH OTH Unknown None WAES0806USA01539 Unknown OTH OTH Unknown Unknown WAES0806USA01568 0 Unknown PVT PVT Dermatitis; Rhinitis allergic; WAES0806USA01606 Latex allergy; Drug hypersensi 0 Serum varicella OTH zoster,OTH 06/05/08, negative Calcium (unspecified); Hypercholesterolaemia Female Fatty acids genital (unspecified); operation; WAES0806USA01976 LOVASTATIN; Vitamin d (unsp 2116 None OTH OTH Unknown Unknown WAES0806USA01981 0 Unknown PVT PVT Unknown Unknown WAES0808USA03475 0 Unknown OTH OTH Unknown Unknown WAES0806USA01988 1 Unknown PVT PUB Unknown Unknown WAES0806USA02200 1 Unknown OTH OTH Ginkgo; Prinzide; Drug hypersensitivity Omega-3; Pravastatin sodium; WAES0806USA02231 Vitamin D (unspecified); Vitamin 0 Unknown OTH OTH Unknown Unknown WAES0806USA02238 0 Unknown OTH OTH Unknown WAES0806USA02254 Unknown OTH OTH Unknown Unknown Unknown WAES0806USA02400 0 Unknown OTH OTH Albuterol Asthma WAES0806USA02442 0 Unknown OTH OTH Unknown Unknown WAES0806USA02462 0 body temp, OTH 06/10/08, 103 OTHF Unknown Immunization WAES0806USA02464
Unknown OTH OTH Unknown Unknown WAES0806USA08984 1 Unknown OTH OTH None WAES0806USA09014 0 Unknown OTH OTH Unknown Unknown WAES0807USA00017 0 Unknown OTH OTH Unknown Unknown WAES0807USA00054 None OTH OTH None None WAES0807USA00089 0 Unknown OTH OTH Unknown Unknown WAES0807USA00128 0 None OTH OTH None WAES0807USA00349 0 None PVT OTH Unknown None WAES0807USA00665 Unknown OTH OTH Unknown Chickenpox WAES0807USA00666 Unknown OTH OTH Unknown Unknown WAES0807USA00669 Unknown OTH OTH Unknown Hypersensitivity WAES0807USA00691 Unknown OTH OTH Unknown Unknown WAES0807USA00809 0 Unknown OTH OTH Unknown Unknown WAES0807USA00967 0 None PVT OTH Unknown None WAES0807USA01026 laboratory test, OTHvzv antibody OTH titer negative None Unknown WAES0807USA01040 0 serum varicella OTHzoster,OTH 05/??/08, negative None None WAES0807USA01145 Unknown OTH OTH Unknown Unknown WAES0807USA01292 25 None OTH OTH None WAES0807USA01373 0 Unknown OTH OTH Unknown Unknown WAES0807USA01397 2 Unknown PVT PVT Unknown WAES0807USA01406 Unknown PVT PVT Unknown None WAES0807USA01410 Unknown OTH OTH Unknown Unknown WAES0807USA01429 0 None PVT PVT None WAES0807USA01517 0 Unknown OTH OTH Unknown Unknown WAES0807USA01574 2 abdominal ultrasound, PVT PVT 07/10/08, mesentery Unknown adenitis; WBC None count, 07/10/08, 6.91 WAES0807USA01785 thou/; red blood cell count, 07/10/ 0 None OTH OTH None Unknown WAES0807USA01649 4461 Unknown OTH OTH Unknown None WAES0807USA01841 0 Unknown OTH OTH Unknown Unknown WAES0807USA01850 3597 Unknown OTH OTH Unknown Unknown WAES0807USA02218 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0807USA02223 (Varivax)~UN~8~Sibling 448 Unknown OTH OTH Unknown Unknown WAES0807USA02243 0 Unknown OTH OTH Unknown Upper respiratory Unknown tract infection WAES0807USA02376 serum varicella OTHzoster,OTH 09/04/07, 0.13, Nonenegative Chickenpox WAES0807USA02470 402 None PVT PVT None WAES0807USA02504 0 Unknown OTH OTH None WAES0804USA00300 1 Unknown OTH OTH Unknown WAES0804USA00377 Unknown OTH OTH Unknown Unknown WAES0807USA02643 2330 diagnostic laboratory, OTH 03/24/08, OTH onNone 24-MAR-2008 Confirmed: Asthma Herpes zoster WAES0804USA00398 OTH OTH Unknown WAES0804USA00423 Unknown OTH OTH Obesity WAES0804USA00444 Unknown OTH OTH Unknown Obesity WAES0804USA00447 104 Unknown PVT OTH Unknown WAES0807USA02754 Unknown OTH OTH Unknown Unknown WAES0804USA00882 5 Unknown OTH OTH Unknown Unknown WAES0807USA02921 Unknown OTH OTH Unknown Unknown Inappropiate WAES0807USA03007 age at~Zoster (Zostavax)~UN~11 1 None PVT PVT albuterol None WAES0804USA00888 3207 Unknown OTH OTH Unknown Unknown WAES0807USA03021 Unknown OTH OTH Unknown Unknown WAES0804USA00920 Unknown OTH OTH Unknown Unknown WAES0804USA00995 0 None OTH OTH ZOLOFT None WAES0804USA01011 9 Unknown PVT PVT Unknown None WAES0804USA01013
body temp, PVT 100F OTH Unknown Asthma WAES0804USA01062 1 None PVT PVT None None WAES0804USA01096 583 Unknown OTH OTH Unknown Unknown WAES0804USA01264 Unknown OTH OTH Unknown Unknown WAES0804USA01337 0 Unknown OTH OTH Unknown Unknown WAES0804USA01438 Unknown OTH OTH Unknown Peanut allergy; Hypersensitivity WAES0804USA01494 1 None OTH OTH Seasonale, Ibuprofen None WAES0804USA01495 1 diagnostic laboratory OTH 04/05/08, OTH C-reactive Unknownprotein elevated Unknown WAES0804USA01711 7 Unknown OTH OTH Unknown Unknown WAES0804USA02209 0 None UNK UNK None None WAES0804USA02212 Unknown OTH OTH Unknown Unknown WAES0804USA02081 0 Unknown OTH OTH Unknown WAES0804USA02228 0 Unknown OTH OTH Unknown Unknown WAES0804USA02242 Unknown OTH OTH Unknown Unknown WAES0804USA02299 542 Unknown PVT PVT Unknown None WAES0804USA02106 Unknown OTH OTH Unknown Unknown WAES0804USA02328 Unknown OTH OTH Unknown Unknown WAES0804USA02143 None OTH OTH None None WAES0804USA02144 4565 None PVT PUB Unknown Rhinitis allergic; Scoliosis WAES0804USA02202 0 Unknown OTH OTH Unknown Unknown WAES0804USA02516 Unknown OTH OTH Unknown Unknown WAES0804USA02538 3592 Unknown OTH OTH Unknown Unknown WAES0804USA02743 2466 Unknown OTH OTH Unknown Unknown WAES0804USA02747 853 PVT PVT Unknown Unknown WAES0804USA02816 Unknown OTH OTH None Unknown WAES0804USA02879 1 None PVT PVT WAES0804USA03185 1132 Unknown PVT OTH Unknown Unknown WAES0804USA03118 697 None PVT PVT Slight feverAutism; Slow speech development; WAES0804USA03201 Encopresis 3790 Unknown PVT OTH Unknown Penicillin allergy WAES0804USA03231 Unknown OTH OTH Unknown Unknown WAES0804USA03236 1593 clinical immunology OTH test, OTH 03/??/08,None less than 0.91; clinicalChickenpox immunology test, 09/??/06, WAES0804USA03282 1.25; clinical immunology tes 0 Unknown OTH OTH Unknown WAES0804USA03508 4474 None OTH OTH SYMBICORT; Asthma; ZYRTEX; Seasonal FLONASE; allergySINGULAIR; WAES0804USA03602 MAXAIR 0 Unknown OTH OTH Unknown Unknown WAES0806USA03399 Unknown OTH OTH Unknown Obesity WAES0804USA03682 None UNK UNK None Allergic reaction to antibiotics WAES0804USA03766 Unknown OTH OTH None None WAES0806USA03425 406 Unknown OTH OTH GriseofulvinRingworm of scalp WAES0804USA03793 0 None OTH OTH None None WAES0804USA03730 4 None PVT PVT antimicrobial Ear (unspecified) infection WAES0806USA03727 0 Unknown PVT PVT Unknown WAES0804USA03861 Unknown OTH OTH Dilated cardiomyopathy; Cardiac arrestHypoxic encephalopathy; WAES0804USA03907 Spastic quadripare Serum varicella OTH zoster,OTH 06/??/08, 0.91, Unknown negative Unknown WAES0806USA03742 Unknown OTH OTH Unknown Unknown WAES0804USA03960 0 Unknown PVT OTH Unknown Unknown WAES0806USA03746 1832 None OTH OTH [therapy unspecified] Epilepsy; Convulsion WAES0804USA04000 0 None OTH OTH None WAES0806USA03794 437 Unknown OTH OTH Otitis media; Rhinitis Reactive allergic; airways Otitis disease media WAES0804USA04032 chronic 1263 None PVT PVT Acetaminophen, BENADRYL None WAES0804USA04033 0 None PVT PVT ADDERALL TABLETSNone WAES0806USA03803 2697 None OTH OTH Benadryl Adenotansillectomy WAES0804USA04034
1079 None PVT PUB Otitis MediaAsthma; Rhinitis allergic WAES0804USA04035 1505 None PVT PUB None WAES0804USA04040 0 None OTH OTH None None WAES0806USA03808 1008 None MIL MIL Premature birth WAES0804USA04042 0 Unknown OTH OTH Unknown Unknown WAES0806USA03822 2780 None PVT OTH Rhinitis allergic WAES0804USA04044 1452 Unknown PUB PUB Unknown Rhinitis allergic; Asthma; Food allergy WAES0804USA04045 2 Body temp PVT 06/18/2008,PUB 99-100 De F None WAES0806USA07561 14 None OTH OTH Unknown Unknown WAES0806USA07744 None OTH OTH Unknown Hypersensitivity; Atopy WAES0806USA07770 Complete blood OTH cell OTH Unknown Unknown WAES0806USA07877 57 Unknown PVT PUB Cardiac disorder; Asthma WAES0804USA04047 0 Body temp,OTH 03/09/08 101 OTH Unknown Unknown WAES0806USA07882 0 Unknown OTH OTH Unknown Unknown WAES0804USA04050 Diagnostic laboratory, UNK negative UNK titer Unknown as 0.91 Unknown WAES0804USA04223 7 None PVT OTH KELFEX Skin infection None WAES0804USA06300 Unknown OTH OTH Unknown Unknown WAES0804USA04630 18 None PVT OTH Albuterol Asthma Exercise induced WAES0804USA06332 0 None PVT PVT Unknown None WAES0804USA06409 0 None PVT PVT Unknown Unknown WAES0806USA07918 292 Unknown PVT PUB Penicillin allergy WAES0804USA04788 14 Unknown OTH OTH None Unknown WAES0804USA06413 1473 Unknown PVT PUB Unknown None WAES0804USA04790 Unknown OTH OTH Unknown Unknown WAES0804USA04795 0 Unknown PVT PVT Unknown Unknown WAES0804USA04809 Unknown OTH OTH Unknown Unknown WAES0804USA06420 1 None PVT PUB None Autism; Allergy Muscular to vaccine; weakness Muscular Drug weakness~Pertussis hypersensitivity WAES0804USA05242 (no brand name 0 None OTH UNK None None WAES0805USA00081 1861 None OTH OTH None Seasonal allergy WAES0805USA00205 526 None OTH OTH Unknown Unknown WAES0805USA00268 494 None OTH OTH Unknown Unknown WAES0804USA05266 Unknown OTH OTH Unknown None WAES0805USA00288 0 None OTH OTH SINGULAIRMilk allergy; Meat allergy; Asthma;WAES0804USA05432 Penicillin allergy. Unknown OTH OTH Unknown Unknown WAES0805USA00323 0 None PVT OTH None WAES0804USA05960 2 Unknown PVT PVT Unknown Unknown WAES0804USA06103 20 None OTH OTH Unknown None WAES0805USA00372 Unknown OTH OTH None None WAES0805USA00409 26 Unknown OTH OTH Unknown Unknown WAES0805USA00451 Diagnostic laboratory OTH 05/02/2008 OTH 0.85 Unknown IgG VZV antibodyUnknown titer. WAES0805USA00509 2 None PVT PVT Unknown None WAES0805USA00557 2 Unknown OTH OTH Unknown Unknown WAES0805USA00588 0 Unknown OTH OTH Unknown Unknown WAES0805USA00591 0 None PVT PVT Eczema WAES0805USA00592 Unknown OTH OTH Unknown Unknown WAES0805USA00651 Unknown OTH OTH Unknown Unknown WAES0805USA00670 Unknown OTH OTH Unknown Unknown WAES0805USA00818 VZV strain Vacci, OTH VZV OTH OKA/MERCK Unknown VACCINE STRAIN Unknown WAES0805USA00862 14 Serum immunoglobulin OTH OTH G 04/23/08, None negative; serum immunoglobulin None M 04/23/08, WAES0805USA00871 negative 3785 Serum varicella OTH zoster OTH 02/07/08 no, Unknown serum varicella zoster Unknown 04/29/08 unequ WAES0805USA00964 0 None OTH OTH Unknown None WAES0805USA01014
0 Unknown PVT PUB Unknown Unknown WAES0805USA01073 0 Unknown PVT PVT Unknown None WAES0806USA02948 Unknown OTH OTH Unknown Unknown WAES0806USA03064 7 Laboratory OTH test OTH None WAES0806USA03065 None OTH OTH Clonidine, RITALIN Attention deficit disorder. WAES0806USA03076 3 None OTH OTH None WAES0806USA03113 Unknown OTH OTH Unknown Unknown WAES0806USA03360 1 None PUB OTH None None NotedNone 0 Diagnostic laboratory, OTH specimens OTH Therapy from the unspecified, rash Autism; was sent Allergic FOCALIN to the reaction CDC for to PCR antibiotics analysis. WAES0806USA01075 0 PVT PVT None 5 PVT PVT None None PVT PUB Zinc Oxide None Ointment None 3 OTH PVT None that I am aware 0 None PVT PVT None None None 1 None PVT OTH None None 1 PUB OTH None None Seasonal Allergies 0 PVT PVT None None PVT PVT None None 127 Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0905USA01493 PUB OTH 7 Unknown. 7/9/09 OTH Medical OTH records None received DOS Nerve 6/5/07 damage; to Gastric 10/5/07. Irritable ulcer LABS bowel perforation and syndrome; Diagnostics: WAES0905USA02258 Partial All pending. hearing loss; PAP,Gastro GC, V Unknown OTH OTH Unknown Cerebral palsy; Premature Shunt occlusion; baby Hydrocephalus WAES0905USA01937 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0905USA01916 574 None PVT OTH ATENOLOLNone 25mg qd Lansoprazole; clarithromycin; amoxicillin Unknown UNK UNK None None WAES0905USA01868 0 CBC; BMP PUB culture; (-)UA; PUBCXR allVitamin performed (Tri-Vi-Sol) None & OK None PVT UNK None Prematurity diagnostic laboratory, OTH Blood OTH work-Results poliovirus not vaccine reported inactivated Unknown WAES0905USA01999 387 viral culture,PVT 03/19/09, PVT negative forGLUCOPHAGE VZV, Varicella Diabetes and HSV Chickenpox WAES0903USA04278 2 Unknown PVT OTH FOSAMAX; hydrochlorothiazide; None DYAZIDE; NAPROSYN; WAES0901USA02736 EVISTA 1 PVT PVT 0 X-ray; diagnostic OTH laboratory; OTH magnetic albuterol; resonance, VALIUM; Latexarm allergy; ASMANEX MRI;Specific ultrasound, allergy of arm; (drug); WAES0902USA02392 diagnostic Penicillinlaboratory, allergy nerve test: co 0 None OTH PVT Denies Denies Denies 0 PVT PVT 0 PVT PVT PUB UNK 0 n/a PVT PVT n/a n/a n/a 3 PVT PUB None None None 1 PVT PUB none none none 1 MIL MIL Good healthLatex Allergy 0 PUB PUB WISDOM TEETH COMING OUT 0 UNK UNK Vyvanse - not no acute taken illness. onallergy day of 7/7/09 to vaccine fruit; ERattention-deficit records received disorder; DOS 5/22/09. Kawasaki LABS disease and 2 MIL PUB PUB PUB Vaccines being repeated as client had bone marrow transplant. 5/22/0 1 None PUB PUB No Hypoglycemic Allergic to sulfa 0 UNK PUB aspirin, etodolac tinnitus x 4 months; h/o CVA 1 None PVT PVT 1. Abilify daily. None2. Risperdal ALLERGIES: daily. 3.ASPIRIN KlonopinWHICH daily. 4.CAUSES Atenolol RASH, as needed. HIVES, 5. A 2 ECG showed MILan incomplete MIL right bundle Ferrousbranch sulfate None block; 325mg ESR, Iron po daily deficiency cardiac troponin, anemiaand D-dimer normal; graded exercis 2 N/A PVT PVT Metformin 850mg no no 1 flu test: negative PVT UNK NA NA NA 117 none PVT PUB Cough - thought none to be viral, otitis media
1 PUB PVT Avapro none high blood pressure 0 PUB PUB none none 0 He had blood PVT work andUNK urine testsFlovent that day2 with puffs none his a day physical. multiple I was food toldallergies(peanut,treenuts,eggs,soy,fish,cocon blood work was normal. He had had other b 30 NONE UNK PUB NONE KNOWN NONE KNOWN NONE KNOWN 2 Sent in ER UNK for KUB, 2 view UNK (paucity NONE of bowel KNOWN NONE gas in lower KNOWN, NONE quadrants), SEEN KNOWN FOR thenFamily IMMZ send to ONLY. hx: radiology TB, currently for airbeing contrast/enema tx. 2 N/A UNK PVT N/A When reporting the incident the patient remarked that she 1 ESR elevated UNK at 71 (3/17/09), UNK CPK Flomax normal0.4 atNone mg 99 QPM NKDA 11 Reduced with PVT air contrast PVTenema. None. 6/5/096/5/09 Medical None Medical records Known records received received DOS 4/30/09 DOS 4/30/09 to 5/1/09. to 5/1/09. CHEM: Ondansetron, CL 107 MMOL/ LM 1 Severe local PVT Rx PVT Nifedipine; None ASA; TOPROL; AorticHCTZ valve stenosis 0 PVT PUB TYLENOL @ URI Phen (runny PMNone nose & sneezing) 2 PVT OTH HYDRODIURIL; Routine FOLIC Physical Prinivil ACID; - tendonitis; DIOVAN; Multivitamins some shoulder pain. PVT UNK None None 1 None PVT OTH None None 0 BP, decrease PVT 88/51; HR, PVT decrease 36; BP, increase None 116/81 None after 20minutes. 0 PUB PVT None 2 OTH OTH PROPRANOLOL; None PANTOPRAZOLE; No PRIMIDONE 1 None PVT PUB None None Eczema; Food allergies. 6 PVT PUB Well visit 5 None MIL MIL None None None known 0 PVT PUB 1 PVT PUB 0 well child visit 0 None PUB OTH None 01/08 - RSV, Birth - corrected great vessel transposition, 0 1 PUB PUB None None None AR0916 1 PVT PVT None None 0 None PVT PVT Concerta None ADHD 4/10/2009: MIL Evaluation by MILthe agency None and dermatology None noted Noneseveral active areas of scattered fine red slightly raise 1 PVT PUB ZYRTEC 10 mg qd 2 PVT PUB PROZAC; CLONIDINE; No Depression IMIPRAMINE 3 PUB PUB Rxs given 5/18/09 L. earache; - CLARITIN; NKA; SinusMyopia; congestion; ZADITOR Obesity; Red ophthalmic HTN; itchy eyes; Allergic dorps Feet Rhinitis/Conjunctivitis aches. None PVT PVT SIVASTIN None None 1 PVT PVT YAZ Iron No Iron def, anemia 1 PVT PUB 1 None OTH PUB unknown None None 1 None OTH PUB Unknown None None 1 None PUB PUB LISINOPRIL; None HCTZ 10/12.5 None ml qd; TYLENOL Sinus PRN 1 PUB OTH PREPRIN; No Levothyroxine NKDA; Hypothyroidism; Hysterectomy 0 Below: the manufacturers PVT UNKare correct, previdid but I am colitis, unsure reflux ofcthe olitis, subheadings reflux for DTaP and Hib. The nurse's writing is 9 PVT PUB A mistake was made, I was given a TB tested injected instead of subcue??? Cou PVT PVT none none none Hives, Fever, reaction at injection site~Measles 1 PUB UNK 1 CLINICAL MIL MIL NONE NONE 2 PVT PVT Zithromax and sinusitis Mucinexnone and diflucan prn 0 None MIL MIL None None None Severe muscle pain~Anthrax (Biothrax)~3~25~ 2 PVT UNK Zertec for allergies NONE Had allergies before vaccination UNK PVT PVT Unknown There were no concomitant A0785336A vaccinations and no relevant m 8 Discharge summary PVT included PVT LABS: None WBC 9K None segs 51%,bands None 9%, lymphs 22%. Plts 502K. Sterile pyuria. CRP Unknown OTH OTH Unknown None WAES0905USA02502 Unknown OTH OTH Unknown Unknown WAES0904USA03617 PVT PVT None None None 2 PVT PUB 2 PVT UNK none
12 PUB PUB None None None 0 PVT PUB NONE NONE NONE OR200921 0 none PVT PVT none none 2 None PVT PUB None None 0 Not reported. PVT UNK CORGARD;None Vitamins The patient had a history of diabetes, ### asthma and allergies 1 none PVT PVT ACTOS; ZOCOR; none FLONASE NIDDM; high cholesterol; multi nodular 0 Glucose finger PVTstick 73,PUB o2 Sat RA=98%, None RR=14 None BP 128/80 None HR=64 None PVT PVT TUBERSOL 0 Pulse ox, 98% PVT UNK No 1 Electrocardiogram; OTH Electrocardiogram; OTH KLONOPIN; Cardiac Drug LEXAPRO exercise hypersensitivity; Low blood pressure WAES0905USA02285 2 None PVT PVT None None None 8 PVT PVT No No No 5 CBC, in office PVT 5/26/2009 PVT (ER labs, UA/CBC, 5/23/09) diarrhea NKDA; Entopic dermatitis, 11/17/08 1 PUB UNK PVT PVT None Bananas; adhesive; Allergies only PVT UNK Autopsy by PVT Medical Examiners OTH office Keppra 0.5 None mg PO daily S/P Cardiac arrest; S/P stroke; R hemiparesis; S/P ALTE 1 PVT PUB None None None UNK UNK 1 None PVT PVT PATANOL drops; None ZYRTEC; AllergicPREVACID rhinitis; GER 0 Patient given OTH DEPO MEDROL PUB injection and steroid None doseHx pack of asthma 22 Medical records UNK from Hospital UNK included NONE(will be NONE faxed to VAERS) NONE 5/27/09-records SC0915 received- WBC 12.5. Positive mo 4 PVT UNK no no no 0 none UNK PVT SINGULAIRnone DAILY knownAllergic to dust,cats,horses and pollen/Asthma 1 PVT UNK BENADRYL PR-09-09 0 PUB PUB 13 5/29/09 Medical UNK records UNK recieved zyrtec, DOS 5/01/09 allegra NONE to 5/27/09. pecans, LABS red anddye DIAGNOSTICS: None. 10 UNK UNK N/A N/A N/A N/A~ ()~~0~Patient|N/A~ ()~~0~Sibling|N/A~ () 4 normal PVT PVT iron Iron deficiency 1 stoolcx, serial UNK abd films, UNK blodcx, electrolytes, none stool none for viral none cx 6/11/09 Medical records received LABS: CBC, CMP, 20 PVT PUB adenopathynone only, no other symptoms 5 PVT PVT none none 2 6/9/09 Medical, UNKhospital, UNK DC summary 6/9/09 received Medical, DOS hospital, 5/22/09 DCtosummary 5/23/09. received LABS and DOS DIAGNOSTICS: 5/22/09 to 5/23/09. Ultrasound Tylenol, He 0 PUB PUB None None None 1 UNK PVT Bacitracin allergy NKMC. None PVT PVT None None None PVT UNK NKDA 0 PVT UNK None None None 658 none MIL MIL flu like symptoms 6 PVT PUB None known None None 9/9/09 Rheumatology PVT consultant UNK records received NoneDOS 1/5/05 9/9/09 to Rheumatology 6/17/09. LABS consultant and DIAGNOSTICS; records received PPD DOS (-) Ches 1/5 (-) Blood, Urine PVT culture;OTH (+) stool Rotavirus test 6/2/09 ED and inpatient records received DOS 5/14/09 to 5/16/09. 0 PVT PVT Vitamin C; PREVACID; GERD; PostAllergic Multivitamin nasal drip rhinitis 2 PVT OTH None Chronic fatigue syndrome but no previous reactions to vac 1 none PVT UNK Cow's milk allergy; atopic dermatitis 1 None PVT PUB kindergarton Dx 30 November UNK 2008 to 02 UNK December XOPENEX 2008: Urine drug screen A healthy was male negative. with no Anrecent MRI with/without ### history of trauma contrast or on substan 01 D 1 PVT PVT None Lingering coughNone improving 14 X-ray of theUNK mandible was UNKunremarkable, DEPAKOTE; and serology SEROQUEL; studies The subject Metformin; for Epstein has "ZOCOR"; a Bar history virus ofSYNTHROID; and bipolar ### Bartonella disorder, PROZAC; henselae benign Simva familia were 1 None PVT PVT none None A urine drugUNK screen was UNK negative LITHIUM; and her TSH RISPERDAL; level (1.64 The CONCERTA; mcU/ml) subjectwas hasZOLOFT normal. a historySerum of bipolar ### lithium disorder, level was oppositional within thed
0 Exam: on 5/14OTH pt reluctant PUB to move None arm afterMild vaccine cold beginning +None L digits known cool. On 5/18 - normal exam. 1 PVT PVT None Asthma 0 MIL MIL E-mycin - not taken yet 0 MIL MIL BICILLIN; BENADRYL UNK UNK 0 CT; LumbarPVT puncture; PVT electrolytesNone normal No None MIL MIL Pregnancy NKDA 0 PUB PVT None Asthma; Diabetes; Hyperlipidemia; Osteoarthritis; Alcoh 1 PUB UNK None 2 PUB UNK None None 0 OTH PVT 1 None PVT PVT None None None 5 Influenza A&B, PUB5/11/09-neg; PVT Monospot, EFFEXOR 5/19/09-neg None 150mg QD Psoriasis; Arthritis; Localized PMDD reaction~Measles + Mumps + Rubell 0 None/patient PUB did not make PUBappt with RITALIN private provider. None reported. Non-known-per guardian PVT PVT None None None 11 OTH OTH ZANTAC NONE GER, DD, ASTHMA, ANISOCARIA, FEEDING DYSFUNC 20 PVT PUB Cold, runnynone nose 1 UNK PUB Well child visit None 0 MIL MIL UNK UNK 21 PUB UNK None No No UNK UNK 0 CBC Pending PVT PVT Unknown No NKDA 1 PVT PVT Known hypertension All PCN; codeine 0 PVT PUB none None None 1 UNK UNK Amoxicillin 125 Recent mg/5ml bilateral 6.4 ml Otitis TIDMedia-treated-improving; (last dose) Dermatitis 0 PVT PVT None None Amoxicillin,Hives gluten& fever x2 weeks~Measles + Mumps + R 699 PVT PVT None None None UNK UNK UNK UNK MIL MIL none none 1 UNK PVT imipramine,none Plavix, Lantus, nonemetformin, Pt reports Diovan, getting meloxicam, the smallpox mirapex, vaccine amlodipine, three di blood tests PUB - endocrinologist UNK and gynecologist, several visits to dermatologists - had cortisone shots in temples 1 CT Head/Brain UNKwithoutUNK contrast- Normal, None CBCD, None Blood Culture, Premature BMPbirth wnl. at 32 EEG-wnl. weeks gestation. 7/15/09-records Delivered received-CX by C/S s 0 none UNK PVT none none oral allergy syndrome: apples, Penicillin, allergic rhinitis/s -274 7/1/09 Consultant UNK OB-GYN UNK records 7/1/09 received Consultant DOS 5/28/09 OB-GYN 7/1/09 to 6/9/09. records Consultant LABS received OB-GYN andDOS DIAGNOSTICS: records 5/28/09 received to 6/9/09. PAP DOS test Oral(-), 5/28/09 contrac Prog 0 UNK UNK 1 PUB UNK none none 6 none PVT PUB none current, recovering was on bactrim from recurring OM prior OM,hypertrophic to rash tonisils 1 none knownMIL MIL NONE KNOWN NONE KNOWN NONE KNOWN 3 PVT UNK None None None 10 N/A MIL MIL None N/A None, member started Wellbutrin for depression but AFTE 0 PUB PUB NASONEX GRAVES DISEASE 10 PVT PVT ATENOLOL; None LIPITOR;Hypertension; NEURONTIN;Coronary CELEBREX; disease; DETROL; Neuropathy; DYAZIDE; Osteoarthrit FOSAM PVT UNK Diplopia; Astigmatism 0 CBC WBL 5.9, PVTCT-NML PVT None None None. Febrile seizure 2/2009. O2 sat-96%PUB on Room air. PVTB/P 119/57 Temp 99.0 Pulse 85 history of tick bite 3weeks prior to immunizations . Reporte 0 blood culture PVT drawn 5/22/09-neg, PVT WBC levothyroxine 14/rbcnone 4.55/hct 39.0/PLT vicodin allergy(rxn 303, neut 80/lymp unknown), 10/mono shoulder 10/eos tendonitis, 0/basothyroid 0/ aneu 3 UNK UNK None Penicillin adr 1 None PUB PVT None None Gout, Arthritis 5 N/A PVT PUB N/A none none
UNK PUB simvastatinnone and atenolol known 0 PUB PVT HTN, DM II 1 5/29/09 Medical UNK records UNK received ortho DOS 5/27/09. tri-cyclen fatigue LABS lo due and none to DIAGNOSTICS: undiagnosed condition CBC WNL. CHEM WNL. TSH WNL. 1 PUB PVT none none Fever & Rash~Measles + Mumps + Rubella (no 1 PVT PUB None None Bronchiolitis 5-15-09 0 PUB PVT none none none 1 PVT PUB None NKA 1 None PVT PVT Suprax Acute OtitisNone Media 2 PVT PVT None PVT PVT ZANTAC; REGLAN; None MARAX GERD 0 PUB PUB PPD test, skin none none 1 PUB OTH PPD SKIN TEST None None PUB PUB None 2 Blood work PVT to test for rheumatoid PVT arthritis YAZ; FIORICET; mayLACTATION havePrenatal beenMIGRAINE; performed. vitamins The A biopsy subject's A0783241A wasalcohol not done. use was social and she 1 None PUB PVT 1 None PUB PVT 1 PUB PUB fish; codeine Unknown OTH OTH Unknown Unknown WAES0905USA02514 42 Magnetic resonance, OTH negative OTH None None WAES0905USA02266 411 cervical smear, OTH05/04/09, OTH diagnosed None with high grade squamous Unknown intraepithelial lesion WAES0905USA02293 carcinoma in situ 0 Unknown OTH OTH Unknown Unknown WAES0905USA02211 112 Mammography, OTH 04/16/09, OTHabnormality Truvada; in R breast/highly Loestrin; Alcohol Kaletra use;suspicious Acquired immunodeficiency for ductal carcinoma WAES0905USA01582 syndrome in situ; Biopsy, 05/04/09, c Unknown OTH OTH Unknown Unknown WAES0904USA03943 Unknown OTH OTH Unknown unknown WAES0904USA03942 31 Serum beta-human, OTH 10/27/08, OTH positive ALBUTEROL Pregnancy NOS (LMP = 6/1/2008); WAES0810USA05176 Asthma 1 Unknown OTH OTH Levaquin; Vancomycin Pneumonia; Urinary tract infection;WAES0905USA03263 Diabetes; Hypertension; Coronary 0 urine beta-human, OTH 02/??/09, OTH Positive Pregnancy NOS (LMP = 1/1/2009)WAES0903USA01606 0 None PVT PVT Birth controlNone None 1 None PVT UNK 1 None MIL MIL None None PVT PUB 36 PVT PVT None 2 UNK UNK 1 None PVT PVT ADVAIR none Asthma, obesity 709 PVT UNK unknown unknown 0 PUB PUB none nka 2 none PUB PUB none none none SC0916 10 None MIL MIL Gout PCR positive PVT 05/19/2009 UNK unknown unknown 0 UNK PUB 8 None. PUB PUB none none none 0 PUB PUB 2 Physician did UNK blood tests UNK and looked in eyes with Noneopthalmoscope. Pt. had breast cancer 10 years ago, had bilat. mastectomy MRI C-Spine UNK & MRA Brain/brainstem UNK are normal. no 7/7/09 none. Hospital 7/7/09 records Hospital received records DOSreceived 5/11/09DOS to 5/15/09. 5/11/09LABS to 5/1 14 UNK UNK hyperlipidemia, generalized anxiety d/o 0 MRI PVT UNK 1 PVT PUB none none none Rapid strepPVT DNA UNK 2 History of asthma PVT PVT lipitor, advair, none flonase, seasonal prilosec allergies, dust and pet dander allergies 0 None PVT PUB None None None 0 none PVT PUB Poly-Vi-Flornone 31 week premie
0 PVT PVT None None 0 PVT PUB None None 0 None PVT PVT None Physical Exam No known allergies, Has Breast cyst & osteopenia. 0 OTH OTH Low-ogestrel Possible URI none 0 PVT PVT PREVACID; OLOVAT 1 PUB UNK 47 PVT PUB 7/31/09 Medical MIL records MIL received denies DOS 6/13/06 Viral to 2/27/09. illness7/31/09 LABSMedical and DIAGNOSTICS: records received Pulmonary DOS 6/13/06 function to 2/27/09. tests - M 406 Clinical Observation PVT PUB None Unknown None 21 PVT PVT None 0 None PVT PVT FLONASE; None XYZAL; VENTOLLIN No 1 none PVT PVT none stepped on prior nail; history neededofTd local booster reaction to Td, no systemic reaction hi 24 None. 6/2/09 OTH Medical records OTH received Adderall DOS tablets; 2/13/09 Hormonal to 5/27/09. Nonecontraceptives. 6/2/09 LABSMedical and Diagnostics: 6/2/09 records WAES0905USA03370 Medical received Pending records DOS - CBC, received 2/13/09 monospot toDOS 5/2 209 Unknown OTH OTH COMBIVENT; Hypertension; OS-CAL;Heart PLAVIX; Diabetes; attack fentanyl; Cancer LASIX; WAES0905USA03234 insulin; IMDUR; metoprolol; FL 9 Unknown OTH OTH Unknown Unknown WAES0905USA03404 0 OTH OTH No other medications Unknown MA20091372 1 None PVT PVT PRAVASTATIN; None NEXIUM; History LEXAPRO of Penicillin allergy 2 PVT PUB None 0 PUB PUB No None None AR0917 1 PUB PUB None ear infectionNone un-dx AR0918 1 None PVT PVT Fluoride None None 0 BP 94/60; PPUB 72; PERRLA, PUBresponsive Noneafter about None1 minute denies 2 None MIL MIL No No No 3 PVT PVT 0 PVT PVT 0 PVT MIL 2 UNK PUB None 0 PVT PVT None 1 none MIL MIL zyrtec; albuterol; no flovent asthma; seasaonal allergies 1 None. PUB PVT None. None. None. NKD/FA 0 PVT PVT None MIL MIL 1 UNK PVT 0 STREP TEST PVTAND CBC PVT PERFORMED TYLENOL TODAY Temp 102,vomiting,uri~ ()~NULL~1~In Patient 1 None UNK PVT Flonase nasal None spray and History allergy of eye left brachial drops plexus injury at birth, Seasonal aller 0 PUB PUB none none none n/a~ ()~NULL~~In Patient UNK UNK NONE s/p Renal transplant 5/4/2007 7 None PVT PVT Throid medication/Vitamins None reported Allergy to "Floxin" None reported~ (muscle spasms) ()~NULL~~In & allergy Patient to "Sulfa" (hiv 1 WBCs 14.3.UNK Labs: WBCs UNK14.3. Hgb 10.1. UA hospitalized with tracenone. blood. for perforated PMH: bloodHTN. and viscus Urine diverticulosis.hyperglycemia. cx (-). s/p intesti 3 PUB PUB None None Nothing in last 10 years.Did use inhaler in youth for a few y 0 n/a PVT PVT none allergy to diflucan 1 PVT PVT Yasmin None 32 UNK UNK Cold and cough. Autism PMH: LostColic language & irritable and in potty infancy. training~Polio Multiple ear Virus, infec O 12 None at thisPVT point PVT BP med and none DM med from DM2the (notPhillipines compliant), htn; no known allergies 26 PVT PVT None None Strabisme 0 None PVT PVT none none Sensitivity to sunscreens, skin rash 0 None PVT PVT Slight papular None rash. OTH PVT 1 PVT PVT A-FIB; HTN; Asthma; Allergies. 2 PUB PVT None None 1 PVT UNK None S/P MV repair 12/28
0 None PUB PUB None None Egg intolerance; VICODIN reaction 0 PUB PUB Birth controlNone pills None Known felt faint~Hep B (no brand name)~UN~0~Patien 0 PVT PVT 10 FebruaryOTH 2005: MRI OTH of the Brain with andUnknown without Contrast: Partially empty A0785349A sella. Right frontal venous angioma 0 None available PUBat this time. OTH Patient's ppdMD (skin requested test) none 12/04/07 listed that patient sinus left forearm. allergies. have an6/8/09 6/8/09 MRI done, Medical Medical however, records records itreceived has received not been 3/27/08 3/27/08 done. toto5 3 PVT PVT Milk thistle None 1 PVT PVT none none 0 None PVT PVT No No No 3 OTH PVT none none 0 MIL MIL 0 OTH UNK Resolving upper resp infection. Taking abuterol. 3 Rotavirus antigen PVT detected PUB in stool 5/27 None Staphlococcal impetigo in diaper area at 2 w.o. - resolved. 0 PVT PVT UNK PUB PUB Unknown There were no concomitant A0780868A medications, relevant medical UNK PUB PUB There wereUnknown no concomitant Theremedications. were no concomitant A0780875A medications, relevant medical UNK PUB PUB Unknown There were no concomittant A0780876A medications, relevant medica UNK PUB PUB Unknown There were no concomitant A0780877A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780878A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780879A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780880A medications, relevant medical 0 UNK PVT PVT Unknown The subject had no relevant A0782620A medical history, and had expe UNK OTH OTH Unknown A0784358A 1 Unk OTH OTH Unknown There were no concomitant A0785071A medications. UNK UNK UNK Unknown A0785075A 3 PUB PUB none none 0 UNK PVT None - Hip None replacement Surgery 5 weeks ago 1 PVT UNK MultivitaminNone with Fluoride None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 None PVT PVT None None None 2 6/15/09 Received UNK PCPUNK medical records LABS: none, CXRnever done sick 5/10inWNL. her life Bronchoscopy up until the vaccines w/mucous plug; echocardiogr 12 UNK UNK none none none 1 PVT PVT No PVT OTH Allergies-penicillin and Relpax - migraine, IFG, PMDs 0 None PUB PUB None None None Known, KNA 2 PUB PUB NONE 6 PVT UNK Orapzed; Omnicef; Pneumonia Zithromax 11 PUB PUB none stated OR200922 0 None PVT PVT Levoxyl; VitNone D Hypo-thyroid 2 PVT UNK No Sulfer / decongestants 1 No labs done. PVT UNK URI (Cold sx) Eczema 1 CBC, WNL;PVT U/A, WNL;OTH Basic chemistry, TYLENOL WNLgiven Healthy None 0 None OTH PUB Tramaedol;None Seroquel; Levothyroxine Mild heart murmur; Migraines 0 PVT PVT 1 UNK UNK NONE- physical exam 0 PUB PUB No Unknown OTH OTH Unknown Unknown WAES0905USA03626 0 Unknown UNK UNK Unknown Unknown WAES0905USA03333 1 PUB OTH None None Allergic to sulfur; Based LA090505 antibiotics and Neomycin Unknown UNK UNK Unknown Unknown WAES0905USA03323 0 Received 2nd PUB DEPO PROVERA PUB prior DEPO to Immunization PROVERA LA090504 2 PUB PUB None None AR0918 1 PVT PUB None
5 None PVT UNK Atenolol 50None mg, Potassium Allergic:Sufa. Chloride Hx 20 mg, diabetes, Enalapr/HCTX High Blood 10-25 Pressure, mg, Diclofenac tachycard 0 none PVT UNK none none none 0 N/A PVT PUB n/a n/a n/a 4 heme positive UNK stool, positive UNK barium none enema 6/2/09 none ER records Reactive received airway DOS disease 4/3/09. and LABS eczema and DIAGNOSTICS: C 0 PVT PUB n/ n/a n/a 0 UNKNOWNUNK UNK NONE KNOWN NONE KNOWN 10 N/A PVT UNK none none none 1 PVT UNK none none none 3 See above.UNK 6/11/09 Neurology UNK records received DOS 3/10/09 febriletoseizure 5/18/09. at LABS 14 mos. and DIAGNOSTICS: CHEM - Biliru 1 5/28 CBC done-WBC's UNK UNK 11.3 , elevated On insulin bloodpump glucose, ketones Diabetes in urine. Mellitus. 7/7/09 PMH: Hospital Diabetes records Typereceived I. Persistant DOShyper 6/1/0 UNK UNK 0 PUB UNK D5W1/2NS,Diverticulitis Pregabalin, Tramadol, Zofran, Ciprofloxacin, Heparin 1 PUB PVT Headache,fever, stomach ache~Meningococca 1 none completed PUB PVT none none Headache, fever, stomache ache, and injection 1 PUB UNK LEVOTHYROXINE NONE 100NONE MCG ONCE Sore DAILY arm with prior tetanus~Tetanus Toxoid, ad 0 PVT PUB PRESCRIBED NONE ON 5/27/09 INGUINAL CEPHALEXIN, HERNIA, AND W/O HYDROXYZINE MENTION OF OBSTRUCTION 1 CT of Head,UNK EEG bothUNK normal. 6/29/09 Hospital records received DOS 5/19/09 to 5/21/09. LABS and DIAGNOSTIC 0 none PVT PVT Benadryl N/A NONE KNOWN 0 FS glucose:UNK 97 UNK 8 Derm Consult MIL MIL PPD Sanofi Pasteur C3149AA None Known Lt Forearm yearly 5/7/09 None PVT PUB None None 1 PVT PUB none none none 0 PVT UNK None, Dr Appointment PVT PVT None Heart murmur resolved 6/02 (perimembranes VSD) 1 None PVT UNK None None None 0 MIL MIL GABAPENTIN None for DDDDDD shoulder and neck 4 PUB PVT none Anti-inflam Drugs GA09019 0 PUB OTH None GA09018 0 PUB PVT None None Allergy to Codeine; Latex GA09017 sensitive 0 PUB PUB None No GA0R016 0 None PUB PUB None No NKDA, HX pneumonia GA09015 2 weeks earlier 2 Seen in ERPUB PUB None GA09012 1 EEG: 5/22/09, PVTirregularUNK diffuse spikes, polyspikes, No generalized Near-syncope synchronized episodes. spikes PMH: suggestive Allergyof togeneralized Amoxicillin seizu 367 Labs and diagnotics: MIL Vocal MIL cord bx (+) for CA PMH: Chronic sinusitis. Allergy to PCN. dematophytosis. G 21 7/13/09 Hospital MIL DC summary UNK received AUGMENTIN DOS None 4/15/09 ESknown 600 to 4/22/09. N on one 4-6-09 Known. LABS .7 ml 7/13/09 and twice DIAGNOSTICS: aHospital day for records 8 d CT received Head - abnormal, DOS 3/22 14 Urine samples; PVTSurgeryOTH to insert shunt; see other MRI's; side No Spinal tap;ankylosing Plasma Phoresis; spondylitis; blood-work. neuropathy; 6/22/09 hypertension. Hospital records 6/22/09 D 1 Lumbar puncture; PVT blood PUB cultures; negative None workup Mild non-bloody including None EEG diarrhea. and MRI. 6/22/09 6/22/09 Medical Medical records records DC summary DC summary receir 9 KUB dose at PVT office/air enema PUB at medical RANITIDINE center None 6/3/09 6/3/09Hospital Hospital Gastroesophageal records recordsreceived received Reflux DOS DOS Disease 5/22/09. 5/22/09.Reglan, LABS and Zantac. DIAGNO OTH OTH 1 PVT PUB None Hashimotos; UTI's; Add-on Adderall 102 PVT PVT No No No 0 Negative PVT PVT SPIRONOLACTONE; None Menclopramide DIAZEPAN; LIPITOR; HCL + Sulfa LASIX; allergies GLUCOPHAGE; LISINOP 0 PVT PVT None Epstein Barr; Hx of Hypothyroidism, Allergy to Morphine T 11 None OTH OTH None None None 7 Culture of fluid PVTfrom furuncle OTH --> MRSA 0 MIL MIL None None Atrial septal defect Referred toPVT derm as PMD PUBnot sureNone this is an INj None reaction None 0 None. 6/9/09 UNK Hospital UNK records received DOS 5/21/09. LABS Noneand DIAGNOSTICS: WAES0905USA03247 CHEM - Sodium 143 mml/L (H) C UNK UNK Lantus; Dhea; Glucosamine Patientsulfate; had history Gymnema of Type sylvester; II Diabetes, ### HMFHashimoto's PWD; EPA-DHA thyroie 0 None PUB PUB None Rash - eczema None 1 PVT UNK
PUB PVT pt had a laceration ID09012 2 OTH PVT None Smoker, Hx of bronchitis ID09011 1 PUB PUB -Inhaler PRN; No -Nebulizing NKA; TxHistory PRN of Asthma ID09010 0 PVT PVT 0 PVT PUB No PVT PVT ESTRACE;No CLINORIL; - AnnualQuinidine SYNTHROID; Exam MAXZIDE; ZESTRIL; ASA 716 PVT PVT AMOXICILLAN Resolving otitis No media 1 PVT PVT 221 PVT PVT UNK UNK 1 Physical Exam PVT PVT 1 PUB PVT 3 MRI brain nlPVT 1/8/09, Awake PUB and drowsy EEG nl 1/13/09 35 week twin gestation, IUGR, h/o maternal chlamydia and 22 None PVT PUB 35 week twin Asgestation, above~Varicella IUGR, maternal (Varivax)~0~1~In chlamydia Sibling2| and tob 0 none MIL MIL synthroid 100mcg none dailyna 0 unknown UNK UNK none notedPMH: fainting w/immunizations. Acne on doxycycline. Alle 372 Currently undergoing UNK numerous UNK neurological none testing: CT none scan, PMH: MRI, MRS, anemia. muscle Family testing. hx: early LABS: death MRIsecondary brain, EKG, to 0 None PUB PVT Birth Control,Meds On Job injury 6-01-09 None 5-26-09 Nasal Abrasion spray,Omeprazole of the forehead(910.0) 40 mg,Triamterenl 37.5-25 1 PUB PUB none listed none listed PVT UNK none none 10 air contrast UNK enema. 7/14/09 UNK Hospital records received none DOS none 5/25/09 to 5/26/09. LABS and DIAGNOSTICS: Abdomi 6 PUB PVT Client is on None INH 300 mg NKDA. PO QD Anemia. and B6Latent 25 mgTB POInfection QD for LTBI 1 PUB PUB 1 PUB PUB albuterol, pulmicort None notedDevelopmental Delay, strabismus, microtrigonocephaly, st 7 NONE PVT PUB NONE NONE NONE 1 NONE PUB PUB NONE NONE NKDA/NONE 1 7/21/09 ERUNK records received UNK DOS 6/2/09. LABS None and DIAGNOSTICS: None Neutrophils 89.4% (H) Lymphocytes 4.8% (L 0 UNK PVT PVT Unknown There were no concomitant A0787216A medications. The subject had 1 EEG - waiting PVT for results. PUB6/12/09 Hospital records None and DC None. summary 6/12/09received HospitalDOS records 5/19/09 and to DC5/20/09. summary LABS received and 0 EKG per MD PVT order PUB Ibuprofen for cramps monthly prn PVT PVT None 2 None PVT UNK None None 1 None PUB PUB SYNTHROID; No CONCERTA thyroid condition; Attention deficit disorder 1 None PVT PVT None None 2 None PVT PVT None None 10 none PVT PVT TYLENOL none none 3294 PVT PVT 3 PVT PVT BENADRYL prn Asthma 0 PUB PVT None None 0 OTH PVT None None None 1 None PVT PVT None None None 0 OTH UNK LEXAPRO,none 10mg, qd none 2 PVT UNK Allergic to Varicella upper respiratory~Varicella (no brand name)~1 1 PVT PVT NONE 9 PUB PUB UNITHROID; NoRAMIPRIL; PCN; Metoprolol; Sulfa; Caffeine; HCTZ ASA 3 OTH OTH PVT PVT 1 Rapid strepPVT (-); Throat PVT Cx sent, (-)None None None 9 OTH OTH None None None 0 PUB UNK None PCN; No birth defects or medical condition. 9 PUB UNK None None
1 Unknown PUB OTH 0 PUB PUB None None None 1 PUB PUB 1 PUB PUB None None None/NKA 3 none yet PUB PVT None None NC09022 1 PVT PVT LOTAGEN;None KEFLEX; PAXIL; DM; CKD; PRILOSEC; HTN; COPD; Elavil; PVD; DITROPAN; Hyperlipidemia; ASA anemia; GE 9 PVT UNK None Heart murmur Temp 105-06~Pertussis (no brand name)~1~0~ 0 OTH UNK Unknown Unknown Unknown 1 None PVT PVT None None Septra --> rash 1 None PVT OTH KCL; FOSAMAX; upper respiratory ALLOPURINOL; HTN infection SYNTHROID; Vitro; TOPROL; HCTZ; glucosa 0 None PVT PVT None None None 0 PUB PVT None None 1 CBC 11.9 11.3 PVT35.1 249 PVT L 3.4 G 7.4 FLOURIDE; ZYRTEC 11 PVT PVT 1 Diminished PVT grip tilt test-PVT autonomicAmoxil nerve 800mg damage Strepsweat throatN testoneautonomic nerve damage. 1 None PVT PVT None None 2 PVT PVT Been seen None for needle Known stick Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0905USA03655 Unknown OTH OTH Unknown Unknown WAES0905USA04021 0 Febrile seziure UNK UNK NA Presented to NAclinic with out moderate to severe illness, low grade feve 0 CLINICAL MIL MIL NONE NONE NONE 1 UNK PVT YAZ oral contraceptive none all - penicillin, sulfa 0 PUB PUB none none none rash~DTaP (Infanrix)~5~5~In Patient 11 25 May 2009 MIL 1411, Serum: MIL Troponin Possibly I Cardiac Doxycycline Unknown 3.31 (H*)(Rx Shin ng/mL; written splints; Creatine onTobacco 5/14/09 Kinase for Use; MB predeployment) NKA. 29.407/10/09 ng/mL;Hospital Myoglobin outpatie 109.3 327 MRI spine w/o UNKcontrastUNK 3/10/09; Angio DESOGEN; Arch Cervicocerebral Clindamycin 3/18/09; Angio Carotid External Bilateral 3/18/09 273 EKG; Echo UNK cardiogram; UNK Blood work; notChest known. x ray, Achilles 8/4/09 done PCP tendinitis. with My medical nothing daughter records notable was received a seen; healthy Blood DOS teenwork 8/20/08 female forwith to thyroid 10/25/08. stable levels weight Etod wer 1 PUB PUB Dm Type 2, UTI CBC, UA, Chemistries OTH PUB - see attached. None None None found 11 None PUB PUB None None Asthma; Allergies - dogs 3 UNK UNK None None 0 None PVT PVT None None 0 6/9/09 Medical UNKrecordsUNK received DOS 6/9/09 5/18/09 Medical to 5/20/09. records6/9/09 received LABSMedical and DOS DIAGNOSTICS: records 5/18/09 received to 5/20/09. Urine DOS -Tylenol blood 5/18/09 (+) CBC to 5/20/09. - Lymp 1 Child also had UNKtuberculin/PPD UNK implanted no known in right no known foream. no Lotknown # C2907BA 0 CT Scan ofPVT head...normal PVT Bloodwork/lytes...normal none none Post-concussion 7 PVT PVT Seasonal allergies, mild asthma 1 UNK UNK N/A N/A 0 PVT PVT 1 UNK UNK BrOnchitis Patient informed technician administering the anthrax vacc 1 PVT PVT none none none 0 PVT PUB none none none UNK UNK 568 6/15/09 Oncology UNK records UNKreceived DOS 12/23/08 to 5/5/09. 6/19/09 LABS PMH andrecords DIAGNOSTICS: received. PMH: CT Scan Appy, - paratracheal, ankle fx, ovar p 1 PVT PVT BENADRYL; None SOLUMEDROL; Seasonal Prednisone allergies 1 PVT PVT 0 PUB PUB None notedNo known illness None noted on screening questionnaire 6 PUB PUB BP Meds None Hypertension None at thisPVT time. UNK None None 1 PVT OTH Triamcinolone; Rhinitis NASONEX None rash~Measles + Mumps + Rubella (MMR II)~2~ 0 PUB PUB None NKA / No Related 1 None PVT PVT None None Allergy to Amoxicillin ant Erythromycin 2 Unkn PVT PUB None None None swollen arm~ ()~~0~Patient
0 Cultures (viral PVT & bacterial) PVTat sores pending Left arm pain 11 Unknown PUB PUB Unknown/None None None listed in PCHD records or chirp registry 0 None PUB PVT None None 1 PVT PVT None fever~Measles (no brand name)~0~1~In Patien 0 PVT PVT none had transvesmylitis- attacked the nerves in her rt leg 10/04 1 PUB PUB NONE NONE KNOWN NONE KNOWN NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 0 None PVT PVT ZYRTEC; MIRALAX; Diarrhea xAXID; 2AUGMENTIN; -dayFluoride before shot dairy; wheat; soy; egg; peanut; banana; ecz Unknown OTH OTH Unknown Unknown WAES0905USA04048 3 stool rotavirus OTH antigen,OTH positive Unknown Unknown WAES0906USA00249 0 Unknown PVT PVT Unknown Unknown WAES0904USA03633 58 Unknown OTH OTH Unknown Unknown WAES0906USA00042 2 None PVT PVT Flovent, Albuterol None Known inhaler Asthma 4743 PVT UNK None None 0 CBC PUB OTH Ibuprofen None None 0 PVT UNK NO NO 840 PVT PVT Albuterol Pulmicort No > Nebs. Asthma 1 Possible Rxn PVT to Menactra PUBvaccine PUB OTH 1 PVT PUB 0 None UNK UNK None Spinal fusion for scoliosis at 11 yrs old 77 PUB UNK None None None 1 PUB PUB None None 1 None PVT UNK None None 1 PVT PVT Fosamax, calcium none none 20 exstensive PVT list UNK none none PN~Lyme (LYMErix)~2~38~In Patient 1 None PVT PUB None 3mm splinter None in right hand; removed at office visit. No erythema or str 0 TO EMERGENCY UNK ROOM UNKFOR EVALUATION. NONE 23 HOURACNE, OBSERVATION BACK-MILD IN HOSPITAL, CONCUSSION.CT HEA 1 ROS : ALSO PUB LL CRAMPS PUB EXAMFexofenadine/Glucometer/Atorvastatin/Atenolol/Oxaprozin : WD, WN, WM T 97, AllergyP 65, RR Sulfa 16, BP Drugs 118/71 Medical RIGHT conditions: ARM : AREA Diabetes/Hyperte OF REDNE 5 NONE PUB UNK UNKNOWNNONE PATIENT STATES THAT SHE HAS DIABETES 0 PUB PVT NO NO 1213 PVT PUB none none, this was N/Ayears after varicella~Varicella vaccine (Varivax)~2~4~In Patient 1 None UNK UNK ALBUTEROL nose SULFATE bleed CROUP (evening (2.5 MG/3ML) [464.4] - day before POSTCONCUSSION 0.083% appointment IN NEBU; and FEXOFENADINE SYNDROME morning - day [310.2 HCL of a 2 PVT PUB none none 1 none PVT PVT none none none 6 Shingles UNK PVT allegra, nexium, none trazadone none except hay fever type allergies 0 Medical Center UNKdid lab UNK work and CT unknown scan, perNone parent known unknown None of. known results.of.Medical Parent records advisesstate no previous LABS: CT adverse head signs WNL 3 Between 4/24/09 UNK and 6/4/09 UNK she received Zyrtec and approx red Fluoride rash 8 CTtoscans, none neck and 1 CTA, trunk none~ 1 CT()~~0~Patient|none~ angiogram, 1 cerebral ()~~0~Sibling|none angiogram, 1 MR 0 Normal EEG PVT and Echocardiogram PVT None None None - local reaction to bee stings 1 None PVT UNK None None 10 PVT PVT None None None 1 PVT PVT Nuvaring None None 0 PVT PVT 0 On steroidsUNK and BENADRYL UNK none NKDA ~ ()~~4~Patient 1 None PVT PVT None None None 25 PUB PVT No 3 PVT PVT 1 PVT PUB Allergies to Rocephin insect bites Ceftriaxone eyes swollen 0 OTH PVT None None None 0 OTH OTH Unk No Unk seizure~Hep B (no brand name)~UN~0~Patien 0 PVT UNK None 10 UNK OTH OTH Loratadine Unknown Poison Ivy; The subject A0784219A had consumed tuna fish and wore
1 UNK PVT PVT Atenolol Unknown CARDIAC ARRHYTHMIA A0785145A 1 UNK UNK None None 0 PUB PUB VYANESE,No VANTEX Asthbergers, Asthma, food (milk, soy, peanut, wheat, corn 2 PVT PVT None None An immunology OTH screenOTH performed by a pulmonologist UnknownonThe an unspecified subject haddate some prior A0718745A upper to the respiratory 5th dosecongestion of INFANRIX thatsho be UNK OTH OTH Concurrent Unknown medications Pertinent were unspecified. medical history A0721690A was unspecified. 1 UNK PVT PVT Haemophilus Unknown Influenzae This + event occurred in A0722975A four different subjects. The reporter 0 UNK PVT PVT Unknown This event occurred in A0722979A four different subjects. The reporter Unk OTH OTH Unknown This event occurred in A0722980A four different subjects. The reporter UNK OTH OTH Unknown This event occurred in A0722981A four different subjects. The reporter 2 UNK PVT PUB Unknown Concurrent medications A0723483A and relevant medical history were UNK PVT PVT Unknown Concomitant medications A0725470A and relevant medical history was UNK PVT PVT Unknown Concomitant medications A0725480A and relevant medical history was 1 UNK PVT PVT Unknown No concomitant medications A0726359A or relevant medically history. 1 UNK PVT PVT Unknown The subject was born at A0729267A 39 weeks gestation. The newborn UNK PVT OTH Unknown A0730297A UNK PVT OTH Unknown A0740764A UNK OTH OTH Unknown A0740770A 1 UNK PVT OTH No concurrent Unknown medication Following vaccination with A0742478A PEDIARIX in April 2004, the su UNK OTH OTH Unknown A0744175A UNK PVT PVT Unknown A0744483A 0 UNK PVT PVT Unknown The subject had no medical A0745500A history, nor any history of adve 0 UNK PVT PVT Season trival Unknown Influ Dresd; TheParacetamol subject had no medical A0745514A history, nor any history of adve 2 UNK PVT PVT Season trival ALLERGIES, Influ Dresd The ECZEMA subject had a history A0745523A of allergies (unspecified) and ecz UNK OTH OTH Unknown A0746380A UNK PVT OTH Unknown A0746407A UNK PVT PVT Unknown A0746417A UNK PVT PVT Unknown A0746425A UNK PVT PVT Unknown A0746426A UNK PVT PVT Unknown A0746427A 0 UDS (-); 140/5.4 PVT / 110/19 PUB / 12/0.2;PULMICORT; 98 6/8/09Middle Hospital Albuterol; earrecords effusion Follow Amoxicillin; received up and otitis RAD ZYRTEC. media. DOS 5/14/09. 6/22/09 6/8/09LABS: Hospital Finger records Stickreceived GlucoseD 6 head CT c/w PVT small R. frontal PVT ICH. Vancomycin/Ceftazidime/FLAGYL/Ampicillin/Acyclovir On labs, WBC None 9.2 on admission, BPH, intra-cranial LFTs, electrolytes hemorrhageWNL, 10yrsCSF ago(5/26) (on antibio Seen on ultra UNK sound before UNK birth seen received laboratory 3rd injection had labs when During done 2 pregnancy weeks found no preg genetic no didother not defect/instructed know medication about or pregnancy vaccine to register given/re at this on thti 5 Parent reports PUBno lab work UNKwas done. None Denies any pre existing conditions. 1 PUB PUB None None 0 None PVT PUB None None 1 PVT PVT None 0 UA; UOS; CT PVT head/brain PUB w/o contrast, Trinessa Chest 28d None Birth Control None 779 PVT PVT 2 PVT OTH None 1 None PVT UNK None None 0 PVT PVT Tylenol No No 1 OTH PVT Pen; Morphine allergy 1 OTH OTH None None None 0 PVT PVT None None Unknown OTH OTH Unknown Bechet's Syndrome Colitis WAES0906USA00244 Unknown OTH OTH Unknown Unknown WAES0905USA04140 Unknown OTH OTH Unknown Unknown WAES0906USA00013 electrocardiogram, OTH longOTH QT interval Unknown Unknown WAES0905USA03885 9 None performed OTH Pt. never PVTfelt thatLORATIDINE he requiredNo being seen Noby a physician. 1 None PVT PVT None None
1 Exam 0 10 None 1 None
PVT PUB None None None UNK UNK 7/13/09 Hospital ER records NKDA;received Non smoker; DOS No 5/13/09. chronic Shot conditions; of "Depo". Father states s PVT PVT None None PUB UNK None None UNK UNK 1 PVT PVT CLARITIN; None SINGULAIR; Allergies WELLBUTERON; general, asthma VENTALIN INHALER 7 Labs done by PVT children'sPVT hospital ERNone normal None Allergic AMOXIL None OTH PUB Fluoride pills - daily 0 PUB PVT CELEXA 20None mg/ day; - Travel MELOXICAM vaccination15 mg/ day X 1 0 PVT UNK None 0 None PVT PVT None None UNK PVT PVT Unknown A0746428A UNK PVT PVT Unknown A0746429A UNK PVT PVT Unknown A0746430A UNK PVT PVT Unknown A0747164A UNK PVT PVT Unknown A0747167A was one ofA0747167A four cases reported by the same h UNK PVT PVT Unknown A0747168A was one ofA0747168A four cases reported by the same h UNK PVT PVT Unknown A0747169A was one ofA0747169A four cases reported by the same h 1 UNK PUB PUB Poly-Vi-FlorAllergic (Sodium Rhinitis salt+;Fluoride The subject has salt;aVitamin history A0749667A of E+; seasonal Vitamin allergies A; Ascorbic andacid no hist +; P UNK PVT PUB Unknown The subject had no medical A0750362A history and no history of adver UNK PVT PVT Unknown A0752555A was one ofA0752555A five cases reported by the same h 0 UNK OTH OTH Unknown No concomitant medications A0763451A or relevant medical history we Electroencephalogram, OTH OTH 11Mar2009, NoNormal concurrent Unknown medication The subject had no relevant A0769820A medical history or allergies. UNK OTH OTH Unknown A0770288A UNK PUB OTH Unknown Linked cases include A0772416A A0772419Aand A0772420A UNK PUB OTH Unknown Linked cases include A0772416A A0772420Aand A0772419A. 0 UNK PVT PUB No concurrent Unknown medication. The subject has no relevant A0774207A medical history and no history 1 PVT PUB 1 no tests MIL MIL Rx for: Cymbalta None 60mg, Err:508 Concerta Severe 18mg, Acyclovir, reaction (Similar Claratin, asFloNase above; no medical 2 PUB PUB 400 mg augmentin none 3x anone day 1 Ultra soundUNK of legs to rule UNKout blood Lovstatin clot. Contact 20mg/day; NoneDr. for Tarka Elevated test 2/240 resultLipids mg/day and record @ 210ofand office intermittent visit. cardiac arrhythmia 0 none PVT PUB NONE no 0 pending with PUB pmd PUB nothing perno MOC per mocnothing per MOC 3 None PVT PVT Flonase None Allergic rhinitis 0 UNK UNK Acutane, OCP None 1 work up in progress. UNK (Blood UNK cultures, Metoprolol, Urine cultures, Syncope HyzaarCXR). PMH: Rule HTN. out other sources of infxn Labs and Diagnostics: 8 UNK UNK HAD JUST JUST FINISHED FINISHED TUBES ZITHROMAX TXINFOR EARS FOR EAREAR INFECTION. ND0905 INFECTION (TUBES RECENTLY PU 6 7/24/09 Hospital UNK records UNK received DOS 4/9/09 to 4/27/09.7/24/09 LABS and Hospital DIAGNOSTICS: records received Abdominal DOS 4/9/09 X-ray -toPossible 4/27/09.In 1 none PVT MIL none sulfa drugs 0 none PUB PUB None known none 0 N/A PVT UNK 6 none PVT PUB None None None 0 CT of head,UNK CXR. EEG UNK results not available.Mom reports PCN had ear infection and medication was antibiotic was stop 506 STOOL STUDIES: PVT POSITIVE PVT ROTAVIRUS ROTATEQ NONE ALL 3 DOSES NONRECEIVED 9/2/2008, 11/14/2008, 01/05/2009 4 MRI UNK UNK none n/a migraine headaches 1 PUB UNK Vomiting, head aches, body aches, dizziness, b 13 none UNK PUB none none NKA, no history of birth defects or medical conditions 1 UNK UNK 0 UNK PVT Benadryl 2.5 ml po x1 0 PUB UNK 0 UNK PVT none none none
0 NONE PUB PUB NONE NONE NONE 0 PVT PUB 1 PUB PUB Unknown Not applicable Unknown 3 NONE PVT PUB TYLENOL NONE 0.4 GIVEN NONE 0 PVT PUB 2 UNK UNK Right Otitis None Media 0 UNK UNK PNC 1 None PVT UNK None None Overweight 1 PVT PUB Cough; URINone 2 PVT PUB 1 PVT OTH Cellulitis~ ()~~0~Sibling 3 PVT UNK Well 2 PVT UNK Well 0 UNK PVT PVT TRIAMTERENE; Unknown MAXIDE; The subject MULTIVITAMIN had not experienced A0788374Aadverse events following 1 PUB PUB None None UNK PVT OTH LISINOPRIL; Chronic Warfarin obstructive Allergy sodium; topulmonary CEFPODOXIME; Diltiazem disease hydrochloride A0788583A Allergy to CIPRO; Allergy to S 1 PVT UNK none 1 PVT UNK Started OMNICEF Sinusitisnight of 6/3/09 only had one dose 2 PVT PUB CBC - CXRUNK Normal; B/Cx; UNK U/A -UCX pending. None RAD - cough 1 None PVT PUB 2 Blood work PVT 5/23/09 - result PVT = low WBC SINGULAIR presently. None for asthmaAsthma 10 MIL MIL None None 2 Contrast enema PVT 6/16/09 PVT Medical none records LABS: viralBE exanthem, diagnosed noneprobable IS but unable Fifth disease to reduce. 1 PVT PVT None Seasonal allergies 0 PVT PVT Flovart HFAAcute pharangitis ALL: Amoxil, sulfa/acne, migraines, GERD; IBS; asthma 1 none PVT PUB 1 OTH OTH Sulfa, PCN Asthma 0 None PVT OTH None None Denies 0 None PVT UNK None None 0 Normal things UNK like, Temp, UNKpulse, BP and then blood workLow wasBlood done.pressure 1 PVT UNK allergic to molds, pollens, etc. 0 MIL MIL NO MEDS SYNCOPE NONE NONE~ ()~NULL~~In Patient 1 Normal CBC; PVT P.T. & PTT PVT None None 1 Colonoscopy MIL from previous MIL eventsZoloft, concluded Triglide, No noillness abnormal Multi-vitamin Light events seasonal (some Rectal allergies. hemrroidal Bleeding~Anthrax tissue) (Biothrax)~3~3~In Pa 0 UNK UNK reflux meds...reglan, not sick...just zantac none reflux 8/24/09 exsema, Medical hyperactivity~Pneumo records received PMH: (noGERD, brand nam URI 9 EmergencyUNK room records UNK from 10-19-07. none Pddnos No diganose. unknown 5-8-09.Rash~Hep Labs and diagnostics: B (no brand name)~UN~0~Patient audiology exam WNL. 0 None. 6/9/09 UNK Medical records UNK received ZyrtecDOS & Tylenol 6/1//09 Patient prn 6/3/09. hadNone seasonal LABS and allergies DIAGNOSTICS & a scratchy - None. throat. 13 9/10/09 LABS MILand DIAGNOSTICS MIL None only - received DOS 6/1/04 to 4/24/06. PT 45.9 sec (H). PTT 44.9 (H). INR 1.8 ( 0 OTH PVT Sulfa drugs; hay fever 1 PUB OTH None None 0 OTH OTH EFFEXOR None X; MOTRIN; Closed NEURONTIN; head injury; TYLENOL Allergic to erythromycin. 1 PUB UNK None None MI2009004 1 UNK UNK None None None OR200923 0 PVT PUB No None AR0920 0 None PVT PVT None None Overweight 11 PUB UNK None None Reflux (Gastric) "seizure MI2009005 disorder) 0 PUB PUB No No 0 None OTH OTH Yaz Convulsion WAES0906USA00554 0 PUB PUB NO NO 0 Unknown. 7/23/09 OTH Hospital OTH records Unknown received DOS 6/25/08 Unknown. to to 4/18/09. 6/12/09 LABS Medical WAES0906USA00298 and DIAGNOSTICS: records receivedUrinalysis DOS 2/7/08. - Clo H
2 NONE PVT PUB NONE NONE Unknown OTH OTH Unknown Unknown WAES0906USA00048 Unknown OTH OTH Unknown None WAES0906USA00056 0 Unknown OTH OTH Unknown Unknown WAES0906USA00039 1 None PVT UNK Mild URI sxNone 8 PVT PUB 1 None PUB PUB None None Allergy to; Pertussis, PENICILLIN, IA090006 AMOXICILLIN 1 None UNK UNK None None 1 PUB UNK None none none AL0909 0 MIL MIL Tricor, Lisinopril, none HCTZ, Hypertension, Fish oil, multivitamin High triglycerides Aventis Pasteur 4 6/10/09 ERUNK records received UNK DOSMicroGestin 6/6/09. LABS None B120 andbirth DIAGNOSTICS Penicillin. control 6/10/09 - None ER records received DOS 6/6/09. Melan 18 none MIL MIL none no no 0 9/14/09 Hospital UNK records UNK received DOS 5/15/09 9/14/09 to 5/18/09. Hospital No LABS known records and allergies. DIAGNOSTICS: received 9/14/09 DOS Hospital 5/15/09 EKG -to records No5/18/09. Change. received Assessme CXRDO -N 1 CT Head 11/Moderate UNK UNK amount of acute hemorrhage Dermatitis layering Possible within Marfan. superior 7/31/09 sulci of Hospital both cerebellar records received hemispheres. DOS 1N 0 PVT UNK none allergic rhinitis 0 NONE UNK UNK NONE NONE NONE 0 None UNK PUB unknown none psoriasis, seasonal allergies 1 Doctor requested PVT lab tests. PVT Will get After datavaccination backno in illness a few anddays. prior bronchitis avoids to vaccination. antihystamines symptoms none thatstarted: i know - experienced of~ 25 mg ()~NULL~~In azithromychin dizzinessPatient|none in the (greenst past 2 PUB PUB Denies 7 none PVT PVT none Keflex None~ ()~NULL~~In Patient 1 UNK UNK none none 0 GLUCOSE-105 UNK UNK FLOVENT, NONE ALBUTEROL, ACID SINGULAIR REFLUX, ALLERGIES 1 none UNK PVT none knownnone knownAmoxicillin rash/redness~Influenza (no brand name)~1~56 8 n/a PUB UNK Lopid, Lotrel, none and asprin. hypertension 2 NONE PUB UNK none. None. none~ ()~NULL~~In Patient 1 PUB UNK none none none 0 PVT PVT 3 None PVT PVT None None 1 OTH OTH Seasonal None Known None Known 1 PUB PUB low grade fever 99.7 0 Unknown OTH OTH None None WAES0906USA00012 628 Unknown. 8/14/2009 OTH MR OTH rec'd from Unknown PCP. Labs and Diagnostics: Unknown EMG 8/14/2009 abnormal. MR WAES0906USA00536 rec'd CSFfrom protein PCP. increased. Allergy to9/1/09 CeclorH Unknown OTH OTH Unknown Fever; Reaction to previous WAES0906USA00524 exposure to any vaccine 0 None PVT PVT PRINIVIL ; Meclizine Chronic obstructive pulmonary WAES0905USA00702 disease 0 Labs: Bacterial PVT testingPUB (-). CSF culture None (-), gram Nonestain with None. rare8/3/09 WBCs, Hospital no organisms. records received CXR (+) DOS perihilar 5/29/09 thickening to 6/1 0 None. 6/25/09 PVTPCP records PVT received None DOS 5/4/09 Noneto 6/15/09. NKDA; LABS No med and DIAGNOSTICS: conditions Ultrasound Pelvis - Abnor 35 PVT PVT 0 PUB PUB TIAZAC 240 None mg; Hydrochlorothiazide High blood pressure 25 mg; SEPTRA DS 160-800 m as needed 1 PVT PUB Obesity 0 PUB UNK 0 OTH OTH 2 PVT PVT none none allergic to shellfish, dairy, Histex 2 UNK UNK PVT PVT 1 MIL MIL Multivitamins 0 MIL MIL NONE NONE 1 NONE PVT PUB None No No 0 PVT PVT None 2 All normal MIL MIL None None 1 OTH OTH None None 1 None Known OTH PVT None Known None PENICILLIN
0 none PVT PUB TYLENOL, none infant none 0 PUB UNK None Spina Bifida; VP shunt; Club feet 10 Stool culture; PVT Fecal leukocytes; PVT O&P; Giardia;None Rota All neg Preterm 34 wks 10 Stool culture, PVT Fecal leukocytes PVT Otp, Giardia, Rota Noneall neg.Preterm 34 wks 0 UNK UNK Bronchitis, Asthma TYLENOL exacerbation with CODEINE 29 7/2/09 Medical PVTrecordsPVT received DOS 11/11/08 None to 6/12/09. None LABS and DIAGNOSTICS: Ultrasound abdomen - PCO 1 PUB PUB None 0 None PVT UNK None None 0 PVT PUB 0 PVT PVT None None Eczema, 3/30/09 0 MIL MIL None None Milk allergy? --> causes emesis using formula 1 None PVT PUB None No No 0 PVT OTH Injury 0 PVT UNK None Exercise induced RAD 2 PVT PUB No PVT PVT Albuterol soln for NEB 2 PVT OTH ADVIL; GLUMETZA; phenol D.M. 13 Given Zyrtec PVT + Atarax on PVT 5/23/09 Hydrocortisone No 25% BID No Rash~Measles + Mumps + Rubella (MMR II)~1 2 none PUB PUB ever VAZOL none 1/2 tsp poSeasonal Bid allergies 0 None PVT PVT None Healthy - noNone illness 1 PVT PUB None None None 398 PVT PVT no no no PVT PUB 0 PVT PVT UNK UNK 2 Unknown what OTHlab work OTH was doneIsosorbide, in ER no report None ASA of Sodium abnormal Chronic Bicarts, lab renal work. Gemfibrozil, failure, onCaduet hemodialysis , Corey, Hydralazine, Lantu 1 PVT UNK Metformin; amitriptyline; Codeine, IMITREX (nose bleeds) PUB UNK None None 0 PVT PVT None Passed out once before, after venipuncture and once after 0 PVT UNK Orthonovum None 1/35, Metformin, Asthma,Effexor Seasonal XR,Allergies Nexium, Clarinex D. None PVT UNK ZYRTEC, SINGULAIR, None Allergic MVI rhinitis 0 PUB PUB None None None IA090007 PVT PVT 0 See by PCPPVT 6/9/09 continues UNK with symptomsNone Referred toAllergy neurology. to Pork, BENEDRYL, VALIUM, SULFA. PVT PVT 33 Aspirate culture PVT no growth. PVT LacerationsNone 0 PUB PUB 0 see above UNK PUB Roxanol, Percocet, Please see Saline NKA PMH flush underfor ADE admin description times please see ADE description 0 HCG positive MIL MIL No other medications No illness atNo the medical time - no problems illness 11 MRI Head showed UNK demyelinization UNK None typical of ADEM. None but Lumbar developed Pectus puncture Excavatum significant showed (mild) pneumonia normal PMH: Glucose recent two to pneumonia three and Protein. days later. CSFHa W 0 none PVT PVT none none 0 ** Date indicated UNK in date UNK of vaccination OrthoisTri-Cyclene 3rd none and final Low, dose Seasonal Midrin of gardasil allergies none~ vaccination ()~~0~Patient|none~ only 6/26/09 when Received existing()~~0~Sibling symptoms medical records severe 0 PUB PUB 0 None PUB PUB None None None None~ ()~NULL~~In SA0901 Patient|None~ ()~NULL~~ 9 PVT PVT NONE NONE 1 PVT UNK None PVT UNK None None None~ ()~NULL~~In Patient 1 CBC with diff/ UNK plt, C-reactive UNK protein, Lexapro SED rate, Healthy electrolyte OCD. panel, 6/17/09 Epstein Medical Barr AB and panel immunization 6/17/09 Medical recordsand received immu 1 PVT UNK Hyperlipedemia; No NKA;NKA Seborrheic Keratosis; Non inflamed. 0 PVT UNK None allergic reaction PVT OTH CYMBALTA; none ACIPHEX; NKMA MIRAPEX; baclofen; Lisinopril; PREMPRO; NEURONTI
0 CBC; BMP;PVT Influenza; PUB Strep; monospot-negative None None Allergic to codeine 0 PVT PUB None None Sm colon syn, chronic constipation, R10 cystic fibrosis, Hd 1 None PVT PUB No None 1 PVT PUB No 0 None PVT PVT KLONOPIN; ACTIVELLA; Anxiety; WELLBUTRIN; osteopenia;BONIVA; with postBaclofen; menopausal; B2 migraine HA's 1 PVT PUB 1 PVT PVT 1 None reported PUB OTH None ### 1 None PVT UNK Patient denies medical history.### 12 PUB PUB None None 0 PVT PVT 0 MIL UNK None None 0 None PVT PVT Daily vitamins; Autoimmune Nifedipine; Penicillin's Hepatitis Naproxen 0 WBC 1-8.3,PVT 44/50; Hgb, PUB 12.6; Plt, 260K; Bld Cult None neg 1 PVT OTH Pt takes SINGULAIR 2-3 d after vaccineqd; Many ALBUTEROL environmental started SxPRN ofallergies; enterovirus Allergic rhinitis; Asthma 0 Unknown PVT PVT Unknown Unknown WAES0906USA00344 Unknown OTH OTH Unknown Unknown WAES0906USA00895 not reportedOTH OTH Patient has a history of "bp". ### PUB UNK MOTRIN; PITOCIN; TYLENOL The patient WITH hadCODEINE a vaginal delivery ### on 02 June 2009 and de PUB UNK KEFLEX None None 1 CBC; CMP PVT all WNL. PVT Finger laceration None 10 Cellulitis 682.6 PVT/ No labPVT test preformed TYLENOL; NO MOTRIN No preexisting NKDA 1 Acyclovir OTH PVT None None 0 PVT PVT Budeprion SR; No at LEVOXYL; doctorMetabolic forPREMARIN; general syndrome physical CYTOMAX; X; thyroidhydrochlorothiazide; deficiencies; hysterectomy; multivita 0 UNK PVT VALIUM; FLEXERIL; Broken neck TOPAMAX; Stroke (2 years Rd hightwice ago); dosesize~Influenza pain PEPCID; medication ZOCOR; (noallergy; brand AMBIEN; name)~UN~ on speech CELEXth 0 PVT PVT None 2 PT/INR andPVT RUE doppler PVTto rule out Altace, DVT.Fortamet, Both No negative. acute Lantus, illness. Allergy Prednisone, Patient to Penicillin. has Folic history Acid, See of #18 Darvocet, DVT, for medical Rhematoid Vicoden, history. Arthritis, Baby asprin IDD 5 UNK UNK none VA09006 1 MIL MIL N/A RECOVERING N/A FROM EAR INFECTION - MD VISIT PRIOR TO VACC 0 UNK UNK 5 stool positive UNK for rotavirus. UNK6/18/09 ER records none received DOS none.6/10/09 7/02/09 vomiting,diarrhea,dehydration~ toMedical 6/11/09. records LABS received and DIAGNOSTICS: 6/1/09 ()~~0~Patient to 6/16/09. Urine 0 Head X-rayPUB PUB Takes Orthotricyclen Denies qd Denies 2 UNK UNK None None Hypertension that was currently under control and was not PUB PUB None None none none~ ()~NULL~~In Patient 0 UNK UNK ADHD, Bunion No Known Drug Alleriges 5 see numberUNK 7 UNK Patient hadVery antibiotics, mild cold none butincluding had finished runny them nose 2 days prior to shots. 13 none PVT PVT none molluscum none 3 UNK UNK 1 NONE PUB PUB NONE NONE NONE 0 none. 6/12/09 UNK Medical UNK records received none DOSnone 6/8/09. LABS atopic andderm, DIAGNOSTICS: pectus excavatum, Hgb 10.3 RAD, g/dL.urticarial milk allergy 0 None PVT PUB None None None but hemangioma right upper back 8 Negative testing PVT for HSV; PUB EBV; CMV; 7/16/09 ViralHospital DFA; Ear mycoplasma; infection. records 7/16/09 received Negative Hospital DOStesting 5/31/09 records fortoHHV6; received 6/1/09.(+)Amoxicillin. DOS test for 5/31/09 Rhinovirus; to 6/1/0 M 2 Immunocap. PVT 7/24/09 ER UNK records received None DOS 6/3/09 and 7/24/09 6/22/09. ER LABS records and received DIAGNOSTICS: DOS 6/3/09 CHEM and 6/22/09. - Postassium Ch 0 CBC, with diff; PVTPT; PTTUNK None No 0 None as of PVT 6/10/09. OTH PREMARIN;MVI; None Calcium; Environmental ALAVERT;allergies; LYRICA;chronic ALLEGRA; OA; Menopausal KENALOG im prn. 27 Elevated ANA; PUBElevated PUB Rheumatoid None Factor. None 8/4/09 Rheumatology None. 8/4/09 consult Rheumatology records CA090005 received consult records DOS 3/5/09 received to 5/15/0 DOS 7 PVT PUB None None Tiny patent foremen ovale with left to right shunting 0 None PUB PUB None Eczema 2 PVT OTH 0 PVT PUB None None None 1 None PVT PVT ZYRTEC; VERAMIST None Seasonal allergies; Allergic Rhinitis
UNK UNK 0 PUB PUB None 0 None PVT PVT None. This No washxa medical well-childconditions check 8 an MRI of brain PVT was ordered PUB - child none referred tonone mental health noneclinic 1 PVT PVT Diagnostic Tests: MIL 6/14/05, MIL MRI Lumbar NEURONTIN spine- unremarkable; 100 mg 1Congenital TID;6/13/05, ADVIL flat200 Electromyography, feetmg prn Abnormal study. These e Diagnostic Tests: MIL mostMIL recent: L spine Cyclobenzaprine MRI (9/03) L4/L5 10 mg; None stenosis Percocet-5/325; R>L disc bulge; Elavil 10 R knee mg; Albuterol MRI (10/02) 90 mcg; chondromala Prinivil 4/19/05, CBC MILwith diff-WNL MIL exceptPt.HCT=44.9 denies (32.7-44.1); Pt. 2/22/05, denies LFT-WNL; 1/21/05, Occult blood x3-negative; None UNK MIL Multivitamins only Allergies: CODEINE None MIL MIL Birth control pills NKDA; No medical conditions or birth defects. None UNK UNK None NO birth defects; NKDA; No medical conditions. None UNK MIL Aciphex Allergies: IMITREX; Birth defects: None; Medical condition None MIL MIL None None; NKDA; No birth defect or medical conditions. 513 Blood cultures, UNK#1 Enterobacter UNK cloacae, None MND; None #2 Klebsiella Nonepneumoniae, (in infant) MND; #3, Bacillus species, MND (not B. PUB PUB Unknown Unknown Unknown OTH OTH None None WAES0906USA00687 0 Unknown UNK OTH Unknown Unknown WAES0906USA00544 0 Beta-humanOTH chorionic,OTH positive ZOLOFT Pregnancy NOS (LMP = 1/6/2008)WAES0802USA05190 10 Unknown 6/22/09-records OTH OTHreceived-Two DEPO-PROVERA weeks prior platelet Nonecount 6/22/09-records of 26. Rheumatology receivedWAES0906USA01158 labs PMHnegative. Depo Provera. 3 None MIL PUB mesalamine 1 mg qid, HTN, Vitmain Crohn's D, Calcium 1 PUB PUB None Bees/Wasp; BIAXIN; OMNICEF 0 None PVT PVT None None None 0 PVT PUB None None None MIL OTH 2 PVT OTH None None 229 PVT PVT ZYRTEC; ADVAIR; None PROVENTIL Asthma 3 PVT UNK See list included None None None PUB PVT Chantix pac Pt medical Hx of blood transfusion. 1 PVT PUB Zyrtec 5mgNone OTC after AM None MIL UNK None Flat Foot 0 UNK UNK The patient is a nonsmoker with occasional alcohol use an 1 PUB PUB None None None 1 None PVT OTH Albuterol Muscular dystrophy 4 PUB PVT None 0 OTH UNK 1 PVT PVT None None 2 None PVT PVT None PVT UNK None None 1 PVT PUB None None 1 OTH UNK ACTONEL None Osteoporosis AntinuclearOTH antibody, 26Nov2008, OTH 35AU/mL; ALLERGY Diagnostic TO FAMILY Results: STEROIDS; HISTORY 05 February PENICILLIN OF2002: A0784372A ARTHRITIS MRI ALLERGY of the head: 1. No area 6 UNK UNK none none none 1 NA PUB PUB Cymbalta 60mg Bloody daily, Stools, Aricept Cataract Rule10mg Out Extraction, GI daily, bleed, Zocor Bunionectomy, possible 10 mgpneumonia daily, Hysterectomy, Timoptic 0.5% Cholec 1 dro 10 Pt responded MILin a day MIL or two to Motrin See #400mg 12. None. Benedryl 25 None. mg, keflex 500 tid x 10 days, ciprofloxin 500 bid x 2 day 1 PUB PUB 1 PVT PVT None~ ()~NULL~~In Patient 2 PVT PVT none fever a few none days before. 0 PVT PVT none known 0 CBC, TSH 6/12/09 UNK Medical UNK records received DOS NO 9/14/2006 NO to 6/4/09. LABS and PR0910 DIAGNOSTICS: Thyroid Functio 12 None PVT PVT None None Concurrently UNK taking Chloroquine UNK Phosphate Chloroquine for None Phosphate anti-malarial Nut 250 prophylaxis allergy mg (One and dose Idiopathic for travel four reasons. days Shortprior) Stature and Nutropin AQ 1.6
1 PVT UNK Insulin, Trazodone, None Metaformin, Diabetes and Aspirin, None~ ADHD Chlorquine ()~NULL~~In Phosphate, Patient Ramapril, Glimep 0 UA with WBC PUB clumps but PUB Urine Culture none was negative none umbilical hernia 10 PVT UNK 6 PVT UNK 1 N/A PUB PVT Depo Provera None Sickle Cell Trait 7 n/a UNK UNK none None none 0 29 May 09: UNK cardiac ultrasound UNK waslast normal. medication conjunctivitis, 29pt.May had09: None: taken otherwise CBC was Pt. was has onthe normal. 24 nopt. May history was 09: inof400 completely seizures. mg ibuprofen She normal does for state menstrual have of a good his 0 PUB PUB None None None 0 UNK UNK NONE NONE MILD SCOLIOSIS. 7/29/09 Consultant records received D 0 No PUB UNK 1044 PVT PVT None None 34 WK GA Twin birth 0 PVT PUB ADDERALL; clonidine ADHD; ; RISPERDAL Bipolar disorder 1 None PVT PVT Singulair, Claritin None + Albuterol Asthmainhaler 0 EKG - normal. PVT PVT None None None 0 OTH PUB URI RSV 4/09 2 PVT PUB None None None 2 PVT PVT 264 none PVT PUB None None None 0 PVT PVT None None VALTREX PVT OTH 1 Checked forUNK vertigo, by: UNK Dr. said: no vertigo! Headaches, Back, hip, neck, left leg pain, tremors 376 None PVT PVT None None None Fever~Hib (no brand name)~1~0~Patient|Feve 14 MIL UNK None None 2 PVT PVT None None Penicillin; Peanut allergies (Peanuts no longer per allergist 1 None PUB PUB Currently had None a medication Nonetopically for ring worm 3 PVT PVT None None None 0 PUB PUB 2 OTH PVT None None 0 EKG, normal, PVT 6-8-09 PVT None Allergies to AMOX ; ZANAX (rash). Initially did not pass ne 2 None PVT PUB None None None 0 None PVT PVT None None 13 PUB UNK None 8 None PVT OTH Vitamin D, Lipitor, None Vitamin None E, Verapamil, Cod liver oil, Citalopram HBC 0 PVT PVT None None None 0 None PVT PVT None None None 0 urine beta-human OTH OTH None Pregnancy NOS (LMP=11/20/2007 WAES0801USA05575 41 ultrasound, OTH LMP was 06-AUG-2008; OTH INSULIN; diagnostic SYNTHROID Pregnancy laboratory, NOS OB(LMP profile: = 8/6/2008); all resultsWAES0901USA03065 in Diabetes; normal limits; Hypothyroidism ultrasound, 12/24 Unknown OTH OTH Unknown Unknown WAES0906USA01328 4 diagnostic laboratory, OTH shingles OTH Unknown Unknown WAES0904USA02912 1 None PVT UNK ZYRTEC Allergic rhinitis None 1 PVT PVT No 1 PVT PVT 2 PVT PVT None No Known No Known 0 None PVT PUB None None Jaundice at birth 0 BP 110/70.PUB PUB None None None 0 PVT PVT Duaces; Econazole; None Strattera; Asthma;Symbicort; ADHD; Tourettes Xopenex disorder 4 MIL MIL none none pulmonary nodules of unknown etiology 17 MRI -6/3/09UNK 1. MULTIFOCAL UNK AREAS noneOF SIGNAL none ABNORMALITY none 6/26/09 AND none~ Medical EDEMA ()~~0~Patient|none~ records IN THE received BASAL()~~0~Sibling PMH: GANGLIA, nose &SUBC wris 1 UNK UNK 0 MIL MIL lescol norvasc no pen vonwillingbrand yes~Vaccine disease not specified (no brand name)~NU 0 PUB PUB fainting~HPV (Gardasil)~1~17~In Patient
1 PUB PVT SYNTHROID 50mg Hypothyroidism, Asthma, and allergic reaction to Influenza 1 xray of cervical PVTspine (pt. UNK has known Albuterol bulgingInhaler,Cyclobenzaprine, cervical Sinusitis,disc Allergic Asthma, problems) Rhinitis allergic Prednisone, rhinitis Sronyx, Zyrtec 1 MIL MIL NONE 0 MIL MIL none none poultry allergy 0 PUB PUB 9 None to date UNK - will perform UNKscreening Prilosec for hivesNo illness at the time 1 Sedimentation PVTRate, Creatine PVT kinase Ibuprofen labs drawn None on 6/12/2009. No known Already Drug had Allergies; normal sugar, liver, anemia, thyroid te 10 N/A PUB UNK None reported. None reported. 1 PUB PUB OrthoTricyclen None 1 PUB PUB none knownno no 0 XRAYS, BLOODWORK PVT UNK SHOWS WBC RESPIRDOL,CLONODINE,ZYRTEC,SINGULAR,ALBUTEROL HIGHNONE ADHD,IMMUNE DEF,ASTHMA,BIPOLARINHALER OTH OTH Unknown A0790455A 1 OTH OTH Penicillin; FELDENE; diphenhydramine 2 Low Platelets PUB Count PUB No 0 PVT UNK None PVT OTH 1 PVT PVT no none 0 PVT PVT 1 PVT PUB SINGULAIRNone Seasonal allergies 0 CBC; CMP PUB normal. 6/22/09 PUB Hospital Zantac records 0.2 None ml DOS (3mg); 5/28/09 Liquidation; Reflux to 5/29/09. 6/22/09 Mylicon; LABS Hospital Tylenol andrecords DIAGNOSTICS: DOS 5/28/09 CHEM to 5/29/09. - SodiumC 0 OTH PVT 0 OTH PVT 1 No PVT PVT 2 PVT PUB 1 Possible early PVTabscessPVT L upper arm. No None 0 PVT PUB 7 PVT OTH 0 PVT PVT CELEXA; YAZ No Depression with anxiety 4 PUB UNK 0 OTH PVT None None 0 PVT PUB None h/o fainting - saw Ped neuro - No chronic dx. 8 CBC, bloodPVT culture pending PUB None No allergies, healthy child 0 None PUB PUB Runny Nose, None but no fevers 1 PVT PVT NONE NONE eczema & failure to thrive~Hep B (Engerix-B)~2 10 none PVT PUB 2 PUB PUB allergic to erythromyocin 1 RN outlinedPUB area and will UNK cont to follow. No further Bilateral intervention lower NKAextremity prior needed to this cellulitis at incident. this time. beingCAD treated andwith chronic vancomycin venous stasis and le Alanine Aminotransferase, OTH OTH12 IU/L, Normal; Aspartate Aminotransferase, Atrial fibrillation; Chronic 16 IU/L,Obstructive Normal; ### Haematocrit, Pulmonary24%, Disease; DeprH 1 Not reported PVT UNK SYNTHROID; CRESTOR The patientHives~Tetanus had a history ofToxoid penicillin ### (noallergy, brand name)~~0~Si seafood aller UNK UNK ### 153 Urine beta-human, OTH 05/31/08, OTH negative; [Therapy Urine unspecified] Pregnancy beta-human, Attention NOS 06/03/08, (LMP deficit =positive Unknown); disorder WAES0806USA00890 Depression 0 Unknown PVT PVT Unknown Unknown WAES0906USA00708 beta-humanOTH chorionic, OTH positive Unknown Pregnancy NOS (LMP = Unknown) WAES0806USA08747 0 beta-humanOTH chorionic, OTH 06/03/09, positive Pregnancy NOS (LMP = 5/1/2009)WAES0906USA00865 328 None OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0805USA05079 Unknown OTH OTH None Wheezing WAES0906USA00696 Unknown OTH OTH Unknown Unknown WAES0906USA01783 0 6/29/09-records PVT receivedPUBCBC WNL, basic metabolic None profile Azithromycin; WNL. CEFTIN - rash 0 PVT UNK none acetaminophen 0 SEE ABOVE UNK FOR MED, UNK MRI, BLOODWORK,NO SPINAL TAP. NO 7/1/09 NONE~ Hospital()~~0~Patient records received DOS 6/6/09 to 6/10/0 0 PUB UNK
1 NONE AVAILABLE PUB PUB CLIENT WAS DENIED NOT TAKING ANY DENIED ILLNES ANY ANY MEDICATIONS ATPRE-EXISTING THE TIME OF ATVACCINE CONDITION THE TIME INJECTIONS OF VACCINE IN 0 PVT PVT Fluoride None None 3 UNK UNK 7 MIL MIL NONE NONE 0 none PVT PVT HCTZ, Diltiazem, None Gemfibrozil, HTN, Hyperthyroidism, Warfarin, Methimazole GERD, Gout, A-fib, prostate CA, H 0 PVT UNK none knownnone diagnosed, although patient may have a digestional 4 PVT PUB none none none 1 PVT PUB Flovent, Singulair, Coughing Miralax NKDA; hx of wheezing, asthma, allergic rhinitis, constipatio 1 PUB PVT NONE SHRIMP-CRAB 2 Clinical Exam PVT UNK lortab, norvasc, nonemonopril, Afib,levoxyl, Back Pain, amiodorone, HTN, Anxiety restoril, xanax 1 UNK UNK None None None 0 None PVT PUB None Not noted None 66 PVT PVT none infection induced asthma, sulfa allergy 1 PUB PVT N/A Penicillin; Non-Steridal anit-inflammatory; Flagyl; Adhesive 3 PVT PVT zyrtec, aspirin,fosamax, None NKDA, zantac, HLP, simvastatin, osteoporosis flonase, calcium, multivitamin 1 None PVT OTH None None 1 PVT PUB 0 None PVT OTH Abscess, L Allergic arm Rhinitis 6 Doppler U/SOTH on legs (-)PUB Methotrexate; None OXYCONTIN; Polymyositis; Leucovorin; Same~Hep NKDA. PLAQUENIL A (no brand name)~1~36~Patient 4 PVT PVT MOTRIN after vaccine 1 Potassium hydroxide PVT preparatio, OTH 20Apr2009 ZIANA; ORTHO -ACNE, ve yeast TRI-CYCLEN DYSMENORRHEA, The subject LO; had TYLENOL no HEAVY known A0780629A NO. PERIOD drug 3; antibiotics; allergies. The lignocaine subjecthydro was 0 PUB PUB None None PVT PUB None notedHypothyroidism; Depression; Hx of overdose 2005; ETOH 0 PUB PUB 4 Blood tests;OTH Results; 11/20/08, OTH Varicella LIPITOR; Zoster Atenolol/Chor.; None virus antibodies None Levothyroxine; - 1.65; 12/11/08, KLOR Varicella CON; Aspirin; ZosterCalcium; virus antibodies Vitamin; -P 2 None PVT OTH 18 elevated CSF PVT protein; Head PVT CT and MRI normal. None7/21/097/21/09 Hospital Hospital recordsrecords received received 6/11/096/11/09 to 6/23/09. to 6/23/09. LABS and AllerD None OTH OTH 1 PUB OTH 1 CT - scan PVT PUB Yes~Varicella (no brand name)~1~10~Sibling 1 PVT OTH MOTRIN/TYLENOL 1 Blood work PUB normal; UAPVT normal None None 0 None PVT PVT None None None 1 UA wnl PVT PVT EFFEXOR; ZOCORT NKA 4 PVT UNK No 1 None PUB UNK None 0 None PUB PVT None None Allergies: Bactrum, Horse hair, Cat hair. 1 None PVT OTH PPD, 02990AB, NoneLA, 0 None 1 PVT UNK 1 PUB PUB None None PVT UNK None "Almost never happy" per parents, since age 3-4 wk. 1 None at adverse PVT eventOTH SYNTHROID; Arthritis Vitamins L hip Hypothyroid; Arthritis; Allergies; mold; dust; trees - pollen None PVT OTH DM 2 PVT OTH 1 PVT OTH None 19 see attached PVT PVT 0 See attached PVT PVT No see sheet B~Vaccine not specified (no brand n 2 PVT PVT None Unknown OTH OTH Unknown Unknown WAES0906USA00130 0 Unknown OTH OTH Sulfonamide allergy; Allergic reaction WAES0905USA03639 to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0905USA02240
Unknown OTH OTH Unknown Unknown WAES0905USA00980 Unknown OTH OTH Unknown Unknown WAES0906USA00258 78 ultrasound, OTH 05/02/07, within OTH normal Unknown limits; serum alpha-fetoprotein, Gestational04/04/07, diabetes negative mellitus WAES0707USA01443 0 urine beta-human, OTH 01/06/08, OTH negative; Noneurine beta-human,Cholecystectomy; 02/04/08, positiveCesarean WAES0803USA00128 section 47 Unknown OTH OTH BENTYL, 10 Pregnancy mg; ORTHO NOS TRI-CYCLEN, (LMP = 2/12/2008); 0.025 WAES0804USA02086 mg; Depression; ZOLOFT,Iron 25 mg deficiency anem 0 ultrasound, OTH 08/22/208,OTH screening; azithromycin; diagnostic laboratory, Pregnancy vitamins chlamydia NOS (unspecified) (LMPpositive = 4/8/2008) X2; W urine AES0806USA08328 beta-human, positive; platelet 63 ultrasound, PVT 06/26/08, EDC=02-FEB-2009; OTH BENADRYL; urine Pregnancy MACROBID; beta-human, Pyelonephritis NOSvitamins 06/05/2008, (LMP = (unspecified) 4/20/2008); positive; WAES0807USA00352 Seasonal serum alpha-fetoprotein, allergy 08/21/ Unknown OTH OTH Unknown Unknown WAES0903USA00005 Unknown OTH OTH Unknown Concurrent Conditions: PregnancyWAES0903USA01240 NOS (LMP = 1/12/2009) 0 Unknown PVT PVT LUPRON Unknown WAES0903USA01849 0 Unknown PVT PVT Unknown Unknown WAES0903USA04686 0 diagnostic laboratory OTH 01/18/09 OTH - Group vitamins B Streptococcus (unspecified) Pregnancy :Polycystic NOS negative; (LMPdiagnostic ovaries = Unknown) laboratory WAES0904USA00153 Penicillin- gestational allergy diabetes: neg 0 urine beta -OTH human - positive OTH hormonal contraceptives; Pregnancy NOS BACTRIM (LMP = 2/23/2009) DS TABLETS WAES0904USA01441 6 PUB PUB DIASTAT prn None childhood febrile seizure disorder PUB PVT None No parasite identification, OTH false OTH positive Unknown Unknown WAES0905USA00193 0 None OTH OTH None None WAES0905USA00220 1 Unknown. OTH OTH Unknown Parakeratosis 7/13/09 Medical notes WAES0905USA00239 received DOS 4/28/09 to 6/30/09 0 Beta-humanOTH chorionic,OTH positive None Pregnancy NOS (LMP= 4/25/2009) WAES0905USA00270 1 None PVT PVT None None WAES0905USA00342 0 None OTH OTH Ortho Evra; Singulair None WAES0905USA00366 1 Unknown OTH OTH Unknown Epstein-Barr virus infection; WAES0905USA00380 Lymphadenectomy Unknown OTH OTH None None WAES0905USA00383 57 Serum ANAUNK 04/24/09 -UNK negative; serum FLONASE rheumatoid Penicillin factor allergy 7/13/09 04/24/09 Medical - negative; records WAES0905USA00387 urine received drug screen DOS 4/24/09 04/24/09 to 5/4/09. - negativ P 138 Diagnostic laboratory, OTH 12/16/08, OTH Blood Nonework results Dizziness; normal; Fatigue; Unknown Physical Influenza examination, like illness WAES0905USA00500 12/16/08, diagnosed fatigue and Unknown OTH OTH Unknown Unknown WAES0905USA00510 0 None OTH OTH None Unknown WAES0905USA00521 Unknown OTH OTH Unknown Unknown WAES0905USA00528 Unknown OTH OTH Unknown Unknown WAES0905USA00529 None OTH OTH Unknown Unknown WAES0905USA00538 0 None PVT PVT ascorbic acid; calcium None (unspecified); cyanocobalamin; WAES0905USA00561 SEASONIQUE; store bran 0 Ultrasound,OTH 05/04/09, positive OTH for pregnancy; None Pregnancy Urine beta-human, Ovarian NOS (LMP cyst 04/21?/09, = 3/26/2009); negative; WAES0905USA00563 Depression Urine beta-human, 05/04/09 0 None OTH OTH None Pregnancy NOS (LMP + 7/22/2008) WAES0905USA00570 Unknown OTH OTH Unknown Unknown WAES0905USA00572 17 None OTH OTH None None WAES0905USA00707 0 Unknown OTH OTH Unknown Unknown WAES0905USA00733 61 None OTH OTH Unknown None WAES0905USA00944 Biopsy, negative; OTH Diagnostic OTH laboratory, Omega-3 testmarine for sexually triglycerides Eczema; transmitted Food diseases-negative; allergy WAES0905USA00950 Skin and/or subcutaneous, 0 Unknown OTH OTH None WAES0905USA01104 Unknown OTH OTH Unknown Unknown WAES0905USA01112 0 Diagnostic laboratory, OTH blood OTH work,Flagyl pregnant ;Pregnancy Urine beta-human, NOS (LMP) 05/01/09, = Unknown negative WAES0905USA01140 0 None UNK UNK None Penicillin allergy WAES0905USA01261 Unknown OTH OTH Unknown Unknown WAES0905USA01306 0 Unknown OTH OTH Unknown Unknown WAES0905USA01307 0 None OTH OTH None None WAES0905USA01432 Unknown OTH OTH Unknown Unknown WAES0905USA01443 Unknown OTH OTH None Drug hypersensitivity WAES0905USA01447 Unknown OTH OTH Unknown Unknown WAES0905USA01464 17 None OTH OTH None Lactose intolerance WAES0905USA01625 0 Unknown OTH OTH None WAES0905USA01633 2 None OTH OTH None None WAES0905USA01662
None OTH OTH Unknown Unknown WAES0905USA01665 2 None OTH OTH None None WAES0905USA01684 Unknown OTH OTH Unknown Unknown WAES0905USA01721 0 Unknown UNK UNK TYLENOL None WAES0905USA01879 0 Ultrasound,OTH 03/05/09, EDC OTH 10/19/2009; None Diagnostic Gestational laboratory, diabetes 03/05/09, Prenatal WAES0905USA01888 lab work(results not reported); Pl 0 skull x-ray, OTH 5/8/09, no fracture OTH Unknown Unknown WAES0905USA01902 Unknown OTH OTH Unknown Unknown WAES0905USA01923 5 beta-humanOTH chorionic, OTH 05/14/09, positive None Pregnancy NOS (LMP = Unknown) WAES0905USA02012 None OTH OTH Unknown Unknown WAES0905USA02013 0 None OTH OTH None None WAES0905USA02018 serum Herpes OTH simplex,OTH positive; serum CELEXA; Herpes ADVAIR; simplex, hormonal positive None contraceptives;WAES0905USA02021 ATIVAN Unknown OTH OTH Unknown Unknown WAES0905USA02029 0 Unknown OTH OTH ZYRTEC, hormonal Drug hypersensitivity; contraceptives, House NASONEX dust WAES0905USA02230 allergy; Pollen allergy Unknown OTH OTH Unknown Unknown WAES0905USA02247 Unknown OTH OTH Unknown Headache WAES0905USA02253 0 Unknown OTH OTH None Unknown WAES0905USA02260 0 OTH OTH Unknown Unknown WAES0905USA02572 1 Unknown OTH OTH None Penicillin allergy WAES0905USA02728 30 Serum stimulated, OTH 04/??/09, OTH Adrenal Unknown Insufficiency. Unknown WAES0905USA02843 5 computed axial, OTH 01/16/09 OTH - normal;ALASE electroencephalography, Familial risk6/23/09 factor; 01/16/09 Contraception Medical - abnormal; records WAES0905USA02892 received underlying PMH: predisposition Tonsillectomy for and seiz None. 6/25/09 OTHMedicalOTH records received None DOS 12/28/09 to None. 12/24/08. 6/25/09 LABS Medical andWAES0905USA02921 DIAGNOSTICS: records received Chest DOS 12/28/09 X-ray negat to 0 None UNK UNK None None WAES0905USA02951 0 None PVT PUB None WAES0905USA03183 Unknown OTH OTH Unknown Unknown WAES0905USA03218 395 Pap test, the OTH specific type OTHof HPV ORTHO has not been TRI-CYCLEN determined None WAES0905USA03240 0 blood pressure, OTH 05/18/09, OTH115/68 YAZ Syncope WAES0905USA03248 Unknown OTH OTH Unknown Unknown WAES0905USA03257 None OTH OTH DEPO-PROVERA None WAES0905USA03276 Unknown OTH OTH Unknown Unknown WAES0905USA03359 1 None OTH OTH None None WAES0905USA03367 Unknown OTH OTH Unknown Unknown WAES0905USA03371 7 None OTH OTH Unknown Cystic fibrosis WAES0905USA03380 0 Unknown OTH OTH RHOGAM Pregnancy NOS (LMP = 10/31/2008); WAES0905USA03385 Drug hypersensitivity Magnetic resonance, OTH demyelinating OTH lesions Unknown WAES0905USA03402 0 Urine beta human, OTH 05/05/2009, OTH showed None she was Pregnancy pregnant. Nos (LMP= 3/27/2009)WAES0905USA03625 Anaemia; Irregular menstrual cycle Unknown OTH OTH Unknown Unknown WAES0905USA03635 7 None OTH OTH None Miscarriage WAES0905USA03670 0 electrocardiogram, OTH 05/19/09, OTH sinus tachycardia, HR 140 Unknown to 150 WAES0905USA03677 0 Unknown OTH OTH None WAES0905USA03692 Unknown OTH OTH NECON 1/35, Pregnancy EFFEXOR Attention NOS (LMP deficit = 3/2/2008) disorder; WAES0905USA03695 Sulfonamide Depression;allergy; Anxiety; Allergic Obesity react 0 Unknown PVT OTH None WAES0905USA03777 26 None OTH OTH None Unknown WAES0905USA03812 0 Unknown OTH OTH Unknown Brachial plexus lesion; Drug hypersensitivity WAES0905USA03847 1 electrocardiogram, OTH 05/19/09 OTH - normal, SEASONALE diagnostic laboratory, Unknown 05/19/09 - lab work: WAES0905USA03861 normal; beta-human chorionic, 05 Unknown OTH OTH NEXIUM Hospitalisation WAES0905USA03862 0 None Medical OTHrecordsOTH received 6/22/09 sertraline LABS hydrochloride Yeast and infection DIAGNOSTICS: Medical records STDreceived Screen WAES0905USA03865 (-). 6/22/09 PMH: Anxiety Disorder G Unknown OTH OTH Unknown Unknown WAES0905USA03883 Unknown OTH OTH Unknown Unknown WAES0905USA03904 6 Unknown OTH OTH Unknown Unknown WAES0905USA03905 0 urinalysis, 05/01/09, OTH positive OTH Unknown Pregnancy NOS (LMP = 3/26/2009); WAES0905USA03906 Seasonal allergy Unknown OTH OTH Unknown Nervousness WAES0905USA04039
Unknown OTH OTH Unknown Unknown WAES0905USA04056 Unknown OTH OTH Unknown Unknown WAES0906USA00009 Unknown OTH OTH Unknown Unknown WAES0906USA00010 Unknown OTH OTH Unknown Unknown WAES0906USA00011 Unknown OTH OTH Unknown Unknown WAES0906USA00103 Unknown OTH OTH Unknown Unknown WAES0906USA00112 9 Unknown UNK OTH Unknown Unknown WAES0906USA00118 Unknown OTH OTH Unknown Unknown WAES0906USA00135 0 Unknown OTH OTH Unknown Unknown WAES0906USA00139 Unknown OTH OTH Unknown Unknown WAES0906USA00143 Unknown OTH OTH Unknown Unknown WAES0906USA00242 Unknown OTH OTH Unknown Unknown WAES0906USA00243 1 TWO BLOOD UNK WORK-UPS, UNK CT SCAN, NONE MRI, EEG NONE6/16/09 NONE Received 6/16/09 NONE~ medical Received ()~~0~Patient|NONE~ records medical for LABS: records CT ()~~0~Sibling|N for head, PMH: CBC, steroty CM 6 stool culture, PVT 06/04/09,PVT rotavirus antigen positive; Skin stool tags occult blood, 06/04/09, positive; WAES0906USA01449 body temp, 06/03/09, no te 40 Unknown OTH OTH Unknown Unknown WAES0906USA01742 Unknown OTH OTH Unknown Unknown WAES0906USA01436 Beta-humanOTH chorionic,OTH positive None Atrial septal defect repair WAES0805USA01495 Physical examination UNK by UNK health care Corticosteroid provider andinjection examination Female into bald and with spots; treatment latexsteroidal allergy. from cream specialist applied - dermatologist. to bald spots. 11 8/6/09 Dermatology UNK consultant UNK records received DOS 7/25/06 8/6/09toDermatology 3/13/09. LABS consultant and DIAGNOSTICS: records received Multiple DOSBiops 7/25 1 None PVT PVT Speech delay 2 PVT PVT Vitamin with iron; ALBUTEROL CODEINE, Hairy Nevus - got referred to derm 0 PVT PVT None Migraines 0 PVT UNK 18 PVT PVT None None None 0 PUB PUB Oral contraceptive (unable Asthma; to recall) Received cochlear implant on 05/18/2009 PUB UNK Fibromyalgia Fibromyalgia PUB PUB None None None 2 PVT PVT Vitamin with Iron. 1 PVT PUB Vitamin C; fe Salicylic acid Obesity 6% 0 MIL MIL 2 Skin culturePVT - nL flora PUB None No. 6/17/09No Medical record received DOS 6/1/09. At time of immuniza PVT UNK DEPAKOTE; ZYRTEC;Seizure NASONEX D/O 2 PVT PVT NASONEX; SINGULAIR 1 OTH PVT Codeine; Sulfa; latex 1 PVT PVT None None None 2 Child beingMIL treated for MIL cellulitis. None None None 1 MIL MIL 5 PVT OTH Thyroid, Birth Control 8 MIL OTH Birth Control None No 0 None OTH PUB None Hay fever only 1 None PVT PUB None None Amoxicillin; Tetralogy of Fallot 1 UNK UNK None BronchiolitisNone 1 None PUB OTH None None None 0 for headache MIL stated work MILplace was "very cold" Prostatitis and he felt better since arriving. " A little nervous" after receiving 3 0 Seen at ERPVT on 6/21/09PUB and was diagnosed with None allergic reaction. NKDA NoCBC birth9defect; x7 13137.4 NC09024 H/O Bronchial 2gl; N 42.5; asthma Lym 37.4/ Ess, 12 1 PVT PVT PROVENTIL; Acute ADVAIR extrinsic rotator/Tendonitis 2 PVT PVT GLUCOVANCE; was having metoprolol; DM-2; pain inPLAVIX; HTN; someobesity; area ALTACE; Psoriasis; SINGULAIR; COPD; VYTORIN; AS CAD. SPIRIVA 10 none exceptPVT rapid strepPVT screen & culture None None PENICILLIN ALLERGY 3 6/29/09 Medical PUB records PUB received None. DOS 8/07/08 6/29/09 NotoMedical 4/08/09: PCN records LABS allergy received and Chills DIAGNOSTICS: fever~Tdap DOS 8/07/08 (no PLT tobrand 4/08/09: 457 K/uL name)~UN~0~Pat Aleve (H). CHEM: A 0 Rapid Flu test PVTnegativePVT None None 1 UNK PVT None None None
2 Hemacult, Positive PVT X2,PVT Dates 6/6/09 None and 6/8/09 None None 1 PVT PVT ALLEGRA 30 None mg; ORTHOTRI-CYCLIN Anemic 5 Allergy testing PVTshowedOTH no allergiesNITROFORANTOIN to foods, just dust mites MACROCRYSTAL; AMOXYCILLIN; Erythromycin; EVISTA Gantrisin; Osteoporosis 1 PUB PUB None None None UNK UNK 1 PVT PVT Atenolol; Levoxyl; ASA;Cephalosporins; HCTZ; LisinoprilPCN; Risedronate; Azathiopine 2 PVT PUB None None 0 PVT PVT NKDA 2 PVT PUB None Penicillin; Bee sting UNK UNK 2 PVT PVT None Exercise-induced RAD UNK UNK UNK UNK 1 PVT PVT ALBUTEROL PRN 69 MIL MIL None None 1 PVT UNK No menopause UNK UNK None PVT PUB None Penicillin -3652 None PVT PVT None None PVT UNK PVT PVT 0 PVT PUB prednisone,none fluorinef congenital adrenal hyperplasia 0 Member had MIL lyme disease MIL antibody IGM wasMember negativehad immunoglobulins none been known biten by was a tickalso 5 days negative. prior inMember the rightrecovered upper back. com 36 UNK UNK COPD PMH: COPD 90 UNK UNK COPD PMH: COPD 652 UNK UNK COPD PMH: COPD, anxiety, depression, HTN, hypothyroidism, la 12 NONE COMPLETED PUB PUB Unknown NONE UNknown 29 UNK PVT none no none 533 Blood and CSF UNKspecimens UNK collected Insulin 3/29/2009 were culture Diabetes positive mellitus. for Neisseria 7/8/09 Hospital meningitidis records serogroup received C. DOS 6/24/0 3 0 PUB PVT EffexorXR, None NaturThroid, Sulfa Seasonelle 3 UNK UNK none pt states allergy to spiders and bees 1 PUB PUB PCN MO-2009-13 1 - derm biopsy UNK pending,UNK - CBC originally none normal. none repeat known CBC Err:508 shows ANC 200-3rd CBC normal . repeat CBC pendi 33 cbc, cmp, esr, UNK arthritis UNK panel all normal. allegraMedical D, veramyst. Allergic records rhinitis Oral NKDA. received contraceptives. only.Chickenpox. DOS 5/27/09 Medical to 6/16/09. records LABS received and DIAGNOSTI DOS 5/27/0 0 PVT PVT 0 PVT PVT none 2 none UNK PVT calcium, Vitamin Sore throat,nasal D, Thyroid High cholesterol, support congestion (herbal thyroid andthyroid post problems nasal supplement) drip. 0 UNK UNK 2 MRI and Catscan. UNK 6/29/09 UNK Hospital none records received None DOS None. 5/24/09 6/29/09 to 5/25/09. Hospital LABS records andreceived DIAGNOSTICS: DOS 5/24/09 CT Head to 5 0 UNK UNK 9 PUB UNK None None 4 None PVT PUB CARBATROL No 300 mg Seizure bid disorder 0 CBC; Chem PVT panel ordered PVT 6-15-09 None None None 8 PVT PVT daily vitamin None OTH OTH Aspirin; Calcium (unspecified); UnknownOmega-3 marine WAES0905USA00985 triglycerides; Prilosec; Paxil; Evi Diagnostic laboratory, OTH HPV OTH positive; Unknown Diagnostic laboratory, Unknown ?/?/07, HPV: negative WAES0905USA01063 0 Unknown OTH OTH Penicillin allergy WAES0905USA01064 1 MIL MIL NONE Unknown OTH OTH Unknown Coronary artery bypassWAES0906USA02086 2 8/26/09 Hospital PUB records PUB received DOS 6/10/09. Rash LABS on back and No.DIAGNOSTICS: and 8/26/09 abdomen HospitalCBCrecords WBC received 40000 DOS K/mm3 6/10/09. (H) PLT Multip 479 2 PVT UNK None IA090008
2 PVT UNK None IA090009 66 GUILLAIN BARRE OTH syndrome. PVT 7/13/09 Lisinopril; Hospital Lovastatin None records received 7/13/09 Hospital DOS 12/26/09 records toreceived 1/3/09. LABS DOS 12/26/09 and DIAGNOSTIC to 1/3/09 1 PUB PVT PVT UNK none none 3 PVT PVT Ibuprofen PRN, nonemultivitamin daily, Vicodin PRN, Valium PRN, Fluconazole 1 tabl 1 PVT UNK none 3 days of high fever after shots given~ ()~NULL 0 none UNK UNK none none none SC0917 0 NONE MIL MIL NONE NONE NONE 1 Patient hadPVT subsequent PUB vaccines none at age 6 months none with no none sequelae, including Pentacel, Prevnar, and Rotateq. 2 UNK UNK Norvasc 2Xday(5mg), None HCTZ Emphesyma 1day(25Mg) & Spiriva Stopped 0 PVT PUB 0 UNK UNK lisinopril, multivitamin, No St. elevated John'sPSA, Wort, None~ aortic fish ()~NULL~~In oil, valve aspirin, insufficiency, simvastatin, Patient hypertension, hctz. hyp 3 EMG datedUNK 2/06/2009 UNK revealed a left anterior interosseous nerve syndrome. 7/27/09 Consultant medical records re 0 PUB PUB NONE 406 Blood culture UNK positive for UNK N. meningitidis. 6/24/09 Unknown. Hospital Unknown records received Unknown~Meningococcal DOS 3/27/09 to 4/3/09. (Menactra)~1~0~Pat LABS and DIA 20 N/A UNK UNK Clarinex, Armor NoneThryo None tab, BonivaN/A~ ()~~0~Patient 0 PUB PUB 0 PUB PVT None None 8/24/09 Medical PVT records PVT received None w/LABS: CT sinus c/w None chronic8/24/09 sinus disease. Medical records CT chest received c/w pulmonary w/PMH: nodules. lactose in Diagnostic Tests: MIL allergy MILskin testing None - NEG for aeroallergens; None peak flow-wn) Labs: none. Diagnostic Tests: UNK MRI's UNK and plainTENORMIN films of hands 50 knees mg; HYDROCHLOROTHIAZIDE feetDermatitis; negative NOS; except History for surgical of 25optic mgchanges neuritis from 1988.plantar fasc 2 See above PUB PVT None None 0 Diagnostic Tests: MIL Request MIL for medNone records sent; Labs: Request Denies for med records sent. 6/23/09 Medical records rec 1 PVT OTH None None NKA or medical conditions 1 PUB UNK None None None 0 None PVT PVT None None ceiving Tdap on 6-8-09. None PUB PVT 1 PVT PVT ASACOL; Vitamin No supplements. Ulcerative colitis in remission. Allergies. Seasonal & Sulfa 1 None (Reports PUBmother)UNK None (Reports None mother)None 0 PVT PUB Tylenol None NKDA None 25 CXR revealed UNK "infiltrateUNK in the rightPREVACID middle lobe30which mg; ZESTRIL was Active consistent Hypertension 40 mg;with NAPROSYN pulmonary essential 500 hemorrhage"; NOS; mg; ItHydrochlorothiazide appeared UA, revealed that his ex h5 0 EEG, Neurology PVT consult PVT pending None None None (35 wk pre term newborn) 1 None PVT PVT LURIDE chewable None tab Born at 37 weeks; Allergic rhinitis 1 None PVT PVT None None None 1 7/12/04, CXR, UNK nl PA and UNK Lat; 7/26/04, Zomig Brain 5 mg; MRI, Albuterol nl; 8/5/04, Asthma Sulfate LFTs, 90 asWNL; mcg/inh; a child; 9/15/04, Lyme Ibuprofen disease CBC 800 withmg diff, lytes, lipids, and U 1 UNK PUB None None NKDA 2 Diagnostic Tests: UNK 1/27/05 UNK Echo: Normal MOTRIN LV 800 systolic mg PRNAllergic function withrhinitisEF 65%; 1991 Small anteriorly located pericardial effus 1 None PVT PUB None Asthma; Sleep disturbance ght sided axillary adenopathy; Diagnostic no constitutional Tests: UNK Pending; UNK symptoms. Labs: Pending TYLENOL Muscle Pain with Start: CODEINE 9/17/2004 NONE #3, 300 - Fatigue mg-30 Start: mg; 9/17/2004 INDOCIN, -25 Lymphadenopathy, mg; CLARITIN, 10axi m 0 None PVT PUB 0 Well child immunizations PVT PVT Tylenol 2 hours Noneprior toNone immunizations Diagnostic Test: UNK pending; UNK Labs: pending None 08/27/2004,UNK EKG, NSRUNK with left axis None deviation; Echo, Borderline Pt. Denies LV size with normal wall thickness and contractility 0 PVT PVT None None None 1 PVT PVT None None None 2 PVT UNK Asthma/Influenza PVT OTH 0 PVT PVT NOVOLOG,Well LANTUS, Type MACRODANTIN II Diabetes, Pyelonephritis, allergic to codeine PERC 0 PVT PUB None None 1 PVT PUB Warts 7 Labs/08/04,UNK CBC with diff; UNKESR = ZANTAC, all WNL 150 150 mg;None BENADRYL, 25 mg; CLARITIN, 10 mg
Labs: 5/5/04 UNK ESR= 22 UNK (H) (0-15) lyme Pt. denies antibody = (H) (1.00) Hyperlipidemia, RF, HbA1C, Pt. TSH, allergic vitamin to Daypro B12, folate - WNL, ANA- neg Diagnostic Tests: UNK requested; UNK Labs:None requested ; Patient has None been lost to follow-up. Diagnostic Tests: MIL HeadMIL CT (without TYLENOL contrast)with = nl;Codeine Labs: Herpes 2/10/05, #3 300Simplex Lyme mg-30disease mg screen= 2/46 H (<1.0); Lyme disea CBC W/DiffMIL Site/Specimen MIL 09 Jul birth 2007control 0805 Units pill Ref Rng; noneWBC BLOOD 9.9 x10(3)/mcL (4.4-11.0); RBC BLOOD 8 Troponin- Negative MIL (6/11/09), MIL CPKNone Level - Negative None (6/11/09) None pending UNK UNK Ibuprofen 400 mg; Vitamin NoneE 400 iu; Vitamin C 500 mg; Vitamin B Complex Vitam Diagnostic Tests: UNK L spine UNK flims-posFlexeril HNP at10mg; L4/L5;Floricet bone scan Influenza 325 mg-50 pelvicvaccine-itching flims-neg; mg-40mg;abdom/pelvic/U/S Wellbutrin 100 mg; and Klonopin CT-pos1liver mg; hP Diagnostic Test: UNK awaiting UNK records None ; Labs: awaiting records. X-rays (shoulders UNK cervical UNKspine) -None Neg; bone scan - Neg;None MRI cervical / thoracic spines- NEG Diagnostic tests: UNK N/A , UNK Labs: N/A ,None Medical records requested. None 0 Unknown OTH OTH Unknown Unknown WAES0804USA02211 0 None OTH OTH Unknown Unknown WAES0805USA00117 Unknown UNK UNK Unknown Obsessive compulsive disorder WAES0805USA00253 0 Unknown OTH OTH Unknown Unknown WAES0805USA04761 allergy test,OTH negative OTH Unknown None WAES0906USA03749 Unknown OTH OTH Unknown Unknown WAES0806USA08382 0 None OTH OTH None WAES0806USA08842 Unknown OTH OTH Unknown Unknown WAES0807USA04110 0 Unknown OTH OTH Unknown Unknown WAES0807USA04415 0 Unknown OTH OTH [therapy unspecified] Egg allergy; Peanut allergy; Food WAES0808USA00305 allergy 0 None OTH OTH None Allergy to nuts WAES0808USA01129 0 Unknown OTH OTH Unknown WAES0808USA03172 1304 serum hepatitis OTHA IgM, OTH 08/27/08, titer None negative None WAES0809USA01568 0 Unknown OTH OTH Unknown Unknown WAES0810USA00555 diagnostic laboratory OTH - OTH "blood work" Unknown unspecified Unknown WAES0810USA04484 Unknown OTH OTH Unknown Unknown WAES0811USA01825 0 Unknown OTH OTH Unknown Unknown WAES0901USA02697 40 None OTH OTH Unknown Unknown WAES0902USA04490 Unknown OTH OTH Unknown Unknown WAES0805USA01028 Unknown OTH OTH Unknown Unknown WAES0807USA01622 1 Serum Glucose, PVT 08/06/2008, PVT 183 Insulin Type 1 diabetes mellitus WAES0808USA04266 0 urine glucose, OTH 08/15/08, OTH diagnosed Unknown with diabetes Egg allergyAsthma WAES0808USA04659 Unknown OTH OTH Unknown Unknown WAES0809USA03250 Unknown OTH OTH Unknown Unknown WAES0811USA02717 Unknown OTH OTH Unknown Unknown WAES0812USA02364 0 Unknown OTH OTH Unknown Movement disorder WAES0811USA00271 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0812USA03761 Unknown OTH OTH Unknown Unknown WAES0812USA04292 7 None OTH OTH Unknown Unknown WAES0812USA04527 Unknown OTH OTH Unknown Unknown WAES0812USA05081 954 Serum mumps OTHIgG antibody OTH 11/12/08 LIPITOR; - negative; LEVOTHYROXINE Drugserum hypersensitivity; rubella SODIUM IgGArthritis; 11/12/08Osteoporosis; - positive; WAES0812USA05090 serum Hyperlipidaemia; rubella IgG 11/12/08 Hypoth 379 serum hepatitis PUBC, 03/25/08, OTH pending; serum rubella IgG,Unknown 03/25/08, 4.13; serumWAES0804USA00374 varicella zoster, 03/25/08, 2.05; se 962 None OTH OTH None WAES0804USA00375 5979 Serum mumps OTHIgG antibody, OTH 03/28/08 None- just adequate; Serum None rubella IgG, 03/28/08 WAES0804USA01041 - adequate; Serum measles Ig Unknown OTH OTH Unknown Unknown WAES0804USA01249 diagnostic laboratory, OTH titer; OTHbody temp, Unknown 98 Unknown WAES0804USA02195 Unknown OTH OTH Unknown Hypersensitivity WAES0804USA02356 35 Diagnostic laboratory, OTH 24-dec-2007, OTH Unknown pt underwent severalConvulsion unspecified in outpatient childhood. WAES0804USA02566 tests; Neurological examination, n serum rubella OTH IgG, negative; OTH serum Unknown rubella IgG, negative;Unknown serum rubella IgG, negative WAES0804USA02684 0 Unknown OTH OTH Stroke; Cardiac disorder WAES0804USA02805 diagnostic laboratory, OTH ?/?08, OTH titersNone were equivocal; diagnostic Nonelaboratory, 80?, titers WAES0804USA02851 were equivocal
45 None PVT PVT None None WAES0804USA03127 12 None OTH OTH None None WAES0804USA03762 0 Diagnostic laboratory, OTH 03/25/08 OTH - negative measles, mumps, Unknown and rubella titer; Diagnostic WAES0804USA03905 laboratory, 05/16/2008 - m 0 Unknown OTH OTH Unknown None WAES0804USA04024 3143 serum measles OTHAb, 04/??/08, OTH posit, None serum mumps Ab, 04/??/08, None negat; serum rubella WAES0804USA04732 IgG, 04/??/08, posit Unknown OTH OTH Unknown Unknown WAES0804USA04855 6 Streptococcus OTHagalactiae, OTH04/22/08, Unknown negative Urinary tract infection WAES0804USA04886 diagnostic laboratory, OTH 12/??/07, OTH negat, Unknown rubella antibody titer; Unknown diagnostic laboratory, WAES0804USA04958 ?/?/07, negat, rubella antibody t 11 None PVT PUB Penicillin allergy; Hives Viral infection WAES0804USA04963 1648 diagnostic laboratory, OTH positive OTH for mumps; Unknowndiagnostic laboratory, Unknown 03/07/08, 0.32,WAES0804USA05045 mumps titer; diagnostic laboratory, Unknown OTH OTH Unknown Drug hypersensitivity WAES0804USA05494 Diagnostic laboratory, OTH not OTHimmuneUnknown to rubella Unknown WAES0804USA05945 0 Unknown OTH OTH Unknown WAES0804USA06452 0 Unknown OTH OTH Unknown WAES0805USA00604 serum mumps OTH Ab, negat OTH Unknown None WAES0805USA00963 Unknown OTH OTH Unknown Unknown WAES0805USA00472 0 Unknown PVT PUB Unknown Unknown WAES0805USA01259 9 completed blood OTH cell. OTH None WAES0805USA01301 serum rubella OTH IgG, negative OTH rubella Unknown titer ELISA Unknown WAES0805USA01724 Unknown OTH OTH Unknown Unknown WAES0805USA02007 Unknown OTH OTH Unknown Unknown WAES0805USA02008 None PVT PUB None WAES0805USA02851 Unknown OTH OTH Unknown Unknown WAES0805USA03043 Unknown OTH OTH Unknown Unknown WAES0805USA03044 0 Unknown OTH OTH Unknown WAES0805USA03443 Unknown OTH OTH Unknown Egg allergy; Allergy to grains; Allergy WAES0805USA04017 to nuts; Fruit allergy; Milk allerg 72 Magnetic resonance, OTH pendi; OTH electromyography, ZYRTEC Drug pendi; hypersensitivity; diagnostic laboratory, Penicillin pendi, allergy; WAES0805USA04028 comprehensive Iodine allergy metabolic pane 13 None OTH OTH vitamins (unspecified) None WAES0805USA04742 1968 Serum mumps OTHIgG antibody OTH 05/22/08 Unknown 1.9 - elevated; serum Unknown immunoglobulin G 05/22/08 WAES0805USA04823 < 0.8 - negative; serum am 0 None OTH OTH None None WAES0805USA05616 serum mumps OTH Ab, negative OTH mumps Unknown titer; serum measlesUnknown Ab, acceptable titer; serum WAES0806USA00334 rubella IgG, acceptable titer 47 ultrasound 04/12/08 OTH epidi OTH Unknown Unknown WAES0806USA00655 0 Unknown OTH OTH Unknown Atopy; Hypersensitivity; Egg allergy WAES0806USA01349 0 None OTH OTH Unknown None WAES0806USA01956 Serum mumps OTHAb, Titer OTH is negative Unknown for mumps. Unknown WAES0806USA01991 Diagnostic laboratory, OTH MMR OTH titer - Unknown did not respond to oneUnknown of the components WAES0806USA02474 6150 serum mumps OTH IgG antibody, OTH 06/02/08, nortriptyline; 0.97, 0.91 Sulfonamide IMITREX to 1.09Migraine; considered allergy; Drug Hypersensitivity; equivocal hypersensitivity WAES0806USA03069 (low); Sleep serum disorder hepatitis B core, result 0 diagnostic laboratory OTH 12/??/07 OTH negat Unknown - rubella antibody titer; Unknown diagnostic laboratory WAES0806USA03246 01/??/07 negat - rubella antibody 0 Diagnostic laboratory, OTH 12/??/07, OTH neg rubella antibody titer; Unknown Diagnostic laboratory, WAES0806USA03247 ?/?/07, neg rubella antibody titer 15 None OTH OTH Unknown None WAES0806USA03736 serum mumps OTH Ab, Low; OTH serum measles Unknown IgG, Adequate; serum Unknown rubella IgG, Adequate WAES0806USA08308 13 diagnostic laboratory, PVT 06/23/08, PVT "no, amoxicillin "blood work"; Otitis body media; temp, Upper 06/23/08, respiratory low,tract atWAES0806USA09015 the infection physician's office; body temp, 0 4 None PVT OTH None Eczema; Cardiac murmur WAES0807USA00301 None OTH OTH Unknown Respiratory tract infection WAES0807USA00647 viral diagnostic laboratory, OTH low OTH mumps None titer Penicillin allergy; Allergic reaction WAES0807USA01282 to antibiotics 0 None OTH OTH [therapy unspecified] Port wine naevus; Allergic reactionWAES0807USA01385 to antibiotics diagnostic laboratory OTH - OTH antibody blood Nonetiter negative Egg allergyEczema for mumps WAES0807USA01390 serum rubella OTH IgG, negative; OTH serum None hepatitis B Ab, positive, None within range WAES0807USA01882 3679 serum albumin, PVT 02/20/08, PVT3.3 G/DL, Unknown low; mean Autoimmune corpuscular, disorder; 02/20/08, Colitis 32.8ulcerative G/DL, WAES0807USA02212 low; RDW, 02/20/08, 17.0 %, hig 2 biopsy, 11/25?/08, PVT it was PVT not contagious PLAQUENIL; and Penicillin could APLISOL be viral allergy; in nature; Drug hypersensitivity serum mumps WAES0807USA02259 Ab, 08/08/08, posit 0 OTH OTH Unknown Unknown WAES0807USA02929
serum rubella OTH IgM, negat OTH Unknown Unknown WAES0807USA03594 serum measles OTHAb, negative; OTH serum Unknown mumps Ab, able to seroconvert; Unknown serum rubella WAES0807USA04023 IgG, able to seroconvert; serum serum rubella OTH IgM, negat OTH None None WAES0807USA04121 diagnostic laboratory, OTH non-reactive OTH Unknown mumps titer Unknown WAES0807USA04834 1 None PVT PVT None Hypersensitivity WAES0807USA05192 serum measles OTHAb, 06/10/08, OTH <0.91, hydrochlorothiazide; negative;Hypertension; serum mumps lisinopril Cervical Condyloma; Ab,conisation; 06/10/08, Immunisation; <0.91, Cervical WAES0807USA05497 negative; dysplasia Fibromyalgia; serum rubella Penicillin IgG,alle 06 Unknown OTH OTH Unknown Pregnancy (LMP = Unknown) WAES0807USA05524 12 chest X-ray,OTH 07/28/08, OTH within normal limits; complete blood Unknown cell, 07/??/08, Normal; WAES0807USA05530 body temp, 07/19/08, 103 degre serum measles OTHAb, normal; OTH serumUnknown rubella IgG, Infertility normal; serum mumps Ab, low WAES0807USA05546 diagnostic laboratory, OTH negative OTH titers Unknown for Rubella Unknown WAES0807USA05695 0 Unknown OTH OTH Unknown Unknown WAES0808USA00136 0 Unknown OTH OTH Unknown Unknown WAES0808USA00284 Unknown OTH OTH Unknown Heart disease congenital WAES0808USA00678 9 WBC count,OTH 05/??/08, OTH 5000; WBCUnknown count, 08/08/08, Breast 2000; cancerWBC count, 08/12/08, WAES0808USA01310 5500 Unknown OTH OTH Unknown Unknown WAES0808USA01337 3878 serum measles OTHAb, 07/01/08, OTH Non-reactive None WAES0808USA01347 3 Unknown1/2008 OTH OTH Unknown Unknown WAES0808USA01675 8 None OTH OTH None WAES0808USA01729 diagnostic laboratory, OTH no OTH titers Unknown Postmenopause WAES0808USA01806 10 Unknown OTH OTH Unknown Premature birth WAES0808USA01821 Unknown OTH OTH NEXIUM; PENTASA; Penicillin allergy; ENJUVIA Drug hypersensitivity WAES0808USA01953 0 beta-humanOTH chorionic, OTH 08/12/08, positive Unknown Adhesion WAES0808USA02149 2 None OTH OTH None None WAES0808USA02648 2 None PVT OTH None Asthma Premature birth WAES0808USA02658 10 body temp, OTH 08/15/08, 101.9 OTH F None WAES0808USA03170 Unknown OTH OTH Unknown Peanut allergy WAES0808USA03536 7 body temp, PVT 07/30/08, 102; PVTbody temp, None08/02/08, Penicillin 36.9 Callergy Vomiting WAES0808USA04342 serum measles OTHIgM, low OTH measles Unknown titer Unknown WAES0808USA04672 -5 diagnostic laboratory, OTH 07/30/08, OTH titers-negative Unknown Drug hypersensitivity WAES0808USA04970 Unknown OTH OTH Unknown Unknown WAES0903USA01084 Unknown OTH OTH Unknown Unknown WAES0903USA01085 Unknown OTH OTH Unknown Unknown WAES0903USA04716 0 Unknown OTH OTH Unknown Unknown WAES0903USA04868 213 magnetic resonance, OTH normal; OTH computed axial, normal; electroencephalography, Unknown WAES0808USA04990 abnormal 0 None OTH OTH Unknown WAES0808USA05346 Unknown OTH OTH Unknown Unknown WAES0809USA00020 24 serum mumps OTH IgG antibody, OTH 4.41;Unknown serum mumps IgM antibody, Salivary80 gland disorderWAES0809USA00264 serum measles OTHIgG, >0.91 OTHU [therapy unspecified] None WAES0809USA00311 serum measles OTHIgG, 06/06/06, OTH negative None None WAES0809USA00514 body temp, OTH 107 F OTH Unknown Unknown WAES0809USA00720 1 OTH OTH Renal disorder Feeding tube insertion;WAES0809USA01166 Congenital genitourinary abnormal 1040 Diagnostic laboratory, OTH 08/08, OTH titer test revealed not protected Nonefrom mumps. WAES0809USA01376 12 Unknown OTH OTH Unknown Unknown WAES0809USA01587 229 Diagnostic laboratory, OTH negative OTH for rubella titers; Drug diagnostic hypersensitivity laboratory 08/18/08,WAES0809USA01970 rubella titer still negative. Serum umps OTH Ab, 09/05/2008, OTH negative. None None WAES0809USA02105 Erythrocyte,OTH increased OTH from the 60's to 188 Glaucoma; Breast Depression; mass Insomnia;WAES0809USA02613 Drug hypersensitivity; Food allergy Unknown OTH OTH Unknown Unknown WAES0809USA03791 0 Serum measles OTH IgG, low OTH titer; Serum Unknown mumps IgG antibody, Unknown low titer; Serum rubella WAES0809USA04333 IgG, low titer. 1 None OTH OTH None None WAES0809USA04517 55 None OTH OTH Unknown Unknown WAES0809USA04525 diagnostic laboratory, OTH low OTH mumps None titer Penicillin allergy; Allergic reaction WAES0809USA04597 to antibiotics
0 Unknown OTH OTH None WAES0809USA04616 7 None OTH OTH None None WAES0810USA00010 16 pelvic ultrasound, PVT normal; PVTurine beta-human, FLONASE; Pregnancy positive ibuprofen NOS (LMP = 8/15/2008); WAES0810USA00544 Seasonal allergy; Thyroid disord serum measles OTHAb, adequate; OTH serum None mumps Ab, adequate; None serum rubella IgG,WAES0810USA01976 negative or low 13 None OTH OTH Unknown None WAES0810USA03413 0 Unknown OTH OTH Unknown Unknown WAES0810USA03422 Unknown OTH OTH Unknown Unknown WAES0810USA03729 Unknown OTH OTH Unknown Unknown WAES0810USA03787 None OTH OTH None None WAES0810USA03948 8 Unknown OTH OTH Unknown Unknown WAES0810USA04143 Unknown OTH OTH Unknown Unknown WAES0811USA00283 924 serum mumps PVTIgG antibody, PVT 10/25/08, Unknown positive; serum mumps None IgM antibody, 10/29/08, WAES0811USA02891 positive; serum mumps IgM Unknown OTH OTH Unknown Unknown WAES0811USA03062 15 OTH OTH Unknown Drug hypersensitivity WAES0811USA04133 Unknown OTH OTH Unknown Unknown WAES0812USA02053 11 None OTH PVT Citalopram,Depression Olanzapine WAES0812USA02331 Unknown OTH OTH Unknown Unknown WAES0812USA02373 serum measles OTHAb, 02/24/08, OTH negat; Unknown serum measles Ab, Unknown 04/30/08, negat WAES0812USA02572 Unknown OTH OTH Unknown Unknown WAES0812USA02587 7 None OTH OTH None None WAES0812USA02768 body temp, OTH 104 degrees OTH Unknown Latex allergy Anaphylactic reaction WAES0812USA02808 Unknown OTH OTH Unknown Unknown WAES0812USA03174 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0812USA03218 4 Unknown PVT PVT Injection site irritation WAES0812USA03515 Unknown OTH OTH Unknown Unknown WAES0901USA00128 0 None OTH OTH LAMICTAL;Drug SEROQUEL hypersensitivity Emotional problems WAES0901USA00177 serum rubella OTH IgM, 01/01/09 OTH - low Unknown titer WAES0901USA00190 None OTH OTH None Unknown WAES0901USA00321 1 None OTH OTH None Drug hypersensitivity; Tonsillar disorder Hypersensitivity WAES0901USA01341 0 Unknown PVT PUB None WAES0901USA01725 Unknown OTH OTH Unknown Unknown WAES0901USA01824 Unknown OTH OTH Unknown WAES0901USA03456 diagnostic laboratory, OTH rubella, OTH mumps Noneand rubeola titers None WAES0901USA03472 0 Unknown OTH OTH Unknown Hypersensitivity WAES0901USA04120 Unknown OTH OTH Unknown Unknown WAES0901USA04183 None OTH OTH Drug hypersensitivity WAES0902USA00262 Unknown OTH OTH Unknown Unknown WAES0902USA00430 serum mumps OTH Ab, negative OTH Unknown None WAES0902USA00441 Unknown OTH OTH None Attention deficit disorder WAES0902USA00453 7 None OTH OTH None None WAES0902USA00468 Unknown OTH OTH Unknown Unknown WAES0902USA00612 Unknown OTH OTH Unknown Unknown WAES0902USA01084 25 Diagnostic laboratory, OTH rubella OTH non immune; Ultrasound, Pregnancy01/23/09, Miscarriage NOS (LMP 7 weeks = 11/30/2008); 3 days WAES0902USA01110 gestation Fertility decreased Unknown OTH OTH Unknown Unknown Asthma~Measles WAES0902USA01776 (no brand name)~UN~5~Sibl Unknown OTH OTH Unknown Unknown WAES0902USA01784 diagnostic laboratory, OTH antibody OTH response Unknown to MMR is negative Unknown WAES0902USA01858 None OTH OTH Unknown None WAES0902USA01880 Unknown OTH OTH Unknown Unknown WAES0902USA02376 Unknown OTH OTH Unknown WAES0902USA02405 0 None OTH OTH Unknown Jaundice WAES0902USA02482 Unknown OTH OTH Unknown Unknown WAES0902USA02618
serum measles OTHAb, 0.98, OTH negative;Unknown serum rubella IgG, positive; Unknown serum mumps Ab, WAES0902USA02792 positive Unknown OTH OTH Unknown Unknown WAES0902USA02907 Diagnostic laboratory, OTH rubella OTH titersUnknown were normal; Serum measles UnknownAb, negative; WAES0902USA02944 Serum mumps Ab, normal 2775 Unknown PVT PVT Unknown Unknown WAES0902USA03071 Unknown OTH OTH Unknown Unknown WAES0902USA03102 Unknown OTH OTH Unknown None WAES0902USA03118 serum mumps OTH Ab, negative OTH Unknown Sulfonamide allergy WAES0902USA03602 Unknown OTH OTH Unknown Unknown WAES0903USA00343 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0903USA00538 body temp, OTH 105 OTH Unknown Unknown WAES0903USA00594 Unknown OTH OTH Unknown Unknown WAES0903USA00746 Unknown OTH OTH Unknown Injection site reaction WAES0903USA00892 Diagnostic laboratory, OTH negative OTH forNone rubeola antibody titersNone WAES0903USA00918 4 Unknown OTH OTH Unknown Unknown WAES0903USA00923 None OTH OTH None Seafood allergy; Shellfish allergy WAES0903USA00967 9 Unknown OTH OTH Unknown Unknown WAES0903USA01091 0 diagnostic laboratory OTH OTH None Gluten intolerance Gastrointestinal discomfort WAES0903USA01096 Unknown OTH OTH Unknown Unknown WAES0903USA01408 Unknown OTH OTH Unknown Unknown WAES0903USA02001 None OTH OTH None None WAES0903USA02076 Unknown OTH OTH CYANOCOBALAMIN, Pernicious SYNTHROID anaemia; Hypothyroidism; WAES0903USA02227 Back surgery 0 None OTH OTH None None None WAES0903USA02298 Unknown OTH OTH Unknown Unknown WAES0903USA02334 Unknown OTH OTH Unknown Unknown WAES0903USA02338 0 Body temperature, OTH 08/??/05, OTH high Unknown fever None WAES0903USA02344 16 None OTH OTH None None WAES0903USA02357 Unknown OTH OTH Unknown WAES0903USA02558 Unknown OTH OTH Unknown WAES0903USA02571 body temp, OTH 104 OTH Unknown Unknown WAES0903USA02669 serum rubella OTH IgG, 03?/??/09, OTH lowUnknown levels of immunity Pregnancy NOS (LMP = Unknown); WAES0903USA02918 Food allergy Unknown OTH OTH Drug hypersensitivity; Asthma Breathing difficult~Varicella WAES0903USA03186 (Varivax)~UN~8~P Unknown OTH OTH Unknown Unknown WAES0903USA03661 0 Unknown OTH OTH Unknown Unknown WAES0903USA04009 Body temperature, OTH overOTH 105 degrees Unknown Fahrenheit Unknown WAES0903USA04524 Unknown OTH OTH Unknown Unknown WAES0903USA04535 200 Serum measles OTH Ab, 03/16/2009, OTH negative. Albuterol; Veramyst; Asthma; Seasonal Trazodone allergy; hydrochloride AllergicWAES0903USA04550 reaction to antibiotics Unknown OTH OTH Unknown Unknown WAES0903USA04711 Serum measles OTH Ab, negative OTH PROSCARBenign prostatic hyperplasia WAES0903USA04728 Unknown OTH OTH Unknown Unknown WAES0903USA04776 0 None OTH OTH None None WAES0903USA04855 Unknown OTH OTH Unknown Unknown Adverse event~Measles WAES0903USA04857 + Mumps + Rubella (n Unknown OTH OTH Unknown Unknown fever~Measles WAES0903USA05410 + Mumps + Rubella (no brand n Unknown OTH OTH Unknown Unknown WAES0903USA05433 Unknown OTH OTH Unknown Unknown Waes0903USA05610 0 Unknown OTH OTH Unknown WAES0904USA00002 Unknown OTH OTH Unknown Unknown WAES0904USA00009 Unknown OTH OTH Unknown Cardiac septal defect WAES0906USA01886 3683 Unknown OTH OTH None Drug hypersensitivity WAES0906USA02262 8 Not reported MIL MIL Medical history not reported ### CT Scan - revealed UNK lesions UNK in liver The patientNo hadadverse a history e~Japanese of chronic ### hepatitis Enceph. B. (J-VAX)~1~0 It was unk 0 CLINICAL MIL MIL NONE NONE NONE
1 PUB PVT 687 UNK PVT none 1 05/14/2009:UNK WBC 11.8UNK H /cumm RBC ALBUTEROL 5.0 M/cumm None 90MCG HGB(CFC-F) PMH: 16.4 GERD, g/dL 200D HCT low ORAL 46.8 back INHL MCV pain,INHALE 93.6 chronic fem/l 2airway MCH PUFFS 32.7 obstruction, BYpic MOUTH 35.0% al 0 PUB PUB UNK NONE NONE 1 UNK UNK 257 PUB PVT None reported Allergic to Dimetane History of Infectious Mononucleosis 1 1 PVT PVT none none none 1 PVT PVT none history of fever seizure 0 UNK UNK NA NA NA 0 MIL MIL Mobic, Claritin, No GenericAllergic Prozac, toCentrum penicillian, Siver hayfever 113 UNK PUB 0 UNK UNK 0 UNK UNK UNK UNK 11 MIL MIL 0 None PVT PUB None Known 5/18/09: Chronic Amoxilcough 6/8/09: Pnuemonia. 6/16/09: A 0 N/A PVT UNK Advair & Albuterol No Allergies to pollen and pet dander, asthma 10 MIL MIL 1 7/7/09 Hospital UNKrecordsUNK received DOS ALBUTEROL 5/5/09 N/A 5/9/09. NEBULIZER LABS RSV and SOLUTION BRONCHILOITIS. DIAGNOSTICS: 7/7/09 RSV (+) Hospital Leukocytosis. records received D 0 UNK UNK N/A PUB PUB None None No known allergies 1 PUB PVT no but sleep deprived and stressed (patient works night shifts) 2 CT scan ruled UNK out postUNK op infectionPropanolol, as sourcefollowing Alavert of fever.D, laparoscopic 7/2/09 Codeine, Darvocet, Hospital aspirin. Xanax, None~ cholecystectomy records 7/2/09 Wellbutrin, ()~~0~Patient|None~ received Hospital Bayer DOS records vitamin 6/18/09 ()~~0~Sibling|Non received to 6/20/09. DOS 6/L 1 PVT PVT None None PVT UNK 2 none UNK UNK none none none 1 None PVT PUB After event None on CEPHALIXIN None 1 None PVT PUB Well Child GER 0 No further testing PVT donePVT None Congenital Nystagmus 1 None PUB PUB None None Child is a twin 14 10/08/08 EEG; PUB02/12/09 PUB EEG & MRI None None None KS200903 4 PVT PVT KS200907 2 PVT PVT BACTRIM Sinusitis Allergies to PCN, CEPHALOSPORINS KS200906 0 None PUB PVT None KS200905 7 Spinal Tap PUB to check forPUB meningitis. Test came None back negative. None KS200904 0 electroencephalography, UNK OTH results not hydromorphone; provided;Anxiety; full blood SINGULAIR; Depression; chemistry, Spinal fracture ZOLOFT Asthma; results not Twitching; provided WAES0906USA02278 Tremor 0 PVT PVT YASMIN. 11 Nerve conduction PVT study, PVT positive for TOPROL acute axonal XL; None PLAVIX; injury. CAD; 7/8/09 Aspirin; peripheral consult COZAAR records neuropathy; ; ZOCOR received HTN; DOS gout; 11/3/08 Hyperlipidemia; to 6/13/09. A L 0 OTH PUB Benadryl given None Hosp VSD repair/transfusion required. 1 6/26/09 Received PVT medical PVTrecordsTYLENOL; LABS: EEG None ZANTAC WNL. CTGERD head WNL. 6/26/09 Osseous Received survey medical x-rays records neg except PMH: Parainflue for right c 12 EEG PVT UNK Allergic rhinitis / cough 0 PVT PVT 1 PVT PVT None None 2 MRI; EEG PVT UNK Yes, had abnormal CBC 2548 PVT OTH Unknown None 2 None PVT OTH PPD Cold; urticaria Cold Aug URI '06Aug '06~Vaccine not specified (no br 1 None donePUB PUB None diabetes 0 PVT PVT None Pure Hyperglyceridemia None 1 PVT PVT None Prematurity; stenosis of nasolacrimal duct None PVT PVT MOTRIN; KEFLEX; None BENADRYL Ectopic testes; Atopic dermatitis 0 No 9/22/09-records PVT receivedPVT EKGNone sinus arrhythmis. None EEG None normal. Labs ~HPV WNL. (Gardasil)~1~17~Patient
1
PUB PUB None Fussy, increase gas on Similac advance- Doing well on Si OTH MIL OTH MIL 10 None PVT OTH None Conjunctivitis None 2 See attached OTH documentation. UNK Dyazide; Zoloft; NoneNasacort Allergies AQ; Travatan (mold, dust); High blood pressure; Glaucoma 1 NONE MIL UNK NONE UNKNOWNNONE 0 PVT UNK none 0 ultrasound, PUB 09/01/08, OK OTH vitamins (unspecified), Pregnancy NOS tab (LMP = 5/5/2008)WAES0810USA02712 1 chest X-ray,OTH 06/10/09, OTH negative; diagnostic None laboratory, Immune-mediated 06/10/09,thrombocytopenic negative for influenza; WAES0906USA02119 purpura; diagnostic Anaemia urinalysis, macrocytic 06/10 1 Unknown UNK OTH Unknown Unknown WAES0906USA02577 Unknown OTH OTH Unknown Unknown Autism~Measles WAES0906USA02082 (no brand name)~UN~0~Sibli 7 None OTH OTH Unknown None WAES0906USA02085 Unknown OTH OTH Unknown Unknown Leukaemia~Measles WAES0906USA02257 (no brand name)~UN~0~S 0 Ultrasound,UNK 12/21/07, positive UNK None Pregnancy NOS (LMP = 10/29/2007) WAES0802USA04905 100 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0906USA02049 Unknown OTH OTH Unknown Predisposition to disease WAES0906USA02099 0 Unknown OTH OTH NASOCORT; Drug erythromycin; hypersensitivity Overgrowth NASONEX; bacterial neomycin WAES0906USA02310 Unknown OTH OTH Unknown WAES0906USA01892 0 Unknown OTH OTH None Oxygen supplementation. Premature baby6/23/09 less than WAES0906USA02328 Medical 26 weeks; records Intensive received care DOS 6/12 0 PUB PUB 0 UNK UNK 0 UNK UNK 0 UNK UNK 0 UNK UNK 1 none at time PUB of this report PUB none reported no none reported 0 none UNK PUB protonix, toprol, nonesynthroid NKA 0 PVT PVT none none eczema 0 N/A MIL MIL N/A None None 1 PUB PVT None None None 0 none PUB PUB None overweight 0 PVT PVT NO 0 UNK UNK 1 PVT PUB VITAMINS N/A 0 PVT PVT none none 0 UNK UNK 1 none UNK PVT Lipitor, Metoprolol none allergy to Plavix and pollen. Medical condition includes hea 0 UNK UNK 2 PUB PUB COUGH ASTHMA 3 None PVT UNK Zocor, Sinemet, NoneTriamterene/HCTZ, Hyperlipidema,Cimetidine, RLS, HTN,Etodolac GERD, DJD, 0 UNK UNK 0 UNK UNK 0 none PUB PUB MOTHER STATES NONE NONE MOTHER STATES N/A~ ()~NULL~~In NONE Sibling1|N/A~ ()~NULL~~In 2 PVT UNK Norvasc none NKDA; HTN; pre- DM 0 UNK UNK 0 UNK UNK 17 PVT PVT 1 CM INGUNAL REGION~Measles + Mumps + 1 PVT UNK WARFARIN, NONE TRAZODONE, DILTIAZEM COMBIVENT, - NAUSEA/VOMITING METOPROLOL, SIMVASTATIN, LAS 1 PUB PUB None No No 1 N/A PVT PVT none none none 4224 PVT UNK 4 NONE PVT PUB NONE THIS IS A FOSTER CHILD MOTHER WAS ON DRUGS A
3 UNK UNK Ct rcvd Rx for n/aTy21a and n/aChloroquine from health dept on 6/15/09. Ct purchased 1 UNK UNK 104 PVT UNK 4 n/a PVT PVT NONE N/A N/A 6 6/29/09 Medical UNK records UNK received DOS 1/15/08 Acute to 8/20/08. Diarrhea Diarrhea LABS and for 2DIAGNOSTICS: weeks, watery mucousy, Stool - Fecal greenish. Reducing 6/29/09 SubsM 222 MIL MIL none none none 0 na PVT PVT no None 2 UNK UNK oral Hydrocortisone, see #19-NO Synthroid, Addison's ACUTEOxycodone ILLNESS Disease, Lymph nodes Cushing's CR, in Oxycodone neck Syndrome, on side IR, of Valium SEVERE injection 2mg, fluid terribl Xan re 196 PVT OTH None 0 PVT PUB None 3 wks URI Sx 1 None OTH PVT None None None 1 OTH PVT None 0 PUB PVT Fever, JointH/A pains -5 PVT PUB 8 UNK. 7/9/09PVT Hospital records PUB received DOS 6/5/09 Unknown to 6/7/09. The subject LABS and wasDIAGNOSTICS: completely A0792059A healthy Hemoccult prior to vaccination. (+). X-ray Che H 1289 (+) PCR OTH OTH 0 CBC; INR normal. PVT 7/7/09 PUBHospitalAspirin; recordsSotalol; received Enalapril; DOSComplex 6/0/09 COUMADIN tocongenital 6/3/09. LABS heartand defect; DIAGNOSTICS: s/p surgeries; CBCHx ofRBC SVT5 7 thrombophilia PVT evaluation OTH is entirelyLORAZAPAM negative. 9/17/09 None Hospital None.records PMH 9/17/09 received Hospital DOS 4/27/09 recordsto received 4/28/09.DOS LABS 4/27/0 and MIL MIL 19 None. OTH PUB TOPROL XL None 25 mg one Hypertension; once daily; HCTZ Hypercholesterolemia 25 mg one once daily PUB PUB None None 1 PVT PUB 1 Acute URI 465.9; PVT Viral PUB Syndrome 079.99 Viral Syndrome; NoneAfebrile 0 None PVT PVT None None 0 PVT PUB None 0 None PVT PVT None None None 1 PVT OTH none none 2 UNK UNK 9 Stool for C.PVT difficile toxin PVT (both times None was positive). None None OTH OTH None None None 1 None PVT PUB None None Right ear canal obstructed birth defect (Atresia) 0 PVT PUB MIRALAX 2 PVT PUB PPD No No None PVT PVT None None UNK UNK 1 None PVT PVT No None 1 None PVT PVT None None 0 PUB PUB ZYRTEC; RANITIDINE Denied Seasonal/pollen allergies 0 PVT PVT None None 2 PVT PUB SUDAL 12; SINGULAIR Unknown 0 None PVT UNK None Sulfa ASA allergies; Reiter's syndrome; Anxiety; Spastic co 1 PVT PVT Synthroid, 0.100 None mg. Zyrtec None 10mg. qd 0 PUB PVT at visit BENADRYL None known 25 N mg one po, known 50 mg IM 2 none PVT OTH None None None 1 Dad req. Abx. PVT therapy PVT (1) given ZYRTEC 10mg None QD x7 day Asthma - (2) Cefadroxil 250mg 1 1/2 tsp BID x10d. 718 PAP smearPVT PUB CONCERTA None 27mg None OTH OTH 0 PVT PUB None None VSD, surgically completely repaired 1 PUB UNK None - tookNone baby aspirin None and Lovostatin later in the night 1 UNK UNK EMSAM (Transdermal None Allergic Selegiline) rhinitis Dose associated is 6 mg/24 withhours environmental EMSAM allergies is an MA UNK UNK
2 I am seeingUNK a board certified UNK rheumatologist who None can confirm allergies my diagnosis. to sulfa drugs and barbiturates 0 PVT UNK none none 77 colagenosisUNK estudies( c3 PVT c4 anas),NONE RMN ANDNONE ANGIO-RMN, NONE EMG, VDRL, PCR , LUMBAR PUNCTION WITH DIFF 1 PVT PVT none allergic to peanuts 1 NONE AS OF PUB YET. UNK NONE REACTS TO NONE~ AMOXICILLAN ()~NULL~~In Sibling1|NONE~ ()~NULL 1 PVT UNK none none none 8 body temp, OTH 4/22?/08, 103; OTHbody temp, 4/22?/08, 104 Unknown WAES0804USA05245 0 Unknown OTH OTH Unknown Unknown WAES0810USA02860 Unknown OTH OTH Unknown Unknown WAES0903USA03639 Unknown OTH OTH Unknown Renal insufficiency; Diabetes;Hypertension; Asthma; Myocardial WAES0906USA01827 Coronary infarction artery disease 2 MIL OTH Medical history Cardiac included diso~Influenza multiple ###seasonal (Fluzone)~~0~Patient allergies. OTH OTH Cardiac diso~Influenza ### (Fluzone)~~0~Patient 0 Stool for fecal, PVT03/08/09, PVT not seen; Nasopharyngeal RSV, Unknown 03/08/09, negative for WAES0904USA04516 RSV antigen; Nasopharyngeal hu 0 beta-humanOTH chorionic, OTH "positive" albuterol Pregnancy NOS (LMP= 2/15/2008); WAES0807USA03017 Asthma; Drug hypersensitivity 0 urine beta-human, OTH 08/18/08, OTH positive None Pregnancy NOS (LMP = 7/29/2008) WAES0808USA03705 154 magnetic resonance, OTH fine; OTHhead computed axial, fine; hematology, None PMH: immune scoliosis, system WAES0906USA02285 costochondritis, is compromised. sinusitis, Labs:pahryngiti Spirome 1 none PVT PUB none none 0 CBC, BasicMIL Metabolic Panel, MIL CT Scan Unknown of head None and HCGNone Ql test performed. Blood test normal with only elevation in 2 N/A PUB UNK Albuterol Inhaler, N/A Augmentin Allergies: (start Aspirin 6/07, end (GI distress), 6/17), Atorvastatin, Propafenone Coenzyme (dysrhythmia Q10, 0 none PVT PUB none no none 21 UNK UNK 8 UNK UNK None notednone 1 UNK PVT Sanctura, furosemide, Advair, Zetia, Midodrine, Glipizide, Simvastatin 0 PUB PUB none pt had not eaten no prev. all day. nka It was late afternoon 0 NONE PVT PVT NONE NONE NONE 0 PVT PVT no no no no~ ()~NULL~~In Patient 6 7/30/09 Hospital UNK records UNK received Prednisone DOS 6/17/09 none and 6/19/09. Plaquenil none. LABS 7/30/09 and DIAGNOSTICS: Hospital records Chest received X-ray DOS No evidence 6/17/09 for 6/19 a 2 PVT PVT NONE NONE 0 PVT PVT none none none 1 PVT PUB 0 PVT PUB on concerta & clonidine 0 None PVT UNK None Alergies: Prozac 0 Possible allergic PUB reaction PVT given Benadryl None by mouth None by mother, Allergic fully to Penicillin/shoulder recovered within several (R) surgery hours.3 weeks. 136 UNK UNK COPD 3 UNK UNK none He said that he is allergic to cephalosporins which he had 1 PVT PVT 0 N/A PVT UNK N/A No UNK UNK None none 11 CBC Platelet UNK count 8,000. UNKHospitalNone records received None DOS Hospital 4/8/09 records to 4/9/09. received LABS and DOS DIAGNOSTICS: 4/8/09 to 4/9/09. CBC Allergies - Plate 4 OTH OTH None No information provided 0 NONE PUB PVT NONE NONE NONE 0 UNK UNK None No None 8 UNK UNK aspirin 81 mg, none vitamin iodine D, multiple and shellfish vitamin allergies 9 None PVT PVT TYLENOL/PRN 2 None donePVT UNK None 2 PVT PUB Drug allergy, sulfa 2 None PVT PUB no meds. used Currently 0 CBC; CMP;PUB lipid panel;PUB urine pregnancy; Varicella titers None 0 PUB PVT 0 None MIL MIL Fluocinonide, None 0.05% Allergies : iodine; shellfish 0 none PUB PUB none asthma
- none -
OTH OTH PPD - None - - None 0 OTH OTH well child none 40 Plt count 26,000, PVT low; decrease PUB platelet count; ITP; stillBruises waxing from and waning; Low Platelet She has count chronic idiopathic thrombocytopen Unknown OTH OTH Unknown None WAES0906USA02596 1 CBC - 19.2 PVT > - < 446 UANME PVT None None None 1 None UNK UNK Hypertension; Degenerative joint disease; Peripheral neu PVT PVT NONE None NONE 2 None PVT PVT Icepack; MOTRIN None None 2 None PVT PVT Cold compress; NoneTYLENOL None 2 Rapid Strep-Negative. PVT PVT 0 MIL PVT Seasonal allergies only. 0 PUB PUB ORTHO CYCLEN none allergic to horses OR200924 1 PVT PVT 0 PVT OTH none Pt states sulfa allergy 1 PUB PUB Poor wt gain Developmental delay; Cerebral Palsy 0 PVT PUB None 1 None PVT PVT ALLEGRA None DQD all year Seasonal Allergies X 2 none~ ()~~0~Sibling 0 Stool culture, PVT negative PVT None None 0 PVT PVT None Hemoglobin C trait 0 None PVT PVT None None 4 OTH PVT ADVIL none reported none reported other than allergy to BACTRIM 0 PVT PVT 0 PVT OTH PPD 0 UNK UNK 0 UNK UNK 18 None UNK UNK None, extremely healthy 90 year old. 1 PVT PVT 1 PVT PUB SINGULAIRNone RAD 2 PVT PUB none no Per mother sensitive skin, reacts to insects 0 PVT PVT none PVT PVT None Well visit 0 BP: 100/70;PVT Sp02: 99 PUB PULMICORT, none-well 0.5 mg child in asthma nebulizer BID 5 PVT PUB No No PVT PUB 0 PVT PVT Well Child 0 PVT PVT None 1 None 6-18-09 OTH PVT None 6-18-09 None 6-18-09 Seasonal Allergies 1 None PVT OTH None None 1827 None PVT PUB None None None 91 Baby with ring UNK chromosome UNK 21 by mutation. Both husband none and wife carry normal gene. Not reported UNK UNK Not reported ### Not reported UNK UNK Not reported ### 0 beta-humanOTH chorionic, OTH result negative None Miscarriage; Anaemia WAES0906USA02881 92 Electroencephalography, OTH OTH normal; Magnetic LEXAPROresonance, Depression10/19/09 normal Neurology consultation WAES0906USA02971 records received, service Unknown OTH OTH Unknown Unknown WAES0906USA03450 0 Unknown OTH OTH Unknown Unknown WAES0906USA01707 3 stool testedPVT positive forPUB ROTATEQ virus. Severe reaction to Rota vaccine. 7/22/09 Hospital records received 5/18/0 17 Dx: Guillain-Barre PUB Synd; PUB Electromyography; None CXR, NoneMRI Spine; NIDDM; Lumbar HTN PMH: puncture HTN. LabsDM. andTachycardia.Sinus diagnostics: LP traumati surger 2 OTH OTH Unknown none none 1 PVT PVT WCC 0 PVT UNK None Cows milk intolerance, eczema, atrial septal defect, benign
PUB UNK None NotedNone Noted 0 OTH PVT None Allergy to Lipitor UNK UNK 2 None PUB PVT None None None 1 PVT UNK None PVT PVT None Peanut allergy 0 PUB PUB 3 PVT PVT None None 2 PVT PVT NONE NONE NONE 3 PUB PVT none known 9 Chest x-ray,PVT blood andPVT urine cultures Fungal cream Yeast infection Imbilical hernia 3 UNK UNK 0 Unknown atUNK time of thisUNK reporting. LevetiracetaNone Sol. 0.4 mlMother Bid. child has a seizure problem and was found to be h 1 PUB PUB none none none~ ()~NULL~~In Patient 1 unknown. PUB PUB none none none 1 I just sent aUNK note to Kaiser UNKstaf today. Protonix (40mg Noneonce aNone day); Fluoxetine (10mg twice a day) 0 None PVT PVT None no known None 0 N/A PUB PUB None None None Mother~DTP (no brand name)~NULL~~In Patie 0 PVT PVT 1 PVT PVT NONE NONE NONE 2 UNK UNK NONE NONE 34 WEEK PREMATURE DEVELOPED SOME GRUNTING 0 N/A PUB PUB Topical cortisone None cream Client for seborrhoeic diagnosed by dermatitis pediatrician with seborrhoeic dermatit 14 PUB PUB N/A None None 5 7/2/09 Consultant UNK records UNKreceived DOS 5/22/09 none6/2/09. none LABS and DIAGNOSTICS: Videonystagmography abnorm 1 Blood testing MIL at Emergency MIL Room, also X-Rays no known were taken. illness noneresults noted at timeunknown. of vaccination 52 esr and crpPVT elevated. echocardiogram PUB normal.none cradle-cap 25 MRI of left footUNKrevealed UNK bursitis and Ortho bone Tri-cycle marrow None. edema Allergy to lefttocalcaneus amoxicillinand andtalus. cefzil. CT scan of left foot- normal. 0 MRI of Left/Right UNK Shoulder UNK(Note: MRI was not None of the bicep Allergic muscle to sodium which was pentathol where the pain was); EMG of Left/Ri 27 Patient hadOTH his vision checked PVT by SIMVASTIN opthalmologist. None 20mg None 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 PUB PUB ALBUTEROL None occasionally. lethargic/fever~Varicella (no brand name)~1~5 0 MIL UNK None None Allergies to; ASA, Codeine, Benadryl, Latex 0 Went to ER.PUB had CT scan PUB& blood7/9/09 tests. Hospital 7/9/09 None Hospital ED records None. ED records received 7/9/09received Hospital DOS 6/15/09. DOS ED records 6/15/09. Ultramreceived LABS and DOS DIAGNOST 6/15/09. H PVT PUB PVT PUB 1 LABS and DIAGNOSTICS: MIL MIL Sigmoidoscopy None - Abnormal. None Gram None stain of stool - many white blood cells and several ty PVT PUB 0 PVT PVT 0 none acceptPVT sx mostly OTH resolved atNone evaluation.None None NC09025 490 PVT PUB 0 None UNK UNK None None Seasonal allergies -3286 PVT PUB None 0 PVT OTH None at time none of vaccination knownnone known 1 PVT PUB None None None
1 None PVT PVT None Fibromyalgia 3 OTH PVT None 0 PVT UNK Pt was hereNKDA for physical - Dermatophytosis of foot 1 Mono; Strep; PUB EKG PUB None No Recurring Mono, elliptocytosis NC09026 since birth None PUB PUB Unknown None None None PUB PUB Unknown None None 1 AST/ALt 74PVT each; LP negative; UNK CK-1232. None None 1 PVT PUB None None 2 MIL MIL None None 0 Transfer to OTH hospital; CTPUB scan at hospital TB Skin testNone Unknown Known None Known 0 None PUB OTH None None obesity; heart murmur 2 PVT PVT 0 None PVT PVT None None None 1 Labs i.e. CBC PVTwith diff PVT HCTZ; ASA; Simvastatin; Ibuprofen Redness and NJ200902 swelling in past with vaccines.~V 1 PUB OTH 1 PVT PVT 1 PUB PUB Vitamins None None 0 None PVT PUB None None 27 PVT PVT None None 0 PVT PUB None None None 1 None PVT PUB 0 UNK UNK 4 PVT PUB PREVACID;none MYLOCON knownGERD (simethicone) 0 t2- normal, UNK mri unknown UNK result, blood None tests ok.None 7/16/09 ER None. and 7/16/09 Hospital ~Anthrax ER records and (Biothrax)~UN~0~Patient Hospital receivedrecords DOS 6/11/02 received to 6/18/02. DOS 6/11 0 PUB PVT none highfever , cried for 3 hours~DTaP + IPV (KINR 31 PVT OTH No pre-existing medical conditions; ### was recovering from a 526 serum beta-human, OTH 06/08/09, OTH pregnant None Migraine WAES0906USA02582 Complete blood OTH cell, low OTH Unknown Unknown WAES0906USA02844 48 Unknown. 6/25/09 OTH Medical OTHrecords received DOS 5/22/09. Unknown. LABS and 8/6/09 DIAGNOSTICS: Hospital WAES0906USA03651 records C. Difficile received Toxins DOSA&B 6/03/09 not dt 30 Unknown. 8/21/09 OTH Hospital OTH records Unknown including extensive lab Unknown testing received DOS WAES0906USA03729 6/8/09 to 6/23/09. LABS and DIAG 0 LacerationsPVT PVT facial laceration 2 PVT UNK None None 0 None PVT PUB None None Known 0 N/A. UNK UNK None. None. None. 0 PVT PVT 10 Biopsy performed UNK of satellite UNK lesions 1. benadryl on June no 23, 25 illness mg 2009. 1 or at 7/16/09 no 2time tabs known ofMedical po vaccination diagnosed q 6 hrs records 2. Claritin allergies. received po7/16/09 3. DOS Zyrtec 2/08/08 Medical 10 mg torecords 7/15/09. po bid.rec 7 0 PVT PUB No Croup on 3/16/09, given decadron 0 Not Applicable PVT PVT None None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 0 7/30/09 Hospital UNK records UNK received None DOS 5/21/09 None to 5/24/09. None. MRI7/30/09 and EEG Hospital normal. records LABS received and DIAGNOSTICS: DOS 5/21/09Ches to 5 12 PVT PVT none fever,vomting,spots none onemmaleigh belly and back noah~Measles + Mumps + Rubella 1 8/26/09 Hospital UNK records UNK received Danazol 6/19/09 to 7/8/09. None reported LABS None andreported. DIAGNOSTICS: 8/26/09 Blood Hospital Alcohol records 250 received (H). Urine 6/19/09 Drug 15 PVT UNK none None None 2 PUB PVT fexofenadine, no tizanadine seasonal prn allergies, allergic to tree mold, cats, pseudephed 1 UNK UNK none 1 Medical records UNK received UNK 6/29/09 LABS: WBCNone 14.1(H), ANC None12.13(H)lymphs Medical records 8%(L). received 6/29/09 PMH: nasal fx. A 1 2 view CXRPUB PUB Zyrtec dailyRunny noseTracheomalacia, that he has had ASD, all spring Potential related asthma to allergies 1 none PVT PVT Lasix, Atenolol, nonePravastatin, no allergies; fish oil,hypertension, Calcium and D hyperlipidemia 1 UA, negative; PVT urine culture, PUB negative; None lactic acid; None MRI brain, Developmental abnormal; UA Delay; organic Warts; acids, Sebaceous results pending, nevus. ammonia 7/7/09 Ho 117 failed school PVT hearing test PVT ADDERALLacne; XR finger7/8/09 injury Medical records received DOS 8/6/07 to 6/24/09. A 12 5/13-15/2009: MILESR 66-75 MIL(high), CRP None10-12 pt (high), reported WBCquestionable "chest 3000 congestion" range history (low), xHct mild 3 weeks 31-32 chronic antecedent (low), leukopenia, Plt 65-74 to vaccination; thrombocyto (low); norma w 0 None PVT PVT CRYSELLE-28 sore throat None
1 information PUB not provided UNK to me None None 9 6/17/2009, MIL HSV1/2 IgM/G MIL both negative; oral contraceptives VSVnone Ab, immune none 1 None at present PVT PVT None None None PVT PVT None None Left clavicular hemangioma; Preterm twin 3 1/2 wks 0 PVT PUB none none 0 PVT PVT FLONASE 50mcg/ACTUATION Pt allergicQD to BACTRIM 0 Pt. evaluated PVT by primary PVT care physician HCTZ; Metoprolol; None Lisinopril; Hypertension; WELLBUTRIN; asthma;Senna; GERD;Polyethylene h/o breast cancer; Glycol;Anxiety/d PRILO 2 None PVT OTH None None 0 PUB PVT ZOLOFT; SYNTHROIDSulfa and Erythromycin allergies. 2 Patient evaluated PVT by primary UNK care physician Cough, improving PCN, "Cillins", latex, Naprosyn 1 OTH OTH None None None 1 Varicella culture PVT is pending OTH None None 0 PVT PVT 0 PVT PVT 6 No prior H/oPVT allergic reaction OTH to Td. Denies Denies any medical problem. NKDA. 1 normal pulse OTH 56-62; BPPVT of 116/60 mastectomy 95 complete blood OTHcell; serum OTH progesterone vitaminstest; (unspecified) Pregnancy HIV antibody NOS screen; (LMP Rapid = 12/14/2007) plasma WAES0802USA00127 reagin; serum rubella IgG; serum 0 beta-humanOTH chorionic, OTH 03/19/08, positive Unknown Pregnancy NOS (LMP = 2/25/2008) WAES0803USA03943 0 Unknown OTH OTH Unknown Apprehension; Nervousness WAES0906USA03355 0 Unknown. 8/10/09 OTH ER OTH records received Unknown DOS 6/16/09. LABS Unknown and DIAGNOSTICS: WAES0906USA03836 CT - Right frontal scalp hematom 74 MRI; Brain scan PVT 7/13/09 UNK Hospital records received DOS Milk; 12/28/01 Penicillin; to 12/31/01. CMT. 7/13/09 LABS and Hospital DIAGNOSTICS: records received NerveDO C 3 6/26/09 Hospital PUB records OTH and DC summary MAALOX,received ATIVAN,DOS LOXITANE, CMT; 11/07/08 Allergies ZYPNEXA, to same 11/10/08. to as milk above~Hep COGENTIN and LABS penicillin; and B (no DIAGNOSTICS: Schizophrenia. brand name)~3~19 MRI PMH: B 2 Cellulitis (R)OTH upper arm.PVT Labs and Birth Diagnostics: controlNone pills; WBC Clindamycin 14,900. None. RUE No started known US (-). 6/10/09 allergies. Echo (-).PMH: blood none cx (-). 0 PPD UNK UNK PVT OTH LANTUS; COZAAR; diabetes, FLUOXETINE;GEM poorly controlled FIBROZIL; METEPROLOL; GLYBURID 1 None PVT PUB None None hemangioma x 2; eczema 3 PVT PVT 0 PVT PVT none none 2 PVT PVT none knownnone 1 PVT PUB None None obesity -9 PUB PUB none none none 2 Throat cult.PVT 1/16/09 (-) PVT for GABS. Motrin for sore PharyngitisNone throat at time of physical. 1 None MIL MIL ALEVE, BCP None None 8 Mother states PUB "some kind PUB of bloodNone test" None 1 PUB PUB Bees OR200925 0 None UNK UNK None None hat accelerated to 5 episodes in 2008 UNK and 3 this UNK year with the last only 2 weeks apart so it made things worse and the back nerve pain is in PVT OTH None None PVT OTH None None None None PVT OTH None None None 11 EBV titers were PVT c/w previous PUB infection; NoneIGM was None <0.2. Strep Allergic culture to PCN was(moderate negative. non-specific An MRI of the rash). brainAllergic was ordere rhin UNK UNK None PVT UNK DRYSOL None None None PVT OTH None 1 Drug screenPVT neg for street PVTdrugs/ Influenza CLARITINA10mg None for swine 1 po,neg 6/29/09 METHYLIN labs.ER 6/29/09 records 20 mg Medical FR received (3po) records DOSreceived 6/18/09:DOS ADD6/18/09 LA 10 UNK UNK None known Preterm twin infant (34 weeks gestation), SGA, hypoglycem PVT PVT 31 none UNK UNK none none None UNK UNK None known. None known. None. 1 PVT UNK NO NO NKDA 2 NONE UNK UNK Albuterol MDI, none bupropion, - yearly COPD, check-up etodolac, new-onset fexofenadine, hypertension, hydrocodone/APAP, chronic low backlisinopril, pain, no
0 PUB PVT Dura Med slight congestion urinary tract infection 0 None UNK UNK 0 N/A UNK UNK N/A NONE NONE NONE~ ()~~0~Patient|NONE~ ()~~0~Sibling|N 0 None PVT PUB None None 0 Asthma PVT PVT Proventil, Ventolin None NKDA 6 OTH OTH Allegra; Lipitor None 40 mg; PCN-rash, Singulair 10mg; Ceclor-rash Atacand 16mg Inappropriate PVT Immunization UNK 1 PVT PVT 1 PUB PUB None 0 None PVT PVT None 1 PVT OTH None None 1 PVT PUB none none PVT PVT mood swings~Measles + Mumps + Rubella (no 1 PVT PUB 1 OTH PVT None None Rapid strepPVT negative PUB None None None 24 5/29 MRI head PVT& spine.PVT LABS and DIAGNOSTICS: Mild URI 7/2/09 1-2 Unilateral week Hospital prior Cryptorchidism records illness received - CF DOS carrier. 5/29/09 to 6/2/09. MRI S 13 5/6/2009: hCG, MIL UA neg; MIL 5/8/2009:None Non-contrast None brain MRI None negative;H/Al 5/9/2009; blurredVA, vision; IOPS, nausea; chemistry/hCG/CXR fatigue onset within norm 2 None PVT PVT None None 0 Unknown PVT PVT NKA None PVT OTH PULMICORT; None AlbuterolAsthma sulfate (NEB) None PVT OTH Albuterol sulfate None inhalerNone None PVT OTH None None None 9 PVT PVT none no 2 PVT PUB 2 UNK UNK ### 0 MRI of Brain OTH and orbital OTH Sockets; CBC; SYNTHROID; Ferritin None level MOBIC;History PREMPRO of migraines; Hypothyroid; ### Arthritis-osteo 7 OTH OTH PRILOSEC ### 3 OTH OTH ### 3 OTH OTH ### 3 OTH OTH ### 3 OTH OTH None None None ### 0 OTH OTH COUMADINStroke in Dec Minor 2008 back surgery in Nov 2008; ###Fractured pelvis in Nov 2 Unknown OTH OTH Unknown Unknown WAES0906USA04131 7 serum beta-human, OTH 09/02/08, OTH positive Papanicolaou smear abnormal; WAES0809USA00445 Cervical dysplasia 0 vital sign, 06/13/09, OTH normal; OTH bloodNone glucose, 06/13/09, normal None WAES0906USA02614 692 Chest X-rayOTH (results: no OTH infiltrates,Unknown vascular congestion, The patient's pulmonary concurrent nodules illnessorincludes pleural USWYEH09220209 effusions.) gastroesophageal and antibody reflux test dise 0 PVT PUB None None None 0 PVT PVT None None 0 PUB UNK None None None PVT PUB No Heart - mitral valve pulmonary stenosis 1 PUB PUB None None 0 PVT PVT Children's Tylenol She had a cold approx 1 month prior. 0 None-referred PVTto Allergist PVT None None None None PVT UNK None None 1 None PVT PUB None None None 38 Parvovirus PVT B19 Ab, IgGPVT S, 4.57; Parvovirus None at time B19 None ofAb, vaccination IgM,Osteoporosis; S, 0.20 skin CA 1 PUB PUB CADUET and None ZANTACHypertension 25 6/13/09 CT PVT of neck- C-spine UNK normal. None No None 1 Chest X rayOTH 6/1/09 OTH None Had viral URI Allergythe week peanuts. prior - was getting better. 0 UNK UNK
1 None UNK PVT None None 0 1530 spokePUB to mom and PUB mom stated "she is doing None fine". 2 Unknown OTH PUB None None PVT UNK PVT PVT BCP (KANVA); no CLARITIN; allergies XANAX to sulfa, prn amoxicillin, PCN, ZITHROMAX 0 6/25/2009 WBC UNK 14.2 with UNK17 neut, 80 lymp, 2none eos, 1 baso; none Hb 10.3 now but had dropped to 8.9 and 9.2. Platelet co 0 all labs apparently PUB negPVT Pt. had surg. p. 5-15-09 is on a B/P for bladder med andrepair. Neurontin. no illness Has at hxtime of kidney/bladde of vaccinatio 1 Antonio wasPUB taken by ambulance UNK to Brandywine none Hospitalnone in Coatesville, PA. Labs include CMP and urine tox scree 1 UNK UNK N/A none none 1 UNK PUB Nuva Ring No Penecillin allergy, Hx migraine headaches 0 unknown UNK PVT Claritin-D 24 Patient hour once reports Cervical daily, full loestrin recovery cancer24 (surgically from Fe, recent Nasacort, excised sinus Singulair, infection, 2003, no Advair reports recurrence), Diskus feeling 1a 0 UNK UNK None None None 1 PVT PUB CBOM CBOM 1 UNK PVT none none none 0 PVT PUB 2 MIL MIL none none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 6 PUB PVT 0 Rotavirus Antigen UNK in stool UNKpositiveNone on 6/25/09None (3 days - one after None soft vaccine). stool - healthy in Stool morning termculture/O infant prior to&vaccination, P are pending. but not 7/30/09 watery, Hosn 0 UNK UNK xanax,prozac,hyrochlorithiazide,lipitor,metformin,trazodone,lisinopril no crohns disease, hypertension, arthritis, diabetes 0 PVT PVT 70 None required. PUB UNK 2 None required. PUB UNK None. 0 PVT PVT None 2 Blood work UNK of DNA, ANA, UNKcomplement Nonelevels.None Urine analysis. None.X-rays PMH:Periodic ofnone. ankles. Sib swelling Later with oligoarticular of didlipHistone and eye~HPV tests juvenile which (Gardasil ideopath indica 0 None MIL MIL None None None (+) preg testPUB 6/10/09 UNK 0 MMR titer was PUB3.5 "took PUB MMR shot." None None Fever~Measles + Mumps + Rubella (no brand 0 none PVT OTH none none none 0 PVT OTH sinusitis NKDA Leg swelling, irritable.~DTaP (no brand name)~ 0 see attachment OTH OTH None per mother None per mother 2 PVT PUB None None 0 Albuterol nebulizer PVT tx inPUB office for bronchospasm. None None 0 OTH PVT None None 0 None PVT PVT PREVACID;none TAMIFLU Gastroesophageal reflux 1 PVT PVT 1 PVT PVT None Latex 15 PVT PVT Metformin 2000 Nonemg. daily, Allergic Glipizide to bee10stings, mg. daily, TypeActos 2 Diabetic 45 mg. daily, Lantus Solo 4 PVT PVT 7 UNK UNK enalapril 20ptmg, hadlovastatin told vaccinator asthma 20mg symbicort about an appointment 160/25, nasonex with ent for a recurring si 9 NONE UNK UNK NONE NONE NONE 0 Unknown OTH OTH ABILIFY; PROZAC; Pregnancy TRILEPTAL NOS (LMP = 8/8/2008); WAES0810USA01631 Depression; Attention deficit disor 0 Blood pressure, OTH 06/18/09, OTH90/60; Blood Hormonal pressure, contraceptives; 06/18/09, Vaccination 118/6 SOLODYN adverse reaction WAES0906USA03812 0 None OTH OTH None Unknown WAES0906USA04118 0 Unknown OTH OTH Unknown Unknown WAES0906USA04162 48 Negative rheumatoid UNK factor UNK and CCP Diclofenac; antibody,Codeine; 05/11/2009 LIPITOR Pt has labs:a20mg history CRP 2.3. daily; of Guillian-Barre HLAB27 XALATAN andeye HLADR4 Syndrome, drops; (-). Medroxyproges 1986 ANAPMH: weakly G 0 None PVT PVT None No None Pt did not seek UNKtreatment UNK for symptoms. albuterol/ipratropium No acute illnesses mdi Atrial (combivent); fib; chroniccarvedilol systolic heart 3.125failure; mg BID; history loratadine of (hx)10 MI,mg h 218 UNK UNK No Allergic to Bioxin 1 PVT PVT none none 1 N/A PVT PUB N/A N/A N/A 1 UNK UNK Left leg laceration infected
2 PVT PVT chronic rhinitis/cough 4 MRI, CAT Scan, UNK Lumbar UNK puncture,birth blood control,prozac. tests. none 7/16/097/16/09 Medical 7/16/09 Medical records Medical records received records received received DOS 7/25/07 DOS DOS 7/25/07 to 7/25/07 7/08/2009. to to 7/08/2009 7/08/200 LABS 1 ESR 36, CRP UNK 1.4, WBC UNK 10.9 7/6/09 Hospital Rash records received DOS 6/21/09 0/23/09. LABS and DIAGNOSTICS: C 0 PUB PUB none none none known 2 NONE PUB UNK ? NONE HTN & A-FIB, NO~ ALLERGIC ()~NULL~~In TO CODEINE Patient|?~ ()~NULL~~In Sib 3 PUB UNK Z-Pac Exposure toNone Pertusus -work related- no illness 0 Seeing physician PUB on 6/30/2009 PUB at 2:50 PM. Still none not doing Had well previous crying reaction and high at 2 mo fever~DTaP+IPV+HepB+Hib shots when he received sin (n 0 none PUB PVT none 3652 UNK UNK 2 unknown UNK PVT unknown none reported latex allergy 16 PUB PUB None None 13 PUB PUB ACOLATE OD; InhalerAsthma - ALBUTEROL 1 PVT PVT Unknown None None OTH OTH No other medications Unknown MA20091692 PUB PUB None Cough; respiratory infection, antibiotic taken. Resolved when he took 0 PUB PUB None Allg.; PCN 0 Not done PUB PUB None Fever and respiratory~DTaP + IPV + Hib (Pent OTH OTH No other medications Unknown MA20091708 OTH OTH No other medications Unknown MA20091709 OTH OTH No other medications Unknown MA20091710 0 None UNK UNK None None LA090602 OTH OTH No other medications Unknown MA20091712 OTH OTH No other medications Unknown MA20091713 OTH OTH No other medications Unknown MA20091714 OTH OTH No other medications Unknown MA20091715 0 PUB PUB OTH OTH No other medications Unknown MA20091716 1 NCS/EMG 2/16/09 PVT OTH DIOVAN; HCT; suspected COLCHILINE gout spherocytosis/HTN/ flare mild CKD/gout OTH OTH No other medications Unknown MA20091717 OTH OTH No other medications Unknown MA20091718 L-4, L5 Anterior MIL Spend;MIL loss, moderate Please toreview marked None vaccine central Prior None 4:on canal; applications canal 11 narrowing listed record above~Anthrax (PHS - 731(no REV brand 1-82)name)~UN~ OTH OTH No other medications Unknown MA20091719 OTH OTH No other medications Unknown MA20091720 OTH OTH No other medications Unknown MA20091721 None MIL MIL None OTH OTH No other medications Unknown MA20091722 PUB UNK None None 0 None PVT PVT None None None 0 UNK UNK 0 Many-beingPVT treated forUNK last 5 months. Medical None records received 6/30/09 7/7/09 Received LABS: medical Bartonella records benselae PMH: appendectomy, (+) s 1 Head CT; LP; PVT CBC & other OTH labs reported YAZ 0.02mg/3mg normal None by hospital. 1 qd;Codeine VOLTAREN 7/23/09 allergy Hospital 75mg 1records po bid PRN received DOS 6/21/09 to 6/2 None PVT UNK None ADHD; Ocular Highalbinisim fever~DTP (no brand name)~4~2~Sibling PVT PUB Started DDAVP same day of Imms 0 PUB PUB none none 0 Negative stool PVTstudies UNK - Stool cx, *Rotavirus ag None None PUB OTH NONE None PUB OTH None None 7 Laboratory MIL studies included: MIL 5/20/08 None WBC 15; CK 1358; 7/7/09 CKMBER neg; records Trp neg. received 5/21/08 DOS CK 5/22/08 917 withtopositive 1/7/09.troponi Episod 7 PVT OTH None Allergy to all sunscreens. No ### other medical conditions and 1 None PUB OTH ibuprofen PRN. Had been treated none in ER for deep laceration to right hand 2 None - wasPVT given CEPHAXRIN PVT on 6/26/09 06/29/09 - less None redness & swelling
4 None 1 1 None 1 0 5 0 0 None 11 None
PVT PVT YASMIN; ALDAETONE None Hidradenitis UNK PVT PVT UNK None None PVT PVT SINGULAIRNone 4mg daily None 0 PUB PUB Gyn Exam PVT PVT ZOVIA 1/35; None RETINA Sulfa .05% -> hives PVT PVT Codeine; PCN PVT PVT No None relevant, Pain/notenderness~Pneumo meds. (no brand name)~1 PVT PUB None cow's milk UNK UNK 0 urine beta-human, OTH 02/18/08, OTH negat; None urine beta-human, Pregnancy02/27/08, NOS (LMP posit, = 1/16/2008) 6 weeksWAES0804USA01051 pregnant; serum beta-human, 02/2 diagnostic laboratory, OTH 04/14/08, OTH pregnant; Unknowngynecological, Pregnancy NOS 04/14/08, (LMPpregnant = 3/12/2008) WAES0805USA00039 Unknown OTH OTH Unknown Unknown WAES0906USA04964 0 Unknown OTH OTH Unknown Unknown WAES0906USA05053 arterial blood OTH O2, 01?/??/09, OTH 87 PREMARIN; Asthma; thyroid Drug hypersensitivity WAES0906USA05010 0 PVT PVT None. ### Positive Mono PVTand Lyme's OTHdiseaseTubersol test results. The patient had not received any ### other vaccines within fou UNK UNK Not reported. ### 13 LABS and DIAGNOSTICS: OTH PVT NCS - None abnormal. at time Total None of vaccination CPK known is None 91. -> Alkaline known currently orPhosphatase specified on METOPROLOL. . PMH: is 97,back SGOT pain, 128, right SGPT tibia301, / fibu 6 glucose, 263. PVT 7/1709 Hospital PVT records not prior received (currently NoDOS NOVOLOG) 5/24/09 allergic to 5/26/09. rhinitis especially LABS and cat; DIAGNOSTICS: mild seasonal Serum glucos 1 CXR #1 w/ PVT air trapping;UNK #2 w/ interst infiltration, decreased Recurrent air trapping; cough NL&CBC wheezing. & CMP 7/20/09 Hospital records 13 Strep test =PVT negative PVT No No 0 PVT PUB 2 PVT OTH RELPAX Wellness exam NKDA 0 None MIL MIL None None None 0 PVT PVT 0 pulse oximetryPVT 100% PVT Penicillin, ZOLOFT s/p splenectomy @ 5 yr 4 Biopsy of rash PVTon torsoOTH TRAMADOL None BID Arthritis in Lumbar leg paralysis~Polio back Virus, Inact. (no brand nam 1 CXR: normal PVT UNK TRIAMCINALONE mild runny as needed nose None/Eczema and cough 1 PVT PVT none History of vasovagal vasovagal~DT+IPV+Hib+HepB syncope last in 2004 (no brand name 1 PVT OTH 0 UNK PUB None None 1 OTH PVT 1 PUB PUB Albuterol ; Flovent None Asthma Local Reaction~Measles + Mumps + Rubella (n 2 PUB PUB All Natural None Asthma local reaction~DTaP (no brand name)~5~7~Sib 1 OTH OTH None Lt ear pain/Eustachian None tube dysfunction PUB UNK None None 1 None PVT PVT ASA; THYROXINE; None CRESTON; None except METOPROLOL; CAD LISINOPRIL 0 PUB PUB NO NO None PUB UNK None None 0 PUB UNK NONE NONE Allergies to; ASA, Codeine; BENADRYL, Latex 1 PVT PUB GEODON; Clonidine; anemia; allergic Lithium; bipolar; rhinitis LAMICTAL; ADHD; Hypothyroid NASONEX; Levothyroxine 1 PUB PVT None None Allergic to tomatoes and turkey 1 PUB OTH None 0 PVT PUB None 0 PVT PVT none none none local reaction~DTaP (no brand name)~4~1~Pa 2 None PVT PVT None None None MIL UNK PVT UNK None 6 PVT PVT Simvastatin;None Metoprolol/HCTZ; HTN; enlarged Fish Oil; thyroid; CO QID NKDA 14 MIL MIL none
0 UNK UNK None None 1 None PVT UNK None None 1 PUB PUB Unk PVT OTH Unknown Concomitant medications A0794348A and relevant medical history wer 10 7/20/09 Hospital PVT records UNK received None. DOS 7/18/08 BirthNone control to 7/13/09. pills. None. LABS 7/20/09 and DIAGNOSTICS. Hospital recordsUpper received GI Series DOS 7/18/08 Normal.toAb 7 None PVT PVT None None 14 None PVT PVT None None 1 PVT OTH 0 none PVT UNK none none none 0 Radiology skull PUBfilms 2 PUB view, CT Scan otitis medianone with rupture noted of TM 0 n/a PVT PVT none none none 3 PUB PVT Rx fish oil; Nasonex None prn Hypertriglyceridemia; None~ ()~NULL~~In seasonal allergic Patientrhinitis PVT PVT acetaminophen Mononucleosis 10 none , just phyiscal PVT exam. PVT was on amoxil none forday om,ofnone but vaccines rash started varicella~Varicella before use of (Varivax)~0~1~In med. onset 6/27/2009, Patient and m 0 none PUB PUB fainting, vomiting~HPV (Gardasil)~NULL~14~In 0 UNK UNK Pt. denied Pt. denied Pt. Denied 10 none PUB PUB none none NONE 0 UNK UNK NKDA 6 blood tests UNK on 6/29/2009 UNK Inderal, Tricor, None Diovan, Singulair 3 Abdominal UNK ultrasound. UNK 7/27/09 Hospital Mylicon records drops None received and Infant None DOS Tylenol 6/15/09 to 6/16/09. LABS and DIAGNOSTICS: Abdo 1 None PVT PVT None None PVT PVT Sulfa drugs 0 Strep test and PVTblood work UNKwas normal. None none Allergy to Bactrim, rash 0 MIL MIL none none none 113 None PVT PUB none Had mild back none pain and facial acne. Was seen the following day by o 0 PVT PVT None Narrow QRS Tachycardia. Pt had an ablation 7/08 3 9/8/09 Hospital UNKrecordsUNK received DOS NONE 6/21/09NONE to 6/25/09.NONE. LABS9/8/09 and DIAGNOSTICS: Hospital recordsKUB received - Abnormal, DOS 6/21/09 distended to 6 0 PVT PVT Mortin givenNo prior illness to injections. atAsthma, time of Benadryl seizure vaccination disorder, given approx diaphragmatic 45min after hernia injections s/p repair, adm 0 PVT UNK 218 PUB PUB 3 PVT PVT Amoxicillin resolving sinusitis none none~ ()~NULL~~In Patient 0 UNK PVT Aciphex 20mg qd, BENAZEPRIl/HCTZ hypertension, reflux 20MG/12.5MG disease qd 0 vaccinationPUB for hepatitsUNK A none none none fever~Hep A (no brand name)~1~1~In Patient 3 troponin 6.0UNK elevated heart UNK CK. 7/31/09 Hospital nonerecordsnone. received PMH: DOS 7/31/09 6/28/09 Hospital to 7/1/09. records LABS received and DIAGNOSTIC DOS 6/28/0 20 6/1/09, CXR, MIL WNL; 6/11/09, MIL EMG/NCD ZITHROMAX; - Summary SUDAFED; interpretation: None; MUCINEX; NKDA 1. TheTYLENOL right median, (initiated ulnar,after radial, vaccine sural and administr supe 1 None PUB PUB None None None IA090010 2 PUB OTH 6 PVT PVT ? Depression and overweight 0 Heart rate 75; PVT O2 saturation's UNK 95-100% 7 Culture of vesicular PVT lesion. OTH Right Otitis Media 0 None PUB PVT Baby aspirin N/A No allergies known 1 PVT UNK Swelling hard lump pain~Hep B (no brand nam 3 Unk PVT OTH Unknown Enlarged tonsil; streptococcal A0790451A throat 0 PVT PVT 0 X-ray soft tissue PVT neck c/w UNKmild edema. NoneLABS None and DIAGNOSTICS: None X-Ray Neck - minimal subglottic tracheal narrow 6 Stool Rotazyme PVT > positive PUB 214 CBC; Thyroid PUBtests- negative PUB results reported by mother. 1 MIL MIL None None None 1 PVT UNK Not reported UNK UNK Not reported ### 70 None OTH OTH hormonal contraceptives Pregnancy NOS (LMP = 8/26/2008) WAES0810USA00881
Not reported UNK UNK The patient had a history of unspecified ### reactions to many 1 Unknown OTH OTH Unknown WAES0906USA02593 65 Initial bloodwork UNK revealed UNK liver enzymes in thenone thousands. none Liver biopsy none~ revealed ()~~0~Patient|none~ significant scarring ()~~0~Sibling and damage. 0 PUB PVT hctz 25mg po qd lisinopril 10mg po qd naproxen 500mg 0 PUB PUB 533 PVT PVT Resolving URI 4 7/2/09 Hospital UNKrecordsUNK received DOS Amlodipine, 6/12/09Cat Augmentin, to 6/29/09. bite, upper Hypertension, LABS Atenolol, respiratory andTricor, DIAGNOSTICS: Vascular infection Hydrochlorothiazide, surgery, CHEM hysterectomy, - Glucose Fish oil 111 rightmg/dL carpa 0 7/23/09 Hospital UNK records UNK received Atarax DOS 7/1/09none to 7/2/09. Formaldehyde EKG. LABS and and DIAGNOSTICS: Quaterium 15 allergies. Troponin 7/23/09 I <0.01 NG/ML Hospit 0 WBC 5.2 onPVT 06/22/09 UNK 1 NONE PUB PUB NONE NO NO NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL 1 NONE PVT UNK PVT PUB NONE BILATERAL PNEUMOTHORACES AND PNEUMONIA 0 UNK UNK Cataprese 0.1mg No illness two patient tabs Patient at was bedtime waswell born with pulmonary artery atresia congenital 5 PHYSICAL PUB EXAM DONE. PUBPAIN WITH NONE RANGE NONE OF MOTION. NONEDISCOMFORT REPRODUCED WITH DEEP PALPA 19 none collected UNK PVT Advil/Tylenol Denied. PRN Stated NoneNegative Medical Hx 1 None PVT PVT Adderall 0 None PVT PUB None 1 PVT PUB None 1 CBC/diff; CMP; OTHHgbA1C UNK Insulin; Thyroid 0 Ophtomist advised MIL hadMIL slight myopia None; correctable PRNNone eyetodrops 2020None for (lasik seasonal surgery allergies had vision at 20/10) with no corneal lesions 2 None PVT PVT None None None 1 PVT UNK None None known 3 examined by PUB the nursePUB None None 0 PVT PVT ZITHROMAX - Sinusitis 6-30-09; ZOFRAN in the ER 0 All less - WNL PVT PVT No No None OTH OTH None None None 1 WBC 5,900PVT PVT Citalopram;None ibuprofen; None BENADRYL 1 PUB OTH 0 None PUB PUB None None None OTH OTH 15 ESR 17T3 1.5 PVTAND T4PVT 8.75 AND NO TSH 1.74 NO NO 0 PVT PUB neuro testing UNK 5/2009. 7/7/09 UNK NCS report received DOS 4/8/09. None. LABS 8/18/09 and PCP DIAGNOSTICS: medical records NCS received DOS 7/21/06 1 PVT PUB 79 PVT UNK 4 OTH OTH Unknown Allergic Rhinitis; hyperlipidemia; hypertension; DM type II 0 PUB PUB none 0 PUB PUB None None None 7 None yet OTH PVT unknown NONE NONE 0 PUB UNK none allergy to PCN 1 PVT PVT 2 PUB UNK None None None 7 CRP = 2.87;PVT ESR = 23;OTH RF - neg; ANA = neg;None Lyme = neg; No Lupus allergies studies or birth pending. defects; Oa Minocycline; RETIN A; Ac Unknown OTH OTH Unknown Unknown WAES0906USA05296 Unknown OTH OTH Unknown Unknown WAES0906USA05217 0 UNK OTH PVT Unknown No concomitant vaccines A0794805A or medications. Relevant medic 0 UNK UNK None per client asthma-no report other conditions or allergies. 9/1/09 ER records 0 Labs and diagnostics: UNK UNK CXR abnormal. None BloodNone cx (-). EEGNone. WNL.PMH: physiological jaundice as newborn. 1 UNK PVT Lithium, synthroid, none prilosec bipolar; no thyroid, itching~Zoster hemochromotosis (no brand name)~1~69~In Patie 5 COLITIS from UNK stool sample. UNK 7/13/09 none Hospital none records received none. 7/13/09 DOS 3/6/08 Hospital to 3/7/08. records LABS received and DIAGNOSTICS: DOS 3/6/08 to 3/7 A 0 Influeza A and PVTB negative. PUB none none none
1 PVT UNK None 2 normal physical PVT on examination PUB none none 0 none PVT PUB NONE NO NO 2 UNK PUB none none none 2 OTH PVT PREVACID;None Amoxicillin; None Clarithromycin 0 None; Unable PVT to find documention PUB in EHR to None document this, no ED visit 1 UNK UNK None None Obesity BMI = increased 97%; Speech/articulation problem 0 OTH OTH NKDA 1 PVT PUB 0 9/15/06, Antigliadin MIL Ab,MIL IgG, 3; Antigliadin None at time Ab,None IgA, of vaccination 2; Endomysial Diagnosed Abwith IgA,angiomyolipoma Negative; 11/13/06, at age Duodenum 16; No previous Bx, no ho pa 0 PVT UNK 0 Done at ERPUB PUB HISTATAD;Sinus OMHICEF infection None 2 PVT PUB TYLENOL Speech impediment OTH PUB 2 PVT PVT ALBUTEROL; none LASIX; ACTIFED; Hyperlipidemia; ZONEGRAN; PAM; Sleep MS CONTIN apnea 2 None PVT PVT None None None 0 PUB PUB Cough, allergic nose, enlarged tonsils and wheezing. 1 none PVT PVT none none none none~ ()~NULL~~In Patient 0 PVT UNK None None None This was her first vaccine~ ()~NULL~~In Patien 0 HR 70 BPM; OTH BP 110/70 PUB -> after event None PVT PVT Eczema; Macrocephaly 3 PVT UNK None None None 2 PVT UNK lo ovral birthnone control irritable bowl syndrone 0 UNK UNK no allergies to milk and soy protein, congenital cataracts, nyst 10 none PUB UNK none none none 0 PVT PVT n/a 22 Brain MRI showed UNK periventricular UNK none white matternone hyperintensities, eczema. one PMH: with biliary enhancement. atresia with Visual Kasaiacuity procedure, in the right oral se 0 beta-humanOTH chorionic, OTH positive; beta-human Unknown chorionic, Pregnancy05/16/08, NOS (LMP=4/20/2008) negative WAES0805USA04794 0 None OTH OTH None Pregnancy NOS (LMP = 3/28/2008) WAES0806USA07772 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 6/17/2008) WAES0812USA02378 4 Magnetic resonance, OTH normal; OTH Vascular Unknown imaging, normal None WAES0906USA04956 electroencephalography, OTH OTH some "activity" Unknown Unknown WAES0906USA05043 366 Unknown OTH OTH Unknown Anaemia; Colitis ulcerative WAES0906USA05205 0 Unknown OTH OTH Unknown Seasonal allergy WAES0906USA05705 ultrasound, OTH ileocolic intussusception OTH Unknown Unknown WAES0906USA05211 Ultrasound,OTH intussusception OTH Unknown Unknown WAES0906USA05214 Unknown OTH OTH None None WAES0906USA05672 3 CBC, CMP,PVT Strep, Monospot, PVT Influenza none none none 1 PVT PVT BENZACLIN NONE NONE 5 none reported PUB PVT Armour thyroid Denies 60mg illness, daily; Allergies only Diovan issue include: itching~Zoster 80mg withamoxicillin, daily; fingerBumex (Zostavax)~~77.50~Sibling doxycycline, 0.5mg daily; macrobid clorazepate and bd 0 none PVT PUB none none none 0 PVT PVT 1 PUB PUB None None MO-2009-14 0 PVT PVT 108 EKG: SHOWED UNK ATRIAL UNK FLUTTER MULTIVITAMIN, WITH RAPID NO RATE. METAMUCIL NONE NORMAL TSH. ECHOCARDIOGRAM SHOWED LVEF 4 0 UNK PVT Syntheroid 1 PUB PUB 0 none PUB PUB none none none 2 PUB PVT treximet taken none on 7/2 for asthma migraine (mild), none~ allergic ()~NULL~~In to shrimpPatient|none~ ()~NULL~~I 1 NONE PUB PUB NONE NO ALLERGIC NONE~ TO SULFA ()~NULL~~In Sibling1|NONE~ ()~NULL 20 Complement UNK Antigen C3, UNK Complement total CH50,Cultures NONE None. of Blood 9/23/09 none~ 2 sets Hospital ()~~0~Patient|none~ at 2 sites. records Normal received results ()~~0~Sibling|none DOS for6/19/09 all. 9/23/0 to 6
0 NA PUB PUB None NA NA UNK~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In 1 PUB UNK 2 OTH PVT LAROXYL 0.75 None; mcgm arthritis Breast PO D; Vitamins Cancer ~Influenza Survivor(no NJ200903 - Rbrand breast name)~3~60~Patient Lumpectomy 1 PVT PUB SINGULAIRNone Seasonal allergic rhinitis 1 None PVT PVT None at time None of immunizations None 0 None PUB PUB None None None 0 PVT PVT On site swelling None 0 None PVT PVT None None 2 PUB PUB None None per Mom NK allergies - Has short urethral tube - Freq U.T.I's Seen by anPVT ophthalmologist. UNK The eye itself is None normal. To None scheduled for an MRI 6/30/09. 7/2/09 MRI normal. PVT UNK None None PVT UNK None None 0 PVT OTH METFORMIN Weight HCI 1000 management VICODIN; MG TABS; MORPHINE; ATIVAN 2 MG ALBUTEROL; TABS; CRESTOR AMOXICILLEN; 5 MG TABS CO 2 Unknown OTH OTH Unknown Unknown Unknown 1 PVT PVT None 0 OTH PUB 13 PVT PVT YAZ; MAXALT;BACTRIM UTI 6-17-09; 6-30-09 DS, give URI, at time started of injection XYZAL 0 UNK PVT PVT Unknown No concomitant medications A0795082A or relevant medical history. N 2 EKG on 6/22/09 PVT withinPUB normal limits No PMH: eczema 0 Ultrasound PVT (R) thigh; No UNK abscess; Positive edema of softneurofibromatosis. tissue. 9/4/09 Hospital 9/4/09records Hospital received recordsDOS received 6/25/09. DOSLA 6 365 Lost all metabolic PVT ability. PVT None Hole in heart ASD 43 EMG; lumbar OTH puncture;PVT neurology consultation None 8/27/09 Medical Hypertension; recordsT2received DM; atrial w/LABS: fibrillation; InitialCHF CSF:8/27/09 proteinMedi (N). 0 blood pressure, OTH "good";OTH venous blood Nonepo(2), "good" None Syncope~Varicella WAES0906USA05684 (no brand name)~2~9~Sibli 0 Unknown OTH OTH None None convulsion,WAES0907USA00006 Dizziness, Stomach discomfort, we 14 None OTH OTH Unknown Unknown WAES0906USA05165 Unknown OTH OTH Unknown Unknown WAES0907USA00183 107 ultrasound, OTH 09/23/08, normal, OTH routine None anatomy Pregnancy scan; beta-human NOS (LMP chorionic, = 5/23/2008) positive; WAES0807USA03163 serum alpha-fetoprotein, 10/1 Unknown OTH OTH Unknown WAES0906USA05239 Unknown OTH OTH Unknown Unknown WAES0906USA05566 288 Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0906USA05633 Unknown OTH OTH Unknown Unknown WAES0906USA05780 Unknown OTH OTH MAXAIR Asthma WAES0907USA00186 0 none reported PVT OTH ### 2 Stool culture; PUB Blood work PUB Labs: ClNone 109 (H), Ca++ None 10.6 (H), None Platelets PMH: LGA, 616, MPV neonatal AR0922 7.2 (L). hypoglycemia. Rotovirus (+). RSV 20 Blood w/u; KUB; PVT LABS:PVT abdominalNone x-ray, abdominal None US both Noneabnormal. 1 7/17/09 Medical PVT records UNK received DEPO-PROVERA DOS 6/25/09. None LABS and BeeDIAGNOSTICS: stings. 7/23/09 Hospital Monofilament records feels received different DOS on 6/30/0 left. CB 0 None PVT UNK 0 None PVT UNK None None GERD 0 CBC, normal PVT PUB TYLENOL; PharyngitisHx ZITHROMAX of OM LA090603 1 NO PVT PVT No 9 MIL MIL Amoxicillin,10-11 11Jun09; Jun Mefloquin, 2009, Seasonal fevers allergy weekly; ZIRTEC 10 mg 0 PVT PVT None None 1 Pt started on PVT oral ABX.PVT None None 0 PUB PUB LORATADINE None 5mg 1 Pt. stated that PUB MD wasn't PUB sure of the None reaction No but there was No no oozing. 0 None PVT PVT 1 OTH OTH None Penicillin; eggs 40 CT Brain Normal, PVT WBCUNK 13800, 65%, 5, 6% Mono, 17 EOSIN, Type 8/24/09 II DM HxER HPV records allergy received "Mold" cheese. DOS 4/21/09 8/14/09 - 4/22/09. MR rec 3 none PVT OTH Citalopram; Pravastatin; Levothyroxine; PPV, Merck, 1117X, LA. 0 PVT PVT None None 1 Mild Superficial PVT Cellulitis; PVT CBC WNL None None Allergic Amoxicillin
0 NONE PUB PUB ASA 7 None PVT PUB None None None 0 PVT PVT Allergic, NYASTATIN, CECLOR, sulfa, CLARITIN; AUGME 1 PVT PUB 1 none PVT PVT none none 14 MIL MIL None None 3 PVT UNK 18 none PVT PVT ELIDEL Cream; ATARAX Dermatitis syrup; VENTOLIN - sand paper HFA rash over skin, peeling of wrists, a 1 PUB PVT Simvastatin;None Metoprolol; NKA Triamterene/ HCTZ 1 PUB PUB None None 1 None OTH PUB None None None 0 None PVT PVT Levothyroxine; alendronate; Vit B; Simvastatin 0 DX with ERETHEMA PVT multiforme PVT 6/25/09 None None None 0 None PVT PVT Veramyst; Maxifed; None Singular; Recurrent Saline sinusitis, nasal non-allergic rinse rhinitis, eustachian tube dy 1 PVT PVT PVF no no 1 PVT UNK No 2 PVT PUB 08/20/2004~DTaP (no brand name)~5~5~Patie 0 OTH PVT 1 PVT PVT 2 vaccinated PVT reaction PVT None 0 PVT PVT None None 0 PVT PVT Albuterol; CLARITIN; nasal congestion; FLOVENT; sneezing RECLIPSEN None PUB PUB ALBUTEROL None PRN (NotAMOXICILLIN used for 2 mo); -> PPD, Severe APM, rash;Lot asthma Number - mild C3149AA, intermittent Route PVT OTH none 0 NONE PVT PVT NONE hives per mom NONE 1 PVT PVT Red ear (?bug Allergic bite?) Rhinitis 9 7/17/09 EROTH records received OTH DOS 7/4/09. LABS and DIAGNOSTICS: 7/17/09 ER records Chest received X-ray - NoDOS acute 7/4/09. radiographic Palpitations abnorm sinc 1 None PVT PVT None None 0 OTH OTH Amlodipine; DIOVAN; PREMARIN; Carvedilol; HCTZ; Simvastatin; Zolpidem 0 Saw allergist PVT - evaluation PVT negativeAmoxicillin/BACTRIM after prior OME problem Prior reaction anaphylaxis~Pneumo after receiving PENTACEL, (Prevnar)~2~0~Patient|a PREVNAR, ROT 2 PVT PVT MAXIFED; None DEXAMETHASONE; asthma, allergic ADVAIR; rhinitis, SINGULAIR; chronic sinusitis PEPSID; VENTOLIN; AS 1 None PVT UNK None No 0 PVT PUB None None None 3 none PVT PUB Had experienced hives 2 weeks before. 2 PVT PVT NO Hypertension; Cardiac arrhythmia PVT PVT None None 2 PVT UNK TOPROL XL None High blood pressure 0 PVT PUB none 0 none PUB PUB none none none 1 PUB PVT None to knowledge None reported None reported 2 None donePVT UNK None None None 6 none PUB PUB none none none UNK UNK None None stated 903 732 PVT PVT 2 Unknown UNK UNK NONE UNKNOWNUNKNOWN 0 None. 7/7/09 UNK Hospital records UNK received DOS None 5/5/09 to 5/6/09. None.LABS 7/7/09 0~ and Hospital ()~~0~Patient|0~ DIAGNOSTICS: records received ()~~0~Sibling|0~ WBC 20.1 DOS(Elevated). 5/5/09 ()~~0~Si to 5/6/ Ot 0 PVT PVT Healthy Peanut Allergy, Eczema, GI Reflux 1 PUB PUB 0 PVT UNK no no 2 None PVT PUB Loratadine Allergies 5mg/5ml 1 PVT PVT None None None known
6 PVT UNK Yasmin 28 None Allergic to Penicillin, Warts on Suprax, Hands and Biaxin. Fingers~HPV Patient has (Gardasil)~2 Pre-existi 312 PVT PVT 0 CSF, bloodUNK and urine cultures UNK negative. 7/17/09 None HospitalNone. records 7/17/09 received Hospital DOSrecords 6/30/09received to 7/4/09.DOS LABS 6/30/09 and DIAG to 7 1 Influenza swab UNKA & B (pending) UNK Headache x 2 days 2 none UNK PVT unknown none reported none reported none known~ ()~NULL~~In Patient 1 PVT UNK flovent-Pro mild air asthmamild asthma persistent 11 none PVT PVT 2 PVT PVT hypertension; Parkinson; osteoporosis; GERD; high choles 98 Head CT, chest UNK xray, urine UNK and blood. NoneNegative. No 8/4/09 Medical None. records Seizure~HPV received DOS (Gardasil)~2~13~Patient 7/8/09 to 7/15/09 LABS and 0 Across all ages UNKand race. UNK Pt was taken UNK to the Hospital UNK the day of the seizure, 26th Pt April lived 2009, most and of she her life wasingiven the foreign an ECG country, and a just CT Scan. returned W 1 NONE UNK UNK Past medical history includes hyperlipidemia; back surgery UNK UNK None Past medical history includes Diabetes mellitus; Gastroes 0 None PVT OTH The patient was takingThe concomitant patient had medications no reported of illnesses TOPAMAX, ### at the FLONASE time of vaccin and P Unknown UNK UNK Unknown Unknown WAES0907USA00328 Unknown UNK UNK Unknown Unknown WAES0907USA00329 Unknown OTH OTH Unknown Unknown WAES0907USA00233 n/a UNK PVT none none none none~ ()~NULL~~In Patient 0 blood work,PVT Cat skans,UNK UA vagefem, Furosemide,Lonazapam, none sesaonal allergies, none~ nexium, ()~NULL~~In spastic Nifedical vessel XL, Patient inAdvar, bottom Vytorin, of heart, Midrin high(P c 0 Mother stated PUB her daugher PVT had a CT none scan in ER none and a number none of tests to rule out appendicitis,tests came back nor 8 578.1 PVT PUB 0 Scheduled PVT to have evaluation UNK by neurologist singulair, albuterol with allergic possible rhinitis Penicillin EEG. allergy, allergic rhinitis, wheezing 0 ct head/routine UNKblood tests/ UNK refused NONE spinal tap. NONE 7/9/09 Hospital HEARING records LOSS received DOS 5/29/09 to 6/1/09. LABS and 0 MIL MIL just released from hosp for unknown reason 1 UNK UNK Calcitonin nasal, Depression, MVI, ASA, Breast HTN,simvastatin, ca vaginal s/p lumpectomy wallcalcium, bleeding. July08, vit D, levothyroxine, s/p radiation 9/08. fish oil, Also lisin 58 None required. PUB UNK None. 0 N/A PVT PVT Grave's dz, hyperlipidemia, IBS, GERD, osteopenia, HTN, 0 PVT PUB None None None 0~ ()~NULL~~In Patient|0~ ()~NULL~~In Siblin 1 CBC drawnUNK with normal UNK results. UNK UNK 3 We arranged UNK for her toUNK have a left brachial plexus NoneMRI performed. None This showed a mild localized superficial bone m 1 NONE PUB PUB None NO NONE 0 UNK UNK PUB PVT none occasional migraines with vision loss 1 None PUB PUB None None Atopic Dermatitis, Possible allergic Rhinitis UNK MIL Unknown Unknown 1 PUB UNK DX w/ fever; febrile SZ; pneumonia 3/27/09 evaluated and 3 OTH PVT 0 CBC, CMP PUB PVT Metformin ER Pt here - 500mg for 1 DM2 - month BID; MVTfollow-up daily PVT UNK Rabies Ig (6 vials), Talecris, 26N9R61, IM deltoid 5 MD Dx Varicella PUB vaccine PUB induce chicken None pox None (1) Rhinitis; (2) FTT; (3) Atopic dermatitis 0 Rast panel PVT PUB NC09027 6 CT of head;PVT Blood workOTH no illness; pre exposure 2 none PVT PUB 0 PVT PVT Hyperlipidemia; Prediabetic syndrome. 2 PVT PVT No None 3 UNK PVT OTH Unknown Enlarged Tonsil; Streptococcal A0790451A throat 24 X-ray, negative; PVT magnetic PVTresonance, Unknown negative; computed None axial, negative; sleepWAES0907USA00275 study, negative; electroencephalog 3 Unknown OTH OTH None None WAES0906USA05681 53 electromyography, OTH There OTH are some TENORMIN; interferences MAXIDE; of transmission None AMBIENof the nerve impulses WAES0907USA00456 in the muscle of the upper a cerebrospinal OTH fluid, for OTH genotypingUnknown Unknown WAES0906USA05714
0 Not reported PVT OTH Vomiting~Tdap (Adacel)~UN~11~Patient ### 6 A chest x-ray PUB was completed PUB that was negative. TheApatient CBC (complete has concurrent blood count) medicaland condition Chemistry ### of lupus, paneland were prior complet to va 0 PVT PVT none 0 PVT PVT PUB PVT UNKNOWNUNKNOWNUNKNOWN 0 None PUB PUB None None known None 7 PVT PUB None None None 0 PUB PVT None None Patient stated after fainting that she had fainted before but 0 PUB PVT Crestor,Zoloft,Levethroxin,Metrafumin,Glipizide, No Allergic to: Sulfa, Compuzine, & Actos IV Iodine. Medical condition 0 Normal head PVT CT and EEG PVT none none At 4 and 6 months he had episodes of curling in 0 PVT PVT N/A N/A 0 From ER CBC: UNK4,200 WBC(L), UNK H/H NuvaRing, 12.1/35.1,Ativan Was grans in0.5mg for 45.6 annual Penicillins, (L), lessMonos exam. thannone situational 5/month 12.1(H), Lotsreported~ of stress CMP stressunremarkable ()~~0~Patient|unknown~ from recent death of her father ()~~0 4 C-spine x-ray MILthat was MIL resulted asnon normal per patient none per patient none per patient none~ ()~NULL~~In Patient|none~ ()~NULL~~I 1 PUB PVT sbiriba, travatan, none trusodt, glaucoma simvastatin, eye none~ surgery ()~NULL~~In 2008. treatment Patient for tuberculosis in 2 0 PUB PUB 0 PVT PVT None None 1 arthritis panel UNK pending PVT Hep C txn none Sulfa allergy, HEP C 2 UNK UNK 0 PVT PUB Benadryl Rash - contact NKDA derm vs viral exanthem 5 9/22/09 PCP UNK medical records UNK received YAZ (drospirenone DOS 12/02/08&toethinyl 9/22/09 6/19/09. estradiol) PCP LABS ~HPV medical and (Gardasil)~~0~Patient DIAGNOSTICS: records received CHEM DOS-12/02/08 Glucose to 101 6 0 LABS: CXRUNK WNL. UNK None none 1 UNK UNK 0 7/10/09 Medical PVT Records PVT receivedMantoux DOS 7/7/09. PPD LABS and 7/10/09 DIAGNOSTICS: Medical Records Mantoux received (-). EKG DOS and7/7/09. unspecified Fainting/di labs 2 PUB PUB 2 Scheduled OTH for MRI on 7/16/2009 OTH None at theNone time None 1 PVT OTH 1 UNK PVT Unknown None None shingles~Zoster (Zostavax)~1~61~Patient 1 PUB PUB None None 1 None PVT OTH None Fibromyalgia; hypertension; asthmatic bronchitis; esophag 2 PVT PUB 3 PVT PUB None 1 PVT PVT 3 none PVT PVT SYNTHROID none Hypothyroidism 1 PVT PUB PPD skin test, Aventis Pasteur, C2920AB, Lower Lt Arm, 2 previous doses 1 None OTH OTH ALBUTEROL; None QUAR inhaler. Dx cellulitis 1 PVT PVT ZIAC 10/6.25 None Hypertension 1 PVT PVT FLOVENT inhaler; None SINGULAIR; Allergies, SINGULAIR, NASONEX spray NASONEX, FLOVENT; Asthma 0 PVT PVT 2 PVT PVT 0 None PVT PVT None 1 none PVT UNK 2 Sed rate; UA, PUB Tr protein; UNK EKG; CAT PROCARDIA scan; CXR; Thyroid HTN - all WNL; BMP, WNL; CBC, WNL 1 none PUB PUB None None None 2 PVT PVT None None 0 see att. emerg PVTroom data OTH 7/8/09 ADDERALLnone knownnone known 1 OTH UNK PCN; Codeine; Bimatoprost WBC- normal PVT OTH None None None 0 None PVT OTH Multi vitamin None None 1 PVT PVT The patient has allergies to Augmentin ### and Ampicillin. No 7 PVT UNK no none none 1 None, seenPVT in ER PUB None None None
Unknown OTH OTH Unknown Unknown WAES0907USA00248 Unknown OTH OTH Unknown Unknown WAES0907USA00445 11 Unknown OTH OTH NEXIUM Diabetes; Gastrooesophageal Oesophageal operation reflux WAES0907USA00680 disease; Contrast media allergy; 189 Unknown OTH OTH CELEBREXArthritis WAES0907USA00756 0 7/23/09 ERPVT records received PUB LABS: all WNL. None Sulfa; PCN; Contrast dye; CT200911 OMNICEF; cats; mold. 7/23/09 Labs with increased PVT WBC, PUBNL CT None head 10/20/09: None Hospital None. records 10/20/09: and andischarge Hospital records summary and discharge received for summar dates 2 none PVT PVT none history of hypertension allergies to bee stings,shellfish, 1 none PUB UNK none none none AL0910 0 N/A PUB PUB N/A N/A 2 UNK UNK None Occasional use of albuteral inhaler--like once a year 0 PVT UNK 1 PUB PUB 1 PUB PUB 0 PVT PVT none none none 1 PVT PVT none none 9 7/23/09 Received UNK hospital UNKmedicalEnalapril records forNone 7/4-7/10/2009. HTN. LABS: 7/23/09ESR Received & CRPhospital increased. medical ANArecords reactiveforbut 7/4-7/ insig 0 None UNK UNK MOTHER AND NONE/DENIES PATIENT NONE/ DENIES DENIES ANY OTHER MEDICATIONS. PVT PVT 8 None MIL UNK None None NDKA, None 4 Stool for Rotavirus UNK PUB Well Child visit. None Known 2 None. PVT PVT Effexor, Estrace None.vaginal Macrobid cream, Veramyst allergy-anaphylaxis. nasal spray, calcium and vitamin D sup 1 UNK UNK Occasional None. use of However, Betamethasone Small patient areas on ofcomplained psoriasis small areas on of head. of congestion headTubes for psoriasis the in day earsafter when the you v 0 none MIL MIL none none none 8/25/08: Positive UNK serumUNK HCG None None 5 Bacterial cultures; PVT viralOTH cultures none none 0 PUB PUB Penicillin 1 PVT PVT None None None 1 None PVT PVT None None None 2 None. OTH OTH MVS; HYZAAR; NoneMetoprolol; HTN -Simvastatin; Controlled Meloxicam; ASA 81mg 0 None PVT OTH 0 PVT PVT Spina Bifida Occulta; acne; Headache; asthma; allergies None PVT UNK None None None 2 PUB UNK PPD TEST None - JHP Pharmaceutical; Lot Number 78539, Route/site Left forearm; N 0 PUB PUB No No Certmaxone05/12/2009~Vaccine allergic reaction not specified (no brand na 0 None PVT PVT No Iodine (Swelling / Hives); Erythromycin (Tinnitis) None PUB PUB None None None DC20091 1 PVT UNK None None 0 PVT OTH Hives: PCN; sulfa; cephalexin; Hives 1 PVT PVT Folliculitis NKDA, HTN, Arthritis, Cancer 0 PVT PVT None No Allergy to Salicilates 1 PUB UNK None No None 2 DNA PVT PUB Hormones None Allergy to Tesslon pearls NONE MIL MIL NONE CLINDAMYCIN, DACON'S SOLUTION NONE MIL MIL NONE NONE MOTIN/IBUPROFEN EYES 1 UNK UNK Fosinopril, Zetia, none Prilosec 3 8/5/09 Medical UNKrecordsUNK received DOS 6/17/09Prior to 7/14/09. seizure seizure LABS disorder and disorder DIAGNOSTICS: complex partial Ironseizures. 12 ug/dL7/31/09 (L) UIBC Neurolo 388 u 10 MIL MIL None None NKA 1 NONE PVT PVT NONE NONE NONE UNK UNK 92 Went to dr, PUB and got myUNK anual check Birth up control, everything n/aadvil was normal, club foot, butsinus, if i stop food taking allergies my birth control i dont get my per 1 none MIL MIL None Denies PCN
0 None MIL MIL NONE Denies NONE 23 PUB UNK klonopin, flonase, asthmabiestrogen, testosterone. caltrite, 7 None OTH OTH aspirin; simvastatin; Herpes zoster VALTREX ophthalmic WAES0907USA00916 Unknown OTH OTH Unknown Unknown WAES0907USA00189 0 Unknown 9/15/09 OTH Received OTH medical None records w/LABS: monospot None 9/15/09 (+). CTReceived brain WNL WAES0907USA00372 medical except records for mildw/PMH: diffuse viral brainme at 0 Unknown UNK UNK LIPITOR The patient has allergy to bee### stings and pesticides; howe 2 UNK PVT PVT Unknown Concomitant medications A0796478A and relevant medical history wer 2 UNK PVT PVT Unknown Concomitant medications A0796480A and relevant medical history wer 1 PUB PVT None. None. Hyperglycemia, asthma, allergy (pollen). 448 PVT PVT 0 PUB PVT None None 0 PUB PVT NONE NONE NONE 0 PVT PVT 6 PneumoniaUNK was non resolving UNK through April 2009. None Bronchoscopy Elevated cholesterol. and biopsies8/28/09 on 03/12/09 Hospital revealed records elevated received leve DO 4 UNK PVT UNKNOWNNONE 0 UNK UNK none none 1 None MIL MIL Lisinopril 20mg nonedaily, Simvastatin hypertension, 80mg hyperlipidemia, daily, aspirinceliac 81mgsprue daily 1 UNK UNK NONE NONE NONE White bloodUNK cell count UNK 4.1, H&H 13.6 MAXIDE, and 40.3, PROTONIX, platelets Past 280, ENTEX, medical MCV SINGULAIR, 96,history: lymphsGastroesophageal 37, CIPRA, neutrophils VICODIN, 30,reflux PREDNISONE. Sodium disease, 136, pot hyM 0 UNK UNK none none none~ ()~NULL~~In Patient UNK UNK 2 Patient still MIL requires theMIL 2nd dose None of varicella No Father~Varicella (no brand name)~NULL~~In P 3 biopsy of Area, MIL being tested MIL for diabetes unknown unknown 1 na PUB PUB childrens multivitamin none none OTH OTH 1 PVT PVT FOSAMAX;Superficial Pravastatin; rash Lovastatin; Metformin; resolving Back Clindamycin abdpain; Dyslipidena; DMTZ; Osteoporosis 3 OTH PVT None 0 PVT PUB 2 PVT PVT Fluoride None None Developed Pertussis~DTaP (no brand name)~1 1 None UNK UNK 2 None PVT PUB None None None 3050 A punch biopsy MIL (11/18/1998) MIL identified Nonechanges None consistent hx with pseudofolliculitis psoriasiform barbae spongiotic (neck) dermatitis. 1997-98 1 None PVT UNK None Xray contrast = rash; NEURONTIN = "numbness"; DILANT None MIL MIL None None 2 PVT PVT None None None 0 PVT UNK runny nose PMH: and cough RAD, URI 1 PVT PVT 12 None PUB PVT No None GA09021 0 PUB PUB No No No GA09023 0 PUB PUB PPD placedNo in (L) forearm. No GA09024 3 PUB UNK Allergy to penicillin-takes GA09025 Kt for leg cramps 1 PVT PVT Diazepam Prn; H/O Pro asthma Air Erythromycin MDI Prn - GI SE; Percocet - visual Sx 0 PUB PUB None None None 2 PVT PVT No 1 OTH OTH None None PVT UNK None None PVT UNK None known 2 Strep test inPUB office 7/8/09, PUBnegativeNone per mom No None, NKA 0 None PVT PUB TRILEPTALNone Seizure disorder PVT UNK No Fish; Flaygl; Macrodantin 0 PVT OTH ZETIQ; LIPITOR; FOSAMAX Mitral regurg, Hx colon cancer; Allergies; PCN; NIACIN; Xe
4 Unknown OTH OTH Unknown Drug hypersensitivity WAES0902USA04530 0 Unknown OTH OTH Unknown Bipolar disorder; Mastectomy; Drug hypersensitivity; Breast cancer WAES0902USA04535 Penicillin allergy; Hypothyroidi 3 Unknown OTH OTH Unknown Unknown WAES0902USA04539 Unknown OTH OTH Unknown Unknown WAES0902USA04588 0 Unknown MIL OTH Unknown Cardiac failure congestive; WAES0902USA04590 Atrial fibrillation 0 None PVT PVT None None WAES0902USA04615 31 None OTH OTH BONIVA; SYNTHROID Allergy to vaccine Intestinal functional disorder; WAES0903USA00011 Colon spastic; Seasonal aller 3 body temp, PVT 02/15/09, 102 PVT None None WAES0903USA00012 1 Unknown PVT PVT albuterol; AGGRENOX; Hypertension;LIPITOR; Sleep apnoea; enalapril Asthma maleate; WAES0903USA00036 ADVAIR; PROTONA 1 PVT OTH Unknown Hypertension; GastrooesophagealWAES0903USA00039 reflux disease; Fibrocystic breast; D None OTH OTH Unknown Unknown WAES0903USA00069 Unknown PVT PVT Unknown Unknown WAES0903USA00118 1 None OTH OTH Unknown Unknown WAES0903USA00287 0 Unknown OTH OTH Unknown Unknown WAES0903USA00290 14 chest X-ray,PVT 02/17/09, PVT normal; eosinophil atenolol;count, LIPITOR; Hypertension; 02/20/09, PAXIL8%, Cholesterol high; serum high;EBV Sulfonamide WAES0903USA00421 early antigen, allergy; 02/20/09, Depression; 10.2 U/mL Hyp 5 Unknown OTH OTH Unknown Unknown WAES0903USA00439 3 Unknown PVT PVT allopurinol; Hypertension; aspirin; hydrochlorothiazide; Cancer Hypothyroidism of skin (excl SYNTHROID; melanoma) WAES0903USA00561 COZAAR; verapamil; vitam 2 Blood pressure, OTH 03/03/09, OTH128/7 mmHg Unknown Drug hypersensitivity; Allergic reaction WAES0903USA00573 to antibiotics 0 None PUB PVT Atenolol; Hydrochlorothiazide; Depression; Blood pressure Lisinopril high WAES0903USA00597 Unknown OTH UNK WAES0903USA00722 1 None OTH OTH Unknown Allergic reaction to antibiotics WAES0903USA00741 35 Unknown PVT OTH Sterile diluent Type 2 diabetes mellitus WAES0903USA00872 Unknown OTH OTH Unknown Unknown WAES0903USA00898 Unknown OTH OTH Unknown Diabetes; Hypertension Brain neoplasm; Shingles WAES0903USA00899 0 None OTH OTH VICODIN Shoulder pain; Asthma; Hypersensitivity WAES0903USA00953 1 Unknown OTH PVT Unknown Penicillin allergy; Sulfonamide allergy; WAES0903USA00989 Drug hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA01130 1 None OTH OTH Hypercholesterolemia WAES0903USA00954 0 Unknown OTH OTH Unknown Unknown WAES0903USA01131 0 Unknown OTH OTH Unknown Unknown WAES0903USA01135 6 Unknown OTH OTH Unknown Unknown WAES0903USA01140 None OTH OTH ALLOPURINOL; Penicillin PREMARIN; allergy; Sulfonamide LASIX (FUROSEMIDE); allergy; WAES0903USA01405 Drug hypersensitivity; PLAQUENIL; SYNTHR Fish al 0 None OTH OTH None None WAES0903USA01407 0 None OTH OTH Activella; Hydrochlorothiazide; None Lisinopril, Protonix WAES0903USA01425 Unknown OTH OTH Unknown Unknown WAES0903USA01438 1 Unknown OTH OTH Unknown Unknown WAES0903USA01462 0 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0903USA01586 0 Unknown OTH OTH Unknown Unknown WAES0903USA01587 7 None OTH OTH Aspirin; Carbidopa + Levodopa; Simvastatin; WAES0903USA01594 Terazosin Hydrochloride None OTH OTH Unknown PENICILLIN allergy WAES0903USA01610 Unknown OTH OTH Unknown Unknown WAES0903USA01648 Unknown OTH OTH aspirin; ADVAIR; lisinopril; Unknown metformin WAES0903USA01842 2 Unknown OTH OTH Unknown Unknown WAES0903USA01846 0 Unknown OTH OTH Unknown Unknown WAES0903USA01847 399 None PVT PVT None Hypertension WAES0903USA01848 1 Unknown OTH OTH Unknown Unknown WAES0903USA01854 Unknown OTH OTH Unknown Shingles Diabetes WAES0903USA01878 Unknown OTH OTH Unknown Unknown WAES0903USA02069 0 None OTH OTH FOSAMAX Shingles WAES0903USA02079 0 Unknown OTH OTH Unknown Unknown WAES0903USA02271 Unknown OTH OTH Unknown Herpes virus infection WAES0903USA02296
Unknown OTH OTH Unknown Unknown WAES0903USA02321 0 body temp, PVT 98.6 OTH PLAVIX; TRICOR; Sulfonamide metoprolol allergy WAES0903USA02331 287 Unknown PVT PVT calcium (unspecified), MyastheniaZYRTEC, gravis; Ptosis ACTIVELLA,WAES0903USA02342 TOPROL XL TABLETS, BENICAR 0 VZV strain; PVT VZV wild type PUBstrain. LIPITOR; PLAVIX; Drug hypersensitivity; PRINIVIL; Chickenpox TOPROL ArthritisXL tablets. WAES0903USA02559 0 UNK PVT PVT Unknown Concomitant medications A0794475A and relevant medical history wer 75 None PVT OTH Calcium (unspecified); SulfonamideVitamins allergy; (unspecified) Drug hypersensitivity WAES0903USA02580 82 thyroid function OTHtest, Normal; OTH metabolic CELEBREX; marker Hypertension; lisinopril test, Normal Surgery Arthritis WAES0903USA02594 0 None OTH OTH Unknown Unknown WAES0903USA02605 0 None PVT PVT UROXATRAL; Drugaspirin; hypersensitivity; Chickenpox; ROCAL; NEXIUM; Iodine Thrombocytopenia allergy FEOSOL; WAES0903USA02612 SINGULAIR; potassium (uns 414 None OTH OTH VYTORIN; Hypercholesterolaemia; Ibuprofen; Lisinopril; CIALIS; Hypertension Triamterene WAES0903USA02633 0 None OTH OTH LIPITOR; INSULIN; Atrial fibrillation; LORAZEPAM; Diabetes;METOPROLOL; Drug hypersensitivity. WAES0903USA02637 COUMADIN. 0 None OTH OTH None None WAES0903USA02894 Unknown OTH OTH Unknown Unknown WAES0903USA02917 None OTH OTH FOSAMAX;Hypertension; ATENOLOL; Oesophageal NEXIUM acid WAES0903USA02940 reflux; Osteoporosis; Penicillin alle 2 Unknown OTH OTH Unknown WAES0903USA02950 2 None OTH OTH Drug hypersensitivity; Osteopenia;WAES0903USA03624 Migraine valve prolapse; Spondylo 0 None OTH OTH None Penicillin allergy; Shingles Allergic reaction WAES0903USA03646 to antibiotics; Drug hypersensitivity 2 None PUB OTH PREVACIDCardiac disorder; Osteoporosis; Colonic WAES0903USA03653 tubulovillous adenoma; Stres Unknown OTH OTH Unknown Unknown WAES0903USA03948 107 None OTH OTH ZETIA; ZOCOR Penicillin allergy; Allergic reaction WAES0903USA03949 to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0903USA03956 41 spine X-ray,OTH spinal x ray OTH have been Unknown negative,Asthma; does seem Allergic "neuropathic"; reaction toX-ray, antibiotics lung WAES0903USA03992 x ray have been negative, does Unknown OTH OTH Unknown Unknown WAES0903USA04008 709 Unknown OTH OTH Unknown Unknown WAES0903USA04010 497 Unknown OTH OTH Unknown Unknown WAES0903USA04014 -19 None OTH OTH Unknown Latex allergy WAES0903USA04241 1 Unknown OTH OTH Unknown Unknown WAES0903USA04286 -19 None OTH OTH Unknown Penicillin allergy WAES0903USA04311 505 Unknown OTH OTH Unknown Unknown WAES0903USA04319 7 computed axial, OTH 03/24/2009 OTH Unknown Blood pressure high; cholesterol high WAES0903USA04510 68 None OTH OTH TEKTURNA; Blood aspirin; pressure lovastatin; Shingles high; NAMENDA; Depression EFFEXOR WAES0903USA04531 XR 0 Unknown OTH OTH Unknown Unknown WAES0903USA04539 Unknown OTH OTH Unknown Unknown WAES0903USA04567 Unknown OTH OTH Unknown Unknown WAES0903USA04625 9 Unknown OTH OTH Unknown Drug hypersensitivity WAES0903USA04687 0 Unknown OTH OTH aspirin; ZETIA; Sulfonamide propranolol allergy hydrochloride; simvastatin WAES0903USA04690 Unknown OTH OTH Unknown Chronic obstructive pulmonary disease WAES0903USA04712 276 None OTH OTH LANOXIN; AVAPRO; TOPROL None XL TABLETS;WAES0903USA04895 COUMADIN 7 blood pressure, OTH 03/??/09, OTH190/9 Unknown Hypertension WAES0903USA04920 OTH OTH COREG Unknown WAES0903USA05193 0 Unknown OTH OTH Unknown Unknown WAES0903USA05208 Unknown OTH OTH Unknown Unknown WAES0903USA05211 611 Unknown OTH OTH Unknown Unknown WAES0903USA05220 0 None OTH OTH Unknown Hypertension; Hyperlipidaemia WAES0903USA05292 8 None OTH OTH COMBIVENT, Hypertension; 90-180, Osteopenia; puff; Essential aspirin, Hyperlipidaemia; hypertension; 325 mg; ALLEGRA, WAES0903USA05388 Allergic Stress 180 rhinitis urinary mg; due FLONASE, incontinence; to pollen; 0.05 H blood pressure, OTH 180/9 OTH Unknown Unknown WAES0903USA05479 None OTH OTH Unknown None WAES0903USA05503 362 Unknown OTH OTH Unknown Unknown WAES0903USA05528 0 Unknown OTH OTH alprazolam;Arthritis LIPITOR; AMOUR THYROID TABLETS WAES0903USA05531 Unknown OTH OTH Unknown Unknown WAES0903USA05560 Unknown OTH OTH Unknown Unknown WAES0903USA05631
0 None PVT OTH None Drug hypersensitivity Breast cancer WAES0904USA00007 31 Unknown OTH OTH Unknown CholesterolShingles high; Hypertension WAES0904USA00023 Unknown OTH OTH Unknown Unknown WAES0904USA00033 Unknown OTH OTH Unknown Unknown WAES0904USA00055 7 None OTH OTH Unknown Unknown WAES0904USA00219 2 Unknown OTH OTH Unknown Hypersensitivity WAES0904USA00226 Unknown OTH OTH Unknown Unknown WAES0904USA00358 Unknown OTH OTH Unknown Unknown WAES0904USA00359 Unknown OTH OTH Unknown Unknown WAES0904USA00362 0 Unknown OTH OTH Unknown Abdominal aneurysm; Hypothyroidism; WAES0904USA00365 Anaemia; Scleroderma 21 Unknown OTH OTH Unknown Unknown WAES0904USA00366 Unknown OTH OTH Unknown Unknown WAES0904USA00370 1 None UNK UNK aspirin; RHINOCORT; Drug hypersensitivity CLARINEX; niacin WAES0904USA00382 Unknown OTH OTH Unknown Unknown WAES0904USA00411 19 None OTH OTH None None WAES0904USA00419 0 Unknown OTH OTH Unknown Unknown WAES0904USA00478 425 Unknown OTH OTH Unknown Unknown WAES0904USA00483 14 None OTH OTH None None WAES0904USA00572 5 None OTH OTH None Penicillin allergy; Drug hypersensitivity WAES0904USA00611 Unknown OTH OTH Unknown Unknown WAES0904USA00619 None OTH OTH PROTONIX; LYRICA; REQUIP None WAES0904USA00622 3 None OTH OTH Unknown None WAES0904USA00635 1 Unknown OTH OTH VICODIN; cephalexin; Osteoporosis; BONIVA; Sulfonamide lovastatin allergyWAES0904USA00640 1 Unknown OTH OTH Unknown Unknown WAES0904USA00641 Unknown OTH OTH Unknown Unknown WAES0904USA00859 0 None OTH OTH Calcium (unspecified); Gastrooesophageal Omega-3reflux marine disease triglycerides; WAES0904USA00879 PROTONIX; Vitamins (uns 0 Electrocardiogram, OTH 02?/??/09, OTH normal. Unknown Unknown WAES0904USA00891 Unknown OTH OTH Unknown Unknown WAES0904USA00894 1 Mammography PVT03/06/09 PVT - begin findings Unknown in the Fibrocystic left breast, breast two abnormal appearing WAES0904USA00978 lymph nodes in the left axilla; U 0 Unknown OTH OTH Unknown Penicillin allergy WAES0904USA00985 0 Culture rash. PVT OTH PRINIVIL. Blood pressure high. WAES0904USA01027 4 None OTH OTH LIPITOR; lisinopril Hypertension; Hypercholesterolemia WAES0904USA01139 2 Unknown OTH OTH Unknown Melanoma, Chemotherapy WAES0904USA01268 0 endoscopy OTH OTH FOSAMAX; aminopyrine; Perforated VASOTEC; ulcerLovastatin; WAES0904USA01351 omeprazole Unknown OTH OTH Unknown Unknown WAES0904USA01359 49 Streptococcus OTHgroup A,OTH strep test Unknown proved negative. Penicillin allergy Chickenpox WAES0904USA01543 -2 upper extremity OTH X-ray, OTH 04/13/09 Unknown Pain WAES0904USA01885 7 diagnostic laboratory, PVT 04/11/09, PVT Tzanck FOSAMAX; test =positive Disease aspirin; complication for atenolol; Cholecystectomy; zoster;calcium VZV strain, (unspecified); Chickenpox; 04/11/09, WAES0904USA01886 ESTER-C; no Breast varicella-zoster cancer chondroitin virus sulfate dete 10 Unknown OTH OTH Unknown Unknown WAES0904USA01894 Unknown. OTH OTH Unknown Unknown WAES0904USA02021 2 Unknown OTH OTH Unknown Unknown WAES0904USA02055 20 None OTH OTH lisinopril; simvastatin Penicillin allergy Dental implantation WAES0904USA02065 113 Pap test, 04/08?/09, OTH HPV OTH positive.Thyroid medication. Allergic to aspirin and sulfa WAES0904USA02072 drugs; Thyroid disorder. 14 None OTH OTH CELEXA; NEXIUM; TARKA Unknown WAES0904USA02087 0 Unknown OTH OTH Unknown Unknown WAES0904USA02306 Unknown OTH OTH Unknown Unknown WAES0904USA02311 10 Unknown OTH OTH REMICADE Unknown WAES0904USA02319 Unknown OTH OTH Unknown None WAES0904USA02348 28 Unknown OTH OTH Unknown Blood pressure Immunisation high; Scar WAES0904USA02359 Unknown OTH OTH Unknown Unknown WAES0904USA02785 0 Unknown PVT PVT Unknown None Unknown WAES0904USA02790
Unknown OTH OTH Unknown Unknown WAES0904USA02807 8 None OTH OTH None None WAES0904USA02906 1 None OTH OTH None None WAES0904USA02915 0 Unknown OTH OTH Unknown Unknown WAES0904USA02938 2 Unknown OTH OTH Unknown Unknown WAES0904USA02969 0 None OTH OTH vitamins (unspecified) None WAES0904USA03184 615 None OTH OTH DOXYCYCLINE, Penicillin PREMARIN, allergy; Drug HYDROCHLOROTHIAZIDE, hypersensitivity; WAES0904USA03188 Hypersensitivity; DILAUDID, Allergic ACTONE react 303 Unknown OTH OTH Unknown Unknown WAES0904USA03195 Unknown OTH OTH Unknown Unknown WAES0904USA03273 None OTH OTH None None WAES0904USA03450 2 Unknown OTH OTH Unknown Unknown WAES0904USA03566 2 complete blood OTHcell, 66000 OTH levothyroxine Idiopathic sodium;thrombocytopenic prednisone purpura WAES0904USA03598 1 Unknown OTH OTH Unknown No medical history or allergies; WAES0904USA03629 Shingles. 84 Unknown OTH OTH Unknown Diabetes WAES0904USA03693 242 Unknown OTH OTH Diltiazem-HCL; NEXIUM; A history aspirin,ofmg; chickenpox CENTRUM; WAES0904USA03793 as youngster; Calcium (unspecified); Allergy to sulfa; Vitamin rofe 0 Unknown OTH OTH Unknown Unknown WAES0904USA03804 5 None PVT PVT ZOCOR None WAES0904USA03835 2 None OTH OTH FOSAMAX;Sulfonamide VITA C; ASPIRINE; Uterine allergycancer; chondroitin Cervical sulfate WAES0904USA03950 cancer; sodium Appendicectomy (+) levoglutamide; SY 0 Unknown OTH OTH NEXIUM Unknown WAES0904USA04005 5 Unknown OTH OTH Unknown Shingles WAES0904USA04009 1 None OTH OTH HYDROCHLOROTHIAZIDE None WAES0904USA04015 201 laboratory test, OTHscraping OTH of the bumps FOSAMAX; negative Arthritis; CELEBREX; Osteopenia; BENTYL; Cholesterol TOPROL high; WAES0904USA04025 XL TABLETS; Blood pressure ramipril; high; simvastatin; Iodine al 740 Unknown OTH OTH Unknown Unknown WAES0904USA04180 Unknown OTH OTH Unknown Unknown WAES0904USA04185 1 VZV strain, OTH 05/05/2009, OTH VZV WildUnknown Type strainType 2 diabetes Hepatitis mellinus; C Hyperlipidaemia; WAES0904USA04196 Hypertension; Erectile d 143 None OTH OTH None WAES0904USA04201 Unknown OTH OTH Unknown Unknown WAES0904USA04209 2 Unknown OTH OTH albuterol Herpes simplex WAES0904USA04211 3 Biopsy - cellulitis PVT OTH Xanax(unspecified) Hypertension ; Estrogens(unspecified) Gastric ; Arthritis; bypass Drug hypersensitivity; ;WAES0904USA04215 Minerals (unspecified) Contrast media ; Vitamins allergy; (u 0 None OTH OTH Evista None WAES0904USA04216 None OTH OTH None None WAES0904USA04235 Unknown OTH OTH HYDROCHLOROTHIAZIDE; Chronic liver disease LORAZEPAM; PROPRANOLOL WAES0904USA04249 HYDROCHLORID None OTH OTH None Unknown WAES0904USA04250 4 abdominal computed PVT axial, PVT 03/07/09, Unknown and pelvis: Drugsee hypersensitivity; narrative; Rash erythematous; bodySulfonamide temp, 98.6, Rash WAES0904USA04379 allergy; max papular; Anaemia; Hysterectomy; CoronaryAppend artery 5 Unknown OTH OTH Unknown Unknown WAES0904USA04390 1 None OTH OTH IMITREX Migraine; Allergic Intraocular reaction melanoma to bee sting; WAES0904USA04398 Allergy to vaccine; Hyperchol Unknown OTH OTH Unknown Chickenpox WAES0904USA04433 501 Unknown OTH OTH NORVASC;Hypertension; AVALIDE; NIASPAN Benign prostatic hyperplasia; WAES0904USA04449 Aortic stenosis 31 None OTH OTH PREMARIN; levothyroxine Shingles sodium; lisinopril; lovastatin; WAES0904USA04519 KLOR-CON Unknown OTH OTH MICARDIS Blood pressure Varicella high zoster WAES0904USA04551 Unknown OTH OTH Unknown Unknown WAES0904USA04563 613 Unknown OTH OTH None None WAES0904USA04571 Unknown OTH OTH Unknown Unknown WAES0905USA00012 0 None OTH OTH LOTREL None WAES0905USA00026 Unknown OTH OTH Unknown Unknown WAES0905USA00030 12 VZV strain, OTH 05/05/09, inadequate, OTH alprazolam; negative forChest aspirin; B-globin, pain; cyanocobalamin; and Knee Obesity; noarthroplasty; strain Dumping was ferrous identified Adverse syndrome; WAES0905USA00047 sulfate; drug Tremor; gabapentin; reaction; Post-traumatic Stomach omeprazole; discom stre pr Unknown OTH OTH Unknown Unknown WAES0905USA00053 Unknown OTH OTH Unknown Unknown WAES0905USA00055 0 Unknown OTH OTH Unknown Unknown WAES0905USA00183 661 None OTH OTH None None WAES0905USA00208 4 None OTH OTH Atenolol; RHINOCORT Hypertension; Anaemia (BUDESONIDE); Gastrooesophageal SYMBICORT; WAES0905USA00222 reflux disease; NEURONTIN; Drug hypersensitivi Hydrochlo
Unknown OTH OTH Unknown Unknown WAES0905USA00229 Unknown OTH OTH Unknown Unknown WAES0905USA00231 0 Unknown PVT PVT Unknown None WAES0905USA00233 298 Unknown OTH OTH furosemide;Sulfonamide lisinopril allergy WAES0905USA00346 21 Serum varicella OTH zoster,OTH positive; Body NEXIUM; temp,DIOVAN; 97; Chronic Bodyobstructive Allopurinol; temp, Elevated 98. pulmonary Simvastatin. liver enzyme disease; WAES0905USA00353 levels;Arthritis; Gastric disorder. Hypertension; Hyper 0 Unknown OTH OTH Unknown Unknown WAES0905USA00356 gia and arthritis and a history of a fall UNK on her left UNK side a couple aspirin; of years OXYCODONE Post agoherpetic and shingles Shingles; neuralgia; who FallArthritis; on 04-APR-2009 Drug WAES0905USA00376 hypersensitivity was vaccinated with ZOSTE 0 None OTH OTH Unknown Unknown WAES0905USA00393 0 Unknown OTH OTH Unknown Unknown WAES0905USA00515 None OTH OTH None None WAES0905USA00519 0 Unknown OTH OTH Unknown Unknown WAES0905USA00552 786 Unknown OTH OTH None Unknown WAES0905USA00564 Unknown OTH OTH Unknown Unknown WAES0905USA00580 serum varicella OTHzoster,OTH 04/17/09, 3.04 None- IGG Chronic fatigue Shingles syndrome WAES0905USA00638 None OTH OTH None Chickenpox WAES0905USA00700 1 Body temp,OTH 98.9; VZV UNK strain, inadequate TENORETIC; specimen, Hypertension; BONIVA; no strain Chickenpox Omeprazole; Osteoporosis; identified Potassium DrugWAES0905USA00860 hypersensitivity (unspecified) 1 None OTH OTH Unknown Skin disorder WAES0905USA00940 0 Unknown OTH OTH VASOTEC;Type glipizide; 2 diabetes DICHLORTRIDE; Toothmellitus; disorderAllergy metformin; to WAES0905USA00949 vaccine ACTOS; ZOCOR 1 None OTH OTH aspirin; LIPITOR; Hypertension; PREMARIN; Hypercholesterolaemia; glucosamine; hydrochlorothiazide; WAES0905USA00952 Allergic reactionDAYPRO; to antibiotics; pota 5 VZV strain, OTH 05/13?/09,OTH VZV wild type Senna strain. syrup, Chronic mL; Metoprolol, obstructive Hyponatraemia; mg; pulmonary Fluticasone Methicillin-resistant disease; WAES0905USA00965 inhaler, Hypertension; microgm; staphylococcus multi Anaemia; vitamins aureu Chro (u Unknown OTH OTH Unknown Rheumatoid arthritis WAES0905USA00983 Unknown OTH OTH Unknown Unknown WAES0905USA01036 732 None PVT PVT None Prostate cancer WAES0905USA01058 7 None OTH OTH calcium (unspecified); Cholesterolomega-3 high; Breast marine cancer triglycerides; WAES0905USA01069 ZOCOR; tamoxifen citrate; v Unknown OTH OTH Unknown Unknown WAES0905USA01098 0 Unknown OTH OTH Unknown Unknown WAES0905USA01101 Unknown OTH OTH Unknown Unknown WAES0905USA01253 1 Abdominal PVT ultrasound, PVT 04/21/09, See Unknown narrative; Urinary Serum tract albumin, Migraine infection; 04/20/09, Drug hypersensitivity 4.1 gm/dl; WAES0905USA01255 Erythrocyte, 04/20/09, 37 mm 4 None OTH OTH Tricor; Ferrous Diabetes sulfate; Lasix; Glyburide; Lisinopril; WAES0905USA01271 Minoxidil; Cialis 439 temperatureOTH measurement OTH98.6 - Maximum aspirin; hydrochlorothiazide; temperature Diverticulitis; Breast Hyperlipidaemia; LEVOXYL; cancer; Knee lisinopril; Hypertension; arthroplasty; WAES0905USA01287 lovastatin; Hypothyroidism; Chickenpox INDERAL Anaem 614 None OTH OTH Unknown Unknown WAES0905USA01301 2 VZV strain -OTH VZV wild type OTHstrain Aspirin; Atenolol; Synthroid; Chickenpox Lisinopril; ViagraWAES0905USA01312 0 None OTH OTH Zyrtec Hypersensitivity WAES0905USA01422 543 None OTH OTH Unknown Chronic obstructive Nephrectomy pulmonary disease; WAES0905USA01423 Hypertension; Cardiac failure 2 None OTH OTH FLONASE; Seasonal VIAGRA allergies WAES0905USA01465 4 VZV strain 05/13/09 OTH - Sample OTH adequate: Unknown VZV WILD TYPE Unknown STRAIN WAES0905USA01623 4 Unknown OTH OTH CIPRO Unknown WAES0905USA01656 1 VZV strain; OTH 05/14/2009, OTH VZV WildVYTORIN; Type Strain. Hypothyroidism; Fenofibrate; Hydrochlorothiazide; Hyperlipidaemia;WAES0905USA01657 Drug LEVOXYL; hypersensitivity. SINGULAR. 1 None OTH OTH lisinopril; meclizine Hypertension; Sulfonamide allergyWAES0905USA01842 1 None OTH OTH Premarin Perfume sensitivity Shingles WAES0905USA02008 1 Unknown OTH OTH Unknown Unknown WAES0905USA02208 None OTH OTH None None WAES0905USA02276 2 Unknown OTH OTH ZETIA; PROZAC; Promethazine; Unknown CRESTOR. WAES0905USA02488 Unknown OTH OTH Unknown Unknown WAES0905USA02517 X-ray - Something OTH on his OTH lung Unknown Unknown WAES0905USA02520 0 Unknown OTH OTH Unknown Unknown WAES0905USA02523 1 None OTH OTH Unknown Allergic reaction to antibiotics. WAES0905USA02846 461 None OTH OTH Celebrex; Lasix; Hypertension; Hydrocodone; Hyperlipidemia; Zocor; Coumadin. Arthritis; WAES0905USA02876 Aortic valve disease; Fruit alle Unknown OTH OTH Unknown Blood pressure high; Eye disorder.WAES0905USA02917 26 None OTH OTH GLIMEPIRIDE, Ischaemic HUMULIN, cardiomyopathy; Defibrillator/pacemaker METFORMIN, Diabetes TOPROL WAES0905USA02926 insertion XL TABLETS, VIAGRA, DIO 2 Unknown OTH OTH Unknown Unknown WAES0905USA02944
Unknown OTH OTH Unknown Unknown WAES0905USA02976 1 PPD OTH OTH Phantom limb pain; Neuralgia. WAES0905USA02979 305 Unknown OTH OTH Unknown Unknown WAES0905USA03099 Unknown OTH OTH Unknown Unknown WAES0905USA03224 0 None OTH OTH Unknown Genital herpes WAES0905USA03226 hemoglobin,OTH 7 OTH Unknown Unknown WAES0905USA03236 1 None OTH OTH LEVOTHYROXINE Hypothyroidism SODIUM WAES0905USA03363 None OTH OTH None Penicillin allergy WAES0905USA03373 0 None OTH OTH Unknown Unknown WAES0905USA03378 21 OTH OTH None Heart rate irregular; Candidiasis. Arthritis. WAES0905USA03386 1 None. PVT PVT APLISOL, 62418, At the time ID Forearm The of vaccination patient left, had 0 previous henoreported known doses allergies. feeling ### tired. His past medical histo 0 UNK UNK Anemia Allergic to shrimp 1 Labs: CRP PUB 1.6. urine tox PUB (-). CBC unremarkable. Na+ 139. CSF WNL. Head CT LA090702 WNL. 18 PVT PUB None Well check None up/constipation UNK UNK None UNK UNK This is a very healthy infant with no medical problems. 0 electrocardiogram, OTH 06/18/09, OTH normal; None blood pressure, hematoma 06/18/09, Unknown under 2normal. toe nails Labs and WAES0907USA00742 Diagnostics: CT brain (-). EEG 2 Reviewed by PUB Doctor atPUB Hospital Current Metoporal 50 mg; Hypertension Flonase 0 None PVT UNK None - veryNone healthy - Hx baby &AtPx 2 mo. -> Completely & 4 mo.~Rotavirus healthy infant (no brand name)~2 0 PVT PVT Multiple infections varicella~Varicella (no brand name)~1~1~Patie 29 Unknown. OTH 6/25/09 Labs OTH and Diagnostics: COLACE; EEG LEXAPRO; Hepatic normal. cirrhosis; estradiol; Transfusion. CSF WNL. Borderline LASIX (-)Penicillin oligoclonal (FUROSEMIDE); hypertension; WAES0907USA01157 Allergy. bands. Multiple Hepatitis MRI MIRALAX; brain Drug C; Hypersensitivi with allergies RESTORIL someand mild 10 PVT PVT none none 10 PVT PUB 1 visual examination PVT of injection PUB site by PA 06/27/2009~Measles + Mumps + Rubella (no b 0 PUB OTH Birth Control Pills Lactose intolerance; Allergic to grass and hay 1 PVT PVT None None L Conjunctival Protuberance 1 PVT PUB NKDA Wolfe-Parkinson-White syndrome 1 PUB UNK PPD; Sanofi Pasteur Ltd; C3150AN; Right Forearm, ? PVT PVT None epilepsy 2 UNK PUB PUB Unknown Asthma; Concomitant medications A0796705A unknown. No adverse e 6 9/24/09 Medical PVT records PVT received None for date of service No 6/22/09. 9/24/09 Diagnostics/Labs: Medical recordschest received xray for findings: date ofasymmetric service 6/22/0 inc 0 PUB PUB No 0 UNK UNK Advil None None None~ ()~~0~Patient 0 PUB PUB none none 1 PVT UNK Retin A 0.05% None top cream, Ulcerative Fluocinonide proctitis 0.05% top cream, Canasa 1,000 MG Rec 1 UNK PVT celebrex, lipitor, none actonel, none levoxyl 1 CXR: poor inspiratory UNK effort, UNK infiltrate left lowerNO lobe COMPLAINTS base,ASTHMA resolving OR Obesity infiltrate. ANY OBVIOUS Labs: WBC SIGNS/SYMPTOMS 16.6(H),Auto ANC14.6(H) 2 None PVT PVT None None None 2 PVT PVT AUGMENTIN OM NONE KNOWN 0 NONE PVT PUB NONE NONE 1 None PVT PUB Otitis MediaNKDA Pt. had Nonot medical taken problems any other medications prior to or on day 11 None PUB PUB none none none AZ0906 1 Treated for UNK cellulitis at UNK the vaccination site no 0 PUB PUB 34 inutssusception. UNK 7/30/09 UNK Clinic records none received none DOS 6/2/09 noneand 7/30/09 7/6/09. intussussception~Rotavirus Clinic LABS records and DIAGNOSTICS: received DOS (Rotarix)~3~1~Pat 6/2/09 CHEMand - Anion 7/6/ 0 PVT PVT adderall, proair 11 yr phy astma,allergic rhinitis,adhd 0 Referred toPVT allergist to PVT evaluate forNone possible gelatin None allergy Premature infant None PVT PVT None PENICILLIN PVT PUB 0 Doctor instructed PUB to hold PUB dose of Typhoid None vaccine Nonex 1 dayNone & call if symptoms worsen. 1 None MIL MIL CETIRIZINE None HCL NKA, no birth defects, no medical conditions
1 3 0 None
PUB PUB None None AR0923 PUB UNK None None None AR0924 PUB PUB None None None AR0925 UNK UNK None None PVT UNK None None 2 None PVT PVT Swelling None 0 PVT PVT Tylenol prior None to vax. None 0 PVT PVT 0 Vitals PVT PVT PCN; Cephalosporins 1 PVT PUB None None None NC09028 1 PUB UNK ALLEGRA; Fish oil; NORVASC; Hypertension; LOVAZA;NEXIUM Hyperlipidemia; NC09029 GERD; Allergies OA 0 PVT PVT 0 Unknown PUB PUB None Known None No Known allergies 0 None OTH OTH None 0 None PVT OTH None None None 1 PUB PUB METFORMIN HCL; GLYBURIDE; DM; Hyperlipidemia; DIPHENYDRAMINE. Esophageal reflux; Allergic Rhinitis; 6 neuro checkPVT PVT no Migraine headaches 0 PVT PUB None Teething -> Molars 1 PVT UNK None Twin- 33 wks gestation with gastroesophageal reflux. 1 PVT OTH None None None 1 PUB UNK None Undescended (L) testicle None PVT PUB None None PVT PUB PVT PUB 0 PVT PUB 0 PVT PVT Captopril; Digoxin None except Congenital for chronic heart condition disease 5 Spinal Tap,PVT MRI PVT None None allergy to CECLOR Unknown OTH OTH Unknown Unknown WAES0903USA02916 OTH OTH Unknown Unknown WAES0903USA04731 1 Not reported PVT UNK FLONASE; ATENOL; The ADVAIR; patientSINGULAIR had no illness and### no known drug allergies at 5 None PVT PVT Aspirin The patientThe had patient no illness hadatathe history timeofofdiverticulosis; vaccination. ### Shingles, March 0 PVT OTH Lithium, LOMENTIL History of sulfa drug allergy and ###bipolar disorder. The patie On 09 JuneUNK 2008 serology UNKtestingPrenatal was completed vitaminsthat was Thenormal. patientOn has22a July history 2008 of pollen an### ultrasound allergy. was Obstetrical completed histo 2 No relevantPVT diagnostic PVT tests/laboratory data were performed. The patient had no illnesses at### the time of vaccination on 1 1 PVT PVT LEXAPRO;ItSYNTHROID; was reported Medical CEFTIN; that history the patient Omega of hypothyroidism had 3; Vitamin sinusitis ### C; atand Vitamin theallergy timeE;ofto Vitamin vaccination AUGMEN B 2 Not reported. UNK UNK NORVASC;Illnesses MOTRIN; atFLEXERIL There the time were of vaccination no known allergies. were cough ### Concomitant and staple medications in the patie UNK UNK None reported. ### 1 None UNK UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK Not reported. ### 1 None reported. PVT OTH ZYRTEC; BENTYL No known allergies. ### Not reported UNK OTH ### 0 Not reported PUB UNK Birth control pills The patient had no illness at the ###time of vaccination and ha 1 None OTH OTH None ### 0 UNK UNK ### 0 not reportedOTH OTH none ### UNK UNK ### None PVT PVT FOLIC ACID; CRESTOR; History SYNTHROID; of rheumatoid DIVON; arthritis,ASPIRIN; ### hypothyroidism, CYMBALTA hypertensio 13 16/Mar/2009: PVT Cultures PVT - no growth Medical history and concomitant ###medications were not rep 0 Not reported PVT OTH No known allergies. No medical ###conditions other than seas
4 none OTH UNK Sudafed none ### 7 not reported. OTH UNK ### 1 None PVT OTH Topamax, Maxalt Patient has a history of migraines. ### Concurrent therapy incl 1 PVT PVT HRT Lyme Disease ### 1 PVT PVT ASA; Vitamins No medical history. Last Td vaccination ### was 20 years ago. not reported. PVT From information OTH received 19 March 2009, History no testing of hypothyroidism performed for the andevent; ### an allergy only routine to antibiotics. lab work The fo 1 UNK UNK SYNTHROID; Sinus LISINOPRIL; infection History without ALDACTONE; of high fever blood at the METFORMIN; pressure, time of### vaccination. metabolic FOL-TX; syndrome, CALTRATE; fibrom 3 none reported. UNK UNK Not reported. ### 0 None. PVT PVT Multivitamin; TUBERSOL No medical conditions. No known ### allergies. No illness at tim 1 None PVT UNK No illness at the time of vaccination, ### other medications unk 6 OTH OTH TUBERSOL 5 TU No medical history, no known ### allergies, no concomitant me 39 Not reported. PUB Follow-upPVT information prenatal received vitamins; on 13 November PPDRefugee SKIN2008 TEST whose indicated past obstetrical the following: ### history An ultrasound is "unknown." performe The 4 None reported PVT OTH ACIPHEX; Fluoxetine; The LUNESTA; patient had CELEBREX a history of allergy ### to CELEXA. It was indi 1 None reported. OTH OTH None reported. ### Patient reported PUB havingUNK "tests" (notCELEXA; specified). Prenatal From information vitamins; HistoryZOFRAN; includes received an PHENERGAN on allergy 09/Feb/2009, to penicillin ### the patient and one had previous the follow p 3 MIL MIL 6 Numerous -PUB labs normal; PVT brain MRI Vitamin essentially C 500 Had normal mg cold daily. per dxExertional but 7/29/09 neurosurgeon; deemed Consultant compartment stable gallfor bladder medical flu syndrome shot HIDA records 12/30/08 -scan bilateral received essentially fasciotomy. DOSnorma 6/30/0 7 61 Extracted from PVTD/C on OTH 08/31/08 and None Neurology None Consultation Not Applicable Report to PCP - None following 09/23/08 F/U visit. CT head-N 102 Culture sentPVT on fluid drained PVT from abscess were None negativeNone - no aerobic or anaerobic bacteria present. 8 none MIL MIL none No illness none 4 MIL MIL 0 None PVT PVT Unknown OTH OTH Unknown WAES0907USA00699 0 None PUB PUB Singular; Claritin Asthma 0 Unknown OTH OTH Unknown Unknown WAES0907USA01326 0 PVT PVT None Well Child None 0 OTH PVT Knee laceration None Unknown OTH OTH Unknown Unknown WAES0907USA01296 None PVT PUB None None None 229 Unknown. OTH Medical records OTH received Morphine; DOS 7/15/08 PRILOSEC; to 7/7/09. None. prednisone LPMedical recordsWAES0907USA00930 received DOS 7/15/08 to 7/7/09. Ea PUB PVT None None PUB UNK None None Unknown OTH OTH Anaphylactic Anaphylactic reaction WAES0907USA01222 reaction~Varicella (Varivax)~UN~ 1 PVT PUB None None 1 PUB PUB None Asthma. 17 body temp, PVT 06?/??/09,OTH 101 F VICODIN; fentanyl; Sulfonamide SEROQUEL allergy; Drug hypersensitivity; WAES0906USA02621 Smoker 1 None PVT PVT 2 None PVT PUB None None 2 PVT OTH Cough; sleeplessness PUB PUB None None PVT PVT No Osteoporosis See I-693, Report PUB of Medical UNK Vaccination Record A cold attached. Pollen See+copy unspecific of I-693! food additive allergies 4 None PUB UNK myalgia NKDA esicular noted) posteriorNone scalp red raised PVT lesion UNK (L) neck. 4 none PUB PUB denies denies denies 0 None PUB PUB None Not prior to None vaccination 5 PUB PVT No Sulfa drugs allergy 0 PVT PVT None None None 0 PVT PVT none Growth delay-? Allergies; Eosinophilic Disease; Eczema; E 1 None MIL MIL PPD, SanofiNo Pasteur, C2681AA, ID/ Left arm; Zyrtec 2 OTH PVT Metoprolol 50 mg; Allopurinol Gout; High 300 BP; mg; BPH Lisinopril 10 mg; Doxazosin 4 mg
1 None PVT PVT None No No 2 PVT PVT Xanax XR, healthy Paxil, Zyprexa, seasonal, Provigil, Lamictal Advairand Diskus, Diflucan Flonase, allergies; Singulair, CeliacCalrinex, disease,U 1 PVT PUB none none 0 None PVT PVT None None None 1 ECG-normal PVT PVT Lovastatin, None Zyrtec, Nexium No known allergies 1 MIL MIL implanon no reportedno illness reported illness or pertinent medical history 0 PUB PVT No Diabetic 1 Labs: CBC,UNK CMP , PT,UNK PTT, TSH,metformin, Magnesim,diovan, no Phosphorous januvia, hypertension, alllipitor, normal. lisinopril, diabetes, D-dimer nexium high hyperlipidemia at 0.56 Dx PMH: studies/Xrays: OA, HTN, CXR DM 0 None. MIL PVT Cabergoline, None Zyrtec, Motrin PCOS, Allergic Rhinitis, elevated prolactin. Has had tende 0 PVT PVT none no born with B pneumo-thorax - resolved 1 UNK PUB None Known None known None known 0 UNK UNK accutone none 7/17/09 Medical site soreness~HPV records received (Gardasil)~1~25~Patient DOS 7/13/09 to 7/17/09. 0 UNK UNK PCN;Sulfa;MS;Cephalosporins;codeine;Negram;Vinegars, PUB PUB Allergic to Monostat 1 N/A PVT PVT 1 PUB PUB Tylenol URI-viral, Rash Eczema 10 none PUB PUB n/a no no AZ0907 1 none PVT PVT none none 0 UNK UNK Hydrochlorothiazide 25MG, Primary 1 tablet Hyperoxaluria BID; Pyridoxine HCl 100MG, 5 Tablet daily; U 1 none UNK UNK none nkda 1 UNK UNK ALBUTEROL NONE 90MCG (CFC-F) NONE 200D ORAL CITALOPRAM HYDROBROMIDE 20 0 PVT PVT Prevacid, Metoclopramide 10 days of cold GE reflux symptoms 3 culture taken PVT in ER to test PVTfor respiratory None infections None - all cultures born with returned Bi-lateral None~ negative ()~NULL~~In club foot; otherwise Patient|Unknown~ no other pre-existin ()~NUL 3104 UNK OTH OTH Unknown A0796729A 0 PUB UNK None None 1 MIL MIL Bell's PalsyBell's Palsy resolved one month prior 1 PVT PUB No 9 7/7/09, Creatine MIL KinaseMIL SERUM 88 none (22-269);none Troponin Tnone Cardiac SERUM 0.028(0.00-0.029); Creatine Kinase MB 3 Creatine Kinase MIL MB SERUM MIL 2.050 ng/mL (0-6.73), None Troponin NoneT Cardiac SERUM <0.010 ng/mL (0.00-0.029), Creati 0 None PVT PUB None Reactive airway disease & allergic to some milk, tomato so 2 None PVT OTH TRI-VI-FLOR None / WCC None 4 PVT PVT 2 None OTH OTH None None None 2 PVT PUB 25 PVT PVT At birth, pectus excavatum (mild); mild umbilical hernia 31 None PUB PUB None Latex; Erythromycin; Sulfa 1 OTH OTH None None 1 PVT UNK SINGULAIR 4mg, 9 hrsEnvironmental Allergies 23 None done PVT / available PVT None Serious Otitis environmental media seizure~DTaP allergies + HepB + IPV (Pediarix)~2~0~S 0 None PVT PVT None None None 0 EEG normal. PVT LABS and UNK DIAGNOSTICS: Liquid multivitamin CBC, None MetabolicHealthy; Profile. full-term baby 5 PVT PVT None Fever 102-103 None 24 hrs after for 24-48 hrs 0 PUB PUB none asthma 29 Nerve test; PVT Lumbar puncture. OTH 9/3/09 Hospital None records received No. PMH: DOSBirth 5/5/09 at 34 to weeks, 5/6/09. APGAR LABS and was DIAGNOSTICS: 8 becoming 9. C H 3 PUB UNK none none 1 MIL MIL PPD 4 OTH OTH HUMALOGNone in pump; Phenobarbital Diabetes- Type Neck/shoulder -seizure 1; seizure control; pain.~Pneumo disorder; 81 mgHiatal Aspirin (no hernia; brand RTname) bund 8 see above MIL UNK ALEVE PRN None None 0 MIL MIL None None 1 None PVT OTH None Allergic Rhinitis 0 PUB PUB Completed None AMOXIL poSulfa X 10 days, 2 wks prior to immunization
0 PVT OTH None Dizziness.~HPV (Gardasil)~1~12~Patient 0 None PVT PVT None Asthma; CODEINE; VICODAN; TYLENOL; IBUPROFEN 0 PVT PVT None None None 2 PUB UNK No None 1 PVT PVT Nut; Animal dander 1 None OTH PUB COZAAR None Hypertension Unknown OTH OTH Unknown Unknown WAES0907USA01302 0 UNK PVT OTH Unknown Concomitant medications A0796919A were unknown. No known releva 0 UNK PVT OTH Unknown Concomitant medications A0796919B were unknown. No known releva 1 UNK OTH OTH Unknown A0796945A 0 UNK UNK Prozac none otherwise healthy 8 UNK UNK 0 All diagnostic UNK bloodwork UNK results were Allegra, negative Nasonex None and/or normal. Asthma, 7/17/09 food Hospital and seasonal records allergies. received 7/17/09 DOS 6/18/09 Hospitaltoreco 6/ 0 none UNK UNK none allergies / rhinitis 1 none PUB PUB Vesicare 5 No mg qd, aspirin amoxicillin 81mg qd, nasonex prn 4 None PVT PVT none No None 1 PVT UNK 0 PUB UNK None None 1 Elevated WBC UNKand Low UNK platelets. None 7/22/09 Hospital None records None. received 7/22/09 DOS Hospital 7/11/09 records to 7/15/09. received LABS DOS and7/11/09 DIAGNOS to 7 1 none PUB PUB prescribed keflex none NKA, Contact Dermatitis 1 PUB PUB 1 PVT PUB none none 1 PVT PVT LOPRESSOR. FLIC ACID. EVISTA 1 PVT PVT None None 0 UNK UNK 0 No testing done. PVT PUB None. HadSee tonsilitis otherone medications, Prior week allergies prior,above. treated to Ceclor, with cefzil, zithromax. omnicef (vomiting, vomiting 1 none PVT PVT None None None 1 Mother reports PUBchest x-ray PUBnegative, None CBC negative None None 1 UNK UNK Patient wasNone healthy known no illness 1 PVT UNK Metformin 500mg none bid,aspirin diabetes 81mg typeqd II 0 Normal EKG PUB PUB synthroid, nexium, mesenteric heparin, percocet, adenitis flagyl, zithromax, cipro, colace, codeine, senna erythromycin, lidocaine, hyd 1 UNK UNK none none none knownnone~ ()~NULL~~In Sibling1|none~ ()~NULL~~ OTH PVT 1 OTH OTH None NKA 1 None PVT PVT Prenatal vitamins; None CLARITIN; Irregular Given menses Rx/ for selfProAir reported: HFAoccasional 7/10/09. asthma; Infer 5 ER did urinary PVTtract infection UNK test that None was negative; None told None by Dr. no blood Patient tests has could had be varying donedegrees to determine of reactions if child w to 1 Visual examPVT PVT None Allergy to sulfa PVT PUB 0 Physical exam PVT PUB None None None 8 MIL MIL None None 4 CBC, negative; MIL CHEM MIL 20, negative; Vitamin Cardiac D-Calcium enzymes, None Complex negative None twice daily 0 CBCt, 67.8 PVT lymphocytes, PUB 7/1/09 (Viral TYLENOL; URI) None ZITHROMAX; Chronic RYNATAN BAUM;syrup ETD; OME 0 UNK UNK I had an allergic reaction to PROPOFOL for my colonosco 1 UNK UNK 0 PUB PUB No 2 PVT PUB 2 CBC PVT PVT None None 1 PVT PVT None None NKDA 1 PVT PVT None Allergic to Lisinopril/HCTZ 0 None PVT UNK None None 2 PVT PUB Allergic Rhinitis Allergic Rhinitis, Allergic Conjunctivitis
0 PUB UNK None 1 Ultrasound PVT of upper extremity; OTH CT of shoulder & upper arm CF; Diabetic; GERD; Gastroparesis; Allergic Rhinitis; Chro 4 Report indicated UNK AST value UNK was 82 and ALT value was 171 Theon patient 12 July had2008. not been On 15 taking July ###any 2008concomitant ALT was 100. medicati 2 None PVT OTH None. ### From information PUB received PVT29/Dec/2008, no relevant laboratory The patient and diagnostic had no concurrent tests were ### illnesses, performed. no known allergie PVT PVT Allergies to Keflex and Ortho Tricyclen ### 7 Unknown UNK UNK Unknown ### 1 OTH OTH none ### 1 UNK UNK na na One week prior to having the shots, patient had a febrile s 9 June 27th -MIL CSF: Testing MILfor gramNone negative bacteria None wasNKDA negative. CSF testing for PCR< IgG and IgM pending per 1 PVT UNK none none fever, swelling~Tdap (no brand name)~UN~11~ 2 PVT PVT 5 PVT UNK Nuvanna healthy temperatureOTH on initial evaluation OTH in the Emergency Room:Medical 39.2 degrees history Celsius; not reported Initial### troponin I: 0.16 mg/dL; CK a 0 none PVT OTH none none none 0 PVT PVT 1 PVT PVT none none none; history spasmadic bronchitis PVT PUB 42 Not reported UNK UNK Birth control pills The patient had not received any ### other vaccines within fou 2 none PVT UNK none none 43 urine beta-human, OTH positive; OTH serumMOTRIN; beta-human, vitamins Pregnancy positive (unspecified) NOS (LMP = 7/1/2008); WAES0808USA04839 Allergic reaction to antibiotics 1 none PVT PVT none none 1 none PVT PVT none none 28 Computed axial, OTH 06/25/09, OTHnegative; ADACEL; Mantoux HAVRIX; test, 07/16/08, FLUMIST; None. negative. 9/11/09 tuberculin 7/21/09 Medical purified WAES0907USA01273 ER records records protein received received DOS DOS 7/16/08 6/25/09. to 7 1 PVT PUB NONE NONE PVT PVT 5 OTH UNK No meds; calcium; no multivitamin none PVT PUB None None 4 PVT PUB 0 MIL MIL Omeprazole, None 20 mg Gerd Flu- like illness~Influenza (no brand name)~UN 0 None PVT PVT Unknown None injury to left shoulder 0 OTH PVT None - newDM2, patient Hyperlipidemia visit 1 UNK OTH OTH Hydrochlorothiazide Unknown Relevant medical history A0796970A was unknown. No adverse even 0 Patient hadMIL urinalysis test MIL conducted. None reported None reported 2 Unknown PUB PUB none MO-2009-15 0 none PVT PVT none None- patient None states she was feeling great 2 None. PVT PVT none Asthma, Obesity 0 7/24/09 ERUNK records received UNK DOS 7/17/09. LABS NO.BUT and AFTER DIAGNOSTICS: NO. 7/24/09 THE INCIDENT ER EKG records WNL. PATIENT received Urinalysis SAYS DOS - Cloudy, SHE 7/17/09. HAS Leukocytes Phobia PASSED of 1 None PUB PUB NONE NONE NONE LOCAL REACTION~Tdap (Adacel)~1~12~In S 1 none PUB PUB NONE NO NONE LOCAL REACTION~DTaP + IPV (KINRIX)~5~5 2 PVT PVT none none none 0 none PVT UNK Levothyroxine none 150 mcgnone daily, Celexa 40 mg daily, fish oil, flaxseed oil, evening p 1 PUB PUB none asthma 0 NONE PUB PVT NONE NONE NONE 8 Bloodwork PVT PVT None 1 PUB UNK Wellbutrin, None Crestor, Levoxyl Medication allergies- ceclor, penicillin, Levaquin 8 PUB PUB 1 UNK UNK Reglan 1 NONE. PUB PUB PCN- FINISHED ALLERGIES, 10 DAYS NONE. COUGH AGO. MUCINEX, NYQUIL PRN. 1 UNK UNK NONE KNOWN NONE KNOWN 1 None PVT PVT None None Obesity
1 7/21/09 Medical PVT records UNK received DOS 5/1/09None to 6/08/09.7/21/09 LABS and Medical DIAGNOSTICS: records received EKG DOS - WNL. 5/1/09 CBCto- Lymphoc 6/08/09. A 0 PVT OTH None Hay fever; CAD 1 PVT OTH Allergies - Doxycycline 2 PVT UNK 1 PVT PVT Well Child 1 None UNK PVT Effexor 150None mg per day; Drug Phentermine allergy to all 30forms mg. per of codeine day 0 CAT scan; PET UNK scan, bone UNK marrow Fosamax. biopsy, echocardiogram; 7/24/09 None Medical Allergic records finetoneedle sulfa; received have biopsy; DOS glaucoma; two2/20/09. surgical osteoarthritis. Voltaren, biopsies carteolol 7/24/09 oph Me 0 UNK UNK 23 Rubella IgM, PVT IgG titers PUB -NoneNoneNone 1 PVT PUB Dexamethasone None 1 mg None 1 tab at bedtime 1 PVT PVT 0 PVT PVT PVT PVT None 0 None PVT PVT None None 0 Being evaluated PVT at hospital PUB on 7/17/09 None None None PVT UNK PUB PUB 6 months pregnant Physical examination, OTH 12/19/08, OTH postpartum Unknown exam: Pregnancy full normal NOS (LMP exam;= 2/9/2008) Beta-human WAES0804USA01770 chorionic, positive 67 None OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0805USA02346 0 Beta-humanOTH chorionic,OTH positive; Urine Unknown beta-human, 04/25/08, Asthma negative WAES0805USA04045 84 Unknown OTH OTH Wellbutrin Pregnancy NOS (LMP= 1/7/2008)WAES0807USA04408 Anxiety; Depression 43 Beta humanOTH chorionic, OTH positive. Insulin Pregnancy NOS (LMP -7/1/2008);WAES0808USA01387 Juvenile diabetes 21 Ultrasound,OTH 12/04/08, normal OTH ; Ultrasound, Vitamins (unspecified) 01/08/09, Pregnancy normal NOS; (LMP=8/6/2008) Ultrasound, 03/27/09, WAES0810USA02180 normal ; Diagnostic laboratory Ultrasound OTH 10/15/08 - Normal UNK Vitamins (unspecified) Pregnancy NOS (LMP=8/16/2008)WAES0810USA03304 ultrasound, OTH 10/18/08, patient OTH has aNATELLE bicornuatePregnancy uterus Chickenpox NOS (LMP = 9/1/2008); WAES0810USA05202 Bicornuate uterus 117 ultrasound, UNK Fetal ultrasound: UNK positive; BACTRIM ultrasound, DS Pregnancy TABLETS 10/07/08, NOS 6 weeks (LMP =08/20/2008) days; spotting, WAES0811USA03512 pain; ultrasound, 11/19/08, 2 49 urine beta-human, OTH 02/08/07, OTH positive Unknown Termination of pregnancy WAES0905USA04071 - elective Unknown OTH OTH Unknown Unknown WAES0906USA01687 0 None OTH OTH drospirenone (+) ethinyl Unknown WAES0906USA01721 Pap test, was OTH negativeOTH prior to beginning Unknown the vaccines; Pap Vaginosis test, Demonstrated bacterial WAES0906USA01741 "high risk HPVA DNA detected" Unknown OTH OTH Unknown Unknown WAES0906USA01763 27 Pap test, 05/28/09, OTH atypical OTH cells ofNone undetermined significance None with high risk HPV WAES0906USA01774 include HPV 16 and 18 159 Cervical Smear, OTH 03/??/08, OTHnormal Unknown ; Cervical Smear, 05/09/09, Unknown low grade CIN, HPV WAES0906USA01895 positive; Cervical Smear, 01/?? None OTH OTH Unknown Unknown WAES0906USA01909 Unknown OTH OTH Unknown Unknown WAES0906USA01913 Unknown OTH OTH Unknown Unknown WAES0906USA02001 0 Unknown UNK OTH Unknown Unknown WAES0906USA02050 0 Diagnostic Laboratory UNK OTH - unspecified Aspirin; blood Lipitor; work, Blood results Citracal pressure notD;provided. Felodipin; high; Cholesterol Centrumhigh WAES0906USA02051 silver; / Oesophageal Omega-3 marine Refluxtriglyceride acid reflu 0 None OTH OTH prednisone;Seasonal triamcinolone allergy acetonide WAES0906USA02057 0 none OTH OTH None None WAES0906USA02088 0 Unknown OTH OTH Albuterol; Ibuprofen, Pregnancy200 NOS mg.(LMP=6/10/2008)WAES0906USA02122 Asthma serum directOTH bilirubin, increased OTH inNone bilirubin None WAES0906USA02126 1 None OTH OTH Unknown Unknown WAES0906USA02135 0 Unknown OTH OTH Unknown Unknown WAES0906USA02136 Unknown UNK OTH Unknown Unknown WAES0906USA02262 Unknown OTH OTH Unknown Unknown WAES0906USA02639 Unknown OTH OTH Unknown Unknown WAES0906USA02641 0 None OTH OTH PROZAC None WAES0906USA02645 0 Unknown OTH OTH Unknown Unknown WAES0906USA02647 0 None OTH OTH None None WAES0906USA02655 1 Unknown OTH OTH Unknown Unknown WAES0906USA02657
0 Unknown OTH OTH Unknown Unknown WAES0906USA02879 0 Unknown OTH OTH Unknown WAES0906USA02895 0 Unknown OTH OTH Unknown Unknown WAES0906USA02901 1 body temp, OTH 5/21/09, 102 OTH degrees SEASONIQUE Latex allergy WAES0906USA02915 Unknown OTH OTH Unknown Unknown WAES0906USA02926 0 Unknown OTH OTH None WAES0906USA02932 1 Unknown OTH OTH Unknown Penicillin allergy; Drug hypersensitivity WAES0906USA02937 1 Unknown OTH OTH None Unknown WAES0906USA02949 0 Unknown OTH OTH Unknown Unknown WAES0906USA02300 None OTH OTH ZYRTEC; FLONASE; Hormonal Unknown contraceptives; WAES0906USA02302 DETROL Pap test, positive OTH OTH Unknown Unknown WAES0906USA02309 0 None OTH OTH Unknown Unknown WAES0906USA02313 31 Unknown OTH OTH Unknown Unknown WAES0906USA02318 OTH OTH Unknown Unknown WAES0906USA02962 Unknown OTH OTH Unknown Unknown WAES0906USA02991 Unknown UNK OTH Unknown Unknown WAES0906USA02514 None OTH OTH Unknown WAES0906USA03285 Unknown OTH OTH Unknown Unknown WAES0906USA03335 None OTH OTH Hormonal contraceptives None WAES0906USA02576 1 Unknown OTH OTH Unknown Unknown WAES0906USA02623 1 Unknown OTH OTH Unknown Unknown WAES0906USA03361 Unknown OTH OTH Unknown Unknown WAES0906USA03372 0 None OTH OTH Unknown Vasovagal reaction WAES0906USA03400 Unknown OTH OTH Unknown WAES0906USA03422 Unknown OTH OTH Unknown Unknown WAES0906USA03424 0 Unknown OTH OTH Unknown Fractured toe WAES0906USA03428 0 Unknown OTH OTH Unknown Passed out WAES0906USA03431 Unknown OTH OTH Unknown Unknown WAES0906USA03718 0 Unknown OTH OTH MUCINEX Unknown WAES0906USA03719 Pap test, ASCUS; OTH PapOTH test, high risk Unknown HPV (the second PAP Unknown test) WAES0906USA03736 Unknown OTH OTH Unknown Unknown WAES0906USA03745 66 None OTH OTH Unknown Unknown WAES0906USA03753 Unknown OTH OTH Unknown Unknown WAES0906USA03754 3 None OTH OTH NORTREL Sulfonamide Endometriosis allergy; Shellfish allergy WAES0906USA03807 6 None OTH OTH None Anaphylactic reaction to WAES0906USA03821 vaccine 4 Unknown PVT PVT ZYRTEC; FLONASE; Overactivehormonal bladder; Hypersensitivity contraceptives; WAES0906USA03965 DETROL LA Unknown OTH OTH Unknown Unknown WAES0906USA04017 1 Body temp,OTH 06/18?/09,OTH 101 F Unknown Asthma WAES0906USA04076 Unknown OTH OTH Unknown Sickness Unknown WAES0906USA04091 Unknown OTH OTH Unknown Premature baby WAES0906USA04097 715 Unknown OTH OTH None Unknown WAES0906USA04116 0 None OTH OTH None None WAES0906USA04127 0 Unknown OTH OTH Unknown Unknown WAES0906USA04136 0 None OTH OTH None WAES0906USA04137 Unknown OTH OTH Unknown Unknown WAES0906USA04269 63 Unknown OTH OTH Unknown Unknown WAES0906USA04379 Unknown OTH OTH Unknown Unknown WAES0906USA04389 0 None OTH OTH None Penicillin allergy; Syncope Sulfonamide allergy WAES0906USA04393 Pap test, 10/27/08, OTH abnormal; OTH PapDESOGEN test, 06/15/09, abnormal Unknown WAES0906USA04724 Unknown OTH OTH Unknown Unknown WAES0906USA04739 OTH OTH Unknown Sulfonamide allergy WAES0906USA04750
19 Unknown OTH OTH Unknown Unknown WAES0906USA04767 Unknown OTH OTH Unknown Unknown WAES0906USA04859 None OTH OTH None None WAES0906USA04941 Unknown OTH OTH Unknown None WAES0906USA04949 Unknown OTH OTH Unknown Unknown WAES0906USA04961 10 None OTH OTH None None WAES0906USA04977 Unknown OTH OTH Unknown Unknown WAES0906USA04981 Unknown OTH OTH Unknown Unknown WAES0905USA04982 Unknown OTH OTH Unknown Unknown WAES0908USA04987 None OTH OTH None None WAES0906USA04995 1 Unknown OTH OTH None Unknown WAES0906USA04998 403 electrocardiogram, OTH normal OTHLABS and Unknown DIAGNOSTICS: ECG Unknown - WNL. Thyroid Studies WAES0906USA05000 WNL. Throat culture (-). Skin 0 Unknown OTH OTH None Drug hypersensitivity WAES0906USA05017 0 None OTH OTH Unknown None WAES0906USA05019 Unknown OTH OTH Unknown Unknown WAES0906USA05048 -81 Unknown OTH OTH STRATTERA Attention deficit / Hyperactivity disorder WAES0906USA05055 0 diagnostic laboratory, OTH full OTH work up Unknown including a blood workUnknown up: the patient was fine WAES0906USA05091 Unknown OTH OTH NUVARING; MACROBID Unknown WAES0906USA05163 5 Unknown OTH OTH Unknown WAES0906USA05171 Unknown OTH OTH Unknown Unknown WAES0906USA05329 None OTH OTH Unknown Unknown WAES0906USA05189 0 Unknown OTH OTH XANAX; ADDERALL TABLETS; Unknown CLEOCIN; NUVARING; WAES0906USA05359 ZOLOFT;AMBIEN 30 Pap test, 05/??/09, OTH abnormal OTH Unknown Unknown WAES0906USA05192 0 Unknown OTH OTH Unknown WAES0906USA05197 0 beta-humanOTH chorionic, OTH positive None SYNCOPE WAES0906USA05225 0 Unknown OTH OTH Unknown PASSED out WAES0906USA05369 3 Unknown OTH OTH MENACTRA None WAES0906USA05392 0 Unknown OTH OTH Unknown Unknown WAES0906USA05615 0 cervix HPV OTH DNA assay,OTH 07/??/06, None negative; cervix HPV DNA Noneassay, 06/15/09, positive WAES0906USA05616 2 Unknown OTH OTH Unknown Unknown WAES0906USA05627 0 Unknown OTH OTH Unknown None WAES0906USA05641 Unknown OTH OTH Unknown Unknown WAES0907USA00009 0 None UNK UNK LODRANE None WAES0906USA05666 0 None OTH OTH None PENICILLIN allergy WAES0907USA00012 Pap test, abnormal OTH OTH Unknown Unknown WAES0907USA00019 0 Computed axial, OTH 06/29?/09, OTH CT scan None of the head Unknown WAES0907USA00034 0 Unknown OTH OTH Unknown Fear of needles WAES0906USA05668 None OTH OTH Unknown Unknown WAES0907USA00043 None OTH OTH Unknown None WAES0906USA05674 0 None OTH OTH None None WAES0907USA00064 6 None OTH OTH None Drug-induced hallucinosis WAES0907USA00070 Unknown OTH OTH Unknown Unknown WAES0906USA05677 Unknown OTH OTH Unknown Immunisation WAES0906USA05702 0 None OTH OTH hormonal contraceptives None WAES0907USA00075 None OTH OTH None None WAES0907USA00097 Unknown OTH OTH Unknown Unknown WAES0907USA00122 Unknown OTH OTH Unknown WAES0907USA00144 Unknown OTH OTH Unknown Unknown WAES0907USA00182 Unknown UNK UNK Unknown Unknown WAES0907USA00330 0 Unknown OTH OTH None None WAES0907USA01092 0 UNK UNK Lidocaine
0 PVT UNK anxiety n/a stmoache pains~HPV (Gardasil)~3~26~In Patie 0 PVT UNK Wellbutrin, Celexa, Trazedone, Latex,Penicillin, HCTZ, Sulfa,Prozac Diclofenac. 0 CT scan, blood PVT sugar level UNK (84), blood and urine None taken (not None sure what soreness was checked) at injection site and headaches~HPV 4 CAT Scan; UNK MRCP; blood UNK work at Underwood-Memorial none Hospital 7/24/09 (Woodbury, Hospital records NJ). received 7/24/09 Hospital DOS 7/11/09. records Gastrodu receive 0 Unknown OTH OTH Vitamins (unspecified) Pregnancy NOS (LMP = 8/29/2008) WAES0810USA02010 0 Unknown. 8/31/09 OTH Hospital OTH records Unknown received DOS 6/24/09 Unknown. to 6/28/09. 8/31/09 LABSHospital and WAES0907USA01994 DIAGNOSTICS: records received CSFDOS - WNL 6/24/09 MRI 2 spinal tap, no OTH permanent OTH damage Unknown Unknown WAES0907USA02007 0 diagnostic laboratory, OTH 09/01?/05, OTH Autosomal None Dominant OPITZ None Syndrome WAES0907USA02018 1 None OTH OTH None None WAES0907USA02011 69 Unknown OTH OTH Unknown Unknown WAES0907USA01687 0 None PVT OTH The patientAt has theconcurrent time of vaccination medical conditions on 07 ### Julyof2009 allergy thetopatient pollen,was dus 0 RegressivePVT autism - GIOTH issues. 7/21/09 Medical none, records otherreceived no. than 7/21/09 immune, DOS Hep Medical 11/14/05 born B~Measles with records tocompromised 6/20/08. +received Mumps LABS DOS +immune Rubella and 11/14/05 DIAGNOSTI system (no brand to 6/2 (sw 30 Autoantibodies MIL positiveMIL indicating See Millerattached Fisher None Variant. but URI See None following attached. PMH: vaccination, URI Seeatattached time of see vax note. attached Labs and Diagnostics: M 5 08 August 2007, OTH Computed OTH axial tomography Warfarin sodium; Unknown (CAT)Lisinopril; scan: Cataract; diagnosis Ascorbic Hearing subdural acid;loss; Unknown hematoma A0797113A Pacemaker of the (Atrial brain. Fibrillation); Qua 1 PVT PUB 77 A lot of lab.PUB MRI +ve forPUB ADEM. None at theNone time Dyslexia 1 PUB PUB Vitamins C none ICU x 5 days-possible LA090703 bacterial infection-low blood sugar 0 PVT PUB Area of redness.~DTaP (no brand name)~5~5~ 0 UNK PUB PUB Unknown There was no concomitant A0797402A medication and no relevant me PUB UNK No Syncope, Neuropathy 4 PVT PVT 1 none PVT PVT none none 7 None PVT PVT None None Penicillin - Generalized hives 0 Sent to A/I for PVT eval. PUB None None None 5 None OTH OTH None None NKDA 0 None PVT PUB None None None 1 N/A UNK UNK PT WAS PUT N/AON KEFLEX H/O ECZEMA 250/5, BENADRYL, AND SKIN AND BOILS IBUPROFEN 9 PVT PVT 81mg Aspirin, none 12.5 mgneuropathy, metoprololpneomovax~Pneumo tartrate, irregulargabapentin heart rate, 100mg B-12 (Pneumovax)~1~59~In deficient, 1 cap TID, Vitamin B-12 D 1m P 0 PVT PVT enalapril, metformin,maxzide, none codeineproventil, allergy; morbid advair obesity, hypertension, asthma 4285 PVT PVT None None None Shingles~Varicella (Varivax)~1~14~In Patient 1 doctor did culture PVT on the UNK site of the shots no optic nerve hypoplasia 6 none at thisPUB time PUB none none Asthma, allergy to oats, cow's milk, bees 30 Normal CBC PVT except forPUB plt count 10,000 none on 7/17 none then 13,000 noneon 7/19. 15 n/a MIL MIL none none none 0 N/A PVT PVT none none none N/A~ ()~NULL~~In Patient none UNK UNK none none none none UNK UNK none listed none none listed 1 PVT PVT SYNTHROID, NOLIPITOR, Bactrum LISINOPRIL, hctz 1 Patient did UNK not notift PVT Prescribed Flagyl 250 mg NKDA, bid on History 7/09/09 of Depression and question of polycystic ov 5 None PVT PVT Depakote 250mg, None Yasmin none 0 None PVT PVT None None None 1 2 blister opened UNK for Zoster UNKculturealendronate - positive result 70mg 1 q wk, verapamil 80mg 1 qd, simvastatin 5mg 1 qd 0 PUB PUB None None NKA 6/16/2009 negative PVT varicella PVT titer prior to vaccination V-Z AB IGG EIA : V-Z IGG AB EIA Negativ 1 PUB UNK Novolog none type 1 diabetes swelling, red hot spot~Influenza (no brand nam 690 UNK UNK COPD 1 NONE PVT PVT NONE NONE CEFZIL, SULFA DRUGS 0 PUB PUB 27 UNK UNK 1 PVT UNK none none none none~ ()~NULL~~In Patient 58 UNK PVT
0 Unknown PUB PUB None Unknown CBC; CMP;UNK Amylase, u/A UNK 0 PVT PVT 1 None PVT PUB No None PUB UNK none 19 OTH PVT Positive pregnancy PVT testPUB 0 PUB PUB 0 PVT PUB Redness - swelliing~DTaP + IPV (KINRIX)~UN None Known PVT PVT Lyrica 3 OTH PUB ACIPHEX; NIFEDIPINE; No All:FOSAMAX; PCN; Gerd, Red, SYNTHROID HT; swollen Osteoarthritis arm~Zoster Prevention; (Zostavax)~1~75~Pa Hypothyroid 1 PUB PVT ALBUTEROL None Asthma 2169 PVT PUB 0 PVT PVT None ADHD UNK UNK 17 A lot of lab PVT done. MRI positive PUB for None ADEM. at theNone time. Dyslexia 1 none PVT PVT none none none 0 PUB PUB None None 1 none PVT PUB Physical None PVT PVT None None None 9 None donePVT PVT None None 7-14-09~Varicella (no brand name)~1~1~Patie 1 None PVT OTH None None 0 None PVT PUB None None 0 PUB OTH Unk None Unknown OTH OTH Unknown Unknown WAES0905USA02043 0 PVT UNK Nuvaring No known allergies. No medical ###history. No concomitant m 45 head computed UNK axial tomography, UNK None 06/22/2009, HIV see infection narrative; Migraine; spinal Amphetamine tap, 06/23/2009, WAES0907USA01529 abuse; seeBell's narrative; palsyspinal tap, 06/2 24 Spinal tap, OTH there was protein OTH in theNone spinal fluid. 8/6/09 Multiple Ear tube hospital insertion; inpatient, Adenoidectomy. WAES0907USA01998 DC summary, 8/6/09 andMultiple ER records. hospita LA Unknown OTH OTH Unknown Unknown WAES0907USA02337 33 ultrasound, OTH 05/29/09, showed OTH no evidence Hydrocortisone of Dermatitis recurring intussusception; 7/30/09 HospitalKUB records X-ray, WAES0907USA02033 received 05/18/09, DOS showed 5/18/09 intussuscep to 5/24/09 6 Unknown OTH OTH Unknown None WAES0907USA02071 24 TSH 1.074PUB (N) OTH None None Depression; generalized anxiety disorder; acid reflux disea 0 UNK UNK 0 PVT PVT None per Mom None None 0 None PVT PUB ZANTAC 1ml Bid GERD Mother as reported by g.mom (similar reaction 1 PVT PUB PPD intradermal None givenNone 7/8/09, no mm 11 None PUB PUB None seasonal UNK PVT 1 PUB PUB 1 None PUB OTH ZYRTEC; FLONASE None nasal Hx "allergies" spray 0 PUB OTH None None 5 NONE PVT PVT NEXIUM, PRAVACHOL, NONE HYPERTENSION, SINGULAIR, METFORMIN, ALLERGIES, LISINOPRIL HYPERCHOLESTEROLE HCT PUB PUB None. None. PVT PVT Tylenol for cold Coldprior timesto2receiving weeks. vaccines. 1 evaluation only UNKper patient's UNK husband None NKA 0 PUB PUB None None None 0 PVT PVT none no none 0 None PUB PUB none none none DID NERVEUNK TEST. IT IS UNK POSSIBLE THAT THE EXTREME NEEDLE ALLERGIC HIT THE NERVE. REACTION PT HAS WITHPOSSIBLE PAIN, RASH, REPORT AND INTENS LIKE A 1 PUB UNK ibuprofen 200mg, pruritic wellbutrin rashdarvocet, on hips xl 150mg and codeine chest BID 2 Blood work,UNK Urinalysis,UNK Flu test. None No illness None
0 PUB UNK Prozac 20mg abdominal 3 tabs daily, pain klonopin, benadryl malaria 25mg pills qhs prn, vitamin D 1000mg daily 0 PVT PVT Fioricet, Topamax, Vicodin, Cluster hydroxyzine, Headaches,HCTZ, HTN, Synthroid, Obesity omiperazole, Atenolo 4 none MIL UNK none none none 0 UNK UNK Rx-Xopenex Bronchitis MDI II Halations Anxiety,q4hrs depression, prn. Tessalon Hx of diverticulitis. perles 200 1 NKDA q8hrs po prn cou 0 UNKNOWNPUB PUB NONE NONE NONE 0 UNK UNK none none 2 N/A MIL MIL Levothyroxine .15, simvastatin Sulfa drugs .40, phenytain 100, Fosama .35 0 UNK UNK NONE NONE NONE 0 CBC and UA PVT obtained PVT prior to injection Clartin PRNno - pt did notseasonal take dayallergies of injection - pt premature at birth with resp. problem 10 PVT PUB EAR INFECTION ON BOTH EARS 0 none PVT UNK AXID, 150 mg/10 none ml-Take none2ml po BID 0 UNK PVT None None 0 PVT PUB 2 PVT PVT 1 stool culturePVT negative. UNK 7/30/09 Hospital POLYVISOL records None with received iron Prematurity DOS 7/9/09(28 to 7/10/09. wks) twin.LABS 7/30/09 andHospital DIAGNOSTICS: records receive 4+ fec 0 PVT PUB TYLENOL Infant None dropsNone 0 Stool culture PVT negative. UNK 7/30/09 Hospital Polyvisol records With None received Iron prematurity DOS 7/9/09(28 to wks) 7/10/09. twin.LABS 7/30/09 andHospital DIAGNOSTICS: records receive 4+ Fe PVT PVT No 1 None PVT PUB DEPAKOTE; NoVitamin CSeizure supplement, disorder "EMERGEN-C"; quiescent; Autism SEROQUEL 1 PUB PUB NONE NONE NONE 10 PUB PUB None None 1 None PUB UNK None None Allergy to PNC- beestings (carries EPI-PEN) 1 None PVT PVT None None None 1 OTH PVT Tetracycline; Hypercholesterolemia; Thrombocytopenia fo 3 MIL MIL Nicotine gum None None 0 MIL OTH RISPERIDONE 0.25 mg; Allergies: one QHS OMNICEF; CLINDAMYCIN; SEPTRA; PCN'S; D 1 PVT PVT BACTRUM;Puncture AUGMENTIN wound None 2 PVT OTH None None Swelling & Ped~DTaP (no brand name)~3~15~ 0 HospitalizedPVT 7/10-7/13/09 PVTfor recurrent Phenobarbital sz. Labs None and diagnostics: Seizure disorder EEG abnormal. (known). PMH: seizure 6 PUB PUB None None. Father Unknown states mosquito bite on arm. 7 None PVT OTH ASPIRIN 81None mg; CLARINEX Allergic5mg; rhinitis. FOSAMAX; LEXAPRO; Multivitamin. 0 CT head and PVT facial bones(6/26/09), PVT Seasonique MRI brainNone (7/14/2009) None 4 MRI pending. PVT PVT DEPO-PROVERA None known~ ()~~0~Patient 0 PVT PVT None None Microcephaly; Craniosystosis. 1 PVT PUB ZYRTEC 10 mg QD PCN; CEFZIL; Redness/swelling~Tdap CELOXIN; TETNUS (TDAP) (no brand name)~1~12 10 None needed. PUB PUB TYLENOL None None NKDA 1 OTH PVT No 0 PVT PUB Allergic rhinitis Ellis - Van Creveld syndrome 0 PVT PUB 0 None OTH PVT None PVT PUB 0 PVT PUB None None 0 PVT PVT None None 0 PVT OTH Sertraline, 50 Syncope mg 1.5 take NKDA daily - No other birth defects/medical conditions I'm awar 0 No PVT PVT No breakfast None 2 PUB PVT TETRACYC 0 PUB OTH Just for Allergies Has a cough None from cold 1 PVT PUB none 0 PVT OTH None Skin Avulsion None PVT UNK 1 None PVT PUB None None
0
OTH UNK None None None Unknown OTH OTH Unknown Sickness Unknown WAES0906USA01923 1 None MIL MIL None None 1 PUB UNK 8 none PVT OTH none none 1 UNK UNK I am allergic to penicillin and erythromycin. 0 PVT OTH UNK OTH OTH Allergy to aluminum; Details regarding Allergy to tobacco yeast; A0793154A or Anxiety alcohol use were not known. 105 MRI, Multiple UNK EEG, Multiplte UNK Doctor N/A Visits, 7/28/09 all N/A from Medical having records N/A to traveling 7/28/09 received N/A~ Medical long DOS ()~~0~Patient|N/A~ distances. records 5/30/07 7/23/09 received to 1/29/09. ()~~0~Sibling|N/A~ Consultant DOS Oral 5/30/07 contraceptiv records to 1/29 () re 7 MRI brain and UNK spine showed UNK multiple enhancing No white matter PMH:lesions; none Allergies: CSF showed none 40 wbcs, 2 rbc, prot 41. 9/14/09 0 MIL MIL None NA NA 1 NONE UNK PVT NONE NONE 2 PUB PUB None None 0 None PVT UNK none 0 MRI demonstrated UNK a solitary, UNK 1 cmNone ring enhancing NonelesionHistory in the right of musculoskelatal cerebellar region pain and (elbow, 2 small lumbar), enhancing no PMH lesiona 0 PVT UNK 2 MIL UNK 1 PVT PUB No illness atnothe time of vaccination 5 7/23/09 Medical UNK records UNK and DC summary received. None LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CB 2 PVT UNK Intermittent Chest Pain 1 none UNK UNK no no no 0 ORDEREDPVT LABS UNK NO PREVIOUS RIGHT HISTORY INGUINAL OF HERNIA CHILDHOOD ND_09_06 REPAIRED ILLNESS 1 none PVT PUB none rash-multiple none mosquitonone~ bites ()~NULL~~In Patient 3 hx of celiacPVT disease UNK 0 UNK UNK no no Allergies to Ceftin and Zithromax 17 Labs and diagnostics: PUB EEG PUB WNL. MRI brain No abnormal, MRA No PMH: WNL.none LE duplex studies (-). Echo WNL. TEE (+) for 13 CBC RockyPUB Mtn Spotted PUB fever, lgG, IBUPROFEN, 1, M None TYLENOL Known None Known 2 PUB UNK None None Reported None Reported 0 PVT PVT none none PVT PVT TYLENOL 100mg None PO Systolic Murmur 2 All cultures PVT (-) of site. PVT FOSAMAX None None Localized reaction 6/1/09~Hep A + Hep B (no b 5 PVT PVT None 0 None PVT PVT then Ophth.Corneal Sacortin, Abrasion 2None g hr pid TD 0 MIL MIL None Asthma 0 PVT PVT 7 None PVT PVT None None None 8 Presented with PVTfaint macular-papular PVT NONE rash on NONE torso 7-15-2009 Reaction tovomiting, flu vaccine fever~Influenza 12/08; GERD (no brand name)~1~1 0 None PVT OTH None 0 MIL MIL PPD; Albuterol InhalerIodine 1 None PVT UNK None No None Unknown OTH OTH Unknown Unknown WAES0906USA03421 0 PVT PVT None None-Very None healthy, active 11 year old Unknown OTH OTH Unknown Chronic obstructive pulmonary disease; WAES0907USA02055 smoker Unknown OTH OTH Unknown Unknown WAES0907USA02939 27 UNK UNK ### 0 PUB PUB 0 PVT UNK 2 PVT UNK No PVT PUB None None PVT PUB PVT PVT None None
PVT PUB None None 2 None PVT PVT BEMCIN 40None mg; LIPTON Sulfa 10 Antibiotic mg 1 PVT PVT None Penicillin allergy 0 Monitored q5 PUB minutes; PUB dischargedNone w/parent 10:45 None None 22 PVT PVT CELEBREX; None FOSANOSE; high PROTONIX; blood pressure; VESICZRE; GERD; Arthritis BENICAR; CLONIDINE 2 Strep throatPUB culture only. PUB None. Antibiotic Noneused in Lyme Junedisease 2009 forinLymes past 2 disease yrs. 1 PVT PUB 1 PVT PUB 0 PVT PVT Immunodeficiency 0 PVT PVT 1 PVT PVT 0 PUB PUB None 0 PUB PVT None None Sinus allergies - non specific 7/25/09; pregnant EDC 1/6/0 2 CT of head;PVT CT of spine; PVT CBC; Chem BACTRIM panel; DS; Drug UTI ABILIFY screenNKA; 20 mg; VUR; RITALIN depression; 10 mg; Acne FOCALIN x 2 10 mg; PROZAC; 1 None UNK UNK None None None 1 None PVT OTH None None None 1 PUB PUB None None NKDA 1 PVT PVT asa;calciumnone with d;insulin sulfa N and R;lopressor;others 1 none PUB PUB none none none 1 PVT PVT no amoxicillin 3 Client states UNK had liver function, UNK other Nexium screenings, 5-10 None mgallevery normal Allergic morning; results. to Penicillin; low dose ASA Typedaily; II DM; Amlodipine/Benazepril Hypertension; Sleep5/10 apn 53 Autopsy unknow/undetermined, UNK UNK did not fit SIDS. None Planning further review decreased of autopsy levelby of private consciousness~DTaP pathologist, hopedull (Dapt 2 none UNK UNK none Asthma visitAsthma and well child N/A~check ()~NULL~~In Patient|N/A~ ()~NULL~~In S 5 none PVT PVT fosamax, premarin, none provera,zinc,calcium, sulfadiazine - allergy Vitpyridium D allergy 3 UNK PVT 0 N/A UNK UNK 0 None PVT PVT BENADRYLNone IM None 0 PUB PUB none none 2 PVT PVT none Dairy allergy 2 PUB PUB NONE NONE 2 PUB PUB CECLOR NONE NONE 5 PVT PVT none none Asthma 0 UNK PVT TRIAMCINOLONE NONE KNOWN ACETONIDE PENICILLIN 0.1ALLERGY, % CREAM, DEPRESSION, CALCIUM 1200 HYPERLIPIDEMI PO, GLUCOSA 0 NONE PUB PUB NONE NONE NONE 58 8/14/09 Hospital UNK records UNK recieved DOS 11/30/2008 None/experienced to 12/03/08. None. 8/14/09 flu-like LABS and symptoms Hospital DIAGNOSTICS: records approxrecieved 2 wks MRIafter Spine DOSvaccination 11/30/2008 - Abnormal 0 Neuro assessment PUB withPUB assess forNone injuries; BP None 110/70, known P80, None R16 known 1 minute after falling to floor; contusion to Rt front 2 PVT PUB None None None 0 PVT OTH 1 None PVT PVT None None PCN 0 UNK UNK BERNA20090222 Unknown OTH OTH Unknown Unknown WAES0907USA03043 18 MRI/EMG: demyelinating PVT PVT process LAMICTAL consistent with SoreGuillain-Barre/axonal throat/fever absence seizures. damage 8/10/09 8/17/09 PCP medical Medical records records received received 2 others in our community who had the UNK shinglesUNK vaccine and still got shingles. Does this shot really work? Is my experience unusual. I have 0 None PVT PVT None None 0 None PVT PUB ~DTaP + IPV + Hib (Pentacel)~2~0~Patient 2 PUB PUB Nadolol- 40No mg Hypertension 0 PVT PVT None UNK UNK 1 PVT PUB None NKDA 6 None PUB PVT None None 1 None PVT PUB SINGULAIR; None ALBUTEROL; Asthma; FLOVENT; Eczema;TRIAMCINOLONE; IgG deficiency BETAMETHASONE
4 None 3 None 0 None 2 EKG 0 10/11/07: 0 0
OTH PVT HTN, elevated HTN, lipid elevated lipid PUB PVT No Could be pregnant nothing PUB PUB SIMVASTATIN none20mg Atypical seizure D/O; Depression, S/p meningioma resecti PUB PUB None None None MI2009007 Seen PUB at General PUB Hosp ER: CT andNone lab work reported normal. None reported No information noted. 10/19/07: Seen at children PUB PUB None None None PUB PUB ADVAIR; NASOCORT Denies Asthma, Ibuprofen PUB PVT ACTOS; AMARYL; Laceration Metformin; (R) Diabetes foot. BENICAR; Mellitus. BYETTA; CIPRO 1 PUB UNK None None None 1 PVT PUB PENICILLIN allergy 161 None PVT PUB None None None 1 PUB PUB None None 0 MIL MIL None None None 1 PUB PVT No Amoxicillin, Ceclor, Septra + Codeine 1 None PVT PVT None None None 0 PUB PUB None None 0 PVT PVT 0 PUB PUB none asthma 1 N/A PUB UNK Nasonex, claritin, None singulair Allergic rhinitis, Hx of MRSA 13 EMG { not sure UNKof all the UNK other test they gave me} Would8/24/09 have toHospital getN/A~ hospital ()~~0~Patient|N/A~ records records. recieved 8/24/09 DOS ()~~0~Sibling|N/A~ Hospital 11/21/07 records to 12/02/ rec () 1 none PVT PUB none patient wasnone treated known with topical anibiotic for multiple insect bites 2 Unknown UNK PVT Unknown None reported No known drug allergies. All others unknown. 0 n/a UNK UNK none knownnone none known 0 None PUB PUB None None None 0 PUB PUB none none 2 PVT PVT None No 0 NONE PUB PUB NONE NONE NONE 1 Chem-20 normal, UNK CBCUNK normal, CRP none 10.55, ESR 28. Labs PMH: and Diagnostics: reflux 2' to overfeeding. Head CT WNL. CBC with WBC 12.5 ( 0 none PUB PUB none none Allergies to:none PCN,reported~ Sulfa, Omnicef ()~NULL~~In Patient 1 UNK UNK None None 5 none PUB PUB NONE NONE Seasonal allergies PVT PUB N/A N/A N/A 0 None known UNK UNK Unknown Steam burnUnknown to arm @ different site 1 MIL UNK NONE NONE NONE NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S 1 positive guiac PVT PVT 0 N/A PUB PUB Effexor Synthroid None Hormone ThyroidPatch nodules 1 MIL MIL aspirin, multivitamin, None, routine fish Nooil, annual known moloxicam, clinic allergy, follow valsartan, hypertension, up visitsimvastatin,hydrochlorothiazid hyperglycemia, PTSD, hy 2 NO PVT PUB NONE NO ADHD NO~ ()~NULL~~In Patient|NO~ ()~NULL~~In S 1 CBC, UA, RAPID PVT STREP PVT NONE NONE POSS. ALLERGY HIGH FEVER TO Td OF 104, HEADACHE, ACHY AR 1 PUB PUB NONE REPORTED, not known -10 None PVT PUB None None None 1 PVT PVT None Mild asthma 0 OTH UNK ZOLOFT; WELLBUTRIN; Allergy COMTRIN; to penicillin; SINIMET; Parkinson's LOMETIL; Disease AZILECT; KLONOPIN 0 None PVT PUB None None None 2 PUB UNK 0 PUB PUB None None None 0 PUB PUB None None HX: SZ's 5yrs, age. 0 PVT PVT SINGULAIR, None XYZAL, SYMBICORT, asthma, allergic VERAMYST, rhinitis, acne DUAC 8 OTH PVT METFORMIN; No ZOCOR;NKDA LUMIGAN; ELIPIZIDE; DOLETASOL cream 2 PVT PUB 4 Stool Cultures PVTNeg - Rotavirus PVT Ant (-), (+) Fecal None leukocytes. PMHLABS - Tongue and DIAGNOSTICS: tied at birth, neonatal Stooljaundice. Test for Blood (-) Sto
0 neurologist PVT consulted EEG PVT - normal none Labs andno diagnostics: illness (sickle EEGcell WNL. trait)WBC possible 17.3. PMH: blood none cx (-). noted 1 PVT UNK Omnicef - rash 0 PVT PVT SINGULAIRNone 5 mg Asthma; Allergies 1 PVT PUB None None UNK PUB PVT Unknown A0758212B Unk PUB PUB Blood pressure Unknown medication No known adverse events A0794397A were reported with previous vac 1 PVT PVT none none none 0 None yet. PVT PVT none none none Swelling at site for 4 wks (nodule still present), 0 none PVT PVT NONE NONE NONE 1 N/A PVT PVT None None Likely Peach Allergy 0 N/A PUB PVT Lipitor 10mg None daily, calcium High600mg cholesterol 2x a -day, controlled Vitamin D 400IU 2x a day, Aspriin 81 0 UNK PUB 166 Multiplle blood PVTand mris; PVT lumbar puncture. lipitor, nexium High none protein count, none hi alpha 2 gobulin. IMM, IMG 13 Small bowelUNK biopsy with UNK intraepithelial lymphocytes. Labs: Pectus EBV Excavatum IgG (+). 10/8/09 PMH: abdominal Hospital records pain. 10/8/09 3/16/09 Hospita to 3/18/ 7 UNK UNK Recovering from acute laryngotrachiitis 1 Referred toPVT hospital ENMIL bec. continued dizziness. None None None PVT UNK None Allergies; Sulfa; Sotalol; Naprosyn PUB PUB Food allergy - Citrus 1 PVT PUB None None None 0 PVT PVT None known CODEINE, DEMEROL; SULFA; Erythromycin 8 None PVT OTH None None 7 PVT UNK MELOXICAM None as needed, back HYOSCYAMINE pain as needed, HYDROCORTISONE VAL 0 MRI; CAT Scan; PUB Labwork; OTHSpinal Tap Hypothyroidism 2 PVT UNK 5/09/06~DTaP (no brand name)~4~2~Patient|2 1 None MIL MIL None None Allergic RxnCellulitis to tetanus Fever~Tetanus vaccine Diphtheria (no brand n OTH OTH 1 Rash/light fever, MIL MIL EUCERIN Eq Rash cream; the next Acetaminophen. None day 1 PUB OTH Erythema NKDA Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0907USA03354 Unknown OTH OTH Unknown Unknown WAES0907USA03373 Unknown OTH OTH Unknown Unknown WAES0907USA03589 8 Plt = 0; HgbPVT 12.0; WBCPVT 7,900. LABS and DIAGNOSTICS: No NoPTT 35.6 (H) Thrombin Time 18.0 (H) CBC - WBC 6.7 k 24 PUB PUB None None None known 1 PVT PVT None 7-18-02 MMR 07/26/2002~Measles reaction. + Mumps + Rubella (no b 0 None PVT PVT ATENOLOL; None TRIZADONE; Chronic SERTILINE depression chronic neck Pn HTN 0 PVT PVT None None None 0 PVT OTH None Asthmatic MIL MIL None 2 PUB PUB 7 PUB PUB Tylenol No No 2 Fever - CBC PVT BID cult. PUB CXR -see ER NYSTATIN note. None. cream Given for diaper None at WCC rash. 2 PVT UNK None None None 2 PVT PUB Hx - Astrocytoma (surgery) PVT PVT 2 PVT UNK 0 PVT PVT Singulair; MV;Albuterol; None Neb PRN 0 PVT PVT None None None ~DTP + IPV + Act-Hib (no brand name)~2~0~P 1 PVT PVT CLARITIN None 0 None PVT UNK ZYRTEC None None 0 None PVT PVT No No 0 Per allergistPVT - Acute urticarial PVT reaction Well child VIGOMOX eye GHS; OMNICEF, BACTRIM
0 None OTH OTH None Surgery; LaparoscopicWAES0907USA03631 surgery; Convulsion Unknown OTH OTH Unknown Unknown WAES0907USA03652 2 None OTH OTH None None None 1 None PVT PVT None None None AR0928 0 PUB PVT 0 Unknown OTH OTH Unknown Unknown WAES0907USA03060 Unknown OTH OTH Unknown Unknown WAES0907USA03359 0 Blood work PVT (not specified) UNK Z PACK antibiotic; ZYRTEC; Bitten by TOPROL a stray XL; cat (date Albuterol not ### reported). inhaler; CARDIAZEM The patient had a 0 Unknown OTH OTH None Penicillin Allergy; Contraception Anxiety WAES0907USA02308 91 Unknown. 8/10/09 OTH ER OTH Records received NECON DOS 1/354/9/09. LABS Unknown. and DIAGNOSTICS: 8/10/09 ER WAES0907USA02326 Records Venous received DopplerDOS Study 4/9/09. - Abnorma Alco 1 none PVT PVT none allergy-Bactrim,h/o asthma and diabetis 1 n/a UNK UNK n/a none none none~ ()~~0~Patient|none~ ()~~0~Sibling|none 1 PVT PUB Behavioral concerns POISON CONTROL UNK CONTACTED UNK 10/17/2005 FEVER AND STATED OFPARENTS 101.00 TOF.HAVE HAD BROUGHT MOTHER WATCH PATIENT FOR INTO LOCALIZED THE E.R. REA AT 1 Neurological PUB exam only, PUB mom states None no known lab test None or X-rays notedAllergy: per performed. mom PCN 0 PVT UNK None None None 2 PVT PUB NONE SAN FILIPPO SYNDROME 0 NONE PUB PUB NONE NONE NONE 2 MIL MIL 1 PUB PUB HPV/Gardasil none 1312X allergies 1 WBC 16.4 PUB UNK none unsure none 3 PUB PUB 0 PVT PVT None Known None Known 2 PVT PVT 0 none PUB PVT none none none 1 UNK UNK actone, aloeNone vera cap, HTN, asa, benadryl, Polycythemia, cartiaosteoarthitis; XL, prevacid,Allergies: glucosamine, Altace, dramami daypro 2532 UNK UNK 41 EmergencyUNK room visit on UNK July 19 because Methotrexate/weekly I was Rhuemation in a great injection Arthritis deal ofSalsalate--750 pain and had been mg since 2 dailytheLevothyroxine first outbreak on 50 Jul mc 1 MIL MIL Celebrez; plaquenil; none Prylosec; Systemic Lisinopril; Lupus; hypertension; Prevastin; ASA; reflux Calcium with D 0 None PUB PVT Daily multivitamin None None A0796919A 0 None PUB PVT Daily Multivitamin None None syncope~Hep A0796919B A + Hep B (Twinrix)~1~~In Patie 0 Patient's visit UNK was for aUNK routine physical 2 Extra exam Strength None. whichTylenol included ThisNone was administered apatient's really. negative Mom annual at urinalysis, physician's toldphysical. me fingerstick patient officehad prior hemoglobin upset to vaccine stomach of admin 13.7 wheg 0 Blood pressure UNKat 15:32 UNK in the office None for physical None blood pressure was 143/71, after KS200908 episode and back in office B/P w 6 UNK UNK Singulair 10mg noneQD; reported Lipitor sulfa by 10mg and patient iodine QD none~ ; Evista allergies ()~NULL~~In 60mg QD; Patient|none~ Benicar 20mg ()~NULL~~I QD; K-Cl 0 Scheduled PVT for EEG @ PUB Hospital No meds None 2 PVT PVT None 0 PVT PUB None None None 0 None PVT PUB None None None 0 CBC done that PVTday right PUB after shots None was not done. None None ~Measles + Mumps + Rubella + Varicella (no b 4 None PVT PVT None None None 1 PVT UNK 2 OTH OTH None None None Ultrasound PUB -> EnlargedUNK lymph node. None 0 UNK UNK DIOVAN; SYNTHROID; NoKEFLEX (Temporary) PVT PUB None 1 UNK UNK 0 UNK PVT PVT Unknown Concomitant medications A0794475A and relevant medical history wer 0 UNK OTH OTH Simvastatin; Warfarin sodium; The subject Digoxin; had previously Risedronic A0794688A received acid; Loratadine; influenzaOmeprazole; vaccinations 1 None PVT PVT 0 None PVT OTH 0 CXR; CBCPVT done @ hospital. PVT None None None
0 Blood pressure: PVT 115/73PUB after fall 0 Meds 0 Temp 97; Blood PVT sugarPVT 140 None None 607 PVT UNK Premature 25 wks. 1 PVT PVT None None Allergy to Aspirin; Learning disability 4 PUB PUB None None 0 PUB PUB None None 2 MIL MIL 1 MIL MIL None None (School None phy) 6 Unknown OTH PVT Rash Sulfur; PCN allergies 1 PVT PVT Oral Contraceptive None No 1 PVT PUB 0 PVT PVT TYLENOL 1 PVT PVT 1 none PVT PVT no no 2 PVT UNK None None 3 PUB PVT No Alg 9 CODEINE / OXYGODONE; AVELOX; Breast cancer 10 VARICELLA PUB ZOSTER PUB & Neg lab test for Herpes simplex 1 & 2 0 PUB PVT Hx asthma Fever~DTP (no brand name)~UN~0~Patient 1 None PUB UNK ADDERALLWell X 20check mg. None 1 OTH PVT None None 0 PVT PUB TYLENOL None None 0 EKG - sinusPUB bradycardia PUB with sinus None arrhythmia None with nor. variant allergies ofPCN ECG 1 PVT PVT See attached Lymphedema See attached 1 PVT PUB PUB UNK No No 0 PUB UNK 0 None PVT PVT CLARINEX; NASONEXHistory of seizure disorder as ### a young child which resolved Unknown OTH OTH Unknown WAES0907USA03112 2 None OTH OTH Unknown Unknown WAES0906USA02656 1 None PVT PVT 1 None PVT PVT FLUORIDENone None 0 PVT PUB MENTAX; DIFLUCAN NC09031 1 PVT PUB SINGULAIR; None NASONEX. 0 SP O2 = 98PVT % RA; BPPVT as low as 85/70. Hematoma (R) groin 3 PUB PUB None No None NC09030 0 PVT OTH None None None 0 NA UNK UNK unknown none at visithistory of hepatitis C and VA09:007 HIV positive; CHF 0 none MIL MIL none none none None at thisUNK time. UNK Claritin, Singulair, no Xopenex Reactive Airways None~Disease ()~~0~Patient 1 none UNK UNK none excessive wt. 1 MRI showing UNK thrombosis UNK of the Right none middle cerebral No artery. bronchiolitis, Positive blood mastocytoma. culture for8/10/09 S. Aureus. Hospital 8/10/09 records Hospital receir 24 PVT PVT singulair none none chronic rash rhinitis fine~Hep A (Havrix)~1~6~In Patient 0 UNK PVT Tylenol 325None mg as needed Hypertension, every fourHepatitis hours C ring reciept of shot. UNK UNK none None none 2 PVT UNK NONE 0 PUB PUB 0 None PUB PVT Patient on Birth NoneControlHistory pills per of mom. Scoliosis. 1 MIL MIL Zyrtek, Flonase, someNuva cold symptoms, environmental Ring pre-existing allergies surgical wound that re-opened repe 0 PVT PUB None None None 1 PVT UNK none none none 0 UNK UNK Ibruprofen, None Hydrocodone/APAP Nafitine HCL.
0 7
UNK PVT prevera, abilify, nonenexium, evista PVT PUB none none Platelet Counts: PVT 7/11, 7; UNK 7/12 at 1:35, 22; 7/12None at 18:00, 2; No7/13, known 11;allergies. 7/14, 23;8/10/09 7/15, 98Hospital 8/10/09records Hospitalreceived recordsDO rec PVT PVT SIMVISTATIN; None ANAGRELICLE; PCN; Copp; ADVAIR; ATN, Gerd HCTZ Hypothyroidism ALBUTEROL; PREMIDONE; PR 0 PVT PVT No No PMH: Bee sting allergy. Obesity. Plantar fascitis. swe 1 PVT PUB 1 PVT UNK 2 PVT PVT None None None PVT PVT 1 Aerobic Bacterial PVT CX DX PVT cellulitis ordered None 7-24-09 9 None MIL MIL No medical history reported. ### 5 Not Reported MIL MIL reported recent sprained ankle: ### onset 21-April-2009. 1 UNK UNK Miralax daily, None. Cyproheptadine Chronicas constipation, needed forG-tube, weight gain mild (none hypotonia given that day) 69 None UNK UNK Allergy to erythromycin, seasonal rhinitis, breast cancer su 4 PVT PVT 1 Took 7 vilesUNK of blood on UNK 7-10-09, do not know results. Had chickenpox as a child and took shingles vaccines as p 1 none UNK UNK none 1 PUB PVT None Thyroid - med taken daily for total thyroidectomy 11/07 6 None PVT OTH candida diaper Neonatal area; sepsis Eczema post birth 0 OTH PVT None 1 PUB PUB 6 Unknown OTH OTH Unknown None WAES0907USA04214 Unknown OTH OTH Unknown Unknown WAES0907USA03645 laboratory test, OTH"bunchOTH of test in ER" Unknown Unknown WAES0907USA03675 0 7/29/09 Hospital PVT ER records UNK DOS GEADON; 7/22/09. LABS LEXAPRO; No and DIAGNOSTICS: asthma; ABLUTEROL; mood CBC disorder; MDI;-Polyhistefante Mono allergic 11.5% Rxn (H)toHCT BENADRYL-swells 35.3% (L) MCV 1 This child had PUB similar episode PUB after 2nd PEDIARIX, None PREVNAR, None. 8/20/09 HIB Seizure~Hib andHospital ROTA. records 8/20/09 (no brand received Hospital name)~1~0~Patient|Sei records DOS 7/16/09 received to 7 0 None PVT PUB PRILOSECMild erythematous Laryngomalacia; patch GER 1 PVT UNK 9 5/8/09 - Stool PVT studies
0 UNK UNK none none none hives~HPV (no brand name)~1~15~Patient 1 MIL MIL allergic to Ceclor fever, and headRocephin and body aches~Smallpox (ACAM2 188 8/4/09 ER records MIL received UNK DOS 5/29/09. None CTNone and MRI ofNone. brain; 8/4/09 All metabolic Hospital and records infectious received disease DOS work-up. 5/29/09.LABS Anx 0 UNK PVT PVT Unknown A0798931A 0 Unk PVT PVT Unknown A0798941A UNK OTH OTH Unknown A0798942A 11 Saw Dr on 4/23/09; PUB NoOTH lab work - Issued Rx Doxephen - None Told patient had chicken pox 4 PUB PUB None None 0 None PVT PVT Alesse OCP; None Prevacid Allergic OTC; Retin-A Rhinitis; topical, Acne Allegra 1 Pt was given PVT ADX KEFLEX PVT 500mgCLARITIN 1 QID x 610 None days. mg 1PO Seasonal QD allergies. ~Meningococcal (Menactra)~1~20~Patient 1 PVT PVT Swelling and redness.~DTaP (no brand name)~ 0 PVT PUB None None 1 PUB PUB Diarrhea 37 week gestation; SGA (sm. for gestational age) 0 BP after recovery PVT 91/56; PUB initial BPalbuterol 106/73; BP 90Dizziness after mcg/ACT dizziness aerosol Asthma; 81/46 solution NKDA Dizziness.~HPV (Gardasil)~2~18~Patient 0 PVT PVT PRN asthma Noinhaler. complaints Asthma; hlo hives. 0 OTH PUB BACTRIM IA090011 0 None PVT PUB None None None; Has had near -syncope before once or twice. 1 PUB UNK PCN 3 Mom says hospital PUB ER PUB did test to R/o None staph. None 7 weeks premature-d/c from hospital at 2 wks. old. PUB UNK None None 0 PVT PUB None Well check None 3 PVT PUB 1 PUB PVT Vitamins; CLARITAN; BENADRYL 1 PUB OTH Vidal Dot None Old herniated disc L4-5 1 PUB PUB No No No 375 Unknown PVT OTH Unknown Urinary tract infection; Hypothyroidism; WAES0906USA04063 Hypertension; Gastrooesopha 1 Unknown OTH OTH Unknown WAES0907USA03334 71 Labs and Diagnostics: PVT OTH Head CT (-). EEG abnormal. high BP EMG Blind c/winpost-infectious left eye; loss of neuropathy/GBS. hearing left ear; High CSF BP. glucose PMH: 120 C 5 UNK UNK UNK UNK 0 None PUB PVT None None 3 PUB UNK 1 None PVT UNK None Innocent heart murmur. 1 PUB PUB None 1 CBC; ultrasound PVT right thigh. PUB 8/10/09 ER records No receivedNone. DOS 8/10/09 7/25/09.ER LABS records and DIAGNOSTICS: received DOS 7/25/09. Ultrasound Allergies of r 0 PUB PUB T103~Vaccine not specified (no brand name)~1 10 Troponin T MIL Cardiac SERUM, MIL 0.041 None (H*); Creatine NoneKinaseNone SERUM, 127 U/L; WBC Blood, 10.0 x10(3)/mcL; RBC Blo 0 Abdominal PUB an chest X-Ray; PVT BloodNone work, all normal None None 2 None PVT PVT None None None 13 Head CT; EEG; PVT blood culture. PVT 8/27/09 Hospital None records received None. 8/27/09 DOS 7/20/09 Hospitaltorecords 7/22/09. received LABS and DOSDIAGNOSTIC 7/20/09 to 7 3 None PVT PVT Levoxyl 0.1 Atenolol 50 2x simuvastatin 40 hct 225 PUB PUB None None 0 PUB UNK 0 None PUB PUB NK NK NK 1/2/09~HPV (Gardasil)~1~16~Patient 1 PVT PUB None None 0 8/13/09 Hospital PVT records PUB received DOS 8/5/09None to 8/6/09. Tuberous LABS andSclerosis. DIAGNOSTICS: 8/13/09EEG Hospital activities records of wakefullness received DO 2 PVT PUB 0 UNK UNK PUB PUB None None PUB PUB 2 PVT UNK None None None
none required MIL MIL NONE NONE NONE 0 PVT PUB none none none 3 UNK UNK STRATTERA DENIES 40 MG BID DENIES 1 PVT UNK 0 PUB PUB 0 PVT UNK egg allergyhigh fever~DTaP (no brand name)~4~2~In Pat 0 none PVT PVT no no no 0 PUB PUB none knownnone known MO-2009-16 1 PVT PUB 33 none UNK UNK None RAD 0 PVT PVT None Reactive Airway Disease UNK UNK 1 None PVT PVT None None - in for None check-up 2 N/A PUB PVT DENIES DENIES DENIES 9 PUB PUB 7 RASH/CELLULITIS PUB PVT UNKNOWNNONE UNKNOWN 0 UNK UNK no just that as shestated failedtoto911 report staff that sheshe was was asthmatic asthmatic 0 PVT PUB claritin, albuterol nebs,latex, multivitamin, egg, milk reglan, allergy, pulmicort, growth hormone nystatin, deficiency glycolax, flouride 2 PUB PVT Client denied NKDA. any acute Diabetes. illness at time of vaccine. 0 none PVT UNK insulin none DM-I 1 NONE PUB UNK NONE NONE NONE 66 After examination PVT fromPVT Dr. Janet Kerrigan, she None is not sure None if this is neuropathy type pain from Zostavax or more of m 0 unknown atPUB this time PUB Ortho tricyclin none lo Pierre-robin symdrome 8 PVT PVT 1 PUB UNK None reported None reported None reported 0 CBC 7/29/09 PVT with elevated PVT WBC 13.85 Aggrenox,Norvasc, DiabetesMetformin, type No II, known Hypertension, Simvastatin, drug allergies Prostate Casodex, Cancer Hytrin, Hydrochlorthiazide 1 PUB UNK None None None 0 PVT UNK CIPRODEX;None BACTRIMCornelia deLange Syndrome; Reactive airway dz 9/4/09-re 7 PVT OTH 1 PVT PVT None None known 1 None PVT PVT None None known. 1 PVT PVT None None Known 1 None PVT OTH None NKA, none 9 Blood; BoneOTH marrow bio; PVT Urine; Scans (Alleged (All after neg. None event) NEXIUM; None - BPH AMBIAN none PVT PVT none none enuresis OTH OTH OTH PUB Albuterol 2.5 mg per neb Asthma as needed; Prednisone 5mg every day for 5 days. 0 PVT PVT No No PUB PUB Prenatal vitamin None 1 PVT PVT Insulin pump Diabetes None PUB UNK None None NKDA 0 CBC, normal, MIL7/25/2009; MILCBC, PT, None PTT, INR,None normal, 7/27/2009; None; butTetanus family history toxoidof Abpenicillin IgG pending. allergy, so has never t 1 PUB PVT PRO-AIR IN; SINGULAIR Asthma; 10mg;allergy ADVAIR - PCN 250/50 1 PUB PUB None None Allergic to Latex; Lactose intolerant 2 PVT PUB No None 0 MIL MIL ELAVIL None Anxiety 0 UNK UNK None None None 0 MIL MIL OCPs no none 0 MIL MIL None 0 EMG; CBC;PVT MRI's; Vascular OTH studies; MIRAPEX; B12; Folate; Lisinopril; NA; K;NEXIUM; PCN Cl; CO2; (rash, KLONOPIN; anion tempgap; andCa; inflammed ZANAFLEX; BS; BUN; lymph LASIX; Creatinine; glands); SINGULAIR; GFR; EPI (LOC T.P.; SY 1 MIL MIL None None
6 0 1 None
PVT UNK None None None OTH PVT Thyroid Aciphex; Arthrotec Hi BP; Tylenol, cat scan dye; connective tissue disorder PVT PVT None None None PVT PVT None None None PUB PUB VYVANASE 40 mg QDIntermittent for 6 years asthma-last attack 2 months ago 1 None OTH PUB None None 0 PVT UNK None 1 None PVT PVT None None None 1 None PVT PVT ANSAID; FLONASE; None PREMPRO Arthritis; Seasonal allergies 0 OTH PVT None None dizziness~Vaccine not specified (no brand nam 5 MIL MIL None None None ~Anthrax (no brand name)~2~41~Patient 3 PUB PVT High fever~DTaP (no brand name)~1~0~Patien blood pressure, OTH 100/42OTH mmHg; chest Unknown X-ray, revealed Asplenia;right Pulmonary Urinary lung haziness; tract fibrosis; infection; computed Chronic WAES0907USA03866 Sepsis; alcoholism axial, Pneumonia abdomen and pelvis sho 8 PVT UNK None None Unknown OTH OTH Unknown Unknown WAES0907USA05047 1 None PVT PVT None None 1 None PVT PUB None None None 1 PVT OTH Rhinorrhea x 1 week Unknown OTH OTH Unknown Unknown WAES0907USA04814 2 UNK UNK 1 NONE PVT PVT NONE NONE NONE 0 Exray - 7/30/09 PVT normal.UNK MRI to be done none, pain in hypothyroid shoulder 1 PVT UNK None None 1 PVT PUB GERD [Gastroesophageal Abnormal neonatal reflux screening disease] GERD [Gastroesophageal 1 PUB PUB 0 PUB PUB unknown n/a unknown 2 PUB PUB GuanfacineNone reported ADHD with med Guanfacine per mother for treatment; His 1 PVT PUB None None None 0 UNK PVT 1 Not known PUB at this time UNK No medications No illness takenat by No time client existing of vaccination illnesses 0 UNK UNK 0 None PVT PUB None None Pre-existing asthma and allergies causing anaphylaxis afte 0 PVT UNK None None None 1 none PVT PVT tylenol, mortin none AR/RAD localize reaction~DTaP (Daptacel)~5~6~In Pat 1 None PUB PUB None None None 0 Vitals WNL;PVT BS 130; PUB None None 6 KUB: findings UNK which suggest UNK an intussusception with the leading edge in the left transverse colon. The air in the rig 20 Not applicable PVT PVT None None None Known 7 None needed. PVT PVT Artane and None Klonipin Cerebral Palsy 1 UNK PVT 2 UNK PVT None None Pt allergic to Iodides, Sulfa and Cipro 1 none PUB PVT none none none 0 NA PVT UNK NAUSEA, VOMITING, NA DIARRHEA, HEADACHE 1 NONE PVT PUB N/A NONE N/A 1 UNK UNK NONE HX OF ASTHMA. DENIES ANY OTHER ALLERGIES ARE none. WasPVT clinically dehydrated PVT by lipitor vital signsnone Pcn, Erythromycin 1 PVT PVT None None Cleft Palate, s/p repair 1 EEG - NL; Blood PVT tests UNK - WNL. 8/17/09 Hospital records received 8/17/09 Hospital DOS 7/22/09 records to 7/23/09. receivedLABS DOS and 7/22/09 DIAGNOSTIC to 7/23/09 0 PVT PVT None None None 2 PVT PVT 1 PVT PVT Asthma
PUB OTH NKDA 0 PVT PVT None None None 1 PVT PVT None None known 1 MIL MIL PPD, C3149AA, None ID-Lt forearm, None 1 previous dose 1 F/u test, Strep PVTscreen, PVT 7/24 were negative; PHENERGAN CBC, 25 CMP, mg essentially Tab No known - Quantity: normal; drug10 allergies. tablets, mono screen, Sig:1/2negative. tablet every See8 attached hours as n 1 OTH PVT No No 1 PUB PVT Poison ivy -Ovarian off steroids cysts; x2Shellfish/iodine wks allergies 0 None PVT PUB H/o headaches None(+) 0 PUB OTH None No Pt. stated NKDA. 2 holes in heart at birth ASD & VSD whic 2 PVT PVT None 0 OTH OTH None None None PVT UNK 0 PVT PVT Non-Hodgkin lymphoma; LASIX; ALACOL; Carvedilol; ART 1 Allergy testPVT PUB ATARAX; OTC NoneeczemaSevere creameczema; dry patches Allergies of redness, inconsolable crying~DT 1 PVT PUB Well visit BIAXIN; ADD UNK OTH OTH Unknown A0795567A 2 Unk PVT PVT Unknown Concomitant medications A0796476A and relevant medical history wer 2 Unk PVT PVT Unknown Concomitant medications A0796479A and relevant medical history wer 2 UNK PVT PVT Unknown Concomitant medications A0796481A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796720A and relevant medical history wer UNK OTH OTH Concomitant medications A0796722A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796723A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796724A and relevant medical history wer 0 UNK PUB PUB Allergy medication Unknown There was no relevant A0798874A medical history. The subject had n UNK OTH OTH Unknown A0798883A 2 PVT UNK N/A N/a N/A 2 PUB PVT n/a n/a n/a 1 none PVT UNK none 0 None at thisUNK time. UNK None None None 0 pap smear,leep UNK biopsy,UNK colposcopy, Birth CBC control wasnone pills normal thats butnone. it.Glm filtration 8/5/09 PCP Rate, medical Es was records 70 normal received is 60,strep DOS 08/16/06 screen 0 CBC PVT UNK None Hx lung CA 1 Hospital Psychological PVT PVT Assessment Given 1/8/2008; Tylenol None Numerous prior to vaccination(s) None Hair/Urine/Stool analysis tests. 0 CBC; Serum PVT Iron; CMP; PVT PT; PTT; NONE stool guaiac; NONE urinalysis; NONE. Blood8/12/09 transfusions. Hospital 8/12/09 records Hospital recieved records DOSrecieved 11/23/08DO to 1 CBC with diff PUB -> WNL. PUB 8/17/09 Hospital None records Well received Allergy DOS 7/26/09 to amoxicilin; to 7/28/09. whenLABS has bug and bites DIAGNOSTICS: arm swells-sensi Blood 6 Referred toPVT hospital. 8/17/09 OTH Hospital recordsIntussusception; received DOS 7/30/09 diarrhea. - 7/31/09. LABS and DIAGNOSTICS: X-Ray A 0 PVT PVT 0 PVT PVT syncope~ ()~UN~17~Patient 1 MIL MIL None 0 PUB PUB 1 PVT PVT Sinusitis 0 None PVT OTH None None Geographic tongue. 0 None PUB PUB HTN; elevated cholesterol. 3 None PVT PVT 2 PVT PUB None None None 0 None PVT PVT None None 193 Apgar score, OTH 06/01/09,OTH 7, at the first vitamins minute; (unspecified) Apgar Pregnancy score,NOS 06/01/09, (LMP=9/10/2008); 8, at 5 minute; WAES0907USA04864 Heavy Apgar smoker; score, Anaemia 06/01/09, 9, at 10 0 None OTH OTH tetracycline Acne WAES0907USA04871 Unknown OTH OTH Unknown Unknown WAES0907USA05126 1 n/a PVT PVT n/a GERD 3 UNK UNK mononessanone no. 1 UNK UNK Lisinopril, generic None Paxil, Hypertension Ambien
1 N/A PUB PUB none no none 9 PUB PVT None per parent 0 PVT PVT none none none 9 no tests were PVT ordered. UNK None. None. MIL MIL Fever 12 hours noneafter administration 0 None UNK UNK None None 10 blood culture, MILwound culture MIL none none none 0 PUB PUB None None 2 n/a UNK PVT none 0 PUB PUB None None 2 PVT UNK NONE 2 PUB UNK Cardizem cd none 120 MG, none baby aspirin 0 None PUB PUB None None None 0 PUB PUB 0 N/A PatientPVT did not seek PVT medical intervention Paroxetine Patient 30 for mg; her illness. came Synthroid Charcot into 112 clinic Marie-Tooth mcg's; for a med Fosinopril20 type check. 2 neuropathy; mg; Prednisone Arthritis5mg; neuropat Triam 12 6/29/09 - not PVT immune to PVT rubella Imatrex, VitNone D known Rosacea, Migranes Unknown~ ()~NULL~~In Patient|Unknown~ ()~ 0 UNK PVT UNKNOWNUNKNOWNUNKNOWN 0 UNK UNK none no Dx with asthma rash since over several age 6 orareas~Hep 7, no problems B (no for brand 2-3 name year 1 UNK UNK none reported 1 UNK PVT none 1 MIL MIL 2 Spinal Tap,UNK Bacteria Negative, UNK Virology: CurrentnoMeds: results, Swollen Prednisone MRI/CAT Tonsils Open5mg with Scan. Heart 2tabs elevated LABS Surgery poand BID,Albuterol White 7/2001, DIAGNOSTICS: Blood Pituitary Cell 1.25mg Count, Surgery Spinal 1 vial indicative Tap 12/2006, via neb - CSF ofq4h Di InP 0 PUB PUB DENIES~ ()~NULL~~In Patient 0 X-ray of nasal PVTbones PVT None known None known 0 MIL MIL NICU respiratory distress from birth until 7 days old; chorio 0 PVT UNK None known None 0 PUB PUB ENJUVIA 1.5mg No QD None OR200926 79 Please see PVT attached PVT none heart murmur 1 PVT PVT Epi-pen; Fluticasone, 50 mcg; Omeprazole 20 mg 0 None PVT UNK None Hypertension; Allergic Rhinitis PUB OTH VERAMYST nasal spray 0 None PUB PUB None None None Nausea, Fever~Hep A (Havrix)~1~1~Patient 0 18 Apr 2009, MIL Glucose,MIL 133; BUN/Cr, None 23/1.1; Na+, None147; K+, NKDA; 4.3; Cl-, Around 106;age CO2, 6, pt 22;was Anion hospitalized Gap, 22.3;x2Ca++, for pneumoni 10.3; C 0 OTH PUB None None None 1 PUB PUB Started Cephalexin None 7/2/09 Autism; Asthma; Obesity OR200929 0 PVT PUB MOTRIN (Children's) 1 1/2 tsp @ 830 1 PUB PUB OR200930 PVT PVT 1 PVT PVT None None red swollen~Varicella (no brand name)~2~9~P 5 None PVT PUB None None noted 0 None PUB PUB None None None PVT OTH None 0 PUB PUB Methotextrate 12.5 mgCROHN's PO weeklydisease 1 None PUB OTH None None None ~DTP (no brand name)~4~6~Patient 0 none PVT OTH none none none 1 PUB PUB Allergy to Sulfa 0 None PUB PUB None Seizures with stress and fevers. 0 Assessed by OTH medical center UNK None Seasonal allergies none specific 1 None PVT PVT None None 1 None PUB UNK None None None PUB PVT None None
2 PVT PUB None None 1 None PVT PVT Multivitamins None None Hard spot, red, fever~DTP + IPV (no brand nam 1 None OTH UNK None Mild ulcerative colitis -194 see attached PVT PVT none heart murmur weak, fatigued~HPV (Gardasil)~2~15~Patient 10 Labs: CSFPVT WNL. ESRPVT 38. EKG WNL. 10/8/09 None service Heart dates murmur 8/14/09 SeePMH: toattached~ 10/1/09. low K+. LABS ()~~0.00~Patient 10/8/09 and DIAGNOSTICS: service dates 8/14/09 CDC PVT PVT 1 PVT PVT No No No 68 ITP/Evans Syndrome... UNK UNK Will eventually Noneturn into NoLupus. LABS allergies andtoDIAGNOSTICS. penicillin. 'Easy 1/2/09 bruiser". to 3/18/09: PenicillinPlatelets allergy. 'Ear 63 ( 0 Unknown OTH OTH Unknown Unknown WAES0907USA05038 64 Ultrasound,OTH normal; Echocardiography, OTH LEXAPRO 05/01?/08, Pregnancy fetal normal; NOS (LMP Blood = 8/15/2008) pressure,WAES0907USA03319 05/08/09, pregnancy induced hype 33 Unknown. 8/7/09 OTH Medical OTH records Unknown. received DOS 8/7/09 8/7/09 11/12/08 Medical Medical Unknown. torecords records 7/28/09. 8/10/09 received received LABSHospital and DOS DOS WAES0907USA04234 DIAGNOSTICS: 11/12/08 11/12/08 records to received to7/28/09. 7/28/09. Mantoux. DOS 'B12 C/O 12/26/0 8/10/09 pills' heartb 0 head computed OTH axial, 06/18/09, OTH baby: "vastly Pregnancy abnormal"; NOS ultrasound, (LMP =06/18/09, 6/1/2008)W baby: AES0907USA04345 "vastly abnormal" 0 Unknown OTH OTH NEXIUM Sulfonamide allergy WAES0907USA04362 162 09/23/09 Medical PVT Records PVTreceived for date ofNone service 7/22/09 None. to 8/20/09 7/23/09 Vaccine ultrasound: records intussusception received. Pneumo RUQ./ Air Wyeth con 0 UNK OTH OTH No concurrent Unknown medication The subject had a broken A0799772A collar bone with birth. Apgar sco 0 8/6/09 Hospital PUBrecordsPUB received DOS 5/15/09none to 5/24/09. notedSpina LABSbifida. and DIAGNOSTICS: 8/6/09 Hospital records Chest CT received positive. DOS Mycoplas 5/15/0 12 PPD, 7/2/09. MIL 8/17/09 Hospital MIL records received None DOS 8/2/09 8/17/09 to 8/5/09. Hospital LABS records and DIAGNOSTICS: received DOS 8/2/09 CBC to - Eos 8/5/09. 8.6%E 1 PVT PUB None Tinea pedis;Same Acne;asChronic above~HPV knee pain; (Gardasil)~1~14~Sibling Overweight 1 None PVT PUB None None None 2 PVT PVT None None PVT PVT 0 PUB OTH None None - per mom 4 PVT PVT none none 1 MIL MIL ZYRTEC; XOPENEX; BENZACLIN Allergy to cats. 1 PVT PVT AZITHROMYCIN None 250mg Episodic annual pleurisy Sx 1 PVT PUB HTN; Dust mite allergy 1 None PUB PUB DEPO-PROVERA None UTI; Migraines 3 PVT PUB 0 PVT UNK None None 0 None MIL MIL No No 20 Plts count 4,000 MIL UNK None None None 1 PVT PVT 1 PVT PUB Benzyl peroxide none 10% Gel acne; overweight same as above~HPV (Gardasil)~1~16~Sibling 0 None OTH PUB None None Allergic to pollen Rash forehead~Varicella (no brand name)~2~9 Pregnancy OTH verified by ultrasound PUB 7/14/09. None Pregnancy unknown at time of administration. 19 UNK UNK none none 0 PUB UNK levothyroxine none 50mg excercise induced anaphlaxis food allergy to shrimp and lo 0 PVT UNK NKDA 0 none PUB PUB unknown none none 3 N/A UNK PVT Lipitor 40mg 1 PVT PVT simvastatin tab 10mg, mulitvitimans 0 PUB PUB nONE nONE 3 PUB UNK 0 8/2/09- Fever UNK 104, Heart UNK rate 104 Seroquel, bpm, BP 80/60mmHg, Fioricet, status-post Effexor, Anxiety, splenectomy and Klonopin, marked migraines, leukocytosis. after Vicodin, fall andfrom Oxycontin, endometriosis WBC2 story24,000 Ambien balcony /L,8/31/09-record RBC 2.77 mil/ N/A PUB UNK No illness reported 55 A multitudeUNK of blood tests UNK were done, along with none MRIs, x-rays, none and a lumbar puncture 8/24/09-records received-JC 1 Available upon PVTrequestPVT from Crestwood Hospital. 06/29/2009 pt had bilateral cochlear implants inserted at C 1 CK:(55) WNL, MILCMP: WNL MIL Flonase and None Zantac None 43 MIL MIL None None 1 Normal CT UNK of head, lumbar UNK puncture/CSF None analysis, none inblood/urine/CSF the none weekPMH: beforecx. febrile or EEG week seizures normal. after Labs and diagnostics: CXR0 nothing wasPVT done. dr never PVT even came to seenone. her as was nurse healthy said at these timeweren't of shot.usually side effects of this shot.
0 PVT PVT 0 UNK UNK ~Tetanus Diphtheria (no brand name)~NULL~~ 11 8/31/09 Hospital PVT records PVT received DOS 7/20/09 None to 7/28/09. None LABS and DIAGNOSTICS: EEG - WNL. CT Scan Head 2 PVT PVT LISINOPRIL; None SINGULAIR; Hypertension; CLARITINIncreased D. cholestoral; NKDA 1 Lab work - drug PVT levels PVT C..P; Seizure C.P. disorder 1 PVT PVT None 1 PVT OTH 0 None PVT PVT None Drug and food allergies, Dyes, Zithromax, Cefzil, melons a 8 PVT PVT Boniva None Sulfa 1 PVT UNK None None 1 PVT PVT Yasmin; Lexapro; Mild allergic Nasonex PCN rhinitis allergy; Palpitations 0 Seen by allergist. PVT RAST PUB testing, 0.61 Amoxicillin (class I -Seen positive) Onset by7/13/09; dentist to PMH egg white. same Albuterol - Palate dayrepair; as for needed; a lesion Bilateral Budesonide on PE righttubs; buccal Cleft as mucosa. needed. palate. 0 None PVT PVT TetracyclineNone 500mg cap None twice a day; PPD PVT PUB Unknown OTH PUB None disclosed Noneby disclosed parent Noneby disclosed parent by parent 1 None PVT PUB Depo Provera No Morphine 0 PVT PVT Simvastatin; Benicar / Hct; HTN,Protonix; AAA, Carcinogen Celexa renal, renal cyst and fatty liver dise 1 PVT PVT ORTHO-NOVUMM None 777; None FLOVENT; PROAIR; VIACTIV CHEW 0 Benedryl Given PVT PVT None None None PVT PVT None None 0 PUB PUB None Known 3 PUB PUB None No No 5 Blood work PVT medical Eval PVT None None None 0 PUB UNK 0 PVT PVT None NKA UNK UNK 2 PVT OTH 15 OTH PVT 6/21/09 started Noneon MAXICLEX Allergies:eye Fish; drops PCN; SULFA; CODEINE; DILAUDID; Arthr 1 PVT PVT No None 13 OTH OTH None None None 2 PVT PUB No 2 PVT PUB None None 0 None PVT PVT None None None 0 Unknown PUB PUB None notedMom transfusion during pregnancy- Soy formula infancyUnknown OTH OTH Unknown Cardiac disorder WAES0907USA04758 38 ultrasound, OTH 09/03/08, results OTH wereUnknown normal andPregnancy 12 weeks NOS gestation; (LMPserum = 6/15/2008) alpha-fetoprotein, WAES0810USA04728 10/13/08, normal 0 magnetic resonance; OTH diagnostic OTH laboratory, None various testsNone for MS 10/2/09 Medical WAES0907USA05405 records received for Neurologist c Unknown OTH OTH Unknown Unknown WAES0908USA00003 16 Unknown OTH OTH Prednisolone Crohn's disease Pancreatitis; Adverse drug WAES0907USA04071 reaction 6 Unknown OTH OTH Unknown Unknown WAES0907USA05644 0 Labs and diagnostics: PVT PUB BS 138-242. None head CTNone WNL. Febrile seizures. Same~Influenza PMH:ID09014 Seizures (no brand with vaccines name)~1~1~Patien at 12, 15 a 0 Electroencephalography UNK UNK (EEG) and Unknown blood work were performed, None results not reported ### UNK UNK ### Not reported UNK UNK Not reported ### 0 8/24/09-records UNK receivedUNKLabs WNL. noneALT 108 none and AST none 41, A/G ratio 1:1, lymphocyte % 63.3. -365 PUB PUB None Allergic to phenergan 0 NONE PVT PVT CLEOCIN-T; NONE RETIN-A NON CREAM; BENZOYL PEROXIDE ND-09-07 WASH 2 No lab testsPVT were obtained. PVT Detrol LA 4mg; NoneLevothyroxine reported. Allergies: 0.025mg; Tetracycline; KCL 10meq; Prinivil; Atenolol/chlorthyladone Cipro; Augmentin; Clindam 50/ 0 PUB PUB NKA none none fainted~Tetanus Diphtheria (no brand name)~6 1 none PVT PUB NONE N/A Seizures at age of 6 months 0 history of severe PVT food allergiesPVT egg, flovent, milk, albuteral squash no prn, floridel, allergies, synthroid asthma, food allergies, hypothyroid
17 PUB PUB None none 0 None PUB PUB None Known None None Known 1 MIL MIL concerta not ill n/a 5 PUB PVT N/A Allergy to Penicillin 0 None PUB PVT 1 8/6/09 Hospital UNKrecord UNK received DOS 8/4/09. LABS and DIAGNOSTICS: Sulfa. Chest X-ray - Normal. Urinalysis - pH 8.0 ( 0 None PUB PUB NONE NONE NONE REPORTED 4 in the skin biopsy UNK we found UNK that i had none hsp. kidney none.biopsy 8/17/09 none. showed PCP 8/17/09 medical protein PCP and records medical scarring. received records it was DOS received all un 8/12/08 normal. DOS to 7/13/09 8/17/09 8/12/08 7 Movement tests PVT of my PVT forehead muscles, mouth, I have and a normal closing tests of myoftrachea, holdingand my arms have a out stent straight in place determined keepingthat my 7 child seen in PVT urgent care UNK had head ct with normal noneresultsnone 1 PVT PVT Children's multivitamin; None None Children's fish oil; Bioplasma cell salts 1 UNK UNK unknown none none knownnone~ ()~NULL~~In Patient 3 PVT PVT flax seed oil swelling~Td Adsorbed (no brand name)~NULL 6 UNK PVT none none 1 PVT PVT Benicar, levothyroxine,erythromycin Lexapro allergy, anxiety, hypertension, hypothyroidism 2 PVT PVT Fosamax, Dovonex allergic to iodine, latex. Psoriasis, osteoarthritis UNK UNK None None 0 PUB PUB MOTHER DENIED UNKNOWN ANY ILLNESS AT THE TIME OF VACCINES ADM 0 None PVT PUB CREST Syndrome, Allergies:HTN, Nifedipine, None~ Asthma, ()~NULL~~In Keflex, Osteoporosis, Adalat, Patient Tomentin, Osteoarthritis, Clinoril, Hype 2 none UNK UNK none 0 UNK UNK 11 It was first believed UNK I had UNK an inner ear problem. An ENT Do whonot specializes smoke or in drink inner butear dosent haveme fibromyalgia to a neurologist. non specif I wa 0 PUB PUB Parent (father) who was accompanying ID09017 child stated they got home fro 0 PVT PUB ID09015 5 MIL OTH None 2 UNK UNK remote history of radiation to skin for mycosis fungoides 0 PVT PUB None None Congenital hypertrophic pyloric stenosis - surgically resolv 0 none PUB UNK no specific obesity illness 0 PVT PVT BENTYL 2O None mg IBS 17 Blood work UNK completed UNK in LRMC - C-RP; None TSH;None B12; Lyme; GERD, RPR; 2003 heavy- metals; Sought protein evaluation electrophoresis for chest pain. andHad A1CUGI. -e 0 UNK UNK 1 None PVT PVT None None 2 None PVT OTH BENAZEPRIL; None CITALOPRAM; None TRICOR; METFORMIN; CLONIDINE UNK UNK None 0 MIL UNK none none 1 PVT PVT PATADAY eye No drops; NASONEX Environmental nasal allergies spray; ALLEGRAL 80 mg d/y 0 VS: 94/65 right OTHarm; BP PUB 20, oriented x3 no no per mom dates age unknown~ ()~~0~Patient 2 none PVT PVT none none none 25 PVT PUB No 6 PVT PVT BONIVA; CYMBALTA;Depression; Folic Acid;TRINSICON; esoph. reflux; Zinc; osteopenia; Vit B; Multivitamin; plantar fascitis; Omepraz tinn 1 none PUB OTH none none none none~ ()~~0~Patient 1 PVT OTH NONE NONE NONE 0 None PVT PVT None Multiple Allergies 0 BP, 130/88;PUB RBS, 120;PUB Temp 98 degrees; Prenatal NST vitamin reactive NKA 3 seen in office PVT 7/29/09 OTH None No None 1 PVT UNK None None 0 MRI; Blood PVT work PUB ZOCOR; DETROL None None; Pacemaker inserted 4 wks prior 4 MIL MIL None None 2 8/4/08, TSH, UNK 1.94; 2/25/09, UNK TSH, 1.74 before vaccine and Heart fever; patient: 3/27/09, mechanical TSH, 0.04, mitral extreme valve,change, controlled after with vaccine high 2 PVT PUB none exercise induced asthma; ID09016 allergic rhinitis 0 X-ray; MRI PVT showed questionable OTH result; Physical None therapyPenicillin couldn't restore Allergy.to8/17/09 normal;PCP Bone medical scan. records received D
UNK UNK None 0 PVT PVT 0 None at thisPVT time - referred PVT to Allergist None None None 1 PVT PVT None CECLOR and BACTRIM 9 PVT OTH CRESTOR; Triamterene; Allergic NIASTAN; to codeine. HCTZ;InASA; addition, METROGEL; ### the patientRanitidine; was takingZETIA the f 6 None PUB UNK No No OR200931 0 PVT PVT YAZ 0 Allergy testing PVTperformed PVT 7/27/09 PRN ZYRTEC NONE Severe food sensitivities; previous EEG; not allergies, has 5 PVT OTH Cough 3 None PVT PVT None Tetracycline 7 Unknown PVT PVT PROZAC; trazodone Hypersensitivity hydrochloride WAES0906USA04748 1 PVT UNK Allergic to bee sting 38 None OTH OTH Antimicrobial Chronic (unspecified); UTI; Blood Hydrazide; pressureToprol high;WAES0907USA05669 Drug XL tablets hypersensitivity; Penicillin alle Unknown OTH OTH Unknown Unknown WAES0907USA05682 0 Unknown. OTH 8/24/09 Consultant OTH records Nonereceived Allergic DOSreaction 8/20/08 Eye redness. to antibiotics; 8/4/09. 8/24/09 LABS Food Consultant and WAES0908USA00058 allergy DIAGNOSTICS: records received Complement DOS 8/ 1 1 CBC = normal; PVTInfluenza PVT A + B = negative None None 2 PVT PUB Global Developmental Cellulitis~DTaP Delay (no brand name)~4~3~Patient 2 PVT PVT none none UNK UNK asthma; allergies 0 UNK UNK ZOSTAVAX, ONE SHOT, 7/30/2009 wheezing ice applied on & off to sitePVT X 20 minutes. PVTLess redness Infant TYLENOL and None no increased None swelling noted 30 X 45 mm. Infant TYLENOL 0.4 cc giv 0 PVT PUB PROVENTIL Asthma and FLOVENT Asthma both used as needed only 1 None PUB PUB None None None 1 PVT PUB None 3 PVT OTH HRIG 7-31-09; None Lot number NKDA; B0886-5; NKFA; Route/Site, 0 conditionsRt Gluteus ; No Previous Doses CBC normal; PUB ESR 16 UNK None 1 None PVT PUB None None None same~Hep A (no brand name)~1~12~Patient 0 none UNK UNK none none none none~ ()~~0~Patient|none~ ()~~0~Sibling 1 None doneUNK UNK none reported none none None Reported~ ()~~0~Patient|None Reported PUB PUB none Penicillin allergy 3 N/A MIL PUB NONE NONE NONE 1 PVT PUB NONE NONE NONE, HEALTHY 0 CBC resultsPUB indicated low UNKwbc andNone low platelet, None chest xray None normal, UA normal, child has follow up appt on 8/7/09. P 0 PVT PVT none none hives from red fever,nausea, dye. Had hives vomiting~Rabies 2 months ago (RabAvert)~2~8 from unknown 1 none PUB UNK None reported 0 None MIL MIL Multivitamins None None 1 PVT PUB NONE ALLERGIC TO PCN. PT. HAS DX: ADHD AND IS TAKING 0 INITIAL VITALS: UNK B/P 104/59 PUB HR 33 None R 14 SPo2 None 98% -HEART None MONITOR SHOWED NORMAL SINUS RHYTHM. P 1 PVT PUB NONE NONE 0 None PUB PUB none none AL0911 0 None PUB UNK AL0912 UNK UNK NONE N/A N/A 1 UNK UNK none no AL0913 1 UNK UNK NONE NONE-GOOD DX:HEALTH CEREBAL PALSEY HAS LIMP ON RT. SIDE SECON 2 9/14/09 Hospital UNK Records UNK DOS 7/24/09 to 7/27/09. No LABSNo and DIAGNOSTICS: Echocardiogram - Normal. Urinalysi 34 Lab tests performed, UNK allUNK with normal results: Monospot, None EBV Nonetiters, CBC, urinalysis, pancreatic enzymes. Many oth 1 PUB PUB 11 18Jul09- Non UNK contrast UNK head CT- NO EVIDENCE fever, OFchills, ACUTE None night INTRACRANIAL sweats, coughing HEMORRHAGE up blood-quarter ORsize PARENCHYMA amount of b 0 Follow-up exam UNK on 8/6/09 UNKshowedAugmentin myalgia atcystitis 875mg site of (afebrile) of BID, injection diabetes metformin (Lmellitus deltoid), 500mg type but BID, 2, nobenazepril carpal erythema/pus/swelling/induration tunnel 5mg syndrome qd 1 UNK UNK Z-Pak Zithromax None None UNK PVT OTH Blood pressure HIGHmedication BLOOD SEIZURE PRESSURE DISORDER;A0800464A The subject had experienced adve
2 UNK PVT PVT ASTHMA Concomitant medications A0796476A and relevant medical history wer 1 PVT PVT None None None 0 None PVT UNK 1 PVT PVT None NKDA, no preexisting illness/conditions 0 PUB PUB None None Pediazole 0 PVT PVT NYSTATIN None Oral Suspension; None Multivitamin 0 EKG; CBC;PVT UA; RSTR; PVTComp LANTUS None Splenectomy age 10; Diabetes 0 None PVT PUB None Had recent None cough, resolved 0 PVT PUB ADDERALL; Nasal CLONIDINE congestion; AMOXICILLIN Rhinorrhea 0 PVT PVT None Atopic dermatitis. Hx absence Rash sz. under Seizure. nose. 6 PVT PVT 0 None PUB PVT None None 1 PVT PUB 1 PUB PUB See question # 7 1 PVT PUB No Coxsackie virus NKDA 1 6/5/09 CT Scan PVT (R) upper PVTarm inflam. GABAPENTIN changes, No fascitis 300mg;Migraine 2 BID; PRN; headaches; AXERTIntermittent sinusitis 0 BUN, CBC,PVT CREAT, Electrolytes, OTH Glucose Unknown Unknown None OTH OTH Unknown Fruit allergy WAES0810USA03151 0 None OTH OTH None WAES0810USA03209 None OTH OTH None WAES0810USA03324 0 Unknown OTH OTH ENBREL; NAPROSYN Rheumatoid arthritis WAES0810USA03681 0 magnetic resonance, OTH on OTH elbow ADVAIR; pravastatin Allergic reaction sodiumto antibiotics; Penicillin WAES0810USA03742 allergy; Asthma Unknown OTH OTH Unknown WAES0810USA04978 1 complete blood OTHcell OTH LIPITOR; LOVENOX; Latex allergy; LEXAPRO; Stroke; Drug Acute hypersensitivity; NEXIUM; myocardial GLUCOTROL; WAES0810USA05305 Hypertension; infarction KEPPRA; Hypothyroidism; SYNTHRO D 1 body temp, OTH 10/10/08, 103.6 OTH F; body aspirin; temp,bupropion 10/11/08, Coronary hydrochloride; 101 artery F disease; KLONOPIN; Hypertension; WAES0811USA00059 COZAAR; Depression; nefazodone Hyperlipidaemi hydrochlori 2 Urinalysis, (+) PVT blood, leukocytes OTH Hypothyroidism Ovarian cyst; Gastroenteritis WAES0811USA00680 Unknown OTH OTH Unknown Unknown WAES0811USA00890 1 Unknown OTH OTH Unknown WAES0811USA00896 1 Unknown OTH OTH Unknown WAES0811USA00903 2 anion gap, 11/07/08, PVT 16; PVT serum glucose, FOSAMAX; 11/07/08, CADUET; 91 mg/dl; None aspirin; serum AMBIEN blood urea,WAES0811USA00907 11/07/08, 16 mg/dl; serum creatinin 4 Unknown OTH OTH Unknown WAES0811USA01139 0 physical examination, PVT mechanical PVT darbepoetin purpura, upper Anemia; alfaextremity: Cancer; erythema Asthma;around Thrombocytopenia; the WAES0811USA01642 right biceps; Macrocytosis; tenderness;Colitis blood ul p 2 WBC count,PVT 11/28?/08,PVT 33000; WBC count, 11/28/08, 25.4; Unknown WBC count, 11/29/08, WAES0812USA00522 17000 0 WBC count,OTH 18000 OTH Hypertension; Right Diabetes cataract extraction WAES0901USA00144 0 Unknown OTH OTH Unknown Breast cancer; Drug hypersensitivity WAES0902USA01799 Unknown OTH OTH Unknown Unknown WAES0903USA01440 0 WBC count,OTH 03/10?/09,OTH 20.1; body temp, 03/08?/09, Penicillin 103F allergy; Surgery; Hospitalisation Back disorderWAES0903USA03638 0 Unknown OTH OTH Unknown Hospitalisation; Alcoholic withdrawal WAES0903USA03645 symptoms 0 Unknown PVT OTH Unknown WAES0802USA03729 1 urinalysis, 05/??/08, PVT results OTH not reported; (therapybody unspecified); Drug temp, hypersensitivity 05/??/08, calcium100.6 (unspecified); LESCOL WAES0806USA00286 80mg; glucosamine; LACT 1 Unknown PVT OTH Unknown Hospitalisation; Adverse drug reaction WAES0806USA01049 Unknown OTH OTH Unknown Unknown WAES0806USA01241 0 Unknown OTH OTH Unknown Unknown WAES0806USA02894 0 Unknown OTH OTH Unknown Unknown WAES0806USA02898 1 Unknown OTH OTH Unknown Unknown WAES0806USA07565 2 Unknown OTH OTH Unknown Unknown WAES0806USA07568 Unknown OTH OTH Unknown Unknown WAES0806USA07732 0 Unknown PVT PVT Unknown Penicillin allergy Immunisation WAES0806USA07736 1 None OTH OTH LOTREL; ATENOL; Blood pressure TAXUS Cholesterol high; Heart raised; disease Breast WAES0806USA07821 congenital; cancer Hypersensitivity reacti 0 chest X-ray,PVT 06/26/08, OTH no evidenceFOSAMAX; of acute cardiopulmonary Gastrooesophageal NEXIUM; estrogens abnormality; reflux (unspecified); disease; diagnostic WAES0806USA08865 Cholesterol ZETIA; urinalysis, ACTONEL high; 06/26/08, Osteoporosis; normalH1 None OTH OTH Fosamax; Lexapro; Hypertension; Synthroid; Dyslipidemia; Lisinopril;Senile Zocor; WAES0806USA09012 dementia; Detrol LA;Depression; Tuberculin purified Osteoporo pro
4 VZV strain, OTH 5/13/09, sample OTH adequate: Unknown VZV WILD TYPE STRAIN WAES0905USA01623 0 Unknown OTH MIL ZIAC; PREVACID Unknown WAES0807USA00408 0 Unknown PVT OTH Bio Atenolol; Hypertension Casodex;Prostate Lupron; cancer; Hexal Lisinopril ColonWAES0807USA00831 cancer; Colectomy; Bone spur 2 None UNK PUB None None WAES0807USA00845 0 None OTH OTH None WAES0807USA01192 Unknown OTH OTH Unknown Unknown WAES0807USA03005 0 None OTH OTH None None WAES0807USA03096 0 Unknown OTH OTH Unknown Unknown WAES0807USA03097 OTH OTH Unknown Unknown WAES0807USA03320 Unknown OTH OTH Unknown None WAES0807USA03677 Diagnostic laboratory, OTH high, OTH testedNone high on anti-nuclear Arthralgia;antibodies Connective tissue disorder; WAES0807USA03837 Drug hypersensitivity 365 None OTH OTH albuterol; PROZAC Depression;Breast Asthma cancer WAES0807USA04021 0 Unknown OTH OTH ALBUTEROL; Hypersensitivity ALLEGRA-D; NASONEX; SINGULAIR WAES0807USA04071 0 None OTH OTH aspirin; atenolol; fexofenadine Unknown hydrochloride; WAES0807USA04073 FLONASE; hydrochlorothiazide (+) Unknown OTH OTH Unknown WAES0807USA04128 2 Unknown PVT PVT None Unknown WAES0807USA04404 0 Unknown OTH OTH Unknown Unknown WAES0807USA04828 0 Unknown OTH OTH Unknown Unknown WAES0807USA04830 None OTH OTH Unknown Unknown WAES0807USA04938 0 Unknown OTH OTH Unknown Unknown WAES0807USA05269 0 Unknown OTH OTH Unknown Unknown WAES0807USA05671 1 Unknown OTH OTH Unknown Unknown WAES0808USA00513 Unknown OTH OTH Unknown Hospitalisation WAES0808USA00992 Unknown OTH OTH Unknown Unknown WAES0808USA01259 2 None OTH OTH FOSAMAX; PREMARIN; Hypersensitivity PRAVACHOL WAES0808USA01705 0 Unknown PUB OTH Unknown Hip replacement WAES0808USA01940 5 chest X-ray,OTH Results not OTH back as yet Unknown Unknown WAES0808USA02145 diagnostic laboratory, OTH ?/?/08, OTH low titers Unknown Immunodeficiency WAES0808USA02583 1 Unknown OTH OTH atenolol; CASODEX Hypertension Prostate cancer WAES0808USA02621 Unknown OTH OTH Unknown Diabetes WAES0808USA02641 1 Unknown OTH OTH Hydrochlorothiazide Hypertension; Sulfonamide allergyWAES0808USA02675 0 Unknown PVT PVT Unknown Unknown WAES0808USA03612 0 body temp, OTH 08/18/08, 104 OTH Unknown WAES0808USA04048 0 PVT PVT Unknown Drug hypersensitivity WAES0808USA04242 None OTH OTH None None WAES0808USA04684 0 None OTH OTH Unknown Unknown WAES0808USA04828 Unknown OTH OTH Unknown Unknown WAES0808USA04971 1 Body temp OTH 102 OTH None Allergy to vaccine WAES0808USA05316 Body temp,OTH 103 OTH Unknown Unknown WAES0808USA05370 0 Unknown OTH OTH ASPIRIN; PREMARIN; Hyperlipidaemia; Gastrooesophageal SYNTHROID; Hypothyroidism; ZOCOR reflux WAES0808USA05487 Drug disease; hypersensitivity Kidney stone; Atrial fi order, severe mental retardation, high UNK cholesterol UNKand no drug reactions Convulsion or allergies disorder; or illness Mental at time retardation; ofWAES0809USA00032 vaccination Cholesterol who inhigh 2005 was vacci 1 None OTH OTH None None WAES0809USA00048 1 body temp, OTH 08/28/08, 102 OTHdegreesUnknown None WAES0809USA00085 0 None PVT OTH ARMOUR THYROID Sulfonamide TABLETS allergy; Drug hypersensitivity; WAES0809USA00331 Allergic reaction to antibio Unknown OTH OTH Unknown Unknown WAES0809USA02160 0 total blood O2, OTH09/02/2008, OTH 90% Unknown diabetes; Osteomyelitis; Anxiety disorder; WAES0809USA00337 Hospitalisation; Diarrhoea; 0 Unknown OTH OTH Unknown Unknown WAES0809USA00805 1 None OTH OTH Unknown WAES0809USA01236 Unknown OTH OTH Unknown Unknown WAES0809USA02521 Unknown OTH OTH Unknown Unknown WAES0809USA02624 Unknown OTH OTH Unknown Unknown WAES0809USA02626
diagnostic laboratory OTH - OTH "Strain" - Result Unknown not reported Down's syndrome; Immunisation; AllergicSkin reaction tagWAES0809USA02630 removal; to antibiotics; Pneumonia Hypersensitivity streptococcal Unknown OTH OTH SYNVISC Unknown WAES0809USA01415 Unknown OTH OTH Unknown Unknown WAES0809USA02766 0 Unknown OTH OTH Unknown Unknown WAES0809USA01447 0 None PVT OTH BONIVA; CRESTOR Drug hypersensitivity; Osteoporosis; WAES0809USA03151 Cholesterol high 0 OTH OTH Unknown Unknown WAES0809USA03172 Unknown OTH OTH Unknown Unknown WAES0809USA03215 Unknown OTH OTH Unknown Unknown WAES0809USA03216 0 Unknown OTH OTH FOSAMAX; CRESTOR Drug hypersensitivity WAES0809USA03819 Unknown OTH OTH Unknown Unknown WAES0809USA01583 Unknown OTH OTH Unknown Unknown WAES0809USA01662 0 Unknown OTH OTH Unknown WAES0809USA03863 1 Diagnostic radiology, OTH for OTH right hand-negative Unknown WAES0809USA03866 Unknown OTH OTH Unknown WAES0809USA01821 0 ultrasound, PVT 09/12/08, left OTH upper extremity Unknown venous Diabetes; doppler Disability; evaluation: Drugnohypersensitivity evidence WAES0809USA01855 of DVT; diagnostic laboratory, 09 Unknown OTH OTH Unknown WAES0809USA01935 1 None OTH OTH Sulfonamide allergy WAES0809USA01945 1 Arteriography PVT 08/29/08,OTH See narrative; Unknown Body temp Peripheral 08/27/08, ischaemia; Embolism 103F; Complete Ulcer Haemorrhage blood WAES0809USA03888 cell 08/29/08, normal; Hemoglo 0 laboratory test, PVT09/18/208, PVTmetabolic AUGMENTIN, panel (normal); coldLEXAPRO, symptoms; WBC Rash; count, mg; Allergic Adverse NASONEX; 09/18/08, reaction reaction slightly SINGULAIR, toWAES0809USA03927 antibiotics elevated mg; PATANASE 0 None OTH OTH PROAIR HFA; Chronic CYANOCOBALAMIN; obstructive pulmonary VERAMYST; disease; WAES0809USA04150 Sulfonamide ADVAIR; SYNTHROID allergy OTH OTH Unknown Asthma WAES0809USA04166 0 Unknown PVT PVT Unknown Penicillin allergy; Reaction to ASPARTAME; WAES0809USA04173 Drug hypersensitivity 0 Unknown OTH OTH Unknown Hospitalisation WAES0809USA04197 Unknown OTH OTH Unknown WAES0809USA04522 0 None OTH OTH Unknown Unknown WAES0809USA04643 4 None OTH OTH SYNTHROID; Drug aspirin; hypersensitivity calcium Penicillin; (unspecified); codeine; sulfa; vitamins WAES0810USA01827 DARVON; (unspecified) DEMEROL; morphine Unknown OTH OTH NEURONTIN; Glaucoma; Glyburide; Headache; LANTUS;Depression; Metformin; WAES0810USA01844 Diabetes ZOLOFT 0 Body temp,OTH 103f OTH Aspirin, calcium Chronic (unspecified); fatigue syndrome; PREMARIN; Hyperthyroidism; PLAQUENIL; WAES0810USA01845 Arthritis; PREVACID; Stress; LEVOXYL Incontine 3 PPD Skin test, OTHpositiveOTH Metoprolol; Gout; Allopurinol; Thalamic Bladder Omeprazole; syndrome; cancerLIPITOR; Gastroesophageal WAES0810USA01854 Amlodipine; reflux Ascorbic disease; acid/vitamin Benign p Unknown OTH OTH LOTREL; Aspirin; Diabetes; FLEXERIL; Low backGLUCOVANCE; pain; Hypertension; WAES0810USA01859 Hydrochlorothiazide; Knee pain MOTRIN; Ny Unknown OTH OTH Unknown Unknown WAES0810USA01995 Unknown OTH OTH Unknown Unknown WAES0810USA01996 Unknown PUB OTH influenza virus vaccineUnknown WAES0801USA02006 2 None OTH OTH Hormonal contraceptives PENICILLINSplenectomy allergy; SULFONAMIDE WAES0810USA02028 allergy Unknown OTH OTH calcium (unspecified) (+)' None vitamins (unspecified) WAES0810USA03065 1 None OTH OTH AMOXICILLIN; Enalapril Hypertension maleate; SIMVASTATIN WAES0810USA02030 Unknown OTH OTH Unknown WAES0809USA04790 2 Unknown OTH OTH albuterol; benazepril Arthritis; Chronic hydrochloride; back pain; CELEBREX; Hyperthyroidism; WAES0810USA02038 PREMARIN; Hypertension; felodipine;Drug hydroch hyp Unknown OTH OTH Unknown WAES0809USA04791 0 None OTH OTH Unknown None WAES0809USA04852 0 Unknown OTH OTH Unknown Unknown WAES0809USA04922 0 None PUB PUB Unknown Unknown WAES0810USA02075 0 None UNK UNK Unknown Unknown WAES0810USA02076 0 Unknown OTH OTH Unknown WAES0809USA04968 0 Unknown OTH OTH Unknown Unknown WAES0810USA02124 Unknown OTH OTH Unknown Asthma WAES0810USA00198 Unknown OTH OTH Unknown WAES0810USA00321 Unknown OTH OTH Unknown WAES0810USA00443 electrocardiogram, UNK Result UNKnot reported; serum potassium, None Result not reported; serum WAES0810USA00448 glucose, Result not reported Unknown OTH OTH Unknown Cardiac disorder; Epilepsy; WAES0810USA00482 Chronic pulmonary heart disea 0 Unknown OTH OTH Unknown Unknown WAES0810USA02125
Unknown OTH OTH Penicillin allergy; Immunisation Allergic reaction WAES0810USA00486 to antibiotics; Sulfonamide allergy 1 None OTH PVT Unknown Unknown WAES0810USA02187 Unknown OTH OTH Unknown Unknown WAES0810USA00524 Unknown OTH OTH Unknown Immunisation WAES0810USA00525 Unknown OTH OTH None Sulfonamide allergy WAES0810USA02394 Unknown OTH OTH influenza virus vaccineUnknown WAES0810USA02479 0 Unknown PVT PVT VOLTAREN EMULGELUnknown WAES0810USA02695 0 Unknown OTH OTH PROTONIX; ALTACE; Unknown ZOCOR WAES0810USA02778 2 diagnostic urinalysis, OTH 10,08/08, OTH positive for nitrites and protein; Unknown negative for leukocytes WAES0810USA02784 and blood; WBC count, 10/0 0 Unknown OTH OTH Unknown Knee arthroplasty WAES0810USA02797 Unknown OTH OTH Unknown Unknown WAES0810USA02891 1 None OTH OTH ALBUTEROL; Asthma ADDERALL TABLETS; NECON; WAES0810USA00547 FLONASE; ADVAIR; SINGUL OTH OTH Unknown Unknown WAES0810USA00645 0 Unknown OTH OTH Unknown Unknown WAES0810USA00701 0 WBC, 21800 PVT PVT Amyl nitrite;COPD GLUCOPHAGE; exacerbation Unknown Paroxetine; Lisinopril WAES0810USA01153 0 Unknown OTH OTH Unknown Unknown WAES0810USA01200 0 None PVT PVT albuterol; LOTREL; Blood pressure aspirin;high; ZYRTEC; Thyroid ARTHROTEC; disorder; WAES0810USA01683 Drug doxepin hypersensitivity; hydrochloride; Pseudoc MAX 2 None PVT PVT None Unknown WAES0810USA01715 0 Unknown OTH OTH Unknown Unknown WAES0810USA01762 0 Unknown OTH OTH Unknown Unknown WAES0810USA01813 0 None OTH OTH Unknown Sulfonamide allergy; Penicillin allergy WAES0810USA03140 1 Unknown PVT PVT Unknown Unknown WAES0810USA03150 1 Unknown PVT PVT Unknown Parkinson's diseases; Osteoporosis WAES0810USA03163 2 Unknown PVT PVT Hypertension; Atrial Gastroesophageal fibrillation reflux WAES0810USA03172 disease; Hyperlipidaemia 0 Unknown OTH OTH Penicillin allergy; Allergic reaction WAES0810USA03232 to antibiotics 0 None OTH OTH None Hypertension; Oesophageal acid WAES0810USA03238 reflux Unknown OTH OTH Rheumatoid arthritis WAES0810USA03312 Unknown OTH OTH Unknown Unknown WAES0810USA03314 3 Unknown OTH OTH Unknown Unknown WAES0810USA03338 1 Unknown OTH OTH Unknown Unknown WAES0810USA03352 1 None OTH OTH Unknown None WAES0810USA03399 0 None OTH OTH Allergic reaction to antibiotics WAES0810USA03401 None OTH OTH None Unknown WAES0810USA03423 0 Unknown UNK UNK Unknown Unknown WAES0810USA03561 3 Unknown OTH OTH Unknown Unknown WAES0810USA03616 Unknown OTH OTH None Shellfish allergy; Latex allergy WAES0810USA03664 0 OTH OTH ATENOLOL; ZOCOR; Unknown thyroid; vitamins (unspecified) WAES0810USA03673 3 Unknown PVT OTH Unknown Unknown WAES0810USA03713 None OTH OTH None Drug hypersensitivity WAES0810USA03803 0 Unknown PUB PUB Unknown Unknown WAES0810USA03858 0 Unknown PUB PUB Unknown Unknown WAES0810USA03859 0 Unknown PUB PUB Unknown Unknown WAES0810USA03865 None OTH OTH Unknown Hypertension; Coronary WAES0810USA04002 artery disease; Osteoarthritis; Gas Unknown OTH OTH Unknown Unknown WAES0810USA04020 0 Unknown PUB PUB Unknown Unknown WAES0810USA04111 2 Unknown OTH OTH Unknown Unknown WAES0810USA04158 1 Unknown OTH OTH Unknown Unknown WAES0810USA04316 Unknown OTH OTH Unknown WAES0810USA04317 0 None OTH OTH Unknown Allergic reaction to antibiotics; SULFONAMIDE WAES0810USA04320 allergy; Hypersensitiv 0 Unknown OTH OTH Unknown Unknown WAES0810USA04324 0 Unknown OTH OTH BISOPROLOL FUMARATE None (+) CYMBALTA; TIZANIDINE WAES0810USA04337 HYDROCHLORIDE
0 OTH OTH Unknown Unknown WAES0810USA04352 1 None PVT PVT Anaemia Family history of cancer; WAES0810USA04363 Progression of prostate cancer; H 2 Unknown OTH OTH Unknown WAES0810USA04371 2 Unknown OTH OTH Unknown Unknown WAES0810USA04374 1 Unknown OTH OTH Unknown Unknown WAES0810USA04396 1 Unknown OTH OTH Unknown Unknown WAES0810USA04401 2 Unknown OTH OTH Unknown Unknown WAES0810USA04477 2 Unknown OTH OTH Unknown Unknown WAES0810USA04478 Unknown OTH OTH Unknown Unknown WAES0810USA04592 Unknown OTH OTH Unknown Unknown WAES0810USA04594 Unknown OTH OTH Unknown Unknown WAES0810USA04685 0 OTH OTH ASPIRIN; LESCOL; METOPROLOL; Hypertension; Cardiac TOPROL WAES0810USA04783 disorder; XL TABLETS; Anxiety;SINGULAIR; Bleeding tende OM Unknown OTH OTH Unknown Unknown WAES0810USA04903 0 None OTH OTH Unknown WAES0810USA04918 0 OTH OTH [therapy unspecified]; Allergy to grains; dietarySulfonamide supplement; allergy; estradiol; WAES0810USA04920 Hypersensitivity FLOVENT; FLONASE; SYNT 0 Unknown OTH OTH Unknown Unknown Unknown WAES0810USA04935 0 Unknown OTH OTH Unknown Unknown WAES0810USA04944 10 Unknown OTH OTH Unknown WAES0810USA05190 1856 Unknown OTH OTH Unknown Unknown WAES0810USA05083 0 None OTH OTH aspirin; calcium Diabetes; (unspecified) Hypertension; (+); insulin, Drug biphasic hypersensitivity; WAES0810USA05120 isophane; Lipids lisinopril; NOS lovastatin; high 0 Unknown PVT PVT Anxiety; Menopause; Irritable bowel Rhinitis syndrome allergic WAES0810USA05159 0 Unknown OTH OTH Unknown Unknown WAES0810USA05164 Unknown OTH OTH Unknown Unknown WAES0810USA05228 0 Unknown OTH OTH Unknown WAES0810USA05286 Unknown OTH OTH Unknown Unknown WAES0810USA05310 0 blood culture, PVT negative;PVT complete blood MAXZIDE; cell, 17,00, Cervical ibuprofen; CBC radiculopathy; levothyroxine count was 17,00 Lumbar sodium; with radiculopathy; the metoprolol; WAES0810USA05337 left shift potassium Depression; (unspecified) Hyperlipid 0 Unknown PVT PVT FLONASE; Hyperlipidaemia; Vitamins (unspecified) Sinusitis WAES0810USA05340 0 None OTH OTH Unknown None WAES0810USA05362 Unknown OTH OTH Unknown Unknown WAES0811USA00039 Unknown OTH OTH Unknown Unknown WAES0811USA00048 0 chest x-ray,PVT 11/07/08, pulmonary PVT fibrotic calciumchanges (unspecified); Drug hypersensitivity; oxygen; Swellingvitamins Lupus (unspecified) erythematosus; WAES0811USA00069 Pulmonary fibrosis; Coug 0 None PVT PVT None WAES0811USA00073 Unknown OTH OTH Unknown Unknown WAES0811USAD0127 3 Unknown PVT OTH LIBRAX capsules, Chronic5/2.5 abdominal Rib mg; fracture; Vitamin pain;Sleep Knee D (unspecified); disorder; pain; WAES0811USA00159 Irritable Kidney Ascorbic bowel stone syndrome; acid; Omega-3 Constip ma Unknown OTH OTH Unknown Unknown WAES0811USA00160 Unknown OTH OTH Unknown Unknown WAES0811USA00161 0 Unknown OTH MIL Unknown WAES0811USA00699 Unknown UNK UNK Unknown Egg allergy WAES0811USA00709 0 Unknown OTH OTH Unknown Unknown WAES0811USA00162 Unknown OTH OTH Unknown WAES0811USA00873 1 Unknown OTH OTH Unknown Unknown WAES0811USA00236 0 Unknown PVT PVT Unknown Unknown WAES0811USA00879 0 Unknown OTH OTH Unknown Heart disease; Stroke Elevated cholesterol; WAES0811USA00900 Atrial fibrillation; Enlarged prosta Unknown OTH OTH Unknown Unknown WAES0811USA00906 0 Unknown OTH OTH Unknown Penicillin allergy; Sulfonamide allergy; WAES0811USA00940 LEVAQUIN; certain drops aller 1 Unknown OTH OTH Unknown Unknown WAES0811USA00238 Unknown OTH OTH Unknown Diabetes WAES0811USA00943 Unknown OTH OTH Unknown Unknown WAES0811USA01068 Unknown OTH OTH Unknown Unknown WAES0811USA00242 Unknown OTH OTH Unknown Unknown WAES0811USA01092 1 None PVT OTH ALBUTEROL; DrugAmitriptyline hypersensitivity; hydrochloride; Asthma; Arthritis PEPCID; WAES0811USA01101 AEROBID; PLAQUENIL;
0 Unknown PVT PVT calcium (unspecified) Arthritis; Bursitis; (+); PREMARIN; Fatigue MOBIC; WAES0811USA00476 omega-3 marine triglycerides; tra 0 None OTH OTH SYNTHROID; Allergic TOPROL reaction XL TABLETS to antibiotics; High WAES0811USA01339 pulse rate 0 None OTH OTH Latex allergy; Iodine allergy; Allergic WAES0811USA00502 reaction to antibiotics; Hypersens 0 Unknown OTH OTH Unknown WAES0811USA00506 1 None PVT PVT albuterol Drug hypersensitivity; SulfonamideWAES0811USA00510 allergy; Allergic reaction to antibio 0 None OTH OTH Unknown Cholesterol high; Blood pressure high; WAES0811USA01345 Lupus erythematosus; Arthritis Unknown OTH OTH Unknown WAES0811USA00542 None OTH OTH None WAES0811USA01387 0 Unknown PVT PVT [therapy unspecified]; Hypertension; TENORMIN; Discomfort LIPITOR; in jointsWAES0811USA00642 hydrochlorothiazide 1 Unknown PVT PVT Calcium (unspecified); Reflux oesophagitis; hydrochlorothiazide Hypertension 25WAES0811USA00643 mg; TOPROL XL TABLETS; PRILO Unknown OTH OTH Unknown Unknown WAES0811USA00651 Unknown OTH OTH Unknown Unknown WAES0811USA01388 Unknown OTH OTH Unknown Unknown WAES0811USA01636 0 None OTH OTH Unknown Cancer WAES0811USA01648 Unknown OTH OTH Unknown Automobile accident; Splenectomy WAES0811USA01664 None OTH OTH None Unknown WAES0811USA02061 0 blood pressure, OTH 11/05/08, OTH130/7 mmHg; Unknown respiratory Drug hypersensitivity rate, 11/05/08, 16 breat; temperature WAES0811USA02120 measurement, 11/05/08, 0 None OTH OTH Diabetes; Drug hypersensitivity WAES0811USA01674 0 None PVT OTH albuterol; SINGULAIR Penicillin allergy; Asthma; Drug hypersensitivity; WAES0811USA02128 House dust mite aller Unknown OTH OTH Unknown WAES0811USA01681 3 Unknown OTH OTH Unknown WAES0811USA01713 Unknown OTH OTH Unknown Unknown WAES0811USA01735 -365 Unknown OTH OTH Unknown Unknown WAES0811USA01826 0 Unknown OTH OTH COUMADINSulfonamide allergy; Cardiovascular WAES0811USA01830 disorder 0 Unknown PVT PVT Unknown WAES0811USA01870 None OTH OTH None Unknown WAES0811USA02060 Unknown OTH OTH Unknown Unknown WAES0811USA02172 Unknown OTH OTH Unknown Unknown WAES0811USA02173 Unknown OTH OTH Unknown Unknown WAES0811USA02271 Unknown OTH OTH Unknown Unknown WAES0811USA02272 Unknown OTH OTH Unknown Unknown WAES0811USA02273 Unknown OTH OTH Unknown Unknown WAES0811USA02309 0 None OTH OTH None None WAES0811USA02318 0 Unknown OTH OTH Unknown Unknown WAES0811USA02329 0 None OTH OTH Drug hypersensitivity WAES0811USA02349 0 None OTH OTH Drug hypersensitivity WAES0811USA02350 None OTH OTH Sulfonamide allergy; Allergy to vaccine WAES0811USA02359 0 None OTH OTH Unknown Unknown WAES0811USA02382 Unknown OTH OTH Unknown Unknown WAES0811USA02543 3 Unknown OTH OTH ALBUTEROL; Asthma; PULMICORT; Seasonal SINGULAIR; allergy MAXALT WAES0811USA02643 0 Unknown OTH OTH FOSAMAX;Hypertension; lisinopril; lovastatin; Lipids increased; potassium (unspecified) Osteoporosis; WAES0811USA02665 Penicillin allergy Unknown OTH OTH Unknown Unknown WAES0811USA02784 0 None OTH OTH None None WAES0811USA02871 None OTH OTH None None WAES0811USA02908 2 None OTH OTH None Asthma WAES0811USA02951 Unknown OTH OTH None None WAES0811USA02985 Temperature OTH measurement; OTH 100 degrees Unknown Hypertension; Raynaud's syndrome; WAES0811USA03043 Arthritis; Hypercholesterolaemi Unknown OTH OTH Unknown Asthma; Chronic obstructive pulmonary WAES0811USA03056 disease Unknown OTH OTH Unknown Unknown WAES0811USA03116 Unknown OTH OTH Unknown Unknown WAES0811USA03416 0 Body temp,OTH 101F OTH ADVAIR; LEVOXYL; Asthma; Graves' NASONEX disease WAES0811USA03461
Unknown 0 Unknown None 0 None Unknown 0 Unknown None 1 None 1 Unknown Unknown Unknown 0 None 0 None 0 Unknown 1 Unknown 0 Unknown 1 Unknown 1 None None 1 None 0 Unknown Unknown 0 Unknown 1 None Unknown 1 Unknown None Unknown Unknown 1 Unknown 1 None 3 None None 0 None 1 Unknown 0 Unknown 0 None Unknown Unknown Unknown 0 Unknown Unknown 0 Unknown Unknown Unknown 0 Unknown Unknown Unknown 2 Unknown 0
OTH OTH OTH OTH OTH OTH OTH PVT OTH OTH PVT OTH PVT OTH PVT OTH OTH OTH OTH PVT OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH OTH PVT OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH PVT PVT OTH
OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT PVT OTH
Unknown
Unknown WAES0811USA03502 Immunosupression WAES0811USA03556 Asthma WAES0811USA03663 FOSAMAX;Hypertension; amlodipine; Thyroid aspirin; Hypercholesterolaemia nodule; ALTACE; Lung ZOLOFT; nodule WAES0811USA03709 ZOCOR Unknown WAES0811USA03726 Unknown Unknown WAES0811USA03758 [therapy unspecified]; Penicillin allergy; PROCARDIA Raynauds; Drug Emphysema hypersensitivity WAES0811USA03825 ECOTRIN, Bronchiectasis; calcium (unspecified), Hypertension; PENICILLIN BONIVA, Osteoporosis allergy; LABETALOL WAES0811USA03827 Iodine allergy; HYDROCHLORIDE, Drug hypersensitiv BE Unknown WAES0812USA00288 Unknown Unknown WAES0812USA00370 Unknown WAES0812USA00525 Aspirin; WELCHOL; Cholesterol TIAZAC; high; Peptic TRICOR; ulcerniacin disease; WAES0812USA00529 Coronary artery disease; Hype ZETIA; hydrochlorothiazide; Coronary artery disease; insulin; ACTOS; Diabetes;WAES0812USA00532 potassium Hypertension; (unspecified) Atrial fibrillation Penicillin allergy; Drug hypersensitivity WAES0812USA00573 Cardiac disorder WAES0812USA01254 Unknown Unknown WAES0811USA03896 LIPITOR Unknown WAES0812USA01580 thyroid Hypertension; Cholesterol; Sulfonamide WAES0811USA03949 allergy; Thyroid disorder; Dru FIORICET with DrugCodeine; hypersensitivity Graves' atenolol; disease desipramine WAES0811USA03950 hydrochloride; LEVOXYL Sulfonamide allergy WAES0811USA03983 Unknown Unknown WAES0811USA03987 Unknown WAES0811USA03990 Unknown Unknown WAES0812USA01584 Aspirin; PRINIVIL; CardiacNiacin murmur; Hyperlipidaemia WAES0811USA04022 Unknown Unknown WAES0811USA04098 Unknown Unknown WAES0811USA04099 Unknown Unknown WAES0811USA04160 Unknown Unknown WAES0811USA04174 Unknown Unknown WAES0812USA01645 Unknown Unknown WAES0812USA00016 Unknown Hyperlipidaemia; Hypertension; Coronary WAES0812USA01762 heart disease; Diverticulitis; Unknown None WAES0812USA00035 Unknown Diabetes; Convulsion disorder; Chronic WAES0812USA01763 fatigue syndrome; Drug hyper OS-CAL, NEXIUM, Hypercholesterolaemia; SYNTHROID, PRAVACHOL Hypothyroidism; WAES0812USA01791 Drug hypersensitivity; Food Unknown Unknown WAES0812USA01792 Unknown Unknown WAES0812USA01793 Influenza virus vaccineUnknown WAES0812USA01802 Unknown Asthma; Penicillin allergy; Allergic WAES0812USA01977 reaction to antibiotics Unknown Unknown WAES0812USA01978 Unknown Unknown WAES0812USA01979 Unknown Unknown WAES0812USA01999 (therapy unspecified); Sinus infection; vitamins Thyroid (unspecified) disorder; Drug WAES0812USA02021 hypersensitivity Unknown Unknown WAES0812USA02078 Unknown Unknown WAES0812USA02327 Unknown Unknown WAES0812USA02079 Unknown Unknown WAES0812USA02089 Unknown Asthma WAES0812USA02094 Unknown Unknown WAES0812USA02104 Unknown Unknown WAES0812USA02109 Unknown Unknown WAES0812USA02110 Unknown Unknown WAES0812USA02135
1 Unknown OTH OTH (therapy unspecified); Hyperlipidaemia; alendronate Sleep sodium; apnoea; citalopram; Osteopenia; WAES0812USA02383 omeprazole; Insomnia; Oesophageal simvastatin; 2 None OTH OTH PROTONIX None WAES0812USA02597 1 Body temp OTH 12/17/08 102F OTH Unknown Unknown WAES0812USA03787 1 Unknown OTH OTH Unknown Unknown WAES0812USA04089 Unknown OTH OTH Unknown Unknown WAES0812USA04095 0 Unknown OTH OTH Unknown Fibromyalgia WAES0812USA04096 Unknown OTH OTH Unknown WAES0812USA04278 3 Unknown OTH OTH Unknown WAES0812USA04279 None OTH OTH Unknown Allergy to vaccine; Hives Egg allergy; Hypersensitivity WAES0812USA04296 0 Unknown PUB OTH Unknown Unknown WAES0812USA04338 Unknown OTH OTH Unknown Unknown WAES0812USA04345 0 None OTH OTH FOSAMAX;Hypertension; ZOCOR Hypercholesterolaemia; WAES0812USA04556 Osteoporosis 0 None OTH OTH ZETIA; COUMADIN Hypercholesterolaemia; CoronaryWAES0812USA04557 artery disease; Aortic valve stenos 0 temperatureOTH measurement, OTH 12/10/08, Unknown 102 Degrees None WAES0812USA04696 1 Unknown PVT OTH Lung cancer stage IV; Allergic reaction WAES0812USA05189 to antibiotics; SULFONAMID Unknown OTH OTH Unknown Unknown WAES0812USA05265 Unknown OTH OTH Unknown Unknown WAES0812USA02772 Unknown OTH OTH Unknown Unknown WAES0812USA02773 Unknown OTH OTH Unknown Unknown WAES0812USA02774 0 Unknown PVT PVT Unknown Peanut allergy; Environmental WAES0812USA03238 allergy Unknown OTH OTH Unknown Unknown WAES0812USA03261 Unknown OTH OTH Unknown Unknown WAES0812USA03345 0 None OTH OTH carisoprodol; Drug NEXIUM; hypersensitivity; gemfibrozil; Sulfonamide SYNTHROID; WAES0812USA03347 allergy CLARITIN; TOPROL XL Table None OTH OTH Chronic obstructive Mastectomy pulmonary disease; WAES0812USA03348 Arthritis 0 temperatureOTH measurement, OTH 12/09/08, Unknown 102 Degrees Drug hypersensitivity WAES0812USA03357 0 None OTH OTH ASTELIN; fexofenadine Hypertension;hydrochloride; Hypothyroidism; fluticasone Tinnitus; WAES0812USA03741 propionate; Latex allergy; SYNTHROID; Food allergy; KLO Io 2 body temp, OTH 12/13/08, 104, OTHFahrenheit Unknown Unknown WAES0812USA03769 0 None PVT PUB Unknown Bronchiolitis; Reactive WAES0901USA00067 airway disease 1 None OTH OTH None None WAES0910USA00145 0 None OTH OTH Unknown Drug hypersensitivity; Meningitis viral Penicillin allergy WAES0901USA00153 Unknown OTH OTH Unknown Unknown WAES0901USA00828 0 None OTH OTH None Wrong vaccine WAES0901USA01300 administered.~Pneumo (Pneum Unknown PVT PVT Unknown Unknown WAES0901USA01573 0 None OTH OTH None Wrong drugWAES0901USA01583 administered~Pneumo (Prevnar)~1 Unknown PVT PVT Unknown Unknown WAES0901USA01937 Unknown OTH OTH Unknown Unknown WAES0901USA01938 Unknown PVT PVT Unknown Unknown WAES0901USA01939 Unknown PVT PVT Unknown Unknown WAES0901USA01940 Unknown OTH OTH Unknown WAES0901USA01996 Unknown OTH OTH Unknown Unknown WAES0901USA02375 0 Unknown OTH OTH Unknown Unknown WAES0901USA02407 1 Unknown OTH OTH Unknown Unknown WAES0901USA02438 None OTH OTH VICODIN; albuterol; Asthma; Drug LIPITOR; hypersensitivity; captopril; carvedilol; Penicillin WAES0901USA02510 ADVAIR; allergy; Sulfonamide LAXIS (FUROSEMI allergy 0 Unknown OTH OTH Unknown Unknown WAES0901USA03048 0 None PVT PVT Unknown None WAES0901USA03163 0 Blood pressure, PVT 01/29/09, PVT130/7; Total Unknown heartbeat Hypertension count, 01/29/09, 76; Temperature WAES0901USA03327 measurement, 01/29/09, 98.2 1 None PVT PUB Calcium (unspecified); Allergic reaction Chondroitin to antibiotics; sulfateDrug sodium WAES0901USA03349 hypersensitivity (+); Lovastatin; Ramipril; Vitam 1 Unknown PVT PVT ALBUTEROL; PULMICORT; Unknown Hormonal contraceptive; WAES0901USA03350 ZOLOFT 0 None PVT PVT Calcium (unspecified); Drug hypersensitivity CELEBREX; PROZAC; WAES0901USA03377 Iron (unspecified); SINGULAIR; C None OTH OTH Unknown Unknown WAES0901USA03452 0 Unknown OTH OTH Unknown Unknown WAES0901USA03520
0 Unknown OTH OTH Unknown Rheumatoid arthritis WAES0901USA03673 0 Unknown PVT PVT Unknown Mixed hyperlipidaemia; Diabetes mellitus; WAES0901USA03820 Gout; Hypertension 0 Unknown OTH OTH Unknown Unknown WAES0901USA03840 0 Unknown OTH OTH Unknown Fibromyalgia; History Short-bowel of diarrhea; syndrome; Rotator WAES0901USA03911 Allergies cuff surgery; to penicillin; ShinglesSulfa; Ne 2 Unknown OTH OTH Unknown PENICILLINGastrostomy allergy; Drugtube hypersensitivity insertion; WAES0901USA04143 Gastrointestinal disorder 3 None OTH OTH Unknown Lung disorder; Cardiac disorder; Arthritis; WAES0901USA04159 Penicillin allergy; Sulfonami 8 None OTH OTH None Type 2 diabetes mellitus; Chronic WAES0901USA04168 obstructive pulmonary disease; Hyp 1 None OTH OTH Unknown Chronic obstructive pulmonary disease; WAES0901USA04200 Cardiac disorder 0 Unknown OTH OTH Unknown Unknown WAES0901USA04309 2 Unknown OTH OTH Unknown Osteoporosis; Osteoarthritis; Iodine WAES0901USA04436 allergy; Hypersensitivity 1 Unknown OTH OTH Unknown Osteoarthritis; Allergic reaction to WAES0901USA04445 antibiotics; Hypersensitivity 0 body temp, PVT 102.9 OTH Unknown Unknown WAES0902USA00017 2 Unknown OTH OTH Unknown RheumatoidNonspecific arthritis; Allergic reaction reaction toWAES0902USA00036 tuberculin to vancomycin, test streptomycin, p 1 None OTH OTH VICODIN; vitamins Sulfonamide (unspecified) Arthralgia; allergy Alcoholism; WAES0902USA00040 Hepatic failure; Adverse drug react 0 Unknown UNK UNK Unknown Unknown WAES0902USA00041 Unknown OTH OTH Unknown Unknown WAES0902USA00044 1 Unknown PVT PVT Unknown None WAES0902USA00045 0 Unknown OTH OTH estrogens (unspecified), Sulfonamide vitamins (unspecified) allergy WAES0902USA00061 0 Unknown OTH OTH Unknown Hospitalisation WAES0902USA00187 3 None OTH OTH ALBUTEROL; Asthma; Calcium Drug Dermatitis gluconate; hypersensitivity atopic CELEBREX; WAES0902USA00459 PREMARIN; ADVAIR; ATROV 1 Unknown PVT PVT Unknown PneumoniaUnknown WAES0902USA00588 0 Unknown PVT PVT Unknown Bronchitis Unknown WAES0902USA00853 0 Unknown OTH OTH Unknown Unknown WAES0902USA00953 0 Unknown OTH OTH Unknown Unknown WAES0902USA01462 Unknown OTH OTH Unknown Unknown WAES0902USA01664 0 Unknown PVT PVT Unknown Hypertension; Hypothyroidism; Hypercholesterolaemia WAES0902USA01696 Unknown OTH OTH Unknown Unknown WAES0902USA01697 Unknown OTH OTH Unknown Unknown WAES0902USA01706 Unknown OTH OTH Unknown WAES0902USA01832 2 Unknown PVT PVT Unknown Unknown WAES0902USA02181 0 None PVT OTH hormonal contraceptives Sinusitis recurrent; Sulfonamide allergy; WAES0902USA02382 Allergic reaction to antibiotics 1 Unknown OTH OTH Unknown Arthritis; Scoliosis; Hypersensitivity WAES0902USA02406 Unknown OTH OTH Unknown Unknown WAES0902USA02686 Unknown OTH OTH Unknown Unknown WAES0902USA02934 0 None PVT PVT aspirin; PREMARIN; Mitral valve ZETIA; prolapse; PREVACID; Lipids NOS NASONEX; WAES0902USA02973 high; Diverticulitis; NIASPAN;Irritable DITROPAN bowel sy 0 Unknown PVT PVT Sulfonamide Stent allergy; placement Terazosin allergy; WAES0902USA03742 Hyperlipidaemia; Hypertension 0 Unknown OTH OTH Unknown WAES0902USA03983 1 None OTH OTH Unknown Polycythaemia; Phlebotomy WAES0902USA04040 138 None OTH OTH CYMBALTAHypothyroidism Depression; Breast cancer WAES0902USA04076 0 Unknown OTH OTH Unknown Unknown WAES0902USA04437 0 None PVT OTH TRICOR; MICRO Hypercholesterolaemia K WAES0902USA04524 0 Unknown OTH OTH BENICAR, PROTONIXUnknown WAES0902USA04569 0 Unknown OTH OTH diuretic (unspecified), hormonal Unknown contraceptives WAES0902USA04573 1 None PVT PVT Unknown None WAES0902USA04600 Unknown OTH OTH Unknown Unknown WAES0903USA00003 0 None OTH OTH ASPIRIN; DIAZIDE; PENICILLIN Levothyroxine allergy; Drug sodium; hypersensitivity WAES0903USA00065 ZOCOR 0 None OTH OTH Influenza virus vaccineUnknown WAES0903USA00082 Unknown OTH OTH Unknown Unknown WAES0903USA00278 0 Physical examination, PVT 02/10/09, PVT normal; Unknown Blood Polycythaemia; pressure,Hernia 02/10/09, Gastroesophageal repair 110/70; Blood WAES0903USA00443 reflux pressure, disease; 02/10/09, Irritable130/80; bowel synd Tota Unknown OTH OTH Unknown Unknown WAES0903USA01102 3 OTH OTH Glucosamine; Naprosyn; None Saw palmetto; Vitamins WAES0903USA01420
Unknown Unknown 0 Unknown 1 None 0 Unknown 0 Unknown 4 Unknown 0 Unknown 1 None 0 Unknown Unknown Unknown Unknown 0 Unknown 0 Unknown Unknown Unknown Unknown Unknown 2 None 2 None 1 None None 0 None 4 None 0 None 0 None 0 1 Unknown 0 Unknown Unknown 0 Unknown 0 Unknown 0 Unknown Unknown 1 Unknown 0 Unknown 1 None Unknown Unknown Unknown 0 Unknown 4 Unknown 0 Unknown 0 Unknown 0 None 0 Unknown 1 Unknown 0 Unknown 1 Unknown -1 Unknown
OTH OTH PVT PVT UNK OTH OTH OTH PVT PVT OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH UNK PVT PVT OTH PVT PVT PVT OTH OTH OTH OTH UNK OTH OTH OTH MIL OTH PVT OTH OTH OTH OTH OTH OTH
OTH OTH PVT PVT UNK OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH UNK OTH PVT OTH PVT PVT PVT OTH OTH OTH OTH UNK OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH
Unknown Unknown WAES0903USA01608 Unknown Unknown WAES0903USA01623 Unknown Drug hypersensitivity; Oesophageal WAES0903USA02278 reflux; Hypertension; Venous insu ASPIRIN; SYNTHROID; Diabetes; Hypertension; QUINAPRILHypercholesterolaemia; HYDROCHLORIDE; WAES0903USA02295 RANITIDINE Hypothyroidism. Unknown Diabetes; Hyperlipidaemia; Hypertension WAES0903USA02434 Unknown Unknown WAES0903USA02557 Unknown Unknown WAES0903USA02865 CLINORIL Arthritis WAES0903USA02960 BENADRYL; Hypertension; SYNTHOID; Lung Chronic SINGULAIR neoplasm obstructive malignant WAES0903USA03208 pulmonary disease; Hypothyroidism Unknown Unknown WAES0903USA03612 Unknown Unknown WAES0903USA03623 Unknown Unknown WAES0903USA03641 Unknown Unknown WAES0903USA03649 Unknown Unknown WAES0903USA03650 Unknown Unknown WAES0903USA03655 Unknown Unknown WAES0903USA03944 Unknown Unknown WAES0903USA04218 Unknown Unknown WAES0903USA04219 Unknown Unknown WAES0903USA04220 Unknown Unknown WAES0903USA04244 Unknown Unknown WAES0903USA05142 Albuterol Allergic reaction to bee sting; Allergic WAES0903USA05498 reaction to antibiotics, Drug hyp XANAX Penicillin allergy; Allergic reaction WAES0904USA00034 to antibiotics Albuterol Immunodeficiency Pneumonitis common variable; WAES0904USA00220 Sulfonamide allergy YAZ, SINGULAIR, Drug hypersensitivity propranolol Pneumonia hydrochloride,WAES0904USA00258 VALTREX None WAES0904USA00577 Azithromycin Asthma; Penicillin allergy; Blood pressure WAES0904USA01355 high; Migraine; Cardiac diso docusate sodium; Diabetes; LOVENOX; Hospitalisation; FLONASE; Pneumonia MUCINEX; WAES0904USA01566 LEVEMIR; ATROVENT; CL Unknown Sinus congestion; Drug hypersensitivity; WAES0904USA02040 Diabetes ESTRADIOL; Drug Hydrochlorothiazide; hypersensitivity; Type GLUCOPHAGE; 2 diabetes WAES0904USA02058 mellitus; NAPROXEN; Nausea; ACCUPRIL Rash; Hyp Unknown Unknown WAES0904USA02253 aspirin; calcium Type(unspecified); 2 Diabetes mellitus; TRICOR; Hypertension; PRAVACHOL; WAES0904USA02733 Hyperlipidaemia vitamins (unspecified) aspirin; ASTELIN; AllergicSYNTHROID reaction to antibiotics; Nausea; WAES0904USA02734 Vomiting; chronic obstructive p Unknown Unknown WAES0904USA02780 Unknown Unknown WAES0904USA02893 ASTELIN, WELLBUTRIN, Migraine; SinusLEXAPRO, infection ALLEGRA-D, WAES0904USA03163 ZOFRAN, PROTONIX Glimepiride;Immunoglobulins HUMALOG; Recurrent GLUMETZA; decreased; infection CRESTOR Diabetes; WAES0904USA03182 Hypercholesterolaemia; Drug Hospitalisation; Pneumonia WAES0904USA03405 Unknown None WAES0904USA03422 Unknown Unknown WAES0904USA03586 Unknown Unknown WAES0904USA03813 Unknown Diabetes WAES0904USA03823 Unknown Unknown WAES0904USA03974 Unknown Drug hypersensitivity; Hypersensitivity; WAES0904USA04192 Fruit allergy; Allergy to nuts; R Unknown Unknown WAES0904USA04343 ENBREL; SYNTHROID Rheumatoid arthritis; SulfonamideWAES0904USA04462 allergy None Hypersensitivity; Convulsion; Pancreatic WAES0904USA04500 disorder TYLENOL; BENADRYL Unknown WAES0905USA00187 hormonal contraceptives None WAES0905USA00215 Unknown Depression WAES0905USA00359 Unknown Immunisation WAES0905USA00375
0 Unknown PVT OTH Unknown Unknown WAES0905USA00444 1 Unknown OTH OTH TYLENOL; BENADRYL Unknown WAES0905USA00491 0 Unknown OTH OTH LIPITOR; ZYRTEC; Diabetes;glucosamine; Drug hypersensitivity lisinopril; metformin WAES0905USA00504 0 None PVT PVT Unknown None WAES0905USA00509 1 None OTH OTH None None WAES0905USA00517 0 Unknown UNK UNK EPIPEN; XYZAL; Rhinitisphentermine allergic; Cough; Drug Nasal hypersensitivity; congestion WAES0905USA00546 Pruritis; Dermatitis allergic; Upp 0 Unknown PVT PVT Unknown Unknown WAES0905USA00663 0 Unknown PVT PVT Unknown Unknown WAES0905USA00664 0 Unknown PVT PVT Unknown Unknown WAES0905USA00665 0 Unknown PVT PVT Unknown Unknown WAES0905USA00666 0 Unknown PVT PVT Unknown Unknown WAES0905USA00667 0 Unknown PVT PVT Unknown Unknown WAES0905USA00668 2 Unknown OTH OTH TYLENOL, Chronic Z-PAK, BENADRYL cough WAES0905USA00697 0 Unknown PVT PVT Unknown Unknown WAES0905USA00669 0 Unknown OTH OTH Unknown Unknown WAES0905USA00962 0 Unknown PVT PVT Unknown Unknown WAES0905USA00670 1 None OTH OTH Unknown Unknown WAES0905USA01065 Unknown OTH OTH Unknown Unknown WAES0905USA01086 0 Unknown PVT PVT Unknown Unknown WAES0905USA00671 0 Unknown PVT PVT Unknown Unknown WAES0905USA00672 Unknown OTH OTH Unknown Latex allergy WAES0905USA01282 Unknown OTH OTH Unknown Unknown WAES0905USA01415 0 None OTH OTH Unknown Unknown WAES0905USA01468 0 Unknown PVT PVT Unknown Unknown WAES0905USA00673 Unknown OTH OTH Unknown Unknown WAES0906USA01560 0 OTH OTH Unknown WAES0905USA01941 0 Unknown OTH OTH Unknown Unknown WAES0905USA02311 0 Unknown PVT PVT Unknown Unknown WAES0905USA00674 2 None OTH OTH None Sulfonamide allergy; Penicillin allergy; WAES0905USA04069 Food allergy 1 None OTH OTH Unknown Hospitalisation Surgery WAES0906USA00003 1 OTH OTH Advair Asthma, Colitis WAES0906USA00104 0 Unknown PVT PVT Unknown Unknown WAES0905USA00675 Unknown OTH OTH Unknown Unknown WAES0906USA00127 0 Unknown PVT PVT Unknown Unknown WAES0905USA00676 0 Unknown PVT PVT Unknown Unknown WAES0905USA00677 0 Unknown PVT PVT Unknown Unknown WAES0905USA00678 0 Unknown PVT PVT Unknown Unknown WAES0905USA00679 0 Unknown PVT PVT Unknown Unknown WAES0905USA00680 0 Unknown OTH OTH Unknown Unknown WAES0905USA00686 0 Unknown OTH OTH Unknown Unknown WAES0905USA00993 diagnostic laboratory, OTH negative OTH titers Unknown to MMR Unknown WAES0908USA00374 0 Unknown OTH OTH Ibuprofen Vaccination adverse reaction; WAES0908USA00060 Aura; Blindness; Anxiety; Pe 31 Described in MIL HPI narrative. MIL 8/14/09 None Medical at the records None time received None.1/27/1986 8/14/09 Medical to 8/3/09. records LABSreceived and DIAGNOSTICS: 1/27/1986 to EMG 8/3/0 1 Done in hospital. PVT 8/12/09 UNK HospitalCLARITIN; records received none SINGULAIR DOSAsthma; 7/12/09 MEDS:Seasonal to Septra, 7/14/09. 8/12/09 allergies. LABSHospital and 8/12/09 DIAGNOSTICS: records Hospital received records Perpheral DOS rece7 8 Visit with Dr. PVT ENT one UNK week later. 8/11/09 8/11/09 Otolaryngology Otolaryngology None Hypertension; consult consult records records deafness~Zoster GERD; received received Atherosclerosis; DOS DOS (Zostavax)~1~84~Patient 2/05/02 2/05/02Arthritis. to to 7/21/08. 7/21/08. 8/11/09 Atenol LABS O None PVT PVT None None 8 PVT PVT No Febrile seizure seizure~Vaccine not specified (no brand name) (-) varicella PVT - viral swabUNK from lesion None Myeloproliferative Dz; Increased lipids; Depression; HTN; T 2 OTH PVT Unknown None None 3 PVT UNK None 1 None PUB PUB None None Capillary hemangioma
1 PVT PUB NKDA 5 PVT OTH none none 0 PUB UNK Wheat sensitivity; MoldIA090012 allergies; Tree pollen 0 PVT UNK None 4 UNK OTH OTH Unknown 10/5/09 Medical records A0800503A received w/PMH: left clavicle fx at 0 UNK PVT OTH Unknown Concomitant vaccines,A0800582A medications and relevant medical h 2 PVT PVT HMV 2 PVT PVT 1 None PVT PUB None None None 0 OTH PVT Advair; Pentoxifylline; Chronic bronchitis, Combigan Allergiesno toClaritin; acute codeine, illness Combigan chronic bronchitis, glaucoma. 0 None PUB UNK Calcium; Vitamin D None None PVT UNK None 2 PVT PVT Patient is allergic to fish and beans. ### 1 OTH UNK None None 1 PVT UNK None Esophageal reflux 1 OTH PVT None 1 PVT PVT TYLENOL prior Noneto vaccinations. Preterm (35 weeks); NKDA 0 None PVT PUB None None None None PVT PUB None None None Over vaccination~Varicella (no brand name)~1 1 PVT PVT Patient has a history of allergies. ### Complete negative PVT septic PUB work up None 4 OTH PUB None None None 0 PUB PUB None None 2 None PVT PVT Claritin; Tylenol Allergic Rhinitis None Erythema edema~Vaccine not specified (no bra 0 None PUB PVT No illness DM2 0 PUB PUB Tuberculin PPD, 84839, Allergic RFA, 3conjunctivitis; previous doses Allergic rhinitis 1 PVT PVT PPD, C3059AA, R arm, 1 previous dose 1 None PVT PVT None None 2 CBC -WNL-PVT UNK 1 PVT UNK 1 PUB UNK Infected insect No bites 1 PVT PVT Depakote None Seizure disorder all -Tegretol (hives) MIL MIL PVT PUB None PVT PVT None None None 1 UNK UNK Pt. was he for PVT ZOSTAVAX PVT vaccine - none None DM, Hearing loss, Arthropathy. 1 PVT PVT 0 None PVT PVT None ERYTHROMYCIN allergy N/A PVT OTH None None Unknown 0 PVT PUB DDAVP 1 degree Nocturnal Enuresis 5 CRP, 1.032MIL (H), 22 Jul,MIL now normal; none LDH, 894 none (H), 28 Jul; ankylosing ALT, 237spondylitis (H), 24 Jul, 137 on 28 Jul; AST, 276 (H), 22 Ju Unknown OTH OTH Unknown Hypersensitivity WAES0806USA02901 1 No PUB OTH No No 1 PVT PVT No PVT PUB 1 None PVT PVT None None None 1 NA PVT PVT NA NA NA 0 NONE PUB PUB NONE NONE 18 none notedMIL MIL None notedNone noted 0 PS OX = 100% PVT Blood glucose UNK = 79mg All. Rhinitis
0 PUB PUB Unk None None 3 None yet. CBC UNK and diff PUB ordered. Ibuprofen, Tylenol Not apparent History but viral of Ovarian illness with Cyst,high Dysmenorrhea,Enviromental temp going around other stude Aller 21 PUB PVT None known None reported None reported 812 CT scans, MRI's, UNK Visual UNK Evoked Potential Imipramine: test, none 25 eeg, mg.sleep-deprived daily, ADD, Lipitor:10 familial eegs, mg. typespinal daily 2 hyperlipidimia. tap, video electronystagmography, 8/20/09 ER records re 1 PVT PVT Claritin None 1 UNK UNK none allergies:sulfa drugs, penicillins, morphine Medical: MS, 379 UNK UNK COPD 494 UNK UNK COPD 468 UNK UNK COPD 231 UNK UNK COPD 1 PVT PUB Prilosec no none known 90 UNK UNK COPD 2 None PVT PUB Zantac None None 45 UNK UNK COPD UNK UNK COPD 7 no tests done UNK UNK none none none 0 none PUB PUB Prozac, Adderall, none Topamax ADDHD, Migraines, and History of seizures as infant, 1 PVT PVT None Diabetes 1 UNK UNK none none 1 None PUB PVT Lissinopril none none 1 MIL MIL No mom states pt allergic to artificial preservatives. 0 PVT UNK none seasonal allergies unknown UNK UNK 0 none PVT PVT none none none 0 blood pressure, OTH 05/31/08, OTH104/6; serum FOSAMAX; C-reactive Arthritis; PRILOSEC; protein, Gastrooesophageal Herniated trazodone 05/31/08, disc; 0.06 hydrochloride; Wrist mg/dl; reflux surgery; WAES0807USA02924 disease; erythrocyte, RETIN-A De Sleep Quervain's 05/31/08, apnoea; tenosynovitis 16 Osteopen mm/hr; 0 Unknown OTH OTH Unknown Unknown WAES0810USA04593 0 None PVT PVT Asthma; Cholesterol Pneumoniahigh; Type 2WAES0812USA00052 diabetes mellitus; Arthritis; Penic 0 None OTH OTH Ambien None WAES0812USA02349 7 UNK. 10/2/09 PVT Hospital PVT records, DC summary,Unknown received DOS There 7/16/09 were no to 7/17/09. reportedA0799191A LABS concomitant and DIAGNOSTICS: medications orUltraso releva 0 Body temperature, PVT Jul2009, PVT 99.6 Unknown A0796973A 1 UNK PVT PUB Ranitidine hydrochloride Gastro Esophageal Reflux A0797376A OTH OTH Unknown The subject's medical history A0797394A was unknown. UNK OTH OTH Unknown A0798920A UNK OTH OTH Unknown A0798921A 0 UNK PVT OTH No concurrent Unknown medication The subject had no adverse A0799188A events following previous vac 24 no tests were PVT done. I couldn't PUB get her back in none to the dr. They nonewere over shebooked had a bad andreaction couldn'tto see vaccine~Varicella her (no 0 Uvula slightly PVT swollen initially. UNK Pulse/oxygen Singulair, Advair, rate None normal. Flonase Extremely Blood used pressure daily. allergic ProAir normal. (still--at inhaler Temperature 14 and yrs old) Allegra to normal. milk taken andonly eggas prote ne 0 PVT PUB NOne None NOne 0 blood work UNK stool culture UNK spinal tap eeg xray allnone normal. 9/21/09 none. 9/21/09 HospitalHospital records records receivedreceived DOS 8/3/09 DOSto8/3/09 8/5/09. to LA 8/5 1 Comprehensive UNK metabolic, UNKDNA, infectious, None and None. chemicalNone. bloodBabesiosis testing, echocardiogram, (babesia duncani). CT scans, 8/11/09MRI's, Cardiology heavycm 3 PVT PUB 1 PUB PVT n/a none none PATIENT WENT PVT TO CHINA PVT FOR MEDICAL WORK UNKNOWN UP UNKNOWN PVT UNK pulmicort, prevacid no asthma, eczema, multiple food allergies, GER 1 8/21/09 Psych/Autism UNK consultation UNK none records received none DOSnone 9/12/07. LABS socialand withdrawl/speech DIAGNOSTICS: delays/conitive Autism Diagnostic delays~ O 0 PVT UNK none 1 PUB PUB Eczema 0 Vital signs, PUB within normal PUB range None None None 3 UNK UNK Allergra halfNo tspillness. 2x a day Illness allergies; (5ml)and at time milk, hives baby of soybean, immunization: or Vitamin rashes wheat, drops all over Child eggs, 1.0ml her given nuts,sesame once bodymilk aexcept day product seed, her fac acf Unknown OTH OTH Unknown Unknown WAES0908USA00379 29 Unknown. 8/24/09 OTH Hospital OTH records received DOS Pregnancy 7/23/09 8/24/09 NOS to 8/10/09. (LMP Hospital = LABS 5/1/2009) records and WAES0908USA00387 DIAGNOSTICS: received DOS 7/23/09 Ultrasound to 8/10/09 - Preg
Unknown OTH OTH Unknown Unknown WAES0908USA00562 1 echocardiography, PVT 10/25/07, OTH traceZYRTEC; tricuspid regurgitation; LEXAPRO; Infected toe; ZANTAC Tonsillectomy. electroencephalopathy, Sulfonamide allergy; 9/15/09WAES0907USA02626 Allergic Neurological 10/25/07, reaction short consult tobursts antibiotics; records of left receiv Seas tem 107 electroencephalography, OTH OTH 05/05/09, abnormal; magnetic resonance, None. 8/12/09 05/12/09, PCP records right WAES0908USA00064 frontal received matter DOS hyperintensity. 6/16/08. Torn8/2 A 11 Unknown OTH OTH BUSPAR; PROZAC; Hypothyroidism levothyroxine sodium WAES0908USA00613 152 cardiac exercise, UNK showed UNK she hadAZOR a slight heart Blood attack; pressure hematology, high; Sulfonamide showed she WAES0908USA00359 allergy had a slight heart attack 29 computed axial, UNK 07/25/09, UNKnegative; ECOTRIN; electrocardiogram, Gastrooesophageal LIPITOR; PLAVIX; 07/29/09,ACIPHEX; reflux negative disease vitamins WAES0908USA00349 (unspecified) Unknown OTH OTH albuterol; XANAX; Reflex sympathetic ELAVIL; Bronchiectasis FLEXERIL; dystrophy; ADVAIR; Allergic WAES0908USA00602 RELAFEN; reaction to NASACORT antibiotics; Sulfonam 39 beta-humanPVT chorionic, OTH home pregnancy Unknown test; Pregnancy beta-humanAbortion NOS chorionic, (LMP spontaneous =home Unknown); pregnancy WAES0803USA00547 Cardiac test;murmur serum varicella zoster, 0 0 PVT PVT History of autism and speech ### delay. 0 PVT PVT History of autism and speech ### delay. 0 O2 Sats monitored. PVT PVT ZYRTEC; albuterol none used allergies. prn (eggs; p-nuts) 9/14/09 Hospital records received 0 None PVT PUB BENADRYLTakes BENADRYL Otitis Media for "red X 2 eyes". by age 9 mo. PVT UNK 3 EMG reveals OTH a sensoryPUB peripheralCLARITIN; neuropathyNone LIPITOR; Labs andFLONASE; Allergies, diagnostics: Arthritis, BENADRYL EMG Asthma, abnormal. Migraines Protein PMH: electrophoresis dyslipidemia, WN 195 None PVT PVT None 35 OTH PVT Lisinopril; QVAR 0 PVT PVT 3247 PUB OTH Unknown Unknown Unknown 3 CBC done at PVT 8/3 visit. UNK Diaper rashDiaper medication, rashHxNYSTATIN 1 Bro crib Rash~DTaP death HC1%1 Zinc wk(no after oxide brand DTAP. name)~UN~0~Sibling|R 1 None PUB UNK None None reported 1 PVT UNK None None 0 OTH PVT None None None 1 Strep (-); Flu PVT (-) PVT 0 None OTH PUB PNEUMOVAX Pain0.8 in right ml DM; knee; NKA DM None PVT PVT None None None 0 PUB PUB None None 0 Head CT Scan; PUB Head MRI; OTH EEG; Neurology consult; None Cardiology Previousconsult. history of fainting episodes 8 None OTH PVT Unknown but None no medications Unknown that- but would no interact contraindications w/vaccine.to ZOSTAVAX. 0 PVT OTH None None None 0 None PVT PVT None None 1 PVT PUB 3 PVT PVT TYLENOL; None None 1 PVT PVT none 0 PUB PUB CT of her head UNKwas negative UNK for subdural hematoma, EKG healthy was NSR 12 year old female 0 OTH OTH None None Penicillin; sulfur based antibiotics. 1 None PUB PVT None None 2 None PUB PVT ALBUTEROL Inh (pen) 3 PVT PVT None 2 None PVT PVT None None 2 ECG, ne MIL MIL BACTRIM Had mild cellulitis Exercise of induced leg asthma 1 NONE UNK UNK NONE NONE SC0918 0 n/a UNK UNK n/a No illness reported NKA 0 none UNK UNK none no Past medical History of epilepsy, but no seizures or meds 0 UNK UNK none KS200910 0 Vitals and neuros PUB within PUB normals limits; unknown no pain none redness or none injury noted on exam of scalp. 0 PUB PUB none known-just bug bites 2 LEFT ARM UNK INDURATION UNKAFTER IMMUNIZATION NONE NONE 0 None PVT PVT Ranitidine GER None 0 PVT UNK 0 PVT UNK
1 UNK UNK Advair 250/50 None Asthma 1 UNK PUB on Keflex for had bronchitis possible Asthma and bronchitis albuterol went inhaler to doctor for asthma for 9 days prior, got antibitic for 0 PUB PUB egg allergy 2 PUB PUB Prenatal vitamins none (pt. postpartum) wellbutrin allergy 0 none PVT PVT none none none 0 none UNK UNK zantac; premarin; none lisnopril asthma (with water none~ pill); ()~NULL~~In allegra; nasonex; Patientazmacort; pro air 75 MIL MIL NA UNK PUB Tylenol none small perimembranous VSD 0 Echo, spidometry PUB test PVT I was recovering Allergyfrom to penicilline, a mono virus. sulfaI was drugs. diagnosed with mono on Ju 15 PVT PVT 0 UNK UNK antibiotics s/p mildwisdom URI with None tooth runny extraction nose for5 one daysday. prior. I don't know what they are as 0 PVT PUB None None Allergic to medications: Cefzil & Naldecon 1 none PUB PUB none none none 2 PUB PUB Cymbalta none none 8 NONE PVT PVT Zyrtec only seasonal beta allergies thalassemia minor Diagnostic Results: OTH 30 OTH November TOPIRAMATE 2001: Non HEADACHE Contrast CT of the Brain: Normal study. A0632485A 11 August 2003: Right ribs U 1 Normal WBC. UNK 8/27/08 UNK Hospital records received DOS 8/5/09 8/27/08 8/6/09. Hospital LABSrecords and DIAGNOSTICS: received DOS 8/5/09 CAT Scan 8/6/09. L Shou Con 1 PUB PVT ZOLOFT; CLARITIN No No 6 None MIL MIL None None NKDA; No birth defects; No active medical illnesses 2 PUB PVT None No NONE slight redness~Varicella (no brand name)~1~5~ 1 None PUB PUB None None None KS200909 0 EKG, PulsePVT ox, blood glucose PVT None None None Stool CX - PVT PVT 1 PUB PUB None ADD?; Speech problems 16 2/20/2009, MIL HSV1, AbIgG MILpos; HSV2, None AbigG neg; NoneVZV, AbIgM None 1.13 (pos); VZV, AbIgG 1.49 (pos); 2/20/2009 Tissue 9 PVT PVT None None None 0 None PVT UNK None None 0 None PVT OTH None None 1 None PVT PVT None None Rash/fever~Measles + Mumps + Rubella (no b 10 PVT PVT None 5 PUB PUB 5 PUB PUB 2 PVT PVT MultivitaminNone Allergic to AMOXIL and CEFZIL - hives 2 PVT OTH Albuterol, RHINOCORT; None in nurse Allergies Omeprazole; summary to ADVAIR, Simvastatin; Ibuprofen, RedPERCOCET, Yeast Rice; Fish PARAFON oil; Calc F 0 None PVT UNK None Asthma; severe allergic reaction to all nuts; tree nuts; seed 1 PVT PUB ZURTEC Otitis media-resolved; Allergic Rhinitis; Conjunctivitis 0 None PVT PVT No No 1 None PVT PVT Constipation None 0 BP 101/55; PUB P69 PUB None Reported None reported None reported 0 PVT PVT None None None 1 None PVT PVT None None None 1 None PVT PUB None Autism 1 None PUB OTH none @ time None of inj per Allergies; mom or 1 Asthma wk prior or previous. visual acuityOTH test, was told OTHno vision acyclovir; in her left COSOPT; Herpes eye virus prednisolone infection; Glaucoma WAES0907USA05691 55 chest X-rayOTH 01/16/08, unremarkable; OTH KUB X-ray, 01/16/08, Premature negative,baby; Fall, no free irritability, Diarrhoea; airWAES0908USA00771 or foreign laceration Fungal body, dermatitis; of face, no intestinal Otitis Circumcisio media, dilatio 6 None PVT PVT None Known 6 9/8/09 Hospital PVTrecordsPVT received DOS 7/31/09None to 8/1/09. Milk, LABSegg, andpeanut DIAGNOSTICS: and soy allergies; BP 121/81 eczema. mmHg (H) Apical H 0 PVT PVT None Eczema Eczema Will do Yellow PUB Fever titer PVT in one month None Sulfur; Milk 1 PVT OTH None No No 1 None PVT PVT FLONASE Cold the week Celiac prior disease; ( resolved Faceallergic swelling~ per parents) rhinitis. ()~UN~0~Patient
1 9/17/09 Hospital PVT records PVT received TYLENOL DOS 8/9/09No toillness 8/11/09.None LABS9/4/09 and DIAGNOSTICS: Received medical CTrecords Head - w/PMH: Unremarkable. Family MR hx 1 None PVT PUB None None 0 None PVT PVT None None 0 PUB PUB None Tremors - unknown Iteology. 1 None PUB OTH TOPROL XL; Laceration FENTANYL of High forearm patch Blood25 (RT) pressure; mg Severe lumbar spine scliosis + DJD 2 OTH PVT TRICOR 45NONE mg; CRESTOR NKDA;10DM mg(250.01) ICD-9 3 OTH UNK None 24 None MIL MIL None None 0 None PUB PUB None None None 0 Head CT, negative PVT in ER PVT None 0 None PUB PUB None None None 5 UnavailablePUB - Mother reports PUB child eval. for Lyme None diseaseNone - Tick site the end of June or early July. 0 PVT PVT Hematuria Vasodepressor Syncope 1 None PVT PVT None None None None~ ()~~0~Patient 1 PVT PVT None None ~Varicella (no brand name)~2~7~Sibling 3 ESR - 60; nl PVT CBC PVT None Appendectomy 17 d before. 1 None PVT UNK None None 1 PVT PVT None None 1 PVT PVT None None 1 None Known PUB PUB None Known None Known None Known 2 CBC; sed rate PVTchecked; PVT mono test; LEXAPRO-20mg; Lymes disease; abdominal VYVANSE-30mg; allergicultrasound. to mites, YAZ molds, Labs and agedDiagnostics: cheeses. PMH: EEGADD, WNL.Anxie Na+ 1 negative; N/A PVT PUB 0 OTH OTH None None 7 None PVT PVT KEFLEX; CELEXA; Skin D/O;Lisinopril; Electrolyte/fluid NKDA; Hyperlipidemia; HLCTZ 20/25mg; HTN; MEDOTAR; Arthritis; KLOR-CON; Back pain MOBIC 1 None PVT PUB None 1 PUB PUB ALBUTEROL None INHALEN Astha Hx; Pneumonia; UTI 0 PVT PVT None Asthma 20 WBC 7,170;PVT Blood cultures PVT had no growth. 0 None MIL OTH None None ~Anthrax (no brand name)~3~32~Patient|~Anth 1 PVT OTH 1 None PVT UNK None None 0 UNK UNK None None 1 MIL UNK None None 0 PUB PUB 2 PVT PVT celebrex prn, synthroidallergic 88 mcgto vicodin 0 Mild cellulitis UNK UNK None None None 1 none. 10/6/09 UNK PCP medical UNK records none 2/10/02 to none 9/09/09. reported LABS none. and 10/6/09 DIAGNOSTICS: PCP medicalEEG records - Abnormal. 2/10/02 to CT9/09/09. Brain - No Su 1 CBC, Strep,PVT and urine PVT all WNL none 2 latest lab values UNK done 8/10/09 UNK were bcps within normal here limits for a follow-up except depression/anxiety/panic forexam neut%73.9(H) and attacks lymph%20.1(L) 1 None PUB PUB Tylenol No No 0 None PVT PVT Flouride drops, None. triamcinolone No fever, Kawasaki URI cream syndrome symptoms, None~ ()~NULL~~In diagnosed GI symptoms. 3/2007. Patient|None~ Urticaria ()~NULL~~ pigmento 0 UNK UNK BCP, Clonozepam none Latex allergy 1 PVT PVT Aspirin 80mg Pt daily, in office Multivit for NKDA HME. daily;Ongoing Omeprazole probs20mg include delayed recurrent release left sided daily chest 1 UNK UNK None IBS, Migraine HA 2 None PVT UNK Tylenol for fevers None None 1 UNK UNK Yaz, albuterol. noneVaccine lactose givenintolerance was Adacel from Sanofi Pasteur 0 PVT PVT Yasmin. Qvar. Albuterol. Amoxicillin. Asthma. 0 UNK UNK Fainting~DTaP + IPV (KINRIX)~1~5~Patient 0 PVT PVT lessina-28, none sertraline, singulair, Depression, zolpidem, migraines, zyrtec, UTI, Proair asthma 1 UA done through PVT the clinic PUB none none none hives~Pneumo (no brand name)~2~1~In Patien 4 PVT UNK none no none Arrythmia, Rapid Heart Rate, Excessive Sweat
0 PUB UNK none none HISTORY OF BENZONATE (TESSALON PEARLS) INDU 8 UNK UNK 0 UNK UNK NONE UNKNOWN 6 1) Air contrast PVTenema. PUB 2) Abdominal x-ray; 3)URI Abdominal (AM of NP vaccination) ultra-sound. Reflux LABS and DIAGNOSTICS: Barium Air Contra 0 PVT UNK CELEBREXNone 9 knee surgeries on meniscus/cartilage; Arthritis present 2 OTH OTH None None None 2 OTH PVT ASA; LIPITOR; NoneNORVASC hypertension; hyperlipidemia 1 None PUB UNK None Overweight. 2 OTH OTH 2 OTH OTH 0 None PVT PUB Albuterol; AUGMENTIN mild chronicasthma; allergies; allergic asthma rhinitis 0 PUB PUB None Left ear infection 1 PVT PVT MIRALAX 1 None PVT PVT None None 0 TB PPD. PVT OTH None None 1 PVT PVT None None None 0 PVT PVT No 1 PVT PVT None/ annual Hypertension; check up. Hyperlipidermia; Osteoporosis; Osteoarthrit 2 PVT PVT None None PVT PVT -3652 PVT PVT None None None Localized swelling.~Varicella (Varivax)~1~1~Pa 0 PUB PUB None None Oppositional Mom defiant stated disorder. this has happened before. No furth 1 Bacterial CX PUB -> normal;PUB Viral CX herpes None simplex No & VZV -> None prelim report negative. 0 PVT PVT none none mild asthma, eczema 91 I had extensive UNKlab work UNK done, blood, noneurine, xrays, none etc failed back syndrome, chronic pain syndrome, alergic to m 0 I am not sure PVT of the lotPUB number forNone the vaccine. None However,None the babies first two doses of the Hep B vaccine was actua 1 PUB PVT none none, allergy to pen and sulfa 2 NONE PVT PVT NONE KNEE ARTHRITIS, RBBB, VARICOSE VEINS ON LEFT W 43 PVT PVT Faxil mild anxietyNone for about 10 years 0 None PUB PUB TriSprintec No oral daily (oral BC pill) MO200917 114 Computed axial, OTH 05/04/09, OTHnegative; Electroencephalography, None. 05/19/09, HPV #3 given abnormal, 5/14/09, WAES0908USA00614 showing Lot # 1312X, spikes inLA. the8/14/09 left anteri PC 0 Unknown OTH OTH Unknown Asthma WAES0908USA01032 1 PUB PUB 171 None PVT PUB None none/well checkup. None 1 PVT PVT None Chronic (R)None neck lymph node 1 None PVT UNK None None None 2 None PVT PUB TYLENOL None seen PUB PUB Not known None None 1 None OTH UNK None None None 1 UNK OTH Wellness check Not PVT PVT Stye on eye; Allergic Nasal to congestion metformin; HTN; DM; Hypothyroid; Hyperlipidem 366 PVT UNK None None None 1 None PUB OTH Came in forNone a wellnessNone~ V-up; No ()~~0~Patient illness 1 None PVT PVT None None ### None PVT PVT ### 1 None PVT PVT None ### 1 None PVT PVT None ### 15 vaginal exam PVT and wet prep PVT N/A None None 1 PVT PUB 1 None UNK UNK None Allergic to Bactrim, Biaxin, Amoxil, Epinephrine 0 PUB UNK NONE REPORTED NONE REPORTED
0 none PVT UNK none none none decreased babbling~Pneumo (Prevnar)~2~0~I 0 CBC, BMP,UNK prolactin within UNK normalnone limits. 10/8/09 noneLABS and noneDIAGNOSTICS Service dates 8/8/09. Urinalysis - clou 0 UNK UNK None None None known 0 UNK UNK None None None known 1 N/A PVT PVT Trentnoid sulfacelamid None None oint/Erythromycin-acne 0 none PVT PVT none none none 6 None PVT UNK Calcium w/ None Vitamin D; No Epipen knowprn; drug Flonase allergies; Nasal Peanut Spray; and Flaxseed; Sesame Glucosamine Oil Allergies 1 PVT PUB None. None. None. 1 PVT PVT synthroid None reported none reported 0 UNK UNK Vitamin supplements, vertigo no none prescriptions 0 None. PVT PUB None none 0 PVT PVT none none none 0 PVT PVT NO NONE PUB PUB NONE N/A NEW PATIENT 3 UNK UNK Simvastatin,NONE Metoprolol, none Plavix, Fosamax plus D, Aricept 0 PVT UNK Was given Depo None at theAllergic same time to imitrex IM Prozac 1 Labs and Diagnostics: UNK UNK MRI brain NONE WNL. EEGNONE WNL (except PMH: increased neonatalbeta jaundice 2' to medication). CSF culture/grams s 0 PUB PUB none at time none vaccination at time non vaccination was at time given n/a~ vacccination to was pt. ()~NULL~~In given to was pt given Patient|n/a~ to patient. ()~NULL~~In S 0 The area isUNK very red and UNK swollen. none It is also under skin the reaction, area. HeTwo pain, hadareas aitching, reaction Alexander arefever. effected. on 4-10-08 Gardner~Tetanus hugeThis in as diameter. also well.happend Diphtheria the last (notime bra 181 Blood albumin, OTH05Nov2008, OTH belowParicalcitol; 5mcg/L; Blood Alcohol Calcium bicarbonate, use; acetate; Biopsy Arteriovenous 05Nov2008, Prednisone; kidney; Central fistula; 17mEq/L; Amlodipine; A0801390A line Bone placement; metabolism Blood Heparin; chloride, Chest Cyclosporin; disorder; 01Apr2008, tube insertion Chronic Dex9 2 WBC 23.26;PVT Anion GapUNK 24 (increased); CO2 17; none Glucosenone. 60 9/22/09 Medical office note received DOS 6/08 to 6/ 2 PVT PVT MCTZ None S/p Lumpectomy (L) breast, radiation 8/08 - 10/08 0 None PVT PVT Recently finished No AMOX None for ear infection 2 PUB UNK Denies None None 1 MIL MIL 19 PVT OTH None 1 None PUB OTH AUGMENTIN No None 1 None PVT UNK No No 0 PUB OTH Reaction toDifficulty hepatitisbreathing~Hep A vaccination -Adifficulty (no brand breathing name)~2~ 1 CBC PVT OTH Insect bitesNone resolving ~DTaP (no brand name)~4~1~Patient 0 None PVT OTH none none 31 Unknown PUB OTH WELLBUTRIN; Migraine; LOESTRIN Depression Convulsion WAES0908USA00799 0 Computed axial, OTH 07/21/09, OTHliver: normal; None Upper Rheumatoid GI seriesPregnancy X-ray, arthritis; 07/21/09, Allergic 9/25/09 normal; reaction Received WAES0908USA01092 Computed to antibiotics; medical axial, records Drug 07/21/09, hypersensiti w/PMH: kidne JR Unknown OTH OTH Unknown Unknown WAES0908USA01451 Unknown OTH OTH Unknown Unknown WAES0908USA01533 1 UNK UNK ADDERALL-XR; Levothyroxine ### Not reported UNK UNK Not reported ### 12 Air contrastPVT enema - reduced PUB transverse none colon none intussusception none 10/02/09 10/2/09 Medical records received w/LABS: w/PMH: 41 stool Pree gu 0 PVT PVT 8/20/09 PCP note received DOS 8/4/09 Never experienced PUB UNK 0 Unknown PUB PUB Not Known No No 665 PVT PVT asthma, migraines, reflex neurovascular dystrophy, chiari m 813 PVT UNK 386 PVT PVT 217 PVT PUB 0 UNK UNK None None Congenital hearing loss. Pt has cochlear implant in right e 1064 PVT PUB 1183 PVT PVT 0 8/19/2009 Hospital UNK DCUNK summary received Singulair,DOS Zyrtec, None 8/12/09 Veramyst to PCN 8/14/09. allergy. LABS Patient and has DIAGNOSTICS: congenital hearing EEG Results loss. She Pendi ha 2 PUB PUB none none none Fever, soreness~DT Adsorbed (DECAVAC)~3~ 1 PUB PUB NONE NONE NONE KNOWN, 1ST TIME SEEING PATIENT.
155 PVT UNK HTN 80 2 - MRI's, 2PVT - EEG's. 2 UNK EKG's, 24 hour YASMIN; EEG birth ->; None All control were pills. negative. None 2 PVT PVT None 1 8/7/09 PHNPUB referred mother PUB to local none clinic for none assessment. 0 Just finished PVT ZITHROMAX, UNK KEPPRA PCN; Epilepsy ~DTaP (no brand name)~5~5~Patient|~Varicel 6 None PVT PVT PRARASTATIN, None HCTZNone 0 MIL MIL EmergencyPVT Dept Dx: Fever PVT by history, Clindamycin possiblePhosphate Viral Syndrome SpeechorDelay; reaction Mother ?Asthma; to feels immunization ptAspergers gets sickshots. after D/O all his shots~ ()~ 0 PUB PUB None Known None Known None PVT PVT None None None 0 none PUB PUB none notednone notednone noted 1 None PUB PUB None None Seasonal allergies (hay fever) 1 PUB PVT PPD None Known None Known 7 None PVT PUB None None 0 UNK UNK The only thing I've been allergic to is NAPRASYN -spelling 228 UNK UNK 1 None PVT PUB None No No 0 UNK UNK 1 None PVT PVT None None In for None check-up 0 None; History PVT and Physical PVT exam only None 10 Unknown MIL MIL Yaz BCP None None 2 MIL MIL plavix, naproxen,hctz, none inderal, penicillin, zorcor, sulpha, simikliar low-dose erthromyacin, reaction aspirin,effexor to scheduled anythingXR made allergy prilosec, with shots~ molds vit D, () 3 RXn (L) deltoid; PVT redness PVT None None 3 PVT PVT None None 1 PVT UNK None RDHD 0 PUB PUB None None None OTH PUB None None 0 PVT UNK none 0 ALCUV glucose PVT -80 OTH None None None 0 OTH PUB None None None 1 PVT PUB Singulair 4mg None 5 MIL MIL None None 0 OTH PUB None None None 1 PVT PVT none 0 UNK UNK Adderal, ocella none none 535 Blood work PVT done everyPVT 1-4 months, as well as a bone marrow mitro-valve biopsyregurgitation 0 PUB UNK Motrin prn None None 14 culture of facial UNKlesionsPVT sent none 0 none UNK PUB Sertraline 25 none mg, Singulair seasonal 5 mgallergic rhinitis, in foster care since 2/6/09 7 PUB PUB unknown Unknown Unknown 23 MIL MIL Pre natal 1 PVT UNK None None 0 PVT PUB Lipitor, Diovan/HCT, None Toprol, SulphaAspirin Allergy 0 None PVT PVT Back Pain 0 None PVT PUB PPD; PAST; Well C3036AA; baby LA 0 PVT PVT None None None 2 PVT OTH Swelling of arm 08/12/09~DTaP (no brand name)~4~5~Patient 0 Vital signs stable PVT PVT Multivitamins None Previous Vaso-vagal and blood draw 2 none PVT PVT none Type I diabetes 0 PVT PUB 1 PVT PUB No WCC No
1 870 0
PVT OTH CELEXA 40None mg. Allergy to peanut; CEFTIN; CONIERTA. PVT UNK BronchiolitisVaricella~Varicella (no brand name)~1~3~Patie PUB OTH Captopril 2ml x 3 daily Hypoplastic 9A 3P 9P; ZANTAC left heart1syndrome ml x 2 daily 9A-9P; 1/2 Baby ASA x None PVT PVT None None 1 PUB OTH 2 PVT PVT None None None 0 None PUB PUB None None WV0906 Wound culture PUBof 7/28/09 PUB from hospital None shows Known None Streptococcus Known Nonepyogenes By parent (Groupreport A) pt had a bad bruising on R leg 0 None UNK UNK Well baby PVT PVT None None None 1 PVT UNK None None 0 None PUB PUB None NKDA 538 Head CT 7/21/1999 PVT documented PVT sphenoid None sinus None mucosal Hxdisease cluster normal. headaches since AVA #3 2 CBCD; plts;PVT Barp PVT Amoxicillin;Otitis MOTRIN MediaNone 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007106 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007310 1 Blood cultures, PVT10/28/08, OTH negative;Concomitant White bloodDrug(s) cell count, Not No Reported 10/28/08, allergies; 24,000 No prior medical MEDI0007353 history 0 PVT OTH Concomitant Drug (s) Not Reported. MEDI0006522 1 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007064 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007079 5 OTH OTH Not Reported MEDI0007080 0 OTH OTH Not reported MEDI0007031 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007082 0 OTH OTH Concomitant Cold Drug (s) Not Reported. MEDI0007098 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007160 7 OTH OTH LAMICTAL; BUSPAR; Allergy EFFEXOR; to aspirin CYMBALTA MEDI0007111 0 PUB OTH Concomitant Drug (s) Not Reported MEDI0007118 0 OTH OTH Concomitant Asthma Drug (s) ( 10003553) Not Reported MEDI0007120 2 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007121 0 PVT PVT Concomitant Asthma Drug (s) Not Reported MEDI0007124 2 OTH OTH Concomitant Drug (s) Not Reported MEDI0007139 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007141 2 OTH OTH Concomitant Drug (s) Not TheReported patient has no known MEDI0007144 allergies to food including eggs, 0 PVT OTH Concomitant Down's Drug (s) syndrome Not Trigonocephaly Required (10013616), Hypothyroidism MEDI0007146(10021114), Alopecia 0 OTH OTH Concomitant Drug(s) Not TheReported patient has no history MEDI0007152 of asthma, wheezing, or allergie UNK UNK Concomitant Drug(s) Not Medical Reported history not reported MEDI0007158 1 OTH OTH Concomitant Drug(s) Not TheReported patient has no eggMEDI0007159 or milk protein allergy nor asthma; 0 OTH OTH ASPIRIN Medical history not reported. MEDI0007161 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007164 1 Abdominal PVT X-ray, ??/??/08, PVT normal; FOCALIN Stool analysis, XR ADD; 2) ??/??/08 Constipation MEDI0007168 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007176 OTH OTH LEVOTHYROXINE; Migraine CYMBALTA; SINGULAIR. MEDI0007179 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007181 0 MIL OTH Concomitant Drug (s) Not Reported. MEDI0007182 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007183 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007184 0 MIL OTH Not Reported MEDI0007185 0 MIL OTH Concomitant Drug (s) Not Report. MEDI0007186 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007187 1 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007188 0 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007189
0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007190 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007191 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007192 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007193 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007194 0 MIL OTH Concomitant Drugs(s) Medical Not Reported history not reported MEDI0007195 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007196 0 MIL OTH Not Reported MEDI0007197 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007198 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007199 0 MIL OTH Concomitant Drug (s) Not Reported. MEDI0007200 5 06-Oct-2008-Chest PUB X-ray, OTHunknown Birth result; control 06-Oct-2008-EKG, unknown result;MEDI0007201 06-Oct-2008-Blood work, unknow 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007204 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007205 0 OTH OTH Concomitant Drug (s) Not 7th Reported. grade female. MEDI0007210 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007211 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007212 0 OTH OTH Concomitant Drug (s) Not 8th Reported. grade female. MEDI0007213 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007214 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007215 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007216 0 OTH OTH 8th grade male MEDI0007217 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007219 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007221 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007222 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007223 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007224 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007225 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007227 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007228 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007229 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007230 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007231 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007232 0 PVT OTH Concomitant Drugs (s) Not Reported MEDI0007237 6 Influenza serology, MIL 10/09/2008, OTH Positive Concomitant for type Drug A influenza (s) Not Reported virus MEDI0007242 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007243 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007246 0 OTH OTH Concomitant Drug (s) Not Required MEDI0007254 0 OTH PVT Concomitant Drug (s) Not Reported MEDI0007293 0 PUB OTH VYVANSE MEDI0007255 0 OTH PVT Concomitant Drug (s) Not Reported MEDI0007294 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007296 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007299 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007300 0 OTH OTH Concomitant Asthma Drug(s) Not Reported MEDI0007277 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007301 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007302 0 PUB OTH Concomitant Pregnant Drug (s)(10036586) Not Reported MEDI0007279 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007284 UNK UNK Concomitant Drug (s) Not Adult Reported female with second MEDI0007304 hand exposure to FLUMIST
0 PVT OTH 0 PVT OTH 0 OTH OTH 0 Urine test- Unknown PUB PUB 0 PUB OTH 2924 OTH OTH 0 MIL MIL 0 OTH OTH 0 OTH OTH 0 PUB PVT 0 CAT Scan, PVT 10/14/2008,PVT Negative 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 PVT OTH 8 Lyme's Disease: OTH Negative OTHtest 0 OTH OTH 0 OTH OTH 0 OTH OTH 1 OTH OTH OTH OTH 0 OTH OTH 0 OTH OTH 2 OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL OTH OTH 0 MIL MIL 0 MIL MIL 3 OTH OTH 0 MIL MIL OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 5 OTH OTH 0 MIL MIL 0 MIL MIL 2 PVT OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL
Concomitant Drug (s) Not Reported MEDI0007305 Concomitant Drug (s) Not Reported MEDI0007307 Concomitant Drug (s) Not Reported MEDI0007308 Concomitant Drug (s) Not Reported medi0007313 Concomitant Drug (s) Not Reported MEDI0007285 Concomitant Drug (s) Not Reported MEDI0007291 Concomitant Drug (s) Not Reported MEDI0007292 Concomitant Asthma Drug (s) Not Reported MEDI0007316 Concomitant Drug (s) Not Reported MEDI0007317 RITALIN ADHD, Epilepsy Brother or sister experienced MEDI0007318 hives with the diphtheria, teta Concomitant Drug (s) Not Reported MEDI0007319 Concomitant Drug (s) Not Reported MEDI0007320 Concomitant Drug (s) Not Reported MEDI0007329 Concomitant Drug (s) Not Reported MEDI0007330 Concomitant Drug(s) Not No Used known allergies or history MEDI0007331 of hypersensitivity. FLONASE Allergy MEDI0007333 Concomitant Drug (s) Not Reported MEDI0007334 Concomitant Drug(s) Not Reported MEDI0007337 Concomitant Drug(s) Not Reported MEDI0007342 Concomitant Drug(s) Not Reported MEDI0007343 Concomitant Drug(s) Not Reported MEDI0007345 Concomitant Drug(s) Not Reported MEDI0007349 Concomitant Drug(s) Not Reported MEDI0007350 Concomitant Drug (s) Not Reported MEDI0007352 Concomitant Drug (s) Not Reported MEDI0007376 Concomitant Drug (s) Not Reported MEDI0007377 Concomitant Drug (s) Not Reported MEDI0007378 Concomitant Drug (s) Not Reported MEDI0007379 Concomitant Drug (s) Not Reported MEDI0007380 Concomitant Drug (s) Not Reported MEDI0007356 Concomitant Drug (s) Not Reported MEDI0007382 Concomitant Drug (s) Not Reported MEDI0007383 Concomitant Drug (s) Not Reported MEDI0007357 Concomitant Drug (s) Not Reported MEDI0007384 Concomitant Drug (s) Not Reported MEDI0007360 Concomitant Drug (s) Not Reported MEDI0007385 Concomitant Drug (s) Not Reported MEDI0007386 Concomitant Drug (s) Not Reported MEDI0007387 Concomitant Drug (s) Not Reported MEDI0007362 Concomitant Drug (s) Not Reported MEDI0007388 Concomitant Drug (s) Not Reported MEDI0007389 Concomitant Drug (s) Not Reported MEDI0007390 Concomitant Drug (s) Not Reported MEDI0007391 Concomitant Drug (s) Not Reported MEDI0007363 Concomitant Drug (s) Not Reported MEDI0007366 Concomitant Drug (s) Not Reported MEDI0007369 Concomitant Drug (s) Not Used MEDI0007370 Concomitant Drug (s) Not Reported MEDI0007371 Concomitant Drug (s) Not Reported MEDI0007392 Concomitant Drug (s) Not Reported MEDI0007393 Concomitant Drug (s) Not Reported MEDI0007394
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0
MIL MIL Concomitant Drug (s) Not Reported MEDI0007395 MIL MIL Concomitant Drug (s) Not Reported MEDI0007396 MIL MIL Concomitant Drug (s) Not Reported MEDI0007397 MIL MIL Concomitant Drug (s) Not Reported MEDI0007398 MIL MIL Concomitant Drug (s) Not Reported MEDI0007399 MIL MIL Concomitant Drug (s) Not Reported MEDI0007400 MIL MIL Concomitant Drug (s) Not Reported MEDI0007401 MIL MIL Concomitant Drug (s) Not Reported MEDI0007402 MIL MIL Concomitant Drug (s) Not Reported MEDI0007403 MIL MIL Concomitant Drug (s) Not Reported MEDI0007404 MIL MIL Concomitant Drug (s) Not Reported MEDI0007405 MIL MIL Concomitant Drug (s) Not Reported MEDI0007406 MIL MIL Concomitant Drug (s) Not Reported MEDI0007372 MIL MIL Concomitant Drug (s) Not Reported MEDI0007373 MIL MIL Concomitant Drug (s) Not Reported MEDI0007374 MIL MIL Concomitant Drug (s) Not Reported MEDI0007375 MIL MIL Concomitant Drug (s) Not Reported MEDI0007407 MIL MIL Concomitant Drug (s) Not Reported MEDI0007408 MIL MIL Concomitant Drug (s) Not Reported MEDI0007409 MIL MIL Concomitant Drug (s) Not Reported MEDI0007410 MIL MIL Concomitant Drug (s) Not Reported MEDI0007411 MIL MIL Concomitant Drug (s) Not Reported MEDI0007412 MIL MIL Concomitant Drug (s) Not Reported MEDI0007413 MIL MIL Concomitant Drug (s) Not Reported MEDI0007414 MIL MIL Concomitant Drug (s) Not Reported MEDI0007415 MIL MIL Concomitant Drug (s) Not Reported MEDI0007416 OTH OTH Concomitant Drug (s) Not Reported MEDI0007417 MIL MIL Concomitant Drug (s) Not Reported MEDI0007418 MIL MIL Concomitant Drug (s) Not Reported MEDI0007419 MIL MIL Concomitant Drug (s) Not Reported MEDI0007420 MIL MIL Concomitant Drug (s) Not Reported MEDI0007421 MIL MIL Not Reported MEDI0007422 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007423 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007424 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007425 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007426 MIL MIL Concomitant Drug (s) Not Reported MEDI0007427 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007428 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007429 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007430 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007431 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007432 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007436 MIL MIL Concomitant Drug(s) Not Reported MEDI0007437 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007438 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007439 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007440 MIL MIL Concomitant Drug(s) Not Reported MEDI0007441 MIL MIL Not reported MEDI0007442 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007443 0 Pregnancy OTH test, 10/23/08, PVTPositiveMultivitaminNo (Prenatal) illness at2 the weeks timegestation of vaccination; at the MEDI0007444 time of FLUMIST administration;
0
OTH OTH OTH OTH 0 PUB OTH 0 OTH OTH UNK UNK 0 PVT PUB 1 OTH OTH OTH OTH 0 PUB UNK 0 PUB OTH 0 OTH OTH 0 OTH OTH 3 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 2 OTH OTH 0 PUB PUB 0 OTH OTH 0 PVT OTH 0 PVT PVT 2 PVT OTH 0 OTH OTH 32 A scheduled PVT MRI was cancelled. PVT 29 PVT PVT 0 OTH OTH OTH OTH 0 OTH OTH
Concomitant Drug (s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported
MEDI0007449 MEDI0007450 MEDI0007451 MEDI0007454 MEDI0007455 Concomitant Drug(s) Not reported MEDI0007459 Concomitant Drug(s) Not Reported MEDI0007460 Concomitant Drug (s) Not Reported MEDI0007461 Concomitant Drug(s) Not reported MEDI0007464 Not reported History of hives of unknown MEDI0007457 etiology with trips to emergenc Concomitant Drug(s) Not Reported MEDI0007468 Concomitant Drug (s): None Not reported MEDI0007469 Concomitant Drug(s) Not Past Used Disease: Headache MEDI0007472 Concomitant Drug (s) Not Reported MEDI0007473 Concomitant Drug(s) Not reported MEDI0007475 Concomitant Drug(s) Not Reported MEDI0007476 Concomitant Drug(s) Not Reported MEDI0007477 Concomitant Drug(s) Not Reported MEDI0007478 Concomitant Drug(s) Not Reported MEDI0007479 Concomitant Drug (s) Not Reported MEDI0007480 MEDI0007481 Concomitant Drug(s) Not Reported MEDI0007482 Concomitant (s) DrugsNone Not Reported MEDI0007483 Concomitant Drug(s) Not Reported MEDI0007484 Concomitant Drug(s) Not Reported MEDI0007485 Concomitant Drug(s) Not Reported MEDI0007486 Concomitant Drug(s) Not Reported MEDI0007487 Concomitant Drug (s) Not None Reported MEDI0007488 Concomitant Drug(s) Not Reported MEDI0007489 Concomitant Drug(s) Not Reported MEDI0007490 Concomitant Drug(s) Not Reported MEDI0007491 Concomitant Drug(s) Not Reported MEDI0007492 Concomitant Drugs(s) Not Reported MEDI0007493 Concomitant Drug (s) Not None Reported MEDI0007494 Concomitant Drug(s) Not Reported MEDI0007495 Concomitant Drug(s) Not Reported MEDI0007496 Concomitant Drug(s) Not Reported MEDI0007497 Concomitant Drug(s) Not Reported MEDI0007498 Concomitant Drug(s) Not Reported MEDI0007502 Concomitant Drug(s) Not Reported MEDI0007517 Concomitant Drug (s) Not Reported MEDI0007531 Concomitant Drug (s) Not Reported MEDI0007544 Concomitant Drug (s) Not Reported MEDI0007580 Concomitant Drug(s) Not Reported MEDI0007549 Concomitant Allergy; Drug(s)Asthma; Not IgG2 Used deficiency; Skin granuloma OtitisMEDI0007581 infections Concomitant Drug(s) Not Reported MEDI0007552 Concomitant Drug(s) Not Experienced Reported right arm MEDI0007582 pain after the 2007 dose of FLUMIS Concomitant Drug (s) Not Reported MEDI0007583 Concomitant Drug(s) Not Reported MEDI0007584 Concomitant Drug(s) Not Reported MEDI0007587 Concomitant Drug(s) Not 11/2008: Reported Pregnancy confirmed MEDI0007554 2 weeks after FLUMIST do
0 0 0 1 0 0 0 1 0 0 0 0 5 0 0 0
PVT OTH SYNTHROID Hypothyroidism; Asthma; Gestational MEDI0007555 diabetes; Gastroesophageal ref PUB PVT Concomitant Drug (s) Not Reported MEDI0007593 OTH OTH Concomitant Drug(s) Not Reported MEDI0007598 PUB PUB Concomitant Drug(s) Not Reported MEDI0007559 PUB PUB Concomitant Drug(s) Not Reported MEDI0007552 PUB PUB Concomitant Drug(s) Not Reported MEDI0007564 OTH OTH Concomitant Drug(s) Not Reported MEDI0007585 PVT OTH Concomitant Drug(s) Not Used MEDI0007566 PVT OTH FLONASE Seasonal allergy Sensitive stomach withMEDI0007567 vomiting; nasal allergies; OTH OTH Concomitant Drug(s) Not Reported MEDI0007603 OTH OTH Concomitant Drug (s) Not Reported MEDI0007605 OTH OTH Concomitant Drug(s) Not Reported MEDI0007606 PVT PVT Concomitant Fungal Drug(s) infection Not At the Reported time he receivedMEDI0007611 FLUMIST the patient had mild skin OTH OTH Concomitant Drug(s) Not Reported MEDI0007572 OTH OTH Concomitant Drug(s) Not Reported MEDI0007615 OTH OTH Concomitant Drug (s) Not Reported MEDI0007620 PVT OTH Concomitant Drug(s) Not Reported MEDI0007576 0 PUB PUB Prenatal vitamin; Asthma Albuterol Gravida 9, terms birthsMEDI0007578 4, premature births 1 (set of twins b 0 PVT PVT Concomitant Drug (s) Not No medical Reportedhistory obtained. MEDI0007621 5 Urine Pregnant OTHTest, 12/10/08, OTH positive Concomitant Drug(s) Not Past Reported Disease: Psychiatric MEDI0007628 disorder NOS 1 PUB OTH Concomitant Drug(s) Not Reported MEDI0007629 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007630 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007670 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007671 0 OTH OTH Concomitant Drug(s) Not Used MEDI0007632 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007676 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007635 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007677 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007642 2 PUB PUB Concomitant Drug(s) Not Reported MEDI0007644 0 OTH OTH Concomitant Drug(s) Not reported MEDI0007645 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007657 0 OTH OTH Concomitant Drug (s) Not Sibling Reported also received expired MEDI0007687 FLUMIST 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007661 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007689 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007690 0 OTH OTH Concomitant Drug(s): Not Reported MEDI0007663 0 PVT OTH Concomitant Drug (s) Not None Reported MEDI0007693 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007665 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007668 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007694 0 PVT PUB Concomitant Drug(s) Not Reported MEDI0007695 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007669 0 OTH OTH ADDERAL Precocious and ADDERALLL No puberty known XR,allergies. 20 mg MEDI0007707 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007709 0 PVT PVT Concomitant Drug(s) Not No Reported medical history information MEDI0007713 collected. No allergies to F 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007717 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007726 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007727 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007728 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007729
0 0 0 0 0 0
PVT PUB PUB PVT PUB PVT OTH 0 PUB 0 OTH 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PUB 7 OTH 0 OTH PUB PUB 0 PVT 0 MIL 0 MIL 0 MIL 0 MIL 0 PVT 0 MIL 0 MIL 0 MIL 0 MIL 0 OTH 0 OTH 7 OTH 0 MIL 0 MIL 0 PVT 0 MIL 0 OTH 0 MIL 0 MIL 0 MIL 0 MIL 0 OTH 0 MRI, normalOTH 0 OTH 0 PVT 0 OTH
OTH PUB PUB OTH PUB OTH OTH PUB OTH PVT OTH OTH PVT PVT PVT PVT PVT PVT OTH OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH
Concomitant Drug (s) Not None Reported MEDI0007730 Concomitant Drug(s) Not Reported MEDI0007738 Concomitant Drugs(s) Second Not Reported vaccination with MEDI0007739 FLUMIST Concomitant Drug (s) Not Reported MEDI0007696 Concomitant Drug(s) Not Reported MEDI0007741 Concomitant Drug(s) Not Reported MEDI0007697 Concomitant Drug (s) Not Reported MEDI0007699 None Second vaccination with MEDI0007742 FLUMIST Concomitant Drug(s) Not Reported MEDI0007704 Multivitamin MEDI0007705 Concomitant Drug(s) Not Reported MEDI0007751 Concomitant Drug (s) Not Reported MEDI0007752 None None MEDI0007753 Concomitant Drug(s) Not Reported MEDI0007754 Concomitant Drug(s) Not Patient Reported is one of a set of MEDI0007757 twin girls Concomitant Drug (s) Not Patient Reported is one of a set of MEDI0007758 twin girls; None None MEDI0007759 None None MEDI0007761 Concomitant Drug(s) Not Reported MEDI0007765 Concomitant Drug (s) Not PastReported obstetrical history:MEDI0007768 Para 1, Gravida 1, Premature 0, S Concomitant Drug(s) Not Reported MEDI0007769 Concomitant Drug(s) Not Reported MEDI0007776 IMURAN; PROVENTIL Asthma; Colitis Asthma (since childhood); MEDI0007780 Colitis Concomitant Drug(s) Not Patient's Reported first flu vaccination MEDI0007791 Concomitant Drug (s) Not Reported MEDI0007797 Concomitant Drug (s) Not Reported MEDI0007878 Concomitant Drug (s) Not Reported MEDI0007880 Concomitant Drug (s) Not Reported MEDI0007882 Concomitant Drug (s) Not Reported MEDI0007883 Concomitant Drug (s) Not Reported MEDI0007799 Concomitant Drug (s) Not Reported MEDI0007890 Concomitant Drug 9s) Not Reported MEDI0007893 Concomitant Drug (s) Not Reported MEDI0007896 Concomitant Drug (s) Not Reported MEDI0007897 Concomitant Drug (s) Not Reported MEDI0007812 Concomitant Drug (s) Not Reported MEDI0007821 Concomitant Drug (s) Not Reported MEDI0007822 Concomitant Drug (s) Not Reported MEDI0007898 Concomitant Drug (s) Not Reported MEDI0007899 Concomitant Drug (s) Not Reported MEDI0007841 Concomitant Drug (s) Not Reported MEDI0007902 Concomitant Drug (s) Not Received Reported first dose 4 weeks MEDI0007850 ago Concomitant Drug(s) Not Reported MEDI0007904 Concomitant Drug (s) Not Reported MEDI0007905 Concomitant Drug (s) Not Reported MEDI0007906 Concomitant Drug (s) Not Reported MEDI0007908 Concomitant Drug(s) Not Reported MEDI0007852 Concomitant Drug (s) Not Reported MEDI0007853 Concomitant Drug(s) Not Reported MEDI0007854 Concomitant Drug (s) Not Reported MEDI0007858 Concomitant Drug(s) Not Reported MEDI0007869
0 0 0 0 0 0
MIL OTH Concomitant Drug (s) Not Reported MEDI0007873 MIL OTH Concomitant Drug (s) Not Reported MEDI0007875 MIL OTH Concomitant Drug (s) Not Reported MEDI0007876 MIL OTH Concomitant Drug(s) Not Reported MEDI0007877 MIL OTH Concomitant Drug (s) Not Reported MEDI0007909 MIL OTH Concomitant Drug (s) Not Reported MEDI0007910 The patientPVT had an eight-year-old PVT MUPIROCIN brother vaccinated on the same day who did MEDI0007911 not experience any events; 131 09-Feb-2009 PVT InfluenzaOTH A test positive Concomitant Drug (s) Not Reported MEDI0007918 OTH OTH Concomitant Drug (s) Not Reported MEDI0007926 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007996 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007997 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008006 1 OTH OTH Concomitant ADHD Drug (s) Not Behavioral Reported problems: MEDI0008056 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008007 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008074 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008008 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0008026 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008076 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008027 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008078 28 OTH OTH Concomitant Drug (s) Not Reported MEDI0008030 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008044 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008079 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008080 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008081 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008082 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008109 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008121 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008122 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008123 0 MIL MIL Concomitant Drug(s): Not Reported MEDI0008124 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008125 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008127 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008128 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008129 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008130 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008131 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008132 0 UNK UNK MEDI0008133 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008134 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008135 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008136 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008137 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008138 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008139 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008140 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008141 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0003142 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008143 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008144 0 MIL MIL MEDI0008145
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL
MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL
Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported None None Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported None None Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported
MEDI0008146 MEDI0008147 MEDI0008148 MEDI0008149 MEDI0008152 MEDI0008153 MEDI0008154 MEDI0008155 MEDI0008156 MEDI0008157 MEDI0008158 MEDI0008159 MEDI0008160 MEDI0008161 MEDI0008162 MEDI0008163 MEDI0008164 MEDI0008167 MEDI0008168 MEDI0008169 MEDI0008170 MEDI0008171 MEDI0008172 MEDI0008173 MEDI0008174 MEDI0008175 MEDI0008176 MEDI0008177 MEDI0008178 MEDI0008179 MEDI0008181 MEDI0008182 MEDI0008183 MEDI0008184 MEDI0008186 MEDI0008188 MEDI0008190 MEDI0008191 MEDI0008192 MEDI0008193 MEDI0008194 MEDI0008195 MEDI0008196 MEDI0008199 MEDI0008200 MEDI0008201 MEDI0008202 MEDI0008203 MEDI0008204 MEDI0008205 MEDI0008206
0 0 0 0 0 0 0
MIL MIL Concomitant Drug(s) Not Reported MEDI0008207 MIL MIL Concomitant Drug(s) Not Reported MEDI0008208 MIL MIL Concomitant Drug (s) Not Reported. MEDI0008209 MIL MIL Concomitant Drug(s) Not Reported MEDI0008210 MIL MIL Concomitant Drug(s) Not Reported MEDI0008211 MIL MIL None None MEDI0008212 MIL MIL Concomitant Drug (s) Not Report. MEDI0008213 MIL MIL Concomitant Drug(s) Not Reported MEDI0008214 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008215 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008216 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008218 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008219 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008220 MIL MIL Concomitant Drug(s) Not Reported MEDI0008224 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008225 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008226 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008228 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008230 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008234 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008236 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008237 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008238 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008239 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008241 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008242 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008243 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008249 0 MIL MIL Concomitant Drug(s) Not reported MEDI0008250 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008252 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008253 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008254 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0009255 230 UNK UNK Concomitant Drug(s) Not Reported MEDI0008390 14 None OTH OTH None None WAES0908USA01558 Unknown OTH OTH Unknown Unknown WAES0908USA01559 Unknown OTH OTH Unknown Unknown WAES0908USA01660 61 Unknown OTH OTH None Thyroid disorder Shingles WAES0908USA01537 None OTH OTH TYLENOL with Codeine Heart #3; atorvastatin enlarged; Rheumatic calcium; WAES0908USA01584 VOLTAREN; fever SINGULAIR; vitam 1 MIL MIL none per mother none per mother delayed speech 1 PUB UNK 4 None. PUB PVT None known. None Occasionally Nonetakes ibuprophen. 9 PVT PVT None 0 Pt has recovered PUB doingPUB great. NKDA Pt at clinic for school shots only checkup. 0 None PVT PVT None None Healthy Child 1 QBC in office PVT did not show PVT active illness None Fever, R arm soreness 0 Scheduled PUB to see neurologist PUB . Mild "common Patient cold"foramen ovale 0 None PVT PUB None None 2 PVT UNK None None 0 Hep A vaccine PUBgiven toPUB sibling on same visit. None Sibling hadper no reaction. mother possible seasonal allergies 0 PVT PVT 0 PVT PVT Actonel 150Postop mg, Levothyroxin, L4L5 Allergic Laminectomy to Neurotin, mold Severe and May Maxide, swelling, dust. 7, 2009. Have Carisoprodol some Fractures 3 ureters. pain &prn, ofoozing~DTaP sacrum. Osteoporosis, Advair, Calciu (n
1 PUB PUB 7 PUB PUB unknown none history of allergies mother states. 1 PUB UNK NONE NONE 1 UNK PVT daily multivitamin No Febrile seizures bruising X2 at site~ age 3()~NULL~~In Patient 0 PUB PUB NA "serum sickness" (to cephalosporin VA09:009 antibiotic) 2 years ago 5 PVT PVT 1 PUB PUB 1 UNK UNK No Environmental Localized allergies reactions to previous vaccinations~ ( 0 Has not been PUB seen by PUB clinition. possibly Prozac, none not taken allergic daily to PCN, Demerol, Codiene, Percocet....depression 1 Dx CellulitisPVT (682.9) PVT None None Astma 1 LP: normal UNK CT of Head: UNK normal All none cultures:none normal/no none growth. 8/17/09 Hospital records received DOS 8/13/09 to 2 Skin testingUNK to vaccine UNK and gelatinTricor, pending. epipen Prior None.complement NSAID/Cox-1 studies,inhibitor CBC, CMP, induced TSHangioedema/allergy; normal in 2008. LABS dyslip an 4 UNK UNK none none tree pollen allergy guillan barre~Influenza (no brand name)~~7~S 0 CBC, throatPVT culture, urinalysis, PVT blood none culture, none chest xray, none flu screen, lyme titer, EBV AL0914 titer, metabolic profile. 0 none UNK UNK none none none AL0915 0 UNK UNK none no none 1 None. PUB PUB Singular, Synthroid, Chronic illnesses Naproxen, The mother listed Tylenol, states in pre-existing Albuterol, that the conditions child Calcium, has been Fish section. Oil having No increasin acute illn 2 PVT PUB None Asthma 16 PUB UNK NONE NONE NONE~ ()~NULL~~In Patient 1 PVT PVT seasonal allergies and asthma 3 PVT PUB None None 1 PUB PUB 1 cbc, cardiacMIL enzymes, MIL x-ray & ultrasound none pcn, sulfa, ees, flagyl, dilaudid, iv iodine 1 PVT PUB None None 1 PVT UNK KARATOSIS KARATOSIS PILARIS AND PILARIS ECZEMA AND ECZEMA 1 PVT PUB None None 3 none UNK UNK flomax, ASA, none-acuteDM( ultram, Lipitor,diet Omeperazole, controlled), metoprolol, HTN, CAD, advil GERD. 0 NONE PUB PUB NONE MOTHER STATES NONE-REPORTED NONE NONE~ ()~NULL~~In BY MOTHERPatient|NONE~ ()~NULL 1 PVT PUB none none 1 None UNK UNK Concerta 27mg nonedaily none 2 PVT PUB PVT UNK lexapro no allergy sulfa 0 Pulse ox 89% PVT initially PVT Flovent; Albuterol None Allergy to MUCOMYST; Has cerebral palsy; asthma; dysph 0 PVT UNK nail puncture bee 8/2/09 allergy only 2 OTH PVT SIMVASTATIN, NoneALENDRONATE, hyperlipidemia, LEVOXYL hyperthyroidism, decreased Bone density 0 PVT PUB None No illness- seen Nonefor well child eval. 2 PVT UNK none none 1 PVT PUB 22 9/14/09 ER/Hospital PVT Records PUB received DOS 8/4/09 None to 8/5/09. None.LABS 'Full body and DIAGNOSTICS: allergy' etiology Stool unknown. Heme-Positive. Abd 0 PUB PUB none none milk allergy and asthma 0 PVT OTH None None 1 PUB PUB None None None 1 None OTH PVT No NKDA PUB PUB No none 0 PUB PUB None None 52 9/15/09 LABS PVTand DIAGNOSTICS UNK received. Oral NonePathology Reactive Report Airway DOS disease, 2/13/08 -possible Biopsy Mandible Asthma. 9/24/09 right side Infecti - abn 2 none OTH PUB none None Mild asthma 1 WBC 20,100; PVT No infection PVTfound in exam none none 0 PVT PVT none none History of wheezing 0 PUB PUB ORTHO NOVUM irregular 1/35 menses None 1 po qd 2 PUB PUB
0 None PVT PUB None None None 0 none PVT UNK none none Overweight; dry skin 1 PVT UNK 5 UNK UNK no no 0 MRI, Heart-stress PVT test,PVT chest x-ray, blood tests (mercury, liver electrolytes, thyroid tests) PVT PUB None None None 19 IBS,post dramatic UNK mono UNK syndrome, None Anxiety. at thenone time of vaccination. none 0 Endoscopy,UNK CT Scan, MRI, UNK Transvaginal daily multivitamin ultrasound, none IgGnone and IgE allergy fatigue, testing, menstrual thyroid irregularities, tests, blooddigestive lipids, metabo issue 0 PUB PVT 0 PVT PVT None PCN; Codeine 0 blood pressure, OTH 07/27?/09, OTH fine; diagnostic laboratory, 07/27?/09, Unknown heart rate: fine WAES0908USA00788 26 Unknown Labs OTHand Diagnostics: OTH Gastric None Emptying study None (+) forPMH: decreased wrist surgery, bowel WAES0908USA00793 transit shingles, time. pertussis Hepatobiliary rxn./ scan W 0 magnetic resonance, PVT 06/17?/09, PVT normal; electroencephalography, Fruit allergy 06/17?/09, abnormal WAES0906USA03683 - see narrative; urine cultur 23 Blood pressure, OTH 01/21/09, OTHsystolic blood pressure Anaemia - 90 -of100s; Foetal prematurity; Renal distress; ultrasound, Hospitalisation; Premature WAES0908USA00966 01/21?/09, baby; Bronchopulmonary Bradycardia; mild dilationNeonatal ofdysplasia left rena re 153 Unknown OTH OTH None None WAES0908USA01712 Unknown OTH OTH NEURONTIN Unknown WAES0908USA01582 30 biopsy, 05/??/09, OTH diagnosed OTH with bullous Unknown pemphigoid Neuromuscular disorder (NOS) WAES0908USA01901 UNK OTH OTH No concurrent Unknown medication It was notedNo that reaction the subject A0802324A with the received first injection breathing of HAVRIX.~ treatments UNK OTH OTH No concurrent Unknown medication A0802329A 0 8/27/09 PCP PVT medical records OTH received AMBIEN; 8/7/03 CLARITIN to 10/03/05. asSeasonal needed LABS and allergies; DIAGNOSTICS: Anxiety RBC 3.72 mil/UL (L) HCT 36 3 CXR - (+) Left OTH lower lobe PVT infiltrate;None Positive Fluid None in majorNone; fissure(+) per Ptradiologist; had had one WBC prior8.9 episode after ATB. of wheezing 0 None PUB PUB None Known None Known None Known 0 PVT PUB No No None PVT PVT 0 None PUB PUB None None 1 None PUB PUB No No 1 OTH PVT Prozac No None ` 0 PVT PVT 1 PUB OTH None None 3 PVT PVT 523 PVT PVT 9 Flu negative/ PUB Strep negative. PVT None 0 See attached PVT PUB None 1 None PVT PUB TB; JHP Pharmaceuticals; Physical NoneLot number 111056; Route/site, Left forearm; Previou 0 PUB UNK AR0929 1 PUB PUB LA090802 1 PUB PUB None None reported LA090801 441 None; only PVT clinical exam UNK 1191 PVT PUB 860 Clinical exam PVT only PVT 1 Negative Strep PVT OTH None None Dymenorrhea Headaches~HPV (no brand name)~2~14~Patie 31 28th July, Nasendoscopy PVT UNK at hospital None None 1 PVT PVT None None 1 PUB UNK 0 None PVT UNK None NKDA, No chronic medical diagnoses PUB UNK None None None 0 PVT OTH Pt on LOESTRIN NKA PCOS 2 Wt loss 11-08 OTH --> 11-06PUB Acetaminophen Nonedrops None; 35 wk premature 1 PUB PUB None None 0 PVT UNK CLARITIN D None as needed None 1 PVT UNK NO FOOD ALLERGIES
19 Platlets 149, UNK Sodium 134, UNKC-Reactive NoneProteinnone 3.66 10/2/09 none Received medical records w/LABS: CRP 3.66(H). plts 0 none PVT PVT 0 UNK PVT Naprosyn None None 1 PVT PUB None None 0 MIL MIL 2 PVT PVT Not Applicable PUB PUB Not Applicable Not Applicable Not Applicable 1 N/A UNK UNK 1) ACETAMINOPHEN 59 YO M with Hypertension, TAB R subdural 650MGhematoma chronic PO Q6H alchol pain. s/p abuse, R2)craniotomy ALBUTEROL GERD,on cigarette 7/2/09 INHL,ORA 2/2 smok g 369 HHV6 PCRUNK positive-roseola UNK infection none8/24/09none Medical records febrile received seizures LABS: 8/24/09 HHV-6 Medical PCR(+). recordsVirus, received: CSF,PMH: bloodf 1 None. UNK PVT Unknown None reported. Allergic to penicillin 0 echocardiogram PUB pending UNK Yasmin, OCP no ADHD 2 None PVT PUB None None None 0 UNK PVT Simvastatinnone none 1 MIL MIL 0 n/a PVT PVT None givenPatient at clinic. denies No drug allergies. Patient has medical conditions of hypoth 0 PUB PUB none none none 0 PVT UNK ALBUTEROL NONE ASTHMA FEVER~Measles + Mumps + Rubella (no brand 0 GLUCOSE PVT 89 PVT NA NA OCCASSIONAL MIGRAINES 2 None PVT UNK Ethedent None None 0 N/A PUB UNK N/A N/A 1 no tests performed PVT PVT NA None Known NA 2 PUB PUB NO NO NO 11 PUB PUB none none none PUB PVT 7 n/a; UNK PVT Benicar, naproxen, none; Boniva, HTN,levothyroxin; osteopenia/porosis, hypothyroid; 12 CBC, BMP,UNK STOOL FOR UNK ROTAVIRUS, Ba ENEMA none STUDY. none9/3/09 Hospital records received DOS 8/11/09 to 8/14 1 PVT PUB 7 PVT PVT None None 0 PPD PVT PUB 3 PVT PVT None None None 0 None PVT UNK None None 1 PVT PUB None 1 PVT PVT None None None 0 PVT PUB None None None 1 PVT UNK None Alopecia; PICA; Eczema 10 None stated. MIL PUB MOTRIN; PRN None None 0 PUB PUB Astapron Veramist; Nasal Environmental Spray for sinus allergies 0 Pt sent for MRI PVTof brain; PUB EEG and ADVAIR; CMP (results ALBUTEROL; None pending)Trees; PREVACID; Grass; Mite; AllergyCat; injections; Molds (receives VERAMYST; allergy ZYRTEC shots) 0 None PVT PVT None 0 UNK UNK 2 PVT UNK Loratadine None 0 PVT PVT None NKDA - Healthy 1 none PVT OTH none penicillin, sulfa, milk, migraines 1 none PUB UNK 2 PUB PUB None None 2 PVT PVT None None 13 OTH PVT None Latex allergic 0 None; per pt PUB doctor states PUBanxiety. None None None~ ()~~0~Patient 1 PVT PVT ENULOSE; BACTRIM; hydrocortison; 8/15/09~Varicella albuterol (Varivax)~2~8~Patient 1 NONE PVT PVT ALEVE NONE NONE 0 PVT UNK ADHD
PVT OTH 1 UNK UNK 1 PVT PUB None None Eczema 3 MIL MIL 0 PUB OTH Acetaminophen-Codeine#3; Alprazolam; COZAAR; Diclofenac sodium; Fluoroura PUB PUB Cold beforeNone shots 0 MIL MIL Concomitant Drug(s) Not None Reported MEDI0008227 3 Unknown OTH OTH ascorbic acid; Macular OCUVITE; degeneration; aspirin; calcium Penicillin (unspecified); allergy WAES0908USA01904 hydrochlorothiazide (+); C Unknown OTH OTH Unknown None WAES0908USA01599 -69 Unknown PUB OTH Pregnancy NOS (LMP = 10/26/2008) WAES0902USA03594 26 Pulse oximetry, OTH03/10/09, OTH 94; Pulse Unknown oximetry, 03/10/09, 84, Premature on admission; baby; Respiratory Chest WAES0908USA01696 X-ray,distress; 03/10/09, Bruising atelectasis of face; or pne Jau 0 head computed OTH axial, 07/27/09, OTH negative None None WAES0908USA01728 0 electrocardiogram, OTH negative; OTH diagnostic Unknown laboratory, "CMP" Convulsion urine analysis; in childhood hematology, WAES0908USA01924 genetic blood tests negative 0 None OTH OTH Unknown Unknown WAES0908USA01957 10 15/Feb/2007: UNK Cultures UNK (+) Pseudomonas; SEPTRA; 02/Mar/2007: SULPHA DS"Strip"and The patientFlu had tests a bump (negative); on the ### Low backwhite of her blood left thigh cell count which 73 Hemocult (-); PVT Rota (+); PUB C-diff (+) 0 Pulse ox. inPVT ER 100% PVT SINGULAIR; None PULMICORT; AllergicZYRTEC; to milk, peanuts, CALCITRATE tree nuts, fish, shellfish, mold, du 14 LABS and DIAGNOSTICS PVT PVT6/10/09 to 6/14/09:Healthy Lumbar Puncture Seasonal - elevated allergies protein 207 mg/dL. MRI - Abnormal sig 1 None PVT PUB ADHD 0 PVT PVT Congenital imperforated anus, repaired; 35 wk gestation 0 None PUB PUB None None None 1 PVT PUB None Reported Shell fish; MSG 0 PUB UNK None PUB PUB None reported None reported None reported 1 PUB PVT None Bruise & swelling~Tetanus Diphtheria (no bran OTH OTH 2 Clinical Exam PVT PUB None Chronic disease of tonsil & adenoids 0 PVT PVT None 0 PVT PUB No No 0 CBC-4.7>15.0, PVT44.8, <221 UNK; Mono% 8.7(7), Eos% None7.2(7) None 0 9/2/09 ER records PUB received PUB DOS 7/29/09. None reported LABS None and reported DIAGNOSTICS: NKDA; AllergyUrine to crabs pregnancy and mites; test no (-).other conditions repo 6 PUB PUB None None None 1 PVT UNK None UTI 5 PUB PUB Motrin for fever None None Rash~Measles + Mumps + Rubella (no brand n 6 None PVT PUB None None None 2 PUB UNK Denies None None 2 PUB UNK None None None 1 Varicella_Zoster PVT IgG Ab, UNK >1.10, OD Ratio - positive, indicates past or current VZV infection, Immune; Ratio Interpre 0 PUB PUB None None None 1 PVT PUB 0 None PUB PUB None None None 0 PVT PVT None known 1 MIL MIL 0 PVT PVT 0 Rapid influenza, PUB Neg PUB 100mg Sertraline Healthydaily DepressionFever~Vaccine not specified (no brand name)~ 2 PVT PUB None None known Normal PAPPVT 6/13/2006, UNK 6/14/2007, 3/26/2008; None ASCUS HPV +, 8/13/2009 0 None OTH PUB None None None UNK UNK 1 H1N1 negative PUB PVT none NKA 0 UNK UNK
370 MRI by neurologist PUB - reported UNK reaction flonase, to employer birth None control November None 2008 0 exam by er PVT doctor UNK had tylenol none 1 hour before Allergic doctor to appt amoxicillian, to help with double shotpnuemathorsis pain at birth, ven 0 None. The PVT left deltoid PVT muscle is the none site of immunization with Vaqta/Hepatitis A vaccine. 1 CRT Scan showed UNK no PVT aneurism orBisoprol other structural Tab None generic problems. for Borderline ZIAC Followup 5/6.25MG hypertenson NRI with and and without watching contrast variousofunusual brain show neu 1 PVT PVT none knownNone Allergic to Penicillin 0 None in office. UNK UNK Flovent 44 2 None puffs bid Seasonal allergies, sore throat, Reactive eyelidAirway swelling~Influenza Disease (no brand 0 995.3-ALLERGIC PVT REACTION UNK 7/17/09 VACCINE no (Hepatitis asthma/ A vs measles, mumps, rubella) 1. Use a heating pad. 0 PUB PUB None No None 0 Blood pressure MIL was taken MIL and heart None. rate recorded. None. None. None.~ ()~NULL~~In Patient 0 PUB PUB 1 UNK UNK Advair none Asthma, allergy to nuts 1 See above UNK 9/24/09 Discharge UNK summary received NONE for datePREMATURITY of service 8/15/09. (31-32 EEG WEEKS and CTEGA) head9/24/09 normal,Discharge CBC, Elec 42 too many toUNK list. would UNK have to get medical records. consistant 8/24/09 extreme Same PCP asfull and #18. body oncology 8/24/09 Uticaria PCP medical andrecords oncology received medicalDOS records 4/15 6 PVT PVT none 1 None UNK PVT Patient received none "sedation nonemedicine" none~ from()~NULL~~In the dentist before Patient|unknown~ coming for well ()~NUL child PVT PUB None Seizure Disorder 1 PUB OTH None Asthma 1 PVT PVT 0 PVT PVT Claritin last None dose per 8/16/09; Parent Night Multivitamins; shades grass, Probiotic wheat,acidophilus; dairy, sugar,Grass eggs and weed m 1 None PVT OTH Pulmicort; Singulair; Stable asthma Albuterol Asthma; Alpha thalassemia 1 PUB PUB 0 None PVT PVT None Amoxicillin allergy 1 EKG Nl. Head PVTCT Nl. Comprehensive PVT Metabolic None Panel : Na Seasonal 132; o/w allergies Nl; CBC with diff Nl Cellulitis RtPVT upper arm.UNK KEFLEX 250 LANTUS; mg TidNOVOLOG; X 10 days warm Type GLUCAGON; compress I diabetes; Focalin; twice Aspergers daily. Glucose disorder 0 PVT PVT 0 PUB PUB Asthma 6 PVT PVT cat bite NKA 2 PVT UNK None GER; Eczema 1 PVT OTH None None None 3 PUB PUB 5 None PVT OTH None None None speech delay~Measles + Mumps + Rubella (no 1 PVT MIL 0 PVT OTH ARMOUR PO QD Allergies to AXID and Sulfa 2 none PVT PUB None None 1 PVT PUB 10 PVT PVT None None 0 PVT PUB Fever 103 0 PVT PVT 2 UNK PVT PVT TriNessa (Ethinyloestradiol Penicillin allergy; The subject +Sulfa Norgestimate) allergy had no alcohol A0786137A or tobacco use and there were 40 Dr Visits, Biopsy, UNK CT/PET UNKScans. 8/20/09 GYN none medical records none. 9/8/09 received. HeadAnnual & Neck PAP Clinic Smear. consultation 9/8/09 Head records & Neck DOS 0 None PVT PUB None None None Known Same as above~HPV (Gardasil)~1~11~Patient 2 CSF culturePVT (results: Positive OTH for Streptococcus Concomitant Unknown medications pneumoniae) 9/1/09-records Thewere patient andnot blood has reported. received-Upper culture a past USWYEH10544309 history (results: respiratory ofPositive wheezing for viral (during Streptococcus infection the wint 2w UNK UNK Not reported. ### 7 Unknown OTH OTH Unknown Stroke; Anaemia; Dementia; WAES0908USA02407 Hypersomnia; Alzheimer's dis 80 Electroencephalography, OTH OTH 11/??/07, YASMIN negative; Magnetic resonance, None 11/??/07, negative; WAES0908USA02226 Electrocardiogram, 11/??/07 1 PUB PVT None None None 1 PUB PVT None None None 1 None PVT PVT None None None Left shoulder PUB X-ray PVT LEVOXYL None Allergy to Sulfa - HX: decreased THYROID. 0 None PUB PVT NKA None None 0 PUB PUB TOPROL; DOXYCYCLINE; No Allergy BENTYL; to shellfish. Mother SHELAXAN allergic NC09032 to>TETANUS X 2 yrs. vaccine~Tetanus
1 PVT OTH None None NC09034 0 PVT PVT Lisinopril/HCT; None ASA 81HTN; mg; AMBIEN dyslipoproteinemia; Osteoporosis 1 PVT PUB None None None NC09033 38 OTH OTH Concomitant Drug(s) Not Reported MEDI0008737 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008739 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008740 24 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008742 18 OTH OTH Concomitant Drug(s) Not Reported MEDI0008744 21 OTH OTH Concomitant Drug(s) Not Reported MEDI0008746 4 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008747 15 OTH OTH Concomitant Drug(s) Not Reported MEDI0008748 7 OTH OTH Concomitant Drug(s) Not Reported MEDI0008750 21 OTH OTH Concomitant Drug (s) Not Reported MEDI0008752 30 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008753 22 OTH OTH Concomitant Drug(s) Not Reported MEDI0008754 2 OTH OTH Concomitant Drug(s) Not Reported MEDI0008755 20 OTH OTH Concomitant Drug(s) Not Reported MEDI0008756 24 OTH OTH Concomitant Drug (s) Not Reported MEDI0008757 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008758 1 OTH OTH Concomitant Drug(s) Not Reported MEDI0008759 0 Glucose=95PVT Pulse= 82 PVT and regular NONE BP= 102/60, NONEbrachial, WELL Patient CHILD sitting has seasonal allergies. 0 PVT PVT Tenex Tic disorder, OCD, Anxiety disorder 18 No tests have UNK been performed UNK yet. Visit to the none pediatrician. noneNo9/4/09 diagnosis crying Medical given uncontrollably~DTP records yet. Dermatologist received(no w/PMH: brand appt.pertussis name)~1~ schedulev 0 PVT PUB none near faiting PUB PUB 1 PUB PUB none none 266 PVT UNK Simvastatin,None Niaspan, Flonase Hyperlipidemia, Nasal Spray Obesity 1 NO LABS DONE. PVT PATIENT PVT EVALUATED NO OTHER BYNO MEDICATIONS NURSE ILLNESS AT NKA, 5:30.FEVER AT NO TIME BIRTH OF OF VACCINATION DEFECTS, 99, INJECTION NO MEDICAL SITES BARELY COND NOTIC 0 Head Ct, MRI, PVTEEG, bloodwork, PVT toxicology screen None allergic to erythromycin per mom 13 Coombs test, UNK CBC, others. UNK 8/21/09 none Hospital records none received none DOS 6/26/98 to 7/3/98. LABS and DIAGNOSTICS: C 18 Systemic Lupus PVT Erythematosus; UNK Raynaud's. 9/16/09 Rheumatology records received DOS 4/28/09 to 9/9/09. LABS 0 Head CT normal; PVT Chem PUB normal. 8/31/09 Children's ERMOTRIN Slight / hospital cough records Hx of seizures. received 8/31/09 DOS 8/17/09 ER / hospital to 8/18/09. records LABS received and DIAGN DO 0 EEG pending; PVTEKG normal; PUB BMP normal; Magnesium normal; PMH: CRP rash on normal cheeks, Labseczema and diagnostics: EKG WNL. K+ 6 2 PVT PUB None None None UNK PVT None None None PVT UNK 17 unknown OTH PUB METOPROLOL 50 BID; IMOUL 20 AD; LIPITOR 50 QHI; ADVAIR L50 150 1 puf 2 PVT OTH PREVENTATIVE 18 PVT PUB 0 None PVT PVT None administered None Seizure disorder 2 PVT OTH 0 None MIL MIL Benadryl None No medical conditions; No Congenital Defects; Allergy: Sh 1 PUB UNK None None 1 PVT OTH Imuran 50mg None Ulcerative Proctitis 1 None low grade PVT temp (< PUB 105 F), erythropiesis None None None 0 none PVT PVT none none none 460 10/6/09 PCP UNK medical records UNK received Flonase DOS 7/30/08 None to 8/27/08. LABS Seizure; and DIAGNOSTCS: Hashimoto Thyroiditis; CBC - RBC compensated 3.84 Mill/uL h 21 UNK UNK Soreness atNone injection site from Gardasil. 0 none PUB UNK no no allergies seasonal 1 UNK UNK none no none 10 8/31/09 Hospital UNK records UNK received Keppra DOS 2/5/09None to 2/16/09.History LABS of and seizure DIAGNOSTICS: with febrile EEG illness, - Abnormal. was prolonged, Chestthus X-ray
0 none PUB UNK Client states Client nonestates none 1 UNK UNK 0 CBC wbc 7.9, PVT ly 29.0, gr PVT 59.3, hct/ hgb 40.6/13.9, mild URI plt 248 0 UNK UNK none 1 8/25/09 Hospital UNK records UNK received None service dates None 8/18/09 Developmental to 8/21/09. LABS Delay. and DIAGNOSTICS: 8/25/09 HospitalCHEM records- Glucose received 14 s 0 None PUB PUB None notednone latex 1 PVT PUB celexa 40mg none social difficulty, borderline Aspergers. 0 PUB PVT mild lactose intolerance, previous temporal aneurysm 1 PUB PUB Running nose RSV and 12/28/07; cough Asthma 6/25/09; Bronchiolitis 6/25/09 1 PVT PVT none none none same as this time~Influenza (no brand name)~ 2 MIL MIL ALERGY TO AMOXICILLIN AND NICKEL 344 CBC, CMP,UNK CT, PET, supraclavicular UNK lymph node biopsy.9/1/09 9/1/09PCP PCPmedical medicalrecords recordsreceived receivedDOS DOS7/15/08 7/15/08toto1/19 1/1 2 MIL MIL 0 urine beta-human, OTH negative; OTH beta-human Unknown chorionic, Pregnancy positive NOS (LMP= Unknown)WAES0804USA01984 19 Jan. 2, 08 -PVT Blood CBCUNK - ESR; Jan. DIOVAN; 2, 08, Comprehension SIMVAS None Hypertension; CMP, TSH, ANA Hyperlipidemia; and Rheumatoid Shellfish; factor, Prinivil. Neurological 8/27/09 N e 7 Ultrasound PVT suggestive PUB of intussusception. Contrast enema Milk diagnosed/reduced protein intoleranceintussusception. WBC 20.9 0 CBC/RASTPVT UNK Penicillin allergy; History of incarcerated (L) inguinal hernia 10 MRI (normal); PVT chest X-ray PVT(normal). None None Environmental allergies; dairy intolerance. 1 PUB PUB None None 32 Err:508 PVT UNK No Insulin dependent + Diab Mellitus Type 1; Celiac Sprue; P 0 PPD/Mantoux, PVT ID Lt forearm PVT None None 1 None donePVT PVT Pt is on ZYRTEC None for seasonal None allergies Only low fever~ ()~~0~Patient 4 PVT PUB None None 1 PVT OTH Same 0 PUB OTH QVAR; SINGULAIR; KOPENEX; ALVESCO 0 None PUB OTH None Demerol PVT UNK 1 BENADRYL; PVT TYLENOL PVT BENADRYL; TYLENOL 1 None PVT OTH None None None None OTH PUB None known None NKA or conditions 2 UNK UNK VYVANSE None 20mg; ABILIFY None5mg 0 UNK UNK 0 None UNK UNK My oldest daughter has seasonal allergies, ovarian cysts, 6 not known PUB PUB none denied none 8 Normal CBC, UNK CHEMISTRY, UNK MILDLY none ELEVATED noneLIVER none EMZYMES, NORMAL CK 8/25/09 Medical records receive 0 None PUB PUB None None we are Did aware not receive of. full dose~Measles + Mumps + R 25 Tilt table test UNK and echocardiogram. UNK 9/29/09 PCP No medicalnone. records 9/29/09 and multiple PCP medical consultations recordsreceived and multiple DOSconsulta 7/18/05 1 PVT PVT none Cefizil - hives 17 UNK UNK OmeprazoleNone 20mg/daysulfa, penicillin 0 PUB PVT None Denies illness None at time of None~ vaccination. ()~NULL~~In Patient|None~ ()~NULL~~ 12 Lab results PVT found elevated PVT muscleNone enzymes, at thatNone sed time rate, etc. None Muscle at that Biopsy Muscle time. performed 8/27/09 Cramps~HPV Hospital at Hospital (Gardasil)~1~15~Patient records in Jan received. 09 resulted DOS 0 none PUB PUB no 2 PVT PVT 1 PVT PVT 1 none PVT PVT none none none 0 MIL MIL none Benadryl ALLERGY 1 North Kansas PVT City Hospital: OTH BloodNone test. Children's None MercyNone Hospital: CT scan, lumbar puncture. 9/1/09 ER records r 8 pending UNK UNK none none none 0 PVT UNK Possible dehydrationNo Allergies, patient Migraine told headaches, EMT's that she Smoker. had not had anythin 7 HEMOCCULT PVTPOSITIVE PUB NONE NONE STOOL NONE SENT FOR CULTURE 1 None PVT PUB None no allergic to penicillin (gives rash)
3 PVT PVT Recent wheezing/ viral uri...had resolved by date of vaccination 71 3/27/08 urinalysis UNK w/o 6/21/08UNK CT.9/17/09 6/22/08 EREcho, records transthoracic received 9/17/094/5/08 (2D), ER records to doppler, 5/27/09. received cardiography NuvaRing. 4/5/08 to color 5/27/09. flow velocity Thyroidma cy 0 PVT PVT URI mild nasal NOne congestion mild cough no fever 6 None PVT PUB No None 0 PUB PUB Depo-Provera None None 1 none PUB PUB ORAL CONTRACETIVES DENIES DENIES -ORTHO TRI CYCLEN LO 3 PVT UNK 6 None PVT PUB None No None 5 She was told UNK she has pots UNKdisease. none Urin andnone blood worknone and EKG 9/15/09 were Received good. Heart medical raterecords goes way w/PMH: up when Allergy: sittinP PVT PVT Seafood-hives, sudafed-hyperactive, metal-rash. 174 EEG, EKG,PVT CAT SCAN, UNK HEART HALTER BIRTH CONTROL MONITOR, NONE - YAZ TILT NONE TABLE TEST BLOOD WORK 0 PUB PUB 2009PH01 0 PUB PVT No Mother was surprised that child fainted with vaccinations b 0 PUB PVT N/A 1 hemoccult positive PVT PVT none 0 none PVT PVT none none Allergies: Sulfa, exacerbation clarithromycin, of dishydrotic mango eczema~Yellow fev 0 NONE PUB UNK NONE NONE NONE 9 n/a PVT PVT none. none. Left lower neck/shoulder cavernous hemangioma. 1 PVT PVT Desogen No Depression 1 MIL MIL None No None PVT UNK Concerta No ADD, Premature(28 week gestation) 0 PVT UNK Sprintec 28-day Epilepsy - age 4-8, then diagnosed with syncope. Allergic 0 PVT PUB none seizures, developmental seizures~Hepdelays, B (Genhevac hypotonia, B)~1~0~In scoliosis Patient 0 UNK UNK Lyme Disease PMH: DM, HTN, Hypothyroidism Allergies: 0 I have not had UNKany relevant UNK tests done to support my claims, I have because no other it was relevant always history. late at I don't nighthave whenany mydrug problems uses 1 None PVT PVT LISINOPRIL None-Well 5mg + qd;visit/annual NKMA TRAZEDONE 50mg + @ hs 1 None OTH OTH Byetta , Gabapentin. None Imipramine, Diabetes hypothyroid; OmeprazoleGERD anxiety; Depression. 1 None PVT UNK Well child visit Juvenile Rheumatoid Arthritis 1 PVT PUB None 0 PVT PVT None None None~ ()~~0~Patient None. O2 Sat UNK(room air) UNK 100% None Latex allergy PVT UNK 0 OTH PUB None 0 UNK UNK Baby is allergic to disposable diapers. 5 UNK UNK Allergies: MORPHINE, PERCOCET, CODEINE 1 PVT UNK None Colon polyps; 32 weeks Gest age at birth; Seasonal Aller 0 PVT PUB None None Stress hyperglycemia 0 PVT PUB Bee Stings 3 None PVT PVT None None None 1 None PVT PVT None None None 1 CBC; Blood PVT cultures OTH None Reflux; Hypothyroidism; Allergy to DEMORAL 0 PVT OTH No None 1 PVT PUB None None None 1 PVT PUB No 1 PUB PUB 0 PVT PVT None None 2 OTH OTH ENALAPRIL - LEXAPRO - FEXOFENADINE- LOVASTATIN - COMBAVENT 0 PVT PUB None None 10 PVT PVT 0 PVT PUB Keratosis 1 None PVT OTH SINGULAIRNone None
8 Hemoccult + PVT UNK None None 718 PVT UNK 1 MIL MIL None Extensive back surgery 1 12 mo WCC PVT UNK None None Milk allergy; Reflux; Hydrocele Bilateral 1 None PVT PVT NASONEX;None FLOVENTAsthma HFA; SINGULAIR 1 None PVT PUB None None None 1 None PVT PVT None None Flat foot, exposure to lead - no lead level done 214 whole bloodOTH mercury, results OTH cameNone back fine; serum Al, results None came back fine WAES0908USA02717 0 Unknown OTH OTH None None WAES0908USA01951 Unknown OTH OTH Unknown Unknown WAES0908USA02263 1 cardiac monitoring, OTH results OTHwere fine; ORTHO total heartbeat EVRA Migraine; count, Drug 8/28/09 07/29/09, hypersensitivity ER records 200, beats received WAES0908USA02768 per minute; DOS 7/29/09. total heartbeat Caffeine. count, 0 temperaturePVT measurement PVT 6/11/09, Unknown 100 deg None WAES0906USA04117 11 hearing test, OTH 08/??/09,OTH results not LIPITOR; provided; COREG; otic Deafness procedure, digoxin; unilateral; Dialysis 08/??/09, NEXIUM; Hypertension; "ear LASIX popper" (furosemide); WAES0908USA02786 Diabetes; Coronary LANTUS; artery HUMULIN; disease 7 Not reported UNK UNK The patient has no known allergies ### and denied any medica None PUB PUB None None Child had a seizure at birth. MI2009008 14 None PUB PUB none none 1 PVT PVT No Right brachial plexus. 1 PVT PUB None None None 0 Sent to ED PVT PVT 1 Lyme titre; CBC; PVT ESR all PUB pending Amoxicillin 0 PVT OTH None None Adhesive 1 PVT PVT None None None 0 PVT PVT None 1 PVT PVT None Allergies Hives~ ()~~22~Patient 0 None PVT PVT Poly-VI-SOL/Iron None solution None 1 None PUB PUB None None None Known 0 PUB PVT 1 PUB PUB 1 PVT UNK No No 5 None PVT PUB None None 0 None OTH OTH None None None PVT UNK None None 1 PVT PUB None None AMOXIL 0 None OTH OTH Blood pressure Nonemed Latex 1 PVT PVT None No No 1 Cellulits of the PVTarm PVT aricept, furosemide, aspirin, remeron, metoprolol, levothyroxine, humalog, insulin MIL MIL Nothing noted in record 2 None PVT PVT Synthroid, ibuprofen No Hypothyroidism 0 UNK UNK 7 None PVT PVT Aspirin None None 3 none PVT PVT none none none 20 MIL MIL NONE ACNE 0 UNK UNK None 1 PVT PVT none none none 2 No testing done. UNK Patient UNK evaluatedNONE by Dr. Fraschetti. NONE NONE 0 N/A PVT PVT Kaletra, Truvada, Needlestick, Norflex PCN, BBF andIodine, exposure, Prilosec Shellfish work related N/A MIL MIL 1 PUB PUB Zithromax for Yes, ?infection on Zithromax for infection. No fever. 1 PUB PUB 7 None Known UNK UNK Unknown Non reported 8-20-09 A neuro-muscular disorder was reported by the m 1 MRI of spine PVT and headPVT normal, ionized calcium none 1.10, WBC none 13.89, CPK 114, creatinine 1.1,Na 147
UNK UNK NONE NONE NONE~ ()~~0~Patient 2 PVT PVT PrednisoneNone 2.5 mg daily; Bechet's Zantacdisease 150 mg daily; Calcium/Magnesium one daily 0 N/A PVT PVT 0 PUB PVT Allegra no allergic to Penicilen and sulfa; history of passing out 2 UNK UNK The patient is on albuterol, flonasse and flovent 2 PVT UNK NONE 1 UNK UNK 0 Positive ANA, UNK PostitiveUNK EEG. LABS and DIAGNOSTICS: none none. Lumbar Chronic Puncture lower-back Normal. pain.MRI Seasonal Head and allergies. Spine Bilatera - Norm 1 PVT PVT FORTICAL None NASAL SOLN Alergy ASPIRIN to Cipro None~ 81 & MG Macrobid ()~NULL~~In LEVOTHROID HYPOTHYROIDISM Patient|None~ 75 MCG TABS ()~NULL~~ OSTEOP CYA UNK PUB OTH Prenatal vitamins Unknown (Potassium iodide + Potassium A0758632B sulphate + Calcium salt + Phos Colonoscopy, OTH Normal; OTH Sigmoidoscopy, Mercaptopurine; Abnormal Bloody Sulphasalazine; Mucus; Rectal;Prednisone Bleeding; Ulcerative B0589174A Proctitis; Uveitis UNK OTH OTH MERCAPTOPURINE Unknown Bloody mucus; Leukopenia; B0589174B Loose stools; Rectal bleeding 47 Unk OTH OTH Unknown R0005824A 1 OTH PVT Lisinopril; ASA None Low dose; Benign Multivitamin; heart murmur. Glucosamax; Chondroitin 2 PVT PVT MVI None None Rash~Vaccine not specified (no brand name)~ OTH PUB 0 PUB UNK None None None 0 None PVT PVT None None None 1 PUB PVT None None None 1 None OTH OTH None None 0 PVT UNK BENTYL; Birth None control Irritable pills; VALTREX bowel 0 PVT PUB None None None 1 PUB PUB No No 0 PUB PUB July o9 ? Asthma~DTaP + IPV (KINRIX)~9~5~ RAST testing PVT for latex-PVT Negative 6/29/09 None None 0 OTH OTH CITALOPRAM None None 1 None PVT PVT None None None 1 None PUB OTH None 1 PVT PVT BENADRYLNo None 0 Upon arriving UNK at the ERUNK at Medical Center, prior Moderate to seeing pain Asthma, theatdoctor, injection seasonal Pain, thesite nurse dizziness, allergies. took severe my 9/1/09 vitals headaches, ERand records noticed received vision-shak that one D 2 PVT PVT none cardiomyopathy, hyperlipidemia, a-fib, hypothyroidism, div 2 PVT PVT none none none tantrums/irrational~DTaP + IPV (KINRIX)~UN~ 0 8/31/09 Received PUB medical UNKrecordsLISINOPRIL LABS: CT none scan 2.5mg brain none abnormal. 8/31/09 Received medical records PMH: HTN 0 PVT PVT None asthma 0 UNK UNK none none 0 Was in the PVT ER with vitals PVT monitored. None We don'tNone have the data. None Hospital None~ could ()~NULL~~In not do bloodwork, Patient said sample was c 0 UNK UNK NO Allergic to trees, ragweed0 Blood tests PVT 7/14/09 (allUNK normal) including UPS Thyroid aldolase, None CBC Hypothyroidism; w/Diff;CPK;C-Reactive Allergies: Protein;Sed Pencillin, Rate. Sulfa MRIs drugsdone 8/80 0 UNK PVT Microgestinnone none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 1 UNK UNK latex, amphicillin, depo provera PMH: seasonal allergies, 0 Clinical lab PUB tests performed UNK at ED;81MG unknown ASPIRIN as NONE to what DAILY specific AMPICILLIN tests were performed but ED Attending indicated al 0 blood, urine, PUB analysis of PUB fluid from Verapamil, bursa sac General Acidophilus, ill health, Ankylosing Ciprofloxacin bacterial Spondylitis, overgrowth hypertension, in small intestine. mesenteric ischemia 2 PVT OTH None None None known 1 N/A PVT PVT synthroid, lasix, N/A zestril,Asthma, singulair,flexeril,megadose Hypertension, post-thyroid vit. D, Ca,K,Fe CA and B12 20 12/30/09 Lab PVT glucose 348; OTHSodium 136; Potassium None 3.5; Chloride None 103; CO2 9; Urea Nitrogens 14; Creatinine 1.0. 9 0 See attached. PVT9/9/09 Hospital UNK records received None DOS 4/17/09 Noneto 5/6/09. LABS and DIAGNOSTICS: Urine and plasm 1 OTH OTH none none none 2 PVT UNK PropranololNone 160; lovastatin 40mg 405 PUB PUB None Scoliosis; Allergy to Molds Fungus 0 Lateral neckPVT X-ray; Direct PVTlaryngoscopy None by ENT Milddue URI toby clinical None history concern of epiglottis (ruled out). 8/31/09 Hospital m 0 Did X-Rays;PUB CAT scansUNK None None None
1 No erythema. PVTDecrease PVT shoulder ROM. PainNone on palpation. None 1 None PVT OTH None None Per mother sick~Varicella may have had(no reaction brandto name)~1~0~Patient previous varicella 47 Had EKG; PVT Blood test; PVT Inner Ear, None sit, stand testsNoneEverything Nonecame back normal. 1 None PVT PVT None None 0 None PVT OTH None None None None PVT PVT None None None 0 diagnostic laboratory, OTH 07?/??/08, OTH normal; Unknown stool culture, 07?/??/09, Unknown no bacteria found WAES0908USA02573 366 Echocardiography, OTH 08/??/08, OTH Negative; Unknown Body temp, 08/12/08, Unknown 104 F; Blood culture, WAES0908USA02787 08/??/08, Negative; WBC cou Unknown OTH OTH Unknown Ear infection; Gastrointestinal disorder; WAES0908USA02477 Adverse event 0 Unknown OTH OTH None WAES0908USA02404 0 Unknown Labs OTHand diagnostics: OTH MRI brain WNL. EEG WNL. None MRI c-spine with WAES0908USA02799 bulging cervical discs Unknown OTH OTH Unknown Pregnancy NOS (LMP=Unknown)WAES0908USA03124 1 None PVT PVT None None None PVT UNK 1 None PVT PVT None None 1 PUB PUB Unknown None None reported 25 PUB PUB None None None, NKA 0 EKG (=) normal PUB OTH Food allergies-pizza, corn None MIL MIL None None None PUB PUB Stop BC 2 weeks at timeprior; unknown None Birthpregnancy Control; MOTRIN PRN 1 week ago; OTC - since me 2 PVT PVT COPAXONE; PRONGIL; Multiple GABAPENTIN sclerosis 1 PVT UNK No None 2 None PVT PUB PPD None None 1 PUB OTH None None 1 vital signs; measured PVT redness PVT None None 0 None PVT UNK DEPAKOTENone 250mg 3 tablets Known PO seizure BID disorder x4 yrs ago 3 PVT PVT 1 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0803375A medical history. A no reported 32 UNK Labs and PVTdiagnostics: PUB Abd US No (+) concurrent mass, Unknown ? medication IS. Contrast The subject enemahas (+) no for relevant ileocolic A0803583A medical IS. Repeat history US (-) and no history 5 PVT UNK Zocor, Allegra, None Vitamins Peripheral vascular disease 0 Was testedUNK for the flu during UNK doctor visit and was nonenegative. asthma 1 na PUB PUB none none 0 none PVT UNK none no none 1 PUB PUB none notednone noted 0 PVT PVT Zyrtec prn slight stuffynone nose, cough 0 PUB PVT List includes anaphylaxis PRN meds Allergy (immediate) / standing to ace orders inhibitors over (swollen one month lips,hospital a sign of stay:Tylenol angioedemP 3 some temp,PUB difficulty breathing, PVT tired, none pain in arm noneupset stomach none 1 EKG and Chest UNK X-ray within UNK normal limit results no none SC0920 2 None UNK UNK none none none SC0919 2 PVT OTH none none Regression~DTaP + HepB + IPV (Pediarix)~UN 0 MIL MIL None None none~ ()~NULL~~In Patient 0 PUB PVT 1 n/a UNK PVT n/a 0 N/A PVT PVT N/A N/A N/A 27 PUB PUB no none MO200918 0 N/A PUB PUB none no medications, no medical MO-2009-19 conditions 0 NONE UNK PVT NONE NONE 8 PUB UNK None known PCN 0 PUB PUB Denied Denied Neuropathy 1 Throat swab UNK negative from UNK KU Watkins None Clinic. at theNone time at theSeasonal time. allergies; ADD; acne 2 Was evaluated PUBby heart PUB monitor atNone her office of None employment None (Dr. Sinnathamby). NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S
2 PVT PVT N/A N/A 212 urine tests(2x); UNKfull blood UNK work (2x), naupper/lower na GI; stoolpenicillin cultures (2x); CT scan Urinalysis: PH 5.0 (L), Blood 1+ (H 14 Had blood drawn MIL from UNK Lab on 24 August 2009, None located at the Thomas Moore Clinic. Doctor scheduled a consult to 7 PVT PVT 5 MRI negative. PVTLABS and PUB DIAGNOSTICS: MOTRINCHEM - Postassium H/O asthma/RAD; 5.1 mmol/L (H) Previously CO2 29worked mmol/Lup (H). forCBC incontentia - MCV 70 pig 0 PVT PVT 6 HVA; VMA.PVT LABS and PVT DIAGNOSTICS: AMOXIL Urinary 400mg/5mL; Eczema HVA (-) VMA MUPIROCIN Eczema. (-). MRI Ear Brain 21 tubes.- Normal. X-ray Femur - Normal. 6 PUB PUB No No Unknown - none of conditions on screening form for teen i 2 OTH PVT 105 Seen by dermatologist PVT PVT - elsewhereNone None None 7 CK fractionated, PVT CBC, PVT aldolase, ESR None all nl; CRP None 1.2. LABS None. and9/23/09 9/23/09PCP PCPrecords recordsreceived receivedDOS DOS8/10/09 8/10/09toto8/30 8/3 8 None PVT PVT None None None 2 PUB OTH 0 CXR normal, PVT CBC normal; OTHEKG rhythm NL None None 1 PVT PVT None at time None of vaccination 1 PVT PVT PPD None 0 None PVT UNK None None 2 No tests were OTH done PVT PROZAC; BUSPAR Sinusitis Sulfa; Amoxicillin Proteinuria/Hypoalbuminemia. PVT PVT 10/2/09 DULAPRED Hospital None now records, None. allergy/immunology 10/2/09 Hospital andrecords, neurology allergy/immunology consults, receivedand DOS n 2 PVT PVT 2 PVT PVT No No 1 None PVT OTH None None 0 Rast test forPVT latex and PVT gelatin allergy in 4 wksNone (of 2 wks.)club foot, cloacae exstropory, latex allergy None PVT PVT None Cough; Runny Nonenose; SL. fever OTH OTH None 1 WBC=13.0 PVT with 84% Neutrophils; PVT NASONEX; On steroids;None CELEXA CRP>0.3,40 Penicillin; Sed mg;Rate ELAVIL; Migraines =10 IMITREX; Multi vitamins; Naproxen; TRISP 1 none PVT PUB none none none 3 None PVT PUB None None None 10 None PVT UNK None None 0 PVT UNK Unknown Similar blisters with insect NC09035 bites 1 PVT UNK None None 1-7-08- Allergic / 12-13-05 NC09036 allergic Rhinitis 1 none MIL MIL ibuprofen denies denies Large local reaction to AVA # 7 admin in April 0 PUB PUB ZANTAC None GERD 2 None PVT OTH None. Zantac. None None 0 9/8/09 Hospital PVTrecordsPVT received DOS 8/20/09 to 8/21/09.Eggs; LABSPenicillin. and DIAGNOSTICS: 9/8/09 Hospital IgErecords 2564.5 received IU/ML (H). DOS Heart 8/2 16 Ba Enema reduced PVT intussusception. PVT None 9/1/09 Hospital None records Nonereceived DOS 6/28/09 to 6/29/09. LABS and DIAGNO 712 DepressionPVT - anxiety disorder PUB 1 Due to behavioral PVT decompensation, PVT BUPROPION; he was referred CLONIDINE; to neurologist Obesity; FLUOXETINE; Sleep and geneticist. and aggression CONCERTA; Genetic evaluation SYMBYAX;currently TOPOMAX und 96 8/27/09 Hospital UNK records UNK received DOS 2/23/09 to 2/28/09. LABS and DIAGNOSTICS: CBC - RBC 4.00 m/uL (L) M 10/2/09 Medical UNK records UNK received for date of service 9/2/09 10/2/09 Diagnostics/Labs: Medical records CT,received EKG, CXR for Normal. date of service CBC w/diff9/2/09m 69 None Labs OTH and diagnostics: OTH pelvicNone US WNL None WAES0908USA03209 Unknown OTH OTH Unknown Unknown WAES0908USA03257 None OTH OTH LIPITOR; DIAZEPAN; Diabetes; Hypertension Brain glyburide; neoplasm lisinopril; JANUVIA; WAES0908USA03151 AMBIEN Unknown OTH OTH alprazolam;Sulfonamide hydrochlorothiazide; Anxiety allergy SYNTHROID; WAES0908USA03203 potassium (unspecified); quinapri 0 None OTH OTH COSAMIN DS; DrugCENTRUM hypersensitivity Stroke SILVER; omega-3WAES0908USA03208 marine triglycerides; ZOCOR 1 None PVT PUB None None None 2 None PVT PVT Pauciarticular JRA None PUB PVT No Dx at age 6yrs with GBS 2 None PVT PVT MULTIVITAMIN/TYLENOL None None 5 Pt verbalizes OTH understanding OTH to follow NIASPAN; up with TOPROL Rash his physician. with blisters None to (L) shoulder 2 None OTH OTH none
1 2
PVT UNK Hepatitis B PVT UNK Prenatal multivitamin; None Seasonal PARLODEL Allergies; Hyperprolactinemia PUB PUB 0 PVT UNK Albuterol Inhaler; PYRYDIUM 1 None PVT UNK None Congenital heart condition 0 None PUB UNK None 0 PVT PUB None None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 PVT PVT Zyrtec, motrin,Tylenol none started none Keflex 500mg TID on 8/24/09 0 none PUB UNK SIMVASTATIN none80MG TAB none Sig: TAKE ONE-HALF TABLET BY MOUTH AT BED 0 MIL UNK BPH, hyperlipidemia, tinea unguinum, GERD, Ischemic He 1 MIL MIL alprazolam 1 mg 3 times morbid a day; obesity; amlodipine connective 10 mg tissue daily; cyclobenzaprine diseases; esophageal 10 mgme 1 Ultra soundPUB venous doppler UNK report,n/a radiology,None blood workDiabetes incl: CBC, CMP, CPK. 2 UNK PVT Levoxyl, Flonase, none sinusitis 2 none UNK UNK NO NO 2 Labs: WBCs UNK 17K-23K UNK with decreased SYNTHROID, lymph% POST-OP and BABY increased ASA, VAGINAL UTERINE NEXIUM,SULINDAC grans%, SURGERY, PROLAPSE WNL byUTERINE d/c. PMH: UAGERD. (+) PROPLAPSE blood, Uterine 1+ leuk prolapse est, 6-10 jus 0 During phone UNK call, mom UNK said that "we're waiting None. on test results, None per butmom so farafter everything I asked has her been routine fine." screening question 0 PUB PVT No No No 7 UNK PVT amlodipine none besylate 5mg none tamyl 6 none besides UNK the histology UNK of the heart. None None, maybe jaundice several days after birth 65 OTH OTH COPD 0 PUB PUB no no no 0 N/A PUB PUB 1) Pantoprazole None40mg No daily known 2) Metformin allergies.500mg Medical daily conditions: 3) Benicar Diabetes, Hctz 40-25 Hyperte daily 54 Lumbar puncture UNK negative, UNK blood work none negative. NoneMRI- lesion Mitralmyelin Valve cervical. Prolapse.2nd 9/8/09 MRIHospital now shows records 2ndreceived lesion onDO th 1 N/A UNK UNK N/A N/A Premature with Bradycardia and Intracranial Hemorrage. C 2 UNK UNK None None listed 2 PUB UNK Nexium, Ultra none MT 12, Calcium, high cholesterol omega3, sameand as anti-inflamatory above~Hep acid reflux A and + Hep antiB (Twinrix)~1~10 cholestrol 14 None UNK UNK None None NKDA, No medical conditions 0 None PVT PUB none none none 29 Endoscopy,colonoscopy, UNK UNK multiple none stool specimens, none blood8/31/09 tests ,Ct PCP scans,& none~ Note()~~0.00~Patient x-rays. DOS 2/9/07. LABSFever, and DIAGNOSTICS: nausea. Cough.End Or 0 PVT PUB was prescribed nonePULMICORT; here for - none vaccines -EPI PEN; only Prednisolone; BENADRYL 1 PVT PVT none knownnone none 0 UNK UNK none no Mild asthma PUB PUB levothyroxine none hypothyroid 1 none PVT PVT none no none 1 none PVT PVT none no none 1 PVT UNK 1 PVT PVT ASA; Metformin; None Lisinopril; Diabetes; Verapamil; No allergies HCTZ; Simvastatin; GLUCOTROL. 0 None OTH OTH None None 7 UNK PUB PPD None 9/3/09 PCP medical records received DOS 4/1/08 to 8/18/ 0 PVT PVT None ~Pneumo (Prevnar)~2~0~Patient|~Rotavirus (R None PVT PVT None None None 0 none PVT UNK none none none 1 None PVT PUB None 9 PUB PVT Lisinopril; BONIVA; ZOCOR 0 PVT PVT 0 None PVT UNK Albuterol None None 7 OTH OTH PRILOSEC;None Hydrochlorothiazide; None Provocol 2 Not known PUB PUB Possible spider bite AR0930 1 Shingles dxPVT confirmed PUB at uregent care; Aspirin; Neg Lisinopril; eye None exam. Metformin; Diabetes; Metoprolol; CAD; Hypertension; PLAVIX; Pravastatin; Hypercholesterolemia; VIAGRA BPH 0 In ER and Hospital. PVT 9/9/09-records PVT received-CT normal. 0 PUB PUB
0
PVT PVT None None None none UNK PVT none h/o mollusctum none 6 Had normalPUB blood and OTH urine tests None day of seizure; None EEG is Hx stillfebrile pending. seizure 2 PVT PVT Hives~DTaP (no brand name)~4~2~Patient 1 UNK UNK No Allergy to sulfa + Lisinopril 1 UNK OTH None 0 PUB PVT None None 1 None PVT UNK None None 1 PUB UNK None None 1 PUB OTH None None None PVT PVT None None 0 PVT OTH Lisinopril HCT; None CIALIS;No Metoprolol; drug allergies; Simvastatin; High Cholesterol; Fenofibrate; Diabetes; Amlodipine; SleepVitamin apne 0 PVT PUB None None ~DTaP + IPV (KINRIX)~2~5~Sibling 0 PVT PUB Mild URI ? allergy to ~Measles cashews + Mumps + Rubella (MMR II)~2~5~S PUB PUB No No 0 PUB PVT None No No syncope~Vaccine not specified (no brand name 3 PVT PUB Atropine eye None drops None Unknown OTH OTH Unknown Seasonal allergy Insomnia, Mental WAES0810USA00371 disorder transient, Movement 0 PVT UNK None None Known 0 PUB PVT None None PVT UNK None 2 PUB PUB 4 PVT PVT None 0 Allergic Reaction PVT UNK None NKA 0 PVT PUB No 0 Glucose 86.PVT Child observed PVT x 30 mins. None Normal None exam. BPNone 96/60 prior to d/c home. Sign/symptoms of TD PVT UNK Seasonal allergies 0 PUB PUB diabetic Diabetes (DMII); HTN 3 OTH PVT MAXIDO; RUNITIDO UTI h/o Breast cancer 2 PVT PUB 3 PVT PUB None 10/05 Had reaction to DTaP or LPV or HIB 0 PVT PUB No No 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007546 PUB PVT Hives Suffer badly with eczema Not to my knowledge. PUB PUB 0 Started to become UNK sexual; UNKcannot be in to much Flu heat like symptom; or have sugar breathing problems; hyperacted sexual 0 Setting stage PUB for early PUB Autism Early stages of Autism Cannot be in PUB to much heat, PUB or have sugar. Flu like syndrome 0 Setting early PUB stages of PVT Autism. None Hives; Crying/Headaches; Hyperacted; Breathing problem 22 See med. records PVT - tooPUB numerous.FLOMAX; 9/11/09 Hospital ASPIRIN; Diabetes; records LOPID; Renal Diabetes; received failure TORSEMIDE; Diabetic DOS 10/6/08 neuropathy; LYRICA; to 10/21/08. QUINAPRIL; Renal disease; LABSDIOVAN; and Stroke. DIAGNO ZOC 9/1 none PUB PVT none no none ~Zoster (no brand name)~UN~84~Patient 0 UNK UNK 13 MIL MIL 1 PVT PUB 0 CBC & diff -PVT NL PUB None No Atopic Dermatitis Fever 48 hr~ ()~UN~0~Patient 2 PVT PUB None None None 0 None PVT PVT None None None Red bumps all over body~Vaccine not specified 0 PVT PUB No No 11 NA - Px exam PVTonly PVT None 0 EKG = Normal PUB PVT None None 0 PUB PUB CEFZIL
2 None PVT PVT None None None Not reported OTH OTH The patientThe had patient no concurrent has allergy illnesses, to NEOSPORIN, or ### use of other and medication a history ofat c Not reported UNK UNK Not reported ### 1 computed axial, OTH 08/18/09, OTHnegative; ADVAIR laboratory test, 08/18/09, None negative 9/3/09 Medical 9/3/09 records Medical WAES0908USA03202 received records received w/PMH: right w/LABS: kneeC 633 hematology,OTH 11/??/07, OTH normal; platelet hormonal count, contraceptives 10/03/08, 190,0; Unknown platelet count, 07/30/09, WAES0908USA03204 21,00 Unknown OTH OTH Unknown Unknown WAES0908USA03468 0 UNK UNK 0 UNK UNK 0 9/9/09 ED records UNK received UNK DOS 8/25/09. Also none Labs fromFebrile 8/28/09. seziures LABS Mom and DIAGNOSTICS: and Dad hx of childhood CBC - MCH seziures. 26.7 PG 9 0 none PUB PUB None None None 1 PUB UNK 0 MIL MIL Smallpox vaccination na 1 None at thisPUB time - referred PUB to Urgent None Care forNone evaluation - Client None onDenies 8-26-2009. illness @ time of Vaccination 3 Post vaccinal UNK acquiredUNK auto immunity-clinical No hypothyroidism, illnessesHiatalliver hernia, disease, prolopse probable valve.auto PMH: immune. previously I have healthy had MR 200 9/2/09 Hospital UNKrecordsUNK received DOS 6/29/09COPD to 7/10/09. LABS and DIAGNOSTICS: Bronchoscopy with Biopsy - A 0 PVT PVT NO Asthma UNK UNK 4 none PVT PUB HCTZ, Pantoprazole, none Lescol, no allergies. aspirinHypertension, hypercholsterolemia, colon po 4 CBC, stool UNK for blood and UNK culture, KUB Nystatin and oral abdominal Thrush susp ultrasound None 9/3/09 Received medical records w/LABS: Abdom 12 cbc - WNL; UNK glu 85; ekg:UNK sinus bradycardia; other Nonelabs pending History 9/25/09 of pyelonephritis Medical records 9/25/09received Medicalw/LABS: records received (+)ASO 41 9/29/09 PCP UNK records received UNK DOS Doxycycline 1/5/07 tonone. 8/7/09. 9/29/09 LABS allergic PCP and DIAGNOSTICS: to records cats. 9/29/09 received PCP Rapid DOS records Strep 1/5/07Test received to 8/7/09. (+). CBC DOS Depressio -1/5/07 WBC 10 none PVT PVT none diarrhea, rash no 2 PUB PUB NONE denied none 1 PVT PVT none None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 none PUB PVT antihypertensive none hypertension 87 PUB PUB Humira andRheumatoid methotrexate None arthritis Rash~Zoster (no brand name)~0~76~In Patien 0 8/26 EEG- pending; UNK CTUNK spine- no none fractures; CT DENIED head- normal; DENIED Hx of back problems/cortisone injections X 1 year 2 N/A PUB PVT Unknown NO NKDA CBC;RPR; UNK Igm; IgG; Varicella UNK None None None 0 PVT PVT none none 0 None UNK UNK Multi-vitamins None None 3 PVT PVT Trileptal, Concerta Bipolar Disorder, BipolarADHD Disorder, ADHD, Allergic to Amoxicillin 1 UNK PVT 0 UNK UNK none 1 no lab test obtained UNK UNK none none JIA 15 XRAY OF AFFECTED PVT PVT ARM WASYAZ NEGATIVENONE HISTORY OF HERPES 0 PUB UNK levothyroxine no Zithromax 1 9/17/09 Hospital UNK records UNK received DOS 8/24/09 Noto 8/27/09. Insects LABSand andstings. DIAGNOSTICS: 9/17/09 Hospital Bloodrecords culture -received No growth. DOS U 1 none PUB PUB none none 1 UNK UNK none none none known 2 UNK PVT 0 N/A PUB PUB none No none AZ0908 1 PUB PVT 0 PUB UNK Ciproflaxin Puncture wound Ampicillin allergy 21 None UNK UNK None None None Intra-arterial injection resulting in brief vasculitis 1 PVT PVT ~DTaP (no brand name)~UN~0~Patient 2 None PVT PVT None None RAD 1 PUB OTH None None None 0 None PVT PVT None None None None PVT PUB No illness NKDA; No condition on other None PVT PUB No illness NKDA, no condition on other
6 0 None
PVT PUB None None None PVT PVT No No PUB PUB None None 1 PVT PUB None No None 0 UNK UNK KBH exam Asthma; developmental delays 1 OTH PVT None None None PVT PVT None None Allergic rhinitis 0 Father and OTH patient refused PVT to be taken to hosp. She Spoke said ittowasn't patientbad & dad (hurtful) at 7:30pm then slouched 8.21.09 &soon 8.22.09. after. 1 PVT PUB None 1 None PVT PVT No None 0 PVT PVT None Dairy, Torticollis, Fever Bronchiolitis ongoing~Polio Virus, Inact. (no brand na 0 PVT PVT ### 0 Titers were OTH drawn on 30 UNK June 2008 (negative); 07 July 2008 History andof28 three August doses 2008. of IPOL### as a child. Other pre-existin 0 None reported OTH OTH The patient had many unspecified ### drug allergies. The patie 1 None PVT OTH The patient had previously received ### DTAP and IPV vaccin 0 Not Reported PVT PVT At 6 monthsFever~DTaP old, received(no DTAP brand ###dose name)~3~0.60~Patient 3 and experienced f 0 PVT OTH Desowen lotion, RHINACORT History of AQ, asthma Albuterol, and thrombocytopenia; ZYRTEC, ###PULMICORT allergies to sulfa 2 None reported PVT OTH CLARITIN None Reported ### Not Reported UNK UNK Not Reported ### 4 UNK UNK No know allergies or medical conditions. ### 0 No labs completed. PVT OTH The patient had no concurrent### ill and had not been taking 1 PVT PVT No medical~Polio history,Virus, no concomitant Inact.### (Ipol)~1~0.00~Patient|~Poli medications, and no ill 3 None performed PVT UNK None reported. From information ###received on 29 Septemb 1 PVT UNK None The patient had no concurrent### illnesses or use of other me 4 None reported PVT OTH The patient did not have any known ### allergies or medical co 5 None reported. PVT OTH The patient did not have any know ### medical conditions or a Not reported PVT PVT The patient~Influenza had no known (Seasonal) allergies ### (no or brand pre-existing name)~UN~0. medica Unknown OTH UNK ### Not reported UNK UNK The patientInjection had no known site~Influenza allergies. ### (Seasonal) (Fluzone)~~ 1 PVT OTH No medical history reported, no ### known allergies. PVT OTH No history of medical conditions, ###no known allergies. 2 UNK UNK Possible allergy to amoxicillin,### no other medical history. PVT PVT The patient had slight runny nose ### at the time of vaccinatio 0 None PVT PUB No No No Unknown OTH OTH Unknown Unknown WAES0908USA03961 Unknown OTH OTH Unknown Unknown WAES0908USA04182 Unknown OTH OTH Unknown Unknown WAES0908USA03811 60 magnetic resonance, OTH 03/18/09, OTH venus Noneand arterial phaseNone which was negative; magnetic WAES0907USA00788 resonance, 05?/??/09, neg Unknown OTH OTH Unknown Unknown WAES0908USA03465 Not reported UNK UNK ATENOLOL The patient is allergic to latex,### thimerosal, PCN, and sulfa. 1 On 20 August UNK 2009, the UNK patient had a "spinal tap" (lumbar It was puncture unknown test) ifperformed; the patienthowever had ### anythe illnesses, results pre-existin were not r 78 9/28/09 Hospital PVT records PVT received, multiple admissions none-preventative and None. outpatient 8/27/09visits, PCP DOS medical 8/22/09 records to 9/09/09. receivedLABS DOS 4/16/08 and DI 0 None PVT PVT None None None 2 None PUB PUB 0 PVT PUB None None 1 PVT PVT None None 0 PUB OTH PPD None Had reaction nottoconsidered previous tetanus serious~Tetanus booster Toxoid (no bra PVT PUB No No 1 PVT PUB None 7 None PVT UNK LOTREL 5/10 Well visit/physical HTN; Obesity; Tobacco UN 8 UNK PUB PROTONIX;Acid PRN Reflux TN09011
1 Referred toPUB minor emergency. OTH TYLENOL TN09012 2 None PVT PVT None None None family hx of migraine headache 0 None PVT PVT PPD; KEPPRA; NoneLEXAPRO; Seizure ZONEGRAN; disorder Amityiptyline; YAZ 1 OTH PUB unknown unknown 1 PVT PVT 2 None PVT PVT None None None 0 EEG PVT PVT None None 0 None PVT PVT Birth controlNone None 2 PVT OTH 1 PVT UNK 2 PVT PUB None None 1 PVT OTH 1 PUB PUB None None None 1 None PVT PVT None 8/19/09 hadAllergy laceration to eggs. left AC. "upset Sutural stomach. "Fainting spells". 57 Lab pathology MILstates, "...organism MIL none reaction such none. as vaccine none. injection and infection, sarcoidosis. In this case we thi 0 UNK UNK NONE NONE NKA 6 Occult blood UNK positive on UNK 26 AugustNone 09 and onNone repeated study Noneon 27 August 09. Stool study + for WBC/RBCs, H&H 0 10/7/09 Medical UNK records UNK an DC summary Lasix, Coreg, received post KCl, cardiac forCozaar dates post catherization 12/25/08 cardiac catherization to 1/14/09. Diagnostics/Labs: 10/7/09 Medical records Left heart ancath, DC 1 UNK PVT Nexium, Xyzal, nonetriamterene, none synthroid enablex, magnesium, biotin, Vit D, red wine 2 PVT UNK ASPIRINE 81mg DAILY EPSTEIN ANOMALY SKIN RASH (HEART PR-09-11 AND VOMITING~HPV MURMUR) (Gardasil)~ 0 EKG DONEPVT , REPEATPVT HR=60,B/P 94/61, RR=18, NO 02 SAT=100%. ( PREV. HX OF DIZZINESS W/ EXERTION) RE 1 UNK UNK None 0 PUB PUB NONE DIABETES 0 N/A PVT PUB None None 0 NONE PVT PVT NONE NONE HEART MURMUR, GERD, FAILURE TO THRIVE 0 PUB PUB Bloody nasal discharge noted on exam. 2 PUB UNK hx of seizures never given vaccine w/pertussis component 1 MESSAGE UNK LEFT WITH UNK ANSWERING SERVICES NONEREGARDING NONE FOLLOW UP. NO RETURNED CALL AFTER 2 A 1 PVT PUB Asthma 1 UNK PVT THYROID, NONE FOSAMAX, FOLIC ACID 0 N/A PUB PVT ZOLOFT N/A BEE STINGS 1 None PVT PUB None No None 0 none PUB UNK none none 4 PVT PVT caduet, provera none hypertension, dyslipidemia, osteoarthritis, hard of hearing 0 PUB PUB NO NO 2 Lymnes titrePVT was equivocal PVT but theLoEstrin24 Weatern Block NONE Fe, Tindamax was negative. NONE CBC,Sed Rate and CT Scan negative 13 CBC,Strep,Urinalysis,and PVT PUBInfluenza None testing done No in the ER. No 7 UNK UNK none none Reactive Airway Disease (Remission) 0 UNK UNK Zyrtec None None 0 UNK UNK Norinyl, Cyclobenzaprine, none penicillin, bupropion, flunisolide, montelukast, allergic omeprazole, rhinitis, asthma fluticasone, zolm Pt. instructed PUB to informPUB OB/GYN of vaccines Pt. reported LMP 06-26-2009, taking BCM. Pt. was advised regarding 0 MIL MIL NONE NONE NKDA/NONE 1 UNK UNK none none none 0 UNK UNK Venlafaxine, none prazosin, clindamycin, sodium fluoride, keflex, combivent, asthma, oxycodone, allergic rhinitis bupropion, diclofe 1 NONE PVT PVT NONE NO LEFT HYDRONEPHROSIS @ BIRTH SURGERY 7/30/20 1 9/14/09 ERUNK records received UNK 8/21/09. alprazolam, LABS and None, Micardis, DIAGNOSTICS: UTI Vytorin, 5/09 PACs/arrhythmia, multivitamin, Systolic BP melanoma Flecainide 150 mmHg in situ, (H).basal Peripheral cell carcinoma, Pulse Rat 0 Patient hasUNK had numerous UNKblood tests, Noneskin priorbiopsies, to none 5/1/09muscle 9/1/09 biopsies. PCP medical Musclerecords biopsy received conducted DOS by University 2/3/09 to 8/19/ of Io PVT PVT NONE NONE NONE 7 Elevated CRP PVTand Sedimentation PVT Multi rate. - vitamin No No 1 none PVT OTH none none 29 PVT OTH None PATANOL; ALLEGRA
0 none 1 1 None 1 1 1098 0 0
PVT PVT none none - was none here for P.E. PVT PUB None None None PVT PUB LAMICTAL; CLONIDINE; Stable TRAZODONE bipolar; ADHD; anxiety disorder; stable allergic rhin PVT PVT Done 4 days Over priorillness ADVAIR; Asthma Prednisone; Albuterol PVT OTH None None None PVT PVT None none PVT PVT LAMICTAL 25mg; PROZAC Depression 10mg daily PVT UNK None None PVT PVT None 14 CT head negative PVT 8/26/09 PVT Albuterol prn Pneumococcal meningitis, 1/17/1998; Asthma; PCN allerg 2 PVT PUB 1 None PVT PUB Sinus infection No 0 None PVT PVT TYLENOL; None PRN None 1 None OTH PUB None None None 1 PVT PVT Unknown no unknown 0 PVT PUB PVT UNK Left thumb Hypertension; laceration hyperlipidemia; NKDA. 0 TEGRETOLOTH and comprehensive PUB metab ALDACTAZIDE; panelNone doneFURADANTIN; 8/27 Congenital - results pending. Multivitamins Myopathy; 8/31/09 Trach w/ Fluoride; PCP Tube; medical Ventilator-depend; TEGRETOL; records 7/2/07 Potassiu Gto none PVT PUB diaper dermatitis none 2 None OTH PVT ZYRTEC; SINGULAIR None Allergies; taken daily. Asthma 0 PUB PUB None None None 0 PUB PUB none none none 9 PUB PUB 6 Unknown. 9/22/09 OTH Hospital OTH records Unknown received DOS 8/13/09 Unknown to 8/22/09. LABS and WAES0908USA03925 DIAGNOSTICS: Chest X-ray -Abn 41 Unknown. 9/8/09 OTH Hospital OTHrecords received DOS 8/3/09 to None 8/5/09. LABS and DIAGNOSTICS: WAES0908USA04230 Urine culture (-). Urin 0 Blood pressure, OTH 08/18/09, OTH110/7; Blood pressure, 08/18/09, Syncope 102/6; Arterial blood WAES0908USA03108 O2, 08/18/09, 98%; Arterial blood 9 Unknown. 9/14/09 OTH Medical OTHrecordsHormonal received contraceptives DOS 8/25/08 None. to 8/27/09. 9/14/09LABS Medical andWAES0908USA03802 records DIAGNOSTICS: received DOS Colonoscopy 8/25/08 to -W 8 0 Magnetic resonance OTH OTH Unknown Unknown WAES0908USA04086 Unknown OTH OTH Unknown Unknown WAES0908USA04199 2 Negative EEG; PVTNegative PUB MRI None None None 0 None PUB PUB Seasonal BCP's. None No known allergies. hives~Yellow fever (no brand name)~1~28~Sib 0 None PUB PUB Birth controlNone pills (yaz).ASA; NSAID's; ModPCN. local reaction~Tdap (no brand name)~UN 0 History of anxiety. PVT PVT PREVACID & PEPCIDGall AC bladder removed 5/09. 0 PVT PVT None Hx of Strat 15 pills. has glasses. 0 PVT UNK PVT UNK Aspirin 0 R Wrist x-ray UNK UNK NONE Crohn disease-controlled, pt complains of vomiting approx 3 Positive Pregnancy MIL Test MIL 4 CBC UNK UNK NONE 1 none PUB PUB none allergic to penicillin; febrile VA09:009 seizures 15 8/4/2009 CtUNK of head - negative. UNK 8/6/2009 Toprol XlGlucose 150m Upper p.o. 96, respiratory b.i.d., BUN Supraventtricular 8, Xanax. creatinine infection with 0.6, tachycardia dry sodium cough 140, with around potassium cardiac Julyablation 4,3.8, 2009. chloride 2004 evalu a1 0 UNK UNK Albuterol prn none Food allergies, asthma 0 PVT UNK 0 PUB UNK None None 0 none PVT PVT lipitor, citracel, none centrumacoustic silver, nasonex, neuroma, cellulitis~Pneumo ventolin, s/p gamma allegra (Pneumovax)~NULL~72~In knife xrt, obesity, hypercholP 0 PVT PVT OrthocyclenNone None PVT PVT BENADRYLPOISON IVY POISON IVY-CURRENT; URI-RESOLVED, STREP PHAR 0 None PUB PUB None None None PVT PVT ZYRTEC CONSTIPATION ALLERGIC RHINITIS-CONTROLLED 1 PUB PUB none none reported VA09:010 1 CBC WBC 13,000 UNK CRP UNK 2.5 ESR 40. 9/17/09 no Hospital none records received DOS 8/27/09 to 8/28/09. LABS and DI
PVT PVT MOTRIN OTITIS MEDIA OTITIS MEDIA, 0 PVT PUB None None None 1 none available PUB PUB none none reported none VA09:011 0 UNK UNK Xanax, Lipitor, None Paxil, Flexeril,& Anxiety &Atenol-chlor high cholesterol 1 PUB PUB Multivitamins/minerals s/p mastectomy for breast cancer allergies - Sulfa, perhap 0 PUB PUB 0 angioedema, PVT hives PVT fracture of radial head, asthma 0 PUB PUB NONE NO NO 0 PVT PVT levoxyl, lisinopril, none tetracycline, HTN, hypothyroid, zanaflex, paxil anxiety None PUB UNK NONE 0 See above PUB (#7) UNK amitriptyline, Patient citalopram, admitted Allergies enoxaparin, for possible include estradiol, penicillin, pyelonephritis gemfibrozil, walnuts andand levothyroxine, respiratory cats which infection. all nicotin caus 2 PUB PVT HCTZ, metoprolol, Watery nose, Singulair, Hypertension, soreTylenol, throat, glaucoma, dry Calciu+Vitamin mouth, allergic (chronic). D rhinitis, 0 UNK UNK 1 PUB PUB 1 PUB PUB N/A None Not Known 0 UNK UNK nuva ring. Phenteramine. none Poss PCOS, hirsutism, obesity, tobacco abuse, MVP. App Chest x-rays/ PVT MRI/ EEG UNK / Echo cardiogram / Tilt none Test / allergic to dust, maple, cock roach 1 none UNK UNK none none none unknown~ ()~~0~Patient|unknown~ ()~~0~Sibl 0 PVT UNK None 0 None PVT PUB None None Post-op surgical repair of both atrial septal defect and pulm 49 10/31/08 Abd PVT x-ray; USPUB of abd.; Barium Multivitamin enema None (Peds) for reduction Noneof intussusception. 3 PUB UNK No No Pap 8/13/09UNK UNK 0 None PUB PUB none no allergies, birth defects or medical condition 0 PVT PVT None None None 0 PVT PUB None None Penicillin allergy; Lumbar spondylolysis 1 None PVT PVT None None None 1 none PVT PVT none none 2 PVT PVT None None 1 None donePUB PUB None None No known allergies; No birth defects; No med. condition 0 None OTH OTH SYNTHROID; None CELEBREX; statedPCN;ADVAIR Tetanus-toxoid; Hives~Tetanus inhaler; GERD; Miacalcin Toxoid hypothyroidism; nasal (no brand spray; name)~1~0~P ZANTAC; Asthma; Art CA 3 PVT PVT 0 9/8/09 Hospital PVTrecordsPVT received DOS 8/27/099/8/09 to 8/29/09. Hospital CTrecords Scan - Subarachnoid received DOS Bleed. 8/27/09LABS to 8/29/09. and DIAGNOSTIC Poison sum 0 OTH UNK None None None 1 Exam PVT PVT None None 0 PVT PVT 1 OTH PVT Unknown None reported Heart disease; Hypercholesterolemia 11 UNK UNK LIPITOR, ATA, CALCIUM AS / hyperlyedemia 0 PVT PVT Heart MurmurSyncope~Varicella benign (Varivax)~1~15~Patient|Syn OTH PUB No No No OTH PUB No No No OTH PUB o Yes URI No PVT UNK 1 PVT PVT Simvastatin;none lisinopril; estradiol; HTN; Highamitriptyline; Cholesterol Naproxen 2 UNK UNK None None 2 PVT PVT UTI RAD; PVD; HTN; Hyperlipidemia 1 X-ray left shoulder PVT & clavicle PVT None None cyst rem. left clavicle above noted site 3 years ago 1 Blood culture/ PVT CBC with UNK diff. None None ~DTaP + IPV (KINRIX)~1~5~Patient 0 PVT PUB 1 PVT PUB none none 1 PVT PVT none none none
1 None UNK UNK none none none 0 UNK PUB Timolol , lisinopril high blood pressure pcn Glucoma 1 none PVT UNK ibuprofen none none 78 9/15/09 Neurology UNK consult UNKrecords received DOS 6/10/09. 9/15/09 LABS Neurology and DIAGNOSTICS: consult records EEG received - ABNORMAL. DOS 6/10/09. MRI - N 1 None PVT PVT None None None 0 PVT UNK none Grade IV IVH at birth with ensuing diagnosis of Cerebral P 0 PVT PUB None Cleft Lip and Cleft Palate 23 9/8/09 Hospital UNKrecordsUNK received DOS no 12/26/08 none to 1/03/09. no.LABS 9/8/09and Hospital DIAGNOSTICS: records received Lumbar DOS Puncture 12/26/08 / CSF to 1/03 - Ly 1 UNK UNK none none none 2 Patient aliveUNK and typingUNK this report at this time.None, Sunday, except August probable helminthes 30,penicillin 2009, infection. and allergey, willBeing report see treated to below Veteran's for fordual conditions Administration heart valve (dual 0 MIL MIL Not reported MEDI0008180 0 MIL MIL Concomitant Drug(s) Not reported MEDI0008185 55 Specific laboratory PUB tests PUB performed"ANATRIPTALINE"; were unknown; however Herbal History the Medications; of patient Bells had Palsy Vitamins anone x-ray year of### the ago.shoulder, From new EMG information and MR Not reported UNK UNK The patient stated that she is ### allergic to a lot of different co UNK UNK ### Not reported UNK UNK Not reported ### 0 Not reported UNK UNK The patient had a history of a ### milk allergy. Unknown OTH OTH Unknown Unknown WAES0908USA03993 Unknown. 9/4/09 OTH Hospital OTHrecordsDEPO-PROVERA, received DOS Asthma; 8/12/08 Vicodin. Food 9/4/09 to allergy 8/14/08. Hospital LABS records ANDWAES0908USA03159 received DIAGNOSTICS: DOS 8/12/08 MRI Foot to 8/14/08. (at othe 15 Metabolic panel; PVT Thyroid; PVTCT; MRI; CXR; MRA; Cough; MRV;Wheeze. CBC NONE. and platelets; 9/29/09 Neurology Coccidioides Consult antibody; received EBVDOS panel; 7/1/09 Mycop to 0 PVT PVT Singulair 4mg Rhinorrhea; daily Eggs; Just over Peanut bronchitis butter; Jelly beans (anaphylactic react)PMH 159 UNK UNK 9/1/09 PCP medical records DOS 10/03/07 to 4/25/09. Ba 306 CAT Scan; UNK Pharmaceutical UNK agents; Hospitalization; Seeing None a surgeon on 8/28/2009 to remove a mass on her he 14 PUB PUB ORTHO-TRICYCLEN None No known allergies; yes~HPV No (no LA090807 med. brandcondition name)~1~16~Patient 1 PVT UNK None None None 5 PVT PUB Zithromax PCN-Sulfa- Keflex 0 PUB PVT TOPROL; SULAR; None known AVAPRO; Heart condition; PRILOSEC; Hypertension; NORTRIPLINS; Post Hx ASA Ulcers. 81 mg. 2 UNK UNK 0 PUB PUB None None PVT OTH Rash on AMOXICILLIN PUB PUB None known None None known 2 None PVT PVT None 1 None PVT UNK None Amoxicillin Rash~ ()~~0~Patient 0 UNK UNK None 1 None PVT PUB None None None 15 PUB PUB None None None 13 15 Jul: ViralMIL cultures and MILVacciniaNone PCR, neg; None 15 Jul: Punch bx-shows epidermal spongiosis, focal mounds of parak 2 PVT PUB Albuterol via Noneb-PRN;Anemia; ChildrenObesity MVI 3 Labs drawnUNK 8/27/2009:UNK CPK 8784;Concerta CKMB 31.1; None AST 186;PMH: ALT 72; learning Serum disability. Protein 8.9; menstrual Serum H/A. Albumin metabolic 4.7; Globulin syndr 29 WBC- 8.0; rprMIL non-reactive; MIL None None None 1 Hematuria. PUB CBC, CMP,UNK Complement, Plavix, ESR Crestor, pending. Coronary Lisinopril, Artery None HCTZ, Disease, metoprolol Hypertension, Hypercholesterolemia 37 9/3/09 Hospital UNKrecordsUNK received DOS none8/24/09none to 8/26/09none and 9/2/09 9/3/09 to Hospital 9/3/09.records LABS and received DIAGNOSTICS: DOS 8/24/09 Ultrasou to 8/2 1 PUB UNK nONE CODEINE, MORPHINE 2 PVT PUB none none unknown 0 UNK UNK Unsure of name none of newHx medication of asthmafor when migraines younger. started Father today reports no meds for it 0 PUB PUB Asthma; Allergies Vommitting~Hep to NSAIDs,BCodeine, (no brandhydrocodone, name)~1~39~In oxycP 0 Strep test negative. PVT UNK Plaquenil - Patient 400mg daily, hasPre-existing: a Celebrex history of,- and Mixed 200mg is currently Connective as needed being Tissue treated Disease; for, mixed Allergies: conn 0 PUB PUB NONE NONE NONE 0 DATE/TIMEMIL TEMP PUBPULSEAPAP/hydrocodone, RESP BP gastricPAIN pain, estrogens previous testing WEIGHT ordered, conjugated, allergic PULreactions previous OX trazodone, 7/15/09 with diarrhea, @ airway venlafaxine,fluticasone 1955 now constriction only 97.3loose 79 tostools azith 20 na 0 UNK UNK Rampril no illness high blood pressure 0 PUB PUB MO-2009-20
1 NO TESTSPUB DONE PUB SEASONALJUST ALLERGIES SEASON NONE~ WAS ALLERGIES ()~NULL~~In ON CLARITIN Patient|NO~ ()~NULL~~I 1 PVT PVT Fosamax, Evista, None Dyazide, Osteoporosis, K-Dur,None Calcium+Vitamin hypertension, Known~ ()~NULL~~In hyperlipidemia, D, Centrum Patient Silver hypokalemia 0 None PVT PVT None None None 6 did several UNK tests at ERUNK to include:Strep test, Chest na xrays, blood culture, urine culture, etc. 0 none PUB PUB Prozac none depression 0 UNK UNK Vyvanse; Celexa; no anusol Allergy suppository to morphine; microscopic colitis; mononucleosis req 0 N/A MIL MIL NONE NONE KNOWN NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 None donePVT PUB NA none eczema NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S 8 none PUB PUB DENIES Bactrium 1 ULTRASOUND PUB PUB 1 none UNK PVT 15 MIL PUB Celebrex 100 None mg -daily Prostate Cancer - No known drug allergies 0 PVT UNK 10 PVT PVT 0 none UNK PUB none no none no~ ()~NULL~~In Patient|unknown~ ()~NULL~ 1 PUB PUB NONE NOTED NONE 0 UNK PVT None None None~ ()~NULL~~In Patient 1 UNK UNK 0 CT scan, EKG, UNKlumbarUNK puncture, chest Yaz, Minocycline, xray, CBC, none CMP, (albuterol, asthma, sed rate, advair, acne. drugflonase 9/9/09 screen,precscribed PCP UA medicalbut records not being received used DOS at tim 1 PUB UNK No None 2 None PVT PVT Symbicort None None 1 PVT PUB None None 1 PUB PUB None None RSV; Rotavirus (RSV 10 mths) and (Rota 18-24 mths) 12 CRP - 1.4, 1.6 PVT(up); ESR PVT -1; CBC ZOLOFT; - ok; UA-ok; NUVARING none WBC notedAllergic - 9.3 and 5.2; rhinitis; T- 37.0; Allergies: Chest VICODIN; x-ray-negative Amoxicillin; Aspirin 2 OTH OTH None None None 1 None PVT PVT None Bad reaction to smallpox vaccine 1 None UNK PUB None None 0 PUB OTH None No No No~ ()~~0~Patient 1 PVT PVT Redness~Smallpox (no brand name)~1~34~Sib 1 None PVT PVT None None BMI greater than 95th percentile; Voiding dysfunction 3 OTH MIL 2 None PVT PVT No None 1 PVT PUB none none none 1 None PUB PUB No No 0 PUB PUB None None 2 PUB PUB None 1 Quick flu negative PVT PVT Birth Control None - type unknown None 0 None PVT PUB None None None 4 HemoglobinPVT performedPVT on 8/21/09None - normal result Noneper pts.Allergic mom. Influenza to sulfa, KEFLEX, test - result DURICEF pending. 1 None PUB PUB Current Tx Physical for low back therapy pain for & rt. pain hipinpain rt hip & low back PVT PUB None None 1 Milk and egg PVT IGe confirmed=3/09 PVT ZYRTEC 3 Stool cultures; PVTRotavirus PVT antigen none 1 MIL MIL rash~Tdap (no brand name)~UN~44~Patient 0 PVT PVT ORTHO TRINone CYCLEN None 1 tab daily 0 PVT PVT None 1 None PUB OTH None None Unknown~ ()~~0~Patient|Unknown~ ()~~0~Sib 0 PUB UNK None None 0 OTH PUB Treatment- UNK TAC oint %PUB Keflex 3 tsp BID x 10 None days. NKDA 2109 None PVT UNK None None
0 PVT PVT 1 PVT PUB 0 No PVT PVT No HTN; GERD; High Cholesterol; Osteoporosis 0 PUB OTH Pt takes CENENTA Unknown54mg ADHD Daily; CELEXA 08/19/2008~Hep 20mg Daily; A (noKLONIDINE brand name)~1~0~Pati 0.1mg Daily 26 CBC, ChemMIL 24, Thyroid, MILimmune ZOLOFT; studies all Cabergoline normal. None Prolactinoma-controlled; PTSD-Controlled 1 PVT PUB None None None 6 PVT OTH OR200935 6 PVT OTH OR200934 1 PVT PVT none; Redness, swelling to arm 7 Quick strepPVT neg; ThroatPVT CX pos. None None None 2 PVT PUB None None 3 CBC, UA < MIL CHEM 24, MIL Immune studies, None RF allNone negative. None No objective symptoms on exam. Rheumatology consult 0 PVT UNK None None None 0 None PUB UNK No NKA; No medical conditions 8 MIL MIL None None None 5 PVT PVT Vaginal yeast None infection 1 PUB PVT None indicated None indicated None indicated OR200933 None PUB PUB ALBUTEROL None Inh;known PRN. Exercise induced asthma OR200936 1 OTH OTH VYTORIN None None 16 PUB OTH Blood pressure No High Blood pressure 2 PUB PUB no 1 PVT PVT None COPD, Asthma, heart mummur, pneumonia 20 PVT PVT None 1 NONE PVT PUB None Balanitis None 1 PVT UNK None 0 Did not seek PUB med. attention PUB ~ ()~0~0~Patient 2 EEG #1 Poss PVT Abnormality; PUB EEG #2 Normal None None 1 PVT UNK PROVENTIL; TUSSINEX; PastXOPENEX; history of asthma; SYMBICORT allergies ###to cats and smoke. 0 Unknown OTH OTH Unknown Latex allergy; Exomphalos; Genital disorder Congenital female WAES0908USA04275 clubfoot; Meningomyelocele 4 OTH PUB NKDA Unknown OTH OTH None None WAES0908USA04511 0 OTH PVT None None None 0 Non PVT PVT None Deltoid swollen~Influenza SA0906 (Seasonal) (no brand 5 H/H as above. PVT9/18/09UNK Hospital discharge summary None received Precocious w/LABS: Puberty Pelvic US abnormal. Hgb 6.2(L). Initial von 0 PVT PVT Question of shrimp and tree nut allergies Unknown OTH OTH Unknown Unknown WAES0908USA04691 19 Resp. Failure; PVTBronchitis; PUB CerebralPROAIR; edema ZITHROMAX Teething; Fever ~DTP (no brand name)~1~0~Patient PVT PVT 0 MRI has revealed PUB a small PUBclot in his Nomedulla. No 9/22/09 Hospital None records Known. received 9/22/09 Hospital DOS 8/20/09 records to received 9/4/09. LABS DOSand 8/20D 0 None OTH OTH None Fever; Respiratory Unknown tract congestion WAES0908USA04714 PUB UNK none none 9 Done @ Hospital PVT PVT None 0 PVT UNK 0 None PVT PVT None None None 0 None PVT PVT None None No UNK UNK None PVT PVT VERAMYST Allergic Nasal rhinitis Spray DX:477.9 0 PVT UNK None Short stature. 0 PVT OTH None 0 none PVT PVT none Deltoid swollen.~Influenza SA0905 (Seasonal) (no bran 680 UNK UNK
45 UNK UNK No preexisting medical condition. 0 UNK UNK 0 None PUB PUB None None WV0907 1 None PVT UNK None None Pt. previously (couple yrs ago reported (L) arm weakness 0 PUB PUB None None 131 Neurology (17 MILSept 2009) MIL diagnosed none post-vaccination none myelitis none which was slowly resolving. Reflexes were all norma 25 2007, elevated UNKTSH 5.08 UNK (0.27-4.20); Thyroglobulin None Ab 53 None (0-20) and thyroperoxidase 537 (0-35); normal FT4 and PVT PUB None None None 0 Clinical improvement PVT with UNKobservation. No None 0 No correlation PVTexcept onset OTH of symptoms FLOVENT was44 None w/in X 21/hour. daily; Autism/ FLONASE dev delay/ 2 sprays asthma/ daily.seasonal allergies. 0 None OTH PVT NUVA ring (Lt) Calcaneous Nonesuperficial laceration 0 Unknown 11:45 PUB PUB Unknown 1 UNK PVT None None 4 PUB PUB None None None 0 0 test performed PUB by MD. PUB None None 0 Moms reports had RSV LA090806 as an infant. 0 NKA 0 PVT UNK Yes~Meningococcal (Menactra)~1~12~Sibling| 0 PVT PVT No No 9/3/09-records received- Mom has history of panic atta 2 None PVT PUB None Migraine headaches 0 PVT PUB No None PVT PUB None 2 None PVT PVT 0 PVT OTH none none none 0 none PVT PVT 0 PVT PUB Yes~Meningococcal (Menactra)~1~12~Sibling| 0 None PVT OTH None None Yes~Measles + Mumps + Rubella (no brand na 13 MIL MIL None None 6 None PUB PUB None None None 1 OTH PVT Diabetic 2 0 UNK PVT OTH No concurrent Unknown medication A0805211A 19 LABS and DIAGNOSTICS: PVT OTH CT - Negative. None X-rays Noneof C-spine, Nonechest, abdomen, pelvis - Negative. CHEM - Glucose 0 D F/U w/pt OTH 7:20 pm - She's PUB doing Unknown well; said it None wasn't seizure. Seizure (10 yrs ago). 1 none PVT PVT none environmental allergies 0 PVT PUB None None Asthma; NKDA None PUB PUB None None None 16 Neg for mono, PVTstrep, etcPVT None None 12 None OTH PUB None None None 1 None PVT PVT none None None 0 pulse oximetry-normal UNK UNK at 97% on room Multivitamin air None with fluoride except None common wart on (L) 4th finger 0 None PVT PVT 0 EmergencyPVT room-physician PVT assessment Pre-natal vitamins; none SYNTHROID NKA; hypothyroidism; 1st trim. pregnancy 0 OTH OTH ADVAIR; SPIRIVA COPD COPD PVT PVT bumps in hair~Meningococcal (Menactra)~1~1 0 n/a PVT PUB no no NKA, in 2003 exercise he hadinduced a respiratory asthma~Varicella illness with wheezing (Varivax)~2 an 0 none PVT PVT Poly-vi-sol vitamin, none probiotics cat allergy, strawberry allergy 13 LABS and DIAGNOSTICS: UNK UNK Abdominal Sonogram None- Abnormal. None.Abdominal 9/14/09 Hospital X-ray -records Abnormal. received CHEM DOS - Bicarbonate 8/27/09 to 28 0 None PVT UNK Qvar, Multivitamin, Rhinocort Patient has asthma, eosinophillic esophagitis and hypoalb 3 None PUB PUB None None ODH 0 PVT PVT Pt. takes singulair none and just zyrtec seasonal allergies 1 Food allergy PVT testing drawn PVT on 8/31/09. Flovent,Albuterol None Asthma 1 PVT UNK None No Mild asthma 0 PUB PVT ECZEMA (CHEEKS)
2 Stool sample PUB on 8/12/09 PUB and bloodwork on 8/18/09. Unknown Poor weight what specific gain tests performed. 0 MRI brain normal. UNK 9/2/09 UNK Consultant No record received None DOS No8/31/09. 9/17/09 Hospital records received DOS 8/31/09 0 PUB PVT 0 CT scan PVT PVT none no none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 PUB PUB NONE NONE KNOWN NONE KNOWN 0 PVT PVT none none - came none in just for vaccines 322 9/4/09-records UNKreceived-X-ray UNK confirmed degenerative COPD arthritis 9/4/09-records primarily received-PMH: affecting medialCOPD, compartment. dyslipidemia, MRI advanc GERD 1 PUB PVT 0 N/A UNK UNK N/A N/A 23 PUB UNK none had allergies to pollen AL0915 11 UNK UNK None None None 0 none PUB PUB none none none AL0917 2 None PUB PUB FeSO4, unknown unknown antihypertensive Has h/o anemia, med,hypertension, unknown sedative sleep disorder 1 PVT MIL 0 PUB UNK allergy to codeine 2 PVT PUB Albuterol 0 9/22/09 Medical UNK records UNK received w/LABS: CTNone Headknown - Abnormal. none known CBC9/22/09 - WBC 14.8 Medical 3/uLrecords (H) RBC received 4.05 6/uL w/PMH: (L) Hem Le 1 UNK UNK Paxil, Flax seeds-1 NONE TBSP Allergies ground, to PCN Vitamin andD,Bactrim Caltrate, Ambien CR, Simvastatin, 11 UNK UNK 15 EKG (results UNK were normal), UNK checked None oxygen level None(resultsSinusitis were 100%), and. 10/14/09 blood levels ED and wereHospital checkedrecords (potassium received wass 1 PVT PVT NONE NONE NONE 0 UNK UNK none none 1 UNK UNK none 0 PVT UNK None None None 1 PUB PVT fluoxetine, finasteride, loratadine, famitodine 1 None PVT PUB None None None 7 PUB PVT UNK PUB None None None 1 PVT OTH Concomitant Asthma Drug(s) Not Reported MEDI0008788 PUB PUB ABILIFY; PROZAC None Soft tissue mass - neck - 4 wks; depression. 0 Unknown PVT PVT Unknown Chickenpox WAES0908USA00396 0 computed axial, OTH 08/26/09 OTH Labs and Unknown diagnostics: Penicillin CT brain allergy PMH: WNL.allergy CBC/CMP to Amoxicillin/ WNL. WAES0908USA04708 drug screen (-). EEG abnormal. 17 PUB OTH None None None autism~Vaccine not specified (no brand name) 47 9/14/09 Hospital PVT records PVT received DOS 3/13/08 None to 7/15/08. Type LABS I DM;and Mild DIAGNOSTICS: cerebral palsy but Thyroid was Ultrasound an honor student. - Norma 9 1 CBC and diff PUB + within normal MIL limits. None None None~ ()~~0~Patient 0 PVT PUB 0 PVT PVT None None 1 none PUB PVT ZOLOFT; podacly; none clonazepam; Hx of highOTC cholesterol; MUCINEX panic attacks; Depression 160 EKG; Echocardiogram; PVT OTH Tilt table test; None EEG; Bloodwork. No LABS None.and 9/25/09 DIAGNOSTICS: ER records reeived EKG - Abnormal, DOS 11/10/08 sinusand bradyca 11/2 0 none OTH PVT none none None 1 CBC & CRP. PVT PUB None None 1 CBC & CRPPVT PUB None None Amox allergy; asthma. 1 None PVT PUB ZYRTEC; FLONASE None 3 PVT UNK MIRALAX; 81mg None ASA;MACROBID ZOCOR -> chest pain, short of breath 134 blood work PVT 8-14-09 to check PUB for cause Noneof hairNone loss None 4 Unknown PUB PUB None Motrin 7 PVT PUB 0 OTH OTH Thyroid med. No No 0 8/26/09 CBC PUB n except PUB thrombocytolysis; CMPNone normal. Eczema 2 PVT UNK 0 PVT PVT None None None
OTH PVT OTH PVT No Sensitive to Latex 1 PUB UNK CLARITIN Seasonal allergies; allergic rhinitis 2 PVT UNK NONE NONE NONE 1 PVT UNK Azithromycin ear infectionAmoxicillin, cephalosproins 1 PVT UNK No nkda 0 PUB UNK coumadin, sertraline, none albuterol, Leiden Factor singular 1 MIL MIL Yaz No None 1 na UNK UNK Singulair, Premarin, no Advair asthma, Norvasc, COPD, Demadex hypertension, anemia 1 PUB UNK zyrtec none latex, melon, sulfa meds, bactrim 2 comprehensive UNKmetabolic UNKpanel, cbc, urine analysis NONE,and HAD GERD. urine VIRAL culture, 10/13/09 URI 2blood WEEKS Hospital culture, PRIOR, records, stoolWHICH culture, DC summary WAS giardia MANAGED received and crypts 0 N/A PUB UNK Prozac - daily None vitamin that I N/A was aware of 0 PUB PUB None Hypertension, Hay Fever PVT PUB None None 4 PVT PVT None None None 1 PVT PUB none none 31 Varicella IgG/ UNK IgM (Patient's UNK spouse NONE - reports NONE childhood Varicella NKDA infection) NONE~ ()~~0~Patient|NONE~ ()~~0~Sibling|N 0 PVT PVT Metformin, Mobic, none reported Nexium, Diabetes Seraquil, none ASA, reported~ Provigil,()~NULL~~In Vitorin, Effexor Patient 0 None PUB PVT NA Cardiac disease, Adult Onset Diabetes 0 None PVT PVT None None None 23 HIV Ab 13 AUG MIL 2009 Negative MIL Ranitidine none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 UNK UNK hypothyroidism fever,diarhea~Influenza 9/8/09-records received-PMH: (Seasonal)hypothyroid (no brand n 0 NCHCT reportedly PVT wnl,PVT ChemistryNone and CBC wnl. noneEEG performed none results pending and pt will receive and MRI 2 PUB PUB seasonal rhinitis 0 Pt has scheduled PVT allergy PVT testing Sept. polyvitamin 21, 2009. none drops Dr. with has none suggested fluoride.25 continuing mg vaccines one at a time, not grouping 1 CT scan etcUNK 9/25/09 Medical UNK records receivednofor DOS 8/12/09 no 9/25/09 to 8/16/09. MedicalDiagnostics/Labs: records received CT for DOS scan 8/12/09 consistant to 8/ w 0 PVT UNK Levothroid, No spironolactone, allergies omeprazole to:cephradine,erythromycin, clindamycin,penicillin 1 none PUB PVT Metoprolol for None hypertension Hx of latent Herpes Simplex virus Hypertension - controlle 0 Chest x-rayUNK on 8/31/09UNK which showed aspirin mild 81right mg chronic daily, basilar gingivitis, doxepin infilatrate. none 10 dietmg The controlled daily patient hypertension, is in the study diet and controlled had coincidently hyperchh 0 CBC; BloodPVT culture; Urinalysis; UNK Lumbar puncture. None10/15/09 None. Received 10/15/09 Medical Received Records Medical and Records Discharge and Summary Discharge fo 0 Blood Cx: no PVT growth; Urine PUB Cx: noCaffeine; growth; CRP: Multivitamins Prematurity; 7.16; CBC: Prematurity; with Cholestasis 7.3, Fe;9.6, Folic Cholestasis; 28.8, Acid;66; Vit28% D;ELBW; Bicitra; Segs,Rickets; 11% Phenobarbital; Bands, Respiratory 45% Actigall; Lymph DistA 1 1156am 8/14, PUB CRP, 13.79 PUBmg/L; 11.9, Caffeine; 12, 35, Citrate; No 175; 43S, Vitamin BPD; 16B, D; 26L, Apnea MVI 13M; with of Fe; prematurity; caffeine, Actigall; 10.9; Vit Grade E; 8/15 Albuterol II6am, IVH with CRP, VM; 22.67 PDA mg/ lig PVT PUB None 29 None PVT PVT SYNTHROID None None 0 OTH PVT Unknown Unknown 1 OTH PVT 28 None PUB PUB None None None (FX 3 Proximal fingers - 8/29). OTH PUB 1 PVT UNK Right shoulder pain None PVT PUB Nausea & vomiting Was already having nausea & vomiting. 1 PVT PUB none none none 0 PVT PVT On birth control None(TRI-PHASIL) None 0 PVT PVT 1 None PVT PVT None 1 PVT PVT None None Known 3 THROAT CULTURE PUB OBTAINED PUB 9/2 NONE NONE NONE 2 none PVT PVT None None Torticollis 0 None, clinical PVT PVT TYLENOL PRN URI (viral); None runny nose; sneezing 0 PVT UNK 0 PVT UNK Nine None None Known 2 None PUB PVT
19 None
MIL MIL Unknown Unknown PUB PUB 2 None PUB PUB None None None 10 None PVT UNK None 0 None PVT UNK None Hashimoto's; Hypothyroid. 0 none UNK UNK none NKA 5 WBC countUNK was 9.2 x 10^9 UNK cells/L with 91% granulocytes. None None AST was elevated at 245 U/L. A urinalysis was without 0 OTH PUB none none none 17 cerebrospinal OTH fluid; blood OTH culture Unknown Unknown WAES0908USA04882 0 computed axial, OTH 08/08/09, OTHNormal Unknown WAES0908USA04339 0 diagnostic laboratory, OTH Blood OTH test Normal. DEPO-PROVERA 9/14/09 Ovarian PCPcyst; medical Caesarean Papilloma records section. viral received infection; 9/14/09 WAES0908USA04943 DOS Hypersensitivity. PCP 9/7/07 medical to 10/18/07. records 9/14/09 LABS received PCP an Unknown OTH OTH Unknown Unknown WAES0908USA05014 19 UNK UNK Birth Control Focal Pills seizures Acne ### 25 PUB PUB none none reflux 0 EKG-NORMAL, PVT PFT-NORMAL, PUB HGB-12.6, NONE RANDOM NONE BS-100 NONE 1 None PUB PVT No COPD,Asthma, 0 blood work PUB cat scan and UNK is scheduled for mri none and eeg onnone september 18, 2009. 0 PUB PUB same symptoms, "cold"~DTaP + IPV + Hib (Pe 0 Vital signs were PUB stable PUB when responsive N/A afterN/A incident, Accucheck Did report 86. previous episodes of fainting and seizures with 0 none UNK UNK calcium 600none mg. bid Penicillin none~ ()~NULL~~In Patient 1 Had a urinePVT test, throatPVT culture and blood tests everything came back Sister~DTaP negative + Hib (no brand name)~3~1~In S 0 N/A PVT UNK Ortho-Cyclen No None N/aA~ ()~NULL~~In Patient 1 PVT PVT HYPOTHYROIDISM 0 NONE UNK MIL One A Day None Vit Allergie to Nuts 2 none UNK PVT Xopenex HFA, noneNeurontin, Hypertension, Ativan, whole Nicardipine, diabetes, arm swelled~Pneumo Metoprolol, cholesterol,Fexofenadine, allergies, (no brand stroke, name)~ Fenofib COP 1 PVT PVT Synthroid None Hypothyroidism 2 None. PVT PVT None. No. None. 0 unknown UNK UNK Rebif 22 mcg NONE Multiple sclerosis x 10 years; patient's disease has been w 0 UNK PUB none none no fainted~HPV (Gardasil)~1~17~In Patient 0 NONE PVT PVT ESTRADIOL NONE 1MG, PRILOSEC NONE 20MG, FLEXERIL 10MG, FISH OIL, CALCIUM/V 0 PVT PUB NONE NONE NONE 0 PVT PVT Not sure, she had ear infections Sister~DTaP on and (no brand off andname)~5~4~In had been on amoxicila Sibling1 0 none PVT PVT Aspirin 325mg. N/A.qD He was Hypercholesterolemia here for physical exam. 1 PVT PVT 1) IbuprofenBronchitis 200 mg Tablet, None 3 Tablet(s) by mouth 2) Pseudoephedrine-DM-Guaif 0 PVT PUB NONE NONE NONE 1 None PUB PUB None Start of a cold None 3 None PUB PUB None None None 69 UNK UNK monofeme Cold (oral contraceptive)ventolin durig first asthma. vaccine - feltinhaler fine for(asthma) 2nd. 12 None UNK UNK none None noted/assessed. None noted. Patient was in clinic for sports physical. 16 CBC, ESR,PVT CRP, ANA,PVT RF, ASO, CMV, Parvo titers, all negative. 1 None UNK UNK None Well appearing child interactive awake alert 2 None at thePVT time of visitUNK Unknown Well appearing child 1 Not yet-no tests PUB PVT None None PCN, Fibromyalgia, flu-like symptoms~Influenza osteopenia, (Seasonal) (no bra 8 N/A UNK UNK n/a None Per patient taking high blood pressure medication 0 PVT PVT None None, None. 0 none PUB PUB none none none 1 PVT PVT Albuterol, Adderall, None Symbicort None 2 Autopsy was PVT performed. PUB 9/11/09 Autopsy Prevacid; received Tylenol None DOD Failure 07/09/2009. to thrive; LABS GEand Reflux; DIAGNOSTICS: Ht. murmur; Pre-maturity. Negative Radiog 9/11 0 PUB PUB None Omphalocele 1 PVT OTH None None None 0 OTH PVT None None
2 none PVT UNK CLARITIN; Well Albuterol child MDl check-up HTN; Psoriasis; Asthma; Obesity 2 PVT UNK 2 UNK UNK 1 PVT PUB Amoxicillin, allergic 1 PVT UNK 1 PVT UNK 1 OTH PVT lisinopril; LIPITOR; none PRILOSEC rxn to injectable dye; HBP; high cholesterol 2 PVT PVT None None None 0 None PVT UNK None No No 0 None PVT UNK None None 0 PVT UNK No 0 None OTH PVT None None Denies 0 PUB PUB none none 0 none OTH OTH Amitriptyline; None Levothyroxine; None Fluoxetine; Naproxen; Simvastatin 0 UNK UNK None PCN; Seasonal sameallergies symptom~Td Adsorbed (no brand name) 9 CT (head) PVT PUB None None None 2 None PVT PVT None 0 PUB PUB None None None 2 OTH OTH ALLEGRA D None 24 HOUR; Asthma DUAC GEL; DIFFEREN GEL 2 UNK UNK None None 0 OTH PUB Put on ibuprofen None & diphenhydramine No known for rxn 3 CBC - Urinalysis PVT - Flu test PUB- Strep test. T - 100.4 Rectal - runny nose - nasal cong. (+) urine HCG PUB (preg. test UNK later performed afterNone vaccine given) None GA09026 0 BP 113/67; PUB HR 68; Resp. OTH 18-20; Pulse None Ox 100% None Anemia GA09 1 None PUB PUB None None Erythromycin GA09028 0 PUB PUB None Known None Known GA09029 1 None PVT PUB None None 0 None PVT PVT None None Known 0 PVT PVT 1 No testing PVT PUB None None None None PVT PVT 2 PUB UNK No No GA09030 1 PVT PVT Meloxicam,None 15mg; Byetta Elevated 5mcg/0.02; laceration Celebrex on right 200mg; hand.Trazodone Hcl, 150mg; P 0 PVT PVT PREMARIN; None Simvastatin; Iodine; Acyclovir TYLENOL; TESSALON PERLE; Penicillin; Sulfame PVT UNK 0 9/14/09 Received MIL medical MIL recordsTYLENOL w/LABS: ALT/AST for None fever (H). None. Influenza, 9/14/09 blood, Received urine hospital & CSF c/s medical neg. records CSF glucose for 6/8/0 &p 17 Labs at hospital PVT pending. PVT None 1 OTH PVT PREMARIN; Vitamin E;Allergy-Codeine ACIPHEX; Vitamin C; CALTRATE; Multivitamin; Magnes 8 PVT OTH None PCN allergy 1 PVT PVT Unknown None 0 None PVT PVT None 13 PVT UNK 9/15/09 PCP Medical records received DOS 8/12/09 to 9/8 1 None OTH OTH CARDENE;None ENALAPRIL; Blood Simvastatin; clot; A-fib Methylxyleprene 0 BP 104/67; PVT HR 58; O2 PVT Sat: 99% on R.A. None None 0 PVT PVT 1032 PVT OTH None 0 None donePVT PUB 1 OTH PVT None None 2 None PVT UNK CITALOPRAM None HCTZ Amoxicillin 0 PUB PUB None 1 PVT UNK None
MIL MIL None None Eczema; Food allergies; Allergic to amoxicillin 1 PVT PVT PPD School physical None 16 PVT PUB CONCERTA; Joint STRATTERA; pain-wrist 719.40/314.01/477.9 SINGULAR 1 9/24/09 Discharge PVT summary PUB and medical Amoxicillin; records Bilateral TYLENOL received Otitis 9/24/09 for Media date Discharge of service summary 8/30/09 and to 9/3/09: medical Diagnositics/Labs: records received 0 PUB PVT none none none PVT UNK 1 PVT PVT POLY VI SOL vitamins 7 MIL MIL No None Unknown OTH OTH Unknown Unknown WAES0908USA05166 0 None PVT UNK None None None 0 PVT PVT synthroid and Eczema estrogenallergies-cortisone, patch neosporin, progesterone 0 Head CT WO PVT contrast PVT (negative), Cervical spine None4 viewsAllergy ( negative) to Augmentin 1 N/A PVT PVT N/A N/A PSEUDOESTROPIA/MYOPOC ASTIGMATISM 1 None UNK UNK NO KNOWN NONE OTHER MEDICATIONS 1 PUB PUB 1 REFER CLIENT PUB BACKPUB TO PRIVATE NONE MD IF INJECTION NONE AT THE N/A SITETIME GETS OFWORST ADMINISTERING VACCINES 1 PUB PUB 1 PUB PUB None none 280 NONE PVT PVT none Exercise hypertention, chronic renal failure (moderate), hy 0 PUB PUB 0 UNK UNK none related none to vaccination no known allergies 1 UNK PVT None 7 none PUB PUB none none Allergic to amoxicillen 0 9/16/09 ERUNK records received UNK DOS9/16/09 9/4/09. ER LABS records and DIAGNOSTICS: received Lamictal. DOS 9/16/09 9/4/09. CBCER - Trileptal, Neut records 77.2% Abilify, received (H) Lamictal. Lymph DOS 17.3% 9/4/09.(L). Asper CH 1 Flu A Antigen-negative. UNK UNK Flu B Antigen-negative. atenolol, calcitriol, No. WBC-13.8. calcium None. acetate, LABS 9/24/09 and clonidine, Hospital 9/24/09ferrous records Hospital sulfate, received records hydralazine, received DOS 9/4/09 DOS lantus, to 9/4 9/1 1 UNK UNK He was notNone feeling well, but was not running a fever or had specific co 0 N/A UNK UNK Keflex Dermatitis None 0 UNK UNK Valtrex, Nystatin,Diflucan, None Autism Strattera, Loss Celexa of auditory processsing~Measles + Mump 96 PVT PVT unknown none 2 PVT PVT Torticollis, GE reflux 51 carnitine level UNK low, scope UNK nl, fasting micronor blood sugar, atwell timeb12, of vaccination. folate, menorrhagia. heavyNow metal none~ PMH: onscreen, lo ovral, ()~~0~Patient|none~ Menorrhagia. sleep ponstel, study, ankle zofran, ekg ()~~0~Sibling pain. all carafate, nl as farlactaid as I 1 UNK PVT LOW-OGESTROL, PERCOCET 0 PUB PUB severe migraine requiring ER visit.~HPV (Gard 0 UNK PUB HYPERTENSION 0 n/a UNK UNK none none none 0 UNK UNK NOne I am a type I diabetic (diagnosed 30 years ago). 0 0 UNK PUB 1 Cardiolyte stress PVT test; chest PVT CT scan; ASACOL; pulmonary Calcium; Primary function sclerosing Vitamin None testing; D; cholangitis Aspirin heart catheterization; open lung biopsy 1 UNK PUB PVT Unknown In follow-up it was reported A0802994A that the subject has not experie 0 PVT PVT No medications Internal mass on left side of head - has VP shunt 1 PVT PVT 0 None OTH PVT VYTORIN; None Lisinopril; Estrogen; BYETTA; MTV 0 PVT PUB None None None known 1 PVT PVT No migraine~Tdap (Adacel)~UN~13~Patient 8 Had CBC, Blood PVT culture PVT and CRP at ER None-Ear infection None at ER 9/2/09 0 PVT PVT none none 2 PUB PUB No No 0 OTH PVT No No No 1 Requested OTH patient to return PVT to clinic AMARYL; but she refused. LANTUS; None She Levothyroxine; Diabetes; plans to see Hypothyroidism; Hydrocodone her PCP. Chronic pain 0 UNK OTH None 0 OTH PVT Unknown None Controlled seizure disorder
0 OTH PUB Unknown None Hypertension; Hypercholesterolemia 0 OTH PVT None Percocet allergy 2 OTH OTH No Codeine 0 OTH PVT None None 1 PVT UNK No HTN; Back & neck injuries 2 site reactionOTH PUB None 2 OTH OTH NEXIUM; PERCOCET; None XANAX; OXYCONTIN; COMBIVENT 0 OTH PUB SINGULAIR; None PIROXICOM; High blood pressured med 1004 None PVT PVT None None RAD 0 OTH UNK Oxycodone/APAP 5/325mg NKA 0 OTH PVT None 0 E Room gave PUB IV BENADRYL UNK - no BCP rash present None None 1 PVT PVT MIRALAX None notedADHD; Constipation 1 PVT PVT None None None 1 PVT PVT None None 1 None PVT PUB None None 0 PVT UNK 2 PVT PUB 24 pending visit PVT with neurologist PVT None Body ache;Seasonal pain on left allergies arm - not in treatment at this time 3 PVT PUB None None - WCE NKA (physical) 646 PVT PUB None Unknown Asthma 1 PVT UNK No No 1828 UNK UNK 1 PVT UNK Tetanus & diphtheria localized reaction~Pneumo toxoid; Pneumococcal (no brand - onset name)~1 7-16-2 PVT PVT 0 PVT PVT none none none 0 They diagnosed UNK her with UNK constipation none& pain in nonelower she abdomen. went none.in9/28/09 for This annual isER notschool records a correct check-up received diagnosis, DOSmy 8/4/09 daughter to 8/5/09. was n 1 none UNK PVT Unknown Unknown Unknown unknown~ ()~NULL~~In Patient 0 UNK UNK Propranolol 20mg twiceAllergy daily to mold and mildew. Recent injuries in car acciden 6 PVT UNK NOne food allergies:Milk, Wheat, Soy, Nuts. Allergic reaction to A 0 None performed PVT as of yet PVT none none none none~ ()~NULL~~In Patient 0 PUB PUB also recieved dtap shotwas reffered loss to aofspeech appetite,redness,stiffness therpist at the injectio 1 PUB PUB swelling in the injection site, redness, fever, bu 0 UNK PVT synthroid,cymbalta,provigil, None Nonemultivitamins,calcium, d, Preservision 183 The RA diagnosis UNK has UNK been established None at (after theNone time examination Hashimoto and blood (Thyroid) tests) on July 22, 2009 by Dr. at the Hospital 1 UNK UNK none 1 PVT UNK singular, prednisone, syncopy advair, pcn, erythromycin, cymbalta, nexium, ceftin, pepcid, codeinexyzal 1 PUB PVT NONE 2 Atrial Flutter, UNK increase UNK in enzymes. 9/9/09 ERnone records received congestive DOSheart 9/4/09. andLABS afib. and 9/9/09 DIAGNOSTICS: ER records received CK-MBDO 12 0 Received flu UNK vaccine and PUB pneumovax Atenolol/Diovan in left arm NONE atand 11:40am CNONE on Sept.5. By night had arm pain and by morning had 2 NONE PVT PVT Runny nose-minor asthma coldSevere symptoms Diarrhea~Rotavirus (no brand name)~3 1 PVT PVT Synthroid, antibiotics Absess on Left Hypothyroidism leg 1 PUB UNK None None None 3 not applicable UNK PVT unknown none none 1 Seizure 10/7/09 UNK ER record UNKreceived None for date 9/3/09 None Diagnostics/Lab: None Seizure~HPV CT scan of head, (Gardasil)~3~16.00~Patient UA. 0 UNK UNK 2 PVT PUB Toprol XL 25mg/da, None Fosamax C5-6 disc 70degeneration, mg/wk, Sertraline spondylosis; 25 mg/da, L3-5 glucosamine lumbar spinal 1500 s 1 urine bilirubin OTH test, 11/10/08, OTH Neonatal bilirubin: Circumcision 9.5 ug/dL; urine bilirubin test, 11/07/08, WAES0908USA04685 Neonatal bilirubin: 12.6 ug/ 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 9/15/2008) WAES0810USA04754 48 head computed OTH axial, normal OTH Unknown Unknown WAES0909USA00007 35 Ultrasound,OTH ?/?/09, results OTHnot provided; hormonal Factor contraceptives. V activityUnknown. test, 9/18/09 ?/?/09, 9/18/09 Hospital results Hospital records not WAES0909USA00201 provided. records received 9/18/09 received DOS 7/8/09 Hospital DOS to 7/8/09 record 7/9/09 t
Unknown OTH OTH Unknown Unknown WAES0909USA00202 90 Unknown. 9/18/09 PVT Hospital/medical OTH Unknown records received DOS Unknown. 4/16/09 9/18/09 to 8/24/09. Hospital/medical LABS WAES0909USA00324 and DIAGNOSTICS: records received CBCDOS -W 2 Unknown OTH OTH Unknown Unknown WAES0908USA05165 Unknown OTH OTH Egg allergy; Allergy to nuts; Food WAES0909USA00028 allergy Unknown OTH OTH Unknown Unknown WAES0909USA00354 1 OTH OTH None Sulfa Drugs 366 2/11/09, CTPVT chest; 2/11/09, PVT D dimer none 1960. 9/11/09 none Hospital beerecords sting allergy; received L5-S1 DOS disc 2/11/09 herniation; to 2/17/09. LymeLABS 8/06. 9/11/0 and D Liver function OTH test, abnormal OTH Unknown There was no information A0798512A available regarding concomitant 0 OTH OTH 1 None PVT PVT None None Swelling~DTaP (no brand name)~1~1~Patient 4 Allergic reaction OTH PUB None Allergy to shellfish; Hx asthma 1 PVT PUB YAZ None None 0 PVT PVT Pt takes YAZ UA pendingPVT UNK None None 1 None PUB PUB None None Seafood -Shrimp 0 PVT PVT none none none 3 OTH OTH None None 0 BP 150/80; OTH pulse 68. After PVT 30 minUnknown 128/76; pulse Unknown/ 60. none Unknown mentioned 1 PUB UNK Pain in rightDID shoulder, right shoulder back and and neck. cervical thoracic 0 PVT PUB WCE Asthma 1 ER Dr. cellulitis PUBinfection. PUB AMOXICILLIAN No tid X No10 days. Merca OR200938 1 None PVT OTH None AMOXICILLIN allergy, Asthma. 0 ER - dx anxiety PUBattack.PUB PCP referred CONCERTA to neurologist, No appointment Penicillin next allergy, mo.bee stings, OR200937 mosquitoes, ADD. PVT UNK No None 5 PUB UNK LIPITOR; BP NoRX; PROZAC; Increased Hormone cholesterol; replacement MI2009010 BP; depression. therapy. 11 PUB PVT Been on this None 10 years,Asthma; SYNTHROID, Hypothyroid None~ .1mg/x/day ()~~0~Patient controlled MI2009009 with medicine 7 PUB UNK 0 OTH PVT None Resolving poison Allergicoak. to bees, penicillin, outdoor allergies. No history of 1 None PUB PUB None None Known 1596 Labs: Hgb A1C UNK7.5 BSUNK 400. FBS Lisinopril 190. UA trace HTN ketones.HTN. Glutamic PMH:acid HTN, decarboxylase dyslipidemia.antibody insomnia(+). 2' to 09/22/09 shift work reco Fa 0 URI; viral infection PUB by ER PUB none none none VA09:012 0 Varicella vaccine PVT givenPVT 8/6/09 andadvair, on 9/3/09 singulair patient none and had albuterol asthma, food epicutaneous allergic rhinitis testing with Control no Wheal no Flare PATIENT WAS PVT GIVENPVT 0.5ML OF FLUZONE ECZEMA ON 26-AUG-2009 N/A AND THEN AGAIN GIVEN 0.5ML OF FLUZONE O 0 PUB PVT 10 9-8-09 T/C UNK to parent, states UNK she has not taken client to Urgent care due to cost. State she doesn't have a PCP, doe 0 NA UNK UNK none no eczema 2 PVT UNK Daily asthma None. inhaler (symbicort), Asthma, facial zyrtec, tics.and guanfacine. 0 N/A PUB UNK Hormones, no vitorin N/A 3 MIL MIL Denies Denies Denies 2 N/A UNK PVT Unknown None No known allergies 1 PVT PUB Claritin None known Rhinitis 1 none PVT PVT none none none 3 PVT PUB 1 PVT PVT None None None 1 UNK UNK 0 NONE PVT PVT 2 995.2 UNK UNK Altrace, Clonidine, none toprolol, potassium 0 9/25/09 Medical PVT records UNK received for DOS 9/1/09 Noneto 9/2/09 Heart Diagnosis/Labs: murmur; Respiratory MRSA negative distress at birth 9/25/09 Medica 0 OTH OTH None None 3 Waiting for OTH patient call-back PVT with more information. Sulfa; Codeine; Quinolones; Nifedipine 0 PVT PVT None None None
0 PVT PVT None Pregnant 0 OTH OTH allergies: Varenicline; Tramadol; VICODIN; conditions: Os 1 PVT PUB BENADRYL 1 CBC; C-reaction PVT protein; OTH None None Save Symptoms~Influenza (Seasonal) (no bran 1 PUB PUB None Stuffy noseNo only 0 UNK OTH 3 PUB PVT TB test, Sanofi None Pasteur, C3060AA, IM Left arm 0 OTH PUB 3 Chemistry, PVT HematologyOTH - and Lyme titer - negative. None None 0 OTH OTH ZOLOFT 100mg qd Asthma stable for yrs per pt. OTH PVT None None 1 PVT PVT ADVAIR PharyngitisAsthma 3 None PVT PVT None None PVT UNK No 31 See attached PVT pre & post PVT charts, EINone evaluation,None Genetics evaluation Mild expressive - see speech attacheddelay. Labs No andreceptive Diagnostics: delay.Chromos PMH: m 2 None completed PVT UNK Concurrent illness: none. The ### patient had no known allergi 1 OTH OTH ### 1 UNK UNK NO known allergies. ### 1 CBC and sed PVT rate wasUNK to be performed None None None ### UNK UNK The patient had an unknown past ### medical history. The pa 1 UNK PVT OTH The subject had no adverse A0799188B events following previous vac 0 UNK OTH OTH Unknown There were no known concomitant A0805392A medications. 0 UNK PVT Lisinopril, Toprol none XL, Klonopin, Lovastatin, shivering,Levothyroxine, chills~PneumoTriamterene/HCT, (no brand name)~NU Alev 2 PUB PUB 0 PVT UNK Sulfa 0 diagnostic laboratory, PVT 05/05/09, OTH lesion LORTAB; type: aspirin; vesicle; MOTRIN; diagnostic Chickenpox TOPROL laboratory, XL05/05/09, tablets WAES0907USA05837 rash type: herpes vesicular; V 5 Unknown PVT PVT Unknown Delayed delivery WAES0909USA00325 1 Unknown PVT PVT Unknown None WAES0908USA01926 Unknown OTH OTH Unknown Unknown WAES0909USA00049 42 ultrasound, OTH 01/20/09, Single OTH Live Intrauterine None Pregnancy Pregnancy,NOS 12 weeks, (LMP =2 10/31/2008) days; diagnostic WAES0905USA01040 laboratory, 08/08/09, Cord p Unknown OTH OTH None WAES0909USA00206 magnetic resonance, PVT 05/01/09, OTH abnormal. ALESSELABS and DIAGNOSTICS: Unknown 9/16/09 CT Brain Received WAES0909USA00318 - Abnormal. medical MRI records Brainw/PMH: - Abnormal. Aller 41 12/6/07 - ER PUB - Spinal Tap OTH and CT Lisinopril scan - 12/7/07 None - MRI - High All blood blood work pressure 0 Unknown 9/25/09 PUB Medical PUBrecordsnone received stated DOS Prior by mom 9/2/09 to vaccination to 9/3/09: Latex - Bandaids none Diagnostics/Labs: stated 9/25/09 Medical CBC, records Chemistry, received CRP, DOS UA W9 0 EEG- Hypsarrhythmia PVT PVT Labs and Diagnostics: Septra 1/2 tsp Right EEG POabnormal-hypsarrhythmia. otitis BIDmedia Cleft lipBox and18: palate purulent PMH: Auditory earcleft drainage Evoked lip/palate-with Potentials repair. abnorma 36 we 0 MIL MIL Insulin; AMOXICILLIN;Acetaminophen; DILTIAZEM Swelling~Influenza HYDROCHLORIDE; CODEINE; DEMEROL; (Seasonal) SALMETEROL MORPHINE. (no brand XINAFO name 0 Referred toPVT EmergencyOTH Dept. for further None evaluation None and treatment. No 1 PVT PVT None None 0 PVT PVT 0 None PVT PUB None Sulfa, PCN 0 None PVT PUB None Sulfa PCN. 6 None PVT PVT None None Eczema 392 OTH PVT ZOLOFT, PROTONIX, None None CRESTOR, CARDIZEM, MultVita plus Vita B and C, Ome 10 None PUB PUB None None Seasonal allergies Fever 102 up degrees to 18 months X 2d of hives age.X 1d~Hep B (no 1 None PVT PUB None None 1 None PVT PVT None indicated None indicated None OTH PUB ALBUTEROL None Inhaler as Noneeded. 286 10/6/09 medical PVT records OTH service dates 2/10/02none to 9/09/09. none. LABS 10/6/09 andSeizure.~Measles DIAGNOSTICS: medical recordsEEG +service Mumps - Abnormal. dates + Rubella 2/10/02 CT(no Brain tobran 9/0 1 PUB PUB None None 1 PUB PUB 0 PUB UNK
None
OTH PUB PRILOSEC,No FCL, HCTZ, NoMethotrexate, Bupropion, LIPITOR, Betamethasone Dip 0 MIL MIL 116 PVT UNK None None 1 None OTH PVT ASACOL 400 Ulcerative mg 8 tabs Colitis daily; SIMVASTATIN 20 mg 1 tab at bedtime; ALENDRO 0 PVT PVT None None Latex Allergy 1 PVT PVT OCP-levonorgestrel Mild cough -EES; Dysmenorrhea; illness; DRYSOL menstruating prn hyperhidrosis topical 0 WBC 12,100; PVT82%. PRN; PVT Hgb 14.6; FLONASE Platelets LAMISIL None 203,000; PO Bili LEVAQUIN; 250 2.21; mg;Disect ALLEGRA Aspirin. .26; LFTS 80 mg; WNL BinBif PULMICORR. 13 Cr 1.1. 0 PVT PUB None 0 None PVT PUB None None None 0 PVT PVT None None None 0 PVT PVT None None None ~Hib (no brand name)~2~0.30~Patient 1 PUB PUB 2 PVT PUB None Augmentin 0 MIL MIL BICILLIN None 0 None OTH UNK None/Unknown None 2 PVT PVT 0 UNK UNK Levothyroxine, None Metroprolol No 0 PUB PUB PVT PVT None 0 None PVT PVT Ibuprofen None 0 None PUB UNK None 1 PVT UNK None None 2 PVT PVT 0 none PUB PUB ibuprofen, acetaminophen, no illnesses. nopatient allergies acetaminophen wasorvaccinated medical with conditions post-delivery codeine, docusate, of babyprenatal vitam 14 N/A PVT PUB clindamycinacne, gel, salicylic dandruff unknown acid topical, benzoyl peroxide 1 UNK UNK none none none 1 PVT PVT none none 0 PUB PUB 0 PVT PVT 0 PVT UNK OTH UNK Acyclovir; HYZARR; Fever; Swelling; TRAVATAN Unknown redness; Z per welts. profile PUB PUB No meds No illness No pre-existing redness, conditions warmth,hardness~DTaP or allergies noted by + HepB parent.+ IP 0 None PUB UNK Lotrel 10mg-20mg Hypertension, capsule shellfish-Hives Colon po daily, Cancer, last does s/p recent 9/7/09treatment PUB PUB 1 None UNK UNK tylenol, asa,UTI dulcolax, clonidine, Pt. was allergic B12, doripenem, to PCN, andlovenox, cephalosporin levaquin, morphine, M 2 NONE PVT PVT NONE NONE NONE 1 None PUB PUB None Known No None Known 0 "Pt is fine". PUB PUB 1 none PUB PUB none none PCN, Codeine, Sulfa 0 None. PUB UNK None. None. None. 1 PUB PVT None None None 0 PVT PUB 0 UNK PVT None None 0 Food allergy PVT (egg) panel PUB pending.No NONE other testing NONE HEMANGIOMA - NECK 1 PUB PVT 2 pt developed PVT a fever of PUB 103 2 days none after vaccination. none Fever none resolved after 36 hrs . vomited x 1 2 None PUB PUB Remicade Infusions None last Rheumatoid 7-22-09, Vitamin Arthritis, C, Osteo Calcium Arthritis, Citrate,Hearing Promethazine, and Balance Aza 2 None of theUNK tests that patient UNK has none endured have none determined none a cause for the seizures. 10/20/09 Medical record rece 0 PUB PVT SUDAFED ACTIFED ASTHMA 228 CBC's.Coobs UNK test. Bone UNK marrow aspirate None. Atand the None BM time biopsy. of vaccination. Short ANA.Stature Retic Treated count. 9/28/09 with LDH. Medical Growth Complements. records Hormone and Chest from DC age summary x ray. 10-13 Sero re 1 none PVT UNK remission from crohns crohns disease disease
1 MIL UNK Fibromyalgia; Arthritis; Depression; Chronic Pain; ETC. 3 PVT PVT Garlic; FishNone oil; ASA 81None mg 0 NONE PVT PUB None None None 25 State Lab ran UNK PCR for UNK Vaccinia onNone trunk scraping/swab No &Elevated oral lesion Serum swab. Albumin/Globulin Negative. Alsoratio negative - Recurrent for Herpes - Norm by 2 PUB PUB 9 Myositis with PVT Elevated PVT CPK of 4,164. Synthroid, ANA, RF ctomel, Nonegatiive Bioidentical Pseudocholinesterase hormones deficiency 0 NO TESTSUNK PERFORMED UNK QVAR, XOPENEX, NONE. Seen TIZANIDINE4MG, Note for in fluabt shot, 2002 for had a prna diuretic pneumonia rx invaccine case of with edema an injectio occure 1 UNK PVT None applicable None Allergy to pre-exposure rabies vaccine given in 1968 (arm 0 None PUB PUB None None None; was born premature 51 LABS and DIAGNOSTICS: PVT PVT Rheumatoid Factor Asthma; 28 (+).Scoliosis; Anti-Saccharomyces Pistachio; Migraine reaction HAto Cerevisiae valium. Received Antibody2(ASCA) doses Hep (+). X-ray A vac 0 OTH UNK 10 None PVT PVT None None None 0 MIL MIL 0900 am started Allergic tingling to SULFA 0 PVT PUB capillary hemangioma on lip 2 OTH PVT Unknown Asthma 0 PVT PVT None None PVT PVT None None 0 OTH OTH None None Allergic to milk 0 None OTH PVT None None Allergies - food 1 CBC PVT UNK 4 PVT PVT 1 L arm formed OTH a blister OTH at site after 48 hours; RNone arm bruised Rheumatoid after 48 hours Arthritis; Asthma 1 PVT PVT None Amoxil; Nuts 0 PVT PVT Albuterol prn None mild asthma Seasonal 0 PVT UNK None None 0 OTH OTH None None 0 OTH UNK None Known Dx of Eczema age 11 3 None OTH UNK None None Poison Oak tx'd with Prednisone 10mg 8/17/09 PVT PVT None PUB PUB None reported None 0 Electrolytes;PVT glucose nl. PVT None None 1 PVT PVT SINEMET; Parkinson's MIRAPEX Allergy-sulfa; disease Parkinson's disease; Osteoarthritis 1 PVT PUB 1 None MIL MIL None None None 1 None PVT PUB Asthma NOS w/o status asthmatics 1 None PVT PVT None None OTH UNK None 1 PVT UNK None None 0 PUB PUB None Denied Denied 0 PVT PUB None None 3145 Clinical observation PVT PUB Unknown None 1 Glucose PLASMA, UNK 80 mg/dL; UNK Ureanone Nitrogen PLASMA, none 14 none mg/dL; Creatinine PLASMA, 0.9 mg/dL; Urea Nitrogen/C 14 Blood work PVT done continuously OTH throughout the six weeks 7 None PVT PUB None None None 0 PrednisonePUB 20 mgm #6PVT 3/2/1; BENADRYL PRN. None Asthma; Allergic fever/sore~Tetanus to AUGMENTIN Toxoid (no brand name)~U 2 UNK PVT PVT Unknown No concomitant medications A0806120A or relevant medical history. N 0 PVT PUB None None None 1 PVT OTH None None 0 OTH PUB 1 None MIL OTH 7 PVT OTH 6pm 8/20/09 No
0 Unknown OTH OTH Unknown Unknown WAES0909USA00557 None PVT UNK ADVAIR The patient had no illness at the ###time of vaccination and sh 0 CT Scan; CBC PUB9/27/09UNK Hospital records received Headaches9/27/09 DOS 8/31/09 toHospital 9/2/09. records LABS and received DIAGNOSTICS: DOS 8/31/09 CBC to -9/2/09. MPV 6 9 MRI being done, PVT results PVT pending None Autism OTH PVT None None 1 None PUB PUB Unknown None Allergic to PCN; ? Latex allergy None PVT PVT None For well child None care 0 PVT UNK SEASONALE None (BCP) 154 None UNK UNK None None 0 Bloodtests, UNK CT, MRI, EEG, UNK ENT-Doctor twice, x-rays. All None these9/29/09 tests were Medical donerecords betweenreceived April and from May dates 2009. of 9/29/ serv 7 to be seen by PVT her neurologist UNK 1 PVT PVT TRISPRINTEC none 0 UNK PVT None None None 0 None PUB PUB None None None 0 Pulse Ox 97-98% PVT on Room PUB air None@ Vaccine Had similar3/19/09~Measles reaction 3/19/09 to + Mumps MMR; Congenital + Rubella hydrocep (no brand 0 UNK PVT None None/Body Temp 98.3 1 PUB PUB no no 0 PUB UNK 0 PVT UNK None "head cold"None known 0 UNK UNK 1 None performed. PUB UNK None. None. 81 9/15/09 PCP UNK medical records UNK received NoneDOS 7/10/07 No. 9/15/09 to 8/24/09. None. PCP medical 9/15/09 LABS Fainting~HPV and records PCPDIAGNOSTICS: medical received (Gardasil)~2~13~Patient records DOS Rapid received 7/10/07 Strep to DOS (+). 8/24/09. 7/10/07 MonoP 6 All laboratory UNK tests were UNK normal. Bun flaxseed and Creatinine oilNo 2000mg illnesses were perat day, normal. time vitamin of Dehydration vaccination b6 tablet once was ruled a day, out. prozac Temperature 20 mg once wasa 9 5 UNK PVT guillaine-barre~Influenza (Seasonal) (no brand 5 PUB PUB acetaminophen noneatenolol, obestity, glipizide, HTN, HCTZ, PVD,lisinopril, DJD, diverticulitis, methocarbamol,pioglitazone, hyperlipid, onychom 1 PVT UNK Amoxicillin (amoxicillin), 1 Depression NKDA 500 DIAZ, mg,HEATHER capsule Elavil 09/07/2009 (amitriptyline), 2 Diabetes 25 mg, tablet Mellitus 0 PVT PVT None Reflux, Asthma, environmental allergies, food allergies-mil 0 PVT PVT Flonase None 0 PVT PVT None 0 none. PVT UNK 1 PUB UNK 53 None. I do UNK have copies UNK of all medical Yaz history until 3/17/08. None from 01/08/2004 Femcon Nonebeginning to theNone~ time 3/17/08. of()~~0~Patient her Anaprox death that asI needed. can provide if needed. 8 MRI of headPVT and spineUNK +/- contrast with smallNone areas of intensity. LP with CSF normal, including evaluation for oligo 11 PVT PVT none none none fever of 104~Measles + Mumps + Rubella (no b 0 n/a UNK UNK none none none 0 UNK PVT Friedreich's Ataxia Diagnosed March 2009 0 UNK UNK Zoloft - 50 mg Patient hadnone flu/virus symptoms the prior week but was not suffering fro 0 MIL PVT n/a none seasonal allergies 1 UNK UNK none knownnone none known 0 allergic reaction UNK from influenza UNK vaccine 1 PVT UNK Chest pain 0 visited doctor, UNK no testsPVT lisinopril, hydrochlorothiazide, none Iodine allergy, maxide, nausea, essential atenolol, weakness, hypertension, probenecid, aches~Influenza baby gout,aspirin asthma (Seasona 52 Doctors performed UNK many UNK tests andNone. we came 9/18/09 back None. PCP with 9/18/09 medical noNone. answers. PCP records 9/18/09 medical Other received PCP records than medical DOS positive received records 10/2/06 results DOS received tofor 6/27/08. 10/2/06 numerous DOS to Ortho 6/27/08 10/2/06 yeast Tri3 UNK OTH OTH Unknown A0806613A 0 BP @ 1407PVT 130/80; BPPVT @ 1410 160/82; BP @ Diarrhea; 1425 164/82 Weight Penicillin lossAllergy; Emphysema; High BP; Renal Failure 0 Blood Pressure, OTH stablePVT 1 PVT UNK DEPO-PROVERA; Not ill- 9/9/09 PROCTOFOAM NKDA - None 0 Wt - 103#; Oral PUBTemp -PVT 97.4 none asthma 0 PVT UNK 2 None PVT UNK None None None Sever fever and seisure~Measles + Mumps + R None PVT PVT None None None
1 WBC 22.3; PVT GRAN 89.0 OTH (Drawn 9/9/09 after visit) Elevated WBC count 0 PUB PUB ZOVIRAX 200mg Cold symptoms divided None by 5xday; MOTRIN; Antihistamine 0 OTH PUB Unknown None None 0 Blood workOTH UNK None 0 UNK UNK none none none 3 Crp 8.40 911ccl PVT 127 (normal UNK on 9/10/09)AST FLUOXETINE, None Co4FLUTICASONE, ALT 94 HTN, (38 & NASH/fatty 52KETOCONAZOLE, on 9/10/09) liver allergy (>) quick to LISINOPRIL-HCTZ, FEXOFENADINE strep 7.4, 15.2, 275 METAM (increas 0 None UNK UNK 0 PVT PUB SYNTHROID None Preterm 27 weeks; GERD; Hypothyroid None PUB PUB None Febrile seizure Dx at 9 months old Unknown OTH OTH Unknown None WAES0909USA00464 0 None OTH OTH Surgery WAES0909USA00635 cervical smear, OTHabnormal OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0909USA00783 120 Unknown. 9/18/09 OTH Hospital OTH records hormonal receivedcontraceptives DOS 5/27/09 9/18/09 to 6/4/09. Hospital LABS records andWAES0909USA00762 DIAGNOSTICS: received DOS 5/27/09 CT - Abnormal. to 6/4/09. Ve 87 Unknown OTH OTH Unknown Unknown 9/29/09 Received WAES0909USA00753 medical records w/PMH: idiop 0 Unknown OTH OTH Fear of needles WAES0909USA00773 0 N/a MIL UNK None Allergies to strawberry, eggs, outside and inside, sinusitis, 1 PVT PVT none none allergic to sulfa 0 None UNK MIL Bacitracin 500U/g None topical Acne. ointment. Metatarsalgia. none~ Hydocodone/Acetaminophen ()~NULL~~In No known allergies. Patient|unknown~ 7.5-500mg ()~NUL PRN 435 Still doing tests. UNK Will have UNKmri and eeg. LABS none, and healthy DIAGNOSTICS: none 9/15/09 Cranial Received CAT medical Scan Unremarkable. records w/Menactra, CervicalLot Spi# 1 She had a sonogram UNK showing UNK ileocolic none intussesseption None which Nonewas not reducible with air enema. She went to the OR 0 PVT PVT 1 PVT PVT valtrex none knownnone knowncellulitis~Tdap (Adacel)~NULL~25~In Patient 0 PUB UNK Hydroxychloroquine none 200 Allergies: mg TabXylocaine Take 1 Tablet, HCl:Hives, PO 2X Rashweekly-Iodine ASA--Calcium : Hives, Ra 2 PUB PUB ALLERGY TO CEFZIL 0 PUB UNK Hydroxychloroquine None Oral Overlap - ASA-Hydroxychloroquine syndrome - lupus, Sjogren's, Oral -restasis RA c/beye CVA drops and 0.0 h/o 0 PVT UNK 0 PUB PUB none, at 4 mo. allergies: immunizations zithromax, "took seasonal 2 months to recover and be back 0 Upon examination UNK a blood UNKtest showed None WBCsNone within normal Chronic limits. neck Patient's pain; spondylosis vitals were checked of lumbarand region. the patient ha 2 PUB PVT 0 None UNK UNK None Celiac Sprue None~ Disease ()~~0~Patient 1 n/a PUB PVT n/a none n/a 23 EKG, CT scan, PUBnumerous PVTlabs Vitamins None None 0 None PVT UNK Fluoride drops None PVT PVT none 0 PVT PVT NA NA Previous GERD Similar reaction~DTaP (no brand name)~4~1~I 1 PVT PVT NONE NONE 0 PUB UNK Sulfa allergy Culture (results: OTH S. pneumococcus) OTH Concomitant was doneUnknown on medications an unspecified Relevant weredate. not medical reported. history USWYEH10816209 was not provided. UNK UNK ### 18 UNK UNK Prenatal vitamins No medical history, allergies, or ### medical conditions; no pre 27 MRI head; EEG; PVT Echo;PVT carotid ultrasound. None 10/1/09 10/1/09 Consultant Consultant Allergies records records to PCN. received received 10/1/09 DOS DOS Consultant 8/28/09. 8/28/09. records LABS Fatigue, and received DIAGNOS leg stiffne DO 53 PUB UNK None None 2 CBC PVT PVT Claritin PRNNone 2 previous febrile seizures OTH PUB None None None 0 PVT PVT Lisinopril - HCTZ; Oxaprizin-600mg 0 Unknown OTH PVT Warmness Unknown feeling 2 None PVT PVT MVI; CLARITIN None None 0 PVT OTH None No Peanuts - anaphylaxis 2047 PVT PUB Fluoride; Multivitamins None None 1 None takenUNK PVT None None 1 PVT PVT Well child check NKA
7/30/09 HCS=Positive MIL MIL 0 OTH UNK LISINOPRIL No No No~ ()~~0.00~Patient 2 PVT PVT None Well child cheek 2 PVT PVT Well Child Check NKDA 1 PVT OTH None None Hgb, trait 6 None PVT PVT None Hospitalized 8/18 to 8/20 with UTI with bacteremia and fev 1 None MIL MIL Allergra None ASA/PCN A+ 1 PVT UNK None None 0 None PVT UNK None None 0 PVT PUB MYCOLOGDiaper cream rash to diaper area PVT UNK None None 18 PVT PUB MultivitaminNone DEMEROL 1 28 wk gestation; PUB CXR after PVT event with Oral poss Fe aspiration; Growing Preemie Hct 28after wk gest event at 24.8 delivery; (chronic anemia anemia of prematurity of premat) 0 None. Patient PVT was advised PVT by administrator Estradiol, Cymbalta, that None. it was generic anNone. allergic Wellbutrin reaction. None.~ Advised ()~NULL~~In to take Patient Benadryl and ibuprofen 586 9/22/09 Pneumo UNK StudyUNK SAE report hospitalization COPD DOS 8/24/09 9/22/09to Pneumo 8/27/09.Study LABSSAE andreport DIAGNOSTICS: hospitalization C. Diff. DOSCult 8/2 UNK PVT none 1 Asymptomatic PVTUTI present UNKat timevitamins, of vaccine. temazepam none-only All other routine asymptomatic, (PRN) none lab work none~ undiagnosed was()~NULL~~In normal. UTI Patient|none~ ()~NULL~~I 0 PUB PUB PT. HAS HISTORY KEFLEX,CECLOR. OF GLAUCOMA. PT HAS GLAUCOMA. 0 UNK UNK Adderall 15mg None daily, Dextrostat ADHA 5mg prn 0 No labs were PVT performed PVT on her doctor budesonide visit onNone (RHINOCORT 9.10.09. AQUA) 32 MCG/ACT NASAL SUSP cetirizine-p 1 PUB PVT BCP None none none~ ()~NULL~~In Patient 0 NONE UNK UNK TYLENOL AS NONE NEEDED NONE SC0928 1 PUB PVT Shellfish, peanuts 1097 PUB PUB 0 PVT UNK 1 none PUB PUB none none; reports seasonal "felt fine" allergies 0 none PUB PUB Depakoate;none aspirin; psych Emphysema meds Sister is allergic to eggs does not take seasona 0 UNK UNK unknown none patient could not receive injections in left arm due to a prev 1 Had PPD placed UNK the same PUB date and None time of MMR Nonevaccination. None PUB UNK None None 0 OTH PVT None None 1 None OTH OTH None 0 PUB PUB Allergy to high dose NAPROXEN 7 OTH OTH None reported or observed. Pt did have a rash 5 hours before inj. 7 OTH PVT none 0 Blood pressu OTH 106/60 mmHG; PVT Pulse 65 BPM None -10 None OTH PVT None allergic to fur; apples 1 PUB PUB None None 9 PVT PUB None 2 PVT UNK None None 0 PVT PVT ACETAMINOPHEN No Omphalitis; Umbilical Hernia 1 UNK PVT None 1 Awaiting results OTH PVT OTH PUB 1 None PUB UNK None None None 1 PVT PUB 6 None PVT PVT LOTREL; VYTORIN; None NKDA GLYMPRIDE; B COMPLEX; ASA 0 none PVT PVT None None 0 OTH PVT 0 OTH OTH Lisinopril 2 OTH UNK None None
1 PVT PUB Albuterol inhaled None solution None 0 None OTH PVT SINGULAIRAsthma; 10mg; PROVENTIL Influenza Asthmaprevention HFA MDI (PRN) 42 OTH PUB None was not aware she was pregnant 1 PVT PUB 1 PUB PVT None None 1 None PVT PUB None None 0 PUB PUB None None None 0 None PVT PUB None None Autism 0 OTH UNK 0 PVT PVT None None None 0 PUB OTH LEXAPRO None 5mg/daily Allergic to sulfa; Denies any other medical conditions 0 PVT UNK None None 1 CBC w/diff;PVT Flu test; Strept PVT test, all normal 1 UNK PVT Unknown Allergy to penicillin and DIFLUCAN 1 PVT PUB none none 1 Seeing pt today PVT 9-11-09 PVT for office visit - givennone prednisone. Asthma; Hypothyroidism; depression 1 PUB UNK MIL OTH None 19 7/20/09, CRP, UNK 11.0 H; UNK CMP wnl except none 105 H, none AST 50 H;environmental CBC wnl except allergies WBC (self 11.8 diagnosed); H; 7/20/09, CT migraine Lumbar headac Spine 1 OTH OTH Unknown NKDA; NKFA 1 WBC 9.5, 72% UNKneutrophils; UNK CMP normal, UA none normal, CXR none including PMH: none spine noted. normal, Lyme negative; CSF 0 WBC, 0 R 0 none PVT PVT none none none 0 UNK PVT 10 Possible Non-viral MIL Pustulosis MIL N/A NKA 1 UNK UNK non listed no no, howeverna~ patient's ()~NULL~~In husband Patient|na~ mentions the ()~NULL~~In next day she Sib 0 n/a UNK UNK prilosec prnnone none 1 chemistry/serology PVT demonstrate PVT elevated digoxin, amylase diltiazem,morphine, acute and pancreatitis lipase no known prior ondansetron allergies, to injection; dementia SGOT and (ageSGPT related) elevated slightly d 51 UNK UNK None Allergies: Metal (dermatitis), antihistamine/decongestant c 0 None. Called PVT Dr. OfficeUNK regarding None fever, as is None listed on the None CDC form and was told that it couldn't be from the nasal 0 UNK UNK veraspimil 240 ear infection mg cozaar chronic week 50mg preceding asthma/high amoxycillin measle like blood 500mg rash~Measles pressure/anxiety + Mumps disorder/majo + Rubella 1 MIL MIL 0 PUB PVT none none none 6 PUB PVT 5 mg crestor none daily serious reaction to polio vaccine~Polio Virus, O 1 PVT PUB FLONASE; None CLARITIN;Chronic MV2; SENOKOT; constipation; MIRALAX; Renal allergies CASTER OIL OTH OTH No other medications Colitis Ulcerative MA20092378 OTH OTH No other medications Unknown Ulcerative colitis MA20092379 10 10/13/09 Received OTH MROTH from Hematologist. Diagnostics/Labs: No known Platelets medical 1(L),history. RBC 4.26(L), Concomitant ### WBC 12.6(H), drugs and Neutrophi illness 0 Unknown OTH OTH None None WAES0909USA01041 21 None OTH OTH Unknown WAES0909USA00746 33 beta-humanOTH chorionic, OTH 11/17/08, positive None Pregnancy NOS (LMP = 10/20/2008) WAES0811USA02648 730 magnetic resonance, OTH 01/??/08, OTH was None diagnosed with mild None CHIARI malformationsWAES0908USA04768 and the rest of the MRI was norma 0 Unknown OTH OTH ORTHO EVRA None WAES0909USA00694 DAP and gave to 18 month old instead UNKof DTAP. UNK Letters too similar or rather same in just different order. Mom said child had diarrhea for 2 1 PUB PUB None None Asthma-type s/s, 1 year AR0931 ago, resolved. Allergy to Penicillin 9 None OTH UNK None None None OTH PVT prenatal 0 PUB UNK 1 PUB PUB None Multiple Rx None~ allergies ()~~0~Patient|None~ ()~~0~Sibling 0 PUB UNK 1 PUB UNK None 19 PVT PUB BENADRYL
0 None 11 3 None 620 None None None None None None None None None None None None None None
PVT PVT None None None PVT UNK None None PUB PUB None Febrile Seizure Dx at 19 months old PVT UNK Cough OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None None OTH OTH None None None UNK UNK None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None 3 NONE PVT PVT BENADRYL;ALLEGRA SEASONALEXERCISED ALLERGIESINDUCED ASTHMA 10 none UNK UNK none no none 2 Pt is havingUNK a liver panel UNK drawn this none am but upon nonecalling mom NKA-none this am, medical mom conditions reports pt is reported less jaundiced and continu 1 PUB PUB None None 1 UNK UNK SC0922 2 PUB PUB Unknown unknown 2 Biopsy - SEVERE UNK SPONGIOTIC UNK DERMATITIS Zonegran, Keppra, None WITHMiralax, PROMINENT GlobalPoly-Vi-Sol developmental INTRAEPIDERMAL delay, Chromosome BLISTER FORMATION abnormality, se A 1 PVT PUB None None None 0 PVT PVT Tenormin 50mg Nonedaily, Vitamin Allergic D to 50,000 beans and IU once peanuts; a week nitrofurantoin; --C-sulfa ant 0 PVT PVT none congenital hypotonia, developmental delay. 0 UNK UNK allergy congestion allergies seasonal 0 PVT UNK 0 none, she did UNK not seekPVT medical care followingnone the vaccine no known allergies, hx of hiatal hernia 1 UNK UNK none none none 0 PVT PVT Trileptal and Complex Lamectal, Partial Complex twice, Epilepsy daily. Partial - no Epilepsy symptoms at time of FluMist. 1 NONE PVT PUB ALBUTEROL NONE PRN REACTIVE AIRWAY
1 None None None None None None None
UNK UNK zicam takenDenies 9/6/09 allergy to peanuts OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None 1 PVT UNK 1 UNK UNK Lyrica 75mgDenied HS and illness Flexeril Cervical 10mg Herniated HS Disk, Scleroderma(no treatment), Allerg 1 PUB UNK Yaz None Allergic/Sensitive none~ to ()~NULL~~In penicillin and Patient Bactrim 1 PVT PVT None None None 0 PVT UNK None None None none~ ()~NULL~~In Patient 2 none PVT UNK None NO None described above~Influenza (Seasonal) (FluMis 11 UNK UNK none beforegurd the vaccination 9/16/09 Received medical records w/PMH: Circumci 0 NONE PUB PUB NONE NONE NONE 0 blood work,PVT arthrocentesis, UNK arthoscopically samples nothingshouler relevant Sulfa joint drug fluid allergy. all indicating Nothinginflammation, else of possible but relevance. stains and cul 0 None PUB PVT None Vomit Asthema None OTH OTH None None None None OTH OTH None None None Not known PVT PVT None No Common variable immune deficiency 0 OTH PVT Albuterol; Singulair None Asthma 0 OTH PVT LIPITOR; Folic None acid Aspirin; ADVIL allergies 0 None PVT PUB None None Hypospadias; GERD 2 Viral culturePVT PVT None None Known 0 That evening PVT more HAPVT + confusion. NoTo ER. Head No CT normal. PeanutLabs allergy dizzy~HPV normal. Discharged (no brand name)~2~0~Patient with concussion diagnos 1 PVT UNK None None 1 PVT PVT Albuterol; Claritin None Asthma 1 PVT PVT ADVAIR; ALBUTEROL; None Asthma LORATADINE 0 BP 123/96, OTH 118/92 PVT No known allergies/conditions OTH PVT 0 PUB PUB None None 0 OTH PVT None None None OTH UNK 0 PVT PVT None None None 1 None PVT PVT Ambien; Nortriptyline; None Zoloft; Migraine Topamax; Birth control IA090021 - 10mg 0 None PVT PVT Birth Control None - YAZ Seasonal - allergies - PCN; IA090020 Sulfa. 1 none PVT PVT none no none IA090019 1 None PVT PVT LEXAPRO None None 0 None PVT PVT Vicodin; Synthroid; None Ambien Allergy- Erythromycin hypothyroid 1 None PVT PVT LAMICTAL;None Hormone replacement Seizures - 9 yrs 1 None PVT PVT ADVAIR Ear Infection Asthma - Z pack 0 None PVT PVT IMITREX; YAZ; NoneCEIEXA. Hay fever; Migraines. 1 None PVT PVT None None Allergies - environmental 0 OTH PVT PROPECIA None indicated PUB PUB None None Known 0 None OTH PVT Requip; Zestoretic; Mild Nausea Tramadol, Hypertension, Prednisone; prior GI Estradiol; bleed (unspecified) Klonopin anxiety, allergy 1 PVT PVT None None 1 OTH PVT ZYRTEC; Vita None reported ULTRAM; FLOXIN; BACTRIM 0 No tests were OTH performed OTH (patient did TOPROL not have XL None recent 50mg blood once Allergic po pressure qD; toCOZAAR dextrose; med changes) 50mg Hypertension once po qD 0 PVT PUB SINGULAIRnone None ID09019
1 None 7
PUB UNK None None None~ ()~~0~Patient|Had ID09018 seizure, 2X a996 age PVT PUB None ID09020 PVT PVT Fish hook in finger ID09022 2 PVT PVT None None ID09021 0 OTH PUB None reported ADVIL 0 None PVT OTH HCT2; LOPRESSOR. None Allergy to PCN 0 None PVT UNK None None 0 PUB PVT None None None 0 PVT PVT NONE NONE NONE 7 None PVT PVT CRESTOR; ESTRACE;Allergies; PROMETRLM; Penicillin, LABETATOR. CECLOR; VICODIN; BIWIN. OTH PVT None None 69 UNK UNK 9/21/09 Medical dermographia~HPV records received (Gardasil)~~13~Patient DOS 9/10/07 to 11/8/07. 0 PVT UNK Actonel, Evista, no Levothyroxine, none Calcium, Vit D, Omeprazole. 1 EKG showed MIL irregular MIL rythem andNone blood workNone showed elevated None enzymes. 2 PVT PUB None NC09039 0 PVT UNK Local Site Reaction NKDA; as of 2005- functional NC09037 murmur 1 PVT PUB REGLAN, HYDROXYZINE, Bipolar, PROLOL manic depression, NC09040 cleft palate 0 PVT PUB none NC09038 1 OTH OTH unknown none unknown PVT PVT None None 3 PUB PUB None PCN 0 Unknown OTH OTH morphine Lymphoma; Radiotherapy WAES0909USA00700 443 Unknown OTH OTH CLARITIN; Drug SUDAFED hypersensitivity; Reactive airways WAES0909USA00549 disease 0 None OTH OTH vitamins (unspecified) Pregnancy NOS (LMP = Unknown) WAES0908USA04775 0 PUB UNK none Asthma 1 OTH PUB None 1 PUB OTH CEPHALEXIN Resolving 250 UTI None PVT UNK Thumb laceration None 1 none PUB PUB none none 0 OTH PVT None 0 OTH OTH None Denies None 0 OTH OTH None Denies None 32 OTH PVT None None 1 none PVT PVT Hydrochlorothiazide; none Atenolol; hyperlipidemia Lorazepam; ZOLOFT; WELLBUTRIN; cyclobenza 2 OTH OTH 0 None MIL UNK AUGMENTIN sinusitis Egg; Milk; Seasonal 1976~Influenza allergic(Seasonal) rhinitis (no brand name)~1 0 All per parent PVT report PVT None None Fish allergy, seasonal allergies. 2 OTH PVT ALPRAZOLAM; No METFORMINR; None CRESTOR; CARVETILOL; MTX; RANITIDINE; 0 OTH OTH No No 0 PVT UNK Well visit Being treated with BACTRIM for impetigo OTH UNK Cough 12 PVT PVT ORTHOTRICYCLEN None LO. Anemia in past . None PUB PVT None None 0 None PUB PVT None None 1 PUB OTH none no no UNK UNK 2 None done.PVT PUB No medication None Club Foot 0 PVT PVT Asthma 3 PVT UNK Vitamins/Herbs None None 1 PUB PUB None None None 0 OTH UNK Synthroid, Nexium, None Lipitor; NoneDivan; Metformin
11 10/16/09 Received PVT hospital PUB records and DC summary No/had otitis forNone dates media 10/16/09 9/14/09 at hospto Received admission 9/22/09.hospital Diagnostics/Labs: records and CXR(-), DC summa CT b 0 UNK PUB None 0 OTH UNK 2 UNK PUB DEPAKOTE; None Phenobarb; Seizure Vit C;disorder BP med OTH UNK LIPITOR; Ramipril; No Atenolol; No Alendronate 0 Rapid strepPVT & cult was UNK (-) No No 2 PUB UNK 3 None PVT PVT EPI PEN PRN None Walnuts 1 PVT PVT LIPITOR; LOVAZA; Neuropathic BENENID; Hyperlipidemia; pain NEURONTIN; Insomnia; PROZAC; Hypogonadism. TRAZODONE. 8 MRI; Echo; PVT TEE; clotting PVT labs (P) None None None 1 OTH PVT No 1 PVT PVT None 0 None PVT OTH None None 0 OTH PVT PREVACID;No LAMICTAL Grass allergy 0 Abnormal- Cellulitis OTH PUB None 1 None PUB PUB None No None 3 None PVT PUB None None None OTH PVT Lovastatin Pt reported she fainted in antibiotic response to "shot" in h 2 None PUB PUB None Fibromyalgia for 6 yrs 1 OTH PVT None 3 OTH PVT BONIVA 0 OTH PVT ALCHOLOLNone 25 mg 10 Hypertension HS 1 PUB PUB No No UNK UNK None Sinus infection None 600 Was in Hospital UNK for 5 days, UNK they ran all the relevant none test for none blood clots. Then went to clinic, and they ran numerous 0 PUB PUB none none SC0921 1 PUB PVT MILD COLD 0 PUB PUB 10 EEG completed PUB on September PUB 14th with results pending 0 PUB PUB 1 PVT PVT Toprol, Diova, Allegra, Hyperlipidemia, ASA, Lisinopril, NIDDM, Actos, Simvastatin OA, HTN 24 Vaccine dates: PUB Feb 27/07, PVT Apr 27/07, Sept 07/07 none 1 PVT PVT NA Asthma 2 PVT PVT Pt had a rash none. on arms and torso. 5 Unknown UNK UNK Lipitor 20MG N/A 1 daily forPatient 2 years states duration N/A~ that ()~~0~Patient he has a history of compressed disk bu MRI on 09/10/2009. UNK 9/18/09 UNK Medical records (Middle School) 9/18/09 DOS Medical 3/14/08 records to 11/14/08. (MiddleLABS School) andDOS DIAGNOSTICS 3/14/08 to 1 0 UNK UNK 0 Subsequently PVT tested for PVT egg allergy pre-existing peanut allergy 6 n/a UNK UNK Simcor 500/20 None 1 everyPatient day, Lipofen states None~ 150 mild ()~~0~Patient Mg seasonal 1 everyallergies day, Loradatadine 10 MG 1 EEG's (5 orUNK 6) only theUNK last 2 have none shown normal none with medication. none. Dislocated none~ Tested shoulder, ()~~0.00~Patient|none~ on a regular irregular basis periods. since()~~0.00~Siblin 8/15/2008. Migraine hea La 3 None PUB PUB None None None 0 No blood tests PVT PVT Aspirin; Flecainide; Metoprolol Sulfa; MACROBID 0 OTH PVT PENICILLIN allergy None PVT PVT None None None 1 MIL MIL NONE NONE NONE 2 PVT PVT none none noted 0 UNK UNK none none none. Numbness after taking Percocet. 11 UNK UNK None 0 PVT PVT None None None 0 PVT PVT none none none 13 I took patient UNK back to his UNK pediatrician none when the none hives firstI appeared recall thatand he had he confirmed hives oncethat or twice patient before has hives. but only Hefor re
0 na UNK UNK na na na 0 none UNK PUB Benadryl post none reaction.Kabuki Also take syndrome, Xopenex asthma, when ill, h/oprilosec multipleand pneumonias atrovent includ 2 none, just the PVT Doctor looking PVT at it. Asmacort, singulair, none protonix, Asthmaflonase, doxepin, fish oil, multi-vitamin 0 CBC, sed rate PVTnormal. PVT CELEXA 20mg /day toAnxiety treat anxiety - started CELEXA 10/27/08 0 UNK UNK None 0 PVT PVT none Penicillin; CECLOR; lymphangioma left orbital area 17 Plt count 6000 PVT PUB No No 1 N/A PUB PUB None None 0 PVT PUB No PUB PVT N/A N/A 0 N/A OTH PVT None None 0 PUB OTH NORVASC,Ear HCTZ, itching FLEXERIL, Asthma, T NEUROTIN, BP, arthritis, ULTRACET, depression,PROSIQ Acid Reflux 0 OTH OTH Penicillin, Darvon, Codeine, had pace maker which pt infor 0 Vital signs Normal PUB @ ER. PVTBP 100/87. None Discharged Anxiety/Panic w OralPenicillin Benadryl AttacksAllergy & Dexamethasone. 1 None UNK PVT None None None 3 OTH PUB None None 2 PVT PVT None NKDA 0 OTH OTH None None 0 N/A PVT PUB None None 0 OTH OTH 85 None PVT PVT None None None 0 Per EMS - BP OTH and pulse OTH , normal None None None 0 No actual syncope; OTH reports OTH signs of ASA, dizziness 81 mgNone or @wooziness HS; PAXIL, Hx asthma; 25 mg recent @ HS Dx bronchitis 8/09 went on PREDISON PUB PUB None 0 Exam; vision PVT normal PVT MOTRIN None None 1 Right upperPVT quadrant ultrasound. PVT None Latex allergy; HTN; A-fib; Hypothyroid; Depression; Anxiet 0 None PVT PVT None (+) SinusitisAsthma; Allergic rhinitis 0 PVT UNK 0 PVT PVT N/A N/A N/A 0 PUB UNK None None PUB PUB No Food allergy to nuts 2 None PUB PVT Ketlek antibiotic Nonegiven on Allergies same day to Sulfa 1 None PUB PVT None None None 0 N/A PVT PUB Well child N/A 0 OTH PVT 1 9-3-09 Pt reports PUB BP 124/68. PUB Hx ofTylenol chronicES back No Ibuprofen pain-Takes Chronic Tylenol back ES-Ibuprofen pain daily AM & PM. 26 Have not been PVTtold to get PVTtest for this condition None 0 None MIL MIL ZURTEC 1/2 None Tsp HS seasonal allergic rhinitis 32 Hx shinglesOTH five years OTH ago. 0 PUB PVT Prenatal Vits, Tylenol Pregnant, gallstones 0 None PUB PUB Claritin Seasonal-Allergies None 0 None PVT PVT Xopenex PRN, NoneImitrex Pediazole PRN Susp 0 None PUB PVT None (very Environmental healthy) allergies/eczema (out growing it now). 0 OTH PVT 0 OTH PVT None that would No causeType such2problem. diabetes, no~ ()~~0.00~Patient allergic to penicillin, topical iodine, strawb 1 PVT PVT Prenatal Vitamins none 30 weeks pregnant H/H 52.7/39; PVT WBC 6500; PVT pH 228; VA 20/20 ou Congen hip dysplasia 0 PUB PUB None None 0 CBC PVT PVT None Unknown OTH OTH Unknown Unknown WAES0909USA01369 1 None PVT UNK None Allergic to latex & rubber.
0 None PVT OTH None None Migraine; Eczema, atopic 1 None PVT PVT CLARITIN None Seasonal Allergies; Tourettes. 0 Lab work within PVT normalUNK limits. PULMICORT 0.5 mg; ALBUTEROL Asthma 25 mg/sml. 4 None PVT PVT None None None 0 PVT OTH Albuterol Allergy to PCN, Amoxil 1 PVT OTH 1 PVT UNK ALLEGRA-D 24 Hour 180-240 VICOPROFEN; mg Tablet Ciprofloxacin Extended Release Tabs; Codeine 24 Hour; derivatives; Aspirin 81F 0 PUB PVT None None 0 UNK PVT Atenelol 50mg None 1xd; Plavix 198470Quad mg 1xd; None~ Bypass; Pravastatan ()~NULL~~In 1994 Double 80mg Patient|None~ bypass; 1xd; Lisinopril 2000()~NULL~~ Diagnosed 20mg 2x 0 ADVERSE PVT REACTIONUNK TO FLU SHOT. NONE NONE NONE 2 None MIL PVT Estrodial 1mf None once a day, Latex Calcium supplements, vitamens 0 n/a PUB PUB none none / nka 2 CBC WAS DRAWN, PVT PLATELETS PUB AND WBC NONE WERE LOW. NONE MONO CAME BACK NEGATIVE. 2 PVT PVT CEREBRAL PALSY 5 PUB PVT 1 PVT PVT NONE N/A N/A 0 Not applicable. PUB PUB Not applicable Penicillin, Demerol, Percocet 2 HAS BEENUNK REFEREDUNK TO ALLERGIST SINTHROID, N/A BCP LATEX AND BEE ALLERGY 9/17/09 Received medical re 0 None PUB PVT None Known None known None Known 0 PUB PVT None None BACTRIM CECLOR IVP DYE KEFLEX SEASONAL ALLE 0 PUB PVT none none 0 In #13 - I have PVTno ideaUNK the manufacturer On 9/14ofhad the none taken vaccination fioricet sulpha but forto migraine hit submit - 3 Idoses have to forchoose. a total of Again.. 5 pills.DON'T On 9/15 KNOW in th 0 None PUB PUB None None 0 None UNK UNK Poison ivy none 2 PUB PUB None None. JustSeasonal some minor allergies pain 0 UNK PUB none NONE NONE 1 PUB MIL none no none 0 none UNK UNK none mild asthma 35 PVT PVT Warfarin, Lipitor, none Prilosec,Synthriod Hypertension, Afib, Hypothriodism, Anemia, Hypercholeste 0 UNK PVT HCTZ, thyroid none replacement HTN, hypothyroidism 0 UNK PVT NONE 1 PVT PUB none short stature 5 PVT PVT 0 PUB PUB 1 PUB PVT 0 n/a UNK PVT non none asthma 24 Negative LP, UNK Mono spot, UNK EBV titers, Strep Screen, NONECBC,LACTOSE CMP, UA, INTOLERANCE CMV titers, Mumps 9/17/09 titers.Received 9/17/09 Received medical rec m 2 unknown PUB PUB unknown none knownunknown 761 PUB PVT altace, lipitor none hypertension 1 Returned toPVT physiciansUNK office on 09/11/09. None No Nodiagnostic illness atNone. tests time of or vaccination. lab data collected. Physician measured affected 0 UNK UNK 0 UNK UNK None None Depression, ADHD 1 OTH UNK COREG; Trazodone; None Sertraline; heart attack Alprazolam; 3/09; broken BUDEPRION R ankle; neuropathy XL; LYRICA 0 OTH PVT Atenolol; Chlorthalidone None Unknown physician diagnosed conditions. 0 None PVT PVT ALBUTEROL No No 0 OTH UNK 0 9/16/09 at 5:53pm OTH - doing OTHwell strongly None believes None was reaction Noneto vaccine. 1 OTH PUB Lorazepam; Lunesta 3 UNK UNK 0 No known history PUB of allergy PVT to eggs. Pt does have history Environmental of environmental allergies allergies. 1 OTH UNK Denies None
1 0
PUB OTH None None PVT PVT Conjunctivitis Adenoviral/Rhinitis PVT PVT None None none~ ()~~0.00~Patient PVT PVT None None 3 None PVT PVT None None None 0 Err:508 OTH OTH CRESTOR;No LEVITRA; acute illness; FLOMAX; "Not sick" ZETIA; lisinopril; Gemfibrozil 0 OTH OTH 0 UNK UNK 0 OTH PUB Isosorbide; none Methotrexate; LEVEMIR; NOVALOG; COMBIVENT; Potassium; Furo None PVT PVT TYLENOL; No CELEBREX; apparent NKDA/ TRAMADOL; HA; Arthritis; PREVACID; Carpal tunnel; ALLEGRA; Hip knee; AMITRIPTYLIN Back surge OTH OTH None None 1 UNK PUB None 1 None PVT PVT None None Asthma 0 PVT PVT healthy Exercise induced asthma; allergic rhinitis 0 OTH OTH None None reported until after vaccination. 0 None PVT PUB None None None 0 OTH OTH SINGULAIRNone CECLOR; arm Mold;swelling~Influenza Deg Disk Disease(Seasonal) (no brand n 1 PVT OTH FEMARA; HCTZ; No LISINOPRIL; AMOXICILLIN. ZOCOR. 1 OTH OTH Calcium +D; Multivitamin; NKA; Glucosamine osteopenia; migraine headaches; mixed incontinenc 0 PUB PVT Coumadin, 1lanoxin, week before cardizen Sinus hadcomes CD, sinus toprol and infection XL, goes, aspirin. stomach ulcer, kidney problems, o 3 UNK UNK N/A No Ear infections Fever, resolved swelling by ear & vomitting~Measles tubes. + Mumps 1 MIL MIL Topical meds None for eczema Mild eczema. No known allergies 1 Chest X-ray; UNK Blood work UNK 10/5/09 Medical records Viral illness received Premature; (non-febrile) w/LABS:GERD; CXR c/w Hxatelectasis of apnea; Hx vs pneumonia. of tachypneaWBC 10/5/09 17. 48 magnetic resonance, PVT ?/?/07, OTH no complications; Unknown vascular imaging, None HPV#3 ?/?/07, given no complications; 12/14/07, WAES0907USA04940 Lot#diagnostic 0890F, RAlaboratory, n Unknown OTH OTH ALDARA. 9/28/09 Wart. Genital PCP medical warts. records received WAES0909USA01170 DOS 8/24/08 to 9/18/09. Oral c 16 complete blood OTHcell, 09/04/09, OTH 8000 vitamins /L; complete (unspecified) Pregnancy blood cell, 10/1/09 NOS 09/??/09, (LMP Medical = 7/1/2009) 11600 records /LWAES0909USA01378 received w/PMH: childhood chick Unknown OTH OTH Unknown Unknown WAES0909USA01466 0 Unknown. 9/25/09 OTH PCPOTH medical records Unknown received DOS 8/21/09. Convulsion. LABS and DIAGNOSTICS: WAES0909USA01474 PPD - Results pending not reportedUNK UNK not reported ### 0 26 August 2009: UNK computed UNK axial tomography (CAT), (results Patient not has reported). a penicillin allergy.### not reportedUNK UNK Unknown ### 10 PUB PUB UNK UNK 1 None MIL UNK CAD, s/p CABG, Iodine,BPH, atorvastatin GERD, HTN 0 none UNK UNK NONE NONE NONE SC0927 1 UNK UNK No 2 PUB UNK None None 3 WBC 5.9, Neutrophils PVT 11.0%, PVT Lymphocytes None 75.0%, None platelets None150. 0 PUB PVT History of PAD 759 original TSH UNK was < 0.1.UNK LABS andnone DIAGNOSTICS: none Free PCN, T4 4.6Asthma ng/dl Graves (H) T3Disease~HPV 672 ng/dl (H) TSI (Gardasil)~3~12.00~Pat 247% (H) Thyroglob 0 PUB UNK mom deniesmom reports history of downs syndrome 0 UNK UNK None None SC0923 1 PUB PVT asthma 0 UNK PVT 34 Lyme test, JRA, UNK Thyroid UNK testing, CMV, Xyzal,EBV Xopenex, AdvairAsthma, Uticaria Pigmentosa 9/21/09 Medical records rec 0 PUB PVT None Gentamycin 1 PVT UNK 0 PVT PUB none none PUB OTH None 0 BP readingsOTH 9:38am 122/80, UNK 9:43am 122/80; 9;48 am 108/72 3 PVT PVT None Dairy allergy in past; Peanut allergy at present
0 PUB OTH None None None known None~ ()~~0~Patient 0 None needed PVT PVT None 1 UNK UNK None None. Had shingles in 12/08. 2 None PVT PVT None 0 OTH PVT LEVOTHYROXINE; None VERAPAMIL None 1 PVT PUB No 135 PVT PUB None None None 1 PVT PUB Runny noseNKA; & dryleft cough ear cavernous hemangioma. 2 None PVT PVT Mebendazole Pin100mg worms None None PUB PVT None None None 0 None PVT PUB None No 5 UNK UNK none none Exercise induced none~ asthma.Allergy ()~~0.00~Patient|none~ to amocicillin. ()~~0.00~Siblin 1 None UNK UNK None None None/unknown 3 SHOT REACTION PVT (ICD-786.05) UNK discussed CYMBALTA topical none 60 MG treatmetn, CPEP Current (DULOXETINE ice Allergies: nsaid (motrin. ! STEROIDS HCL) alleve) one tablet monitor * FLU daily VACCINATION for PROTONIX fever return 40 ifPEN reM 0 None UNK UNK Yaz - BCP, Getting Glucosmainr overNone aChondroitin cold, States was relaxed SC0924 0 UNK PVT 0 UNK UNK NA None per ptShe said she's allergic to dairy products and eggs 0 Client also received PUB 2.4UNK milliunits of None Penicillin Starting G, approx. treatment None 30 minutes for Late priorLatent to theSyhphilis. administration of Twinrix. 0 PVT PVT prenatal vitamin none sulfa 2 none PVT PVT NO 0 None PVT PVT Benadryl given Glossitis after reaction. Epilepsy, Hypothyroidism 0 chest xray and UNKEKG UNK Zoloft, Imitrex, denies Tropramax, Allergies,migraine Allergy shots weekly headaches 0 PUB PUB Allergy to PCN 2 PUB PVT none none 0 UNK PUB NKDA, hypertension 2 Not able to UNK reproduce the UNK carpal spasms Maxide,by lisinopril, inflating None sertraline Blood None pressure cuff for one minute on the right arm. 0 PUB PUB 2 PVT UNK being treated for anemia 0 Physical examination UNK UNK Addeeral 20None mg daily, Claritin Reactive 10airway mg daily, disease and Flonase and nasal prn. allergies 3 CXR--LLL PNA UNK PUB Diovan none childhood asthma 1 PVT PVT 8 Viral culture, MIL results pending MIL None None None 1 none PUB PUB None Hypertension 1 none PUB PVT none none 0 None PVT PVT None. None None 6 Normal chest PVT x-ray on PVT 9/14/09 none no none 7 None PVT PUB Spironolactone; BPD Levothyroxine; = Hypothyroid:Prematurity Hyponatremia Chlorothiazide; FeSO4; NaCl; O2 377 Lab studiesMIL 6/1/2009 showed MIL normal None ESR and 6 hr chemistry. GI illness None. Thyroid @ 1-2 PMH: panel weeks Undescended ordered prior to but onset testicle nos/s. results - surgery. available. Cigarettes. Lab studi A 1 OTH OTH None notedNone noted 0 None PVT PVT ATENOLOL, Back PLAVIX, Pain ASA CAO, increased lipids 1 PVT PVT None None 0 PVT PVT 0 PUB UNK None None 0 OTH OTH TRAZODONE None None 0 PVT PUB None No None PVT UNK None PCN; Codeine; HBP; Hypothyroidism; Osteoarthritis; Arthr 0 PVT PVT None None NKDA - Scheumam's hyphosis with Back Pain 2 MIL OTH no None that pt disclosed 0 OTH UNK Denies Migraine headaches 0 NA UNK UNK Welbutrin, Singular, No/Z pacProlonix, 20Asthma-allergic URI Advain, Albuterol to lemon, garlic, gasses, mold, caused wh 1 OTH UNK None
0 Abdominal PVT X-rays (R/OUNK intussuscaption) and None urinalysis done Hydronephrosis; (R/O UTI - has feeding hydronephrosis). problem. UNK UNK None 0 None OTH PUB None 0 No other tests OTH OTH See attached None list Since 8 years old, rhinitis 1 PUB PUB AMOXICILLIN; SinusFLONASE; infection Seasonal ALLEGRA allergies 3 Physical exam PVToffice visits OTH 0 PUB UNK SYBICORT; PULMICORT; Asthma; PROAIR allergies: First forTime~ asthma; cat; mold ()~~60~Patient VALTREX; & dust; palo ZOCOR; verde WARFARIN bloom; rece 0 N/A OTH PUB same~Influenza (Seasonal) (no brand name)~U 0 None PUB UNK Iron/Orthotrycln None Anemic 0 none OTH PVT none none 5 UNK UNK Painful finger Polymyalgia Rheumatica 0 None PVT PVT GOLUCOPHAGE None BID;Hypothyroidism; SYNTHROID 125 premg diabetic daily; LOPOTOR condition. daily. 3 OTH PVT no NKA/none 2 PVT PVT none. allergy to PCN; urinary reflux. 0 Needle electromyography OTH PVTand nerve None conduction Known None studies None No PUB UNK No Duricef 0 PUB PUB NA NA NA 3 OTH PVT OMEPRAZOLE; LOVASTATIN; CILOSTAZOL; CTHYROXINE. 1 PVT PVT Mirena IUDNone unknown None 0 N/A PUB PVT Lisinopril N/A N/A 1 none PVT PVT None None 13 UNK PVT None None 1 None PVT PUB Cough/congestion/Runny nose PVT PVT None 0 "T-7 inflammation." PVT CXR PVT performed MVI; by chiropractor BENADRYL None in prn N Carolina. None (kidney stone 2004) 1 None PUB PUB Unknown None NKA 2 PVT OTH Upper resp Sulfa and sinus drugscongestion, no fever 0 WBC up 13.6 PVT PVT ALLOPURINOL; None BENICAR; Hypertension, labetalol;obesity, BUMEX;rosacea, LIPITOR; dyslipidemia, amlodipine;hx oxycodone gout, mitr OTH PVT None None NKA 1 PVT UNK None None None~ ()~~0.00~Patient 0 None OTH OTH None WAES0909USA01717 4 Unknown OTH OTH ZETIA; folicDiabetes acid; propranolol hydrochloride WAES0909USA01760 PUB UNK 0 None OTH PVT ZYRTEC; ADVAIR; Cold for 24 NUVARING; Hay hours-no fever,fever FLONASE allergies, asthma 0 PVT PVT None None 1 OTH PUB None at time None of vaccination specified None specified 0 PVT PVT None None 1 None OTH OTH None Healthy- noNone complaints 0 CT scan onOTH lymph nodes, PVT9/18/09 None Lupus 2 PVT OTH LOTRIL; VITORYN; None NOREL Dermatitis None~ ()~~0.00~Patient Diagnostic results: OTH 19 May OTH2004: electrodiagnostic Asthma; studies Gastrooesophageal Allergic revealed bronchitis; essentially Reflux Arthroscopy A0604761A normal Disease; findings knees Ingrown bilaterally; with toe no evidence nail; Epididym Motor of 2 10/6/09 Hospital PVT records PUB received service dates (L) 9/17/09 Otitis Media None to 9/19/09. LABS and DIAGNOSTICS: CBC - Polys 53.0% 0 OTH PVT SINGULAIR; None BENADRYL; Asthma; Albuterol Seasonal allergies 0 PVT PVT Asthma 1 UNK PVT none none none~ ()~NULL~~In Patient 1 UNK UNK Unknown None PCN 0 MIL PVT lipitor 40mg,nosynthroid 112mcg. arimadex 1mg, menmtex 1 mg. 0 UNK UNK lisinopril, lasix, not reported protonix, tylenol,cephalosporins potassium and prilosec 0 UNK UNK denied not reporteddenied 1 PVT PVT 2 PVT UNK Unknown Denies Denies
0 PUB PUB UNKNOWNNONE UNKNOWN 0 No problems PVT with 4 month PUBshots (on 9/1/09), when No patient Norefused DtAP but received all other vaccines due 0 PUB UNK 1 none PVT PUB none none none~ ()~NULL~~In Patient 0 PUB UNK 2 NA PVT PVT DIOVAN, FISH NA OIL HYPERTENSION, NA~ ()~NULL~~In HYPERLIPIDEMIA Patient 0 None MIL MIL Acetozolamide None Migraines none~ ()~NULL~~In Patient 1 UNK UNK 1 UNK UNK 2 PUB UNK None None 0 blood tests,UNK chest xrayUNK and nuclear50mg stress lopressor/10mg testlow all kidney normal.function, lipitor/.5mm allergic Only shows toGFR iodine, ativan sign 53 betadine, no of diminished other illness regelan, kidney function which was 0 PUB PVT NONE 0 BP, 120/70;OTH Fingerstik PVT BS, 133 BICITRA; LIPITOR; Diabetic -LEXAPRO; no Diabetes; other illness PROTONIX K+ low; High cholesterol None PUB OTH Otitis externa 2 PVT PVT Sodium fluoride None0.5 mgEczema; daily; FLOVENT Asthma; HFA, Past otitis 2 sprays media; bid;RSV; PROAIR Impetigo; HFA, Sinusi 1 puff PVT UNK 2 None PVT UNK None None None~ ()~~0.00~Patient 0 OTH OTH None None 1 PVT PUB Vitamins; metoclopramide None Reflux; prematurity 1 PUB PVT 1 NA PVT PVT NA NA 1 PVT PUB None No None 1 PVT UNK Allegra-D 12, Desogen. Phentermine, Topamax, Vitamin B-12, Zolpidem Tartratc 0 UNK UNK 0 PVT UNK None notedUnknown to provider 1 Allergen forPVT clam, egg PUB white, cod fish, Nonecorn, milk, None peanut,None shrimp, soybean, walnut, wheat, scallop, sesame seed, a 6 PUB PVT TRAZADONE None None 0 PVT PVT None None None 1 MIL UNK None None 2 PVT PVT Asthma 0 UNK UNK Atrovent 0.6% None Nasal Spray, HTN, Estring Hypercholesterolemia None~ Vag.,()~NULL~~In Flector Top., Patient Hydroxychloroquine Oral, 0 VS 2 HOURS PUB AFTER Incident: PUB O2Lialda sat 100%, and birth None peakcontrol flowsUlcerative 350 pills and 400. colitis BP 120/70 heart rate 70.At the time of evalu PVT PVT daily prescribed n/a medications allergies 0 PUB PVT 0 PVT PVT Levsin 0.125 States mg no Patient states has hx of allergies-has strange reactions to 1 N/A PUB PUB NONE no Codeine AL0919 0 UNK PVT diphenhydramine 50mg/ml 1 PUB PUB MultiVitamins, none Fish Oil none 500 mg cap, ASA 81 mg tab delayed release, Vit. D_1000 0 No tests PUB PVT None None No 1 PUB PUB allergy to penicillin 0 10/12/09-records UNK received-Labs UNK and Home Diagnostics: medications Reported CT include ofthat Chest-no Past patient lasix, Medical PE, avapro wasHistory: Hgb in her and 8.3usual Hypertension, (L), vitamin Hct state b26.2 of (L). health CHF, WBC asthma, 12.6 (H), atrial17. fib 0 UNKNOWNPUB PUB NONE NONE NONE 0 none so farPVT PVT MV with Fl. none and received none Septa on 8/28 for 10 day course 1 MIL MIL 1 CMP, CBCw/Diff, UNK StrepPVT test, Sed rate-Westergren, Nexium 40mg, None Allegra EKG,Asthma, 180, Chest Flonase X-ray, Allergic 2Full sprays Rhinitis, exam each by GERD, PCP nostril, (including Migraines, Symbicort eyes Slow 160/4.5 and intestina ears) 2 in 0 OTH PUB PREMARIN None Swelling, redness, pain~Tetanus Toxoid (no br 0 On 9-19-09PVT I spoke to health PVT professional None andNone gave her the None feedback fever~DTP re my daughters (no brand condition. name)~1~0.00~Patient 0 Cursory neuro OTHexam byPVT MD and bloodwork None onNone 9/17/09. Referred Seasonaltoallergies neurologist. 0 None PVT PVT None None 0 PVT PVT PREDNISONE 40 mg; CROHN'S PENTESAdisease 0 CMP, UA, CBC, PVT underlying PVT UTI None Anal CA-3 months since last chemo
None
OTH PUB VENTOLIN;None HFA; PRN; Asthma; CLARITIN Allergic 10 Rhinitis mg qd PCN due to pollen dust. 7 PUB PVT Crestor, ASA, "Runny Vitamins, nose" ? Calcium Seasonal allergies allergies 0 OTH PVT None Unknown 0 PVT PUB Hx TOF repair 9/8/04 11 PVT PUB None 0 PVT PVT LamotrigineNo 200, budeprion_SR, Seasonal allergies, paroxetine, depression. fluticasone propionate nasal spray, 1 UNK UNK Ativan, Proventil, N/A Claritin, I have Aciphex, no known Metamucil, allergies & to Probiotic. Medications, but have season 9 Per ER: Mildly UNKabnormal UNK EKG; normal Nonetroponin None None 1 PVT PVT none none none 0 PUB UNK Zoloft, trazadone, none abilify Bipolar, generalized anxiety 0 unknown UNK PVT prednisone,none ipatropium,DM, diltia, Asthma, singular, HTN, metformin, SMI/depression, advair, bupropian ADHD, tremors SR, lorazep 1UNK UNK none no none 6 PVT UNK cozaar, amlodipine none besylate,lipitor, penicillin, sulfa, levoxoyl, bees actonel 1 none UNK PVT none none none 0 None UNK UNK Lasix, Potassium, Left earSpironolactone, feltBipolar " plugged Disorder, up," Trazodone, with Anxiety decreased Xanax Disorder, hearing Sleep in Disorder this ear. (has "ve 2 PVT PVT none none 0 UNK UNK Adderall xr headache 30 mg once allergic a day to cephlasporins 0 UNK UNK none none none 0 PUB PUB Vit E, Fish oil, none Flax oil, asthma Garlic, B complex 0 PUB PUB blood pressure nonemedication none 0 Still sick, spoke PVT with a UNK doctor and a nurse. Nono one knowslatex,clindamycin what to do. Keep telling me to take tylonol. I don't think th 2 RLL consolidation PVT on chest PVT X-ray.Mefloquine Negative EIA None given for known group one dose NA one step 250 known and mg,influenza 3/4 tabletAaround and B. the Elevated time ofneutrophil symptom onset count 3 Waiting to speak UNK with pediatric UNK neurologist Trileptol, on children's No 09/21/2009. aspirin moyamoya see disease; above~ operated ()~~0.00~Patient on (piel synagosis) Dec, 200 0 PVT PVT Tylenol at time None of vaccination None at doctor-recommended fever~Influenza (Seasonal) dose (no brand name)~1 0 Taken to Hospital UNK for treatment. UNK Given unknown Tamaflu. (daughter none filling this form out) 1 UNK PVT None None celiac 0 OTH OTH Vitamin-D; Advair None None 0 OTH PVT No 0 None OTH PVT Downs Syndrome; Pulmonary Hypertension 1 PVT OTH None New DX HIV NKDA +; CD4 428 129% 10 UNK UNK 3 None UNK UNK None EX-27 week gestational age- Previously healthy. 0 06-16-09 Blood UNK work reveals UNK Epstein Barr; 6-15-09 - Ultrasound Seasonal abdomen; allergies;5-14-09 Occasional -CT;mild EKG; EBS Upper GI; Blood wo UNK UNK 1 None PVT PVT albuterol sulfate None(25mg/mL) None 0.083% prn 12 PUB OTH None None 1 PVT PVT None No None 0 Home positive PVTstool in PVT office Labs: guiac stoolnone positive, stool PMH: cultues none Allergies were negative : NKDA PVT PVT none 0 OTH PVT None PVT UNK None None 0 CT & CTA PUB UNK No 2 None PUB PUB MYLECON None PRN; NoneNone OR200939 1 PUB PUB None None OR200940 1 PVT PVT None Had egg allergy as infant, ok'd by allergist. Eats eggs. 2 PUB PVT CYMBALTA; METROPOLOL Splenectomy about 11 yrs ago. 1 PUB PUB PUB UNK No aying words again until 3 yrs old. HePVT cont'd to babble. UNK Mom contacted doctor due to event. 194 Unknown OTH OTH Unknown Unknown WAES0909USA01484 49 She has had UNK blood testUNK to see if it None is Thyroid and None the testNone was well within the standards and the only other thing she
1 UNK UNK None sunblock / sunscreen allergy 3 UNK UNK none none 0 Head CT UNK UNK none none none 2 none UNK UNK none none developmental enuresis 1 UNK UNK bancomyacin cellulitis IV synthroid. on allergic left leg celebrex, to: erythromycin, coumadin, zithromyacin cozaar, bee stings: 0 continuous MIL cardiac andMIL SPO2 monitoring, EPI-Pen timed N/Ablood pressure Presbyopia, checks, Anserine EKG, serial Bursitis, blood No glucose allergieslevel listed, checks, No medi p. 0 patient wentUNK to Dr. on 9-16-09 UNK andboniva had INR 150mg, done.Warfarin 2mg, amlodipine5mg, lisinopril 40mg 97 mono - AprilUNK 9, 2009 and UNK June 30,none 2009. Twonone Positive strep Ortho-tryclen tests. Tested Low.positive 10/13/09 Hashimoto's Medical records - 6/30/2009. received, Thyroi Da 0 UNK UNK none GERD, abdominal migranes, chronic pain, peripheral nerv 0 UNK UNK NONE NONE 0 NA UNK UNK None None None that were noted on consent form. UNK PUB PUB Unknown A0807305A 0 UNK OTH PVT Isotretinoin Unknown The subject had previously A0808086A received influenza vaccinations 9 Labs and Diagnostics: PVT PVT UA with 1+CLARITIN; ketones, trace No ZYRTEC protein,Outdoor 2 Urobilinogen, allergies;4+Tic mucus. disorder. UC (+) PMH: for ear 7K Gram tubes,(+) adenoide cocci. 0 OTH PUB None Allergy, PCN; swollen Tetracycline arm at injection site~Pneumo (no brand 0 Not available OTH PVT Not available 1 CT head - calcification PVT PUB posterior occiput; EEG,Seizure normal; MRI None calcification c/w Sturge Weber 2 729.5 Arm Pain OTH UNK None None 0 OTH UNK No No 0 OTH OTH 1 None PVT UNK None 0 None OTH PVT None None None 3 None PVT PVT None Zithromax - Rash IA090022 2 None OTH UNK None None 1 OTH PVT None None 0 UNK UNK Fine (None)None 0 None PVT PUB None None 35 week Premie 0 PVT UNK None multiple allergies include anaphylactic to nuts, ragweed, m 1 none PVT PVT Hypertension ~Hep B (no brand name)~1~55~Patient 0 OTH PVT None None PNC; Codeine; Keflex 0 OTH PVT MultivitaminNone OTC Allergy to: ERYTHROMYCIN & SULFAS (per patient) 1 none PVT PUB None None None 1 PVT PUB None None None 2 PVT PVT HCTZ; Potassium None Hypertension 1 OTH OTH None Sulfa drugs. OTH OTH AVELOX; Parkinson's disease UNK UNK None None 0 none PVT PVT none no EES; Cepradine; Rynatar, allergies 2 PUB UNK none CT200912 0 None UNK PUB none none 1 CMP, CBC,PUB TSH, SEDPVT RATE, PSA No No 0 Unknown OTH PVT None None Reports neurological (local) reaction to other vaccines. 2 OTH PVT 0 PVT PVT No medical history, no concomitant ### medications, no illness 0 not reportedUNK UNK Patient has a history of asthma, ###allergies to penicillin, sulfa 0 OTH PUB Pregnancy 0 PUB UNK Unknown None SEPTRA; CODEINE 0 OTH OTH None None PUB UNK 1 PVT PVT LIPITOR; ARMOUR None THYROID; Sulfa; Penicillin; NORVASC DONNATAL 0 None OTH PUB PRILOSE; CRESTOR; None Acid AMBIEN; reflex;NORVASC; hypertension; DIOVAN; hypercholesterolia; LEXOPRO. depression
2 Given Rx PNR OTHAUGMENTIN PVT / VICODIN None None 1 UNK UNK 1 UNK UNK 1 OTH PVT Emphazema 5 PVT UNK LISINOPRILNone 10MG; SIMVASTATIN- 10MG PVT PVT 1 PUB PUB None None CMP,CBC, PUB CK OTH ADVIL; ACYCLOVIR; None CYMBULTA, None WELLBUTRIN. 0 None OTH OTH None Allergies - seasonal 4 PVT UNK none none none 1 None PVT PVT None None Asthma 0 None PVT PUB None GERD Irritability~DTaP (no brand name)~3~0.20~Sibl 2 None PVT OTH None seen PCN for a & physical. Sulfa. 2 None PUB PVT None None 0 None OTH OTH None None WAES0909USA02121 0 None OTH OTH None None WAES0909USA02188 1 OTH PUB 1st positivePVT Rotavirus test UNK11/6/08. Rotavirus typing at CDC None consistent at the time w/ of vaccine vaccination type; still ROTA ELA Positive. 0 HR > 200; Sinus PVT tachycardia; PUB Normal O2 saturation; PossibleNo mild fever. Exviral 35 10/5/09 +illness; week Hospital prematurity. Borderline records, anemia Delivered DC summary, early secondary received tachy DO 0 NL Chest X-ray; PVT NL EKG; PVTNL pulse ox greaterNone than or equal None. to 90%. 10/5/09 ER report received, service date 9/10 2 EEG; MRI;PVT MRA PUB ELOCON Nephrotic syndrome Nephrotic syndrome; Asthma 0 Pulse oximetry PVT97-100% PVT throughout None episode.neonatal CBC, Urine, acne None CSF, blood cx, EKG, EEG all negative/normal. No furthe 0 OTH PVT Unknown 0 OTH PVT PVT UNK 3 None PVT PUB None 0 OTH OTH MOVIPREP Solution 5 CBC; Lytes;UNK glucose UNK None None ZITHROMAX; Last asthma S/S 4-02, 0 None PVT PVT Viral pharyngitis Peanut allergy (and tree nuts) 1 None PVT PUB Albuterol neb none as needed Asthma 0 OTH OTH HCTZ 25 mg None High cholesterol 0 Unknown OTH PVT LIPITOR; Felodipine; Atenolol; None K+ 1 PVT PUB None None None 0 None OTH PVT Unknown None None 14 A acute episode PVT of altered UNKmental status and None neurologic None sequelae due to acute disseminated encephalomyelitis (AD 0 None PVT PVT None Anemia Anemia, Allergic ~DT +Rhinitis, IPV (noviral brand Syndrome name)~4~4.00~Patient 2/09 6 Zoster, Herpes PVT UNK COUMADIN; None LEXAPRO; Penicillin; Aspirin Codeine; Sulfur; C.H.D. 1 OTH OTH None NKDA 1 None PUB PUB None None None None PVT PVT 1 PVT PVT No No 0 OTH OTH None Vloxx 0 PVT PVT PRILOSEC;None LOPRESSOR; known NoneASA; FLONASE; ESTRADIOL; MVI 0 UNK UNK No Known None NKMA wasp venom 1 None PVT OTH None Shellfish allergy 0 OTH PVT Unknown None Unknown 0 OTH OTH EVISTA; ATENOLOL; S/P TRIANIT/HCTZ; right mastectomy MVI 2005; Hypertension; Osteoporosis. 0 OTH PVT LEVOXYL 75 None mg QD. Hypothyroidism 3 CBC; CMP;PVT UA - see attached PUB ERNone visit/labs 9/4/09 None None 0 none OTH PUB none Osteopenia; tachycardia; mild high cholesterol 0 PVT PUB None Head injury;hyperthium; Hyperthium.head injury.
0 PVT OTH Hospital employee None health. PCN ~Influenza (Seasonal) (no brand name)~1~33.0 3 PVT PVT None None 1 OTH OTH Unknown None None 0 PVT PVT COUMADIN; None PPD Atrial fibrillation; HTN 1 PVT PVT LIPITOR None Hypercholesterolemia 0 Influenza APVT swab sent PVT PUB UNK None RA; Osteo arthritis 1 None OTH OTH None Possible impetigo None in groin - related to hot tub. 1 OTH OTH PUB UNK 2 PVT PVT None None None 0 None OTH PUB Tyl. prior toNone vaccinationNone 2 No PUB UNK NKDA 1 PVT PUB 2 PVT UNK Rynatan Dust allergies 0 NONE PVT PVT SEASONIQUE, NONE PROPANOLOL, KNOWN RED FOOD BUSPAR BREATHING DYE, NUTS DIFFICULTY~Influenza AND SEASONAL MILD (Seasona ALLERG 3 MIL MIL ketoralac tromethamine no codiene, drops, prednisolon floxin acetate drops, moxifloxcian hydrochlo 1 PUB PVT NONE NONE NONE none. only heart PUB clinic monitoring PUB coreg, cozaar, amiodarone, pacemaker-defibrillator lipitor, asprin 4 1.5 cm tender PVT swelling PUB to left lateral thigh; 1 cm swelling on amoxicillin right lateral thigh. Areas red and hard on palpation but 0 PUB PUB HISTORY OF ASTHMA ALLERGY TO PCN 11 As stated above, UNK thereUNK was no findings of bacterial healthy infections. Heart Patient condition was ASD fine10/5/09 one dayMedical then inrecords the hospital received the nex for 1 None PUB PUB No HIV 0 NONE PUB PUB NONE NONE NONE 0 PUB PUB Cardiac meds-post None cardiac Post surgery cardiac None~ surgery ()~NULL~~In Patient 1 none UNK UNK none none none 105 0 Bp 150/101UNK (very high UNK usually runs low Asthma Asthma 2 PVT PVT NONE NONE 1 UNK PUB 0 Labs: CBC:UNK Hct 42 high, UNK CMP: Glucose none 140 high, noneArterialnone blood PMH: gases: none~ none PO2 Allergies: ()~~0.00~Patient|none~ 487 high, NKDA O2 sats 60%()~~0.00~Siblin low, Ua norma 6 none PVT UNK none none 0 none PVT PVT none no none 23 Zostavax administration PVT UNK 0 PVT PVT None 0 UNK UNK Recently recovered Nonspecific fromallergy unknown to "grasses, illness. wheat". 2 PUB PVT 3 UNK PVT unknown None notedNONE 1 UNK UNK Proair; Maxalt; None Seasonique Asthma; allergic to Penicillin 2 UNK UNK 0 NONE PUB PVT NONE EXCEPT NO ILLNESS ASPIRIN HIGH DAYCHOLESTEROL OF NO~ ADMINISTRATION ()~NULL~~In Patient|NO~ NOR RECENTLY ()~NULL~~In S 0 UNK UNK None 0 UNK UNK PMH: Living conditions are reportedly very dirty and bug in 0 UNK UNK NONE Latex AL0920 UNK PUB benicar 20 mg, metoprolol succ er 50, simvastatin 20mg, fluoxetine 10,boniva 15 0 UNK UNK 0 MIL UNK none none 0 UNK UNK Albuterol inhaler. None. Sulfa, seasonal allergies. Has eczema. PUB UNK Compounded None EstrogenNone Progesterone cream topical every day 1 n/a PVT PVT none wellness exam, nonept was not ill. 5 PVT PUB No Primary hypotony 0 UNK UNK ACTOS, ADVAIR, EMPHYSEMA, CARDIZEM BUTORPHANOL HYPERTENSION CD, ERGOCALCIFERAL, TARTRATE, SC0926 DARVOCET, IMDUR, LANOXIN, IODINE, MEP LAS
0 None 0 0 0 10 None 271 1 3 none 2
UNK PVT PUB UNK Crestor 5mgNone qd, Centrum, HighVitamin cholesterol, D 1000iu, Arthritis, Move Minor Freely eczema (glucosamine and chon PUB UNK slight sinus cold PUB UNK Benicar 20 none mg High blood pressure PVT UNK None Runny noseNo PVT PVT None None UNK UNK Lisinopril 40mg none reported Levothyroxine none reported na~ 125mcg ()~NULL~~In Patient MIL MIL HCTZ 25mgnone daily none none~ ()~NULL~~In Patient|none~ ()~NULL~~I OTH PVT Unknown Unknown Unknown OTH PUB 0 OTH PUB 0 OTH OTH CODEINE allergy 0 WBC count:OTH 22,000 OTH None None 0 OTH PVT None 0 OTH PVT None Penicillin and sulfa allergy. 0 None PVT UNK AZELEX cream; None NASONEX; Multiple COPAXONE sclerosis; rosacea inj.; ZOLOFT; ADVAIR; ALBUTEROL 2 PVT PUB 0 OTH OTH None None 0 OTH PVT 1 None OTH OTH No Bradycardia, allergic bronchitis asthma 0 Flu test neg, PVT CBC nl PVT 0 UNK UNK LIPITOR; EFFEXORD; Bronchitis 2Shrimp; weeks SYNTHROID; prior Morphine; LYME; SULFA ALTREX 1 None PVT PVT None None 0 Born with small PVT anteriorPUB Fontanelle, Premature 37-38 wk gestation 0 PVT PVT B complex Vitamins Left sup scapular Solution; Multiple pain CYELOBENZAPRINE sclerosis; pain disorder; HCI asthma; 5 mg tablet; Tietze's PROVENT syndrom 1 UNK UNK 1 UNK UNK 0 PUB UNK UNK UNK 0 OTH PVT BENADRYLSinus 25 mg drainage 2 PUB OTH COUMADINNone Hx blood clots, clotting deficiency 0 BP-120/70.OTH Fingerstik BS-133. PVT Bieta, Lexapril, Diabetic-no Lupipor, Diabetes; other Protonix illness K+ low; high cholesterol 0 PVT PUB None Well visit None 0 Eye exam +PVT stitches PVT ALBUTEROL; None MDI; SINGULAIR Asthma 2 PVT PUB None NKDA 2 Physical exam OTHonly PUB Lasix, Prednisone, None Chantix NKDA->conditions: COPD, hypertension, cholesterol 0 PVT PVT None None None 0 PVT PVT OXYBUTYNIN; NoneCLARITAN; SpinaSINGULAIR; bifida; erythema~Measles V-P Shunt. XOPENEX. + Mumps + Rubella (no bra 0 PVT OTH Concomitant Drug (s) Not Used MEDI0008785 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008816 0 Body temperature, PVT 102.2 OTH Concomitant Drug (s) Not Reported MEDI0008781 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008799 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0008795
12USA04456 12USA04542 08USA02610 12USA04870 12USA05315 peas. Hx of Dermitits - Eczematous.
pmental disorder (mixed) ergy to avocado k pain x 1 yr.
artery disease)
No~ ()~~0~In Patient ent|None~ ()~~0~In Sibling
ient|NONE~ ()~~0~In Sibling
biotics, watermellon.
G; Hypertension;Hyperlipidemia; Type II diabetes; benign prostatic hypertrophy; Hx Bells palsy; s/p squamous CA of tonsils, with subsequen mbar disc disease; Peripheral neuropathy; Hypothyroidism; Cardiomyopathy; GERD; Cervical disc disease; Nonunion R hip fx-repaired; AO
; and a weak heart due to a viral infection
ons reported
Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2
# 1446U, LA.
rand name)~3~1~In Patient
ar infection 12/15 treated w/antibiotics x 8 days. brand name)~UN~0~In Patient
very healthy before this shot and the only conditions that she had or has is seasonal allergies.
; Carotid Stenosis
ctor prior to immunization with vaccines~ ()~~0~In Patient|Brothers don't get flushot~ ()~~0~In Sibling
nd ceftriaxone 11USA03496 12USA05190 12USA05011 12USA00348 11USA02209 12USA05099 hol, Sulfa, PCN, metal allergy PMH: environmental allergies.
mild asthma, GERD. Known allergy: PCN.
r of 105~Measles + Mumps + Rubella (no brand name)~NULL~1~In Patient
N, A-fib, Sleep apnea-on CPAP. Kidney cancer-partial nephrectomy. Anxiety e not specified (no brand name)~UN~2~In Sibling
12USA05247
e, PCN, Novacaine, E-mycin.
unknown etilogy
EN-JOHNSON SYNDROME~Smallpox (no brand name)~UN~23~In Patient
es:amoxicillin. Obstructive sleep apnea. Tonsillectomy adenoidectomy.
a, obesity, anxiety, angina pectoris, gastritis, OA, platar fasciitis, SSS s/p pacemaker placement 5/08 & revised 6/08, HTN.
ed; H/O drugs use in, child was in D 2/17/09-records received-sickle cell anemia trait recovered, born at 36 wks 1/12/09-records received-Family history, twin sister with DM since age of 2.
duct (benign)
11USA00270
othrax)~5~40~In Patient
ULL~~In Patient
itions: hypertension, hypercholesterolemia. PMH: Allergy to codeine. HTN, Depression, Hyperlipidemia
uma, hypercholesterolemia, chronic migraines, constipation, depression. Allergies: codeine. Family hx: Parkinson's & Alzheimers. Patient|None~ ()~NULL~~In Sibling1
STATE CANCER HYPERLIPIDEMIA HTN Coronary artery disease. hyperlipidemia, hypothyroidism, depression.
~Measles + Mumps + Rubella (MMR II)~1~4~In Patient
01USA00094 05USA00247 12USA02633 01USA00056 04USA02244
12USA02385
03USA00533
nt|none~ ()~~0~In Sibling|none~ ()~~0~In Sibling
al hernia repair. NKDA.
e w/NICU & intubation. ITP at 2-3 yo. Sibling w/intrauterine CVA, cerebral palsy & protein s def; aunt w/DVT; parent & grandparent w/prote
22/2008" per mom and client statement.
t|N/A~ ()~~0~In Sibling
: HTN, High cholesterol.
Dysphagia; Gastrointestinal reflux; High blood pressure; Panic disorder
ure, 12/04; allergic rhinitis, with reactive airway disease; allergies, nuts, oral reaction. PMH: chronic neck pain s/p snowboarding accident. L
lipidemia; sarcoidosis
rand name)~UN~2~In Patient
y of anti-biotics. Recently, dental shots which contain epinephrine. Avelox. Plus, dust, dust mites, and one type of grass.
01USA00339 01USA00354 01USA00096 01USA00389 Obesity; BPH 07/27/04; Sprain/Strain, Back 11/22/04; Stenosis, Spinal 12/16/04; abnormal liver or cardiac enzymes 10/27/05; Screening fo
fa, vibromycin, CELEBREX, TRIMAX, ROBITUSSIN M, MIACALCIN, codeine and LOTREL, rand name)~UN~0~In Patient udes mood disorder, hyperlipidemia, right AKA with phantom limb pain, GERD, major depressive disorder, diabetes, elevated LFTs, and hip
, loss of apetite, vomiting~Tdap (Boostrix)~1~12~In Patient
w normal .Immune dysfunction
11USA03767
oxoids (no brand name)~UN~0~In Sibling
specified (no brand name)~UN~0~In Patient 11USA03927 3 week preemie twin, NICU x 3 weeks Family hx: parents w/hypothyroidism & psoriasis; others w/protein S factor deficiency, DM, HTN, ast of Glycosylation. PMH: Autosomal recessive cutis lax due to congenital defect of glycosylation. Pneumonia. G-tube. Hypotonia
and name)~2~18~In Patient
01USA00781 01USA00809 01USA00452
|NA~ ()~~0~In Sibling|NA~ ()~~0~In Sibling B + IPV (Pediarix)~2~0~In Patient |NA~ ()~~0~In Sibling|NA~ ()~~0~In Sibling
ability~DTaP + HepB + IPV (Pediarix)~1~0~In Patient
~0~In Sibling|FACE FLUSHED, RASH~DTaP + HepB + IPV (Pediarix)~2~0~In Patient on at (afebrile) at time of immunization. PMH: hospitalization for URI 1.5 mos prior to admit. OR, ZESTRIL, LOTENSIN, ZETIA 3/3/09-records received-PMH: morbid obesity. insulin dependent diabetes type 2. hypothyroidism. gout. GENTAMICIN, TETRACYCLINE, ULTRAM (RASH). BIRTH DEFECTS: NONE. MED CONDITIONS: HRT, HIP & BACK ARTHRITIS.
, Chronic migraines, Chronic Vitamin D deficiency, GERD
ardasil)~1~18~In Patient
nd name)~6~14~In Patient
no brand name)~1~73~In Patient
06USA02506 07USA00576 07USA02893 07USA04603 08USA01657 10USA05385 es -- No drug use, alcohol or smoking. Had all her medical check ups!!!
non-smoker; limited alcohol consumption.
01USA00898 01USA00986 01USA01014 12USA03732
MH: Kidney stone. Diverticulitis. history of DJD. Chronic sinusitis.
mononucleosis 2 months ago and several colds since then.
o brand name)~1~1~In Sibling1 ITIS~Hep A (Havrix)~1~4~In Patient
+ IPV (Pediarix)~2~0~In Patient l meningitis 3 weeks prior to flu shot
Mumps + Rubella (MMR II)~1~12~In Patient dication for environmental allergies ral Palsy and followed by Dr. action, told to avoid by physician
kin tested at local allergist office-specific results unknown
0 mcg - once daily, simvastatin tab 20 mg - one daily.
ryl; Tetracycline; No chronic medical conditions
Measles + Mumps + Rubella (no brand name)~1~1~In Sibling
poisoning 2001.
no brand name)~1~5~In Patient ed in therapeutic use, smallpox vaccine (Active) ollen, pet dander
en he was younger
01USA01153 01USA00384 01USA00993
name)~1~0~In Patient
algia, GERD. PMH: NKA. prematurity. Congenital cataract. Fibromyalgia-dx 2/2008. L~~In Patient
actrim and Iodine dye
pitations), Lexapro + Kiwi fruit (throat closes) HX: splenectomy 2002, sinus surgery 1983 + 1984; chronic UTI's treated with post coital antib t OM & ear tube insertion.
ches. PMH: thyroid problems. s, projectile vomiting, arching of back~Hep B (no brand name)~1~0~In Patient
, major depression
gb electrophoresis; refer to cardiology
on, contraception irregular periodsrecently changed from depoprovera to yasmin
12USA08098 01USA01220 01AUS00036 01USA01109 01USA01201 01USA01203 01USA01139 01USA00290
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2 arm~ ()~UN~0~In Patient|N/A~ ()~~0~In Sibling
01USA00619 01USA01342 12USA05078 01USA01615
h Stufflon (medication); High blood pressure (in medication)
sion. L breast cyst-removed. L facial cyst-removed. Allergic to Betadine
(Gardasil)~1~16~In Patient
HepB + IPV (Pediarix)~1~0~In Patient
E, MACRODANTIN, MILD SENSITIVITY TO NEOSPORIN (ON MY ASSESSMENT)
llor~Smallpox (no brand name)~UN~35~In Patient
forward(dime size), Medical conditions: Crebral palsy
media . PMH: PCP records reveal normal childhood illnesses (OM, URI, bronchits) in 1st yr of life. Excessive wt gain noted at 3 months.
OTHYROID past)
L (DIZZY), LORATIDINE (DIZZY), VIAGRA (GI INTOLERANCE) PMH: mild GE reflux, excessive drooling.
T THIS PATIENT OR THE VACCINE. PT IS BEING SEEN AT HOSPITAL
ib (no brand name)~4~1~In Patient|Stirling Goulete~Measles + Mumps + Rubella + Varicella (no brand name)~UN~1~
MRSA(+) abscesses
l forearm fractures, varicella
myalgia; N; S; fatigue
&A age 4. Ovarian cyst. mild scoliosis. Apnea and reflux as infant. Allergy to sulfa
nonucleosis. family hx: arthritis.
2~7~In Patient
12USA02570 12USA02379 12USA02368 12USA02360
12USA02344 12USA02177 10USA05371 09USA01795 05USA00593 04USA04002 04USA00010 03USA00972 02USA04664 12USA03380 12USA03339 12USA03231 12USA03225 12USA02823 12USA02818 12USA02787 12USA02632 12USA02627 12USA02624 12USA02612 12USA02603 12USA02593 12USA04118 12USA04111 12USA04110 12USA04104 12USA03784 12USA03782 12USA03779 12USA03770 12USA03750 12USA03738 12USA03713 12USA03685 12USA03609 12USA03414 12USA03385 12USA04585 12USA04584 12USA04554 12USA04543 12USA04513 12USA04291 12USA04284 12USA04280 12USA04272 12USA04270 12USA04263 12USA04143 12USA04134 12USA04131
12USA04119 12USA05232 12USA05223 12USA05222 12USA05150 12USA05125 12USA05115 12USA05114 12USA05103 12USA05034 12USA04902 12USA04828 12USA04823 12USA04815 12USA04777 01USA00023 01USA00012 12USA05266 12USA05263 12USA05239 01USA00735 12USA04863 12USA04847 12USA04810 12USA04738 12USA02697 12USA02608 12USA02152 12USA02054 12USA02028 12USA01781 12USA01749 12USA01223
rgies to food thought to be related to a birch tree allergy; dust allergies, some nut allergies; gluten sensitivity; several occasions of exercise
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2 atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
state, high cholesterol.
atient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2
ntal delay, seizure disorder,eczema,sleep disturbance,adenoidal hypertrophy,egg allergy
HPV (Gardasil)~2~25~In Patient
none~ ()~~0~Sibling re-auricular skin tag.
; erythromycin; penicillin; polysporin 01USA01598 04USA03264 01USA01174 01USA01835 01USA01603 01USA01746
01USA01749 hma out grew PMH:multiple allergies. Acne. Trauma to hip by sibling jumping on her 6/08, seen in ER & x-rays WNL. nt; TB exposure; PT converter, all, +
01USA01755 01USA01301
01USA00165 ~~0~In Patient
cified (no brand name)~1~0~In Patient
01USA02129 01USA02073 01USA01962 01USA01834 01USA02001 01USA01992
D. Seasonal allergies. depression. s/p sinus surgery. s/p tonsillectomy. Allergies to sulfa, NSAIDS.
eceived wrong vaccine should have been pedarixs. NO reaction or harm noted to patient except patient rece~
ut no recent flares.
blood pressure
in 15 years; multiple medication allergies, sulfa; PHENOBARB; DILANTIN
P (no brand name)~5~5~In Patient
01USA01809 01USA02024 01USA02577 01USA01952 01USA02002 01USA02731
resolved; left ankle swelling; menstrual cramping. mild depression. HPV #2 given 7/18/08, lot # 0063X, IM/LA; HPV #3 given 12/2/08, lot#
B (no brand name)~NULL~0~In Patient
residual effects at time of visit.
refers to as a compromised immune system as a result of a virus that she contracted 2-3 years ago. The virus apparently weakened her im
mie, no prenatal care. Family hx: HTN, asthma.
H: GERD. Cow's milk sensitivity. Constipation
xide, PCN, ASA, Sulfa, Eggs. hospitalized~Influenza (no brand name)~UN~18~In Patient gkins Lymphoma, but it was treated successfully with chemotherapy and radiation in 2007. Patient had no relapses since treatment, and his -had outbreak on arms chickenpox around 1/20/2009
High Blood pressure; MS, in remission
esophageal reflux
12USA00347 01USA02460 (Pneumovax)~2~69~In Patient
H: pneumonia x 2. last one 3 yrs prior. Toxic synovitis at 3yo. Ear tube insertion.
phageal stricture, empyema, RAD, hyperlipidemia. Family hx: both parents w/stroke. ncy. Hypothyroidism. Fatigue. Constipation. Hormone Deficiency. Allergic Rhinitis. Eczema. Kidney stones
tis, migraine headaches hx.
o beestings.
P I & D at age 8m
othyroid; Anxiety
thyroidectomy in the early 1990s.
01USA02427 01USA03131 01USA03143 01USA02676
ia. PMH: hypospadias. chronic ear infections. OM p (Adacel)~1~16~In Sibling1|same sibling Elizabeth~Meningococcal (Menactra)~1~16~In Sibling2 HPV #2 Lot # 0570X, given 9/26/08
ngococcal (Menactra)~1~18~In Sibling1 slipidemia 3. Osteoarthritis 4. Depression 5. Obesity st history of Gluten Sensitivity Diagnoses: remote hx colon cancer, hypothyroidism, Alzheimer's , coronary atherosclerosis, osteoporosis, lip
rin. History of Depression
01USA03149 11USA02650 11USA02652 01USA03112 07USA01140 01USA03330
N; COPD; Obesity; DM; h/o A Fib 2/2/09-records received-PMH:paroxysmal atrial arrhythmias and systemic hypertension syncope, dyslip
yroidism; intermittent pulmonary hypertension; Hypercholesterolemia; osteoporosis
se allergy-anaphylaxis. molds and nuts allergy-watering eyes and sneezing.
nthrax (no brand name)~1~20~In Patient
ema, 786.09,786.05
trial fibrillation, sleep apena and fatigue. remission); Allergy to PCN
01USA03219 01USA03646 01USA03508 01USA02709 . No alcohol or drug use.
IENT HIVES
hinitisis. PMH: remote hx of seizure- lat 2 yrs ago
arly. Small for age, club feet otherwise appeared normal.
of spitting up.
CVA, BPH, ED, Tubular Adenoma, Colonie polyps
ved; fever requiring hospitalization; developmental delays & in special ed class. Had received flu shot prior years w/o reaction. Family hx:
t dermatitis 10/2008, chickenpox, shingles.
ient|NONE~ ()~~0~In Sibling|NONE~ ()~~0~In Sibling
cancer surgery, cardiac cath 2006 WNL, CTS surgery
us & colon polyps, mitral valve disorder, hyperlipidemia, spinal fusion, allergic rhinitis, false (+) hep C.
h), Hypertension, Type II DM, Hypercholesterolemia.
hyperlipidemia, DM, GERD, breast ca, HTN LMP 20 May 2008, vaccination 11 June 2008. +UCG around 15 July 2008.
sulin just 1 week ago.
(no brand name)~1~5~In Patient
01USA03970 01USA03979 01USA03957 01MEX00007 uenza (Fluzone)~3~53~In Patient
uced Asthma
ent|None~ ()~~0~In Sibling|None~ ()~~0~In Sibling
Elevated BP readings Nicotine Dependence Mild PAD Left Shoulder Pain Hemorrhoids aine headache, IUP, 70kg and 69.4" height
sm's; nephrolithiasis; Pituitary (?)
01USA03921 01USA03924 01USA03994 01USA04190 01USA04478 12USA02105 01USA03562 01USA03312 01USA03564 01USA03679 01USA01798 01USA03674 01USA03680 01USA03777
ossible milk allergy
ks. 45 day NICU stay. NKDA
stor Chronic health problems: seizures, immune deficiency, HTN, Right carotid stenosis, hyperlipidemia, bronchistasis
X OF HTN, DIABETES
HPV (Gardasil)~1~12~In Patient
KA until now
k; mild asthma
o brand name)~UN~0~In Sibling
ecords received-history of febrile seizures. mild asthma
ty, alcohol/tobacco use, depression
eived-PMH: asthma, attention deficit hyperactivity disorder.
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
Patient|none known~ ()~NULL~~In Sibling1
aricella (no brand name)~1~1~In Patient
12USA01983 02USA00048 01USA04400 cohol. I have never been pregnant. No health problems prior to March of 1987. I never have had any accidents or PMH: PTSD/depressio
. recent URI
formation available.
HT SHOULDER
MH: Congenital Hydrocephalus. VP shunt
PMH: chronic back pain.
11USA01317 07USA05579 07USA01777 07USA01095 05USA00246 05USA00144 01USA03341 04USA02904 04USA02907 04USA02908 04USA04868
01USA03519 02USA00303
n, no known allergies
orn at about 37 weeks gestation via C-section delivery as this was a twin gestation. Child was twin A. mother was group B strep positive how ech presentation, 36 wk preemie. Family hx: seizures
gery, depression, hx. of chronic back pain, hip fracture
asil)~3~22~In Patient
iothrax)~7~22~In Patient
econdary to clear, occlusive bandage applied over SPV eschar. 0-120mm - Not extending beyond elbow (In remission); 05/14/2008 Effect, adverse, medicinal/biol subst NOS (Active) o birth defects. Medical conditions: 1) HTN; 2) Hypertriglyceridemia; 3) Nephrolithiasis. Birth defects: None. PMH: Nephrolithiasis. HTN.
S, (Assumed inactive); 07/26/2004, Edema, (Resolved); 07/26/2004, Fever, (Resolved); 07/26/2004, Enlargement, lymph nodes, (Resolved c skin eruption (Resolved)
name)~1~69~In Patient
medications)
02USA00378 02USA00259 01USA04389 02USA00158 02USA00475 02USA00481 02USA00103 02USA00026 01USA03633
02USA00416 09USA02697
d injection monthly for 28 yrs.)
to see again after 1 year of age. ardasil)~2~11~In Sibling ardasil)~2~17~In Sibling
a (Fluarix)~0~48~In Patient m, chronic back pain s/p mva PMH:panic attack
~NULL~~In Patient
~HPV (Gardasil)~1~18~In Patient on immunization record.
Solsate; Zocor; Altac a, DJD - knees, Anemia, Lt bicipital tendon work up pending for RUB pain
02USA01054
er care, maternal drug abuse
02USA00587 02USA00564
02USA00449 02USA00464 12USA00471
Asthma. Seasonal allergies. Acne nd name)~5~54~In Patient|~Hep A (no brand name)~2~0~In Sibling|~Polio Virus, Oral (no brand name)~4~0~In Sibli
TaP + HepB + IPV (Pediarix)~2~0~In Patient
a form of lupus.
der infections. Allergies to Amoxicillin. PCN. 9-records received-History of vaccinaitons 6 monts prior and a visit to Africa. PMH:epilepsy.
Acel-Imune)~2~0~In Patient
tory of congenital defects; No chronic medical conditions PMH: concussion, hernia repair. Smoker. Allergy: sulfa (rash).
opmental delay, V-P shunt for hydrocephalus
02USA01032 02USA01057 02USA01069 02USA01095 02USA00873 02USA00919 01USA00170 04USA05621 02USA00860
nt|none~ ()~~0~In Sibling
dissection (R)
00 it closed 6 months later and another was put in; HBP
+ Rubella (no brand name)~UN~42~In Patient
tation of any birth defects or medical conditions
sed mood 2/24/09-records received-PMH: Chronic tension headaches, neck and shoulder tension. Headaches for many years but now wor
Developmental delay. PPS murmur and previously hospitalized for respiratory distress.
rivax)~2~13~In Sibling1
02USA01092 02USA01085 ercholesterolemia, L colon diverticulosis.
- hyatil hernia - hypothyroid
acne, irregular heavy menses, OCPs, headaches, palpitations x 2 yrs. Family hx: MVP.
Rotateq)~2~0~In Patient
nza (Fluzone)~1~1~In Patient
valve prolapse/mitral regurgitati
Facial assymetry
Degenerative joint disease
Systolic htn
asms in lumbar area. PMH: difficulty falling asleep 4/2008 ap~DTaP (no brand name)~3~1~In Patient
uterine growth retardation, NICU, developmental delays, learning disability, amenorrhea.
ongenital abnl kidney - removed
Bronchitis
Hearing change left 200
B (no brand name)~1~0~In Patient
02USA01061
d bilateral OM which was resolved with oral steroids, antibiotics
and name)~~1~Patient
uenza (no brand name)~NULL~4~In Patient days~Rotavirus (Rotateq)~3~0~In Patient ent|None~ ()~~0~In Sibling d had no fever, but did have sinus problems on day of MMR/Varicella vaccinations.
endent alcohol abuse; tobacco use disorder; pneumonia, organism unspecified - 5-2002; unspecified thrombocytopenia - 5-2002; unspecif OX, TORADOL, PNU-IMUNE IV CONTRAST
d (no brand name)~UN~0~In Patient
URI, sinusitis/som
no brand name)~UN~~In Patient
nt|none~ ()~~0~In Sibling
ention of intractable migraine; Other, mixed, or unspecified drug abuse in remission; Tobacco use disorder; Calculus of kidney; Hepatitis C;
ost rheumatic fever, Hx asthma lergies. 2/27/09-records received- History of panic attacks and anxiety. Hospital records Service dates: 4/1/09 to 4/5/09. (R) knee surgery.
I, reports 'cold' 1-2 weeks prior to vaccines. PMH: DM-recently dx. Migraines. Bicuspid valve AI. NKDA. E, DIVERTICULITIS, LYMPHEDEMA, OSTEOARTHRITIS, S/P HIP REPLACEMENT, S/P APPENDECTOMY, OSTEOPENIA, CHRONIC
, remission since 10/06;migraine HAs; asthma; heart murmur; overweight. Allergy: PCN, cephalosporins, adhesive tape, mountain cedar tre
LEEP/LEETZ; bilat breast augmentation; allergies/hay fever; GERD; contraception. ame)~UN~0~In Patient
PMH: gout. HTN. hyperlipidemia. Allergy to PCN.
02USA01640 02USA01693 02USA01522 01USA03436 02USA02156 11USA06688
02USA01700 02USA01836 02USA01121
tes; codeine; MEPERGAN FORTIS; CIPRO.
ardasil)~1~14~Patient
nd name)~1~0~Patient|none~ ()~~2~Sibling 17/2009 Class: Print Route: Oral Sig: take by mouth. Take two orally daily for 5 days with food; check blood
sugar dailyl
after blood draws in 2005 & 2007
4/6/09 PMH: acne, allergies, possible arthritis, stress fractures. c Ovary Syndrome PMH: exercised induced asthma
s of childhood. PMH: lacrimal duct stenosis/infection.
nza (no brand name)~UN~30~In Patient cognitive impairment. Tinnitus. Headache. PTSD. Major depression recurrent. R knee arthralgia
eight gain). PMH: poor wt gain
roxysmal atrial arrhythmia. Aortic valve replacement. Anti-coagulation
ntly started oral contraception use Yaz 3 weeks prior to onset of symptoms.
dasil)~3~13~Patient
ords received-lactose intolerant to mild and cheese gives GI upset. cholesterol 2/26/09-records received-PMH:low back pain. neck pain. hypothyroidism.
hypermobility
layed speech
02USA02357
02USA02190
02USA01791
02USA02174 moved due to cancer. 02USA02257
ling2|na~ ()~NULL~~In Patient|na~ ()~NULL~~In Sibling1
weeks before. Was on E-ymcin drops. Stopped taking prior to comeing to clinic. Took the drops again few days afterwards.
PMH:seasonal allergies.
malformation Type 1, VP shunt
er vaccinations
, BPD, GERD;
ess with mild jaundice 11/14/08
brand name)~2~6~In Patient rand name)~4~5~In Patient
min; Coenzyme Q-10
itis, seasonal allergies, anaphylaxis to shellfish, and adenoma of the adrenal gland, surgically removed in Mar 08.
d cond: Type I Diabetes, Adrena, Hypertunction, Hypothy
ccine not specified (no brand name)~UN~0~In Patient
~Influenza (no brand name)~UN~0~In Patient brand name)~UN~49~In Patient
diopathic polyarthritis.
Varivax)~2~14~In Sibling
eumo (no brand name)~1~50~In Patient
|No~ ()~~0~In Sibling
CUR gr 3 (L)
e; Oxybutynin; Furosemide; Lisinopril; Lovastatin; Citalopram; Aspirin; Vitamin C; Vitamin E; Vitamin B12; B Complex; cranberry; Cinnamon
lar heart beat; High blood pressure; IBS
, sodium phosphate
ax)~1~0~In Sibling
A; Asthma; Constipation; Esophageal Reflex
ncreased cholesterol
A; Theodore/Hyperlipidemia; Depression; Bipolar.
01USA00323 01USA00324 01USA01206 01USA01951 01USA01953 01USA01966 01USA02430 01USA02433 01USA02724 01USA02746 01USA03061 01USA03138 01USA03733 01USA03797 01USA04170 02USA00407 02USA00406 02USA00083 02USA00068 02USA00031 02USA00020 01USA04442 02USA04426 01USA04422 01USA04407 01USA04393 01USA04391 01USA04385 01USA04376 01USA04368 01USA04367 01USA04253 01USA04188
01USA04169 01USA04124 01USA03986 01USA03895 01USA03981 01USA03962 01USA03954 01USA03943 01USA03940 01USA03934 01USA03906 01USA03830 01USA03709 01USA03695 01USA03688 01USA03572 01USA03670 01USA03669 01USA03655 01USA03654 01USA03641 01USA03640 01USA03550 01USA03543 01USA03541 01USA03523 01USA03516 01USA03509 01USA03506 01USA03501 01USA03498 01USA03494 01USA03441 01USA03440 01USA03437 01USA03348 01USA03315 01USA03292 01USA03289 01USA03288 01USA03159 01USA03127 01USA03113 01USA03100 01USA03098 01USA03097 01USA03093 01USA03077 01USA03066 01USA03059 01USA03056
01USA03051 01USA02938 01USA02772 01USA02752 01USA02751 01USA02738 01USA02737 01USA02713 01USA02707 01USA02700 01USA02699 01USA02690 01USA02575 01USA02567 01USA02535 01USA02502 01USA02494 01USA02463 01USA02390 01USA02385 01USA02384 01USA02133 01USA02114 01USA02093 01USA02043 01USA02042 01USA02018 01USA02008 01USA01986 01USA01979 01USA01978 01USA01971 01USA01963 01USA01947 01USA01860 01USA01832 01USA01823 01USA01820 01USA01813 01USA01810 01USA01808 01USA01796 01USA01793 01USA01766 01USA01758 01USA01741 01USA01731 01USA01652 01USA01631 01USA01626 01USA01623
01USA01616 01USA01610 01USA01588 01USA01517 01USA01508 01USA01340 01USA01321 01USA01318 01USA01310 01USA01304 01USA01294 01USA01258 01USA01227 01USA01221 01USA01181 01USA01176 01USA01148 01USA01143 01USA01142 01USA01138 01USA01134 01USA01128 01USA01027 01USA01024 01USA01020 01USA01008 01USA01005 01USA00984 01USA00872 01USA00856 01USA00808 01USA00803 01USA00802 01USA00796 01USA00457 01USA00375 01USA00366 01USA00365 01USA00353 01USA00352 01USA00349 01USA00342 01USA00341 01USA00318 01USA00315 01USA00309 01USA00308 01USA00307 01USA00289 01USA00200 01USA00188
01USA00173 01USA00154 01USA00061 01USA00052 01USA00041 12USA04853 11USA02352 11USA02127 10USA02628 10USA00870 06USA02226 02USA06329 02USA00364 12USA00292
asles + Mumps + Rubella (no brand name)~UN~0~In Patient (no brand name)~UN~27~In Sibling
nar)~3~1~In Patient
f thyroid s/p thyroidectomy
el)~1~51~In Patient
02USA02263 02USA01655
opause; uterine fibroids : 25 wk premie.
R carotid stenosis; bronchiectasis; immune deficiency IgM; allergies: HCTZ; Simvastatin; CRESTOR
uzone)~1~6~In Patient
roids. Pt. denied allergy to Neomycin or Gelatin. B + IPV (Pediarix)~4~0~In Patient
o diagnosed having Thrombophilia per mother. 2/25/09-records received-PMH: MTHFR mutation. rgy - metronidazole (urticaria)
D for 10 days
by emergency c-section at 29 weeks gestation (12/31/2007) secondary to placenta previa and bleeding. He was born with a birth weight of
02USA02409 02USA02177 02USA02440 ERD); NB hearing screen (L) ear did not pass
eing tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
, Ocular albinism, Hx of Pylonepariti
ow fever (no brand name)~1~41~In Patient
DX: HTN, Depression, and Hyper Cholesterol
OLECTIN, TCN, ZOLOFT, DEMEROL, KEFLEX
no brand name)~1~32~In Patient
Sibling1|None~ ()~NULL~~In Patient|None~ ()~NULL~~In Sibling2 asil)~2~16~In Patient
kle Cell Trait / Chronic Renal Failure / Pulmonic Stenosis and Small ASD /Hyperparathyroidism /Developmental Delay /? Visual Impaired / N
h Failure to gain weight, vaginal bleeding and jaundce at 5 days of age. PMH: none
Vaccine not specified (no brand name)~NULL~~In Patient . Vertigo. Factor V Leiden WNL. Family hx: endometrial ca, CVA. 9/19/08 HPV#1, no lot # available.
l stenosis correction
nose, Atopic dermatitis
cardiovascular disease.
nfection lower abd.
s prior. PMH: eczema
Mumps + Rubella + Varicella (ProQuad)~UN~1~In Sibling
01USA03717 02USA02626 02USA02661 02USA02666 02USA02698 02USA02926 02USA02933 02USA02939 02USA02882
n to any medicine in previous situations. asthma, seasonal allergies.
ed & resolved
oidism, hypertension, degenerative dise disease. 4/3/09-records received-PMH:HTN, arrhythmia with PVCs, hypothyroidism, HRT, GERD,
; penile cancer
onditions: ADHD; Bipolar disorder, DDD, Mild persistent asthma; Obesity; Allergic rhinitis ~1~2~In Patient
une disorder; reactive airway disease; GUILLIAN BARRE syndrome in 2 family members (very distant) on pt's grandfather's side. Both with
reness~Pneumo (no brand name)~1~21~In Patient 02USA03903
reported as Zoster and not as Varicella.
)~2~15~In Patient
ays of life from high fevers, no seizures since 2/18/08 until 2/15/09.
xiety, suicidal ideation history.
y to Augmentin reaction with severe diarrhea.
02USA02413 02USA02932 02USA02974 02USA03097 11USA01322 02USA01674 02USA03098 02USA02699 PMH: Myasthenia Gravis. Diverticulitis. cataracts.
event~ ()~~0~In Patient
la (no brand name)~UN~1~In Sibling
evated PSA, sulfa allergy
osis; emphysema
N; Sulfa; Zithromax; Pineapple
n due to daughter's suicide
Carpal Tunnel Syndrome, Fibromyalgia, Osteopenia, Hypercholesterolemia, Cervical Degenerative Disc Disease, Myofascial Pain Syn
n Acute Coronary Syndrome - Non ST-Elevation MI days in Sept 2008 for fever of unknown source b fractures found at autopsy PMH: 36 wk preemie.
mild language & motor delays. GERD. Birth hx: uncomplicated. Family hx: dyslexia, dysgraphia & spina bifida occulta.
rgy; shellfish allergy DX with GERD; 1/10/09 Acute Bronchitis PMH: RSV
B09) Allergy work-up, which was negative for environmental allergens per skin testing. Normal Pulmonary Function testing. Dx was vasom
02USA03575 02USA03396 A, 0469U; HPV #3 given 2/20/08, LA, 1287U PMH: environmental allergies.
ng|none~ ()~~0~In Sibling|none~ ()~~0~In Patient Allergic to penicillin.
Patient|none sister~ ()~NULL~~In Sibling1|none brother~ ()~NULL~~In Sibling2 cluding congenital CMV, microcephaly, cerebral palsy and pre-existing seizure history. 3/6/09-records received-PMH: CP, seizure disorder
gias less severe~Td Adsorbed (no brand name)~UN~20~In Patient
mandate that drug manufacturers make separate vaccines for Measles, Mumps and Rubella. It would give parents an option over the MMR
02USA02176 occurring brain bleed from birth
MH:bronchitis and whooping cough.
is in 1987); Pecans, Walnuts; Pollen; Dust mites. "Mild verbal tick" emia; elevated LDH
no brand name)~1~0~Sibling gnificant medical history.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
A, acute sinusitis, cough, acne vulgaris tx w/minocin, abdominal pain, diarrhea. Family hx: depression, suicide.
A, SVD, vertex. Preterm labor tx w/steroids. Neonatal jaundice w/tx x 1 wk. Labial adhesion tx w/steroid cream. Colic. EDIS eval @ 11 m
pe, HCTZ, Verapamil
as held breath before.
AD, T&A. Strep pharyngitis. ADD. obesity. Behavior changes 2008
10USA02517 02USA03537 02USA03735 02USA03764 02USA03784 02USA04026 02USA04035 02USA03761
ipidemia; HTN; Rosacea; Urge incontinence; Osteoarthritis; Cataracts; History of gout; Tendonitis.
ease, asthma
mental allergies and asthma ng with my children. PMH: Asthma. : hypertension
|None~ ()~~0~Sibling
sil)~1~13~Patient Allergies; Asthma; GERD
sophagitis, severe acid reflux (GERD), investigating bleeding disorder (no confirmed or denied diagnosis to date), multiple food allergies, no
Recurrent sinusitis, status post rhinoseptoplasty. hepatitis C. Questionalbe history of Epstein-Barr virus infection. Gastroesophageal reflux d
or facial abcess.
esterolemia, lithium-induced renal disease.
diagnosed 5 days after vaccine administered.
02USA04226
02USA03436 02USA03722 02USA04183
d name)~1~0~In Sibling
02USA04059 02USA04441 02USA04580 02USA04384 02USA04455
eated & outgrew them. PMH: Allergy to eggs (flu vax OK before 2008). Food allergies as child
FFEXON; WELLBETRIN; ZOLOFT Numerous ear infections
ion, asthma, rhinitis, renal insufficiency
erpes simplex around her mouth but has never had the virus around nose or eyes.
nd h/o asthma
asthma. Family hx: CAD, DM.
(no brand name)~UN~20~In Patient
02USA04394 02USA04440 02USA04545 02USA04564
COPD-lung reduction surgery. Severe emphysema. Right-sided CVA small residual weakness. Former smoker. oronary artery bypass grafting. COPD. HF, COPD oxygen dependent, pulmonary HTN, hyperlipidemia, HTN, cervical cancer w/hysterectomy, chronic hyponatremia, tobacco abus
reast cancer status post right mastectomy, cervical cancer, glucose intolerance, hypertension, cough with lisinopril, muscle aches with prav
9/09-records received-PMH: Migraines, renal cyst vesus angioma.
exercise-induced asthma
MH:long history of migraine headaches similar in severity. on in yr 2005.
Dx allergies and eczema
penicillin; Cephalosporins; ketones & mocrotides; Busperione; Hydroxyzine hcl
MNICEF; AUGMENTIN
N-D" makes heart flutter); reports cervical spine narrow pathway- not a lot of fluid in my spine. HTN; Increase cholesterol; whiplash history a
02USA01641 03USA00102
o brand name)~1~23~Patient ed hospitalization for apnea; bradycardia; Gastroesophageal reflux. PMH: 30 wk premie. RDS. on TPN.
o brand name)~UN~32~In Patient ~Varicella (no brand name)~1~0~In Patient
osteoarthritis, osteoporosis, sunus node dysfunction, hearing impaired, constipation, atrial fibrillation, mental retardation
itis, depression, degenerative arthritis of knee, NKDA,
arthritis. Hip surgery. Allergies to PCN & Tetracycline
02USA03994 02USA04266 03USA00062 03USA00104 03USA00467 03USA00374 ess test, DM, hypercholesterolemia
patellofemoral syndrome PMH: acne on minocycline x 2 yr; left orbital rim fracture; amblyopia; high triglycerides; dysautonomia; MRSA ce - surgery @ 2 days - fine now
sturbance; Otitis Media; Constipation
ergic to shell fish
les + Mumps + Rubella (MMR II)~5~2~In Patient nomune)~~0~In Patient
azine, adhesives, fish ccal (Menactra)~1~11~In Sibling1
nal allergies. NICU x 2 wks for resp distress as 34 wk preemie. Family hx: food allergies.
PV + Hib (Pentacel)~2~0~In Patient|~ ()~2~0~In Sibling
TX with antibiotics
03USA03327 03USA00423 01USA03522 12USA05084
ncy; tonsillar hypertrophy. Family hx: leg length discrepancy.
and name)~1~11~In Sibling
olerance: codeine (nausea & vomiting) coronary artery disease, hyperlipidemia, hypothyroidism. PMH: hyperlipidemia, CAD s/p stent, hypo
astic bronchitis 1/09 previous febrile seizure on 10/08 and 1/09
TN, hearing impaired Rotavirus (Rotarix)~1~0~In Patient
sels~DTaP (Daptacel)~2~2~In Patient
eipt of MMR~Measles + Mumps + Rubella (no brand name)~1~0~In Patient
Similar episodes occurred one month prior as shaking episode. 03USA00787 03USA00750 03USA00745
H:hypothyroidism, anxiety, smoker. Allergy: lidocaine, cipro.
ERD. Depression. Allergy to Geodon
+ IPV (Pediarix)~2~1~In Patient ; RA; onychomycosis
Motrin, Compazine. Can take erythromycin. No liver or Kidney problems.
ANEMIA, LE VARIX, LE EDEMA, LYMPH ENLARGEMENT
keratosis, hyperlipidemia, rotator cuff tendonitis. Family hx: DM nd name)~1~9~In Patient ergy to eggs.
rdasil)~NULL~~In Patient none~ ()~~0~Sibling|none~ ()~~0~Sibling
pitations, stroke, coronary stent placement, OA & joint pain.
rand name)~1~0~In Sibling1
~1~0~In Patient
arivax)~1~16~In Patient
03USA00963 03USA00563 03USA00757 03USA00933 03USA00740
Vi Polysaccharide (no brand name)~UN~8~In Patient
NO BIRTH/CONGENTIAL DEFECTS, NO CHRONIC MEDICAL CONDITIONS 3/18/09-records received- Allergy to Sulfa-rash. urmur; cleft lip; cleft
DTaP (no brand name)~1~0~Sibling
2 yrs ago; High Cholesterol
rand name)~2~7~In Patient|~Varicella (no brand name)~2~11~In Sibling a (no brand name)~2~7~In Sibling
ORIN (topical)
radiculopathy; Neck pain; Carpal Tunnel Syndrome; Peripheral Neuropathy; Chest pain; Actinic Keratosis; Bunion, right foot; Impaired fast C- Section d/t placental abruption
nvironmental allergies.
rds received-Allergic to Penicillin V Potassium-itch. MH:hypoxic episode at birth NICU.Mother had history of seizures as a child.
|None~ ()~~0~Sibling|None~ ()~~0~Sibling 03USA01427 03USA00564 03USA00934 03USA00921 8 amoxicillin x 10 days. mitral valve prolapse; hypothyroidism PMH: Kidney infection. hyperlipidemia. shingles x 2. Atrial fib w/ablation. cardiac angiogram WNL
brand name)~4~2~In Patient
dical conditions.
bling1|N/A~ ()~NULL~~In Sibling2|N/A~ ()~NULL~~In Patient
a, depression, hypothyroidism, GERD
bdominal pain, H. pylori, lactose intolerance. Allergic rhinitis.
ords received- febrile seizures.
sal syndrome; Obesity; Constipation Hypothyroid; Tetracycline; PCN; SULFA
es (seasonal)
03USA00835 12USA08457 01USA05057 01USA01143
12USA08565 12USA04824 12USA08834 12USA09091 01USA00319 01USA00333 01USA00950 01USA01636 01USA02463 01USA05671 01USA05750 01USA05767 02USA04639 02USA05318 03USA01282 04USA01172 04USA01932 04USA05095 05USA00195 06USA02567 08USA04750 09USA01524 09USA03003 09USA04523 11USA00853 11USA02934 12USA02271
DOS 12/21/07 to 2/26/09. Anemia, c-section, thyroid, PPD(+) placed on INH, pneumonia. Salpingo-oophorectomy. 4/6/09 Records receive
03USA00952 02USA00806 04USA04091
tion preservative.
1st doses of same vaccination~Vaccine not specified (no brand name)~UN~0~In Patient
(no brand name)~UN~0~In Patient
(Varivax)~2~3~Patient
deficiency, GERD, asthma, nonallergic rhinitis, abnormal Pap smear, CIN 1, smoker, s/p c-section delivery x 2 yrs prior. Family hx: asthma esity, Vitamin D Deficiency (mild/treated), Anxiety (mild), remote history of viral meningitis, status post L Ankle fracture (remote) PMH: smok
ood pressure
12USA03381 03USA00854 03USA01644 SV bronchiolitis
easonal allergies No known allergies to meds.
n AZT for 6 weeks and has negative testing for HIV to date. PMH: none.
NAL ALLERGIES
cal conditions
llergies: Betadine, latex. ASCUS 1/30/08.
sorder. PMH: hyperlipidemia, anxiety, low back pain s/p surgery
02USA04090 02USA03978 02USA03082 02USA02902 02USA02647 02USA02385 02USA02251 02USA02243 02USA02170 02USA01794 02USA01704 02USA01652 02USA01525 02USA01491 02USA01091 03USA00060 03USA00014 02USA04196 02USA04614 02USA04623 02USA04624 03USA00004 03USA00009 03USA00013 03USA00033 03USA00052 03USA00057 03USA00076
03USA00096 03USA00106 03USA00120 03USA00502 03USA00274 03USA00134 02USA04579 02USA04576 02USA04551 02USA04538 02USA04537 02USA04531 02USA04526 02USA04519 02USA04518 02USA04517 02USA04500 02USA04481 02USA04477 02USA04453 02USA04362 02USA04356 02USA04044 02USA04071 02USA04072 02USA04176 02USA04180 02USA04190 02USA04195 02USA04198 02USA04249 02USA04250 02USA04252 02USA04343 02USA04346 02USA04350 02USA04032 02USA04019 02USA04004 02USA04000 02USA03917 02USA03801 02USA03797 02USA03770 02USA03739 02USA03734 02USA03713 02USA03633 02USA03603 02USA03589 02USA03555
02USA03553 02USA03545 02USA03544 02USA03536 02USA03528 02USA03115 02USA03112 02USA03108 02USA03107 02USA03106 02USA03105 02USA03094 02USA03093 02USA02975 02USA02682 02USA02694 02USA02704 02USA02705 02USA02709 02USA02879 02USA02904 02USA02914 02USA02929 02USA02935 02USA02937 02USA02962 02USA02969 02USA02669 02USA02388 02USA02175 02USA02184 02USA02194 02USA02197 02USA02212 02USA02237 02USA02269 02USA02274 02USA02276 02USA02390 02USA02426 02USA02649 02USA02167 02USA02030 02USA01667 02USA01676 02USA01682 02USA01699 02USA01707 02USA01775 02USA01813 02USA01815
02USA01871 02USA01879 02USA02003 02USA01614 02USA01435 02USA01468 02USA01470 02USA01481 02USA01500 02USA01507 02USA01517 02USA01531 02USA01588 02USA01615 02USA01625 02USA01635 02USA01636 02USA01653 02USA00928 02USA00931 02USA00934 02USA00935 02USA00938 02USA00942 02USA00951 02USA01036 02USA01062 02USA01064 02USA01080 02USA01104 02USA01115 02USA01120 02USA00924 02USA00894 02USA00485 02USA00488 02USA00535 02USA00570 02USA00575 02USA00579 02USA00589 02USA00619 02USA00628 02USA00849 02USA00858 02USA00881 02USA00883 02USA00476 02USA00470 02USA00462 02USA00461
02USA00455 02USA00450 02USA00427 02USA00426 02USA00425 02USA00287 02USA00281 02USA00256 02USA00221 02USA00215 02USA00185 05USA03343 12USA08122 04USA01176 05USA02898 05USA05753 05USA05935 06USA03410 07USA01851 07USA03262 07USA04636 01USA03966 01USA04179
03USA02000 03USA01794 03USA01668 03USA01845 11USA00715 03USA02039 03USA01841 03USA02062 03USA02038 rmer 34 week preterm infant. amoxicillin at admit. Hives, viral illness, bronchitis, OM, nosebleeds. Family hx: eczema, hypothyroidism, GERD, IBS. ubation, NICU x 1 wk. Recurrent RSV 2 wks prior to admit, seen in ER only.
trait, Incontinentia pigmenti
edicine; central sleep apnea; brain trauma
nus Diphtheria (no brand name)~UN~48~In Patient Adenoids removed for sleep apnea d 101~ ()~~0~In Sibling
phtheria (no brand name)~UN~~In Patient
OM. Left middle ear effusion 12/08. Left lacrimal duct obstruction. 36 wk preemie, mild neonatal feeding difficulty resolved.
MH: eczema.
he did have other medication allergies 4/27/09-records received-PMH:borderline DM and HTN with DVT. allergies to grass, animals, dust.
flux (G-E); Myeloproliferative disorder 5/19/09-records received-PMH: Down Syndrome with transient myeloproliferative disorder. Congenit
s: Pulmonic; Tricuspid; Mitral a, fibromyalgia, cervical CA s/p hysterectomy
03USA02047 03USA02042 03USA01872 03USA01804 03USA02071 03USA02043 03USA01837 03USA01470
ce + body~Measles + Mumps + Rubella (no brand name)~1~1~In Patient No known birth defects.
ON~Anthrax (Biothrax)~1~31~In Patient
uising~Measles + Mumps + Rubella (MMR II)~1~29~In Patient
age 11 and everyother month very heavy and cramping.
eved amoxicillin that was stopped after only 5 days due to rash. y diagnosed with HTN and insulin resistence.
LL~~In Patient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2
lthy and athletic; so healthy she wouldn't drink but maybe two soft drinks a year; she is allergic to the fruit formula given before having a ca
done; Flexeril; Ibuprofen; Latex/Rashes 3/24/09-records received-PMH:allergic reactions in past. T& A, asthma, epilespy, Wolff-Parkinson-
ous only; HSV meningitis, as infant; normal development
01USA00098 12USA03330 12USA03312 01USA00317 12USA04898 12USA03569 12USA03314 12USA02004 12USA01523 12USA00544 12USA00480 12USA00053 11USA03029 11USA02988 11USA02844 11USA02841 11USA02798 11USA02544 11USA02179 11USA01659 11USA01658 11USA00783 11USA00635 11USA00563 01USA03990 10USA03139 10USA03070 10USA02502 10USA02436 10USA02427 10USA01821 10USA00820 10USA00425 10USA00194 10USA00177 01USA00075 10USA00002
08USA05347 08USA03602 09USA04880 09USA04315 09USA03422 09USA03006 09USA01661 09USA01605 09USA00797 08USA05345 08USA04151 08USA03995 07USA05660 07USA05790 08USA03092 08USA02804 07USA05683 07USA05549 07USA04094 07USA04037 08USA04836 07USA02498 07USA01576 07USA01112 10USA01573 01USA02974 02USA05298 01USA03311 01USA04102 01USA04436 02USA02695 02USA03013 02USA03149 03USA01725 03USA03063 03USA04159 04USA00190 04USA00205 04USA02481 04USA03139 07USA00728 05USA00046 05USA00042 04USA03842 05USA00927 05USA04759 05USA04852 06USA00720 06USA00825 06USA02494 06USA03414
06USA08376 07USA00061 07USA00802
03USA02330
03USA02361 03USA02096 03USA02102 03USA02288 03USA02340 03USA02644 06USA01608 07USA00388 PMH:eczema.
one~ ()~~0~In Patient
(Varivax)~1~1~Patient|11/07/2008~Measles + Mumps + Rubella (no brand name)~1~1~Patient 03USA00042 03USA00043 enisia; Pt has hx of HTN, insulin resistance, nonspecific autoimmune disease, brain lesion in left frontal lobe from possible infection in 200
none~ ()~~0~Sibling|none~ ()~~0~Sibling
, Hepatitis B
hylactic reaction. hadenopathy~HPV (Gardasil)~1~17~In Patient Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
DX, Asthma
ladder; malrotation; club feet
d spots on mouth)
03USA02427 07USA00609 03USA02931 01USA00529 03USA02626 03USA02913 03USA02548 03USA02604 03USA02370 03USA02366 03USA02364 03USA02363 03USA02306 03USA02292 02USA03560
umovax)~1~0~Patient
l)~UN~16~In Patient
mps + Rubella (MMR II)~2~1~Patient
ax)~2~10~Patient since but we switched to DTAP!!~Vaccine not specified (no brand name)~UN~0~Patient
IBUPROFEN
cl. "Molds and dust"
blood pressure; Gout. PMH: ETOH abuse. Dementia. COPD. HTN. Gout. OA. lumbar laminectomy. L PTX with thoracotomy and partial g PMH: hives approx 6 mo earlier, cause unknown; dyspnea at rest; eczema. Allergy: lobster.
AUGMENTIN
ginal infections 11/08. Family hx: migraines.
d name)~3~35~Patient
o (Pneumovax)~1~58~In Patient
03USA01874 03USA01790
03USA02848 03USA02914 03USA02570 03USA02249 03USA02300 03USA02305 03USA02329 03USA02563 03USA02567 03USA02860 03USA03197 03USA03220 cords received-Clinical history of patent ductus arteriosus and ventricular septal defect. Slit-like communication between atria. One of twins
02USA01705 02USA01848
100, ASA, Celebrex, Ultram, Sulfa
Allergy: latex.
pertension, hyperlipidemia, gout, PVD, CAD, diabetes hritis in shoulders and hands. ERVE LEFT LEG
Patient|none~ ()~NULL~~In Sibling1
PV (Gardasil)~1~18~In Patient
2 stents implanted in LAD. Hashimoto's thyroiditis in 2000.
vs atrial septal defect
02USA00596 03USA02949 03USA03341 03USA03254 03USA02086 03USA02561 03USA02926 03USA02954 03USA03241 03USA02618
HTN, diverticulosis, fibromyalgia, vitiligo, cholecystectomy, parathyroidectomy, and R tendon repair
ecords received-PMH: ADHD.
e month ago. P (no brand name)~1~0~Patient
None~ ()~~0~Patient
sterol, controlled with meds was on oral antibiotics when admitted. Allergic rhinitis, kidney stone, shoulder & knee arthroscopy. Family Hx: prostate cancer, HTN, MI.
wo years prior to receiving GARDASIL, that's why my MD wanted to administer the vaccine.
rand name)~1~32~Patient
emia, Obesity
ppened before", non specific re date/type~Vaccine not specified (no brand name)~UN~0~Patient
summer; hx of of hives e, secondary to preaclamptic; Birth mother + methamphetamines at 6mos
nd name)~4~1~Patient
V (Gardasil)~1~20~Patient
ission breast cancer; osteoporosis; high cholesterol; insomnia
03USA02034 02USA00936 09USA04651
mia; Allergic; Amitriptyline
s 3/26/09-records received-PMH: sprained thumb and mononucleosis 4/20/09-records received-PMH:Depression PVCs. t, Status post multiple lacunar CVA with residual left side coordination deficit
ancomycin, Verelan, Altace, Cardizem, Tegretol, Reglan. Medical conditions: Heart arrhythmia (pacemaker), Severe leakage of tricuspid va history of high blood pressure
ecords received DOS 3/23/09 to 5/4/09. Laparoscopic knee surgery, gun shot wound to abdomen with surgical repair of small bowel.
llergies, PTSD, multiple medication reactions
n dye, dx: myalgia in 2008
on; Colonic Polyps; Hearing loss; Gout; SOB.
03USA03963 03USA04511 03USA00408
03USA02617 03USA03061 03USA04267 03USA03605 03USA03764
destroyed cartilage; Chronic fatigue syndrome; Mitral valve regurg; Diabetes type II PMH: anxiety, arthritis, LBP, smoker, hyperlipidemia, apparent injury
nt ear infections
04USA02884 05USA01280 05USA02022 eceived-PMH: food allergies and reactions to cephalosporins and amoxicillin, has anaphylaxis. Allergic to lidocaine. Adopted. miles/week). 2) Anxiety and obsessive thoughts.
mia, allergic to adhesive tape
nd name)~NULL~~In Sibling1
ombivax HB)~1~34~In Patient
airway obstruction PMH: ASCAD, DOE, chest pain; aortic stenosis; DM; HTN; hyperlipidemia; obstructive sleep apnea; herniated disks; G ASD; Hypotonia; Intrauterine growth retardation PMH: recent failure to gain weight, nutritional deficits. VSD, hypospadias, CP, torticullis.
al affective disorder; Depression; Foot Pain Chronic; Constipation; Alcohol Abuse; Headache; Abdominal pain, Generalized; Tobacco use D
athy; pelvic pain
03USA00457 03USA03393 03USA03647 03USA04016 03USA03176
03USA03666 03USA03958 03USA04509
+ swelling~DTaP (no brand name)~1~4~Sibling s, swelling~DTaP (no brand name)~1~2~Sibling
t|UNKNOWN TO ME~ ()~~0~Sibling|UNKNOWN TO ME~ ()~~0~Sibling
uding Fainting~HPV (Gardasil)~1~22~Patient dometriosis, migraines
demia, degenerative joint disease PMH: BPH.
d face; flu-like sickness~Tetanus Toxoid (no brand name)~UN~30~In Patient
MH: HTN, hyperlipidemia, PVD.
N and Amoxicillin
o brand name)~1~1~Patient
PMH: GERDs/p pyloric stenosis repair 3/10/09. LFTs & bilirubin elevated
o brand name)~2~7~Patient
o brand name)~1~0~Patient
s or medical conditions. ardasil)~2~15~In Patient
mic, arthritis, anemia,gerd.
nxiety disorder; insulin resistance; Lupus (SLE); migraine disorders; TMJ; chronic pain with arthritis involving hands/neck; asthma/RAD; Glo
wks prior to patients outbreak.
S; CHRONIC DEPRESSION; HYPERLIPIDEMIA; CHRONIC MYALGIAS
03USA04260 03USA04265 03USA04534 03USA04681 03USA03608 05USA01355 08USA02136
mptoms - not treated
TN, hyperlipidemia
done, mycins, sulfa
on 3/27/09. It wasn't listed above History - osteoarthrithis, hypertension, hyperlipidemia, CAD, MI - s/p Bare Mental Stent placement 3/07
able bowel, stomach ulcers
03USA01775 03USA04013 03USA04572 03USA04669 03USA04692 03USA04586 03USA03246 03USA03954 03USA04221 03USA04679 03USA04682 03USA04714 03USA04713 03USA04843 03USA03663
MH: asthma. constipation, obesity
ery. Family hx: CAD
ape; Lactose intolerance; OXYCOTRIN; NEOSPORIN; Meds from horse serum
k, allergic to AMOXICILLIN, ASA, TOPOMAX
CA, COPD, hypertension, chronic neck and back pain in setting DDD, dyslipidemia, erectile dysfunction. NKDA 4/13/09-records received-P
SULFUR ABOUT THE AGE OF 6 AND 7 YEARS OLD - PENICILLIN = STOP BREATHING, LOC, REQUIRED CPR; SULFUR = WEAKNES Hypertension
RGY TO AMOXICILLIN 3/26/07 Allergies to nuts, crab, and sulfa. 4/6/09-records received-Allergies to penicillin, sulfa, peanuts crab and sulfites.
oss Valvular Heart Disease (valve repair not replacement) Hyperlipidemia
nd Poor Feeding~Hep B (no brand name)~1~0~Patient
ocolate; alcohol; talcum powder; peaches; nectarines
03USA04224 03USA04860 03USA04869 03USA04886 03USA01840 01USA02732 03USA04863 03USA04907 03USA04916
two; traumatic birth. I - 2years ago with 1 stent placed; Osteoarthritis; Hypertension; CAD; Hyperlipidemia.
ain; Obesity; GERD
t hospital for rash on thigh with "cream".
ng, upset stomach,sore throat, runny or stopped up nose,weak,pale, and cried most of the time.~HPV (Gardasil
L~13~In Sibling1 n~Zoster (no brand name)~UN~64~In Patient
~12~In Sibling1 NEARLY 5 YEARS AGO; NKA
bumps in legs~DTaP + IPV + Hib (Pentacel)~2~1~In Patient
DOS 3/27/09. Asthma, exercise induced.
DMII; Sciatica; Neuropathy
03USA04905 03USA03214 03USA04710 03USA04678
ED INTRAVASC CONTRAST. PMH: UE DJD, Impingement syndrome, shoulder bursitis, abd pain, diverticulosis, osteopenia, polyarthralgia onia, chronic SDH s/p head trauma, BPH, cardiac disease. Ex-smoker. Allergy: lidocaine.
RROSTENOSIS
ope; Diabetes, HTN, Hyperlipidemia; Osteoarthritis-hands; Parox. atrial fib.; Osteoarthritis-spine
ng and swelling; General anesthesia: Nausea us and was told never to get~ ()~NULL~~In Patient y, hyperbilirubinemia us and was told never to get~ ()~NULL~~In Patient
hrax.~Anthrax (Biothrax)~2~23~In Patient
l pain, dizziness, pale~HPV (no brand name)~3~12~Patient|none~ ()~~0~Sibling|none~ ()~~0~Sibling
holesterol. Allergy: latex.
ar prn; PROAR prn; Ortho Noverex; VERAMYST; REQUIP 03USA05210 03USA05205 03USA01463 03USA05483
Lupus nephritis. renal transplant x 2. Breast CA s/p lumpectomy, R&L hip replacements, L knee replacement. allergies: hydrocodone, Rel
ronchitis at time of vesicular rash. 4/10/09-records received-PMH: asthma.
easles + Mumps + Rubella (no brand name)~2~45~Patient
~DT+IPV+Hib+HepB (no brand name)~2~0~In Patient
of seizures in paternal aunt.
se; High cholesterol; Anxiety; Chronic pain
TIN; allergic rhinitis; obesity; asthma
arivax)~2~8~Sibling 2~11~Sibling
cardiac syndrome X, multiple food allergies (diagnosed by physican allergy specialist), multiple drug allergies, fibromyalgia/
03USA05627
03USA04882 03USA05206 03USA05533 03USA05489 03USA05181 01USA05565 01USA02454
exies 8.9g/dl (11/26/08)
: HTN, asthma. Family hx: HTN.
ing red dye. PMH: Planter's wart on foot, anxiety r/t school work and difficulty focusing, keratosis on arms and allergy sx. Mono-summer 2
uncomplicated. eived-PMH: seasonal allergies. Tonsils and adenoids removed.
04USA00158 04USA00372 04USA00334
ULFONAMIDES) can) - Ate crab 3 days prior to rash.
duced asthma-stable/controled omycin (Feb 2009)
, pollen) S/P acute rheumatic fever
mps + Rubella (no brand name)~2~5~Patient
a)~5~~In Patient
ords state PMH: allergic rhinitis; heartburn; menopause; tinnitus; acute bronchitis, anemia, epistaxis & OM resolved; appendectmy.
()~~1~Patient
adriplegia, multiple joint contractures, bilateral carpal tunnel syndrome, congenital mitral valve prolapse, hemorhoids, constipation, cataract
10USA00442 04USA00519 04USA00310
04USA00203 ever; allergic to SULFA X CODEINE
05USA03810 03USA00673
04USA00488
eciebing allergy shots weekly for 3 1/2 years, No allergies to yeast. I have never had a reaction to any vaccine before this one 4/13/09-reco
RD, high cholesterol
started taking Oral Typhoid prophylaxis starting 4/3/09 rash may be related to this. Patient has not pre existing conditions and no known al
PMH: eczema.
01USA03661 01USA03665 01USA03667 01USA03668 01USA03677 01USA03836 01USA03902 01USA03955 01USA03956 01USA03965
01USA04130 01USA04150 01USA04153 01USA04173 01USA04306 01USA04404 01USA04396 01USA04370 01USA03135 01USA03157 01USA03303 01USA03307 01USA03329 01USA03333 01USA03341 01USA03446 01USA03447 01USA03463 01USA03466 01USA03540 01USA03649 01USA03095 01USA02961 01USA02833 01USA02800 01USA02715 01USA02708 01USA02698 01USA02650 01USA02589 01USA02579 01USA02573 01USA02537 01USA02505 01USA02101 01USA02381 01USA02397 01USA02403 01USA02404 03USA02373 01USA04418 01USA04420 01USA04430 02USA00018 02USA00136 02USA00195 02USA00207 02USA00208 02USA00225 02USA00269 02USA00292
02USA00421 02USA00435 02USA00443 02USA00474 02USA00486 02USA00505 02USA00546 02USA00561 02USA00562 02USA00594 02USA00857 02USA00947 02USA00952 02USA01008 02USA01029 02USA01040 02USA01078 02USA01108 02USA01461 02USA01473 02USA01476 02USA01488 02USA01627 02USA01630 02USA01656 02USA01663 02USA01665 02USA01744 02USA02379 02USA02384 02USA02441 02USA02652 02USA02660 02USA02679 02USA02680 02USA02684 02USA02713 02USA02787 02USA02901 02USA02954 02USA02966 02USA03055 02USA03099 02USA03124 02USA03186 02USA03535 02USA03564 02USA03736 02USA03747 02USA03762 02USA03787
02USA03808 02USA03809 02USA03811 02USA04034 02USA03984 02USA03991 02USA04015 02USA04081 02USA04091 02USA04093 02USA04102 02USA04107 02USA04109 02USA01793 02USA04181 02USA01812 02USA04193 02USA01851 02USA04217 02USA02162 02USA02166 02USA02178 02USA04397 02USA04401 02USA04516 02USA02189 02USA02244 02USA02253 01USA01764 01USA01762 01USA01761 01USA01750 01USA01748 01USA01737 01USA01730 01USA01717 01USA01639 01USA01575 01USA01561 01USA01560 01USA01471 01USA01366 01USA01337 01USA01333 01USA01302 01USA01470 01USA01289 01USA01288 01USA01231 01USA01219 01USA01207
01USA01184 01USA01183 01USA01182 01USA01161 01USA01154 01USA01151 01USA00075 01USA00062 01USA00038 01USA00028 12USA05244 12USA05241 12USA05203 12USA04879 12USA04852 12USA04849 12USA04830 12USA04714 12USA04643 12USA04568 12USA04555 12USA04552 12USA04530 12USA04509 12USA04273 12USA04260 12USA04142 12USA04112 12USA04103 12USA04087 12USA04037 12USA04036 12USA04035 12USA03774 12USA03763 12USA03704 12USA03607 12USA03603 12USA03597 12USA03386 12USA03374 12USA03371 12USA03349 12USA03315 12USA03240 12USA03215 12USA03191 12USA02814 12USA02780 12USA02628 12USA02621
12USA02617 12USA02596 12USA02350 12USA02325 12USA02200 12USA02144 12USA02139 12USA02115 12USA02032 12USA02055 12USA01823 12USA01782 12USA01775 12USA01655 12USA01630 12USA01604 12USA01189 12USA00539 12USA00393 10USA00373 12USA00362 12USA00358 12USA00054 12USA00050 12USA00009 01USA01076 01USA01075 01USA01009 01USA01004 01USA01001 01USA00990 01USA00804 01USA00790 01USA00787 01USA00333 01USA00314 01USA00196 01USA00135 01USA00132 04USA00201 04USA00198 04USA00475 03USA03642 04USA00186 name)~UN~0~Patient
nation GARDASIL 10/18/07 OCP since 11/08. Allergy: possibly sulfa, hives. Family hx: Factor V leiden deficiency. and name)~5~11~Patient
/08 with liver and spleen palpable at rib cage. Allergy to Biaxin
ut, PVD, CAD, diabetes
es. Currently breast feeding. No daycare. Healthy pregnancy and birth.
Morphine,oxycodone,sulfa. Reports swelling of lips cheeks and tongue after 1 1/2 day of pepsid |no~ ()~~0.00~Sibling|no~ ()~~0.00~Sibling
mately 4-6 years of age. n at 30 weeks gestation PMH: alpha thalassemia.
rgy's, penicillin
ed 2007); peritoneal shunt present. 6/15/09 Received hospital medical records for 3/27-3/28/2009 & ER records for 3/25/09. Brain tumor/Me
04USA01379 02USA01068 04USA00618 04USA01122 04USA00236 04USA00813 04USA00610
01USA03627
o first two pertussis, then stopped pertussis.~DTP (no brand name)~2~0~Patient on, Family hx: childhood seizures, migraine HAs. cef, Biaxin,Amoxicillin HX:DM,Hyperlipidemia,HTN,MVP,IBS,Anemia,cervical fusion,hysterectomy,fibrocystic breast disease
PMH: cyclic vomiting & abdominal migraines.
rthritis, knee replacement; Breast cancer 2001
d name)~2~0~Patient
towards mother~ ()~UN~8~Patient
03USA04563 04USA00862 04USA00866 04USA00886 es (epilepsy); severe mental retardation PMH: severe epilepsy since age 2 w/last seizure 2008, BMI 13, decreased vision, stool & urine inc nown cause. RAST testing WNL w/only slight reaction to peanuts. Allergy: PEN, motrin. Family hx: allergic rhinitis, asthma.
0 days on 3-20-09. History enlarged uterus, resolving by follow-up ultrasound
havioral / eval.
besity; sleep apnea; hyperlipidemia
nd name)~UN~11~Patient
tenosis; spitting up & formula changed; strawberry hemangioma left forehead. Family hx: asthma.
on 4/3/09 and was deemed to be in perfect health. She is progressing as expected for her age. She has been walking since 12/25/08, per
ometriosis w/surgery. Family hx: DM.
x 9 months. Bells Palsy 7/2008. Mono 2009. Strep throat. RAD W BACK PAI-L2 FX, ALLERGY :ANCEF,CEPHAZOLIN,KEFLEX
al lung disease, pulmonary fibrosis, chronic pain, chronic pleural effusion, febrile neutropenia, ANCA (+), pulmonary HTN. Allergy: morphine
due to adminstration to BCG as a child. Fibrous lump in breast. Allegies PCN, Codeine, Duraprep
yl. Pt. has history of epilepsy and anxiety.
kin lymphoma left axilla 2003, tx w/chemo & radiation tx completed 2007. Left supraclavicular mass 8/08 tx w/radiation tx completed 10/3/0
Osteoporosis
lba; Asthma; Obesity
04USA00644 04USA00515 04USA01011 04USA00594 03USA00682 04USA01136 04USA01186 04USA01349 04USA01164
RMIN 500 mg oral tablet; CRESTOR 20 mg oral tablet; AMLODIPINE 10 mg oral tablet; IMDUR 120 mg oral tab sr 24hr; TOPROL XL 50
eceived DOS 2/3/07 to 5/7/09. Hairy mole, Pes planus with pain, scar
dasil)~1~0~Patient
ulfa, LISINOPRIL ypertension, osteoarthritis Allergy: NSAIDS
emia~Influenza (no brand name)~1~40~In Patient
cal records reveal: PMH: eczema since 6-8 wks old w/skin infections tx w/antibiotics; constipation; breastfeeding w/formula supplement. Fa
|None~ ()~~0~Sibling Head ache, stuffy nose~Pneumo (no brand name)~1~55~In Patient
has current prescription for epi-pen.
or for macrocephaly WNL. Family hx: allergies. heomalacia, pneumonia, bacterial croup, seasonal allergies. Family hx: HTN, epilepsy, DM, heart disease.
al syndrome w/rash; recurrent bilateral AOM; large anterior fontanelle. Birth hx: Mom on Depo when conceived; Mom smoker & social ETO
brand name)~UN~0~Patient
03USA02289 04USA01356
birth defects. Had endometriosis and ovarian cysts, however had a total abd. hysterectomy in 2003. I have right knee mild arthritis, otherwi
ctomy in 2003 which included resection of 19 lymph nodes. Client had a R breast reconstruction in 2004. Cl reports that she had some lym
disorder, but parent states that he had similar episodes before.
ud's syndrome. PMH: H/A. thyroid nodule with surgery. acne. Raynaud's. folliculitis. herpes zoster 8/07, abnormal brain MRI, ear tubes, a
hma and seasonal allergies 04USA01876 04USA01551 04USA01347
e not specified (no brand name)~~0~Patient
order; hypothyroidism; elevated BP; arthritis; aneurism
dical conditions. 6/17/09 Hospital records and DC summary received DOS 3/25/09 to 3/30/09. Cardiac murmur, shortness of breath, gout, a
icillian. 6/1/09 Rheumatology records DOS 2/18/09 to 5/27/09. Heartburn, tennis elbow, knee pain, chronic fatigue. PMH: environmental a YPOTHROIDISM, HYPERTENSION, HYPERLIPIDEMIA PMH: hypothyroidism, HTN, and hyperlipidemia, knee scope, R inguinal hernia re
2 & in hospice care since 5/08; CAD; PVD; CHF; nicotine dependence & currently smoking; HTN; hyperlipidemia; cervical cancer; pulmona
dryl. Epilepsy
tient|na~ ()~NULL~~In Sibling1|na~ ()~NULL~~In Sibling2
npox, seasonal allergic rhinitis, keratosis pilaris, mild scoliosis, anemia. MH: HTN, A-fib, ovarian CA. Fx tib/fib. NKDA.
02USA04952 03USA00880 03USA01292 03USA01406 05USA04750 06USA02242 07USA03038 07USA03843 08USA04369 08USA04377 09USA01360 02USA01505 02USA04263 03USA01086 03USA01403 03USA05482 03USA05497 03USA05499 03USA05512 03USA05548 03USA05559 03USA05566 04USA00004 04USA00014 03USA02293 04USA00051 03USA02323 04USA00085 03USA02643 04USA00089 03USA03984 03USA04598 03USA01645 04USA00097 03USA01677 03USA01999 03USA02061 03USA02101 03USA02285 03USA02333 03USA02337 03USA01421 03USA01423 03USA01428 03USA01434
03USA01443 03USA01445 03USA01457 03USA01595 03USA01609 03USA01611 03USA01628 03USA01631 03USA01637 03USA01639 03USA02345 03USA02346 03USA02349 03USA02354 03USA02374 03USA02555 03USA02593 03USA02852 03USA02886 03USA02903 03USA02907 03USA02927 03USA02993 03USA03188 03USA03192 03USA03221 03USA03230 03USA03231 03USA03237 03USA03242 03USA03245 03USA03247 03USA03252 03USA03626 03USA03643 03USA03665 03USA03945 03USA03970 03USA03974 03USA03975 03USA03979 03USA03982 03USA03986 03USA04004 03USA04033 03USA04036 03USA04255 03USA04259 03USA04271 03USA04275 03USA04281
03USA04302 03USA04310 03USA04317 03USA04511 03USA04517 03USA04527 03USA04889 03USA04897 03USA04899 03USA04903 03USA04909 03USA04915 03USA04528 03USA04536 03USA04922 03USA04544 03USA04924 03USA04933 03USA04982 03USA05175 03USA05202 03USA05288 03USA04553 03USA05321 03USA04559 03USA05328 03USA04582 03USA04594 03USA04609 03USA04725 03USA04851 03USA04853
04USA02014 04USA02004 04USA02281 04USA02052 04USA01867 04USA02046 01USA05068 04USA02013 04USA02011 04USA02010
04USA02003 04USA01998 04USA01997 04USA01993
04USA01992 hysema. 7/7/09 Hospital records received DOS 3/25/09 to 4/4/09. Parkinsons disease, bipolar disorder, dementia, hypertension, coronary a
rd lump x2-3 mos~DTaP (no brand name)~2~0~Patient
capularis, tx Amoxicillin 500 mg.
aptacel)~1~0~In Patient
nanas, Strawberries, Nectarines Diagnosed with Plantar Fasciitis in heel 4/16/09. Tonsillectomy.
brand name)~1~5~In Patient , dust mites, trees, grass,perfume allergies PCOS, blounts, hypoglycemia, PMH: exudative pharyngitis, metabolic syndrome w/hirsutism, T
ectomy, Non-Hodgkins lymphoma onset 8/01 last chemo 10/01
TaP (no brand name)~2~2~Patient ein intolerance). Family hx: CVA, DM.
peanut, shellfish, fish, tree nut
04USA02081
easonal allergies
04USA02000 04USA02001 04USA02002 04USA02009 04USA02012 04USA01725
odine, latex, morphine, Alphagan, many barbiturates, adhesive tape. Have had corneal transplants for Fuchs' Endothelial Corneal Dystroph
ple ear infections, tubes in ears, Anxiety, encopresis, depression, seizures. himotos, Anxiety, Depression, OCD, eye tics Varicella(Merck) #2 Lot # 1182U given 10/26/07, LA; HPV #2, Lot # 1267U given 11/20/07, IM
(no brand name)~2~0~Patient
dasil)~2~12~Patient
5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
ell fish-mushrooms-molds-fungi; Hypertension.
04USA02836
04USA02298 04USA02303 04USA02789 04USA02794
ONSTIPATION Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
sodes with injections and umbilicus piercing.
ons: None; Birth defects: None
etaproterenol
07USA04419 01USA03372
02USA02446 03USA00415 03USA00427 03USA00454 03USA00457 03USA00536 03USA00539 03USA00547 03USA00572 03USA00589 03USA00747 03USA00761 03USA00774 03USA00792 03USA00860 03USA00891 03USA00901 03USA00904 03USA00914 03USA00926 03USA00928 03USA00936 03USA00937 03USA00956 03USA00962 03USA00966 03USA01098 03USA01124 03USA01138 03USA01155 03USA01367 03USA01378
ATARAX; CODIENE; DEMERO
Family history of asthma and seizures. Previously evaluated for losing his breath at 6 months of age.
ies (pets, pollen, molds); experienced adverse reaction to biaxin, but this was not physician diagnosed. , ASD repair, psoriasis, breast CA
r custodial guard
ouse dust; per allergist.
04USA03237 04USA03291 04USA02392
rol Hypothyroidism ocular migraine imbalance Bipolar disease stable right periclynoid meningioma Urinary incontinence Factor V leiden
therapy, retinoopathy of prematurity, periventricular leukomalacia, 24 week prematurity n 9/16/2005 and diagnosed with severe milk allergy as well as positive skin tests to egg antigen, peanut antigen, and tree nut antigens thma.Patient is not taking any medication at this time.
romyalgia & depression
bites,mild eczema
complications. GERD. airy; eczema. 6/1/09 Hospital records received DOS 4/16/09 to 5/6/09. Fever previous day. Ring worm, eczema, atopic dermatitis. Frequen
s apraxia, sensory integration dysfunction, and had a run of myoclonic seizures 5 years ago.
ochondrial disorder; RAD; ADD; Duane's Syndrome.
name)~1~12~Patient
name)~1~1~Patient
d epilepsy, LBP. Extensive foreign travel x 5 yrs. Family hx: hypotension.
brand name)~UN~1~Patient
04USA03213 04USA03207 04USA02827
TUSSIS~DTaP (Acel-Imune)~2~0~In Patient
yndrome, PTSD, asthma, obesity, GERD, hypothyroidism.
environment ndmother and aunt having "reactions" to DTP several years ago. /11/08 to 2/2/09. Orchidectomy for undescended testicle. 6/8/09 Hospital record (Multiple Sclerosis Center) received DOS 4/1/09. Uveitis, M
PMH:testicular cancer. Chronic alcohol use.
eived 05/06/09 PMH: Recent workup for dizziness
me)~1~5~Patient me)~1~4~Patient
brand name)~1~0~Patient
(Gardasil)~1~0~Sibling
ROMYCET; XANAX; OIL OF OLAY 01USA00777 04USA03453
OF 4/15/09. small for gestational age as of 4/4/08. wheezing as of 3/30/09
P (no brand name)~NULL~2~In Sibling1
Appy. On birth control
pilespy, CAD with mildly elevated calcium score
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
ved without intervention.
09. urinary or chlamydial infection
deferred till now.
fluenza (no brand name)~UN~0~Patient
7; NKA ; recently changed laundry detergent - no other areas had affected. mo (Prevnar)~2~0~Patient
metimes "faints" with shots, but had not indicated this prior to vaccine.~Vaccine not specified (no brand n
04USA03689 04USA03576 04USA03788 04USA03416
symptoms) and Tomatoes eaten in large quantity cause rash & hives
Sibling1|none~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Patient
Dehydration 5/11/09-records received-PMH: GERD. Family history of SIDS approximately 30 years ago.
ecords received DOS 4/27/09 to 7/8/09. Recurrent staph skin infections, gluteal abscess. Acute severe headaches. Smoker. d DOS 4/22/09 to 4/24/09. Gastroesophageal reflux
and was fit tested that day
e not specified (no brand name)~UN~4~Patient
09USA04176
04USA03645 04USA03992 08USA00962
/08 and for bronchiolitis 11/08, otherwise healthy. Anthrax (Biothrax)~2~27~In Patient +reaction to TST (PPD) in the past; not under any treatment for TB or other illnesses at this time.
, 2009; medication helped and all symptoms were gone by October. PMH: ADD, anxitey, exudative pharyngitis, ulcerative tonsillitis, epigas NAL ALLERGIES) MOM STATED MAY BE ALLERGIC TO PENICILLIN
k, trying to take apart frozen fish. on and ADD, no allergies or birth defects known
ative colitis, migraines
b (no brand name)~1~0~Patient|~DTP + IPV + Act-Hib (no brand name)~1~0~Sibling (Gardasil)~2~15~Patient
posure; NKA
ere Bilateral Kidney Reflux as infant/tod
dasil)~1~18~Patient
al x-rays otherwise none
nuresis, hypothyroidism
04USA03499
yrs; well 2006-200
me)~4~2~Patient eumo (Prevnar)~1~0~Patient
s once but now eats them without problems
Allergic rhinitis; anxiety.
(no brand name)~1~2~In Patient
nal allergic rhinitis iasis, low back pain 04USA04339 04USA04222 04USA04218 03USA04872 03USA03976
lergy; Has sarcoidosis
Sulfa, Opioid
DOS 5/2/09 to 5/3/09. Kidney stones removed by cystoscopy, D&C, ovarian cyst removed, surgery to left TMJ, LEEP, breast implants, torn
months shots. Breathing problems, ER visit, was given breathing treatments and diagnosed with asthma. nt also reported, "I had an IV when I had my daughter about 8 years ago and I got cellulitis from it and had to be hospitalized for 6 days wit arm requiring surgical removal of cherry sized mass at injection site. Fever. Very limited range of moti~
cture with associated subdural hemorrhage
VOLTAREN; ? Anti-inflammatory drug.
P + IPV + Hib (Pentacel)~1~0~Patient
04USA04467 04USA04614 04USA03962 03USA05524 05USA06266 uscle spasms, alopecia. Family hx: MI, HTN.
s PMH: Asthma, allergic rhinitis, overweight, ovarian cyst, endometriosis. Laproscopic surg. HTN & chest pain while on OCPs. Allergy: P
e and PCN allergy. Pt otherwise healthy. nt placement; cardiac "problems"; headaches. headaches; skin lesions
e Ants, Polyurethane ords and DC summary received DOS 4/03/09 to 4/17/09. Anxiety and fibromyalgia. 6/9/09 ER records received DOS 4/3/09. Allergies to Cip l records received DOS 3/18/09 to 3/20/09. DVT
tn, hyperlipidemia
spital records received DOS 12/4/08-12/9/08. PMH: hypertension, vitamin B12 deficiency. Shrimp allergy. Kidney stones, knee surgery.
t age 4 y/o, similar reaction occurred. No documentation available.~Vaccine not specified (no brand name)~UN~
b diffciency; DJO.
DOS inpatient 11/25/08 to 11/26/08 and GI consult 3/27/09. Cataract surgery, arthritis. Drug allergies: Penicillin, Keflex, flagyl, clindamycin ngioplasty with stent (DEC 1998 and FEB 2000) 6/24/09 Hematology/Oncology consult received DOS 6/12/08 to 4/16/09. Hypertension, hy
04USA04537 01USA00303 04USA04464 04USA04459 04USA04521
ON AND ASTHMA
GI reflux onset 04/01/2004 and Enviromental Allergies es, mom stated client passed out 2 other times, once when having blood drawn and once when she had an oral surgery.
rying~Hib (OmniHIB)~1~0~In Patient
PMH: heart murmur since birth.
OPD; HTN; Hypothyroidism
e loss of memory - continues to have amnesia for all events prior to this
04USA03995 05USA00040 02USA03044 04USA04193
mild asthma. Family hx of migraines
ous colitis; Osteoporosis; Herniated lumbar disc.
genital ear deformity, hearing loss
bling1|NA~ ()~NULL~~In Sibling2|NA~ ()~NULL~~In Patient
pital records received DOS 1/12/09 to 1/22/09. Shoulder sprain, open wound of head, bursitis, nicotine dependence, sensoineural hearing l
ecords received-Adopted from another country. c ear inf; sleep apnea; FFT; Asthma.
Graves Disease
o seizures for 12 years) gia, Hyperlipidemia, allergic rhinitis 04USA04566
05USA00320 05USA00386
onychomycosis
PMH: ear infection 1/09.
reported after this event.~Vaccine not specified (no brand name)~UN~0~Patient
ardasil)~1~15~Patient
d proto colitis
nce age nine. Acid reflux. Penacillin allergy.
horse serum in the tetanus series 05USA00584 05USA00372 05USA00360 05USA00344 05USA00188 09USA03554 12USA08104 05USA00497 05USA00367 jor surgery on his right shoulder with all the bursae sacs being removed at that time, years ago.
R, OBESITY (BMI MORE THAN 40) kers cause asthma symptoms, coumadin caused rash,welts,Dilacor felt poorly
Inact. (Ipol)~3~4~In Sibling1|SISTER~Measles (Attenuvax)~1~4~In Sibling2
aptacel)~4~4~In Sibling1|BROTHER~Measles + Mumps + Rubella (MMR II)~1~4~In Sibling2
pital records received DOS 5/2/09 to 5/3/09. Allergy to unknown antibiotic - hives. st, since young age.
(no brand name)~3~1~Sibling
traumatic fracture. Rosacea on face.
HTN; and taking PAXIL for menopause.
05USA00539
~DTP (no brand name)~5~4~Patient 05USA00506 05USA00582 05USA00550 OS 7/10/06 to 3/10/09. Hypospadias 05USA00526
ation~ ()~UN~0~Sibling
pilaris; Acne; Convulsions.
upper right arm 12 pervious doses PHINE; ACETAMINOPHEN.
al allergies/Asthma.
isone; BENADRYL
ENCE SYNDROME, OM, CIGARETTE SMOKE EXPOSURE
no brand name)~NULL~~In Patient
esection & colostomy; COPD on home O2; CHF; HTN; GERD; osteoporosis; ex-smoker. Family hx: CHF, DM, COPD. Chronic Stage IV decubitus ulcer. Hep C CKD anemia of ckd chronic shoulder pain;Severe arthrosis of the left shoulder and chronic rotator c stained fluid present at delivery. NB exam showed mongolian spot on buttocks and head molding and extremity cyanosis, otherwise WNL.
asil)~2~12~Patient bar spine L4, L5-S1. PMH: Asthma, disc herniations, concussion 4/2008. 8/13/09 ER records received DOS 11/18/09. PTSD. Herniated dis
well possible bacteria infection and MD treated with antibiotics~DTaP + HepB + IPV (Pediarix)~3~1~Patien
pidemia/osteopenia
cords on vaccinee only - no chronic health problems; NKDA; Contact/PT: No pre-exiting medical conditions. 6/4/09 ER records received DO 02USA00071
tter; Allergies: Antibiotics (FLAGYL); NSAIDS; Beta-adrenergic blocking agent y of almonds, shampoo, gardasil vaccine.
easonal allergies. Sibling2|NONE~ ()~NULL~~In Patient|NONE~ ()~NULL~~In Sibling1
received-Ear infection 1 week prior. Burn to hand from curling iron. Croup 2 months prior. Cough and nasal congestion x 1 week. diarrhea~Measles + Mumps + Rubella (no brand name)~1~1~Patient|decreased speech~Measles + Mumps + Rubella (
d DOS 11/10/08 to 2/24/09. Milk protein intolerance and name)~1~4~Patient s of age. 5/15/09 medical records received (also contains copy of ED records for 5/11/09) DOS 5/11/09 to 5/13/09. Allergy to Rondec 05USA01139 05USA01070 05USA01035 05USA01034 05USA00720 ceived DOS 4/29/09 to 4/30/09. GERD ) (no brand name)~UN~57.00~Patient eceived DOS 5/4/09 to 5/5/09. PMH: appendectomy d DOS 1/22/09 to 2/3/09. Ulcer during childhood. Allergy - bee sting. eceived-PMH:hepatitis A, hernia, hypercholestolemia, hypothyroid, hypertesnion, gastroesophageal reflux disease and obesity.
d DOS 5/12/09 - 5/16/09. Patent foramen ovale.
, Atopic Dermatitis
eafood PMH: asthma, SVT, chole. ANA(+) w/no clear dx. Allergy: zofran(anaphylaxis), demerol, codeine. Family hx: SVT.
LL~~In Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
eceived DOS 1/24/08 to 4/9/09. Tonsillectomy. Infectious mononucleosis, chronic fatigue syndrome. Spinal tap headaches, Strep throat, AD Hearing loss to right ear, and reoccuring UTI's. + Hib (Pentacel)~NULL~~In Patient
dical records received (hosp discharge summary included) DOS 4/29 and 5/1/09 to 5/3/09. Tennis elbow, breast pain. ental delays.
(Pneumovax)~1~65~Patient
gestation Allergies: NKDA birth defects: None
d - uses Albuterol inhaler pm, no steroid inhalers necessary; 2 migraines; 3. bout of Cholecystitis / Cholelithiasis diagnosed at ED in CA on 1 , food, or medication allergies Medical conditions: Sleep APNEA, HTN, Hyper Cholesterolemia. m; allergy to insects; Lyme Disease
otateq)~1~0~Patient
rent sinusitis; allergic rhinitis
s received PMH: back pain.
eceived DOS 12/30/08 - 5/13/09 ADHD, Adjustment Disorder-Depressed, joint pain left leg
L~~In Patient|known known~ ()~NULL~~In Sibling1
vaginal delivery. no significant prenatal or postnatal complications. Birth weight was 7 pounds and 7 ounces., soft palate mucocele diagnos
d Nodular Goiter, and allergic to allergic/dairy products.
had a reaction did not report it~Vaccine not specified (no brand name)~UN~0~Sibling allergies and asthma.
rosis Gerd, varicose veins.
Patient|none~ ()~NULL~~In Sibling1
05USA01427 05USA00689 05USA01449 05USA00483 07USA01442 05USA01250 05USA00574 2 mos-screen passed; No crawl/pincer @ 9 mos 7/7/09 Medical records received DOS 11/20/07 to 3/30/09. Abscess finger. I&D. es~Influenza (no brand name)~~0~Patient|Seizures~Hib (no brand name)~~0~Patient|Polio~Polio Virus, Inact. (n
cardiology and neurology. Two episodes were following blood draws
antibiotic ointment listed in chart
mo (Prevnar)~3~3~In Sibling1 Daptacel)~NULL~4~In Sibling1
story of asthma. GONE BY NOW.
asil)~~15~Patient S 5/15/09. Seasonal Allergies.
eceived DOS 5/15/09 to 5/16/09. Spit-up/emesis, born 2 weeks early. Hx of Prior Limited Abdominal Ultrasound (5/13/090 WNL.
no brand name)~5~5~Patient
No birth effects.
partial nephrectomy; Anxiety state; Epiretinal membrane; Cataract, senile, NSC; Vitreous degeneration/detachment; Arthragia-Pain in joint, 03USA00777 03USA02222 03USA03226 04USA00156 04USA00174 04USA00178 04USA00185 04USA00225 04USA00234
04USA00246 04USA00248 04USA00267 04USA00325 04USA00379 04USA00380 04USA00409 04USA00429 04USA00456 04USA00469 04USA00480 04USA00484 04USA00575 04USA00581 04USA00584 04USA00585 04USA00586 04USA00590 04USA00591 04USA00592 04USA00596 04USA00604 04USA00606 04USA00630 04USA00631 04USA00634 04USA00852 04USA00874 04USA00883 04USA00972 04USA00982 04USA01003 04USA01004 04USA01016 04USA01018 04USA01025 04USA01030 04USA01032 04USA01113 04USA01121 04USA01123 04USA01148 04USA01149 04USA01169 04USA01183 04USA01198 04USA01201 04USA01260 04USA01342 04USA01354 04USA01367
04USA01427 04USA01436 04USA01437 04USA01514 04USA01519 04USA01528 04USA01902 04USA01837 04USA01907 04USA01849 04USA01850 04USA01851 04USA01864 04USA01868 04USA01952 04USA01877 04USA01895 04USA01986 04USA02036 04USA02039 04USA02071 04USA02076 04USA02301 04USA02305 04USA02308 04USA02324 04USA02753 04USA02326 04USA02771 04USA02777 04USA02792 04USA02800 04USA02904 04USA02972 04USA03132 04USA03214 04USA02907 04USA03407 04USA02911 04USA02916 04USA03412 04USA03414 04USA03419 04USA02944 04USA03425 04USA03434 04USA02949 04USA02953 04USA03612 04USA03620 04USA03626
04USA03644 04USA03444 04USA03729 04USA03746 04USA03456 04USA03790 04USA03798 04USA03458 04USA03523 04USA03811 04USA03815 04USA03556 04USA03816 04USA03824 04USA03927 04USA03959 04USA03961 04USA03985 04USA03990 04USA04012 04USA04212 04USA04242 04USA04245 04USA04370 04USA04423 04USA04430 04USA04435 04USA04437 04USA04458 04USA04514 04USA04522 04USA04530 04USA04552 04USA04573 04USA04574 05USA00001 05USA00009 05USA00054 05USA00061 05USA00065 05USA00074 08USA00976 04USA00481 05USA01285 05USA01663 05USA01445 05USA01453 05USA01673 eived- PMH:IgA deficiency, marked number of ear infections and one episode of poorly defined pneumonia. IgMs tend to be low and has va
levated chol, HTN, Osteparosis
me)~4~2~Patient
Patient|NONE~ ()~NULL~~In Sibling1
PMH: frequent HA, thigh abscess w/hospitalization.
atient hospital records received DOS 5/19/09 to 5/21/09. Hypertension, childhood asthma, egg allergy.
orbed (no brand name)~UN~0~Sibling
05USA01825 aired fasting glucose,monoclonal gammopathy, TB bone, chronic shoulder pain, hemorrhoids, blood in stool, cataracts, ex-smoker, acute UR , TONSILLECTOMY AS CHILD, CCY APPY HEMORRHOID; SURGERY RECTAL FISSURE REMOVAL AND RECTAL ABSCESS - emerg
atoma; skull fx 05USA01925 05USA01680 12USA03680 05USA01298
DOS 5/7/2009 and 5/18/09. Evaluation for short stature. Seizure-like activity when very young.
ki Syndrome
none~ ()~~0~Sibling eat Allergy. 6/4/09-records received-PMH-gluten intolerance and gastritis. d feeling irritable.
No pre-existing medical conditions. ripheral vascular disease, depression/anxiety. 6/4/09 Hospital records received DOS 5/18/09 to 5/21/09. hypercholesterolemia, breast canc
nt tachypnea and jaundice
ore the pneumovax.
c illnesses per patient
ds received DOS 6/17/09. Prior convulsion.
yndrome6/5/09-records received-Family history of WPW syndrome.
o chronic medical conditions
l records received DOS 2/25/09 to 2/27/09. COPD.
8/09 Medical records received DOS 4/27/09 to 5/21/09. Heartburn. 6/12/09 Medical records received DOS 4/27/09 to 6/1/09. GERD.
atient|n/a~ ()~NULL~~In Sibling1 NT PAIN , MUSCLE PAIN~Anthrax (Biothrax)~2~20~In Patient
Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2 OPHEN), Benadryl 4 cc
o Ibuprofen but no other medical conditions or birth defects.
n, etc. No food allergies.
cholesterol. Not on immunosuppressants, not immunocompromised -other than type 2DM-
04USA02063 09USA01336 06USA04214 08USA01924 08USA02965 10USA05607 03USA03034 03USA03040 03USA03056 03USA03075 03USA03503 03USA03627 03USA03170 03USA03645 03USA03699 03USA03716 03USA03316 03USA03806 03USA03909 05USA04042 03USA03335 03USA04047 05USA03728 03USA04131 05USA00361 03USA03372 04USA02505 04USA00432 03USA04185
04USA00234 03USA03375 03USA04192 03USA04437 03USA03502 03USA04442 03USA04497 03USA04509 03USA04513 03USA04643 05USA01178 05USA01256 03USA04691 03USA04699 05USA01387 05USA01692 03USA04721 05USA01842 03USA04722 05USA01972 03USA04954 50USA01975 03USA04973 05USA02046 03USA05043 05USA02125 05USA02311 03USA05062 05USA02345 04USA00134 05USA02351 04USA00167 05USA02862 05USA02918 04USA00214 02USA00004 02USA00005 02USA00006 02USA00010 02USA00021 02USA00178 02USA00932 02USA00937 02USA01026 02USA01058 02USA00203 02USA00246 02USA01103 02USA00298 02USA00420 02USA00423
02USA00601 02USA01524 02USA00865 02USA01617 02USA01622 02USA01929 02USA01623 02USA01660 02USA01711 02USA02200 02USA02265 02USA01828 02USA01864 02USA02333 02USA02410 02USA02447 02USA02690 02USA03691 02USA03715 02USA02913 02USA03795 02USA03986 02USA03109 02USA03137 02USA03989 02USA03138 02USA04049 02USA03509 02USA03510 02USA04063 02USA03512 02USA03573 02USA04096 02USA04099 02USA04167 02USA04172 02USA04213 02USA04374 02USA04533 02USA04540 02USA04599 03USA00002 03USA00050 03USA00130 03USA00325 03USA00365 03USA00401 03USA00419 03USA00571 03USA00610 03USA00789
03USA00790 03USA00893 03USA01183 90USA02671 09USA02688 09USA03225 09USA03272 09USA03440 09USA03452 09USA03499 09USA03816 09USA03869 09USA03897 09USA03909 09USA03920 09USA03925 09USA04059 09USA04165 12USA01769 09USA04304 09USA04569 09USA04612 11USA00877 09USA04621 10USA05270 10USA02178 09USA04626 10USA02126 09USA04655 09USA04657 10USA00203 07USA05344 10USA00210 01USA00386 07USA02635 06USA07544 10USA00430 10USA00436 10USA00472 03USA01626 03USA01816 03USA01817 03USA02317 03USA02365 03USA02553 03USA02592 03USA02948 03USA03185 03USA03573 10USA02135 10USA02142
10USA02144 10USA02460 01USA02468 10USA02478 10USA02490 10USA02491 10USA02775 10USA03250 10USA05257 10USA05259 10USA03306 10USA05327 10USA03346 10USA03365 11USA00032 11USA00045 11USA00196 10USA03366 11USA00209 11USA00253 11USA00275 11USA00279 10USA03381 11USA00282 11USA00520 11USA00620 10USA03753 10USA03770 11USA00674 11USA00711 11USA00736 10USA03910 11USA00878 11USA00949 10USA03915 10USA03963 11USA00986 11USA01187 10USA03983 11USA01304 11USA01326 11USA01329 10USA03995 11USA01618 10USA04022 11USA01815 11USA02164 11USA02212 11USA02274 10USA04025 10USA04135
10USA04137 10USA04155 10USA04174 10USA04356 10USA04357 10USA04483 10USA04487 10USA04509 10USA00546 10USA04513 01USA00557 10USA00560 10USA00824 11USA02843 11USA02852 10USA01021 11USA03030 10USA01157 10USA01158 11USA04005 10USA04557 10USA01539 10USA01665 10USA04738 10USA01668 11USA04023 10USA01701 10USA01718 11USA04139 10USA01841 10USA04869 10USA01850 11USA04150 10USA04909 10USA02115 10USA04948 10USA04953 12USA00343 10USA05081 12USA00513 10USA05179 12USA00536 12USA00568 12USA00579 12USA03195 12USA03263 12USA03384 12USA03602 12USA04027 12USA04091 12USA01179
12USA01180 12USA04107 12USA04116 12USA04526 12USA04560 12USA05110 12USA05278 01USA00086 01USA00142 01USA00325 12USA01212 12USA01225 12USA01586 12USA01614 12USA01644 12USA01656 12USA01784 12USA02011 12USA02022 12USA02023 12USA02159 12USA02785 12USA02789 12USA03185 01USA00326 01USA00337 01USA00774 01USA00798 01USA01025 01USA01040 01USA01048 01USA01127 01USA01283 01USA01284 01USA01303 01USA01324 01USA01525 01USA01552 01USA01596 01USA01608 01USA01625 01USA01722 01USA01763 01USA01975 01USA01993 01USA02045 01USA02473 01USA02496 01USA02572 01USA02711 01USA02740
01USA03087 01USA03310 01USA03332 01USA03381 01USA03444 01USA03477 01USA03497 01USA03507 01USA03656 01USA03678 01USA03712 01USA03751 01USA03923 01USA04117 01USA04155 01USA04409 01USA04419 01USA04421 07USA03549 07USA03550 07USA03577 07USA03721 07USA03815 07USA03817 07USA03862 07USA04012 07USA04064 07USA04317 07USA04320 07USA04417 07USA04481 07USA04575 07USA04602 07USA03035 07USA03059 07USA03067 07USA03136 07USA04794 07USA04949 07USA03137 07USA04950 07USA05051 07USA03138 07USA03139 07USA03193 07USA03201 07USA03258 07USA05129 07USA03325 07USA05163 07USA03367
07USA03548 07USA05182 07USA05202 07USA05281 07USA05354 07USA05376 08USA03476 07USA05521 07USA05538 08USA03477 08USA00277 08USA00495 08USA00964 08USA03615 08USA03651 08USA04116 08USA03664 08USA04170 08USA03770 08USA04209 08USA03954 08USA03964 08USA04357 08USA03968 08USA04359 08USA03987 08USA04413 08USA04011 08USA04415 08USA04419 08USA04038 08USA04423 08USA04427 08USA04442 08USA04450 08USA04634 08USA04849 08USA05003 08USA04850 08USA05051 08USA05052 08USA05234 08USA05326 08USA05342 08USA05343 08USA05355 08USA05366 08USA05407 09USA00001 09USA00002 09USA00004
09USA00022 09USA00025 08USA01202 08USA01282 09USA00050 08USA01309 08USA01368 09USA00313 09USA00328 09USA00335 09USA01407 09USA00352 08USA01378 08USA01388 09USA01418 08USA01647 09USA00367 09USA01435 08USA01650 09USA01455 09USA01502 09USA01549 09USA00471 08USA01573 09USA01575 09USA00528 09USA01579 09USA01648 09USA00743 09USA01745 09USA00753 09USA01778 09USA01790 09USA00773 09USA00867 09USA01837 09USA01223 09USA01951 08USA01671 09USA01380 09USA01975 09USA01980 09USA02014 09USA02162 09USA02177 09USA02297 09USA02316 09USA02379 09USA02380 09USA02381 09USA02483
09USA02576 09USA02598 09USA02664 07USA05568 07USA05664 07USA05694 07USA05699 07USA05735 05USA02934 07USA05738 05USA03403 07USA05739 05USA03488 07USA05754 05USA03651 05USA03659 05USA03797 08USA00063 05USA04502 08USA00081 05USA04544 08USA00094 05USA03823 05USA03860 05USA04691 08USA00101 05USA04055 08USA00147 05USA04395 05USA04744 05USA04396 08USA00206 05USA04785 05USA04398 08USA00207 05USA04786 05USA04400 05USA04838 05USA04489 05USA04874 05USA04876 05USA04930 05USA04967 05USA05060 05USA04998 05USA05068 05USA05058 05USA05071 05USA05059 05USA05072 05USA05073
05USA05105 05USA05122 05USA05128 05USA05445 05USA05499 05USA05592 05USA05615 05USA05620 05USA05622 05USA05644 05USA05627 05USA05950 05USA05955 08USA02799 05USA05977 06USA00627 08USA02801 05USA06174 08USA02808 05USA06432 08USA02844 06USA00003 06USA00008 08USA02857 06USA00648 06USA00077 06USA00316 06USA00650 08USA03096 06USA00326 08USA03110 06USA00672 06USA00699 08USA03124 06USA00991 06USA00616 06USA01000 06USA00625 08USA03213 08USA03225 06USA01006 08USA03245 06USA01035 08USA03473 08USA01959 08USA02047 08USA02146 08USA02179 06USA01077 08USA02181 08USA03474
06USA01078 08USA02427 06USA01079 08USA02457 06USA01090 08USA02461 06USA01091 08USA02475 08USA02606 08USA02627 08USA02671 08USA02721 06USA08049 06USA08138 06USA08305 06USA08306 06USA08307 06USA08331 06USA08400 06USA08402 06USA08695 06USA08741 06USA08832 06USA08878 06USA01092 06USA08935 06USA08942 06USA01107 06USA01151 06USA01251 06USA01287 06USA01294 06USA01300 06USA01311 06USA01497 06USA01502 06USA01539 06USA01568 06USA01606 06USA01976 06USA01981 08USA03475 06USA01988 06USA02200 06USA02231 06USA02238 06USA02254 06USA02400 06USA02442 06USA02462 06USA02464
06USA08984 06USA09014 07USA00017 07USA00054 07USA00089 07USA00128 07USA00349 07USA00665 07USA00666 07USA00669 07USA00691 07USA00809 07USA00967 07USA01026 07USA01040 07USA01145 07USA01292 07USA01373 07USA01397 07USA01406 07USA01410 07USA01429 07USA01517 07USA01574 07USA01785 07USA01649 07USA01841 07USA01850 07USA02218 07USA02223 07USA02243 07USA02376 07USA02470 07USA02504 04USA00300 04USA00377 07USA02643 04USA00398 04USA00423 04USA00444 04USA00447 07USA02754 04USA00882 07USA02921 07USA03007 04USA00888 07USA03021 04USA00920 04USA00995 04USA01011 04USA01013
04USA01062 04USA01096 04USA01264 04USA01337 04USA01438 04USA01494 04USA01495 04USA01711 04USA02209 04USA02212 04USA02081 04USA02228 04USA02242 04USA02299 04USA02106 04USA02328 04USA02143 04USA02144 04USA02202 04USA02516 04USA02538 04USA02743 04USA02747 04USA02816 04USA02879 04USA03185 04USA03118 04USA03201 04USA03231 04USA03236 04USA03282 04USA03508 04USA03602 06USA03399 04USA03682 04USA03766 06USA03425 04USA03793 04USA03730 06USA03727 04USA03861 04USA03907 06USA03742 04USA03960 06USA03746 04USA04000 06USA03794 04USA04032 04USA04033 06USA03803 04USA04034
04USA04035 04USA04040 06USA03808 04USA04042 06USA03822 04USA04044 04USA04045 06USA07561 06USA07744 06USA07770 06USA07877 04USA04047 06USA07882 04USA04050 04USA04223 04USA06300 04USA04630 04USA06332 04USA06409 06USA07918 04USA04788 04USA06413 04USA04790 04USA04795 04USA04809 04USA06420 04USA05242 05USA00081 05USA00205 05USA00268 04USA05266 05USA00288 04USA05432 05USA00323 04USA05960 04USA06103 05USA00372 05USA00409 05USA00451 05USA00509 05USA00557 05USA00588 05USA00591 05USA00592 05USA00651 05USA00670 05USA00818 05USA00862 05USA00871 05USA00964 05USA01014
05USA01073 06USA02948 06USA03064 06USA03065 06USA03076 06USA03113 06USA03360
06USA01075
05USA01493
05USA02258 05USA01937 05USA01916
05USA01868
05USA01999 03USA04278 01USA02736
02USA02392
sorder; Kawasaki disease as a child that led to coronary aneurysm that completely resolved per cardiologist. 7/7/09 ER records received D marrow transplant. 5/22/09 Called mother and Maria having no problems. Parent and doc
CAUSES RASH, HIVES, AND TROUBLE BREATHING. ALSO ALLERGIC TO BEE STINGS, SKIN IRRITANTS, CATS, AND RESPIRATOR
enuts,eggs,soy,fish,coconut,sunflower,cherry,strawberry,corn,tomato) avoiding:shellfish,legumes,sesame.Asthma
currently being tx. patient remarked that she now remembers that she once had a topical reaction to neomycin and thinks this reaction may be related to a neo
eat vessel transposition, 06/08 - Orahiop hernia repair
ergic Rhinitis/Conjunctivitis
nstead of subcue??? Could that have caused my indention? Thanks! n at injection site~Measles + Mumps + Rubella (MMR II)~1~1~In Patient|High fever lasting several days, seve
Anthrax (Biothrax)~3~25~In Patient
05USA02502 04USA03617
05USA02285
R hemiparesis; S/P ALTE
pollen/Asthma
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
22/09 to 5/23/09. Tylenol, Benadryl, Motrin
records received DOS 1/5/05 to 6/17/09. Coronary artery disease post myocardial infarction with stent. Anxiety, asthma, obstructive sleep
previous reactions to vaccines.
mia; Osteoarthritis; Alcohol abuse
easles + Mumps + Rubella (no brand name)~1~0~Patient
RIA, FEEDING DYSFUNCTION, CONGENITAL HSV INFECTION
ng; Dermatitis ks~Measles + Mumps + Rubella (no brand name)~1~2~Sibling
smallpox vaccine three different times when she was five years old, but she states it never "took." She d
tation. Delivered by C/S secondary to pregnancy induced hypertension. Birth depression recovering quickly after she received a dose of N Penicillin, allergic rhinitis/seasonallergies, asthma rds received DOS 5/28/09 to 6/9/09. Allergy to codeine.
n for depression but AFTER he received the Anthrax vaccine. Started Wellbutrin in Sept 2008.
; Neuropathy; Osteoarthritis
o immunizations . Reported tiredness/fatigue off and on with headaches. oulder tendonitis, thyroid
es + Mumps + Rubella (no brand name)~1~1~In Patient
05USA02514 05USA02266 05USA02293 05USA02211 05USA01582 04USA03943 04USA03942 10USA05176 05USA03263 03USA01606
go, had bilat. mastectomy. Took tamoxifen for 5 years. Is cancer free. ceived DOS 5/11/09 to 5/15/09. Bilateral wrist fractures. Abdominal pain and fever. Milk allergy. Fell on head several times. Vertical nystagm
dander allergies
cyst & osteopenia.
d DOS 6/13/06 to 2/27/09. Peritonsillar abcess, conjuntivitis chronic allergic.
d, no systemic reaction history to Td 05USA03370 05USA03234 05USA03404
ri~ ()~NULL~1~In Patient ury at birth, Seasonal allergies
ULL~~In Patient hyperglycemia. s/p intestinal resection. LFTs raised. hip fx. NKDA inhaler in youth for a few years but "grew out of sickness.Diagnosed at that time with Asthma.
otty training~Polio Virus, Oral (no brand name)~UN~0~Patient wn allergies
rand name)~UN~0~Patient
ecords received 3/27/08 to 5/7/09. Hysterectomy, 'fish poisoning'.
area at 2 w.o. - resolved.
Patient|None~ ()~NULL~~In Sibling1
migraine, IFG, PMDs
05USA03626 05USA03333
05USA03323
Blood Pressure, tachycardia
s Type I. Persistant hyperglycemia. Tonsillectomy. Benedryl allergy. Insulin pump. Asthma.
mach ache~Meningococcal (Menactra)~1~18~In Sibling1 mache ache, and injection site swelling for Menactra~Meningococcal (Menactra)~1~15~In Sibling1 etanus~Tetanus Toxoid, adsorbed (no brand name)~NULL~11~In Patient ION OF OBSTRUCTION OR GANGRENE; HERNIA OF OTHER SPECIFIED SITES.
imembranes VSD)
Allergy to Amoxicillin o PCN. dematophytosis. GERD ecords received DOS 3/22/09 to 5/29/09. Congenital Hydrocele. hy; hypertension. 6/22/09 Hospital records DC summary received DOS 12/29/08 to 01/11/09. Had cold within the past week. Obesity, herni
sm, Allergy to Morphine Tetvacyeline
05USA03247
/o maternal chlamydia and tobacco, mom with diet controlled gestational diabetes, breech delivery, h/o cellulitis R ankle MRSA, allergic rhin Varivax)~0~1~In Sibling2|Diarrhea and speech/motor regression, VAERS E-29842~Measles + Mumps + Rubella (MMR
Acne on doxycycline. Allergic rhinitis. early death secondary to amebiasis, childhood leukemia, DM, asthma.
s, microtrigonocephaly, structural brain anomalies (absent corpus callosum)
and DC summary received DOS 5/19/09 to 5/20/09. Neonatal jaundice.
ricella (no brand name)~1~1~Patient|upper respiratory~Measles + Mumps + Rubella + Varicella (no brand name)~
yperlipidemia; anemia; GERD; Asthma sis (no brand name)~1~0~Patient
05USA03655 05USA04021
~5~5~In Patient 7/10/09 Hospital outpatient records received 5/25/09 to 7/10/09. Stress fracture, myopia, astigmatism, pain in leg, tendonitis patellar, flat fo
female with stable weight over her high school years. She was a runner who competitively raced and took remarkably good care of herself,
DOS 5/18/09 to 5/20/09. PMH: legally blind R eye.
nistering the anthrax vaccine the first anthrax vaccine cause her vomiting and nausea for 3 days. She had swelling the size of a golf ball s
PMH: Appy, ankle fx, ovarian cyst, blocked duct, UTI.
mps + Rubella (MMR II)~2~4~Patient
chirp registry
and name)~0~1~In Patient e nerves in her rt leg 10/04 Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2 egg; peanut; banana; eczema; and GERD 05USA04048 06USA00249 04USA03633 06USA00042
~2~38~In Patient
ditions: Diabetes/Hypertension/Hyperlipidemia/Obesity/Osteoarthritisdical HAS DIABETES
arivax)~2~4~In Patient SION SYNDROME [310.2] ADVANCE DIRECTIVE INFORMATION [EP888] EXTRINSIC ASTHMA, UNSPEC [493.00] ALLERGIC RHINITI
no previous adverse signs and symptoms with immunizations. none~ ()~~0~Sibling|none~ ()~~0~Sibling
and name)~UN~0~Patient
soy, peanut, wheat, corn, eggs) ADHD.
ospital records received DOS 5/15/09 to 5/16/09. Meconium aspiration syndrome, RSV, reflux.
cation or vaccine given/received gard 3rd injection when 2wks pregnant.
06USA00244 05USA04140 06USA00013 05USA03885
conditions; Father states she has had 1 similar episode of fainting. 7/13/09 Hospital ER records received DOS 5/13/09. Previous syncopal e
ilar as above; no medical treatment)~Typhoid Vi Polysaccharide (no brand name)~1~18~In Patient
mittent cardiac arrhythmia-rapid heart beat and slightly elevated blood pressure 140/90
d DOS 4/9/09 to 4/27/09. Hyperbilirubinemia at birth, phototherapy. Eczema. 7/31/31 Hospital records received DOS 12/15/08 to 6/17/09. N
s, body aches, dizziness, bad mood,~Measles + Mumps + Rubella (no brand name)~1~50~In Patient or medical conditions
es, GERD; IBS; asthma
hrax (Biothrax)~3~3~In Patient y~Pneumo (no brand name)~1~3~Sibling|exsema, hyperactivity~Polio Virus, Inact. (no brand name)~3~3~Sibling nd name)~UN~0~Patient
rythromycin.
06USA00554
06USA00298
06USA00048 06USA00056 06USA00039
ceived DOS 6/6/09. Melanoma.
pital records received DOS 5/15/09 to 5/18/09. Appendectomy. Stab wound. Shortness of breath. al records received DOS 11/15/08 to 11/18/08. Migraines with aura, sinusitis with headaches associated, nonspecific dermatitis. Possible M
()~NULL~~In Patient|none that i know of~ ()~NULL~~In Sibling1|none that i know of~ ()~NULL~~In Sibling2
za (no brand name)~1~56~In Patient
06USA00012 06USA00536 06USA00524 05USA00702 ceived DOS 5/29/09 to 6/1/09. Possible febrile seizures. PMH: 1 episode of brief jerking.
using formula
mps + Rubella (MMR II)~1~1~Patient
nipuncture and once after GARDASIL shot at GYN office
LIUM, SULFA.
ecent pneumonia
none~ ()~~0~Sibling
nization records received DOS 4/23/09 to 6/3/09. OCD, depression, anxiety, suicide attempts. Kidney stones. Weakness, dizziness. Allergy
on, R10 cystic fibrosis, Hdg C.
enopausal; migraine HA's
llergic rhinitis; Asthma 06USA00344 06USA00895
eficiencies; hysterectomy; allergic to shellfish, methyl, latex; seasonal allergies za (no brand name)~UN~43~Patient
r medical history.
hydration~ ()~~0~Patient
under control and was not on any medications.
RAD, urticarial milk allergy. 6/12/09 Medical records received DOS 6/8/09. Hemangioma, atopic dermatitis, pectus excavatum, milk allergy
ved DOS 5/31/09 to 6/1/09. Otitis Media S 6/3/09 and 6/22/09. Chicken pox. Bulemia, depression.
OA; Menopausal
eft to right shunting
birth defects. dical conditions. s: None; Medical conditions: GERD medical conditions.
06USA00687 06USA00544 02USA05190 06USA01158
occasional alcohol use and normal laboratory results except for slightly low WBC, due to methotrexate therapy. Then was the patient's sec
my, Hysterectomy, Cholecystectomy, Tonsillectomy, Dementia, Depression, Hypertension, Stroke
ures. She does have a history of seasonal allergies, but does not take any medication for it. Pt. had a history of allergic reaction to bee stin
sultant records received DOS 6/11/09. Similar episode Jan 08 - jerking, no loss of consciousness, seen in ER.
name)~1~0~Patient|Fever~Pneumo (Prevnar)~1~0~Patient|Fever~DTaP + HepB + IPV (Pediarix)~1~0~Patient|Fever~Ro
nuts no longer per allergist)
h). Initially did not pass newborn heart test but passed at 6 mos of age - normal heart now
01USA05575 01USA03065 06USA01328 04USA02912
none~ ()~~0~Sibling
cified (no brand name)~NULL~22~In Patient sil)~1~17~In Patient
ergic reaction to Influenza vaccine resultin in pneumonia.
DOS 5/28/09 to 5/29/09. Constipation, reflux.
hrive~Hep B (Engerix-B)~2~0~In Patient
and chronic venous stasis resulting in lower extremity cellulitis and ulcerations.
06USA00890 06USA00708 06USA08747 06USA00865 05USA05079 06USA00696 06USA01783
Gout, A-fib, prostate CA, Hyperlipidemia nt may have a digestional allergy to strawberries.
allergic rhinitis, constipation
mmatory; Flagyl; Adhesive tape
nd name)~1~36~Patient
of overdose 2005; ETOH dependence
d 6/11/09 to 6/23/09. Allergic rhinitis. Augmentin causes vomiting.
and name)~1~10~Sibling
s, since age 3-4 wk. mold; dust; trees - pollen
not specified (no brand name)~UN~0~Patient
06USA00130 05USA03639 05USA02240
05USA00980 06USA00258 07USA01443 03USA00128 04USA02086 06USA08328 07USA00352 03USA00005 03USA01240 03USA01849 03USA04686 04USA00153 04USA01441
05USA00193 05USA00220 05USA00239 05USA00270 05USA00342 05USA00366 05USA00380 05USA00383 05USA00387 05USA00500 05USA00510 05USA00521 05USA00528 05USA00529 05USA00538 05USA00561 05USA00563 05USA00570 05USA00572 05USA00707 05USA00733 05USA00944 05USA00950 05USA01104 05USA01112 05USA01140 05USA01261 05USA01306 05USA01307 05USA01432 05USA01443 05USA01447 05USA01464 05USA01625 05USA01633 05USA01662
05USA01665 05USA01684 05USA01721 05USA01879 05USA01888 05USA01902 05USA01923 05USA02012 05USA02013 05USA02018 05USA02021 05USA02029 05USA02230 05USA02247 05USA02253 05USA02260 05USA02572 05USA02728 05USA02843 05USA02892 05USA02921 05USA02951 05USA03183 05USA03218 05USA03240 05USA03248 05USA03257 05USA03276 05USA03359 05USA03367 05USA03371 05USA03380 05USA03385 05USA03402 05USA03625 05USA03635 05USA03670 05USA03677 05USA03692 05USA03695 05USA03777 05USA03812 05USA03847 05USA03861 05USA03862 05USA03865 05USA03883 05USA03904 05USA03905 05USA03906 05USA04039
05USA04056 06USA00009 06USA00010 06USA00011 06USA00103 06USA00112 06USA00118 06USA00135 06USA00139 06USA00143 06USA00242 06USA00243 t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling 06USA01449 06USA01742 06USA01436 05USA01495
ecords received DOS 7/25/06 to 3/13/09. Brown /pink flat lesions on face, scalp. Brown waxy papule left leg. Lentigo on cheek, back, scalp.
erred to derm
ant on 05/18/2009
COPD; AS CAD. brand name)~UN~0~Patient
antrisin; Osteoporosis
ate; Azathiopine
n, HTN, hypothyroidism, laminectomy, hernia repair, CAD w/angioplasty, cholecystectomy, chronic gastroparesis, vertigo, chronic sinus infe
al records received DOS 3/29/09 to 4/1/09. Insulin-dependent diabetes, mononucleosis, fractured tibia.
ords received DOS 5/27/09 to 6/16/09. Second dose Gardasil given 5/27/09 (Lot# 0100Y) no worsening of symptoms.
received DOS 5/24/09 to 5/25/09. Chronic constipation, conjunctivitis, influenza A.
05USA00985 05USA01063 05USA01064
06USA02086 eived DOS 6/10/09. Multiple otitis media. PE tubes.
d DOS 12/26/09 to 1/3/09. Hypertension, Dyslipidemia, TIA, Anxiety disorder, lower extremity spasms. Hysterectomy. 7/22/09 Neuro consu
after shots given~ ()~NULL~1~In Sibling1
occal (Menactra)~1~0~Patient
eceived w/PMH: lactose intolerance. Allergy: codeine (rash).
c neuritis 1988.
llergies. Seasonal & Sulfa drugs.
OS; It appeared that his experience of sxs listed on HPI came before he received his fourth anthrax vaccination.
allergic to codeine PERCOCET
04USA02211 05USA00117 05USA00253 05USA04761 06USA03749 06USA08382 06USA08842 07USA04110 07USA04415 08USA00305 08USA01129 08USA03172 09USA01568 10USA00555 10USA04484 11USA01825 01USA02697 02USA04490 05USA01028 07USA01622 08USA04266 08USA04659 09USA03250 11USA02717 12USA02364 11USA00271 12USA03761 12USA04292 12USA04527 12USA05081 12USA05090 04USA00374 04USA00375 04USA01041 04USA01249 04USA02195 04USA02356 04USA02566 04USA02684 04USA02805 04USA02851
04USA03127 04USA03762 04USA03905 04USA04024 04USA04732 04USA04855 04USA04886 04USA04958 04USA04963 04USA05045 04USA05494 04USA05945 04USA06452 05USA00604 05USA00963 05USA00472 05USA01259 05USA01301 05USA01724 05USA02007 05USA02008 05USA02851 05USA03043 05USA03044 05USA03443 05USA04017 05USA04028 05USA04742 05USA04823 05USA05616 06USA00334 06USA00655 06USA01349 06USA01956 06USA01991 06USA02474 06USA03069 06USA03246 06USA03247 06USA03736 06USA08308 06USA09015 07USA00301 07USA00647 07USA01282 07USA01385 07USA01390 07USA01882 07USA02212 07USA02259 07USA02929
07USA03594 07USA04023 07USA04121 07USA04834 07USA05192 07USA05497 07USA05524 07USA05530 07USA05546 07USA05695 08USA00136 08USA00284 08USA00678 08USA01310 08USA01337 08USA01347 08USA01675 08USA01729 08USA01806 08USA01821 08USA01953 08USA02149 08USA02648 08USA02658 08USA03170 08USA03536 08USA04342 08USA04672 08USA04970 03USA01084 03USA01085 03USA04716 03USA04868 08USA04990 08USA05346 09USA00020 09USA00264 09USA00311 09USA00514 09USA00720 09USA01166 09USA01376 09USA01587 09USA01970 09USA02105 09USA02613 09USA03791 09USA04333 09USA04517 09USA04525 09USA04597
09USA04616 10USA00010 10USA00544 10USA01976 10USA03413 10USA03422 10USA03729 10USA03787 10USA03948 10USA04143 11USA00283 11USA02891 11USA03062 11USA04133 12USA02053 12USA02331 12USA02373 12USA02572 12USA02587 12USA02768 12USA02808 12USA03174 12USA03218 12USA03515 01USA00128 01USA00177 01USA00190 01USA00321 01USA01341 01USA01725 01USA01824 01USA03456 01USA03472 01USA04120 01USA04183 02USA00262 02USA00430 02USA00441 02USA00453 02USA00468 02USA00612 02USA01084 02USA01110 02USA01776 02USA01784 02USA01858 02USA01880 02USA02376 02USA02405 02USA02482 02USA02618
02USA02792 02USA02907 02USA02944 02USA03071 02USA03102 02USA03118 02USA03602 03USA00343 03USA00538 03USA00594 03USA00746 03USA00892 03USA00918 03USA00923 03USA00967 03USA01091 03USA01096 03USA01408 03USA02001 03USA02076 03USA02227 03USA02298 03USA02334 03USA02338 03USA02344 03USA02357 03USA02558 03USA02571 03USA02669 03USA02918 03USA03186 03USA03661 03USA04009 03USA04524 03USA04535 03USA04550 03USA04711 03USA04728 03USA04776 03USA04855 03USA04857 03USA05410 03USA05433
04USA00002 04USA00009 06USA01886 06USA02262
onic airway obstruction, alchohl dependence, chronic hepatitis C, positive PPD, BPH, depression, cocaine dependence, opioid dependence
nfectious Mononucleosis 11/17/05
ospital records received DOS 5/5/09 5/9/09 Nausea, vomiting, and diarrhea.
works night shifts) |None~ ()~~0~Sibling|None~ ()~~0~Sibling
06USA02278
N; gout; Hyperlipidemia; Allergy: LIPITOR/NIASPAN. 7/8/09 consult records received DOS 11/3/08 to 6/13/09. Hearing loss, atherosclerosi
al records PMH: Parainfluenza bronchiolitis w/hospitalization, 3/09. GERD. 33-wk preemie, 17 days in NICU due to respiratory distress. PR
ccine not specified (no brand name)~UN~0~Patient
advance- Doing well on Similac sensitive
d pressure; Glaucoma
10USA02712 06USA02119 06USA02577 06USA02082 06USA02085 06USA02257 02USA04905 06USA02049 06USA02099 06USA02310 06USA01892 06USA02328
ical condition includes heart condition, treated with medication.
bling1|N/A~ ()~NULL~~In Sibling2|N/A~ ()~NULL~~In Patient
GION~Measles + Mumps + Rubella (MMR II)~0~1~In Patient
THER WAS ON DRUGS AND ALCHOHOL USE. AND ALSO BABY HAS GERD.
cousy, greenish. 6/29/09 Medical records received DOS 1/15/08 to 8/20/08. Overfeeding, diarrhea, milk allergy.
on side of injection terribly swollen, arm swollen and red~Tdap (no brand name)~UN~26~Sibling
; s/p surgeries; Hx of SVT. 7/7/09 Hospital records received DOS 6/0/09 to 6/3/09. VSD, ASD, transposition of great vessels. ords received DOS 4/27/09 to 4/28/09. Anxiety disorder. Reaction to general anesthesia.
defect (Atresia)
drome; Anxiety; Spastic colon.
nvironmental allergies
Sibling1|NONE~ ()~NULL~~In Sibling2
04USA05245 10USA02860 03USA03639 06USA01827
04USA04516 07USA03017 08USA03705 06USA02285
Propafenone (dysrhythmia) PMH: A-Fib, hyperlipidemia, hypothyroidism, myopia, pericarditis, pulmonary hypertension, TIA, vitiligo
e, Simvastatin
eceived DOS 6/17/09 6/19/09. History of positive ANA
surgery 3 weeks.
halosporins which he had a reaction to in 2003 or 2004. Several years later, he had taken amoxicillin with no problems.
4/8/09 to 4/9/09. Allergies to milk, peanuts, and eggs. Eczema. Tympanostomy, tubes placed. Adenoidectomy. Multiple ear infections.
06USA02596
t disease; Peripheral neuropathy.
to BACTRIM
06USA02881 06USA02971 06USA03450 06USA01707
Tachycardia.Sinus surgery. appy. Herniated disc w/ surgery. Nausea, diarrhea and vomiting 11/2008.
atrial septal defect, benign heart murmur; allergies-Amoxicillin, OMNICEF.
em and was found to be having seizures before birth while in the womb.
nd name)~NULL~~In Patient
OPED SOME GRUNTING AND SOME RESPIRATORY DISTRESS. JAUNDICE 6/29/09-records received-PMH:born 6 weeks premature. with seborrhoeic dermatitis
ella (no brand name)~1~5~Patient
s received DOS 6/15/09. Headaches
UN~0~Patient hours~DTaP + IPV (KINRIX)~UN~0~In Patient|none~ ()~NULL~~In Sibling1
06USA02582 06USA02844 06USA03651 06USA03729
/16/09 Medical records received DOS 2/08/08 to 7/15/09. Varicose veins, atypical chest pain, dyspnea, joint pain shoulder. hypothyroidism,
Patient|None~ ()~NULL~~In Sibling1 eceived DOS 5/21/09 to 5/24/09. Recent cold symptoms. Frenulum clipped. Hypospadias. Thrush. asles + Mumps + Rubella (MMR II)~0~1~In Patient records received 6/19/09 to 7/8/09. Alcoholism. Drug abuse. History of angioedema. Depression.
e mold, cats, pseudephedrine, erythromycin
6/29/09 PMH: nasal fx. Allergy: Keflex.
baceous nevus. 7/7/09 Hospital records received DOS 6/20/09 to 6/22/09. Global Developmental Delay. Ear infection. DOS 8/6/07 to 6/24/09. ADD. Ingrown toenail. Acute bronchitis. Allergic rhinitis. leukopenia, thrombocytopenia, anemia with no known evidence immunodeficiency PMH: sensorineural hearing loss. Allergy: vancomycin
term twin 3 1/2 wks
/o breast cancer; Anxiety/depression
02USA00127 03USA03943 06USA03355 06USA03836 spital records received DOS 12/28/01 to 12/31/01. Respiratory tract infection with cough, fever, headache, and chest pain. Penicillin allergy B (no brand name)~3~19~Patient
pecific rash). Allergic rhinitis.
S 6/18/09: ADD estation), SGA, hypoglycemia, apnea of prematurity. 7/13/09 DC summary received DOS 2/14/09 to 3/14/09 Discharge Diagnosis: First bor
chronic low back pain, nocturnal cramps, intermittent claudication, decreased hearing, tinea versicolor
t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling
es + Mumps + Rubella (no brand name)~UN~2~Patient|irritability, "zoning" seizures~DTaP (no brand name)~UN~2~Sib
ausea; fatigue onset within 24 hrs following typhoid~Anthrax (no brand name)~~0~Patient
06USA04131 09USA00445 06USA02614
N, ZITHROMAX
n. Has hx of kidney/bladder problems. Pt. reports she has kidney stones in both kidneys.
ed 2003, no recurrence), asthma (stable), environmental allergies ("many" per patient). Previous smoker, quit one year ago.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
thritis, diabetes
p and eye~HPV (Gardasil)~1~9~Sibling
mps + Rubella (no brand name)~1~54~Patient|Dizziness~Measles + Mumps + Rubella (no brand name)~1~54~Patient
.~DTaP (no brand name)~4~2~Patient
10USA01631 06USA03812 06USA04118 06USA04162 Syndrome, 1986 PMH: GBS (20 yrs ago), hyperlipidemia, GER, tubular adenoma of colon. Allergy to sulfa.
ailure; history of (hx) MI, hx 6 vessel CABG; hyperlipidemia; COPD; CAD; obesity; GERD; hx medication adverse events (PCN, niacin, sulfa
d DOS 7/25/07 to 7/08/2009. Penicillin allergy, C. Trachomatis, Anxiety disorder.
atient|?~ ()~NULL~~In Sibling1|?~ ()~NULL~~In Sibling2
~DTaP+IPV+HepB+Hib (no brand name)~1~0~In Patient
. Resolved when he took VIVOTIC.
~DTaP + IPV + Hib (Pentacel)~0~0~Patient
rax (no brand name)~UN~47~Patient
ds PMH: appendectomy, small bowel resection, tonsillectomy. Medical records received 7/7/09 PMH: motor vehicle accident, pleurisy, sulfa
brand name)~4~2~Sibling|Rash~DTP (no brand name)~4~2~Sibling
S 5/22/08 to 1/7/09. Episode of generalized urticaria "shrimp gumbo", heartburn, smoker
eumo (no brand name)~1~72~Patient
04USA01051 05USA00039 06USA04964 06USA05053 06USA05010
back pain, right tibia / fibula fracture requiring ORIF.
rus, Inact. (no brand name)~UN~0~Patient
Hib+HepB (no brand name)~UN~12~Sibling
sles + Mumps + Rubella (no brand name)~UN~5~Sibling (no brand name)~5~7~Sibling
ADRYL, Latex
(no brand name)~4~1~Patient
eceived DOS 7/18/08 to 7/13/09. Fibromyalgia/chronic pain, platelet dysfunction, Lyme disease, orthostatic hypotension. Allergy to Stimate
arivax)~0~1~In Patient V (Gardasil)~NULL~14~In Patient
d an ablation 7/08 eceived DOS 6/21/09 to 6/25/09. Concerns regarding respiratory pattern in newborn nursery. agmatic hernia s/p repair,and shunt
nd name)~1~1~In Patient ords received DOS 6/28/09 to 7/1/09. Migraine headaches.
ain~Hep B (no brand name)~2~19~Patient
10USA00881
06USA02593 none~ ()~~0~Sibling po qd naproxen 500mg
hysterectomy, right carpal tunnel release. Hyperlipidemia. 5 allergies. 7/23/09 Hospital records received DOS 7/1/09 to 7/2/09. Atopic Dermatitis. Loss of consciousness when donating blood. Sibling1|NONE~ ()~NULL~~In Patient
ES AND PNEUMONIA artery atresia congenital
ords received DOS 7/21/06 to 4/6/09. URI. Contact dermatitis on chin. ADHD.
hypertension; DM type II
Minocycline; RETIN A; Acne 06USA05296 06USA05217
ergies. 9/1/09 ER records received DOS 4/30/09. Asthma. ice as newborn. and name)~1~69~In Patient eceived DOS 3/6/08 to 3/7/08. Born by caesarean section. Jaundice. Anal opening mildly displaced. 7/13/09 PCP medical records received
peech/articulation problem
at age 16; No previous hospitalizations, other than related to surgeries; Allergies: Raisins -->generalized itching, BACTRIM -->rash; Surgic
cine~ ()~NULL~~In Patient|None but has only received the DTaP to date~ ()~NULL~~In Sibling1
congenital cataracts, nystagmus, under genetic investigation
h Kasai procedure, oral surgery 05USA04794 06USA07772 12USA02378 06USA04956 06USA05043 06USA05205 06USA05705 06USA05211 06USA05214 06USA05672
vax)~~77.50~Sibling
Patient|none~ ()~NULL~~In Sibling1 Sibling1|NONE~ ()~NULL~~In Patient none~ ()~~0~Sibling|none~ ()~~0~Sibling
Sibling1|NA~ ()~NULL~~In Patient|UNK~ ()~NULL~~In Sibling2
tube - Freq U.T.I's
EROL; AMOXICILLEN; CODEINE
al records received DOS 6/25/09. Neurofibromatosis Type 1. Infantile Spasms. NICU. (L) tibia/fib fracture. Myringotomy tubes. Chronic lung
ation; CHF 8/27/09 Medical records received w/PMH: hypothyroidism; dyslipidemia; obstructive sleep apnea; s/p gastric bypass Roux-en-Y 06USA05684 07USA00006 06USA05165 07USA00183 07USA03163 06USA05239 06USA05566 06USA05633 06USA05780 07USA00186
ords received DOS 6/30/09. Gravida 1, para 0. Chickenpox. Wheezing as a toddler. Smokes. Alcohol. Marijuana. Allergy to a venom.
d" cheese. 8/14/09 MR received from pcp for DOS 3/12/09 OCs, type II DM, HPV (+), ADD, allergies to molds/grass, anxiety/panic attacks.
sulfa, CLARITIN; AUGMENTIN, CEFZIL; Asthma
r skin, peeling of wrists, ankles, palms and soles
rhinitis, eustachian tube dysf.
o brand name)~5~5~Patient
sthma - mild intermittent
S 7/4/09. Palpitations since a child.
Simvastatin; Zolpidem o (Prevnar)~2~0~Patient|anaphylaxis~Rotavirus (Rotateq)~2~0~Patient|anaphylaxis~DTaP + IPV + Hib (Pentacel)~2~0
)~~0~Sibling|0~ ()~~0~Sibling
Fingers~HPV (Gardasil)~2~20~In Patient
eceived DOS 6/30/09 to 7/4/09. Bronchiolitis.
L~~In Patient
orosis; GERD; high cholesterol sil)~2~13~Patient
eign country, just returned to country on a permanent basis with myself, and her father. She suffered with ITP between the ages of 9yrs to 1 perlipidemia; back surgery; BARRETT's esophagus with NISSEN'S fundoplication; vitamins B12 deficiency and diverticulosis. abetes mellitus; Gastroesophageal reflux disease; Osteoarthritis; Obesity; and Coronary artery disease.
07USA00328 07USA00329 07USA00233
8, s/p radiation 9/08. Also fibrocystic breast disease, depression, HTN, osteoporosis, obesity, hypothyroidism, hyperlipidemia, osteoarthritis
GERD, osteopenia, HTN, abnormal liver enzymes ent|0~ ()~NULL~~In Sibling1
nia 3/27/09 evaluated and TX.
07USA00275 06USA05681 07USA00456 06USA05714
she had fainted before but not with immunizations. Patient had received tetanus only as a prior immunization. Iodine. Medical conditions,Diabetes, Hypertension, elevated cholesterol,Hypo-thyroid,occas. anxiety. had episodes of curling into the fetal position on Moms chest clenching his fists, body tightness~DTaP + He
~Patient|unknown~ ()~~0~Sibling Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
ed DOS 7/7/09. Fainting/dizzy after 'shots'. 7/14/09 ER records received DOS 7/7/09. Previous episodes in the past.
tavax)~1~61~Patient
matic bronchitis; esophageal reflux
m, 2 previous doses
EX, FLOVENT; Asthma
07USA00248 07USA00445 07USA00680 07USA00756
ds and discharge summary received for dates of service 7/09/09 to 7/12/09. PMH: None. to bee stings,shellfish,
er--like once a year
medical records for 7/4-7/10/2009. Extensive foreign travel history, recent heparin induced thrombocytopenia, HTN, hypertriglyceridemia, to
. Tubes in ears when younger. Not present now.
dache; asthma; allergies
not specified (no brand name)~UN~1~Patient mycin (Tinnitis)
seizures. 7/31/09 Neurological consultation records received DOS 4/1/02 to 4/07/09. All consultant records are dated prior to the adverse e
07USA00916 07USA00189 07USA00372
spital records received DOS 3/12/09. Hyperlipidemia.
phageal reflux disease, hypertension, sinusitis, aspergillus pneumonia, shingles, urinary tract infection, thrombophlebitis.; Sulfa allergy; Pas
brand name)~NULL~~In Patient
na; DMTZ; Osteoporosis
~DTaP (no brand name)~1~0~Patient
IN = "numbness"; DILANTIN-hepatitis
Allergies; PCN; NIACIN; Xenical
02USA04530 02USA04535 02USA04539 02USA04588 02USA04590 02USA04615 03USA00011 03USA00012 03USA00036 03USA00039 03USA00069 03USA00118 03USA00287 03USA00290 03USA00421 03USA00439 03USA00561 03USA00573 03USA00597 03USA00722 03USA00741 03USA00872 03USA00898 03USA00899 03USA00953 03USA00989 03USA01130 03USA00954 03USA01131 03USA01135 03USA01140 03USA01405 03USA01407 03USA01425 03USA01438 03USA01462 03USA01586 03USA01587 03USA01594 03USA01610 03USA01648 03USA01842 03USA01846 03USA01847 03USA01848 03USA01854 03USA01878 03USA02069 03USA02079 03USA02271 03USA02296
03USA02321 03USA02331 03USA02342 03USA02559
03USA02580 03USA02594 03USA02605 03USA02612 03USA02633 03USA02637 03USA02894 03USA02917 03USA02940 03USA02950 03USA03624 03USA03646 03USA03653 03USA03948 03USA03949 03USA03956 03USA03992 03USA04008 03USA04010 03USA04014 03USA04241 03USA04286 03USA04311 03USA04319 03USA04510 03USA04531 03USA04539 03USA04567 03USA04625 03USA04687 03USA04690 03USA04712 03USA04895 03USA04920 03USA05193 03USA05208 03USA05211 03USA05220 03USA05292 03USA05388 03USA05479 03USA05503 03USA05528 03USA05531 03USA05560 03USA05631
04USA00007 04USA00023 04USA00033 04USA00055 04USA00219 04USA00226 04USA00358 04USA00359 04USA00362 04USA00365 04USA00366 04USA00370 04USA00382 04USA00411 04USA00419 04USA00478 04USA00483 04USA00572 04USA00611 04USA00619 04USA00622 04USA00635 04USA00640 04USA00641 04USA00859 04USA00879 04USA00891 04USA00894 04USA00978 04USA00985 04USA01027 04USA01139 04USA01268 04USA01351 04USA01359 04USA01543 04USA01885 04USA01886 04USA01894 04USA02021 04USA02055 04USA02065 04USA02072 04USA02087 04USA02306 04USA02311 04USA02319 04USA02348 04USA02359 04USA02785 04USA02790
04USA02807 04USA02906 04USA02915 04USA02938 04USA02969 04USA03184 04USA03188 04USA03195 04USA03273 04USA03450 04USA03566 04USA03598 04USA03629 04USA03693 04USA03793 04USA03804 04USA03835 04USA03950 04USA04005 04USA04009 04USA04015 04USA04025 04USA04180 04USA04185 04USA04196 04USA04201 04USA04209 04USA04211 04USA04215 04USA04216 04USA04235 04USA04249 04USA04250 04USA04379 04USA04390 04USA04398 04USA04433 04USA04449 04USA04519 04USA04551 04USA04563 04USA04571 05USA00012 05USA00026 05USA00030 05USA00047 05USA00053 05USA00055 05USA00183 05USA00208 05USA00222
05USA00229 05USA00231 05USA00233 05USA00346 05USA00353 05USA00356 05USA00376 05USA00393 05USA00515 05USA00519 05USA00552 05USA00564 05USA00580 05USA00638 05USA00700 05USA00860 05USA00940 05USA00949 05USA00952 05USA00965 05USA00983 05USA01036 05USA01058 05USA01069 05USA01098 05USA01101 05USA01253 05USA01255 05USA01271 05USA01287 05USA01301 05USA01312 05USA01422 05USA01423 05USA01465 05USA01623 05USA01656 05USA01657 05USA01842 05USA02008 05USA02208 05USA02276 05USA02488 05USA02517 05USA02520 05USA02523 05USA02846 05USA02876 05USA02917 05USA02926 05USA02944
05USA02976 05USA02979 05USA03099 05USA03224 05USA03226 05USA03236 05USA03363 05USA03373 05USA03378 05USA03386
no medical problems. 07USA00742
tavirus (no brand name)~2~0~Patient o brand name)~1~1~Patient 07USA01157
+ Mumps + Rubella (no brand name)~2~2~Patient rass and hay
d for date of service 6/22/09. PMH: Blocked tear duct
avirus (Rotarix)~3~1~Patient
al reflux; Allergic Rhinitis; Allergic Conjunctivitis.
roesophageal reflux.
03USA02916 03USA04731
me - bilateral fasciotomy. 7/29/09 Consultant medical records received DOS 6/30/09. Compartment syndrome of legs - fasciotomies. Ear tub
07USA00699
07USA01326
07USA01296
07USA00930
07USA01222
06USA02621
philic Disease; Eczema; Esophageal reflux
allergies; Celiac disease, osteoarthritis, high titer ANA positive, Depression
medical history
demia PMH: OA, HTN, DM, chronic reflux esophagitis, hyperlipidemia Allergies: Sulfa d prolactin. Has had tenderness, redness, and muscle soreness with previous Td injections.
Gardasil)~1~25~Patient odeine;Negram;Vinegars,onions,Feta and aged things......Hx lupus with osteoarthritis;migraines;
Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
ic to some milk, tomato soup & instant mashed potato's
); mild umbilical hernia
B + IPV (Pediarix)~2~0~Sibling
GAR was 8 becoming 9. Head trauma - contusion.
Pneumo (no brand name)~UN~66~Patient
dasil)~1~12~Patient TYLENOL; IBUPROFEN.
07USA01302
gies. 7/17/09 Hospital records received DOS 6/18/09 to 6/19/09. Tonsillectomy, asthma. Allergies/hives - codeine, penicillins, eggs, dairy.
eceived DOS 7/11/09 to 7/15/09. Mono, allergy to Cefaclor.
mnicef (vomiting, vomiting, rash)
ythromycin, lidocaine, hydrododone, acetaminophen-hydrocodone, demerol, clinoril, xylocaine, egg containing compound, flexeril, tylox, con Sibling1|none~ ()~NULL~~In Sibling2
occasional asthma; Infertility; Environmental allergies; weight concern; GI problems. ng degrees of reactions to vaccinations in past. Medical records would show onset of illnesses after vaccin
POFOL for my colonoscopy. I am not a smoker and have an alcoholic beverage infrequently.
sis; Allergic Rhinitis; Chronic OBST asthma
ots, patient had a febrile seizure associated with having a high temperature. The cause of the fever was not known. Blood work and urine sa
(no brand name)~UN~11~Sibling
08USA04839
07USA01273
enza (no brand name)~UN~53~Patient
d DOS 7/17/09. Phobia of needles. would pass out as a child. Tdap (Adacel)~1~12~In Sibling1 DTaP + IPV (KINRIX)~5~5~In Sibling1
icillin, Levaquin
d DOS 5/1/09 to 6/08/09. Allergic rhinitis, acne. 9/1/09 Consultant Pain Clinic records received DOS 6/5/09 to 7/10/09. Therapy for stress an
osteoarthritis. 7/24/09 Medical records received DOS 2/20/09. Hysterectomy, hypercholesterolemia, malaise, appendectomy, osteoarthritis
04USA01770 05USA02346 05USA04045 07USA04408 08USA01387 10USA02180 10USA03304 10USA05202 11USA03512 05USA04071 06USA01687 06USA01721 06USA01741 06USA01763 06USA01774 06USA01895 06USA01909 06USA01913 06USA02001 06USA02050 06USA02051 06USA02057 06USA02088 06USA02122 06USA02126 06USA02135 06USA02136 06USA02262 06USA02639 06USA02641 06USA02645 06USA02647 06USA02655 06USA02657
06USA02879 06USA02895 06USA02901 06USA02915 06USA02926 06USA02932 06USA02937 06USA02949 06USA02300 06USA02302 06USA02309 06USA02313 06USA02318 06USA02962 06USA02991 06USA02514 06USA03285 06USA03335 06USA02576 06USA02623 06USA03361 06USA03372 06USA03400 06USA03422 06USA03424 06USA03428 06USA03431 06USA03718 06USA03719 06USA03736 06USA03745 06USA03753 06USA03754 06USA03807 06USA03821 06USA03965 06USA04017 06USA04076 06USA04091 06USA04097 06USA04116 06USA04127 06USA04136 06USA04137 06USA04269 06USA04379 06USA04389 06USA04393 06USA04724 06USA04739 06USA04750
06USA04767 06USA04859 06USA04941 06USA04949 06USA04961 06USA04977 06USA04981 05USA04982 08USA04987 06USA04995 06USA04998 06USA05000 06USA05017 06USA05019 06USA05048 06USA05055 06USA05091 06USA05163 06USA05171 06USA05329 06USA05189 06USA05359 06USA05192 06USA05197 06USA05225 06USA05369 06USA05392 06USA05615 06USA05616 06USA05627 06USA05641 07USA00009 06USA05666 07USA00012 07USA00019 07USA00034 06USA05668 07USA00043 06USA05674 07USA00064 07USA00070 06USA05677 06USA05702 07USA00075 07USA00097 07USA00122 07USA00144 07USA00182 07USA00330 07USA01092
V (Gardasil)~3~26~In Patient
site and headaches~HPV (Gardasil)~1~14~In Patient d DOS 7/11/09. Gastroduodenitis, laparoscopic cholecystectomy. recurrent menstrual pain, NSAID use. Hypothyroidism. Alcohol use. Iron 10USA02010 07USA01994 07USA02007 07USA02018 07USA02011 07USA01687
umps + Rubella (no brand name)~1~1~Patient
aP (no brand name)~5~5~Patient
(Pneumovax)~1~59~In Patient hypertension, asthma arivax)~1~14~In Patient
d question of polycystic ovaries
statin 5mg 1 qd
~Influenza (no brand name)~NULL~12~In Patient
DTaP + IPV (KINRIX)~UN~4~Patient
ster (Zostavax)~1~75~Patient
o brand name)~1~1~Patient
05USA02043
07USA01529 07USA01998 07USA02337 07USA02033 07USA02071 disorder; acid reflux disease . PMH: constipation
y g.mom (similar reaction to a vaccine given early in life~DTP (no brand name)~~0~Patient
HYPERCHOLESTEROLEMIA, DIABETES
AIN, RASH, AND INTENSE HEAT.
iculitis. NKDA
e at birth with resp. problems. 5 sets of tube inserted bilateral ears
09 Hospital records received DOS 7/9/09 to 7/10/09. Premature, born at 29 weeks. Placental hypoperfusion. Apnea of prematurity. Respirat
9 Hospital records received DOS 7/9/09 to 7/10/09. 29 week premie. Twin. Placental hypoperfusion. NICU. Respiratory insufficiency, periph
mia; Thrombocytopenia form Valtrex.
YCIN; SEPTRA; PCN'S; Diagnosis: Pervasive Developmental D/O; sleep apnea, Autism Spectrum D/O
P (no brand name)~3~15~Patient
ap (no brand name)~1~12~Patient
edical conditions I'm aware.
06USA01923
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
elbow, lumbar), no PMH allergy. PMH: Tooth infection. Skin graft right 'pinky'.
1/09~Hep A + Hep B (no brand name)~1~0~Patient|Localized reaction 6/1/09~Tdap (no brand name)~1~0~Patient
nza (no brand name)~1~1~Patient
06USA03421
07USA02055 07USA02939
5/09; pregnant EDC 1/6/09 3 1/2 mo.
; Hypertension; Sleep apnea nsciousness~DTaP (Daptacel)~1~0~Patient|allergies, asthma, adhd, learning disabilities, language delay, mot atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
SSION, HYPERLIPIDEMIA
ecieved DOS 11/30/2008 to 12/03/08. Low back pain with radiation of pain and numbness down right lower extremity, heaviness, pins and
07USA03043 medical records received DOS 5/26/09 to 6/9/09. Fever, throat hurting. 8/17/09 Medical records received w/PMH: absence seizure disorder
Pentacel)~2~0~Patient
n, S/p meningioma resection
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
ers unknown.
ULL~~In Patient
tient|NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In Sibling2
hyperglycemia, PTSD, hyperlipidemia S/P right knee arthroscopic surgery (2006) atient|NO~ ()~NULL~~In Sibling1|NO~ ()~NULL~~In Sibling2 4, HEADACHE, ACHY ARM~Tetanus Diphtheria (no brand name)~6~13~In Patient
atal jaundice.
wks (nodule still present), extremely cranky, would not sleep for days - up very frequently, would not fi
inal pain. 10/8/09 Hospital records 3/16/09 to 3/18/09. Blastocystis hominis infection. Possible Joubert's Syndrome.
Erythromycin
and name)~4~2~Patient|2005~DTaP (no brand name)~5~4~Sibling nus Diphtheria (no brand name)~2~44~Patient
07USA03354 07USA03373 07USA03589
+ Mumps + Rubella (no brand name)~2~4~Patient|03/07/2007~DTaP (no brand name)~4~1~Patient
b (no brand name)~2~0~Patient
07USA03631 07USA03652
07USA03060 07USA03359
07USA02308 07USA02326
none~ ()~~0~Sibling|none~ ()~~0~Sibling
TIENT INTO THE E.R. AT 2 MONTHS OLD AND THEN TO OUR OFFICE AT 7 MONTHS OLD FOR FACIAL BRUISING. THE E.R. THOUG
; Allergies: Altace, daypro, iodine, hydrea, latex, lomotil, sulfa, meloxicam
nt had upset stomach when much younger from the antibiotic Augmentin and reacted nervously or wildly from a "tuss" medication.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
+ Rubella + Varicella (no brand name)~2~4~Sibling
; AVELOX; Breast cancer 2007
d name)~UN~0~Patient
07USA03112 06USA02656
/09 Hospital records received DOS 6/6/09 to 7/06/09. Motrin allergy. Hospitalizations for bronchiolitis and pneumonia. Mastocytosis. Heman vrix)~1~6~In Patient
pital records received DOS 7/11/09 to 7/20/09. Patent Ductus Arterious. Neonatal intensive care. 'Lung disease'.
esity. Plantar fascitis. swelling/edema hands and feet
l rhinitis, breast cancer survivor, 2 successful pregnancies
ook shingles vaccines as precaution
al thyroidectomy 11/07
07USA04214 07USA03645 07USA03675 Rxn to BENADRYL-swells d name)~1~0~Patient|Seizure~Pneumo (Prevnar)~1~0~Patient|Seizure~DTaP + HepB + IPV (Pediarix)~1~0~Patient|Se
wn) and hives with Sulfa drugs.
none~ ()~~0~Sibling
ypertension, Bladder spasms rdasil)~3~13~In Patient
philic gastroenteritis
e~Influenza (no brand name)~UN~26~In Patient
name)~1~15~Patient aches~Smallpox (ACAM2000)~1~24~In Patient eceived DOS 5/29/09. Anxiety. Head injury - Iraq veteran, improvised explosive device explosion.
nactra)~1~20~Patient .~DTaP (no brand name)~4~1~Patient
gestational age) dasil)~2~18~Patient
efore once or twice.
pital at 2 wks. old.
06USA04063 07USA03334 eft ear; High BP. PMH: COPD, high cholesterol. HTN. back surgery.
ed DOS 7/25/09. Allergies: E-Mycin, Penicillin. Bacterial infection. Asthma. ecified (no brand name)~1~0~Patient
eceived DOS 7/20/09 to 7/22/09. Reactive Airway Disease.
il)~1~16~Patient
pital records received DOS 8/5/09 to 8/6/09. In utero drug exposure. Early life neglect.
brand name)~4~2~In Patient
ormone deficiency
eactive airway dz 9/4/09-records received-PMH: allergic to augmentin, wheat (hives), peanuts (rash). Cornealia de Lange Syndrome.
llin allergy, so has never taken it.
lymph glands); EPI (LOC); TEGRETOL (hepatitis); DILANTIN (ataxia at subtherapeutic dose); SANSERT (feet neuropathy); Iodone eyes (h
nnective tissue disorder
ot specified (no brand name)~UN~0~Patient ame)~2~41~Patient brand name)~1~0~Patient 07USA03866
07USA05047
07USA04814
GERD [Gastroesophageal reflux disease]
Heart murmur
Plagiocephaly
mother for treatment; History of febrile seizures till one year ago. None reported after vaccinations.
s causing anaphylaxis after ingestion of milk or milk products, penicillin, and ibuprofen/NSAIDs.
aP (Daptacel)~5~6~In Patient
OTHER ALLERGIES ARE MEDICAL CONDITIONS PER PT'S MOTHER
d DOS 7/22/09 to 7/23/09. One focal seizure on 7/4/09.
t at birth ASD & VSD which she said have closed. Has heart murmur. Denies other health probl.
ALACOL; Carvedilol; ARTHROTEC; RELACON ss, inconsolable crying~DTaP (no brand name)~4~1~Patient
ds received DOS 08/16/06 to 7/20/09. Eye surgery. Caffeine use. Pelvic pain. Oral contraceptives. Penicillin allergy. Hives. Bacterial vagino
recieved DOS 11/23/08 to 11/26/08. Smoker. ug bites arm swells-sensitive. 8/17/09 Hospital records received DOS 7/26/09 to 7/28/09. No prior vaccine reaction. Rash from Amoxicillin.
07USA04864 07USA04871 07USA05126
opathy; Arthritis neuropathy; Hypertension; Migraines; Depression; Glaucome; Hypothyroidism; Asthma; Atopic rhinitis;Fibromylagia; GERD ~In Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
as~Hep B (no brand name)~2~4~Patient
uitary Surgery 12/2006, Diabetes: Under Control, High Blood Pressure: Under Control. 9/9/09 Prior Medical History - Hospital records receiv
rth until 7 days old; chorioamnionitis from mecomium fluid
A (Havrix)~1~1~Patient spitalized x2 for pneumonia; 1987, S/P splenectomy after traumatic injury; Latent TB - positive PPD converter in March 2009 (not recorded
(no brand name)~2~9~Patient
e)~4~6~Patient
~DTP + IPV (no brand name)~2~1~Sibling|Hard spot, red, fever~Hib + Hep B (Comvax)~1~1~Sibling|Hard spot, re
(Gardasil)~2~15~Patient
er". Penicillin allergy. 'Ear tubes', dental extractions. 07USA05038 07USA03319 07USA04234 07USA04345 07USA04362 eceived. Pneumo / Wyeth Prevnar Lot# D33126 IM 2 Previous doses. Administered on 3/27/09 per vaccine records. 9/23/09 Medical record
ords received DOS 5/15/09 to 5/24/09. Myelomeningocele, ventriculoperitoneal shunt, seizure disorder. Hydrocephalus. Neurogenic bowel d DOS 8/2/09 to 8/5/09. Eye laser surgery. V (Gardasil)~1~14~Sibling
(Gardasil)~1~16~Sibling ella (no brand name)~2~9~Sibling|Rash forehead~Hep A (no brand name)~1~9~Sibling dministration.
od allergy to shrimp and lobster
ear implants inserted at Childrens' Hospital in Birmingham
(no brand name)~NULL~~In Patient
ithromax, Cefzil, melons and bananas.
E tubs; Cleft palate.
nal cyst and fatty liver disease
ODEINE; DILAUDID; Arthritis
cy- Soy formula infancy- WM-at 9ml 07USA04758 10USA04728 07USA05405 08USA00003 07USA04071 07USA05644
Cipro; Augmentin; Clindamycin; Narcotics cause nausea. Patient diagnosis includes Hypertension; Hypothyroidism; GERD; Low back pain; c htheria (no brand name)~6~13~In Patient hypothyroid
rds received DOS 8/12/08 to 7/13/09. Hyperhydrosis, allergic rhinitis, recurrent otitis media, chronic constipation, GERD. 8/17/09 Consultan stent in place keeping my trachea open. I have had 24 medical admissions related to b
d (no brand name)~NULL~~In Patient
pertension, hypothyroidism, dyslipidemia , osteoarthritis
ve fibromyalgia non specific colitits and interstitial cystitis
n for mycosis fungoides tenosis - surgically resolved
n for chest pain. Had UGI. Controls symptoms through diet modification, no medications. Gout. 2004 - Diagnosed based on clinical presen
nknown~ ()~~0~Patient
penia; plantar fascitis; tinnitus
valve, controlled with high BP, VYTORIN to control cholesterol; blood thinner to assist valve, 50% heart function due to the emergency natu
medical records received DOS 10/24/07 to 10/30/07. Tonsillectomy, ectopic heartbeats, hysterectomy, hernia, benign breast biopsy, osteope
us EEG; not allergies, has been raw eggs
06USA04748
07USA05669 07USA05682 08USA00058
rand name)~4~3~Patient
nd name)~1~12~Patient none~ ()~~0~Sibling 0~Patient|None Reported~ ()~~0~Sibling
g~Rabies (RabAvert)~2~8~In Patient
X: ADHD AND IS TAKING ADDERALL XR 20MG 1 QAM AND CLONIDINE 0.1MG QHS. PT. HAS DX:OBESITY AS WELL.
MP ON RT. SIDE SECONDARY TO CONDITION.
unnel syndrome
10USA03151 10USA03209 10USA03324 10USA03681 10USA03742 10USA04978 10USA05305 11USA00059 11USA00680 11USA00890 11USA00896 11USA00903 11USA00907 11USA01139 11USA01642 12USA00522 01USA00144 02USA01799 03USA01440 03USA03638 03USA03645 02USA03729 06USA00286 06USA01049 06USA01241 06USA02894 06USA02898 06USA07565 06USA07568 06USA07732 06USA07736 06USA07821 06USA08865 06USA09012
05USA01623 07USA00408 07USA00831 07USA00845 07USA01192 07USA03005 07USA03096 07USA03097 07USA03320 07USA03677 07USA03837 07USA04021 07USA04071 07USA04073 07USA04128 07USA04404 07USA04828 07USA04830 07USA04938 07USA05269 07USA05671 08USA00513 08USA00992 08USA01259 08USA01705 08USA01940 08USA02145 08USA02583 08USA02621 08USA02641 08USA02675 08USA03612 08USA04048 08USA04242 08USA04684 08USA04828 08USA04971 08USA05316 08USA05370 08USA05487 09USA00032 09USA00048 09USA00085 09USA00331 09USA02160 09USA00337 09USA00805 09USA01236 09USA02521 09USA02624 09USA02626
09USA02630 09USA01415 09USA02766 09USA01447 09USA03151 09USA03172 09USA03215 09USA03216 09USA03819 09USA01583 09USA01662 09USA03863 09USA03866 09USA01821 09USA01855 09USA01935 09USA01945 09USA03888 09USA03927 09USA04150 09USA04166 09USA04173 09USA04197 09USA04522 09USA04643 10USA01827 10USA01844 10USA01845 10USA01854 10USA01859 10USA01995 10USA01996 01USA02006 10USA02028 10USA03065 10USA02030 09USA04790 10USA02038 09USA04791 09USA04852 09USA04922 10USA02075 10USA02076 09USA04968 10USA02124 10USA00198 10USA00321 10USA00443 10USA00448 10USA00482 10USA02125
10USA00486 10USA02187 10USA00524 10USA00525 10USA02394 10USA02479 10USA02695 10USA02778 10USA02784 10USA02797 10USA02891 10USA00547 10USA00645 10USA00701 10USA01153 10USA01200 10USA01683 10USA01715 10USA01762 10USA01813 10USA03140 10USA03150 10USA03163 10USA03172 10USA03232 10USA03238 10USA03312 10USA03314 10USA03338 10USA03352 10USA03399 10USA03401 10USA03423 10USA03561 10USA03616 10USA03664 10USA03673 10USA03713 10USA03803 10USA03858 10USA03859 10USA03865 10USA04002 10USA04020 10USA04111 10USA04158 10USA04316 10USA04317 10USA04320 10USA04324 10USA04337
10USA04352 10USA04363 10USA04371 10USA04374 10USA04396 10USA04401 10USA04477 10USA04478 10USA04592 10USA04594 10USA04685 10USA04783 10USA04903 10USA04918 10USA04920 10USA04935 10USA04944 10USA05190 10USA05083 10USA05120 10USA05159 10USA05164 10USA05228 10USA05286 10USA05310 10USA05337 10USA05340 10USA05362 11USA00039 11USA00048 11USA00069 11USA00073 11USAD0127 11USA00159 11USA00160 11USA00161 11USA00699 11USA00709 11USA00162 11USA00873 11USA00236 11USA00879 11USA00900 11USA00906 11USA00940 11USA00238 11USA00943 11USA01068 11USA00242 11USA01092 11USA01101
11USA00476 11USA01339 11USA00502 11USA00506 11USA00510 11USA01345 11USA00542 11USA01387 11USA00642 11USA00643 11USA00651 11USA01388 11USA01636 11USA01648 11USA01664 11USA02061 11USA02120 11USA01674 11USA02128 11USA01681 11USA01713 11USA01735 11USA01826 11USA01830 11USA01870 11USA02060 11USA02172 11USA02173 11USA02271 11USA02272 11USA02273 11USA02309 11USA02318 11USA02329 11USA02349 11USA02350 11USA02359 11USA02382 11USA02543 11USA02643 11USA02665 11USA02784 11USA02871 11USA02908 11USA02951 11USA02985 11USA03043 11USA03056 11USA03116 11USA03416 11USA03461
11USA03502 11USA03556 11USA03663 11USA03709 11USA03726 11USA03758 11USA03825 11USA03827 12USA00288 12USA00370 12USA00525 12USA00529 12USA00532 12USA00573 12USA01254 11USA03896 12USA01580 11USA03949 11USA03950 11USA03983 11USA03987 11USA03990 12USA01584 11USA04022 11USA04098 11USA04099 11USA04160 11USA04174 12USA01645 12USA00016 12USA01762 12USA00035 12USA01763 12USA01791 12USA01792 12USA01793 12USA01802 12USA01977 12USA01978 12USA01979 12USA01999 12USA02021 12USA02078 12USA02327 12USA02079 12USA02089 12USA02094 12USA02104 12USA02109 12USA02110 12USA02135
12USA02383 12USA02597 12USA03787 12USA04089 12USA04095 12USA04096 12USA04278 12USA04279 12USA04296 12USA04338 12USA04345 12USA04556 12USA04557 12USA04696 12USA05189 12USA05265 12USA02772 12USA02773 12USA02774 12USA03238 12USA03261 12USA03345 12USA03347 12USA03348 12USA03357 12USA03741 12USA03769 01USA00067 10USA00145 01USA00153 01USA00828 01USA01300 01USA01573 01USA01583 01USA01937 01USA01938 01USA01939 01USA01940 01USA01996 01USA02375 01USA02407 01USA02438 01USA02510 01USA03048 01USA03163 01USA03327 01USA03349 01USA03350 01USA03377 01USA03452 01USA03520
01USA03673 01USA03820 01USA03840 01USA03911 01USA04143 01USA04159 01USA04168 01USA04200 01USA04309 01USA04436 01USA04445 02USA00017 02USA00036 02USA00040 02USA00041 02USA00044 02USA00045 02USA00061 02USA00187 02USA00459 02USA00588 02USA00853 02USA00953 02USA01462 02USA01664 02USA01696 02USA01697 02USA01706 02USA01832 02USA02181 02USA02382 02USA02406 02USA02686 02USA02934 02USA02973 02USA03742 02USA03983 02USA04040 02USA04076 02USA04437 02USA04524 02USA04569 02USA04573 02USA04600 03USA00003 03USA00065 03USA00082 03USA00278 03USA00443 03USA01102 03USA01420
03USA01608 03USA01623 03USA02278 03USA02295 03USA02434 03USA02557 03USA02865 03USA02960 03USA03208 03USA03612 03USA03623 03USA03641 03USA03649 03USA03650 03USA03655 03USA03944 03USA04218 03USA04219 03USA04220 03USA04244 03USA05142 03USA05498 04USA00034 04USA00220 04USA00258 04USA00577 04USA01355 04USA01566 04USA02040 04USA02058 04USA02253 04USA02733 04USA02734 04USA02780 04USA02893 04USA03163 04USA03182 04USA03405 04USA03422 04USA03586 04USA03813 04USA03823 04USA03974 04USA04192 04USA04343 04USA04462 04USA04500 05USA00187 05USA00215 05USA00359 05USA00375
05USA00444 05USA00491 05USA00504 05USA00509 05USA00517 05USA00546 05USA00663 05USA00664 05USA00665 05USA00666 05USA00667 05USA00668 05USA00697 05USA00669 05USA00962 05USA00670 05USA01065 05USA01086 05USA00671 05USA00672 05USA01282 05USA01415 05USA01468 05USA00673 06USA01560 05USA01941 05USA02311 05USA00674 05USA04069 06USA00003 06USA00104 05USA00675 06USA00127 05USA00676 05USA00677 05USA00678 05USA00679 05USA00680 05USA00686 05USA00993 08USA00374 08USA00060 eceived 1/27/1986 to 8/3/09. EMG and Nerve conduction studies consistant with Brachial Plexitis 12/3/86. herniorrhaphy. Left testicle surge 2/09 Hospital records received DOS 7/12/09 to 7/14/09. Itchy rash on legs present prior to vaccination. Myringotomy tubes. stavax)~1~84~Patient
specified (no brand name)~UN~0~Sibling lipids; Depression; HTN; TIA; GERD; Anemia; Urinary incontinence
nchitis, glaucoma.
ricella (no brand name)~1~4~Patient
ccine not specified (no brand name)~4~2~Patient
06USA02901
orrhea,Enviromental Allergies, Obesity, Childhood history of Asthma.
ia. 8/20/09 ER records received DOS 7/19/04. Adult ADD. History of boxing with blows to the head. 8/25/09 Consult medical records rec
morphine Medical: MS, CAD, Osteoporosis,
of seizures as infant,
preservatives.
07USA02924 10USA04593 12USA00052 12USA02349
on to vaccine~Varicella (no brand name)~NULL~6~In Patient old) to milk and egg proteins. Asthmatic. Seasonal allergies (allergy shots every two weeks).
eceived DOS 8/3/09 to 8/5/09. Recurrent colds. ani). 8/11/09 Cardiology consult records received DOS 7/16/09 to 3/12/09. Pancarditis. CHF. Allergy to ChloraPrep. Endoscopy. Hypertens
llergies, GER ch delays/conitive delays~Measles + Mumps + Rubella (no brand name)~1~1~Patient
er her body except her face, fever lasting 4 days, lack of appitite, very upset and crying and vomitting~P 08USA00379 08USA00387
08USA00562 07USA02626 08USA00064 08USA00613 08USA00359 08USA00349 08USA00602 03USA00547
Hospital records received DOS 7/30/09. Allergies eggs milk, asthma.
aines PMH: dyslipidemia, tachycardia, MVP, H/A, migraines. asthma, carpal tunnel, restless legs, Vit D deficiency, shingles,arthritis.allergie
d name)~UN~0~Sibling|Rash - fever - Crib death 1 wk after vaccine occured in 1980~DTaP (no brand name)~UN~0~Si
ons to ZOSTAVAX.
but no seizures or meds in 10 years.
d DOS 8/5/09 8/6/09. Contact Lenses. Lupus Erythematosis, lupus nephritis. Allergy: Latex, tape. Depression, Listeria sepsis, Pneumocyst
ive medical illnesses ella (no brand name)~1~5~Patient
+ Mumps + Rubella (no brand name)~1~1~Patient
PERCOCET, PARAFON FORTE DSC to all nuts; tree nuts; seeds; fur bearing animals
07USA05691 08USA00771
ecords w/PMH: Family hx: strong hx of febrile seizures. 9/17/09 Hospital records received DOS 8/9/09 to 8/11/09. Seizure disorder.
mbar spine scliosis + DJD
name)~2~7~Sibling
eeses. PMH: ADD, Anxiety, Sensory integration issues, env allergies. 9/24/09 Hospital operative report DOS 6/12/09. Recurrent tonsillitis,
hritis; Back pain
ame)~3~32~Patient|~Anthrax (no brand name)~6~34~Patient
rds 2/10/02 to 9/09/09. Subcutaneous fatty tumor on back. Fell of bed and struck head. Penicillin, sulfa allergies.
Patient|None~ ()~NULL~~In Sibling1
(KINRIX)~1~5~Patient
rand name)~2~1~In Patient art Rate, Excessive Sweating, Shortness of breath. Dehydration.~Influenza (Fluvirin)~1~25~In Patient
SSALON PEARLS) INDUCED RASH
artilage; Arthritis present
Osteoporosis; Osteoarthritis.
Varicella (Varivax)~1~1~Patient happened before. No further information.~ ()~~0~Patient
ain syndrome, alergic to methadone, morphine
COSE VEINS ON LEFT W/ STASIS DERMATITIS, OBESITY
08USA00614 08USA01032
Hypothyroid; Hyperlipidemia
il, Epinephrine
Pneumo (Prevnar)~2~0~In Patient
and Sesame Oil Allergies (Anaphylaxis); Right Breast Cancer History; Hypercholesterolemia
atient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2 Tetanus Diphtheria (no brand name)~UN~6~Patient
e received DOS 6/08 to 6/09. Stomach aches. ation 8/08 - 10/08
ep A (no brand name)~2~2~Patient me)~4~1~Patient
08USA00799 08USA01092 08USA01451 08USA01533
received w/PMH: 41 Preemie, hospitalized with r/o sepsis; eczema 8/4/09 Never experienced these symptoms with previous shots.
ascular dystrophy, chiari malformation
cochlear implant in right ear. Was recieving pneumovax due to scheduled surgery for an implant in the left ear. 8/14/09 Hospital admitting
nital hearing loss. She had a right cochlear implant placed in 1999. She is scheduled for another implant later in September and was recei Adsorbed (DECAVAC)~3~2~In Patient ING PATIENT.
me)~5~5~Patient|~Varicella (Varivax)~2~52~Patient
sick after all his shots~ ()~~0~Patient
to is NAPRASYN -spelling?-. At the 3rd day of taking it for the inflammation in my knees. I broke out with hives.
cheduled allergy shots~ ()~NULL~~In Patient
r care since 2/6/09
brand name)~4~5~Patient
o brand name)~1~3~Patient
ad a bad bruising on R leg after 1st set of vaccines given on 3/16/09 but did not report same to Dr. until
08USA01558 08USA01559 08USA01660 08USA01537 08USA01584
s only checkup.
e pain & oozing~DTaP (no brand name)~NULL~47~In Patient
ULL~~In Patient
o previous vaccinations~ ()~~0~Patient ne, Percocet....depression
ngioedema/allergy; dyslipidemia. 8/21/09 PCP medical records received DOS 8/14/09 to 8/14/09. NSAID induced angioedema. No prior rea za (no brand name)~~7~Sibling
has been having increasing sensitivities to various foods and medications for the past few years. She has been diagnosed with Celiac disea
Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2
ebral palsy; asthma; dysphagia. PMH: CP asthma decreased Bone density
le Asthma. 9/24/09 Infection Disease Consultation medical records received DOS 3/10/08 to 11/27/08. Fall with bruise to right side of face a
egularities, digestive issues, emotional issues~HPV (Gardasil)~1~25~Patient
08USA00788 08USA00793 06USA03683 08USA00966 08USA01712 08USA01582 08USA01901
pisode of wheezing
brand name)~2~14~Patient
se, GERD, cigarette smoker records received: PMH: febrile seizures 2/09.
edical conditions of hypothyroidism and fibromyalgia
Mumps + Rubella (no brand name)~2~5~In Patient
s (receives allergy shots)
arivax)~2~8~Patient
lofenac sodium; Fluorouracil; Kenalog Aerosol solution; Metoprolol succinate; NASONEX; Simvastatin
08USA01904 08USA01599 02USA03594 08USA01696 08USA01728 08USA01924 08USA01957
s, fish, shellfish, mold, dust mites PMH: asthma
epaired; 35 wk gestation
tanus Diphtheria (no brand name)~UN~0~Patient
s; no other conditions reported. 9/2/09 ER records received DOS 7/29/09. Shellfish, environmental allergies. VSD repair as infant. menstru
mps + Rubella (no brand name)~1~1~Patient
pecified (no brand name)~UN~2~Patient|Fever~Vaccine not specified (no brand name)~UN~2~Sibling
nuemathorsis at birth, ventilator for 7 days and chest tubes, premature by 5 weeks, suffered severe reflux at 3 months, severe constipation
ching various unusual neurologic symptoms....optic neuritis and minor paresias....always with complete recovery
elling~Influenza (no brand name)~1~0~Patient
EGA) 9/24/09 Discharge summary received for date of service 8/15/09. PMH: prematurity 31 weeks gestation 765.26A, initally intubated, u oncology medical records received DOS 4/15/08 to 5/15/09. Persistant urticaria, penicillin allergy, allergy cat dander. \ksk
Patient|unknown~ ()~NULL~~In Sibling2|unknown~ ()~NULL~~In Sibling1
, sugar, eggs
es + Mumps + Rubella (no brand name)~1~1~Patient|speech delay~Hep A (no brand name)~1~1~Patient
consultation records DOS 12/19/08 to 8/14/09 Tobacco use, smoked for three years - quit 08/08. Alcohol use. V (Gardasil)~1~11~Patient
08USA02407 08USA02226
~DTP (no brand name)~1~0~Patient
MEDICAL COND
pital records received DOS 8/17/09 to 8/18/09. Seizures. Arachnoid cyst. Cerebral Shunt. No reaction to previous MMR and Varicella vacci
HI; ADVAIR L50 150 1 puff BID; LISINOPRIL LO AD.
enital Defects; Allergy: Shellfish
Thyroiditis; compensated hypothyroidism~HPV (Gardasil)~~12.00~Patient
ess, was prolonged, thus was on Keppra and being weaned off. 8/31/09 Hospital records received DOS 2/5/09 to 2/16/09. PMH: Left vocal
ospital records received service dates 8/18/09 to 8/21/09. Allergy Amoxicillin.
s temporal aneurysm Bronchiolitis 6/25/09 luenza (no brand name)~NULL~~In Patient
eived DOS 7/15/08 to 1/19/09. Minocycline allergy. Fasting glucose elevated. 9/1/09 PCP medical records received 2/17/09 to 7/17/09. Alle
04USA01984 hellfish; Prinivil. 8/27/09 Neurology consult records received DOS 1/2/08 to 7/22/09. Sensitivity to cold in extremities. Hypertension, mid bac
cerated (L) inguinal hernia
s Type 1; Celiac Sprue; Pancreatitis; Increase chol.
l allergies, ovarian cysts, but no other known medical conditions. My youngest daughter had a fever seizure as an infant we think because
ose~Measles + Mumps + Rubella (MMR II)~1~6~In Patient ords and multiple consultations received DOS 7/18/05 to 10/2/08. Exercise-induced asthma. Allergic rhinitis. Allergy to household dust. 10
Patient|None~ ()~NULL~~In Sibling1 V (Gardasil)~1~15~Patient
date of vaccination /08 to 5/27/09. Thyroid cyst. Ovarian Cyst. 10/05/09 Vaccine records received: HPV #2, Merck, given 10/15/08, lot# 1061U, RA; Adacel, S
records w/PMH: Allergy: PCN. tive, metal-rash.
ainted with vaccinations because she has received allergy shots without problems. Child states had not eaten lunch.
drotic eczema~Yellow fever (no brand name)~3~40~In Patient
ous hemangioma.
ed with syncope. Allergic to erythromycin. nhevac B)~1~0~In Patient Hypothyroidism Allergies: none noted I don't have any drug uses or allergies. I haven't had any pre-existing conditions that could cause me to be so severely sick as I am.
xiety; Depression.
CET, CODEINE ge at birth; Seasonal Allergic Rhinitis
to DEMORAL
ATIN - COMBAVENT
ead level done 08USA02717 08USA01951 08USA02263 08USA02768 06USA04117 08USA02786
hyroxine, humalog, insulin, citalopram, simvastatin
der was reported by the mother this day and PHN made multiple attempts to contact her for specific information with no results. Per RN
story of passing out
Seasonal allergies. Bilateral shoulder dystocia as a child. Wisdom tooth extraction. Migraine and tension headaches. Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2
ecified (no brand name)~UN~0~Sibling
TaP + IPV (KINRIX)~9~5~Patient
re headaches, vision-shaking~HPV (Gardasil)~1~18~Patient a-fib, hypothyroidism, diverticulosis TaP + IPV (KINRIX)~UN~5~Sibling records PMH: HTN
llin, Sulfa drugs Patient|none~ ()~NULL~~In Sibling1 PMH: seasonal allergies, kidney stones, tendon release-hand.
sion, mesenteric ischemia, abdominal pain, clinical volume depletion.
and name)~1~0~Patient
08USA02573 08USA02787 08USA02477 08USA02404 08USA02799 08USA03124
lips, a sign of angioedema). PMH of hypertension x 14 years.
HepB + IPV (Pediarix)~UN~2~Sibling
tient|NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In Sibling2
rked up for incontentia pigment
n screening form for teen immunization
ived DOS 8/10/09 to 8/30/09. URI, Strep Pharyngitis, Menorrhagia, Sinusitis, Chickenpox.
allergy/immunology and neurology consults, received DOS 8/19/09 to 9/14/09. Rhinorrhea. Strep throat. Premature 35.5 weeks.
o AVA # 7 admin in April 04~Anthrax (Biothrax)~UN~0~Patient
records received DOS 8/20/09 to 8/21/09. Allergies to eggs, dairy, pork, beef, amoxicillin.
d for date of service 9/2/09 PMH: none 08USA03209 08USA03257 08USA03151 08USA03203 08USA03208
Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2
num, GERD, Ischemic Heart Disease, penicillin, aspirin, naproxen, Plavix e diseases; esophageal motility disorders; primary Raynaud's phenomenon; fibromyalgia; anxiety disorder; GERD; major depression; HTN;
ERD. Uterine prolapse just recently repaired. PCN allergy routine screening questions. (No allergies, serious medical conditions, immune system problems, medications, etc.) Child was alert, talkati
ays after birth
ditions: Diabetes, Hypertension, Hypercholesteremia, Atrial Fibrillation, BPH, GERD/ESOPHAGITIS spital records received DOS 11/1/08 to 7/20/09. PMH: Allergy Wellbutrin. Adverse reaction to codeine and Demerol. Mitral valve prolapse. B Intracranial Hemorrage. Croup at 5 months.
A + Hep B (Twinrix)~1~10~In Patient
eived DOS 4/1/08 to 8/18/09. Acne, myopia. 2~0~Patient|~Rotavirus (Rotateq)~2~0~Patient|~DTaP + IPV + Hib (Pentacel)~1~0~Patient
ypercholesterolemia; BPH; ED
nd name)~4~2~Patient
rol; Diabetes; Sleep apnea; Impotence; Hypertension; Dermatitis X)~2~5~Sibling + Rubella (MMR II)~2~5~Sibling|~Varicella (Varivax)~2~5~Sibling|~DTaP + IPV (KINRIX)~2~5~Sibling
t specified (no brand name)~UN~0~Patient
10USA00371
racted sexual
athing problem Renal disease; Stroke. 9/11/09 Hospital records received DOS 10/6/08 to 10/21/08. Known history of recent myocardial infarction. Type 2 D me)~UN~84~Patient
ody~Vaccine not specified (no brand name)~1~1~Sibling
08USA03202 08USA03204 08USA03468
x of childhood seziures. 9/9/09 ED records received DOS 8/25/09. Also Labs from 8/28/09. Febrile seizures. Normal MRI Brain. EEG - Abn
MH: previously healthy
ercholsterolemia, colon polyps
9 Medical records received w/PMH: pyelonephritis. Allergy: amoxicillin. ords received DOS 1/5/07 to 8/7/09. Strep Pharyngitis with fever, nausea and vomiting.
Patient|None~ ()~NULL~~In Sibling1
nd name)~0~76~In Patient
to Amoxicillin
pital records received DOS 8/24/09 to 8/27/09. Anaphylactic reaction to bee stings. Pituitary tumor. 10/16/09 Additional Hospital Record rece
resulting in brief vasculitis~DTaP + HepB + IPV (Pediarix)~2~0~Patient me)~UN~0~Patient
d soon after.
Virus, Inact. (no brand name)~3~1.30~Patient|~Pneumo (no brand name)~4~0.00~Patient
08USA03961 08USA04182 08USA03811 07USA00788 08USA03465
ords received DOS 4/16/08 to 5/15/08. PMH: Wart on hand - Histofreezer - Cryosurgery.
us~Tetanus Toxoid (no brand name)~UN~42~Patient
. "Fainting spells".
9 Medical records an DC summary received for dates 12/25/08 to 1/14/09. PMH: HTN, CHF, CAD, arthritis, cardiomegaly, appendectomy,
URE TO THRIVE
ne w/pertussis component- no seizures since 10 mos old
oarthritis, hard of hearing
Pt. was advised regarding pregnancy.
IRTH SURGERY 7/30/2004 NO RESIDUAL PROBLEMS situ, basal cell carcinoma, HTN, complex migraine with TIA, hyperlipidemia, spondylosis. 9/14/09 ER records received 8/21/09. Hypertensio eived DOS 2/3/09 to 8/19/09. Egg Allergy.
sorder; stable allergic rhinitis; RAD
1998; Asthma; PCN allergy; cughlear implar
e; Ventilator-depend; G - tube. 8/31/09 PCP medical records 7/2/07 to 8/27/09. Severe congenital hypotonia - Carey-Fineman-Ziter Syndro
08USA03925 08USA04230 08USA03108 08USA03802 08USA04086 08USA04199
o brand name)~1~28~Sibling dap (no brand name)~UN~28~Patient|Difficulty Breathing~Yellow fever (no brand name)~1~31~Sibling
mplains of vomiting approx once daily
h cardiac ablation 2004 anemia, choleysystectomy, endometrial biopsy July 28, 2009, No known allergies. Smokes half pack per day.
neumovax)~NULL~72~In Patient
ESOLVED, STREP PHARYNGITIS-RESOLVED,ALLERGIC RHINITIS-CONTROLLED, ASTHMA-CONTROLLED,
r allergies - Sulfa, perhaps bees
uts and cats which all cause angioedema. Bee venom causes hives.
Type 2 diabetes Hepatitis
obacco abuse, MVP. Appendenctomy.
ient|unknown~ ()~~0~Sibling
rial septal defect and pulmonic stenosis; Mild mitral insufficiency; moderate pulmonary insufficiency. PMH: congenital heart defect. Allergic
ical condition
ects; No med. condition d (no brand name)~1~0~Patient
09 to 8/29/09. Poison sumac.
Varivax)~1~15~Patient|Syncope~Tdap (Adacel)~1~15~Patient|Syncope~HPV (Gardasil)~2~15~Patient
d site 3 years ago X)~1~5~Patient
ds received DOS 6/10/09. Trauma (L) elbow with surgical fixation.
ng diagnosis of Cerebral Palsy (Quad) VP Shunt for Non-Communicating Hydrocephalus
ved DOS 12/26/08 to 1/03/09. Cholecystectomy.
below for conditions (dual cardiac valve replacement, full heart block, pacemaker. History of helminthes infection, current Pinworms.
08USA03993 08USA03159 ult received DOS 7/1/09 to 7/20/09. Pneumonia perinatal period. Mood and speech problems (anaphylactic react)PMH: ear tubes. Allergies to eggs, peanuts and chili beans. Anaphylaxis to jelly beans S 10/03/07 to 4/25/09. Back Pain, lumbago. Bulging disk and facet inflammation. Plantar wart. Wart removal. Penicillin allergy.
ost Hx Ulcers.
rual H/A. metabolic syndrome
eived DOS 8/24/09 to 8/26/09 and 9/2/09 to 9/3/09. Ovarian cysts, endometriosis. Hysterectomy. Appendectomy.
her reports no meds for it and that client "outgrew" it. Also client dx with ADHD o brand name)~1~39~In Patient Tissue Disease; Allergies: Penicillin, Demoral
irway constriction to azithromycin, ciprofloxacin, and sulfa antibiotics, PTSD, carpal tunnel
Patient|NO~ ()~NULL~~In Sibling1|NO~ ()~NULL~~In Sibling2 LL~~In Patient
colitis; mononucleosis requiring hospitalization Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2 tient|NA~ ()~NULL~~In Sibling1
tient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2
cal records received DOS 8/25/08 to 8/31/09. Asthma, allergies. Chronic folliculitis.
nd (Rota 18-24 mths) DIN; Amoxicillin; Aspirin
no brand name)~1~34~Sibling ; Voiding dysfunction
name)~UN~44~Patient
ient|Unknown~ ()~~0~Sibling
Osteoporosis no brand name)~1~0~Patient
08USA04275
08USA04511
08USA04691 e)~1~0~Patient
ecords received DOS 8/20/09 to 9/4/09. Clubfoot. 08USA04714
ported (L) arm weakness had a work/up all was (-).
onal allergies.
(Menactra)~1~12~Sibling|Yes~Influenza (Seasonal) (FluMist)~1~12~Sibling m has history of panic attacks.
(Menactra)~1~12~Sibling|Yes~Influenza (Seasonal) (FluMist)~1~0~Sibling ps + Rubella (no brand name)~1~1~Patient
gococcal (Menactra)~1~13~In Patient hma~Varicella (Varivax)~2~12~In Patient
eceived DOS 8/27/09 to 8/31/09. Constipation. Cough. Noisy breathing. c esophagitis and hypoalbuminemia, as well as food allergies to pork, eggs, soy, wheat and milk.
Patient|none~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Sibling1
COPD, dyslipidemia, GERD, osteoporosis. left knee degenerative arthritis with left total knee arthroplasty in 3/08. Allergies to sulfonamindes
leep disorder
cords received w/PMH: Left knee discomfort and left knee chondromalacia patella.
Hospital records received service dates 8/28/09 to 8/31/09. Asthma. Tonsillectomy.
08USA00396 08USA04708 specified (no brand name)~~1~Sibling ut was an honor student. 9/14/09 Hospital records received DOS 3/13/08 to 7/15/08. Mild spastic diplegia cerebral palsy. Insulin-dependen
cks; Depression ed DOS 11/10/08 and 11/22/08. Caffeine beverages.
s, DC summary received service dates 7/22/09 to 7/23/09. Upper respiratory infection. Baby is exposed to tobacco smoke. Mother has hx o
t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling ULL~~In Patient
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2 za (Seasonal) (no brand name)~0~1~Patient
ved for DOS 8/12/09 to 8/16/09. PMH: Asthma, lipid disorder, cervical spondylosis. ycin, clindamycin,penicillin class,sulfonamides,propoxyphene compound,betadine antibiotic(bacitracin,polymixin B sulfate s Hypertension - controlled w/ Rx
medical con
cal Records and Discharge Summary for Dates of Service 8/28/09-8/30/09. PMH: None. Rickets; Respiratory Distress 9/25/09 Medical records received w/PMH: C-section, 24 wk premature birth for decelerations. Mechanical v de II IVH with VM; PDA ligation; GER; Cholestasis; Anemia (stable)
08USA04882 08USA04339 08USA04943 08USA05014
d"~DTaP + IPV + Hib (Pentacel)~1~0~In Patient ainting and seizures with fever, injury and vaccine.
o brand name)~3~1~In Sibling1
neumo (no brand name)~1~63~In Patient
ient's disease has been well controlled sil)~1~17~In Patient
nd name)~5~4~In Sibling1
luenza (Seasonal) (no brand name)~1~49~In Patient ssure medication
murmur; Pre-maturity. 9/11/09 Autopsy received DOD 07/09/2009. Born at 37-38 weeks gestational age, small for gestational age.
dsorbed (no brand name)~UN~30~Patient
PERLE; Penicillin; Sulfamethoxazole/TMPDS; ENTEX; PARON FORTE; Tetracycline; Codeine; Erythromycin; DARVOCET; FLOXIN; Pneum medical records for 6/8/09 to 6/9/09. Circumcision. Neonatal jaundice.
ceived DOS 8/12/09 to 9/8/09. Eye surgery at 8 months of age.
to amoxicillin
medical records received for date of service 8/30/09 to 9/3/09: PMH: otitis media with treatment 2 weeks prior to episode.
08USA05166
ASTIGMATISM
enal failure (moderate), hyperlipedemia
ceived DOS 9/4/09. Asperger, attention deficit hyperactivity disorder, mood disorder. Previous adverse reactions to vaccines. eceived DOS 9/4/09 to 9/10/09. Chronic renal failure, diabetes mellitus, hypertension, anemia, asthma, peptic ulcer disease, diastolic cong
esssing~Measles + Mumps + Rubella (no brand name)~~2~Patient
none~ ()~~0~Sibling
iring ER visit.~HPV (Gardasil)~1~13.80~In Patient
30 years ago).
d - has VP shunt
cel)~UN~13~Patient
ment at this time
eumo (no brand name)~1~82~Patient
ed DOS 8/4/09 to 8/5/09. Penicillin Allergy.
cent injuries in car accident aggravating previous car accident injury from year ago. Being treated by chiropractic doctor and massage thera Nuts. Allergic reaction to Amoxcicilin
ess,stiffness at the injection site, fever and sleepy~Hep A (no brand name)~2~3~In Patient|swollen at injec on site, redness, fever, bump~Measles + Mumps + Rubella (no brand name)~2~4~In Patient
9 ER records received DOS 9/4/09. Recurrent atrial flutter, coronary artery bypass graft, stent placement, congestive heart failure. Angina.
avirus (no brand name)~3~1~In Patient
sil)~3~16.00~Patient
osis; L3-5 lumbar spinal stenosis; osteoarthritis; osteopenia; Celiac disease; similar neuropathic pain 04/2007-12/2007; Chicken Pox at age 08USA04685 10USA04754 09USA00007 09USA00201
09USA00202 09USA00324 08USA05165 09USA00028 09USA00354
niation; Lyme 8/06. 9/11/09 Hospital records received DOS 2/11/09 to 2/17/09. Lyme disease. Herniated disc. Burns to fingers of left hand.
rand name)~1~1~Patient
or allergies. No history of anaphylaxis or severe allergic reaction.
nsomnia 2' to shift work Family History Aneurysm
ess at birth 9/25/09 Medical records received for DOS 9/1/09 to 9/2/09. PMH: PPHN with intubation at birth, methadone maint. at birth in NIC
VICODIN; conditions: Osteoporosis; lateral epicondylitis (elbow); depression with anxiety; hypothyroidism; nicotine use
uenza (Seasonal) (no brand name)~UN~41~Patient
o receptive delay. PMH: mild expressive speech delay
umo (no brand name)~NULL~72~In Patient
07USA05837 09USA00325 08USA01926 09USA00049 05USA01040 09USA00206 09USA00318
al records received DOS 9/2/09 to 9/3/09: PMH: none p/palate-with repair. 36 week premie. tympanostomy tubes. failed NB hearing screen. Seasonal) (no brand name)~UN~0~Patient
2d hives X 1d~Hep B (no brand name)~2~1~Patient|Fever 102 degrees X 2d hives X 1d~DTaP (no brand name)~2~1~P
Mumps + Rubella (no brand name)~1~0.00~Patient
)~2~0.30~Patient
dness~DTaP + HepB + IPV (Pediarix)~3~3~In Patient
ritis, Hearing and Balance loss, Dermitis, Thyroid.
cords and DC summary received from date of service 11/1/08 to 11/7/08 PMH: anemia, menstral irregularities with heavy flow, short stature
ion; Chronic Pain; ETC.
n ratio - Recurrent - Normal serum protein/electrophesis., onset 2009
nia vaccine with an injection site 'satellite'reaction elsewhere and was told just unusual but not to worry. HAS ALLERGIES TO SULPHA & R accine given in 1968 (arm swelled to twice size and had fever for several days)
ceived 2 doses Hep A vaccine recalled for poss lack of potency. Scoliosis, back pain. Scoliosis brace. Thigh, calf pain. Numbness tingling r
10mg 8/17/09
e; Osteoarthritis
Toxoid (no brand name)~UN~0~Patient
09USA00557
d DOS 8/31/09 to 9/2/09. Allergic rhinitis.
ceived from dates of service 2/2/09 to 8/24/09 PMH: HA, sinusitis, allergic rhinitis.
Mumps + Rubella (no brand name)~UN~0.00~Patient
asil)~2~13~Patient
nza (Seasonal) (no brand name)~1~40~In Patient culitis, hyperlipid, onychomycosis, BPH, low back pain, chronic kidney dz
llergies, food allergies-milk and eggs (pt is a physician assistant and stated the egg allergy was not an issue as she has had flu vaccine in
s + Mumps + Rubella (no brand name)~1~1~In Sibling1
ches~Influenza (Seasonal) (no brand name - brand name unknown)~1~61~In Patient ords received DOS 10/2/06 to 6/27/08. Septal rhinoplasty with tonsillectomy.
High BP; Renal Failure
ure~Measles + Mumps + Rubella (MMR II)~1~1.50~Patient
FEXOFENADINE (increased LFB & liver pain).
09USA00464 09USA00635 09USA00783 09USA00762 09USA00753 09USA00773 tside and inside, sinusitis, border line diabetes.
Patient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2 records w/Menactra, Lot #U2670AA, given LA on 6/24/2009.
el)~NULL~25~In Patient Rash- Iodine : Hives, Rash-------------- pt dx Lupus
en's, RA c/b CVA and h/o lupus nephritis
of lumbar region.
P (no brand name)~4~1~In Patient
ltant records received DOS 8/28/09. Carpal tunnel syndrome, abnormal EMG. Anemia.
TI with bacteremia and fever.
f prematurity
ort hospitalization DOS 8/24/09 to 8/27/09. COPD, hypertension, obesity. Smoker. Oxygen dependent.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
gs does not take seasonal flu vaccine~ ()~NULL~~In Sibling1 ns in left arm due to a previous diagnosis, so both injections were given in the same arm and were given about 2 inches apart, however the
ash 5 hours before inj.
er medical conditions
gnosed); migraine headaches (self diagnosed)
tient|na~ ()~NULL~~In Sibling1|na~ ()~NULL~~In Sibling2
histamine/decongestant combinations, Medical:S/P perthes L hip, asthma (controlled),seasonal allergies
asles + Mumps + Rubella (no brand name)~~0~Patient
olio vaccine~Polio Virus, Oral (no brand name)~1~16~In Patient
09USA01041 09USA00746 11USA02648 08USA04768 09USA00694
|None~ ()~~0~Sibling
omosome abnormality, seizure disorder, VSD repaired PMH: chromosomal abnormalities, global developmental delay, VSD-repaired, G-tu
itrofurantoin; --C-sulfa antibiotics; --C-sulfonamide derivatives
erma(no treatment), Allergic to PCN
uenza (Seasonal) (FluMist)~UN~6~In Patient records w/PMH: Circumcision.
of possible relevance.
name)~2~0~Patient
specified) anxiety, allergy to Levaquin, Penicillin, Bactrim
ICODIN; BIWIN.
Gardasil)~~13~Patient
09USA00700 09USA00549 08USA04775
sonal) (no brand name)~1~22.00~Patient
al records and DC summary for dates 9/14/09 to 9/22/09. PMH: Reactive airway disease, pneumonia, heart murmur. FH: seizures
tic response to "shot" in hip 5 years ago; Known allergy to morphine
School) DOS 3/14/08 to 11/14/08. Ankle sprain. Nasal Congestion. Strep Throat.
ent|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
twice before but only for a day or two and on a very small area. I dont recall if it occurred close to a vaccination.
multiple pneumonias including aspiration, h/o persistent pulmonary HTN (now resolved), horseshoe kidney, h/o cleft palate, feeding aversion
ma left orbital area
on, Acid Reflux pace maker which pt informed later after shot.
8/09 went on PREDISONE then off but rxtn, Nephrotic edema; Hyperglycemia -
hyroid; Depression; Anxiety
(out growing it now).
09USA01369
bs; Codeine derivatives; FLEXERIL; SKELAXIN Sulfa drugs; VICODIN
Patient|None~ ()~NULL~~In Sibling2|None~ ()~NULL~~In Sibling1
17/09 Received medical records w/PMH: T&A. Allergy: Demerol.
EFLEX SEASONAL ALLERGIES MENOPAUSE
m, Anemia, Hypercholesterolemia
7/09 Received medical records w/PMH: Allergy: PEN.
e; neuropathy
nel; Hip knee; Back surgery
za (Seasonal) (no brand name)~UN~0.00~Sibling
aches; mixed incontinence ulcer, kidney problems, osteoporosis, eye problems due to small stroke, brain aneurysm about 10 years ago. During brain surgery had rea mitting~Measles + Mumps + Rubella (no brand name)~1~1.00~Patient
Hx of tachypnea 10/5/09 Medical records received w/PMH: 29 wk preemie w/intubation 07USA04940 09USA01170 09USA01378 09USA01466 09USA01474
V (Gardasil)~3~12.00~Patient
21/09 Medical records received w/:Menactra, Lot# U237BA, given LA 9/14/07; HPV #2, Lot# 1263U given LA 10/12/2007; Fluzone, Lot# U2
rgy at present
ent|none~ ()~~0.00~Sibling
* FLU VACCINATION PENICILLIN COMPAZINE TYLENOL PHENERGAN
roducts and eggs
le - surgery. Cigarettes. Alcohol use. Caffeine use. Acne. Contact Lens-Induced Corneal disorder. Elevated triglycerides. Heel fracture, had
dism; Osteoarthritis; Arthralgia with Back Pain
gasses, mold, caused wheezes in past
sonal) (no brand name)~UN~75.00~Patient
dyslipidemia, hx gout, mitral insufficency
09USA01717 09USA01760
dia; RSV; Impetigo; Sinusitis
n B-12, Zolpidem Tartratc
-has strange reactions to certain elements.
on, CHF, asthma, atrial fibrillation, and kidney stones. Allergies include sulfa. 10/12/09-records received-PMH: Obesity, hypertension, cong
Migraines, Slow intestinal motility in~Tetanus Toxoid (no brand name)~1~0.00~Patient name)~1~0.00~Patient
dications, but have seasonal allergies. Three years ago I was diagnosed with anxiety. I have grown up with asthma.
on, ADHD, tremors high blood pressure - moderate - controlled by meds arthritis
er, Sleep Disorder (has "very little REM time")
sonal) (no brand name)~1~1~In Sibling1
eviously healthy.
y allergist. Eats eggs.
09USA01484
yacin cozaar, bee stings: atrial fibrillation, arthritis o allergies listed, No medications listed
dical records received, Dates of Service 4/19/09-8/10/09. PMH: Streptococcal infection 4/9/09, ear infections, mononucleosis 4/12/09, Alle onic pain, peripheral nervous system disorder, anemia, type 2 diabetes, poly cystic ovarian disease
PMH: ear tubes, adenoidectomy. seasonal allergies on site~Pneumo (no brand name)~1~61~Patient
lactic to nuts, ragweed, molds, cats me)~1~55~Patient
SULFAS (per patient)
tion to other vaccines.
holesterolia; depression
brand name)~3~0.20~Sibling
09USA02121 09USA02188
ered early secondary tachycardia and concern for infection. Jaundiced at birth.
name)~4~4.00~Patient
ertension; Osteoporosis.
gh cholesterol
) (no brand name)~1~33.00~Patient
ULTY~Influenza (Seasonal) (no brand name)~NULL~30.00~In Sibling1
dical records received for dates of service 7/23/09 to 7/28/09. PMH: VSD
ent|none~ ()~~0.00~Sibling
atient|NO~ ()~NULL~~In Sibling1
tedly very dirty and bug infested.
g, fluoxetine 10,boniva 150 mg,
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
asthma; Tietze's syndrome.
rtension, cholesterol Mumps + Rubella (no brand name)~1~1.40~Patient
of tonsils, with subsequent excision and resolution therapy; s/p excision of basal cell, epithelioma of right ear; Hypothyroidism; Hx of pulmo nion R hip fx-repaired; AODM; BPH; MOTRIN; MYCARDIS; PREVACID; FLOMAX; trimethoprim 1/7/09-records received-PMH: CHF, pancr
n's & Alzheimers.
ent & grandparent w/protein s deficiency; parent w/no hx of thrombosis & not on coumadin; grandparent w/recurrent thrombosis.
snowboarding accident. LOC after baseball strike to R eye. Wisdom teeth extraction.
es 10/27/05; Screening for Colon Cancer 04/28/06; Neuropathy, Peripheral 06/07/06; Arthritis, NOS/DJD/Osteoarthritis, S 06/19/06; Varicos
es, elevated LFTs, and hip arthralgia.
deficiency, DM, HTN, asthma be. Hypotonia
e 2. hypothyroidism. gout. hypertension. osteoarthritis of knee. BACK ARTHRITIS.
eated with post coital antibiotics
gain noted at 3 months.
eral occasions of exercise induced asthma;
PV #3 given 12/2/08, lot# 0651X, IM/LA; MMR#2 given 12/2/08, lot # 1083X, SQ/RA.
parently weakened her immune system and she says she is more susceptible to colds etc. now. Pt says she sees a rhuematalogist for this
es since treatment, and his latest WBC count the week of the ZOSTAVAX administration was normal. Patient's physician wanted patient to
sclerosis, osteoporosis, lipoprotein deficiencies
pertension syncope, dyslipidemia, GERD, morbid obesity,emphysema, congestive heart failure, pancreatitis, degenerative arthritis, mild valv
w/o reaction. Family hx: congenital heart defect.
or PMH: PTSD/depression; chronic night sweats; chronic poly-joint pain; 35# weight loss due to abd pain & decreased appetite; seizure di
group B strep positive however child's blood culture was negative at 72 hours at time of the discharge to home. Renal ultrasound done duri
MH: Nephrolithiasis. HTN. Hypertriglyceridemia. L shoulder pain 2' to labrum tear
t, lymph nodes, (Resolved); 07/26/2004, Shortness of breath, (Resolved); 07/26/2004, Pericarditis, acute NOS, (Resolved); 06/01/2004, Pa
r many years but now worse. Double vision. Stated always had tracking issues with reading. Strep throat 5/7/07.Allergy to penicillin.
Hearing change left 2007
Head injury 12/07
Blue nodule right 2nd pip finger 2/08
Bacterial endocarditis 1983
Lyme disease
openia - 5-2002; unspecified essential hypertension; colon polyps; hypercholesterolemia; disorder of bone and cartilage, unspecified - 5/19
lus of kidney; Hepatitis C; Hypothyroidism; Anemia
4/5/09. (R) knee surgery.
STEOPENIA, CHRONIC RHINORRHEA, ALLERGIES: PENICILLIN, ADHESIVE TAPE
e tape, mountain cedar tree pollen.
ood
sugar dailyl
CLINDAMYCIN 300 MG CAP
plex; cranberry; Cinnamon; Iron; Multivitamin; Garlic; One daily men vitamin; M
born with a birth weight of 1.45 kilograms. He also had Trisomy 21, imperforate anus, colostomy at 3 days of age, hypospadia, hypothyroidi
elay /? Visual Impaired / Nissen Fundoplication / Gastrostomy Placement / Sickle Cell Trait / GERD / Hypospadius / Premature Birth, 34 we
othyroidism, HRT, GERD, chronic low back pain with sciatica, osteoarthritis. 4/16/09-records received-PMH migraine headaches and daily
ndfather's side. Both with paralysis.
ease, Myofascial Pain Syndrome
on testing. Dx was vasomotor rhinnitis.
MH: CP, seizure disorder and Congenital CMV. Chronic constipation.
s an option over the MMR shot or no shot. The MMR is too much at one time.
Colic. EDIS eval @ 11 mo for mild motor/language delays; picky eater. Family hx: seizures, HTN, CAD, high cholesterol, hypoglycemia,
multiple food allergies, no known drug allergies 3/16/09-records received-PMH: 31 week premie in NICU on ven, severe GER, eosinophilc
Gastroesophageal reflux disease.
ponatremia, tobacco abuse, urticarial vasculitis, depression.
il, muscle aches with pravachol, colonscopy. Allergy to sulfonamides causes rash.
esterol; whiplash history arthritis; cervical disk degeneration; congenital defect
; dysautonomia; MRSA cellulits/abscess left thigh 9/08; tonsillectomy; PE tubes. Family hx: asthma, allergies, migraines, SLE, melanoma,
emia, CAD s/p stent, hypothyroidism, anxiety, heart cath, cholecystectomy, bladder surgery. Allergies to EES and macrolides.
to Sulfa-rash.
n, right foot; Impaired fasting glucose; Low back pain; Hypertension; S/P Total Hysterectomy; S/P Removal of Appendix; S/P Anesthesia fo
. cardiac angiogram WNL 1/08. Family hx: autoimmune disorder
y. 4/6/09 Records received PMH: hypothyroidism; arthritis, C6-7 DDD; chronic fatigue; joint pain.
prior. Family hx: asthma, DVTs, factor V Leiden heterozygous, MI, colon cancer. cture (remote) PMH: smoker; daily alcohol. Allergy: PCN, rash. Family hx: Hashimoto's, DM, HTN.
s to grass, animals, dust.
erative disorder. Congenital heart disease.
a given before having a catscan; we discovered that whe she was hospitalized for severe abdominal going to her side
pilespy, Wolff-Parkinson-White syndrome ablation. Allergies to penicillin, hydrocodone, Flexeril, ibuprofen.
m possible infection in 2005
h thoracotomy and partial pneumonectomy. R renal insufficiency
etween atria. One of twins.
rostate cancer, HTN, MI.
ere leakage of tricuspid valve, Moderate leakage of mitral valve, peripheral neuropathy, Type II Diabetes, Hiatal hernia, reflux, gastroparesi
epair of small bowel.
, smoker, hyperlipidemia, asthma, allergic rhinitis, cervical disc degeneration, sensorineural hearing loss, prostate cancer. Allergy: ace inhib
apnea; herniated disks; GERD; COPD. Recent ex-smoker. Allergy: PCN, tetanus, tetracycline & now pneumovax. ospadias, CP, torticullis.
eneralized; Tobacco use Disorder; Fatigue; Bacterial Pneumonia; Weight loss; Staphylococcal Infection; Back Pain; Hyperkalemia. Allergie
ds/neck; asthma/RAD; Glossitis episodes
/13/09-records received-PMH: chronic obstructive pulmonary disease,low back pain, coronary artery disease. Tobacco user. Hyperlipidemia
PR; SULFUR = WEAKNESS IN LEG; WAS HOSPITALIZED.
osteopenia, polyarthralgia, allergic rhinitis, knee pain, pharyngitis, back pain, JDD, hemorrhoids, rectal bleeding, BPH, TURP, conjunctivitis
ergies: hydrocodone, Relafen, metoclopramide, Vicodin.
lergy sx. Mono-summer 2007
d; appendectmy.
ids, constipation, cataracts OU, CVA. PMH: CVA, CP, quadriplegia, cataract, pyelonephritis, osteoporosis. mental retardation, Vit D deficie
fore this one 4/13/09-records received-PMH:migraines.
onditions and no known allergies.
or 3/25/09. Brain tumor/Meningioma resection, resultant hydrocephalus, VP shunt placement with 2 revisions.
ed vision, stool & urine incontinence, malaria 2008.
alking since 12/25/08, performs a few examples of sign language, recognizes family members, understands her name when called, dances
ry HTN. Allergy: morphine, sulfa, ASA, levaquin, latex.
diation tx completed 10/3/08.
b sr 24hr; TOPROL XL 50 mg oral tab sr 24hr; ASPIRIN 325 mg oral tab ec.
w/formula supplement. Family hx: parent w/asthma, seasonal rhinitis & drug allergies.
Mom smoker & social ETOH during pregnancy. Family hx: autism.
knee mild arthritis, otherwise healthy.
orts that she had some lymphedema on the Right side post surgery which resolved completely with chiropractic care.
al brain MRI, ear tubes, arm fx, nasal fx./
hortness of breath, gout, ankle swelling, numbness in feet and hands, Type-2 diabetes, hypertension, hyperlipidemia, triglyceridemia. L sho
e. PMH: environmental allergies, obesity, hirsutism, acne, on BCP. cope, R inguinal hernia repair. NKDA.
cervical cancer; pulmonary HTN; cutaneous T-cell lymphoma; urticarial vasculitis; hyponatremia; depression; hysterectomy; arterio-bifemo
, hypertension, coronary artery disease, BPH, atrial fibrillation, coumadin coagulopathy, hiatal hernia, sleep apnea, knee surgeries.
c syndrome w/hirsutism, Type II DM w/peripheral neuropathy, metromenorrhagia, morbid obesity, Blount's disease w/left tibial lengthenins &
dothelial Corneal Dystrophy and responded to prednisone eye drops with high Intraocular Pressure.
1267U given 11/20/07, IM/LA; HPV #3, Lot #1978U given 3/28/08, IM/LA. 5/1/09 Received vaccine & PCP medical records of 11/07-1/09.
ontinence Factor V leiden Allergies TETANUS - Rash CEPHALEXIN - Thrush, Hives Erythromycins - VOMITING,
and tree nut antigens
atopic dermatitis. Frequent fevers, vomiting, runny nose and cough. Syndactyly fingers bilateral.
ved DOS 4/1/09. Uveitis, Mycarditis.
ulcerative tonsillitis, epigastric pain, GERD, HA, fatigue, stiff neck, environmental allergies, vocal cord nodules, right shoulder AC strain.
EEP, breast implants, torn left meniscus knee, 6 miscarriages, hypercoagulability state. Allergies to ibuprofen, phenergan.
hospitalized for 6 days with antibiotics..."
while on OCPs. Allergy: PCN, keflex, levaquin.
OS 4/3/09. Allergies to Cipro, prednisone. Panic attacks; fatigue; lupus. PPD (+).
stones, knee surgery.
Keflex, flagyl, clindamycin. 4/16/09. Hypertension, hypercholesterolemia, coronary artery disease, BPH, hernia repair, psoriatric arthritis, Baker's cyst, chronic kidney d
ce, sensoineural hearing loss, arthropathy shoulder, tendonitis rotator cuff, bronchopneumonia, pulmonary infections, chest pain. 6/2/09 Ho
ulder and chronic rotator cuff injury, neurogenic bladder; allergies to PCN and linezolid cyanosis, otherwise WNL. Currently in NICU
8/09. PTSD. Herniated disks.
09 ER records received DOS 5/5/09. Asthma, T&A, wisdom tooth extraction. 6/9/09 PCP medical records received DOS 5/4/09 to 5/8/09. Va
estion x 1 week.
. Allergy to Rondec
e and obesity.
adaches, Strep throat, ADD, ruptured ovarian cyst. Rheumatoid arthritis. Has abused alcohol and used drugs. 7/27/09 Hospital records rec
iagnosed at ED in CA on 12/24/08 - dietary recommendations given, no surgery performed.
t palate mucocele diagnosed April 2005 evaluated by ENT and treated conservatively. Surgical History: circumcision as a newborn. Hosp
cess finger. I&D.
5/13/090 WNL.
nt; Arthragia-Pain in joint, NOS; Pain back (postural); Myofascial pain syndrome; Urethral stricture, meatal stenosis s/p urethroplasty (90)
tend to be low and has variable white counts.
acts, ex-smoker, acute URI. 7/13/09 Hospital records received DOS 3/2/09 to 3/6/09. Coronary artery disease, hyperlipidemia. ECTAL ABSCESS - emergent cardiac path - STENT placed OM3, PTCA to PLA 11/26/08 - DR - colonoscopy - proctitis OTHER: CROHN'S
olesterolemia, breast cancer post lumpectomy and radiation therapy
9 to 6/1/09. GERD.
09 ER records received DOS 5/22/09. ADD, T&A.
CATS, AND RESPIRATORY ALLERGENS AS WELL. PAST MEDICAL HISTORY: 1. Schizoaffective disorder with bipolar features. 2. Gen
on may be related to a neomycin allergy. When filling out the consent & release form she hadn't thought about topical ADR.
asthma, obstructive sleep apnea, hypertension, GERD, MVA, headaches.
she received a dose of Narcan in delivery room. Cord pH7.37. Intubated due to respiratory failure. Received one dose of surfactant and e
eral times. Vertical nystagmus. Neck pain.
past week. Obesity, herniated disc, neuropathy secondary to unknown causes. Hypertension.
ankle MRSA, allergic rhinitis
g, tendonitis patellar, flat foot, shin splint, pes planus, nicotine dependence.
kably good care of herself, ate well and exercised regularly. Her medical history was remarkable only for a history of strep throat and resultin
ng the size of a golf ball size, bruising that last couple weeks. The technician told her to pretend he wasn't giving her the shot. She believe
3.00] ALLERGIC RHINITIS NOS [477.9]
13/09. Previous syncopal episodes.
OS 12/15/08 to 6/17/09. Nasal congestion, nonproductived cough. Fever, upper respiratory infection. Umbilical hernia, completely reducible
cific dermatitis. Possible Marfan syndrome, high-arched palate, shoulder subluxation and hyperlax finger joints. Nasoseptal deformity with o
eakness, dizziness. Allergy - Lamictal. 8/3/09 Consultant medical records received DOS 12/12/08 to 6/29/09. Tremor with intention, obsessi
us excavatum, milk allergy, food allergy, anemia, RAD. Records include prior chest x-ray and blood test for lead.
hen was the patient's second PNEUMOVAX vaccine. She had received her first such vaccine around 12/2001 without any adverse effect. S
allergic reaction to bee stings (swelling and pruritis at sting site) and poison oak (both successfully treated with Benedryl).
igo on cheek, back, scalp. Seborrheic dermatitis. Hepatitis C. Actinic keratosis.
vertigo, chronic sinus infection.
omy. 7/22/09 Neuro consult records received PMH: migraine HAs, HTN, hyperlipidemia, CTS. Allergy: PCN. Family hx: daughter w/MS; he
dence, opioid dependence
earing loss, atherosclerosis coronary, idio periph neuropathy, essential hypertension, hyperlipidemia, gout, diverticulosis of colon.
to respiratory distress. PROM.
nsion, TIA, vitiligo
ultiple ear infections.
born 6 weeks premature.
shoulder. hypothyroidism, vaginitis.
loss. Allergy: vancomycin. Family hx: bleeding disorder.
hest pain. Penicillin allergy.
harge Diagnosis: First born twin, small for gestational age, Preterm very low birthweight newborn, Low risk of sepsis, breech presentation, A
events (PCN, niacin, sulfa, ACE inhibitor).
le accident, pleurisy, sulfa allergy
ension. Allergy to Stimate. Head trauma. Leg injury. Irregular menses. 7/1/09 Received medical records w/PMH: Excercise-induced asthma
en donating blood.
P medical records received DOS 11/19/07 to 9/17/08. Reflux, hiccups, gassy. Presacral dimple. Discharge from umbilicus. Total Bilirubin 16
BACTRIM -->rash; Surgical History: Adenoidectomy, age 3; L) Knee arthroscopy, 1999; R) inguinal herniorraphy, 1999. PMH: inguinal he
otomy tubes. Chronic lung disease, gross motor delay, hypotonia, GERD. 26 week premie. gastric bypass Roux-en-Y; overweight
Allergy to a venom.
ss, anxiety/panic attacks. 8/24/09 ER records received DOS 4/21/09 - 4/22/09. hypothyroidism, hypoglycemia. Tonsillectomy, pyloric steno
ween the ages of 9yrs to 12yrs old, but has had no symptoms in the last 7 years. She is a social smoker, 10 - 15 cigarettes a day, and a so
perlipidemia, osteoarthritis. Previous allergies/ADR reported to PCN, sulfa, Quibron, Fosamax, Actonel. 7/23/09 Hospital outpatient records
N, hypertriglyceridemia, tonsillectomy. Allergy: augmentin, heparin. Family hx: RA, fatty liver, HTN. 10/13/09 Received hospital medical re
ated prior to the adverse event onset. Unprovoked generalized seizure disorder at age 3. Febrile seizures. Partial seizures with generalizati
hlebitis.; Sulfa allergy; Past surgical history: Hysterectomy, right breast biopsy which was benign, and a toe bunion removed.
egs - fasciotomies. Ear tubes. Allergic esophagitis possibly to dairy products.
, penicillins, eggs, dairy.
mpound, flexeril, tylox, contrast dye, marcaine Hcl
n. Blood work and urine samples and x-rays could not help in finding a cause of the fever. This was the only seizure she has ever had.
0/09. Therapy for stress and anxiety. Asthma. Depression with suicidal thoughts. PMH: Intermittent shortness of breath. Hypersensitivity to
pendectomy, osteoarthritis, rosacea, total hip replacement, endometriosis. Alcohol use. Sulfa allergy.
oidism. Alcohol use. Iron deficiency anemia. Tubal pregnancy. Tonsillectomy. Allergies: Lactose intolerant, Seasonal, Strawberries, wheat.
ea of prematurity. Respiratory insufficiency, CPAP and O2.
ratory insufficiency, peripheral pulmonic stenosis, anemia of prematurity, intraventricular hemorrhage and associated periventricular leukom
mity, heaviness, pins and needles sensation. Left knee arthroscopy for meniscal tear. Seasonal allergies. Left thumb surgery for injured ten
absence seizure disorder.
UISING. THE E.R. THOUGHT THERE WAS A PROBLEM WITH ABUSE AND NEGLECT AND CONTACTED CHILD PROTECTIVE SERVI
uss" medication.
nia. Mastocytosis. Hemangioma.
e Lange Syndrome.
europathy); Iodone eyes (hives everywhere including throat); MORPHINE (overall itching and hallucinations); Betadine (blistering immediate
gy. Hives. Bacterial vaginosis
on. Rash from Amoxicillin. Attended camp. Contact with cat and reptiles. Lactose free diet.
hinitis;Fibromylagia; GERD; Lumbosacral back pain;pre-diabetes; Asymptomatic cholelithiasis; Cognitive decline; and Dizziness.
y - Hospital records received DOS 1/4/09 to 1/7/09. Assessment: Acute sialadenitis, leukoplakia of lower lip, hypertension, coronary artery d
March 2009 (not recorded as positive). Positive Quantiferon gold in April 2009; Hx of travel abroad during summer of 2008 with hx of last pri
ds. 9/23/09 Medical records received for date of service 7/22/09 to 7/23/09 Left inguinal hernia repair
halus. Neurogenic bowel and bladder with history of multiple urinary tract infections. MACE and Monte, Tonsillectomy and adenoidectomy.
m; GERD; Low back pain; chronic pedal edema; Hysterectomy.
GERD. 8/17/09 Consultant records and labs received DOS 11/18/08 to 8/10/09. Ear infections. Dental extraction.
d based on clinical presentation (Left great toe pain which responded to INDOCIN). Upper extremity numbness and weakness, early to mi
due to the emergency nature of the valve surgery which has been raised 10% in 3 years due to healthy life-style and athletic activities prior
ign breast biopsy, osteopenia.
rhaphy. Left testicle surgery, vasectomy.
nsult medical records received w/PMH: family hx: MS, ALS, melanoma. 9/3/09 Medical records received w/PMH: anxiety, rash, MVA 2004.
ep. Endoscopy. Hypertensive heart disease. 9/29/09 Medical records received from ID physician for date range: 11/9/08 to 8/28/09 PMH: L
y, shingles,arthritis.allergies: PCN, sulfa, EES, NSAIDS and other meds
steria sepsis, Pneumocystis. Biopsies. Diffuse glomerulonephritis.
. Seizure disorder.
2/09. Recurrent tonsillitis, hypertrophic tonsils. Tonsillectomy performed. 10/8/09 Neurology and cardiology consults service dates 2/6/08 t
/14/09 Hospital admitting record DOS 8/12/09. Congenital hearing loss. Cochlear implant left ear. Tonsillectomy and adenoidectomy.
September and was receiving this injection as prophylaxis prior to surgery. Medical records received 8/17/09 PMH: congenital hearing loss
angioedema. No prior reactions to vaccines.
agnosed with Celiac disease and does not eat anything with gluten. The mother states the child also has been diagnosed with Osteoperos
ruise to right side of face at age 5 yrs.
D repair as infant. menstrual cramps.
nths, severe constipation at 3 1/2 months - released from GI specialist on 7/31/2009 and pulmanary specialist on 8/13/2009 due to excellen
5.26A, initally intubated, umbilical hernia 553.1A, neonate jaundice, feeding difficulty 783.3D, ICD-9 codes, V65.49BADL, E869.4C, 780.39
MMR and Varicella vaccines. Multiple other prior vaccinations with no side effects.
2/16/09. PMH: Left vocal cord paralysis, stridor following birth.
d 2/17/09 to 7/17/09. Allergy to nuts. 9/21/09 Received medical records w/PMH: acne under treatment. migraines. Allergy: tetracycline. F
es. Hypertension, mid back pain, rosacea, hyperlipidemia, environmental allergy. Allergies to Prinivil, Pro-Banthine, allergy to shellfish, Eryt
n infant we think because of the pertussis in the APT shot. She also had ADHD. My middle daughter -the one who had no reaction to the sh
gy to household dust. 10/5/09 Vaccine records received: Hep A #1, SKB, given 10/1/08, lot# AHAVB246AA, LA. Flu shot, Conn, given 1
lot# 1061U, RA; Adacel, Sanofi, given 10/15/08, lot# C2768BA, LA; Twinrix, given 10/15/08, no lot # provided.
verely sick as I am.
ith no results. Per RN
re 35.5 weeks.
; major depression; HTN; personal history of exposure to Persion Gulf Region; Adjustment disorder unspecified; sexual abuse of adult(DSM
tc.) Child was alert, talkative, and cooperative while here.
ol. Mitral valve prolapse. Breast lump. Smoker.
ardial infarction. Type 2 Diabetes Mellitus. Diabetic neuropathy and retinopathy. Diabetic nephropathy. Hyperlipidemia. Bilateral ankle surge
mal MRI Brain. EEG - Abnormal. Born 32 weeks gestation. Inguinal hernia repair. Circumcision.
ional Hospital Record received, Dates of Service 8/24/09-8/27/09. PMH: None
omegaly, appendectomy, knee replacement.
ived 8/21/09. Hypertension. Atrial Fibrillation. Allergies - Pink eye drop medication. Sulfamethoxazole, Zestril.
rey-Fineman-Ziter Syndrome. Ventilator dependant entire life. Cerebral atrophy. Tracheostomy, gastrostomy. Bulbar palsy. Tube fed. Reac
kes half pack per day.
Type 2 diabetes Hepatitis C, s/p treatment with pegasys and copegus Migraines, Hypothyroid s/p thyroidectomy for Hashimoto's thyroiditis
nital heart defect. Allergic reaction to MMR or DTaP
current Pinworms.
icillin allergy.
Allergies to sulfonamindes causes rash. Naproxen anaphylaxis. Ibuprofen-hives, ACE inhibitors-cough. NSAIDS tongue swells throat closed
al palsy. Insulin-dependent diabetes mellitus.
o smoke. Mother has hx of vaginal herpes and took Valtrex prior to delivery. Mother took Zoloft during last trimested of pregnancy.
B sulfate
medical conditions:Cancer of breast,osteoarthritis,GERD,chondromalacia patella
celerations. Mechanical ventilation. SGA, PDA, RDS, IVH, hypotension, anemia, apnea, ileus, hyperbilirubinemia, electrolyte imbalance, th
gestational age.
RVOCET; FLOXIN; Pneumonia shot
er disease, diastolic congestive heart failure, CVA, hyperlipidemia. BPH, anemia, obesity.
doctor and massage therapist in affected area. Was injected with muscle relaxer in July 2008 at same medical clinic after first car accident
tive heart failure. Angina. Type 2 diabetes, hyperlipidemia, non-Hodgkins lymphoma, pacemaker with internal defibrillator. Appendectomy. S
2007; Chicken Pox at age 43
rns to fingers of left hand. Allergic to bee stings. Alcohol use.
adone maint. at birth in NICU, feeding difficulties, raspy breathing with color changes.
h heavy flow, short stature with growth hormone treatment, Oral contraceptives.
ERGIES TO SULPHA & RED DYES. CONDITIONS: TBI, OCCASIONAL B/L LOWER EDEMA. ORTHO/NEUROPATHOIES s/p x 11yrs,NE
pain. Numbness tingling right foot, insomnia. Sacroiliac joint syndrome. Adverse reaction to Valium. Eye rolling and facial twitching. Myoclo
he has had flu vaccine in the past and wanted to proceed).
inches apart, however the reaction occured lower down on the arm
delay, VSD-repaired, G-tube feeds, seizure d/o
mur. FH: seizures
ft palate, feeding aversion, GT with Nissen, multiple placement of ear tubes
ring brain surgery had reaction to 1 of the following medications: seldane, hismanal, sotals, variomycin, rocephin, erythromycin, estrioxene,
12/2007; Fluzone, Lot# U2448AA given 11/21/07 LA
cerides. Heel fracture, had fracture, dislocated right knee.
besity, hypertension, congestive heart failure, asthma, permanent pacemaker, appendectomy, cholecystectomy, hysterectomy, kidney ston
ononucleosis 4/12/09, Allergic to Penicillin.
pothyroidism; Hx of pulmonary nodule. PMH: Organic heart disease s/p CABG, known RBBB. HTN, dyslipidemia, Type 2 DM, BPH, hx eceived-PMH: CHF, pancreatitis, UTI, Diabetic, coronary stents. Stroke.
ent thrombosis.
thritis, S 06/19/06; Varicosity, Leg (NOS) 05/18/07; Ulcer, Lower Extremity 09/21/07; Elevated Liver or Cardiac Enzymes 09/21/07; Obe
s a rhuematalogist for this condition and will try to contact them as to the condition's effect on vaccinations and vis versa.
ysician wanted patient to be vaccinated.
nerative arthritis, mild valvular regurgitation and COPD. Smoker.
eased appetite; seizure disorder due to MVA w/head injury approx 1985; CAD; HTN; hyperlipidemia; hypothyroidism; asthma; kidney
enal ultrasound done during newborn or should he show an extra renal ureteral pelvis but no hydronephrosis. Birth weight was
Resolved); 06/01/2004, Pain in joint, unspecified site, (Resolved) PMH: Allergy: sulfa, environmental allergies.
llergy to penicillin.
is 1983
Lyme disease - clinically 6/08
artilage, unspecified - 5/19/08; bone density generic - 1-13-04; cytopath smear cerv/vag, manual - 12-11-03; colonoscopy- 1-29-04; ey
hypospadia, hypothyroidism, pulmonary hypertension, ASD/VSD, PDA ligation 1/13/08, pulmonary vein stenosis and other problems at bi
s / Premature Birth, 34 weeks /Hx of aspiration pneumonia
aine headaches and daily headaches for 20 years.
holesterol, hypoglycemia, migraines.
severe GER, eosinophilc esophagitis, mutliple food allergies. RAD. Family history of epilepsy.
graines, SLE, melanoma, DM, HTN, enlarged heart, hypothyroidism.
pendix; S/P Anesthesia for Tubal Ligation/Transection; FX closed lateral malleolus; Health Maintenance exam; Hyoerlipidemia; Antihy
ernia, reflux, gastroparesis, CHF records received-4/13/09-PMH:coronary disease. Multiple pulmonary nodules stable greater th
cancer. Allergy: ace inhibitors, guaiffenesin, biaxin, xanax, codeine, wellbutrin, effexor, prozac, lortab, protoni
in; Hyperkalemia. Allergies Effexor; Prozac; Wellbutrin; Nortriptyline HCL
bacco user. Hyperlipidemia. Hypertension.
BPH, TURP, conjunctivitis, glaucoma, CVA, GERD, venous insufficiency, erectile dysfunction, joint effusion, kidney calculus, R inguinal
al retardation, Vit D deficiency, MVP
ame when called, dances, etc. She is in the 75th percentile for height and the 93rd percentile for weight as of 4/3/09.
mia, triglyceridemia. L shoulder surgery, Inguinal herniorrhaphy, throat polyp removal.
sterectomy; arterio-bifemoral bypass, 2002. Allergy: risedronate, rash. Family hx: DM, MI, HTN, CAD.
a, knee surgeries.
e w/left tibial lengthenins & reshaping via cage, left gastrocnemius contracture, bronchitis, URI, sleep apnea, restless leg syndrom
cal records of 11/07-1/09. Hypothyroidism, 23# weight loss, anxiety, depression, HAs, dizziness. Family hx: parent w/MS, tics, OCD.
ht shoulder AC strain.
er's cyst, chronic kidney disease. Hep B surface antibody (+). Asthma with sulfa drugs.
ons, chest pain. 6/2/09 Hospital inpatient records received DOS 1/11/09 1/21/09. Rotator cuff injury, sensononeural hearing loss
d DOS 5/4/09 to 5/8/09. Vaginal discharge.
27/09 Hospital records received DOS 5/9/09 to 5/11/09. Allergies to hydrocodone and provigil. Babesiosis.
ision as a newborn. Hospitalization/Major Diagnostic Procedure: Denies Past Hospitalization. Family History: Father:
s s/p urethroplasty (90)
yperlipidemia. octitis OTHER: CROHN'S DISEASE TIA HYPOKALEMIA HYPERTENTION GLAUCOMA -DR - Echo 6/2/08 - ER 608, Grade 2 diastolic dys
h bipolar features. 2. Generalized anxiety disorder with panic attacks. 3. Borderline personality disorder. 4. ADHD. 5. History of arrhythm
e dose of surfactant and extubated after a few hours to room air. Sepsis ruled out. Feeder and grower. 7/15/09-records receiv
of strep throat and resulting tonsillectomy and adnoidectomy at age 10 and a knee injury from a bike accident after her sophomor
her the shot. She believed the vaccinator misunderstood what she told him.
ernia, completely reducible.
asoseptal deformity with obstruction. MRI shows slight ectasia of ascending thoracic aorta. Multiple dermal nevi - biospy demonst
mor with intention, obsessive-compulsive dysfunction, mood disturbance. Allergy to Lacmictal. Kidney stone. Flexion of torso occuring m
hout any adverse effect. She has rheumatoid arthritis and was recommended for a second vaccine because of being on immune suppress
mily hx: daughter w/MS; heart disease, cancer, migraines, Parkinson's.
culosis of colon.
sis, breech presentation, Apnea of prematurity resolved. Born 33-6/7 Week. C-Section. During hospital stay infant was hypoglycem
Excercise-induced asthma.
mbilicus. Total Bilirubin 16.2 MG/DL (H)
1999. PMH: inguinal hernia 1995. Dural/epidural thoracic angiolipomas malformation
nsillectomy, pyloric stenosis as infant.
cigarettes a day, and a social drinker, 1 - 2 days a week, average 4-6 drinks. She has had no other medical conditions.
ospital outpatient records received DOS 6/12/09 to 7/8/09. Major depression, and vitamin D deficiency. Hypertension. Allergies
eceived hospital medical records and discharge summary for dates of service 6/22/09-7/1/09. PMH: as above.
seizures with generalization. Tonic-Clonic Seizures. Jaw/face/teeth injured - multiple surgeries. Side to side, in and out j
ure she has ever had.
reath. Hypersensitivity to sounds and light. Lower back pain. Wrist fracture. Chickenpox. Environmental allergies. Milk allerg
onal, Strawberries, wheat.
ated periventricular leukomalacia.
mb surgery for injured tendon. Left ankle surgery for spurs.
ILD PROTECTIVE SERVICES. OUR OFFICE ORDERED BLOOD WORK FOR BLOOD DISCRASIA AND EASILY BRUISING. BLOOD WO
adine (blistering immediately); LYRICA (weight gain-i.e. 10 lbs in 4 days, spontaneous bruising legs, chest and arms); Persantine (immedia
and Dizziness.
rtension, coronary artery disease post coronary artery bypass graft, dyslipidemia, type 2 diabetes mellitus uncontrolled, GERD,
of 2008 with hx of last prior negative PPD in 2007 post-deployment. After VACCINE: Taking 4-month course of RIFAMPIN, with follo
omy and adenoidectomy. Allergies - penicillin, latex.
and weakness, early to mid - 1990s - Had evaluation including lumbar puncture and MRI of spine with questionable history of syrinx. (
nd athletic activities prior to the surgery. AMIODARON to calm A-fib, had stopped the A-fib near the beginning of the year b
anxiety, rash, MVA 2004. CSF leak 1983. Extensive foreign travel.
11/9/08 to 8/28/09 PMH: Lyme Disease, Babesia, EBV as a child/teen.
ults service dates 2/6/08 to 6/1/2009. ECG - Normal Sinus Rhythm. Sleep disorder Patient presents with hypersomnolence.
and adenoidectomy.
H: congenital hearing loss w/cochlear implant right ear. Seizures 2008 w/normal EEG. Allergic: PCN.
agnosed with Osteoperosis, Juveneille Arthritis, Fybromyalgia and Asthma. The child has also recently had surgery to her nasal
8/13/2009 due to excellent reports on both! Birth weight 7 lbs 11.7 oz 5 weeks early and 0 siblings.
49BADL, E869.4C, 780.39B, 502079.
s. Allergy: tetracycline. Family hx: cancer & leukemia.
e, allergy to shellfish, Erythromycin. Alcohol use.
o had no reaction to the shot- also had ADD but no other medical conditions.
Flu shot, Conn, given 10/1/08, lot# U278414A.
sexual abuse of adult(DSM-IV 995.83)
emia. Bilateral ankle surgery. Immobility. History of lumbar degenerative disk disease. Hypertension.
bar palsy. Tube fed. Reactive airway disease. Constipation, conjuctivitis, atopy. Bilateral clubbed feet. Seizures, GERD, chronic lun
for Hashimoto's thyroiditis Vertigo Depression Hyperlipidemia
ongue swells throat closed. Ciprofloxin-diarrhea and vomiting.
ed of pregnancy.
, electrolyte imbalance, thrombocytopenia, renal failure, respiratory failure, pulmonary HTN, pneumonia, sepsis, tracheitis, femu
inic after first car accident.
brillator. Appendectomy. Sulfa allergy.
PATHOIES s/p x 11yrs,NECK,SHOULDER, SPINE, LOWER.
nd facial twitching. Myoclonic jerking, anxiety, hallucinations, headaches. Panic attacks. Asthma. Vertigo. Injured should
erythromycin, estrioxene, ees.
hysterectomy, kidney stones, atrial fibrillation, 1 pack per day for 10 years smoking history, history of binge drinking. DVT of
Type 2 DM, BPH, hx
nzymes 09/21/07; Obe
sm; asthma; kidney
th weight was
oscopy- 1-29-04; ey
and other problems at bi
yoerlipidemia; Antihy
able greater th
y calculus, R inguinal
ess leg syndrom
nt w/MS, tics, OCD.
al hearing loss
608, Grade 2 diastolic dysfunction.
HD. 5. History of arrhythmia, possibly SVT. Followed b
ecords receiv
er her sophomor
biospy demonst
on of torso occuring m
eing on immune suppressant
t was hypoglycem
sion. Allergies
Y BRUISING. BLOOD WORK WAS NOT DONE. PARENTS ARE NON-COMPLIANT WITH MEDICAL ORDERS. PARENTS BROUGHT CH
ms); Persantine (immedia
rolled, GERD,
RIFAMPIN, with follo
e history of syrinx. (
ry to her nasal
GERD, chronic lun
racheitis, femu
PARENTS BROUGHT CHILD
AGE_YRS CAGE_YR CAGE_MOSEX U 0.2 F 14 14 F 62 62 M U 5 5 F 1 1 0M 32 31 M 0.6 0 0.6 F 0.5 0 0.6 M 0.3 0 0.3 M 15 15 F 5 5 M 5 5 F 0.5 0 0.5 F 0.5 0 0.5 F 0.3 0 0.3 F 9 0 0.4 F 20 20 F 18 18 F 53 53 F 17 17 F 17 17 F 2 1 0.9 M 38 38 M 1.5 1 0.5 M 37 37 F 4 4 F 37 37 F 10 10 M 48 48 F 46 46 M 40 40 M 55 55 F 48 48 F 33 33 F 27 27 F 48 48 M 23 23 M 45 45 M 38 38 F 61 61 F 41 41 M 1.1 1 0.1 F 17 17 F 69 69 F 0.3 0 0.3 F 11 11 M 63 63 F 9 9 M
RPT_DATESYMPTOM_TEXT DIED ### Information has been received from ### Information has been received from ### Information has been received from ### Information has been received from ### Information has been received from 1/2/2009 Local reaction of redness, swelling, 1/2/2009 Vesicular eruption, 3-4 lesions cons 1/2/2009 As reported by patient, he began to 1/2/2009 Fever of 102 within 24 hours of imm 1/2/2009 Fever of 101 beginning within 24 ho 1/2/2009 Fever of 100.5 within 24 hours of im 1/2/2009 Was in reception area immediately a 1/2/2009 Child was given an adult Hep A dos 1/2/2009 Adult Hep A given to child instead o 1/2/2009 Approximately 8 hours after receivin 1/2/2009 Received vaccines along with twin s 1/2/2009 Pt fussy with low-grade fever of 100 1/2/2009 3cm x 4cm raised tender eryth arou 1/2/2009 Slight fever, chills; local redness, sw 1/2/2009 syncope or seizure still being determ 1/2/2009 Beginning 12/11/08 Pt reports bump 1/2/2009 BROKE OUT W/ CHICKEN POX 1/2/2009 Marked local swelling, induration, er 1/2/2009 None 1/2/2009 Patient describes reaction as increa ### Seizure lasting 1-5minutes. Fever 1 ### Has area on L arm located about 2### Seen at hospital 12/03/08 for swellin ### Swelling, redness, induration, warm ### Pt received vaccines below and app ### Swollen, tender supra clavicular lym 12/3/2008 Nov 3rd got flu shot and needle inse 12/7/2008 (2008) Received flu shot Nov 3 & ok 12/8/2008 Received flu shot left deltoid on 11/3 ### Nov 3rd 2008 rec'd flu shot pt sore f ### Pt reports getting her shot 11/3/200 12/3/2008 Nov 3, 2008, shot given Nov 4 & 5 s 12/3/2008 c/o left arm pain. Refusal RN intervi ### He received his flu shot on Nov 3, 2 12/3/2008 Flu shot received 11/3/08. States to 12/3/2008 Since 11/3/08- W/E of Nov 8 & 9. -> 1/2/2009 Patient got rash after getting vaccin 12/3/2008 On Nov 3, 2008 flu shot given left a ### Site of injection was blistered , raise ### Mom reports child with "severe" hip ### Redness, itching one vaccine left ar 1/3/2009 Fever on 12/30/2008- Temp 101 de 1/3/2009 Patient received Menactra vaccine o 1/3/2009 Patient developed Shingles 3 days 1/3/2009 Reaction occurred immediately afte
336399 336400 336401 336402 336403 336404 336405 336406 336407 336408 336409 336410 336411 336412 336413 336414 336415 336439 336440 336441 336442 336443 336444 336445 336446 336447 336448 336449 336450 336451 336452 336453 336454 336455 336456 336457 336458 336459 336460 336461 336463 336466 336471 336472 336473 336474 336475 336476 336477 336478 336479
1/3/2009 NJ 1/4/2009 IN 1/4/2009 VA 1/5/2009 VA 1/5/2009 VA 1/5/2009 CT 1/5/2009 TN 1/5/2009 KY 1/5/2009 NE 1/5/2009 PA 1/5/2009 CA 1/5/2009 PA 1/5/2009 1/5/2009 UT 1/5/2009 OR 1/5/2009 IA 1/5/2009 IL 1/5/2009 OH 1/5/2009 KY 1/5/2009 KY 1/5/2009 MA 1/5/2009 MA 1/5/2009 NC 1/5/2009 MA 1/5/2009 MA 1/5/2009 MA 1/5/2009 TX 1/5/2009 MA 1/5/2009 TX 1/5/2009 MA 1/5/2009 MA 1/5/2009 MA 1/5/2009 MS 1/5/2009 MA 1/5/2009 SD 1/5/2009 MA 1/5/2009 WI 1/5/2009 FL 1/5/2009 KY 1/5/2009 CA 1/5/2009 OH 1/5/2009 NY 1/5/2009 MO 1/5/2009 CO 1/5/2009 TN 1/5/2009 1/5/2009 MT 1/5/2009 NY 1/5/2009 NY 1/5/2009 PA 1/5/2009 NY
4 77 74 75 60 0.5 59 3 34 1.7 6 39 63 38 48 45 6 70 19 20 1 1 6 1 0.5 1.5 21 4 21 0.3 0.3 11 1.1 1 59 15 14 65 1.3 16 1.3 41 0.2 67 18 13 46 17 65 75 29
4 77 74 75 60 0 59 3 34 1 6 39 63 38 48 45 6 70 19 20 1 1 6 1 0 1 21 4 21 0 0 0 1 1 59 15 14 65 1 16 1 41 0 67 18 13 46 17 65 75 29
F M M M M 0.5 F F F F 0.7 M F M F F F F M F M M 0M 0M F 0F 0.5 M 0.5 M M M M 0.4 M 0.3 F 0F 0.1 F 0M F F M M 0.3 M M 0.3 M F 0.2 M F F F F F M F F
1/3/2009 Raised red area approximately 4 inc 1/4/2009 The patient complains of major swe 1/4/2009 Patient was given Zostavax vaccine ### Pt states he had itching at injection ### Chest tightness, Y shortness of breath ### Received flu vaccine 12/8. On 12/10 ### Severe congestion-nasal,ears,head ### 3 days after DTaP was given right th 1/2/2009 States fatigue, itching around face, ### Large red bumps on legs after shots 1/2/2009 Mother reports temp of 103 degrees ### Redness and swelling around vacci 1/2/2008 On December 26 at 10 am received ### 3 days following Flu vax developed ### Severe pain "10/10" in deltoid area ### About 4 weeks after the f/u shot, I e ### Child was struggling before shot- he 1/5/2009 Patient states she recieved Zostava 1/5/2009 Patient complains of generalized ur 1/5/2009 Patient observed having trouble bre 1/5/2009 Suspect post- MMR reactions; fine p 1/5/2009 Suspect MMR rash. Pt developed p 1/5/2009 PATIENT SEEN FOR WELL CHILD 1/5/2009 Local redness at vaccine site with lo 1/5/2009 Localized heat, redness, and swellin 1/5/2009 Firm nodule, red skin at DTaP imm 1/5/2009 PT PRESENTED TO ALLERGY/IMM 1/5/2009 Localized rxn to DTaP- area of eryth 1/5/2009 Erythematous, maculopapular rash 1/5/2009 Induration, bruising at site of immun 1/5/2009 3-4 mm subcutaneous swelling at im 1/5/2009 Site of varicella vaccine swollen to t 1/5/2009 patient received the MMR & Varicel 1/5/2009 Redness and swelling in left thigh w 1/5/2009 Got flu shot on 12/2/08 and on 12/4 1/5/2009 Extreme Hives, trouble breathing / p 1/5/2009 Weakness, pain in back, headache, 1/5/2009 within 2 days developed ipsilateral u 1/5/2009 patient received vaccine on decemb 1/5/2009 Menactra was ordered for the patien ### Initial information was received on 2 1/5/2009 This case was reported by a lawyer ### Admitted to hospital on 12/24/08 fo ### Pt got ZOSTAVAX shot 6-16-08. Ha ### Onset increased muscle pain, fatigu ### After my daughter received her 1st 12/8/2008 1) Headaches 2) Visual Change: fel ### She received flu shot and Pneumov 12/9/2008 Patient was given PNEUMOVAX an 1/1/2009 Pt came to clinic on 12/30/08. After ### She developed severe right arm pai
336480 336482 336483 336484 336485 336486 336487 336488 336489 336490 336491 336492 336493 336494 336495 336496 336497 336498 336499 336500 336501 336503 336504 336505 336506 336507 336508 336509 336510 336511 336512 336513 336514 336515 336518 336520 336521 336522 336462 336550 336551 336552 336553 336554 336555 336556 336557 336558 336559 336560 336561
1/5/2009 FL 1/5/2009 MI 1/5/2009 FL 1/5/2009 VA 1/5/2009 NY 1/5/2009 MA 1/5/2009 CO 1/5/2009 NY 1/5/2009 1/5/2009 MS 1/5/2009 IN 1/5/2009 FL 1/5/2009 MN 1/5/2009 GA 1/5/2009 TX 1/5/2009 NC 1/5/2009 NC 1/5/2009 WA 1/5/2009 NY 1/5/2009 WA 1/5/2009 CA 1/5/2009 1/5/2009 CA 1/5/2009 TX 1/5/2009 NJ 1/5/2009 LA 1/5/2009 NJ 1/5/2009 PA 1/5/2009 MA 1/5/2009 MD 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/5/2009 GA 1/6/2009 CA 1/6/2009 NJ 1/6/2009 WI 1/6/2009 WI 1/6/2009 MA 1/6/2009 GA 1/6/2009 AL 1/6/2009 MO 1/6/2009 LA 1/6/2009 CA 1/6/2009 NV 1/6/2009 IL 1/6/2009 OK
0.2 66 66 69 7 11 39 1
0 66 66 69 7 11 38 1
26 5 50 1.3 34 1.1 13 17 60 2 46 1.2 15 1.1 60 4 26 23 37 57 49 14 32 0.5 11 47 12 29 85 1 30 53 60 1 44 64 17 18 4 42
26 5 50 1 34 1 13 17 60 2 46 1 15 1 60 4 26 23 37 57 49 14 32 0 11 47 12 29 85 1 30 53 60 1 44 64 17 18
1
0
42
0.2 F M F F M M F 0M F F F F 0.3 M F 0.1 F F F M 0.5 F F 0.2 F F 0.1 F F M M M F M F M F 0.5 F F F M F F 0F F F F 0M F F F F F F F 1M
### Vaccine was administered 12/15/08 ### On 12-22-08 Patient received PNEU ### Possible reaction to vaccine 1-2 day ### Muscle pain (next morning) extendin ### Patient presents with stomach pain, ### Left deltoid hypersensitivity reaction ### 2 days after vaccine had slight rash ### scattered diffuse maculo-papular ra ### Soon after receiving Hep A vaccine ### None Stated ### Mother called, daughter is very wea ### Heat, tenderness, erythema left upp ### Rash started 12/27, started on face ### 3 1/2 X 5 inch raised, erythematous ### Erythema 20X26 ### Immunization was administered in le ### None. Hep B injection in gluteal reg 1/5/2009 Mild swelling, tingling and redness a 1/5/2009 Pt here for well child visit and had ju 1/5/2009 C/o nausea, light headed, dizziness 1/4/2009 Red rash after getting immz on rt lg. 5/15/2008 SM reported receipt IM Influenza ag ### 13 mo brought by mom for over 1 w ### Patient left arm still sore. Hard to gr ### Right arm red and swollen 12cm by 3/10/2008 Description: rash 10 days after SMP ### Noticed 12/15/08, notes soreness, s 1/5/2009 Patient had suspected immune reac 1/5/2009 Pain at injection site x 2 days. On 3 1/5/2009 Ringing in ears, jaw tightness, lighth 11/6/2008 Pt received vaccine on Friday. Satu ### 12/3/2008 TWINRIX given. Blistery ### Received on immunizations on 10-2 ### Child in school nurse office-phone c 10/7/2008 Patient complains of swelling at site ### Mother called and stated this (L) arm 10/9/2008 Client complains of swelling at injec ### Had PNU on 12/10/08 arm red from 1/5/2009 Within 5 hours, patient experienced 1982 I was given vaccines for Typh ### 11/30 T 101 Dr. ran rapid strep -> n 1/2/2009 Headache within 15 min - 5 cm red ### Vaccines administered in L thigh on ### Patient reports that a rash began 3 ### Approximately 1 wk following injecti ### Patient blacked out after receiving H Increased headache, increase men ### Site of DTaP on L deltoid very red, s ### Raised red area at vaccine site + ab 4 female school teachers c/o S.O.B ### Patient RTC on 12/31/08- c/o .5cm
336562 336564 336565 336578 336580 336581 336582 336583 336586 336603 336604 336605 336606 336607 336608 336609 336610 336611 336612 336613 336614 336615 336616 336617 336618 336620 336625 336626 336627 336628 336629 336630 336631 336632 336633 336634 336635 336636 336637 336638 336654 336655 336656 336657 336664 336665 336666 336667 336668 336669 336670
1/6/2009 FL 1/6/2009 AZ 1/6/2009 WI 1/6/2009 NJ 1/6/2009 FL 1/6/2009 1/6/2009 NJ 1/6/2009 IL 1/6/2009 PA 1/6/2009 MD 1/6/2009 MA 1/6/2009 MA 1/6/2009 PA 1/6/2009 OH 1/6/2009 MT 1/6/2009 TN 1/6/2009 MA 1/6/2009 CO 1/6/2009 IA 1/6/2009 VA 1/6/2009 MA 1/6/2009 PA 1/6/2009 MO 1/6/2009 IL 1/6/2009 OH 1/6/2009 NJ 1/6/2009 FL 1/6/2009 ME 1/6/2009 PA 1/6/2009 NE 1/6/2009 MN 1/6/2009 MN 1/6/2009 MN 1/6/2009 CA 1/6/2009 ME 1/6/2009 IN 1/6/2009 MI 1/6/2009 MD 1/6/2009 NY 1/6/2009 FL 1/7/2009 NC 1/7/2009 CO 1/7/2009 MA 1/7/2009 MI 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH 1/7/2009 NH
32 16 61 19 25 18 9 65 71 48 1.3 1.3 71 74 0.3 0.2 9 45 73 0.2 0 1 12 41 41 36 52 0.6 71 52 54 22 29 69 41 30 15 25 1.5 34 0.2 55 1.4 63 38 32 31 28 38 29 30
32 16 61 19 18 9 65 48 1 1 71 74 0 0 9 45 74 0 0 1 12 41 41 36 0 71 52 54 22 29 69 41 30 15 25 1 0 55 1 63 38 32 31 28 38 29 30
M F F F F F F F F F 0.3 F 0.3 F F F 0.3 M 0.2 F F F F 0.2 M 0F 0M F M M F F 0.6 M M F F M F M F F M F 0.5 M F 0.2 M M 0.4 F F F F F F F F F
### Swollen shoulder w/red itchy rash ### 12/26/08 1520 client fainted 5-10 se ### Left upper arm just distal to shoulde 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/5/2009 Information has been received from 1/6/2009 Post viral symptoms 4 weeks post In 1/6/2009 Redness swelling and induration an 1/6/2009 Patient had a seizure two hours afte 1/6/2009 pain in arm, mild redness, progress 1/6/2009 Client stated that the evening after r 1/6/2009 Parents stated that pt developed a m 1/6/2009 Within 5 minutes of getting vaccines 1/6/2009 Pt presented with approx 5 cm area 1/6/2009 Fever of 101 -102, body aches, and 1/6/2009 12/16/08 RECIEVED VACCINE. 12 1/6/2009 High fever (102.9F), SOB & rash 3 d 1/6/2009 Patient was given Hep B shot at 1 m 1/6/2009 Vesicles noted on right arm near sit 1/6/2009 Vaccines given in same arm 12/20/0 1/6/2009 Associate was given Tdap vaccinati 1/6/2009 Approx. 10 hours after getting Tetan 1/6/2009 This case was reported by a lawyer ### A serious spontaneous report of Be This is a previously health 8-month1/6/2009 On November 10 pt received Flu va 1/6/2009 Injection site hurt longer than any pr 1/6/2009 Arm was sore for prolonged amount 1/6/2009 Arm was sore at site of injection for 1/6/2009 Arm was sore after receiving flu sho 1/6/2009 Bell's palsy-absence of muscular co 1/6/2009 Patient got dizzy, was short of breat 1/6/2009 Severe bilateral leg pain with cramp 1/5/2009 Within 12 hrs of vaccine. L arm at va ### 12/11/08 6:00pm, Rash appeared o Localized swelling (L) lateral thigh. 1/6/2009 Pt given vaccine and after a few min ### Pt developed Y decreased PO intake ### Began with left elbow pain, progress 1/2/2009 As part of flu clinic 17 mo was given ### Woke up on the 11th with a horrend 1/5/2009 This serious case was received from 1/5/2009 Initial report was received 27 Decem 1/6/2009 Initial report received on 27 Decemb 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial report received on 27 Decemb 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial report was received 27 Decem
336671 336672 336673 336675 336698 336699 336700 336701 336702 336703 336704 336705 336706 336707 336708 336709 336710 336711 336712 336713 336714 336715 336716 336722 336723 336724 336725 336726 336727 336728 336729 336730 336731 336732 336733 336773 336777 336778 336783 336784 336785 336786 336788 336789 336790 336791 336792 336793 336794 336795 336796
1/7/2009 NH 1/7/2009 NH 1/7/2009 NC 1/7/2009 FL 1/7/2009 FL 1/7/2009 VA 1/7/2009 AR 1/7/2009 NY 1/7/2009 WI 1/7/2009 PA 1/7/2009 WI 1/7/2009 PA 1/7/2009 LA 1/7/2009 NY 1/7/2009 WV 1/7/2009 PA 1/7/2009 UT 1/7/2009 VA 1/7/2009 CA 1/7/2009 CA 1/7/2009 GA 1/7/2009 MI 1/7/2009 NJ 1/7/2009 TX 1/7/2009 MN 1/7/2009 IA 1/7/2009 CA 1/7/2009 1/7/2009 CA 1/7/2009 CA 1/7/2009 CO 1/7/2009 MI 1/7/2009 VT 1/7/2009 IL 1/7/2009 TX 1/8/2009 1/8/2009 TN 1/8/2009 DC 1/8/2009 CA 1/8/2009 IL 1/8/2009 IL 1/8/2009 SC 1/8/2009 PA 1/8/2009 PA 1/8/2009 AZ 1/8/2009 PA 1/8/2009 AR 1/8/2009 MN 1/8/2009 OH 1/8/2009 AZ 1/8/2009
29
29
51 6 77 44 1 65 0.2 64 13 12 11 13 65 4 29 11 38 0.8 14 73 46 62 40 40 4 9 1 4 15 21 14 14 14 0.3
51 6
0.6 78 2 1 5 63 38 18 6 6
0 78 2 1 5 63 38 18 6 6
77 60 1.3
77 60 1
44 1 65 0 64 13 12 11 13 65 4 28 11 38 0 14 73 46 62 40 40 4 9 1 4 15 21 14 14 14 0
F M F M F F 0F F 0.2 M F M F M F F M M M F 0.7 F F M F F F F F F 0M F F F F F M 0.3 U M 0.6 F F 0F 0M M F M M F M U F M 0.3 F
1/5/2009 Initial report was received on 27 De 1/5/2009 Initial report was received 27 Decem 1/5/2009 Initial information was received on 2 ### Some shots have given patient the 1/6/2009 Information has been received from 1/7/2009 Rash appeared 3 days after immun 1/7/2009 10 days past her 1 yr. shots she sta 1/7/2009 Severe headache 48 hours after ad 1/7/2009 Patient developed upper respiratory 1/7/2009 Severe dizziness lasting 6 - 8 hours 1/7/2009 Pt developed a blister like rash on to 1/7/2009 Dizziness, nauseous, ringing in the 1/7/2009 Child came in one day later with hiv 1/7/2009 Patient presented to Immunization c 1/7/2009 Patient complained of severe pain, 1/7/2009 1 day after vaccine administration, p 1/7/2009 PT SUFFERED FROM HIVES, RAS 1/7/2009 Left Deltoid area on arm warm and 1/7/2009 f/u redness and swelling to left uppe 1/7/2009 One day after receiving the first dos 1/7/2009 Patient had Gardasil shot and then 1/7/2009 I Called Pt. Wed night to check up o 1/7/2009 This case was reported by a lawyer 1/7/2009 On Jan 2, arm began itching. Got w 1/6/2009 Arm was sore after receiving flu sho 12/3/2008 Initial information was received on 0 ### Left cellulitis; red, warm, tender trea 1/5/2009 My daughter received her second in 1/7/2009 Mild varicella-like rash - Rt upper ar 1/6/2009 Local reaction with itching, redness, 1/7/2009 Dizziness, fever 106 degrees F, red 1/7/2009 Patient received first dose of GARD 1/7/2009 Syncope within minutes of administr 1/6/2009 GARDASIL administered 12/22/08, 1/6/2009 Sleepless night, back pain, fever, he 1/7/2009 Initial report received from health au 1/6/2009 Initial reportYwas received 05 Janua 1/6/2009 Initial report received on 05 January On Oct. 27th Monday: Nurse at me 1/8/2009 Pt developed seizure activity < 12 h 1/7/2009 Patient seen Y on 12/18/08, received 1/8/2009 Diagnosed with juvenile onset diabe ### 10/17/08 3:30 am Hives hospital ER 1/5/2009 10/22/08 - 8pm- Body aches, fever/ ### Patient administered flu vaccine; pa 1/7/2009 Local redness & swelling - started ### Child had facial swelling hives body Injected in left arm - net sore at first ### Swollen left arm, pain ### 60 y/o male with left arm swelling fro 1/6/2009 Patient received VARIVAX on 9/26/
336797 336798 336799 336801 336802 336803 336810 336819 336820 336821 336822 336823 336824 336825 336826 336827 336828 336829 336830 336831 336832 336833 336834 336835 336836 336837 336838 336839 336840 336841 336842 336843 336844 336845 336846 336847 336848 336850 336851 336852 336853 336854 336861 336865 336866 336867 336868 336870 336871 336872 336873
1/8/2009 1/8/2009 OR 1/8/2009 1/8/2009 OR 1/8/2009 1/8/2009 1/8/2009 TX 1/8/2009 SC 1/8/2009 ND 1/8/2009 OR 1/8/2009 WI 1/8/2009 MO 1/8/2009 WV 1/8/2009 NY 1/8/2009 CA 1/8/2009 DE 1/8/2009 NM 1/8/2009 TX 1/8/2009 IA 1/8/2009 VA 1/8/2009 TX 1/8/2009 MI 1/8/2009 CA 1/8/2009 MN 1/8/2009 1/8/2009 NV 1/8/2009 CT 1/8/2009 FL 1/8/2009 WI 1/8/2009 IL 1/8/2009 AZ 1/8/2009 VA 1/8/2009 HI 1/8/2009 NM 1/8/2009 TX 1/8/2009 NY 1/8/2009 PA 1/8/2009 AZ 1/8/2009 1/8/2009 MN 1/8/2009 CO 1/8/2009 NY 1/9/2009 WY 1/9/2009 OR 1/9/2009 FL 1/9/2009 OH 1/9/2009 OH 1/9/2009 NM 1/9/2009 CT 1/9/2009 WI 1/9/2009 MD
1.3 1.2
1 1
12
12
18 25 40 15 66 18 60 16 2 0.8 29 4 68 20 23 52 44 5 15 72 64 42 4 0.2 0.2 66 1.2 82 54 74 13 0.2 4 26 15 16 18 2 8 14 11 18 38 15 25
25 40 15 66 18 60 16 2 0 29 4 68 20 22 52 44 5 14 72 64 42 4 0 0 66 1 82 54 74 13 0 26 15 16 2 8 14 11 18 38 15 25
0.3 F 0.2 F U F M U F F M F F F F F 0.9 M 0.8 F F M F F F F F F F M F F F 0.2 F 0.2 M F 0.2 M F F F F 0.2 M F F F F F 0.5 F M M M F M F F
1/6/2009 Patient received VARIVAX on 1/12/ 1/6/2009 Patient received VARIVAX on 5/7/0 1/6/2009 Patient received VARIVAX on 2/15/ 1/6/2009 Patient received VARIVAX on 12/27 Reacci¢n alergica, ronchas, comez¢ Allergic reaction, hives, itchiness, di ### Information has been received from 1/8/2009 12/15/08--Patient received Td on 9/ 1/8/2009 Pt. has increased swelling on L arm 1/8/2009 Redness on arm and spreading. Ho 1/8/2009 The patient received the Pneumova 1/8/2009 Within about one minute of receivin 1/8/2009 Pt telephoned 1/08/09 and stated th 1/8/2009 after the vacc,pt c/o dizzyness,when 1/8/2009 Flumist was administered at 11:00a 1/8/2009 Hives, starting 1 day after shot. Str 1/8/2009 Received a call from patient above 1/8/2009 Fell asleep after injection. Awoke lim 1/8/2009 Patient experienced acute leg weak 1/8/2009 9:50 am: phone call received by he 1/8/2009 23 year old female presented to Stu 1/8/2009 Pt came three days later w/complain 1/8/2009 Pt reports tingling and numbness/ne 1/8/2009 Received the shots on 10/23/2008 a 1/8/2009 Five to ten minutes after Td shot pt. 1/8/2009 SHINGLES FACE; NOSE; EYE NO 1/8/2009 Gillian Barre Syndrome after receivi 1/8/2009 I received an MMR shot on Decemb 1/8/2009 Diagnosis of double pneumonia one 1/9/2009 Patient found Y unresponsive in crib b 1/7/2009 Onset of bilious vomiting, abd. bloat 1/7/2009 Numbness of upper lip < lower lip a 1/8/2009 Several fluid-filled vesicles on red b 1/8/2009 Cellulitis to RUE to include erythem 1/8/2009 Local reaction to ADACEL . Pt has 1/7/2009 Pain & redness - Left deltoid - pt. di 1/7/2009 Loss of consciousness approximate 1/7/2009 12 hrs after vaccine, infant became 1/7/2009 Information has been received rega 1/7/2009 Initial and follow up information has 1/7/2009 Information has been received from 1/7/2009 Information has been received from ### Information has been received from 1/5/2009 Prolonged soreness/pain complaint ### Mother states child developed swell 1/5/2009 After vaccination patient appeared p 1/5/2009 Approximately ten minutes after his ### Patient was mistakenly administered 1/4/2009 Pt presented with redness on his to ### Rec'd varicella and FLUZONE R arm 1/6/2009 Pt passed and approximately 15-30
336875 336876 336877 336878 336879 336880 336881 336882 336888 336913 336914 336915 336916 336917 336918 336919 336920 336921 336922 336923 336924 336925 336926 336927 336928 336929 336930 336931 336932 336933 336934 336935 336936 336937 336938 336939 336940 336941 336942 336943 336944 336945 336946 336961 336962 336963 336964 336968 336969 336970 336971
1/9/2009 IL 1/9/2009 NC 1/9/2009 PA 1/9/2009 WA 1/9/2009 CA 1/9/2009 LA 1/9/2009 NJ 1/9/2009 1/9/2009 MI 1/9/2009 VA 1/9/2009 VA 1/9/2009 OH 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 VA 1/9/2009 TX 1/9/2009 WA 1/9/2009 TX 1/9/2009 UT 1/9/2009 MS 1/9/2009 VA 1/9/2009 AZ 1/9/2009 KY 1/9/2009 TX 1/9/2009 MA 1/9/2009 MA 1/9/2009 TX 1/9/2009 MO 1/9/2009 FL 1/9/2009 AR 1/9/2009 AR 1/9/2009 TX 1/9/2009 OH 1/9/2009 CO 1/9/2009 CO 1/9/2009 AZ 1/9/2009 AZ 1/9/2009 NY 1/9/2009 MT 1/9/2009 MI 1/9/2009 MI 1/9/2009 KY
76 0.1 50 14 69 1.1 0.7 28 18 28 5 31 49 27 45 23 36 27 29 43 42 29 38 37 18 32 27 49 3 26 0.2 24 62 17 4 17 21 39 24 47 5 18 47 0.2 0.2 32 65 0.4 8 57
76 0 50 14 69 1 28 18 28 5 31 49 27 45 23 36 27 29 41 41 29 38 37 18 32 27 49 3 26 0 24 62 17 4 17 21 39 24 47 5 18 47
32 65 0 8 57
F 0.1 M F M U 0.1 F F F F M F F F M F F M M M M M M M M F M F F M F 0.2 F F F F F F F F F M F F F F U U F M 0.4 M F F
1/6/2009 Information has been received from 1/6/2009 Crying nonstop day of vaccines unc 1/2/2009 Patient had right deltoid IM injection Right deltoid soreness, dizziness an 1. Received vaccine on 12-10-08. 2 1/5/2009 Patient received vaccines (PREVNA No physical exam. Child received H 1/6/2009 Migraine with auras, nausea and he ### Information has been received from 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 Redness/Swelling 4 inches around 1/9/2009 Had been sick the week before vacc 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 RECEIVED INFLUENZA IM VACCI 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 SM RECEIVED THE INFLUENZA IN 1/9/2009 pain from left elbow to left shoulder 1/9/2009 Patient recieved Flumist (lot 500570 1/9/2009 TC from patient @ 11am. Started w 1/9/2009 1) 5 min after injection, heat flush & ### Mom noted swelling to left upper arm 1/9/2009 HAD THE SERIES OF 3 GARDISIL 1/9/2009 ON 1/1/2009 CHILD STARTED RUN 1/9/2009 Received tdap in the afternoon of 11/9/2009 AFTER TWO DAYS OFIMMUNIZAT 1/9/2009 Patient received HPV vaccine on 10 1/9/2009 Left arm where dtap and polio was g 1/9/2009 Mother of patient called immunizatio 1/8/2009 1/7/09@1000-Patient calls this offic 1/9/2009 On January 6, 2009, 2.5 weeks afte 1/9/2009 COMPLAINING OF PAIN AND TEN 1/9/2009 Patient received vaccine on 12/18/0 1/9/2009 Per mom C/O at about 5 - 6 PM sta 1/9/2009 Woke up that Sunday a.m. feeling v 1/9/2009 Got the vaccine at 4 in the afternoon 1/8/2009 This case was reported by a healthc 1/8/2009 This case was reported by a physici 1/8/2009 This case was reported by a physici 1/8/2009 This case was reported by a physici 1/9/2009 Pt phoned 1/8/09 stating that he had 1/7/2009 Mother states child developed Temp 1/7/2009 No information Provided 1/9/2009 Patient reported to facility with 5 1/2
336972 336973 336974 336975 336977 336978 336979 336980 336981 336982 336983 336984 336985 336986 336947 336948 336949 336950 336951 336952 336953 336954 336955 336956 337031 337032 337033 337035 337036 337037 337038 337039 337040 337041 337042 337043 337045 337046 337047 337048 337049 337050 337051 337052 337053 337054 337055 337056 337057 337058 337059
1/9/2009 ND 1/9/2009 IN 1/9/2009 AZ 1/9/2009 NY 1/9/2009 HI 1/9/2009 UT 1/9/2009 OR 1/9/2009 TX 1/9/2009 NY 1/9/2009 NH 1/9/2009 CO 1/9/2009 VA 1/9/2009 CA 1/9/2009 CA 1/10/2009 TX 1/10/2009 PA 1/10/2009 CA 1/11/2009 MA 1/11/2009 NE 1/11/2009 MN 1/11/2009 UT 1/11/2009 FL 1/11/2009 CA 1/11/2009 TN 1/12/2009 1/12/2009 TN 1/12/2009 1/12/2009 GA 1/12/2009 NY 1/12/2009 FL 1/12/2009 AZ 1/12/2009 WI 1/12/2009 CT 1/12/2009 NV 1/12/2009 FL 1/12/2009 MN 1/12/2009 NC 1/12/2009 IN 1/12/2009 TN 1/12/2009 TN 1/12/2009 FL 1/12/2009 LA 1/12/2009 HI 1/12/2009 MN 1/12/2009 MT 1/12/2009 MI 1/12/2009 WV 1/12/2009 OR 1/12/2009 FL 1/12/2009 CO 1/12/2009 MI
20 1.1 11 18 20 19 18 1.2 75 12 0.3 1.5 1.3 1.5 31 80 65 3 28 42 50 29 72 0.3 18 18
20 1 11 18 20 19 18 1 75 12 0 1 1 1 31 80 65 3 28 42 50 29 72 0 18
0.2 71 25 32 17 17 60 1.2 53 0.2 47 0.8 1 1.1 0.4 11 2 65 51 4 8 1 12 62
0 71 25 32 17 60 1 53 0 47 0 1 1 0 11 2 65 51 4 8 1 12 62
M 0.1 F F F F F M 0.2 F F M 0.3 M 0.5 M 0.3 F 0.5 F F F F M F F F M F 0.3 F F F U 0.2 M M F M M F F 0.2 M F 0.2 M F 0.8 M 0M 0.1 M 0.4 M F 0.2 F F F F M 0M M F
1/2/2009 1-2-09 client received MENACTRA 1/9/2009 Rash over body started 1/8/09, wors 1/9/2009 B/L deltoid area with erythema/ war 1/9/2009 Patient given GARDASIL- fainted af 1/5/2009 Dizzy, lightheaded, tachycardia, inte 1/9/2009 15 min after immunization complain 1/9/2009 Mini stroke. 2/18/09 Neurology cons 1/9/2009 DTAP 0.5 cc IM right deltoid. With in 1/9/2009 Patient developed shingle along C3 1/9/2009 Patient developed redness and pain 1/9/2009 Within 72 hrs of receiving 4 month v 1/9/2009 Profuse Vomiting 1/9/2009 8:51 am onset of 104 degree fever. 1/9/2009 (L) chin swelling. Increase fever of 4 1/10/2009 Low grade fever, sore throat, swolle 1/10/2009 Patient's son (a DMD) is visiting from 1/10/2009 Dermatofibroma at site (subcutaneo 1/11/2009 Vomiting and fever. Had Vaccine m 1/11/2009 Erroneously received two doses of M 1/11/2009 Fever (<100dF), which lasted sever 1/11/2009 Wed, 7 Jan afternoon, shut van slid 1/11/2009 high temperature, respiratory illness 1/11/2009 Swelling, inflamation, pain at shot s 1/11/2009 Behavior changes including fussine 1/9/2009 Information has been received from 1/9/2009 Information has been received from 1/9/2009 InformationYhas been received from 1/9/2009 Information has been received from 1/7/2009 6-27-02 1st PNEUMOVAX - 0 reach ### Cellulitis infection near injection site 1/6/2009 Nausea, vomiting, fatigue and hot fl ### Loss of consciousness sonorous br Fluctuating total body urticaria. Tre 1/7/2009 Client called and reported a rash all 1/7/2009 rash ### 4 Inch redness at injection site that ### High pitched unconsolable crying + 1/3/2009 Received MMR + VARIVAX vaccine ### Local reaction redness, swelling for ### Had temp 102.4 evening following v 1/5/2009 Red bumps all over face, neck, arm ### 1 by 1 cm redden area to (R) thigh & ### Right arm redness 7.5cm x 3.5cm, t Temperature unknown. Symptoms i 12/3/2008 Female complains of sore right arm 1/6/2009 Pain at injection site for 2 months. ### At approx 11:30 am pt developed ra ### 12/30 Mom noticed swelling at injec 1/7/2009 Pt received varicella immunization o ### Developed diffuse, maculopapular r Pt states about 2-3 days after inject
337060 337061 337062 337063 337064 337065 337067 337068 337069 337070 337071 337072 337073 337074 337075 337076 337077 337078 337079 337080 337081 337082 337083 337084 337086 337099 337100 337101 337102 337103 337104 337105 337113 337087 337088 337089 337094 337095 337096 337097 337098 337115 337130 337132 337133 337134 337135 337136 337137 337138 337139
1/12/2009 OH 1/12/2009 PA 1/12/2009 MN 1/12/2009 WV 1/12/2009 MI 1/12/2009 GA 1/12/2009 PA 1/12/2009 VA 1/12/2009 SC 1/12/2009 CA 1/12/2009 ND 1/12/2009 OH 1/12/2009 OK 1/12/2009 GA 1/12/2009 CA 1/12/2009 TN 1/12/2009 HI 1/12/2009 MD 1/12/2009 MD 1/12/2009 LA 1/12/2009 OK 1/12/2009 1/12/2009 AZ 1/12/2009 CO 1/12/2009 KY 1/12/2009 1/12/2009 AL 1/12/2009 KY 1/12/2009 MI 1/12/2009 AL 1/12/2009 AL 1/12/2009 FL 1/12/2009 MN 1/13/2009 GA 1/13/2009 WA 1/13/2009 OH 1/13/2009 AZ 1/13/2009 MN 1/13/2009 PA 1/13/2009 TX 1/13/2009 WA 1/13/2009 MO 1/13/2009 TX 1/13/2009 CA 1/13/2009 WA 1/13/2009 OR 1/13/2009 MN 1/13/2009 NC 1/13/2009 IN 1/13/2009 NH 1/13/2009 VT
71 0.4 23 42 90 44 57 50 6 26 14 18 0.2 0.3 14 0.2 19 63 0.1 0 55 4 46 34 67 21 1.8 46 0.5 9 41 62 70
71 0 23 42 90 44 57 50 6 26 14 18 0 0 13 8 19 65 0 0 55 4 46 34 67 21 1 46 0 9 41 62
70
70
1.4 60 12 35 19
1 60 12 35 19
0.3 1.8 16 44 0.9 1.6 33 26 54
0 1 16 44 0 1 33 26 54
F 0.4 F F F F F M F F F M F 0.2 F 0.3 F M F M M 0.1 M 0F F F F F F M 0.8 F F 0.5 M F M F U F F F 0.4 M F F F M F 0.3 M 0.8 F F F 0.9 F 0.6 F F M F
Hard, warm swelling shoulder to elb 1/12/2009 Intussusception. 2/23/09 Received 1/12/2009 Patient felt hot, dizzy, lightheaded, h 1/8/2009 Right deltoid developed edema afte 1/7/2009 Elevated swelling with in duration an 1/6/2009 States she had nausea and chest p 1/12/2009 Patient received a pneumococcal va 1/12/2009 "Tender anterior cervical adenoopat 1/12/2009 Parent reported temp of 101.1 on ev 1/12/2009 Received TDAP Vaccine on 1/7/200 1/12/2009 Four hours after vaccination, patien 1/12/2009 Patient left message on voicemail 0 1/12/2009 gave pt wrong immunization in wron 1/12/2009 SPOKE WITH MOTHER AND NOT 1/12/2009 fever 104, Rt arm swollen from elbo 1/12/2009 diarrhea 1/12/2009 FEVER 102F, VOMITING X1 DAY. 1/12/2009 Malaise onset 36-48 h after immuniz 1/12/2009 3 DAYS AFTER VACCINES PT DE 1/12/2009 Pt recieved two Hep B vaccines dur 1/12/2009 Complains of upper right arm pain s 1/12/2009 RASH ALL OVER BODY 1/12/2009 Nerve tingling at all sites from bottom 1/12/2009 "Breathing difficulty, fever, body ach 1/12/2009 Arm developed a 3 inch diameter re ### 18 Days after small pox and anthrax 1/5/2009 Febrile seizure - Had flu shot 11-141/9/2009 Patient had Tdap injection LT arm o ### Infant found listless, poor muscle to FLUMIST received 12/27/08. On 12 ### Flumist received on Saturday, 12/27 1/6/2009 Had a headache from 12-17-08 time ### Information has been received from 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 Vomiting, fever, Heat @ site. 1/12/2009 Shortness of breath, bodyaches. Tr 1/12/2009 Pt recvd menactra + Hep A vaccine 1/12/2009 Developed shaking, shivering with p 1/12/2009 Patient filled out info sheet stating h ### Information has been received from Pt. examined Y and vaccinated on 12 1/8/2009 Developed cold, cough, vomiting aft ### Within 5 mins of receiving HPV injec 1/6/2009 Saw PCP With X 3days fever 99 , H 1/8/2009 Hours after flu vaccine administered 1/9/2009 Seen on 1-7-09 = lt leq red + swolle 1/9/2009 Patient had a flu shot in October 20 ### Member developed a satellite pustu 12/3/2008 Burning itch over upper body, extrem
337141 337142 337143 337144 337145 337146 337147 337148 337149 337150 337151 337152 337153 337155 337157 337158 337159 337160 337161 337162 337163 337165 337166 337167 337168 337169 337170 337171 337172 337173 337174 337175 337176 337177 337178 337179 337180 337181 337182 337183 337184 337185 337186 337187 337188 337189 337190 337191 337192 337193 337194
1/13/2009 MN 1/13/2009 PA 1/13/2009 NJ 1/13/2009 IL 1/13/2009 TX 1/13/2009 TX 1/13/2009 VA 1/13/2009 MA 1/13/2009 MN 1/13/2009 MA 1/13/2009 AL 1/13/2009 1/13/2009 1/13/2009 FL 1/13/2009 OH 1/13/2009 MN 1/13/2009 MI 1/13/2009 OK 1/13/2009 MI 1/13/2009 OK 1/13/2009 GA 1/13/2009 WI 1/13/2009 LA 1/13/2009 VA 1/13/2009 FL 1/13/2009 TX 1/13/2009 GA 1/13/2009 TX 1/13/2009 CO 1/13/2009 AZ 1/13/2009 FL 1/13/2009 PA 1/13/2009 IL 1/13/2009 CA 1/13/2009 MI 1/13/2009 MO 1/13/2009 NV 1/13/2009 ME 1/13/2009 IL 1/13/2009 HI 1/13/2009 HI 1/13/2009 HI 1/13/2009 CA 1/13/2009 NM 1/13/2009 KY 1/13/2009 NY 1/13/2009 NY 1/13/2009 NC 1/13/2009 NC 1/13/2009 CA 1/13/2009 NY
63 3 18 1.1 26 26 5 11 49 37
63 3 18 1 26 26 5 11 49 37
63 15 4 22 5 16 0.8 6 41 0.3 14 0.2 11 0.6 0.5 0.3 63 58 35 75 11 0.2 38 12 17 35 15 20 20 20 4 52 1.3 1.7 1 37 26 1.3 18
63 15 4 22 5 16 0 6 41 0 14 0 11 0 0 0 63 58 35 75 11 0 38 12 17 34 15 20 20 20 4 52 1 1 1 37 26 1 18
U F F F 0.1 M F F M M F F M F F M F M F 0.8 M F M 0.4 M F 0.2 F F 0.6 F 0.5 U 0.3 M F F F F F 0.2 M F M F M F F F F M F 0.3 M 0.7 M 0M F F 0.3 M M
Right Arm cellulitis. 10/20/08 Vaccinated at 9AM- Pain i ### Slept 14 hours; woke up dizzy; then 1/6/2009 Patient fainted 4 days after vaccinat 1/8/2009 Erythema 20 x 20 over (L) arm PCV 1/6/2009 Dizzy, headache, brown spot in visio 1/9/2009 Blister at the side where HEPTAVAX 1/7/2009 (L) deltoid with 11.5cm x 13cm area ### 20cm erythema, pruritis and pain at 1/8/2009 Generalized body rash with mild ede 11/4/2008 Nerve damage in right arm. I have p 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received for th 1/13/2009 Redness noted at injection site on le 1/13/2009 after first two HPV shots had muscle 1/13/2009 Patient has received two Varicella v 1/13/2009 PT RECEIVED GARDASIL, MENAC 1/13/2009 On 1-9-09 patient had a seizure at 7 1/13/2009 PT PRESENTED TO OFFICE ON 1 1/13/2009 Headache, malaise, myalgias began 1/13/2009 3 days following vaccination patient 1/13/2009 Started complaining with joint pain, 1/13/2009 1/8, 11:40am - parent returned to he 1/13/2009 My daughter recived the first HPV g 1/13/2009 Child had seizure 7 hours after 2nd 1/13/2009 Flush race on face and swelling of f 1/13/2009 Sseizure within 24 hours of vaccina 1/13/2009 WEAKNESS; PAIN & NUMBNESS 1/13/2009 10/16/08 1 PM-PT REPORTED FRE 1/13/2009 Right deltoid slightly swollen, with w 1/13/2009 Four days of chills without fever, my 1/13/2009 Itchy rash, raised bump at the site, s 1/13/2009 My son was a very happy and relax 1/13/2009 1-10-09 11am stiff neck, tight jaw m 1/13/2009 Within five minutes of vaccine admin 1/13/2009 Pt developed strong daily headache 1/13/2009 Site was mildly painful, warm, red, s 1/8/2009 Patient developed genital herpes pr Dizziness, lightheaded, tachycardia Dizziness, lightheaded, tachycardia Dizziness, lightheaded, tachycardia 1/12/2009 L upper arm- erythematous mac rais Swelling of entire arm down to finge 1/8/2009 Developed fever of 104 degrees foll 1/13/2009 Swelling to LL at site of vaccine. Ad 1/9/2009 Fever (low grade), rash of a vesicula ### (L) dt area where she got ADACEL ### Patient developed low back pain tha 1/9/2009 Fever 104 - x2Days, Motrin/Tylenol. 1/13/2009 Night of vaccines pt broke out in hiv
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1/13/2009 NY 1/13/2009 CT 1/13/2009 CT 1/13/2009 CT 1/13/2009 CT 1/13/2009 OH 1/13/2009 MO 1/13/2009 OR 1/13/2009 NC 1/13/2009 NC 1/13/2009 VA 1/13/2009 NY 1/13/2009 NY 1/13/2009 1/13/2009 TX 1/13/2009 NY 1/13/2009 OH 1/14/2009 1/14/2009 NM 1/14/2009 PA 1/14/2009 OH 1/14/2009 MA 1/14/2009 PA 1/14/2009 1/14/2009 1/14/2009 1/14/2009 1/14/2009 1/14/2009 PA 1/14/2009 1/14/2009 CT 1/14/2009 OK 1/14/2009 MA 1/14/2009 IL 1/14/2009 RI 1/14/2009 FL 1/14/2009 NE 1/14/2009 MI 1/14/2009 AZ 1/14/2009 TX 1/14/2009 FL 1/14/2009 TX 1/14/2009 MN 1/14/2009 CT 1/14/2009 NC 1/14/2009 NC 1/14/2009 MI 1/14/2009 MI 1/14/2009 MI 1/14/2009 KS 1/14/2009 FL
16 26 70 72 50 73 79 56 18 57 19 48 1.3 1.1 0.3 1.3 61 20 0.4 1 14 38 27 20 77 65 16 17 12 67 66 55 78 51 12 76 2 4 4 12 44 0.5 28 5 14 36 18 22 65
16 26 70 72 50 73 79 56 18 57 19 48 1
1 20 0 1 14 38 27 20
16 17 12 66 55 78 51 12 76 2 4 4 12 44 0 28 5 14 36 18 22
M F M M F F F F M F F F M 0.1 F U M 0.3 M F F 0.4 M 0M F F F F F M M F F F F F M M M F F 0.2 F M M M F 0.5 M F F F M F F M
1/13/2009 Mom stated child had congestion, s 1/6/2009 Left arm pain since flu shot reported 1/6/2009 Pt states his whole right arm was sw 1/12/2009 Pt states his whole right arm was sw 1/6/2009 12/10/08 Reported persistent pain a 1/12/2009 1/6/09 left upper arm became red, w 1/5/2009 30x50 mm area of erythema and wa 1/13/2009 Day 3 post tetanus/pertussis vaccin ### Pt given RECOMBIVAX HB instead ### Infection of left deltoid following Influ 1/12/2009 C/O redness and swelling at injectio 1/12/2009 45 minutes after injection - develope 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from 1/12/2009 Information has been received from ### Information has been received from 1/9/2009 My daughter Y had her 3rd GARDASI 1/9/2009 Patient developed Y hemorrhagic sho 1/9/2009 Can the chicken pox vaccine cause 1/12/2009 VARIVAX & influenza given in left a 1/8/2009 Pain in L upper arm with 2 hours of 1/12/2009 Hives after ZOSTAVAX vaccination 1/12/2009 Diagnosed with rheumatoid arthritis ### Pt describes onset of pain at R shou ### 12/22/08 patient called after hours w 1/3/2009 Fever, Erythema Multiforme, Diarrhe 1/13/2009 Information has been received from 1/13/2009 Information has been received from 1/13/2009 Information has been received from 1/13/2009 Initial and follow-up information has ### PNEUMOVAX 23 given 12/2/08 bet 1/13/2009 Persistent right deltoid pain after He 1/14/2009 Patient began with cough and uppe 1/14/2009 01/05/2009 Increase Tempature/ 0 1/14/2009 Provider notified Y on 1/2/09 that patie 1/14/2009 TWO WEEKS AFTER VACCINATIO 1/14/2009 A little more than 24 hours I noticed 1/14/2009 2 days after receiving Hepatitis A an 1/14/2009 THE DAY AFTER I ADMINISTERED 1/14/2009 Pt ran fever to 102. Had a large kno 1/14/2009 upper arm 7cm red/warm tender bu 1/14/2009 Pt developed fever of 104.5 with irri 1/14/2009 Flushot given around 11AM? About 1/14/2009 RED,SWOLLEN LEFT DELTOID RE 1/14/2009 Arm swelling (site of innoculation), a 1/14/2009 Approximately 2 hours after receive 1/14/2009 Given Meningococcal (MCV4) vacci 1/14/2009 Sharp stomach pains within 2 hours 1/14/2009 yfvax administered 01/12/09, 01/13/
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1/14/2009 IL 1/14/2009 MN 1/14/2009 NC 1/14/2009 UT 1/14/2009 ME 1/14/2009 VA 1/14/2009 1/14/2009 GA 1/14/2009 OR 1/14/2009 NY 1/14/2009 TX 1/14/2009 FL 1/14/2009 CA 1/14/2009 CA 1/14/2009 AZ 1/14/2009 NC 1/14/2009 NY 1/14/2009 MI 1/14/2009 IN 1/14/2009 NC 1/14/2009 IL 1/15/2009 1/15/2009 1/15/2009 OH 1/15/2009 NH 1/15/2009 AZ 1/15/2009 WA 1/15/2009 WA 1/15/2009 AZ 1/15/2009 AZ 1/15/2009 1/15/2009 WA 1/15/2009 1/15/2009 NC 1/15/2009 NC 1/15/2009 1/15/2009 NC 1/15/2009 NC 1/15/2009 NC 1/15/2009 1/15/2009 1/15/2009 1/15/2009 NC 1/15/2009 FL 1/15/2009 1/15/2009 1/15/2009 1/15/2009 OR 1/15/2009 CO 1/15/2009 AZ 1/15/2009 AZ
4 26 45 23 64 65 63 6 4 47 20 68 4 0.4 67 7 48 1.2 12 1.3 16 33 25 60 53 22 67 52 2 2 21 12 27 19 40 32 21 41 22 19 21 28 29
4 26 45 23 64 65 63 6 4 47 20 68 4 0
16 0.2 55 0.5 64 0.3 5
16 0 55 0 64 0 5
7 48 1 12 1 16 33 25 60 53 22 67 52 2 21 12 27 19 40 32 21 41 22 19 21 28 29
F F M F F F F F F F U F F 0.4 M F F F 0.2 M F 0.3 M F M M F F F U F 0.1 F M F F M M F M M M M M M F F M F 0.2 U F 0.5 M F 0.3 M F
1/14/2009 DTaP given on 1/12/09 right arm, H 1/14/2009 4 hours after shot administered, felt 1/14/2009 1 1/2 hours after receiving the MMR 1/14/2009 Shots at 2:30pm 12/30/08 Slight he 1/14/2009 Patient reported having a fever, loca 1/14/2009 Shingle Shot was administered and 1/14/2009 patient came down with Shingles. W 1/14/2009 SHE RECEIVED THE FLU SHOT IN 1/14/2009 Fever at least 103, chills, fatigue, lo 1/11/2008 Description: 47 y/o female AD SM re 1/14/2009 The patient states with every flu vac 1/14/2009 Pt came in c/o pain to L side of face 1/14/2009 Mild local hypersensitivity Rxn to va 1/14/2009 Injection given on 01/13/09 in arm. M 1/7/2009 Rash- has been to 2 Doctors who s 1/19/2009 Rt arm red & swelled where VARIVA 1/14/2009 C/O chills, fever, headache, body ac 1/14/2009 There is a 6x7cm hard red patch on 1/14/2009 Patient eyes swollen shut, itchy. BE 1/14/2009 3 erythematous areas distal to site o 1/6/2009 Lower abdominal discomfort, onset 1/12/2009 This patient was a 34 year old male 1/15/2009 SM who received multiples doses o 1/12/2009 1-05-2009 received flu vaccine. Pt r 1/12/2009 Pt developed cellulitis on the site of 1/13/2009 Patient received yellow fever and ty Within 18 hours-swelling 2"x3" raise 1/11/2009 Flu Shot was fine at first but overtim 1/10/2009 Pain at sight, fever, non-weight bea 1/10/2008 Pain at injection site, fever, non-wei 1/10/2009 Prior to 3 doses of GARDASIL I had 1/7/2009 After first shot of GARDASIL on 2-7 6/2/2008 27 y.o. AD AA male SM presents wi 1/15/2008 SM received his primary SPV on 11 1/9/2008 Less than one minute after receiving 1/4/2008 SM developed redness, swelling, pa ### noted rash on arm, redness into his ### SM with h/o eczema that received S ### SM noted redness, swelling around ### SM had large local reaction with his 12/7/2007 SM notes he had large local reactio ### Developed large local reaction to an 11/7/2007 SM went to PCP for evaluation of H 1/14/2009 Information has been received from 1/14/2009 Information has been received, for t 1/14/2009 Information has been received from 1/15/2009 This case was reported by a consum 1/15/2009 Intussusception. First began with bl 1/12/2009 Bright red, hard area approximately 1/13/2009 Mother reported elevated temperatu 1/13/2009 Redness developed at injection site
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1/15/2009 NY 1/15/2009 NY 1/15/2009 CA 1/15/2009 KS 1/15/2009 PA 1/15/2009 KY 1/15/2009 IA 1/15/2009 OH 1/15/2009 MD 1/15/2009 CA 1/15/2009 WA 1/15/2009 GA 1/15/2009 WA 1/15/2009 ID 1/15/2009 NY 1/15/2009 CA 1/15/2009 OR 1/15/2009 CO 1/15/2009 TN 1/15/2009 CA 1/15/2009 MI 1/15/2009 CA 1/15/2009 IN 1/15/2009 NC 1/15/2009 NH 1/15/2009 NC 1/15/2009 1/15/2009 CA 1/15/2009 WI 1/15/2009 TX 1/15/2009 GA 1/15/2009 MA 1/15/2009 NC 1/15/2009 CA 1/15/2009 IN 1/15/2009 1/15/2009 ME 1/15/2009 IA 1/15/2009 OH 1/15/2009 IN 1/15/2009 MD 1/15/2009 CA 1/15/2009 MI 1/15/2009 VT 1/15/2009 NY 1/16/2009 CA 1/16/2009 CA 1/16/2009 FL 1/16/2009 MO 1/16/2009 MO 1/16/2009 NY
17 18 1.4 0.2 0.2 2 86 0.5 17 69 12 4 63 54 3 40 6 50 62 25 1.3 42 1 4 1.6 0.3 0.8 0.2 5 46 5 23 9 15 68 32 10 0.4 0.2 0.9
17 18 1 0 0 2 85 0 17 69 12 4 63 54 3 40 6 50 62 25 1 42 0 4 1 0 0 0 5 46 5 23 9 15 68 32 10 0 0 0
35 29 58 1.5 4 25 75 15 15 61
35 29 58 1 4 25 75 15 15 61
M F 0.4 F 0.2 M 0.2 M 0.6 F F 0.6 F F F F F F F F F M M F F 0.3 M F 0M M 0.6 F 0.3 M 0.8 M 0.2 F F M M F F F F M M 0.4 F 0.2 M 0.9 M U F F M 0.5 F F M F F F F
1/15/2009 About 2-3 mins after receiving vacci 1/15/2009 Patient states that right wrist was sw 1/15/2009 Red, warm to touch rash at injection 1/15/2009 Mother noted blood in infant's stool 1/15/2009 high pitched screaming for hours on 1/15/2009 Mother reports hives on back- uppe 1/15/2009 Patient reported raised red very pai 1/15/2009 Motehr called and reported need to 1/15/2009 Within 3 days of receiving the 2nd r 1/15/2009 patient was accidently give Tdap ins 1/15/2009 High fevers 102+, Nausea, Dizzy, le 1/15/2009 Pt R leg 11 x 7 cm reddened area n 1/15/2009 Lower upper arm is very swollen an 1/15/2009 Received 3rd hep B injection on 12/ 1/15/2009 low grade fever, vomiting, dehydrati 1/15/2009 Patient complained of persistent red 1/15/2009 Acute icshemic stroke (basilar artery 1/15/2009 Following receipt of vaccines in trav 1/15/2009 Patient received vaccine 01/06/2009 1/15/2009 Hepatitus B Vaccine series given at 1/15/2009 Uncontrollable screaming and fits of 1/15/2009 Onset of reactive lymphadenopathy 1/15/2009 Jacob had a febrile seizure with a te 1/14/2009 Dar reported patient "almost passed 1/15/2009 Mom called-mosquito bite size area 1/13/2009 When pt was brought to my office fo 1/6/2009 Hepatitis A given to 9 month old chi ### persistent severe irritability, 4-6 hrs 1/8/2009 Upper leg Swelling, warmth redness 1/8/2009 12/20 1 1/2 area of redness with ele 1/9/2009 Left upper arm - redness and swellin 1/9/2009 C/O light headedness and inability t 9/22/2008 Client given Tdap - recommended fo 1/15/2009 Complained of pain radiating from in 1/15/2009 Five inch red circle around administ 11/1/2007 SM changed bandage over SPV site 1/15/2009 1/12/09- Area swelled red raised. V 1/14/2009 Child came to appointment for 4 mo 1/12/2009 Abnormal sounding cry, crying cons 1/15/2009 On 1-14-09 per mother at 10:30 pm None stated 1/15/2009 Within 2 hours of vaccination Pt exp 1/15/2009 11-14-09 back of neck began to itch 1/13/2009 Severe Shaking Chills myalgias for ### Here with both parents for rash, Frid 1/12/2009 1/5/09 received DTAP, IPV, MMR,V 1/13/2009 Left arm cellulitis 24 hours after vac Vaccine injection 3:45p- woke up 9: 1/8/2009 10/07- Vomiting, Diarrhea Daily-No 1/12/2009 Within 24 hours of HPV dose given 1/12/2009 1/9/09 0830 Pt. called to report that
337548 337549 337550 337551 337552 337553 337584 337585 337586 337590 337591 337592 337595 337596 337600 337601 337602 337603 337605 337606 337607 337608 337609 337610 337611 337612 337613 337614 337615 337616 337617 337618 337633 337649 337650 337651 337652 337663 337664 337665 337666 337667 337668 337670 337671 337672 337674 337675 337688 337689 337690
1/16/2009 NY 1/16/2009 CA 1/16/2009 NY 1/16/2009 IL 1/16/2009 AZ 1/16/2009 1/16/2009 PA 1/16/2009 1/16/2009 1/16/2009 IL 1/16/2009 FL 1/16/2009 CA 1/16/2009 1/16/2009 NJ 1/16/2009 FL 1/16/2009 FL 1/16/2009 FL 1/16/2009 NY 1/16/2009 TX 1/16/2009 NM 1/16/2009 NM 1/16/2009 DC 1/16/2009 SC 1/16/2009 TN 1/16/2009 FL 1/16/2009 CA 1/16/2009 WY 1/16/2009 AZ 1/16/2009 WY 1/16/2009 AZ 1/16/2009 CA 1/16/2009 PA 1/16/2009 CT 1/16/2009 UT 1/16/2009 1/16/2009 1/16/2009 MA 1/16/2009 NJ 1/16/2009 NY 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 NY 1/16/2009 AL 1/16/2009 AR 1/16/2009 MA 1/16/2009 GA 1/16/2009 IL 1/16/2009 VA 1/16/2009 KS 1/16/2009 MN
60 0.1 4 2 1.1 62 0.2
60 0 4 2 1 62 0
22 13 19 59
22 13 19 59
66 69 67 24 1 15 13 5 42 42 44 54 0.2 34 33 18 2 29 64 1.1 90
66 69 67 24 1 15 13 5 42 42 44 54 0 34 33 18 2 29 64 1 90
48
48
52
52
46 0.1 0.5 5 8 32 87 19 44
46 0 0 5 8 32 87 19 44
F 0.1 F F 0M 0.1 F U 0.2 F U M F F F F F F F M F 0F F M F F F F F 0.2 F F M F 0.1 F F F 0.1 M F F F M M M M F M 0.1 M 0.5 F F F U F M F
patient developed a 1"x1 1/2" indura 1/12/2009 Bloody, mucousy stools after ROTA 1/4/2009 24 hrs after UMM placed erythema, 1/12/2009 Child received PEDIARIX/PREVNA ### Started 10-15 min after getting vacc Large lump- size of "grape" in arm 12/1/2008 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information was obtained on reques 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/15/2009 Information has been received from 1/16/2009 Within 30 minutes of vaccination to 1/16/2009 The patient presented with swelling 1/16/2009 Patient presented with cellulitis of rig 1/16/2009 I HAD SEVERE PAIN AT THE SITE 1/16/2009 Patient had a rash on the thighs and 1/16/2009 Abdominal pain/stomach cramps for 1/16/2009 Was disoriented, unable to answer 1/16/2009 PT RECEIVED EXPIRED FLUMIST 1/16/2009 Reported rash & periorbital swelling 1/16/2009 Patient reported burning and stingin 1/16/2009 Pt experienced large local reaction 1/16/2009 Patient came to clinic today and pre 1/16/2009 Patient developed watery diarrhea 1 1/16/2009 Patient came to Health Center at 12 1/16/2009 eyes itching, tightness in chest, cou 1/16/2009 Had 1st HPV on November 4th, 200 1/16/2009 Patient had an afebrile seizure even 1/16/2009 Sore arm, fever, body aches, chills, 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/15/2009 This case was considered medically 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/16/2009 This case was reported by a lawyer 1/12/2009 Found by father Y not breathing appro 1/16/2009 Pt was administered Y vaccines on 01 1/12/2009 Developed hives/facial swelling, loc 1/16/2009 11/4 had varicella shot R arm. 11/5 Lt deltoid became red, swollen, war 1/14/2009 VARICELLA- like rash 1/15/2009 Chills, fever of 101.9, aches, stiffnes 1/9/2009 My left shoulder started pinching. T
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1/16/2009 MN 1/16/2009 NC 1/16/2009 WI 1/16/2009 AZ 1/16/2009 TX 1/16/2009 FL 1/16/2009 WI 1/16/2009 1/16/2009 1/16/2009 CA 1/16/2009 MI 1/16/2009 MN 1/16/2009 OH 1/16/2009 1/16/2009 1/16/2009 DC 1/16/2009 GA 1/16/2009 MO 1/16/2009 NY 1/16/2009 CT 1/16/2009 WI 1/16/2009 OK 1/16/2009 CA 1/16/2009 1/16/2009 1/16/2009 CA 1/16/2009 IN 1/16/2009 NY 1/16/2009 1/16/2009 1/16/2009 IN 1/16/2009 1/16/2009 NC 1/16/2009 PA 1/16/2009 1/16/2009 1/16/2009 IL 1/16/2009 OH 1/16/2009 OH 1/16/2009 NJ 1/16/2009 TX 1/16/2009 TX 1/16/2009 TX 1/16/2009 MI 1/16/2009 PA 1/16/2009 NC 1/16/2009 TX 1/16/2009 WI 1/16/2009 1/16/2009 IN 1/16/2009 IN
43 0.6 15 53 1.4 1.3 12 36 31 9 65 1 1
43 0 15 53 1 1 12 36 31 9 65 1 1
21 45
21 45
10 39
10 39
38 8
38
48 0.3
0
0.1 38 26 48
0 38 26 48
50 72 45
50 72 45
3
3
26
26
27
27
F 0.6 F F M 0.4 F 0.3 M M M M F F 0F 0M U U F M M U F M F F F U U F 0.3 F F F 0.1 M F M M F U M M M M F M M F F M M F F U U
1/9/2009 Worst shot ever given- hurt immedia 3/5/2008 Redness, induration, swelling on R 1/16/2009 Syncopal episode following GARDA 1/16/2009 Redness, firm, warm to touch 6.0cm Area is swollen, hot red to left thigh. 1. Inconsolable, crying within 6 hrs. 1/14/2009 Confused/blurriness/head pain/naus 1/25/2008 SM developed redness, swelling an 1/31/2008 Developed redness, pain and swelli 1/15/2009 Pt received vaccine at our office on 1/16/2009 Vaccines given 1/14/09. Left arm s 1/19/2009 Patient developed hives within 2 hrs 1/12/2009 Red raised rash over torso, about 3 1/12/2009 On unspecified dates, the subjects r 1/12/2009 This case was reported by a sales r 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharm 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a health 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a nurse a 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a pharma
338094 338095 338096 338097 338098 338138 338147 338148 338150 338151 338152 338154 338155 338156 338157 338158 338159 338160 338161 338162 338163 338164 338165 338166 338167 338168 338169 338170 338171 338172 338173 338174 338175 338176 338177 338178 338179 338180 338181 338182 338183 338184 338185 338186 338187 338188 338189 338190 338191 338192 338193
1/16/2009 IN 1/16/2009 DE 1/16/2009 1/16/2009 TX 1/16/2009 SC 1/16/2009 SC 1/16/2009 1/16/2009 TX 1/16/2009 1/16/2009 1/16/2009 MO 1/16/2009 IN 1/16/2009 NY 1/16/2009 MO 1/16/2009 1/16/2009 1/16/2009 CT 1/16/2009 1/16/2009 GA 1/16/2009 NY 1/16/2009 CT 1/16/2009 CT 1/16/2009 1/16/2009 AZ 1/16/2009 1/16/2009 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 1/16/2009 FL 1/16/2009 GA 1/16/2009 MD 1/16/2009 TX 1/16/2009 MI 1/16/2009 MN 1/16/2009 AZ 1/16/2009 AZ 1/16/2009 1/16/2009 1/16/2009 KY 1/16/2009 ND 1/16/2009 1/16/2009 NY 1/16/2009 1/16/2009 1/16/2009 1/16/2009 1/16/2009 AK 1/16/2009 1/16/2009 TX 1/16/2009 IA
50
22 18
18
36 13 37 55 77
36
62
62
29 42 31
29 42
75 52
75 52
25 23 32 54 79 30 78 76 60
25
58
58
37 55 77
32 79 78 76
53
53 29 15
29 15
U M U M M M M F U M U F M F M U M U F F M F F F U U M M U M F F F M M F F F U M U U F M U M F M F F M
1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a pharma 2/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported a physician, 1/12/2009 The subject was in clinic for day 180 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by healthca 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a pharma 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a consum 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc
338194 338195 338196 338197 338198 338199 338200 338201 338202 338353 338354 338355 338356 338357 338358 338359 338360 338361 338362 338363 338364 338365 338366 338367 338368 338369 338370 338371 338381 338383 338385 338388 338389 338390 338391 338392 338393 338394 338395 338396 338397 338398 338399 338524 338525 338526 338527 338528 338529 338530 338531
1/16/2009 1/16/2009 1/16/2009 1/16/2009 TX 1/16/2009 1/16/2009 WI 1/16/2009 TX 1/16/2009 TX 1/16/2009 MI 1/16/2009 FL 1/16/2009 CO 1/16/2009 IL 1/16/2009 IA 1/16/2009 CA 1/16/2009 1/16/2009 1/16/2009 1/16/2009 TN 1/16/2009 IN 1/16/2009 NC 1/16/2009 NC 1/16/2009 NJ 1/16/2009 NJ 1/16/2009 TX 1/16/2009 VA 1/16/2009 NY 1/16/2009 WA 1/16/2009 1/16/2009 IL 1/16/2009 GA 1/16/2009 GA 1/16/2009 GA 1/16/2009 1/16/2009 CA 1/16/2009 MI 1/16/2009 IN 1/16/2009 IL 1/16/2009 PA 1/16/2009 IN 1/16/2009 IL 1/16/2009 OR 1/16/2009 1/16/2009 TX 1/16/2009 MO 1/16/2009 CT 1/16/2009 KS 1/16/2009 KY 1/16/2009 IN 1/16/2009 CA 1/16/2009 TN 1/16/2009 GA
56
21 0.5 5 2 5 0.3 0.5
21 0 5 2 5
0.2 0.2 0.3 0.3 0.2 0.2
0 0
2 0.6 11 1.1 0.6 1 0.2 0.2
2 0
1.3 1.5 0.3 0.3 0.4 0.2 0.1
1 1 0
57 0.7 4 1.8 1.6 0.9 4 0.6 2
57
0
0 1 0 0
0 0 0
1 4
U U M U U F U M M 0.5 M M 0.7 M F U F U U 0.2 M 0.2 M U U F 0.2 M U 0.1 M 0.6 F M F 0.6 M 0F 0.2 M 0.2 M M M 0.3 M 0.5 F 0.3 F U 0.4 M 0.2 F 0.1 M U F M M F 0.6 M M M U F
1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a physici 1/12/2009 This case was reported by a healthc 1/12/2009 This Case was reported by a pharm 1/12/2009 This case was reported by a healthc 1/12/2009 On 18 September 2007 the subject 1/12/2009 This case was reported by a healthc 1/12/2009 This case was reported by a healthc ### This case was reported by a healthc ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a pharma ### This case was reported by a pharma ### This case was reported by a healthc ### This case was reported by the moth ### This case reported by a physician, v ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a consum ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by the moth ### This case was reported by a consum ### This case was reported by a healthc ### This case was reported by a physici ### This case was reported by a healthc ### This case was reported by a consum ### This case was reported by a healthc ### This case was reported by a physici 1/12/2009 This case was reported by a healthc ### A non-serious spontaneous report o 12/3/2008 A non-serious spontaneous report a 12/4/2008 A spontaneous non serious report o 12/8/2008 A non-serious report "given FLUMIS ### A non serious report of "gave FLUM ### A non-serious report of administratio ### A non serious, spontaneous report o ### Expired vaccine used (Expired drug
338532 338533 338534 338535 338536 338537 338538 338539 337619 337620 337621 337676 338994 337622 337623 337624 337625 337626 337627 337628 337629 337630 337634 337635 337636 337637 337638 337639 337640 337645 337669 337673 337677 337678 337679 337680 337681 337682 337683 337684 337685 337686 337687 337704 337705 337706 337707 337708 337709 337710 337711
1/16/2009 FL 1/16/2009 CA 1/16/2009 WV 1/16/2009 MO 1/16/2009 1/16/2009 MI 1/16/2009 MI 1/16/2009 MI 1/17/2009 TN 1/17/2009 NY 1/17/2009 1/17/2009 IL 1/17/2009 TX 1/18/2009 NJ 1/18/2009 CO 1/18/2009 IA 1/18/2009 VA 1/19/2009 TX 1/19/2009 WY 1/19/2009 TN 1/19/2009 SC 1/19/2009 WY 1/19/2009 TN 1/19/2009 TX 1/19/2009 NJ 1/19/2009 UT 1/19/2009 TX 1/19/2009 GA 1/19/2009 AZ 1/20/2009 VA 1/20/2009 MI 1/20/2009 OH 1/20/2009 GA 1/20/2009 KY 1/20/2009 DE 1/20/2009 NJ 1/20/2009 NJ 1/20/2009 OR 1/20/2009 OR 1/20/2009 CA 1/20/2009 AL 1/20/2009 AL 1/20/2009 WA 1/20/2009 1/20/2009 MO 1/20/2009 MA 1/20/2009 TN 1/20/2009 PA 1/20/2009 MI 1/20/2009 TX 1/20/2009 LA
4 1.9 4 2 3 3 4
1 4
61 1 59 4 60 48 66 15 19 0.5 60 17 63 70 31 41 2 0.5 43 1.3 5
61 0 59 4 60 48 66 15 19 0 60 17 63 70 31 41 2 0 43 1 5
1 0.3 0.4 12 73 1.9 0.9 80 53 42 16 11 67 54 16 18 54 20 64 1.6 11
1 0 0 12 73 1 0 80 53 42 16 11 67 54 16 18 54 20 63 1 11
M 0.9 F F F F F M U M 0F U M M F F F F 0.6 F F F F F F M 0.5 M 0.5 M M 0.3 M F M 0M 0.3 F 0.4 M F F 0.9 M 0.9 M F F F F M F M F F F F M 0.6 M F
### A non serious spontaneous report o ### A non serious report of a child unde ### A non serious report of administered ### A non serious, spontaneous report o ### A non-serious report of administratio ### A non-serious report of administered ### A non-serious spontaneous report o 1/5/2009 This case was reported by a healthc 1/17/2009 Redness, swelling, itching, pain and 1/17/2009 Patient has history of seizures. She 1/17/2009 Raised bubble 2 inches by 4 inches 1/17/2009 8cm wide x 10cm long, redness, wa 1/7/2009 This case was reported by a pharma 1/18/2009 Patient suffered Severe back pain, T 1/18/2009 lower leg,ankle,and foot were swolle 1/18/2009 Seizure activity, lower paralysis, exh 1/18/2009 Immediately after receiving shot,sev 1/19/2009 Prolonged crying spell for hours afte 1/19/2009 Slight, itchy red rash area across be 1/19/2009 SYNCOPE 1/19/2009 PATIENT FELT LIKE HER HEART 1/19/2009 Patient reported slight rash across b 1/19/2009 Approximately 6-8 hrs after taking th 1/19/2009 30 minutes after vaccine developed 1/19/2009 Pt received MMR on 1/10/09. On 1 1/19/2009 Acute onset right hemisphere ische 1/19/2009 Pt developed Myocardial infarction a 1/19/2009 On 04/13/07, my son was treated in 1/19/2009 Temperature 104.1, heavy chest co 1/16/2009 This case was considered medically 1/19/2009 Pt given HIB Y #4; PREVNAR #4; Hep 1/14/2009 Abd. pain, (+) Stool Guaiac, scream 1/8/2009 4 month old male, received shots by 1/19/2009 Mother states "eye lids swelling, and 1/16/2009 Presented to office on 1/9/09 c/o "ra 1/19/2009 ? febrile sz on 1/16/09 - started seiz 1/19/2009 Localized redness, lump, tendernes 1/19/2009 Pt complained of pain in muscle aro 1/11/2009 1st attempt to administer dose: Una 1/19/2009 Lymph Node swelling 1/19/2009 red wheel apprx 3" immediately afte 1/19/2009 Red wheal immediately after giving 1/19/2009 Red disc at eye of 50 cent piece pin 1/20/2009 Within a few hours after immunizatio 1/13/2009 Headache in "forehead". Nausea - n 1/20/2009 Tdap administered R deltoid 1/16/08 1/20/2009 After 24 hours, injection site swelled 1/20/2009 Client given dose of adult hep A. Cl ### PATIENT CAME INTO OFFICE ON 1/20/2009 behavioral changes, encephalopath 1/20/2009 I believe the symptoms started after
337712 337713 337714 337715 337716 337717 337718 337719 337720 337721 337722 337723 337724 337725 337735 337736 337737 337738 337739 337740 337741 337742 337743 337744 337745 337746 337747 337748 337749 337751 337752 337753 337754 337755 337756 337758 337759 337760 337761 337762 337763 337764 337765 337766 337767 337768 337769 338540 338542 338543 338544
1/20/2009 TX 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 NM 1/20/2009 CA 1/20/2009 WI 1/20/2009 IA 1/20/2009 TX 1/20/2009 TX 1/20/2009 HI 1/20/2009 MA 1/20/2009 1/20/2009 IN 1/20/2009 MT 1/20/2009 FL 1/20/2009 AR 1/20/2009 PA 1/20/2009 OH 1/20/2009 OR 1/20/2009 NY 1/20/2009 NY 1/20/2009 CA 1/20/2009 ID 1/20/2009 MN 1/20/2009 CA 1/20/2009 MI 1/20/2009 CA 1/20/2009 WA 1/20/2009 NY 1/20/2009 MD 1/20/2009 NC 1/20/2009 NJ 1/20/2009 NE 1/20/2009 CA 1/20/2009 WI 1/20/2009 LA 1/20/2009 NM 1/20/2009 PA 1/20/2009 GA 1/20/2009 KY 1/20/2009 PA 1/20/2009 1/20/2009 PR 1/20/2009 CT 1/20/2009 PA 1/20/2009 CA 1/20/2009 SC 1/20/2009 1/20/2009 IL
23 25 23 21 20 23 1.1 47 1.3 5 0.9 47 4 4 2 15 41 16 1 17
23 25 23 21 20 23 47 1 5 11 0 47 4 4 2 15 41 16 1 17
21 0.2 65 11 0.2 15 80 69 15 15 12 13 57 13 1.3 12 14 0.4 0.4 0.5 7 59 29 4 18 16
21 0 65 11 0 15 80 69 15 15 12 13 57 13 1 12 14 0 0 0 7 59
13
13
4 18 16
F M M M M M M F 0.3 F F M 0.9 F M U F 0.1 M M F F 0F F U F 0.2 F F M 0.2 F F F F F M F F M F 0.3 M F F 0.4 M 0.4 M 0.5 F F M F M F F F F F
1/20/2009 Tues - Administered vaccine Wed 1/20/2009 Patient complains of excessive swe 1/20/2009 Patient came in on Friday 16 Jan 20 1/20/2009 Patient came in complaining of exce 1/20/2009 Patient complains of lump, hardnes 1/20/2009 Patient complaining of fever. 1/20/2009 PT DEVELOPED ,MACULOPAPUL 1/20/2009 PATIENT RECIEVED VACCINATIO 1/20/2009 Cheeks swollen and hot 1/20/2009 PATIENT STARTIED TO BREAK O 1/20/2009 PT HAD LOCALIZED HIVE REACT 1/20/2009 I have seen the slightest symptoms 1/20/2009 A week after I received my flu shot I 1/20/2009 Patient received 2 varicella vaccines 1/20/2009 6:45pm Jan 17th mom noticed welts 10/8/2008 Severe seizure (grand mal) lasting o 1/5/2009 Seizures X 2 1-5-09. First time seiz 1/6/2009 Pt had TDAP vaccine on 10/29/08, 1/15/2009 Arm Pain- Contests Rash 1/20/2009 Child broke out in lesions mostly on 1/12/2009 Bilateral leg weakness / had to use 1/20/2009 24 After immunization unable to ma 1/20/2009 Felt faint 30 sec post injection, laid d 1/20/2009 Rash is diffuse in location, reddish a 1/20/2009 Phone call from patient stating a po 1/19/2009 Patient received 1st Tdap in L uppe 1/13/2009 2 months old girl with one day histo Hypotensive, unresponsive for NSR 1/20/2009 24 hrs after ZOSTAVAX - develope ### Redness, induration, just below delt 1/13/2009 25 days after GARDASIL #3 develo 1/14/2009 No adverse symptoms known-3rd M 1/12/2009 Induration - 2x2, Erythema - 5x3 lef 1/14/2009 1/12/09 received call from mother sh ### 7pm 12/14/08 received flu shot 10p 1/20/2009 Patient had fainted about 2-4 min po 1/5/2009 Patient developed fever, irritability a 1/7/2009 Vomiting x 2 approx 6-8 hours after 1/16/2009 Week of 1/23/2007 pain at site of G 1/13/2009 No adverse reactions. Child was giv 1/8/2009 4 month old male, received shots by 1/18/2009 Patient seen in office today for seizu 1/20/2009 Err:508 1/20/2009 Patient was given Td vaccine and in None Stated 1/13/2009 1-9 Had immunization at 11 am tem June 1 Sun- fever, chills, abdomina 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from
338545 338546 338547 338548 338550 338551 338552 338553 338554 338572 338573 338576 338577 338578 338579 338580 338581 338582 338583 338584 338585 338586 338587 338588 338589 338590 338591 338592 338593 338643 338644 338645 338646 338648 338649 338650 338651 338652 338653 338654 338655 338656 338657 338658 338659 338660 338661 338662 338663 338664 338665
1/20/2009 CO 1/20/2009 CA 1/20/2009 CA 1/20/2009 CA 1/20/2009 1/20/2009 IL 1/20/2009 CA 1/20/2009 KS 1/20/2009 CA 1/20/2009 ID 1/20/2009 VA 1/20/2009 1/20/2009 IL 1/20/2009 NJ 1/20/2009 NJ 1/20/2009 1/20/2009 WA 1/20/2009 TX 1/20/2009 CA 1/20/2009 CA 1/20/2009 CA 1/20/2009 FL 1/20/2009 DE 1/20/2009 1/20/2009 1/20/2009 MI 1/20/2009 FL 1/20/2009 NY 1/20/2009 AL 1/20/2009 PA 1/20/2009 CA 1/20/2009 UT 1/20/2009 PA 1/20/2009 CA 1/20/2009 NJ 1/20/2009 VA 1/20/2009 OR 1/20/2009 TX 1/20/2009 TX 1/20/2009 1/20/2009 MD 1/20/2009 CO 1/20/2009 VA 1/20/2009 1/20/2009 GA 1/20/2009 1/20/2009 CA 1/20/2009 IN 1/20/2009 IL 1/20/2009 PA 1/20/2009 DE
14 26 40 26 15 24 2 15 23 18 19 19
14
23 22 14 15 24 15 23 13 20 20 16 21 18
23
16 19 20 16 17 12 23 24 19 14
16
40 26 15
15 23 18 19
14
23 13 20 16 21 18
20 16 17 12 24
26 21 25 22 12 23 15 25 11 14
22 12
25 11
F F F F F F F F F F F F F F F F F F F F F F F F F F M F F F F F F F F F F F F F F U F F F F F F F F F
1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received a co 1/18/2009 Initial and follow-up information has 1/16/2009 Information has been received from 1/16/2009 Initial Information and follow up has 1/16/2009 Information has been received from 1/16/2009 Information has been received for th 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received for th 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from
338666 338674 338675 338676 338677 338678 338680 338681 338682 338683 338684 338685 338686 338687 338688 338699 338700 338701 338702 338703 338748 338749 338750 338751 338752 338753 338754 338755 338756 338757 338758 338759 338760 337726 337727 337770 337771 337772 337773 337774 337775 337776 337777 337778 337779 337780 337781 337782 337783 337784 337785
1/20/2009 NY 1/20/2009 PA 1/20/2009 WI 1/20/2009 MA 1/20/2009 1/20/2009 1/20/2009 PA 1/20/2009 1/20/2009 NJ 1/20/2009 MI 1/20/2009 1/20/2009 IN 1/20/2009 MA 1/20/2009 AZ 1/20/2009 MD 1/20/2009 CA 1/20/2009 MO 1/20/2009 CT 1/20/2009 1/20/2009 NE 1/20/2009 TN 1/20/2009 NJ 1/20/2009 TX 1/20/2009 MI 1/20/2009 1/20/2009 CA 1/20/2009 NJ 1/20/2009 NY 1/20/2009 PA 1/20/2009 1/20/2009 1/20/2009 CT 1/20/2009 CA 1/21/2009 CA 1/21/2009 NY 1/21/2009 MI 1/21/2009 MI 1/21/2009 MI 1/21/2009 MI 1/21/2009 DC 1/21/2009 DC 1/21/2009 CO 1/21/2009 VA 1/21/2009 MD 1/21/2009 FL 1/21/2009 TX 1/21/2009 IL 1/21/2009 CA 1/21/2009 AZ 1/21/2009 NJ 1/21/2009 OH
18 12 0.6 14 18 22 18 19 23
14 22 18 19
16
16
24 12 18 20 25
24 12 18 20 25
14 19 0.6 0.4
14 19 0
0.8 0.3 1.1 0.2 0.2 0.3 0.4 0.2 0.1 62 12 0 54 56 0.4 2 2 15 33 22 62 29 1.3 82 51 3 10
1 0
0 62 12 0 54 56 0 2 2 15 33 22 62 29 1 82 51 3 10
F F M F F F F F F U F U F F F F F F F F 0.6 M U U M U 0.1 F 0.2 M U F U F F 0.1 M M F 0F F F 0.5 M 0.4 M 0F F M F M M 0.3 M M F F F
1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Initial and follow-up information has 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Information has been received from 1/16/2009 Pediatric medical records were rece 1/21/2009 Severe swelling and pain. Took Cep 1/21/2009 Within a couple hours of receiving th 1/21/2009 3 day old recieved comvax. Nurse w 1/21/2009 No known reaction because patient 1/21/2009 No knowm symptoms. She never ca 1/21/2009 The day after infant was given Tdap 1/21/2009 PT RECEIVED EXPIRED FLUMIST 1/21/2009 PT RECEIVED EXPIRED FLUMIST 1/21/2009 Received HPV vaccine on January 1/21/2009 approximately 1100 1-20-08 given s 1/21/2009 PT is complaining of post smallpox 1/21/2009 Soreness of skin on abdomen and l 1/21/2009 16 Jan 09 arms were sore. 17 Jan 0 1/21/2009 PATIENT CAME IN OFFICE ON 1-7 1/21/2009 Patient developed herpes zoster on 1/21/2009 Local reactions on upper Lt. arm, re 1/21/2009 Child received the Flu vaccine betw 1/21/2009 RECEIVED VARICELLA VACCINE
337786 337787 337788 337789 337790 337791 337792 337793 337794 337795 337796 337797 337798 337799 337800 337801 337802 337803 337804 337805 337806 337808 337809 337810 337812 337815 337817 337819 337820 337821 337822 337823 337824 337825 337826 337827 337828 337829 337830 337831 337832 337833 337834 337835 337837 337838 337840 337845 337848 337849 337850
1/21/2009 TX 1/21/2009 DC 1/21/2009 GA 1/21/2009 FL 1/21/2009 NM 1/21/2009 VT 1/21/2009 IL 1/21/2009 MI 1/21/2009 MI 1/21/2009 SC 1/21/2009 MO 1/21/2009 NM 1/21/2009 CO 1/21/2009 TX 1/21/2009 VA 1/21/2009 MT 1/21/2009 TX 1/21/2009 CA 1/21/2009 AZ 1/21/2009 NY 1/21/2009 MN 1/21/2009 PA 1/21/2009 IN 1/21/2009 ND 1/21/2009 MI 1/21/2009 FL 1/21/2009 CA 1/21/2009 GA 1/21/2009 1/21/2009 1/21/2009 MI 1/21/2009 PA 1/21/2009 VA 1/21/2009 MI 1/21/2009 1/21/2009 NJ 1/21/2009 ME 1/21/2009 TX 1/21/2009 MA 1/21/2009 MA 1/21/2009 MA 1/21/2009 1/21/2009 WI 1/21/2009 NJ 1/21/2009 NJ 1/21/2009 MI 1/21/2009 1/21/2009 1/21/2009 1/21/2009 NJ 1/21/2009 NC
24 4 0.5 47 4 24 25 65 9 27 14 18 0.5 13 50 27
23 4 0 47 4 24 25 65 9 27 14 18 0 13 50 27
0.4 4 13 23 0.6 0.3 79 21 21 11 0.2 6 1.7 1 81 1.3 86 61 12 68 1 13 0.3 5
0 4 13 23 0 0 79 21 21 11 0
76 26 19 51 26 28 0.3 41 0.4
76
1 81 1 86 61 12 68 1 13 0 5
19 51
0 41 0
M F 0.5 F F M F F F F F F F 0.5 F F F M M 0.4 M F F F 0.6 M 0.3 F F F F F 0.2 M F M 0M F 0.3 M M F F M 0M F 0.3 M F U F M F F F U 0.3 M F 0.4 M
1/21/2009 HA, temp of 104.8, B/P 168/80, ach 1/21/2009 EXPIRED FLUMIST GIVEN TO CH 1/21/2009 Mom phoned today 01/21/2009 @9 1/21/2009 Approximately 12 hours after vaccin 1/21/2009 itching, difficulty breathing, lips swel 1/21/2009 Headache, Nausea, Vomiting, Diarr 1/21/2009 extreme weakness, fatigue, dizzines 1/21/2009 Pt felt fine after shot. 6 hrs later site 1/21/2009 Patient developed large area of eryt 1/21/2009 Client reports noticing itching and so 1/21/2009 Passed out immediately after HPV s 1/21/2009 Headaches,Yperiods were very errat 1/21/2009 Possible seizures (repetitive head tu 1/21/2009 Pt c/o pain, swelling, redness to righ 1/10/2009 Fever developed; Right arm red, sw 1/22/2009 Jan 16 received vaccine (Anthrax) in 1/21/2009 Patient reported a lot of pain in left a 1/20/2009 Within a few hours of shots pt devel 1/21/2009 Left upper arm 6 inch by 9 inch eryt 1/21/2009 Site never got swollen or red. Just v 1/21/2009 Gave pediatric dose of HEP A was 1/21/2009 Child received PENTACEL, HEP B, 1/21/2009 Developed red rash around injection 1/21/2009 Red, slightly warm to touch, swelling 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/21/2009 Patient developed erythematous pa 1/21/2009 Patient lips were swelling. Patient w 1/20/2009 Quarter- sized erythema around inje 1/21/2009 Erythema and pruritis on forehead & 1/20/2009 Information has been received from 1/20/2009 1. Legs pain. 2. Some time weake 1/21/2009 Patient had vaccination- shortly afte 1/20/2009 1 yr old boy (WM) seen 1/9/2009 fo ### Localized reaction to VARIVAX give ### Patient received 2nd dose of Rotate 12/5/2008 7x6cm area erythema, warm, tende 1/20/2009 Information has been received from 1/20/2009 Information has been received from 1/16/2009 Left upper arm & shoulder; edema & 1/15/2009 Vaccination small pox, left shoulder ### Deep aching pain in upper arm, and 1/20/2009 Information has been received from W/in 30 seconds: tingling & numbne 1/21/2009 This male subject was enrolled in th 1/16/2009 T 98.0 degree rash on left arm surro 1/21/2009 Fever to 103.5, lethargy with crying
337851 337853 338761 337950 337951 337952 337953 337958 337959 337962 337963 337965 337966 337967 337968 337969 337970 337971 337972 337973 337974 337975 337976 337977 337978 337979 337980 337981 337982 337983 337984 337985 337986 337988 337989 337990 337991 337992 337993 337994 337995 337996 337997 337998 337999 338000 338002 338003 338004 338005 338006
1/21/2009 ME 1/21/2009 CA 1/21/2009 FL 1/22/2009 1/22/2009 1/22/2009 1/22/2009 CA 1/22/2009 VA 1/22/2009 OH 1/22/2009 OH 1/22/2009 OR 1/22/2009 NJ 1/22/2009 IL 1/22/2009 AL 1/22/2009 NC 1/22/2009 NC 1/22/2009 IA 1/22/2009 PA 1/22/2009 CA 1/22/2009 CA 1/22/2009 NC 1/22/2009 KY 1/22/2009 OH 1/22/2009 WA 1/22/2009 KY 1/22/2009 SC 1/22/2009 MO 1/22/2009 MN 1/22/2009 HI 1/22/2009 SC 1/22/2009 IN 1/22/2009 KY 1/22/2009 NJ 1/22/2009 NH 1/22/2009 MD 1/22/2009 NY 1/22/2009 UT 1/22/2009 TX 1/22/2009 1/22/2009 VA 1/22/2009 HI 1/22/2009 AZ 1/22/2009 PA 1/22/2009 CA 1/22/2009 1/22/2009 NC 1/22/2009 NY 1/22/2009 NY 1/22/2009 CA 1/22/2009 NJ 1/22/2009 OH
0.4 0.4 17 13 14 22 19 70 34 5 21 15 1.6 0.2 59 58 65 0.2 46 25 54 17 54 16 0.2 20 1 11 5 61 11 17 1.3 0.6 1 10 1.1 1 63 1.4
0 0 17
2 0.6 57 27 0.6 17 29 3 32 0.3
2 0 57 27 0 17 29 3 32 0
70 34 5 21 15 1 0 59 58 65 0 46 25 54 17 53 16 0 19 1 11 5 61 11 17 1 0 1 10 1 1 1
0.4 M 0.4 M M F F F F M F F F F 0.6 F 0.2 F F F F 0.2 F F F F F F F 0.2 F F 0M F F M F F 0.3 M 0.6 M 0M F 0.1 M 0F F 0.4 F F 0M 0.6 F F M 0.6 F F F F M 0.3 M
1/15/2009 Patient was admitted to medical cen 1/20/2009 On 12/17 and 12/18 4-5 episodes w 9/29/2008 Initial report received on 12 March 2 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from 1/21/2009 Information has been received from ### DKA New onset juvenile diabetes. 1/14/2009 Soon after Gardasil, pt developed fe 1/22/2009 ON 1/21/2009 APPROXIMATELY @ 1/22/2009 NEST DAY AFTER INJECTION, 2 S 1/22/2009 No adverse event, just diagnosed w 1/22/2009 Injection site swelled about the size 1/22/2009 Patient described area around vacc 1/22/2009 Patient was vaccinated on 01/08/20 1/22/2009 2 month shots (HepB, Rotavirus, Pn 1/22/2009 I have had pain in my Deltoid area t 1/22/2009 On 15Jan2009, pt was administered 1/22/2009 The 2 nights after the inject I was ve 1/22/2009 Patient fainted miniutes after the inj 1/22/2009 Pain/swelling/erythema at injection s 1/22/2009 dizziness, hot flushing, sweating, bl 1/22/2009 no adverse event at this date and tim 1/22/2009 Approximately 10 minutes after rece 1/22/2009 Mild varicella disease, less than 50 1/22/2009 Adolescent became lightheaded the 1/22/2009 Local swelling, erythema, warmth an 1/22/2009 In the week following the vaccinatio 1/16/2009 About 12 hrs after vaccines, mild diz 1/21/2009 Vaccine given 6 days ago Pt noticed 1/22/2009 Fever to 102, maculopapular rash o 1/22/2009 Neck: normal, supple, no lymphade 1/22/2009 Started breaking out 1/19. Itches - r 1/19/2009 Left upper arm - hot and swollen, re 1/21/2009 Patient received VARIVAX (chicken 1/22/2009 Received vaccine 1-16-09 - On 1-21 1/14/2009 Patient received ZOSTAVAX shot o 1/16/2009 Pt developed fever to 102 degree a 1/18/2009 Pt. scratching at site & next day arm 1/22/2009 Had temp of 101-102 X 24 hours - s 1/13/2009 Fussiness in the hours after vaccine 12/1/2008 Nerve in arm feel affected. Cannot l 1/22/2009 Denied problems with AVA #1 and # 1/15/2009 105 fever night that vaccines given. 1/8/2009 Swelling in both wrist, itching on pal 1/22/2009 Large area of erytheima & edema & 1/20/2009 Pt given 1 (HEP A) vaccine/left offic 1/14/2009 Within 2 minutes of vaccination c/o 1/19/2009 Vomiting, fussiness X 24 hrs, vomiti
338007 338008 338009 338010 338011 338012 338013 338014 338015 338016 338017 338049 338050 338052 338057 338058 338061 338064 338065 338066 338067 338068 338069 338070 338071 338072 338073 338074 338099 338100 338101 338102 338103 338104 338105 338106 338107 338109 338110 338111 338112 338113 338114 338122 338123 338124 338125 338126 338127 338128 338129
1/22/2009 VA 1/22/2009 1/22/2009 DC 1/22/2009 AL 1/22/2009 UT 1/22/2009 RI 1/22/2009 OR 1/22/2009 PA 1/22/2009 PA 1/22/2009 CA 1/22/2009 OR 1/23/2009 KY 1/23/2009 SC 1/23/2009 MO 1/23/2009 FL 1/23/2009 GA 1/23/2009 NJ 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 ID 1/23/2009 MA 1/23/2009 FL 1/23/2009 MD 1/23/2009 KS 1/23/2009 MI 1/23/2009 TX 1/23/2009 NH 1/23/2009 GA 1/23/2009 CO 1/23/2009 PR 1/23/2009 TX 1/23/2009 GA 1/23/2009 VA 1/23/2009 NJ 1/23/2009 PA 1/23/2009 CA 1/23/2009 MT 1/23/2009 MI 1/23/2009 IL 1/23/2009 FL 1/23/2009 OR 1/23/2009 MA 1/23/2009 NC 1/23/2009 NM 1/23/2009 IA 1/23/2009 GA 1/23/2009 MD
0.4 37 55 12 13 2 12 1.9 0.7 62 70 14 17 15 0.2 0.2 27 4 6 29 39 27 59 58 15 4 43 0.3 1.3 5 21 0.4 10 39 5 26 5 41 1 0.2 59 18 1.5 0.2 12 5 6 11 71 66 13
0 37 12 13 2 12 1 0 62 70 14 17 0 0 4 6 29 39 27 59 58 15 4 43 0 1 5 21 0 10 39 4 26 41 1 0 59 18 1 0 12 5 6 11 71 66 13
0.4 F M F M F 0.9 F F 0.9 F 0.7 F F F F F F 0.2 F 0.2 F F F M M F F F F F F F 0.3 M 0.3 F F F 0.4 F M F F M M M 0M 0.2 M F F 0.5 M 0.2 M F M M M F M M
1/14/2009 Pt developed temp to 106 degrees a 1/21/2009 2 days post ava #1 broke out in a ra 1/16/2009 Patient complains of pain in left delt 1/19/2009 None Stated 1/22/2009 No side effect, patient was fine. 1/22/2009 1 cm nodule. 7 cm erythema + indu 1/14/2009 After receiving 3 shots, client becam 1/13/2009 Non stated. 1/13/2009 None stated. 1/22/2009 Pt called 10/31/08 said had blurring 1/22/2009 11/27/2006 Patient noticed pain in h 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from 1/22/2009 Information has been received from ### Developed angio edema of face, lar 10/2/2008 Redness occurred evening of vaccin ### Client woke up following morning wi ### Afternoon of day HEB B# 3 received ### 1 hr after HBV #1 patient experienc ### Incident occurred on 7/16/08 and ag ### Received TDAP on 11/24/08 for trav 1/20/2009 Pt reports had significant vomiting d 1/9/2009 Lat 4 1/2" X 4" circular swelling red, 1/21/2009 Few hours after TdAP in left deltoid 1/14/2009 Immunizations given (Hib in upper R 1/23/2009 After receiving immunizations the pa 1/23/2009 "Rash" 1 day after MMR. Parent con 1/23/2009 Vaccine given in error. PCP ordere 1/23/2009 NO ADVERSE REACTIONS NOTE 1/23/2009 Dizziness, very pale, fainted getting 1/23/2009 Numbness of hand and legs, cough 1/23/2009 Patient went came into the Immuniz 1/23/2009 PT had an itching sensation in the b 1/23/2009 Left arm swollen and warm to touch 1/23/2009 generalized rash noticed approxima 1/23/2009 On 1/21/09 at the time of immunizat 1/23/2009 It happen over night (Dec 16th 2008 1/23/2009 Immediately following venipuncture 1/23/2009 Received MCV4, Hep.A, Varicella o 1/23/2009 rash on the body and neck, has bee 1/8/2009 Severe diarrhea, dehydration, 1 wee 1/23/2009 She received her immunizations on 12/5/2008 S1. erythematous left upper arm, sli 1/23/2009 24 hours after influenza and HAVRI 1/23/2009 Received both MENACTRA and BO Patient broke out with a couple of re 1/23/2009 Patient stopped by the clinic and sta 1/23/2009 Possible erythema multiform.
338130 338131 338136 338137 338500 338789 338828 338829 338830 338837 338115 338116 338117 338118 338119 338120 338121 338209 338210 338212 338213 338214 338215 338216 338217 338218 338219 338220 338221 338222 338223 338224 338225 338226 338229 338240 338241 338242 338243 338244 338245 338246 338247 338248 338249 338250 338251 338252 338253 338254 338255
1/23/2009 CA 1/23/2009 KY 1/23/2009 GA 1/23/2009 SC 1/23/2009 1/23/2009 NY 1/23/2009 TX 1/23/2009 CT 1/23/2009 OH 1/23/2009 NC 1/24/2009 TN 1/24/2009 IN 1/24/2009 MA 1/24/2009 IL 1/24/2009 CA 1/24/2009 CA 1/26/2009 1/26/2009 OH 1/26/2009 CA 1/26/2009 1/26/2009 1/26/2009 1/26/2009 PA 1/26/2009 TX 1/26/2009 MA 1/26/2009 UT 1/26/2009 LA 1/26/2009 IA 1/26/2009 NY 1/26/2009 TX 1/26/2009 GA 1/26/2009 WA 1/26/2009 CA 1/26/2009 PA 1/26/2009 LA 1/26/2009 GA 1/26/2009 MI 1/26/2009 OK 1/26/2009 MA 1/26/2009 MI 1/26/2009 NC 1/26/2009 MT 1/26/2009 NC 1/26/2009 KY 1/26/2009 ID 1/26/2009 MI 1/26/2009 GA 1/26/2009 MO 1/26/2009 TX 1/26/2009 OK 1/26/2009 FL
1.1 1.6 54 1 21 39 5 68 71 55 0.2 54 1.3 21 68 50 22 27 47 71 74 71 2 0.5 14
1 1 54 1
63 1 63 1 1 5 5 79 54 68 17 11 52 14 77 1 17 22 21 40 1 69 42 3 13
63 1 63 1 1 5 5 79 54 68 17 11 53 14
5 68 71 55 0 54 1 21 67 50 22 27 47 71 74 1 0 14
1 17 22 21 40 1 69 42 0 13
0.1 M 0.6 F F 0M F M M M F M 0.2 F F 0.3 F M F M M F F M M F 1U 0.5 F F F F 0F F 0M 0M F M F U F M M M F F 0M F F F F 0M M F 0.2 F F
1/23/2009 About 10 hrs after giving immunizat 1/23/2009 Fever 103.3 Febrile seizure X 5 min 1/7/2009 Client reports shortly after the shot, 1/23/2009 Rash- looks like measles. No fever 1/21/2009 I took the GARDASIL shot series. I ### Initial report received from the patie 8/27/2008 Initial report was received 08 May/2 ### Initial report received on 02 Septem ### A 71-year-old female patient experie 7/17/2008 Initial report was received from a he 1/24/2009 Developed rash within 24 hours of a 1/24/2009 Patient stated pain began 4 hours a 1/24/2009 About 3 hours, after the vaccines, m 1/24/2009 His a 21yo navy recruit that present 1/24/2009 Patient called to report reddened ar 1/24/2009 Mild rash on thorax. Lasted for 5 da 1/26/2009 mild cellulitis of arm. 3/3/09 MR rece 1/22/2009 Initial information received on 21 Ja 1/20/2009 Acute to chronic resp. congestion, m 1/26/2009 On Wednesday had sore throat, run 1/1/2009 Pt has no history of shingles, but in 1/20/2009 I received the vaccine ZOSTAVAX. None Stated 1/24/2009 Seizure approx 16 hour after immun 1/23/2009 After waiting in office for 15 minutes 1/22/2009 Intermittent soreness let deltoid sub 1/21/2009 Three days after I received the ZOS 12/1/2008 11-12 day after injection developed 1/26/2009 See note attached. Called patient 1 1/22/2009 The infant had an immediate reactio 1/20/2009 Rash at injection site- plus erythema 1/22/2009 Developed hives 12 hrs after receiv 1/23/2009 Swollen Left thigh with redness arou 1/23/2009 Information has been received from 1/23/2009 Information has been received from 1/26/2009 Pt called Health Department this am 1/26/2009 2:13 pm - shots given,alert and orie 1/26/2009 Left arm red, hot and swollen 1/26/2009 Received vaccine at 9:30 am, stated 1/26/2009 Passed out with seizure like behavio 1/26/2009 Swelling of arm and itching one day 1/26/2009 Patient had his 1 yr well-baby check 1/26/2009 7/16/07 - Developed severe case of 1/26/2009 On 1/12/09 pt received a Tdap inj b 1/26/2009 Client received Engerix B vaccine o 1/26/2009 Pt was fine fol shot. Woke up the ne 1/26/2009 DIAGNOSED WITH SHINGLES 01/ 1/26/2009 Hospitalized and diagnosed with Gu 1/26/2009 Symptoms started two days after re 1/26/2009 Mother reports high fever (104.7, se 1/26/2009 15 minutes after the vaccine the pat
338256 338257 338258 338259 338260 338265 338266 338267 338268 338269 338270 338271 338272 338273 338274 338275 338276 338277 338280 338281 338282 338283 338284 338285 338286 338287 338288 338289 338290 338291 338292 338293 338294 338295 338296 338297 338298 338299 338300 338301 338302 338303 338304 338305 338306 338307 338308 338309 338310 338311 338312
1/26/2009 CA 1/26/2009 MA 1/26/2009 WI 1/26/2009 CA 1/26/2009 MI 1/26/2009 PA 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 AR 1/26/2009 MO 1/26/2009 NH 1/26/2009 VA 1/26/2009 TX 1/26/2009 KS 1/26/2009 KS 1/26/2009 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 FL 1/26/2009 FL 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 PA 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 KS 1/26/2009 NH 1/26/2009 WA 1/26/2009 KY 1/26/2009 TX 1/26/2009 WA 1/26/2009 1/26/2009 ND
60 13 65 64 18 0.2 54 53 42 58 58 56
60 13 65 64 18 0 54 53 42
26 58 46 61 1 1.2 1.5 52 14 12 5 14 14 5 18 11 36 13 23 18 57 58 10 4 0.4 1.1 11 10 10 4 0.5 20 1 4 9 58 4 45
26 58 46 61 1 1 1 52 14 12 5 14 14 5 18
58 56
36 13 23 18 57 58 10 4 0 1 11 10 10 4 0 20 1 4 9 58 4 45
F F M F M 0.2 F F F F F F U U F F F F 0M 0.2 M 0.5 F M M F M M M M F F M F U F F F F M 0.4 M 0.1 F M F F M 0.5 F F 0F F M F M F
1/26/2009 Patient called to report swelling of ri 1/26/2009 Patient received the Varivax on Sat 1/26/2009 After receiving vaccination at 11am 1/26/2009 64 yo F calling to report possible rea 1/26/2009 3-4 hours after being vaccinated pt. 1/26/2009 Right leg with erythema and edema ### Redness, swelling, warmth to site fe 11/3/2008 Approximately 24 hrs after injection, Tetanus shot. Red, sore. Bump 3 to 12/4/2007 Swollen, warm, painful area 2"x4" a 11/7/2007 Where shot given-is red and warm t Moderate headache with fatigue ap Hot swelling, hives, feverish. ### 12/10 Wed. got shot. Thursday the ### 2" red, round, fever, swollen area, te 1/20/2009 Dizziness (severe vertigo) vomiting, 2/9/2009 1/24/08 onset right flank rash-itchy v 1/22/2009 Rash - erythematous maculopapula 1/26/2009 Mom returned to clinic 2d after vacc ### Right lower back - few small red rais ### Pt received ADACEL RA upper delt 11/7/2008 C/O pain left shoulder, et with deep 8/19/2008 Headache, chills, fatigue, fever (hig 8/8/2008 Left arm with erythema, warmth + s 8/12/2008 Patient immediately began to feel tir 8/12/2008 Headache, fever 101.0F, neck ache 7/25/2008 Pt. on 7/23/05-1445- after receiving 7/2/2008 Very fearful - Hyperventilating - trem 1/26/2009 Patient's mother reported that child 1/26/2009 Patient states developed muscle an Mother states" child can not move h Was given HPV during her pregnan ### After giving MMR patient eyes rolled ### Got vaccination 10-27-2008. 10-29### Headache, weakness, decreased co 10/1/2008 Redness, Tenderness, difficulty bre 9/29/2008 Redness at swelling from top of kne 8/25/2008 Incorrect immunization administered 8/8/2008 Redness/ Rash immediately around 7/8/2008 Mother called clinic at 5:15 pm 7/8/ 6/9/2008 10 Minutes after administering vacc 5/8/2008 TDAP administered 6 mo too soon p ### Mother noticed last NOC right thigh 1/5/2009 101-102 Temp- eyes matted - clear ### W/ 1st dose broke out in hives, w/2n 1/23/2009 Erythematous Maculopapular rash a 1/23/2009 Rash over abdomen, onset 1-22-09 1/23/2009 FLUMIST and VARIVAX vaccine we 1/22/2009 Morning of 1-16-2009 noticed back 1/22/2009 Patient has about 2in erythema and 1/23/2009 Patient received pediatric dose of A
338313 338314 338315 338316 338317 338318 338261 338372 338374 338376 338379 338386 338406 338407 338419 338420 338421 338422 338423 338424 338425 338426 338427 338428 338429 338430 338431 338432 338433 338434 338435 338491 338492 338493 338494 338497 338498 338499 338504 338505 338436 338437 338438 338439 338440 338441 338443 338444 338445 338448 338454
1/26/2009 TX 1/26/2009 IA 1/26/2009 NC 1/26/2009 IA 1/26/2009 MA 1/26/2009 MI 1/27/2009 MI 1/27/2009 LA 1/27/2009 NY 1/27/2009 MA 1/27/2009 AZ 1/27/2009 FL 1/27/2009 FL 1/27/2009 1/27/2009 GA 1/27/2009 NY 1/27/2009 NY 1/27/2009 KY 1/27/2009 WI 1/27/2009 TX 1/27/2009 TX 1/27/2009 WI 1/27/2009 LA 1/27/2009 MI 1/27/2009 OK 1/27/2009 OK 1/27/2009 FL 1/27/2009 WA 1/27/2009 AL 1/27/2009 LA 1/27/2009 WA 1/27/2009 NC 1/27/2009 GA 1/27/2009 NC 1/27/2009 GA 1/27/2009 WA 1/27/2009 OH 1/27/2009 NJ 1/27/2009 KY 1/27/2009 CA 1/28/2009 SC 1/28/2009 VA 1/28/2009 OH 1/28/2009 NC 1/28/2009 MO 1/28/2009 NJ 1/28/2009 PA 1/28/2009 PA 1/28/2009 1/28/2009 1/28/2009 LA
0.5 15 20 67 14 63 60 1.1 65 16 14
0 15 20 67 14 63 60 1 65 16 14
0.4 1.1 34 14 1.5 30 17 24 65 15 47 83 12 13 51 23 68 22 17 23 66 68 18 33 0.4 13 7 1.1 11 0.3 69 1.3 1 78 65 49
0
18 15
34 14 1 30 17 24 65 15 57 83 12 13 51 23 68 22 17 23 66 68 18 33 0 13 7 1 11 0 69 1 78
18
0.5 F F F F F F M 0.1 M M M F F 0.4 F F M F 0.5 M F F F F F F F F F F F F F F F M F F M 0.4 M F F 0.1 M M 0.3 F M M 0.1 F F M M U F F
1/23/2009 Received DPH and IPV. Reporting m 1/20/2009 C1 woke up at 5pm with vomiting. F 1/22/2009 Redness-itching-blistering at injectio 1/2/2009 Red swollen arm - about size of bas 1/26/2009 Onset of nausea, dizziness within 3 1/12/2009 Pt. given Tdap in left upper arm-IM 1/27/2009 Shingles vaccine was administered 1/23/2009 Initial report received on 13 January 1/23/2009 Initial report received on 15 January 1/23/2009 Initial report was received 16 Janua 1/26/2009 Information has been received from 1/26/2009 Information has been received from 1/26/2009 Information has been received from 1/26/2009 It was reported Y in a published article 1/27/2009 erythema, edema of the eye, distort 1/27/2009 About 7 minutes after patient had th 1/27/2009 coughing, wheezing, hives, dyspnea 1/27/2009 Received Hepatitis B #2 and TdaP. 1/27/2009 Few minutes after vaccine administe 1/27/2009 I had my first injection on 7/10/2008 1/27/2009 Upset Stomach, sore Muscles, joint 1/27/2009 Client received two vaccines after o 1/27/2009 Left upper arm pain that remains se 1/27/2009 Mild cellulitis and soreness in left ar 1/27/2009 Within 5 minutes of receiving the Td 1/27/2009 Approximately 6 minutes after recei 1/27/2009 PT CLAIMS TO HAVE FLU AFTER 1/27/2009 Pt Received Anthrax vaccine 10 De 1/27/2009 Redness, swelling, heat, bruising & 1/27/2009 approximately 3-6 wks after vaccina 1/27/2009 Localized inflamation at injection sit 1/9/2009 12X12 can area of redness + swellin 1/23/2009 Patient had injury to left arm and ca 1/27/2009 Redness, swelling at injection site; s 1/27/2009 Patient presented in Health Departm 1/27/2009 TDAP administered 1-21-09 pt wife 1/23/2009 Hives + fever on arms and legs 1/21 1/27/2009 Started with redness on 01/23/09 an 1/27/2009 Large red swollen area at injection s Localized reaction to MMR & VARIV 1/28/2009 Local reaction to Tdap 1/28/2009 Baby was fussy and very gassy for 1/28/2009 redness, inflammation and pain at in 1/28/2009 Presented 1/27/09 with Zoster L1 de 1/28/2009 Mild varicella rash started 1/27/2009 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received from 1/27/2009 Information has been received throu 1/27/2009 Information has been received from
338457 338458 338459 338466 338467 338468 338469 338470 338471 338472 338473 338474 338475 338476 338477 338478 338479 338480 338481 338483 338484 338485 338486 338487 338488 338489 338495 338496 338501 338502 338503 338506 338508 338509 338510 338511 338512 338522 338523 338556 338557 338558 338559 338560 338563 338567 338568 338569 338570 338571 338594
1/28/2009 PA 1/28/2009 NY 1/28/2009 DE 1/28/2009 NC 1/28/2009 TX 1/28/2009 CA 1/28/2009 CA 1/28/2009 OH 1/28/2009 IL 1/28/2009 WI 1/28/2009 NC 1/28/2009 NY 1/28/2009 OH 1/28/2009 CA 1/28/2009 TX 1/28/2009 NY 1/28/2009 MO 1/28/2009 MI 1/28/2009 MS 1/28/2009 MO 1/28/2009 CA 1/28/2009 OR 1/28/2009 CA 1/28/2009 UT 1/28/2009 AK 1/28/2009 OH 1/28/2009 NC 1/28/2009 TN 1/28/2009 GA 1/28/2009 KS 1/28/2009 NJ 1/28/2009 AZ 1/28/2009 IL 1/28/2009 CA 1/28/2009 VA 1/28/2009 FL 1/28/2009 IL 1/28/2009 IL 1/28/2009 NC 1/29/2009 1/29/2009 NJ 1/29/2009 1/29/2009 1/29/2009 OH 1/29/2009 1/29/2009 1/29/2009 1/29/2009 KY 1/29/2009 WY 1/29/2009 NV 1/29/2009 NY
48 46 47 62 15 58 33 0.2 64 46 79 3 24 4 68 0.3 1 15 24 1 1.1 5 5 49 1 16 22 28 71 5 4 60 1.8 1 4 70 65 35 2 0.5 1 24 15 73 61 43 73 2 1.3
48 46 47 62 15 33 0 64 46 79 30 24 4 68 0 1 15 24 1 1 5 47 -1 49 1 16 22 28 71 5 4 60 1 1 4 70 65 35 0 1 24 73 61 43 73 2 1
F M M M M M F 0.2 F F M M F F F F 0.4 F 0F M M 0M 0M U F 1M F 0M F F F F M F M 0.8 F 0M F M M M U 0.5 F 0F F F F F F F F 1M 0.2 F
1/28/2009 This case was reported by a lawyer 1/28/2009 This case was reported by a lawyer 1/28/2009 This case was reported by a lawyer 1/28/2009 Retiree who received flu and ZOSTA 1/28/2009 In AM: Post vaccination: dizzy, dimm 1/22/2009 58 yo M with ESRD on HD, HTN, an 1/22/2009 Pt had vaccination 1/20/09, and 1/2 1/21/2009 Parents state that infant cried screa 1/25/2009 24 hours after the injection patient n 1/27/2009 Received FLUZONE 1/15/09. 1 we 1/28/2009 Five days after administration, a 2 in 1/28/2009 CELLULITIS TO LT. DELTOID REG 1/28/2009 I received 2 of the 3 Gardisil shots. 1/28/2009 Patient recieved vaccines on 1/16/0 1/28/2009 patient experienced swollen, red, ho 1/28/2009 24 hours after 1st PCV, baby's thigh 1/28/2009 Varicella rash; about 2 dozen lesion 1/28/2009 None 1/28/2009 Chills, fevers of up to 103.2, body a 1/28/2009 20-25 ERYTHEMATOUS LESIONS 1/28/2009 FOURTH IPV GIVEN AT 12 MONTH 1/28/2009 Area of swelling 10.5 cm x 9.5 cm, f 1/28/2009 Patient developed a rash 7-10 days 1/28/2009 Mom to clinic with 5 yo with concern 1/28/2009 THE FLU SHOT WAS GIVEN DIRE 1/28/2009 My son was on target with speech a 1/28/2009 1. Bruising x 3 weeks. 2. Local pain 1/27/2009 Pt describes temp 102.2 F orally se 1/28/2009 Employee c/o headache, nausea, v 1/28/2009 Very stiff neck muscles, onset 24 ho 1/26/2009 1-16-09 vaccine given. 1-22-09 at 6 1/28/2009 Left deltoid localized reaction with re 1/28/2009 Patient c/o right upper arm swelling, 1/28/2009 Erythema, Hyperemia and edema a 1/28/2009 Triaged by Dr via telephone and ad 1/26/2009 Swelling, redness with the left shou 1/28/2009 Patient was diagnosed with shingles ### On May 1, 2006 I went to the Hospi 6/10/2008 35 y/o male SM referred to hospital 1/27/2009 Initial report received on 21 January 1/26/2009 Initial report received on 15 January 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/28/2009 Information has been received from 1/27/2009 Shingles vaccine given 12/31/2008. 1/26/2009 Patient reported rash and itching ar 1/22/2009 L arm - deltoid region with redness, Left arm Pneumonia Vaccine R arm 1/21/2009 MOC called on 1/15/08 at 11 am, st 1/29/2009 Patient developed a facial palsy on
338595 338596 338597 338598 338599 338600 338601 338602 338604 338605 338606 338607 338608 338609 338610 338611 338612 338614 338615 338616 338617 338618 338619 338620 338621 338622 338623 338624 338638 338639 338640 338641 338642 338667 338671 338672 338673 338689 338690 338691 338692 338693 338694 338695 338696 338697 338698 338704 338705 338706 338707
1/29/2009 NY 1/29/2009 MI 1/29/2009 NY 1/29/2009 NC 1/29/2009 VA 1/29/2009 ID 1/29/2009 MS 1/29/2009 AL 1/29/2009 WA 1/29/2009 NY 1/29/2009 MO 1/29/2009 CO 1/29/2009 AZ 1/29/2009 IL 1/29/2009 CA 1/29/2009 CA 1/29/2009 WI 1/29/2009 NE 1/29/2009 WI 1/29/2009 VA 1/29/2009 RI 1/29/2009 PA 1/29/2009 CO 1/29/2009 NJ 1/29/2009 NY 1/29/2009 MA 1/29/2009 WI 1/29/2009 WI 1/29/2009 1/29/2009 PA 1/29/2009 CT 1/29/2009 1/29/2009 NC 1/30/2009 PA 1/30/2009 TX 1/30/2009 NC 1/30/2009 AR 1/30/2009 AZ 1/30/2009 FL 1/30/2009 NC 1/30/2009 VA 1/30/2009 KY 1/30/2009 AZ 1/30/2009 MO 1/30/2009 CA 1/30/2009 AR 1/30/2009 CA 1/30/2009 MI 1/30/2009 ND 1/30/2009 MD 1/30/2009 OH
21 1.5 67 14 0.2 52 26 14 11 14 31 0.3 4 62 13 0.4 61 60 0.2 51 65 1.3 64 65 0.2 12 63 61
21 1 67 14 0 52 26 14 11 14 31 0 4 62 1 0 61 60 0 51 65 1 64 65 0 12 63 61
0.5 8
0 8
28 1 62 32 0.2 61 14 0.5 44 1.2 14 1 4 3 5 14 1
28 1 62 32 0 61 14 0 44 1 14 1 4 3 5 14 1 42 37
35
F 0.5 F F F 0.1 M F M F F F F 0.3 F F F 0.1 F 0.4 F F F 0.2 F M M 0.3 F M F 0.2 F M F F M 0.5 M F F M 0M F F 0.2 M M F 0.5 F F 0.2 F M 0M M M M M 0F F M
1/29/2009 PT. HAD FLUSHOT 12/15/08 AND 1/29/2009 NONE REPORTED 1/29/2009 SWELLING AT INJECTION SITE 1/29/2009 01/28/2009 pt report n&v, confussio 1/29/2009 first vaccinations, including rotateg, 1/29/2009 To start with, I was never alergic to 1/29/2009 20 Jan 2009- received vaccination. 1/29/2009 On 1/20/09 after clinic visit, and @ 7 1/29/2009 Lip swelling for 12 hours. 10 days la 1/29/2009 Bell's palsy 1 week after HPV #3 va 1/12/2009 Within 6 hours of receiving vaccine 1/29/2009 Infant received HIB #1, Prevnar #1, 1/29/2009 Local reaction, erythema, induration 1/29/2009 Six Hours post Injection patient exp 1/29/2009 About 3-5 days after injection, 2 cm 1/29/2009 6 hours after immunization, patient 1/28/2009 2cm X 3cm Reddened Raised area Right sided neck pain/stiffness radia After 1st dose of ROTATEQ pt. had 1/29/2009 Pt states that in 2004 she received 1/23/2009 4x5cm area of redness. Left should 1/29/2009 Localized VARICELLA reaction - red 1/29/2009 Patient complaining of rash on right 1/29/2009 Zosterform eriphan with pain, itching 1/29/2009 Baby has rash on both thighs. No fe 1/29/2009 Developed lump in R. arm circumfer 1/29/2009 Administered ZOSTAVAX IM instea 1/29/2009 None administered IM instead of Su 1/29/2009 This case was reported by a lawyer 1/29/2009 Patient received ROTATEQ on 1-27 1/28/2009 Pt has received FLUMIST in previou 1/29/2009 Patient received injection 6-9-08. Ex 1/29/2009 SM developed erythematous, pruriti 1/28/2009 Sudden death Y at home morning of 1 1/26/2009 Patient called our office approx 30 m 1/8/2009 None stated 1/15/2009 Lethargy started in 1/14/09, had to b ### Received Flu shot 10/14/08 Fry's. T 1/21/2009 Passed out, tremors, eyes rolling in 1/29/2009 No known reaction. KINRIX acciden 1/30/2009 Pt states she gets frequent breakou 1/30/2009 On 12-19-08 increased temp 105.8 1/29/2009 Immediately after the 2 vaccines ad 1/30/2009 Pt received VARIVAX vaccine on 09 1/30/2009 Redness, Swelling, itching, warmne 1/30/2009 Itchy, red, swollen. Cold compress a 1/30/2009 Early Thursday morning fever of 100 1/30/2009 HE HAD CONVULSIONS FOR A D 1/30/2009 Incident occured 1/2/09 mid-mornin 1/30/2009 Pt states that the Last flu vaccine ca ### Within 4 hours, patient began cough
338708 338709 338710 338711 338712 338713 338714 338715 338716 338717 338718 338719 338720 338721 338722 338723 338724 338725 338726 338727 338738 338740 338741 338742 338743 338744 338745 338746 338747 338886 338887 338888 338889 338890 338924 338925 338926 338927 338928 338929 338930 338931 338932 338933 338934 338935 338936 338937 338938 338939 338940
1/30/2009 IL 1/30/2009 DC 1/30/2009 PA 1/30/2009 KY 1/30/2009 NY 1/30/2009 PA 1/30/2009 IL 1/30/2009 OK 1/30/2009 NY 1/30/2009 GA 1/30/2009 NY 1/30/2009 NJ 1/30/2009 OR 1/30/2009 AZ 1/30/2009 OH 1/30/2009 DC 1/30/2009 TX 1/30/2009 CA 1/30/2009 OR 1/30/2009 NE 1/30/2009 NM 1/30/2009 WA 1/30/2009 CO 1/30/2009 MA 1/30/2009 CT 1/30/2009 VA 1/30/2009 MO 1/30/2009 CA 1/30/2009 AR 1/30/2009 TX 1/30/2009 CA 1/30/2009 WV 1/30/2009 WV 1/30/2009 CT 1/30/2009 MA 1/30/2009 MD 1/30/2009 IN 1/30/2009 IN 1/30/2009 IN 1/30/2009 IN 1/30/2009 1/30/2009 1/30/2009 IN 1/30/2009 1/30/2009 1/30/2009 1/30/2009 TX 1/30/2009 TX 1/30/2009 IA 1/30/2009 AZ 1/30/2009 AZ
43 39 41 51 0.5 52 1.7 67 11 4 24 4 6 4 79 63 19 28 1 61 0.6 77 14 9 4 51 3 25 29 47 48 27 27 65 42 66 47 23 37 22 44 39 47 18 45 39 42 37 31 27 81
43 39 41 51 0 52 1 67 11 4 24 4 6 4 79 63 19 28 1 61 0 77 14 9 4 51 3 25 29 47 27 27 65 42 66 47 23 37 22 44 39 47 18 45 39 42 37 31 27 81
M F F M 0.5 M M 0.7 F F M M M M F M F F F F 0M F 0.6 F F M F M M F F M F F M F F F M M F M F M F F M M F F F F F F
1/30/2009 Patient presented to BHC 237 with 1/30/2009 TDAP given 1/14/09 in L arm Patien 1/30/2009 Fever 102.7 degrees, chills, body ac 1/30/2009 MEMBER REPORTED TO SICK CA 1/30/2009 Immunized 1/21 morning. Rash to n 1/30/2009 On 1/08/09 Pt. awoke with flu like sy 1/29/2009 CLIENT HAS IMMUNIZATIONS ON 1/30/2009 Patient experienced soreness at the 1/30/2009 Father reports fever of 100-103 for 3 1/30/2009 Five minutes post administration of 1/30/2009 right arm swelling, pain & redness 2 1/30/2009 Seen in our office on 1/22/09 and re 1/30/2009 One day after administration of Vari 1/30/2009 ACCORDING TO MOTHER, CHILD 1/30/2009 patient with extremely sore arm limi 1/30/2009 Fever (Tmax 102F 2 days after shin 1/30/2009 Vaccine administered around 11 Ju 1/30/2009 Skin rash all over the body, mostly i 1/30/2009 Evening of 7/22/2008 child had a pr 1/30/2009 The pain in my upper left arm is som 1/30/2009 This case was reported by a healthc 1/31/2009 Started with lower back progressing 1/30/2009 In the evening after his shot, he dev 1/30/2009 Left arm large red, warm, painful are 1/30/2009 R arm. 15x15 cm. edema, erythema 1/29/2009 To H.D. 12-23-08 for vaccines to tra 1/30/2009 Left deltoid area red, swollen, warm 1/30/2009 Pt. C/O redness some swelling at si 1/29/2009 C/O diarrhea and aching approxima 1/16/2008 Patient received TD vaccination on 2/4/2008 The patient received a routine boos 3/24/2008 Patient received TD-171 on 01/25/0 1/9/2009 Patient received TD on 03/12/2008. 9/4/2008 Patient was vaccinated on 02/01/08 9/4/2008 Patient experienced a high fever of 6/16/2008 Patient received TD vaccine on 6/12 8/14/2008 A male patient received vaccine on 8/14/2008 A female patient received vaccine o 8/14/2008 A male patient received vaccine on 8/14/2008 A female patient received vaccine o 8/15/2008 C.K. received TD vaccine on 06/20/ 8/15/2008 Patient received TD vaccine on 06/2 1/21/2009 Patient received Td injection intrade 7/16/2008 A male patient came to doctor's offic 8/12/2008 Patient was administered TD vaccin 8/12/2008 Patient was administered Td vaccin 9/12/2008 Patient received TD injection on 04/ 9/12/2008 Patient received TD injection on 10/ ### On 08/25/08 TD was administered t 1/22/2009 Patient developed induration at inje 1/9/2009 Patient reported not feeling good af
338941 338942 338943 338944 338945 338946 338947 338948 338949 338950 338951 338952 338953 338954 338955 338956 338957 338958 338959 338961 338962 338963 338964 338965 338966 338967 338968 338969 338970 338971 338972 338973 338974 338975 338982 338983 338984 338985 338986 338987 338988 338989 338990 338991 338992 338993 338995 338996 339055 339056 339057
1/30/2009 AZ 1/30/2009 MA 1/30/2009 IN 1/30/2009 MA 1/30/2009 MA 1/30/2009 MN 1/30/2009 FL 1/30/2009 FL 1/30/2009 NY 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 NC 1/30/2009 FL 1/30/2009 CA 1/30/2009 VA 1/30/2009 MA 1/30/2009 UT 1/30/2009 1/30/2009 KY 1/30/2009 CT 1/30/2009 CT 1/30/2009 CT 1/30/2009 NY 1/30/2009 PA 1/30/2009 TN 1/30/2009 NV 1/30/2009 NV 1/30/2009 AZ 1/30/2009 LA 1/30/2009 MD 1/30/2009 FL 1/30/2009 CA 1/30/2009 CA 1/30/2009 DC 1/30/2009 MN 1/30/2009 CT 1/30/2009 NM 1/30/2009 IN 1/30/2009 MA 1/30/2009 AZ 1/30/2009 AZ 1/30/2009 AZ 1/30/2009 TX 1/30/2009 1/30/2009 1/30/2009 VA 1/30/2009 VA 1/30/2009 KY
13 71 18
13
1.3 65
1 65
37 35 30 60 57
37 35
82 69 77 68 29 68 58 20 52 54 65 21 64 34 62 34 37 35 8 13 17 42
82 69 77 68 29 68 58 20 52
81 33
81
18
57
65 21 64 34 62 34 37 35
42
F F M F F 0.3 M M F F F F M M M U F F F F F U U F F F F F F F F F F M M F F F F F F F M F M M F U U U F F
1/22/2009 Patient developed induration and re 12/2/2008 Patient received TD vaccine, lot TD ### Fever, sweating, migraine headach 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by an allerg 1/27/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a physici 1/7/2009 This was reported by a healthcare p 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a mother 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc
339058 339059 339060 339061 339062 339063 339064 339065 339066 339067 339068 339069 339071 339072 339073 339074 339075 339076 339077 339078 339079 339080 339081 338728 338729 338730 338731 338732 338733 338762 338763 338764 338765 338766 338767 338768 338770 338771 338772 338778 338782 338785 338786 338788 338790 338791 338792 338793 338794 338795 338797
1/30/2009 1/30/2009 1/30/2009 UT 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 FL 1/30/2009 CO 1/30/2009 CO 1/30/2009 OH 1/30/2009 NC 1/30/2009 IN 1/30/2009 1/30/2009 NC 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 KS 1/30/2009 MA 1/30/2009 MA 2/1/2009 2/1/2009 2/1/2009 GA 2/1/2009 AZ 2/1/2009 PA 2/1/2009 NY 2/2/2009 MA 2/2/2009 2/2/2009 LA 2/2/2009 WI 2/2/2009 PA 2/2/2009 PA 2/2/2009 WA 2/2/2009 VT 2/2/2009 2/2/2009 2/2/2009 IN 2/2/2009 PA 2/2/2009 OH 2/2/2009 KS 2/2/2009 2/2/2009 OK 2/2/2009 MN 2/2/2009 MA 2/2/2009 MI 2/2/2009 MI 2/2/2009 PA 2/2/2009 FL
15 39 25
15 39 25
39
39
40 41 4 0.5 70 16 20
40 41 4 0 70 16 20
1.2 63 4 16 0.2 51 67 41 41 26 0.4 1.3 0.3 54 69 24 11 1.2 29 65
1 63 16 0 51 67 41 41 26
54 68 24 11 1 29 65
U U F M M F F F F M F F F F F F M M F F F F F M M M 0.5 M M F F F 0.2 M F M F 0.2 F M F F M F F F F F M F U 0.2 F F F
1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a physici 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a pharma 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a consum 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 1/7/2009 This case was reported by a healthc 2/1/2009 On January 8, 2009, patient recieve 1/3/2009 LEFT SIDE UPPER BODY MUSCL 2/1/2009 My son had a seizure the day after 2/1/2009 Patient received the vaccine on 1/30 2/1/2009 Patient devleoped herpes zoster on 2/1/2009 February 2008 first shot experience 1/29/2009 I got the first HPV vaccine, and 1 hr 1/29/2009 Pt. received ZOSTAVAX IN; approx 1/23/2009 Pt given 5th PCV7 instead of Hept A 1/29/2009 1-2 inch red & warm spot just below 1/28/2009 5 m. erythema, swelling L upper arm 1/28/2009 LA posterior redness 3x4 1/2 in elev 2/18/2009 Started giving RATATEQ by mouth, 1/16/2009 Fever, Chills, and cramps, vomiting 1/29/2009 Patient was given 0.5 ml pneumocc 1/28/2009 12/1/08 patient received tetanus/dip 1/29/2009 Initial report received on 07 October 1/30/2009 Information has been received from 1/30/2009 Information has been received from 1/30/2009 Information has been received from 1/30/2009 Information has been received on re 2/2/2009 Early the next day after receiving in 2/2/2009 Red and swollen underarm muscle 2/2/2009 Severe swelling, cold sweats, vomit 2/2/2009 2 DAYS AFTER INJECTION, SHE D 2/2/2009 Mom states child had a seizure 1/31 2/2/2009 DAY AFTER INJECTION-FEVER A 2/2/2009 swelling lips , throat and very itchy r
338798 338799 338800 338801 338802 338803 338804 338805 338806 338807 338808 338809 338811 338812 338813 338814 338815 338817 338818 338820 338821 338822 338824 338825 338826 338827 338823 338839 338840 338841 338844 338845 338846 338847 338849 338851 338856 338867 338868 338869 338870 338873 338891 338892 338893 338894 338895 338896 338897 338898 338899
2/2/2009 AK 2/2/2009 MN 2/2/2009 CA 2/2/2009 OH 2/2/2009 UT 2/2/2009 CT 2/2/2009 NC 2/2/2009 KY 2/2/2009 VA 2/2/2009 CA 2/2/2009 WA 2/2/2009 CA 2/2/2009 OH 2/2/2009 AZ 2/2/2009 MI 2/2/2009 LA 2/2/2009 OH 2/2/2009 VA 2/2/2009 MA 2/2/2009 NH 2/2/2009 WA 2/2/2009 NJ 2/2/2009 OR 2/2/2009 IN 2/2/2009 AL 2/2/2009 PA 2/3/2009 MO 2/3/2009 2/3/2009 TX 2/3/2009 TN 2/3/2009 LA 2/3/2009 LA 2/3/2009 FL 2/3/2009 2/3/2009 NM 2/3/2009 2/3/2009 2/3/2009 CT 2/3/2009 2/3/2009 FL 2/3/2009 2/3/2009 2/3/2009 2/3/2009 IL 2/3/2009 LA 2/3/2009 CA 2/3/2009 NJ 2/3/2009 SC 2/3/2009 CT 2/3/2009 OH 2/3/2009 NY
42 0.2 1 48 33 62 40 1 67 1.1 11 0.4 47 0.4 49 37 30 5 60 45 1 16 4 17 84 5 0.2 16 20 20
42 0 1 48 33 62 40 1 67 1 11 0 47 0 49 37 30 5 60 45 1 16 4 17 84 5 0
81 1.3 0.6 0.3
81
15 14 17 13 23 23 57 2 42 0.8 53 69 0.2 0.7
15 14 17
20
0
23 57 2 42 0 53 69 0 0
F 0.2 F 0F M M M F 0F M 0.1 M M 0.4 F F 0.4 F F F F F M M 0F F M M M F 0.2 F F F F U U M U 0.6 F F F F F F F F M F 0F F 0.8 M M F 0.2 M 0.7 M
2/2/2009 Headache 6 hours after injection las 2/2/2009 2 month old in for immunizations. B 2/2/2009 fever w/ poss tonic seizure, mild ras 2/2/2009 7:00 p.m. fever and dizziness. 8:00 2/2/2009 Received vaccines on 1-12-09. Sym 2/2/2009 Pt presents to the emergency room 2/2/2009 40 yo 70kg WF received 0.5ml Pneu 2/2/2009 After getting the MMR, Hep A, and V 1/30/2009 At approximately 6:00 pm on 1/24/0 2/2/2009 Low grade fever (100-107 F) multifo 2/2/2009 1/30/09 - seen in office with redness 2/2/2009 2pm - received shots. 2:08pm- dev 2/2/2009 Shot 1-27-09 reported 1-30-09 L arm 2/2/2009 fever > 102 X 48 degrees. Fever de 2/2/2009 Flu vaccine received on 1/30/08 her 2/2/2009 Pain upon injection, in 24 hours, ho 2/2/2009 Onset pain in upper outer arm wher 2/2/2009 Fever- few pustules on trunk (small 2/2/2009 Hours after following injection patien 1/29/2009 Bell's Palsy 2/2/2009 This case was Y reported by a healthc 1/31/2009 MENACTRA + VARIVAX given on 1 1/28/2009 (see attached) seizure - like episode 11/4/2008 At about 6pm he received his two v 1/29/2009 Right upper arm swollen and warm1/29/2009 Fever for 4-6 hr > 24 hrs post vaccin 1/27/2009 T 39, diarrhea, mottled, decreased c 2/2/2009 Information has been received from 2/2/2009 Information has been received for th 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 It was reported in a published article 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from 2/2/2009 Information has been received from ### This case was received on 27 Nove 2/3/2009 Swelling, Inflamation 2/3/2009 I became very light headed, as thou 2/3/2009 Vaccination was administered 11/5/ 2/3/2009 Patient received MMR vaccination o 2/3/2009 Kawaski disease, resulting with the 2/3/2009 Pain in shoulder of same side as va 2/3/2009 Pt. received Zostavax on 01/06/200 2/3/2009 Brought to the office on 01/31/09 fo 2/3/2009 Few hours later high fever. Next day
338900 338901 338902 338903 338904 338905 338906 338907 338909 338910 338911 338912 338913 338914 338915 338916 338917 338918 338919 338920 338921 338922 338923 339054 338960 338978 339004 339014 339015 339016 339017 339018 339019 339020 339021 339022 339023 339024 339025 339026 339027 339028 339029 339030 339031 339032 339033 339034 339035 339036 339037
2/3/2009 HI 2/3/2009 MA 2/3/2009 MI 2/3/2009 OH 2/3/2009 CO 2/3/2009 IL 2/3/2009 MN 2/3/2009 WI 2/3/2009 OK 2/3/2009 NY 2/3/2009 WI 2/3/2009 MI 2/3/2009 2/3/2009 FL 2/3/2009 PA 2/3/2009 2/3/2009 WA 2/3/2009 DC 2/3/2009 WI 2/3/2009 NC 2/3/2009 AL 2/3/2009 GA 2/3/2009 IN 2/3/2009 2/4/2009 MN 2/4/2009 CA 2/4/2009 GA 2/4/2009 NJ 2/4/2009 WI 2/4/2009 IL 2/4/2009 IL 2/4/2009 MO 2/4/2009 KY 2/4/2009 CT 2/4/2009 ME 2/4/2009 CA 2/4/2009 IL 2/4/2009 ME 2/4/2009 FL 2/4/2009 MO 2/4/2009 NM 2/4/2009 FL 2/4/2009 PR 2/4/2009 NY 2/4/2009 IL 2/4/2009 IA 2/4/2009 OH 2/4/2009 CA 2/4/2009 GA 2/4/2009 FL 2/4/2009 WA
1 20 67 70 78 3 14 12 57 1 16 21 23 72 3 73 68 1.2 18 0.2 1 37 8 84 0.4 0.3 1.2 0.6 2 68 1.3 14 68 15 37 10 1.3 1.5 0.2 1 4 56 0.2 1.3 50 52 1.3 11 33 4 19
1 20 67 70 3 14 12 57 1 16 21 23 72 3 68 1 18 0 1 37 8 84
1 0 2 68 14 68 15 37 10 1 0 1 4 56 0 1 50 52 1 11 33 4 19
0F F M M M M M F F 0M F M M F F M F 0.2 M F 0.2 M 0M F F F U M 0.2 M 0.6 F 0M F F F F F F M M 0.5 F 0.2 F 0F M U 0.2 F 0.4 F F F 0.3 M F F F F
2/3/2009 Shingles diagnosed 1/09 2/3/2009 48 hours after administration - Feve 2/3/2009 NO ADVERSE EVENTS, SYMPTOM 2/3/2009 ON FRIDAY, JAN 30 PAT CALLED 2/3/2009 One day after receiving the pneumo 8/19/2008 Rash at injection site after varicella 2/3/2009 father states symptoms started at 1 2/3/2009 FATHER REPORTS CHILD DEVEL 2/3/2009 PATIENT REPORTS TINGLING RIG 2/3/2009 MMR and Varicella shot given on 1/ 2/3/2009 Severe, chronic headaches that beg 2/3/2009 Fever, pain, severe swelling, hives. 2/3/2009 1) Developed vasculltic lesions on le 1/31/2009 On day 7, broke out in welts. Entire 2/3/2009 1/7/09 Large cluster of pinpoint vesi 1/23/2009 Patient had used topical Neosporin 1/31/2009 Shot given 12/23. Pt had ache front 1/12/2009 None Stated 2/3/2009 US Army NG SGT who noticed a sin 1/27/2009 High pitch screaming x 48 hrs. 2/2/2009 Possible staring spells vs sandifer's 1/9/2009 Rash on upper arm flu shot 46 X 44 1/29/2009 Leg turned a little red immediately a 2/3/2009 Almost after the vaccine neck starte 2/3/2009 Initial report received on 23 January 2/3/2009 Initial report received 28 January 20 2/1/2009 The exact dates of adverse events w 2/2/2009 104 degree T 24 hours after shots. 2/4/2009 Right leg pain, fever, vomiting, perio 2/4/2009 Starting on Tues eve (2/3) pat expe 2/4/2009 Received vaccine 1/23/09. Febrile 2/4/2009 Temp 102 degree F the day after Td 1/26/2009 Received ZOSTAVAX vaccine appr 1/29/2009 Fever, headaches, rash prior to imm 2/4/2009 Myalgia beginning w/; 24 hrs- fatigu ### None (patient was given DTap at 10 2/4/2009 Erythematous maculopapular spots 2/2/2009 Given Dtap, Hep A at well child che 2/4/2009 Mucoid diarrhea for 1 month. 1/30/2009 1/23/09 1:30 p.m. I administered MM 2/4/2009 Patient hadYfever within 24 hours of 2/4/2009 Large lump on arm at site of admini 2/4/2009 Irritability and crying for more than 3 2/4/2009 Received MMR and Varivax on 1/30 2/4/2009 Pt. reported headache, upper torso 2/4/2009 Patient underwent surgical debridem 2/4/2009 Developed vomitting, diarrhea, and 2/4/2009 Progressive weakness and muscle 2/4/2009 Client developed fever of 103 and v 2/4/2009 Parent returned to clinic 1/29/09 wit 2/4/2009 Complained of fever last night (2/3/0
339038 339039 339040 339041 339042 339043 339044 339045 339046 339047 339048 339049 339050 339051 339052 339053 339315 339316 339318 339319 339320 339070 339085 339088 339092 339093 339095 339096 339097 339098 339099 339100 339101 339102 339103 339104 339105 339106 339107 339108 339109 339110 339111 339112 339113 339114 339115 339116 339117 339119 339120
2/4/2009 PA 2/4/2009 PA 2/4/2009 CA 2/4/2009 AZ 2/4/2009 WA 2/4/2009 CO 2/4/2009 CA 2/4/2009 HI 2/4/2009 OH 2/4/2009 AL 2/4/2009 WA 2/4/2009 CA 2/4/2009 TN 2/4/2009 WA 2/4/2009 WA 2/4/2009 IN 2/4/2009 OH 2/4/2009 WV 2/4/2009 LA 2/4/2009 LA 2/4/2009 LA 2/5/2009 FL 2/5/2009 WV 2/5/2009 OH 2/5/2009 FL 2/5/2009 2/5/2009 2/5/2009 CA 2/5/2009 2/5/2009 2/5/2009 FL 2/5/2009 MI 2/5/2009 LA 2/5/2009 MD 2/5/2009 NC 2/5/2009 IA 2/5/2009 MO 2/5/2009 WA 2/5/2009 PA 2/5/2009 TX 2/5/2009 VA 2/5/2009 MN 2/5/2009 MO 2/5/2009 MA 2/5/2009 NY 2/5/2009 CA 2/5/2009 OR 2/5/2009 CO 2/5/2009 LA 2/5/2009 MA 2/5/2009 ID
15 55 1.3 16 0.2 2 1.2 79 25 57 12 1.4 1.1 20 11 4 0.2
15
5 4 5 35 2 42 19 17 62 36 50
5 4 5
5 1.5 29 0.3 39 0.4 8 0.2 11 1.6 46 26 54 12 45 2 1 40 85 0.2
16 0 2 1 79 25 57 12 1 1 20 11 4
2 42 19 17 62
5 1 28 0 72 0 8 0 11 1 46 26 15 54 12 45 2 1 40 85 0
F U U F 0.2 M 0.2 M 0.2 F M F M M 0.4 M 0.1 M F M M U U M M F F 0M F F F M F F M M 0.5 M U 0.4 M F 0.4 F F 0.2 F F 0.6 M M F F F F F 0M 0M F M 0.2 M
2/4/2009 HEPATITIS A VACCINE WAS ADM 2/4/2009 Subject in pneumococcal vaccine tr 2/4/2009 RASH INNER L EAR AND CHEEK. 2/4/2009 Patient fainted after vaccines 2/4/2009 Physician ordered pneumo vaccine. 2/4/2009 fever up to 104 24 hours after vacci 2/4/2009 Small blister on the inside, left lower 2/4/2009 PNEUMOVAX administered at 10:0 MMR vaccine administered IM in rig Hives and wheezing 01 hour after In 2/4/2009 6" area of redness and swelling in L 1/29/2009 Mom reports that patient had sudde 2/4/2009 Mild localized reaction 2/4/2009 48 degrees after vaccine given (give 2/4/2009 3"x3 1/2" raised tender erythematou Had area of blanchable erythema a 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a physici 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a healthc 1/30/2009 This case was reported by a healthc 1/7/2009 This case was reported by a pharma 2/4/2009 Information has been received from 2/4/2009 Information has been received from 2/4/2009 Information has been received from 2/2/2009 When I joined in March of 1987 I wa 2/2/2009 Patient Received ADACEL vaccine 2/4/2009 Unlikely time vaccine reaction. The 2/2/2009 Chest pain, hoarse throat 3 hrs afte 2/2/2009 Large local reaction 10X18 cm arou 2/5/2009 Area of redness, swelling + warmth 2/3/2009 Seizure activity at 3-4 minutes durat 2/5/2009 Pt is allergic to eggs, and vaccine c 2/5/2009 child deleloped rash bilaterally over 2/5/2009 Severe redness and swelling in arm 2/5/2009 Pt. presented to the family practice 2/5/2009 Local allergic skin reaction. 2/5/2009 Sudden onset of lethargy and vomit 2/5/2009 Parent reports adolescent having hi 2/5/2009 Patient began febrile episode on 1/3 2/5/2009 10"x10" warm erythema area on rt. 2/5/2009 Spoke with pt on Tuesday 2/3/09 sh 2/5/2009 Patient complains of severe pain in 2/5/2009 raised errythematous tender reactio 2/5/2009 Client was administered Hep A in rig 2/5/2009 Immediate localized reaction at injec 2/5/2009 Patient recieved HAV#2 on 2/3/09, 2/5/2009 Recurrent generalized seizures with 2/5/2009 ADMINISTERED IN LEFT DELTOID 2/5/2009 The above client had within 24 hour 2/4/2009 Inconsolable crying X 8 hours
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2/5/2009 NM 2/5/2009 HI 2/5/2009 WA 2/5/2009 NH 2/5/2009 MA 2/5/2009 AL 2/5/2009 WA 2/5/2009 OR 2/5/2009 CA 2/5/2009 IL 2/5/2009 PR 2/5/2009 PR 2/5/2009 2/5/2009 2/5/2009 2/5/2009 MA 2/5/2009 NY 2/5/2009 MA 2/5/2009 2/5/2009 CA 2/5/2009 CA 2/5/2009 CA 2/5/2009 CA 2/6/2009 2/6/2009 NE 2/6/2009 2/6/2009 VA 2/6/2009 NE 2/6/2009 OK 2/6/2009 NE 2/6/2009 TX 2/6/2009 MI 2/6/2009 ID 2/6/2009 AZ 2/6/2009 AL 2/6/2009 CA 2/6/2009 AR 2/6/2009 LA 2/6/2009 OH 2/6/2009 OR 2/6/2009 SC 2/6/2009 CA 2/6/2009 OK 2/6/2009 WA 2/6/2009 OH 2/6/2009 SC 2/6/2009 IL 2/6/2009 2/6/2009 NC 2/6/2009 KY 2/6/2009 MO
0.5 1.6 13 15 11 24 0.2 1.6 19 76 25 21 1.3 42
0 1 13 15 11 24 0 1 19 76 21
2 0.7 62 24 1.1 1.3 1.3 1.3 30 21
30 21
0.2
0
26 64 2 38 52 1.3 0.8 2 28 4 0.4 1.5 72 0.4 66 1 20 17 0.2 22 0.3 67 0.3
26 64 2 38 52 1 0 2 28 4 0 1 72 0 66 1 20 17 0 32 0 67 0
0.5 M 0.6 F F F M F 0.2 F 0.6 M M M M M M F F M M F F M M M M M F F 0.2 F M F F 0.2 M M M 0.3 F 0.8 F 0.1 M F M 0.4 M 0.5 F F 0.4 F M 0.8 F F F 0.2 M M 0.3 F M 0.3 F
2/5/2009 Rash all over body. Got shot yester 2/4/2009 Redness, warmth, swelling around s 2/5/2009 Call patient dad who said skin was b ### Patient experienced a vasovagal re Chicken pox rash site 2/2/09 - No o 2/5/2009 c/o right arm & chest with + urticaria 2/5/2009 Sleeping and lethargic and poor fee 2/5/2009 No adverse reactions known patien 2/5/2009 Pt noted right eye to be a "little pink 2/5/2009 Patient developed hundreds of vesi 2/5/2009 Since 2003, hearing loss, sleep diso 2/5/2009 2003-present, hearing loss, scoliosi 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been recieved from 1/26/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 1/29/2009 Information has been received from 2/6/2009 Bell's Palsy developed 17 DEC 08 2 2/5/2009 Information has been received from 2/5/2009 Information has been received from 2/6/2009 Baby expired Y 7 days after immuniza 2/6/2009 Pt reports swelling due to tetanus to 2/6/2009 The day I got the vaccine I didn't ha 2/6/2009 Employee received a Tdap vaccine 2/6/2009 approx 19 hours after rec'ing the MM 2/6/2009 4:30pm found alert but shaking in b 2/6/2009 Patient started receiving Anthrax va 2/6/2009 Rash at vaccination site and over en 2/6/2009 Received Vaccines on 2/3/2009, an 2/6/2009 Cellulitis of left thigh. Hospital admis 2/6/2009 0815 Hep B vaccine administered. 0 2/6/2009 Left Thigh noted to get red, swollen 2/6/2009 Mom was up with patient around 2-3 2/6/2009 Patient had a hard time walking the 2/6/2009 Day after vaccine, left deltoid becam 2/5/2009 Child presented w. generalized hive 2/6/2009 Pt. was given pneumovax shot (I.M. 2/6/2009 aBOUT 10 MIN. AFTER SHOTS, BA 2/6/2009 Patient fainted immediately after firs 2/6/2009 None at time of Gardasil vaccine, bu 2/6/2009 The day after my 2 month old son re 2/6/2009 Recieved booster anthrax on 2/2/09 2/6/2009 Pt developed L sided seizures 24 ho 2/8/2009 Patient started to feel tingling sensa 2/6/2009 No adverse events. Medication give
339188 339189 339190 339192 339193 339196 339198 339199 339200 339201 339202 339203 339204 339205 339206 339207 339208 339209 339210 339211 339212 339213 339214 339215 339174 339175 339176 339177 339178 339232 339234 339237 339238 339239 339241 339244 339245 339246 339247 339248 339249 339250 339253 339255 339256 339257 339258 339259 339260 339261 339262
2/6/2009 PA 2/6/2009 NY 2/6/2009 CA 2/6/2009 NC 2/6/2009 WA 2/6/2009 NC 2/6/2009 VA 2/6/2009 NJ 2/6/2009 NC 2/6/2009 CA 2/6/2009 SC 2/6/2009 WI 2/6/2009 OH 2/6/2009 GA 2/6/2009 WI 2/6/2009 NY 2/6/2009 GA 2/6/2009 IN 2/6/2009 OH 2/6/2009 CO 2/6/2009 PA 2/6/2009 WV 2/6/2009 MO 2/6/2009 PA 2/7/2009 PA 2/7/2009 MO 2/7/2009 MI 2/7/2009 WA 2/9/2009 CA 2/9/2009 VA 2/9/2009 AZ 2/9/2009 MS 2/9/2009 CA 2/9/2009 GA 2/9/2009 2/9/2009 NJ 2/9/2009 2/9/2009 2/9/2009 2/9/2009 2/9/2009 2/9/2009 GA 2/9/2009 IL 2/9/2009 VA 2/9/2009 2/9/2009 2/9/2009 NM 2/9/2009 VA 2/9/2009 WV 2/9/2009 OH 2/9/2009 TX
4 3 0.4 22 30 36 37 30 36 32 0.2 0.7 55 13 50 1.5 1.8 40 1.2 0.3 14 11 12 75 1.5 17 4 0.3 25
4 3 0 22 30 36 37 30 36 32 0 0 55 13 50 1 1 40 1 0 14 11 12 75 0 17 4 0 25
75 61 70
75 61 70
6 7
3 17 22 15 17 21 16 51 22 1.3 22 61
22 14 17 16 51 22 1 22 61
M F 0.4 M M F M F M F M 0.2 F 0.7 M M M F 0.5 F 0.8 F F 0.2 F 0.3 F M M M F 0.5 F M M 0.4 U F U F F F F M M M M M F F F F F F F M F 0.3 M F F
2/6/2009 Abdominal pain within 5 min after v 2/6/2009 Mom reported severe local reaction Hives all over. Hives. No respirator 7/29/2008 22 y/o male pt. presents to clinic wi 5/28/2008 "I got my first Anthrax vaccine and a ### 36 y/o male with possible adverse re 10/2/2008 The patient is a 38 year old female. 6/27/2008 34 y/o AD male with hx of hospitaliz 5/25/2008 36 y/o female, spouse of retired SM 2/6/2009 Itching, swelling, discoloration, sore 2/4/2009 Patient received ROTATEQ ON 1/1 Developed emesis and cyanosis a f 2/6/2009 2-6-09 Client phoned in and report h 2/5/2009 Hep A site, fever 104, red, swollen i 1/30/2009 Onset of symptoms began on 1-272/6/2009 After VARIVAX vaccine, developed 2/5/2009 Febrile seizures, temp 103.2 degree 2/3/2009 Pt. c/o L arm "tingling", numbness & 2/3/2009 Per mom, patient developed fever 1 2/6/2009 None stated. 2/6/2009 Left upper arm with 10x7 cm faint e 2/6/2009 Rapid onset of redness, pain, swelli 2/6/2009 red, warm, indurated area left arm. 2/6/2009 fever, chills, arm pain, warm to touc 2/6/2009 At 8 days, large hive appeared first 2/7/2009 Approximately 5 minutes after immu 2/7/2009 r arm cellulitus requiring hospital ad 2/7/2009 Thick mucus in mouth, wheezing,dif 2/9/2009 I have lost at least 25% of my hair. I 11/6/2008 Initial information was received on 2 2/5/2009 Initial information received on 29 Ja 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received via a 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/8/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 Information has been received from 2/6/2009 On 6/16/00 the pt received HepB #1 1/19/2009 I took GARDASIL shot series, It did 2/5/2009 Daughter had second shot of GARD 2/2/2009 Body aches, fever (>100 degrees), 2/5/2009 Right arm swollen, red, and hot to to 2/2/2009 Evening of vaccination developed ra 2/5/2009 States hives on both arms & trunk d 2/4/2009 Dec. 22, 2008, family medicine--Go
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2/9/2009 MO 2/9/2009 WI 2/9/2009 WI 2/9/2009 WA 2/9/2009 OR 2/9/2009 WI 2/9/2009 WV 2/9/2009 OK 2/9/2009 MI 2/9/2009 UT 2/9/2009 VA 2/9/2009 AZ 2/9/2009 WA 2/9/2009 IL 2/9/2009 TX 2/9/2009 MT 2/9/2009 MD 2/9/2009 CA 2/9/2009 TN 2/9/2009 2/9/2009 WI 2/9/2009 CO 2/9/2009 MD 2/9/2009 CA 2/9/2009 NC 2/9/2009 IA 2/9/2009 CA 2/9/2009 DC 2/9/2009 WA 2/9/2009 IN 2/9/2009 NC 2/9/2009 NY 2/9/2009 NJ 2/9/2009 CA 2/9/2009 IN 2/9/2009 CA 2/9/2009 NC 2/9/2009 NM 2/9/2009 CO 2/9/2009 NH 2/9/2009 MI 2/9/2009 NC 2/9/2009 PA 2/9/2009 WV 2/9/2009 2/9/2009 NC 2/9/2009 NY 2/10/2009 TX 2/10/2009 NY 2/10/2009 NJ 2/10/2009 TX
1.1 17 11 11 42 63 5 41 53 38 4 39 19 60 49 62 0.5 1.3 4 18 0.2 1 65 3 0.3 4 43 1 0.3 2 4 37 4 1.3 8 9 24 28 18 58 43 39 57 21 34 0.2 13 14 12
1 17 11 11 42 63 5 41 53 38 4 39 19 2 60 49 62 0 1 4 18 0 0 65 3 0 4 43 1 0 2 4 37 4 1 8 9 24 28 18 58 43 39
34 0 13 14 12
0.1 F F F F F F M M F M F M F 0M M M F 0.5 M 0.3 F M F 0.2 M 0F M F 0.3 M F F 0F 0.3 M 0.5 F M F M 0.3 M M M F F F F F M F F M 0.2 M M M F F
2/4/2009 Morn after imm. child had fever 101 2/5/2009 Alicia had complained of pain in her 2/5/2009 Daughter complained of pain in her 2/5/2009 I took patient to receive the 3rd sho 1/26/2009 Fever of 101 degrees F > Broke out 2/2/2009 Redness, swelling, pain. 2/4/2009 Chicken pox 2/9/2009 pt reported dog bite in am and need 2/9/2009 Pruritus as soon as injection given t 2/9/2009 Shot given Monday, February 2, 20 2/9/2009 BREAKTHROUGH CHICKENPOX F 2/9/2009 Suspected spread of smallpox due 2/7/2009 pt recieved yellow fever vaccination 2/9/2009 Mom Called in and states that child 2/9/2009 After Zoster vaccination, varicella-zo 2/9/2009 Pt experienced shoulder girdle pain 2/9/2009 12/3/08 pt started with "strangled co 2/9/2009 Diffuse upper and lower extremity s 2/9/2009 Hives over entire body that itches. 2/9/2009 Patient contracted cellulitis in his lef 2/9/2009 Persistent headaches and numbnes 2/9/2009 Patient presented to clinic with moth 2/9/2009 103 Fever (48 hours later) Low-gra 2/9/2009 An itchy, slightly swollen red rash (a 2/9/2009 hives/raised rash at injection site, fe 2/9/2009 None 2/9/2009 Redness, swollen, & rash around va Beginning 1/10/2009, red bumps ap 2/2/2009 Client was noted to have Red spots 2/7/2009 Facial Swelling, rash prescribed Ora 2/9/2009 Vaccine on 25-09 2-6-09 fever (ele 2/9/2009 Hives on face, neck, groin area, bac 2/3/2009 On 2/3/09 student came in with c/o 2/8/2009 Fever + Chills 5 hours after vaccine 2/9/2009 After 10 days fever and runny nose. 2/6/2009 Chills, lethargic 10 minutes after the 2/9/2009 24-30 hours after vaccine pt broke o 2/9/2009 During administration the patient ha 2/9/2009 Pt contacted clinic on 2/6/09 (injecti 2/6/2009 Patient states she had a S/E of righ 2/6/2009 Tdap 1/30/09- Rx scarred immediat 2/6/2009 Pt presented to ER c/o arm sorenes Pt presented to office with erythema 2/6/2009 Excessive swelling at injection site. 2/9/2009 Information has been received from 12/9/2008 Whole body aches, anxiety, high Ch 2/9/2009 After receiving the vaccinations, the 2/6/2009 Initial information received on 02 Fe 2/6/2009 Initial information received on 02 Fe 2/9/2009 Information has been received from 2/9/2009 Information has been received from
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2/10/2009 PA 2/10/2009 FL 2/10/2009 2/10/2009 2/10/2009 2/10/2009 WA 2/10/2009 MI 2/10/2009 ID 2/10/2009 AZ 2/10/2009 MA 2/10/2009 NY 2/10/2009 CO 2/10/2009 WI 2/10/2009 MI 2/10/2009 MA 2/10/2009 PA 2/10/2009 IL 2/10/2009 VA 2/10/2009 TX 2/10/2009 CA 2/10/2009 VA 2/10/2009 OR 2/10/2009 PA 2/10/2009 GA 2/10/2009 TX 2/10/2009 TX 2/10/2009 HI 2/10/2009 OH 2/10/2009 IL 2/10/2009 IL 2/10/2009 2/10/2009 2/10/2009 WI 2/10/2009 CA 2/10/2009 CA 2/10/2009 CA 2/10/2009 PA 2/10/2009 MI 2/10/2009 CA 2/10/2009 MA 2/10/2009 AR 2/10/2009 WA 2/10/2009 NC 2/10/2009 LA 2/10/2009 OR 2/10/2009 IA 2/10/2009 NC 2/10/2009 LA 2/10/2009 MO 2/10/2009 MI 2/10/2009 WI
14 5 67 62 0.6 1.5 0.1 12 4 0.2 12 23 5 39 37 0.5 60 24 7 48 39 0.2 9 35 17 40 20 25 1.3 0.4 10 34 4 11 0.6 0.2 15 11 4 11 0.2 19 1.5 14 61 0.3 17 0.8 1 21
67
1 0 12 4 0 12 23 5 37 0 60 24 7 48 39 0 9 35 17 40 20 25 1 0 10 51 34 4 11 0 0 15 11 4 11 0 19 1 14 61 0 17 0 1 21
F F F M M 0.5 F 0.1 M M M 0.2 M F F M M M 0.5 M F M F F F 0.2 F F F F F M F 0.3 M 0.4 M F M F F M 0.6 M 0.2 M F M F M 0.2 M M 0.5 F F F 0.3 M F 0.8 M 0F F
2/9/2009 Information has been received from 2/9/2009 Information has been received from 2/9/2009 Information has been received from 2/9/2009 Weakness 2/7/2009 Shot given: PENTACEL. persistent 2/4/2009 Mom States child started becoming 2/10/2009 On 01-26-09 patient presented to U 2/9/2009 Mom states child was dizzy, nausea 2/9/2009 Patient received KINRIX (DTap and 2/9/2009 Reported notability, poor feeding, le 2/10/2009 Chronic headache pain. 2/18/09MR 2/10/2009 Severe headache, head congestion 2/9/2009 Redness at sight and swelling of leg 2/10/2009 I feel that I am having an adverse re 2/10/2009 Patient vaccinated on Friday 2/6/20 2/10/2009 Mom noticed redness around neck 2/10/2009 td administered on 01/29/09 left del 2/10/2009 PATIENT HAS A RASH ON HIS FA 2/10/2009 Right arm with 2 1/2" x 1 1/8" erythe 2/10/2009 This patient present with a Swollen 2/10/2009 Approximately 2 hours (10:00 AM) 2/10/2009 2mmx2mm firm cystic lesion on Rt l 2/10/2009 syncopal event fifteen minutes after 2/10/2009 Left axillary lymphadenopathy: swol 2/10/2009 Patient began having frequent UTI's 2/10/2009 Patient states had problems with "le 2/10/2009 Event dated 1 Jan 1992. Approxima 2/10/2009 Severe pain after injection. Few min 2/10/2009 rash that started on face 8 days afte 2/10/2009 Within an hour of arriving home from 2/10/2009 In Spanish: The HPV vaccine Garda 2/10/2009 This case was reported by a law off 2/10/2009 Approximately two hours after recei 2/10/2009 Mom brought child to office 4 days a 2/9/2009 Red, rash to right upper arm Pt. given shots on Feb 02, 2009 - na 2/10/2009 Fever, vomiting x 2 days, lethargic, 2/10/2009 Pt seen for headaches on 1/21/09 2/10/2009 He started to vomiting and diarrhea 2/10/2009 3x4 inch area of ERYTHEMA 2/10/2009 Per pediatrician who saw Pt in office 2/6/2009 None Stated 2/9/2009 19 Y/O White male ADSM is referre 2/10/2009 5 minutes after receiving DTaP, HIB Pt developed a pruritic rash starting 2/10/2009 -Mild headache for 2 days. -Welt at 2/10/2009 Misadministration of vaccine. 2/3/2009 Reported back to clinic with report o 2/10/2008 On 2/04/2007 Child received DTP # 2/9/2009 Child was suppose to receive MMR 2/10/2009 Received dose Amox 2-5-09. C/o H
339404 339405 339374 339410 339411 339414 339415 339417 339418 339420 339421 339425 339426 339427 339428 339429 339430 339431 339432 339433 339434 339435 339436 339437 339438 339439 339440 339441 339442 339443 339444 339445 339446 339447 339448 339449 339450 339451 339452 339453 339454 339455 339456 339457 339458 339459 339460 339462 339463 339464 339465
2/10/2009 IL 2/10/2009 AK 2/11/2009 OH 2/11/2009 FL 2/11/2009 2/11/2009 2/11/2009 NM 2/11/2009 OR 2/11/2009 PA 2/11/2009 OH 2/11/2009 CA 2/11/2009 NC 2/11/2009 AZ 2/11/2009 CA 2/11/2009 CA 2/11/2009 CA 2/11/2009 IL 2/11/2009 IA 2/11/2009 AZ 2/11/2009 MA 2/11/2009 WA 2/11/2009 2/11/2009 CA 2/11/2009 WI 2/11/2009 AK 2/11/2009 NE 2/11/2009 WI 2/11/2009 CA 2/11/2009 MA 2/11/2009 TX 2/11/2009 CO 2/11/2009 MI 2/11/2009 MD 2/11/2009 AZ 2/11/2009 GA 2/11/2009 PA 2/11/2009 PA 2/11/2009 NY 2/11/2009 AZ 2/11/2009 CA 2/11/2009 NY 2/11/2009 MI 2/11/2009 KY 2/11/2009 MN 2/11/2009 MI 2/11/2009 AZ 2/11/2009 NE 2/11/2009 OR 2/11/2009 IA 2/11/2009 MI 2/11/2009 CA
68 1.1 11 49 1 21
68 1 11 49
18 20 17 15 70 69 41 38 4 9 17 11 0.2 3 6 0.2 4 59 8 45 8 10 65
18
46 49 56 10 16 35 4 4 34 0.2 1.8 42 15 55 4 50 11 0.3 0.6 1
45 48 56 10 16 35 4 6 34 0 1 42 15 55 4 50 11 0 0 0
21
17 15 70 69 41 38 4 9 17 11 0 3 6 0 4 59 8 45 8 10 65
F 0.1 M F M F F F F F F F M F M U M F F M 0.2 F F F 0.2 F M F F F F M F F F M F F F F F M M 0.2 M 0.9 M U F M F M F 0.4 M 0.6 M 1F
2/10/2009 Mild allergic Reactions - Redness, s 2/2/2009 Patient received vaccines at approx 2/11/2009 My dughter became very ill when we 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/10/2009 Information has been received from 2/3/2009 Ophthalmic rash, vesicles, fever X 2 2/9/09 = Red swollen left arm painfu (L) arm pain, vomiting, malaise, R/O 2/11/2009 6 cm x 6 cm red, warm, swollen are 2/11/2009 Redness and swelling at site of inje 2/10/2009 1-2 minutes after receiving vaccine 2/9/2009 Dizziness after injection 2/9/2009 Severe crying/inconsolable and fuss 2/11/2009 None 2/11/2009 < 50 crusted lesion Pt. had fever for 2/12/2009 Really drowsy and dazed lasting ab 2/11/2009 Swollen, red right arm (hyperimmun 2/6/2009 Rash, itching, Rash spread all over 2/2/2009 Swelling greater than 5cm w/ erythe 2/11/2009 patient with pain, Erythema, warmth 2/10/2009 Patient noticed a 4 in by 3 in area o 2/11/2009 (8x4inch) itching, redness at site 2 d 2/6/2009 Red, irritated blotchy rash at PNEUM 2/10/2009 24 hr after shot she developed redn 2/11/2009 vaccine given 2/6/2009. patient sta 2/11/2009 Pt woke up at 1:00 am with chills, th 2/11/2009 The patient called the Dept of Healt 2/11/2009 4 CM x 4 CM SWOLLEN SPOT ON 2/11/2009 Patient was in office for routine visit 2/11/2009 Fever (102-103, severe arm pain an 2/11/2009 She initially had fever and redness t 2/11/2009 ERYTHEMA APPROX. 4 CM IN SIZ 2/11/2009 On 2/4/09 in received 1st dose of JE 2/11/2009 Onset of diarrhea 4 days after 1st d 2/11/2009 Parent reported increased swelling 2/11/2009 Begab with weakness in right side o 2/11/2009 Developed symptoms of severe hea 2/11/2009 Within 2 hours of getting Pneumova 2/11/2009 HARD TIME BREATHING,NOT FEE 2/11/2009 Joe called and reported about 15 m 2/11/2009 PATIENT STOOD WITHIN A MINU 2/11/2009 erythema at injection site. 2/11/2009 Initial flu vaccine given 1-6-2009. H 2/11/2009 Presented on 02.02.2009 with rash
339466 339467 339468 339469 339470 339471 339472 339473 339474 339482 339483 339484 339485 339486 339488 339490 339495 339496 339497 339498 339499 339500 339501 339502 339503 339504 339505 339506 339507 339508 339509 339510 339511 339512 339513 339514 339515 339516 339517 339519 339525 339526 339527 339528 339529 339530 339531 339532 339533 339534 339535
2/11/2009 GU 2/11/2009 VA 2/11/2009 CO 2/11/2009 TX 2/11/2009 CA 2/11/2009 MD 2/11/2009 NM 2/11/2009 WA 2/11/2009 VA 2/11/2009 WI 2/11/2009 TX 2/11/2009 KY 2/11/2009 2/11/2009 CA 2/12/2009 MI 2/12/2009 AR 2/12/2009 MI 2/12/2009 NC 2/12/2009 SC 2/12/2009 TX 2/12/2009 SC 2/12/2009 GA 2/12/2009 PA 2/12/2009 AZ 2/12/2009 FL 2/12/2009 WA 2/12/2009 OH 2/12/2009 CO 2/12/2009 TX 2/12/2009 CA 2/12/2009 CA 2/12/2009 MA 2/12/2009 WA 2/12/2009 CA 2/12/2009 WA 2/12/2009 WA 2/12/2009 NC 2/12/2009 WA 2/12/2009 OR 2/12/2009 IA 2/12/2009 OK 2/12/2009 NC 2/12/2009 UT 2/12/2009 SC 2/12/2009 WA 2/12/2009 AL 2/12/2009 MO 2/12/2009 RI 2/12/2009 OH 2/12/2009 OH 2/12/2009 NY
32 14 53 0.1 11 17 1.5 47 30 16 1.2 0.2 34 1.1 0.1 10 58 6 37 0 0.3 8 72 61 28 14 72 0.5 28 1.5 0.5 65 0.9 41 30 30 55 14 2 52 16 16 11 76 9 12 17 1.9 0.4 1.4 10
32 14 53 0 11 17 1 47 30 16 1 0 34 1 0
6 37 0 0 8 71 61 28 14 72 0 28 0 65 0 41 30 30 55 14 2 16 16 11 76 9 12 17 1 0 1 10
M F F 0.1 M M F 0.5 M M F M 0.2 M 0.2 M M 0.1 M 0.1 M F U M F 0M 0.2 M M F F F F F 0.5 M F M 0.5 M F 0.9 F F F F F F 0.9 M M F F M F F M F 0.9 F 0.4 M 0.4 F F
2/11/2009 Redness, swelling, warm Fever 104 2/11/2009 Pt was sitting on exam table after va 2/11/2009 metallic taste in mouth, feeling of sw 2/11/2009 Seizures/Spasms (they look like infa 2/11/2009 GAVE Dtap INSTEAD OF Tdap 2/11/2009 RASH ON HANDS< AND OVER FO 2/11/2009 2/9/09 DTaP: Sanofi Pasture Limite 2/11/2009 shot given 1600(Sun) by 1100 next 2/11/2009 Patient received Merck's Gardasil v 2/11/2009 This case was reported by a physici 2/10/2009 Fever 102.3 (r) for 2 days morning a 2/9/2009 Inconsolable crying for 3 days after 2/10/2009 From shot 1-3 of ANTHRAX I felt ha 2/11/2009 Maculopapular rash over trunk, face 2/11/2009 Information has been received from 2/11/2009 Information has been received from 2/12/2009 Subject in pneumococcal vaccine tr 2/12/2009 5 MIN AFTER GETTING VARICELL 2/12/2009 Client called and reported L arm "pu 2/12/2009 Extreme lethargy after Hepatitis B v 2/12/2009 On 10/25/08, @ 8-9AM, mom obser 2/12/2009 vaccine given 02/09/09. on 02/10/09 2/12/2009 On 1/16/09, two days after vaccine 2/12/2009 temperature 102 deg. - hives - seve 2/12/2009 client returned to clinic 2/9/09 statin 2/12/2009 After the third dose my daughter go 2/12/2009 Client states approximately ten days 2/12/2009 The patient developed diarrhea (10 2/12/2009 40mm x 35mm area of "bruising", er 2/12/2009 MOM STATES "HAD FULL BODY R 2/12/2009 urticarial rash onset 5 days after vac 2/12/2009 Vaccine given 2/20/08. On about 2 2/12/2009 PARENT CALLED AND REPORTE 2/12/2009 I received the TDAP vaccine on the 2/12/2009 pain at injection sight up into should 2/12/2009 Erythema, pain at injection sight up 2/12/2009 6.5 x 12 cm area of erythema, indur 2/12/2009 2/6/2009 7:00 p.m. To E.R. by amb 2/12/2009 Four inches long by three inches wi 2/13/2009 We received from a health care prof 2/12/2009 12/17/08 mom took patient to ER fo 2/12/2009 Patient fainted within 2 minutes of v 2/12/2009 Local rxn both sites - Erythema no f 2/12/2009 Pt's face and neck turned red with a 2/12/2009 Pt had severe bronchospasm and s 2/12/2009 Patient started temp 1:30 am 2/12/0 2nd shot left deltoid swollen and ten 2/12/2009 Immediately after administering, Pt 2/5/2009 2-5-09 mother reports fever 102 deg 2/6/2009 Left thigh- 1/2 dollar sized red rash. 2/12/2009 8x8 cm red, warm to touch. Local re
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2/12/2009 NY 2/12/2009 MO 2/12/2009 MO 2/12/2009 CO 2/12/2009 MO 2/12/2009 VA 2/12/2009 MD 2/12/2009 FL 2/13/2009 AZ 2/13/2009 VA 2/13/2009 FL 2/13/2009 PA 2/13/2009 NY 2/13/2009 NJ 2/13/2009 FL 2/13/2009 WI 2/13/2009 GA 2/13/2009 WA 2/13/2009 OH 2/13/2009 AZ 2/13/2009 NY 2/13/2009 CO 2/13/2009 NC 2/13/2009 TX 2/13/2009 SC 2/13/2009 NJ 2/13/2009 CA 2/13/2009 AL 2/13/2009 NJ 2/13/2009 MO 2/13/2009 CA 2/13/2009 CO 2/13/2009 CT 2/13/2009 CO 2/13/2009 TX 2/13/2009 GA 2/13/2009 NC 2/13/2009 PA 2/13/2009 WI 2/13/2009 CA 2/13/2009 CA 2/13/2009 IN 2/13/2009 KY 2/13/2009 OR 2/13/2009 OR 2/13/2009 GA 2/13/2009 NC 2/13/2009 CT 2/13/2009 CT 2/13/2009 TX 2/13/2009 MO
15 3 2 1.3 1 5 36 10 73 25 22 1 1.5 27 61 1.3 23 60 0.3 8 34 0.7 62 66 5 3 0.3 14 11 0.3 43 1.1 58 13 67 16 1 16 73 53 1.1 1 58 5 61 15 47 5 1.5 67 8
15 3 2 1 0 5 36 10 73 25 22 1 1 27 61 1 23 60 0 8 34 62 66 5 3 0 14 11 0 43 1 13 67 16 1 16 73 53 1 1 58 5 61 15 47 5 1 67 8
M M 0.2 M 0.3 F 1M M F M F F F 0M 0.5 M F M 0.3 F F M 0.3 F M F M F M M M 0.3 M F M 0.3 M F 0.1 M M M F F 0M F F F 0.1 F 0F F F M F F F 0.5 M F F
2/12/2009 Zoster (shingles) developed # days 2/12/2009 Administered FLUMIST with expirat 2/12/2009 Administered FLUMIST with expirat 2/12/2009 None stated 2/11/2009 Rash on chest, back, face, scalp, ar 2/12/2009 Mother reported within 7 minutes of 2/12/2009 ENGERIX B #2 administered at 11 2/11/2009 Had emesis and upset stomach with 2/12/2009 Patient reports she got shingles from 2/9/2009 Patient developed rash on neck, fac 2/12/2009 Information has been received from 2/12/2009 This case was considered medically 2/13/2009 1/14/09 pt received vaccines (Dtap, 2/13/2009 Patient was vaccinated on 1/30/09 a 2/13/2009 PT REPORT RED, BURNING ABDO 2/13/2009 0945: given Varicella/DTaP 1530: 2/13/2009 I received the Gardasil vaccine and 2/13/2009 myalgias, fever, chills, loss of appet 2/13/2009 High pitch shrill cry for 45 minutes (n 2/13/2009 8 year old male received 2nd doe o 2/13/2009 Local injection site reaction to the R 2/13/2009 Within 24 hours of Jeff's first DPT sh 2/13/2009 PATIENTS HUSBAND PRESENTE 2/13/2009 Severe arm pain upper arm, can't lif 2/13/2009 2/5/2009--Back of L arm--upper are 2/13/2009 Mother states he started a fever@ 1 2/13/2009 The child received his second immu 2/13/2009 1st Gardasil vaccination on 2/19/08 2/13/2009 Morning after injection, child woke u 2/13/2009 12/09/08 - patient was administered 2/13/2009 1/14/09 afternoon began chest pain 2/13/2009 TC from State Epidemiologist statin 2/13/2009 4 hours after shot - mild malaise dev 2/13/2009 Diffuse erythematous papular erupt 2/13/2009 Moderate swelling and erythema 2/13/2009 Minutes after vaccine admin., pt. wa 2/13/2009 rash, mildly pruritic chicken pox 2/13/2009 Pt had Px exam 11-25-08. GARDA 2/13/2009 With 4 hours stated arm was the siz 2/12/2009 Patient called and notified that the d 2/11/2009 Brief 1 minute seizure - tonic clonic 2/10/2009 Rash. Mom unsure of onset, but pt. 2/5/2009 Pt. returned to office at 4:00 pm- wit 1/30/2009 Child had Rec'd vaccines in AM and 2/5/2009 Ringing in ears 1 hour post injection 2/6/2009 Redness, swelling to site, itching. (V 2/11/2009 2/15/09 Night of injection L arm bec 2/13/2009 Swelling noticed next day- became 2/13/2009 Swelling a redness noted same eve 2/12/2009 24 hours after shot began headache 2/13/2009 Scattered raised papulovasicular les
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2/13/2009 NY 2/13/2009 WA 2/13/2009 WA 2/13/2009 PA 2/14/2009 OR 2/14/2009 NC 2/14/2009 PA 2/14/2009 TX 2/15/2009 PA 2/15/2009 ME 2/16/2009 2/16/2009 2/16/2009 2/16/2009 SC 2/16/2009 SC 2/16/2009 SC 2/16/2009 SC 2/16/2009 IL 2/16/2009 PA 2/16/2009 OH 2/16/2009 NC 2/16/2009 MO 2/16/2009 AZ 2/16/2009 LA 2/16/2009 PA 2/16/2009 LA 2/16/2009 FL 2/16/2009 CA 2/16/2009 2/16/2009 CO 2/16/2009 FL 2/16/2009 WY 2/16/2009 IL 2/16/2009 2/16/2009 SC 2/16/2009 OH 2/16/2009 CA 2/16/2009 WA 2/16/2009 FL 2/16/2009 NY 2/16/2009 KS 2/16/2009 NY 2/16/2009 IN 2/16/2009 AZ 2/17/2009 2/17/2009 2/17/2009 IA 2/17/2009 2/17/2009 NC 2/17/2009 2/17/2009 MI
0.5 41 1.3 1.2 0.3 12 81 0.3 53 20
53 1.8 1.2 5 4 35 4 1 36 17 6 48 78 17 45 14 16 11 0.2 22 1.4
0 41 1 1 0 12 81 0 53 20
1 1 5 4 35 4 1 36 17 6 48 78 17 45 14 11 0 22 1
69 61 8 10 72 1 1 17 18 22 35
69 61 8 10 72 1 1 17 18 22 35
17 5 71 14 17
17 71 14
0.5 M M 0.3 F 0.2 M 0.3 M F M 0.3 F F M U F M 0.8 F 0.2 M M F F M 0F F F F M F F F M F F 0.3 M F 0.4 F F M F M M M 0F 0F F F F F F F M M F F
2/13/2009 8 hours after vaccination, at 7 pm d 2/6/2009 Pt states reoccurrence of Reitens D 2/6/2009 fever w/seizure 24 hours post vaccin 2/5/2009 About 2 weeks after vaccines given 2/14/2009 A few hoursYafter his well child chec 2/14/2009 Patient given 1st dose of Gardasil L 2/14/2009 After Zostavax injection, patient's ar 2/14/2009 She develop a fever, irrability, decre 2/15/2009 24 hours after receiving D/T immuni 2/15/2009 Guillian Barre requiring hospitalizati 2/16/2009 About 2 minutes after the shot I wal 2/12/2009 This serious case was received from 2/9/2009 States after flu injection 9/29/08, pt 9/4/2008 Pt. Rx with VARICELLA on 9-4-08 v ### Few vesicles over trunk x 4 days. 9/19/2008 Mild VARICELLA - few vesicles on t 12/9/2008 Few vesicles on trunk X 3 days Dx 2/9/2009 2/02 5:30PM feet starting itching. 2 2/16/2009 Received vaccines 2/3/09, 2 days la 2/16/2009 Fever started 02/13/09, highest was 2/16/2009 Immediate onset of erythema, prurit 2/16/2009 Headaches starting January 3rd. Na 2/16/2009 Developed Influenza A 2/16/2009 Night after vaccine administered pa 2/16/2009 PATIENT RECIEVED A SUB-Q DO 2/16/2009 Patient received 1st dose of Gardas 2/16/2009 Pt. developed burning, itching rash 2/16/2009 Fever,dizziness & fast heart beat 2/16/2009 My daughter received Gardisil vacci 2/16/2009 Patient experiences severe flushing 2/16/2009 My son has had chronic constipatio 2/16/2009 Fever, headache, nausea, joint pain 2/16/2009 MMR given 1/21/09. Came in with s 2/16/2009 This case was reported by a healthc 2/12/2009 Leg Pain 2/12/2009 Fatigue, myalgia. Episode of tachyc 2/5/2009 Diffuse abdominal pain after first do 2/16/2009 DTap given outside guidelines. Per Fever,chills, weakness, RUQ pain a 2/12/2009 Pink papule on L Tricep Area with w 2/6/2009 Infant had some sinus congestion a 2/16/2009 Pt c/o feeling dizzy after shot. Pt to 2/12/2009 Patient was given two tetanus inject 2/13/2009 Rash. swelling pain @ injection site 2/17/2009 Patient reported pain and swelling a 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/16/2009 Information has been received from 2/16/2009 Information has been received from 2/16/2009 Information has been received throu
339697 339698 339706 339708 339710 339711 339712 339713 339714 339715 339716 339717 339718 339719 339720 339721 339722 339723 339724 339725 339726 339727 339736 339737 339738 339739 339740 340200 340201 340202 340203 340204 340205 340206 340207 340208 340209 340210 340211 340212 340213 340214 340215 340216 340217 340218 340219 340220 340221 339741 339742
2/17/2009 2/17/2009 CA 2/17/2009 2/17/2009 NH 2/17/2009 CA 2/17/2009 WA 2/17/2009 NC 2/17/2009 VA 2/17/2009 NM 2/17/2009 GA 2/17/2009 OR 2/17/2009 FL 2/17/2009 IN 2/17/2009 2/17/2009 ND 2/17/2009 OR 2/17/2009 NC 2/17/2009 IN 2/17/2009 MS 2/17/2009 VA 2/17/2009 SC 2/17/2009 CA 2/17/2009 WI 2/17/2009 FL 2/17/2009 PA 2/17/2009 IN 2/17/2009 VA 2/17/2009 OH 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 KY 2/17/2009 CA 2/17/2009 TX 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 DC 2/17/2009 DC 2/17/2009 AZ 2/17/2009 MO 2/17/2009 MO 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 AZ 2/17/2009 NJ 2/17/2009 NJ 2/17/2009 OH 2/18/2009 IL 2/18/2009 OH
14 18 14 0.5 40 55 65 16 10 0.8 3 79 13 26 5 41 76 13 0.2 68 67 30 1 80 17 1.8 40 30 3 4 4 2.7 5.7 2 3.3 3.2 4 2 2 2 2 3.8 4
14 18
4 2 4 0.4 0.8
4 2 4 0 0
0 40 55 65 16 10 0 3 79 13 26 5 40 75 13 0 68 67 30 1 17 1 40 3 4 4
3 3 4 2 2 2 2 3 4
F F F 0.5 M F F F F F 0.8 M M U F F M M F F 0.2 M F F F 0F F F 0.8 F F F F M F F M F F M F 0F 0.4 M 0U 0.8 F F U U U U M 0F M 0.4 M 0.8 F
2/16/2009 Information has been received from 2/16/2009 Information has been received from 2/15/2009 Information has been received from 2/2/2009 Patient received the three doses of 2/6/2009 Headache, emesis. 2 ED visits. 1/27/2009 (L) arm/hand "pinging" when I tap th 2/11/2009 None 2/12/2009 GARDASIL injection given in left de 1/29/2009 Rt Arm- 6.5X 8cm erythematous, ind 2/11/2009 Patient was seen at the Emergency 2/13/2009 morning after had HEP A shot had b 2/17/2009 pT. STATES GENERALIZED RASH 2/17/2009 Approx 3 weeks after getting 1st se 2/17/2009 Vaccinated during pregnancy. Preg 2/17/2009 Mother called stated that child bega 2/17/2009 Chronic fatigue, difficulty concentrat 2/17/2009 pt contracted shingles 8 months s/p 2/17/2009 Mom states that 4 hours after immu 2/17/2009 He had a high Y fever 4 days after ge 2/17/2009 Red swollen Left arm. Patient came 2/17/2009 Zostavax injection given on 2/10/20 2/17/2009 Observed large reddened area appr 2/17/2009 Erythema multiforme 2/16/2009 Patient developed vesicular rash in 2/17/2009 Patient's mother called 2/17/09 repo 2/17/2009 C/o rash on shoulders, back, (R) sid 2/16/2009 Swelling, pain left index finger mcp 1/23/2009 A non-serious, spontaneous report 1/15/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/21/2009 A non-serious spontaneous report o 1/19/2009 A non-serious spontaneous report o 1/12/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/13/2009 A non-serious, spontaneous report 1/13/2009 A non-serious, spontaneous report 1/7/2009 A non-serious report of "six patients 1/9/2009 A non-serious, spontaneous report 1/9/2009 A non-serious, spontaneous report 1/7/2009 A non-serious report of "six patients 1/8/2009 A spontaneous non-serious report o 1/8/2009 A non-serious spontaneous report o 1/8/2009 A spontaneous non-serious report 1/6/2009 Expired vaccine used Expired drug 1/6/2009 A non-serious spontaneous report o 1/2/2009 A non-serious report of "gave patien Parent went to make f/u apt child no 1/14/2009 Vomiting that started several hours
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2/18/2009 MN 2/18/2009 NY 2/18/2009 2/18/2009 CO 2/18/2009 MA 2/18/2009 CA 2/18/2009 IN 2/18/2009 CA 2/18/2009 HI 2/18/2009 TN 2/18/2009 ME 2/18/2009 GA 2/18/2009 NY 2/18/2009 CA 2/18/2009 CA 2/18/2009 NY 2/18/2009 MN 2/18/2009 FL 2/18/2009 OH 2/18/2009 MI 2/18/2009 OR 2/18/2009 IN 2/18/2009 WA 2/18/2009 NJ 2/18/2009 KY 2/18/2009 OH 2/18/2009 WY 2/18/2009 IL 2/18/2009 KY 2/18/2009 UT 2/18/2009 CO 2/18/2009 MD 2/18/2009 TN 2/18/2009 OH 2/18/2009 HI 2/18/2009 CA 2/18/2009 CT 2/18/2009 AL 2/18/2009 IL 2/18/2009 MO 2/18/2009 NY 2/18/2009 PA 2/18/2009 IL 2/18/2009 MA 2/18/2009 VA 2/18/2009 NM 2/18/2009 WV 2/18/2009 WA 2/18/2009 FL 2/18/2009 WI 2/18/2009 TX
24 11 29 22 17 0.4 0.5 1.3 23 0.2 50 11 46 25 18 22 18 73 11 0.2 70 40 1 3 23 38 25 13 0.3 1.3 59 0.5 0.3 34 26 68 53 13 20 67 54 47 42 0.3 0.8 3 26 64 0.2 39 0.3
24 11 29 22 17 0 0 1 23 0 50 11 46 25 18 22 18 73 11 0 70 40 1 3 23 38 25 13 0 1 59 0 0 34 26 68 53 13 20 67 54 47 42 0 0 3 26 64 0 0
F M F F F 0.4 U 0.5 F 0.3 M M 0.2 M F F F F M M F F F 0.2 F M M 0F F F F M F 0.3 M 0.3 M F 0.5 M 0.3 M F F F F F F F M F M 0.3 M 0.8 F M F M 0.2 M M 0.3 F
12/1/2008 Soreness 1/20/2009 11 year boy passed out suddenly af 2/6/2009 Several hours after receiving the va 1/27/2009 Autoimmune-type disorder. Fever, jo 1/29/2009 Immunizations given on 1/12/09 at a Infant was seen 11/12/08 for pulling 1/16/2009 24 hrs after shots had episode of vo 1/28/2009 Convulsions, Shaking, High Fever. 2/10/2009 After receiving the third series of An 1/14/2009 Intussusception - open reduction aft 1/20/2009 Sudden onset arthralgias 12/29/08. ### Pain & swelling to the right deltoid a 1/19/2009 Right after Tdap I started having nu 1/16/2009 Weakness, nausea, tiredness, confu 1/27/2009 Developed Guillain Barre Syndrome 1/22/2009 Chest pain began 4 days after prima 1/15/2009 Pt given GARDASIL vaccine about 1/29/2009 Dead feeling in lower part of body. 1/20/2009 Pt returned to office about 1 hour po 1/20/2009 Baby previously well except noted t 1/20/2009 Headache- intense Flu-like symptom 1/29/2009 Pt suffer very severe local Rxn at si 2/5/2009 Developed petechiae 1/30/09. Diag 1/20/2009 Telephone call from parent - reports 2/9/2009 1/6/09 - Vaccine administered. 1/19 1/19/2009 I had received the Tdap shot in my 2/10/2009 Syncope episode following injection 2/9/2009 She developed Y a pulmonary emboli 2/6/2009 Patient found Y in cardiopulmonary ar 1/20/2009 About one week after shot. Fever 1 2/3/2009 Hospitalization for numbness, pain, 1/12/2009 Pt seen in ER twice for abdominal p 1/12/2009 Intussusception. Required partial co 1/15/2009 Noticed AM 1/15/09 - Right upper a 1/12/2009 Patient vacant 15 minutes after the ### Local area enduration, erythema & 12/1/2008 On 10/24/08 pt. presented to office 1/12/2009 Multiple lesions (>250) on extremitie Approx 10min after injection while s 1/12/2009 After approximately 8 minutes after 1/14/2009 Approx 3 hours after vaccine pt repo 1/13/2009 Achy, Chills, Diarrhea, Malaise follo 1/13/2009 Fever (102 degrees F), severe left a 1/14/2008 Rec'd PENTACEL, PCV7 and Rotav 1/14/2009 Facial flushing & macular rash on th 1/12/2009 Immunizations given on 1/8/09 at ap 1/14/2009 Pt called office and c/o L upper arm 12/23 ZOSTAVAX Received 12/25 1/19/2009 Pt became very irritable Abd pain. 2/17/2009 Information has been received from 1/16/2009 dev. vomiting and diarrhea within 4
339800 339801 339802 339804 339805 339806 339807 339808 339809 339810 339812 339813 339816 339818 339821 339823 339824 339825 339826 339827 339828 339829 339830 339831 339832 339833 339834 339835 339836 339837 339838 339839 339840 339841 339842 339843 339844 339845 339846 339847 339848 339849 339850 339851 339852 339853 339854 339855 339856 339857 339858
2/18/2009 CA 2/18/2009 FL 2/18/2009 IL 2/18/2009 FL 2/18/2009 2/18/2009 NE 2/18/2009 2/18/2009 TN 2/18/2009 MI 2/18/2009 VA 2/18/2009 IL 2/18/2009 NJ 2/18/2009 PA 2/18/2009 CA 2/18/2009 SC 2/18/2009 OR 2/18/2009 ND 2/18/2009 PA 2/18/2009 GA 2/18/2009 PA 2/18/2009 WA 2/18/2009 HI 2/18/2009 MS 2/18/2009 WI 2/18/2009 MA 2/18/2009 FL 2/18/2009 FL 2/18/2009 CA 2/18/2009 GA 2/18/2009 NY 2/18/2009 AL 2/18/2009 IL 2/18/2009 2/18/2009 TN 2/18/2009 MI 2/18/2009 IL 2/18/2009 NE 2/18/2009 CA 2/18/2009 NY 2/18/2009 PA 2/18/2009 NM 2/18/2009 TX 2/18/2009 CA 2/18/2009 CA 2/18/2009 MN 2/18/2009 VA 2/18/2009 GA 2/18/2009 MI 2/18/2009 OR 2/18/2009 WI 2/18/2009 WA
21 0.2 22 44 4 0
21 0 22 44
43 74 68 49 1 14 5 43 1.6 3 17 56 52 54 11 0.2 0.1 1.1 0.4 1.3 1.1 16 35 17 69 24 11
43
82 0 83 62 33 11 1 0.9 30 1.8 62 19 1 68 0.2 10
82 0 82 63 32 11 1 0 30 1 62 19 1 68 0 10
0
68 49 1 14 5 43 1 3 17 56 52 54 11 0 0 1 0 1 1 16 35 17 69 24 11
F 0.2 F F F M 0F M F F F F 0F F F F 0.6 M M F M F F F 0.2 M 0.1 M 0.1 M 0.4 M 0.3 M 0.1 F F M F M M F U M 0F F F M F 0M 0.9 F F 0.8 M F F 0F F 0.2 F F
1/12/2009 Patient complaints of wheezing at n 1/14/2009 Prolonged crying - went to clinic. Se 2/17/2009 Information has been received from 1/11/2009 Received TDAP vaccine 12/29/08 2/17/2009 Information has been received from 1/15/2009 Pt was given Influenza virus vaccine 2/17/2009 Information has been received rega 2/9/2009 Client called my cell phone and left 2/17/2009 Information has been received from 1/15/2009 Started stiff and could not move righ 2/10/2009 Arm became very swollen and red, 2/10/2009 Chicken pox 2/9/2009 Administered HEP A into R deltoid. 2/3/2009 Patient brought back in office by gu 2/2/2009 Patient was given inj f/m PNEUMOV 2/3/2009 1 d after vaccines - on 1/16/09, low 1/22/2009 First influenza vaccine given approx 2/3/2009 Extensive macular rash extending m 2/4/2009 MENACTRA was administered to 56 2/2/2009 Left shoulder discomfort reported 11 3/24/2008 Pt felt tingling in fingers, unable to li 1/31/2009 Increased local redness/swelling wit 1/15/2009 Fever 103.4 and red rash all over ar 1/20/2009 Severe diarrhea after 1st ROTATEQ ### Macular rash c/w RUBELLA. Irritab 1/16/2008 Pt received PREVNAR vaccine 1-14 1/16/2009 fever and rash 1/17/2009 fever 103-104 X 3 days post vaccin ### Within 10 minutes of receiving GAR 2/18/2009 Patient came into the clinic complain 2/18/2009 Approx. 30 minutes after injections 2/18/2009 had 5 weeks of peripheral neuropat 2/18/2009 According to patient he was sufferin 2/18/2009 Red,swollen warm touch left arm 2/1 2/18/2009 Received HPV Vaccine dose #3. D 2/18/2009 On 2/11/09, patient called the health 2/18/2009 a newborn was given an Adacell va 2/18/2009 Bilaterally symmetrical eruption of d 2/18/2009 Client was taking oral Typhoid Feve 2/18/2009 Arm Swollen burned and very hard 2/18/2009 VACCINE GIVEN AT 0915 LD IM W 2/18/2009 on 12/06/08 Mom called provider of 2/18/2009 Baby got vaccine, developed fever i 2/18/2009 After the shot was given I had mild t 2/18/2009 Dtap given right thigh, Hib given left 2/18/2009 noticed spot about the size of a qua 2/18/2009 3rd in the series of Guardasil on 7/2 1/21/2009 Pt was seen 11/16/09 & given VARI 1/16/2009 Received Tdap, influenza and PNEU 1/20/2009 Patient developed severe diarrhea a 1/15/2009 Pt. received Varicella vaccine 1/12/0
339859 339860 339862 339864 339865 339866 339867 339868 339869 339870 339871 339876 339878 339879 339880 339881 339882 339883 339884 339885 339886 339887 339888 339889 339890 339891 339892 339893 339894 339895 339896 339897 339898 339899 339900 339901 339902 339903 339904 339905 339906 339907 339908 339909 339910 339911 339912 339913 339914 339915 339916
2/18/2009 MI 2/18/2009 WI 2/18/2009 CO 2/18/2009 CO 2/18/2009 WA 2/18/2009 IN 2/18/2009 PA 2/18/2009 MI 2/18/2009 PA 2/18/2009 NY 2/18/2009 AZ 2/18/2009 PA 2/18/2009 IN 2/18/2009 HI 2/18/2009 CA 2/18/2009 MD 2/18/2009 NJ 2/18/2009 MI 2/18/2009 TX 2/18/2009 IL 2/18/2009 MD 2/18/2009 TX 2/18/2009 MI 2/18/2009 CA 2/18/2009 MO 2/18/2009 KY 2/18/2009 PA 2/18/2009 ME 2/18/2009 NJ 2/18/2009 NJ 2/18/2009 IA 2/18/2009 NY 2/18/2009 TX 2/18/2009 NY 2/18/2009 SC 2/18/2009 CA 2/18/2009 CA 2/18/2009 FL 2/18/2009 VT 2/18/2009 NC 2/18/2009 NY 2/18/2009 PA 2/18/2009 OH 2/18/2009 MD 2/18/2009 CA 2/18/2009 VA 2/18/2009 NV 2/18/2009 2/18/2009 AZ 2/18/2009 MO 2/18/2009 CA
1 1 34 1 35 1 1.5 4 1.5 4 4 28 24 32 3 15 12 0.3 0.3 17 1
1 1 34 1 35 0 1 4 1 4 4 28 24 32 3 15 12 0 0 17 1
1.6 1.2 34 4 0.2 1.6 6 6 0.5 8 0.3 4 0.5 14 17 4 1.2 65 61 1 4 9 1.9 22 2 1.6 1.3 66 31
1 1 34 4 0 1 6 6 0 8 0 4 0 14 17 4 1 65 61 1 4 9 1 22 2 1 1 66 31
0M 0M F 0F F 1M 0.5 F M 0.5 M F M F F M F F M 0.3 M 0.3 M F 0F M 0.6 M 0.2 F U F 0.2 M 0.6 F F F 0.5 M M 0.3 M M 0.5 F M F F 0.2 F F F 0M U F 0.9 F F 0.4 M 0.6 F 0.3 M M F
2/9/2009 Patient was vaccinated on 1/22/09 ( Rash-12-16 scattered red pin point 2/6/2009 Received MMR#2 2/2/09 woke 2/3/0 4 hours after having 3 vaccines (VA ### Pt's husband called for help Pt foun 2/2/2009 Pt had imm around 4:30PM. Went h 2/4/2009 Febrile seizure. 1/12/2009 None stated 2/4/2009 Febrile seizure. 1/27/2009 RT. arm red swollen - Hot to touch ### Fever of 104 and higher for seven d 2/13/2009 Initial report received on 02 June 20 1/12/2009 Left deltoid pain at injection general 2/18/2009 Pt waited 10 min after receiving YF2/18/2009 Dose #1 J-VAX given 2/10/09 (1cc g 2/19/2009 Given 1st GARDASIL 1/7/09 at rout Received Flu and MENACTRA 10/3 12/8/2008 4 hours post administration infant ve 1/13/2009 Maternal grandmother described sta 2/18/2009 Vaccine given 1/2/09 symptoms beg ### Infant began staring & jerking involu 2/12/2009 The evening after receiving the vacc 1/13/2009 Left thigh swollen upper thigh to me 2/18/2009 Patient received vaccines on 01/23/ Phone call received from family mem 1/14/2009 Vaccines 1/5/9 no problems. 1/6/9 1/14/2009 Patient received PENTACEL injectio 1/14/2009 MMR given R upper arm - minutes l 1/12/2009 Patient received HEP B3 vaccine on 1/12/2009 Patient received HEP B vaccine on 1/15/2009 1) Rash within 24 hrs. Started on le 1/23/2009 Generalized lesions head to toe-not 1/21/2009 Induration and redness over (L) leg 1/23/2009 redness and swelling of right upper 1/20/2009 PENTECEL given right thigh in am 1 2/18/2009 Patient fainted after receiving vaccin 2/17/2009 Patient was given vaccine. Approxim 2/18/2009 Severe right deltoid pain and swellin Intermittent fever and maculopapula 2/18/2009 Pt received a PNEUMOVAX on 2/17 2/18/2009 Pain, swelling, itching, rash, warmth 1/23/2009 Varicella vaccine breakthrough. Dia 2/18/2009 At 48 hours had 3" diameter celluliti 1/19/2009 Wheezing started within 10-15 min a 1/22/2009 Pt is brought by Mom, had vaccinat 1/16/2009 R cervical lymph swelling/tendernes 1/16/2009 12 x 10 cm lesion R thigh around sh 1/22/2009 Pt has dime size swelling and tende 1/23/2009 Hives at injection site, gave BENAD 12/5/2008 Pt c/o shock like sensations in his (L 1/30/2009 Large redness area (4 1/2 inches x
339917 339918 339919 339920 339921 339922 339923 339924 339925 339926 339927 339928 339929 339930 339931 339932 339933 339934 339935 339936 339937 339938 339939 339940 339941 339942 339943 339944 339945 339946 339947 339948 339949 339950 339952 339953 339954 339955 339956 339957 339958 339959 339960 339961 339962 339963 339964 339965 339966 339967 339968
2/18/2009 HI 2/18/2009 PA 2/18/2009 IL 2/18/2009 CA 2/18/2009 MO 2/18/2009 NY 2/18/2009 2/18/2009 DC 2/18/2009 PA 2/18/2009 WA 2/18/2009 PA 2/18/2009 KS 2/18/2009 PA 2/18/2009 OH 2/18/2009 SC 2/18/2009 NJ 2/18/2009 NY 2/18/2009 NY 2/18/2009 NY 2/18/2009 MT 2/18/2009 2/18/2009 NY 2/18/2009 OK 2/18/2009 CO 2/18/2009 PA 2/18/2009 OR 2/18/2009 CA 2/18/2009 NJ 2/18/2009 MA 2/18/2009 CA 2/18/2009 NH 2/18/2009 NH 2/18/2009 NM 2/18/2009 NY 2/18/2009 WI 2/18/2009 MN 2/18/2009 MS 2/18/2009 SC 2/18/2009 TX 2/18/2009 MO 2/18/2009 MN 2/18/2009 PA 2/18/2009 OR 2/18/2009 PA 2/18/2009 MO 2/18/2009 TX 2/18/2009 CA 2/18/2009 FL 2/18/2009 AZ 2/18/2009 AZ 2/18/2009 VT
0.2 9 21 72 71 0.7 21 38 13 6 22 28 1.7 12 12.9 58 49 0.8 49 59 49 1.1 64 4 19 11 0.6 37 6 10 12 10 29 8 15 69 38 16 40 61 9 32 24 68 5 4 69 4 18 12 4
0 9 21 72 71 0 21 38 13 6 22 28 12 12 58 49 0 49 59 49 1 64 4 19 11 0 37 6 10 12 10 29 8 15 69 38 16 40 61 9 32 24 68 5 4 69 4 18 12 4
0.2 M F M F F 0.7 F M F M F F M M F F F F 0.8 F F F F 0.1 F F F F F 0.6 F F F F F F F M F F M F F F M F F M M F F M F F M
1/20/2009 At 2 months old patient received va ### 2 day history of rash prior to presen ### Had immunization at 12:15 pm on T ### weakness-fell to the ground stomac 1/13/2009 Noted 2" diameter, slightly elevated 1/27/2009 Child became limp and unresponsiv 1/27/2009 Developed Ulcerative Colitis after A 1/27/2009 She states she was well at the time 1/23/2009 6 X 4 induration, pain on LT arm co 1/26/2009 Vaccine administered on 1/23/09 - O 1/23/2009 Vaccine given 1-12-09. Pt complain 1/22/2009 Rash on (R) deltoid, fever, swelling 1/26/2009 Red DTG bump on L legs. Shot 2 d 1/23/2009 Urticarial rash - generalized RX - BE 1/19/2009 Approx 5 hours after injection, pt c/o 1/13/2009 According to pt several hrs after inje 1/21/2009 Increasing redness, itching + swellin 1/9/2009 HEP A vaccine given to a patient un 1/23/2009 Right arm became very painful, una 1/23/2009 Felt like touch of flu- woke up with h 1/22/2009 3 days after receiving tetanus shot1/23/2009 Dev'd rash that spread over body an 1/22/2009 Pt reports redness and swelling. It r 1/8/2009 None stated 1/22/2009 Developed Rheumatoid Arthritis-- P 2/6/2009 Client fainted approximately 5 min a 2/6/2009 Woke up with a full body rash and fe 1/16/2009 Had flu shot 1/12/09. Also, exposed 1/26/2009 Low grade fever, symmetric erythem 1/29/2009 Chronic Headache (Migraine) 1/23/2009 1/21/09 woke in AM with redness si 1/23/2009 VARIVAX administered 1/21/2009 R 1/26/2009 C/O pain, redness, inability to perfo 2/5/2009 Patient is on STRATTERA. Mother 1/30/2009 The phone call from Pt's mother sta Bell's palsy 4/08 and 12/08 (Not cer 12/5/2008 Developed hives (urticaria) in under 2/3/2009 Onset severe bilateral knee pain, sp 2/5/2009 Pt c/o rash 3 weeks after injection. 1/21/2009 1/20/09 Client called to report 1/15 a 1/20/2009 No adverse reaction known 2/3/2009 Onset redness, swelling, discomfort 1/21/2009 One day after receiving injection pa 2/7/2009 Sicker than usual, cold or pains afte 2/4/2009 The evening of the vaccines child st 1/22/2009 Localized swelling and redness to in 1/22/2009 Patient developed redness & swellin 1/22/2009 Erythema & swelling @ injection site 1/22/2009 Syncope 3/3/09-records received-br 1/22/2009 Syncope 1/19/2009 Patient developed itchy rash minute
339969 339970 339971 339972 339973 339974 339975 339976 339977 339978 339979 339980 339981 339982 339984 339985 339986 339987 339988 339989 339990 339991 339992 339993 339994 339995 339996 339997 339998 339999 340000 340002 340005 340011 340021 340023 340026 340030 340031 340032 340033 340038 340039 340041 340045 340048 340054 340056 340057 340059 340060
2/18/2009 AK 2/18/2009 NY 2/18/2009 NE 2/18/2009 WA 2/18/2009 PA 2/18/2009 MA 2/18/2009 TX 2/18/2009 TN 2/18/2009 DE 2/18/2009 VA 2/18/2009 ME 2/18/2009 TX 2/18/2009 FL 2/18/2009 NE 2/18/2009 NC 2/18/2009 VA 2/18/2009 WA 2/18/2009 2/18/2009 ID 2/18/2009 DC 2/18/2009 WA 2/18/2009 PA 2/18/2009 FL 2/18/2009 WA 2/18/2009 AZ 2/18/2009 MO 2/18/2009 VA 2/18/2009 MN 2/18/2009 GA 2/18/2009 OK 2/18/2009 OK 2/18/2009 IL 2/18/2009 GA 2/18/2009 MO 2/18/2009 NJ 2/18/2009 NV 2/18/2009 NV 2/18/2009 AK 2/18/2009 SC 2/18/2009 ME 2/18/2009 WI 2/18/2009 2/18/2009 2/18/2009 CA 2/18/2009 WA 2/18/2009 FL 2/18/2009 NJ 2/18/2009 NY 2/18/2009 WA 2/18/2009 MA 2/18/2009 TN
0.2 1 17 1.1 1.6 5 0.5 0.4 68 0.5 55 63 67 33 4 51 74 21 33 32 4 79 4 64 45 17 59 56 17 25 0.4 8 30 10 1.6 5 44 4 18 10 1.5 1.3 15 1 4 6 1.9 71 0.2
0 1 1 1 5 0 0 68 0 55 63 67 33 4 51 74 21 33 32 4 79 4 64 45 17 59 56 17 25 0 8 30 10 1 5 44 4 18 10 1 1 1 15 1 6 1 71 0
0.2 M 0F F 0.1 M 0.6 F M 0.5 F 0.4 F F 0.5 F F F F F F F M M F F M F U F F F F F F F F 0.4 F M F F 0.6 F F F M F F 0.5 F 0F 0.3 M M 0M F F 0.9 F F 0.2 F
2/11/2009 1 hr after screamed. 5 1/2 hrs. after 1/19/2008 Dermatomial shingles left side T 3-6 1/27/2009 Flushed fatigue chills fever - flu- like 2/11/2009 high fever x 3 nights (night only) (hig 1/17/2009 Onset of high fever, irritable beginni 2/7/2009 The day after the immunization was 2/12/2009 Patient was diagnosed with rotaviru 1/13/2009 About 4 hours after immunization, h 2/9/2009 Cellulitis in (R) arm. 2/10/2009 "Low grade " temp 2/9/09 in PM. 2/1 2/9/2009 2/4/09 Discomfort in (L) arm - 2/6/09 2/9/2009 Patient called 24 hours after immun Shingles itchy leaky rash on left side 2/11/2009 Had Td and influenza vaccine on 2/ 2/6/2009 Swelling, redness and itching aroun 2/13/2009 "Bad" headache, fatigue, general fu 2/9/2009 Fever, temperature of 100.0 degree 1/23/2009 Rash on arms, legs, hands, &* feet. 2/7/2009 Symptoms stated within 24 hrs. of th 11/3/2007 Sinus & nasal congestion & pressur 2/11/2009 None at this time 2/12/2009 7:45 P.M. shortly after the injection Hives @ injection site, raised, red, h 2/12/2009 12 cm red area, slightly raised, firm, 2/10/2009 L Arm pain radiating to the neck. Pt 2/13/2009 Shortly after vaccination c/o being li Breathing problems -mucus spitting 2/12/2009 First dizzy, increased blood pressur 2/10/2009 9:25 - TWINRIX + TDAP given 9:35 1/21/2009 On 8/5/08 pt rec'd HPV-4. On 1/12/0 2/4/2009 c/o pain numbness going down L ar ### Approximately 24 hours after vaccin 2/4/2009 Pt developed symptoms of chickenp 2/6/2009 Pt stated she felt faint, nauseated, s 2/4/2009 Child developed varicella on 2/4/200 2/2/2009 PREVNAR 1/28 - Next AM, thigh vis 2/16/2009 2 days after DTaP and VARIVAX in 2/10/2009 Patient stated she has had pain in h 2/11/2009 (L) Thigh swelled within hrs of recei 2/11/2009 Developed blurry vision within 24 h 1/30/2009 Arm began itching in area of vaccin 2/6/2009 Pt had immunization 2-3-09 and wa 1/28/2009 Within 4 hrs of receiving MMR/VZV/ 1/30/2009 Received DTaP at 2:30 pm. Per cal 1/30/2009 C/o arm + generally hot feeling well 1/27/2009 Pt had VARIVAX immunization on 6 1/26/2009 Severe local reaction with 15 cm are 1/29/2009 Mom said child had redness and are 2/3/2009 R Lat, post thigh with mild erythema 1/29/2009 red edematous rash cheek & peri or 2/6/2009 Awoke from nap this p.m. screaming
340063 340064 340066 340067 340068 340069 340070 340071 340072 340074 340075 340077 340080 340081 340082 340083 340084 340085 340222 340223 340224 340225 340226 340227 340228 340229 340230 340231 340232 340233 340234 340235 340236 340308 340309 340310 340311 340312 340313 340314 340315 340316 340317 340318 340319 340320 340321 340322 340323 340324 340325
2/18/2009 AZ 2/18/2009 ME 2/18/2009 IN 2/18/2009 AZ 2/18/2009 GA 2/18/2009 CA 2/18/2009 IN 2/18/2009 PA 2/18/2009 2/18/2009 OK 2/18/2009 NV 2/18/2009 MD 2/18/2009 NE 2/18/2009 GA 2/18/2009 NC 2/18/2009 WI 2/18/2009 IN 2/18/2009 PA 2/18/2009 AL 2/18/2009 2/18/2009 2/18/2009 FL 2/18/2009 PA 2/18/2009 MN 2/18/2009 WY 2/18/2009 WI 2/18/2009 TN 2/18/2009 TN 2/18/2009 CT 2/18/2009 WI 2/18/2009 WA 2/18/2009 TX 2/18/2009 CA 2/18/2009 VA 2/18/2009 2/18/2009 VA 2/18/2009 2/18/2009 WA 2/18/2009 2/18/2009 2/18/2009 CA 2/18/2009 MD 2/18/2009 2/18/2009 2/18/2009 IN 2/18/2009 2/18/2009 NJ 2/18/2009 CT 2/18/2009 MA 2/18/2009 IL 2/18/2009 CO
64 24 25 33 12 0.4 17 10 16 24 9 34 1 1.5 1.3 3 5 0.4 0.2 0.2
24 25 33 12 0 17 10 15 24 9 34 1 1 1 3 5 0 0
1.9 0.3 2
0
0.2 0.3 1.3
0
0.2 0.7
16
16
11 11
11
26 15 18
26 15
21
21
F F M F M 0.4 M M F M F F F 0F 0.5 M 0.3 F M M 0.4 F 0.2 M U U F 0.3 M M F U 0.2 F M U U F U U U U U F F F F F F F F F U F F F U F
2/13/2009 Redness at site, size of apple swelli 2/10/2009 She developed varicella rash on tru 1/29/2009 tender quarter size area left ECU te 2/10/2009 Immunization was received at 10:45 2/12/2009 2 days after vaccine developed feve 2/11/2009 Rt ear red/swollen Rt injection site s 2/11/2009 Patient became nauseous, lighthea 1/29/2009 Within 24 hrs had pain, swelling, low 2/11/2009 2/4/2009 body aches, headache, fe 2/3/2009 She got a little light headed and sick 2/2/2009 1/26 VARIVAX. That night after sho 1/29/2009 Pt to ER c/o reaction to Varicella va 2/2/2009 (1/26) Subq VARIVAX given Rt lowe 1/29/2009 101 degree fever - 2 hrs after shots 2/2/2009 N/A 2/2/2009 Around 10:00 AM - Fri morning - Ha 1/16/2009 Pt. received his vaccines and when 1/27/2009 Administration site with vesicular les 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received form 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information hs been received from a 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
340326 340327 340329 340331 340332 340347 340353 340354 340355 340400 340401 340403 340443 340444 340445 340446 340447 340448 340449 340450 340451 340452 340453 340454 340455 340456 340457 340458 340459 340460 340461 340462 340464 340465 340466 340467 340468 340469 340470 340471 340473 340475 340476 340477 340478 340479 340480 340481 340482 340483 340484
2/18/2009 NC 2/18/2009 2/18/2009 2/18/2009 2/18/2009 CT 2/18/2009 TX 2/18/2009 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 VA 2/18/2009 OH 2/18/2009 MO 2/18/2009 MO 2/18/2009 VA 2/18/2009 2/18/2009 TX 2/18/2009 2/18/2009 2/18/2009 2/18/2009 NM 2/18/2009 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 MA 2/18/2009 MO 2/18/2009 PA 2/18/2009 VA 2/18/2009 FL 2/18/2009 2/18/2009 OH 2/18/2009 FL 2/18/2009 OH 2/18/2009 KY 2/18/2009 OH 2/18/2009 CA 2/18/2009 AZ 2/18/2009 KS 2/18/2009 CA 2/18/2009 TN 2/18/2009 2/18/2009 NJ 2/18/2009 PA 2/18/2009 MA 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 FL 2/18/2009 OH 2/18/2009
13
13
14 18 16 22 22 17 23 18 16 18 11 48 26
14 18 16
14 18 15
23
18 11
18 15
12 18 14 16
12
14 19 23
14
19 18 13
19
12 13 15 18 14
12 13 15
16 20
20
18 16 17 21 23 12 14
17 21 23 12
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F U F F F F F F F F
2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/12/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
340485 340486 340487 340488 340489 340490 340491 340492 340493 340494 340596 340597 340598 340599 340600 340601 340602 340603 340604 340605 340606 340607 340608 340609 340610 340611 340612 340613 340614 340615 340616 340617 340618 340619 340620 340621 340622 340623 340624 340625 340626 340627 340628 340629 340630 340631 340632 340633 340634 340635 340636
2/18/2009 CA 2/18/2009 AL 2/18/2009 2/18/2009 MA 2/18/2009 TN 2/18/2009 CO 2/18/2009 2/18/2009 CA 2/18/2009 2/18/2009 KY 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 2/18/2009 WV 2/18/2009 TX 2/18/2009 NY 2/18/2009 2/18/2009 2/18/2009 2/18/2009 2/18/2009 2/18/2009 OK 2/18/2009 OK 2/18/2009 2/18/2009 RI 2/18/2009 2/18/2009 GA 2/18/2009 2/18/2009 NC 2/18/2009 2/18/2009 2/18/2009 PA 2/18/2009 2/18/2009 2/18/2009 NJ 2/18/2009 2/18/2009 TX 2/18/2009 2/18/2009 KY 2/18/2009 2/18/2009 CA 2/18/2009 MA 2/18/2009 NC 2/18/2009 VA 2/18/2009 2/18/2009 VA 2/18/2009 2/18/2009 AL 2/18/2009 IL 2/18/2009 NY
14 22 19 9 25
22 19 9
16 14
16 14
17 19
17 19
1.3 12 13 20
12 20
19 16 19
18
20 19 23 22 16 15
16 15
17
17
14 15 26 14 17 19 25 18 19
18
26 17 19 25 18 19
F F F F F F F F F F F F F F M F F F F F F F F F F F F F F F F F F F U F F F F F F F F F F F F F F F F
2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has bee received from a 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
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2/18/2009 2/18/2009 NY 2/18/2009 2/18/2009 CA 2/18/2009 AR 2/18/2009 NJ 2/18/2009 TX 2/18/2009 NY 2/18/2009 2/18/2009 MI 2/18/2009 PA 2/18/2009 NE 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 2/18/2009 NY 2/18/2009 AZ 2/18/2009 TN 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 AZ 2/18/2009 MO 2/18/2009 2/18/2009 FL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 CO 2/18/2009 NM 2/18/2009 2/18/2009 OH 2/18/2009 IN 2/18/2009 OH 2/18/2009 2/18/2009 UT 2/18/2009 MA 2/18/2009 2/18/2009 CA 2/18/2009 IL 2/18/2009 LA 2/18/2009 VA 2/18/2009 MA 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 OH 2/18/2009 2/18/2009 AZ
25 15
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2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from
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2/18/2009 VA 2/18/2009 PA 2/18/2009 OH 2/18/2009 PA 2/18/2009 2/18/2009 MN 2/18/2009 2/18/2009 IL 2/18/2009 2/18/2009 2/18/2009 2/18/2009 HI 2/18/2009 PA 2/18/2009 GA 2/19/2009 IL 2/19/2009 WA 2/19/2009 PA 2/19/2009 UT 2/19/2009 NJ 2/19/2009 IL 2/19/2009 VA 2/19/2009 WA 2/19/2009 MN 2/19/2009 CA 2/19/2009 MA 2/19/2009 HI 2/19/2009 GA 2/19/2009 CA 2/19/2009 UT 2/19/2009 CA 2/19/2009 OH 2/19/2009 IL 2/19/2009 MN 2/19/2009 NY 2/19/2009 SC 2/19/2009 IL 2/19/2009 MO 2/19/2009 WA 2/19/2009 PA 2/19/2009 NJ 2/19/2009 WI 2/19/2009 WV 2/19/2009 PA 2/19/2009 OH 2/19/2009 NC 2/19/2009 ME 2/19/2009 PA 2/19/2009 NY 2/19/2009 NC 2/19/2009 NJ 2/19/2009 WA
12 17 21 26 16 16 19 24 23 26
17 21 26 16 19 24 23 26
23 17 25 1 22 80 45 34 0.6 45 1
23 17
0.2 64 0.6 27 0.6 0.6 17 1.1 5 1.3 11 1.3 1.3 18 1.2
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58 34 15 16 0.4 74 62 58 60 67 11 51
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0 17 1 4 1 11 1 1 18 1 65 58 34 15 16 0 74 62 58 60 67 11 51
F F F F F F F F F F F F F F 0M F F F M 0.6 M F 0F U 0.2 M M 0.6 M F F 0.6 F F 0.1 M F 0.3 M M 0.3 U 0.3 M F 0.2 M F F F F M 0.4 F F F F F F F F
2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Information has been received from 2/13/2009 Initial and follow up information has 2/13/2009 Information has been received throu 2/13/2009 Information has been received from 2/13/2009 Information has been received throu 2/5/2009 10 days after vaccinations, he deve Rash, shortness of breath. Rx- BEN Patient received vaccine 01/19/09 ( 2/4/2009 - Hives reported - symptoms of Brac 2/4/2009 102 degree fever, chills, body ache, 2/6/2009 Vaccine was given 1/30/09-same da 1/30/2009 9 cm x 10 cm erythematous plaque, 1/26/2009 Quarter sized swelling @ injection s I had a tetanus shot in my right arm 1/22/2009 Within 5-10 min of giving immunizat 1/23/2009 Pt reported coldness, stiffness, chill 1/26/2009 Developed hives approximately 12h 1/27/2009 1/21/09 pm fever, hot to touch, pain 1/12/2009 Given TDAP instead of DTAP 1/29/2009 fever, seizure like activity 1/28/2009 Gave vaccines, pt. was nervous, I le 1/28/2009 patient received vaccines on 1-16-0 1/29/2009 Upper arm with erythema, length of 1/28/2009 high temp 103.5 degree F X 48 deg 2/12/2009 Local inflammatory reaction to right Pt had an onset of facial rash & rash 1/22/2009 Seizure with fever - suspicious CT 1/6/2009 Reported rash on (R) side of face a 1/19/2009 Shingles- TX: BENADRYL TYLENO 2/6/2009 Administered vaccine to patient. Pa 1/22/2009 Initial report received on 16 January 1/26/2009 Numbness in right thumb that rapidl 1/28/2009 Pt had brief near syncopal episode 1/30/2009 Vomited x 2 since midnight. Fever to 2/2/2009 Influenza vaccine given to child less 1/29/2009 Erythematous, tender to palpitation. 1/30/2009 Tired, chills, nausea, sore at inj site 2/2/2008 Positive local cellulitis (L) deltoid tre 1/30/2009 Received ZOSTAVAX 1/27/09. 1/30 2/2/2009 Redness, tenderness, and warmth @ 1/28/2009 Site of immunization red, swollen, te 2/3/2009 Since receiving Tdap pt. had fever,
340058 340061 340062 340065 340073 340076 340078 340079 340091 340092 340098 340099 340100 340101 340102 340103 340104 340105 340106 340108 340110 340111 340112 340113 340114 340115 340117 340118 340119 340120 340121 340122 340123 340124 340125 340126 340127 340128 340130 340133 340135 340136 340137 340138 340139 340140 340141 340142 340143 340144 340145
2/19/2009 CO 2/19/2009 AZ 2/19/2009 FL 2/19/2009 PA 2/19/2009 LA 2/19/2009 WI 2/19/2009 OH 2/19/2009 CA 2/19/2009 2/19/2009 MO 2/19/2009 MD 2/19/2009 FL 2/19/2009 PA 2/19/2009 WI 2/19/2009 2/19/2009 PA 2/19/2009 CT 2/19/2009 OH 2/19/2009 KY 2/19/2009 NY 2/19/2009 IN 2/19/2009 NH 2/19/2009 CO 2/19/2009 TX 2/19/2009 MD 2/19/2009 MD 2/19/2009 FL 2/19/2009 IL 2/19/2009 OH 2/19/2009 GA 2/19/2009 PA 2/19/2009 VA 2/19/2009 WA 2/19/2009 WA 2/19/2009 WA 2/19/2009 MI 2/19/2009 AZ 2/19/2009 TX 2/19/2009 CA 2/19/2009 2/19/2009 2/19/2009 TX 2/19/2009 TX 2/19/2009 IN 2/19/2009 WA 2/19/2009 CA 2/19/2009 CA 2/19/2009 IA 2/19/2009 IL 2/19/2009 MO 2/19/2009 CA
4 72 12 9 0.2 49 2 17
4 72 12 9 0 49 2 17
33 66 1.9 51 69 0.8 0.2 10 4 38 19 13 18 6 22 64 0.2 22 16 56 84 54 1.8 1.8 2 62 7 0.5
33 65 1 51 69 0 0 10 4 38 19 13 18 6 22 64 0 22 16 56 84 54 1 1 2 62 7 0
68 56
68 56 -1 23 17 3 14 1 1 1 1 1
23 17 3 14 1.1 1.5 1.5 1.1 1.1
F F F F 0.2 M F 0.5 F F U U M F 0.9 M F F 0.8 F 0.2 M M M F M M U F F F 0.2 M M F F M F 0.8 F 0.8 M 0.1 F F M 0.5 F U F F 0.2 M F M M M 0.1 F 0.5 M 0.5 M 0.1 F 0.1 M
1/30/2009 Redness, edema, itchiness @ site o 1/28/2009 Itchy. Red - warm area 2 days and g 2/1/2009 Became dizzy while walking , fainte 2/2/2009 Light headed, heart racing, palpitati Parent states the child had diarrhea 2/2/2009 2/2/09 TC from client states "upper Patient with swelling, induration, wa 1/21/2009 Pt had syncope within 3 min, fell to 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/11/2009 2/2/09 11 PM Tongue "thick and ha 2/1/2009 Received ZOSTAVAX - on 9/17/08 2/14/2009 Ataxic gait on 12/3/08, Flu vaccine 2/16/2009 Patient developed sore right arm the 2/3/2009 Pt. received ZOSTAVAX on 01/06/2 2/13/2009 Pt developed urticaria (Hives) within 2/12/2009 Vaccine @ approx 2 pm, slept for 6 2/17/2009 Patient was given Hepatitis A and V 2/13/2009 After getting 4 y/o shots, 1 day post 2/19/2009 Lt deltoid area of vaccine MIN local 2/19/2009 Generalized Vaccinia characterized 2/19/2009 Patient has been running a fever up 2/19/2009 Nausea, headaches, frequent illnes 2/19/2009 Patient developed temperature of 1 2/19/2009 February 17 started to get a papula 2/19/2009 Per TC from pt: sx's began 2-17-09 2/19/2009 Fever of 102.5 one hour after the D 2/19/2009 That night( 2/12/09) he was shiverin 2/19/2009 Two weeks before Thanksgiving, m 2/19/2009 malaise, headache, right earache, le 2/19/2009 Patient lost his hair- all of it over the 2/19/2009 Left arm pain - stiff after receiving va 2/19/2009 0 reaction-Pt received Fluzone MDV 2/19/2009 0 reaction - Pt received Tdap instea 2/19/2009 0 reaction- Pt received Fluzone MD 2/19/2009 Patient called and questioned soren 2/19/2009 Right arm swollen and tender and h 2/19/2009 Family noticed onset of partial seizu 2/19/2009 slept all day after receiving vaccines 2/19/2009 We received the following informatio 2/19/2009 This case was reported by a lawyer 2/19/2009 This case was reported by a healthc 2/19/2009 This case was reported by a healthc 2/17/2009 Rash on abdomen and spread to ba 2/18/2009 None 2/19/2009 Erythema and swelling at site, Dors 2/19/2009 Rash fever all over body 10 days af 2/19/2009 Rash - Hive like. Swollen Rt leg - re 2/19/2009 Onset of chicken pox disease on 22/19/2009 Patient developed #3 1-2 mm papul 2/18/2009 None stated. 7/7/09 Medical record
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2/19/2009 IL 2/19/2009 OH 2/19/2009 TX 2/19/2009 MI 2/19/2009 VA 2/19/2009 2/19/2009 KS 2/20/2009 WA 2/20/2009 2/20/2009 NM 2/20/2009 MA 2/20/2009 AR 2/20/2009 NY 2/20/2009 FL 2/20/2009 FL 2/20/2009 FL 2/20/2009 WV 2/20/2009 PA 2/20/2009 NY 2/20/2009 NC 2/20/2009 NC 2/20/2009 MD 2/20/2009 MD 2/20/2009 MD 2/20/2009 MD 2/20/2009 NE 2/20/2009 OH 2/20/2009 ME 2/20/2009 NY 2/20/2009 VA 2/20/2009 WI 2/20/2009 IN 2/20/2009 SD 2/20/2009 2/20/2009 WI 2/20/2009 AR 2/20/2009 OH 2/20/2009 KY 2/20/2009 WI 2/20/2009 SC 2/20/2009 CO 2/20/2009 WI 2/20/2009 IL 2/20/2009 DE 2/20/2009 VA 2/20/2009 IN 2/20/2009 VI 2/20/2009 IL 2/20/2009 KS 2/20/2009 CO 2/20/2009 FL
23 0.5 32 14 0.8 41 51 32 19 0.4 18 0.5 1.3 26 4 4 39 74 41 21 18 21 17 48 0.2 47 0.3 50 5 74 61 19 61 1.1 47 27 43 32 4 50 29 5 14 14 24 17 37 16 43
23 0 32 14 0 41 51
0 18 0 1 26 4 4 39 41 21 18 21 17 48 0 47 0 50 5 74 61 19 61 1 47 27 43 32 4 50 29 5 14 14 24 17 37 16 43
F 0.5 M U M 0.8 M F M M F F 0.4 M F 0.5 M 0.3 M M F F F F F F M F M M F 0.2 M F 0.3 F F M F M M U 0.1 F F F M M M F M F F F F F F F F
2/18/2009 On 2-19-09 donor reported a rash s 2/16/2009 High fever reported by parent to be 2/19/2009 Multiple erythematous vesiculopapu 2/18/2009 Pt was give 1 dose of MENACTRA ### On 15 Oct 2008 his mother brought ### developed bilateral red eyes, itching ### I received 3 AVA vaccinations in 20 2/19/2009 Information has been received from 2/19/2009 Information has been received from 2/19/2009 Information has been received from 2/19/2009 None stated. Y 7/20/09 Autopsy repor 2/6/2009 Paralysis - entire body - breathing o 2/10/2009 Admitted to hospital 2/6/9 for intuss 2/20/2009 Thursday Feb. 5, 2009 fever 102- C 2/20/2009 Red pruritic rash encircling entire ba 2/20/2009 Fever, chills, muscle aches. Redness & warmth of left thigh whe 2/20/2009 Hives on inner thighs and lower bac 2/20/2009 Dizziness, tight chest, hives, and dif 2/15/2009 Nauseated, extremely cold chills, di 2/16/2009 12:15 - Pt in today for yellow fever a 2/17/2009 Pt received FLUMIST on 10-8-08, b 2/17/2009 Pt received FLUMIST on 10-9-08, b 2/17/2009 Pt received FLUMIST on 10-8-08, b 2/17/2009 Patient received FLUMIST on 10-91/12/2009 Had flu shot in Oct - (first shot ever 2/4/2009 5 hrs of unconsolable crying, poor fe 2/12/2009 Right deltoid has 2cm annular red in 2/16/2009 high pitch cry after PENTACEL vacc 2/13/2009 3-4 hours after Vaccine given patien 2/13/2009 Was given MMR & DTAP into left de 2/16/2009 Patient called the pharmacy with co 2/15/2009 I received the shingles vaccine 7-07 2/8/2009 Chest Pain got the shot on Jan 7-09- my arm ac 2/9/2009 Mother reports child with facial swel 2/13/2009 Swelling/redness/warmth of (R) arm 2/19/2009 Following 15 min. Wait after Hep B 2/18/2009 Red, warm area longer than palm si 2/17/2009 Patient complained of severe body 2/14/2009 24 hr after injection, itching L deltoid 2/13/2009 developed raised, red area at inject 2/20/2009 High fever (103.6), sweats, chills, m 2/20/2009 The Flu Vaccine was administered a 2/20/2009 the day after the vaccine was given 2/20/2009 Vomiting, headache and achy, a few 2/20/2009 patient states she had itchy, red spo 2/20/2009 Patient was given 4 vaccines on 2/1 2/20/2009 Reported observing redness and sw 2/20/2009 Patient C/O of headache, swelling r 2/20/2009 FINE RED RASH ON UPPER TRUN
340246 340247 340248 340249 340250 340251 340252 340253 340254 340255 340256 340257 340258 340259 340260 340261 340262 340263 340264 340285 340286 340287 340289 340290 340291 340292 340293 340294 340295 340296 340297 340298 340299 340300 340301 340302 340303 340304 340305 340306 340307 340265 340266 340267 340268 340269 340270 340271 340272 340273 340288
2/20/2009 MI 2/20/2009 CA 2/20/2009 PA 2/20/2009 NY 2/20/2009 HI 2/20/2009 NY 2/20/2009 NH 2/20/2009 NY 2/20/2009 LA 2/20/2009 CA 2/20/2009 GA 2/20/2009 MI 2/20/2009 NY 2/20/2009 WA 2/20/2009 FL 2/20/2009 PA 2/20/2009 CA 2/20/2009 UT 2/20/2009 2/20/2009 CA 2/20/2009 CA 2/20/2009 VA 2/20/2009 CA 2/20/2009 2/20/2009 AZ 2/20/2009 MS 2/20/2009 MO 2/20/2009 CA 2/20/2009 IL 2/20/2009 VA 2/20/2009 FL 2/20/2009 NC 2/20/2009 MI 2/20/2009 FL 2/20/2009 CA 2/20/2009 CA 2/20/2009 MI 2/20/2009 IL 2/20/2009 OH 2/20/2009 OH 2/20/2009 TN 2/21/2009 OR 2/21/2009 OR 2/21/2009 CO 2/21/2009 NC 2/21/2009 MI 2/21/2009 FL 2/21/2009 NE 2/21/2009 OR 2/21/2009 MD 2/21/2009 TX
1.3 11 0.2 38 33 21 2 4 4 8 66 0.2 35 49 4 16 10 11 30 0.3 14 61 4 60 29 18 4 77 29 1.3 67 8 73 2 11 5 62 0.2 1.5 1.6 47 5 0.2 26 1 0.2 47 67 0.3 4 33
1 11 0 38 32 21 2 4 4 8 66 0 36 0 0 15 10 11 30 0 14 61 4 60 29 18 4 77 1 67 8 73 2 11 5 62 0 1 1 47 5 0 26 1 0 47 67 0 4 33
0.3 M F 0.2 F M M F 0.2 M F M M F 0.2 M F 0F 0F F M F F 0.3 M M M F F F F F F U 0.3 F F M F 0.2 M M F M 0.2 F 0.5 M 0.6 M F M 0.2 M F 0M 0.2 F F F 0.3 M M M
2/20/2009 Grandmother called and spoke with 2/20/2009 Local swelling and erythema 2 days 2/20/2009 Approximately 10 minutes after imm 2/20/2009 Injection site swollen, red, itchy and 2/20/2009 Patient received Yellow Fever and H 2/20/2009 Loss of balance, double vision, dizz 2/20/2009 Developed entire body rash with les 2/20/2009 Vaccine administered 2/6/2009 on f 2/20/2009 Approximately 5 min after giving imm 2/20/2009 LEFT UPPER ARM PAIN, SWELLIN 2/20/2009 Pt came back to clinic today to repo 2/20/2009 None at this time 2/20/2009 14-16 days post Varivax immunizati ### "massive" headache. Facial swelling 2/20/2009 Emma passed out about 10 minutes 2/20/2009 After giving Varicella vaccine, Tdap, 2/20/2009 swelling, warmth, pain/soreness and 2/20/2009 Increasing Fever and stomach ache 2/21/2009 Nov. 14, 08 pt received anthrax and 2/20/2009 02/09/09, mother Y of Pt said that 02/ 2/20/2009 Fever, cough. Y Diffuse bilateral pneu 2/16/2009 Tingling both legs and arms with we 2/21/2009 Received DTAP, IPR, MMR & VARI 2/19/2009 Rash on lower back bilateral 2 days 2/19/2009 2/12/09 - tiredness from 14:00pm 2/20/2009 Shots were given 2-09-09 (Monday) 2/20/2009 Left thigh redden, hot to touch at inj 2/20/2009 Pt reports that she had a flu shot he Grand mal seizure. PMH negative. 2/20/2009 4 days ago developed pinpoint red r 2/20/2009 Local swelling & itching. 2/13/2009 Child presents with pain in upper rig 2/20/2009 Redness itching pain began 1 day p 2/18/2008 Hardness at vaccine site with 3X4 c 2/20/2009 Mom notice today 2/20/09 vaccine T 2/20/2009 Today 2/20/09 mom saw arm swolle 2/19/2009 72 hours after vaccine administered 2/2/2009 Swollen reddened thigh with 1 1/2 2 2/20/2009 Localized redness @ injection site2/20/2009 Hives, redness @ injection site - (im 2/20/2009 Complained of itching all over. Rash 2/21/2009 Syncope approximately 5 minutes a 2/21/2009 After his 2 month shots, my son dev 2/20/2009 temp of 100, chills, redness behow 2/21/2009 Child immediately developed fever, 2/21/2009 24hrs-lethargic, not eating well, not 2/21/2009 EXPERIENCED ITCHING ,SHORTN 2/21/2009 Redness occurred at site of adminis 2/21/2009 After recieving the vaccines at his 4 2/21/2009 The same day as receiving the com 2/21/2009 Hiccups continuous non stop, nause
340274 340275 340276 340277 340278 340279 340330 340333 340334 340336 340337 340341 340342 340343 340345 340356 340357 340359 340360 340361 340362 340363 340364 340365 340366 340367 340368 340369 340370 340371 340372 340373 340374 340376 340377 340378 340379 340380 340381 340382 340383 340384 340385 340386 340387 340388 340389 340390 340391 340392 340393
2/22/2009 ID 2/22/2009 NY 2/22/2009 2/22/2009 CA 2/22/2009 KY 2/22/2009 NC 2/23/2009 IL 2/23/2009 2/23/2009 FL 2/23/2009 CA 2/23/2009 2/23/2009 NM 2/23/2009 NM 2/23/2009 NM 2/23/2009 OH 2/23/2009 MN 2/23/2009 FL 2/23/2009 2/23/2009 2/23/2009 OH 2/23/2009 OR 2/23/2009 CA 2/23/2009 CA 2/23/2009 OH 2/23/2009 OR 2/23/2009 OR 2/23/2009 MT 2/23/2009 NC 2/23/2009 MI 2/23/2009 FL 2/23/2009 GA 2/23/2009 VA 2/23/2009 IA 2/23/2009 AL 2/23/2009 AZ 2/23/2009 GA 2/23/2009 MN 2/23/2009 HI 2/23/2009 WV 2/23/2009 LA 2/23/2009 LA 2/23/2009 PA 2/23/2009 NC 2/23/2009 FL 2/23/2009 MA 2/23/2009 AR 2/23/2009 OH 2/23/2009 2/23/2009 MN 2/23/2009 OR 2/23/2009 UT
4 1.3
4 1
59 1 60 16 19 20
59 0 61 16
58 49 38 60 10 15 20 11 1.1 14 1 1 0.3 77 4 67 56 65 0.4 2 58 1.5 16 14 0.2 11 1.1 11 0.3 0.2 15 28 29 0.7 1.2 11
58 49 38 60
3 8 42
3 8 42
15 11 1 14 1 1 0 77 4 67 56 65 0 2 58 1 16 14 0 11 1 11 0 0 15 28 29 1 11
F 0.3 M M F 1M F F F F F F F F F M F F F F 0.1 M F 0F 0F 0.3 M F F F F F 0.4 M 0.4 M M 0.5 F F F 0.2 M F 0.1 F M 0.3 F 0.2 F F F M M 0.2 F F U M F M
2/22/2009 No reaction 5 hours post vaccinatio 2/22/2009 Immediately after the proquad and h 2/20/2009 Contact tranfer from sharing towels/ 2/22/2009 Temperature of 102.6. Headache. 2/22/2009 loss of muscle control in both arms, 2/22/2009 Single patch of shingles in C5 distrib 2/20/2009 Information has been received from 2/20/2009 Information was viewed on the Inter 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/20/2009 Information has been received from 2/17/2009 My daughter started to get restless 2/13/2009 Patient received her 1st GARDASIL 2/19/2009 I was given the GARDASIL shot. A 2/19/2009 My daughter had the vaccine GARD 2/18/2009 Pt developed trunkle red micropapu 2/7/2009 pt c/o "fuzziness". Slumped in chair 1/30/2009 Blanchable nonspecific rash. Descri 2/16/2009 Blanchable non-specific rash descri 2/18/2009 Fever, crying non stop x 1-2 hr. 2/18 2/12/2009 Pt. began to have stiff neck on (L) s 2/18/2009 2 days after receiving shots RT leg, 2/10/2009 2 days after shot injection site itched 2/16/2009 L arm sore and client dizzy evening Acute onset of excruciating right sho 2/16/2009 Ran fever after imm Fever 101.1 2/18/2009 Mother called Health Dept @ 3:45p 2/18/2009 Patient was given vaccines on 2/13 2/16/2009 Hives started 2 days after flu vaccin 2/16/2009 Pt received varicella vaccine RA SQ 2/6/2009 Pt learned she was pregnant 2 mon 2/16/2009 Patient received Tdap instead of DT 2/16/2009 Gave 3 immunizations, about 3-4 m 2/11/2009 Fever (low grade) starting five days 2/16/2009 Mom states erythema in shot area s 2/13/2009 Pt administered 2nd dose of ROTAT 2/13/2009 Pt administered 1st dose ROTATEQ 2/12/2009 Headache - post immunization even 2/17/2009 Local reaction - mild redness, soren 2/21/2009 Soon after receiving the tetanus, inf 2/20/2009 Mistakenly gave DTAP #4 to 8 mon 2/23/2009 Parent's report on 2/21/09 at 1 pm p 2/19/2009 Pt with initial syncope, nausea, lasti 2/19/2009 Although GSK labels their pre-filled 2/19/2009 Temp 103 degrees within hours of i 2/18/2009 Received DTD on 2/7/09. Mom up 1/28/2009 Client returned 7 days after immuniz
340394 340395 340396 340397 340398 340402 340405 340406 340407 340408 340409 340410 340411 340412 340413 340414 340416 340417 340418 340419 340420 340421 340422 340423 340424 340425 340426 340427 340428 340429 340430 340432 340433 340440 340441 340442 340495 340497 340498 340499 340500 340501 340502 340503 340508 340509 340510 340511 340512 340513 340514
2/23/2009 CO 2/23/2009 MI 2/23/2009 PR 2/23/2009 NY 2/23/2009 AK 2/23/2009 CT 2/23/2009 AZ 2/23/2009 MT 2/23/2009 NC 2/23/2009 PR 2/23/2009 OR 2/23/2009 PR 2/23/2009 WI 2/23/2009 CO 2/23/2009 MN 2/23/2009 NM 2/23/2009 NY 2/23/2009 TX 2/23/2009 TX 2/23/2009 FL 2/23/2009 CA 2/23/2009 OH 2/23/2009 GA 2/23/2009 NC 2/23/2009 MD 2/23/2009 IL 2/23/2009 CT 2/23/2009 MA 2/23/2009 NY 2/23/2009 PA 2/23/2009 PA 2/23/2009 LA 2/23/2009 2/23/2009 MO 2/23/2009 CA 2/23/2009 TX 2/24/2009 MA 2/24/2009 IL 2/24/2009 CO 2/24/2009 2/24/2009 DE 2/24/2009 2/24/2009 WA 2/24/2009 2/24/2009 ME 2/24/2009 PA 2/24/2009 OK 2/24/2009 CA 2/24/2009 MD 2/24/2009 OR 2/24/2009 MA
75 29 39 36 28 24 12 45 14 4 61 0.6 1 1.8 0.5 37 12 69 66 76 0.3 14 52 1.7 1 31 11 19 5 49 1.5 4 54 24 1.2 78 0.2 79
75 29 39 36 28 24 12 45 14 4 61 0 1 1 0 38 12 69 66 76 0 14 52 1 0 31 11 19 5 49 1 54 24 1 78 0 79
23 19 14 49 64 11 1.1 0.2 13 45
64 11 1 0 13 45
M M M M F F F M F F F 0.6 F 0.1 F 0.8 M 0.5 F F F M F F 0.4 M F F 0.7 F 1F M M F M M 0.5 F M F F 0.2 M F 0.2 F F U M F F F F F F F 0.1 M 0.2 F F F
2/13/2009 Received Hepatitis A inoculation on 2/10/2009 Severe headache day of vaccine, th 2/11/2009 Rash on skin. 2/14/2009 2/9/09 started with rash, fever and H 2/10/2009 Discomfort started around 2pm. Slig 2/13/2009 Information has been received from 2/23/2009 PATIENT FAINTED IMMEDIATELY 2/23/2009 Dizziness, nausa, shakiness increas 2/23/2009 After receiving 2 IM injections in left 2/23/2009 TWENTY SECONDS AFTER VACC 2/23/2009 Injection site became red, swollen, s 2/23/2009 MOTHER REFERS THE CHILD SU 2/23/2009 Redness & swelling at injection sites 2/23/2009 Per father of child= developed high 2/23/2009 Day after vaccine child had general 2/23/2009 PAIN AND SWELLING AT INJECTI 2/23/2009 Varicella vaccine administered in a 2/23/2009 bump, redness, rash (2"x1"), itching 2/23/2009 bump, redness, rash (1"x1"), itching 2/23/2009 Patient woke up the morning of 2/19 2/23/2009 Reported today to our Health Cente 2/23/2009 Client became pale and complained 2/23/2009 Redness, soreness, and swelling at 2/23/2009 itching began 4 days after receiving 2/23/2009 Patient was running a fever on and 2/23/2009 Patient states, awakened with fever 2/20/2009 Received ADACEL @ 10:30 am - w 2/23/2008 Pt called @ 10:20 AM stating she h 2/23/2009 Per mom-since the vaccines pt. has 2/23/2009 Tdap given on 2/18. C/o sitting sore 2/18/2009 Vomited <1hr post immunization an 2/23/2009 This case was reported by a physici 2/23/2009 This case was reported by a lawyer 2/23/2009 Pt received GARDASIL injection 1/2 2/20/2009 Urticarial rash that resolved with ora 1/26/2009 Called the patient and she states th 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Initial and follow-up information has 2/23/2009 Information has been received from 2/23/2009 Information has been received from 2/23/2009 Information was viewed on the inter 2/19/2009 Initial information received on 21 Ja 2/17/2009 At time weakness in extremities, nu 2/19/2009 Left arm was swollen from shoulder 2/18/2009 None stated 2/19/2009 vomited immediately following rotov 2/17/2009 Fever same day, then stomach ups 2/20/2009 Received ADACEL, in Left delt and
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2/24/2009 UT 2/24/2009 IA 2/24/2009 CA 2/24/2009 IL 2/24/2009 FL 2/24/2009 MN 2/24/2009 VA 2/24/2009 SD 2/24/2009 OR 2/24/2009 MT 2/24/2009 OR 2/24/2009 MA 2/24/2009 IN 2/24/2009 PA 2/24/2009 OR 2/24/2009 MI 2/24/2009 PA 2/24/2009 OR 2/24/2009 VT 2/24/2009 OR 2/24/2009 NC 2/24/2009 FL 2/24/2009 MI 2/24/2009 TX 2/24/2009 KY 2/24/2009 AZ 2/24/2009 OH 2/24/2009 OH 2/24/2009 WA 2/24/2009 CA 2/24/2009 TN 2/24/2009 CA 2/24/2009 CA 2/24/2009 PA 2/24/2009 SD 2/24/2009 NY 2/24/2009 TX 2/24/2009 NE 2/24/2009 NY 2/24/2009 MS 2/24/2009 OR 2/24/2009 MI 2/24/2009 CA 2/24/2009 IN 2/24/2009 2/24/2009 UT 2/24/2009 AZ 2/24/2009 NC 2/24/2009 CA 2/24/2009 UT 2/24/2009 AL
60 1.3 67 11 12 1.1 0.2 1 17 17 12 31 8 18 12 50 1 10 74 9 11 1.6 39 77 16 76 48 32 48 37 0.2 0.2 2 76 56 11 14 64 25 1.4 1 60 1.4 0.2 4 4 0.5 69 4 68 0.2
60 1 67 11 12 1 0 1 17 17 12 31 8 18 12 50 1 10 74 9 11 1 39 77 16 76 48 32 48 37 0 0 2 76 56 11 14 64 25 1 1 60 1 0 4 4 0 69 4 68 0
M 0.3 M F M F 0.1 F 0.2 M 0F F F F M F F F M 0M F F F M 0.6 M F M F F F M F F 0.2 F 0.2 F 0M M M F M F F 0.4 F 0.1 M F 0.4 F 0.2 M F M 0.5 F F M F 0.2 M
2/11/2009 According to patient he was seen by 1/19/2009 Rash appeared 2 days after shot lig 2/18/2009 Pt. received ZOSTAVAX 12/18/09; Left sided facial paralysis began da Quick fever up to 103.3 degrees F, 2/17/2009 Within 1 hr of vaccines being given 2/19/2009 Inconsolable crying, pallor, & loss o 2/19/2009 Rash on face, stomach, back, legs s 2/18/2009 < 1 hr post vaccine admin. Pt c/o lig 2/19/2009 TC from pt one hour after recurring 2/17/2009 Swollen glands, (femoral), redness 2/17/2009 12/27/08 - Presented with 3 weeks 2/19/2009 Received flu shot 2-16-09 came to o 2/17/2009 1 hour after receiving MENACTRA d 2/18/2009 C/O feeling hot, HA, eyes burning th 9/24/2008 Pain and warmth and firmness felt a 2/19/2009 Has red bumps on stomach, legs & 2/18/2009 DTaP+IPV combo administered 2-1 1/27/2009 Developed Bells Palsy 8/12/08 rece 2/17/2009 Pt given HEP A (VAQTA) on 2/11/0 2/18/2009 02-07-09 (L) arm 8X8 in redden- wa 2/16/2009 Rash after antibiotics + MMR. Face Had knot & a lot of pain after receiv 2/18/2009 4 days after receiving the shingles v 2/17/2009 Hyperpigmentation on (L) arm (Line 2/17/2009 Itching at injection site urthen 1 hr. Extreme muscle pain, edema to 3x 2/17/2009 Rabies immunization given 2/15/09 2/18/2009 Appointment for Hep-B vaccine. Prio Localized Rxn. Redness, Swelling & 2/21/2009 Right side of her face red and swoll 2/19/2009 Swollen Right thigh. 2/19/2009 Fever temperature 105 core. 2/24/2009 Vesicular lesions around left flank 2/24/2009 Diarrhea, gas, distended stomach. p 2/24/2009 Has had a dull frontal headache sin 2/24/2009 6-7 hours after Tdap given had 101 2/24/2009 Pt was given two injections in the le 2/24/2009 pt states after she received 2nd vac 2/24/2009 Urticaria to anterior and posterior tru 2/24/2009 DTAP administered to Left deltoid a 2/24/2009 Started hurting when given and nev 2/23/2009 Infant patient started having fevers 2/24/2009 Received first Y set of baby shots, left 2/24/2009 DEVELOPED SIGNIFICANT ERYT 2/24/2009 Rt. thigh became erythematous, wa 2/24/2009 Patient had hives all over body few 2/24/2009 2 hours after vaccination patient exp 2/24/2009 Redness swelling L arm 2/24/2009 Pneumococcal vaccination given on 2/24/2009 Patient had seizures and had to be
340566 340567 340577 340578 340579 340580 340581 340582 340583 340584 340585 340586 340587 340588 340589 340590 340591 340592 340593 340594 340595 340568 340659 340663 340667 340668 340669 340670 340671 340672 340673 340674 340675 340676 340677 340678 340679 340680 340681 340682 340683 340684 340685 340686 340687 340688 340689 340690 340691 340696 340698
2/24/2009 MI 2/24/2009 CA 2/24/2009 TN 2/24/2009 WA 2/24/2009 MA 2/24/2009 SC 2/24/2009 NE 2/24/2009 NE 2/24/2009 NE 2/24/2009 NC 2/24/2009 KY 2/24/2009 MT 2/24/2009 SD 2/24/2009 MD 2/24/2009 MO 2/24/2009 MN 2/24/2009 MA 2/24/2009 CA 2/24/2009 VA 2/24/2009 MD 2/24/2009 NY 2/25/2009 2/25/2009 MI 2/25/2009 2/25/2009 2/25/2009 NY 2/25/2009 MA 2/25/2009 TX 2/25/2009 NC 2/25/2009 OH 2/25/2009 VA 2/25/2009 KY 2/25/2009 FL 2/25/2009 NJ 2/25/2009 SC 2/25/2009 FL 2/25/2009 GA 2/25/2009 MI 2/25/2009 CA 2/25/2009 TX 2/25/2009 CA 2/25/2009 NH 2/25/2009 CA 2/25/2009 RI 2/25/2009 MO 2/25/2009 MA 2/25/2009 PA 2/25/2009 CA 2/25/2009 TX 2/25/2009 CA 2/25/2009 PA
0.1 4 0.7 1.4 37 0.3 0.5 31 28 24 73 30 81 14
0 4 0 1 37 0 0 31 28 24 73 30 81 14
67 0.4 1.1 0.4 17 32 27 46 71
67 0 1 0 17 32 27 46
18 11 23 56 1 1.3 26 11 11 11 12 13 59 48 3 51 29 62 1.9 15 0.5 17 1 74 18 0.2
18 11 23 56 1 1 26 11 11 11 12 59 3 29 62 1 15 0 17 1 74 0
0.1 M M 0.7 M 0.4 M F 0.3 M 0.5 F F F F F M F F U M 0.4 F 0.1 F 0.4 F F M M F F M F F M F 0F 0.4 M F F F F F F M F F F F F 0.9 M F 0.6 M M 0M M F 0.2 M
2/24/2009 Advised parent of error.Will call in A 2/24/2009 Redness of face around eyes; no sw 2/24/2009 Reported from mother: Pt was admi 2/24/2009 Cellulitis Right thigh 2/24/2009 Day # 12 post immunization with 2 s 2/23/2009 Melena 1/11/2009 Left leg - red, swollen, warm to touc 2/24/2009 ADACEL shot given right arm 2/15. 2/24/2009 ADACEL given 2/14 2/17 - arm puf 2/23/2009 Patient calls VHC x 3 in past week. 2/24/2009 Injection was on 02/19. On 02/22 in 2/23/2009 Patient called 6 days following vacc 2/24/2009 Pt complained to dentist about sore 2/23/2009 2/19/09. Local Reaction with contin 2-10-09 MMR & VARICELLA given. 2/23/2009 Had ZOSTAVAX injection 2-12-09. 2/24/2009 Erythematous nodule app 0.5 cm in 2/23/2009 Received MMR and VARIVAX on 1/ 2/24/2009 4 month-old female who came for a 2/24/2009 3rd dose of GARDASIL administere 2/23/2009 Developed fever < 12 alter shot swo 2/25/2009 Early in the morning following the va 2/23/2009 This non-serious event was reported 2/24/2009 Information has been received from 2/24/2009 Information has been received from 2/23/2009 Abdominal pain, diahrrea, general il 2/20/2009 Received a BOOSTRIX vaccine (R) 2/25/2009 within 24 hours, urticarial rash on ch 2/25/2009 approximately 12 hrs after reaction, 2/23/2009 Per parent, Kitra Woodall, child had 2/25/2009 seizure 2/25/2009 Local reaction and cellulitis at inject 2/25/2009 10 days following the vaccine, pt be 2/25/2009 fainting episode which lasted for ap 2/25/2009 mild nausea immediately following G 2/25/2009 Fainted shortly after administration o 2/25/2009 Mom calling office c/o site where va 2/25/2009 Within 24 hours of receiving vaccine 2/25/2009 Tellow Fewver, Polio and oraL 7/14 2/23/2009 On 10/17/09 patient was taken to ho 2/25/2009 fever,myalgia. pt received rabies va 2/25/2009 Very ill with fever, chills, severe mya 2/25/2009 In January patient reported pain on 2/25/2009 redness and tenderness where sho 2/25/2009 Patient was administered the Merck 2/25/2009 On 1/30/09 Pt presented with a tem 2/25/2009 Mother called office today and repo 2/25/2009 Injec. site became red and indurate 2/25/2009 PT RECEIVED ZOSTAVAX ON 2/2 2/25/2009 Information has been received from 2/24/2009 Two days after the shot was admini
340700 340701 340702 340703 340704 340705 340706 340707 340708 340709 340710 340711 340712 340713 340714 340715 340716 340717 340718 340773 340775 340776 340777 340778 340779 340780 340781 340782 340783 340784 340785 340786 340787 340788 340789 340790 340792 340793 340794 340795 340796 340797 340798 340799 340800 340801 340802 340803 340804 340805 340806
2/25/2009 NM 2/25/2009 IL 2/25/2009 OR 2/25/2009 WA 2/25/2009 CA 2/25/2009 CA 2/25/2009 MI 2/25/2009 NY 2/25/2009 WA 2/25/2009 KY 2/25/2009 CA 2/25/2009 AZ 2/25/2009 IN 2/25/2009 KY 2/25/2009 MO 2/25/2009 KY 2/25/2009 FL 2/25/2009 IN 2/25/2009 TX 2/26/2009 MI 2/26/2009 NJ 2/26/2009 IN 2/26/2009 CA 2/26/2009 OR 2/26/2009 OR 2/26/2009 OR 2/26/2009 WI 2/26/2009 2/26/2009 WV 2/26/2009 MN 2/26/2009 FL 2/26/2009 PA 2/26/2009 ME 2/26/2009 IL 2/26/2009 2/26/2009 CA 2/26/2009 PA 2/26/2009 MI 2/26/2009 MI 2/26/2009 TN 2/26/2009 AZ 2/26/2009 FL 2/26/2009 AR 2/26/2009 FL 2/26/2009 FL 2/26/2009 FL 2/26/2009 OH 2/26/2009 MI 2/26/2009 TX 2/26/2009 MN 2/26/2009 FL
11 16 33 9 10 4 50 8 4 0.5 15 67 4 4 1 29 10 24 41 32 4 0.5 17 13 93 12 17 54 12 47 24 0.6 1.1 64 69 61 1 31 61 3 24 52 12 16 1.5 1.3 31 0.9 65 3
11 16 33 9 10 4 8 4 0 15 67 4 4 1 29 10 24 41 32 4 0 17 13 93 12 17 12 47 24 0 1 1 69 61 1 31 61 29 52 12 16 1 1 31 0 65 3
F F M M M F U F F 0.5 F F F M M 0M F F F F F F 0.5 M F M F M F F F F F 0.6 M 0.1 F 0.5 F M F F 0M M F M M M F M 0.5 F 0.3 M F 0.9 M F M
2/25/2009 About 1 wk after 1st GARDASIL, my 2/25/2009 Pt had an episode of syncope, swea 2/24/2009 2/24/09 At 9am Donor started havin 2/25/2009 Rash on back & face. 2/25/2009 - Large firm (3 inch wide) round tend 2/24/2009 Large Erythema, hyperemia and pru Injection administered 10-17-08, on 2/21/2009 Within 5 minutes of injection into rig 2/24/2009 Redness at injection site (L) thigh, h 2/25/2009 Staring, rolled eyes back of head ? 2/24/2009 Pt seen on 2/23/09. Complaining of 2/25/2009 Vaccines administered on 2-17-09 2/24/2009 Within 30 minutes patient experienc 2/25/2009 Fever of 102 degree at home the ni 2/25/2009 None stated. 2/20/2009 Noticed 30 min after while on elevat 2/25/2009 Left arm SQ swelling, local reaction 2/25/2009 Information received from patient's m 2/25/2009 Fever, nausea, vomiting; patient rec Received Hepatitis B & MMR vaccin 2/26/2009 Redness, swelling 5"X51/2" 2/20/2009 Received vaccines on 2-17-09 No b 2/19/2009 Patient's mother informed clinic on 0 2/18/2009 Pt fainted after receiving vaccines, a 2/10/2009 2/9/09 Call from pt that she had acu 2/17/2009 Mother called 2-13-09 reporting ash 2/24/2009 About 1 month after vaccination dev 2/24/2009 Patient received a flu vaccine on 10 2/26/2009 Erythema, edema around immuniza 2/18/2009 Swelling & erythema of left upper ar 2/12/2009 Migraine headache for 11-13 days f 2/20/2009 Fever - Tmax 104.8 oral per parent; 2/20/2009 Pt with runny nose, fuzziness and 2 2/20/2009 Severe nausea and vomiting. 2/24/2009 Symptoms: 1. Pain and swelling. 2/23/2009 2/13 Vaccine given in left arm. On 2 2/26/2009 I received a pneumonia shot on Mo 2/26/2009 PT GIVEN VARICELLA VACCINE O 2/26/2009 Client called with c/o pain and swell 2/26/2009 Swelling and heat at injection site 2/26/2009 After the vaccine he stated starring 2/26/2009 Pain, swelling w/ warm to the touch 2/26/2009 Shot adminstered at work. A week a 2/26/2009 Temp 102.6 12:20 pm 2/26/09 2/26/2009 Vaccine administered on 1/14/2009 2/26/2009 Mother complained that baby vomiti 2/26/2009 On 2/18/09 at about 9:30PM, his ey 2/26/2009 2-25-2009 at 6pm pt stated had nau 2/26/2009 Pt's mother c/o diahrrea, decreased 2/26/2009 Given Pneumonvax Immunization o 2/26/2009 AFter recieving the pentacel in his le
340807 340808 340809 340815 340816 340817 340818 340819 340820 340821 340822 340823 340824 340825 340826 340827 340829 340830 340810 340831 340832 340833 340834 340835 340839 340840 340841 340848 340849 340850 340851 340852 340853 340854 340855 340856 340857 340858 340859 340860 340861 340862 340863 340867 340868 340869 340870 340871 340872 340873 340874
2/26/2009 CO 2/26/2009 MI 2/26/2009 MA 2/26/2009 VA 2/26/2009 FL 2/26/2009 FL 2/26/2009 WI 2/26/2009 MO 2/26/2009 WA 2/26/2009 CA 2/26/2009 CA 2/26/2009 ID 2/26/2009 ID 2/26/2009 ID 2/26/2009 ID 2/26/2009 NC 2/26/2009 MD 2/26/2009 CO 2/27/2009 AR 2/27/2009 2/27/2009 VA 2/27/2009 ME 2/27/2009 2/27/2009 TX 2/27/2009 IN 2/27/2009 IL 2/27/2009 2/27/2009 MN 2/27/2009 CO 2/27/2009 NC 2/27/2009 CA 2/27/2009 WI 2/27/2009 AZ 2/27/2009 TX 2/27/2009 FL 2/27/2009 WI 2/27/2009 OR 2/27/2009 MN 2/27/2009 NY 2/27/2009 WI 2/27/2009 RI 2/27/2009 WI 2/27/2009 IN 2/27/2009 VA 2/27/2009 NY 2/27/2009 VA 2/27/2009 VA 2/27/2009 2/27/2009 GA 2/27/2009 IN 2/27/2009 ND
16 36 67 1.3 3 43 59 5 10 0.2 10 3 47 37 40 1 1.2 11 0.3 19 23 15 26 14
16 36 94 1 3 43 59 5 10 0 10 3 47 37 40 1 1 11 0 19
14
21 68 13 0.8 72 9 11 4 1 26 12 62 31 57 55 11 4 18 1 20 19 30 8 1 58
68 13 0 72 9 11 4 1 26 12 62 31 57 55 11 4 18 1 20 19 30 8 1 58
F M M 0.3 F F F F F M 0.2 F M F F F F 0M 0.2 F F 0.3 F F F F F F F F M F F 0.8 F F F F F 0F M F F F F F M F M 0.1 F F F F M 0M M
2/26/2009 chronic debilitating headaches, chro 2/26/2009 One day after receiving the injection 2/26/2009 within 24 hours after injection Pain a 2/26/2009 Seizure like activity, Loss of conscio 2/24/2009 5-8 min after receiving CODEINE ch 2/26/2009 Pt. reports LUE arm, shoulder pain 1/8/2009 Pt called clinic reporting SOB, throa 2/26/2009 Raised spots - back abd, 12/26/09 s 2/11/2009 None Phenyl & Pt sister PKU + mom 2/26/2009 High pitched screaming started ~45 ### Upon leaving the clinic per mother, 1/26/2009 Phone call - Employee stated recei ### Rash, itching, took BENADRYL 50m ### L arm injection site with large redde ### Site of injection hot to touch, red an 2/26/2009 Received MMR, VARIVAX, and PRE 2/26/2009 The child is a 14 month old female w 2/26/2009 Pt c/o headaches, severe @times (6 2/27/2009 Less than 24 hours after administra 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/26/2009 Information has been received from 2/12/2009 On 2/12/2009 Pt. talked with PHN + 2/25/2009 Pt with extreme discomfort following 2/23/2009 Patient was administered diluent for 2/13/2009 Patient noticed patch of red skin in a 2/23/2009 patient inadvertently received Tdap 2/16/2009 Day after vaccinations, Pt develope 2/19/2009 10 minutes after the shots where ad 2/23/2009 Mom noted few itch spots on abd 4 2/24/2009 This service member contacted the 2/20/2009 Mother called to report pt c/o "loosin 1/30/2009 Histamine-like reaction. Hives - seve 2/26/2009 Shaking chills, fever X 24 hrs. (X hrs 2/23/2009 The day after shot employee experi 7/7/2008 Headache, Flu- like symptoms, low 2/19/2009 Hives, throughout, injection site arm 2/26/2009 Local Right - swelling redness- cove 2/27/2009 C/o dizziness and weakness approx 2/27/2009 Mom reported child got puffy around 2/27/2009 C/O arm soreness and hand and fin 2/27/2009 C/O dizziness and vomiting (4-5X) a 2/27/2009 On 08 NOV 2005 around noon, swo 2/27/2009 2-3 minutues following administratio 2/27/2009 Each time my identical twin sons we 2/27/2009 Pt called and spoke with RN on 2/19
340875 340876 340877 340927 340928 340929 340930 340931 340933 340878 340879 340880 340881 340882 340883 340884 340885 340886 340887 340888 340889 340890 340891 340892 340893 340894 340895 340896 340897 340899 340900 340901 340907 340911 340920 340921 340922 340923 340924 340925 340926 340932 340934 340935 340936 340937 340938 340939 340940 340941 340942
2/27/2009 PA 2/27/2009 CT 2/27/2009 FL 2/27/2009 KY 2/27/2009 CA 2/27/2009 CO 2/27/2009 AR 2/27/2009 NY 2/27/2009 VA 2/28/2009 WI 2/28/2009 IN 2/28/2009 TX 2/28/2009 NJ 2/28/2009 NV 3/1/2009 MI 3/2/2009 IL 3/2/2009 ME 3/2/2009 AZ 3/2/2009 WA 3/2/2009 WI 3/2/2009 KS 3/2/2009 AL 3/2/2009 CO 3/2/2009 TX 3/2/2009 WA 3/2/2009 CA 3/2/2009 3/2/2009 TX 3/2/2009 MD 3/2/2009 MD 3/2/2009 3/2/2009 3/2/2009 3/2/2009 3/2/2009 CA 3/2/2009 IL 3/2/2009 FL 3/2/2009 MO 3/2/2009 IN 3/2/2009 TX 3/2/2009 MA 3/2/2009 CA 3/2/2009 AZ 3/2/2009 FL 3/2/2009 HI 3/2/2009 GA 3/2/2009 NC 3/2/2009 GA 3/2/2009 CO 3/2/2009 FL 3/2/2009 MO
1 22 60 35 4 11 20 13 54 43 40 2 13 17 53 35
1 22 60 35 4 11 20 13 54 43 40 2 13 17 53 35
58 13 60 1 5 5 63 0.2 20 1 0.2 11 10 16
57 13 60 0 5 5 63 0 20 1 0 11 10 16
12 43 4 14 1 1.6 15 0.5 40 9 70 0.1 25 1 1.4 62 4 1.4 9
4 14 1 1 15 0 40 9 70 0 25 1 1 62 4 1 9
0M F M F F F F F F F F 0.5 M F F F F M F M M 0F F F M 0.2 F M 0M 0.2 M F F F F M F F M 0M 0.6 M F 0.5 F F M F 0.1 M M 0M 0.4 F F F 0.4 M F
2/27/2009 Seen 2/24/09 at 2pm due to rash ov 2/27/2009 Was given the Gardasil shot in Dece 2/27/2009 Generalized joint/body ache, weakn 2/26/2009 Pain at injection site, diffuse myalgia 2/27/2009 Redness Swollen on L deltoid uppe 2/27/2009 Pt rec. vaccine on 2/24, called office 2/27/2009 Pt experienced HA which was const 2/12/2009 Persistent LUQ pain, fatigue and we 2/27/2009 Low grade fever, dizziness, pain an 2/28/2009 Severe Muscle pain to the extent of 2/28/2009 Extensive pain in upper left arm at i 2/28/2009 Patient received the MMR vaccine o 2/28/2009 Syncope,fainting loss of consciousn 2/28/2009 AFTER FIRST GARDASIL VACCIN 3/1/2009 Fever, myalgias, Arthus reaction 2/24/2009 Itching and Hives over entire body e 3/2/2009 received pneumoccal/flu vaccine 2 d 3/2/2009 1/29/09--Pt. stated did not feel shot 3/2/2009 Loss of eyesight startin at about two 3/2/2009 Severe pain swelling and redness a 3/2/2009 Pt has large reddish purple area wit 3/2/2009 PATIENT STATED VACCINES WE 3/2/2009 Two weeks and two days after rece 3/2/2009 64 yr old white male presents with c 3/2/2009 Local reaction with redness and swe 3/2/2009 **suspected** case of progressive v 3/2/2009 Severe raised and hot rash on torso 2/27/2009 Information has been received from 2/27/2009 Initial report received on 17 Februar 2/27/2009 Initial report received on 17 Februar 2/27/2009 Information has been received from 2/27/2009 Information has been received from 2/27/2009 Information has been received from 2/27/2009 Report 2001005622-1 described "lo 3/2/2009 Infection to left thigh where IPV and 3/2/2009 Pt c/o bad HA that started at back o 3/2/2009 Erythemia Multiform Minor, etiology 2/27/2009 local allergic reaction. Redness som 3/2/2009 Costochondritis R side > 1wk. Patient diedYof influenza A on 2/10/0 1/28/2009 Severe headache, chest pain, incre 2/27/2009 Varicella Breakthrough by baby sist 3/3/2009 Local (around area of injection) swe 3/2/2009 Vaccine given 930 AM on 3/2/09: w 3/2/2009 Local reaction to the R forearm. red 3/2/2009 See notes. 3/2/2009 Multiple vesicles 3/2/2009 2 hours after office & receiving PNE 2/23/2009 Shots given 2/18/09. MOC called 2/ Grandmother states rashes appears 3/2/2009 reddened are L upper arm BENADR
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3/2/2009 3/2/2009 MT 3/2/2009 NE 3/2/2009 NY 3/2/2009 CA 3/2/2009 MA 3/2/2009 WI 3/2/2009 TN 3/2/2009 MI 3/2/2009 3/2/2009 3/2/2009 NY 3/2/2009 3/2/2009 NJ 3/2/2009 VA 3/3/2009 3/3/2009 3/3/2009 IL 3/3/2009 OR 3/3/2009 OR 3/3/2009 CO 3/3/2009 3/3/2009 NC 3/3/2009 AL 3/3/2009 OK 3/3/2009 IL 3/3/2009 OH 3/3/2009 VA 3/3/2009 LA 3/3/2009 NY 3/3/2009 OR 3/3/2009 CA 3/3/2009 WA 3/3/2009 MN 3/3/2009 NY 3/3/2009 FL 3/3/2009 NM 3/3/2009 CA 3/3/2009 CA 3/3/2009 FL 3/3/2009 TX 3/3/2009 IL 3/3/2009 NY 3/3/2009 MD 3/3/2009 TX 3/3/2009 UT 3/3/2009 IN 3/3/2009 MN 3/3/2009 MI 3/3/2009 TX 3/3/2009 OH
66 9 53 5 57 10 48 4 42 16 13 0.4 62 5 4 15
66 9 53 5 57 10 48 4 42 13 0 62 5 4
15 26 26 65 14 48 29 1.3 32 34 17 12 7 4 69 0.1 0.2 4 66 25 29 60 1.1 1.6 1.3 68 20 54 21 66 35 62 62
14 48 29 1 32 34 17 12 7 4 69 0 0 4 66 25 29 60 1 1 1 68 20 54 21 66 35 61 62
F F M M F F F M M F U 0.4 F F F M F F F F F U M M M F 0.3 M M M F M F M F 0.1 M 0.2 M F F F F F 0.1 F 0.6 F 0.3 M F M M M M F F F
3/2/2009 Multiple lumps - deltoid strength dec 2/27/2007 Redness, swelling of R upper arm 4 9/21/2008 Pt was over 50 yo. and received the 2/19/2009 8" x 5" area of slight erythema and p 2/24/2009 Immediate and excessive pain cont 2/10/2009 Left arm-2cm area of erythema and 2/16/2009 Patient presented to Employee Hea 2/25/2009 L upper arm just below axillae has w 2/9/2009 Pain, swelling, dizziness, nauseous 2/15/2009 My daughter received her 3rd inject 2/26/2009 My daughter received GARDASIL v 2/8/2009 Daughter started throwing up, could 2/27/2009 On 2/24 patient started with breathin 2/24/2009 Within 24 hrs of being given MMR p 2/27/2009 Mother called advising pt's arm whe 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 3/2/2009 Information has been received from 2/27/2009 Initial reportYreceived on 20 Februar 2/26/2009 Initial information received on 20 Fe 2/27/2009 Initial report received 19 February 2 2/27/2009 Initial information received on 18 Fe 2/24/2009 30 min after shot- hives, pain shooti 1/21/2009 At 2:30 pm on 7/22/2008, fever star 2/24/2009 10/28 flu shot @ store. 10/29 flu-like 2/26/2009 Felt sharp pain in chest approx 3 da 2/25/2009 Tdap and Varicella administered wh 2/26/2009 Crusty and itchy: topical skin reactio 2/25/2009 Client in today with sister who are g 2/24/2009 Redness, induration L deltoid 6cm x 2/27/2009 A week after immunization started w 2/23/2009 Patient here today for Right thigh re 2/26/2009 Profuse diarrhea for 7-8 days on da 2/27/2009 Sudden onset of fever 103.9 with co 2/26/2009 7"-8" wheal, redness, tender to touc 2/24/2009 Redness-trial of ZYRTEC, and if wo 2/25/2009 Redness - ZYRTEC/allergy med, an 2/26/2009 Redness, swelling, pain, itching at s 2/25/2009 On 2/24/09- Rash all over, fever, co 2/25/2009 Mother stated red and swollen right 2/27/2009 Hives noted 7mm took Benadryl non 2/25/2009 Itch and rash on left side of neck arm 3/3/2009 Immediately got left sided eye pain 3/3/2009 Client received immunizations for tra 3/3/2009 nodular, pustular, follicular eruption 3/3/2009 None - vaccine given outside age ra 3/3/2009 2-26-2009 Right Deltoid Red, Swolle 3/3/2009 left arm swellimg at injection site, wi 3/3/2009 Patient developed sores on lip appr
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3/3/2009 TX 3/3/2009 UT 3/3/2009 UT 3/3/2009 CA 3/3/2009 NY 3/3/2009 TX 3/3/2009 MI 3/3/2009 NY 3/3/2009 CO 3/3/2009 3/3/2009 ID 3/3/2009 PA 3/3/2009 NH 3/3/2009 CA 3/3/2009 RI 3/3/2009 NY 3/3/2009 PA 3/3/2009 WV 3/3/2009 CA 3/3/2009 OH 3/3/2009 CA 3/3/2009 OH 3/3/2009 TX 3/3/2009 MI 3/3/2009 MI 3/3/2009 WI 3/3/2009 OH 3/3/2009 MI 3/3/2009 MI 3/3/2009 FL 3/3/2009 MI 3/3/2009 MI 3/3/2009 MI 3/3/2009 3/3/2009 MI 3/3/2009 MI 3/4/2009 3/4/2009 TX 3/4/2009 MI 3/4/2009 3/4/2009 MO 3/4/2009 MO 3/4/2009 OH 3/4/2009 MN 3/4/2009 FL 3/4/2009 GA 3/4/2009 SC 3/4/2009 MI 3/4/2009 MN 3/4/2009 MN 3/4/2009 UT
11 1.3 1 5 13 2 13 17 5 4 7 69 1 41 48 1.3 15 11 66 40 4 69 34 42 26 26 22 56 22 26 36 26 23
11 1 1 5 13 2 13 17 5 4 7 69 1 41 48 1 15 11 66 40 4 69 34 42 26 26 22 56 22 26 36 26 23
24 34 1.5
24 34 1
14 17 4 8 4 13 1.1 0.3 29 52 90 69 12
14 17 4 8 13 1 0 29
12
M 0.4 M 0M F F 0.5 F F F F M F M 0F F F 0.3 M F M F M F F F F M F F M F M F F F M M F 0.5 M F F F F M F F 0.1 F 0.3 F F F M F F
3/3/2009 Patient received Menactra vaccine o 3/3/2009 High Fever 106 3/3/2009 fever for 5-6 days. 3/3/2009 Redness, swelling, warm and hard @ 3/3/2009 Patient had pain and swelling at inje 3/3/2009 Mild swelling and redness of the left 3/3/2009 Within 2 days of injection client pass 3/3/2009 Fainting episode within 5 minutes o 3/3/2009 1) Extreme anxiety - moody and irrit 3/3/2009 Pt was given his 4 year old immuniz 2/17/2009 A serious spontaneous report of sei 3/1/2009 Patient had shingles like rash that it 3/3/2009 General hives BENADRYL. Observe 3/3/2009 Severe local erythema, swelling, stif 3/3/2009 Per patient- She had a rash + fever 2/27/2009 Swelling of leg with a fine urticarial r 3/3/2009 Patient experienced a syncope epis 1/16/2009 Received Tdap and meningitis vacc 3/3/2009 - Red itchy injection site rash that sp 3/3/2009 Deep muscle pain @ injection site, 2/27/2009 Localized reaction to vaccines. MO 3/2/2009 Area around vaccine became red. 3/2/2009 Temp to 102, with R shoulder swelli 2/11/2009 Redness, swelling and warmth at in 2/11/2009 Received a haircut on 4/15/08. At th 2/11/2009 Reporter contacted manufacturer in 2/11/2009 Subject experienced moderate (7x6 2/11/2009 Subject reports that at approximatel 2/11/2009 Subject reports being tired on the fir 2/11/2009 Palm-sized dry rash localized to the 2/11/2009 Redness at injection site at 24 hour 2/11/2009 Subject reports that approx 5 hours 2/11/2009 Subject reports that three days after 2/11/2009 Recd via e-mail: Subject has a latex 2/11/2009 Soreness of muscle, left leg, from m 2/11/2009 Pain at injection site, itching at injec 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/3/2009 Information has been received from 3/2/2009 Initial report received 23 February 2 3/2/2009 Initial report received 23 February 2 3/2/2009 Initial report received on 27 Februar 2/25/2009 4-21 - 4-22-08 was in hospital for sy 2/27/2009 Red raised spots that started on tor 3/4/2009 DIARRHEA AND VOMITING 3/4/2009 Pt c/o pain and swelling in L arm the 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Patient was vaccinated for meningit
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3/4/2009 MN 3/4/2009 MI 3/4/2009 TX 3/4/2009 SC 3/4/2009 ME 3/4/2009 IL 3/4/2009 IL 3/4/2009 NY 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 AL 3/4/2009 IL 3/4/2009 IL 3/4/2009 IL 3/4/2009 ID 3/4/2009 NJ 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 OK 3/4/2009 MO 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 CA 3/4/2009 TN 3/4/2009 WA 3/4/2009 MI 3/4/2009 CO 3/4/2009 MN 3/4/2009 MN 3/4/2009 MO 3/4/2009 WI 3/4/2009 MA 3/4/2009 PA 3/4/2009 WI 3/4/2009 NJ 3/4/2009 NJ 3/4/2009 PA 3/4/2009 PA 3/4/2009 MI 3/4/2009 FL 3/4/2009 NJ 3/5/2009 NJ 3/5/2009 3/5/2009 3/5/2009 3/5/2009 CA 3/5/2009 TX
81 66 1.7 15 27 51 50 0.2 22 41 24 49 11 36 35 43 15 34 6 4 44
66 1 15 27 51 50 0 22 41 24 49 11 36 35 43 15 34 6 4 44
0.3 1.1 50 4 5 4 18 53 5 11 13 13 1.5 3 50 66 57 4 0.5 14 0.7 13 84 11 0.5
0 1 50 4 5 4 18 53 5 11 13
0.2
0
1 50 66 57 4 0 14 0 13 84 11
F M 0.7 F F F F F 0.2 M F F F F M F F F F F F M F F M 0.3 M 0.1 M F M M M M F F F M M 0.5 M F F F F F 0.5 M F 0.7 F M F F U U 0.2 F U
3/4/2009 Subject in pneumococcal vaccine tr 3/4/2009 Sore throat-WATERY EYES-RUNN 3/4/2009 Erythema and edema localized at in 3/4/2009 She recived Gardisil in left arm then 3/4/2009 Patient called and states she has ha 3/4/2009 arm soreness 3/4/2009 no adverse reaction Administer 3/4/2009 Pt. received 2 month vaccines in off 3/4/2009 no adverse event Administered 3/4/2009 sore throat for 24 hours. Adminis 3/4/2009 no adverse events. Administered D 3/4/2009 no adverse reaction. Administere 3/4/2009 Approximately 2 weeks after receivi 3/4/2009 Patient self reported sore arm for 3 3/4/2009 no adverse reaction. Administered 3/4/2009 no adverse reaction. Administered 3/4/2009 Immediately following vaccination g 3/4/2009 Complained of itchy throat, "patient 3/4/2009 SITE OF INJECTION WITH REDNE 3/4/2009 Exagerate local reaction. Painful wit 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a lawyer 3/4/2009 This case was reported by a physici 3/4/2009 Pt experienced vomiting and 1 bloo 3/4/2009 Right thigh began to get red and sw 3/4/2009 Initially redness, soreness at injectio 3/4/2009 Swelling of Right thigh and vomiting 3/4/2009 1.3.5 inches X 3 inches round, red, 3/4/2009 Pt developed fever 101.7. 15 cm are 3/3/2009 T-101.3, achy at site of injection, ten Swelling in tongue - Labored breath 3/5/2009 5 yr injections given - mom calling s 3/3/2009 None 3/3/2009 Severe headache-fever-dizziness. D 3/4/2009 Mother called 2 days after immuniza 8/31/2007 Fever after receiving Tdap at 03/02 2/24/2009 Cellulitis at injection site dx by CHO 3/3/2009 Pt received flu shot at clinic on 11/3 3/4/2009 PNEUMOVAX vaccine administered 3/4/2009 Within 1/2 of immunization, patient r 3/4/2009 (L) thigh has 2.5 X 2.5 cm indurated 3/4/2009 Child became limp, unable to hold h 3/3/2009 Child rcvd ADACEL, MENACTRA, F 2/26/2009 Per Mom and Dad; reporting to us t 3/2/2009 22 hours later had fever of 102.5 de 3/4/2009 Information has been received from 3/4/2009 Information has been received from 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a physici 3/3/2009 This case was reported by a physici 3/3/2009 This case was reported by a healthc
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3/5/2009 TX 3/5/2009 TX 3/5/2009 TX 3/5/2009 TX 3/5/2009 3/5/2009 PA 3/5/2009 CT 3/5/2009 AZ 3/5/2009 NM 3/5/2009 3/5/2009 CA 3/5/2009 VA 3/5/2009 OR 3/5/2009 OR 3/5/2009 OR 3/5/2009 OH 3/5/2009 PA 3/5/2009 TN 3/5/2009 NY 3/5/2009 NC 3/5/2009 OH 3/5/2009 KS 3/5/2009 MI 3/5/2009 IL 3/5/2009 GA 3/5/2009 MA 3/5/2009 MI 3/5/2009 PA 3/5/2009 CA 3/5/2009 NC 3/5/2009 TX 3/5/2009 MA 3/5/2009 MS 3/5/2009 CA 3/5/2009 CA 3/5/2009 IL 3/5/2009 NC 3/5/2009 GA 3/5/2009 CA 3/5/2009 AZ 3/5/2009 CA 3/5/2009 TX 3/5/2009 WA 3/5/2009 NC 3/5/2009 CA 3/5/2009 CA 3/5/2009 IL 3/5/2009 PA 3/5/2009 CA 3/5/2009 CT 3/5/2009 CT
22 54 0.2 66 14 82 0.3 1.1 12 14 11 41 14 28 83 49 34 39 12 1.3 55 5 26 77 12 49 67 25 1 4 65 1.3 1.3 16 3 14 4 62 0.2 62 1.3 13 4 10 0.2 57 1.6
22 54 0 66 14 0 1 12 14 11 41 14 28 49 34 12 1 55 5 26 77 12 49 67 25 1 4 1 1 16 3 14 4 62 0 62 1 13 4 1 0 57 1
U U U U F M 0.2 M F F F 0.3 M 0.1 M M M M F F M U F F F M 0.3 M M F F M F F M F 0F M F 0.3 F 0.4 U F M M F F 0.1 F M 0.3 M F M 0.3 F 0.2 F M 0.6 M
3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 This case was reported by a healthc 3/3/2009 I had the 1st GARDASIL vaccination 3/2/2009 Guillian-Barre Syndrome with loss o 2/27/2009 Vaccines administered 2/05/09 in m 3/2/2009 Approximately 4 days after immuniz 2/26/2009 Student dropped off at Mall. At 5:30 3/3/2009 Pt received ZOSTOVAX vaccine on 3/2/2009 Pt received IZ on 2/18/2009, mothe 3/2/2009 See attached. Neurologist's assessm 2/23/2009 Fainting after vaccines given. 2/23/2009 After 2 shots, pt complained of feeli 2/18/2009 Afternoon after am shot, mom called 2/1/2009 3 days post immunization pt. c/o wh 2/16/2009 Onset of fever, generalized aching 2 2/27/2009 PNEUMOVAX given IM Left deltoid Shingles broke out at 4:30 pm 11/08 2/27/2009 Came in today stating that the day a 3/2/2009 Hive like rash across abdomen with 3/2/2009 Pt got a large reddened area with ra R arm with severe redness/swelling 2/27/2009 Left thigh cellulitis. Treated with Om 3/2/2009 Hemorrhagic purpura - developed 4 2/27/2009 Left cervical lymphadenitis. 3/5/2009 I went in for the 1st of three Guardis 3/5/2009 Developed grouped papules and ve 3/5/2009 Within 5 minutes of injection, arms f 3/5/2009 49 yo WF was given IM Pneumovax 3/5/2009 redm wram swollen right bicep. trea 3/5/2009 RECEIVED YELLOW FEVER VACC 3/5/2009 Localized wheal (3 cm x 1 cm) and 3/5/2009 PATIENT DEVELOPED REDNESS 3/5/2009 Patient received flu shot at unknown 3/5/2009 Developed swelling of right eye with 3/5/2009 localized redness for two days at sit 3/5/2009 Mother called and reported that pati 3/5/2009 multiple wheals around injection site 3/5/2009 Austen was very anxious when give 3/5/2009 5cm x 5 cm Red, Swollen, Hardness 3/5/2009 received the vaccine at 3pm, februa 3/5/2009 Unconsolable crying for 6 hours afte 1/26/2009 Patient received pneumococcal vac 3/5/2009 Erythema and swelling of L upper th 3/4/2009 Pt had seizure while sitting and eati 3/5/2009 3/4/2009 at 7:30pm child had a seiz 3/5/2009 Had 2 doses of VARIVAX, develope 2/26/2009 After receiving all ten shots - PENTA 2/19/2009 Pain, tingling and weakness in legs, 3/5/2009 2 days later (after 3rd DTaP) leg fro
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3/5/2009 FL 3/5/2009 SC 3/6/2009 WA 3/6/2009 MO 3/6/2009 NY 3/6/2009 NC 3/6/2009 3/6/2009 CO 3/6/2009 IA 3/6/2009 WI 3/6/2009 PA 3/6/2009 CA 3/6/2009 NM 3/6/2009 MI 3/6/2009 MD 3/6/2009 WI 3/6/2009 WA 3/6/2009 WA 3/6/2009 FL 3/6/2009 PA 3/6/2009 NJ 3/6/2009 OH 3/6/2009 CO 3/6/2009 GA 3/6/2009 NJ 3/6/2009 WI 3/6/2009 WI 3/6/2009 AZ 3/6/2009 OR 3/6/2009 WA 3/6/2009 MT 3/6/2009 3/6/2009 3/6/2009 NC 3/6/2009 TX 3/6/2009 TX 3/6/2009 IL 3/6/2009 FL 3/6/2009 AR 3/6/2009 NY 3/6/2009 OH 3/6/2009 WV 3/6/2009 WI 3/6/2009 NJ 3/6/2009 MN 3/6/2009 NY 3/6/2009 OK 3/6/2009 MA 3/6/2009 NY 3/6/2009 CO 3/6/2009 PA
15 61 66 26 20 14 23 13 0.3 60 16 4 84 4 16 1 0.3 3 12 21 15 16 16 5 16 70 7 16 1.4 9 33 61 40 38 1.3 0.5 1.2 0.8 1.1 62 74 1.3 4 3 65 9 11 4 47 70 60
15 61 66 26 20 14 23 13 0 60 16 4 84 4 16 1 0 3 12 21 15 16 16 5 16 70 7 16 1 9 33
1 0 1 0 1 62 74 1 4 3 65 13 11 4 47 70 60
F F F F F F F F 0.3 M M F M F F M 0F 0.3 F M F F F F F M F F M M 0.4 M M F F M F 0.3 M 0.5 F 0.2 M 0.8 U 0.1 M F M 0.3 M M M F M F M M M F
3/4/2009 None stated 3/3/2009 Patient had swelling and soreness t 3/6/2009 Hives all over body, very large and r 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 3/5/2009 Information has been received from 1/30/2009 Lightheadedness. Malaise. Chills. H 2/10/2009 Pt described chest heaviness, naus 2/25/2009 L arm swelling and redness at sight 3/2/2009 Patient received shingles vaccine o 3/3/2009 Left arm red day after vaccines adm 2/27/2009 Pt got FLUMIST and came down wi 3/2/2009 Rash beginning one week after rece 3/2/2009 Pt was given PEDIARIX at 4mo. WC 2/18/2009 Pt was given Hep A vaccination, no 2/24/2009 Patients received HPV # 1 6-26-07. 2/28/2009 2/13/09 stabbing head pain, 2/14/09 2/11/2009 Tingling/numbness in left leg, move 3/2/2009 Mother stated generalized Rash in A 2/4/2009 Ongoing dizziness, dysautonomia, f 3/3/2009 My son age 5 was given the MMR/V 2/27/2009 Broke out in hives on 2/22/09. Wor 1/30/2009 Low grade fever, muscle aches, nau 1/30/2009 Swelling red hot left arm pain Tyleno 3/3/2009 Patient c/o nausea immediately afte 3/3/2009 3/1 Febrile seizure. about 0300 -> E 2/28/2009 Patient stood up after injection, walk 2/11/2009 Clt first noticed a blister at site of inj 3/4/2009 Received shingles vaccine- ZOSTA 2/21/2009 Attached. 2/27/2009 N/A 2/25/2009 Redness & swelling at injection site. 2/27/2009 Fussy, congestion, cough, decrease 2/28/2009 Pt presented to office on 2/28/09 wi Had swelling at site of injection 3/2/2009 Received PREVNAR injection 2/23/ 3/2/2009 Significant swelling, redness, erythe 3/2/2009 Redness & induration 10 inches aro 2/25/2009 Local reaction redness swelling 4 cm 3/3/2009 Patient c/o sore arm on 2-28-09. M 2/27/2009 Mild reaction right upper arm 2 - PN 2/20/2009 Phone call -> Per note from/by Dr. : 3/6/2009 3/5/2009 - Telephonce call from sch 3/6/2009 Approximately 24 hours after admin 3/6/2009 MMR Vaccine was administered on 3/6/2009 Headache, lymph node reacted and 3/6/2009 On 3/2/09 6 PM vacine given- head 3/6/2009 Pt noted a rash 2 days after adminis
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3/6/2009 AZ 3/6/2009 GA 3/6/2009 LA 3/6/2009 GA 3/6/2009 OR 3/6/2009 NY 3/6/2009 NC 3/6/2009 OK 3/6/2009 CA 3/6/2009 TX 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 CA 3/6/2009 AZ 3/6/2009 GA 3/6/2009 WA 3/6/2009 AL 3/6/2009 AL 3/6/2009 VA 3/6/2009 VA 3/6/2009 CA 3/6/2009 AZ 3/6/2009 CA 3/7/2009 GA 3/8/2009 3/8/2009 NJ 3/8/2009 KS 3/9/2009 ID 3/9/2009 AZ 3/9/2009 AZ 3/9/2009 TN 3/9/2009 TX 3/9/2009 MI 3/9/2009 TN 3/9/2009 TN 3/9/2009 MI 3/9/2009 MD 3/9/2009 MD 3/9/2009 CA 3/9/2009 MO 3/9/2009 NJ 3/9/2009 OH 3/9/2009 OH 3/9/2009 CT 3/9/2009 CA 3/9/2009 TN 3/9/2009 FL 3/9/2009 TN 3/9/2009 SC
62 17 1 11 5 80 36 12 32 47 5 16 69 0.4 11 7 0.6 25 1.3 1.3 34 26 46 15 66 1.1 9 46 20 17 15 67 61
62 17 1 11 5 80 35 12 32 48 5 16 69 0 11
14 17 17 52 4 5 64 17 14 11 13 0.5 16 12 1.7 68 8
14 17 17 52 4 5 64 17 14 11 13 0 16 12 1 68 6
0 25 1 1 34 26 46 66 1 9 46 20 17 67 61
F F 0M F F M M F F F M F F 0.4 M F U 0.6 M F 0.3 M 0.3 M M F F M M 0.1 F M F M F F F F U F F M F F M F F M F F 0.5 F F F 0.7 M F F
3/6/2009 Severe headache from back of neck 3/6/2009 RED WARM AREA TO RIGHT ARM 3/6/2009 Red bumps all over body that starte 3/6/2009 RED WARM AREA AROUND THE 3/6/2009 Patient received 4 vaccinations on 0 3/6/2009 PT. REC'D ZOSTER VAX. ON 1/29 3/6/2009 UNKNOW 3/6/2009 Patient received Gardasil and Mena 3/6/2009 The morning after receiving the Tda 3/6/2009 area became swollen and red, seve 3/6/2009 Patient developed fever and light se 3/6/2009 Sudden onset full body myalgia and 3/6/2009 Local side effect at injection site (R 3/6/2009 10 min after administrating ROTATE 3/6/2009 The day post vaccine child c/o pain None stated. 3/6/2009 At 2 months, patient had rash at loc 3/5/2009 Pt received #2 GARDASIL vaccine 3/6/2009 Vomiting occurred after having vacc 3/6/2009 Vomiting and low grade fever occur 3/6/2009 8 days post yellow fever vaccination 3/4/2009 Left upper arm cellulitis - treated wit 2/4/2009 Arthralgia - severe, malaise- severe 3/6/2009 Pt received TDAP. He developed fe 2/3/2009 Approx 4 hours after injection patien 3/7/2009 Moderate fever for several days the 3/8/2009 Crystallia sudamina rash developed 3/8/2009 Stiffness, very painful and swollen w 3/8/2009 Became highly anxious after vaccin 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received by a 3/6/2009 Information has been received from 3/4/2009 Initial report received 24 February 2 3/5/2009 Given TDAP & VARIVAX 3/3 0900 A 2/11/2009 Swelling at site of injection- Sorenes 1/22/2009 Pt received TDAP, HEP A, MENAC 2/27/2009 Client states onset of soreness + "S 2/26/2009 Pt received flu shot and came down 2/26/2009 Pt received flu shot and came down 2/23/2009 Shoulders up to neck-soreness still 3/3/2009 C/o frontal headache, neck pain, bo 3/6/2009 Severe leg pain, particularly in knee 2/27/2009 After 5th injection, pt. felt nauseated 2/27/2009 Immediately after 4th injection (HPV 3/5/2009 Fever approximately 7 PM 1/23. Ab 2/25/2009 Left arm/chest area pain and rednes 2/20/2009 10:00, nurse practitioner at clinic ph 3/4/2009 Rash covering body. 3/9/2009 Vaccine administered 0945 1/28/09 3/9/2009 Received flu shot on Thursday. Frid
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3/9/2009 MO 3/9/2009 GA 3/9/2009 MO 3/9/2009 MO 3/9/2009 MN 3/9/2009 IA 3/9/2009 CO 3/9/2009 MI 3/9/2009 MA 3/9/2009 DE 3/9/2009 NC 3/9/2009 NC 3/9/2009 TX 3/9/2009 CA 3/9/2009 NV 3/9/2009 NV 3/9/2009 CA 3/9/2009 AZ 3/9/2009 IN 3/9/2009 WI 3/9/2009 OH 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 GA 3/9/2009 AZ 3/9/2009 CA 3/9/2009 CA 3/9/2009 CA 3/9/2009 GA 3/9/2009 MO 3/9/2009 NY 3/9/2009 WA 3/9/2009 WA 3/9/2009 WA 3/9/2009 IN 3/9/2009 FL 3/9/2009 TN 3/9/2009 FL 3/9/2009 TX 3/10/2009 NC 3/10/2009 3/10/2009 3/10/2009 KS 3/10/2009 NY 3/10/2009 NH 3/10/2009 3/10/2009 WV 3/10/2009 CO 3/10/2009 NC
26 23 1 3 1.3 1.3 4 17 60 1 14 1 62 23 2 3 66 4 2 64 22 1 1 1 1.7 4 11 1.2 4 4 15 5 1.5 75 65 51 1 4 5 12 56 2
26 23 1 3 1 1 4 17 60 1 14 1 62 23 2 3 66 4 2 64 22 1 1
60 8 12 63 17 0.5 17
60 8 12 63 17 0 17
1 4 11 1 4 4 15 5 1 75 65 51 1 4 5 12 56 2
F F 0F M 0.3 M 0.3 M F F F 0F M 0F M F 1M M F M 0.8 F F M 0F 0M F 0.7 F M F 0.2 F M F F M 0.5 F F F F 0F F M M M 0M F U M F F F F 0.5 M F
2/27/2009 Immediately flushed and hot with in 3/9/2009 Pt presented on 2/11/09 and had a 10/1/2008 Child started having a rash on face ### 10-10 a.m. - swollen right thigh, red 3/9/2009 patient received vaccine on 3/3/09 i 3/9/2009 Diarrhea since 3-6-09; Bloody nose 3/9/2009 pain, swelling, erythema, itching, sig 3/9/2009 HAD HEADACHE AND GENERALI 3/9/2009 Vaccine administered 3/5/2009 3 pm 3/9/2009 Patient developed high fever, erythe 3/9/2009 Redness,swelling,heat and firmness 3/9/2009 Mom reports a blister, smaller than 3/9/2009 i got the shingles vaccine that my D 3/9/2009 Left deltoid area swollen, tender and 3/9/2009 A week after DTAP given mom repo 3/9/2009 72 hours offer IPV given child has d 3/9/2009 3/05- shot given. 3/06- arm swelled 3/9/2009 Swollen red R upper area > resolve 3/6/2009 Cellulilitis L thigh around vaccine ad 3/9/2009 Pt reports she saw Dr for "horrible b 3/9/2009 Approx 10-15 minutes after injection 2/26/2008 Redness, induration and warmth at 2/26/2008 Redness, induration and warmth at 2/26/2009 Redness, induration and warmth at 3/4/2009 Broke out small rash over left upper 3/6/2009 Child developed a tight cough and p 2/24/2009 C/O join pain, and pain in arm of AD 3/9/2009 Warm to touch, redness 6 1/2cm X 3/9/2009 3/4 vaccine; 3/5 arm swelling redne 3/8/2009 Local redness, 2"/3" on Rt. thigh. M 9:15 am 3/3/09 Pt. received HEP A 3/9/2009 Local reaction to IMM. Left deltoid x 3/9/2009 Developed generalized pink maculo 10/1/2008 11 x 19 cm raised, red urticarial-app 10/8/2008 Pt experienced pain, redness and s 9/26/2008 Client walked into clinic stating she 2/26/2009 Rash 3/9/2009 Left leg with Baseball sized knot wa 3/9/2009 Temperature has been normal, it is 3/7/2009 Patient developed rash to left chest 3/6/2009 Fever, myalgias, N/V and arthralgia 3/10/2009 Fourteen days after his vaccine he r 3/9/2009 Information has been received from 3/9/2009 Information has been received from 3/9/2009 Information has been received from 3/4/2009 Bilateral weakness in legs and urina 2/12/2009 8/1/08- 1st shot- fainting began, hea 3/6/2009 Patient was given ZOSTAVAX vacc 3/5/2009 Within 5 minutes after vaccination c 2/27/2009 Pt had no adverse rxn, doctor did no 2/25/2009 Pt has a history of tic disorder in Jan
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3/10/2009 CA 3/10/2009 WI 3/10/2009 VT 3/10/2009 GA 3/10/2009 NM 3/10/2009 TX 3/10/2009 OR 3/10/2009 PA 3/10/2009 3/10/2009 3/10/2009 MA 3/10/2009 NY 3/10/2009 NJ 3/10/2009 MN 3/10/2009 NM 3/10/2009 MN 3/10/2009 CA 3/10/2009 NJ 3/10/2009 VA 3/10/2009 OK 3/10/2009 NC 3/10/2009 MD 3/10/2009 CT 3/10/2009 VA 3/10/2009 FL 3/10/2009 OK 3/10/2009 PR 3/10/2009 IN 3/10/2009 FL 3/10/2009 MI 3/10/2009 PA 3/10/2009 NY 3/10/2009 OR 3/10/2009 NC 3/10/2009 PA 3/10/2009 PA 3/10/2009 MN 3/10/2009 HI 3/10/2009 IN 3/10/2009 IA 3/10/2009 MO 3/10/2009 GA 3/10/2009 WI 3/10/2009 CA 3/10/2009 WA 3/10/2009 CO 3/10/2009 CA 3/10/2009 NJ 3/10/2009 IL 3/10/2009 CO 3/10/2009 TX
14 4 1.5 54 59 77 11 66 13 63 24 31 5 12 2 32 61 4 71 57 13 44 53 42 7 30 14 1 29 17 16 1.3 0.6 61 56 52 20 33 1.3 5 2 42 24 1 15 0.2 26 0.3 7 57 66
14 4 1 54 59 77 11 66 13 24 31 5 12 2 32 61 4 71 57 13 44 53 42 7 30 14 1 29 17 16 1 0 61 52 20 33 1 5 2 42 24 1 15 0 26 0 7 57 66
F F 0.5 M F F U F F F F F F M F 0F M F F M F M M F M M F F 0F F F F 0.3 M 0.6 M F U M F M 0.3 F F 0.7 F F M 0F F 0.2 F F 0.2 M F F F
2/26/2009 Dizzy episode after 1st GARDASIL 3/4/2009 4-6 cm redness left deltoid & soft tis 3/5/2009 Patient spike a fever of 102, becam 2/19/2008 Patient experienced nausea and itc 3/6/2009 Red Rash covering 5 inch Diameter None Stated 3/5/2009 Painful red and swollen x 4 days; be 3/6/2009 Large, red, swollen, itchy lump hurts 3/5/2009 Around February of this year my da 3/5/2009 Recd vaccine on Tues. 3/2/09 abou None Stated 3/18/09-records receiv 3/5/2009 Headache, nausea, vomiting, fatigu 2/25/2009 Per father - child experienced occas 2/24/2009 Day #1 following vaccinations finger 3/2/2009 Red rash & small vesicles on neck, 3/3/2009 Mild dizziness. 3/5/2009 Swelling and puffy red @ site and a 3/7/2009 DTAP shot to my 4 yr old within 8 hr 3/5/2009 Onset of redness only 1hr after sho 1/30/2009 Fever 100.5, myalgias, with redness 3/6/2009 Hives. 3/10/2009 This case was reported by a lawyer 3/10/2009 This case was reported by a lawyer 3/10/2009 Flu Mist administered as part of ann 3/10/2009 sudden paleness, weakness, dizzin 3/10/2009 This Tdap was given as no history o 3/10/2009 PATIENT REFERS DIZZINESS, PE 3/10/2009 Developed 4cm red hive with centra 3/10/2009 Developed shortness of breath, hive 3/10/2009 Within 1 minute of receiving Menact 3/10/2009 After getting the gardasil vaccine th 3/10/2009 RECEIVED 15 MONTH SHOTS 4 D 3/10/2009 Patient started jerking/seizure for ab 3/10/2009 injection site reaction: redness and 3/10/2009 Subject in pneumococcal vaccine tr 3/10/2009 Subject in pneumococcal Y vaccine tr 3/10/2009 Fever, Nausea and vometing, ment 3/10/2009 Onset of bilateral profound bilateral 3/10/2009 At 4:45 PM child felt warm. Mother 3/10/2009 Less than 5 mins after Varivax given 3/10/2009 Mother presented to office with child 3/10/2009 On 03/10/2009 at approximately 2:4 3/10/2009 Pt c/o extremely sore arm with mild 3/10/2009 Child seen in health center on 03/04 3/10/2009 Pt felt dizzy a few minutes after HPV 3/10/2009 The patient received 0.4cc of Infant 3/10/2009 I received my first and only dose of 3/10/2009 Immediately after vaccination, a few 3/10/2009 Within 16 hrs, had sore arm, legs, h 3/10/2009 Patient was given her first flu shot w 3/10/2009 Onset 3/10/09 2 red areas 1 to inne
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3/10/2009 OR 3/10/2009 AZ 3/10/2009 WA 3/10/2009 AK 3/10/2009 AL 3/10/2009 AK 3/11/2009 MI 3/11/2009 KY 3/11/2009 3/11/2009 3/11/2009 MO 3/11/2009 CA 3/11/2009 3/11/2009 FL 3/11/2009 FL 3/11/2009 CA 3/11/2009 TX 3/11/2009 TX 3/11/2009 NC 3/11/2009 FL 3/11/2009 MO 3/11/2009 NY 3/11/2009 TX 3/11/2009 MA 3/11/2009 CO 3/11/2009 FL 3/11/2009 WA 3/11/2009 WI 3/11/2009 OH 3/11/2009 WV 3/11/2009 TX 3/11/2009 CT 3/11/2009 TX 3/11/2009 MO 3/11/2009 NC 3/11/2009 NC 3/11/2009 GA 3/11/2009 TX 3/11/2009 KS 3/11/2009 KS 3/11/2009 NC 3/11/2009 AL 3/11/2009 MN 3/11/2009 NY 3/11/2009 AL 3/11/2009 CT 3/11/2009 IL 3/11/2009 WA 3/11/2009 KY 3/11/2009 OR 3/11/2009 WI
40 73 1.6 19 15 72 80 0.4 3 13
40 73 1 19 15 72 0
13
55 53 53 32 67 25 1.2 1.1 12 0.2 17 14 16 4 8 0.2 12 11 35 1.5 1.3 0.2 37 31 1 7 11 71 1.3 48 13 79 4 0.4
55 53 53 32 67 25 1 1 12
23 1.5 21
23 1 21
17 14 16 4 8 0 12 11 35 1 1 0 37 31 1 7 11 71 1 48 13 79 4 0
F M 0.6 M F F F F 0.4 M M M F U U F F M F F M 0.2 M 0.1 F F F M F F M F 0.2 F F M M 0.5 M 0.3 F 0.2 M F F 0F F M F 0.3 F F M F F 0.4 M F F 0.5 F F
3/10/2009 TDAP given 2/27/2009. (left deltoid) 1/7/2009 Rash on trunk and local swelling, pa 5/14/2008 Swollen x 48 hours-entire leg 2x NL 3/4/2009 12/8/08 - Rt shoulder tenderness, p 3/9/2009 None stated 3/5/2009 Localized redness and tenderness t 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/10/2009 Information has been received from 3/11/2009 This case was reported by a healthc 3/10/2009 This case was considered medically 3/6/2009 Initial information was received on 2 3/3/2009 I was told by the hospital that I had 3/11/2009 Swelling to injection site, no rednes 3/11/2009 Pt. reported: Had L) upper arm swe 3/10/2009 Left SQ red area size of 1/2 dollar 3/11/2009 26 y/o male ADMS is referred to the 3/11/2009 About 10 minutes after vaccines ad 3/11/2009 Came in 3-9-09 with 101-102 degre 3/11/2009 Given HPV & MENACTRA @ 08:30 3/9/2009 Lethargy, poor feeding for 7-10 day 3/6/2009 Site of injection started to ache 3/5/ 3/6/2009 Vaccine administered 3-3-09, on 3-4 3/5/2007 After administering Tdap vaccine th 3/5/2009 10 x 8cm area of erythema/tenderne 3/4/2009 Rash and cellulitis secondary to imm 3/9/2009 Excessive (inconsolable) crying ove 3/8/2009 Vasovagal syncope- twice, oral fluid 3/9/2009 Immediate itching/hiving @ site & lip 3/6/2009 Felt hot and sweaty about 30 min af 3/6/2009 Fever high of 104 degree F vomiting 3/2/2009 Received Dtap + PREVNAR on 2-5 2/19/2009 High pitched scream, inconsolable f 3/4/2009 Fever and chills started about 9 hou 3/5/2009 2/23/09- Dizziness, body aches, fev 3/6/2009 Developed VARICELLA lesions 9 d 3/10/2009 Rash on arms and torso consistent 3/10/2009 Rush on checks, forearms, hands s 3/10/2009 Patient thought she had shingles, n Vomiting onset 3 hrs after vaccine la 3/10/2009 Received TDAP 3/6/09. Within 1-2 d 2/5/2009 Patient received a 3rd dose of varic 3/10/2009 Small red rash around injection site, 3/11/2009 8X11 cm induration at site of KINRI 3/9/2009 None stated 3/5/2009 On 3/2 pneumonia vaccine was give 3/10/2009 Employee complains of dizziness ap Mother reports evening 3/05/09 Pt d 3/11/2009 Self innoculated self on Right index
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3/11/2009 OH 3/11/2009 MN 3/11/2009 AZ 3/11/2009 CA 3/11/2009 ID 3/11/2009 WA 3/11/2009 ND 3/11/2009 PA 3/11/2009 KY 3/11/2009 CA 3/11/2009 MD 3/11/2009 IL 3/11/2009 IA 3/11/2009 MO 3/11/2009 IL 3/11/2009 TX 3/11/2009 AK 3/11/2009 CA 3/11/2009 CA 3/11/2009 OR 3/11/2009 CA 3/11/2009 CA 3/11/2009 GA 3/11/2009 NJ 3/11/2009 MO 3/11/2009 IL 3/11/2009 IN 3/11/2009 OH 3/11/2009 IL 3/11/2009 NY 3/11/2009 NY 3/11/2009 NY 3/11/2009 PA 3/11/2009 PA 3/11/2009 DE 3/11/2009 PA 3/11/2009 NY 3/11/2009 IN 3/11/2009 TX 3/11/2009 TX 3/11/2009 TN 3/11/2009 MD 3/12/2009 IN 3/12/2009 PA 3/12/2009 3/12/2009 3/12/2009 3/12/2009 IN 3/12/2009 KY 3/12/2009 3/12/2009 PA
4 13 21 22 41 70 22 63 0.5 1.3 0.5 30 3 1 43 0.5 35 43 64 4 46 18 0.5 17 25 5 1 38
4 13 1 21 22 41 70 22 64 0 1 0 30 2 1 43 0 35 43 4 46 18 0 17 25 5 1 38
5 5 1.5 2 1.3 26 13 14
5 5 1 2 1 26 13 14
12 26 74
12 26
34 1 1.1 65
34
4
4
1 65
F F 0.2 M F F F F F F 0.5 F 0.3 F 0.5 F M 0.9 F 0M F 0.5 F F M F M F F 0.5 F M M F 0F M U U U M M 0.5 M 0.4 F 0.3 F F F F F F F F U F M 0.1 F F U F
3/11/2009 Mom reports pt with hard red area 2 3/11/2009 October, 2007 - Back and Hip pain 3/11/2009 EXPOSE TO CHICKEN POX AT DA 3/11/2009 I got a concussion and with the stitc 3/11/2009 Patient vaccinated with Flu vaccine 3/11/2009 pain, swelling, redness, hotness, ha 3/11/2009 Red- blistery patches and itchy with 3/11/2009 Following Tdap vaccine patient dev 3/11/2009 Herpes zoster rash 2 x 4 cm right th 3/11/2009 Death 7 days Y later 4/20/-09-autopsy 3/11/2009 VACCINATION SITE BECAME RED 3/11/2009 On 3/7/09, pt developed intermitten 3/11/2009 Approximately 7 hours after vaccina 3/11/2009 Kinrix was given to this patient. No r 3/11/2009 developed area of erythema (1 cm d 3/11/2009 PATIENT CLAIMS THAT AS SOON 3/11/2009 10m 3 wk old had INTUSSUSCEPT 3/11/2009 MONDAY(9 MARCH 2009): EVENIN 3/11/2009 Patient just wanted to touch basis w 3/2/2009 (1) welt / swelling at site 5" long X 2 3/10/2009 Erythematous, edematous at vaccin Non stated. 12/9/2008 8-19-08 Slurred speech. 8-13-08 Eq 3/11/2009 Head bobbling; Questionable seizur 3/11/2009 Following Immunizations client sittin 3/11/2009 No adverse events 3/11/2009 Patient received DTaP, IPV, MMR a 3/10/2009 Rash and fussy 20 days after admin 3/9/2009 Generalized rash similar to classic m 5/12/2008 This report was received from a hea 5/12/2008 This report was received from a hea 5/12/2008 This report was received from a hea ### Initial report was received 04 Septe ### Initial report received on 15 Septem 10/7/2008 Initial information was received from ### Initial report was received 17 Octob 7/18/2008 This case was received from a cons 9/26/2008 Initial report received on 22 Septem 1/9/2009 A 13-year-old female patient with a ### Initial report was received 12 Decem ### Initial report received from a physici ### Initial information was received on 1 3/12/2009 Head to toe rash, respiratory distres 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/11/2009 Information has been received from 3/10/2009 Patient diedY1-11-09. Had received 3/5/2009 Kidney involvement, nerve inflamma 3/6/2009 Red Lumps all over. 3/9/2009 Lump under surface of skin. Small a
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3/12/2009 TX 3/12/2009 VA 3/12/2009 CA 3/12/2009 NC 3/12/2009 OH 3/12/2009 ME 3/12/2009 WI 3/12/2009 WI 3/12/2009 NJ 3/12/2009 FL 3/12/2009 3/12/2009 IL 3/12/2009 NC 3/12/2009 TX 3/12/2009 VA 3/12/2009 OK 3/12/2009 CT 3/12/2009 FL 3/12/2009 MO 3/12/2009 DC 3/12/2009 NE 3/12/2009 NY 3/12/2009 GA 3/12/2009 NC 3/12/2009 NC 3/12/2009 WA 3/12/2009 IN 3/12/2009 WA 3/12/2009 AZ 3/12/2009 MO 3/12/2009 CA 3/12/2009 NC 3/12/2009 OR 3/12/2009 TX 3/12/2009 NC 3/12/2009 VT 3/12/2009 CA 3/12/2009 MA 3/12/2009 TX 3/12/2009 CA 3/12/2009 IL 3/12/2009 3/12/2009 VT 3/12/2009 AK 3/12/2009 CA 3/12/2009 CA 3/12/2009 OR 3/12/2009 OH 3/12/2009 IL 3/12/2009 NM 3/12/2009 PA
68 4 68 1.5 16 4 5 13 15 1.1
68 4 68 1 16 4 5 13 15 1
1 1.9 4 0.8 2 15 2 0.5 40 30 27 11 19 18 64 25 56 0.3 0.5 1 3 60 11 37 13 13 4 11 47 1.3 65 1.2 5 1.2 4 62 20 7 4 15
1 1 4 0 2 15 2 0 40 30 27 11 19 18 64 56 0 0 1 3 60 11 37 13 13 4 11 47 1 1 5 1 4 62 20 7 4 15
F F M 0.5 F F F F F F 0.1 F U 0F 0.9 M F 1M 0.7 M M 0.2 F 0.5 M F F F F M M M F F 0.3 F 0.5 F 0F F M F F F M M M F 0.3 M F 0.2 M M 0.2 M M F F F F M
3/6/2009 Localized redness and itching past 3/5/2009 7" area of induration, warmth, erythe 3/6/2009 Malaise, anorexia, SOB on mild exe 3/3/2009 None. Tdap given instead of DTap # 3/9/2009 Patient began noticing rash on ches 3/9/2009 Vaccines administered to patient. P 3/10/2009 Low grade 99 degree-102.4 degree 3/6/2009 Father reports his daughter has had 3/10/2009 Rt arm red, swollen, firm, hot @ are 3/6/2009 Rash all over. 3/6/2009 Bumps all over. 3/7/2009 Vaccine > PREVNAR / VARIVAX a 3/6/2009 Approx. 1 hr after receiving immuniz 3/6/2009 1) Pt. comes in 3 days later. Her VA 3/12/2009 vomiting x 1 day; afebrile and fine th 3/12/2009 erythematous swelling at the site of 3/12/2009 MOM CALLED STATING CHILD HA 3/12/2009 Pt. mother state child had a fever, h 3/12/2009 PENTACEL IMMUNIZATION GIVEN 3/12/2009 Patient with difficulty breathing, itch 3/12/2009 Had Tdap on 3-10-09, right deltoid. 3/12/2009 Appoximately 25 minutes after Stac 3/12/2009 03/11/2009 13:45 Immunization adm 3/12/2009 1. PT hospitalized 4 months prior to 3/12/2009 PT recieved anthrax shot and one h 3/12/2009 Received Shingles Vaccine Zostava 3/12/2009 I never had any types of warts. Afte 3/12/2009 Got Bronchitis and flu like symptom 3/12/2009 Diagnosed with intussusception 8 d 3/12/2009 PENTACEL IMMUNIZATION GIVEN 3/12/2009 ON 2/24/09, AN MMR AND A VARI 3/12/2009 swelling and redness of left deltoid r 3/12/2009 Developed shingles 19 days followin 3/12/2009 MOM STATE FEW MINUTES AFTE 3/12/2009 Major pain at and around injection s 3/12/2009 Mom is requesting VAERS done...o ### Pt has severe headache and was a 3/12/2009 Local reaction w/ erythematous rash 3/12/2009 Injection of VARIVAX (L) shoulder 3/11/2009 Headache, joint aches/pains, chills 3/12/2009 Rash and fever developed 1 week a 3/12/2000 Pt was given Td & pneumonia vacc 3/12/2009 Red, swollen, hard, lump "the size o 3/5/2009 Immunization, INFANRIX, given on 3/12/2009 3/9/09 IZ received @ bedtime T-101 3/10/2009 Pt brought in by aunt to have PPD r 3/10/2008 Pt states her (L) arm has been sore 3/12/2009 Headache, vertigo, tingling in arms, 3/12/2009 Dad noted late on 3-9-09 a red swo 3/12/2009 One hour after injection c/o severe p 3/12/2009 24 hours after shot given swollen fo
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3/12/2009 AZ 3/12/2009 3/12/2009 VA 3/12/2009 NJ 3/12/2009 IA 3/12/2009 GA 3/12/2009 SC 3/12/2009 NY 3/12/2009 NC 3/12/2009 NH 3/12/2009 PA 3/12/2009 CO 3/12/2009 3/12/2009 AZ 3/12/2009 3/12/2009 3/12/2009 CA 3/12/2009 PA 3/12/2009 CO 3/12/2009 UT 3/12/2009 IN 3/12/2009 NC 3/12/2009 NM 3/12/2009 3/12/2009 NY 3/12/2009 CT 3/12/2009 3/12/2009 CA 3/12/2009 MI 3/12/2009 GA 3/12/2009 NY 3/12/2009 NY 3/12/2009 NY 3/12/2009 MO 3/12/2009 3/12/2009 3/12/2009 3/12/2009 3/12/2009 IN 3/12/2009 3/12/2009 MD 3/12/2009 SD 3/12/2009 MO 3/12/2009 3/12/2009 NE 3/12/2009 MO 3/12/2009 3/12/2009 NE 3/12/2009 3/12/2009 NY 3/12/2009 CO
6 71 33 74 20 0.4 61 4 42 11 8 19
6 71 33 74 20 0 61 4 42 11 8 19
0.5 64 0.5 16 18 15 13 17 0.8 1.2 1.1 2 3 5 1.1 1.5 1.3 0.3 0.6 0.2 0.2 6 1 5 0.4 0.2 0.5 0.2 0.3 0.2 0.3
0
18 15 17 0 1 1
5 1 1
0 0
0 0 0 0 0 0 0
0.2 0.2 0.4
0 0 0
9 5
5
F F U F F 0.4 F F M M M F F F 0.5 F F F F F F F F 0.8 M 0.2 F 0.1 M M F F 0.1 M 0.5 F F F F 0.2 M 0.2 M F M F 0.4 F 0.2 F 0.5 F 0.2 F 0.3 M 0.2 F 0.3 F F 0.2 F 0.2 M 0.4 M M U M
3/12/2009 (L) swollen arm. Pt. had adverse RXN to PCV Pt. req 3/12/2009 Pt woke with tingling in the heel sur 15 min after ZOSTAVAX numbness 3/10/2009 Within Minutes of receiving HPV vac 3/11/2009 5 days after receiving PENTACEL, P 3/12/2009 Redness, swelling at site of vaccina 3/12/2009 Left deltoid area, red, swollen and w 3/12/2009 PNEUMOVAX administered SQ R a 3/11/2009 (L) hive shaped 9 x 9 cm erythema 3/12/2009 Administered KINRIX as "catch up" 3/12/2009 Pt developed mild case of pyelonep 3/6/2009 Information has been received from 2/24/2009 Initial and follow up information has 2/18/2009 Information has been Roche Pharm 2/24/2009 Information has been received from 2/27/2009 Initial report received on 24 Februar 2/27/2009 Initial report received 23 February 2 3/4/2009 Initial report received 23 February 2 2/24/2009 This non serious case was received 2/20/2009 Initial report received on 11 Februar 2/18/2009 Initial and follow-up information has 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Initial and follow up information has 2/18/2009 Initial and follow-up information has 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received rega 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received for a 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 2/18/2009 Information has been received from 4/3/2008 This adult male (unknown age) took Initial report was received on 22. Ju 3/12/2009 This case was reported by a physici
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3/13/2009 WA 3/13/2009 IL 3/13/2009 NV 3/13/2009 NY 3/13/2009 TX 3/13/2009 WA 3/13/2009 NY 3/13/2009 IN 3/13/2009 3/13/2009 UT 3/13/2009 IL 3/13/2009 FL 3/13/2009 OH 3/13/2009 OK 3/13/2009 CO 3/13/2009 AK 3/13/2009 CA 3/13/2009 IA 3/13/2009 MI 3/13/2009 NC 3/13/2009 MI 3/13/2009 NC 3/13/2009 OK 3/13/2009 PA 3/13/2009 CA 3/13/2009 OH 3/13/2009 VA 3/13/2009 KY 3/13/2009 CT 3/13/2009 KY 3/13/2009 OR 3/13/2009 PA 3/13/2009 CA 3/13/2009 CA 3/13/2009 CA 3/13/2009 MD 3/13/2009 OR 3/13/2009 AK 3/13/2009 CA 3/13/2009 CA 3/13/2009 VA 3/13/2009 NC 3/13/2009 WI 3/13/2009 KY 3/13/2009 IA 3/13/2009 MA 3/13/2009 AZ 3/13/2009 ME 3/13/2009 NJ 3/14/2009 VA 3/14/2009 MD
1.7 48 5 4
1 48 5 4
65 31 72 16 15
65 31
4 26 36 1.3 55 0.3 1 49 5 18 50 4 62 4 23 3 0.2 17 4 59 70 1.1 1.4 11 42 2 0.3 4 5 12 4 4 1.3 22 14 0.2 16 4 24 1.4
4 26 36 1 55 0 1 49 5 18 50 4 62 4 23
16 15
0 17 4 59 1 1 11 42 2 0 4 5 12 4 1 22 0 4 24 1
0.7 F F M M F F M M F F M M F F 0.3 M F 0.4 M 0F F M F F F M F F M 0.2 M F F F F 0.1 M 0.4 F F F 0.5 F 0.3 M F M M F F 0.3 M F F 0.2 F F M M 0.5 F
3/13/2009 Geneva was given vaccines on 2/25 3/13/2009 First symptoms was my left arm whe 3/6/2009 MOC (mother of child) called to clini 3/9/2009 E. multiforme rash in palms and pla Red rash around shot area. Tingling 3/6/2009 Developed fever 101.8 with chills; re 2/9/2009 Induration and erythema 10X13 cm 3/12/2009 Information has been received from 3/12/2009 Information has been received from 3/12/2009 Information has been received from 3/11/2009 Initial information was received on 0 3/13/2009 RIGHT THIGH BECAME RED, WAR 3/13/2009 MEMBER RECIEVED ANTHRAX V 3/13/2009 reddness, swelling, nausea, headac 3/13/2009 Mother reports the following: Child h 3/13/2009 10/31/08 5pm c/o sore right armpit, 3/13/2009 URTICARIA PRESENTED ITSELF 3/13/2009 DEVELOPED HERPES ZOSTER 5 3/13/2009 One week after immunization she n 3/12/2009 LOCAL REATION OF LEFT ARM. A 3/13/2009 Pt has experienced pain in R arm co 3/13/2009 terrible back, neck shoulder and hea 3/13/2009 MOTHER BROUGHT PATIENT IN 3/13/2009 Rash - 2-3" long by 1&1/2" oval. It i 3/13/2009 RASH & REDNESS ON VACCINAT 3/13/2009 Rash of small blisters in a circular p 3/13/2009 Difficulty with balance within an hou 3/12/2009 Mother stated baby cried nonstop fo 3/12/2009 5 x7 cm induration approx 12 hrs af 3/12/2009 Child was given DAPTACEL on 3-5 3/13/2009 Approximately 24 hours after admin 2/14/2008 Swollen injection site - repeated Be 3/13/2009 rash on body x 2 weeks. Pt got chic 3/13/2009 Localized redness, swelling at site o 3/13/2009 Localized redness, swelling at site o 3/13/2009 On 3/11 in eve., pt. noted onset "sti 3/13/2009 Pt received HIB and DTAP into left 3/11/2009 102 Rectal temp Friday eve 3/06/09 3/13/2009 Approximately 24 hours after receiv 3/13/2009 Large erythematous hyperemic plaq 3/1/2009 12:30 Hives developed on right sho 3/13/2009 Sx: Vessicular erruption with subse 3/13/2009 Generalized rash - hives on chest, b 3/13/2009 Mom noticed he had hives / whelps 3/12/2009 Lt arm swollen, hives (Lt arm), Lt ar 3/13/2009 Received ADACEL 430 PM. 3/11 T 3/12/2009 Within 24 hrs after receiving ROTAV After GARDASIL #3 Pt. c/o stomach 3/12/2009 Approximately 10 minutes following 3/14/2009 Localized Urticaria around (L) Delto 3/14/2009 small amount of hives noted in groin
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3/14/2009 KS 3/15/2009 VA 3/15/2009 NC 3/15/2009 CA 3/15/2009 TN 3/15/2009 PA 3/15/2009 WA 3/16/2009 CO 3/16/2009 PA 3/16/2009 LA 3/16/2009 3/16/2009 PA 3/16/2009 OH 3/16/2009 GA 3/16/2009 CA 3/16/2009 NC 3/16/2009 NJ 3/16/2009 WA 3/16/2009 FL 3/16/2009 SC 3/16/2009 OH 3/16/2009 CA 3/16/2009 NY 3/16/2009 CO 3/16/2009 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 CO 3/16/2009 CA 3/16/2009 FL 3/16/2009 CA 3/16/2009 TX 3/16/2009 WV 3/16/2009 3/16/2009 MA 3/16/2009 SD 3/16/2009 MO 3/16/2009 MO 3/16/2009 CA 3/16/2009 LA 3/16/2009 WI 3/16/2009 OH 3/16/2009 WI 3/16/2009 WI 3/16/2009 NY 3/16/2009 TX 3/16/2009 MN 3/16/2009 KS 3/16/2009 FL 3/16/2009 HI
12 20 28 0 26 70 6
12 20 28 0 26 70 6
84 4
84
0.3 0.3 11 0.4 48 1.1 0.3 11 1.1 5 4 15 1.6 65 12 62 18 3 9 1 1.3 48 81 31 0.4 6 1.2 1 1.1 13 5 46 43 43 11 44 58 57 25 12
0 0 11 0 48 1 0 11 1 5 4 15 1 65 62 18 3 9 1 48 81 31 0 6 0 1 1 13 5 46 43 43 11 44 58 55 25 1
F F F 0F F F M F M M M 0.3 M 0.3 F F 0.4 M F 0.1 M 0.3 M M 0.1 F F F M 0.6 M F F F M M M 0F M F F M 0.4 M M 0.3 F 0F 0.1 M F F F M M M F F F F 0M
3/14/2009 dizziness and seizures. 4/16/09 MR 3/15/2009 encephalitis 24 h after guardasil vac 3/15/2009 Vaccine administered as part of rou 3/15/2009 Was administered Hep B vaccinatio 3/15/2009 After recieving first round of Gardas 3/15/2009 Severe red burning rash on arm 4in 3/15/2009 L upper thigh with erythematous, te 3/12/2009 Initial report received from another m 3/13/2009 Information has been received from 3/13/2009 This report was received from Glaxo 3/13/2009 Information has been received from 3/10/2009 About 2 weeks s/p ROTATEQ vacci Immunizations given 2-26-09 had n 3/10/2009 Left arm- 5.5 - 6.5cm SL. red soft ar 3/10/2009 None at this time 3/12/2009 On 2-18-09 sudden onset of knot in 2/19/2009 Developed urticarial lesions on back 3/11/2009 Mom stated child cried 4-5 hours aft 3/13/2009 Pt had episode of a fainting spell/?s 3/10/2009 Had shots 3/4/09 (MMR, VARIVAX, 3/10/2009 C/O sore left arm at 8am, around 93/5/2009 Mother states noticed L arm swollen 3/9/2009 Pt c/o right arm pain started 24 hou 3/9/2009 Acute cerebellar ataxia 3/3/2009 Pt had severe outbreak of herpes zo 3/12/2009 GARDASIL injection, fever headach 3/10/2009 THIS IS AN UNEXPECTED GOOD 3/11/2009 Immediately after receiving Hepatitis 3/12/2009 Swollen area of shot. immobility - m 3/5/2009 Lip/ facial/ oropharyngeal swelling. V 3/11/2009 Itchy rash covering body. 3/4/2009 5x11 cm erythema with induration a 3/9/2009 The pneumonia vaccine was given 3/10/2009 Left clinic after injection + returned t 2/23/2009 None Stated 3/16/2009 Patient had an ileo-colic intussusce 3/16/2009 High fever, hysterical laughing, non 3/10/2009 3-3-09 Child's mom reported fever, 3/16/2009 Rec telephone call on 3/11/09 from 3/16/2009 This child received 2 doses of Varic 3/16/2009 Returned to facility approximately on 3/16/2009 Mother reported very hard, red, war 3/16/2009 Received Boostrix in right arm on 03 3/16/2009 Developed area cellulitis at innocula 3/16/2009 Developed Cellulitis at innoculation 3/16/2009 L arm 3x4cm induration, redness, itc 3/16/2009 Severe sharp pain and swelling righ 3/16/2009 Sore, swollen left arm. Fever, nause 3/16/2009 Has continued L upper arm pain an 3/16/2009 PT STATES ONE WEEK AFTER VA 3/16/2009 Fever, mild generalized diffuse mac
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3/16/2009 NC 3/16/2009 IL 3/16/2009 ID 3/16/2009 CA 3/16/2009 NY 3/16/2009 IN 3/16/2009 IN 3/16/2009 CA 3/16/2009 WI 3/16/2009 NY 3/16/2009 CA 3/16/2009 IL 3/16/2009 MA 3/16/2009 DE 3/16/2009 TX 3/16/2009 CA 3/16/2009 VA 3/16/2009 TX 3/16/2009 NY 3/16/2009 TN 3/16/2009 KY 3/16/2009 MI 3/16/2009 FL 3/16/2009 CA 3/16/2009 3/16/2009 CA 3/16/2009 TN 3/16/2009 NH 3/16/2009 IN 3/16/2009 IL 3/16/2009 OH 3/16/2009 NH 3/16/2009 NC 3/16/2009 TX 3/16/2009 3/16/2009 CA 3/16/2009 CA 3/16/2009 CA 3/16/2009 PA 3/16/2009 NY 3/16/2009 TX 3/16/2009 CA 3/16/2009 3/16/2009 CA 3/16/2009 VA 3/16/2009 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 CA 3/16/2009 CA
30 42 12 19 0.2 5 4 54 16 11 5 10 3 22 59 0.4 3 38 1.6 5 53 11 15 0.6 31 0.8 0.5 0.8 1.1 0.1 0.5 0.3 0.3 0.3
30 42 12 19 0 5 4 54 16 11 5 10 3 22 59 0 3 38 1 5 53 11 15
0
0
0.2 0.3 0.4 0.6 12 18 14 25 13
12
17
17
F F M F 0.2 F F M F F F M M M F F 0.4 M M M 0.6 M F M F F U M F M 0.5 M M U U 0.5 M M M M F M M U U U F F F F F F F F F F
3/16/2009 Received PPV shot around 10:45 a 3/16/2009 Swelling and pain at axilla on left sid 3/16/2009 Pain, swelling, redness at injection s 3/16/2009 Fever, headaches, myalgias, sore th 3/16/2009 Lethargic, listless, not self for 1 wk p 3/16/2009 Notice hive like 1 cm raised area 1 i 3/16/2009 Mom notified us 48 hours after vacc 3/16/2009 Pt C/O redness / itch on L mid arm u 3/16/2009 C/O itchiness on nape of neck @ H 3/16/2009 Approx 10 min after immunizations 3/21/2009 As per dad they noticed redness on 3/16/2009 Pt developed a large red swollen (1 3/16/2009 Pt presented with 30-50 lesions on 3/16/2009 Pt had, chest pains, heaviness on c 3/16/2009 Left arm pain, Fatigue, and nausea. 3/16/2009 Rash at bilateral injection site. 3/16/2009 Was anxious after - then tired/fatigu 3/16/2009 BELL's Palsy 2 weeks after MCV4 v 3/16/2009 Generalized erythema multiforme ex 3/15/2009 Redness and swelling around inject 3/16/2009 Lymphadenopathy of R axillary nod 3/13/2009 Fatigue, joint pain after immunizatio 3/12/2009 Swelling/hematoma at injection site. 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
342137 342138 342139 342141 342142 342143 342144 342145 342146 342147 342148 342149 342150 342151 342152 342153 342154 342155 342156 342157 342158 342159 342199 342200 342201 342203 342204 342205 342206 342207 342208 342209 342210 342212 342213 342214 342227 342229 342233 342236 342238 342240 342246 342247 342248 342249 342250 342251 342252 342253 342351
3/16/2009 CA 3/16/2009 IL 3/16/2009 NJ 3/16/2009 3/16/2009 VA 3/16/2009 NM 3/16/2009 3/16/2009 MD 3/16/2009 3/16/2009 TN 3/16/2009 3/16/2009 IL 3/16/2009 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 3/16/2009 3/16/2009 TX 3/16/2009 3/16/2009 3/16/2009 3/16/2009 NY 3/16/2009 3/16/2009 IL 3/16/2009 PA 3/16/2009 3/16/2009 OR 3/16/2009 3/16/2009 PA 3/16/2009 MA 3/16/2009 HI 3/16/2009 3/16/2009 GA 3/16/2009 3/16/2009 GA 3/16/2009 CA 3/16/2009 OH 3/16/2009 IL 3/16/2009 NC 3/16/2009 IL 3/16/2009 3/16/2009 KS 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 3/16/2009 MA 3/16/2009 LA 3/16/2009 CO 3/16/2009
15 21 17
15
20
20
18 17 22
18
26 14
26
19 19 15 14 15 24
19 19
15
15
15 24
16 20
16 15 23 16 19 38 17 15 26 16 23 11 20 17 15 14 14
23 19 38 15 26 16 11 17 15 14
F F F F U F F F F F M F F F F U U F F F F F F F F F F F F U F F F F F F F F F F F F F F F M F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received initia 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received form 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received form 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
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3/16/2009 TX 3/16/2009 MS 3/16/2009 3/16/2009 3/16/2009 PA 3/16/2009 PA 3/16/2009 VA 3/16/2009 3/16/2009 KS 3/16/2009 MN 3/16/2009 3/16/2009 NY 3/16/2009 3/16/2009 3/16/2009 3/16/2009 MI 3/16/2009 MI 3/16/2009 3/16/2009 3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 CA 3/16/2009 3/16/2009 KY 3/16/2009 NJ 3/16/2009 NV 3/16/2009 FL 3/16/2009 3/16/2009 WI 3/16/2009 CO 3/16/2009 TX 3/16/2009 TX 3/16/2009 OR 3/16/2009 LA 3/16/2009 3/16/2009 3/16/2009 TN 3/16/2009 SC 3/16/2009 3/16/2009 3/16/2009 MD 3/16/2009 3/16/2009 NY 3/16/2009 WA 3/16/2009 3/16/2009 CA 3/16/2009 3/16/2009 3/16/2009 NY 3/16/2009 PA
20 14 21 19 25 17 20 16 25 38
14 21
25
16 25 17
15 27
27
13
13
17 20 12 17 17
17 17
16 16
16 16
15 13
13
23 14 15 22 17 21 14 14 24
14
21
14
22 16 18 31 20
18
F F F F F F F F F F M F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
342451 342452 342453 342608 342609 342610 342611 342612 342613 342614 342615 342616 342617 342618 342619 342620 342621 342622 342623 342624 342625 342626 342627 342628 342629 342630 342631 342632 342633 342634 342635 342636 342637 342638 342639 342640 342641 342642 342643 342644 342645 342646 342647 342648 342649 342650 342651 342693 342694 342703 342704
3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 NJ 3/16/2009 PA 3/16/2009 3/16/2009 3/16/2009 GA 3/16/2009 WA 3/16/2009 MI 3/16/2009 3/16/2009 3/16/2009 NC 3/16/2009 NJ 3/16/2009 3/16/2009 PA 3/16/2009 FL 3/16/2009 OH 3/16/2009 OR 3/16/2009 3/16/2009 CA 3/16/2009 3/16/2009 FL 3/16/2009 3/16/2009 CA 3/16/2009 OH 3/16/2009 CT 3/16/2009 LA 3/16/2009 3/16/2009 GA 3/16/2009 KY 3/16/2009 VA 3/16/2009 3/16/2009 3/16/2009 ID 3/16/2009 3/16/2009 TN 3/16/2009 SC 3/16/2009 WV 3/16/2009 PA 3/16/2009 NJ 3/16/2009 WA 3/16/2009 3/16/2009 PA 3/16/2009 3/16/2009 PA 3/16/2009 NJ 3/16/2009 3/16/2009 3/16/2009 3/16/2009 TX
15
15
15 17 15 15
15 17 15
28 13 17 23
28 13
11
11
23 23
23 21
33 19
33 19
24 25 14 21 14 15
23
25 21
26 23 29 14 37 15
14 37
22 15
22 15
18
18
14 12 20 11 21 22 20 24
20
20 11 22
20
F F F F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from
342719 342720 342721 342722 342723 342724 342725 342726 342727 342728 342729 342754 342755 342756 342760 342761 342762 342763 342764 342765 342766 342767 342768 341843 341874 341875 341877 341878 341879 341880 341882 341883 341884 341888 341889 341890 341891 341892 341893 341894 341895 341896 341897 341898 341899 341900 341901 341902 341903 341904 341905
3/16/2009 3/16/2009 NJ 3/16/2009 3/16/2009 NJ 3/16/2009 3/16/2009 3/16/2009 3/16/2009 CA 3/16/2009 NY 3/16/2009 PA 3/16/2009 3/16/2009 MD 3/16/2009 MO 3/16/2009 3/16/2009 3/16/2009 DE 3/16/2009 MA 3/16/2009 MN 3/16/2009 TX 3/16/2009 MN 3/16/2009 3/16/2009 3/16/2009 MI 3/17/2009 CA 3/17/2009 3/17/2009 3/17/2009 3/17/2009 VT 3/17/2009 NJ 3/17/2009 3/17/2009 3/17/2009 3/17/2009 VA 3/17/2009 WA 3/17/2009 IL 3/17/2009 NY 3/17/2009 3/17/2009 TX 3/17/2009 CA 3/17/2009 WA 3/17/2009 TX 3/17/2009 CA 3/17/2009 NC 3/17/2009 MI 3/17/2009 HI 3/17/2009 WA 3/17/2009 IN 3/17/2009 CA 3/17/2009 OR 3/17/2009 CO 3/17/2009 AL
22 24 21
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3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Initial and follow up information has 3/13/2009 Initial information and follow up has 3/13/2009 Information has been received from 3/13/2009 Information has been received throu 3/13/2009 Initial information has been received 3/13/2009 Initial and follow-up information has 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/17/2009 redness, swelling, heat and hard sp 3/16/2009 InformationYhas been received from 3/16/2009 InformationYhas been received from 3/16/2009 InformationYhas been received form 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/16/2009 Information has been received from 3/12/2009 Apnea 12-24 hours after vaccines. I 3/1/2009 By 11/28 evening upper left arm wa 3/4/2009 "Night tremor" type incident "weird c 3/15/2009 Fever of 103 for 72 hours, severe so 3/11/2009 Increased her neuropathy symptom 3/9/2009 No adverse effects observed. Fathe Pt states her Rt arm has been hurtin 3/12/2009 Pt received shots Monday afternoon 3/11/2009 Malar rash erupted day post vaccina 3/13/2009 None stated. 3/5/2009 lymph node in the deltoid region and 3/10/2009 Itch: 2-21-09. Severe welts (red, pu 3/2/2009 My back of head left side bottom sta 3/11/2009 Began vomiting approx 6-8 hr post i Weakness, Dizziness, Mild Nausea 3/12/2009 Injection site was warm/hot to touch 3/11/2009 Immediately after shot, had onset o 3/10/2009 N&V, diarrhea, Pale, Lethargic, Wea
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3/17/2009 IN 3/17/2009 CA 3/17/2009 PA 3/17/2009 NY 3/17/2009 WA 3/17/2009 IL 3/17/2009 ID 3/17/2009 IN 3/17/2009 MD 3/17/2009 3/17/2009 TX 3/17/2009 MD 3/17/2009 FL 3/17/2009 NH 3/17/2009 NJ 3/17/2009 NJ 3/17/2009 NC 3/17/2009 OR 3/17/2009 CT 3/17/2009 TX 3/17/2009 SD 3/17/2009 MA 3/17/2009 TX 3/17/2009 CA 3/17/2009 WA 3/17/2009 CA 3/17/2009 KY 3/17/2009 PA 3/17/2009 PA 3/17/2009 CA 3/17/2009 IL 3/17/2009 MA 3/17/2009 LA 3/17/2009 IL 3/17/2009 NC 3/17/2009 GA 3/17/2009 IN 3/17/2009 PA 3/17/2009 MN 3/17/2009 SC 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 WV 3/18/2009 PA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 KY
0.8 4 18 10 17 21 7 48 0 44 15 18 16 1 21 43 1 19 20 38 0.8 7 36 31 15 62 24 19 4 0.7 0.2 1 5 23 46 47 1 15 1 11 1 1 1 1.4 23 14 14 14 73 0.4
0 4 10 21 7 48 0 44 15 18 16 1 21 43 1 19 20 38 0 7 36 31 15 62 24 19 4 0 0 1 5 23 46 47 1 15 1 0 0 1 1 23 14 14 73 0
0.8 F M U F M F M M 0F M M M F 0M M F 0M F F M 0.8 M F F F F F M F M 0.7 M 0.2 F 0F M U F F 0M F 0M 1M U 1M 0M 0M M F F F F F 0.4 F
3/5/2009 On 3-2-09 parent called and reporte 3/10/2009 Half hour after vaccines were admin Day after injection of MENACTRA. P 3/11/2009 Local cellulitis at site of injection res 3/12/2009 Patient was given 3 GARDASIL vac 3/2/2009 See attached medical records. 3/3/2009 DTaP given to a 7yr old will count a 3/10/2009 Rubella rash - maculopapular, fine, 3/14/2009 None - just to report accidental (unin 3/17/2009 Diarrhea, GI upset, "flare of Ulcerati 3/17/2009 headache, dizziness, stiff and sore 3/17/2009 Patient informed nurse that he usua 3/17/2009 Within several days of her second s 3/17/2009 1 week after patient was given the F 3/17/2009 Pt is a member on Mobilization Orde 3/17/2009 Pt is a member of the military. Vacc 3/17/2009 pATIENT PRESENTED WITH RED 3/17/2009 Menactra, Varivax, and Havrix admi 3/17/2009 Received Yellow Fever vaccine 2/27 3/17/2009 Day after administration: myalgias, s 3/5/2009 Rash on neck, swelling and redness 3/17/2009 Patient is well appearing and presen 3/17/2009 Immunizations given 3/16/09. Client 3/17/2009 The member was examined in flight 3/17/2009 Pt was given #2 HPV and left area w 3/17/2009 She dies onY12/31/08 - clinicians lis 3/17/2009 Service member was a basic trainee 3/17/2009 Nausea, Dizzy, Weak 3/17/2009 3/10 2pm - immunization administer 3/17/2009 Sterile abscess left thigh. 3/17/2009 Intussusception Y (ileo-cecal) requirin 3/17/2009 Dermal infiltrate L anterior thigh: ind 3/17/2009 Approximately 30min after receiving None stated. 3/17/2009 Patient was given pneumococcal va 3/16/2009 Patient reports developing a pruritic 3/17/2009 Febrile seizure - ER visit treated wit 3/16/2009 Fatigue, severe muscle aches all ov 3/17/2009 High fever - up to 103- March 13-14 3/16/2009 Dx with chicken pox. 3/17/2009 This case was considered medically 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 It was reported in a published repor 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/17/2009 Information has been received from 3/16/2009 Got shingles vaccine last week. Got 3/12/2009 Rash to head and neck 2 hours afte
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3/18/2009 GA 3/18/2009 GA 3/18/2009 GA 3/18/2009 3/18/2009 OH 3/18/2009 3/18/2009 GA 3/18/2009 KY 3/18/2009 TX 3/18/2009 KS 3/18/2009 AR 3/18/2009 TX 3/18/2009 ME 3/18/2009 TX 3/18/2009 NC 3/18/2009 3/18/2009 ME 3/18/2009 KS 3/18/2009 TX 3/18/2009 MO 3/18/2009 MD 3/18/2009 MO 3/18/2009 MO 3/18/2009 WA 3/18/2009 LA 3/18/2009 IL 3/18/2009 MO 3/18/2009 ID 3/18/2009 PA 3/18/2009 IN 3/18/2009 NY 3/18/2009 PA 3/18/2009 MS 3/18/2009 MS 3/18/2009 TN 3/18/2009 OK 3/18/2009 CA 3/18/2009 TX 3/18/2009 AK 3/18/2009 CT 3/18/2009 GA 3/18/2009 NJ 3/18/2009 NY 3/18/2009 NJ 3/18/2009 CA 3/18/2009 CA 3/18/2009 LA 3/18/2009 CA 3/18/2009 PA 3/18/2009 MA 3/18/2009 TX
6 52 17 0.4 7 67 10 4 25 11 1 38 1.3 22 33 64 17 29 25 40 13 13 5 13 1 0.3 23 45 4 1.3 18 0.8 1.3 13 0.2 4 3 23 4 1.3 53 65 32 4 4 40 16 0.6 24 4
6 52 17 0
67 10 4 25 11 1 38 1 22 33 64 17 29 25 40 13 13 5 13 1 0 23 45 4 1 18 0 1 13 0 4 23 4 1 53 65 32 4 4 40 16 0 24 4
F F M 0.4 F U M M F F M F 0M F 0.3 F M F M M F F U F F F F 0F 0.3 F F M F 0.3 M M 0.8 M 0.3 M F 0.2 F F M F M 0.3 F M M F F F U F 0.6 M F F
1/7/2009 Phone call from mom- stated when ### About 1 1/4 hrs post pneumonia vac 2/26/2009 Dr from mother, reports client had e 3/18/2009 This case was reported by a physici 3/18/2009 This case was reported by a physici 3/18/2009 This case was reported in a literatur 3/17/2009 Pt received TDAP instead of rec. TD 2/26/2009 Soon after administer- flushed chee 3/5/2009 L Thigh with swelling / Erythema. 3/18/2009 Member has small bump on chest, b 3/18/2009 2 days post vaccination, pt presente 3/18/2009 Fever for 2 days. Red spots on face Err:508 3/17/2009 firm, hard knot at injection site R up 3/13/2009 24 y/o male ADSM is referred by Re 3/18/2009 Pt called at 10:20 to Immunization c 3/18/2009 Pt given varicella vaccine in error, s 3/18/2009 Nausea, vomitting, headache, pain, 3/18/2009 Local reaction. 40mm X 26mm area 3/18/2009 Patient complained of a itchy, painfu 3/18/2009 Received Tdap vaccine. Approx. 18 3/18/2009 Approximately one hr. after receivin 3/18/2009 Approximately three hours following 3/18/2009 Pt developed a rash, resembling ch 3/18/2009 She has not had a period after rece 3/18/2009 Right thigh where vaccine was adm 3/18/2009 Patient recieved vaccines on 3/17/0 3/18/2009 Bilateral arms red, raised rash. Wa 3/18/2009 Pt awoke at 7AM on 3/12/2009 with 3/18/2009 Patient presented day after vaccina 3/18/2009 Approximately 1 week after shot wa 3/18/2009 syncopal episode condition and vita 3/18/2009 pt returned to clinic 2 days after vac 3/18/2009 PT RETURNED TO CLINIC WITH R 3/18/2009 Fever, severe abdominal pain; musc 3/18/2009 Baby died 4Ydays after vaccines we 3/18/2009 left deltoid swollen and reddness no 3/6/2009 A serious, spontaneous report of sta 3/18/2009 Client reported of experiencing heav 3/18/2009 swelling, redness, pain, increased te 3/18/2009 Had Hep B # 3, DTaP # 4, PCV # 4 3/16/2009 Started with cough 1900 15MAR09, 3/18/2009 Like usual after vax, jogged for 3 1/2 3/16/2009 3/19/09 T/C to reporter who states p 3/17/2009 Erythematous induration area at the 3/18/2009 Local redness and swelling 13 x 10 6/7/2005 Incidental diagnosis of thrombocyto 3/18/2009 Dizziness and LOC x 30 sec, about 3/17/2009 On 5/28/08, Pt was 7mo old and rec 2/11/2009 Pt had a c/o feeling as though she w 2/12/2009 A serious, study report of right lowe
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3/18/2009 WA 3/18/2009 OK 3/18/2009 OH 3/18/2009 UT 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 TX 3/18/2009 GA 3/18/2009 NJ 3/18/2009 NJ 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 OK 3/18/2009 3/18/2009 3/18/2009 3/18/2009 SC 3/18/2009 3/18/2009 MA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 PA 3/18/2009 SD 3/18/2009 MD 3/18/2009 MI 3/18/2009 3/18/2009 3/18/2009 TX 3/18/2009 PA 3/18/2009 IN 3/18/2009 NC 3/18/2009 FL 3/18/2009 3/18/2009 3/18/2009 WI 3/18/2009 MN 3/18/2009 IA 3/18/2009 FL 3/18/2009 PA 3/18/2009 NJ 3/18/2009 3/18/2009 3/18/2009
2.8 2 4
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2/19/2009 A non-serious spontaneous report o 2/11/2009 A non-serious, spontaneous report 2/11/2009 A non-serious, spontaneous report 2/6/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/17/2009 A non-serious, spontaneous report 2/3/2009 A non-serious spontaneous report o 2/3/2009 A non-serious spontaneous report o 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information had been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received for a 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial information has been received
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3/18/2009 3/18/2009 VA 3/18/2009 NJ 3/18/2009 TX 3/18/2009 3/18/2009 AZ 3/18/2009 3/18/2009 PA 3/18/2009 IN 3/18/2009 MN 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 DE 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NH 3/18/2009 3/18/2009 3/18/2009 MD 3/18/2009 3/18/2009 3/18/2009 3/18/2009 OH 3/18/2009 3/18/2009 IL 3/18/2009 TX 3/18/2009 OK 3/18/2009 PA 3/18/2009 OH 3/18/2009 IA 3/18/2009 3/18/2009 UT 3/18/2009 NH 3/18/2009 3/18/2009 PA 3/18/2009 PA 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 CO 3/18/2009 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NJ 3/18/2009
11 32 49 0.1 0 0 0.1
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3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial information has been received 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Pediatric medical records were rece 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from 3/6/2009 Initial and follow-up information has 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received rega 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received rega 3/6/2009 Information has been received rega 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Initial and follow up information has 3/6/2009 Information has been received from
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3/18/2009 WA 3/18/2009 3/18/2009 TN 3/18/2009 NC 3/18/2009 IL 3/18/2009 OH 3/18/2009 OR 3/18/2009 CA 3/18/2009 TX 3/18/2009 NC 3/18/2009 NJ 3/18/2009 MD 3/18/2009 3/18/2009 GA 3/18/2009 NJ 3/18/2009 3/18/2009 VA 3/18/2009 MI 3/18/2009 CA 3/18/2009 3/18/2009 CO 3/18/2009 NV 3/18/2009 3/18/2009 3/18/2009 3/18/2009 NY 3/18/2009 OH 3/18/2009 NY 3/18/2009 CO 3/18/2009 MD 3/18/2009 CO 3/18/2009 NY 3/18/2009 NY 3/18/2009 KY 3/18/2009 TN 3/18/2009 KY 3/18/2009 KY 3/18/2009 NY 3/18/2009 GA 3/18/2009 3/18/2009 WI 3/18/2009 CA 3/18/2009 PA 3/18/2009 MI 3/18/2009 CO 3/18/2009 SD 3/18/2009 PA 3/18/2009 MA 3/18/2009 NC 3/18/2009 3/19/2009
52 28 13 1.3
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3 1.2 18 41 47 45 45 29 27 1.2 20 65
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3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/6/2009 Information has been received from 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a physici 3/4/2009 The subject's medical history includ 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/4/2009 This case was reported by a physici 3/4/2009 This case was reported by a healthc 3/4/2009 This case was reported by a consum 3/18/2009 InformationYhas been received from
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3/19/2009 ME 3/19/2009 OH 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 3/19/2009 ND 3/19/2009 NC 3/19/2009 CA 3/19/2009 CA 3/19/2009 WI 3/19/2009 MD 3/19/2009 TX 3/19/2009 WA 3/19/2009 CO 3/19/2009 NY 3/19/2009 NJ 3/19/2009 NJ 3/19/2009 TX 3/19/2009 SC 3/19/2009 MA 3/19/2009 NY 3/19/2009 FL 3/19/2009 OH 3/19/2009 3/19/2009 3/19/2009 MO 3/19/2009 ND 3/19/2009 TX 3/19/2009 IN 3/19/2009 CA 3/19/2009 WA 3/19/2009 AK 3/19/2009 MI 3/19/2009 FL 3/19/2009 OH 3/19/2009 CA 3/19/2009 PA 3/19/2009 CA 3/19/2009 CA 3/19/2009 CA 3/19/2009 WA 3/19/2009 NJ 3/19/2009 CA 3/19/2009 CA 3/19/2009 KS 3/19/2009 CA 3/19/2009 NY
3 1.7 1.4 54 2 5 1.5 15 20 5 0.5 35 17 2 18 72 1.1 81 0.1 0.3 11 0 65 4 2 1.4 20 15 38 35 0.5 14 64 0.3 34 4 11 0.5 5 7 1 4 22 16 20 14 0.2 4 1.2
1 1 54
15 20 5 0 35 17 2 18 72 1 81 0 11 0 65 4 2 1
38 35 0 0 64 0 34 4 11 0 0 5 1 1 5 22 16 20 14 0 4 1
U 0.7 M 0.4 M M M M M U F F M 0.5 M F F 0.9 M F M 0.1 M F 0.1 F M F 0F F M 0M 0.4 M F F F F 0.6 F 0M F 0.4 F F M F 0.2 M 0.5 M M 0.3 M 0M F M F F F 0.2 F F 0.2 F
3/17/2009 A 3-year-old child had received thei 3/17/2009 Initial report received on 13 March 2 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Information has been received from 3/18/2009 Initial information has been received 3/18/2009 Within 10 min. of vaccines pt. had c 3/13/2009 On 3/13/09 pt. received 3rd dose of 3/14/2009 Approx. 24-28 after 12 pt. noted sw 10/12 - tingling in arms/legs, feeling 3/11/2009 Pt received flu vaccine & got INFLU 3/14/2009 Feb-2-09 at 3:00 pm vaccines were 3/12/2009 Increased somnolence and headach 3/16/2009 Diffuse macular papular rash. 3/6/2009 Pt went to a fast food restaurant afte 3/19/2009 3-4 hrs. of non-stop crying. 3/19/2009 Jerky movements of head to right 3/18/2009 Received Varicella and Hepatitis A v 3/9/2009 Patient was given HEPATITIS B vac 3/9/2009 Red swollen, painful (L) upper arm a 3/13/2009 48 hrs after the vaccine the site bec 3/19/2009 Fever 102.7 48 hrs after administrat 3/19/2009 Starting at 8:00PM on 3/18/09 Temp 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/19/2009 Began having chills, achy joints, sho 3/19/2009 DEVELOPED ACHING/ FEVER AB 3/19/2009 BREAKTHROUGH ROTAVIRUS DI 3/19/2009 has temp of 102, hurts to move,bod 3/19/2009 A red swelling developed that has b 3/19/2009 Tdap given to patient in error, shoul 3/19/2009 Flu vaccine administered at 10 a.m. 3/19/2009 None 3/19/2009 PATIENT NOTED HIVES ONCE AG 3/19/2009 Pt was fully immunized and pretty m 3/19/2009 Infant developed hives 22 hours pos 3/19/2009 Within a few hours after receiving 4 3/19/2009 Saw a black dot on patient's left arm 3/19/2009 Patient had 5 minute tonic clonic se 3/19/2009 Noticed black dot on patient's right a 3/19/2009 Patient complained of tightness and 3/19/2009 supraclavicular lymphadenopathy o 3/19/2009 UTI like symptoms, frequent urinatio 3/19/2009 HPV #1, 8/18/08; HPV #2, 10/20/08 3/19/2009 Red, papular, vesicular, asymptoma 3/18/2009 Left & right thigh swollen, red, pain. 3/19/2009 Fever started 03/16/09 and develop
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3/19/2009 ME 3/19/2009 NM 3/19/2009 MA 3/19/2009 KY 3/19/2009 OR 3/19/2009 KY 3/19/2009 NC 3/19/2009 CA 3/19/2009 WA 3/19/2009 MO 3/19/2009 MA 3/19/2009 VA 3/19/2009 TX 3/20/2009 FL 3/20/2009 MN 3/20/2009 3/20/2009 FL 3/20/2009 3/20/2009 3/20/2009 3/20/2009 CA 3/20/2009 IN 3/20/2009 3/20/2009 WI 3/20/2009 3/20/2009 3/20/2009 3/20/2009 MN 3/20/2009 3/20/2009 NY 3/20/2009 TX 3/20/2009 FL 3/20/2009 ID 3/20/2009 VA 3/20/2009 CA 3/20/2009 MO 3/20/2009 WA 3/20/2009 TX 3/20/2009 PA 3/20/2009 WV 3/20/2009 FL 3/20/2009 TX 3/20/2009 FL 3/20/2009 IN 3/20/2009 OH 3/20/2009 ID 3/20/2009 LA 3/20/2009 ID 3/20/2009 ID 3/20/2009 ID 3/20/2009 TX
5 1.3 17 4 4 4 4 66 1 1.6 12 4 33 46 19
5 1 17 4
22 4 2
22
1.3 1.5 1.4 1 1 2
1
23 11 0.3
23
4 1.3 11 1.8 73 0.6 20 16 18 72 8 13 11 11 0.7 0.5 42 8 20 46
4 1 11 1 73 0 20 16 18 71 8 13 11 11 0 0 42 8 20 46
4 4 66 1 1 12 4 33 46 19
2
1 1
0
M 0.3 M M M F F F F 0F 0.6 M M F M F F M F F 0.1 F M 0.3 M M 0.4 F 0F M M M F U 0.3 M U M 0.3 M M 0.8 M F 0.6 F F F F F M M M F 0.7 M 0.5 F F M F F
3/19/2009 Patient was given MMR vaccine on 3/19/2009 Child started with redness to right th 3/19/2009 "Blacked out" for a few seconds the 3/19/2009 Redness and warmth to deltoid site Immus given 03-16-09. Called by m 3/19/2009 Patient with local reaction, left uppe 3/19/2009 Left thigh 8x10cm red oval. mild ede 3/18/2009 For the past 15 yrs, pt has had sing 3/19/2009 Hives developed on entire torso 7 h 3/19/2009 Head to toe macular papular rash. P 3/19/2009 2 cm in diameter erythematous lesio 3/18/2009 Chicken pox 3/18/09 after 2 vaccina 3/18/2009 3/14/09- Experienced diarrhea, vom 3/19/2009 Information has been received from 3/19/2009 Initial information has been received 3/19/2009 Information has been received from 3/19/2009 Initial and follow-up information has 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/19/2009 Information has been received from 3/13/2009 Information has been received form 3/20/2009 This case was reported by a pharma 3/12/2009 12 hours after 4 month vaccines giv 3/6/2009 This non serious case was received 3/20/2009 9 X 9 cm irregular area to left delt. 3/20/2009 Fever up to 105 3/20/2009 Onset of fever to 102, hives under b 3/18/2009 About 1540 pm MA had just finished 3/16/2009 3" x 6" erythema at injection site no 3/13/2009 Pt had nonstop crying for 3 + hours 3/15/2009 Non stated. 1/30/2009 Reactive Lymphadenopathy, cervica 3/16/2009 Head to toe rash and headache. Re 3/16/2009 Received Herpes Zoster Vaccine 5/ 3/16/2009 Initial, hives, abdominal pain ( <5 m 3/9/2009 Extensive local swelling including en 3/16/2009 The a.m. after vaccinations pt. notic 1/26/2009 Mom states that eve after a shower 3/21/2009 Fever 102-103 degrees F wouldn't c 3/13/2009 Vomiting, fever to 103 degrees. Fev 2/19/2009 Client reports that she had a softbal 3/11/2009 Small pea-sized redness @ site of i 3/10/2009 Patient reports approximately 40 mi 3/20/2009 The day after the vaccine was given
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3/20/2009 LA 3/20/2009 MD 3/20/2009 MO 3/20/2009 OH 3/20/2009 KY 3/20/2009 DE 3/20/2009 PA 3/20/2009 VA 3/20/2009 WA 3/20/2009 NY 3/20/2009 ME 3/20/2009 KS 3/20/2009 NJ 3/20/2009 MD 3/20/2009 NY 3/20/2009 MD 3/20/2009 MN 3/20/2009 RI 3/20/2009 PA 3/20/2009 PA 3/20/2009 PA 3/20/2009 PA 3/20/2009 FL 3/20/2009 PA 3/20/2009 VA 3/20/2009 MA 3/20/2009 DC 3/20/2009 MI 3/20/2009 CT 3/20/2009 MD 3/20/2009 OR 3/20/2009 AZ 3/20/2009 CA 3/20/2009 IL 3/20/2009 PA 3/20/2009 OR 3/20/2009 NC 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 OH 3/20/2009 AL 3/20/2009 FL 3/21/2009 VA 3/21/2009 SC 3/21/2009 AL 3/21/2009 ID 3/21/2009 NY
71 4 40 11 1.2 76 64 46 1.5 33 21 1 10 58 26 19 12 19 25 4 60 65 20 12 20 1 27 60 13 60 7 12 19 1 41 7 26 20 31 38 51 0 26 4 43 4 16 1.3 74 34
71 4 40 11 1 76 64 46 1 33 0 10 26
19 25 4 60 65 20 12 20 1 27 1 60 13 60 7 12 19 1 41 7 26 20 31 38 51 0 26 4 43 4 16 1 74 34
F M M M 0.2 M M F F 0.5 M M M 1M F F M F F M F M F F M F M 0F M 0F F M F M F F 0M F M F M F M M 0F F F M F F 0.3 M F M
3/20/2009 Pt received shot 12/30/08 - Raised 3/19/2009 Local inflammatory reaction. 7x7 wa 3/2/2009 Stated developed raised red "bump 3/16/2009 Post vaccine VARICELLA. 3/16/2009 3/14/09 Diagnosis of chickenpox Re 3/11/2009 Pt received ZOSTER & TD BOOST 3/17/2009 Pain 24/7. Limited movement of righ 3/16/2009 03/13/2009 pt. called to report "hive 3/6/2009 Abscess on Rt thigh hard red lump, 3/20/2009 Patient presented to the clinic on th 3/20/2009 Patient developed pain and redness 3/20/2009 Crying nonstop from 1am-8am. Sho 3/20/2009 Seen on 3/13/09 for 10 year old wel 3/20/2009 After 1 series of Hepatitis B vaccine 3/20/2009 Member developed erythema swelli 3/20/2009 After 1 series of Hep B vaccine (4/2 3/20/2009 fever to 103.4, muscle spasm, r thu 3/20/2009 Pt received adacel vaccine on 3/18/ 3/20/2009 After receiving the second dose of t 3/20/2009 MMR given at 0930am, developed e 3/20/2009 Pt noted an ugly looking rash, which 3/20/2009 Pt noted a faint red rash around the 3/20/2009 Mother reported to Health Dept. tha 3/20/2009 12 hours after receivng vaccines pa 3/20/2009 PT RECIEVED ANTHRAX VACCIN 3/20/2009 Hives appeared on 3/19/09 and a ve 3/20/2009 Localized soreness/tenderness in u 3/20/2009 One inch area of inderation at the s 3/10/2009 Had cold symptoms in Nov - Dec. F 3/20/2009 3-4 hours after vaccines (and after d 3/21/2009 Redness, itching and shortness of b 3/20/2009 Fever, left arm swelling, redness an 3/18/2009 Within 5 minutes of receiving 3 vacc 3/19/2009 Blurred vision, Nausea. Vomiting 20 3/20/2009 Child noted to have Erythema Multif 3/20/2009 Sensation of swelling in legs, knees 3/20/2009 L arm swollen around site. 1/28/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP 1/28/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP 1/29/2009 TD given instead of TDAP. 1/29/2009 TD given instead of TDAP. 1/28/2009 TD given instead of TDAP. 3/20/2009 Urticaria = Legs and arms. No other 3/20/2009 Swelling @ site of injection. Post 12 3/21/2009 My daughter had her 4yr old injectio 3/21/2009 Shortly after first shot, daughter star 3/21/2009 Sudden onset of fever accompanied 3/21/2009 TDAP ADMINISTERED (L) DELTOI 3/21/2009 In 2002 patient started to loose mus
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3/21/2009 CT 3/21/2009 TN 3/22/2009 CA 3/22/2009 CO 3/23/2009 3/23/2009 3/23/2009 TN 3/23/2009 MS 3/23/2009 3/23/2009 FL 3/23/2009 3/23/2009 VA 3/23/2009 WA 3/23/2009 3/23/2009 3/23/2009 FL 3/23/2009 3/23/2009 3/23/2009 IN 3/23/2009 3/23/2009 3/23/2009 NY 3/23/2009 VT 3/23/2009 PA 3/23/2009 ME 3/23/2009 CT 3/23/2009 GA 3/23/2009 FL 3/23/2009 NC 3/23/2009 TN 3/23/2009 CA 3/23/2009 PA 3/23/2009 MN 3/23/2009 NJ 3/23/2009 3/23/2009 MA 3/23/2009 GA 3/23/2009 CA 3/23/2009 CA 3/23/2009 3/23/2009 ME 3/23/2009 3/23/2009 3/23/2009 3/23/2009 NY 3/23/2009 OK 3/23/2009 NY 3/23/2009 MT 3/23/2009 VA 3/23/2009 IN 3/23/2009 TX
58 0 1.8 1
58 0 1 1
47 17 0.7 71 77 15 4 43
17
1.3 9 4 8 1.3
1
10 5 12 63 14 1.1 0.6 27 4 51 14 14 70 10 62 33 18 20 24 67 23 22 26 30 5 37 64 48 75 29
10 5 12 63 14 1 0 27 4
71 15
14 14 70 62 33 20 24 67 23 22 26 30 5 37 64 48 75 29
F 0M 0.8 M 0M F F U M F F M F F M F 0.3 M F M M M M F M M M F 0.1 F 0.6 F M M F F F F M F F F F F F M M M F F M M F F F
3/21/2009 Patient received both a pneumovax 3/21/2009 We left the clinic and within 1-2 hou 3/22/2009 This previously healthy 22-month-ol 3/22/2009 Complex febrile seizure (15-20 min 3/20/2009 InformationYhas been received from 3/20/2009 InformationYhas been received form 3/19/2009 Initial report received 09 March 200 3/19/2009 This case was received from a heal 3/19/2009 Initial report received on 17 March 2 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/20/2009 Information has been received from 3/23/2009 Possible vaccine Y failure. Child expir 3/9/2008 7x7 cm local swollen, red , warm on 3/19/2009 3 inch area of erythema, fever to 10 2/26/2009 Vaccines given 2/23/09. Patient mo 3/19/2009 On 3/12/09 Pt presented here with v 3/16/2009 Red maculopapules x 3 clustered o 3/16/2009 Febrile seizure seen at Hospital on 3/10/2009 Pt developed rash approx 10 days p 3/13/2009 Left thigh red, hot and swollen x 6 d 3/1/2009 Induration and tenderness at injectio 3/23/2009 On 12/17/08 patient presented as a 3/23/2009 Patient fainted and hit her head, app 3/20/2009 Zoster 3/20/2009 Local erythema with superficial swe 3/23/2009 Pt developed papulovesicular lesion 3/23/2009 C/o fall with knee pain on 11-19-08 3/13/2009 Information has been received from 3/13/2009 Information has been received from 3/23/2009 Unspecified disease of pericardium 3/23/2009 1 inch red raised area at injection si 3/23/2009 Non-specific myocarditis 3/23/2009 Acute pericarditis, unspecified 3/23/2009 Acute pericarditis, unspecified; Unsp 3/23/2009 supraventricular tachycardia, dizzine 3/23/2009 Pediarix given IM to LD and MMR g 3/23/2009 member presented for follow up afte 3/23/2009 Patient received the zoster vaccine 3/23/2009 Rabies vaccine was given on 3-6-09 3/23/2009 ON 3/20/09 BROKE OUT WITH 3-4 3/23/2009 RIGHT ARM SWOLLEN FROM SH
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3/23/2009 MD 3/23/2009 TX 3/23/2009 IL 3/23/2009 3/23/2009 OK 3/23/2009 PA 3/23/2009 NC 3/23/2009 CA 3/23/2009 CT 3/23/2009 CA 3/23/2009 NM 3/23/2009 CA 3/23/2009 NC 3/23/2009 NV 3/23/2009 MT 3/23/2009 AZ 3/23/2009 CA 3/23/2009 CA 3/23/2009 NC 3/23/2009 MN 3/23/2009 MA 3/24/2009 CA 3/24/2009 CA 3/24/2009 3/24/2009 3/24/2009 CA 3/24/2009 3/24/2009 3/24/2009 3/24/2009 3/24/2009 3/24/2009 NV 3/24/2009 OH 3/24/2009 IL 3/24/2009 PA 3/24/2009 SC 3/24/2009 NC 3/24/2009 AL 3/24/2009 VA 3/24/2009 PA 3/24/2009 MI 3/24/2009 IN 3/24/2009 OH 3/24/2009 GA 3/24/2009 NJ 3/24/2009 3/24/2009 NC 3/24/2009 IL 3/24/2009 CA 3/24/2009 TX 3/24/2009 CT
60 46 4 26 18 1 61 39 16 1 8 15 11 5 23 4 1.3 9 0.6 5 37 10 0.2 24 21 0.3 1.5 2 1 6 57 83 0.3 79 9 11 32 5 60 0.2 12 40 64 6 21 14 0.3 1 4 5
60 46 4 26 18 1 61 39 16 1 8 15 11 5 23 4 1 9 0 5 37 0 24
83 0 80 9 11 32 5 0 12 40 64 6 21 14 0 1 4 5
F M F M F 0F M F F 0M F F F M F M 0.3 F F 0.6 M M F M 0.6 M F F U U M M M M F F 0.3 M F F F F F U 0.2 M F F M F F F 0.4 F 0M M M
3/23/2009 The patient received the Tdap immu 1/23/2009 LEFT ARM RED & SWOLLEN FRO 3/23/2009 On 3/20/09, approximately 24 hours 3/23/2009 Pt. developed his initial symptoms o 3/23/2009 Syncope immediately following injec 3/23/2009 One day post vaccine patient develo 3/23/2009 2/12/09 - Shingles Vaccine and Teta 3/23/2009 Neurologic symptoms started in my 3/23/2009 Less then 24 hours after Meningoco 3/23/2009 Varicella - like exanthem 20 days po 3/3/2009 Varicella rash 2 weeks after admin o 3/23/2009 Gave Pt MMR on 2-2-09. Paperwor 3/23/2009 Left arm swollen, red, hot to touch f 3/20/2009 Walked out of exam room after vacc 3/19/2009 Soreness in arm for over a month 3/23/2009 (L) upper arm cellulitis Deltoid area. 3/23/2009 About 7 days after receiving VARIV 3/20/2009 Patient developed hives 2 dys after 3/23/2009 Fever > 100 x 2 days. Rash x3 days 3/23/2009 10x8cm erythema on L thigh around 3/23/2009 Date of injection 3/17/09 - 1st 8 hou 3/24/2009 The must important efect was today 3/24/2009 My son's upper left thigh started to s 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/23/2009 Information has been received from 3/24/2009 Two events of intussusception, each 3/24/2009 Approximately 8 days after administ 3/24/2009 Pt. was given varivax on 3/5/09. Wit 3/24/2009 reddened area on right arm with a d 3/24/2009 Came in clinic on 03/24/2009 c/o se 3/24/2009 Cellulitis at injection site, redness, s 3/24/2009 Subject in pneumococcal vaccine tr 3/24/2009 NO ADVERSE REACTIONS 3/24/2009 child found on the floor due to faintin 3/24/2009 MMR was given on 3/12/09. She st 3/24/2009 right shoulder swollen & extremely s 3/24/2009 Patient developed left-sided neck pa 3/24/2009 Patient came to ER for 2nd injection 3/24/2009 Patient received her first shot 5/24/0 3/24/2009 Flatulence, vomiting, lack of appetit 3/17/2009 4 days after vaccine got vesicular ra 3/19/2009 Thigh Red, Swollen, hot to touch - A 3/17/2009 Within 24 hours entire upper arm wa
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3/24/2009 PA 3/24/2009 WA 3/24/2009 AL 3/24/2009 NV 3/24/2009 OR 3/24/2009 OK 3/24/2009 SC 3/24/2009 PA 3/24/2009 3/24/2009 CO 3/24/2009 TX 3/24/2009 IA 3/24/2009 FL 3/24/2009 NC 3/24/2009 PA 3/24/2009 MD 3/24/2009 NY 3/24/2009 WA 3/24/2009 MA 3/24/2009 KY 3/24/2009 CA 3/24/2009 CA 3/24/2009 MI 3/24/2009 ID 3/24/2009 PA 3/24/2009 3/24/2009 TX 3/24/2009 WA 3/24/2009 3/24/2009 GA 3/24/2009 NY 3/24/2009 AR 3/24/2009 PA 3/24/2009 CA 3/24/2009 AZ 3/24/2009 CA 3/24/2009 3/24/2009 PA 3/24/2009 PA 3/24/2009 NY 3/24/2009 3/24/2009 NC 3/24/2009 PA 3/24/2009 MI 3/24/2009 PA 3/24/2009 KS 3/24/2009 FL 3/24/2009 IN 3/24/2009 MN 3/24/2009 NY 3/24/2009 PA
1.3 4 36 0.3 32 7 67 4 4 56 40 4 0.2 14 6 18 4 1.7 17 39 53 4 11 1.5 0.9 23 44 54
1 4 36 0 32 7 67 4 4 56 40 4 0 14 6 18 4 1 17 39 53 4 11 1 0 23 44 54
47 1 9 69 15 1.1 1.1 13 1.6 4 30 13 70 0.4 70 29 0.2 0.5 0.5 8 20
47 1 9 69 15 1 1 13 1 4 30 13 70 0 70 29 0 0 0 8 20
0.3 F F M 0.3 F F F F F M M M F 0.2 M F F F M 0.7 M M F F M F 0.5 M 0.9 F F F F U M F 0M F F F 0.1 M 0.1 M F 0.6 M F M F F 0.4 U F M 0.2 M 0.5 F 0.5 M M F
3/13/2009 Developed rash 8 days after receivi 3/19/2009 Erythema multiforme- Itchy red rash 3/15/2009 C/o minor rash on arms & forehead 3/16/2009 Non stop crying for 3 Hour for no re 3/12/2009 Chills, Fatigue, itching, hands hard 3/18/2009 3x3 induration with 2x2 redness in c 3/20/2009 Sat. - site of injection was red and s 3/17/2009 Temperature 104.2 within 12 hours 3/24/2009 This case was reported via a legal c 3/18/2009 Tinnitus - continual ringing in left ea 3/18/2009 I asked pt if he felt ok after I adminis 3/18/2009 Thigh was red, warm + swollen, pai 3/20/2009 Vaccine admin. 12/20/83, immediat 3/16/2009 Mom reports fever started 3/14/09. 3/24/2009 Seizure 13 days post VARIVAX. Se 3/24/2009 GARDASIL given 3/17/2009. Patien 3/24/2009 Right upper arm completely swollen 3/23/2009 24 hours after shots given, swelling 3/27/2009 24 hours after second dose of VARI 2/25/2009 Swelling, redness and induration dis 3/24/2009 I developed a 103 degrees fever for 3/24/2009 Slightly edematous + erythematous 2/24/2009 Patient c/o itchy hives on Left deltoi 3/10/2009 24 hours post injection patient had l 3/13/2009 No adverse reaction reported - *Chi 3/20/2009 My primary care physician informed 3/16/2009 Broke out in hives on arm where inje 3/16/2009 Friday 3-13-09 Body aches, fever, le None Stated None stated 3/20/2009 Patient received TDAP & PNEUMO 2/24/2009 Patient diagnosed with chicken pox 3/13/2009 After receiving MENACTRA, in proc 3/17/2009 Facial and arm rash lasting several 3/19/2009 (D:) BP 102/60; P 60 - R-12;- Pt fee 3/18/2009 3/13/09, fever 104.5, poor appetite, 3/20/2009 Non stated. 3/19/2009 Redness, swelling (half dollar sized) 3/11/2009 Received PENTACEL on 03/10/09. 3/17/2009 Erythema and induration (L) deltoid 3/18/2009 None stated. 3/17/2009 GARDASIL dose #3 1/27/09 2/17/09 3/15/2009 Patient experienced a headache Tu 3/17/2009 Varicella given before age 1 no side 3/17/2009 Patient reported that injection site w 3/15/2009 3 vaccines were given, the patient w 3/16/2009 Mild swelling on legs. Slightly raised 3/16/2009 Patient woke up the day after vaccin 3/12/2009 Hives one day after vaccination. 3/17/2009 Immediately after receiving HAV pa 30 minutes after injection - hive 3x4
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3/24/2009 IN 3/24/2009 IL 3/24/2009 VA 3/25/2009 WA 3/25/2009 TX 3/25/2009 FL 3/25/2009 OK 3/25/2009 3/25/2009 AZ 3/25/2009 AR 3/25/2009 NY 3/25/2009 AR 3/25/2009 AR 3/25/2009 AR 3/25/2009 NC 3/25/2009 AL 3/25/2009 UT 3/25/2009 MO 3/25/2009 GA 3/25/2009 MO 3/25/2009 OH 3/25/2009 NC 3/25/2009 VA 3/25/2009 OR 3/25/2009 FL 3/25/2009 IN 3/25/2009 WY 3/25/2009 TN 3/25/2009 NJ 3/25/2009 SD 3/25/2009 WA 3/25/2009 CO 3/25/2009 CA 3/25/2009 MN 3/25/2009 CO 3/25/2009 UT 3/25/2009 VA 3/25/2009 PA 3/25/2009 NJ 3/25/2009 TX 3/25/2009 PA 3/25/2009 MN 3/25/2009 CA 3/25/2009 PA 3/25/2009 NH 3/25/2009 KS 3/25/2009 CT 3/25/2009 FL 3/26/2009 OH 3/26/2009 3/26/2009 WA
5 5 72 90 67 67 0.3 16 13 59 23 4 11 3 38 54 23 16 15 5 13 59 33 65 29 5 4 82 79 8 37 0.3 13 37 0.4 69 52 11 11 15 25 36 17 70 6 12 33 11 1 17 23
5 5 72 90 67 67 16 13 59 23 4 11 3 38 54 23 16 15 5 13 59 33 65 29 5 4 82 79 8 37 0 13 37 0 69 52 11 11 15 25 36 70 6 33 11 17
M M F M F F M F F F F M F F F F M F F M F F F F M M F F F F M 0.4 F M F 0.4 F F F F M F F F F M M M U M M F F
3/17/2009 Pt given HEP A dose 2 in our office 3/10/2009 Mother called office 2 hrs after vacc 3/19/2009 Rash appeared on neck 1 week afte 3/25/2009 Pt broke out in full body rash consis 3/17/2009 3/17/09 Approx. 11:15am shingles v 3/23/2009 Initial information was received on 2 3/24/2009 Information has been received from 3/24/2009 Information has been received from 3/24/2009 Information has been received from 4-20-07 - onset "bruising" dx: ITP. 4 3/19/2009 Severe Nausea, vomiting, fever + jo 2/26/2009 Mom noticed around 7:00 AM this m 2/13/2009 Red-itchy-warm to touch-rash over e ### Rec'd flu vacc 110708; presented to 3/17/2009 None Stated 3/10/2009 pain in (R) arm at inj site. redness, w 3/16/2009 None stated 3/19/2009 After vaccination, patient collapsed 3/25/2009 Pt experienced vasovagal reaction w 3/25/2009 Mother states client woke up from a 3/25/2009 Approximately 4:00PM 12/7/08 Sym 3/25/2009 59 yo BF presented to clinic 3/24/09 3/25/2009 1. Severe pain/muscle locking appro 3/25/2009 Hep B vaccine administered in Lt De 3/25/2009 29 y/o AD male flyer w/ no significan 3/25/2009 Mother noted a red, hot raised area 3/25/2009 Reported by Mother of client on 3/2 3/25/2009 Zostavax administered Jan 27th, 20 3/25/2009 Elevated Blood pressure, Face and ### Left hand red, swelling and itching, 3/25/2009 Arm redness, tightness in chest. S/s 3/25/2009 no adverse reactions/symptoms. pa 3/25/2009 Had 2 swollen lump area. One lump 3/25/2009 erythematous vessicles at injection 3/25/2009 Nurse gave first dose of Rotateq aft 3/25/2009 I am submitting this report per patie 3/25/2009 Itchy, hot rash broke out the night o 3/25/2009 Localized erythema, plaque lesion; 3/18/2009 DV made by pt to show nurse react 3/25/2009 L arm red and swollen all around ba 3/25/2009 Swelling of throat with difficulty swa 3/25/2009 3-20-09: Tdap left deltoid, 3-22-09: 2/27/2009 Pt was waiting in line about 15 minu 3/25/2009 No reaction reported yet. Misadmin 3/25/2009 Developed Acute L arm swelling + r 3/24/2009 Vomiting Thurs. night Temp 105 Fri Pt reported a fever 103-104 F on Sa 3/25/2009 My son right after getting vaccines s 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from
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3/26/2009 3/26/2009 NJ 3/26/2009 NJ 3/26/2009 LA 3/26/2009 LA 3/26/2009 GA 3/26/2009 NY 3/26/2009 KY 3/26/2009 IL 3/26/2009 CA 3/26/2009 CA 3/26/2009 IL 3/26/2009 VA 3/26/2009 KY 3/26/2009 MA 3/26/2009 AZ 3/26/2009 TX 3/26/2009 UT 3/26/2009 TX 3/26/2009 RI 3/26/2009 3/26/2009 3/26/2009 IN 3/26/2009 TX 3/26/2009 TX 3/26/2009 WI 3/26/2009 VA 3/26/2009 3/26/2009 3/26/2009 GA 3/26/2009 MN 3/26/2009 3/26/2009 IN 3/26/2009 VA 3/26/2009 AK 3/26/2009 PA 3/26/2009 TX 3/26/2009 3/26/2009 LA 3/26/2009 LA 3/26/2009 VA 3/26/2009 MD 3/26/2009 DE 3/26/2009 VA 3/26/2009 OH 3/26/2009 TX 3/26/2009 WI 3/26/2009 AZ 3/26/2009 WA 3/26/2009 NJ 3/26/2009 WA
16 25 25
8 18 67 0.3 12 43 40 6 60 11 65 40 4 1.9 1.5 29 10 2 9 1.9 8 4 23 22 19 18 11 43 1 43 28 19 5 7 27 46 0.3 52 34 0.5 11 13 0.2 22 0.2
25 25
18 67 0 12 43 40 6 60 65 40 4 1 1 29 10 2 9 1 8 4 23 22 19 18 11 43 0 43 28 19 5 7 28 0 52 34 0 11 13 0 23 0
F F F U U M F M 0.3 M M F F F M F F M M 0.9 F 0.5 F M M 0.5 M F 0.9 F F F M U F F F F M 0.1 M M F F F F M F 0.2 F F F 0.6 M M M 0.2 F F 0.2 F
3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/25/2009 Information has been received from 3/24/2009 This case was received via an autho 3/23/2009 Headache, vomiting approximately 3 3/13/2009 Severe pain - whole body - muscles 3/20/2009 Pt administered PENTACEL, PREV 3/23/2009 MENACTRA given left upper arm 3/ 3/18/2009 Redness and swelling 3/23/2009 Had some significant pain in arm at 3/24/2009 rash - scattered papules -> Probabl 3/12/2009 1) Swollen, red circle about 4" in dia 3/23/2009 Given 11 yr old immunizations on 3/ 3/23/2009 Swelling, Red rash size, 2 " in diam 3/20/2009 None stated. 3/18/2009 Polio vaccine given March 12 3:00 p Urticaria at injection site noted after 3/20/2009 Febrile seizure-no treatment 3/23/2009 A 31 year old male subject presente 3/21/2009 Patient received varicella vaccine at 3/22/2009 4 days after vaccine, he ran a fever 3/20/2009 Chicken pox #2 given on 3/17/09 an 3/21/2009 Urticaria at injection site noted after 3/20/2009 Received immunization on 3/12/09. 3/19/2009 Redness & swelling at injection site. 3/26/2009 Redness, itching, swelling, fever at Redness, itching, swelling and feve 3/13/2009 Information has been received from 3/13/2009 Information has been received throu 3/13/2009 Information has been received from 3/26/2009 c/o numbness, tingling, tightness rig 3/26/2009 Patient received Tdap (Adacel) on 3 3/26/2009 HE BEGAN TO HAVE SEIZURES A 3/26/2009 Patient received vaccine and report 3/26/2009 Itching began about 2 hours after re 3/26/2009 She came in for labs and for a Gard 3/26/2009 SEIZURE LASTING APPROX. 3 MI 3/26/2009 30 minutes post administration of V 3/26/2009 Client received second dose of pre3/26/2009 Arm warm, very edematous, erythm 3/20/2009 Unconsolable crying for more than 3 3/25/2009 After receiving vaccine patient beca 3/26/2009 Received second dose in series of H 3/26/2009 INTERFERENCE WITH LIMB MOV 3/26/2009 Outer aspect of left arm at Varicella 3/26/2009 Patient received his Tdap vaccine fi 3/26/2009 Fever to 103, nausea, vomiting app 3/26/2009 Immediate weakness, lethargic, mu 3/26/2009 Pneumovax was ordered and admin
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3/26/2009 PA 3/26/2009 3/26/2009 MA 3/26/2009 KY 3/26/2009 PA 3/26/2009 OR 3/26/2009 VT 3/26/2009 WA 3/26/2009 WA 3/26/2009 CA 3/26/2009 CA 3/26/2009 CA 3/26/2009 CA 3/26/2009 PA 3/26/2009 CA 3/26/2009 NC 3/26/2009 AL 3/26/2009 MI 3/26/2009 PA 3/26/2009 FL 3/26/2009 MI 3/26/2009 NE 3/26/2009 MA 3/26/2009 NY 3/26/2009 OR 3/26/2009 3/27/2009 3/27/2009 CA 3/27/2009 3/27/2009 HI 3/27/2009 3/27/2009 AZ 3/27/2009 3/27/2009 LA 3/27/2009 3/27/2009 3/27/2009 3/27/2009 LA 3/27/2009 PA 3/27/2009 WA 3/27/2009 NC 3/27/2009 WA 3/27/2009 IA 3/27/2009 IA 3/27/2009 GA 3/27/2009 GA 3/27/2009 GA 3/27/2009 TX 3/27/2009 TX 3/27/2009 VA 3/27/2009 MN
43 51 66 4 49 1.6 1 1.9 42 5 15 12 60 5 21 45 25 36 0.2 4 7 1.1 45 28 1.3
43 51 66 4 49 1 1 1 42 5 15 12 60 5 21 45 25 36 0 4 7 1 45 28 1
30 24 21 23 16 15 4 11 6
30 24 21
0.7 1 28 12 25 2 4 18 14 13 1.3 7 39 58
0 1 28 12 25 2 4 18 14 13 1 7 39 58
11
F M M M F 0.6 M 0F 0.9 M M M F M F M M F F F 0.2 M F M 0.1 M M F 0.3 F U M F F F F F M M M M M 0.7 F 0F F F F 0.8 M F M F F 0.3 M F F M
3/26/2009 This case was reported via medical 3/26/2009 This case was reported by a lawyer 3/16/2009 12/2/08 S&S inc. numbness/tingling 3/26/2009 Pt.'s mother called 2 days after imm 3/25/2009 Within 10min of getting the shot, pt 3/17/2009 Mom reports about 14 hours after s 3/26/2009 Mom calling today to report that on 3/26/2009 Fever ; Febrile Seizure 3/26/2009 Exaggerated local reaction. 3/27/2009 Redness with swelling to R deltoid. 3/26/2009 High fever, achy all over body and n 3/25/2009 Itch. redness. induration pain. Since 3/26/2009 Rash on chest 3 days after adminis 3/26/2009 Redness, swelling and warm to touc 3/26/2009 Pt states felt woozy approx 5pm afte 3/26/2009 1 day after injection - Pt c/o rash, sw 3/26/2009 Local Rx, delayed. Redness, warmt 3/26/2009 Localized swelling and pain after sh 3/23/2009 ROTARIX was reconstituted with ste 1/9/2009 Large, red inflammatory reaction, rig 3/26/2009 Rash on the left upper arm 2cm/3cm 3/19/2009 Redness + minimal swelling @ site. 3/25/2009 Pain in upper right arm and neck an 3/26/2009 Pt received Tdap + Typhoid 3/9/09 f 3/25/2009 Developed 8x15cm local erythema, Pt showed up to ER 2/27/09 after re 3/27/2009 Joint pain and fevers. 3/27/2009 Achy feeling all over started and he 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received rega 3/16/2009 Parent stated that right arm was sw 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/26/2009 Information has been received from 3/19/2009 Patient was accidentally administere 3/24/2009 Mild fever, fussiness and swollen gl 3/24/2009 Diaphoresis and lightheadedness sh 3/23/2009 1 wk. after pt. received vaccine she 3/18/2009 Rash on back, chest, abdomen with 3/23/2009 Two days after receiving immunizat 3/23/2009 Arm swelling & redness at injection 3/24/2009 Pt was given Tripedia U2397BA ins 3/24/2009 Pt was given Tripedia U2397BA ins 3/24/2009 No adverse problem- Pt was given D 3/23/2009 As per mom left thigh red, hot and s 3/23/2009 As per mom left upper arm with eryt 3/27/2009 Developed headache within 2-3 hou 3/27/2009 DURING LATTER PART OF FEBRU
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3/27/2009 AZ 3/27/2009 NY 3/27/2009 AK 3/27/2009 CA 3/27/2009 TX 3/27/2009 AZ 3/27/2009 NC 3/27/2009 AL 3/27/2009 MD 3/27/2009 MI 3/27/2009 TX 3/27/2009 MI 3/27/2009 MI 3/27/2009 TX 3/27/2009 CO 3/27/2009 KY 3/27/2009 MO 3/27/2009 IA 3/27/2009 3/27/2009 AZ 3/27/2009 IA 3/27/2009 MO 3/27/2009 CA 3/27/2009 CA 3/27/2009 ID 3/27/2009 SC 3/27/2009 CA 3/27/2009 MT 3/27/2009 CA 3/27/2009 NE 3/27/2009 CA 3/27/2009 NC 3/27/2009 MT 3/27/2009 WA 3/27/2009 VT 3/27/2009 CA 3/27/2009 GA 3/27/2009 VA 3/27/2009 VA 3/27/2009 NJ 3/27/2009 NH 3/27/2009 CA 3/27/2009 VA 3/27/2009 MI 3/27/2009 TX 3/27/2009 VA 3/27/2009 3/28/2009 TX 3/28/2009 MI 3/28/2009 OH 3/28/2009 NY
8 22 31 4 64 64 84 1 30 1 2 66 55 4 0.3 0.2 4 17 58
8 22 31 4 64 64 84 1 30 1 2 66 55 4 0 0 4 17
1.3 1.1 0.2 5 4 54 58 24 5 4 12 67 11 0.3 4 4 30 60 73 0.2 11 1.3 67 1.3 15 47 56 1.6 15 1 4
1 -1 0 5 4 54 58 24 5 4 67 11 0 4 4 30 60 73 0 11 1 67 1 15 47 56 1 15 1 4
F F F F M F F 0M M 0F 0M F F M 0.3 M 0.2 F M F F F 0.3 M 0.2 M 0.2 M F M F F F M F F F F 0.3 M F M F F M 0.2 M F 0.3 M F 0.3 F F F M 0.7 F F 0M M
3/27/2009 NOT CLASSIC LESIONS, BUT HAS 3/27/2009 Headaches and Fatigue increasing 3/27/2009 Pt came in to have TB test read 3/1 3/27/2009 VACCINES ADMINISTERED IN AM 3/27/2009 64HM h/o DM, HTN, HLD, BPH p/w 3/27/2009 ITCHING,PAIN LEFT SHOULDER S 3/27/2009 She received vaccine on Fri. She d 3/27/2009 On March 3rd 2009 my son recieved 3/27/2009 Persisting headache from day after 3/27/2009 child presented to er on 3-20-09 wit 3/27/2009 2 y/o male. After receiving Hepatitis 3/27/2009 Left arm and shoulder very sore, sw 3/27/2009 site became red, inflamed, sore, pa 3/27/2009 Child was inoculated with 6 separat 3/27/2009 a rash that started at the site of the 3/27/2009 Day after shot was given, her legs s 3/27/2009 Redness & induration on left arm m 3/25/2009 High fever, injection site pain, redne 3/27/2009 We received the following from a co 3/26/2009 Vaccinated with 2 doses of 2 month 3/27/2009 Lump Rt thigh and red area both siz 3/27/2009 Developed raised blister like lesions 3/27/2009 Fever 103F at 11 PM, following imm 3/27/2009 Left leg swollen @ injection site with 3/27/2009 Left upper leg with large warm eryth 3/27/2009 Left shoulder joint pain with occasio 3/26/2009 Redness and swelling at injection si 3/27/2009 Client received IMOVAX IM on 3/26 3/23/2009 Large area of swelling & redness in 3/24/2009 Gave patient BOOSTRIX instead of 3/27/2009 10 days after GARDASIL (#2) Pt de 3/27/2009 Dizziness, nausea, sweating - soon 3/27/2009 Local reaction - redness and indura 3/28/2009 Seen 3/27/09 for "diffuse maculo - p 3/25/2009 2 hrs after MMR began screaming, Parent brought patient in stated tha Client c/o tingly warm feeling in L fin 3/27/2009 Swelling at injection site, redness an 3/27/2009 None 3/27/2009 Fever > 102, irritable. S/S started pm 3/26/2009 Pt received HPV (GARDASIL) #2 in Rash; Fever. 3/27/2009 Swelling at injection site, redness an 3/26/2009 TDAP was given but it was suppose 3/27/2009 Dizziness, nausea, headache, slurre 3/25/2009 Reported receipt of FLUSHIELD Lo 3/26/2009 The patient reported receipt of IM in 3/28/2009 1 Hour after injections, raised, red a 3/28/2009 FELT DIZZY AND LIGHTHEADED, 3/28/2009 2/24/09REPORTED TO PEDIATRIC 3/28/2009 Received Flu vaccine on 3/12/09. H
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3/28/2009 CA 3/28/2009 NC 3/28/2009 NC 3/28/2009 OH 3/29/2009 AR 3/29/2009 KY 3/30/2009 WA 3/30/2009 TN 3/30/2009 3/30/2009 3/30/2009 ID 3/30/2009 NC 3/30/2009 TX 3/30/2009 KY 3/30/2009 CA 3/30/2009 CT 3/30/2009 WV 3/30/2009 MO 3/30/2009 OH 3/30/2009 MO 3/30/2009 MN 3/30/2009 TX 3/30/2009 3/30/2009 3/30/2009 NJ 3/30/2009 NY 3/30/2009 NY 3/30/2009 TX 3/30/2009 PA 3/30/2009 MO 3/30/2009 WA 3/30/2009 NC 3/30/2009 TX 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 GA 3/30/2009 NJ 3/30/2009 UT 3/30/2009 NE 3/30/2009 CA 3/30/2009 MI 3/30/2009 AL 3/30/2009 MA 3/30/2009 MI 3/30/2009 MA 3/30/2009 FL 3/30/2009 VA
12 67 69 18 56 0.4 1 73
12 66 69 18 56 0 1 73
35 4 1 12 4 11 63 61 11 14 35 0.3 0.5 1.6
35 4 1 12 4 11 63 61 11 14 35 0 0
0.7 3 14 15 76 1.1 15 0.2 11 2 60 4 1.2 17 70 43 5 66 4 6 60 24 18 3 12 62
0 14 15 76 1 15 0 11 2 60 4 1 17 70 43 5 66 4 6 60 24 18 3 12 62
F F M M F 0.4 F 0M F M F F F 0F F M M M F F F F 0.3 F 0.5 M M M 0.7 M M F F F 0.1 M F 0.2 F F 0M F M 0.2 F M M M M F F F F F M M F M
3/28/2009 Pt got vaccinated with MCV4 (MENA 3/28/2009 Moderate to severe hives, relieved b 3/28/2009 Severe hives on ankles and lower le 3/28/2009 8/08-High fever-102, chills, body ac 3/29/2009 Hard,painful, hot to the touch, egg s 3/29/2009 Patient received shots Dec. 29th, se 3/30/2009 Fever of 103.5 at 0130 in the AM on 3/26/2009 Initial report received from a health 3/25/2009 Initial report received on 19 March 2 3/25/2009 Initial report received on 19 March 2 3/27/2009 Cellulitis R upper arm injection site. 3/27/2009 Right leg thigh red and swollen over 3/26/2009 Vaccinated 3/9/09 - on 3/14/09 moth 3/24/2009 Mother brought patient to the clinic 3/5/2009 Redness and swelling LUD. Warm 3/25/2009 Redness & swelling on arm - right s 3/26/2009 Fever (102 degrees) multiple muscl 3/23/2009 Patient called 2 days after vaccine t 3/4/2009 Site reaction, large area of redness 3/20/2009 Morning after immunizations, child h 3/24/2009 Initial information was received from 3/27/2009 This case was received on 23 Marc 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/20/2009 C/o chest pain radiating from back t 3/24/2009 Pt given 12mo shots on 3/9/09. Ha 3/23/2009 Awakened with joint pain, & nausea Received 1st immunizations 3/13/09 3/5/2009 Pt's mom reports today that child is 3/4/2009 Fever, rash and hair loss. 2/17/2009 Received ZOSTAVAX 2-2-09, then ### Broke out with red patches and sma 3/18/2009 Mother brought child back to Health 3/17/2009 Vaccines received 3/16/09 5pm, Mo 2/19/2009 Developed redness, swelling, pain a 3/30/2009 This case was reported by a lawyer 3/30/2009 Urticarial type rash on legs and arm 03/24/09 Sore + tender - Hurt with m 3/12/2009 7.5 cm x 11.3 w. with redness, warm 3/3/2009 Patient was given a second dose of 3/23/2009 3/9/09, tingling in jaw and lips, very 3/26/2009 Tingling and numb feeling in legs, it 3/30/2009 Client was given a Tdap on 03/24/2 3/30/2009 CHILD WAS GIVEN HIB AND PCV7 3/30/2009 swelling of injection site, low-grade 3/30/2009 Comes to clinic as walk-in with c/o n
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3/30/2009 AZ 3/30/2009 OK 3/30/2009 DC 3/30/2009 CA 3/30/2009 VA 3/30/2009 MO 3/30/2009 MA 3/30/2009 VA 3/30/2009 TX 3/30/2009 NM 3/30/2009 UT 3/30/2009 CA 3/30/2009 WI 3/30/2009 PA 3/30/2009 IL 3/30/2009 GA 3/30/2009 NM 3/30/2009 AR 3/30/2009 CT 3/30/2009 NC 3/30/2009 MI 3/30/2009 NC 3/30/2009 CA 3/30/2009 MI 3/31/2009 3/31/2009 CA 3/31/2009 3/31/2009 3/31/2009 3/31/2009 NE 3/31/2009 MD 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 3/31/2009 NE 3/31/2009 NJ 3/31/2009 OK 3/31/2009 MS 3/31/2009 CA 3/31/2009 KY 3/31/2009 AZ 3/31/2009 WA 3/31/2009 ME 3/31/2009 KS 3/31/2009 CA
50 18 61 54 53 60 65 62 39 4 4 0.1 60 41 1 63 9 10 39 65 0.7 5
50 18 61 54 53 60 65 62 39 4 4 0 60
20 24 70
20 24 70
15 24 0.5 1.6 8
15 24 0 1
1 63 9 10 39 65 0 5
12 1.3
1.4 3 44 36 11 4 4 26 1.1 48 0.3
3 44 36 11 4 4 26 1 48 0
F F F F F F F F F M F 0.1 F M F 0M M F F F F 0.7 M F F F F M F F F 0.5 F 0.6 M M F M U M M U F M M F M M M M F F 0.1 F F 0.3 M
3/30/2009 Soreness and bruising noted at inje 3/30/2009 Clients mother call to Health Depart 3/30/2009 THE DAY AFTER RECEIVING THE 3/30/2009 03/26/09 swelling began left arm. 03 3/30/2009 Infjection on Thursday, March 26, 2 3/30/2009 Chills, full and deep bone & body ac 3/30/2009 First day: Very fatigued, with severe 3/30/2009 Patient claims "huge" bruise near el 3/30/2009 With receipt of AVA # 1, TYPHOID, 3/19/2009 Right thigh with significant swelling, 3/30/2009 Patient was given MMR and Varicel Crying for about 3 hours, didn't wan 3/30/2009 Tdap injection 3/18/09 left deltoid, 3 3/30/2009 Urticarial reaction at injection site 4 3/10/2009 Patient fell over forward while sitting 3/30/2009 Vaccine was given Mon 3/23/09 abo 3/30/2009 Patient had redness, swelling and p 3/30/2009 Rash outbreak - vaccinated 3/5/09. 3/18/2009 Vaccine, associated Varicella rash. 3/30/2009 Injection site reaction. Sore with in 1 3/30/2009 Rota given at 32 weeks and 10 day 3/30/2009 Right thigh swollen, red, warm to tou 3/26/2009 Patient got shingles around 3 days 3/30/2009 Adult patient received a pediatric do 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/30/2009 Information has been received from 3/27/2009 Initial report received on 17 March 2 3/27/2009 This serious case was received on 2 3/30/2009 Caretaker states pain, erythema, an 3/24/2009 Signs of bruising and petechiae in A 3/27/2009 Developed chest pain, SOB and dia 3/31/2009 Left deltoid 13 1/2 x 12 cm reddene 3/31/2009 Localized reaction, red, warm to tou 3/30/2009 L arm Swelling With mild erythema. 3/31/2009 Patient had a hot, red, swollen lump 3/25/2009 Red ring around injection site. Low 1/23/2009 Right after injection I got very hot an 3/26/2009 Developed rash on Both anterior thi
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3/31/2009 WA 3/31/2009 MA 3/31/2009 OK 3/31/2009 MI 3/31/2009 MI 3/31/2009 AZ 3/31/2009 OH 3/31/2009 IN 3/31/2009 CA 3/31/2009 UT 3/31/2009 CO 3/31/2009 IL 3/31/2009 MA 3/31/2009 OH 3/31/2009 TX 3/31/2009 TX 3/31/2009 TN 3/31/2009 WA 3/31/2009 MI 3/31/2009 MO 3/31/2009 MO 3/31/2009 3/31/2009 NV 3/31/2009 TX 3/31/2009 VT 3/31/2009 PA 3/31/2009 MN 3/31/2009 MA 3/31/2009 NJ 3/31/2009 AZ 3/31/2009 CA 3/31/2009 CA 3/31/2009 IL 3/31/2009 FL 3/31/2009 NY 3/31/2009 CO 3/31/2009 OK 3/31/2009 CO 3/31/2009 OR 3/31/2009 CT 3/31/2009 GU 3/31/2009 SD 3/31/2009 AZ 3/31/2009 WI 3/31/2009 TX 3/31/2009 MA 3/31/2009 VA 3/31/2009 NY 3/31/2009 CA 3/31/2009 MA 3/31/2009 FL
45 6 11 25 65 11 1 61 4 11 5 78 63 4 66 49 2 5 1.9 32 22 1.6 23 51 53 1.6 53 50 1.5 18 0.8 26 0.2 42 0.7 13 1.3 38 11 76 1.5 0.2 46 48 1.1 1.3 10 61 1.6 46 4
45 6 11 25 65 11 1 61 4 11 5 78 63 4 66 49 2 5 1 32 22 1 23 53 1 53 50 1 18 0 26 0 42 0 13 1 38 11 76 1 0 46 48 1 1 10 1 46 4
F F F F F F 0M F M M F F F M M F 0.1 M F 0.9 M F F 0.6 F M M U 0.6 M M F 0.5 M F 0.8 F F 0.2 M F 0.7 M F 0.4 M F F M 0.5 M 0.2 M M M 0.1 F 0.3 M M F 0.6 F F M
3/24/2009 Right arm pain, swelling radiating up 3/25/2009 None as of this date. 3/25/2009 Approximately 48 hours after admin 3/27/2009 No adverse event, dose given 3 we 3/25/2009 Developed low grade fever, arthralg 3/23/2009 Redness, swelling and hot touch. 3/25/2009 Presented in ED 3/11/09 with possib 3/25/2009 Local reaction of pain, warmth, + er 3/19/2009 Whole left arm red and swelling. 3/26/2009 Red, swollen arm, bump, raised and 3/27/2009 Redness, swelling of left arm. 48 hrs 11/24/08 - Office visit - Dr. - Shingle 3/30/2009 3-18-09 3:40p seen for erythema 3. 3/30/2009 4 yr old male received DTAP, MMR 3/31/2009 Redness, hard knot. No fever or chi 3/31/2009 Cellulitis to left arm. Running tempe 3/26/2009 Right leg at injection site was warm 3/26/2009 Chicken Pox. 3/26/2009 Phone call from mom got Imms (HIB 3/25/2009 Approximately 15 minutes after rece 3/25/2009 HEP B vaccine administration on 33/23/2009 Patient was given adult dosage of H 3/24/2009 23 y/o male with generalized mildly 3/23/2009 Non stated Diarrhea for 12 hours 3/25/2009 Patient returned to office 3-23-09, a 3/31/2009 Patient received Pneumovax 23 vac 3/31/2009 Pain, warmth and induraton at vacc 3/31/2009 received IPOL on 3/27/09 and deve 3/31/2009 After administration of GPV, patiien 3/31/2009 Pt was noted to have a thigh mass o 3/31/2009 PATIENT CALL A DAY AFTER AND 3/31/2009 On 3/27/09 Mom reports to IM clinic 3/31/2009 Swollen arm after Tdap vaccine give 3/31/2009 Patient had a tactile fever for 3 days 3/31/2009 Client developed localized eythema 3/31/2009 URTICARIA/HIVES- TREATMENT 3/31/2009 The following was reported by the c 3/31/2009 Fainted aprox 5 min after vaccinatio 3/31/2009 - Pt called clinic and later seen on 3 3/31/2009 High fever for three days (T. Max 10 3/31/2009 On 1-4-09 patient Y had Hep B Vaccin 3/31/2009 Symptoms began the same evening 3/31/2009 1. Swelling warmth, redness injectio 3/31/2009 Scattered erythema rash, primarily t 3/31/2009 Dry, seal barky cough, hard time bre 3/24/2009 Vaccine administered on 3-20-09 in 3/30/2009 Patient c/o body ache, weakness, p 3/26/2009 Lumps on thigh: No tx. Telephone a 3/31/2009 Lump (bigger than a bean) tenderne 3/31/2009 Err:508
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3/31/2009 CA 3/31/2009 MN 3/31/2009 MN 3/31/2009 CA 3/31/2009 CA 3/31/2009 CA 3/31/2009 MT 3/31/2009 PA 4/1/2009 MN 4/1/2009 MI 4/1/2009 NY 4/1/2009 4/1/2009 4/1/2009 NE 4/1/2009 CT 4/1/2009 4/1/2009 4/1/2009 NC 4/1/2009 NJ 4/1/2009 MO 4/1/2009 4/1/2009 MN 4/1/2009 UT 4/1/2009 FL 4/1/2009 TN 4/1/2009 MT 4/1/2009 NC 4/1/2009 TX 4/1/2009 TX 4/1/2009 WI 4/1/2009 NJ 4/1/2009 TN 4/1/2009 NC 4/1/2009 LA 4/1/2009 FL 4/1/2009 NC 4/1/2009 CA 4/1/2009 OR 4/1/2009 MI 4/1/2009 GA 4/1/2009 IL 4/1/2009 CA 4/1/2009 TX 4/1/2009 NE 4/1/2009 IL 4/1/2009 TX 4/1/2009 AZ 4/1/2009 AZ 4/1/2009 NY 4/1/2009 4/1/2009 IN
19 0.5 12 1.1 12 0.6 11
19 0 12 1 12 0 11
15 0.2 1 3
15 0
18 21 16
18 21 16
19 39 9 62 0.2 62 4 1.7 70 14 13 56 19 1.6 1.4 63 22 13 13 61 5 59 1.3 4 0.8 0 83 16 2 18 0.2 5
39 9 0 62 4 1 74 14 13 56 19 1 1 63 22 14 13 61 5 59 1 4 0 0 83 16 2 18 0 18 5
F 0.5 F F 0.1 F F 0.6 F M U F 0.2 F M M M F F F F F F M M 0.2 M F M 0.7 F M F F M M 0.6 F 0.4 M U F M F F F M F 0.3 M F 0.8 F 0M F F 0.3 F F 0.2 F F F
3/31/2009 Tingling around mouth with swelling 3/30/2009 Approx 6 hrs after receiving 6mo va 3/31/2009 1. 2 lesions on labia - lidocaine jelly 3/31/2009 (1) Reactive nodule. No sign of infe 3/31/2009 About 6 minutes after administering Mother brought her daughter in @ 1 3/31/2009 Large red spot, raised area, Lt uppe 3/26/2009 Nonspecific reaction, This case was 3/31/2009 Upon injection, My daughter immed 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information and follow up has been 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from 3/31/2009 Information has been received from Started having severe stabbing ach 3/26/2009 5.5 X 2.5 Cm red, raised, hot area c 3/30/2009 Patient received PNEUMOVAX vac 3/24/2009 Child developed ROTAVIRUS infec 3/27/2009 Pt returned to clinic the day after rec 4/1/2009 MMR was possible mixed with IPV f 4/1/2009 3-31-09 Mom states light rash on fa 3/31/2009 Has a red heavily speckled line or b 4/1/2009 Client became dizzy after vaccinatio 4/1/2009 several fevers a day, bad headache 4/1/2009 Patient was given flu shot and pneu 4/1/2009 Developed one-sided facial palsy w 4/1/2009 Child developed fever and had febri 4/1/2009 Red macular rash over chest, abdom 4/1/2009 PATIENT LOST CONSCIOUSNESS 4/1/2009 @ 24 hrs post-vaccine: egg-shaped 4/1/2009 Yellow Fever vaccination given on 3 4/1/2009 CLIENT BECAME DIZZY AFTER R 4/1/2009 24 hours after varicella vaccine #2 d 4/1/2009 AFEBRILE - REDDNESS AND ERY 4/1/2009 Last PM temp up to 103 - today 102 4/1/2009 Symptoms:Shortness of Breath, Ra 4/1/2009 Gave Pediarix instead of DTaP. No 4/1/2009 Returned to clinic one day after rece 4/1/2009 Large Welts under skin, muscle feel 4/1/2009 My son received Influenza vaccine ( 4/1/2009 Patient reported redness for a few d 4/1/2009 Gardasil shot was given. Pain start 3/19/2009 A serious, spontaneous report of se 3/27/2009 Pt was given GARDASIL vaccine w 4/1/2009 Started to become fussy, crying - ha 4/1/2009 Rash. 4/1/2009 Left thigh red.
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4/1/2009 CA 4/1/2009 TX 4/1/2009 TX 4/1/2009 ID 4/1/2009 NY 4/1/2009 NY 4/1/2009 WI 4/2/2009 NC 4/2/2009 MA 4/2/2009 4/2/2009 4/2/2009 NC 4/2/2009 WV 4/2/2009 CA 4/2/2009 NY 4/2/2009 OH 4/2/2009 CA 4/2/2009 NY 4/2/2009 NJ 4/2/2009 VA 4/2/2009 NC 4/2/2009 CA 4/2/2009 IA 4/2/2009 KS 4/2/2009 SC 4/2/2009 TX 4/2/2009 RI 4/2/2009 RI 4/2/2009 WY 4/2/2009 PA 4/2/2009 MS 4/2/2009 TX 4/2/2009 TX 4/2/2009 PA 4/2/2009 AZ 4/2/2009 TN 4/2/2009 TN 4/2/2009 TX 4/2/2009 WV 4/2/2009 TX 4/2/2009 MO 4/2/2009 NY 4/2/2009 NY 4/2/2009 CA 4/2/2009 MA 4/2/2009 MN 4/2/2009 IL 4/2/2009 DE 4/2/2009 OR 4/2/2009 NY 4/2/2009 NC
16 26 66 0.2 32 4 16 20 6 23 74 84 0.9 1 1 11 41 17 4 0.2 18 12 1 1 0.6 31 53 0.4 25 12 5 14 1.4 63 25 70 2 48 37 23 4 15 31 12 4 95 16 18
16 41 26 66 0 32 4
84 0 1 0 11 41 17 4 0 18 12 1 1 0 31 53 25 12 5 14 1 63
2 48 23 4 15 31 12 4 95 16 18
F F F F 0.2 F M F F F U M M M M 0.9 F 0F U 1M F M F F 0.2 F F M 0F 0F 0.6 M F F F M M F F 0.4 F F F M 0M M M F M F F F M F F F
3/29/2009 Hot, red area @ injection site. Started getting a rash of small red b 4/1/2009 Pt reports woke up the morning afte 4/1/2009 Severe pain, induration warmth at in 4/1/2009 Pt given vaccines 10:30 am, began 3/23/2009 2 hrs after immunization patient sha 48-72 Hrs after VARIVAX develope 4/1/2009 Information has been received from 4/1/2009 Information has been received from 4/1/2009 Information has been received from 4/1/2009 Information has been received from 3/30/2009 This serious case was received on 2 4/2/2009 This is a 74yo, Male, came to ER w Complete loss of control - 9-13-08. H 4/1/2009 Acute disseminated encephalomyel 4/2/2009 generalized rash over trunk, face & L Leg 4 cm erythema and induration 3/30/2009 Patient developed fever up to 103.2 3/30/2009 105 fever 12 hours later. Headache 2/9/2009 The moment needle was in right de 3/25/2009 Injection about 15:40. Approximatel 3/20/2009 Large area of redness and induratio 3/25/2009 2 doses of PREVNAR were adminis 3/29/2009 Fever, headache, neck soreness, vo 4/2/2009 Malaise, poor appetite, nausea/vom 3/26/2009 Post vaccine hives for 15 min. Then 4/1/2009 fever of 101 degrees, rubbing @ he 4/1/2009 @ 3 AM on 3/18/2009 pt. awoke wit 3/27/2009 Received TDAP vaccine 3/19/09. D 3/30/2009 Patient received Tdap on 3/23/09. C 3/26/2009 None stated 3/18/2009 A rash began to develop around the 3/27/2009 Home visit B/P 106/60 Temp 98.4 P 3/30/2009 VARIVAX breakthrough. Had 2 dos 3/19/2009 Patient turned pale a minute after re 3/11/2009 Child developed diarrhea evening o 3/18/2009 Received TdaP 3/16/09 Developed 4/2/2009 Experienced tightness in throat 30 m 4/1/2009 from pt. States he was in this office 4/2/2009 Fever 101-103.8 and diarrhea. 4/2/2009 Patient states he felt some numbne None stated Facial palsy (R). Pt states a few hou 4/1/2009 Large local swelling @ site of KINR 4/2/2009 0.1 cm in diameter nodule, palpable ### Severe total body itching for 1 1/2 m 4/1/2009 After 2 h erythematous rash and sm 4/2/2009 Right upper arm swollen, warm to to 3/31/2009 Pt had a TETANUS shot a week ag 4/2/2009 2/22/09 to 2/24/09 Fever by report f 4/2/2009 CLIENT RECEIVED 7 VACCINES O
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4/2/2009 CO 4/2/2009 CA 4/2/2009 FL 4/2/2009 MO 4/2/2009 CO 4/2/2009 WA 4/2/2009 CO 4/2/2009 CA 4/2/2009 CA 4/2/2009 CA 4/2/2009 AZ 4/2/2009 NM 4/2/2009 WA 4/2/2009 IL 4/2/2009 WA 4/2/2009 NE 4/2/2009 4/2/2009 SC 4/2/2009 4/2/2009 4/2/2009 MN 4/2/2009 MN 4/2/2009 MN 4/2/2009 TX 4/2/2009 AR 4/2/2009 NC 4/2/2009 IN 4/2/2009 MN 4/2/2009 KY 4/2/2009 WA 4/2/2009 CA 4/2/2009 MA 4/2/2009 TX 4/2/2009 AK 4/3/2009 CT 4/3/2009 4/3/2009 CA 4/3/2009 NY 4/3/2009 NC 4/3/2009 HI 4/3/2009 4/3/2009 4/3/2009 OH 4/3/2009 AL 4/3/2009 OH 4/3/2009 CA 4/3/2009 CA 4/3/2009 NC 4/3/2009 NC 4/3/2009 HI 4/3/2009 NM
64 0.3 4 66 59 0.2 59 77 1.1 4 4 65 32 0.5 0.2 11
64 0 4 66 59 0 59 77 1 4 4 65 32 0 0 11
29 58 28 69 44 6 2 11 3 0.2 58 3 59 4 78 64 31 72 1.4 15 12 33 38 30 37 16 35 29 11 4 12 58 48 0.2
29 57 28 69 44 6 2 11 3 0 58 3 59 4 78 64 31 1 15 12 33 38 30 37 16 29 11 4 12 58 48 0
F 0.3 F F F M 0.2 F M M 0.1 F F M F M 0.5 M 0.2 M F F F M M F M F 0.6 M F M 0.2 M F M F F F F F M 0.4 M F F F F M M M F F F M F M F 0.2 M
3/9/2009 Soreness and erythema (~4 inches 4/2/2009 Child was in office for a 6 month ph 4/2/2009 On the evening of the shots, she de 4/2/2009 Patient call on 4/2/09 stating that on 4/2/2009 Had inner gluteal pain starting four d 4/2/2009 Pt received a vaccination from an e 4/2/2009 Took first oral typhoid capsule as di 4/2/2009 Developed full blown Shingles appr 4/2/2009 Child received subcutaneous injecti 4/2/2009 GAVE 4TH PEDIARIX 4/2/2009 EDEMA AND ERYTHEMA TO RIGH 4/2/2009 Patient started to notice hives on th 4/2/2009 Minor local reaction at the left deltoi 4/2/2009 He vomited about 5 hrs. after being 4/2/2009 N/A 4/2/2009 High fever of 106F, wheezing, uppe 4/2/2009 This case was reported by a consum 4/2/2009 This case was reported by a pharma 4/2/2009 This case was reported by a lawyer 4/1/2009 While attending graduate school, th 4/2/2009 Per pt had orange size lump/ swellin 4/2/2009 None 3/30/2009 About 2 1/2 inches red area with sw 4/2/2009 Swelling red ball under skin @ injec 4/2/2009 Nausea 15 min after GARDASIL Diz 3/31/2009 Febrile seizure. Temp. 105. TYLEN 4/1/2009 12 n Mother gave child TYLENOL 0 4/2/2009 Soreness in joints, muscles - consta 4/2/2009 Lg area of bumps at injection site go 4/2/2009 Redness/ itching at injection site rig 4/2/2009 Moderate redness and swelling of R 4/2/2009 Erythema right upper arm below inje 4/2/2009 3-27-09 1:00 PM - began experienc 4/2/2009 Pain at injection site, malaise, naus 4/2/2009 Information has been received from 4/2/2009 Information has been received from 4/2/2009 Information has been received from 4/2/2009 Information has been received from 3/31/2009 Respiration problems, dizziness, ne 3/31/2009 RUE cellulitis, pain, fever, tachycard 4/3/2009 Pt had SPV on 3/6/09 and AVA on 3 4/3/2009 Vesicular rash on (L) arm, neck and 3/27/2009 Fever (103 degrees), headache, bo 3/31/2009 After last flu shot experienced head 4/3/2009 4cm X 4cm pink area around where 4/3/2009 Patient fainted for a few seconds af 3/18/2009 Reaction began 1 hr after injection. 3/31/2009 Hours after the vaccines, patient c/o None 3/30/2009 4 days after administration, nickel si 3/31/2009 Patient came in 3/31/09 stated that
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4/3/2009 FL 4/3/2009 PA 4/3/2009 MA 4/3/2009 LA 4/3/2009 KY 4/3/2009 NJ 4/3/2009 NY 4/3/2009 KY 4/3/2009 OH 4/3/2009 FL 4/3/2009 KY 4/3/2009 TX 4/3/2009 TX 4/3/2009 PA 4/3/2009 MI 4/3/2009 IN 4/3/2009 NJ 4/3/2009 PA 4/3/2009 OH 4/3/2009 AL 4/3/2009 MO 4/3/2009 GA 4/3/2009 TX 4/3/2009 MI 4/3/2009 WI 4/3/2009 IL 4/3/2009 WA 4/3/2009 WA 4/3/2009 RI 4/3/2009 OK 4/3/2009 CA 4/3/2009 CA 4/3/2009 MO 4/3/2009 OH 4/3/2009 PA 4/3/2009 MN 4/3/2009 AR 4/3/2009 AR 4/3/2009 CA 4/3/2009 CA 4/3/2009 CA 4/3/2009 CT 4/3/2009 PA 4/3/2009 CT 4/3/2009 NM 4/3/2009 IN 4/3/2009 IL 4/3/2009 NJ 4/3/2009 LA 4/4/2009 NC 4/5/2009 GA
46 71 12 13 51 5 0.1 11 4 0.2 1.3 75 7 18 0.8 0.6 0.5 75 0.5 30 14 11 11 39 0.9 14 1 0.2 1.1 16 1 48 68 73 1 5 1.4 5 63 10 8 0.5 0.8 3 0.6 0.2 2 1.3 36 0.2 11
46 71 13 51 5 0 11 4 0 1 75 7 18 0 0 0 75 0 30 14 11 11 39 0 14 1 0 1 16 1 48 68 73 1 5 1 5 10 8 0 0 0 0 2 1 36 0 11
F F M M F F 0.1 M M F 0.2 F 0.3 M M F F 0.8 M 0.6 M 0.6 F F 0.5 M F F F M M 0.9 M F 0M 0.2 M 0.1 F F 0F F F F 0M M 0.4 M M M M M 0.5 M 0.8 M F 0.6 F 0.2 F 0.9 M 0.3 M U 0.2 M M
3/31/2009 Began to feel nauseous, vomited x 3/28/2009 Severe lightheadedness within 15 m 3/25/2009 Baseball sized swelling at site of VA 3/20/2009 Pt reports broke out in small blisters 3/31/2009 Swelling + erythema + pruritis of Rt 4/2/2009 While at home: (Location) bilateral a 3/31/2009 Patient received 6 wks immunization 4/2/2009 Pt presents today 4/1/09 with red ar 4/3/2009 Large local reaction 9X6 cm local ic 4/3/2009 Vaccine administered to left thigh bu 4/3/2009 Swelling of Rt thigh area after vacci 4/3/2009 Redness, soreness, swelling. 4/3/2009 Patient developed redness around b 3/31/2009 3-30-2009 Received Hep A at appro 3/30/2009 Hep A was given at 9 months. 4/3/2009 Given DTap/Hib/IPV and HebB/Hib4/3/2009 NICKEL SIZE DARK PINK RAISED 4/3/2009 Patient broke out in shingles 6 days 4/3/2009 High fever, strong crying, for many h 4/3/2009 Golf ball sized knot on right arm. Re 3/30/2009 Headache adn hives were around s 4/3/2009 Cellulitis on left deltoid where Tdap 4/3/2009 No noted adverse reaction. Patient 4/3/2009 Developed bilateral kidney area pai 4/3/2009 4/1/2009 MOTHER PRESENTED T 4/3/2009 approx two weeks after my daughte 4/3/2009 Pt received a vaccination from an e 4/3/2009 Pt received a vaccination from an e 4/3/2009 My daughter developed a large red 4/3/2009 Within 5-10 minutes of patient recei 4/3/2009 Varicella disease (rash, fever). 4/3/2009 Received TDaP and PNEUMOVAX Pt stopped by Clinic today to report 4/3/2009 Red blistering rash in groin and hip 4/3/2009 Fever, max 100.5; redness, indurati 4/1/2009 Sore arm -> redness + swelling at th 4/1/2009 >10 cm area of redness on L thigh i 4/3/2009 >10 cm area of redness, warmth an 4/3/2009 Myalgias / arthralgias / HA (L) shoul 4/2/2009 Ameliorated varicella rash (Sib with 4/2/2009 Ameliorated Varicella rash (Sib with 1/23/2009 Initial report received on 20 January 3/17/2008 Initial report received on 13 March 2 1/26/2009 Initial report received from a manufa 1/29/2009 Initial report received on 22 January 9/9/2008 Initial information was received on 1 8/19/2008 Initial report received on 08 August 8/12/2008 This case was received from a heal ### This case was received from a heal 4/4/2009 SCREAMING AFTER WAKING, CR 4/5/2009 First 20 hrs- He had extremely sore
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4/5/2009 IN 4/5/2009 DE 4/5/2009 IN 4/5/2009 CA 4/5/2009 CA 4/5/2009 NV 4/5/2009 MO 4/6/2009 4/6/2009 SC 4/6/2009 PA 4/6/2009 4/6/2009 4/6/2009 4/6/2009 4/6/2009 4/6/2009 LA 4/6/2009 ME 4/6/2009 IL 4/6/2009 AL 4/6/2009 HI 4/6/2009 PR 4/6/2009 GA 4/6/2009 TX 4/6/2009 NY 4/6/2009 OH 4/6/2009 IL 4/6/2009 IN 4/6/2009 CA 4/6/2009 IA 4/6/2009 MN 4/6/2009 TX 4/6/2009 FL 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 WA 4/6/2009 NE 4/6/2009 IN 4/6/2009 OH 4/6/2009 KS 4/6/2009 CT 4/6/2009 MN 4/6/2009 GA 4/6/2009 AL 4/6/2009 MI 4/6/2009 AL 4/6/2009 CO 4/6/2009 IL 4/6/2009 MI 4/6/2009 CA
57 60 69 36 46 40 24
60 69 36 46 40 24
8 49
8 49
7 1.3 17 2 0.5 1.3 15 0.5 67 1.4 36 1.7 5 8 55 8 65 11 39 0.8 0.2 0.2 0.2 0.2 29 18 40 39 14 19 60 5 6 17 0.4 4 28 34
2 0 1 15 0 67 1 36 1 5 8 55 8 65 11 39 0 0 0 9 0 29 18 40 39 14 19 60 5 6 17 0 4 28 34
M M M M F M F M M F M M M M M U 0.2 U 0.5 F 0.3 F F 0.5 F M 0.4 M M 0.7 F F F F F F M M 0.8 M 0.2 F 0.2 M F 0.2 F F F F M F F F F F F 0.4 M F F F
4/5/2009 Pt had receive.5cc pneumo-vac on 4/5/2009 Moderate Fever ~ 101 F, Malaise, M 4/5/2009 On 11/28/08, pt was in clinic and C/ 4/5/2009 Patient was given scheduled vaccin 4/5/2009 On Friday, 4/3/09, I received two va 4/5/2009 2-3 day after hives around vaccinati 4/5/2009 Had Hep A and Hep B shots on 4/4 4/3/2009 InformationYhas been received from 4/2/2009 This non serious case was received 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 4/3/2009 Information has been received from 3/24/2009 Information has been received from 3/27/2009 Information has been received from Developed fever 3/26/09/ER visit fo 3/26/2009 4 hours after receiving DTAP, PREV 4/1/2009 Seizure, thought to be febrile seizur 3/23/2009 Syncope 5 minutes after HPV (GAR 3/31/2009 Pt developed erythematous rash, ur 4/2/2009 None. Patient said arm slightly sore 4/1/2009 Developed hives within 15 minutes 3/7/2009 Small localized reaction started day 4/1/2009 1. Erythema around injection site, n 4/3/2009 Received KINRIX (DTaP/IPV) Rt thi 3/28/2009 Received VARIVAX 3/26/09 mom n 4/5/2009 Patient is a USAFR female service m 3/25/2009 Injection given 3-20-09 AM. Seen in 3/30/2009 Sore arm very painful every time I m 4/6/2009 Localized allergic reaction 4/6/2009 Pt. felt weak, muscle soreness for 3 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt received an expired dose of Hep 4/6/2009 Pt called clinic, c/o redness and blo 4/6/2009 Mother called on 4-6-09 stating that 4/6/2009 pain started out as aching 1 hour af 4/6/2009 On 3/27/09 the employee went to th 4/6/2009 swelling pain of both knees. 4/13/09 4/6/2009 Approximately 24 hours after the va 4/6/2009 Patient noticed on 4/5/08 at 2:00AM 4/6/2009 4/3/09 @ 9am- phone call from pare 4/6/2009 Rash - localized papules. No bullae 4/6/2009 Varicella given 3/31/09 approx. 10:3 4/6/2009 Rotateq (rotavirus) vaccine given vin 4/6/2009 Child received IPV and DTAP in Rig 4/6/2009 24hrs after shot pt had swollen, pain 4/6/2009 Pt was given Pneumovax vaccine a
343591 343592 343593 343594 343596 343597 343598 343601 343602 343603 343604 343605 343606 343607 343608 343609 343610 343620 343621 343622 343626 343627 343628 343629 343630 343631 343632 343633 343634 343635 343636 343637 343638 343639 343640 343641 343642 343644 343645 343646 343649 343650 343651 343652 343653 343654 343655 343656 343657 343658 343659
4/6/2009 OK 4/6/2009 IL 4/6/2009 WI 4/6/2009 WI 4/6/2009 FL 4/6/2009 CA 4/6/2009 WA 4/6/2009 CA 4/6/2009 ID 4/6/2009 IA 4/6/2009 CA 4/6/2009 TX 4/6/2009 CA 4/6/2009 OR 4/6/2009 MO 4/6/2009 FL 4/6/2009 MI 4/7/2009 4/7/2009 TX 4/7/2009 CA 4/7/2009 NY 4/7/2009 OH 4/7/2009 CA 4/7/2009 4/7/2009 4/7/2009 4/7/2009 MA 4/7/2009 MS 4/7/2009 NC 4/7/2009 MN 4/7/2009 CO 4/7/2009 CA 4/7/2009 PA 4/7/2009 AL 4/7/2009 MO 4/7/2009 PA 4/7/2009 PA 4/7/2009 NJ 4/7/2009 NY 4/7/2009 PA 4/7/2009 PA 4/7/2009 CO 4/7/2009 KY 4/7/2009 NJ 4/7/2009 MI 4/7/2009 TX 4/7/2009 WA 4/7/2009 4/7/2009 4/7/2009 OH 4/7/2009 ME
18 19 30 28 79 14 60 11 0.5 15 1.3 12 17 5 14 0.5 7 18 50
18 19 30 27 79 14 60 11 0 15 1 12 17 5 14 0 7 18
4 4 4 66 69 30 20 1.3 0.7 0.3 83 2 12 0.5 69 4 1.2 4 14 1 4 60 11 21 17 1 68
4 4 4 66 69
70 0.5 10
20 1 0 0 83 2 12 0 69 4 1 4 14 1 4 60 11 21 17 1 68
0 10
F F F M F F F F 0.5 M F 0.3 F F M M M 0.5 M U F F U M M M F F F F 0.3 M 0.7 M 0.3 F M 0.1 M F 0.5 F F M 0.2 M F F 0F F F F F M 0M F U M 0.5 M F
4/6/2009 Unexplained sudden and severe ha 4/6/2009 Pt called Clinic on 4-6-09 to report t 4/6/2009 Hypotonic-Hyporesponsive Episode 4/6/2009 PT HAD A TDAP SHOT ON FRIDA 4/6/2009 red, swollen, feverish arm where sh 4/6/2009 He had some numbness and tinglin 4/6/2009 This case was reported by a consum 4/6/2009 On 3/30/09, pt presented w/ about 1 3/31/2009 The grandmother and mother repor 4/2/2009 Progressive Diarrhea, Vomiting, Bac 4/6/2009 She had a reddish purplish area on 4/6/2009 Erythema at injection site "burning" 3/11/2009 Headache: onset: 3/10/09-present. 4/6/2009 Redness and swelling L leg. Started 4/6/2009 Fri - 4-3-09 - School nurse phoned H 4/6/2009 Irritability with long periods of crying 4/6/2009 Both legs red and swollen. Cellulitis 4/6/2009 Information has been received from 4/6/2009 Information has been received from 4/6/2009 Information has been received from 4/2/2009 Fever one week after vaccinations 4/6/2009 Red swollen thigh left - side left day 3/31/2009 Redness to site with induration x 3-4 3/29/2009 Received shingle shot. Asked nurse 4/1/2009 Developed petechial rash on inner t 3/29/2009 Laceration so had ADACEL vaccine 4/2/2009 1st GUARDISIL vaccine administere Increase swelling & erythema of ent 4/2/2009 About a 2cm red wheal appeared af 4/2/2009 Local reaction right thigh with erythe 4/3/2009 Developed rash L side neck in derm 4/2/2009 Vaccine given 3/19/09, fever develo 4/2/2009 Syncopal event. 3/10/2009 Pt. received 6 mo. well baby checku 3/30/2009 3/30 Pt called, c/o erythema (L) upp 4/1/2009 No adverse events recorded 4/1/2009 Presented to the office on 3/31/09 w 3/26/2009 Received KINRIX 3/24/09 (R) deltoi 3/31/2009 Protracted headache 5/26/09 Rece 4/1/2009 Bright red maculo papular rash to fa 4/6/2009 patient received KINRIX as part of 4 4/1/2009 3/30/09 Rec. Yellow Fever Vaccine 3/31/2009 Immediately following injection pt. b 3/25/2009 Complained of itchy throat 40 minut 4/1/2009 Pain, redness, swelling and firmnes 3/31/2009 1-5-09 pm notices red spots on bac 4/7/2009 Reaction to pneumonia vaccine give 3/25/2009 10 mg of Hep B vaccines were give 4/1/2009 Frompt. States he was in his office y Immunization given on 3/27/09 3 ho 4/1/2009 Developed redness around upper a
343660 343661 343662 343663 343664 343665 343666 343667 343668 343669 343670 343671 343672 343673 343674 343675 343676 343677 343678 343679 343680 343681 343682 343683 343684 343685 343686 343687 343688 343693 343694 343695 343696 343697 343699 343700 343701 343702 343704 343707 343708 343710 343711 343712 343713 343714 343715 343716 343717 343719 343721
4/7/2009 FL 4/7/2009 OK 4/7/2009 DE 4/7/2009 TN 4/7/2009 MA 4/7/2009 AK 4/7/2009 WI 4/7/2009 TN 4/7/2009 OK 4/7/2009 CO 4/7/2009 OH 4/7/2009 IN 4/7/2009 4/7/2009 KY 4/7/2009 4/7/2009 MN 4/7/2009 OH 4/7/2009 NC 4/7/2009 CA 4/7/2009 MI 4/7/2009 4/7/2009 4/7/2009 4/7/2009 CT 4/7/2009 FL 4/7/2009 PA 4/7/2009 TX 4/7/2009 TX 4/7/2009 PA 4/7/2009 NV 4/7/2009 AZ 4/7/2009 MO 4/7/2009 IA 4/7/2009 4/8/2009 KS 4/8/2009 4/8/2009 MA 4/8/2009 4/8/2009 4/8/2009 MO 4/8/2009 CA 4/8/2009 NE 4/8/2009 KY 4/8/2009 4/8/2009 GA 4/8/2009 NC 4/8/2009 4/8/2009 CA 4/8/2009 NE 4/8/2009 NE 4/8/2009
1.5 4 1.5 39 10 0.4 13 9 14 15 34 5 20 12 24 5 2 54 12 69 29 24 36 5 4 81 18 28 56 1.4 74 1.5 0.1 70 16
1 4 1 39 10 0 13 9 14 15 34 5 20 12 24 5 2 54 12 69 29 24 36 5 4 81 18 28 56 1 74 1 0 70 16
16 20 17 51 5 49 4 66 9 9 15 24 12 46 1.3
16 20 51 49 4 66 9 9 15 24 12 46
0.5 M F 0.5 F F F 0.4 M F M F F F F F F F M 0.7 F F M F M F M F F F F F M 0.4 M F 0.5 F 0.1 F M F F F M F F M F F F M F F F M F M
3/30/2009 Fever began two days after shot wa 4/2/2009 Immunization site reaction with mild 4/2/2009 Vomiting X 24 hr, injection site rash 4/2/2009 Redness, heat, swelling left deltoid 3/30/2009 Acute RAD with throat itching within 3/26/2009 5 month old with spots on body, sta 4/1/2009 Left arm pain, left sided facial flushi 4/2/2009 Erythema and swelling to left upper 3/27/2009 Next day noticed itching at site of va 4/2/2009 Redness 5 cm X 5 cm; Swelling + P 4/7/2009 Fever, rash 4/7/2009 felt sick to stomach,head hurt, feet f 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Received 3rd dose of Gardasil on 3 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 patient was given Adacel instead of 4/7/2009 Child missed appt for Well Child Clin 4/7/2009 11/4/08 Optic Neuropathy leading t 4/7/2009 DIZZY,FAINTED.ASSESSED MY M 4/7/2009 2 days following vaccination, pt. dev 4/7/2009 Non-specific myocarditis. This case 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Subendocardial infarction (410.7), u 4/7/2009 MMR and Kinrix innoculations given 4/7/2009 Mother brought child in today for as 4/7/2009 Two weeks after her vaccine was gi 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Vaccinated with ACAM2000 during 4/7/2009 Patient states he got his second inje 4/6/2009 Rash head to toe. Not sleeping or e 4/7/2009 Shingles (rash with blisters) on lowe 4/7/2009 None reported 4/6/2009 Onset of erythema L thigh day after 4/1/2009 Mar 26, 2009@09-43 from pt. State 4/7/2009 Information has been received from 4/7/2009 Information has been received via a 4/7/2009 Information has been received from 3/31/2009 Developed focal deficits temporally 4/7/2009 Information has been received from 4/3/2009 Client reports pain & burning sensa 4/1/2009 Right deltoid (arm) red and swollen, ### Angloedema & swelling of uvula. 4/3/2009 Rt arm red swollen warm to touch. 3/29/2009 Received shingle shot. Asked nurse 4/3/2009 Pt. had slightly raised, warm to touc 4/4/2009 15x10cm area of blanching erythem 4/7/2009 Information has been received from 4/7/2009 Information has been received from 8/20/2008 Red spot on arm. Not sure if it was 9/22/2008 Patient had syncopal episode, short 4/7/2009 Information has been received from
343726 343736 343737 343739 343740 343741 343742 343743 343744 343745 343746 343747 343748 343749 343750 343751 343752 343753 343754 343755 343756 343757 343758 343759 343760 343761 343762 343763 343764 343765 343766 343767 343768 343769 343770 343771 343772 343773 343774 343775 343776 343883 343884 343885 343886 343887 343888 343889 343890 343891 343892
4/8/2009 CA 4/8/2009 HI 4/8/2009 NY 4/8/2009 CA 4/8/2009 NC 4/8/2009 4/8/2009 MD 4/8/2009 IN 4/8/2009 MD 4/8/2009 TX 4/8/2009 SC 4/8/2009 IL 4/8/2009 NY 4/8/2009 CA 4/8/2009 NY 4/8/2009 CA 4/8/2009 AL 4/8/2009 NY 4/8/2009 NY 4/8/2009 NY 4/8/2009 TX 4/8/2009 MO 4/8/2009 MO 4/8/2009 TN 4/8/2009 TN 4/8/2009 DC 4/8/2009 CA 4/8/2009 MN 4/8/2009 OR 4/8/2009 WA 4/8/2009 CA 4/8/2009 AZ 4/8/2009 CA 4/8/2009 WI 4/8/2009 TN 4/8/2009 MA 4/8/2009 CA 4/8/2009 HI 4/8/2009 HI 4/8/2009 PA 4/8/2009 CA 4/8/2009 SC 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 OH 4/8/2009 WA 4/8/2009 ID 4/8/2009 MA 4/8/2009 CO 4/8/2009 WA
75 8 23 2 41 71 4 9 18 32 2 47 4 44 0 0.3 63 58 25 22 5 11 77 4 62 5 20 12 31 0.4 14 20 1.3 52 1.1 88 60 64 62 22 76 77 74 75 71 55
75 8 23 2 41 72 4 9 18 32 2 47 4 44 0 0 62 17 25 22 5 10 77 4 62 5 19 12 31 0 14 20 1 52 1 88 60 64 62 22 76
61 87 63
61 87
75 71 55
U F F F 1M M F M F F F 0.4 F F M F 0M 0.3 M F F F F M F M F F M F F F 0.4 M F M 0.3 M M 0.1 F F F F F F F F F F F F F F F M
4/3/2009 This case was received from a heal 2/16/2009 See attached copy. 3/19/2009 Whelps developed. Got in waiting a 4/8/2009 1st GARDASIL 1-30-09 - At 2nd app 4/8/2009 Erythema induration at left thigh ele 4/8/2009 Persitant redness, itching and swell 4/8/2009 Rash at injection site. 4/8/2009 Mother called stating that left arm is 4/8/2009 Pt arm Turned red and slightly raise 4/8/2009 Vaccinated with ACAM2000 during 4/8/2009 Edema of the tongue and throat. No 4/8/2009 CLT SCREAMED ALL DAY RIGHT 4/8/2009 The patient received Tdap vaccine ( 4/8/2009 HEP A GIVEN X3 4/8/2009 The patient received Tdap and expe 4/8/2009 Patient has a Methicillin Sensitive S 4/8/2009 Injection site blanched and cool to 4/8/2009 The patient received Tdap and expe 4/8/2009 The patient received the Tdap vacc 4/8/2009 The patient received Tdap and expe 4/8/2009 I had the HPV vaccine Gardisil on M 4/6/2009 Received Hep B shot 3-31-09 VLL. 4/1/2009 Administered DTAP instead of Tdap 4/8/2009 03/14/2009@ 11:05AM, Injection sit 4/8/2009 Approximately 48 hours after immun 4/8/2009 Patient is a 62 year old African Ame 4/8/2009 Vaccinations were received on 04/0 4/8/2009 On 4/7/09 had a rash on neck and c 4/8/2009 At time and the months up to March 4/8/2009 WITHIN 48HRS DEVELOPED LOC 4/8/2009 Within 10 minutes of receiving the v (Per mother), child went to ER 2-13 4/8/2009 Pt received immunizations (FLUMIS 4/8/2009 Local (L) thigh-redness, 14x17 cm s 4/8/2009 Pt states today that he had a reactio 4/9/2009 Developed rash around belly button 4/8/2009 Swelling, redness, 12 cmx8cm. Not 4/3/2009 Headache began about 3 days after 4/8/2009 Patient noticed red welt on site of in 4/8/2009 Silver sized red itchy mark ant injec 4/8/2009 Pt had syncopal episode after GAR 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
343893 343894 343895 343896 343897 343898 343899 343900 343901 343902 343903 343904 343905 343906 343907 343909 343910 343911 343912 343913 343978 343979 343980 343981 343982 343983 343984 343985 343986 343987 343988 343989 343990 343992 344075 344076 344077 344078 344079 344717 344718 344719 344720 344721 344722 344723 344724 344725 344727 344728 344729
4/8/2009 MS 4/8/2009 SC 4/8/2009 VA 4/8/2009 GA 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 4/8/2009 AL 4/8/2009 KY 4/8/2009 TN 4/8/2009 IN 4/8/2009 LA 4/8/2009 ME 4/8/2009 FL 4/8/2009 4/8/2009 LA 4/8/2009 CO 4/8/2009 CA 4/8/2009 4/8/2009 MI 4/8/2009 LA 4/8/2009 4/8/2009 4/8/2009 TX 4/8/2009 AR 4/8/2009 IL 4/8/2009 SC 4/8/2009 4/8/2009 4/8/2009 4/8/2009 OK 4/8/2009 ID 4/8/2009 4/8/2009 KS 4/8/2009 4/8/2009 FL 4/8/2009 LA 4/8/2009 FL 4/8/2009 4/8/2009 4/8/2009 MS 4/8/2009 CA 4/8/2009 KS 4/8/2009 OH 4/8/2009 MI 4/8/2009 MD 4/8/2009 MO 4/8/2009 CA 4/8/2009 FL 4/8/2009 FL
65 73 68 68 73 65 60 58 79 3 67 65 80 70 71 67 62 62 4 64 62 70 67 60 80 74 35 81
65 73 68 73
58
67 65 80
71 62 62 4 64
70 60
35
60 67 1
76 87 2 81 76 62 62 62 80 68 62 77 67
67
87 2 76 62 62 62 80 68 62 77
M F F F M F F F M U F F F F F M F M M F F F M F F M M F F F F M F F M F M M M 0.3 M F F F F M F F U F F M
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received form 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information was received from a 80 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received form 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 4/7/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
344731 344734 344735 344743 344745 344746 344748 344749 344752 344753 344754 344755 344756 344757 344758 344761 344765 344769 344776 344777 344778 344779 344780 344781 344782 344783 344784 344785 344821 344823 344826 344830 344831 344834 344837 344839 344840 344842 344844 344847 344849 344851 344856 344857 344858 344859 344860 344861 344862 344863 344864
4/8/2009 KY 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 MD 4/8/2009 PA 4/8/2009 MI 4/8/2009 CA 4/8/2009 MO 4/8/2009 PA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 SD 4/8/2009 OH 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 FL 4/8/2009 PA 4/8/2009 NY 4/8/2009 FL 4/8/2009 VA 4/8/2009 WV 4/8/2009 AZ 4/8/2009 IL 4/8/2009 NY 4/8/2009 CO 4/8/2009 IL 4/8/2009 MS 4/8/2009 NC 4/8/2009 VA 4/8/2009 4/8/2009 PA 4/8/2009 FL 4/8/2009 CA 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 LA 4/8/2009 NE 4/8/2009 NC 4/8/2009 RI 4/8/2009 4/8/2009
76 66 64 60 1.2
1
66 70 65 63 1.2
70 65 63 1
66 74
66 74
60 63 72 77 70
61
63 72
61
62
79 88 80 59 77
79 88 80 59 77
76 61 67
61 67
60 78
60
70 80 65
70 80
70
M F F F F 0.2 F U F F F M 0.2 M M U F M F M F F F M F M F U M M U F U U F M F F F U M F F U F M F F F U M U F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
344865 344866 344867 344868 344869 344871 344874 344875 344876 344877 344879 344880 344881 344882 344883 344884 344885 344886 344887 344888 344889 344890 344891 344892 344893 344894 344895 344896 345480 345481 345482 345483 345484 345485 345486 345487 345488 345489 345490 345491 345492 345493 345494 345495 345496 345497 345498 345499 345500 345501 345502
4/8/2009 4/8/2009 NY 4/8/2009 4/8/2009 NC 4/8/2009 4/8/2009 IL 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 IN 4/8/2009 NV 4/8/2009 WA 4/8/2009 WV 4/8/2009 NY 4/8/2009 PA 4/8/2009 CA 4/8/2009 VA 4/8/2009 4/8/2009 4/8/2009 KS 4/8/2009 IL 4/8/2009 AR 4/8/2009 NC 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 NY 4/8/2009 4/8/2009 MI 4/8/2009 4/8/2009 4/8/2009 4/8/2009 OH 4/8/2009 MD 4/8/2009 4/8/2009 MI 4/8/2009 FL 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 PA 4/8/2009 IA 4/8/2009 CA 4/8/2009 CA 4/8/2009 AR
65 63 73 67 77 73
65
84 61 61 81 82 70 78 71 64 70 65
84 61 61 81 82 70 78
72 71
73 77
64
71
61 65 81 9 65 60 65 60 66 67 60 78 22 65 80 76
81 9
61 72
61
77 68 61 66 68 69 91 74
77
60 65 60 66 60 78
80 76
61 66
91 74
F F F F F F U F M M F F F M F F F F M F F U F F F F F F F M F F F M M F F F F U M F M M F F F F F F F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been provided from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial information has been received 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 NJ 4/8/2009 4/8/2009 4/8/2009 SD 4/8/2009 PA 4/8/2009 OH 4/8/2009 FL 4/8/2009 OH 4/8/2009 CA 4/8/2009 FL 4/8/2009 OR 4/8/2009 WA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 MD 4/8/2009 KY 4/8/2009 4/8/2009 MA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 IN 4/8/2009 4/8/2009 MD 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 4/8/2009 FL 4/8/2009 4/8/2009 MI 4/8/2009 TX 4/8/2009 4/8/2009 4/8/2009 MI 4/8/2009 4/8/2009 4/8/2009 MO 4/8/2009 4/8/2009 OK 4/8/2009 OH 4/8/2009 MI 4/8/2009 4/8/2009 FL
62
62
62 65
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82 75
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60 67 63 66
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68 61 63
68
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84 74 62 15
15
62 85 61 85 71
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77 70 59
77
74 71 56 65 60 66
74
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73 62 74 62 65
62 73 62
F U M F F M F F F U F F F F F F F F U F M M M F U F F F F F U U U F M F F F M M F F U F M F F M F F F
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial information has been received 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial and follow-up information has 3/27/2009 Information has been received from 3/27/2009 Information has been received from
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4/8/2009 VA 4/8/2009 4/8/2009 4/8/2009 SC 4/8/2009 IL 4/8/2009 ID 4/8/2009 4/8/2009 4/8/2009 NJ 4/8/2009 4/8/2009 4/8/2009 CO 4/8/2009 4/8/2009 CT 4/8/2009 4/8/2009 4/8/2009 HI 4/8/2009 OR 4/8/2009 4/8/2009 NJ 4/8/2009 4/8/2009 OR 4/8/2009 4/8/2009 WI 4/8/2009 CA 4/8/2009 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 FL 4/8/2009 OH 4/8/2009 4/8/2009 4/8/2009 PA 4/8/2009 4/8/2009 IN 4/8/2009 4/8/2009 MD 4/8/2009 VA 4/9/2009 VA 4/9/2009 MI 4/9/2009 4/9/2009 IL 4/9/2009 4/9/2009 MO 4/9/2009 NE 4/9/2009 IN 4/9/2009 KY 4/9/2009 PA 4/9/2009 NH 4/9/2009 CO
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M U F M 0.1 F F F F F F F M F U M M F F M F U F M M F U U F M F F U M F M F F M F U F M F F F F F F F F M
3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Initial and follow-up information has 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 3/27/2009 Information has been received from 4/8/2009 InformationYhas been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from 4/8/2009 Information has been received from When the rib cracked went to docto 4/6/2009 Patient is a 16-year-old female who 4/3/2009 Received vaccines on 3-16-09. The 4/3/2009 Right thigh swollen, red with blisters 4/2/2009 24 hours dizziness, vomiting low gra Developed bilateral pulmonary emb 4/4/2009 Redness, pain and swelling in arm.
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4/9/2009 VA 4/9/2009 MA 4/9/2009 NY 4/9/2009 CA 4/9/2009 FL 4/9/2009 GA 4/9/2009 4/9/2009 4/9/2009 CA 4/9/2009 MI 4/9/2009 PA 4/9/2009 NY 4/9/2009 MS 4/9/2009 CA 4/9/2009 WA 4/9/2009 IN 4/9/2009 MO 4/9/2009 GA 4/9/2009 CA 4/9/2009 4/9/2009 4/9/2009 CA 4/9/2009 NC 4/9/2009 MA 4/9/2009 AL 4/9/2009 KS 4/9/2009 FL 4/9/2009 IN 4/9/2009 KY 4/9/2009 IA 4/9/2009 MI 4/9/2009 TX 4/9/2009 MI 4/9/2009 FL 4/9/2009 CA 4/9/2009 KY 4/9/2009 FL 4/9/2009 MI 4/9/2009 MO 4/9/2009 CA 4/9/2009 IN 4/9/2009 PA 4/9/2009 IA 4/9/2009 CA 4/9/2009 VA 4/9/2009 OH 4/9/2009 WI 4/9/2009 TX 4/9/2009 NY 4/9/2009 GA 4/9/2009 VA
15 13 5 4 0.3 4 64 66 1.1 4 1.7 1.3 40 28 14 31 21 15 52 51 64 1.3 40 38 76 43 44 1.2 12 1.3 61 1 11 0.2 19 1.5 0.2 8 4 1.9 81 31 16 16 22 1 13 14 18 16 33
15 13 5 4 0 4 66 1 4 1 1 40 28 14 31 21 15 52
1 40 47 43 44 1 12 1 61 1 11 0 19 1 8 4 1 81 31 16 16 22 1 13 14 18 16 33
F F M F 0.3 M M M M 0.1 M F 0.7 M 0.3 F M F M M M F M U M 0.3 F U F U F F 0.2 F F 0.3 F M 0F F 0.2 M M 0.5 F M F M 0.9 F M F F F F 0M M M M F U
4/2/2009 During the course on the vaccines, 3/27/2009 Fever 103 at 10:45 am 3/26/09, sha 4/6/2009 410PM LPE complete immunization 4/2/2009 Local reaction lasting 4 days. 4/3/2009 Pt received PREVNAR vaccine @ t 4/3/2009 Positive redness and swelling of left 3/23/2009 Patient received the Zoster vaccine 4/7/2009 I had an injection of ZOSTAVAX on 4/8/2009 Pt. developed rash after vaccines w 4/9/2009 Patient came to pick up a sticker an 4/7/2009 Rash, several scattered vesicles. S 4/9/2009 Urticaria broke out on left thigh as s Large are of redness to the right de 4/9/2009 Patient called 4/9/09 AM to notify us 4/9/2009 VARICELLA vaccine (along with TD 4/6/2009 None stated. 3/31/2009 Gave pediatric/adolescent dose of H 4/6/2009 Patient was inadvertently given DTa 4/3/2009 L arm swelling - Pt reported fever to Rash and fever. 4/2/2009 Urticaria Pruritus 4/9/2009 16 month old female presents with f 4/9/2009 Pt called the dept and left message 4/9/2009 Patient immunized with Varivax vac 4/9/2009 Subject in pneumococcal Y vaccine tr 4/9/2009 Silver dollar sized redness and warm 4/9/2009 Reports felt "woozy,dizzy" when got 4/9/2009 developed fever Y and rash approx. 1 3/30/2009 Appointment at 10:15am, pt. called 4/9/2009 developed Herpes Zoster (C5 distrib 4/9/2009 Patient has a softball sized area at t 4/9/2009 Started fever 6 hours after injection. 4/9/2009 Patient received #2 VZV, #1 HPV, a 4/9/2009 Patient brought Y in the clinic in the af 4/9/2009 During 5 week field exercise, patien 3/17/2009 Child recieved shots at health depa 4/9/2009 Patient bacame cranky cried her de 4/9/2009 About 24 hours after TD was given 4/9/2009 Patient received Kinrix (DTaP,IPV, M 4/9/2009 Fever up to 102.5, rhinorrhea, and e 4/7/2009 Started w/chest Y congestion/shortne 4/9/2009 This case was reported by a physici 4/9/2009 Pt developed acute abdominal pain 3/20/2009 Oval hyperemic swelling on Rt uppe 4/9/2009 On 3/25/09 at 1030 the pt received 4/9/2009 Swelling and rash reaction with ang 4/9/2009 Within a few minutes client turned p Paleness, weakness BP prior to eve 4/8/2009 15 minutes after receiving vaccine s 4/2/2009 Patient was in office to have mening 4/9/2009 Received vaccination on 3/31/09: T
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4/9/2009 AZ 4/9/2009 AZ 4/9/2009 IL 4/9/2009 CO 4/9/2009 TX 4/9/2009 TX 4/9/2009 NY 4/10/2009 NY 4/10/2009 AZ 4/10/2009 4/10/2009 4/10/2009 4/10/2009 4/10/2009 MN 4/10/2009 IL 4/10/2009 NC 4/10/2009 NY 4/10/2009 MO 4/10/2009 NC 4/10/2009 NV 4/10/2009 MI 4/10/2009 KY 4/10/2009 KY 4/10/2009 IL 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 MD 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 KY 4/10/2009 SC 4/10/2009 CA 4/10/2009 NV 4/10/2009 4/10/2009 KY 4/10/2009 OR 4/10/2009 WA 4/10/2009 AK 4/10/2009 CA 4/10/2009 MN 4/10/2009 MA 4/10/2009 CT 4/10/2009 MI 4/10/2009 CA 4/11/2009 PR 4/11/2009 TX 4/11/2009 IN
34 34 14 15 12
34 34
0.2 16 16 17
0 16 16 17
81 25 4 68 31 71 4 4 18 0.3 51
81 25 4 68 31 71 4 4 18 0 51 11 10 1 11 36 12 11 0 16 1 12 69 1 4 3 77 4 9 4 4 4 15 40 44 33
10 1 11 36 12 11 2 16 1.5 12 69 1 4 3 77 4 9 4 4 4 15 40 44 33
15 12
F M U F M U 0.2 F F F F F M M M F F F M F F F F M F 0.3 M F M F 0M M M F M 0.2 M F 0.5 F M F 0M M M F F M F M M F M M F
4/8/2009 Patient states she started having co 4/8/2009 Approximately 2 weeks after immun Patient complaining of intermittent s 4/9/2009 48 hrs after vaccine administered ha 4/9/2009 Patient came to our clinic on 4/9/09 1/27/2009 Initial information was received on 2 ### Initial report was received on 08 De 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/9/2009 Information has been received from 4/7/2009 Initial report was received from anot 3/27/2009 Information has been received from 4/10/2009 Employee reporting disturbed sleep 4/3/2009 Reddness about 4-6 cm left deltoid. 4/10/2009 Patient had rash. She went to the d 4/10/2009 I had rash on all my neck for two da 4/10/2009 Two days after receiving the shingle 4/2/2009 03/31/09 Dtap given, 04/01/09 Pt. h 4/1/2009 Local reaction to Dtap (given on 03/ 4/10/2009 within 20 mins of injections, pain, st 2/10/2009 seizures X2 4/29/09 Received Hos 8/21/2008 Reddened area, size of half-dollar, l 6/13/2008 Pt. had painful red swollen 4 X 3 1/2 4/10/2009 40mmx28mm red raised area at site ### low appetite, fever, seizure ### urticaria- abdomen/chest/lumbar 12/7/2007 Intermittent shooting pains in right a 8/20/2007 Administered Tdap and Gardisil, pt. 8/6/2007 left arm 2" redness, warm to touch, 8/2/2007 high fever and high pitched screami 4/10/2009 After administration of all 4 vaccines 4/10/2009 5 days after MMR vaccination our d 4/9/2009 Protracted vomiting, dehydration an Pt. came in 02-25-09. States she ha 4/10/2009 Pt developed a rash on right arm sh 4/10/2009 Swelling, redness, very hot, doubled 4/11/2009 8X6 cm area of induration over R de 4/10/2009 On March 20, 2009 - developed sev 4/10/2009 L thigh with large erythematous ede 4/10/2009 Eye twitching, blinking, facial grimac 4/8/2009 Bilat parotitis day 13 after MMR. 4/10/2009 Erythematous discoloration with slig 4/10/2009 Positive erythema 15x16cm left thig 4/9/2009 pass out after the shots, became pa 4/11/2009 Joints ache and pain in all of them, 4/11/2009 Weakness and dizziness especially Patient given vaccine IV push instea
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4/12/2009 TN 4/12/2009 FL 4/12/2009 FL 4/12/2009 NC 4/13/2009 CA 4/13/2009 4/13/2009 FL 4/13/2009 NY 4/13/2009 4/13/2009 WI 4/13/2009 4/13/2009 CO 4/13/2009 CA 4/13/2009 CA 4/13/2009 MN 4/13/2009 IN 4/13/2009 OR 4/13/2009 OR 4/13/2009 OR 4/13/2009 UT 4/13/2009 VA 4/13/2009 AL 4/13/2009 KS 4/13/2009 MD 4/13/2009 MS 4/13/2009 DE 4/13/2009 TX 4/13/2009 SC 4/13/2009 CA 4/13/2009 VA 4/13/2009 4/13/2009 MA 4/13/2009 GA 4/13/2009 PA 4/13/2009 HI 4/13/2009 NY 4/13/2009 TX 4/13/2009 NC 4/13/2009 WV 4/13/2009 FL 4/13/2009 MA 4/13/2009 VA 4/13/2009 DE 4/13/2009 4/13/2009 IL 4/13/2009 CA 4/13/2009 KY 4/13/2009 CA 4/13/2009 NJ 4/13/2009 AR 4/13/2009 CA
7 64 88 66
7 64 88 66 -1
0.4 24 24
0 24 24
2 24 1.3 1 0.5 64 18 64 14 45 4 23 48 34 1.5 26 4 21 4 11 33 42 5 69 0.5 55 4 15 5 5 14 4 54 1.4 32 1.2 4 13 31 48
24 1 1 0 64 18 64 14 45 4 23 48 34 1 26 4 21 4 11 42 5 69 0 55 4 15 5 5 14 4 54 1 32 1 13 31 48
M M M F 0.5 U M 0.4 M F F U U F 0.3 F 0M 0.5 F F F F M F F F U F 0.5 F F F F M M F M M F 0.5 F F F F F M F F M U 0.4 F F 0.2 F F F F F
4/12/2009 Patient was extremely exciteable wh 4/12/2009 Right arm is red, no swelling noted, 4/12/2009 ulcerated left upper arm 4/12/2009 Feaver, caugh,weak, breathing prob 4/8/2009 This serious case was received on 0 4/8/2009 Initial report received 01 April 2009 4/9/2009 This serious case was received on 0 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/10/2009 Information has been received from 4/3/2009 Seizure - Full clonic/tonic 1 hr 45 mi Fever 2 days after vaccine. Hospita 3/25/2009 Erythema multiforme major possible 4/1/2009 Infantile spasms started on the 3rd 4/6/2009 T=99.7 swelling, induration + erythe 3/27/2009 3/20/2009 swelling, redness and pa 3/31/2009 Within 2 hrs of vaccination, Pt deve 3/31/2009 Called 3-27-09 with c/o dizziness, p 3/30/2009 Pt came into clinic after shots for im 4/9/2009 She had a swelling and rash at site 3/17/09 Received PC from Pt states Local Rxn w/ redness & warmth x 4 Afternoon after receiving vaccine fe 4/3/2009 Mom stated child had a tem up to 1 4/7/2009 Pt. notes truncal pruritis (primarily B 3/18/2009 Injection site - swollen, red, sorenes 4/8/2009 Patient received ANTRAX and Typh 4/7/2009 Diagnosed with shingles along L4 4/7/2009 (lt) arm - reddened, "hst to touch", s 4/8/2009 Non stated. 3/27/2009 Fatigue; night sweats 3/12/09 + 3/13 3/30/2009 Right thigh was red & swollen with s 4/2/2009 5cm area erythema, swelling, heat, 4/4/2009 Morning of 04-1-09 : "Restussness" 3/23/2009 Pt received injection and by next mo 4/6/2009 Patient inadvertently received BOO 4/6/2009 Approximately 5 minutes post inject 4/10/2009 Large, red, hard area with streaking 4/13/2009 Patient right shoulder and right delto 4/10/2009 Cellulitis 4X6 inch area of redness 2 4/8/2009 Pt developed hives at the IPV site. 4/8/2009 Patient developed erythema & purit Arthus reaction left shoulder - Swell 4/8/2009 Reddened, warm to touch, swollen 4/7/2009 On 3/9/09 Pt received Td & Hep B o 4/1/2009 3 X 3 cm erythema R upper arm wit 4/5/2009 Left thigh red w swelling. Ice packs 4/3/2009 Significant itch, redness + swelling a 3/20/2009 3/19/09 Started with rash neck + ch 4/8/2009 Fever, total body aches, nausea, fa
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4/13/2009 MI 4/13/2009 CT 4/13/2009 OR 4/13/2009 VA 4/13/2009 IN 4/13/2009 FL 4/13/2009 KY 4/13/2009 AZ 4/13/2009 MA 4/13/2009 LA 4/13/2009 MS 4/13/2009 4/13/2009 NJ 4/13/2009 MN 4/13/2009 NJ 4/13/2009 PA 4/13/2009 WI 4/13/2009 TX 4/13/2009 CA 4/13/2009 VA 4/13/2009 PA 4/13/2009 OH 4/13/2009 IN 4/13/2009 OH 4/13/2009 WY 4/13/2009 OK 4/13/2009 MA 4/13/2009 FL 4/13/2009 OK 4/13/2009 GA 4/13/2009 AZ 4/13/2009 4/13/2009 TX 4/13/2009 NC 4/13/2009 NY 4/13/2009 IA 4/13/2009 FL 4/13/2009 IL 4/13/2009 4/14/2009 TX 4/14/2009 OH 4/14/2009 CT 4/14/2009 MI 4/14/2009 KY 4/14/2009 KS 4/14/2009 KY 4/14/2009 KY 4/14/2009 KY 4/14/2009 KY 4/14/2009 LA 4/14/2009 AR
61 7 21 1 0.3 0.3 1.3 4 12 25 0.2 52 68 58 1.7 24 1 81 10 10 83 5 21 29 4 42 1.3 13 66 0.5 4 38 4 61 11 72 4 14 39 38 45 20 20 11 2 0.2 0.3 5 1.3 8 64
61 7 21 1 0 1 4 12 25 0 52 68 58 1 24 1 81 10 10 83 5 21 29 4 42 1 13 66 0 4 38 4 61 11 72 4 40 38 45 20 20 10 1 0 0 5 1 8 64
F F F 0F 0.3 F M 0.3 M F F M 0.2 F F M F 0.7 M M 0F M M F F F F F M F 0.4 F F M 0.5 M M F F F F F M F F F F M F F 0.4 M 0.2 M 0.3 M F 0.3 U M F
4/13/2009 2 hours after rec vaccine, welts dev 4/13/2009 12x14 cms- erythema on right right 4/6/2009 Pt states rash on face day following 4/8/2009 VARIVAX eruptions treated with BE 4/8/2009 This case was reported by a healthc 4/8/2009 This case was reported by a physici 4/9/2009 Seen 4/9/09 with small induration an 4/9/2009 Right thigh with erythema and swell 4/10/2009 Pt developed 8cm X 4.5 cm warm, e 3/26/2009 Patient reports a rash - itching - dev 4/13/2009 4/3/09 Hx acting different, restless, 4/13/2009 This case was reported by a lawyer 4/13/2009 This case was reported by a lawyer 4/12/2009 Report 1999019267-1 describes join 4/13/2009 fever, irritability 8 days after vaccina 4/13/2009 Vaccinated 12 days ago with MMR. 4/13/2009 Nine days after receiving the 1st MM 4/13/2009 PATIENT CALLED COMPLAINING 4/13/2009 Pt mom reported that son's develop 4/13/2009 Mildly swollen area 1" to 2" wide pe 4/13/2009 Pt noted an oval shaped, bright red 4/13/2009 Parent reported child was not acting 4/13/2009 Severe suicidal ideation, ever since 4/13/2009 HIVES OVER FACE AND NECK AP 4/13/2009 Immunized 4/8/09, The following da 4/13/2009 numbness in fingers/hands/feet app 4/13/2009 Immunization given on 3/31/2009. C 4/13/2009 Client recieved four vaccines on 4/2 4/13/2009 PT STATES HE REC'D PNEUMOV 4/13/2009 6 month old child received Hepatitis 4/13/2009 mother noticed Saturday night 4/11/ See History & Physical. This patient 4/9/2009 Approximately 2" induration and red 4/10/2009 Red spot on arm at shot site. It's the 4/8/2009 11 y/o experienced a short, 5 secon 4/13/2009 Patient received vaccination on 4-84/13/2009 Blister on the site of injection; next d 4/15/2009 VARIVAX given L arm on 4/9/09, Pt 4/13/2009 Severe pain and edema localized a 4/14/2009 April 7,2009 employee came in to c 4/14/2009 Pt developed erythrematous local s 4/14/2009 Non-viral Pustulosis. 4/14/2009 Nausea, fatigue for one week after v 4/14/2009 Local redness, swelling around injec 4/14/2009 Febrile seizure 3/19/2007 Apnea episodes on day after receiv 3/8/2007 Rotateq started after 12 weeks. 3/28/2007 03/28/07 Pt. developed red rash all Redness and hives at injection site 4/14/2009 On 04/07/09 pt. presented to the off 4/14/2009 lightheaded, dizzy, especially when
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4/14/2009 MI 4/14/2009 CA 4/14/2009 FL 4/14/2009 MI 4/14/2009 RI 4/14/2009 PR 4/14/2009 MD 4/14/2009 PR 4/14/2009 FL 4/14/2009 PR 4/14/2009 PA 4/14/2009 ND 4/14/2009 WI 4/14/2009 CA 4/14/2009 CO 4/14/2009 FL 4/14/2009 4/14/2009 FL 4/14/2009 TX 4/14/2009 PA 4/14/2009 KY 4/14/2009 ND 4/14/2009 CA 4/14/2009 TX 4/14/2009 CA 4/14/2009 MA 4/14/2009 AL 4/14/2009 CA 4/14/2009 AZ 4/14/2009 CA 4/14/2009 NM 4/14/2009 4/14/2009 4/14/2009 4/15/2009 PA 4/15/2009 4/15/2009 GA 4/15/2009 4/15/2009 4/15/2009 4/15/2009 WI 4/15/2009 4/15/2009 MI 4/15/2009 OH 4/15/2009 NH 4/15/2009 CO 4/15/2009 OH 4/15/2009 NJ 4/15/2009 NY 4/15/2009 AL 4/15/2009 CA
20 40 4 6 12 0.2 18 0.7 31 27 63 0.2 67 0.3 39
20 40 4 6 12 0 18 0 72 31 27 63 0 67 0 39
71 39 11 0.2 70 4 4 2 28 4 68 9 0.2 1
71 39 11 0 70 4 4 2 28 4 68 9 0 0
20 18 3
20
11
11
4 18 10 18 2 82 1 0.9 1 13
10 18 82 1 0 1 13
F F U M F 0.2 M F 0.7 M F F F M 0.2 M F 0.4 F M M F M M 0.2 M M M F 0.4 F F M F M 0.2 F 1M F F F U U F F U M M M F F F M F 0M 0.9 F 0M F
4/14/2009 Onset of signs/symptoms approxima 4/14/2009 REQUIRED MD VISIT.2 DAYS S/P 4/14/2009 Received call from mom @ 1:29 sta 4/14/2009 Area where varicella (RA-SQ) becam 4/14/2009 Syncopal episode about 5-10 minut 4/14/2009 RASH ALL OVER THE BODY 2 HO 4/14/2009 UNPLANNED PREGNANCY 4/14/2009 SYSTEMIC URTICARIAL RASH A F 4/14/2009 Red and indurated area on left delto 4/14/2009 PATIENT REFERS HAVING A RAS 4/14/2009 Administration site reaction. 2 inch 4/14/2009 Developed nausea and vomiting aft 4/14/2009 Unconsolable crying for several hou 4/14/2009 Patient developed Guillan Bare syn 4/14/2009 Patient experienced 5-6 bouts of dia 4/2/2009 A serious clinical trial report of allerg 4/14/2009 This case was reported by a physici 4/14/2009 Local redness and swelling at the in 4/10/2009 None. WNL. 3/6/2009 Vaccine given in Left deltoid. Redn 4/10/2009 Left thigh redness/swelling/tender 4 4/13/2009 Pt. called @ 11:10 A on 4-13-09 an 4/14/2009 Pt with hot, tender, swollen area rig 4/14/2009 Shingles, recurrent area on face, 4/13/2009 Had IZ on 4-9-09 04-11-09 2/3 of up 4/14/2009 Peri-oral rash and slight numbness, 4/14/2009 9X9 cm red reaction on L thigh with 4/14/2009 Rash at injection site (large lumps) i 4/14/2009 L arm has rash & VARICELLA appe 4/14/2009 Small rash after receiving Rotavirus 4/14/2009 Mother called 8 days after DTap wa 4/9/2009 My daughter is 13 yrs old and has r 4/10/2009 After first dose, there was a very sh 4/11/2009 After injection at 2:33 pm on the dat 4/14/2009 It was reported Y in a newspaper artic 4/14/2009 It was reported Y in a newspaper artic 4/14/2009 InformationYhas been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/13/2009 Information has been received from 4/10/2009 None Stated 4/9/2009 Patient left office after getting 4 vac 4/10/2009 (red, swollen, warm, painful; he had 4/10/2009 2" oval area of redness & induration 4/2/2009 Cough, fever- Sat morning (3/28/09 4/10/2009 Urticaria 4/7/2009 Rash - BENADRYL Rash X 24 hour 4/8/2009 Patient came in for MD visit 4/8/200
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4/15/2009 MN 4/15/2009 CA 4/15/2009 NJ 4/15/2009 NM 4/15/2009 4/15/2009 FL 4/15/2009 AZ 4/15/2009 MN 4/15/2009 TX 4/15/2009 OK 4/15/2009 PA 4/15/2009 NY 4/15/2009 TX 4/15/2009 CO 4/15/2009 IL 4/15/2009 PA 4/15/2009 MI 4/15/2009 4/15/2009 IN 4/15/2009 NE 4/15/2009 IN 4/15/2009 CA 4/15/2009 TN 4/15/2009 PA 4/15/2009 SC 4/15/2009 NJ 4/15/2009 IA 4/15/2009 FL 4/15/2009 MI 4/15/2009 WI 4/15/2009 MI 4/15/2009 CA 4/15/2009 CO 4/15/2009 DC 4/15/2009 HI 4/15/2009 VA 4/15/2009 VA 4/15/2009 NY 4/15/2009 WI 4/15/2009 NY 4/15/2009 MO 4/15/2009 MO 4/15/2009 VA 4/15/2009 VA 4/15/2009 IL 4/15/2009 AL 4/15/2009 NH 4/15/2009 NC 4/15/2009 IA 4/15/2009 MO 4/15/2009 CA
28 4 57 4 26 27 65 14 21 4 1.3 43 9 4 13 1 1.4 28 4 41 1 45 0.5 1.1 12 12 11 15 55 4 55 18 38 62 1.2 9 2 0.2 1.5 0.5 19 45 6 6 49 1.1 0.2 21 52 0.2 62
28 4 57 4 26 27 65 14 21 4 1 43 9 4 13 0 1 28 4 41 1 45 0 1 12 12 11 15 4 55 18 38 62 1 9 2 0 1 0 19 45 6 6 49 1 0 21 52 0 62
F M F M F M M F M F 0.3 M M F U F 1M 0.4 M F F F 0M M 0.5 M 0.2 F F M M F M F M F F M 0.2 M F 0.5 M 0.2 F 0.5 M 0.5 F M M F M F 0.1 F 0.2 M M F 0.2 M F
4/6/2009 Employee reports fever ranging from 4/8/2009 Developed fever, high 103 degrees Pain, redness & edema left deltoid w 4/9/2009 Warm to touch and little swelling LD 4/8/2009 Headache same day lasted 3 days. 4/9/2009 Flu Shot 4/10/2009 On 4/3 observed rash arms, hands, 4/9/2009 Pt received shingles vaccine @ app 4/8/2009 Nodular rash red indurated 1 1/2 inc 4/8/2009 41/2"x 51/2" duration, warm to touch 4/8/2009 As per mom, he was drinking juice, 4/10/2009 Severe left arm pain, fever, chills an 4/2/2009 Redness & slight swelling posterior She got a fever the evening of the im 4/3/2009 Child became very pale, lightheade Erythema multiform - treatment 5 da 4/15/2009 Zoster Vaccine administered to child 4/15/2009 Vaccinated with ACAM2000 during 4/15/2009 Mother noted Left upper arm was sw 4/15/2009 At 1800, noted dime size erythemia 4/15/2009 Patient presented to the emergency 4/15/2009 Chills, fever, joint aches Right shoul 4/15/2009 within half-hour of Pentacel injection 4/15/2009 On 4/14/09 mother reported child ha 4/15/2009 Patient called our office to inform us 4/15/2009 High body temperature 103.2 F 4/15/2009 1.5 CM AREA DIRECTLY OVER LE 4/15/2009 AMENORHEA SINCE DECEMBER 4/15/2009 Was given a shot of PPV Pneumoco 4/15/2009 Woke up with severe pain yesterday 4/15/2009 PPV vacine shot on 4/13, 99.4 feve 4/15/2009 States 2-3 days after recieving 1st G 4/15/2009 One day post-vaccination with JE-V 4/15/2009 This case was reported by a healthc 4/15/2009 Petechial rash + bruising + oral blee 4/14/2009 Fever to 101-102. (R) arm erythema 4/14/2009 L septic hip requiring prolonged IV a 4/15/2009 Pt. received vaccine 3/31/09. Prese 3/19/2009 On 10.14.04 - Patient received FLU 3/31/2009 Patient admitted to hospital for a bo 4/15/2009 Red slightly raised sand paper type 4/15/2009 Scattered red raised itching welts pe 4/14/2009 L upper arm cellulitis at injection site 4/14/2009 R upper arm cellulitis at injection sit 4/15/2009 Hives around neck, hairline and bila 4/15/2009 Erythematous rash, swelling of hand 4/9/2009 Having runny yellow diarrhea stools 4/13/2009 Fainted - had not eaten. 4/13/2009 3/25/09 received vaccination. 3/30/0 4/13/2009 Patients mother called office approx 4/15/2009 Pt noticed there was a 4" circle at in
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4/15/2009 CA 4/15/2009 CA 4/15/2009 CA 4/15/2009 WA 4/15/2009 MA 4/15/2009 4/16/2009 CA 4/16/2009 WI 4/16/2009 4/16/2009 CA 4/16/2009 CA 4/16/2009 PA 4/16/2009 NJ 4/16/2009 VA 4/16/2009 NM 4/16/2009 FL 4/16/2009 NC 4/16/2009 CT 4/16/2009 OR 4/16/2009 NY 4/16/2009 SD 4/16/2009 NY 4/16/2009 TX 4/16/2009 AK 4/16/2009 CA 4/16/2009 MD 4/16/2009 SC 4/16/2009 CA 4/16/2009 CA 4/16/2009 CO 4/16/2009 WA 4/16/2009 NC 4/16/2009 NC 4/16/2009 PA 4/16/2009 4/16/2009 CA 4/16/2009 PA 4/16/2009 NY 4/16/2009 UT 4/16/2009 MI 4/16/2009 FL 4/16/2009 PR 4/16/2009 NC 4/16/2009 PA 4/16/2009 MA 4/16/2009 FL 4/16/2009 IA 4/16/2009 UT 4/16/2009 CA 4/16/2009 NC 4/16/2009 MS
41 14 0.5 11 23 1.2 0.3 19 17 36 0.6 42 1.6 0.2 31 0.2 54 0.2 58 68 18 5 1 62 0.5 4 1.3 48 0.5 62 17 5 15.7 13 0.6 16 4 35 21
41 14 0 11 23 1 0
28 43 1 1.5 65 14.4 76 4 0.2 11 3
28 43 1 1 65 14 76 7 0 11 3
36 0 42 1 0 31 0 54 0 58 68 18 5 1 62 0 4 1 47 0 62 17 5 15 13 16 4 35 21
F F 0.5 F M M 0.2 F 0.3 F F F F 0.6 F F 0.6 M 0.2 F F 0.2 M F 0.2 M F M M M 0F F 0.5 F F 0.3 M F 0.6 F F F F F M M F F F F F F M 0F 0.5 F F F F M 0.2 M M F
3/18/2009 Onset of mild - mod fever, nausea, 4/15/2009 Redness with swelling to R deltoid. 4/15/2009 Seizure with fever T 103.8. 4/15/2009 See attached chart note dated 4-15 4/10/2009 Headache, fever muscle weakness. 4/11/2009 Blisters on back and on face. 4/15/2009 ABOUT H+4 HOURS AFTER WE N 4/15/2009 Information has been received from 4/15/2009 Information has been received from 4/13/2009 This serious case was received on 0 4/13/2009 Initial SAE report received on 04 Ap 4/16/2009 Pain, redness, swelling, fever(101), 4/16/2009 LARGE RED LUMP WITH BLISTER 4/13/2009 Parents reported blank stare and un 4/16/2009 I had local pain, irritation, swelling, a 4/16/2009 Polyarticular arthritis within 3days o 4/16/2009 Client c/o pain from Lt shoulder eigh 4/16/2009 He received his vaccination on Mon 4/16/2009 Client reports that 3 weeks after rec 4/16/2009 Right upper arm swelling, edema an 4/3/2009 Severe H/A, Stiff Neck Temp 100 4/16/2009 Less than 1 minute after administer 4/16/2009 seizures, Anemia, low red and white 4/16/2009 5 hours after vaccination, became o 4/16/2009 GAVE ROTARIX AT 6 MONTHS OF 4/16/2009 PATIENT HAD A REACTION ON LE 4/16/2009 vaccine given in left thigh, brought b 4/16/2009 LOCALIZED REACTION ON (R)UP 4/16/2009 A black dot appeared on infant's rig 4/16/2009 EDEMA, ERYTHEMA, PRURITIS, S 4/16/2009 3 days post vaccination, patient had "Red, hot swollen size of dollar bill" 7 x 7 cm raised erythematous plaqu 4/15/2009 Fever 101, headache, malaise durin 4/9/2009 PEDIARIX given R thigh 4-1-09 per 4/16/2009 Patient was given the GARDASIL # 4/16/2009 Mom called office 4/16/09 0900 to r 4/13/2009 Pt presented to PCP 1 wk after she 4/13/2009 Fever, runny nose, itching started e 4/14/2009 Administration of ZOSTAVAX 4-7-0 4/10/2009 Received FLUZONE vaccine on 9/1 4/1/2009 1 hr after vaccine: Headache, neck 4/2/2009 3-4 cm area of redness - right thigh 4/15/2009 Below vaccines were given at abou 4/16/2009 Developed rash on forearms 7 days 4/16/2009 After receiving shot in AM of 4-7-09 4/16/2009 Received ZOSTAVAX 1500 on 4/8/ 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w 4/16/2009 Cried non-stop for at least an hour. 4/16/2009 Swelling, erythema, warmth & indur 4/16/2009 Right thigh hot, swollen and red at i
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4/16/2009 KY 4/17/2009 4/17/2009 4/17/2009 VA 4/17/2009 NH 4/17/2009 NH 4/17/2009 MS 4/17/2009 CA 4/17/2009 PA 4/17/2009 OR 4/17/2009 GA 4/17/2009 IA 4/17/2009 NY 4/17/2009 NY 4/17/2009 WA 4/17/2009 OH 4/17/2009 MI 4/17/2009 KS 4/17/2009 PA 4/17/2009 MI 4/17/2009 AL 4/17/2009 OH 4/17/2009 CO 4/17/2009 KS 4/17/2009 KS 4/17/2009 MN 4/17/2009 VA 4/17/2009 WI 4/17/2009 MS 4/17/2009 MT 4/17/2009 WA 4/17/2009 MO 4/17/2009 OH 4/17/2009 TX 4/17/2009 PA 4/17/2009 OR 4/17/2009 MN 4/17/2009 FL 4/17/2009 MD 4/17/2009 LA 4/17/2009 NY 4/17/2009 TX 4/17/2009 CA 4/17/2009 PA 4/17/2009 CA 4/17/2009 CA 4/17/2009 CA 4/17/2009 PA 4/17/2009 IN 4/17/2009 PA 4/17/2009 WY
14 6 18
13 0.5 4 19 14 6 56 13 0.2 22 9 0.2 1 73 4 17 66 80 69 3 10 2 12 41 37 34 13 79 4 5 0.2 9 15 74 14 5 63 53 53 51 0.4 0.5 4 20
14 18 10 13 0 4 19 14 6 56 13 0 22 9 0 1 73 4 17 66 80 80 3 10 2 12 41 37 34 13 78 4 5 0 0 15 74 14 5 62 53 53 48 0 0 4 20
F M F U U M 0.5 F F F F F U F F 0.2 F F M 0.2 M 0M M M F M F F U F M 0.6 M M F F F F F M F 0.2 F 0.2 M F F F M F F M F 0.4 F 0.5 M M F
4/16/2009 Chest pain, slight shortness of brea 4/16/2009 Information has been received from 4/16/2009 Information has been received from 4/16/2009 Information has been received from 5 cm indurated local reaction. 4/16/2009 Large local reaction 10-12 cm, with Fever morning after vaccine T max 4/10/2009 Child had a DTAP on 4/09/09. Bene 3/26/2009 3/20/09 had GARDASIL #2 at appro 4/8/2009 Pt. had acute onset of severe vomit 4/14/2009 Chicken Pox with HX of one dose o None Stated 4/13/2009 Same evening arm soreness + swe 4/10/2009 Headache, bodyache, some nausea 3/24/2009 Patient's leg starting swelling right a 4/10/2009 Rash on stomach, chest, genitals 4/14/2009 Right arm swollen, red, and hot to th 4/9/2009 [As reported to me by ER physician 4/11/2009 04/09/09 vomit, diarrhea, stomach p 4/17/2009 Patient developed chills overnight a 4/17/2009 Phone call from parent on 4/15/09 @ 4/17/2009 Initial fatigue, headaches, muscle cr 4/17/2009 ON 04/12/2009, PT BROKE OUT O 4/17/2009 The patient received the Zostavax v 4/17/2009 The patient received the Zostavax v 4/17/2009 Subject in pneumococcal vaccine tr 4/17/2009 Parent noted redness and swelling 4/17/2009 Pt received immunizations and abou 4/17/2009 moderate sized erythema to left thig 4/17/2009 Patient developed red "Rash" accor 4/17/2009 Received Tdap vaccination on 4/13 4/17/2009 I developed I large area around the 4/17/2009 Redness and swelling at injection si 4/17/2009 fatigue,headache ,feels warm ,no fe 4/17/2009 Patient had some redness appear a 4/17/2009 Tolerated immunizations fine Given 4/17/2009 PT LEFT ARM SWOLLEN AND WA 4/17/2009 Intussusception 4/29/09 Received h 4/17/2009 right arm red and swollen and vomit 4/17/2009 During summer of 2008, patient had 4/17/2009 Vaccinated with Pneumovax on 3/3 4/17/2009 Palm size hot swelling at injection s 4/17/2009 PT REPORTS LOCALIZED (R) UPP 4/17/2009 Red rash on left arm (arm of injectio 4/17/2009 Warm, redness and tenderness 6x1 4/17/2009 6x8 cm area around injection site te 4/17/2009 Left deltoid = 4x5 cm area of erythe 4/17/2009 Paleness, vomiting, lethargic, breath 4/17/2009 Erythematous, warm 7X7 cm. indura 4/17/2009 Local erythema + induration 3X2 cm 4/11/2009 After immunization was given pt we
344379 344380 344381 344382 344383 344384 344726 344730 344732 344733 344736 344737 344738 344739 344740 344741 344742 344744 344747 344750 344751 345209 345210 345211 345212 345213 345214 345215 345216 345217 345218 345219 345220 345221 345222 345223 345224 345225 345226 345227 345228 345229 345230 345231 345232 345233 345234 345235 345236 345237 345238
4/17/2009 NJ 4/17/2009 NM 4/17/2009 UT 4/17/2009 FL 4/17/2009 WA 4/17/2009 IL 4/17/2009 CA 4/17/2009 PA 4/17/2009 VA 4/17/2009 KS 4/17/2009 4/17/2009 GA 4/17/2009 IL 4/17/2009 4/17/2009 4/17/2009 TN 4/17/2009 DC 4/17/2009 4/17/2009 OR 4/17/2009 TX 4/17/2009 4/17/2009 4/17/2009 NY 4/17/2009 CO 4/17/2009 OR 4/17/2009 4/17/2009 CA 4/17/2009 4/17/2009 4/17/2009 MD 4/17/2009 FL 4/17/2009 IL 4/17/2009 TX 4/17/2009 AR 4/17/2009 VA 4/17/2009 TX 4/17/2009 4/17/2009 AZ 4/17/2009 OR 4/17/2009 4/17/2009 4/17/2009 MI 4/17/2009 CA 4/17/2009 4/17/2009 PA 4/17/2009 4/17/2009 TX 4/17/2009 4/17/2009 OH 4/17/2009 OK 4/17/2009
4 1.6 4 1.2 1.3 10 18 14 23 16 14 25 18 14 20 15 17 16 9
4 1 7 1 10 18 14 23 16 14 25 18 20 15 17 16 9
18 27 25 23 21 14
25 23 21
19 22 15 15 21
21
16 17 18 18 15
15
17 22 20 14 16 23
14 16
M 0.6 M M M 0.3 M F F F F F F F F F F F F F F U F F F F F F F F U F F F F F F F F F F F F F F F F F F F F F F
4/17/2009 Localized reaction right upper arm + 4/18/2009 None 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w 4/17/2009 Pt had fever followed by generalized 4/16/2009 Pts mom called on 4/16/09 & said 4 4/13/2009 Patient started on GARDASIL serie 4/14/2009 Information has been received throu 4/14/2009 Information has been received via th 4/14/2009 Information and follow up informatio 4/14/2009 Information has been received from 4/14/2009 Information has been received throu 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Initial and follow-up information has 4/14/2009 Information has been received for th 4/14/2009 Initial and follow-up information has 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received for th 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information hs been received from a 4/14/2009 Information has been received from
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4/17/2009 4/17/2009 FL 4/17/2009 4/17/2009 NE 4/17/2009 WI 4/17/2009 MA 4/17/2009 4/17/2009 SC 4/17/2009 NJ 4/17/2009 NY 4/17/2009 4/17/2009 MO 4/17/2009 MO 4/17/2009 MO 4/17/2009 NJ 4/17/2009 4/17/2009 FL 4/17/2009 MD 4/17/2009 NC 4/17/2009 4/17/2009 4/17/2009 CA 4/17/2009 4/17/2009 FL 4/17/2009 MO 4/17/2009 GA 4/17/2009 4/17/2009 IN 4/17/2009 FL 4/17/2009 IL 4/17/2009 4/17/2009 WI 4/17/2009 4/17/2009 NJ 4/17/2009 FL 4/17/2009 MN 4/17/2009 4/17/2009 4/17/2009 4/17/2009 4/17/2009 PA 4/17/2009 PA 4/17/2009 4/17/2009 NJ 4/17/2009 4/17/2009 4/17/2009 4/17/2009 4/17/2009 MD 4/17/2009 KY 4/17/2009 MD
11 18 49
18 49
23 16 22
23
19
19
14 12 16 13 18 21
13 21
15 24
15 24
22
22
11
11
14 15
14
15
15
11 21 16 24 23
11
18
18
11 19 23
11
18 20 15 19
18 20 15 19
16
F F F F F F F F F F F F F F F F F F F F F F U F F F F F F F F F F F F F F U F F F F F F F F F F F F F
4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from 4/14/2009 Information has been received from
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4/17/2009 WI 4/17/2009 4/17/2009 4/17/2009 TX 4/17/2009 4/17/2009 4/17/2009 PA 4/17/2009 CA 4/17/2009 NY 4/17/2009 MO 4/17/2009 4/17/2009 MD 4/17/2009 4/17/2009 VA 4/17/2009 NC 4/17/2009 DE 4/17/2009 4/17/2009 4/17/2009 4/17/2009 FL 4/17/2009 SD 4/17/2009 VA 4/17/2009 4/17/2009 OR 4/17/2009 VA 4/17/2009 4/17/2009 PA 4/17/2009 4/17/2009 4/17/2009 SC 4/17/2009 PA 4/17/2009 4/18/2009 TX 4/18/2009 NY 4/18/2009 NJ 4/19/2009 CA 4/20/2009 CA 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 CA 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009 4/20/2009
21
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25 26 26
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24 25 27
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4/20/2009 4/20/2009 MS 4/20/2009 NY 4/20/2009 ID 4/20/2009 ID 4/20/2009 ID 4/20/2009 ID 4/20/2009 VI 4/20/2009 NY 4/20/2009 TX 4/20/2009 TX 4/20/2009 MI 4/20/2009 OH 4/20/2009 IN 4/20/2009 4/20/2009 FL 4/20/2009 CA 4/20/2009 LA 4/20/2009 NY 4/20/2009 NC 4/20/2009 IL 4/20/2009 CA 4/20/2009 OH 4/20/2009 OH 4/20/2009 MD 4/20/2009 SD 4/20/2009 LA 4/20/2009 WI 4/20/2009 VA 4/20/2009 OK 4/20/2009 OR 4/20/2009 GA 4/20/2009 FL 4/20/2009 FL 4/20/2009 UT 4/20/2009 OR 4/20/2009 MN 4/20/2009 NY 4/20/2009 4/20/2009 OH 4/20/2009 NH 4/20/2009 CA 4/20/2009 CA 4/20/2009 CA 4/20/2009 CA 4/20/2009 OH 4/20/2009 NY 4/20/2009 RI 4/20/2009 MD 4/20/2009 NY 4/20/2009 MN
78 68 5 4 5 4 13 64 1 40 1.1 5 2 23 11 5 18 3 4 1.5 0.3 1 0.2 12 15 49 12 12 18 22 0.2 79 14 26 16 13 1 19 1.2 21 4 1.8 1.3 3 11 4 76 0.4 4 30
78 68 5 4 5 4 13 64 1 40 1 5 2 23 11 5 18 3 4 1 0 1 0 12 15 49 12 12 18 22 0 79 14 26 16 13 19 1 21 4 1 1 3 11 4 76 0 4 30
U M F M F M F F F 0M F 0.1 M M 0M M F M M F M 0.5 F 0.3 M 0F 0.2 F F F F F F F F 0.2 M F F M M M F M 0.2 M U M 0.8 M 0.3 F M M M M 0.4 F M M
4/17/2009 Information has been received from 4/3/2009 Drooling, very slurred speech, loss o 4/17/2009 Papular rash, left groin area, about 4/1/2009 Pt woke up this am with redness to 4/10/2009 Pt noticed itching to right arm 2d aft 3/23/2009 Pt here in clinic today with chicken p 4/1/2009 Pt's mom states that pt c/o pain with 4/20/2009 Client state "notice bumps on body 4/3/2009 PNEUMOVAX given on 4/1/09 - had 4/16/2009 As per mom Pt swollen to Lt thigh. 4/15/2009 Patient developed pain/tenderness 4/14/2009 Pt with rash that developed 10 days 4/15/2009 At site of DTaP noticed red welt on 4/16/2009 4-14-09 Mother brought pt to office 4/20/2009 I received 5 doses of the Anthrax va 4/20/2009 Hives and swelling of face and eyes 4/20/2009 Three days after being immunized, 4/20/2009 Severe joint stiffness-difficulty in get 4/20/2009 Patient was given Chicken Pox (Var 4/20/2009 localized rash on left thigh, red patc 4/20/2009 Mother of child reported that child h 4/20/2009 Got a fever after 48 hours of receivi 4/20/2009 vaccines admin 01/08/09, pt started 4/20/2009 fussy and lowgrade fever day of imm 4/20/2009 Pt stated that twice since administra 4/15/2009 Fever 1 day after vaccinations, Face 4/20/2009 Was aware of soreness in arm 4/18 4/20/2009 After recieving vaccine, Mariah start 4/20/2009 Localized swelling at injection site. R 4/20/2009 No complaints-screened Jan 13, 20 4/20/2009 Left sided facial redness, itching an 4/20/2009 Apparant SIDS/Post Y Mortem Exam 4/20/2009 I had the shingles vaccine on April 1 4/20/2009 fever, vomiting,malise, headache co 4/15/2009 Fever (102 degrees F) lasting 36 ho 4/11/2009 Local reaction at injection site, left d 4/13/2009 Redness and swelling at injection si 4/14/2009 Child started with erythematous ma Vasovagal episode Records recieve 4/14/2009 Swelling at sight of injection. Pt complained of severe pain at site 4/16/2009 Left leg swollen to the knee. No pa 4/2/2009 Family took patient to walk-in vaccin 4/13/2009 Swelling, pain, high fever due to mis 4/9/2009 Pain, fever and swelling due to mist 4/15/2009 BOOSTRIX given in (L) deltoid on 4 4/10/2009 Bullae at injection site within 24 h (a 4/20/2009 This case was reported via medical 4/15/2009 2 - PREVNAR administered on 4/13 4/13/2009 10 minutes after shot: body aches4/14/2009 Pt had the TDAP vaccine 10-29-08.
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4/20/2009 LA 4/20/2009 NY 4/20/2009 TX 4/20/2009 MN 4/20/2009 NE 4/20/2009 CA 4/20/2009 CA 4/20/2009 IL 4/20/2009 PA 4/20/2009 CA 4/20/2009 MN 4/20/2009 MI 4/20/2009 4/20/2009 KY 4/20/2009 PA 4/20/2009 TX 4/20/2009 RI 4/20/2009 CT 4/20/2009 NV 4/20/2009 CO 4/20/2009 4/20/2009 CT 4/20/2009 NY 4/20/2009 MN 4/20/2009 CA 4/20/2009 VA 4/20/2009 VA 4/20/2009 SC 4/20/2009 CA 4/20/2009 MD 4/20/2009 MD 4/20/2009 MD 4/20/2009 MD 4/20/2009 TX 4/20/2009 4/21/2009 WI 4/21/2009 CT 4/21/2009 AZ 4/21/2009 FL 4/21/2009 CA 4/21/2009 NC 4/21/2009 OH 4/21/2009 MA 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 4/21/2009 TX 4/21/2009
53 31 28
53 31
0.6 76 72 0.7 1.4 0.1 1.4 64 1 4 1 12 13 34 19 55 15 5 1.4 28 2 2 5 76 15 4 1.3 3 3 3
0 76 72 0 1 0 1 64 1 4 0 12 13 34 19
11 9 4 32 16 14 1 1
11 9 4 32 16 14 1 1
20
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15 5 1 28 2 2 5 76 15 4 1 3 3
F M M F 0.6 M F F 0.7 F 0.4 M 0.1 F 0.4 M F 0M F 1F F F M M F M M 0.4 M U 0.1 M 0.3 M F F F F 0.3 F F F M M F F M F F F 0F 0M U U U U U F M 0.4 M
4/6/2009 4/4/09 Sat. noon sudden onset with 4/20/2009 Swelling of arm at injection site, diar 4/13/2009 None stated. 4/13/2009 Extremely swelling to the site. Moth 4/20/2009 6 mos had 3 seizures following 6 mo 4/18/2009 2 days after vaccination, patient had 4/20/2009 Rash, itch, rhinorrhea started the fo 4/17/2009 03/21/2009 started with cold & coug Vesicles and ulcers over scrotum, tr 4/20/2009 Hives, swollen feet + hands 4/15/2009 Within 48 hours, he had an 11 cm s 4/20/2009 Cellulitis (R) upper arm. Started on 4/20/2009 Chicken pox. Patient had vaccine o 4/17/2009 Local reaction 4x5cm, induration an 4/20/2009 Patient experienced a seizure appro 4/20/2009 As per patient on off dizziness since 4/17/2009 Syncope post GARDASIL and MEN 4/20/2009 Developed fever approximately 8 ho 4/17/2009 Student had fever 100.1 and chills. 4/16/2009 Headache, nausea after 1st shot, re 4/15/2009 Patient given VARICELLA & MENA 4/17/2009 Sneezing, congestion, swallowing fr 4/20/2009 04/16/2009 Mother called and spok 4/20/2009 Pt received SPV left arm on 4/4/09. 4/20/2009 Urticaria started 48-72 hours after H 4/20/2009 Oval upper thigh induration 10x9cm 4/20/2009 Within minutes of the DTAP, pt had 4/17/2009 Patient developed shingles 4/15/09. 4/15/2009 Per mother of Pt; Pt arms became t 3/12/2009 A non-serious, spontaneous report 3/12/2009 A non-serious, spontaneous report 3/12/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/2/2009 A non-serious spontaneous report o 4/20/2009 Information has been received from 4/9/2009 Received MENACTRA 4/8/09 at 4:1 4/14/2009 5 minutes post vaccine -> felt dizzy, 4/15/2009 Pt presented with Sx of allergic Rxn 4/15/2009 Rash Tightness of chest next day. 4/16/2009 After Gardasil #3 woke up with shou 4/15/2009 Hives on face and trunk extremities. 4/16/2009 Pt seen with vesicular rash on trunk 4/16/2009 3/30/09 physical with immunization 4/20/2009 Information has been received from 4/20/2009 Via agency concerning a patient wh 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/20/2009 Information has been received from 4/17/2009 Initial report received 07 April 2009 4/20/2009 Initial report received 09 April 2009
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4/21/2009 WI 4/21/2009 MS 4/21/2009 VA 4/21/2009 CA 4/21/2009 NY 4/21/2009 IL 4/21/2009 NC 4/21/2009 MA 4/21/2009 VA 4/21/2009 CA 4/21/2009 TX 4/21/2009 IL 4/21/2009 TX 4/21/2009 TX 4/21/2009 IL 4/21/2009 NY 4/21/2009 LA 4/21/2009 VA 4/21/2009 CA 4/21/2009 NC 4/21/2009 FL 4/21/2009 4/21/2009 NC 4/21/2009 WI 4/21/2009 MO 4/21/2009 CT 4/21/2009 PA 4/21/2009 MI 4/21/2009 CO 4/21/2009 AL 4/21/2009 CO 4/21/2009 CA 4/21/2009 NY 4/21/2009 4/21/2009 NJ 4/21/2009 ME 4/21/2009 NC 4/21/2009 MA 4/21/2009 MA 4/21/2009 KS 4/21/2009 NE 4/21/2009 CA 4/21/2009 IL 4/21/2009 AZ 4/21/2009 OH 4/21/2009 NC 4/21/2009 4/21/2009 MN 4/21/2009 TN 4/21/2009 KS 4/21/2009 CA
1.5 5 0.3 13 0.8 11 1.5 35 1 0.2 40 13 66 73 68 6 1 0.2 58 14 1 22 12 21 8 12 11 13 51 1.1 35
1 5 0 13 0 11 1 35 1 0 40 13 66 73 68 1 0 58 14
14
22 12 21 0 12 11 13 51 1 35 18 14
62 21 0.6 1.7 1.3 12 5 53 20 1 12 20 41 5 0.5 1.3 11
62 21 0 1 1 12 5 53 20 1 12 20 41 5 0 1 11
0.5 F M 0.3 M F 0.8 M M 0.5 F F 0F 0.2 M F M F F F M 0M 0.2 F F M M M M F 0F F M M M 0.1 F M F F M M M 0.6 F 0.7 M 0.3 F M M F M 0M F F U F 0.5 F 0.3 M F
4/14/2009 Syncopal episode, fever - 102.7, pa 4/3/2009 Mom stated child c/o pain, redness 4/16/2009 Approximately 15-20 minutes after v 4/15/2009 About 5-10 min after vaccination giv 4/16/2009 Fever to 102 degrees and diffuse ur 4/10/2009 Seen on 4/10/09 left deltoid noted to 4/8/2009 Child received vaccination on 3-27-2 4/16/2009 Pt reported swelling and hardness a 4/16/2009 Blue blotches over body, especially 4/13/2009 2 mo old male received vaccines 4/1 4/15/2009 Rec'd varicella 4/7/09. At 3:30am on 4/16/2009 Patient had swelling and pain of inje 4/21/2009 Patient came down with shingles wi 4/21/2009 Patient developed painful rash with 4/21/2009 Shingles vaccine administered 04/1 4/21/2009 Child received PPD and Flu vaccine 4/21/2009 15 minutes following injection of var 4/21/2009 On 4/15 and 4/16 baby was cranky 4/21/2009 Increase itching and rash on arm wh 4/21/2009 red, swollen, hot area where vaccin 4/21/2009 About 12 days after getting Proquad 4/21/2009 Unspecified disease of the pericard 4/21/2009 red, swollen, hot area around where 4/21/2009 On day of administration, had flu-lik 4/21/2009 NO ADVERSE EVENT-MD ORDER 4/21/2009 Syncopal episode fainted 4/21/2009 Pt recieved tdap and varicella and p 4/21/2009 Patient received a Tdap and 1st He 4/21/2009 Two days following Twinrix vaccine 4/21/2009 2 day h/o rash starting on face and 4/21/2009 fever body aches HA vomitng for 3 4/21/2009 Given HPV injection approx. 8:20 a. 4/21/2009 Previous diagnosis to vaccine-Hypo 4/21/2009 This case was reported via medical 4/21/2009 This case was reported by a lawyer 4/20/2009 Received vaccines 4/2, on 4/9 deve 4/21/2009 Child ran a fever up to 104 with last 3/26/2009 Patient received DTap and VARIVA 3/26/2009 Patient received DTap vaccine in le 4/20/2009 Sore throat, difficulty swallowing, ho 4/21/2009 Large target lesion (7cm x 5 cm) wit 4/15/2009 Pt c/o mild pain at left upper arm at 4/21/2009 Fever and cold sweats and chills 4-2 4/21/2009 Erythema on L thigh with chicken po 4/21/2009 Erythematous papular and plaque li 4/13/2009 Received smallpox 31 Mar 09 Lt up 7/28/2008 This is a follow-up to a previously su Nausea, vomiting and diarrhea, sub 4/20/2009 Knot upper (R) leg. 4/17/2009 Fever, decreased appetite, rash, sh 4/10/2009 After vaccines were given the patien
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4/21/2009 FL 4/22/2009 MN 4/22/2009 NY 4/22/2009 RI 4/22/2009 NJ 4/22/2009 UT 4/22/2009 WA 4/22/2009 MI 4/22/2009 TX 4/22/2009 KY 4/22/2009 4/22/2009 4/22/2009 NC 4/22/2009 GA 4/22/2009 MT 4/22/2009 NH 4/22/2009 4/22/2009 AZ 4/22/2009 4/22/2009 4/22/2009 MO 4/22/2009 WI 4/22/2009 DC 4/22/2009 AR 4/22/2009 NC 4/22/2009 MA 4/22/2009 IN 4/22/2009 DC 4/22/2009 IA 4/22/2009 IA 4/22/2009 MN 4/22/2009 NC 4/22/2009 CA 4/22/2009 CA 4/22/2009 CA 4/22/2009 CT 4/22/2009 4/22/2009 TX 4/22/2009 NY 4/22/2009 NC 4/22/2009 IN 4/22/2009 MI 4/22/2009 TX 4/22/2009 CA 4/22/2009 VA 4/22/2009 SC 4/22/2009 NC 4/22/2009 MN 4/22/2009 NC 4/22/2009 4/22/2009 NJ
1 15 14 0.3 1.5 44 12 58 12 12 21 87 0.2 0.2 5 0.6 31 13
1 15 14
18 15 1 16 4 32 0.2 18 7 17 4 5 0.3 4 4 14 63 60 11 39 36 22 60 53 21 4 0.2 67 4 17 23 22
18 15 1 16 4 32 0 18 7 17 4 5 0 4 4 14 63 60 11 39 36
1 44 12 58 12 21 87 0 0 5 0 31 13
60 53 21 4 67 4 17
0F F F F 0.5 M F F M F M M M 0.2 F 0.2 M F 0.6 F F F F F F 0F F M F 0.2 F F M F F M 0.3 M M M M F M M F M F U F M F F F F F F F
4/21/2009 Sudden (<15min) onset of facial sw Immediately after vaccination, eyes 4/20/2009 Since 8/5/08, 2 wks after her 2nd G 4/10/2009 On 4/15/09 Patient brought by pare 4/17/2009 Choking during swallowing; Febrile 4/17/2009 Fatigue after immunization. Woke u 4/17/2009 Immediately after receiving 2nd GAR 4/9/2009 Customer is having tingling sensatio 4/17/2009 Patient was given Hep A 1st, then H 4/17/2009 area of redness where injection give 4/19/2009 10 days after vaccine with smallpox 4/17/2009 @ 18 hrs after injection erythematou 4/17/2009 Hematochezia, twice - Fussiness - C 4/21/2009 InformationYhas been received from 4/16/2009 3" area of erythema, induration at Iz 4/6/2009 HIB vaccine was mixed with sterile w 4/21/2009 Information has been received from 4/21/2009 Initial and additional information has 4/21/2009 Information has been received from 4/21/2009 Information has been received from 4/22/2009 Mother reports child woke up "Sund 4/22/2009 Patient developed a skin infection a 4/22/2009 PT RECEIVED DTAP INSTEAD OF 4/22/2009 Left upper arm from just above elbo 4/22/2009 Patient had loss of consciousness a 4/22/2009 Child received 2 month vaccines as 4/22/2009 Patient received vaccinations and a 4/22/2009 THIRD VARICELLA VACCINE REC 4/22/2009 Patient turned pale and diphoretic a 4/22/2009 Red and inderated at injection site. 4/22/2009 Large local reaction from left elbow 4/22/2009 3 days after receiving his 4 month b 4/22/2009 WITHIN 24 HR OF VACCINES, PT 4/22/2009 LT DELTOID MACULAR RASH,MIL 4/22/2009 developed large local reaction at sit 4/22/2009 This case was reported by a lawyer 4/22/2009 This case was reported by a lawyer 4/21/2009 Patient became dizzy, pale, clammy 4/22/2009 Received telephone call from patien 4/21/2009 34 y/o ADSM referred from aid stati 4/21/2009 Non stated. Pt given injection 02/13/2009 @ 4:0 4/23/2009 MMR given on 4/8/2009. Pt noted s 4/22/2009 Patient vaccinated with Hepatitis A 4/22/2009 Left thigh large area redness/heat d After leaving office, parents report b Vax given on 4/17 - Sore, red and it 4/21/2009 Swollen left thigh around on a or inj 4/21/2009 Patient had hives 3 days after gettin 4/7/2009 Information has been received from 4/7/2009 Information has been received from
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4/22/2009 4/22/2009 SC 4/22/2009 MI 4/22/2009 4/22/2009 CA 4/22/2009 4/22/2009 4/22/2009 NY 4/22/2009 NY 4/22/2009 4/22/2009 4/22/2009 4/22/2009 4/22/2009 CO 4/22/2009 4/22/2009 4/22/2009 VA 4/22/2009 4/22/2009 OH 4/22/2009 TX 4/22/2009 4/22/2009 4/22/2009 NJ 4/22/2009 4/22/2009 MI 4/22/2009 OH 4/22/2009 TX 4/22/2009 CO 4/22/2009 NE 4/22/2009 4/22/2009 AZ 4/22/2009 4/23/2009 ID 4/23/2009 NC 4/23/2009 4/23/2009 CA 4/23/2009 IL 4/23/2009 WA 4/23/2009 MI 4/23/2009 NM 4/23/2009 OH 4/23/2009 IN 4/23/2009 MI 4/23/2009 PA 4/23/2009 WI 4/23/2009 NH 4/23/2009 AL 4/23/2009 UT 4/23/2009 CA 4/23/2009 SD 4/23/2009 CA
25 16 11 16 19 15 25 13 14 17 16 17 14 41
24 19 14 13
17 13 15 18 23 14 6 3 5 0.7 69 0.4 5 12 4 38 0.7 15 4 0.2 52 18 4 21 4
25 11 19
13 14 16
19 14 13
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23 14 6 3 0 69 0 5 12 4 38 0 15 4 0 52 18 4 21 4
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F M M M 0.7 F F 0.4 M F F M M 0.7 M F M 0.2 F M M F F F
4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/7/2009 Information has been received from 4/12/2009 Redness, swelling ANT LT Thigh, d 4/18/2009 10 X 12 cm red patch on L thigh 2 d 4/22/2009 This case was considered medically 4/20/2009 Rash appeared over mid back and b 4/20/2009 Call from immunization clerical staff 4/19/2009 Mother called Pt. crying, unable to c 4/17/2009 After receiving a HEP A injection pt 4/16/2009 Acute erythema and edema extend 4/21/2009 3-12-09. Mom called re: 4 bumps to 4/23/2009 Pt. c/o H/A (intense when moves he 4/23/2009 Mother states that a few hours after 4/23/2009 SCHOOL NURSE PHONED TO SA 4/23/2009 On evening of 4/22/09, the day afte 4/23/2009 WCC done on 4/15/09 at which time 4/23/2009 Extreme muscle pain in the deltoid a 4/23/2009 Took 1st dose of oral typhoid in the 4/23/2009 After administration of a subcutaneo 4/23/2009 Diarrhea nausea w/o emesis and Cr 4/23/2009 After a subcutaneous injection of th
344677 344678 344679 344681 344682 344683 344684 344690 344691 344692 344693 344694 344695 344696 344697 344698 344699 344700 344701 344703 344704 344705 344707 344708 344709 344710 344711 344712 344713 344714 344715 344716 344702 344764 344766 344767 344775 344786 344787 344788 344789 344790 344791 344792 344793 344794 344795 344796 344797 344798 344799
4/23/2009 ND 4/23/2009 PA 4/23/2009 MI 4/23/2009 NC 4/23/2009 WI 4/23/2009 NC 4/23/2009 PA 4/23/2009 ID 4/23/2009 VT 4/23/2009 OR 4/23/2009 CO 4/23/2009 MO 4/23/2009 NY 4/23/2009 PA 4/23/2009 IL 4/23/2009 WA 4/23/2009 TN 4/23/2009 KS 4/23/2009 AK 4/23/2009 CA 4/23/2009 IN 4/23/2009 AZ 4/23/2009 WA 4/23/2009 GA 4/23/2009 NY 4/23/2009 NC 4/23/2009 TX 4/23/2009 IA 4/23/2009 NC 4/23/2009 WI 4/23/2009 MA 4/23/2009 CA 4/24/2009 CA 4/24/2009 LA 4/24/2009 LA 4/24/2009 WA 4/24/2009 NY 4/24/2009 NY 4/24/2009 IN 4/24/2009 IL 4/24/2009 PA 4/24/2009 MD 4/24/2009 CA 4/24/2009 TX 4/24/2009 NV 4/24/2009 MA 4/24/2009 CA 4/24/2009 NY 4/24/2009 CA 4/24/2009 IN 4/24/2009 MI
61 21 38 51
50 61 21 38 51
61 45 16 65 8 4 1.3 11 4 54 5 5 1.4 4 5 5 31 0.3 55 70 45 18 4 1 1 0.5 0.4 0.5 0.5 15 11 30 1.3 60 85 61 16 0.4 14 62 52 0.4 4 15 18
61 45 16 65 8 4 1 11 4 54 5 5 1 4 5 5 31 0 55 70 45 18 4 1 1 0 0 0 0 15 11 30 1 60 85 61 16 0 14 64 52 0 4 15 19
F F F F F U M F F F M F 0.3 F F F F M F 0.4 F M M M M 0.3 F F F F F M 0M 0M 0.5 M 0.4 M 0.5 U 0.5 U F M F 0.3 M M F F M 0.4 F F F F 0.4 M M M F
4/23/2009 RECEIVED T-DAP 4/1/09 AT BEGI 4/23/2009 developed severe pain at injection s 4/23/2009 Within 2-3 minutes after second vac 4/23/2009 On 4/21/2009, arm was sore and re 4/23/2009 L upper arm redness, swelling, feve 4/23/2009 Site where shingles vaccine adminis 4/23/2009 This case was reported by a lawyer 4/23/2009 This case was reported by a consum 4/23/2009 After leaving office Pt had a delayed 4/22/2009 4 hours after injection - pain at site 4/1/2009 Temperature starting within 24 hour 4/23/2009 Left arm is red, swollen, itchy 4/23/2009 Fever 101 degrees (rectal) on 4/23/ 4/16/2009 Pt noticed red area on LA last night 4/17/2009 5-10 min after vaccines given mom 4/17/2009 Pt reported redness, swelling, pain 4/22/2009 On 4/17/09, he was given MMR in r 4/23/2009 10cm X 8cm redness & swelling aro 4/23/2009 Mild rash appeared on arm in vicinit 4/23/2009 4 y. o received varicella vaccine on 4/23/2009 Red, warm to touch, inflammation in Pt L upper arm is red, hot to the tou 4/23/2009 Raised irregular shaped welts - No t 4/23/2009 fever fussiness symptomatic tx 4/21/2009 pain, swelling, redness at site of inje 4/22/2009 Soreness, swelling, heat (L) upper 4/23/2009 Swelling, itching - burning - tired - a 4/23/2009 Half hour post pt left boyfriend calle 4/22/2009 Within 20 min child had cough, whe 4/17/2009 Red hard spot at injection site. 4/23/2009 presented 4/22/09 with rash. 4/21/2009 Tactile. Fever and erythematous, bl 4/23/2009 Parents report that after shots on 24/23/2009 Information has been received from 4/23/2009 Information has been received from 4/23/2009 Initial information has been received 4/22/2009 Initial report was received 17 April 2 4/24/2009 The evening of the vaccine swelling 4/24/2009 The patient had a seizure on the Fri 4/24/2009 This patient received travel vaccines 4/24/2009 Recieved pneumonia vaccine 4/20/0 4/24/2009 Right arm had slight swelling about 4/24/2009 GAVE 2ND MCV 4/24/2009 Patient received her 4 month vaccin 4/24/2009 Symptoms started exactly 2 months 4/24/2009 Patient was vaccinated 4/14. Prese 4/24/2009 I had severe muscle pain in lower le 4/24/2009 about 12 hours Y after receiving his va 4/24/2009 Developed shortness of breath, whe 4/24/2009 Patient experienced two episodes o 4/24/2009 Within 10 minutes of receiving her fi
344800 344801 344802 344803 344812 344816 344817 344818 344819 344820 344822 344824 344825 344827 344828 344829 344832 344833 344835 344836 344838 344841 344843 344845 344846 344848 344850 344852 344853 344854 344855 344870 344872 344873 344878 345009 345010 345011 345012 345013 345014 345015 345016 345017 345022 345024 345025 345030 345124 345125 345126
4/24/2009 WY 4/24/2009 MO 4/24/2009 MN 4/24/2009 FL 4/24/2009 4/24/2009 AR 4/24/2009 NE 4/24/2009 IL 4/24/2009 NC 4/24/2009 NJ 4/24/2009 CA 4/24/2009 WA 4/24/2009 TX 4/24/2009 NC 4/24/2009 AR 4/24/2009 AZ 4/24/2009 NC 4/24/2009 IN 4/24/2009 FL 4/24/2009 GA 4/24/2009 RI 4/24/2009 NY 4/24/2009 CO 4/24/2009 CA 4/24/2009 IL 4/24/2009 WA 4/24/2009 WV 4/24/2009 TN 4/24/2009 NC 4/24/2009 CT 4/24/2009 LA 4/24/2009 WV 4/24/2009 VA 4/24/2009 CO 4/24/2009 MD 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009
18 43 5 4
18 43 5 4
0.2 0.5 4 0.5 11 91 40 1.5 27 12 35 5 5 11 11 0.2 25 12 8 9 16 4 4.8 0.2 58 6 3.8 1 65 65 1
0 0 4 0 11 91 40 1 27 12 35 5 5 11 11 0 24 12 8 9 15 4 4 0 58 6 3 1 65 65 1
1.5
1
1.6 1.4 0.2 1.3 0.5 1 0.5 0.3 0.5 0.3 0.4
1 0 1 0
0 0 0 0
F F M M F 0.2 M 0.5 F F 0.5 M F F F 0.5 F F F F F F M F 0.2 F M F F M F M F 0.2 M F M M 0F F F 0M U 0.5 F F M 0.4 M 0.2 M 0M 0.5 M M F 0.3 M 0.5 M 0.3 M U 0.4 F
4/9/2009 Within 24 hrs after receiving the imm 4/24/2009 client called this facility and stated t 4/24/2009 10 minutes after receiving MMR vac 4/24/2009 After the vaccination on April 16th 2 4/24/2009 This case was reported by a lawyer 4/21/2009 None stated. Y 6/22/09 Autopsy repo 4/24/2009 Intussusception, Bilious vomiting, Irr 4/16/2009 1545 vaccines emesis about 10 min Intussusception, s/p surgical reduct 4/22/2009 My daughter received her second G 4/25/2009 4/23/09 - reviewed PROTCOL ques 4/24/2009 -migraine headache, - flu-like sympt 4/23/2009 After receiving IM DTaP and IM PRE 4/24/2009 4-20-09 pt was given a DTaP immu 4/24/2009 Localized swelling, redness, and wa 4/24/2009 Body aches, shortness of breath, ve 4/16/2009 The day of the she c/o itching at the 4/24/2009 Known Cerebral Palsy, 1 seizure pe 4/3/2009 R shoulder to elbow swollen twice th 4/20/2009 Child received 2 chicken pox vaccin 4/16/2009 Developed hives within 10 minutes 4/20/2009 None stated. 4/20/2009 About 2:30PM Hep A #1 given LA. A 4/15/2009 Err:508 4/17/2009 Received vaccines - approx 30 mins 4/20/2009 Received GARDASIL shot. Approx 4/17/2009 As related by parent, Pt.'s R arm an 4/20/2009 Large red warm area without indura 4/20/2009 Administered ROTATEQ orally befo 4/16/2009 Patient is here for evaluation of dizz 4/6/2009 Upper right arm within about 4" from 4/14/2009 Patient was brought back to office 2 4/24/2009 Rash at injection site 2" x 1" rednes 4/24/2009 Pt. c/o pain in Rt. deltoid about 2-3 I am almost 66, have always had a 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 This case was considered medically 4/10/2009 Information regarding PREVENAR w 4/10/2009 This case was considered medically 4/10/2009 Follow-up provided Quality Assuran 4/10/2009 Follow-up received provided additio 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Follow-up information provided patie 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa
345127 345128 345129 345130 345131 345132 345133 345134 345135 345136 345251 345263 345264 345265 345266 345267 345268 345390 345391 345392 345393 345394 345395 345396 345397 345398 345399 345400 345401 345402 345778 345779 344804 344805 344806 344807 344808 344809 344810 344811 344902 344904 344905 344921 344922 344923 344924 344925 344926 344927 344928
4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/24/2009 4/25/2009 OR 4/25/2009 MT 4/25/2009 OR 4/25/2009 FL 4/25/2009 MD 4/25/2009 WA 4/26/2009 TX 4/26/2009 FL 4/27/2009 CA 4/27/2009 4/27/2009 NY 4/27/2009 WI 4/27/2009 MS 4/27/2009 NY 4/27/2009 CO 4/27/2009 LA 4/27/2009 TX 4/27/2009 NC 4/27/2009 IL
0.2 0.5
0
0.5 0.2 0.3 4
0 0 0 4
0.4 0.3 0.8
0
0.3 0.3 1.3 0.2 0.6
0
1.1 0.2 0.2 1.1
1 0 0 1
0.3 0.5 0.5 1 1.1 0.5 0.2 11 65 1 40 39 64 1 76 45 1.5 1 42 20 41 12 58 10 13 40
1 0 0 11 65 1 40 39 64 1 75
42 20 40 12 58 10 12 40
F 0.5 F U 0.5 F 0.2 U 0.3 M F U M 0.4 F M U U M U U F 0.6 M U 0.1 F 0.2 M 0.2 M 0.1 M U U U U U U 0.1 M 0.5 M 0.2 M F F 0F F F F 0F M F M M M M M M M M F F
4/10/2009 Information regarding PREVNAR wa 4/10/2009 Follow up information was received 4/10/2009 Information regarding PREVNAR wa 4/10/2009 New information was received in do 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Additional Information provided test 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVENAR w 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Additional information was received 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information was received from a ped 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information was received from a hea 4/10/2009 Information regarding PREVNAR wa 4/10/2009 Information regarding PREVNAR wa 4/25/2009 Pt developed a sore throat and feve 4/25/2009 Localized injection site reaction. So 4/25/2009 Parents told me today at a sibling's 4/25/2009 Warmth, redness, swelling, induratio 4/25/2009 Intense sweating, chills, fainting, pa 4/25/2009 Several hours after the vaccine my 4/26/2009 fever, diarrhea, crying (insolable), st 4/26/2009 After shot(pneumococcal polysacch 4/24/2009 Information has been received from 4/24/2009 Information has been received from 4/24/2009 Information has been received from 4/27/2009 reaction to small pox lot number VV 4/27/2009 PT PRESENTS WIH SKIN IRRITAT 4/27/2009 Pt received TD vaccination 18 April 4/27/2009 Mom states son ran high fever (102 4/27/2009 Local reaction at injection site. Red 4/27/2009 SWELLING RIGHT ARM FROM DE 4/27/2009 CLIENT GIVEN TDAP AND MENAC 4/27/2009 Headache and fever reported on 4/3
344929 344930 344931 344932 344933 344934 344935 344936 344937 344938 344941 344942 344947 344948 344950 344951 344952 344953 344954 344955 344956 344957 344958 344959 344960 344961 344962 344963 344964 344965 344966 344967 344972 344974 344975 344977 344978 344980 344981 344982 344984 344985 344986 344987 344989 344990 344992 344994 344995 344997 344999
4/27/2009 IL 4/27/2009 CA 4/27/2009 KS 4/27/2009 CA 4/27/2009 PA 4/27/2009 LA 4/27/2009 CO 4/27/2009 MN 4/27/2009 AK 4/27/2009 MI 4/27/2009 4/27/2009 WA 4/27/2009 MO 4/27/2009 AK 4/27/2009 AZ 4/27/2009 AZ 4/27/2009 CA 4/27/2009 OH 4/27/2009 MA 4/27/2009 NY 4/27/2009 CA 4/27/2009 CA 4/27/2009 IA 4/27/2009 TX 4/27/2009 CA 4/27/2009 CA 4/27/2009 MN 4/27/2009 VT 4/27/2009 PA 4/27/2009 CA 4/27/2009 AL 4/27/2009 MI 4/27/2009 NY 4/27/2009 VA 4/27/2009 CA 4/27/2009 GA 4/27/2009 OH 4/27/2009 WI 4/27/2009 CO 4/27/2009 AK 4/27/2009 NY 4/27/2009 CO 4/27/2009 CT 4/27/2009 CO 4/27/2009 NJ 4/27/2009 MD 4/27/2009 AZ 4/27/2009 FL 4/27/2009 TX 4/27/2009 WA 4/27/2009 NC
17 50 1 40 1 6 64 17 48 22
17 50 1 40 0 6 64 17 48 22
57 9 4 1 57 29 4 18 65 50 1.4 16 5 4 12 21 36 1.3 44 17 5 1 71 15 0.8 12 63 1.4 18 12 1.2 4
57 9 4 1 57 29 4 18
13 66 79 35 61 17
50 1 16 5 4 12 21 36 1 44 17 5 1 71 15 0 12 63 1 18 12 1 4 4 13 79 35 61 17
M F 0M M 0.1 M F M F F F M M M F F 0M F F F F F M 0.4 F F M M M F M 0.3 F F F F 0M F F 0.8 M M F 0.4 M F F 0.2 M M F F F M F F F
4/27/2009 Per mother, child started with fever 4/27/2009 Diagnosed with severe arthus allerg 4/27/2009 Patient's father reports elevated tem 4/27/2009 After I received the flu shot I develo 4/21/2009 Fever of 104, not responding to infa 4/27/2009 Immediately after receiving her seco 4/27/2009 Started wuth pain on right leg and it 4/27/2009 Soreness at site starting at 4/23 inc 4/27/2009 Patient had increased pain that eve 4/27/2009 autoimmune disease fibromyalgia, r 4/23/2009 Initial report was received on 21 Ap 4/23/2009 Initial report received on 21 April 20 4/20/2009 Flu like symptoms for two to three w 4/20/2009 On 4/20/09 pt came to my office - h 4/27/2009 Redness & swelling after inj. given & On 3-25-09 pt presented with classi 4/24/2009 Given tetanus shot in clinic on 4/21/ 3/26/2009 Approx. 1/2 hr after immunization gi 4/20/2009 L deltoid area with redness, warmth 4/16/2009 Pt's mom called doctors office 4/16/ 4/23/2009 Approx. 4-09-09 I started getting a ' 4/22/2009 Received Flu and PNEUMOVAX 3/2 4/21/2009 1/7/09 Parent called, red puffy (R) le 4/22/2009 Day after injection erythema and pru 4/21/2009 Redness, swollen arm, hot tender 4/21/2009 Redness, swelling of arm; Hot. 4/17/2009 Blotchy rash, few hives occurring af 4/20/2009 Pt received first GARDASIL injection 4/20/2009 Rash on ankles, elbows, arms, and 4/20/2009 Vomiting, loose stools, fever Tyleno 4/20/2009 LP Rash, itching, Skin Inflammation 4/21/2009 HPV# 2 4 1/2 hours after patient g 4/27/2009 5 - 10 minutes after Pt received 2nd 4/26/2009 Local Varicella at VARIAX shot site 4/24/2009 On 4-16-09 around 11:30 A.M. had 4/22/2009 Member complained of itching at inj 4/21/2009 Received vaccine 041409 fever low 4/22/2009 Welts developed on back, abd, arm 4/22/2009 Zoster out break along 2 T-11. Derm 4/17/2009 Mom reported "dime" size swelling4/13/2009 24 hours after vaccine administratio 4/23/2009 Received vaccine on 4-21-2009. Wh 4/21/2009 Limping (unable to bear weight on le 4/23/2009 4-21-09 - 7:50 PM Mother called to 4/17/2009 L lateral upper arm: L red, warm, ind 4/23/2009 Syncope following vaccinations, the 4/16/2009 Welt - 4 X 4 cm allergic skin reaction 4/27/2009 Pt given ZOSTAVAX vaccine 4/14/0 4/22/2009 Red around the area itchy, raised a 4/22/2009 Adenopathy. Knee pain. Fever. Ras 4/22/2009 1) first few hours - splotches noted o
345000 345002 345018 345021 345038 345040 345041 345042 345043 345044 345045 345046 345047 345048 345049 345050 345051 345052 345053 345054 345055 345056 345057 345058 345059 345060 345061 345062 345063 345064 345065 345066 345067 345068 345069 345071 345072 345073 345074 345075 345076 345077 345078 345079 345080 345081 345082 345083 345084 345085 345086
4/27/2009 TX 4/27/2009 OK 4/28/2009 PA 4/28/2009 SC 4/28/2009 NY 4/28/2009 KS 4/28/2009 MI 4/28/2009 MD 4/28/2009 IN 4/28/2009 NJ 4/28/2009 NC 4/28/2009 MA 4/28/2009 TX 4/28/2009 LA 4/28/2009 OH 4/28/2009 IN 4/28/2009 CA 4/28/2009 MN 4/28/2009 TX 4/28/2009 NM 4/28/2009 SC 4/28/2009 IL 4/28/2009 AZ 4/28/2009 CA 4/28/2009 TX 4/28/2009 WY 4/28/2009 VA 4/28/2009 CA 4/28/2009 MT 4/28/2009 GA 4/28/2009 MI 4/28/2009 CA 4/28/2009 FL 4/28/2009 4/28/2009 4/28/2009 FL 4/28/2009 OH 4/28/2009 MS 4/28/2009 HI 4/28/2009 CA 4/28/2009 CA 4/28/2009 MS 4/28/2009 MA 4/28/2009 NH 4/28/2009 PA 4/28/2009 VA 4/28/2009 FL 4/28/2009 ND 4/28/2009 TX 4/28/2009 VA 4/28/2009 KY
32 73 20
32 73 20
42
42
69 1 0.3 2 21 48 5 11 1 16 37 12 68 12 7 57 21 9 60 41 15 15 0.9 17 0.2 0.2 1
69 1 0 2 21 48 5 11 1 16 37 12 68 12 7 57 21 9 60 41 15 15 0 17 0 0 1
0.3 72 19 0.2 51 14 11 64 4 0.5 18 53 41
0 72 19 0 51
10
10
64 4 0 18 53 41
M F F M F M M 0M 0.3 M 0M M M F F 0M F F F M M F F F M F F F M 0.9 F M 0.2 M 0.2 M 0M F M M 0.3 F M F 0.2 F F M M F M 0.5 M F M M M F
4/20/2009 Call received 4/20/09 - Pt states itch 2/3/2009 Redness, tenderness & increased w 4/27/2009 Information has been received from 4/27/2009 Information has been received from 4/24/2009 Initial report received on 15 April 20 4/24/2009 This serious case was received on 2 4/28/2009 No adverse effects. Received the T 4/28/2009 DEVELOPED FEVER ON 4/23/09. 4/28/2009 On 4/22/08 Client received both Pen 4/28/2009 Patient was very irritable and "not h 4/28/2009 None. Patient recieved four doses 4/28/2009 COULD NOT SLEEP AT ALL, JOIN 4/28/2009 collapse, profuse sweating, disorien 4/28/2009 Within 4 hours of Tdap and Varivax 4/28/2009 About 10 minutes after IPV,Prevnar 4/28/2009 seizure activity taken by ambulance 4/28/2009 PATIENT HAD VACCINE ON 4/21/2 4/28/2009 Patient seated on a chair in exam ro 4/28/2009 Patient (68 Y year old male) received 4/28/2009 Symptoms: hives, vasculitis, joint pa 4/28/2009 Pt developed an egg shaped redden 4/28/2009 TDAP GIVEN 4/22/09 IN AFTERNO 4/28/2009 Patient broke out in hives all over he 4/28/2009 he developed hives after injection a 4/28/2009 Client received the influenza, pneum 4/28/2009 Pt received Tdap on 4-22-2009, IM 4/28/2009 Mother states arrived home @ abou 4/28/2009 PATIENT C/O PAIN STARTING 8 H 4/28/2009 Child received a 4th DTaP and IPV 4/28/2009 Approximately 1 minute after receiv 4/28/2009 Initially patient was quite irritable an 4/28/2009 Notable change in feeding pattern a 4/28/2009 Child developed bilateral buccal mu 4/28/2009 This case was reported by a lawyer 4/28/2009 This case was reported by a lawyer 4/28/2009 This case was reported by a lawyer 4/28/2009 Intussusception reduced 5/04/09 R 4/23/2009 Received Yellow fever immunization 4/23/2009 Extensor surfaces rash on elbows, k 4/23/2009 High Pitch screams for 3 days and f 4/25/2009 Received Flu Vaccine on Oct. 10, 2 4/28/2009 Gave pt varicella #2 9/26/9 (1st dos 4/27/2009 R upper arm swelling red, tender, itc 4/27/2009 Herpes zoster type rash developing 4/28/2009 Started with pain at the injection site 4/24/2009 "3 cm circle of erythema on right sid 4/28/2009 Shortness of breath, tingling, sweat 4/27/2009 Body aches, high fever. At night ch 4/28/2009 None stated 4/28/2009 Pt came into office + reported vacci 4/28/2009 About 2hrs after getting vaccine, arm
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4/28/2009 NJ 4/28/2009 NC 4/28/2009 FL 4/28/2009 NC 4/28/2009 NC 4/28/2009 VA 4/28/2009 IL 4/28/2009 MI 4/28/2009 MI 4/28/2009 TX 4/28/2009 NC 4/28/2009 CA 4/28/2009 MI 4/28/2009 WI 4/28/2009 IL 4/28/2009 FL 4/28/2009 MS 4/28/2009 TX 4/28/2009 4/28/2009 NV 4/28/2009 OH 4/28/2009 AR 4/28/2009 CA 4/28/2009 SC 4/28/2009 VA 4/28/2009 MN 4/28/2009 NY 4/28/2009 NY 4/28/2009 4/28/2009 ID 4/28/2009 PA 4/28/2009 MI 4/28/2009 AL 4/28/2009 PA 4/28/2009 4/28/2009 IN 4/28/2009 TN 4/29/2009 MI 4/29/2009 4/29/2009 FL 4/29/2009 4/29/2009 4/29/2009 4/29/2009 VA 4/29/2009 OH 4/29/2009 MA 4/29/2009 NC 4/29/2009 ID 4/29/2009 CO 4/29/2009 MA 4/29/2009 NC
5 27 4 12 41 0.2 1 0.2 5 1.3 16 4 0.3 5 31 81 23 44 14 53 2 27 15 10 4 23 0.7 42 0.5 27 70 0.3 18 0.3 36 13 27 53 11 1 1.5
5 27 4 12 40 0 1 0 5 1 16 4 0 5 31 81 23 44 14 53 2 27 15 10 4 23 0 42 0 27 70 0 18 0 36
18 59 3 3 14 62 65 25 1.3
18 59 3 3 14 62 65 25 1
27 53 0 1
M F M F F 0.2 M 0M 0.2 M F 0.3 F F U 0.3 F M F F F M F F 0M F M M M M 0.7 F F 0.5 F M F 0.3 M F 0.3 M F M F M F 1M 0.7 F M M F F M F F F F 0.3 M
Presented to hospital 4/23/09 with r 4/16/2009 Pt c/o pain at injection site beginnin 4/22/2009 Small area of petechiea under right 4/9/2009 Fever 102 shakes chills abdominal p 4/13/2009 Client reports rash to inner arms ap 4/28/2009 Bloody stools, crying spells, abdomi 4/23/2009 4/18 developed rash behind ears, b 4/23/2009 Pt came back into office. Per mothe 4/23/2009 Pt administered VARIVAX and DAP 4/21/2009 Urticaria generalized 2 days after im 9/18/2008 DTAP given instead of TDAP. -Swelling of LA, tender, hot, itchy - 2 4/22/2009 3 days after vaccine developed diar 4/22/2009 Large redness, itching & induration 4/23/2009 None stated. 4/28/2009 2 days later had bad stiffness on ba 4/28/2009 On 4/27 at 8:45am patient was vacc None Stated 4/26/2009 Excessive rapid hair loss a month a 4/28/2009 Rash developed 2 days after shot 4/27/2009 Rash after HEP A with in 24 hr ATA 4/28/2009 1600 Pt bad at clinic c/o having reac 4/28/2009 Pt with redness, edema 3 d after va 4/17/2009 3-31-09 Mom reports that client "wa 4/17/2009 Redness, swelling and pain at injec 4/21/2009 Received vaccine on 4/13/09- symp 4/23/2009 Local reaction at injection site right 4/24/2009 Patient presented to clinic on 4/24/0 4/22/2009 She was hoarse and hives - She los 4/21/2009 Rash to trunk and back that started 4/23/2009 PNEUMOVAX administered right de 4/22/2009 Pt developed hives right after vaccin 4/24/2009 Within 24 hours, developed fever - 1 4/23/2009 2 days later, with bulging fontanelle 4/23/2009 Red raised rash appox. 1 1/2 " X 1 4/24/2009 Erythematous area surrounding inje 4/22/2009 Pt. became pale after the vaccinatio 4/28/2009 Subject received BIOTHRAX in 200 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 Information has been received from 4/28/2009 This report was received from a hea 4/27/2009 Initial report was received 28 Janua 4/29/2009 hives covering entire body, swelling 4/29/2009 Within 5 min. post injection patient h 4/29/2009 Client received Tdap without any sy 4/29/2009 Reaction to Tdap, muscle aches, he 4/29/2009 Read area around the Shingles vac 4/29/2009 Member reports beginning to feel na 4/29/2009 HIGH FEVER WITH NORMAL CBC
345170 345171 345172 345173 345174 345175 345176 345177 345178 345182 345190 345191 345192 345193 345194 345195 345196 345197 345198 345199 345200 345201 345202 345203 345204 345205 345206 345207 345208 345249 345252 345254 345257 345260 345261 345299 345301 345302 345303 345304 345305 345306 345307 345308 345309 345310 345311 345312 345313 345314 345315
4/29/2009 AZ 4/29/2009 CA 4/29/2009 KS 4/29/2009 KS 4/29/2009 AZ 4/29/2009 WA 4/29/2009 CA 4/29/2009 OR 4/29/2009 PA 4/29/2009 4/29/2009 NC 4/29/2009 PA 4/29/2009 CA 4/29/2009 CA 4/29/2009 4/29/2009 TX 4/29/2009 NH 4/29/2009 AZ 4/29/2009 CO 4/29/2009 AZ 4/29/2009 CA 4/29/2009 PA 4/29/2009 DC 4/29/2009 NH 4/29/2009 NC 4/29/2009 NC 4/29/2009 4/29/2009 4/29/2009 PA 4/30/2009 MO 4/30/2009 CA 4/30/2009 MI 4/30/2009 TX 4/30/2009 IA 4/30/2009 KS 4/30/2009 MA 4/30/2009 AR 4/30/2009 MA 4/30/2009 SD 4/30/2009 WI 4/30/2009 TX 4/30/2009 4/30/2009 IL 4/30/2009 FL 4/30/2009 UT 4/30/2009 MI 4/30/2009 HI 4/30/2009 4/30/2009 CA 4/30/2009 CA 4/30/2009 IN
1.2 11 9 34 1 63 17 12 0.2 0.6 20 0.1 0.2 20 13 45 9 11 61 1 0.3 65 42 1.3 10 5 80
1 11 9 34 1 63 17 12 0 0 20 0 0 20 13 45 9 11 61 0 0 65 42 1 10 5 80
5 71 0.2 46 23 3 27 35 15 1 28 25 28 28 17 16 50
5 71 0 46 23
63 55 30 16 1.2
27 35 15 1 28 25 28 28 17 16 50 3 55 30 16 1
0.2 M M M M 0.1 M M M F 0.2 M 0.6 F M 0.1 M 0.2 F F M F F F F 1F 0.3 M F F 0.3 M M F F F M M 0.2 F F F M F M F 0M M M M M F F M F F M F M 0.1 M
4/29/2009 Pt received MMR and Varicella vacc 4/29/2009 Right deltoid- 2 days sfter vaccine a 4/29/2009 Herpes Zoster C34 dermatoma G 4/29/2009 The first signs begin with a pain in m 4/29/2009 SCALEY RASH THATS GETTING W 4/29/2009 Pt given injection in deltoid. develop 4/29/2009 27cm from injection site a 15x15cm 4/29/2009 headache, facial swelling- in pts tem 4/25/2009 4-23-09 Child Y had respiratory arrest 4/29/2009 This female subject was enrolled in 4/28/2009 VHC inpatient consult has been req 4/22/2009 Temp 101. Baby presented the day 4/29/2009 04-27-09 patient came for a well ch 4/28/2009 Fever, nausea, HA, sore throat, rhin 4/29/2009 Local reaction on R upper arm (injec 4/27/2009 Pt stated arm was sore for 3 days. T 4/29/2009 Vaccine administered on 4/23/09. Im 4/29/2009 950am student in nurses office or im 4/29/2009 Hives 4/29/2009 Local Pox 3-4 lesions with cellulitic a 4/29/2009 Faint erythematous rash under the s 4/28/2009 (R) arm swollen and red about 10 cm 4/24/2009 Received ADACEL on 4/16/09 and 4/23/2009 Pt broke out in hives face to legs 1 1 4/22/2009 Vaccine given 10:15 A and by 12:00 4/25/2009 .5 cm diameter redness, and warm 4/17/2009 PL received the Zostavax vaccine o 4/27/2009 Our infant received the roto vaccine 4/29/2009 2 days after DTAP, arm red & swolle 4/29/2009 Information has been received from 4/29/2009 Information regarding PREVNAR wa 4/28/2009 This case was received from a heal 4/29/2009 Information has been received from 4/29/2009 Information has been received from 4/29/2009 Information has been received from 4/30/2009 Td administered to patient. Less tha 4/30/2009 Nursing student mistook Menactra a 4/30/2009 Patient developed maculopapular ra 4/30/2009 Fever, Chills, Bodyaches, Nausea, V 4/30/2009 ON 4-3-09 PATIENT WAS ADMINIS 4/30/2009 Circumferential swelling and rednes 4/30/2009 Soldier presented to the ER with R 4/30/2009 Immediate severe pain in left arm, 'a 4/30/2009 PATIENT WAS GIVEN ALL THREE 4/30/2009 left arm warm to the touch and red 4/30/2009 Typical Varicella rash began 04/28/ 4/30/2009 Patient called me the day after the a 4/30/2009 Fever 100.3F and chills and Severe 4/30/2009 Client called today, stating she had 4/30/2009 Patient was seen by this physician t 4/30/2009 Night wakening, fussiness, constan
345318 345319 345320 345321 345322 345323 345324 345325 345326 345327 345328 345329 345330 345331 345332 345333 345334 345335 345336 345337 345338 345339 345340 345341 345342 345343 345344 346035 346036 346037 346038 346039 346040 345403 345404 345405 345406 345407 345408 345409 345410 345411 345412 345413 345414 345415 345416 345417 345418 345419 345420
4/30/2009 PA 4/30/2009 MA 4/30/2009 4/30/2009 CA 4/30/2009 OH 4/30/2009 AK 4/30/2009 MD 4/30/2009 NM 4/30/2009 MS 4/30/2009 MT 4/30/2009 IN 4/30/2009 CT 4/30/2009 PA 4/30/2009 VA 4/30/2009 TN 4/30/2009 ND 4/30/2009 FL 4/30/2009 NY 4/30/2009 OH 4/30/2009 KY 4/30/2009 MI 4/30/2009 KY 4/30/2009 CO 4/30/2009 KY 4/30/2009 OH 4/30/2009 CT 4/30/2009 SC 4/30/2009 CA 4/30/2009 SD 4/30/2009 SD 4/30/2009 4/30/2009 ID 4/30/2009 FL 5/1/2009 CA 5/1/2009 NY 5/1/2009 NC 5/1/2009 VA 5/1/2009 ID 5/1/2009 WI 5/1/2009 WI 5/1/2009 MO 5/1/2009 WI 5/1/2009 SC 5/1/2009 TX 5/1/2009 SC 5/1/2009 GA 5/1/2009 WI 5/1/2009 CA 5/1/2009 WI 5/1/2009 MA 5/1/2009 GA
0.1 0.5 46 1 15 1.8 1.1 23 7 13 1 26 17 4 11 12 1.1 1 20 1 16 1.2
0 0 46 1 15 1 1 23 7 13 1 26 17 4 11 12 1 1 20 1 16 1
28 18 4 49
28 18 4 49
19 19 58
19 19 58
75 42 13 32 24 11 33 42 1 20 5 47 3 1.3 23 1.6 39 0.5 14
75 42 13 32 25 11 33 42 2 20 5 47 3 1 23 1 39 0 14
0.1 F 0.5 M M 0F F 0.8 M 0.1 F F F M 0F F M F F M 0.1 M 0F F 0M F 0.2 F U F F M F U M M M U M M F M F F M M 0F M M F F 0.2 M M 0.6 M M 0.5 M F
4/28/2009 None. 10/5/09 Y Autopsy received. Ca 4/27/2009 Came down with Evans Syndrome 3 4/30/2009 Developed neck right arm pain imm 4/26/2009 Patient developed severe systemic 4/26/2009 Began with stomach pains, rash on 4/30/2009 Redness + swelling, heat @ site of 4/30/2009 Child received above listed vaccines 4/30/2009 Patient complained of headache, rin 4/30/2009 Redness, warmth to injection site - 4 4/28/2009 Mother reports patient complaining 4/21/2009 Pt received 12 month vaccinations o 4/30/2009 Within 2 Hrs of vaccine, pt noted ex 4/23/2009 Pt waited x 15 min & c/o HR. No se 4/30/2009 Left deltoid swollen with erythema o 4/30/2009 Right upper arm with redness, swell 4/24/2009 Left arm swollen, hot, reddened (siz 4/27/2009 Bumps on face and back. 4/27/2009 Left thigh erythema & swelling exten 4/21/2009 Pt. became slightly lightheaded imm 4/24/2009 Child developed chicken pox diseas 4/24/2009 24 hrs after injection: lip swelling, na 4/13/2009 Mom states 2 days after vaccines p Severe vomiting + diarrhea 48 hour 4/21/2009 Unable to use my arm/shoulder, ext 4/24/2009 Pharyngitis, odynophalgia, nausea, 4/24/2009 Right arm immunization site reaction 4/27/2009 C/o chest pain, local reaction seen i 4/15/2009 This case was reported by a pharma 4/15/2009 This case was reported by a healthc 4/15/2009 This case was reported by a healthc 4/15/2009 This case was reported by a consum 4/15/2009 This case reported by a healthcare 4/15/2009 This case was reported by a consum 5/1/2009 4/17/2009: SM contacted VHC repo 5/1/2009 My daughter was given all three dos 5/1/2009 A GOLF BALL SIZE NODE IN ARM 5/1/2009 fever of 100.7F, body aches, HA, so 5/1/2009 Vomiting, indegestion, lack of appet 5/1/2009 Localized erythema Left shoulder an 5/1/2009 Rash over chest, back, and arms. 5/1/2009 Mother reports client with elevated t 5/1/2009 Painful Hardened red area mid clav 5/1/2009 Patient's mom stated symptoms of r 5/1/2009 Vaccine administered on 04/28/200 5/1/2009 Pt's mom stated sylmptoms of redne 5/1/2009 About 5-6 hrs after DTaP pt had fev 5/1/2009 Rednes and Pain at injection site, in 5/1/2009 FEBRILE SEIZURE ON 28APRIL20 5/1/2009 Extensive Erythema Multiforme on b 5/1/2009 Indurated area at site of each inject 5/1/2009 APPROXIMATELY 3-5 MINUTES A
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5/1/2009 NC 5/1/2009 UT 5/1/2009 5/1/2009 NY 5/1/2009 NM 5/1/2009 WA 5/1/2009 VA 5/1/2009 MI 5/1/2009 NC 5/1/2009 TX 5/1/2009 NJ 5/1/2009 KY 5/1/2009 OH 5/1/2009 SD 5/1/2009 5/1/2009 MS 5/1/2009 WY 5/1/2009 MA 5/1/2009 WA 5/1/2009 AZ 5/1/2009 ND 5/1/2009 NY 5/1/2009 ND 5/1/2009 IL 5/1/2009 VA 5/1/2009 WA 5/1/2009 WA 5/1/2009 IL 5/1/2009 MN 5/1/2009 CA 5/1/2009 SC 5/1/2009 NC 5/1/2009 IL 5/1/2009 NC 5/1/2009 PA 5/1/2009 NY 5/1/2009 NC 5/1/2009 CA 5/1/2009 NC 5/1/2009 CT 5/1/2009 CA 5/1/2009 CA 5/1/2009 PA 5/1/2009 TX 5/1/2009 5/1/2009 5/1/2009 5/2/2009 NC 5/2/2009 KS 5/2/2009 CA 5/2/2009 CA
43 5 21 2 17 2 11 17 46 13 70 0.3 12 3
43 5
57 71 5 42 13 1.1 14 14 27 0.4 32 7 2 12 5 1.1 1.4 1 2 5 4 27 3 33 5 5 4 4 4
57 71 5 42 13 1 14 14 27 0 32 7 2 12 5 1 1 1 2 5 4 27 3 33 5 5 4 4
33 17 59 4
33 17 59 4
2 17 2 11 17 46 13 70 0 12 3
F F F 0.6 M F 0F M F F M M 0.3 F M M U M F M F M 0.1 F M F F 0.4 F F M 0.2 U M F 0.1 M 0.4 M 0F 0.8 F F F F F F M F F M F U U U M F M F
5/1/2009 Six days after administration of MMR 5/1/2009 Right and Left legs had cellulitis, red 4/30/2009 InformationYhas been received via th 5/1/2009 On 4/29 (the day after receiving the 5/1/2009 On 4/24/09, Pt came in for #2 GARD 5/1/2009 Within 12 hours after admin of vacc 5/1/2009 4x6cm area on right deltoid of eryth Swollen like a size of a baseball hot 5/1/2009 C/o lightheaded with tunnel vision (c 5/1/2009 L arm SQ area red and swollen abo 5/1/2009 TC from son (MD): Pt had dried like 4/27/2009 Prev. healthy 4 mo. old admitted to 4/27/2009 Approx 3" area right upper arm warm 5/1/2009 16 X 16 cm Erythemic warm rash on Felts like open cut. used rubbing al 4/1/2009 Extreme swelling and redness of wh 5/1/2009 Swelling (L) arm 5/1/2009 Cellulitis 4/27/2009 Patient reported severe injection sit 4/24/2009 R upper arm redness with swelling s 4/27/2009 Patient was given Pediarix vac. but 4/24/2009 Left deltoid region w/ 7x7 cm round, 4/28/2009 Broke out in a rash that evening. Ra 4/24/2009 2 d Hx generalized weakness + mal 5/1/2009 Rotavirus vaccine was administered 4/20/2009 Left arm localized redness + swellin 4/29/2009 Allergic reaction - hives - severe wh Patient was given HEP & DTAP vac 4/27/2009 Patient given MMR vaccine instead 4/30/2009 HEP A, HEP B & MMR given in (L) 3/23/2009 When pt was given MMR & VAR pt 4/27/2009 Erythema multiforme - minor. 4/28/2009 2 wks after VARICELLA was given o 4/28/2009 (B) eyelids swollen, puffy and red w 4/27/2009 Vesicular lesion trunk with scabbing 4/30/2009 Pt developed a local rxn one day af 4/30/2009 At 24-36 hours, pain, swelling at inje 5/1/2009 Caregiver called stating child compl 4/30/2009 At 48 hours, ipsilateral axillary pain, 4/29/2009 This case was reported by a consum 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a physici 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 4/29/2009 This case was reported by a healthc 5/2/2009 Received vaccination 10/30/07; retu 5/2/2009 Fever, ache, lethartic onset 48 hour 5/2/2009 a week later, very tired and rash (sk 5/2/2009 Measle-like rash all over legs and a
345427 345428 345429 345430 345438 345431 345432 345433 345434 345528 345530 345533 345534 345540 345541 345542 345543 345545 345546 345547 345548 345549 345550 345551 345552 345553 345555 345556 345558 345561 345573 345574 345575 345576 345577 345578 345579 345580 345581 345582 345583 345584 345585 345586 345587 345588 345589 345590 345591 345592 345593
5/2/2009 WA 5/2/2009 CA 5/2/2009 FL 5/2/2009 FL 5/2/2009 AZ 5/3/2009 NH 5/3/2009 CO 5/3/2009 CA 5/4/2009 PR 5/4/2009 5/4/2009 5/4/2009 PA 5/4/2009 5/4/2009 5/4/2009 IL 5/4/2009 AR 5/4/2009 TN 5/4/2009 AR 5/4/2009 AZ 5/4/2009 MA 5/4/2009 AR 5/4/2009 PA 5/4/2009 MA 5/4/2009 VA 5/4/2009 IL 5/4/2009 PA 5/4/2009 OR 5/4/2009 MA 5/4/2009 MA 5/4/2009 VA 5/4/2009 MA 5/4/2009 NY 5/4/2009 NY 5/4/2009 MO 5/4/2009 PA 5/4/2009 NY 5/4/2009 TX 5/4/2009 MN 5/4/2009 CA 5/4/2009 FL 5/4/2009 DC 5/4/2009 FL 5/4/2009 MI 5/4/2009 5/4/2009 FL 5/4/2009 KS 5/4/2009 VT 5/4/2009 OK 5/4/2009 UT 5/4/2009 VA 5/4/2009 OH
24 2 12 1 14 44 36 22 44 16 11 83 25 17 29 35
24 2 12 1 14 44 36 22 44
1 11 19 0.2 0.6 54 54 14 5 37 1.3 0.4 0.2 18 32 28 53 31 54 74 0.2 26 36 1.3 1.5 1.6 11 0.5 24 33 61 0.4 26 12
1 11 19 0 0 54 54 14 5 37 1 0 0 18 32 28 53 31 54 74 0 26 36 1 1 1 11 0 24 33 61 0 26 12
83 25 17 29 35
M 0.7 F F 0M M F F M M F M M F F F F F 0F M M 0.2 M 0.6 M F F F F M 0.3 M 0.4 M 0.2 F F F F F F F F 0.2 F F F 0.3 M 0.5 F 0.6 F M 0.5 M F F F 0.5 F F M
5/2/2009 Arm goes numb for approximately 3 5/2/2009 Ataxic symptoms, shaking, "bobbleh 5/2/2009 WITHIN A LITTLE OVER 24 HOUR 5/2/2009 swelling iside of cheeks. 5/2/2009 Mom returned to office - stated "my 5/3/2009 I needed a tetanus shot for an infec 5/3/2009 R deltoid injection 5/1/09 yellow fev 5/3/2009 Papulo-pustular rash extending from 5/4/2009 Diabetis,Vision,Blood restal,soryasis 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 5/1/2009 Information has been received from 4/30/2009 This serious case was received on 2 4/30/2009 Initial report received on 24 April 20 5/1/2009 This serious case was received on 2 4/24/2009 Pt vaccinated at approx. 0830 4/22/ 4/29/2009 Pt was given SQ left arm of VARICE 4/28/2009 8 hours after shot, fever, headaches 4/24/2009 See ER sheet - mom reports infant 4/21/2009 Patient was given initial dose of RO Suprasternal chest tightness withou 4/29/2009 There is a darkened raised area on 4/22/2009 Child received 2 vaccines, MENACT 4/29/2009 5 days after vaccine was administer 48 hrs - following vaccine, swelling d 4/24/2009 Typical post vaccine rash "mini mea 4/28/2009 Fever >103, start at 9pm & vomited 4/29/2009 Prolonged screaming/crying. 5/4/2009 Within 10 hours of shot fever,palene 5/4/2009 redness and swelling, painful at site 5/4/2009 redness, pain and swelling at injecti 5/4/2009 Patient reports extreme pain at site 5/4/2009 2 days after receiving the for about 5/4/2009 redness and pain at site of injection 5/4/2009 Patient received Zostavax Vaccine 5/4/2009 I received the MMR vaccine on 4-20 5/4/2009 Administered yellow fever vaccinatio 5/4/2009 WITHIN 12 HOURS: SEVERE DRO 5/4/2009 mother noted thigh swelling at injec 5/4/2009 Fever, irritablity and rash about 9 da 5/4/2009 Within 15 minutes post injection pat 5/4/2009 Vaccination was received on 4/28/2 5/4/2009 high fever, projectile vomiting, letha 5/4/2009 Adverse reaction to right deltoid afte 5/4/2009 Temp of 100-102 within 24 hours. M 5/4/2009 Patient described onset of large 'ora 5/4/2009 Pt recieved regular vaccines at two 5/4/2009 10/11/09 awoke with severe pain an 5/4/2009 Right arm cellulitis developed at imm
345594 345595 345596 345597 345598 345599 345600 345601 345602 345607 345608 345609 345610 345611 345612 345613 345615 345616 345617 345628 345630 345631 345633 345634 345636 345638 345639 345640 345641 345643 345644 345645 345646 345647 346062 346063 346064 346065 346066 346067 346068 346069 346127 346128 346129 345676 345677 345678 345679 345680 345681
5/4/2009 FL 5/4/2009 MI 5/4/2009 CA 5/4/2009 GA 5/4/2009 LA 5/4/2009 MI 5/4/2009 IL 5/4/2009 CA 5/4/2009 AZ 5/4/2009 CA 5/4/2009 MI 5/4/2009 IA 5/4/2009 VA 5/4/2009 WI 5/4/2009 ID 5/4/2009 PA 5/4/2009 MD 5/4/2009 NM 5/4/2009 MN 5/4/2009 OH 5/4/2009 NM 5/4/2009 TX 5/4/2009 NY 5/4/2009 WV 5/4/2009 ME 5/4/2009 NY 5/4/2009 CT 5/4/2009 IL 5/4/2009 OH 5/4/2009 OH 5/4/2009 KY 5/4/2009 PA 5/4/2009 CA 5/4/2009 KY 5/4/2009 PA 5/4/2009 MI 5/4/2009 AZ 5/4/2009 FL 5/4/2009 FL 5/4/2009 IN 5/4/2009 IN 5/4/2009 NY 5/4/2009 VA 5/4/2009 WA 5/4/2009 PA 5/5/2009 CA 5/5/2009 NY 5/5/2009 MI 5/5/2009 MI 5/5/2009 MN 5/5/2009 LA
1.3 0.2 4 52 1 1 4 0.8 14 16 1 59 6 11.2 65 0.2 28 53 4 11 1 52 23 0.1 32 4 11 0.6 1 11 31 6 13.3 11 54 62 63
1 0 4 52 1 1 4 0 14 16 1 59 6
39 49 62 31 21 26
39 49 62
28 46 5 7 11 0.4
28 46 5
65 0 27 53 4 11 52 23 0 32 4 11 0 1 11 31 6 13 11 54 62 63
21 26
11 0
0.3 F 0.2 F M M 0.1 M 0.1 M F 0.8 F M F 0F M M F F 0.2 M F F F M F F M 0.1 F F F M 0.6 M 0F M F M F F M F F U M F M F M F M F F M F F 0.4 M
5/4/2009 On 4/26/09 patient started to develo 5/4/2009 Blue streaking across the leg from t 5/4/2009 24 hours after injection - mom noted 5/4/2009 NONE 5/4/2009 Had measle like red, raised bumps 5/4/2009 NO ADVERSE EVENTS, SYMPTOM 5/4/2009 CELLULITIS LEFT LEG DIAGNOSE 5/4/2009 2 days after administration of rotate 5/4/2009 Mother, phoned clinic and left a mes 5/9/2009 Tremors in R hand started 12-24 ho 5/4/2009 Pt broke out with 9 blisters on 5-3-0 5/4/2009 Pt was given 2nd dose of Hep B ser Localized cellulitis at administration 5/3/2009 Teen had syncopal episode after ta 5/4/2009 Pt developed shingles 7 days after Z 5/4/2009 TC received from stating pt seems t 5/4/2009 Pt. presented to GARDASIL clinic 7 4/30/2009 Swelling & Lg redness at injection s 5/1/2009 (L) thigh swollen from upper thigh to 5/4/2009 Fainted - lasting 15 seconds - return 5/4/2009 Uticaria to R upper chest welt 3 cm 5/4/2009 Swollen red left upper arm approx s 5/4/2009 Hepatitis B #3 vaccine given on 4-2 5/4/2009 1 month old given Hep A vaccine in 4/28/2009 L shoulder vaccine site (deltoid) was 5/11/2009 About 5-10 min after vaccinations (H 4/23/2009 Mom reports eyes red, puffy & warm 5/1/2009 Inf received 6 mon vaccinations at 2 4/14/2009 Fever and rash trunk after 8 hrs. Te 4/28/2009 Shot RA- 4/26 - Rt arm swollen, hot 4/30/2009 Pt describes reddened area around 4/29/2009 Parent of patient returned to clinic 2 4/21/2009 Fever on 4-17-09, 7 PM. On 4-18-0 4/28/2009 6 cm red rash with pain and swelling 6/17/2008 Initial report was received 05 June 2 8/27/2008 A cluster of four cases of injection s 10/4/2008 Initial report received from a consum 3/25/2009 Initial report received form a health 12/9/2008 A 39 year old male patient with a his 2/9/2009 A 49-year-old female patient, who h 2/10/2009 A 62-year-old male patient, who had 3/6/2009 Initial report received 27 February 2 7/16/2008 Initial report received from a health 8/18/2008 Initial report was received 15 May 2 Initial report was received 20 May 2 4/27/2009 Pt reports 1 mo after receiving vacc 4/27/2009 Pt received Immunization on 4/22/0 4/27/2009 Gave adult dose of HEP A instead o 4/27/2009 Gave adult dose of Hep A instead o 4/30/2009 4cm localized inflammation to left up 5/1/2009 4mo shots. High pitched crying x1 h
345682 345683 345684 345685 345686 345687 345688 345689 345690 345692 345694 345696 345697 345698 345700 345701 345702 345703 345704 345705 345706 345707 345708 345709 345710 345711 345712 345713 345714 345715 345716 345717 345718 345719 345720 345721 345722 345723 345724 345725 345726 345727 345728 345729 345730 345731 345732 345733 345734 345735 345736
5/5/2009 IN 5/5/2009 IL 5/5/2009 OH 5/5/2009 NY 5/5/2009 MI 5/5/2009 OH 5/5/2009 5/5/2009 TX 5/5/2009 TX 5/5/2009 TN 5/5/2009 5/5/2009 TX 5/5/2009 5/5/2009 5/5/2009 5/5/2009 PA 5/5/2009 AZ 5/5/2009 AZ 5/5/2009 TN 5/5/2009 OK 5/5/2009 FL 5/5/2009 IN 5/5/2009 NC 5/5/2009 NH 5/5/2009 TX 5/5/2009 OH 5/5/2009 NE 5/5/2009 CA 5/5/2009 CO 5/5/2009 IL 5/5/2009 WI 5/5/2009 NE 5/5/2009 WI 5/5/2009 MD 5/5/2009 GA 5/5/2009 MD 5/5/2009 NY 5/5/2009 MO 5/5/2009 SD 5/5/2009 FL 5/5/2009 FL 5/5/2009 MO 5/5/2009 GA 5/5/2009 NY 5/5/2009 NY 5/5/2009 OK 5/5/2009 MO 5/5/2009 SC 5/5/2009 CA 5/5/2009 OK 5/5/2009 CA
15 4 5 5 14 6 18 62 61 1.9 15 22 19 17 35 1 6 5 23 1.3 20 13 15 9 10 11 1.3 4 20 42 11 1.3 33 29 13 39 1.3 14 24 68 73 0.2 68 28 43 50 5 61 18 16 71
15 4 5 5 14 6 18 62 61 1
19 17 35 1 6 5 23 1 20 13 15 9 10 11 1 4 20 42 11 1 33 29 13 39 1 14 24 67 73 0 68 28 43 50 5 61 18 16 71
F F M M F M M F F 0.9 M F F F F M 0F F F F 0.3 M M F F F M M 0.3 M F F M M 0.3 M F F F M 0.3 F M F M F 0.2 M F F M M M M F M F
4/29/2009 Pt given vaccine 4/16/09 - Mother c 4/30/2009 (1) leg/injection site swollen and pai 4/29/2009 Red, warm and itchy area over TRIP 4/28/2009 10 mm diameter area of erythema o 4/30/2009 Patient fainted, difficult to arouse (1 4/28/2009 Child received Kinrix injection in R t Non Stated 4/29/2009 Pt. called today 4/29/09 at 12:10 PM 4/29/2009 Pt received vaccine on 4/24/09. Sh 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Information has been received from 5/4/2009 Initial information and follow up has 4/28/2009 Smallpox site still itches. Recently b 4/29/2009 L thigh firm area of redness 1" diam 4/30/2009 Hives at injection site Benadryl 25 m 4/30/2009 Red swollen lump at injection site (R 4/29/2009 c/o itching over all of body, tongue + 4/28/2009 Varicella lesions eruption 4/27/09 A 5/4/2009 Patient received both TWINRIX & T 5/5/2009 Patient became lightheaded, pale, a 5/5/2009 Parents concerned that vaccine (s) 5/5/2009 Pt received Varicella vaccine on 4/3 5/4/2009 8x4 cm redness + swelling at injecti 4/29/2009 Redness/swelling @ upper arm - 8" 5/1/2009 104 fever & fussiness 9 days after M 4/22/2009 Local reaction swollen redness injec 4/13/2009 04/06/09 Rash on Rt leg above kne 5/1/2009 Pt started experiencing rash/hive ty 4/30/2009 Local reaction right arm 5/1/2009 Fever 102.8 at 5:00 pm day followin 4/30/2009 Local reaction left arm 5/5/2009 @ 1/2 hour after vaccine administra 5/5/2009 Hives occured 9 days after administ 5/5/2009 constipation, some lost of vision 5/5/2009 VACCINES ADMINISTERED 4-13-0 5/5/2009 Skin pale with heat and edema surr 5/5/2009 Pt presented for pre-travel vaccinati 5/5/2009 Rcvd call from pt. wife stating husba 5/5/2009 Adm. zoster vax on 2/4/09. Rcvd ca 5/5/2009 MOTHER CALLED AND STATED H 5/5/2009 24 hrs following, swelling, itchiness 5/5/2009 Guillain-Barre' Syndrom 6/8/09 Hos 5/5/2009 Patient states that he developed dif 5/5/2009 PNEUMOVAX .5 CC GIVEN R DEL 5/5/2009 Child received the MMR vaccine an 5/5/2009 dramatic swelling of the site w/ redn 5/5/2009 Patient became lightheaded and los 5/5/2009 Pt c/o tingling, itching on back of arm 5/5/2009 Patient stated area of injection had
345737 345744 345745 345747 345748 345749 345750 345751 345752 345753 345754 345755 345756 345757 345758 345759 345760 345761 345762 345764 345738 345740 345786 345787 345788 345789 345790 345791 345792 345793 345794 345795 345796 345797 345798 345799 345800 345801 345802 345803 345804 345805 345806 345807 345808 345809 345813 345818 345819 345820 345821
5/5/2009 CA 5/5/2009 5/5/2009 NM 5/5/2009 CA 5/5/2009 GA 5/5/2009 OR 5/5/2009 PA 5/5/2009 PA 5/5/2009 5/5/2009 MI 5/5/2009 IL 5/5/2009 AR 5/5/2009 CA 5/5/2009 CO 5/5/2009 AR 5/5/2009 IL 5/5/2009 NC 5/5/2009 CA 5/5/2009 CA 5/5/2009 5/6/2009 NY 5/6/2009 WA 5/6/2009 5/6/2009 5/6/2009 WI 5/6/2009 5/6/2009 5/6/2009 SC 5/6/2009 AZ 5/6/2009 VA 5/6/2009 NY 5/6/2009 IL 5/6/2009 MO 5/6/2009 PA 5/6/2009 OK 5/6/2009 NY 5/6/2009 OH 5/6/2009 NC 5/6/2009 IL 5/6/2009 MI 5/6/2009 GA 5/6/2009 IL 5/6/2009 MO 5/6/2009 CA 5/6/2009 FL 5/6/2009 5/6/2009 5/6/2009 5/6/2009 FL 5/6/2009 WA 5/6/2009 NC
64
64
0.3 0.2 58 1.3 10 52 1.3 37 81 13 52 14 3 1 11 1 72 75 4 2
0 0 58 1 10 52 1 37 81 13 52 14 3 1 11 1 72 75 4 2
61 13 24 64 15 1.3 0.9 14 9 18 14 29 66 64 24 6 11 15 0.5 16 13
61 13
1.1 41 0.2 15 27
1 41 0 15 27
65 15 1 0 14 9 18 14 29 66 64 24 6 11 15 0 16 13
F M 0.3 M 0.2 M M 0.3 F F F 0.3 F F F F F F F 0F F 0M F M M 0.3 M M M F F F M F 0.3 M 0.9 M F F M F F F F F F M F 0.5 F U F F 0.1 M M 0.2 F F M
5/5/2009 Approximately 4-5 hours after receiv 5/5/2009 This case was reported by a physici 5/5/2009 This case was reported by a physici 5/5/2009 3 days of fever, 2 days of rash. Had 3 times Emergency Rooms. 6 days 5/5/2009 Increased redness & swelling @ site 5/5/2009 Received TYLENOL at home. Pt. re 5/5/2009 100 temp 24 after shot, erythema te 5/5/2009 Fever. 5/5/2009 Client found out pregnant 2 wks afte 5/5/2009 Patient had been diagnosed with sh 5/5/2009 3 1/2 cm x 5 cm swelling and redne 5/5/2009 Pt reported swelling, redness, and i 5/5/2009 Immunization administered - child s 5/5/2009 Pt received combination vaccine of 5/5/2009 Fever, redness, swelling at injection 5/5/2009 Mother of child called Health Dept 5 4/16/2009 Per mom, child was in the ER last n 4/22/2009 Blister rash present on knees, elbow 4/22/2009 Early June 2008, noticed large ecch 5/6/2009 Administered 4:05pm. Reacted at 4 5/6/2009 Fussiness, Tiredness and poor app 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/5/2009 Information has been received from 5/6/2009 left arm turned red, very sore, itchy. 5/6/2009 Had Hep A vaccine--became dizzy a 5/6/2009 Prior to shot child had some conges 5/6/2009 PATIENT PRESENTED WITH TEM 5/6/2009 CLIENT C/O BEING COLD, DIZZY, 5/6/2009 9 year old female had foot stuck wit 5/6/2009 Patient reported to student health se 5/6/2009 Approximately 2 minutes after recei 5/6/2009 received shot in a.m. on Monday 4/2 5/6/2009 PT REPORTS DIFFICULTY BREAT 5/6/2009 Two days after vaccine pt. reports a 5/6/2009 ~ 24 hours after gardasil #1, patient 5/6/2009 RED RASH AROUND INJECTION S 5/6/2009 SITE OF INJECTION-LEFT ARM IS 5/6/2009 Pt. received vaccines listed below a 5/6/2009 within 3 hours of vaccine child had h 5/6/2009 She also received TdaP and menac 5/1/2009 This serious case was received on 2 5/5/2009 Initial report received on 28 April 20 5/5/2009 This case was considered medically 5/1/2009 See HPI: n/v fever, headaches 12-2 5/6/2009 Crying inconsolable. Swelling of thig 5/6/2009 Within 5 mins of receiving immuniza 4/30/2009 Smallpox vaccine received 24MAR2
345822 345823 345824 345825 345826 345827 345828 345829 345830 345831 345832 345833 345834 345835 345836 345837 345838 345839 345840 345841 345842 345843 345844 345845 345846 345847 346131 346132 346133 346134 346135 346136 345848 345849 345850 345851 345855 345857 345859 345861 345864 345865 345866 345867 345868 345869 345870 345871 345872 345873 345874
5/6/2009 MI 5/6/2009 TX 5/6/2009 VA 5/6/2009 VA 5/6/2009 MN 5/6/2009 OH 5/6/2009 5/6/2009 NC 5/6/2009 MN 5/6/2009 TX 5/6/2009 LA 5/6/2009 IL 5/6/2009 CA 5/6/2009 IA 5/6/2009 FL 5/6/2009 PA 5/6/2009 MA 5/6/2009 WA 5/6/2009 AR 5/6/2009 NY 5/6/2009 KY 5/6/2009 MS 5/6/2009 IL 5/6/2009 WI 5/6/2009 NY 5/6/2009 RI 5/6/2009 ME 5/6/2009 VA 5/6/2009 NY 5/6/2009 MI 5/6/2009 WI 5/6/2009 NJ 5/7/2009 TX 5/7/2009 5/7/2009 HI 5/7/2009 5/7/2009 CA 5/7/2009 NY 5/7/2009 5/7/2009 UT 5/7/2009 MS 5/7/2009 NY 5/7/2009 ID 5/7/2009 NJ 5/7/2009 AZ 5/7/2009 PA 5/7/2009 AZ 5/7/2009 CA 5/7/2009 TX 5/7/2009 MD 5/7/2009 TX
18 46 1.3 6 5 51 32 80 53 34 10 5 4 1.5 82 80 60 48 5 23 25 4 18 15 4 1.4 41 21 18 40 59 67 13 15 23
18 46 1 6 5 51 32 80 53 34 10 5 4 1 82 80 60 48 5 23 25 4 18 15 4 1 41 21
0.2 57
0 57
0.2 3 12 5 70 2 0.5 3 77 20 12 45
0 3 12 5 70 2 0 3
40 59 67 13 23
20 12 45
F M 0.3 M M M F M M F F M M M 0.5 M M F F F F F F F F F F 0.4 F F M F F F F F F F M 0.2 F F U 0.2 F F F M F 0M 0.5 F M F F F F
5/5/2009 Immediately after receiving GARDA 5/6/2009 None stated 5/5/2009 Localized cellulitis 5 cm X 5 cm red, Localized cellulitis at administration 5/4/2009 about 4 - inch area of redness, warm Went to ER on 4-29-09 c/o fever na 5/6/2009 Worsening joint pain, numbness (lef 5/5/2009 Patient developed itching on his bac 5/5/2009 Non stated 5/6/2009 Rash appeared at site of vaccinatio 5/6/2009 Redness after 24 hours and warmth 5/6/2009 Erythema 10ml around injection of c 5/5/2009 Left arm red, warm with pain -> trea 5/6/2009 Lt leg @ injection site showed redne 4/16/2009 Large local reaction redness & swel Shooting @ throbbing pain L arm + 5/6/2009 The patient developed shingles on l 5/5/2009 Erythema of the Rt upper arm, temp 5/6/2009 Pain, swelling, redness, large circle 4/28/2009 Injection given @ 4:30 pm- Pt C/0 it 5/6/2009 Pt complained of having dizziness, Swollen right tricep area with indura 4/30/2009 4" diameter erythema 1-2mm vesicl 4/30/2009 Swelling in right arm post receiving 5/1/2009 About 5-10 minutes after vaccinatio 5/6/2009 Fever 102-103, rash on face - dry c 4/2/2008 This case was received from a heal 7/16/2008 Initial report received from a health 7/31/2008 An 18-year-old female patient, who 1/5/2009 Initial non-serious case received fro 2/19/2009 Initial information was received on 0 8/12/2008 Initial non-serious case received fro 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/6/2009 Information has been received from 5/5/2009 Initial report received 29 April 2009 5/5/2009 This serious case was received on 3 5/5/2009 This case was received on 01 May 2 5/6/2009 Information regarding PREVNAR wa 5/1/2009 4/28 had fever with chills - arm swol 5/13/2009 Daily severe migraine headache un 4/30/2009 On 4/28/09 Mom called on her son 5/3/2009 5 days after flu shot, I developed a r 4/22/2009 Upper L arm was red/irritated no pa 4/30/2009 Had ROTATEQ vaccine 4-14-09. De 4/22/2009 Rash all over body, swollen and hot 5/7/2009 Fever up 102 for 3 days with mild po 5/7/2009 Patients calls the day after immuniz 5/7/2009 Localized reaction 13x26mm indura 5/7/2009 30 cm X 10 cm length width erythem
345875 345876 345877 345878 345879 345880 345881 345882 345883 345884 345885 345886 345887 345888 345889 345890 345891 345892 345893 345894 345895 345896 345897 345905 345906 345907 345908 345909 345910 345911 345912 345913 345914 345915 345916 345917 345918 345919 345920 345922 345925 345926 345927 345928 345929 345930 345931 345932 345934 345935 345937
5/7/2009 NY 5/7/2009 NY 5/7/2009 NC 5/7/2009 NC 5/7/2009 PA 5/7/2009 MI 5/7/2009 NC 5/7/2009 GA 5/7/2009 CT 5/7/2009 CO 5/7/2009 MD 5/7/2009 KS 5/7/2009 WA 5/7/2009 NC 5/7/2009 NC 5/7/2009 CA 5/7/2009 NC 5/7/2009 WA 5/7/2009 CA 5/7/2009 CA 5/7/2009 IN 5/7/2009 IN 5/7/2009 VT 5/7/2009 NC 5/7/2009 TX 5/7/2009 KY 5/7/2009 MI 5/7/2009 WA 5/7/2009 AZ 5/7/2009 FL 5/7/2009 CT 5/7/2009 CA 5/7/2009 FL 5/7/2009 NY 5/7/2009 OH 5/7/2009 FL 5/7/2009 TX 5/7/2009 NY 5/7/2009 OH 5/7/2009 WA 5/7/2009 VT 5/7/2009 OH 5/7/2009 RI 5/7/2009 CA 5/7/2009 OH 5/7/2009 SD 5/7/2009 CO 5/7/2009 TX 5/7/2009 FL 5/7/2009 ME 5/8/2009
0.2 34 11 63 17 52 1 1.5 2 35 35 0.3 18 1 1 11 14 23 4 16 1.1 4 65 0.3 29 0.4 54 1 4 4 2 4 13 1.3 19 0.6 1 5 56 17 61 27 14 15 1 65 50
0 34 11 63 17 52 1 1 2 36 35 0 18 0 0 11 14 23 4 16 1 4 65 0 29 0 54 1 4 4 2 4 13 1 19 0
30 81 24
30 81
5 56 17 61 14 15 1 65 50
0.2 F F F F F M 0F 0.6 M 0.6 M M F 0.3 F F 1M 1M M F M M F 0.1 M F F 0.3 M M 0.4 M F 0F M M 0M F F 0.3 M F 0.6 M F M F F F F F M 0M F F M M F F
5/6/2009 Irritability for 5 hours crying, given T 5/5/2009 2 days after administration of TDAP 5/7/2009 Left upper arm red, warm to touch, 5/6/2009 Arm sore, tired, muscle ache lasting 5/7/2009 Mother of patient states patient rece 5/7/2009 He states Imm given in AM. The foll 5/7/2009 EXTREME FUSSINESS AND 103 D 5/7/2009 Fever highest 104.6, hives off and o 5/7/2009 4/29/09 (Telephone consult) rash on 5/7/2009 Aproximately 28 hours after vaccina 5/7/2009 Developed 5 pox blisters/spots 11 d 5/7/2009 Pt is only 4 months and was given v 5/7/2009 SM tested negative BHCG on 30Ma 5/7/2009 Pt rec'd vaccines at 11a.m. and retu 5/7/2009 Pt rec'd vaccines at 11a.m. and retu 5/7/2009 GAVE DTaP INSTEAD OF Tdap 5/7/2009 Within approximately 5-10 minutes o 5/7/2009 Pt. w/ peri-umbilical follicultis on 2 M 5/7/2009 L arm redness and swelling 4 cm x5 5/7/2009 Pt had syncopal episode 15 min afte 5/7/2009 No adverse event reported. RN gav 5/7/2009 Fell to floor after getting vaccines. P 5/7/2009 L Deltoid muscle was extremely pai 5/6/2009 Seizure activity 3-4 hrs after receivin 5/7/2009 Coughing up blood, chest pain, and 4/30/2009 Seizure - 11 AM 4/28/09 - taken by 5/5/2009 Symptoms: 1. Rash 2. local swelling 5/1/2009 Pt was adopted at about 7 m/o from 5/7/2009 Redness and swelling at injection si 5/7/2009 Cellulitis L thigh - fever 101.7 given 4/25/2009 3/10/09 - AM shaking arm when rea Reddness & swelling noted at inject 5/7/2009 Fever 103 degrees. Diarrhea. Vomit 5/7/2009 Papulo-vesicular rash over torso / p 5/7/2009 April 29, 09 - Injection given R shou PE had a seizure like episode and s 5/5/2009 Given 12 mo vaccines on 4/24/09. 4/30/2009 6 cm x 7 cm area of erythema with s 5/4/2009 Warmth erythema at injection site. 5/7/2009 Pt had vaccines (shots) for flu, polio 4/30/2009 Received vaccination in left arm on Several areas other various location 4/29/2009 Syncope after vaccination given, pa 5/6/2009 Swelling, redness, and warmth. 5/3/2009 Left thigh - No initial local reaction u 5/4/2009 Arm were ZOSTAVAX was given go 5/1/2009 Sever headache and feeling of insid 5/1/2009 None Stated 5/7/2009 Appx 0930 - vaccination administere 5/6/2009 Patient felt a lump on left arm after a 5/7/2009 Information has been received from
345938 5/8/2009 345939 5/8/2009 FL 345941 5/8/2009 IL 345944 5/8/2009 345945 5/8/2009 CA 345948 5/8/2009 MD 345949 5/8/2009 TX 345950 5/8/2009 FL 345951 5/8/2009 WA 345953 5/8/2009 KS 345954 5/8/2009 TX 345955 5/8/2009 345956 5/8/2009 345958 5/8/2009 CA 345959 5/8/2009 MD 345960 5/8/2009 AZ 345968 5/8/2009 PA 345976 5/8/2009 CA 345977 5/8/2009 NC 345978 5/8/2009 WA 345979 5/8/2009 WA 345980 5/8/2009 CA 345981 5/8/2009 PA 345982 5/8/2009 FL 345983 5/8/2009 OR 345984 5/8/2009 NJ 345985 5/8/2009 PA 345986 5/8/2009 PA 345987 5/8/2009 MD 345988 5/8/2009 IN 345989 5/8/2009 345990 5/8/2009 FL 345991 5/8/2009 GA 345992 5/8/2009 PA 345993 5/8/2009 GA 345994 5/8/2009 NJ 345995 5/8/2009 IA 345996 5/8/2009 TN 345997 5/8/2009 NY 346000 5/8/2009 NM 346001 5/8/2009 WV 346002 5/8/2009 IN 346004 5/8/2009 NJ 346007 5/8/2009 PA 346008 5/8/2009 CA 346010 5/8/2009 NC 346184 5/8/2009 CA 345961 5/9/2009 NC 345962 5/9/2009 CA 345963 5/9/2009 345964 5/10/2009 LA
73
73
39 17 33 66 22 25 11 78 32 3 0.2 37 4 0.4 1 47 72 4 84 35 1.6 0.6 5 9 1 5 1.1 0.2 28
39 17 33 66 22 25 11 -23 32 3 0 37 4 0 1 47 72 4 84 35 1 0 5 9 1 5 1 0 28
4 4 0.6 5 15 57 2 1.1 2 0 0.8 2 16 31 1 47 36
4 4 0 5 15 57 2 1 2 0 0 2 16 31 1 36
M F U U F F F F M F F 1M F M 0.2 M F M 0.4 F 0F F F M M F 0.6 M 0.6 F F M 0F F 0.1 M 0.2 M M F F F 0.6 F M F F 0F 0.1 M 0.5 F 0M 0.8 F 0.4 F F F 0F M F
5/7/2009 Information has been received from 5/7/2009 Information has been received from 5/7/2009 This case was considered medically 5/5/2009 This case was received on 01 May 2 5/6/2009 Initial report received from a health 5/8/2009 Pt & Foster Mother walked into Cen 5/8/2009 At 48 hours, significant Local React 5/8/2009 On 3/12/09 Tetanus/Diptheria toxoid 5/7/2009 papular rash back of both hands an 5/8/2009 Elevated temperature of 100 F withi 5/8/2009 reddness swelling upper arms 5/8/2009 ONE WEEK AFTER SHINGLES VA 5/8/2009 Vaccinated with ACAM2000 during 5/8/2009 GAVE 3RD HEP A 5/8/2009 My son was given his 2 month rout 5/8/2009 Small lump Lt upper arm at injection 5/8/2009 This case was reported by a healthc 3/16/2009 Child received oral Rotavirus vaccin 5/8/2009 Prolonged fever 3/14/09 - 3/18/09 w 4/14/2009 Rash, redness pain, swelling at and 5/8/2009 Small red circle around shot. Now w 5/8/2009 Pt had localized erythema/ induratio 5/5/2009 Shaky No appetite Tremors Loss of 5/5/2009 Pt was given shots on 5-1-09. 45 m 5/4/2009 See accompanying note. 4/22/2009 Crying uncontrollably for 5 days afte 5/4/2009 Varicella vaccine breakthrough diag 5/4/2009 Varicella Vaccine Breakthrough. Dia 5/4/2009 Behavior change. Sleepy day after 5/8/2009 Mother states pt has red, swollen, it 5/8/2009 12 mo received immunizations (Pre 5/4/2009 Patient was lethargic moaned and m 5/8/2009 We gave him a shot by annual chec 5/8/2009 Local, allergic reaction, rt arm redne 5/8/2009 Hives with sig. facial swelling Benad 5/8/2009 L deltoid redness and hardness pt. 5/8/2009 Client received vaccinations @ app 5/7/2009 Both thighs red, swollen, hot to touc 5/4/2009 c/o dizziness-instructed to lay down 5/5/2009 swollen lymph nodes @ neck, rapid 5/2/2009 48 hours after receiving MMR she b 5/5/2009 Fever started 6 days after vaccines 5/4/2009 4/28/09 fever 102 degrees - 103 de 5/4/2009 Varicella vaccine break through. Dia 5/4/2009 Erythema multiforme- started 5/2/09 4/24/2009 Fever 103 4/15/2009 Initial report received on 02 April 20 5/9/2009 Woke up with Very sore arm (painfu 5/9/2009 Febrile Seizure lasted 60 seconds s 5/9/2009 I'm currently serving my 4th deploym 5/10/2009 Starting the day the first dose rabies
345965 345966 346046 346052 346053 346054 346055 346056 346058 346059 346060 346070 346071 346072 346073 346074 346075 346076 346077 346078 346079 346080 346081 346082 346083 346084 346096 346097 346098 346099 346100 346101 346102 346103 346104 346105 346106 346107 346108 346109 346110 346111 346112 346113 346114 346115 346116 346117 346118 346119 346120
5/10/2009 NV 5/10/2009 GA 5/11/2009 CA 5/11/2009 NC 5/11/2009 FL 5/11/2009 5/11/2009 5/11/2009 5/11/2009 PA 5/11/2009 CA 5/11/2009 CA 5/11/2009 WY 5/11/2009 MD 5/11/2009 MD 5/11/2009 NY 5/11/2009 IL 5/11/2009 CA 5/11/2009 CA 5/11/2009 WA 5/11/2009 CA 5/11/2009 MI 5/11/2009 VA 5/11/2009 MI 5/11/2009 NY 5/11/2009 AL 5/11/2009 CA 5/11/2009 VA 5/11/2009 5/11/2009 TX 5/11/2009 NC 5/11/2009 KS 5/11/2009 GA 5/11/2009 IA 5/11/2009 CA 5/11/2009 ME 5/11/2009 ME 5/11/2009 VA 5/11/2009 TX 5/11/2009 NV 5/11/2009 GA 5/11/2009 MO 5/11/2009 NM 5/11/2009 NJ 5/11/2009 FL 5/11/2009 NY 5/11/2009 ME 5/11/2009 DC 5/11/2009 ME 5/11/2009 CA 5/11/2009 MN 5/11/2009 NJ
4 65 2 13 21 15 11 20 18 1.3 1.3 54 0.5 7 1.5 0.4 50 32 76 61 4 10 4 22 15 5 4 11 32 87 12 39 15 4 2 12 57 72 0.7 11 10 22 11 16 5 2 60 1.3 5 17 40
4 65 13 22
20 18
54 0 7 1 0 50 32 76 61 4 10 4 22 15 5 4 32 87 12 39 15 4 2 12 57 72 0 11 10 22 11 16 5 2 60 1 5 17 40
M F M F F F F F F U U M 0M F 0.5 F 0.4 F F F F M M M U F F F M F M F F M F F 0F F F M 0.7 F M F M F F M 0.6 F F 0.3 U F F F
5/10/2009 right deltoid with induration, mild ery 5/10/2009 My arms swelled up to double its siz 5/8/2009 Information has been received from 5/8/2009 Initial and follow-up information has 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/8/2009 Information has been received from 5/11/2009 5/5/09 At time of injections noted cli 5/11/2009 6 month old received immunizations 5/11/2009 Patient and patient's father returned 5/11/2009 RASH STARTED ON 5/10/2009 FR 5/11/2009 Evening of injections got fussy, then 5/11/2009 Developed fevers, malaise and hea 5/11/2009 Skin Rash and/or Hives, swollen fee 5/11/2009 On Day 2 after the injection (5/2), de 5/11/2009 1/2 DOLLAR bill redness c some sw 5/11/2009 LOCAL RXN R>L THIGH W/IN MIN 5/11/2009 Tdap was administered in school se 5/11/2009 LOCAL RXN R THIGH W/IN MINUT 5/11/2009 Approx. 20 hours after receiving vac 5/11/2009 Parent states that patient had on lef 5/11/2009 Noted slight swelling of the left delto 5/7/2009 Toxic synovitis (L) hip. 6/24/09 Hosp 5/7/2009 Received second dose of GARDAS 5/8/2009 None Stated. 5/11/2009 Tingly pains in left hip with weaknes 5/8/2009 Pt Developed a right upper extremit 5/4/2009 Patient reported C/o redness and so 5/8/2009 3-4 Months after 3rd dose of GARD 5/8/2009 Swelling, redness, pain. Entire delt 5/11/2009 Vaccine given instead of VARIVAX 4/30/2009 Hives - began around 6pm on 4/28/ 5/11/2009 May 7 after shot arm sore and some 5/11/2009 Loss of sensation in right arm; arm i 5/11/2009 02/24/2009 Severe Seizures < 3 da 5/11/2009 Local reaction, quarter sized erythe 5/11/2009 Redness Swelling itching warm to to 5/11/2009 Developed tender mildly pruritic ery 5/11/2009 Within 24 hrs following vaccinations 5/11/2009 Pt fainted, gave oxygen and checke 4/30/2009 6cm x 7cm area of erythema with sl 5/6/2009 Diffuse papular/macular erythemato Minor swelling + tenderness at injec Diffuse macular erythematous rash 4/30/2009 Rec'd vacc 4:30 p 4/27. Pt went to s 5/4/2009 About 5 hours after shot developed 5/11/2009 Erythema local. Myalgias. Arthralgia
346121 346122 346123 346124 346125 346130 346137 346139 346145 346146 346147 346148 346151 346153 346155 346156 346157 346158 346161 346163 346165 346170 346171 346172 346173 346174 346175 346176 346177 346178 346179 346180 346181 346182 346183 346186 346187 346188 346189 346190 346191 346192 346193 346194 346195 346196 346197 346198 346200 346201 346202
5/11/2009 OH 5/11/2009 CA 5/11/2009 FL 5/11/2009 WI 5/11/2009 IA 5/11/2009 GA 5/12/2009 5/12/2009 WV 5/12/2009 OK 5/12/2009 5/12/2009 5/12/2009 MD 5/12/2009 NY 5/12/2009 DC 5/12/2009 KY 5/12/2009 PA 5/12/2009 5/12/2009 LA 5/12/2009 NC 5/12/2009 PA 5/12/2009 SC 5/12/2009 IN 5/12/2009 OH 5/12/2009 MD 5/12/2009 CA 5/12/2009 LA 5/12/2009 IL 5/12/2009 PA 5/12/2009 TX 5/12/2009 TX 5/12/2009 NC 5/12/2009 NY 5/12/2009 PA 5/12/2009 OH 5/12/2009 MO 5/12/2009 MI 5/12/2009 IN 5/12/2009 SC 5/12/2009 MI 5/12/2009 VT 5/12/2009 WV 5/12/2009 ME 5/12/2009 NH 5/12/2009 LA 5/12/2009 CT 5/12/2009 CT 5/12/2009 CA 5/12/2009 OH 5/12/2009 KY 5/12/2009 NM 5/12/2009 KY
30 58 13 14 4 0.2 54 11
20 2 0.4 10 2 38 20 30 11 15 22 13 59 53 11 0.5 60 39 39 4 0.2 19 5 5 0.2 5 12 1.3 1.3 13 68 31 33 11 12 5 1.3 11 20 1
30 58 13 14 4
11
20 2 0 10 2 38 20 30 11 15 13 59 53 11 0 60 39 39 4 0 19 5 5 0 5 12 1 1 13 68 31 33 11 12 5 1 11 20 1
M F F F M M U M M U F F 0.6 M 0.4 M F 0.7 M F F F F M M F F F F 0.5 M F F F M 0.2 M F M F 0.2 M M M 0.3 M 0.3 F F F M F M M M 0.3 F F M 0F
5/11/2009 Pt rec VARICELLA vaccine on 4/20 4/17/2009 4-17-09 9:10 AM Pt. c/o ears tinglin 5/5/2009 Syncopal episode - hit head. 4/20/2009 Patient received shots on 4-14-09. 5/6/2009 Mother PHONED 5/5 @ 1 pm. Rep 5/5/2009 This case was reported by a healthc 5/11/2009 InformationYhas been received from 5/7/2009 Initial report received on 04 May 20 Imm - ADACEL, MENACTRA, varic 5/11/2009 Information has been received from 5/11/2009 Information has been received from 5/11/2009 Information has been received from 4/20/2009 Mild fever within 1 week change in c 5/11/2009 Information has been received from 5/6/2009 Cellulitis at injection site of varicella 5/4/2009 Mom called 5/1/09, c/o pain. "limpin None Stated 4/29/2009 None stated 5/6/2009 Localized induration, fever, chills, m 5/4/2009 L arm pain initially & then recurred w 5/7/2009 "Breaking out in bumps all over his 5/6/2009 Popular rash on R deltoid began 5/4 5/7/2009 Arm soreness, fever, joint pains, he 5/15/2009 5/5/09 Administration of L arm eryth 5/2/2009 Less than 24 hrs after injection site 5/7/2009 11 y/o female was administered VA 5/7/2009 Rash appeared 3 days after vaccine 5/10/2009 Began 12 hours post vaccination: F 5/7/2009 Red, fever, painful. 3rd day reaction 5/6/2009 (1) Hives, (2) SOB, (3) Throat swelli 5/7/2009 Redness, warmth, induration - diffus 5/8/2009 Vaccine given 4/23/09 - Pt began ha 5/8/2009 None 5/4/2009 12 cm diameter redness, warmth, sw 5/7/2009 None (received Td. - Should have re 5/6/2009 Blood in stool noted 4-29-09 5 days 5/6/2009 Patient felt weak, lost balance, beca 4/30/2009 Right deltoid swelling, heat, pain. L Possible seizure activity, brief altera 5/6/2009 High fever followed by seizure 24 af 5/7/2009 Patient's arm red, swollen and fever 5/5/2009 (Vac. 4-30-09) - site irritation only th 5/6/2009 Temp 101.7 Po since evening after 5/8/2009 None stated 5/5/2009 Red, swelling and pain at the site of 5/5/2009 Red, swelling & pain at the site of in 5/5/2009 48 hrs post administration child had 5/5/2009 Rash & fever 11 days post vaccine 5/5/2009 Rash 1st noticed behind ears, now 5/1/2009 C/O sore throat, difficulty swallowing 5/4/2009 5/1/09 Patient received immunizatio
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5/12/2009 CA 5/12/2009 OH 5/12/2009 KS 5/12/2009 IL 5/12/2009 ME 5/12/2009 KS 5/12/2009 KS 5/12/2009 CA 5/12/2009 CA 5/12/2009 OH 5/12/2009 OH 5/12/2009 NY 5/12/2009 OH 5/12/2009 MD 5/12/2009 MD 5/12/2009 OH 5/12/2009 AL 5/12/2009 AZ 5/12/2009 MA 5/12/2009 CA 5/12/2009 CA 5/12/2009 NC 5/12/2009 FL 5/12/2009 CT 5/12/2009 NM 5/12/2009 IA 5/12/2009 WA 5/12/2009 WA 5/12/2009 CA 5/12/2009 WA 5/12/2009 CA 5/12/2009 KY 5/12/2009 NC 5/12/2009 MN 5/12/2009 CT 5/12/2009 MI 5/12/2009 PA 5/12/2009 OH 5/12/2009 OR 5/12/2009 NC 5/12/2009 NJ 5/12/2009 TX 5/12/2009 UT 5/12/2009 MI 5/12/2009 OH 5/12/2009 KY 5/12/2009 MN 5/13/2009 NC 5/13/2009 5/13/2009 5/13/2009
5 24 15 0.2 4 14 12 1.1 20 61 4 1.5 1.3 71 71 64 0 4 70 0.2 36 1 12 22 12 74 4 4 0.5 27 11 4 1.6 77 12 30 61 71 73 1 13 48 11 67 4 61 26 24 85 94 25
5 24 15 0 4 14 12 1 19 61 4 1 1
63 0 4 70 0 36 1 12 22 12 74 4 4 0 27 11 4 1 77 12 30 61 71 73 1 13 48 11 67 4 61 26 24 85 94
U F M 0.2 M F M M 0.1 M F F M 0.5 M 0.3 F U U M 0F M F 0.2 M F 0F F F M F M M 0.5 M F M M 0.6 M F F F F F F 0M F F F M M F F F F F U
5/1/2009 Swollen, red & hot to the touch. 5/12/2009 4 DAYS AFTER RECIEVING ANTH 5/12/2009 Experienced fever (102.0 degrees F 5/12/2009 Foster parent says that patient only 5/12/2009 Parents noticed rash on upper arm 5/12/2009 Arm was sore, low grade fever, felt 5/12/2009 Sore arm, low grade fever, fatigue 5/12/2009 IMMEDIATELY AFTER GIVING MM 5/12/2009 Redness and swelling at injection si 5/12/2009 On 1/9/09 the patient called the offic 5/12/2009 Patient received the vaccination on 5/12/2009 Infant screaming in tantrums which 5/12/2009 Per ER Physician varicella rash on b 5/12/2009 Subject in pneumococcal vaccine tr 5/12/2009 Subject in pneumococcal vaccine tr 5/12/2009 Pt received Tdap injection 3/17/09. 5/12/2009 patient had no signs of complication 5/12/2009 5-7-09 Crying, sore arms, couldn't m 5/12/2009 pT DEVELOPED SIGNS AND SYM 5/12/2009 A hard, red lump the size of a blueb 5/12/2009 On Wednesday May 13th I visited m 5/12/2009 FEVER BETWEEN 102.5 AND 103 5/1/2009 Dx-encephalitis etiology unkonwn. F 3/15/2009 At 1248am, I fainted, had possible s Swelling, warmth & hardness at site 1/15/2009 12/27/08 --> Lt scapular pain - gen O 5/12/2009 ?Neck swelling w/ slight tenderness 5/8/2009 Inflammation , tenderness left uppe 5/12/2009 Per Dr possible granuloma. 5/12/2009 Patient fainted after administration o 5/11/2009 About 20 minutes after receiving im 5/6/2009 Mother of child reports that child ha 5/15/2009 Pt developed urticaria (generalized) 5/11/2009 Pt walked into clinic at 10:00 am on 5/12/2009 HPV vaccine give with expired date 5/11/2009 Approximately 24 hrs post receiving 5/11/2009 Injection site {erythema warm sensa 5/1/2009 Client had ZOSTAVAX injection 5/2 5/7/2009 Rash, pain, loss of eye sight for 2 w 5/12/2009 Multiple papules + pustuls on back + 5/12/2009 Pt was home 1 1/2 hrs post vaccine 5/12/2009 Left arm pain and swelling saw Dr 5 5/12/2009 5/9 Cellulitis left arm s/p Tdap place 5/7/2009 Next day developed cough and con 5/6/2009 DTaP administered @ thigh on 5-35/1/2009 Local edema, pain, redness. 5/12/2009 Probable secondary transmission of 5/12/2009 Information has been received from 5/3/2009 Pt receives a PNA vaccine on 5-2-0 5/6/2009 Pt called around 2100 on 5/2/09; sp 4/17/2009 Pt c/o lip tingling and respiratory sym
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5/13/2009 TX 5/13/2009 PA 5/13/2009 GA 5/13/2009 NJ 5/13/2009 AR 5/13/2009 WI 5/13/2009 WI 5/13/2009 MD 5/13/2009 MD 5/13/2009 GA 5/13/2009 MI 5/13/2009 SC 5/13/2009 KY 5/13/2009 KY 5/13/2009 FL 5/13/2009 SC 5/13/2009 MI 5/13/2009 PA 5/13/2009 NY 5/13/2009 PA 5/13/2009 PR 5/13/2009 AK 5/13/2009 NY 5/13/2009 VA 5/13/2009 OR 5/13/2009 NE 5/13/2009 CA 5/13/2009 IL 5/13/2009 MD 5/13/2009 AZ 5/13/2009 WI 5/13/2009 IA 5/13/2009 PA 5/13/2009 OR 5/13/2009 MD 5/13/2009 GA 5/13/2009 TX 5/13/2009 CA 5/13/2009 MO 5/14/2009 TX 5/14/2009 5/14/2009 5/14/2009 5/14/2009 5/14/2009 MI 5/14/2009 IL 5/14/2009 WI 5/14/2009 NC 5/14/2009 5/14/2009 IL 5/14/2009 IL
63 1 17 46 4 4 1 38 48 43 10 0.3 33 5 4 30 38 31 0.3 26 0.3 1 44 17 19 1.2 4 70 1.1 0.5 20 1 4 2 1 0.4 9 0.2 16 17 18 1
0.2 0.6 57 21 19 60 11
63 1 17 46 4 4 1 38 48 43 10 0 33 5 4 30 38 31 0 26 0 1 44 17 19 1 4 70 1 0 20 1 4 2 1 0 9 0 16 17 18
0 57 21 19 60 11
F 0F F F F M 0M M M F F 0.3 F F F F F F F 0.3 F M 0.5 M 0F F F F 0.2 M M F 0.1 M 0.5 F F 0M M 0.1 M 0F 0.4 F M 0.2 M F F F M M M M 0.6 F F M M M F
5/13/2009 Patient states awoke to arm red swo 5/12/2009 Rash on back itchy, especially on A 5/11/2009 Patient give hep B (peds) on 5-1-09 5/7/2009 Vaccine administered to pt on 4-1-0 5/4/2009 L upper 2 length area of redness + l 5/8/2009 8 by 7 cm area of erythema + warm 5/7/2009 None Stated 5/5/2009 Constipation, some lost of vision. 5/13/2009 This case was reported by a lawyer 5/13/2009 "...began to hve severe joint pain 5/13/2009 Patient was given a Zostavax vaccin 5/13/2009 Pt seen in hospital on May 11, 2009 5/13/2009 Employee received 2nd dose of Hep 5/13/2009 Immunizations administered at 12:4 5/13/2009 AS SOON AS THE VARICELLA AN 5/13/2009 Pt developed a raised red area on b 5/13/2009 Ct satates that a couple of hours aft 5/13/2009 Patient stated she had received a M 5/13/2009 Patient ran a 102 fever, breathing v 5/13/2009 Reported to clinic 4/21/2009 with sw 5/13/2009 PATIENT'S MOTHER REFERS RA 5/13/2009 Local hives and swelling at site of V 5/13/2009 PATIENT DEVELOPED ITCHY HIV 5/13/2009 Started developing warts on inside o 5/12/2009 Pt saw PCP on 2/4/09 for GYN/PAP 5/13/2009 Ear infection 1 week prior to abnorm 4/26/2009 The following day, noted increased 5/12/2009 Examined by MD 5-12-09 in Derma 10mm induration with redness R lat 5/8/2009 Parents took child across street to g 5/13/2009 15-20 seconds after injection becam 5/13/2009 Fever X 9 days vomiting X 2 days 5/13/2009 Local redness approximately 10mm 5/13/2009 Pt reacted immediately to VAR + MM 5/13/2009 40mm X 30mm area of induration o 5/13/2009 No adverse event of symptoms, wro 5/13/2009 Achy headache, fatigue, tremors, ar 5/13/2009 Infant with "milk protein allergy" at 1 5/13/2009 Deep, aching pain in Rt arm, very te 5/14/2009 First complaint was neck arm stiffne 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from 5/13/2009 Information has been received from Diagnosed with rotavirus on 4/30/09 4/27/2009 5-day(s) hospitalization for IVIG - ex 5/11/2009 21 y/o patient seen for F/U s/p hosp 3/18/2009 Pt woke up with CP and SOB in the 5/8/2009 "Cold sore on lower lip within 48 hou 5/11/2009 Rt. arm red, slightly warm to touch,
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5/14/2009 NC 5/14/2009 5/14/2009 OH 5/14/2009 CA 5/14/2009 WI 5/14/2009 OH 5/14/2009 KY 5/14/2009 TX 5/14/2009 5/14/2009 MA 5/14/2009 PA 5/14/2009 SD 5/14/2009 TX 5/14/2009 VA 5/14/2009 VA 5/14/2009 AL 5/14/2009 TX 5/14/2009 AZ 5/14/2009 PA 5/14/2009 ME 5/14/2009 NY 5/14/2009 IA 5/14/2009 CA 5/14/2009 MI 5/14/2009 MD 5/14/2009 NJ 5/14/2009 TX 5/14/2009 NC 5/14/2009 CA 5/14/2009 SC 5/14/2009 IN 5/14/2009 NC 5/14/2009 CA 5/14/2009 NC 5/14/2009 NC 5/14/2009 NC 5/14/2009 NY 5/14/2009 IA 5/14/2009 OH 5/14/2009 IL 5/14/2009 NC 5/14/2009 PA 5/14/2009 MA 5/14/2009 TN 5/14/2009 GU 5/14/2009 CA 5/15/2009 IN 5/15/2009 IN 5/15/2009 PA 5/15/2009 IL 5/15/2009 OR
0.8 0.4 0.4 5 4 5 24 1 40 25 30 4 25 11 16 14 0.5 25 40 52 3 1.3 5 65 1 10 11 10 17 4 1 22 1.2 21 45 22 49 14 0.7 11 60 64 4 23 63 10 36 4 16 4
0 0 0 5 4 5 24 1 40 25 30 4 25 11 16 14 0 24 40 52 3 1 5 65 1 10 11 10 17 4 1 22 1 21 45 22 49 14 0 4 11 60 64 4 23 63 10 36 4 16 4
0.8 M 0.5 M 0.4 M F F M F 0.1 M M F F F F M F F 0.3 F F F F M 0.3 F M F 0M F M F F F 0M F 0.2 F F M M F F 0.7 M U F M F F M F M M M F M
5/14/2009 Patient c/o fever 102,less of appetit 5/14/2009 Patient given Rotarix vaccine. On fir 5/14/2009 Pt was found Y face down in his crib a 5/14/2009 Received vaccination on Friday, by 5/14/2009 Warm, red, hard 2.5 X 3 inch cellulit 5/14/2009 On 5-11-09 mom called and spoke 5/14/2009 after few hours of taking the vaccine 5/14/2009 Received Varicella and Hepatitis A v 5/14/2009 Chest Pain 786.5 (5-000008) 5/19 5/14/2009 was administered Tdap, no previous 5/14/2009 sore, warm, red, bruised spot on the 5/7/2009 Right upper arm redden and swollen 5/14/2009 Patient presented to the emergency 5/14/2009 injection site red and swollen x 1 da 5/14/2009 During the series of 3 injections and 5/14/2009 Patient reports that after receiving s 5/14/2009 PATIENT SEEMED TO HAVE PRO 5/14/2009 pt was given hpv vaccine pt was the 5/14/2009 This case was reported by a healthc 5/6/2009 - Hallucinations. - Fever, chills. - Loc 5/14/2009 Cranky and decreased appetite star 5/13/2009 Patient presented to hospital with 15/14/2009 R arm swelling, redness within 48 o 5/6/2009 Developed redness, swelling locally 5/14/2009 Pt received Varicella vaccine (lot #0 5/14/2009 Pt. received vaccines TDAP, Hep A 5/14/2009 Swelling, redness, pain, warmth at i 5/14/2009 1 inch X 1 1/4 inch upper arm redne 5/13/2009 Urticaria- Erythematous Wheals all 5/14/2009 Mom noted redness, heat and swell 5/14/2009 On 5/3/09 Mother noticed L arm red ### 22 y/o pregnant female, ADSM, rep 5/2/2009 Local allergic reaction at site of injec 3/19/2009 21 y/o AD female presents for walk### 45 y/o male, ADSM, is referred to th 5/7/2009 Dr. calls clinic (06May09) re 22 y/o A 5/12/2009 Pt has rash left arm, swelling, no fev 5/9/2009 Swelling, itchiness, redness at site o 5/7/2009 Lip droops down on R side of face w Large 3 1/2" urticarial patch over inj 5/11/2009 After vaccination on way home mom 4/10/2009 Noticed 2 swollen lymph nodes und 5/9/2009 1 wk symptoms 2 wk recovery comp 5/8/2009 2 1/2 round rash on 1 thigh, warm to 5/14/2009 0840- IM injection given - HEPA. HE 5/15/2009 Shingles vaccination: Next few days 5/15/2009 Localized erythema - mom describe 5/15/2009 05-12-09, Feverish, C/o "feeling sick 5/3/2005 Immunization (KINRIX) given on 5/1 5/8/2009 Scattered hives occurred that pm or 4/30/2009 4/29/09 - Rt arm inflamed and swoll
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5/15/2009 IL 5/15/2009 PA 5/15/2009 NJ 5/15/2009 CT 5/15/2009 TN 5/15/2009 TN 5/15/2009 VA 5/15/2009 GA 5/15/2009 NV 5/15/2009 CA 5/15/2009 CA 5/15/2009 RI 5/15/2009 CA 5/15/2009 VA 5/15/2009 VA 5/15/2009 VA 5/15/2009 VA 5/15/2009 NY 5/15/2009 MA 5/15/2009 MN 5/15/2009 KS 5/15/2009 CA 5/15/2009 CA 5/15/2009 AZ 5/15/2009 SC 5/15/2009 NC 5/15/2009 IL 5/15/2009 5/15/2009 FL 5/15/2009 PA 5/15/2009 MI 5/15/2009 LA 5/15/2009 MD 5/15/2009 NM 5/15/2009 WI 5/15/2009 OH 5/15/2009 CA 5/15/2009 MA 5/15/2009 AZ 5/15/2009 UT 5/15/2009 5/15/2009 CO 5/15/2009 NE 5/15/2009 5/15/2009 NC 5/15/2009 MO 5/15/2009 IN 5/15/2009 VA 5/15/2009 FL 5/15/2009 IL 5/15/2009 MO
18 1.6 4 0.4 32 26 10 11 1.1 77 13 54 5 27 13 5 4 32 14 5 29 15 15 10 11 4 14 38 11 79 13 4 40 17 13 24 16 2 1 0.6 25 5 5 13 76 3 5 5 13 78 4
18 1 4 0 32 26 10 11 76 13 54 5 27 13 5 4 32 14 5 29 15 15 10 11 4 14 38 11 79 13 4 40 17 13 25 16 2 1 0 5 5 13 76 3 5 5 13 78 4
F 0.6 U M 0.4 F M F F M M F M M F F M M M F F F F M F F F M M M M F F M F F F M F 0.8 F 0M 0.6 F F U F F F M M F F F F
5/8/2009 Hives and blisters up both arms. Tre Mild hives treated with BENADRYL 5/15/2009 Localized reaction at IM injection sit 3/23/2009 Low grade fever (101), diarrhea, mil 5/1/2009 Pain, redness and swelling in L arm Itching, onset one hour after vaccina 5/8/2009 Received Tdap around 9:00-9:30 am 5/8/2009 Nurse administered 0.5 cc of Tdap t 5/5/2009 Received IZ's 4.29.09 - 5-1-09 pale 5/8/2009 24 hours -->72 hours : 5 x 7 cm eryt 5/7/2009 Hives began at injection sites on rig 5/8/2009 Rigors, increased temperature. See 5/8/2009 Right arm- red and swollen with sma 3/4/2009 2/27/09 Day 8- joint and muscle pai 5/15/2009 vaccinate site red and swollen x 1 d 5/15/2009 Child was brought in for office visit t 5/15/2009 Child was brought in for an office vis 5/15/2009 Received vaccine on may 12,2009 a 5/15/2009 Patient presented to our office on 5/ 5/15/2009 3 inch red, swollen, hot area on left 5/15/2009 Ct received her first rabies vaccine o 5/15/2009 Right outer aspect of arm extending 5/15/2009 developed chest pain and palpation 5/15/2009 Warm, erythamatous, tender lesion 5/15/2009 Rt arm swollen and knot the size of 5/15/2009 Received 5 yo vaccines today, kinrix 5/15/2009 Patient was given Gardisil instead o 5/15/2009 Chest Pain (786.59) 5-000009 6/1 5/15/2009 Within a few days of receiving Mena 5/15/2009 Patient presented 24 hours later wit 5/15/2009 3 RED "WELTS" ON LT ARM TOW 5/15/2009 4 year 7 month old male presents w 5/15/2009 New admission from E.R.,recieved P 5/15/2009 Student came in to my office 5/15/0 5/15/2009 Patient was given MCV4 and Var #2 5/15/2009 I had only experienced a short dura 5/15/2009 10 X 9 welt with swelling and redne 5/16/2009 (L) upper arm injection site swelling 5/15/2009 Developed erythematous rash at sit 5/15/2009 Woke up day after shot with a rash 5/13/2009 Seriousness Criteria: Other- Medica L thigh 7X9 cm, warm, erythematou 5/13/2009 4" x 5" red reaction right thigh. 5/15/2009 This case was reported by a healthc 5/12/2009 Patient received vaccine 5-8-09; no 5/15/2009 Have noticed redness @ swelling to 5/15/2009 Red area of inflammation occurred i 5/14/2009 Indurated red skin in roughly rectan 5/15/2009 1:35 Pt complaints of dizziness, Pt p 5/13/2009 12-18 Hours after receiving injection 5/15/2009 Developed 4.5mm x 5mm areas + r
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5/15/2009 LA 5/15/2009 NC 5/16/2009 NC 5/16/2009 5/16/2009 KY 5/16/2009 AK 5/18/2009 5/18/2009 NJ 5/18/2009 OK 5/18/2009 5/18/2009 5/18/2009 NY 5/18/2009 5/18/2009 FL 5/18/2009 TN 5/18/2009 WI 5/18/2009 MI 5/18/2009 IA 5/18/2009 PA 5/18/2009 5/18/2009 MD 5/18/2009 TX 5/18/2009 PA 5/18/2009 OH 5/18/2009 MA 5/18/2009 MI 5/18/2009 GA 5/18/2009 NY 5/18/2009 VA 5/18/2009 MO 5/18/2009 TX 5/18/2009 GA 5/18/2009 KS 5/18/2009 UT 5/18/2009 IA 5/18/2009 MA 5/18/2009 NC 5/18/2009 SC 5/18/2009 NC 5/18/2009 CA 5/18/2009 CA 5/18/2009 MO 5/18/2009 MI 5/18/2009 MT 5/18/2009 MI 5/18/2009 CA 5/18/2009 PA 5/18/2009 PA 5/18/2009 MO 5/18/2009 CO 5/18/2009 PA
4 53 12 37 41 1 2 0.5 0.5 24 22 1.2 11 0.6 44 18 11 13 6 65 7 4 1.1 67 15 17 32 11 19 38 35 65 19 2 18 25 24 26 4 3 14 69 18 60 12 16 14 12 69 11
4 53 12 37 41 1 0 0 24 22
0 44 18 11 13 6 65 7 4 1 67 15 17 32 11 19 38 35 65 37 19 2 18 26 24 26 4 3 14 69 15 60 1 7 14 12 69 11
M F M M F 0F M 0.5 M 0.5 M F F F M 0.6 M F F M F F F M F 0F F F F M F M F F F F M 0M F F F F F F F F M F 0F M M F F M
5/15/2009 Local reaction Left deltoid; erythema 5/15/2009 Arm sore, red and swollen. 5/16/2009 Severe hives over entire body, head 5/16/2009 Generalized vaccinia with diffuse ra 5/16/2009 On the day of the shot, the injection 5/16/2009 11-28-08 Mom reports body rash fo 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/7/2009 Influenza vaccines rec'd 10/18/07 a 4/28/2009 Pt called 4/28/09 after sx has resolv 5/18/2009 3x3.75 inches erythematous area o Erythema @ injection site edema pa 5/18/2009 Pt. at clinic received HPV, MENACT 5/14/2009 Patient received VARIVAX immuniz 5/18/2009 Bell's Palsy 5/18/2009 On day of vaccination, (hours later) 5/18/2009 localized alergic reaction to left thigh 5/18/2009 macular papular rash post auricular 5/18/2009 Patient presented to the Emergency 5/18/2009 Pt was given Menningicoccal vaccin 5/18/2009 On 5/15/09 Adriana returned to hav 5/18/2009 client complained swollen area abou 5/18/2009 Patient tolerated vaccine well, but u 5/18/2009 PT BROKE OUT WITH PIMPLES O 5/18/2009 Pt reports slight fever and flu like sy 5/18/2009 Delivered baby on 5/11/09. Got MM 5/18/2009 Pt reported localized swelling at inje 5/18/2009 Developed hard bump in arm that g 5/18/2009 Client was administered vaccines, b 5/18/2009 Patient was given Vaccines and 48 5/18/2009 On 4/28/09 the patient was given th 5/18/2009 extreme fatigue, migraines, nose ble 5/18/2009 The site where the vaccine was adm 5/18/2009 diffuse itching began less tan 12 ho 5/18/2009 rash left deltoid from Prevnar admin 5/18/2009 rash at site of vaccine(prevnar) left d 5/18/2009 Pt became weak and dizzy while wa 5/18/2009 Client received Zostavax in am on 0 5/18/2009 Fever (101.9), achiness, headache, 5/18/2009 RAISED INDURATED AND ERYTH 5/18/2009 THE VACCINE WAS INJECTED ON 5/18/2009 Rash started 4/15/09, chicken pox. 5/18/2009 syncope after vaccines 5/18/2009 Left Deltoid raised, reddened, appro 5/18/2009 pt. received in clinic Td and Pneumo 5/18/2009 fine red rash all over body, no urtica
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5/18/2009 WI 5/18/2009 NY 5/18/2009 KY 5/18/2009 CA 5/18/2009 WA 5/18/2009 CA 5/18/2009 GA 5/18/2009 TX 5/18/2009 AL 5/18/2009 VA 5/18/2009 ND 5/18/2009 SC 5/18/2009 VA 5/18/2009 CA 5/18/2009 AR 5/18/2009 OH 5/18/2009 NC 5/18/2009 NE 5/18/2009 MN 5/18/2009 FL 5/18/2009 PA 5/18/2009 CT 5/18/2009 IN 5/18/2009 LA 5/18/2009 5/18/2009 LA 5/18/2009 MT 5/18/2009 CA 5/18/2009 OR 5/18/2009 OR 5/18/2009 5/18/2009 AL 5/18/2009 GA 5/18/2009 MA 5/18/2009 PA 5/18/2009 MI 5/18/2009 TX 5/18/2009 5/18/2009 NY 5/18/2009 TN 5/18/2009 5/18/2009 WI 5/18/2009 5/18/2009 IL 5/18/2009 NC 5/18/2009 NY 5/18/2009 KS 5/18/2009 5/18/2009 5/18/2009 IL 5/18/2009
15 13 27 27 0.2 5 0 16 5 23 14 4 35 4 0.4 4 30 5 1.5 4 2 3
15 13 27 28 0 5 0 16 5 23 14 4 35 4 0 4 30 5 1 4 2 3
17 0.3 45 11 4 39 20 2 8 11 38 4 21 1.6 23 4 17 17 69 18 22 14 18
17
26 20 21 29
26 20
45 11 4 39 20 2 8 11 38 4 1 23 4 17
18 22 14 18
29
F F F M 0.2 M F 0M F M U F F M M 0.4 M F F M 0.5 M M 0.7 F F M F U F M F F F 0.1 F F F U M M 0.6 F M F F F M F F F F F F F F F
5/18/2009 Shortly after her first shot patient sta 5/18/2009 She has had dizziness, nausea and 5/18/2009 With the first booster injection given 5/18/2009 Large lump at injection site. Sore a 5/18/2009 Eyes twitching, unresponsive. Fussi 5/18/2009 Left deltoid swollen with redness an 5/18/2009 This case was reported by a pharma 5/18/2009 Fever 103-104 X 2 days 5/18/2009 Site swollen/red 2 days after vaccin 5/18/2009 Pt had AVA and Influenza shot on 4 5/18/2009 In evening of day of shots - She dev 5/15/2009 DTap #5 given in R thigh- 48 hours 5/5/2009 HEPATITIS B #2 (accelerated sche 4/23/2009 L deltoid inflammation 3 cm Rx for B 5/11/2009 Fine rash systemically see clinical d 5/11/2009 Redness, swelling-hard and warm to None stated 5/11/2009 None stated 5/7/2009 Erythematous, swollen, large local r 5/4/2009 Hives 5/7/2009 Right thigh red, indurated 1 1/2 - 2" 5/13/2009 Vomiting, which began a couple of h 5/13/2009 Site on upper right arm appeared re 5/6/2009 Pt's aunt called back 2 days after ER 5/18/2009 This case was reported in a literatur 5/6/2009 Patient came in for Flu vaccine, Rig 5/11/2009 Itching at injection site, right arm. Er 5/11/2009 Left deltoid 13X14 CM Swollen, Red 5/12/2009 Patient should have received a Tda 5/8/2009 Client reports that after HPV vaccine 5/9/2009 Red swollen lump L thigh. 5/13/2009 Several vesicles at injection site, fol 5/11/2009 Patient received VARIVAX vaccine Vaccine given 5/1/09 pri 5/1 - 5/09 R 36% After receiving vaccine, mild sw 5/13/2009 None Stated 5/12/2009 Urticaria, generalized. Benadryl 6.25 5/18/2009 25 y/o WM ADSM is referred from a 5/18/2009 DDX reaction to the pertussis in DT 4/29/2009 4-28-2009 1150/AM.- MMR #2 give 5/12/2009 Daughter received first GARDASIL 3/24/2009 Pt seen by MD on 3/13/09. Pt c/o ra 5/14/2009 Information has been received throu 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from
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5/18/2009 AZ 5/18/2009 CA 5/18/2009 OK 5/18/2009 VA 5/18/2009 NJ 5/18/2009 NY 5/18/2009 NY 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 HI 5/18/2009 5/18/2009 IA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 FL 5/18/2009 MA 5/18/2009 CT 5/18/2009 IL 5/18/2009 PA 5/18/2009 AL 5/18/2009 5/18/2009 5/18/2009 VA 5/18/2009 5/18/2009 TN 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 AR 5/18/2009 5/18/2009 TX 5/18/2009 CO 5/18/2009 IA 5/18/2009 IN 5/18/2009 CA 5/18/2009 5/18/2009 5/18/2009 TX 5/18/2009 NY 5/18/2009 5/18/2009 5/18/2009 SC 5/18/2009 5/18/2009 5/18/2009 LA 5/18/2009 CA 5/18/2009 MI 5/18/2009
15 15 9 30 23 19 13 14 20
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16 19 27 20 21 20 19 17 16
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18 15 22 26
18 15 22
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5/18/2009 5/18/2009 WA 5/18/2009 5/18/2009 5/18/2009 OH 5/18/2009 MA 5/18/2009 NC 5/18/2009 5/18/2009 5/18/2009 NY 5/18/2009 NY 5/18/2009 NY 5/18/2009 MA 5/18/2009 5/18/2009 CA 5/18/2009 5/18/2009 CT 5/18/2009 5/18/2009 5/18/2009 NJ 5/18/2009 NC 5/18/2009 NH 5/18/2009 5/18/2009 TX 5/18/2009 CT 5/18/2009 NY 5/18/2009 OH 5/18/2009 5/18/2009 5/18/2009 5/18/2009 OK 5/18/2009 5/18/2009 FL 5/18/2009 NY 5/18/2009 5/18/2009 MS 5/18/2009 NY 5/18/2009 NJ 5/18/2009 TX 5/18/2009 5/18/2009 FL 5/18/2009 IA 5/18/2009 5/18/2009 MI 5/18/2009 OH 5/18/2009 5/18/2009 5/18/2009 5/18/2009 FL 5/18/2009 5/18/2009 MN
22 12
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13 15 17
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25 16 19 26
25 16 19 26
25 10 21 25 21 18 18 27 24 14
17
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19 16 29 16
19 16 29 16
17 24 16 25 16 21 16
17 24 16 25 16 21 16
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16 22
18 19 25 25 22
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5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information hs been received from a 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information hs been received from a 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Initial information was received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received via m 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Initial and follow-up information has 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received for th 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Initial and follow-up information has 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from
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5/18/2009 OR 5/18/2009 NY 5/18/2009 NY 5/18/2009 NM 5/18/2009 NY 5/18/2009 5/18/2009 IL 5/18/2009 5/18/2009 OH 5/18/2009 5/18/2009 NY 5/18/2009 5/18/2009 WA 5/18/2009 MI 5/18/2009 MI 5/18/2009 5/18/2009 5/18/2009 MD 5/18/2009 WA 5/18/2009 5/18/2009 5/18/2009 5/18/2009 NC 5/18/2009 NC 5/18/2009 5/18/2009 CT 5/18/2009 CT 5/18/2009 CT 5/18/2009 CA 5/18/2009 5/18/2009 NM 5/18/2009 CA 5/18/2009 5/18/2009 NM 5/18/2009 MN 5/18/2009 MA 5/18/2009 5/18/2009 MN 5/18/2009 VA 5/18/2009 5/18/2009 5/19/2009 5/19/2009 CA 5/19/2009 5/19/2009 CA 5/19/2009 TX 5/19/2009 CA 5/19/2009 5/19/2009 CA 5/19/2009 CA 5/19/2009 MO
18 26 14 11
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19 17 24 16 40 19 20 28 22 25 18 18 17
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19 17 17 21 33 21 19 21 13
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23 52 69 54 0.3 0.5 1 3 37 41
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F F U F F F F F U F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F 0.3 M 0.5 M M F F F
5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information hs been received from a 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Information has been received from 5/14/2009 Initial information was received from 5/14/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 5/18/2009 Information has been received from 4/24/2009 3yo with isolated IgA deficiency, adm 5/14/2009 Initial report received from a consum 5/15/2009 This case was received on 13 May 2
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5/19/2009 TX 5/19/2009 MA 5/19/2009 OH 5/19/2009 TX 5/19/2009 PA 5/19/2009 IL 5/19/2009 PA 5/19/2009 TX 5/19/2009 NM 5/19/2009 TX 5/19/2009 WI 5/19/2009 AZ 5/19/2009 MI 5/19/2009 AZ 5/19/2009 CA 5/19/2009 NC 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 CO 5/19/2009 OK 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 HI 5/19/2009 AZ 5/19/2009 CA 5/19/2009 WA 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 AZ 5/19/2009 MS 5/19/2009 NY 5/19/2009 CA 5/19/2009 WA 5/19/2009 WA 5/19/2009 PA 5/19/2009 PA 5/19/2009 MD 5/19/2009 MT 5/19/2009 MT 5/19/2009 KS 5/19/2009 AL 5/19/2009 AL 5/19/2009 NC 5/19/2009 NE 5/19/2009 CA 5/19/2009 ND 5/19/2009 AZ 5/19/2009 NC 5/19/2009 OR 5/19/2009 PA
65 14 2 0.2 18 65 11 12 4 17 47 20 16 26 0.3 71 22 26 22 16 22 19 62 19 11 67 20 21 23 21 41 28 4 29 67 0.2 1.2 4 18 14 11
65 14 2 0 18 65 11 12
13 0.5 42 9 4 10 1.1 66
13 0 42 9 4 10 1 66
17 47 20 16 26 0 71 22 26 22 16 -1 19 62 19 11 67 20 21 23 21 41 28 4 29 67 0 1 4 18 14 11
F F 0.1 M 0.2 M F F M M M F F M F M 0.3 F M M M M F 0.6 M M F F F F M M M M M M M F F 0.2 F 0.2 M F M M F U U F 0.5 F F F F F 0.1 F F
5/11/2009 Pt developed pain, swelling and red 5/12/2009 Mother states pt received vaccine th 5/15/2009 6.5 cm long by 8 cm wide erythema 5/15/2009 Abrupt onset (10-12 hours) post vac 4/20/2009 Pt was given Adacel, Menactra + PP 5/8/2009 3 days later, I awoke with a 3 inch r 5/14/2009 Pt was given MENACTRA 0.5 ml @ 5/19/2009 Within 24 hours- Left arm (between 5/19/2009 Approximately 24 post Kinrix vaccin 5/19/2009 HPV #3 GIVEN 4-14-09 AND PATIE 5/19/2009 Temp - 102 degrees Body aches.ch 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient received MCV4 in Left delto 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Adverse side effects include: diarrhe 5/19/2009 None 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient had baseball size knot with 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Accidently administered an expired 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 3 days after second gardasil, pt wen 5/19/2009 Pt. brought immigration form from c 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 Patient recieved smallpox vaccine th 5/19/2009 5 days after receiving vaccines, he 5/19/2009 First a feeling of nausia. Sycope wi 5/19/2009 PT COM[PLAINING OF VOMITING 5/19/2009 Extreme pain in arm of injection, ina 5/18/2009 Pain, erythema, vesicular rash in de 5/14/2009 Immediately post immunizations bab 5/14/2009 Patient returned 30 min after immun 5/14/2009 Localized warmth, erythema approx 5/13/2009 No adverse effects noted per patien 5/13/2009 His father stated that his "arm is sor 5/12/2009 IM injections were given at 2:30 pm 5/19/2009 This case was reported by a physici 5/19/2009 This case was reported by a physici 5/12/2009 C/o pain in muscles, joints. Felt hot 5/14/2009 Fever 102.5 within 24 hrs of vaccine 5/19/2009 Severe back ache in mid + lower ba 5/18/2009 - Pain & bruised at injection site - hi 5/13/2009 Noticed L upper pain with 3" swellin 5/8/2009 Redness, swelling, 6" down arm, 3Fever, lethargy, rash started 6 days 5/18/2009 Fever blisters branching out / poppi
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5/19/2009 NJ 5/19/2009 MA 5/19/2009 CA 5/19/2009 MT 5/19/2009 LA 5/19/2009 CA 5/19/2009 CA 5/19/2009 MN 5/19/2009 CA 5/19/2009 VA 5/19/2009 CA 5/19/2009 CA 5/19/2009 MO 5/19/2009 CA 5/19/2009 WA 5/19/2009 NC 5/19/2009 AR 5/19/2009 NY 5/19/2009 WV 5/19/2009 ND 5/19/2009 5/20/2009 PA 5/20/2009 5/20/2009 NY 5/20/2009 5/20/2009 NY 5/20/2009 NM 5/20/2009 GA 5/20/2009 PA 5/20/2009 MD 5/20/2009 5/20/2009 NY 5/20/2009 IL 5/20/2009 AZ 5/20/2009 MD 5/20/2009 SC 5/20/2009 FL 5/20/2009 TX 5/20/2009 VA 5/20/2009 SD 5/20/2009 5/20/2009 CO 5/20/2009 WI 5/20/2009 CA 5/20/2009 TX 5/20/2009 NV 5/20/2009 AL 5/20/2009 RI 5/20/2009 MI 5/20/2009 MI 5/20/2009 NC
41 14 43 1.7 36 17 15 2 62 14 16 0.3 5 1.2 68 35 0.2 5 5 1 19 37 12 76 85 67 0.2 55 76 1.2 14 15 18 1 12 0 15 38 2 1.5 27 5 18 59 41 70 38 4 61 68 0.3
41 14 43 1 36 17 15 2 62 14 16 0 5 1 68 35 0 5 5 1 19 37 76 85 67 0 76 1 14 15 18 1 12 0 15 38 2 1 27 5 18 59 41 70 38 4 61 0
M F M 0.7 F F F F 0.5 M M F F 0.3 F F 0.2 F F M 0.2 F U F 0M M M F M F M 0.2 M M M 0.2 F F F F 0M M 0F F F 0.3 M 0.5 M F F F M F M M F F F 0.3 M
5/8/2009 Pt. developed rash behind his leg, f 5/15/2009 Bell's palsy - few hrs. after Gardasil 5/18/2009 Arm swollen and red at injection site 5/14/2009 KINRIX prepared for older sister & a 5/11/2009 HA, dizziness, malaise, swelling of l 5/18/2009 Patient received Hep A on right arm 5/19/2009 Pt received Tdap, HPV and Menact 5/15/2009 Patient was fatigued a few hours aft 5/19/2009 Fever, arm swelling, leg and back 5/7/2009 Nausea, dizziness, pulse rate 100, l 5/19/2009 Patient fainted about 10 minutes aft 5/19/2009 Crying alot. Extreme fussiness trou 5/15/2009 Red, swollen, warm, painful area to 5/19/2009 Patient had high fever to 104 with le 5/8/2009 5/4/09 ZOSTAVAX administered; pa None stated 5/19/2009 Localized reaction with redness & s Patient presented shortly after recei 3/19/2009 Pt received #2 Hep A vaccine. 3 m 5/11/2009 Evening of 5-8-09. Mom noticed a r 4/27/2009 Over 3 day weekend, use bandages 5/18/2009 Initial reportYreceived from an assist 5/19/2009 InformationYhas been received from 5/8/2009 Pt s/p TD vaccine 3/1/09, developed 5/10/2009 85 yo female presented to the office 4/23/2009 6 hours after - chills - increased puls R thigh red with bruise @ site of imm 5/19/2009 The subject identified himself as a c 5/18/2009 Typhoid Herpes Zoster - began 5-35/15/2009 L thigh rash "hives" x 3 days; improv 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/19/2009 Information has been received from 5/20/2009 Received Menactra on 5/13/09 and 5/20/2009 Patient received a Hepatitis B vacci 5/20/2009 Patient received the HPV vaccine in 5/20/2009 6 days after receiving VZV#2, felt co 5/20/2009 Father reports they were awakened 5/20/2009 Mother reported that child's entire le 5/20/2009 Had employee PE 11/10/08. Receiv 5/20/2009 Had DTaP and IPV vaccines on 4/2 5/20/2009 Pain at injection site, difficulty breat 5/20/2009 Within a few months of the vaccinat 5/20/2009 On March 11, 2009, I went in for a c 5/20/2009 Patient experienced chest pain and 5/20/2009 Patient was immunized with Yellow 5/20/2009 Large hot red spot at injection site; s 5/20/2009 Patient described a tightness in che 5/20/2009 12-24 hours after injection, patient d 5/20/2009 na
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5/20/2009 MI 5/20/2009 AZ 5/20/2009 NJ 5/20/2009 LA 5/20/2009 NY 5/20/2009 SC 5/20/2009 UT 5/20/2009 CA 5/20/2009 OK 5/20/2009 FL 5/20/2009 TX 5/20/2009 MN 5/20/2009 TX 5/20/2009 MD 5/20/2009 AR 5/20/2009 CT 5/20/2009 VA 5/20/2009 NC 5/20/2009 CA 5/20/2009 CA 5/20/2009 MD 5/20/2009 CA 5/20/2009 OK 5/20/2009 NC 5/20/2009 GU 5/20/2009 CA 5/20/2009 NC 5/20/2009 KY 5/21/2009 MI 5/21/2009 IN 5/21/2009 NE 5/21/2009 MI 5/21/2009 AL 5/21/2009 NJ 5/21/2009 CA 5/21/2009 MN 5/21/2009 MN 5/21/2009 OK 5/21/2009 5/21/2009 NM 5/21/2009 CA 5/21/2009 NC 5/21/2009 MD 5/21/2009 MT 5/21/2009 NY 5/21/2009 KS 5/21/2009 MO 5/21/2009 CA 5/21/2009 KY 5/21/2009 PA 5/21/2009 CA
12 28 48 68 72 54 0.2 0.5 0.6 4 28 0.3 0.8 12 28 18 16 21 4 6 66 1 25 29 4 0.4 66 0.2 60 55 66 12 15 4 77 72 72 5 22 17 1.5 20 13 61 1 55 24 1.8 0.6 54 1.3
12 28 48 68 72 54 0 0 0 4 28 0 0 12 28 18 16 21 4 6 66 1 24 29 4 0 66 0 60 54 66 12 15 4 77
5 22 17 1 21 13 61 1 55 24 1 0 54 1
F M M M M F 0.2 M 0.5 F 0.6 F F M 0.3 M 0.8 M F F F F F M F F 0F M M M 0.4 M F 0.2 M F F M F F F F U U F M F 0.5 F M F F 0M F F 0.8 M 0.6 F F 0.3 M
5/20/2009 C/O OF ARM NUMBNESS AFTER 5/20/2009 Patient recieved smallpox vaccine th 5/20/2009 Hepatitis B Vaccine, Dose 2 adminis 5/20/2009 S+O;WALKIN;CC swelling and redn 5/20/2009 Developed herpes simplex in the ey 5/20/2009 Despite have no known allergies (es 5/20/2009 DEVELOPED HIGH-PITCHED SCR 5/20/2009 Seizure requiring 2 doses of IV med 5/19/2009 At 1150 injection administered. Imm 5/20/2009 Left deltoid swollen, hard, hot & red 5/20/2009 Fever, chills, muscle aches. 5/18/2009 None Stated 5/19/2009 Rash on face, trunk and extremities 5/20/2009 15-20 minutes after vaccine adminis 5/20/2009 Vomiting- (R) arm- swollen, unable 5/19/2009 Pt felt faint after receiving ADACEL, 5/20/2009 Sleepy, Swollen, Eye lid, decreased 5/20/2009 Husband vaccinated with SPV arou 5/20/2009 L arm 2x2 in erythema edema and p 5/13/2009 1 d post vaccine onset redness @ v 5/20/2009 Cellulitis R upper extremity treated w 5/19/2009 - Febrile illness. - Generalized skin r ### Description: the day after receiving 5/19/2009 29 y/o Hispanic male, PVT, ADSM r 5/21/2009 3.5 cm x 5 cm slightly tender red sw 5/19/2009 None. 5/20/2009 5/1/09 - Vaccine administered - no a 5/20/2009 Right leg red, warm, and swollen cry 5/21/2009 Patient came down with shingles an 5/21/2009 clinet c/o fine red rash on both her a 5/21/2009 Pt developed a rash thought to be S 5/21/2009 5 vaccines were administered to this 5/21/2009 Received HAV and Depo Provera a 5/21/2009 Seen in our office on 5/12/09 for 4 y 5/21/2009 Next day left deltoid to elbow redne 5/21/2009 Subject in pneumococcal vaccine tr 5/21/2009 Subject in pneumococcal vaccine tr 5/21/2009 Received call from Mom 5/21/2009 5/21/2009 Pt developed myocarditis. Symptom 5/21/2009 Administered vaccines at 11:40; pro 5/20/2009 Shingles - Zoster- Appeared on pati 5/21/2009 SICK, RASHES, JOINT PAIN , MUS 5/21/2009 After receiving vaccinations, patient 5/21/2009 Exactly 7 days after receiving Zosta 5/21/2009 Complaint of rash and swollen on b 5/21/2009 Allergic reaction - itching - immediat 5/21/2009 Patient came in on 8/12/08 for Gard 5/21/2009 Patient returned to clinic two days p 5/14/2009 Notified Provider pt seen in ER 5/13 5/21/2009 Patient stated she had localized sw 5/21/2009 5/21/09 Fever 101.8, eating ok, not
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5/21/2009 CA 5/21/2009 CO 5/21/2009 MA 5/21/2009 TX 5/21/2009 CA 5/21/2009 TX 5/21/2009 IN 5/21/2009 DE 5/21/2009 IN 5/21/2009 AR 5/21/2009 MA 5/21/2009 VT 5/21/2009 VA 5/21/2009 GA 5/21/2009 DE 5/21/2009 5/21/2009 WV 5/21/2009 5/21/2009 IL 5/21/2009 GA 5/21/2009 CA 5/21/2009 NJ 5/21/2009 5/21/2009 OK 5/21/2009 TX 5/21/2009 5/21/2009 IL 5/21/2009 WI 5/21/2009 PA 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 CA 5/21/2009 CA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 LA 5/21/2009 WI 5/21/2009 OH 5/21/2009 5/21/2009 MA 5/21/2009
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5/21/2009 HAVRIX given at about 12:30pm. B 5/21/2009 Erythema multiforme 4 days after ad 5/20/2009 Arm pain and tenderness with local 5/21/2009 Urticaria, rash, hives around injectio 5/20/2009 (Rt) deltoid (+) erythema and edem 5/21/2009 Err:508 5/19/2009 The patient fainted immediately (30 5/15/2009 3rd GARDASIL injected into left del 5/19/2009 The patient turned pale, felt tingling 5/21/2009 Right arm is red, swollen, tingling fe 5/21/2009 4 inch diameter erythema/induration 5/13/2009 Local pain (L) deltoid area began pr 5/20/2009 HPV vaccine number 1 given . Sync 5/21/2009 Whelp left upper arm-hot to touch- V Patient called 2 1/2 hours after shot 5/11/2009 I received a PNEUMOVAX shot on 5/21/2009 Starring spells X 5 lasting approx 3 5/19/2009 Patient given varivax 5/8/9. On 5/14 5/14/2009 Vaccine given Approx 6pm on 5/12/ 5/21/2009 Mom called our office on 5-21-09 to 5/21/2009 Redness and induration (R) thigh. 5/21/2009 ROTATEQ oral vaccine administere 5/14/2009 Information has been received from 5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received throu 5/15/2009 Information has been received throu 5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 NY 5/21/2009 IN 5/21/2009 CT 5/21/2009 AZ 5/21/2009 OH 5/21/2009 NC 5/21/2009 VA 5/21/2009 5/21/2009 NC 5/21/2009 TX 5/21/2009 MN 5/21/2009 5/21/2009 5/21/2009 CT 5/21/2009 CA 5/21/2009 MA 5/21/2009 TX 5/21/2009 IA 5/21/2009 TX 5/21/2009 WA 5/21/2009 MD 5/21/2009 5/21/2009 MD 5/21/2009 LA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 CA 5/21/2009 NJ 5/21/2009 TX 5/21/2009 5/21/2009 TX 5/21/2009 IL 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 IL 5/21/2009 MO 5/21/2009 MO
1 1 1 45 1.1 5 1 3
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5/21/2009 5/21/2009 IN 5/21/2009 KY 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 ND 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 IL 5/21/2009 NJ 5/21/2009 5/21/2009 TX 5/21/2009 TX 5/21/2009 IL 5/21/2009 WA 5/21/2009 ID 5/21/2009 5/21/2009 OH 5/21/2009 MA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 NY 5/21/2009 PA 5/21/2009 MA 5/21/2009 MA 5/21/2009 IN 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 ID 5/21/2009 ME 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 MI 5/21/2009 5/21/2009 GA 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 NJ 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 CA
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5/21/2009 CA 5/21/2009 5/21/2009 NJ 5/21/2009 MI 5/21/2009 CA 5/21/2009 MN 5/21/2009 WI 5/21/2009 TX 5/21/2009 5/21/2009 MA 5/21/2009 MA 5/21/2009 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 ME 5/21/2009 MA 5/21/2009 5/21/2009 NY 5/21/2009 FL 5/21/2009 MI 5/21/2009 FL 5/21/2009 TX 5/21/2009 IN 5/21/2009 FL 5/21/2009 5/21/2009 VA 5/21/2009 VA 5/21/2009 5/21/2009 WA 5/21/2009 CT 5/21/2009 NY 5/21/2009 5/21/2009 WI 5/21/2009 NY 5/21/2009 NY 5/21/2009 NY 5/21/2009 5/21/2009 AL 5/21/2009 AL 5/21/2009 AZ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 TX 5/21/2009 CA 5/21/2009 AL 5/21/2009 AL
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5/21/2009 AL 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 NJ 5/21/2009 PA 5/21/2009 TX 5/21/2009 5/21/2009 PA 5/21/2009 OR 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 OH 5/21/2009 PA 5/21/2009 KY 5/21/2009 KY 5/21/2009 VA 5/21/2009 NY 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 SC 5/21/2009 NC 5/21/2009 MI 5/21/2009 5/21/2009 NY 5/21/2009 MO 5/21/2009 MI 5/21/2009 MA 5/21/2009 5/21/2009 AR 5/21/2009 5/21/2009 MA 5/21/2009 MI 5/21/2009 MA 5/21/2009 OR 5/21/2009 IN 5/21/2009 5/21/2009 5/21/2009 CO 5/21/2009 5/21/2009 TX 5/21/2009 CA 5/21/2009 TX 5/21/2009 PA 5/21/2009
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5/21/2009 PA 5/21/2009 FL 5/21/2009 AZ 5/21/2009 TX 5/21/2009 TX 5/21/2009 VA 5/21/2009 TX 5/21/2009 IA 5/21/2009 NJ 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 5/21/2009 5/21/2009 CA 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 VA 5/21/2009 AZ 5/21/2009 5/21/2009 FL 5/21/2009 NJ 5/21/2009 GA 5/21/2009 PA 5/21/2009 MA 5/21/2009 NE 5/21/2009 TX 5/21/2009 FL 5/21/2009 AZ 5/21/2009 IN 5/21/2009 AZ 5/21/2009 NJ 5/21/2009 MA 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 5/21/2009 FL 5/21/2009 IN
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5/21/2009 IN 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 LA 5/21/2009 TX 5/21/2009 5/21/2009 TX 5/21/2009 MA 5/21/2009 KY 5/21/2009 LA 5/21/2009 LA 5/21/2009 CA 5/21/2009 CT 5/21/2009 MI 5/21/2009 OH 5/21/2009 NY 5/21/2009 NY 5/21/2009 VA 5/21/2009 NY 5/21/2009 FL 5/21/2009 AZ 5/21/2009 MI 5/21/2009 IL 5/21/2009 FL 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 CA 5/21/2009 OH 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 CA 5/21/2009 PA 5/21/2009 CA 5/21/2009 NY 5/21/2009 5/21/2009 CA
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5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information was been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 NJ 5/21/2009 OH 5/21/2009 GA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 TX 5/21/2009 NJ 5/21/2009 LA 5/21/2009 5/21/2009 OH 5/21/2009 OR 5/21/2009 5/21/2009 5/21/2009 KY 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 NY 5/21/2009 5/21/2009 NJ 5/21/2009 IN 5/21/2009 WA 5/21/2009 5/21/2009 NE 5/21/2009 OH 5/21/2009 MA 5/21/2009 CA 5/21/2009 CA 5/21/2009 CO 5/21/2009 TX 5/21/2009 TX 5/21/2009 CO 5/21/2009 TX 5/21/2009 5/21/2009 CO 5/21/2009 CO 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 AZ 5/21/2009
27
27
74 5
74 5
1 1.3 4 1 4 5 1
1 1 4 0 5 1
4 16 43 9
16 43
14 5
14 5
1.5 1.1 35 7
1 7
8 18 66 1.1 8 9 1
18 66 1 8 9 1
2
1.3
1
3 1 1.1 4
1 1
M M U M M U 0M 0.3 M F 1M F F 0M U M F M F U U F F M F 0.1 M F F F U M F F M 0.1 M M F 0F U U U U M U U 0.3 M U F F 0M 0.1 F M
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 KS 5/21/2009 KY 5/21/2009 WI 5/21/2009 VA 5/21/2009 5/21/2009 IL 5/21/2009 VA 5/21/2009 CA 5/21/2009 PA 5/21/2009 FL 5/21/2009 PA 5/21/2009 PA 5/21/2009 WA 5/21/2009 PA 5/21/2009 NJ 5/21/2009 PA 5/21/2009 CA 5/21/2009 PA 5/21/2009 VI 5/21/2009 TX 5/21/2009 NY 5/21/2009 5/21/2009 NY 5/21/2009 PA 5/21/2009 MN 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 TX 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 SD 5/21/2009 ME 5/21/2009 5/21/2009 MA 5/21/2009 CA 5/21/2009 5/21/2009 KY 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 OH
5 7 17 1 12 11 6
17 1 11
11 1 63 7 6 10 14 4 1.2 10 1 15 15 4 5
11 1 63 7 6 10 14 4 1 10 1 15 15 4 5
5 14 16 10 12
5 16
10 10 7 67 3
3
1 18
1 18
2 13
2 13
5 13
13
6 67 1
1
U U M F 0M F F F F F 0U F F F M F F 0.2 M M 0M F F F F F F U M U M F M F U U M M M 0F F F 0.8 M M F M F U M F U 0M
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347673 347674 347675 347676 347677 347678 347679 347680 347681 347682 347683 347684 347685 347686 347687 347688 347689 347690 347691 347692 347693 347694 347695 347696 347697 347698 347699 347700 347701 347702 347703 347704 347705 347706 347707 347708 347709 347710 347711 347712 347713 347714 347715 347731 347732 347733 347736 347737 347740 347742 347745
5/21/2009 CA 5/21/2009 LA 5/21/2009 MO 5/21/2009 5/21/2009 MI 5/21/2009 VA 5/21/2009 FL 5/21/2009 CT 5/21/2009 CA 5/21/2009 CA 5/21/2009 NY 5/21/2009 CA 5/21/2009 FL 5/21/2009 5/21/2009 OH 5/21/2009 5/21/2009 PA 5/21/2009 GA 5/21/2009 5/21/2009 MA 5/21/2009 5/21/2009 GA 5/21/2009 FL 5/21/2009 NE 5/21/2009 FL 5/21/2009 5/21/2009 TN 5/21/2009 5/21/2009 OH 5/21/2009 PA 5/21/2009 FL 5/21/2009 TN 5/21/2009 NM 5/21/2009 5/21/2009 IN 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 5/21/2009 VA 5/21/2009 FL 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 CT 5/21/2009 OH 5/21/2009 VA 5/21/2009 FL 5/21/2009 FL 5/21/2009 FL 5/21/2009 KS
10
9 10 12 4 5 5 1 8 4 1
10
10 4 5 5 1 4 1
5 5
5 5
1.4
1
7 1.4 1.1 5 12 16 2 15 11 9 29 11 1.1 7 1 13 4 5 6 9 9 1.3 1.1 11 9 11 67
1 1 5 16 2 11 29 10 1
4
9 1 1
67
U U F M M M F M F F M 0F F F 0M F F F U 0.4 M F M 0.4 F 0.1 F M F M F 0.2 F M F F F M 0.1 F M F F M U U M F F 0.3 F 0.1 M U M M F F
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Initial information has been received 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received form 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has
347748 347751 347753 347758 347759 347760 347761 347763 347764 347765 347766 347767 347768 347769 347770 347771 347772 347773 347774 347775 347776 347777 347778 347779 347780 347781 347782 347783 347784 347785 347786 347787 347788 347789 347790 347791 347792 347793 347794 347795 347796 347797 347798 347799 347800 347801 347802 347803 347804 347805 347806
5/21/2009 5/21/2009 KS 5/21/2009 MI 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 LA 5/21/2009 OH 5/21/2009 NY 5/21/2009 OH 5/21/2009 MI 5/21/2009 IL 5/21/2009 LA 5/21/2009 LA 5/21/2009 NJ 5/21/2009 CA 5/21/2009 MA 5/21/2009 5/21/2009 ME 5/21/2009 OH 5/21/2009 OR 5/21/2009 5/21/2009 IN 5/21/2009 CT 5/21/2009 5/21/2009 CA 5/21/2009 AZ 5/21/2009 OH 5/21/2009 5/21/2009 NC 5/21/2009 5/21/2009 LA 5/21/2009 5/21/2009 KY 5/21/2009 LA 5/21/2009 CA 5/21/2009 CA 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 FL 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 5/21/2009 GA 5/21/2009 OH 5/21/2009 GA 5/21/2009 OH 5/21/2009 GA 5/21/2009 GA
7 68 11 20 47 24 6 1
68 20
1 7 4 60 10 1.1 1.3 29 2 5 1.1 0.2 5 5 1.6 75 5 10 28 8
4
29 5 1 0 5 1 75 5 28
2.5 1.3 5 10 1.3 11 7 48 1.3 6 29 4 1 4 7 4 4
5 10
1 6
7
M M F F F F M M M F M M M U U F F F F M 0.1 M M 0.2 U M M 0.6 M F M U F U U F F U M F U M U F M 0.3 M F F F U M F U M
5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received via li 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347807 347808 347809 347810 347811 347812 347813 347814 347815 347816 347817 347819 347820 347821 347822 347823 347824 347825 347826 347827 347828 347829 347830 347831 347832 347833 347834 347835 347836 347837 347838 347839 347840 347841 347842 347843 347844 347845 347846 347847 347848 347849 347850 347851 347852 347853 347854 347855 347856 347857 347858
5/21/2009 5/21/2009 CA 5/21/2009 FL 5/21/2009 KY 5/21/2009 5/21/2009 VA 5/21/2009 NY 5/21/2009 PA 5/21/2009 NY 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 MD 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 NJ 5/21/2009 5/21/2009 MD 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 CT 5/21/2009 FL 5/21/2009 GA 5/21/2009 CA 5/21/2009 AR 5/21/2009 MA 5/21/2009 5/21/2009 5/21/2009 NH 5/21/2009 KY 5/21/2009 TX 5/21/2009 OH 5/21/2009 FL 5/21/2009 MN 5/21/2009 OH 5/21/2009 MO 5/21/2009 CA 5/21/2009 PA 5/21/2009 MI 5/21/2009 IN 5/21/2009 TX 5/21/2009 VA 5/21/2009 5/21/2009 5/21/2009 TX 5/21/2009 5/21/2009 PA 5/21/2009 MT 5/21/2009 VA
20 14 1.3 8 2 13 21 1.1 67 8 12 1
20 14
21 67
1
1.5 4 1 1 30 18 10 1 7 82 4
1 4 0 0 30 18 10
1
1
25 1.2 9 8 70 85 8 1 45 13 8 1 1 12 68 69 12 9 12
7 82 4
9
85 1
13 8 1 1 12
69
12
F M F M U M M F M F M M 0F U 0.5 F M 1M 1F F F F F F F F U U 0F F F M F M F M F 0M U M F F 0M 0F M F U F F U M M
5/15/2009 Information has been received throu 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2008 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 This report was identified from a line 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
347859 347860 347861 347862 347863 347864 347865 347866 347867 347868 347869 347870 347871 347872 347873 347874 347875 347876 347877 347878 347879 347880 347881 347882 347883 347884 347885 347886 347887 347888 347889 347890 347891 347892 347893 347894 347895 347896 347897 347898 347902 347903 347904 347905 347906 347907 347908 347909 347910 347911 347912
5/21/2009 PA 5/21/2009 KS 5/21/2009 PA 5/21/2009 5/21/2009 PA 5/21/2009 TX 5/21/2009 5/21/2009 KY 5/21/2009 NY 5/21/2009 OK 5/21/2009 VA 5/21/2009 CT 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 NY 5/21/2009 PA 5/21/2009 MA 5/21/2009 PA 5/21/2009 IN 5/21/2009 DE 5/21/2009 MO 5/21/2009 IL 5/21/2009 OH 5/21/2009 MO 5/21/2009 MO 5/21/2009 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 FL 5/21/2009 PA 5/21/2009 5/21/2009 CA 5/21/2009 5/21/2009 MI 5/21/2009 5/21/2009 5/21/2009 VA 5/21/2009 VA 5/21/2009 VA 5/21/2009 NC 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 MA 5/21/2009 NY 5/21/2009
19
19
8 3 15
3 15
11
11
12 12 12 12 6 1.8
1
7
7
8 10 10 11 1.2 1.2 11 1.5 9 8 2 58
8 10 10 11 1 1 1
2 58
5 14 40 3 10 1 11 46 63
14 40 3 10 0 11
17
17
4
U F U U U F M F F M F U F F F F F M 0.8 M U M U U M M M M 0.2 M 0.2 M F 0.5 M M M 0F M U F U F F M M 1M M F U M M F U M
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5/21/2009 MI 5/21/2009 FL 5/21/2009 5/21/2009 TX 5/21/2009 CA 5/21/2009 5/21/2009 KY 5/21/2009 WI 5/21/2009 NY 5/21/2009 AZ 5/21/2009 VA 5/21/2009 CA 5/21/2009 5/21/2009 WI 5/21/2009 PA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 5/21/2009 PA 5/21/2009 PA 5/21/2009 CA 5/21/2009 IL 5/21/2009 PA 5/21/2009 IL 5/21/2009 OH 5/21/2009 FL 5/21/2009 NY 5/21/2009 5/21/2009 CO 5/21/2009 5/21/2009 OH 5/21/2009 NY 5/21/2009 FL 5/21/2009 VA 5/21/2009 TX 5/21/2009 PA 5/21/2009 PA 5/21/2009 MA 5/21/2009 MA 5/21/2009 MA 5/21/2009 IN 5/21/2009 5/21/2009 NJ 5/21/2009 5/21/2009 TX 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 TX 5/21/2009 PA
4 12 65
60 4 73 24
4 73
1 6 77 20 25 6 1
25 1
4 8
4 8
11 63 5 4 1.3
11 63 5 4 1
1 10 8 1 14 1 13 12
0
1 14 1 13 12
1
1
12 9
9
8 3 10 1.5 7 1.3
8 3
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M F U U M M F F F F F U F M F F M 0F U F F U F F M F 0.3 F F 1F M F 0F F 0M F F U 0F U F M M F U F M M F M M 0.3 F
5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from
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5/21/2009 OH 5/21/2009 TX 5/21/2009 5/21/2009 MA 5/21/2009 MD 5/21/2009 5/21/2009 IA 5/21/2009 5/21/2009 5/21/2009 5/21/2009 5/21/2009 WA 5/21/2009 FL 5/21/2009 PA 5/21/2009 MI 5/21/2009 WA 5/21/2009 5/21/2009 OH 5/21/2009 MA 5/21/2009 5/21/2009 TN 5/21/2009 OH 5/21/2009 5/21/2009 VA 5/21/2009 5/21/2009 PA 5/21/2009 NY 5/21/2009 AZ 5/21/2009 MA 5/21/2009 CA 5/21/2009 5/21/2009 5/21/2009 NY 5/21/2009 5/21/2009 MA 5/21/2009 NC 5/21/2009 5/21/2009 LA 5/21/2009 MA 5/21/2009 NE 5/21/2009 TX 5/21/2009 AZ 5/21/2009 5/21/2009 VA 5/21/2009 KY 5/21/2009 FL 5/21/2009 PA 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 SC 5/21/2009 AZ
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5/21/2009 AZ 5/21/2009 AZ 5/21/2009 SC 5/21/2009 AZ 5/21/2009 5/21/2009 AZ 5/21/2009 AZ 5/21/2009 NH 5/21/2009 VA 5/21/2009 5/21/2009 5/21/2009 AZ 5/21/2009 VA 5/21/2009 FL 5/21/2009 MD 5/21/2009 PA 5/21/2009 CA 5/21/2009 PA 5/21/2009 NY 5/21/2009 CA 5/21/2009 MA 5/21/2009 CO 5/21/2009 MA 5/21/2009 KY 5/21/2009 PA 5/21/2009 5/21/2009 ID 5/21/2009 MI 5/21/2009 5/21/2009 PA 5/21/2009 5/21/2009 GA 5/21/2009 5/21/2009 NJ 5/21/2009 NJ 5/21/2009 OH 5/21/2009 MS 5/21/2009 NY 5/21/2009 5/21/2009 TX 5/21/2009 PA 5/21/2009 TX 5/21/2009 TX 5/21/2009 KS 5/21/2009 TX 5/21/2009 5/21/2009 5/21/2009 LA 5/21/2009 5/21/2009 5/21/2009 IN
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5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received conc 5/15/2009 Initial information has been received 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received form 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information haws been received fro 5/15/2009 Information has been received from
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5/21/2009 TX 5/21/2009 FL 5/21/2009 CA 5/21/2009 5/21/2009 WA 5/21/2009 5/21/2009 5/21/2009 OH 5/21/2009 PA 5/22/2009 NJ 5/22/2009 MA 5/22/2009 MS 5/22/2009 PA 5/22/2009 CO 5/22/2009 KY 5/22/2009 TX 5/22/2009 GA 5/22/2009 MN 5/22/2009 5/22/2009 TX 5/22/2009 NY 5/22/2009 5/22/2009 5/22/2009 MA 5/22/2009 5/22/2009 NE 5/22/2009 NY 5/22/2009 CA 5/22/2009 NJ 5/22/2009 MO 5/22/2009 AL 5/22/2009 KS 5/22/2009 WI 5/22/2009 MI 5/22/2009 GA 5/22/2009 SD 5/22/2009 OH 5/22/2009 KS 5/22/2009 ID 5/22/2009 MD 5/22/2009 TX 5/22/2009 NJ 5/22/2009 KS 5/22/2009 OH 5/22/2009 IN 5/22/2009 TX 5/22/2009 CA 5/22/2009 HI 5/22/2009 NH 5/22/2009 OK 5/22/2009 SD
4 9 60 1.5 11 1.1 60 29 10 1.2 1.1 66 4 0.6 32 39 0.3 22 21 13 70 19 0.2 1.3 1.5 66 65 10 59 18 36 23 1.6 5 5 0.8 27 20 15 47 10 18 54 25 25 22 1 1
4 9 1 1 28 10 1 1 66 4 0 32 39 22 26 21
70 0 1 66 65 10 18 36 23 1 4 5 0 27 20 15 47 10 18 53 25 25 22 1 1
M M U 0.5 M F 0.1 M U M M F 0.2 F 0.1 F F F 0.6 F M F F F M F F F F F 0.2 M M 0.4 M F F M F M F F 0.4 F F F 0.8 F F F F M F F M F F F 0F 0.1 M
5/15/2009 Information has been received from 5/15/2009 Initial and follow-up information has 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/15/2009 Information has been received from 5/26/2009 Pt. stated he had vaccine on May 2 5/15/2009 Information has been received from 5/18/2009 Vaccine Adm. 3/18/09 for 6 mos. w 5/19/2009 Mom called starting 5/18 that Pt has 5/15/2009 Pt started breaking out into rash on 5/18/2009 Fever blisters breaking out/popping 5/9/2009 Immediate hypersensitivity reaction 5/6/2009 Patient broke out in a rash after RO 5/14/2009 Alvarado stated - that after thigh vac 5/18/2009 Swelling of arm, redness, severe pa 5/18/2009 Red papular rash appeared on foreh 5/21/2009 Information has been received from None stated. 5/21/2009 Information has been received from 5/20/2009 Information has been received from 5/20/2009 Information has been received from 5/19/2009 Apparent vaccine failure. Pt present 5/20/2009 Information has been received from 5/19/2009 Patient had irregular breathing with 5/18/2009 Red mark to R thigh, area hard, red 5/21/2009 Information has been received from 5/21/2009 Information has been received from 5/21/2009 Information has been received from 5/18/2009 24 hours after vaccine redness & sw 5/21/2009 Information has been received from 4/25/2009 -Develop fever of 102 degrees F ora 5/22/2009 4x2.5" area of severe swelling aroun 5/22/2009 As medication was being injected, b 5/22/2009 A 5th Pneumococcal vaccination wa 5/22/2009 Local reaction with arm swelling 5/22/2009 Clinic observation: slight diffuse indu 5/22/2009 Pentacel administered in Right delto 5/22/2009 Pt c/o pain in left arm after receiving 5/22/2009 CLIENT RECEIVED VACCINE ON 5/22/2009 Immediately after administering the 5/22/2009 Patient started having reaction to va 5/22/2009 Family called in on very hectic day w 5/22/2009 Patient complained of dizziness, na 5/22/2009 altered mental status per MD 5/22/2009 Headache and worsening myalgias 5/22/2009 ~2 days after receiving smallpox an 5/22/2009 Pt was given Pneumovax on 5/11/0 5/22/2009 fever, vomiting, eyes rolling to back 5/22/2009 Presented to cinic with herpes zoste
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5/22/2009 WV 5/22/2009 CO 5/22/2009 MA 5/22/2009 CA 5/22/2009 CA 5/22/2009 OR 5/22/2009 HI 5/22/2009 GA 5/22/2009 PA 5/22/2009 TX 5/22/2009 WI 5/22/2009 IL 5/22/2009 CA 5/22/2009 CA 5/22/2009 CA 5/22/2009 PA 5/22/2009 AZ 5/22/2009 NJ 5/22/2009 NC 5/22/2009 TX 5/22/2009 IL 5/22/2009 KS 5/22/2009 AR 5/22/2009 MA 5/22/2009 OH 5/22/2009 MS 5/22/2009 VA 5/22/2009 TX 5/22/2009 NJ 5/22/2009 TX 5/22/2009 TX 5/22/2009 AR 5/22/2009 NM 5/22/2009 NM 5/22/2009 NC 5/22/2009 PA 5/23/2009 AZ 5/24/2009 CA 5/24/2009 CA 5/24/2009 MD 5/25/2009 5/25/2009 CA 5/26/2009 NY 5/26/2009 CA 5/26/2009 FL 5/26/2009 UT 5/26/2009 5/26/2009 5/26/2009 CA 5/26/2009 NC 5/26/2009 PA
47 11 5 1.5 0.5 65 77 0.2 67 0.4 62 11 0.5 13 52 79 5 1.3 4 1.8 3 1.5 0.2 9 14 23 5 8 4 40 16 10 5 5 49 67 0.3 45 4 43 20 66 25 15 42 4 1.1 2 10 4 1.2
47 11 5 1 0 65 76 0 67 0 62 11 0 13 52 79 5 1 4 1 3 1 0 9 14 23 5 8 4 40 16 10 5 5 49 67 0 45 43 20 66 25 15 4
10 4 1
M M U 0.5 M 0.5 M F M 0.2 F M 0.4 M M F 0.5 M M F F F 0.3 M M 0.8 F M 0.5 M 0.2 F F M F M F M M F F M F F F 0.3 F F F M M F M M F F M M F M 0.2 F
5/22/2009 Rash at injection site and on the ba 5/22/2009 patient sitting in chair for injection. a 5/22/2009 Shortly after DTAP vaccine his left u 5/22/2009 After receiving Varicella vaccine on 5/22/2009 Pt received Rotavirus vaccine on 4/ 5/22/2009 Patient developed three lesions at 2 5/22/2009 Pt. developed gradually worsening m 5/22/2009 Baby was brought in today by her m 5/21/2009 Severe local swelling and tendernes 5/24/2009 Patient had soft node to R/L anterio 5/24/2009 Developed shingles on forehead - re 5/23/2009 (R) Posterior arm - 1 area maculopa 5/22/2009 Started with fever - 103 - last night + 5/22/2009 Pt felt dizzy about 2-3 minutes after 5/22/2009 Painful upper (L) arm: Pain radiates 5/22/2009 Patient developed firey red rash on 5/22/2009 Day after injection (L) arm was swol Temp 103 degree 6 days later - Chr 5/22/2009 New onset rash on anterior R thigh, 5/24/2009 Pt was administered a TD vaccine w 5/22/2009 DTAP/IPV combination given into L 5/22/2009 Patient in office for well child visit. G 5/20/2009 Per CoronerY mom was in bed with b 5/27/2009 6 - 7 cm oval red, raised area at site 5/22/2009 Fever to 104 F and whole upper arm 5/21/2009 Initial VAERS filed Feb 2003. This 3 4/29/2009 6 X 5 cm urticarial plaque on left lat Shot given on 5-20-09 Pt came bac 5/22/2009 5/21/09 Swollen, reddened, tender a 5/22/2009 None stated 5/21/2009 Received vacc. approx 1500 5/20/0 5/24/2009 Redness and swelling to left arm ap 5/20/2009 Left deltoid, warm to touch, red, ext 5/20/2009 Left deltoid, slight swelling, light red 5/21/2009 Left arm red, swollen at sight of inje 5/21/2009 5cm x 3cm erythematous indurated 5/23/2009 high pitched crying for at almost 12 5/24/2009 I lost about a cubic inch of muscle, b 5/24/2009 Extreme swelling at injection site, si 5/24/2009 103 fever, tachycardia, myalgias, se 5/25/2009 PT PRESENTED WITH COMPLAIN 5/25/2009 red inflammed area 8 inches by 3 1 5/26/2009 Severe muscle pain in shoulder whe 5/26/2009 Day 2 (May 23rd) after vaccination o 5/22/2009 This case was reported by a physici 5/21/2009 Kawasaki's syndrome. Received IVI 5/22/2009 Information has been received from 5/22/2009 Information has been received from 5/20/2009 Was given SANOFI PASTEUR'S TD 5/20/2009 Huge area of erythema 5" x 5", left u 5/15/2009 5/15 presents with maculopapular p
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5/26/2009 MT 5/26/2009 OR 5/26/2009 LA 5/26/2009 NM 5/26/2009 NJ 5/26/2009 MI 5/26/2009 VA 5/26/2009 AL 5/26/2009 TN 5/26/2009 MI 5/26/2009 PA 5/26/2009 CA 5/26/2009 GA 5/26/2009 MD 5/26/2009 TX 5/26/2009 OH 5/26/2009 FL 5/26/2009 WI 5/26/2009 CA 5/26/2009 PA 5/26/2009 KS 5/26/2009 SC 5/26/2009 IL 5/26/2009 IN 5/26/2009 PR 5/26/2009 GA 5/26/2009 NY 5/26/2009 TN 5/26/2009 MD 5/26/2009 CO 5/26/2009 GA 5/26/2009 TX 5/26/2009 CA 5/26/2009 CA 5/26/2009 WA 5/26/2009 HI 5/26/2009 CA 5/27/2009 WA 5/27/2009 GA 5/27/2009 GA 5/27/2009 OR 5/27/2009 NY 5/27/2009 NH 5/27/2009 CA 5/27/2009 CA 5/27/2009 NE 5/27/2009 TX 5/27/2009 CA 5/27/2009 TX 5/27/2009 NC 5/27/2009 TX
1 1.1 0.2 12 63 48 16 22 1.3 62 10 1 1.3 25 26 14 2 1.6 1.1 4 15 14 59 18 0.3 19 45 1.2 0.2 0.2 1 10 0.2 4 62 1
1 1 0 12 63 48 16 22 1 62 10 1 1 25 26 14 2 1
0.3 19 0.2 45 0.2 50 48 0.3 5 14 4 13 11 16
0 19 0 45
4 15 14 59 18 0 19 45 1 0 0 1 10 0 4 62 1
50 48 0 5 14 4 13 11 16
0M 0.1 M 0.2 F F F F F M 0.3 F F M 0M 0.3 M F F F 0F 0.6 F F M F M F F 0.3 M F F 0.2 F 0.2 M 0.2 M 0M F 0.2 M M F 0M F 0.4 M M 0.2 M F M M F 0.3 M M M F M M F
5/21/2009 5/13/09 Per nurse child was seen to 5/13/2009 One hour after receiving vaccines, p 5/19/2009 Localized reaction to PENTACEL va 5/18/2009 Adolescent received vaccines on 3/ ### Initial non-serious case received fro 5/20/2009 Vaccine given 5/8/09. Fever to 101. 5/20/2009 Sleepy, Swollen eyelid, decreased a 5/21/2009 Patient Rt arm with redness from sh 5/13/2009 Immediately after vaccine administr 5/22/2009 Information has been received from 5/21/2009 Severe local reaction 4 X 5 cm Eryth 5/22/2009 While nursing began to scratch ears 5/26/2009 Seizure/fever. 5/26/2009 24 hours after receiving GARDASIL 5/21/2009 None 5/22/2009 Mom called @12:30 am 5/22/2009 s 5/26/2009 None noted.Y Pt was not seen in our 5/19/2009 Patient with fever, irritability and cry 5/12/2009 T 101 about 12 hours after vaccinat 5/26/2009 Parent noticed increased redness + 5/26/2009 On 5/7/09 patient reports almost im 5/26/2009 Several weeks (end of November) a 5/26/2009 Three days following administration 5/26/2009 tingling of lips and tongue 30 min af 5/26/2009 MOTHER REFERS THAT THE NEX 5/26/2009 THE PT FAINTED AT A RESTURA 5/26/2009 Lesions on chest, back, and arms p 5/26/2009 Patient was healthy at the time she 5/26/2009 Fever 5/26/2009 Necrotizing enterocolitis, symptoms 5/26/2009 blanching macules on trunk, extrem 5/26/2009 Patient developed mucosal wart ins 5/26/2009 Pt was taken to facility on 5/21. Re 5/26/2009 After receiving last vaccine MMR no 5/26/2009 Pt reported a swollen arm that subs 5/21/2009 5/21/09 developed chickenpox rash 5/26/2009 11 days after MMR, developed itch 5/27/2009 Approximately five hours after the v 5/27/2009 memory loss, achy muscles and join 5/18/2009 5/5/09 Pt was Y brought into ED by EM None stated. 9/9/09 Rheumatology 5/19/2009 Fever to 103; diarrhea; lethargy; de 5/21/2009 Weakness and pain in arm. No feve 5/19/2009 4-5 inch swelling with hard middle, i 5/14/2009 8-4-08, received PEDIARIX, HIB an 5/21/2009 L upper deltoid with 100 cm of eryth 5/22/2009 Initial report received on 13 May 20 5/20/2009 woke up and left deltoid dark red, pu 5/22/2009 Initial report received on 13 May 20 5/20/2009 Red swollen area on deltoid of right 5/22/2009 Initial report received on 13 May 20
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5/27/2009 MN 5/27/2009 IN 5/27/2009 IL 5/27/2009 IL 5/27/2009 5/27/2009 CO 5/27/2009 5/27/2009 MA 5/27/2009 IL 5/27/2009 WI 5/27/2009 AK 5/27/2009 CO 5/27/2009 IN 5/27/2009 NC 5/27/2009 AR 5/27/2009 IN 5/27/2009 WA 5/27/2009 MD 5/27/2009 LA 5/27/2009 IL 5/27/2009 CO 5/27/2009 NC 5/27/2009 CA 5/27/2009 FL 5/27/2009 CA 5/27/2009 IN 5/27/2009 IN 5/27/2009 PA 5/27/2009 NC 5/27/2009 NC 5/27/2009 NM 5/27/2009 TN 5/27/2009 CA 5/27/2009 GA 5/27/2009 MA 5/27/2009 TN 5/27/2009 TX 5/27/2009 WI 5/27/2009 NH 5/27/2009 5/27/2009 MA 5/27/2009 MD 5/27/2009 TX 5/27/2009 MA 5/27/2009 CA 5/27/2009 TX 5/27/2009 5/27/2009 CA 5/27/2009 TX 5/27/2009 FL 5/27/2009 OR
18 11 25 22
18 11 25 22
0.5 24 46 10 5 60 5 37 13 0.3 1.1 1.4 4 36 44 26 42 65 65 7 1.3 1.4 5
0 24 46 10 5 60 5 37 13 0 1 1 4 36
20 0.2 53 49 0.6 16 26 0.2 44 5 20 21 23 35 79 5 1 24 42 66 58 7
20 0 53
26 42 65 65 7 1 1 5
0 17 26 0 44 5 20 21 23 44 79 5 1 42 66 58 7
F M M F U 0.5 F F M F M F M F M 0.3 M 0.1 M 0.4 M M F M M F M F F 0.3 F 0.4 F M F M 0F F F 0.6 F F F 0.2 F F M F F M F F M 0M M F M F M
5/18/2009 After vaccine given, pt complained o 5/20/2009 Large area of erythema and swellin 5/20/2009 C/o tightness in chest & throat 20 m 5/28/2009 C/o swelling of throat after receiving None stated. 5/12/2009 Had generalized tonic - clonic seizu Patient was administered SMALLPO 5/19/2009 Patient reports redness at injection 4/1/2009 With erythema and swelling on Rt d 5/19/2009 5/15 TC from mom reporting child d 5/18/2009 Pt fainted 10 min. after leaving phar 5/18/2009 Local reaction - pain, erythema star 5/19/2009 Joint pain and exhaustion started 1s 5/12/2009 5/12/09 PC received from guardian 5/18/2009 This patient was accidently given HP 5/18/2009 Pt. developed 2 cm erythema at loc 5/19/2009 1 red spot on belly 5-17-09 in AM, 1 5/21/2009 Swelling with redness, itchiness ove 5/4/2009 Please see attached encounter 5/18/2009 NONE 5/4/2009 ~ 7-10 vesicles at site of injection of 5/27/2009 None stated 5/19/2009 Pt developed diffuse Myalgias appro 5/20/2009 3 areas (small) of red flat rash in up 5/18/2009 Pustule at VZV injection site on 5/12 5/20/2009 Local reaction on left and right ante 5/20/2009 Mother called the office at 230 PM o 5/20/2009 Varicella vaccine breakthrough. Had 5/19/2009 None stated. 5/19/2009 None stated. 5/27/2009 prevnar was given twice, no adverse 5/27/2009 Patient reports a gradual onset of e 5/27/2009 Severe Hair loss (alopecia) around 5/27/2009 Presented via EMS to Emergency D 5/27/2009 Patient received the Typhoid Vaccin 5/27/2009 I have random twitches and involun 5/27/2009 local reaction red, hot and swollen a 5/27/2009 Pt experiencing flu like symptoms w 5/27/2009 Six days after vaccine administratio 5/27/2009 10July08-First Anthrax vaccination 5/27/2009 Three days after experienced fever 5/27/2009 tightness in chest, shortness of brea 5/27/2009 HAS HX OF GRAVES DISEASE SI 5/27/2009 Received ZOSTAVAX 4/16/09. Dev 5/22/2009 ZOSTAVAX given to 5 year old with 5/27/2009 Fever, Tmax 103.8. Multiple tonic / 5/27/2009 Client seen at ED on 5/11/09 for c/o 5/27/2009 Info reported to our clinic by patient 5/27/2009 48 hours after vaccine administratio 5/27/2009 Called on 5/25 to report severe mus 5/27/2009 Generalized varicella-like rash, grea
347564 347565 347566 347567 347568 347569 347571 347573 347574 347578 347580 347581 347587 347589 347594 347597 347599 347717 347719 347720 347721 347722 347723 347724 347727 347728 347729 347734 347735 347743 347746 347749 347752 347755 347913 347914 347915 347916 347917 347919 347920 347921 347922 347923 347924 347925 347926 347927 347928 347947 347949
5/27/2009 WA 5/27/2009 AZ 5/27/2009 CA 5/27/2009 GU 5/27/2009 FL 5/27/2009 WI 5/27/2009 WA 5/27/2009 TX 5/27/2009 NC 5/27/2009 NY 5/27/2009 IL 5/27/2009 IL 5/27/2009 MN 5/27/2009 FL 5/27/2009 AZ 5/27/2009 AZ 5/27/2009 MI 5/28/2009 5/28/2009 UT 5/28/2009 MI 5/28/2009 5/28/2009 5/28/2009 5/28/2009 5/28/2009 5/28/2009 TX 5/28/2009 5/28/2009 VA 5/28/2009 FL 5/28/2009 KY 5/28/2009 SC 5/28/2009 5/28/2009 WA 5/28/2009 5/28/2009 OH 5/28/2009 MA 5/28/2009 SC 5/28/2009 NY 5/28/2009 OH 5/28/2009 CA 5/28/2009 MO 5/28/2009 FL 5/28/2009 ND 5/28/2009 CA 5/28/2009 OR 5/28/2009 LA 5/28/2009 OR 5/28/2009 MN 5/28/2009 OR 5/28/2009 TX 5/28/2009 NY
68 52 28 3 0.6 19 4 1.3 81 1.5 8 5 9 28 5 2 31
68 52 28 3 0 19 4 1 81 1 8 5 9 28 5 2 31
17 22 19 35 2 2 16 62 22 22 11 33 5 1.5 81 7
17 21
55 19 27 4 1.2 0.3 63 12 24 32 4 1.5 50 1 4
35
16 62 22 22 11 33 5 1 81 7 5 55 19 27 4 4 1 0 63 12 23 32 4 50 1 4
U M F F 0.6 M M F 0.3 M F 0.5 F M F M F M 0.5 M F F F F F F M M F F F F F M F 0.5 F F F M M F M F F 0.2 F 0.4 F F F F F F F F 0M F
5/27/2009 Unintentionally gave expired Pneum 5/27/2009 pt left hand and forearm had slight s 5/27/2009 paresthesias of bilateral feet and low 5/27/2009 Fever over 103 F 12 hours later last 5/27/2009 Temperature 101-103 approximatel 5/27/2009 Hep A given- immediately after patie 5/27/2009 Patient developed hives about 22 h 5/13/2009 Patient received DTAP, HIB + HEP 5/27/2009 Patient came to office 5-26-09 + rep 4/24/2009 1st Hep A vaccination 2/20/09 - only 5/27/2009 Patient c/o itching at the site, 5min l 5/21/2009 Rash at injection site right deltoid (1 5/26/2009 No adverse event. Mis administratio 5/27/2009 This case was reported by a healthc 5/22/2009 KINRIX & VARICELLA vaccine give 5/22/2009 DAPTACEL and VARIVAX vaccines 5/26/2009 Rash on arm next day, took BENAD 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/26/2009 Information has been received from 5/27/2009 Information has been received from 5/27/2009 Information has been received from 5/27/2009 Information has been received from 5/28/2009 Pt passed out 5/28/2009 Urticaria/Hives neck back, abdomen 5/21/2009 L. arm "PPD" testing using ANTHRA 5/27/2009 None. HPV vaccine ordered by phy 5/21/2009 Papular (raised) rash in crops over t 5/22/2009 Reaction at Inj site. Red itchy rash 5/15/2009 erythematous patch over the vaccin 5/28/2009 Would consider this a vaccine failur 5/28/2009 Vaccine was administered to left de 5/28/2009 Quarter-sized area of enduration 25/28/2009 Member had small pox vaccine on 5/28/2009 This should probably be considered 5/28/2009 Low grade fever (not even 100) 5/26 5/28/2009 Mom noticed swelling and redness a 5/28/2009 TELEPHONE CALL FROM MOTHE 5/28/2009 2nd day after receiving TdaP imm., 5/28/2009 Rash, decreased sensation and dec 5/28/2009 patient had rash c/ second injection 5/28/2009 Tingling, numbness, pain, limited RO 5/28/2009 Three vaccines given to pt, Lt leg V 5/28/2009 Rash developed 48 hours after imm 5/28/2009 I received this second HB shot durin 5/28/2009 Mom called stated Pt had started ge 5/28/2009 Patient with reddened raised area a
347950 347951 347952 347953 347954 347955 347956 347957 347958 347959 347960 347929 348105 348115 348120 348128 348135 348136 348137 348138 348139 348140 348141 348142 348143 348144 348145 348146 348147 348148 348149 348150 348151 348152 348153 348154 348155 348156 348157 348158 348159 348161 348162 348163 348170 348171 348173 348174 348175 348178 348182
5/28/2009 MI 5/28/2009 FL 5/28/2009 SC 5/28/2009 FL 5/28/2009 GA 5/28/2009 5/28/2009 PA 5/28/2009 5/28/2009 NC 5/28/2009 MA 5/28/2009 WA 5/29/2009 CA 5/29/2009 5/29/2009 IL 5/29/2009 MN 5/29/2009 5/29/2009 NY 5/29/2009 KY 5/29/2009 AR 5/29/2009 AR 5/29/2009 NY 5/29/2009 GA 5/29/2009 GA 5/29/2009 GA 5/29/2009 MA 5/29/2009 MA 5/29/2009 PA 5/29/2009 CA 5/29/2009 MD 5/29/2009 TX 5/29/2009 CA 5/29/2009 CA 5/29/2009 OK 5/29/2009 GA 5/29/2009 WI 5/29/2009 WV 5/29/2009 VT 5/29/2009 SC 5/29/2009 GA 5/29/2009 MI 5/29/2009 OK 5/29/2009 HI 5/29/2009 TX 5/29/2009 NV 5/29/2009 TX 5/29/2009 KS 5/29/2009 NJ 5/29/2009 AZ 5/29/2009 PA 5/29/2009 5/29/2009 MA
0.3 1 52 18 4
0 1 52 18 4
1.1 44 1 45 37 53 22 81 0.2
1 44 1 45 37 53 22 81 0
68 4 0.2 0.6 1 11 30 30 10 9 67 56 4 23 56 26 21 0.6 11 4 72 48 76 48 77 18 4 50 5 12 0.4 33 36 11 55
68 4 0 0 1 11 30 30 10 9 67 56 4 23 56 21 0 11 4 72 48 76 48 77 19 4 50 5 12 0 33 36 11 55
0.3 F 0F F F M U 0.1 F M 0M F M F F M 0.2 M F F F 0.2 F 0.6 F 0F F M M F F F M M M F F F 0.6 M F F M F F F F F M M M M 0.4 M F M F M
5/28/2009 Inconsolable crying with head twitch 5/26/2009 Hives on arm, legs + face. 5/27/2009 - Fever body aches, arm pain. Appr 5/22/2009 Patient complained of "high" fever s 5/27/2009 Vomited x 1; eyes and lips became Redness- painful - swelling (L) thigh 5/26/2009 None stated. 5/28/2009 2 days post 1st dose pt noted flashe 5/28/2009 Multiple Vesicles 5/28/2009 Generalized rash developed within 5/28/2009 Deltoid muscle pain and swelling. S 5/29/2009 Patient developed myalgias in the n 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/29/2009 We received from a consumer the fo 5/22/2009 Administered ZOSTAVAX vaccine 5 5/21/2009 5/9/09 went to ED with swelling to ri 4/1/2009 Red, hot, firm area on Rt deltoid app 4/1/2009 Rash on back, abdomen, arms, face 5/24/2009 Chief Complaint (1/1): This 12 mont 5/26/2009 2:10 fainted after vaccination and bu 5/22/2009 Right thorax- rash and pain. Treated 5/22/2009 Rash on right thorax returned after 2 5/26/2009 Received VARIVAX 5-21-09, seen i 5/26/2009 On 5/18/09 given VARIVAX, develo 5/29/2009 Rash at injection site 5/29/2009 Approximate 4 minutes after receivi 5/29/2009 4 inch circular redness with warmth. 5/29/2009 Patient states that he had vaccinatio 5/29/2009 Approximate 2 minutes after receivi 5/29/2009 a few minutes after i got the 1st sho 5/29/2009 tdap booster given approx 10 am on 5/29/2009 TEMP103LN,VOMITING,URI.sYMP 5/29/2009 Woke early AM 5/19/09 with frequen 5/29/2009 5/28, mother called and reported tha 5/29/2009 Pt went to a pharmacy clinic to rece 5/29/2009 1-2-09 Tdap administered R deltoid 5/29/2009 within 24 hrs after vaccination, arm 5/29/2009 Hep B #1 adm. 2:30pm,Fri.22 May 2 5/29/2009 localized reaction distal to injection 5/29/2009 Has fever, generalized body aches 5/29/2009 August 18, 1991. "Hold up four finge 5/29/2009 Pt presented 13 days s/p vaccinatio Vesicular rash on trunk 26 days afte 5/28/2009 Patient received vaccines at 12:00 a 5/29/2009 Pt had been lethargic, decreased ap 5/29/2009 Received MMR and VARIVAX vacc 5/26/2009 Large, red area on arm; Warm to to 5/29/2009 2 days after, redness 2-3 " down arm 5/29/2009 Site reaction. mild edema, tenderne
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5/29/2009 WI 5/29/2009 MI 5/29/2009 IN 5/29/2009 5/29/2009 VI 5/29/2009 PA 5/29/2009 TX 5/29/2009 NY 5/29/2009 AK 5/29/2009 CA 5/29/2009 WI 5/29/2009 NY 5/29/2009 OH 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 MT 5/29/2009 TX 5/29/2009 5/29/2009 CA 5/29/2009 5/30/2009 NY 5/30/2009 AL 5/30/2009 MN 5/31/2009 NJ 5/31/2009 WA 6/1/2009 6/1/2009 CA 6/1/2009 MD 6/1/2009 GA 6/1/2009 OH 6/1/2009 FL 6/1/2009 OR 6/1/2009 OR 6/1/2009 WA 6/1/2009 LA 6/1/2009 WI 6/1/2009 CA 6/1/2009 MD 6/1/2009 FL 6/1/2009 CA 6/1/2009 NY 6/1/2009 6/1/2009 LA 6/1/2009 6/1/2009 LA 6/1/2009 AR 6/1/2009 WA
31 24 4 56 54 57 4 17 58 19 1.3 0.2 4
31 24 4 56 54 57 4 17 58 19 1 0 4
4
4
4
4
0.4 73 12 4 1.3 19 5 47 4 1 1.5 1.1 51 68 0.5 11 28 70 18 0.5
0 73 12 4 1 19 5 47 4 0 1 1 51 68 0 11 28 70 18 0
43
43
16 4 4
16 4 4
F F M M F M M F F M 0.3 M 0.2 M F U U U U U U U F U M U 0.4 M F F F 0.3 F M M F F 1F 0.5 M 0.1 M F F 0.5 M F F M F 0.5 F F M F F F F F
5/29/2009 2-2 1/2 inch area around injection s 5/19/2009 Patient was given initial dose of Gar 5/29/2009 Redness, swelling, warmth, bruising 5/29/2009 This case was reported via a statem 5/29/2009 Patient came in clinic stating that sh 5/29/2009 Pt called on 5/26/09 c/o feeling nerv 5/29/2009 Blotchy, red-macular rash to left thig 5/28/2009 Tdap vaccine given, Patient with h/o 5/29/2009 Patient received Subcutaneous dos 5/21/2009 About 5-10 mm after immunizations 5/29/2009 Approx 15 min after 1 mms given, c 5/29/2009 Fever 101.7 degrees F, vomiting, irr On Tues 05/18/2009 pt told mom le 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a healthc 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/27/2009 This case was reported by a physici 5/30/2009 Urticarial rash at vaccine site and on 5/30/2009 Shingle Shot;It was not until 3rd day 5/30/2009 Fever - 102.7; Headache; Fatigue; W 5/31/2009 Large area of induration at injection 5/31/2009 Patient had gunk in her eyes real ba 5/31/2009 Patient was vaccinated with Smallpo 5/29/2009 Patients arm swelled up to the wrist 5/28/2009 Feverish, body aches - Patients rela 5/29/2009 Patient in for immunizations on 5/28 5/29/2009 Mother called, client had high tempe 5/28/2009 Fast heart rate, fever, vomiting, diar 5/19/2009 Vaccinated 4/29/09. Mother noticed 5/27/2009 Took 1st Typhoid cap appropriately 5/27/2009 Redness, swelling pruritus in place 5/28/2009 Fever 12-14 hours after vaccines ad 5/27/2009 5/27/09 about 12:00 patient became 5/7/2009 Pain and area of redness over the s 11:30 AM severe hives. 5/26/2009 Patient complain of muscle pain in l 3/12/2009 Rotavirus is not to be started after 1 5/29/2009 Information has been received from 5/29/2009 Information has been received via a 5/13/2009 Patient returned to clinic on 5-13-09 5/29/2009 Information has been received from 4/24/2009 Dizzy head spinning, stomach sore, 5/22/2009 Mom stated redness and swelling b 5/30/2009 Cellulitis 4 x 2 1/2 cm indurated, inc
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6/1/2009 AR 6/1/2009 MI 6/1/2009 MI 6/1/2009 TN 6/1/2009 MI 6/1/2009 FL 6/1/2009 MO 6/1/2009 CA 6/1/2009 NC 6/1/2009 MI 6/1/2009 6/1/2009 NY 6/1/2009 KS 6/1/2009 KS 6/1/2009 IL 6/1/2009 CA 6/1/2009 CA 6/1/2009 CA 6/1/2009 TX 6/1/2009 NJ 6/1/2009 CA 6/1/2009 CA 6/1/2009 TX 6/1/2009 CA 6/1/2009 IL 6/1/2009 AZ 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/1/2009 GA 6/2/2009 IL 6/2/2009 PR 6/2/2009 LA 6/2/2009 LA 6/2/2009 AR 6/2/2009 TN 6/2/2009 6/2/2009 NH 6/2/2009 PA 6/2/2009 OH 6/2/2009 OR 6/2/2009 CA 6/2/2009 OH 6/2/2009 KS 6/2/2009 NY 6/2/2009 TX 6/2/2009 OR 6/2/2009 MO 6/2/2009 ME
42 9 11 0.5 10 12 1.3 12 3 9 25 54 14 17 51 4 0.2 11 11 20 10 5 12 6 4 44 53 4 53 18 9 1.3 13 32 0 57 0.3 0.2
42 9 11 0 10 12 1 12 3 9
12 1 55 37 1
12 1 55 37 1
4 1 14
4 1 14
0.2 5
0 5
54 14 17 51 4 0 11 11 20 10 5 12 6 4 44 53 4 53 18 9 1 13 32 0 57 0 0
F F M 0.5 M M F 0.3 M F F F M M F F F F 0.2 F U M F M F F F F M F F F F M 0.3 M F M 0M M 0.3 M 0.2 M U F 0F F F 0F F F 0F F F 0.2 M M
6/1/2009 Pain, swelling, redness, heat, and ra 6/1/2009 Pt came into office and never was im 6/1/2009 N/A, Pt was administered the DTaP 6/1/2009 4 days after dose of Rota vaccine g 6/1/2009 N/A, the patient was given the MCV 6/1/2009 I assessed a 12 year old female wh 6/1/2009 Patient received MMR and Varicella 6/1/2009 severe swelling in lympyh node on s 6/1/2009 Based on photographs the patient d 6/1/2009 Child woke up the night of vaccinati 6/1/2009 Left Shoulder soft tissue infection w 6/1/2009 Swelling, Tenderness at surroundin 6/1/2009 Became ill Saturday 05/30/2009 wit 6/1/2009 Day following administration of vacc 6/1/2009 Vaccine given on 5/26/09. Day after 6/1/2009 Reacted post vaccine 2 days ago, n 6/1/2009 Tonic Clonic Seizure acttivity lasting 6/1/2009 Rash to face torso arms and legs on 6/1/2009 After the vaccine was administered, 6/1/2009 Diffuse maculopapular rash on face 5/21/2009 Swelling over injection site - X 2 day 5/21/2009 Swelling at injection site x 2 days. T 6/1/2009 Immediately following injection patie 6/1/2009 Feverish on 5/29/09, raised, itchy, p 6/1/2009 Erythema at site of injection up to 1 5/8/2009 SM reports receipt of third AVA vacc 4/15/2009 Patient received Tdap IM R arm on 4/3/2009 Client presented in clinic on 4/3/09 @ 2/3/2009 Head ache and vomiting within a few 4/9/2009 Immunization were given at 5:25pm 4/14/2009 1635 Generalized itching right shou 3/30/2009 Client received Immunization on 3/2 5/26/2009 Pt had unwitnessed seizure on 5/21 5/23/2009 Left, vocal cord, right vocal cord, po 5/22/2009 Seizures - 4/14/09, diarrhea, diaper 5/26/2009 Numbness in face, body, hands, fee 5/26/2009 Fever; febrile seizure; Negative wo 5/27/2009 Child developed poor appetite with None stated. 5/28/2009 L arm swollen, itchy & hot to touch. 5/27/2009 Varicella vaccine breakthrough. Dia 5/20/2009 Swelling + redness at injection site. 5/26/2009 Tingling in left arm, jaw, left leg for t 5/27/2009 Patient developed an erythematous 5/22/2009 Patient developed furuncle abscess 5/28/2009 Left thigh erythema and induration a 5/28/2009 Approx. 2 days after inj pt was seen 6/1/2009 Information has been received from 5/29/2009 This case was received from a cons 5/21/2009 Approximately two minutes after inje 5/28/2009 On 5/27/2009 24 hours after immun
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6/2/2009 ID 6/2/2009 ID 6/2/2009 ID 6/2/2009 MD 6/2/2009 NY 6/2/2009 MI 6/2/2009 PA 6/2/2009 MD 6/2/2009 FL 6/2/2009 6/2/2009 TX 6/2/2009 MD 6/2/2009 GA 6/2/2009 GA 6/2/2009 CT 6/2/2009 MO 6/2/2009 OK 6/2/2009 TX 6/2/2009 WI 6/2/2009 CO 6/2/2009 IL 6/2/2009 FL 6/2/2009 CA 6/2/2009 CA 6/2/2009 ID 6/2/2009 AZ 6/2/2009 CA 6/2/2009 WI 6/2/2009 NY 6/2/2009 CA 6/2/2009 MI 6/2/2009 IA 6/2/2009 WI 6/2/2009 CA 6/2/2009 TX 6/2/2009 IL 6/2/2009 KY 6/2/2009 OH 6/2/2009 MA 6/2/2009 NE 6/2/2009 AZ 6/2/2009 CA 6/2/2009 TX 6/2/2009 PA 6/2/2009 NY 6/2/2009 CA 6/2/2009 CA 6/2/2009 MD 6/2/2009 NM 6/2/2009 CA 6/2/2009 AZ
52 24 4 4 0.2 82 1.3 1
52 24 4 4 0 82 1 5 1
11 5 1 1 35 17 2 24 2 5 0.5 30 49 4 1.3 1 14 0.2 0.5 16 0.7 21 18 4 0.2 1.3 1 67 43 23 13 30 4 72 77 4 4 9 22 17 1.1
11 5 1 1 35 17 2 24 2 5 0 30 48 4 1 1 14 0 0 16 0 21 18 4 0 1 1 67 43 23 13 30 4 72 77 4 4 9 22 17 1
F F M M 0.2 M F 0.3 M M 0F F F F 0M 0M F F 0F F 0.3 M F 0.5 F M F F 0.3 M 0M F 0.2 M 0.5 F F 0.7 F F F F 0.2 F 0.3 M 0M F F F F F F F F F M F F F 0.1 F
5/22/2009 Patient got a Tdap 5/14/09 and dev 5/20/2009 Pt received ADACEL 4/27/09- And d 4/20/2009 On 4-16-09 Patient received DTaP 5/29/2009 Febrile Seizure. 5/26/2009 Infant rec'd PENTACEL 3/3/09 @ 2 5/26/2009 Patient was given Tdap in error as t 5/27/2009 Varicella vaccine breakthrough. Dia 5/27/2009 Swelling and bruising at site with pa 5/27/2009 Typical shingles of L chest and arm None stated. 5/28/2009 Left deltoid area developed erythem 5/27/2009 Leg Swollen, hard to touch, painful 6/2/2009 Developed diarrhea for 3 weeks, fev 6/2/2009 Diarrhea x 3 weeks 6/2/2009 Pain in the right deltoid since injecti 6/2/2009 Headache and dizziness s/p Tdap a 6/2/2009 Progressing ataxia with onset appro 6/2/2009 5-28-09 Loss of felling in left arm, h 6/2/2009 CLient received dose #4 of DTAP IM 6/2/2009 Menactra administered instead of M 6/2/2009 this patient recevied 3rd dose of Ro 6/2/2009 Vaccine was administered on 5/26/0 2/5/2009 Patient woke up the next day with ra 6/2/2009 Patient returned to clinic 3 days pos 6/2/2009 Developed fever 103 with diffuse sw 6/2/2009 ERYTHEMA, EDEMA AND INDURA 6/2/2009 My daughter fainted and was taken 6/2/2009 This case was reported by a healthc 6/2/2009 Fever - seizures - 5-20 minutes of s 5/18/2009 After 3 vaccines given Pt c/o dizzine 5/18/2009 None - 5/20/09 Spoke to Dad - baby 5/26/2009 Given Immunizations Thurs. PM 5/2 5/21/2009 5/21/09 Midmorning patient develop 48 hr Evolution-Progressive swelling 5/21/2009 Pt. developed petechiae of lower ex 5/26/2009 Fever started Saturday 5/23/09 102 5/26/2009 Scattered chicken pox lesions- head 5/26/2009 Generalized urticarial rash at site L 5/26/2009 Received Tdap to right deltoid 5/22; 6/2/2009 Headache, too warm, flushing and n 6/2/2009 Day after HPV she was weak, T.100 6/2/2009 Left deltoid muscle and tender pain 5/26/2009 Leg swollen, shortness of breath. M 5/20/2009 Swelling, redness, and soreness lef 6/2/2009 Approximately 3 weeks post ZOSTA 5/22/2009 Red, swollen, cellulitis (TYLENOL). 5/29/2009 Erythema and edema, warm to touc 5/22/2009 Fever started 1 day after receiving v 6/1/2009 At site check, Day 7, c/o some naus 5/17/2009 c/o "sick stomach", shaky, jittery, ch 5/28/2009 Red raised bump at the injection sit
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6/2/2009 CA 6/2/2009 CA 6/2/2009 WI 6/2/2009 CA 6/2/2009 NC 6/2/2009 CA 6/2/2009 VA 6/2/2009 TX 6/2/2009 OR 6/2/2009 IA 6/2/2009 NY 6/2/2009 MA 6/2/2009 VA 6/2/2009 OH 6/2/2009 GA 6/2/2009 CO 6/2/2009 CA 6/3/2009 AR 6/3/2009 6/3/2009 6/3/2009 VA 6/3/2009 OH 6/3/2009 MI 6/3/2009 WA 6/3/2009 6/3/2009 6/3/2009 CA 6/3/2009 TX 6/3/2009 WI 6/3/2009 TN 6/3/2009 MI 6/3/2009 NY 6/3/2009 NY 6/3/2009 MO 6/3/2009 CT 6/3/2009 FL 6/3/2009 CA 6/3/2009 NJ 6/3/2009 CA 6/3/2009 OH 6/3/2009 6/3/2009 MA 6/3/2009 6/3/2009 CA 6/3/2009 MO 6/3/2009 GA 6/3/2009 OH 6/3/2009 CA 6/3/2009 PA 6/3/2009 MA 6/3/2009 WA
26 13 0.2 20 40
26 13 0 20 40
1 74 5 57 14 43 1.5 1.1 10 6 43
1 74 5 57 14 43 1 1 10 6 43
22 2 21 27 5 22 23 18 40 12 1.3 35 15 14 4 13 5 0.6 67 22 9 22 22 34 39 4 29 69 4 4 62 27 11
2 21 27 5 22 18 40 1 35 15 14 4 13 5 0 67 22 9 22 34 39 4 29 69 4 4 62 27 11
F F 0.2 F F M F 0M F M F F F 0.5 M 0.1 F M F F F F 0M F F M M F F F M 0.3 M F F F M M M 0.6 M M F F F F M F M F F F M M F M
5/11/2009 C/O HA radiating to her jaw, should 5/15/2009 Per Pt's mother at approx. 9 pm on 6/1/2009 Mom reports child vomited on Thurs c/o dizzy 5/19, 20 c/o pain lt side o 5/26/2009 A few days after 3 17-09 injections ( 5/27/2009 Patient with c/o rash on chest and b 6/1/2009 Received MMR shot on 1/16/09. Dia 5/25/2009 Patient returned to the pharmacy co 6/1/2009 Marked local swelling and erythema 6/2/2009 Shot given 5/28/09 patient noticed n 6/2/2009 Pt felt lightheaded & thinks she may 5/26/2009 Received Tdap to R Deltoid 5/22; d 5/27/2009 Woke up 5 AM on 5/27/09 T 102 Cr 6/2/2009 Err:508 5/27/2009 Patient given a TB vaccine while he 5/28/2009 On 5/14/09 - pt had swelling & redn 5/29/2009 Left upper arm became very red, wa 6/2/2009 Information has been received from 6/2/2009 Information has been received from 6/3/2009 Patient while at home developed 10 6/3/2009 PT PRESENTED WITH COMPLAIN 6/3/2009 Returned to clinic 5/29/09 with 1 da 6/3/2009 Within 7 hrs of receiving vaccines p 6/3/2009 Developed chest pain and was adm 3/27/2009 Patient admitted to hospital with par 5/29/2009 The date above is simply the most r 6/3/2009 R deltoid with erythema, mildly infla 6/3/2009 5/27/09 Immunizations administered 6/1/2009 Full body rash Tylenol given as nee 5/27/2009 Severe pain in left arm w/tingling se 6/2/2009 Nausea, vomiting, fatigue. 5/20/2009 I took my daughter to a physician sh 6/3/2009 Patient vaccinated on 5/28/09, went 6/3/2009 After leaving our office, the patient p 6/3/2009 7 days after receiving the MMR vac 6/3/2009 Mom called approx 1530 on 6/3/09 6/2/2009 1. discomfort in abdomen, like cram 5/26/2009 A LARGE RED BUMP FIRST SHOW 6/3/2009 Cellulitis of right arm where vaccine 6/3/2009 I felt intense headaches and fainted 5/24/2009 About 5 hours after receiving the thi 5/26/2009 Close to 9 months after being given 6/3/2009 On Tuesday arm (R) became painfu 6/3/2009 R deltoid edema erythema hyperem 6/3/2009 5/29/09 Approx. 10:45 AM - Pt faint 5/27/2009 Td given 5/21/09 LDT - RTC 5/27/0 6/3/2009 Itchy, erythematous, macular rash o 6/2/2009 Lt arm lateral 5 inches x 2 inches te 6/3/2009 Immediate red rash raised bumps (h 6/3/2009 Client called Health center on 6/3/09 6/3/2009 Pt had a swollen arm. was seen a E
348446 348447 348422 348448 348449 348450 348452 348453 348454 348456 348457 348459 348460 348461 348462 348463 348464 348465 348466 348467 348469 348470 348471 348472 348473 348474 348475 348477 348478 348479 348480 348481 348482 348483 348484 348485 348486 348487 348488 348489 348490 348491 348492 348493 348494 348495 348496 348497 348501 348505 348513
6/3/2009 CA 6/3/2009 IN 6/4/2009 VA 6/4/2009 MD 6/4/2009 MO 6/4/2009 IN 6/4/2009 PA 6/4/2009 6/4/2009 KY 6/4/2009 GA 6/4/2009 6/4/2009 VA 6/4/2009 PA 6/4/2009 WI 6/4/2009 NE 6/4/2009 PA 6/4/2009 GA 6/4/2009 WI 6/4/2009 WI 6/4/2009 NY 6/4/2009 AZ 6/4/2009 KS 6/4/2009 CA 6/4/2009 MA 6/4/2009 NY 6/4/2009 PA 6/4/2009 IN 6/4/2009 MO 6/4/2009 NY 6/4/2009 6/4/2009 GA 6/4/2009 PA 6/4/2009 NC 6/4/2009 MI 6/4/2009 NM 6/4/2009 CA 6/4/2009 OK 6/4/2009 CA 6/4/2009 CA 6/4/2009 VA 6/4/2009 PA 6/4/2009 KS 6/4/2009 AZ 6/4/2009 AZ 6/4/2009 AZ 6/4/2009 TX 6/4/2009 VA 6/4/2009 OR 6/4/2009 MO 6/4/2009 IA 6/4/2009 PA
54 15 18 1.2 14 13 1.6
54 15 18 1 14 13 1
49
49
7 2 38 4 1.3 13 64 5 18 10 11 11 58 38 4 13 65 60 31 1.1 11
7 2 38 4 1 13 64 5 18 10 11 11 58 38 4 13 65 60 31 1 11 2 1 63 13 1 14 12 1 26 13 4 11 78 1 1 49 22 2 57
1.4 63 13 1.1 14 12 1.6 26 13 4 11 78 1.1 1.6 49 22 2 57
M F M 0.2 M F F 0.6 M F M F M M 0.9 M F F 0.3 M F M F U F F F F F M F M F F 0.1 F M 0.6 M 0.4 F M F 0.1 F F F 0.6 F F M F F F 0.1 M 0.6 F M M 0.1 M F
6/2/2009 Patient given Pneumovax on 5-26-0 6/3/2009 4-30-09 VARICELLA vaccine given 6/1/2009 After receiving immunizations and w 6/4/2009 fever over 103 for 3 days, loss of ap 6/4/2009 w/in 3 minutes of receiving the 1st d 6/4/2009 FEVER OF 101.8, ACHY ALL OVER 6/2/2009 Within 15 minutes cheeks were red 6/3/2009 Information has been received from 6/3/2009 Information has been received from 6/3/2009 Initial information has been received 6/3/2009 Information has been received from 5/29/2009 Pt c/o redness, swelling and itchy @ 5/29/2009 Generalized nodular papular rash 5/5/2009 Redness. swelling, heat @injection 5/29/2009 Redness on the area of injection 5x 5/29/2009 Varicella vaccine break through. Dia 5/28/2009 Ascending motor paralysis 6/9/09 H 5/29/2009 None stated. 6/1/2009 Patient came to the clinic 6-1-09. S Sensation of chest tightness within 5/21/2009 Pt denied being preg. 12/31/08. Ha 6/4/2009 06/04/2009 MILD Other - Fatigue, S 6/3/2009 Received vaccine 5/27/2009 and se 6/4/2009 Large red mildly itching rash, 10 cm 6/4/2009 Periphral Neuropathy. 3-6mo after 6/4/2009 1 day following vaccination, child de 6/4/2009 RECIEVED TDAP, GARDISIL, MEN 6/4/2009 PATIENT HAD PNEUMOVAX ON R 6/4/2009 PATIENT STATED THAT SHE EXP 6/4/2009 Called Immunization clinic 6/04/09 a 6/4/2009 Pt started with rash and fever of 102 6/4/2009 Pt received vaccines on 6/2/09. On 6/4/2009 rash, redness, swelling at site, starte 6/4/2009 facial swelling morning after vaccine 6/4/2009 Shingles symptoms appears one we 6/4/2009 Approx 5 min after receiving immz, 6/4/2009 After well-baby check-up and vaccin 6/4/2009 Was standing in line 5-10 minutes a 6/3/2009 Given 3rd GARDASIL on 5/27/2009 6/8/2009 10 days after receiving MMR, patien 6/4/2009 Hives all over body. 6/4/2009 Felt bad last PM (about 5-6 hours a 6/4/2009 Very itchy rash on chest, abdomen, 6/4/2009 Pt experienced (L) arm pn @ injecti 6/4/2009 Rash developed one month after th 6/4/2009 Rash - Red, papular to trunk & limbs 6/4/2009 Projectile vomiting approximately 86/4/2009 Pt received immunization 9:05 AM, 5/28/2009 Employee had c/o nausea with eme 6/1/2009 2 doses PEDIARIX given simultane 6/4/2009 This case was reported by a healthc
348514 348515 348516 348517 348519 348520 348521 348522 348523 348524 348525 348526 348527 348528 348529 348530 348531 348532 348533 348534 348535 348536 348537 348538 348539 348540 348541 348542 348543 348544 348545 348546 348547 348548 348549 348550 348551 348552 348553 348554 348555 348556 348557 348558 348559 348563 348565 348567 348569 348570 348573
6/4/2009 TX 6/4/2009 GA 6/4/2009 GA 6/4/2009 ND 6/5/2009 6/5/2009 6/5/2009 CA 6/5/2009 CA 6/5/2009 CA 6/5/2009 6/5/2009 NV 6/5/2009 TX 6/5/2009 TX 6/5/2009 CA 6/5/2009 CA 6/5/2009 DE 6/5/2009 IL 6/5/2009 CA 6/5/2009 IN 6/5/2009 6/5/2009 TX 6/5/2009 MN 6/5/2009 MN 6/5/2009 MN 6/5/2009 6/5/2009 WV 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 TN 6/5/2009 CT 6/5/2009 6/5/2009 NC 6/5/2009 NY 6/5/2009 LA 6/5/2009 NJ 6/5/2009 AZ 6/5/2009 PA 6/5/2009 LA 6/5/2009 WI 6/5/2009 PA 6/5/2009 NM 6/5/2009 NM 6/5/2009 NJ 6/5/2009 PA 6/5/2009 6/5/2009 VA 6/5/2009 6/5/2009 OR 6/5/2009 NV
46 8 4 5 5 61 0.2 4 2 0.5 4
46 8 4 5
4 5
4 5
4
4
4 1.6 5 5
1 5
0 4
4
0.3
0.4 68
0 68
12 4 11 43 16 7 11 5 0.2 51 61 18
12 4 11 43 16 7 11 5 0 51 61 18
15 23 5
23 5
F F M M M F 0.2 F M U U M U U M M U U U M U U 0.6 F F M U M U U U U 0.4 F M M F F F M F M F M 0.2 M F F F F M M F M F
6/4/2009 This case was reported by a physici 5/1/2009 3 X 3 cm induration (R) arm 6/4/2009 Baby given VYANESE doses after v 6/3/2009 Pt received shot Fri - Pt brought in M 5/1/2009 This case was reported by the moth 5/1/2009 This case was reported by an other 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by the moth 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a pharma 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/16/2009 3hrs after vaccine administered, mo 5/29/2009 68yo M h/o BPH, intra-cranial hemo 6/3/2009 Born without legs. 6/3/2009 Temp. 100.5 degrees F, achy joints 6/2/2009 Received KINREX + MMR on R del 6/2/2009 Approx 5 minutes after injection Pt b 6/1/2009 100 - 102 degree F fever, body ach 5/29/2009 Pt was injected with 2nd GARDASIL 5/29/2009 Rash- 20-30 papules on trunk and g 5/29/2009 9 cm X 5cm red whelp to (R) deltoid 6/1/2009 Mom stated pt came home form Da 6/1/2009 About 6 hrs after receiving vaccines 5/29/2009 Swelling, redness, heat, bruising aft 5/21/2009 (L) arm SQ site redness, heat. Pt sa 6/1/2009 Urticaria on arms / legs about 1 hou 6/4/2009 Information has been received from 6/4/2009 It was reported in a news magazine 6/4/2009 Information has been received from 6/4/2009 Information has been received from 5/27/2009 5/24/09 experienced swelling in the 5/28/2009 5cm erythema and induration at arm
348575 348576 348577 348578 348579 348580 348581 348582 348583 348584 348585 348586 348587 348588 348589 348590 348591 348592 348593 348594 348595 348596 348597 348598 348599 348600 348601 348602 348603 348604 348605 348606 348607 348608 348609 348610 348611 348612 348613 348614 348615 348616 348617 348618 348619 348620 348621 348622 348623 348624 348625
6/5/2009 SD 6/5/2009 IL 6/5/2009 VA 6/5/2009 NM 6/5/2009 IN 6/5/2009 TX 6/5/2009 NY 6/5/2009 MO 6/5/2009 CT 6/5/2009 NY 6/5/2009 IN 6/5/2009 WI 6/5/2009 WI 6/5/2009 WI 6/5/2009 CO 6/5/2009 CO 6/5/2009 CO 6/5/2009 CO 6/5/2009 RI 6/5/2009 CO 6/5/2009 CO 6/5/2009 NH 6/5/2009 6/5/2009 CA 6/5/2009 CA 6/5/2009 CA 6/5/2009 UT 6/5/2009 GA 6/5/2009 TX 6/5/2009 FL 6/5/2009 PA 6/5/2009 MA 6/5/2009 6/5/2009 TX 6/5/2009 TX 6/5/2009 NY 6/5/2009 ND 6/5/2009 VA 6/5/2009 CA 6/5/2009 KS 6/5/2009 PA 6/5/2009 WA 6/5/2009 AR 6/5/2009 NC 6/5/2009 OH 6/5/2009 NY 6/5/2009 CA 6/5/2009 TX 6/5/2009 NY 6/5/2009 CO 6/5/2009 TX
4 15 1.4 2 49 34 3 4 22 11 0.3
4 1 1 4 5 5 3 0.5
4 15 1 2 34 4 22 11 0
5 5 0
0.3
4 4 37 11 61 4 15 1.5 19 69 1.2 0.4 23 13 1.3 3 1.3 0.6 27 50 1.3 57 1 45 60
4 4 37 11 61 4 15 1 19 69 1 0 23 13 1 3 1 -1 27 50 1 67 1 45 60
F F 0.4 M 0.2 M M F M M M M 0.3 F U U U F F M M M F F 0.5 F F F U U F F M F M F F 0.5 M F F 0.2 M 0.4 F M F 0.3 M M 0.3 F 0.5 F F F 0.4 M F 0M F F
6/1/2009 Entire (R) thigh red/warm swollen w 5/13/2009 Patient given dose #2 of GARDASIL 6/3/2009 Swelling and erythema at Lt site of i 5/31/2009 (L) thigh with erythema and purpura 6/2/2009 None stated 5/19/2009 Left arm - substantial swelling of inje 6/2/2009 Erythema Multiforme rash started on 5/29/2009 Pain and swelling of R deltoid area. 6/5/2009 Within 5 min of receiving JE vaccina 6/4/2009 c/o itchiness on neck, arms, legs, ab 6/4/2009 Right knee swollen warm to touch. 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a physici 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a consum 5/1/2009 This case was reported by the gran 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 5/1/2009 This case was reported by a healthc 6/5/2009 redness and swelling in a 6x6 are to 6/5/2009 - Received shot Tues afternoon; min 6/5/2009 rash began 2 days following the inje 6/5/2009 A feeling of malaize approximately 1 6/5/2009 Mom reports child developed night t 6/5/2009 06052009@9:16am MOC t.c. c/o m 6/5/2009 Developed urticaria all over body 3 6/5/2009 Above client had 3 vaccines admini 6/5/2009 Erythema, Swelling, Tenderness, fe 6/5/2009 TC FROM MOTHER REQUESTING 6/5/2009 Child received rotateq on 4/3/09 and 6/5/2009 swelling in left arm wth mild erythem 6/5/2009 Patient's mother calls to report that 6/5/2009 He received Hib and DTP/DTap vac 6/5/2009 VARICELLA FROM VACCINE 6/5/2009 Mom reports child had 1st seizure 6 6/5/2009 2 WEEKS OF DIARRHEA (5 TIMES 6/5/2009 Around 4 days after Hepatitis B vac 6/5/2009 Dizziness, vomiting, headaches, pa 6/5/2009 child experienced generalized macu 6/5/2009 pt received vaccine on 6-2-09. on 6 6/5/2009 Child break out in hive after MMR a 6/5/2009 Intense pain in deltoid area, swelling 6/5/2009 6/3: Injection site became itchy with
348626 348627 348628 348629 348630 348631 348634 348635 348642 348643 348644 348645 348646 348647 348648 348649 348652 348655 348656 348657 348658 348660 348663 348664 348665 348666 348667 348668 348669 348670 348632 348633 348636 348641 348637 348638 348639 348640 348671 348672 348673 348674 348675 348676 348677 348678 348679 348681 348682 348683 348684
6/5/2009 CA 6/5/2009 OR 6/5/2009 TX 6/5/2009 AZ 6/5/2009 OR 6/5/2009 IA 6/5/2009 CA 6/5/2009 IN 6/5/2009 IN 6/5/2009 NY 6/5/2009 TX 6/5/2009 CO 6/5/2009 CO 6/5/2009 VA 6/5/2009 CA 6/5/2009 VA 6/5/2009 CA 6/5/2009 NC 6/5/2009 MA 6/5/2009 FL 6/5/2009 WA 6/5/2009 NJ 6/5/2009 6/5/2009 AZ 6/5/2009 DE 6/5/2009 NH 6/5/2009 CA 6/5/2009 CO 6/5/2009 CA 6/5/2009 NJ 6/6/2009 MD 6/6/2009 OH 6/6/2009 WA 6/6/2009 OH 6/7/2009 6/7/2009 CA 6/7/2009 DE 6/7/2009 IL 6/8/2009 CA 6/8/2009 PA 6/8/2009 FL 6/8/2009 MI 6/8/2009 MI 6/8/2009 OR 6/8/2009 AR 6/8/2009 PA 6/8/2009 MI 6/8/2009 CA 6/8/2009 GA 6/8/2009 CA 6/8/2009
11 69 78 0.2 63 1.7 66 4 5 11 4 65 53 45 1.3 81 22 11 12 1.6 5 24 24 0.6 16 21 4 67 57 3 18 34 22 0.2 38 1 1 4 32 69 10 57 1 11 1 14 1.5 15 17 16 17
11 99 78 0 63 1 66 4 5 11 4 65 53 1 22 11 12 1 5 24 24 0 16 21 4 67 57 3 18 34 22 0 38 1 1 4 32 69 10 57 1 11 1 14 1 15 17 16 17
M M F 0.2 F M 0.6 F F F F F M M M F 0.3 U M F M F 0.6 F F M M 0.6 M F F M F F M F M M 0.2 F M 0M 0M M M F M F 0F F 0M F 0.5 F F F F F
6/5/2009 GAVE 2ND TdAP 6/5/2009 During the evening on the day of inj 6/5/2009 Pt. described itching during the nigh 6/5/2009 MOTHER NOTICED ON 06/04/2009 6/5/2009 The injection site was found to be s 6/5/2009 Pt comes for evaluation of red swoll 6/3/2009 An hour later of administration of the 6/5/2009 Skin swelling, erythema (10 x 10 cm 6/6/2009 4.0cm x 6.5 cm erythema around in 6/5/2009 Severe swelling, tenderness, redne 6/4/2009 Lower 2/3 of left arm with edema an 6/5/2009 Localized reaction. Sore and swellin 6/5/2009 Patient had severe localized reactio 6/5/2009 This case was reported by a healthc 2/5/2009 Child presented to clinic 6-4-09 w. c 6/5/2009 This case was reported by a consum 6/5/2009 Shortness of breath and dizziness 6/5/2009 Pt was admitted to clinic with warm 6/5/2009 1 inch diameter induration with 2 in 6/5/2009 Pt started 2 days after vaccine T. 10 6/4/2009 Redness, pain, swelling left arm ons 6/1/2009 5/23/09 - chest & back rash red, bum 6/3/2009 Red, irritated skin under bandage a 6/5/2009 Pt developed intussusception requir 6/5/2009 Low grade fever, overall "joint achin 6/5/2009 Acute muscle spasms to arm x 24hr 6/5/2009 Right deltoid with erythema and swe 6/5/2009 Swelling, excessive of arm, shoulde Redness and swelling after 6 hours Acute onset of wheezing approx 10 6/6/2009 Patient had received the Typhoid va 6/6/2009 Received Tetanus booster and Hep 6/6/2009 PT CAME IN TO RECIEVE ANTHR 6/6/2009 Pedal pecechiae & edema - transien 6/7/2009 Soreness in all muscle groups, Fatig 6/7/2009 Child went from a typically developin 6/7/2009 Broke out in hives (10/19/07). Deve 6/7/2009 Left upper thigh was red, warm, swo 6/8/2009 Two weeks after the vaccination, I'm 6/2/2009 It looked like a huge hive 2 x 3 1/2 i 5/29/2009 Reddness, swelling and warmth to s 5/12/2009 After each rabies vaccine, had prog 5/7/2009 Patient's mom, states she tried to fe 5/27/2009 Has hard, red swollen area at one in 5/28/2009 Received immunizations @ 9AM - b 6/4/2009 Immediately following administration 3/16/2009 Vaccines 2/20/09 ----> mom reports 5/14/2009 Pt had small area of urticaria @ flex 6/5/2009 Information has been received from 5/14/2009 Pt developed severe urticaria over e 6/5/2009 Information has been received from
348687 348688 348689 348690 348691 348700 348701 348702 348703 348704 348705 348706 348707 348708 348709 348710 348712 348713 348714 348715 348716 348717 348718 348719 348720 348721 348722 348724 348725 348723 348726 348729 348730 348734 348736 348737 348738 348739 348740 348741 348742 348743 348744 348745 348747 348749 348750 348751 348752 348756 348758
6/8/2009 HI 6/8/2009 6/8/2009 6/8/2009 MD 6/8/2009 NC 6/8/2009 MA 6/8/2009 IA 6/8/2009 IL 6/8/2009 AL 6/8/2009 FL 6/8/2009 TX 6/8/2009 WA 6/8/2009 CA 6/8/2009 MN 6/8/2009 CA 6/8/2009 FL 6/8/2009 NY 6/8/2009 NY 6/8/2009 CO 6/8/2009 IN 6/8/2009 KS 6/8/2009 LA 6/8/2009 WA 6/8/2009 CA 6/8/2009 OR 6/8/2009 MN 6/8/2009 GA 6/8/2009 FL 6/8/2009 NJ 6/9/2009 CA 6/9/2009 6/9/2009 MI 6/9/2009 6/9/2009 GA 6/9/2009 TX 6/9/2009 MI 6/9/2009 OH 6/9/2009 NC 6/9/2009 PA 6/9/2009 IA 6/9/2009 CT 6/9/2009 VA 6/9/2009 MI 6/9/2009 OR 6/9/2009 DE 6/9/2009 IN 6/9/2009 AR 6/9/2009 OR 6/9/2009 ME 6/9/2009 CA 6/9/2009 NE
3 16 12 1 1 18 9 1.4 36 29 20 55 30 27 12 12 43 18 72 14 4 56 64 1 48 52 4 31 35 24 13 55 1.1 26 17 53 7 36 4 5 4 0.2 53 0.3 0.3 27 5 69
3
12 1 1 18 9 1 35 29 20 55 30 27 12 12 43 18 72 14 4 56 64 1 48 52 4 31 35 13 55 1 26 17 53 7 36 4 5 4 0 66 53 0 0 27 5 69
M F M F 0F 0M F M 0.2 F M F M M M M F F F F F M F F M 0F F F F F F F F M F 0.1 M F F F F F F F M 0.2 M F F 0.3 F 0.3 M U M F
5/29/2009 Redness and induration at injection 6/5/2009 Information has been received from 6/5/2009 Information has been received from 6/5/2009 Information has been received from 6/4/2009 Morbilliform rash 24-36 degrees afte 6/8/2009 5/7/09 VARIVAX + PCV given. 5/15 6/8/2009 Reddened, raised, tender, warm to 6/8/2009 6/5/09 - Mom brought child in, Dr sa 6/8/2009 Parent stated 18 hrs after vaccine c 6/8/2009 Nausea, diarrhea, vomiting, fatique, 6/8/2009 Diarrhea and itching palms on even 6/8/2009 3 weeks following vaccination with A 6/8/2009 Pneumococcal vaccine given at 090 6/8/2009 Headache and diplopia accompany 6/8/2009 Tonic Seizure lasted 1 min about 2 6/8/2009 I ASSESSED A 12 YEAR OLD FEM 6/8/2009 fever, nasal congestion, lost voice, b 6/8/2009 Within 12 hours: Significant swelling 6/8/2009 Varicella administered on Tuesday,6 6/8/2009 On 6/2/09 / 6 days post vaccine not 6/8/2009 Patient woke up with a very sore arm 6/8/2009 Immediately after having vaccines, p 6/8/2009 Patient received injection on 5/26/09 6/8/2009 Onset of head ache, nausea, bloatin 6/8/2009 PARENT RECORD OF FEVER x48 6/8/2009 breast on side of injection swelled s 6/8/2009 Pt's states her arm was very swollen 6/8/2009 Developed a large local reaction at 6/8/2009 Fever x 24 hours, body ache and so 6/9/2009 Tetanus shot was given on Friday, J 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/8/2009 Information has been received from 6/2/2009 Fever 104.7, Myoclonic movements 6/4/2009 GARDASIL vaccine - neuritis (LUE 6/3/2009 Joint pain in arms & shoulders. Eva 6/4/2009 Dtap given in LDMIM. 30 minutes af 6/3/2009 Redness and induration at site injec 6/4/2009 Patient reports pain at site, fever, so 6/4/2009 Total body urticaria, agitation about 6/4/2009 Induration and warmth to left thigh a 4/20/2009 (R) Leg reaction to KINRIX DTAP-P 6/5/2009 Patient received PENTACEL vaccin 6/4/2009 Pt states 6/3/09 she noticed onset o 5/1/2009 Sore arm and low grade temperatur 6/3/2009 103 degree temperature and letharg 6/5/2009 Pt. was given PENTACIL at 9:00 am Pain with arm swollen below injectio 6/3/2009 ER Report states: Left upper extrem 6/3/2009 Large red rash at injection site. Ras
348759 348760 348761 348762 348763 348764 348765 348766 348767 348768 348769 348770 348771 348772 348773 348774 348775 348776 348777 348778 348779 348780 348781 348782 348783 348784 348785 348786 348787 348788 348789 348790 348791 348792 348793 348794 348796 348797 348798 348799 348800 348801 348802 348803 348804 348805 348806 348807 348810 348811 348812
6/9/2009 AZ 6/9/2009 NY 6/9/2009 CA 6/9/2009 CA 6/9/2009 VA 6/9/2009 OH 6/9/2009 IL 6/9/2009 VA 6/9/2009 FL 6/9/2009 IA 6/9/2009 WA 6/9/2009 CA 6/9/2009 KS 6/9/2009 MA 6/9/2009 MA 6/9/2009 IA 6/9/2009 LA 6/9/2009 FL 6/9/2009 AR 6/9/2009 TX 6/9/2009 PA 6/9/2009 PA 6/9/2009 WA 6/9/2009 WA 6/9/2009 NC 6/9/2009 NY 6/9/2009 AZ 6/9/2009 PA 6/9/2009 NJ 6/9/2009 DE 6/9/2009 IN 6/9/2009 IA 6/9/2009 TX 6/9/2009 AZ 6/9/2009 GA 6/9/2009 CT 6/9/2009 TN 6/9/2009 CA 6/9/2009 CO 6/9/2009 CT 6/9/2009 PA 6/9/2009 FL 6/9/2009 MN 6/9/2009 TX 6/9/2009 OH 6/9/2009 WA 6/9/2009 IA 6/9/2009 TX 6/9/2009 CA 6/9/2009 OR 6/9/2009 AZ
0.3 4 0.3 0.3 22 14 4 0.2 4 0.5 0.6 4 33 13 0.5 1.2 18 1.2 4 8 1.4 6 1 37 28 72 22 4 20 22 4 16 36 49 1 64 4 85 24 4 0.2 20 20 11 1.2 1.3 18 17 65 76 51
0 4 0 0 22 14 4 0 4 0 0 4 33 13 0 1 18 1 4 8 1 6 37 28 72 22 4 20 22 4 16 36 49 1 64 4 85 4 0 20 20 11 1 1 18 17 65 76
0.3 F M 0.3 U 0.3 U F F F 0.2 M F 0.5 M 0.6 F F F F 0.5 F 0.2 M F 0.2 M M M 0.4 M F F F M F F M F F F F F F 0F F F F F F 0.2 F F F F 0.2 M 0.3 M M F F F F
6/2/2009 Persistent inconsolable crying. DTa 6/5/2009 Hives, eye swelling approximately 1 Persistent diarrhea 12-15 x 1 day. L Persistent diarrhea 12-15 x 1 day la 6/3/2009 Per patient legs broke out in hives e 2/26/2009 Weakness, fatigue, rapid HR, abd p 6/4/2009 Child's mother states that pt was a l 6/3/2009 High pitch cry for 4 hrs - hard to con 6/3/2009 Left upper thigh, redness, some pai 6/2/2009 Mom noticed hives on torso, no feve 6/1/2009 Pt given vaccines and approximatel 6/1/2009 Gave school IZ's 5/26/09, when chil 5/29/2009 7 x 10 cm Erythema 6/2/2009 Pt fainted 5 min after 3rd GARDASI 6/3/2009 Temp 101-102 rash on 6-3-09 seen 6/2/2009 Red, raised rash. Started on 5/30/09 2X5 cm whelps, cellulitis treated wit 5/28/2009 Rash head to toe entire body on 5/2 5/22/2009 Right upper arm red, swollen, and w 6/4/2009 Pt got fever, T: 99 - 101 degree F fr 6/4/2009 "(+) Local reaction to INFANRIX vac 6/5/2009 Varicella vaccine break through. Dia 6/9/2009 Pt was given HIB that was expired. 4/27/2009 Swelling redness pain at injection si 6/4/2009 None Stated 6/3/2009 Pt received ENGERIX B vaccine IM 5/30/2009 Arm pain, redness, and swelling ext 6/8/2009 Client inadvertently received ZOSTA 6/8/2009 Passed out after received shot with 6/9/2009 Patient received #2 GARDASIL on 5 6/8/2009 10 cm erythematous indurated lesio 6/8/2009 Pt. stated stomach felt queasy; sat d 6/5/2009 None stated. 6/8/2009 Employee given 5th HEP B today w 5/19/2009 The above named patient was seen 5/29/2009 Sterile abcess @ site of injection. N 6/9/2009 Mom states high temp starting 1 ho 6/9/2009 85 y/o F NKA, PMH: Dementia, Hyp 6/9/2009 Patient did not know she was pregn 6/9/2009 Developed meningitic like illness wh 6/9/2009 3-5 minutes after receiving Pediarix 6/9/2009 Beginning with 2nd gardasil vaccina 6/9/2009 The client's sister also received an i 6/9/2009 Syncope <5 min. after admin of vac 6/9/2009 ANTHONY DEVELOPED HIGH FEV 6/9/2009 2 episodes of L facial drooping sinc 6/9/2009 None 6/9/2009 Gardasil #1 (1423X) given in right a 6/9/2009 Pt c/o redness, swelling of about 3 i 6/9/2009 Drunk stare, drooling, swelling of inj 6/4/2009 Severe rash on arms and hives + jo
348813 348814 348815 348816 348817 348818 348819 348820 348821 348823 348824 348826 348827 348828 348829 348834 348836 348839 348841 348846 348847 348848 348849 348850 348851 348852 348853 348854 348855 348856 348857 348858 348859 348860 348861 348862 348863 348864 348865 348866 348867 348869 348870 348871 348872 348873 348874 348875 348876 348877 348878
6/9/2009 WI 6/9/2009 AZ 6/9/2009 NC 6/9/2009 WA 6/9/2009 NC 6/9/2009 MA 6/9/2009 NV 6/9/2009 TX 6/9/2009 TX 6/9/2009 OH 6/10/2009 MO 6/10/2009 IN 6/10/2009 MA 6/10/2009 NC 6/10/2009 OH 6/10/2009 GA 6/10/2009 6/10/2009 CA 6/10/2009 PA 6/10/2009 CA 6/10/2009 MD 6/10/2009 OH 6/10/2009 MI 6/10/2009 WA 6/10/2009 CO 6/10/2009 DE 6/10/2009 MI 6/10/2009 VA 6/10/2009 VA 6/10/2009 MD 6/10/2009 VA 6/10/2009 IL 6/10/2009 IL 6/10/2009 GA 6/10/2009 MN 6/10/2009 WI 6/10/2009 GA 6/10/2009 WA 6/10/2009 AZ 6/10/2009 NY 6/10/2009 IL 6/10/2009 IL 6/10/2009 TX 6/10/2009 OH 6/10/2009 ND 6/10/2009 CA 6/10/2009 WI 6/10/2009 CA 6/10/2009 CA 6/10/2009 WA 6/10/2009 MI
18 0.2 4 7 68 15 5 22 12 1 15 24 56 0.4 11 46
18 0 4 7 68 15 5 22 12 1 15 24 56 0 11 46
58 47 4 44 1 65 60 52 25 64 11 4 29 0.2 18 32 24 11 1.6 4 830 4 1.6 1.3 1.6 17 0.3 59 11 1 2 4 11 4
58 47 4 44 1 65 60 52 25 64 11 4 29 0 18 32 24 11 1 4 83 4 1 1 1 17 0 59 11 0 2 4 11 4
F 0.2 F M M F F F M F 0M F F F 0.4 M M F U M F F M 0F F F F F F F F F 0.2 M F M F M 0.6 F F F M 0.6 M 0.4 F 0.6 F F 0.3 M F F 1F 0.5 M M F M
Within 24 hours of vaccine c/o sore 6/9/2009 Fever even with TYLENOL, fussines 6/9/2009 Fever 104 degrees about 12 hours 6/8/2009 Arm swollen 2X NL size, Red, hot v 6/4/2009 Fever 102 - large hives at site of inje 6/9/2009 1 day after the immunization, child d 6/8/2009 Erythematous swelling, right deltoid 5/7/2009 A 22 year old male patient received 5/27/2009 This non serious case was received 6/9/2009 Rash started on (L) ear - Spread do 6/5/2009 Patient had syncope episode imme 5/1/2009 None stated 6/3/2009 Within 4 hours, fever (up to 101 deg 6/3/2009 Petechiae and small purpuric areas 6/4/2009 Started 24-36 hours after vaccine (R 6/9/2009 Information has been received from 6/9/2009 Information has been received from 6/8/2009 Initial report received on 29 May 20 6/8/2009 Initial report received on 05 June 20 6/9/2009 Received MMR II and HAVRIX vacc 6/10/2009 Patient received DT on 6/1/09. Star 6/9/2009 Vaccines given 5/26/2009. Left leg 6/9/2009 "Tennis ball" sized area around inje 6/9/2009 Noticed low fever, broke out in tiny h 6/8/2009 Headache within 2 hours. Had fastin 6/10/2009 Patient had severe vaso response a 6/10/2009 Right upper extremity cellulitis. Swo 6/10/2009 Patient received Tdap vaccine durin 6/10/2009 Swelling to right thigh 5 cm around 6/10/2009 Pt received Hep B #2 dose on 06/08 6/10/2009 vomiting and diarrhea, dehydration. 6/10/2009 Parent called clinic approximately 2 6/10/2009 Client received Y Twinrix vaccination o 6/10/2009 Client was given an adolescent dos 6/10/2009 Patient's mother reported patient ha 6/10/2009 This child was given shots 05/06/09 6/10/2009 10 to 12 red papules. Red base with 6/11/2009 VACCINE GIVEN ON THURSDAY, 6/10/2009 EDEMA, ERYTHEMA 1"X 2" TO RI 6/10/2009 Anaphylaxis (w/in 30 min, irritability, 6/10/2009 After child received DTaP and Prevn 6/5/2009 Vaccines given 5/20/09. Vomited st 6/10/2009 Rash beginning on bilateral arms. O 6/10/2009 Bloody stools 24 hours after admini 6/9/2009 Pt had flu vaccine on 1-23-09. Since 5/20/2009 Diagnose Juvenile Rheumatoid Arth 6/3/2009 7 days following inj - inj site slowly t 6/10/2009 Approx. 30 minutes after receiving v 6/10/2009 Inflammation, redness and tenderne 6/10/2009 About 5 mins after rec'vg all imm. ap 6/10/2009 Redness started (L) thigh increased
348879 348880 348882 348883 348885 348898 348899 348900 348902 348903 348904 348905 348906 348907 348908 348915 348918 348919 348920 348926 348927 348928 348929 348930 348931 348932 348933 348934 348935 348936 348937 348938 348939 348940 348942 348943 348944 348945 348946 348947 348948 348958 348959 348960 348961 348962 348963 348964 348965 348966 348967
6/10/2009 6/10/2009 CA 6/10/2009 IN 6/10/2009 CA 6/10/2009 KY 6/10/2009 6/10/2009 VA 6/10/2009 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/10/2009 NC 6/11/2009 6/11/2009 AR 6/11/2009 NJ 6/11/2009 TX 6/11/2009 IL 6/11/2009 FL 6/11/2009 NY 6/11/2009 TN 6/11/2009 MI 6/11/2009 NC 6/11/2009 GA 6/11/2009 MS 6/11/2009 PA 6/11/2009 OR 6/11/2009 MA 6/11/2009 MO 6/11/2009 PR 6/11/2009 6/11/2009 TN 6/11/2009 IN 6/11/2009 IN 6/11/2009 6/11/2009 IL 6/11/2009 CA 6/11/2009 MT 6/11/2009 MA 6/11/2009 IL 6/11/2009 6/11/2009 MN 6/11/2009 MN 6/11/2009 6/11/2009 GA 6/11/2009 MO 6/11/2009 KY 6/11/2009 FL 6/11/2009 PR 6/11/2009 MD 6/11/2009 CA
0.8 8 5 60 40 30 22 35 36 33 37 1.9 25 18 1.3 23 26 16 65 14 51 12 41 4 17 77 39 5 32 51 2 12 52 54 5 60 4 0.3 66 26 72 82 39 28 10 1 15 17 1.3 11
0 8 5 60 30 30 22 35 36 33 37 1 25 18 1 26 16 65 14 51 12 41 4 17 77 5 32 2 12 52 54 5 60 4 0 66 26 72 82 39 28 10 1 15 17 1
U 0.8 M F F F M M F F F F F 0.9 F F F 0.3 M F F F M M M F M F M F M F F F 0.6 M M F F F F M 0.3 F F M F F M F F 0F F F 0.2 F M
No data given. 6/2/2009 Gave PEDIARIX but didn't need a d 6/10/2009 Redness -"Kiwi size"- approx. 3-4 in 6/10/2009 Seen in clinic 1 week after vaccine 6 6/10/2009 Arm sore next day with increased re 7/15/2005 Description: 11/10/98. Received ant 6/23/2005 Multiple medical conditions diagnos 6/16/2005 Symptom: Dermatitis, focal Start: 0 11/9/2006 Patient received FLUMIST and ADA 11/7/2006 Patient received Tdap into the left s 11/3/2006 Symptom: Fever start: 10/31/2006 11/6/2006 Description: 37 y/o female develope ### 22 month old female received DTaP 6/11/2009 NOTE: Reported Y Adverse Event is d 6/10/2009 None stated 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/10/2009 Information has been received from 6/11/2009 rash, uticaria 5/15/2009 Pt recd ADACEL and MENACTRA 0 ### Fever 103 degree and rigor 12 hour 6/4/2009 Generalized Urticaria Patient treated 6/5/2009 The shot was given to me months a Red, warm to touch 2x2 circumferen 6/5/2009 Varicella vaccine breakthrough. Dia At 3d after vaccine. Severe local rea 6/5/2009 Pt called on 6/5/09 c/o pain in (L) ar 6/8/2009 Right upper arm area of induration a 6/8/2009 See attached side effects which hav 6/9/2009 Patient received PNEUMOVAX 23 v 5/20/2009 Pt came in the clinic on 5/20. Mom s 5/29/2009 Local reaction with marked erythem 6/11/2009 Had rash on neck after 1st shot (4-5 6/11/2009 About 2min after injection (s/s) Pt go 6/11/2009 Redness, swelling from shoulder to 6/10/2009 Right arm red, swollen, bruised, war 6/11/2009 Patient given ADACEL instead of D 6/11/2009 Forceful vomiting 24 degrees after v 6/11/2009 Swollen, itchy, warm, sore, rash 6" l 6/11/2009 This case was reported via medical 6/11/2009 Pt received Tdap vaccine in the ED 6/11/2009 From physician note: "her right arm 6/11/2009 3day fever to 101F responded to NS 6/11/2009 client received vaccines MMR, and 6/11/2009 C/O pain, erythema, swelling 3-4" in 6/11/2009 Diffuse drug reaction of head chest 6/11/2009 Immediately after vaccine was given 6/11/2009 HEADACHE, DIZZINESS, PROBLE 6/11/2009 maculopapular, red in color, blanchi 6/11/2009 rash on trunk and forearms present
348968 348969 348970 348971 348972 348973 348974 348975 348976 348978 348979 348980 348981 348982 348983 348984 348985 348986 348987 348988 348977 348989 348990 348991 348992 348993 348994 348995 348996 348997 348998 348999 349000 349001 349002 349003 349004 349005 349007 349010 349011 349012 349013 349014 349015 349016 349017 349018 349019 349020 349022
6/11/2009 CA 6/11/2009 MI 6/11/2009 TX 6/11/2009 FL 6/11/2009 NC 6/11/2009 TX 6/11/2009 CA 6/11/2009 SD 6/11/2009 AR 6/11/2009 CA 6/11/2009 CA 6/11/2009 KY 6/11/2009 KY 6/11/2009 WI 6/11/2009 CA 6/11/2009 AZ 6/11/2009 AZ 6/11/2009 WA 6/11/2009 AZ 6/11/2009 CO 6/12/2009 WA 6/12/2009 MI 6/12/2009 CA 6/12/2009 VA 6/12/2009 MO 6/12/2009 VA 6/12/2009 TX 6/12/2009 CA 6/12/2009 SC 6/12/2009 NC 6/12/2009 MD 6/12/2009 NE 6/12/2009 CT 6/12/2009 OR 6/12/2009 WI 6/12/2009 MI 6/12/2009 OH 6/12/2009 OH 6/12/2009 IA 6/12/2009 FL 6/12/2009 GA 6/12/2009 OH 6/12/2009 PA 6/12/2009 KY 6/12/2009 TX 6/12/2009 KY 6/12/2009 TX 6/12/2009 PA 6/12/2009 PA 6/12/2009 CT 6/12/2009 WI
42 1.3 1.8 7 28 26 14 17 16 47 1 11 4 11 1 4 5 5 65 15 57 0 19 9 8 5 1 78 2 5 1 66 63 0.2 16 15 17 16 69 1.9 2 17 65 0.5 13 18 25 11 5 67 18
42 1 1 7 28 26 14 17 16 42 1 11 4 11 1 4 5 5 65 57 0 19 9 8 5 1 78 2 5 1 66 63 0 16 15 17 69 1 2 17 65 0 13 18 25 11 5 67 18
M 0.3 M 0.8 F M F M F M F U 0F F F M 0F M M F M M M 0F F M M F 0M F 0.2 F F 0F F F 0.2 F F F F F F 0.9 F 0.4 M F F 0.5 M F M F M F F F
6/11/2009 Rash to trunk and back with some it 6/11/2009 2-3 minute long seizure associated 6/11/2009 Rash: onset 6/7/09, duration of 3 da 6/11/2009 patient experienced yesterday (6/10 6/11/2009 55 X 60 mm area of induration, war 6/11/2009 redness, induration, pain, itching, w 6/11/2009 April 2009: Pt. had conjunctivitis in b 6/11/2009 Second dose of Hepatitis A given by 6/11/2009 Approx 90 seconds after the first inj Not recently, but want to report now 6/11/2009 Varicella Molluscum after previous d 6/11/2009 Woke up from a nap around 5pm on 6/11/2009 Pt presents with red, raised area on 6/11/2009 Fainted after Tdap, Menactra , Varic 6/11/2009 Urticarial rash within 6 H of adminis 6/11/2009 Localize reaction. Injection site, swe 6/11/2009 (L) arm 2x2 cm red, cellulitic area w 6/11/2009 Shingles - dx 5/5/09. 6/11/2009 Red arm syndrome, headache + fev 6/11/2009 Broke out with blisters on mouth. 6/11/2009 Thickness of the eyelids, dizziness, 6/8/2009 Febrile (101) 24 hours after immuniz Bilateral finger rash, erythematous n 6/9/2009 1 1/2" diameter redness no induratio 6/9/2009 6/9/09 Mother of the client reported 6/9/2009 Marked by swollen upper left arm sh 6/8/2009 Child broke out in hives within 24 hr 6/6/2009 Patient developed rash about 1 1/2" 6/5/2009 Shortly after vaccine administration, 6/8/2009 Pt developed redness, swelling & in 6/10/2009 Received MMR, varicella, PREVNA 6/10/2009 Developed spots located on her sca Difuse varicellaform rash on chest, b 6/5/2009 very fussy 6/8/2009 After administration of GARDASIL p 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/11/2009 Information has been received from 6/12/2009 Patient had vaccines 6/10/09. Had H 6/11/2009 Swelling and warmth at the site of in 6/11/2009 Sore at injection site. Low grade fev 6/11/2009 Site reaction- Red, itchy, warm 2 1/2 6/12/2009 Stated after patient received shots c 6/12/2009 Pt given VAQTA and MENACTRA. 6/12/2009 Pt received vaccines approx. at 2:30 6/12/2009 acute postvaccinial lymphadenitis b 6/12/2009 on 5/23/09 developed headaches th 6/12/2009 6/10/2009 Patients Mother called of 6/12/2009 14:30 vaccine administered pt beca 6/12/2009 Client fainted for a few seconds. I h
349023 349024 349025 349026 349027 349028 349029 349030 349031 349032 349033 349045 349046 349047 349048 349049 349050 349051 349052 349053 349054 349055 349056 349057 349058 349059 349060 349061 349062 349063 349064 349065 349066 349034 349035 349036 349037 349067 349076 349080 349082 349083 349084 349085 349086 349087 349088 349090 349091 349092 349093
6/12/2009 GA 6/12/2009 FL 6/12/2009 VA 6/12/2009 NM 6/12/2009 OK 6/12/2009 MO 6/12/2009 GA 6/12/2009 CA 6/12/2009 OR 6/12/2009 CA 6/12/2009 OH 6/12/2009 6/12/2009 WA 6/12/2009 WA 6/12/2009 CA 6/12/2009 TX 6/12/2009 TX 6/12/2009 SC 6/12/2009 AR 6/12/2009 NE 6/12/2009 KY 6/12/2009 KY 6/12/2009 TX 6/12/2009 NC 6/12/2009 OH 6/12/2009 CA 6/12/2009 FL 6/12/2009 MN 6/12/2009 MO 6/12/2009 OR 6/12/2009 ID 6/12/2009 WI 6/12/2009 NE 6/13/2009 NY 6/13/2009 CT 6/14/2009 TX 6/14/2009 MI 6/15/2009 6/15/2009 PA 6/15/2009 ME 6/15/2009 TX 6/15/2009 RI 6/15/2009 MD 6/15/2009 CA 6/15/2009 DE 6/15/2009 NY 6/15/2009 6/15/2009 NY 6/15/2009 OH 6/15/2009 KY 6/15/2009 MI
58 24 23 36 1.6 27 43 28 17 5 8
58 24 23 36 1
68 1.1 4 1.3 12 15 2 0.2 29 36 10 4 66 1.1
68 1 4 1 12 15 2 0 29 36 10 4 66 1
25 1.2 28 11 1.5 0.6 0.2 1 34 50 64 66
25 1 28 11 1 0 0 1 34 50
18 86 18 29
18 86
0.8 15 6 19 0.4
43 28 17 5 8
66
29
6 19 0 15
F F F M 0.6 M M F M F F M M F 0.1 M M 0.3 F M M 0.8 M 0.2 M F F M F F 0.1 M U F 0.2 M F F 0.5 M 0.6 M 0.2 M 0F F M M F F F F F F F F F M F 0.4 F F
6/12/2009 Exactly 24 hours from the vaccinatio 6/12/2009 decreased sensation in left arm, left 6/12/2009 Approximately 24 hrs after vaccinati 6/10/2009 Pt was experiencing itchy palms and 6/12/2009 area surrounding vaccine site was r 6/12/2009 Patient is 28 year old male with com 6/12/2009 Day after immunizations began hav 6/12/2009 Individual developed a maculopapu 6/12/2009 Reports rash and swelling noted in 6/12/2009 Left Deltoid muscle red/swollen and 6/12/2009 CHILD RECEIVED VACCINE ON 0 6/12/2009 This case was reported via a statem 6/12/2009 Rash & pain at injection site (~ 3" in 6/12/2009 Pt came in with what looked like bug 6/12/2009 Redness with swelling to right arm. 6/12/2009 Large erythematous rxn to both legs 6/12/2009 Large, warm and tender indurated a 6/12/2009 After MENACTRA injection. Child ha 6/12/2009 Erythema confluent smooth area L d 6/1/2009 On 05/26/09 after receiving immuniz 6/12/2009 Patient complains of headache afte 6/12/2009 Donor states she has muscle cramp 6/12/2009 Red puffy reaction at site of VARIVA 6/12/2009 Patient presented to office with redn 6/12/2009 Pt received ZOSTAVAX vaccine on 6/12/2009 Instant swelling and redness at injec Swelling and redness at injection sit 6/11/2009 Right deltoid pain with radiating to n 6/9/2009 6/7/09 Head to toe rash. Blisters m 6/12/2009 Tightness, in chest, pale, warm, nau 6/11/2009 Evening of 5/27. arm pain On 5/28. 6/12/2009 Child was at daycare. He took a lon 6/1/2009 Had immunization on 5/26/09, had e 6/13/2009 Child developed Abnormal Seborrhe 6/13/2009 rash to MMR 10 days post vaccine 6/14/2009 About two days after my 2nd vaccin 6/14/2009 Pt received vaccine in the hospital. 6/12/2009 Report obtained Y from literature case 6/11/2009 Initial report was received 04 June 2 6/10/2009 Initial report received on 08 June 20 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/10/2009 Patient started sneezing approx. 20 6/14/2009 Achy joints (not just in shoulders wit 6/15/2009 THURSDAY, JUNE 4TH, RIGHT SI 6/15/2009 syncope and briefly passed out a fe
349094 349095 349096 349097 349098 349099 349100 349101 349102 349103 349104 349105 349106 349107 349108 349110 349111 349112 349113 349114 349115 349116 349120 349123 349125 349127 349128 349129 349130 349131 349132 349133 349134 349135 349136 349137 349138 349139 349140 349141 349142 349143 349144 349145 349146 349147 349148 349149 349150 349151 349152
6/15/2009 TX 6/15/2009 WI 6/15/2009 KS 6/15/2009 PA 6/15/2009 MI 6/15/2009 MI 6/15/2009 WA 6/15/2009 WA 6/15/2009 CO 6/15/2009 NC 6/15/2009 WA 6/15/2009 WA 6/15/2009 MN 6/15/2009 CO 6/15/2009 RI 6/15/2009 OK 6/15/2009 OK 6/15/2009 FL 6/15/2009 MA 6/15/2009 6/15/2009 CT 6/15/2009 AK 6/15/2009 IL 6/15/2009 CO 6/15/2009 IL 6/15/2009 MN 6/15/2009 VA 6/15/2009 CA 6/15/2009 PA 6/15/2009 NC 6/15/2009 CA 6/15/2009 OH 6/15/2009 NY 6/15/2009 KS 6/15/2009 MA 6/15/2009 OH 6/15/2009 MT 6/15/2009 TX 6/15/2009 FL 6/15/2009 NC 6/15/2009 OH 6/15/2009 NY 6/15/2009 OR 6/15/2009 NJ 6/15/2009 NH 6/15/2009 VA 6/15/2009 VA 6/15/2009 MD 6/15/2009 6/15/2009 CT 6/15/2009 MA
29 11 62 40 69 8 1.6 1.5 56 71 1.5 4 13 61 66 4 11 37 1 16 0.7 19 10.4 69 61 11 60 4 4 1.4 54 11 17 40 18 24 4 22 10
29 11 62 40 69 8 1 1 56 71 1 4 13 61 66 17 4 11 37 1 16 0 10 69 61 11 60 4 4 1 54 11 17 40 18 24 4 22 10
64 66 30 30 13 12 72
64 66 30 29 11 12 72
19
19
F F F F M M 0.6 M 0.6 M F F 0.5 F M F F F F F F F 0F F 0.7 M F M F M F F M M 0.4 M F F F F M F M F M U F M F F M M M U F F
6/15/2009 CLIENT RECEIVED ALL THE VACC 6/15/2009 Day of injection patient complained 6/15/2009 3010/29 Itching under armpits 10/30 6/15/2009 Following anthrax vaccination, mem 6/15/2009 Pt developed zoster rash within 24h 6/15/2009 Vaccination given at 9:20 a.m. Patie 6/15/2009 4 days after receiving DTaP #4 and 6/15/2009 Shots were given on 5/20/09. Shot s 6/15/2009 HAD yellow fever INJECTION ON 6 6/15/2009 Developed zoster pain 48 hours afte 6/15/2009 Redness/extreme swelling to injectio 6/15/2009 Pt received vaccinations on 6/9/09. 6/15/2009 Fainting spells started in January 20 6/15/2009 4x4 Swelling, redness, irritation at in 6/15/2009 Varicella-like rash developed 3 days 6/1/2009 Red swollen dots around injection s 6/15/2009 At injection site approximately equa 6/8/2009 Patient suddenly fell to the floor abo 6/9/2009 Severe bilateral lower extremity ede 6/10/2009 Developed erythema multiforme w/i 6/15/2009 This case was reported by a healthc 5/28/2009 Mom reports she noticed hives on b 6/10/2009 Pt. was seen on 6/9/09 for pap sme 6/11/2009 Pt fainted in waiting area. 6/10/2009 (No pain) 11/11/08 - 1st sore on out 6/9/2009 Patient has red rash, left side of fore 6/15/2009 5/27/09 S.T. Congestion; 6/2/09 Fev 6/15/2009 Swelling, pain, erythema in (whole u 6/9/2009 At bedtime on 6/5/09 mother noticed 6/15/2009 Rt facial nerve palsy "Bell's palsy" 6/9/2009 Given vaccines 6/3/09, started with 6/13/2009 On 5-29-09-4AM started vomiting/di 5/22/2009 Numbness in wrist, elbow and shou 6/14/2009 Pt developed body aches, myalgias 6/10/2009 Red, swelling R Deltoid 6/15/2009 Red raised rash on hands, chin 6/12 6/15/2009 Syncope in waiting room. Fell and h 6/15/2009 Lt thigh with large area of erythema 6/12/2009 R interior deltoid ~ 3 cm oval shape 6/15/2009 Varicella vaccine adm. on 6/10/09. M Patient received her vaccine on 4/2 6/9/2009 (1) Severe headache and swelling R 6/11/2009 Pt states he had swelling and pain a 6/9/2009 On 5/21/09 Pt saw Doctor reports re 6/15/2009 T to > 102 within 4 hours, cellulitis p (Hep A and MENACTRA) Tdap 8/40 5/13/2009 After HepA on 10/29/08 HA started 5/29/2009 Administered 5/22/09; on Sunday, 5 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
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6/15/2009 6/15/2009 CT 6/15/2009 6/15/2009 MO 6/15/2009 WV 6/15/2009 MA 6/15/2009 AZ 6/15/2009 6/15/2009 IL 6/15/2009 NC 6/15/2009 IL 6/15/2009 MN 6/15/2009 NC 6/15/2009 AK 6/15/2009 WA 6/15/2009 ME 6/15/2009 6/15/2009 6/15/2009 6/15/2009 MI 6/15/2009 6/15/2009 CA 6/15/2009 PA 6/15/2009 NC 6/15/2009 NY 6/15/2009 6/15/2009 NJ 6/15/2009 CA 6/15/2009 6/15/2009 OH 6/15/2009 CT 6/15/2009 OK 6/15/2009 AR 6/15/2009 6/15/2009 FL 6/15/2009 WA 6/15/2009 6/15/2009 NJ 6/15/2009 MI 6/15/2009 6/15/2009 6/15/2009 CT 6/15/2009 CO 6/15/2009 6/15/2009 SC 6/15/2009 NY 6/15/2009 IN 6/15/2009 6/15/2009 6/15/2009 6/15/2009 CO
18 21 17 19 21
18 21 16 19 20
21 11 10 16 14 2 43 16 17 20
21 11 10 16 14 1
17 15 16
17 15
15 15
15 15
19
19
16 17 20
12 21 17 25 25 14 16 23 23 15 23 27 20 21 25 14 16 16 15 21
21 17 25 14 16
27 21 25 16 16 15 21
U F F F F F F F F F F F F 1M F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received for th 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received throu 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 5/28/09: Client received MMR and V None stated 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Initial and follow up information has 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
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6/15/2009 CA 6/15/2009 CA 6/15/2009 6/15/2009 CA 6/15/2009 6/15/2009 CA 6/15/2009 6/15/2009 MI 6/15/2009 NY 6/15/2009 AR 6/15/2009 6/15/2009 IN 6/15/2009 GA 6/15/2009 MA 6/15/2009 CT 6/15/2009 NC 6/15/2009 6/15/2009 6/15/2009 6/15/2009 OK 6/15/2009 PA 6/15/2009 6/15/2009 PA 6/15/2009 IL 6/15/2009 NV 6/15/2009 CA 6/15/2009 6/15/2009 OR 6/15/2009 NY 6/15/2009 FL 6/15/2009 CT 6/15/2009 FL 6/15/2009 6/15/2009 CT 6/15/2009 6/15/2009 RI 6/15/2009 CA 6/15/2009 CA 6/15/2009 MN 6/15/2009 6/15/2009 OH 6/15/2009 GA 6/15/2009 6/15/2009 IN 6/15/2009 NY 6/15/2009 FL 6/15/2009 CT 6/15/2009 LA 6/15/2009 SC 6/15/2009 6/15/2009
33 17
17
21 21 26
21 26
17 24 14
17
25
25
15 18 24 25 14 16 19 15 11 20 16
14
18 24 14 16 19 15 11 19 16
15 23
23
12 34
12 34
17 16 25 11 14 23 15 24 16 25 14 15
17
23 15
25 11 14 15 24 25 15
14
F F U F F F U F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
6/12/2009 Information has been received form 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/21/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from
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6/15/2009 VA 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 6/15/2009 NY 6/15/2009 6/15/2009 6/16/2009 CA 6/16/2009 FL 6/16/2009 FL 6/16/2009 6/16/2009 NJ 6/16/2009 6/16/2009 6/16/2009 CO 6/16/2009 OR 6/16/2009 MA 6/16/2009 TX 6/16/2009 NY 6/16/2009 GA 6/16/2009 WV 6/16/2009 WV 6/16/2009 OR 6/16/2009 OR 6/16/2009 SC 6/16/2009 IN 6/16/2009 OH 6/16/2009 NC 6/16/2009 IN 6/16/2009 OH 6/16/2009 OK 6/16/2009 CT 6/16/2009 LA 6/16/2009 FL 6/16/2009 OR 6/16/2009 CA 6/16/2009 NY 6/16/2009 NE 6/16/2009 FL 6/16/2009 NC 6/16/2009 CA 6/16/2009 FL 6/16/2009 AZ 6/16/2009 IN 6/16/2009 NY 6/16/2009 TX
11
11
14 25
22 0.2 0.6 16 18 18 65 5 6 16 17 22 18 52 59 4 4 32 0.5 5 4 66 0.3 5 45 37 25 66 4 0.6 12 45 4 14 60 13 39 21 14
22 0
18 18 65 5 6 16 17 22 18 59 4 4 32 0 5 4 66 0 5 45 37 25 66 4 0 12 45 4 14 60 13 39 21 14
F F F F F F F U F F F F F 0.2 F F F F F M M M F F F F F F M F F 0.5 F M M F 0.3 F F M F F F F 0.6 F M M F F M F F F F
6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/15/2009 DURING A ROUTINE PHYSICAL, I 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/15/2009 Information has been received from 6/11/2009 Developed Alopecia Areata Univers 6/6/2009 I received the vaccine and a month 6/9/2009 Pt was seen 6/8/09 for 5 year WCC 6/10/2009 6/3/09 office visit: Red, warm area 6/11/2009 Light headedness, dizziness since v 6/12/2009 Patient fainted 6/12/2009 Tingling & numbness of the Rt finge 6/11/2009 Immediately after receiving vaccine, 6/11/2009 Severe pain at the injection, Limited 6/11/2009 Severe tenderness and swelling at s 6/10/2009 6/3/09 Came in for office visit - Urtic 6/10/2009 6/10/09 office visit- firm, red, tender 6/11/2009 Allergic reaction rash, swollen area 6/16/2009 EXFOLIATIVE ERYTHRODERMA 6/8/2009 Mom described area on (R) leg is ap 6/10/2009 Vaccine given on 6/5/09. On 6/7/09 6/8/2009 Patient has a quarter-sized red area 6/8/2009 Received PCV-7 in (R) thigh and PE 6/5/2009 Child has a 6cm x 3cm erythematou 6/10/2009 Member woke during night with chill 6/9/2009 Redness 7cm x 5 1/2 cm warm to to 5/4/2009 Spreading, redness, pain 5/31/2009 Within 1/2 hr. - hives and swelling th 6/5/2009 (L) leg red and swollen 35 mm X 35 5/29/2009 Child received PENTACEL, PREVE 6/10/2009 Right deltoid, red, warm to touch. S 6/8/2009 Frontal headache "head pounding" 6/8/2009 Pt received Immunisation and then 6/4/2009 Pt was given MENACTRA - Vaccine 6/15/2009 A developed shingles like rash in le 6/14/2009 Rash 10 days post vaccination seen 6/12/2009 6-2-09 Rcvd MMR SubQ @ Health 6/3/2009 Fever, chills, headache, sore throat 6/9/2009 Fatigue X 2 days
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6/16/2009 AZ 6/16/2009 MN 6/16/2009 CA 6/16/2009 MI 6/16/2009 AL 6/16/2009 ME 6/16/2009 WA 6/16/2009 WI 6/16/2009 PA 6/16/2009 LA 6/16/2009 CO 6/16/2009 6/16/2009 CO 6/16/2009 GA 6/16/2009 SC 6/16/2009 WA 6/16/2009 6/16/2009 IN 6/16/2009 MN 6/16/2009 IL 6/16/2009 ME 6/16/2009 TX 6/16/2009 NY 6/16/2009 MI 6/16/2009 MI 6/16/2009 CA 6/16/2009 WI 6/16/2009 MA 6/16/2009 CO 6/16/2009 CO 6/16/2009 WA 6/16/2009 MO 6/16/2009 MA 6/16/2009 CA 6/16/2009 NM 6/16/2009 GA 6/16/2009 CO 6/16/2009 NC 6/16/2009 NE 6/16/2009 6/16/2009 AR 6/16/2009 CA 6/16/2009 ID 6/16/2009 MO 6/16/2009 6/16/2009 CA 6/16/2009 6/17/2009 6/17/2009 6/17/2009 NC 6/17/2009 IA
0.1 16 58 17 47 72 9 75 43 12 38
0 16 58 18 47 72 9 75 72 43 12 38
1.3 83 51
1 83 51
7 17 37 1 16 42 73 73 62 47 24 15 29 23 49 1.3 18 67 0.2 56 2 1.9 8 1 10 0.2 5 63 37 13 8
7 17
1.3 0.2
1 0
1 16 43
47 24 15 29 23 49 1 18 67 0 56 2 1 8 1 10 0 5 63 37 13 8
0.1 M F F M M F F F F M M F F 0.3 M F F U F F M 0M F M U U U F F M F M M 0.3 M F F 0.2 F F 0.5 M 0.9 M M 0F M 0.2 F M F F F F U 0.3 F 0.2 M
6/8/2009 Increased irritability with green/muc 6/9/2009 Woke up at 2 AM on 6/9/09 with tem 6/6/2009 Hives occurred 5 to 7 days after shi 4/23/2009 Received vaccines 4/21/09. That nig 6/8/2009 None stated 6/9/2009 Large 9 cm red area with 3x4 cm ra 6/12/2009 Localized itching, erythema, and sw 6/16/2009 Tenderness, swelling, erythema. No 6/9/2009 Pain in arm neck back, chills fever s 6/10/2009 None stated 6/11/2009 Had IZs 6/9/09, on 6/11/09 MOC ca None stated 6/10/2009 No adverse reactions previously 6/9/2009 Patient had fever and a seizure afte 6/11/2009 Pt came in and stated that 2 months 6/10/2009 Left arm edema, tenderness, fatigue UTD 6/10/2009 Injection site is reddened and raised 6/8/2009 Redness, tenderness, nausea 6/5/2009 None stated 6/9/2009 Break through. Chicken pox 6-8-09 6/16/2009 pt c/o itching at menactra injection s 6/16/2009 member was given Typhoid at 0915 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 Subject in pneumococcal vaccine tr 6/16/2009 On the 12th and 13th day after rece 6/16/2009 One month after injection the patien 6/16/2009 3/29/2009 Was hospitalized with me 6/16/2009 After Tdap given, employee experie 6/16/2009 Pt received smallpox vaccination on 6/3/2009 6/03/09 1:10 p.m. - phone call from 6/16/2009 Err:508 6/16/2009 1 month following 1st gardasil inject 6/16/2009 Red, swollen, Painful, warm to touch 6/16/2009 Patient was given Hepatitis A vaccin 6/16/2009 6/12/09 9am: Two days after vaccin 6/16/2009 Patient fell asleep on the car ride ho 6/16/2009 My son got his vaccinations on Thu 6/16/2009 Right Arm reddened, swollen and p 6/16/2009 Pt. had vaccines on 6-5-09, and on 6/12/2009 MOC states child has been seizure 6/16/2009 Shots given around 11am 6-12-09. 6/15/2009 2" red area to injection site- Rt. leg ( 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/12/2009 Information has been received from 6/11/2009 sWELLING AND REDNESS ON RIG 6/16/2009 InformationYhas been received from 6/12/2009 2 days after had a seizure with vom 6/17/2009 Presented to Y ER -Died 6/26/09 Aut
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6/17/2009 IA 6/17/2009 AZ 6/17/2009 IN 6/17/2009 NC 6/17/2009 MI 6/17/2009 NY 6/17/2009 SC 6/17/2009 OR 6/17/2009 MO 6/17/2009 NY 6/17/2009 TX 6/17/2009 AR 6/17/2009 NJ 6/17/2009 NC 6/17/2009 WV 6/17/2009 UT 6/17/2009 FL 6/17/2009 VA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 6/17/2009 NC 6/17/2009 WV 6/17/2009 NE 6/17/2009 CT 6/17/2009 TX 6/17/2009 LA 6/17/2009 TN 6/17/2009 6/17/2009 AL 6/17/2009 PA 6/17/2009 PA 6/17/2009 6/17/2009 CA 6/17/2009 NC 6/17/2009 CA 6/17/2009 NC 6/17/2009 TX 6/17/2009 ND 6/17/2009 NC 6/17/2009 NC 6/17/2009 VA 6/17/2009 VA 6/17/2009 TX 6/17/2009 CA 6/17/2009 WI 6/17/2009 MA 6/17/2009 AK 6/17/2009 NC
0.2 63 26 13 39 2 11 28 0.3 64 14 68 24 10 14 49 1.1 22 28 34 35 25 18 34 5 12 27 63 0.3 0.5 22 1.6 4 4 25 53 39 19 33 0.2 1.1 45 28 17 15 11 4 11 4 9 38
0 63 26 29 2 11 28 0 64 14 68 24 10 14 49 1 22 28 34 35 25 18 34 5 12 63 0 0 22 1 4 4 25 53 39 19 0 1 45 28 17 15 11 4 11 4 9 38
0.2 F F F F F 1F M M 0.4 M M M M F M F F 0.1 M F M M U F M M M F F F 0.3 F 0.5 M M 0.6 M F M M M M U U 0.2 M 0.1 F F M F F M F F M M M
6/17/2009 Mom foundYbaby unresponsive 12-2 6/15/2009 GBS - numbness, tingling, burning o 6/17/2009 i got the hep shot on 4-22-09. it was 6/17/2009 since having gardasil shots my daug 6/17/2009 Tremendous chills and pain in the le 6/17/2009 My son was sore for the remainder 6/17/2009 Three hours after immunizations pa 6/17/2009 Patient was administered vaccine. P 6/17/2009 One day after vaccine was given, on 6/17/2009 Inability to breath, extreme shortnes 6/17/2009 varivax received approx 8 hrslater e 6/17/2009 Fever (104) reduced with acetamino 6/17/2009 Dianosis: Left brachial neuritis after 6/17/2009 CLIENT GIVEN VACCINES BECAM 6/17/2009 Patient developed bacteremia witho 6/17/2009 I received my Zostavax DS PWD #1 6/17/2009 High fever, greater than 103F, axilla 6/17/2009 Wasnt told to wait immediately after ### Description: Had febrile illness withi 2/10/2005 Description: diffuse puritic rash 2 da 6/14/2005 Description: Diffuse maculopapular 6/17/2009 Rash- competent w/ past - MMR ras 2/8/2005 12/13/86 - received spv, yellow feve 6/15/2009 Tdap given on 06-11-09. Began ha 6/17/2009 No fever, redness and swelling from 6/17/2009 Swelling and red reaction with indur 6/9/2009 Received a phone call from patient 6/16/2009 Developed rash on face and upper 6/10/2009 On 6/10/09 grandmother presented 6/17/2009 Seizure 12/7/2004 Anthrax vaccine #1, #2, #3- no prob 6/17/2009 Apparent seizure that evening after 6/15/2009 Received Kinrix on 6/11/09, IM/L ar 6/15/2009 Received Kinrix on 6/10/09 IM/Larm 1/27/2005 2/17/04 - received ANTHRAX vaccin 6/17/2009 Body ache, fever, right hand swellin 2/22/2005 Description: 1/21/05- received prima Rash, but not around injection site. ### Vaccination site erythema, induratio 6/17/2009 Vaccines administered 06/10/09 at 6/17/2009 Patient broke out on forehead, face ### Persistent, reproducible arthralgias 3/15/2005 08/17/04 - received smallpox vaccin 6/17/2009 Erythematous, non-fluctuant, indura 6/17/2009 Mildly indurated, mildly erythematou 6/17/2009 Local reaction to vaccine 6/17/2009 (L) Deltoid - swollen, red AMOXICIL 6/17/2009 7 by 2 cm area of erythema/swelling 6/17/2009 Erythema, induration, swelling, itchi 6/16/2009 9 cm roughly circular red/warm/itchi ### 1/13/03 - received anthrax vaccine #
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6/17/2009 6/17/2009 6/17/2009 CT 6/17/2009 NC 6/17/2009 NC 6/17/2009 NC 6/17/2009 GA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 CA 6/17/2009 IL 6/17/2009 6/17/2009 IL 6/17/2009 SC 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 CO 6/17/2009 MA 6/17/2009 IN 6/17/2009 ME 6/17/2009 6/17/2009 6/17/2009 VA 6/17/2009 6/17/2009 6/17/2009 CO 6/17/2009 CO 6/17/2009 NY 6/17/2009 6/17/2009 MA 6/17/2009 SC 6/17/2009 6/17/2009 MO 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MN 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 AZ 6/17/2009 AR 6/17/2009 MN 6/17/2009 6/17/2009 6/17/2009 IN
39 30 24 22 20 34 40 42 21 35 0.1 3 15 0 10 0.2 2
39 30 21 21 20 34 40 42 21 35 0 15 9 2
36 1.3 3
1 3
0
0
14 49
14 4 32 1.3
14 4
1
0
32 1 65 34 8 6
65 33
19 5 19 47 1 28
6
M M F U M U U U U U 0.1 U M M U M M 0M M F 0.2 M F F F 0U F U F F M F M M F F F 1M M F M M F F F F U F M F F M F
2/1/2005 DOD call received from patient on 1 ### Progressive L arm / shoulder pain w 4/15/2005 Description: 2/3/05- received SPV (3 9/17/2007 Description: SM developed, N&V, H 6/11/2009 20 y/o male, ADSM, presents as a r ### Description : progressive fatigue, co 6/17/2005 Description: This patient reports bac 2/18/2005 Description: Headache, arthralgias, ### Progressive, persistent bilateral sho ### Description: Headache, Myalgias, U 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received from 5/28/2009 Information has been received rega 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Initial information has been received 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2008 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from
349806 349810 349813 349815 349816 349908 349909 349910 349911 349912 349914 349915 349916 349917 349918 349919 349920 349921 349922 349923 349924 349925 349926 349927 349928 349929 349930 349931 349932 349933 349934 349935 349936 349937 349938 349939 349940 349941 349942 349943 349944 349945 349946 349947 349948 349949 349950 349951 349952 349953 349954
6/17/2009 NY 6/17/2009 PA 6/17/2009 NE 6/17/2009 OH 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MA 6/17/2009 NJ 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 OH 6/17/2009 6/17/2009 6/17/2009 IA 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 PA 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 IL 6/17/2009 6/17/2009 MD 6/17/2009 MN 6/17/2009 VA 6/17/2009 PA 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 ME 6/17/2009 NY 6/17/2009 CA 6/17/2009 KS 6/17/2009 6/17/2009 NY 6/17/2009 KS 6/17/2009 IL 6/17/2009 PA 6/17/2009 MI 6/17/2009 TX 6/17/2009 CO
1.7 1.3 12 1 8 1 1.2
1 12 1 8
1.3 5
1 5
1 27 1 5 4 30 2 5 5
5 4
5
1 51 9 1.1 4 1 9 2 2 4
1.2 1.7 1 5 19 1.1 1 10 14 50 1.5
9
4
1 1 1
1 10 4 50
0.7 M F M 0M M F F U 0.3 F F F F M U M M F F F F F F U U F M F M M F U M M M F M M U U U 0.2 F 0.7 F 0M F F F 0F F F F M
5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 A caller reported that her daughter e 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from
349956 349957 349975 349976 349977 349978 349979 349980 349981 349982 349983 349984 349985 349986 349991 349992 349993 349994 349995 349996 349997 349998 349999 350000 350001 350002 350003 350004 350005 350044 350045 350046 350047 350048 350049 350050 350051 350052 350053 350054 350055 350056 350057 350058 350059 350060 350061 350063 350064 350065 350066
6/17/2009 6/17/2009 CT 6/17/2009 6/17/2009 6/17/2009 CT 6/17/2009 PA 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 OH 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 FL 6/17/2009 6/17/2009 AZ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 KY 6/17/2009 6/17/2009 6/17/2009 MI 6/17/2009 MI 6/17/2009 MO 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 WI 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 KY 6/17/2009 TX 6/17/2009 6/17/2009 TX 6/17/2009 PA 6/17/2009 NY 6/17/2009 MS 6/17/2009 MD 6/17/2009 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 6/17/2009 NY
42
4 37
4 37
33 46 5 55 1 11 45 4
1 11 45 4
1.5
1
30 4 5 1 5 1.5
4 5
1
36
36
0.4 4 1.1
0
39
39
23 14 1 4
1 4
42 30 48 36 1.3 5 20
1
41
5
F F M F F F F F F F M F M F 0F M M F F 0.5 M F F M F F F 0.5 M F F F M U 0.4 F F 0.1 M M M M M F 0M F F M F F M F M M F
5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Initial and follow-up information has 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Initial and follow up information has 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from
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6/17/2009 PA 6/17/2009 6/17/2009 TN 6/17/2009 PA 6/17/2009 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 MS 6/17/2009 6/17/2009 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NJ 6/17/2009 MO 6/17/2009 IN 6/17/2009 6/17/2009 VA 6/17/2009 6/17/2009 GA 6/17/2009 CA 6/17/2009 NY 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 FL 6/17/2009 WV 6/17/2009 NJ 6/17/2009 6/17/2009 6/17/2009 6/17/2009 IN 6/17/2009 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 NM 6/17/2009 MN 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NM 6/17/2009 6/17/2009
4 3 34
34
1 1
31 1 4
4
1.3
1
31 2
30 2
4
5
5
14 3 1 1.2
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30 18 5
9 4 28 5 35
4
35
4
2 1.3
2
M M F M U F U M F F M M U 0.3 M U F 0.7 F M F F U U U F U M F M 0M 0.2 F F U M M F M M M M F M U F M F U M M U 0.5 M F
5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/26/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been viewed on the
350198 350199 350200 350201 350202 350203 350204 350205 350206 350207 350208 350209 350210 350211 350212 350213 350214 350215 350216 350217 350218 350219 350220 350221 350222 350223 350224 350225 350226 350227 350310 350312 350313 350314 350315 350316 350317 350318 350319 350320 350321 350322 350323 350324 350325 350326 349456 349461 349464 349465 349470
6/17/2009 LA 6/17/2009 6/17/2009 IL 6/17/2009 FL 6/17/2009 6/17/2009 6/17/2009 MD 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 PA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 CA 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 TX 6/17/2009 6/17/2009 FL 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 MI 6/17/2009 6/17/2009 NY 6/17/2009 6/17/2009 6/17/2009 6/17/2009 6/17/2009 NE 6/17/2009 6/18/2009 NJ 6/18/2009 PA 6/18/2009 6/18/2009 OK 6/18/2009 VA
28 30 1 6 2 1.3
0
1
8
1.2 1
1
1.1 1.2
1 1
55 1 10
0
5 1 1 4 6 37
1
0.2 1.2 1.6 34
34
47
47
1
0
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7
7
35 20
20
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F M M 1M M M 0.3 M M U M M F 0.2 F F F 0.1 F 0.2 M F F F F 1F M M F 0M M F M F M U U 0.2 F F F F M M 1M U U M M 0.1 M F F F M F M
5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been receive from a 5/29/2009 The consumer reported that 10 yea 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received form 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received form 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 6/17/2009 Information has been received from 6/17/2009 Information has been received from 6/16/2009 This case was received on 09-June 6/15/2009 Initial report was received 11 June 2 3/21/2009 PT PRESENTED TO MEDICAL C/O
349471 349472 349473 349474 349475 349476 349477 349478 349479 349480 349481 349482 349483 349484 349485 349486 349487 349488 349489 349490 349491 349492 349494 349495 349496 349497 349501 349502 349503 349504 349505 349506 349507 349508 349509 349510 349511 349513 349514 349515 349516 349517 349519 349520 349521 349522 349523 349524 349525 349526 349527
6/18/2009 PA 6/18/2009 TN 6/18/2009 PA 6/18/2009 CO 6/18/2009 6/18/2009 FL 6/18/2009 MI 6/18/2009 OR 6/18/2009 NC 6/18/2009 FL 6/18/2009 FL 6/18/2009 NC 6/18/2009 NC 6/18/2009 NC 6/18/2009 NY 6/18/2009 CA 6/18/2009 TX 6/18/2009 NY 6/18/2009 TN 6/18/2009 NC 6/18/2009 OH 6/18/2009 6/18/2009 IN 6/18/2009 CA 6/18/2009 TX 6/18/2009 CA 6/18/2009 CA 6/18/2009 TX 6/18/2009 OH 6/18/2009 TX 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 KS 6/18/2009 ME 6/18/2009 VA 6/18/2009 CA 6/18/2009 CA 6/18/2009 FL 6/18/2009 AL 6/18/2009 MA 6/18/2009 VA 6/18/2009 IL 6/18/2009 MA 6/18/2009 HI 6/18/2009 PA 6/18/2009 PA 6/18/2009 MA 6/18/2009 OR 6/18/2009 NC
55 80 54 13 1 18 1 6 35 52 60 45 21 35 35 4 33 38 0.2 21 11
55 61 54 13 1 18 1 6 35 52 60 45 21
41 1.3 64 4 1.4 1.3 18 11 1.2 5 11 33 1 19 27 75 5 0.6 5 19 12.5 0.4 2 4 56 34 2 5 17
41 1 64 4 1 1 18 11 1 5 11 33 1 19 27 75 5 0 5 19 12 0 2 4 56 34 2 5 17
35 4 33 38 0 21 11
F M M F 0M F 0F F M M F M M M M F F M 0.2 M M M U F 0.3 M F F 0.4 M 0.3 M M M 0.2 M M M F 0F F F M M 0.6 M F F F 0.4 F 0.9 M F F M 0.6 F M F
6/18/2009 Fever 102.1 6/18/2009 patient broke out with shingles in his 6/18/2009 Patient received pneumococcal vac 6/18/2009 06-17-09 Fainting episodes x2 afte 6/18/2009 rash 6/18/2009 Patient had vaccine 9/11/08 and be 6/18/2009 Pt presented to our office on 6/18/0 6/18/2009 24 hours after vaccine patient comp 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Patient's throat 10 minutes after the 6/18/2009 Difuse red papule rash and itching f 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Complaining of continued pain and 6/18/2009 2 large blisters on lt arm where varic 6/18/2009 I began to have the following sympt 6/18/2009 Member called stating that he was r 6/18/2009 seen in emergency room twenty-fou 6/18/2009 Anthrax Vaccine exceeded the reco 6/18/2009 Patient was entered into the electro 6/18/2009 Fever, chills, muscle aches, sore joi 6/18/2009 Fever 103, body aches, blotchy red 6/18/2009 could not walk 5 hours after shot wa 6/18/2009 Vaccine administered, vaccine 2 we 6/18/2009 Dr. requested that these side-effect 6/18/2009 L thigh swollen, red, + bump Dxper 6/18/2009 L upper thigh with induration, red 4x 6/18/2009 Sudden LOC onset about 10 minute 6/18/2009 Pt. c/o left arm pain and swelling. N 3/2/2009 See sheet 2/26/2009 Redness and swelling onset 1 day a 2/11/2009 Injection given left Deltoid on 2-7-09 2/13/2009 Fever of 101 degrees, - fever at 5:0 1/21/2009 Patient was in her car seat, after gra 6/18/2009 Information has been received from 6/18/2009 Started day of vaccine 17 hr HA and 6/17/2009 Pt had Td and ZOSTAVAX on 5/4/0 6/17/2009 Within minutes of injections, pt beca 6/18/2009 Convulsions (seizures) approx. 1 da Facial twitching and drooling 6/16/2009 Fainted after injection. No adverse a 6/18/2009 5 cm round, swollen red lesion on R 2 days after 4 month shots, develop 6/15/2009 VARICELLA complications: None 6/10/2009 Cold urticaria. ZYRTEC. 6/16/2009 Pt received Tdap @ 9:30 am on 6/1 6/9/2009 Right deltoid where Tdap administe 6/12/2009 The patient received DTaP vaccine 6/18/2009 Parent noticed the injection site was 6/16/2009 Pt. had fainting episodes with 1st do
349528 349530 349531 349532 349533 349498 349499 349534 349536 349537 349538 349539 349540 349542 349543 349544 349545 349549 349550 349557 349558 349559 349560 349561 349562 349563 349564 349565 349566 349567 349568 349569 349570 349571 349572 349573 349574 349575 349576 349577 349579 349580 349581 349582 349583 349584 349585 349586 349587 349588 349589
6/18/2009 OH 6/18/2009 NJ 6/18/2009 NJ 6/18/2009 VT 6/18/2009 MI 6/19/2009 6/19/2009 WA 6/19/2009 SD 6/19/2009 NE 6/19/2009 6/19/2009 6/19/2009 FL 6/19/2009 6/19/2009 NY 6/19/2009 6/19/2009 6/19/2009 CA 6/19/2009 6/19/2009 CO 6/19/2009 OH 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 IA 6/19/2009 NY 6/19/2009 MD 6/19/2009 WI 6/19/2009 OH 6/19/2009 OK 6/19/2009 NY 6/19/2009 NC 6/19/2009 FL 6/19/2009 NY 6/19/2009 NC 6/19/2009 NC 6/19/2009 NC 6/19/2009 CA 6/19/2009 WI 6/19/2009 NC 6/19/2009 NC 6/19/2009 GA 6/19/2009 CA 6/19/2009 NC 6/19/2009 NC 6/19/2009 MI 6/19/2009 GA 6/19/2009 IL 6/19/2009 IL 6/19/2009 NY 6/19/2009 MI
0.1 32 25 1 69 35 15 24 31 48
0 32 25 1 69 35 15 24 31 48
5
5
22
22
25 96 0.2 18 36 31 21 26 10 86 4 24 22 10 12 34 4 1.3 34 70 27 1.8 70 27 23 11 65 46 41 1.2 64 18 10 2 1
25 0 18 36 31 21 26 20 86 4 24 22 10 12 34 4 1 34 70 27 1 70 27 23 11 65 46 41 1 64 18 10 1 1
0.1 M M M 0F F M F F M F M M M F F U F F 0.2 M M M M M M F F M M M F F M F 0.4 M M M M 0.8 F F M F F F M M 0.2 M M F F 1F 0F
6/3/2009 Diarrhea, vomiting 5/15/2009 Patient came to IMMs complaining o 5/15/2009 Patient came to IMMS complaining 6/18/2009 Pt father reported "it looked like hive 4/23/2009 On March 7, 2009, I noticed a rash 6/19/2009 PT STATES EVERY TIME HE REC 6/18/2009 Vaccines given at about 12:15 PM J 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received throu 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/18/2009 Information has been received from 6/19/2009 Mother driving client home. Client c 6/18/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Grandmother called clinic on 6/19/0 6/19/2009 Cellulitis to upper right arm noted th 6/19/2009 redness and swelling at site of vacc 6/19/2009 Local redness and swelling on site. 6/19/2009 fever, irritability, muscle/joint aches, 6/19/2009 unknown 6/19/2009 Left arm swelling and redness. No f 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Swelling injection site, Left upper ar 6/19/2009 Left arm swelling and redness. No f 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Vaccine administered 6/16 @ 10am 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 LOCAL REACTION TO VACCINE 6/19/2009 Patient developed Shingles on 1st b 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Around 6-7 pm on 6/17/09, client ha 6/19/2009 Patient received Pneumo vaccine ri 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 Anthrax Vaccine exceeded the reco 6/19/2009 LYMPHNODE ENLARGED ON L IN 6/19/2009 ON the site of the flu shot there is a 6/19/2009 The day following administration of 6/19/2009 Patient Received Havrix (Peds Hep 6/19/2009 pt recieved varivax on 11-21-1997, 6/19/2009 NONE
349590 349591 349592 349593 349594 349595 349596 349597 349608 349609 349612 349614 349615 349617 349618 349619 349620 349621 349623 349624 349625 349626 349627 349628 349629 349630 349631 349632 349633 349634 349635 349636 349637 349638 349639 349640 349641 349642 349643 349644 349645 349646 349647 349648 349649 349650 349651 349598 349599 349600 349601
6/19/2009 KS 6/19/2009 AL 6/19/2009 NY 6/19/2009 TX 6/19/2009 NJ 6/19/2009 WA 6/19/2009 CA 6/19/2009 MI 6/19/2009 CA 6/19/2009 HI 6/19/2009 OR 6/19/2009 CA 6/19/2009 GU 6/19/2009 FL 6/19/2009 AL 6/19/2009 OH 6/19/2009 WI 6/19/2009 MA 6/19/2009 PR 6/19/2009 IL 6/19/2009 TN 6/19/2009 AK 6/19/2009 PA 6/19/2009 MI 6/19/2009 KS 6/19/2009 DC 6/19/2009 WA 6/19/2009 6/19/2009 GA 6/19/2009 FL 6/19/2009 CA 6/19/2009 CT 6/19/2009 VA 6/19/2009 IL 6/19/2009 IL 6/19/2009 NV 6/19/2009 MT 6/19/2009 OH 6/19/2009 MD 6/19/2009 VA 6/19/2009 NC 6/19/2009 MD 6/19/2009 OH 6/19/2009 SC 6/19/2009 GA 6/19/2009 MA 6/19/2009 FL 6/20/2009 CA 6/20/2009 CA 6/20/2009 NE 6/21/2009
60 16 1.3 38 0.4 37 20 34 51 2 45 58 53 1.5 0.4 1 7 29 48 88 3 9 0.4 6 5 1.3 5
60 16 8 38 0 37 20 34 51 2 45 58 53 1 0 0 7 29 46 88 3 9 0 6 5 1 5
0.4 29 0.5 7 5 61 51 4 5 15 44 14 66 29 45 41 10 19 18 5 70 34
0 29 0 7 5 61 51 4 5 15 44 14 66 29 45 41 10 19 18 5 70 34
F F M F 0.4 M M F F M 0.9 M F F M 0.5 M 0.4 M 1M M M M F F M 0.4 M F U 0.3 F M U 0.4 M F 0.5 M M M M M F M M F F M F F M F F F M M F U
6/19/2009 Ct obtained the prescription for the 6/19/2009 Client reports back on 6-18-2009, o 6/19/2009 PT RECEIVED VARIVAX ON 1-146/19/2009 rec'd MMR on 6/11/09. Kristin states 6/19/2009 Patient developed afebrile Seizures 6/19/2009 Smallpox shot was uneventful. Afte 6/19/2009 Patient became faint, diaphoretic an 6/19/2009 Received vaccine 6/16/09, each day 6/19/2009 Pt has persistent low grade pain sin 6/19/2009 6.17.09 @ 2:30 pm immunization gi 6/13/2009 On 6/10/09 patient felt generalized j 6/20/2009 Redness, swelling at injection site (l 6/22/2009 Soreness at site of injection - 6/17/0 6/19/2009 Child had redness and edema arou 6/19/2009 This case was reported by a physici 6/16/2009 Developed zoster PCR confirmed. 6/5/2009 Pt had tightness in throat, pale, whe 6/17/2009 04-20-09 - 04-24-09 = left arm, shou 6/11/2009 None stated 6/19/2009 Patient felt pain in her back on 6/10 6/12/2009 Gave HAVRIX in prefilled syringe in 6/19/2009 Right arm swelling at site of injection 6/19/2009 Office visit 6.18.09 Acute URI 4 mo 6/19/2009 Developed 1/2 dollar size hive arou Pt developed localized redness and 6/12/2009 Lethargy soon after immunization fo 6/10/2009 Redness and swelling at injection si Mildly erythemic area approx 3cm d 4/28/2009 Diagnosed with C. difficile on 2/27/0 6/11/2009 None stated 6/18/2009 fever 99.2, Redness around injectio 6/11/2009 Child c/o cough.. mother brought ch 6/19/2009 (L) arm swelling/redness, pain and b 6/8/2009 Pt was given a DTaP rather than a T 4/29/2009 None stated 6/18/2009 Fever, lethargy began 24 hrs after s 6/18/2009 3 inch circular raised red area at (R) 6/18/2009 Near syncopal reaction minutes afte 6/10/2009 Symptoms, started 11 hours after th 6/15/2009 Facial edema (notable lips & (L) eye 6/15/2009 1 hr after receiving Pneumovax & Z 6/12/2009 Vaccine given 6/4/09. Pt developed 6/16/2009 Vaccination LUE with YF Vax 2:30p 6/15/2009 Swelling, redness at site one day af 6/12/2009 (R) arm - swollen to shoulder & dow 6/11/2009 Had PAP at Gyn which came back p 6/9/2009 None stated. 6/20/2009 Child became lethargic, flushed, dip 6/20/2009 Twenty-four hours after the PPV va 6/20/2009 Confusion; Severe and continuing h 6/21/2009 pain at site, chills, unwell, slightly sw
349602 349603 349604 349605 349606 349607 349913 350071 350311 349653 349660 349661 349664 349665 349666 349667 349670 349671 349672 349673 349674 349675 349676 349677 349678 349679 349680 349681 349682 349683 349684 349685 349686 349687 349688 349689 349690 349691 349692 349693 349694 349695 349696 349698 349699 349700 349701 349702 349703 349704 349705
6/21/2009 6/21/2009 PA 6/21/2009 6/21/2009 NV 6/21/2009 TX 6/21/2009 OH 6/21/2009 6/21/2009 CA 6/21/2009 6/22/2009 MI 6/22/2009 WV 6/22/2009 WV 6/22/2009 VA 6/22/2009 WA 6/22/2009 AL 6/22/2009 TX 6/22/2009 AR 6/22/2009 GA 6/22/2009 MI 6/22/2009 VT 6/22/2009 NH 6/22/2009 CA 6/22/2009 SD 6/22/2009 NC 6/22/2009 GA 6/22/2009 WA 6/22/2009 NC 6/22/2009 OK 6/22/2009 NY 6/22/2009 NC 6/22/2009 MI 6/22/2009 SC 6/22/2009 NY 6/22/2009 MI 6/22/2009 MI 6/22/2009 CA 6/22/2009 MN 6/22/2009 FL 6/22/2009 NJ 6/22/2009 TX 6/22/2009 MT 6/22/2009 CA 6/22/2009 PA 6/22/2009 ND 6/22/2009 CT 6/22/2009 OH 6/22/2009 OR 6/22/2009 NY 6/22/2009 NY 6/22/2009 6/22/2009 NM
42 11 16 5 0.8 1.6 1.3 1 6 82 49
42 11 15 5 0 1
0.2 17 14 16 28 20 69 0.2 0.1 19 70 24 38 33 40 5 16 4
0
35 17 79 27 10 17 70 1.3 60 39 13 70 1 37 34 1.2 15 18 33 15
82
14 16 28 20 69 0 0 19 70 24 38 33 40 5 16 5 35 16 27 10 16 70 1 61 39 13 70 1 37 34 1 15 33 15
F M F M 0.8 M 0.6 M M F F F M F 0.2 M F F F F F M 0.2 F 0.1 M M F F F F F F F F M F M U F M F M 0.3 F F F F F 0M F F 0.2 M F F M F
6/21/2009 I was administered the Anthrax Vac 6/21/2009 Extreme tiredess within 1 hour of va 6/21/2009 endocraneal hipertension after 1.5 6/21/2009 local exaggerated reaction at site of 6/21/2009 DALLAS RECEIVED HEP B, POLIO 6/21/2009 My son had his 4th dose of DTAP a 5/29/2009 Information has been received from 5/29/2009 Information has been received from 5/29/2009 Information has been received from 6/19/2009 InformationYhas been received from 6/18/2009 This case was received from a heal 6/18/2009 This case was received from a heal 6/19/2009 Information has been received from 6/19/2009 Information has been received from 6/19/2009 Information has been received throu 6/19/2009 Information has been received from 6/22/2009 The morning after receiving the vac 6/22/2009 Patient in for doctor's visit and was 6/22/2009 Approximately 2 to 4 days after 2nd 6/22/2009 Mother came in 6/22/09 stating that 6/22/2009 THERE WERE Y NO ADVERSE EVE 6/22/2009 Complaining of lesions on right wris 6/22/2009 Patient presented with red, swollen, 6/22/2009 Immediately after Pt received secon 6/22/2009 patient examined - tender, urticarial 6/22/2009 Within about 3-4 hours I had a tight 6/22/2009 MMR given 4/07/09- she developed 6/22/2009 Large area (from knee to buttock) o 6/22/2009 child received HPV and had fingers 6/22/2009 ON 6-17-2009, ONE DAY AFTER R 6/22/2009 Fever 103 & throbbing headache 6/22/2009 Local tenderness and swelling over 6/15/2009 Mother notified office approx 45 min 6/22/2009 Subject in pneumococcal vaccine tr 6/22/2009 Pneumovax 23 was given 6/17/09. W 6/22/2009 VACCINE WAS GIVEN ALONE IN D 6/22/2009 Patient was given a HPV injection a 6/22/2009 Reaction to Pneumovax with the sw 6/22/2009 ITP treated with Win. 9/29/09. Hosp Pt mentioned she had warm facial c 6/22/2009 6/19/09 MMR given Left arm. 2nd in 6/17/2009 Pt. had syncopal event after admini 6/22/2009 Since Zostavax was administered in 2/3/2009 Classic measles vaccination rash. R 6/22/2009 Pain, swelling of from deltoid to just 6/22/2009 Pt. States 2 days post injection. Lef 6/22/2009 Began with rash (small red dots) in 6/22/2009 Pt c/o. not feeling well. Generalized 4/13/2009 Pt c/o feeling dizzy. V/S - HR 100/m 6/22/2009 Generalized pain and swelling of 3" 6/16/2009 Patient became faint for about 15 se
349706 349707 349714 349715 349716 349718 349719 349720 349721 349722 349724 349725 349726 349727 349728 349729 349730 349731 349732 349733 349734 349735 349736 349737 349738 349739 349740 349741 349742 349743 349744 349745 349746 349747 349748 349749 349750 349751 349752 349697 349791 349793 349805 349807 349809 349818 349821 349822 349823 349824 349826
6/22/2009 CA 6/22/2009 NY 6/22/2009 VT 6/22/2009 6/22/2009 CA 6/22/2009 6/22/2009 CO 6/22/2009 CA 6/22/2009 CA 6/22/2009 IL 6/22/2009 NC 6/22/2009 OR 6/22/2009 KS 6/22/2009 CT 6/22/2009 KY 6/22/2009 GA 6/22/2009 IL 6/22/2009 OH 6/22/2009 AR 6/22/2009 OH 6/22/2009 SC 6/22/2009 PA 6/22/2009 NJ 6/22/2009 IL 6/22/2009 6/22/2009 6/22/2009 CA 6/22/2009 PA 6/22/2009 TX 6/22/2009 GA 6/22/2009 TX 6/22/2009 FL 6/22/2009 CO 6/22/2009 ND 6/22/2009 AR 6/22/2009 WI 6/22/2009 IL 6/22/2009 CA 6/22/2009 NH 6/23/2009 6/23/2009 OH 6/23/2009 OH 6/23/2009 6/23/2009 6/23/2009 6/23/2009 6/23/2009 NY 6/23/2009 AR 6/23/2009 CO 6/23/2009 NE 6/23/2009 WA
40 1.6 2
40 1 1
0.6 71 11 4 4 0.6 53 14 5 24 15 2 11 0.2 0.3 0.2 35 18 14 14 30 90 4 4 9 27 1.5 7 1 5 5 78 43 15 0.3 32
0 11 4 4 0 53 14 5 24 16 2 11 0 0 0 35 18 14 14 30 90 4 4 9 27 1 7 1 5 5 78 43 15 0 32
21 15
21 14
0.2 63 60 5 4
0 63 60 5 4
F 0.6 M 1F U 0.6 F U F M F 0.6 F F F M F F 0.4 F M 0.2 F 0.3 F 0.2 F F F F F F F F M M F 0.5 M F 0F M F M M F 0.3 F F F M F F F U 0.2 M M F M F
No adverse events reported by patie 6/15/2009 About 10 cm, overlying cellulitis. 6/15/2009 - Child received MMR and Hep A on 6/22/2009 Information has been received from 6/11/2009 Fever (103.8) and febrile seizure 12 6/17/2009 Given adult diphtheria/tetanus vacc 6/16/2009 Baseball-sized red area back of righ 6/16/2009 Redness 13 1/2 cm x 17 1/2 cm, sw 6/16/2009 Left arm deltoid 10 cm bruise. Warm 6/16/2009 Mother of pt states she developed a 6/15/2009 Employee's left deltoid was red + sw 6/8/2009 Date: 5/28/09. Vaccines were admin 6/17/2009 Imm. 2 days ago. No pain or fever. 6/17/2009 First GARDASIL given 5/11/09. She 6/18/2009 Woke up this am with shot area pain 6/15/2009 MD ordered LPN to give Hep A and 6/18/2009 Rec #2 VARICELLA left deltoid on 6 Diarrhea (5-8/day) for 2 weeks follow 6/18/2009 Fever up to 103.3 within 24 hours o 6/22/2009 Vomited the day of the vaccine, had 6/22/2009 Swollen glands on left side of neck. 6/19/2009 Patient at check-out area stating "i j 6/22/2009 Seconds after PPD placement and 6/22/2009 Pt started with dizziness and SOB 6/14/2009 I work in a hospital. I was informed a 6/15/2009 Patient was given ZOSTAVAX on M 6/22/2009 Rt Arm edema erythema hyperemia 6/22/2009 Leg swollen; red and 3 in x 4 in area 6/22/2009 Pt's mother called 6-19-09 reporting 6/19/2009 Hepatitis B vaccine booster adminis 6/12/2009 Right and left arm red and swollen. 6/19/2009 Pt was checking out after check-up Developed rash c/w very mild VARI 6/22/2009 3rd varicella given, supposed to be 6/22/2009 9 1/2 x 7cm red area (L) Thigh. DTa 6/17/2009 Left deltoid redness/swelling, fatigue 6/18/2009 Donor reported a rash that develope 6/19/2009 Given vaccine 6/3/09. Fever 101 de 6/12/2009 Pain/redness starting 6/11/2009. R 6/23/2009 I took Gardasil 1st dose on Aug 23, 6/18/2009 Initial report was received 10 June 2 6/18/2009 Initial report was received 10 June 2 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/22/2009 Information has been received from 6/21/2009 - Fever of 103 degrees - diarrhea - l 6/2/2009 112408 - Pt c/o pain in feet; 112508 5/28/2009 Patient received ZOSTAVAX vaccin 6/17/2009 R-Deltoid (Dtap) whole arm swollen 6/17/2009 Localized urticarial lesion w/o any s
349827 349828 349829 349830 349831 349832 349833 349834 349835 349836 349837 349838 349839 349840 349841 349842 349843 349844 349845 349846 349847 349848 349849 349850 349851 349852 349853 349854 349857 349858 349859 349860 349861 349862 349863 349864 349866 349868 349871 349873 349874 349875 349877 349878 349879 349880 349881 349882 349883 349884 349885
6/23/2009 MO 6/23/2009 IN 6/23/2009 WA 6/23/2009 NE 6/23/2009 AZ 6/23/2009 NY 6/23/2009 FL 6/23/2009 NY 6/23/2009 NJ 6/23/2009 MI 6/23/2009 FL 6/23/2009 TX 6/23/2009 MO 6/23/2009 VT 6/23/2009 TX 6/23/2009 CA 6/23/2009 FL 6/23/2009 FL 6/23/2009 VA 6/23/2009 NY 6/23/2009 NH 6/23/2009 IL 6/23/2009 FL 6/23/2009 CO 6/23/2009 CO 6/23/2009 VA 6/23/2009 MA 6/23/2009 TX 6/23/2009 PA 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 MS 6/23/2009 AZ 6/23/2009 CA 6/23/2009 CA 6/23/2009 TX 6/23/2009 TX 6/23/2009 6/23/2009 TX 6/23/2009 NJ 6/23/2009 NC 6/23/2009 CA 6/23/2009 VA 6/23/2009 SC 6/23/2009 TX 6/23/2009 NE
53 67 9 44 4 4 11 4 4 46 1.4 86 0.2 19 9 60 12 0.2 18 5 0 0.2 0.9 65 23 0.2 18 49 65 38 19 22 39 22 23 24 24 11 54 22 18 11 22
53 67 8 44 4 4 11 4 4 46 1 86 0 19 9 60 12 0 18 5 0 0 0 65 23 0 18 49 65 38 19 22 39 22 23 24 24 11 54 22 18 11 22
18 1.3
18 1
39 8
39 8
18
18
F F F F F M M M M M 0.4 M F 0.2 F F F M M 0.2 F F M 0F 0.2 M 0.8 M M M 0.2 M F F M M M M M M F M M M F F M F M U M 0.3 F F U F F F
6/19/2009 Swollen, reddened, feverish knot wi 6/19/2009 Vaccine administered 6/17. Arm turn 6/5/2009 Vaccine given to early per manufac 6/15/2009 Received TDAP on 6/9/09 noticed h 6/17/2009 Left shoulder swelling. 6/17/2009 Left arm red and swollen. 6/10/2009 (R) deltoid swollen, warm, red and h 5/4/2009 5/4/09- Pt c/o L upper arm redness 6/23/2009 SEEN IN OUR OFFICE FOR 4 YEA 6/23/2009 The patient is a 46-year-old man wh 6/23/2009 Seizure 9 days after receiving MMR 6/23/2009 Patient received the shingles vaccin 6/23/2009 Child's mother reports 3 to 4 hours a 6/23/2009 pt's mother called pt complained of 6/23/2009 Called in by Father, stated school n 6/23/2009 Received a Shingles vaccination at 6/23/2009 Pt had the vaccine around 9:00 am, 6/23/2009 Inconsolable crying, would not nurs 6/23/2009 She had tdap immunization yesterd 6/23/2009 COMPLAIN OF REDNESS, WARM 6/23/2009 UNKNOWNY6/29/09-autopsy report 6/23/2009 Client developed a few small, raised 6/23/2009 Per Mother and Grandmother after 6/23/2009 Sudden Hearing Loss and balance 6/23/2009 12 Jun 09/1:32pm-Anthrax vax rec'd 6/23/2009 high grade fever, polymorphous ras 6/23/2009 Swelling of both ankles, purple/red c 6/23/2009 I attributed the initial left bicep musc 6/23/2009 Patient had a headache shortly afte 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin Member complains of "severe itchin 6/23/2009 Member complains of "severe" itchin 6/23/2009 Member complains of "serve itching 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin 6/23/2009 Member complains of "severe itchin 6/23/2009 6/23/09 0935 Upon rising client stat 6/23/2009 Pt returned c/o pain + swelling (LD) 6/22/2009 Seizure 3 hours post administration 6/23/2009 Expired lot- MENACTRA 6/23/2009 Expired Lot- MENACTRA 6/23/2009 Received the typhoid vaccine on 26 Expired Lot-MENACTRA 6/23/2009 Patient was shaking violently for les 6/12/2009 Approximately equal to 2 hours afte 6/23/2009 Pt had 2 doses of varicella on 2-176/23/2009 The pt states that after the receipt o 6/19/2009 Significant induration, redness, tend 6/18/2009 Received vaccinations 6/8/2009, de 6/23/2009 Adacel given at the site of redness a
349886 349887 349888 349889 349890 349891 349892 349893 349894 349895 349896 349897 349898 349899 349900 349902 349903 349904 349905 349906 349907 349987 350304 349855 349856 349966 349968 349970 349973 349974 349988 349989 349990 350006 350007 350008 350009 350010 350011 350012 350013 350014 350015 350016 350017 350018 350019 350020 350021 350022 350023
6/23/2009 VA 6/23/2009 NC 6/23/2009 TX 6/23/2009 NC 6/23/2009 TX 6/23/2009 TX 6/23/2009 KY 6/23/2009 CA 6/23/2009 VA 6/23/2009 NC 6/23/2009 OK 6/23/2009 TX 6/23/2009 IL 6/23/2009 NJ 6/23/2009 MI 6/23/2009 IL 6/23/2009 IL 6/23/2009 CA 6/23/2009 NY 6/23/2009 CA 6/23/2009 CA 6/23/2009 WI 6/23/2009 TX 6/24/2009 VA 6/24/2009 TX 6/24/2009 IL 6/24/2009 NJ 6/24/2009 6/24/2009 6/24/2009 TX 6/24/2009 SC 6/24/2009 PA 6/24/2009 LA 6/24/2009 GA 6/24/2009 IN 6/24/2009 GA 6/24/2009 NE 6/24/2009 OR 6/24/2009 TN 6/24/2009 PA 6/24/2009 NY 6/24/2009 MA 6/24/2009 WI 6/24/2009 CA 6/24/2009 VT 6/24/2009 OK 6/24/2009 NC 6/24/2009 NC 6/24/2009 TX 6/24/2009 TX 6/24/2009 PA
50 81 11 19 0.6 0.4 35 4 20 19 11 12 0.4 63 17 9 1.6 0.6 1 0.2 9 32 1.3 20 4 14 18 6 0.2 0.1 50 14 4 14 12 39 0.5 0.3 0.2 1.1 51 27 59 4 23 1.3 65 5 12 34 19
81 11 19 0 0 35 4 20 19 11 11 0 63 17 9 1 0 1 0 9 32 1 20 1 18 0 0 50 14 4 14 12 39 0 0 0 1 51 27 59 4 23 0 65 5 12 34 19
F F M F 0.6 M 0.4 F M M M F M F 0.4 F F F F 0.6 F 0.6 F 0F 0.2 F F F 0.3 M M 0M F F F 0.2 F 0.1 M M F M F M F 0.5 M 0.2 F 0.2 M 0.1 F M F F M F 0.2 M F M F M F
6/19/2009 Arm where she received Tdap is red 6/23/2009 Patient reports an itching bump at s 6/23/2009 Fri Jun 19, 2009 12:04 PM After pt 6/15/2009 As per mother, patient c/o headache 6/22/2009 Inadvertently gave PEDIARIX at sam 6/22/2009 PEDIARIX given inadvertently @ sa Minor + progressive body aches. T 6/18/2009 Significant swelling involving the wh 6/23/2009 Fever, headaches - Given medicatio 6/22/2009 Syncopal episode after MMR vaccin 4/3/2009 1 day of local erythema of skin appr 6/23/2009 R arm swelling from elbow to neck. 6/22/2009 4 mo shot, given & explanation of p 6/12/2009 R arm rash ~ 2" diameter with corre 6/23/2009 The day following vaccine pt - had s 6/17/2009 Right arm, deltoid region : 4x6 cm in 6/18/2009 Client woke up screaming @ 2am. P 6/18/2009 3 to 5 minutes after intramuscular; in 6/18/2009 Patient received VARIVAX 5/21/09 6/23/2009 Urticaria seconds after vaccines giv 6/17/2009 Erythematous circular area around s 5/21/2009 Reddened lump at injection site. 6/26/2009 Scattered macular rash trunk, limbs 6/23/2009 Injection site pain after 20 mins. 2 w 6/24/2009 My son have two knot very swollen 6/22/2009 This case was received from a phys 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/23/2009 Information has been received from 6/22/2009 Pt states he felt sinus congruent wit ### Shakiness legs + arms heaviness a 6/12/2009 Swelling to injection site 3x3 round 6/24/2009 Client became pale and lightheaded 6/24/2009 Redness, warmth and swelling at ad 6/24/2009 Vaccinated with ACAM 2000 (lot VV 6/24/2009 Patient screamed inconsolably for 3 6/24/2009 The patient inadvertantly received a 6/24/2009 Patient received 4 immunizations in 6/24/2009 pt was given 1st varicella on 06/12/2 6/24/2009 Patient received Rabies Post Expos 6/24/2009 swollen right parotid gland without f 6/24/2009 2nd day after administration of zosta 6/24/2009 Left arm redness and swelling appro 6/24/2009 Right after i recieved the vaccination 6/24/2009 The evening of immunizations he th 6/24/2009 Itching at site the day after immuniz 6/24/2009 Received immunizations on 06.16.0 6/24/2009 Mom stated Pt developed hearing lo 6/24/2009 On 6/16/2009 center was notified by 6/24/2009 Pt. received Tdap and then GARDA
350025 350026 350027 350029 350030 350031 350032 350033 350034 350037 350038 350039 350040 350041 350042 350043 350092 350093 350094 350096 350104 350106 350107 350108 350109 350110 350111 350112 350113 350114 350115 350117 350118 350119 350120 350121 350122 350123 350124 350125 350126 350127 350128 350129 350131 350132 350133 350134 350135 350136 350137
6/24/2009 VI 6/24/2009 WA 6/24/2009 AZ 6/24/2009 KY 6/24/2009 FL 6/24/2009 CA 6/24/2009 MA 6/24/2009 TX 6/24/2009 WI 6/24/2009 MA 6/24/2009 MN 6/24/2009 CA 6/24/2009 ME 6/24/2009 ME 6/24/2009 NY 6/24/2009 CA 6/25/2009 NC 6/25/2009 NC 6/25/2009 CA 6/25/2009 MS 6/25/2009 PA 6/25/2009 PA 6/25/2009 NY 6/25/2009 NJ 6/25/2009 MN 6/25/2009 MA 6/25/2009 PA 6/25/2009 MD 6/25/2009 MD 6/25/2009 IL 6/25/2009 AR 6/25/2009 CO 6/25/2009 AL 6/25/2009 MO 6/25/2009 OR 6/25/2009 6/25/2009 6/25/2009 TX 6/25/2009 TX 6/25/2009 TX 6/25/2009 TN 6/25/2009 MD 6/25/2009 TX 6/25/2009 TX 6/25/2009 NY 6/25/2009 NH 6/25/2009 OR 6/25/2009 MA 6/25/2009 VA 6/25/2009 TX 6/25/2009 IA
1.2 28 11 1.3 0.5 11 65 1.4 38 38 26 8 62 53 68 76 23 16 20 13 19 26 21 14 65 1.1 39 14 4 4 12 5 29 1.3 14 16 57 12 14 11 14 37 17 5 12 0.1 49 22 25 11 61
1 28 11 1 0 11 65 1 38 38 26 8 62 53 68 76 23 16 13 19 26 21 14 65 1 39 14 4 4 12 5 29 1 14 16 12 14 11 14 37 17 5 12 0 49 22 25 11 61
0.2 F F M 0.3 F 0.5 M F F 0.4 M F F M F F F F F F F F F M M F F F 0.1 F F F F F F M F 0.3 M M F F M F M F F F M M 0.1 F F F F F M
6/22/2009 Mother states "bumpy rash" to both 6/24/2009 28 y/o female who presented as wa 6/24/2009 Mild fever. Soreness at site (L arm). 6/24/2009 6/19/09 at 3PM increased fussiness 6/24/2009 Mom reports that approximately 7 h 6/22/2009 Pt came in upper arm swelling, warm 6/24/2009 Pt given PNEUMOVAX (L) deltoid 6 6/24/2009 Urticaria rash involving mainly the a 6/22/2009 11:45 am: RN at Dr's office called s 6/22/2009 Hot, reddened skin from elbow to sh 6/24/2009 Pt. reported "low grade fever" the ev 6/24/2009 R arm warmth eryth and 1 vesicle ju 6/24/2009 Late evening of day she received va 6/24/2009 Received vaccine at 830 AM and by 6/24/2009 Pt. with erythematous plaque to L d 6/24/2009 6-11-09 approx 2 pm ZOSTAVAX g 6/24/2009 Information has been received throu 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/20/2009 Pt had stroke-like symptoms such a 6/20/2009 Pt was given a flu shot on Monday. 6/16/2009 Received PNEUMOVAX 0.5 ml IM 6 6/19/2009 Pt came to hospital for routine medi 6/11/2009 ADACEL given in high left shoulder 6/22/2009 6/21 fussy, cranky, clingy, sl. decrea 6/18/2009 redness, swelling, warm to touch at 6/22/2009 45 to 60 seconds after injection, pat 6/22/2009 L thigh with erythema, swelling, war 5/12/2009 Swelling and redness, tenderness in 6/2/2009 Mother and patient reports that patie 6/20/2009 Had bilat. leg pain and refusal to wa 6/19/2009 Tired, weakness, SOB on exertion ( 5/27/2009 Mom called on 5-27 and stated child 6/16/2009 T 00:30 on 6-10-09 c/o headache th 6/19/2009 pt sits on exam table - gave MENAC 6/21/2009 I received the shingles vaccine hopi 6/25/2009 None Stated 6/25/2009 None stated. 6/25/2009 None given 6/25/2009 Patient presented with Bell's Palsy o 6/25/2009 Pt Rcd Pneumococcal vaccine in th 6/25/2009 None Stated 6/25/2009 None stated. 6/22/2009 Patient had temp 100.3, unable to w 6/25/2009 None known. Y 7/2/09 Medical Exami 6/25/2009 Lump at injection site, feels tender a 6/25/2009 6/19/09 patient felt some pain in her 6/25/2009 On June 3, 2009, client returned to 6/25/2009 SWOLLEN RED PATCH ON RIGHT 6/25/2009 Patient is a 61 year old MALE who p
350138 350139 350140 350141 350142 350145 350146 350150 350152 350153 350156 350157 350158 350159 350160 350161 350162 350163 350164 350165 350166 350167 350168 350169 350170 350837 350841 350842 350843 350844 350845 350846 350847 350231 350234 350235 350241 350245 350246 350247 350248 350249 350250 350251 350252 350253 350254 350255 350256 350257 350258
6/25/2009 OH 6/25/2009 MI 6/25/2009 TX 6/25/2009 IN 6/25/2009 CA 6/25/2009 6/25/2009 NY 6/25/2009 IL 6/25/2009 PA 6/25/2009 FL 6/25/2009 6/25/2009 MA 6/25/2009 AL 6/25/2009 AZ 6/25/2009 ME 6/25/2009 NH 6/25/2009 IA 6/25/2009 WA 6/25/2009 NY 6/25/2009 OR 6/25/2009 TX 6/25/2009 TX 6/25/2009 TX 6/25/2009 AZ 6/25/2009 NY 6/25/2009 6/25/2009 IL 6/25/2009 MT 6/25/2009 WA 6/25/2009 WA 6/25/2009 WA 6/25/2009 WA 6/25/2009 6/26/2009 6/26/2009 NY 6/26/2009 6/26/2009 MI 6/26/2009 TN 6/26/2009 OR 6/26/2009 VA 6/26/2009 MI 6/26/2009 TN 6/26/2009 PA 6/26/2009 GA 6/26/2009 WI 6/26/2009 MD 6/26/2009 ME 6/26/2009 RI 6/26/2009 LA 6/26/2009 MD 6/26/2009 OR
21 15 24 0.2 22 50 0.1 4 20 17 11 0.2 5 0.5 21 6 0.6 19 7 63 3 2 3 1 4
21 15 24 0 22 50 0 4 11 17 11 0 5 0 21
59 80
59
79 15 22 15 1 1 0.2 14 1.4 0.5 0.2 17 0.5 1.5 66 49 57 4 0.2
79
0 19 7 63 3 2 3 1 4
22 15 1 1 0 14 1 0 0 17 1 66 49 57 4 0
F F F 0.2 F F M 0.1 F F F F F 0.2 F M 0.5 M M M 0.6 M F M M M 0.1 M F 0F M M F M U U U U F M F F 0F 0M 0.2 M F 0.4 F 0.5 M 0.2 F M M 0.5 M F F M F 0.2 F
6/25/2009 6/15/09 Fever of 102, vomiting, and 6/25/2009 Patient given VFC DTAP. No adver 6/25/2009 Employee recieved 4 vaccines, Hep 6/25/2009 Administered 2 doses of hepatitis B 6/25/2009 Patient received Hep A and Tdap va 6/29/2009 Immediate myalgias after injection. 6/25/2009 All vaccines listed given at 29 days 6/25/2009 Received KINRIX on 6.22.09. Per m 6/24/2009 Mother called @ 10 am 6/24/09 to s 6/23/2009 Pt had a vasovagal reaction abut 5 6/25/2009 Cellulitis to R arm. 6/25/2009 Fussy baby T-99. Red, swollen at si 5/11/2009 Patient would present himself off & 6/19/2009 Swelling of right thigh and bruising. 6/11/2009 Itching, redness, heat, tender, firm a 6/19/2009 Extensive macular rash started 2 da 6/18/2009 progressive decreased motor skills 6/25/2009 VHC re-contacted by pt mid-Jun 200 6/22/2009 One day after administration of vacc 6/15/2009 Evening of injection: Chills, Nausea 6/25/2009 None stated. 6/25/2009 None stated. 6/25/2009 None stated 6/25/2009 Red papular rash at injection site - ( 6/25/2009 Developed AM of 6/25/09 L upper a 6/19/2009 Report received from a physician on 6/22/2009 Migraine. Migraine with loss of centr 6/22/2009 Report received from a nurse on 03 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Report received from a paramedic/f 6/22/2009 Injection site pain lasting 3 months 6/25/2009 Information has been received from 6/25/2009 Information has been received from 6/25/2009 Information has been received from 6/25/2009 Follow-up information received from 6/19/2009 Vaccines given MMR and Varicella. 6/22/2009 Extreme crying baby in severe pain6/22/2009 Mother came to health dept today a 6/25/2009 None stated 5/19/2009 Mo states child spiked temp of 101. 4/1/2009 Symptom: Bright red blood in stool 6/18/2009 Tongue and throat swelling, chest p Hives- Diphenhydramine 6/24/2009 5/26/09 Fever, went to ED -> Dx wit 5/21/2009 Developed elbow and knee burning 6/22/2009 Persistent pain in left arm after rece 6/17/2009 6/17/09 Dr reported to me that 3 da 6/24/2009 Fever, runny nose, coughing Dx 6/1 6/22/2009 Extremely fussy, screaming, incons
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6/26/2009 AZ 6/26/2009 AZ 6/26/2009 FL 6/26/2009 OR 6/26/2009 DC 6/26/2009 GA 6/26/2009 IA 6/26/2009 PA 6/26/2009 PA 6/26/2009 WI 6/26/2009 AZ 6/26/2009 IL 6/26/2009 TX 6/26/2009 PA 6/26/2009 OK 6/26/2009 NV 6/26/2009 MO 6/26/2009 NC 6/26/2009 OR 6/26/2009 VA 6/26/2009 MN 6/26/2009 MN 6/26/2009 WI 6/26/2009 CA 6/26/2009 MO 6/26/2009 IA 6/26/2009 OK 6/26/2009 ME 6/26/2009 CA 6/26/2009 CA 6/26/2009 MA 6/26/2009 NJ 6/26/2009 CA 6/26/2009 UT 6/26/2009 CO 6/26/2009 PA 6/27/2009 MI 6/28/2009 GA 6/28/2009 PA 6/28/2009 RI 6/29/2009 6/29/2009 NJ 6/29/2009 6/29/2009 6/29/2009 NY 6/29/2009 IL 6/29/2009 MI 6/29/2009 GA 6/29/2009 MA 6/29/2009 MI 6/29/2009 TX
11 15
11 15
71 27 0.3 59 20 20 24 25 5 4 63 2 4
71 27 0 59 20 20 24 25 5 4 63 2 4 72 0 61 64 32 1 13 13 19 37
0.2 61 64 32 1.1 13 13 19 37 1.3 1.2 5 16 1 0.2
1 4 1 5 16 0 0
11 66 2 68 1.1 16 18 20
11 66 2 68 1 16 18 20
72 13 74 15 36 0.3
72 13 74 15 36 0
F F F U F 0.3 F U M M F F M M F 0.1 M M F 0.2 M F F F 0.1 M F F M F U 0.3 U F 0.2 F F F 1F 0.2 M M F M 0.1 M M 0.1 F F F F F F F M F F 0.3 M F
6/19/2009 Erythema @ injection site 6/23/2009 Immediately after varicella vaccine, 6/24/2009 Post immunization client developed 6-11-09 After shot, arm swell up, tur On 6/1/09, pt. called & left a messag 6/26/2009 Fever started about 6 to 8 hours aft 6/26/2009 Achey on 6-3-09. Severe pain in arm 6/26/2009 Patient had symptoms of dizziness 6/26/2009 About eight hours after vaccine adm 6/26/2009 Developed nausea and vomiting, in 6/26/2009 Patient presents to clinic at approxim 6/26/2009 Client was given a Dtap/Polio IM inj 6/26/2009 PATIENT HAD KINRIX ON 06-23-2 6/26/2009 itchy red welt, larger then usual 6/26/2009 Large area of erythema with a sligh 6/26/2009 red, blotchy, hard, swollen around th 6/26/2009 red, raised swollen area approx 4x4 6/26/2009 Several hours after receiving Oral R 6/26/2009 A couple hours after the vaccination 6/26/2009 Her arm was swollen all the way do 6/26/2009 Expired vaccine administered inadv 6/26/2009 Expired vaccine administered inadv 6/26/2009 Patient received Menactra and variv 6/26/2009 Immediately following vaccine, patie 6/28/2009 Pt given TWINRIX 1ml, Tdap 0.5 ml 6/26/2009 Patient was given an MMR by agen Temp 102 sweats, dizziness. Diffuse urticaria that started about 1 6/25/2009 Arm swelling - 1 1/2 cm circumferen 6/26/2009 Per mother of child: See attachmen 6/26/2009 DTaP given 6/24/09. 6/26/09 woke 6/26/2009 30 minutes after receiving GARDAS 6/25/2009 After few minutes of MMR + Varicel 6/26/2009 Child with 3hr prolonged crying epis 6/26/2009 Received imms. 6/9/09. On 6/10/09 6/26/2009 R arm red with warmth ~ 6-7 cm dia 6/27/2009 On March 24,2009 received injectio 6/28/2009 fussy, loss of appetite, fever as high 6/28/2009 severe asthma attack, no fever, sinu 6/28/2009 PATIENT STARTED WITH A FEVE 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/26/2009 Information has been received from 6/22/2009 Patient experienced two episodes o 6/29/2009 For 2 days, pt experience moderate 6/29/2009 Pt contacted Merck first to report ad 6/29/2009 Chronic Hives...They were first notic 6/29/2009 Next day, pt called to report GI sxs: 6/29/2009 TEMP 99.7 TO 100.8 FOR 2 DAYS 6/29/2009 right arm started getting red over 24
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6/29/2009 MD 6/29/2009 MA 6/29/2009 CA 6/29/2009 PA 6/29/2009 TX 6/29/2009 MO 6/29/2009 OH 6/29/2009 NY 6/29/2009 AZ 6/29/2009 CA 6/29/2009 WA 6/29/2009 WA 6/29/2009 CA 6/29/2009 6/29/2009 CO 6/29/2009 IN 6/29/2009 NE 6/29/2009 6/29/2009 6/29/2009 6/29/2009 LA 6/29/2009 6/29/2009 6/29/2009 6/29/2009 6/29/2009 LA 6/29/2009 6/29/2009 MA 6/29/2009 6/29/2009 6/29/2009 PR 6/29/2009 6/29/2009 6/29/2009 6/29/2009 AZ 6/29/2009 6/29/2009 SD 6/29/2009 PA 6/29/2009 6/29/2009 CA 6/29/2009 SC 6/29/2009 IL 6/29/2009 ID 6/29/2009 CA 6/29/2009 IN 6/29/2009 CO 6/29/2009 CO 6/29/2009 6/29/2009 NJ 6/29/2009 MN 6/29/2009 ND
1.1 21 4 17 64 45 0.9 23 1 63 43 62 5
1 21 4 17 64 45 0 23 0 63 43 62 5
17 10 0.6
17 10 0
12
12
32
32
65
65
21
21
1.8 0.4 68 19 18 19 14 4 0.2 14 12 25 17 18 49
1 0 19 18 14 4 0 14 12 25 17 18 49
0.1 F F F F F F 1M F 0M F F F M U M F 0.6 M U U U M U U U U M U M U U U U U U M U 0.8 M 0.4 M F F F F M F 0.2 F F M M F M F
6/29/2009 rash at injection site, R leg "hundred 6/29/2009 First event 4 days after vaccine (2nd 6/29/2009 Received DTaP, MMR, IPV, Varivax 6/29/2009 Patiet received Menactra, Gardisil, A 6/29/2009 ON 6/27/2009 CLIENT NOTICED T 6/29/2009 Severe aches in joints, especially in 6/29/2009 Uncontrollable crying, arching back 6/29/2009 Client stated that she developed hiv 6/29/2009 RED ITCHY BUMPS ON BADY NO 6/29/2009 Patient received Zostavax vaccine o 2 days after vaccination temp. - sore 6/22/2009 05-27-09 Right hand swollen, numb 6/24/2009 Reported by mother: 5/8 Right arm 6/30/2009 We received the following literature 6/23/2009 After taking 2 doses of VIVOTIF, de 6/26/2009 Client immediately suffered syncope 6/15/2009 1st set (PENTACEL, HVB, PCV7, R 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/9/2009 Approx. 5 minutes after receiving va 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/4/2009 Pt reported swollen lymph nodes to 6/30/2009 We received the following literature 6/18/2009 Pt experienced arm pain and should 6/30/2009 We received the following literature 6/30/2009 We received the following literature Headaches, irritation, lack of sweat 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/30/2009 We received the following literature 6/8/2009 Fevers, rash/pustules, RX with NSA 6/30/2009 We received the following literature 6/23/2009 Tdap given instead of DTaP, no rea 6/29/2009 Sudden Death. Y 8/12/09 Autopsy re 6/1/2009 Erythema, swelling, tenderness (all 6/29/2009 Pt c/o headache, the began c/o sen 6/25/2009 Severe HA, myalgias, back pain, LE 6/26/2009 Fainted about 2 - 3min after receivin 6/25/2009 Child was accidently given PCV-7 in 6/25/2009 Left arm with 4/3" reddened area. W 6/29/2009 Diarrhea since day after vaccine up 6/29/2009 Pt was given dose of TDAP, MENAC 6/29/2009 Pt was given 2 doses of TDAP and 6/29/2009 Consultation with the Vaccine Healt 4/9/2009 Hives seen @ ER 3/6/09 6/24/2009 Spiked temp > 103 degrees F @ 2A 6/26/2009 Redness & swelling size - began 50
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6/29/2009 AZ 6/29/2009 CA 6/29/2009 WI 6/29/2009 NV 6/29/2009 CA 6/29/2009 CA 6/29/2009 OH 6/29/2009 CA 6/29/2009 WA 6/29/2009 6/30/2009 OH 6/30/2009 MD 6/30/2009 FL 6/30/2009 6/30/2009 CA 6/30/2009 GA 6/30/2009 IL 6/30/2009 CA 6/30/2009 PA 6/30/2009 IL 6/30/2009 MI 6/30/2009 NY 6/30/2009 CT 6/30/2009 VA 6/30/2009 6/30/2009 PA 6/30/2009 KY 6/30/2009 TN 6/30/2009 OR 6/30/2009 OR 6/30/2009 PA 6/30/2009 LA 6/30/2009 MI 6/30/2009 CO 6/30/2009 CO 6/30/2009 MO 6/30/2009 NC 6/30/2009 VA 6/30/2009 VA 6/30/2009 OK 6/30/2009 CA 6/30/2009 OH 6/30/2009 CO 6/30/2009 CA 6/30/2009 MA 6/30/2009 NY 6/30/2009 PA 6/30/2009 PR 6/30/2009 CO 6/30/2009 WI 6/30/2009
21 60 15 1.3 43 32 80 72 1 54 16 14 14 15 80 0.5 17 11 33 11 1 4 4 38 0.5 15 16 52 1 15 10 0.5 82 6 5 56 10 75 18 18 54 14 52 0.6 4 5 46 77 43 21
21 60 15 1 43 32 80 72 1 16
0 17 33 11 1 4 4 38 0 15 16 52 1 15 10 0 82 6 5 56 10 75 18 54 14 52 4 0 4 5 46 77 43 21
F F M 0.3 M F F F M 0M F F F F F F 0.5 F F U M M 0M M F F 0.5 M F F F 0M M F 0.5 M F F F F F M M M F F F F 0.6 F M F M F F M
6/28/2009 Severe abdominal cramping & pain Injection site swollen, red, itchy - Pt 6/2/2009 Redness, swelling localized to injec 6/29/2009 Father of pt called office 6/25/09 sts 6/29/2009 06/29/09 Pt came in today c/o redn 6/16/2009 See attached notes. Edema, redness of entire circumfere 6/23/2009 L Deltoid persistent pain and mild te 6/22/2009 Patient developed 10 vesicular rash 6/22/2009 Redness, swelling, and a hard lump 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/29/2009 Information has been received from 6/26/2009 This case was received from a heal 6/26/2009 Initial report received 19 June 2009 6/25/2009 This case was retrieved from a new 6/24/2009 Pt. developed onset of paresthesias 6/25/2009 Pt was seen for annual physical 5/1 6/24/2009 1 yr old w/ h/o recurrent cough w/ w 6/25/2009 1. 6/15/09 called arm red & swollen 6/26/2009 C/o cellulitis of the left arm at the sit 6/26/2009 Pt received vaccine on 06/18/2009, 6/24/2007 Low grade fever w/ knot in left thigh 6/23/2009 (LT) upper arm weak & numb x 6 da 6/23/2009 PNEUMOVAX given @ 0900 on 6/2 6/24/2009 6/11/09 - Vaccine given. 6/12/ - 6/1 6/21/2009 Approximately 24 hours after vaccin 6/22/2009 Unwitnessed syncope vs possible s 6/29/2009 Generalized red papular rash every Hematoma to right thigh. Size smal 5- 27 - 28 - Hot flush - 5-28 - red rai 6/24/2009 Developed 20cm X 25cm area of re 6/24/2009 Developed 105 cm x 70 cm area of 6/24/2009 Tdap given Lt deltoid 6/20/09 - no p 6/24/2009 Pt given adacel - recommended for 6/25/2009 Redness in area of injection site. La 6/12/2009 FLUVIRIN was in box labeled PPD 6/23/2009 About 1 hr after immunization (10:3 6/23/2009 Pt returned c/o pain and swelling (L 6/24/2009 On 6-23-09 received Hep A and MC 6/25/2009 Area of Lt arm, red tender and hot. 5/24/2009 Swollen arm, redness, hardness pa 6/25/2009 Mom reported fever 103 + irritability 6/24/2009 Significant local reaction on L arm, r 6/25/2009 Red rash local to inject - fussy and f 6/24/2009 Hand pain, joint pain, diarrhea, high 6/25/2009 Redness, tender, sore, red, warm to 6/25/2009 2 inch lump, itching, hot to the touch 6/18/2009 Right shoulder pain for a couple of w
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6/30/2009 WA 6/30/2009 TX 6/30/2009 AR 6/30/2009 NY 6/30/2009 CA 6/30/2009 MI 6/30/2009 MI 6/30/2009 KS 6/30/2009 MD 6/30/2009 OK 6/30/2009 TN 6/30/2009 TN 6/30/2009 OR 6/30/2009 PA 6/30/2009 MI 6/30/2009 TX 6/30/2009 NC 6/30/2009 IN 6/30/2009 CO 6/30/2009 TN 6/30/2009 NJ 6/30/2009 TX 6/30/2009 IL 6/30/2009 HI 6/30/2009 WA 6/30/2009 NY 6/30/2009 MO 6/30/2009 UT 6/30/2009 LA 6/30/2009 NV 6/30/2009 NY 6/30/2009 WA 6/30/2009 VT 6/30/2009 NJ 6/30/2009 CA 6/30/2009 IA 6/30/2009 KY 6/30/2009 VA 6/30/2009 CO 6/30/2009 AL 6/30/2009 CA 6/30/2009 WI 6/30/2009 MN 7/1/2009 WV 7/1/2009 TX 7/1/2009 NC 7/1/2009 ND 7/1/2009 HI 7/1/2009 FL 7/1/2009 NJ 7/1/2009
22 16 4
22 16 4
14 0.5 1.5 2 14 12 20 51 19 1 14 27 49 11 63 0.6 1 18 11 16 13 14 0.2 5 3 4 11 66 2 15 20 4 49 19 4 1 59 29 5 18 11 0.2 13 48 12
14 0 1 2 14 12 20 51
26
26
1 14 27 49 11 63 0 1 18 11 16 13 14 0 5 3 4 11 66 2 15 20 4 49 19 4 0 59 29 5 16 11 0 13 48 12
F M M M F 0.5 M 0.5 M 0.4 F M F F M F 0M F M F M F 0.6 M 0M M F F F F 0.2 M F M M M M 0.3 M M M F F M F 1F F F M F M 0.2 M F F M F F
6/29/2009 Pt. turned white and became sick/fe 6/30/2009 Headache, nausea, fatigue 6/25/2009 Significant local reaction. - *see atta 6/30/2009 This case was reported by a physici 6/28/2009 Faints - blacks out - low blood press 6/30/2009 No reaction 6/30/2009 Pt came in w/ rash all over body on 6/30/2009 Pain in left leg, high fever, refused t 6/30/2009 starting having bloody noses at app 6/30/2009 Pt left clinic with mom approx 5 min 6/30/2009 Pt called office to report approx 12 h 6/30/2009 Vaccine administered 6-22-09, 2nd 6/30/2009 Erythema, edema, hives, lymphade 6/30/2009 pt with c/o rash onset 6/28/2009 and 6/30/2009 fainted immediatley with slight jerkin 6/30/2009 Pt received vaccines ~ 1230 pm. Pt 6/30/2009 Patient states that Right arm becam 6/30/2009 Patient passed out in the hallway ab 6/30/2009 The patient experienced hives 1 we 6/30/2009 Patient received Rotateq 6-12-09, o 6/30/2009 Temperature elevation 104 degrees 6/30/2009 No adverse reaction noted. Verified 6/30/2009 Shot was administered around 4:15 6/30/2009 Pt c/o "dizziness", stomach pain wit 6/30/2009 Inability to close right eye, facial num 6/30/2009 Patient received Varivax, Gardasil, a 6/30/2009 Rotateq given on 6-18-09 & patient 6/30/2009 Patient had swelling of the eye's, lip 6/30/2009 My son received two vaccinations, H 6/30/2009 Child was evaluated on 6/30/09 and 6/30/2009 Matthew developed bright red macu 6/30/2009 About 2 hours after vaccine adminis 6/30/2009 High fever,lethargic,shakes,chills,no 6/30/2009 chest pain, myocarditis treated with 6/30/2009 Pt was in excellent health prior to se 6/26/2009 24 hrs after shot 2 areas of large bli 6/30/2009 Swelling and redness of right arm. 6/30/2009 Corneal abrasion/ shield ulcer follow 6/29/2009 About 10 minutes after vaccination 6/30/2009 06/25/09 - Started with multiple sma 6/30/2009 Within a few hours of receiving TDA 6/30/2009 Hard lump in arm swelling & pain 6/25/2009 This case was reported by a physici 7/1/2009 felt very weak/ shakey. Chest was t 6/24/2009 Wheeze, stridor, cough and shortne 6/26/2009 6 days following ROTATEQ vaccine 6/29/2009 Depression, mood swings, change i 6/24/2009 Swelling, Redness, Soreness 6cm X 6/27/2009 Fever, chills, cold hands, pain in leg 6/29/2009 Initial report was received 25 June 2 6/30/2009 Information has been received from
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7/1/2009 WA 7/1/2009 7/1/2009 MO 7/1/2009 OK 7/1/2009 WV 7/1/2009 PA 7/1/2009 OH 7/1/2009 NV 7/1/2009 MI 7/1/2009 NC 7/1/2009 CA 7/1/2009 OH 7/1/2009 DE 7/1/2009 IL 7/1/2009 TX 7/1/2009 VA 7/1/2009 WA 7/1/2009 NC 7/1/2009 AZ 7/1/2009 CA 7/1/2009 IL 7/1/2009 WA 7/1/2009 IL 7/1/2009 OH 7/1/2009 GA 7/1/2009 MI 7/1/2009 MN 7/1/2009 NH 7/1/2009 TX 7/1/2009 TX 7/2/2009 GU 7/2/2009 MI 7/2/2009 7/2/2009 NM 7/2/2009 PA 7/2/2009 VA 7/2/2009 OH 7/2/2009 IL 7/2/2009 VA 7/2/2009 SC 7/2/2009 NY 7/2/2009 IL 7/2/2009 IL 7/2/2009 7/2/2009 VA 7/2/2009 KS 7/2/2009 IL 7/2/2009 GA 7/2/2009 KY 7/2/2009 LA 7/2/2009 WI
53 2 36 18 1.3 52 20 53 4 5 0 11 25 45 12 11 12 60 38 5 0.5 43 13 0.2 0.5 1 33 0.7 12 15 20 0.1 1 77 4 14 17 16 20 5 14
53 2 36 18 1 52 20 53 4 5 0 11 25 45 12 11 12 60 38 5 0 43 13 0 0 12 1 33 0 12 15 20 0 1 77 4 14 17 16 20 5 14
5 17 0.2 69 0.2 4
5 17 0 69 0 4
F F 0.1 F F M 0.3 M F F F F M 0F M F F M F F F M F 0.5 F M F 0.2 M 0.5 F M 0F F 0.7 M F F F 0.1 F 0F F M F F U F F F F F M M 0.2 M M 0.2 F M
6/29/2009 Initial report received 25 June 2009 6/30/2009 Information has been received from 7/1/2009 After patient's Hepatitis A immuniza 7/1/2009 Patient was given inital dose of Tda 7/1/2009 Developed syncope immediately fol 7/1/2009 Varicella vaccine breakthrough. Dia 7/1/2009 6/12/09 - Pt presented to the emerg 7/1/2009 Pt stopped breathing and had a car 7/1/2009 On 06/19/09 pt received Tdap.That 7/1/2009 06/30/09 MT REPORTS CHILD FEL 7/1/2009 LOCAL REACTION TO L UPPER A 7/1/2009 FIRST DOSE OF HEPATITIS B WA 7/1/2009 With in 10 min after Varivax vaccine 7/1/2009 PERSISTENT PAIN IN LEFT DELT 7/1/2009 Rcvd Varivax on 5/29/09. Reports s 7/1/2009 Circular area (1 3/4"x1 1/4") of mild 7/1/2009 After giving last injection (which was 7/1/2009 4 cm area of swelling/induration aro 6/30/2009 Extreme watery diarrhea, nausea, s 6/16/2009 Visual changes after AVA 1 and 2. 6/30/2009 Child recd #2 dose of VARICELLA o 7/1/2009 Received immunizations 6/29/2009 7/1/2009 Localized skin reaction. Red raised 6-30-09 4:45 pm pt. c/o tingling in a 6/26/2009 Hypotensive episode - pallor & unre 7/1/2009 None 7/1/2009 R arm pain, redness and swelling. 7/1/2009 Mom reported to -us on 6-30-09 tha 7/1/2009 It happened around March 12 and t 6/29/2009 I did not mix the DTaP IPV solution 7/2/2009 SHE WAS GIVEN GARDASIL 1 ST 7/1/2009 Pt was also given T-DAP- MENACT 6/30/2009 I am unsure if the lateral neuropathy Right deltoid area of redness, heat, 6/28/2009 None stated 6/30/2009 Cluster of blisters on hand. Tender 6/25/2009 Erythema around site and down me 6/30/2009 Immediately following immunization 7/7/2009 Tetanus has been hurting since inje Vaccines prior to 11:30 AM 7/1/200 7/12/2009 Dizziness, light headed, fever, naus 6/29/2009 Red, swollen. Hard lump at injection 7/2/2009 Developed pain, swelling and decre 7/1/2009 InformationYhas been received from 7/1/2009 Information has been received from 7/2/2009 This case was reported by a healthc 7/2/2009 4/20/09 Later in the day, respiratory 7/2/2009 Patient was given Immunizations on 7/2/2009 I am experiencing itchiness--Thumb 7/2/2009 Persistent (more than 3 weeks) muc 7/2/2009 Mother reported temperature of 104
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7/2/2009 WI 7/2/2009 GA 7/2/2009 AK 7/2/2009 CA 7/2/2009 VA 7/2/2009 PA 7/2/2009 CA 7/2/2009 CA 7/2/2009 NJ 7/2/2009 7/2/2009 NH 7/2/2009 LA 7/2/2009 MS 7/2/2009 MI 7/2/2009 PA 7/2/2009 CA 7/3/2009 OH 7/3/2009 PA 7/3/2009 PA 7/3/2009 IL 7/3/2009 TX 7/4/2009 MN 7/4/2009 NY 7/4/2009 PA 7/4/2009 AR 7/5/2009 MD 7/5/2009 MD 7/6/2009 CT 7/6/2009 RI 7/6/2009 7/6/2009 NY 7/6/2009 7/6/2009 PA 7/6/2009 KY 7/6/2009 7/6/2009 7/6/2009 PA 7/6/2009 DC 7/6/2009 NJ 7/6/2009 OH 7/6/2009 NY 7/6/2009 IL 7/6/2009 MO 7/6/2009 IL 7/6/2009 WA 7/6/2009 OH 7/6/2009 CA 7/6/2009 NE 7/6/2009 CA 7/6/2009 NC 7/6/2009 MI
5 0.2 35 71 64 20 4 21 4 33 11 16 4 1.8 49 12 10 5 2 14 0.5 1 29 0.4 1 60 17 23 16 16 22 15 18 14 0.3 0.3 19 17 16 75 5 14 14 14 69 52 5 0.2 52 48 76
5 0 45 71 64 20 4 21 4 33 11 16 4 1 49 12 10 5 2 14 0 1 29 0 1 60 17 16 16 22 18
17 16 75 4 14 14 14 69 52 5 0 52 48 76
M 0.2 M F F F F M F M F M F M 0.8 M F F F F 0.2 F F 0.5 U 0F F 0.4 F 0F M F F F F F F F F M M F M M F M F M F M F U 0.2 M F F M
7/2/2009 Fever began 6-4-09 with small red a 7/2/2009 Fussy, crying, hard to console, on a 7/2/2009 Severe pain in upper arm at site of i 7/2/2009 generalize rash - chicken pox lesion 7/2/2009 Bump and rash at injection site deve 7/2/2009 Pt came for Adagio visit, HPV # 3 d None stated. 7/2/2009 6/15/09 Pt. to clinic to receive HPV 7/2/2009 RA swollen the whole length of the 7/2/2009 Same day as received last AVA, no 7/2/2009 (L) arm where he received MENACT 7/2/2009 TDAP administered, then MCV - 4 g 7/1/2009 Pt. received vaccines Monday 6/29/ 7/1/2009 Patient had bumps- Red on arm and 7/1/2009 Erythema, edema, tenderness at inj 6/25/2009 Swelling & redness left arm @ site o 7/3/2009 After administration of albuterol neb 7/3/2009 child recieved dtap on 7\2\2009 was 7/3/2009 Approximately 45 minutes after the 6/19/2009 Pt. received HPV vaccine for 1st tim Swelling and redness at injection sit 7/3/2009 Herpes Zoster involving the left side 7/4/2009 received tetanus shot and was diag 7/4/2009 Patient was unusually sleepy the da 7/4/2009 Mild rash of varicella 7/5/2009 My left upper arm, where the injectio 7/5/2009 The patient received gardisil #1, Td 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Initial and follow-up information has 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/2/2009 Information has been received from 7/6/2009 Patient developed fevers about 2-3 7/6/2009 SEEN ON 6/30/09 FOR 16 YEAR O 7/6/2009 Client reports on Sat., July 4, 09, sh 7/6/2009 redness, diaphoresis, early analphy 7/6/2009 Fainted after recieving immunization 6/29/2009 Felt ill day after infection, by 7:00 p. 7/6/2009 Patient recieved shots, walked out o 7/6/2009 PATIENT DEVELOPED ATRIAL FL 7/6/2009 After receiving both vaccines, patien 7/6/2009 reddness and swelling at injection s 7/6/2009 Edema at site approx 3 hours post i 7/6/2009 severe rash developed by 7/1/09. ra 7/6/2009 PATIENT COMPLAINS OF SWELL 7/6/2009 Hives Tx 50 mg prednisone x 3 day
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7/6/2009 FL 7/6/2009 WA 7/6/2009 NJ 7/6/2009 TN 7/6/2009 MI 7/6/2009 KY 7/6/2009 UT 7/6/2009 NC 7/6/2009 MS 7/6/2009 FL 7/6/2009 FL 7/6/2009 FL 7/6/2009 OR 7/6/2009 CA 7/6/2009 NJ 7/6/2009 IA 7/6/2009 AR 7/6/2009 NC 7/6/2009 AZ 7/6/2009 WI 7/6/2009 NJ 7/6/2009 MI 7/7/2009 TX 7/7/2009 TX 7/7/2009 TX 7/7/2009 7/7/2009 PA 7/7/2009 PA 7/7/2009 7/7/2009 VA 7/7/2009 7/7/2009 TX 7/7/2009 KY 7/7/2009 AR 7/7/2009 TX 7/7/2009 WI 7/7/2009 CA 7/7/2009 TX 7/7/2009 LA 7/7/2009 NY 7/7/2009 7/7/2009 VA 7/7/2009 CA 7/7/2009 NY 7/7/2009 TX 7/7/2009 VA 7/7/2009 PA 7/7/2009 OH 7/7/2009 MA 7/7/2009 PA 7/7/2009 PA
1.3 25 70 4 1.4 14 10 0 1.8 1.7 0 0 54 4 4 80 16 15 0.3 2 12 68 7 9 72
1 25 70 4 1 14 10 0 1 1 0 0 54 4 4 80 16 15 0 2 12 68 7 9
24 15
24 15
23 18
23
11 0.4 0.5 17 61 0.3 1.1 17 27 14 1.6 1 61 1.3 52 22 63 1 13.5
11 0 0 17 61 0 1 17 27 14 1 1 61 1 52 22 63 1 13
0.3 F M F F 0.4 F F F 0F 0.8 M 0.7 F 0M 0F F M M F F F 0.3 M 0.1 F F F F F F U F F F F F F M 0.4 F 0.5 F F F 0.3 M 0.1 M F M F 0.6 M 0M F 0.3 M F F F 0M F
7/6/2009 Temp to 103 degrees started at 6pm 7/6/2009 Pt presents to the clinic with 3 day h 6/25/2009 OV made to inform PHN that approx 7/1/2009 Redness, warmth, tenderness to lef 7/6/2009 Wheal and flared urticaria scattered 6/30/2009 14 yr old fe here today with Aunt (w 1/6/2009 Arm swelled up after it was given. R 6/26/2009 1 X 3 cm area of erythema but no in 6/29/2009 Mom called office 9:10 am 6/29/09 r 6/24/2009 On 6/11/09, we have this 20-month 7/6/2009 Infant accidentally received RUBEL 7/6/2009 Infant accidentally received Rubella 7/6/2009 Low grade fever, nausea, headache 7/3/2009 Pt had DTAP vaccine 6/29/09 @ Lt 7/6/2009 Area red, swollen, warm to touch at 7/6/2009 1 day lump X 2 days 1 1/2 dollar siz 7/6/2009 Red, raised area to right upper arm. 7/6/2009 This case was reported by a physici 7/2/2009 On 6/21/09 mother put infant to slee 6/30/2009 Unable to bear full weight. Fever, R 6/23/2009 GARDASIL. Redness, swelling area 6/23/2009 Less than one week later sleepines 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 Initial information has been received 7/6/2009 Information has been received from 7/6/2009 Information has been received from 7/6/2009 It was reported in a newspaper artic 7/6/2009 Information has been received from 7/2/2009 Initial report received on 24 June 20 6/15/2009 Mom states infant started having dia 6/26/2009 Pt was admitted to hospital on 4/13/ 7/2/2009 Pt had 3rd GARDASIL Injection and 7/6/2009 2 cm raised red wheal 7/2/2009 Patient became very fussy and deve 6/25/2009 Local tissue reaction Left arm and R Day after injection had raised, red, h 6/23/2009 Onset of whole body maculopapula 6/29/2009 Pt. Was given 1st GARDASIL shot t 6/27/2009 Large induration over entire left oute 6/29/2009 While administering vaccines MMR 6/30/2009 Pt. stated that the next day. After th 7/1/2009 Erythematous blanchable rash on tr 6/30/2009 Pt 1st noticed pain in (L) hip on 6/23 4/25/2009 4/21/09 Headache, itching, rash, ch 6/30/2009 3 days after administration of vaccin 6/30/2009 Evening of 6/23 pt whole body turne 6/26/2009 6/24/09 redness, swelling, warmth,
350887 350888 350889 350890 350891 350892 350893 350894 350895 350896 350897 350898 350899 350900 350901 350902 350903 350904 350905 350906 350907 350908 350909 350910 350911 350912 350913 350914 350915 350916 350917 350918 350919 350920 350921 350922 350923 350924 350925 350926 350927 350928 350929 350930 350931 350932 350933 350934 350935 350936 350937
7/7/2009 IL 7/7/2009 NY 7/7/2009 NY 7/7/2009 TN 7/7/2009 NY 7/7/2009 AZ 7/7/2009 NE 7/7/2009 7/7/2009 NE 7/7/2009 CA 7/7/2009 NY 7/7/2009 MN 7/7/2009 IN 7/7/2009 AL 7/7/2009 CA 7/7/2009 TN 7/7/2009 NH 7/7/2009 CO 7/7/2009 NC 7/7/2009 IN 7/7/2009 TX 7/7/2009 MA 7/7/2009 CA 7/7/2009 CT 7/7/2009 NY 7/7/2009 PA 7/7/2009 AZ 7/7/2009 MN 7/7/2009 OR 7/7/2009 TX 7/7/2009 AL 7/7/2009 TN 7/7/2009 MA 7/7/2009 VT 7/7/2009 NY 7/7/2009 IN 7/7/2009 PA 7/7/2009 VT 7/7/2009 TX 7/7/2009 KS 7/7/2009 WI 7/7/2009 OH 7/7/2009 TX 7/7/2009 PA 7/7/2009 IA 7/7/2009 MI 7/7/2009 MN 7/7/2009 OR 7/7/2009 VT 7/7/2009 AZ 7/7/2009 MI
62 1.1 12 1 4 30 1.7 1 70 4 16 67 0.2 47 4 6 9 24 14 5 4 23 9 1.3 0.1 7 30 55 76 0.6 46 6 3 30 66 1.7 61 71 12 18 50 5 4 8 18 0.4 0.3 4 77 4 15
62 1 12 1 4 30 1 1 70 4 16 67 0 47 4 6 9 24 14 5 4 23 9 1 0 7 30 55 76 0 46 6 3 30 66 1 61 71 12 18 50 5 4 8 18 0 0 4 77 4 15
M 0.1 F F 0M M M 0.7 M 0U U F F F 0.2 F F F M M M M F M F F 0.3 M 0.1 M F F F F 0.6 M F M F F M 0.7 F F F M F F F F M F 0.4 F 0.4 M M F F F
6/25/2009 Patient developed bruising at injecti 7/1/2009 Fever + rash typical of rubella. 7/1/2009 At 12:15 pm pt. felt dizzy (6/30/09) a 6/25/2009 Patient had a area - 10 cm- area of 6/25/2009 Area of erythema and induration at 6/29/2009 14 days after vaccination postular ra 7/2/2009 8.5 cm X 3 cm area of tan/lt. brown Pt had eruption of pustules on eryth Red swollen, painful, hard felling (so 7/3/2009 Erythema and induration 7/1/2009 Patient received HPV #2 @ 4 pm 6/ 6/25/2009 Patient developed a red raised area 6/25/2009 Dad stated that immediately after th 7/1/2009 Pt had fever 102-103, body aches, s 9 x 7,5 cm erythematous induration 6/29/2009 Erythematous, swelling at site of inje 6/29/2009 Patient received the varicella vaccin 6/20/2009 Patient fainted, went white, no treat 7/2/2009 Pt had severe HA, myalgias followe 7/7/2009 Half dollar sized area of redness ov Left thigh swollen & hot to touch 7/3 6/30/2009 ER x2 6/22/09, Redness, fever, nau 6/28/2009 Within a few hours of vaccination th 6/30/2009 None. 7/1/2009 Admin IM Hep B dose # 2 of 3 at ap 6/29/2009 Rash started at site of injection with Pt received ACAM2000 on 6/25/09. 5/26/2009 No inflammation at deltoid but very 7/6/2009 Patient had ZOSTAVAX vaccine ad 7/7/2009 10 minutes after receiving DTaP, de 7/7/2009 Pt received vaccine on 6/26/09. On 6/29/2009 Erythematous swelling at site of inje 7/1/2009 Received DTaP on 6/30/09. c/o pain 7/7/2009 Three days after receiving started w 7/1/2009 Redness and swelling of arm. 6/29/2009 0 / parent notified of dose given out 6/19/2009 5/14/09 - Vaccination (itch, no fever 7/7/2009 Small bump, reddened ongoing afte 7/7/2009 Patient became extremely pale, ligh 7/7/2009 Site at varicella injection site becam 7/7/2009 On 7-3-09 came to work at 7am with 7/7/2009 Mother states has red spots with a w 7/7/2009 As per phone conversation w/ grand 7/7/2009 Varicella vaccine breakthrough. Ha 7/7/2009 7/01/2009 Dr. reported that patient h 7/7/2009 Mother states at 7 pm infant began 7/7/2009 About 30 minutes after vaccines we 7/7/2009 Left lower extremity swelling from th 7/7/2009 pt experienced swelling and rednes 7/7/2009 Redness and swelling of left arm tw 7/7/2009 Fever, Headache, Syncope
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7/7/2009 CT 7/7/2009 PA 7/7/2009 NV 7/7/2009 AZ 7/7/2009 CO 7/7/2009 CA 7/7/2009 CA 7/7/2009 NY 7/8/2009 CA 7/8/2009 7/8/2009 7/8/2009 7/8/2009 7/8/2009 OH 7/8/2009 7/8/2009 7/8/2009 GA 7/8/2009 GA 7/8/2009 NE 7/8/2009 IN 7/8/2009 GA 7/8/2009 SC 7/8/2009 CA 7/8/2009 WA 7/8/2009 NY 7/8/2009 MN 7/8/2009 VA 7/8/2009 NC 7/8/2009 KY 7/8/2009 IL 7/8/2009 MN 7/8/2009 AZ 7/8/2009 PA 7/8/2009 CA 7/8/2009 MA 7/8/2009 MI 7/8/2009 CA 7/8/2009 CA 7/8/2009 SD 7/8/2009 TX 7/8/2009 MA 7/8/2009 NC 7/8/2009 GA 7/8/2009 OH 7/8/2009 MI 7/8/2009 MO 7/8/2009 MN 7/9/2009 PA 7/9/2009 NY 7/9/2009 FL 7/9/2009
20 9.5 0.2 11 71 1.3 1.1 66 12 25 19
20 9 0 11 71 1 1 66 12
63 47
47
19 61 19 0.3 0.5 20 24 62 50 70 4 4
19 61 19 0 0 20 24 62 50 70 5 4
28 4 1 29 4 1 0.6 65 43
28 4 1
1.2 1 54 1.1 51 5 5 12 1.3 62 12
1 1 54 1 51 5 5 12 1 62
4 1 0 65 43
F F 0.2 F M F 0.3 M 0.1 M F F M F M M F U U F F F F 0.3 F 0.6 F F F F F F F M U F F 0M F F 0M 0.6 M F M F 0.2 M 0F M 0.1 F F M M F 0.3 M M F
7/7/2009 The injection was given on May 1, 2 7/1/2009 Varicella vaccine break through. Ha 7/7/2009 Right tonic-clonic seizure with left fa 7/7/2009 Pt. came in with headache, pain in l 7/7/2009 Developed 2 chickenpox like rashes 7/7/2009 Dtap and MMR where given on 06/2 7/7/2009 infant had shots app 11 days ago no 7/1/2009 Arm swelling at injection site - red fr 7/8/2009 Nausea and weakness days before 7/2/2009 After taking required doses of the A 7/4/2009 My daughter was encouraged to ha 6/17/2009 Narrative: The patient had a mild fe 6/8/2009 Per clinic note on 5/11/09- Patient h 7/6/2009 Initial report received on 30 June 20 7/7/2009 It was reported Y from an article publis 7/7/2009 It was reported Y from an article publis 7/7/2009 Information has been received from 7/8/2009 No adverse events or treatment nee 7/8/2009 Received S Zostavax and within an 7/8/2009 Pt received Hepatitis A & typhoid @ 7/8/2009 BLOOD IN STOOL 7/8/2009 Patient developed jerking movemen 7/8/2009 lower body paralysis. 7/9/09 Hospita 7/8/2009 after receiving inj. pt sat down and p 7/8/2009 Patient received TDaP injection to le 7/8/2009 Expired vaccine given inadvertantly 7/8/2009 area right outer and anterior upper a 7/8/2009 Patient was given Boostrix instead o 7/8/2009 Patient recieved vaccinations at the 7/8/2009 well he was looking at wheni was ca 7/8/2009 She is a 28-year-old intern in biosta 7/8/2009 Client's Mother called stating that sh 7/8/2009 Child screamed and cried for two fu 7/8/2009 Allergic Reaction five days after inje 7/8/2009 07/07/2008 PM (Less than 24 hours 7/7/2009 MMR vaccination given IM route. 7/7/2009 Fever/Seizure. Febrile seizure- eval 7/8/2009 Patient received ZOSTAVAX vaccin 7/7/2009 Severe pain at injection site. 6/29/2009 None Stated 7/8/2009 Received Varicella 7/1/09, 7/6/09 no 5/14/2009 Rash on chest, back and legs. 6/26/2009 1. Chin numbness. TX: CT of head. 7/8/2009 Multiple blisters at various stages of 7/8/2009 Pt presented to office one day after 7/8/2009 Right upper arm, redness, swollen, 6/25/2009 This case was reported by a physici 7/8/2009 Information has been received from 7/8/2009 Information has been received from 7/8/2009 Information has been received from 7/8/2009 Information has been received from
351039 7/9/2009 VA 351040 7/9/2009 ID 351049 7/9/2009 FL 351050 7/9/2009 PA 351051 7/9/2009 NY 351052 7/9/2009 MI 351053 7/9/2009 OR 351054 7/9/2009 CA 351055 7/9/2009 OH 351056 7/9/2009 MN 351057 7/9/2009 MD 351058 7/9/2009 AR 351059 7/9/2009 NC 351060 7/9/2009 OK 351061 7/9/2009 MA 351062 7/9/2009 OR 351063 7/9/2009 CA 351064 7/9/2009 CA 351065 7/9/2009 CA 351066 7/9/2009 OR 351067 7/9/2009 NJ 351068 7/9/2009 CA 351070 7/9/2009 NJ 351071 7/9/2009 WI 351072 7/9/2009 MD 351073 7/9/2009 IL 351074 7/9/2009 CO 351075 7/9/2009 CA 351076 7/9/2009 CA 351077 7/9/2009 PA 351078 7/9/2009 AZ 351079 7/9/2009 NJ 351080 7/9/2009 NJ 351081 7/9/2009 TX 351082 7/9/2009 CA 351083 7/9/2009 NJ 351084 7/9/2009 IL 351085 7/9/2009 KS 351086 7/9/2009 AZ 351087 7/9/2009 IN 351088 7/9/2009 NY 351089 7/9/2009 KY 351090 7/9/2009 CA 351091 7/9/2009 DE 351092 7/9/2009 IN 351093 7/9/2009 CA 351094 7/9/2009 MN 351095 7/9/2009 MN 351096 7/9/2009 PA 351069 7/10/2009 CA 351098 7/10/2009 NY
14 63 24 7 50 15 1 20 65 2 11 42 24 73 75 5 50 9 1.5 14 13 6 18 5 69 4 10 11 67 10 1.2 17 49 4 4 63 11 5 5 1.3 11 36 1.3 1.5 19 71 5 13 16 1 1.4
14 63 24 7 50 15 1 20 65 2 11 42 24 73 75 5 50 9 1 14 13 6 18 5 69 4 10 11 67 10 1 17 49 4 4 63 11 5 5 1 11 36 1 1 19 71 5 13 16 1 1
F F F F F M 0F F F 0M F F F M F M F F 0.4 M F F U M M F F F M F F 0.2 F F F M M F M F M 0.3 M M M 0.3 M 0.5 F M F F M F 0M 0.4 M
7/7/2009 Initial report was received 01 July 20 7/8/2009 Initial report received on 02 July 200 7/9/2009 It has been over 2 weeks since my 7/9/2009 Near syncope event. 7/9/2009 PINKISH DISCHARGE AT INJECTI 7/9/2009 After administration of vaccines. Clie 7/9/2009 Rash x1 week, develops water filled 7/9/2009 Client fainted after receiving immuiz 7/9/2009 Aproximately 15 minutes after vacci 7/9/2009 Within 12 hours of immuniation Chil 7/9/2009 Swelling, redness and warmth at inj 7/9/2009 Pt received Tdap 0.5ml Im in left de 7/9/2009 Pt received HPV vaccine on 14 Apr 7/9/2009 Received a call from son-in-law of p 7/9/2009 Shingles vaccine given at 1:35PM. A 7/9/2009 Vaccine given in Right deltoid. Nex 7/9/2009 Pt report onset of pain in joints on in 7/9/2009 Measures 10cm x 10cm Flat with ra 7/9/2009 Duplicate doses of DTap and IPV w 7/9/2009 Extreme fatigue (sleeping 20-22 hou 7/9/2009 Coughing, trouble breathing, loss of 7/9/2009 Severe swelling, induration, pain an 7/7/2009 Approx. less than a minute after vac 6/30/2009 Redness around injection site "hard 7/6/2009 1. Shot administered on Wed. 2. Th 7/1/2009 Right thigh (injection site) with 4 in x 6/26/2009 ZOSTAVAX was administered on 6/ 7/3/2009 Induration and erythema. 6/15/2009 Back pain, nausea and vomiting - p 7/3/2009 Patient received GARDASIL and DT 6/26/2009 Pt developed Varicella infection; < 5 7/8/2009 5cm by 4cm swollen right upper arm 7/9/2009 Received yellow fever vaccine on 7/ 7/9/2009 Redness, swelling R arm deltoid. 7/9/2009 Swelling, redness and pruritus. Mar 7/9/2009 Herpetic vesical 2" X 1" surrounded 7/9/2009 Child received vaccination 7-7-09; c 7/7/2009 Pt. received MMR and VARIVAX su 7/9/2009 Large area of erythema at deltoid ar 7/9/2009 L thigh sterile abscess with 5 X 3 cm 7/6/2009 Pt noticed erythema ~2 1/2 inches o 7/6/2009 7-2-09 - Leg, knee pain. 7-3-09 - Nu 7/2/2009 Received 15 mos vaccines. Develop 6/26/2009 Pt with sl swelling at site of injection 7/9/2009 Palpitations. 7/9/2009 (L) arm - red, swollen, tender to touc 6/18/2009 L upper arm swelling, temp and pain 7/9/2009 Approximately 12 hours after admin 6/8/2009 Initial report received on 02 June 20 7/10/2009 The varicella vaccination administer 7/1/2009 Febrile seizure 3:38 am after vaccin
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7/10/2009 AR 7/10/2009 7/10/2009 VA 7/10/2009 7/10/2009 CT 7/10/2009 TX 7/10/2009 NC 7/10/2009 AL 7/10/2009 MI 7/10/2009 TX 7/10/2009 CA 7/10/2009 MA 7/10/2009 MA 7/10/2009 PA 7/10/2009 IA 7/10/2009 AZ 7/10/2009 GA 7/10/2009 MI 7/10/2009 CA 7/10/2009 CA 7/10/2009 WI 7/10/2009 TX 7/10/2009 VA 7/10/2009 NC 7/10/2009 GA 7/10/2009 NY 7/10/2009 NY 7/10/2009 CA 7/10/2009 PA 7/10/2009 CA 7/10/2009 WA 7/10/2009 CA 7/10/2009 CA 7/10/2009 CA 7/10/2009 DE 7/10/2009 DC 7/10/2009 NC 7/10/2009 IA 7/10/2009 FL 7/10/2009 UT 7/10/2009 CA 7/10/2009 AR 7/11/2009 NJ 7/11/2009 NJ 7/11/2009 NC 7/11/2009 NY 7/11/2009 GA 7/11/2009 PR 7/11/2009 TX 7/12/2009 TX 7/12/2009 NY
12 72 65 88 10 0.7 74 5 17 15 74 60 76 11 0.2 26 18 1 22 0.3 56 12 37 19 0.2 20 16 8 66 4 18 11 4 1.2 75 4 8 85 38 53 3 52 27 31 60 15 37 18 0.1 24 24
65 88 10 0 74 5 17 15 74 60 76 11 0 26 18 1 22 0 56 12 37 19 0 20 16 8 66 4 18 11 4 1 75 4 8 85 38 53 3 52 27 31 60 15 37 18 0 24 24
F F M F F 0.7 F F F M F F F F M 0.2 F M M 0M F 0.2 M F M M F 0.2 M F F M M F F F F 0.2 F M M F F M M M F M F M F M M 0.1 F F M
7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Information has been received from 7/9/2009 Anaphylaxis - Vaccine given @ 1:45 7/9/2009 Immunizations followed about 4-5 h 7/10/2009 patient developed approx 12 raised 7/10/2009 Immunization given on 6/30/09. Par 7/10/2009 Patient feeling nausea and dry heav 7/10/2009 Patient developed a bright red, irreg 7/10/2009 extreme burning & itching, extensive 7/10/2009 soreness, redness and swelling left 7/10/2009 SORENESS AND SWELLING, SLIG 7/10/2009 after vaccine administration the pt w 7/10/2009 Patient rec'd vaccines 7/8/09 and on 7/8/2009 Diffuse Musculostreleted pain and w 7/10/2009 2:53 P.M. 18 y.o w/m administered 7/10/2009 Spoke with Mother who has noticed 7/10/2009 Inflamation around the smallpox site 7/10/2009 Diarrhea 4 days after Rotateq (6/26 7/10/2009 Patient presented with redness, war 7/10/2009 The second evening after patient re 7/6/2009 Received AVA #3 and Tdap on 6/29 7/10/2009 No adverse event/pregnancy outcom 7/9/2009 Received 2m vaccination with oral R 7/10/2009 4 hours after receiving vaccine pt c/ 7/10/2009 1 day after GARDASIL developed fe 7/12/2009 About 24h after vaccination, child de 7/11/2009 Swollen (slight), looks reddish (as if 7/9/2009 1 cm raised patch ~ 1cm above MM 7/9/2009 Pt A and O x3. HPV given L deltoid. 7/7/2009 Local redness and swelling 4 days a 7/10/2009 Swelling: blistering of arm. 7/9/2009 1- Vaccine and Anaphylactic reactio 7/10/2009 Pt given PNEUMOVAX in left deltoid 6/19/2009 Vaccine Administration error HIB va 7/10/2009 Patient developed a 3cm erythemat 6/23/2009 Pt states started burning itchy area 7/11/2009 Left arm soreness, tenderness, kno 7/10/2009 30 min- after given, sudden onset h 7/10/2009 Left upper arm is red, swollen from 7/10/2009 Redness at injection site, left deltoid 7/11/2009 ANTHRAX WAS GIVEN AS PPD. 0 7/11/2009 SERVICE MEMBER GIVEN ATHRA 7/11/2009 Arm and head have hurt enough to 7/11/2009 Seizure 7:30PM on 7/10/09 and at 8 7/11/2009 Multiple pustules at site of inoculatio 7/11/2009 FACIAL PALSY(RIGHT SIDE) DAY 7/11/2009 On Tues.7th my 5 week old daught 7/12/2009 after the third vaccine of GARDISIL 7/12/2009 Woke up at 0200 with pounding hea
351135 351136 351168 351172 351173 351181 351184 351185 351191 351192 351193 351194 351195 351197 351198 351199 351200 351201 351203 351204 351205 351206 351207 351208 351211 351212 351213 351214 351215 351216 351217 351218 351219 351220 351221 351222 351223 351224 351225 351226 351227 351228 351229 351230 351231 351232 351233 351234 351235 351236 351239
7/12/2009 NY 7/12/2009 DC 7/13/2009 PA 7/13/2009 7/13/2009 MD 7/13/2009 WA 7/13/2009 OH 7/13/2009 OH 7/13/2009 WI 7/13/2009 PA 7/13/2009 OH 7/13/2009 NY 7/13/2009 CA 7/13/2009 MO 7/13/2009 KY 7/13/2009 KY 7/13/2009 MA 7/13/2009 FL 7/13/2009 CA 7/13/2009 TX 7/13/2009 NY 7/13/2009 FL 7/13/2009 FL 7/13/2009 WI 7/13/2009 CA 7/13/2009 HI 7/13/2009 WA 7/13/2009 CA 7/13/2009 PA 7/13/2009 MA 7/13/2009 CT 7/13/2009 VA 7/13/2009 CT 7/13/2009 DC 7/13/2009 FL 7/13/2009 HI 7/13/2009 CA 7/13/2009 GA 7/13/2009 GA 7/13/2009 GA 7/13/2009 GA 7/13/2009 ME 7/13/2009 IL 7/13/2009 GA 7/13/2009 7/13/2009 MS 7/13/2009 CA 7/13/2009 NC 7/13/2009 UT 7/13/2009 CA 7/13/2009 FL
38 58 63
38 58 63
15 57 5 5 14 4 42 24 12 52 83 28 75 4 69 38 28 34 63 14 4 56 63 14 4 69 4 21 63 45 12 1 61 50 18 18 51 39 17 1.1 2 10 21 1.4 4 65 79
15 57 5 5 14 4 42 24 12 52 83 28 75 4 69 38 34 63 14 56 63 14 4 69 4 21 63 45 12 1 61 50 18 18 51 39 17 1 2 10 21 1 4 65 79
F F F F F F M F F F F F F M F F M F F F F F F M F F F F M F M M F M M 0F F M F F F F M 0.1 F 0.9 M M M 0.4 M M U F
7/12/2009 CHills, myalgias, headache all starte 7/12/2009 3 weeks after Tdap vaccine, awake 7/10/2009 Information has been received from 7/10/2009 Information has been received from 7/10/2009 Information has been received from 7/9/2009 Initial report received on 06 July 200 7/13/2009 This case was reported by a healthc 7/13/2009 This case was reported by a healthc 7/13/2009 Immun. given Mon., 7/6/09 at 3:30 p 7/13/2009 Varicella Vaccine breakthrough. Ha 7/13/2009 Patient complaining of dizziness an 7/13/2009 PATIENT COMPLAINED OF AN ITC 7/13/2009 Patient with fever >102.0 less than 1 7/13/2009 Fever, nights sweats, weight loss, a 7/13/2009 PT PHONED ON MONDAY (7/13/0 7/13/2009 c/o soreness of R arm, mild swelling 7/13/2009 Developed red, hot, raised, itchy blo 7/13/2009 REDNESS WITH EDEMA AROUND 7/13/2009 This 69-year-old female was brough 7/13/2009 Fever of 101, redness, raised bump 7/13/2009 Patient reports having an MMR vacc 7/13/2009 Rec'd one dose Varicella, 48hrs late 7/13/2009 broke out with a rash on buttovk, sid 7/13/2009 Recieved vaccine without incident a 7/1/2009 L deltoid induration (+) erythema, w 7/13/2009 Vaccination site indurated, erythem 7/13/2009 Patient woke up this morning (7-137/13/2009 Scared before injection. Syncopal e 7/13/2009 Woke up 07/11/09 Swelling & cellul 7/13/2009 Headaches Fevers- per pt. None w 7/10/2009 Blistering irregular rash on upper L a 7/13/2009 This 31 year old male reported rece 7/13/2009 Flu-like malaise, weakness, low gra 7/6/2009 Extended rash - additional sores. Pt Had TDAP/Menactra in (L) Deltoid o 7/8/2009 After receiving MMR shot at age 1, 6/22/2009 Redness. pain, swelling localized to 5/29/2009 Broke out with rash 5/26/09. Mild fe 6/5/2009 Received 5 immunizations. After re 6/19/2009 See attached Notes. See back. Cli 6/22/2009 Pt. called 6-19-09 spoke with RN c/o 7/10/2009 7-8-09 receive injection - next day b 7/13/2009 Immediately after the 2 vaccines we Hives Rash over abdomen and extr 7/13/2009 Parents report change of affect of p 7/13/2009 Severe swelling/induration of deltoid 7/6/2009 21 y.o. c/o rash on arms torso ches 7/9/2009 Low grade fever since immunization 7/9/2009 Night after vaccines, right thigh gros None stated 6/19/2009 Onset pulsating pain in shoulder rad
351241 351242 351243 351244 351245 351246 351247 351248 351249 351250 351251 351252 351253 351254 351255 351256 351257 351258 351259 351260 351261 351262 351263 351264 351265 351266 351267 351268 351269 351270 351271 351272 351273 351274 351275 351276 351277 351278 351279 351280 351281 351282 351283 351284 351285 351286 351287 351288 351289 351290 351291
7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 WA 7/13/2009 IN 7/13/2009 CA 7/13/2009 VA 7/13/2009 CO 7/13/2009 MI 7/13/2009 7/13/2009 WY 7/13/2009 7/13/2009 AZ 7/13/2009 TX 7/13/2009 PA 7/13/2009 OH 7/13/2009 PA 7/13/2009 WI 7/13/2009 7/13/2009 7/13/2009 NJ 7/13/2009 NJ 7/13/2009 7/13/2009 7/13/2009 NE 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 OR 7/13/2009 MT 7/13/2009 GA 7/13/2009 OR 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 7/13/2009 NJ 7/13/2009 CA 7/13/2009 OK 7/13/2009 7/13/2009 7/13/2009 7/13/2009 MA 7/13/2009 IL 7/13/2009 7/13/2009 WA 7/13/2009 AL 7/13/2009 PA 7/13/2009 FL
84 57 79 66 85 76 63 61 62 71
84 57 79 85 76 63 61 62 71
73 74 64 63 67 66 72 60 71 60 86 42 63 67 67 65 71 73 71
74 64 63 67 66 72 71 60
42 63 67 65 71
70 62 79 74 84 78 65
79 74 84
67 70
67 69
63 67 80
F F F F M F F M M F F F M F F M M F F F F M U M F F F F F M M F F F F F F M M F F U F F F F F F F F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351292 351293 351294 351295 351373 351374 351375 351376 351377 351378 351379 351380 351382 351383 351384 351385 351386 351387 351388 351389 351390 351391 351392 351393 351394 351395 351396 351397 351398 351399 351400 351401 351402 351403 351404 351405 351406 351408 351409 351410 351411 351412 351413 351414 351490 351492 351493 351494 351495 351496 351497
7/13/2009 7/13/2009 NY 7/13/2009 MO 7/13/2009 OK 7/13/2009 IA 7/13/2009 OH 7/13/2009 CT 7/13/2009 FL 7/13/2009 PA 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 TX 7/13/2009 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 NC 7/13/2009 IL 7/13/2009 IL 7/13/2009 IL 7/13/2009 SC 7/13/2009 MA 7/13/2009 OR 7/13/2009 CA 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 CA 7/13/2009 7/13/2009 7/13/2009 GA 7/13/2009 MI 7/13/2009 7/13/2009 CT 7/13/2009 TX 7/13/2009 ID 7/13/2009 7/13/2009 AZ 7/13/2009 VA 7/13/2009 FL 7/13/2009 7/13/2009
50 70 63 75 56 82 61 70 65 81
63 64 64 57 68
70 63 75 82 61 70 65
64 68
68 61 69
61 69
85 82 59
59
70 73 64 70 61
70
75 66 74 77 75 82 78
75
66 61 65 76 70
64 70 61
78
65
F F F F F F F F M M F F U F M F F F F F M F M F M F F F F F F F M F F F F M F F F F M F F M M F F F U
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 7/7/2009 This case was reported by a healthc 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/21/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
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7/13/2009 SC 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 OR 7/13/2009 FL 7/13/2009 FL 7/13/2009 7/13/2009 VA 7/13/2009 7/13/2009 TX 7/13/2009 FL 7/13/2009 AL 7/13/2009 FL 7/13/2009 CA 7/13/2009 AZ 7/13/2009 7/13/2009 7/13/2009 7/13/2009 7/13/2009 NC 7/13/2009 7/13/2009 7/13/2009 LA 7/13/2009 IL 7/13/2009 7/13/2009 7/13/2009 MN 7/13/2009 NM 7/13/2009 CA 7/13/2009 MN 7/13/2009 VA 7/13/2009 NY 7/13/2009 WA 7/13/2009 7/13/2009 NJ 7/13/2009 MI 7/13/2009 7/13/2009 7/13/2009 NY 7/13/2009 PA 7/13/2009 7/13/2009 TX 7/13/2009 CA 7/13/2009 IL 7/13/2009 SC 7/13/2009 MD 7/13/2009 7/13/2009 IN 7/13/2009 WA
62
62
60 60
60
55 60 66 38 90
66 90
78 73
72 73
81 67 61
67 61
60 64 70 62 72 63 65 67 64 59
64
72 63 65 67 59
62 63 74 68 63
62 63 74 68
76 67 65 16 60
76 67
73 65 25
25
F F U U F F U U F M M M F M F F M F F F F F F F F M F F F M F F M F F M F F U M U M F F U M F F F U F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351643 351644 351645 351646 351647 351648 351649 351650 351651 351652 351653 351654 351655 351656 351657 351658 351659 351660 351661 351662 351663 351664 351665 351666 351667 351668 351669 351670 351671 351672 351673 351674 351675 351676 351677 351678 351679 351680 351681 351682 351683 351684 351685 351686 351687 351688 351689 351690 351691 351692 351693
7/13/2009 HI 7/13/2009 NJ 7/13/2009 VA 7/13/2009 7/13/2009 7/13/2009 MA 7/13/2009 PA 7/13/2009 7/13/2009 TX 7/13/2009 SD 7/13/2009 MO 7/13/2009 CO 7/13/2009 7/13/2009 AZ 7/13/2009 OK 7/13/2009 IN 7/13/2009 OH 7/13/2009 7/13/2009 CA 7/13/2009 HI 7/13/2009 NC 7/13/2009 PA 7/13/2009 TX 7/13/2009 7/13/2009 CO 7/13/2009 7/13/2009 PA 7/13/2009 CT 7/13/2009 ME 7/13/2009 7/13/2009 7/13/2009 MN 7/13/2009 7/13/2009 PA 7/13/2009 PA 7/13/2009 CO 7/13/2009 7/13/2009 PA 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 KS 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 IL 7/13/2009 7/13/2009 7/13/2009 7/13/2009 FL 7/13/2009 RI
66 61 63 70 65 79 70 76 70 65 77 71 81 65 62 68 83 67 61 67 74
61 63
79
70 65 77 71
62 68 83 61
64 69 63 70 69
64
67 60 66 78 62 61
67 60
77 71 80
77 71
63 69
78 61
63 66 82 60
60
65 70 65
70 65
U M F M F F F F U F M M F U F F M F M F F F F M M F F M F F F F F F M F F M F F F M F F F M U U F F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has with allergies to PE 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
351694 351695 351696 351697 351698 351699 351728 351729 351730 351731 351732 351733 351734 351735 351736 351737 351738 351739 351740 351760 351761 351762 351763 351764 351765 351807 351808 351809 351810 351811 351812 351813 351814 351815 351816 351817 351818 351819 351820 351821 351823 351824 351825 351826 351827 351828 351829 351830 351831 351832 351833
7/13/2009 7/13/2009 7/13/2009 NV 7/13/2009 7/13/2009 7/13/2009 ME 7/13/2009 7/13/2009 MO 7/13/2009 7/13/2009 NY 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 AZ 7/13/2009 FL 7/13/2009 TN 7/13/2009 TX 7/13/2009 DC 7/13/2009 7/13/2009 WV 7/13/2009 7/13/2009 PA 7/13/2009 7/13/2009 7/13/2009 OH 7/13/2009 7/13/2009 TX 7/13/2009 7/13/2009 7/13/2009 VA 7/13/2009 OK 7/13/2009 NC 7/13/2009 LA 7/13/2009 MA 7/13/2009 MI 7/13/2009 7/13/2009 AZ 7/13/2009 7/13/2009 FL 7/13/2009 7/13/2009 7/13/2009 CT 7/13/2009 AR 7/13/2009 7/13/2009 IN 7/13/2009 7/13/2009 7/13/2009 7/13/2009 FL 7/13/2009 CA
63 61 72 72 57 67 61 1.5 74 64 87 58 24 68 66 65 65 89 55 75 62 74 60 68 52 62 70 84 79 60 80 72 62 65 60 86 60
61 72 72 57
74 87
68 66 65 65 89
75 62 74
52 62 70 84 79 80 72 62 65 60 86 60
69 65 91 1.2 69 87 76 84 66
69 87 76 84 66
F F M F M U F F M F F M U F F F F M F M M F M F F M F F M F M M F M M F F M F F F F M F M U F M F M F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Initial and follow-up information has 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from
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7/13/2009 ID 7/13/2009 7/13/2009 CA 7/13/2009 TX 7/13/2009 WY 7/13/2009 7/13/2009 7/13/2009 7/13/2009 MI 7/13/2009 7/14/2009 CO 7/14/2009 NY 7/14/2009 LA 7/14/2009 SC 7/14/2009 7/14/2009 7/14/2009 CA 7/14/2009 NV 7/14/2009 KS 7/14/2009 OH 7/14/2009 MI 7/14/2009 AZ 7/14/2009 SD 7/14/2009 NC 7/14/2009 CO 7/14/2009 FL 7/14/2009 VT 7/14/2009 CT 7/14/2009 TX 7/14/2009 NY 7/14/2009 NJ 7/14/2009 7/14/2009 MI 7/14/2009 IL 7/14/2009 CA 7/14/2009 CA 7/14/2009 FL 7/14/2009 CA 7/14/2009 TX 7/14/2009 NC 7/14/2009 TX 7/14/2009 AZ 7/14/2009 WA 7/14/2009 CA 7/14/2009 CA 7/14/2009 AZ 7/14/2009 VA 7/14/2009 FL 7/14/2009 WA 7/14/2009 CA 7/14/2009
62 63 60 58
62
61 63 60 68 18 18 0.6 0.6 12 0.2 17 28 0.4 5 63 1 1 4 18 0.4 61 13 10 4 0.3 16 44 17 46 72 23 1 1 2 2 4 65 0.5 0.5 11 1 11 1 20 26
61
68 18 18 0 0
17 28 0 5 63 1 1 4 18 0 61 13 10 4 0 16 44 17 46 70 23 1 1 2 2 4 65 0 0 11 0 11 20 26
F M F F F U F F F F M F 0.6 M 0.6 F F F F F 0.4 F M F 0F 0M F F 0.4 M F F F M 0.3 F F F F F F F 0F 0M 0.6 M 0F F F 0.5 F 0.5 F F 1M M M F F
6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 6/24/2009 Information has been received from 10/7/2008 Initial information received from a he 7/13/2009 Coughing, shortness of breath edem 6/22/2009 Imun given Thursday - 6/18/09 appr 7/7/2009 Intussusception requiring surgical re 7/12/2009 Daughter has adverse reaction to G 7/10/2009 At 2 mo, child was given her 1st dos 7/13/2009 Information has been received from 6/25/2009 Shot Saturday, swollen knot on righ At 2 mo. well child visit, pt. was give 7/10/2009 13x8 cm region of erythema and ed 7/13/2009 Information has been received from 7/8/2009 On 6/12/2009 MMR, Varicella, PCV 7/9/2009 None stated 6/29/2009 MMR + Varicella given in (L) upper/ 7/6/2009 Per client, 30 minutes after vaccine, 7/6/2009 After last immunization pt had fever 5/29/2009 Vaccine given 5-26- AM. Symptom 7/6/2009 Painful arms at inj. site - warm to tou 7/3/2009 The child had an episode of dizzine 7/14/2009 This case was reported by a healthc 7/14/2009 6/22/09 - ER Hospital for elevated te 7/7/2009 Pt became light headed. Blood pres 7/14/2009 Patient presented today to emergen 7/14/2009 90 minutes after receiving vaccine c 7/14/2009 Soreness at injection site and sever 7/14/2009 4 inch redness, bumpy, warm, itchin 7/14/2009 Client stated that she experienced c 7/14/2009 On 7/8/09 patient received Prevnar, 7/14/2009 STARTED WITH A RASH ALL OVE 7/14/2009 SEVERE GENERALIZED RASH AN 7/14/2009 Urticaria Mom noticed rash upon aw 7/14/2009 Flat, red rash and spots on chest; in 7/14/2009 Shingles vaccination 7/1/09; 7/2/09 7/14/2009 VACCINE WAS ADMINISTERED A 7/14/2009 6month term previously healthy fem 7/14/2009 severe headache,soreness in arms 7/6/2009 Within 5 min of vaccines being given 6/26/2009 Edema, Tenderness (L) Deltoid, wa 6/30/2009 Hard, warm to touch, red area state 7/7/2009 Developed headache p.m. of 7/2/09 7/14/2009 Vaccine administered 7-10-09, pt re
351346 351347 351348 351349 351350 351351 351352 351353 351354 351355 351356 351357 351358 351359 351360 351361 351362 351363 351364 351365 351366 351367 351368 351369 351370 351371 351372 351381 351407 351844 351845 351846 351847 351848 351849 351850 351851 351852 351853 351854 351855 351856 351857 351858 351859 351860 351861 351862 351877 351878 351879
7/14/2009 AR 7/14/2009 AR 7/14/2009 AR 7/14/2009 CA 7/14/2009 WA 7/14/2009 WI 7/14/2009 FL 7/14/2009 CA 7/14/2009 FL 7/14/2009 NC 7/14/2009 NC 7/14/2009 MN 7/14/2009 CA 7/14/2009 CA 7/14/2009 CA 7/14/2009 AZ 7/14/2009 OH 7/14/2009 WA 7/14/2009 NY 7/14/2009 CA 7/14/2009 CA 7/14/2009 TX 7/14/2009 WA 7/14/2009 WA 7/14/2009 WA 7/14/2009 MI 7/14/2009 IA 7/14/2009 7/14/2009 NC 7/14/2009 CA 7/14/2009 SC 7/14/2009 TX 7/14/2009 NC 7/14/2009 KY 7/14/2009 CO 7/14/2009 PA 7/14/2009 NJ 7/14/2009 TN 7/14/2009 TN 7/14/2009 TN 7/14/2009 TN 7/14/2009 UT 7/14/2009 OR 7/14/2009 CA 7/14/2009 7/14/2009 7/14/2009 7/14/2009 7/14/2009 MD 7/14/2009 CA 7/14/2009 NC
33 5 18 0.4 1 4 0.2 11 12 5 57 12 12 14 57 42 46 1.3 0.9 9 3 3
33 5 18 0 1 4 0 11 12 5 57 12 12 14 57 42 46 1 0 9 3 3
10 14 1.8 18
14 1 18
42 73 29 20 57 58 43 60
42 73 28 20 57 58 43 60
56
56
38
38
31 58 42 34 26 74 34 42
31
74 34 42
F F M 0.4 U 0M F 0.2 F F F F F M F F F F F 0.3 M 0.9 M M M M F M M 0.8 M M U U F F F F F F F M F F F F F U F F F F F F F F
Vaccine administered 9/10/08 and n 6/16/2009 Mom stated that she took client to P 6/5/2009 Pt was given MMR II, RECOMBIVA None stated 7/14/2009 Fever 103, crying, fussy, red rash o 7/14/2009 Redness, swelling, tenderness on le 7/14/2009 (B) legs - 5-10 min after vax bright r 7/13/2009 Per Grandma- patient got a "pimple 7/14/2009 About 20 seconds after administerin 7/2/2009 Mom noted red knot on arm and leg 7/6/2009 Injection site was red, tender, itchy. 7/14/2009 7/10/09 Pt. presented to doctor with 7/14/2009 12 year old child, new to area, no va 7/13/2009 1600 pt passed out, in the lobby on 7/13/2009 Severe pain and inability to lift arm h 7/6/2009 Painful, swollen, red right arm. 7/7/2009 Started feeling sluggish on 6/27/09, 7/7/2009 Received DTAP, HIB and PREVNA 7/6/2009 High fever up to 104.8 (R) for 3 day 7/2/2009 4 cm round reddish area at site of in 7/3/2009 Erythema and induration. 7/7/2009 12 X 13 cm red mildly tender area a 7/7/2009 Injection site red, itchy, hot to touch 7/7/2009 Swollen, irritated, itchy Injection site 7/7/2009 7 cm swelling with 5cm induration/s 7/13/2009 Fever, vomiting, fussiness/irritability 7/2/2009 Transient vision loss. 6/24/2009 Information has been received from 6/24/2009 Information has been received from 9/9/2008 A 42-year-old female patient had re 8/5/2008 Initial report was received 29 May 2 9/9/2008 This non-serious case was received 5/6/2009 Initial report received on 24 June 20 8/26/2008 Initial report received on 07 July 200 ### Initial non-serious case received fro ### Initial report received from a health ### This non-serious case was received 2/13/2009 Initial report received from a healthc 2/13/2009 Initial report received from a healthc 2/13/2009 Initial report received from a healthc 3/18/2009 Initial report received from a healthc 2/9/2009 Initial information was received on 1 4/27/2009 Initial report received on 05 Februar 4/28/2009 Initial report received 19 February 2 3/4/2009 This non serious case was received 3/4/2009 This case was extracted from the VA 3/4/2009 This non serious case was received 3/3/2009 This case was extracted from the VA 3/5/2009 This non serious case was received 3/26/2009 A cluster of 3 patients who received 4/30/2009 Initial report received on 20 March 2
351880 351881 351882 351883 351884 351885 351886 351961 351963 351964 351965 351966 351967 351968 351969 351339 351415 351416 351417 351418 351419 351420 351421 351422 351423 351424 351425 351426 351427 351428 351430 351434 351435 351436 351438 351440 351443 351444 351445 351446 351447 351448 351449 351450 351451 351452 351453 351454 351455 351456 351457
7/14/2009 PA 7/14/2009 PA 7/14/2009 AZ 7/14/2009 NJ 7/14/2009 LA 7/14/2009 MA 7/14/2009 OH 7/14/2009 NY 7/14/2009 7/14/2009 TN 7/14/2009 CA 7/14/2009 ID 7/14/2009 CA 7/14/2009 NC 7/14/2009 GA 7/15/2009 7/15/2009 NE 7/15/2009 FL 7/15/2009 CO 7/15/2009 VA 7/15/2009 WI 7/15/2009 NC 7/15/2009 7/15/2009 VA 7/15/2009 FL 7/15/2009 PA 7/15/2009 AZ 7/15/2009 CO 7/15/2009 NH 7/15/2009 AZ 7/15/2009 MN 7/15/2009 MN 7/15/2009 CA 7/15/2009 NY 7/15/2009 OR 7/15/2009 MA 7/15/2009 NY 7/15/2009 WI 7/15/2009 MN 7/15/2009 MN 7/15/2009 SC 7/15/2009 OH 7/15/2009 OK 7/15/2009 PA 7/15/2009 CA 7/15/2009 AZ 7/15/2009 OH 7/15/2009 MI 7/15/2009 ME 7/15/2009 CA 7/15/2009 RI
40 28 47 58 54 49 47 11 28
40 28 47 58 54 49 47 11 28
41 37 61 54 37 2 16 0.5 0.9 28 25 0.2
41 37 61 54 37 0 16 0 0 28 25 0
11 15 5 48 23 12 11 39 40 5 0.4 4 45 51 4 61 20 70 40 54 73 32 27 26 0.2 3 8 65
11 5 48 12 11 39 40 0 4 45 51 4 61 20 70 40 54 32 27 26 0 3 8 65
F F F F F F F F M F F F F F F 0.6 M M 0.5 M 0.9 F M M 0.2 F U M F F F F F F M F M 0.4 F M F M M F M F M F M F M M 0.2 F M F M
4/8/2009 This non serious case was received 4/23/2009 This non serious case was received 5/13/2009 A 47 year old female patient with a 6/17/2008 This case was received from a cons 10/9/2008 Initial report received on 22 Septem 3/21/2009 This non serious case was received 3/11/2009 This report was received from a con 9/8/2008 Initial information was received from 9/29/2008 A 28 year old male patient, with no 2/13/2009 Case received from a healthcare pro 9/30/2008 A cluster of 2 adult patients who rec 3/31/2009 A 37-year-old female patient who w ### Initial non-serious case received fro ### Initial information was received on 2 2/20/2009 Initial report received from a health 7/15/2009 SWELLING, REDNESS AND WARM 7/7/2009 Severe nausea; weight loss over 20 7/10/2009 Information was extracted from his d 7/7/2009 Patient developed small lump at site 7/6/2009 Chills x 3 days ago. Cellulitis 6.5 cm 7/9/2009 Cellulitis secondary to smallpox vac 7/9/2009 Redness & swelling at site. Mostly 7/14/2009 InformationYhas been received from 7/8/2009 Pt. received 2 vaccines @ approxim 7/14/2009 Information has been received from 7/9/2009 Swelling, redness, warmth of right u 7/9/2009 Chills, cramps, severe weakness, d 7/14/2009 Information has been received from 7/9/2009 This child developed hives within 48 7/14/2009 Information has been received from 6/29/2009 None stated 6/29/2009 None 7/14/2009 Information has been received from 7/8/2009 Fever up to 106 degrees and irritab 7/9/2009 R arm swelling > 2 in width & length 7/14/2009 Information has been received from 7/15/2009 Typical Arthur reaction at right delto 7/9/2009 Local vaccine reaction. Left arm ext 7/8/2009 2cm swelling at injection site. No sig 7/2/2009 No adverse reaction. MMR II given 7/6/2009 Denied any symptoms-soreness, fe Inflammation of optical, nerves + mu 7/17/2009 Redness, Swelling at site of injectio 7/7/2009 Shortly after admin of ZOSTAVAX p 6/17/2009 Pt. reports "severe pain" in muscles 6/29/2009 Found vomiting x 2 in waiting room7/8/2009 Pt called 7/2/09 stating he became 7/7/2009 Unconsolable crying/screaming x 37/9/2009 1 -1/2 hrs after receiving vaccine pa 6/26/2009 Raised, red, round- approx. 2 inche 7/7/2009 Generalized pruritus. Fatigue. Myalg
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7/15/2009 OH 7/15/2009 NC 7/15/2009 NH 7/15/2009 TX 7/15/2009 NC 7/15/2009 NC 7/15/2009 IN 7/15/2009 NY 7/15/2009 NM 7/15/2009 IN 7/15/2009 CA 7/15/2009 CA 7/15/2009 VA 7/15/2009 MD 7/15/2009 CA 7/15/2009 OH 7/15/2009 AZ 7/15/2009 CA 7/15/2009 NC 7/15/2009 UT 7/15/2009 OR 7/15/2009 CO 7/15/2009 PA 7/15/2009 7/15/2009 IA 7/15/2009 IL 7/15/2009 NM 7/15/2009 NC 7/15/2009 NC 7/15/2009 OH 7/15/2009 CA 7/15/2009 CA 7/16/2009 CA 7/16/2009 CA 7/16/2009 PA 7/16/2009 AZ 7/16/2009 MI 7/16/2009 KY 7/16/2009 PA 7/16/2009 MD 7/16/2009 NY 7/16/2009 OH 7/16/2009 MA 7/16/2009 GA 7/16/2009 CO 7/16/2009 HI 7/16/2009 PA 7/16/2009 AZ 7/16/2009 CO 7/16/2009 CO 7/16/2009 TX
6 55 3 37 46 21 34 62 37 5 1.2 25 62 22 5 1.5 1 4 18 66 0.5 1.3
6 55 3 37 46 21 34 62 37 5 1 25 62 22 5 1 1 4 18 66 47 0 1
0.4 45 10 23 21 4 0.1 54 5 5 4 20 67 5 1.3 0.2 0.2 1.5 53 1.6 0.4 23 72 27 0.4 10.5 1.4
0 45 10 23 21 4 0 54 5 5 4 20 67 5 1 0 0 1 53 1 0 23 72 27 0 10 1
M F M F M F M F F M 0.2 M F F F F 0.5 F 0.1 F M F M M 0.5 F 0.2 M F 0.4 F F M M M M 0.1 M F M F M F F M 0.3 M 0.2 F 0.2 F 0.5 M F 0.6 F 0.4 F M F M 0.4 F F 0.4 F
7/15/2009 Mild erythema 4cm X 6cm at injectio 7/15/2009 approximately 42 hours post Zostav 7/15/2009 3 year old male brought in by his mo 7/15/2009 Within 1 hour of administration patie 7/15/2009 He had a varivax booster on Monda 7/15/2009 She has developed generalized vac 7/15/2009 Patient developed a burning sensat 7/15/2009 1-2 days later: dizziness, malaise fo 7/15/2009 Hour after immunization, experience 7/15/2009 Child was given a double dose of V 7/15/2009 12 1/2 x 10cm Circular, swollen leas 7/15/2009 Nausea, chest pain, asthsma, diarrh 7/15/2009 arm became swollen down to elbow 7/15/2009 Rabavert (Rabies vaccine)#1 given 7/15/2009 REDNESS AND SWELLING AROU 7/15/2009 Legs were tender to touch where va 7/15/2009 On 7-5-09, child developed raised p 7/15/2009 pt developed local reaction to vaccin 7/15/2009 Shortly after receiving her Gardasil, 7/15/2009 Woke up with head ache, slight nau 7/15/2009 c/o that he felt poorly last night. He 7/15/2009 Given 6 month vaccines including P 7/15/2009 104.2 fever taken at 2:15 a.m. on 4/ 7/15/2009 This case was reported by a lawyer 7/14/2009 On 7-2-09 at 10pm father noticed ey 7/14/2009 Symptoms of Bells Palsy returned. T 7/15/2009 Raised papule, erythema at site of V 7/15/2009 SM woke up with chest pain that go 7/15/2009 Sm developed chest pain that lasted 7/15/2009 Sneezing, coughing, wheezing, leth 7/15/2009 L thigh area red and swollen, hot to 7/15/2009 Redness, tender swelling at site of i 6/5/2009 R Leg - Varicella red + swollen + itc 7/7/2009 Redness and induration in right thig 7/7/2009 On 6-20-9, child complained of rt ch 7/6/2009 Fever, nausea, diarrhea, itchy Skin/ 7/10/2009 ZOSTAVAX administered 7/7/09. P 7/9/2009 In less than 24 hours after vaccinati 7/4/2009 Pt's family called on 6/2/09 to let us 7/14/2009 Intermittent cyclical crying/ screamin 7/10/2009 Outstretching of arms & legs for a fe 7/10/2009 Complex partial seizure, head nodd 7/13/2009 Approximately 10-15 min after vacc 7/6/2009 Child loss the use of her muscles, b 7/1/2009 Whole body tremor/spasmed (seizu 7/7/2009 Patient had moderate swelling R de 7/9/2009 Neck pain began on LFT side (wher 7/7/2009 Pt presented 10 d. after vaccines w 7/9/2009 Infant vomited at home x 3 and had 7/9/2009 Patient rec'd Hep A and VZV #2 on 7/2/2009 7/2/09 1500. Received call from pts
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7/16/2009 FL 7/16/2009 NY 7/16/2009 MA 7/16/2009 GA 7/16/2009 PA 7/16/2009 7/16/2009 7/16/2009 CO 7/16/2009 CO 7/16/2009 7/16/2009 MI 7/16/2009 VA 7/16/2009 GA 7/16/2009 OH 7/16/2009 OR 7/16/2009 MI 7/16/2009 FL 7/16/2009 FL 7/16/2009 IL 7/16/2009 CT 7/16/2009 WI 7/16/2009 TX 7/16/2009 OH 7/16/2009 TN 7/16/2009 TX 7/16/2009 ID 7/16/2009 TN 7/16/2009 OK 7/16/2009 TX 7/16/2009 IN 7/16/2009 NM 7/16/2009 MI 7/16/2009 NM 7/16/2009 IL 7/16/2009 MO 7/16/2009 MD 7/16/2009 NM 7/16/2009 MI 7/16/2009 TX 7/16/2009 NJ 7/16/2009 NC 7/16/2009 GA 7/16/2009 7/16/2009 7/16/2009 NJ 7/16/2009 LA 7/16/2009 MN 7/16/2009 FL 7/16/2009 TX 7/16/2009 GA 7/16/2009 AK
11.9 24 14 0.4 12 49
11 24 14 0 12 49
30 30 18 18 27 5 15 62 12 12 8 18 4 12 12 59 10 4 5 10 1.3 11 46 48 36 64 67 25 2 60 0.1 0.2 1.2 28 1.1 68 30 9 12 4 11 64 9 17
30 30 18 5 15 62 12 12 8 18 14 12 12 59 10 4 5 9 1 11 46 48 36 67 25 2 60 0 0 1 28 1 30 9 12 4 11 64 9 17
F M F 0.4 F F F M M M M F M M F F F F F F M F M F F M M M 0.3 F F F F F F F F 0F F 0.1 M 0.2 M 0.2 F M 0.1 M F F M M M M F M F
7/9/2009 Child almost bumped in the door as 7/8/2009 Pt reports temp of 104.3 degrees F, 7/13/2009 Pt received varivax vaccine sc in lef 7/13/2009 Mom stated child had a rash to both 7/7/2009 Redness, slight elevation. 6/30/2009 Migratory skin rash, diarrhea, soren 7/15/2009 Information has been received from 7/16/2009 This case was reported by a pharma 7/16/2009 This case was reported by a pharma 7/16/2009 This case was reported by a physici 7/16/2009 Fever onset of 9:00pm on 7/14/09, b 7/16/2009 localized swelling, redness and itchi 7/16/2009 4 hours after receiving IPV vaccine, 7/16/2009 This 15 year old received the follow 7/16/2009 Client presented to clinic 2 days afte 7/16/2009 Mom states that pt had a nose blee 7/16/2009 My daughter received the HPV Vac 7/16/2009 Per mother, patient experienced an 7/16/2009 07-08-2009 Patient came home with 7/16/2009 Arm swelling, redness, pain, itching 7/16/2009 2 X 3 inch reddened area on left arm 7/16/2009 Right arm swollen at sight of injectio 7/16/2009 EXTENSIVE REEDNESS AND PAI 7/16/2009 Received Varivax and had a local re 7/16/2009 redness streaks from scratching irrit 7/16/2009 On 7/8/09 patient received following 7/16/2009 Received Varivax on 7/13/09 on 7/1 7/16/2009 Mother called office at 8:30 am on 7 7/16/2009 Patient was vaccinated on July 14, 7/16/2009 Mumps titer came back too low on 5 7/16/2009 Approx 2 minutes after pneumococc 7/16/2009 fever, chills, shakiness, nausea, join 7/17/2009 Dizziness and profuse sweating for 7/16/2009 Pt received vaccine on Mon 7/13/09 7/16/2009 Pt received GARDASIL #2 on 7/10/ 7/16/2009 June 16th onset of fever and child c Area surrounding injection site redd 7/14/2009 None Known 7/15/2009 Increased "startle reflex" every few 6/17/2009 MOC brought child to clinic 7 days a 7/15/2009 28 y/o male ADSM is referred from 7/14/2009 Pt with macular rash on trunk - antih 7/13/2009 I was given the shingles vaccination 7/13/2009 Pt was given TDAP and VARIVAX v 7/15/2009 Immediately after giving vaccines - V 7/16/2009 24 hrs after injection outer aspect o 7/8/2009 Red & swollen at injection site. Ice 7/16/2009 Mom states hot, red and painful ind 7/16/2009 Pt. called on 7/16/09 self reported e 7/16/2009 '15min episode of nausea then vom 7/16/2009 Swelling around injection sight, eryt
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7/16/2009 NJ 7/16/2009 OH 7/16/2009 WA 7/16/2009 PA 7/16/2009 CA 7/16/2009 CA 7/16/2009 KS 7/16/2009 NY 7/17/2009 KY 7/17/2009 WA 7/17/2009 WA 7/17/2009 GA 7/17/2009 NY 7/17/2009 7/17/2009 MN 7/17/2009 NY 7/17/2009 NE 7/17/2009 WA 7/17/2009 MA 7/17/2009 MI 7/17/2009 MD 7/17/2009 TX 7/17/2009 TX 7/17/2009 PA 7/17/2009 IL 7/17/2009 WI 7/17/2009 OH 7/17/2009 MN 7/17/2009 WA 7/17/2009 NY 7/17/2009 MT 7/17/2009 TX 7/17/2009 OH 7/17/2009 AL 7/17/2009 MO 7/17/2009 MI 7/17/2009 GA 7/17/2009 OH 7/17/2009 WI 7/17/2009 WI 7/17/2009 IN 7/17/2009 WI 7/17/2009 WA 7/17/2009 NY 7/17/2009 NJ 7/17/2009 TX 7/17/2009 WI 7/17/2009 TX 7/17/2009 NC 7/17/2009 PA 7/17/2009 OR
74 23 46 22 56 29 21 22 1.8 24 11 4 26 28 12 4 13
74 23 46 22 56 29
35 4 26 12 10 19 4 29 46 25 1.2 56 55 42
35 4 26
28 14 47 11 18 4 11 5 24 12 24 1.8 38 1.2 27 21 17 12
27 14 47 11 18 4 11 5 24 12 24 1 38 1 27 21 17 12
22 1 24 11 4 26 12 4 13
10 19 4 29 46 1 56 55 42
F F M M M F M F 0.8 F M M M F M M M F F F M F M M F M F F M 0.2 M M F M F M F F M F F M F F F F 0.9 F F 0.2 M F F F F
7/16/2009 Swelling and redness of left upper a 7/16/2009 Friday after injection arm became e 9/2/2008 A 46-year-old male, with no illness a 1/23/2009 Initial information was received on 0 3/27/2009 Initial report was received 03 Decem 3/10/2009 This case was received from a heal 4/3/2009 This non serious case was received 5/21/2009 This non serious case was received 7/17/2009 Fever that lasted 2 days straight. Ev 7/17/2009 June 24th - Reported to the ER with Redness and swelling up to 5" in pla 7/13/2009 Rash on abdominal, face, legs, and 7/13/2009 After 2nd HPV vaccine 5 days later 7/13/2009 A 28-year-old male patient received 7/10/2009 Patient felt clinic was reported by m 7/13/2009 7/11 - arm (upper) was reported as 7/11/2009 Pain 24 hours after shot - swelling r 7/7/2009 4-5 inch raised, red, hot area aroun 7/15/2009 Initial report was received 14 July 20 7/16/2009 7-13-09 child received 4 immunizati 7/16/2009 Information has been received for th 7/16/2009 Left upper arm below injection site i 7/15/2009 Left deltoid at injection site red\swol 7/16/2009 Information has been received from 7/17/2009 Right upper arm swollen, warm to to 7/9/2009 Pediatric dose of Hep B given to ad 7/13/2009 Pain. Pressure both lower legs (calf 7/13/2009 Tetanus booster given on: DECAVA 7/14/2009 Local Rxn. 2 Red papules L thigh, s 6/29/2009 High fever, chills, diarrhea, weaknes 7/14/2009 Patient described dizziness, vision d 7/17/2009 Pt c/o pain and swelling to R arm se 7/17/2009 This case was reported by a healthc 7/16/2009 Pt recieved four shots right arm (Me 7/9/2009 6-24-09 Fever 103 and nausea 6-2 7/17/2009 severe joint pain, headache, nausea 7/17/2009 Had swelling and redness at the inje 7/17/2009 PATIENT CAME TO HEALTH DEPA 7/17/2009 Local reaction, red, swollen, hurts, n 7/17/2009 Local reaction, red, swollen, hurts, n 7/17/2009 The patient received a Dtap in the le 7/17/2009 Calls to say is declining 3rd Gardas 7/17/2009 Red, warm, raised area at vaccine s 7/17/2009 SEVERAL HOURS AFTER RECEIV 7/17/2009 Painfull swelling of joints(knees and 7/17/2009 Less than 24 hours after vaccination 7/17/2009 Fever began on 7/16/2009, 8 days a 7/17/2009 Localized erythema, warmth to touc 7/17/2009 PT'S MOM CALLED TODAY TO RE 7/17/2009 Client had vaccines 7/16/2009. Rep 7/17/2009 4in by 4in redness surrounding vacc
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7/17/2009 CA 7/17/2009 WA 7/17/2009 MN 7/17/2009 KY 7/17/2009 AR 7/17/2009 TX 7/17/2009 FL 7/17/2009 AK 7/17/2009 MD 7/17/2009 MO 7/17/2009 CA 7/17/2009 IL 7/17/2009 CO 7/17/2009 TN 7/17/2009 NY 7/17/2009 GA 7/17/2009 TX 7/17/2009 7/17/2009 TX 7/17/2009 7/17/2009 OK 7/17/2009 TX 7/17/2009 7/17/2009 CA 7/17/2009 AZ 7/17/2009 OR 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 TX 7/17/2009 PA 7/17/2009 OK 7/17/2009 NJ 7/17/2009 WV 7/17/2009 OH 7/17/2009 PA 7/17/2009 7/17/2009 FL 7/17/2009 VA 7/17/2009 AL 7/17/2009 7/17/2009 VA 7/17/2009 FL 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 NY 7/17/2009 CT 7/17/2009 7/17/2009 7/17/2009
16 67 42 4 4 60 80 12 1 13
16 67 42 4 4 60 80 12 1 13
0.2 16
0 16 4 0 0 17 18 18 22 24 20 24 17 15 19 25
0.2 0.3 17 18 18 22 24 20 24 17 15 19 25 17 25
17
23
23
11 18
71 12 23 17 13 22 22 19 19 24 15 22 26
71 12 23 17 13 22
24 22
F M F M F F F F 0M F F 0.2 F F M 0.2 F 0.3 M F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
7/10/2009 Pt. developed acute arm pain at the 7/17/2009 Shingles vaccine resulted in a case 7/17/2009 Woke am after injection with chills, m 7/17/2009 7 mm brawny edema area on right u 7/17/2009 7-16-09 pm noticed swelling adn red 7/17/2009 Approx. 24 hours after vaccination, 7/17/2009 Patient received Zostavax vaccine f 7/17/2009 Moderate fever, hoarseness, palene 7/17/2009 13 mth old male received MMR #1, 7/17/2009 6"X4" area on back of left arm. Red 7/17/2009 (L) side Deltoid swollen noticed 7.16 7/17/2009 Urticana @ vaccine sites 0 anaphyl 7/17/2009 L deltoid injection, 2 hours later L ar 7/17/2009 DPT and IPV given in lower mid Lt t 7/17/2009 Persistent crying with loss of appetit 7/16/2009 Developed stools with bloody mucu Client given 6 shots on 7-14-09. Re 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received throu 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/17/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Initial information has been received 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from 7/15/2009 Information has been received from
352176 352177 352178 352179 352180 352181 352182 352183 352195 352198 352200 352201 352203 352204 352205 352206 352207 352208 352209 352210 352211 352212 352213 352215 352216 352217 352218 352219 352220 352221 352229 352231 352232 352233 352234 352235 352236 352237 352239 352241 352242 352243 352244 352245 352246 352271 352272 352273 352274 352275 352276
7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 MN 7/17/2009 CO 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 VA 7/17/2009 7/17/2009 AZ 7/17/2009 7/17/2009 IL 7/17/2009 CA 7/17/2009 7/17/2009 NY 7/17/2009 VA 7/17/2009 7/17/2009 CA 7/17/2009 NY 7/17/2009 FL 7/17/2009 7/17/2009 MA 7/17/2009 7/17/2009 PA 7/17/2009 NY 7/17/2009 TX 7/17/2009 7/17/2009 PA 7/17/2009 7/17/2009 MO 7/17/2009 7/17/2009 NJ 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 TX 7/17/2009
17 15
15
23
23
17 26 24 11 22 12
17 26 24 11
14
21 13 15 22 14 14 17 17
17 17
22
22
32 19 22
32 19 22
25 13
25
22 16
16
18
18
15 17 26 18 13
15 26
F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F
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7/17/2009 7/17/2009 7/17/2009 KY 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 7/17/2009 VA 7/17/2009 MI 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 OH 7/17/2009 7/17/2009 TX 7/17/2009 FL 7/17/2009 7/17/2009 PA 7/17/2009 7/17/2009 SC 7/17/2009 TX 7/17/2009 MI 7/17/2009 VA 7/17/2009 NY 7/17/2009 7/17/2009 MI 7/17/2009 7/17/2009 IL 7/17/2009 CT 7/17/2009 KY 7/17/2009 PA 7/17/2009 7/17/2009 NY 7/17/2009 CT 7/17/2009 NY 7/17/2009 TX 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 7/17/2009 CA 7/17/2009 7/17/2009 7/17/2009 VA 7/17/2009 7/17/2009 CA 7/18/2009
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7/18/2009 FL 7/18/2009 WA 7/18/2009 AR 7/18/2009 FL 7/20/2009 MI 7/20/2009 NE 7/20/2009 7/20/2009 7/20/2009 MI 7/20/2009 AZ 7/20/2009 NJ 7/20/2009 NV 7/20/2009 NC 7/20/2009 7/20/2009 FL 7/20/2009 MS 7/20/2009 LA 7/20/2009 NC 7/20/2009 NC 7/20/2009 AZ 7/20/2009 NC 7/20/2009 NE 7/20/2009 VA 7/20/2009 GA 7/20/2009 NJ 7/20/2009 FL 7/20/2009 MI 7/20/2009 MN 7/20/2009 MI 7/20/2009 CO 7/20/2009 NY 7/20/2009 IN 7/20/2009 TN 7/20/2009 WA 7/20/2009 NY 7/20/2009 IN 7/20/2009 IN 7/20/2009 PA 7/20/2009 MA 7/20/2009 NC 7/20/2009 TN 7/20/2009 VA 7/20/2009 OH 7/20/2009 TN 7/20/2009 WI 7/20/2009 MD 7/20/2009 IL 7/20/2009 KS 7/20/2009 CA 7/20/2009 MA 7/20/2009 WA
26 54 14 40 16 14 15 1.3 61 0.3 29 1 21 70 4 10 0.2 6 29 79 12 13 51 4 1.2 0.2 1.3 65 25 3 1.4 8 1 20 0.2 17 4 66 32 22 1 72 17 18 17 67 14 59 1 70 38
26 54 14 40 16 14 1 61 0 29 0 21 70 4 10 0 6 29 12 13 51 4 1 0 1 65 25 3 1 8 1 20 0 17 4 66 32 22 1 72 17 18
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7/18/2009 at 9:00 am I had the 3rd gardasil sh 7/18/2009 Had the injection 7-6-09 at 5 pm. B 7/18/2009 2nd dose of gardasil administered in 7/18/2009 7/11/09: Abdominal pain, nausea, v 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/17/2009 Information has been received from 7/16/2009 Initial report received on 08 July 200 6/30/2008 Loss of eye contact, words, repetitiv 7/15/2009 Developed GUILLAIN BARRE Synd 7/20/2009 This case was Y reported by a consum 7/17/2009 Red swollen area measuring 4 1/4 " Child began to have emesis around 7/8/2009 Mom reported blister at injection site 7/14/2009 3 x 3 cm area of redness at vaccina 7/20/2009 This case was reported by a healthc 7/15/2009 Dermatologist - gave Valtrex 16m + 7/16/2009 Developed severe headache on 7/1 7/14/2009 Myalgias, nausea, episode of faintin 7/14/2009 Administration site became red & sw 7/14/2009 Eyes swollen, clear runny nose. Sw 7/13/2009 10 AM 7/13/2009- Seizure activity- f 7/14/2009 Pt start crying inconsolable the day 7/20/2009 C/O LEFT LEG RED AND SWOLLE 7/20/2009 Received vaccine July 10, 2009 with 7/20/2009 Rec'd Boostrix on 7/17/09; reports v 7/20/2009 Shingles 7/20/2009 the next day his leg was blistered, r 7/20/2009 On 7/19/09 noted lethargy, headach 7/20/2009 Pt developed marked thrombocytop 7/20/2009 rash on hands, elbows, and chest. c 7/20/2009 Patient received Pentacel, Prevnar, 7/20/2009 none 7/20/2009 none 7/20/2009 Outbreak of vessicular rash in L5/S1 7/20/2009 Patient describes receiving Tetanus 7/20/2009 Employee reported that approximat 7/20/2009 Received her 1st Varivax 7/6/09 in h 7/20/2009 temp 100, rash, itching, left upper u 7/20/2009 Client received a Menactra on 7/20/ 7/20/2009 Varicella virus vaccine was ordered 7/20/2009 The injection site began to itch, turn 7/20/2009 Subject in pneumococcal vaccine tr 7/20/2009 6 cm wide tender erythmatous area 7/20/2009 I gave a pediatric dose of Hep B ins 7/20/2009 Low Platlet Count 7/20/2009 Vaccine administered Friday afterno 7/20/2009 Employee who works in Dental scho
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7/20/2009 CA 7/20/2009 TX 7/20/2009 FL 7/20/2009 AZ 7/20/2009 CA 7/20/2009 WA 7/20/2009 IL 7/20/2009 NC 7/20/2009 AZ 7/20/2009 ME 7/20/2009 NV 7/20/2009 WV 7/20/2009 MA 7/20/2009 WI 7/20/2009 MI 7/20/2009 MS 7/20/2009 TN 7/20/2009 GA 7/20/2009 AZ 7/20/2009 CA 7/20/2009 OR 7/20/2009 ID 7/20/2009 TX 7/20/2009 MN 7/21/2009 WI 7/21/2009 VT 7/21/2009 7/21/2009 GA 7/21/2009 PA 7/21/2009 NC 7/21/2009 RI 7/21/2009 MS 7/21/2009 7/21/2009 NV 7/21/2009 MD 7/21/2009 NH 7/21/2009 OH 7/21/2009 ID 7/21/2009 OH 7/21/2009 MS 7/21/2009 TX 7/21/2009 NC 7/21/2009 GA 7/21/2009 MD 7/21/2009 MA 7/21/2009 TX 7/21/2009 OK 7/21/2009 VA 7/21/2009 PA 7/21/2009 LA 7/21/2009 MD
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7/15/2009 Per translator Y client died 2 to 3 hrs. 7/20/2009 Within 1-2 days c/o headache, naus 7/20/2009 Increased temperature 105 degrees 7/20/2009 Left arm - noted severe redness, er 7/20/2009 Patient received VARIVAX IM instea 7/20/2009 Pt reports insect bite like sensations 7/10/2009 Patient here for physical with foster 7/14/2009 7-14-09 8:35 AM - Patient received 7/13/2009 Redness and swelling on the left arm "Fever, chills, body aches began 2 h 7/14/2009 Redness, swelling, warmth & streak 7/17/2009 Redness at injection site, knot in arm Less than 24 hrs, acute onset, on b 7/20/2009 Within 1 min after vaccines adminis 7/20/2009 Pt was given Adult dose of Hep A Child began to have emesis around 7/18/2009 Patient complained of pain in injecti 7/10/2009 Hives started on shoulders and then 7/14/2009 Swelling, erythematous, hot, 3/12 cm 7/2/2009 All of patient's upper arm, where va 7/15/2009 Lump & pustule on right thigh. 7/11/2009 Red - indurated - pruritic 12 X 6 cm 7/14/2009 None Stated 7/1/2009 Received vaccine 6/29 - developed 6/24/2009 Information has been received from 10/3/2008 Initial report received on 16 Septem 7/20/2009 InformationYhas been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 7/20/2009 Information has been received from 3/26/2009 Fatigue for the first few weeks, pani 7/8/2009 50yo male received pneumococcal 7/15/2009 After 15 minutes of giving KINRIX, V 7/20/2009 G. mom - Reports crying x 2/2 hrs a 7/14/2009 Raised erythematous somewhat con 7/16/2009 On 7/3/09 patient started running a 7/16/2009 N/A 7/17/2009 Swelling, redness, pain and itching 7/17/2009 7/16/09 pm - Received care from M 7/16/2009 X 1 Hive at the site of injection. Mea 7/21/2009 Patient received Zostavax vaccine o 7/21/2009 Administered adult dose of Hep B v 7/21/2009 Received two doses of Tdap. First 7/21/2009 Patient complained of right swollen 7/21/2009 Varicella vaccine given 7-18-09 in L 7/21/2009 Starting the night of immunization h 7/21/2009 Approximately seven hours after rec 7/21/2009 BURNING REDNESS AND EXTRE 7/21/2009 Pain right deltoid starting the day af 7/21/2009 Tdap received IM on 7/16/09. Emplo
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7/21/2009 ME 7/21/2009 NV 7/21/2009 IL 7/21/2009 TX 7/21/2009 CA 7/21/2009 CA 7/21/2009 WA 7/21/2009 VA 7/21/2009 NC 7/21/2009 CA 7/21/2009 IL 7/21/2009 NC 7/21/2009 IL 7/21/2009 GA 7/21/2009 OR 7/21/2009 WV 7/21/2009 OR 7/21/2009 PA 7/21/2009 MN 7/21/2009 MT 7/21/2009 IL 7/21/2009 ND 7/21/2009 LA 7/21/2009 NC 7/21/2009 7/21/2009 KY 7/21/2009 VA 7/21/2009 WI 7/21/2009 CA 7/21/2009 PA 7/21/2009 MN 7/21/2009 CA 7/21/2009 AR 7/21/2009 OH 7/21/2009 AL 7/21/2009 OH 7/21/2009 IL 7/21/2009 MO 7/21/2009 CA 7/21/2009 IL 7/21/2009 ID 7/21/2009 CA 7/21/2009 CA 7/21/2009 WI 7/21/2009 NY 7/21/2009 PA 7/21/2009 MA 7/21/2009 OH 7/21/2009 IL 7/21/2009 NV 7/21/2009 TN
43 24 56 48 11 15 65 15 12 1 0.3 62 14 14 0.2 1.2 0.2 36 12 15 18 23 6 48 27 4 11 4 0.2 2 70 18 32 10 12 1 68 4 1.4 80 10 17 13 18 9 58 44 6 45 66 5
43 24 56 48 11 15 65 15 12 1 0 62 14 14 0 1 0 36 12 15 18 23 6 48 27 4 11 4 0 2 70 18 32 10 12 1 68 4 1 80 10 17 13 18 9 58 44 6 45 5
F F F F M F F F M 0M 0.3 F F M M 0.2 F 0.2 M 0.2 F F M F F F F F M M M F 0.2 F 0.2 F F F F M M 0F F M 0.4 F F M F F F M F M F F F F
7/21/2009 Patient reports fever last evening. M 7/21/2009 Patient with history of cluster heada 7/21/2009 fever, rash at site, swelling at site, d 7/21/2009 Localized inflammatory irritation with 7/21/2009 VARICELLA 3 7/21/2009 Immediately after administration of H 7/17/2009 Left upper arm rash/pain starting 1 d 7/21/2009 LEFT SIDED FACIAL SWELLING, T 7/21/2009 Beginning at 6:00 pt c/o soreness. 7/21/2009 VACCINE GIVEN ON THE 10 OF J 7/4/2009 Received vaccines at 2:30 pm office 7/16/2009 Monday administration, dizziness fo 7/21/2009 Pt developed chills Monday evening 7/22/2009 2 d. after immunization began havin 7/14/2009 The day after child received rotaviru 7/16/2009 Inconsolable crying last evening (77/14/2009 After child received rotavirus vaccin 7/16/2009 Temp. 1004, body aches, nausea. 7/16/2009 Dizziness, weakness, had to stop u 7/16/2009 Client experienced dizziness, faintin 7/16/2009 Immediately after shots were given 7/17/2009 Rt arm-area red-warm-swollen-tend 7/16/2009 Developed hives after KINRIX immu 7/11/2009 Zostavax vaccine given subcutaneo 7/7/2009 Pruritis, painful, papular rash of han 7/14/2009 Anaphylaxis: Child presented with h 7/16/2009 11 yo with large amount of swelling 7/14/2009 Shots given on 7/10/09 Pt in to U.C 7/13/2009 Tonic-clonic seizures, 3 hours after 7/15/2009 Pts father stated that pt developed f 7/10/2009 Patient was given Tdap immunizatio 7/14/2009 Pt was given GARDASIL vaccine up 7/14/2009 Patient called 7-6-09 c/o (L) arm stif 7/21/2009 - Acting delirious - severe headache 7/21/2009 Pt had redness & swelling to injectio 7/20/2009 Morbilliform rash - generalized - Rx 7/21/2009 Redness + itching at site, has persis 7/21/2009 Developed urticaria, angio edema, t 7/21/2009 Right arm (erythematous & edemato 7/21/2009 Swelling, redness, severe itching at 7/21/2009 N/A given TDAP before age 11 yrs. 7/21/2009 Dizziness with Pt blurring of vision a 7/21/2009 Fainted briefly after immunization: in 7/21/2009 Patient was given GARDASIL on 7/ 7/21/2009 Became lightheaded and nauseous 7/20/2009 7-17-09 - Sleep & H/A 7-19-09 - H/ 7/16/2009 Client states about 4o after shot his 7/20/2009 L lump at injection site - egg size, re 7/21/2009 Pt. has persistent left arm pain since Arm swelled, red rash, itchy, ice 15 7/16/2009 16 cm + 11cm red area surrounding
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7/21/2009 CA 7/21/2009 OH 7/22/2009 CA 7/22/2009 MD 7/22/2009 CA 7/22/2009 7/22/2009 VA 7/22/2009 AZ 7/22/2009 IL 7/22/2009 OH 7/22/2009 TX 7/22/2009 UT 7/22/2009 KS 7/22/2009 WA 7/22/2009 CO 7/22/2009 PA 7/22/2009 SC 7/22/2009 TX 7/22/2009 NV 7/22/2009 TX 7/22/2009 PA 7/22/2009 ND 7/22/2009 AR 7/22/2009 CO 7/22/2009 NC 7/22/2009 NJ 7/22/2009 NM 7/22/2009 KS 7/22/2009 NY 7/22/2009 OR 7/22/2009 MI 7/22/2009 MI 7/22/2009 CA 7/22/2009 AK 7/22/2009 7/22/2009 MN 7/22/2009 MN 7/22/2009 FL 7/22/2009 AK 7/22/2009 MD 7/22/2009 MD 7/23/2009 CA 7/23/2009 WA 7/23/2009 7/23/2009 TX 7/23/2009 MI 7/23/2009 MN 7/23/2009 NH 7/23/2009 MO 7/23/2009 MO 7/23/2009 MO
4
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0 0 59 63 62 26 21 17 10 60 12 66 43 22 77 4 0 4 8 1 5 60 10 26 1 4 17 2 58 53 23 8 12 0 1 11 23 4
11
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Spiked a fever, began vomiting, & s 7/15/2009 Information has been received from 7/21/2009 The patient had what were describe 7/17/2009 25 wker now 11 wks old received 2 7/17/2009 Blister like spots to back, arms,ches 7/20/2009 I have received the ZOSTAVAX vac 7/16/2009 Bright red rash 3 x 7 cm at injection 7/22/2009 This case was reported by a pharma 7/22/2009 Seizures, Slurred speech, Dizziness 7/22/2009 Acute disseminated encephalomyel 7/22/2009 Small, bumpy, itchy rash at injection 7/22/2009 PT REPORTS WAKING WITH HEA 7/22/2009 Parent states child c/o right arm pai 7/22/2009 Per patient secure message (email) 7/22/2009 Patient experienced change in sens 7/22/2009 Patient received a gardasil vaccine 7/22/2009 Patient presents with redness and w 7/22/2009 Site of injection red, swollen, with pa 7/22/2009 The baby died Y under suspicious con 7/22/2009 Left upper arm wheal measured at 5 7/22/2009 5/20/09 received telephone call from 7/22/2009 SEIZURE LASTED 10-30 SECOND 7/22/2009 localized swelling, redness, and war 7/22/2009 patient reports vaccination site with 7/22/2009 On 7-14-09 pt received varicella and 7/22/2009 Pt went to ER on 6/26/09. Pt states 7/22/2009 Petechial Rash entire body. Fever t 7/22/2009 Mother reported erythema swelling 7/22/2009 Evening of vaccines, pt developed r 7/22/2009 None Stated. 7/22/2009 Onset of swelling, erythema <48 ho 7/22/2009 Approximately 4 days after vaccinat 7/22/2009 Fever, sweats, nausea, vomiting & s 7/22/2009 Pt came in on 20 Jul 09 to receive V 7/10/2009 Left upper arm over Tricep with 3x4 7/21/2009 7-10 days post injection, site of VAR 7/21/2009 7-10 days after injection, at site of V 7/22/2009 Headache, dizziness AP 89 reg R-2 Pt came back to clinic after 15 min c 6/24/2009 Vaccine administered on 6/22/2009 7/15/2009 Information has been received from 7/23/2009 Complained of feeling faint, lighthea 7/22/2009 Information has been received from 7/22/2009 Information has been received from 7/22/2009 This case was received from a heal 7/21/2009 Pt complained of thirst after receivin 7/22/2009 3 hours after injections-pt became m 7/22/2009 Mom called said she wanted it docu 7/23/2009 HPV #1 lot# 0171U, exp 6/29/09 wa 7/23/2009 Received HPV # 3 on 7/15/2009. T 7/23/2009 Received HPV #3 on 7/15/09. This
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7/23/2009 MO 7/23/2009 OH 7/23/2009 NY 7/23/2009 NY 7/23/2009 ME 7/23/2009 PA 7/23/2009 CT 7/23/2009 GA 7/23/2009 NY 7/23/2009 NC 7/23/2009 NC 7/23/2009 GA 7/23/2009 TX 7/23/2009 NE 7/23/2009 ME 7/23/2009 CA 7/23/2009 AZ 7/23/2009 NY 7/23/2009 IN 7/23/2009 NY 7/23/2009 MO 7/23/2009 OK 7/23/2009 OK 7/23/2009 NY 7/23/2009 AK 7/23/2009 7/23/2009 TN 7/23/2009 IA 7/23/2009 OR 7/23/2009 IN 7/23/2009 IN 7/23/2009 TX 7/23/2009 WA 7/23/2009 CA 7/23/2009 CA 7/23/2009 TX 7/23/2009 AL 7/23/2009 PA 7/23/2009 AZ 7/24/2009 7/24/2009 7/24/2009 CA 7/24/2009 7/24/2009 MD 7/24/2009 WA 7/24/2009 TX 7/24/2009 IL 7/24/2009 ID 7/24/2009 NY 7/24/2009 AL 7/24/2009 VT
12 60 5 21 66 10 5 1.3 8 67 65 11 18 17 6 1.1 4 72 11 19 57 0.3 11 73 66 9 0.2 4 8 22 57 72 39 51 14 4 9 15
12 60 5 21 66 10 5 1 8 67 65 11 18 17 6 1 4 71 11 19 57 0 11 72 66 58 9 0 4 8 22 57 72 39 51 14 4 9 15
12
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3 4 71 5
F F M F F F M 0.3 F M F F M F F F 0.1 F M F F F M 0.3 F F F F M F 0.1 M F F M F F F M M F M F F F F U F 0.2 M F U F M M M
7/23/2009 Received HPV #2 7/21/09. This vac 7/20/2009 7 X 9 cm. area of redness and edem 7/20/2009 Patients arm swelled up and appea 7/17/2009 Pt fell to floor post GARDASIL vacc 7/20/2009 Broke out in severe rash left side ne 7/17/2009 Mother reports child began having r 7/17/2009 Upper left deltoid area reddened, sw 7/8/2009 -Skin redness over body, -Rash, -Itc 7/16/2009 Red, warm, swollen "2x2 " tender co 7/17/2009 Redness, itching, and induration aro 7/17/2009 Redness, swelling, and pain surroun 9/23/2009 After MENACTRA, TDAP, vaccinati 7/23/2009 Reported 7/23/09 - came to clinic to 7/23/2009 Seizure - like activity noted on 7-227/23/2009 Patient arrived at ED 17 Jul 2009 @ 7/23/2009 Macular - papular rash 1 day after v 7/25/2009 Local erythema, induration, warmth, 7/23/2009 chicken pox like rash/hive like, occu 7/23/2009 large, red welt at site of vaccine. Pa 7/23/2009 erythema to left tricep area started d 7/23/2009 3 days after shots, had joint aches a 7/23/2009 She was born Y August 22nd, 2008, p 7/23/2009 Right upper arm with large red, indu 7/23/2009 off balance with nausea and vomitin 7/23/2009 Shingles vacccine: first and second 7/23/2009 PT REPORTED FEVER AND PAIN 7/23/2009 Patient received 2nd Varivax on 7/2 7/23/2009 Unconsolable crying for 3 and 1/2 h 7/23/2009 10 cm x 11 cm red, warm, localized 7/23/2009 Patient returned to District Health O 7/23/2009 CLIENT RETURNED TO CLINIC FO 7/23/2009 Severe rash to arms and legs, seen 7/23/2009 Patient reported experiencing wide7/23/2009 SWOLLEN ARM, FEELING LOTS O 7/23/2009 Suffered a transverse myelitis which 7/23/2009 Ten minutes after receiving immuniz 7/23/2009 (L) thigh red, swollen with heat. War 7/23/2009 Pt had syncopal episode post receiv 7/23/2009 Swelling / redness with 3 cm x 2 cm 7/16/2009 This case was initially reported by a 7/23/2009 Information has been received from 7/17/2009 Developed progressive lower extrem 7/21/2009 Not an adverse event, but I have ha 7/13/2009 Had a panic attack (shortness of bre 7/21/2009 (1) very pale, white - bluish lip - one 7/17/2009 TDAP given in left arm 7-13-2009. P Facial swelling, rash No adverse events. I gave a Hepati 7/20/2009 Red/ swollen left deltoid, warm to to 6/30 - Small dark bump around righ 7/21/2009 5 cm X 6 cm erythema, red, tender
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7/24/2009 IL 7/24/2009 CA 7/24/2009 NM 7/24/2009 MI 7/24/2009 OH 7/24/2009 PA 7/24/2009 VA 7/24/2009 CO 7/24/2009 NC 7/24/2009 GA 7/24/2009 GA 7/24/2009 CA 7/24/2009 TX 7/24/2009 GA 7/24/2009 FL 7/24/2009 MI 7/24/2009 FL 7/24/2009 FL 7/24/2009 NC 7/24/2009 OK 7/24/2009 MO 7/24/2009 IA 7/24/2009 MI 7/24/2009 IL 7/24/2009 MI 7/24/2009 CA 7/24/2009 ID 7/24/2009 NY 7/24/2009 TN 7/24/2009 WI 7/24/2009 CO 7/24/2009 MI 7/24/2009 OH 7/24/2009 NC 7/24/2009 NY 7/24/2009 AR 7/24/2009 NY 7/24/2009 CA 7/24/2009 MI 7/24/2009 MO 7/24/2009 MN 7/24/2009 MI 7/24/2009 PA 7/24/2009 NH 7/24/2009 MA 7/24/2009 AZ 7/24/2009 AZ 7/24/2009 IL 7/24/2009 AK 7/24/2009 KY 7/24/2009 CA
79 20 64 18 1.1 15 36 40 18 5 10
79 20 64 18 1 15 36 40 18 4 10
23 16 11 21 16 11 4 57 8 65 0.4 15 15 34 1.3 0.2 12 18 10 0.5 57 5 0.2 37 65 7 22 4 0.2 4 63 0.5 4 12 14 11 65 4 0.2
23 16 11 21 16 11 4 57 8 65 0 15 15 34 1 0 12 18 10 0 57 5 0 37 65 7 22 4 0 4 63 0 4 12 14 11 65 4 0
F F M F 0.1 M F F F M M M M M F F F F F M F M F 0.4 F F F F 0.3 M 0.2 M M F F 0.5 F F F 0.2 M F M M M F 0.2 M M M 0.5 M F M F F M M 0.2 M
7/21/2009 4 days after injection, vomited biliou 7/20/2009 Patient received MMR vaccine on 7 7/16/2009 After patient received SUB-Q injecti 6/22/2009 On 6/20/09 per parent, client got ou 7/21/2009 On 10/11/2007 client had his first co 7/24/2009 Patient got lightheaded immediately 7/20/2009 Four hours after taking pill # 1 - bac 7/8/2009 None stated. 7/17/2009 Redness, puffiness + warm to touch 7/20/2009 Swelling/ redness < 24 hrs after adm 7/21/2009 Red papulo-vesicular rashes all ove Red and itchy and a lump at the site 7/23/2009 Difficulty swallowing began 15 minu 7/24/2009 Presented with Health Dept today, 7 7/24/2009 Swelling and redness/induration (R) 7/23/2009 Patient fainted directly after adminis 7/24/2009 Patient tolerated the HPV vaccine in 7/24/2009 clammy skin, right sided chest pain, 7/24/2009 REDNESS AND SWELLING 3CM B 7/24/2009 I received a flu shot at this clinic on 7/24/2009 Local reaction at injection sites, red 7/24/2009 Patient had large, swollen, firey red 7/24/2009 Per patient's mother, baby had 4 da 7/24/2009 Injection site swollen to softball size 7/24/2009 Immediately after receiving Tdap, M 7/24/2009 Swollen glands around neck, breast 7/24/2009 07-21-09 Given vaccines. Started w 7/24/2009 patient had 2 episodes of seizure-lik 7/24/2009 On 7/9/09 Patient received Hep a, M 7/24/2009 Varicella administered on 7/22/09. 7/24/2009 Initially patient had a red, swollen, w 7/24/2009 N/A 7/24/2009 Client treated at ER for steam burn 7/24/2009 OBLONGED SHAPE RED RASH(P 7/24/2009 positive guiac stool 1 day after rotav 7/24/2009 12 hours later started continuous sh 7/24/2009 Swelling, redness at site and upper 7/24/2009 VACCINE WAS GIVEN 2 DAYS AG 7/24/2009 TEMP OF 102.1 FOR TWO DAYS. 7/24/2009 Pt. develped redness at site and low 7/24/2009 Parents report (at 4 mo visit) excess 7/22/2009 Swelling of thigh, development of er 7/24/2009 Patient developed a debilitating hea 7/24/2009 Lethargy, poor feeding, fever to 103 7/24/2009 (R) arm red, warm to touch, red rash 7/24/2009 Client talking while receiving vaccin 7/24/2009 7/24/09 1300 client became pale, L 7/25/2009 Fainting immediately after MENACT 7/26/2009 Pt had received ZOSTAVAX on 7-1 7/24/2009 4x4 cm erythema around injection s 7/23/2009 Developed Inflammatory Diarrhea w
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7/24/2009 NJ 7/24/2009 PA 7/24/2009 LA 7/24/2009 GA 7/24/2009 SC 7/24/2009 IL 7/25/2009 MI 7/25/2009 NJ 7/25/2009 NJ 7/25/2009 AZ 7/25/2009 NJ 7/26/2009 PA 7/26/2009 FL 7/27/2009 SC 7/27/2009 7/27/2009 CA 7/27/2009 CA 7/27/2009 PA 7/27/2009 NC 7/27/2009 WA 7/27/2009 CA 7/27/2009 NY 7/27/2009 OH 7/27/2009 CA 7/27/2009 7/27/2009 NC 7/27/2009 SC 7/27/2009 AZ 7/27/2009 CA 7/27/2009 7/27/2009 CO 7/27/2009 WI 7/27/2009 WY 7/27/2009 GA 7/27/2009 NM 7/27/2009 NY 7/27/2009 NC 7/27/2009 7/27/2009 NV 7/27/2009 NV 7/27/2009 PA 7/27/2009 MN 7/27/2009 TX 7/27/2009 VA 7/27/2009 VA 7/27/2009 PA 7/27/2009 NY 7/27/2009 AL 7/27/2009 TN 7/27/2009 WA 7/27/2009 NJ
0 10 11 11 0.7 32 5 0.8 0.7 9 70 73 59 17 41 19 82 14 0.2 40 59 71 28 4 47 67 1 1.8 25 19
0 10 11 11 -1 32 5 0 0 9 70 73 59 17 41 19 82 14 0 40 59 71 18 4 47 67 0 1
1 1.7 11 54 0.3 2 52 0.2 0.3 0.5 12 13 13 15 9 0.5 10 1 52 8
1 1 11 54 0 2 52 0 0 0 12 13 15 9 0 10 1 52 8
0M F M M 0.7 M F M 0.8 M 0.7 M F F M M F M F F F 0.2 F F F F F F M F 1F 0.8 M F F F 0M 0.7 F M F 0.3 M 0.7 F M 0.2 M 0.3 F 0.5 F F F F F M 0.5 M M 0M F F
7/24/2009 7-17-09 pt was given Hep B vaccine 7/24/2009 Tender, erythematous, slightly warm 7/24/2009 Four hours after injection pt started 7/23/2009 Site reaction to vaccine in left deltoi 7/24/2009 This case was reported by a pharma 7/24/2009 This case was reported by a healthc 7/25/2009 entire arm swelled that the shot was 7/25/2009 Within an hour of the shot (took plac 7/25/2009 Lump at injection site, lasted 4 wks( 7/25/2009 Erythema (14cm X 15cm), itchiness 7/25/2009 Slight itching at injection site immed 7/26/2009 Redness and itching at injection site 7/26/2009 6 months post shingles vaccine, I be 7/27/2009 Nausea & vomiting, abdominal pain 7/27/2009 Guillain Barre Syndrome developed 7/27/2009 Fainted briefly after - body was shak 7/23/2009 Pt developed red lesions with itchin 7/23/2009 Mother reports,7/17/09 Pt. had redn 7/24/2009 Prolonged high pitched screaming a 7/20/2009 Received TDAP 4/21/09. At 7/7/09 7/17/2009 Blister like spots to back, arms, che 7/20/2009 Began having painful needle like pri 7/22/2009 Initially cold, chills, achy, arm pain T 7/20/2009 Patient experienced severe adverse 7/6/2009 Macular rash 4 x 4 cm surrounding 7/21/2009 The vaccine was to prevent further 7/20/2009 Rash and mild fever X 2 days starte 7/21/2009 Rash 3 cm X 4 cm patch of erythem 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/24/2009 Diagnosed with Idiopathic thromboc 7/27/2009 Had a small outbreak of pox with fe 7/27/2009 (R) deltoid - MENACTRA - large sw 7/24/2009 Injection given 7/20/09 right deltoid; 7/23/2009 10 seconds head & hands shaking. 7/22/2009 Fever to 102 degrees F nausea, vom 7/1/2009 Leg problems, sleep difficulties, phy 1/29/2008 ROTATEQ given 12/17/07. 12/19/0 12/5/2008 Received immunization 9/11/08- PE 7/21/2009 Fever 105(R) 2 days after immuniza 7/20/2009 12 yr old received VARIVAX and TD 7/27/2009 Local redness, swelling, blanching, 7/27/2009 Varivax on 7/20/09 - Developed, 2 d 7/27/2009 Received VARIVAX #2 on 7/22/09, 7/27/2009 Pt stated it started hurting right awa 7/28/2009 5 seconds hands shaking w/ head s 7/27/2009 Rash 5 X 5 to right arm, around inje 7/23/2009 Elevated temperature with diminishe 7/10/2009 Erythema, heat, mild edema, pain 7/22/2009 Hives on cheeks, chest, arms & legs
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7/27/2009 7/27/2009 7/27/2009 CA 7/27/2009 AR 7/27/2009 NV 7/27/2009 7/27/2009 7/27/2009 PA 7/27/2009 ME 7/27/2009 NM 7/27/2009 MI 7/27/2009 ME 7/27/2009 PA 7/27/2009 MI 7/27/2009 IN 7/27/2009 CA 7/27/2009 TX 7/27/2009 CA 7/27/2009 ID 7/27/2009 KS 7/27/2009 VA 7/27/2009 MO 7/27/2009 TN 7/27/2009 OR 7/27/2009 FL 7/27/2009 KY 7/27/2009 AZ 7/27/2009 ND 7/27/2009 GA 7/27/2009 CO 7/27/2009 CO 7/27/2009 KY 7/27/2009 KS 7/27/2009 PA 7/27/2009 WA 7/27/2009 IN 7/27/2009 AZ 7/27/2009 TX 7/27/2009 CA 7/27/2009 FL 7/27/2009 NY 7/27/2009 OK 7/27/2009 CA 7/27/2009 7/27/2009 WI 7/27/2009 KY 7/27/2009 IA 7/27/2009 OK 7/28/2009 AR 7/28/2009 CA 7/28/2009 CA
17 17 45 0.2 36 1.3 13 50 22 26 33 3 4 1.4 17 12 14 4 61 14 30 1.1 52 10 44 67 1 62 62 30 30 18 15 75 4 5 16 11 1.3 0.2 12 19 0.3 66 4 2 56 77 15 12 1
17 17 45 0 36
50 22 26 33 3 4 1 17 12 14 4 61 14 30 1 52 10 44 67 1 62 62 30 30 18 15 75 4 5 16 11 1 0 12 19 0
2 77 15 12 1
F F F 0.2 F F M U F F F F M F 0.4 U M M U M M F F 0.1 M F F F F 0M F F M M F F F F M F F 0.3 F 0.2 F F F 0.3 F F M 0.2 F F F F F 0M
7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/22/2009 Post 1st Dose 07.15.09 Throbbing b 6/12/2009 "Cried for 3 d"; cried for more than 3 2/19/2009 Hives on thighs BENADRYL and Alo 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/22/2009 Initial report was received 20 July 20 7/24/2009 Information has been received from 7/24/2009 Information has been received from 7/27/2009 Patient states she had fatique, weak 7/27/2009 Redness, swollen, nodule, tender to 7/27/2009 24 hours after immunization, Left ar UPON PHONE CALL WE MADE TO 7/27/2009 Immunized on 7/15/09, on 7/16/09 a 7/27/2009 After the 4th vaccine was given (me 7/27/2009 3 CM AREA OF ERYTHEMA, WAR 7/27/2009 KINRIX GIVEN TWICE 7/27/2009 Patient presented to the ER the follo 7/27/2009 The back of the right arm where the 7/27/2009 This employee of the hospital receiv 7/27/2009 Parent noted swollen lymph nodes i 7/27/2009 3 inch by 3 inch indurated area with 7/27/2009 7/25/09 patient came in with 4 x 5 in 7/27/2009 approximately 30 minutes after Tda 7/27/2009 24 hours after injection developed a 7/27/2009 RASH ALL OVER BODY 7/27/2009 Received the Shingles vaccination o 7/27/2009 Large red, hot and itchy patch or 4" 7/27/2009 First vaccine in series was given on 7/27/2009 Twinrix dose #2 given on 7/13/09. P 7/27/2009 Patient experienced problems breat 7/27/2009 Had a syncopal episode in the park 7/27/2009 Red blotch ~ 2 inches in length and 7/27/2009 upper extremities became stiff imme 7/27/2009 Left thigh red and raised 7/13/2009 VARICELLA - redness / swelling 7/1 7/23/2009 Localized hives, erythema, itchy wit Patient got MMR #1, VARICELLA # 7/27/2009 48 hrs after DTaP Imm. infant sleep 7/27/2009 Site warm, firm erythematous mild a 7/27/2009 HEP B injection given on Monday. W 7/24/2009 Pt developed enlarged left inguinal Redness - Soreness proximal to inje 7/25/2009 erythema, edema, warmth entire rig 7/22/2009 Cellulitis left thigh 7/15/2009 This case was reported by a healthc 7/7/2009 This case was reported by a physici 7/21/2009 After vaccine started having severe 7/21/2009 1) Pt fainted / or passed out after va 7/23/2009 Febrile seizure the night after immu
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7/28/2009 ID 7/28/2009 UT 7/28/2009 PA 7/28/2009 CO 7/28/2009 NC 7/28/2009 IN 7/28/2009 HI 7/28/2009 KY 7/28/2009 AR 7/28/2009 MD 7/28/2009 IN 7/28/2009 OH 7/28/2009 OH 7/28/2009 MI 7/28/2009 FL 7/28/2009 PA 7/28/2009 OH 7/28/2009 KS 7/28/2009 WI 7/28/2009 CA 7/28/2009 MA 7/28/2009 TN 7/28/2009 NH 7/28/2009 CA 7/28/2009 IL 7/28/2009 KS 7/28/2009 TN 7/28/2009 FL 7/28/2009 7/28/2009 PA 7/28/2009 PA 7/28/2009 NC 7/28/2009 SC 7/28/2009 OH 7/28/2009 NC 7/28/2009 WI 7/28/2009 VA 7/28/2009 WA 7/28/2009 TX 7/28/2009 TX 7/28/2009 FL 7/28/2009 TX 7/28/2009 NY 7/28/2009 PA 7/28/2009 CA 7/28/2009 LA 7/28/2009 MI 7/28/2009 CO 7/28/2009 TX 7/28/2009 CA 7/28/2009 NV
17 12 1.2 11.2 5 18 10 11 63 19 5 0.3 6 13 73 76 61 12 16 75 0.2 46 64 1.3 14 18 10
17 12 1 11 5 18 10 11 63 19 5 0 6 13 73 76 61 12 16 75 0 46 64 1
73 4 4 16 11 12 35 40 61 24 11 5 1.1 12 49 36 3 11 14 32 15 3 26
73 4 4 15 11 12 35 40 61 24
18 10
5 1 12 49 3 11 14 32 15 3 26
F M 0.2 M M M F F M F F F 0.3 F F M F F F M F F 0.2 M M M 0.3 F F F F U M F M F M M F F F F F U 0.1 M M F M M F F F F M F
7/22/2009 Before administering vaccine patien 7/23/2009 Within 1-2 minutes of administration 7/21/2009 Shingles on 7/19/09. - Acyclonir 7/22/2009 Redness and heat at vaccine sites. 7/22/2009 Child fever 102 degrees F, sleepy, l 6/22/2009 Parent stated RA swelled and redde 7/22/2009 She got vaccinated on Monday 7/20 7/20/2009 Rash on left forearm and trunk, Sat 7/17/2009 Pt developed shingles like rash acro 7/21/2009 7 hours after GARDASIL (HPV) vac 7/21/2009 Localized rxn with redness, warmth 7/22/2009 c/o rash, fever, fussy x 1 day. c/o sw 7/22/2009 Mom called office and stated child w 7/23/2009 Left arm (entire upper arm) edemato Face only. Swollen cheeks, hot and 7/22/2009 Patient is allergic to AVELOX. Deve 7/22/2009 9 days after ZOSTAVAX - began wi 7/22/2009 General malaise began day 1 follow 7/20/2009 Mom reported posterior right arm, 1 7/3/2009 Raised red area, long, around inject 7/23/2009 Received 2 mo vaccines at 11 AM o 7/21/2009 Pt given 4 vaccines (Tdap, MMR, H 7/21/2009 Temp. 101.2 B.P. elevated @ 160/9 7/23/2008 Bump on Left leg where vaccine wa 7/14/2009 High fever 102 degrees, about 3 da 7/17/2009 Pt. with brief (< 1 minute) syncopal 7/24/2009 Initial report received on 07 July 200 7/27/2009 Information has been received from 7/27/2009 Information has been received from 7/27/2009 Received KINRIX on 7/23/09, grand 7/27/2009 Received KINRIX on 7/21/09, paren 7/16/2009 Pt experiencing erythema, warmth, 7/24/2009 Menactra + varicella given wed. 7-2 7/27/2009 Immediately after shot pt felt light he 7/7/2009 Patient began having swelling pain, 7/28/2009 Got injection on 07/24/09. On 07/2 7/28/2009 Referred to health dept. by Dr. for y 7/27/2009 L arm pain for five days following va 7/28/2009 This child was given a Dtap instead 7/28/2009 swollen and redness right leg dtap # 7/28/2009 Patient developed fever, seizure, Le 7/28/2009 Painful rash to abdomen. treatment 7/28/2009 Pain, swelling at site of injection on 7/28/2009 Discomfort to Left Arm Constant pai 7/28/2009 Redness,swelling and tenderness 1 7/28/2009 Tdap, Varicella, MCV4, & Gardasil w 7/28/2009 Per patients mom, patient complain 7/28/2009 Dimple at injection site (left upper ar 7/28/2009 Localized allergic reaction to vaccin 7/28/2009 L lateral upper extremity with ~ 4 cm 7/28/2009 Pt developed systemic hives, pruriti
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7/28/2009 MO 7/28/2009 VA 7/28/2009 NE 7/28/2009 NY 7/28/2009 IN 7/28/2009 CT 7/28/2009 IL 7/28/2009 PA 7/28/2009 ID 7/28/2009 IL 7/28/2009 7/28/2009 7/29/2009 CA 7/29/2009 7/29/2009 CO 7/29/2009 7/29/2009 7/29/2009 WV 7/29/2009 7/29/2009 MO 7/29/2009 GA 7/29/2009 7/29/2009 FL 7/29/2009 7/29/2009 TX 7/29/2009 IN 7/29/2009 MA 7/29/2009 VA 7/29/2009 NY 7/29/2009 PA 7/29/2009 IA 7/29/2009 MA 7/29/2009 TX 7/29/2009 TN 7/29/2009 CA 7/29/2009 TN 7/29/2009 NC 7/29/2009 CA 7/29/2009 WA 7/29/2009 KY 7/29/2009 PA 7/29/2009 FL 7/29/2009 MO 7/29/2009 IA 7/29/2009 MN 7/29/2009 MD 7/29/2009 SD 7/29/2009 SD 7/29/2009 ID 7/29/2009 NV 7/29/2009 NC
68 4 1 68 18 11 0.3 43 66 9
68 4 1 68 18 11 0 43 66 9
41 4 85 11 66
41 4
59 25 11 78 10 20 12 0.3 0.5 11 0.2 19 26 12 5 11 0.2 14 1.1 1.3 1 83 13 72 18 14 5 21 0.9 0.9 67 67 40
11 67 59 25 11 10 12 0 0 11 0 19 26 12 5 11 0 14 1 1 1 83 13 71 18 14 5 21 0 0 67 67 40
F M 0M F F F 0.3 F F F M M M M F M M M F F F M M F F M 0.3 M 0.5 M F 0.2 F M F F M M 0.2 F M 0.6 M 0.3 F 0M F F F F M F F 0.9 M 0.9 M M M F
7/28/2009 redness at site of injection; c/o left s 7/28/2009 vaccine related varicella (skin rash) 7/15/2009 Child had fever for 2 weeks (intermi 7/28/2009 0 adverse events 7/28/2009 Feels warm though no fever. Edem 7/24/2009 Vaccine given: 7/21/09 - Fever day 7/22/2009 Projectile vomiting irritability Clingy 7/28/2009 Began 7-25-09 with "mild achy". W 7/28/2009 TDAP given instead of TD. No adve 7/24/2009 Vesicular eruption at injection site d 4/3/2009 Initial report received from a consum This case was received on 05 May 2 7/29/2009 Had injections at 11:20 am on 7-277/23/2009 On 03/20/09 I received ZOSTAVAX 7/23/2009 Patient contracted Chicken Pox dise 7/15/2009 Had shingles vaccine injected on 77/23/2009 ZOSTAVAX vaccine injection side e 7/25/2009 For 1 wk after - can't lift arm (left) - h 7/24/2009 6 days post MMR/VARIVAX adminis 7/21/2009 Patient c/o lightheadedness, "feeling 7/24/2009 On 7/22/2009 right arm became sw 7/28/2009 Information has been received from 7/28/2009 Information has been received from 7/28/2009 Information has been received from 7/24/2009 Got shots just after 9 AM. Left office 7/28/2009 Child had rectal temp of 101.4 F an 7/22/2009 Approx. 10 minutes after receiving v Received VARIVAX #2 on 7/27/09 7/26/2009 More than three weeks of moderate 7/28/2009 Sitting in waiting area after administ 7/29/2009 Patient had fainting episode shortly 7/29/2009 At yearly physical this year 7/22/07, 7/29/2009 Mother reports she noted large red 7/29/2009 Patient received Varivax on 7/27/09 7/29/2009 Intussusception. 8/24/09 Hospital re 7/29/2009 Patient received 2nd Varivax on 7/2 7/29/2009 EYTHERMA, WARMTH AND TEND 7/29/2009 Patient woke up with several large a 7/29/2009 Febrile illness without ill contacts, G 7/29/2009 Patient received vaccine at pharma 7/29/2009 Received HPV #3 on 7/22/09. Abou 7/29/2009 Zostavax (0561Y/4131x)administere 7/29/2009 Within 2-3 minutes following mening 7/29/2009 Ben went to the school to lift weight 7/29/2009 4" x 3" area of swelling, hard, red, h 7/29/2009 bilateral arm rash 7/29/2009 PATIENT WAS ADMINISTERED A 7/29/2009 PATIENT WAS GIVEN SECOND D 7/29/2009 Redness - silver dollar size - at adm 7/29/2009 Half dollar sized rash and swelling a 7/29/2009 Moving severe pain in arm from sho
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7/29/2009 DE 7/29/2009 MS 7/29/2009 CA 7/29/2009 PA 7/29/2009 PA 7/29/2009 7/29/2009 FL 7/29/2009 VI 7/29/2009 CO 7/29/2009 OR 7/29/2009 IL 7/29/2009 NC 7/29/2009 KY 7/29/2009 FL 7/29/2009 KY 7/29/2009 IA 7/29/2009 FL 7/29/2009 NM 7/29/2009 TN 7/29/2009 WI 7/29/2009 SC 7/29/2009 AZ 7/29/2009 TX 7/29/2009 AL 7/29/2009 NJ 7/30/2009 IA 7/30/2009 OK 7/30/2009 MD 7/30/2009 7/30/2009 VA 7/30/2009 ME 7/30/2009 NE 7/30/2009 NJ 7/30/2009 NY 7/30/2009 TX 7/30/2009 MI 7/30/2009 NC 7/30/2009 MI 7/30/2009 OH 7/30/2009 NY 7/30/2009 AZ 7/30/2009 GA 7/30/2009 KY 7/30/2009 WV 7/30/2009 AZ 7/30/2009 WV 7/30/2009 SC 7/30/2009 NY 7/30/2009 NC 7/30/2009 NC 7/30/2009 NY
15 24 21 16 10
15 24 21 16 10
14 1.5 17
14 1 17
5 4 0.2 18 16 18 12 5 0 19 1.3 8 6 52 0.3 64 0.1 67 60
5 4 0 18 16 18 12 5 0 19 1 8 6 52 0 64 0 67
14 9 5 4 5 0.2 37 0.2 5 1.8 67 0.6 11 16 4 0.4 11 69 5 18 2
14 9 5 4 5 0 37 0 5 1 67 0 11 16 4 0 11 69 5 18 2
F M M M F U F 0.5 M F U M F 0.2 F F F F F F 0M F 0.3 F F F F 0.3 F F 0.1 M M F M F F F M F 0.2 M M 0.2 M F 0.8 F F 0.6 F F F F 0.4 F M U M F 0.1 M
7/29/2009 Fever 102.9, chills, body aches, mild 7/29/2009 Vaccine administered day 0, 1000. 7/28/2009 Pt had seizure (new onset) 19 Apr 2 7/29/2009 This case was reported by a healthc 7/29/2009 This case was reported by a healthc 7/29/2009 This case was reported by a healthc 7/24/2009 Pt received vaccine - at above clinic 7/29/2009 On 7/27/09 presented with rash on Patient got dizzy, 30-60 minutes aft Redness at site with swelling and sk 7/29/2009 Entire L thigh swollen and erythema 7/29/2009 Pt. reported back to clinic after rece 7/29/2009 Cellulitis R vastus lateralis Patient received HPV vaccine (3rd d 7/29/2009 Hives after injection #1 Gardasil. 1 7/28/2009 After administering vaccines listed b 7/29/2009 1-2 seconds after immunizations ad 7/20/2009 Red and swollen area (approx 31/2" 7/29/2009 Mother reports that he spent Sat. ni 7/29/2009 Period delayed 3 days after 2nd dos 7/29/2009 Fever 105.7, febrile seizure, eyes ru 7/29/2009 Area warm, rash, redness & from pr 7/29/2009 Right arm posterior area red; very s 7/29/2009 Vaccinated 7/24/09. 7/25/09 evenin 7/29/2009 Rash B/L legs - Bumpy rash with fev 7/29/2009 Information has been received from 7/29/2009 Information has been received from 7/19/2009 May 26, 2007 couldn't walk right - to 7/27/2009 After receiving the new shingles vac 7/27/2009 None Stated 7/24/2009 Low grade fever, muscle aches, site 7/28/2009 Red raised rash on neck, legs, arms 7/23/2009 Swollen, red, warm 31/2X4cm area 7/27/2009 Raised, red, hot, tender to touch. Le 7/29/2009 Severe swelling at injection site day Temperature 102 - 103 x 2 days 4 h 7/29/2009 SM noticed some chest discomfort o 7/27/2009 Five hours after immunizations, pt. d 7/24/2009 Gave KINRIX on 7/22/09 in left upp 7/20/2009 Patient developed an unexplained o 7/24/2009 I was in pain felt sick on Sat. and Su 7/24/2009 7 month old was given pediatric HE 7/27/2009 10:45 AM fainted - ice pack, counse 7/24/2009 Shortly after receiving vaccine, while 7/24/2009 Rash developed to the medical area 7/28/2009 Foster-mother reports that approx. 1 7/24/2009 On right arm: (cm) 11x9 erythemato Vaccine administered to upper L arm 7/27/2009 Client was given a TDAP and shoul 7/27/2009 Client received VARIVAX 17 days a 7/16/2009 Thrush on lips and tongue Dr. presc
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7/30/2009 7/30/2009 MS 7/30/2009 FL 7/30/2009 MI 7/30/2009 WI 7/30/2009 CA 7/30/2009 NY 7/30/2009 MO 7/30/2009 PA 7/30/2009 NY 7/30/2009 AZ 7/30/2009 WA 7/30/2009 7/30/2009 FL 7/30/2009 FL 7/30/2009 FL 7/30/2009 TX 7/30/2009 WV 7/30/2009 MD 7/30/2009 KS 7/30/2009 CA 7/30/2009 CA 7/30/2009 NC 7/30/2009 NC 7/30/2009 OK 7/30/2009 MI 7/30/2009 FL 7/30/2009 AL 7/30/2009 IL 7/30/2009 CA 7/30/2009 CA 7/30/2009 CA 7/30/2009 VA 7/30/2009 CA 7/30/2009 MN 7/30/2009 WI 7/30/2009 MI 7/30/2009 CA 7/30/2009 SD 7/30/2009 IL 7/30/2009 WA 7/30/2009 TX 7/30/2009 TX 7/30/2009 GA 7/30/2009 TX 7/30/2009 NC 7/30/2009 NC 7/30/2009 7/31/2009 7/31/2009 MA 7/31/2009 NV
20 11 31 63 18 2 14 12 4 3 11 71
20 11 31 63 18 2 14 12 4 3 11 71
45 18 35 73 4 51 15 6 61 18 46 4 71 37 5 1.5 38 42 39 11 60 12 68 1.7 13 18 17 5 22 10 12 1.5 38 30 28 39 66 20
45 18 35 73 4 51 15 6 60 18 47 4 71 0 5 1 38 42 38 11 67 12 68 1 13 18 17 5 22 10 12 1 38 30 28 39 66 20
M F F F F 0M F F M F M M U M F F F M F F F F F M M M 0F M 0.5 F F F F F M M F 0.7 F F F F F F M F 0.5 M M U F M F F
7/30/2009 Member was recieving a routine ser 7/30/2009 Seizure lasting thirty seconds, follow 7/30/2009 CLIENT RETURNED TO ADULT CL 7/30/2009 redness, swelling, itching, hardness 7/30/2009 Immediately following administration 7/30/2009 Injection site pain to the point where 7/30/2009 Came in for Gardisil #3. Layed down 7/21/2009 Patient recedived vaccines. While p 7/30/2009 Patient recieved DTaP, MMR, IPV in 7/30/2009 Patient c/o knee pain x 1 week then 7/30/2009 Pt. with syncope x 2 events. Synco 7/30/2009 Employee was given Tdap by me (M 7/30/2009 Patient received her 2nd Varivax on 7/30/2009 CLIENT RETURNED TO CLINIC FO 7/30/2009 PATIENT RECEIVED VZV ON 7-21 7/30/2009 AFTER RECEIVING MMR INJECTI 7/30/2009 Client did not state on the screening 7/30/2009 Patient had wheezing, swelling of lip 7/30/2009 Initially an area of erythema of abou 7/30/2009 Less than 8 hours later right leg itch 7/30/2009 LEFT ARM SWOLLEN, REDDNESS 7/30/2009 Patient reported to our facility on 4/6 7/30/2009 Pt was administered Tdap and Men 7/30/2009 RECEIVED PHONE CALL FROM P 7/30/2009 Patient went into his Primary Care P 7/30/2009 location reaction,cellulitis L arm, pt. 7/30/2009 Fever of 102.7, extreme weakness 7/30/2009 Within 15 minutes of administration 7/30/2009 Progressive vesicular eruptions on t 7/30/2009 Red, swollen, itchy, hot to touch. Lt 7/30/2009 Pain, redness, raised semi solid kno 7/30/2009 Subdermal nodule, pain L axilla x 37/27/2009 Pt came to doctors office on 7/25/09 7/30/2009 10 days after injection, chronic urtic 7/30/2009 Right arm, began to become red/sw 7/30/2009 3 - 5 cm raised red area. Pt treated 7/28/2009 MENACTRA given from Lot #U2867 7/30/2009 Patient almost fainted. 7/29/2009 HPV vaccine given, no adverse eve Hives on upper chest. BENADRYL 7/30/2009 Shot was given on 07/23/09 at clinic 7/30/2009 22 y/o female, developed unexplain 7/30/2009 Redness, swelling, warmth, tendern 7/30/2009 Mother states when client woke up 7/29/2009 Severe swelling and redness at inje 7/27/2009 SM developed HA approx 4 hrs afte 7/30/2009 Approx 5 hrs after receiving his mos 7/23/2009 SM developed redness, swelling, pa 7/31/2009 Extreme red skin color, loss of moto 7/23/2009 1/14-8/3/09. Large local reaction las 7/27/2009 The following day my throat was sw
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7/31/2009 MO 7/31/2009 PA 7/31/2009 NE 7/31/2009 TX 7/31/2009 NY 7/31/2009 IN 7/31/2009 CA 7/31/2009 NY 7/31/2009 MI 7/31/2009 CA 7/31/2009 NV 7/31/2009 OH 7/31/2009 7/31/2009 FL 7/31/2009 7/31/2009 NC 7/31/2009 CA 7/31/2009 TN 7/31/2009 CA 7/31/2009 AL 7/31/2009 GA 7/31/2009 WV 7/31/2009 VA 7/31/2009 TX 7/31/2009 AZ 7/31/2009 IL 7/31/2009 MO 7/31/2009 OK 7/31/2009 AR 7/31/2009 TX 7/31/2009 WI 7/31/2009 MD 7/31/2009 CO 7/31/2009 PA 7/31/2009 CA 7/31/2009 WA 7/31/2009 NY 7/31/2009 TX 7/31/2009 MI 7/31/2009 CO 7/31/2009 KY 7/31/2009 NY 7/31/2009 PA 7/31/2009 TX 7/31/2009 WA 7/31/2009 CA 7/31/2009 TX 7/31/2009 CA 7/31/2009 TX 7/31/2009 NY 7/31/2009 WA
1 64 12 11 11 0.5 18 4 57 47 50 18 67 1
1 64 12 11 11 0 18 4 57 47 50 18
1.5 1.4 1.6
1 1 1
72 4 55 5 0.5 8 12 5 0.2 74 12 13 15 35 11 4 18 0.3 45 5 68 67 1 26 11 12 34 2 0.4 1 25 24
72 4 55 5 0 11 12 5 0 74 12 13 15 35 11 4 18 0 45 5 68 67 1 26 11 12 34 2 0 1 25 24
1
0M F M M M 0.5 M F M F F M M F 0M U 0.5 F 0.4 M 0.6 M F F M F F 0.5 F F F M 0.2 M F F F F F M F M 0.4 M F M F F 0F F M F F 0F 0.4 M 0F F F
7/25/2009 Rash all over body x 6 days. Fever 7/18/2009 Rash around injection site - size of 5 7/27/2009 Pt received Tdap in Rt deltoid on 7/ None stated 7/25/2009 C/O redness and slight swelling on 7/28/2009 Patient developed multiple pruritic e 7/23/2009 18 year old female became dizzy an 7/30/2009 Erythematous Edematous and firm 7/24/2009 Noted red, warm sore area on Lt. de 7/27/2009 Nausea, vomiting, dizziness. 4/21/2009 Tetanus (L) arm 6 d ago. Next AM n 7/27/2009 Red rash on neck and legs. 7/30/2009 InformationYhas been received from 7/27/2009 - Pt began to have fever 8 days afte 7/30/2009 InformationYhas been received from 7/27/2009 Swelling and redness from elbow to 7/27/2009 Temp. 98.8, redness at the site of im 7/27/2009 Per mother - 7/25/09 A.M. had feve 7/30/2009 Information has been received from 7/31/2009 Large red circle where vaccine was 7/31/2009 07/20/2009 PATIENT RCD VARICE 7/31/2009 Shoulder pain, lack of back range m 7/31/2009 Started a low grade fever yesterday 7/31/2009 on 07/28/09 patient was brought in 7/31/2009 Clt. was administered Varicella vacc 7/31/2009 Incident occured 7-30-09. After adm 7/31/2009 Client at clinic for kindergarten immu 7/31/2009 Vaccines given 7/22/09. Child deve 7/31/2009 HAD LOCAL RASH, AS WELL AS R 7/31/2009 Patient received hpv vaccine on 7/2 7/31/2009 Broke out in hives all over her body 7/31/2009 Patient received Gardasil immuniza 7/31/2009 Received the injections in my left ar 7/31/2009 Redness, swelling, warm to touch, p 7/31/2009 3" x 3" erythema muscle hot to touc 7/31/2009 Approximately 5-10 minutes after in 7/31/2009 intussusception 7/31/2009 Diffuse papular rash erupted 6/17/0 7/31/2009 Patient came down with Varicella 8 7/31/2009 24 hours after vaccination pt noticed 7/31/2009 Patient did not have any initial probl 7/31/2009 patient received 12 mo vaccinations 7/31/2009 Pt was given the following injections 7/31/2009 RIGHT ARM HAS A 13CM RED IRR 7/31/2009 PT'S MOTHER STATED THAT ABO 7/31/2009 Severe emesis (x7) 24 - 30 hours fo 7/31/2009 Approx 1 day after vaccines given, p 7/30/2009 4 month old male had had upper ex 7/31/2009 Vaccines given at 2:40 pm. 2 hives 7/31/2009 Pt came to clinic 2 days after receiv 7/31/2009 Red Itching
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7/31/2009 CA 7/31/2009 CA 7/31/2009 CA 7/31/2009 AK 7/31/2009 TX 7/31/2009 IL 7/31/2009 IN 7/31/2009 FL 7/31/2009 IL 7/31/2009 NY 7/31/2009 FL 7/31/2009 CA 7/31/2009 NJ 7/31/2009 FL 7/31/2009 SC 7/31/2009 7/31/2009 OH 7/31/2009 OH 7/31/2009 OH 7/31/2009 7/31/2009 7/31/2009 7/31/2009 7/31/2009 IL 7/31/2009 8/1/2009 NJ 8/1/2009 PA 8/1/2009 CA 8/1/2009 CA 8/2/2009 IA 8/3/2009 MA 8/3/2009 OH 8/3/2009 MI 8/3/2009 NJ 8/3/2009 TX 8/3/2009 IA 8/3/2009 PA 8/3/2009 NC 8/3/2009 MT 8/3/2009 NY 8/3/2009 IN 8/3/2009 CA 8/3/2009 8/3/2009 FL 8/3/2009 NY 8/3/2009 KS 8/3/2009 8/3/2009 SC 8/3/2009 MD 8/3/2009 FL 8/3/2009 GA
12 11 45 5 12 75 32 11 21 23 25 10 68 1.5 11
12 11 45 5 12 75 32 11 21 23 25
5 5 4
5 5 4
5
5
11 66 4 1.1 19 68 1.3 44 5 0.2 12 45 0.3 17 45 0.1 62
11 66 4 1 19 68 1 44 5 0 12 45 0 17 45 0 62
4 5 15 16 82 0.2 17 65
4 5 15 16 82 0 17 65
68 1 11
F M F M F F F F F F F F F 0.5 M M U M F M U U U U M U F F M 0.1 F F F 0.3 M F M 0.2 F F F 0.3 M M F 0.1 F F U F F F F M 0.2 F F M
7/20/2009 - L.O.C for 2 sec. - Paleness in face 7/31/2009 Severe headaches evening of vacci 7/31/2009 Developed golf ball size swelling at 7/31/2009 Vaccines given 29JUL2009. Mom re 7/31/2009 She received her vaccines 1 week a 8/1/2009 Pt received shot on Wed 7/29/9. On 7/31/2009 7-28-09 Vaccine admin after approp 7/30/2009 Dizziness and headache. 7/31/2009 Pt. here today for TBST reading C0 7/31/2009 Pt presented to clinic 2 days after in 8/2/2009 The patient received a 1st Hep-B va 7/31/2009 Dizziness starting - few hours after v 7/31/2009 1-2 min after vaccination of HAVRIX 7/31/2009 Crankiness at 10:30. Fell asleep, wo 7/31/2009 Pt received VZV and Hep A immuni 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a physici 7/28/2009 This case was reported by a healthc 7/28/2009 This case was reported by a physici 8/1/2009 Within 48 hours of receiving vaccine 8/1/2009 large red mark at injection site 8/1/2009 pt developed large area of firmness 8/1/2009 Within hours, Jonah became letharg 8/2/2009 After first gardasil shot on 03/27/08 7/31/2009 None stated 7/10/2009 Decreased-low eye contact, unresp 7/28/2009 Went to emergency room, transferre 7/29/2009 R arm - swelling on 7/24/09 - site of 8/3/2009 Intussusception, diarrhea, vomiting, 8/3/2009 Pt. passed out, 1 day laid back on ta 8/3/2009 Approximately 5 minutes after being 7/31/2009 Rash noted this morning by mother 7/23/2009 Client sitting in chair while vaccines 7/30/2009 Pt reported fever to 101-102. Pt rep 7/30/2009 Patient had no adverse event. Patie 7/24/2009 Developed left arm swelling, rednes Eczematoid rash both legs @ immu 7/28/2009 Rash, itching and red patch of skin 7/28/2009 Fever 101 degrees --> 12 hr. after v 7/31/2009 Information has been received from 7/31/2009 Information has been received from 7/31/2009 Information has been received from 8/3/2009 possible seizure 8/3/2009 Patient had the menactra vaccine o 8/3/2009 Approximately 24 hours after pneum
353000 353001 353002 353003 353004 353005 353006 353007 353008 353009 353010 353011 353012 353013 353015 353016 353017 353018 353019 353020 353022 353023 353024 353032 353033 353034 353035 353037 353040 353042 353044 353045 353046 353047 353048 353049 353050 353051 353053 353054 353055 353056 353057 353058 353059 353060 353061 353062 353063 353064 353065
8/3/2009 MI 8/3/2009 KS 8/3/2009 NJ 8/3/2009 NC 8/3/2009 NV 8/3/2009 MN 8/3/2009 GA 8/3/2009 IN 8/3/2009 AR 8/3/2009 IN 8/3/2009 CA 8/3/2009 WY 8/3/2009 CA 8/3/2009 IN 8/3/2009 MN 8/3/2009 CA 8/3/2009 WI 8/3/2009 MI 8/3/2009 OK 8/3/2009 OK 8/3/2009 GU 8/3/2009 TX 8/3/2009 CA 8/3/2009 MO 8/3/2009 SD 8/3/2009 WA 8/3/2009 OR 8/3/2009 TN 8/3/2009 WA 8/3/2009 WI 8/3/2009 OK 8/3/2009 WI 8/3/2009 NC 8/3/2009 PA 8/3/2009 OR 8/3/2009 NM 8/3/2009 OR 8/3/2009 8/3/2009 NY 8/3/2009 NE 8/3/2009 NJ 8/3/2009 CA 8/3/2009 IL 8/3/2009 KS 8/3/2009 NJ 8/3/2009 MI 8/3/2009 UT 8/3/2009 AZ 8/3/2009 NY 8/3/2009 MS 8/3/2009 TN
16 12 21 1.2 21 60 19 11 72 11 4 88 1.7 2 65 47 66 17 61 61 4 68 1.8 15 0.2 16 34 15 67 62 10 1.6 49 18 4 4 0.5 13 10 1.1 0.4 1.6 5 14 0.2 17 34 25 5 19
16 12 21 1 21 60 19 11 72 11 4 88 1 2 65 47 66 17 61 61 4 68 1 15 0 16 34 15 67 62 10 1 49 18 4 4 0 13 10 1 0 1 5 14 0 17 5 34 25 5 19
M M F 0.1 F M F M F F F F M 0.7 F 0.3 M F F F M M F M M 0.8 M F 0.2 F F F F F F M 0.6 F M M M F 0.5 M U F 0.1 F 0.4 F 0.6 M M M 0.2 F F M F F M M
8/3/2009 2- 2 1/2 inch sized red/hot painful sw 8/3/2009 Varivax vaccine administered to Rig 8/3/2009 rash on face 8/3/2009 My daughter got her MMR and Varic 8/3/2009 Fever, Chills, Neausa 8/3/2009 Client called local health departmen 8/3/2009 Autoinoculation with the following sk 8/3/2009 Syncope occurred 5 minutes after im 8/3/2009 Patient developed a 4 inch are of re 8/3/2009 Syncopal episode occurred 2 minut 8/3/2009 patient here with mother for ppd rea 8/3/2009 A day or two after his vaccination fo 8/3/2009 Patient developed hives after secon 8/3/2009 CT'S MOTHER REPORTS CT VOM 8/3/2009 Patient complained of jaw pain, dizz 8/3/2009 Pt states a rash on arms and joint p 8/3/2009 Patient developed a large red and s 8/3/2009 Evening of imm. (07/23)developed r 8/3/2009 patient reports no known drug allerg 8/3/2009 patient reports no drug allergies. pa 8/3/2009 Pt developed cellulitis in his right up 8/3/2009 Two days after administration of Va 8/3/2009 According to Dr. Lee's report, "VAC 7/27/2009 Pt fainted very shortly after injection 7/13/2009 Rash to torso told to leave t-call with 7/28/2009 Approx. 2 min after injections, beca 7/22/2009 Nine hours after vaccination, pt dev 7/24/2009 7/22 Woke up during the night from 7/29/2009 Injection site visible. Redness is 8-9 7/27/2009 Patient reported symptoms began in 6/30/2009 He said it burned. 7/24/2009 Nausea, vomiting, diarrhea, fever. M 8/3/2009 Pt received his 3rd AVA booster on 7/31/2009 Pt received Tdap, MCV, & Varicella 7/8/2009 7-2-09 per report taken, pt. had c/o 8/3/2009 Swelling and redness of rt arm. Tx c 7/7/2009 TC from mother of client on 6/30/09 None Stated 8/3/2009 Swollen harden area, 7cm x 7cm re 7/31/2009 Rash over upper torso and fever Ra 8/3/2009 Fever 102.4 7-29-09.7-28-09- Seen 8/3/2009 The Tdap immunization was given i 8/5/2009 Swelling noted on arm same day af 8/3/2009 Pt had received a 4th dose of DTP w 8/2/2009 Received vaccinations approx. 345p 7/30/2009 L arm has two welt sites one aprox. 8/3/2009 Pt came in on 07/31/09 for vaccines 8/3/2009 Had sore throat & some mild swellin 7/15/2009 Erythema, edema, induration at inje 8/3/2009 Varicella vaccine admin 7-30-09. Fa 8/3/2009 None.
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8/3/2009 MA 8/3/2009 CA 8/3/2009 AZ 8/3/2009 TN 8/3/2009 TN 8/3/2009 DE 8/4/2009 CA 8/4/2009 WA 8/4/2009 8/4/2009 SC 8/4/2009 NJ 8/4/2009 8/4/2009 8/4/2009 NY 8/4/2009 NH 8/4/2009 IN 8/4/2009 NJ 8/4/2009 IL 8/4/2009 MO 8/4/2009 CA 8/4/2009 ID 8/4/2009 NC 8/4/2009 LA 8/4/2009 OK 8/4/2009 MN 8/4/2009 MN 8/4/2009 NC 8/4/2009 LA 8/4/2009 TN 8/4/2009 FL 8/4/2009 GA 8/4/2009 NY 8/4/2009 IL 8/4/2009 8/4/2009 MI 8/4/2009 AR 8/4/2009 MA 8/4/2009 PA 8/4/2009 OH 8/4/2009 NC 8/4/2009 GA 8/4/2009 IN 8/4/2009 CA 8/4/2009 CO 8/4/2009 OK 8/4/2009 FL 8/4/2009 AL 8/4/2009 8/4/2009 VA 8/4/2009 TN 8/4/2009 KY
1.1 2 28 16 15 1.6 5 17 0.5 23 23 16 23 0.5 0 12 22 16 1 11 61 12 17 13 50 59 15 16 4 18 1.1 15 14 12 15 60 60 13 65 61 12 4 23 2 27 1.3 36 14 1.6 10
2 28 16 15 1 5 17 23 23 16 23 0 0 12 22 16 1 11 61 12 17 13 50 59 15 16 4 18 1 15 14 12 15 20 61 60 13 65 61 12 4 23 2 27 1 36 14 1 10
M 0.4 F F F F 0.6 F M F F F F F F 0.5 M 0M M M F 0F M F M F F F F F F M M 0.1 M M F F F M F M F F M F F F 0.2 M F 0.3 M M M 0.6 M F
7/28/2009 Fever 102.2. 8/3/2009 7/30 PM left thigh big red welt at site 8/3/2009 Had sore throat nasal congestion co 7/24/2009 I want to give a little history on this p 7/24/2009 1/08 - school reported she was very 7/29/2009 Received Hep#2 only 4 months afte 8/4/2009 Redness, pain, swelling, itching, an 8/4/2009 Was doing fine after first after first s 8/3/2009 Information has been received from 8/3/2009 Initial and follow-up information has 8/3/2009 Information has been received from 8/3/2009 Information has been received from 8/3/2009 Information has been received from 7/29/2009 Intussusception 4 mo after completi 8/4/2009 This case was reported by a consum 6/5/2009 Fever - started night after vaccine. F 8/4/2009 Received smallpox vaccination on 7 7/29/2009 7-8" of redness, itchy and painful fo 7/31/2009 Fever, rash. (R) arm red swollen X 2 days; tende 7/29/2009 Vaccine was given IM rather than S 7/31/2009 Pt fainted following immunization. P 7/31/2009 Rash to hands and feet (blisters) so 7/31/2009 On 27 July 09 child received 3rd HP 7/29/2009 Paula woke up on 7-11-09 and her 7/10/2009 7/6 Arm aches pm. 7/7 Body aches, 7/31/2009 Neck stiffness, Headache, Extreme 7/28/2009 7-27-09 1:00 PM Mom called to rep 7/30/2009 Patient returned to clinic after 30 mi 7/29/2009 Dizziness, 0 Syncope, diaphoretic w 7/29/2009 Pt 2 wks after MMR/Varicella develo 7/27/2009 According to parents woke up next 7/29/2009 2-3" circular redness-itchy and pain 7/24/2009 Night of immunization mac/pap rash 7/30/2009 Vaccine administered to pregnant fe 8/4/2009 Possible secondary innoculation to 8/4/2009 After a few hours the injected arm u 8/4/2009 TETANUS SHOT WAS GIVEN ON 8/4/2009 Childs mother called at 9:30am this 8/4/2009 Patient presented 8/3/2009 concern 8/4/2009 24 hours after vaccine, arm had slig 8/4/2009 Syncopal episode 2 minutes after im 8/4/2009 Redness, swellling and induration o 8/4/2009 Approximately 1 week prior patient w 8/4/2009 Pt given combo vaccine of Dtap/IPV 8/4/2009 Approximately 1 month after receivi 8/4/2009 Pt had a seizure 2:00 a.m. the follow 8/4/2009 had body aches and muscle cramps 8/4/2009 Herpes Zoster Rash on trunk on the 8/4/2009 Pt received second Hep A vaccine a 8/4/2009 About one minute after shot Kayla b
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8/4/2009 KY 8/4/2009 MA 8/4/2009 NJ 8/4/2009 PA 8/4/2009 WI 8/4/2009 UT 8/4/2009 NY 8/4/2009 KS 8/4/2009 PA 8/4/2009 KY 8/4/2009 MA 8/4/2009 MI 8/4/2009 MI 8/4/2009 NJ 8/4/2009 CA 8/4/2009 OH 8/4/2009 MA 8/4/2009 MA 8/4/2009 AZ 8/4/2009 KS 8/4/2009 CA 8/4/2009 KS 8/4/2009 NJ 8/4/2009 VA 8/4/2009 VA 8/4/2009 LA 8/4/2009 FL 8/4/2009 FL 8/4/2009 TX 8/4/2009 OK 8/4/2009 TX 8/4/2009 NM 8/4/2009 AZ 8/4/2009 NJ 8/5/2009 8/5/2009 NJ 8/5/2009 8/5/2009 8/5/2009 NJ 8/5/2009 RI 8/5/2009 ID 8/5/2009 8/5/2009 8/5/2009 KY 8/5/2009 DE 8/5/2009 NM 8/5/2009 ND 8/5/2009 MN 8/5/2009 TX 8/5/2009 IA 8/5/2009 OH
0.5 18 0.2 56 26 60 5 12 60 31 25 4 14 4 1.5 20 45 46 19 38 0.1 14 42 54 12 27 54 66 8 30 14 9 5 0.7 63 21 25 76 61 1.8 5
28 39 15 85 19 4 11
0 18 0 56 26 60 5 12 60 31 25 4 14 4 1 20 45 46 19 0 14 42 54 12 27 54 66 8 30 14 9 5 0 21 25
1
28 39 15 85 19 4 11
0.5 M M 0.2 F M F F M M F F F M F F 0.5 M F M F F F 0.1 F M F F F M F F F F F F F 0.7 M F F F F F M 0.8 F M M F M F F F F M F
8/4/2009 Child had 6 month shots at 11:00am 8/4/2009 Shots administered at 2:30 p.m. app 8/4/2009 Intussusception 7/20/09 - symptoms 8/4/2009 6/23/09 BOOSTRIX given -> mild so 7/24/2009 Pt has history of seizures. Has C.P. 8/4/2009 Sweating, dizzy, nausea, rash on fa 8/4/2009 Temp 101 F x 2 days of markedly sw 8/4/2009 Temp of 103.1 a few hrs after gettin 8/4/2009 Local reaction left upper arm 7/23-7 8/4/2009 Pt noticed redness, swelling, tender 8/4/2009 Fever, feeling "off", dizziness, red lo 8/3/2009 Onset of coughing and hives within 8/4/2009 Within 5 min of receiving HPV #3 in 8/4/2009 1/2 upper arm on right side, swollen Father of patient came to our office 8/4/2009 Pt. came in 2/+ pain in L elbow on 8 8/4/2009 Redness, swelling and pain in R arm 8/4/2009 Redness at injection site, pain at inj 7/28/2009 Hives 8/4/2009 08/04/2009 MODERATE Other IND 8/4/2009 Crying, fussy after the vaccines wer 8/4/2009 07/23/2009 MODERATE Other. FA 7/31/2009 7/10/09 Received vaccinations. 7/15 8/3/2009 (R) upper arm was slightly swollen & 8/3/2009 Patient fainted after administration o 7/30/2009 None stated. 7/29/2009 Red rash/welts on inside portion of 7/13/2009 6/23/09. Itch developed and got wo 7/28/2009 Pt with severe erythema localized & 7/30/2009 Developed VARICELLA Disease (ch 7/29/2009 Redness, warm, 7 cm X 7 cm 7/28/2009 Right arm red and warm to touch. 8/4/2009 Left arm with immediate itching and 8/4/2009 At 10 PM parents reported increase 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 8/4/2009 Information has been received from 7/20/2009 Febrile seizure. 8/21/09 ERrecords 7/31/2009 Initial report was received 27 July 20 8/2/2009 Initial report received on 27 July 200 7/31/2009 Initial report was received from anot 8/5/2009 I received an anthrax shot at 0830 o 8/5/2009 Vaccination administered in left delt 8/5/2009 SHORTNESS OF BREATH, CHEST 8/5/2009 Patient complained of rash, redness 8/5/2009 Immediately after receiving vaccines 8/5/2009 Red Swollen at site of injection 8/5/2009 Vaccines were given at about 1030a
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8/5/2009 CA 8/5/2009 MI 8/5/2009 MD 8/5/2009 CT 8/5/2009 MD 8/5/2009 MA 8/5/2009 OH 8/5/2009 NC 8/5/2009 CA 8/5/2009 NM 8/5/2009 OR 8/5/2009 VA 8/5/2009 IL 8/5/2009 IL 8/5/2009 IL 8/5/2009 IL 8/5/2009 LA 8/5/2009 TX 8/5/2009 IA 8/5/2009 CO 8/5/2009 8/5/2009 8/5/2009 ID 8/5/2009 ID 8/5/2009 FL 8/5/2009 8/5/2009 NM 8/5/2009 DC 8/5/2009 PA 8/5/2009 NC 8/5/2009 8/5/2009 MN 8/5/2009 CA 8/5/2009 WA 8/5/2009 NM 8/5/2009 IA 8/5/2009 TX 8/5/2009 ND 8/5/2009 PA 8/5/2009 MN 8/5/2009 WI 8/5/2009 CA 8/5/2009 OH 8/5/2009 TX 8/5/2009 CA 8/5/2009 CA 8/5/2009 TX 8/6/2009 8/6/2009 8/6/2009 ID 8/6/2009 PA
2 18 11 21 18 21 12 15 70 4 3 40 25 44 49 64 4 4 72 20 60 5 5 63 66 0.3 21 15 44 55 4 36 14 12 12 12 12 1.2 63 28 72 5 28 23 2 86 31 72 11 64
2 18 11 21 18 21 12 15 69 4 3 40 25 44 49 64 4 4 72 11 60 5 5 63 66 0 21 15 44 4 36 12 12 12 12 1 63 28 72 5 28 23 2 86 31 11 64
0.1 F F M F F F F F F F F F M F F F M M F M F F F M F F 0.3 M F F M M M M F M M F F 0.2 M F F F M F M 0.1 F M F F F F
8/5/2009 Received vaccines on 7/13/09. Fam 8/5/2009 Immediately after Hepatitis B vaccin 8/5/2009 Fluid-filled blister, scab forming afte 8/5/2009 Weakness, body aches, joint pain, h 8/5/2009 After receiving MCV4, while seated, 8/5/2009 Headache, Nausea, Vomiting, Chills 8/5/2009 Mother brought child to HD office 8/ 8/5/2009 48 hours after the vacination of Gar 8/5/2009 Within a week, I had begun to expe 8/5/2009 Mother is stating that 7days after va 8/5/2009 My daughter received a DTAP vacc 8/5/2009 Arms and fingers feeling numb. Bo 8/5/2009 Redness and pain at injection site fo 8/5/2009 skin erythema and warm to touch 8/5/2009 vomiting, diarrhea, fever of 102 x 2 8/5/2009 Noticed redness/swelling/warmth at 8/5/2009 Patient received Pentacel vaccine c 8/5/2009 CHILD SEEN IN EMERGENCY RO 8/5/2009 Pneumovax administered at approx 8/5/2009 Localized red, warm , tender, inflam 7/31/2009 Severe stomach pain and weakness 7/31/2009 Developed vestibular neuritis 12 da 7/22/2009 Lost consciousness with skin pallor, 6/26/2009 Large (about size of baseball) Lt thi 7/30/2009 After a few days of the initial vaccin 7/31/2009 Pt with Hx radiation to skin years ag 8/3/2009 Vaccines (PENTACEL, PREVNAR & 7/31/2009 On the day of the vaccine was given 8/5/2009 Patient given GARDASIL vaccine a 8/5/2009 On 12/15/07, SM received AVA (2), 7/28/2009 Pt. c/o fever of 102.5, left arm red, s 8/4/2009 Would this 8/4 L thigh swollen red + 8/5/2009 Patient reported fever, left arm pain Pt getting up from exam table fell fo 8/5/2009 Red, sore, hot, fever, blister pustule 8/5/2009 After vaccine given mom then tells R Pt. received vaccines. Mom stated p 8/5/2009 Left upper arm, shoulder pain, swel 8/15/2009 Shingles 8/3/2009 Pt got a rash on her wrist, arm, ches 8/5/2009 Redness to upper arm fever 102 de 8/5/2009 Cellulitis, redness, swelling, warmth Anaphylaxis ~ 1/2 in after receipt o 8/5/2009 28 yo girl presented to clinic at 4:05 8/4/2009 On 7/20/09 received a T booster F a 8/3/2009 Local popular pruritic rash around s 8/15/2009 Debilitating weakness all over, unab 8/6/2009 Urticaria without systemic symptom 8/2/2009 On March 3rd, I received a shingles 6/22/2009 Patient had a reaction to VARIVAX 7/23/2009 PPV shot given at top of left should
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8/6/2009 8/6/2009 GA 8/6/2009 NV 8/6/2009 LA 8/6/2009 WA 8/6/2009 OR 8/6/2009 VA 8/6/2009 CO 8/6/2009 CA 8/6/2009 CO 8/6/2009 UT 8/6/2009 NY 8/6/2009 CA 8/6/2009 RI 8/6/2009 PA 8/6/2009 NE 8/6/2009 MO 8/6/2009 NC 8/6/2009 8/6/2009 8/6/2009 SC 8/6/2009 PA 8/6/2009 TX 8/6/2009 NC 8/6/2009 MO 8/6/2009 SD 8/6/2009 NC 8/6/2009 OH 8/6/2009 VA 8/6/2009 MI 8/6/2009 PA 8/6/2009 LA 8/6/2009 NH 8/6/2009 MN 8/6/2009 TX 8/6/2009 GA 8/6/2009 LA 8/6/2009 NE 8/6/2009 MI 8/6/2009 AL 8/6/2009 AL 8/6/2009 CO 8/6/2009 AL 8/6/2009 LA 8/6/2009 MO 8/6/2009 TX 8/6/2009 OH 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CO
4 6 11 71 18 19 8 1.3 67 60 11 76 80 16 28 4 11 14 61 0.3 11 20 2 69
4 6 11 71 18 19 8 1
1.6 14 14 19 2 11 1.3 8 12 11 13 15 5 14 13 0.2 4 10 0.3 12 42 17 32 42 31
1 14 14 19 2 10 1 8 12 11 13 15 5 14 13 0 4 10 0 12 42 17 32 42 31
60 11 76 16 28 4 11 61 11 20 2 69
F M M M M F F M 0.3 M F F M F F F F M M F F U F F 0.2 F F M 0.6 F M M M 0.2 M M 0.3 F F F M F F M F F 0.2 M M F 0.4 M F F M F M M
8/4/2009 My daughter had serious problems 8/6/2009 Patient received Immunizations, we 8/6/2009 Anaphylaxis - instant hives - lip swe 7/31/2009 Localized warm redness to vaccine 8/4/2009 This case was received from a heal 7/30/2009 Within one week of vaccination the 8/3/2009 Following vaccines, episode of sync 7/29/2009 Itchy sensation, hives. Went to ER, 7/30/2009 Febrile Illness 103.5 Bronchiolitis po 7/30/2009 Developed shingles 3 days after vac 8/5/2009 Information has been received from 8/1/2009 Seen on 8/1 (2 days later) with swe 8/5/2009 Information has been received from 8/5/2009 Information has been received from 8/5/2009 Information has been received from 7/27/2009 Chills, muscle weakness, body ache 7/31/2009 Lt. thigh with 5 X 5 cm erythema dis 8/3/2009 6x5 cm area of pruritic angioedema 8/4/2009 Severe fatigue and soreness. 8/3/2009 side effect to ZOSTAVAX, bright red Pt had PENTACEL given (never ha 8/5/2009 Patient received 3 vaccines MENAC 8/6/2009 8/5/09 upper outer arm red, warm 4 8/4/2009 R thigh red, swollen and painful. Fe 8/6/2009 Pt was bit by lab confirmed rabid fox 7/31/2009 Local reaction with swelling of thigh 7/31/2009 First & 2nd Hep A local erythema in 8/6/2009 This clinic client became nauseated 8/6/2009 Mother of patient came by clinic at 8 8/6/2009 Administered a pediatric Hepatitis A 8/6/2009 Baby woke up three days after vacc 8/6/2009 Varicella was administered to the le 8/6/2009 Pt in office on 7/31/09 for 15 month 8/6/2009 Received rabies pre-exposure #3 on 8/6/2009 Pt represents to clinic with a 4cm x 8/6/2009 Patient received vaccination of Tdap 8/6/2009 PT.HERE STATED AREA WHERE 8/6/2009 APPROXIMATELY 2 MINUTES AFT 8/6/2009 Redness, rash and swelling at injec 8/6/2009 7/27/09 Came in to HD c/o side effe 8/6/2009 Started vomitting at noon 8/4/09 and 8/6/2009 none, 9/25/09 Y Autopsy report receiv 8/6/2009 Awake, Thurday a.m., 7/30/09, with 8/6/2009 PT. MOTHER PHONED OFFICE ST 8/6/2009 Fever 2 days after vaccination, rash 8/6/2009 On 11/16/08, pt went about her day 8/6/2009 24 hours after Tdap, client had pain 8/6/2009 18 yo recruit on day 24 of his trainin 8/6/2009 Vaccine (Pneumovax 23) was admi 8/6/2009 8/4/09 TDaP given to client who is a 8/6/2009 This case was reported by a consum
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8/6/2009 OH 8/6/2009 UT 8/6/2009 CA 8/6/2009 VA 8/6/2009 MI 8/6/2009 IN 8/6/2009 PA 8/6/2009 FL 8/6/2009 MO 8/6/2009 CA 8/6/2009 TX 8/6/2009 AZ 8/6/2009 NM 8/6/2009 CA 8/6/2009 IL 8/6/2009 CA 8/6/2009 CA 8/6/2009 FL 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 AR 8/6/2009 PA 8/6/2009 CA 8/6/2009 FL 8/6/2009 MS 8/6/2009 NE 8/6/2009 8/6/2009 FL 8/6/2009 FL 8/6/2009 OR 8/6/2009 NJ 8/6/2009 VA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 MI 8/6/2009 GA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 MI 8/6/2009 8/6/2009 FL 8/6/2009 NY
5 4 56 5 15 0.5 39 4 11 16 5 0.9 8 3 5 48 14 76 66 97 19 60
5 4 56 5 15 0 39 4 11 16 5 0 8 3 5 48 14
81 61 27
81 61 27
79 85 70 36 49 18 71 41
79 85 70 36 49 18 71
46 66 1.1 68 67
46
66 19 60
1 68
70 64 68 71 61 71
68 61 71
M M F M F 0.5 M M F M F M 0.9 F F M F F F F F F M M M F M F U F M F F F F M F U M F 0.1 M F M U M F F F U F F F F
8/6/2009 This case was reported by a healthc 8/6/2009 (L) injection (MMR & DTaP) 8/3/09 2 8/6/2009 Adverse effect fever 100.8, myalgia 8/6/2009 10cm x 6cm area of induration, warm 8/6/2009 Became pale 5 min after injection. L 8/6/2009 Fever began a few hours after immu 8/6/2009 Headache, (leg, neck, and back pai 7/29/2009 Patient received vaccines- KINRIX, 8/6/2009 Pt. c/o wheezing & swelling of face 8/6/2009 About 4 pm, pt was at a restaurant, 8/7/2009 Erythema multiforme minor 8/6/2009 Diffuse rash to face, torso, buttocks 8/6/2009 Lt arm swollen, hot touch. Onset Au 8/6/2009 Right leg with 12cm macule, warm t 8/6/2009 Received DTAP shot (5th shot) on 8 6/10/2009 Day after vaccination Pt. experience 8/6/2009 Presented to urgent care clinic with 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Initial and follow up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow up information has
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8/6/2009 MI 8/6/2009 NE 8/6/2009 MN 8/6/2009 MN 8/6/2009 TX 8/6/2009 8/6/2009 TX 8/6/2009 TX 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 MN 8/6/2009 FL 8/6/2009 MN 8/6/2009 8/6/2009 CA 8/6/2009 KY 8/6/2009 KY 8/6/2009 VA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 8/6/2009 GA 8/6/2009 PA 8/6/2009 8/6/2009 CA 8/6/2009 TX 8/6/2009 CA 8/6/2009 KS 8/6/2009 OR 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NC 8/6/2009 NC 8/6/2009 MI 8/6/2009 MI 8/6/2009 MD 8/6/2009 MD 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 GA 8/6/2009 WA 8/6/2009 FL 8/6/2009 TX 8/6/2009 TX
62 60 78 87 35
62
72 65 68 0.4 60 69 36 66
72 65
65 94 55
65
78 87 35
0 69 66
84 71 82 57 62 76 50 72 60 0.5 65 61 38 76 58 56 60 44 13 5 67 28 0.3 48
71 82 57 76 72 60 65 38
60
67
48
F F M F M F M F F 0.4 F F F F M F F F M U U U M F U F M F F M F F M M F F F U F M F F F F F M F F M F U U
6/24/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initials and follow up information ha 7/30/2009 Initial and follow up information has 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up formation has b 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 VA 8/6/2009 8/6/2009 OK 8/6/2009 NJ 8/6/2009 FL 8/6/2009 8/6/2009 OK 8/6/2009 OK 8/6/2009 8/6/2009 WV 8/6/2009 8/6/2009 WV 8/6/2009 WV 8/6/2009 8/6/2009 AR 8/6/2009 MI 8/6/2009 FL 8/6/2009 WV 8/6/2009 CA 8/6/2009 8/6/2009 8/6/2009 MO 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 NY 8/6/2009 TX 8/6/2009 TX 8/6/2009 OR 8/6/2009 TX 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 WA 8/6/2009 MA 8/6/2009 CA 8/6/2009 CA 8/6/2009 IA 8/6/2009 IA 8/6/2009 8/6/2009 MA
4
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46 63 32
46 63
97 72
72
74 86 55
55
65 73 44 46 31 69 61
73 44 46 31 69
65 56 66 60 64
66 49 65 65
65 56 66 60
49
66 60 22 29 0.5 52 71 2 50
22 29 0
F F M F F F M F F U U M M F M M M M F F F F M F U F M F M M U U F F F F U F U M F F F 0.5 U U F U F F M U
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 IA 8/6/2009 CA 8/6/2009 WV 8/6/2009 WV 8/6/2009 8/6/2009 8/6/2009 KY 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 MI 8/6/2009 8/6/2009 ID 8/6/2009 8/6/2009 NC 8/6/2009 MI 8/6/2009 CA 8/6/2009 MA 8/6/2009 8/6/2009 NC 8/6/2009 NC 8/6/2009 NC 8/6/2009 CA 8/6/2009 PA 8/6/2009 OR 8/6/2009 8/6/2009 NY 8/6/2009 NJ 8/6/2009 8/6/2009 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 GA 8/6/2009 MO 8/6/2009 CT 8/6/2009 WA 8/6/2009 8/6/2009 NY 8/6/2009 NY 8/6/2009 FL 8/6/2009 VA 8/6/2009 NY 8/6/2009 MS 8/6/2009 NJ 8/6/2009 NJ 8/6/2009 NJ 8/6/2009 NC 8/6/2009 NC
65 65
65
66 64 60 65 66
64
49 0.3 36 73
49
82 26 0.4 50 66 82 56 66 60 88 53 64
82 26
63 52 43 70 57
63 52 43 70 57
87 85 70 50 36 57 70
87 85
43
43
82 61 63
82 61
64
65 66
36 73
66 82 56 66 88
50 36 57 70
F F M M F M M F M M M F U M M M F F M M F F F F M F F F F F F F F F F F F F F F F F F F F M F M F F F
7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from
353851 353852 353853 353854 353855 353856 353857 353862 353863 353929 353931 353935 353937 353938 353939 353940 353941 353942 353943 353944 353945 353946 353947 353948 353949 353950 353951 353952 353953 353954 353955 353956 353957 353958 353959 353960 353961 353962 353963 353964 353965 353966 353967 353968 353969 353970 353971 353972 353973 353974 353975
8/6/2009 NY 8/6/2009 OH 8/6/2009 MN 8/6/2009 ME 8/6/2009 MN 8/6/2009 MN 8/6/2009 MS 8/6/2009 MS 8/6/2009 VA 8/6/2009 VA 8/6/2009 8/6/2009 MI 8/6/2009 TX 8/6/2009 LA 8/6/2009 FL 8/6/2009 WA 8/6/2009 WA 8/6/2009 NJ 8/6/2009 8/6/2009 WA 8/6/2009 IA 8/6/2009 NJ 8/6/2009 VA 8/6/2009 8/6/2009 CA 8/6/2009 UT 8/6/2009 UT 8/6/2009 8/6/2009 NY 8/6/2009 IL 8/6/2009 IN 8/6/2009 CA 8/6/2009 8/6/2009 CT 8/6/2009 CT 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 OH 8/6/2009 FL 8/6/2009 UT 8/6/2009 8/6/2009 8/6/2009 SD 8/6/2009 VA 8/6/2009 TX 8/6/2009 MO 8/6/2009 WI
48 66 61 67 65
48 66 61 67 65
60
66
66
55 65
65
66 50 75
66 50 75
60 51 70 53
60 51
69 69 20 81
69 69
65 76
65
53
81
65 50
63
63
M M F F F F M M F F U F U M F F F F F F F F F U F F F M F U F F F F F F M F F U F F M F F M F F F F F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has
353976 353977 353978 353979 353980 353981 353982 353983 353984 353985 353986 353987 353988 353989 353990 353991 353992 353993 353994 353995 353996 353997 353998 353999 354000 354001 354002 354003 354004 354005 354006 354007 354008 354009 354010 354011 354012 354013 354014 354015 354016 354018 354019 354020 354027 354028 354030 354031 354101 354102 354103
8/6/2009 ID 8/6/2009 8/6/2009 GA 8/6/2009 8/6/2009 TX 8/6/2009 WI 8/6/2009 8/6/2009 8/6/2009 IN 8/6/2009 IN 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 OR 8/6/2009 8/6/2009 8/6/2009 MI 8/6/2009 PA 8/6/2009 WI 8/6/2009 CA 8/6/2009 8/6/2009 NY 8/6/2009 CA 8/6/2009 FL 8/6/2009 OH 8/6/2009 8/6/2009 8/6/2009 8/6/2009 IL 8/6/2009 IL 8/6/2009 IL 8/6/2009 8/6/2009 NC 8/6/2009 8/6/2009 OH 8/6/2009 OH 8/6/2009 OH 8/6/2009 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 NY 8/6/2009 8/6/2009 VA 8/6/2009 VA 8/6/2009 NC 8/6/2009 AZ 8/6/2009 MD 8/6/2009 8/6/2009 MD 8/6/2009 NJ
63 76 59 20 52 63
63
67 65 70
67 65 70
59 20 52 63
65 53
53
73 72 13 0.2 60 46
73 72 13 0
86 63
86 63
59 71 0.5 53 35 62 70
70
30 65 84
65
7 6
7 6
67
37
37
F F F F F F F F F F F F U F F U F F M 0.2 U M F M M F U U M U U U F F F F F F F U F F F F F F U M M U M F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial information has been received 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial information has been received 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 This report was received from Sano 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354104 354105 354106 354107 354108 354109 354110 354111 354146 354147 354148 354149 354150 354151 354152 354153 354154 354155 354156 354157 354158 354159 354160 354161 354162 354163 354164 354165 354166 354167 354168 354169 354171 354172 354173 354174 354175 354176 354177 354178 354179 354180 354181 354182 354183 354184 354185 354186 354187 354188 354189
8/6/2009 8/6/2009 ID 8/6/2009 NJ 8/6/2009 CT 8/6/2009 ID 8/6/2009 8/6/2009 PA 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 VA 8/6/2009 VA 8/6/2009 CA 8/6/2009 WV 8/6/2009 8/6/2009 CT 8/6/2009 MI 8/6/2009 NJ 8/6/2009 FL 8/6/2009 MI 8/6/2009 ID 8/6/2009 CT 8/6/2009 TN 8/6/2009 8/6/2009 8/6/2009 KS 8/6/2009 ID 8/6/2009 8/6/2009 8/6/2009 MD 8/6/2009 OR 8/6/2009 MD 8/6/2009 GA 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 NH 8/6/2009 8/6/2009 8/6/2009 VA 8/6/2009 WI 8/6/2009 8/6/2009 TX 8/6/2009 8/6/2009 CT 8/6/2009 CA 8/6/2009 CA 8/6/2009 GA 8/6/2009 GA 8/6/2009
67 49 73 17 72 80 60 0.5 69 61 73 67 61
73
80
61 73 67 61
70 77 50 69 3
70 77 50 69 3
62 65 42 31
62 65 42 31
72 56 53 50 70 17 17 37
72 56
51 64
50 17 37
64
2
56 71 65 66 71
66 71
F F U F F F F F U U F M M F M M F F F F F M M M M F F U F U F F F F F F F M U U M F M U F M F M M F M
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354191 354192 354198 354199 354201 354204 354206 354207 354211 354212 354213 354214 354215 354216 354220 354221 354222 354223 354224 354225 354226 354227 354228 354229 354230 354231 354232 354233 354234 354238 354239 354240 354243 354244 354247 354249 354252 354254 354255 354256 354327 354328 354329 354330 354331 354332 354333 354334 354335 354336 354337
8/6/2009 MN 8/6/2009 FL 8/6/2009 CA 8/6/2009 8/6/2009 TX 8/6/2009 AZ 8/6/2009 8/6/2009 8/6/2009 8/6/2009 OK 8/6/2009 8/6/2009 8/6/2009 IL 8/6/2009 GA 8/6/2009 CA 8/6/2009 8/6/2009 CT 8/6/2009 CT 8/6/2009 CT 8/6/2009 CO 8/6/2009 TX 8/6/2009 8/6/2009 AZ 8/6/2009 NJ 8/6/2009 GA 8/6/2009 CO 8/6/2009 CA 8/6/2009 WA 8/6/2009 VA 8/6/2009 VA 8/6/2009 WA 8/6/2009 8/6/2009 KY 8/6/2009 8/6/2009 KY 8/6/2009 KY 8/6/2009 KY 8/6/2009 KY 8/6/2009 8/6/2009 8/6/2009 NJ 8/6/2009 VA 8/6/2009 CA 8/6/2009 NJ 8/6/2009 OR 8/6/2009 AZ 8/6/2009 MO 8/6/2009 MO 8/6/2009 MO 8/6/2009 CA 8/6/2009 AZ
70 52
70 52
53 52 52 43 57 74
53
54 75 71 50 58 51
54 75 71 50 58 51
1 66
1
66 83 67 71
66
1 55 62
1 55 62
2 60 2 41 79 68 81 53 65 80 79 74 69 80 75 32 65
67 71
60 41 79 68
79 74 69 80 75 32 65
F M F F F F F F F F M F F M F F M F M 0M M U F F F F M 0F M F F M M F M U F M F F F F F F F M F F F M U
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received by a 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
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8/6/2009 ID 8/6/2009 NC 8/6/2009 AZ 8/6/2009 CA 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 CA 8/6/2009 8/6/2009 8/6/2009 8/6/2009 CA 8/6/2009 CA 8/6/2009 VA 8/6/2009 NM 8/6/2009 MN 8/6/2009 ID 8/6/2009 ID 8/6/2009 ID 8/6/2009 8/6/2009 IA 8/6/2009 OH 8/6/2009 8/6/2009 MD 8/6/2009 8/6/2009 FL 8/6/2009 FL 8/6/2009 NC 8/6/2009 DC 8/6/2009 VA 8/6/2009 IN 8/6/2009 TX 8/6/2009 TX 8/6/2009 TX 8/6/2009 TX 8/6/2009 8/6/2009 MN 8/6/2009 TX 8/6/2009 8/6/2009 AZ 8/6/2009 8/6/2009 NC
58 72 50 85 78 83 84 84 65 32 81 43 36 32 65 65 67 26 50
58
50 85 78 83 84 65 32 81 43 36 32 65 65
26 50
57 66 50 4
66
0.7 36 43
0 36 43
67 81 1 46 75
67 81 1 46 75
71
71
69 77 65 60 45
77 65
65
65
45
F M U F F F F M F M F M F F F M F F F F M M M M F F M F U 0.7 F F F U M F M 0M F U F M F F F F F M M M F M
7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received conc 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received via N 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354693 354694 354695 354696 354697 354698 354699 354700 354701 354702 354703 354704 354705 354706 354707 354708 354709 354710 354711 354712 354713 354714 354715 354716 354717 354718 354719 354720 354721 354722 354723 354724 354725 354757 354758 354759 354760 354761 354762 354763 354764 354765 354766 354788 354789 354790 354822 354826 354827 354828 354829
8/6/2009 NV 8/6/2009 PA 8/6/2009 FL 8/6/2009 VA 8/6/2009 FL 8/6/2009 PA 8/6/2009 MA 8/6/2009 MO 8/6/2009 FL 8/6/2009 IL 8/6/2009 FL 8/6/2009 8/6/2009 IL 8/6/2009 NY 8/6/2009 NY 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 FL 8/6/2009 WV 8/6/2009 WV 8/6/2009 VA 8/6/2009 PA 8/6/2009 FL 8/6/2009 FL 8/6/2009 GA 8/6/2009 MO 8/6/2009 IN 8/6/2009 GA 8/6/2009 PA 8/6/2009 8/6/2009 PA 8/6/2009 PA 8/6/2009 RI 8/6/2009 8/6/2009 GA 8/6/2009 FL 8/6/2009 SC 8/6/2009 CA 8/6/2009 GA 8/6/2009 8/6/2009 MI 8/6/2009 FL 8/6/2009 NJ 8/6/2009 SC 8/6/2009 CA 8/6/2009 NY 8/6/2009 FL 8/6/2009 AZ 8/6/2009 PA 8/6/2009 OH
1.5 71 67 65 0.2
71 67 65
81 72 71
72 71
58 65 62 60
62 60
19 75 48 33 2 59 40 71 67
48 33 2 59 71 67
85 80 51
85 80 51
17 64 73 56
17 64 73
27 65 65 1 60 47 80 29 72 0.8
65 1 47 80 29 72 0
U F F F F F M M F F U M M M F M F F F F U F F F F 0.2 M F F M F M M F F U M F F M U F M F F 0F F M F F F 0.8 M
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/3/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received form 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from
354833 354838 354841 354845 354849 354850 354851 354852 354855 354857 354864 354865 354866 354867 354868 354869 354870 354871 354872 354873 354874 354875 354876 354877 354878 354879 354880 354881 354882 354883 354884 354885 354886 354887 354888 354889 354890 354891 354892 354893 353369 353370 353374 353375 353376 353377 353378 353379 353380 353381 353382
8/6/2009 RI 8/6/2009 FL 8/6/2009 8/6/2009 SC 8/6/2009 KS 8/6/2009 TX 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 FL 8/6/2009 SC 8/6/2009 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 SC 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 GA 8/6/2009 SC 8/6/2009 ID 8/6/2009 8/6/2009 IN 8/6/2009 SC 8/6/2009 8/6/2009 8/6/2009 CT 8/6/2009 SC 8/6/2009 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 SC 8/6/2009 OR 8/6/2009 8/7/2009 8/7/2009 OH 8/7/2009 MD 8/7/2009 FL 8/7/2009 GA 8/7/2009 NY 8/7/2009 NJ 8/7/2009 WI 8/7/2009 NC 8/7/2009 8/7/2009 CA
21 58 74 30 54 32 0.3 0.6 1 0.2 0.2 0.4 54 0.5
21 58 74 30 54 32 0 0 1 0 0 0 54 0
1
1
0.7 1
0 1
78 0.2 64 0
78 0
0.2 64 71 49 0.6
0 64 71 49 0
0.2 1 0.3 0.5 0.2 0.4 55
0 1 0 0 0 0
16 34 4 84 4 5 73 69 70 4
16 34 4 84 4 5 73 69
0
4
M F M F F F 0.3 M 0.6 F 0M 0.2 M 0.2 F 0.4 F F 0.5 F F 0M F U 0.7 M 0F F U F 0.2 F F 0M M 0.2 F F M F 0.6 M F 0.2 F 0F 0.3 F 0.5 M 0.2 M 0.4 F M M F M M F F F F F U F
7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 8/6/2009 Information has been received from 8/6/2009 Information has been received from 8/4/2009 Service member reports that in Jan 7/28/2009 Vaccine on the 10th, Left thigh into 8/3/2009 ZOSTAVAX administered 2/18/08. H 7/28/2009 None stated. 7/31/2009 Suspected seizure. Disoriented. Diff Pt. was given zoster vaccine 7/10/0 8/3/2009 Rash, small dots on neck 7/14/09 Shingle shot - 4 days later b 8/5/2009 (R) upper arm red warm to touch. B
353383 353384 353385 353386 353395 353396 353398 353399 353400 353401 353402 353403 353405 353406 353407 353408 353409 353410 353412 353413 353414 353415 353416 353417 353419 353420 353423 353425 353426 353428 353429 353430 353431 353432 353433 353434 353435 353436 353438 353439 353440 353442 353443 353444 353445 353447 353448 353456 353457 353458 353459
8/7/2009 WA 8/7/2009 WA 8/7/2009 IA 8/7/2009 KS 8/7/2009 8/7/2009 CO 8/7/2009 TX 8/7/2009 VA 8/7/2009 NE 8/7/2009 OH 8/7/2009 MI 8/7/2009 TX 8/7/2009 MD 8/7/2009 IL 8/7/2009 TX 8/7/2009 VA 8/7/2009 CA 8/7/2009 WI 8/7/2009 DC 8/7/2009 MI 8/7/2009 MA 8/7/2009 CA 8/7/2009 TX 8/7/2009 LA 8/7/2009 AZ 8/7/2009 NY 8/7/2009 TX 8/7/2009 PA 8/7/2009 MN 8/7/2009 PA 8/7/2009 CA 8/7/2009 IL 8/7/2009 CA 8/7/2009 DC 8/7/2009 DC 8/7/2009 TX 8/7/2009 CA 8/7/2009 TX 8/7/2009 OH 8/7/2009 CA 8/7/2009 AZ 8/7/2009 DC 8/7/2009 8/7/2009 WI 8/7/2009 LA 8/7/2009 GA 8/7/2009 MD 8/7/2009 MI 8/7/2009 NC 8/7/2009 NV 8/7/2009 TX
10 69 18 12 0.3
10 69 18 12 0
12 4 0.3 67 63 11 19 67 0.5 58 0.5 10 4 13 0.3 14 13 4 68 5 10 5 4 58 2 17
12 4 0 67 63
0.5 4 12 68 13 65 6 15 55 70 11 9 1.5 9 4 18 23 10
0 4 12 68 13 65 6 15 55
19 67 0 58 0 10 4 13 0 14 13 4 68 5 10 5 4 58 2 17
11 9 1 9 4 18 23 10
F F F F 0.3 M F M M 0.3 M F F U F F 0.5 M M 0.5 F M F F 0.3 F F F F F M M M M M 0.4 M F U 0.5 M F F F M F F F M F F M 0.5 M M F F M F
8/3/2009 Pt had TDAP vaccination in the (L) 7/16/2009 Dev a rash 6d after ZOSTAVAX inje 8/6/2009 Pt received immunizations at 0800 a 8/7/2009 103.0 fever the night of injection, he 8/7/2009 This case was Y reported by a healthc 8/7/2009 This case was reported by a physici 8/7/2009 Surrounding erythema and swelling 8/7/2009 VARIVAX given 8/5/09 - 48hrs later 8/7/2009 (L) upper thigh dime size red swolle 8/7/2009 Received ZOSTAVAX on Friday, Ju 8/7/2009 Fever developed day of immunisatio Redness at the site of injection. Ant 7/15/2009 Initial report received on 14 July 200 8/8/2009 Mild headaches all day long. 8/8/2009 Stridor and bronchospasm gave Ra 8/7/2009 Patient had some arm swelling that 8/7/2009 7 AM red face, trouble breathing 3 P 8/8/2009 Pt fainted after receiving BOOSTRIX 8/6/2009 Live vaccine administered less than 7/29/2009 This report was received from a hea 8/7/2009 Lethargy and poor feeding in the 1s 8/5/2009 Four days after vaccines (8/4/09), te 8/7/2009 Tenderness, inflammation, runny no 8/6/2009 Erythema to L deltoid with edema n 8/7/2009 Swollen left arm- inflammation and t 8/6/2009 Patient had cough and shortness of 8/6/2009 2 inch by 4 inch erythematous on (L 8/5/2009 Left lateral thigh SC with 3 inch in d 8/5/2009 Multiple large masses of lymph nod 8/5/2009 Localized redness and swelling at in 8/7/2009 Left leg upper medial side swollen, 8/6/2009 Received Hepatitis A #1 vaccine on Noted to have maculopapular rash 1 8/6/2009 3rd Hepatitis B administered 7 week 8/6/2009 Live vaccines administered less tha 8/7/2009 5 X 8 cm erythema at site of VARIV 8/5/2009 Pt. given VARIVAX instead of ZOST 8/4/2009 5 X 8 erythema at site of VARIVAX 8/7/2009 Local skin reaction with warmth, dis 8/6/2009 L arm red in area vaccinated not wa Presyncope, Hypotension, diaphore 8/4/2009 55 year old staff physician, active du 7/30/2009 Information has been received from 7/31/2009 Noticed round red spot size of a bas 8/3/2009 (L) leg (pt seen @ urgent care) 2" d 7/30/2009 Patient developed redness and swe 8/7/2009 Vaccine given 8/4/09; Seen on 8/6/ 8/7/2009 2" x 3" raised erythema on L thigh, s 8/7/2009 AFTER RECEIVING VACCINES, C 8/7/2009 Red, itchy rash on trunk, shest, and 7/30/2009 Patient had syncope ~ 10 min after
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8/7/2009 CA 8/7/2009 PA 8/7/2009 IN 8/7/2009 WA 8/7/2009 IL 8/7/2009 MT 8/7/2009 PA 8/7/2009 PA 8/7/2009 MD 8/7/2009 MN 8/7/2009 MA 8/7/2009 PA 8/7/2009 MA 8/7/2009 PA 8/7/2009 PA 8/7/2009 MO 8/7/2009 NC 8/7/2009 MI 8/7/2009 CA 8/7/2009 MI 8/7/2009 FL 8/7/2009 KS 8/7/2009 TN 8/7/2009 CA 8/7/2009 WA 8/7/2009 VA 8/7/2009 NC 8/7/2009 NY 8/7/2009 NY 8/7/2009 MD 8/7/2009 GA 8/7/2009 GA 8/7/2009 8/7/2009 8/7/2009 MN 8/8/2009 MO 8/8/2009 MI 8/8/2009 MA 8/8/2009 AL 8/8/2009 CA 8/8/2009 MA 8/8/2009 CA 8/8/2009 CA 8/9/2009 PA 8/9/2009 CA 8/9/2009 NY 8/10/2009 MI 8/10/2009 CA 8/10/2009 TX 8/10/2009 MI 8/10/2009 AL
60 19 72 46 14 64 55 55 54 66 0.5 55 1 54 56 1 12 56 1.3 5 35 12 67 67 70 0.2 0.3 0.2 0.3 0.2 0.1 0.3 5 14 0.2 0.6 24 4 20 72 1.3 0 2 15 14 1.3 19 18
60 20 72 46 14 64
0 1
1 12 56 1 41 5 35 65 12 67 67 70 0 0 0
0 5 14 0 0 24 4 20 72 1 2 15 14 1 18
F F F F F F U U U U 0.5 M U 0M U U 0M F M 0.3 M F F F F F F F F F 0.2 F 0.3 F 0.2 F F F F 0.3 M F F 0.2 F 0.6 M M M F M M 0F 0.1 M F F 0.3 F F F
8/7/2009 7/29/09 TDaP placed in Travel Clini 8/7/2009 Patient received Tdap on 07-31-09. 8/7/2009 Patient reported that she received Z 8/7/2009 First injection of Engerix B: 04/17/02 8/7/2009 Child received Menactra 8/6/2009am 8/7/2009 First, dizziness and diarrhea. Later, 8/7/2009 subject in pneumococcal vaccine tri 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Received 6 mo immunizations on 7/ 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Recieved Prevnar on 7/28/09, on 7/ 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 Subject in pneumococcal vaccine tr 8/7/2009 High fever ranging from 101.5-104 d 8/7/2009 Patient received Tdap. Approximat 8/7/2009 12 hours after injection, arm becam 8/7/2009 6.5cmX6.0cm erythematous indurat 8/7/2009 24 hours after receiving Tdap client 8/7/2009 Cellulitis around injection site. Hive 8/7/2009 Fever 102.5, headache, chills, naus 8/7/2009 pt said she had a reaction, it was th 8/7/2009 fainted as leaving clinic after receivi 7/30/2009 Initial and follow-up information has 7/30/2009 Information has been received from 7/30/2009 Information has been received from 7/30/2009 Information has been received from 8/5/2009 This case was reported by a healthc 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a physici 8/5/2009 This case was reported by a consum 8/5/2009 This case was reported by a consum 8/5/2009 This case was reported by a healthc 8/8/2009 Destiny had fevers of 102 for 3 days 8/8/2009 Stomach hurt, body red and itchy, m 8/8/2009 Dramatic irritability several hours aft 8/8/2009 he receved vaccination on a friday a 8/8/2009 Sweating, chills, headache, head c 8/8/2009 Limping, favoring right leg. Limitatio 8/8/2009 Tingling and numbness in both hand 8/8/2009 PER PATIENT'S FAMILY, PATIENT 8/9/2009 fever, seizure x2 8/9/2009 After first vaccination (Hepatitis B) 8/9/2009 On August 6, 2009 my son recieved 8/7/2009 Client received 1st GARDASIL and 8/6/2009 Pt was nervous prior to receiving va 8/9/2009 she has developed hives all over he 8/7/2009 Information has been received from 8/7/2009 Information have been received from
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8/10/2009 8/10/2009 KS 8/10/2009 IL 8/10/2009 TX 8/10/2009 8/10/2009 8/10/2009 NY 8/10/2009 WA 8/10/2009 OH 8/10/2009 OH 8/10/2009 FL 8/10/2009 AZ 8/10/2009 TX 8/10/2009 TX 8/10/2009 FL 8/10/2009 AK 8/10/2009 VA 8/10/2009 OK 8/10/2009 NC 8/10/2009 IA 8/10/2009 WI 8/10/2009 GA 8/10/2009 NC 8/10/2009 CA 8/10/2009 IL 8/10/2009 GA 8/10/2009 CA 8/10/2009 NC 8/10/2009 IN 8/10/2009 KS 8/10/2009 LA 8/10/2009 AZ 8/10/2009 OH 8/10/2009 NC 8/10/2009 8/10/2009 8/10/2009 TX 8/10/2009 TX 8/10/2009 MD 8/10/2009 NY 8/10/2009 8/10/2009 SC 8/10/2009 MO 8/10/2009 TX 8/10/2009 KS 8/10/2009 SD 8/10/2009 IL 8/10/2009 CA 8/10/2009 CA 8/10/2009 WA 8/10/2009 WA
17 17 18 62 73 72
17 18 62 72
32 5 5 4 1 0.5 57 1.2 74 14 1.1 1.4 17 73 27 18 37 5 11 15 80 11 16 4 0.3 11 10 12
32
11 11 30 11
11 11 30 11
51 18 14 15 12 5 4 0.3 7 1.5
51 18 14 15 12 5 4 0 7 1
4 1 0 57 1 74 14 1 1 17 73 27 18 37 5 11 15 80 11 16 4 0 11 10
F F F F F M F F U U F 0F 0.5 F F 0.2 F F F 0.1 M 0.4 M M F F M F M F F F U F M 0.3 F F F F U F F F F M F F M F F M F 0.3 M F 0.5 M
8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received from 8/7/2009 Information has been received for th 8/6/2009 Initial report received on 29 July 200 8/6/2009 Initial report received on 29 July 200 8/3/2009 Following administration of DTaP-IP 5/28/2009 Upper lip swelling 3 hour after Immu 7/23/2009 None Stated 3/10/2009 After immunization, patient develop 8/3/2009 Temp on & off X 4 days, rash on ba 8/4/2009 Pt reported 35 days post vaccinatio 8/4/2009 14 yo female fainted for seconds an 8/3/2009 VARICELLA lesions erupted 8/3/09 8/4/2009 Erythema multiforme skin RXN. 8/4/2009 8/3/09 Mother phoned at approx. 3: 8/5/2009 Headache - Induration at site of inje 8/3/2009 Patient reports pain at injection site 8/15/2009 Headache, neck, back pain, nausea 8/3/2009 Site was reddened warm to touch, & Left leg swelling, left arm bumps. Client received MCV4 on 8/4/09 in l Patient fainted and fell to the floor, s 8/5/2009 Pt received ZOSTAVAX on 7/16/09 Vaccines given on Aug. 4, 2009, we 8/6/2009 Arm pain followed by tingling in the 8/6/2009 Red, swollen upper/forearm, warmth 8/5/2009 Fever, hives 7/27 went to ER CXR N 8/7/2009 8x9mm area of redness, warm to to 8/4/2009 Pt fainted with assistance to floor. P 8/5/2009 My daughter received her 1st dose Fatigue, achy muscles, fever warmt 8/7/2009 Reddened/ raised area. Warm to to 8/7/2009 Pt developed nausea, paleness, dia 2-3 days mild itchy scattered pruritic 8/10/2009 Injection site red and swollen - Advi Developed diffuse macular rash and 8/10/2009 SC DAY AFTER VACCINES- FATIG 8/10/2009 Mom reports that Friday (8/7/09)eve 8/10/2009 Patient had just received Tdap, Hep 8/10/2009 Pt presents to HD 08/10/09 @ 800a 8/10/2009 No contraindications to vaccine on s 8/10/2009 Swollen left arm-deltoid area-was se 8/10/2009 PT GIVEN IPV AND MMR RIGHT A 8/10/2009 Persistent high pitched crying x 3 da 8/10/2009 Localized swelling measuring 3.5 in 8/10/2009 Localized redness measuring 6.5 in
353605 353606 353607 353608 353609 353610 353611 353612 353613 353614 353615 353616 353617 353618 353619 353620 353624 353625 353626 353627 353628 353629 353630 353631 353632 353633 353634 353635 353636 353637 353638 353639 353640 353641 353642 353643 353644 353645 353646 353647 353648 353649 353650 353692 353693 353731 353732 353734 353736 353738 353740
8/10/2009 DE 8/10/2009 AK 8/10/2009 MO 8/10/2009 TN 8/10/2009 PA 8/10/2009 CA 8/10/2009 WI 8/10/2009 CA 8/10/2009 MS 8/10/2009 WI 8/10/2009 OH 8/10/2009 SD 8/10/2009 CA 8/10/2009 WA 8/10/2009 LA 8/10/2009 8/10/2009 TX 8/10/2009 KS 8/10/2009 NC 8/10/2009 KS 8/10/2009 KS 8/10/2009 NJ 8/10/2009 AZ 8/10/2009 CA 8/10/2009 WA 8/10/2009 MN 8/10/2009 TN 8/10/2009 TN 8/10/2009 MD 8/10/2009 MD 8/10/2009 OR 8/10/2009 8/10/2009 TX 8/10/2009 MA 8/10/2009 CA 8/10/2009 GA 8/10/2009 NV 8/10/2009 MO 8/10/2009 GA 8/10/2009 CT 8/10/2009 NE 8/10/2009 NC 8/10/2009 TX 8/11/2009 8/11/2009 KS 8/11/2009 TN 8/11/2009 TN 8/11/2009 CA 8/11/2009 NE 8/11/2009 PA 8/11/2009 MS
44 11 14 25 11 61 24 0.2 37 1 16 11 1.3 25 4
44 11 14 25 11 61 24 0 37 1 16 11 1 25 4
20 18 20 19 0.4 20 0.3 4 19 5 4 5 4 65 2 2 8 69 14 7 4 1.5 9 7 39 7 8
20 18 20 19 0 20 0 4 19 5 4 5 4 65 1 1 8
0.2 17 2 1.6 26 4 4
0 17 2 1 26 4 4
14 7 4 1 9 7 39 7 8
F M M F F F F 0.2 F F 0F F M 0.3 F F F F F M M F 0.4 M F 0.3 F F M F F M F F 1M 1M M F F M F 0.5 M F M F M M F 0.2 M M 0.1 M 0.6 M F F M
8/10/2009 States 12-14 hours after immunizati 8/10/2009 2.5 inch raised red welt formed the 8/10/2009 Several minutes after shots were giv 8/10/2009 Approx. 2 days after the vaccine wa 8/10/2009 Received Gardasil dose #2. Walked 8/10/2009 Shingles vaccination Zostevax rece 8/10/2009 Vaccine administered May22, 2009 8/10/2009 Non stop crying for more than 4 hou 8/10/2009 chills, dizziness, difficulty breathing, 8/10/2009 Varicella vaccine administered on 7 8/10/2009 Immediately following HPV#2 and V 8/10/2009 Developed papular rash over entire 8/10/2009 left thigh with mild erythema, 3cm w 8/10/2009 Received vaccines on 07/29/09, Va 8/10/2009 c/o Rash for 3 days left side around 8/10/2009 This case was reported by a lawyer 8/6/2009 Severe erythema, warmth, tenderne 8/10/2009 Pain left arm, armpit, down side from 8/10/2009 20 y/o AA male ADSM/Specialist is 8/10/2009 08/09/2009 Mild, other. Redness. 3 7/28/2009 Inj. site top R thigh covered by band 8/10/2009 Syncope. Bradycardia - pulse < 40. 7/27/2009 Vaccines given 7/20 including ROTA 8/7/2009 On 8/5/09 pt rec'd KINRIX on L arm 6/17/2009 Per clinical notes: 19 y/o male who 8/10/2009 5 yo with onset of LE and buttock pu 8/10/2009 Gave pt vaccine in R DM. approxim 8/10/2009 Approx dime sized induration, quart 8/6/2009 Local red indurated area @ site of v 10 days post vaccine increase itchy 8/3/2009 Mother described red swollen extrem 8/3/2009 Red, warm, swollen extremity where 7/31/2009 Had HA and was nauseated 7/29 ev 8/3/2009 Received pneumococcal vaccine in 7/27/2009 6-10-09 at 5 PM lips started swelling 8/4/2009 Pt had urticaria, and extreme erythe 7/31/2009 Mom reports swelling & redness in r 8/5/2009 An 18 cm X 14 cm red, warm to tou 8/4/2009 Varicella vaccine administered with Facial and nasal swelling, throat cle 8/5/2009 Very painful. States on 7/2 her Lt. a 8/5/2009 Within 24 hours the pt. developed e 8/7/2009 Swelling, redness, warmth @ site o 8/10/2009 Information has been received from 8/10/2009 Information has been received from Pt. committed Y suicide on 8-3-09. 9/2 8/4/2009 Wheezing - admitted 7/31/09 for 24 8/4/2009 5/15/9 - MMR given with Hep A, Hib 6/17/2009 Pt had taken an MMR vaccine 2 day 8/6/2009 A LU arm slightly red and tender. 8/1/2009 Fever and shaking chills X 16-17 hr
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8/11/2009 CA 8/11/2009 AZ 8/11/2009 IN 8/11/2009 IN 8/11/2009 PA 8/11/2009 HI 8/11/2009 HI 8/11/2009 DE 8/11/2009 MI 8/11/2009 VA 8/11/2009 TX 8/11/2009 OH 8/11/2009 OH 8/11/2009 NY 8/11/2009 KY 8/11/2009 UT 8/11/2009 TX 8/11/2009 IN 8/11/2009 KY 8/11/2009 TN 8/11/2009 NC 8/11/2009 NC 8/11/2009 8/11/2009 MS 8/11/2009 NY 8/11/2009 8/11/2009 CO 8/11/2009 KY 8/11/2009 MS 8/11/2009 MI 8/11/2009 CA 8/11/2009 WI 8/11/2009 DE 8/11/2009 IN 8/11/2009 MI 8/11/2009 MI 8/11/2009 IN 8/11/2009 IA 8/11/2009 PA 8/11/2009 OH 8/11/2009 CA 8/11/2009 KY 8/11/2009 MI 8/11/2009 NC 8/11/2009 WA 8/11/2009 OH 8/11/2009 CA 8/11/2009 MN 8/11/2009 MA 8/11/2009 MT 8/11/2009 CA
0.4 5 16 5 59 66 64 22 15 11 14 13 13 19 11 12 15 15 4 18 18 10 0.2 73 5 9 5 1 36 4 3 29 25 12 69 4 5 0.5 20 0.2 2 24 51 26 1 24 17 5 18 5 24
0 5 16 5 59 66 64 -1 15 11 14 13 13 19 11 12 15 15 4 18 18 10 73 5 9 5 1 36 4 3 29 25 12 69 4 5 0 20 0 2 24 51 26 1 24 17 5 18 5 24
0.4 M F F F M F M 0.9 F F M F M F M F F F F M M F M M F F M M 0M F F F F U F F M M 0.5 F F 0.2 F 0.7 M F M F 0F F F F F F U
8/7/2009 Pt. had vaccine on 7/31/09 in late a 8/6/2009 Left arm swollen, tight 24 hours. 8/3/2009 C/o fainting 8/5/2009 20 minutes post immunizations pt.'s Servere left hip pain at injection site reddened area (4 cm X 6 cm) below 8/5/2009 Redness and slight swelling below a 7/30/2009 Seen @ Sick call with headache aft 8/6/2009 Left health department, in car-driven 8/6/2009 Seizure within 2-3 minutes after give 8/4/2009 On 08/04/09 approx 10:10 AM vacc 8/5/2009 Developed "tiny red bumps" on arm 7/30/2009 Syncope, vomiting, grey skin tone. S 8/5/2009 Fever to 101 degrees F, myalgias, c 8/5/2009 About 24 hrs after receiving vaccine 8/10/2009 Polyarthralgias, rash 24 hours post 8/11/2009 Pt developed marked redness and s 8/11/2009 Body aches, fatigue, blisters inside 8/11/2009 R arm swollen, red, hot over entire a 7/28/2009 Received MENACTRA 7/24/09. Felt 8/10/2009 Severe diarrhea w/in 48 hrs. of 3rd 8/3/2009 Pt received HEP A & VARIVAX on 7 7/31/2009 Severe crying episode lasting > one 8/5/2009 On 7/27/09, Pt. was administered te 7/15/2009 Edema & mild erythema of injection 8/6/2009 Pt presented to clinic today one day 8/5/2009 Pt. developed large red area around 8/6/2009 5/24 developed fever 103.4 given A 8/5/2009 (Left arm) swelling, redness, itching 8/1/2009 Redness around injection site. Swe 8/6/2009 On 8/6/09, Pt was brought in by her 7/27/2007 1115 immediately c/o light headedn Anthrax vaccine administered Frida 8/11/2009 About 10-15 minutes after receiving 8/11/2009 11x11" R deltoid, 7x7" distal, increa 8/11/2009 Swollen, hot and red on anterior left 8/11/2009 Mother noted redness, swelling, and 8/11/2009 Patient was given vaccines in AM a 8/11/2009 had 2 episodes of numbness and tin 8/11/2009 7/29/09 - 2Pm Shots. Fever - mid. 8/11/2009 Fever to 103, tachycardia, flushing o 8/11/2009 C/o itching on arms and legs. Fine r 8/11/2009 Generalized body aches, elevated t 8/11/2009 Induration and erythema at the injec 8/11/2009 Fevers to 104.8 starting ~36 hours a 8/11/2009 Spoke to patient. States had pain rig 8/11/2009 Pt received HPV4 vaccine injection 8/11/2009 Pt was given kindergarden immuniz 8/11/2009 Two episodes of malaise, headache 8/11/2009 rt arm red and very warm to touch. s 8/11/2009 Arrythmia, Rapid Heart Rate, Exces
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8/11/2009 AZ 8/11/2009 FL 8/11/2009 TX 8/11/2009 TX 8/11/2009 CO 8/11/2009 CA 8/11/2009 KS 8/11/2009 CO 8/11/2009 IA 8/11/2009 IA 8/11/2009 NC 8/11/2009 NY 8/11/2009 TX 8/11/2009 MD 8/11/2009 NE 8/11/2009 CA 8/11/2009 VA 8/11/2009 VA 8/11/2009 CA 8/11/2009 FL 8/11/2009 OH 8/11/2009 GA 8/11/2009 CA 8/12/2009 TN 8/12/2009 AZ 8/12/2009 FL 8/12/2009 MI 8/12/2009 8/12/2009 TX 8/12/2009 MO 8/12/2009 8/12/2009 8/12/2009 SC 8/12/2009 LA 8/12/2009 AZ 8/12/2009 NC 8/12/2009 GA 8/12/2009 NC 8/12/2009 AZ 8/12/2009 TX 8/12/2009 TX 8/12/2009 CO 8/12/2009 TX 8/12/2009 MI 8/12/2009 MI 8/12/2009 MI 8/12/2009 MI 8/12/2009 TX 8/12/2009 MI 8/12/2009 PA 8/12/2009 TX
51 1.4 15 0.5 21 4 60 11 79 67 5 1.4 3 16 27 4 2 69 73 70 1.6 9 4 11 59 0.9 28 57 36 17 14
51 1 15 0 21 4 60 11 79 67 5 1 3 16 27 4 2 69 73 70 1 9 4 11 59 0 28 57 36 17 14
12 1.1 4 13 0.9 18 4 0.4 61 14 1.3 30 51 82 76 18 0.3 67 4
12 1 4 13 0 18 4 0 61 14 1 30 51 82 76 19 0 67 4
F 0.4 F F 0.5 F F F F M F F M 0.4 F M M F M 0.6 F F F M 0.6 F F F F M 0.9 F F F M F F U U 0.1 M M M 0.9 M F F 0.4 M F M 0.3 M F F F M F 0.4 M F F
8/11/2009 received hepatitis B vaccine at emp 8/11/2009 8th and 9th day after shot patient ra 8/11/2009 APPROX 3-4 MIN AFTER ADMINIS 8/10/2009 Vomiting. Bile stained. Abdominal 7/29/2009 A couple of hours after 1st shot, my 8/10/2009 4 1/2 X 4 cm left arm swollen with re 8/11/2009 "3 days after vaccination pt develop 7/29/2009 Approximately 24 hours after receiv 8/11/2009 Injection site reaction- 1/2 dollar size 8/10/2009 Injection site reaction - 2.5 inch diam 8/11/2009 Pt had erythema of head, chest, arm 8/16/2009 Within 10-15 min's developed hives 8/11/2009 Given R upper lat leg - VARIVAX - 4 8/6/2009 Localized erythema/induration w/ sp 8/5/2009 Received 7/31/09- R. arm hives tha 8/4/2009 Erythematous, indurated are 4.5 x 4 8/6/2009 Patient started coughing, wheezing, 8/10/2009 5 X 7 erythematous swelling of the l 8/11/2009 Localized redness at injection site. 8/10/2009 Localized edema/erythema. 8/11/2009 - Pt developed swelling of and eryth 7/27/2009 Approximately 5 minutes after vacci 8/11/2009 Pt. rev'd 3 vaccines on left arm (DTA 8/12/2009 Severe pain at injection sight in left 8/11/2009 I had a flu vaccine on 10-18-26 on t 8/12/2009 Red un-raised splotches appeared o 8/12/2009 no fever, but pain from the shoulder 8/12/2009 LEFT DELTOID 6 X 8 CM OF ERYT 8/12/2009 Received Varicella vaccine on June 8/5/2009 15-20 minutes after injection client e 8/11/2009 Information has been received from 8/11/2009 Information has been received from 8/12/2009 Fever 102, dizzy, nausea weak nex 8/12/2009 Pt presented to clinic on 8/11/09 wit 8/10/2009 Pt had diffuse swelling/redness of (L 7/31/2009 Severe headache and low grade tem 8/6/2009 1) Approximately 2.5 + 2.0 erythema 8/7/2009 Tdap given before realizing patient Patient given 4 go shots (DTAP, IPV 7/31/2009 Swelling to injection sites 2 1/2 cm. Went to eye doctor = pt thought she 8/6/2009 Arm red, swollen, warm to touch. Sk 7/31/2009 Increase swelling thigh - 10 cm swe 8/4/2009 A cluster of four patients (patient ide 7/20/2009 A cluster of four patients (patient ide 8/4/2009 This non serious case was received 7/20/2009 This non serious case was received 8/12/2009 Patient developed severe and longl 8/12/2009 Day after vaccines were given, pt w 8/12/2009 Pt received Zostavax on 08/10/09 a 8/12/2009 Parent states the child had "vomitin
353898 353899 353901 353902 353903 353904 353905 353906 353907 353908 353909 353910 353912 353913 353914 353915 353916 353917 353918 353920 353922 353923 353924 353925 353927 353928 353930 353932 353933 353934 353936 354017 354022 354023 354032 354034 354035 354036 354037 354039 354040 354041 354042 354043 354044 354045 354046 354047 354048 354049 354050
8/12/2009 MA 8/12/2009 TX 8/12/2009 TX 8/12/2009 TX 8/12/2009 TX 8/12/2009 AZ 8/12/2009 WI 8/12/2009 WA 8/12/2009 SC 8/12/2009 IA 8/12/2009 WA 8/12/2009 IL 8/12/2009 PA 8/12/2009 CA 8/12/2009 PA 8/12/2009 OH 8/12/2009 WA 8/12/2009 CA 8/12/2009 MO 8/12/2009 8/12/2009 GA 8/12/2009 CT 8/12/2009 GA 8/12/2009 PA 8/12/2009 VA 8/12/2009 CA 8/12/2009 CA 8/12/2009 NC 8/12/2009 AK 8/12/2009 TX 8/12/2009 CO 8/13/2009 MI 8/13/2009 TN 8/13/2009 8/13/2009 8/13/2009 MN 8/13/2009 AZ 8/13/2009 MO 8/13/2009 NJ 8/13/2009 UT 8/13/2009 KS 8/13/2009 PA 8/13/2009 PA 8/13/2009 PA 8/13/2009 PA 8/13/2009 AL 8/13/2009 PA 8/13/2009 PA 8/13/2009 AL 8/13/2009 WA 8/13/2009 TN
0.2 0.5 16 15 12 9 61 5 22 17 13 11 4 16 83 15 1 5 5 21 5 60 2 5 4 28 4 8 9 1.8 24 24 14 22 23 37
0 0 16 15 12 9 61 5 22 17 13 11 4 16 83 15 0 5 5 21 5 60 2 5 4 28 4 8 9 1 24 24 14
0.5 16 12 15 15 5 11 2 10 1.5 1.5 13 4 5
0 16
37
15 15 5 11 2 10 1 1 13 4 5
0.2 F 0.5 F F M F M F M F F F F M F F F 1M F M F F F 0.4 F F F F F F F 0.8 F F F F F F F F 0.5 M F F M F M F 0.4 F F 0.5 F 0.5 F F F M
8/12/2009 According to parents child had decr 8/12/2009 Patient with symptoms c/w partial se 8/6/2009 Maryan rec'd 6 immunizations here 8/6/2009 Pt rec'd 6 immunizations. Waiting fo 8/4/2009 Welps on arms, trunk, back, neck 8/12/2009 Redness, swelling at injection site, e 8/12/2009 Pt was given Zostavax to LUE on 08 8/12/2009 Onset of low-grade fever (100.2 ora 8/12/2009 Fever of 100.0,joint pain, body ache 8/12/2009 Patient was sent to the nurses statio 8/12/2009 Patient passed out about 5 minutes 8/12/2009 Patient experienced vomitting appro 8/12/2009 PATIENT WOKE UP LAST NIGHT, 8/12/2009 PT WAS GIVEN AN EXTRA IPV NA 8/12/2009 3 days after receiving Zostavax pati 8/12/2009 Pt became shaky and nauseuos wit 8/12/2009 Febrile Seizure 8-11-09 Seen in ER 8/12/2009 pt presented 2 days post vaccinatio 8/12/2009 The area is very red and swollen. It 8/12/2009 This case was reported by a physici 8/11/2009 Pt c/o acute abdominal pain then sy 8/13/2009 Swelling pain at site of vaccine 8/6/0 8/12/2009 After receiving 4 mos. vaccines child 8/12/2009 Pt's mother, called this RN at 12:15 8/12/2009 Pt had redness; Itching and warmth 8/12/2009 Rash / Urticaria appears 2 days afte 8/12/2009 Swollen injection site with vesicles, 8/10/2009 Left thigh @ injection site by day 2 a Varicella administered R upper arm 8/12/2009 Rash and lump to site fever 103.4. 8/12/2009 Pt received DTaP left deltoid at hos 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/12/2009 Information has been received from 8/11/2009 This case was received from a heal 8/11/2009 Initial report received on 07 August 8/12/2009 Intussusception. Vaccine give 7/22/ 8/5/2009 Vaccine was administered, patient b 8/11/2009 Approximately 20 seconds after the 7/30/2009 Pt. passed out in lobby after receivin 8/13/2009 Pt acquired PCR positive for pertuss 8/13/2009 Patient acquired pertussis (positive 8/13/2009 Pt developed pertussis (PCR positiv 8/13/2009 Patient acquired pertussis and was 8/13/2009 Approximately 5 minutes after inject 8/13/2009 Pt acquired pertussis and was PCR 8/13/2009 Patient acquired PCR positive pertu 8/13/2009 Approximately 5 minutes after recei 8/13/2009 Irritation at site of injection (right sho 8/13/2009 Mother of patient reported some sw
354051 354052 354053 354054 354055 354056 354057 354058 354059 354075 354076 354077 354078 354080 354081 354082 354083 354084 354085 354086 354087 354088 354090 354091 354092 354093 354094 354095 354096 354097 354098 354099 354100 354112 354113 354114 354115 354116 354117 354118 354119 354120 354121 354122 354123 354124 354125 354126 354127 354128 354129
8/13/2009 WI 8/13/2009 VA 8/13/2009 FL 8/13/2009 MN 8/13/2009 TN 8/13/2009 MD 8/13/2009 FL 8/13/2009 PA 8/13/2009 IL 8/13/2009 IL 8/13/2009 OH 8/13/2009 IA 8/13/2009 CA 8/13/2009 WA 8/13/2009 8/13/2009 8/13/2009 8/13/2009 PA 8/13/2009 TN 8/13/2009 NC 8/13/2009 MN 8/13/2009 VA 8/13/2009 8/13/2009 AZ 8/13/2009 MN 8/13/2009 NC 8/13/2009 NV 8/13/2009 CO 8/13/2009 FL 8/13/2009 CA 8/13/2009 NC 8/13/2009 NC 8/13/2009 CA 8/13/2009 AZ 8/13/2009 NH 8/13/2009 FL 8/13/2009 MI 8/13/2009 AL 8/13/2009 TX 8/13/2009 WI 8/13/2009 WA 8/13/2009 SD 8/13/2009 CA 8/13/2009 TX 8/13/2009 TX 8/13/2009 NY 8/13/2009 CA 8/13/2009 WI 8/13/2009 NE 8/13/2009 WI 8/13/2009 NH
64 21 4 0.3 5 69 16 11 14 4 5 39 1.3 65 5 16 13 11 26 66 3 5 9 17 1.3 62 14 4 4 8 5 11 21 22 19 4 10 72 23 0.4 74 4 12 0.4 5 12 11 11
64 21 5 0 5 69 16 11 14 4 5 5 39 1 65 74 5 16 13 11 26 66 3 5 17 1 62 14 4 4 8 5 11 21 22 19 4 11 72 23 0 74 4 12 0 5 12 11 11
F F F 0.3 F F M F M M M F F F 0.3 M F F M U F F F F F F M F 0.3 M F F F F F F M F F F F F M F 0.4 F M F F 0.4 M M F M F F
8/12/2009 Pt developed shingles 8/12/09. 8/5/2009 Patient reported to us on 8/5/09. Sh 8/13/2009 R arm. Site of injection became hard 8/7/2009 Vaccinated 8/5/09. Projectile vomitin 8/7/2009 Red, raised area on left upper thigh 8/9/2009 4 days after admin - diffuse trunk pa 7/23/2009 Patient experienced dizziness and n Vomiting, high fever (104 Rectal), h 8/4/2009 Received Tdap & Varicella L arm 7/ 8/6/2009 Left leg 4" diameter erythema with m 8/10/2009 L arm site. Mother called Health De 8/10/2009 Immunizations listed below given in 8/7/2009 Patient came in on 7/27/09 c/o sore 8/7/2009 6-0.5-1 mm red papules with surrou 8/8/2009 I had the ZOSTAVAX injection at a 8/8/2009 I received the ZOSTAVAX on April 1 5/3/2006 About 24 hours after DTaP + IPU gi 8/13/2009 pt had headace and stomache slef r 8/13/2009 Patient received 4 immunizations on 8/13/2009 Fever to Tmax of 103, soft tissue sw 8/13/2009 Pt described feeling lousy, muscle a 8/13/2009 reddish rash and swelling, similar to 7/23/2009 Redness, swelling, cool compress. 7/23/2009 Redness & swelling of arm. Cool co 8/11/2009 Developed a 4x4 in erythematous, w 8/6/2009 1st dose of HEP A gave pt. "severe 7/31/2009 PCV 7 #4 vaccine given @ 12 mont 8/10/2009 High fever, accelerated heart rate, m 8/12/2009 Patient became very dizzy, nauseou 8/12/2009 Pt mother called health center on 88/13/2009 Injection site reaction- erythema, wa 8/14/2009 Varicella vaccine given in left arm a 8/12/2009 Pt given immunization and within fiv 8/13/2009 Pain, redness right upper arm. 8/13/2009 urticaria, throat scratchiness 8/13/2009 Blood work was done as a routine p 8/13/2009 Patient received third dose of series 8/13/2009 Hundres of lesions on body 8/13/2009 Received the following vaccinations 8/13/2009 08/13/2009 Caregiver noted a red a 8/13/2009 Pt was given Smallpox vaccine and 8/13/2009 2 days after 1-09 4 month shots of D 8/13/2009 Swollen Arm, Muscle Aches, 100 F 8/13/2009 Both legs swollen & red. Both arms swollen & red. 8/11/2009 Mom called office child screaming (u 8/13/2009 8/12/09 - Swelling of left arm where 7/28/2009 Loc for a few seconds body stiffene 8/13/2009 Hives on right arm, right leg and abd 8/13/2009 Pt felt lightheaded and was pale. 8/13/2009 Red, Raised, Warm, Size -->1.5 in d
354130 354131 354132 354133 354134 354135 354136 354137 354139 354140 354141 354143 354144 354145 354941 355008 355011 355104 355105 355106 355107 355108 355114 355115 355116 355117 355118 355119 355120 355121 355122 355123 355124 355125 355126 355127 355129 355151 355152 355153 355154 355155 355156 355157 355158 355159 355160 355161 355162 355163 355164
8/13/2009 MN 8/13/2009 NC 8/13/2009 KS 8/13/2009 SD 8/13/2009 MO 8/13/2009 MI 8/13/2009 WV 8/13/2009 MO 8/13/2009 TX 8/13/2009 CA 8/13/2009 GA 8/13/2009 CA 8/13/2009 8/13/2009 AZ 8/13/2009 CA 8/13/2009 NC 8/13/2009 MN 8/13/2009 CA 8/13/2009 8/13/2009 MI 8/13/2009 PA 8/13/2009 8/13/2009 8/13/2009 OH 8/13/2009 NY 8/13/2009 MD 8/13/2009 MO 8/13/2009 FL 8/13/2009 MN 8/13/2009 VA 8/13/2009 MD 8/13/2009 MD 8/13/2009 KY 8/13/2009 MN 8/13/2009 NY 8/13/2009 IL 8/13/2009 FL 8/13/2009 8/13/2009 TX 8/13/2009 PA 8/13/2009 IL 8/13/2009 MI 8/13/2009 MI 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 NC 8/13/2009 TX
12 1.2 1.2 33 1.9 13 18 0.5 10 8 10 1.8 34 1.5 4 4 9 5 14 31 7
12 1 1 33 1 13 18 0 10 10 1 34 1 4 9 5
13 52 27 7 6 5 12 40 5 31 5 11 5 5 9 8 9 5 7.5 19 18 21 26 21 22 5 7
27
40 5 5
8 5
M 0.2 M 0.2 M F 0.9 M M F 0.5 M F M M 0.8 M F 0.5 F M U M F F F M U M M M F M F F M M M F F M F M M F M M F M M M M F M F M F
8/13/2009 Local reaction: swelling, redness, w 8/13/2009 Varicella - low grade temp and red s 8/13/2009 8/12 3:40 PM- vomited - (crying sinc 7/22/2009 None 8/13/2009 Child received immunization 1 on 88/12/2009 R shoulder (trapezius muscle) enlar 8/13/2009 Immediately following HPV injection 8/13/2009 Parent brought pt into clinic on 7/24 8/13/2009 Both legs swollen & red. 8/13/2009 Patient came in with ~24 hr history o 8/10/2009 Blisters around injection site swellin 8/13/2009 08/12/09 Pt returned with reddened 8/11/2009 This 42 year old USAF services me 8/11/2009 Diagnosed with R OM 7/22/09, put o 9/5/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A serious labeled spontaneous repo ### A non-serious report of expired dos 8/11/2008 A non-serious spontaneous report o 8/20/2008 A non-serious spontaneous report o 8/21/2008 A non-serious spontaneous report o 8/22/2008 A non-serious spontaneous report o 8/22/2008 A non-serious spontaneous report o 9/3/2008 A non-serious spontaneous report o 9/29/2008 A non-serious spontaneous report o 9/30/2008 A non-serious spontaneous report o 3/24/2009 A non-serious spontaneous report o 9/11/2008 A non-serious spontaneous report o 9/19/2008 A Non - serious spontaneous report 9/25/2008 A non-serious spontaneous case of 9/17/2008 A non-serous spontaneous report o 9/17/2008 A non-serious spontaneous report o 9/19/2008 A non-serious spontaneous report o 9/30/2008 A non-serious spontaneous report o 9/24/2008 A non-serious spontaneous report o 9/25/2008 A non-serious spontaneous report o 9/26/2008 A non-serious spontaneous report o 9/29/2008 A non-serious report of administratio 9/29/2008 A non-serious, spontaneous report 11/6/2008 A serious report of vomiting, diarrhe 1/12/2009 A non-serious unlabeled spontaneo 10/3/2008 A non-serious spontaneous report o 10/6/2008 A non-serious spontaneous report o 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 10/6/2008 A non-serious, spontaneous report 10/6/2008 A non-serious labeled, spontaneous
355165 355166 355167 355168 355169 355170 355171 355172 355173 355174 355175 355176 355177 355178 355179 355180 355181 355182 355183 355184 355185 355186 355188 355189 355190 355191 355192 355193 355194 355195 355196 355197 355279 355284 355286 355287 355290 355292 355294 355297 355298 355299 355300 355304 355305 355306 355307 355308 355309 355310 355311
8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 MT 8/13/2009 TN 8/13/2009 TX 8/13/2009 TX 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 NM 8/13/2009 IA 8/13/2009 SD 8/13/2009 NJ 8/13/2009 FL 8/13/2009 KY 8/13/2009 CO 8/13/2009 OH 8/13/2009 CO 8/13/2009 GA 8/13/2009 GA 8/13/2009 KS 8/13/2009 UT 8/13/2009 NC 8/13/2009 TX 8/13/2009 KS 8/13/2009 MD 8/13/2009
21 34 31 24 21 25 22 37 21 19 20 24 5 5
85 24 48 45 28 43 7
8 7 52 69 16 56
69
M M M M M M M M F M M F F F F F F F M F F M M M F M F M M M M M M F F M F M F F F M M M M F M U F M F
11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio 11/7/2008 A non-serious report of administratio A non-serious report of administratio 4/9/2009 A non-serious report of administratio A non-serious report of administratio A non-serious report of administratio 4/9/2009 A non-serious report of administratio 10/6/2008 A non-serious, spontaneous report 10/7/2008 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A nonser 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non - s 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 Inappropriate dose of vaccine admin 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non ser 10/6/2008 One of twenty-one cases: A non-se 10/6/2008 One of twenty-one cases: A non-se ### A non-serious spontaneous report o 10/9/2008 A non-serious, spontaneous report 10/9/2008 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious Spontaneous report o ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious spontaneous report o 11/3/2008 A non-serious spontaneous report o 11/3/2008 A non-serious spontaneous report o 11/7/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious, spontaneous report A non-serious report of inadvertentl ### A non-serious spontaneous report o ### A non-serious, spontaneous report
355312 355313 355314 355315 355317 355318 355319 355320 355321 355322 355323 355324 355325 355326 355327 355328 355329 355330 355331 355332 355333 355334 355335 355336 355337 355338 355339 355340 355341 355342 355343 355344 355345 355346 355347 355348 355349 355350 355351 355352 355353 355354 355355 355356 355357 355358 355359 355360 355361 355362 355363
8/13/2009 TX 8/13/2009 OH 8/13/2009 NC 8/13/2009 OH 8/13/2009 KY 8/13/2009 FL 8/13/2009 GA 8/13/2009 MN 8/13/2009 KY 8/13/2009 8/13/2009 IN 8/13/2009 NV 8/13/2009 MN 8/13/2009 MN 8/13/2009 IL 8/13/2009 IL 8/13/2009 UT 8/13/2009 MN 8/13/2009 WA 8/13/2009 TX 8/13/2009 NC 8/13/2009 IN 8/13/2009 MN 8/13/2009 WI 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 NM 8/13/2009 KS 8/13/2009 KS 8/13/2009 VA 8/13/2009 KS 8/13/2009 FL 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 CA 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 CA 8/13/2009 KS 8/13/2009 KS 8/13/2009 AL 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS
76 62 7 5 5 28 10 9 12 13 50 34 5 8 13 8 34 37 6 35 9 59
76 7 5
28
12
34
9
58
30 5
8
5
5
U F M M M F M F M F F M M M M M U M F M F M M F U U U U U F U U F U M U U U F U U U U M U U F U U U U
### A non-serious, spontaneous report 11/7/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious report of Henoch Sch ### A non-serious, spontaneous report ### A non-serious report of runny nose 11/3/2008 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious, spontaneous report ### A non-serious spontaneous report o 1/8/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o 11/7/2008 A non-serious, spontaneous report ### A serious spontaneous report of par 3/24/2009 A non-serious spontaneous report o A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious report of swelling of t ### A non-serious spontaneous report o ### A non-serious, spontaneous report ### A non-serious spontaneous report o ### A non-serious, spontaneous report 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious, spontaneous report 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 1/13/2009 A non-serious spontaneous report o 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/3/2008 A non-serious, spontaneous report 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU
355364 355365 355366 355367 355368 355369 355370 355371 355372 355373 355374 355375 355376 355377 355378 355379 355380 355381 355382 355383 355384 355385 355386 355387 355388 355389 355390 355391 355392 355393 355394 355395 355422 355423 355424 355425 355426 355427 355428 355429 355430 355431 355432 355433 355434 355435 355436 355437 355438 355439 355440
8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 PA 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 KS 8/13/2009 SD
6
24
24
U U U U U U U U U U U U U U U U U U U U U U U U U U F U U U U U U U U U U U U U U U U U U U U U U U F
4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/3/2008 A non-serious, spontaneous report 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 11/2/2008 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FluM 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-used report of expired FluMis 4/9/2009 A non-serious report of expired FLU ### A non-serious spontaneous report o
355441 355442 355443 355444 355445 355447 355448 355449 355450 355451 355452 355453 355454 355455 355456 355457 355458 355459 355460 355461 355462 355463 355464 355465 355466 355467 355531 355532 355533 355534 355535 355536 355537 355538 355539 355540 355541 355542 355543 355546 355560 355561 355563 355564 355565 355566 355567 355568 355569 355570 355571
8/13/2009 MN 8/13/2009 OR 8/13/2009 KS 8/13/2009 CA 8/13/2009 MA 8/13/2009 NC 8/13/2009 TN 8/13/2009 MN 8/13/2009 8/13/2009 CO 8/13/2009 PA 8/13/2009 NY 8/13/2009 VA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 GA 8/13/2009 IN 8/13/2009 VA 8/13/2009 NV 8/13/2009 CT 8/13/2009 TX 8/13/2009 MD 8/13/2009 NY 8/13/2009 OH 8/13/2009 OH 8/13/2009 KY 8/13/2009 WI 8/13/2009 CA
27 11 11
11
8 7 54 41 43 7 17
8 6 57 10 31 19 10 10 9 7 52 34
41
17
6
31 19 10 9
F F F F F M F F F F F M F F F F U F F F F F F F F F F M M F M M M M M M M M M F F F F F M F F F M F F
11/5/2008 A non-serious, spontaneous report 11/4/2008 A non-serious spontaneous report o 11/5/2008 A non-serious, spontaneous report 11/5/2008 A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o 11/6/2008 A non-serious spontaneous report o 11/6/2008 A non-serious, spontaneous report 11/6/2008 A non-serious spontaneous report o 11/5/2008 A non-serious, spontaneous report ### A non-serious, spontaneous report 11/7/2008 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### Inappropriate dose of vaccine admin ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o ### A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious report of administrati 12/3/2008 A non-serious, spontaneous report ### A spontaneous non-serious report o 1/8/2009 A non-serious spontaneous report o 12/2/2008 A non-serious unlabeled spontaneo 12/3/2008 A non-serious spontaneous report o 12/3/2008 A non-serious spontaneous report o ### A spontaneous non-serious report o
355572 355573 355574 355575 355576 355577 355578 355579 355580 355581 355582 355583 355584 355585 355586 355587 355588 355589 355596 355597 355598 355599 355600 355601 355602 355603 355604 355605 355606 355607 355608 355609 355610 355611 355612 355613 355614 355615 355616 355617 355618 355619 355620 355622 355623 355625 355628 355631 355633 355636 355637
8/13/2009 NV 8/13/2009 IA 8/13/2009 KY 8/13/2009 VT 8/13/2009 WI 8/13/2009 MD 8/13/2009 GA 8/13/2009 TX 8/13/2009 TX 8/13/2009 IA 8/13/2009 NY 8/13/2009 NY 8/13/2009 IN 8/13/2009 TX 8/13/2009 CA 8/13/2009 MI 8/13/2009 PA 8/13/2009 PA 8/13/2009 MO 8/13/2009 TX 8/13/2009 OH 8/13/2009 NV 8/13/2009 MD 8/13/2009 MI 8/13/2009 IN 8/13/2009 MI 8/13/2009 CA 8/13/2009 MI 8/13/2009 MI 8/13/2009 MD 8/13/2009 MI 8/13/2009 MI 8/13/2009 MI 8/13/2009 KY 8/13/2009 WI 8/13/2009 WA 8/13/2009 WV 8/13/2009 RI 8/13/2009 AZ 8/13/2009 MN 8/13/2009 TX 8/13/2009 CT 8/13/2009 MN 8/13/2009 AL 8/13/2009 TX 8/13/2009 MO 8/13/2009 IA 8/13/2009 OR 8/13/2009 MO 8/13/2009 MO 8/13/2009 MO
35 12 55 10 48 46
35 12
12 9 42 6 9 6 9 7 54 5 26 49 14 6 22 23 6 55
12 9
48
6 7
26 49
22
55
6 24 5 28 6 52 14 11 7 9 14 15 15 13 17 9 19 29 43 22 5 5 8
24 28
11 7
13 9 29 43 5 5 8
F F M F F U M F F M F M M U M F F F F F F F F M M F F F F M F F F F M M M M M M M F F F F M F F M F F
### A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o 12/8/2008 A spontaneous non-serious report o ### A non-serious report of fever, vomiti ### A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o ### Neither relevant medical history nor ### A non-serious, spontaneous, report 3/31/2009 A non-serious spontaneous report o 12/8/2008 A spontaneous non-serious report o 12/8/2008 A spontaneous non-serious report o ### A non-serious spontaneous report o 12/1/2008 A non-serious spontaneous report o 1/5/2009 A non-serious spontaneous report o ### A non-serious, spontaneous report ### A spontaneous non-serious report o 4/21/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A spontaneous non-serious report o ### A spontaneous non-serious report o ### A non-serious spontaneous report o ### Vaccine exposure during pregnancy 4/9/2009 A non-serious, spontaneous report 1/13/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o ### A non-serious spontaneous report o ### A spontaneous non-serious report o ### A spontaneous non-serious report o 4/9/2009 A non-serious spontaneous report o 3/27/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious report of administered 4/9/2009 A non-serious, spontaneous report 3/13/2009 A spontaneous non-serious report o 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 1/5/2009 A spontaneous non-serious report o 3/31/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of expired FLU 4/9/2009 A non-serious report of administratio 3/20/2009 A non-serious report of administratio 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious, spontaneous report
355640 355643 355645 355648 355649 355650 355651 355652 355653 355654 355655 355656 355657 355658 355660 355661 355662 355664 355666 355667 355668 355669 355670 355671 355672 355754 355755 355756 355757 355758 355759 355760 355761 355762 355763 355764 355765 355766 355767 355768 355769 355770 355771 355772 355773 355774 355775 355776 355777 355778 355779
8/13/2009 MD 8/13/2009 AR 8/13/2009 AZ 8/13/2009 RI 8/13/2009 AZ 8/13/2009 RI 8/13/2009 CA 8/13/2009 AZ 8/13/2009 MN 8/13/2009 OH 8/13/2009 DC 8/13/2009 DC 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 MO 8/13/2009 GA 8/13/2009 RI 8/13/2009 8/13/2009 RI 8/13/2009 NC 8/13/2009 NJ 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 NJ 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 NM 8/13/2009 IA 8/13/2009 FL 8/13/2009 TX 8/13/2009 TX 8/13/2009 MN 8/13/2009 TX 8/13/2009 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 VA 8/13/2009 MA 8/13/2009 IL 8/13/2009 MN 8/13/2009 SC
12 5 10 15 5 18
12 5 10
6
6
5 10 11 5 5 5 5 7 6 9 26 12 9 33 20 13 6 5 5 40 7 16 7 7 7 27 13 9 5 6 59 9 5 9 8 5 35 30 11
5 10 11 5 5 5 5 7 6
36 6
5
26 9 20 13
7
M U U M U F U U U F F F F M F F M F F F F F F F M M F M F M F F F M F F M M M M F M F M F F F M F F F
4/9/2009 A spontaneous non-serious report o 1/7/2009 A non-serious report of "six patients 1/7/2009 A non-serious report of "six patients 3/27/2009 A non-serious spontaneous report o 4/9/2009 A non-serious report of "six patients 4/9/2009 A non-serious spontaneous report o 3/20/2009 A non-serious spontaneous report o 4/9/2009 A spontaneous non-serious report o 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serous, spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 1/6/2009 A non serious spontaneous report o 1/6/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 1/13/2009 A spontaneous non-serious report o 1/13/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 1/20/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/15/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/23/2009 A non-serious spontaneous report o 1/27/2009 A non-serious spontaneous report o 1/27/2009 A spontaneous, non-serious report 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 1/27/2009 A spontaneous, non-serious report 2/5/2009 A non-serious spontaneous report o 4/9/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/2/2009 A non-serious spontaneous report o 2/2/2009 A spontaneous, non-serious report 4/9/2009 A spontaneous, non-serious report 4/9/2009 A non-serious, spontaneous report 4/9/2009 A non-serious spontaneous report o
355780 355781 355782 355783 355784 355785 355786 355787 355788 355789 355790 355791 355792 355793 355794 355795 355796 355797 355798 355799 355800 355801 355802 355803 355804 355805 355806 355807 355808 355809 355810 355811 355812 355813 355814 355815 355816 355817 355818 355819 355820 355821 355822 355823 355824 355825 355826 355827 355915 355918 355920
8/13/2009 TX 8/13/2009 TN 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 TX 8/13/2009 LA 8/13/2009 NJ 8/13/2009 MD 8/13/2009 AZ 8/13/2009 AZ 8/13/2009 FL 8/13/2009 IN 8/13/2009 FL 8/13/2009 MD 8/13/2009 FL 8/13/2009 MD 8/13/2009 MD 8/13/2009 8/13/2009 MD 8/13/2009 8/13/2009 NJ 8/13/2009 MD 8/13/2009 MD 8/13/2009 MD 8/13/2009 MD 8/13/2009 TX 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ
9 11 5 6 6 9 7 14 10 65 42 8 11 10 24 12 4 7 14 9 5 38 6 6 8 6 11 19 26 26 24 21 20 28 21 34 28 36 45 45 41 22 38 34 40 40 39 27 40
7
11 24 4 7 9 38 6 6 8 6 19 26 26 24 21 20 28 21 34 28 36 45 45 41 22 38 34 40 40 39 27 40
F M M F M U F M M M F M M F F M F M F M F M F M M M M F F M M F F M M M M F M M F M M F M M M F F M M
3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 3/31/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/5/2009 A non-serious spontaneous report o 2/6/2009 A non-serious spontaneous report o 2/10/2009 A non-serious spontaneous report o 2/11/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 4/28/2009 A non-serious spontaneous report o 3/9/2009 A non-serious, spontaneous report 4/28/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 2/19/2009 A non-serious spontaneous report o 2/27/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 2/23/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 2/27/2009 A non-serious, spontaneous report 3/18/2009 A non-serious spontaneous report o 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 3/31/2009 A non-serious, spontaneous report 4/9/2009 A spontaneous, non-serious report 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o
355921 355922 355923 355924 355925 355926 355927 355928 355929 355930 355931 355932 355953 355954 355955 355956 355957 355958 355959 355960 355961 355962 355963 355964 355965 355966 355967 355968 355969 355970 355972 355973 355974 355975 355977 355978 355979 355980 355981 355982 355983 355984 355985 355986 355987 355988 355989 355990 355991 355992 355993
8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ
48 44 36 44 38 27 48 21 34 48 23 23 38 21 26 26 31 49 37 23 26 24 28 40 45 33 29 25 27 45
48 44 36 44 38 27 48 21 34 48 23 23 38 21 26 26 31 49 37 23 26 24 28 40 45 33 29 25 27 45
25
25
27 43 23 49 24 37 21 41 19 19 21 41 43 28 23 27 33 28
27 43 23 49 24 37 21 41 19 19 21 41 43 28 23 27 33 28
F F F M M F M M M M F M M M M M M M M M M M M M M M M M M M M M M F M M M M M F M F F M M F M M F M M
5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 3/18/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou
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8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NJ 8/13/2009 NC 8/14/2009 8/14/2009 8/14/2009 8/14/2009 8/14/2009 IL 8/14/2009 8/14/2009 ME 8/14/2009 MO 8/14/2009 NY 8/14/2009 OK 8/14/2009 MI 8/14/2009 TX 8/14/2009 GA 8/14/2009 IN 8/14/2009 KS 8/14/2009 IN 8/14/2009 MI 8/14/2009 TX
23 20 36 37 21
23 20 36 37 21
23 20 33 20 44 21 24 24 20 35 20 26 20 45 23 26 35 26 32 46 20 30
23 20 33 20 44 21 24
38 28 23 8 26
38 28 23
64 79 4 48 23 1.2 9 12 11 1 0.5 4 7 36 68
64
20 35 20 26 20 45 23 26 35 26 32 46 20 30
26
4 48 33 1 9 12 11 1 0 4 11 38 68
M M F M M M M M M M M F F M M F F F M M M M M M M M M U M M M M F F F M F M M M M 0.2 F M F M 0M 0.5 F F M M F
5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 3/18/2009 A non-serious spontaneous report o 5/12/2009 A non - serious spontaneous report 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 Expired vaccine used. A non-seriou 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/12/2009 A non-serious spontaneous report o 5/19/2009 A non-serious report of positive influ 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/13/2009 Information has been received from 8/14/2009 Pt presented on 14 Aug 2009 for cli 8/14/2009 24 hours post Pneumococcal Vacci 8/14/2009 Complains of muscle soreness at in 8/14/2009 Pt has had a fever with rash on face 8/13/2009 Pt received shots stayed in office fo 8/13/2009 Severe headache 2-3d after vaccine 8/13/2009 (1) Fever (T max 103.2) began with 8/11/2009 MMR and PREVNAR given, child w 8/11/2009 Temperature of 104.5 R. 8/10/2009 Erythema surrounding injection site 8/14/2009 Hep A vaccine given IM L deltoid. R 8/14/2009 injection give 8-13-2009 approx. 11 8/14/2009 Extreme pain, swelling, unable to m
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8/14/2009 IA 8/14/2009 TX 8/14/2009 OK 8/14/2009 WI 8/14/2009 VA 8/14/2009 PA 8/14/2009 MO 8/14/2009 WI 8/14/2009 NC 8/14/2009 FL 8/14/2009 TX 8/14/2009 IN 8/14/2009 MI 8/14/2009 AL 8/14/2009 AL 8/14/2009 TX 8/14/2009 TX 8/14/2009 TX 8/14/2009 CA 8/14/2009 TX 8/14/2009 TX 8/14/2009 IL 8/14/2009 WA 8/14/2009 TX 8/14/2009 AL 8/14/2009 TX 8/14/2009 IL 8/14/2009 TX 8/14/2009 AR 8/14/2009 OH 8/14/2009 NC 8/14/2009 NJ 8/14/2009 OH 8/14/2009 MN 8/14/2009 WY 8/14/2009 MT 8/14/2009 OR 8/14/2009 CT 8/14/2009 CA 8/14/2009 MO 8/14/2009 NY 8/14/2009 MI 8/14/2009 NV 8/14/2009 MO 8/14/2009 TX 8/14/2009 MI 8/14/2009 CA 8/14/2009 MN 8/14/2009 MN 8/14/2009 TX 8/14/2009 WY
4 12 9 4 11 4 5 17 36 4 1 42 15 5 42 3 12 4 5 14 11 3 40 11 4 11 64 9 11 13 12 22 5 37 83 12 61 4 0.5 14 5 4 11 18 12 11 12 1 4 34 1.6
4 12 9 4 11 4 5 17 36 4 1 42 15 5 41 3 12 4 5 14 11 3 40 11 4 11 64 9 11 13 12 22 5 37 83 12 61 4 0 14 5 4 11 18 12 11 11 1 4 34 1
F M F M M M M M F M 0F M F F F F F F M M F F F M F M M F F M M F M M F F F F 0.5 M F F M M F F F M 0F M F 0.6 F
8/14/2009 large area of erythema, warm to tou 8/14/2009 Had Fever on day after shots was g 8/14/2009 REDNESS AND SWELLING AT INJ 8/14/2009 Patient developed fever to 102 per m 8/14/2009 Mother called stating son had Tdap 8/14/2009 Patient was diagnosed in our office 8/14/2009 Woke up on 8/13/09 with a temp of 8/14/2009 Call received from mom 8/13/09, sta 8/14/2009 Pain in Left arm that began as soon 8/14/2009 Symptoms: Circular swelling 3"x3", 8/14/2009 Pt. developed high fever one day af 8/14/2009 Localized erythema/edema affecting 8/14/2009 Mom states that pt had cracked lips 8/14/2009 Fever of 103 axcillary with 2 minute 8/14/2009 Swelling of leftside of lower lip occu 8/14/2009 We think Grace had a seizure that l 8/14/2009 Mother states that the child began t 8/14/2009 Swelling, redness, warm and slightly 8/14/2009 High fever for 6 days, Full body rash 8/14/2009 12 hours later, fever, headache, nec 8/14/2009 Redness to vaccine site, tenderness 8/14/2009 R DELTIOD NOTICE SWELLING, R 8/14/2009 8/11/00: vaccine (varicella #2). 8/12 8/14/2009 Redness and swelling to vaccine sit 8/14/2009 REDNESS AND SWELLING AT INJ 8/14/2009 Redness and swelling to vaccine sit 8/14/2009 Single non erythematous raised les 8/14/2009 PT. RECEIVED HPV AND VARICE 8/14/2009 Localized redness, edema, and itch 8/14/2009 Pt developed a red circular rash on 8/14/2009 15x11 cm area reddness and swelli 8/14/2009 After receiving gaurdicil, lauren faint 8/14/2009 Shortly after receiving vaccines pati 3-4 hours after taking the Tdap I ha 8/14/2009 Silver dollar size redness - Site is w 8/14/2009 Pt reported HR 100, temp. 100 degr 8/14/2009 Shingles Left herpes zoster ophthal 8/14/2009 6"x 6" erythema, slight warmth, sligh 8/14/2009 Was seen at hospital on 8/4/09 for I 8/13/2009 Approximately 15 minutes after imm Approx 5am after injection Pt starte 8/6/2009 Swelling to left deltoid at injection si 8/13/2009 Redness Swollen Warm to touch } in 8/14/2009 Client was inadvertently given a Tda 8/14/2009 Mother states "At 6:30 pm pt c/o nu 8/14/2009 Mom did Reading on GARDSIL and 8/15/2009 2 days after MENACTRA L deltoid o 8/19/2009 Developed hives 24 hours after MM 8/14/2009 To ER via ambulance. Got epi pen b 8/14/2009 EMS notified 7:02 (Numbness in ton 8/11/2009 Grandmother reports scattered hive
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8/14/2009 NC 8/14/2009 WA 8/15/2009 PA 8/15/2009 IN 8/15/2009 CA 8/16/2009 DC 8/16/2009 UT 8/16/2009 MN 8/16/2009 OR 8/16/2009 OH 8/17/2009 8/17/2009 8/17/2009 IL 8/17/2009 IL 8/17/2009 NV 8/17/2009 8/17/2009 8/17/2009 KY 8/17/2009 KY 8/17/2009 NY 8/17/2009 FL 8/17/2009 FL 8/17/2009 MA 8/17/2009 MA 8/17/2009 CA 8/17/2009 CA 8/17/2009 VA 8/17/2009 NJ 8/17/2009 MN 8/17/2009 PA 8/17/2009 MA 8/17/2009 NC 8/17/2009 MA 8/17/2009 AZ 8/17/2009 AR 8/17/2009 LA 8/17/2009 LA 8/17/2009 GA 8/17/2009 GA 8/17/2009 GA 8/17/2009 NH 8/17/2009 PA 8/17/2009 OR 8/17/2009 TX 8/17/2009 NV 8/17/2009 KS 8/17/2009 OH 8/17/2009 CA 8/17/2009 OH 8/17/2009 CT 8/17/2009 GA
0.2 8 1 0.2 22 0.4 15 25
0 8 1 0 22
47 16 14 1 0.2 3 73 77 5
47
45 20 12 0.4 0.1 17 11 46 11 0.5 4 65 41 1.3 10 1.3 11 13 2 1 1 15 65 65 60 37 1.3 18 0.2 18 11 4
45 20 12 0 0 17 11 46 11 0 4 65 41 1 10 1 11 13 2 1 1 15 65 65 60 37 1 18
15 25
14 1 0
77 5
18 11 4
0.2 F M 0F 0.2 M F F F F U F F F 0F 0.2 F M F M F U F F F 0.4 M 0.1 M F F F M 0.5 F F M F 0.3 F F 0.3 F M M 0M 0F 0F F F F F F 0.3 F F M F U F
8/11/2009 Parents state child became very list 8/13/2009 Rash with papules on erythematous 8/15/2009 Rash on right cheek and both upper 8/15/2009 Pt develop a rash consistent with er 8/15/2009 Encephalopathy, severe malnutritio 8/6/2009 None- Vaccine administered @ inap 8/16/2009 I had the last shot in early Novembe 8/16/2009 Within one week of receiving the firs 8/16/2009 Not feeling well two hours after vacc 8/18/2009 Right arm cellulitis following ADACE 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/14/2009 Information has been received from 8/17/2009 This case was reported by a healthc 8/17/2009 This case was reported by a healthc Dizziness, chronic flu like symptoms 8/10/2009 Pt. presented to clinic Aug. 04/09 - S 8/12/2009 After receiving Tdap, VZV, MENACT 8/17/2009 Quarter size lump R. leg sm Lump o 8/6/2009 Pt received TDAP 8/4/09 @ 3:50 PM 8/12/2009 Started feeling dizzy, ears felt plugg 8/10/2009 Mom and daughter back today. Pati 8/12/2009 Left upper arm swollen, redness, wa 8/11/2009 Painful 4.5 cm X 4.5 cm Red Raised 8/13/2009 4 x 3 cm Reddened with lump unde 8/13/2009 Red, scabbed dots upper R arm. 8/12/2009 Received vaccine 2/1/8 but develop 8/12/2009 6/12 by history hives like rash, fever 8/13/2009 Irritable leg pain, limping, unsteady 8/10/2009 Swelling, warm. TX: KEFLEX, BEN 7/31/2009 Pt. ran fever 6 hours after vaccines 8/3/2009 Presents to clinic today, 8/3/09, c/o 7/23/2009 Client reports left arm started swellin 8/12/2009 Lesions noted 2 days prior to visit 8/13/2009 3 days ago developed rashes with d 8/12/2009 Vesicular lesions together w/crusted 8/12/2009 Pt vaccinated 8-5-09. Onset 8-6-09 19th July, Fever, unable to swallow 8/10/2009 26 hrs. later I got the chills (6pm) by 8/9/2009 Redness, great deal of swelling (righ 8/11/2009 Pt reported swelling in same side up 8/5/2009 No known adverse reaction. Tdap a 8/10/2009 12 minutes after injection patient go 8/11/2009 Excessive diarrhea - watery. X 2/ 88/11/2009 8/7/09. c/o redness. Swelling and so Varicella vaccine administered 8/7/0 8/17/2009 COUGH(WHOOPING COUGH LIKE
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8/17/2009 FL 8/17/2009 FL 8/17/2009 MI 8/17/2009 TX 8/17/2009 TX 8/17/2009 IA 8/17/2009 TX 8/17/2009 CO 8/17/2009 GA 8/17/2009 MI 8/17/2009 AR 8/17/2009 AK 8/17/2009 PA 8/17/2009 TX 8/17/2009 FL 8/17/2009 OR 8/17/2009 NY 8/17/2009 VA 8/17/2009 MI 8/17/2009 FL 8/17/2009 MO 8/17/2009 OK 8/17/2009 CA 8/17/2009 KS 8/17/2009 PA 8/17/2009 IL 8/17/2009 TX 8/17/2009 PA 8/17/2009 TX 8/17/2009 MT 8/17/2009 OH 8/17/2009 TX 8/17/2009 OH 8/17/2009 NC 8/17/2009 CO 8/17/2009 NJ 8/17/2009 LA 8/17/2009 NC 8/17/2009 MD 8/17/2009 TX 8/17/2009 IL 8/17/2009 FL 8/17/2009 MN 8/17/2009 LA 8/17/2009 NV 8/17/2009 AZ 8/17/2009 CA 8/17/2009 MD 8/17/2009 WA 8/17/2009 AL 8/17/2009 IL
31 83 18 12 13 29 2 59 0.3 81 16 4 65 31 49 15 12 13 5 4 4 1.3 2 19 81 0.3 11 61 11 18 13 13 17 14 4 24 11 10 19 34 5 27 12 11 4 4 59 22 8 32 9
31 83 18 12 13 29 59 0 81 16 4 75 31 49 15 12 13 5 4 4 1 2 19 81 0 11 61 11 18 13 13 17 14 4 24 11 10 19 34 5 27 12 11 4 4 59 22 8 32 9
F M M F M F M M 0.3 F F F M F M F M F F M M M 0.3 M 1F F F 0.3 M M F M F F F F F F M M F F M M F M F F M F F M F M
8/17/2009 Difused rash, erythemaos, macular, 8/17/2009 TD vaccine ordered and TDAP give 8/17/2009 Patient became light headed, dizzy 8/11/2009 Fever of 102. Body aches. Both sta 8/17/2009 After completion of vaccinations pat 8/17/2009 3x5 inch area in SQ tissue on back 8/22/2009 HIB dilute with wrong solution. No a 8/17/2009 At approximately 2100, Pt complain 8/17/2009 Child developed fever with 24 hours 8/17/2009 Significant skin reaction at site of in 8/17/2009 Ongoing chest pain intermittently sin 8/17/2009 Localized - Red, swelling, warmth to 8/17/2009 Patient has a reddened area at injec 8/17/2009 Patien developed rash approximate 8/17/2009 Patient states that she suffered from 8/17/2009 After receiving 2nd injection (MMR) 8/17/2009 Redness, painful hard lump with Pn 8/17/2009 AFTER RECEIVING 1ST GARDAS 8/17/2009 Patient developed a fever, headach 8/7/2009 URTICARIAL LESIONS ON FACE, 8/17/2009 Left lateral thigh was swollen, red, f 8/17/2009 On 8/15/09 about 6:00pm child deve 8/17/2009 Localized inflammatory reaction of s 8/17/2009 None reported 8/17/2009 1 week after receiving Zostavax, on 8/17/2009 THE PATIENT PRESENTED WITH 8/17/2009 R arm 7.0 x 6.0 cm wider. 8/17/2009 Raised red blotchy rash at site of in 8/17/2009 Swollen and red left arm. 8/15/2009 Vaccine on 8-7-09. 8-10-09 elevate 8/17/2009 20 m after given GARDASIL, had 20 8/15/2009 Pts arm got swollen up and pt had a 8/17/2009 Fever of 102 or above and headach 8/11/2009 2-3 min after immunization of HPV g 8/12/2009 Morning after receiving vaccines aw 7/8/2009 Non stated. 8/18/09 spoke w/pt say 8/7/2009 Approx. 30 min after administration 8/11/2009 HPV injection given IM in R deltoid. 8/12/2009 Immediately became pale and fainte 7/27/2009 Tdap, red hard tricep, inflamed large 7/31/09, left leg is swollen, red, and 8/7/2009 2:30pm Nausea / emesis shaking h 8/7/2009 Less than 24 hours post imm starte 8/10/2009 Reported both cheeks, chin and fore 8/17/2009 Child received DTAP, VARAIVAX va 8/17/2009 Redness to R deltoid area. 8/17/2009 Employee received MMR vaccine 5 7/16/2009 Episode of tremors X approx. 30 se 8/17/2009 Redness and rash. 8/17/2009 LEFT UPPER ARM REDNESS WIH 8/14/2009 Talked to mom 9:00 am- completely
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8/17/2009 CO 8/17/2009 IL 8/17/2009 SC 8/17/2009 SD 8/17/2009 CA 8/17/2009 8/17/2009 NJ 8/18/2009 PA 8/18/2009 FL 8/18/2009 LA 8/18/2009 ND 8/18/2009 FL 8/18/2009 CA 8/18/2009 KS 8/18/2009 OK 8/18/2009 FL 8/18/2009 NJ 8/18/2009 NC 8/18/2009 NC 8/18/2009 TX 8/18/2009 MO 8/18/2009 FL 8/18/2009 TX 8/18/2009 GA 8/18/2009 OR 8/18/2009 VA 8/18/2009 KY 8/18/2009 OR 8/18/2009 NC 8/18/2009 NE 8/18/2009 VA 8/18/2009 VA 8/18/2009 WI 8/18/2009 AZ 8/18/2009 VT 8/18/2009 PA 8/18/2009 PA 8/18/2009 CA 8/18/2009 OR 8/18/2009 WI 8/18/2009 NY 8/18/2009 AZ 8/18/2009 WA 8/18/2009 VA 8/18/2009 WI 8/18/2009 NV 8/18/2009 TX 8/18/2009 TX 8/18/2009 IA 8/18/2009 IA 8/18/2009 SD
32 9 1 5 67 0 20 62 70 17 0 18 17 16
32 9 1 5 67 0 20 62
0.5 17 12 12 0.5 11 38 4 9 66 68 4 16 11 19 15 4 18 1.1 11 5 5 67 4 5 11 14 12 42 15 6 19 12 60 29 5
0 17 12 12 0 11 38 4 9 66 68 4 16 11 19 15 4 18 1 11 5 5 67 4 5 11 14 12 42 15 6 19 12
17 0 18
29 5
M F 0M F F 0M M F F F 0M F F F F 0.5 M M F M 0.5 M F F F F F F M F M F F F F 0.1 M M F F F F M F F F M F M F F F M M
8/17/2009 None stated. 8/17/2009 Allergic reaction from the chicken po 8/10/2009 Febrile seizure on evening. 8/10/2009 Rash and bruise on leg Rt red 8/10/2009 Local skin reaction large 12cm x 9cm Coatinous breakouts hives, rashes, 5/12/2009 A non-serious spontaneous report o 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/17/2009 Information has been received from 8/14/2009 Initial report was received on 07 Au 8/13/2009 2-23-09 Office visit vomiting, diarrhe 8/12/2009 Shortly after receiving Hepatitis A an 7/28/2009 Severe headaches, belly pain, bilate 8/17/2009 (Rt) Deltoid vaccine site swollen, ery 8/12/2009 Mom describes child as "limp" "wea 8/13/2009 Fever - Nausea x 2 days - vomiting 8/12/2009 8-12-09 Am RN Supervisor received 8/11/2009 X1 Hive on site of administration 18 8/5/2009 Pt given TDaP < 10 yrs of age. No 8/13/2009 Redness, soreness, swelling and itc 8/14/2009 Typical. Redness, soreness -swellin 8/13/2009 7"x5" red area, swelling, 8/13/09 8:0 8/12/2009 About 5 min after receiving the belo 6/29/2009 Hep A #1 given 6-26-2009 - Also giv 8/13/2009 11:30pm 8-11-2009 vomited, upset 8/4/2009 7/29/09 - Client called Health Depar 8/13/2009 @ site of injection- large area of ery 8/7/2009 About 12 hours after HPV & HEP A 8/12/2009 Child received MMR and VARIVAX 8/12/2009 5 inch by 3 3/4 red raised area at si 8/12/2009 Pt's mother, called this RN at 12:15 8/12/2009 Pt's mother called RN at 12:15 pm a Vesicular eruption c/u varicella Zost 8/12/2009 Hives on torso- anterior ! Posterior ! L rash, hematoma approximately 2 8/12/2009 Patient became light headed and m 8/12/2009 Gave HAVRIX #1 in (L) arm and pa 8/8/2009 5:00 am following day awoke with b 8/12/2009 While at son's football game pt start 8/12/2009 08/10/09 - @ approximately 3:15 pm 8/12/2009 L shoulder area is erythematous, m 8/12/2009 Received GARDASIL 6/4/2007, 7/3 8/17/2009 Itching swelling to vaccine site. ABX 8/18/2009 round faint red rash around injection 8/18/2009 Pt called the following day with c/o f 8/18/2009 Pt. was given a DTaP on August 6th
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8/18/2009 GA 8/18/2009 NC 8/18/2009 TX 8/18/2009 MT 8/18/2009 MA 8/18/2009 NJ 8/18/2009 VA 8/18/2009 CO 8/18/2009 FL 8/18/2009 MO 8/18/2009 KS 8/18/2009 CA 8/18/2009 NY 8/18/2009 AL 8/18/2009 TX 8/18/2009 TN 8/18/2009 OK 8/18/2009 IL 8/18/2009 OR 8/18/2009 OR 8/18/2009 VA 8/18/2009 NY 8/18/2009 NC 8/18/2009 VT 8/18/2009 CA 8/18/2009 LA 8/18/2009 GA 8/18/2009 FL 8/18/2009 MI 8/18/2009 CA 8/18/2009 OH 8/18/2009 ME 8/18/2009 KY 8/18/2009 GA 8/18/2009 MS 8/18/2009 GA 8/18/2009 OH 8/18/2009 PA 8/18/2009 WI 8/19/2009 KY 8/19/2009 WI 8/19/2009 NJ 8/19/2009 TN 8/19/2009 GA 8/19/2009 8/19/2009 NY 8/19/2009 NY 8/19/2009 TX 8/19/2009 MI 8/19/2009 PA 8/19/2009 NC
39 12 14 57 33 5 5 11 25 0.3 13 1.2 16 36 4 11 4 5 5 1.2 11 11 13 11 1.1 9 1 1.6 4 1.8 71 46 10.5 16 31 4 8 22 22 12 1 14 79 21 54 44 27 42 20 44
39 1 14 56 33 5 5 11 25 0 13 1 16 35 4 11 4 5 5 1 11 11 13 11 1 9 61 1 1 4 1 71 46 10 16 32 4 8 22 22 11 1 79 21 54 43 27 42 20 44
F 0M M F F M M U F 0.3 M M 0.2 F F M F F F F M 0.2 M F M M M 0.1 M M F 0F 0.6 F M 0.8 U M F F F F M F F F F 0M M M F F F F F F F
8/18/2009 Varicella Vaccine received 08/13/20 8/18/2009 fever of 103 for 28 hours, with conti 8/18/2009 5-6 hours following vaccination, pat 8/18/2009 Within 24 hours of the vaccination h 8/18/2009 Noted rash on arms and chest 24 h 8/18/2009 Patient received MMR and Varivax 8/18/2009 Brysen is here because he had his 8/18/2009 Syncopal episode following Tdap va 8/18/2009 Within 10 seconds of vaccine, I got 8/18/2009 RECEIVED 4 MO SHOTS 1PM @ H 8/18/2009 Pt received varicella vaccine 08/17/ 8/18/2009 New onset generalized tonic-clonic 8/18/2009 My daughter had been suffering from 8/18/2009 mild fever of 100 degrees F.; heada 8/18/2009 Patient was found walking outside r 8/17/2009 12cm area of erythema at site of ME 8/13/2009 Local reaction to left shoulder/deltoi 8/18/2009 Left upper arm redness and swelling 8/19/2009 Parent reports 7pm Pt C/o throat dis 8/18/2009 R Thigh, indurated, erythematous, s 8/18/2009 Child has fever to 103.5 headache " 8/18/2009 Swelling upper arm c/erythema - las 8/17/2009 Day after vaccines, woke up feeling Temp 104 degrees & some delirium 8/18/2009 Child right away react w/ hives. 8/18/2009 Pt Rcvd vaccine @ 11am - went ho 8/11/2009 4/29/09 Pt. given Tdap injection dur 8/13/2009 Crying hysterically. Lips and hands 8/13/2009 Shots done on Tuesday August 11, 8/10/2009 Red area of warmth and itching on R 3-5 days after the Hib vaccine my so Site was "hot and red to the touch. A 8/12/2009 Approx. 1 minute after inj. patient st 8/7/2009 Pt had swelling, erythema and bruis 8/3/2009 Itchy rash - of neck, trunk, arms. 8/17/2009 Swelling at injection site, red with fe 8/18/2009 High Fever, bellyache, tired with MO 8/18/2009 About 5min after receiving Hep A va 8/18/2009 This case was reported by a healthc 8/19/2009 I received the 1st round of Gardasil 8/14/2009 Nausea, vomiting, low grade fever x 8/18/2009 InformationYregarding PREVNAR wa 8/17/2009 This case was received from a heal 8/18/2009 Information has been received from 8/18/2009 Information has been received from 8/10/2009 Body aches and temp. 99 started 8/ 8/12/2009 Burning sensation and pain in shou 8/13/2009 Pt. felt light headed & weak at 01:00 8/19/2009 Received flu vaccine Nov. 2008 - wi 8/19/2009 08.17.09 - R arm soreness, immed. 7/30/2009 Arm swollen, itching in arm, warm to
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8/19/2009 NC 8/19/2009 DC 8/19/2009 NC 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 CA 8/19/2009 FL 8/19/2009 VA 8/19/2009 MD 8/19/2009 TX 8/19/2009 IN 8/19/2009 NC 8/19/2009 FL 8/19/2009 MI 8/19/2009 CT 8/19/2009 FL 8/19/2009 CA 8/19/2009 AL 8/19/2009 CA 8/19/2009 AZ 8/19/2009 CA 8/19/2009 MN 8/19/2009 PA 8/19/2009 MO 8/19/2009 PA 8/19/2009 MI 8/19/2009 HI 8/19/2009 NC 8/19/2009 NE 8/19/2009 MN 8/19/2009 CA 8/19/2009 CA 8/19/2009 LA 8/19/2009 UT 8/19/2009 TX 8/19/2009 WA 8/19/2009 CA
13 65 1.2 4 3 4 4 3 3 3 3 3 3 4 4 4 4 2 2 3 11 22 14 13 12 8 66 12 14 16 17 4 0.4 0.2 4 19 70 77 1 24 9 30 5 66 0.6 15 11 11 11 55 1
13 65 1 4 3 4 4 3 3 3 3 3 3 4 4 4 4 2 2 3 11 22 14 14 12 8 66 12 14 16 17 4 0 0 4 19 70 77 1 24 11 30 5 66 0 15 11 11 11 55 0
M F 0.2 F F F M F M M F M F M F M F F 0.1 F 0.5 M F F F F F M M M M M F F M 0.4 F 0.2 F M F F F 0F F F F F F 0.6 M F F F F F 0F
8/13/2009 Vaccine were given, pt tolerated we 8/13/2009 Patient was given PNEUMOVAX mo 7/31/2009 Red area a site of injection - dime s 7/21/2009 A serious report of lymphadenitis ha 7/21/2009 A serious report of septic arthritis ha 7/21/2009 A serious report of hearing loss/dea 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of urinary tract infec 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of nail disorder has 7/21/2009 A serious report of trauma has been 7/21/2009 A serious report of sleep apnea and 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of sleep apnea and 7/21/2009 A serious report of encopresis has b 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of abscess and pos 7/21/2009 A serious report of congenital anom 7/21/2009 A serious report of abdominal pain a 7/21/2009 A serious report of trauma has been 8/19/2009 Patient was in waiting room about 1 8/19/2009 Pt. had seizure like activity after the 8/19/2009 First injection of Garadsil was given 8/19/2009 Near Fainting Heart rate 52 pale 8/19/2009 On 7-18-07, DTaP vaccine was give 8/19/2009 circular red edematous area at site 8/19/2009 The patient came in to see the doct 8/19/2009 PATIENT'S MOTHER STATES THA 8/19/2009 Approx 5 hours after receiving vacc 8/19/2009 acute idiopathic autoimmune hemol 8/1/2009 Fatigue, dry skin, extreme fatigue, li 8/17/2009 Lip swelling, earlobe swelling and e 8/19/2009 Patient had sudden onset of rolling 8/19/2009 Seizure. 8/18/2009 (L) lateral upperarm onset redness 1 8/19/2009 Patient Reported intermittent hives 8/19/2009 Developed ocular viral, herpes infec 8/19/2009 Patient stated she received the ZOS 8/19/2009 Mother stated first vesicle rash on a 8/19/2009 Pt observed following inj./ After 15 m 7/22/2009 Erythema, slight tenderness @ injec 8/19/2009 30 year old female complains of fac 8/19/2009 Allergic Rx -Mod/Severe local with o 8/19/2009 Swollen, erythematous, indurated a Low grade temp (<105 degrees F), 8/19/2009 stood up after injection and had pro 8/19/2009 Had seizure 7/25/09. Had Mri & Ct s 8/19/2009 My daughter is going into junior high 8/19/2009 Severe headaches that come on su 8/19/2009 Arm very sore, headache, fever/chil 8/19/2009 10 days after receiving her MMR va
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8/19/2009 FL 8/19/2009 NY 8/19/2009 IN 8/19/2009 AR 8/19/2009 PA 8/19/2009 IN 8/19/2009 NH 8/19/2009 MO 8/19/2009 8/19/2009 CA 8/19/2009 8/19/2009 CA 8/20/2009 8/20/2009 AR 8/20/2009 ME 8/20/2009 CO 8/20/2009 NJ 8/20/2009 KY 8/20/2009 KY 8/20/2009 MN 8/20/2009 NY 8/20/2009 IL 8/20/2009 TX 8/20/2009 IL 8/20/2009 NE 8/20/2009 GA 8/20/2009 MI 8/20/2009 TN 8/20/2009 IL 8/20/2009 NV 8/20/2009 NV 8/20/2009 CO 8/20/2009 8/20/2009 VI 8/20/2009 SC 8/20/2009 NM 8/20/2009 PA 8/20/2009 IL 8/20/2009 NY 8/20/2009 KS 8/20/2009 TN 8/20/2009 MI 8/20/2009 AZ 8/20/2009 AZ 8/20/2009 WI 8/20/2009 NY 8/20/2009 MO 8/20/2009 MI 8/20/2009 WA 8/20/2009 NC 8/20/2009 NM
38 42 54 11 1.1 14 18 14 2 12 9 14 5
38
57 0.5 0 9 11 21 14 5 4 5 12 56 46 12 0.3 4 16 21 15 10 39 5 12 11 58 18 14 4 11 4 1 35 1.3 1.9 17 0.3 13
57 0 0 9 11 21 14 5 4 5 12 56 46 12 0 4 16
54 11 1 14 18 14 2 12 9 14 5
15 10 39 5 12 11 58 18 14 4 11 4 1 35 1 1 17 0 13
F F F F 0.1 F F M M 0M F F F F F F 0.5 M 0M F M F F F M M F F F F 0.3 F F F F F F M M F F F F F M F F 0F M 0.3 M 0.9 M F 0.3 F M
8/19/2009 Client stated that she felt a tingling f 8/19/2009 BELL'S PALSY DIAGNOSED BY P 8/19/2009 6 hours following vaccine administra 8/19/2009 Sine the shot was given, pt. has had 8/19/2009 Vomiting, Fever, Seizure. 8/25/09 H 8/19/2009 Administered four vaccines during im 8/19/2009 large hives all over body appeared d 8/19/2009 Hives on chin, arms, legs, caps of s 8/19/2009 Child's father reported that the fever 8/19/2009 bad muscle pain, severe headache, 8/20/2009 PT COMPLAINED THAT INJECTIO 8/19/2009 Pt received the Gardasil series of sh 8/20/2009 ON 19 AUG 09, PT COMPLAINED 8/19/2009 Information has been received from 8/13/2009 Jan 2008 diagnosed Sensory Guilla 8/14/2009 Pt had vomiting, bloody diarrhea. Se 8/7/2009 Anaphylaxis, admitted to hospital. B 6/10/2009 Approx. 1 1/2 weeks after receiving 8/19/2009 Hives, rash, swelling of most of arm 8/20/2009 Had 2nd HPV vaccine 2/10/09; star 8/17/2009 Pt felt lightheaded/dizzy - No LOC, 8/10/2009 Pt was ok day of injections, got low 8/17/2009 6X8 cm area with redness - 3X3 cen 8/12/2009 4cm Red-firm-warm to touch Rx for 8/13/2009 Left deltoid warm, red, swollen, pain ### Approx. 1 hour post injection, pt. ca 8/14/2009 6-8-09 Presented to our ER with an 8/14/2009 VARIVAX vaccine given in right arm 8/17/2009 Awoke early morning with shallow b 8/5/2009 Inappropriate DTAP given (extra) an 8/14/2009 Mom states pt felt tired yesterday, li A couple of hours after first shot, my 8/18/2009 Took my three daughters to their do 8/20/2009 8/19/09 mother called clinic stating 8/20/2009 LOCAL REACTION, FEVER, CHILL 8/20/2009 While administering MMR vaccine p 8/20/2009 Initially loss of hair. Then dizziness 8/20/2009 Local reaction within 24hrs. But las 8/20/2009 About two weeks after I received the 8/20/2009 Patient started vomiting and having 8/20/2009 1st vaccination was on 07/15/08, sh 8/20/2009 Client developed fever of 100, vomi 8/20/2009 Red area to back of left arm the size 8/20/2009 LEFT SQ AREA LARGE SWELLING 8/20/2009 Cranky overnight after receiving vac 8/20/2009 Patient had Vaccinations at 8 am w 8/20/2009 Increased temperature leading to se 8/20/2009 started with a fever on 8/13/09 rash 8/20/2009 Patient had first Gardisil injection at 8/20/2009 HAD 1ST ROTATEQ 06/25/2009 AN 8/20/2009 Less than 24 hours after vaccine ad
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8/20/2009 VA 8/20/2009 UT 8/20/2009 CA 8/20/2009 NH 8/20/2009 SC 8/20/2009 GA 8/20/2009 FL 8/20/2009 NH 8/20/2009 ND 8/20/2009 ND 8/20/2009 OH 8/20/2009 PA 8/20/2009 IL 8/20/2009 IL 8/20/2009 OK 8/20/2009 GA 8/20/2009 CA 8/20/2009 MD 8/20/2009 NE 8/20/2009 8/20/2009 MA 8/20/2009 NC 8/20/2009 NC 8/20/2009 8/20/2009 8/20/2009 WA 8/20/2009 KY 8/20/2009 TX 8/20/2009 NC 8/20/2009 CA 8/20/2009 VA 8/20/2009 NE 8/20/2009 CA 8/20/2009 8/20/2009 8/20/2009 CO 8/20/2009 AZ 8/20/2009 WA 8/20/2009 IL 8/20/2009 MN 8/20/2009 MN 8/20/2009 AZ 8/20/2009 PA 8/20/2009 PA 8/20/2009 VA 8/20/2009 OH 8/20/2009 NC 8/20/2009 OR 8/20/2009 KS 8/20/2009 TX 8/20/2009 NC
0.6 20 0.2 13 32 16 10 15 10 20 15 11 11 0.1 45 13 1.8 18 27 18 23 15 54 20 54 70 4 5 8 24 15 65 0 30 4 11 10 26 12 66 12 11 5 10 5 74 4 11 11 11
0 20 0 13 32 16 0 10 15 10 20 15 11 11 0 45 13 1 18 27 23 15 54 20 54 70 4 5 8 24 65 0 30 4 11 10 26 12 66 12 11 5 10 5 4 11 11 11
0.6 M F 0.1 F M F F 0.5 M F F F F F F F 0.1 F F F 0.8 F F M F F F F F F F F F F U M F 0F F M F F M M F F F M F M F M M F F
8/20/2009 About 72 hours after DtaP vaccinati 8/20/2009 She started having "seizures" or "st 8/20/2009 Patient vomited and then became le 8/20/2009 Swelling, tenderness at the injection 8/20/2009 Cluster of itchy read rash on face, a 8/20/2009 Received varicella, TDAP, MCV4 on 8/20/2009 FEVER OF 105 ON 8/8/09 WENT T 8/20/2009 Developed itchy scattered vesicles 7 8/20/2009 ON July 21 had shot. On July 26 pa 8/20/2009 patient developed a hive appearanc 8/20/2009 FAINTING, DIZZYNESS HEADACH 8/20/2009 - approx 2 minutes post-vaccination 8/20/2009 Convulsive syncope 5min post vacc 8/20/2009 Client was given Tdap, Hep A, Men 8/20/2009 blood in stool 8/20/2009 Onset of flu-like symptoms ~4 hours 8/20/2009 RAISED AREA LOA, APPROX.70M 8/20/2009 01/30/09 with diarrhea (day 0 only); 8/20/2009 Large local reaction noted 2 days af 8/20/2009 Pain and redness X 1 day 8/20/2009 Shortly after receiving third dose of 8/20/2009 Within seconds of receiving vaccine 8/20/2009 Prompted seizures to reappeared. H 8/17/2009 This report might have been reporte 8/15/2009 I've had the same reaction to GARD 8/19/2009 The day after the vaccination, she d 8/20/2009 Herpes Zoster, R side breast (under 8/20/2009 Patient presented with vesicular les 8/20/2009 Left deltoid swelling & redness. 3 X 8/20/2009 On Aug. 18, 2009, patient came for 8/20/2009 Pt received Hep B #1 in her left arm 7/30/2009 15 yo developed herpes zoster in T 8/16/2009 Throat swelled/ made swallowing di 8/14/2009 Baby received varicella vaccination 8/10/2009 Date of inj 7/16/09, Date of event 7/ 8/20/2009 R upper arm significant edema, redn 8/20/2009 c/o Headaches, Right arm numbnes 8/20/2009 TDAP given left deltoid about 11:30 8/20/2009 ADACEL administered (L) deltoid 8/ 8/20/2009 Pt. has fever 99.0 - C/o SA last nigh 8/20/2009 Redness spreading into armpit/brea 8/20/2009 Sudden onset left sided chest pain a 8/19/2009 Left arm swelling one day after vacc 8/20/2009 98 degrees - not noticed until visit 4 8/20/2009 Tues PM 8/18/09 left arm red swolle 8/20/2009 After vaccination mom reports the p 8/20/2009 Patient presented to Doctor 8/20/20 8/20/2009 Left thigh 20 X 18 cm swelling / war 8/20/2009 08/20/2009 Other Red raised rash. 8/13/2009 L Deltoid erythematous wheal 8/20/2009 TDAP injection site left deltoid. Are
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8/20/2009 IL 8/20/2009 AR 8/20/2009 MO 8/20/2009 IA 8/20/2009 CA 8/20/2009 NM 8/20/2009 OH 8/21/2009 8/21/2009 NY 8/21/2009 8/21/2009 KY 8/21/2009 OR 8/21/2009 OH 8/21/2009 MI 8/21/2009 MI 8/21/2009 RI 8/21/2009 OH 8/21/2009 LA 8/21/2009 MD 8/21/2009 NH 8/21/2009 AZ 8/21/2009 TX 8/21/2009 WA 8/21/2009 IN 8/21/2009 IL 8/21/2009 IL 8/21/2009 NC 8/21/2009 SC 8/21/2009 NE 8/21/2009 RI 8/21/2009 PA 8/21/2009 AZ 8/21/2009 FL 8/21/2009 IN 8/21/2009 CO 8/21/2009 MA 8/21/2009 FL 8/21/2009 OH 8/21/2009 PA 8/21/2009 OH 8/21/2009 AL 8/21/2009 WA 8/21/2009 CA 8/21/2009 CA 8/21/2009 CA 8/21/2009 CA 8/21/2009 WA 8/21/2009 OH 8/21/2009 WI 8/21/2009 MT 8/21/2009 KS
0.3 1.1 26 1 9 1.3 1.3 1.4 25
0 1 26 1 9 1 1 1 25
16 63 81 46 0.4 1.3 5 0.7 14 4 26 12 12 74 0.2 5 71 18 41 11 15 0.1 3 48 15 75 24 54 31 53 0.2 20 14 14 0.2 53 39 4 11 5 14
16 63 81 46 0 1 5 0 14 4 26 12 12 74 0 5 71 18 41 11 15 3 48 15 75 24 54 31 53 0 20 14 14 0 53 39 4 11 5 14
0.3 M 0.1 M F 0M M 0.3 F 0.3 M 0.4 M F F F F F F 0.4 F 0.3 F M 0.7 F F F F M F F 0.2 F F F F F F M F F M F M F F F M 0.2 M M F F 0.2 F F M F F M F
8/20/2009 Blood in stool no Tx given. 1 wk po 8/20/2009 2 days w/ rash, Dx: chickenpox . 8/13/2009 Swollen glands on side shot admini 8/20/2009 103.4 temp 8/20/2009 Reaction at the injection site. Lump 8/20/2009 - Fever up to 101 x 72 degrees - Sw 8/17/2009 Mother called stating son broke out 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/20/2009 Information has been received from 8/19/2009 Initial report received on 17 August 8/6/2009 None. I gave Pentacel inadvertently 8/18/2009 15 days after varicella vaccine deve 8/12/2009 From knee up on left leg swollen. A 8/14/2009 Redness to thigh quarter sz. 8/13/09 Within 10 minutes of receiving vacc 8/17/2009 None stated. 8/17/2009 Patient received MMR injection left 8/13/2009 High fever, nausea, stiff neck 103 d 8/17/2009 5 min after rec GARDASIL, HAVRIX 8/12/2009 Itching - mostly on chest - arm and h 8/12/2009 Pt noticed right eyelid swollen. No o Extreme redness, warmth of left arm 8/20/2009 Injection site swollen and warm to to 8/20/2009 Dizzy, headache, increased heart ra 8/21/2009 Pain in chest and along shoulder bla 8/19/2009 Vasovagal syncope w/in 2 minutes 8/17/2009 Pain behind eye vomiting, nausea; p 8/11/2009 Patient was crying for about 6hrs; R 7/31/2009 5x7cm red area noted to LT injectio 8/18/2009 Rash (localized) 8/14/2009 Has large lump - tennis ball size at s 8/21/2009 Pt received PPV23 in his right arm o 8/21/2009 Patient noted a history of eczema o 8/21/2009 Two days of wide spread urticarial e 8/21/2009 Following my fourth rabies booster s 8/21/2009 Wide spread urticarial pruitic rash. N 8/21/2009 had seizure 3 days after vaccines g 8/21/2009 MULTIPLE SATELLITE LESIONS O 8/21/2009 She got very dizzy immediately afte 8/21/2009 Pt had Tdap and varicella shots 6/1 8/21/2009 Patients mother reports that at 2:00 8/21/2009 8-18-09 Pt with severe left arm indu 8/21/2009 Pt was initially vaccinated for smallp 8/21/2009 Was informed child was on Zithroma 8/21/2009 Arm where Tdap and varicella vacci 8/21/2009 8-20-09--Pt. came to medical center 8/21/2009 rapid heart beat,weakness of the lef
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8/21/2009 NC 8/21/2009 PA 8/21/2009 VA 8/21/2009 NC 8/21/2009 FL 8/21/2009 WI 8/21/2009 AZ 8/21/2009 WI 8/21/2009 MN 8/21/2009 MN 8/21/2009 8/21/2009 8/21/2009 8/21/2009 GA 8/21/2009 PA 8/21/2009 8/21/2009 TX 8/21/2009 CA 8/21/2009 TX 8/21/2009 TX 8/21/2009 IL 8/21/2009 NC 8/21/2009 KS 8/21/2009 MA 8/21/2009 TX 8/21/2009 NH 8/21/2009 AL 8/21/2009 MN 8/21/2009 MO 8/22/2009 CA 8/22/2009 CA 8/22/2009 TX 8/22/2009 MD 8/22/2009 CA 8/22/2009 FL 8/22/2009 TX 8/22/2009 MD 8/22/2009 OH 8/22/2009 WA 8/23/2009 MD 8/23/2009 NY 8/23/2009 WI 8/23/2009 FL 8/23/2009 IN 8/24/2009 AZ 8/24/2009 WV 8/24/2009 PA 8/24/2009 FL 8/24/2009 OH 8/24/2009 MD 8/24/2009 LA
0.2 39 14 39 10 4 71 18 82 52 52 1.4 71 7
12 4 12 55 11 11 5 14 72 1 23 4 17 55 2 40 14 16 14 4 53 22 38 45 67 1.5 40 14 0.4 1.8 67 74 2 16
0 39 14 39 10 4 71 18 82 -1
1 71 7
12 4 12 55 11 11 5 72 1 23 4 17 55 2 40 14 16 14 4 53 22 38 45 67 1 40 14 0 1 67 74 2 16
0.2 M F F F M M M F F 0.7 M F F 0.4 F M M M U F F M F M F M F F 0M F M F F 0.1 M M M M F M F F F F M 0.5 F F F 0.4 F 0.8 M F F 0M F
8/21/2009 PT WAS GIVEN THIRD HEP B TO 8/21/2009 Left deltoid swelling, pain, erythema 8/21/2009 Dizziness, nausea, vomiting starting 8/21/2009 Received vaccines at 4:30 pm. At 1 8/21/2009 Pt. was given the vaccine at 4:00 PM 8/21/2009 Arm swelling from elbow to shoulde 8/21/2009 Within a day after Shingles shot, I d 8/21/2009 Light-headed, dizzy, and nauseous 8/21/2009 Redness and swelling from site of in 8/21/2009 This case was reported by a healthc 8/21/2009 This case was reported and describ 8/21/2009 This case was reported in a literatur 8/21/2009 This female subject was enrolled in 8/22/2009 Noticed when went to bed last night 8/22/2009 Right deltoid area was a little pale 8 8/22/2009 Patient report soreness to right delto Fell to floor - pale, fainted. V/S take 8/21/2009 Pt. received (1) Tdap in (L) arm then 8/21/2009 Local reaction (L) upper arm/tricep a 8/21/2009 Varicella vaccine reaction started 24 8/21/2009 Pt given vaccine about 11 o'clock, A 8/21/2009 Knot in (L) arm 1 1/2 inch circle. 8/21/2009 Parent of client called reporting that 8/21/2009 Pt. had IZS 8-20-09, began wheezin 8/21/2009 Rec'd HPV #1 12-16-08- No reactio 8/21/2009 At 3:30 pm pt developed swelling sl 8/21/2009 Left thigh, red swollen warm to touc 8/21/2009 Developed fever, pain, redness & sw 8/21/2009 None Stated 8/20/2009 From the time of vaccination until ab 8/22/2009 fever 8/22/2009 A few days after the shot, he started 8/22/2009 My husband received the vaccinatio 8/22/2009 approx 12 hours after the shots my 8/22/2009 Pt was given shot on 08/18/09 in Le 8/22/2009 8 hours after shot: Tremors,vertigo,h 8/22/2009 Fever of 103, complaint of headach 8/22/2009 Arm soreness never went away afte 8/22/2009 Patient given vaccin afternoon of 8/ 8/23/2009 severe hives, itching, wheezing with 8/23/2009 Severe dizziness cuasing inability to 8/23/2009 Administered just prior to discharge 8/23/2009 Pt had a fever of 102.7 F taken und 8/23/2009 injection @ 2130--urticaria bilat han 8/18/2009 Diagnosed with Type 1 Diabetes Me 8/17/2009 Hypoxic brain injury after a possible 8/18/2009 Child received both vaccines in righ 8/17/2009 Received Shingles Vaccine ZOSTA 8/19/2009 Outbreak of shingles Post Vaccine R 8/23/2009 I saw him for well check up at 09:30 8/14/2009 Immediately following vaccine (abou
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8/24/2009 MN 8/24/2009 TN 8/24/2009 IL 8/24/2009 NC 8/24/2009 KS 8/24/2009 MA 8/24/2009 8/24/2009 CA 8/24/2009 8/24/2009 WY 8/24/2009 TX 8/24/2009 8/24/2009 VA 8/24/2009 CT 8/24/2009 KY 8/24/2009 LA 8/24/2009 LA 8/24/2009 CT 8/24/2009 CA 8/24/2009 TX 8/24/2009 VA 8/24/2009 OH 8/24/2009 CA 8/24/2009 WI 8/24/2009 CA 8/24/2009 NY 8/24/2009 MI 8/24/2009 CO 8/24/2009 TN 8/24/2009 MN 8/24/2009 TX 8/24/2009 MT 8/24/2009 MN 8/24/2009 MI 8/24/2009 TX 8/24/2009 FL 8/24/2009 TX 8/24/2009 SC 8/24/2009 SC 8/24/2009 TX 8/24/2009 VA 8/24/2009 MI 8/24/2009 PA 8/24/2009 NC 8/24/2009 MO 8/24/2009 MO 8/24/2009 VA 8/24/2009 FL 8/24/2009 MD 8/24/2009 KS 8/24/2009 OH
27 11 18 0.2 33 19 0.2
27 11 18 0 33 0
3 13 15
13 15
13
13
4 11 33 13 0.5 23 39 5 4 10 3 11 44 11 0.5 63 12 12 9 5 6 50 15 13 4 5 37 18 73 16 1 78 59 58 65 18 27
4 11 33 13 0 23 39 5 4 10 3 11 44 11 0 63 12 12 9 5 6 50 15 13 4 5 37 18 73 16 1 79 59 58 65 18 11
U F F 0.2 M F F 0.2 M M M F F F F F M M M M 0.5 F F F F M F M F F M 0.5 M F M M F F M M M F F F F F F F 0M M F M M M F
Left shoulder pain, decrease ROM a 8/14/2009 Pain- redness - firm - Golf ball size t 8/19/2009 Right leg had no feeling/wd not sup 8/19/2009 12 noon approx Received Pentacel 8/20/2009 7" length x 6" width. Redness, with Fainting and dizzy 1 hour after shot 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/21/2009 Information has been received from 8/12/2009 arm pain - severe fatigue, lethargy, 8/4/2009 Right arm injection site with large X 8/21/2009 Localized reaction to left thigh. 8/19/2009 Vaccines given on 8/11/09 (Tdap, M 8/11/2009 Patient states he developed a rash 8/21/2009 9:35AM pt. returns with c/o malaise, 8/21/2009 No adverse reaction noted to extra 8/17/2009 Client going into nursing school, rec 8/18/2009 Febrile illness t max 103. Severe my 8/20/2009 Area of induration & erythema at sit 8/19/2009 Redness & swollen where immuniza Local reaction: red, swollen, hard to 8/20/2009 Father states child began favoring le 8/22/2009 Patient had syncopal episode & fell 8/20/2009 Rt upper arm 2in x 2in reddened ha 8/24/2009 This case was reported by a healthc 8/24/2009 This case was reported by a healthc 8/24/2009 initial small erythema for 2 days, res 8/24/2009 Received vaccinations around 12:30 8/24/2009 Extensive Left Deltoid swelling, eryt 8/24/2009 Pt given outside of FDA approved a 8/24/2009 Vaccine administered 08/20/2009. C 8/24/2009 After patient received the immuniza 8/24/2009 anaphylaxisY(immediate) 8/24/2009 some temp, difficulty breathing, tired 8/24/2009 Mother reports fatigue and complain 8/24/2009 Received 4 year vaccines on 8-20-0 8/24/2009 Within a few days of the vaccination 8/24/2009 Recieved first hep b shot and IPV s 8/24/2009 Gave vaccines to pt while she was l 8/24/2009 Injection given on 08/20. Approx 3" 8/24/2009 Pt became dizzy 20 min. after first G 8/14/2009 Broke out with rash all over extremit 8/17/2009 8-14-09 Ball of left foot extremely so 8/24/2009 20 MINUTES AFTER RECEIVING H 8/24/2009 Patient complained of continued mu 8/24/2009 8/21/09 Received phone call from p 8/24/2009 Sean is complaining of muscle fatig 8/24/2009 Developed an increased heart rate
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8/24/2009 TX 8/24/2009 AL 8/24/2009 TX 8/24/2009 VA 8/24/2009 DC 8/24/2009 8/24/2009 UT 8/24/2009 MO 8/24/2009 MI 8/24/2009 TX 8/24/2009 CO 8/24/2009 VA 8/24/2009 CA 8/24/2009 AZ 8/24/2009 WI 8/24/2009 CA 8/24/2009 PA 8/24/2009 MI 8/24/2009 PA 8/24/2009 CA 8/24/2009 MO 8/24/2009 VA 8/24/2009 OH 8/24/2009 MI 8/24/2009 TX 8/24/2009 SD 8/24/2009 CA 8/24/2009 TX 8/24/2009 MD 8/25/2009 NC 8/25/2009 NC 8/25/2009 TX 8/25/2009 WA 8/25/2009 OH 8/25/2009 FL 8/25/2009 TN 8/25/2009 NC 8/25/2009 WI 8/25/2009 LA 8/25/2009 AL 8/25/2009 8/25/2009 HI 8/25/2009 8/25/2009 IA 8/25/2009 8/25/2009 AR 8/25/2009 CA 8/25/2009 KS 8/25/2009 NC 8/25/2009 GA 8/25/2009 OR
13 11 40 2 4 12 1 15 63 14 14 1 4 12 5 12 11 19 4 4 4 11 9 3 13 35 0.6 4 11 5 12 34 0.3 1.1 4 0.4 12 11 13 18 14
13 11 40 2 4 12 1 15 63 14 14 1 4 12 5 12 11 19 4 4 4 11 9 3 13 35 0 4 11 5 12 34 0 1 4 0 12 11 13
63 69 71 4 13 14 11 68 75
63 69 71 4 13 14 11 68 75
14
F F M 0.2 M F M 0M M F F F 0M M F F M F F F F M F F F F F 0.6 M M F F F M 0.3 F 0.1 M F 0.4 M F M F F F F M F F M F F M M F
8/24/2009 SWELLING AND REDNESS TO LE 8/24/2009 Long-term chronic nausea, chronic 8/24/2009 Reoccurring headaches, chronic fat 8/24/2009 loss of appetite & 102 degree fever; 8/24/2009 8/7/09- 4 y.o. Received immunizatio Swelling, redness, and itching of the 8/24/2009 On 9/28/08 he developed a tremor a 8/24/2009 8/10/09: Rash (small) on the tummy 8/24/2009 Shot given 8/19/09 -Weds- Onset o 8/24/2009 Report by parent of "nodule" develo 8/19/2009 4 days after HPV #3 and MENACTR 8/24/2009 Fever-developed 8 days after vaccin 8/24/2009 (R) deltoid reddened - size 8cm x 4c 8/20/2009 Sudden onset left sided chest pain a 8/21/2009 Began with true urticarial rash on 8/ 8/21/2009 Swollen, red, hard, hot. 8/20/2009 10 minutes following shot pt becam 8/24/2009 - Had rash and soreness developed 8/24/2009 8-19 developed swelling of face/han 8/24/2009 3.5cm indurated dark red. 6cm total 8/24/2009 Approx 2 1/2 cm x 3 cm area of red Erythema circumferentially 2/3, leng 8/24/2009 Child rec'd VARIVAX and HAV; left 8/29/2009 None 8/24/2009 Reports "feeling bad" about an hour 8/24/2009 8/13 - Vaccine given at 11 am - 8/14 9/19/2009 Low grade temp (100 degrees F) an 8/24/2009 Rash on upper thigh. Red and raise 8/24/2009 Pt received #2 varicella on 7/28/09. 8/20/2009 2 1cm. Blisters above sight where I 8/12/2009 Rash on legs. One leg shape of a tr 8/25/2009 Received booster dose of AVA 18 A 8/21/2009 Pt found dead Y in crib on 8/14/09. Pr 8/8/2009 2 days after my son received MMR 8/20/2009 Immediately after vaccines started t 8/21/2009 Intussusception 2 wks after receivin 8/14/2009 She was seeing black shapes, said 5/4/2009 This patient has been diagnosed wi 8/21/2009 Daughter was given two injections o 8/20/2009 This year my daughter and two of m 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/24/2009 Information has been received from 8/19/2009 Red swollen area (Lt) thigh, no feve 8/17/2009 Approximately 38 hrs after administ 8/20/2009 Vaccinations given on 8-10-09, scre 8/21/2009 Acute onset hives about 40-44 hrs a 8/20/2009 Received ZOSTAVAX (shingles vac 8/21/2009 "Quarter-sized" lump at injection site
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8/25/2009 OR 8/25/2009 MN 8/25/2009 OH 8/25/2009 MN 8/25/2009 MA 8/25/2009 MA 8/25/2009 OK 8/25/2009 PA 8/25/2009 AZ 8/25/2009 AR 8/25/2009 AR 8/25/2009 FL 8/25/2009 PA 8/25/2009 KS 8/25/2009 MO 8/25/2009 OH 8/25/2009 MI 8/25/2009 AL 8/25/2009 TX 8/25/2009 MI 8/25/2009 MI 8/25/2009 CA 8/25/2009 MO 8/25/2009 PA 8/25/2009 VA 8/25/2009 IL 8/25/2009 MI 8/25/2009 CA 8/25/2009 FL 8/25/2009 TX 8/25/2009 MI 8/25/2009 MA 8/25/2009 AZ 8/25/2009 CA 8/25/2009 CA 8/25/2009 MS 8/25/2009 MN 8/25/2009 CA 8/25/2009 CA 8/25/2009 ID 8/25/2009 TX 8/25/2009 WA 8/25/2009 WA 8/25/2009 DE 8/25/2009 ID 8/25/2009 NY 8/25/2009 CA 8/25/2009 AR 8/25/2009 CA 8/25/2009 FL 8/25/2009 IN
64 36 36 11 25 36 7 10 65 72 41 49 68 17 65 14 17 67 0 59 8 64 37 4 11 57 0.2 11 15
45 36 11 25 36 7 10 65 72 41 50 68 17 65 14 17 67 0
14 11 66 17 15 3 62 70 16 0.5
8 64 37 4 11 57 0 11 15 5 14 11 66 17 15 3 62 70 16 0
16 5 69 27 11 59 28 71 15 14
16 5 69 27 11 59 28 71 15 14
M F M F F F F F M M F F M M F F F F 0F U F M F M F F 0.2 F F F M F M U F F F F F F 0.5 M U M M F M M F F M F M
Has bitterness in mouth, unable to e 8/20/2009 Gradual onset pain, redness swellin 8/4/2009 Temperature of 103 F and fever like 8/19/2009 Bump at injection site - difficulty bre 8/14/2009 Erythema induration right deltoid. M 8/20/2009 Pt complained of "mild" shortness o 8/25/2009 Pt received varicella vaccination on 8/25/2009 Pt received varicella vaccine sub-Q 8/25/2009 S: pt returned to clinic 2 days after v 8/25/2009 Severe flushing, back pain, shortne 8/25/2009 Reaction started on July 31 - had so 8/25/2009 Pt's left arm began to swell x 3 days 8/25/2009 Sub normal temperature, Headache 8/25/2009 2 days after getting vaccine, arm be 8/25/2009 CELLULITIS, BUTTOCKS AT INJEC 8/25/2009 Patient received Menactra vaccine i 8/25/2009 3 minutes after client received5 vac 8/25/2009 Shingles vaccine received on 08/11 8/25/2009 Decedent isYa 7 day old neonate wh 8/25/2009 Subject in pneumococcal vaccine tr 8/25/2009 Child in for vaccinations, she had 2 8/25/2009 Patient with moderate to severe pai 8/25/2009 Received vaccine on 9/5/08. On 10 8/25/2009 Call from mother on 8/25/09. States 8/25/2009 Pt. received her Adacel booster and 8/25/2009 Client called on 8/24/09 that she ha 8/25/2009 2.5 mo Female received the Oral Ro 8/25/2009 redness, swelling and tenderness o 8/25/2009 Severe Gastritis, weakness, wt. loss 8/18/2009 Pt started sneezing, and eyes got v 8/25/2009 Received vaccine 08-24 PM. C/O di 8/25/2009 11 year old generally healthy male w 8/25/2009 Got slight rash on inner upper thigh 8/25/2009 24 hours post injection, high fever (m 8/25/2009 24 hours after injection had fever re 8/14/2009 Local reddness, warmth and swellin 8/17/2009 On 8/14 local reaction - red firm are 8/19/2009 Within 5 minutes of injection of ZOS 8/19/2009 Pt had reaction after giving HPV vac 8/19/2009 Within a couple of minutes of giving 8/14/2009 None. 8/18/2009 After receiving MENACTRA and He 8/18/2009 (L) arm swollen and red from elbow 8/17/2009 I had the vaccination for the shingle 8/19/2009 TWINRIX give IM in the dorsoglutea 8/19/2009 Itching at and around injection site a Inflammation at injection site - Eye a 8/12/2009 Developed hives 2 days after shot t 8/21/2009 Developed shingles L facial (V- 1 n 8/25/2009 As per patient - 2hrs after vaccines 8/25/2009 Received call from mother. Says ab
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8/25/2009 PA 8/25/2009 MA 8/25/2009 WA 8/25/2009 MI 8/25/2009 CA 8/25/2009 8/25/2009 OH 8/25/2009 MN 8/25/2009 TX 8/25/2009 TX 8/25/2009 PA 8/25/2009 GA 8/25/2009 NC 8/25/2009 NC 8/25/2009 WA 8/25/2009 NY 8/25/2009 IA 8/25/2009 NC 8/25/2009 VT 8/25/2009 WI 8/25/2009 LA 8/25/2009 WA 8/25/2009 OH 8/25/2009 TX 8/25/2009 SC 8/25/2009 IN 8/25/2009 TX 8/25/2009 CA 8/25/2009 8/25/2009 MA 8/25/2009 CT 8/25/2009 NC 8/25/2009 SC 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/25/2009 CA 8/26/2009 KY 8/26/2009 ID 8/26/2009 MN 8/26/2009 CA 8/26/2009 MO 8/26/2009 AL 8/26/2009 PA 8/26/2009 GA 8/26/2009 GA 8/26/2009 TX 8/26/2009 KS 8/26/2009 TN
15 8 11 1.6 60 72 48 8 1.3 0.9 3 66 5 5 50 25 5
15 8 11 1 60 72 48 8 1 0
15 12
15 12
11 4 24 1.1 11 12 49 77 5 4 1.7 6 9 0.2 2
11 4 24 1 11
0.2 63 85 5 19 4 1 1.3 1 10 13 11 11
0 63
66 5 5 50 25 5
49 77 5 4 1
0 2
5 19 4 1 1 1 10 13 11 11
M M M 0.6 M F F M M 0.3 F 0.9 M F M F F F M F M M F M M M M 0.1 M M U F F M M 0.7 F F F 0.2 F 0.1 M F F 0.2 F M F M M F 0M 0.3 F 0F M F M M
8/25/2009 Had flu vaccine - shortly after got lig 8/27/2009 Mother states after receiving vaccin 8/19/2009 Child had generalized non-febrile se 8/19/2009 DTAP given on 8-11-09 Hives on 88/25/2009 Mondays night noticed a red/pink kn Small raised red rash at site of injec 8/21/2009 Vaccine (TWINRIX #3) Administere 8/19/2009 Developed a lump Rt upper arm. It 8/19/2009 Developed blister link rash over both 8/25/2009 Rash all over body. 8/25/2009 Attended facility on 8-15-07. Rash e 8/19/2009 Patient noticed stinging during injec 8/24/2009 Within 30 minutes of injection of all 8/24/2009 Pt. returned to office approximately 8/14/2009 Received Hepatitis B vaccination (E 6/10/2009 Pt became pale approx 1/2 min afte 8/25/2009 Fever 103.0 8/22/09 8/14/2009 Information has been received from 8/25/2009 Syncope x 2 8/25/2009 Patient experienced fainting, and na 6/4/2009 Vesicular, blanching rash with pruiri 8/20/2009 Left deltoid red, swollen and painful 8/25/2009 Erythema multiforme, seen on 8/24/ 8/24/2009 10 Minutes after shot pt. complained 8/21/2009 Pt given shot Sat 830A. Returns at 8/25/2009 Following vaccination, pt. and his m Redness, warmth, firmness to uppe 8/21/2009 Facial edema ("puffy eyelids"). Incre 8/25/2009 3 days after vaccines patient develo 8/12/2009 Received DTaP, IPV in left arm 8/5/ 8/25/2009 6 d after DTaP given, patient recove 8/25/2009 Fever began a few hours after vacc ### A spontaneous non-serious report o 8/18/2009 Hive broke out on her body - Hypera 8/18/2009 Respiratory alway clearing her nose 9/25/2008 Flu like symptoms every time. Folde 9/25/2008 Vomiting, diarrhea, rocking back an 9/25/2008 Folded bowel movement, vomiting a 9/25/2008 Flu like symptoms, picky skin, thinni 8/25/2009 On 10-01-08 Y he complained of sore 8/20/2009 Shortly after vaccinated: broke out o 8/21/2009 Night tremors; upset agitated; not q 8/18/2009 Pt vaccinated smallpox 8/8/09; left a 8/19/2009 Swelling of arm at injection site with 8/3/2009 Had fever for 1st 2 sets of shots for 8/20/2009 Shot RXN left thigh red, sore, fever. 7/24/2009 Within 48 hours: High fever, irritabili 8/25/2009 Injection site is warm to touch, red & 8/26/2009 Morbilliform rash of trunk. 8/26/2009 Pt passed out after receiving vaccin 7/21/2009 Approx 5 min post vaccine became
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8/26/2009 UT 8/26/2009 MI 8/26/2009 IL 8/26/2009 AZ 8/26/2009 PA 8/26/2009 8/26/2009 GA 8/26/2009 NC 8/26/2009 AR 8/26/2009 MN 8/26/2009 MI 8/26/2009 VA 8/26/2009 GA 8/26/2009 NY 8/26/2009 MI 8/26/2009 MN 8/26/2009 MI 8/26/2009 IL 8/26/2009 TN 8/26/2009 VA 8/26/2009 ND 8/26/2009 NY 8/26/2009 VI 8/26/2009 CO 8/26/2009 VI 8/26/2009 MI 8/26/2009 IN 8/26/2009 OH 8/26/2009 IL 8/26/2009 MO 8/26/2009 NE 8/26/2009 CT 8/26/2009 CO 8/26/2009 TX 8/26/2009 SC 8/26/2009 IA 8/26/2009 MN 8/26/2009 WA 8/26/2009 CA 8/26/2009 RI 8/26/2009 OR 8/26/2009 AZ 8/26/2009 TX 8/26/2009 MN 8/26/2009 OH 8/26/2009 NV 8/26/2009 CA 8/26/2009 TX 8/26/2009 NC 8/26/2009 MN 8/26/2009 MN
4 33 72 17 17
4 33
61 11 4 33 12 20 18 54 59 4 5 74 0.2 16 14 1.3 11 11 44 75 17 63 1.1 10 31 19 65 8 13 31 51 18 1.4 48 66 13 67 41 2 11 4 44 0.1 37 12
61 11 4 33 12 20 18 54
17 17
4 5 74 0 16 14 1 11 11 44 75 17 63 1 10 31 19 65 8 13 30 51 18 1 48 66 13 67 41 2 11 4 44 0 37 12
M F F F F F F M M M F F F F M M M M 0.2 F F F 0.3 M F M F M F F 0.1 M M F F F U M F F F 0.4 M F F F F F 0.1 M F M F 0.1 M M M
8/26/2009 Pain in leg with TETNUS shot, fever 8/25/2009 Initial report received on 13 August 8/24/2009 Initial report received on 14 August 8/25/2009 Information has been received from 8/25/2009 Information has been received from 8/25/2009 Information has been received from 8/26/2009 BREAKOUT IN OOZING SENSITIV 8/26/2009 Pt developed swelling and itching a 8/26/2009 Had Gma Seizures starting at 10pm 8/26/2009 This individual received the flu shot 8/26/2009 Multiple Uriticariae Shoulders. Raise 8/26/2009 Pt became pale,weak c/o dizziness 8/26/2009 Adverse event onset was 8-08-09 8/26/2009 Within a few days I became ill with a 8/26/2009 Subject in pneumococcal vaccine tr 8/26/2009 By 5:30 on the night of his immuniza 8/26/2009 pulled up mcir the night before didn 8/26/2009 4 days after vaccination I experienc 8/26/2009 Patient received Rotarix oral vaccin 8/26/2009 Initial near syncopal episode at time 8/26/2009 Severe headaches/migraines which 8/26/2009 7/30/09 temp 101, febrile sz, seen b 8/26/2009 mother and client report at this vist ( 8/26/2009 Developed dizziness, high-fever (10 8/26/2009 Patient had swelling in the back of t 8/26/2009 Pt has been on Humira and methotr 8/26/2009 After a few minutes patient lost cons 8/26/2009 Local reaction to LT posterior upper 8/26/2009 Pt. vaccinated 7/31/09, His mother, 8/26/2009 Within 15 minutes of vaccination, pt 8/26/2009 The patient received the Tdap vacc 8/26/2009 First acute schizophrenic episode (d 8/26/2009 Patient developed 2 inch red circle a 8/26/2009 Varicella vaccine administered to rig 8/26/2009 pt recieved vaccine on 8/24/09. Pt s 8/26/2009 PATIENT RECEIVED THIS VACCIN 8/26/2009 She recieved the flu vaccine on 8-1 8/26/2009 Redness and swelling, the size of g 8/26/2009 Extensive local reaction 8/26/2009 Had vaccine at approx 9:30am felt s 8/26/2009 Large red and swollen area around 8/26/2009 1515: Client c/o nuasea after vaccin 8/26/2009 Developed shingles in nose the nex 8/26/2009 Deltoid muscle weakness. Pain in d 8/25/2009 21 days after primary Varicella vacc 8/26/2009 MENACTRA shot given in LD Wedn 8/26/2009 Redness with swelling to R Deltoid. 8/26/2009 Itching, redness, warmth, swelling. 8/25/2009 Excessive prolonged crying, rednes 8/26/2009 Pt feels fine- When I called to his ho 8/26/2009 Pt feels fine - when I called to his ho
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8/26/2009 IL 8/26/2009 MN 8/26/2009 TX 8/26/2009 MI 8/26/2009 KS 8/26/2009 AZ 8/26/2009 TX 8/26/2009 TX 8/26/2009 CA 8/26/2009 IL 8/26/2009 TX 8/26/2009 OH 8/26/2009 CA 8/26/2009 VA 8/26/2009 CA 8/26/2009 IL 8/26/2009 TX 8/26/2009 FL 8/26/2009 NY 8/26/2009 TX 8/26/2009 PA 8/26/2009 WV 8/26/2009 PA 8/26/2009 PA 8/26/2009 FL 8/26/2009 FL 8/26/2009 CA 8/26/2009 WA 8/26/2009 MA 8/26/2009 ME 8/26/2009 ME 8/26/2009 ME 8/26/2009 NY 8/27/2009 SD 8/27/2009 8/27/2009 8/27/2009 8/27/2009 8/27/2009 WA 8/27/2009 GA 8/27/2009 PA 8/27/2009 IL 8/27/2009 CA 8/27/2009 CA 8/27/2009 IN 8/27/2009 MI 8/27/2009 SC 8/27/2009 8/27/2009 VA 8/27/2009 MI 8/27/2009 TN
4 11 0.6 4 5 31 13 16 4 4 1.5 0.2 28 61 5 1.6 4 4 0.2 4 28 4 4 0.2 0.4 0.2 4 0.5 5 5 5 5 1.4 12
4 11 0 4 5 31 16 4 4 1 28 61 5 1 4 4 4 28 4 4 0 0 0 4 0 5 5 5 5 1 12
17 14
14
52 13 13 11 4 5 49 53 4 11 31 44
52 13 13 11 4 5 49 53 4 11 31 44
F M 0.6 M F M M F F F M 0.5 M M M F F 0.6 M F F U M F F M 0.2 F 0.3 F 0.2 F F 0.5 M M F F F 0.4 M F F F F F M F F F M F F F F F F F M
8/26/2009 Develop rash that resembles Rubell 8/24/2009 Seen 2 days after vaccine with prog 8/26/2009 "none reported by parent". 8/26/2009 Lt leg (anterior thigh) 10 x 10 cm ery 8/25/2009 Minor hives, swelling around eye. N 8/26/2009 Pt received shot 8pm on 8/24/09. A 8/26/2009 Red, swollen X 4 days. 8/22/2009 Headache. Momentarily passed out 8/26/2009 Redness swollen to (L) deltoid. 8/26/2009 Erythema & mild pain at site of DTa 8/24/2009 None provided. 8/27/2008 Initial report received on 21 August ### This non-serious case was received 2/17/2009 Initial report received from a health 5/26/2009 This non serious case was received 4/13/2009 Case is linked with case 2009-0055 3/6/2009 This event was received from a hea 5/11/2009 This non serious case was received 6/19/2009 Initial report was received 16 June 2 6/26/2009 This case was received from a heal 7/31/2008 Initial report was received 18 July 20 10/7/2008 Initial report received on 25 August 9/30/2008 This case was received from a heal 9/29/2008 This case was received from a heal 9/18/2008 Initial information was received from 9/18/2008 Initial information was received from 12/8/2008 Initial non-serious report received fr ### Initial report was received 19 Novem 1/6/2009 Initial report was received 17 Decem 5/26/2009 This case was received from a heal 5/26/2009 This case was received from a heal 5/26/2009 This case was received from a heal 6/2/2009 A 17 months old male patient receiv 8/19/2009 CNP present after incident. 1550- B 8/26/2009 InformationYhas been received from 8/26/2009 Information has been received from 8/26/2009 Information has been received from 8/26/2009 Initial and follow-up information was 8/26/2009 Information has been received from 8/21/2009 Initial report received on 17 August 8/25/2009 Initial report received on 21 August 8/21/2009 Developed Hodgkins lymphoma. We 8/19/2009 About 3-4 hours after vaccine admin 8/7/2009 L humeral area 5x5cm red in duratio 8/21/2009 9 cm across, redness, warm to the t 8/20/2009 Report of muscle ache throughout e 8/21/2009 Severe pain at injection site & arm ( 8/19/2009 Localized erythema & swelling of De 8/20/2009 18-20 hrs after injection, pt develop 8/19/2009 L deltoid soft tissue abscess. 7/23/2009 "I wake up at 4:30 AM with my Rt ja
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8/27/2009 TN 8/27/2009 VA 8/27/2009 PA 8/27/2009 TX 8/27/2009 MN 8/27/2009 TX 8/27/2009 TX 8/27/2009 FL 8/27/2009 NH 8/27/2009 NH 8/27/2009 NY 8/27/2009 NH 8/27/2009 VA 8/27/2009 CT 8/27/2009 MD 8/27/2009 NY 8/27/2009 8/27/2009 IL 8/27/2009 LA 8/27/2009 PR 8/27/2009 NJ 8/27/2009 NC 8/27/2009 TX 8/27/2009 MI 8/27/2009 CA 8/27/2009 TX 8/27/2009 WI 8/27/2009 FL 8/27/2009 8/27/2009 CA 8/27/2009 FL 8/27/2009 MI 8/27/2009 NJ 8/27/2009 CA 8/27/2009 MD 8/27/2009 DE 8/27/2009 MO 8/27/2009 WA 8/27/2009 CO 8/27/2009 CA 8/27/2009 NC 8/27/2009 NM 8/27/2009 CA 8/27/2009 CA 8/27/2009 CA 8/27/2009 CA 8/27/2009 IL 8/27/2009 CA 8/27/2009 MI 8/27/2009 NC 8/27/2009 SD
4 12 20 65 5 12 16 18 18 9 16 11 8 33 44 22 0.3 72 60 16 15 65 10 0.2 0.3 4 12 4 11 68 40 11 66 6 27 1 1 40 38 28 24 65 42 5 72 19 0.9 59 5 69
4 12 20 65 5 12 16 18 18 9 16 11 8 33 47 22 0 72 60 16 15 65 10 0 0 4 12 4 11 68 40 11 53 66 6 27 0 1 40 29 18 24 65 42 5 72 18 59 5 69
F F F F F M M F M M F M F M M F 0.3 M M F F F F M 0.2 F 0.4 M F M M M F F M F F F F 0M 0F F F F M F M M F F M M M M
7/29/2009 (1) 4 + Local reaction (L) arm (2) C/ 8/27/2009 Received 1st GARDASIL 8/13/09; m 8/27/2009 Few minutes after shots, patient had 8/27/2009 Reports a lump as large as a baseb 8/19/2009 On 8/18/09, day following vaccinatio 8/26/2009 9x10 cm warm\pink\non-tender; 2x3 8/25/2009 30min after shot-BOOSTRIX mom r 8/26/2009 Patient had Tdap and GARDASIL th 8/21/2009 Patient started to experience warmt 8/21/2009 Patient developed tenderness, redn 8/21/2009 Injection site shows a swollen lump 8/21/2009 Redness, swelling, and tenderness 8/24/2009 8-10-09 Received varicella vaccine. 8/27/2009 Approximately 20 hrs after administ 8/27/2009 knots on arm at vaccine site that did 8/27/2009 Pt. was a 22 yr old Female, inproce 8/27/2009 Rotavirus Vaccine administered on 8/27/2009 Pt was due to be discharged after u 8/27/2009 80mm red circle 8/27/2009 MOTHER REFERS THE PATIENT 8/27/2009 APPROX. 20 SECONDS AFTER RE 8/27/2009 Hives developed on face and neck w 8/27/2009 Vomitting; Loss Consciousness with 8/27/2009 Pentacel along with IPV was admin 8/27/2009 HAIR FALLING OUT 8/27/2009 Patient left clinic after vaccinations a 8/27/2009 redness, hardness & swelling, mildly 8/27/2009 CLIENT COMPLAINING OF PAIN A 8/27/2009 mild localized erythema 7 X 5.5 cm 8/27/2009 DAY 2 - SORE, TENDER, ITCHING 8/27/2009 REC'D FLU VACCINE @9AM. @ 1 8/27/2009 Rt Deltoid swollen, red, hot,itchy an 8/27/2009 developed fever 101 degrees 12 hr 8/27/2009 Zostavax administered on 8/10/200 8/27/2009 PT LEFT ARM (DELTOID AREA) B 8/27/2009 Patient has had moderate to severe 8/27/2009 Febrile seizure, temp 104.3(tempora 8/27/2009 High fever (102.2) and Fever Seizur 8/27/2009 After about 10 minutes after receivin 8/27/2009 VET CALLED BACK REPORTING P 8/27/2009 Pt. presented to clinic for second M 8/27/2009 RASH AND ITCHING COVERING W 8/27/2009 65 y/o female/employee who presen 8/27/2009 Vet reporting tender, warm and sligh 8/27/2009 RIGHT THIGH RED, SWOLLEN AN 8/27/2009 4 episodes of atrial fibrillation (new o 8/27/2009 1st vaccine: 11/28/08; Rash on han 8/27/2009 SWELLING AND REDNESS WITH 8/27/2009 Shoulders, hips, neck weakness, m 8/27/2009 (L) lateral upper thigh 13x13 cm, lig 8/27/2009 Patient has a rash at rt side T5 & T1
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8/27/2009 MA 8/27/2009 VT 8/27/2009 NE 8/27/2009 MT 8/27/2009 NJ 8/27/2009 CA 8/27/2009 PA 8/27/2009 WI 8/27/2009 NY 8/27/2009 IA 8/27/2009 WA 8/27/2009 NM 8/27/2009 PA 8/27/2009 CA 8/27/2009 MA 8/27/2009 WA 8/27/2009 MA 8/27/2009 HI 8/27/2009 MI 8/27/2009 KS 8/27/2009 WI 8/27/2009 WI 8/28/2009 KY 8/28/2009 NJ 8/28/2009 TN 8/28/2009 PA 8/28/2009 8/28/2009 IN 8/28/2009 8/28/2009 NC 8/28/2009 VA 8/28/2009 VA 8/28/2009 CT 8/28/2009 NY 8/28/2009 ME 8/28/2009 MI 8/28/2009 WI 8/28/2009 GA 8/28/2009 WI 8/28/2009 VA 8/28/2009 VA 8/28/2009 VA 8/28/2009 IL 8/28/2009 IN 8/28/2009 PA 8/28/2009 IA 8/28/2009 AR 8/28/2009 TX 8/28/2009 AR 8/28/2009 VA 8/28/2009 KY
48 4 12 12 16 8 16 12 5 12 11 9 1 4 21 10 54 10 0.6 5 11 15 1.3 0.5 0.2 18 26
48 4 12 12 16 8 16 12 5 12 11 9 1 4 21 10 54 10 0 5 11 15 0 0 0 18 26
0.2 31 28 18
0 31 28 18
18 52 17 26 1 11 34 20 11 64 72 24 6 3 10 5 4
52 17 26 1 11 34 20 11 64 72 24 6 3 10 5 4
F F M M F M F F F M F M 0M F F F M M 0.6 F M F M 0.2 F 0.5 M 0.2 M F F F U 0.2 M F F F M F F F F 0M F F F M M F F M F F F F
8/27/2009 Pt received ADACEL vaccine on 8/2 8/27/2009 Upper arm redness, swelling & disc 8/27/2009 Upper L) arm red swollen, itchy area 8/27/2009 10 x 7 cm red erythema. Decreased 8/27/2009 Induration of 1 cm diameter at site o 8/26/2009 Erythema, swelling, pain to site of in 8/25/2009 1118AM 3 minutes after shots were 8/27/2009 Pt fainted, subsequent headache di 8/27/2009 none 8/27/2009 Patient received MENACTRA and V 8/26/2009 Redness, slight swelling, hot to touc 8/27/2009 None stated. 8/27/2009 8/28/09 Was shaking and off balanc 8/27/2009 1 d after immunization; pt developed 8/27/2009 Reported local redness and pruritis. 8/26/2009 Redness, slight swelling, hot to touc 8/27/2009 Administered DTAP instead of inten 8/27/2009 4:55 p: Decreased O2 saturation, 70 7/17/2009 Fever. Hive type rash widespread. 8/27/2009 Rash slight warm area to left leg. Ashley received MENACTRA & TDA Patient received Tdap and MENACT 8/28/2009 Fever that was 103.5, Vomiting, Ra 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/27/2009 Information has been received from 8/25/2009 Fever 103.8 later on day of vaccine 8/28/2009 "Trouble breathing & getting air" R e 8/28/2009 Started with hives on wrist, itching a 8/24/2009 Second dose of GARDASIL given to 8/26/2009 Syncopal episode after receiving TD 8/25/2009 8/24/09 around 1:30pm after I gave 8/28/2009 Red, Rash on left upper arm, warm 8/28/2009 11:30am-Pt was given Tdap, HPV, 8/28/2009 Patient received FLu Mist on 25Aug 8/28/2009 The pt developed fever later in the d 8/28/2009 Mother called stating child had red s 8/28/2009 7/9/2009 Associate reports cold sx , 8/28/2009 Pt's mom called and says that expi 8/28/2009 Pt presented to clinic 2 days after a 8/28/2009 Chills, sweats, body aches, light-hea 8/28/2009 Received pneumovax at about 10am 8/28/2009 Patient developed hives and itching 8/28/2009 No adverse events noted to date. 8/28/2009 None noted at present. But client go 8/28/2009 NO Adverse Events to date. 8/28/2009 Tired, sleepy after vaccines. 2 am 8/28/2009 Patient presented on 8/27/09 with re
355869 355870 355871 355872 355873 355874 355875 355876 355877 355878 355879 355880 355881 355882 355883 355884 355885 355886 355887 355901 355902 355903 355904 355905 355906 355910 355911 355913 355914 355916 355917 355919 355934 355935 355936 355937 355938 355939 355941 355942 355943 355944 355945 355946 355947 355948 355949 355950 355951 355952 355888
8/28/2009 AR 8/28/2009 MI 8/28/2009 VA 8/28/2009 IL 8/28/2009 WA 8/28/2009 WI 8/28/2009 WI 8/28/2009 NC 8/28/2009 CA 8/28/2009 OK 8/28/2009 UT 8/28/2009 NY 8/28/2009 AZ 8/28/2009 ID 8/28/2009 TX 8/28/2009 AK 8/28/2009 OH 8/28/2009 TX 8/28/2009 MO 8/28/2009 CA 8/28/2009 WA 8/28/2009 PA 8/28/2009 WA 8/28/2009 ND 8/28/2009 IA 8/28/2009 MA 8/28/2009 OH 8/28/2009 NE 8/28/2009 MI 8/28/2009 NY 8/28/2009 NM 8/28/2009 GA 8/28/2009 MA 8/28/2009 AZ 8/28/2009 OR 8/28/2009 AZ 8/28/2009 NC 8/28/2009 MA 8/28/2009 CO 8/28/2009 MA 8/28/2009 MA 8/28/2009 MA 8/28/2009 PA 8/28/2009 WA 8/28/2009 8/28/2009 MN 8/28/2009 TX 8/28/2009 IN 8/28/2009 MA 8/28/2009 VA 8/29/2009 NY
4 8 4 76 82 17 35 5 63 16 28 63 11 71 14 25 15 6 17 10 0.5 5 19 51 12 15 12 12 17 11 73 3 13 11 11 5 63 90 15 11 11 12 69 48 4 68 17 5 11 5 5
4 8 4 76 82 17 35 5 63 16 28 63 11 71 14 25 15 6 17 10 0 5 19 51 12 15 12 12 17 11 73 3 13 11 11 5 63 90 15 11 11 12 69 48 4 68 17 5 11 5 4
F M F F F M F M F F F F M F F F F M F M 0.5 M F F M F F F M F F M F F F M F M F F F M M F F F F F M M M M
8/28/2009 NO ADVERSE EVENTS TO DATE 8/28/2009 Patient left the office and came imm 8/28/2009 Swelling of Left arm & shoulder and 8/28/2009 Client recieved Pnuemovax 23 Rt a 8/28/2009 Patient took 2nd dose of Vivotif on e 8/28/2009 Fainting on and off for about 20 min 8/28/2009 8/19 2:30 noticed itching, 3:00 notic 8/28/2009 2 TO 3 MINUTES AFTER RECEIVI 8/28/2009 Pox-like structure on the arm where 8/28/2009 None noted 8/28/2009 The pneumvax vaccine was adminis 8/28/2009 Tenderness, pruitic, macular rash a 8/28/2009 After vaccination parent and child le 8/28/2009 Client called EIPHD on 8/27/09 repo 8/28/2009 8/25/2009: VZV#2 given SQ to Righ 8/28/2009 Pt had a left leg pain withing hours a 8/28/2009 between shot 2 and 3 started having 8/28/2009 The patient was seen 2 days after th 8/28/2009 Developed migrane headache 8/27/2009 1605 Administered Hep A and VZV 8/28/2009 10/31/08 Pt seen in office for vomiti 8/28/2009 TC received by grandmother; states 8/20/2009 Patient developed ASCUS PAP and 8/28/2009 Child broke out with pox-like rash a 8/27/2009 Patient was given ADACEL first with 8/28/2009 8/24 afternoon- pt received vaccine 8/27/2009 Patient had low grade fever and hea 8/28/2009 Large welt measuring 4x3 on back o 8/27/2009 Joint swelling to include digits, knee 8/27/2009 When child woke up next morning a 8/28/2009 Stated the night of 25 Aug 09 she d (L) thigh erythematous w/ clearing p 8/28/2009 Pt. had nasal flu mist. Fell back in w 8/28/2009 Patient received MENACTRA 0.5cc 8/28/2009 11x18 cm area of well demarcated e 8/28/2009 Left deltoid swelling, red, hot touch. 8/28/2009 About 2 hrs following vaccine he aw 8/28/2009 full blown case of Zost 2 wks after 8/28/2009 After administration GARDASIL pt w Tdap expired on 5/2/09 and was ad Tdap expired 5/2/09 and was admin Tdap expired on 5/2/09 and was ad 8/24/2009 Pt had herpes zoster outbreak. 8/27/2009 Swollen lymph nodes under right ar 8/28/2009 Pt. given vaccines on 8/24/2009; ca 8/28/2009 Severe swelling and redness down 8/28/2009 Collar bone sore. Bump on left side 8/21/2009 Large amt swelling next AM redness 8/28/2009 Pt. Received vaccines in office. Whe 8/29/2009 8-18-09 Erythema, swelling at site. T 8/29/2009 24 hours after vaccination the patien
355889 355892 355893 355894 355912 355896 355897 355898 355899 355900 355971 355976 356000 356001 356002 356003 356005 356010 356026 356029 356030 356031 356032 356033 356034 356035 356036 356037 356038 356039 356040 356041 356042 356043 356044 356046 356047 356048 356049 356050 356051 356052 356053 356054 356055 356056 356057 356058 356059 356060 356061
8/29/2009 NY 8/29/2009 PA 8/29/2009 CA 8/29/2009 CA 8/29/2009 NE 8/30/2009 OH 8/30/2009 LA 8/30/2009 CA 8/30/2009 AZ 8/30/2009 CA 8/31/2009 NJ 8/31/2009 NJ 8/31/2009 OH 8/31/2009 8/31/2009 IN 8/31/2009 IN 8/31/2009 OH 8/31/2009 8/31/2009 AZ 8/31/2009 AZ 8/31/2009 OH 8/31/2009 OH 8/31/2009 8/31/2009 LA 8/31/2009 NE 8/31/2009 LA 8/31/2009 IL 8/31/2009 CA 8/31/2009 WI 8/31/2009 TX 8/31/2009 MO 8/31/2009 AZ 8/31/2009 OR 8/31/2009 MI 8/31/2009 ID 8/31/2009 FL 8/31/2009 TX 8/31/2009 NY 8/31/2009 MI 8/31/2009 GA 8/31/2009 FL 8/31/2009 MI 8/31/2009 MN 8/31/2009 TX 8/31/2009 IL 8/31/2009 GA 8/31/2009 NY 8/31/2009 MI 8/31/2009 MO 8/31/2009 CA 8/31/2009 MO
11 65 0.5 15 5 21 8 62 32 62
11 65 0 15 5 21 8 62 32 62
31 70
31 70
12 16 15 7 4 18 13 17 12 5 77 4 17 4 3 16 53 18 5 4 26 3 14 19 74 35 37 4 15 39 31 15 48 61 15
15 7 4 18 13 17 12 5 77 4 17 3 16 53 18 5 4 26 3 14 19 73 35 37 4 15 39 31 15 48 61 15
M F 0.5 F F M M M F M M M M F F M U F F F M M F F F F F F M M M M F M F M F M M F M F F F M M F F F F M M
8/29/2009 Pt. complained that he wasn't feelin 8/29/2009 Patient received the vaccine today a 8/29/2009 Fever to 103 degrees 8/29/2009 fatigue, fainting, dizziness and seizu 8/28/2009 (L) upper thigh swollen to softball si 8/30/2009 Constant tingling in right hand. Red 8/30/2009 Hives. Received Dexamethasone IM 8/30/2009 Week of NOv. 24th did not have ene 8/30/2009 Vaccine was given on a Wednesday 8/30/2009 Vaccinated 8/28/09 about 4 p.m. Fi 5/12/2009 Expired vaccine used (expired drug 5/12/2009 Expired vaccine used (Expired drug 8/26/2009 This case was received from a heal 8/27/2009 Initial report received on 18 August 8/27/2009 Initial information received on 19 Au 8/27/2009 Initial report was received 19 Augus 8/27/2009 Initial report was received 24 Augus 8/28/2009 Information has been received via in 8/28/2009 Information has been received from 8/23/2009 Daily intermittent headaches, fatigu 8/25/2009 Received vaccines and left office to 8/27/2009 My daughter had the series of GAR 8/25/2009 My daughter received all three injec 8/20/2009 See copies of pt's record 7/31/09. 8 8/26/2009 Local redness & swelling at injection 8/26/2009 Rash 5 days after shot around site r 8/27/2009 Headache started shortly after injec 8/27/2009 Pt began to swell on (LF) leg. 8/26/2009 Client received MCV4 and TDAP. A TM 101 at 50 + hrs after injection w 8/28/2009 Gave client TD by mistake. Should 8/27/2009 Developed fever of 100 last night an 8/21/2009 Pt reported "rash on abd and groin a 8/25/2009 Urticaria. Rx BENADRYL 25 mg P. 8/28/2009 Swelling in R thigh, redness - tende 8/28/2009 Guillan - Barre syndrome. Respirat 8/31/2009 Onset of pruritic and painful papular 8/28/2009 Large area of erythema and blisters 8/31/2009 Patient presented in the office on 8/ 8/31/2009 large erythematous edematous patc 8/31/2009 Headache, Fever, Facial Swelling, H 8/31/2009 Inflammation a few days after vaccin 8/31/2009 Redness with orange peel texture, s 8/31/2009 Swollen red left arm. hot sensation 8/31/2009 Approx. 10 minutes after receiving T 8/31/2009 Toxic Drug reaction; Severe dehydr 8/31/2009 Sore and numbness in arm 8 hours 8/31/2009 Client became lightheaded, pale an 8/31/2009 Patient received vaccination at prim 8/31/2009 Adverse reaction to Shingles vaccin 8/24/2009 Reaction started 45 minutes after T
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8/31/2009 MI 8/31/2009 MI 8/31/2009 AR 8/31/2009 VA 8/31/2009 MN 8/31/2009 MO 8/31/2009 TN 8/31/2009 OR 8/31/2009 GA 8/31/2009 CA 8/31/2009 WA 8/31/2009 WA 8/31/2009 OH 8/31/2009 IN 8/31/2009 CA 8/31/2009 IN 8/31/2009 IN 8/31/2009 IN 8/31/2009 AZ 8/31/2009 WI 8/31/2009 OH 8/31/2009 NE 8/31/2009 FL 8/31/2009 IA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CA 8/31/2009 CO 8/31/2009 IL 8/31/2009 PA 8/31/2009 VA 8/31/2009 IA 8/31/2009 NJ 8/31/2009 MT 8/31/2009 MA 8/31/2009 IN 8/31/2009 NH 8/31/2009 NC 8/31/2009 NC 8/31/2009 IN 8/31/2009 WI 8/31/2009 SC 8/31/2009 VA 8/31/2009 OH 8/31/2009 TX 8/31/2009 AZ 8/31/2009 IN 8/31/2009 OR 8/31/2009 8/31/2009 IL
9 61 6 4 36 32 32 2 13 4 82 70 0.3 1 4 14 29 62 15 14 34 12 4 31 4 63 4 0.5 9 5 61 5 4 16 5 5 20 0.4 16 38 1.9 5 0.4 44 19 15 52 0.6 17 8 2
9 61 6 4 36 32 32 3 13 4 82 70 0 1 5 14 29 62 15 14 34 12 4 31 4 63 4 0 9 5 61 5 4 16 5 5 20 0 16 38 5 0 44 19 15 52 0 17 8 2
F F M F F M M M F M F M 0.4 M 0M M F F F F F M F F F F M F 0.5 F F F F F M F M F F 0.4 F F F F M 0.4 F F F F F 0.6 F F U 0F
8/31/2009 24 HOURS AFTER SHOTS SHE BR 8/31/2009 24 hours after vaccination patient de 8/31/2009 Within an hour after receiving immu 8/31/2009 6 days after vaccines were given pa 8/31/2009 Flu shot received 08/24/09 @ 10:30 8/31/2009 Shortly after receivcing vaccinations 8/31/2009 swelling of lower lip, soreness of thr 8/31/2009 Redness, heat, swelling and discom 8/31/2009 Patient received vaccine on 8/17/09 8/31/2009 CELLULITIS RIGHT THIGH. KEFLE 8/31/2009 redness at the site of injection. the r 8/31/2009 Maculopapular rash of trunk and ex 8/31/2009 urticarial rash 5 minutes following P 8/31/2009 <20 red papules on trunk, not itchy, 8/31/2009 none 8/31/2009 MOTHER REPORTED CHILD HAD 8/31/2009 Patient complains of severe pain in 8/31/2009 chills, sweats, body ache, difficulty s 8/31/2009 After receiving vaccine daughter c/o 8/27/2009 N, stomach, dizzy, HA, backache, c 8/31/2009 Headache, tiredness, nausea, diarrh 8/31/2009 Area around injection site red & bum 8/31/2009 8-31-09 mother phoned, client ok ev 8/31/2009 Severe myalgia - fatigue - started 8/ 8/28/2009 Pt received vaccine on 8-26-09 on 8 8/31/2009 Fever to 103 F with shaking chills da 8/31/2009 None Stated 8/31/2009 Infant developed edema, redness/p 8/31/2009 VARIVAX administered 8/28/09 to R 8/28/2009 Redness, swelling & induration at in 8/31/2009 Injection site reaction (redness; abo 8/14/2009 Approximately 36 hours after vax ad 8/28/2009 Pt began having rash on leg admini 8/31/2009 Headache, fatigue. Local swelling, r 8/21/2009 Pt. returned to clinic 20 minutes afte 6/25/2009 See attached 8/25/2009 Fever 100.4, chills, H/A, swollen lips 8/24/2009 Post vaccine fever. Temperature ele 8/25/2009 Per pts. mother, pt. started experien 8/26/2009 Shots given and instructed to use co 8/24/2009 Mild case of chicken pox. 8/5/2009 Noted orange sized, red, hard, warm 8/24/2009 Diarrhea/ Hematocrit leading to sev Pt received TDAP (BOOSTRIX) on 8/25/2009 Patient called our office 4 hours afte 8/12/2009 Jerking, shaking, "locked up" (2 min 8/24/2009 By 08/22/09 around 3:30 pm there w 8/21/2009 Temp up to 105 degrees duration 2 8/24/2009 Pt had HPV, Hep A, & Verasella. S Swelling of LA, red, hot. 8/31/2009 Presented to office with rash - Bega
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8/31/2009 OH 8/31/2009 CA 8/31/2009 MD 8/31/2009 WV 8/31/2009 8/31/2009 AZ 8/31/2009 OR 8/31/2009 OR 8/31/2009 AZ 8/31/2009 MN 8/31/2009 LA 8/31/2009 FL 8/31/2009 NC 8/31/2009 MS 8/31/2009 CA 8/31/2009 LA 8/31/2009 OR 8/31/2009 OR 8/31/2009 IL 8/31/2009 8/31/2009 FL 9/1/2009 TX 9/1/2009 ME 9/1/2009 PA 9/1/2009 MI 9/1/2009 MS 9/1/2009 TN 9/1/2009 FL 9/1/2009 OH 9/1/2009 MD 9/1/2009 9/1/2009 OH 9/1/2009 TX 9/1/2009 WA 9/1/2009 NJ 9/1/2009 9/1/2009 OK 9/1/2009 TX 9/1/2009 AZ 9/1/2009 CA 9/1/2009 MT 9/1/2009 CA 9/1/2009 OH 9/1/2009 HI 9/1/2009 HI 9/1/2009 LA 9/1/2009 OK 9/1/2009 ID 9/1/2009 WA 9/1/2009 TX 9/1/2009 GA
9 4 65 5 37 8 1.1 1.1 4 11 0.5 30 15 5 20 1.1 55 10 80 71 2 54
9 4 65 5 37 8 1 1 4 11 0 30 15 5 20 1 55 10 80 71 2 54
1.7 18 5 0.2 48 9 7 6 49 11 12 6 0.5 0.6
1 18 5 0 48 9 7
17 19 18 1.7 5 12 11 56 10 11 54 12
17
49 11 12 6 0
18 1 5 12 11 56 11 54 12
F F F M F M 0.1 M 0.1 M M M 0.5 M M F F M 0.1 F F M F F 0.4 M F F 0.7 M M F 0.2 F F F M M M F F F U 0.6 M F M F F 0.7 F M F F F M F F F F
8/28/2009 Erythema & swelling upper arm (16 8/28/2009 Skin rash & swelling 6x7 cm. Requir 8/24/2009 PNEUMOVAX 8/17/09 developed h 8/26/2009 Pt received Hep A vaccine on 8/25/ 8/26/2009 Developed suddenly around 21 May 8/24/2009 Left arm 6 inch erythematous area. 8/21/2009 Fever, vomiting. 5 cm swelling and e 8/21/2009 Fever, vomiting, diarrhea, and fussin 8/26/2009 Slight swelling and redness to inject 8/31/2009 Rash, low grade fever, fatigue, head 8/21/2009 Fever 103 degrees. Lt thigh swollen 8/26/2009 2-3 day after flu like symptoms, leth 8/24/2009 After administration of GARDASIL v 8/19/2009 Pt. displayed redness at the site of i 12 days following vaccination pt dev 8/12/2009 Rash. Fussiness. 8/10/2009 8/10/09 - Pt in for HEP B #3 - Repo 8/18/2009 Pt was given MENACTRA before he 8/31/2009 Back & thigh pain within 24 hrs afte 8/31/2009 Cold sores 8/27/2009 Parent reported increased swelling 9/1/2009 Shingles Vaccine on Left arm: 1st d 8/26/2009 Was admin. 8/21/09. Noticed reactio 8/27/2009 Left thigh became red and swollen o 8/21/2009 24 hours after vaccine broke out in 8/25/2009 Rash - red, raised - to chest, back, s 8/26/2009 See attached sheets. 8/27/2009 This spontaneous case was receive 8/31/2009 Information has been received from 8/31/2009 Swelling in (L) arm - site of where va 8/31/2009 Information has been received from 8/24/2009 Approx 9-10:00pm on day of immun 8/24/2009 Both vaccines administered in same 8/24/2009 Presented to clinic 4/30/07 with 2d m 8/29/2009 Mother states patient ran a fever of 8/31/2009 Information has been received from 8/20/2009 Stop sleeping nights, fever, irritabilit 8/24/2009 None 8/28/2009 Patient had Varicella vaccination ab 8/31/2009 Information has been received from 8/27/2009 Pt. given Hep A VFC, instead of He 8/26/2009 Pt received vaccine on 8/14/09. Pt 8/25/2009 Pt. broke out in a rash, swelling, vom 8/28/2009 Fever to 102, night of GARDASIL # 8/28/2009 Fever to 102, night of GARDASIL a None. 8/26/2009 None stated. Pt received hep A (L deltoid) and AD 8/26/2009 Redness and swelling of injection si 8/24/2009 Both arms between shoulders and e 7/21/2009 I received the shingles vaccine on 2
356210 356211 356212 356213 356214 356215 356216 356217 356218 356219 356220 356221 356222 356223 356224 356225 356226 356227 356228 356229 356230 356231 356232 356233 356234 356235 356236 356237 356240 356241 356242 356243 356244 356245 356246 356247 356248 356249 356250 356251 356252 356253 356254 356255 356256 356257 356259 356260 356261 356262 356263
9/1/2009 9/1/2009 IL 9/1/2009 WV 9/1/2009 NC 9/1/2009 FL 9/1/2009 9/1/2009 VA 9/1/2009 NC 9/1/2009 NC 9/1/2009 NJ 9/1/2009 NY 9/1/2009 WA 9/1/2009 VA 9/1/2009 CO 9/1/2009 LA 9/1/2009 WI 9/1/2009 MA 9/1/2009 VT 9/1/2009 MA 9/1/2009 PA 9/1/2009 GA 9/1/2009 MN 9/1/2009 PA 9/1/2009 WI 9/1/2009 WI 9/1/2009 OK 9/1/2009 MS 9/1/2009 TX 9/1/2009 GA 9/1/2009 IL 9/1/2009 MD 9/1/2009 NE 9/1/2009 ID 9/1/2009 MS 9/1/2009 KY 9/1/2009 TX 9/1/2009 DE 9/1/2009 MI 9/1/2009 AZ 9/1/2009 IL 9/1/2009 IL 9/1/2009 GA 9/1/2009 NH 9/1/2009 PA 9/1/2009 NY 9/1/2009 KY 9/1/2009 OH 9/1/2009 MI 9/1/2009 OH 9/1/2009 MA 9/1/2009 IA
11 68 14 46 15 34 37 4 10 11 21 11 60 4 12 12 17 46 1 0.2 4 5 12 12 1 25 17 77 20 14 73 5 11 0.1 14 1 4 3 48 32 78 13 12 1 0.3 5 1 7 6 4 0.3
11 14 46 15 34 37 4 10 11 21 11 60 4 12 12 17 46 1 0 4 5 12 12 1 25 17 77 20 14 73 5 11 0 14 1 4 3 48 32 78 12 1 0 5 1 7 6 4 0
F F F F F M M F M M F M F M M M F F 0M 0.2 F M F F M 0M M F F F F F M M 0.1 F F 0M F M F F F M M 0M 0.3 F M 0.1 F F M M 0.4 F
8/30/2009 Female vaccinated with GARDASIL 8/30/2009 Vaccinated with ZOSTAVAX for shin 8/20/2009 Fainting/feeling hot. Placed patient 9/1/2009 Received ADACEL 8/27/09 - 8/28/0 8/21/2009 On 8/10/09 - 7 pm client taken to ER 8/31/2009 On 27 April 2009 he received AVA # 8/27/2009 This 37 year old AD US Navy office 9/1/2009 No adverse symptoms noted. 9/1/2009 Swelling redness pain warmth of lef 8/28/2009 Within 1 hour child developed angry 8/26/2009 Pt. developed chills, fever, SOB afte 8/27/2009 Telephone call from parent reporting 8/26/2009 24 hours after receiving vaccine, be 8/26/2009 Erythema and inflammation onset a 8/17/2009 About 30 min - 1 hr after vaccines p 8/27/2009 Passed out. Stomach pain. 8/27/2009 Near syncope - some chest pain & d 8/25/2009 HA, neck stiffness, myalgias and pa 8/26/2009 Developed <12 erythematous papul 8/27/2009 Hep B-dose #3 given at age 8 wks b 8/27/2009 Swelling, inflammation, bruising, wa 8/27/2009 Redness, warmth, slight bruising to 8/27/2009 Left deltoid area redness, itching wi 8/27/2009 Passed out. Stomach pain. 8/26/2009 Local hypersensitivity reaction to MM 8/20/2009 Isolated pox developed on right foot 7/23/2009 Severe headache with fever 100 de 8/28/2009 Shot on 8/19/09. Next day large red 9/1/2009 This case was reported by a healthc 9/1/2009 Patient received HPV #3 on 07/13/0 Dizziness (within 10 minutes of FLU 9/1/2009 Erythema multiforme within 24 hour 9/1/2009 A couple hours after vaccines L side 9/1/2009 Student Nurse gave vaccines to you 8/20/2009 Extreme fatigue- persistent, precede 9/1/2009 Net like rash, itching, 12 days after 9/1/2009 Mother reported high fever and fron 8/31/2009 Approx. 10-20 minutes after receivin 8/31/2009 Persistent pain; numbness in injecti 9/1/2009 Symptoms of feeling overheated, ta 9/1/2009 After receiving her shots pt c/o shor 9/1/2009 Within 2-4 days of receiveing menac 9/1/2009 Per patient and mother, Shad felt "fu 9/1/2009 Ryan (22 pounds, 7 oz; 31 inches) h 9/1/2009 Intussusception. Failed reduction. R 9/1/2009 Patient had high fever spikes of 104 8/31/2009 Within three days had head to toe ra 9/1/2009 According to mom approximately 59/1/2009 Developed hives around injection si 9/1/2009 Varicella and MMR vaccines given o 9/1/2009 After my daughter's 4mo check up a
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9/1/2009 IL 9/1/2009 FL 9/1/2009 KS 9/1/2009 VA 9/1/2009 PA 9/1/2009 NJ 9/1/2009 MN 9/1/2009 OH 9/1/2009 NC 9/1/2009 AL 9/1/2009 UT 9/1/2009 AL 9/1/2009 CA 9/1/2009 IL 9/1/2009 MD 9/1/2009 IL 9/1/2009 CO 9/1/2009 NC 9/1/2009 WA 9/1/2009 LA 9/1/2009 UT 9/1/2009 CA 9/1/2009 VA 9/1/2009 GA 9/1/2009 CA 9/1/2009 NY 9/1/2009 AL 9/1/2009 TX 9/1/2009 NE 9/2/2009 WI 9/2/2009 AL 9/2/2009 OK 9/2/2009 OH 9/2/2009 NM 9/2/2009 TX 9/2/2009 PA 9/2/2009 PA 9/2/2009 NC 9/2/2009 IN 9/2/2009 IL 9/2/2009 NC 9/2/2009 NC 9/2/2009 NC 9/2/2009 VA 9/2/2009 LA 9/2/2009 ID 9/2/2009 VA 9/2/2009 AZ 9/2/2009 WA 9/2/2009 KY 9/2/2009 VA
0.5 16 18 8 9 11 73 20 72 5 5 10 70 8 56 12 16 48 24 13 15 74 61 1 30 1.8 61 0 2 15 70 12 50 13 4 14 14 43 17 25 12 16 5 55 13 12 11 93 0.3 4 0.8
0 16 18 8 9 11 20 72 5 5 10 70 8 56 12 16 48 24 13 15 74 61 1 30 1 61 0 15 70 12 50 13 4 14 14 43 17 25 12 16 5 55 13 12 11 93 0 4 0
0.5 F F F F F M F F F F F F F M F M F F M F M F F 0F M 0.8 M F 0F M F F F F F M M M F F F F M F F F U M F 0.3 F F 0.8 M
9/1/2009 received vaccineson 8/4/09. On 8/6 9/1/2009 Bell's palsy (unilateral). 9/2/09 Cons 9/1/2009 Patient fainted and fell to floor hittin 9/1/2009 Received Hep A and Flumist, left ro 9/1/2009 Child received TD, IPV,HEP A,MMR 8/31/2009 syncope, occured about 2 min after 9/1/2009 Subject in pneumococcal vaccine tr 9/1/2009 Severe leg cramps in the calves 9/1/2009 Patient reports a rash, fever and he 9/1/2009 Had a rash with blisters over some p 9/1/2009 Patient came to clinic on 8-17-09 co 9/1/2009 On 8/21/09 Mother reported child ha 9/1/2009 10 cm x 6.5cm mild erythema left ar 9/1/2009 1 day following varicella administrat 9/1/2009 client had twinrix vaccine (3rd dose) 9/1/2009 4 cm erythematous oval shaped are 9/1/2009 Patient administered Hep A and HP 9/1/2009 Approximately 10-12 hours after rec 9/1/2009 Pt had satellite lesions 1/2 an inch t 9/1/2009 Stiffening and aching muscles, ches 9/1/2009 HIGH FEVER 102.4, HEADACHE 9/1/2009 pt recevied flu shot on left arm,and 9/1/2009 Her whole arm(on which vaccine wa 9/1/2009 Approx. 4 hours after receiving MMR 9/1/2009 Vertigo and stomach cramps beginn 9/1/2009 Superficial skin reaction occurred th 9/1/2009 Zoster L chest 9/1/2009 Dr. went did physical & came out th 8/18/2009 A serious, spontaneous report of me 8/27/2009 Lg reddened area - Warm & itchy rt 9/1/2009 Information has been received from 9/1/2009 Information has been received from 8/11/2008 I received 2 of the 3 HEPATITIS B V 8/25/2009 Aggression, seizures, rapid heart ra 8/27/2009 Swelling and erythema to site; exten 8/28/2009 After receiving immunizations at offi 8/26/2009 None stated 8/28/2009 Patient went to ER 8/13/09 with com 8/25/2009 Bradycardia, arrythmias, heart block 8/28/2009 More than normal bleeding at time o 8/25/2009 Angioedema 8 cm on right posterior 8/25/2009 Angioedema noted in right posterior 8/25/2009 Erythema on right arm - posterior 3 8/25/2009 Fever, chill, muscle pain all over, bo 8/27/2009 Severe hair loss. Headaches. 10/14 Broke out in rash on 8/18/09, seen i 8/29/2009 Pt developed chickenpox 10 days a 9/2/2009 Face swollen, eyes swollen, itching 8/28/2009 Day of vaccine administration, patie 8/27/2009 Localized reaction at site of injection 8/28/2009 Approx < 2 hrs after HEP B vaccine
356350 356351 356352 356353 356354 356355 356356 356357 356358 356359 356360 356361 356362 356363 356364 356365 356366 356368 356369 356370 356371 356372 356373 356374 356375 356376 356377 356378 356379 356381 356382 356383 356384 356385 356386 356387 356388 356389 356390 356391 356392 356394 356395 356396 356397 356398 356399 356400 356401 356402 356403
9/2/2009 CO 9/2/2009 CO 9/2/2009 MI 9/2/2009 IL 9/2/2009 TX 9/2/2009 NJ 9/2/2009 MN 9/2/2009 NV 9/2/2009 AL 9/2/2009 MO 9/2/2009 IA 9/2/2009 IN 9/2/2009 VA 9/2/2009 TN 9/2/2009 MI 9/2/2009 TX 9/2/2009 WA 9/2/2009 SC 9/2/2009 MI 9/2/2009 OR 9/2/2009 WA 9/2/2009 MA 9/2/2009 NJ 9/2/2009 VA 9/2/2009 NV 9/2/2009 WA 9/2/2009 CA 9/2/2009 OK 9/2/2009 NJ 9/2/2009 NC 9/2/2009 PA 9/2/2009 PA 9/2/2009 WA 9/2/2009 AK 9/2/2009 CO 9/2/2009 TX 9/2/2009 OH 9/2/2009 OR 9/2/2009 CA 9/2/2009 NM 9/2/2009 NM 9/2/2009 OH 9/2/2009 CA 9/2/2009 TX 9/2/2009 ME 9/2/2009 NY 9/2/2009 IL 9/2/2009 SC 9/2/2009 IN 9/2/2009 WI 9/2/2009 TX
56 80 8 34 4 56 17 59 47 0.2 43 41 4 32 6 31 46 54 1.3 32 1.3 13 12 0.6 62 61 61 65 0.2 0.3 0.2 11 56 12 76 11 51 17 12 17 3 7 13 10 0.3 1.3 62 2 14
8 34 4 73 56 17 59 47 0 43 41 4 31 6 31 46 54 1 32 1 13 12 0 62 61 60 65 0 0 0 56 12 76 11 51 17 12 17 3 7 13 10 0 1 62 2 14
U U F M M F F F F F 0.2 F F F M F M M F F 0.3 F M 0.3 M F F 0.6 M F F F M 0.2 F 0.3 M 0.2 M M F F F M F U F F F M F F F 0.3 F 0.3 M M 0.2 M F
Reported general malaise - Temp u Reported: Didn't feel good, shaky, a 9/1/2009 Behavior changes with in 1-2 days. 9/2/2009 PAIN, ITCHING, REDNESS AND S 9/2/2009 Within 12 hours of flu shot injection 9/2/2009 nausea, Vomiting, throat tightness w 9/2/2009 At the time of the vaccination, she fe 9/2/2009 Sore arm evening of vaccination. W 9/2/2009 Employee developed large welped, 9/2/2009 The day after vaccine was administe 9/2/2009 Generalized tonic clonic seizure as 9/2/2009 Received shot in clinic around 2:00 9/1/2009 Patient experienced wheezing and c 9/2/2009 Administered PENTACEL vaccine in 9/2/2009 8/5/2009 Soreness of Right upper a 9/2/2009 SITE OF INJECTION IS SWOLLEN 9/2/2009 Patient inadvertantly innoculated sp 9/2/2009 Recieved Tdap in L deltoid on 08/29 9/2/2009 Induration and redness/swelling in a 9/2/2009 Diffuse urticaria after receiving DTa 9/2/2009 Patient with pustular lesions on eryt 9/2/2009 My child suffered severe reactions t 9/2/2009 About 5 minutes after receiving Gar 9/2/2009 Outbreak of pruritic small papules o 9/2/2009 Vaccines were given and we left Dr 9/2/2009 Patient reports that she had a Shing 9/2/2009 developed "headache,chills, fever o 9/2/2009 Pt developed 5 painful, fever blister 9/2/2009 Patient had pneumovax 9 am on 8/2 9/2/2009 Patient developed fever of 104 in th 8/24/2009 Patient developed abdominal disten 8/24/2009 Increased number of apneic and bra 9/2/2009 Swelling & redness in right arm. 9/1/2009 Patient was given 0.5 mL of flu vacc 9/12/2009 Pt given flu shot (told to hang aroun 9/2/2009 Patient developed large rash that sh 9/1/2009 11 am 8/31/09 vaccines administere 9/2/2009 Redness, warmth in shoulder and s Redness, swollen tender to touch. 9/2/2009 Pt had nausea & vomiting after GAR 9/2/2009 Right arm red, swollen. 9/1/2009 Pt got GARDASIL # 3 given as injec 9/2/2009 Erythema, edema, hyperemia meas 9/2/2009 Cough, runny nose congestion snee Imm Friday- Saturday had fever 10 9/2/2009 FEVER ONSET 9/1 at 9PM,CHILLS 9/2/2009 7/2/09 irritable since 7/01/09 noc ; d 9/2/2009 Patient administered PCV, Hep A, a Rash, hives, tongue swelling, itching 9/2/2009 Approximately 1/2 hr. after receiving 8/31/2009 Redness and swollen right arm. AU
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9/2/2009 WA 9/2/2009 NC 9/2/2009 TN 9/2/2009 WA 9/2/2009 OR 9/2/2009 IL 9/3/2009 HI 9/3/2009 OR 9/3/2009 9/3/2009 CA 9/3/2009 VA 9/3/2009 CA 9/3/2009 9/3/2009 KY 9/3/2009 NC 9/3/2009 MI 9/3/2009 KY 9/3/2009 IN 9/3/2009 FL 9/3/2009 PA 9/3/2009 NJ 9/3/2009 AR 9/3/2009 VA 9/3/2009 ND 9/3/2009 PA 9/3/2009 PA 9/3/2009 NC 9/3/2009 NY 9/3/2009 IL 9/3/2009 OR 9/3/2009 CA 9/3/2009 NJ 9/3/2009 TX 9/3/2009 WI 9/3/2009 CA 9/3/2009 ND 9/3/2009 MI 9/3/2009 9/3/2009 NV 9/3/2009 NE 9/3/2009 CA 9/3/2009 CA 9/3/2009 MI 9/3/2009 TX 9/3/2009 MA 9/3/2009 CA 9/3/2009 AZ 9/3/2009 WA 9/3/2009 GU 9/3/2009 WA 9/3/2009 CO
19 11 15 47 46 33 21 18 72 19 25 19 18 0.2 11 65 17 0.7 20 56 4 41 16 35 65 16 18 42 16 62 11 0.8 65 39 15 11 2 17 15 12 3 4 51 72 3 4 41 0.7 0.3 11 57
19 11 15 47 46 21 18 19 24
0 11 65 17 0 20 56 4 41 16 35 65 16 18 42 15 62 11 0 65 39 15 11 1 17 15 12 3 4 51 72 3 4 41 0 0 11 57
M M M F F F M M M F F F F 0.2 M F F F 0.7 F M F F F F F F M F F F F F 0.8 F M M F M 1M F F F M F F F M F F 0.7 F 0.3 M F M
9/2/2009 19 y/o male, US Army AD PFC, dev 9/2/2009 Pt presented. Was given TDAP. W 8/19/2009 Arthalgia of joints. Stiffness of extre 9/2/2009 Severe Bruising. 9/2/2009 Severe GI, vomiting, diarrhea. Neg 9/6/2009 Received Hep B vaccine IM @ 08:3 9/3/2009 The patient was febrile to 102.1 with 8/28/2009 Edema of lips, red eyes, hives on ar 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 Information has been received from 9/2/2009 This case was received from a heal 9/3/2009 No known adverse Y reactions. Aunt r 9/3/2009 CHILD RETURNED WITH MOTHER 9/3/2009 Received Influenza and PPV23 vac 9/3/2009 Recieved menactra on june 24 2009 9/3/2009 That evening the child became cong 9/3/2009 After receiving Hepatitis A vaccine p 9/3/2009 began developing symptoms approx 9/3/2009 Red, raised and very hot at site of s 9/3/2009 Tightness in throat, radiating to che 9/3/2009 Patient claims that she felt lighthead 9/3/2009 Member was administered the Anth 9/3/2009 Patient noticed a small red rash aro 9/3/2009 Fever 104 9/3/2009 A 3 cm round erythromatous indura 9/3/2009 The patient received the flu shot on 9/3/2009 patient lying on exam table. While ly 9/3/2009 PAINFUL, SWOLLEN, WARM TO T 9/3/2009 PT BECAME PALE, WEAK AND DI 9/3/2009 swelling, red and hot at the site, crie 9/3/2009 Patient received Pneumovax injectio 9/3/2009 Warmth, redness, pain at site of vac 9/3/2009 PT BECAME PALE, WEAK AND DI 9/3/2009 9/1/2009 Jonathan experienced a ra 9/3/2009 Pt developed rash on whole body, it 9/3/2009 Had seizure aporx 1 month after ha 9/3/2009 Fever per patient's mother (temp no 9/3/2009 About 2 weeks after vaccine admini 9/3/2009 Redness, swelling warmth to L thigh 9/3/2009 R arm red swollen warm "band" pos 9/3/2009 Pain in left tricep 1 hour following sh 9/3/2009 A 72 year old female came in to the 9/3/2009 The patient developed a headache 9/3/2009 DTap #5 administered to left Deltoid 9/3/2009 R Arm - site of injection swollen red 9/3/2009 Death. 9/11/09 Y Autopsy received DO 9/3/2009 Vomiting started within 2hrs after va 9/3/2009 Redness & swelling around site of in 9/3/2009 Fever, chills, aches, hard to move, h
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9/3/2009 PA 9/3/2009 VA 9/3/2009 CA 9/3/2009 NC 9/3/2009 TN 9/3/2009 IL 9/3/2009 DE 9/3/2009 CA 9/3/2009 WA 9/3/2009 WA 9/3/2009 CA 9/3/2009 NV 9/3/2009 AZ 9/3/2009 IL 9/3/2009 IN 9/3/2009 KY 9/3/2009 CO 9/3/2009 CA 9/3/2009 VA 9/3/2009 OR 9/3/2009 CO 9/3/2009 NC 9/3/2009 GA 9/3/2009 GA 9/3/2009 GA 9/3/2009 GA 9/3/2009 NY 9/3/2009 CA 9/3/2009 OR 9/3/2009 WA 9/3/2009 CA 9/3/2009 GA 9/3/2009 KS 9/3/2009 MN 9/3/2009 VA 9/4/2009 FL 9/4/2009 NY 9/4/2009 AR 9/4/2009 FL 9/4/2009 CA 9/4/2009 IL 9/4/2009 MO 9/4/2009 MO 9/4/2009 OR 9/4/2009 FL 9/4/2009 CT 9/4/2009 OH 9/4/2009 PA 9/4/2009 WI 9/4/2009 NM 9/4/2009 MD
12 12 1.7 15 14 5 60 5 1.1 1.1 4 22 11 62 50 1 3 11 19 51 16 1.8 23 19 11 18 15 4 3 0.3 54 11 66 65 49 0.2 13 62 26 4 11 11 68 15 12 71 5 69 45 13 8
12 12 1 15 14 5 60 5 1 1 4 22 11 62 50 1 3 11 19 51 16 1 23 19 11 18 15 4 3 0 11 66 65 49 0 13 62 26 4 11 11 68 15 12 71 5 69 45 13 8
M M 0.7 F M M M F M 0.1 F 0.1 M M F F F F 0M F M F U F 0.8 M F F M F F M M 0.3 F F F F F F 0.2 M M F M F F F U F F F M F F F F
9/2/2009 Fever x 1 day. Itching, vomiting x 1. 9/3/2009 Received VARIVAX # 2 on 08/31/09 9/3/2009 skin r thigh Erythemic rash with few 9/3/2009 Patient presented to office on 9/1/09 9/3/2009 Pain and soreness to left deltoid on 9/3/2009 Patient had reaction to shots give o 9/3/2009 Large rash at injection site, radiating 9/3/2009 Vaccine 8/27/09 8/29/09 Urticaria sw 9/3/2009 Quarter size hive at site of VARIVAX 9/3/2009 Quarter size hive @ site of Varicella 9/3/2009 Small rash all body with no SOB or 9/3/2009 Stiffness on left side of neck and the 9/3/2009 Patient had syncopal episode after 9/3/2009 Right arm hurts, patient says can't li 8/26/2009 Swollen, red, hot area - hard to mov 9/3/2009 Non febrile seizure on 9/12/2009. L 9/3/2009 Fever - 103 degrees, stomach-ache 9/1/2009 Received phone call from mother, c 9/3/2009 Pt. had generalized reaction at injec Pt reports onset of fever, chills & all 9/2/2009 Youth here today complaining of sw 9/4/2009 Immunizations were given 8-28-09. 6/17/2009 No adv s/sx. 7/1/2009 Client reported feeling weak and un 7/28/2009 Right arm swollen, red, and warm to 4/14/2009 MCV given in left deltoid at approxim 8/31/2009 Local reaction with varicella vaccine 9/3/2009 Left thigh 10 mm X 8 mm red, inflam 9/2/2009 Low grade fever started last night re 9/3/2009 Within day or two of vaccine started 9/3/2009 Urticaria around the injection site. P 8/17/2009 Swollen, red area where varicella va 9/1/2009 On 8/29/09- morning Pt noticed a sw 8/29/2009 Upper arm turned black/blue first nig Swelling erythema warmth around s 6/8/2009 Fever 101-105 w/in 24hrs of receivin 8/31/2009 Transverse myelitis of acute onset o 9/1/2009 Within 24 hrs I had a red rash at the 8/28/2009 Pt received MMR vaccine on 8/19/0 8/28/2009 Right deltoid swollen, red, warm to t 8/27/2009 By the evening. Child had redness, 8/27/2009 None stated. 9/15/09 PCP Medical With erythema, redness to (L) latera 8/29/2009 Within 1 hour of receiving the injecti 8/31/2009 Pt passed out while in hall after rece 9/1/2009 Pt diagnosed with shingles 9-1-09. 9/1/2009 Soon after vaccines petechial rash n 8/31/2009 Patient had redness and itching at t 8/31/2009 Urticarial rash beginning 2 days afte 8/31/2009 Mother reported hive-like eruption a 9/2/2009 Erythema of upper arm & few vesicl
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9/4/2009 MS 9/4/2009 OH 9/4/2009 NC 9/4/2009 NC 9/4/2009 OH 9/4/2009 MN 9/4/2009 KY 9/4/2009 MS 9/4/2009 9/4/2009 WI 9/4/2009 CA 9/4/2009 WI 9/4/2009 MI 9/4/2009 VA 9/4/2009 NY 9/4/2009 GA 9/4/2009 NY 9/4/2009 TN 9/4/2009 CA 9/4/2009 OH 9/4/2009 CA 9/4/2009 CA 9/4/2009 NJ 9/4/2009 MI 9/4/2009 MO 9/4/2009 AK 9/4/2009 MD 9/4/2009 VA 9/4/2009 VA 9/4/2009 IL 9/4/2009 KY 9/4/2009 TX 9/4/2009 CO 9/4/2009 TX 9/4/2009 KS 9/4/2009 IA 9/4/2009 IL 9/4/2009 ND 9/4/2009 PA 9/4/2009 TX 9/4/2009 TX 9/4/2009 WY 9/4/2009 WA 9/4/2009 IN 9/4/2009 GA 9/4/2009 IA 9/4/2009 GA 9/4/2009 TX 9/4/2009 KS 9/4/2009 TX 9/4/2009 CT
3 21 12 1 20 15 1 30
3 21 12 1 20 15 0 30
11 51 13 4 65 29 11 45 66 57 4 26 0.5 10 15 74 15 19 14 1.3 0.3 12 27 14 76 50 37 82 66 39 4
11 51 13 4 65 29 11 45 66 56 4 26 0 10 15 74 15 19 14 1 0 12 27 14 76 50 37 82 66 39 4 4 65 11 13 1 13 11 48 75 69 57
65 11 13 1.3 13 11 48 75 69 57
F F M 0F F F 1F F F M F M M F M M F M F M F 0F M F M F M M 0.3 M 0.4 F F F F F M F F F F M M F F M 0.3 M F F F F F F
4/24/2009 Hives and slight shortness of breath 8/31/2009 Given Td on 8/28/09 along with PPD 8/31/2009 Vesicular rash - 17 days post vaccin 9/4/2009 Received 12 month immunizations o 8/19/2009 8-14-09 - 8-19-09 pt c/o eye lids bei 8/28/2009 Large area of redness surrounding 8/31/2009 Hoarseness, diarrhea - 24 hours aft 9/3/2009 7/27 = vaccine. 8/3 = swollen lymph 9/3/2009 Information has been received from 9/4/2009 Travis received Intranasal Influenza 9/4/2009 patient experienced a deep aching p 9/4/2009 After receiving the Hepatitis A vacci 9/4/2009 RIGHT UPPER THIGH ERYTHEMA 9/4/2009 Patient reported a 2 inch area surro 9/4/2009 Patient was given Day 14 HDCV 1c 9/4/2009 ADVERSE ONSET WAS ON 9/2/20 9/4/2009 Patient received Day 14 HDCV 1cc 9/4/2009 Patient called on 09/04/09 to report 9/4/2009 Contracted Shingles about 9 month 9/4/2009 Right arem very swollen, red and ho 9/4/2009 Patient called this am c/o pain and r 9/4/2009 12 hours after the injection my son h 9/4/2009 Clear or white areas on fingertips an 9/4/2009 Patient received Gardasil HPV vacc 9/4/2009 Received vaccine at primary care ph 9/4/2009 Received Tdap on 8/28/09. Reports 9/4/2009 Rash/Itching following FLUMIST (Fl 9/4/2009 Following Tdap and Hepatitis A vac 9/4/2009 developed pustules/papules differen 9/4/2009 Diarrhea 6 times a day for 2 weeks 9/4/2009 Gardasil #1, Hep A #1, Menactra an 9/4/2009 SITE RXN 2.5-3 INCH DIAMETER, 9/4/2009 Father states that his daughter beca 9/4/2009 Patient received Flulaval Vaccine IM 9/4/2009 Vaccine administered 8/19/09 at 09 9/4/2009 Pneumonia vaccine received this m 9/4/2009 Patient started to feel numbness in 9/4/2009 Shortness of Y breath, initially with ex 9/4/2009 This case was reported by a physici 9/3/2009 Patient returned to office on 9/2/09 9/4/2009 Patient came in to office on 9/2/09. 9/3/2009 Swelling (local), pain, fever. Husba 8/31/2009 Local reaction (R) arm, red, swollen 9/4/2009 Woke up at 3AM on 9/2/09 & felt ve 9/3/2009 MMR given 8/25/09. Taken to ER o 9/4/2009 Pt's parent reports pt fainted while a 9/4/2009 Pt. complains of pain and swelling in 9/7/2009 She received vaccine on Friday 9-4 9/7/2009 Patient called in. Itchy rash to upper 9/6/2009 Patient received vaccines (FLUVIRI 9/5/2009 Shortly after FLUVIRIN administere
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9/4/2009 TX 9/4/2009 CA 9/4/2009 FL 9/4/2009 CA 9/4/2009 CA 9/4/2009 MD 9/4/2009 KY 9/4/2009 TX 9/4/2009 WI 9/4/2009 CO 9/4/2009 TN 9/4/2009 WI 9/4/2009 MN 9/4/2009 NY 9/4/2009 SC 9/4/2009 NH 9/4/2009 NY 9/4/2009 TX 9/4/2009 NY 9/4/2009 OR 9/4/2009 NC 9/4/2009 PA 9/4/2009 NC 9/4/2009 IN 9/5/2009 TX 9/5/2009 TX 9/5/2009 FL 9/5/2009 CO 9/5/2009 WA 9/5/2009 CA 9/5/2009 AL 9/5/2009 TX 9/5/2009 TX 9/6/2009 MD 9/6/2009 9/6/2009 TX 9/6/2009 OH 9/6/2009 TX 9/6/2009 MI 9/6/2009 OH 9/6/2009 AZ 9/7/2009 VA 9/7/2009 OH 9/7/2009 GU 9/7/2009 NC 9/7/2009 WV 9/7/2009 TX 9/8/2009 9/8/2009 9/8/2009 9/8/2009 OH
65 32 68 53 72 64 51 67 5 36 55 17 12 17 13 11 4 12 9 4 1.6 15 38 84 13 2 12 60 58 1.3 0.3 2 4 66 13 65 35 68 61 66 1.1 49 43 71 0.6 4 65 0 18 10 24
65 32 68 53 72 64 51 67 5 36 55 17 12 17 13 11 4 12 9 4 1 15 38 84 13 2 12 60 58 1 0 2 4 66 13 65 35 68 61 66 1 49 43 72 0 4 65 0 18 10 24
F F F M M F F F M M F F M M F F F U M M 0.6 M F F F M 0.8 M F M F 0.2 M 0.3 F 0.7 F F F F F U F M F 0.1 M F F F 0.6 F M F 0M F F F
9/6/2009 5 minutes after receiving PNEUMOV 9/5/2009 Reports of soreness in the whole ar 9/6/2009 Pt came to pharmacy states she wo 9/4/2009 Right arm had vaccine injected was 9/5/2009 9/2 at noon receive influenza, pneum 9/5/2009 2"-3" flat red rash now itching at inje 9/5/2009 Redness at injection site - swelling f 9/5/2009 Swelling - warm. Aches - all over es 9/4/2009 Pt developed chicken pox after havi 9/4/2009 Patient appeared okay after flu vacc 9/4/2009 Administered vaccine at 1:15pm on 9/4/2009 10:05A - received vaccines shortly a 9/3/2009 1 day after vaccine had area at site 9/3/2009 Red face & eyes after vaccine - sne 9/4/2009 Where VARIVAX was given (subcut 9/4/2009 Pt presented with large red area sur 9/4/2009 Swelling of her thigh. 9/3/2009 Patient had vaccines on 8/31/09. Pa 9/2/2009 He has a "dent" on his upper arm 9/4/2009 Pt received immunization 8/27, 8/30 9/6/2009 Low grade fever. Multiple bumps bil 9/5/2009 Seen @ 48 hours ago - got 3 shots 9/4/2009 Nummular induration 2-3 cm X 3-4 d 9/4/2009 Pt stated that was very sore on 9-39/5/2009 Patient was ordered to get meningo 9/5/2009 none 9/5/2009 After recieving the Gardasil vaccine 9/5/2009 Swelling from ankles to knees, wors 9/5/2009 At approximately 9:00 pm, my left a 9/5/2009 Vaccines Administered 08/26/09. H 9/5/2009 extreme irritability for 6 days. chron 9/5/2009 left leg swollen,stiff and really red at 9/5/2009 had a fever redness and now has a 9/6/2009 local site or injection became inflam 9/6/2009 My daughter was adminstered GAR 9/6/2009 Next day after receiving Zostavax va 9/6/2009 pneumonia shot given while patient 9/6/2009 WITHIN 24 HOURS PATIENT DEV 9/6/2009 Difficult Breathing. Rapid Heart Rat 9/6/2009 Received pneumovax and influenza 9/6/2009 DIARHHEA AND FEVER BEGINNIN 9/7/2009 Redness, pain, extreme swelling & b 9/7/2009 Administered 8/11/09 for pre-emplo 9/7/2009 Patient phoned the pharmacy to com 9/7/2009 Gardasil vaccinations administered 9/7/2009 self injurous behavior, tantrums, reg 9/7/2009 neuropathic pain (tingling, numbnes 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from
356651 356653 356655 356656 356657 356661 356662 356666 356672 356673 356674 356675 356676 356677 356678 356679 356680 356681 356682 356683 356684 356685 356686 356687 356688 356689 356690 356691 356692 356693 356695 356696 356697 356698 356699 356700 356701 356702 356703 356704 356705 356706 356707 356708 356709 356710 356711 356713 356714 356715 356716
9/8/2009 9/8/2009 9/8/2009 9/8/2009 AZ 9/8/2009 9/8/2009 VA 9/8/2009 PA 9/8/2009 9/8/2009 NY 9/8/2009 MN 9/8/2009 NM 9/8/2009 VA 9/8/2009 NJ 9/8/2009 MN 9/8/2009 WV 9/8/2009 MI 9/8/2009 CA 9/8/2009 MA 9/8/2009 CA 9/8/2009 NY 9/8/2009 OR 9/8/2009 CA 9/8/2009 OR 9/8/2009 AZ 9/8/2009 MI 9/8/2009 MI 9/8/2009 PR 9/8/2009 CA 9/8/2009 CA 9/8/2009 MD 9/8/2009 VA 9/8/2009 OH 9/8/2009 AR 9/8/2009 OR 9/8/2009 OH 9/8/2009 NC 9/8/2009 WA 9/8/2009 AR 9/8/2009 NY 9/8/2009 NC 9/8/2009 OH 9/8/2009 CA 9/8/2009 WA 9/8/2009 CA 9/8/2009 CT 9/8/2009 VA 9/8/2009 WA 9/8/2009 NY 9/8/2009 OH 9/8/2009 CO 9/8/2009 CO
15 18 0.5
18
56 15
56 15
31 5 12 18 24 3 4 4 34 67 47 16 4 4 11 4 70 40 18 39 3 31 11 13 1.3 35 13 64 9 52
31 5 12 18 24 3 4 4 34 67 47 16 4 4 11
54 4 51 1.1 5 9 10 65 0.3 31 50 25
70 40 18 39 3 31 11 13 1 35 13 64 9 52 34 54 4 52 1 5 9 10 65 0 31 50 25
F F F M U F F U F F F F F M M M F F F F M F M F F F F F F M M M 0.3 M M F F M F M F F M 0.1 M M F F F 0.3 M F F F
9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/4/2009 Information has been received from 9/3/2009 Started hurting and then swelling. P 9/4/2009 Onset of chest pain, SOB, cough - 2 9/8/2009 This case was Y reported by a physici 9/8/2009 Chest tightness - monitored a little li 9/8/2009 Extensive swelling, redness and ind 9/8/2009 Developed severe and prolonged al 9/14/2009 (L) Deltoid Cellulitis after MENACTR 9/8/2009 Hives 9/8/2009 Flu mist administered 8/27/2009, On 9/3/2009 Immunization 9-1-09 and on 9-2-09 9/4/2009 Generalized swelling to L thigh from 8/31/2009 LA subcutaneous nodule noted app 9/1/2009 Patient complained of dizziness, ligh 9/1/2009 Patient stated that on Saturday (8-2 9/2/2009 Pt was given GARDASIL and ADAC 8/11/2009 Shots given on 8-10-09. Mom notic 8/31/2009 Redness, edema induration is warm 8/25/2009 12:54 pm pt arms and legs retracted 8/17/2009 Rt posterior arm reddened. 8/20/2009 On 8/17/09 on right arm injection sit 8/14/2009 8/9/09 rash started on lower buttock 9/3/2009 Swelling eyes and lips, and all over 7/15/2009 Employee agreed to receive the HE 9/3/2009 Pt woke up 9/1 - clingy, didn't eat, li 9/8/2009 Developed type 1 diabetes. 9/16/09 9/8/2009 5 hrs after vaccination, arm sore, m 9/8/2009 5-6 Minutes after varicella vaccine w 9/8/2009 NO ADVERSE EVENTS NOTED AT 9/8/2009 Redness, warmth, swelling, left delt 9/8/2009 9-3-09 Rec'd T/C from MGM, advise 9/8/2009 Pt. received vaccine on 8/17/09 11: 9/8/2009 Swelling and itchiness at injection s 9/8/2009 headache, difficulty breathing, ches 9/8/2009 Pt woke up 3days post flu mist adm 9/8/2009 Patient was administered Pneumov 9/8/2009 Localized reddened area left anterio 9/8/2009 patient reported low grade fever, ac 9/8/2009 Developed rash 3 days after recievi 9/8/2009 Pt's R. arm at inj. site became swoll 9/8/2009 Cellulitis at vaccine site. Seen at ER 9/8/2009 RASH, ITCHING, BLEEDING AT IN 9/8/2009 Pt presented to facility after recievin 9/3/2009 Pt had episodes on significant cryin 9/8/2009 Flu shot administered about 5:30 PM 9/8/2009 Patient described "pain in arm with 9/8/2009 Headache, dizziness and shortness
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9/8/2009 IA 9/8/2009 IL 9/8/2009 WA 9/8/2009 CO 9/8/2009 MO 9/8/2009 TX 9/8/2009 MI 9/8/2009 SC 9/8/2009 MA 9/8/2009 KY 9/8/2009 AK 9/8/2009 GA 9/8/2009 PA 9/8/2009 CT 9/8/2009 MA 9/8/2009 9/8/2009 PA 9/8/2009 WA 9/8/2009 FL 9/8/2009 NE 9/8/2009 MN 9/8/2009 MN 9/9/2009 CA 9/9/2009 OH 9/9/2009 VA 9/9/2009 MD 9/9/2009 NY 9/9/2009 AZ 9/9/2009 IN 9/9/2009 9/9/2009 OK 9/9/2009 9/9/2009 CA 9/9/2009 TX 9/9/2009 VA 9/9/2009 SD 9/9/2009 MA 9/9/2009 VA 9/9/2009 OH 9/9/2009 NH 9/9/2009 NH 9/9/2009 VA 9/9/2009 GA 9/9/2009 OH 9/9/2009 MO 9/9/2009 NC 9/9/2009 CA 9/9/2009 WA 9/9/2009 TX 9/9/2009 AZ 9/9/2009 MS
37 52 4 45 5 38 16 75 38 32 60 50 2 11 1.4
37 52 4 45 5 38 16 75 38 32
24
24
17 0.2 0.4 74 16 12 63 5 69
17 23 0 0 74 16 12 63 5 69
22 14 27 46 1.3 0.3 61
22 14 27 46 1 0 61
4 5 5 5 11 77 2 5 12 4 1.2 30 8 5
4 5 5 5 11 76 2 5 12 4 1 30 8 5
50 2 1
F F M F M F M F M F U F 0.2 M M 0.4 M U M F F M 0.2 M 0.4 M M F M M M M U F F F F 0.3 M 0.3 F F F M F F F F F 0.1 F M F F 0.2 F F M M
9/4/2009 Had "asthma-like" attack, body ache 9/8/2009 Pt experienced "heart racing" follow 9/8/2009 6.5 x 4.5 cm raised erythematous d 9/8/2009 Myalgia, muscle joint pain, fatigue, n 9/8/2009 Child received vaccine on 9/1/09. A 9/7/2009 Pt only reported sharp pain in left ar 9/8/2009 Erythema and pain in upper deltoid 9/8/2009 15 minutes after patient received inj 9/1/2009 T 97.2 - loss of appetite, fatigue, va 9/4/2009 Hoarseness, wheezing, weakness, Pt developed hives 1 day later on in 9/4/2009 Circular raised silver-dollar sized are 9/8/2009 Developed serum sickness with hive 8/31/2009 5cm x 5cm area of redness & swelli 9/3/2009 At 16 mo visit on 1/23/09, child had Initial report was received 10 Augus 8/19/2009 Fever, headache, injection site pain 8/20/2009 Initial information received on 18 Au 8/25/2009 Initial report was received 20 Augus 8/27/2009 Inappropriate schedule of vaccine a 9/3/2009 This case was reported by a healthc 9/3/2009 This case was reported by a healthc 9/9/2009 Patient reported that he had not rec 9/4/2009 None Stated. 9/8/2009 Hives appeared within 6 hours of va 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/8/2009 Information has been received from 9/3/2009 11/27/07 had scratchy throat, cough 9/3/2009 1412 Shots given PENTACEL, MMR 9/3/2009 One week after 4 month check, pres 9/2/2009 Swelling and bruising at injection sit 8/28/2009 RN here this AM for flu vaccination. Pt woke up day after injections with 9/2/2009 Mom brought in 2 children for vaccin 9/2/2009 9-1-09 4 P fever 101.7 temp. TYLE 9/2/2009 9-1-09 2:30 PM fever 100.9 temp - v 9/3/2004 Generalized urticaria 6 days after re 9/1/2009 One year after administration of ZO 9/2/2009 Mom reported hives over entire bod 8/26/2009 DTaP & MMR administered approx 9/1/2009 - Fever x 2-3 days (102.0). - Alterna 8/31/2009 None reported. 8/31/2009 Onset of seizures and development 9/3/2009 Warmth and swelling up left arm, itc 9/4/2009 8/27/09 pt came in this morning c/o 9/4/2009 Mother states fever of 101 degrees
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9/9/2009 WA 9/9/2009 IL 9/9/2009 NY 9/9/2009 CO 9/9/2009 OH 9/9/2009 MN 9/9/2009 MN 9/9/2009 AZ 9/9/2009 NH 9/9/2009 PR 9/9/2009 IN 9/9/2009 NY 9/9/2009 NY 9/9/2009 IL 9/9/2009 IN 9/9/2009 MD 9/9/2009 TN 9/9/2009 CO 9/9/2009 CT 9/9/2009 CA 9/9/2009 CA 9/9/2009 FL 9/9/2009 WI 9/9/2009 NC 9/9/2009 FL 9/9/2009 MI 9/9/2009 NY 9/9/2009 NY 9/9/2009 PA 9/9/2009 9/9/2009 OH 9/9/2009 NY 9/9/2009 NY 9/9/2009 TX 9/9/2009 NC 9/9/2009 VA 9/9/2009 AZ 9/9/2009 AZ 9/9/2009 AL 9/9/2009 TX 9/9/2009 TX 9/9/2009 MI 9/9/2009 OH 9/9/2009 CO 9/9/2009 MO 9/9/2009 NH 9/9/2009 MI 9/9/2009 FL 9/9/2009 TX 9/9/2009 FL 9/9/2009 NC
67 19 4 61 1.4 14 39 14 5 15 0.6 66 11 18 58 5 66 12 14 55 39 12 12 19 14 3 4 14 13
67 19 4 61 1 14 39 14 5 15 0 66 11 18 58 5 66 12 14 55 39 12 12 19 14 3 4 14 13
76 2 47 42 86 4 15 10 12 13 40 0.2 42 1 61 1 75 0.2 39 15 40
76 2 47 42 86 1 15 10 12 13 40 0 42 1 61 0 75 0 39 15 40
F M M F 0.4 F F M F M F 0.6 F F M M F F F F F F F F F F F F F F F U F 0.5 F F F M 0M F M M M F 0.2 F F 0F M 1M F 0.2 M F F F
9/4/2009 Red, hot. Tues evening using ice pa see attached SF 600 9/2/2009 After my son received his booster sh 9/2/2009 Redness and inflammation at the in 9/1/2009 8-31-09 @ 7:30 pm - lower right thig 9/3/2009 Postural Syncope immediately follow 9/2/2009 Developed fever to 103. Painful sw 9/1/2009 Patient fainted after administering H 9/3/2009 12x19 cm, red, swollen, warm to the 9/3/2009 Patient developed dizziness after ad 9/3/2009 Localized allergic reaction. 9/3/2009 Difficulty breathing, rash developme 9/1/2009 Pt complained of left arm swelling / See attached. 9/3/2009 Within 5 mins of receiving flu shot, p 3/6/2009 (R) arm red 3 X 2 cm. 9/1/2009 8-29-09 (Mild Fever). 8-30-09 & 8-3 9/1/2009 Syncopal episode immediately follow 9/4/2009 Onset of chronic headaches 21/2 m 8/28/2009 All my muscles are sore. My back h 8/28/2009 Distinct pain @ injection site within 8/31/2009 Swelling & Redness 8-6-09 R arm. 9/1/2009 Received Wed 8/26/09 fever next d 9/9/2009 -itching of the face, swelling of lips; 9/9/2009 2 weeks after administration of Gard 9/9/2009 24 hrs after MMR shot, Patient stop 9/9/2009 Red raised welts around injection si 9/9/2009 Pt fainted at about 3:50pm at the wa 9/9/2009 Pain, swelling, lump on arm at injec 9/9/2009 REACTION NOTED POST VACCIN 9/8/2009 After receiving vaccine, pt states he 9/9/2009 Parent reported 1 day following vac 9/9/2009 Employee reported progressively wo 9/9/2009 Clent stated a few days after receiv 9/9/2009 Left upper arm was very swollen, re 9/9/2009 AREA OF ERYTHEMA ON UPPER 9/9/2009 Received Tdap & MCV4 9/8/2009 @ 9/5/2009 Within 2 minutes of vaccination, Pt c 9/9/2009 Left arm swelling- inflammation arou 9/9/2009 As per client's mother, he started co 9/9/2009 I received the seasonal flu shot arou 9/9/2009 Hives, severe crying and localized R 9/9/2009 Painful at site when arm moved up 9/9/2009 Large localized swelling, urticaria (g 9/9/2009 While there was no pain when shot 9/9/2009 developed fever 103 2 days after 9/9/2009 Right arm redness(softball size), sw 9/9/2009 2 days after receiving his scheduled 9/9/2009 PT COMPLAINED OF HER THROA 9/9/2009 Evans Syndrome. Autoimmune hem 9/9/2009 fevers, tmax 100.6 within 12 hrs of a
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9/9/2009 SD 9/9/2009 PA 9/9/2009 GA 9/9/2009 AZ 9/9/2009 CA 9/9/2009 CA 9/9/2009 IL 9/9/2009 PA 9/9/2009 IN 9/9/2009 NJ 9/9/2009 WA 9/9/2009 CA 9/9/2009 MS 9/9/2009 PA 9/9/2009 CO 9/9/2009 CA 9/9/2009 AZ 9/9/2009 IL 9/9/2009 NY 9/9/2009 LA 9/9/2009 AL 9/9/2009 OR 9/9/2009 PA 9/9/2009 MA 9/9/2009 VT 9/9/2009 CA 9/9/2009 OK 9/9/2009 CA 9/9/2009 TX 9/9/2009 OR 9/9/2009 IL 9/9/2009 NJ 9/9/2009 NH 9/9/2009 9/9/2009 AR 9/9/2009 OR 9/9/2009 OH 9/9/2009 FL 9/9/2009 AZ 9/9/2009 KY 9/9/2009 MN 9/9/2009 VA 9/9/2009 NY 9/9/2009 WA 9/9/2009 MN 9/9/2009 IL 9/9/2009 AK 9/9/2009 MN 9/9/2009 IL 9/9/2009 IL 9/9/2009 AZ
61 57 4 29 5 52 55 63 5 13 60 1 41 0.8 50 72 30 31 39 11 39 58 13 46 15 69 25 21 0.5 24 0.4 69 9 38 1.8 69 26 1.2 12 1.3 2 45 1.2 13 55 4 4 4 69 51 34
61 57 4 29 5 52 55 63 5 13 60 1 41 0 50 72 30 31 39 11 39 58 13 46 15 69 25 21 0 24 0 69 9 38 1 69 26 1 12 1 2 45 1 13 55 4 4 4 69 51 34
M F F M F F F F M F F 0M F 0.8 F M F F M F F F F F F F F F F 0.5 F F 0.4 F F M M 0.8 M F M 0.2 F F 0.3 M 0.9 M M 0.2 F M F M M F M F F
9/8/2009 Breathing Difficulty, body ache, chill 9/9/2009 Noticed mild redness on Saturday. E 9/9/2009 HOT, RED, SWOLLEN AREA FROM 9/9/2009 23 days after vaccination pt. develo 9/9/2009 Erythema, induration and warmth ov 9/9/2009 Onset of intense myalgias, fever, di 9/9/2009 Injection site red & hot inflammation 9/9/2009 Experienced the expected redness, 9/8/2009 Pt received KINRIX IM and Varicella 9/8/2009 Diagnosed w/ juvenile rheumatoid a 9/8/2009 Jaw -> eye numbness *Sx's gone @ 8/31/2009 Onset VARICELLA vesicles sympto 9/2/2009 Tingling sensation heavily on tongu 9/1/2009 My baby almost immediately becam 8/30/2009 2 days post inj pt had large localized 9/1/2009 Skin, rash and hives. 8/17/2009 Reports "cold" with intermittent cong 9/9/2009 Sweating, Lethargic after 5 minutes 9/9/2009 1 1/2 hrs after immunization (flu) c/o 9/9/2009 Patient presented with swollen, infla 9/9/2009 MMR administered 09/04. Reports 9/3/2009 Pt arm 4 cm x 3.5 cm red, raised, ho 9/4/2009 Numbness and paresthesias in arm 9/9/2009 15 min. post vaccine, reported red b Syncope several seconds after HPV 9/9/2009 Swelling of entire left arm. Pressure 9/2/2009 Rabavert given @ 1635 on 9-1-09. 9/1/2009 Noted (L) upper arm very sore 8/26/ 9/2/2009 Rash all over legs and arms 9/4/2009 Client got vaccine 9/3/09 and called 9/2/2009 Brief seizure following vaccine < 1 m 9/4/2009 Tetanus-diphtheria vaccine given 5/ 9/3/2009 Patient has a 5 in. x 4 in. raised, red 8/20/2009 Approx 12 hrs after receiving vaccin 8/20/2009 Pruritic rash surrounding polio and h 8/31/2009 Fever (101 degrees), myalgias, redn 9/1/2009 Received tetanus injection on 8/28/0 8/31/2009 Developed rash on L arm & body cl 9/5/2009 Had arrived home - made bagel and 9/9/2009 Immediately after receiving varicella 9/9/2009 15-20 small red papulopustules. 9/9/2009 Pt received AVA in his right arm on 9/9/2009 104+ fever followed by rash. Platele 9/8/2009 Generalized varicella-like eruption w 9/9/2009 Seen in ER. Voice hoarse, throat sw 9/9/2009 This case was reported by a physici 9/9/2009 Inflammatory reaction to DTaP in Rt 9/8/2009 Vesicular rash in S2 dermatome - R 9/9/2009 Localized reaction to flu shot. 5:25P 9/9/2009 Patient received influenza vaccinati 8/28/2009 Pain in the arm, swelling, itching wa
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9/10/2009 LA 9/10/2009 NJ 9/10/2009 TX 9/10/2009 MD 9/10/2009 VA 9/10/2009 NC 9/10/2009 CT 9/10/2009 GA 9/10/2009 9/10/2009 IA 9/10/2009 MA 9/10/2009 MA 9/10/2009 NJ 9/10/2009 KY 9/10/2009 WV 9/10/2009 NC 9/10/2009 NY 9/10/2009 MD 9/10/2009 NM 9/10/2009 WA 9/10/2009 NE 9/10/2009 MO 9/10/2009 ID 9/10/2009 PA 9/10/2009 NY 9/10/2009 OR 9/10/2009 MI 9/10/2009 MI 9/10/2009 MI 9/10/2009 NC 9/10/2009 FL 9/10/2009 OK 9/10/2009 LA 9/10/2009 CA 9/10/2009 GA 9/10/2009 TX 9/10/2009 ME 9/10/2009 TX 9/10/2009 PA 9/10/2009 IN 9/10/2009 NC 9/10/2009 CO 9/10/2009 ND 9/10/2009 ID 9/10/2009 CA 9/10/2009 NY 9/10/2009 OR 9/10/2009 KS 9/10/2009 AZ 9/10/2009 AZ 9/10/2009 CA
14 46 10 17 44 58 0.3 46 15 13 24 17 1.1 2 4 58 4 24 39 55 1.1 12 32 66 74 45 37 36 49 1.8 3 19 17 2 36 17 20 32 24 46 68 62 18 76 20 26 9 56 17 1
46 10 17 58 0 46
24 17 1 2 4 58 4 24 39 55 1 12 32 66 74 45 37 36 49 1 4 19 17 2 36 17 20 32 24 46 68 62 18 76 20 26 9 56 17 1
F F M F F F 0.3 F F F F F F 0.1 M 0.4 F M F M F F F 0.1 F F F F F F F F F 0.7 M U F F 0.9 F F M M F F F F F F U F F F F M F 0F
9/9/2009 Information has been received from 9/4/2009 Initial report was received 26 Augus Headaches. 9/27/09 Hospital recor 9/8/2009 Received MENACTRA & Tdap on 6 With 24 hrs of receiving AFLURIA 0 8/12/2009 Rash - 8-13-09 - Groups of raised re 9/3/2009 4 month old given inactivated flu va 9/3/2009 Eye itch night of day of injection. Fa Diffuse myalgias, fatigue, nausea, s 8/25/2009 Severe headache and dizziness afte 9/4/2009 Seizure (unwitnessed). Date. Sever 9/4/2009 Patient reports feeling nauseated ap 9/10/2009 Had syncopal episode at home. Fel 9/10/2009 Hives, temp 102.3, fussy-given stero 9/3/2009 Within 5 minutes developed wheezi 9/10/2009 Had vaccine at 6p, dry cough and h 9/10/2009 Mother stated child's Left arm very r 9/10/2009 Immediately after receiving Gardasi 9/10/2009 rash/hives rt upper arm and upper b 9/10/2009 I received a flu shot from walk-in fac 9/10/2009 Initial low grade temp (99F) treated 9/10/2009 My daughter has passed out TWICE 9/10/2009 Flu vaccination was given to me on 9/10/2009 Patient complained of pain and ting 9/10/2009 Returned to clinic 9-9-09 with a red 9/10/2009 10cm localized swelling to left deltoi 9/10/2009 Pt was given double dose of flu vac 9/10/2009 Pt given double dose of flu vaccine9/10/2009 Pt given double dose of flu vaccine9/10/2009 WITHIN 48 HOURS FEVER OF 105 9/10/2009 rt arm swollen,red,hard and hot to to 9/10/2009 Headache, Y Nausea, dizziness, chilli 9/10/2009 Mental status changes starting 7 da 9/10/2009 Patient ran fever of 100-102 for 3 da 9/10/2009 Roughly 10 minutes after injection, 9/10/2009 Approximately 4 hours after vaccine 9/10/2009 Patient was sitting receiving vaccina 9/10/2009 Itchy arms and chest. No hives or b 9/10/2009 Pt received TDaP and varicella in L 9/10/2009 Influenza shot was received at 3:25 9/10/2009 Redness and soreness at site 9/10/2009 vomiting, nausea, diarehha, chills, b 9/10/2009 Symptoms began with hair loss two 9/10/2009 This case was reported by a pharma 9/10/2009 Patient was given 0.5ml of Influenza 9/6/2009 1 minute after administering FLUEN 9/10/2009 Raised, red, warm to touch bilateral 9/10/2009 Mother presented child for flu vaccin 9/14/2009 Left deltoid region became erythem 9/10/2009 Severe pain 2 days after injection- n 9/10/2009 Left thigh with 3 areas of raised pink
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9/10/2009 AK 9/10/2009 GA 9/10/2009 NC 9/10/2009 NE 9/10/2009 VA 9/10/2009 MN 9/10/2009 OR 9/10/2009 PA 9/10/2009 NV 9/11/2009 9/11/2009 TX 9/11/2009 SC 9/11/2009 MI 9/11/2009 UT 9/11/2009 9/11/2009 MD 9/11/2009 GA 9/11/2009 MD 9/11/2009 KY 9/11/2009 NY 9/11/2009 NC 9/11/2009 PA 9/11/2009 MI 9/11/2009 AR 9/11/2009 MI 9/11/2009 TX 9/11/2009 OH 9/11/2009 TX 9/11/2009 AK 9/11/2009 MT 9/11/2009 OH 9/11/2009 OR 9/11/2009 PA 9/11/2009 MI 9/11/2009 TX 9/11/2009 AZ 9/11/2009 MI 9/11/2009 9/11/2009 MA 9/11/2009 WA 9/11/2009 OH 9/11/2009 NV 9/11/2009 OH 9/11/2009 NV 9/11/2009 IN 9/11/2009 CA 9/11/2009 PA 9/11/2009 VA 9/11/2009 MA 9/11/2009 NM 9/11/2009 GA
16 11 76 66 47 58 43 2 3.8 4 4 18 18 12
16 11 76 66 47 58 43 2
43 55 20 16 0.5 6 24 33 5 48 29 1.5 54 52 60 78 40 1.5 15 1.6 36 35
0 54 20 16 0 6 24 33 5 48 29 1 54 52 60 78 40 1
3 29 53 71 2 12 56 15 4 5 5 72 4
4 18 12
1 36 35
29 53 71 2 56 15 4 5 5 72 4
F F M F U F M 0.1 F F U M F F F F 0.5 F M M F 0.5 F F F M F F M 0.5 M M F F F F 0.6 M U 0.4 M F F M M F F F 0M F F F F M M F M
9/10/2009 6x7 cm erythema at injection site lef 9/10/2009 Client c/o swelling, soreness bilatera 9/10/2009 Once I gave shot, his arm immediat 9/10/2009 In ER 1 am had a fever 103. Diagn 9/10/2009 The pt states in approx. 2005 while 9/10/2009 Sore Throat, swollen tonsils, T 100. 9/10/2009 Raised red area silver dollar size ho 9/18/2009 Hives on both arms within 5 minutes 9/10/2009 FOC called 9/2/09. States child had 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/10/2009 Information has been received from 9/11/2009 Body itching, eyes swollen shut, red 9/11/2009 Inability to concentrate, cognitive dif 9/11/2009 Generalized rash and puritis develo 9/11/2009 patient recieved Gardasil on 12/19/0 9/11/2009 Patient received vaccine on 8/25/09 9/11/2009 Pt left office, vomit x1 on the way ho 9/11/2009 Patient developed redness, swelling 9/11/2009 pt states arm was swollen whole bic 9/11/2009 LEFT ARM RED,WARM TO TOUCH 9/11/2009 Pt.states that her left arm started hu 9/11/2009 Complete loss of appetite. Body chi 9/11/2009 9/9/09 at 6 PM started screaming an 9/11/2009 Patient first experienced headache 9/11/2009 2 inch diameter redness, slight swel 9/11/2009 Pt received Flu vaccine and pneum 9/11/2009 Right arm (inside bicep) was slightly 9/11/2009 Labrynthitis diagnosed after second 9/11/2009 My son had fever 99.1 degree last n 9/11/2009 Pt did not have any reaction to the v 9/11/2009 Severe swelling and fever at injectio 9/11/2009 REDNESS,SWELLING, INDURATIO 9/11/2009 Tingling in Right arm from deltoid to 9/10/2009 This case was considered medically 9/9/2009 Initial information received on 31 Au 9/8/2009 This spontaneous case was receive 9/7/2009 Pt. presented to E.R. on 7/27/09 aft 9/3/2009 Guillain-Barre Syndrome - LE Weak 9/4/2009 Febrile seizure 7 days after HIB and 8/14/2009 3rd Varicella given accidentally. Pre 9/4/2009 Received shot around 2pm 9/2. App 9/4/2009 Pt came back on 9/3 (1 day later) w 9/4/2009 9-1-09 DTAP in R thigh. 9-3-09 mo 9/3/2009 Tongue swelling, hives, itching, flus 9/3/2009 Pt noticed "rash" on trunk that sprea 9/3/2009 Gave too low - fluid went into tissue 9/3/2009 Fever x3 day 102 & increasing. Loc
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9/11/2009 VA 9/11/2009 DE 9/11/2009 GA 9/11/2009 GA 9/11/2009 IL 9/11/2009 SD 9/11/2009 TX 9/11/2009 CT 9/11/2009 CA 9/11/2009 WV 9/11/2009 TX 9/11/2009 PA 9/11/2009 WA 9/11/2009 CO 9/11/2009 MN 9/11/2009 UT 9/11/2009 CA 9/11/2009 TN 9/11/2009 MT 9/11/2009 MN 9/11/2009 GA 9/11/2009 SC 9/11/2009 MI 9/11/2009 TN 9/11/2009 MA 9/11/2009 MA 9/11/2009 MA 9/11/2009 TX 9/11/2009 CA 9/11/2009 MN 9/11/2009 IL 9/11/2009 WA 9/11/2009 CA 9/11/2009 OH 9/11/2009 OR 9/11/2009 IL 9/11/2009 GA 9/11/2009 OH 9/11/2009 MO 9/11/2009 MN 9/11/2009 WI 9/11/2009 CA 9/11/2009 AL 9/11/2009 OR 9/11/2009 CA 9/11/2009 NY 9/11/2009 NY 9/11/2009 OH 9/11/2009 WI 9/11/2009 PA 9/11/2009 NE
25 71 10 17 3 90 14 0.4 10 0.4 2 15 0.2 53 60 55 61 21 26 37 29 1.6 11 31 39 25 50 76 23 25 61 25 75 55 81 33 9 1.2 1 4 0.2 66 56 83 4 16 67 13 20 66 76
25 71 10 17 3 90 14 0 10 0 2 15 0 53
61 21 26 37 29 1 11 28 39 25 50 76 23 61 25 75 55 81 33 9 1 1 4 0 66 56 83 4 16 67 13 20 66 76
F F F F F F U 0.4 M F 0.4 M 0.1 F F 0.2 M F F F F F M F F 0.6 F M F F M F F F M F F F U M M F 0.2 F 0M F 0.2 M M F M F F M F F M M
7/30/2009 On 7-28-09 Patient received TDAP 9/2/2009 Received pneumonia shot at 3:30 p 9/3/2009 Redness & Warmth 2-3 hours after 9/3/2009 Localized swelling (quarter size), re 9/11/2009 Swallowing dysfxn and annuciation 9/4/2009 Received ZOSTAVAX vaccine 8/28 Rash at site developed 28 hours sp 9/10/2009 Very fussy- inconsolable through mo 9/3/2009 Tingling sensation of (L) arm lasted 9/11/2009 Hives/urticaria Redness and swelling of entire (R) t 9/3/2009 Patient developed urticaria/lesions f 9/6/2009 Coded. Former 28 wk gest infant wa 9/11/2009 Feeling disoriented and dizzy within 9/11/2009 Subject in pneumococcal vaccine tr 9/11/2009 Severe sore throat, extreme red eye 9/11/2009 Zoster vaccine was given after stro 9/11/2009 PT. EXPERIENCED PAIN,REDNES 9/11/2009 At 5:30 pm,William came in with a re 9/11/2009 Patient reports feeling "fine" after in 9/11/2009 redness, swelling, and warmth at sit 9/11/2009 MOTHER STATES CHILD "NOT AC 9/11/2009 Large red swollen area on right arm 9/11/2009 Onset of weakness and tingling in L 9/11/2009 Immediately after receiving the Td v 9/11/2009 Reports feeling dizzy right after adm 9/11/2009 At the time of administrtion, patient 9/11/2009 patient experience swelling/warmne 9/11/2009 Pt noted pruritis in the area 9/10/09 9/11/2009 Coughing. Troubles breathing. Sw 9/11/2009 Patient not feeling well after receivin 9/8/2009 Rashes on face and legs and gener 9/9/2009 C/o rash forming a ring approximate Patient claims her blood pressure h 9/12/2009 Vaccine on 8/13/09 rash on lower to 9/12/2009 Patient reported diaphoresis, tachyc 9/13/09 - 3PM - Patient received ina 9/11/2009 Local redness, warmth & tendernes Patient has a localized reaction also 9/10/2009 Rt thigh redness and swelling devel 9/10/2009 Rash following immunization, not ut 9/13/2009 Patient received FLUVIRIN flu shot 9/13/2009 Day following immunization, patient 9/12/2009 Painful injection site followed with a 9/12/2009 Swelling, erythema, pruritus (L) delt 9/11/2009 Fainting, feeling of coldness and we 9/10/2009 Vaccine administered 09/01/09; On 9/11/2009 Urticaria on face, legs, torso - impro 9/11/2009 Patient had hotflush, passed out an 9/11/2009 Pt got a flu shot in the pharmacy at 9/11/2009 Err:508
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9/11/2009 MN 9/11/2009 CA 9/11/2009 IL 9/11/2009 AR 9/11/2009 KS 9/11/2009 MO 9/11/2009 PA 9/11/2009 NY 9/11/2009 RI 9/11/2009 NY 9/11/2009 TX 9/11/2009 NC 9/11/2009 GA 9/11/2009 CA 9/11/2009 MO 9/11/2009 PA 9/11/2009 TX 9/11/2009 CO 9/11/2009 SC 9/12/2009 WA 9/12/2009 WI 9/12/2009 WI 9/12/2009 VA 9/12/2009 OR 9/12/2009 SC 9/12/2009 FL 9/12/2009 CA 9/12/2009 IN 9/13/2009 GA 9/13/2009 OH 9/13/2009 DE 9/13/2009 NY 9/13/2009 OR 9/14/2009 CA 9/14/2009 9/14/2009 9/14/2009 TX 9/14/2009 NY 9/14/2009 MA 9/14/2009 FL 9/14/2009 NY 9/14/2009 9/14/2009 9/14/2009 AR 9/14/2009 CA 9/14/2009 CA 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 AZ 9/14/2009 WA
5 26 17 4 66 11 18 15 30 2 34 65 1.5 54 12 86 4 76 18 49 4 10 39 27 73 19 85 21 3 42 38 39 68 11
5 26 17 4 66 11 18 15 30 2 34 65 1 54 12 86 4 76 18 49 4 10 39 27 72 19 85 21 3 42 38 39 68 11
44 62 6 22 19 21 1.5 25 1 23 61 49
44 62
30 4
30 4
22 17 21 25 1 23 61 49
F M F F M F F M M 1M F F 0.5 F F F F M F M F M F F M F M F F F M M F F M F F M M M F F F F F 0M F F F F M M
9/11/2009 Immunization on 9/9/09. Mom noted 9/11/2009 Pt said he got some itchy hives dev 9/11/2009 Miscarriage Pt was not aware she w 9/10/2009 Fever, swelling in L upper arm. Reaction to pneumonia vaccine -arm 9/4/2009 Pt. rec'd VARIVAX injection subcuta 9/10/2009 10 mins after vaccine admin. pt c/o 9/11/2009 Per mother pt. experienced hallucin 9/10/2009 Patient very apprehensive re flu vac 9/11/2009 Pt sneezing, face red, no breathing 9/11/2009 States that about 30 minutes after s 9/11/2009 Chills, tired all over, tenderness + p 9/10/2009 Fever 105.9, no appetite. 9/13/2009 Patient received PNEUMOVAX on 9 9/4/2009 None stated. 9/11/2009 Fever 101- injection site red and sw 9/11/2009 Swelling, redness, tenderness, to le 9/11/2009 Reported to Dr's office on 9-4 arm w 9/14/2009 Pt received immunizations (FLUMIS 9/12/2009 redness, warmth, soreness at swelli 9/12/2009 Significant irritability, back pain, mus 9/12/2009 Shot given under the arm, odd spot 9/12/2009 Numbness and tingling in arm wher 9/12/2009 Red bumps on upper left chest and 9/12/2009 Patient was given vaccination at ab 9/12/2009 pt described numbness in arm wher 9/12/2009 Left arm red, swollen, and hot from 9/12/2009 Had dizziness after first shot on 5/1 9/13/2009 MY Daughter received the "MIST" in 9/13/2009 Got shot at 1:00 pm on thursday se 9/13/2009 Muscle and joint pain all over, fatigu 9/13/2009 Began to feel dizzy and light headed 9/13/2009 8/21 Zoster vaccine administered; 8 9/9/2009 (R) deltoid sore, (R) arm mild-mode 9/14/2009 We received the following informatio 9/14/2009 We received the following informatio 9/7/2009 Initial report received on 02 Septem 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 9/11/2009 Information has been received from 1/26/2009 Very busy immunization clinic. Bes 6/30/2009 Went to ER 6/17/09 0200 for chills, 9/10/2009 Pt developed redness and itching a 9/10/2009 Patient was injected with Fluvirin ins 9/8/2009 Noted pain (Lt) lower back. While dr 9/2/2009 Localized warmth and pruritus at inj 9/8/2009 Was given Influenza on 8/31/009, s 8/27/2009 Flu vaccine given (Lt) upper arm , n 9/8/2009 6.5 X 4.5 cm raised erythematous d
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9/14/2009 PA 9/14/2009 MN 9/14/2009 NV 9/14/2009 FL 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 VA 9/14/2009 FL 9/14/2009 KS 9/14/2009 TX 9/14/2009 SC 9/14/2009 TX 9/14/2009 CA 9/14/2009 NC 9/14/2009 VA 9/14/2009 IA 9/14/2009 NC 9/14/2009 WA 9/14/2009 AZ 9/14/2009 NJ 9/14/2009 NJ 9/14/2009 NC
4 8 3 1 25 22 20 24 27 25 22 21 22 11 23 17 21 22 18 20 21 24 20 21 22 22 25 15 24 23 14 23 23 21 19 17 34 12 4 55 4 5 21 65 2 56 53 73 4 2 4
4 8 3 0 25 22 20 24 27 25 22 22 11 23 17 21 22 18 20 21 24 20 21 22 22 25 15 24 23 14 23 23 21 19 17 34 12 4 55 4 5 21 65 2 56 53 73 4 2 4
M F F 1F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F M F M F M F F F 1M F F F F 0.7 M M
9/9/2009 After shots, patient returned within a 8/28/2009 Received VARICELLA vaccine 8/17 9/10/2009 FOC called 9/2/09. States child had 9/8/2009 Rash, Acycliver 200 1/2 tp to qil 45D 8/24/2009 GARDASIL vaccine was noted at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was noted at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was not stored 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 Gardisil vaccine was stored at temp 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at te 8/25/2009 GARDASIL vaccine was stored at a 8/25/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was store at tempe 8/30/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was stored at temp 8/30/2009 GARDASIL vaccine was stored at te 8/20/2009 Gardisil vaccine was stored at temp 8/20/2009 GARDASIL vaccine was stored at te 8/21/2009 GARDASIL vaccine was stored at te 8/21/2009 GARDASIL vaccine was stored at te 8/29/2009 GARDASIL vaccine was stored at te 9/14/2009 LEFT SHOULDER AND DELTOID 3 9/14/2009 3 days ago 4 mm rash inceased, pr 9/14/2009 Mom reports pt developed jaundice 9/14/2009 Left arm became very red and swoll 9/14/2009 Patient contacted the health dept th 9/14/2009 Patient received Tdap instead of Dt 9/14/2009 2 days after vaccine administration, 9/14/2009 Patient presented 24 hours followin 9/14/2009 Received Yellow Fever Vaccine (Lo 9/14/2009 pt had varicella vaccine, within 2 hrs 9/14/2009 Patient felt dizzy 30 minutes after th 9/14/2009 Pt received injection on the 11th, sh 9/14/2009 Patient's husband described: within 9/14/2009 Patient began complaining of sore t 9/14/2009 Began running fever, almost immed 9/14/2009 C/O BURNING AND REDNESS LE
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9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 MO 9/14/2009 NM 9/14/2009 MD 9/14/2009 LA 9/14/2009 TN 9/14/2009 NV 9/14/2009 NE 9/14/2009 NV 9/14/2009 CA 9/14/2009 WV 9/14/2009 AZ 9/14/2009 MO 9/14/2009 MO 9/14/2009 OH 9/14/2009 NY 9/14/2009 NY 9/14/2009 NH 9/14/2009 VI 9/14/2009 PA 9/14/2009 MA 9/14/2009 OH 9/14/2009 OH 9/14/2009 OH 9/14/2009 OH 9/14/2009 CA 9/14/2009 NM 9/14/2009 NM 9/14/2009 CO 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 IA 9/14/2009 MI 9/14/2009 9/14/2009 MI 9/14/2009 WA 9/14/2009 NC 9/14/2009 IN 9/14/2009 ID
17 20 22 21 27 22 23 19 51 50 23 24 1.5 6 0.1 4 59 8 21 23 19 35 50 0.1 4 16 12 14 13 19 73 4 26 63 0.5 27 24 26 26 41 43 34 41 49 62 9 64 5 44 65 11
17 20 22 21 27 23 19 51 50 23 24 1 6 0 4 59 8 21 23 19 35 50 0 4 16 12 14 13 73 4 26 0 27 24 26 26 41 43 34 41 49 62 9 64 5 44 65 11
F F F F F F F F F F F F 0.5 F M 0.1 M M F F F F M F F 0.1 M M F M F F F F F F F 0.5 M F F F F F F F F F M F F F F F F
9/14/2009 On 9/4/09@ 1400 client called me a 8/24/2009 Gardisil vaccine was stored at at tem 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/29/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 Gardisil vaccine was store at tempe 9/14/2009 extreme achiness at site and into jo 9/14/2009 Client reported 4" X 11/2" area of in 9/14/2009 morning after receiving the Pneumo 9/14/2009 Enlarged, grape-sized nodule above 9/14/2009 High Fever (104 degrees), dizziness 9/14/2009 48 hours after nasal flu mist vaccina 9/14/2009 My son's whole body was shaking. H 9/14/2009 SWOLLEN,REDNESS ON VACCIN 9/14/2009 Severe shoulder pain beginning ~2 9/14/2009 Daughter vomitted 4 hours after rec 8/24/2009 GARDASIL vaccine was stored at te 8/24/2009 Gardisil vaccine was stored at temp 9/6/2009 He got PNEUMOVAX vaccine (SC) 9/14/2009 Itchy all over, feels warm all over Be 9/14/2009 "Throat closing" - itching, hives - Lo 9/14/2009 Infant was given vaccines. Cried, an 9/14/2009 The patient developed erosive lesio 9/10/2009 Received flu shot and Hep A. 3 min 9/21/2009 Urticarial rash all over body. 8/27/2009 Swelling 4.5cm x 4.5 cm, erythema, 8/27/2009 Swelling, erythema, warmth at injec 9/14/2009 Several minutes after vaccine patien 9/9/2009 4 hours after immunization, left delto 9/14/2009 Left outer aspect of arm swollen wit 9/14/2009 Err:508 9/14/2009 Indigestion, 20 minutes. 9/14/2009 Episode of apparent limpness, letha 9/10/2009 Received flu shot on 9/1/09 by 1200 9/10/2009 By evening a nickel size welt appea 9/10/2009 Two Quarter size welts on left deltoi 9/10/2009 1/2 dollar size welt on (L) deltoid. W 9/10/2009 "Right deltoid burned on injection an 9/10/2009 Over the course of 2 days develope 9/10/2009 Developed redness and started to it 9/10/2009 Received the flu shot on 9/2/09 at 0 9/10/2009 On 9/3/09 in the evening face and e 9/14/2009 Patient said shortly after vaccination 9/14/2009 Patient received Boostrix one month Was not feeling well prior to shot (na 9/14/2009 Pt awoke approx 18 hours after vac 9/14/2009 Pt reported on 09-12-09 at 9:30 AM 9/14/2009 4 hours post vaccination 5 episodes 8/13/2009 Patient immunized in am, a few hou
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9/14/2009 ID 9/14/2009 ID 9/14/2009 ID 9/14/2009 ID 9/14/2009 IL 9/14/2009 HI 9/14/2009 HI 9/14/2009 WI 9/14/2009 TX 9/14/2009 NY 9/14/2009 NY 9/15/2009 OR 9/15/2009 IA 9/15/2009 CA 9/15/2009 NC 9/15/2009 NC 9/15/2009 NC 9/15/2009 NC 9/15/2009 OH 9/15/2009 OH 9/15/2009 KS 9/15/2009 AZ 9/15/2009 AZ 9/15/2009 VA 9/15/2009 VA 9/15/2009 WA 9/15/2009 CA 9/15/2009 ID 9/15/2009 CA 9/15/2009 PA 9/15/2009 PA 9/15/2009 PA 9/15/2009 ID 9/15/2009 MN 9/15/2009 PA 9/15/2009 FL 9/15/2009 VA 9/15/2009 DE 9/15/2009 PA 9/15/2009 NJ 9/15/2009 PA 9/15/2009 CA 9/15/2009 CT 9/15/2009 CT 9/15/2009 ME 9/15/2009 LA 9/15/2009 NH 9/15/2009 MD 9/15/2009 CA 9/15/2009 IA 9/15/2009 OH
5 1.3 72 5 69 49 59 19 42 69 23 13 62 47 8 8 11 10 35 11 15 85 5 19 8 62 4 66 1.3 18 21 18 65 56 77 55 6 57 72 1.6
5 1 72 5 69 49 59 19 42 69
21 13 14 33 34 1 43 68 5 72
21 13 14 33
13 62 46 8 8 11 10 35 11 15 85 5 19 8 62 4 66 1 18 21 18 65 56 77 55 6 57 72 1
1 43 68 5 72
M 0.3 F M M F F F F F F M F F U M M F M F M F F F F M F F F 0.3 F F F F F F F F M F U 0.6 M F F M M F F 0M F F F F
7/31/2009 Redness began 7/30 with swelling o 8/17/2009 Patient vaccinated 8-4-09, pt presen 8/29/2009 None Stated 8/14/2009 Diffuse swelling of entire L thigh to k 9/14/2009 Redness, swelling, not itching, very 9/9/2009 Slight sore throat. Aches & pains in 9/5/2009 Received vaccine @ 08:40, @ 10:0 9/12/2009 I was driving home from a friends ho 9/19/2009 arm swelling, large red streak, itchin 9/14/2009 Patient c/o itchiness after taking 3rd 9/14/2009 Pt in few hour experienced numbne 9/15/2009 Shortly after vacinnation with Garda 9/15/2009 About 3 hours after vaccine was giv 9/15/2009 Received Samllpox vaccine along w 9/8/2009 Red area on back of left arm. Cool p 8/21/2009 Heat, red, itching, swelling @ site ( 9/8/2009 9-3-09 Back of Lt arm red, > than go 9/6/2009 2 1/2 hours post vaccination, swellin 9/15/2009 Pt call 9AM rash developed/itching 9/15/2009 Administered FLULAVAL 0.5ml to h 9/14/2009 Approx. 3 days after varicella immun 9/14/2009 Information has been received from 9/14/2009 Information has been received from 9/14/2009 Information has been received from 9/4/2009 Flu vaccine licensed for 18 yrs and 9/1/2009 Chills, fevers, sweating, severe pain 9/3/2009 Pt received DTaP 9/1/09 came into 9/9/2009 No adverse events. 9/11/2009 Maculo papular rash starting on fac 9/9/2009 The student received the flu shot R 9/9/2009 The student became lightheaded ab 9/9/2009 The student received a flu vaccinati 9/10/2009 Vaginal Herpes infection 9/9/2009 9/4/09, low grade fever, vomiting, na 9/10/2009 Patient came back to our pharmacy 9/8/2009 IM (R) deltoid - injection of PNEUMO 9/11/2009 Pt received FLUMIST at about 14:2 9/9/2009 Itching in area of injection down to e Patient called 9-15, reported itching 9/15/2009 Grand mal febrile Seizure. 9/3/2009 Eyes red, swollen throat and face sw 9/14/2009 Pt given GARDASIL left deltoid on 9 9/14/2009 Administered GSK to < 18 yr old. 9/14/2009 Administered GSK to < 18 yr old c/o 9/8/2009 Body ache from injection site to top 9/8/2009 None stated 9/2/2009 Maculo papular blanching pink rash 9/10/2009 7.0 x 5.0 cm wheal. 25mg BENADR 9/11/2009 My veins all around site of shot pron 9/10/2009 Child woke up crying with a headac 9/10/2009 9/9/09- Injection 1100 am. 2-Tyleno
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9/15/2009 NC 9/15/2009 AL 9/15/2009 MA 9/15/2009 MA 9/15/2009 DE 9/15/2009 CT 9/15/2009 CT 9/15/2009 OH 9/15/2009 VA 9/15/2009 KY 9/15/2009 FL 9/15/2009 NE 9/15/2009 CA 9/15/2009 CO 9/15/2009 TX 9/15/2009 OH 9/15/2009 WA 9/15/2009 HI 9/15/2009 OH 9/15/2009 AL 9/15/2009 SC 9/15/2009 WA 9/15/2009 VA 9/15/2009 GA 9/15/2009 MI 9/15/2009 SC 9/15/2009 MD 9/15/2009 OK 9/15/2009 MS 9/15/2009 GA 9/15/2009 OK 9/15/2009 HI 9/15/2009 MN 9/15/2009 CA 9/15/2009 KY 9/15/2009 NC 9/15/2009 FL 9/15/2009 NJ 9/15/2009 KY 9/15/2009 TN 9/15/2009 VA 9/15/2009 CA 9/15/2009 AL 9/15/2009 CA 9/15/2009 MD 9/15/2009 ID 9/15/2009 DE 9/15/2009 AK 9/15/2009 MI 9/15/2009 MI 9/15/2009 NJ
1.3 87 60 80 78 11 4 14 66 3 68 2 12 62 69 27 5 74 44 51 64 57 22 31 17 5 25 18 1 15 67 17 12 4 41 13 16 2 42 16 4 47 38 11 1.7 12 15 11 7 8 11
1 87 60 80 78 11 4 14 66 3 68 2 12 62 69 27 5 74 44 51 64 57 22 31 17 5 25 18 1 15 67 18 12 4 41 13 16 2 42 16 4 47 38 1 12 15 11 7 8 11
0.3 M F F F F M M F M F F 0.9 F F F F F M F F F F F M M F M F F 0F F F F F M F F F 0.9 M M F M F F M 0.7 M M F M F M M
9/15/2009 Deep febrile seizure 11 days after M 9/15/2009 Knot under skin at site of injection 9/14/2009 Once given flu shot, patient immedi 9/11/2009 Redness approx. 4 inches in diam. 9/3/2009 Swelling from elbow upwards, mild p 9/4/2009 Parents noted malaise, headache, s 9/4/2009 Swelling and cellulitis at sight. 9/5/2009 Swollen area around injection site. T 9/8/2009 Approx 12 hours after ZOSTAVAX v MCA stroke on 9/4/09. Aphasia. He 9/6/2009 Redness, inflammation, hardening o 9/9/2009 Facial swelling, nose & eyes, 12 hrs 8/31/2009 12yr female who had a syncope spe 9/4/2009 Bitter taste in mouth that happened 9/8/2009 Patients arm was in pain the evenin 9/9/2009 In the afternoon the day the vaccine 9/15/2009 "Clumps of Blistering Hives" to L arm 8/27/2009 Tingling, stinging, itching, at and ab 9/8/2009 Extreme muscle pain on L side arm 9/3/2009 Patient feels like she has a cold com 9/8/2009 Patient reported redness, swelling, 9/4/2009 About 1 hour after receiving flu shot 9/11/2009 Fever, sweats, headache, swollen/r 9/9/2009 Swollen lips in AM after - Treated w 9/15/2009 Blood Clot in lung on 4-12-2009 and 9/15/2009 Administered immunization to patien 9/15/2009 Reports pain, reddness and swelling 9/15/2009 Pt. stated that she didn't feel well af 9/15/2009 1:00 p.m. on September 12th, 2009 9/15/2009 Client was given a Tdap on 2/6/09 a 9/15/2009 Pt received Pneumovax 0.5mL IM R 9/15/2009 the first two vaccines were no extrem 9/15/2009 fever, arm-swollen, red, sore, nause 9/15/2009 Redness, swelling, warm to the touc 9/15/2009 Patient received yellow fever vaccin 9/15/2009 Grandmother/guardian reports head 9/15/2009 Dizzines,Hypotension,Blurred Vison 9/15/2009 Hives post flu vaccine, pain in leg 9/15/2009 Patient received an subcutaneous in 9/15/2009 Patient had the 1st shot of Gardasil Pt grandmother reported to staff on 9/8/2009 Throat tightness, chest congestion , 9/1/2009 Approximately 2 hours after receivin 9/10/2009 Vaccines given 8/24/09 - red swolle 9/15/2009 PT FATHER SAID A KNOT DEVEL 9/15/2009 Bilateral axillary lymphadneopathy 4 9/15/2009 within 20 minutes of shot, became d 9/8/2009 Head shaking, approximately every 9/15/2009 Concerns about dosage. Child given 9/15/2009 no advers events reported. Concern 9/15/2009 Hives (urticaria) from head to toe ap
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9/15/2009 WA 9/15/2009 CA 9/15/2009 OK 9/15/2009 OR 9/15/2009 MI 9/15/2009 WA 9/15/2009 UT 9/15/2009 IN 9/15/2009 LA 9/15/2009 AZ 9/15/2009 WA 9/15/2009 MS 9/15/2009 FL 9/15/2009 GA 9/15/2009 CA 9/15/2009 FL 9/15/2009 VA 9/15/2009 OH 9/15/2009 DC 9/15/2009 NM 9/15/2009 MO 9/15/2009 MN 9/15/2009 CA 9/15/2009 ND 9/15/2009 SC 9/15/2009 PA 9/15/2009 CA 9/15/2009 WA 9/15/2009 AZ 9/15/2009 FL 9/15/2009 IL 9/15/2009 MI 9/15/2009 MI 9/15/2009 AZ 9/15/2009 TX 9/15/2009 MO 9/15/2009 CA 9/15/2009 KS 9/15/2009 CA 9/15/2009 IA 9/15/2009 NC 9/15/2009 OR 9/15/2009 NY 9/15/2009 IL 9/15/2009 VA 9/15/2009 OH 9/15/2009 WA 9/16/2009 DC 9/16/2009 PA 9/16/2009 9/16/2009 WA
23 5 48 18 18 16 2 5 5 40 38 48 72 31 80 77 5 81 4 67 1 40 61 3 12 42 18 2 57 49 5 73 13 0.2 28 45 77 1 63 17 11 19 11 18
23 5 49 18 18 16 2 5 5 40 38 48 72 31 80 77 5 81 4 67 1 40 61 3 12 42 18 2 57 49 5 73 13 0 28 45 77 1 63 17 11 19 11 18 63
20 11 4
4
19
19
F F F F F M 0.2 F M F M F F F F F F M F M F 0F M F F F F M 0.1 F M F M F M 0.2 M F F F 0M F F M F F M U F F M F U F
9/15/2009 After beng given a Hep A vaccinatio 9/15/2009 Pt. got red cheeks, forehead, nose a 9/15/2009 Redness on arm, soreness of arm, f 9/7/2009 On 12/1/08 patient given GARDASI 9/8/2009 After injection patient started turning 7:45 pm 8-21-09 nausea, headache 9/15/2009 ITP 9/8/2009 R leg is Red, warm, and swollen the 9/8/2009 Knot-swollen-red 9/15/2009 L arm cellulitis-Rx Keflex 500 QiD< 9/15/2009 Patient reported CHill, panic, Racing 9/9/2009 None stated. 9/15/2009 None stated. 9/18/2009 General weakness 10 minutes after 9/15/2009 Patient complaint of nose bleeding a 9/4/2009 Patient returned three days after va 9/15/2009 Rash at injection site area - Erythem 9/15/2009 9/15/09 Pt. had 0.5ml of FLUVIRIN 9/15/2009 DTAP/IPV given 2 months after 4th 9/15/2009 Reaction @ injection site [redness] 9/15/2009 9/11/09 broke out all over red, raise 9/12/2009 Pt filled a VAR and said he had prev 9/11/2009 Site swollen on injected (L) arm, beg 9/14/2009 Given PEDIARIX, MMR, Chickenpo 9/15/2009 Received 3rd dose HPV vaccine in 9/11/2009 Pt complained of right forearm tend 9/15/2009 Fainted in car a few minutes after sh 9/15/2009 Pt has a raised bump at the injectio 9/4/2009 Tingling in throat & cough for appro 9/13/2009 Left arm very swollen, red, hot to to 9/3/2009 L arm became swollen & warm & pa 9/8/2009 No History of allergy to getatin of Ne 7/8/2009 I placed injection (IM) on 7-7-09 & re 9/11/2009 Patient developed a bump with redn 9/6/2009 Patient noticed numbness below elb 9/4/2009 TDAP given 9-1-09. On 9-2-09 at 2: 9/11/2009 Received shingles vaccination 7/15 4/23/2009 Staring, dazed appearance for 4 hrs 9/9/2009 July 29 got shingles vaccine. On 8-3 9/9/2009 Eyes became red & sore, face red, 9/11/2009 Temp up to 103.4 & Headache x 4 d 9/8/2009 Approx. 3 hours after receiving TDA After the nurse administered the vac 9/8/2009 Patient fainted after receiving flu va 9/14/2009 Received vaccine same time as hus 9/11/2009 C/o left upper extremity numbness a 9/24/2009 Complaints of blurry vision, R knee 9/14/2009 Client in advertently given KINRIX fo 9/15/2009 Redness swelling and itching of R a 9/15/2009 Initial and follow-up information has 9/11/2009 Left upper arm local reaction with er
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9/16/2009 MD 9/16/2009 DE 9/16/2009 NY 9/16/2009 MS 9/16/2009 FL 9/16/2009 MN 9/16/2009 VA 9/16/2009 FL 9/16/2009 TX 9/16/2009 IL 9/16/2009 FL 9/16/2009 LA 9/16/2009 ME 9/16/2009 MI 9/16/2009 NY 9/16/2009 MD 9/16/2009 MA 9/16/2009 OH 9/16/2009 TX 9/16/2009 ND 9/16/2009 CA 9/16/2009 OH 9/16/2009 TN 9/16/2009 IN 9/16/2009 KY 9/16/2009 CA 9/16/2009 PA 9/16/2009 IN 9/16/2009 NY 9/16/2009 WA 9/16/2009 PA 9/16/2009 WA 9/16/2009 WA 9/16/2009 UT 9/16/2009 MO 9/16/2009 TX 9/16/2009 WA 9/16/2009 TX 9/16/2009 IL 9/16/2009 OR 9/16/2009 TX 9/16/2009 FL 9/16/2009 NC 9/16/2009 IA 9/16/2009 FL 9/16/2009 SC 9/16/2009 MI 9/16/2009 OH 9/16/2009 9/16/2009 KS 9/16/2009 CA
23 11 1.6 3 27 15 51 54 81 43 40 33 15 5 55 0.5 64 39 67 61 26 48 18 34 13 16 55 45 69 42 56 14 4 81 54 34 12 14 61 1.8 35 23 58 42 26 79 49 74 65 5 13
23 11 1 3 27 15 51 54 81 43 39 33 15 5 55 0 64 39 67 61 26 48 18 34 13 16 55 45 69 42 56 14 4 81 54 33 12 14 61 1 35 22 58 42 26 79 49 74 65 5 13
F M 0.6 M M F F F F M M F F M M F 0.6 M F F F F U F F F F M F F F F F F F F F F F F F 0.8 M F F F F F F F F F F U
9/15/2009 9-9-09 - Pt received 3rd GARDASIL 9/11/2009 1 day after shot felt nauseate pale f 9/14/2009 Swelling and tenderness to left uppe 9/16/2009 Pt developed oval rash adjacent to 9/16/2009 Diffuse hives and pruiritis- onset 2hr 9/16/2009 Varicella given Rt arm SQ on 9/14/0 9/14/2009 Pt reported pain, redness and bliste 9/16/2009 Throat constriction, stomach pains & 9/16/2009 Took Influenza & Pneumoccal shot 9/16/2009 Red and itchy eyes, upper back pai 9/16/2009 Individual called my office to report 9/16/2009 Received flu shot at 0900 am Septe 9/16/2009 MALAISE, JOINT PAIN, NUMBNES 9/16/2009 LEFT LEG BECAME SWOLLEN AN 9/16/2009 Patient stated that she had fever, ch 9/16/2009 RECEIVED VACCINES AT APPRO 9/16/2009 Within 5 minutes of immunization, p 9/16/2009 APROXIMATELY 40HRS AFTER R 9/16/2009 Employee states that after 2 hours o 9/16/2009 After receiving the seasonal flu shot 9/16/2009 Patient reported a hive-like rash to a 9/16/2009 Received the flu shot around 4:30-5 9/16/2009 Patient fainted and was assisted to 9/16/2009 Within a half an hour, I began to sw 9/16/2009 Vaccine administered 9/14/09 at 2:0 9/16/2009 patient got VZV/Tdap/MCV 4, and w 9/16/2009 received influenza vaccine 9/14/200 9/16/2009 extreme fatigue, tingling of left arm 9/16/2009 Patient presented with rash 1 month 9/16/2009 Swelling started soon after the shot 9/16/2009 Received shot on Sept 14 at 1:30PM 9/16/2009 Pt was to receive Gardasil #1, Fluvi 9/16/2009 5 days after receiving her 2nd varcil 9/16/2009 Patient complained of agitation, trem 9/16/2009 Patient developed redness, warmth 9/16/2009 The patient developed high fever >1 9/16/2009 at 25 days after shot she developed 9/16/2009 Per mother, pt awoke on Saturday, 9/16/2009 On four occasions in the two years 9/16/2009 Induration, swelling, redness and ra 9/16/2009 RASH AT INJECTION SITE CONSI 9/16/2009 I received the injection around 10 am 9/16/2009 Beginning 9/15/09 at 6 or 7 PM EST 9/16/2009 Patient complained feeling slight fai 9/16/2009 Received a call from a patient reque 9/16/2009 Right after vaccine administered ble 9/16/2009 Received injection 10:30am within o 9/16/2009 Serious swelling of upper arm, shou 9/16/2009 Red, swelling at injection site. lastin 9/16/2009 Approx 30-40 min after receiving a i Patient received vaccine 9/14/09 &
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9/16/2009 CA 9/16/2009 GA 9/16/2009 MN 9/16/2009 MN 9/16/2009 CA 9/16/2009 PA 9/16/2009 MO 9/16/2009 CA 9/16/2009 IL 9/16/2009 FL 9/16/2009 TX 9/16/2009 TX 9/16/2009 OH 9/16/2009 MA 9/16/2009 KY 9/16/2009 OH 9/16/2009 KY 9/16/2009 NC 9/16/2009 WI 9/16/2009 RI 9/17/2009 WA 9/17/2009 9/17/2009 MI 9/17/2009 MA 9/17/2009 PA 9/17/2009 PA 9/17/2009 9/17/2009 9/17/2009 MD 9/17/2009 9/17/2009 9/17/2009 IL 9/17/2009 CA 9/17/2009 OH 9/17/2009 SC 9/17/2009 VA 9/17/2009 NY 9/17/2009 NY 9/17/2009 KS 9/17/2009 PA 9/17/2009 FL 9/17/2009 SC 9/17/2009 IL 9/17/2009 OH 9/17/2009 CT 9/17/2009 WI 9/17/2009 NM 9/17/2009 AR 9/17/2009 MN 9/17/2009 OH 9/17/2009 IL
18 1.5 76 65 15 73 79 71 86 46 22 9 5 15 31 0.3 31 65 67 75 3 6 0.5 23 23 15
18 1 76 65 15 73 79 71 86 46
14
14
12 3 2 9 81 17 68 4 0.8 58 10 17 12 69 19 13 45 10 2 29 19 5
9 5 15 31 0 31 65 67 75 3 6 0 23 23 15
2 81 17 68 4 0 58 10 16 12 69 19 13 45 10 2 19 5
F 0.5 M M F F M F M F M F F F M F 0.3 F F F F F M F 0.5 F F F F F F F F F 0.4 M F M F F M 0.8 M F F M F F F F F F 0.8 F F M M
9/11/2009 Redness & swelling to site. Doctor 9/15/2009 Mom called our office later in the da 9/16/2009 None stated. 9/16/2009 Given FLUZONE vaccine injection o 9/15/2009 Nausea, dizziness (Patient received 9/16/2009 Vaccinated 9-12-2009 @ 3:15PM. S 9/15/2009 Pt complained of severe arm pain. S 9/8/2009 At 9:30 PM (4 hrs after injections/ p 9/16/2009 Pt experienced unusual swelling an 9/14/2009 Pain, redness & swelling at site, R a 9/26/2009 Approx. 2 1/2 - 3 hours after injectio 9/16/2009 Pt developed redness of about 3 1/2 9/16/2009 Sterile abscess and cellulitis on upp 9/16/2009 Nausea and vomiting s/p flu vaccina 9/15/2009 Patient received FLUZONE shot - a 9/12/2009 PENTACEL, PREVNAR and ROTA 9/14/2009 Day after flu shot patient relied com 9/16/2009 TD given 9-14-09; patient experienc 9/16/2009 On 9-15-09 pt developed nausea, th 9/16/2009 Most painful shot ever gotten, walke 9/17/2009 Received Hep A and Flu Mist on 12 9/17/2009 Large local reaction, 3x4 cm wheal, Had nasal congestion for 2-3 days p 9/16/2009 Information has been received from 9/16/2009 Initial information from a consumer w 9/16/2009 Information has been received from 9/16/2009 Information has been received from 9/16/2009 Information has been received from 9/14/2009 Initial information was received on 0 9/14/2009 Initial report received on 08 Septem 9/14/2009 Initial report received on 10 Septem 9/17/2009 Patient received Varicella Vaccine o 9/17/2009 Cough and stuffy nose lasting more 9/17/2009 Patient experienced nausea and run 9/17/2009 PATIENT STATES THAT ON 9-149/17/2009 Fever 100-101.4 developed approx. 9/17/2009 Left arm with erythema and edema 9/17/2009 CBC obtained 3 days post influenza 9/17/2009 Approx. 12:30 p.m. Inluenza injectio 9/17/2009 pt developed Graves Disease an au 9/17/2009 30-45 min after vaccines given child 9/17/2009 Approximately 2 minutes after recei 9/17/2009 Received pneumonia vaccine 9/14/0 9/17/2009 Swelling at injection site which got w 9/17/2009 Extreme Fatigue, Nausea, migratory 9/17/2009 Influenza vaccine administered at 7 9/17/2009 Fever of 104 degree noted by schoo 9/17/2009 scratching/clawing at eyes crying 9/9/2009 Severe dizziness, nausea, vomiting 9/12/2009 About 5 min after vaccination, pt c/o Behavioral changes, agitation, obse
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9/17/2009 AZ 9/17/2009 GA 9/17/2009 OR 9/17/2009 NY 9/17/2009 CO 9/17/2009 SD 9/17/2009 FL 9/17/2009 WA 9/17/2009 VT 9/17/2009 ME 9/17/2009 CA 9/17/2009 OH 9/17/2009 MN 9/17/2009 ME 9/17/2009 SC 9/17/2009 PA 9/17/2009 VA 9/17/2009 IL 9/17/2009 MN 9/17/2009 MI 9/17/2009 TN 9/17/2009 KY 9/17/2009 OH 9/17/2009 NY 9/17/2009 IA 9/17/2009 9/17/2009 MI 9/17/2009 NM 9/17/2009 TX 9/17/2009 VA 9/17/2009 AZ 9/17/2009 WA 9/17/2009 OH 9/17/2009 MT 9/17/2009 CA 9/17/2009 NY 9/17/2009 VA 9/17/2009 VA 9/17/2009 TX 9/17/2009 CA 9/17/2009 NJ 9/17/2009 TX 9/17/2009 CA 9/17/2009 KY 9/17/2009 GA 9/17/2009 LA 9/17/2009 OH 9/17/2009 PA 9/17/2009 MA 9/17/2009 MA 9/17/2009 IA
11 66 64 50 73 4 1 1.3 3 14 1.4 15 22 43 34 38 70 29 25 1.1 22 51 32 4 93 41 18 49 13 41 24 29 62 65 3 14 0.5 18 62 67 0.2 65 4 28 0.2 70 14 60 53 44
11 66 64 50 73 4 1 1 3 14 1 15 22 43 34 38 70 29 25 0 22 51 32 4 93 41 18 49 13 42 24 29 62 65 3 14 0 18 62 67 0 65 4 28 0 70 14 60 53 44
F F F F F M 0M 0.3 F M F 0.4 M F F F F F F M F 0.1 U F F F F F M F F F M F M F F M M 0.5 M M F F 0.2 M F F M 0.2 M F F F M F F
9/9/2009 "Persistent crying for 3 hrs, with fev 9/14/2009 Red, swollen, heat in area, hard kno 8/24/2009 Next morning: red blister/rash 1" lon 9/11/2009 Positive cellulitis on vaccine site. 9/15/2009 Red skin at injection site approx 199/11/2009 Entire thigh to under knee of left leg Red rash all over. Fever coughing ru 9/10/2009 Fever 101.0 - 103.0. 9/10/2009 Pt received Shot Thur and reported 9/6/2009 Patient and mother report - after HP 9/10/2009 Pt's mother stated swelling, red and 9/17/2009 Five days after receiving the guardis 9/17/2009 Pt is an International student from C 9/17/2009 She had injection on tuesday here i 9/17/2009 Received T/C from Carole Chiv. Sta 9/17/2009 rash on chin, abdomen, and both ar 9/17/2009 At 2pm pt got Zostavax shot. By the 9/17/2009 5 minutes after recieving vaccine, cl 9/17/2009 approx. 12 hrs after vaccine I starte 9/17/2009 slight rash and low fever. 9/17/2009 Patient broke out in hives/rash withi 9/17/2009 c/o of itching at the site of injection i 9/16/2009 Pain in Left Shoulder where vaccine 9/17/2009 Progress Notes JOSEPH LURIO 9/ 9/17/2009 Redness and swelling from the shou 9/17/2009 2 days after anthrax vaccination to t 9/17/2009 Client received HPV, HAv, MCV4. A 9/17/2009 arm described by employee as "swo 9/17/2009 The study subject is a 13-year-old fe 9/17/2009 LLL pneumonia (fever 101-102 x 3 d 9/17/2009 Diffuse urticarial reaction 9/17/2009 One week after recieving smallpox v 9/17/2009 Pain from mid clavical to upper arm 9/17/2009 Vaccine administered without any n 9/17/2009 Developed itchy rash all over body a 9/17/2009 Patient developed chest tightness/p 9/11/2009 NICU graduate Y (24 5/7 wks) gestatio 9/17/2009 This 19 yo patient reported onset of 9/14/2009 Rt. eye is not clear. Suggested pt. c 9/15/2009 7-8 after receiving PNEUMOVAX, p 9/17/2009 Rash around mouth, and on angle o 9/17/2009 10:10 AM rec'd flu vac 9/1/09. 4:00 8/29/2009 4 y/o female received MMR, IPV in 9/17/2009 Approximately 10 minutes after vacc 7/24/2009 Diarrhea x 4 days 9/17/2009 Redness, cellulitis at site of injection 9/17/2009 Vaccine given on 9-16-09 @ 245/PM 9/17/2009 Injection given 9/11/09 on 9/17/09 p 9/16/2009 Headache, nausea, achy, numbnes 9/17/2009 Flu vaccine received @ 10:30-within 9/17/2009 09/16/09 weak, tired, feeling cold.
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9/17/2009 WA 9/17/2009 AL 9/17/2009 NY 9/17/2009 SC 9/17/2009 SC 9/17/2009 WI 9/17/2009 AZ 9/17/2009 IN 9/17/2009 MI 9/17/2009 MI 9/17/2009 NY 9/17/2009 MI 9/17/2009 DE 9/17/2009 OH 9/17/2009 TX 9/17/2009 MN 9/17/2009 WV 9/17/2009 WA 9/17/2009 MO 9/17/2009 MD 9/17/2009 GA 9/17/2009 GA 9/17/2009 OH 9/17/2009 DE 9/17/2009 DC 9/17/2009 TX 9/17/2009 TX 9/17/2009 ND 9/17/2009 OR 9/18/2009 MA 9/18/2009 NC 9/18/2009 CA 9/18/2009 RI 9/18/2009 IN 9/18/2009 IL 9/18/2009 CA 9/18/2009 FL 9/18/2009 FL 9/18/2009 FL 9/18/2009 NY 9/18/2009 9/18/2009 AZ 9/18/2009 AZ 9/18/2009 GA 9/18/2009 FL 9/18/2009 GA 9/18/2009 TX 9/18/2009 FL 9/18/2009 FL 9/18/2009 NY 9/18/2009 MI
1 50
1 50
69 7 3 60 76 27 44 76 46 40 4 48 17 69 74 26 61 11 4 2 68 28 74 53 66
69 7 3 60 76 27 44 76 46 40 4 48
40
40
73
73
27 7 10 14 71 62 67 39 4 6 7 54 65 59 64 74 3 47
27 7 10 14 71 62 67 39 4 6 7 53 65 59 64 64 3 47
69 74 26 61 11 4 2 68 28 74 53 66
0F F F F F M F M F F F F M F U F F M F F M F 0.9 F M F F F M F F F M F F M F F F F M M M M M F F F F M M F
9/17/2009 Excessive crying, irritability. Resulte 9/17/2009 Redness, puffed or swollen, abut siz 9/17/2009 Numbness & tingling of hands & ext 9/8/2009 Customer noticed red rash on left a 9/11/2009 One day following administration of 9/19/2009 Left Parotitis. 9/14/2009 Received flu shot 9/10/09 @ mid mo 9/11/2009 Patient received shot at approximat 9/11/2009 Redness. Heat radiation aft swelling 9/13/2009 Five minutes after FLUVIRIN injectio 9/15/2009 High fever, vomiting, SPLITTING he 9/11/2009 Lt arm sore and red, firm warm area 9/9/2009 -Bruise on left arm in area of injectio 9/11/2009 DTaP and IPV administered in R thi 9/10/2009 L arm pain & swelling following imm 9/8/2009 Itchy, swelling, lungs filling up, swol 9/10/2009 Lq. red swollen area entire upper ar 9/9/2009 Patient described extreme achiness 9/17/2009 Per pt phone call 9/14/09, pt receive 9/15/2009 Light headed, itchy eyes, red eyes, 9/17/2009 Right arm red and swollen around in 9/17/2009 Right thigh swollen, red area around 9/17/2009 Bruise was next day, swelling starte 9/17/2009 No adverse events 9/14/2009 Reports that within 8 hrs of receiving 9/16/2009 L mild upper arm - Red, warm, sligh 9/17/2009 Pneumonia shot given Sept 14, 200 9/11/2009 Relates the evening of the vaccine t 9/17/2009 Severe pain developed locally at inj 9/10/2009 Rev'd vaccine Wed 9/2/09 and had 9/17/2009 Information has been received from 9/17/2009 Information has been received from 9/18/2009 Pt received pneumonia vaccine 9/16 9/14/2009 Received shot on 9-11-09 approx 1 9/12/2009 Red swollen arm. 9/14/2009 Within 24 hours of receiving varicell 7/27/2009 Within minutes of the administration 9/18/2009 Patient states that she was not able 9/17/2009 9/8 vaccinated -migraine starting ab 9/18/2009 Red rash on left and right hand- Itch 9/18/2009 This case was reported by a lawyer 9/18/2009 2 days after receiving VARIVAX and 9/20/2009 (L) arm erythematous, hot, edemato 9/18/2009 Moderate/Severe swelling and redn 9/18/2009 24 hours after receiving my vaccina 9/18/2009 On 9-17-2009 patient called me to r 9/18/2009 Reddness at site on right arm, down 9/18/2009 shot hurt more than usual shotsSOB 9/18/2009 hurt more at onset; SOB, muscle ac 9/18/2009 Pt. presented 24hrs post immunizat 9/18/2009 Skin rash with some itching appeare
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9/18/2009 WI 9/18/2009 MN 9/18/2009 MN 9/18/2009 AZ 9/18/2009 MN 9/18/2009 LA 9/18/2009 NV 9/18/2009 FL 9/18/2009 TX 9/18/2009 IL 9/18/2009 MI 9/18/2009 WI 9/18/2009 AZ 9/18/2009 AZ 9/18/2009 OR 9/18/2009 OR 9/18/2009 NY 9/18/2009 NM 9/18/2009 IL 9/18/2009 GA 9/18/2009 PA 9/18/2009 CA 9/18/2009 VA 9/18/2009 KS 9/18/2009 MN 9/18/2009 MA 9/18/2009 MA 9/18/2009 UT 9/18/2009 GA 9/18/2009 MN 9/18/2009 TN 9/18/2009 NY 9/18/2009 NC 9/18/2009 MI 9/18/2009 OR 9/18/2009 AL 9/18/2009 TX 9/18/2009 AZ 9/18/2009 WI 9/18/2009 OH 9/18/2009 AZ 9/18/2009 CA 9/18/2009 NY 9/18/2009 OK 9/18/2009 VA 9/18/2009 IL 9/18/2009 CA 9/18/2009 MA 9/18/2009 AR 9/18/2009 NH 9/18/2009 KS
7 0.2 68 4 23 42 29 48 57 54 45 36 46 5 1.1 3 50 0.2 46 1 4 29 19 57 1.1 60 11 16 4 62 18 66 49 43 15 64 59 6 80 2 11 67 32 66 14 36 33 32 43
7 0 63 4 23 42 29 48 53 57 54 45 36 46 5 1 3 50 0 46 1 4 29 19 57 1 60 11 16 4 62 18 66 49 43 15 32 64 59 6 80 2 11 67 32 66 14 36 33 32 43
F 0.2 M F M F M F F F M F F F F M 0.1 F M F 0.2 F F 0M F F M F 0.1 F F M M F F F F M F F F F F F F 0.4 M F F F F F M F F F
9/18/2009 MOTHER CALLED THIS AM TO RE 9/18/2009 Persistent, unconsolable crying all n 9/18/2009 Itching, slight rash, and facial flushin 9/18/2009 12 cm by 10 cm swelling and indura 9/18/2009 Itching, hives, headache, sore throa 9/18/2009 LYMPHNODE SWELLING AND PA 9/18/2009 2330, 16 Sep 09. Pt states the left 9/18/2009 Pain and swelling to left deltoid area 9/18/2009 PATIENT STATES INSIDE ARM AN 9/18/2009 I recieved the Flu shot on 15 Sep 20 9/18/2009 Tdap was administered at 11am 11 9/18/2009 HIVES NEAR LEFT ELBOW 45 MIN 9/10/2009 Pt states when vaccine was injected 9/18/2009 Flat erythematous - "hive like" - area 9/17/2009 Woke on day 2 after KINRIX (DTaP 9/15/2009 Febrile seizure 9 hours p shots. 9/18/2009 Localized vesicular rash/eruption at 9/18/2009 Patient felt lightheaded and needed 9/18/2009 Within 24 hours of administration, m 9/18/2009 Pt noticed increasing redness and s 9/18/2009 Lump & redness at HIB vaccine site 9/17/2009 Extensive local reaction, redness, m 9/18/2009 Enlarging red, tender area around in 9/18/2009 Injected Novartis FLUVIRIN vaccine 9/17/2009 Small ruptured capillary immediately 9/18/2009 Diffuse mildly raised erythematous p 9/19/2009 Within 1 wk of vaccination rash beg 9/18/2009 Arms are swollen. No redness or wa 9/18/2009 Pt was given JE-VAX yesterday at a 9/18/2009 Hives 9/18/2009 Uniformly erythemic, pruritic, round 9/18/2009 Received the vaccine at 12, about 1 9/18/2009 Left arm was red,swollen, and warm 9/18/2009 Client seen in clinic for routine Tdap 9/18/2009 Patient states she had pain, rednes 9/18/2009 Redness, warmth- left arm. 9/18/2009 Adverse reaction occured at about 1 9/18/2009 Lt upper arm above elbow to below 9/18/2009 Three hours after receiving immuniz 9/18/2009 24 hours after second Varivax she d 9/18/2009 9/16/09 1630 patient was in her usu 9/18/2009 GAVE 5TH DTAP TO A 2YR OLD 9/18/2009 Received Tdap and Varicella and M 9/18/2009 Pt. received Pnueovax in right delto 9/18/2009 Received vaccine 9/1/09 at 6:44pm 9/18/2009 Patient's right upper arm became ve 9/18/2009 My daughter had the flu shot given 9/18/2009 Joint pain. Bilat. upper extremity we Pt got vaccine after lunch. Since sh 9/16/2009 Hives all over body, neck and face, 9/17/2009 9/14/09 after shot arm pain. 24 hour
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9/18/2009 CT 9/18/2009 MA 9/18/2009 IL 9/18/2009 PA 9/18/2009 GA 9/18/2009 UT 9/19/2009 IL 9/19/2009 9/19/2009 FL 9/19/2009 OK 9/19/2009 AZ 9/19/2009 NE 9/19/2009 NY 9/20/2009 ID 9/20/2009 IL 9/20/2009 IN 9/20/2009 GA 9/20/2009 MI 9/20/2009 MT 9/20/2009 MT 9/20/2009 WA 9/20/2009 AK 9/20/2009 MA 9/20/2009 FL 9/20/2009 NH 9/20/2009 TX 9/21/2009 MN 9/21/2009 WI 9/21/2009 CO 9/21/2009 DE 9/21/2009 9/21/2009 9/21/2009 9/21/2009 9/21/2009 NV 9/21/2009 IL 9/21/2009 LA 9/21/2009 CA 9/21/2009 WI 9/21/2009 MA 9/21/2009 WA 9/21/2009 NJ 9/21/2009 OR 9/21/2009 OR 9/21/2009 VA 9/21/2009 OH 9/21/2009 AZ 9/21/2009 OR 9/21/2009 CA 9/21/2009 9/21/2009 FL
16 64 53 5 4 45 27 24 13 34 57 0.2 68 59 42 2 49 57 37 61 40 8 9 0.2 70 39
16 64 53 5 4 45 27 24 13 34 57 0 66 59 42 2 49 57 37 61 40 8 9 0 70 39
55 19 19 0 0.2 75
55 19 19 0 0 75
4 27 4 0.2 16 59 4 36 2 4 9 35 11 11
4 27 4 0 16 59 4 36 2 4 9 35 11 11
1 16
16
F F F F F M M M F F M 0.2 M F F F 0.7 F F F M M F F M 0.2 M M F F M F F 0M 0.2 F F F F M F 0.2 M F M F F 0.8 F M M F F F M F F
9/18/2009 None. Student given a second MEN 9/18/2009 Nosebleeds occurring spontaneous 9/19/2009 Patient came to pharmacy for Pneu 9/18/2009 Varivax & IPV given at 3:15 pm. Pt 9/18/2009 Looks like break-through Varicella in 9/18/2009 Left arm sore. By 9pm felt nauseate 9/19/2009 I was having shortness of breath, w 9/19/2009 Mild pericarditis treated with NSAID 9/19/2009 day after immunization generalized 9/19/2009 Nausea, vomiting, fever of 101 degr 9/19/2009 Asthma exacerbation: wheezing, dif 9/19/2009 Patient received the rotavirus vaccin 9/19/2009 Shingles vaccine given on same da 9/20/2009 Unexplained body itching, progress 9/20/2009 On 5/19/09 when making a follow-u 9/20/2009 ABOUT FORTY HOURS AFTER TH 9/20/2009 After receiving the flu vaccine at wo 9/20/2009 I received a flu vaccination around 1 9/20/2009 Had influenza vaccine approx 1:30 9/20/2009 had flu shot at 6pm. 10 pm felt thro 9/20/2009 Extreme pain at injection site, unabl 9/20/2009 Flumist vaccine was given intranasa 9/20/2009 Patient was administered LAIV even 9/20/2009 low grade fever (100.5F), diarrhea in 9/20/2009 Onset of symptoms within a few hou 9/21/2009 Itchy rash across chest. 9/19/2009 Patient had swelling and itching at s 9/20/2009 Swelling at the injection site. 9/18/2009 Patient became light headed, dizzy, 9/18/2009 Patient given PNEUMOVAX on 9/14 9/16/2009 Infant received Hepatitis B vaccine 9/16/2009 2.5 mo. female vaccinated with ROT 9/11/2009 E.R. on 04-29-09: Dry hives - heada 9/16/2009 RN requested DPT vaccine but rece 9/11/2009 One day after immunization, child d 9/16/2009 Maculo papular rash on Bilat upper 9/17/2009 Left deltoid 5 1/2 cm wide to 4 1/2 c 9/18/2009 Enteritis (loose, mucousy stools x 1 9/15/2009 None 9/15/2009 Patient complained of tingling in left 9/16/2009 Pt had got 4 yo imms in May in ano 9/11/2009 Reports left pupil dilated 60" after in 9/14/2009 Shots recd 9-9-09 PM. Lt. leg a littl 9/4/2009 Low grade fever noted @ "bed time 9/18/2009 9/1/09 - Left arm red, hot, tender no 9/1/2009 Client made a phone call to clinic on 9/16/2009 On 9-16-09 clients aunt called clinic 9/15/2009 Patient received all 5 doses of Rabi 9/8/2009 When pt was a little over 1yr old he 9/18/2009 Information has been received from 9/21/2009 Patient had her second injection of
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9/21/2009 MO 9/21/2009 TX 9/21/2009 WI 9/21/2009 WI 9/21/2009 CA 9/21/2009 VA 9/21/2009 TX 9/21/2009 TX 9/21/2009 OR 9/21/2009 CA 9/21/2009 MO 9/21/2009 CA 9/21/2009 FL 9/21/2009 IL 9/21/2009 CA 9/21/2009 GA 9/21/2009 NJ 9/21/2009 IL 9/21/2009 OR 9/21/2009 LA 9/21/2009 AZ 9/21/2009 IL 9/21/2009 IA 9/21/2009 FL 9/21/2009 AL 9/21/2009 NM 9/21/2009 MO 9/21/2009 MI 9/21/2009 OK 9/21/2009 KY 9/21/2009 CA 9/21/2009 WA 9/21/2009 AZ 9/21/2009 PA 9/21/2009 FL 9/21/2009 FL 9/21/2009 CA 9/21/2009 MN 9/21/2009 CT 9/21/2009 MA 9/22/2009 AZ 9/22/2009 AZ 9/22/2009 DE 9/22/2009 OH 9/22/2009 KS 9/22/2009 FL 9/22/2009 FL 9/22/2009 TN 9/22/2009 TX 9/22/2009 PA 9/22/2009 VA
12 12 11 4 74 48 90 18 35 53
12 12 11 4 74 48 90 18 35 53
23 11 66 55 4 67 37 51 80 32 6 71 62 28 0.2 13 58 21 60 2 11 52 81 67 49 53 4 3 42 33 71 18 33 25 68 48 21 55 63
23 11 66 55 4 67 37 51 80 32 6 71 62 28 0 13 58 21 60 2 11 52 81 67 49 4 3 42 33 71 18 33 25 68 48 21 55 63
M F F M F M M F F F F U F M F F F F F F M F F F F F 0.2 M M F M F 1F F F M F F F M M M F F F F F F F M F F
9/21/2009 My son developed a low grade feve 9/21/2009 Mom called 6 days after immunizati 9/21/2009 Pt was given 3 immunizations and w 9/21/2009 Pt was given pre-kindergarten immu 9/21/2009 I was a patient in the hospital for a c 9/21/2009 After pt properly screened and iden 9/21/2009 Within days of receiving Fluvirin pat 9/21/2009 extreme fatigue, mono, chronic stre 9/21/2009 The flu shot was administered via in 9/21/2009 Within 24 hours of the vaccination, I 9/21/2009 Patient recieved flu shot at approxim 9/21/2009 This case was reported by a physici 9/21/2009 This case was reported by a healthc 9/18/2009 Woke up at night with hot flashes, s 9/16/2009 Red, swollen about 4-5 inches below 9/21/2009 4 hours after vaccination she was n 9/21/2009 Seizure - went to ER. Received 4 do 9/22/2009 24 hours after vaccine administratio 9/21/2009 My left arm hurts from shoulder to w 9/21/2009 One minute after receiving vaccine 9/18/2009 Flu like symptoms, chest congestion 9/21/2009 Shortness of breath, lightheadednes 9/21/2009 Urticaria tx with Celadrin 4mg, antih 9/21/2009 Patient states she had a rash 2 day 9/21/2009 Red spot at injection site with little re 9/21/2009 Pt stated a couple of hour after rece 9/21/2009 Swelling of bottom lip with repetitive 9/21/2009 Child was given a VARIVAX and ME 9/17/2009 Day of vaccination- No symptoms. 2 9/21/2009 Pt complained of dizziness, light he 9/20/2009 Patient experienced lightheadednes Swollen red hot left arm where flu sh 9/21/2009 (R) upper arm cellulitis - Itching and 9/21/2009 L Axillary lump noted in arm on 9-20 9/20/2009 Itching+ red blotches on arms + legs 9/20/2009 Itching and bright red blotches on b 9/18/2009 12:20pm 9/18/09 patient returned to 9/21/2009 Patient contacted clinic the 17th sta 9/16/2009 Erythema right upper arm. Warm no Approx. 1 hour after receiving vacci 9/18/2009 Started feeling tenderness, pain in h 9/21/2009 9/14 - going to bed extremely sore a 9/22/2009 Rash/swelling at inj site. 9/17/2009 A cluster of seven patients who all r Initial report received on 09 Septem 9/9/2009 Patient had arm being sore at end o 9/14/2009 Diaphoretic, felt faint, numbness in 9/18/2009 Pt complained of numbness in arm 9/14/2009 None 9/3/2009 Redness, induration at injection site 9/21/2009 Large red area on rt arm is inflamed
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9/22/2009 MO 9/22/2009 CA 9/22/2009 CA 9/22/2009 OH 9/22/2009 MI 9/22/2009 CA 9/22/2009 IN 9/22/2009 CO 9/22/2009 KS 9/22/2009 NH 9/22/2009 CA 9/22/2009 MA 9/22/2009 CA 9/22/2009 IL 9/22/2009 9/22/2009 CA 9/22/2009 CA 9/22/2009 NY 9/22/2009 VT 9/22/2009 CO 9/22/2009 FL 9/22/2009 OR 9/22/2009 CA 9/22/2009 NE 9/22/2009 CA 9/22/2009 FL 9/22/2009 IL 9/22/2009 WA 9/22/2009 NC 9/22/2009 ME 9/22/2009 IL 9/22/2009 ID 9/22/2009 AK 9/22/2009 MI 9/22/2009 IL 9/22/2009 CA 9/22/2009 NC 9/22/2009 NC 9/22/2009 MI 9/22/2009 PA 9/22/2009 NV 9/22/2009 IL 9/22/2009 IA 9/22/2009 MT 9/22/2009 IL 9/22/2009 FL 9/22/2009 IL 9/22/2009 IN 9/22/2009 CA 9/22/2009 MI 9/22/2009 NY
52 25 71 50 66 4 10 62 63 0.2 10 0.2 64 55 66 17 67 0.2 0.2 0.2 7 0.1 40 21 15 4 66 10 10 2 73 67 10 37 14 4 68 68 11 42 1.1 62 68 56 4 79 65 76 0.4 71 34
52 25 71 50 66 4 10 63 0 10 0 55 66 17 67 0 0 0 7 0 40 21 15 4 66 10 10 2 73 67 10 37 14 4 68 68 11 42 1 62 68 56 4 79 65 76 0 71 34
F F M F F M F F F 0.2 F M 0.2 M F M M F F 0.2 F 0.2 F 0.2 M M 0.1 F F F F M F F M 0.2 M F M F M M M M F F F 0.1 F F F F M F F F 0.4 M F M
9/14/2009 Arm erythema, painful to the touch, Pain between the spine and shoulde 9/21/2009 24 hrs after vaccination, pt's neck (b 9/14/2009 Headache, Fever, Arm Swollen, Arm 9/15/2009 Got shingles as a result of vaccine. 9/4/2009 Left arm erythema and induration no 9/14/2009 9-11-09 off @ 2:30p (showing swell 9/14/2009 Erythema, induration, fevers, myalg 9/15/2009 3 hrs after shot developed severe le 9/14/2009 Erythema Multiforme. 9/11/2009 Varicella shot given on 9/10/09 at 2 9/16/2009 Irritability: "Screaming" "inconsolabl 9/11/2009 Two days after shot, there was swe 9/14/2009 Rash on legs, knees & forearms. U 9/21/2009 Information has been received from 9/21/2009 Information has been received from 9/21/2009 Extreme case of cellulitis (according 14 mo girl w/ SCID s/p 1 dose ROTA 9/9/2009 Sustained tachycardia presenting a 9/14/2009 Within hours of receiving vaccines, 9/15/2009 Partial seizure - new onset 1 week a 9/17/2009 About 5 pm pt. was asleep in mom's 9/16/2009 On Sep 1 2009 pt received Inactiva 9/4/2009 Felt lightheaded about 5 minutes af 8/19/2009 Chest pain, trouble breathing, rapid 9/15/2009 Vaccines administered 9/11/09 LT A 9/16/2009 Pt states she hasn't been able to mo 9/15/2009 Confusion lasting < 24 hours 5 days 9/16/2009 Mild inflammation with erythema 8-1 9/16/2009 9.3 x 6.5 cm area of erythema with 9/17/2009 Gave flu shot, and pt started bleedin 8/17/2009 Client seen 7-29-09 for travel, was g 9/17/2009 Pt broke out in hives shortly after th 9/18/2009 Within 2 minutes of shot he felt light On 8/18/09 I took my son to his prim 9/15/2009 Allergic Reaction, left arm turned re Pain in the left shoulder and arm 8-1 9/18/2009 Pt broke out in hives on arms, neck 9/15/2009 Child woke today with low grade fev 8/31/2009 Complained of soreness L arm with 9/14/2009 5X3 cm Erythema, very itchy, red an 9/15/2009 Swelling, redness, and warmth in ar 9/16/2009 Flu vaccine given @ 0922 AM. Ons 9/18/2009 Patient received self limiting left side 9/17/2009 Red raised sandpaper appearance 9/17/2009 Pt reported arm swelling and "bruise 9/13/2009 Pt given PNEUMOVAX & FLUVIRU 9/11/2009 Following injection, patient reported 9/14/2009 Received vaccines 8/31/09. Fever 1 9/16/2009 Thursday- Sept. 10 6pm - vaccine; 1 9/17/2009 Shortness of breath, coughing, light
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9/22/2009 MO 9/22/2009 MA 9/22/2009 OH 9/22/2009 CA 9/22/2009 IL 9/22/2009 CA 9/22/2009 MT 9/22/2009 IL 9/22/2009 MO 9/22/2009 AZ 9/22/2009 NV 9/22/2009 IA 9/22/2009 ME 9/22/2009 NH 9/22/2009 WV 9/22/2009 VA 9/22/2009 MO 9/22/2009 NC 9/22/2009 MO 9/22/2009 MN 9/22/2009 OR 9/22/2009 NJ 9/22/2009 CA 9/22/2009 CA 9/22/2009 IL 9/22/2009 OH 9/22/2009 NY 9/22/2009 CA 9/22/2009 MI 9/22/2009 UT 9/22/2009 NV 9/22/2009 MS 9/22/2009 CA 9/22/2009 AZ 9/22/2009 GA 9/22/2009 MN 9/22/2009 PA 9/22/2009 GA 9/22/2009 VA 9/22/2009 NC 9/22/2009 WA 9/22/2009 IN 9/22/2009 AL 9/22/2009 CO 9/22/2009 WA 9/22/2009 NC 9/22/2009 GA 9/22/2009 CA 9/22/2009 AR 9/22/2009 WA 9/22/2009 SC
35 12 24 82 36 17 66 13 49 5 4 0.7 55 9 7 39 79 62 73 1.5 38 1.2 48 1.1 47 4 52 50 80 4 61 3 67 11 24 70 72 22 14 43 52 0.2 15 67 31 42 32 53 13 0.4 73
35 12 24 82 36 17 66 13 49 5 4 0 55 9 0 39 80 62 73 1 38 1 48 1 47 4 52 50 80 4 60 3 67 11 24 70 72 22 14 43 52 0 15 31 42 32 13 0 73
F M M F M F F M F F F 0.7 M M M 0.5 M F F F M 0.5 F F 0.2 M F 0.1 F M F F F M F M F F F F M M F F F F 0.2 F F U F F F F M 0.4 M F
9/17/2009 Shot was given in Lt arm. Patient re 9/18/2009 Mother called 9/18/09 @ 1:46p to re 9/17/2009 FLUVIRIN vaccine administered in R 9/18/2009 On 9/18/09 this volunteer for hospita 9/15/2009 Next day fever, headache - 30 degr 9/16/2009 Received tetanus shot 9-14-09. Tha 9/17/2009 Pt. given Tdap, she is over 64 yrs. o 9/15/2009 Mother stated child developed 2X3i 9/18/2009 Pt said lymph node swollen on left s 9/16/2009 Fever only up to 102 degrees 1 day 9/14/2009 Local reaction 3 - cm - Redness and 9/13/2009 Vomited several times bit. 7 & 10:30 9/3/2009 The pt reported fever, pain, redness 9/11/2009 RA swelling, erythema 8x6 cm, indu 9/22/2009 Flumist given on Thursday, Sept. 17 9/22/2009 RASH 2 HOURS POST VACCINE. 9/22/2009 she presented to the clinic with redn 9/22/2009 CLIENT RECEIVED PNEUMOVAX 9/22/2009 an hour and a half after getting a re 9/22/2009 Cellulitis on bilateral thighs where in 9/22/2009 ABOUT 10 MINUTES AFTER RECE 9/22/2009 On July 10, 2009 patient received o 9/22/2009 9/18/09 8am client called and retur 9/22/2009 HEP B NOT NEEDED 9/22/2009 Broke out in red flat rash on inner a 9/22/2009 R thigh started swelling on Sat.am 8 9/22/2009 Within 1/2 hour of vaccine administr 9/22/2009 I was injected with the flu vaccine o 9/22/2009 patient says muscle still tender after 9/22/2009 Patient put in car after receiving sho 9/22/2009 L arm severe pain 9/22/2009 rash began about 1 hour after shot 9/22/2009 shingles rash eruption 2 weeks afte 9/22/2009 Immediately following injections, pa 9/22/2009 Developed cough, throat/chest tight 9/22/2009 I experienced extreme dizziness aft 9/22/2009 Pt developed a red rash around the 9/22/2009 Pt presented with swollen, firm uppe 9/22/2009 Left arm injection site was warm, re 9/22/2009 STARTED FEELING WEAK ABOUT 9/22/2009 Within two hours of vaccination, the 9/22/2009 Patient hadYa high fever and scream 9/22/2009 9/17/09- Rec'd Tdap, varicella at He 9/22/2009 three days after injection patient rep 9/22/2009 Pt complained of itching, redness of 9/22/2009 12 hours after vaccine, general feel 9/22/2009 Developed chest/throat tightness, fl 9/22/2009 3 hours after receiving seasonal infl 9/22/2009 Pt had meningitis vaccine on 09/15/ 9/22/2009 Death of patient. Y 9/22/2009 Immediately after receiving flu vacci
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9/22/2009 OR 9/22/2009 VA 9/22/2009 MA 9/22/2009 NJ 9/22/2009 CA 9/22/2009 SC 9/22/2009 PA 9/22/2009 9/22/2009 OR 9/22/2009 IL 9/22/2009 IL 9/22/2009 NC 9/22/2009 CA 9/22/2009 IA 9/22/2009 IN 9/22/2009 WI 9/22/2009 AZ 9/22/2009 MA 9/22/2009 MI 9/22/2009 CA 9/22/2009 KY 9/22/2009 VA 9/22/2009 VA 9/22/2009 MI 9/22/2009 MI 9/22/2009 CA 9/22/2009 CA 9/22/2009 CA 9/22/2009 NY 9/22/2009 MI 9/22/2009 VA 9/22/2009 AZ 9/22/2009 NY 9/22/2009 TX 9/22/2009 VA 9/22/2009 OH 9/22/2009 CA 9/22/2009 NY 9/22/2009 FL 9/22/2009 TX 9/22/2009 FL 9/22/2009 OK 9/22/2009 OH
41 55 49 32 1.3 12 82 48 41 74 52 34 65 49 33 45 4 21 48 66
41 55 49 32 1 12 82 48 41 74 52 34 65 49 33 45 4 21 48 66
40 6 0.3 59 71 25 67 1 23 50 36 4 12 5 76 5 4 3 4 4 2 1.6
40 6 0 59 71 25 67 23 50 36 4 12 5 76 5 4 3
2
F F F F 0.3 F F F F F F F F F F F F M F M F F F F 0.3 F F M F M M M F F F F M M F M F M F 0.2 F M
9/22/2009 Rash and some itching appeared on 9/22/2009 Whole body itching, esp. of scalp an 9/22/2009 TIngling/numbness down arm and in 9/22/2009 Around 11 pm started coughing and 9/22/2009 Chicken pox rash 10 days after vac 9/22/2009 Shortly after taking the vaccine she 9/22/2009 Swollen right arm from elbow to fore 9/22/2009 Pt rcvd immunization on Friday and 9/22/2009 Swollen node left side of neck. 9/22/2009 The patient received a flu shot on W 9/22/2009 Pt called 9/20/09 and complained o 9/22/2009 Vanish Point retractable syringe 25G 9/22/2009 Approximately 1-2 hours afterwards 9/22/2009 Used 1 1/2 needle over 240 lbs not 9/21/2009 Patient said she was experiencing s 9/22/2009 Pt received FLUZONE on 9/15/09 a 9/18/2009 L arm swollen, warm. 5 cm long, 3 c 9/22/2009 Syncope episode, lightheaded, nau 9/22/2009 Patient was breathing very deeply. 9/21/2009 Had fever of >103 and projectile vom Fever M/V, soreness at site within 1 9/22/2009 Sx began 4 hours after vaccine adm 9/22/2009 A/P neck pain - right side of neck w 9/22/2009 Once arrived at home, from Dr office 9/22/2009 Breathing difficulties started about 3 9/21/2009 24 hrs after vaccination, pt's neck (b Pain between the spine and shoulde 9/22/2009 Patient experienced chest pain imm 9/22/2009 Mother reports swollen leg. Says shot did not hurt but 5-10 mins 9/22/2009 Seen in clinic 9/17/09 with L arm inj 9/10/2009 Pt states when vaccine was injected 9/4/2009 Within one hour after injections of p 9/15/2009 Given MENACTRA, GARDASIL, Inf 9/15/2009 Rash at injection AREA Erythema a 9/14/2009 -patient got flu & pneumo shots on W See copy of progress note. 9/10/2009 Developed wheezing & cyanosis aft 8/17/2009 A non-serious, spontaneous report 8/27/2009 A non-serious spontaneous report o 8/17/2009 A non-serious spontaneous report o 8/22/2009 A non serious spontaneous report o 8/21/2009 A non-serious spontaneous report o
DATEDIEDL_THREATER_VISIT HOSPITALHOSPDAYS X_STAY DISABLE RECOVD VAX_DATEONSET_DATE n has been received from a physician concerning a child who was vaccinated with a dose ofUROTATEQ. Subsequently, the patient had dev n has been received from a physician Y concerning an 8 week old female who on 17-DEC-2008 Y was vaccinated ### with the first ### dose of ROTAT n has been received from a certifiedYmedical assistant (C.M.A.), for the Pregnancy Registry Y for GARDASIL, concerning ### 2/18/2008 a 14 year old femal n has been received from a 62 yearYold male physician with environmental allergies, Y asthmaNand atopic 11/9/2008 dermatitis who on### 09-NOV-2008 w n has been received from a physician concerning Y a patient (age and0 gender not reported) who Y on an unspecified date was vaccinated with ction of redness, swelling, itching at injection site. Y 6/4/2008 6/5/2008 eruption, 3-4 lesions consistent withYVaricella lesions. Fever of 103 and febrile convulsions lasting Y approx. 1/24/2008 one minute. 2/8/2008 ed by patient, he began to complain Yof generalized itching, then nausea approximately 30 min. Y to 1 hr. after Hep ### B vaccine### administration. 02 within 24 hours of immunization,Ysmall pink lesions on trunk. Y 2/13/2008 2/14/2008 01 beginning within 24 hours of imm. Y Y 4/29/2008 4/30/2008 00.5 within 24 hours of immunization. No other illness symptoms. Y 5/27/2008 5/28/2008 ception area immediately after injection Y of Gardasil and fell to floor and had full body twitching Y for 5 to 10 seconds. 1/2/2009 Was 1/2/2009 not observed fallin given an adult Hep A dose instead of a pediactric dose. Y 4/3/2008 4/4/2008 A given to child instead of a pediactric dose. Y 1/2/2009 1/2/2009 ately 8 hours after receiving vaccines Y child spiked fever of 104 degrees(rectal) with vomiting Y and diarrhea. Twin### sister had ### fever spike as we vaccines along with twin sister and Y spiked a fever of 103 degrees (rectal) within 8 hours afterY administration. She ### wasn't having ### the vomitti with low-grade fever of 100.8 within 24 hours of immunizations. Y 6/10/2008 6/11/2008 m raised tender eryth around injection Y site, temperature of 99.8 Y 6/9/2008 6/11/2008 er, chills; local redness, swelling at site Y of imm. Symptoms developed 7 days after imm. Y 5/30/2008 6/5/2008 or seizure still being determined,events Y startedYin june of 08, she has 3Y experienced over 100 N syncope episodes 5/1/2008 since6/24/2008 that time, a month or s 12/11/08 Pt reports bumps on the back of hands bilaterally approx 1cm in diameter that spread N all over body. ### Pt repots the ###bumps are ver OUT W/ CHICKEN POX Y ### ### cal swelling, induration, erythema, warmth, Y and tenderness resulting in a physician office visit. Y ### ### U 1/2/2009 scribes reaction as increased tempYof 103F, Red hot swollen right arm, body aches and nausea. U Patient was seen ### at1/2/2009 ED and recieved Ben sting 1-5minutes. Fever 104+. Final Y Diagnosis: Febrile Convulsions. Additional: Acute Suppurative Y OM12/8/2008 w/o ruptured eardrum. ### Treatment on L arm located about 2-3 in away from affected area where shot was administered. There Y were a 2 rounded ### red areas and ###then several ospital 12/03/08 for swelling of rightYupper arm, treated with Bactrim, seen again 12/4/08 for Y flu area slightly 12/1/2008 bigger, 12/2/2008 sent to hospital redness, induration, warmth in posterior upper arm (triceps area); occurred one mo. after vaccine. Y ### ### d vaccines below and appeared well Y with no complaints. Upon exiting, pt collapsed in hallway. Y Pt unresponsive ###for a short ### time, with sligh ender supra clavicular lymphadenopathy. Y Also some milder adenopathy in brachial region. Y Both were in left arm, ### which had ###received DTA ot flu shot and needle insertion didn't hurt, but "it felt like the needle hit something". Reports N he had a "fireball" 11/3/2008 of pain when ### medicine inject ceived flu shot Nov 3 & ok until Nov.Y 22nd. Woke up and had #6 pain left arm (upper only) with N pain to left 11/3/2008 LUE distal to that. ### Still has som flu shot left deltoid on 11/3/08. No significant increased pain when administered flu shot as N compared with 11/3/2008 other years 11/3/2008 when got flu shot. C 008 rec'd flu shot pt sore for 1st couple Y of days. Ok until Nov. 15 pain (L) shoulder just belowNacromion #3. 11/3/2008 Nov 20 call Dr.### & used Alleve, T getting her shot 11/3/2008. Reports Y bowling that night and noticing sore arm. Reports on 11/13/08 N noticed 11/3/2008 she was dropping ### things. Hav 08, shot given Nov 4 & 5 sore arm, "went away". Nov 8 & 9 am sore arm around injection site. N Reports 11/3/2008 some tingling 11/8/2008 left arm shoulder to e m pain. Refusal RN interview. Therefore below is not completed. U 11/3/2008 ed his flu shot on Nov 3, 2008. States 1-2 days after the shot he had stiffness in his arm (left)... N "Can't lay11/3/2008 on it"...." have 11/5/2008 to move it around a eceived 11/3/08. States toward the end of November (approx. Nov 12th) he developed an achiness N in both 11/3/2008 shoulders rating ### it a #5. States e 3/08- W/E of Nov 8 & 9. -> sender couldn't hardly life her arm - was weak. On & off ever since. N 12/1/08 11/3/2008 left arm- had 11/9/2008 to hold arm close to h t rash after getting vaccine, 12 days after rash blister appeared, a few days after that blister N were gone but 12/5/2008 area still itchy and ### painful. Patie 2008 flu shot given left arm. Nov 4, noted tensed muscle feel- expected. 8-10 days later right N shoulder 11/3/2008 started hurting in ### rotator cuff-intens ection was blistered , raised , red and tender to touch. No fever. Plus irritability. Area aroundYsite was red x an ### elongated area ### appears "bur rts child with "severe" hip and joint pain. Complains of severe pain in legs, feels like she has the flu, mom feels### this is more ### than an averag itching one vaccine left arm administered area. Symptoms started 11/25/2008, Dx Arthrus reaction. Y Rx with ATARAX ### 12/2/2008 25 mg QID as neede 12/30/2008- Temp 101 degrees- redness and induration at left upper thigh. Y ### ### ceived Menactra vaccine on 12-31-2008. Rapidly developed redness and swelling at injection Y site only. Area of### redness was ###5 in x 5 in. Are veloped Shingles 3 days after vaccination. Patient had no prior history of Shingles, was notNill, had not been ill### for atleast ### 3 months prior to occurred immediately after the shot was administered. large raised red area approximately 6Yinches in circumference ### with ### itching and burnin
d area approximately 4 inches in diameter with a pink circular eurthmia approximately another Y 2 inches surrounding ### the outer ### portion of the nt complains of major swelling in the arm where the vaccine was administered. Swelling to the U point where1/2/2009 he could not 1/2/2009 lift his arm. He com as given Zostavax vaccine at approximately Y 12:30pm on 12/20/08 (subcutaneously per protocol) Y at Pharmacy. ### He had no problems ### at time he had itching at injection site beginning soon after Y vaccine given (given 2 12/19). Around midnight Y 12/21, pt awoke ###to get out ### of bed and had 9/29/2008 Y N 9/29/2008 9/29/2008 flu vaccine 12/8. On 12/10 developed fever andY seizures. Sepsis work 2 up negative, head CTYnegative. Dx: 12/8/2008 complex febrile### seizures. 3/3/09 ngestion-nasal,ears,head - vision and hearing. Severe headaches. Chills - cold sweatsY fever, N severe weakness, ###confusion###very, very bad er DTaP was given right thigh became erythematous and very edematous, no treatment necessary. Y 12/8/2008 ### gue, itching around face, neck, scalp, shoulders, ears. Flushing of face, also apparent. Started U itching again 1/2/2009 left arm1/2/2009 toward back. bumps on legs after shots. Y ### ### ports temp of 103 degrees vomiting,Ydiarrhea starting 12/29/08. Seen at hospital on 1/1/09 U ### ### and swelling around vaccination siteYwith warmth. Pt took BENADRYL 11/7/08 and IBUPROFEN Y X several 11/5/2008 days. Saw 11/6/2008 family practitioner. mber 26 at 10 am received the ZOSTAVAX vaccine; about 10pm had a terrible headache andU took 2 ADVIL. On### 27 at 2 am### woke up with ch owing Flu vax developed pain and tenderness LUE with decreased ROM persist Sx as of 12-29-08. N ### ### ain "10/10" in deltoid area rad. downYbiceps area also into shoulder/neck. This was flu shot #2 Y alt recall of first vaccine ### by manufacturer. ### eeks after the f/u shot, I experienced Y joint pain, in the foot, ankles, knees, neck, arm, elbow and hand. 2/10/09### Received PCP ### medical reco struggling before shot- held by father. Shot was administered to L arm. Child looked up at Y mom and "smiled" ### then became ###briefly limp, res ates she recieved Zostavax 12/10/08 Y and developed Zoster 12/13/08. Location of Zoster wasYon scalp ### ### mplains of generalized urticara withYtightness in chest. Swelling of the tonsils was observed,Uhowever patient 1/5/2009 denied1/5/2009 any prior illness. served having trouble breathing. Patient Y had altered mental status. Patient did not improveUafter epi-pen1/5/2009 administration. 1/5/2009 ost- MMR reactions; fine pink papular rash and fever onset 8 days after MMR vaccine administration. Y Fever 5/21/2008 of 103. 5/29/2008 MMR rash. Pt developed pink macular Y rash on 5/14; initially few spots on legs, then on trunk Y and arms. Afebrile. 5/5/2008 Acting 5/14/2008 well. No other sx. SEEN FOR WELL CHILD VISIT ON 12-29-2008,RECEIVED VARICELLA, HEPATITIS A, AND Y FLU VACCINES. ###PARENT ### CALLED ON 12 ness at vaccine site with low grade fever Y of 100.5 and crankiness since night before Y 4/8/2008 4/9/2008 heat, redness, and swelling at imm site (right thigh). Y 4/25/2008 4/26/2008 le, red skin at DTaP imm site. Y 2/13/2008 2/15/2008 ENTED TO ALLERGY/IMMUNIZATIONS CLINIC C/O A 5 DAY RASH OVER BOTH ARMS AND U INSIDE OF THIGHS. ### 1/1/2009 PT BELIEVES IT M rxn to DTaP- area of erythema, localized firm edema, and heat at DTaP site on arm Y 5/1/2008 5/2/2008 tous, maculopapular rash midly pruritic in the antecubital fossae bilaterally as well as dorsumNof the hands and ### on the1/1/2009 proximal legs bilatera , bruising at site of immunization Y Y 3/24/2008 3/27/2008 ubcutaneous swelling at immunization Y site, not red, not tender. No additional symptoms. Y 4/15/2008 4/22/2008 icella vaccine swollen to the size of a half dollar, red and hot. Tender to the touch. No Shortness Y of Breath 4/28/2008 4/29/2008 ceived the MMR & Varicella vaccines in the left anterior thigh. She had a large area of redness Y with an irregular 1/5/2009 border 1/5/2009 present over the are and swelling in left thigh where Varicella vaccine was given appeared 6 days after imm. Fever Y from 6/3 - 5/27/2008 6/5 (6-8 days 6/3/2008 after imm). ot on 12/2/08 and on 12/4/2008 hadYsevere pain and edema in ankle and foot and with in a week Y total joint 12/2/2008 involvement. 12/4/2008 MD visit follow wee Hives, trouble breathing / problems have Y continued since first injection / she breaks out in hives N when there 1/23/2008 is a change 3/25/2008 of temperature (outs s, pain in back, headache, chills, stiffness Y Y 1/2/2009 1/2/2009 ays developed ipsilateral upper arm numbness and pain and tingling into the L hand. WithinYa few days,10/3/2008 ipsilateral thigh had numbness and ceived vaccine on december 18, had Y fever of 102F on december 24 and first chicken pox were U noted on january ### 3. 1/3/2009 was ordered for the patient and Prevnar was given. Patient felt light headed after the shot and Y fully recovered. 11/6/2008 11/6/2008 rmation was received on 23 December Y 2008 from a health care professional. A one year old Nmale patient with a### runny nose at the time of v was reported by a lawyer and described the occurrence of joint pain in a female Y subject of unspecified U age 9/1/1999 who was vaccinated with LYME o hospital on 12/24/08 for intussusception; ROTATEQ Y vaccine was1given on 11/3/08. 1/21/09 Y Reviewed 11/3/2008 hospital medical### records of 12/23 STAVAX shot 6-16-08. Has had restricted range of motion in that arm. If she immobilizes Y arm U couple days 6/16/2008 the pain 6/16/2008 dissipates. Exercise ma reased muscle pain, fatigue, Y weakness, dysphagia, weight loss. Pt requiring Prednisone Y IVIGNevery q monthly. 8/7/2007 Methotrexate 9/1/2007headache, mu daughter received her 1st shot of 3 (to complete full dose) she started having problems Y soon after.- light headed, 3/12/2008 dizziness, 3/12/2008 fainting, fatigue, ches 2) Visual Change: felt like water was in her left eye 3) Neck pain 4) Total body myalgiasY5) BP 0f 140/100 ### ### ved flu shot and Pneumovax in different arms on 11/11/08 . Later that day she developed L arm Y soreness with ### fevers to 102 ###degrees F. Als as given PNEUMOVAX and Flu shot on 11/11/08 he developed chills and significant aches and Y fatigue later that ### day. Had ### a large red rash o clinic on 12/30/08. After leaving PCP's Y office (in clinic at approx. 5pm) - had tennis ball sized U area of inflammation, ### redness ### at left arm - a oped severe right arm pain a few hours Y after the shot. Had chills and continued arm pain. Developed Y a blotchy### red indurated ###rash on right d
was administered 12/15/08. Baby returned Y 12/16/08 with bloody diarrhea. Stool culture done-Ynegative for O and### P negative ### for salmonella, 08 Patient received PNEUMOVAX around 230. At midnight woke up left arm sore at injection Y site at 2am woke### up pain at### injection site radi eaction to vaccine 1-2 days after administration. Nauseous, dizziness, headache, ringing in the ears. Was 10/8/2008 exposed10/9/2008 to grand children just p ain (next morning) extending down arm to fingers - around left shoulder blade. Shortness ofYbreath - red (hives) ### fever. Pt called ### MD. Told t esents with stomach pain, watery red eyes, itching, sweaty, red, flushed face. Y ### ### d hypersensitivity reaction, warmth,Yredness and swelling locally. Patient reported hives bilaterally Y on arms, but### not observed ### on examinati er vaccine had slight rash at vaccine site (RA-VARIVAX) with itching. Following day had rash Y on face - more 2/12/2008 pronounced 2/14/2008 with itching. No diffuse maculo-papular rash on shoulder, Y back, upper thigh, neck, spots face, arms, no fever. Y non pruritic. ### 12/6/2008 r receiving Hep A vaccine pt developed sand papery rash, slight irritation. No fever, cough, sob, Y and no 7/21/2008 recent illness. 7/21/2008 U ### ### lled, daughter is very weak, cannot Y keep eyes open. Llips are pale. Weak. Told mother to take Y her to ER. Took### to ER -started ### feeling better derness, erythema left upper arm no fever- probable allergic reaction. Could not rule out cellulitis. U ### ### ted 12/27, started on face and is slowly spreading downwards. ### ### nch raised, erythematous area to right Y deltoid warm to touch. Vaccine given 12-22-08, reaction Y began on 12-23-08 ### around ### 1:00 pm. Reac Y ### ### tion was administered in left arm. Patient then passed out & was laid down. Pt was drooling, Y then her legs & arms ### extended ###outward (strai p B injection in gluteal region. Y ### ng, tingling and redness around corners of mouth. N ### ### r well child visit and had just finished 10 day course OMNICEF this am for bilat. ear infections. Y Developed1/5/2009 generalized 1/5/2009 hives couple hrs afte ea, light headed, dizziness at 13:20. B/P 136/85, P. 89 Denies respiratory problems. Face flushed, N diaphoretic. 1/5/2009 14:00 1/5/2009 continued c/o nause after getting immz on rt lg. Treatment cold compress. 1/2/2009 ed receipt IM Influenza age 16-17 (1997-98) Y with development red rash. Told not to take again....no Y documentation 1/1/1998 available. No other sy ught by mom for over 1 week h/o small "knot" right anterior thigh after vaccinations. No painYor discomfort. Small ### 1" diam. ### area of non ten t arm still sore. Hard to grasp or lift heavy objects. Vaccine given on 12-4-08. No treatmentUgiven at this 12/4/2008 time. 12/5/2008 red and swollen 12cm by 7cm tense and tender Y ### ### n: rash 10 days after SMPX, MEN, Y AVA vaccine. Believes due to SMPX vaccine. Symptom: Rash, diffuse3/3/2003 start: 03/10/2003 3/13/2003 Comment: 782 2/15/08, notes soreness, states no below waist eccythmosis, scattered lesion anterior and posterior trunk12/5/2008 and neck, reddened ### raised macul d suspected immune reaction. Patient has lost sleep. Arm has pain without swelling. PatientUhas seen doctor and ###has had### Medrol DP + Sle ection site x 2 days. On 3rd day radiated Y to L shoulder at deltoid. Constant throbbing pain, restricts N mobility. Severe ### enough ###to wake from s ears, jaw tightness, lightheadedness, Y chest tightness 20 after Engerix-B #1 U 1/5/2009 1/5/2009 d vaccine on Friday. Saturday night pt noticed site where he received the vaccine was itching U and he had developed ### 11/1/2008 a rash that was abou TWINRIX given. Blistery type scab 12/11/08, now has a scar barely visible and felt like had Yflu, muscle aches, 12/3/2008 tiredness, maybe ### a little feve on immunizations on 10-23-08- Broke out i rash (generalized) and periodic temp (101)- no temp today, but still### rash- irritable ###at first but not chool nurse office-phone call from RN- states "big wheel- she can put 4 fingers over to coverUdiameter-appears### red raised ### - slightly painful to mplains of swelling at site of injection. stomach cramping and headache. Swelling at site of injection Y approximately 10/6/2008 10/7/2008 the size of a nickel. lled and stated this (L) arm around injection Y is red and swollen and getting larger. States sheYhas been using 10/7/2008 cool compresses, 10/8/2008 no fever. Ad mplains of swelling at injection site on left arm. Swelling is approximately size of golf ball. Y 10/8/2008 10/9/2008 on 12/10/08 arm red from site of injection to elbow, took TYLENOL today in am, no relief as Uof yet (350pm) sleeping ### off and ###on all day due ours, patient experienced motor function impairment with her legs buckling underneath her, Y 10-12 times over the ###next 3 hours ### falling each t s given vaccines for Typhoid and Cholera. Y I was allergic to them. In less than 24 Y hrs I had difficulty Y moving2/1/1982 and was taken 2/1/1982 to ER at hospital 01 Dr. ran rapid strep -> negative continue Y to have ear and sinus trouble. 12/18 Dr. irrigated U (L) ear (perforated)### & did sinus ### x-rays. e within 15 min - 5 cm red spot painful Y - itchy- muscle weakness- slept 12hrs- went to urgent Y care on 12/28/08. ### No infection ### at vaccine siteadministered in L thigh on 12/18/08. On 12/26/08, 4 vesicles appeared @ injection site. Slight U firm mass underneath, ### some ###discomfort. ports that a rash began 3 days afterYthe vaccine on her hands. She described as bumps andNreported itching. Then ### rash progressed ### to her ately 1 wk following injection: large hives 4" to 6" (blister like) on both legs from knee to hip for N about 1 week- shooting ### pains ###in hands-follow acked out after receiving HPV vaccine. Y ### ### headache, increase menstrual periods (3 in 2 months). N ### aP on L deltoid very red, swollen, hot to touch, site of flu shot on R deltoid also very red, swollen Y and hot to touch. d area at vaccine site + about 1.5cm. Hardened area- circular. U 12/9/2008 12/9/2008 school teachers c/o S.O.B. & wheezing to school nurse - treated with Ibuprofen. Y ### ### TC on 12/31/08- c/o .5cm red area with 3 small bumps that appeared 2 days after Immunization. Y ### ###
houlder w/red itchy rash Y U ### ### 1520 client fainted 5-10 secs., did not fall, no injuries noted, B/P 90/60, R14, P60, no SOB noted, Y push/grips strong, ### perria### intact, skin u/d a arm just distal to shoulder, reddened Y area roughly 4cm in diameter with another 1cm borderUwhich is lightly reddened. ### The ### area is very wa n has been received from a Certified Y Medical Assistant for the Pregnancy Registry for GARDASIL Y concerning 6/30/2008 a 19 year 6/30/2008 old female with pen n has been received from a consumer, for the Pregnancy Registry for GARDASIL vaccine, concerning U his 25 year old wife general anesthe n has been received from a physician, for the pregnancy registry for GARDASIL, concerningUan 18 year 5/27/2008 old female 8/30/2008 with a history of 2 pregn n has been received from an office manager concerning Y a female who 4 Y in August 2007, was Y vaccinated with 8/15/2007 a dose 8/17/2007 of PNEUMOVAX 23 va n has been received from a physician Y concerning Y a 65 year old female 4 who was vaccinated Y with a second 0.5 ### ml dose of PNEUMOVAX ### 23 n has been received from a physician concerning his 71 year old wife with no known Y allergies N and no pertinent### medical history ### who on 19-D symptoms 4 weeks post Influenza vaccine, Y increased difficulty ambulating x 4 weeks myalgias, N neuropathies, 10/9/2008 evaluated 11/9/2008 by ER physician on swelling and induration anterior Right Y thigh at typical location of immunization -- MMR and DTaP Y adm on3/25/2008 right side x 2-3 4/4/2008 days. Afebrile. Tre d a seizure two hours after recieving Y the vaccine. She had no history of seizures and she did Y not have a fever### at the time### m, mild redness, progressing in severity Y and radiating dowm arm to wrist and up into shoulder U and neck, rash ### at injection ### site extending d ed that the evening after receiving her shot she had redness, swelling, and slight pain at siteYof injection. 1/5/2009 1/5/2009 ated that pt developed a mild URI and vomitingY3 days post immunization 3 and a fever of 102. Y Parents brought 12/3/2008 pt in12/6/2008 2 weeks post immuniza minutes of getting vaccines Left leg (injection site) broke out with whelps spreading to the abdomen. U Patient 1/5/2009 given 1/41/5/2009 tsp. of Benadryl po an ted with approx 5 cm area of redness, Y sl warmth but minimal swelling. Mildly tender. No streaking. Y Rx'd 3/19/2008 Tylenol or Motrin 3/20/2008 for discomfort. 01 -102, body aches, and fatique x 4 days. Y 1/2/2009 1/3/2009 RECIEVED VACCINE. 12/23/08 VISITED DOCTOR COMPLAINING OF UPPER RESPIRATORY U INFECTION/### EXACERBATION ### OF ASTH r (102.9F), SOB & rash 3 days afterYreceiving Pediarix, Y hib, Prevnar.4 Evaluated in ER 11/6/08 Y at Hospital. 11/3/2008 Patient admitted 11/6/2008 for 1 week due as given Hep B shot at 1Yminute of age. Y On theYsecond day of life patient 84 Y was having Y seizures N and could no longer ### drink from ### her bottle. O noted on right arm near site of varicella administration. U ### 1/3/2009 given in same arm 12/20/08. 12/22/08 Rt arm w/2" area of erythema, ver tender, induration N and tender distal deltoid, ### continue ### pain control, was given Tdap vaccination on 12/29/2008 Y for post exposure to Whooping cough. He followed Y up on 12/30/2008 ### c/o dizziness, ### chills, wea 0 hours after getting Tetanus booster I started having servere chills and body aches the entire U day. The night 1/3/2009 after that 1/4/2009 I had a fever of 102. was reported by a lawyer and described the occurrence of rheumatological symptoms in a female U subject3/1/1999 of unspecified 3/15/1999 age who was vacc spontaneous report of Bell's Palsy has been received from a Registered Nurse concerning aN52-year-old10/5/2008 female subsequent 10/5/2008to FLUMIST. M previously health 8-month-old Y boy with a 2-weekY history of runny nose 25 and cough without fever. Y Three days prior ### to admission ### he developed mber 10 pt received Flu vaccine. At 9:30 Y am. After Y the vaccine he went 1 to the dentist who prescribed U an antibiotic ###for the tooth ### infection. On ite hurt longer than any previous flu shot and muscle continues to hurt especially with movement N of arm, with some ### restriction ### of movemen sore for prolonged amount of time after receiving flu shot. Burning all the way down to the elbow Y for a few seconds, ### then ached ### for a month sore at site of injection for a prolonged Y amount of time immediately after injection. Y ### ### sore after receiving flu shot for a prolonged Y amount of time "joint pain"-not relieved by Ibuprofen. Y ### ### y-absence of muscular control of right Y facial muscles-upper, middle, lower face-Drooping eye N and mouth. 12/8/2008 ### t dizzy, was short of breath, and had Y a dry mouth 20 minutes after leaving the hospital, which Y lasted for 4/14/2008 2 hrs. In the 4/14/2008 evening the patient de ateral leg pain with cramping. Generalized muscle and joint pain, symptoms began around midnight U today. 1/5/2009 1/6/2009 hrs of vaccine. L arm at vaccine swollen, red and painful. Treated with BENADRYL. Also, had Y a fever. ### ### 6:00pm, Rash appeared on L arm and Y L side of face and chest. Pt. also had local reaction ofY warmth and redness, ### described ### "like the size swelling (L) lateral thigh. ### ### accine and after a few min. later had asthenia, numbness and tingling down (L) arm, dizzy, ringing N in ears, frontal headache, no SOB. Coug ### N ### ### h left elbow pain, progressed to right Y elbow, then to other joints. Peaked, with all over, achy N body and high 10/9/2008 fever. Patient has ###been slowly g flu clinic 17 mo was given FLUMIST approved for equal to or greater than 2 year olds. No reactions. U 11/6/2008 on the 11th with a horrendous headache. Lasted about 3 hrs. Woke up on the 12th with a bad Y headache and ### dizziness. ### Headache went a us case was received from a health professional on 27 December 2008. The patient was enrolled Y in a study 5/3/2006 for which Sanofi Pasteur was n ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/2/2006 a sponsor. A 32 ### year old female p ort received on 27 December 2008 from Y a physician. A 31-year-old pregnant female experienced Y oligohydramnios 5/4/2006approximately ### 193 days a ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/1/2006 a sponsor. A 28-year-old ### pregna ort received on 27 December 2008, Y from a physician, as part of a study for which is not a sponsor. Y A 38-year-old 5/4/2006 pregnant female experienc ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur Y is not 5/3/2006 a sponsor. A 28-year-old pregnan ort was received 27 December 2008Yfrom an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006 A 30 year old female
ort was received on 27 December 2008 Y from an investigator as part of a study for which Sanofi U Pasteur is 5/5/2006 not the sponsor. 1/10/2006 A 29 year old fem ort was received 27 December 2008 from an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006 A neonate male patie rmation was received on 20 OctoberY2008 from a health care professional. A 51 year old female Y patient received ### an intramuscular ### injection ts have given patient the not unexpected warmth and redness at the shot site. What is unusual U is that he subsequently ### developed hyper pi n has been received from a consumer concerning his 77 year old wife with depression, Penicillin N allergy, Sulfonamide ### allergy, ### LEVAQUIN a eared 3 days after immunization was given. Rash is located behind the left ear and has spread N onto the12/1/2008 neck. Rash 12/4/2008 is described as itchy. ast her 1 yr. shots she started running a 100,5 temp. she had vomiting and loose stools..sheYalso developed a ### rash 11/1/2008 all over..i was told the r eadache 48 hours after administration of Zostivax and pneumococcal vaccines. Redness to Y site of zoster 1/2/2009 vaccination.1/4/2009 veloped upper respiratory symptoms, Y cough, and fussiness one day following his 2 month immunizations. Y 7 days ###following### vaccination he d zziness lasting 6 - 8 hours. No other symptoms. Completely resolved in approximately 18 hours. Y ### ### ped a blister like rash on top of left hand about 2 hours after receiving the vaccine parents administered Y 2 1/6/2009 children's chewable 1/6/2009 Benadryl chil nauseous, ringing in the ears, paleness for about 10 minutes after the vaccine. Y 1/7/2009 1/7/2009 e in one day later with hives, treatedY with atarax. Y 1/6/2009 1/6/2009 esented to Immunization clinic on 01/06/09 for the second dose of HPV vaccine, having received N the first8/19/2008 dose on 08/19/08. 8/19/2008 During screeni mplained of severe pain, weaknessYin upper arm from site of injection to elbow onset immediately N post vaccine. 12/8/2008 Reported 12/8/2008 12/15/08, advise r vaccine administration, painful, red swelling of left upper arm U 1/5/2009 1/6/2009 ERED FROM HIVES, RASHES ANDY A MILD GRADE FEVER FOR 7 DAYS FOLLOWING VACCINATION. Y 12/1/2007 THE PT 12/2/2007 RECEIVED TX WITH P d area on arm warm and swollen. U 1/6/2009 1/7/2009 s and swelling to left upper arm x 4 Ydays s/p pneumococcal vaccination 28NOV08. Reports Y onset of symptoms### one12/2/2008 day following vaccinatio after receiving the first dose of the injectable flu vaccine, the patient developed red bumps. There Y were three larger ### bumps### near the injection d Gardasil shot and then Depo-Provera Y about 1 week later. 2 months later, this past Friday she passed a mass### of tissue 1/2/2009 vaginally that was t. Wed night to check up on anything and wife told me he was in bed. He noticed earlier thatYevening hive-like 1/3/2009 red bumps 1/7/2009 on arms, torso an was reported by a lawyer and described the occurrence Y of joint pain0 in a 45-year-old femaleNsubject who6/14/2000 was vaccinated with LYMERIX. A arm began itching. Got worse and 1 day later heat & redness began than increased until theYpatient took Benadryl. ### I1/2/2009 advised ice- good res sore after receiving flu shot for a prolonged Y amount of time initially felt burning 3 weeks following. Y Arm was painful ###and hard ### to lift. rmation was received on 02 December Y 2008 from a health care professional. A 40 year old female N patient with### a nut allergy ###received an int tis; red, warm, tender treated with Keflex and Septra Y ### ### ter received her second injection of YGARDASIL on December 22, 2008. On December 31, 2008 U she had a sudden ### and severe ### hives react ella-like rash - Rt upper arm 3 clustered vesicles erupting 1 wk ago, now crusted and 2 1-2 mm Y erythematous papules ### 1/1/2009 on ant. chest. + URI ction with itching, redness, and swelling on right thigh at the site of Flu vaccine. Y ### ### fever 106 degrees F, redness at injection Y site. N 1/5/2009 1/6/2009 ceived first dose of GARDASIL and may have been pregnant 7/31/08-LMP-5/15/08 receivedYGARDASIL6/19/2008 16-1608 within minutes of administration of vaccines. Y ### ### L administered 12/22/08, within hours patient noticed "tremors" (looks like she is having chills). Y Family and friends ### noticed### episodes too. Ep night, back pain, fever, headache, neck, Y stiffness, and arm pain. U 1/5/2009 1/6/2009 ort received from health authorities in Y a foreign country on 5 January 2009 under the authority Y reference number: 7/4/2008 PL-URPL-OCR-20081218 7/4/2008 N ort received on 05 January 2009 from Y an other manufacturer who had provided a copy of a litigation report. 3/27/2001 The report 3/27/2001 referenced a case. F 7th Monday: Nurse at medical center Y gave me Pneumonia shot on Right shoulder. The shotNwas high on the shoulder ### and### it pricked the Bo ped seizure activity < 12 hours. S/P YHep A vaccine Y #2. Admitted and3started on Anticonvulsants. U 3/3/09 MR 1/7/2009 received 1/7/2009 for DOS 1/7-10/2009 w ### N ### ### d with juvenile onset diabetes Y mellitus 17 days Y after live flu vaccine. 11/12/09-records Y receivedN for DOS 12/14-12/15/08-DC ### ### DX: New onset d 3:30 am Hives hospital ER. (10/18/08 Y 9:22 am city hospital ER cover in hives- extreme itching-skin Y turning black ### and blue ### from top to bottom 8pm- Body aches, fever/chills, postYnasal drip, sore throat. Evening of 10/23/08, had increased Y sinus congestion, ### body aches, ### fever/chills ministered flu vaccine; patient began to faint (vasovagal episode) occurred; vital signs taken. Y ### ### ness & swelling - started - by 4-5 pm on 1-5-09 - gotten progressively worse & longer. > 50 cent. U noted at office 1/5/2009 visit 1-7-09 1/5/2009 445pm. facial swelling hives body approximately 3 hours after receiving immunization contacted PCPY MD given ZYRTEC ### not seen ### by PCP. Mothe n left arm - net sore at first - but after 2 days very painful when lifting, putting on coat - etc. Lasted Y about 2 weeks. ###Daughter### was injected as Y Y ### ### le with left arm swelling from mid upper Y arm to mid lower arm. After speaking with provider possibly Y cellulitis not### associated. However starts ceived VARIVAX on 9/26/02 in the right thigh. She returns to clinic on 9/22/03 with a diagnosis of shingles. 9/26/2002 It is described 9/22/2003 in the medical re
ceived VARIVAX on 1/12/98 at another facility. Site of immunization is not recorded in records. U She came 1/12/1998 to our facility on### 11/26/99 with a d ceived VARIVAX on 5/7/07 in the right thigh. She returns to clinic on 10/09/08 with diagnosisUof shingles described 5/7/2007 in 10/9/2008 medical record as "loc ceived VARIVAX on 2/15/05 and 9/18/07. Both immunizations were administered in the left thigh. Patient 2/15/2005 returns to 3/2/2006 clinic on 3/2/06 with a ceived VARIVAX on 12/27/02 and returns to clinic on 6/2/04 with a diagnosis of shingles. She U received the VARIVAX ### 6/2/2004 in the right arm. The s alergica, ronchas, comez¢n, mano, problemas al tragar, se me hincho la cara, hasta la fecha U no se me quita el dolor de cabeza, me siento action, hives, itchiness, dizziness, problem swallowing, my face was swollen, to this day myUheadache doesn't go away, I feel very nervous n has been received from a physician concerning an 18 year old female with no relevant medical N history or allergies who in approximately 2 -Patient received Td on 9/26/2008 and started having soreness at beginning of November/08--started N having 9/26/2008 upper 11/1/2008 arm, neck pain (left side creased swelling on L arm from top of shoulder to mid-humerus, rednessover same area withNitching. Pt. also 1/6/2009 complains 1/7/2009 of pain upon move on arm and spreading. Hot to touch,Ychild could not move arm said it felt numb. Swollen Y ### 1/5/2009 nt received the Pneumovax injection in the Right arm and on 1/7/09 she had noticed increased Y pain in the1/6/2009 arm along 1/7/2009 with 2 areas of rednes out one minute of receiving Gardasil I immediately started throwing up, became dizzy, covered Y in sweat, 5/31/2007 shaking, and 5/31/2007 felt faint. I was requir ned 1/08/09 and stated that she had spoken with her friend who had a reaction to the Tetanus U vaccine, and 9/9/2008 she wanted to### report that she h acc,pt c/o dizzyness,when seen pt looked pale and sweaty,pulse 55,bp 88/54,pt put on tableYat trendlenberg 1/7/2009 position1/7/2009 felt better ,bp 99/69,p as administered at 11:00am on Monday. By 10:00pm Tuesday evening patient has an extremely running 1/5/2009 nose, coughing, 1/6/2009 low fever ~100, s rting 1 day after shot. Strong family history of allergy to flu shot, in mother and brother. Y 1/6/2009 1/7/2009 a call from patient above stating that she became very ill 4 days after the 2 vaccines were given. Y Pt. reported nausea, ### extreme ### fatigue, wh p after injection. Awoke limping with red, hot, tender swollen leg within 5 hours of IZ. Remained Y hot, became itchy, ### leg color ###uneven with do perienced acute leg weakness progressing Y to include arm weakness and overall body weakness N within a11/4/2008 two-week period. ### Saw family phy phone call received by health department Y nurse from patient's mother with complaints of patient Y having itching 1/6/2009 throat,1/6/2009 hives, and SOB, stat d female presented to Student Health Center at TAMU on 11/25/08 with complaint of right arm U pain ever since ### she got her### flu shot in mid o hree days later w/complaint of fever, chills for two days. Has large, warm, reddened area at site, U swelling. 1/5/2009 States began 1/6/2009 the day after injecti tingling and numbness/neuropathy-type symptoms in arm vaccine was administered (right). NShe also states 7/25/2008 some 7/26/2008 motor symptoms, mainl the shots on 10/23/2008 at 19:45 pm. Y After 24 hours developed itching and swelling of the forearm Y that extended ### to the entire ### arm. The ar n minutes after Td shot pt. had seizure Y in car with mother. Pt. reported dizziness, ears ringing, N confusion upon 1/6/2008 arousal. 1/6/2008 Pt. reporting body ac S FACE; NOSE; EYE NOT INVOLVED TREATED WITH ACYCLOVIR 800MG 5X/DAY Y ### ### rre Syndrome after receiving Y the flu Yshot. VeryYsevere case, currently 34 Yin intensive care at Hospital U 2/25/09-records ### received 1/1/2009 for DOS 1/5-2/ an MMR shot on December 19, 2008 as part of my registration requrements. As of today, there U remains a very ### tender area ###on my right arm of double pneumonia one Y week after Y vaccines were given. Treated w/ initial antibiotic shots,Ythen oral antibiotic 9/30/2008 Amoxicillin. 10/5/2008 This was her 2 12/4/2008 N ### 12/4/2008 bilious vomiting, abd. bloating, pain -YER admitted Y - multiple tests run2(x-rays, labs) - no etiology N - remains fussy, ### spitting 1/4/2009 more - mother feels s of upper lip < lower lip as well a little Y swelling. Sinus area feel dry, rash developed on legs,Yarms, and face. 1/7/2009 Swelling1/7/2009 of lower eye lids. uid-filled vesicles on red bases appeared on 1/2/09. VARIVAX done 12/15/08. Y ### 1/2/2009 o RUE to include erythema and edema 15cmx9cm. Warm to touch and pain. SXS started last U night. Pt tx'd1/7/2009 IV Abx and 1/7/2009 PO Abx. ction to ADACEL . Pt has redness, warmth, pain, induration measuring as 3"x5" around injection U site. 1/5/2009 1/5/2009 dness - Left deltoid - pt. did not use ice or take analgesic. She decided not to wait for Dr. - he U was seeing 1/6/2009 in-pts @ hospital. 1/7/2009Advised to use onsciousness approximately ten minutes after GARDASIL, episode lasting less than 30 seconds. Y 1/6/2009 1/6/2009 er vaccine, infant became extremely fussy, "stomach hurting" screamed with feelings- has only N gradually improved### on RANITIDE ### and Hypo n has been received regarding a case in litigation as reported in a newspaper article Y that theNauthor's normal 4 year old daughter was trans follow up information has been received Y from a licensed practical nurse (L.P.N.) for the Pregnancy Y Registry 1/23/2008 for GARDASIL 3/8/2008 concerning a 26 n has been received from a physician Y concerning a female patient with a history Y of mouth ulcers N who on8/18/2007 an unknown 8/18/2007 date was vaccinated n has been received from a consumer Y concerning Y her 16 year old daughter 4 with no medical N history or drug 12/6/2008 allergies12/7/2008 who on 06-DEC-2008 n has been received from a consumer, who is the mother of the patient, for the pregnancy registry Y for GARDASIL concerning 2/25/2008 an 18 year ol d soreness/pain complaints from site of injection diminishing over time but lasting 5 weeks. Complaints Y finally subsided ### 12/31/09. ### ates child developed swelling to the Yleft deltoid area approximately 8-12 hours after receivingYflu vaccine. Also he ###complained ###of itching at th ination patient appeared pale and weak. He was instructed to sit down. His head fell to the side Y and his eyes closed. ### He opened ### his eyes s ately ten minutes after his vaccination, patient was standing by the door and began to faint and Y slowly fall to floor. ### No injuries ### reported. He as mistakenly administered both DT & TDAP vaccines - no adverse reaction was observed subsequently Y ### ted with redness on his torso and reported having a fever the night after receiving influenza vaccine. Y Pt referred 1/3/2009 to primary 1/3/2009 care provider. cella and FLUZONE R arm 12/15/2008. Y Mother reports today an area " 3"x4", that is warm, U red, hard and rashy" ###at the injection ### site R arm and approximately 15-30 sec after injection. Was assisted to prone position. No respiratory effort for approximately ### 30 seconds. ### Color re
n has been received from a physician Y concerning a 77 year old female patient with Y VICODIN, N LYRICA and 10/5/2007 AMBIEN12/7/2008 allergies, diabetes me nstop day of vaccines unconsolable Y 12/5/2008 12/5/2008 d right deltoid IM injection of PNEUMOVAX Y and since then had local reaction, large, of pain,Uedema, a erythema ###slowly improving. ### oid soreness, dizziness and joint pain. U 1/2/2009 1/2/2009 ed vaccine on 12-10-08. 2. Itching around Y neck and back 7 day later. 3. Itching from head to N toe. Also rash inside ###mouth. ### ceived vaccines (PREVNAR, HAVRIX, VARIVAX and MMR II) on 10-16-08. Follow up with FNP Y on 10-20-08 d/t ### a rash that ### started on 10-1 al exam. Child received HIB and DTP on 7/15/08. Child was very limp, quiet the next day, and Y left leg where HIB was given was red and a with auras, nausea and headache. Y 1/5/2009 1/5/2009 n has been received from a Registered Y Nurse for the Pregnancy Registry for GARDASIL concerning U an 18 year ### old1/16/2008 female who on 11-OCT IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### Swelling 4 inches around injection site; observation U 1/7/2009 1/9/2009 sick the week before vaccine with aY'virus'. Day of vaccine was feeling ok, day following vaccine Y (11/21/08) thought ### she had ###burner her ton IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### D INFLUENZA IM VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ### IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANSASAL ROUTE Y ### left elbow to left shoulder with pain/deep ache all around the left shoulder, and Nausea. SheYstates the nausea 1/7/2009 started 1/7/2009 just shortly after rec cieved Flumist (lot 500570P) Y intranasal Y 13Nov08 Y as part of his military 17 Yunit vaccination Y program. N He developed### vague lower ###back pain app atient @ 11am. Started w/diarrhea after getting 1st Hep a/b combo.injection during the night(approx.12-14 U 1/8/2009 hours after 1/8/2009 shot). Morning is no fter injection, heat flush & abd cramping. Y 2) 10 Ymin after, itching & heat 3 @ injection site. 3) 15 N min after, itching### & hives over ###entire arm/sho d swelling to left upper arm @ 7pm Yon 12/4/08 but did't think much of it until swelling had increased Y the next 12/4/2008 morning. 12/4/2008 Child seen in health SERIES OF 3 GARDISIL VACCINES, Y HAVE BEEN EXPERIENCING PAIN IN FEET, HANDS, N THEN OTHER 8/2/2007 JOINTS, 9/2/2007 BEEN TO DOCTO 009 CHILD STARTED RUNNING A Y FEVER, 1O2.2 PARENTS WERE ADVISED TO TAKE TO Y ER. 2 DAYS PRIOR ### TO 1/1/2009 THIS CHILD WAS tdap in the afternoon of 1-06-09. At 6pm that evening noticed a rash around site (Left arm) that Y injection was 1/6/2009 given. Reported 1/9/2009 this on 1-09-0 WO DAYS OFIMMUNIZATION RASH APPEARED AT LOCAL SITE BECAME BIGGER THROUGH Y OUT DAY ### TO APPROX ###7 INCHES IN D ceived HPV vaccine on 10/23/07 Y and Y 12/31/07.Y On 2/25/08 patient 7presented with breathingYdifficulty and was### diagnosed 2/25/2008 with pulmonary e where dtap and polio was given is red and warm to touch. Not painful. Moving fine, no fever,Yno other s/s4/28/2008 illness 4/30/2008 patient called immunization clinic at 1:15pm today 01/09/2009 asking for nurse who administered U vaccination 1/8/2009 to her daughter. 1/9/2009 Mother claim 000-Patient calls this office and speaks to this nurse. States that @ approx. 0630 today sheYwoke up to itchy 1/6/2009 red bumps 1/7/2009 all over her (R) ar ry 6, 2009, 2.5 weeks after vaccine adminstration, Macular rash on chest neck and back, vesicular Y lesions on back, ### number 1/5/2009 less than 10. C NING OF PAIN AND TENDERNESS SINCE INJECTION, PAINFUL TO RAISE ARM OR LAY U ON ARM.STATES ###ARM WAS ###SWOLLEN AN ceived vaccine on 12/18/08. Contacted Y telephone helpline 12/19/08 to report arm is swollen,Yred, warm to the ### touch; temp### was 98. Patient C/O at about 5 - 6 PM started with chills and fever, highest temp 102.9, and headache. In morning Y noticed1/6/2009 both arms1/6/2009 red (from top of hands hat Sunday a.m. feeling very tired. YComplained of arms feeling heavy and a headache. Later Y that day complained 8/18/2008 8/31/2008 of numbness and tinglin accine at 4 in the afternoon, the pain at site woke me up at 3:30 am. Site was raised red andYhive like. Took 1/7/2009 benadryl 1/8/2009 and advil. Site size big was reported by a healthcare professional Y via sales representative and described the occurrence N of muscle 7/1/2008 wasting in an adult female sub was reported by a physician Y via a sales representative Y and described 0 the occurrence Y of abdominal U pain in a 2-month-old subject of unspec was reported by a physician Y via a sales representative Y and described the occurrence Y of abdominal U pain in a 2-month-old subject of unspec was reported by a physician and a Y sales representative and described the occurrence Y of Bell's N palsy in a 32-year-old ### 1/6/2009 female subject who w d 1/8/09 stating that he had receivedYthe Shingles vaccine the day before and was experiencing U facial numbness, 1/7/2009swollen 1/8/2009 tongue and droop ates child developed Temp 103.8 within 24 hours of vaccine administration with prolonged crying. Y Did not 11/5/2008 seen medical 11/6/2008 TR. Advised physi ation Provided U 5/23/2008 ported to facility with 5 1/2 cm x 8cm reddened and indurated area on left deltoid are. Area was Y warm to touch 1/6/2009 and patient 1/7/2009 reported feeling
ent received MENACTRA about 9:15 AM. V/S given and reviewed side effects. After gettingYhome, client1/2/2009 states having 1/2/2009 S.O.B. and tightnes r body started 1/8/09, worsened 1/9/09. Fever. U ### 1/8/2009 d area with erythema/ warmth. Y 1/6/2009 1/7/2009 ven GARDASIL- fainted after getting it, patient complained of headache prior to fainting. Y 1/8/2009 1/8/2009 theaded, tachycardia, intermittent tinnitus. Y Cramps not related to monthly cycle. Mood swings, N abnormal3/18/2008 pap smear.4/22/2008 er immunization complained of nausea, light headed, dizziness patient monitored. Symptoms Y resolved. Patient 1/9/2009 said she 1/9/2009 was better e. 2/18/09 Neurology consult received Y dated 1/15/09 with no definite dx: Impression: Transient U word finding difficulties ### 1/8/2009 (dysphasia) with R h cc IM right deltoid. With in 10 min after IM injection mother noted redness and bruise area 50 Y mm around1/9/2009 top of shoulder. 1/9/2009 veloped shingle along C3 within 1 week of ZOSTAVAX. Y ### ### veloped redness and pain at injection Y site. Evaluated by provider as cellulitis. Treated with CEPHALEXIN Y for 7### days.1/1/2009 Re- evaluated one we hrs of receiving 4 month vaccine (PEDIARIX; Act HIB; PREVNAR; ROTATEQ) child had sleep Y disturbance and### "high1/2/2009 pitched scream-supe U 1/8/2009 1/9/2009 nset of 104 degree fever. Parents administered Y TYLENOL alternating with MOTRIN. At 1:33pm Y parents called. 1/5/2009 Child1/6/2009 with 106 degree fever welling. Increase fever of 45ø C and with projectile vomiting 15-20 mins. after vaccine given symptoms Y started. 1/7/2009 Pt went 1/7/2009 to ER 11 pm 1/8/09 e fever, sore throat, swollen neck lymph nodes, runny nose, muscle aches and fatigue. Taking U ibuprofen. 1/8/2009 1/9/2009 son (a DMD) is visiting from out of time Y and noticed that his mother had a raised area on her U arm that he found 1/8/2009 out was 1/9/2009 the injection site. It broma at site (subcutaneous tissue on left arm) of Pneumovax injection. I first noticed a scab Y had formed 9/18/2008 on the site and was ### surprised. It and fever. Had Vaccine mid-afternoon Y on the 10th. Had a fever that evening and through theUnight. Early1/10/2009 morning complained 1/10/2009 of stomach a sly received two doses of Meningococcal vaccine Y 1/10/2009 00dF), which lasted several months.Y Cough, which lasted a couple months. Head cold, too.Y (Treatment10/9/2008 was with three 10/9/2008 sequential and diff n afternoon, shut van sliding door on my left hand. Went to ER due to severe pain, possibleNbroken hand.1/7/2009 Had a tetanus 1/8/2009 shot during ER tr erature, respiratory illness Y ,flu,running nose. 1/15/09-per vaccine provider phone call-patientNpresented to1/7/2009 office 4 days 1/9/2009 after vaccine C/O flu nflamation, pain at shot site...about 2 1/2 X 3 1/2 inches, lasted over 1 week. Now, 2 weeksUlater, site is visibly### pink; swelling, ### inflation and changes including fussiness towards bath water, speech regression to none and glossy eyedYstaring with 1/5/2009 lack of smiling 1/6/2009 and responsivenes n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y an 18 year### old female### who on 24-NOV n has been received from a physician concerning an 18 year old female who in May Y 2008 was U vaccinated5/1/2008 with the third dose of GARDASIL N n has been received from a physician Y concerning Y a 9 weeks old male, 5 who on 19-DEC-2008, Y was vaccinated with ### the "normal ### dose" of RO st PNEUMOVAX - 0 reachon 1-6-09Y2nd PNEUMOVAX - tenderness, redness from site to elbow Y (Lt), hardness 1/6/2009 @ site 1/6/2009 local RXN only - no nfection near injection site of upper Y left arm. N ### ### omiting, fatigue and hot flashes. Started 20 min after injection. Pt received at work and sent U home early 1/6/2009 1/6/2009 onsciousness sonorous breathing rigid Y extremities twitching extremities lasting approximately Y 15-20 minutes.### ### g total body urticaria. Treated with antihistamine/steroids. Y ed and reported a rash all over her body Y on 12/24/08. Went to ER on 12/29/08 - Urgent careY at medical center.### Rx with Methylprednisolon ### Y ### 1/6/2009 ness at injection site that lasted 4 days- 0 raised - some pain with palpation - itching on 3 of Y 4. ### ### ed unconsolable crying + Screaming >4hrs following immunizations U ### ### MMR + VARIVAX vaccine on 12/22/08 for an employment physical, experienced rash on abdomen U + fatigue. ### Reaction reported ### 1/5/09 ction redness, swelling for > 3days. U ### ### 102.4 evening following vaccine - mother Y took him to after hours pediatric clinic who told herNto watch him 12/9/2008 - saw his regular ### MD on Wednes ps all over face, neck, arms and legs U 7/31/2001 1/5/2009 redden area to (R) thigh & Rash noted to stomach + legs -, mom stated started with rash to Ysite the next am and ###rash started ### 12/19/08. redness 7.5cm x 3.5cm, tender and itchy for 2 days. Rx'd Benadryl. Y ### ### ure unknown. Symptoms include, wheezing, Y runny nose, difficulty breathing through nostrils,Ntime course9/30/2008 - ongoing following 10/3/2008administration omplains of sore right arm, 8 days after shot given. Sats has limited motion of arm without having U full ache in arm ###muscle.### No swelling or ra ection site for 2 months. Y N 11/6/2008 11/6/2008 11:30 am pt developed rash on face, neck, and chest. Dr checked pt. Administered 1 teaspoon Y BENADRYL and ### 1 teaspoon ### prednisolone m noticed swelling at injection site after 5:00PM , 0 fever; spoke with on call triage nurse; applied U cool compress; ###Rx Benadryl, ### Motrin 12/31 d varicella immunization on 7/30/08 He came into the office w/rash for 2 days on 1/6/09 & was Y diagianosed 7/30/2008 with chicken 1/5/2009 pox. Hx symptom d diffuse, maculopapular rash fever 108. Pt previously never vaccinated Y ### ### about 2-3 days after injection her arm Y felt red and warm, told to put ice on it & take TYLENOLY - 2 days later 10/2/2008 she went to ER### where they lanc
m swelling shoulder to elbow, painful. Y Painful to raise arm. Next day red patches same area. Y Took AMOXICILLIN ### 875 MG ### 2 X a day for fi eption. 2/23/09 Received hospital medical records Y of 1/8-1/9/2009. 2 FINAL DX: Intussusception Y Records reveal### patient 1/8/2009 experienced interm t hot, dizzy, lightheaded, hands were clammy, tight fisted, tingly and patient was breathing hard Y and fast 1/9/2009 1/9/2009 oid developed edema after 2 days. U ### 1/5/2009 swelling with in duration and elevated warmth at site of vaccination treated with ice. Y ### ### e had nausea and chest pain within Y30min. Then aching felt bad. Went to bed. Woke and went Y to toilet 4 hours### after vaccine. ###"Passed out" ceived a pneumococcal vaccine (in Y left thigh), an influenza vaccine (in left arm) and his 3rd hepatis Y A&B 11/3/2008 vaccine of the 11/3/2008 series (in left thigh) nterior cervical adenoopathy on left and few shotty nodes on right. Notable scattered faint erythematous Y papules ###on the face, ### trunk, and ar ported temp of 101.1 on evening of vaccines Y with swelling, redness, size of fifty cent piece next Y AM. Fever that### night 103.5### with site red, firm TDAP Vaccine on 1/7/2009. Came in to employee health on 1/9/2009 with left arm red, warm Y to touch, and 1/7/2009 stated the 1/9/2009 area was larger than s after vaccination, patient complained of sore arm, then started to complain of wobbly legs, Yblurred vision, 12/9/2008 and had12/9/2008 high fever, and lasted 2 t message on voicemail 01/09/2009 stating she had sore L jaw after receiving immunizationsYon day prior.1/8/2009 Call returned 1/9/2009 to client 01/12/200 rong immunization in wrong area. Y 1/7/2009 WITH MOTHER AND NOTIFIED HER OF ERROR AND ALSO NOTIFIED DR. AND MY PRACTICE Y MANAGER 1/7/2009 AND 1/7/2009 MEDICATION ERROR Rt arm swollen from elbow up 1 1/2 size. red spot spread to size of hand. approx 7-8 cm. wrsit Y redness, rt. 1/8/2009 ankle swollen 1/9/2009 ,Mom gave advil U 1/9/2009 1/9/2009 02F, VOMITING X1 DAY. RUNNY NOSE, Y COUGHING, FATIGUE X5 DAYS. N 1/6/2009 1/7/2009 nset 36-48 h after immunizations; chills and possible fever 42-54 h after initial immunization;Ydocumented 1/7/2009 afebrile Day 1/9/2009 3 after immunization FTER VACCINES PT DEVELOPEDY MILD URTICARIA TO CHIN AREA AS WELL AS MILDYSWELLING TO 1/9/2009 UPPER 1/12/2009 EARS; NO RESPIRA d two Hep B vaccines during hospital stay. Date and times are listed under # 10 and 11. Y ### ### s of upper right arm pain since vaccine administered. States is painful to raise arm when dressing. N No redness,### swelling, or### pain with palpat L OVER BODY N 5/27/2008 1/9/2009 gling at all sites from bottom of feet to scalp after first dose of rabies shot - ongoing. N 9/16/2008 Now new9/17/2008 onset progressive bila g difficulty, fever, body aches, tongue swelling, vomit, blood was showing as secondary issueYin the nasal 1/9/2009 airway area1/9/2009 and upper throat area oped a 3 inch diameter redness with hardened lump. The area felt as if it were a severe burn. Y Problem lasted### for 10 days. ### fter small pox and anthrax vaccination Y he noted onset of mildly symptomatic and diffuse papular Y rash, No systemic ### or ill symptoms. Impres izure - Had flu shot 11-14-08, 2nd flu Y shot 12-18-08, on same day of flu shot cough, fever, crying, Y decreased appetite ### called ###911. d Tdap injection LT arm on 12-28-08. Y C/o pain movement area below injection site, red swollen. Y PR saw PMD ### and was started ### on predniso nd listless, poor muscle tone AM following Y vaccination. Parent felt he had a seizure while sleeping. Y Was taken### to ER. Dx### with pneumonia, received 12/27/08. On 12/30/2008 Y began experiencing itching of nose, 101 f temperature; aching U of neck and ### back. Dad contacted ### PMD w ceived on Saturday, 12/27/08. On Tues. Y 12/30/08 began experiencing itching of nasal cavity, U nasal infection, nasal ### bleeding, ### 101 degrees adache from 12-17-08 time given till Dec 28, 2008 almost (2 wks) also hoarseness same time. Y Everything is ok### now. ### n has been received from a physician Y concerning an approximately 70 year old patient who Y on an unspecified date was vaccinated with a d was reported by a healthcare professional Y and described the occurrence of anemia in a female U subject of unspecified ### age### who was vaccin was reported by a consumer and described Y the occurrence of injection site burning in a 70-year-old N female 11/7/2008 subject 11/7/2008 who was vaccinated wi was reported by a pharmacist (alsoYthe subject) and described the occurrence of arm rash inU a female subject ### of unspecified ###age who was fever, Heat @ site. Y Y 1/5/2009 1/6/2009 of breath, bodyaches. Treated with Y TORADOL IM & ALBUTEROL NEBULIZER X 2. Symptoms Y started 1/9/2009 around 1800. 1/9/2009 menactra + Hep A vaccine within 5 mins of receiving the vaccine the patient was getting ready Y to leave and 1/12/2009 passed out 1/12/2009 in our waiting room. d shaking, shivering with pain around 1am after receiving flu shot at 6 pm night before. Symptoms Y lasted about 1/8/2009 3 hours. 1/9/2009 Pain was headache ed out info sheet stating he had fainted w/previous injection at Dr's office(date unknown, butYin 2008). He1/10/2009 came to get 1/10/2009 FLUVIRIN, TWINRIX n has been received from a female registered with ankylosing spondylitis. Who on 21-Nov-2008 N was vaccinated ### with a dose ###of ZOSTER va ### N ### ### d cold, cough, vomiting after Y Influenza vaccination, Y requiring hospitalization 48 for Pneumonia. N 1/26/2009 MR 12/9/2008 received for DOS ###12/15/2008-1/ mins of receiving HPV injection pt became pale, lightheaded, vision became black, diaphoretic. Y Had pt wheeled### to obs. room###monitored pt f With X 3days fever 99 , HA, myalgia on 11/12/08 Blood drawn for yellow fever IgG and Igm.YResults was11/7/2008 antibody low-unable ### to separate f er flu vaccine administered, developed diffuse eczematous rash that persisted months after vaccine U given. Rash ### comes and ### goes. 1-7-09 = lt leq red + swollen + warm Yto touch ordered- TYLENOL, Compresses, HC cream & U BENADRYL po-> 1/5/2009 RECK1/6/2009 1-8-09 -> (on AMOX f d a flu shot in October 2008. She felt immediate pain in shoulder, radiating down arm. SheYfelt the flu shot 10/1/2008 was given 10/1/2008 higher up on her sho eveloped a satellite pustule near vaccine Y site. Area appeared to have a generalized cellulitis Y around site. 12/8/2008 Member sent to### ER and was tre ch over upper body, extremities + bottoms of feet. Felt very "hyper" "wired". Difficulty sleeping Y that night, diarrhea, ###sweats,### swollen axillary l
Y Y 10/9/2008 ### Vaccinated at 9AM- Pain in left upper arm 4PM and continues. Shot was given top of arm at N shoulder in back. Saw ### family doctor, ### neurologis ours; woke up dizzy; then complained of a stomachache. Y ### ### nted 4 days after vaccination per mom's report: with HPV vaccine patient was getting up from Y sitting down on couch ### when### she fainted. Mo 20 x 20 over (L) arm PCV7 site. Y 1/6/2009 adache, brown spot in vision - 30 mins. Y - fever 102 degrees x 9hrs. Headache and dizzy afterY72hrs. 1/5/2009 1/5/2009 he side where HEPTAVAX was given with headache for a few hours. Y 1/7/2009 1/7/2009 with 11.5cm x 13cm area of erythema. Warm to touch, painful on palpation. Area blanchesYon palpation,1/5/2009 sl erythematous 1/7/2009 no clearly dema hema, pruritis and pain at site of VARICELLA Y injection within 24 hours vaccine. Seen at 48 hours. U ### ### ed body rash with mild edema,"patches" and hives. Y 12/4/2008 ### mage in right arm. I have peripheral Y neuropathy, blood clots, bone infection and blood veins infected N in right 10/1/2008 arm. n has been received from Y a nurse concerning Y aYmale who was vaccinated 0 with all three doses U of ROTATEQ 11/1/2008 at appropriate 11/1/2008 intervals. In Nov n has been received from a physician Y concerning a 63 year old female patient with Y upper respiratory N tract infection ### at the time ### of vaccinatio n has been received for the pregnancy registry for GARDASIL from a physician concerning aU 15 year old female ###who on 23-OCT-2008 ### was noted at injection site on left leg, without Y itching. Presented to the primary care provider the following Y day and 1/6/2009 received 1/7/2009 prescription for Augm wo HPV shots had muscle sorenessY and slight fever. After Shot #3 had severe whole body Y myalgias and1/6/2009 stiffness "I1/7/2009 can hardly move". Te s received two Varicella vaccinations. The first vaccination was given by our office (administer Y unknown)9/6/2006 on 8-19-02.1/9/2009 The second vaccina IVED GARDASIL, MENACTRA AND ADACEL IMMUNIZATIONS ON 01-12-09. AFTER INJECTIONS, Y PT 1/12/2009 GOT DIZZY 1/12/2009 AND PALE WHILE patient had a seizure at 7:00 pm. No fever was noted by his mom. Diastat 2.5 mg was given Y rectally times 1/9/2009 two doses 1/9/2009 and patient was fully ENTED TO OFFICE ON 12-24-08 WITH C/O SORE THROAT, COUGH AND FEVER. STREP Y SCREEN PERFORMED, ### RESULTS ### NEGAT e, malaise, myalgias began approximately 16 hours after receiving the vaccine. Approximately Y 24 hours later, 1/8/2009 they began 1/9/2009 to improve and ha owing vaccination patient developed Y fever to 102, irritability, rash, wheezing 1/6/2009 1/9/2009 omplaining with joint pain, backpain,Yheadache, and face red the day after the vaccine. Y 1/7/2009 1/8/2009 am - parent returned to health department; states infant difficult to arouse, sleeyp, only sipping Y at bottle. 1/7/2009 Had fever (100.1F 1/7/2009 rectal), 1/7, ar ter recived the first HPV guardasil shot Y on 9-16-2008. She received meningococcal vaccineUat the same9/16/2008 time. After9/17/2008 the first shot she had a seizure 7 hours after 2nd dose of flu vaccine; Patient Y went to Hospital 1 and was admitted. 3/5/09 Y MR received 1/12/2009 for DOS 1/12/2009 1/13/09 with D/C DX e on face and swelling of face. GivenY Benadryl 1cc per Dr. Y 1/13/2009 1/13/2009 within 24 hours of vaccination. No history of seizures Y prior to this episode. 5 None since. 1/19/09 Y Reviewed hospital ### medical### records of 01/01 SS; PAIN & NUMBNESS STARTING Y IN LOWER Y EXTREMITIES; RASH 5 LOWER EXTREMITIES (MILD, ERYTHEMATOUS; ### 1/2/2009NO VESCICL 1 PM-PT REPORTED FREQ NON-PRODUCTIVE Y COUGH AND BRONCHOCONSTRICTION Y (FELT LIKE CHILDHOOD ### ASTHMA, ### BUT NO oid slightly swollen, with warmth to touch and client complains of numbness. Y 1/9/2009 1/10/2009 of chills without fever, myalgias, starting 24 hours after injection. 1/8/2009 1/9/2009 , raised bump at the site, soreness from elbow to shoulder. Y 1/13/2009 1/13/2009 as a very happy and relaxed baby prior to getting vaccinated. He only cried when he was hungry Y or gassy and ### was very social ### with everyon 1am stiff neck, tight jaw muscles. 13:30 Y Left arm bottom itched, 1"x4" hard lump w. red edges N sprayed w/1/10/2009 bactine and 1/10/2009 took anti-histimine. 1 e minutes of vaccine administration the patient developed upper respiratory congestion and sneezing. Y Over 1/12/2009 the next1/12/2009 five to ten minutes he ped strong daily headaches. She reports a history of sever headaches in her past history. She U noticed daily 1/6/2009 headaches 1/8/2009 after 1st Gardasil v mildly painful, warm, red, slightly swollen beginning first day after injection and continues to be U on the 3rd1/10/2008 day following 1/11/2008 injection without wor veloped genital herpes primary episode 12/16/08. Treated with hydrontisone prior to culture Yresult. Resolved 7/12/2007 on own. Pt and ###her mother re lightheaded, tachycardia tinnitus since Y May 08. 2/24/09 MR received from PCP from 3/2008Uto 1/2009 for 3/18/2008 multiple visits 5/23/2008 with multiple c/o. P lightheaded, tachycardia tumoritis Y persisting since May! Patient c/o sf since May 23 (initiallyUseen 5/28/08 5/20/2008 for complaints). 5/23/2008 2/24/09 MR rec lightheaded, tachycardia, tinnitus since Y May 08. 2/24/09 MR received from PCP from 3/2008 U to 1/20095/20/2008 for multiple5/23/2008 visits with multiple c/o. rm- erythematous mac raised. Confluent rash surrounding. Approximately 4cmx2.5cm. LeftYupper arm in1/9/2009 area of Dtap 1/10/2009 injection site. of entire arm down to fingers. Erythema at site. Y 1/6/2009 d fever of 104 degrees following day Y 1/5/2009 1/8/2009 o LL at site of vaccine. Advised to use cool compresses to site and to call office if more concerns. U 1/7/2009 1/9/2009 w grade), rash of a vesicular inflamed Y type; located proximal to injection site, began 2 3 wks after Y injection, 12/5/2008 looking like a red ### bump that furth a where she got ADACEL is tight, hot, red, swollen (about size 4-6" wide and red from elbowUto shoulder). Hasn't ### taken any### otc. meds or us veloped low back pain that radiatedYafter 30 minutes to abdomen. Pain described as cramping Y / pressure. 11/4/2008 7 on pain11/5/2008 scale of 0-10 generaliz - x2Days, Motrin/Tylenol. Y Y 1/5/2009 1/6/2009 accines pt broke out in hives, lg itchy red welts --> both arm, back and chest. Benadryl givenUand change to Zyrtec. ### ###
ed child had congestion, sweats, tiredness and cough since given FLUMIST. Advised to use U asthma meds and### follow up w/ ### MD if symptoms ain since flu shot reported on 12/5/08. Y As of 12/16/08 saw MD, diagnosed with bursitis, RELAFEN U prescribed. 11/7/2008 May11/7/2008 need cortisone injectio his whole right arm was swollen, red & sore down to the elbow for 3 days following vaccination. Y Did not see 11/4/2008 MD. 11/5/2008 his whole right arm was swollen red & sore from shoulder to finger tips. Applied warm soaksYwith relief. Slight ### swelling & redness ### still noted Reported persistent pain after flu shot. Y Saw MD, was told injection "hit a nerve". 1/5/09 Pt reports N receiving cortisone ### shots ### for bursitis. No upper arm became red, warm & swollen. Y Injection site induration to size of 50 cent piece and Y was fury red. 1/5/2009 Cold compress 1/6/2009applied. On 1 m area of erythema and warmth to posterolateral upper R arm U ### t tetanus/pertussis vaccination-onset of reddness, edema, pruritits to injection site area 2-3 inch Y diametric1/6/2009 day 4-apply 1/9/2009 1 degree cortisone c RECOMBIVAX HB instead of Hep A. Discovered when putting in NCIR. Medication Error. Y ### ### of left deltoid following Influenza vaccination Y on 11/4/08. 11/5/08 increased soreness, fever and Y chills; 11/7/08 11/4/2008 went to 11/5/2008 primary care diagnos ess and swelling at injection site, (+)Yfever 1 day after injection; treated at student health services U 1/12/09 for 1/9/2009 severe 1/10/2009 local reaction vs cellulit s after injection - developed bilat. chest pain and around to back. Short of breath. Took Benadryl Y 50mg PO 11/6/2008 and felt 11/6/2008 better in 5-10 min. Also n has been received from a physician Y concerning Y a 15 month old child who on an unspecified Y date was vaccinated with a dose of 0.5ml of n has been received from a registered Y nurse concerning a 15 month old female child who onN01-MAY-2008 5/1/2008 was vaccinated 6/27/2008 SQ with 0.5ml n has been received from a physician concerning a child who on an unknown date was vaccinated U with a dose of PROQUAD (Oka/Merck u n has been received from a licensed practical nurse concerning a 4 month old male patient with N a milk allergy 7/22/2008 and no 7/22/2008 other medical history n has been received from a physician concerning a 15 month old male with a history of sepsis U treated at birth 8/7/2008 who on8/7/2008 07-AUG-2008 was va n has been received from a 61 year old female patient with osteoporosis, hypothyroidism and Y gastroparesis who ###on 24-OCT-2008 ### was vac ### N 1/14/2008 ### ### N ### ### hicken pox vaccine cause herpes one simplex encephalitis? Since my child was given a live strand of the virus### and 6/14/2004 it just so happen he ma & influenza given in left arm 12/1/08, returned to office 12/4/08, developed rash 12/3/08 which Y is expanding, 12/1/2008 area itchy, located medial left upper arm with 2 hours of vaccine did Y not radiate, stabbing, difficulty lift L arm up also 2 dayNhx of nausea, malaise ### ### r ZOSTAVAX vaccination; persisting through present - 1/12/2009-, and worsening -more; more places on body-; effectively ### treated with non d with rheumatoid arthritis on 01/08/2009 by a rheumatologist at a research center. I am 28 U years old, and first### noticed 1/8/2009 pain in feet about 1 es onset of pain at R shoulder vaccination site @ 12/11/08 PM. Exam c/w localized inflammatory reaction 12/4/2008 at lateral aspect of deltoid. No s patient called after hours with c/o fever, n/v/d since he received the flu shot on 12/18. He told the nurse he would ###go to a local ### hospital. I ca ythema Multiforme, Diarrhea, Nausea, Vomiting, chills. ### ### n has been received from a Licensed Practical Nurse concerning a 16 year old female who on Y 30-JUN-2008 1/5/2009 was vaccinated 1/5/2009with the first d n has been received from a nurse practitioner Y concerning Y a 17 year3old female with Y no medical Y history and drug ### allergies 1/2/2009 who on 31-DEC-2 n has been received from a physician Y concerning a 12 year old female who on 29-OCT-2008 Y Y was vaccinated with ### the third### dose of GARDA follow-up information has been received Y from aYphysician concerning 3 a 67 year old female patient Y with osteoporosis and seasonal ### allergy w VAX 23 given 12/2/08 between 1-3pm. On 12/3/08 am T 100 and soft ball sized warm, red area Y noted at12/2/2008 injection site 12/3/2008 (LD). MD called by right deltoid pain after Hepatitis B #2 Y vaccine over a year ago. N ### ### gan with cough and upper respiratory infectionYafter vaccine administered. 17 Patient began taking U over the counter ### meds and ###got worse. Pa 9 Increase Tempature/ 01/06/2009 Tempatrue, nausea, fatigue, headache. Y 1/5/2009 1/5/2009 1/2/2009 Y 1 N 1/4/2006 1/1/2009 EKS AFTER VACCINATION PATIENT Y MAY HAVE COME DOWN WITH A SLIGHT CASE OF Y SHINGLES. 11/7/2008 A RASH/SORES ### APPEARED O re than 24 hours I noticed a rash that started near her injection site on her thigh, on her buttocks, Y near the 1/12/2009 back of her 1/13/2009 neck on her back an er receiving Hepatitis A and DTap the pt presents with redness, swelling, localized fever, andUcontact dermatitis. 1/12/2009 1/14/2009 AFTER I ADMINISTERED VACCINE Y TO THE CHILD,THE MOTHER STATED THAT THE CHILD Y WOKE 1/12/2009 UP IN THE 1/13/2009 MORNING WITH SW er to 102. Had a large knot at the site of injection. U 1/12/2009 1/12/2009 m 7cm red/warm tender but non-indurated Y no streaking U 1/12/2009 1/13/2009 ped fever of 104.5 with irritability. Patient still with temp of 102 48 hours after vaccine administered Y 1/12/2009 1/13/2009 ven around 11AM? About 3 hours after flu shot-started coughing and had a "tickle" in my throat, Y cough became### more frequent, ### then heart r OLLEN LEFT DELTOID REGION, WARM AND SLIGHTLY TENDER. EXTENDS TO AXILLA, U CANNOT 1/12/2009 RULE OUT1/13/2009 SECONDARY CELLUL ng (site of innoculation), arthralgias in knees and ankles bilaterally 2/9/09-records received for U DOS 1/14/09-presented 1/13/2009 1/14/2009 with C/O reaction to ately 2 hours after received flu shot Y client starting sneezing and coughing. Eye lids began toYswell and had 12/5/2008 difficulty12/5/2008 breathing. ningococcal (MCV4) vaccine on 01/09/09 Y in left arm SC instead of IM. Pt was brought to Urgent Y Care on 1/9/2009 01/11/09 with 1/10/2009 pain, erythematous mach pains within 2 hours Y of shot. Y Hands then became tingly and had"pins and needles", throat Y then had 1/14/2009 same feeling. 1/14/2009 Then had feverish ministered 01/12/09, 01/13/09 morning red and swollen by evening small blister that increased in size to 1 inch diameter, blister broke am 1/1
en on 1/12/09 right arm, Had right arm Y swelling, redness, felt firm to touch, worsened over 2 days. U Seen in 1/12/2009 clinic on 1/14/09, 1/12/2009 had indurated e ter shot administered, felt chest pressure, heart pounding, congested chest & cough. Breathing Y problems1/9/2009 also which1/9/2009 lasted about 25 minu s after receiving the MMR vaccine he called by phone and said he felt like he was going to "black Y out" but did not. ### He also### complained of "t :30pm 12/30/08 Slight headache inYafternoon, Oral Typhoid stated that evening, 2 hours later Y became sick. Symptoms ### nausea ### and low gra ported having a fever, local myalgia and pharyngitis after having the TDAP vaccine. Definite Ytime course not known, ### but suspected ### to be wi hot was administered and three hours later I experienced... Poor co-ordination. Tripped getting Y out of a 1/13/2009 car and tripped 1/13/2009 again when I tried t me down with Shingles. Y Was treated with gabapentin and acyclovir. 01/21/2009 Office note received Y from5/1/2007 PCP DOS1/14/2009 1/14/09 with dx: Shing EIVED THE FLU SHOT IN MID-OCTOBER Y AND Y DISPLAYED A FEVER 7 DURING VETERAN'S U DAY WEEKEND ###WITH NO ### OTHER SYMP east 103, chills, fatigue, loss of appetite, diarrhea, vomiting; vomiting lasted at least 2 days (ongoing U but getting 1/12/2009 better) 1/12/2009 n: 47 y/o female AD SM reports theYonset of undocumented fever chills commencing 3 daysYafter BIOTHRAX. ### SM went 12/3/2007 on to develop coug nt states with every flu vaccination since 2000 he will have URI symptoms (post nasal drip, nasal congestion, 6/16/2000 rhinnorhea, 6/19/2000 dry cough, watery n c/o pain to L side of face from nose to L ear and L scalp - tender to touch. No lesions noted U except for small 1/6/2009 macule 1/12/2009 on L upper eyelid an hypersensitivity Rxn to vaccine & erythema/induration in L deltoid Y ### ### given on 01/13/09 in arm. Mom gaveYchild Tylenol after injection at home. At 4:00Am (1-14-09) Y mom noticed 1/13/2009 rash on1/14/2009 child all over body. See s been to 2 Doctors who say it is not related to the ZOSTAVAX injection. Rash is over trunk N but she feels it is spreading. d & swelled where VARIVAX was given Y Y 1/12/2009 1/13/2009 fever, headache, body aches and joint pain, lethargy x 6 days. N 1/6/2009 1/8/2009 6x7cm hard red patch on left leg atYinjection site. U 1/13/2009 1/14/2009 es swollen shut, itchy. BENADRYL 2 Tsp PO Q6 PRN. Y 1/13/2009 1/14/2009 atous areas distal to site of injection. Non tender, non indurated 1 cm in diameter. Y 1/12/2009 1/13/2009 dominal discomfort, onset 4 days after Y injection with nausea. Symptoms lasted X 5 days. Y ### 1/2/2009 nt was a 34 year old male Officer with no medical problems prior to receiving anthrax Y vaccination N #5 in Apr 4/15/1999 1999. In Aug 9/1/1999 and Sept of that ye eceived multiples doses of ENGERIX-B Y within aY one year time period, later diagnosed Y with MS. N Symptoms: 2/1/2006 Loss of vision 5/1/2007 (CN II), weaknes 9 received flu vaccine. Pt reports that evening feeling chilled, dizzy, weak, severe aching bit. Y Forearm and 1/5/2009 difficulty breathing, 1/5/2009pale, HR102,B ped cellulitis on the site of Pneumococcal Y vaccine with fever, vomiting 01/9/09. 11 1/2 hours after the shot1/9/2009 treated with 1/9/2009 Abx augmentin. ceived yellow fever and typhoid injections without incident. Approximately 15 mins later GARDASIL Y inj given. 1/6/2009 Within mins 1/6/2009 patient had synco hours-swelling 2"x3" raised 1/2-3/4 inch, hot, have been-icing/heat pack-5th day=still swollen, N very tender1/5/2009 and hot-very 1/6/2009 uncomfortable. was fine at first but overtime developed Y aching where vaccine was deposited inside arm to point Y of interfering with ###sleep. 11/1/2008 Also general arm w ght, fever, non-weight bearing 1/10/2009 1/10/2009 ection site, fever, non-weight bearing doses of GARDASIL I had all normal pap tests between the years 2004 to 12-1-20066. AfterU3 doses of GARDASIL ### I had### 2 abnormal pap shot of GARDASIL on 2-7-08 had dizziness, headache, missed school. Second shot 5-7-08 Y had dizziness2/7/2008 and severe2/7/2008 headache - missed s D AA male SM presents with 2-day history Y of SPV innoculation site concerns. Reports HA, malaise, Y chills, and ### myalgia. Chills, ### Headache, g ed his primary SPV on 11/27/07. Never Y developed Jennerian pustule. 3 weeks post inoculation, Y he developed### a small, red, raised lesion a one minute after receiving anthrax #1 and 2, she had very brief episodes of chest pain, lasting Y less than 21/8/2008 min that resolved without interve oped redness, swelling, pain approx 24 hrs after receipt of anthrax vaccine. Swelling Start: 12/16/2007; Y Erythema ### Start: 12/16/2007; Edem h on arm, redness into his armpit about 10 days after receipt of primary SPV Symptom: Edema U @ injection site### >120 mm not beyond elbow /o eczema that received SPV and had exacerbation of his eczema. His concern is more focused Y on his children ### at home, 2 of whom have redness, swelling around primary SPV site approx. 6 days after receiving vaccine. Symptom: Y Erythema Start: ### 12/10/2007 Symptom: Swell rge local reaction with his 3rd and 4th anthrax shots. Symptom: Edema @ injection site 50-120mm Start:6/1/2003 06/2003; Edema @ injection site he had large local reaction with his 3rd, 4th and 5th anthrax shots, including redness, swelling Y and pain at7/1/2003 injection site. Erythema Start: 07 d large local reaction to anthrax vaccine Erythema Start: 05/2007; Swelling Start: 05/2007; Pain Y Start: 05/2007 5/12/2007 o PCP for evaluation of HA, body aches, Y general malaise and diarrhea she developed after U being vaccinated 11/5/2007 with SPV, anthrax and typhoi n has been received from a physician concerning a male who was vaccinated with a dose ofUMMR II and was diagnosed with autism. The n has been received, for the Pregnancy Y Registry Y for GARDASIL, from 0 a nurse practitioner concerning Y a 16 6/3/2008 year old female 6/3/2008 with no pertinen n has been received from a physician's Y assistant Y (P.A.) concerning 3 a approximately 3 monthUold patient 12/4/2008 who was vaccinated 1/6/2009with a dose of was reported by a consumer and described Y the occurrence of psoriasis in a 56-year-old female N subject who was ###vaccinated ###with ENGERIX eption. First began with bloody Y diarrhea Y 1-10-09. Y Resolved 1-11-09.2Recurred 1-14-09. US 1-15-09. N Intussusception 1/7/2009 1/11/2009 at cecum. 1/29/09 Re , hard area approximately 2 1/2" in diam. at injection site. Sore and burning. Approximately 12 U days after injection, ### developed ### bumpy, itchy ported elevated temperatures of 104.0 degree F the morning after vaccines, also mentioned Yextreme fussiness 1/12/2009 and 1/13/2009 slight decreased appeti developed at injection site the day of administration. Complains of itching at site. Erythematous Y from top of1/7/2009 deltoid to 1/7/2009 4cm above elbow. Coo
mins after receiving vaccine pt stated that he felt dizzy & had blurry vision. He was placed in Y supine position 1/14/2009 with feet 1/14/2009 elevated v/s HR 100 ates that right wrist was swollen on 01/10/09 about 24 hours after MENACTRA and HAVRIX Ywas administered 1/9/2009 in right 1/10/2009 arm. m to touch rash at injection site. Y 1/7/2009 1/9/2009 ted blood in infant's stool one day after Y immunizations were given. Infant was fussy the evening U of vaccines, 1/9/2009 but has1/9/2009 been fine since. ed screaming for hours on end, severe irritability, lethargy Y 9/5/2008 9/6/2008 ports hives on back- upper torso U 1/14/2009 1/14/2009 ported raised red very painful spot at site of injection, which got better with time. Y 1/6/2009 lled and reported need to go to ER folllowing immunizations given 12/31/2008. She stated respirations Y became### labored 1/1/2009 and temperature 10 ays of receiving the 2nd round of the Y HPV vaccination, Y my daughter2began with severe painYin her arms, legs, ### and hips, difficulty ### walking w as accidently give Tdap instead of Td Y 1/15/2009 rs 102+, Nausea, Dizzy, lethargic, weak & tired U 1/14/2009 1/14/2009 1 x 7 cm reddened area noted this am. 1/13/2009 1/15/2009 per arm is very swollen and hard after receiving Shingle vaccine. Red circle approximately four N inches in1/12/2009 length is present. 1/12/2009 Some itchy. Ve 3rd hep B injection on 12/8/08. Within one day developed tender left axillar adenopathy lasting Y 2-3 days,12/8/2008 followed by 12/9/2008 swelling, erythema an fever, vomiting, dehydration, elevated Y heart rate N 1/12/2009 1/14/2009 mplained of persistent redness, edema, was febrile and noticed streaks down arm post vaccination. Y Treated 1/6/2009 by on-call 1/7/2009 physician with an a hemic stroke (basilar artery Y thrombus). Y Underwent Y mechanical thrombectomy 20 Y 11/25/08. Y 2/2/09 N Received11/5/2008 ER medical records ### of 11/19/200 receipt of vaccines in travel clinic client experienced syncope episode, i.e., lost consciousness, Y became 1/15/2009 pale, dyaphoretic. 1/15/2009 B/P 110/70; clie ceived vaccine 01/06/2009 and called pharmacy 01/14/2009 with complaint of a red rash at the U injection site 1/6/2009 approximately 1/14/2009 2 inches in diam B Vaccine series given at start of new Y job (1st dose 9/13/2006) because blood work Y showedNno immunity 2/14/2007 present from 8/23/2007 previous immunizat able screaming and fits of rage lasting for 15 minutes at a time, happening since an hour and U a half after1/13/2009 vaccination. 1/13/2009 At current time, symp eactive lymphadenopathy and swelling in left anterior cervical chain and supraclavicular areas on 1/15/09 1/12/2009 with torso1/15/2009 macularpapular rash d a febrile seizure with a temperature Y of 106.8 degrees and rising 7 days post MMRV shot. He'd Y had a double-ear ### infection 12/7/2007 as well at the tim ed patient "almost passed out" and patient stated he had headache. I observed the patient to Y be alert/ appropriately 1/14/2009 1/14/2009 responsive. d-mosquito bite size area where received vaccine, no fever, no other issues. No drainage, no Y bigger, not 1/8/2009 painful. 2 days 1/9/2009 later had lump the was brought to my office for the next set of vaccines, his parents described 8 hours of high - pitched Y screaming 7/7/2008 post the 7/7/2008 prev vaccines. No A given to 9 month old child. U 1/6/2009 1/6/2009 severe irritability, 4-6 hrs immunization for several days U ### ### Swelling, warmth redness U 1/5/2009 1/6/2009 2 area of redness with elevated temp and soreness at injection site. 12/25 redness and elevated Y temp resolved, ### quarter" sized ### knot at site arm - redness and swelling, mild rash redness used Benadryl 2t sp Q60 until redness gone.Y 1/7/2009 1/8/2009 headedness and inability to focus visually 5 minutes after 3rd rabies Vac. administered . VitalYsighs remained 1/9/2009 stable. Some 1/9/2009 nausea. All Sx s en Tdap - recommended for ages 11-64 only. ADACEL- lot # C3027AA in right deltoid. Y 9/22/2008 ed of pain radiating from injection site in left deltoid down to her hand diminished grip strength, U normal sensation. 1/14/2009No 1/14/2009 s/s inflammation. Ibu red circle around administration site that was hard to touch, 0 itching. Area was tender to touch. Y Began 2 days ### after administration ### and laste ed bandage over SPV site and approx. Y 3-4 days later develop a localized rash that becameYgeneralized over ### several days. SM received p Area swelled red raised. Very sore. Mom gave BENADRY & ice to area - still present 1/15/09Y 1/12/2009 1/12/2009 e to appointment for 4 mo WCC on YAmoxil started on 1-6-09. Appoint date 1-12-09. Had dry Y rash primarily 1/12/2009 on Abd.1/14/2009 & torso. Dr. instructed sounding cry, crying consistently, not Y consolable, after receiving immunization 0n 1/8/09. Had Y swelling at1/8/2009 injection site 1/8/2009 of DTAP for 1-2 day 9 per mother at 10:30 pm she felt infant Y & he was hot. She gave Tylenol and child had seizure. Y Child taken 1/14/2009 to ER 1/14/2009 by ambulance with temp U ours of vaccination Pt experienced generalized ache ness that lasted 3 days. Itching was significant Y enough 1/8/2009 to require 1/8/2009 antihistamines. No r back of neck began to itch in the PM. Then when woke up 11-15-09 legs and arms were itching resemoline 1/13/2009 hives, welts/redness 1/14/2009 on bilatera haking Chills myalgias for several hours. Resolved spontaneously. Fatigued the next day. Y 11/5/2008 11/5/2008 both parents for rash, Friday had a few spots on chest, has spread entire body and SaturdayY had fever to 102.### Received ### MMR 12/18/08, a eived DTAP, IPV, MMR,Volvox and flu 1/6/09 T100.3 1/7/09 0 fever 1/8/09 fever to 104 lasting Y 3 day associated 1/5/2009with1/8/2009 headache 1/11/09 bl ellulitis 24 hours after vaccination inYleft deltoid Y 1/8/2009 1/9/2009 njection 3:45p- woke up 9:45 pm same day-fever 102- aches all over body - had headache called Y doctor 10/2/2008 next day advised 10/2/2008 take 2 Tylenol an miting, Diarrhea Daily-No reason hospitalized Y for dehydration lost 30lbs. Continued to be sickN Colonoscopy, 8/22/2007 MRI problems 10/1/2007 with Blood sug hours of HPV dose given on 08/27/2008 - Had rash over trunk of body, Lasting 3 days did not Y seek medical 8/27/2008 attention. 8/28/2008 Within 24 hrs after 6/ 30 Pt. called to report that she had a rapid heart rate which started approximately 1/2 hr afterYreceiving the1/6/2009 vaccine and 1/6/2009 lasted for approxim
veloped a 1"x1 1/2" induration that is red and warm where an ADACEL injection was given. U 1/6/2009 ucousy stools after ROTATEQ vaccine x 2 weeks. U ### ### er UMM placed erythema, tenderness and warmth occurred- 9cm X 6 cm oral paten, resolving N after 2 more days. ###At visit 5### days later paten ived PEDIARIX/PREVNAR 1/09/2009 at 09:25 per / LPN- 1/10/2009 Mon report swelling, redness Y at site 1/9/2009 and thigh 1/10/2009 swollen 1/12/09 "doing 0-15 min after getting vaccines small white raised bumps. Lasted about 3 weeks itching 0 treatment Y 9/11/2008 9/11/2008 p- size of "grape" in arm - where shot administered for one week - then thereafter, remains aUlump "pea" size in### upper left ### arm. n has been received from a consumer Y concerning her 8 week old daughter who on 11-DEC-2007 N was vaccinated ###with a dose ### of COMVAX n has been received from a consumer concerning a friend of the family's child who on an unspecified U date was vaccinated with MMR II, and n was obtained on request by the Company from the agency via a Public Case Detail Form U and a Case 3/26/2008 Line Listing concerning an approxim n has been received from Y a physician Y concerning a 22 year old female patient with no pertinent Y medical history 1/7/2009 and no 1/7/2009 known drug allergy n has been received from a physician concerning a 15 year old female with no previous Y medical, N family, 12/7/2007 or social history 12/8/2007 who on 19-NOV-2 n has been received from a health professional concerning a 19 year old female patient whoYon 17-DEC-2008 ### was vaccinated ### with the first n has been received from a physician Y and a hospital Y medical librarian 1 concerning a 59 year N old female who on### 30-DEC-2008 1/1/2009 was vaccinate n has been received from a physician, for VARIVAX (Merck), a Pregnancy Registry product,Yconcerning a female who was vaccinated with minutes of vaccination to the left upper arm, patient felt weakness in right side (muscular and Y joint) from right hip ###to knee; ### weakness lasted nt presented with swelling and redness on upper arm approx 2 inches from injection site 1 day Y post-injection. Her ###upper arm ###was hot and p esented with cellulitis of right arm associated with swelling and axillary lymphadeopathy. Patient Y reported fever, ### chills at home. ### VERE PAIN AT THE SITE OF INJETION FROM 1/13/09(DAY OF VACCINATION) TO 1/14/09...MORE Y THAN 1/13/2009 36 HRS....WITH 1/13/2009 SITE (LEFT d a rash on the thighs and face. U 1/13/2009 l pain/stomach cramps for 2 hours. No treatment given. Y 1/6/2009 1/6/2009 iented, unable to answer questions Yappropriately for 45 minutes. Went to ER and was seen Y by triage nurse, 1/6/2009 then symptoms 1/6/2009resolved and p IVED EXPIRED FLUMIST LOT 500548P EXP DATE 12/18/2008. NO REPORTED ADVERSE U EVENTS TO DATE ### OF COMPLETING REP rash & periorbital swelling beginningY 11/6/08 - Adverse reaction reported to Employee Health Y on 11/7/0811/5/2008 - referred to 11/6/2008 Nurse Practitioner at ported burning and stinging in her hand starting several hours after she received the vaccineUon 12/30/2008. The ###next day### she said that the nced large local reaction as well asYa "rash all over" Y 12/6/2008 12/7/2008 me to clinic today and presented with a possible reaction to the flu vaccine. The flu shot wasUadministered 10/9/2008 on October 10/9/2008 9, 2008. The patient veloped watery diarrhea 1/2/09. The diarrhea lastd until 1/6/09. Patient also developed irritability Y and a decrease ###in appetite. 1/2/2009 me to Health Center at 12:06 pm on 1/16/09, 9 days after injections. Stated "prolonged hardUlump on my1/7/2009 right arm where 1/8/2009 I got the pneumo ng, tightness in chest, cough, swelling Y around his eyes and a bit of difficulty breathing. It was about 4 hours 1/13/2009 after the1/13/2009 shot. PV on November 4th, 2008. she stated she didn't know she was pregnant. Had a miscarrieage Y in December. 11/4/2008 (Came in today ### becase she d an afebrile seizure event lasting 2-3 minutes Ythe evening after receiving 1 influenza A and Hepatitis Y A vaccine 1/14/2009 at her 1/14/2009 PMDs on 1/14/09. Sh fever, body aches, chills, dizziness Y ### ### n has been received from a case inYlitigation from a 64 year old female who on 29-OCT-2008 N was vaccinated in ### the right arm with a dose o n has been received from a consumer Y concerning a 13 month old male with no medical history N or drug allergy 6/5/2006 who on 6/5/2006 05-JUN-2006 was va n has been received from a pharmacist Y concerning Y a 90 year old female 3 Y patient who was vaccinated Y with a dose ###of ZOSTAVAX ### (lot# not p n has been received from a registered nurse who Y reported that the one 0 Y of her patient's mother U reported that there was a female patient who was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a female patient who expe was reported by a lawyer and described the occurrence of arm pain in a 48-year-old Y male subject N who was 5/13/1999 vaccinated 6/1/1999 with LYMERIX (Gla was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age who was vaccinated with LYMER was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified Y age who ### was vaccinated 10/4/1999 with LYMER was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age2/23/2000 who was vaccinated with LYMER was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified N age who was vaccinated with LYME was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified 5/25/2000 age who was vaccinated with 1/10/2009 N 1/8/2009 1/10/2009 1/14/2009 N 1/13/2009 d hives/facial swelling, local Y itching within 5 minutes of vaccine. Required EpiPen administration. Y 1/8/2009 1/8/2009 varicella shot R arm. 11/5 developed redness & blisters on R arm below injection site- pt here Y 11/6/09 1/14/2009 1/15/2009 became red, swollen, warm the evening Y of 12/30/08. Symptoms worsened next day. She was seen at clinic on ### 11/1/09- They ### referred her LA- like rash Y Y ### 1/10/2009 er of 101.9, aches, stiffness - around 6:30 pm. Around 1 am next am0 headache, sweating,Ynightmares,1/12/2009 few hives on 1/12/2009 hands. Symptoms im oulder started pinching. The pain progressed to point of doctor visit. Am currently doing physical Y therapy for left ### shoulder.###
t ever given- hurt immediately and for approx 4 to 5 days after. Got really sick after for 4 days N - puking etc. Started ### noticing ###that arm aches induration, swelling on R thigh where Y Hib and PREVNAR were given. Later developed into Y a localized abcess. 4/1/2006 Had recurrence of similar s episode following GARDASIL administration. Held in clinic for 15 min following incident, withYBP initially 122/64 1/16/2009 and 1/16/2009 126/76 15 min later. G firm, warm to touch 6.0cm X4.5cm, chemical taste in mouth approximately 20min after administration Y patient 1/14/2009 normally 1/14/2009 has chemical taste w wollen, hot red to left thigh. Treatment CLENDA 75/5 1 top po tid x 10 days. U 1/14/2009 1/14/2009 olable, crying within 6 hrs. 2. Not having lower extremities 3. Hypersensitive below waste lineY 1/12/2009 1/12/2009 /blurriness/head pain/nausea. Another Y student at his school had immunizations yesterday also, and was1/13/2009 sent home1/14/2009 from school with simila oped redness, swelling and pain at injection site within 24 hrs of receiving his second ANTHRAX shot. 8/1/2007 d redness, pain and swelling at site of anthrax vaccine within a few hours after receiving the Y shot. 8/7/2007 d vaccine at our office on 1/5/09. On Y 1/6/09 pt started with redness, swelling, hot to touch with Y pain, some 1/5/2009 itching at 1/7/2009 the vaccine site. Wen given 1/14/09. Left arm swelling. Y U 1/14/2009 1/16/2009 veloped hives within 2 hrs of vaccines being given. Rx BENADRYL PO. No tongue/lip swelling/wheezing. Y 1/16/2009 1/16/2009 d rash over torso, about 30 lesions. No open areas, no s/s infection, no crusting. Y ### cified dates, the subjects received unspecified doses of HEPATITIS B vaccine (unknown). At U an unspecified time after vaccination with HE was reported by a sales representative and described the occurrence of decreased therapeutic U response in a subject of unspecified age an was reported by a healthcare professional Y and described the occurrence of hive in a 21-year-old U female subject ### who was ### vaccinated with E was reported by a healthcare professional and described the occurrence of not responding to N therapy in11/2/2006 a male subject of unspecified age was reported by a physician and described the occurrence of hearing deficit in a male subject U of unspecified age who was vaccinated with e was reported by a pharmacist and described the occurrence of not responding to therapy inUa subject of unspecified age and gender who was reported by a healthcare professional and described the occurrence of urticaria in a 10-year-old Y female 9/22/2000 subject9/23/2000 who was vaccinated w was reported by a healthcare professional and described the occurrence of arm weakness in Y a 39-year-old 9/16/2008 male subject 9/16/2008 who was vaccinat was reported by a physician (also the subject) via a sales representative and described the U occurrence of a young adult female subject of u was reported by a healthcare professional and described the occurrence of wrong route of administration N 10/1/2008 in a 38-year-old 10/1/2008 female subject w was reported by a consumer and described the occurrence of foot pain in a 8-year-old female U subject who was vaccinated with hepatitis B was reported by a healthcare professional and described the occurrence of a subject of unspecified U age and gender not responding to ther was reported by a physician and described the occurrence of hepatitis b antigen positive in an adult subject of unspecified 8/1/2008 gender who was was reported by a healthcare professional, who was also the vaccination subject, that described N the occurrence of not responding to thera was reported by a healthcare professional and described the occurrence of rash on trunk in a 35-year-old 8/21/2008 female subject 8/21/2008 who was vaccina was reported by a consumer and described the occurrence of injection site pain in an adult female N subject 8/19/2008 who was8/19/2008 vaccinated with ENGE was reported by a consumer and described the occurrence of injection site soreness in an adult Y female 7/19/2008 subject who7/19/2008 was vaccinated with E was reported by a pharmacist and described the occurrence of hepatitis B surface antigen positive N in a 2-month-old 7/28/2008 8/28/2008 male subject who was was reported by a healthcare professional and described the occurrence of hepatitis b antibody U negative1/16/1998 in a 49-year-old 8/1/2008 female subject w was reported by a health care professional and described the occurrence of swelling of knees Y in a 26-year-old 6/25/2008 male6/26/2008 subject who was vacci was reported by a pharmacist and described the occurrence of elevated liver enzymes in a 48-year-old N male 8/14/2008 subject 8/26/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of hives in an infant Y female subject who was vaccinated with hepa was reported by a physician via a nurse and described the occurrence of allergic reaction inUa subject of unspecified and and gender who w was reported by a consumer, who was also a GSK sales representative, that described thatNoccurrence 7/16/2008 of irritability 8/6/2008 in an adult male subje was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in8/1/2008 a 50-year-old 8/4/2008 male subject who w was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in8/1/2008 a 72-year-old 8/4/2008 male subject who w was reported by a healthcare professional and described the occurrence of hepatitis B antigen U positive 4/30/2008 in a 45-year-old 5/5/2008 male subject who was reported by a healthcare professional and described the occurrence of arm burning in an U adult female 7/1/2008 subject who was vaccinated wit was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008 subject who was vaccinated with was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008 subject who was vaccinated with was reported by a healthcare professional and described the occurrence of hives in a 3-year-old Y female subject ### who was ### vaccinated with E was reported by a nurse and described the occurrence of allergic reaction in an adult femaleUsubject of unspecified age who was vaccinate was reported by a healthcare professional and described the occurrence of swelling of knees Y in a 26-year-old 6/25/2008 male6/25/2008 subject who was vaccin was reported by a healthcare professional and described the occurrence of low hepatitis b antibody U level in a male subject of unspecified a was reported by a healthcare professional and described the occurrence of hepatitis b surface antigen positive 6/10/2008 in a6/11/2008 27-year-old female sub was reported by a physician and described the occurrence of fever in a female subject Y of unspecified Y age who was vaccinated with hepatit was reported by a pharmacist and described the occurrence of nausea in three subject of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccina was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccin
was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified N ages 7/10/2008 and genders 7/10/2008 who were vaccin was reported by a healthcare professional and described the occurrence of a false positive hepatitis N test6/16/2008 in a male subject 6/19/2008 aged between 5 was reported by a pharmacist and described the occurrence of decreased therapeutic response U in an unspecified number of subjects of un was reported by a healthcare professional and described the occurrence of an adult male subject U (a dentist) not responding to therapy follo was reported by a pharmacist and described the occurrence of an adult male subject (a physician) U not responding to therapy following vac was reported by a pharmacist and described the occurrence of an adult male subject not responding U to therapy following vaccination with H was reported by a pharmacist, who was also the consumer, that described the occurrence ofY fever in a 22-year-old male subject who was v was reported by a healthcare professional and described the occurrence of Hepatitis B antibody U negative 1/22/2001 in a 23-year-old 6/12/2007 female patient w was reported a physician, via sales representative and described the occurrence of not responding U to therapy in a subject of unspecified ag ct was in clinic for day 180 on 03 October 20005. Pre-injection vitals were normal with blood pressure (BP) 10/3/2005 of 114/84. 10/3/2005 The subject did not h was reported by a physician via a representative and described the occurrence of HEPATITIS N B antibody negative in a 13-year-old subject was reported by a healthcare professional and described the occurrence of vaccination errorUin a subject4/14/2008 of unspecified 4/15/2008 age and gender wh was reported by a healthcare professional and described the occurrence of metallic taste in Ya 57-year-old4/4/2008 male subject 4/4/2008 who was vaccinate was reported by a healthcare professional and described the occurrence of possible HEPATITIS Y B in an elderly 3/1/2007 female subject who was va was reported by a physician and described the occurrence of not responding to therapy in aUmale subject of unspecified age who was vacc was reported by a healthcare professional and described the occurrence of low Hepatitis B antibody Y level1/1/2001 in an adult male subject who was was reported by a healthcare professional and described the occurrence of HEPATITIS B antibody U negative in### a 63-year-old 3/27/2008 male subject was reported by a healthcare professional and described the occurrence of a subject of unspecified U age and gender not responding to ther was reported by a healthcare professional Y and described the occurrence of rash in a femaleNsubject aged3/1/2008 between 20 and 29 years old wh was reported by healthcare professional and described the occurrence of hives on head in aY29-year-old2/26/2008 female subject 2/26/2008 who was vaccinate was reported by a physician and described the occurrence of a 43-year-old male subject notNresponding to therapy ### following vaccination w was reported by a consumer and described the occurrence of diarrhea in a 31-year-old female U subject who 3/23/2008 was vaccinated 3/23/2008 with ENGERIX was reported by a healthcare professional and described the occurrence of not responding to U therapy in an adult female subject who was v was reported by a healthcare professional and described the occurrence of hepatitis B antibody U negative in an adult female subject of unsp was reported by a physician from a blood center and described the occurrence of HEPATITIS U B surface antigen positive in a subject of uns was reported by a physician and described the occurrence of Hepatitis B surface antigen positive U in a subject of unspecified age and gend was reported by a healthcare professional at a dialysis unit and described the occurrence of HEPATITIS10/1/2006 B antigen positive in a 77-year-old was reported by a healthcare professional at a dialysis clinic and described the occurrence of U HEPATITIS 2/23/2008 B antigen2/26/2008 positive in a 52-year-o was reported by a healthcare professional and described the occurrence of non-seroconversion U in a subject 1/8/2008 of unknown age and gender w was reported by a healthcare professional and described the occurrence of strange taste in Ya 25-year-old 1/24/2008 male subject 1/24/2008 who was vaccinate was reported by a healthcare professional and described the occurrence of injection site redness N in a 23-year-old 2/22/2008 female 2/23/2008 subject who was was reported by a consumer and described the occurrence of flu like symptoms in a 32-year-old N female 2/15/2008 subject who 2/15/2008 was vaccinated with E was reported by a pharmacist and described the occurrence of not responding to therapy inUa 54-year-old female subject who was vaccina was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in2/9/2008 a 79-year-old 2/12/2008 male subject who w was reported by a physician and described the occurrence of HEPATITIS B surface antigenYin a male subject 1/1/2008 aged between 2/1/200830 and 40 yea was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in2/1/2008 a 78-year-old 2/6/2008 female subject who was reported by a healthcare professional and described the occurrence of Hepatitis B antigen Y positive in2/2/2008 a 76-year-old 7/2/2008 female subject wh was reported by a consumer and described the occurrence of bruise injection site in a 60-year-old U female 1/27/2008 subject who was vaccinated with was reported by a physician via a sales representative and described the occurrence of not U responding to therapy in a subject of unspecifie was reported by a physician and described Y the occurrence of hepatitis B surface antigen positive Y in a 48-year-old ### male subject ### who was va was reported by a pharmacist via a sales representative and described the occurrence of discomfort U at time of injection in an unspecified n was reported by a healthcare professional and described the occurrence of low hepatitis B antibody U level in a subject of unspecified age an was reported by a healthcare professional andYdescribed the occurrence of vaccination failure Y in a 53-year-old female 9/1/2007 subject who was vac was reported by a healthcare professional and described the occurrence of stomach pain inUa male subject 10/1/2007 of unspecified 10/1/2007 age who was va was reported by a healthcare professional and described the occurrence of not responding to U therapy in an unspecified number of adult su was reported by a physician and described the occurrence of decreased therapeutic response U in an adult male subject who was vaccinate was reported by a physician and described the occurrence of HEPATITIS B surface antigenUpositive in an 11/1/2007 adult female 11/1/2007 subject who was va was reported by a consumer and described Y the occurrence of hair loss in a 53-year-old maleN subject who6/2/2007 was vaccinated 9/1/2007 with ENGERIX B was reported by a healthcare professional Y via another manufacturer and described the occurrence U of not responding to therapy in an adult was reported by a physician and described Y the occurrence of pain in arm post vaccination inNa 29-year-old 11/8/2007 female subject 11/8/2007 who was vaccina was reported by a healthcare professional and described the occurrence of nausea in a 15-year-old Y male 10/1/2007 subject who 10/2/2007 was vaccinated with
was reported by a physician and described the occurrence of not responding to therapy in aUsubject of unspecified age and gender who wa was reported by a healthcare professional via Merck and described the occurrence of not responding U to therapy in an unknown number of was reported by a physician via sale representative and described the occurrence of alopecia Y in an infant male subject who was vaccinate was reported by a healthcare professional via sales representative and described the occurrence U of not responding to therapy in several su was reported by a pharmacist and described the occurrence of allergic reaction in a subjectUof unspecified age and gender who was vacci was reported by a healthcare professional and described the occurrence of hepatitis B surface Y antigen positive in a female subject of unsp ptember 2007 the subject received a birth dose of ENGERIX B (10 mcg, unknown). On September U 2007,9/18/2007 same day 9/18/2007 as the vaccination with was reported by a healthcare professional and described the occurrence of hepatitis B surface U antigen positive 8/7/2007 in an8/9/2007 infant male subject wh was reported by a healthcare professional and described the occurrence of inappropriate dose U of vaccine 6/27/2005 administered 6/27/2005 in a 21-year-old ma was reported by a healthcare professional and described the occurrence of hive-like rash over N the body9/22/2008 in a 6-month-old 9/23/2008 male subject who was reported by a healthcare professional Y and described the occurrence of swollen thigh (injection Y site) 8/20/2008 in a 5-year-old 8/21/2008 male subject who w was reported by a physician and described the occurrence of injection site reaction in a 2-year-old U male subject 5/1/2008 who5/1/2008 was vaccinated PEDI was reported by a healthcare professional and described the occurrence of fever in a 5-year-old Y female subject 8/6/2008 who 8/7/2008 was vaccinated with P was reported by a physician and described the occurrence of lethargy in a 2-month-old subject U of unspecified gender 7/10/2008 who vaccinated with was reported by a physician and described the occurrence of injection site hives in a 6-month-old Y female subject who was vaccinated with was reported by a pharmacist and described the occurrence of apnea in a subject of unspecified U age and gender who was vaccinated with was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w was reported by a healthcare professional, Y via a GSK sales representative, that described the Y occurrence 7/16/2008 of inconsolable 7/16/2008 crying in a 2-mon was reported by the mother of a consumer and described the occurrence of nausea in a 2-month-old N male 4/29/2004 subject who 4/30/2004 was vaccinated wit reported by a physician, via GSK representative, that described the occurrence of high fever in a 4-month-old subject of unspecified gende was reported by a physician, via a GSK representative, that described the occurrence of high U fever in a 4-month-old subject of unspecified was reported by a physician via a sales representative and described the occurrence of crying U uncontrollably 7/25/2008 in a 2-month-old 7/25/2008 female subje was reported by a physician and described Y the occurrence of hypotonia in a 2-month-old male Y subject who 7/21/2008 was vaccinated 7/21/2008 with PEDIARIX was reported by a physician and described the occurrence of wrong route of administration U in a subject of unspecified age and gender who was reported by a healthcare professional Y and described the occurrence of swelling at the injection N site 6/16/2008 in a 2-year-old 6/17/2008 male subject who w was reported by a physician and described the occurrence of a lump on leg at injection site N in a 7-month-old 4/15/2008 female5/12/2008 subject who was vacci was reported by a healthcare professional and described the occurrence of soreness in a 11-year-old U male 6/5/2008 subject who 6/5/2008 was vaccinated wi was reported by a consumer and described the occurrence of fever in a 13-month-old female N subject who was vaccinated with PEDIARIX. was reported by a physician and described the occurrence of a lump at the injection site in aN7-month-old 4/11/2008 male subject 4/14/2008 who was vaccinated was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 3/28/2008 screaming3/28/2008 in a 4-month-old subje was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 2/8/2008 screaming 2/8/2008 in a 2-month-old subje was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 3/14/2008 screaming3/14/2008 in a 2-month-old subje was reported by a physician and described the occurrence of generalized petechiae in an infant U subject who was vaccinated with PEDIARI was reported by a healthcare professional via a representative and described the occurrence Y of swollen lips in a child male subject who wa was reported by the mother of a consumer and described the occurrence of irritability in a 16-month-old N male 3/3/2008 subject3/3/2008 who was vaccinated was reported by a consumer and described the occurrence of high fever in a 17-month-old female N subject 1/24/2008 who was1/24/2008 vaccinated with PEDIA was reported by a healthcare professional Y and described the occurrence of swelling of legs Y in a 4-month-old female ### subject ###who was vacci was reported by a physician, via sales representative and described the occurrence of bulging U fontalle in a 4-month-old subject of unspecif was reported by a healthcare professional Y via a sales representative and described the occurrence Y of bulging 1/7/2008 Fontanelle 1/10/2008 in a 4-month-old was reported by a consumer, and subsequently confirmed by a physician, that described theY occurrence11/8/2007 of prolonged 11/8/2007 crying in a 2-monthwas reported by a healthcare professional and described the occurrence of crying in a 6 week-old Y male 5/18/2007 subject who5/18/2007 was vaccinated with P was reported by a physician to a sales representative and described the occurrence of feverUin a subject of unspecified age and gender wh was reported by a healthcare professional and described the occurrence of hepatitis B antibody U negative 9/23/2004 in a 60-year-old 6/12/2007 female subject w ious spontaneous report of administration to a seven-month-old has been received from a physician Y concerning 12/1/2008 a seven-month-old 12/1/2008 male w ious spontaneous report administered expired FLUMIST was received from a nurse concerning Y a four-year-old 12/2/2008 male. 12/2/2008 The patient received F eous non serious report of stuffy nose, fever, green mucus coming out of her nose and coughing U was received from12/2/2008 the patient's mother co ious report "given FLUMIST to 19-month-old" was received from a doctor's medical assistantYinvolving a 12/4/2008 19-month-old 12/4/2008 male. On 14-Dec-20 ous report of "gave FLUMIST to an 11-month-old" has been received from a registered nurse Y concerning an 11-month-old ### ### male. Medical h ious report of administration of expired product has been received from a registered nurse concerning Y a four-year-old ### male### who received FL ous, spontaneous report of administration of FLUMIST to a seventh month-old was receivedYfrom a nurse. There ###was no adverse ### event as accine used (Expired drug administered) A non serious, spontaneous report of gave expired YFLUMIST to a three-year-old ### ### female patient wa
ous spontaneous report of influenza A, fatigue, fever, sore throat, and stomach ache has been Y received from a### physician ### concerning a four ous report of a child under two years of age who received FLUMIST was received from a registered Y nurse concerning ### a 23-month-old ### fema ous report of administered expired FLUMIST was received from a registered nurse concerning Y a four-year-old ### female. Medical ### history and ous, spontaneous report of administration of expired product was received from a nurse concerning N a two year-old ### female### subsequent to F ious report of administration of expired product was received from a registered nurse concerning Y a 38-month-old ### female. Neither ### medical hi ious report of administered expired FLUMIST was received from a medical assistant concerning Y a 36-month-old ### female. FLUMIST, ### which e ious spontaneous report of expired FLUMIST given to this child was received from a certifiedYmedical assistant### in a physician's ### office conce was reported by a healthcare professional via sales representative and described the occurrence U of swelling arm in a subject of unspecifie swelling, itching, pain and tenderness and slight bruising at and around injection site on second N day after vaccination ### lasting ###about five day s history of seizures. She had been seizure free for over 3 months after switching drugs. She U had two seizures 1/7/2009 3 days 1/10/2009 after vaccination. bble 2 inches by 4 inches surrounded by a flame red 3 inch in circumfance rash. 1/17/2009,Y2 weeks after 1/3/2009 the injection, 1/3/2009 a flat redish brown x 10cm long, redness, warm to touch (L) upper arm. Y 1/15/2009 1/17/2009 was reported by a pharmacist (also the subject) and described the occurrence of feeling woozy Y in a 60-year-old 10/9/2008 male 10/9/2008 subject who was vac ffered Severe back pain, Tingling ofYlower extremities, Y Loss of sensation, 14 Y Band like Y feeling around N torsoe, Unable ###to stand,### resulted in perm ankle,and foot were swollen. Painful hives on ankle, and on top of foot. smaller hives across Ylower back,on back ### of neck,and ###top of head.th ctivity, lower paralysis, exhaustion, Y nausea Y andYvomiting, brain fog,15 difficulty Y concetrating, low N blood pressure, 8/24/2007 Painful 9/15/2007 periods and off cycle, ely after receiving shot,severe pain in Y injection arm.Had to rest for 10mins in office.BeginningYthe next day,1/6/2009 had a painful 1/7/2009 knot in back, pain i d crying spell for hours after vaccine. Has remained more fussy and easily cries for several days. U Wakes1/13/2009 at night more 1/13/2009 often. hy red rash area across belly Y ### ### Y 1/19/2009 1/19/2009 FELT LIKE HER HEART WAS RACING. SHE HAD A MINOR LOCAL REACTION TO NEOMYCIN Y IN THE 1/19/2009 PAST. BASCIALLY, 1/19/2009 WE CALM ported slight rash across back following a shingle vaccination. Y ### ### ately 6-8 hrs after taking third pill of Y Vivotif on 1/12/09, pt had generalized whelps/hives. Pt works Y in an ER, 1/8/2009 was seen 1/12/2009 by a fellow physician s after vaccine developed chills, progressed to numbness, tingling of lips and palate, increased Y BP and heart 1/19/2009 rate. 1/19/2009 d MMR on 1/10/09. On 1/18/09 at 2am, Y Pt noted with 103F temp at home, with tonic clonic U seizure and 1/10/2009 macular body 1/18/2009 rash. Taken to ER, et right hemisphere ischemic Y strokeYwithin 12 hours Y of vaccine administration. 6 3/11/2009 Y Received N vaccine 1/14/2009 records1/14/2009 & PCP medical record ped Myocardial infarctionYand MI a week Y after administration Y of Anthrax 1 Y vaccination enroute Y to Germany 4/21/2008 after leaving5/7/2008 Ft Hood Texas. Pt did 07, my son was treated in the Emergency Y Room at St. Claire's Hospital in New Jersey. Y He had N recently developed 4/4/2006 4/13/2006 a high fever (103. 2) alo ure 104.1, heavy chest congestion, Y wet hacking cough, chills, sweaty. 3:00 AM 5 ml Childrens Y tylenol 7:00 1/16/2009 AM temp1/17/2009 103.9 7.5 ml childrens was considered medically important. Information regarding PREVNAR was received from aUconsumer regarding a 6-year-old male patient ### N ### ### (+) Stool Guaiac, screaming with eating. Difficult Y to have BM. Intussusception 6 - admitted 1/11/09 Y after reduction ###with 1/15/2009 air enema. (+) recurre ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009 ates "eye lids swelling, and severe stomach cramps". Was not seen by physician in office after Y symptoms9/19/2008 occurred. 9/19/2008 d to office on 1/9/09 c/o "rash". 10 days post vaccination hospital + eruption consistent with H. ZOSTER RT TIV### Denmatine 1/7/2009 treated with AC z on 1/16/09 - started seizuring, eyes Y open wide, then shaking all over, then fell asleep for approximately Y 1/13/2009 1 hr. Had1/16/2009 2nd febrile episode sho redness, lump, tenderness at right thigh. Fever 99-102.6. Vomiting x 1 on 1/14/09. Irritable and Y cranky. Treated 1/13/2009 with1/14/2009 TYLENOL-MOTRIN. S ined of pain in muscle around site ofY injection within days of receiving vaccine. The pain hasNradiated up9/30/2008 and down10/1/2008 arm, has affected sleep pt to administer dose: Unable to get plunger down (resistance) so gave 1/2 dose same arm similar N area and 10/1/2008 was able 10/1/2008 to give dose. Pt state Y ### ### apprx 3" immediately after receiving V2V- wheel baded after 24 hrs after 24 hrs - 3 days after Y a red/blue1/15/2009 discoloration. 1/15/2009 l immediately after giving V2V 31/2"x4" - Wheal faded after 24 hrs- 3 days later and red/blueYdiscoloration 1/15/2009 remains. 1/15/2009 at eye of 50 cent piece pink for at 5-6" from there. 1/13/2009 1/16/2009 ew hours after immunization with influenza Y in the left arm the patient started to experience pain U to the slightest 1/8/2009 touch 1/8/2009 in the left arm between e in "forehead". Nausea - no vomiting. Onset 01/05/09 U 1/3/2009 1/5/2009 inistered R deltoid 1/16/08. Pt describes site becoming swollen & red up to 4 cm circumference Y with a burning 1/16/2009 sensation. 1/16/2009 She felt dizzy & w ours, injection site swelled, reddened, itched, hot to touch and was extremely sore in area covering Y 6 inches 1/15/2009 by 6 inches. 1/16/2009 Pharmacist recom en dose of adult hep A. Client was 2 - 3 mos pregnant at time dose given. Client has not reported U an adverse 1/13/2009 reaction. CAME INTO OFFICE ON 10-11-2008 DESCRIBING COMPLAINT OF COUGH, SLIGHT SWELLING Y AND DIFFICULTY ### SWALLOWING ### AF l changes, encephalopathy, change in eye contact, speech delays, social regression Y 3/17/09-records N received-evaluation 2/20/2007 2/20/2007 8/31/07-Impressi he symptoms started after the second Y dose. Delainey has been having fainting spells where Ushe gets dizzy 4/28/2008 and sees 5/15/2008 black with white spots
ministered vaccine Wed - SorenessYturning into acute muscle pain around injection site and U spreading through 1/6/2009 back and 1/7/2009 torso. Thur - breat mplains of excessive swelling and redness at injectio site, site all is hardened and feels hot to U the touch.1/14/2009 1/15/2009 me in on Friday 16 Jan 2009 complaining of excessive swelling at site of injection, redness, U hardness, and 1/14/2009 hot to the 1/15/2009 touch. me in complaining of excessive swelling, redness, hardness, and hot at site of injection. U 1/14/2009 1/15/2009 mplains of lump, hardness, and redness at injection site. U 1/14/2009 1/15/2009 mplaining of fever. U 1/14/2009 1/15/2009 LOPED ,MACULOPAPULAR RASHY1/19 ON FACE THAT SPREAD TO TRUNK AND ARMSUAND LEGS TODAY. ITCHY RECIEVED VACCINATION ON 01/15/09. HAD RED WELT AT INJECTION SITE APPROXIMATELY U 3 INCHES 1/15/2009IN1/16/2009 DIAMETER WITHIN 24 wollen and hot Y 1/19/2009 1/20/2009 STARTIED TO BREAK OUT IN HIVES ON FACE & CHEST UPON ARRIVAL AT HOME APPROX Y 30 MINS AFTER ### VACCINE. ### NO COUG OCALIZED HIVE REACTION AT THE PPD SITE IN 24HOURS. BY 36HRS DEVELOPED ITCHY Y RED BUMPS 1/13/2009 WITH 1/14/2009 HALO & SOME HIV en the slightest symptoms since the Ybegining of her chart. Consant sinus infections Y acompained N by a weeze 1/15/2009 and cough. 1/20/2009 She also is haveing ter I received my flu shot I fell ill with a severe flu?/viral infection? that took me six weeks to recover Y from.12/9/2008 Symptoms: On the ###first day, seve ceived 2 varicella vaccines (2/23/05, 1/28/08). Patient presented to the office on 1/14/09 withYscattered pox-lke 1/28/2008 lesions. 1/14/2009 Varicella titer obtai an 17th mom noticed welts & bruising Y on child'sYside. She took her to 2 the ER. Seen by MD + Y welts & bruising 1/8/2009 spread 1/17/2009 down body to ankles, izure (grand mal) lastingYover 3 hours. Y Life flighted and hospitalized for 5 days. Results-permanent Y N brain damage ###to the left ### hippocampus. X 2 1-5-09. First time seizures. 1/23/09 Y Reviewed Y hospital medical 1records of 1/5-1/6/2009.YFINAL DX: new onset ### seizures 1/5/2009 Records revea AP vaccine on 10/29/08, exhibited expected Y s/sx Y after injection "knot 1 at side, pain, fever, headache". U Two weeks ###later had### lymph node on c Contests Rash 1/12/2009 e out in lesions mostly on trunk. U 2/22/1999 1/19/2009 eg weakness / had to use crutches for Y weeks / had weakness, numbness / tingling in legs. Still U with some6/19/2008 symptoms. 9/1/2008 1/23/09 Received PC mmunization unable to maintain LUE advection above 90 Y 1/13/2009 1/14/2009 30 sec post injection, laid down that-ammonic inhalant. 15 min later again syncope episode Y ammonia, inhalants 1/20/2009 & crackers 1/20/2009 & juice given ffuse in location, reddish and fine papular, no skin thickening, induration or subcutaneous nodules Y , noted 1/15/2009 after the vaccines 1/16/2009were given. l from patient stating a possible reaction to shingles vaccine. Three days after arm had swelling, N huge welt, 1/14/2009 itchy, painful, 1/17/2009 no fever, lasted fo ceived 1st Tdap in L upper A, then MENACTRA in R upper Arm. I turned around for no moreYthan 6 seconds 1/19/2009 to throw 1/19/2009 needles away in shar old girl with one day history of emesis, Y starting on the morning following her first series of vaccines. Y 1/12/2009 1/13/2009 ve, unresponsive for NSR. Took 1 hr before could vagal episode - No LOC. Y 11/4/2008 11/4/2008 er ZOSTAVAX - developed herpes zoster L ant chest, near arm. N 1/12/2009 1/13/2009 induration, just below deltoid area L arm began 24 hrs after injections of influenza & pneumonia Y vaccine. Achey ###& aneretis ###at onset, + 48 fter GARDASIL #3 developed syncopal Y episodes- recurrent, over course of 6 mos. Neuro and Y cardio work2/4/2008 ups WNL. 2/28/2008 1/22/09 MR received se symptoms known-3rd MMR given. U 1/14/2009 - 2x2, Erythema - 5x3 left arm warm Y compressor. U 1/9/2009 1/9/2009 ceived call from mother she states that about 34 hours post vaccination hives appeared on arms, Y BENADRYL 1/10/2009 given1/11/2009 with relief. On 1/12/09 4/08 received flu shot 10pm 12/14/08 throat started feeling tight and full. Also had red, watery eyes and swelling ### of the eye### lids. Treatment, d fainted about 2-4 min post vaccination with GARDASIL and VARIVAX. As family signed out Y in waiting 1/15/2009 room. Regained 1/15/2009 consciousness, 5 veloped fever, irritability and rash on Y 12-31-08. Parent took child to ER. ER MD noted fever Y and maculopapular### rash diagnosed ### viral exanth x 2 approx 6-8 hours after receiving vaccines. Running 101 degree fever although parent states Y has given1/5/2009 fever reducer. 1/5/2009 Next morning no n /23/2007 pain at site of GARDASIL injection #2 5 week past GARDASIL. Myalgias, hip pain,Yelbow, wrist, 7/18/2007 hand, finger, 8/20/2007 knee, foot pain, fatig se reactions. Child was given influenza vaccine at 4 mo of age- though to be 7 mo when it was U given. Infant had### no ill effects. ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009 en in office today for seizure yesterday Y after vaccines; took child to ER for fever of 104.3 andY developed1/12/2009 seizure. 1/12/2009 U 1/7/2009 1/7/2009 as given Td vaccine and in about 4 to 5 minutes later he was given PNEUMOVAX. After PNEUMOVAX, U patient### stated that### he felt very hot, U mmunization at 11 am temp. started 4 or 5 pm. Cheeks red, eyes blood shot. 1-10 rash on face N and arms,1/9/2009 7 am left arm 1/9/2009 painful. Rash sprea n- fever, chills, abdominal pain, diarrhea Y lasting 3 days. Symptoms subsided-she then felt well. Y No reaction 5/29/2008 at site of 6/1/2008 injection. She was in c n has been received from a physician Y assistant concerning an 18 year old female who on unspecified U dates 2/29/2008 was vaccinated 2/29/2008with a first, sec n has been received from a physician concerning a female patient who was vaccinated with Uthe complete series of GARDASIL (lot not repo n has been received from a sonographer Y concerning her daughter, who an on unspecified date Y was vaccinated with the first dose of GARD n has been received from a nurse and Y later a physician concerning a 13 year old female patient U with asthma 11/3/2008 and allergies to codeine, and
n has been received from a physician Y and a medical assistant concerning a 14 year old female N with a history of### asthma 10/1/2008 and recurrent otitis n has been received from a physician Y concerning a 26 year old female who on 28-OCT-2008 Y was vaccinated with ### the first### dose of GARDA n has been received a consumer through Y a Merck pregnancy registry concerning herself, a 41 Y year old female 10/1/2007 with 10/1/2007 allergies to Sulfa and ir follow-up information has been received Y from a nurse practitioner concerning a 26 year old female Y patient 1/29/2008 with no pertinent 3/3/2008 medical history n has been received from a health care professional for GARDASIL regarding a 15 year old Yfemale who 2/29/2008 on 29-FEB-2008 2/29/2008 was vaccinated w rmation and follow up has been received from a pharmacist and nurse for the Pregnancy Registry U of GARDASIL ### concerning 3/11/2008a 24 year old f n has been received from a nurse practitioner (N.P.) concerning a 1 year old female who was U inadvertently vaccinated with a first dose of G n has been received for the Merck Pregnancy Y Registry for GARDASIL from a health department Y nurse and 5/30/2007 from a registered 1/30/2008nurse concern n has been received from a medical assistant and a nurse practitioner, for the pregnancy registry Y for GARDASIL, 11/8/2007concerning ###a 23 year old n has been received from a physician Y concerning an 18 year old female patient who on 11-DEC-2008 N was vaccinated ### with### the second dose n has been received from a registered Y nurse concerning a 19 year old female patient with asthma N and no known ###allergies### who on 11-DECn has been received from a nurse practitioner Y concerning a 19 year old female patient who 1.5 N year ago, 7/1/2007 approximately 8/1/2007 in July 2007, was v n has been received from a pharmacist, Y concerning a female patient with hyperlipidaemia and N no known drug reactions ### or### allergies, who on n has been received from a registered nurse concerning a 23 year old female patient with drug N hypersensitivity### who a month ###ago was vacc n has been received from a registered Y nurse concerning a 22 year old female with no medical N history and allergy to10/4/2008 KEFLEX, who on 02-O n has been received for the Merck Pregnancy Y Registry for GARDASIL from a Registered Nurse U concerning 12/5/2008 a 14 year 12/5/2008 old female patient wh n has been received from a physician concerning an approximately 15 year old female who Y in November11/1/2008 2008, was11/1/2008 vaccinated with a dose n has been received from a physician concerning a 24 year old female who "more than a year N ago" was vaccinated11/1/2008 with GARDASIL, 0.5 m n has been received from a physician concerning a 15 year old female patient, who was vaccinated N with the first dose of GARDASIL, ### 0.5m n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL concerning a 23 U year old female 10/6/2007 patient who on 06-APR-200 n has been received from a physician Y concerning Y a 13 year old female patient who was vaccinated N with 11/6/2008 the third dose 11/6/2008 of GARDADIL vaccin n has been received from a healthcare Y worker concerning a 20 year old female patient with N no pertinent4/28/2008 medical history and with allergic re n has been received from a physician concerning a 20 year old female who on 12-DEC-2008 N was vaccinated with ### a second ###dose of GARD n has been received from a nurse practitioner Y concerning a 16 year old female with no medical N history of12/9/2008 allergies, who on### 09-DEC-2008 w n has been received from a nurse practitioner Y concerning a 21 year old female with a penicillin allergy and no medical ### history ### who on 14-O n has been received from a healthcare Y worker concerning an 18 year old female with no medical U history and allergies, ### who ### on 18-JUN-200 n has been received from a physician concerning a male patient who on approximately 03-DEC-2008 U was 12/3/2008 vaccinated 12/3/2008 with 1 dose of GARD n has been received from a 16 yearYold female patient with no drug reactions/allergies, who N on 09-DEC-2008 12/9/2008 was vaccinated ### with the first n has been received from a registered nurse concerning a 19 year old female patient with idiopathic Y thrombocytopenia 5/29/2008 and no drug reactio n has been received from a physician Y concerning a 20 year old female patient who on 17-JUN-2008 N was6/17/2008 vaccinated6/17/2008 with the first dose of G n has been received from a physician Y concerning a 16 year old female patient who on 14-AUG-2008 U was 8/14/2008 vaccinated with the first dose of G n has been received from a physician Y concerning an 18 year old female patient who on 6-DEC-2007 N was4/9/2008 vaccinated4/9/2008 with the first dose of G n has been received from an office manager at the physician's office, concerning a female patient, N who was 4/7/2008 vaccinated with ###first, second a n has been received from a medicalYassistant concerning a 23 year old female with no medical Y history, allergies 1/11/2007 or drug reactions who on 1 n has been received from a registered Y nurse concerning a 14 year old female patient with seasonal N allergy 9/17/2008 and no known pertinent medica n has been received from a nurse concerning Y a 129 year old female patient who was vaccinated Y with the first dose of GARDASIL vaccine ( n has been received from a physician Y concerning a 14 year old female patient with no known Y drug reactions or allergies, who in 2008, "a fe n has been received from a physician concerning an adolescent female patient who on an unspecified U date, was vaccinated with GARDAS n has been received from a physician concerning an adolescent female patient who on an unspecified U date, was vaccinated with GARDAS n has been received from a registered Y nurse concerning a 26 year old female who on 25-SEP-2008 Y was vaccinated9/28/2008 with a first dose of GA n has been received from a physician Y concerning a 21 year old female patient with no pertinent U medical history and no drug reactions/allerg n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a dose of GARDASIL, (site, route n has been received from a medicalYassistant concerning a 25 year old female patient who in N approximately 9/1/2008 September 9/1/2008 2008, was vaccina n has been received from a registered nurse concerning of her 22 year old daughter with noNknown allergies and ###a history### of contact derma n has been received from a registered Y nurse concerning a 12 year old female patient with noNknown allergies and ###sickle cell ###anemia who 10 n has been received from a registered nurse concerning her 23 year old daughter who "about U one month11/1/2008 ago" was 11/1/2008 vaccinated with the first n has been received from a physician Y concerning a 15 year old female patient with no pertinent Y medical 7/17/2008 history, no drug 9/5/2008 reactions/allergies n has been received from a nurse concerning a female patient who was vaccinated with a dose U of GARDASIL (lot # not provided). Subseq n has been received from a physician concerning a 25 year old female with no pertinent medical N history or allergies ### who on ### 21-NOV-2008 w n has been received from a licensed Y practical nurse concerning a 11 year old female patientNwith no drug/reactions ### allergies, ###who on 17-DE n has been received from a physician Y concerning a 14-15 year old female. On an unknown Ydate, the patient was vaccinated with her first d
n has been received from a physician Y concerning an 18 year old female who on 14-AUG-2008 N was vaccinated 8/14/2008 with a second dose of GAR n has been received from a physician Y concerning a 12 year old female patient with no pertinent N medical history### who11/1/2008 in the end of October 2 n has been received from a patient's mother concerning her 7 month old son who was vaccinated U with a dose of GARDASIL instead of the n has been received from a registered Y nurse and the patient's mother concerning a 14 year N old female patient 3/23/2007 with no 5/1/2007 allergies and no pert n has been received from a nurse practitioner Y concerning an 18 year old female patient whoNon 10-OCT-2008 ### was vaccinated ### with first dos n has been received from a nurse practitioner concerning a 22 year old female patient with hypothyroidism Y 10/7/2008 and no know 10/8/2008 allergies who on 0 n has been received from a medical assistant concerning a 19 year old female patient for the Y pregnancy12/8/2008 Registry for GARDASIL ### with no kn n has been received from a medicalYassistant concerning a 19 year old female patient with no N pertinent medical 8/13/2008 history and ### a history of an n has been received from a physician Y concerning a 23 year old female patient with depression, N who on an unspecified ### date, was vaccinate n has been received from a healthcare Y worker concerning that "many patients complained ofUburning at the injection site whey ### they get a d n has been received from a nurse practitioner Y concerning a 16 year old female with asthma Y and no allergies who ###was vaccinated ### with the t n has been received from a physician concerning a patient who was vaccinated with GARDASIL U (dose, site and route not reported) on uns n has been received from a registered nurse concerning a 24 year old female patient with noUknown drug reactions/allergies ### ###or medical his n has been received from a registered Y nurse concerning a 13 year old female patient with noNprevious medical 11/8/2007 history reported who in 2007 n has been received from a physician Y for GARDASIL vaccine, concerning an 18 year old female U patient 11/5/2008 with no previous medical history re n has been received from a medical assistant concerning a 20 year old female patient with no Y pertinent medical 8/4/2008 history, 8/4/2008 no drug reactions/a n has been received from a healthcare Y worker concerning a 25 year old female patient who N received second dose ### of GARDASIL and was f n has been received from a medical assistant concerning a patient who may had received aUpartial dose of GARDASIL. The patient did not n has been received from a nurse practitioner Y concerning a 14 year old female who on 30-DEC-2008 Y was vaccinated ### with### the first dose of n has been received from a nurse concerning Y a 19 year old female with asthma, hirsutism and N polycystic ovarian ###syndrome ### and no known follow-up information has been received from a registered nurse and pediatrician concerningUa 7 month 12/9/2008 old male who 12/3/2008 on 09-DEC-2008 wa n has been received from a registered nurse concerning a 30 days old patient who on 04-NOV-2008, U was vaccinated ### with### a dose of rotavir n has been received from a registered nurse concerning a patient "greater than 32 weeks ofUage", who on an unknown date was vaccinate n has been received from a physician Y concerning a 9 month old male patient with a history of N birth weight 10/2/2008 low, who on 28-JUL-2008, ### was v n has been received from a registered nurse concerning a 4 month old patient, who on 16-OCT-2008, U was vaccinated ### with### the first dose of n has been received from a physician concerning a 13 month old female who on 02-DEC-2008 U was vaccinated 12/2/2008 with12/2/2008 ROTATEQ vaccine. co n has been received from a registered nurse concerning a 2 month old male patient with no U illness at time of vaccination ### who ### on 11-DEC-2 n has been received from a physician Y concerning an 8 week old patient who was vaccinatedYwith the first dose of ROTATEQ vaccine 2ml o n has been received from a MedicalYAssistant concerning a 16 week old female patient whoNon 21-NOV-2008 12/5/2008 was vaccinated 12/5/2008 with first dos n has been received from a physician concerning a patient who was vaccinated with ROTATEQ U vaccine, oral, (lot # not provided). The pati n has been received from a physician concerning a female who on 05-DEC-2008 was vaccinated U with her 12/5/2008 first dose12/5/2008 of ROTATEQ (lot# not n has been received from a physician concerning an "about 9 weeks old" female who in October Y 2008, was 10/1/2008 vaccinated 10/1/2008 orally with a 2 ml do medical records were received an reviewed concerning an 4 month old male baby patient with U a history of 8/28/2008 mild respiratory 9/1/2008 distress syndrom welling and pain. Took Cephalexin 500Mg Y 4x/day for 10days. Patient c/o pain periodically. Y 1/2/2009 1/4/2009 ouple hours of receiving the Tdap booster Y (following a routine physical in which my daughterUreceived an1/13/2009 excellent bill 1/13/2009 of health), she devel recieved comvax. Nurse was instructed to go give 1st hep b but instead gave comvax. No known U symptoms. 9/17/2008 mom never called stating her reaction because patient never returned or called stating she had a reaction to the immunization U that was given ### to her. She recieved a Dta m symptoms. She never called to say she is having a reaction to the immunization that was given. U Dr ordered to### give a Tdap but the nurse g fter infant was given Tdap instead of Dtap he was irritable. Y 1/16/2009 1/17/2009 IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ### COMPLETING REPORT. IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ### CMOMPLETING REPORT HPV vaccine on January 15. Aunt called on Jan. 16 and reported that her niece had swelling Y and redness 1/15/2009 from site of injection to her elbo ately 1100 1-20-08 given smallpox immunization w/o authorization by provider and with dx ofNeczema. 1/20/2009 plaining of post smallpox reaction 18 Apr 2008 (8 months) Pimple and nodule formation 2 wks U ago 7 Jan4/18/2008 09 around site 1/7/2009 of skin on abdomen and legs. Draining blister lesions on left side of back at beltline and LeftUleg blister lesions. 1/6/2009 From1/8/2009 Shingles vaccine by M arms were sore. 17 Jan 09 felt conjested. Y 18 Jan 09 more conjested 19 Jan 09 felt conjested and run down. 1/16/2009 20 Jan 1/19/2009 had conjestion fever w CAME IN OFFICE ON 1-7-09 WITHYCHICKENPOX Y ### 1/5/2009 veloped herpes zoster on 12.26.08. Patient presented with grouped blisters on the right posterior Y neck, right 7/1/2008 upper chest ### and right upper b ctions on upper Lt. arm, red area, hot to touch, with some swelling in the area noted. 1/9/2009 1/13/2009 ived the Flu vaccine between 9am & 10:30AM left the building with her mother and in the parking Y lot c/o1/20/2009 being itchy1/20/2009 and scratchy all over in D VARICELLA VACCINE ( SECOND DOSE) LOWER PART OF LEFT UPPER ARM 1/19/09. Y SEEN 1/21/09 1/19/2009 WITH 1/21/2009 9CM BY 7 CM AREA O
of 104.8, B/P 168/80, ache all over-lasted Y for 24 hrs. Y 1/13/2009 1/13/2009 FLUMIST GIVEN TO CHILD DURING WELL CHILD EXAM. NO REPORTED ADVERSE EVENTS U TO DATE ### OF COMPLETING VAERS. ned today 01/21/2009 @9:24am with c/o pt. was very tired last evening. She did well through the night. Mom 1/20/2009 states 1/21/2009 that today patient would ately 12 hours after vaccination; an onset of myoclonus Y seizures began. 3 During the first hour, N as many as 16. ### This continued ### from 10/15/0 ficulty breathing, lips swelling, red face. About 10 minutes after vaccines were give dad noticed Y above symptoms 1/21/2009patient 1/21/2009 was still in clinic. D e, Nausea, Vomiting, Diarrhea, Severe Y stomach ache, Chills, Body Aches. I was unable to perform Y usual 9/12/2008 activities and 9/13/2008 required medical atte weakness, fatigue, dizziness, severeYmood changes, anxiety, low grade fever, severe headaches, U chills 1/30/09 1/20/2009 Received 1/21/2009 PCP medical rec after shot. 6 hrs later site of injection was very painful. Next day it was so painful she could Y not get dressed, 1/19/2009 could not 1/19/2009 go to work. Not swo veloped large area of erythema and induration at 48 hrs, s/p booster dose of varivax (given U on 1-19-09).1/19/2009 Area measured 1/21/2009 7 cm x 4 cm and p orts noticing itching and soreness @Y right arm injection site and a "quarter-sized" area that felt Y hard and was 1/7/2009 yellowish 1/8/2009 in color @ 5PM on 1 ut immediately after HPV shot. Had stinging on right side above pelvic bone for a couple of days Y after. Had 1/5/2009 full body1/5/2009 muscle soreness for a 8/31/2007 N 1/3/2007 8/31/2007 seizures (repetitive head turning andYpossible salaam seizure) occuring Jan 14, 2009 over a Y 10-15 minute1/9/2009 time span.1/14/2009 No fever at that time, n, swelling, redness to right deltoid. No exudate. Dx: cellulitis Y 1/19/2009 1/20/2009 eloped; Right arm red, swollen, hot from upper deltoid to mid humerus- started KEFLUX & ROCEPLIN Y 2gm 1/7/2009 1mx 3 days 1/8/2009 -> improvement is ceived vaccine (Anthrax) in L arm. No pain or erythema. Pt woke up Jan 18 with inability toUleft arm and1/16/2009 paresthesia 1/18/2009 over the lateral aspec ported a lot of pain in left arm and couldn't even sleep on it. The next morning he thought heYwas blacking 1/20/2009 out. Left message 1/20/2009on patient's an ew hours of shots pt developed low grade fever. Subsequently the next day got profuse watery Y diarrhea1/16/2009 (only 1 episode 1/16/2009 of blood in stool). arm 6 inch by 9 inch erythemous plaque, firm,warm to touch with discrete? clusters of vesicles U in center1/19/2009 medial, lateral 1/20/2009 area of left deltoid a got swollen or red. Just very painful. Continues to throb, hurts to raise arm up above head after U few seconds gets ### a shooting ### pain from the iatric dose of HEP A was supposed to give adult dose. U 1/7/2009 ived PENTACEL, HEP B, PREVNAR, ROTAVIRUS & flu vaccines, instead of PEDIARIX, HIB, Y PREVNAR, 1/21/2009 ROTAVIRUS 1/21/2009 & flu vaccines. No d red rash around injection site on thigh within hours of vaccines (8 cm X 8 cm in doctors office) U man reported 1/21/2009 prior to 1/21/2009 arriving @ doctors of tly warm to touch, swelling right upper Y arm approx 8in x5in. Patient applied "anti-itch" cream.U 1/19/2009 1/20/2009 n has been received from a registered Y nurse concerning a 22 year old female with penicillin Y and amoxicillin 6/19/2008 allergy who 6/19/2008 on 19-JUN-2008 wa n has been received from a nurse practitioner Y and a certified nurse midwife, for the pregnancy Y registry for 2/15/2008 GARDASIL, 3/3/2008 concerning a 21 yea n has been received from a physician Y concerning a 11 year old female with no pertinent Y medical N history 9/12/2008 who on 12-SEP-2008 ### was vaccina n has been received from a physician concerning a 9 weeks old male who on 10-NOV-2008Ywas vaccinated oral ###with the ### first dose of ROT n has been received from a consumer concerning his daughter, a 6 year old female with no N medical history 7/1/2004 who "at 18 months of age" was n has been received from a consumer concerning her 20 month old son who was vaccinatedUwith MMR II. Secondary suspected vaccine in veloped erythematous papules on his low back (#12) and his face (#3) following the administration Y of VARICELLA 1/12/2009 vaccine 1/17/2009 s were swelling. Patient was going to call primary doctor. Patient called me on Sunday 1/18/2009 U in the afternoon. 1/14/2009 Patient 1/18/2009 did receive other ized erythema around injection siteYslightly warm no discharge. Y 1/7/2009 1/11/2009 and pruritis on forehead & neck some blistering Y 1/7/2009 1/15/2009 n has been received from a 61 yearYold femaleYpatient with no pertinent 4 Y medical history and Nno known drug 12/9/2008 allergies12/9/2008 who on 09-DEC-2008 ain. 2. Some time weaken of lower limbs. 3. Some time numbness of lower limbs. 4. Shoulder U pain once 6/23/2008 in a while. 7/23/2008 5. Body ache- 3 w d vaccination- shortly after the site Y became red and inflamed. The size increased following Y day and became 1/16/2009 warm 1/16/2009 to touch. Size approx 4 oy (WM) seen 1/9/2009 for 1 yr old health Y steps exam. Mild rhinorrhea reported and nose congested. Y Exam 1/19/2009 otherwise 1/19/2009 normal. Afebrile. 1x 1 reaction to VARIVAX given SC to Left upper arm 12/15/08- 2x3 cm area arm sl, red, sl warmYand swollen. Treatment: ### warm ###compress, OTC ceived 2nd dose of Rotateq on 10/27/08. Pt has diarrhea x 10 days, watery stool 3-4x/days. ### ### ea erythema, warm, tender, slightly hard, Left deltoid. 2 days s/p immunization with DTap, fluYIM and polio 12/3/2008 SC in left 12/4/2008 arm. n has been received from a pharmacy technician concerning a patient who on 14-JAN-2009 Y Nwas vaccinated 1/14/2009 with a 1/14/2009 dose of ZOSTAVAX (O n has been received from a physician Y concerning a 76 year old female patient who Y on 05-JAN-2009 N was 1/5/2009 vaccinated 1/9/2009 with ZOSTAVAX (Oka arm & shoulder; edema & warm with pain 6/10 with movement; itching; T 98.8 degree; tiredness; tender on palpation to underarm; motion on small pox, left shoulder, excess redness est. 70 x 55mm; gauze dressing placed recommend U air dry 30min 1/5/2009 at hs; 1/14/2009 TYLENOL. Seen 16 JA ng pain in upper arm, and shoulderYleft side. Onset 1 week after Tdap. Pain duration approx.Y 3 mo. Weakness 7/17/2008 of arm 7/24/2008 occurred approx. 2 w n has been received from a 26 year old female who on 13-DEC-2008 was vaccinated with aUdose of VARIVAX### (Oka/Merck). ###The reporter s econds: tingling & numbness down arm to fingers. Then, blurred vision, dilated pupils, wain Y skin, light headedness, shallowed breathing. A subject was enrolled in the study 110870 Y (MenACWY-TT-057). Y On 027 August 2008, 22 October N 2008 and 23 December ### 2008, ### he received gree rash on left arm surrounding smallpox vaccination site. Started 2 days ago 14 JAN 09, spread U to axilla 1/5/2009 area, swelling 1/14/2009 in axilla area, ten 03.5, lethargy with crying off and on. Y Tx - IV fluids Y and fever control1with TYLENOL, MOTRIN. Y 1/29//09-records 1/19/2009 received 1/20/2009 for DOS 1/20/09-p
as admitted to medical center. Y Abdominal Y CT was Y performed. Patient 2 diagnosed with intussusception. Y 1/29/09-records ### 1/11/2009 received for DOS 1 and 12/18 4-5 episodes where lips turned blueYand eyes seemed unfocused; 4 lasted 5-10 sec. U on 12/19 11:30 am ###turned blue, ### stopped brea ort received on 12 March 2008 from the patient's parent. A 17-year-old male patient, with no illness at the 3/10/2008 time of vaccination, 3/11/2008 had received n has been received from a representative Y as reported by a colleague concerning a 13 yearUold female who on an unspecified date was va n has been received from a physician concerning a 14 year old female who was vaccinated U with her first 0.5 7/1/2008 ml dose7/1/2008 of GARDASIL toward n has been received from Y a nurse practitioner concerning a 22 year old female who on 14-JAN-2009 N was 1/14/2009 vaccinated 1/14/2009 with a first and only d n has been received from a physician Y concerning a 19 year old female who in approximatelyU2009 was vaccinated with a 0.5 ml second do n has been received from a physician Y concerning a 70 year old male with hypertension Y who Non 05-JAN-2009 1/5/2009 was vaccinated 1/7/2009 with a dose o n has been received from a healthcare worker concerning a 34 year old female who on 02-MAY-2008 Y was 5/2/2008 vaccinated 5/2/2008 with the first dose of onset juvenile diabetes.YVaccine given Y 8/8/08 Ypt developed symptoms 4 consistent with diabetes N over the 8/8/2008 next few months. 12/2/2008 Presented with r Gardasil, pt developed fever, malaise, confusion. Y Admitted to hospital 4 and Dx'd with ADEMNvs. cerebral9/19/2008 vasculitis.9/25/2008 Has made nearly full r 2009 APPROXIMATELY @ 9:20 PM PATIENT RECEIVED A SHOT OF GARDASIL 0.5 ML IM. Y PATIENT 1/21/2009 WAS ADVISED 1/21/2009 TO STAY FOR 2 Y AFTER INJECTION, 2 SMALL RED/ RUFF DRY PATCH SHOWED UP ON HIS STOMACH, Y COUPLE1/15/2009 DAYS LATER 1/16/2009 ONE SHOWED UP se event, just diagnosed with Rotavirus Y after 3 doses Y of Rotateq...Vomiting 3 and diarrhea, stool Y positive for 5/16/2007 Rotavirus.1/27/09-records 1/15/2009 receive ite swelled about the size of an eggYwith redness x approximately 3 days. She developed itching Y all over her body ### day 2 after ### shot that las scribed area around vaccine as red,Y warm, and swollen on 1/21/09. I instructed her to see the physician1/19/2009 as soon as1/20/2009 possible. I followed u as vaccinated on 01/08/2009 with Zostavax Y (LOT 1553X) in the right tricep. On 01/14/09, theNpatient received 1/8/2009 a follow-up 1/16/2009 phone call and re hots (HepB, Rotavirus, Pneumococcal, Polio, Hib, Y DTaP) were given2 on 1/15/2009. On the morning N of 1/17/2009 1/15/2009(approximately 1/17/2009 9:30 AM), d pain in my Deltoid area the entire muscle since 11/05/09. I have had itching in that area asUwell as in the 11/5/2008 back of the 11/5/2008 shoulder.I have pain 2009, pt was administered the Influenza vaccine, Flulaval, instead of Afluria (approved for the U pregnant populaton). 1/15/2009 hts after the inject I was very uncomfortable Y and wakeful. The third day, I began noticing a soreness U in my left breast ### which### during the next nted miniutes after the injection was given. Pt came to and we monitored pt and rechecked blood Y pressure 1/22/2009 and heart 1/22/2009 rate. Patient stayed a ing/erythema at injection site U 12/1/2008 12/2/2008 hot flushing, sweating, blurry vision 5 minutes after vaccination. Pt did not pass out but did Y fall to ground. 1/22/2009 Pt felt better 1/22/2009 immediately upon b e event at this date and time. patients parent notified 1/22/2009 ately 10 minutes after receiving immunizations Y (listed below) the patient C/O difficulty breathing. Y Upon examination 1/16/2009 1/16/2009 patient was anxious an ella disease, less than 50 pox, with fever, Y diagnosed 01/22/09, started 01/20/09 by mother's U history. PO 1/12/2009 Benadryl prn 1/20/2009 itching nt became lightheaded then fainted several minutes after receiving immunizations. LOC approx Y 1 min. and color ### pale. Remained ### nauseous lling, erythema, warmth and tenderness. 1/20/2009 1/21/2009 ek following the vaccination, patient states he felt very tired. In the second week, he had a sore Y throat. In 11/5/2008 the third week 11/7/2008 he had a cough, n hrs after vaccines, mild dizziness, weakness, Y fever, pain @ injection site no treatment 1/15/2009 1/16/2009 iven 6 days ago Pt noticed soreness in shoulder to elbow area. Then spread to Flexor portion U of Forearm 1/15/2009 only describes as "Arthritic. like p 02, maculopapular rash on trunk, cranky. Y 1/8/2009 1/19/2009 mal, supple, no lymphadenopathy, no meningeal signs. Respiratory exam: normal, no intercostal Y retractions, 1/19/2009 movements 1/20/2009 symmetrical, no w eaking out 1/19. Itches - rash. No known exposure. No fever. DX: Varicella Y ### 1/19/2009 arm - hot and swollen, redness to injection site. Y 1/13/2009 1/15/2009 ceived VARIVAX (chicken pox) vaccine on 1/8/09 and came in 1/21/09 complaining of a rash. Y Dr diagnosed 1/8/2009 the rash1/21/2009 as chicken pox caused vaccine 1-16-09 - On 1-21-09 came to office c/o mild fever for 1 day- Friday not feeling well Y post injection1/16/2009 falling a lot1/16/2009 Generalized rash- d ceived ZOSTAVAX shot on 01/09/2009. Five days later, on January 14, 2009 she has noticed U a spreading 1/9/2009 rash at the 1/9/2009 sight of injection. Sh ped fever to 102 degree a chickenpox Y like rash Y 1/7/2009 1/15/2009 hing at site & next day arm red, swollen. Reactions in arm VARIVAX given. U 1/14/2009 1/15/2009 of 101-102 X 24 hours - se & eating otherwise Review of sy-neg. Y 1/20/2009 1/21/2009 in the hours after vaccine. Mother reports patient has typical reaction similar to other vaccination Y in past. 1/12/2009 arm feel affected. Cannot lift arm without pain. Pain goes up to neck. I waited to send this in N to see if pain10/6/2008 subsided.10/7/2008 It did not. I cannot lift m oblems with AVA #1 and # 2. He reported Y that 2 days following vaccination with AVA # 3 heYhad mild joint pain### that12/6/2008 persisted for one day. night that vaccines given. VaccinesYgiven 1-17-09 @ 3 hours am (approx. Seen at ED 1-12-09 Y @ 11pm1/12/2009 with 105 fever. 1/12/2009 n both wrist, itching on palms of hands and soles of feet. Welts on hip bones and on one breast. 1/5/2009 1/7/2009 a of erytheima & edema & pain (10 cm diameter) ice, BENADRYL, TYLENOL/ALLEVE for pain Y 1/21/2009 1/21/2009 (HEP A) vaccine/left office - went to wait for bus/reported by doctor that child suddenly turned Y pale (lasted 1/15/2009 few sec)1/15/2009 taken back to office/ch minutes of vaccination c/o not feelingYwell pallor observed, full body seizure with unresponsiveness Y to shake 1/8/2009 and shout. 1/8/2009 positive pulse but co fussiness X 24 hrs, vomiting, resolved Y after 24 hours. Y 1/14/2009 1/14/2009
ped temp to 106 degrees about 4 hrs Y after vaccines. Y 1/12/2009 1/12/2009 st ava #1 broke out in a rash in his axilliae. Y No itching, or pain. Photo's-confluent maculo-papular N light pink 11/8/2008 rash, with few### descrete distal le mplains of pain in left deltoid of site of influenza injection Y Y Y 1/16/2009 1/16/2009 fect, patient was fine. Y 12/3/2008 ule. 7 cm erythema + induration. R deltoid. Y 1/15/2009 1/16/2009 iving 3 shots, client became pale & "passed out in chair approx. 5 seconds. Assisted to floorYby nurse + 1/13/2009 father. Had1/13/2009 not eaten yet that day Y 1/9/2009 1/12/2009 10/31/08 said had blurring vision, earache, itching, & hives. in our conversation pt stated had. Y hives, & itching previous ### to ### shot. I attribute " 6 Patient noticed pain in her left arm/ shoulder that has not resolved since injection. on 1/21/09 N she saw Dr who ###has noticed ###inflammation n has been received from a physician Y concerning Y a 13 year old female 12 who was vaccinated N with the first dose ### of GARDASIL, 0.5ml. Subse n has been received from a physician Y concerning a 17 year old female with no drug Y allergiesYwho had recent 1/12/2009 urinary1/12/2009 tract infection and com n has been received from a physician Y concerning Y a 15 year old female 0 Y patient who Y on 15-DEC-2007 N was6/9/2008 vaccinated6/9/2008 with the first dose of G n has been received from a healthcare Y worker Y concerning a 9 week0old female with a historyNof "reflux" who 1/8/2009 on 08-JAN-2009 1/8/2009 was vaccinate n has been received from a physician and a nurse concerning a 10 weeks old female patientUwith a possible 1/8/2009 "reflux 1/11/2009 issue" prior to oral vacc n has been received from a 27 yearYold femaleYpatient with no known 0 allergies and no pertinent N medical history, who was vaccinated with t d angio edema of face, large wheal Y @ inj site of MMR @ 10 minutes. Uricaria over truck & limbs Y by 20 minutes### & some drooling ### -> im epin occurred evening of vaccination of left arm. Patient states it resolved in 2-3 days". Y 10/1/2008 ke up following morning with right ankle swollen so much he could hardly walk. Used heat, TYLENOL, U MOTRIN### with relief.### No recent injury of day HEB B# 3 received Pt developed hives on arms/face/stomach. No resp distress. Pt takes U allergy shots ### weekly. Pt has ### taken Benadr HBV #1 patient experienced a migraine Y HIA stabbing pain radiating from back of head through Y to the front. With ### chest pains ###and SOB ccurred on 7/16/08 and again 8/21/08 with 2 different nurses as vaccinations. 11/24/2008 - Y client reports8/31/2008 with 1st injection 8/31/2008 on left arm 4-5 h TDAP on 11/24/08 for travel to Brazil. Y Returned to clinic on 11/28/08 for an arthur-type reaction U left deltoid, 10### x 10 cm, warm ### tissue than s had significant vomiting day after HPV with all three administrations. 3/23/09 Received PCPY medical records 9/19/2007 of 9/19/079/20/2007 FINAL DX: viral g X 4" circular swelling red, no Cellulitis, Y past 2 days vaccine's. applied ice pack which minimized Y swelling. 1/5/2009 1/7/2009 s after TdAP in left deltoid, pt. developed swelling at site, fever, chills and lymph node enlargement, Y supraclavicular 1/16/2009 1/16/2009 area. Now is resolved. tions given (Hib in upper RVL, Prevnar in lower RVL) Injection sights were cleansed with alcohol Y and aspiration 1/8/2009 done1/8/2009 prior to injection of va iving immunizations the patient ate lunch and took a 1/2 hour nap. Awoke suddenly screaming Y terriby-lasted 1/13/2009 15 minutes, 1/13/2009 calmed down even day after MMR. Parent consulted primary Y care provider at pediatric clinic and was advised toUuse Benadryl. 1/20/2009 Presented 1/21/2009 to our facility on day iven in error. PCP ordered a Varicella vaccination and I administered a Zoster Vax. Error identified Y on 1/22/2009. 7/28/2008 7/30/2008 Patient returned for PPD RSE REACTIONS NOTED Y 1/23/2009 very pale, fainted getting out of theYbath father caught patient before he hit the floor. U 1/22/2009 1/23/2009 s of hand and legs, cough, dizziness, Y nausea, malaise, muscular pain, gastrointestinal disturbance, Y face an throat ### rash. ### ent came into the Immunizations clinic Y on the 12Jan09 to receive the MMR, Varicella, IPV, DTAP, N and the 1/12/2009 HEP A vaccine, 1/13/2009 waited 15 minute n itching sensation in the back of the right arm. PT was rubbing the site and noticed a red rash Y like reaction 1/23/2009 going from 1/23/2009 the shot site which w wollen and warm to touch, pink upper left arm. Benadryl Y ed rash noticed approximately 8 hours after receiving vaccine.lotion applied to rash at time noticed. U called1/22/2009 OMS on 1/23/09 1/22/2009 to report rash an 9 at the time of immunization, baby Ywas seen and diagnosed with URI/(L)otitis media. Afebrile. Y During night 1/21/2009 of 1/22 1/23/2009 developed fever of 102 over night (Dec 16th 2008), Y my baby Y wake up, Yfussy, did not wanna5eat, start vomiting yelowY liquid, got pale, went ### to doc.### and told us it cou ely following venipuncture pt said it hurt. Pt supported and encouraged to provide post-injection N pain relief methods. ### She said ###it still hurt whe MCV4, Hep.A, Varicella on 01/20/2009. On 01/21/2009 her lower L. arm (just above the elbow) Y became1/20/2009 swollen, red, 1/21/2009 very sore and warm e body and neck, has been running fever (around 100.5F) for 3 days already. U 1/13/2009 1/21/2009 arrhea, dehydration, 1 week Y following Y 2 month Y immunizations: DTAP, 30 YHIB, PCV7,YROTATEQ. Y (+) intracerebral 10/7/2008 bleeding with ###stroke and sei ved her immunizations on 1/16 and developed urticarial rash 1/21. Patient had 0 previous hxUof reactions1/16/2009 to vaccinations 1/21/2009 and had 0 previou ematous left upper arm, slightly warm and tender. 2 days s/p DTap, flu IM injection Left deltoid Y and Polio 12/3/2008 SC. after influenza and HAVRIX were given Y in the left thigh, patient developed a warm, red, firm, Ytender area surrounding 1/8/2009 1/9/2009 this site. It was measu both MENACTRA and BOOSTRIX 1/23/2009 Y in left deltoid approx 1 cm apart. Area becameYred, hot and 1/22/2009 indurated1/23/2009 after next day. No SOB oke out with a couple of red spots on back. Vaccine given on 1/16/09. Pt saw Dr on 01/17/09. Was diagnosed 1/6/2009 with1/17/2009 shingles. Treated wit opped by the clinic and stated since this flu shot on 11/24/08- He has had left sided neck pain U and left arm soreness. ### He denied any chest p erythema multiform. Y 1/22/2008 1/28/2008
hrs after giving immunization another noted maculo-papular rash all over the body. Follow up check up rash 1/21/2009 all over1/21/2009 the body. Given Bena .3 Febrile seizure X 5 min Y Y 1/21/2009 1/22/2009 orts shortly after the shot, it is hard to Y pinpoint when it started a knot came up on (L) arm where N the injection 10/2/2008 went in and had some swelling ks like measles. No fever kopeck spots. Y 1/12/2009 1/22/2009 GARDASIL shot series. It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008 a change in my v ort received from the patient's parentYon 12 November 2008. A 39-year-old male patient complained of weakness, ### loss of ### appetite, night sw ort was received 08 May/2008 from a Y health care professional. A five-year-old female patientUwith no known 5/2/2008 allergies, had received a subcu ort received on 02 September 2008 from a healthcare professional. A 68 year old male patient Y developed8/26/2008 wheezing8/29/2008 72 hours after had rece -old female patient experienced bilateral axillary rash and bilateral ear redness and itching within Y hours after 11/5/2008 receipt11/5/2008 of an intramuscular left ort was received from a health care provider on 09 January 2008. A 55-year-old male patientYwith no pre-existing ###medical ### history, had rece d rash within 24 hours of administration of her 2 month shots. Diagnosed by the pediatrician N as eczema. 12/6/2000 12/7/2000 ated pain began 4 hours after the immunization Y was administered on October 6, 2008, and has U never been 10/6/2008 the same 10/6/2008 since. She went to he ours, after the vaccines, Ymy daughter Y started making moving in a weird way I had never seen U before. I put 1/16/2009 her in her 1/16/2009 crib because she I tho o navy recruit that present after yellow Y fever vaccine. Y Pt noted sweating, 1 palpatations, weakness, Y dyspnea, 1/8/2009 and hives1/8/2009 immediately after yel lled to report reddened area on date of injection at injection site. Increased redness and lump Y at injection 1/8/2009 site noticed1/8/2009 on second day follow on thorax. Lasted for 5 days. No treatment necessary. Y 1/9/2009 1/20/2009 itis of arm. 3/3/09 MR received fromYreporter including vax rec (no lot #s). Pt presented 1/26/09 U with c/o increasing 1/15/2009 redness 1/24/2009 around SP vacc rmation received on 21 January 2009 Y from a health care professional. A 27 year old female patient N with a1/19/2009 history of 1/20/2009 tonsillectomy received A hronic resp. congestion, myalgia, skin lesions acute to chronic, headaches to migraine, Y neuropathy N pain, 2/6/2002 diarrhea, brown 2/6/2002 urine, chronic fati esday had sore throat, runny nose and developed into cough. fever of 100 degrees taking aspirin U helped. 1/21/2009 Today feeling 1/22/2009 the worst. history of shingles, but in the days following vaccination - vaccination on 12/20/08 - he developed pain on the back ### or his ### scalp in the right the vaccine ZOSTAVAX. I had all the side effects listed, except I had an outbreak on my arms like chickenpox. Was1/15/2009 this normal U 1/8/2009 pprox 16 hour after immunization. Fever increase recent. Y 1/15/2009 1/16/2009 ng in office for 15 minutes after receiving GARDASIL vaccine. Patient complain of left knee feeling Y hot, painful. 1/23/2009 I assessed 1/23/2009 left knee, knee w nt soreness let deltoid subsequent to vaccine. N s after I received the ZOSTAVAX injection , I broke out with a rash on my right arm. It was 2-3 Y cm wide, consisted ### of pruritic ###small red papu after injection developed red hard area Y no painful quarter size. Resolved without sequelae.U ### ### attached. Called patient 1/23/09 return Y call from patient. Swelling decreased still sore and itchy, U still taking 1/19/2009 BENADRYL 1/20/2009 and antibiotic. had an immediate reaction at the MMR injection site. With moderate erythema, warmth, in duration Y patient 1/6/2009 was stable 1/6/2009 and activity unchang jection site- plus erythema approx 2 cm with hard papula pustule next to each other. U 1/6/2009 1/20/2009 d hives 12 hrs after receiving vaccine. Y 1/21/2009 1/22/2009 eft thigh with redness around site ofYinjection. Rx BENADRYL swap 2 tsp q 6 hrs. PRN. Y 1/20/2009 1/23/2009 n has been received from a nurse and Y her 79 year old mother (the patient) who had Y a historyNof shingles on July ### 2008 with### the rash localize n has been received from a registered Y nurse and Y physician concerning 0 a 54 year old patientUwho on 14-JAN-2009 1/14/2009 was 1/16/2009 vaccinated with a in Health Department this am stating she had a reaction from her Pneumonia vaccine. Pt stated U that she has 1/23/2009 a "itchy, 1/23/2009 prickly" rash to both arm shots given,alert and oriented x 3 2:18pm - c/o "ears numb I can't hear", swaying in chair,alert Y x 1(person 1/23/2009 only), blowby 1/23/2009 oxygen given @10 ed, hot and swollen Pt. to take Advil and benadryl Y 1/20/2009 1/21/2009 vaccine at 9:30 am, stated feeling chilled approx 2.5 hours later. Then started to have dry cough and expiratory 1/23/2009 wheezes 1/23/2009 at night starting la ut with seizure like behavior. Y 1/26/2009 1/26/2009 of arm and itching one day after vaccine admin d his 1 yr well-baby check-up on Friday, Y January Y 16, 2009 and everything 1 checked out perfectly Y for him.1/16/2009 He was given 1/20/2009 his vaccinations of Developed severe case of Y pneumonia Y with fever - no cough or cold prior. Was sent to hospital N for chest 1/23/2007 x-ray. Was7/16/2007 given inhalation therap 9 pt received a Tdap inj booster in LYdeltoid in belly of the muscle. Several hours later she developed Y swelling 1/12/2009 and pain 1/12/2009 in the deltoid. No di eived Engerix B vaccine on 1/13/09. On 1/26/09, client reports symptoms of sweating, itchingYon upper extremities, 1/13/2009 pain 1/15/2009 in knees,and fatigu e fol shot. Woke up the next morning, couldn't move arm, "hives" at site, red, warm, swollen,Yvery painful,1/21/2009 pain at joint. 1/22/2009 Was instructed to co SED WITH SHINGLES 01/26/2009 PATIENT HAS ONLY RECEIVED ONE DOSE OF VARIVAX LISTED9/11/2000 ABOVE 1/26/2009 ed and diagnosed with Guillian-Barre Syndrome. Y Weakness in upper 16 extremities. 2/10/09 Received hospital medical ### 1/20/2009 records of 1/20-1/30/2 s started two days after recieving the Y vaccine. Experienced muscle pain, spasm,Yand weakness. N Have seen multiple ### doctors ### for treatment ports high fever (104.7, severe diarrhea, Y and shortness of breathe four hours after vaccines.YWas seen in local### ER was observed ### and given s after the vaccine the patient develop severe migraine headaches, accompanied by nausea. Y She was medicated 1/24/2009 with 1/24/2009 pain medication bef
lled to report swelling of right arm thirty six hours post injection. Patient stated hurt in muscleYand "itched like 1/8/2009 crazy".1/10/2009 She also reported vag ceived the Varivax on Saturday 1/24/2008. The following day she noticed the area was red and hard and1/24/2008 itchy. It continues 1/25/2008 today, she has iving vaccination at 11am on 1/21/09, pt went out to lunch and had a hamburger and a beer.YAround 1pm, 1/21/2009 developed 1/21/2009 Headache, nausea, a alling to report possible reaction to vaccines. Traveling abroad, yellow fever area. On 1/16 received U 5 vaccines. 1/16/2009 Tdap, 1/22/2009 Flu, HepA, HepB an after being vaccinated pt. began having Y SOB and Y then palpitations 5 with heart racing. Pt. taken Y to ER and1/7/2009 admitted with 1/7/2009 tachycardia and BB with erythema and edema. Mom brought baby in. Advised to ice x20' q hr. Motrin 5mg prn. Y 1/5/2009 1/5/2009 swelling, warmth to site fever (100.2), chills, fatigue, achy. Y 11/5/2007 11/6/2007 ately 24 hrs after injection, a hard reddish lump formed at injection site. it was painful to touch Y and very hot. ### ### hot. Red, sore. Bump 3 to 4 inch in diameter-lasting about 2wks and still have a bump aboutUdime size. NO pain ### , no redness. Hep B shot, warm, painful area 2"x4" around injection area. Y ot given-is red and warm to the touch and a little sore. Y 11/5/2007 11/6/2007 headache with fatigue approximately 16 hours after flu shot. Duration was approx. 24 hrs. I rarely Y have a headache. ### ### ng, hives, feverish. N 12/2/2008 12/4/2008 d. got shot. Thursday the 11th small nickel size red area and hard, warm to touch knot. VeryNsore to touch. Friday ###morning### golf ball size kno und, fever, swollen area, tender to touch right upper arm 24 hrs after shot given. Noted givenUposterior mid upper ###arm not deltoid. (severe vertigo) vomiting, nausea. Y Y ### ### nset right flank rash-itchy vesicular anterior and posterior. U 1/24/2009 1/24/2009 ythematous maculopapular on both cheeks and all over trunk and extremities. Swollen-nontender Y (R) thigh. 1/9/2009 1/20/2009 rned to clinic 2d after vaccination & Y voiced pt had been to ER for febrile seizure post vaccination. Y 1/26/2009 er back - few small red raised bumps. Left front chest 1 small / pinpoint raised red bump. Mom Y gave Benadryl P.O. ### after onset ### of symptoms d ADACEL RA upper deltoid, PNEUMOVAX RA lower deltoid. On 11/4/08 since vaccinations Y febrile, chilling. 11/4/2008 Has not 11/5/2008 felt well since. Nega eft shoulder, et with deep breath -dizziness assisted to lie down-ice bag applied to shoulder-skin Y w/d, BP11/7/2008 100/60 P-72 11/7/2008 regular. Encouraged e, chills, fatigue, fever (highest 103.2 F). These symptoms lasted 4-5 days. Still had headache Y 8/18/08. 8/12/2008 8/13/2008 with erythema, warmth + swelling - vaccines given 8-6-08, signs and symptoms started 8-7-08. Y Motrin, Benadryl 8/6/2008 icepacks. 8/7/2008 mediately began to feel tired. He also developed a headache and a low-grade fever (99.0F) Ywithin 2 hours 8/12/2008 of receiving 8/12/2008 immunization. Patie e, fever 101.0F, neck ached, slight sore throat, very tired. Hold not feel well for 2 days. Y 7/22/2008 7/24/2008 3/05-1445- after receiving immunizations on 7/21/08. C/o pain in LUE. Pts. LUE had an area Y of approx 7/21/2008 5 in x 3 in around 7/23/2008 injection site that ul - Hyperventilating - trembling before injection. Became faint approx 3 min after inj. Placed Yin shock position, 7/2/2008 color returned 7/2/2008slowly, got pa mother reported that child had a small bleed after needle was removed pressure and cotton ball U was applied by RN. The child removed ban ates developed muscle and joint aches Y the following day after receiving a Tetanus vaccine. Stated N by 4:001/5/2009 PM on 1/4/09 1/6/2009 his joints began to ates" child can not move her RUE at all: C/O RUE being very sore C/O nausea +HA. Temp 99 N f. Given children 7/9/2008 Ibuprofen. 7/10/2008 Mother states mi n HPV during her pregnancy she was apx 6wks gestation. She was also given varicella at hospital. U When9/25/2008 she was apx 9/25/2008 5 week gestation g MMR patient eyes rolled back, PtYslumped and became unresponsive and dusky. O2 put on U Pt after trying to### revive and### EMS called. B/P nation 10-27-2008. 10-29-08 arm started aching. 10-30-08, arm swollen clear down into handNand up thru shoulder ### into neck. ### e, weakness, decreased concentration, writing illegible, chills, stiffness lower extremities, muscle Y aching, fever 101 ### (although ###this was taken Tenderness, difficulty breathing. U 10/1/2008 10/1/2008 at swelling from top of knee up leg on next day. U 9/24/2008 9/25/2008 mmunization administered TRIHIBIT/DTAP/HIB given instead of ACTHIB HIB U 8/25/2008 8/25/2008 Rash immediately around MMR at varicella injection site. Y 7/31/2008 7/31/2008 lled clinic at 5:15 pm 7/8/08 stating child had temp 101F this am. She has given Motrin and YTylenol and now 7/7/2008 at 5:15 7/8/2008 Pt temp 101.2 even th s after administering vaccine patient c/o dizziness. H20 given and Pt jacket removed with recovery. Y 6/9/2008 6/9/2008 ministered 6 mo too soon per vaccination scheduling guild lines Y ### ticed last NOC right thigh to knee swollen + red. 0 hot to touch, but is tender child does walk,U but with slight limp. ###Advised ### to give Ibuprofen Temp- eyes matted - clear nasal discharge Y - cough - Sx lasted 2 days - to ER Fri, Amoxicillin, and cough med- Dr ###said ok to### proceed with ne se broke out in hives, w/2nd dose lips swelled as well as mouth. Y 6/27/2008 10/9/2008 tous Maculopapular rash appreciated Y in the L2-L3 distribution of the R leg. Largest patch 6cm U in diameter. 8/16/2007 DX shingles. 1/20/2009 TX Acyclovier 300m r abdomen, onset 1-22-09. Y 1/15/2009 and VARIVAX vaccine were administered. Y Pt c/o chest pain at home. Pt returned to office, BP U was taken 1/22/2009 and was monitored. 1/22/2009 c/o rash on b f 1-16-2009 noticed back pain, throughout that morning developed what felt like a mild fevers Y and generalized 1/5/2009 muscles 1/16/2009 aches "flu-like" feeli s about 2in erythema and slight swelling advice to apply ice pack patient denies any pain U 1/20/2009 1/21/2009 ceived pediatric dose of ADACEL. No adverse reaction. Y 12/8/2008
DPH and IPV. Reporting medication error. To date , no reported adverse reaction from IPV over U vaccination. Born ### 3wk's premature. up at 5pm with vomiting. Feels like she could faint. Complains of ears ringing and continued Y nausea.-1. 1/19/2009 1/20/2009 tching-blistering at injection site at about 12 hours after injection-warm compress. BENADRYL Y PRN. 1/8/2009 1/8/2009 en arm - about size of baseball, hot tender. Started 1day after shot and lasted 4-5 days. Y 12/9/2008 ### nausea, dizziness within 30 sec of vaccine administration (HPV) symptoms persisted for full 48hrs Y per Pt1/20/2009 symptoms 1/20/2009 were severe. Tdap in left upper arm-IM 12/15/08. Pt called Tues - achiness Monday night-on AM Tues-L arm Y red, warm, rash, ### swelling took BENADRYL vaccine was administered by the office nurse on the morning of 01/22/09. Exceptional itching, Y pain, tenderness, 1/22/2009 and1/24/2009 soreness at the sight o ort received on 13 January 2009 from Y another manufacturer, report number A0761372A. The N initial reporter 9/29/2008 to this manufacturer 9/29/2008 had been ort received on 15 January 2009 from Y a consumer. A 65-year-old patient, who had no concurrent U illnesses, but ### who has allergy ### to tree polle ort was received 16 January 2009 from Y another manufacturer; document number 927258. The Y other manufacturer ### received ### the report from n has been received from a physician Y concerning Y a 14 year old female 12 who on 17-NOV-2008 Y was vaccinated with ### the second ### 0.5 ml dose n has been received from a physician concerning a female patient who on 25-FEB-2008 wasUvaccinated2/25/2008 with the third 8/1/2008 dose of GARDASIL. n has been received from a physician Y concerning Y a patient who was 11vaccinated Y with a dose Uof ROTATEQ (Lot### not provided) ###although it wa Y N edema of the eye, distorted vision;Ypossible auto-inoculation Y 4 Y ### ### minutes after patient had the shot, we were standing at the receptionist's area and she faintedYand fell down. 1/26/2009 She remembers 1/26/2009getting very d wheezing, hives, dyspnea occured Yat 12 noon.Ytourniquet applied when 1 patient had first cough Y and saw1/27/2009 first hive on1/27/2009 arm. injected epinephr Hepatitis B #2 and TdaP. Developed Y rash on neck, right and left upper arm. Denied rash prior Y to injections. Denied ### itching, ###SOB, edema. tes after vaccine administered client was standing ready to leave, and client later reported felt Y extremities1/26/2009 getting numb. 1/26/2009 Client sat down in irst injection on 7/10/2008. Since my Y second injection (9/26/2008), I haven't had a regular menstrual N cycle, 7/10/2008 even while 9/26/2008 on birth control. I am mach, sore Muscles, joint pain Y 1/12/2009 1/16/2009 eived two vaccines after older sibling received vaccine. Client standing and awake and alert Y and putting on 1/26/2009 coat to leave 1/26/2009 facility when sibing arm pain that remains severe in mid Y upper arm where the injection was given on left since 10/20/2008 N flu shot. ### NSAIDs nto ###helpful. US ne itis and soreness in left arm, where vaccine administered. treated with Tylenol and cold packs. Y 1/21/2009 1/22/2009 minutes of receiving the Tdap immunization, patient had passed out on the floor and started seizureing. Y She 1/23/2009 convulsed 1/23/2009 for approximately 45 ately 6 minutes after receiving the Tdap vaccine in left arm, patient had difficulty breathing and Y felt dizzy,1/23/2009 nauseous,1/23/2009 and light headed. I laye MS TO HAVE FLU AFTER 3 DAYS OF RECEIVING VACCINE AND ABOUT AFTER 5 DAYSUSHE DEVELOPED 11/5/2008 TINNITUS ### AND PATIENT ed Anthrax vaccine 10 Dec 2008, # 3 of 6 shots. Pt found that she was pregnant on 13 Jan 2009. Pt had no reaction ### to the Vaccine. Repor swelling, heat, bruising & pain at injection Y site, along with headache. Patient also stated a red band from 1/21/2009 injection site 1/23/2009 down the back of he ately 3-6 wks after vaccination number Y 2 in september 2008. i had migraines, nausea, vomitting, U fatique with 9/20/2008 no probable cause ### that lasted inflamation at injection site, with increasing Y cellulitis 1/24/2009 1/24/2009 n area of redness + swelling +warm painful to touch on Rt med thigh esp where TETNUS / ADACEL Y was given 1/6/2009 GARDASIL 1/8/2009 suspect + TDAP d injury to left arm and came to clinic requesting a TD. U 1/22/2009 swelling at injection site; some itching in body. Recommended Benadryl and then pt to medical U center if1/23/2009 anything else. 1/24/2009 esented in Health Department one day after receiving Tdap. C/O back pain in Left deltoid. Slightly Y red at1/26/2009 injection site. 1/26/2009 No swelling noted. ministered 1-21-09 pt wife notified us that w/in a few days he had broke out in rash on trunk which Y then spread, 1/21/2009 treated w/OTC Benadryl. ver on arms and legs 1/21, woke upY1/22 with very bad rash on right lower leg. Seen by PCPY 1/22 treated 1/20/2009 with BENADRYL 1/22/2009 for rash and TY th redness on 01/23/09 and severe pain and redness which increased with time. Was very red, swollen and 1/22/2009 painful 1/23/2009 and spread to elbow 1/2 swollen area at injection site, hot toYtouch very itchy- 104 degrees-105 degrees Temp. Y 1/22/2009 1/23/2009 reaction to MMR & VARIVAX - Lo causing erythema onis Y 1/27/2009 1/27/2009 ction to Tdap U 1/20/2009 1/22/2009 fussy and very gassy for 2 days following vaccine. Day 3 brought diarrhea 10-15 times a day, Y watery, green, 1/15/2009 positive 1/18/2009 for occult blood, no f nflammation and pain at injection site extending 4" from site and half-way around arm. Pt told Y to apply cold 1/5/2009 compresses 1/7/2009 x1 day then warm c d 1/27/09 with Zoster L1 dermatome.Recieved Varivax 4/27/04 and ProQuad 11/14/06 1/27/2009 ella rash started 1/27/2009. Y Y 3/21/2005 1/27/2009 n has been received from a physician concerning a 79 year old white female patient who onY05-DEC-2007 12/5/2007 at 13:4510/7/2008 pm was vaccinated into n has been received from a physician concerning a 65 year old male who on 05-NOV-2008 Y was vaccinated 11/6/2008 with PNEUMOVAX ### 23 (Lot #66 n has been received from a physician concerning a 49 year old male with asthma and allergic Y rhinitis who 11/6/2008 on 06-NOV-2008 11/6/2008 was vaccinated n has been received from a pharmacist Y concerning Y a hospitalized patient 0 Y who on an unknown U date was vaccinated with a dose of PNEUMO n has been received through the Merck Pregnancy Registry from a healthcare worker concerning Y a female 4/15/2008 (age not4/15/2008 reported) who on 02-JU n has been received from a physician Y concerning an approximately 15 year old female patient N who was mentally handicapped who in 2007
was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified N age 1/1/2000 who was vaccinated with LYME was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified 5/25/2000 age who was vaccinated with was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified N age 6/2/1999 who was vaccinated with LYMER ho received flu and ZOSTAVAX Y vaccine Y on 11/6/08 Y began to notice12lethargy, myalgias, arthralgias Y that gradually 11/6/2008grew 11/9/2008 worse. Was seen in st vaccination: dizzy, dimming vision, Y nausea. Recovered Y in clinic: In1 P.M: Client experienced Y loss of vision, 1/22/2009 loss of 1/22/2009 muscle control, swelling with ESRD on HD, HTN, and Y DM presents to ER from HD center via ambulance after receiving N PNEUMOVAX 12/4/2008 and developing 12/4/2008sudden SOB. ccination 1/20/09, and 1/22/2009 c/o painful knot, erythema 2 1/4 in on Right Deltoid. U 1/20/2009 1/22/2009 ate that infant cried screaming episodes for 3 hours per episode, for 24 -36 hours after receiving Y immunizations. ### Increased ### T. Eyes and fac after the injection patient noticed a red wheal approximately 1" in diameter. It was itching andUburning. The 1/22/2009 rash increased 1/23/2009 in size to 3 1/2-2 FLUZONE 1/15/09. 1 week later noted pain in both forearms & later both legs. 1/22/09 Mainly U myalgias. 1/15/2009 Still being 1/22/2009 evaluaated. after administration, a 2 inch strip ofY hot, painful whelps developed on middle of the torso, on N the left side. 1/16/2009 The next1/21/2009 dayit spread to the fron TIS TO LT. DELTOID REGION. Y Y 1/20/2009 1/22/2009 2 of the 3 Gardisil shots. One on 10/16/07 andYone on 2/2/08. In April 4 2008 I had a virus thatUlasted for 4 2/6/2008 weeks and5/23/2008 was treated with antib cieved vaccines on 1/16/09 on both upper outerY thighs. On 1/17/09,2patient's father phoned Ydoctor on call, 1/16/2009 stating right 1/17/2009 thigh was swollen. perienced swollen, red, hot upper arm at side of injection, patient took benadryl to relieve theYsymptoms;1/21/2009 symptoms1/22/2009 were dissipating after a after 1st PCV, baby's thigh feels hard and small red area around injection site. Baby extremely Y irritable and 1/27/2009 drowsy 24 1/28/2009 hours after as well. ash; about 2 dozen lesions Y Y 5/14/2008 1/21/2009 ers of up to 103.2, body aches, malaise, Y cough,small pustules on skin Y 1/22/2009 1/24/2009 YTHEMATOUS LESIONS WITH VESICLES Y IN DIFFERENT STAGES. 2-3 LESIONS NEW TODAY. Y ERUPTIONS 1/6/2009 BEGAN 1/19/2009 ABOUT 72 HOU IPV GIVEN AT 12 MONTHS U 1/20/2009 1/20/2009 welling 10.5 cm x 9.5 cm, firm, and warm to touch with pain. Y 1/26/2009 1/28/2009 veloped a rash 7-10 days later. Rash has been diagnosed as pityriasis rosea. The dermatologist informed me### that PR may ###be associated inic with 5 yo with concerns about swelling/redness to R thigh. Received vacc 3d in bil thighs U and mom states 1/23/2009 R thigh had lump next d. with SHOT WAS GIVEN DIRECTLY IN TO Y MY LEFT SHOULDER, UP VERY HIGH, AND BEHIND. N I NOW HAVE A### TEAR ON### MY SUPRASPIN as on target with speech and gross motor skills approaching his first birthday. He Ysaid about N 10 words, knew 6/29/2007 the signs 7/6/2007 for cup, food, mom a g x 3 weeks. 2. Local pain where shot or injection was given. N ### ### es temp 102.2 F orally several hours after injection. Also complained of nausea and vomitingY but was also 1/26/2009 taking Flagyl 1/26/2009 for Vaginitis. c/o headache, nausea, vomiting, fever, rash on arms, neck, chest, abdomen and pain and swelling N at injection 1/26/2009 site.1/26/2009 neck muscles, onset 24 hours later. No other physical events to potentially cause this no fever U or constipation 1/23/2009 symptoms. 1/24/2009 Rx: muscle relaxa accine given. 1-22-09 at 6pm beganYvomiting. At 9:40pm c/o knees "killing me". Mom carriedYto bed 1-23-09 1/16/2009 and 1-24-09, 1/22/2009 child home playin d localized reaction with redness, swelling and itching. Y 1/26/2009 1/27/2009 o right upper arm swelling, localized to immunization site. Hot, painful. Patient seen in clinic, U states it feels 1/27/2009 much better, 1/27/2009 swelling decreased , Hyperemia and edema at injectionYsite R thigh and oral lesion measuring 10x7cm U 1/26/2009 1/27/2009 y Dr via telephone and advised to go Y to emergency room. Patient was triaged by Dr. Y 1/26/2009 1/26/2009 redness with the left shoulder/arm where shot was given. Y 1/21/2009 1/21/2009 as diagnosed with shingles. Y 1/7/2009 1/19/2009 , 2006 I went to the Hospital for my Y annual physical. Y When the Doctor 3 discovered that I had NAtrial Fibrillation 5/12/2006 and kept 5/12/2006 in the hospital for my le SM referred to hospital from ED for Y f/u evaluation of chest pain S/P primary SPV and AVAY#2 1/31/2008. 1/31/2008 Symptoms: 2/6/2008 Dyspnea, Diaphor ort received on 21 January 2009 from a health care Y professional. A 2-year-old 0 child, who hasUpast medical 10/1/2008 history of respiratory 1/1/2009 syncytial vir ort received on 15 January 2009 from a physician. Y A 7-month-old female 0 patient who had no N concurrent illnesses, ###pre-existing ### medical cond n has been received from an investigator Y concerning Y a 12 month old0 female with nasal congestion Y and a history ### of a recent ### cold and methic n has been received from a pharmacist concerning a female who in 2008 was vaccinated with Y a dose of GARDASIL. The patient experienc n has been received from a physician Y concerning Y a 24 year old female 6 Y who on 22-JAN-2009Uwas vaccinated 1/22/2009 with a1/22/2009 0.5 mL third dose of GA n has been received from a consumer concerning Y the 15 year old daughter 0 of her friend whoN"months an months ago" was vaccinated with vaccine given 12/31/2008. Onset of painful genital ulcerations- two total- on approximately 1/14. Evaluation in### office1/16/2009 revealed two isolated ported rash and itching around injection site starting a couple days after receiving the ZOSTAVAX injection. 1/19/2009 1/19/2009 eltoid region with redness, warmth and itching per patient, upon return to office on 1/22/2008,Ywhere ADACEL 1/19/2009 was given. 1/22/2009 Pneumonia Vaccine R arm Flu vaccine Y and 7 hours later, L arm pain so severe + decreased U mobility, went to the ### ER. ER Dr. ###was "uncaring ed on 1/15/08 at 11 am, states child's Y left arm red and swollen post vaccine. Was advised to Y go to PMD. 1/13/2009 On 1/19/08,1/15/2009 called MOC, states too veloped a facial palsy on right side Y that started on or around 12/23/2008. Patient was evaluated Y for Lyme which ###was negative. ### No other c
FLUSHOT 12/15/08 AND MOTHERYSPOKE WITH ON CALL PHYSICIAN 12/16/08 AND STATED Y SHORTLY AFTER ### FLUSHOT ### PATIENT Y 1/22/2009 1/22/2009 G AT INJECTION SITE Y 11/3/2008 11/3/2008 9 pt report n&v, confussion,HA,lip swelling Y & numbness. 2/23/09 MR received for several OVs U beginning 1/26/2009 1/8/09. Seen 1/28/2009 prior to vaccine for nations, including rotateg, received on 1/26/09 at 2mo. of age. mother called clinic to report that U baby had1/26/2009 8 episodes 1/29/2009 of diarrhea 1/28/09 an ith, I was never alergic to anything in my life until they adminestired that flu shot that they told N me I had to 3/13/2000 have to keep 3/13/2000 on working, althoug 09- received vaccination. 21 Jan 2009 Y had chills and weakness. 23 Jan 2009 had chest pains. Y Went to Aid 1/20/2009 Station was 1/20/2009 told he had gas. Co 9 after clinic visit, and @ 7:30p felt dizzy, Y faint, sensitive to light and mom states pt. got really U pale. Mom1/20/2009 gave tylenol 1/20/2009 and went to sleep. W ng for 12 hours. 10 days later subjective sx of swollen tongue and difficulty swallowing. Did not Y seek medical 1/13/2009 care for1/14/2009 condition. y 1 week after HPV #3 vaccine U 1/22/2009 1/28/2009 ours of receiving vaccine had fever greater than 102F, chills, sore throat, muscle aches, fatigue, Y and dee12/9/2008 non-productive 12/9/2008 cough. lasted 4 d eived HIB #1, Prevnar #1, Pediarix #1. Y Started to show sytmptoms of vasovagal response but Y then moved 1/28/2009 into very1/28/2009 shallow, slow respiratio ction, erythema, induration noted 2 days after vaccine administered U 1/27/2009 1/29/2009 post Injection patient experienced swelling,tenderness and warm to touch at injction site, leftYdeltoid. Symptoms 1/27/2009intensified 1/27/2009 for 48 hours af days after injection, 2 cm firm tender, non-erythematous soft tissue mass appeared appeared N at injection 1/15/2009 site. Lump 1/19/2009 enlarged and develop ter immunization, patient projectile vomited Y and stopped breathing. Went to children's Hosp.Y2/4/09-records received ### for DOS ### 11/17/08-pre m Reddened Raised area @ injection site Y 1/19/2009 1/21/2009 d neck pain/stiffness radiating up upward to right side of head. Started day after injection given N in right arm. Continues ### to date. Referred to dose of ROTATEQ pt. had vomited in the office and then contiued diarrhea at home. After 2nd Y and 3rd doses 4/4/2008 vomited 4/4/2008 the next day and the hat in 2004 she received the flu shot while on duty as an RN at the TriCare clinic. Within 15 minutes she had itching ### at the ### site that then sp ea of redness. Left shoulder at injection Y site. Warm to touch. U 1/21/2009 VARICELLA reaction - redness @ the site started 1-28-09 in evening. Y 1/19/2009 1/28/2009 mplaining of rash on right side chestY wall, some pain in his back through his anterior chest +Nin that same 1/13/2009 band of derma 1/17/2009 tone. Aching, irrita m eriphan with pain, itching developed at site of injection within 24 hours of administration. 1/27/2009 1/28/2009 rash on both thighs. No fever, vomit or any other complications. Patient to follow up with Dr in U 1 week. 1/26/2009 1/27/2009 d lump in R. arm circumference size of 2 silver dollars. Very red and sore. Y 1/26/2009 1/28/2009 red ZOSTAVAX IM instead of subcutaneous. No information regarding correct route found on U product vial 1/20/2009 nor in VIS1/20/2009 sheet. ministered IM instead of Sub Cu nothing indicated route route on product bottle nor on his sheet. U 1/21/2009 1/21/2009 was reported by a lawyer and described the occurrence of skin lesion(s) on multiple body sites N in a male subject aged between 50 and 59 ceived ROTATEQ on 1-27-09, Y developed intussusception Y on 1-28-09, 2 required surgical repair Y 1-28-09. 2/9/2009 1/27/2009 MR1/28/2009 received for DOS 1/28 eived FLUMIST in previous years. Received Y FLUMIST Y 1/15/09. Seen 20 in ER 1/17/09 for presumed N viral illness. 1/15/2009 Admitted 1/19/2009 to PICU 1/19/09 w ceived injection 6-9-08. Exposed to Yfamily with in last 1 month with severe chicken pox. Patient Y in our ED 6/9/2008 with other concerns. Presumed ch oped erythematous, pruritic lesions at Y site of primary SPV inoculation approximately 6 weeksYpost vaccination. 9/16/2008 Symptoms:### Dermatitis, foca 1/28/2009 N 1/27/2009 1/28/2009 lled our office approx 30 minutes after getting ZOSTAVAX injection. "on her way home stated Y she felt like 1/26/2009 on. she got 1/26/2009 a shot of morphine". U 1/8/2009 started in 1/14/09, had to be woken Y up for feedings. Fever 100.5. Symptoms subsided 11/5/09. Y Went to ER 1/14/2009 1/14/09 1/14/2009 because couldn't get hi Flu shot 10/14/08 Fry's. That nigh had hallucinations + feet extremely sweaty - wringing wet-Y2nd night same thing ### hallucinations ### not feeling ut, tremors, eyes rolling in the back of Y her head Client sent to ER via ambulance. Y 1/20/2009 1/20/2009 reaction. KINRIX accidentally administered instead of HEP B. Y 1/23/2009 she gets frequent breakouts of "shingles"-about 3X/yr for the last 6 yrs. MD recommended ZOSTAVAX. Y 1/14/2009 Pt was clear 1/26/2009 of any symptoms. Sh 08 increased temp 105.8 and febrile Y seizure. Y 12/8/2008 ### ely after the 2 vaccines admin., student said he was becoming faint. He fainted sitting in chair Y supported1/28/2009 by 2 staff and 1/28/2009 transfer to cot. Stud d VARIVAX vaccine on 09-22-01 at clinic & now is seen at other clinic & developed a rash that Y was cultured 9/22/2001 & positive 1/22/2009 for varicella zoster. Swelling, itching, warmness on left deltoid Y 1/28/2009 1/28/2009 swollen. Cold compress applied. U 1/28/2009 1/29/2009 rsday morning fever of 100 and leg was red, but is better now. Y 1/27/2009 1/30/2009 CONVULSIONS FOR A DURATION OF ABOUT 20 SECONDS; HE DOESN'T REMEMBER Y ANY OF THAT 1/29/2009 TIME; HE 1/29/2009 WAS EXTREMELY P ccured 1/2/09 mid-morning. Zostavax was situated in the freezer next to Varivax and unfortunately Y I mistakenly 1/2/2009 grabbed 1/2/2009 Zostavax instead hat the Last flu vaccine caused difficulty breathing and tighness in his chest for 3 days. He said that he did 10/1/2008 not go to10/1/2008 the doctors because th ours, patient began coughing and sneezing. Y Eyes and lungs began to hurt. Patient advisedYto contact personal ### physician### who prescribed
esented to BHC 237 with rash 24 hrs Y post multiple vaccinations. Patient presented with urticaria Y with large 1/20/2009 red blotches 1/21/2009 with flat raised are en 1/14/09 in L arm Patient states an initial 2-3 days of sore arm, 2 days of no symptoms, then U 1/20/09 awoke 1/14/2009 with excruiating 1/20/2009 pain in L arm .7 degrees, chills, body aches, swollen lymph glands, nausea, pain at injection, unable to lift/move N arm, 1/27/2009 headache, 1/28/2009 backache, burning sens REPORTED TO SICK CALL C/O NOSE Y BLEED Y X 2 DAYS, WITH RASH 8 AROUND HIS WAIST U LINE, CLINIC### ON 1/20/2009 BASE DID BLOOD TES d 1/21 morning. Rash to neck 1/22 evening, Y extending to chest and trunk, very itchy, rash worsened Y 1/231/21/2009 to almost 1/22/2009 entire body, went to ER 9 Pt. awoke with flu like symptoms, Ypain in arms and purpura-like rash on legs. Received prescription N for 1/2/2009 steroid pack 1/8/2009 (pt. could not be mo HAS IMMUNIZATIONS ON 1/23/2009. Y ON 1/24/2009, PARENTS WOKE UP TO CHILD HAVING Y DIFFICULTY 1/23/2009 BREATHING, 1/24/2009THEN PAREN perienced soreness at the site where the Pneumovax was given (left deltoid). Client reportsNchills, fatigue, and### fever of 103 ### degrees for ab ports fever of 100-103 for 3 days fllowing Y immmunization. afebrile today in clinic Y 1/26/2009 1/17/2009 tes post administration of DTaP and MMR, patient's arm began to swell at injection site. Patient Y also developed 1/30/2009 a hive 1/30/2009 like rash, redness a swelling, pain & redness 2 days after administration of vaccines U 1/28/2009 1/29/2009 ur office on 1/22/09 and reecieved 4Yyear old boosters. Woke up 1/23/09 with red and swollen Y left arm. Diagnosed 1/22/2009 with 1/23/2009 cellulitis left arm tre after administration of Varivax, dose #2, the patient developed a warm, itchy, red area on leftUthigh (site of1/27/2009 injection).1/28/2009 The patient was seen ING TO MOTHER, CHILD DEVELOPED Y CELLULITIS Y IN THE LEFT2ARM WITH A TEMPERATURE Y OF 1/22/2009 104.8 AND1/23/2009 NEEDED IV ANTIBIOT h extremely sore arm limiting movement Y 1/27/2009 1/28/2009 max 102F 2 days after shingles vaccine administration) and redness, warmth, tenderness at injection U site.1/26/2009 Fever deffervesced 1/28/2009day 3 after inj dministered around 11 June 2008 prior to deployment. Pregnancy diagnosed during deployment. Y Pt returned 6/11/2008 upon dx of pregnancy. No k all over the body, mostly in the torso regions. N 1/15/2009 1/22/2009 f 7/22/2008 child had a prolinged Y febrile Y convulsion. Y He was admitted 1 to Hospital around midnight Y 7/22/09. 7/22/2008 He was 7/22/2008 observed and did not ha n my upper left arm is something I'v never experienced before. It isn't like a sore muscle, it is worse. It is a disabling ### 1/8/2009 pain. For the past 3-4 was reported by a healthcare Y professional Y and described the occurrence of diarrhea Y in a 6-month-old U female 1/6/2009 subject1/6/2009 who was vaccinated w th lower back progressing into thighs and having difficulty walking a lot of joint pain. Started U next day and1/27/2009 also had rash 1/28/2009 on left thigh, contin ning after his shot, he developed a fever of 100 degrees. The next day, his fever was 101 degrees, Y he had 1/26/2009 a bad headache, 1/26/2009a stiff neck, an arge red, warm, painful area around injection site. Y 1/27/2009 1/28/2009 x15 cm. edema, erythema, induration. Y 1/19/2009 1/20/2009 2-23-08 for vaccines to travel Jan 9 or 10th, 2009 awoke with severe pain in "every" joint. Took N aspirin, pain gradually ### 1/9/2009 decreased. Felt much d area red, swollen, warm to touch 1-29-09. Child active, alert, good movement with arm. NoYfever marked 1/27/2009 redness 1/28/2009 with pen. Advised mom dness some swelling at site. Noted reddened area about 13 mm in diameter. Pt. started to Y feel itchiness 1/28/2009 on L arm 1/30/2009 in the evening after rece hea and aching approximately 2 hrs after Adacel shot given - symptom progressed with severe Y myalgias 1/14/2009 lasting approximately 1/14/2009 72 hrs. ceived TD vaccination on 1/8/08, approximately Y 3 hours after, the patient developed a low-grade Y fever of 100.7F. 1/8/2008Patient 1/8/2008 took TYLENOL fo nt received a routine booster shot with Td-170 on Friday, 02/01/2008. Immediately, she felt aUburning sensation, 2/1/2008 and 2/1/2008 then developed a large ceived TD-171 on 01/25/08. He developed Y flu-like symptoms, including cough, ear pain, pharyngitis, U and1/25/2008 muscle aches, 1/29/2008 and a local reactio ceived TD on 03/12/2008. Patient came Y back to the doctor's office on 03/14/08 with flu-like symptoms Y and 3/12/2008 redness,3/14/2008 tenderness and a nodu as vaccinated on 02/01/08 and the symptoms Y of the event started on 02/08/08. Patient experienced Y a variety 2/1/2008 of symptoms 2/8/2008 over a period of perienced a high fever of 101.3F, body aches, chills and headache after receiving TD booster Y shot. Called 6/9/2008 the physician's 6/10/2008 office and was a ceived TD vaccine on 6/12/08 as a routine Y booster. Later that day, the patient visited his cardiologist Y for6/12/2008 an unrelated 6/12/2008 reason and was not i tient received vaccine on 06/04/08 Y and on 06/08/08 patient went to ER, where he was diagnosed Y with cellulitis 6/4/2008 in the6/8/2008 area of injection site. patient received vaccine on 06/09/08 Y and on 06/13/08 she came to doctor's office with symptoms Y of cellulitis 6/9/2008 - swelling, 6/13/2008 redness, warmth an tient received vaccine on 6/11/08 and Y 6/13/08 patient come to doctor's office with complaintsY of fever, chills, 6/11/2008 muscle6/13/2008 aches, along with sym patient received vaccine on 06/11/08 Y and on 06/18/08 she came to doctor's office with symptoms Y of cellulitis 6/11/2008 - swelling, 6/18/2008 redness and a knot ved TD vaccine on 06/20/08 and started to experience pain on 06/21/08. C.K. described hisYreaction as6/20/2008 feeling a significant 6/21/2008amount of pain ceived TD vaccine on 06/20/08 and experienced pain at injection site and general achiness on Y 06/21/08.6/20/2008 Patient took 6/21/2008 TYLENOL for the ad ceived Td injection intradermally, instead Y of a PPD test, two to three years after receiving herNregular Td booster 6/9/2008 shot.6/9/2008 Patient was suppose tient came to doctor's office to receive TD and MENACTRA vaccinations for admission to college. Y Patient 7/14/2008 was administered 7/14/2008TD IM/left delt as administered TD vaccine on 06/25/08 Y and developed a local reaction of swelling, warmth Y and redness6/25/2008 at injection6/25/2008 site during the same d as administered Td vaccine on 7/30/08 Y and developed a local reaction of swelling, warmth and Y redness at 7/30/2008 injection site 7/30/2008 during the same day ceived TD injection on 04/15/08 andYdeveloped redness and hardness at the injection site. Patient Y was treated 4/15/2008 for cellulitis 4/15/2008 with AUGMENT ceived TD injection on 10/16/07 andYdeveloped cellulitis, redness and induration at injection Y site. Patient was treated ### with### BACTRIM for 10 08 TD was administered to the patient intradermally, in the left inner forearm, instead of a PPD Y test. The8/25/2008 patient immediately 8/25/2008 experienced p veloped induration at injection site, Ythe site was warm to the touch, as well as a swollen lip and Y swelling 7/15/2008 in the mid corner 7/15/2008 of eyes. Follow u ported not feeling good after Td injection Y and developed swelling at injection site. Follow up on Y 10/28/2008: 7/16/2008 As the patient 7/16/2008 did not return to
veloped induration and redness at injection Y site, and a headache. Follow up on 10/28/08: AsYthe patient did 7/7/2008 not return 7/8/2008 to the medical office ceived TD vaccine, lot TD-183 on 09/24/07 Y due to a scrape and developed an itchy rash on arms, Y abdomen, 9/24/2007 legs, face 9/24/2007 and scalp couple of weating, migraine headache, rapid heart Y beat, paresthsia in fingers and toes, localized swelling Y at injection site.### Patient was### examined by a was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional Y and described the occurrence of fever in a 15-month-old Y male11/4/2008 subject who 11/4/2008 was vaccinated with was reported by a physician and described Y the occurrence of pain radiating down arm in a 65-year-old N male subject ### who vaccinated ### with F was reported by a consumer and described Y the occurrence of erythema in an adult female subject N who was vaccinated ### with ###FLULAVAL (G was reported by a healthcare professional Y and described the occurrence of bilateral conjunctivitis U in an adult female ### subject ###who was vacc was reported by a healthcare professional Y and described the occurrence of leg rash in an adult Y female subject### who11/1/2008 was vaccinated with FL was reported by a healthcare professional Y describe the occurrence of leg rash in an adult female Y subject who ### was vaccinated 11/1/2008 with FLULAV was reported by a healthcare professional Y and described the occurrence of leg rash in an adult Y male subject who ###was 11/1/2008 vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of leg rash an adultY subject of unspecified ### gender ### who was vaccin was reported by a healthcare professional Y and described the occurrence of leg rash an adultY subject of unspecified ### 11/1/2008 gender who was vaccin was reported by a healthcare professional Y and described the occurrence of leg rash in an adult N subject of unspecified ### 11/1/2008 gender who was vac was reported by a healthcare professional and described the occurrence of shoulder bursitisNin a 37-year-old female ### subject who was vacc was reported by a physician and described Y the occurrence of generalized itchy rash in a 35-year-old N female 11/7/2008 subject11/7/2008 who was vaccinated w was reported by a healthcare professional Y and described the occurrence of pain in shoulderNjoint in a 30-year-old ###female subject who was was reported by a physician and described Y the occurrence of high fever in a 60-year-old female U subject who was vaccinated with FLULAVA was reported by a healthcare professional and described the occurrence of injection site pruritus Y in a 57-year-old ###female subject ### who was v was reported by a healthcare professional and described the occurrence of local reaction inUa subject of unspecified age and gender who w was reported by a pharmacist and described the occurrence of a product complaint in a subject U of unspecified### age and gender ### who was va was reported by a healthcare professional and described the occurrence of injection site pruritus U in a female 10/1/2008 subject10/1/2008 of unspecified age wh was reported by a healthcare professional and described the occurrence of injection site pruritus U in a female 10/1/2008 subject10/1/2008 of unspecified age wh was reported by a healthcare professional and described the occurrence of injection site pruritus N in a 82-year-old 10/1/2008female 10/1/2008 subject who was v was reported by a healthcare professional Y and described the occurrence of hives in a 69-year-old U female 9/24/2008 subject who was vaccinated with was reported by a physician and described the occurrence of diffuse itching in a 77-year-oldNfemale subject who ###was vaccinated ### with FLUL was reported by an allergy physician Y and described the occurrence of rash-pruritic in a 68-year-old Y female subject ### who was ###vaccinated with was reported by a healthcare professional and described the occurrence of swelling injection U site in a 29-year-old ### female subject who was was reported by a healthcare professional Y and described the occurrence of injection site pruritis U in a 68-year-old ###female subject ### who was v was reported by a consumer and described Y the occurrence of ears clogged in a 58-year-oldUfemale subject who ### was vaccinated ### with FLUL was reported by a physician and described the occurrence of low temperature in a 20-year-old N female subject ### who was vaccinated ### with FL was reported by a physician and described the occurrence of incorrect storage of drug in a 52-year-old U male subject ### who ### was vaccinated w reported by a healthcare professional via a inside sales representative and described the occurrence Y of black spot at injection ### site in a subje was reported by a healthcare professional and described the occurrence of injection site redness Y in a 65-year-old ### female ### subject who was was reported by a healthcare professional and described the occurrence of injection site redness N in a 21-year-old ### female ### subject who was was reported by a consumer and described the occurrence of nerve disturbance in a 64-year-old Y female subject ###who was### vaccinated with F was reported by a consumer and described Y the occurrence of injection site redness in a 34-year-old Y female subject ### who was ### vaccinated w was reported by a physician and described the occurrence of allergic reaction in a 62-year-old U female subject ### who was vaccinated ### with FLU was reported by a healthcare professional Y and described the occurrence of arm redness in a U 34- year- old female ### subject who was vaccina was reported by a healthcare professional Y and described the occurrence of high fever in a 37-year-old N female ### subject who### was vaccinated was reported by a healthcare professional Y and described the occurrence of injection site pain N in a 36-year-old ### male subject ### who was vaccin was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 8-year-old 10/8/2008 female 10/8/2008 subject who was v was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 13-year-old 10/8/2008male 10/8/2008 subject who was va was reported by a mother of a consumer and described the occurrence of injection site soreness Y in a 17-year-old 10/8/2008male 10/8/2008 who was vaccinate was reported by a healthcare professional (also the consumer) and described the occurrence N of chest rash 10/2/2008 in a 42-year-old 10/2/2008female subject was reported by a healthcare professional and described the occurrence of injection site redness in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness U in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness U in a subject 10/1/2008 of unspecified age and gend was reported by a healthcare professional and described the occurrence of injection site redness Y in a subject 10/1/2008 of unspecified 10/5/2008age and gend was reported by a healthcare professional and described the occurrence of injection site redness Y in a 33-year-old 10/1/2008 female 10/1/2008 subject who was
was reported by a healthcare professional that described the occurrence of injection site burning U in a subject of unspecified age and gende was reported by a healthcare professional that described the occurrence of injection site burning U in four to five subjects of unspecified ages was reported by a physician and described Y the occurrence of swelling arm in a female subject U of unspecified 10/2/2008 age who was vaccinated with was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult male subject who was vaccin was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult female subject who was vacc was reported by a healthcare professional Y and described the occurrence of lost consciousness Y in a 15-year-old 10/4/2008 female 10/4/2008 subject who was va was reported by a pharmacist and described the occurrence of radiating pain in the arm in aU39-year-old female ### subject who was vaccinate was reported by a pharmacist and described the occurrence of increase in migraine in a 25-year-old U female 12/1/2008 subject12/4/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of nausea in a female Y subject of unspecified ### age### who was vaccin was reported by a consumer and described the occurrence of red rash on stomach in a 39-year-old N female subject ### who was ###vaccinated wi was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified 11/6/2008age who was vaccinated was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified 11/6/2008age who was vaccinated was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration 11/2/2008in11/2/2008 an adult female subjec ry 8, 2009, patient recieved intranasal life attunated influenza vaccine. In about 3 days, he started Y having1/8/2009 flu symptoms 1/11/2009 including fever, bod E UPPER BODY MUSCLE ACHES, HEADACHE, NAUSEA,PHOTOPHOBIA,PAIN 8/10. TX: Y TYLENOL, 1/1/2009 PHENERGAN, 1/1/2009 BEDREST X 48 H ad a seizure the day after (11/11/08)Yhe had the yellow fever vaccine (11/10/08). It was during U nap time at school. ### He was### rushed to the em ceived the vaccine on 1/30/09. The next day, 1/31/09, he vomited twice. He also didn't eat very Y much that 1/30/2009 day, prompting 1/31/2009 me to think he d vleoped herpes zoster on the left side of the body, where vaccine was administered. U 1/28/2009 1/29/2009 2008 first shot experienced Y headaches, Y dizziness, Y back pain, soreness 15 Y at injection site (still feels U pain in arm 2/7/2008 today). April 2/7/2008 2008 after second rst HPV vaccine, and 1 hr later, I developed Y a fever Y of 102.0, was vomiting, 2 and had Y a severe N headache.9/20/2007 Ever since9/20/2007 9/20/07, I have had a c ed ZOSTAVAX IN; approx. 6 months ago at a local retail pharmacy (not at one facility). Pt presented to an ED with other problems, and on th PCV7 instead of Hept A vaccine. Hept A vaccine then administered. MTR notified of event. 1/23/2009 ed & warm spot just below injection site pt reports not painful U 1/27/2009 1/29/2009 ema, swelling L upper arm, pain, tenderness, low fever, hallucination at nights, belly ache- no vomiting or diarrhea. or redness 3x4 1/2 in elevated in duration Y 1 1/2in initial 0 dc 0 Adenopathy. U 1/26/2009 1/27/2009 ving RATATEQ by mouth, noticed that pt. started having redness around mouth, eyes, right Y ear & blotchy 1/26/2009 redness on 1/26/2009 scalp. Gloves were la ills, and cramps, vomiting Y 1/13/2009 1/13/2009 as given 0.5 ml pneumoccocal vaccine. Developed swelling at injection site. 11/3/2008 11/3/2008 atient received tetanus/diptheria injection. Returned 1/19/09 with complaint of injection site swelling - left12/1/2008 deltoid- Reported 1/17/2009 increased redde ort received on 07 October 2008 from Y a physician. A 41-year-old male patient, with no concurrent N illnesses, 4/19/2008 no known 4/23/2008 allergies, and no use n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL concerning Y a 2810/5/2007 year old female 4/19/2008 patient with no pe n has been received from a registered Y nurse concerning a 20 week old female patient who on U an unspecified date was vaccinated per oral n has been received from a physician Y concerning Y an approximately 15 Y month old female patient Y who on unspecified dates was vaccinated n has been received on Y request from the FDA Y under Freedom of Information 0 Act regarding aUreport from a physician ### concerning ### a 3 month next day after receiving injection herYdeltoid was swollen, hot to touch, knot @ injection site. NThe knot went away ###and the ### hot feeling. Swel swollen underarm muscle with pain traveling up and down to below the elbow and into the lymph Y nodes of 1/27/2009 the arm. 1/28/2009 welling, cold sweats, vomiting, fingerYnumbness, point tenderness at site of injection, severe fever Y for 5 days 1/8/2009 post injection; 1/9/2009 followed by 10 d FTER INJECTION, SHE DEVELOPED Y PAIN, REDNESS AND SWELLING AT INJECTION SITE. N ALSO1/30/2009 FEVER AND 1/31/2009 GENERALIZED RE es child had a seizure 1/31/09 around Y 5am, lasting approx 3 minutes (stiffness, then body shaking), U temp1/30/2009 99.8 F. Called 1/31/2009 911. Child taken to ER INJECTION-FEVER ACHES WHICH RESOLVED IN 24 HRS BUT DEVELOPED LARGEURED WHEEL 1/30/2009 AND INDURATION 1/31/2009 AT INJECT ps , throat and very itchy rash all over the body Y 1/30/2009 1/30/2009
e 6 hours after injection lasting 24 hours, pain, itching and redness at injection site starting 8 Y hours after injection 1/28/2009 and1/28/2009 continuing at this time ld in for immunizations. Began administration with oral RotaTeq. Infant had not even taken Ythe entire amount 2/2/2009 when 2/2/2009 she began vomitting. oss tonic seizure, mild rash Y 1/20/2009 1/29/2009 fever and dizziness. 8:00 p.m. vomiting chills and cough. 12:00 a.m. awoke with body achesYwhich lasted for 72 ### hours. It felt ###like an actual vaccines on 1-12-09. Symptoms started on Sunday, 1-25-09, with a fever, "just not feeling well" Y Took ibuprofen 1/12/2009and 1/25/2009 slept. On Monday, Ja ts to the emergency room on Sat 1/31/09 Y complaining of painful, itchy rash on torso. During Ureview of systems 1/22/2009 and 1/30/2009 physical exam, pt noted g WF received 0.5ml Pneuomvax injection Y IM in her left deltoid at 0930 1/27/09 with no complaints Y or complications. 1/27/2009 1/27/2009 This was her first expo ng the MMR, Hep A, and Varicella vaccines my daughter woke up the next morning with herYright eye looking 1/23/2009 red and 1/24/2009 half closed. It took 3 mately 6:00 pm on 1/24/09 He was unable to lift his right arm due to severe pain. Pain then moved to left 1/27/2009 shoulder 1/27/2009 then both knees began e fever (100-107 F) multiform rash on Y face only. No (grand or trunk) or est or surface. U 1/23/2009 2/1/2009 seen in office with redness, swelling 8 x 10cm with soreness to injection site. 2 x 2 cm ecchymotic Y right arm 1/30/2009 about inj. 1/30/2009 site. Encouraged res eived shots. 2:08pm- developed hives. Y EPINEPHRINE given at 2:10, BENADRYL given at Y 2:15. 2/2/2009 2/2/2009 -09 reported 1-30-09 L arm sore, itchy, warm to touch with erythema. After exam per doctorYno cellulitis.1/27/2009 Hx D.M. Tx 1/29/2009 with Cephalexin 500 m 2 X 48 degrees. Fever decreased with TYLENOL & IBUPROFEN. Q 4 degrees. Y 1/26/2009 1/26/2009 e received on 1/30/08 here in the office at 430 pm - over the past 3 days pt c/o R arm swelling N at site with 1/30/2009 redness 2-4 1/31/2009 cm non-puritic bump injection, in 24 hours, hot, red, swelling. These symptoms dissipated, then pain into arm toNwrist and under 1/15/2009 arm. TX: 1/15/2009 arm sling, cortisone n in upper outer arm where vaccine administered. Persisting from time of injection, on/off to 1/13/09 was12/9/2008 seen - note 12/9/2008 worse again. Hurts to w pustules on trunk (small vesicular lesions). Y 8/4/2004 1/31/2008 er following injection patient states she Y had erythema and slight burning of right upper arm where Y the ZOSTAVAX 1/13/2009vaccine 1/13/2009 was injected. Ery N 10/4/2008 1/4/2009 1/22/2009 Y Y Y N 1/21/2009 1/22/2009 RA + VARIVAX given on 1/19/09. On Y 1/20/09 seen Y in office for vertigo 1 feeling of weakness in N legs, headache, 1/19/2009 vomiting. 1/20/2009 Was seen in ER in hed) seizure - like episode. Y Y 1/27/2009 1/28/2009 6pm he received his two vaccines HAVRIX Y and FLUZONE. He was well and with his mother.YAt 4am that night### he woke up### in extreme pain er arm swollen and warm-tender to touch. MEDROL dose pak ordered per Dr. Encouraged patient Y to alternate 1/28/2009 heat 1/28/2009 and cool compresses to 4-6 hr > 24 hrs post vaccine red, warm, swollen 3 X 5 cm around shot site Y 1/27/2009 1/28/2009 rhea, mottled, decreased cap refill required. Suspect Y mild virus infection. 4 Note: stool sent to office Y for dsRNA 1/23/2009 rotavirus 1/26/2009 genome testing. 2/1 n has been received from a nurse practitioner Y concerning a 16 year old female patient who on Y 03-JUN-2008 6/3/2008 was vaccinated 6/3/2008with a dose of n has been received for the pregnancy Y registry for GARDASIL from a 20 year old female patient Y who was vaccinated with the first dose of G n has been received from a physician Y concerning Y a 10 year old female 3 Y patient with Y anterior and N posterior 5/8/2008 endometriosis 6/1/2008 and SYNAREL alle n has been received from a physician Y concerning Y a child who was vaccinated 0 with a dose ofUROTATEQ (lot# not available) orally. Child dev n has been received from a physician Y concerning Y a child who was vaccinated 0 with a dose ofUROTATEQ (lot# not available) orally. Child de n has been received from Y a physician concerning Y a patient who was5vaccinated Y with a "booster" U dose of PNEUMOVAX ### 23### (Lot # not provid orted in a published article, title as stated above that a 15 month old patient was vaccinated U with a first and second dose 1/1/2008 of PEDVAXHIB at n has been received from Y a registered Y nurse concerning a 22 week old female patient Y who on N 06-JAN-2009 1/6/2009 was orally 1/6/2009 vaccinated with the n has been received from an investigator Y concerning Y a 3 month old 0female Y who was vaccinated U with a first dose of ROTATEQ. This report n has been received from a licensed practical nurse for the pregnancy registry for GARDASIL Y concerning a pregnant female ###patient with he n has been received from a nurse and the patient's mother for the pregnancy registry for GARDASIL, Y concerning ###a 11/8/2008 15 year old female with n has been received from a registered nurse concerning Y a 14 year old 3 Yfemale patient who onY 16-OCT-2008 was ### vaccinated ### with the first do n has been received from a healthcare Y worker concerning a 17 year old female patient with N no known drug reactions/allergies ### ### and medical n has been received from the mother concerning Y her 13 year old daughter 0 who on 16-OCT-2008 N was vaccinated ###with a dose ### of GARDASIL was received on 27 November 2008 via a search Y of the VAERS database (VAERS Id Number: 317893). 5/8/2008 It was originally 5/8/2008 reported to VAER Y Y 2/2/2009 2/3/2009 very light headed, as though Y I was going to lose consciousness. My finger tips began to tingle, Y as though1/9/2009 they were 1/9/2009 asleep. Then my feet on was administered 11/5/2008, pt presented to the clinic on 11/14/2008 with a rash to the injection Y site that 11/5/2008 was diagnosed 11/7/2008 by Dr. as a loca ceived MMR vaccination on 1/16/09. 4-5 days later patient developed rash. Patient's HbA1c U is elevated but 1/16/2009 unsure if1/20/2009 patient was diagnosed disease, resulting with the Y tx of IVIG,Yafter 6-7 days Y of various invasive 7 testing to rule out other U illnesses. 2/28/2008 2/4/09 ER note 3/5/2008 received for DOS 3 oulder of same side as vaccine administration starting 24 hours after given. Exam consistent U with subdeltoid 1/30/2009 bursitis 1/31/2009 and rotator tendinitis. ed Zostavax on 01/06/2009. She developed Y an itchy painful rash on her neck and an itchy sensitive N area on 1/6/2009 right scapula 2/1/2009 and under her rig o the office on 01/31/09 for inconsolable crying. No cause for the crying found on exam. NoYredness or induration 1/29/2009 at1/30/2009 either injection site. N s later high fever. Next day more seriousY letahrgic, high fever despite several doses of Tylonol U and Motrin, 1/30/2009 vomiting,1/30/2009 listless, non communic
diagnosed 1/09 Y ### 1/22/2009 after administration - Fever, Chills, Swelling Y at Injection site, Aches, Diahreah for 6 days. DR.Yvisit then sent to ER ###for fluids### for dehydration. RSE EVENTS, SYMPTOMS, OR TREATMENT REQUIRED Y 1/26/2009 AY, JAN 30 PAT CALLED STATED YHE FELT ILL, DIZZY, ANXIOUS AND LOSING CONTROL Y OF HIS BLADDER. 1/29/2009 WE 1/30/2009 INSTRUCTED PAT after receiving the pneumonia vaccine Y he had redness appear on his left arm. There is minimal Y pruritus and no pain. The redness is at the s jection site after varicella vaccine in left thigh U 8/19/2008 8/19/2008 es symptoms started at 10 PM on 2/2/09 Y he was trembling, and muscle twitching. then aboutU5:30 AM on2/2/2009 2/3/09 woke 2/2/2009 up sick, dizzy, got up REPORTS CHILD DEVELOPED MIDABDOMINAL Y PAIN, DIARRHEA, AND VOMITED ONCE U STARTING 1/21/2009 1/23/09. 1/23/2009 IT BECAME INCREAS REPORTS TINGLING RIGHT ARM WITHIN 5 MINUTES OF ADMINISTRATION OF IMMUNIZATION Y BY2/2/2009 TIME PATIENT 2/2/2009 GOT HOME WIT Varicella shot given on 1/21/09. HeY had a very bad cold with congestion at the time of injection, U he developed 1/21/2009 an ear 2/2/2009 infection 3 days later hronic headaches that began very soon Y (within days) after first vaccination of Gardasil. Headaches N became progressively ### ### worse and curre n, severe swelling, hives. Told to iceY and take motrin. Still discolored, swollen and painful 2 weeks U later. 1/20/2009 I was offered 1/20/2009 the vacine in the hos ped vasculltic lesions on legs/feet with Y pain/swelling & polyarthralgia onset approximately 11Ndays following 1/8/2008 receipt of 1/21/2008 AVA# 3; diagnosed w broke out in welts. Entire body covered Y above hips, including groin, breast, scalp, ears, face, N back. Accompanied 1/21/2009 by 1/29/2009 intense burning and it ge cluster of pinpoint vesicles with clear fluid on right posterior trunk with surrounding erythema. Y DX: Herpes 11/5/2001 Zoster 1/7/2009 d used topical Neosporin 2 + times per year for many years for minor skin abrasions etc. Patient received9/1/2007 ZOSTAVAX 1/1/2008 9/07 and 1 month la n 12/23. Pt had ache front to back 12/30 and reported to MD. Rash break out under left breast Y 1-2-09, patient said ### all symptoms ### gone exce U ### NG SGT who noticed a single 4mm Yvesicular lesion on her left forearm one day following receipt U of ANTHRAX ### (AVA#4), influenza, ### & typhoi screaming x 48 hrs. Y ### ### staring spells vs sandifer's syndrome. Head tilt and head bowed and eyes rolling back in head U - lasts no more than ### 7-10 seconds. No sleep upper arm flu shot 46 X 44 mm left DTAP 65 X 39 mm right Y 1/7/2009 d a little red immediately after shotsYwere given, area gradually enlarged. By 1/15/09 (2 daysYafter shots)1/13/2009 the area covered 1/15/2009 her left thigh + h er the vaccine neck started to ache. Pain went away for 30 to 40 min. Then pain came back. until now. Pain 2/3/2009 located at 2/3/2009 site. Almost after th ort received on 23 January 2009 through Y literature that in 2008, one child aged 5 months hadYreceived two doses of 11/1/2008 ACTHIB (date of vaccin ort received 28 January 2009 from a consumer Y who is the patient's aunt. 0 A four-month-old patient U with a history of respiratory problems, had dates of adverse events were not recorded Y by me. they started in early December, Y 2007 after N a series of shot ### given12/1/2007 by his pediatrician. My e T 24 hours after shots. Y 1/29/2009 pain, fever, vomiting, perioral- rash, YItching (scalp) > -acetaminophen (rectal) - warm compresses U - ZYRTEC 2/3/2009 2/3/2009 n Tues eve (2/3) pat experienced itching Y woke up w/blistering rash on waist, under breast & U arm pits - itchy 2/2/2009 & red 2/3/2009 vaccine 1/23/09. Febrile seizure 1/30/09 Y Y 1/23/2009 1/23/2009 degree F the day after Tdap vaccination. No other symptoms. Y 1/22/2009 1/23/2009 ZOSTAVAX vaccine approx. 1pm 1/22/09 went to bed approx. 1030 pm that night-had bout Y of very fast,hard, 1/22/2009 heart 1/22/2009 palpitations lasting app adaches, rash prior to immunization documented by doctor at medical center. Not resulted from Y MENACTRA. 1/26/2009 Student 1/26/2009 did not report any s eginning w/; 24 hrs- fatigue. Panesthesia hands on 2/4/09. U 1/28/2009 1/29/2009 ient was given DTap at 10 years of age). 11/5/2008 tous maculopapular spots on torso, legs and arms. Not itchy. Occurred about 5 days after vaccination. Y Resolved ### without treatment. ### No feve p, Hep A at well child cheek 1/7. Screamed all night and again next night. No fever. No other Y source. 1/7/2009 1/7/2009 arrhea for 1 month. Y Y ### ### 30 p.m. I administered MMR and Varicella IM rather than sub q. There were no adverse reactions Y while1/23/2009 client here.1/23/2009 8/28/2008 N 8/27/2008 8/28/2008 p on arm at site of administration. Pt also diaphoretic and sweating all night Y 2/3/2009 2/4/2009 and crying for more than 3 hours. Y ### ### MMR and Varivax on 1/30/09. Came to the office on 2/3/09 with a flat pinkish rash on chest U and legs with 1/30/2009 a temperature 2/2/2009 of 103.8. ed headache, upper torso myalgia approx. 6 hours after vaccine. Symptoms lasted approx 48Y hours. 1/12/2009 1/12/2009 derwent surgical debridement of necrotizing Y faciitis Y at the site of immunizations. 7 Discharge to Y home today 1/27/2009 on oral antibiotics. 1/27/2009 d vomitting, diarrhea, and low gradeYtemp withiin 12 hours of vaccine Y 2/3/2009 2/4/2009 ve weakness and muscle atrophy in lower extremities, Y L>R with intermittent 4 parathesias. 3rdNvaccine given 9/9/2008 around 9/12/2008 Sept. 9 and unusaly gat eloped fever of 103 and vomiting on Wenesday 1-28-09 lasting until Thursday 1-29-09. Treated Y herself symptomatically 1/27/2009 1/28/2009 and did not seek m urned to clinic 1/29/09 with child. Noted edematous/reddened upper Right arm. Extremity freely Y mobile;child 1/27/2009 complained 1/28/2009 of pain & itching a ed of fever last night (2/3/09)and today complains of sore throat, red spots on neck,trunk andUarms. Acyclovir 1/26/2009 200mg 2/3/2009 every 4 hrs ordered. B
S A VACCINE WAS ADMINISTERED Y IN LEFT ARM, THEN GARDASIL VACCINE WAS ADMINISTERED Y 2/4/2009 IN RIGHT2/4/2009 ARM AND APPROXI pneumococcal vaccine trial, with severe COPD, Y was hospitalized with COPD exacerbation. YVaccination took 1/2/2008 place 1/15/2009 on 1/02/2008. Accordin NER L EAR AND CHEEK. LOCAL REACTION TO INJECTION SITE- REDNESS AND SWELLLING. TO TAKE 5CC OF BENDADRYL Q 6 H nted after vaccines Y 2/4/2009 2/4/2009 ordered pneumo vaccine. patient given varicella Lot # 0994X Exp: 11 July 2010 U 2/4/2009 2/4/2009 o 104 24 hours after vaccine administered. Y Also had runny nose and mild cough. No rash. U 2/2/2009 2/3/2009 er on the inside, left lower lip. No other adverse reaction noted approximately 24 hours postYinjection. 2/3/2009 VAX administered at 10:00a on 2/4/09 Y at Pharmacy to patient. Wife called at 3:30p and reported N husband 2/4/2009 is experiencing 2/4/2009 excruciating pain cine administered IM in right deltoid instead of SQ 2 calls made to pt 2/4/09 for f/u - no answer Merck contacted2/2/2009 indicated 2/2/2009 vaccine may be wheezing 01 hour after Influenza vaccine. Y 2/5/09-records received for 11/5/08-presented toYER with skin11/5/2008 rash. DX: 11/5/2008 acute allergic reaction t redness and swelling in Lt arm. Had Tdap & flu vaccine in same arm. Y 1/26/2009 1/26/2009 rts that patient had sudden onset ofYepisode of "stiffness" tonic state x 2-3 sec. Followed byYgeneralized1/27/2009 clonic-like1/27/2009 seizure activity of abou zed reaction Y 1/22/2009 1/22/2009 s after vaccine given (given 1/30/09). On 2/1/09 pt. developed "hot, itchy, burning flue rash U on thighs, abdomen 1/30/2009 & back 2/1/2009 of knees- Denies raised tender erythematous reaction at injection site. N 2/2/2009 2/3/2009 of blanchable erythema across left thigh Y spreading laterally to medially. Not tender no induration. Treated 1/29/2009 with antibiotics in ED- discontinu was reported by a healthcare professional and described the occurrence of intramuscular formulation U administered 1/23/2009 1/23/2009 by other route in a 2-m was reported by a physician via a sales representative and described the occurrence of injection Y site redness in a subject of unspecified ag was reported by a healthcare professional and described the occurrence of high erythema inY a child subject 1/1/2009 under the 1/3/2009 age of 6 years and o was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject 1/12/2009 under 1/13/2009 the age of 6 years and was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject 1/5/2009 under the 1/6/2009 age of 6 years and was reported by a pharmacist and described the occurrence of injection site redness in a 35-year-old Y female subject who was vaccinated w n has been received from a licensed Y practical nurse (L.P.N.) concerning a 24 month old premature Y born 12/5/2008 male (2 month 12/6/2008 early) with asthma w n has been received from a physician Y concerning a 42 year old female with multiple Y sclerosis N who on 29-JUL-2008 7/29/2008 was vaccinated with a d n has been received from a 19 yearYold female patient who on 27-JAN-2009 was vaccinatedYwith first dose 1/27/2009 of GARDASIL 1/27/2009 (Lot # not reporte ned in March of 1987 I was Y a healthy teenagerYwith records to prove it. SometimeY between March N and May 3/20/1987 of 19873/20/1987 I received several vacc eceived ADACEL vaccine Y on 11/20/2008 On 12/01/2008 Y he presented 6 with leg numbness Y and tingling which was ###progressive. ### Urgent refer me vaccine reaction. The injection triggered a flare up of pts underlying reflex sympathetic dystoptry. n, hoarse throat 3 hrs after AFLURIA administration. Y Treated with BENADRYL and SOLUMEDROL U and felt better. ### al reaction 10X18 cm around injection site. Area is red + indurated + warm to touch 1/28/2007 dness, swelling + warmth at the injection site (right upper arm) Y 2/3/2009 2/5/2009 ctivity at 3-4 minutes duration with eyes Y rolled back, not responsive to parents. Temperature Y104.2 F rectal 1/30/2009 at urgent1/30/2009 care center. No preced gic to eggs, and vaccine compoents.YSevere stomach cramping, vomiting, headache, dizziness Y which lasted for### 2-3 days ### oped rash bilaterally over both thighs According to mom and maternal grand mother the maculopapularv U 1/30/2009 rash started 1/30/2009 from the the sites =o dness and swelling in arm from injection Y site into elbow Y 1/28/2009 1/30/2009 nted to the family practice clinic on 1/27/09 withYcomplaints of fever x1 1 day. Infant was fussy and Y difficult to 12/1/2008 console, 1/27/2009 and was refusing breas rgic skin reaction. U 2/2/2009 2/3/2009 nset of lethargy and vomiting. Y Hospitalized Y for Y lethargy, to rule out sepsis. 3 Continued vomiting Y lead to diagnosis 1/29/2009of intussussception. 2/2/2009 Succ ports adolescent having hives on hands,knees and feet that began approximately 2-3 days past N receiving1/22/2009 vaccines on 1/24/2009 1/22/09. Also reports gan febrile episode on 1/31 with fever Y up to 102.4 F lasting 3 days. Patient was taken to physician U and 1/30/2009 upon examination 1/31/2009 no signs of infec arm erythema area on rt. arm extending from deltoid to elbow. no blisters. extends around arm. U Client has2/2/2009 red hair and 2/4/2009 very fair skin. h pt on Tuesday 2/3/09 she was administered the HPV vaccine about 4 hours later a rash devloped Y on her 2/3/2009 back that 2/3/2009 grew to cover the maj mplains of severe pain in left arm when lifts the arm, since first injection given N 12/8/2008 12/8/2008 ythematous tender reaction right arm Y 1/2 diameter. No complication Y 2/2/2009 2/3/2009 s administered Hep A in right deltoid and menactra right lateral arm and PPD implant right forearm Y at around 2/5/2009 4:55pm.Erythema 2/5/2009 and few pa e localized reaction at injection site including erythema, hives, itching. Given benadryl 25 mgYp.o. and ice 1/29/2009 to area. Reaction 1/29/2009resolving 25 m cieved HAV#2 on 2/3/09, went home Y and had aY3hr nap, mom woke1patient and noticed coughing Y and wheezing, 2/3/2009which 2/3/2009 continued through generalized seizures with fever. He Y had one seizure by report previous to the vaccination. This Y was a five-minute 1/29/2009 seizure. 2/3/2009 we had at least TERED IN LEFT DELTOID ON 2/4/2009; Y WITH IN 3-4 HOURS EXPERIENCED SEVERE PAIN IN DELTOID 2/4/2009 MUSCLE, 2/4/2009 JOINT OF LEFT S e client had within 24 hours: Fatigue, lethargy, loss of appetite and general weakness. Y 5/2/2008 5/3/2008 ble crying X 8 hours Y 12/2/2008
ver body. Got shot yesterday. RashY today. Y 2/3/2009 2/4/2009 warmth, swelling around site of 2 injections. Y Started 2 days after vaccines given. No fever. UPrescribed oral 2/2/2009 antibiotics, 2/4/2009 BENADRYL, MOTR nt dad who said skin was bumpy for a day or two but has gone away. No treatment. Y 1/13/2009 perienced a vasovagal response to HPV. Duration was 4-6 seconds. BP at 09:30 60/40 pulse-50, Y at 9:45 62/40 ### p-52, BP at ### 10:00 72/40 pox rash site 2/2/09 - No other symptoms. U 1/15/2008 2/2/2009 rm & chest with + urticarial patches Y+ 2 cm swelling @ injection site lungs clear- no wheezing Y Given SOLUMEDROL 2/2/2009 2/3/2009 125 mg IM. ALBUTE and lethargic and poor feeding. Hospitalized Y - Hydrated. Y 1/17/09 MR 2 received for DOS 1/29-30/2009 Y with 1/27/2009 D/C Dx: Sleepiness 1/27/2009 after immun se reactions known patient was sent a letter by mail. Patient has no working phone number. U 2/4/2009 ight eye to be a "little pink". Went toYstation and was prescribed VIROPTIC and ILOTYCIN drops. 01/26/2009 1/15/2009 the right 1/23/2009 eye was worse (sw veloped hundreds of vesicular and papular lesions, described as "itchy", on trunk and LE. U 1/27/2009 2/2/2009 3, hearing loss, sleep disorders, neurological Y problems, Y headaches,1muscle jointYpains, fatigue, N muscle spasms, recurring 7/2/2008 skin lesions, chil ent, hearing loss, scoliosis, sinus,high Y blood pressure, Y tinittus, rhinitis, 6 sleep disorder, Y headaches, N muscles 1/12/2003 joint pain, muscles spasm, recu n has been received from a physician concerning a male patient who is 20 months at present Y who received his first dose of ATTENUVAX, n has been received from registered nurse concerning a 42 year old female nurse who was U vaccinated with a second dose of ATTENUVAX n has been received from a pharmacy student concerning an adult female patient who was vaccinated U with four doses of ATTENUVAX vac n has been received from a physician concerning a 2 year old male who on 26-JUN-2008 was N vaccinated 6/26/2008 with ATTENUVAX 7/4/2008vaccine (Ende n has been recieved from a consumer concerning her 8 month old son who on 29-APR-2008Nwas vaccinated 4/29/2008 with a4/29/2008 dose of MMR II. Suspe n has been received from a 62-year-old female physician, with a history of hepatitis B and an U allergy to penicillin, 2/1/1997who 4/25/2008 in February 1997, wa n has been received from a registered nurse concerning a 24 year old female who was vaccinated Y with ATTENUVAX. The nurse mentione n has been received from a nurse concerning Y a 13 month old male with no pertinent medicalNhistory, drug4/4/2008 reactions or allergies who on 04n has been received from a nurse concerning Y a 16 month old male with no pertinent medicalUhistory and3/20/2008 a milk allergy 3/27/2008 who on 20-MAR-200 n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008 history or allergies, 3/29/2008who on19-MAR n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008 history or allergies, 3/29/2008who on 19-MA sy developed 17 DEC 08 2/17/09-records received Y for DOs 12/22/08-Released 6 form hospitalYafter exhaustive investigation ### ### into sudden left f n has been received from a Registered Y Nurse concerning her 22 year old daughter who on 27-OCT-2006 Y was ### vaccinated 3/2/2007 with first dose of n has been received from a doctor of Y pharmacy for the pregnancy registry of GARDASIL concerning U a female patient who on an unspecifie ### N ### ### swelling due to tetanus toxoid. Vaccine was not administered at this facility, so very little information can be reported. Patient just reports a got the vaccine I didn't have any pain Y or swelling. The next day (Saturday) I had a little soreness. Y As the1/30/2009 day progressed 1/31/2009 the pain got worse received a Tdap vaccine in the left deltoid muscle on 02/02/2009 at 1100. The next day sheU had an approx 2/2/2009 6" red, 2/3/2009 swollen, warm to touch hours after rec'ing the MMR shot our son began to run a low grade fever 99.7, vomiting, irritable U mood. We 2/5/2009 informed2/6/2009 the doctor's office and und alert but shaking in bed at a group Y living setting and then vomited. Evaluated by medical Y staff there and 2/4/2009 sent by2/4/2009 ambulance to local ER arted receiving Anthrax vaccinationsYin 2007 and has had a total of 4 shots. He has had jointUpain, in all joints, 3/1/2008 feeling "achy" after each inje accination site and over entire body. U 1/26/2009 1/26/2009 Vaccines on 2/3/2009, and rash started 2/6/2009 from neck down. Advised mom to give patient U Benadryl 2/3/2009 every 6 hours. 2/6/2009 f left thigh. Hospital admission IV antibiotics. 3/23/09 Y Received hospital 2 medical records of 2/4-2/5/2009. Y 2/3/2009 FINAL DX:2/4/2009 left thigh cellulitis Rec B vaccine administered. 0845 Client still in building came to my office stating her RT arm was Y breaking in2/6/2009 rash and itiching 2/6/2009 real bad. Denie noted to get red, swollen & splotchy in the evenings since Vaccine given - looks fine in the AM, Y when this 1/26/2009 is noted he 1/26/2009 states that entire thig up with patient around 2-3AM on 01/30/2009 Y and Y no problems. When 2 mom was up with patient Y around 1/29/2009 6-6:30AM, 1/30/2009 he had a fever of 103.5 d a hard time walking the day after Y her immunizations, Y she seemed3stiff and sore. Then again, U a week after 1/6/2009 her immunizations 1/12/2009 she had tro vaccine, left deltoid became red andYswollen. Tender and warm to touch. Over the next several U days signs 1/9/2009 and symptoms 1/10/2009 progressively w ented w. generalized hives on neck, chest and general body 3 days after immuniaztions Y 2/2/2009 2/5/2009 ven pneumovax shot (I.M. Right Deltoid) on 2/5/09 @ 1415 in his home. Pt. called clinic this morning and2/5/2009 left a voicemail 2/5/2009 reporting that he 0 MIN. AFTER SHOTS, BABY BECAME LETHARGIC WHILE BEING HELD IN DAD'S ARMS, Y HEAD DROOPING 1/21/2009 DOWN. 1/21/2009 sHE WAS LAID nted immediately after first shot. Has Y experienced Y extreme fatigue,memory 2 loss, trouble concentrating U and 8/20/2007 after the8/20/2007 third shot started exper me of Gardasil vaccine, but one year later adverse immunune system problems that included strep throat, 10/9/2007 urinary tract 6/1/2008 infections,treated fo fter my 2 month old son received the Y rotavirus vaccine with his other 2 month shots he has had N bright green 1/19/2009 diarhea1/20/2009 since, on a daily basis booster anthrax on 2/2/09. On 2/3/09 soldier presented with injection site erythema and itching. Y Treated with 2/2/2009 antihistimine. 2/2/2009 On 2/4/09, sym ped L sided seizures 24 hours after receiving PENTACEL, Y ROTATEQ 3 and PREVNAR. EEGUis abnormal, 2/4/2009 so likely not2/5/2009 vaccine related. Pt w arted to feel tingling sensations on back starting about 01/11/09. These symptoms Y continuedNto manifest until blotches ### 1/11/2009 appeared on the skin se events. Medication given PENTACEL and ACTHIB given at same time, reporting medication. 2/2/2009
l pain within 5 min after vaccine & urticaria 10-15 min after vaccine. Used BENADRYL withYrelief. 2/6/2009 2/6/2009 rted severe local reaction at R leg, very red and swollen x 7 days, would not wear clothing over Y it and very 7/16/2008 bothered7/18/2008 with discomfort x 1 we over. Hives. No respiratory problems. No other problems. 2/3/2009 2/4/2009 le pt. presents to clinic with "infection Y at primary SPV site." Pt. reports receiving primary SPV (left upper7/14/2008 arm) on 7/14/08, 7/23/2008 at same time wit irst Anthrax vaccine and a Typhoid immunization on 4 April 2008. That same night I noticedYa reddish, warm 4/4/2008 lump the 5/14/2008 size of my fist on the le with possible adverse reaction toYSmallpox Vaccine. 2/10/09 Office note received from reporting Y MD. Pt 9/24/2008 seen 10/6/08 9/29/2008 with c/o L arm pain nt is a 38 year old female. Source of patient information was patient. Source of patient information Y was 10/3/2007 medical records. ### Received second male with hx of hospitalization s/p AVA #6 for Y pericarditis/pericardial 5 effusion July 2004, concerned Y receiving 5/10/2004 further 7/1/2004 doses of AVA. PCP co male, spouse of retired SM presents to FBVHC with report of developing a rash "hives" on both Y arms and5/19/2008 legs within5/20/2008 24 hrs of receipt of Tda welling, discoloration, soreness, swelling would be three times the size of opposite shoulder. U 2/4/2009 2/4/2009 ceived ROTATEQ ON 1/12/09. She is breast fed. On 1/13/09 mucousy stools were noted. Y On 1/20/09 1/12/2009 stools were1/13/2009 dark, tarry and heme-p d emesis and cyanosis a few hours Y after flu vaccine. Valvar pulmonic stenosis with 50mm gradient. Y 1/22/2009 1/22/2009 ent phoned in and report he had a reaction Y to pneumonia injection given 2-5-09 here @ PCHD. U Instructed 2/5/2009 client to take 2/5/2009 BENADRYL OTC a e, fever 104, red, swollen injection siteY less than 24 hrs. Patient irritable + crying frequently. YInfluenza site: 2/3/2009 Normal. 2/3/2009 symptoms began on 1-27-09 With client experiencing flushed face, tired, external chills, weakness Y + sharp 1/26/2009 shooting 1/27/2009 aches + pains to all ext IVAX vaccine, developed varicella 20 days later. U 1/15/2009 2/5/2009 izures, temp 103.2 degrees. Y Y 2/2/2009 2/3/2009 rm "tingling", numbness & difficulty Y with any weight bearing L upper extremity. Symptoms started U approx 5-> 6### hrs after injection. ### patient developed fever 101 @ home Y around 10pm 1/31/09- given dose of TYLENOL- shortly Y after pt had 1/30/2009 jerking +1/31/2009 shaking, eyes rolled ba Y ### arm with 10x7 cm faint erythema surrounding 3x3 cm induration with control puncture mark.U Area is sensitive 2/3/2009 to touch. 2/4/2009 et of redness, pain, swelling an painY with movement of RUE. Prescriptions of MOTRIN, PREDNISONE, N DIPROSONE 2/3/2009 2/5/2009 CREAM, DARVOCE , indurated area left arm. BENADRYL, Y IBUPROFEN, ice Y 2/4/2009 2/5/2009 s, arm pain, warm to touch, and swelling 2/4/2009 2/4/2009 large hive appeared first on leg, then hives spread over legs and trunk. Concomitant fever Y lasting 5 days. 1/21/2009 1/29/2009 ately 5 minutes after immunization was Y administered, pt. stated that he felt lightheaded, fell back Y against wall, 2/6/2009 and exhibited 2/6/2009 seizure-like act ulitus requiring hospital admission for 1 1/2 days. Y r arm swelling beginning 2 48 hrs after administration, Y DTap 2/2/2009 and Var given 2/4/2009 in r arm. L arm w cus in mouth, wheezing,difficulty breathing, fever behavior changes. fever showed up day ofUshot. and other 2/5/2009 symptoms 2/6/2009 showed up the next t at least 25% of my hair. I have never Y experienced this type of hair loss before the shot, andNam not under 1/10/2008 any major stress. I had my last s rmation was received on 29 OctoberY2008 from a manufacturer whose initial reporter was a health care professional. A patient experienced rmation received on 29 January 2009 Y from a health care professional. A female patient with a history of diabetes, asthma, and an allergy to n has been received from a health professional concerning a 77 year old white female patient U with sulfonamide 3/1/2007 allergy 1/22/2009 who on 1-MAR-2007 n has been received from a physician concerning a 61 year old female with sulfonamide Y allergy N who on 1/29/2009 29-JAN-2009 1/30/2009 was vaccinated SC w n has been received from a pharmacist concerning Y a 71 year old female 0 Y with a history of shingles N 2 years6/9/2008 ago and no 1/25/2009 allergies, who on 09n has been received via a literature article regarding Y a case in litigation 0 Y concerning a male who U at 2 months of age was 3/30/1998 vaccinated with RE n has been received from a consumer Y concerning her 6 year old son with no medical historyNand drug allergies who was vaccinated with th n has been received from a consumer concerning a 7 year old male who was vaccinated with N a dose of MMR II on unspecified date. Soon n has been received from a consumer who was the relative of a male patient whoY "about 50Nor 60 years ago" was vaccinated with a dose o n has been received from a consumer concerning her relative who was now a 63 year old male N who was vaccinated with MMR II (mfr. unkn n has been received from a consumer concerning her relative 3 year old daughter with symptoms U of autism who was vaccinated at 1 year o n has been received from a physician's assistant concerning a 17 year old female Y who "within U the last month and ###a half", on approximately n has been received from a certifiedYmedical assistant concerning a 22 year old female Y allergic N reaction 1/11/2009 to LEVAQUIN 1/18/2009 who on 17-NOV-200 n has been received from a nurse and Y a physician for the pregnancy registry for GARDASILYconcerning 8/31/2007 a 15 year old4/9/2008 female student with n 0 the pt received HepB #1 and the Meningococcal Y Vaccination in preparation 1 for college entrance. U On 7/17/00 6/16/2000 the pt 7/17/2000 suffered a seizure and RDASIL shot series, It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008 a change in my vagin had second shot of GARDASIL and is having bad headaches, pain in the abdomen, nausea,Unight sweats, 2/3/2009 depression, 2/3/2009 lower back pain. H es, fever (>100 degrees), chills-onset 8 hrs. After administration of FLUZONE. Lasted over night, Y until next A.M.### Took Tylenol ### po. swollen, red, and hot to touch around Y area where VARICELLA was administered. Pt statesYpain has worsened. 2/2/2009Advised 2/4/2009 pt to go to doctor f vaccination developed rash on trunk. Parent thought possible hives. Advised BENADRYLYpo dose. No 1/19/2009 other symptoms. 1/19/2009Rash resolved es on both arms & trunk day after injection - resolving with use of OTC catesine cream Y 1/28/2009 1/29/2009 2008, family medicine--Got shingles vaccine around 2:00pm in my upper right arm; given by medical Y assistant II. ### She had ### taken my temper
r imm. child had fever 101, rash veryY red and much more prominent than usual. No vom or diarrhea. Y Took 1/27/2009 to doctors 1/28/2009 office at 11 AM. Doc complained of pain in her R arm with pain radiating from shoulder to hand the morning of 1/28/09. U This 1/26/2009 pain is still 1/28/2009 present > 1 week after v complained of pain in her entire R arm the afternoon of 1/28/09, approx 2 days after vaccination. U No radiating 1/26/2009 pain-just 1/28/2009 persistant pain in h ent to receive the 3rd shot of GARDASIL. Y The person who administered the shot squeezed patient's arm1/21/2009 and stuck 1/21/2009 the needle in her arm a 01 degrees F > Broke out in Hives > Pt. called into H. Dept 9/23 c/o of these symptoms did not U seek medical 9/22/2008 care- Never 9/23/2008 returned phone c swelling, pain. Y 1/20/2009 1/21/2009 Y Y 4/28/2008 1/22/2009 d dog bite in am and needed booster Y td was given tdap approx 10 am in rt delt im.pt states about U noon his2/6/2009 rt upper arm 2/6/2009 and rt shoulder star s soon as injection given then later that day large reddened area looked like a hive about theYsize of baseball 11/4/2008 which 11/4/2008 lasted several days. n Monday, February 2, 2009. Per patient: Y Tuesday night I could barely move. Sore all over, kinda Y like a flu2/2/2009 ache but much 2/3/2009 worse. Wednesd HROUGH CHICKENPOX FEBRUARY Y 2009. RECEIVED VARIVAX 8/1/2003 AND PROQUAD 8/18/2006. 8/18/2006 2/5/2009 d spread of smallpox due to drying self with towel that may have had possible contact with vaccination U area. 1/29/2009 2/10/09 Per 2/5/2009 reporter-pt was no d yellow fever vaccination 05 Feb09. Y After recieving the injection, pt experienced dizziness, confusion, N nausea, 2/5/2009 and blurred 2/5/2009 vision x 4 days. ed in and states that child has chicken pox despite receiving the vaccine on 05/24/2002 Y 5/24/2002 2/8/2009 er vaccination, varicella-zoster virus-like rash and symptoms. Y ### 1/28/2009 nced shoulder girdle pain for 3 days followd by arm weakness and serratus muscle paralysisNwhich has 11/4/2008 not resolved as of### today. Pt had a s started with "strangled cough" Y and Ybody aches. Y 12/12/2008 Had severe 6 vomiting and diarrheaN extremely weak ### and12/3/2008 barely could walk-no s per and lower extremity swelling and erythema when extemities are warm. Cyanosis of the swollen U extremities 2/5/2009 when2/7/2009 they are cool. Also fac r entire body that itches. Zyrtec 1/2Ytsp q12hrs. given to treat symptoms as needed to help with Y itching. 2/2/2009 2/8/2009 ntracted cellulitis in his left leg, afterYreceiving 3 vaccinations in that leg. He had to be treated U at the ER 38 2/4/2009 hours after 2/4/2009 receiving the vaccin headaches and numbness in left arm, Y fingers, chest and leg starting after HPV #1(7/8/08), which N were annoying 1/22/2009but 1/22/2009 tolerable. Now experie esented to clinic with mother (MOC)Yto receive 4 month vaccinations. During the screening process Y MOC stated ### that infant ### became extrem (48 hours later) Low-grade fever after Y treatment with Tylenol/Ibuprofen lasting at least 5 days, U Mild Rash, 2/3/2008 Lethargy, 11/5/2008 Listlessness, Fussine slightly swollen red rash (approx. 1.5 inches in diameter) was noticed on my upper arm at theYsite of the vaccination 2/2/2009 about 2/3/2009 24 hours after be ed rash at injection site, fever Y Y 1/29/2009 2/5/2009 U 2/9/2009 swollen, & rash around vaccine area notice on 2/6/09 taking bath, on 2/7/09 & 2/8/09. The rash U went away 2/6/2009 redness 2/6/2009 swollen 7cm x 6cm on 1/10/2009, red bumps appeared onY back of hands + face - total E2Y changed to - 5 pustules Y resolved after one ###week 1/10/2009 s noted to have Red spots first on arms, Y trunk and then legs. Rash lasted 5-6 client was taken to ER with1/22/2009 104. fever,1/22/2009 client TX for pneumoni elling, rash prescribed Orapred andYgiven Benadryl at ER Y 2/6/2009 2/6/2009 n 25-09 2-6-09 fever (elevated to 104.7 Y rectally - ER notes) lethargy > febrile seizure Y 2/5/2009 2/6/2009 ace, neck, groin area, back, and torso. Y Y 2/3/2009 2/3/2009 student came in with c/o R hand reddness at the nails. Started with 2-4 fingers then extended U to 4th + 5th 1/16/2009 fingers, 1/21/2009 slight edema, mild tend hills 5 hours after vaccine, lasted 4 days. Y 2/4/2009 2/4/2009 ays fever and runny nose. 12 days-rash-head, belly, arms and legs. Itching. Improvement atN15 days. 1/26/2009 1/30/2009 hargic 10 minutes after the infection chills immediately after injection. U 2/4/2009 2/4/2009 rs after vaccine pt broke out in hives all over hands and face on and off x 3 days. Given Benadryl Y with relief. 2/4/2009 2/7/2009 ministration the patient had a vasovagal response. She was sitting on an exam table was brought Y to a recombant 2/6/2009position 2/6/2009 and recovered w ed clinic on 2/6/09 (injection given on 02/4/09) stating after third HPV injection she experienced U mild swelling 2/4/2009 @ site 2/5/2009 with moderate pain an ates she had a S/E of right arm pain from upper arm down her arm which lasted 5 days, It was Y hard for her 1/15/2008 to lift her1/15/2008 right arm over her shou /09- Rx scarred immediately - dizziness, Y 1/31/09 Temp 103 redness- swelling and warmth. Decreased Y appetite. 1/30/2009 Dizziness 1/30/2009 relieved by antiv ted to ER c/o arm soreness radiating Y to head. Increased soreness over WE. Pt noted mobileYfirm module1/22/2009 (L) elest @1/26/2009 collar bone. MD's note ted to office with erythema & ederma @ below the sight of the injection, pt also developed fevers Y for 2 days 1/23/2009 post injection1/23/2009 treatment was B swelling at injection site. Y 1/14/2009 n has been received from a gynecologist, concerning a 21 year old female patient with history U of pollinosis 3/13/2008 who was3/28/2008 vaccinated with a third dy aches, anxiety, high Cholesterol, Y concentration difficulty, constipation, crampsYarms, depression, digestive problems, ### dry ### mouth, energy iving the vaccinations, the patient was hospitalized Y for six days. The6 patient's symptoms included Y vomiting, 1/23/2009 diarrhea, 1/25/2009 fever. 5/7/09 - Hosp r rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient N with no 8/24/2007 reported past 8/24/2007 medical history rec rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient U received 1/31/2009 MENACTRA 1/31/2009 (lot number U2824 n has been received from a physician Y concerning Y a female patient who 2 on unknown date was Y vaccinated8/16/2008 with the second ### dose of GARDAS n has been received from a nurse who reported Y that she received an 0 email from a former employee U of theirs, who stated in the email that "a
n has been received from a physician Y concerning a 14 year old female who was vaccinated Y with the first dose of GARDASIL. Subsequently n has been received from a consumer concerning her 5 year old daughter with penicillin allergy Y who was vaccinated with MMR II (lot numb n has been received from a nurse practitioner and a female consumer with drug hypersensitivity Y N (No otherwise 5/23/2008 specified) 6/30/2008 who on unspecifie 2/4/2009 2/4/2009 n: PENTACEL. persistent fever- 3 days of 100-102 degrees. Red blotch around shot site 3 inches in diameter and beginning to spread to th es child started becoming grouchy. Y Appetite decreased. Few days later noticed left side of face/jaw Y swollen. Went ### to1/23/2009 Doctor-who was sure 09 patient presented to Urgent Care with c/o crying, Y low grade fever, 7 vomiting, diarrhea. Was Y admitted to 1/20/2009 hospital with 1/26/2009 diagnosis of Gastroe es child was dizzy, nauseated and right Del red swollen, redness under arm as well and is painful. N 2/4/2009 2/5/2009 ceived KINRIX (DTap and IPV) to left medial thigh and Flu to left lateral thigh 2/6/09. MotherUnoticed itching, 2/6/2009 redness 2/8/2009 and swelling at media notability, poor feeding, lethargy and Y sev. min. of 1 y twitching. T 100.3 F in office on 10/19/05, Y and nl exam. Back ### to self### by 10/20/05 per eadache pain. 2/18/09MR received Y from PCP including vax rec and numerous consultations.NInitially c/o 8/30/2007 with visual changes 9/1/200710/3/07. PE (+ eadache, head congestion, chills. N 2/5/2009 2/5/2009 at sight and swelling of leg - right leg Y 2/6/2009 2/7/2009 I am having an adverse reaction to the Anthrax shot I received on Sunday (8Feb09). I haveUbeen experiencing itching 2/9/2009 from the spot where ccinated on Friday 2/6/2009 at 11:45am and then approx. 12 hours after vaccination at 1:30am, Y patient had 2/6/2009 102.5 temp 2/7/2009 with chills, sweats, ced redness around neck later in day Y after vaccinations.Pt has a pink-red collar-like ring around U neck. Given 2/9/2009 Benadryl2/9/2009 in office. stered on 01/29/09 left deltoid area.Returned to clinic 02/02/09 with complaint of left deltoid redness Y 6in/5in, 1/29/2009 erythema 1/29/2009 with warmth and sligh HAS A RASH ON HIS FACE, BOTH Y ARMS ON THE DELTOID AREA, AND A SMALL PATCH U ON HIS CHEST. 1/29/2009 2/8/2009 with 2 1/2" x 1 1/8" erythematous area, warm to touch. (+) pain when touched; (+) itching. Patient's Y mother 2/4/2009 noticed a2/5/2009 small erythematous a nt present with a Swollen and red upper left arm that felt hot to the touch. She denied having Y a fever but1/30/2009 stated her arm 2/2/2009 really hurt a lot. S ately 2 hours (10:00 AM) after receiving 2 immunizations (hepatitis b and Tdap) the back of Y her left leg began 2/9/2009 to have2/9/2009 a burning sensation. m firm cystic lesion on Rt leg at sight of injection Y ### 2/4/2009 event fifteen minutes after vaccine admin. Y 2/7/2009 2/7/2009 ry lymphadenopathy: swollen, tender. Y There was no source of infection, so I had mammogram Y plus ultrasound 1/28/2009 done. 2/6/2009 Multiple suspicious no gan having frequent UTI's after firstYHPV. Then after second got yeast infections every 2 weeks and tingling 1/17/2008 in fingers 1/17/2008 and toes. After third ates had problems with "legs Y giving Y out and weakness." Y Noticed symptoms 5 on 1/27/2009 and Y went to emergency 1/15/2009room. 1/27/2009 Patient states was ed 1 Jan 1992. Approximately Y 30 min Y after receiving Y Typhoid vaccine, 5 member developed severe Y headache, 1/11/1992 vomitted, 1/11/1992 and notable respirat ain after injection. Few minutes later severly dizzy and disoriented. Blurred, splotchy vision. UStill have pain 2/9/2009 in arm to 2/9/2009 which it was administe started on face 8 days after MMR shot, fever, runny nose. Rash spread to back and then next N day to the 1/29/2009 stomach. Today 2/6/2009 he has been claw hour of arriving home from the vaccines, Y patient went down for a nap. He woke up screaming. U As I tried 9/11/2008 to console him, 9/11/2008 give him tylenol, an h: The HPV vaccine Gardasil Y was administered Y Yon January 15, 2009. 10 Y Thirteen days later andYfor 3 days has 1/15/2009 vomit, dizziness 1/28/2009and cephalgia was reported by a law office and described Y the occurrence of shoulder pain in a Y male subject U of unspecified 6/23/2000 age who8/1/2000 was vaccinated with ately two hours after receiving Tdap right arm became numb from shoulder to the hand. No redness Y or swelling 2/10/2009 noted. 2/10/2009 ght child to office 4 days after 1 z given child L thigh was pale red over entire upper area (5"x5") Y stated wasn't 2/5/2009 hard but 2/7/2009 mom stated that be to right upper arm Y 2/6/2009 2/7/2009 shots on Feb 02, 2009 - namely PEDIARIX #3, YHIB #3, PREVNAR #3, 3 ROTAVIRUS #3 and Y FLU #1 - 3 days 2/2/2009 later with 2/6/2009 fever, resp. problem miting x 2 days, lethargic,Y poor PO. Y Seen in hospital Y ED 2/8/09. Admitted, 9 Y had diagnostic laparoscopy Y with1/6/2009 ileocecectomy. 2/8/2009 Dx with intussusc r headaches on 1/21/09 - Seen again Y on 2/7/09 when mother told dr she is concerned this isUrelated to the 7/11/2008 HPV vaccine. 11/1/2008 got related inform d to vomiting and diarrhea - But no fever. Y 2/9/2009 2/9/2009 area of ERYTHEMA U 2/9/2009 2/9/2009 trician who saw Pt in office on 2-5-09 Y - noted 4 cm round Erythematous area to upper (L) arm. Y No induration 2/3/2009 or pain with 2/5/2009 palpation- no crus U 2/6/2009 2/6/2009 hite male ADSM is referred for persisting Y lesion at initial SPV X6 months. Symptoms : Nodule, U subcutaneous, 8/13/2008 Erythema, 9/13/2008 Pain, Lesion, Pust after receiving DTaP, HIB and Influenza, Y patient had a febrile seizure. U 2/10/2009 2/10/2009 ped a pruritic rash starting the day after receiving 2nd GARDASIL vaccine. No work up done. Y Rash on torso 9/19/2008 area. 9/20/2008 Treated with TRIAMCIN dache for 2 days. -Welt at injection site, patient describes as 3 in long & 1 1/2 in deep, patient Y has taken BENADRYL 2/5/2009 2/6/2009 & the welt has decrea stration of vaccine. 2/10/2009 back to clinic with report of "some pain at (L) arm site" immediately after second injection + "around" U 2am 2/2/2009 this morning 2/3/2009 (2-3-09) - Pt c/o ons 007 Child received DTP #4 Polio #3 at Pediatrician's office- seen in our clinic today- Red rash, large welts2/4/2008 torso & extemities 2/5/2008& face- started suppose to receive MMR and received MENACTRA instead. This was done in error by the M.A. U Dr. has reported 2/4/2009this to our local health De dose Amox 2-5-09. C/o HA + nausea Y on 2/6/09 with some soreness and stiffness to (R) armU- 2/7/09 C/o 2/5/2009 tiredness +redness 2/6/2009+ warmth to (R
ic Reactions - Redness, swelling, possible Y development of blisters. U 2/6/2009 2/7/2009 ceived vaccines at approximately 1:45pm. Y Mother reports "Child got really quick in back seat of car, mom 2/2/2009 turned to check 2/2/2009 on him , his face er became very ill when we left the office. Y Complained of headache, stomache ache, had a fever, Y could not 1/26/2009 keep balance. 1/26/2009 Within 8 hrs I had n has been received from Y a physician Y with had hay fever who on 02-FEB-2009 vaccinated himself Y with a 2/2/2009 0.5 ml first dose 2/2/2009 of PNEUMOVAX n has been received from the patient's Y mother concerning her 12 month old female Y daughter, N who in 1999 was vaccinated with a dose of M n has been received from a nurse practitioner Y concerning Y a 22 year0old Y female patient with no N pertinent 8/13/2007 medical history 12/1/2007 and allergic reactio n has been received from a nurse concerning a female "born in 1983" with no pertinent medical U history who 5/29/2007 on 29-MAR-2007 7/1/2007 was vaccinat n has been received from Y a Certified Medical Assistant Y concerning13 an 18 year old female who N on 22-AUG-2007 8/22/2007 was12/1/2008 vaccinated with a first n has been received from a healthcare Y professional concerning her 20 year old daughter who U was vaccinated with all three doses of GARD n has been received from a medicalYassistant and a pediatrician concerning a 17 year old female Y patient for the ### pregnancy ### registry for GAR n has been received from a registered Y nurse (R.N.), for GARDASIL, a Pregnancy Registry product, Y concerning 4/22/2008 a 154/23/2008 year old female patien n has been received from a pharmacist Y concerning a 70 year old male with hypertension and Y allergic to morphine 2/4/2009and 2/4/2009 tramadol hydrochlori ic rash, vesicles, fever X 2days 2/3/09 - given vaccine 1/27/09 U 1/27/2009 Red swollen left arm painful. 2/10/09 = Reddened area on arm, spreading painful. 2/11/09 = cellulitis. U Pt has 2/5/2009 prior Hx staph 2/9/2009 infections. ain, vomiting, malaise, R/O sepsis-doubtful. Pt with prior diagnosis of staph infections Y 2/3/2009 2/4/2009 cm red, warm, swollen area left deltoid. Y 2/9/2009 2/10/2009 and swelling at site of injection U 2/9/2009 2/10/2009 es after receiving vaccine Pt. was getting Y ready to walk out the door with parent - and faintedY- Able to keep 2/9/2009 standing 2/9/2009 and assisted into chai after injection Y 2/9/2009 2/9/2009 ying/inconsolable and fussier X 2-3 Y days after vaccination. Y 1/26/2009 1/26/2009 1/2/2009 ed lesion Pt. had fever for 2 days of 101 F. Y 8/23/2007 2/9/2009 wsy and dazed lasting about 5 mins. Pt. was put back into the RM where Dr. check her andYbaby was doing 2/10/2009 better.2/10/2009 ed right arm (hyperimmune response). Y 2/10/2009 2/11/2009 ing, Rash spread all over body Y 1/29/2009 1/29/2009 greater than 5cm w/ erythema & pain. Y 1/30/2009 2/1/2009 h pain, Erythema, warmth and edema Y at and below site of vaccination within 24 hr of administration. Y 2/4/2009 2/5/2009 ticed a 4 in by 3 in area of redness, warmth and tenderness on site where vaccine was administered, Y 24 hrs 2/3/2009 after administration. 2/3/2009 Unchang itching, redness at site 2 days after. U 2/3/2009 2/5/2009 ted blotchy rash at PNEUMOVAX site starting 1 day after immunization and cleared on 2-3-09 U (said she 1/30/2009 is sensitive1/31/2009 to many things). Feels r shot she developed redness, swelling, itching and pain 5" X 3.5" around shot Y 2/4/2009 2/5/2009 ven 2/6/2009. patient states she noticed swelling. Today 2/11/2009 she reported it to the clinic. U She had2/6/2009 local swelling 2/7/2009 at the site measurin p at 1:00 am with chills, this continued till aprox 4-5:00 am. Pt denies fever and chills at this N time.Today pt 2/10/2009 is feeling2/11/2009 unusually tired and rep nt called the Dept of Health Services for guidance on the adverse event. She plans to self report U to VAERS soon. ### She is ### in good health, an CM SWOLLEN SPOT ON RIGHT ARM, Y NOT RED, NOT WARM, MIDLY TENDER U 2/9/2009 2/10/2009 as in office for routine visit. Pt was ordered HPV vaccine, menactra (meningococcal) vaccine, Y and adacel2/10/2009 (tdap) vaccine. 2/10/2009 Gave all three im 2-103, severe arm pain and injection site swelling, dizziness, sore throat, difficulty swallowing, Y cough, nasal 2/9/2009 congestion, 2/9/2009 nausea, constipatio ly had fever and redness tenderness and swelling of the left arm, site of administration the came U to involve 1/31/2009 the entire2/1/2009 circumference of the a MA APPROX. 4 CM IN SIZE TO LEFT Y SHOULDER AT INJECTION SITE. PRESCRIPTION FOR Y KEFLEX2/2/2009 250MG\5ML-1 2/3/2009 TSP BID X 7DAY in received 1st dose of JE vaccine. He presented to the office for his 2nd dose of japanese U encephalitis vaccine 2/4/2009at the 2/7/2009 1 week follow up int diarrhea 4 days after 1st dose of Rotateq, Y profuse, Y presented 12-24 5hours later with dehydration U (10%) 2/25/09-records 2/4/2009 2/8/2009 received for DOS 2/ ported increased swelling at injection site and increased redness "size of football". She stated Y that patient's 1/30/2009 father felt 1/31/2009 it might be "infected", h weakness in right side of face four days after de vaccionation.PE: Mouth corner deviated to U the right. Non 1/30/2009 blinking right 2/4/2009 eye.Prescibed: Pr d symptoms of severe headache, fatigue, dizziness, Y abnormal vision3and excessive sleepingYon about 5/2/2007, 3/28/2007 5 weeks 5/2/2007 after receiving HP ours of getting Pneumovax vaccine R arm began to hurt, became very painful, 9/10, swollen,Y red areas 5-6" 2/9/2009 long. Started 2/9/2009 2/9/09 PM and re ME BREATHING,NOT FEELING WELL Y WAS ADMITTED Y TO HOSPITAL 3 2/13/09-records received-for U DOS 2/4-2/7/09-DC ### 2/4/2009 DX: Influenza A and reported about 15 minutes after recieving Hepatis B immunization and Td, he had left side Y of head 2/10/2009 and face felt 2/10/2009 numb. This lasted for STOOD WITHIN A MINUTE OR TWO OF GETTING 4 SHOTS, TURNED VERY PALE, THEN Y FELL AGAINST 2/7/2009 HER 2/7/2009 MOTHER AND RN W at injection site. Y Y 2/9/2009 2/11/2009 accine given 1-6-2009. Had fever for Y 48 hours and fussiness after that vaccine. Had 2nd dose U of flu vaccine 1/6/2009 2-9-2009. 1/6/2009 Within an hour or d on 02.02.2009 with rash and fever: had MMR and Varicella immunizations on 1.26.09; on 1.28.09 Y onset1/26/2009 of fever up1/28/2009 over 103 F and then tr
swelling, warm Fever 104.0, chills, nausea, increased Lymphodempathy, decreased ROM ofY extremity, pain 1/30/2009 L shoulder/ 2/10/2009 arm/axilla ting on exam table after vaccine and she felt dizzy. She was assisted to lying position on table Y by mother. 2/11/2009 A few seconds 2/11/2009 later nurse arrive ste in mouth, feeling of swollen lips, blurry vision, lethargy, nausea, headache, body aches. Y Started in am2/6/2009 of day after2/7/2009 vaccine received - 2/ Spasms (they look like infantile Y spasm) But theyY have NO physical signs 1 of the typical Y infantile N spasm. They started ### after ONE ### month shot ap INSTEAD OF Tdap U 2/4/2009 2/4/2009 N HANDS< AND OVER FOURTY Y PERCENT OF BODY AFTER VACCINE>>NOW HAVE GUILLIAN N BARRE SYNDROME> ### 2/6/2007 12/13/09-office aP: Sanofi Pasture Limited: Lot Number: Y C2957AA Y Exp: 21May10 and 1 Hepatitis A: Glaxo Smith Y Kline Lot2/9/2009 Number: AHAVB320BA 2/11/2009 EXP: 25A n 1600(Sun) by 1100 next day(mon)Y1/2" lump on right arm also entire arm and hand swelled,fever N 99.5,weakness,extreme 2/8/2009 2/9/2009 headache. Feve ceived Merck's Gardasil Y vaccine 2 weeks Y ago and since has been experiencing a variety of symptoms, N headaches, 1/20/2009 seizures, 2/3/2009tingling, numb was reported by a physician and described theYoccurrence of aseptic 0 meningitis in a 16-year-old Y male subject ### who 1/10/2009 was vaccinated with HA .3 (r) for 2 days morning after vaccinations. Child later diagnosed with Autism, aphasia, Y developmental N coordination ### disorder. ### 2/24/09 Dev ble crying for 3 days after getting 1st set of vaccines at physician's office. Y ### ### 1-3 of ANTHRAX I felt hands burning and unable to write. From shot 4-6 felt burning at both N hands, arms, 2/3/2009 chest, face 2/4/2009 & back of head. pular rash over trunk, face & extremities. 2/9/2009 2/10/2009 n has been received from a physician concerning Y a 55 day old male0who on 20-JAN-2009 was N vaccinated 1/20/2009 orally with 1/26/2009 a 2 ml first dose of RO n has been received from a physician Y concerning a 10 year old female patient who was vaccinated U with a dose of GARDASIL (lot# not prov pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/30/2008 for COPD exacerbation. Y Vaccination ### took ### place on 12/11/ TER GETTING VARICELLA VACCINE Y SAID HIS THROAT HURT, COUGHING, ITCHING. IMMEDIATELY Y 1/29/2009 GIVEN 1/29/2009 ALBUTEROL, BENEDR ed and reported L arm "purple" all the Y way down and "itching all over" with tingling of L arm.YBegan approx 2/9/2009 30-45 minutes 2/9/2009 after vaccine--to ethargy after Hepatitis B vaccination that was administered at approximately 24 hours after delivery U of child. When ### performing ### metabolic te 08, @ 8-9AM, mom observed infantYto start to choke and exhibited redness all over his faceYand swelling observed ### by mom ### on tongue and ven 02/09/09. on 02/10/09 mother reported Y swelling and redness at injection site, RN advised Y mom to alternate 2/9/2009 cool2/10/2009 and warm compresses 9, two days after vaccine administration, the patient developed a rash on her left lower extremity N and was 1/14/2009 diagnosed 1/16/2009 with shingles. re 102 deg. - hives - severe pain at site and lymph nodes under arm - fatigue Y 2/3/2009 2/3/2009 rned to clinic 2/9/09 stating she noted Y small lump left tricep region appr. 10 days prior. reports U area getting 1/20/2009 progressively 1/31/2009 larger. area appr. hird dose my daughter got very pale, Y sweaty, aand dizzy. The nurse and I layed her back onUthe exam table. 7/15/2008 She became 7/15/2008 unresponsive fo es approximately ten days after receiving Zostavax vaccine, she had severe muscle crampsN5 to 10 times a day ### in the 1/8/2009 following areas of he nt developed diarrhea (10 watery stools Y per day, 2 days after to Rotavirus vaccine. He also developed Y diarrhea 2/4/2009 after 2/6/2009 the rotavirus vaccine g 5mm area of "bruising", erythema right upper outer arm (area of injection site). No systemic Y symptoms. 6/2/2008 6/4/2008 ATES "HAD FULL BODY RASH, NO FEVER." Y ash onset 5 days after vaccines ?rotavirus Y vac. Y 2/4/2009 2/8/2009 iven 2/20/08. On about 2/26 pt went into CHF, symptomatic. She recovered spontaneously Y by about 3/12/08. 2/20/2008 Background: 2/26/2008Severe mital r CALLED AND REPORTED HIVES STARTING 30 MINUTES AFTER DTAP WAS ADMINISTERED.BENADRYL Y 2/10/2009 WAS 2/10/2009 GIVEN. CONTINUE the TDAP vaccine on the morning of Y Jan. 26. That night, I was unable to sleep, felt very dry,Uand consumed 1/26/2009 a large1/27/2009 amount of water. The n ection sight up into shoulder, erythema, entire arm itching, face flushed. Y 12/2/2008 12/2/2008 , pain at injection sight up to shoulder and down arm, entire arm itching, flushing in face, vomitting, Y and fever. 2/11/2009 itching, 2/11/2009 pain, flushing started m area of erythema, induration, hot to the touch, and sharply demarcated. Patient complained U of pain... tender 2/9/2009 to touch.Patient 2/10/2009 had a low g 7:00 p.m. To E.R. by ambulance for Y sudden onset altered loss of consciousness. ObtainedUlabs, CT, lumbar 1/21/2009 puncture. 2/6/2009 Had been c/o inso es long by three inches wide swelling of injection site - 24-48 hours from injection. Red & hotUto the touch. 2/10/2009 Tylenol for 2/11/2009 discomfort. ed from a health care professional via the Medical Y Communication the 0 following information N on 30 JAN 2009: 1/27/2009 A 52-year-old 1/28/2009 male patient wa mom took patient to ER for Y nausea and Y vomiting. Y 12/19/08 mom took 230 Y patient to ER for shortness Y of breath. Diagnosed ### with### acute myeloid le nted within 2 minutes of vaccine administration. Patient obs x 45 minutes. BP checked after Y10min. BS checked-88. 2/12/2009 2/12/2009 Drank water. Walked o both sites - Erythema no fluctuance. (R) arm ~2-5cm; (L) arm ~8cm. TX - BENADRYL + TYLENOL. U 2/9/2009 2/10/2009 and neck turned red with a rash and itch - symptoms ongoing 1/26/2009 1/27/2009 vere bronchospasm and shortness of Y breath 40 minutes after vaccine. No EPi needed; Stable Y Bp and O22/11/2009 SAT, 911 2/11/2009 to ER -discharged hom arted temp 1:30 am 2/12/09. Mom gave MOTRIN temp was 100.8 at highest, no sore at injection Y site. 2/11/2009 2/12/2009 eft deltoid swollen and tender. 1st GARDASIL Y injection given 8/16/08 and no reaction. 2nd GARDASIL injection 2/4/2009given 2/5/2009 2/4/09 and above re ely after administering, Pt developed hives - no other s/s. Doctor ordered BENADRYL and save Y Rx for BENADRYL 2/10/2009 2/10/2009 other reports fever 102 degrees -onset evening after immunizations. 3" redness at site of PENTACEL (L) upper 2/3/2009 thigh-2/3/2009 warm to touch. 1/2 dollar sized red rash. Not hot to touch. Child fussy-more than with other shots. Giving TYLENOL Y and 2/5/2009 MOTRIN. 2/6/2009 d, warm to touch. Local reaction at site of injection. Y 2/10/2009 2/10/2009
ingles) developed # days after vaccine Y administration. red FLUMIST with expiration date 2/3/09 on 2/12/09. No apparent adverse event. red FLUMIST with expiration date of 2/3/09 on 2/12/09. No apparent adverse event.
Y U
1/29/2009 2/1/2009 2/12/2009 2/12/2009 Y 8/21/2007 hest, back, face, scalp, arms - few on legs U 1/12/1998 2/10/2009 ported within 7 minutes of receiving VARIVAX vaccine patient c/o hurting in chest and throatYarea and felt2/4/2009 sick to his stomach. 2/4/2009 No shortness B #2 administered at 11 am on 2/9/09 at noon cheeks became red and flushed then pale, severe Y headache.. 2/9/2009 Premedicated 2/9/2009at 7am with TY sis and upset stomach with 15m of VARIVAX, resolved within, 5-10m in office developed hives Y after vaccine 2/10/2009 2/10/2009 ports she got shingles from the vaccination Y (L) upper thigh near groin area. She saw her MDUwho confirmed it ### and treated 1/8/2009 her. Hives exten veloped rash on neck, face on 2/9. Y Also had some shortness of breath and "watery eyes" onY2/8. Rash on2/6/2009 inner arms, 2/7/2009 back, chest, per nur n has been received from a physician concerning a 24 year old patient with a history of papanicolaou N smear 4/20/2007 abnormal 8/1/2008 who on 20-FEB-200 was considered medically important. Information regarding PREVNAR was received from a U healthcare professional 11/6/2007 regarding a 24-monthreceived vaccines (Dtap, Fluzone).YNo allegeries Y or cold systems noted 1 or reported. 1/15/09Y- mother states 1/14/2009 noted 1/15/2009 "bumps" under patient's as vaccinated on 1/30/09 after fallingY on the ice. After the vaccine she called complaining of redness Y and1/30/2009 pain at the injection 2/6/2009site (rt arm). S RT RED, BURNING ABDOMINAL/CHEST RASH. TODAY PT OBSERVED TO HAVE SMALL N RED RASHES 2/3/2009 TO LEFT 2/5/2009 UPPER ABDOMEN en Varicella/DTaP 1530: call from parent that pt Y awoke from nap congested 1 & wheezing-advised Y to give2/10/2009 albuterol nebulizer 2/10/2009 per Dr. and if n the Gardasil vaccine and walked out of the room. As I exited I lost vision and hearing and collapsed, Y still2/11/2009 conscious2/11/2009 and very nauseated. D fever, chills, loss of appetite for 6 days Y 2/4/2009 2/5/2009 shrill cry for 45 minutes (non-stop crying) Y 12/2/2008 12/3/2008 male received 2nd doe of VZV on 02/10/09 at around 0830. Starting at 2100 on the same day U the child 2/10/2009 exhibited erythema, 2/10/2009edema in the l ction site reaction to the R upper extremity. Pt received pneumovax on day one and erythema, U edema started 2/11/2009 on day 2/12/2009 two and persisted thr hours of Jeff's first DPT Y shot, he had Y a grand mal Y seizure. We continued 2 to give Yhim the series N of shots and at age 5/18/1984 25, he continues to hav S HUSBAND PRESENTED TO PHARMACY ON 2/13/09 STATING THAT HIS WIFE HAD AYRED STREAK 2/5/2009 APPROX. 2/6/2009 4 INCHES LONG AN m pain upper arm, can't lift arm without Y significant pain. TD vaccine given 1/21/2009 10:30 AM. N Saw doctor 1/21/2009 following1/21/2009 week 1/28/2009. Pain -Back of L arm--upper area--above elbow and below arm pit swollen. Approx 70 mm long--warm Y to touch.2/4/2009 Redness 2/5/2009 noted at two injection s ates he started a fever@ 1PM Fri. 1/30/09& Y by 8PM it was 104 degrees. Dr's office suggested Y alternating1/29/2009 Motrin&Tylenol-it 1/30/2009 would go down received his second immunization with DTAP/HIB/IPB on February 9 at about 10 AM. He didYwell after the2/9/2009 vaccine unto 2/9/2009 about about 1:45 P sil vaccination on 2/19/08. Second YGardasil vaccination April 2008. 3 weeks later, on May 9, N she came4/15/2008 home from school 5/9/2008 complaining of s fter injection, child woke up with nausea and stomache ache. Arm very sore for 4 days, including Y his armpit. 12/2/2008 Complained 12/3/2008 that it hurt if he m patient was administered Rotatec. After immunization, patient had 10 days of watery diarrhea Y and vomiting. 2/11/2009 02/11/09 2/12/2009 - patient was admin ternoon began chest pain. By Thurs. Y AM pain unbearable so went to ER. EKG normal & sent Y home. Fri.1/13/2009 AM pain severe 1/14/2009 so went to ER. EK tate Epidemiologist stating that he had Y received a call from local provider stating possible measles Y case.1/12/2009 He spoke1/24/2009 with child's PCP and w ter shot - mild malaise developing, 7 hours after shot- fever and severe chills (chills and shaking Y was worse than ###the worst### malaria attack I ythematous papular eruption, itchy, Y on fore/arms/trunk/thighs. 2/5/2009 2/8/2009 swelling and erythema Y 2/10/2009 2/11/2009 fter vaccine admin., pt. walked backYinto the waiting room complaining of dizziness. AssistedY into a chair2/13/2009 with mother 2/13/2009 at side. Several attem ly pruritic chicken pox U 2/19/2002 2/11/2009 exam 11-25-08. GARDASIL #1, MENACTRA & ADACEL given to update imms- Pt has since learned that she ### was pregnant at time of va urs stated arm was the size of a football. Y Had pain, redness, warmth. Had no fever. Felt weak. < 24 hours 2/12/2009 after shot 2/12/2009 the arm was still 4.5 lled and notified that the day after injection Y her arm was twice the size an extremely painful."YBENEDRYL 1/28/2009 DM and started 1/29/2009 to feel better. Re nute seizure - tonic clonic associated Y with fever. No treatment except TYLENOL, MOTRIN for Y fever 1/29/2009 2/7/2009 m unsure of onset, but pt. had been seen in local ER 2/6/09 with no mention of rash she wasUtreated for croup 2/3/2009 2/6/092/7/2009 with decodnon to EPI ed to office at 4:00 pm- with red spotty rash on facial area. No c/o itching voiced. No rash noted Y on trunk 2/5/2009 at time of visit. 2/5/2009 VS obtained, norm Rec'd vaccines in AM and was fine Yall day. She went to a martial arts class in the pm and after Y class became 9/3/2008 faint and 9/3/2008 had seizure. She w ears 1 hour post injection - Return of Bells palsy, also " set off arthritis & joint pain". Has had Y flu shot every year ###with 0 reaction ### did not see swelling to site, itching. (Varicella). Y 2/4/2009 2/5/2009 ight of injection L arm became sore.Y 2/6/09 Severe pain to L arm. 2/7/09 increase temp, feltNbad. 2/8-9/09 2/5/2009 redness noted 2/5/2009 to L arm below s noticed next day- became worse over next 24 hrs then started to decrease on day 3 -> resolved. Y 2/2/2009 2/3/2009 a redness noted same evening. There was no sleep disturbance. Next day, hard & red thighYSeen 27 hr after 2/5/2009 the shot: 2/5/2009 large red area creat after shot began headache- for next 36-40 hours extreme nausea & headache (sinus & jaw) Y Routine chiropractic 2/8/2009 app't2/9/2009 & therapy helped & m raised papulovasicular lesions arms, wrist and back U 8/3/2007 2/13/2009
ter vaccination, at 7 pm developed fever (101.5F). Given MOTRIN by mother. Fever was 103F Y at 1 am,2/12/2009 102F at 5 2/12/2009 am, and 100 at 9 eoccurrence of Reitens Disease after Y 3rd TYPHOID pill - c/o S-1 pain resolved post backs required Y steroid 1/9/2008 use Last1/13/2008 episode of Reitens dis eizure 24 hours post vaccines 101 degree Y F otitis diagnosis at 24 hours as well Y 2/4/2009 2/5/2009 eeks after vaccines given developed fever and rash (which resolved in short period of time),Ubut rash faded 8/5/2008 and actually persisted until see 11/4/2008 N ### ### ven 1st dose of Gardasil Lot # 14484 Y on 2/4/08. Patient became ill with Severe Adominal Y Pain N and Nausea. 8/18/2008 Patient 9/3/2008 given 2nd dose of Gar avax injection, patient's arm from shoulder Y to injection site started aching (within 15 minutes). Y By the next 2/5/2009 day, the injection 2/5/2009 site was surroun op a fever, irrability, decrease in appetitie Y and diarrhea that I could not control at home which U resulted in an 2/9/2009 ER visit.2/14/2009 after receiving D/T immunization my arm at sight of injection starting hurting. I couldn't lift myYarm up above 2/12/2009 shoulder2/13/2009 level without alot of so arre requiring hospitalization, Y IV gammaglobulin Y Y and acute rehab. Symptoms 7 started 1 weekYafter vaccination 8/19/2008 2/23/09 8/28/2008 Received hospital m minutes after the shot I walked out of the doctors office and into the lobby, and all of a sudden I lost all energy in my body. Literally, I felt as t us case was received from a consumer Y on 06 February 2009. A female patient reported thatUshe received an injection of Tetanus/Diphteria er flu injection 9/29/08, pt became feverish, aching all over, nauseated for a few days, also states U he developed 9/29/2008 a huge 9/30/2008 cold sore on his nos h VARICELLA on 9-4-08 vesicles on face & trunk. fever of 103 degrees X 6 days Y 2/14/2000 9/4/2008 les over trunk x 4 days. Y Y ### ### CELLA - few vesicles on trunk fever Y 101 degrees -> HA -> X 5 days fatigue Y -> 8/16/2007 9/18/2008 les on trunk X 3 days Dx : VARICELLA Y Meds: ZOVIRAX Y ### 12/8/2008 PM feet starting itching. 2/03 2:00 AM Awoke & whole body itched "terrible"- Took < chewable Y BENADRYL 2/2/2009 (Total 25mg). 2/2/2009 2/03 6:00 AM Co vaccines 2/3/09, 2 days later, developed erythematous papules on face then over next few days, U progressed 2/3/2009 cephaolocauded 2/5/2009 to his whole ted 02/13/09, highest was 102.8F, parent noted redness, not wanting to use her right leg. Seen Y on 12/14/09, 2/12/2009 afebrile 2/13/2009 after ibuprofen, 1cm X e onset of erythema, pruritus and edema on right upper arm after receiving MMR vaccine. VSY - B/p-104/64, 2/11/2009 R-20, P-74, 2/11/2009 regular. Patient was es starting January 3rd. Nausea andYflu-like symptoms Y starting around 5 January 15th. Low back N pain started 1/2/2009 early January. 2/2/2009 February 2, patie d Influenza A U ### 2/15/2009 r vaccine administered patient developed Y joint pain, insomnia, numbness of certain areas onNright side of body 2/3/2009 (cheek, 2/3/2009 elbow, thumb, heel), RECIEVED A SUB-Q DOSE OF ZOSTAVAX IN HER RIGHT ARM ON 2/12/2009. THE PATIENT Y TOLERATED 2/12/2009 THE 2/14/2009 SHOT VERY WELL; ceived 1st dose of Gardasil vaccineYon 8/8/08 in Dr. office, since having the vaccine she hasNhad recurring8/8/2008 headaches, 9/28/2008 severe joint pain, ch ped burning, itching rash on both upper Y arms, chest and upper thighs over 3 day period postYvaccination; 1/29/2009 to Er on 1/29/2009 day 3 -received IV solu ziness & fast heart beat Y 2/13/2009 2/13/2009 ter received Gardisil vaccine today..Number 3, and she fainted about 8 minutes after the shot. Y She was2/16/2009 okay..nurse2/16/2009 kept us a few minutes periences severe flushing episodes,Ynausea, severe abdominal pain, back pain, difficulty breathing. N Several 12/1/2008 physicians and ###tests find noth as had chronic constipation with abdominal Y pain since administered the oral vaccine (Rotateq). He has not 2/16/2009 been able 2/16/2009 to have a bowl movem adache, nausea, joint pain, unusualYtiredness/weakness, aching muscles, muscle weakness,Nbad stomach2/6/2009 ache. 2/18/09 2/6/2009 Received vaccine n 1/21/09. Came in with swollen R side of face on 2/9/09 Y 1/21/2009 2/9/2009 was reported by a healthcare professional via another manufacturer and described the occurrence U of grand mal seizure in an adult female Y N 10/8/2008 12/1/2008 myalgia. Episode of tachycardia 24 hours after vaccine, lasted 5-6 minutes. Y 1/29/2009 1/30/2009 dominal pain after first dose. ChestYpain, difficulty breathing, shortness of breath, palpitations Y and cramping 1/29/2009 after second 1/29/2009 dose. No wheez en outside guidelines. Per MFG. No need to revaccinate. Y 2/15/2009 ls, weakness, RUQ pain and tenderness. 2/24/09 Y Mr received for DOS 7 1/30-2/7/09 with D/CYDX: Hypovolemic 1/26/2009 shock 1/30/2009 r/t profuse diarrhea a le on L Tricep Area with wheal of induration, ? early vesicle formation at center of papule. Scattered U papules 1/23/2009 on Trunk 2/10/2009 and extremities App some sinus congestion at the time Yof her vaccinations. Two days later she developed fever Yand cough. She 2/2/2009 was diagnosed 2/4/2009with pneumon ing dizzy after shot. Pt told to sit- down Y - given a cold compress. Pt LOL for under 1min with Y some jerking 2/16/2009 movements 2/16/2009 ammonia inhalant as given two tetanus injections (ADACEL) in 1 year. Denies pain. Edema problems after 4 days. Y 2/12/2009 elling pain @ injection site hives present both arms. U 2/11/2009 2/11/2009 ported pain and swelling at injectionYsite. Exam revealed erythema (approx 3 cm in diameter) Y warm to touch 2/15/2009 and tender 2/16/2009 to palpation. No fe n has been received from a Nurse Practitioner concerning a female who approximately 6 months U ago was8/1/2008 intramuscularly 8/1/2008 vaccinated with t n has been received from a Registered Y Nurse (R.N.) Y concerning a 17 2 year old female with no N family history 1/2/2008 of seizures 4/1/2008 or drug allergies wh n has been received from a consumer Y concerning Y her son, a 5 year1old male who allergic toNamoxicillin who was vaccinated with one dose n has been received from a registered Y nurse concerning Y a 71 year old 0 male patient with penicillin N allergy1/22/2009 and SULFONAMIDE 1/22/2009 allergy, who n has been received from a kindergarten Y teacher concerning her husband's relative's churchmember's U daughter's 8/5/2008 friend 9/1/2008 at school, a girl wh n has been received through the Merck pregnancy registry from a physician concerning a 17Yyear old female who ### on 16-NOV-2007 ### was va
n has been received from a Registered Y Nurse concerning her daughter (a 15 year old female) N who in August 4/16/2008 2008 was 10/1/2008 vaccinated with the n has been received from a physician concerning a female with penicillin and sulfa allergy and U a history of3/1/2008 knee surgery and tube placed in n has been received from Y a kindergarten teacher Y concerning her husband's 0 relative'S Y churchmember's N daughter, a 14 year ### old girl who on ceived the three doses of ROTATEQ - #1 doseYon 06/18/08, #2 dose 1 on 08/22/08, # 3 dose Y on 10/24/08. Diagnosed ### 1/27/2009 on 01/27/09 with rotav e, emesis. 2 ED visits. Y Y 1/27/2009 2/4/2009 and "pinging" when I tap thumb & pinkie Y + ring finger together ; (L) forearm feels irritated & achy N when resting it### on any sfc,### Face of shoulde U 2/9/2009 L injection given in left deltoid at 4:15 pm, client stated she was dizzy and felt hot at that time. Y Client lost consciousness 2/6/2009 2/6/2009 at 4:16 pm, was as 5X 8cm erythematous, indurated area Y 1/28/2009 1/29/2009 as seen at the Emergency Room because Y she was having seizures Y 2/10/2009 2/10/2009 fter had HEP A shot had bilat hand swelling and palms looked red, had been fussy during night. Y swelling1/27/2009 was gone 1/28/2009 by end of day, feet were ES GENERALIZED RASH AND ITCHING OF SKIN SINCE DAY AFTER hEP b VACCINE WAS U ADMINISTERED. 1/26/2009 pT. 1/27/2009 HAD RECEIVED tW weeks after getting 1st set Y of Gardasil, Y patient complained Y that she79 was Y weak and Y was having N a hard time 11/3/2008 speaking. On 11/29/08 ### patient ha d during pregnancy. Pregnancy resulted in Voluntary Interruption of Pregnancy at ~ 11+2 weeks 9/17/2008 10/6/2008 lled stated that child began with fever about 12 midnight Friday night (Feb. 13. She stated child Y convulsed 2/13/2009 3 times and 2/13/2009 threw up. When ask atigue, difficulty concentrating & sleeping following vaccinations N 9/5/2007 10/7/2007 ted shingles 8 months s/p vaccination Y U 6/4/2008 2/8/2009 es that 4 hours after immunization that Hannah complained of "butt & thighs are numb & chest Y feels jittery". 2/10/2009 Did not call 2/10/2009 physician and symp ### Y N ### ### en Left arm. Patient came back to clinic 1 day after receiving injection. Patient treated with N Prednisone 2/16/2009 taper, benadryl 2/17/2009 OTC, and intermitte injection given on 2/10/2009 in the right Y arm subcutaneous. On 2/17/2009 patient presentedUwith extensive 2/10/2009 erythematous 2/12/2009 rash extending fr large reddened area approximately 2.5x3 inches in circumference 3 days after vaccination. Y Area was swollen 2/12/2009 and hot 2/14/2009 to touch. Patient rep U 2/6/2009 2/15/2009 veloped vesicular rash in dermatomal distribution over thoracic area, c/o pain over this area.Y mother called 2/17/09 reporting, about Y 2 hours after receiving MENATRA injection c/o shooting N down left2/16/2009 arm and leg 2/16/2009 2/16/09. Today 2/17/0 on shoulders, back, (R) side family Dr. Y order BENADRYL. U 2/17/2009 2/17/2009 pain left index finger mcp onset 2/13/09 U 2/11/2009 2/13/2009 ious, spontaneous report of administered expired FLUMIST in a 30 month-old female patientYwas received 1/23/2009 from a nurse 1/23/2009 practitioner in the U ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/6/2009 a 38-month-old 1/6/2009 female who ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a four-year-old 1/5/2009 male who rec ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a four-year-old 1/5/2009 female subse ious spontaneous report of hives has been received from a physician concerning a 32-month-old U female, subsequently ### to ### FLUMIST. This c ious spontaneous report of administered of expired FLUMIST was received from a physicianY concerning 1/6/2009 a 58-month-old 1/6/2009 male. who receiv ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/12/2009 a 24-month-old 1/12/2009 female subs ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a 40-month-old 1/5/2009 female who ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a 38-month-old ### male who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a four-year-old ### male who rec ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 24-month-old ### female ### patient subsequ ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 28-month-old ### male ### patient subseque ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a 24-month-old 1/1/2009 patient1/1/2009 (gender unknown). Th ious, spontaneous report of administration of expired product, vomiting and diarrhea was received Y from a nurse### in concerning ### a 33-month-o ious, spontaneous report of administration of expired product, dehydrated, elevated white blood Y cell, vomiting, ### diarrhea and ### lethargic was re ious report of "six patients received expired FLUMIST "was received from a nurse concerning Y a four-year-old 1/1/2009 (unknown 1/1/2009 gender). The patien eous non-serious report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009concerning a c ious spontaneous report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009office concerni neous non-serious report of administration of expired product was received from a certified medical Y assistant 1/7/2009 in a physician's 1/7/2009office concern accine used Expired drug administered) A non-serious spontaneous report of administration Y of expired product### s received ### from a registered ious spontaneous report of administration of expired product was received from a registeredYnurses concerning### a 24-month-old ### female who ious report of "gave patient expired FLUMIST" was received from a nurse concerning a four Y year old male patient. ### On 30-Dec-2008, ### the pa nt to make f/u apt child not responding Y to parent Y when she call child's 1 name, PCR to parent Y to shake baby's 7/7/2008 arm and7/7/2008 PCR called nurse. Ba hat started several hours after receiving her booster flu shot. U 1/13/2009 1/13/2009
U ### ### oy passed out suddenly after receiving vaccines on 1/17/09 @ around 6 pm. I turned aroundYto dispose 1/17/2009 of the needle, 1/17/2009 when he suddenly w ours after receiving the vaccine had chills, fever, Y myalgias, vomiting 1and headache. Sxs were severe enough 5/18/2005 that she 5/18/2005 was admitted to the h ne-type disorder. Fever,Yjoint pain, diffuse swelling. 4/6/09 Received chiropractor medical records U of 11/14/2008. 6/1/2008FINAL DX: ###sciatica, DJD, tions given on 1/12/09 at approx. 4:00 PM. Mom Y called at 10:40 AM31/13/09 stating 2-3 inchYdiameter swollen 1/12/2009 red area 1/13/2009 on (L) arm. Appt wa s seen 11/12/08 for pulling ears x 1 week. He had no URI Sx or fever but mom reported oneYslightly loose stool### that am, sl.### decreased appe er shots had episode of vomiting and developedY seizure. Hospitalized 1 and started on Phenobarb. Y 3/9/091/12/2009 Received hospital 1/13/2009 medical records ns, Shaking, High Fever. Y N 7/11/2006 7/18/2006 iving the third series of Anthrax Y Vax.YBecame insulin Y dependent, shortly after. 2/23/09 Y OfficeYnote received 9/24/2003 for 1/23/08 for### Diabetes Mellitus eption - open reduction after failed enema Y reduction. Y Presenting sx: 1listlessness, decreased Y feedings (fluid1/6/2009 intake) increased 1/9/2009sleep. 3/3/09 nset arthralgias 12/29/08. Pain, swelling elbows, wrists, hands, fingers,knees, ankles low grade N temp initially. ### Seen by PCP ###& Rheumatolo elling to the right deltoid area. ### r Tdap I started having numbness Y inYfeet and (R) Y leg. This went on25 forYa month and Y 1/2 and I never put it together ###at that point. ### 12/12/08 Ha s, nausea, tiredness, confusion, off balance Y AM & PM, racing thoughts and actions in the AM. N 2/25/09 MR1/5/2009 received. 1/7/2009 HPV vax 12/2/08 and d Guillain Barre Syndrome after multiple vaccines Y in basic training. Service 7 member had pneumonia U prior 9/3/2008 to hospitalization 9/6/2008 for GBS, but num n began 4 days after primary smallpox Y vaccine. Service Member meets criteria for "Suspect"Ypericarditis according ### to CDC ### guidelines. Def GARDASIL vaccine about 15 minutes later. Pt had light headiness and dizzy, pale and nausea. Y 1/15/2009 1/15/2009 ng in lower part of body. Y Y 6 Y ### ### d to office about 1 hour post vaccination with c/o rash. Very faint bumpy rash starting on arms, Y progressed through ### day to### include trunk + l iously well except notedYto have poor Y weight gain. Y Appeared well at2visit. Vaccines administered Y approx1/19/2009 10:30 am. Noted 1/19/2009 at daycare to be e- intense Flu-like symptoms w/ feverY coughing- nasal congestion- ending in a visit to ER. Lung, N blood and 1/9/2009 urine samples 1/9/2009 seemed o.k. Cam ery severe local Rxn at site of pneumococcal vaccine. Two days laterYsuffered urinary retention Y and ARF. Vaccine ### was listed ### as one of ma d petechiae 1/30/09. Diagnosed withY I.T.P. 2/1/09 Y (Platelets 5,000). 2Responded to I.V.I.G. - Platelets Y 95,000, 1/8/2009 on 2/2.1/30/2009 Platelets 205,000 on 2 e call from parent - reports child c/o pain left arm + shoulder since vaccine on 1/13/2009 to day Y of call 1/16/09 1/16/2009 - Parent 1/16/2009 reports relief with Ty accine administered. 1/19/09 Y - Developed Y severe Y viral symptoms. 1/25/09 1 - Dx with DVT andUhospitalized; 1/16/2009 put on Heparin. 1/25/2009 1/27/09 - D/C on ived the Tdap shot in my left arm 12-15-08 Y at family practice which my arm became very sore N 12-16-08 & has ### been sore every since 1-15-0 episode following injection, approx 30 Y seconds Y following vaccination.1 Member not caught before Y hitting floor. 2/9/2009 Patient sat 2/9/2009 up at 2-3 mins later ### N 4/28/2008 ### 1/18/2009 N 1/14/2009 1/18/2009 e week after shot. Fever 101 degrees Y F 104 degrees F. Unknown rash (was told Y chickenpoxU& given Prednisone). 5/23/2006 Developed 5/30/2006 food aversion ation for numbness, pain, in hands and Y feet. IVIG, Y Narotin. 2/20/09-records 5 received Y for DOSN11/28/08-presented ###to ED with ###C/O hands an ER twice for abdominal pain, fever,Yvomiting. Diagnosed Y with intussusception. 5 Tried to reduce Y with barium 7/8/2008 enema several 9/25/2008 times but was no eption. Required partial colectomy. 2/24/09-records Y received for DOS 5 1/8-1/13/09-DC DX: Intussusception. Y 1/5/2009 Presented 1/8/2009 with 2 day history of M 1/15/09 - Right upper arm redness, Y pain and swelling to hand, red raised area noted surrounding U injection 1/14/2009 site, seen 1/15/2009 by attending, given cant 15 minutes after the shot. After 15 minutes when she get up + walk she fell little bit dizzy Y + palpitation 1/12/2009 few minutes. 1/12/2009 Notified provider a enduration, erythema & swelling extending Y area 10cm diameter. No treatment rendered. Y 12/8/2008 ### 08 pt. presented to office c/o pain LYdeltoid w/ radiation of pain to elbow. Area of erythema measured Y 1.5x2 cm. ###Normal remainder ### of exam sions (>250) on extremities, torso, face and bucal mucosa 8 days after receiving first varicella Y vaccine. Tx: Acyclovir ### 1/7/2009 800 mg every 6 hours 0min after injection while sitting in waiting area, c/o dizziness, lightheadedness. Attempted toYmove patient1/8/2009 to exam room 1/8/2009 but began to faint oximately 8 minutes after receiving 6 vaccinations, pt. c/o feeling faint. Pt. became unresponsive Y and began 1/12/2009 jerking1/12/2009 movement of her head hours after vaccine pt reports swelling Y and tenderness in left axilla. Also had tenderness at injection site.1/12/2009 Swelling progressively worsened ls, Diarrhea, Malaise following day hives day 4 U 1/8/2009 1/9/2009 2 degrees F), severe left arm pain at site of administration. Y 1/8/2009 1/10/2009 NTACEL, PCV7 and Rotavirus 1/12/2009 Y - developed fever to 106 1/11 per mom, Occ crying. Y Temp on and 1/12/2009 off throughout 1/13/2009 day 101-102 per hing & macular rash on thorax. Y 1/14/2009 1/14/2009 tions given on 1/8/09 at app. 4:30 pm Y - Call from mom on 1/9/09 @ 3:30 noting redness, soreness, Y & swelling 1/8/2009 of L thigh 1/9/2009 - PA notified mom office and c/o L upper arm still being sore 2 weeks after injection. Received GARDASIL 12/30/08- Called office### 1/14/09. ### STAVAX Received 12/25 itching rash started at site of injection Spread all over his body down Y legs and back ### Took BENADRYL ### R on 12/2 e very irritable Abd pain. Y ### ### n has been received from a 39 yearYold male patient Y who was in the0hospital for a hip replacement. U He had 3/1/2007 a chest x-ray 3/1/2007 and then received iting and diarrhea within 48 days after Y admin. of 2nd ROTAVIRUS vaccine at 4 mos well check Y on 11/07/08. 11/7/2008 Was 11/9/2008 tx at hospital ER, with IV
mplaints of wheezing at night and fells pressure on the chest and coughing starts about 2 weeks U after vaccination 10/8/2008 but reported ### to me on 1/ d crying - went to clinic. Sent home -Ydid well. Y 1/13/2009 1/13/2009 n has been received from a physician Y concerning a 22 year old female who was vaccinated U with the second 12/1/2008 0.5 ml 2/12/2009 dose of GARDASIL (lot TDAP vaccine 12/29/08 - felt overlyYfatigued on 12/30 & early. 12/31. Late morning 12/31 IYdeveloped abdominal ### cramping ###- severe- unab n has been received from a male concerning his 4 year old son who in January 2007, was vaccinated U with1/1/2007 PROQUAD. 1/1/2007 His son was diagno ven Influenza virus vaccine instead of Hepatitis B on 12-30-08. She was then given HepatitisYB on 01-2-09. ### n has been received regarding a case in litigation from a consumer, concerning her son whoNon an unspecified date was vaccinated with a ed my cell phone and left message stating she had symptoms of rapid heart rate & dizzinessYafter receiving 2/6/2009 vaccine Friday 2/6/2009 afternoon. I spo n has been received from a 74 year old female with arteriosclerosis, and diabetes and a history N of left eye 7/11/2008 twitching7/19/2008 before vaccination who ff and could not move right arm for Y 3 days. Then the soreness moved down arm and wake up N in middle of night. ###Went to### orthopedic speci me very swollen and red, itched, area about 2 1/2 X 2 1/2 inches. Lasted for 6 days. Then just Y swollen and 1/23/2009 started 1/24/2009 to go away. Had bump U 2/11/2003 2/7/2009 red HEP A into R deltoid. Then administered GARDASIL into R deltoid. 10-15 seconds later, Y patient lost2/9/2009 consciousness 2/9/2009 + fell backwards f ought back in office by guardian 2/2/09 with a c/o (R) BELLS Palsy noted after one day vaccines U for 5 y.o. 1/30/2009 given KINRIX, 1/31/2009 MMR, Varicella, In as given inj f/m PNEUMOVAX last Friday. Pt came in today with c/o high fever (103.8) severe Y pain in rt arm 1/30/2009 & nausea 1/30/2009 30Jan09 accines - on 1/16/09, low grade temp. Y suddenly became limp & unresponsive. Vomited & then Y responsive. 1/15/2009 911 brought 1/16/2009 to ER then he beca enza vaccine given approx. 3pm 1/21/09. Caregiver noted "hives" around injection site and torso Y approx.1/21/2009 6pm. No other 1/21/2009 sx other than hives macular rash extending medial upper arm down to antecubital fossa N ### ### RA was administered to 56 y.o. pt. - only licensed for up to 55 years of age. No adverse reactions Y were reported. 1/13/2009 der discomfort reported 11/13/08 Flu vax given 10/30/08 shoulder X-ray 11/24/08; MRI shoulder 12/4/08 Tx: Physical ### therapy ### ling in fingers, unable to lift arm over head. 3/18/2008 3/20/2008 local redness/swelling with some itching. U 1/29/2009 1/31/2009 .4 and red rash all over arms, trunk, legs, feet 24 hrs after administration. BENADRYL and tepid U bath administered. 1/14/2009 1/15/2009 1/16/09-Rash on face & arrhea after 1st ROTATEQ lasted x 3 months. Eventually resolved, used NUTRAMIGEN. Y 9/9/2008 ash c/w RUBELLA. Irritability, fever, poor po intake. U ### ### d PREVNAR vaccine 1-14-04. Pt had fever of 102 degrees rectally. Y 1/14/2008 1/15/2009 Y 1/2/2009 1/12/2009 104 X 3 days post vaccine Y 1/13/2009 1/13/2009 minutes of receiving GARDASIL, patient Y passed out, regained consciousness. Since that time U - 2 episodes 5/16/2008 of similar 5/16/2008 symptoms with loss o me into the clinic complaining about rash all over body. The Pt. stated that he had been abroad U the weekend 2/5/2009 prior. 2/12/2009 From what the note from 0 minutes after injections began ruritic Y episode with erythematous rash on inner arms, One area Y on chest1/12/2009 with slight1/12/2009 edema of eyes. Sent to eks of peripheral neuropathy - pain and sensitivity to left triceps and left pectoralis area/chestYwall. no weakness. 10/6/2008 saw 10/8/2008 a neurologist. to patient he was suffering from fever, headache, joint pains, nausea, rashes, and diarrhea Y on the 15 Feb2/6/2009 2009. Seen 2/15/2009 by Medical Provider en warm touch left arm 2/17/09 0600 treatment was given on 2/18/09 at 01000 Benadryl 12.5mg/5ml Y and 2/16/2009 Cleocin 75mg/5ml 2/17/2009 HPV Vaccine dose #3. Did fine in office. Fifteen minutes after leaving (while still in car) patient Y noticed that her hand was quite swollen an 9, patient called the health department to state that very soon after he had received the Zostavax U vaccine, he began ### noticing ###that he was b n was given an Adacell vaccine rather than the ordered hep B No adverse reaction Y ### symmetrical eruption of dull erythematous irregular patches to face upper/lower extremities U and anterior posterior 2/4/2009 trunk 2/6/2009 s taking oral Typhoid Fever vaccine for a trip. She took them correctly, one piull every other day. Y The first2/12/2009 day, no problem, 2/15/2009 2nd day, she fe en burned and very hard with itchy Y red bumps. Very large knot in arm. Treated by Hospital for Y Allergic reaction. 2/7/2009 2/8/2009 GIVEN AT 0915 LD IM WAITED 20YMIN IN THE LOBBY WITHOUT REACTIONS. LEFT AND Y WENT BACK 2/18/2009 TO SCHOOL 2/18/2009 AT 1120 SHE C 08 Mom called provider office an spoke Y with nurse Y complaining of left 3 leg swelling. 4/6/09-records Y received 12/1/2008 for DOS 12/6/2008 12/18-12/21/08-DC DX vaccine, developed fever in night, byY next day fever raised to 106 - went to emergency roomYfor tests, antibiotics ### in case it### was an infection shot was given I had mild tenderness Y in the shot area for a few days. It seemed to be gettingUbetter but then 2/12/2009 on the sixth 2/17/2009 day it began to get n right thigh, Hib given left thigh 8 days Y ago. Swelling and lump on right thigh about 3 cm with Y less swelling 2/10/2009 and lump 2/11/2009 on left thigh (1.5 cm pot about the size of a quarter that was tender and warm on friday 2/13/09 U 2/11/2009 2/13/2009 series of Guardasil on 7/24/2008. Y On Y 9/10/2008, patient went to emergency room in ambulance U due to 7/24/2008 rash and difficulty 9/10/2008 breathing, assum en 11/16/09 & given VARIVAX #1, PREVNAR Y #4 & HEP A #1. 1/17/2009 Developed a rashYon legs, face 1/16/2009 & arms. 1/17/2009 @ 8 pm 1/17/09 develo Tdap, influenza and PNEUMOVAX vaccines 01/06/09. Pt called clinic 01/13/09 to report thatYon 01/07/09,1/6/2009 she had experienced 1/7/2009 onset "sev veloped severe diarrhea after 1st ROTATEQ >10 stools per day x2 weeks. Resolved - needed Y Pregestemol. 2/29/2008 ed Varicella vaccine 1/12/09. RTC today Y 20 to reddened area 11X10 CM @ site of vaccine. U 1/12/2009
as vaccinated on 1/22/09 (fluid was Y noted in both ears at the time). His ears became inflamed Y and he was 1/22/2009 given amoxicillin 2/3/2009 (has previously 16 scattered red pin point papules w/ pin point scab Y 1/20/2009 1/20/2009 MMR#2 2/2/09 woke 2/3/09 with L shoulder, neck, upper arm pain/swelling ? and headache.Y Self treated2/2/2009 with IBUPROFEN 2/3/2009800 mg and TY ter having 3 vaccines (VARIVAX, MMR Y & PREVNAR), had hives on face - no other exposures U in interim Given 2/9/2009 (4mg)2/9/2009 1cc decadron Benadr and called for help Pt found sitting pale Y semi responsive. Very pale wiffed ammonia inhalate Y help arrive. Pt taken ### to urgent### care for observa m around 4:30PM. Went home, seemed X 2hrs. Around 8pm became very fussy temp 100.6.Y Didn't sleep 1/30/2009 well that 1/30/2009 nite. Next day was som Y 1/29/2009 1/31/2009 Y Y 1/9/2009 1/9/2009 Y Y 1/16/2009 1/25/2009 ed swollen - Hot to touch Y Y 1/6/2009 1/7/2009 04 and higher for seven days straight. Y Within 48 hours after vaccine U ### ### ort received on 02 June 2008 from aYhealth care professional. A 28-year-old patient, had received U a 0.5 mL 6/6/2008 intramuscular right deltoid inject d pain at injection general malaise, fatigue "out of it" Pt observed with no subsequent sx's. Y 1/6/2009 1/7/2009 10 min after receiving YF-VAX + ENGERIX-B. Y Pt had reaction of SOB and urticaria app. 15min Y after he left 2/18/2009 FLAS. Pt 2/18/2009 was treated with 50m -VAX given 2/10/09 (1cc given rightYdeltoid subQ) @ 1300-1400. On 2/13/09, while at daycare, Y the patient 2/10/2009 had hallucinations 2/13/2009 (tactile of bug GARDASIL 1/7/09 at routine health assessment Patient seen in the office on 2/5/09. Developed N lump in her 1/7/2009 neck on 2/2/2009 2/2/09. Diagnosed wit Flu and MENACTRA 10/31/07. By Thanksgiving Y he had foot droop of 3 left foot. Seen Y by primary in Feb. '08 for ankle ### pain. ### Referred to Ortho ost administration infant very fussy and immunization site with erythema & mild edema, tender Y at 7-8cm. 12/8/2008 12/8/2008 grandmother described staring spells which lasted 2 weeks after visit. She states they were Y "just like patient's mother's ### absence ### seizures c iven 1/2/09 symptoms began 01/03/09 included: dizziness, lasted 2 hrs. rash lasted 2 days nYwith vomiting 1/2/2009 1 X. Per 1/3/2009 the patient mother BEN an staring & jerking involuntarily. (Woke Y up crying at 12:15) We took her to the ER and by 1:30 Y a.m.. she was ### fine.) No other ### reactions. (N ng after receiving the vaccine, c/o fever 102 degrees F, vomiting x1 and muscle aches, joint Ypain2/10/2009 2/10/2009 swollen upper thigh to medial thigh. Y 1/9/2009 1/12/2009 ceived vaccines on 01/23/09; developed low grade fever + x 3 days 01/28 - 01/30; given Amoxil Y for purvulent 1/23/2009 rhinitis. 1/28/2009 Rash noted on 01/30/ l received from family member reporting that vaccine recipient has rash & severe nausea. No U mention of1/13/2009 fever. Vaccine 1/14/2009 was given 1-13-09 1/5/9 no problems. 1/6/9 - Circular welts Y with blisters- itching back, legs, arms, buttocks - worse Y on 1/7/9. 1/5/2009 Went to ER1/6/2009 1/7/9 - placed on BEN ceived PENTACEL injection by itself (IM) in right lateral thigh. 5 hours later mom called stating U his right leg 1/14/2009 was swollen and warm to touch n R upper arm - minutes later 5 cm diameter welt with raised erythematous center painful. Used U ice, TYLENOL, 1/14/2009educated 1/14/2009 pt's mom on brin ceived HEP B3 vaccine on 7/20/06. A few days later she had a severe nose bleed, blood pouring Y out of 7/20/2006 nose and mass 7/25/2006 coughing up blood ceived HEP B vaccine on 4/28/06 A few days later she had a severe nose bleed, blood pouring Y out of nose 4/28/2006 and mouth. 5/2/2006 Coughing up blood ithin 24 hrs. Started on legs-became Y generalized in 48 hrs. 2) Low temperature elevation (38-38.4) U > 481/2/2009 hrs. 3) Periods 1/2/2009 of extreme irritab ed lesions head to toe-not palms or Ysoles. On dorsum of hands and feet though. Y 1/12/2009 1/17/2009 and redness over (L) leg (thigh) 30 x 30. Y 1/19/2009 1/20/2009 nd swelling of right upper arm x 2d, treated w/KEFLEX Y 1/12/2009 1/13/2009 EL given right thigh in am 1/15/07 - Parents Y came back in due to pt crying non-stop 11:30 2:00, U vomiting 1/15/2009 X 2, not nursing 1/15/2009 pt calm at times, re nted after receiving vaccines- Menactra, Tdap, Hep A#2 Y 2/13/2009 2/13/2009 as given vaccine. Approximately 5-7Yminutes after patient's eyes rolled back. Upper body began Y to jerk. Called 2/13/2009 911. 2/13/2009 ght deltoid pain and swelling with vomiting x 1 and low grade fever. After 48 hours patient feltYmuch better. 2/12/2009 2/13/2009 nt fever and maculopapular rash of trunk. Y 2/4/2009 2/10/2009 d a PNEUMOVAX on 2/17/09 and noted Y a reaction on 2/18/09 arm swollen (raised) 7x7 red area with a 2/17/2009 small fine rash, 2/18/2009 Hot to touch and pa lling, itching, rash, warmth at site. Y 1/6/2009 1/6/2009 vaccine breakthrough. Diagnosed with varicella on 1-19-09. U 7/7/2005 1/15/2009 rs had 3" diameter cellulitis. Patient has a history of IgG2 deficiency. Treated with KEFLEX BACTROBAN. U 2/16/2009 Cellulitis 2/18/2009 at site of DPAT. started within 10-15 min after MMR and VARIVAX injection. Slight puffy lips and stable visual Y signs. POS 1/13/2009 decreased 1/13/2009 95% - CTA afterward ght by Mom, had vaccination on 1/20/09. Mom noticed swelling right thigh yesterday. No fever. U Groin - right 1/20/2009 thigh - mild swelling and erythe lymph swelling/tenderness with palpation Y (Jan 15 2009). Hives and itching on neck and extremities Y 12 Jan 1/9/2009 2009. Seen 1/12/2009 and treated with PR m lesion R thigh around shot sight. Red, Y hot, indurated, tender. Began around 1 day after shot. N 1/21/09 decreased 1/14/2009 to1/15/2009 2 1/2 x 2 1/2 cm. me size swelling and tenderness at DTaP Y site. Y 1/21/2009 1/22/2009 njection site, gave BENADRYL advised mom to give in 6 hours if hives came back or go to ER, Y call 911 if1/23/2009 any trouble 1/23/2009 breathing. ck like sensations in his (L) UE that radiate to his hand. At the time of onset, approximately 2Yweeks after the injection, ### the### pt said he did no ness area (4 1/2 inches x 4 inches) on left arm with swelling and soreness. N 1/27/2009 1/28/2009
hs old patient received vaccines (routine) PEDIARIX, Hib, PREVNAR, Rotavirus - 4/21/08. On N 4/22/08 mom 4/21/2008 noted bloody 4/22/2008 stools and cramp ory of rash prior to presentation. On exam, 12cm x 15 cm around erythematous rash lat/post.Y(L) arm warm to touch, ### multiple ###bullae laterally nization at 12:15 pm on Thurs 10-9-08 Y c/o headache starting at 11 pm that night; woke up w/headache Y -10/9/2008 severe at 4:30 10/9/2008 - headache describ -fell to the ground stomach upset on Dec 6, 2008 and on Dec 7, 2008 Y 12/6/2008 12/7/2008 diameter, slightly elevated, red, irregular skin area where injection given. Denies itching or pain. U Instructed 1/12/2009 to notify1/14/2009 primary physician. ame limp and unresponsive x 5 minutes. Y Y 1/26/2009 1/27/2009 d Ulcerative Colitis after ANTHRAX Y 1-4, sxs started 2 years after #4, diagnosis made 1 year N after # 4. Diagnosed 1/4/2000with narcolepsy in 2008, b s she was well at the time and took Y no medications. Approx 24 hours later SM reports she awakened Y with papular ### pruritic### rash on bilateral ration, pain on LT arm cold compress, Y OTC Benadryl U 1/21/2009 dministered on 1/23/09 - On 1/23/09 leg was hot, red, swollen, from hip to knee, painful to touch, Y fever and 1/23/2009 hives on1/23/2009 neck-chest - Pt instruc iven 1-12-09. Pt complained of severe pain at injection site on 01-16-09. It was not relievedYby ice or EXCEDRIN. 1/12/2009 1/16/2009 ADVIL provided minima R) deltoid, fever, swelling at injection Y site, body aches, chest tightness, headache. Pt seen by Y PA at Medical 1/20/2009 Clinic on 1/20/2009 1/22/09. Recommend bump on L legs. Shot 2 days ago. Y ### ### ash - generalized RX - BENADRYLY& PREDNISONE Y 1/19/2009 1/20/2009 hours after injection, pt c/o extreme Ymuscle pain in legs arms, back and abdomen. -No local Y reaction noted 1/15/2009 @ injection 1/15/2009 site. Pt also c/o H/A to pt several hrs after injection, the site became red, raised and warm to touch. Area was the N size of a 50c piece. ###Ice applied ### to area since g redness, itching + swelling at shot Ysite L upper arm starting approximately 24 hours after shot has 8x5cm 1/19/2009 are erythema 1/21/2009 + swelling + tende ccine given to a patient under 1 year of life by mistake. HEP B ordered and HEP A given. Discovered after 1/7/2009 injection. became very painful, unable to lift. Y 1/8/2009 1/8/2009 ouch of flu- woke up with headache took ALEVE. Feels extra tired. This happens some years Y when gets1/22/2009 flu vaccine1/22/2009 also. Arm is sore. Inje er receiving tetanus shot- Had severe pain & aching (deep) in right upper arm - It has been 4 months & although 9/4/2008 the9/12/2008 pain is less, is still very h that spread over body and face swelling 1 d after vaccines, followed by rhinorrhea and cough. Y On 1/12/09 1/9/2009 child was 1/10/2009 wheezing. Also taking redness and swelling. It ran base of neck on right down to right elbow. TYLENOL/BENADRYL U 1/20/2009 1/21/2009 1/7/2009 d Rheumatoid Arthritis-- Pain beganYwithin 5 days of last dose of GARDASIL vaccination. Severe N joint pain--unable ### to 1/2/2008 walk. 2/26/09 Recei ted approximately 5 min after vaccinations Y given. She reported feeling fine just after vaccines. U During check 2/6/2009 out she fainted. 2/6/2009Blood pressure with a full body rash and fever - pt taken Y to hosp. for urticaria. Also has with peanut butter. Y 10/6/2008 10/8/2008 ot 1/12/09. Also, exposed to many children with URI symptoms 1/12. On 1/13/09, had syncope related to1/12/2009 quick changed 1/13/2009 in position. Also n e fever, symmetric erythema, induration, Y slight increased warmth right upper thigh beginning about 20-241/21/2009 hours after1/22/2009 injection 10 1/2 cm dia eadache (Migraine) N 11/3/2008 oke in AM with redness size of baseball Y then increased to size of softball per dad. 1/23/09 seen Y in office 1/20/2009 induration centrally 1/21/2009 with 16x11 ery administered 1/21/2009 Rt arm. Redness Y and swelling next morning 1/22/09. School nurse Y measured redness 1/21/2009 - 9 cm. 1/22/2009 redness, inability to perform R.O.M. with affected arm. Diagnosis Brachial Neuritis post TD U for adults 2 days. 1/24/2009 Treatment 1/25/2009 per pcp Ibuprofen on STRATTERA. Mother reports changes on behavior. Child more opositional and inattentive Y after receiving 1/23/2009 vaccine 1/23/2009 e call from Pt's mother stating Pt has little red bumps/rash on chest and both arms. Instructed U mother to take 1/20/2009 her to 1/30/2009 MD for diagnosis. Mothe y 4/08 and 12/08 (Not certain vaccine related - Pt concerned and asked for it to be reported Y 1/15/2008 4/1/2008 d hives (urticaria) in underarms, waist Y and legs. Prescribed MEDROL DOSEPAK 4 mg and ZYRTEC. Y 11/1/2008 11/2/2008 ere bilateral knee pain, spreading toY proximal lower leg and distal anterior thighs. No benefitYfrom TORADOL 1/17/2009 30 mg1/24/2009 IM. Excellent relief with h 3 weeks after injection. Y ### 1/13/2009 lient called to report 1/15 am experienced Y tingling sensation R side rib cage area into back. By U 1/15/09 afternoon 1/13/2009pain 1/15/2009 R mid rib cage into b se reaction known Y ### ness, swelling, discomfort @ injection Y site within hours of administration. Symptoms persisted Y despite patient 1/30/2009 treating 1/30/2009 with TYLENOL ES, M after receiving injection patient had localized pain at site, aches, drowsy, muscle soreness especially U in back 1/20/2009 down to1/20/2009 middle lower back. C/ n usual, cold or pains after vaccine, got sick with Flu and other symptoms, such as weakness, Y fatigue, continual ### coughing,### mucus constant ng of the vaccines child started limping. Y Right leg from groin to knee swollen with redness and Y warmth present. 1/28/2009 Right 1/28/2009 thigh left above knee swelling and redness to injection site that occurred within minutes to hours of administrationUper mother.1/13/2009 On exam 2 days later, site w/swe veloped redness & swelling at injection Y site- 6.5 X 10 cm. Y 1/15/2009 1/21/2009 & swelling @ injection site in the evening post receiving imms. It now extends to entire upper Y arm- Instruction 1/20/2009 on cool 1/20/2009 compress, BENADR 3/3/09-records received-brief syncopal episode after immunizations, resolved without treatment. Y Seen on1/16/2009 1/19/09 for1/16/2009 PPD reading. Y 1/21/2009 1/21/2009 veloped itchy rash minutes after imms Y have given (DTaP + IPV) Y 1/9/2009 1/9/2009
screamed. 5 1/2 hrs. after vaccines Y cried hard, turned head & started jerking his head 5 seconds Y - foggy look 2/9/2009 on face2/9/2009 - no further episodes mial shingles left side T 3-6. Tx - Zovirax Y 200 mg/5 mL 3/4 tsp three times a day x 1 week. U 9/11/2007 1/18/2008 atigue chills fever - flu- like symptoms Y x 3 nights (night only) (highest 104.5) slight rash all over body, not much appetite, no breathing Y difficulty1/26/2009 2/2/2009 high fever, irritable beginning 2nd day Y after vaccine Temp up to 104 at home per mom. 102.1Yat office 1/10, 1/6/2009 102.3 1/12 1/8/2009 at office use of TYLE fter the immunization was administered, the patient developed a 7.5 cm x 5 cm area of cellulitis. U He was started 2/5/2009 on antibiotics 2/6/2009 (KEFLEX) af as diagnosed with rotavirus after receiving Y vaccination series. Y 9/8/2008 ### ours after immunization, had leg swelling and hives at (R) thigh at site of Hib vaccine associated Y with prolonged 1/9/2009 crying. 1/9/2009 Y U 2/5/2009 2/6/2009 e " temp 2/9/09 in PM. 2/10/09 no temp today but (Rt) leg where PCV given is little swollen. U Red hardened 2/9/2009 area size 2/9/2009 of dime. No excess cr comfort in (L) arm - 2/6/09 redness and swelling (L) arm N 1/30/2009 2/4/2009 lled 24 hours after immunization, stating injection site the size of a dime & was red & raised.UI told patient 2/7/2009 to take 2 BENADRYL 2/8/2009 & I would c tchy leaky rash on left side chest and shoulder. Soreness and shooting "pings" of pain. AchyNshoulder and 8/28/2008 neck. Hydrocodone 1/17/2009 for pain. nd influenza vaccine on 2/9/08-started with vomiting, high fever approx. 2 hours after vaccineY 2/9/2009 2/9/2009 redness and itching around the injection site after DTAP given symptoms began 24 hours after U vaccine given. 2/4/2009 No medications 2/5/2009 or treatment dache, fatigue, general full body aches and joint pain + felt "warm" with 24 hr of vax. Improvement Y within2/5/2009 48 hr but @ 2/6/2009 72 hr - all sx returned mperature of 100.0 degrees blurred vision lasting three days. Only lights out lying in bed gaveYme relief. 2/4/2009 2/5/2009 arms, legs, hands, &* feet. Looks likeY little blisters. Symptomatically treated with ANTHRAX, CLARITIN, Y & 1/4/2009 MOTRIN Vesiculopapular 1/20/2009 lesions s stated within 24 hrs. of the injection. Symptoms include fatigue, weakness in right arm, mildYfever, swollen 2/3/2009 lymph nodes 2/4/2009 involving the right asal congestion & pressure, headaches, muscle & joint aches, dizziness, nausea & light headedness Y for 10 days. ###Took TYLENOL ### & SUDA U 2/6/2008 shortly after the injection (about 0 minute) my head started to whirl - got lightheaded - felt like Y I was going2/3/2009 to pass out. 2/3/2009 Also it increased the njection site, raised, red, hot, multiple. ORAPRED given and BENADRYL cream. U 2/11/2009 2/11/2009 area, slightly raised, firm, not, itchy. Center of area appears to have vesicles 2/9/2009 n radiating to the neck. Pt. can barely Y lift arm. U 2/9/2009 2/9/2009 er vaccination c/o being light headed, dizzy, feeling like she was going to pass out. Slept 2-3 Y hours, R arm 8/14/2008 hurt, did8/14/2008 not seek medical atten problems -mucus spitting day nightY- choke on it about to lose breath mucus worse, eye dry Nskin keep peeling 5/11/2007 off. Weezing, arm hurt come , increased blood pressure-racing pulse, Y nauseous, bronchial spasms, difficulty breathing and Y speaking- Taken### to ER given ###BENADRYL an INRIX + TDAP given 9:35 - passedYout in lobby - unconscious 10 min sustained 1-1 1/2 inchY laceration to 2/10/2009 back of head 2/10/2009 in fall pt rec'd HPV-4. On 1/12/09 when nurse in contact with pt again. Pt reports injection site tingling N for 2 weeks 8/5/2008 then site 8/19/2008 went numb approx 2" umbness going down L arm with injection Y (in left arm). Numbness, tingling severe within 15 Y min-Startes within 2/4/2009 3 hours 2/4/2009 numbness @ L foot ately 24 hours after vaccines had episode Y of eye rolling, shaking and possible apnea lasting Y 2-3 min. No fevers.### Evaluated### in ER. Of interes ped symptoms of chickenpox after having received 2 doses of VARIVAX Y 10/4/2007 1/26/2009 she felt faint, nauseated, sweaty at work. Y Felt "throat tightening, difficulty breathing & only able Y to speak 12/5/2009 or 2 words2/5/2009 at a time". She said eloped varicella on 2/4/2009 - had Rec'd 2 doses of VARIVAX on 2/9/99 and 2/12/08 U 2/12/2008 2/4/2009 R 1/28 - Next AM, thigh visibly raised, pink, well defined, non, tender 21/2 X 3 cm area. No fever. Y 2/2/09 Swelling 1/28/2009gone, looks like a bruise. er DTaP and VARIVAX in R shoulder, 7x7 cm bright red area, with heat, 2x2 induration where Y DTaP given; 2/2/2009 No fever.2/4/2009 4 days later, less red ated she has had pain in her left shoulder and in her left lower arm since receiving the flu vaccine U 2/5/09. No 2/5/2009 redness,2/6/2009 swelling or induration swelled within hrs of receiving MMRY(SQ) and DTaP (IM) on 09Feb09. No erythema. Swelling U approx 1 in 2/9/2009 greater than 2/9/2009 R leg. Non-painful b d blurry vision within 24 hrs of above vaccinations seen by optho- optic neuritis, MRI was negative for mass, 1/21/2009 treated1/22/2009 with oral steroids. Was n itching in area of vaccine admin. right after injection. Later that day swelling began. On 01-30-09Y day after 1/29/2009 injection, 1/29/2009 outside of arm is red munization 2-3-09 and was fine withYinjection. On 2-4-09 mom states Pt had 101 degrees temp Y and pt leg2/3/2009 had swollen 2/4/2009 up the size of baseb rs of receiving MMR/VZV/ Hep A vaccine fever to 103 degrees persisting x 5 days. No local Y reaction. 1/26/2009 1/26/2009 DTaP at 2:30 pm. Per call to On callY doctor at 10:30 pm - vomited several times since 12 with Y possible mild 1/21/2009 temp. Asked 1/21/2009 to eat but not kee generally hot feeling well last night. Erythema 50cm sized. Afebrile. Took BENADRYL + IBUPROFEN. U 1/28/2009 1/29/2009 RIVAX immunization on 6-23-99 now Y has chickenpox Y 6/23/1999 1/19/2009 cal reaction with 15 cm area, painful swelling. Treated with antibiotics for possible Cellulitis. No Y fever. Improved rapidly. Also had superficial child had redness and area felt hot to the touch (around injection site/shoulder area) Advised Y to use cool1/27/2009 compresse 1/29/2009 - give TYLENOL for c st thigh with mild erythema, taut with some mild dimpling swelling (med). 3 puncture sites visible Y in 3-4 cm 1/13/2009 diameter area. 1/14/2009 atous rash cheek & peri orbital tissue, pruritic both wrists Y 1/23/2009 1/28/2009 m nap this p.m. screaming for 2 hours was noted to have erythema and swelling of left leg. Erythema Y & swelling 2/6/2009 has 2/6/2009 subsided at office visit
at site, size of apple swelling at site fever at site Ice applied to site, APAP administered PO oped varicella rash on trunk and extremeties 13 days post varicella vaccination. N 1/19/2009 2/4/2009 arter size area left ECU tender areaYwith left wrist deviation & painful motion. Occurred nightUafter taking1/26/2009 2nd dose of 1/26/2009 oral TYPHOID. Had r tion was received at 10:45 AM. When Y pt. arrived home 11:30-11:45 AM she felt a little strange Y but thought 2/9/2009 it was due2/9/2009 to not eating. Then a er vaccine developed fever & rash on Y back. 2/3/2009 2/5/2009 /swollen Rt injection site slightly redY U 2/9/2009 2/9/2009 came nauseous, lightheaded, and had momentary syncopal episode. Pt. was hypotensive @ Y 80/40 but2/11/2009 BP rebounded 2/11/2009 after pt. was laid on hrs had pain, swelling, low grade fever Y (99 degrees) and rash. Rash was 8X12 cm U 1/27/2009 1/28/2009 body aches, headache, fever, chills Y x 7d. Sl. ST decreased appetite positive weight loss 9 pounds Y in 8 days. 2/3/2009 2/4/2009 little light headed and sick to her stomach. Did not vomit. Recovered quickly. Y 1/9/2009 1/9/2009 IVAX. That night after shower, she had a generalized blotchy rash all over body not hives. 1/27 Y rash gone, 1/26/2009 developed 1/26/2009 swollen tender ill defi /o reaction to Varicella vaccine. Rash Y on Left arm and Back c/o itching. (1/19/09) Pt. given Rx Y for Prednisone 1/5/2009 50 mg1/19/2009 x 1 for 7 days. bq VARIVAX given Rt lower thigh. Parents notified stuff about 5 minutes after with large reddened Y area to 2/2/2009 Rt thigh Dr2/2/2009 notified and seen pati e fever - 2 hrs after shots given- no longer running one Rt. leg- swollen & red 1/27/2009 1/27/2009 Y 1/22/2009 0:00 AM - Fri morning - Had severalYblisters @ site of Vaccine on Lt arm - Midday Fri - Lt armYbecame tight 1/29/2009 and swollen 1/30/2009 by 7:30 pm Lips and ed his vaccines and when he woke up Y noticed a lump on his (R) thigh. When seen in office, the Y lump appeared 1/13/2009 red, 1/14/2009 itchy, and slightly larger ation site with vesicular lesions and circular erythematous tender and generalized erythematous N papular 1/26/2009 trunk, extremities. 1/26/2009 n has been received from a registered Y nurse, concerning a 9 weeks old male patient, with a U history of gastroesophageal ### reflux ### disease and n has been received from a Nurse Practitioner concerning an "about 2 month old" patient who Y in December 12/1/2008 2008, was 12/1/2008 vaccinated with the n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a first and second dose of ROTATEQ (lo n has been received from a nurse concerning a 23 month old female patient who was vaccinated U orally with the three series of ROTATEQ n has been received from a registered Y nurse concerning her 17 week old grandson with no pertinent Y medical history ### who on ###07-OCT-2008 n has been received from a physician concerning a 2 year old patient who on 08-JAN-2009 U was vaccinated 1/8/2009 oral with1/8/2009 his first dose of ROTA n has been received from a registered Y nurse concerning her granddaughter who on 29-DEC-2008 Y was vaccinated ### orally 1/2/2009 with 2 ml of the fir n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h n has been received from a registered nurse concerning a female patient with gastrooesophageal Y reflux1/19/2009 who on 19-JAN-2009 1/19/2009 was vaccina n has been received form a registered nurse concerning an approximately 16 week (4 month) Y male with 1/19/2009 a history of1/19/2009 gastroesophageal reflu n has been received from a physician concerning a 16 week old patient who on 09-JAN-2009 U was vaccinated 1/9/2009 with the 1/9/2009 first dose of ROTAT n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h n has been received from a registered Y nurse concerning a 62 day old female patient with noUpertinent medical 1/26/2009 history 1/26/2009 and no known drug a n has been received from a community pediatrician concerning a 32 weeks patient who wasUvaccinated with ROTATEQ (lot # not reported) n has been received from a physician concerning a patient who on 28-JAN-2009 was vaccinated U orally with 1/28/2009 a dose 1/28/2009 of ROTATEQ (lot numb n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da n has been received from a nurse practitioner concerning 2 patients at the practice who were U vaccinated with a dose of GARDASIL on uns n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da n hs been received from a registered nurse concerning a female with sulfanomide allergy who U was vaccinated with a dose of GARDASIL o n has been received from a receptionist in a physician's office concerning her daughter whoUon 28-JAN-2009 1/28/2009 was vaccinated 1/28/2009 with the fourt n has been received from a nurse practitioner and the mother concerning a 16 year old female Y with no medical 1/28/2009 history 1/28/2009 and drug allergies w n has been received from an office Y staff member concerning a female patient who in approximately U January 1/1/2009 2009 was 1/1/2009 vaccinated with the n has been received from a physician Y concerning an 11 year old female patient who in July 2008 U "6 months 7/1/2008 ago" was7/1/2008 vaccinated with the f n has been received from a physician concerning an 11 year old female patient with asthmaNwho on 25-NOV-2008 ### was vaccinated ### intramu n has been received from a medical assistant concerning 3 female patients who fainted afterYreceiving the first dose of GARDASIL. Medica n has been received from a nurse practitioner Y concerning a female patient who on an unspecified N date received 9/1/2008 the11/1/2008 first dose of GARDASI n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL and her n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL (Lot # not reported). After patie n has been received from a registered nurse concerning a 26 year old female with polycysticNovarian syndrome, 1/27/2009 a history 1/27/2009 of thoracic sympa n has been received from a physician concerning a 15 year old patient who on 13-MAY-2008 Y was vaccinated 7/14/2008 with first 7/14/2008 dose of GARDASIL n has been received from a physician concerning an 18 year old female with no medical history Y who on 30-DEC-2008 ### 1/4/2009 was vaccinated with n has been received from a physician concerning an unknown number of patients who wereUvaccinated with a dose of GARDASIL and exp n has been received from a Certified Y Medical Assistant concerning a 21 year old female withYa history of dysmenorrhea 2/8/2008 and pelvic pain as
n has been received from a physician concerning an approximately 14 year old female who Y was vaccinated 1/1/2009 with the 1/1/2009 first 0.5 ml dose of GA n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL (lot num n has been received from a nurse practitioner Y concerning a 15 year old female patient who in N November5/24/2007 2006, was10/1/2008 vaccinated with GARD n has been received from Merck Pregnancy Y Registry for GARDASIL vaccine from a Nurse practitioner U concerning 12/8/2008 an 12/8/2008 18 year old female wi n has been received from a physician Y concerning a 16 year old female patient who on 25-MAR-2008 Y was 5/27/2008 vaccinated 5/27/2008 with first dose of GAR n has been received from a physician concerning a 22 year old female who on 23-Jan-2009Uwas vaccinated 1/23/2009 in arm 1/24/2009 with the second dose o n has been received from a 22 yearYold female patient with yeast hypersensitivity, no drug/reactions N allergies 1/23/2009 who on 1/23/2008 23-JAN-2009 was va n has been received from a physician concerning a 17 year old female with drug hypersensitivity N and allergic reaction to AMOXICILLIN and n has been received from a nurse practitioner Y concerning a 23 year old female patient with no N pertinent medical ### history and no known drug n has been received from a registered Y nurse concerning a 28 year old female patient with asthma, N allergies an allergies to penicillin, CECL n has been received from a RN concerning a 16 year old female who was vaccinated with her U first dose of GARDASIL on an unspecified d n has been received from a registered Y nurse concerning an 18 year old female student with N a slight temperature 1/9/2009 at the 1/9/2009 time of vaccination ( n has been received from a respiratory Y therapist concerning a 11 year old female patient with U no pertinent 1/26/2009 medical history 1/26/2009 and no known dr n has been received from a physician Y concerning a 48 year old female licensed nurse practitioner N with sulfanomide 1/26/2009 allergy who was admin n has been received from a nurse concerning a 26 year old female who was vaccinated withUa first dose of GARDASIL, lot number not repo n has been received from a physician Y assistant concerning a female patient who "experienced Y a severe headache after her first dose of GA n has been received from a physician Y concerning a 14 year old female patient with attentionNdeficit disorder 10/1/2008 and depression 10/1/2008 who on 24-JUN n has been received from a registered Y nurse concerning an 18 year old female patient who on Y 05-APR-2007 9/4/2008 was vaccinated 9/4/2008with the first d n has been received from a registered Y nurse concerning a 15 year old female patient with noYpertinent medical 6/25/2008 history 6/26/2008 and no known drug a n has been received from nurse practitioner Y concerning a "high school age" female patient who Y on unspecified date was vaccinated with tw n has been received from a consumer concerning her daughter who on 18-Apr-2008 was vaccinated N with 4/18/2008 the first 0.5ml 7/16/2008 dose of GARDASIL n has been received from a nurse practitioner concerning an 18 year old female patient whoNon 26-NOV-2008 ### was vaccinated ### intramuscula n has been received from a consumer concerning her 14 year old female daughter who on 16-OCT-2008 N was ### vaccinated ### with the first dose n has been received from a physician Y concerning a 16 year old female patient who on unspecified Y dates was vaccinated with the first dose n has been received from a physician. Y The physician reported that "she heard from a friendUthat the female patient, who was not the physi n has been received from a Registered Y Nurse concerning a 14 year old female patient with Flu N vaccine allergy 1/23/2009 and 1/23/2009 gastroesophageal reflux n has been received from a clerk inYa physician's office concerning her 19 year old daughterYwho in approximately 6/1/2008 June 6/1/2008 2008 "Summer 200 n has been received from a nurse concerning Y a 23 year old female patient who on unspecified U dates was 1/22/2009 vaccinated 1/23/2009 with the first and the s n has been received from a physician Y concerning a female patient who on unspecified date Y was vaccinated with her second dose of GARD n has been received from a office manager Y concerning a 19 year old female patient with no Y known drug 1/16/2008 allergies/drug 6/2/2008 reactions who on 16 n has been received from a registered Y nurse concerning her 18 year old daughter who on 27-OCT-2006 Y was vaccinated ### with the first dose n has been received from a physician Y concerning a 13 year old female patient with a historyYof passing out 1/23/2009 every time 1/23/2009 she received an injec n has been received from a nurse at physician's office concerning a female patient who on 31-DEC-2008, U was### vaccinated 1/14/2009 with the third dos n has been received from a physician who on 01-DEC-2008 was vaccinated with a dose of GARDASIL U vaccine. 12/1/2008 The patient had an abnorm n has been received from a physician Y concerning his 12 year old daughter with no known medical N history 1/22/2009 and drug 1/22/2009 allergies, who on 22-JA n has been received from a nurse concerning Y a 13 year old female with no drug reactions orYallergies who 7/23/2008 on 23-JUL-2008 7/23/2008 was vaccinated n has been received from a consumer concerning his 15 year old daughter with acne, no known N allergies 1/20/2009 and no pertinent 1/21/2009 medical history, n has been received from a nurse concerning Y an 18 year old female patient who on 16-JAN-2009 Y was vaccinated 1/16/2009 intramuscularly 1/16/2009 with the f n has been received from a consumer Y concerning her 14 year old female daughter with no pertinent N medical history, 7/1/2008 no drug reactions/alle n has been received from a physician Y concerning a female patient who on 15-AUG-2008 was Y vaccinated8/15/2008 with the first 8/15/2008 0.5 mL dose of GAR n has been received from a physician concerning a 16 year old female patient who was vaccinated Y IM with the first dose of GARDASIL (lot n has been received from a nurse practitioner concerning a 20 year old female with no known Y drug reaction/allergies 1/12/2009 1/12/2009 and a history of exerc n has been received from a physician concerning a patient who on 20-JAN-2009 was vaccinated U with third 1/20/2009 dose of GARDASIL 1/20/2009 (Lot # not re n has been received from a nurse concerning Y a 18 year old female patient who was vaccinated U with first dose of GARDASIL (Lot # not repo n has been received from a physician concerning a 16 year old female patient who was vaccinated U with two doses GARDASIL. Subsequen n has been received from a Nurse Practitioner Y concerning a female who was vaccinated withU a first dose of GARDASIL vaccine, and devel n has been received from a physician Y concerning a 17 year old female patient who on 27-JUN-2008 N was vaccinated ### with first dose of GAR n has been received from a practiceYmanager concerning a 21 year old female with no pertinent N medical1/20/2009 history, drug 1/20/2009 reactions or allergies n has been received from an office Y manager (also reported as an emergency medical technician N concerning a ### 23 year old### female patient w n has been received from a registered Y nurse concerning a 12 year old female patient who onU11-OCT-2008 1/19/2009 was vaccinated 1/19/2009 with the first do n has been received from a nurse practitioner Y concerning a 14 year old female who "sometime Y this month" 1/1/2009 was vaccinated 1/1/2009 with the first do
n has been received from a physician concerning several females who on unknown date were U vaccinated with GARDASIL vaccine. On uns n has been received from physician concerning a 14 year old female who was vaccinated the U first dose of with GARDASIL on an unspecifie n has been received from a nurse practitioner concerning a 22 year old female who on 03-DEC-2008 U was 12/3/2008 vaccinated 12/3/2008 with the first dose of n has been received from a registered nurse concerning a 19 year old female who on 12-MAY-2008 Y was vaccinated ### intramuscularly ### in the n has been received from a pharmacist Y concerning her 9 year old daughter who in August 2008, N was vaccinated 10/1/2008with 10/1/2008 a first dose of GARDA n has been received from a nurse concerning a 25 year old female with no drug allergy whoYon 09-JAN-2009 1/9/2009 was vaccinated 1/9/2009 with the first d n has been received from a nurse practitioner concerning a female who was vaccinated withNthe first dose of GARDASIL. 1/1/2008 "Few months ago n has been received from a physician concerning a female who on was vaccinated in the deltoid Y with the1/19/2009 first and second 1/19/2009 dose of GARDAS n has been received from a healthcare worker concerning a 14 year old female with penicillin Y allergy and1/16/2009 drug hypersensitivity 1/16/2009 of DARVOC n has been received from a physician concerning a female with eczema who about 1 year ago, N was vaccinated 1/1/2008 with the 1/1/2008 first dose of GARD n has been received from a registered pharmacist concerning three female patients who on Y unknown dates were vaccinated with GARDAS n has been received from a consumer Y concerning her 18 year old daughter with asthma whoNin the summer 4/15/2008 of 2008,9/1/2008 was vaccinated with t n has been received from a consumer Y concerning her approximately 20 year old daughter with N no pertinent 11/1/2008 medical11/1/2008 history, who in Novem n has been received from a consumer for the pregnancy registry of GARDASIL vaccine concerning U his fiancee 6/1/2008 who has has two doses of G n has been received from a medical assistant and a registered nurse concerning a 15 monthYold patient who vaccinated with a dose of GAR n has been received from a medicalYassistant concerning a female patient who on 14-JAN-2009 N was vaccinated 1/14/2009 subcutaneously 1/24/2009 with the th n has been received from a patient's mother concerning her 12 year old daughter with no pertinent N medical 1/3/2009 history and 1/3/2009 no known drug aller n has been received from a nurse practitioner Y concerning a 13 year old female patient who on Y 15-JAN-2009 1/15/2009 was vaccinated 1/15/2009intramuscularl n has been received from a nurse practitioner Y concerning a 20 year old female patient with AZITHROMYCIN N allergy ### and a history of seizur n has been received from a Nurse Practitioner concerning a female patient who completed GARDASIL U vaccine (lot # not provided) series. n has been received from a doctor of pharmacy who spoke with a nurse in her facility and stated U that on an unspecified date another patien n has bee received from a 19 year old female patient for GARDASIL, concerning herself withNno pertinent 10/1/2008 medical history ### and no known dr n has been received from physician concerning a female patient who was vaccinated with a Y0.5 ml dose of GARDASIL vaccine. The patien n has been received from a physician concerning a 16 year old female who on 15-JAN-2009Nwas vaccinated 1/15/2009 with a1/15/2009 0.5 ml dose of GARDA n has been received from a 19 year old female with no drug allergy who in January 2008 was N vaccinated 1/1/2008 with the first 1/15/2009 dose of GARDASIL. n has been received from a physician concerning a female who was vaccinated with a third U dose of GARDASIL vaccine and experienced p n has been received from a registered nurse concerning a 20 year old female who on 09-OCT-2008 U was10/9/2008 vaccinated with the ###first 0.5 ml do n has been received from a nurse concerning a 19 year old female patient for the pregnancyUregistry for GARDASIL. 2/3/2008 6/27/2008 With allergy to BENAD n has been received from a doctor of pharmacy concerning her daughter who in October 2007 N was vaccinated 10/1/2007 with10/1/2007 the first dose of GARDA n has been received from a physician Y and her assistant concerning 23 year old female whoYon an unknown date was vaccinated ### with a firs n has been received from a Nurse Practitioner Y concerning a 22 year old female virgin patient with no pertinent ### medical 12/1/2008 history no drug reac n has been received from a registered nurse concerning a female, who was vaccinated withUthe second dose of GARDASIL, IM in upper de n has been received from a nurse practitioner Y concerning a 16 year old female patient with penicillin Y allergy, 1/14/2009 who on1/15/2009 14-JAN-2009 was vac n has been received from a consumer concerning her 15 year old female daughter with no pertinent Y medical 8/26/2008 history8/26/2008 and no drug reactions/ n has been received from a nurse concerning "almost every single patient" (approximately 237) U who was vaccinated with GARDASIL. Sub n has been received from a medical assistant concerning a 17 year old female with no pertinent N medical history 1/8/2009 who1/12/2009 on 30-OCT-2008 was n has been received from a nurse practitioner concerning a female who was vaccinated withUa dose of GARDASIL (lot # not reported). Sub n has been received from a Certified Medical Assistant concerning an approximately 14-year-old Y female12/1/2008 with no known 12/1/2008 drug allergies who n has been received from a nurse practitioner concerning her daughter who in October 2008, was vaccinated 10/1/2008 the first 10/1/2008 dose of GARDASIL. n has been received from a physician concerning a 15 year old female who was vaccinated U with a 0.5ml dose of GARDASIL (lot number no n has been received from a registered Y nurse concerning her 26 year old daughter who on 13-JAN-2000 Y 1/13/2009 was vaccinated 1/13/2009 with a second dose n has been received from a nurse concerning a 14 year old female student patient who on 12-JAN-2009 U 1/12/2009 was vaccinated 1/14/2009 with the third dose n has been received from a registered Y nurse concerning a 17 year old female patient with CODEINE Y allergy 8/26/2008 who on8/26/2008 19-JUN-2008 was vac n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL 1/5/2009 (Lot 1/14/2009 # was not available) n has been received from a nurse concerning a 25 year old female patient with no known drug Y reactions/allergies 1/7/2009and 1/7/2009 medical history who n has been received from a female patient, with no known drug reactions/allergies and no pertinent U medical history, who was vaccinated w n has been received from a licensed Y practical nurse concerning a 19 year old female patientUwith no known 8/20/2008 medical history; who on 20-AU n has been received from a nurse practitioner concerning a 19 year old female who on 08-Jan-2009 N was 1/8/2009 vaccinated 1/8/2009 with the first dose of G n has been received from a physician Y concerning a female patient who on vaccinated with the U three doses of GARDASIL. Shortly after the n has been received from a physician concerning a female patient who was vaccinated with Ua dose of GARDASIL 10/1/2008 last fall and said the vac n has been received from a licensed Y practical nurse concerning an 18 year old female patient N with no known 9/15/2008 medical 9/15/2008 history and drugs alle
n has been received from a nurse Concerning a female who was vaccinated with the third dose U of GARDASIL vaccine. The nurse reported n has been received from a physician concerning a female patient with unspecified psychiatric U problems12/1/2007 and restless1/1/2009 legs syndrome who in n has been received from a nurse practitioner Y concerning a 25 year year old female patient with N no pertinent medical history, ###not known dru n has been received from a physician assistant concerning a 15 or 16 year old female patient U who on unknown dates was vaccinated with n has been received from a registered nurse concerning her daughter who was vaccinated with U the third dose of GARDASIL. Four days af n has been received from a physician concerning a female who on unspecified date was vaccinated U with a first dose of GARDASIL and had n has been received from a physician concerning a 13 year old female patient, who on unspecified Y dates, was vaccinated 11/1/2008 with the second n has been received from a nurse concerning a female who was vaccinated with a first doseUof GARDASIL. The patient called the nurse 4 n has been received from a Nurse concerning Y a 20 year old female patient with no pertinentYmedical history 1/8/2009 and no drug 1/8/2009 reactions or allerg n has been received from a registered Y nurse concerning a 23 year old female patient with noYpertinent medical### history and### no known drug a n has been received from a nurse in the physician's office concerning a 43 year old female who U was vaccinated with three doses of GARDA n has been received from a physician's assistant concerning a 15 year old white female, 75.9 Y kg and 157cm 1/8/2009 in height, 1/8/2009 who on unspecified n has been received from a consumer concerning her daughter who was vaccinated with theUthird dose of GARDASIL. 1/1/2009 In January 2009 ("a n has been received from a physician concerning a 14 year old female who on 01-MAY-2008 N was vaccinated 5/1/2008 with the 5/22/2008 third dose of GARDA n has been received from a physician's assistant concerning a 13-15 year old female who onY 08-JAN-2009 1/8/2009 was vaccinated 1/8/2009 with the third do n has been received from a 21 year old female with attention deficit disorder and no medicalUhistory who was vaccinated with ### three doses o n has been received from a consumer concerning her 17 year old daughter with a history of N drug hypersensitivity 1/5/2009to MYNOCYCLINE 1/7/2009 who o n has been received from a physician concerning a female who was vaccinated with a first dose N of GARDASIL 1/8/2009 without any reactions and o n has been received from a registered nurse concerning a 21 year old patient who on 10-NOV-2008 N was vaccinated ### with a first dose of GA n has been received from a 19 year old female with no known drug allergies who on 05-JAN-2009 N was vaccinated 1/5/2009 with 1/8/2009 the third dose of GA n has been received from a nurse concerning a 16 year old female with no medical history ofY drug allergy 7/11/2008 who on 11-JUL-2008 7/11/2008 was vaccin n has been received from a nurse practitioner, for GARDASIL, a Pregnancy Registry product, U concerning7/3/2008 a 17 year12/1/2008 old female who on 03-J n has been received from a medical assistant concerning her daughter who was vaccinated Uwith the first dose of GARDASIL on an unspec n has been received from a physician concerning a female patient who was vaccinated with Uthree doses of GARDASIL vaccine (no lot num n has been received from a nurse practitioner concerning a 15 year female who in May 2008, Y was vaccinated 5/28/2008 with the 6/1/2008 first 0.5ml dose of G n has been received from a consumer concerning her 15 year old daughter with no medical N history and drug 7/1/2008 allergies, 12/1/2008 who in July 2008 wa n has been received from a nurse practitioner Y concerning an 18 year old female who was vaccinated Y with9/3/2008 the second9/4/2008 dose of GARDASIL in n has been received from a nurse practitioner concerning a 17 year old female who on 06-MAY-2008 N was5/6/2008 vaccinated with GARDASIL intra n has been received from a 45 year old female patient who was vaccinated with two doses of U GARDASIL vaccine (no lot number was prov n has been received from a registered nurse concerning a 22 year old female who on unspecified Y dates was vaccinated ### with ###the first and th n has been received from a medicalYassistant concerning a 13 year old female patient with no Y pertinent medical 7/16/2008 history 7/16/2008 and with allergic rea n has been received from a doctor of Y pharmacist concerning a 17 year old female patient with N no pertinent 10/1/2008 medical history and no known d n has been received from a registered nurse concerning a 10 year old female patient who onY 15-MAY-2008 was ### vaccinated ###with the first do n has been received from a physician Y concerning a 14 year old female who on 20-MAY-2008 Y was vaccinated 5/20/2008 with the 5/25/2008 first dose of GARDA n has been received from a consumer concerning her 19 year old daughter who on 09-APR-2007 U was vaccinated ### with 3/12/2008 the first dose of GAR n has been received from a 24 year old female patient, for GARDASIL vaccine, a PregnancyNRegistry product 9/1/2008 concerning 12/6/2008 herself with no p n has been received from a physician Y concerning a 16 year old female with no medical history Y or drug allergy 1/5/2009 who on1/5/2009 05-JAN-2009 was va n has been received from 2 nurses concerning a 17 year old female with a history of faintingYwho on 30-DEC-2008 ### was vaccinated ### with the n has been received from a physician assistant concerning an 18 year old female with reactions Y to vaccines who was vaccinated ### with a dos n has been received from a 24 year old female medical assistant who in December 2008, was U vaccinated 12/1/2008 with a second dose of GARDASI n has been received from a physician concerning an 17 year old female who on 02-JAN-2009 Y was vaccinated 1/2/2009 with the 1/2/2009 first dose of GARDA n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning U an 7/16/2007 18 year old female ### with urinary freq n has been received from a physician concerning an 11 year old female who in August 2007, Y was vaccinated 8/1/2007 with the8/1/2007 first dose of GARDA n has been received from a registered Y nurse, concerning a female patient, who on an unspecified U date was vaccinated with GARDASIL. Th n has been received from a registered Y nurse, concerning a female patient, who on an unspecified U date was vaccinated with GARDASIL ,0. n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 1/1/2008 12 months"1/1/2008 was vaccinated intram n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 1/1/2008 12 months"1/1/2008 was vaccinated intram n has been received from an educator concerning a 7th to 9th grade female student, who "within Y the last 12 months" was vaccinated intram n has been received from a physician concerning a female with allergy to latex who was vaccinated U with GARDASIL. Concomitant therapy n has been received from a 27 year old female patient who on 08-OCT-2008 was vaccinatedY with a first 10/8/2008 dose of GARDASIL, when she was n has been received from a consumer Y concerning her 12 year old daughter with no known medical N history 6/10/2008 and allergies, 6/10/2008 who on 10-JUN-20
n has been received from a physician Y concerning a 12 year old female patient who on an unknown Y date was vaccinated with the first dose n has been received from a Registered Nurse concerning a 17 year old female patient with no Y pertinent 8/31/2008 medical history 9/2/2008 and no drug reactio n has been received from a consumer Y concerning her 21 year old daughter with no previousYmedical history reported ### who### on 06-APR-2007 n has been received from a licensed Y practical nurse for the Pregnancy Registry for GARDASIL, U concerning 10/8/2008 a 26 year old female ### patient wit n has been received from a consumer Y concerning her 16 year old daughter with no drug reactions Y or allergies 12/9/2008 who on 09-Dec-2008 ### was va n has been received from a registered Y nurse concerning a 16 year old female with no medical U history and allergies ### and 0 previous ### pregnan n has been received from a certified nurse midwife for the Pregnancy Registry for GARDASIL U vaccine, concerning 8/15/2008 a8/15/2008 19 year old female wh n has been received from a Registered Nurse regarding the Pregnancy registry for HPV concerning Y a 2411/4/2008 year-old female with penicillin and n has been received from a Registered Nurse, for the Pregnancy Registry for GARDASIL vaccine U concerning a### 24 year 2/26/2008 female with of asth n has been received from a nurse practitioner Y for the pregnancy registry for GARDASIL vaccine Y concerning 1/28/2008 a 27 year 2/11/2008 old female with a his follow up information has been received from a nurse, for the pregnancy for GARDASIL, concerning Y a black female with one previous preg n has been received through the Merck Y pregnancy registry from a female consumer, nurse practitioner Y and 2/22/2008 physician 2/22/2008 concerning female wi n has been received from Pregnancy Registry for GARDASIL vaccine from a Registered Nurse Y (R.N.) concerning 10/9/2007a10/9/2007 female patient who was n has been received through the Merck Y pregnancy registry from a physician concerning a 25Yyear old female with ###a history### of tonsillectomy fter vaccinations, he developed a rash all over body (mostly on face & neck). It was a red, blotchy Y rash with 1/26/2009 tiny raised 2/4/2009 bumps. Rash laste rtness of breath. Rx- BENADRYL 25mg Y IV, SOLUMEDROL 125mg IV; MEDROL DOSC Pack, Y BENADRYL PO###Symptoms ###resolved. ceived vaccine 01/19/09 (Monday) and Y report ear ache and cold sores on 01/23/09. Patient treated Y as such 1/19/2009 but returned 1/23/2009 to MD office and d ported - symptoms of Brachial neuritis Y - R arm deep ache, weakness, numbness. N 1/20/2009 1/26/2009 e fever, chills, body ache, dizziness lasted 36-48 hours Y 1/29/2009 1/30/2009 was given 1/30/09-same day Patient developed repetitive Head nodding 3-4 episodes per hour N per parents. 1/30/2009 Observed 1/30/2009 1 episode in clinic cm erythematous plaque, hot raised, at injection site, mild pruritis. Pt noted began after injection, U enlarging 1/22/2009 qd 1/22/2009 zed swelling @ injection site (upper quadrant of left thigh) 14 days post vaccination pain to the U touch, cranky 1/8/2009 child. Redness 1/22/2009present 4d. Po anus shot in my right arm. About 4Ydays later I noticed a lump on my right shoulder. I had an ultrasound + that### showed 1/4/2009 3 lumps. I had an 0 min of giving immunizations infant became limp 1 eyes appearing "vacant." No jerking motions/cyanosis Y 1/21/2009 - 1 Hr 150-O2 1/21/2009 100% monitored f d coldness, stiffness, chills, spasticity occurred 4 hrs after vaccine (flu). Episode lasted 5 minutes. Y 10/8/2008 10/8/2008 d hives approximately 12hr after PEDIARIX, Hib, PCV7, ROTATEQ. Y 1/13/2009 m fever, hot to touch, pain at injection Y site, shortness of breath, redness and swelling at injection U site. 1/21/2009 1/21/2009 AP instead of DTAP Y zure like activity Y Y 1/28/2009 1/29/2009 cines, pt. was nervous, I left the room so pt. could get dressed. MOP said pt. got up to change Y and pt. fell 1/28/2009 back. Pt.1/28/2009 was pale. We laid her ceived vaccines on 1-16-09- Hepatitis Y A, PREVNAR, influenza, and MMR. On 1-24-09 patient started with 1/16/2009 symptoms 1/24/2009 of rash, fever-rash sta m with erythema, length of deltoid positive Y warmth, positive swelling given 10 days KEFLEX 250 Y mg every 11/6/2008 12. 11/8/2008 103.5 degree F X 48 degree + MOTRIN/TYLENOL Y 1/26/2009 1/26/2009 mmatory reaction to right upper arm 2/10/2009 2/12/2009 onset of facial rash & rash @ sites Y of vaccines within minutes post VARIVAX @ 1205- refractions Y was noticed. 1/8/2009 1/1000 1/8/2009 EPI 0.1 ml given in ith fever - suspicious CT Y Y 1/20/2009 1/21/2009 rash on (R) side of face and on arm. Last for 3 days. Y 9/4/2008 9/5/2008 TX: BENADRYL TYLENOL Topical treatment of lesions N 12/5/2007 1/19/2009 red vaccine to patient. Patient older than eligible age. Product guidelines say age less than 65 Y yrs old is eligible. 1/9/2009 Client is 65 yrs old. ort received on 16 January 2009 from a health professional. A 58 year old female, with a history N of hypertension, ### Hypercholesterolemia ### and s in right thumb that rapidly spread to Y both hands and then into feet. Sense of tongue burning N followed by a sense ### of numbness ### about the f ef near syncopal episode when she got up from exam table, less than 2 minutes after injection. Y Completely 1/27/2009 resolved1/27/2009 in 10 minutes. Did not 2 since midnight. Fever to 102.2 with Y blurred vision short term. Headache. SOB from a few U hours after shot 1/29/2009 until midnight. 1/29/2009 (L) arm sorenes vaccine given to child less than 6 months of age. Y 1/30/2009 tous, tender to palpitation. Anterior aspect Y of left arm. Plaque about 4cm in diameter. U 1/28/2009 1/29/2009 ls, nausea, sore at inj site H/A, achy feeling. Y 1/26/2009 1/26/2009 ocal cellulitis (L) deltoid treated with antibiotics. Y 1/7/2009 1/14/2009 ZOSTAVAX 1/27/09. 1/30/09 presented Y to our office arm pain from elbow to arm pit, "feels on U fire" swollen, 1/27/2009 hard and 1/28/2009 red. Treated with OTC tenderness, and warmth @ site of injection possible infection --> pt. referred to PCP. U 1/30/2009 1/4/2009 munization red, swollen, tender with patient c/o arm, shoulder and neck pain - 1st local reaction U I've seen1/22/2009 with. 1/22/2009 eiving Tdap pt. had fever, vomiting and body aches for 3 days. Y 1/31/2009 1/31/2009
edema, itchiness @ site of injection, c/o general malaise. 1/28/2009 1/30/2009 - warm area 2 days and gradually subsiding. Y 1/1/2009 1/1/2009 izzy while walking , fainted. Y 1/29/2009 1/29/2009 ded, heart racing, palpitations. Y Y 1/15/2009 1/15/2009 ates the child had diarrhea x 7 days. Y 12/1/2008 12/1/2008 from client states "upper right arm has been hurting since she received the hepatitis A-B vaccine U on 1/12/09". 1/12/2009 She 1/12/2009 has applied cold and he th swelling, induration, warmth and ,mild erythema of left thigh. U 1/27/2009 1/28/2009 ncope within 3 min, fell to floor, hit head. Y Unresponsive for several minutes. VS were stable.Y Went to ER1/8/2009 for eval. Recovered, 1/8/2009 sent home. n has been received from a consumer concerning his child who on an unspecified date was U vaccinated with a dose of PROQUAD (lot num n has been received from a physician concerning a patient who on third week of December U 2008 was vaccinated ###with the### first dose of ROT PM Tongue "thick and hard". Y Difficulty breathing and swallowing. 2/3/09 12 Noon (L) arm sore. Y (L) hand/fingers 2/2/2009 tingling. 2/2/2009 2/3/09 Family calle ZOSTAVAX - on 9/17/08 in left upper Y deltoid. On 12/19/08, pain in left arm, left neck, left cheek Y occurred. 9/17/2008 Herpes lesions ### occurred - left no t on 12/3/08, Flu vaccine 11/17. 3/19/09 Y MR received from PCP which include neuro consults. N Pt seen 11/17/08 ###for12/3/2008 URI sx. Flu vax given. veloped sore right arm the day she received the vaccine. Bothers her most at night rolling over U in bed. Difficult 2/9/2009 to put2/9/2009 deodorant on. No feve ed ZOSTAVAX on 01/06/2009. She developed an itchy painful rash on her neck and on itchyUsensitive area 1/6/2009 right scapula 2/1/2009 and under her righ ped urticaria (Hives) within 24 hoursYof receiving vaccine (HEP B) U 2/12/2009 2/13/2009 @ approx 2 pm, slept for 6 hours (unusual) waking once to nurse and cry @ 6 pm and then back Y to sleep until 2/5/2009 8 pm. Upon 2/5/2009 waking went very as given Hepatitis A and VARIVAX; Y within minutes was syncopal and had tonic-clonic seizureY while still in2/16/2009 exam room. 2/16/2009 Pulse 70, B/P 104/62 ng 4 y/o shots, 1 day post getting them Y arm (right arm) blister, red, sore. Fussy all day 2 days U post shots2/11/2009 with red lacy 2/12/2009 rash, clammy, pale, area of vaccine MIN local reaction of Y about 1 inch around VACC site-has pooling reaction area Y under the2/10/2009 vaccine site 2/17/2009 of redness about 6 in ed Vaccinia characterized by headache nausea and generalized erythematous papules sparing face and 2/8/2009 neck 2/19/2009 s been running a fever up to 104, dizziness, Y shakes, muscle ache, headache, weakness, coughing, N flush 2/16/2009 and loss of 2/17/2009 energy. These sympto headaches, frequent illness Y includingY viral spinalY menengitis, numbness 9 and tingling in different U areas of the body. ###First 1/15/2009 shot 10/31/08, seco veloped temperature of 102F and headache on 2-18-2009 around 1:45pm. Parent reported U symptoms to2/17/2009 clinic at approximately 2/18/2009 4:30pm an 17 started to get a papular rash on both feet hands and arms with itching. Took over the counter Y Benadryl 2/11/2009 1 tablet February 2/17/2009 18 2009. The r om pt: sx's began 2-17-09 PM - painYL side only (arm, shoulder, breast). She went to work 2-18 Y and left early 2/17/2009 d/t sx's. 2/17/2009 Co-workers commente 02.5 one hour after the DTaP1/Hib/IVP Y shot administered. Also signs of severe distress, screaming U and5/9/2001 crying. He5/9/2001 continually grasped m ( 2/12/09) he was shivering, temp taken, was 94 degrees. At 2 am,his temp was 103. He had Y an uneasy2/12/2009 stomach for 2/12/2009 a few days. Nausea b s before Thanksgiving, mother Y saysYpatient had Y cold symptoms, coughing 4 and nasal congestion. N The week of ### Thanksgiving, ###Nov. 24, 2008 headache, right earache, left arm pain (same side as vaccination), vomiting x 1. Y 2/10/2009 2/11/2009 st his hair- all of it over the course of 3 months and became completly bald. He has not had any N new growth. 3/30/2007 4/30/2007 ain - stiff after receiving vaccination that has continued to be bothersome U 8/25/2008 8/26/2008 -Pt received Fluzone MDV 0.5ml, and should have received Fluzone 0.25ml. 1/29/2009 - Pt received Tdap instead of Dtap 1/30/2009 - Pt received Fluzone MDV 0.5ml instead of 0.25ml. 1/29/2009 lled and questioned soreness of vaccinated arm. Patient stated that it was warm to the touch U and approximately 2/16/20092" in diameter. It was also swollen and tender and hard after recieving DTaP but should of recieved dT booster insteadY 2/17/2009 2/18/2009 ticed onset of partial seizure like activity the night after vaccines were administered. Episodes U of shaking2/16/2009 the head and 2/16/2009 shaking one arm wi ay after receiving vaccines, lethargic, eyes droopy, woke up 2x only to feed for 8-10 min each U time 2/18/2009 2/18/2009 ed the following information from a nurse via the Y agency on 05 FEB 132009: A 68-year-old woman, Y born on 26 APR ### 1940, was ###vaccinated wi was reported by a lawyer and described the occurrence Y of arm pain0in a female subject of unspecified N age 5/8/2000 who was vaccinated with LYME was reported by a healthcare professional Y via a sales representative and described the occurrence U of vaccine 4/10/2008 exposure 4/10/2008 during pregnancy was reported by a healthcare professional Y via a sales representative and described the occurrence U of pregnancy 4/10/2008in4/10/2008 an adult female subjec abdomen and spread to back with itching, Y stinging and pain. Pain constant treated with VALTREX U 1g tid 10/9/2008 x 7 days and2/2/2009 NEUROTIN 500mg b 2/12/2009 and swelling at site, Dorsal portion of Left arm in subcutaneous area. 4 cm round. Y 2/17/2009 2/18/2009 r all over body 10 days after immunization pt examined 2/9/09 rash resolved Y 1/26/2009 2/4/2009 ve like. Swollen Rt leg - redness. Y Y 2/17/2009 2/18/2009 chicken pox disease on 2-19-09 9/22/2003 2/19/2009 veloped #3 1-2 mm papules red on right thigh 1 week after shots Y 1/29/2009 2/5/2009 ed. 7/7/09 Medical records received Y DOS 12/26/07 to 6/23/09. Assessment: Rash Patient presented Y with1/8/2009 erythematous 1/14/2009 maculopapular ras
9 donor reported a rash she developed following a Hep B injection she received on 2-17-09.YRash on 2-18-09 2/17/2009 stretched 2/17/2009 across abdomen a r reported by parent to be 105.6 degrees Y F. Office temperature within normal limits 97.2 degrees Y F without 2/11/2009 other symptoms. 2/11/2009 Lab work comp rythematous vesiculopapular eruptions Y over arms, hands, legs, heels, chest, upper back, upper trunk, onset 1/15/2009 17 days 2/1/2009 following receipt of SP ve 1 dose of MENACTRA that had expired 2 days before no problems. U 2/4/2009 t 2008 his mother brought him to immunizationsYto receive his 6 month 10 old shots and Synagis. Y Mom reported the ###child was### cranky having a d bilateral red eyes, itching, pain similar Y to 4/29/05 eye infection 2 hours after receiving both IM Y influenza10/1/2005 10/2005 and 10/1/2005 FLUMIST 10/2006. P 3 AVA vaccinations in 2007 and continued Y to experience cough, fatigue, myalgia, arthralgia, dizziness,and 2/28/2007 short term memory problems. n has been received from a physician Y concerning Y a 32 year old male 0 patient with Wilson's disease U and decreased immunoglobulin levels w n has been received from a female who on an unspecified date was vaccinated with the firstYdose of MMR II and "had a reaction like stop b n has been received from a physician Y concerning a female who on an unspecified date was Yintramuscularly vaccinated with the second dos 2/19/2009 N 2/18/2009 2/19/2009 - entire body - breathing on her own,Y difficulty swallowing, Y weakness3arm Y and legs at 2200 then U progressed 2/5/2009 this AM. 2/5/2009 2/27/09-records receiv o hospital 2/6/9 for intussusception. 3/9/09 Received Y hospital medical 2 records of 2/6-2/7/2009. Y FINAL DX: Ileocecal ### 2/6/2009 intussusception Recor Feb. 5, 2009 fever 102- C was the highest Y the fever and slight rash on face, no energy, red eyes Y not eating. 1/27/2009 Fr. Feb 6, 2/5/2009 2009 fever and rash ic rash encircling entire base of neck developed 48 hours after ZOSTAVAX administered without Y rash at injection site of R deltoid. Develop lls, muscle aches. Y Y 2/19/2009 2/19/2009 & warmth of left thigh where KINRIXYwas administered on 2/17/09 U 2/17/2009 2/18/2009 nner thighs and lower back positive pruritis. U 2/17/2009 2/19/2009 tight chest, hives, and difficulty breathing that lasted for three hours. Y 9/20/2008 9/20/2008 d, extremely cold chills, dizziness (these conditions lasted four days). Y in today for yellow fever and Hep AYvaccine for travel to Peru. Vaccine was given (yellow fever) Y SQ in left 2/16/2009 arm and Hep 2/16/2009 A IM in R deltoid at d FLUMIST on 10-8-08, but still tested Y positive for influenza B on 2-4-09. Y 10/8/2008 2/4/2009 d FLUMIST on 10-9-08, but still tested Y positive for influenza A on 1-31-09. Y 10/9/2008 1/31/2009 d FLUMIST on 10-8-08, but still tested Y positive for influenza A on 2-2-09. Y 10/8/2008 2/2/2009 ceived FLUMIST on 10-9-08, but still Y tested positive for A and B influenza on 12-7-08. Y 10/9/2008 12/7/2008 ot in Oct - (first shot ever for flu). By next am lips were swollen and remained for the day. ByYevening lips started ###getting dry ###and chapped a nconsolable crying, poor feeding Y 2/3/2009 2/3/2009 oid has 2cm annular red induration - Pt c/o nausea, vomiting, & fever of 101.4 F 2 days afterYinjection was2/5/2009 given. States 2/7/2009 she has never had cry after PENTACEL vaccine Y 2/13/2009 2/13/2009 after Vaccine given patient called with Y an intense PRURITIC Response - patient returned toYoffice for DEPO 2/9/2009 MEDROC 2/9/2009 Injection. n MMR & DTAP into left deltoid & VARICELLA & IPV in right PT got 10 X 10 area of erythema N on left deltoid 2/11/2009 & a headache 2/12/2009 lled the pharmacy with concern about Y red area excessive swelling and redness at the injection Y site (size2/11/2009 of a grapefruit). 2/12/2009 Patient was conce the shingles vaccine 7-07 and developed shingles exactly at the injection site and then spread N down my arm 7/1/2007 numerous 1/26/2009 lesions and tremen U 1/27/2009 2/9/2009 ot on Jan 7-09- my arm ached- the place were the shot was given it got red and swelled up bigger then a 1/7/2009 50 cent piece. The worst is my n ports child with facial swelling and vomiting Y started 2/6/09. Seen ER at medical center 2/6/09. N Mom reports 2/5/2009 "Dr said she 2/6/2009 had allergic reactio edness/warmth of (R) arm. Area of induration Y 7 cm x 8 cm. Treated with 3 d of Prednisone. U 2/6/2009 2/7/2009 15 min. Wait after Hep B injection, pt Y stated she felt tired. Helped to exam table where she started U having 2/19/2009 seizure like 2/19/2009 movements of arms. m area longer than palm size, tender notes to L auxilla, low grade temp + malaise 2/16/2009 2/16/2009 mplained of severe body ache's, fatigue, night sweats, + fever. Y 2/6/2009 2/6/2009 r injection, itching L deltoid at 48 hrs, 8 x 8 cm red indurated area 2/12/2009 2/13/2009 d raised, red area at injection site used ice with relief this am. C/O sever pain to right arm - no U pain medication 2/12/2009 taken2/12/2009 by RN advised to take r (103.6), sweats, chills, malaise. No treatment. Y 2/18/2009 2/18/2009 accine was administered at 11:30am Y on Wednesday, 2/18/2009. On the way home from herNCF appointment, 2/18/2009 I stopped 2/18/2009 at our Chiropracto ter the vaccine was given the patient Y noticed, redness, swelling, itching and pain of her rightUarm. Dizziness 2/16/2009 and sleepiness 2/17/2009notices as wel headache and achy, a few hours after receiving vaccines. Y 2/11/2009 2/11/2009 ates she had itchy, red spots all over arms, legs, trunk and scalp a few hours after receiving the Y vaccine (2/19) 2/19/2009 that lasted 2/19/2009 until 3am this mor as given 4 vaccines on 2/17/09 afternoon (menactra, varivax, gardasil, adacel). Late that evening note redness 2/17/2009 and2/17/2009 soreness to the back o observing redness and swelling at injection site the morning after the Tdap was administered. U Swelling and 2/17/2009 pain has2/18/2009 increased today (day t O of headache, swelling resulting inYleft arm numbness, swollen tongue and slurred speech.YPatient seen 2/19/2009 in ER and 2/19/2009 treated with Prednison D RASH ON UPPER TRUNK AND BOTH ARMS, TOOK BENEDRYL AT 6PM 2/19/09 AND 8AM N 2/20/09.2/18/2009 2/19/2009
her called and spoke with RN in clinic on 2/18/09 informing her patient had seizure on morning Y of 2/18/09, 2/17/2009 and wanted 2/18/2009 Dr Gold informed. P lling and erythema 2 days after injection with Tdap (ADACEL) and HPV4 at same site. Y 2/17/2009 2/19/2009 ately 10 minutes after immunizations, parent reported Y stiffening and 4eyes rolled. Patient wasUnot in office2/20/2009 at this time/was 2/20/2009 with parents. Bab ite swollen, red, itchy and painful for over 1 week. No treatment. Y 2/8/2009 2/9/2009 ceived Yellow Fever and Hepatitis BYVaccination and waited 10 minutes in the Aid Station before Y departing. 2/18/2009 15 minutes 2/18/2009 after departed he re alance, double vision, dizziness, nausea, Y abnormally high blood platelet count. 3/12/09 Received U ER medical records ### of 11/28/2008. ### FINAL d entire body rash with lesions, itching, elevated temp. lasted for 8 days. Parent states "looked Y like regular 1/8/2009 case of 1/19/2009 Chicken Pox". Child ad dministered 2/6/2009 on february 19, 2009 rash covering trunk and face no fever otherwise normal Y . rash 2/6/2009 pruritic blanching 2/19/2009 raised papule o ately 5 min after giving immunizations, Y pt became Y combative, c/o severe 1 abd pain, throat pain. Y Patient was 2/19/2009 sweating2/19/2009 and scratching skin. M PER ARM PAIN, SWELLING, AND WARM TO THE TOUCH MEASURING 5X5 CM. SYMPTOMS U STARTED 2/18/2009 ON 2/19/09 2/19/2009 AM. PT SEEN BY ack to clinic today to report a reaction to receiving the Pneumovax vaccine in our clinic two days Y prior. Pt 2/18/2009 states receiving 2/18/2009 the vaccine in th 2/20/2009 s post Varivax immunization ( 1st dose) Employee developed itching rash on arms & legs , tiny, Y raised " pimple### like"1/18/2009 ,fluid filled rash Emplo headache. Facial swelling w/rash. Lymphandopathy. Y Prednisone at tapering dose. Doxycycline. Y ### ### ssed out about 10 minutes after receiving 5 vaccinations at her 4 year old well check up. While Y under observation, 2/10/2005 she 2/20/2009 passed out in her m g Varicella vaccine, Tdap, then HPV, child's eyes rolled back, body slumped to right side, b/lYarms and legs 2/19/2008 waved/flapped 2/19/2008 side to side. No warmth, pain/soreness and itchiness since vaccine was administered at left upper arm Y 2/16/2009 2/16/2009 g Fever and stomach ache during the night. To 101.2 degrees Farenheit by 8am 02/19/2009.U Patient complained 2/18/2009 of2/19/2009 headache and nausea 08 pt received anthrax and typhoid vaccines. The following day pt c/o generalized tingling throughout U her body.### Nov. 17, seen ### by Dr. Cash a 1/24/2009 N 1/8/2009 1/24/2009 3/21/2009 Y Y 35 Y U 1/23/2009 2/13/2009 oth legs and arms with weakness. Muscle Y weakness Y (not working right 48 Y in func). Speech impairment. N 4/20/09 Received ### hospital ### & rehab me DTAP, IPR, MMR & VARIVAX IZ onY2-19-09. Came in 2-21-09 to clinic to have PPD read. U Left upper arm 2/19/2009 red, swollen, 2/20/2009 tender & hot to tou ower back bilateral 2 days after vaccine administration. Y 1/29/2009 iredness from 14:00pm - 14:30pm. 2/17/2009 headache @ 15:00pm, took two TYLENOL gel Y capsules @ 2/12/2009 15:00 pm,2/12/2009 Sx resolved by 15:15 e given 2-09-09 (Monday). Mom called Thursday 2-12-09, she reported following: Pt had slight Y fever and2/9/2009 didn't feel2/10/2009 great and some itching redden, hot to touch at injection siteYwith swelling, no fever, no rash, no difficulty breathing, reported Y 2/2/09 2/18/2009 TX. Benadryl 2/20/2009 ETix 120 mg 2.3 that she had a flu shot here in our clinic Y in early December 2007. Although there is no record Y of it being12/1/2007 administered here. Dime-sized ar l seizure. PMH negative. Y Y o developed pinpoint red rash (dots) on torso, legs and arms U 2/6/2009 2/6/2009 lling & itching. U 2/18/2009 2/20/2009 ents with pain in upper right arm. Outer Y aspect of upper arm is noted to be red, raised, increased U temp hard 2/11/2009 & 35 mm 2/12/2009 x 25 mm blistered w tching pain began 1 day post-vaccine Y 2/18/2009 2/19/2009 at vaccine site with 3X4 cm mild redness on LDT. Y 2/11/2009 2/11/2009 ce today 2/20/09 vaccine Tdap has reaction swollen and redness, - as per phone call with mom. U 2/19/2009 2/20/2009 0/09 mom saw arm swollen & red on area of DTAP vaccine area. Mom will apply ice on edutal U arm as per 2/19/2009 phone call 2/20/2009 with mom on 2/20/09 after vaccine administered pt developed a festering lesion about 1 in x 1/2 in under arm (R) that U did not itch 2/13/2009 or hurt. Also 2/16/2009 had numbness in u eddened thigh with 1 1/2 2-d of decreased interaction (per mom; "out of it" X 1-2 d) (did not bring Y in to this8/7/2008 MD for eval8/7/2008 subsequently fine) redness @ injection site- esp with VARICELLA. 0 Rx except for observation for 30 mins Pt.Yadvised to give 2/20/2009 BENADRYL 2/20/2009 @ home no sob, w ness @ injection site - (immediate) --> Hives developed after 5 mins. on chest - observed pt.Yfor 30 mins. 2/20/2009 Advised BENADRYL 2/20/2009 PO @ home ed of itching all over. Rash noted arms, face, inner legs and buttocks. BENADRYL 25mg given N PO. DECADRON 2/20/20094mg 2/20/2009 with Depomedral 40m approximately 5 minutes after receiving vaccinations. Y 2/20/2009 2/20/2009 month shots, my son developed some shrill, high-pitched screaming and alternated between Y screaming8/15/2008 and passing 8/15/2008 out for about 12 hour 00, chills, redness behow injection area, Y swollen around injection area, hot to the touch, hard, N very very painful, 2/17/2009 sweats, 2/17/2009 dizzy ediately developed fever, rash and Y discomfort. Within 2 weeks behavior changedYdramatically, N language4/18/2007 skills regressed, 4/18/2007 frequent fevers, s argic, not eating well, not as many wet diapers U 2/19/2009 2/20/2009 NCED ITCHING ,SHORTNESS OFYBREATH, HEAVINESS IN CHEST DIFFICULTY BREATHING, Y RASH 1/29/2009 ,REDDNESS 1/29/2009 SWELLING ALSO occurred at site of administration within hours, spreading over the next day to a total size of approximately Y 1/29/2009 3" by 5", 1/29/2009 accompanied by itching eving the vaccines at his 4 month appointment, my son demonstrated some jerking/shaking of Y his head while 10/7/2008 sleeping. 10/7/2008 This lasted for abou day as receiving the combo booster Y shot, his arm around the site got very warm, Hard to the U touch and 2/10/2009 he aid it hurt. 2/10/2009 It was a large red ra ontinuous non stop, nausea vomiting Y 1 today, 2 times yesterday, normal breathing, c/o warming, U no report 2/21/2009 of rash 140/92, 2/21/2009 74, 22R, No whe
on 5 hours post vaccination. 24 hours post vaccination: 1.5" hard, raised, hot, red area around Y injection sites 2/18/2009 on thighs. 2/19/2009 36 hours post vacc ely after the proquad and hep A vaccines, Y his appetite severley decreased. Less than a weekNlater, he had a fever ### of 102 to ### 105 for three da anfer from sharing towels/clothing with roomate vaccinated 27 Jan 2009. Developed lesions along jawline 17Feb 2009. 2/17/2009 ure of 102.6. Headache. Sore arm. Strange fluttery sensation in chest. Treatment: Bedrest. Y Aspirin. 2/20/2009 Fluids. 2/21/2009 uscle control in both arms, restless, high Y fever - 103.4 - 105.8 at one point, lethargic, lifeless, Ylimp, blue around 1/20/2009 mouth, 1/20/2009 fingernails and feet, l ch of shingles in C5 distribution 9 days Y after administration of Zostavax Y 1/23/2009 2/1/2009 n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 17 5/12/2008 year old female 5/12/2008 patient with atten n was viewed on the Internet concerning Y a 19 year Y old patient who in 0 approximately April 2008 N (10 months 4/1/2008 ago), was vaccinated with the fi n has been received from Y a physician Y concerning Y a 20 year old female 0 with respiratory allergies N who on 9/16/2008 21-FEB-2008, 11/4/2008 24-APR-2008 and 1 n has been received from a physician Y concerning a female patient who was vaccinated with Uon unspecified date with a dose of GARDASIL n has been received from a consumer Y via the Internet Y concerning her 0 daughter who in August U 2007, was 8/1/2007 vaccinated with GARDASIL. Sub n has been received from a healthcare Y worker concerning a 58 year old female with Y allergy to Y VICODIN 1/21/2009 and MINOCIN 1/21/2009 who on 21-JAN-200 n has been received from a healthcare Y worker concerning a 49 year old female with Y hypertension Y who on 28-OCT-2008 ### was ###vaccinated IM n has been received from a healthcare worker concerning a 38 year old female with Y no medical U history or 2/16/2009 drug reactions/allergies 2/16/2009 who on 1 n has been received from a physician Y concerning a 60 year old male patient with diabetes, hypertension U 12/1/2008 and dyslipidaemia 12/3/2008 who on the mor ter started to get restless in the legs and had many Y headaches. She was twitching and couldn't N stop from jerking movements 1/25/2009in head and le ceived her 1st GARDASIL shot on 1-16-09. Y She received no other shots and wasYon no medication. Y On 1/16/2009 1-20-09, patient 1/22/2009 woke up with flu-lik n the GARDASIL shot. A week after being injected I had a serious allergic reaction and broke out in a very itchy rash 1/27/2009 all over my fingers an ter had the vaccine GARDASIL andYnow her arm is bruising up looks really nasty and she saying U she's got 11/6/2008 numbness of the ###arm and Dr. do ped trunkle red micropapule rash 2 wks post MMR Y 2/6/2009 2/16/2009 ziness". Slumped in chair post immz given pupil dilated. Assisted to cot when appropriate. YApplied cool 2/7/2009 rag. Given2/7/2009 snack & juice when re e nonspecific rash. Described as hives by parents. Y 9/22/2008 9/23/2008 e non-specific rash described as hives by parents. Y 3/20/2007 5/1/2008 ing non stop x 1-2 hr. 2/18/09 - temp Y 101 this mother has cystic fibrosis - not breastfeeding. Y 2/17/2009 2/17/2009 to have stiff neck on (L) shoulder - progressed to stiffness bilaterally in her trapezius muscleYand base of 2/2/2009 skull. Feb. 10 2/4/2009 - symptoms intensif er receiving shots RT leg, sore, red,Ywarm and swollen about the size of mom's palm of hand. N Went to see2/7/2009 Dr on 2/10. 2/9/2009 Told was an allergic er shot injection site itched, became red and raised. Eventually the itching moved down arm Nand red rash8/3/2007 went away.8/5/2007 On 11/2007 she wen e and client dizzy evening after shot.Y Next morning left arm swollen and client began to shiver Y and low grade 1/27/2009 fever 100 1/27/2009 degrees F. Very re et of excruciating right shoulder andYupper arm pain following flu virus immunization. Pain intensity N very 10/1/2008 high (9+/10)10/2/2008 and maximal at onset. after imm Fever 101.1 Y 1/15/2009 1/15/2009 lled Health Dept @ 3:45pm reporting Y that child's lips were turning blue and swelling, she also Y reported child 2/17/2009 to E.R. 2/17/2009 because they were still as given vaccines on 2/13/2009. Patient came into office on 2/17/09 c/o nausea, diarrhea, wtYloss, fever, 2/13/2009 chills, stomach 2/14/2009 bloating and stoma ted 2 days after flu vaccine ? allergyY to eggs. Y 2/11/2009 2/14/2009 d varicella vaccine RA SQ on 2-4-09 Y and returned to office 2-16-09 with red/swollen (15 mm)Y in area around 2/4/2009 injection2/5/2009 site and reported are d she was pregnant 2 months after receiving GARDASIL vaccine. Pt miscarried at 2 1/2- 3 mos Y pregnant. ### ceived Tdap instead of DTap. No adverse reaction. Y ### mmunizations, about 3-4 min later fell to the right off chair, hit head on floor. I helped her up. YShe was twitching. 2/16/2009 Felt 2/16/2009 dizzy, blacked out. La w grade) starting five days after administration, following by rash to face/neck/torso on ninth day U after shots. 2/2/2009 2/6/2009 es erythema in shot area started dayYof injection, worsened through weekend. Presented to Clinic U 2/16 with 2/13/2009 large (about 2/13/2009 10 x 11 cm) erythe stered 2nd dose of ROTATEQ. Rec'd this dose prior to administration of IM vaccines due today. Pt had projectile 2/11/2009 vomiting 2/11/2009 immediately after stered 1st dose ROTATEQ, had projectile vomiting with copious emesis from mouth +nostrils. Y No other vaccine### had been given. ### Pt observe e - post immunization evening - continuing at time/date of call on 02/12/09. Given MOTRIN by U mother - Mother 2/11/2009 related 2/11/2009 - Some relief - but on ction - mild redness, soreness Y 2/9/2009 2/10/2009 r receiving the tetanus, influenza and meningococcal vaccines and having blood drawn, service Y member2/21/2009 complains 2/21/2009 of ringing in his ears, lig y gave DTAP #4 to 8 month old. Received DTAP #3 on 1/21/2009. Mistakenly gave ROTATEQ Y #4 same time. ROTATEQ #3 on 1/21/09 eport on 2/21/09 at 1 pm pt fever 102 degrees axillary. Gave acetaminophen and "fever wentYdown". Crying 2/13/2009 most of2/21/2009 the time. Temp did not tial syncope, nausea, lasting several minutes post injection. Was monitored for 20 min and was Y normal. 12/11/2009 week later2/11/2009 developed chest pain, GSK labels their pre-filled syringes of Hepatitis B Vaccine - ENGERIX-B for adults and children U with a yellow and olive band, respectively, to degrees within hours of injection. C/O severe pain to right leg, nearly intractable pain. Unable N to bear weight 2/16/2009 on leg2/16/2009 x 36 hrs. Post injection DTD on 2/7/09. Mom up pts feet dizzy after leaving clinic & laid down rest of day. Arm was Ysore that even. 2/7/2009 & by next2/7/2009 day was red & swolle urned 7 days after immunization withYlarge bruise on right upper arm, extending from deltoid (bottom Y edge)1/7/2009 to elbow,1/10/2009 approx 5" in width. Sta
Hepatitis A inoculation on 2/10/09 at approximately 11 am. At 10:30 pm experienced symptoms Y similar to 2/10/2009 attack of food 2/10/2009 poisoning. Vomited eadache day of vaccine, through evening. Recurring headaches, constant fatigue, joint pain prominent U in left 2/7/2009 arm where 2/7/2009 administered. Decr Y 3/1/2003 rted with rash, fever and HA. Seen Y on 2/11/09 counted 44 lesions (papules). Seen 2/12/09 vesicular N fluid1/21/2009 sample collected. 2/9/2009 Feels worse. t started around 2pm. Slight swelling. Hurts to move arm. Ibuprofen and ice the shoulder/arm. Y 2/13/09 doing 2/10/2009 much better. 2/10/2009 n has been received from a certifiedYnurse midwife concerning a 24 year old female patient with Y asthma, epilepsy ###and migraine ### headaches FAINTED IMMEDIATELY AFTER INJECTION OF GARDASIL. 5 SEC. OF COMPLETE UNCONSCIOUSNESS Y 2/20/2009 FOLLOWED 2/20/2009BY CONFUSI nausa, shakiness increasing since 4th dose of Imovax received 2/17/09. Recommended use U of aspirin 2/17/2009 on regular basis. 2/19/2009 iving 2 IM injections in left deltoid (Hep A #2, Menactra) while seated, patient stood up and had Y a syncopal 2/23/2009 event. No 2/23/2009 LOC, recovered within SECONDS AFTER VACCINE ADMINISTRATION Y THE GIRL COLLAPSED. SHE APPEARED Y PALE, FLACID ### AND COLD### TO THE TOUCH ite became red, swollen, sore, hot and itchy. Welt and itchiness lasted from 2/17 to 2/22. Only Y treatment 2/16/2009 was cortisone 2/17/2009 cream to ease itch REFERS THE CHILD SUFFERED Y A RASH ALL OVER THE BODY WITH RED BLISTERS.YSHE TOOK12/8/2008 HER TO THE 12/8/2008 DOCTOR'S OFFICE & swelling at injection sites.Low grade temp - 99.0. Fussy and irritable U 2/19/2009 2/20/2009 of child= developed high fever (states Y 104 degrees)the Y evening of 2/19/09 1 and had a seizure U and was taken 2/19/2009 to the 2/19/2009 hospital- time unknown vaccine child had generalized scarletina body rash with confluent 2 cm area left lower thigh and U 1 cm confluent 2/20/2009 right2/20/2009 thigh rash that started D SWELLING AT INJECTION SITE, NOT ABLE TO MOVE ARM, FEVER Y 2/16/2009 2/17/2009 vaccine administered in a local health Y department clinic on 2/18/09 in the morning to this adolescent U female. 2/18/2009 Patient2/22/2009 had history of undocum ness, rash (2"x1"), itching at injection site U 2/19/2009 2/21/2009 ness, rash (1"x1"), itching at injection site U 2/19/2009 2/21/2009 oke up the morning of 2/19/09 to find she had alot of itching on her left hip and discovered 5 N raised spots.2/12/2009 This was the 2/19/2009 same side she had S today to our Health Center with complaints of vomiting and fevers of 103.Today at 103.3R. Dr U Anees requesting 2/20/2009reporting 2/20/2009 for possible adve ame pale and complained of being nauseated and light-headed. RN assisted client in putting Y her in a supine 2/2/2009 position2/2/2009 with legs elevated. T soreness, and swelling at injection site, with mild, red, raised rash on stomach and back (some U itching). Swollen 2/9/2009 glands 2/23/2009 behind the ear/nec gan 4 days after receiving vaccines accompanied by fever for 2 days. Y 2/12/2009 2/16/2009 as running a fever on and off for twoYdays prior and on 2/15/09 around 8:30 pm she had a seizure Y that lasted 2/6/2009 almost2/15/2009 25 minutes and had to ates, awakened with fever 102.8 theYfollowing morning after receiving vaccine. Myalgia, arthralgia Y and continued 2/19/2009 episodes 2/20/2009 of fever over 72 ADACEL @ 10:30 am - within 10 hours Y child c/o severe H/A, dizziness and nausea, and chills. Y BP - orthostatic 2/20/2009 hypotension 2/20/2009- unable to sta @ 10:20 AM stating she had an upset Y stomach, nausea and shortness of breath this was herU3rd GARDASIL 2/23/2009 injections. 2/23/2009 2/26/09 Received since the vaccines pt. has had fevers, headaches Y & generalized weakness. 11 Just prior to admit. noted visual 1/13/2009 problems 1/14/2009 and gait problems. n on 2/18. C/o sitting soreness, muscle ache on 2/19. On afternoon of 2/19 & 2/20 had fever Y 38-38.9 degrees 2/18/2009 C, generalized 2/19/2009 body ache, i 1hr post immunization and had syncopal episode Y - No seizure activity. 1 3/11/09-records received Y for DOS2/17/2009 2/17/09-presented 2/17/2009with vomiting p was reported by a physician via a sales Y representative Y and described 1 the occurrence of itching U in a 4-year-old 2/19/2009 male2/19/2009 subject who was vacci was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age 3/20/2000 who was vaccinated with LYME d GARDASIL injection 1/21/09. Pt reported being pregnant 1/20/09. U 1/21/2009 1/30/2009 ash that resolved with oral diphenhydramine x 1. Y 2/20/2009 2/20/2009 patient and she states that she is feeling better. She is still weak, a little sleepy, not pain. No headache or 1/5/2009 sinus pain at this moment. No n has been received from a nurse concerning Y aY60 day old female 10 who on 05-DEC-2008 was N vaccinated12/5/2008 with one dose 12/8/2008 of ROTATEQ (lot n n has been received from a licensed Y practical nurse Y concerning a 79 0 year old female who onU10-FEB-2009 2/10/2009 was vaccinated 2/12/2009 SQ with a 0.65 n has been received from a physician Y concerning a patient who was vaccinated with a dose Nof ZOSTAVAX (Merck). After receiving ZOSTA n has been received from a consumer concerning his now 22 month old son who at 14-15 months U of age,6/1/2008 was vaccinated with PROQUAD follow-up information has been received through the Merck pregnancy registry through Y a 23Yyear old female consumer 10/2/2007 who was vaccinated n has been received from a Registered Nurse (R.N.) concerning a patient who was vaccinated U with the second dose of GARDASIL. The pa n has been received from a physician Y concerning a 19 year old female who in early Y September N 2008, was9/1/2008 vaccinated9/1/2008 with the first dose of n was viewed on the internet Y concerning Y a 14-year-old Y female patient, 0 who on anYunspecified N date was vaccinated with a dose (s) of GARD rmation received on 21 January 2009 Y from a health care professional. Upon receipt of follow-up information on 17 February ### 2009, it was de eakness in extremities, numbness, Y difficulty Y walking Y and climbing stairs. 9 Diagnosed Y with GBS, N later changed 5/28/2008 to CIPD6/10/2008 due to recurring symp was swollen from shoulder down to elbow, golf ball sized, red, hard knot at injection site + itching. Y 2/9/2009 2/9/2009 Y Y 1/8/2009 1/14/2009 mmediately following rotovirus 'drink'. On 2/12/09, pt. had fever (101.5) rectally, vomited for 3Yhrs. Was very, 2/11/2009 abnormally 2/11/2009 fussy and agitated me day, then stomach upset, dizziness, right sided "numbness". No muscle weakness on testing Y at visit on2/4/2009 2/17/09. All 2/4/2009 symptoms resolved i ADACEL, in Left delt and PNEUMOVAX in Right delt on 2/17/09- Called office 2/19/09 c/o swelling U &pain 2/17/2009 came in for 2/19/2009 eval 2/19/09- Right u
to patient he was seen by an ER Physician Y at hospital on 02/23/09. Diagnosed with Bell's Palsy. U Prescribed 1/23/2009 Prednisone 2/3/2009 and Acyclovir. Pt eared 2 days after shot lightly. Strong heavy rash at 10 days after shot continuing 5 more days. Y Fever 104.5 ### degrees X 72 ###hrs starting 9 d ed ZOSTAVAX 12/18/09; Saw Derm. on 1/7/09 for rash. Returned to medical center 1/10/09 Y + Dx'd zoster rash ### R thigh. Tx'd NEUROTIN facial paralysis began day after vaccinations Y were given. Went to ER on 2/1/09 where Bells NPalsy was diagnosed. 1/28/2009 Is 1/29/2009 improving but not yet er up to 103.3 degrees F, congestion, cough soreness in throat; U ### 2/18/2009 r of vaccines being given pt becameY irritable, facial flushing, hives diffusely esp on trunk/back Y but also on 2/17/2009 extremities. 2/17/2009 Mild swelling of eyel ble crying, pallor, & loss of consciousness, Y 8 hrs after being given immunization for the first time. Y 2/17/2009 2/17/2009 ace, stomach, back, legs started onY2-8-09. Pt. temp 98.5 degrees (2-9-09). 103 degrees Feb N 5 + 6, 2009 1/27/2009 cough, rhinorrhea 2/8/2009 started Feb 2 t vaccine admin. Pt c/o lightheaded,Yloss of appetite, nausea, cold chills, unable to move feet. U C/o vision2/18/2009 change. 12/18/2009 hour later pt c/o heada t one hour after recurring second shot of GARDASIL. Pt self report "3 white spots, on my face" U noticed after 2/17/2009 she left2/17/2009 the clinic. "a little itchy lands, (femoral), redness and swollen site, no fever, Hurt - make her cry. Rest made it betterY- iced +heat 2/6/2009 2/7/2009 Presented with 3 weeks nonproductive Y cough, treated with AZITHROMYCIN. Patient still with symptoms 1/10/2008 as of 02/15/2009. ### flu shot 2-16-09 came to office 2-18-09 left upper arm red & swollen & hard 5 cm no rash Y 2/16/2009 2/16/2009 er receiving MENACTRA developedYflushed face, clammy & weak legs, "feels well''. Y 2/17/2009 2/17/2009 g hot, HA, eyes burning then blacked out. Woke up on floor. Also w/ rash on abdomen and thigh. Y 2/17/2009 2/18/2009 warmth and firmness felt at injection site on upper left arm. 2 1/2 cm at area of induration felt there, no erythema 9/22/2008 9/23/2008 umps on stomach, legs & back. Sm Qtip size red raised bump on VARICELLA site right leg and Y PREVNAR 2/17/2009 site is a2/19/2009 bruise. Pt feels well. Pt V combo administered 2-10-09. Within 24 hrs developed swollen, red, painful arm at site - 2-11-09 U broke 2/10/2009 out in oral blisters 2/13/2009 on tongue, ante d Bells Palsy 8/12/08 received. N 5/16/2008 8/12/2008 HEP A (VAQTA) on 2/11/08 & 8/1/08 Today, mom reporting no local reaction. Y 2/16/2009 (L) arm 8X8 in redden- warm to touch - (R) arm 2X1 in redden - warmth to touch c/o pain. BENADRYL Y 2 tsp 2/5/2009 BID - Cool 2/6/2009 compresses r antibiotics + MMR. Face-trunk some spots on extremities. Y 2/6/2009 2/11/2009 & a lot of pain after receiving TD still having pain, arm weakness & numbness N ### ### er receiving the shingles vaccine in Y his R arm, patient developed a characteristic rash in the Yright C8 T1 1/21/2009 nerve root. 1/25/2009 He also had a neuralgia mentation on (L) arm (Linear appearance), non-raised, even distribution, cramping in hands (B) U on occasions 2/16/2009 injection site urthen 1 hr. Progressed to diffuse edema & erythema from elbow to distal deltoid. Y Some mild 2/16/2009 tenderness. 2/16/2009 Hard slightly numb muscle pain, edema to 3x regular size, Y rash, fever and general malaise. Y 2/13/2009 2/13/2009 munization given 2/15/09 (Booster). States no pain on 2/15/09. States in afternoon on 2/16/09 Y had dull headache 2/15/2009which 2/16/2009 lasted one hour. O ent for Hep-B vaccine. Prior to giving Y shot, assessed allergies to PCN, Sulfa, naproxen, zithromax Y and pineapple. 2/18/2009Denied 2/18/2009 wheat/yeast allerg Rxn. Redness, Swelling & injection site 9X8 cm. Systemic Rxn vertigo, mild headache, nausea. Chills, 2/17/2009 Bodyache. 2/17/2009 of her face red and swollen. Right eye Y swollen completely shut, trouble breathing, trouble sleeping, U fidgety, 1/16/2009 non responsive, 1/17/2009irritable, fever, N 2/19/2009 2/19/2009 perature 105 core. Y 2/12/2009 2/13/2009 lesions around left flank 2/5/2009 2/10/2009 gas, distended stomach. pain. Started within 4 hours of dose and continued for 8 hours (tookY sleeping pill) 2/23/2009 2/23/2009 a dull frontal headache since waking on 2/20/2009 after 1 day of Tdap and still present on 2/24/2009 U 2/19/2009 2/20/2009 after Tdap given had 101.7 temp. Y Y 2/19/2009 2/19/2009 ven two injections in the left arm on 2/23/09. She called the clinic on 2/24/09 and advised us Y that she woke 2/23/2009 at 0300 with 2/24/2009 pain in her left axilla after she received 2nd vaccine of gardasil she continues with a rash on her body.Saw PCP doctor N was then 6/16/2008 referred to dermatologist were o anterior and posterior trunk beginning Y approximately 2/21/09 progressing in intensity. No respiratory Y distress 2/19/2009 noted. 2/21/2009 Patient evaluated by ministered to Left deltoid and a large welt formed at injection site over next 24 hours. Site was Y hot to touch2/5/2009 and tissue2/5/2009 was hard underneath urting when given and never stopped Moved arm around during the rest of the day About 7 hours Y later when 2/17/2009 she went 2/18/2009 to bed, the pain got m ent started having feversYon the dayYof DTaP vaccination Y (2/19/09) up 1 to hospital admission Y(2/20/09). Mother 2/19/2009 reported 2/20/2009 temp of 101.9 on 2/ 1/12/2009 N 1/12/2009 1/12/2009 PED SIGNIFICANT ERYTHEMA IN Y THE SHOT SITE ON HER RIGHT THIGH APPROZ 4 TOY 5 CM IN DIAMETER 2/12/2009 2/13/2009 became erythematous, warm, slight induration. Temp 98.9 Keflex 250/5ml 1tsp TID X 10 days Y Compresses 2/9/2009 Benadryl 2/10/2009 12.5/5ml 1tsp q 6 hrs. d hives all over body few hours after immunizations we're given. Y 2/6/2009 2/6/2009 ter vaccination patient experienced palpitations, and lightheadedness for 45 minutes, A bruise Y 1 inch long 2/17/2009 and 1/2 inch 2/17/2009 wide appeared, a r swelling L arm Y 2/9/2009 2/10/2009 occal vaccination given on 2/22/09 @ 1000. The patient did not experience any symptoms until Y 2/23 when 2/22/2009 she noticed 2/23/2009 her Left Deltoid was d seizures and had to be rushed to Ythe Hospital Y where he stayed for one week. Patient Y has N curious mental 6/1/2006 delays; he 6/1/2006 cannot walk, talk, or
arent of error.Will call in Am to check on patient reaction.Will give HepB at 2 mo check. Y 2/24/2009 of face around eyes; no swelling. Per parents, occurred immediately after vaccine; did not call Y MD until several 2/23/2009 hours 2/23/2009 after immunized. Tre from mother: Pt was admitted to hospital 2-18-09 Y due to fever 104.6.3 Stated blood culture done Y in ER was 2/18/2009 (+) for bacterial 2/18/2009 infection. Repea Y U 2/23/2009 2/23/2009 post immunization with 2 skin lesions. 1) - follicular on neck, throat, (R) arm. - itchy. Pictures Usent to Dr., 2/12/2009 felt to be post-vaccinal 2/24/2009 non-viral pu Y 2/19/2009 2/20/2009 ed, swollen, warm to touch, thigh area, 4 cm in size, raised Y 1/8/2009 1/10/2009 shot given right arm 2/15. 2/17, soreness Y at site, lump at site of injection, warm to touch, swollen. Y Temp 99'. 2/15/2009 2/17/2009 given 2/14 2/17 - arm puffy, warm to touch, redness around site and trailed down arm Y 2/14/2009 2/17/2009 lls VHC x 3 in past week. "Just don't Y feel like myself; very tired, achy, constant HA, nodes on Y side of neck 2/11/2009 and under 2/13/2009 chin are enlarged." R was on 02/19. On 02/22 injection site became red, 2" circle. On 2/24 it is still a 2" around circle. U No heat or 2/19/2009 pain. Arm2/22/2009 is a little sore. Told her lled 6 days following vaccination forYa tip to Brazil. He reports facial swelling with sx. StartingUon Sunday2/17/2009 2/22/09 a 1300, 2/22/2009 which was 5 days ined to dentist about sores in her mouth. Dentist prescribed VALTREX and patient is concerned Y the ZOSTAVAX 1/27/2009caused 2/6/2009 the sores and the Local Reaction with continued erythema & induration at site. 2 Pruritic rash with small dark lesions on thighs 2/19/2009 on 2/21/09 2/19/2009 MMR & VARICELLA given. 2-11-09 PC from mom. States child "broke out" in rash at babysitters. U RN advised 2/10/2009 parent 2/11/2009 to take child to Dr. advi TAVAX injection 2-12-09. That evening arm was very tender. His wife is a nurse, redness noted Y from elbow 2/12/2009 to shoulder. 2/12/2009 States arm felt num tous nodule app 0.5 cm in diam bothY thighs. 2/23/2009 2/24/2009 MMR and VARIVAX on 1/30/09. Fever Y that night for 2 days. Atend of fever had prominent myoclonic Y jerks 1/30/2009 with sleep 1/30/2009 for one day then rec ld female who came for a routine physical exam and vaccines and developed a rash over the Y next 24 hours. 2/12/2009 The rash 2/13/2009 was of rapid progres of GARDASIL administered on 2/24/09. Pt experienced syncope, pt recovered well. WaitedY15 mins. Stated 2/24/2009 she felt 2/24/2009 better exited office. d fever < 12 alter shot swollen tonsil or lymph nodes & L facial swelling injection given SQ on left arm. No 2/21/2009 pain or swelling 2/21/2009 around injection e morning following the vaccinationYmy right shoulder was in severe immobilizing pain. I could U not move1/17/2009 it due to the 1/18/2009 pain. I attempted to t serious event was reported by a health Y care professional on 13 January 2009. Based upon additional Y information ###received on 13 February 2 n has been received from a registered nurse concerning a 71 year old female who was vaccinated U with a 0.65ml dose of ZOSTAVAX (Merc n has been received from a registered pharmacist concerning an adult male who, "many years U ago", was vaccinated with a "complete dose l pain, diahrrea, general ill feeling 12/07. Y Again 8/08 - Diagnosed Crohn's disease 10/08. 3/9/09 U Received 8/16/2007 PCP vaccine 12/1/2007 records & medical a BOOSTRIX vaccine (R) arm 10/30/08. Seen on 11/2/08 area red swollen, hot to touch ### 11/1/2008 hours, urticarial rash on chest, shortness of breath, and nausea Y ### ### ately 12 hrs after reaction, patient experienced Y localized bright red egg sized swollen area atYinjection site, 2/19/2009 itchy, soreness, 2/20/2009 and firm swollen t, Kitra Woodall, child had routine immunizations on 02/11/09. Infant jerked right leg slightly U at the time of 2/11/2009 getting the 2/21/2009 shot, and small bruise Y Y 2/24/2009 2/24/2009 ction and cellulitis at injection Y area.. Y .went to urgent Y treatment care and 4 was put on Keflex and U Prednisone...went 2/4/2009 to Emergency 2/5/2009 Room a we ollowing the vaccine, pt began Y to have Y pain andYprogressive weakness 5 of her left arm and leftY leg. SHe was 1/12/2009 evaluated 1/22/2009 at joe DImaggio Chil pisode which lasted for approximately 10 seconds after administering menactra vaccine.childYclaimed she2/25/2009 felt dizzy after 2/25/2009 the last injection. w ea immediately following Gardasil #1 injection. Sxs resolved spontaneously over course of next Y 30 minutes 2/25/2009 while being 2/25/2009 seen in clinic. hortly after administration of Gardisil. Out for 3-4 seconds. Observed for 45 minutes before going Y home. 2/25/2009 At home and 2/25/2009 still reports nausea a ng office c/o site where varicella given had a hard knot, warm to touch, whole back of arm swollen, painful to the point that it kept patient up hours of receiving vaccine - developed severe lower back pain, diffuse H/A, Shoulder joint pain Y and upon 2/14/2009 rising from2/15/2009 suppine position I wou wver, Polio and oraL 7/14/08 tYPOID Y ORAL -7/17/08eYHE AND LEG RASH AFTER TRAVEL N 5 WEEKS7/18/2008 LATER AND 7/18/2008 SWELLING OF THE 09 patient was taken to hospital for Yseizure activity. Y At hospital she was 3 intubated for respiratory Y failure. Mother### reported low ###grade fevers a lgia. pt received rabies vaccine ist dose on 01/27/09 and second dose on 02/03/09, and wasYscheduled for 2/3/2009 third dose 2/24/2009 02/23/09. When pt pr h fever, chills, severe myaligias and GI upset within 24 hours. Y 2/19/2009 2/20/2009 y patient reported pain on entire arm lasting for more than 3 weeks ### nd tenderness where shot given (pneumococcal conjugate); fever of 100.4 (pneumococcal conjugate); Y drowsy 2/23/2009 and 2/23/2009 loss of appetite (pneum as administered the Merck HPV vaccine - third dose, patient reported left hand tingling. Physician Y evaluated 2/25/2009 - patient2/25/2009 returned home. Physi 9 Pt presented with a temperature of Y 104.2(f) with no other signs. Drew blood cultures positive Y for Invasive 10/9/2008 Streptococcus Pneumoniae. Tr lled office today and reported patient had experienced redness and itching after YF immunization. Y Patient 2/17/2009 showed her 2/23/2009 the site on Monday m became red and indurated. Patents' mother describes purulent blisters approx. 1wk after administration Y 2/2/2009 2/9/2009 IVED ZOSTAVAX ON 2/23/09. ONY2/24/09, PT REPORTED NUMBNESS AND "A WEIRD FEELING" Y ON 2/23/2009 THE LEFT 2/24/2009 SIDE OF HIS FACE n has been received from a physician Y concerning an 18 or 19 year old female with a history Y of seizure "in the past during an IV administrati after the shot was administered, patient Y showed Y limpness in his left 17arm, lasting a little less than Y a minute. About ###2hours later ### more limpnes
k after 1st GARDASIL, my daughterYbegan having headaches, nausea and began passing out. N Began having 8/3/2007 trouble 8/10/2007 breathing. Pediatricia episode of syncope, sweating and clammy Y 2/24/2009 2/24/2009 t 9am Donor started having; headache (pounding), fever, chills, fatigue. Swollen lymphnodes Y under L arm. 2/23/2009 The L arm 2/24/2009 deltoid area where i Y 2/23/2009 2/23/2009 m (3 inch wide) round tender induration at VARIVAX injection site - developed ~ 24 hrs after the injection. 2/17/2009 2/18/2009 thema, hyperemia and pruritus measuring 12x8 cm Y 2/19/2009 2/21/2009 administered 10-17-08, on 10-23-08 pt seen by PA-C for wide spread hives on palms and soles. U Tenderness to area of injection, no swelling minutes of injection into right arm, pt began to have erythema around both injection sites - going Y up arm to 2/21/2009 neck, chest 2/21/2009 & shoulder. C/o puriti at injection site (L) thigh, hot, tender, approx 3" in diameter with fever. 2/23/2009 2/24/2009 olled eyes back of head ? seizure. Seen Y in office 2/25/2009 for this. Y 2/9/2009 2/24/2009 n 2/23/09. Complaining of Hx of itching Y started after given her MENACTRA,/Tdap/Varicella vaccine about2/19/2009 315pm 2/19/09 and at home 715p administered on 2-17-09 - says "3 to 4" days after receiving vaccines, client experienced symptoms Y of fever 2/17/2009 (102-103), 2/20/2009 chills, nausea - clien minutes patient experienced moderate swelling and mild erythema of left thigh extending to Y superior portion of### knee joint. ### The joint was not 02 degree at home the night of vaccine Y 2/24/09. Today in office 97.6 AX. Slightly swollen at Ysite RVL, warm 2/24/2009 to touch, 2/24/2009 no redness. Hives on U 1/2/2008 2/23/2008 0 min after while on elevator. Once off elevator still had symp. Dizziness-noted while still. NoYnausea. Comes 2/17/2009 to a point 2/17/2009 when must slow dow SQ swelling, local reaction with redness. Tender to touch. Treatment: cool compress and MOTRIN Y prn for2/24/2009 soreness. 2/25/2009 n received from patient's mother byYphone. Per mother Pt. began having body pain at 2:00AM N on 10-21-08, unresolved ### by### TYLENOL. No f usea, vomiting; patient received shot of KETOROLAC 60 mg/2ml today, 2/25/09. Also, patient U was prescribed 2/24/2009 PHENERGAN 2/25/200925 mg tabs, 1 Hepatitis B & MMR vaccinations. I have latex allergy. Nurse practitioner (2 of them) said disregard Y latex 6/1/2007 allergy pamphlet. 6/1/2007 I broke out in b swelling 5"X51/2" U 2/24/2009 2/26/2009 vaccines on 2-17-09 No bandaids applied & rash developed 3 days after. Mom stated that happened Y with 2/17/2009 2 mo shots 2/20/2009 also. mother informed clinic on 02/28/09 that daughter had received MCV4 vaccination prior to going U to college 8/4/2008 and has been experiencing swelli after receiving vaccines, approximately 15" after vaccines. Pt did not hit head; No seizure noted. Y Pt. recovered 2/18/2009with 2/18/2009 fluids (juice + water) ll from pt that she had acute joint pain during the night Jan 5, 09. Her doctor told her it was due U to the shingles 11/6/2008 shot. 1/5/2009 Was on 1/2 mg PRED lled 2-13-09 reporting ash of left arm day after HAVRIX injection. By 2-13 rash with itching allY over body. Mother 2/9/2009 did2/10/2009 not get child to ER as r month after vaccination developed fever to 101 degrees for 1 week. This was followed Y by "black N out spells". Within ###several ### days a facial tic s ceived a flu vaccine on 10/15/2008. That evening she felt ill and went to sleep. She awoke in the middle of the ### night to drink ### water and fai , edema around immunization site. Approximately 1 1/2 in. diameter. Y 2/24/2009 2/25/2009 & erythema of left upper arm very painful Y 2/12/2009 2/16/2009 headache for 11-13 days following vaccine - started within 8 hours of receiving vaccine OTC Ymedication ineffective ### - Advil ### Aleve, Aspirins, S max 104.8 oral per parent; 101 rectalY @ office fussy - resolved decreased appetite but takingUbottles. 2/19/2009 2/19/2009 nny nose, fuzziness and 2 lesions on Y back. 2/6/2009 2/6/2009 ausea and vomiting. Y 7/10/2008 7/10/2008 s: 1. Pain and swelling. U 2/3/2009 2/3/2009 ine given in left arm. On 2/14 arm became Y getting swollen and red from the arm to the wrist.YOn 2/15/Pt 2/13/2009 went to ER2/14/2009 were was prescribed w a pneumonia shot on Monday, February 16 around 9:00 a.m. By that evening I had chills and N body aches. 2/16/2009 The entire 2/16/2009 upper arm where th N VARICELLA VACCINE ON 12/31/08 PRESENTED TO OFFICE ON 01/20/09 WITH PAPULAR Y RACH EXTENDED ### 1/16/2009 FROM HEAD TO EXT ed with c/o pain and swelling at site.YVery limited arm movement. Fever above 102, and chills. Has had some 2/25/2009 tingling 2/25/2009 to arm that injection w and heat at injection site Y 2/23/2009 2/25/2009 vaccine he stated starring and his eyes Y would roll up. Didnt think anything was wrong and then U he started5/24/2006 jerking. Diagnosed 5/26/2006with epilepsy lling w/ warm to the touch on left arm. Seen by Dr. - given meds for comfort: Ibuprofen 800mg U T1 TID and Ultram 50mg T1 Q4-6hrs. nstered at work. A weekYafter shot, YI began to have Y difficulty swallowing. 23 Y The difficulty increased N and visited doctor ### 12/2/2008 on 12/1. On 12/2 was o .6 12:20 pm 2/26/09 2/25/2009 2/26/2009 dministered on 1/14/2009 Y and developed Y neurologic Y symptoms on14 or Y about 1/23/2009. He was U subsequently 1/14/2009 diagnosed 1/23/2009 with Guillian Barre mplained that baby vomiting from 02/24/09 Y to present, and fever fora day.tynelol given for fever ,fluids pedalite 2/23/2009 for vomiting. 2/24/2009 9 at about 9:30PM, his eyes rolled back Y and jerked Y some, call squad2 and taken to Hosp andYthen to Children's, 2/17/2009 temo 2/19/2009 102.9. Questioned se 9 at 6pm pt stated had nausea, lightheadedness and a fever up to 103 degrees. 2-26-2009 pt U came to clinic 2/24/2009 left deltoid 2/25/2009 red,itchy,swollen an er c/o diahrrea, decreased urination Ydespite adequate fluid intake, red buttocks and gluetal fold. U Also, consistant 2/24/2009 fever 2/24/2009 of 101 F . Referred eumonvax Immunization on 2-25-09. Pt c/o swelling, warm, rash 3 inches in diameter at injection Y site. Felt 2/25/2009 feverish but 2/26/2009 did not take temp. Sa eving the pentacel in his left arm at the health dept on monday 2/23/2009, he developed left Yarm significant 2/23/2009 swelling,2/26/2009 redness, and pain. Fa
ebilitating headaches, chronic Y diahrrea, Y severe back & abdominal pain, tingling inYhands and Nfeet,numbness in ### hands & feet, ###stabbing pain i after receiving the injection, a bump appeared at the injection site,lasting about a day. It disappeared Y and1/15/2009 then retrurned 1/16/2009 about 1 week later. hours after injection Pain at injection side, redness extending 7 inches by 4 inches; fever of 101 Y degrees2/24/2009 orally; chills; 2/25/2009 severe weakness in a ke activity, Loss of consciousness on 2/25/2009Ysee notes 4/27/09 Received 2 hospital medical Y records of2/23/2009 2/26-2/27/2009. 2/25/2009 FINAL DX: seizur ter receiving CODEINE child's tongue Y started swelling, vomited, HR increase, lips edematous, Y SOB, unresponsive 2/24/2008 EPI 2/25/2008 PEN given IM, O2 s s LUE arm, shoulder pain with rash at Y injection site. Left deltoid has localized cellulitic area 8Ucm L X 5.5 2/24/2009 cm W. temp2/26/2009 is 99.5. No other syste clinic reporting SOB, throat feels funny. Y Instructed to go to ER. At ER, patient did well and left Y with BENADRYL. ###There was ###some confusio ots - back abd, 12/26/09 started ZOVIRAX 200 mg 3 PO BID X 5 days. U 3/22/2007 2/26/2009 nyl & Pt sister PKU + mom strong on mercury free. Physician ordered wrong in Epic Y 1/5/2009 ed screaming started ~45' with shots, continued X 45' Pt slept X 48' then cycle repeated X 5Ydays 2/24/2009 2/24/2009 ing the clinic per mother, pt fainted, Dr responded, SPO2 100-98%. Pulse low. Oxygen given Y to pt after 10 min.### Pt able to### stand ambulate a l - Employee stated received an MMR on 1-16-09 and on 1-20-09 started itching in entire body Y and having 1/16/2009 facial swelling. 1/20/2009 ing, took BENADRYL 50mg followed by 25 mg Q6 hour. Y ### ### ction site with large reddened/warm site- Better today. Y 12/9/2008 ### ection hot to touch, red and swollen. Y ### ### MMR, VARIVAX, and PREVNAR onY 2/24. That night had episode where child stopped breathing Y for 15-20 2/24/2009 sec., eye 2/24/2009 rolled back, went limp is a 14 month old female whose mother called on 2/25 and spoke with RN, Mother advised child Y had "chickenpox" 2/12/2009 after 2/21/2009 vaccinations on 2/1 daches, severe @times (6/10) lasting Y for 10 days post immunization. During 1st 24hrs post Y vaccine, also2/18/2009 c/o lightheadedness 2/19/2009 / dizziness 24 hours after administration, she cried and screamed for more than 6 hours and continuedUto scream and cry### off and on ### for the next seve n has been received from a Certified Y Nurse Midwife, for the Pregnancy Registry for GARDASIL, Y concerning 8/1/2008 a 19 year8/1/2008 old female who in Au n has been received from a physician Y concerning a 23 year old female who was vaccinated Y with a first dose of GARDASIL 0.5ml IM. Subse n has been received from a physician Y concerning a 15 year old female with no medical Y history N and drug allergies who, on an unspecified da n has been received from a nurse concerning her 26 year old daughter who was Yintramuscularly Y vaccinated with the first and second 0.5 m n has been received from Y a registered Y nurse concerning Y a 15 year old 4 female patient Y with noNpertinent medical 9/24/2007 history 12/1/2007 and no known drug a n has been received from a nurse inY a physician's Y office concerning0a female who was vaccinated N with a dose of GARDASIL (lot # not repo n has been received from a physician Y concerning a 21 year old female who on 05-SEP-2008Uwas vaccinated with ### a first dose of GARDASI n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with a dose of MMR II. Subsequentl 009 Pt. talked with PHN + and she stated she had a "reaction" to her Flu shot-stated she had Y "a temperature +### chills, stated ###she could hard treme discomfort following inj. LOC after standing up- approx 10-15 min to fully recover- pt symptoms Y Hx 2/24/2009 of LOC with 2/24/2009 vaccine, but mother as administered diluent for ACT HIB vaccine only without reconstitution of HIB vaccine, but telephone Y call2/23/2009 to mother 2/23/2009 to advise of error. Moth ticed patch of red skin in area where vaccine was administered 7 days after vaccine was given. Y No itchiness, 2/3/2009 pain,2/10/2009 or heat noted at site. N advertently received Tdap and MENACTRA that was meant for older sibling. Therefore get MENACTRA Y and 2/5/2009 Tdap earlier than usual schedu vaccinations, Pt developed severe swelling, Y pain, redness and the area became hard. She initially Y had a2/11/2009 fever, but it2/12/2009 went away. The area(b s after the shots where administered to the patient, patient's mom notified one of the medicalY assistants2/19/2009 that the patient 2/19/2009 was developing a r d few itch spots on abd 4 days ago.YSpots increased over next few days. Y 8/24/2007 2/19/2009 ce member contacted the 24 hour vaccine Y call center to report reproducible flu-like symptoms Y of nausea, vomiting, ### low grade ###fever and diar lled to report pt c/o "loosing vision on Y both sides." Parent to take pt to primary care provider U (Dominican 2/17/2009 Health Clinic) 2/18/2009 for eval. Mother calle -like reaction. Hives - several days 1 Y week apart for 1 day. Y 1/19/2009 1/19/2009 hills, fever X 24 hrs. (X hrs) Y 2/19/2009 2/19/2009 fter shot employee experienced slight nausea & weakness & hand tremors. Symptoms lasted Y 2 days. No 2/20/2009 medical Tx 2/21/2009 sought. Symptoms r e, Flu- like symptoms, low grade fever sore throat, nasal congestion, SOB fatigue, aches, etc.N 7/5/2008 7/6/2008 oughout, injection site arm & neck, w/o resp. distress OTC BENADRYL Y 2/13/2009 ht - swelling redness- covering entire upper arm. Area marked with pen. If redness spreads start U antibiotic. 2/24/2009 2/25/2009 ess and weakness approx 45 mins Y after receiving vaccine. Lasted 4 1/2 hours. Seen at ER given Y Benadryl. 2/26/2009 No co/ rash, 2/26/2009 SOB. Injection site rted child got puffy around eyes the day after vaccination 2/19/09. It resolved 2/24/09. The evening Y of 2/23/09 2/19/2009 child 2/23/2009 presented with patch, r oreness and hand and fingers became Y tingling approx 1-2 hours after vaccine. Then tired and Y vomiting X2 2/26/2009 at about2/26/2009 2-3 hours with headach ness and vomiting (4-5X) approx 1-2Yhours after vaccination. After going to have lunch. Had slt Y headache2/26/2009 and arm and 2/26/2009 flank soreness. Seen V 2005 around noon, swollen Y lips and Y wheals under eyes. Took Claritin and wheals resolved, Y but lips swollen, 11/1/2005 so instructed 11/8/2005to take Benad ues following administration of the vaccine the patients left arm, where the vaccine was givenYbegan to turn 2/27/2009 red and 2/27/2009 develop whelps. Dr. Sp my identical twin sons were given a vaccine (they had the ones for RSV also), they Y got worse N and worse6/4/2003 until at 18 months of age, they we and spoke with RN on 2/19/09 with c/o Y tremors and high BP since vaccination on 11/4/08. She U reported 11/4/2008 that she did11/5/2008 not know side effects o
4/09 at 2pm due to rash over entire body which started 2/23/09. Received vaccines 2/6/09. U 2/6/2009 2/23/2009 n the Gardasil shot in December 2007. Y In January Y 2008, diagnosed with 1 Supraventricular Y Tachycardia N (SVT): Blacked ### 1/14/2008 out/lost consciousne ed joint/body ache, weakness, feverY(flu-like symptoms). The following day, patient reported Y pain (10/10) in left### shoulder and ###left leg, brough ection site, diffuse myalgia and 3 x 4 cm supraclavicular swelling adenopathy. U 2/3/2009 2/24/2009 Swollen on L deltoid upper. Mom just noticed today upper to side on L arm. 0 fever, child active. U Mom called 2/26/2009 today in2/27/2009 office to let us know. ccine on 2/24, called office on 2/25 reporting 'large read area' @ site of injection T99. 2/26 reports still red, 2/24/2009 hot, tender to touch. 2/27 Still r nced HA which was constant x2 wks after GARDASIL vaccine. Ordered DARVOCET & asked Y pt to be seen 1/20/2009 for evaluation 2/21/2009 and she did not LUQ pain, fatigue and weight loss Y since administration of first GARDASIL vaccination. Pt and U pt's mom 7/11/2008 did not report 7/11/2008 these symptoms. Pt e fever, dizziness, pain and swelling at site. N 2/24/2009 2/25/2009 uscle pain to the extent of having diffucult time using all muscles in body needed help gettingYout of bed 2/25/2009 or chair because 2/26/2009 muscles were we pain in upper left arm at injection site Y and tingling in pinky & ring finger of left hand. Dr. suggested N Rx therapy,### MRI and EMG. ### MRI showed ceived the MMR vaccine on 2/18/09.Y Patient had Y an atypically febrile 1 seizure on 2/25/09. AYhigh fever was 2/18/2009 NOT documented 2/25/2009 at the time o ainting loss of consciousness for about a minute while on examining table. Y 2/28/2009 2/28/2009 RST GARDASIL VACCINE Y (administered Y 9/13/06): Y experienced dizziness, 9Y light-headed, Y nauseous, N headaches, 3/13/2007 leg3/13/2007 cramps, and shooting algias, Arthus reaction Y 2/24/2009 2/24/2009 d Hives over entire body except face. Y Y 2/23/2009 2/24/2009 pneumoccal/flu vaccine 2 days priorYto presentation at ED. within 12 hrs developed painful, erythematous Y 9/30/2008 swelling at9/30/2008 the pneumocaccal inje Pt. stated did not feel shot "going in"Ywhen administered; felt a little faint approx 15min after shot, U but recovered. 1/29/2009 2/2/09--severe 2/2/2009 aching pain yesight startin at about two weeks after Y immunization. Y "Optic neuritis"4 Y3/3/09 MR received forUDOS 12/4-8/2008### with12/4/2008 D/C DX: Optic Neuritis ain swelling and redness at administration site. Malaise, headache, upset stomach, myalgias,Ysweats. 2/27/2009 2/28/2009 ge reddish purple area with rashed rash at injection site, didnt show up until 11 days after injection. Y 2/16/2008 2/27/2008 STATED VACCINES WERE ADMINISTERED Y ON WED ON SATURDAY MORNING CHILDYAWOKE WITH 2/25/2009 SWELLIN 2/28/2009 OF LEFT ARM AND s and two days after receiving the Varicella vaccine patient broke out the approximately 20 pox. Y They began 2/11/2009 on her2/27/2009 thigh. Pt ran a fever o white male presents with c/o having a flu and pneumonia injections 2 weeks ago and now has Y soreness, redness, ### and 11/9/2008 skin peeling. He sta ction with redness and swelling to Pentacel. Also, about 3 hours of inconsoleable crying. Fussiness Y over next 1/5/2009 three days. 1/5/2009 Site of other vacci ed** case of progressive vaccinia. smallpox vaccine Y administered127 on 23 Jan 09, patient was diagnosed with 1/13/2009 AML/neutropenic 1/25/2009 fevers on 28 ised and hot rash on torso. Raised hard Y bump at site of shot all occurred two weeks after shot. 2/16/2009 3/2/2009 n has been received from a physician Y and medical Y records concerning 3 an approximately 3 month Y old male with### rash12/1/2007 erythematous, bronch ort received on 17 February 2009 from another Y manufacturer as part 10of a study for which sanofi Y pasteur is not a### sponsor. The ###following is ve ort received on 17 February 2009 from another Y manufacturer as part8of a study for which Sanofi U Pasteur 10/3/2008 is not a sponsor. "The ### patient is a 1 n has been received from Y a physician Y via an email Y from a consumer 10concerning the Y consumer's Y 16 year5/20/2008 old daughter who on 20-MAY-2008 n has been received from a physician Y via an email Y concerning a female 0 who was vaccinatedUwith a dose of GARDASIL. The consumer rep n has been received from a consumer Y concerning Y a 12 or 13 year old 4 male who was vaccinated N with a dose of MMR II on an unspecified d 01005622-1 described "losing mental capacities" Y in a 43-year-old female 0 who received LYMERIX. U This report was received from the vaccin o left thigh where IPV and DTaP given Warm, Red, Induration. TX CEPHALEXIN 250/5ml/5ml U tid (three 2/26/2009 times a day) 2/26/2009 for 10 days 150ml. HA that started at back of his head then through whole head, got very pale and nauseous and Y then vomited 3/2/2009 x 2. Pt c/o 3/2/2009 not feel god and na Multiform Minor, etiology unclear but may be related to MMR and VARIVAX 2/10/2009. U 2/10/2009 2/26/2009 gic reaction. Redness some edema approx 4 1/2 cm diameter. Y 2/24/2009 2/27/2009 ndritis R side > 1wk. N 2/24/2009 2/25/2009 2/10/2009 N 1/14/2009 2/10/2009 eadache, chest pain, increased blood Y pressure,Yloss of consciousness. 4 Y ### ### Breakthrough by baby sister after 1st Var. He also had breakthrough disease (both < 50 each) Y after exposed to ### sister, Hx. Related to nurs und area of injection) swelling, redness, pain, and itching that has been worsening since 2/27/09 U (when 2/27/2009 given). 2/27/2009 iven 930 AM on 3/2/09: with 1 1/2 - 2 hours later cried, high pitch voice; lasted x 4 hours withY15 minutes cat 3/2/2009 naps. Child 3/2/2009 would woke up an ction to the R forearm. redness, itching swelling - numbness in the R arm. Reacted only to vaccine Y given intra 2/6/2009 dermal.2/7/2009 Vaccine was given IM 2/17/2009 2/26/2009 Y 1/4/2000 3/1/2009 ter office & receiving PNEUMOVAX, pt. noted fever on & off. Took TGC. Cold then woke up Y during night 12/2/2008 wet with sweats. 12/2/2008 24 hours after i en 2/18/09. MOC called 2/20/09. On Left arm at site of KINRIX, arm was red, firm, and tender. Y No drainage 2/18/2009 Blotchy red 2/18/2009 rash extended down her states rashes appears on child face 6 days after administration of vaccines. Also states U she uses new 1/26/2009 lotion on child's face and is not s are L upper arm BENADRYL 25mgYq 6 pm. DURIAF 500/s 1 tsp BID X 10days MOTRIN q Y6 hours. 2/20/2009 2/21/2009
mps - deltoid strength decreased 50% with (not inj site) - lower strength fastening clothing inUback; - adjusting seatbelt. ### ### swelling of R upper arm 4 cm in diameter. U 2/25/2009 2/27/2009 er 50 yo. and received the FLUMIST vaccine normally. Clinic notified 9/20/08 and advised toYwatch pt closely 9/20/2008 next 24 hours. On 9/21/08, pt ea of slight erythema and purple discoloration at site of injections. Not warm to touch. Not raised Y when seen 2/13/2009 in our office. 2/14/2009 e and excessive pain continuing for 3 wks; Followed by prolonged weakness in left arm for past N 4 months. ### ### 2cm area of erythema and firmness. Tender to touch. Treatment, cold compress. Y 2/3/2009 2/4/2009 esented to Employee Health Clinic and Y informed the RN that she had an allergic reaction to Y FLUZONE she 2/6/2009 had administered 2/6/2009through Empl rm just below axillae has warmth, redness, Y & edema on side & back of arm. U 2/23/2009 2/24/2009 lling, dizziness, nauseous evening of date shot given. Couldn't lay on right arm to sleep. ByYnext day at 12:00 2/6/2009 Noon 2/6/2009 bruised 50mm across ter received her 3rd injection of GARDASIL vaccine Y on Feb. 9th 2009. 0 She had severe headaches ever since. We took 2/9/2009 her to the emerge ter received GARDASIL vaccine from her doctor on 02/23/2009. Since having the injection she U has had 2/23/2009 a severe headache, 2/23/2009body aches, u started throwing up, couldn't get her to respond afterwards for about 10 min, just starred intoUspace (wasn't 1/22/2009 her normal 1/23/2009 self for another 3 da atient started with breathing problems Y - till her body was shaking. She got hives (slight) on the U arm where 2/23/2009 the shot was 2/24/2009 given. As of today s hrs of being given MMR pt developed erythema multiforme requiring treatment with oral. Y 2/20/2009 2/21/2009 lled advising pt's arm where the Dtap Y was given had gotten Red hot swollen and he complained Y of it itching. 2/25/2009 The swelling 2/27/2009 went all the way n has been received from a nurse practitioner, Y who was told by one of her own patients, concerning N a 156/30/2008 year old female 7/15/2008 patient who is not n has been received from a teenage Y female athlete Y (runner) via a news 0 report who in May 2008, N was vaccinated 5/1/2008with5/1/2008 GARDASIL. In May 2 n has been received from a medicalYassistant concerning a 15 year old female with no previous Y medical history### or drug 1/5/2009 allergies reported w n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### 1/24/2008 who was vaccinated wit n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### who 6/1/2008 was vaccinated wit N rmation received on 20 February 2009 Y from a consumer. A 65 year old male patient who at the Y age of 5 years 2/10/2009 suffered severe chest pain an ort received 19 February 2009 from Y a health care professional. A 14-year-old male patient with U a medical history ### of environmental 11/6/2008 allergies a rmation received on 18 February 2009 Y from a health care professional. A 49 year old male patient N received 8/1/2008 FLUZONE 8/3/2008 (lot number U2761A er shot- hives, pain shooting down arm Y and chest, nurse gave me BENADRYL. One Y week later N I was still having ### hives on ### my chest after ea m on 7/22/2008, fever started 99 degrees, Y in 1/2Y hour went up to 1017 degrees. Seizure started Y went to ER 7/14/2008 in Ambulance, 7/22/2008 seizure lasted 45 shot @ store. 10/29 flu-like sx: myalgia, Y sore throat Y 11/1 pain, tenderness 20 @ site. ER/admit 11/10 Y - 12/1 abscess ###L deltoid### --> staph aureus pain in chest approx 3 days after shot. Shortness Y of breath, fatigue,3 fever, night sweats, muscle Y soreness. 8/25/2008 Hospitalized 8/28/2008 after for 3 days due Varicella administered while she is pregnant. 16wks. EGA. U 2/19/2009 d itchy: topical skin reaction site of flu shot. Resolved with hypopigmented round area 12 mmUdiameter site 12/8/2008 injection. Not itching. ### Not sore. oday with sister who are getting vaccines. Client had vaccines administered on 2/18/09 and U started rash2/18/2009 on her chest 2/25/2009 today mom states cli induration L deltoid 6cm x 6cm. U 2/19/2009 2/20/2009 ter immunization started with lower Y leg itching which then included the abdomen/torso. Rash-full N body after 12/9/2008 @ 2 weeks with ### cont. itching, bu re today for Right thigh red area after shot on Friday, an on Left has softball size red rash where Y the immunizations 2/20/2009 were. Patient did not ha arrhea for 7-8 days on day after vaccine given. Y 1/26/2009 1/27/2009 nset of fever 103.9 with cough, headache, & congestion. U 10/7/2008 2/26/2009 al, redness, tender to touch per patient. Y Swelling and soreness. Y 2/23/2009 trial of ZYRTEC, and if worsening then antibiotics. U 2/19/2009 2/24/2009 - ZYRTEC/allergy med, antibiotics. U 2/20/2009 swelling, pain, itching at site of injection. Instructed pt. to use warm compresses, topical BENADRYL or2/24/2009 Calamine lotion, ADVIL or TYLEN 9- Rash all over, fever, cough x 2 days- Dx: Varicella + Bronchitis Treatment: ACYCLOVIR Y 200/5 1/2 tsp7/12/2007 QID x 5 days 2/23/2009 & BENADRYL 1/2 t ated red and swollen right arm aboutY 2/10/09 with fever 104 degrees and several sm "blisters". Y Took child 2/5/2009 to family doctor 2/10/2009 who DX "vaccine ed 7mm took Benadryl none in am, so not seen in office. Y 2/26/2009 2/26/2009 ash on left side of neck arm and side. Nometasone Furoate, Hydroxyzine HCL 25 mg, Prednisone. Y ### 1/3/2009 ely got left sided eye pain and nausea / an hour and a half later got chest tightness and pain,Ywhich lasted 1/13/2009 intermittently 1/13/2009 5 days. No reaction eived immunizations for travel on 12-17-09 and came into the office on 3-2-09 with rash on his U body. Rash 2/17/2009 appeared 2/27/2009 to be pin point pustule ustular, follicular eruption on the chest and back Y 2/17/2009 3/2/2009 ccine given outside age range Y 2/26/2009 2/26/2009 9 Right Deltoid Red, Swollen, hard induration, Y hot to touch, itchy, red streaks and painful to touch. U Pain with 2/25/2009 Range 2/26/2009 of motion but has full R wellimg at injection site, with rash. pain down left arm and on left shoulder blade. onset immediately N after 2/28/2008 immunization 2/28/2008 was administered t veloped sores on lip approximately 3-4 days after receiving the vaccine. She then developed Y sores on her 2/5/2009 nose as well 2/8/2009 as around here ey
ceived Menactra vaccine on February Y 25th and 24 hours later on February 26th he developed N fever 101.8, 2/25/2009 dizziness, 2/26/2009 nausea, headache, a Y Y 2/26/2009 2/26/2009 Y Y 2/18/2009 2/19/2009 swelling, warm and hard @ site 2.5 x .5 Y 2/27/2009 3/2/2009 d pain and swelling at injection site.YWas seen in the ED 3 days later Y 2/26/2009 ng and redness of the left lower thigh Y 2/25/2009 2/26/2009 ays of injection client passed out at school andYagain at hiome, no other 2 s/s of illness. Admitted Y to hosp.5/22/2007 for tests, all5/24/2007 neg. Has passed out 9 pisode within 5 minutes of administering #3 Gardasil and Varivax #2 Y 3/3/2009 3/3/2009 e anxiety - moody and irritable following flu vaccine - constant meltdowns. 2) Sensory issuesNregarding things ### touching her ### - sometimes un ven his 4 year old immunization on Feb 25, 2009. MMR was given on his right leg and mom stated Y pt developed 2/25/2009 rash 2/25/2009 around the site few ho spontaneous report of seizures and possible transient ischemic attacks has been received from N a parent who is ### also a nurse ###concerning a d shingles like rash that itched. Saw primary care doctor was treated and doing well. Y 2/11/2009 2/16/2009 ives BENADRYL. Observed 90 minutes, Y hives diminishing. Referred to allergist for testing. Y 3/3/2009 3/3/2009 cal erythema, swelling, stiffness with fever up to 102 degrees F. U 2/27/2009 2/28/2009 nt- She had a rash + fever @ time ofYER visit. On 3/3/09 zero rash zero fever-body-aches. Per Y patient. 2/27/2009 2/28/2009 of leg with a fine urticarial rash around injection site. Y 2/24/2009 2/25/2009 perienced a syncope episode Friday Y 2/27/09. Transported to emergency room via ambulance. Y Labs and 2/26/2009 CT of head 2/27/2009 negative. Most recen Tdap and meningitis vaccines. Several minutes later became pale, said he didn't feel well. Became Y unresponsive 1/14/2009for 1/14/2009 < 1 minute. Condition y injection site rash that spread. Became about 2 in x 2 in rash that developed blisters. Very U itchy, red and 2/27/2009 inflamed. No 3/1/2009 fever. No swelling o scle pain @ injection site, progressively getting worse after injection. Pain radiates to shoulder N trapezius muscle 2/9/2009 and neck. 2/9/2009 3 wks post inject reaction to vaccines. MOTRIN and apply cold compress. Y 2/25/2009 2/26/2009 nd vaccine became red. Y U 2/27/2009 3/2/2009 02, with R shoulder swelling and pain X 3d. Seen at ER and started on AbX. Currently afebrile U and improving 2/27/2009 recovering. 2/28/2009 swelling and warmth at injection siteY noted 2/20/08. Treated with CLARITIN 10 mg, 1xday for Y 2 days and2/18/2008 hydrocortisone 2/20/2008 cream to site for 2 a haircut on 4/15/08. At that time, he noticed a dime-sized area of hair loss on scalp, back ofNhead. 4/9/2008 contacted manufacturer indicating that Y the caller had received notification of an AE possible associated U with administration ### ### of BIOTHRAX va xperienced moderate (7x6cm) local reaction to 2nd BIOTHRAX vaccination on 12/1/08. AreaYwarm to touch. 12/1/2008 Malaise12/1/2008 12/2/08, feeling better ports that at approximately 5:00 pm on 10-8-08 he experienced general muscle aches, fatigue Y and fever.10/8/2008 He experienced 10/8/2008 two episodes of ports being tired on the first day after Y receiving the ANTHRAX vaccine. At 6:20 AM on the second Y day she 10/8/2008 noted chest 10/9/2008 pain and shortness d dry rash localized to the injection site (injection site rash). Subject is a military person who Yhad received 7/11/2008 4 previous7/12/2008 doses of Anthrax vacc at injection site at 24 hours after immunization. Y Redness, swelling, itching, tenderness and induration Y at injection 7/15/2008 site7/16/2008 at 48 hours after immu ports that approx 5 hours after immunization, she experienced malaise and fatigue. Her symptoms Y progressed 7/9/2008 to stomach 7/9/2008 pain and nausea ports that three days after receivingYthe ANTHRAX vaccine she felt chest pain and fainted for Y approximately 7/1/2008 30 seconds. 7/4/2008 Subject was take e-mail: Subject has a latex allergy and received the anthrax vaccine. Subject is requesting information U regarding whether the vaccine is mad of muscle, left leg, from mid-calf to behind the knee. Soreness caused limping. Subsequently Y within 3 days, 5/6/2008 pain lessened, 5/9/2008 no longer limpin ection site, itching at injection site, swelling at injection site, redness at injection site, warmthYat injection 4/22/2008 site, 5cm x 4/23/2008 7cm area. n has been received from a consumer Y concerning her 20 month old son with penicillin allergy N who on approximately ### November ### 2004 was v n has been received from a physician concerning a female patient who in August 2008, wasUvaccinated with 8/1/2008 a dose of 2/1/2009 GARDASIL (Lot not n has been received from a consumer Y concerning Y her 14 year old daughter 1 with purple cornflower N allergy 2/16/2009 and no pertinent 2/25/2009 medical history, n has been received from a physician Y assistant concerning a female patient who on an unknown N date was 11/4/2008 vaccinated with### the second dose ort received 23 February 2009 from a health care Y professional. A 4-year-old 2 female patient had Y received 12/4/2008 a third dose12/4/2008 intramuscular left delto ort received 23 February 2009 from Y a health care professional. An eight-year-old male patientY with no past medical ### history,### had received an ort received on 27 February 2009 from Y a physician. A 4-year-old female patient, whose past medical Y history was not provided, had received 2-08 was in hospital for syncopal episode. Y SheYhad normal EEG recording. 2 Was referred for Yevaluation of4/4/2008 a 2 months Hx of spells. First in 2 d spots that started on torso and spreading to her legs. 1/22/2002 2/26/2009 A AND VOMITING Y Y 2/25/2009 2/26/2009 n and swelling in L arm the next morning after receiving a Tdap in this arm. States lymph nodes Y swollen 2/20/2009 and just felt2/21/2009 ill with a bad taste in m pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 11/27/2008 for COPD exacerbation. Y 10/4/2007 Vaccination took ### place on 10/04/ pneumococcal vaccine trial, with severe COPD, Y was hospitalized for 1 chest pain-non cardiacYon 02/06/2009. 1/8/2007 Vaccination 2/6/2009 took place on 1/08 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 6 8/13/2008 for right hip Y fracture. Vaccination 11/7/2007took 8/13/2008 place on 11/07/2007 as vaccinated for meningitis, gardasil, Y and tetanus on 2/18/2009. On 2/19/2009 she could hardly N walk her 2/18/2009 legs were2/19/2009 numb and very weak a
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 1 11/06/2008 for left femYartery reocclusion. 1/9/2008 Vaccination 9/25/2008took place on 1 at-WATERY EYES-RUNNY NOSE-worn ousore right shoulder(shot was in left bicep)-Phlegm-hoarsenessN 2/27/2009 3/1/2009 and edema localized at injection site. slightly raised irregular borders approx. 2-3 in in diameter. N Symptoms 3/2/2009 appeared3/3/2009 24 hours after immun ed Gardisil in left arm then MenigitisYvaccine in right arm. Within a mintue of reciveing the second U shot she 3/3/2009 passed out, 3/3/2009 her body became ri lled and states she has had arm pain Y since receiving infuenza shot 10/16/2008. Has seen MD N X2. Was put on### NSAIDS TID ###X 1 week w/ n ess Administered Daptacel to adult patient. Y Patient should ### have received ### Adacel. Dap e reaction Administered Daptacel to adult patient. Patient should have received Adacel.YDaptacel box 12/4/2008 and vial not marked for pediatric ed 2 month vaccines in office, returned Y home with mother and then cried continuously for >4Yhours, with 2/27/2009 mother unable 2/27/2009 to soothe baby e event Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and vial### not marked for pediatric us t for 24 hours. Administered Daptacel to adult patient. Patient should have received Adacel. Y Daptacel box and ###vial not marked ### for pediat e events. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 1/30/2009 vial not marked for pediatric use e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box1/30/2009 and vial not marked for pediatric u ately 2 weeks after receiving the meningococcal Y Y vaccination and tetanus 5 vaccinations, patient Y developed optic ### neuritis.4/15/09-records 1/3/2009 rece lf reported sore arm for 3 weeks. Administered Daptacel to adult patient. Patient should have Y received Adacel. 5/16/2008 Daptacel box and vial not m e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 5/16/2008 vial not marked for pediatric use e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and 6/5/2008 vial not marked for pediatric use ely following vaccination go light headed Y turned blue and fainted out for approximately 60 seconds Y immediately 2/1/2009 followed 2/16/2009 by a migrain heada ed of itchy throat, "patient stated throat Y closing and feeling very itch all body", abdominal pain, Y mouth numbness,facial 1/19/2009 1/19/2009 erythema, positive ra NJECTION WITH REDNESS,SWELLING,WARM Y TO TOUCH. Y 2/18/2009 2/19/2009 e local reaction. Painful with patient Y asking to be carried. Swelling of left quadricep with loss of U knee landmarks, 3/2/2009 erythema 3/4/2009 and warmth at inj was reported by a physician and described the occurrence of elevated gamma glutamyl transferase N in a 44-year-old ### 1/21/2009 female subject who w was reported by a lawyer Y and described Y the occurrence Y of skin blistering 0 and peeling in a female N child who 2/21/2007 was vaccinated with HAVRIX (G was reported by a physician via a sales representative and described the occurrence of cellulitis Y in a child (4 to 6 years of age) male subjec nced vomiting and 1 bloody stool. He Y was taken Y to ED where they found 1 he had intussusception. Y He was 12/8/2008 treated w/air 1/2/2009 enema. He was obs h began to get red and swell with 2 Y papules appearing in central lesion that had fluid but dried Y up. I saw today 2/18/2009 about2/19/2009 2 weeks post vaccines dness, soreness at injection site - approx Y 8 hrs later increase HR with some PVC'S, severe HA Y and backache, ### low grade fever ### 99.6 lt heade of Right thigh and vomiting. Went to Y emergency room on 2/26/09 follow up. In our office on 3/3/09 Y thigh looked 2/24/2009 normal 2/26/2009 child is fine. es X 3 inches round, red, warm to touch Y region left deltoid. Were HEP A given. Slight red rash Y around injection 3/3/2009 site 3/4/2009 and back. 18 hours po ped fever 101.7. 15 cm area of redness, Y tenderness, and swelling. Localized just to vaccine location. Y Treated 3/3/2009 with oral 3/4/2009 MOTRIN and BENAD achy at site of injection, tenderness and achy in back. Ibuprofen given - 2 hrs later: Pt felt better, Y decrease3/2/2009 fever, back3/3/2009 tenderness gone. Fev n tongue - Labored breathing - BENADRYL Y Y ### ### ons given - mom calling stating childs (L) leg was swollen from knee to groin and red. - No temp - n pain.3/2/2009 3/3/2009 Y 3/3/2009 3/3/2009 eadache-fever-dizziness. Doctor visit, Y bedrest, Toradol injection for headache-Hydrozodone for Y headache2/23/2009 2/23/2009 lled 2 days after immunizations listed were given. States child has Hx of eczema rash-mild, but Y noted some hive-like ### raised ### areas on skin o r receiving Tdap at 03/02/2009 . Temperature= 101 (Ty) control by Tylenol. Y 3/2/2009 3/2/2009 t injection site dx by CHOP. Admitted x 48 hours for IV antibiotics, nml, us, neg, cxs. Full recovery Y of mobility. Had HIB + pneumococcal sa d flu shot at clinic on 11/3/08. States Y she started with discomfort to left upper arm from flu shot N area to her 11/3/2008 elbow and 11/6/2008 states "it feels bruised VAX vaccine administered 2/24/09 Right upper arm. Two days afterward the patient called the N office questioning 2/24/2009if site 2/24/2009 reaction was norma of immunization, patient returned to the doctors office to report injection site was itchy. Site U was seen by 3/3/2009 Dr. Site was also red, slight swolle as 2.5 X 2.5 cm indurated erythematous area @ VARIVAX site. Y 3/2/2009 ame limp, unable to hold head up, Refused to bear weight on Lower extremities. Awake and Yalert but "out 2/16/2009 of it" according 2/16/2009 to father. This las ADACEL, MENACTRA, FLUZONE, Hep A, VARIVAX, and GARDASIL - just after receiving YGARDASIL she 3/3/2009 stiffened3/3/2009 up and eyes rolled ba and Dad; reporting to us today at well Y check visit that on 10/21/08 approx 1900 pt had fever Y of 104, responded### to treatment ### of TYLENOL, in ater had fever of 102.5 degrees, 103 Y degrees on the next day, controlled by TYLENOL/MOTRIN U every 42/23/2009 hours. Called 2/24/2009 doctor the first day b n has been received from a physician concerning an 85 year old female with a history of "lung Y cancer surgery" 2/8/2008 who on 2/2/2009 08-FEB-2008 was v n has been received from the patient's Y sister concerning Y her sister with 4 no pertinent medicalUhistory or drug 9/10/2007 reactions or allergies ### who on un was reported by a healthcare professional and described the occurrence of spitting up in a 6-month-old U subject of unspecified gender who was reported by a physician via another manufacturer and described the occurrence of pellet-like U stools in an infant subject of unspecified was reported by a physician Y and described theYoccurrence of intussusception 4 in a 3-month-old N female subject 1/20/2009 who 1/24/2009 was vaccinated with RO was reported by a healthcare professional via a sales representative and described the occurrence U of swelling of upper arm in a child subje
was reported by a healthcare professional via a sales representative and described the occurrence U of swelling of upper arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje was reported by a healthcare professional via a sales representative and described the occurrence U of swelling 2/1/2009 of upper 2/1/2009 arm in a child subje 1st GARDASIL vaccination in Oct 2008 and ever Y since then I have been having high fevers, N between to 102-103.0. 10/1/2008 ### arre Syndrome with loss of sensation Y in hands/feet Y and proximal muscle 17 weakness onset onN12/08/08. No improvement ### 12/8/2008 as of yet 4 days of administered 2/05/09 in morning. Parents report Y mom picked up child 3 from crib for 9 p.m feeding. Y Child was 2/5/2009 unresponsive 2/5/2009 and limp. Father ately 4 days after immunization, pt had Y nausea Ythat went to fever, chills 14 and extreme diarrhea Y - went to urgent 11/3/2008 care about 11/7/2008 1 1/2 weeks also ropped off at Mall. At 5:30pm student Y called mother with Sx of SOB, grey lips, perspiration, pale N skin color, 2/25/2009 numbness 2/25/2009 of legs, slurred speec d ZOSTOVAX vaccine on 2/17/09 and three days later she developed shingles on right breast. 2/17/2009 d IZ on 2/18/2009, mother phoned 2/19/2009 Y fever 104 advised ER. Y 2/18/2009 2/19/2009 hed. Neurologist's assessment 2/20/09 Y - normal with coincidental viral infection with fever to N 102 on day 2/11/2009 of visit 2/20/09. 2/12/2009 fter vaccines given. Y 2/17/2009 2/17/2009 ots, pt complained of feeling "tired". This "feeling" lasted et mother reports had fever not measured Y via thermometer2/20/2009 2/20/2009 24 hours after injection after am shot, mom called to report itchy rash on left arm with some swelling. Patient complained Y of knee 2/18/2009 and elbow 2/18/2009 pain. st immunization pt. c/o wheezing with Y exhalation. The Monday following 11/10 she came down N with flu-like symptoms ### 11/3/2008 + fever 101 degrees ever, generalized aching 24 hour after vaccine given. Vomited 2 day after vaccine given. Y 2/13/2009 2/14/2009 VAX given IM Left deltoid on 2/18/09. Y On 2/19/09, pt returned to ofc with edema, pain and erythematous U 2/18/2009 streaking from 2/18/2009 injection site down broke out at 4:30 pm 11/08/08. Rash or blister like over left eye- on forehead + into scalp + hair. N Not to painful but very uncomfortable espec oday stating that the day after getting her shots she developed Blisters in her scalp and itchyYrash on her body.### She did not ### seek medical a ash across abdomen with urticaria started 24 hour after Hepatitis B vaccine administration. Self Y treated with 2/26/2009 BENADRYL 2/27/2009 OTC and topical h rge reddened area with raised rash at injection site. 11 days after injection. Y 2/16/2009 2/27/2009 h severe redness/swelling & induration. Y Worsened over several days pt treated with ABX forYpossible cellulitis 2/23/2009 & steroids/BENADRYL 2/24/2009 for al cellulitis. Treated with Omnicef 120/5/ml 3.5 ml twice daily for 7 days. U 2/18/2009 2/19/2009 gic purpura - developed 4-6 hrs after Y vaccine lasted 1 month - 2-3 developed nose bleed lasted N 2 months 10/1/2008 swelling ankles 10/1/2008 lasted 2wks - wh cal lymphadenitis. U 2/16/2009 2/23/2009 or the 1st of three Guardisil Y vaccinations. Y I had a recent previous pap smear that normal, no N HPV, no abnormal 4/27/2007 cells, 7/11/2007 nothing. After another d grouped papules and vesicles withYa red base on his left shoulder on 2/17/09. He was treated Y with Valtrex 2/3/2009 for 7 days. 2/17/2009 Papules, vesicles a minutes of injection, arms felt heavy and tingly, tongue was tingling, felt nautious and felt dizzy, Y collapsed in 3/5/2009 waiting area 3/5/2009 but did not loose co was given IM Pneumovax in left detoid Y on 3/2/09 at clinic visit for cough and sore throat. RNUreported using 3/2/2009 one inch3/3/2009 25 gauge needle and m swollen right bicep. treated with local care only, observation Y 3/3/2009 3/4/2009 D YELLOW FEVER VACCIN SQ, NOTICED REACTION SEVERAL DAYS LATER. REACTION Y CONSISTED 1/23/2009 OF URTICARIAL 1/25/2009 REACTION wheal (3 cm x 1 cm) and flare (5 cm x 6 cm). Started within 5 minutes of vaccination. At 10Yminutes was3/5/2009 still spreading 3/5/2009 without systemic s DEVELOPED REDNESS TO INJECTION SITE (RIGHT ARM) WITH INDURATION AND SENSITIVE Y TO3/2/2009 TOUCH 3/3/2009 ceived flu shot at unknown pharmacy Y 6 months ago. Felt immediate pain in Left lateral upper N arm, and pain has persisted to the present da d swelling of right eye with redness Y 1 hour after Immunizations, then developed swelling of left Y eye and approx 2/27/2009 2 hours 2/27/2009 later had hives on fa edness for two days at site of injection. Right thigh. U 3/3/2009 3/3/2009 lled and reported that patient was pregnant when she received her third Gardisil. Y 2/4/2009 heals around injection site, right shoulder area, and trunks. Hydrocortison cream and Loratadine U given. 3/3/2009 3/3/2009 as very anxious when given his immunizations Y at 11:30am. Immediately after he became pale Y and c/o nausea. 3/2/2009 Less3/2/2009 than 5 minutes after v m Red, Swollen, Hardness, warm to touch. Patient admitted to scratching the arm at the injection Y site. 3/3/2009 3/5/2009 he vaccine at 3pm, february 10, 2009. Suddenly became very dizzy at 4:30 pm. The extreme Y dizziness2/10/2009 slowly subsided 2/10/2009 and was gone by able crying for 6 hours after vaccine administration. No treatment. Y ### ### ceived pneumococcal vaccine on 11/17/2008 and 2 days later complained that his right upper Y arm was hot to the ###touch red, ### and swollen. P and swelling of L upper thigh measuring Y 8 x 7 cm oval. U 3/4/2009 3/5/2009 zure while sitting and eating, talkingYneck twisted and fell to the floor while @ grandmother'sNhouse lasted9/8/2006 2min. Multiple 6/5/2008 seizures since the at 7:30pm child had a seizure lastingY about 1.5 minutes. No fever. Complained of feeling tired Y before and 3/3/2009 after taken 3/4/2009 ER treated and has a ses of VARIVAX, developed 20-30 classic varicella lesions over axillary/trunk area, no cough,Ycoryza, URI 8/23/1999 symptoms,3/4/2009 otherwise well, lesion iving all ten shots - PENTACEL, ENGERIX and ROTATEQ. Pt noted to have significant erythematosis Y lower 2/26/2009 extremities 2/26/2009 that lasted few min ing and weakness in legs, feet, arms, Y hands and face; first noticed numbness in feet end of October, U 2008. Progressed ### to### legs, arms, hand er (after 3rd DTaP) leg from thigh toYknee swollen and red spotty spot on inner thigh not at injection U site but 3/2/2009 near it, no 3/4/2009 fever, warm, tender.
Y 3/3/2009 3/3/2009 d swelling and soreness to injection site. She also had about 6 inches of redness around site. U 2/25/2009 2/27/2009 over body, very large and raised. Benadryl worked somewhat. Zyrtec (20mg) stopped the reaction N almost totally. ### However, 1/15/2009 after about a we n has been received from a licensed Y practical nurse concerning a 26 year old female with noYknown medical history ### and 1/1/2009 drug allergies, who n has been received from a physician Y assistant and a licensed practical nurse, for GARDASIL, Y a Pregnancy 12/2/2008 Registry product, ### concerning a n has been received from a office manager Y concerning Y a 14 year old 0 female patient who on U 28-APR-2008 6/27/2008 was vaccinated 9/1/2008 with the first dos n has been received from an advanced registered nurse practitioner concerning a 23 year old Y female diagnosed 2/24/2009 with 2/25/2009 epilepsy 2 years ago n has been received from a physician Y concerning Y a female patient 31 who in July or August of 2008, N was vaccinated 8/8/2008with 9/1/2008 her second dose of G n has been received from a physician Y concerning Y an 18 week old male 2 patient with a historyYof reflux and umbilical ### infection ###when he was b edness. Malaise. Chills. Headache.YCough. 3/26/09 Y Received hospital 2 medical records of 10/7-10/8/2009. Y 10/3/2008 FINAL DX: 10/4/2008 Percutaneous coron ed chest heaviness, nausea, headache Y after administration of vaccine presented next day with U persistent2/9/2009 complaint. 2/9/2009 3/10/09 Received PC elling and redness at sight. Y 2/6/2009 2/6/2009 ceived shingles vaccine on 2/9/09 at that time she did not note on VAR that she was immunoUcompromised. 2/9/2009 On 3/2/09 2/16/2009 the home healthcar ed day after vaccines administered. Pt arm warm to touch. Pt complained of itchy & soreness. Y Cellulitis2/27/2009 of R arm- AMOXICILLIN. 2/28/2009 UMIST and came down with Influenza Y A anyway. Y ### 2/23/2009 nning one week after receiving MMR, Y Varicella + HepA vaccine. Rash on back and 5 total lesionsU a few2/20/2009 appearing2/27/2009 like typical chickenpox ven PEDIARIX at 4mo. WCC, HEP B was given too early, must re-vaccinate to insure immunization. U ### ven Hep A vaccination, not in child profile or EMR immunizations. Found later in chart note, Pt received third 2/11/2007 Hep A vaccination today, rece eceived HPV # 1 6-26-07. Patient returns 8/30/07 for HPV #2 and says that her legs were hurting Y - come6/26/2007 back 10/23/07 still c/o leg pain lab abbing head pain, 2/14/09 chest pressure, Y 2/15/09 back and neck pain, 2/16/09 all of above.N2/18/09 diagnosed 2/13/2009 with 2/13/2009 costiocondritis. umbness in left leg, moved up bodyYto left arm, then went to other side of body. Headache severe. U Heart 11/5/2008 palpitations. 11/6/2008 Cramping in hands ated generalized Rash in AM-deniesYSOB. Instructed Tx BENADRYL and/or MD or ER if worse. N Called mother 2/26/2009 3-2-09 2/27/2009 AM-she stated went t dizziness, dysautonomia, fatigue. Has been treated for possible Meniere's disease and for anxiety. N Recurrent 9/19/2007 MRSA9/19/2007 skin infections since 9/ ge 5 was given the MMR/Varicella (Chickenpox) Y shots on the same day, February 19th 2009.YOne shot in2/19/2009 each leg. 2/24/2009 On Tuesday February 2 in hives on 2/22/09. Worsened by Y office visit on 2/23/09. No known new products of foods Y treated with 2/20/2009 SOLUMEDROL 2/22/2009 dose pack and hy e fever, muscle aches, nausea and vomiting. Y Y ### ### ed hot left arm pain Tylenol and iceY Y ### ### o nausea immediately after MCV4. Became pale and stated "I feel nervous and like I may throw Y up". BP 90/60 3/3/2009 placed3/3/2009 on floor in supine pos e seizure. about 0300 -> ER had sz Ythere -> Home 0930 - another sz -> ER -> Home. (Dx: Otitis Y Media @ 2/19/2009 this ER visit 3/1/2009 & sent home w/AMO ood up after injection, walked to closed door, slumped forward & said he didn't feel well, thenYthrew his head 2/3/2009 back, went 2/3/2009 stiff & fell over unco ticed a blister at site of injection 8 am on 1-27-09. On 1-28-09 area became red, swollen & sore; Y Clt developed 1/26/2009 HA 1/27/2009 & head felt warm. No t shingles vaccine- ZOSTAVAX- Resulting in break out of shingles. 2/24/2009 Y
& swelling at injection site. Skin warm to the touch. Y 2/23/2009 2/23/2009 ngestion, cough, decreased appetite, temp 104 degree F lasting 3 days. Also diagnosed with Y acute Otitis 2/24/2009 Media on2/24/2009 day 3. Treated with AU ted to office on 2/28/09 with red, swollen area on thigh where DTAP was administered. ShotYwas given on 2/26/2009 2/26/09. 2/27/2009 Family noticed redden ing at site of injection Y 1/26/2009 1/27/2009 PREVNAR injection 2/23/2009. Late evening started having fever to 103 & fussy. Seen by Y Dr. 2/23/09 2/23/2009 - No orgin found 2/24/2009 for fever T-98.9 at t swelling, redness, erythema, pain of left upper arm to elbow - lasting 6 days. After resolution, Y depression 7/8/2008 remains 7/10/2008 in muscle of upper left a & induration 10 inches around injection site. Y 2/27/2009 2/28/2009 ction redness swelling 4 cm x 5 cm Left Y thigh DTAP. U 2/23/2009 2/24/2009 o sore arm on 2-28-09. Mom noted Yredness, inflammation & warmth. Dad took patient to walk-in Y clinic on 2/26/2009 2/28/09. 2/28/2009 Dr. put him on antibiotic ion right upper arm 2 - PNEUMOVAX RX: TYLENOL as needed ice to area as needed Y 2/24/2009 2/25/2009 l -> Per note from/by Dr. : "Patient suddenly Y awoke from her sleep at 2:30 am early Weds. morning U with 2/16/2009 shaking chills 2/18/2009 and "cold sweats" an Telephonce call from school nurse to report that child came to her office in the AM with c/o U severe itching, 3/4/2009 left upper3/5/2009 arm, after recieveing ately 24 hours after administration ofY vaccine patient states she woke in the night feeling "hot", Y and patient's 3/5/2009 cheeks apear 3/6/2009 flushed. Patient cine was administered on 2/13/09. As Y of 2/27/09 my son has had episodes of hives. Started Non lower extermities 2/13/2009and 2/27/2009 then moves to top (fa e, lymph node reacted and created a big bump under the same arm that had the vaccine. Fever, very weak 3/3/2009 legs and knees. 3/3/2009 I still do not hav 6 PM vacine given- headache that night & the next day, flu like symtoms(aching, chills and diarrhea) started. 3/2/2009 I still have 3/3/2009 them as of 3/6/09. a rash 2 days after administration. She describes it as raised and hard, a big red area about Ythe size of her 2/18/2009 palm. 22/20/2009 days later not as big or
eadache from back of neck up to head.Throbbing, general malaise. Sx began about 12 to 15Yhours later. Felt 2/3/2009 hot. 2/4/2009 RM AREA TO RIGHT ARM WHERE MENACTRA WAS GIVEN(03/04/2009).PATIENT WAS SEEN U BY DR.NAVE 3/4/2009 AND 3/6/2009 MOM WAS INSTRU ps all over body that started 9 days after Y vaccine was given. Y 2/2/2009 2/12/2009 RM AREA AROUND THE INJECTION SITE GIVEN IN THE RIGHT ARM. SEEN DR 09/06/2008 Y MOM WAS 9/4/2008 TOLD TO 9/6/2008 WATCH SITE AND A ceived 4 vaccinations on 02-18-09. YLater in that same day, patient complained of right arm pain. Y Per Mom, 2/18/2009 the deltoid 2/18/2009 site was erythemato D ZOSTER VAX. ON 1/29.09. HIS WIFE CALLED CLINIC CHARGE NURSE 2/23/09 TO REPORT Y PT. 1/29/2009 HAD DEVELOPED 2/16/2009 A BLISTER WI 11/6/2003 ceived Gardasil and Menactra Y vaccinations Y on Y Friday, Feb. 27th at about 2 2 pm. She also had Y completed2/27/2009 a course of3/2/2009 Zithromax, but had pr ng after receiving the Tdap, along with a trivalent flu shot, the patient reported jaw pain on the Y left side that "hurt ### like hell" ### and persisted for me swollen and red, several hours after Y administration of vaccine. Area became painful.There Y was quite 3/4/2009 a bit of swelling 3/4/2009 around the entire veloped fever and light sensitive headache after receiving vaccines Y 3/4/2009 3/4/2009 nset full body myalgia and fever 102 less than 24 hours after injections. U 3/5/2009 3/6/2009 effect at injection site (R arm): round, erythematous without pustular lesion 1.5 cm x 1.5 cmYand tenderness 1/8/2009 on Right 1/21/2009 arm. er administrating ROTATEQ baby developed redness on face - chest & back. Administered Y @ 11:50 am -3/6/2009 rash 12 pm3/6/2009 (on 3-6-09). ost vaccine child c/o pain (sharp) inYright hand (vaccine given in left arm) then later in day child U c/o pins &3/3/2009 needle parasthesia 3/4/2009 X 4 extremitie
hs, patient had rash at location of immunization. Y At 4 months with no alcohol or band aids used, U patient had 3/2/2009 rash on legs 3/3/2009 where shots were d #2 GARDASIL vaccine inj 2-17-09. 1st injection was given at another clinic. Pt called 2-25-09 Y & stated 2/17/2009 shortly after 2/17/2009 she got home felt an occurred after having vaccines. Vomiting lasted about 10 hours. Y 3/5/2009 3/5/2009 and low grade fever occurred after receiving vaccines, vomited X 1. Y 3/5/2009 3/6/2009 st yellow fever vaccination (SQ) member Y noted a small area of redness at the site of his vaccination. Y By2/24/2009 this afternoon 3/4/2009 the area of redness arm cellulitis - treated with SEPTRA Y Ds and NAPROSYN. Y 2/11/2009 2/19/2009 - severe, malaise- severe, fatigue severe, headache- moderate, swelling/induration, redness, Y diarrhea, chills-moderate, 1/29/2009 1/29/2009 pain-severe- took 5 d TDAP. He developed fever & headache x 4 days. Per mom they brought him to urgent care. Y Now he is better. hours after injection patient experienced redness and a hard area about the size of a fist. Swelling Y from injection 1/29/2009 site1/29/2009 to wrist. Warm to the t fever for several days then "chicken pox" rash which eventually spread over entire body, fatigue N - I (her 2/23/2009 mother) have3/2/2009 ended up with about sudamina rash developed on body trunk and upper extremities 30 min after administration. Vaccine Y is Trimovax 3/6/2009 of Sanofi 3/6/2009 Pasteur Lot No s very painful and swollen wrists, hands, and knee for duration of close to 2 weeks, appearingY2 weeks and2/4/2009 5 days after 2/24/2009 administration of vac ighly anxious after vaccines given. Reported tingling in mouth, numbness in feet, and diff. breathing. Y States 3/8/2009 couldn't3/8/2009 move legs. Epinephri n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a U 17 year old female 3/6/2008 who on 3/6/2008 06-MAR-2008 was n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 15 9/18/2008 year old female who on 18-SEPn has been received by a drug wholesaler Y representative Y concerning three patients who on 20-JAN-2009 Y 1/16/2009 were vaccinated 1/17/2009 with a dose of P n has been received from a Doctor of pharmacy Y concerning a 61 year old female patient who N on 22-DEC-2008### was vaccinated ### with a dose ort received 24 February 2009 from Y another manufacturer (document number 45214091), who received the report from a health care profes AP & VARIVAX 3/3 0900 AM. 3/3/09Y 2330 To ER via ambulance with high temp muscle tremor, Y arm pain.3/3/2009 3/5 seen in3/3/2009 office with cellulitis (R at site of injection- Soreness at site L arm and up into L neck. Temperature elevation up to 102 N degrees accompanied 2/9/2009 2/9/2009 by some nausea. d TDAP, HEP A, MENACTRA 1-20-09. Y Mom called this am 1-22-09 states he is out on townUon basketball 1/20/2009 trip and 1/21/2009 called c/o stiff neck, sta es onset of soreness + "Shooting pain " Left axilla last night, 2/26/09; 4/10 severity. (Also reports Y mild/moderate 2/25/2009injection 2/26/2009 site tenderness/ d flu shot and came down with influenza Y A anyway. Y ### 2/22/2009 d flu shot and came down with influenza Y A anyway. Y ### 2/25/2009 up to neck-soreness still sore-sometimes more than others times- When sick or after other shots N vaccines. 12/1/2008 12/1/2008 l headache, neck pain, body ache +Yvomited X 1 later same day and went to ER for evaluation. Y Received2/28/2009 IV fluids +2/28/2009 Toradol for pain Dx: V g pain, particularly in knees for 24 hours after vaccine administration. IBUPROFEN administered Y by parent, 3/3/2009 no further 3/3/2009 treatment. njection, pt. felt nauseated then proceeded to faint. Recovered after anonic inhalent used. Again Y c/o nausea, 2/26/2009 sleepiness. 2/26/2009 Was very pale a ely after 4th injection (HPV) Pt had stiffening of body, gluteral oral sound, fixed stare, then fainted. Y Vomited 2/26/2009 after recovery 2/26/2009 from faint. Was pa roximately 7 PM 1/23. About 2 hrs Y after onset fever/ vomited X1 Tylenol mother described seizure Y activity. 1/21/2009 Seen at1/23/2009 emergency clinic. The hest area pain and redness and swelling Y at site of injection of VARIVAX. Vomited once yesterday U morning. 2/23/2009 Today felt 2/24/2009 tightness in chest. se practitioner at clinic phoned to inquire Y about side effects of Hep A vaccine as pt had presented Y this AM 2/19/2009 with nausea, 2/20/2009 sinus congestion a U 11/3/1998 3/3/2009 dministered 0945 1/28/09 and patient Y was discharged Y 10:15. In the5evening hours at home,Ythe patient 1/28/2009 noticed onset 1/28/2009 of pain, swelling arou flu shot on Thursday. Friday--the vaccine Y site became red, hot to touch, and hard. Taken toYdoctor on Saturday ###as clinet ### began having co
ely flushed and hot with infection of Twinrix. That passed and client complained of nausea and U warm feeling 2/27/2009 for next2/27/2009 1 1/2 hours. ted on 2/11/09 and had a positive urine Y HCG. Pt received Anthrax, Typhoid, and Small Pox. U Error was identified 2/11/2009 on 2/11/2009 3/9/09 @ 0820. Pt had ed having a rash on face spread to rest of body. Varicella vaccine given the day before. Rash Y blistered9/23/2008 and scabbed 9/24/2008 over - some itching. . - swollen right thigh, reddened and hot, no fever; applied cold packs 10-14-08 - Unable to see Y doctor. Leg 10/8/2008 (r thigh) apears ### to have redden ceived vaccine on 3/3/09 in the afternoon patient then had fever of 102.7 at 3am on 3/4/09 was Y given tylenol. 3/3/2009 patient 3/4/2009 then had a seizure at 3 since 3-6-09; Bloody nose today 3-9-09, Cranky/fussy since 3-6-09; No rash, or fever. Referred Y patient to3/5/2009 physician for 3/5/2009 care. ling, erythema, itching, significant increase in circumference of upper outer thigh Y 3/3/2009 3/4/2009 DACHE AND GENERALIZED MUSCLE ACHES AFTER VACCINATION. ARM OF VACCINATION Y SORE. 3/5/2009 3/5/2009 dministered 3/5/2009 3 pm. Friday am 3/6/09 individual noted site to be tender only, no erythema, Y but by Friday 3/5/2009 evening 3/6/2009 was experiencing veloped high fever, erythema at injection Y site, and cellulitis which resulted in an office visit toYthe pediatrician 2/25/2009 as well 3/5/2009 as an ER visit and a c swelling,heat and firmness at site. Dark red for quarter-sized area around site and then lighter Y pink for an3/2/2009 area the size 3/3/2009 of a grapefruit. No t rts a blister, smaller than a dime, appeared to back of left arm the day after vaccination. A smaller Y blister 2/24/2009 appeared2/25/2009 in same area the next d hingles vaccine that my Dr said i should get. A few days after the shot every muscle in my body hurts so2/26/2009 bad i cant stand 3/1/2009 it. And exhauste d area swollen, tender and hot to palpation. Unable to move arm or flexion. Fever upt 10 103.0 U by history.3/7/2009 3/7/2009 ter DTAP given mom reports he had "inflamed blood vessels in legs and toes". Pt not seen by Y Doctor- when seen ###exam was ###normal. offer IPV given child has developed stuttering, slowly improving but not gone yet. U 1/21/2009 2/23/2009 given. 3/06- arm swelled to size of tennis ball at site. 3/07 itching, discomfort. 3/08 Broke out Y on torso with 3/5/2009 welts, rapid 3/6/2009 heart rate, discom ed R upper area > resolved w/ Benadryl and 1 1/2 days of Prednisolone. Seen at urgent care. Y 3/5/2009 L thigh around vaccine administration site. Resolved with antibiotics. Y 2/18/2009 2/19/2009 she saw Dr for "horrible blurred vision...and Y flashes on the left side of my left eye". Reports she Y also had12/3/2008 increased 12/3/2008 coughing (forceful) at th 0-15 minutes after injection given employee Y became cool/clammy, face flushed, Rt arm red blotchy Y areas appeared. 3/3/2009 Stated 3/3/2009 "he felt dizzy an induration and warmth at the injection site, measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009 induration and warmth at the injection Y site measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009 induration and warmth at the injection Y site measuring 5-6 cm in diameter. U small rash over left upper eyelid & fever Y 101 degrees approx. 20 hrs after vaccine. Next morning Y awoke2/24/2009 with eyelid2/25/2009 lid swelling & facial/bo eloped a tight cough and progressive Y respiratory distress beginning 3-5 min after vaccination.Y On initial exam 3/5/2009 he has 3/5/2009 tachypneic tachycardia ain, and pain in arm of ADACEL shot. Y 2/24/2009 ouch, redness 6 1/2cm X 5cm. U 3/6/2009 3/8/2009 e; 3/5 arm swelling redness dx "cellulitis" Y urgent care KEFLEX; 3/6 flushed cheeks arm swelling Y dx "vaccine 3/4/2009 reation" 3/5/2009 DC KEFLEX. ness, 2"/3" on Rt. thigh. Minimal induration itching. Y 2/27/2009 2/27/2009 /3/09 Pt. received HEP A #1 and VARIVAX Y #2 wt. 280.6#, temp. 99 T. No reaction noted at Y time. 3/4/09 pt. 3/3/2009 returned3/4/2009 with c/c: Rt lower arm ction to IMM. Left deltoid x 2 days. BENADRYL 1 1/4 tsp po q 4-6 hours prn. Y 3/3/2009 3/5/2009 d generalized pink maculo-papular rash on 3/8/09 about 24 hrs prior to being seen. No fever.UNo other symptons 2/24/2009 - completed 3/8/2009Augmentin fo m raised, red urticarial-appearing patch upper outer L arm at site of Tdap immunization mile excoriation Y at 9/22/2008 lower edge. 9/25/2008 BENADRYL 25mg @ nced pain, redness and swelling at injection site worsening after 2 days of flu & pneumo injection. U TYLENOL 10/6/2008 for pain. ked into clinic stating she thought she was having reaction to HEP B vaccine. Began havingUelevated Temp 9/23/2008 101 degree 9/24/2008 F 2am on the 24th Y ### ### th Baseball sized knot warm at touch and with redness x 1 month after vaccine was administered. U 2/24/2009 2/24/2009 ure has been normal, it is a red, heated rash located on right thigh. The injection was given on U Friday 3/6/09 3/6/2009 the rash3/8/2009 appeared on 3/8/09. T veloped rash to left chest. Left shoulder, and upper left arm. BENADRYL 25mg PO was given. Y 3/7/2009 3/7/2009 algias, N/V and arthralgias. U 3/5/2009 3/5/2009 days after his vaccine heYran a feverYof 102. I took Y him to the pediatrician 40 Y and heYbegan to have N a seizure. 10/2/2008 It lasted 45 minutes ### so he went n has been received from a certified nurse midwife concerning a female who was vaccinatedYwith a dose of GARDASIL. On an unspecified n has been received from a consumer concerning a child in her family who on an unknown date U was vaccinated with a dose of MMR II (dos n has been received from a 60 yearYold male pharmacist with no allergies and hypertension Y N and cholesterol 1/10/2009 who on1/14/2009 10-JAN-2009 was vacc weakness in legs and urinary difficulty, Y starting 2Yweeks after vaccinations. 4 Patient was hospitalized, Y supportive 1/28/2009 care, 2/12/2009 symptoms self-resolve t shot- fainting began, headaches. Y 10/2/08-2nd shot- fainting + headaches continue Y inabilityNto sleep or concentrate, 8/1/2008 inability to see or hav as given ZOSTAVAX vaccine in her Yleft arm and Pneumococcal -PPV-23 in her right arm. Approximately 15 3/6/2009 minutes after 3/6/2009 the vaccine admin minutes after vaccination child passed out, jerking motions of extremities were noted. B/P elevated Y to 158/98. 3/4/2009 Recovered 3/4/2009 quickly. Referred t adverse rxn, doctor did not do any treatment. Y 2/27/2009 istory of tic disorder in January 2009-exacerbation Y of tics. Parent concerned 1 - poss. R/T GARDASIL N administration. ### Persistent ### exacerbation
ode after 1st GARDASIL 8/18/08. Dizzy episode after 2nd GARDASIL 10/22/08. See attached. Y ### ### dness left deltoid & soft tissue swelling Y - onset 48 hrs after vaccinations. T-97.5 PO. Y 2/23/2009 2/25/2009 ike a fever of 102, became "unconsolable and rigid" within 2 hours after receiving vaccine. Also Y site of vaccine 3/4/2009 became 3/4/2009 "hard as a rock" an perienced nausea and itching starting the day after receiving the injection. Y 2/9/2009 2/10/2009 covering 5 inch Diameter Area Around Y injection site, Raised Lump At injection Site. U 3/3/2009 3/4/2009 U ### ### d and swollen x 4 days; better today but continues and now itchy. Used ice and Motrin. N 3/2/2009 d, swollen, itchy lump hurts when touched for 3 weeks. Size of a silver dollar. To date there isYa shadow similar 1/13/2009 to a fading 2/1/2009 bruise. ebruary of this year my daughter came up with a few ringworm's on her stomach and thigh. I U bought the over-the-counter 1/29/2009 3/3/2009 medication and wa cine on Tues. 3/2/09 about 10 am. No immediate reaction. Wed. am patient noticed itching. by Wed. afternoon, 3/2/2009 area of 3/2/2009 injection red, swolle ed 3/18/09-records received-office visit Y office visiti 12/5/08-positive ANA, fatigue and arthralgias. N October 10/3/2008 had asthma flare### that required ste e, nausea, vomiting, fatigue, chills and dizzy started about 48 hours after second dose and lasted Y about 24 hours. ### ### - child experienced occasional vomiting episodes on 2/14 & 2/15/09. There was also redness Y & swelling 2/13/2009 @ site of 2/14/2009 DTAP vaccination on th lowing vaccinations fingers of both hands became + 1 swollen and points of bending on hands Y itched as2/20/2009 well as both 2/21/2009 forearms. Day # 2 no & small vesicles on neck, back upper Y thighs. U 2/20/2009 2/24/2009 Y 3/3/2009 3/3/2009 and puffy red @ site and all below all way to elbow, and hot and sore. Stayed for 7 days. Y 1/28/2009 2/28/2009 ot to my 4 yr old within 8 hrs my daughters Y arm swelled & then she woke up with hives everywhere U on her2/24/2009 body. It is2/24/2009 10 days & they are stil edness only 1hr after shot - Overnight Y arm began to swell & is warm to touch - MD cannot rule U out cellulitis 3/4/2009 based on3/4/2009 exam. .5, myalgias, with redness / swellingY upper arm X 2 wks; skin subseq sloughed off. Tx with Prednisone Y X1/20/2009 7 days. 1/25/2009 Y 2/24/2009 2/25/2009 was reported by a lawyer and described the occurrence Y of joint pain0 in a male subject of unspecified N age12/1/2000 who was vaccinated with LYMER was reported by a lawyer and described Y the occurrence of joint pain in a female subject of unspecified N age 6/30/2000 who was vaccinated with LYME dministered as part of annual physical Y exam caused a severe allergic reaction in right nostrilNand eye. Paient 9/29/2008 started 9/30/2008 losing vision in right e aleness, weakness, dizziness, distortion of hearing, sweating, nausea, wretching and vomiting Y (small amount, 2/20/2009 no food) 2/20/2009 within about 5 minut was given as no history of tetanus was known for a long time. Client had received one on 01-22-2008. Y This 3/6/2009 was found 3/6/2009 when I went to ente REFERS DIZZINESS, PERSPIRATION AND PALENESS.LASTED FOR 20 MINUTES. RECOVERED Y AFTER 2/23/2009 LAYING 2/23/2009 DOWN. d 4cm red hive with central elevation. Given 12.5 mg benadryl. Observed for 1 hour. No SOA. Y Redness 3/10/2009 improved3/10/2009 to 2 cm and no longer r d shortness of breath, hives, itchingYall over approximately 30 minutes after being given PPD, Y Influenza vaccine, 1/27/2009 and1/27/2009 Tdap. Sent to ER; rec minute of receiving Menactra inj, became Y pale, slid to floor out of chair. RN lowered to floor. Stiffened Y body 2/26/2009 for approx 2/26/2009 15-30 secs, face redd ng the gardasil vaccine three weeks ago, my daughter has severe back pain, general muscleNaches, fatigue 2/17/2009 and terrible 2/9/2009 headaches. She al D 15 MONTH SHOTS 4 DAYS AGO- STARTED WITH SWELLING OF LEFT LEG. NO TEMPERATURE. U 3/6/2009 CAME TO 3/8/2009 OFFICE- 1" X 1.25" B arted jerking/seizure for about 1-3 seconds. Then Y had about a dozen 1 episode's of the jerking/seizures Y for 2/10/2009 about 3-52/11/2009 seconds. The patient w ite reaction: redness and soreness-next day and lasting 5+ days. Itching after several days. Y 3/5/2009 3/6/2009 pneumococcal vaccine trial, with severe COPD, was diagnosed with colon adenocarcinoma,Y metastatic.1/31/2008 Vaccination 6/27/2008 took place on 1/31/20 ### N 3/13/2008 ### usea and vometing, mental confusion.This is info taken from the patients mom. Stated pt recovered Y and2/20/2009 is now @ her travel destination. At bilateral profound bilateral brachial weakness approx. Y 6-weeks after 7having received the splitNinfluenza vaccination 1/8/2009 (injectable). 2/15/2009 Vaccine wa M child felt warm. Mother did not take temperture. At 8:15 or 8:20 PM child 's temperture 103.3. Y Child started 3/9/2009 to have 3/9/2009 a seizure. Ambulan 5 mins after Varivax given, pt developed erythema at and above injection site. Per drs orderYgave pt dose3/6/2009 of oral benedryl. 3/6/2009 esented to office with child (Melody) reported that Varicella was given 2/26/09. Papular rashUappeared on 2/26/2009 child 3/8/09. 3/8/2009 No fever was noted 2009 at approximately 2:45pm the above named pt. was in the clinic with her daughter who U was receiving 2/12/2009 services and 2/12/2009 the pt came to me a emely sore arm with mild warmth in the deltoid since day injection was given. He is on day 5 U of pain in that 3/6/2009 arm, which 3/6/2009 is longer than what n in health center on 03/04/09 with a rash that started on 03/03/09. Rash scattered throughtout U body: slightly 2/3/2009 raised 3/3/2009 or macular, erythemat zy a few minutes after HPV vaccine. Pt also felt her L arm turning different color. Pt has notYeaten whole2/18/2009 day prior to 2/18/2009 vaccination. Pt given nt received 0.4cc of Infants Tylenol. An hour later she received DTAP, IPV, Hepatitis B, Haemophilus Y Inf.1/26/2009 B, Prevnar1/26/2009 and Rotateq. The patie my first and only dose of Gardasil in late September, I beleive it was the 20th. I found out inUOctober that 9/20/2008 I was pregnant. 10/2/2008 My due date ba ely after vaccination, a few red hive-looking rash spots appeared on my son's face/neck/arm Y and knee. Also, 3/10/2009 difficult3/10/2009 to console crying a for hrs, had sore arm, legs, headache, fever of 101.3, tiredness, dizzy, lack of appetite. With Jr.UMotrin and cold 3/9/2009 compresses 3/10/2009 on arm and legs as given her first flu shot with Fluvirin on October 29, 2008. To date she still has muscle tenderness at the injection ### site. ### 0/09 2 red areas 1 to inner aspect of (L) arm 1 to back of (L) arm (slightly raised) swelling noted U to axillary3/9/2009 gland (L).3/10/2009
en 2/27/2009. (left deltoid) seen in office Y 3/4/09 for left delt was erythematous and tender. 4X4 U cm area, 2/27/2009 no lymphadenitis 2/28/2009 but slightly tende runk and local swelling, pain, itchingYat vaccination site. Antihistamines Prescribed. N ### ### 48 hours-entire leg 2x NL size feverYup to 104.2 degrees x > 2 day after vaccine. U 5/12/2008 5/13/2008 Rt shoulder tenderness, pain with motion, Y radiation of pain to wrist/hand - ACE wrap, ice or heat, N IBUPROFEN,### light12/4/2008 duty at work 12/29/08 Y U 2/23/2009 3/9/2009 redness and tenderness to site of injection. Y U 3/3/2009 3/4/2009 n has been received from a physician Y concerning Y a female patient "in her 80's" who Y "over a N year ago" was vaccinated with "single dose" of n has been received from a physician Y concerning Y a 22 week male who Y on 15-DEC-2007 (lotNnumber 657673/0904U), 3/14/2008 3/14/2008 14-MAR-2008 (65991 n has been received from a consumer who saw via video clip online last month concerning aNmale "little kid" who was vaccinated with MMR n has been received from a consumer concerning her 3 year old son with allergies to certainNepilepsy medication (unspecified which ones) n has been received from a physician Y concerning a female who was vaccinated with a 0.5mlYdose of GARDASIL. 3/25/2008On 3/30/2008 an unspecified date, a was reported by a healthcare professional andYdescribed the occurrence of cellulitis in a subject U of unspecified age and gender who was va was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a patient who developed a rmation was received on 26 November Y 2008 from a health care professional in the USA. A 55 N year old female 11/6/2008 patient 11/6/2008 received a right arm i by the hospital that I had no recourse, Y I workedYas a nurse for 1 yr before all of this, Y volunteered N as an instructor. ### ### o injection site, no redness or discharge noted. 3/4/2009 3/6/2009 ed: Had L) upper arm swelling starting 3/8, swollen lymph node under L) arm 3/9, Flu like sx Y chills, HA, neck 3/7/2009 ache 3/10, 3/8/2009 Inj site red, swollen ed area size of 1/2 dollar - vaccine give 2/26/09 - and 2/28/09 area turned red and hot to the Y touch and swollen. 2/26/2009 Cheeks 2/28/2009 had a red rash with le ADMS is referred to the FBVHC from Y WAMC Allergy department for persistent leucopeniaUsince receipt 1/27/2009 of multiple2/2/2009 vaccines. 3/18/09-rec minutes after vaccines administered, Y patient became flushed in face with some rash, drooling, Y runny nose, 3/10/2009 gagging,3/10/2009 and coughing. Sent to 3-9-09 with 101-102 degree fever for 5 days previous r. nose cough & 15 "spots" on torso. Mother U called 3/18/2008 3-10-09 to report 3/9/2009 at least 100 more V & MENACTRA @ 08:30 AM FeverY Pm - abd pain & facial hives - given BENADRYL - wentYER @ 6 PM. 3/10/2009 Given IV 3/10/2009 steroids & BENADRYL poor feeding for 7-10 days after vaccine, Y no fever, no seizures. Y 1/5/2004 1/6/2009 ection started to ache 3/5/09 pm. Unable to raise arm and fever. Recd. 1. Ibuprofen 600mg qY6-8 hours with 3/4/2009 food PRN 3/5/2009 discomfort 2. BENAD dministered 3-3-09, on 3-4-09 Pt experienced redness and pain around the injection. DeniesYitching, or fever. 3/3/2009 Redness 3/4/2009 is about size of 50 c inistering Tdap vaccine the patient fainted. TR, BP, WNL. Water given. Was all better <1 minute. Y 3/4/2009 area of erythema/tenderness (L) deltoid area (-) fever. Located above the area the injections were given. 3/4/2009 cellulitis secondary to immunization injection given 11/24/2009. Seen in clinic 12/8/08 placed Y on DURICEF 500mg ### BID 12/4/2008 x 10 days. (inconsolable) crying over 3 hours Y in next 24 hrs with fever to 103. Y 3/4/2009 3/4/2009 l syncope- twice, oral fluids, juice remain Y supine Trendelenberg. She was treated in our facility. Y 2/15/2008 2/15/2008 e itching/hiving @ site & lip tingling. YNo other symptoms BENADRYL by mouth given + sent Y to ER for further 3/9/2009 obs -> no 3/9/2009 further Rx needed. nd sweaty about 30 min after receiving Y vaccine stated "I feel- not like I can't swallow but my throat Y feels tight3/5/2009 like when 3/5/2009 I take MORPHINE a h of 104 degree F vomiting X 1. Y Y 3/5/2009 3/5/2009 Dtap + PREVNAR on 2-5-09 @ 16:30. 300/am 2-6-09 reported temp 104.7 continued running Y temp with 2/5/2009 no other symptoms 2/6/2009for 3 days. D ed scream, inconsolable for 3 days after vaccine administration per mother's report. Y ### ### chills started about 9 hours after vax admin. 3-3-09 was given TWINRIX and ADACEL. StillUfeverish 24 hours 3/3/2009 later but 3/3/2009 feels better. (R) arm Dizziness, body aches, fever, headache. Y 2/24/09- Headache, nausea, body aches. 2/25/09- Dizziness, Y neck 2/23/2009 and back 2/23/2009 pain, body aches, fev d VARICELLA lesions 9 days after receiving VARIVAX. Y 1/29/2009 2/7/2009 arms and torso consistent with mild VARICELLA vaccine on 3/2/09, onset of rash 3/7/09. NoUother symptoms. 3/3/2009 3/7/2009 hecks, forearms, hands similar to varicella but also with papulovesicular lump character. Vaccine U given 3/02/09, 3/3/2009 onset 3/7/2009 3/7/09. No other sys ought she had shingles, no visible outside Y rash, had pain all over her body. Contacted MD for U pain medicine. 2/27/2009 3/9/2009 onset 3 hrs after vaccine lasted 8hrs. Y 3/5/2009 3/5/2009 TDAP 3/6/09. Within 1-2 days developed fever of 102, body aches tender arm & hard bump Uthe size of a 3/6/2009 coin where injection given. ceived a 3rd dose of varicella vaccine in error. Y 2/4/2009 rash around injection site, approximately 24 hour post injection. No itching/pain. Normal sideUeffect. 3/3/2009 3/4/2009 nduration at site of KINRIX 36 hours following administration. No systemic symptoms. Resolved Y spontaneously. 3/5/2009 3/7/2009 Y 3/9/2009 eumonia vaccine was given in left arm. Pt on Tuesday 3/3 am, hurt on Tuesday pm, the armUswollen and 3/2/2009 red, warm to 3/3/2009 touch and was fever complains of dizziness approximately 15 minutes after receiving injections per employee report Y she got 3/10/2009 dizzy after 3/10/2009 smoking cigarette. Tem ports evening 3/05/09 Pt developed swelling and redness at L thigh. U 3/5/2009 3/5/2009 ulated self on Right index finger. Lesion Y developed. Also developed lesions in mounth and on Y Pharynx (stated 3/3/2009 she 3/10/2009 put finger in mouth) una
rts pt with hard red area 2 1/2 inch in diameter. Fever of 104.0. Advised to give benadryl andYtylenol along3/5/2009 with use of3/6/2009 warm compress at th 2007 - Back and Hip pain Winter, 2007/08 - addition of shoulder and elbow pain, ankle pain N and weakness, 8/2/2007 increase 11/1/2007 in back and hip p TO CHICKEN POX AT DAYCARE. WOKE UP ON 2/13 WITH A FEW SAMLL BUMPS ON HEAD Y AND UPPER 2/27/2008 CHEST, AS DAY WENT O ncussion and with the stitches they gave me a tetanus vaccine. My arm since has hurt a great N deal. I cannot 3/9/2009 move it. 3/9/2009 I have a very large lum ccinated with Flu vaccine on 10/29/08 Y and developed syncope on 10/30/09 and passed-out.YCT scan of head was ### negative, ###probably not a ling, redness, hotness, hardened area increasing over several days. started antibiotics on 3/6/09; Y symptoms 3/2/2009 resolved3/3/2009 by 3/8/09 ery patches and itchy without pain all below injection site of left arm. Y 2/19/2009 3/3/2009 Tdap vaccine patient developed "twitching "over the left index finger initially and then generalized U to the entire 3/4/2009 arm/arm 3/5/2009 also had become s oster rash 2 x 4 cm right thorax, pain right ribs, both for past 7 days. U 2/20/2009 3/4/2009 7/29/2008 N 7/22/2008 7/26/2008 TION SITE BECAME RED, HARD AND HOT TO THE TOUCH THE DAY AFTER BEING IMMUNIZED Y 3/9/2009 3/10/2009 , pt developed intermittent fussinessYand apparent abdominal pain (legs curling up). Worsened Y over next 2/16/2009 24 hours, then 3/7/2009 passed a bloody/m ately 7 hours after vaccination on 3/10/09, started feeling febrile (no temperature was taken),Ychills, sweating, 3/10/2009 weakness, 3/10/2009 full body muscle a given to this patient. No reaction or adverse effects noticed as yet. Y 3/11/2009 3/11/2009 d area of erythema (1 cm diameter) and induration (2 cm diameter) in area of vaccine administration U on right 3/9/2009 thigh 3/11/2009 CLAIMS THAT AS SOON AS SHE YWAS ADMINISTERED THE VACCINE (TETANUS BOOSTER) Y ON HER 3/1/2009 RIGHT ARM, 3/1/2009 AS SOON AS S old had INTUSSUSCEPTION, hadYpreviously Yhad 3 doses of Rotateq 1 at correct schedule, last Y dose on 10/20/08 ###10/20/08-office 3/8/2009 visit-well (9 MARCH 2009): EVENING - HEADACHE, CHILLS. LATE NIGHT - HEADACHE, MILD FEVER., N TUESDAY 3/9/2009 (10 MARCH 3/9/2009 2009): HEADAC st wanted to touch basis with Dr on Y some rough reactions to the Tdap injection pt received last U Thursday (3/5). 3/5/2009 Following the injection pt ret swelling at site 5" long X 2" wide. (2) Inj site red. (3) some dizziness. Y tous, edematous at vaccines site on right arm. BENADRYL, apply ice. Y 3/9/2009 3/9/2009 2/17/2009 lurred speech. 8-13-08 EquallibriumYoff. 3/18/09-records Y received for 4 DOS 8/21-8/25/08-DC U DX: Viral encephalitis. 7/14/2008 In8/9/2008 ED C/O dizziness, slu bling; Questionable seizure episodes Y 8 days after Y 6 month vaccines2administered on 2/5/2009. N 3/23/09-records 2/5/2009 received 2/13/2009 for DOS 3/2-3/4/0 Immunizations client sitting in waiting Y room reported "not feeling well". Head dropped to left U side, became 3/11/2009 pale, went 3/11/2009 into deep sleep-snorin Y 3/10/2009 ceived DTaP, IPV, MMR and VARIVAX Y on 3/9/2009. Pt developed blistery rash on 3/10/2009 U and temperature. 3/9/2009 Patient 3/10/2009 presented on 3/11/2 fussy 20 days after administration of vaccines. Rash on face, chest, back and arms. Erythematous U macular/papular 2/18/2009 rash 3/8/2009 with areas where ed rash similar to classic measles rash- (without oral lesions). U 2/23/2009 3/3/2009 t was received from a health professional on 09 May 2008. The patient is one of three patients U reported as part of a cluster. A child (exact a t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac ort was received 04 September 2008Y from a health care professional. A five-year-old patientYreceived an8/22/2008 injection of8/22/2008 DAPTACEL (lot numbe ort received on 15 September 2008 Y from a healthcare professional. A 5 year old male patient, Y with no medical 8/22/2008 history, 8/23/2008 no illness at the time rmation was received from a health Y care professional on 06 October 2008. A 19 month old male Y patient 10/2/2008 with no known 10/3/2008 allergies received a ort was received 17 October 2008 from Y a health care professional. A 2-year-old female patient N with no past 10/1/2008 medical10/1/2008 history, had received a was received from a consumer on 22 April 2008. A consumer reported that her four-year-old N daughter experienced 8/12/2004 "ongoing sicknesses s ort received on 22 September 2008 Y from a consumer, who is the patient's mother. A 26 yearUold female 9/18/2008 patient, with9/19/2008 no medical conditions -old female patient with a medical history of neurogenic bladder, reflux and spina bifida, had Ureceived an injection 9/9/2008of MENACTRA, lot numb ort was received 12 December 2008Yfrom a health care professional. A 14-year-old female pregnant U patient 12/5/2008 had received ### a left deltoid injec ort received from a physician on 29 October 2008. A female patient (age and date of birth unknown) U had received 7/1/2008 a dose 8/1/2008 of MENACTRA (l rmation was received on 14 OctoberY2008 from a health care professional. A 12 year old female U patient 8/20/2008 with a history of acne, ### bronchitis, a oe rash, respiratory distress, elevated Y temperature, Y (102 and higher),3 tachycardia. TreatmentUrequired three 3/10/2009 trips to 3/10/2009 the emergency room w n has been received from a licensed Y practical nurse Y concerning her374 year old mother with N contrast dye2/27/2009 allergy and 3/1/2009 a history of varicose v n has been received from a registered nurse concerning an unknown number of patients who U were vaccinated with a dose of MMR II (dose n has been received from Y a registered Y nurse concerning a 34 year old female with asthma and Y no drug allergies 1/19/2009 who 1/19/2009 was vaccinated with h n has been received from a consumer concerning her son with no medical history (APGAR scores N noted 6/7/2001 to be 9 at birth) 6/7/2001 or drug allergy wh 1/11/2009 N 1/5/2009 1/11/2009 volvement, nerve inflammation: Y numbness, Y tingling, burning, facial and head neuralgia, migraine-like N headaches 11/7/2008 (It began ### with nerve pain a U 5/7/1999 3/4/2009 er surface of skin. Small and hard. Y 3/4/2009 3/6/2009
redness and itching past normal. Advised to take BENADRYL and if not cleared see primary U care doctor.3/6/2009 Was getting 3/6/2009 better at the time. induration, warmth, erythema, & TTP - Treated for possible cellulitis. U 3/3/2009 anorexia, SOB on mild exertion, asthenia - arrhythmia (? PVC). Sx on day 1 and 2, began to Y decrease on2/25/2009 day 3 and 2/26/2009 by day 6 was nl. Starte ap given instead of DTap # 4 at 18 mos well child check. U 1/8/2008 gan noticing rash on chest, spreading to arms, flanks & legs. Reports that rash does itch. Patient U also stated 3/4/2009 that she 3/8/2009 has been utilizing ta administered to patient. Pt. left office well and happy. Twenty minutes later mom carried pt.Yin. She reports 3/9/2009 pt. started 3/9/2009 c/o chest hurting an e 99 degree-102.4 degree temps, watery eyes, loss of appetite, fatigue. Also, reddened, hard, U warm to touch 2/23/2009 3 "diameter 3/6/2009 circle around inje ports his daughter has had fever, up to 102.4, this morning. Ibuprofen takes fever down to 101.2. Y 3/5/2009 3/6/2009 d, swollen, firm, hot @ area of injection site for 48h after receiving Meningitis vaccine. Y 2/25/2009 2/25/2009 U 1/3/2007 3/6/2009 U 7/31/1997 3/5/2009 PREVNAR / VARIVAX administered 2-25-2009, Lt Leg induration and erythema started 3-06-2009. U 2/25/2009 3/6/2009 hr after receiving immunization, child Y developed hives over entire body, no respiratory symptoms. Y Mother3/6/2009 called clinic 3/6/2009 and was advised to mes in 3 days later. Her VARICELLAYvaccine Rt. Humerus caused a circular patch of blistersUto form along3/3/2009 with redness 3/5/2009 & warmth on the si 1 day; afebrile and fine the following day Y 3/11/2009 3/11/2009 ous swelling at the site of the DTaPYimmunization. slightly tender, has a boggy nontender feel. U approximately 3/10/2009 3x3 inches. 3/11/2009 first noticed 24 LLED STATING CHILD HAD SEIZURE THE FOLLOWING Y MORNING 3 ON 3/10/09. TAKEN TO U EMERGENCY 3/9/2009 ROOM 3/10/2009 AND HOSPITALIZED r state child had a fever, hives, and Y wheezing. Hives developed on 03/04/09 around neck and Y shoulder.Wheezing 3/2/2009start 3/4/2009 on Saturday 03/07/0 EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTACEL IS A Y RECONSTITUTED 3/5/2009INJECTION WITH IMMU th difficulty breathing, itching in throat, Y and hive like reaction to scalp. Patient never given fluYshot in our clinic 3/3/2009 but reported 3/3/2009 having it in prior on 3-10-09, right deltoid. Right arm is now sore with limited ROM in right shoulder. Right deltoid U swollen3/10/2009 and warm 3/12/2009 to touch; no redness. A tely 25 minutes after Stacey recieved Rabavert, she stated her ears (bilaterally) felt hot, andYthat radiated3/5/2009 to her jaws3/5/2009 and cheeks. When s 9 13:45 Immunization administered. 13:55 Injection site red, puffy/size of quarter, painful. Cool Y compresses 3/11/2009 applied3/11/2009 with no adverse sympto spitalized 4 months prior to service for Y Guillain Barre. Y 2. Denied Previous 3 Y hospitalizations onNentrance physical. 3/5/2009 3. Denied 3/5/2009 Previous diagno ed anthrax shot and one hour later he Y returned with visual changes. Pt states he blacked outY and when he 3/5/2009 woke he as 3/5/2009 seeing red. Pt state Shingles Vaccine Zostavax. By evening Y had flu symptoms, sore throat and bronchitis. Have Ybeen sick for 3/2/2009 10 since. Zostavax 3/2/2009is made by M d any types of warts. After the gardasil Y injections, I got a filiform wart on my eyebrow that had Y to be removed because it affected my visual hitis and flu like symptoms after getting Y the vaccine. Y 3/2/2009 3/5/2009 d with intussusception 8 days after 4 month vaccines. Y Neede surgery 6 and was discharged 2Ydays later, 3/16/09 3/2/2009 Received 3/10/2009 hospital medical EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTASEL IS A Y RECONSTITUTED 3/5/2009INJECTION WITH IMMUN 09, AN MMR AND A VARIVAX Y WERE Y ADMINISTERED Y TO THIS PATIENT 2 BY THE OFFICEYMEDICAL 2/24/2009 ASSISTANT. 3/10/2009 ON MARCH 10, MOM nd redness of left deltoid region 11cm x 4cm 3/11/2009 3/12/2009 d shingles 19 days following vaccination. Y 1/31/2009 2/19/2009 ATE FEW MINUTES AFTER VACCINE PT COMPLAIN Y OF PAIN LOWER 1 BACK RADIATINGU TO BOTH 3/11/2009 HIP AND LEGS 3/11/2009 THEN GOT WOR n at and around injection site. Pain through entire hand, shoulder and neck is accompied by nauisa U 3/10/2009 3/11/2009 questing VAERS done...one Y month after receiving MENACTRA & 1st GARDASIL on 9/10/08, Y Pt had blurred 9/10/2008 vision. 3 months ### later diagnos vere headache and was admitted toYhospital several Y occasions at ER 2 after not sure if relatedYto vaccination. 5/26/09 ### medical ###records receiv ction w/ erythematous rash. Admitted to hospital. Y IV Vanco --> BACTRIM. 1 4/8/09-for DOS 2/20-2/20/09-DC Y 2/17/2009 DX: Cellulitis-presented 2/18/2009 to ED w of VARIVAX (L) shoulder - 3-10-09 returned 3-12-09 - Erythema 8x8 cm2 Induration 3x3 cm2YHeat 3/10/2009 3/11/2009 e, joint aches/pains, chills - arms swelling/ Y redness. U 3/9/2009 3/9/2009 fever developed 1 week after MMRYseen in ER and diagnosed with measle-like flat rash mostly Y at the trunk 2/2/2009 and back. 2/12/2009 Lasted 2 days. ven Td & pneumonia vaccinations. 10 min later SOB and chest tightness with hives on local Yreaction. EPINEPHRINE 0.3mg 1:1000 and B len, hard, lump "the size of 2 Quarters" no c/o discomfort noted. U 3/11/2009 3/12/2009 tion, INFANRIX, given on 3-3-2009. Patient's mom noticed large, red swollen area on right upper N arm on 3/2/2009 3-5-2009. Patient 3/4/2009 seen today, 3/5 received @ bedtime T-101.0; pt woke Y parent up in am (3/10/09) with febrile Sz (temp in ER 102.7 Y (R)) tonic-clonic 3/9/2009 upper 3/10/2009 extremities stiffeni t in by aunt to have PPD read. No Tx needed. Aunt stated mom noted redness to left deltoidYarea no other3/6/2009 sx noted. 3/8/2009 1 1/2 cm X 7 1/2 cm sl her (L) arm has been sore ever since she had the BOOSTRIX. She has shooting pain with certain N movements,### for weeks 1/7/2009 she couldn't raise e, vertigo, tingling in arms, pain bothYaxilla. 3/17/09-records received for EDvisit 3/6/09-C/O headache N two 3/5/2009 epidsodes 3/6/2009 of syncope and body a d late on 3-9-09 a red swollen area to (R) arm - Today 3-12-09 Dad noted a rash around (R) arm to deltoid3/9/2009 region child 3/9/2009 had a fever 101 on 3 after injection c/o severe pain Lt arm-fever that afternoon - temp not checked -Fever with chills Y - Left school 12/1/2008 next day 12/1/2008 because of temp. after shot given swollen fore arm. Shots Y given in deltoid. N 3/10/2009 3/11/2009
Y 3/9/2009 3/11/2009 dverse RXN to PCV Pt. requested PCV. Pt. received .05 ml on 3/3/09 in (R) arm no RXN @ time of shot. Pt 3/3/2009 called on 3/4/2009 3/4/09 (advised to com with tingling in the heel surface of his feet (bilateral). No difficulty with ambulation or LE weakness. On 3/93/5/2009 pt noted additional 3/8/2009 tingling in his er ZOSTAVAX numbness (L) side of cheek - client very nervous about vaccine (Dental work 6 months) tingling 3/12/2009 in jaw 3/12/2009 up to eye. Hx HTN, B nutes of receiving HPV vaccines, became light headed pale, nauseated, weak, vomited, had Ymuscle weakness### until next day. ### Mother refuse er receiving PENTACEL, PREVNAR, HBV, ROTATEQ mother brought pt in for evaluation onN1) swelling of 3/6/2009 outer thigh 3/6/2009 involving area includ swelling at site of vaccination on Wed. following vaccine began itching and cotton mouth. Began U taking BENADRYL. 3/9/2009 3/11/2009 d area, red, swollen and warm to touch. Y U 3/10/2009 3/11/2009 VAX administered SQ R arm on 3/11/09. Y Developed edema, erythema, warmth from upper 1/3 U arm to elbow. 3/11/2009 Accompanied 3/11/2009by pain & stiffn haped 9 x 9 cm erythematic area cellulitis, cellulitic area. U 3/9/2009 3/10/2009 red KINRIX as "catch up" immunization to 8 year old. Y 3/10/2009 ped mild case of pyelonephritis whileY taking oral typhoid course. Y 3/4/2009 3/5/2009 n has been received from a physician concerning a female who was vaccinated with VAQTAUvaccine. Subsequently the patient experience follow up information has been received Y from a nurse concerning a 19 month old female infant Y with no pertinent ### medical 12/8/2006 history, drug react n has been Roche Pharmaceutical (manufacturer report # 540009) a 64 year old female reported U she was vaccinated with VAQTA and RE n has been received from a company representative concerning a 6 month old female who on U an unspecified date was vaccinated with PE ort received on 24 February 2009 from Y the patient's parent. A 16-year-old female patient hadYreceived a dose of MENACTRA on an unspec ort received 23 February 2009 from a health care professional. An 18-year-old male patient had N received a first### dose, 12/1/2008 left arm injection of A ort received 23 February 2009 from Y a consumer, who is the patient's parent. A 14-year-female U patient had 2/20/2009 received 2/20/2009 a first dose intramuscul serious case was received on 20 February Y 2009 from a health care professional. A 13 year old N female patient who ### inadvertently ### received a ort received on 11 February 2009 from Y a healthcare professional. A 17-year-old female patient, U with an allergy 2/10/2009 to penicillin, 2/10/2009 received a first l follow-up information has been received Y from a physician and a nurse concerning a 10 month N old male who had ###a history### of being born pre n has been received from a consumer Y concerning her 14 month old niece, with no medical history Y and no allergies, ### who on ### 10-DEC-2007 w n has been received from a consumer Y concerning her 13 month old son with no medical history and an allergy### to amoxicillin ###who on 10-NO n has been received from a Nurse Practitioner, Y (N.P.), concerning a 2 year old male patient Y who on 10-DEC-2007 ### was vaccinated ### IM i "left follow up information has been received Y from a registered nurse concerning a 3 year old female U with chronic ear infections and nasal cong follow-up information has been received from a physical therapist concerning a 5 year old female, N who on 26-OCT-2007 ### was vaccinated w n has been received from a physician Y concerning a 15 month old male with no illness at the Ytime of being 12/3/2007 vaccinated 12/3/2007 and no pre-existing ill n has been received from a physician and a medical assistant concerning an 18 month old female Y patient1/3/2008 with a peanut 1/9/2008 allergy, who on 03 n has been received from a consumer Y concerning his approximately 15 month old daughter N who on 12-DEC-2007 ### was vaccinated ### with a do n has been received from a physician Y concerning Y a 4 month old female patient who on 26-JAN-2008 Y was 1/26/2008 vaccinated 1/27/2008 IM with a dose of PED n has been received from a physician Y concerning a 7 month old female with no pertinent medical U history1/24/2008 and no drug 1/24/2008 reactions or allergies, n has been received from the fatherYof the patient (a "doctor") and a physician concerning the Y reporter's 2 month ###old son who ### on 17-NOV-2 n has been received from a consumer concerning her 12 month old son who on 28-NOV-2006 Y was vaccinated### with10/8/2007 the third dose of PEDV n has been received regarding a case in litigation from a lawyer via paralegal articles concerning U a 6 year1/1/2001 old female child with enterovirus n has been received from a mother concerning her 12 month old son with an unremarkable N medical history 2/14/2008 and no allergies, 2/14/2008who was vacc n has been received from a occupational therapist concerning her 5 year old daughter with pertinent Y medical history and drug reaction/aller n has been received for a case in litigation from information obtained from a published literature U article concerning 6/24/2002 a6/24/2002 4 month old female wh n has been received from a physician via medical records concerning a 16 week old female Y with no known 1/11/2008 drug allergies, 3/4/2008 a gastrointestina n has been received from a consumer Y concerning her 1 year old daughter with a murmur and N no drug reactions/allergies ### who ### on 15-NOV-2 n has been received from a physician concerning a 9 month old female infant with a possibleUallergy to CERON ### DM, a maternal ### grandmoth n has been received from pediatric medical records and a pediatrician concerning a 19 weekNold male patient 4/11/2008 with a4/18/2008 history of respiratory s n has been received from a physician Y in the form of pediatric medical records which were received U and reviewed 5/9/2008concerning 6/1/2008an approxima n has been received from a physician Y in the form of medical record concerning a white female U patient who 5/15/2008 on 18-MAR-2008 6/25/2008was vaccinate n has been received from a Licensed Practical Nurse concerning a female patient with allergic Y reaction to antibiotics cefaclor who was vacc n has been received from a physician Y concerning a 16 week old female with a history of nasal Y congestion 7/22/2008 and constipation 9/11/2008 who on 22-JULn has been received from a consumer concerning her 6 week old son with sensitivity to milkYprotein in formula 8/8/2008 and no8/9/2008 other allergies who w n has been received from a physician Y concerning a 23 week old male with a history jaundiceYand group 7/21/2008 b betahaemolytic 8/4/2008 streptococcal pos male (unknown age) took the first dose of VIVOTIF (Batch no. : unknown) on unknown date.U Within one day he experienced severe nause ort was received on 22. Jul.2008 from a physician. This 9-year old patient took first dose of VIVOTIF U (Batch 7/21/2008 no.: unknown) on 21.JUL.2008 was reported by a physician (also the Y father of the subject) and described the occurrence ofUencapsulation 3/2/2009 reaction in 3/3/2009 a 2-year-old male su
as given vaccines on 2/25/09, developed a red cluster of bumps on right leg where vaccine N was given on 2/25/2009 3/6/09, and3/6/2009 by 3/8/09 a full body ptoms was my left arm where flu shot was given, began to be very sore days later.Y ContinuedNthroughout the whole ### arm and ### my hand, wrist ther of child) called to clinic on 3/4/09. Info vax received today. Spoke to MOC, states child had Y reaction of3/2/2009 3" redness, muscle hard and itch me rash in palms and plantar feet, with right ankle swelling - 8 days after HEB B #4 and HEB Y A# 1 given. 2/23/2009 3/3/2009 around shot area. Tingling of lips. Y 2/6/2009 2/7/2009 d fever 101.8 with chills; red, raised rash on arm and legs within 24 hrs of vaccine. Symptoms Y resolved over 2/6/2009 4 days. 2/7/2009 and erythema 10X13 cm below area of vaccine site. U 2/7/2009 2/8/2009 n has been received from a 72 yearYold male patient Y with allergy to 0 several unspecified medications, N Parkinson's 9/1/2008disease, 10/1/2008 hypertension and n has been received from the mother Y concerning her 16 year old daughter with no medical history Y and no allergies ### reported, ###who on an uns n has been received from a medicalYassistant for the pregnancy registry for GARDASIL concerning Y a 15 year 3/4/2008 old female 3/4/2008 patient with type 1 rmation was received on 02 March 2009 from a health care professional. A 15 year old female U received an 8/16/2008 intramuscular 1/8/2009 left arm injection o HIGH BECAME RED, WARM TO TOUCH, Y AND SWOLLEN. WENT TO LOCAL ER, RECIEVED Y 10 DAY SUPPLY 3/9/2009 OF 3/10/2009 AUGMENTIN AND B RECIEVED ANTHRAX VACCINE ON 7 MAR 09. SWELLING AND DISCOLORATION A THE U SITE OF THE 3/7/2009 INJECTION. 3/8/2009 MEMBER STAT swelling, nausea, headache, low grade fever. U 3/10/2009 3/11/2009 ports the following: Child had normalY behavior throughout day until approximately 7 hours post Y vaccination, 3/10/2009 (7 PM) the 3/10/2009 child became letharg 5pm c/o sore right armpit, took ibuprofen 800mg,11/1/08 3pm injection site size of a quarter, Yfever & chills, temp ### 101 degree: ###11/2/08 injecti IA PRESENTED ITSELF ABOUT 5 HOURS AFTER ADMINISTRATION N 3/12/2009 3/12/2009 PED HERPES ZOSTER 5 MONTHS AFTER RECEIVING VARICELLA VACCINE. UNILATERAL Y VESICULAR 10/1/2008 RASH 3/11/2009 FROM MID ABDOME after immunization she noticed a raised, Y red area (slightly bigger than a silver dollar) on herYright deltoid. 2/6/2009 Broke out2/13/2009 in "little bumps" around EATION OF LEFT ARM. ARM IS SWOLLEN& RED FROM TOP OF LEFT SHOULDER TO ELBOW Y (18 3/10/2009 CM). CIRCUMFERENCE 3/11/2009 ABOVE perienced pain in R arm continually since receiving vaccine-worsens with exertion of extremity. N A "divit" at 10/9/2008 injection site 10/9/2008 1st appeared about ck, neck shoulder and head pain, Headache, Y and disorientation, could not concentrate, malaise, U weakness, 3/10/2009 tired. Went 3/11/2009 to my family doctor BROUGHT PATIENT IN WITH COMPLAINTS OF RIGHT UPPER ARM RED AND SWOLLEN U (WARM TO 3/11/2009 TOUCH). 3/12/2009 ONSET OF SYMPTO 3" long by 1&1/2" oval. It is red and inflamed. Not raised and no pain associated with it. WillUtake Tylenol 3/11/2009 or Advil if3/13/2009 it starts to hurt and will REDNESS ON VACCINATION SITE. REACCTION U 3/6/2009 3/6/2009 mall blisters in a circular pattern around the injection site approximately 2 inches in diameter.-not Y sure if exact vaccination ### ### date is correct with balance within an hour of vaccine. Fever 103 began that night, lasted several days. Child had episodes of twitching during fever. Child ated baby cried nonstop for eight hours Y straight.YMother stated no fever 1 or swelling around shot Y site. Mother 1/8/2009 stated took 1/9/2009 to ER, and the bab nduration approx 12 hrs after injected. No fever, HA respiratory symptoms, G1 symptoms. Y 3/9/2009 3/9/2009 given DAPTACEL on 3-5-09, on 3-6-09 her legYwas red about 1-2",1on 3-7-09 swelling and redness Y was about 3/5/2009 5-6 inches 3/6/2009 around, no fever ately 24 hours after admin, Pts arm Y developed sore, red, inflamed rash- diagnosed at ER as U allergic Rx. 2/28/2008 3/1/2009 njection site - repeated Benadryl X1. Y ody x 2 weeks. Pt got chicken pox. Y ### 3/5/2009 redness, swelling at site of DTaP injection. Y 3/4/2009 3/5/2009 redness, swelling at site of TDAP injection. Y 2/23/2009 2/25/2009 n eve., pt. noted onset "stiffness" right Y knee joint; next a.m. (3/12) awoke & noted stiffness w/swelling U @ 2/27/2009 left knees (R 3/11/2009 > L) & "stiffness" in m d HIB and DTAP into left thigh. Erythematous macular lacy area 13cm X 13 cm surroundingYinjection site. 3/11/2009 3/12/2009 al temp Friday eve 3/06/09 beginning around 7pm. Temp remained in that area with Tylenol +Y Motrin alternating. 3/6/2009 All day 3/6/2009 Saturday 3/7/09. Su ately 24 hours after receiving lZ's mmr & Dtap in Rt arm, pt. mom noticed pt. arm red, warm to Y touch & swollen 3/11/2009 in area 3/12/2009 where lZ's were give hematous hyperemic plaque covering Y lat aspect of L arm. U 3/10/2009 3/12/2009 es developed on right shoulder. C/oYwarm ear (right) 12:50 and itchy all over. ZYRTEC - given Y in office 3/13/2009 10 mg. orally. 3/13/2009 20 mins. later hives cular erruption with subsequent cellulitis Y of RLe + inguinal LAB. Tx: ORAPRED 15 mg qd xNsd; AUGMENTIN 250 mg bid x 10d. ed rash - hives on chest, back, arms & face. Started < 24 hrs after vaccines were administered. Treated3/12/2009 with diphenhydramine. 3/13/2009 ced he had hives / whelps to right cheek on his face, right arm/shoulder, and right leg. She put Y child in bathtub 3/11/2009 & called 3/11/2009 the doctor on call. ollen, hives (Lt arm), Lt arm red, hotYswollen pain in Lt arm no fever, no problems breathing. Y Will given Benadryl 3/4/2009 3-6-09 3/5/2009 (per doctor direction ADACEL 430 PM. 3/11 That night, developed vomiting and headache. On 3/12 developed N fever to 1023/11/2009 which responded 3/11/2009 to TYLENOL. V hrs after receiving ROTAVIRUS vaccine, pt. developed diarrhea, blood & mucous present atNtimes for next 2/25/2009 2 weeks.2/26/2009 Pt. was evaluated by RDASIL #3 Pt. c/o stomach pain after 2 days mother report her daughter is doing fine. ately 10 minutes following injections, pruritis and urticarial rash developed. Rx BENADRYL liquid Y 1 tsp. 3/12/2009 3/12/2009 Urticaria around (L) Deltoid area and both hands x 10 days. Patient given Allegra 180 mg # U 14 and told 2/18/2009 to F/U as needed 2/28/2009 for change in con unt of hives noted in groin area approx Y 5 hours after vaccination, rash next day much more U extensive involving 3/13/2009 entire 3/13/2009 trunk -hives with targ
and seizures. 4/16/09 MR Y received from PCP from 2/18/09 to 4/13/09. Pt presented on 2/18/09 N for 3rd Gardasil 2/18/2009 vaccine 3/14/2009 1757U. RTO for f/u tis 24 h after guardasil vaccination. Right temporal-occipital Y T2 flair 7on MRI with negative HSV PCR. 3/26/09 2/12/2009 Received 2/13/2009 hospital medical re dministered as part of routine PEx 2/18/2009. Y Pt Y seen on 2/23/20094with pain and redness inUthe vaccination 2/18/2009 site and3/5/2009 neck soreness. She w nistered Hep B vaccination at 3 days Y old, 4 hours Y later had a seizure. 4 Immediately after vaccination Y she became 1/3/2009sleepy 1/3/2009 and slept until she eving first round of Gardasil shot- three Y weeks later noted small red spoches on chest area( Sat N AM), Sun 2/2/2009 day felt weak, 3/7/2009 back cramps, and n d burning rash on arm 4in in diameter. Experiencing chest pains and joint pains.As well as cold U sweats. 3/12/2009 3/13/2009 igh with erythematous, tender nodule. U 3/13/2009 3/14/2009 ort received from another manufacturer Y (document number 45214356), who received the report U from a health care professional. A female p n has been received from a physician Y concerning an 84 year old male patient with Y diverticulitis N and a history 12/5/2008 of malaria 12/5/2008 who on 05-DEC-200 t was received from GlaxoSmithKline Y and was Y assigned manufacturer 0 report number A0769858A U for KINRIX. 2/19/2009 This 2/19/2009 case was originally repo n has been received from a consumer concerning her son who was vaccinated with all the doses U of MMR II on unspecified dates. Subsequ eeks s/p ROTATEQ vaccine, Y child had intussusception. Y Vaccine 12/29/09, 2 admitted for intussusception Y 1/15/09. ###3/26/09 1/15/2009 Received hospita tions given 2-26-09 had not been entered into system & mom did not bring immunization record. U 3/12/2009 5.5 - 6.5cm SL. red soft area - warm -> hot to touch. U 3/6/2009 3/9/2009 U 3/10/2009 9 sudden onset of knot in left neck Y area, swelling from left neck to left arm & left facial swelling N & twisting 2/5/2009 of face - 3/12/09 2/18/2009 cont. high BP & d urticarial lesions on back, face + extremities 5 days after MMR, varicella, Hepatitis A + influenza N vaccines 2/13/2009 were given. 2/18/2009 Pt had no other sym ed child cried 4-5 hours after having PENTACEL. Notified provider prior to next scheduled dose. Y Next dose not ### given of PENTACEL. ### Only H sode of a fainting spell/?seizure. PtYfell on ground and lifted arms in air 'stiff'. Pt then vomited. Y Vitals were 3/12/2009 w nl and pt 3/12/2009 was stable and was s 3/4/09 (MMR, VARIVAX, PCV, HepY A) had fever 3/7 (100-101) and 3/8, 3/9) developed rash U on back and3/4/2009 neck is cranky. 3/7/2009 Sat night 3/7 scr eft arm at 8am, around 9-10 am Left Y hot, swollen and red. T99.8. U 3/9/2009 3/10/2009 ates noticed L arm swollen 24hrs. after Imms. with redness. 48 Hrs later blisters appeared around Y Imms. area. 3/2/2009 Applied 3/4/2009 topical Benadryl and t arm pain started 24 hours after immunization with MENACTRA. Pt stated his arm was difficult Y to move and 3/5/2009 "felt heavy" 3/6/2009 for a day or so. Pt ebellar ataxia Y U 2/24/2009 3/3/2009 vere outbreak of herpes zoster. Patient received vaccine 1/0/08 then on 12/29/08 had a severe outbreak of 1/9/2008 herpes Zoster.### L injection, fever headache, nausea 3/12/2009 N UNEXPECTED GOOD EFFECT RATHER THAN AN ADVERSE EFFECT! Since I don not know where 1/24/2009 else to report 1/24/2009 this I am making th ely after receiving Hepatitis A, Flu, MMR, MCV4 and Varicella, the patient stated he didn't feel Y well. His color 3/10/2009 became 3/10/2009 pale and he passed o rea of shot. immobility - mild pain. Taking Y MOTRINE. N 3/10/2009 3/10/2009 oropharyngeal swelling. Vomiting, Y flushing and hives on whole body. Y 3/5/2009 3/5/2009 covering body. U ### 3/10/2009 erythema with induration at injection site. U monia vaccine was given in my left arm at around 10:30 A.M. on 03/06/2009. I began experiencing Y the usual 3/6/2009 pain and3/7/2009 fever at the injection after injection + returned to hotel room Y @ 12:30pm stated noticed itching @ injection site (left Y deltoid) and3/9/2009 she applied 3/9/2009 Hydrocortisone (1% U 2/18/2009 d an ileo-colic intussusception which presentedYto the ER 2 days after 2 vaccine administration. Y It was reduced 2/23/2009 with an 2/25/2009 air enema and patien r, hysterical laughing, nonsense speech, rash on legs especially right thigh has a bright red rash U area about 3/4/2009 two inches 3/13/2009 in diameter ild's mom reported fever, redness and hardness on left thigh today which began 3-2-09 p.m. The doctor's3/2/2009 office told 3/2/2009 her to check the temp hone call on 3/11/09 from client's mother Y stating she took ct to dr for rash and swollen lymphYnodes. Dr diagnosed 2/17/2009 her 2/25/2009 with reaction to MMR received 2 doses of Varicella vaccine per appropriate schedule. 08-23-04 dose 1 and 08-19-08 Y dose 2. Developed 8/23/2004 2/20/2009 rash consistent with chi to facility approximately one hour post injection c/o numbness in throat moving to back of tongue Y and roof 3/16/2009 of mouth 3/16/2009 given Benadryl po at 10 ported very hard, red, warm and swollen area to left upper arm and fever of >103 degrees F Ywithin 3 days 2/12/2009 after receiving 2/15/2009 the vaccines. She Boostrix in right arm on 03/05/09. Noted swelling, discomfort and pain at injection site on 03/11/09, Y 6 days3/5/2009 after vaccination. 3/11/2009Contacted fac d area cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009 d Cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009 cm induration, redness, itchiness at site of injection. Rx for Benadryl and hydrocortisone 1%Y 3/13/2009 3/14/2009 arp pain and swelling right arm focussed on injection site for Tdap. Pain into axilla, shootingUdown arm and 3/11/2009 into shoulder 3/13/2009 and neck. No dy llen left arm. Fever, nausea, headache. Symptoms developed 24 hours after injection and continued N for 3/12/2009 48 more hours. 3/13/2009 Patient was unable nued L upper arm pain and numbness down to elbow, cannot raise L arm above 90 degrees.UStates vaccine caused ### these symptoms. Has ES ONE WEEK AFTER VARICELLAY VACCINE ARM BECAME RED AND SWOLLEN. MILD,GENERALIZED 3/2/2009 RASH 3/9/2009 BEGAN TWELVE DAY d generalized diffuse macular rash, herpetiform vesicles on neck Y ### ###
PPV shot around 10:45 a.m. after aYyearly physical with Dr. I have asthma, therefore shouldUbenefit from3/12/2009 getting the3/12/2009 vaccination. I was feel and pain at axilla on left side. Was prescribed Y MEDRAL Pk, antihistamine and KEFLEX BID. Y 3/10/2009 3/11/2009 lling, redness at injection site. Headache, nausea, vomiting, fatigue, fever 24 hrs. Y 3/11/2009 3/12/2009 adaches, myalgias, sore throat about 6 days after immunization given. N 3/4/2009 3/11/2009 listless, not self for 1 wk post immunization. Y 1/12/2009 1/12/2009 e like 1 cm raised area 1 inch from injection site R arm where varicella was given SQ. Notified Y M.D. via phone. 3/9/2009 He ordered 3/9/2009 BENADRYL liqu ied us 48 hours after vaccines that child Y had had hives and increased temp 101 degrees F -Y102 degrees 3/11/2009 F 24 hrs after 3/12/2009 vaccine given. Her dness / itch on L mid arm upon D/C home size 4.5 cm and lump felt about a quarter size, HOUnotified /seen 3/14/2009 Pt. and instructed 3/16/2009 to apply warm ess on nape of neck @ HS on 3/12/09. Y Dx with hives by MD on 3/13/09 Hives prominent on N trunk, groin 3/12/2009 + axillary with 3/12/2009 intense itching. 0 min after immunizations the Pt fainted. No resp. arrest initial V/S BP 109/57 HR 97 RR 24 O2 Y Sat 98-100% 3/13/2009 Room 3/13/2009 Air, monitoring and nutr d they noticed redness on 3/16/09 (L) upper deltoid & swollen. Today I notice a little rednessYaround the 3/13/2009 vaccine area. 3/16/2009 No swollen no indura ped a large red swollen (10cm X 11cm) Y notice 24 hours post injection. Pt says site is painful Y and warm to3/14/2009 the touch. 3/14/2009 ted with 30-50 lesions on arms and Y trunk. Afebrile. Dx with Varicella. Y 6/11/2002 3/13/2009 est pains, heaviness on chest, shortY of breath, neck and shoulder pain in right side where injection Y was given. 3/4/2009 3/30/09 MR received from O ain, Fatigue, and nausea. Pain goes up into her neck. And dizziness. Y 2/20/2009 2/20/2009 lateral injection site. Y Y 3/2/2009 3/4/2009 ous after - then tired/fatigue- wheezing. Y Taken by ambulance (911) to ER. Released. ORAPRED, Y CAREDIN. 3/11/2009 3/11/2009 alsy 2 weeks after MCV4 vaccine. Treated Y with Prednisone, Acyclovir. 4/29/09 MR received U from PCP with 2/27/2009 DX: Bells 3/13/2009 Palsy. Pt presented i ed erythema multiforme exanthem dev. x 8 days after vaccination (was on amoxicillin). U 3/6/2009 3/14/2009 and swelling around injection site, three inches in diameter. Slight pain around site. No otherUsymptoms reported. 3/11/2009 3/13/2009 enopathy of R axillary nodes causingY significant swelling, mottled rash and pain in the R axilla. U Improving3/11/2009 slightly with 3/12/2009 ibuprofen on day 4. oint pain after immunization until 3/08. Y ### 2/13/2008 hematoma at injection site. No redness. N 2/6/2009 2/6/2009 n has been received from a physician concerning a 7 month old patient who was vaccinatedUwith the first dose of ROTATEQ (lot # not prov n has been received from a consumer concerning her son who, "as an infant", was vaccinated Y with a dose of ROTATEQ. Subsequently th n has been received from a physician concerning a 31 year old female nurse who on 17-FEB-2009 U while2/17/2009 she was orally 2/17/2009 administering a ch n has been received from a licensed Y practical nurse (L.P.R.) concerning a 9 month old patient U who on 17-FEB-2009 2/17/2009 2/17/2009 was inadvertently give n has been received from a registered Y nurse with medical records concerning a 12-month-old Y male patient 1/18/2008 with no medical 8/4/2008 history or allerg n has been received from a medical assistant concerning a male who on 01-AUG-2008, 01-OCT-2008 U and 2/10/2009 10-FEB-2009 2/10/2009 was vaccinated w n has been received from a nurse concerning Y a 13 month old patient who on 05-MAR-2008 U was vaccinated 3/5/2008 orally with the first dose of ROT n has been received from a healthcare worker concerning a 28 day old patient who on an unspecified U date was vaccinated orally with the fi n has been received from a physician concerning a 12 month old male who on 13-SEP-2007Ywas vaccinated 1/18/2008 with a 28/6/2008 mL first dose of ROT n has been received from a office manager Y concerning an 18 week old male patient who on Uan unspecified date was vaccinated with the fir n has been received from a physician concerning a "4 month old" male who was vaccinatedUwith a 2 ml second dose of ROTATEQ (lot # w n has been received from a consumer concerning his son who at age of 16 weeks was vaccinated N with the first dose of ROTATEQ and at 6 n has been received from a medical assistant concerning herself who got ROTATEQ (no lotU# provided) in her eye and on the skin around n has been received from a physician Y concerning a 2 month old male who was born at 29 weeks Y gestation, 2/2/2009 who on approximately 2/2/2009 02-FEBn has been received from a physician concerning a 4 month old male patient who in approximately Y 06-DEC-2008, 12/6/2008 was 12/6/2008 vaccinated with sec n has been received from a physician who reported that an extra dose of ROTATEQ (lot notUreported) may have been given at the same vi n has been received from a physician Y concerning a 23 weeks old patient who on 19-FEB-2009 U was vaccinated 2/19/2009 orally 2/19/2009 with the first 2 ml dos n has been received from a physician Y concerning a 7 month old patient who on 24-FEB-2009 U was inadvertently 2/24/2009 vaccinated 2/24/2009 orally with the f n has been received from a physician concerning a female who on 21-FEB-2009 was vaccinated N with first 2/21/2009 0.5mL dose 2/22/2009 of GARDASIL. Ther n has been received from a consumer concerning her daughter a 13 year old female who in NOctober 2008, was ### vaccinated 12/1/2008 with a third dos n has been received from a physician Y and medical assistant concerning a 18 year old female N who received 11/1/2007 all 3 doses 2/16/2009 of GARDASIL. The n has been received from a nurse concerning Y a 14 year old female who was vaccinated withNGARDASIL (Lot# not reported). After receivin n has been received from a registered nurse concerning an approximately 25 year old female Y who in November 1/21/2009 2008, 1/23/2009 was vaccinated with n has been received from a nurse concerning Y a 13 year old female patient who on 10-DEC-2008 U was vaccinated ###with her ### third dose of GAR n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe n has been received from a nurse concerning Y a female patient who on unspecified dates was Y vaccinated with the first and the second 0.5 m n has been received from a physician Y concerning a female patient who on an unspecified date U was vaccinated with a 0.5 ml dose of GARD n has been received from a MedicalYAssistant concerning a 17 year old female patient with no U pertinent 2/23/2009 medical history 2/24/2009 and no drug reactio
n has been received from a certified medical assistant concerning a 15 year old female with allergic rhinitis 1/26/2009 who on 1/26/2009 26-Jan-2009 was vaccin n has been received from a physician concerning a 21 year old female with Raynaud's syndrome N and hypertension 2/26/2009 2/26/2009 who on 26-FEB-2009, a n has been received from a physician Y concerning a female under 18 years old with no pertinent Y medical2/18/2009 history who2/20/2009 on 18-FEB-2009 was v n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL U (Lot# not reported). After receiving n has been received from a licensed Y practical nurse concerning a 20 year old female patient with no medical 2/26/2009 history2/26/2009 and drug reactions wh n has been received from a nurse practitioner concerning a female who was vaccinated withUthe second dose of GARDASIL 0.5 mL. Abou n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning Y an 3/24/2008 18 year old3/24/2008 female who on 14-JAN n has been received from a physician's Y assistant concerning an approximately 17 year old female U patient who was vaccinated with the first n has been received from a consumer concerning her 22 year old daughter, with no known drug N reaction/allergies and 2/19/2009 no pertinent medica n has been received from a consumer concerning her son with no pertinent medical history, U no drug reaction/allergies, who on unspecified n has been received from a 26 yearYold registered nurse, with no known medical history andYdrugs allergies, 2/12/2009 who two 2/12/2009 weeks ago was vacc n has been received initially from a registered pharmacist who reported the pharmacy technician's N daughter 10/1/2008 was given the third dose of GA n has been received from a consumer concerning a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR n has been received from a consumer concerning Y a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR n has been received from a physician concerning a female who was vaccinated with GARDASIL U (Lot # not reported). The patient experien n has been received from a health professional concerning a patient who on 18-FEB-2009 was U vaccinated 2/18/2009 with the first dose of GARDASIL n has been received from a physician Y concerning a 20 year old female patient with no pertinent Y medical history 1/8/2009 and no 1/8/2009 known drug allergie n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 19 year 9/18/2008 old multiracial 9/18/2008 female with no histo n has been received from a consumer concerning a 15 year old female patient who started therapy U in August 1/1/2009 2009 with 2/8/2009 the first dose of GA n has been received from a medicalYassistant concerning a 14 year old female who on unknown N date was vaccinated with two doses of GA n has been received from a nurse practitioner Y concerning a 15 year old female patient with endometriosis Y 8/13/2008 who on unspecified dates was va n has been received from a nurse concerning a 24 year old female patient who on 28-NOV-2008 Y was vaccinated ###with 12/3/2008 first dose of GARDA n has been received from a physician's Y assistant concerning her relative, a female who on an U unspecified date was vaccinated with GARDA n has been received from a registered nurse concerning a 14 year old female student with no U known medical 2/14/2009 history and drug allergies, wh n has been received from a physician concerning a female who was vaccinated with three doses U of GARDASIL (Lot # not reported). The pa n has been received from a consumer Y concerning her 16 year old daughter with allergy to AMOXICILLIN N 10/1/2008 who in August 11/1/2008 2008, was vaccina n has been received from a registered Y nurse concerning a 20 year old female patient with noNpertinent medical history and no known drug a n has been received from a nurse midwife Y concerning an unspecified number of patients who U were vaccinated IM with the second dose 0.5 n has been received from a physician concerning several hundred patient who on unspecified U dates were vaccinated with doses of GARDA n has been received form a physician concerning a female who was vaccinated with a 0.5 ml Y dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning a female patient who was vaccinated intramuscularly U with her first 0.5 ml dose of GARDASIL n has been received from a consumer concerning her daughter who became ill after received U her second dose of GARDASIL. The consum n has been received from a physician Y assistant student concerning a 16 year old female who N on 06-JAN-2009 1/6/2009 was 2/25/2009 vaccinated with first dos n has been received from a consumer Y concerning her 15 year old daughter with no known medical N history 6/26/2008 or drug allergies, 7/1/2008 who on 26-JUN n has been received form a 23 year old female patient, with no known drug reaction/allergiesNand no pertinent 1/1/2009 medical 2/12/2009 history, who in Janu n has been received from a consumer concerning her daughter (a 16 year old female) who in Y March 2008, 3/1/2008 was vaccinated 3/1/2008 with her first do n has been received from a nurse concerning Y her 20 year old daughter who was vaccinatedNwith her third 6/29/2007 dose of GARDASIL 8/31/2008 (lot # not ava n has been received from a physician Y concerning a 38 year old female with no medical history Y or drug allergies 8/7/2008 who was 8/7/2008 intramuscularly va n has been received from a pharmacist Y concerning a 17 year old female patient with no pertinent N medical 2/16/2009 history and 2/16/2009 no drug reactions or a n has been received from a registered nurse concerning a 15 year old female patient with noUpertinent medical 2/17/2009 history 2/17/2009 and no known drug a n has been received from a nurse practitioner Y concerning a 26 year old female patient with allergy Y to sulfa 10/9/2008 and asthma 10/9/2008 and a history of "bra n has been received from a physician concerning a 16 year old female with no pertinent medical Y history 2/20/2009 and no known 2/20/2009 drug allergies who o n has been received from a physician concerning a 23 year old female patient who was vaccinated U with a 0.5 ml IM dose of GARDASIL. Su n has been received from a consumer concerning her 16 year old grand daughter (patient) who Y on 08-JUN-2007 6/8/2007was6/8/2007 vaccinated with a firs n has been received from a physician concerning a health care provider's 20 year old son who Y was vaccinated with the 7/1/2008 second dose of GA n has been received from a nurse concerning a 17-year-old female with no known relevant medical Y history 2/10/2009 nor drug2/11/2009 allergy, who on 10-FEB n has been received from a physician Y concerning a 16-year-old white female student, with no U known relevant 1/15/2007 medical 2/26/2007 history nor drug aller n has been received from a Registered Nurse concerning a 14 year old female with a historyNof back pain2/4/2009 and pin in 2/4/2009 hip, and no drug react n has been received from a physician concerning a 14 year old female who was vaccinated U with the first dose 1/8/2009 of GARDASIL (lot# not repor n has been received from a company representative concerning a female who was vaccinated U with GARDASIL (LOT# not reported). After
n has been received from a 20 yearYold female healthcare student who on 6-FEB-2009 was Yvaccinated with 2/6/2009 a first dose 2/6/2009 of GARDASIL. On n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning U a 14 year 12/1/2008 old female 12/1/2008 with asthma and no n has been received from a female 21 years old who on 14-DEC-2007 was vaccinated with N the first doses 6/26/2008 of GARDASIL 6/26/2008 0.5 ml. On 12-FEB n has been received from a female consumer who on an unknown date, was vaccinated withUGARDASIL (lot # not reported). Subsequentl n has been received from a patient's Y mother concerning a 19 year old female who was vaccinated N with second of GARDASIL. The patient's n has been received from a physician Y concerning a 25 year old female who on 17-FEB-2009Ywas vaccinated 2/17/2009 with the 2/17/2009 first dose of GARDAS n has been received from a physician Y concerning a 17 year old female who on 02-DEC-2008 Y was vaccinated 12/2/2008 with the first### dose of GARDA n has been received from the immunization Y coordinator concerning a 20 year old female patient Y who in approximately 9/1/2008 9/1/2008 September 2008, wa n has been received from a physician Y concerning a female patient who on 26-OCT-2007 was N vaccinated with the ###first dose ### of GARDASIL ( n has been received from a Registered Y Nurse for the pregnancy registry for GARDASIL, concerning Y a 25 5/2/2008 year old female 5/2/2008 patient with anxie n has been received from a physician concerning a 38 year old male with hypertension who Non 13-FEB-2009 2/13/2009 was vaccinated 2/13/2009 with a dose o n has been received from a physician concerning a female who was vaccinated intramuscularly Y with a dose 9/3/2008 of GARDASIL 9/4/2008 (lot number not n has been received from a nurse practitioner Y concerning a 15 year old female who was vaccinated U with the second2/18/2009 dose of GARDASIL (lo n has been received from a registered nurse concerning a female patient with a history of jump U roping injury who was vaccinated with GAR n has been received from a consumer concerning her 28 year old daughter with no pertinentNmedical history, allergies ### 11/1/2008 or drug reactions, wh n has been received from a certified medical assistant concerning a female who on 13-FEB-2009 Y was vaccinated 2/13/2009with 2/13/2009 the first 0.5 ml dose n has been received from a physician Y concerning a 13 year old female who in July 2008, was N vaccinated7/29/2008 with the first1/1/2009 dose of GARDASIL. n has been received from a consumer via internet concerning a female who on an unspecified U date was vaccinated with GARDASIL (lot nu n has been received from a nurse concerning a 17 year old female with no medical history and Y drug allergy who ### on 26-NOV-2008 ### was vac n has been received from a physician concerning a 20 year old female patient who on an unspecified U date was vaccinated with the third do n has been received from a consumer Y concerning her 12 year old daughter with no medical N history and drug allergies1/1/2009 who was vaccinated n has been received from a physician Y for the Pregnancy Registry for GARDASIL, concerning a 17 year old 8/25/2008 female with 8/25/2008 no medical history a n has been received from a Medical Assistant concerning a 17 year old female who 12 weeks U ago was vaccinated ### with the first dose of GA n has been received from a registered Y nurse concerning a female who was vaccinated with Y GARDASIL. Awhile back the patient fainted aft n has been received from a physician concerning a 16 year old female who on 20-NOV-2008 Y was vaccinated with ### the first### dose of GARDA n has been received from a Registered Nurse (R.N.) concerning a 16 year old female with aNhistory of asthma 2/16/2009 and amoxicillin 2/16/2009 allergy who o n has been received from a medical assistant concerning her daughter with a history of RSV (respiratory syncytial virus infection) as a child n has been received from a physician Y concerning a female patient who on an unknown dateUwas vaccinated with GARDASIL 0.5 mL IM. S n has been received from a physician Y concerning Y a 15 year old female 0 who was vaccinated U with a 0.5 ml dose of GARDASIL about a year n has been received from a consumer concerning her 13 year old daughter with drug allergies N to codeine 10/9/2008 and IMITREX 1/17/2009 and no other pertin n has been received from a nurse concerning Y her daughter who on an unreported date was U vaccinated IM with the second dose of GARDA n has been received from a registered nurse concerning a 23 year old female patient with noYpertinent medical 2/4/2009 history, 2/9/2009 no drug reactions/a n has been received from a licensed Y visiting nurse concerning a 15 year old female patient with Y no pertinent 6/26/2008 medical history and no know d n has been received from a physician Y concerning his granddaughter (a 15 year old female) with Y a family history 1/1/2009 of allergies 1/1/2009 who was vaccin n has been received from a physician Y concerning his 22 year old daughter with no pertinent N medical history and no known### drug allergies w n has been received from a patient with positive history of papilloma viral (HPV) who on 22-SEP-2008 N and 9/22/2008 08-DEC-2008 was vaccinated w n has been received from a registered Y nurse concerning a 17 year old female who on 25-JAN-2009 N was1/25/2009 vaccinated with 2/1/2009 a first dose of GAR n has been received from a physician Y concerning a 21 year old female with attention deficit/hyperactivity N disorder 1/1/2007and2/1/2007 a history of depressio n has been received from a nurse concerning a female patient who in "August 2008" was vaccinated Y with8/1/2008 the second 10/1/2008 0.5 ml dose of GARD n has been received from a registered nurse (R.N.) concerning her daughter, a 14 year old female Y who was vaccinated with a second dose n has been received from a nurse practitioner Y concerning a 14 year old female with no pertinent Y medical History 2/2/2009 and 2/2/2009 no known drug reactio n has been received from a physician Y concerning a 24 year old female patient who on 04-FEB-2009 Y was 2/4/2009 vaccinated 2/5/2009 with the third 0.5 ml do n has been received from a consumer Y concerning Y her daughter who0on Y an unspecified date U was vaccinated with a dose of GARDASIL. Th n has been received from a physician Y concerning a 22 year old female patient who in approximately Y 2008 ("about a year ago") was vaccina n has been received from a physician concerning a 16 year old female with a history of irregular N periods who 8/1/2008 has not8/1/2008 had her period since n has been received from a consumer concerning his girlfriend with no medical history or drug Y allergy who 1/22/2009 on 22-JAN-2009 was vaccinated n has been received from a medical assistant concerning a female with AUGMENTIN allergyNwho on 22-JAN-2009 1/22/2009 was vaccinated with the n has been received from a Nurse Practitioner (N.P.) concerning a 31 year old female who on N 06-FEB-2009 2/6/2009 was vaccinated 2/6/2009intramuscularl n has been received from a case in litigation for WAES # 0902USA01678 from a consumer who U reported "her daughter's anemia became w n has been received from a nurse concerning Y a 20 year old female patient who on 08-JAN-2007 U was vaccinated with1/8/2007 the first dose of GAR n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (
n has been received from a Nurse practitioner (N.P.) concerning a 15 year old female who on Y 01-OCT-2008 10/1/2008 was vaccinated 10/1/2008with a 0.5 ml d n has been received from a female , for GARDASIL who in December 2008, was vaccinatedUwith GARDASIL 12/1/2008 (number 12/1/2008 in series not reporte n has been received from a health professional concerning a 15 year old female with no known Y medical history, ### who on 29-DEC-2008 ### was n has been received from a physician concerning a 17 year old female student (weight 134.8Y pounds, height 2/2/2009 65.5 inches) 2/2/2009 who on the aftern n has been received from a physician Y concerning a 15 year old patient who on 14-JAN-2009Uwas vaccinated 1/14/2009 with the 1/14/2009 first dose of GARDAS n has been received from a health professional concerning a 15 year old female with no allergies Y who on an unspecified date was vaccinat n has been received from a nurse practitioner concerning her sister who was vaccinated withY a first dose of GARDASIL in arm. On unknow n has been received from a 29 year old female consumer who in April 2008, was vaccinatedNwith the first 6/1/2008 dose of GARDASIL. On June 20 n has been received from a consumer Y concerning her 14 year old daughter with sulfa allergyNand with no previous ### medical### history reported n has been received from a certifiedYmedical assistant concerning a 17 year old female with asthma and4/28/2008 no known drug 12/1/2008 allergies who on 0 n has been received from a registered nurse concerning a 23 year old female patient with allergy Y to VICODIN 1/21/2009 who on 1/21/2009 21-JAN-2009 was va n has been received from a consumer concerning someone she saw on the television news,Ua female who was vaccinated with GARDASIL n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. The patient's relevant medical n has been received from a physician Y concerning a 11 years old female patient who on 02-FEB-2009 Y at afternoon 2/2/2009 was 2/2/2009 vaccinated with the n has been received from a nurse practitioner concerning a female who was vaccinated withYa first dose of GARDASIL in arm. On unknow n has been received from a physician concerning a 23 years old female with allergy to CIPRO Y and a history 2/2/2009 of mitral 2/2/2009 valve prolapse who on n has been received from a physician concerning a 23 year old female with a history of papanicolaou U smear 7/12/2007 abnormal 1/16/2009 in January 2006 but n has been received from a physician concerning a female patient who was vaccinated with Ua 0.5 ml dose of GARDASIL (lot # was not pro n has been received from a registered Y nurse concerning a 33 year old female who was vaccinated U with her 1/1/2009 first dose1/1/2009 of GARDASIL (lot num n has been received from a Nurse Practitioner Y concerning a 19 year old female who was vaccinated U intramuscularly 5/15/2007 with her first, second a n has been received from a consumer concerning her daughter who developed soreness onUher arm and neck after receiving a dose of GA n has been received from an immunization coordinator concerning a 24 year old female patient. Y "Sometime 1/29/2009 last week" 1/29/2009 the patient was vac n has been received from a physician Y concerning a female (approximately 24 year old) with U history of an abnormal 9/5/2007 Atypical squamous cells n has been received from a Nurse Practitioner (N.P.) concerning a 14 year old female with aNhistory of contact 1/22/2009 dermatitis 1/22/2009 who on 22-JAN-2 n has been received from a consumer concerning her daughter (a 21 year old female) with diabetes Y as well 2/4/2009 as allergies 2/5/2009 to heat and penicil n has been received from a physician Y concerning a 14 year old female who on 01-MAY-2008 N was vaccinated 8/2/2008 with the first dose of GARDA n has been received from a physician Y concerning an approximately 15 year old female patient Y who in December 12/1/20082008, 12/1/2008 was vaccinated with n has been received from a medical assistant concerning a female patient who in approximately N February2/1/2009 2009 finished 2/1/2009 the series of GARD n has been received from a 23 yearYold female patient with no pertinent medical history and Nno known drug 1/15/2009 allergies/drug reactions who on n has been received from a 29 yearYold female consumer who was vaccinated on an unspecified U date with the second dose of GARDASIL n has been received from a consumer Y concerning her 15 year old daughter with no pertinentNmedical history 1/17/2008 and no11/1/2008 drug reactions or allerg n has been received from a 37 year old female with no allergy and medical history who on 18-AUG-2008 Y was vaccinated ### 11/8/2008 with a first dose o n has been received from a nurse practitioner concerning a 15 year old female patient with aYhistory of appendectomy conducted in Decem n has been received from a consumer concerning her daughter who in December 2008, wasNvaccinated12/1/2008 with a first 0.5 ml dose of GARDAS n has been received from a physician Y concerning a female with a history of injection site reaction Y (vaccine 1/20/2009 unknown) 1/22/2009 who was vaccinated w n has been received from a healthcare Y worker concerning her daughter, a 15 year old female N with no pertinent### medical 1/5/2009 history and no know n has been received from a physician concerning a nurse's daughter who was vaccinated with U GARDASIL a year ago. Coincidentally, the p n has been received from an office manager concerning a female patient who in 2008 was vaccinated U with the first dose of GARDASIL (lot n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL concerning U an 18 12/2/2008 year old female 12/2/2008 patient who on 2 n has been received from a Nurse concerning Y a female patient who was vaccinated with theUfirst dose of GARDASIL (Lot # not reported). P n has been received from a consumer Y concerning her 14 year old daughter who on 26-NOV-2007 Y was vaccinated ### with a 0.5 ###ml dose of GA n has been received from a physician Y concerning a 12 year old female patient with no drug reactions U or 1/14/2009 allergy who1/15/2009 on 14-JAN-2009 was v n has been received from a physician Y concerning a 20 year old female patient with no pertinent N medical 4/29/2008 history and4/29/2008 no known allergies/dru n has been received from a nurse concerning a 11 year old female patient who on 04-DEC-2008 U was vaccinated 12/4/2008with 12/6/2008 GARDASIL (lot# 661 n has been received from a consumer concerning her daughter, a 21 year old female with no N medical history 1/16/2007 or drug9/1/2007 allergy who was vacc n has been received from a physician's assistant concerning a female patient who in October Y 2008 was 6/12/2008 vaccinated 6/13/2008 with the third dose of G n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL U and 9/19/2008 may have 10/1/2008 an unspecified reacti n has been received from a nurse practitioner concerning a 24 year old female who on unspecified Y dates was vaccinated with the first and n has been received from a consumer, concerning her daughter who in October 2008 and December N 2008, 12/1/2008 was vaccinated 12/1/2008 with her first an n has been received from a nurse practitioner Y concerning a female patient who was vaccinated N with three dose of GARDASIL. Subsequent n has been received from a physician Y concerning a 20 year old female patient with no drug reaction/allergies U 1/16/2009 history1/16/2009 who on 16-JAN-2009
n has been received from a nurse concerning Y a female with no medical history or allergy who N on 26-DEC-2008### was vaccinated with the firs n has been received from a physician concerning a 22 year old female who was vaccinated N with three dose 8/1/2007 of GARDASIL between Februa n has been received from a consumer concerning herself (a 24 year old female) with migraine N who received the first two doses of GARDAS n has been received from a 21 yearYold female with no pertinent medical history or drug allergy N who on 20-NOV-2008 1/15/2009 1/15/2009 was vaccinated with n has been received from a nurse practitioner concerning a female who was vaccinated withU3 doses of GARDASIL on unspecified dates. S n has been received from a registered nurse concerning her daughter who on an unknown date U was vaccinated with a dose of GARDASIL. n has been received from a registered nurse reporting that she received an e-mail from a woman U who stated that she received the complet n has been received from a medicalYassistant concerning an 18 year old female with asthma, Y bipolar disorder, 6/11/2008 LEXAPRO 6/11/2008 and PAXIL allerg n has been received from a Registered Y Nurse concerning a 22 year old female with psychiatric Y disorders1/29/2009 and a history of pyelonephritis wh n has been received from a certified medical assistant (C.M.A) concerning a 19 year old female Y with no medical 1/8/2009 history 1/8/2009 and no known aller n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning U her daughter 1/22/2009 an 18 year old female with n has been received from a registered Y nurse, for Y the Pregnancy Registry 0 for GARDASIL, concerning Y a 17 12/5/2007 year old female 3/20/2008 with no previous n has been received from the Merck Pregnancy Registry from a 22 year old female with no pertinent Y medical history ### who on ###17-DEC-2007 n has been received from a certified nurse midwife concerning a 23 year old pregnant female Y who is bipolar 1/9/2008 and has1/9/2008 a history of depressio follow up information has been received from a certified nurse midwife for the Pregnancy Registry Y for GARDASIL, 12/4/2007 concerning 2/15/2008 a 22 year old rmation and follow up has been received from a physician for the pregnancy registry for GARDASIL Y concerning 5/21/2008 a 24 year old female who o n has been received from a consumer and a nurse practitioner for the Pregnancy Registry for Y GARDASIL 4/29/2008 concerning 4/29/2008 herself, a 26 year old n has been received through the pregnancy Y Registry for GARDASIL from a nurse concerning Y a 20 year 5/29/2008 old female 5/29/2008 with no pertinent medic rmation has been received from an 18 Y year old female with no pertinent medical history or drug Y reactions11/1/2007 or allergies, 5/29/2008 for the Pregnancy Re follow-up information has been received Y from a nurse, for the Pregnancy Registry for GARDASIL, Y concerning 5/19/2008 a 23 5/19/2008 year old female smoker n has been received from a licensed Y practical nurse through the pregnancy registry for GARDASIL U concerning 6/2/2008 an 186/2/2008 year old female with a n has been received from a nurse practitioner concerning many patients that complain of pain U after receiving GARDASIL. The nurse practit n has been received from a Licensed Practical Nurse (L.P.N.) for GARDASIL, a Pregnancy Registry U product, 11/6/2008 concerning 11/6/2008 an 18 year old pre swelling, heat and hard spot at site of Y injection 24-72 hours after initial injection. Low grade fever U of approximately 3/10/2009100 3/11/2009 degrees farenheit 48 N N Y N n has been received from a 91 yearYold femaleYpatient with an unspecified 0 thyroid disorder, recent N diagnosis 3/26/2008 of hypertension, 4/26/2008 nitroglycerin a n has been received from a licensed Y practical nurse, concerning a 64 year old male patient with N no known drug### reactions/allergies ### and no p n has been received from Y a registered Y nurse concerning Y a 25 year21 old male with Y cystic fibrosis N and a history of renal transplant and 2 or 3 s n has been received from a consumer concerning two males who were vaccinated with a dose U of MMR II. The patients developed autism a n has been received from a consumer concerning her 5 year old son who "a couple years ago" N was vaccinated with a dose of MMR II (Lot n has been received from a consumer Y concerning Y her 18 month old2son with gastric issues, N reflux and no8/1/2005 known drugs 5/1/2006 allergies, who in ap -24 hours after vaccines. In ER. Oxygen, Y Acyclovir, Y Rocephin, propofol, 5 succinocholine, endotracheal Y tube. 3/5/2009 RSV negative, 3/6/2009 influenza = nega evening upper left arm was red, swollen, Y itchy. Y Following day, more 2swelling, hot to touch, very Y itchy. 4 a.m. 12/14, ### severe### swelling in knees mor" type incident "weird cry" X 20 min. Arms flailing, Y eye looking to2left - unfocused. T101.4Y gaze deviating 3/2/2009 rapid eye 3/2/2009 blinking. 3/18/09 R 03 for 72 hours, severe sore throat and cough lasting more than a week, nausea. U 3/8/2009 3/9/2009 her neuropathy symptoms and triggered a flare of her Trigeminal neuralgia. 3/2/2009 3/2/2009 se effects observed. Father instructed on after care. Look for fever, soreness in thighs. Possible Y mild case3/9/2009 of flu in next 2 weeks. her Rt arm has been hurting since injection 4 months ago. N ### ### d shots Monday afternoon. Tuesday Y morning mom noted redness and induration on right thigh N around injection 3/9/2009 site3/10/2009 and child complained o h erupted day post vaccination. -> treated Y with BENEDRYL. Y 3/6/2009 3/7/2009 3/13/2009 de in the deltoid region and lymphadenopathy Y in the left axillary region. Some erythema of the U injection site. 3/3/2009 3/15/2009 09. Severe welts (red, puffy) 2-23-09 to 2-25-09 (peak discomfort) 1 tablet BENEDRYL 2/25.Y Itch relief w/ 2/17/2009 AQUAFLOR 2/21/2009 topical area : Head of head left side bottom started aching Y within about 1hr later that day around noon. I started feeling flush 2/20/2009 10:00 am and 2/20/2009 my throat felt like it w miting approx 6-8 hr post injection - vomiting cont with dizziness, lightheadedness & soreness Y @ site of immunization 3/10/2009 3/11/2009 Sl. swelling, no redne s, Dizziness, Mild Nausea - 20 Mins after injection - feeling (mild) of throat closing VP (Briefly) Y 2/23/2009 2/23/2009 ite was warm/hot to touch, touch tender, pt. febrile and chills, oral temp 99.8 after chills. Fever Y started 29 3/5/2009 hours after 3/6/2009 injection - remained fe ely after shot, had onset of headache Y dizziness. Onset of fever 12:00am 3/3/09, temp 103.9.YReceived Advil, 3/2/2009 water, cold 3/2/2009 pack. Headache, n rhea, Pale, Lethargic, Weak, (Per mother) lasting 2 Days. Y 1/28/2009 1/28/2009
parent called and reported that the child had a lump on her right outside thigh area. It was not U red or sore. 2/23/2009 Lump under 3/2/2009 skin. There is a scr after vaccines were administered developed hives on injection site, right deltoid and scattered Y in the back. 3/10/2009 injection of MENACTRA. Patient developed palpitations, was dizzy, weak and pale. Symptoms Y resolved in3/9/2009 24 hours.3/10/2009 ulitis at site of injection resolving with Y AUGMENTIN. Y 3/5/2009 3/7/2009 as given 3 GARDASIL vaccines in 2008 by her PMD. PAP smear results on 3/4/09 shows LGSIL N with HPV changes. hed medical records. Y Y 2/24/2009 2/24/2009 en to a 7yr old will count as a valid dose, but requested VAERS form submitted. 2/24/2009 ash - maculopapular, fine, to chest, back, face & upper extremities no fever, chills, arthralgiasY 2/26/2009 3/10/2009 st to report accidental (unintentional) administration of 23-polyvalent (PNEUMOVAX ) vaccineY to a 2 1/2 hour 3/14/2009 old newborn. Infant doing clini GI upset, "flare of Ulcerative Colitis". Y Patient reports symptoms began within 1h of vaccine administration. Y 3/6/2009 Patient seen 3/6/2009 in acute care clinic , dizziness, stiff and sore everywhere starting approx 8-12 hours after receiving the Menactra Y vaccine 3/10/2009 3/11/2009 ormed nurse that he usually faints after receiving injections. Patient given one injections (Hepatitis Y A) while 3/16/2009 lying on3/16/2009 exam table. 10 minute veral days of her second shot - she was Y unable to walk without much pain to her feet. WithinN2 weeks she 7/28/2008 was diagnosed ### with RA and now ter patient was given the Flu Shot his Y right eye Y showed signs of not 4 moving properly. It looked U as if he were going ###crossed-eye. ### 24 hours la mber on Mobilization Orders. He received Y his 1st Anthrax Vaccine on 15 Mar 2009 in his leftYDeltoid Region. 3/15/2009 He reported 3/15/2009 to facility complai mber of the military. Vaccine was administered Y 15 Mar 2009, during Mobilization Orders activity. Y Vaccines 3/15/2009 were administered 3/15/2009 at the facility. PRESENTED WITH RED, PAPULAR Y LESIONS ON FACE,HEAD,TORSO,ARMS AND LEGS Y 2/23/2009 2/21/2009 Varivax, and Havrix administered on 11/6/08. Pt. noted abrubt onset of blurred vision in left N eye on 11/26/08. 11/6/2008 Seen by a neuro-ophthalmolo ### Yellow Fever vaccine 2/27/09. According to patient, started having itchy grouped rash on right Y arm area2/27/2009 and continues 3/6/2009 to spread to other a administration: myalgias, subjectiveYfever. Starting the second day after administration: muscle U soreness3/12/2009 in the forearms 3/13/2009 with weakness an neck, swelling and redness of eyelids, lips and ears Y 2/27/2009 2/27/2009 well appearing and presented to clinic Y for varicella vaccine. Patient received first varicella vaccine Y too early 3/13/2009 (before 3/13/2009 one years old)and recec tions given 3/16/09. Client returned to clinic 3/17/09 stating during the evening of 3/16 her left N arm was painful, 3/16/2009 w/pain 3/16/2009 radiating down to ha ber was examined in flight medicineYclinic on 04Feb09. Her symptoms The patient filled out SF Y 600 Small1/23/2009 Pox questionaire 2/3/2009 and responded ven #2 HPV and left area went to pharmacy, Y weYhad a Fire Drill pt walking 5 out to car and fainted. Y Hit head, 2/18/2009 LOC, was2/18/2009 taken to Hospital foun ### N 12/4/2008 ### ember was a basic trainee and received multiple Y vaccines at the end 10 of September 2008 and N then developed 9/29/2008 lower extremity ### weakness an Y 3/17/2009 3/17/2009 - immunization administered. 3/11/09 Y Am - increased redness, swelling at injection sites, iceYapplied, TYLENOL 3/10/2009 given. 3/11/2009 3/12/09 6pm - seen scess left thigh. Y 3/12/2009 3/15/2009 7/5/2009 Y 117 U 3/6/2009 3/11/2009 iltrate L anterior thigh: indurated, reddened, not tender. Y 3/4/2009 ately 30min after receiving MMR vaccine Y Pt's lips + face + ears started swelling, face + headYpruritic +mild 3/17/2009 difficulty swallowing. 3/17/2009 No resp. dis 3/17/2009 as given pneumococcal vaccine in L Deltoid on 3/14/09 @ 1722. Patient noted that her arm was U very sore. 3/14/2009 On 3/15/09 3/15/2009 @ 2038 RN noted th ports developing a pruritic rash on her Y face, fatigue and joint pain within 2 hours of vaccine administration. Y 3/9/2009 She subsequently 3/9/2009 developed pa izure - ER visit treated with MOTRIN Y and TYLENOL. Y 3/6/2009 3/15/2009 evere muscle aches all over body - sore muscles with touch. 3/20/09 Note received from PCP. U Pt has not been### seen at all### since DOV. TC f r - up to 103- March 13-14-2009 FullYbody rash- March 15-16-17-2009 MMR-given 3-02-09 U 3/2/2009 3/13/2009 Y ### 3/16/2009 was considered medically important. Information regarding DRYVAX was received from a literature U source regarding a participant enrolled n has been received from a consumer concerning her son, who received the routine vaccines N (names and5/1/2002 manufacturer 5/1/2002 unspecified) at five n has been received from a consumer concerning Y her 12 month old3son Y who on 21-AUG-2002 N was vaccinated 8/21/2002 with8/22/2002 an only first dose of MM n has been received from a consumer concerning her son who on 27-DEC-2001 was vaccinated N with the first dose ### of MMR II (Lot # 63870 orted in a published report, title stated above regarding a case in litigation concerning an approximately U 17 4/23/1998 month old male who on 23-APR n has been received from a nurse practitioner Y concerning a 23 year old female who on 09-JAN-2009 N and 3/9/2009 09-MAR-2009 was vaccinated wi n has been received from a registered Y nurse concerning Y a 14 year23 oldYfemale patient with noNpertinent medical### history, 1/10/2008 no drug reactions/a n has been received from a consumer Y concerning Y his 14 year old granddaughter 2 with a history N of migraine 9/1/2008 who in September 10/1/2008 2008, was va n has been received from a registered nurse concerning an adolescent female between 14 and U 17 who was vaccinated with GARDASIL. T es vaccine last week. Got shingles this week. 3/10/2009 3/16/2009 ead and neck 2 hours after vaccinesYwhich lasted about an hour, then went away. Father ofYbaby said 23/12/2009 small red dots 3/12/2009 appeared again sam
l from mom- stated when child wokeY up this AM- She was experiencing some facial edema,Ydifficulty opening 1/6/2009 her mouth, 1/7/2009 + difficulty swallo /4 hrs post pneumonia vaccine started Y having some problems with swallowing & felt bad. During Y that night had### problems swallowing, ### breat other, reports client had episode of Y dizziness and blacked out at school. Ambulance took him Y to hospital.2/13/2009 Reports he 2/17/2009 had mental confusion was reported by a physician Y and described theYoccurrence of convulsion 0 syndrome in a 5-month-old U female 2/27/2009 subject2/27/2009 who was vaccinated w was reported by a physician and described the occurrence of incorrect storage of drug in anUinfant subject of unspecified gender who was was reported in a literature article and described the occurrence of WELL's syndrome in a 7-year-old Y male subject who was vaccinated wit d TDAP instead of rec. TD. No reactions reported. Pt contacted of error. Rec. ACIP recommendation. 3/16/2009 r administer- flushed cheeks- then went Y home, nausea, urine retention and fever 102-103- condition Y persisted 2/23/2009 + Pt.2/24/2009 went to ER-fu evaluatio ith swelling / Erythema. U 3/3/2009 3/5/2009 as small bump on chest, back, and head / some painful to touch. Member was seen by Dr and U she stated3/7/2009 it was Type 3/15/2009 II hypersensitivity - s st vaccination, pt presented with 7cm Y area of redness on (L) deltoid with warmth/redness. Y 3/16/2009 3/17/2009 2 days. Red spots on face and body. Y N 3/4/2009 3/11/2009 Y 3/13/2009 3/13/2009 knot at injection site R upper leg. Y 3/10/2009 3/17/2009 le ADSM is referred by Research Nurse Y for inclusion in the Anthrax study. SM reports increased Y erythema, 5/11/2007 swelling, and ### pain after each of at 10:20 to Immunization clinic and stated Y she had broken out in hives and her throat was swelling Y up, pt3/18/2009 was then instructed 3/18/2009to call 112 (am aricella vaccine in error, should have been given zostavax. No adverse reaction noted. Zostavax Y will be 3/4/2009 given in 4 weeks, 3/4/2009 due to it being a omitting, headache, pain, 100.3 fever, pain at injection site U 3/17/2009 3/18/2009 ction. 40mm X 26mm area of erythema and itching at site. No systemic symptoms. Similar toYprevious reaction 2/9/2009 to MMR 2/11/2009 on 6/2/08. mplained of a itchy, painful rash begining the day after the injection was recieved U 3/12/2009 3/13/2009 Tdap vaccine. Approx. 18 hours later, felt a combination of chills, fever, body aches which lasted Y approximately 3/16/2009 2 full 3/17/2009 days. ately one hr. after receiving vaccinations c/o itching to left cheek then progressing to right cheek, Y chin and 2/17/2009 ankles. Red 2/17/2009 raised "pimple-like" ately three hours following vaccination c/o itching on neck, cheeks and chest areas. Also reports Y accompanied 2/17/2009 by red,raised 2/17/2009rash. Sympto ped a rash, resembling chicken pox, on both arms and both legs, starting the night after she Y received the3/13/2009 vaccines. 3/13/2009 Still evident 5 days late ot had a period after receiving her third Y vaccine. It's been ten months since she Y had a period.4/2/09-records N 5/27/2008 received 6/1/2008 for DOS 3/17/09-offic h where vaccine was administered was reddened, swollen and had a rash with raised vesicles Y similar to chickenpox. 3/5/2009 3/12/2009 Symptoms started 7 d cieved vaccines on 3/17/09 around 1600 Mom reports that infant woke up in the middle of the U night with 3/17/2009 102.5 fever.3/18/2009 Patient did recieve am rms red, raised rash. Warm to touch. N 3/16/2009 3/18/2009 at 7AM on 3/12/2009 with fever of 101, Y pain and redness at the administration site, pain all over Y including 3/11/2009 jaw, joints3/12/2009 and muscles. Pt also esented day after vaccination with redness and swelling to site of shot administration on rightYthigh (MMR 3/16/2009 injection site) 3/17/2009 Dr. prescribed Zyrt ately 1 week after shot was given, my Y son developed a large hive at the injection site, a measles U like rash, 3/10/2009 a high fever 3/17/2009 102.5, refusal to eat episode condition and vitals monitored Y 3/17/2009 3/17/2009 d to clinic 2 days after vaccine given with red raised wheal around injection site. Y 3/11/2009 3/13/2009 RNED TO CLINIC WITH RAised red wheal measuring 9cm by 7cm . Area was warm to touch Y. 2/24/2009 2/26/2009 vere abdominal pain; muscle aches,Ylethargic, has Y asthma now, also1developed skin indentions N (tissue break down ### up underneath ### the skin) 3/17/2009 N 3/13/2009 3/17/2009 d swollen and reddness noted approx. 3 inches over deltoid area. pt told to applt cold comperss U and to give 3/17/2009 tylenol or 3/18/2009 motrin according to we spontaneous report of status epilepticus, dehydration Y and fever was 0 received from a physician, Y concerning a 36-month-old ### ### male subseque orted of experiencing heavy chest, rashes swelling Y throat 1 1/2 hour1after vaccination, went to Y E.R and received 3/16/2009 BENADRYL/Epinephrine. 3/16/2009 R edness, pain, increased temp 101 degrees Y U 3/16/2009 3/17/2009 B # 3, DTaP # 4, PCV # 4 and MMRY# 1 on 12/4/08. At 8pm that night, pt had seizure with 104.2 Y temp. Went 12/4/2008 to medical 12/4/2008 center ER. TX with th cough 1900 15MAR09, progressed Y to headache, nausea, sore throat, tachycardia, fever (103 Y degrees3/15/2009 F), muscle3/15/2009 ache, general weakne after vax, jogged for 3 1/2 hours with 2-3lb weights. At 2p had lunch and became nauseous,Y dizzy and weak 10/1/2008 so went 10/1/2008 to sleep. Woke up at C to reporter who states patient experienced redness & pain at anthrax site right arm & had Ylimited mobility 3/15/2009 w/right arm, 3/15/2009 using left arm to lif tous induration area at the injection site on (R) thigh. Treated with BENEDRYL/ KEFLEX. U 3/16/2009 3/17/2009 ness and swelling 13 x 10 cm on the L thigh. Noted approximately 30 minutes after Imms. Given Y BENADRYL 3/11/2009 and warm 3/12/2009 compresses. Resol diagnosis of thrombocytopenia during routine physical. Menorrhagia (excessive menstrual bleeding) Start: 11/15/2004 ### and LOC x 30 sec, about 10 min after vaccination. Y 3/18/2009 3/18/2009 8, Pt was 7mo old and received a Tdap instead of DTaP. No known injury. Y 5/28/2008 /o feeling as though she were goingYto pass out as she was checking out with secretaries. Secretary Y called 2/5/2009 M.A. and2/5/2009 they assisted Pt to si study report of right lower lobe pneumonia wasY received from an investigator, 1 concerning a U four-year-old female ###subject number ### 1-08-0294
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 2/19/2009 a 34-month-old 2/19/2009 female who ious, spontaneous report of gave expired FLUMIST in a 33-month-old female patient was received Y from 2/11/2009 a nurse practitioner. 2/11/2009On 11-Feb-20 ious, spontaneous report of gave expired FLUMIST in a four-year-old male patient was received Y from a nurse 2/11/2009 practitioner. 2/11/2009 The patient's me ious spontaneous report of administration of expired product was received from a RegisteredYNurse concerning 1/24/2009 a child. 1/24/2009 FLUMIST was adm ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 male. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 36-month-old 1/6/2009 male. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a four-year-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y in the 1/6/2009 concerning1/6/2009 a 36-month-old femal ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 36-month-old 1/6/2009 female. The ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a three-year-old 1/6/2009 male. The ious, spontaneous report of administration of full dose in one nostril was received from a nurse Y concerning a female ### child of ### unknown age s ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/22/2009 a four 1/22/2009 year-old male, which ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/29/2009 a 41-month-old 1/29/2009 female, who n has been received from a case in litigation via a case report concerning a 63 year old female U with pre-diagnosis and pre-vaccination med n has been received from a case in litigation via a case report concerning a 48 year old female U who on 12-NOV-1992, 5/25/1993 6/21/1993 18-DEC-1992 and 2 n has been received from a case inYlitigation via a case report concerning a female who on 29-MAR-1999 U 3/29/1999 was vaccinated 4/12/1999 with a dose of RE n has been received from a female who in 1994 or 1995 was vaccinated with RECOMBIVAXYHB (manufacturer unknown). In 1994 or 1995 n has been received from a registered Y nurse concerning a 21 year old female patient who onY an unspecified date as a child was vaccinated n has been received from a physician Y concerning a 12 weeks old female with no known drugNallergies and 8/17/2008 born with9/10/2008 vocal cord paralysis, h n has been received from a case inYlitigation via a case report concerning a male who in 1997, U received the usual infant 1/1/1998 vaccinations that y n has been received from a consumer Y concerning her approximately 5 year old son with no N known allergies or pertinent medical history wh n has been received from a physician concerning an 8 week old male with no known drug allergies U and a 5/29/2008 history of 6/30/2008 circumcision and family n has been received from Y a registered Y nurse concerning a female child who on an unspecified Y date was vaccinated with RECOMBIVAX HB n has been received from a physician concerning a 16 year old male with no pertinent medical U history who was vaccinated with a dose of R n has been received from a pharmacist Y concerning a 50 year old female with hypertension and N no history 10/1/2008 of drug reactions/allergies, 10/2/2008 who o n has been received from a pharmacist concerning a 1 day old male infant who on 19-NOV-2008 U was inadvertently ### vaccinated ### SQ with RE n had been received from a physician Y via pediatric medical records concerning a 40 day oldUfemale who7/30/2008 on 30-JUL-2008 9/8/2008 was vaccinated w n has been received from a physician Y assistant concerning a 30 year old female patient withUno pertinent medical ###history and ### no known dru n has been received from a physician concerning an adolescent patient (exact age not provided) U who on an unspecified date was vaccinat n has been received from a physician Y via medical records concerning a 51 day old white female Y infant with 8/22/2008 bottle feeding ### and a history of c n has been received from a physician via pediatric medical records concerning a 10 day old Yfemale with 6/13/2008 no known drug 6/16/2008 allergies who on 13 n has been received from a pharmacist, Y with no medical history of allergies, 43 year old female, Y who on 11-NOV-2008 ### was ### intramuscularly n has been received from a lawyer regarding a case in litigation concerning a 39 year old female U with variety of ailments (general symptom n has been received for a case in litigation from information obtained from a published articleUconcerning a female with acne who was vacc n has been received from a medical record via a pregnancy registry concerning a 6 month old Y female with 4/11/2008 bilateral feet 4/11/2008 inversion most likel n has been received from a medicalYrecords via of a health professional concerning a 1 day U old male who 4/27/2008 on 27-APR-2008 4/30/2008 was vaccinated n has been received from a physician Y concerning a 2 day old, 6 pound 12 ounce black infantUfemale. On 7/11/2008 11-JUL-2008 9/11/2008 she was vaccinated n has been received from a medical assistant concerning a 35 year old female with no pertinent N medical9/30/2008 history or drug 10/2/2008 reactions/allergies n has been received from a physician Y concerning a 25 year old female with PENICILLIN allergy N who on 9/25/2008 25-SEP-2008 9/28/2008 was vaccinated with n has been received from a physician Y through medical records concerning a 1 day old, 3345Ugram, white 7/2/2008 male who on 02-JUL-2008 was va n has been received from a nurse practitioner concerning a female who at the age of 13 (approximately U 1996) was vaccinated with a first d n has been received from pediatric Y medical records and a physician concerning a 15 week old U female with 6/30/2008 diaper rash 8/20/2008 who on RECOMBIV n has been received from a physician through medical records concerning a 1 day old, 3608Ygram, 21.56/12/2008 inch, white6/14/2008 male with a head circum n has been received from a certified medical assistant concerning a patient who "years ago"Ywas vaccinated with RECOMBIVAX HB (manu n has been received from a certified medical assistant concerning a 34 year old female patient Y who 20+ years ago (approximately 1988) wa follow up information has been received from a Registered Nurse (R.N.) concerning a 26 year Y old (also 9/29/2008 reported as10/1/2008 24 year old) female wit n has been received from a medical assistant concerning a 22 year old female who was vaccinated Y with a dose of RECOMBIVAX HB, on a n has been received from a lawyer from a case in litigation concerning a 43 year old patient Y who on 20-JUN-2003 6/20/2003 was vaccinated with a fir n has been received from a pharmacist concerning a patient (age and gender unspecified) who Y was vaccinated on an unspecified date with rmation has been received from a vaccine nurse and follow-up information was received fromY the physician, concerning a patient who in 20
n has been received from a nurse practitioner Y concerning Y an 11 year 0 old female who was vaccinated Y with RECOMBIVAX HB (manufacture n has been received from a registered Y nurse concerning a 32 year old male with sulfonamide Y and penicillin allergy ### who on### 12-NOV-2007 a n has been received from a physician concerning a 49 year old female with thyroid papillary N carcinoma, asthma 9/3/2008 and 9/3/2008 drug hypersensitivity to rmation has been received from theYphysician's office via medical records concerning a babyYgirl with a history 3/31/2008 of neonatal 5/1/2008 jaundice, mongo n has been received from a pediatrician concerning a 14 day old female baby with a history N of exposure to GARDASIL ### 12/4/2007 while in uterus (app n has been received from certified physician assistant (PAC) concerning a 3 day old, 7 pounds, 5 ounce, 4/9/2008 19.75 inch, 4/12/2008 female with a history o medical records were received and received Y concerning an 6 week old male with cleft lip andUa history of4/29/2008 jaundice, spitting 5/19/2008 up and blood bili n has been received from a female pharmacist concerning herself who in earlier 2008 was vaccinated N with a first and second dose of RECO n has been received from an office manager concerning a male who on unspecified dates was U vaccinated with three doses of RECOMBIVA n has been received from a nurse practitioner concerning a 34 year old, unemployed, femaleUpatient with7/10/2008 depression 7/31/2008 and a history of hepat follow up information has been received from a nurse practitioner concerning a 20 year old female U who on an unspecified date was vaccina n has been received from a registered nurse concerning a 46 year old female with a history Y of knee problems 8/12/2008 and an 8/13/2008 allergy to band aids, w follow-up information has been received regarding Y a case in litigation 0 from information obtained U from a published 1/9/2002article 1/12/2002 concerning a fema n has been received from a nurse practitioner via the patient's mother concerning her daughter Y with a history of bulimia who about 9 years n has been received from a medical assistant concerning a 20 year old female who was vaccinated Y with RECOMBIVAX HB. Concomitant n has been received from a nurse practitioner concerning a 14 year old female who was vaccinated Y with the first dose of RECOMBIVAX HB n has been received from a 50 yearYold female registered nurse with hypothyroidism and allergy N to non-steroidal 7/2/2008anti-inflammatory 7/13/2008 medicat n has been received from a registered Y nurse concerning her daughter who sometime in 1998 U was vaccinated with a dose of RECOMBIVAX n has been received from a nurse concerning a dialysis patient who was vaccinated with fiveUdoses RECOMBIVAX 2/19/2008 HB (dates of vaccinatio n has been received from a nurse practitioner who heard that a female who was vaccinated Ywith a dose of hepatitis B virus vaccine (manuf n has been received from a consumer concerning her friend's son who in 2008 (also reported Y as 2001) was vaccinated with one dose of RE n has been received from a physician concerning a patient who was vaccinated with RECOMBIVAX U HB. Subsequently the patient experien n has been received from a consumer concerning her daughter who in 1995 was vaccinatedUwith RECOMBIVAX HB. In 1995 the patient w n has been received from a registered Y nurse concerning a 32 year old female with a history Y of migraine headaches, 6/6/2008 PENICILLIN 6/6/2008 allergy, hy n has been received from a nurse practitioner Y concerning an approximate 35-year-old female N with a history of ### motor vehicle ###accident that r n has been received regarding a case in litigation from a physician concerning a 30-year-oldUpatient who was vaccinated with a second dos n has been received from a case inYlitigation via a case report concerning a 53-year-old maleN who on 04-NOV-2000 11/4/2000 was vaccinated ### with a n has been received from a health professional Y concerning a 21 year old female with no pertinent Y medical 1/14/2008 history, drug 1/15/2008 reactions or allergie n has been received from a registered Y nurse concerning a 22 year old female with no medical Y history or 1/15/2008 allergies who 1/16/2008 on 15-JAN-2008 was n has been received from a pharmacist concerning a 23 year old female with a history of unspecified N surgery and contemplated blood dona n has been received from a registered Y nurse concerning a female in approximately her mid 40's N with no allergy 2/6/2008 to yeast 2/7/2008 (any other allergies n has been received from a physician Y via medical records concerning a 4 week old female who Y on 30-JUN-2006 6/30/2006was 7/28/2006 vaccinated with a firs n has been received from a registered nurse concerning a Caucasian female with allergies to Y CODEINE,8/28/2007 METHANOL and### PENICILLIN wh n has been received from a nurse practitioner concerning a female who was vaccinated withYa nurse practitioner concerning a female who n has been received from a registered nurse concerning a 14 month old female patient with Y no pertinent medical history 2/28/2008 or drug allergies w n has been received from medical records Y concerning a female infant (full term normal babyUgirl weighing 9/17/2007 7 pounds9/28/2007 8.4 ounces with a lengt n has been received from a nurse practitioner Y concerning a 65 year old female with allergiesYto DEMEROL, codeine, and "DARVIN", and a n has been received from a physician Y concerning an 8 month old black female with no known U drug allergies, 8/2/2007 who on 02-AUG-2007 ### was vac n has been received from a physician, Y concerning a 1 day old Caucasian male infant (a normal U 9 lb 0.2 oz, male ###infant with ### no abnormalitie n has been received from medical records and a health professional concerning a 4 week old U female infant with ### small 11/1/2007 heart murmur and va n has been received from a case in litigation concerning a female physician who on 03-SEP-1996, U 11-NOV-1996 4/3/1997and 03-APR-1997 was va n has been received regarding a case Y in litigation which was reported in Litigation Report concerning U a 48 year### old female who in Novembe n has been received regarding a case Y in litigation concerning a 43 year old female with carpal U tunnel syndrome and numbness in hand (bo n has been received from a Nurse Practioner (N.P) concerning a 49 year old female patient N with sulfonamide 3/13/2008 allergy3/13/2008 who on 13-MAR-2008 n has been received from medical records Y concerning a 5 week old infant male who on 28-JUN-2007 Y was 6/28/2007 vaccinated8/1/2007 intramuscularly with w n has been received from a pharmacist concerning a 66 year old female patient who in 1997Uor 1998 was vaccinated with a dose of RECO n has been received from a patient who was vaccinated with a dose of RECOMBIVAX HB. U Subsequently, the patient reported that she fell n has been received from a mother concerning her daughter who in August 1993, was vaccinated U with a first 1/1/1994 dose of RECOMBIVAX HB (m n has been received from a registered nurse concerning a 21 year old male with a history ofNyeast of allergy who stated that he had an "alle follow up information has been received Y from a physician and from medical records concerning N a 27 year5/5/2006 old white male physician with gilb n has been received from a mother concerning her son who was vaccinated with a second dose U (date unspecified) of RECOMBIVAX HB (m
n has been received from a registered nurse concerning a patient (age and gender unknown), U who on 24-JUN-2008 6/24/2008 6/24/2008 was vaccinated with a n has been received from a 52 year old male physician who in 1998 was vaccinated IM withYa second 0.5 ml dose of RECOMBIVAX HB an n has been received from pharmacist concerning a patient who on unspecified date was vaccinated N with the third dose 7/2/2008 of RECOMBIVAX H was reported by a healthcare professional and described the occurrence of dizziness in a 28-year-old Y female 8/21/2007 subject 8/22/2007 who was vaccinated was reported by a healthcare professional Y and described the occurrence of near fainting in aY 13-year-old 2/2/2008 female subject 2/2/2008 who was vaccinat was reported by a healthcare professional Y and described the occurrence of rash in a 15-month-old Y male1/24/2008 subject who 1/26/2008 was vaccinated with H was reported by a healthcare professional and described the occurrence of high fever in an U adult male subject 2/5/2008 who was vaccinated with HA was reported by a healthcare professional and described the occurrence of night terrors in aY2-year-old 2/27/2008 male subject 2/27/2008 who was vaccinated w was reported by a physician via a sales represented and a health care professional and described Y the occurrence 5/14/2008 of rash in a 15-month-ol was reported by a consumer (also the subject) and described the occurrence of shooting pain U up the neck 5/6/2008 in a 18-year-old 5/6/2008 female subject was reported by a healthcare professional, via a sale representative, and described the occurrence N of swollen 4/30/2008 gland 5/3/2008 in a 41-year-old femal was reported by a healthcare professional Y and described the occurrence of injection site redness U in a 47-year-old 1/7/2008 male subject who was va was reported by a healthcare professional and described the occurrence of diarrhea in a 45-year-old N female 2/15/2008 subject who was vaccinated w was reported by a consumer and described Y the occurrence of dizziness in a 45-year-old female U subject who 2/8/2008 was vaccinated 2/8/2008with HAVRIX, was reported by a physician and described Y the occurrence of laboratory test interference in N a female subject in her late 20's who was vacc was reported by a consumer and described the occurrence of abnormal laboratory test value U in a 27-year-old 1/1/2008 female subject who was vacc was reported by a healthcare professional and described the occurrence of low grade fever U in a 1-year-old 3/19/2008 female subject 3/19/2008 who was vaccina was reported by a healthcare professional Y and described the occurrence of sweating in a 20-year-old Y female 3/20/2008 subject 3/20/2008 who was vaccinated w was reported by a healthcare professional and described the occurrence of pruritic papular rash Y in a 65-year-old 2/28/2008male 3/9/2008 subject who was vac was reported by a consumer and described the occurrence of tingling feet in an adult femaleUsubject who was vaccinated with HAVRIX (Gl was reported by a healthcare professional, via an agency sales representative, and described U the occurrence 5/1/2008 of injection 5/1/2008 site soreness in a was reported by a consumer and described the occurrence of a nonspecific reaction in a female U subject of 5/1/2006 unspecified age who was vaccin was reported by a healthcare professional and described the occurrence of arm pain in a subject U of unspecified age and gender who was v was reported by a healthcare professional and described the occurrence of burning in a female U subject of unspecified age who was vaccin was reported by a healthcare professional and described the occurrence of burning in a male U subject of unspecified age who was vaccinat was reported by a healthcare professional and described the occurrence of vaginal yeast infection N in an6/12/2008 adult female 6/18/2008 subject who was vacc was reported by a healthcare professional and described the occurrence of localized inflammatory Y reaction 6/27/2008 in a 10-year-old 6/27/2008male subject w was reported by a physician and described the occurrence of vaginal yeast infection in a 17-year-old N female 6/12/2008 subject6/13/2008 who was vaccinated w was reported by a healthcare professional Y and described the occurrence of injection site hives Y in a 3 year-old 6/10/2008 female 6/11/2008 subject who was vacc was reported by a healthcare professional (also the subject) and described the occurrence of Y injection site 5/1/2008 redness in5/1/2008 a 67-year-old female was reported by a healthcare professional, via a GSK sales representative, and described the U occurrence of injection site soreness in an u was reported by a healthcare professional via a sales representative and described the occurrence Y of hive 6/27/2008 in a 8-year-old 6/27/2008 male subject wh was reported by a healthcare professional via a sales representative and described the occurrence N of hives 6/27/2008 in a 3-year-old 6/27/2008 male subject wh was reported by a healthcare professional and described the occurrence of heart palpitation in a 25-year-old 4/2/2008 female 4/2/2008 subject who was vacc was reported by a healthcare professional and described the occurrence of accidental overdose Y in a 5-year-old 7/16/2008 female 7/16/2008 subject who was va was reported by a healthcare professional via a sales representative and described the occurrence U of an unspecified, severe event in a pe was reported by a healthcare professional via a sale representative and described the occurrence U of an unspecified, severe event in a ped was reported by a physician and described the occurrence of sweating in a 13-year-old maleY subject who8/2/2008 was vaccinated with HAVRIX (Gl was reported by a healthcare professional Y and described the occurrence of purpura in a 19-month-old Y male 8/12/2008 subject8/12/2008 who was vaccinated w was reported by a physician and described the occurrence of anaphylaxis in a 1-year-old subject U of unspecified gender who was vaccinate was reported by a healthcare professional and described the occurrence of an accidental overdose Y in a 2/20/2008 1-year-old female 2/20/2008 subject who was was reported by a physician and described the occurrence of fever in a 2-month-old male subject Y who was 7/3/2008 vaccinated 7/3/2008 with HAVRIX (Glaxo was reported by a healthcare professional and described the occurrence of bleeding from cut N in a 52-year-old ### female subject ### who was vac was reported by a physician and described Y the occurrence of fussiness in a 2-month-old male Y subject who 11/7/2008 was vaccinated 11/7/2008 with HAVRIX (G ct's medical history included high blood Y pressure and high cholesterol. Previous and/or concurrent Y vaccination 4/30/2008 included 5/3/2008 inactivated IPOL; u was reported by a healthcare professional and described the occurrence of vaccination complication U in a 6-year-old ### female ### subject who wa was reported by a consumer and described Y the occurrence of fever in a 10-month-old female Y subject who was### vaccinated### with HAVRIX, G was reported by a physician via a sales Y representative and described the occurrence of hives Y in a 22-year-old ### female subject ### who was vac was reported by a healthcare professional and described the occurrence of low grade fever Yin a 6-month-old male ### subject### who was vaccina was reported by a consumer and described the occurrence of colic in a neonate subject of unspecified gender 12/1/2006 who was exposed to HAVRI N
old child had received their two and four month YHib immunizations (manufacturer, 0 lot numberNand dates of administration not reported) and ort received on 13 March 2009 from Ya health care professional. A 20-month-old male patient U had received 3/4/2009 on 04 March 3/5/2009 2009 a fourth intram n has been received from a consumer concerning her son with no medical history or allergies N who on 20-SEP-2006 9/20/2006 was vaccinated with a n has been received from a pharmacist concerning Y a 54 year old male 5 Y with hypertension, Y obesity, U diabetes, 3/3/2009 atherosclerosis, 3/4/2009asthma and he n has been received from a nurse practitioner concerning her approximately 30 month old grandson U with a little autism prior to receiving the n has been received from a consumer Y concerning her 5 year old son with no medical historyNor allergies who 3/1/2006 was vaccinated with a dose o n has been received from a consumer concerning her 18 month old nephew with no medicalNhistory who in 1/1/2008 January 2008, was vaccinated n has been received from a consumer who reported that she has 3 friends whose children were U vaccinated with a dose of MMR II and deve n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y a 15 5/6/2008 year old female with attention def rmation has been received through the Merck Pregnancy Y Registry for 0 GARDASIL from a registered Y nurse 6/3/2008 concerning6/3/2008 a 20 year old female min. of vaccines pt. hadYcough, sneezing. Y Tongue Y and mouth pain. 1 Doctor found periorbital edema Y with 3/17/2009 wheals, no 3/17/2009 swelling of lip or tongue 9 pt. received 3rd dose of PENTACEL, Y HEP B, PREVNAR & ROTATEQ. Within 4 hours pt. Ydeveloped large 3/10/2009 area of3/10/2009 confluent erythema (s 24-28 after 12 pt. noted swelling redness & heat @ inj. site on left upper arm 4 cm X 2 cm area. Y Instructed 3/12/2009 to use compresses 3/14/2009 & TYLENOL gling in arms/legs, feeling weak, nauseated 10/13 - see doctor 1st time & twice more in OctNOct - tingling 10/6/2008 in arms/legs, feeling ### weak, nause d flu vaccine & got INFLUENZA B anyway. Y Y ### 3/10/2009 at 3:00 pm vaccines were given Within Y 5 minutes of vaccines, she was feeling nauseated and Y a numbness 2/2/2009 in right arm 2/2/2009 which started to sp somnolence and headache. Y Y 2/20/2009 3/2/2009 acular papular rash. Y U 2/24/2009 2/25/2009 a fast food restaurant after leaving Your office. Halfway there she got a pain in mid-sternal toYepigastric region. 2/26/2009 Then 2/26/2009 she felt very flushed, non-stop crying. Y ### ements of head to right Y Varicella and Hepatitis A vaccine in L arm on day prior to visit. This AM noted significant swelling U erythema 3/17/2009 @ injection 3/18/2009 site. Area of erythem as given HEPATITIS B vaccine on 2/25 @ 17:30. The second dose was given on 2/26 @ 02:00. Y 2/26/2009 en, painful (L) upper arm at area of Y injection. Mild erythema & cellulitis. PREDNISONE/CEPHALOXIN. Y 3/5/2009 3/5/2009 er the vaccine the site became red itchy swollen with scattered hives around the site & on trunk. Y 3/9/2009 .7 48 hrs after administration cellulitis Y left anterior thigh. 3-4 cm annular area erythema and Ywarmth. Tenderness 3/16/2009 to3/18/2009 touch. t 8:00PM on 3/18/09 Temp of 101 degrees. 3/19/09 Temp 102.9. To use Tylenol or Motrin. UTo take to ER 3/18/2009 if lethargic 3/18/2009 or not doing well. n has been received from a nurse practitioner Y concerning a 20 year old female with not drugYreactions or2/20/2009 allergies who 2/21/2009 on 20-FEB-2009 wa n has been received from an aunt concerning Y her 15 year old niece with asthma who in JulyN2008, completed 7/1/2008 her three 2/23/2009 doses GARDASIL. ving chills, achy joints, shoulder (left) and neck pain (left arm received vaccine) around 2200Non eve of vaccine. 3/16/2009 Began 3/16/2009 running fever of 100 PED ACHING/ FEVER ABOUT 24 HOURS AFTER ADMINISTRATION OF TDAP. TEMP 102 Y DEGREES,3/5/2009 48 HOURS 3/6/2009 LATER. BODAY AC HROUGH ROTAVIRUS DISPITE 3 DOSES Y OF ROTATEQ AT 2, 4, & 6 MTHS OF AGE Y 9/2/2008 3/6/2009 of 102, hurts to move,body achy all over, crying from pain, has not called MD, called at 10:30 this am. encouraged 3/18/2009 3/19/2009 to call MD. lling developed that has been increasing in size with time. It has not resolved as yet. My wifeUis now taking 3/16/2009 zyrtec, pepcid 3/17/2009 and Keflin 500 m n to patient in error, should have gotten HepB Y 3/4/2009 e administered at 10 a.m. when I was 34 weeks Y and 5 days pregnant. 4 This was a twin pregnancy Y with lots of monitoring ### (ultrasounds, ### etc.) Y 3/19/2009 3/19/2009 NOTED HIVES ONCE AGAIN, ONLY THIS TIME WORSE, MOTHER GAVE PATIENT BENEDRYL Y AND 2/11/2009 PUT SOME 2/11/2009 CREAM ON HIVES T ly immunized and pretty much on schedule Y but was still diagnosed with pertussis per PCR on Y 3/13/2009. Immunizations ### 2/10/2009 dates were 11/16/2 eloped hives 22 hours post immumizations Y on neck, trunk, and legs. No swelling of lips nor Y difficulty breathing. 3/12/2009 Consult 3/12/2009 to allergy clinic ew hours after receiving 4 vaccines, patient developed a rash over both upper arms that spread U to lower 3/17/2009 arms, back,3/17/2009 and face. He had no re ck dot on patient's left arm after administration of Varivax #2 using VanishPoint 5/8" syringe.U 1/13/2009 1/13/2009 d 5 minute tonic clonic seizure withYtemp 101 on evening shots were given. Patient had a history Y of prior3/17/2009 febrile seizures. 3/17/2009 Seen at Hospita ack dot on patient's right arm immediately after administration of MMR. U ### ### mplained of tightness and pain in his Y chest, went Y to the clinic at the 2Hospital on 15 Mar 09. Y The clinic then 3/4/2009 transferred 3/15/2009 him to another hosp cular lymphadenopathy on same shot was given for gardasil #1 and #2 U 3/12/2009 3/19/2009 ymptoms, frequent urination, burningY on urination beginning 11 days after initial dose, continuing U sporadically 6/11/2008 to present 6/23/2008 time, 9 months late 8/18/08; HPV #2, 10/20/08; HPV #3,Y3/3/09. Hospitalized Y within 2 weeks 25 of each vaccine for severe Y depression 3/3/2009 exacerbation. 3/10/2009 3/23/09 Rece ular, vesicular, asymptomatic chin, upper/lower Y extremities left ear very red, swollen 2/7/09 Y 2/4/2009 2/6/2009 ht thigh swollen, red, pain. 3/17/2009 3/18/2009 ted 03/16/09 and developed generalized rubelliform rash- continues to today though now defervesced. U 3/2/2009 3/16/2009
as given MMR vaccine on 3/16/09. Route IM the right lower thigh, Mom noticed reaction nextYday. Swollen. 3/16/2009 Warm to3/17/2009 touch. Large ring aroun ed with redness to right thigh at around Y 10am 3/18/09. Redness worse & area getting swollen N leg looks3/17/2009 more swollen. 3/18/2009 Child seen at 8am out" for a few seconds then felt dizzy. Y 3/19/2009 3/19/2009 and warmth to deltoid site. Y 3/16/2009 3/17/2009 en 03-16-09. Called by mom about red hot areas on arm. Came in for eval. No resp. problems. Y Relaxed and reading 3/17/2009 book. R arm (delto th local reaction, left upper thigh. Warmth and redness about 10x6 inches. U 3/17/2009 3/19/2009 8x10cm red oval. mild edema and tender to exam. U 3/18/2009 3/18/2009 ast 15 yrs, pt has had single spot zoster breakouts on her gluteal area approx every year. She N received ZOSTAVAX 11/7/2008 11-7-08. Since that tim eloped on entire torso 7 hrs after MMR #1 givenY 3/17/2009 3/17/2009 oe macular papular rash. Purplish face Y coloring, fussiness, fever, runny nose and swollen face. N 3/18/2009 3/19/2009 ameter erythematous lesion on the (R) Y upper arm. Site of varicella shot 24 hrs after injection. U 3/17/2009 3/18/2009 ox 3/18/09 after 2 vaccinations for VARIVAX 9/26/05 12/9/08. Y 12/9/2008 3/18/2009 Experienced diarrhea, vomiting and fever (102.0) for 24 hrs. Had same reaction to Hep B # 1Yof 3 on 11/17/2008. 3/13/2009 3/14/2009 n has been received from a manager Y concerning a 46 year old female hospital employee with Y allergy to 2/12/2009 LIPITOR, diabetes, 2/12/2009 hypertension, h rmation has been received through the Merck Pregnancy Registry from a medical assistant concerning Y a6/19/2008 19 year old6/19/2008 female with asthma wh n has been received from a consumer Y reported that "her former student's sibling was diagnosed N with autism after receiving MMR II the pati follow-up information has been received Y from a certified medical assistant for the pregnancyYregistry for 9/21/2007 GARDASIL concerning a 22 year o n has been received from a consumer concerning her 4 year old granddaughter who on an unspecified N date was vaccinated 9/1/2008with a dose of n has been received from a consumer Y concerning her approximately 26 month old daughterNwho in April 2000, 4/1/2000 was vaccinated 4/1/2000 with a dose n has been received from a consumer concerning her friend's son who on an unspecified date U was vaccinated with a dose of MMR II. It wa n has been received from a consumer concerning her 16 month old son with no pertinent medical N history 9/1/2005 and no allergies 9/1/2005 reported, who in n has been received from a consumer concerning her grandson who on an unknown date was U vaccinated with MMR2/1/2001 II. It was reported that n has been received from a consumer concerning her approximately 16 month old daughterNwith no pertinent 2/13/1995 medical 2/13/1995 history of drug reacti n has been received from a consumer concerning her now 5 year old daughter with no drug Nreactions/allergies 3/22/2004 who on 3/1/2005 22-MAR-2004 at the n has been received from a consumer concerning her now 22 year old son with an allergy toYyeast who in "1988" at approximately 12 mont n has been received from a consumer concerning her approximately 24 month old son who U on an unspecified date was vaccinated with the n has been received from a consumer concerning a male patient who was vaccinated with aNsingle dose of MMR II on an unspecified date. n has been received form a nurse concerning a 23 year old female who on 21-NOV-2008 was Y vaccinated injection ### with the ### first dose of GA was reported by a pharmacist and described the Y occurrence of tremor in a 11-year-old subject U of unspecified gender who was vaccinated w after 4 month vaccines given, pt withYfever, multiple Y episodes of emesis 1 and several cyanoticYspells. 1 spell 3/3/2009 lasted 30-60 3/4/2009 seconds - patient w serious case was received on 27 February 2009 from a health care professional. A child received PENTACEL (lot number not reported) on rregular area to left delt. Nt, slightly warm N 3/17/2009 3/18/2009 Y U 3/17/2009 3/18/2009 ever to 102, hives under bilat axilla,Ypain and redness at injection site, perceived wheezing and Y dry mouth 3/18/2009 with nausea. 3/19/2009 Patient went to ER 40 pm MA had just finished giving pt IZZ's, when pt's foster mother asked if it was normal for Y pt to be all red 3/17/2009 MA turned 3/17/2009 to see pt and he was ythema at injection site noted several hours after receipt of vaccine - lasted 3 days and no c/oY pain or discomfort. 3/11/2009 3/11/2009 nstop crying for 3 + hours Y 3/11/2009 3/16/2009 Lymphadenopathy, cervical, BIL. Y 1/14/2009 1/15/2009 oe rash and headache. Reported by parent, did not see rash. Referred to family doctor. Unable Y to reach client 3/6/2009 for follow3/11/2009 up information. Herpes Zoster Vaccine 5/8/2008 gotY rash on L eyebrow - forehead (slight) no blisters. Oct 11, U 2008 - went5/8/2008 to eye Dr - clear. ### Nov 23 2008 es, abdominal pain ( <5 min from getting Y shot). Within minutes, trouble breathing, emesis. PO Y BENADRYL 3/12/2009 given initially 3/12/2009 before resp distres local swelling including entire arm and Y proximal forearm with localized pain and urticaria. Y 1/23/2009 1/23/2009 after vaccinations pt. noticed back ofY left arm sore & redness around injection site. The redness Y continued3/9/2009 to spread, 3/10/2009 was not to the touch. es that eve after a shower noted area was red & swollen with a pinpoint flat rash that extended Y down from1/9/2009 injection site 1/9/2009 3 fingers width. C/o -103 degrees F wouldn't crawl or sleep or eat for 2 days very uncomfortable and just wantedUto be held. 4/13/1995 I get angry4/13/1995 because I could have g fever to 103 degrees. Fever was noted Y (rectal) 102.7 on admit to ER, uncontrollable vomiting. Y Dehydration. Neuro ### signs intact. ### Received IV orts that she had a softball size knot on left arm the day after her last TWINRIX on 2/11/09. ItY"had local fever 2/11/2009 and I itched 2/12/2009 and was very sor -sized redness @ site of injection yesterday after school. This morning pt c/o slight pain andYsite was itchy. 3/9/2009 Mom noticed 3/10/2009 that redness had ports approximately 40 min after receiving Y vaccine became lightheaded, pale, clammy & thenY became semi 3/5/2009 unresponsive. 3/5/2009 Co-workers call fter the vaccine was given, subject experienced tenderness, irritation, and swollenness in her Y left arm. Tenderness 3/17/2009 3/18/2009 and swelling has decre
d shot 12/30/08 - Raised red area around shot site is still red - not swollen just red - pt. is notYin pain just doesn't ### like mark on arm. mmatory reaction. 7x7 warm erythematous area assoc w/ persist fever. DX cellulitis, secondary Y to sterile3/17/2009 abscess from 3/18/2009 DTap vax. veloped raised red "bumps" all over (L) arm 2 days after shot. States area itching but betterYnow. Instructed 2/24/2009 to notify 2/26/2009 MD for further instruc ine VARICELLA. Y 8/8/2007 3/15/2009 iagnosis of chickenpox Received VARICELLA vaccine 3/1/02. Sibling had chickenpox - 2 wks U prior had not 3/1/2002 received 3/12/2009 VARICELLA vaccine d ZOSTER & TD BOOSTER vaccinations on 6Mar2009. Pt received vaccines on R deltoid.YZoster vaccine 3/6/2009 caused localized 3/7/2009 rxn to include Limited movement of right arm. Y N 8/12/2008 8/13/2008 9 pt. called to report "hive-like rash" appeared on face within 2-3 days of 1st Hep-B vaccine Y given on 3-03-09. 3/3/2009 Rash now 3/5/2009 itchy and spreadin on Rt thigh hard red lump, warm to touch, Y no fevers using BACTROBAN oint and warm compresses. Y 2/23/2009 3/3/2009 esented to the clinic on the 19th of March complaining of a rash across his back and chest as Y well as behind 3/8/2009 his ears 3/18/2009 and some on his legs veloped pain and redness at the injection site of Flu vaccine. His entire right shoulder turned Y purple. 1/17/2009 1/19/2009 nstop from 1am-8am. Shots were given at 3:20pm the day before. U 3/19/2009 3/20/2009 3/13/09 for 10 year old well child visit. Y Recieved varivax #2. On 3/15/09 developed large area Y of redness, 3/13/2009 pai, and warmth 3/15/2009 on left arm. See ries of Hepatitis B vaccine(6/10/08, 7/15/08, and 11/25/08), the post-vaccine surface antibody N on 3/10/2009 was negative. eveloped erythema swelling and lymphedema on the upper arm at the injection site. He had severe pruritis. 3/7/2009 Symptoms 3/11/2009 started on 11 Mar. ries of Hep B vaccine (4/20/07, 12/21/2007 and 02/15/2008) post-vaccine HBsab was negative Y (titer on 3/10/09). 03.4, muscle spasm, r thumb-treatedY with anti-pyretics, time U 3/19/2009 3/20/2009 d adacel vaccine on 3/18/09. TodayY3/20/09 noticed rash on left forearm that is itchy, raised, were 9 bumps 3/18/2009 initially,3/20/2009 now only 3. No other iving the second dose of the Gardasil vaccine, I had a large lump under the skin at the injection U site that 3/12/2009 felt almost 3/12/2009 like a marble. The skin w n at 0930am, developed erythematous wheal, 4 cm & warm, almost immeditely and small hives U down both 3/19/2009 arms and 3/19/2009 face. an ugly looking rash, which she describes as bright red and a lengthwise oval that is about 2-3" Y long. She 3/18/2009 notes that3/20/2009 it may be slightly raise a faint red rash around the injection site. It was about 1/2" X 1&1/2" in the shape of a lenthwise Y oval. It does 3/18/2009 not itch. 3/19/2009 ported to Health Dept. that pt. wokeYup on the morning of 3-19-09 complaining of being dizzyYand unable3/18/2009 to get out of 3/19/2009 bed. He followed up after receivng vaccines patient had temp (102F), n/v, chills and malaise. Mom treating with tylenol U and fluids. 3/19/2009 3/20/2009 EVED ANTHRAX VACCINATION AS A TUBERCULOSIS TEST ON HIS LEFT FOREARM. HE Y HAD THE 3/20/2009 NORMAL3/20/2009 SIDE EFFECTS OF TH eared on 3/19/09 and a vesicular rash around injection site. Treated with benadryl Y 3/12/2009 3/19/2009 soreness/tenderness in upper arm near site of injection. Mild sore throat and diarrhea. N 3/19/2009 3/20/2009 area of inderation at the site of the chicken pox injection. No rash in the area. I felt it was an uncommon reaction. 3/6/2009 3/19/2009 symptoms in Nov - Dec. Y Flu symptoms Y 1st Jan.YSaw P.C. 1/5/09, showed 60 Y signs of choking often, U called paramedics ### 1/18/2009 1/18/09 - could not stan after vaccines (and after dinner + dessert), Y developed Y hives, lip/tongue 1 swelling, throat and chest Y discomfort 2/26/2009 and dyspnea; 2/26/2009 then syncope. itching and shortness of breath. Y 3/18/2009 3/19/2009 arm swelling, redness and tenderness. N 3/18/2009 3/18/2009 minutes of receiving 3 vaccines - MENACTRA, ADACEL, and GARDASIL, pt developed a macular/papular Y 3/18/2009 rash L arm 3/18/2009 and trunk. BENADRY sion, Nausea. Vomiting 20-25 mins.Y Prior to EMS being called. Treated with a cold compress Y until EMS3/18/2009 arrived. 3/19/2009 d to have Erythema Multiforme 7 days after receiving vaccines. Also had mild URI, so E. Multiforme Y could 3/10/2009 be due to3/17/2009 viral etiology. ? Possib of swelling in legs, knees, elbows and hands. Mild pain in quads, sweating, sensation of dyspnea. U Treated 3/18/2009 2 weeks3/18/2009 prior for hives due to ib ollen around site. Y 3/18/2009 3/20/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP Y 1/27/2009 nstead of TDAP. Y 1/27/2009 nstead of TDAP. Y 1/27/2009 nstead of TDAP. Y 1/27/2009 = Legs and arms. No other symptoms. Occurred after shot. Disappeared after Benadryl. Y 3/19/2009 3/20/2009 @ site of injection. Post 12-12 hours later redness, hot to touch and swelling. U 3/19/2009 3/19/2009 ter had her 4yr old injections, she has Y always had a slight fever with each vaccination. This time N however3/19/2009 she hasn't3/19/2009 been producing much er first shot, daughter started having Y weakness/tingling in left arm. Also, dizziness. Within aNweek after second 3/9/2009 shot, 3/12/2009 she began to have mo nset of fever accompanied with febrile Y seizuresYapproxmitatly 9 days1 after vaccinations wereYrecieved. visited 3/10/2009 ER after 3/19/2009 first seizure on 3/19/ MINISTERED (L) DELTOID 3/6/9 @Y1045. PT NOTED HIVES & ITCH @ SITE 3/11/9. PT CONTACTED U 3/6/2009 DR 3/12/9 3/11/2009 & WAS BROUGHT IN atient started to loose muscle Y and in May 2003, was diagnosed with ALS. 4/22/09 Y MR received N from neuro 9/1/2001 2/7/05 to 9/1/2002 4/6/09 with DX: Proba
ceived both a pneumovax and influenza injection on 10/21/08, The influenza vaccination wasUgiven in patient's### right arm, and ### the pneumov e clinic and within 1-2 hours had 103-104 temp and is still having extremely high fever and chills U today. 3/19/2009 3/19/2009 ously healthy 22-month-old male had Y the following Y vaccinations on 1/20: 1 4th HIB, 1st hepatitis U A, and 1st1/20/2009 varicella. The 1/21/2009 following day, he de ebrile seizure (15-20 min of generalized Y T-C seizure Y but with eye deviation 1 to the right). Fever Y 39. Hoarseness. 3/2/2009 RSV3/21/2009 antigen positive. Rec'd N Y 0 N 5/20/1998 ort received 09 March 2009 from a health Y care professional which involved a cluster of two patients. U Two patients, 9/1/2008also 3/1/2009 reported as employe was received from a health care professional Y on 13 March 2009. A 17-year-old male patient,Nwith a one-week 3/11/2009 history 3/11/2009 of upper respiratory in ort received on 17 March 2009 from Ya literature collection. "An 8 month old female patient developed Y a left sixth nerve palsy 6 weeks after D n has been received from an office Y manager concerning a patient who on an unspecified date, Y was vaccinated 2/10/2009 with2/10/2009 PNEUMOVAX 23 (lot# n has been received from a doctor of Y pharmacy concerning a 77 year old male patient Y with arthritis N of wrist, enlarged ### prostate ### (benign), hyp n has been received from a consumer Y concerning her 15 year old daughter with no Y past medical N history 8/20/2008 and no drug 10/1/2008 reactions or allergies n has been received from a consumer Y concerning his daughter (a year old female) with no medical N history3/3/2006 or drug allergies who on 3-MARn has been received from a consumer concerning her son (a "43 year old" male) who "developed U autism after receiving a dose of MMR II". n has been received from a consumer concerning her daughter who became autistic after receiving U a dose of MMR II. Upon internal review n has been received from a consumer Y concerning her 36 month old son with gastrointestinalNissues who7/24/1998 on 24-JUL-1998 was vaccinated w n has been received from a consumer Y concerning his 9 year old daughter, who on an unspecified N date, was vaccinated with MMR II (Lot nu n has been received from a consumer Y concerning a her 4 year old son with allergy to metalsNand a history 2/10/2004 of high fever 2/11/2004 in approximately in n has been received from a consumer concerning her 8 year old grandson with no medical history N who in 2001 was vaccinated with a 0.5 m n has been received from a consumer concerning her grandson, a now 10 year old male, with N no known drug reaction/allergies and no per n has been received from a consumer her son, with no known drug reactions/allergies and no N pertinent medical history, who on unspecified 2/15/2009 N ### 2/13/2009 cal swollen, red , warm on lateral leftY arm. No fever. Y 3/2/2009 3/2/2009 a of erythema, fever to 101.5 degrees F 24 hours after injection of ADACEL left arm. Y 3/17/2009 3/10/2009 given 2/23/09. Patient monitored 30 minutes post vaccines. No problems or complaints reported. Y Patient 2/23/2009 returned2/24/2009 for visit 2/26/09 & repor 9 Pt presented here with vesicular like lesions to tip of nose and another vesicular like area with Y redness2/26/2009 to left side3/12/2009 of nose. Normal eye an ulopapules x 3 clustered on left upper anterior thigh at site of VCZ vaccine. U 3/6/2009 3/15/2009 izure seen at Hospital on 03-08-09.YNo activity since. Y 2/26/2009 3/8/2009 ped rash approx 10 days post SPV inoculation. Y Petechiae also noted. Pt also had a dental surgery Y the day2/9/2009 following2/19/2009 SPV inoculation and w red, hot and swollen x 6 days measured 10cm x 6cm. ZYRTEC given and started on 3/10. Y 3/10/2009 3/11/2009 and tenderness at injection site when seen one week later. U 08 patient presented as a new patient and I found she was under immunized needing one polio Y and two tetanus ### boosters.### I elected to give nted and hit her head, applied ice pack and examined by Dr. Waited in clinic for 1/2 hour after Y and was fine. 3/23/2009 Did have 3/23/2009 a bump on her forehe Y 1/26/2009 2/2/2009 hema with superficial swelling 5x6 cm over vacc site apparently on the next day. Adv Motrin,UOTC Benadryl, cold compress. ped papulovesicular lesions which developed into a rash along the T8 dermatome approximately Y Pt called 2/17/2009 back 2 days 2/21/2009 after ZOSTAVAX. th knee pain on 11-19-08 - Motrin, knee Y brace - C/o stickling knee with pain on 12-17-08; numbness U in toes-INDOCIN ### with### MRI (L) knee wit n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning N her daughter 9/2/2008 in law, 9/2/2008 an 18 year old fema n has been received from a 20 year old female with no medical history and drug allergies who Y in February2/1/2008 2008 was 2/1/2008 vaccinated with her fir ed disease of pericardium Y U 12/8/2008 ### raised area at injection site hot to touch and lump felt under the area Y 3/19/2009 3/19/2009 fic myocarditis Y U 1/12/2009 1/22/2009 carditis, unspecified Y U 12/9/2008 ### carditis, unspecified; Unspecified disease Y of pericardium. U ### ### ricular tachycardia, dizziness, chestYpain. Brought Y to emergency room 7 by ambulance and admitted N to a cardiac 1/21/2009 telemetry 1/28/2009 unit for 7 days. Nu iven IM to LD and MMR given on 03/18/09. Mom returned on 03/19/09 and child had edema Y at injection3/18/2009 site that started 3/18/2009 2 inches above in resented for follow up after recieving his small pox vaccine and anthrax on the 8th. On the 17th U he had erythema 3/8/2009and 3/20/2009 itching at the site. On ceived the zoster vaccine at the VA clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed Y a shingles 2/5/2009 rash approx 2/15/2009 10 days after the ccine was given on 3-6-09 @ 9:35 am. On 3-16-09 @ 2 pm patient developed a mild headache. N Between 3/16/2009 5:30 and3/18/2009 6 pm she developed g 09 BROKE OUT WITH 3-4 CHICKEN Y POX LIKE SORES WITH PINS & NEEDLES LIKE PAIN N AND CONTINUED 3/11/2009WITH 3/20/2009 BREAKOUTS UNT RM SWOLLEN FROM SHOULDER TO ELBOW AND WARM TOO TOUCH, STARTED ON SATURDAY U 3/17/2009 3/21/09 3/21/2009
nt received the Tdap immunization without complications on Friday, March 6, 2009. Pt stated Y she felt fine3/6/2009 with no problems 3/11/2009 until Wednesda M RED & SWOLLEN FROM SHOULDER TO ELBOW Y 1/20/2009 1/23/2009 9, approximately 24 hours after injection, left arm red, hard, swollen, hot and c/o itching. Over Y the next 33/19/2009 days, redness, 3/20/2009 swelling and itchin ped his initial symptoms of low back pain within a month of his 3rd anthrax vaccination. Y His N low back pain 12/3/2007 was later determined ### to be due t mmediately following injection of HPV vaccine. No fall or injury. Rapid recovery - regained consciousness Y 3/19/2009 when client 3/19/2009 placed in suppine po post vaccine patient developed feverY102 F. Mom was on her way to taking child to ED whenYchild had a3/18/2009 seizure in 3/19/2009 the car Shingles Vaccine and Tetanus, Diphtheria Y Pertussis (Tdap) Vaccine received from Dr. Reporting Y administered 2/12/2009 vaccines 2/23/2009 here rather than un c symptoms started in my left hand within 2-3 weeks of a vaccination in my left arm. Y It startedNwith lots of7/18/2008 tremors and8/3/2008 then certain fingers in 24 hours after Meningococcal Vaccine,the Y site of injection and surrounding area was red, painfull,swollen, U 3/19/2009 tender, and 3/20/2009 very hot to touch. H like exanthem 20 days post vaccination. Y 3/3/2009 3/21/2009 ash 2 weeks after admin of vaccine. 1/29/2009 2/19/2009 MMR on 2-2-09. Paperwork signed by pt & guardian that she is not currently pregnant, no possible way she 2/2/2009 is pregnant & understands shou wollen, red, hot to touch from shoulder Y to elbow. 3/20/2009 3/21/2009 ut of exam room after vaccinations and experienced syncope at check out desk. Event witnessed Y by/patient 3/20/2009 helped3/20/2009 down by nursing who d in arm for over a month - Stinging pain, unable to lift arm. N 2/6/2009 2/6/2009 arm cellulitis Deltoid area. Y Y 3/6/2009 3/6/2009 ays after receiving VARIVAX left Deltoid Y Pt developed erythematous papular left Deltoid which U have persisted 3/11/2009 about3/17/2009 1 week with minor loca veloped hives 2 dys after vaccines were given. Y 3/13/2009 3/15/2009 00 x 2 days. Rash x3 days - red circular Y hives. Right TM red - CEDAX, 1 tsp every day ORAPRED U 1 tsp 3/20/2009 po every day 3/20/2009 x 5 days. rythema on L thigh around Dtap & polio Y site with induration. Pt on AUGMENTIN. Y 3/18/2009 ection 3/17/09 - 1st 8 hours painful 3/19/09 rash behind knee. 3/20/09 rash to arms & legs, & N then surrounding 3/17/2009 area3/19/2009 of injection. Red papul important efect was today the Dr.toll me his LIVER get a little damage,the result from the laboratory Y give as this matter, he always have BIG upper left thigh started to swell within a day after receiving the shots. Area was warm to the touch, Y VERY2/27/2009 swollen, red, 2/27/2009 and I could feel a ha n has been received from a registered Y nurse concerning Y a 14 year old female patient with a Y history of pre-eclampsia 2/4/2009 2/4/2009 and BELL's palsy duri n has been received from a physician concerning Y a 21 year old female 21 ("who is a family friend Y of the physicians") who was vaccinated with n has been received from a physician Y concerning a patient was vaccinated with a dose of GARDASIL U on an unspecified date. Subsequentl n has been received from a physician concerning her newborn 3 month old baby who on an Yunspecified date was vaccinated orally with the n has been received from a consumer Y concerning her 18 month old son "generally sensitiveNto different ingredients" and with no pertinent m n has been received from a consumer concerning her son with no pertinent medical history and N penicillin allergy, who on an unspecified da n has been received from a consumer Y concerning her 12 months old son who on 13-DEC-2004 N was vaccinated ### with one dose of MMR II al n has been received from a consumer Y concerning her son who had been developmentally disabled N and who was vaccinated approximately n has been received from a physician Y concerning Y a 57 year old female Y hospitalized patient who N while hospitalized was vaccinated with PNE n has been received from a physician concerning Y an 83 year old female who on 17-FEB-2009 N was vaccinated 2/17/2009 with 3/10/2009 a dose of ZOSTAVAX ( ts of intussusception, each Y after given Y rotateq vaccine, Y the second episode 3 was 7 days afterYthe rotateq 3/13/2009 was administered. 3/20/2009 Was life flighted ately 8 days after administration, the site of administration became sore, then burning and painful U sensations 3/13/2009 began3/21/2009 on day 11 following adm ven varivax on 3/5/09. Within 10-15Ymins. of receiving vaccine pt. complains of flushed face,Ystinging at injection 3/5/2009 site 3/5/2009 and redness at site. P area on right arm with a darker center surrounded by an erythematous area around it. It measures U 4cm3/13/2009 by 4cm. warm 3/14/2009 to touch. No fever. linic on 03/24/2009 c/o severe painYat injection site. Unable to lift arm due to pain. Fever at injection U site3/19/2009 and erythema 3/19/2009 noted at injection sit t injection site, redness, swelling, hot to touch, tx w/ Y 3/19/2009 3/21/2009 pneumococcal vaccine trial, with severe COPD, Y was hospitalized for 2 worsening interstitial cystisis. Y Vaccination 7/28/2008 took place 3/3/2009 on 7/28/2008. Ac RSE REACTIONS Y ### ### d on the floor due to fainting. she stated Y she was dizzy and the floor was spinning. She did not Y eat breakfast. 3/21/2009 Approx3/21/2009 1/2" in length and 1/4" given on 3/12/09. She started having an erythemitous papular rash on 3/23/09. The rash began U on her3/12/2009 face and spread 3/23/2009 to her neck, ches lder swollen & extremely sensitive with severe pain for approx. 3 weeks. called office was told U to ice area. 9/24/2008 went to other 9/25/2008 office was told som veloped left-sided neck pain approximately Y 48 hours after receiving varicella vaccination. The Y neck pain3/16/2009 was related 3/18/2009 to any head movemen me to ER for 2nd injection of Hep B series on 3/10/09. The next am she noticed weakness in Y right hand3/10/2009 upon awakening.Patient 3/11/2009 was seen ceived her first shot 5/24/07 Y - she had Y sorenessYin her arm and headaches 26 Y but tollerated them. N On 10/1/2007 9/30/2008 patient 10/4/2008 was at basketball prac e, vomiting, lack of appetite, extremeYfussiness N 3/20/2009 3/21/2009 er vaccine got vesicular rash on face. Y U 3/9/2009 3/13/2009 d, Swollen, hot to touch - Afebrile TX- warm compress to site three times/day recheck in 24hrs. U 3/18/2009 3/19/2009 hours entire upper arm was erythematous, Y swollen and area around injection site was hard to Y palps - No3/12/2009 fever. By about 3/13/2009 36 hours erythem
d rash 8 days after receiving MMR and VARIVAX. Rash is diffuse on legs and trunk. There isYswelling of 2/27/2009 hands and feet. 3/7/2009 Dx'd with erythem multiforme- Itchy red rash all over body. Y Tx BENADRYL and cortisone ointment. U 3/10/2009 3/18/2009 rash on arms & forehead within 24 hrs of receiving TDaP vaccine recommended OTC BENADRYL Y & hydrocortisone 3/14/2009 3/15/2009 cream prn itching. No crying for 3 Hour for no reason Y 2/25/2009 2/25/2009 igue, itching, hands hard to make a fist. Slight chest pressure insomnia anxiety anorexia. Y 3/10/2009 3/11/2009 ation with 2x2 redness in center with small bumps and tenderness. Y 3/16/2009 3/17/2009 of injection was red and swollen - very light & hot to the touch. Sun. - redness covered all ofYupper arm 3/13/2009 - down to the 3/14/2009 elbow, pulsating & ho ure 104.2 within 12 hours of vaccine and stomach pains. U 3/16/2009 3/17/2009 was reported via a legal complaint, and described the occurrence of autism in a 4-year-old Y male U subject11/2/2004 who was vaccinated with INFANR continual ringing in left ear. Started Y 24-48 hours after receiving a .05 cc Tetanus/Diphtheria Y booster N injection. Still ###continual ### ringing today. N if he felt ok after I administered his Yshot and heY said yes, then said 2 he felt lightheaded and fainted. Y I had3/18/2009 my tech call 3/18/2009 911 and I administere s red, warm + swollen, painful T99.5. Doctor ordered Benadryl + Motrin. Area was cleared the Y next morning, 3/13/2009 but returned 3/13/2009 that evening so re dmin. 12/20/83, immediate adverse reaction, pt cried hysterically for next 6 months, Y dark black N appeared under### eyes, learning ### special ED c rts fever started 3/14/09. Rash started Y Sunday on chest & face. Itching. Swollen glands. Mucous N in throat. 3/6/2009 Seen 3/14/2009 at ER- Dx chick pox. S 3 days post VARIVAX. Seen by neurologist. Y 1/29/2008 2/11/2009 L given 3/17/2009. Patient got headache and vomiting on 3/19/2009 and 3/20/2009. Y 3/17/2009 3/19/2009 er arm completely swollen, warm but not tender, swelling was beyond elbow on 2/19/09. Recheck U if redness 2/18/2009 starts to 2/18/2009 extend rather than rec after shots given, swelling size of grapefruit, red and hot. Treatment, BENADRYL, TYLENOLYand cold packs. 3/18/2009 3/19/2009 after second dose of VARIVAX vaccine (first dose on 1/27/97) developed swollen red arm at Yinjection site, 3/16/2009 fevers, and 3/17/2009 severe myalgia. Also redness and induration distal to vaccination Y site with severe pain about 12 hrs after injection.YNext day redness 2/18/2009 increased 2/19/2009 in size with fever ed a 103 degrees fever for 2 days and Y cellulitis at the injection site. I also still have a lump inYmy arm. 3/5/2009 3/6/2009 dematous + erythematous at R upper arm surrounding injection site. BENADRYL, apply ice.Y 3/20/2009 3/20/2009 o itchy hives on Left deltoid appearing 5 days after injection. Y 2/16/2009 2/21/2009 post injection patient had large areaYof erythema >10 cm around point of injection. Y 3/9/2009 3/10/2009 se reaction reported - *Child mistakenly given Hep A 35 days prior to 1st Birthday. Y 2/10/2009 y care physician informed me on the use of GARDASIL and how it prevents cervical cancer.NAfter reading 10/1/2008 a small pamphlet 10/1/2008on the drug I a in hives on arm where injection was given and chest. Relieved w/ 2 Benadryl. Y 3/13/2009 3/13/2009 3-09 Body aches, fever, left arm swelling, red & warm to the touch. Pt given BENEDRYL & Y on 3/16/09. 3/12/2009 3/13/2009 U U ceived TDAP & PNEUMOCOCCAL on 3-16-09. Presented to office on 3-19-09 with a 4 1/4 Y X 2 1/2" red,3/16/2009 raw, hard 3/18/2009 area, painful. agnosed with chicken pox one month after receiving vaccine. U 1/19/2009 iving MENACTRA, in process of receiving GARDASIL, child became extremely pale and experienced Y LOC 3/12/2009 x about 15 3/12/2009 seconds, slumping in d arm rash lasting several days, treated Y with BENADRYL. Y 3/10/2009 3/11/2009 02/60; P 60 - R-12;- Pt feel lightheaded, skin tone change to pale. Saw spots, alteration in hearing Y (A:) Pt 3/19/2009 given Kool 3/19/2009 Aid to drink Patient lay ever 104.5, poor appetite, sleeping 21 Y hours/day. Fever controlled with TYLENOL and MOTRIN Y to 100-102 3/3/2009 degrees.3/10/2009 Afebrile 3/15/09, conti Y Y 6/11/2002 3/20/2009 swelling (half dollar sized) at injection site of VARIVAX vaccine 24 hours prior. U 3/17/2009 3/18/2009 PENTACEL on 03/10/09. On 03/11/09 which mom was changing diaper she noted L upper thigh U at injection 3/10/2009 site was 3/11/2009 swollen + red and see and induration (L) deltoid at site of injection - blanching erythema - local allergic rxn vs cellulitis. Treated3/12/2009 for both (AUGMENTIN 3/14/2009 and CLARI 3/18/2009 L dose #3 1/27/09 2/17/09 - DysuriaY with Lower Abdominal Pain UA - Large Blood, small leuks, Y Prot > 300 1/27/2009 mg/DL cx-neg 2/17/2009 symptoms lasted perienced a headache Tue evening of vaccine administration. Headache was "tolerable" and Y went away3/14/2009 by morning. 3/14/2009 given before age 1 no side effects reported. 3/16/2009 ported that injection site was red, itchy and sore since last night. Limited to round area around U injection site. 3/14/2009 3/16/2009 s were given, the patient was conversing Y with giver of immunization while drawing up 4th vaccine Y - Pt fell3/15/2009 out of chair, 3/15/2009 hit head and was seiz ng on legs. Slightly raised red rash on arms, legs, face, torso and back. 1 Temp 100.5. U 3/12/2009 3/13/2009 oke up the day after vaccinations with Y fever of 103 degrees. She was very fussy and had quarterY sized red 3/12/2009 lumps on 3/13/2009 each thigh where vacc day after vaccination. Y Y 3/9/2009 3/10/2009 ely after receiving HAV patient developed macular rash at site and upper back. Not hives, RxYwith BENADRYL. 3/16/2009 3/16/2009 s after injection - hive 3x4cm, (-) itching (-) shortness of breath --> ice pack, ZYRTEC PO, recheck Y 24 hours. 3/16/2009 3/17/093/16/2009 still with redness / (-)
HEP A dose 2 in our office mom called 1 hr later & stated child's eye lids are swelling has callUinto MD. Child 3/17/2009 has seasonal 3/17/2009 allergies. lled office 2 hrs after vaccinations were given. Child had hive- like rash on legs and abdomen. Y Instructed to 3/9/2009 give antihistamine. 3/9/2009 eared on neck 1 week after vaccineYpreceded by a headache and stiff neck. Rash is shingles-like. N Continued 2/25/2009 to spread 3/4/2009 down right arm, sho out in full body rash consisting of small, Y red, itchy dots 10 days after vaccine was administered. U Pt saw a3/13/2009 dermatologist 3/23/2009 who told him he had pprox. 11:15am shingles vaccine administered Y to L arm SQ, tolerated well. Approx. 11:30 am Y client complained 3/17/2009 of nausea 3/17/2009 VS taken B/P 13 rmation was received on 26 November 2008 from Y a health care professional. 5 A female patient Y received an 9/18/2008 injection 9/20/2008 of FLUZONE SV 2008n has been received from a physician who received a "health alert" from the state health department U concerning a 16 2/24/2009 week old patient who n has been received from a registered nurse and a nurse practitioner, for GARDASIL, a Pregnancy Y Registry 1/20/2009 product, 1/20/2009 concerning a 16 year n has been received from a consumer, Y who was the guardian of the patient, for the Pregnancy Y Registry for 4/8/2008 GARDASIL, 4/8/2008 concerning a 14 ye onset "bruising" dx: ITP.Y4-25-08 - GUILLAIN-BARRE Y Syndrome - 32 hosp Y 32 days. 4/1/09 MRY received for 11/8/2007 4 DOS- 11/27-29/07 ### with DX: Th ausea, vomiting, fever + joint pain. 6/19/09 Y Pt reports she never sought medical tx. Took Benadryl. N Case 3/17/2009 closed 3/17/2009 ced around 7:00 AM this morning that Y (R) upper arm was very red and very swollen. Redness N about 4 inches 2/25/2009 on diameter 2/26/2009 and arm is very s -warm to touch-rash over entire upper Y arm- shoulder pain and swelling radiating down arm- Referred Y to family 2/13/2009 doctor. 2/13/2009 Pt is 31, she got an M vacc 110708; presented to ER 110808 Y with itchy red rash over entire body face, extrem. Started Y with neck, 11/7/2008 broke out 11/7/2008 with all over rash next 3/17/2009 ) arm at inj site. redness, warmth, temp 100 deg. SEPTRA given for possible cellulitis. TYLENOL/MOTRIN Y 2/16/2009 for discomfort, 2/18/2009 apply cool compr 3/16/2007 ination, patient collapsed to floor - fainting lasted 5 seconds or less. BP 118/80, no dizzness, Y nausea, headache. 3/18/2009 Left 3/18/2009 with mother walked nced vasovagal reaction within one minute following injection of HPV # 3. She was sitting on Y the exam table 3/24/2009 during3/24/2009 vaccine administration ates client woke up from a nap around Y 4pm the same day of vaccination and his legs were stiff Y and he was 3/20/2009 screaming 3/20/2009 in pain. Mom states ately 4:00PM 12/7/08 Symptom: Headache Y ThisY came on suddenly. 4Pain level was a 5. Described as aching 12/4/2008 pain on 12/7/2008 back (upper) head. W presented to clinic 3/24/09 with c/o pins Y and needles and tingling in right arm x ~ 3.5 weeks. U Onset was weeks 2/9/2009 following 3/1/2009 02/09/2009 vaccin pain/muscle locking approximately Y five days after vaccine administered at left shoulder and U left elbow, tingling ### in left11/3/2008 hand 2. Prolong ccine administered in Lt Deltoid IM on 3/20/09. within 24 hiours patient reported left arm andYhand numb.3/20/2009 She experienced 3/21/2009 flu like symptom male flyer w/ no significant past medical Y history Y received smallpox vaccination 7 by scarification U on 10MAR09. 3/10/2009 Pt then 3/20/2009 deployed. On 20MAR ted a red, hot raised area on the child's left upper arm 2 days after receiving the vaccines. ItYwas 3 in in 3/17/2009 diameter and 3/19/2009 had a white area in th by Mother of client on 3/25/09 @ 08:30 Y a.m.): "Left leg is sore by her knee with swelling, redness N (in a big 3/23/2009 red circle3/24/2009 where vaccine given) administered Jan 27th, 2009. FeverYdevelopedYwithin 2-3 days of vaccine 10 administration, pt felt Y bad, experienced 1/27/2009body 1/29/2009 aches and weaknes Blood pressure, Face and eye swelling, Y shortness Y of breath and chest 4 pain went to the emergency N department 3/24/2009 and 3/24/2009 is currently admited at M red, swelling and itching, mom administered childrens benadryl ### ### ess, tightness in chest. S/s started 10 Y days after vaccination. Pt was given naproxen 500mgUtwice daily and 3/12/2009 zantac 3/22/2009 150mg twice daily. Con e reactions/symptoms. patient given extra dose of IPV (Polio) vaccine, FOC upset. 3/16/2009 ollen lump area. One lump to left deltoid 8.5x5.5mm. One lump to left arm sub-q 5 x 5mm. Lumps occurred 3/16/2009 one day 3/18/2009 after injection. ous vessicles at injection site, pain and burning 3/13/2009 3/25/2009 ve first dose of Rotateq after 15 weeks of age on 3/20/09. Infant has had no untoward affectsYwhen nurse3/20/2009 checked with the parent the next mitting this report per patient's primary Y care physician's request. Patient was hospitalized andUwas given Pneumovax 3/16/2009 3/18/2009 prior to discharge on 3/ rash broke out the night of the vaccination on elbows, moving the buttocks and then ankles. UFeet sweating profusely. ### Lasted ### about 3 week erythema, plaque lesion; mild tenderness; no fevers, no chills, no airway compromise; treated Y with ALTABAX; 3/16/2009 no other 3/18/2009 problems reported. by pt to show nurse reaction. Pt told nurse that 8:30 A.M. 3/18/2009 - area became hot to touch N & itchy. 3/17/2009 1:30 P.M. -3/18/2009 Pt went to see school n and swollen all around back of arm approximately 5 1/2 inches long. Pt. states site itches. Y 3/23/2009 3/24/2009 of throat with difficulty swallowing, fever, Y weakness, red and swollen arms Y 2/13/2009 2/16/2009 Tdap left deltoid, 3-22-09: arm sore, fatigue, 3-23-09: pain in arm with movement swollen left axillary lymph 3/20/2009 node, tender 3/23/2009 to touch, 3-24-09: aiting in line about 15 minutes after receiving iz and fainted, hitting head on wall and floor. Received Y immediate medical attention. VSS. nl ne on reported yet. Misadministration 2 hrs ago. 3/24/2009 d Acute L arm swelling + redness. Was Y seen on 3/18/09 + started on Keflex. Was seen againY on 3/20/093/16/2009 redness + 3/16/2009 swelling had improved. Thurs. night Temp 105 Friday with HA Y dizziness Temp lasting till seen Tuesday - 100.1 in clinic. Y 3/18/2009 3/19/2009 d a fever 103-104 F on Sat 3/21/09.YHe also C/O abdomen discomfort X vomited x1 and backache. U 3/19/2009 3/20/2009 ght after getting vaccines started with Y chills, low grade fever and headaches. I called doctors Noffice told it 3/23/2009 was normal. 3/23/2009 Today 3/25/2009 Son n has been received from a physician Y concerning Y an approximately 12 month old (reported as Y "1 year") male who within the last few weeks n has been received from a health professional Y Ythrough the Merck pregnancy 6 registry concerning Y a 17 year 1/22/2008 old female 1/22/2008 who on 22-JAN-200 n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 23 year 1/26/2009 old female 3/16/2009 who was vaccinated wit
n has been received from a physician Y assistantYconcerning a 16 year old female Y with no allergies Y who on3/12/2009 12-NOV-2008 3/13/2009 was vaccinated wit n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 24 year old 4/26/2008 female patient 4/26/2008 with no known dru n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 25 year old 6/30/2008 female patient 10/5/2008 with no known dru n has been received from a physician Y concerning Y a children patient who Y on an unspecified date Y was vaccinated with the third dose of ROT n has been received from a physician Y concerning a child who on an unspecified date was vaccinated Y with the third dose of ROTATEQ (Lot was received via an author of a newspaper Y article on 19 March 2009. It is part of a cluster involving U one identified eight-year-old 1/1/2009 male pati e, vomiting approximatelyY36 hrs after Y vaccine administration. Y Admitted 6 Yto SICU on 3/21/09 for U observation 3/18/2009 and close3/19/2009 monitoring for Intraven ain - whole body - muscles stiff - jawYmuscles sore sore throat - needed assistance Y dressing -Ngetting out of2/3/2009 bed - etc. 2/5/2009 Used wheel chair and stered PENTACEL, PREVNAR and Y ROTATEQ Y3/16/09. Pt had 5 generalized 3 seizures on 3/17/09. Y Temp3/16/2009 100.1 rectally. 3/17/2009 4/2/09 MR receive RA given left upper arm 3/18. Increased Y redness and swelling around site 3/20. 7"x7" warm, U firm with vesicular 3/18/2009 lesions 3/19/2009 in center, with crusti U 2/27/2009 2/27/2009 e significant pain in arm at injection site. Y Had some redness around site the next day as wellYas some joint 3/17/2009 discomfort 3/18/2009 in wrist/hand. ttered papules -> Probable chickenpox Y *Child rec'd 2 doses of VARIVAX dose #1 age 12 mos. Y dose #2 age 9/26/2007 6 yr. 3/24/2009 n, red circle about 4" in diameter at injection site. Sore to touch. 2) Slight headache and same Y feeling I get 3/10/2009 if I eat food 3/11/2009 with MSG, surprised yr old immunizations on 3/18 noted swelling & redness on right arm 3/19. Also c/o fainting feeling Y with h/a 3/19 for several hrs that subside Red rash size, 2 " in diameter started Sat. AM some soreness. 2 days later still bright red, rash Y itching. No 3/20/2009 swelling. 3/21/2009 Dx localized reaction. P 3/20/2009 cine given March 12 3:00 pm March 16 low grade fever, tired, March 18 broke out in hives. March Y 16 - 183/12/2009 low grade 3/16/2009 fever March 18 bad hiv t injection site noted after administration of vaccine. 1 tsp BENADRYL given start: 2 doses ofY steroid for 3/19/2009 HS and next 3/19/2009 day AM. izure-no treatment Y Y 3/16/2009 3/19/2009 old male subject presented to the Healthcare Y Center for evaluation of a progressively disabling Y fatigue-like 8/9/2004 syndrome that he believed was ceived varicella vaccine at ages 19 months and 10 years -on 5/12/08-. The vaccine was administered in5/12/2008 the left arm2/23/2009 at 10 years of age, loc er vaccine, he ran a fever of 100-102 Y degrees F on and off for 6 days. On the 7th day after vaccine, Y he broke 3/5/2009 out in severe 3/9/2009 full-body hives ox #2 given on 3/17/09 and came back on 3/19/09 with (R) arm posterior redness and swelling. Y Tx: Ice daily 3/17/2009 to affected 3/19/2009 area for 20 mins an t injection site noted after administration of vaccine. 1 tsp BENADRYL given STAT 2 doses with Y steroids3/19/2009 for HS and3/19/2009 in AM. immunization on 3/12/09. Parent of child noticed pain, swelling on 3/19/09 came into clinic on Y 3/20 with area 3/18/2009 of redness, 3/19/2009 swelling and pain & swelling at injection site. Y Y 3/18/2009 3/19/2009 itching, swelling, fever at injection site Y and rash extending from deltoid to elbow on (R) arm. U 3/25/2009 3/25/2009 itching, swelling and fever at injection Y site and rash extending from deltoid to elbow on left arm. U 3/24/2009 3/24/2009 n has been received from a 22 year old white female consumer (medical assistant), for the pregnancy Y registry 4/11/2008 for GARDASIL, 3/1/2008 who on 11-A n has been received through the Merck Y Pregnancy Registry via a physician concerning a 19Yyear old female 4/21/2008 with a 4/21/2008 history of tobacco abus n has been received from through the Y Merck Pregnancy Registry via a nurse, concerning a 19 U year old female 9/7/2007 with a9/7/2007 history of asthma, and ness, tingling, tightness right side ofYface, could hardly open mouth. given two 12.5 mg. childNBenadryl strips. 3/21/2009 taken3/21/2009 to Goshen General Ho ceived Tdap (Adacel) on 3-23-09 @Y3:20 pm. He awoke @ 8 am on 3-24-09 with joint aches, N chills (hot,3/23/2009 cold, sweats), 3/24/2009 malaise, weakness N TO HAVE SEIZURES AN HOURYAFTER THE VACCINATIONS. I TOOK HIM TO THE EMERGENCY Y ROOM. 2/2/2008 WHERE 2/2/2008 THEY SAID THA ceived vaccine and reports not feeling well a few hours later. Symptoms began as a headache Y and bodyaches, 3/25/2009 and3/25/2009 later progressed to swe gan about 2 hours after receiving vaccine. No local, injection site reaction. She took a Benedryl Y and was 3/25/2009 clinically stable 3/25/2009 when seen. in for labs and for a Gardasil vaccination. She was vaccinated, and then while having labs drawn, Y she became### lightheaded ### and fainted. M LASTING APPROX. 3 MINUTES TRANSPORTED Y BY EMS TO ER. Y 3/25/2009 3/25/2009 s post administration of Varicella vaccine, pt reports swelling at site. Upon inspection, erythema Y and swelling 3/26/2009 noted3/26/2009 to the site. Denies any eived second dose of pre-exposure Y Rabies vaccine on 2/3/2009, and telephoned health department Y on 2/10/2009 2/3/2009with 2/9/2009 concerns over vacci , very edematous, erythmatous, painful. able crying for more than 3 hours. Tylenol did not help. Kept on crying in her sleep Y 1/19/2009 1/19/2009 iving vaccine patient became light-headed and dizzy. Pt. admits that this has happened before. Y She said 3/19/2009 she's not 3/19/2009 surpised that this happe second dose in series of Hepatitis BYvaccine on 3/18/09. Reported that she started vomitingYon 3/19/09.3/18/2009 Was treated 3/19/2009 at an Urgent Care fa RENCE WITH LIMB MOVEMENT LEFT LOWER EXTREMITY. REFERRAL: NEUROLOGY Y 3/11/2009 3/19/2009 ect of left arm at Varicella vaccination site has several clear filled vesicles. Arm warm, red and U swollen from 3/24/2009 shoulder 3/25/2009 to elbow. 5 inch by 5 i ceived his Tdap vaccine first. It took us 10 minutes after administration of the Tdap to determine N he also3/23/2009 needed MCV. 3/23/2009 This was administe 03, nausea, vomiting approx 8-10 hours Y after vaccination Y 1/5/2009 1/5/2009 e weakness, lethargic, muscule painYin all extremities. Continued to remain ill for Ymonths with N dizziness, stomach 9/2/2008pains, 9/2/2008 diahrea, numbness ax was ordered and administered to a 2 month old patient. No adverse reaction has been reported. U 3/25/2009
was reported via medical records forwarded by a lawyer and described the occurrence of Lyme N disease in 6/4/1999 an adult female 6/4/1999 subject who wa was reported by a lawyer and described the occurrence of stiff neck in a male subject Y of unspecified N age 5/4/2000 who was vaccinated with LYMER &S inc. numbness/tingling in hands/feet. Y 12/3/08 Y ER for intense pain5 in Y joints = Dilaudid. 12/5/08 N medical11/5/2008 center = constipation/MAALOX. 12/2/2008 1 er called 2 days after immunizations was given,Ywith c/o non-wt bearing 1 and swelling at site,Ybrought pt to 3/16/2009 office 3 days 3/18/2009 after with redness, s min of getting the shot, pt had hives,Ychest pain,Y difficulty breathing, 1had called 911, pt admitted Y to hosp. 3/24/2009 4/6/09 Received 3/24/2009 hospital medical rts about 14 hours after shots, pt was seizing inY his bed. 911 was called 2 /ambulance son to hosp U and pt 1/30/2009 taken to medical 2/5/2009 center (then trans ng today to report that on 3/25/09 bright red lump appeared on left leg where she received vaccines U at 1yr3/6/2009 wcc 3/6/09. 3/25/2009 No warmth, dime siz ebrile Seizure Y Y 3/25/2009 3/26/2009 ted local reaction. Y 3/24/2009 3/25/2009 with swelling to R deltoid. U 3/24/2009 2/25/2009 r, achy all over body and nauseated. Discussed possible reaction versus onset of viral illness. U To treat fever 3/24/2009 and push 3/25/2009 fluids. If not better by ess. induration pain. Since he got the vaccine. 0 fever . given Cephalexin - Benadryl - cold compresses. Y 3/23/2009 3/24/2009 hest 3 days after administration. Rash was clustered only in this area. Y 2/5/2009 2/8/2009 swelling and warm to touch. 10x8cm. Advised to ice and apply warm compresses, observe area U of erythema 3/24/2009 circle 3/26/2009 with marker, advised, m elt woozy approx 5pm afternoon he received vaccine. Has had headache/nausea & vomiting. U Vomiting3/24/2009 occurred only 3/24/2009 on 3/26/09. r injection - Pt c/o rash, swelling, itching @ site. Y 3/17/2009 3/18/2009 delayed. Redness, warmth and swelling around injection site, 4x4cm. Given antihistamine and N hydrocortisone 3/19/2009 cream. 3/24/2009 Local Rx started sam swelling and pain after she received a MMR vaccine on 3/19/09 in Lt. upper arm. Y 3/19/2009 3/19/2009 was reconstituted with sterile water and was given as a injection to the Lt arm. Y 3/23/2009 d inflammatory reaction, right thigh from Y upper thigh almost to knee with warmth and tenderness. Y 10/6/2008 10/6/2008 he left upper arm 2cm/3cm red rash round noted left upper arm tender to touch. 3/25/2009 3/26/2009 + minimal swelling @ site. Y 3/9/2009 3/10/2009 per right arm and neck and swelling upper right chest since flu injection 2/25/09. Notices pain U in upper right 2/25/2009 arm when he lifts things. d Tdap + Typhoid 3/9/09 for pre-travel immunization. Within 10 min of receiving vaccine pt c/o Y pain + swelling 3/9/2009 L posterior 3/9/2009 deltoid. Pt. denie d 8x15cm local erythema, induration in thigh. 3/23/2009 3/23/2009 d up to ER 2/27/09 after receiving shot Y at Hospital with fever 39 + C + Febrile seizure. HIB inYFB #3 & PCV#3. 2/27/2009 2/27/2009 Y 3/24/2009 3/25/2009 ng all over started and headache 45 minutes after shot received, but able to still function. Took Y Tylenol 1000 3/25/2009 mg about 3/25/2009 3 hours later due to n has been received from a Certified Nurse Midwife concerning a female with a penicillin allergy Y who on 01-FEB-2008 2/1/2008 3/1/2008 was vaccinated IM w n has been received from an office manager and a physician, for the Pregnancy Registry forYGARDASIL, concerning ### a 23 year old female w n has been received from Y a nurse practitioner Y concerning a 16 year old female with history of Y mild reaction 3/5/2009 (itching) to 3/5/2009 orange who on 23-D n has been received from a medicalYassistant concerning Y a 15 year old female who in approximately U March 10/1/2008 2008 and in October 2008, was n has been received regarding a case in litigation concerning a 4 year old male who on 13-OCT-2000 N was 4/25/2001 given a multi-vial (first) dose of R ated that right arm was swelling, warm, Y red and firm to touch. States child c/o hurting and swelling Y seemed 3/12/2009 to be increasing. 3/14/2009 Parent took chi n has been received from a consumer concerning her son (a "6 year old" male) with history of U gastrointestinal 2/1/2004 dysbiosis and high yeast leve n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated N with one dose of MMR II on an unsp n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated N with one dose of MMR II on an unsp as accidentally administered PEDIARIX (instead of PENTACEL) et Hepatitis B resulting in anUextra dose 3/19/2009 of Hepatitis B given. Patient was c , fussiness and swollen glands. Y 3/12/2009 3/20/2009 sis and lightheadedness shortly after Tdap administration, resolved after 15 minutes. Fever 103 Y by history 3/20/2009 18 hours after 3/20/2009 injection, lasted 2 d r pt. received vaccine she started c/o feeling tired. Pt had several weeks of fatigue symptoms Y that continued until ###Feb. 11/5/2007 2008. Several differ back, chest, abdomen with itching. Resolved OTC antihistamines. Y 3/16/2008 3/18/2009 after receiving immunization, injection site red, hot & larger in size. On exam: Right anteriorY thigh injection 3/20/2009 site is firm, 3/22/2009 slightly warm, & ten ng & redness at injection site 3-20-09 Tx. cephalexin 125 mg PO TID X 10 days. Y 3/19/2009 3/20/2009 ven Tripedia U2397BA instead of Td with pertussis. No adverse event reaction. Adverse reporting Y notified. 3/20/2009 Physician states that re-vaccina ven Tripedia U2397BA instead of Td with pertussis. No adverse reaction. Adverse reporting notified. Y States 3/20/2009 that re-vaccination was not requ se problem- Pt was given DTAP Tripedia U2397BA instead of Td with pertusis- was told revaccination not3/20/2009 needed. om left thigh red, hot and swollen since Y vaccine given on 2/25/09. U 2/25/2009 2/25/2009 om left upper arm with erythema, hotYelevated rash 3"x 2 1/2 ". 2nd degree to vaccine area. U 3/18/2009 3/18/2009 d headache within 2-3 hours after Typhoid Y vaccine. Within 24-30 hr joint paint in hips,shoulders,elbows N and 2/23/2009 knees. Elevated 2/23/2009temp at 72 hou LATTER PART OF FEBRUARY Y PATIENT Y REPORTED Y TO LOCAL60 EMERGENCY ROOM WITH U COMPLAINT 12/3/2008 OF WEAKNESS 3/1/2009 AND LEG P
SSIC LESIONS, BUT HAS RECIEVED 2 VARIRAX AND THE DISTRIBUTION AND ITCHINESS U ARE C/W 6/19/2007 CHICKENPOX. 3/25/2009 es and Fatigue increasing in first 6 months Y after, leading up to dizzy and fainting spells, low blood N pressure, 4/24/2008 and Migraines. 4/24/2008 Still experiencin n to have TB test read 3/13/09 1300. Rt deltoid where Tdap injection had been given "circle slightly Y larger3/11/2009 than a quarter 3/13/2009 is red, warm to tou S ADMINISTERED IN AM ON 3/24/2009. T/C FROM MOC 3/27/09 AT 9:15 AM TO REPORT CHILD C/O 3/24/2009 HER LEFT 3/27/2009 ARM ITCHING. aRM DM, HTN, HLD, BPH p/w weakness that started Y yesterday midmorning. 18 He firstYfelt weak during N work, when ### he noticed ### that he could not PAIN LEFT SHOULDER SINCE INJECTION- POSITIVE RASH N 2/25/2009 3/1/2009 ved vaccine on Fri. She did not experience Y any adverse effects until waking up the next day.Y She was dizzy, 3/20/2009 had some 3/21/2009 episodes of rapid h 3rd 2009 my son recieved the Varicella vaccine along with the Hepatitis A and MMR vaccine. U Seven days3/3/2009 later he had 3/10/2009 a slight fever aroun headache from day after vaccine 4YMarch 2009 to 12 March 2009. Accompanied by fever (101 Y deg), chills, 3/3/2009 burning 3/4/2009 eyes, cough, sore thro ented to er on 3-20-09 with a full body rash andYfever of 105 F. Admitted 6 to hospital the nextYday. currently 3/16/2009 the rash3/21/2009 has faded, no temp., l e. After receiving Hepatitis A IM 0.5ml Y injection the nurse noted that the patient was not breathing Y with his3/20/2009 eyes rolled 3/20/2009 back and body had be nd shoulder very sore, swollen, difficult to move arm or shoulder. SiteYreddened, swollen raised, Y warm to3/24/2009 touch for several 3/25/2009 days. 4/28/09 R me red, inflamed, sore, patient developed fevers Y 3/5/2009 3/6/2009 inoculated with 6 separate vaccines at approximately 3:40 p.m. and after about 2 min., MomYnoticed that3/26/2009 child's face 3/26/2009 had broken out with h t started at the site of the pentacel injection and then extended to the length of the leg, the other Y leg, the3/26/2009 arms, the trunk, 3/26/2009 & the face; red/pin shot was given, her legs started teitching. Y TheYdoctor told me this 26 was normal. ItYkept up, got N worse where 12/9/1999 she would turn### blue, eyes bulge & induration on left arm measuring 3 1/2 X 5 1/2. Y 3/25/2009 3/26/2009 r, injection site pain, redness, swelling, Y pain in eyes Instructed to see physician Y 3/24/2009 3/25/2009 ed the following from a consumer via the agency on 12 MAR 2009: A 58-year-old female patient, N was vaccinated with FLUVIRIN i.m. in Oc d with 2 doses of 2 month immunizations < 28 days no adverse reaction reported @ 5 days.Y 3/23/2009 high and red area both size of a dime. No swelling of the leg. Applying cool pack and TYLENOL. N 3/24/2009 3/25/2009 d raised blister like lesions with erythema base at site of injection (clustered), then dried and Y became flesh 2/19/2007 colored. No 3/13/2009 fever, no other lesion F at 11 PM, following immunizations Y (PEDIARIX, HIB, PREVNAR, ROTATEQ) in the morning. Y 4/7/09 Received 3/26/2009 ER3/26/2009 medical records of 3/2 wollen @ injection site with mild painYinduration measured @ 4 X 4, mom was told to apply cool U compress 3/24/2009 to site. Admin. 3/26/2009 BENADRYL 1 tsp leg with large warm erythematous Y area tender small rash macular to same leg lateral side, two U days after 3/24/2009 vaccine. 3/24/2009 Treated with KEFLEX 1 der joint pain with occasional low grade fever at night. N 2/27/2009 2/27/2009 and swelling at injection site pain through shoulder, arm, 50 mm x 50ml L deltoid. U 3/23/2009 3/24/2009 eived IMOVAX IM on 3/26/09 on L deltoid. Reports severe pain and knot at injection site andYlimited range 3/26/2009 of motion3/27/2009 L arm at 9am on 3/27/ a of swelling & redness in deltoid area of left arm. Y 3/17/2009 3/20/2009 ent BOOSTRIX instead of HAVRIX along with IPOL, MMR, VARIVAX and DTap. Y 3/24/2009 fter GARDASIL (#2) Pt developed acute respiratory problems. "Lack of breath" after thanksgiving Y dinner. ### ### nausea, sweating - soon after injection - Pt put head between legs - pt felt better in 10-15 minutes. Y Offered 3/27/2009 pt. cold3/27/2009 water - pt said she wa ction - redness and induration on left deltoid. N 3/24/2009 3/26/2009 7/09 for "diffuse maculo - papular rash "from abdomen down -slight "scaly" feel to it - macular rash on bottom 3/26/2009 of feet.3/27/2009 MMR began screaming, writhing and Y complaining of arm pain (not at site of injection which Y was not inflammed) 3/25/2009 screamed 3/25/2009 x 3 hrs, had feve ought patient in stated that his R leg was swollen. Pt was given injection on 3/18/09 on his RUleg was his 3/18/2009 IPV and DTP. 3/20/2009 Dr look at Pt and inf tingly warm feeling in L fingers (1st and 2nd digits). U 3/27/2009 3/27/2009 at injection site, redness and swelling Y around elbow and an overall sick feeling. Y 2/25/2009 2/26/2009 Y Y 2/26/2009 02, irritable. S/S started pm 3/23/09. Redness, warm to touch right thigh edema. Left thigh edema Y and "knot" 3/23/2009 present 3/23/2009 treated with Tylenol. d HPV (GARDASIL) #2 in L deltoid. Here for TI DM follow-up, not acutely ill. Within < 1 min, Y pt c/o pain, 3/26/2009 and erythema 3/26/2009 noted. I was called in U 3/10/2009 3/21/2009 at injection site, redness and swelling Y around elbow and overall sick feeling. Y 2/26/2009 2/27/2009 s given but it was suppose to be a DTAP due to patients age. 3/19/2009 nausea, headache, slurred speech.Y 4/17/09 MR received from PCP from 3/25 to 3/27/2009. U Seen for PE 3/25/2009 and vax 3/26/2009 3/25/09. Seen 3/26/09 f receipt of FLUSHIELD Lot #4998274 Y in 1999 to her left deltoid. The next day she noted fine Ypruritic red spots 10/8/1999 to bilateral 10/9/1999 cheeks progressin nt reported receipt of IM influenza vaccination Y at NMCP while working the ER in 2002 or 2003. Y He denied 12/7/2007 any illness 12/8/2007 (URI) prior to this vac er injections, raised, red area around injection sites. Advised to apply cool compresses, and Yadministor 13/27/2009 tsp oral Benadryl 3/27/2009 every 6 hours a ZY AND LIGHTHEADED, FELT BETTER ONCE SHE LAID DOWN ON THE EXAM TABLE FOR Y ABOUT3/27/2009 20 MINS 3/27/2009 EPORTED TO PEDIATRICIAN Y ABOUT HIGH FEVER. Y TYLENOL NOT 53 Y WORKING. BY 2/28/09 U FEVER HIT 2/17/2009 103.7. TESTED 2/23/2009 POSITIVE FOR Flu vaccine on 3/12/09. Had R leg pain starting on 3/18 and fever on 3/17. Seen in the office U on 3/19 and 3/12/2009 noted to3/18/2009 be walking slowly on to
cinated with MCV4 (MENACTRA) 3/24/09, Y returned 3 days later with swelling and pruritus ofYinjection site. 3/24/2009 She was3/25/2009 treated with Benadryl. to severe hives, relieved by antihistamine; severe itching, redness and swelling at injection site Y for 24 hours. 3/27/2009 3/27/2009 ves on ankles and lower leg, relieved by antihistamine. Itching at injection site for 24 hours. Y 3/27/2009 3/27/2009 fever-102, chills, body aches, mild headache. Soreness in arm. Symptoms lasted 48hrs, although N fever 8/26/2008 lowered to 8/27/2008 100 on 2nd day.11/08-p ful, hot to the touch, egg sized knot @ injection site. Fever up to 100.8, chills, body aches,generalized Y weakness 3/25/2009headache,nausea, 3/26/2009 loss of ceived shots Dec. 29th, seizures Y started Y that weekend Y following, progressed 6 into Y5-10 daily, N mostly rt. sided jerking ### turning 1/4/2009 blue and eyes g 03.5 at 0130 in the AM on the day after Y the shot, that would not go down w/ Tylenol, Motrin U or tepid baths. 3/23/2009 Fever stayed 3/24/2009 around for 3 days ort received from a health care professional Y on 13 March 2009. The reporter stated that two of N his patients "got ### the Flu" 3/5/2009 after receiving FLUZ ort received on 19 March 2009 from Ya consumer who is the patient's parent. A male patient had received DTaP when he was an infant (man ort received on 19 March 2009 from Ya consumer who is the patient's aunt. A female patient had received a DTP vaccine (manufacturer, lot R upper arm injection site. Headache, nausea, myalgias, arm pain, itching. Prescription for hydrocodone Y 3/19/2009 and prednisone 3/20/2009 given. high red and swollen over entire lateral thigh from knee to hip. Treatment per Dr. > ice and Y watch for further 3/25/2009 developments 3/26/2009 3-30-09 I spoke d 3/9/09 - on 3/14/09 mother noted fine red rash on face, abdomen, neck trunk & upper legs,YNo treatment. 3/9/2009 3/14/2009 ought patient to the clinic on 3/23/09 to be evaluated by RN. Child was "covered" in pox. Some Y were still3/17/2009 in the vesicule 3/20/2009 stage, but most we and swelling LUD. Warm to touch. Soreness X2days. Mother states applied ice and gave TYLENOL Y for 3/3/2009 low-grade fever 3/4/2009 X1day. & swelling on arm - right side. Y 3/23/2009 3/28/2009 2 degrees) multiple muscle aches, mild Y nausea was seen and released from ER 3/25/09 stillUhas muscle3/23/2009 aches & erythema 3/25/2009 around injection lled 2 days after vaccine to say that vaccine site " reddened and raised" (erythema) starting Y about half dollar 3/18/2009 in size3/20/2009 and moving "to a much on, large area of redness and swelling at site. (baseball size) + pain+ itch + fever 102-103 degrees, Y 5x within 2/23/2009 6 hours 2/23/2009 of injection. Resolved fter immunizations, child had red, swollen Y left deltoid. Also c/o HA & burning throat & not feeling Y well. Parent 3/18/2009 took child 3/19/2009 to Dr. on Fri, 3-20rmation was received from a health Y care professional on 09 October 2008. A 35 year old pregnant female 9/22/2008 with no reported### obstetric history was received on 23 March 2009 from a health Ycare professional. A 4 month old female patient received 2/11/2009 ACT-HIB lot2/12/2009 number UF516AA (Sa n has been received from a consumer concerning his son, with no pertinent medical history N and no known2/1/1991 drug allergies, who in February 1 n has been received from a consumer Y concerning his 12 month old son with no pertinent medical U history and no drug reactions allergies wh n has been received from a consumer concerning her son with no medical historyY or drug allergies U who was vaccinated with the booster do n has been received from a registered nurse and the mother of a 9 month old male who on 10-DEC-2002, U 3/5/2003 05-MAR-2003 3/5/2003 and 10-JUN-2003 n has been received from a registered Y nurse and Y from a mother concerning Y her approximately U 35 months old son with oesophageal acid re n has been received from a physician for the pregnancy registry for GARDASIL concerning aY 14 year old 1/3/2008 female who1/3/2008 on 03-JAN-2008 was n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y15 year old female 6/9/2008 with no 6/9/2008 relevant medical his pain radiating from back to front 1 wk post vaccine. Denies rashes or other symptoms stateYwent to ER 2/25/2009 & was "ruled3/4/2009 out for heart problem 2mo shots on 3/9/09. Had seizure Y on 3/19/09. Febrile after seizure noted. Continued to beYfebrile X 2d. 3/9/2009 Fever broke, 3/19/2009 developed full body d with joint pain, & nausea vomited 1 time - joint pain worsened thru the day, difficulty walking. U Next day3/19/2009 less pain, still 3/20/2009 had nausea 3rd d. 1st immunizations 3/13/09 - PEDIARIX left thigh, HIB left thigh and PCV7 right thigh and RV5 N orally. Developed 3/13/2009 subjective 3/13/2009 temp few hours reports today that child is dizzy and has redness about size of a "fifty cent piece" some swelling U and warmth 3/3/2009 in area where 3/5/2009 TDAP was given h and hair loss. Y U 2/24/2009 2/25/2009 ZOSTAVAX 2-2-09, then developed rash to both lower extremities (below knees) on 2-7-09 U - Only fine red 2/2/2009 rash, no blisters 2/7/2009 - Describes ras with red patches and small white welts Y on upper torso and itching; within 5 mins of receivingUimmunizations. BENADRYL ### ### was given (1 1/2 ought child back to Health Dept due to redness, swelling and fever to right thigh. Client received Y immunization 3/16/2009 to area 3/17/2009 3/16/09. Mother appl received 3/16/09 5pm, Mother called Y Health Department 3/17/09 stated child broke out in hives Y on trunk,3/16/2009 back, "water 3/16/2009 blisters" under eyes. d redness, swelling, pain and welts on Y left arm from shoulder to elbow. Saw MD on 2-5-09. Given Y Z-Pak, NAPROSYN, 2/4/2009 2/4/2009 steroid and steroid c was reported by a lawyer and described the occurrence Y of arthralgias in a male subject of unspecified U age 7/13/2000 who was vaccinated with LYME ype rash on legs and arms, widespread and itchy. Y 3/25/2009 3/26/2009 Sore + tender - Hurt with movement 3-25-09 redness started on hours later but less tender 3-20-09 Y - still3/24/2009 red to arm,3/24/2009 warm to touch. 11.3 w. with redness, warm to touch, itchy to left upper arm. Instructed parent to apply BENADRYL Y oint. Cool 3/6/2009 compress 3/7/2009 2-3 times per day, T as given a second dose of Hep A vaccine Y and within seconds she fell backwards and hit her head. Her back 2/5/2009 remained2/5/2009 arched backward an gling in jaw and lips, very mild. 3/12/09, Y spasms in jaw and face itching. BENADRYL 25mg. U For one per day 3/6/2009 q6h prn 3/6/2009 itching. 3/18/09, office nd numb feeling in legs, itch associated Y with tingling. Also tight feeling in legs. U 3/25/2009 3/25/2009 s given a Tdap on 03/24/2009. When entering data on MCIR, imm clerk noted that Tdap wasYgiven per private 3/24/2009 provider 3/24/2009 on 11/08/2008. Th AS GIVEN HIB AND PCV7 ON 3/24/09. Y PT HAS A HISTORY OF SEIZURES. PT WAS CLEARED Y TO GET 3/24/2009 IMMUNIZATIONS. 3/25/2009 CHILD'S MO f injection site, low-grade temperature, muscle soreness, fatigue Y 3/27/2009 3/27/2009 clinic as walk-in with c/o non-productive Y cough with shortness of breath x 2w after the evening U after he 3/11/2009 got his Pneumovax. 3/11/2009He states he i
and bruising noted at injection site on March 27, 2009. Noted discomfort on March 29 to injection Y site around 3/24/2009 10, awoke 3/27/2009 client up, discomfo other call to Health Department on 03/30/09, Y received 1st HPV 07/29/08 at Health department, U no adverse 9/30/2008 reactions10/7/2008 after this vaccine. Rec AFTER RECEIVING THE ZOSTAVAX VACCINE THE PATIENT REPORTED PAINFUL RASH Y AT INJECTION 3/24/2009 SITE 3/25/2009 BUT ALSO BILATER swelling began left arm. 03/27/09 reddness and hot feeling occured with fever of 101.8. 03/28 N and 03/293/23/2009 swelling increased 3/26/2009with itching. De on Thursday, March 26, 2009. Initial itching within minutes. Friday, March 27 area around injection U site was 3/26/2009 swollen,3/26/2009 red and hot. Evening F and deep bone & body aches, site of shot swelling,(6 X5 inches) red and hot X 5 days so far. U Nausea X3/27/2009 4 days. Unable 3/28/2009 to sit up longer th Very fatigued, with severe swelling of arm from shoulder to elbow. Muscles in back of arm extremely Y tender. 3/24/2009 Ran fever 3/24/2009 alternating with ch aims "huge" bruise near elbow and quarter size bruise at injection site. Red in between bruises. Y Not painful, 2/13/2009 but states 3/16/2009 that she was on che pt of AVA # 1, TYPHOID, and SPV on 22 Jun 07, Y SM reported localized 5 soreness, low gradeY fever, muscle 7/25/2007 twitching and insomnia. ### Insomn h with significant swelling, urticaria 8x6cm area. Treated with BENADRYL 'X2 with improvement. Y 3/17/2009 3/18/2009 as given MMR and Varicella injection. Within 2 minutes of vaccine patient's legs swelled and Ya rash appeared. 3/30/2009 Was 3/30/2009 given 7.5 mg of BENAD about 3 hours, didn't want to be touched. Soft spot on head was hard. U 3/24/2009 3/24/2009 ction 3/18/09 left deltoid, 3/19/09 wife Y noticed red ring around injection site. Pt. didn't sleep all Y night due 3/18/2009 to left arm &3/19/2009 pain up in left side of n eaction at injection site 4 x 3 cm, + erythema + edema, TX BENADRYL, ice and CLARITAN.Y l over forward while sitting on the floor Y 4 hours after vaccination. Found to be breathing but blue Y lips and non-responsive. 3/9/2009 3/9/2009 Event lasted abou was given Mon 3/23/09 about 12:45PM Y Pt started with nausea, + diarrhea that evening 4PM. YSeen in ER3/23/2009 on (Th) 3/26/09 3/23/2009 Given 1 liter of IV d redness, swelling and pain at injection site on right arm. Y 3/28/2009 break - vaccinated 3/5/09. U 3/5/2009 3/28/2009 associated Varicella rash. Y ### 1/17/2009 ite reaction. Sore with in 12 hours, redness and increased pain by 24 hours mark, 2" x 3" redness, Y raised, 3/26/2009 warmth from 3/26/2009 the area. No fever. n at 32 weeks and 10 days (too late for 3rd dose to be given). U 3/27/2009 h swollen, red, warm to touch - consistent Y with cellulitis. Will treat with SEPTRA 1 1/2 tsp BIDUX 10 days 3/27/2009 and BACTROBAN 3/29/2009 topical TID x 10 t shingles around 3 days after the vaccine (March 20th is when she started having symptoms). U Patient got better after medications were giv ent received a pediatric dose of Hepatitis A, no adverse events, no treatments needed. Y 2/27/2009 n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 24 year ### old female ### with a history of n has been received from a physician Y concerning Y a 70 year old male 0 patient whoYon 11-MAR-2009 N was 3/11/2009 vaccinated with a dose of ZOSTAV n has been received from a consumer concerning Y his granddaughter 0 (a female patient of unknown U age) who experienced paralysis after ge n has been received from a physician Y concerning Y a 15 year old female 2 Y patient with atypical seizure N disorder 3/10/2009 (started3/13/2009 following an episode o n has been received from a nurse practitioner Y concerning a 25 year old female with no allergies Y who on 5/22/2007 22-MAY-2007 4/1/2008 was vaccinated IM w n has been received from a physician Y concerning Y an approximately 13 year old female, who on Y 29-JAN-2007 6/4/2007 was vaccinated 3/1/2009with the first d n has been received from a consumer Y concerning Y her approximately0 20 month old son with N no pertinent 5/11/2006 medical history 5/11/2006 and no known drug n has been received from a consumer concerning "three of her friend's sons" who were vaccinated U with MMR II (lot number, route and site n has been received from a consumer concerning a stranger's granddaughter who was vaccinated U with MMR II (lot number, route and site n has been received from a parent concerning her son via e-mail a male who was vaccinated U with MMR II and subsequently the child expe n has been received from a consumer reported "she knows several children (exact number is U unknown) who experienced a high fever and n has been received from the mother of her 12 year old son with a previous Pyloric StenosisUsurgery, who was vaccinated with a dose of M n has been received from a consumer Y via the internet concerning her 16 month old son whoNin January 2005, 1/1/2005 was vaccinated 1/1/2005 with a dose o n has been received from a consumer via the internet reporting that she knew of toddlers who U on an unspecified dates were vaccinated wit n has been received from a consumer concerning her daughter who on an unspecified date U was vaccinated with a dose of MERUVAX II. S ort received on 17 March 2009 from Ya literature collection. " A previously healthy 17 month old N boy was inoculated with FLUZONE SV '2005 us case was received on 26 March Y 2009 from another manufacturer. The initial reporter wasUthe consumer's spouse. A male patient receive states pain, erythema, and tenderness Y developed Y at sites of vaccines 2 given 3 days prior to ER U admission 3/25/2009 at hospital. 3/25/2009 Erythema & warmth s ruising and petechiae inYApril/May 2008. Y Petechiae Y on lower legs and 6 feet. 4/24/2009 MR received N for DOS 1/30/2008 2/17-19/2009 4/1/2008 WITH D/c dx: Im d chest pain, SOB and diaphoresis. YAdmitted toYclinic and diagnosed4 with MI. Troponins elevated, EKG normal, 1/30/2009 Cardiac 2/11/2009 cath primarily norm d 13 1/2 x 12 cm reddened swollen and warm to touch. Rub area 2 Hrs. and apply ice pack for U 15 min. for 3/26/2009 24 Hrs - then warm compress. reaction, red, warm to touch, raisedYarea 2 1/2 X 2 inches RT. Y 3/25/2009 3/26/2009 elling With mild erythema. Y Y 3/26/2009 3/27/2009 d a hot, red, swollen lump under skin where vaccine was given. Are marked with skin marker. U Patient advised 3/23/2009 to contact 3/26/2009 clinic if redness or around injection site. Low grade fever. Cool compress and TYLENOL prn. Y 3/24/2009 3/25/2009 r injection I got very hot and dizzy. I could not stand up. Health Dept had to lay me down. MyYblood pressure 1/16/2009 was very 1/16/2009 low, I was pale in col d rash on Both anterior thighs within 24 hours after vaccine slightly pink maculopapules on both thighs. 3/23/2009 3/23/2009
pain, swelling radiating up to neck and down to fingers.
N
2/19/2009 2/20/2009 3/18/2009 ately 48 hours after administration of Tdap + MCV4, Pt. had fever & didn't feel well. Could not Y pin point. 3/17/2009 16 hours later 3/19/2009 cried uncontrollably se event, dose given 3 weeks to soon. 3/20/2009 d low grade fever, arthralgias and red swollen area at injection site. Y 3/19/2009 3/19/2009 swelling and hot touch. 3/20/2009 3/21/2009 d in ED 3/11/09 with possible seizure. Per parent history lasted several seconds, child's eyesYrolled up, became 2/24/2009 stiff 3/11/2009 and poorly responsive. ction of pain, warmth, + erythema (7X 15cm) Y 3/18/2009 3/20/2009 arm red and swelling. Y U 3/17/2009 3/18/2009 len arm, bump, raised and hard. 3/24/2009 swelling of left arm. 48 hrs. after receiving Imm's. 0 temp. Y 3/25/2009 3/27/2009 Office visit - Dr. - Shingles on R forehead & scalp - mild - 2 wks. 12/23/08 - Office visit - Dr.Y- Pink eye 2/20/09 3/28/2007 - Office visit ###- Dr. - Shingles :40p seen for erythema 3.5 cm X 3.5 Y cm & sore. Right Axilla tenderness. R upper arm started Y 3-17-09 with 3/16/2009 pain in 3/18/2009 Axilla & progressed to i ale received DTAP, MMR, VAR, IPV, Y HEP A 3/27/09 no history of recent illness! h/o febrile seizures Y 3/28/09: 3/27/2009 pt sleeping, 3/28/2009 woke up @ 1AM hard knot. No fever or child. Did notYtreat with AX. Kept close eye on arm. Y 3/23/2009 3/25/2009 o left arm. Running temperature started Y evening after vaccine. Started on Ax on 3-20-09. Y 3/17/2009 3/17/2009 at injection site was warm to touch, red and very hard. Y 3/25/2009 3/25/2009 Y 3/12/2009 3/24/2009 l from mom got Imms (HIB and PVNR) Y 3-23-09. On 3-25 had a seizure in the car. He had been Y drinking 3/23/2009 a bottle, began 3/25/2009 shaking, and choki ately 15 minutes after receiving vaccine she started feeling shaky, clammy, itchy, KP 3-25-09Nnauseous, 3/25/2009 & became 3/25/2009 diaphoretic & light head ccine administration on 3-23-09 @ approximately 1645. She stated she was fine until 2200 that U night. She 3/23/2009 noticed hives 3/23/2009 on arms, legs, & a as given adult dosage of Hep A. 3/23/2009 le with generalized mildly pruritic maculopapulae Y eruption of the arms, sides, flanks/ lower back, Y legs, feet 2/18/2009 and hands3/5/2009 approx. 2 weeks after
Y 3/24/2009 3/24/2009 turned to office 3-23-09, after vaccine 3-20-09 with rash. Reviewed sx and hx with MD who U also saw patient. 3/20/2009 Diagnosed 3/21/2009 with viral EXANTH ceived Pneumovax 23 vaccine IM to right deltoid Y on 03/24/09. On 03/25/09 1 he presented with Y progressive 3/24/2009 painful swelling 3/24/2009 and erythema a mth and induraton at vaccine site. Tender aillary nodes. U 3/28/2009 3/29/2009 POL on 3/27/09 and developed hives Y within 24 hrs Y 3/27/2009 3/28/2009 inistration of GPV, patiient expressed feeling weak and nausea. Provider was notified and patient Y was taken 3/3/2009 to tx room. 3/3/2009 Initial BP was 104/6 ted to have a thigh mass one monthYafter administration of hib3 and flu vaccines. The massYcontinued to grow### and was removed ### on 12/23 CALL A DAY AFTER AND COMPLAINS Y OF DIFFICULTY IN BREATHING, HEAD PAINS, SWOLLEN Y TONGUE/THROAT, 3/24/2009 AND LEFT SID 9 Mom reports to IM clinic at 2nd shot Y visit, thatYpatient developed projectile 1 vomiting & abd.Ypain about 24 hours ###after his ### 1st set of shots. rm after Tdap vaccine given on 3/16/09. Small amount of redness noted after injection. About Y 3/19/09 employee 3/16/2009 noted 3/19/2009 increase redness, sw d a tactile fever for 3 days after the vaccine and then developed a blanching, macular rash on Y the face, torso, 3/24/2009 arms3/24/2009 5 days later. eloped localized eythema of injection site approx. 4-8 mm per Mother of client via phone call.Area U reported 3/23/2009 as triangular 3/23/2009 in shape with bruis IA/HIVES- TREATMENT ATARAX 10 MG PER 5 ML-1 TEASPOON EVERY SIX HOURS. BAKING Y SODA OR### OATMEAL### BATHS. wing was reported by the client: Vaccines Y given on 03-09-2009 in the morning with complaintsUof soreness3/9/2009 at the injection 3/9/2009 site and a mild he prox 5 min after vaccination received. Recovered quickly. Y 3/30/2009 3/30/2009 clinic and later seen on 3/30/09 forYan urgent visit for complaints of non-pruritic red rash onUleft side of trunk 3/24/2009 - Per PCP 3/27/2009 physical exam: ery r for three days (T. Max 103.7f Y 3/28/2009 3/29/2009 1/31/2009 Y Y Y 9 Y N 1/15/2009 1/30/2009 s began the same evening I received Y the influenza vaccination given at work site. Fever, body N aches, sore throat, ###weak, lightheaded, ### dizzin g warmth, redness injection site 2. Left axilla pain -> tender enlarged isolated 2.5 cm lymph node U 3. Non-tender, 3/26/2009 sl. irritated rash - both axill erythema rash, primarily to trunk and bilateral legs. Y 3/26/2009 3/30/2009 barky cough, hard time breathing red Y welt on L arm. Y 3/30/2009 3/31/2009 dministered on 3-20-09 in AM. By afternoon tips of fingers hurt. Played basketball after school. Y Noticed3/20/2009 tips of fingers 3/20/2009 had blisters. Some o body ache, weakness, pain in left arm, behind shoulder and left upper chest. Pain and discomfort N with ROM. thigh: No tx. Telephone advice given. Right thigh. Y 3/24/2009 3/26/2009 ger than a bean) tenderness, slight redness and warmth near L shoulder. U 3/27/2009 Y U 3/30/2009 3/31/2009
round mouth with swelling spreading Y over both cheeks over period of several days. Applied steroid Y cream 3/19/2009 which helped 3/19/2009 -> course last 5 da hrs after receiving 6mo vaccine hadYvomiting with associated limp/pale episode. No seizure activity. Y Returned 3/16/2009 to baseline 3/16/2009 within 60-90 min. ns on labia - lidocaine jelly, ACYCLOVIR 200 mg/ 2tsp TID 5cc TID. 2. Fever 100.2. 3. Coughing U for 3 days. 2/27/2009 4. Colitis 3/3/2009 x 3+ days. 5. Pharyng ve nodule. No sign of infection. U 3/18/2009 3/28/2009 minutes after administering HPV vaccine, patient fainted. No history of fainting in the past. Y 3/31/2009 3/31/2009 ought her daughter in @ 1630, with a nodule on left leg about the size of a quarter. I referredUher to PCM5/21/2008 as W/I. Patient 5/21/2008 didn't seem to hav spot, raised area, Lt upper arm where varicella was administered. Dr checked area on 3/31/09. Y 3/30/2009 3/31/2009 ic reaction, This case was reported by a healthcare professional via a sales representative and U described 3/12/2009 the occurrence 3/12/2009 of nonspecific rea ction, My daughter immediately put her head back and said I don't feel very good. I feel like I'm Y going to faint. 3/31/2009 The nurse 3/31/2009 was standing behin n has been received from a pediatric Y medical records and a physician concerning a 15 weekNold bottle fed female ### with 1/19/2009 no known drug aller n has been received from a registered nurse concerning her 1 year old son with milk Y allergy N and no other medical history who was vaccinat n has been received from a consumer concerning her 42 month old son with "gene mutations" N who "when 12/1/2006 he was 15 month old" in approxi n has been received from a consumer Y via the internet concerning her now 5 year old son who N on an unspecified date was vaccinated with n and follow up has been received from a physician for the Pregnancy Registry for GARDASIL Y concerning1/9/2008 a 18 year 1/9/2008 old female with sulfon n has been received from a nurse for Y GARDASIL, a Pregnancy Registry product, concerningUa 21 year old 1/15/2009 female with 1/15/2009 no medical history o n has been received from a medicalYassistant concerning a 16-year-old female with no medical Y history or3/25/2009 allergies who 3/25/2009 on 25-MAR-2009 w n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from someone concerning 2 n has been received from a physician concerning a 19 year old female who was vaccinated U with unknown how many doses of GARDASIL. aving severe stabbing ache in shoulder & upper arm approximately 2-3 days afterYvaccine. Began N having, numbness ### & tingling. ### Discolorat Cm red, raised, hot area c/o itching Yat the site starting the next day. TX: Ice, Benadryl and Hydrocortisone U 3/25/2009 cream. 3/26/2009 ceived PNEUMOVAX vaccine on 3/11/09. contacted outpatient primary care clinic on 3/30/09 N with the following 3/11/2009 - c/o3/30/2009 non-productive cough eloped ROTAVIRUS infection after receiving vaccination. Y 1/7/2009 1/13/2009 d to clinic the day after receiving vaccine. Y Per her report approximately 30 min after receivingY vaccine her 3/24/2009 arm started 3/24/2009 swelling, she felt feve possible mixed with IPV form submitted per CDC recommendations No Reaction per client's parent. 3/30/2009 Mom states light rash on face yesterday prior to vaccines (not mentioned or noticed prior to injection) this 3/31/2009 morning (4-1-09) 4/1/2009 child has fine ras heavily speckled line or band going up his arm from the injection site. U 3/12/2009 3/13/2009 ame dizzy after vaccination Y 3/30/2009 3/30/2009 vers a day, bad headaches with fever, sore throat, stopped up nose or runny, weak, upset stomach U and vomiting, 2/3/2009pale 2/9/2009 skin, cried because as given flu shot and pneumonia vaccine Y right before discharge. Patient reports that when he U got home 3/15/2009 he began experience 3/15/2009 generalized p d one-sided facial palsy with a significant Y droop that affected the eye early in February of 2009. Y Went to 1/13/2009 ER. Significant 2/10/2009 change in sensatio eloped fever and had febrile seizureYat home Temperature 102. Child is fine today. Fever was Y treated in3/23/2009 ER 3/31/2009 ular rash over chest, abdomen, and back within 15 minutes of injections. No treatment administered. U Still 3/31/2009 present early 3/31/2009 AM the following da LOST CONSCIOUSNESS AFTER RECEIVING THE LAST OF 5 VACCINES. CLIENT WASYSITTING IN3/31/2009 CHAIR AND 3/31/2009 HEAD FELL BACK. post-vaccine: egg-shaped area of rash on arm below shot site; @ 30 hrs post-vaccine: sudden Y onset of moderately 3/28/2009 3/29/2009 severe muscle/joint pai ver vaccination given on 3/27/2009 @ 10:20 a.m. Student returned to Clinic at 11:35 a.m. forYswelling of3/27/2009 lower lip, left 3/27/2009 lower lip to middle of ECAME DIZZY AFTER RECEVING THE LAST OF 3 VACCINES. CLIENT REMAINED IN CHAIR, Y FEET3/31/2009 ELEVATED. 3/31/2009 DIZZINESS ABATED after varicella vaccine #2 developedYredness and swelling at injection site. 48 hrs post vaccine Y developed 3/29/2009 increased3/30/2009 redness, swelling and E - REDDNESS AND ERYTHEMA LEFT Y ARM DISTAL TO THE INJECTION SITE AREA - C/O HEADACHE 3/30/2009 AND MUSCLE 3/31/2009 ACHES - SAYS emp up to 103 - today 102.6 - left arm hurts and slightly swollen - left hand pain "tingles" - fatique U - today3/31/2009 slight cough 3/31/2009 - eyes watery - no ap s:Shortness of Breath, Racing Heart, Y Anxiety, some Dizzyness, These symptoms got progressively N worse3/7/2009 over the course 3/8/2009 of 2 weeks. The iarix instead of DTaP. No adverse Symptoms and do not expect any. Y 3/24/2009 3/24/2009 to clinic one day after receiving vaccinations with Right upper arm reddened, swollen and warm U to touch.3/30/2009 Patient stated 3/31/2009 tenderness; denied lts under skin, muscle feels very tight even after constant massage. Also high fever of 102.9 Udegrees. High 3/31/2009 pain in legs 4/1/2009 - enough to prevent ceived Influenza vaccine (adult dose) instead of Hepatitis B vaccine. He is now 12 weeks of U age. To date, we have ### not experienced ### an adv ported redness for a few days. This progressed into pain and tingling in arm, like "ants crawling U on my arms". 2/11/2009 Still itching, 2/12/2009 but was told my M hot was given. Pain starting in arm of injection site, quickly moved to shoulders and neck. Within U two days 3/26/2009 it included 3/27/2009 the entire back and h spontaneous report of seizure, influenza, wheezing Y and fever was received from a physician Y concerning a 27-month-old ### 11/2/2008 female subsequen ven GARDASIL vaccine was informed would have to wait 20 minutes to be observed, pt wasYsitting on exam 3/27/2009 table after 3/27/2009 injection passed out become fussy, crying - had to console approx 2 hrs- 3 vaccines were given crying lasted forYapprox 9 hours3/18/2009 Mom had 3/18/2009 to hold Pt constantl Y 3/17/2009 3/22/2009 Y N 3/31/2009 4/1/2009
rea @ injection site. Y 3/23/2009 3/24/2009 etting a rash of small red bumps on my face on Friday 3-27-09. Saturday rash had spread to Yneck and chest. 3/13/2009 By Sunday it had spread to ar woke up the morning after the injection with "puffy face and L side of neck" which turned into U a rash. States 3/16/2009 also had 3/17/2009 some rash on stomac ain, induration warmth at injection site with redness at site and extending distal to injection site U to elbow. 3/25/2009 3/25/2009 accines 10:30 am, began with vomiting, uncontrollable crying and apnea 45 min-1 hr later. Heard Y pt on phone 3/19/2009 - screaming, 3/19/2009 high pitched cry immunization patient shaking, teeth chattering / cold - felt frozen under 3 blankets. Doesn't Y believe he had a fever. ### Achy. ### Fatigued X 12 ho after VARIVAX developed varicella lesions on arms, legs, mouth. Y 3/23/2009 3/25/2009 n has been received from a physician Y concerning a 16 year old female patient who completed Y GARDASIL series. The patient was HPV pos n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning a 20 year old female patient with n n has been received from a consumer regarding a case in litigation concerning his child whoUwas diagnosed with autism shortly after receiv n has been received from a parent concerning his 6 year old son who was vaccinated with MMR U II (Lot# not reported). The patient was on us case was received on 26 March Y 2009 from a consumer (patient's parent). A 23 year old male N patient with seasonal allergies received AD 74yo, Male, came to ER with - Had flu Y shot yesterday, this am developed rash right thigh, now U diffusely spread 12/3/2008 to both 12/4/2008 legs, chest arm. Eyes loss of control - 9-13-08. Hospitalized five days. Y Diagnosed virus syndrome. 4 Home doctor said U had Guillain 10/2/2008 Barre syndrome. 10/3/2008 4/8/09 Receiv seminated encephalomyelitis Y about Y 1 week after Y shot. Fever started. 27Extreme irritability and screaming. Y Altered 12/2/2008 state of consciousness ### 12 d ed rash over trunk, face & extremities Y with classic pox like vessels with erythematous bases. Y 3/20/2009 3/26/2009 m erythema and induration. Y veloped fever up to 103.2 F rectally on 3/26/2009 - and an erythematous papular rash - descendant - started 3/17/2009 on face on 3/27/09. Fever res 12 hours later. Headache, couldn't move Y arms and legs. Y 3/26/2009 3/27/2009 ent needle was in right deltoid, pt started to waver w/eyes rolling back. Pt began to wobble to N a fro. I helped 2/9/2009 him to his 2/9/2009 seat. Water was giv about 15:40. Approximately 17:30 became Y dizzy light headed, face tingled and broke out in aYsweat. Lasted 3/24/2009 about 303/24/2009 min. Later arms and le a of redness and induration on L upper arm approximately 12x10 cm. 3/18/2009 f PREVNAR were administered on the same day. Patient's Dr. notified @ 11:30am 3-25-09. Y 3/25/2009 adache, neck soreness, vomiting, nausea, Y dizziness and fatigue N 3/24/2009 3/25/2009 poor appetite, nausea/vomiting, left arm pain and soreness. Unable to attend school since 3-30-09. N Out of3/30/2009 character 3/30/2009 for this child. Arm pain ine hives for 15 min. Then resolved. Clear lung. Y 3/26/2009 3/26/2009 01 degrees, rubbing @ head, increased Y fussiness There is a question of secondary viral illness Y 3/31/2009 4/1/2009 n 3/18/2009 pt. awoke with temperature Y of 105.4 degrees @ 11 AM after waking up c/o entire Y body twitching, 3/17/2009 and increased 3/18/2009crankiness. 3 TDAP vaccine 3/19/09. Developed Y sore arm within 24 hrs became indurated, red, hot in injection area around 3/19/2009 48hrs, 3/21/2009 felt flu like (tired, achy ceived Tdap on 3/23/09. Came into office today 3/30/09 arm slightly red, small lump at site. Patient N states 3/23/2009 "it is much3/24/2009 better than it was. Arm
gan to develop around the injection site and spread to my chest, neck and back. Rash began approx. 4 days 3/8/2009 ago and 3/18/2009 has steadily worsene t B/P 106/60 Temp 98.4 Pulse 72 Resp. 20 - c/fired, dizzy. c/o feeling hot and sweating on & off. 1245 T3/27/2009 malise 1245 3/27/2009 T.C. to mother child ta breakthrough. Had 2 doses of VARIVAX (3-2-04 & 3-4-08). Diagnosed with varicella in our office U on 3-28-09. 3/4/2008 Had 30 3/24/2009 vesicles. No fever. rned pale a minute after receiving all 4 vaccines, then her lips turned blue 1/2 minute later, she Y had a seizure, 3/13/2009 with her 3/13/2009 eyes flipping upward eloped diarrhea evening of 3/6/09. Fever Y Sat-Mon & Tues. which mo. kept controlled with Tylenol & Advil. 3/5/2009 Caught runny 3/6/2009 nose developed ov TdaP 3/16/09 Developed symptoms 3-17-09. State fever 104.0 F orally, chills, muscle aches, Y arm deltoid 3/16/2009 red. Taking 3/17/2009 Tylenol. given (Rt) ar ed tightness in throat 30 min. after receiving vaccines - Took BENADRYL and felt better after Y 1 1/2 hours. tates he was in this office yesterday, received pneumonia vaccine in rt arm. Report this was Y he second pneumonia 3/25/2009 vaccine. 3/26/2009 States approx -103.8 and diarrhea. Y Y 3/31/2009 4/1/2009 ates he felt some numbness and tingling in my 3rd and 4th digits in lower left arm along ulnaUnerve. States 3/12/2009 he is experiencing 3/12/2009 mononeuritis U sy (R). Pt states a few hours after vaccine Y she noticed Y drooping on right 4 side of face - hospitalized. N Referral 3/23/2009 to neurologist. 3/23/2009 Not resolved at v al swelling @ site of KINRIX Y 3/30/2009 3/30/2009 diameter nodule, palpable. Y U 3/31/2009 4/2/2009 tal body itching for 1 1/2 months after Y the injections. Flushing of skin, resolved in ER, MD and Y allergy visits. ### ### erythematous rash and small vesicles around vaccine injection with out any treatment rash cleared Y in 3 days 3/25/2009 with out3/28/2009 any signs. er arm swollen, warm to touch, sore, mildly red. Treating with cool compresses and IBUPROFEN Y as needed. 3/13/2009 4/2/2009 TETANUS shot a week ago, then started having pain in the area of the injection, but then in the N last couple 3/23/2009 days or so 3/24/2009 has had pain, swellin 2/24/09 Fever by report from mom.Y2/27/09 Patient Y began experiencing 4 ankle pain. 2/28/09YAnkle began 2/20/2009 to swell with 2/22/2009 redness. 3/1/09 Pa RECEIVED 7 VACCINES ON THE 26 OF MARCH. CLIENT HAD POSITIVE PREGNANCY TEST U TODAY3/26/2009 IN OUR ADULT 4/2/2009 HEALTH CLINIC
and erythema (~4 inches red ring in diameter) appeared on 03/06/09, 2 days after receivingYthe vaccine. 3/4/2009 Patient also complained of swelllin in office for a 6 month physical on 9/09/08. Prior to adminsitering vaccinations black dots were U noticed on7/8/2008 the child's left thigh. It was noted ening of the shots, she developed low grade temp that increased the following day to 104F. U She also developed 3/31/2009 emesis 3/31/2009 (NBNB) x 3 with la ll on 4/2/09 stating that on Monday March 30 she received the Shingles vaccine. She did not U have any problems 3/30/2009for3/31/2009 greater than 24 hours gluteal pain starting four days after vaccination and lasting for four days. Pain relieved with anti-inflammatories. Y 2/25/2009 No other 3/1/2009 symptoms. Decli d a vaccination from an expired vial of Hep B. (exp date was 2-2-09). Parents were advised to revaccinate 3/12/2009 the child. No adverse reactions oral typhoid capsule as directed and within several hours had vomiting, diarrhea, fever and fatigue. Y Symptoms 3/6/2009 resolved 3/6/2009 by next day. Advis d full blown Shingles approximately Y 4 days following vaccination. Prescribed ACYCLOVIR, 800MG, ONE TABLET 3/5/2009 5 TIMES 3/9/2009 A DAY FOR 10 ived subcutaneous injections of MMR and Varivax on right and left thighs respectively usingUVanishPoint synringes. ### Black### dots noticed on b H PEDIARIX U ### ### ND ERYTHEMA TO RIGHT DELTOID Y 16.25 CM x 16.25 CM. ADVISED PARENT ON APPLICATION U OF 3/31/2009 COLD COMPRESSES, 4/2/2009 MED W\ arted to notice hives on the back of her neck, between legs and on wrist about 5 hours after U administration 3/31/2009 of the vaccine. 3/31/2009 Patient has been al reaction at the left deltoid - mild erythema, tenderness and edema. U 3/31/2009 4/2/2009 d about 5 hrs. after being vaccinated Y and still continues. He became very unresponsive at times. U He ended 3/26/2009 up getting 3/26/2009 dehydrated which ca U 3/18/2009 r of 106F, wheezing, upper right quadrant Y pain Y and lower right quadrant 1 pain. It lasted for 8 months. Y Treatments 8/29/2007 were 9/19/2007 antibioctics. 5/26/09 was reported by a consumer and described the occurrence of possible acute hepatitis in a female U subject of unspecified age who was vacc was reported by a pharmacist and described Y the occurrence of injection site soreness Y in a 29-year-old N female 2/11/2009 subject 2/11/2009 who was vaccinated was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age 6/1/1999 who was vaccinated 5/1/2000 with LYMER nding graduate school, this 40 year old member Y reported receipt of 7hepatitis A #1, influenza, and typhoid 8/5/1997 vaccinations 11/8/1997 on 11/7/1997. Medic d orange size lump/ swelling/ redness - sore to touch first 24h - used ice - advised use allergyYcrm & ice for4/1/2009 sx 4/1/2009 Y 3/26/2009 /2 inches red area with swelling, mild Y induration. U 3/26/2009 3/27/2009 ed ball under skin @ injection site that Y is painful DX: Cellulitis Y 3/31/2009 3/31/2009 5 min after GARDASIL Dizziness 30 min after vaccine still c/o dizziness, now on 4/2 , got vaccine Y on 3/31/09 3/31/2009 3/31/2009 izure. Temp. 105. TYLENOL. 4/30/09 Y scheduled for f/u MRI. Y 3/26/2009 3/27/2009 er gave child TYLENOL 0.4ml but did not take temp. 1pm Mom woke child for feeding. Mother Y stated he 3/26/2009 was upset, 3/26/2009 he could not decide if in joints, muscles - constant. Periodic nausea, periodic chest pain. N 3/20/2009 3/20/2009 bumps at injection site going down into underarm & side of back started date of injection & Y still present 3/19/2009 on 4-2-09 3/19/2009 itching at injection site right delt. PtYstates "feels like sunburn" U 3/28/2009 3/30/2009 redness and swelling of Rt triceps after Y DTAP. Moderately tender. This is a minor side effectU 3/31/2009 4/2/2009 right upper arm below injection site extending to medial arm. Warm to touch. Pt reported itching Y started3/31/2009 several hours 3/31/2009 later. Warmth note :00 PM - began experiencing rt. eyeYitching, burning, watery raw @ rt. corner of eye, later in N day blister appeared 3/25/2009corner 3/27/2009 of rt. eye went to D ection site, malaise, nausea, photosensitivity, headache, diarrhea and trouble sleeping. U 3/31/2009 4/1/2009 n has been received from a physician Y concerning Y a 72 year old male 0 patient with heart condition U who in August 8/1/2007 2007,2/1/2009 was vaccinated with n has been received from a consumer concerning her 4 year old son with no pertinent medical N history or drug 9/1/1995 reactions or allergies who in n has been received from a medicalYassistant concerning her 16 year old daughter who on 11-FEB-2008 Y 2/12/2008 was vaccinated 1/1/2009 the third dose of w n has been received from a physician Y concerning Y a 12 year old female 6 with allergies to Augmentin N who on 9/17/2008 10-OCT-2007, 3/27/2009 17-JAN-2008 and n problems, dizziness, near Y fainting,Y rapid heart Y beat, broke out in rash Y all immediately. Y Now: N MS, Graves 6/23/2008 Disease, 6/23/2008 Fibromyalgia, daily mig litis, pain, fever, tachycardia. Redness/pain at site Y w/ worse progression. 3 Vanc and Zosyn given Y upon presentation 3/16/2009 to 3/18/2009 ER. D/C home with p V on 3/6/09 and AVA on 3/11/09. On 3/17/09 pt Y describes feeling fatigued, 1 he had non positional U left sided 3/6/2009 chest pain 3/17/2009 (1-2/10), cp worse w rash on (L) arm, neck and face; rash Y appearedY3/27/09. No fever. Patient's 2 daughter received Y live attenuated 2/23/2009 varicella 3/27/2009 vaccine 3-4 weeks p 3 degrees), headache, body aches, dizziness, fatigue. U 3/26/2009 3/26/2009 lu shot experienced headache, dizziness + flu like symptoms. Y m pink area around where PNEUMOVAX given. Y 4/1/2009 4/3/2009 nted for a few seconds after that patient had major headache, in addition patient pain on upper Y right arm. 3/19/2009 3/19/2009 began 1 hr after injection. Today Right inner and anterior thigh- diffuse swelling from 1 1/2 above U knee to 3/16/2009 groin crease. 3/16/2009 er the vaccines, patient c/o feeling "bad". Y Had anorexia and nausea, was very pale. The nextYday also extremely 2/25/2009 pale, 2/25/2009 weak, couldn't eat, na Y 4/1/2009 er administration, nickel size redness. Y On 5th day after; hive looking rash appears. On 6th day Y after administered 3/18/2009vaccine 3/23/2009 entire deltoid red me in 3/31/09 stated that the day heY got vaccines 3/23/09 his legs both got swollen and purple. Y They took 3/23/2009 to urgent3/23/2009 care, advised them jus
feel nauseous, vomited x 3 in spaceYof 2 hours. Saw ER physician for meds which stopped emesis. Y 3/10/2009 3/10/2009 htheadedness within 15 minutes of ZOSTAVAX administration. Paramedic took vital signs +Ublood sugar3/27/2009 (all WNL). 3/27/2009 Pt refused work up at h sized swelling at site of VARIVAX reported by mom. 1-2 days after immunizations. Later pt developed Y vomiting /diarrhea illness, 2 d after i broke out in small blisters on abdomen 2 days after receiving varicella immunization. StatedYblisters itched 2/16/2009 but no fever 2/18/2009 noted. Today in clin + erythema + pruritis of Rt upper arm. U 3/24/2009 3/27/2009 ome: (Location) bilateral arm. Pt. mother Y describes it as painful. Relieving factors include: BENADRYL. Y Associated 3/27/2009 3/29/2009 symptoms include: pain ceived 6 wks immunization of 5 wks. Y 3/10/2009 ts today 4/1/09 with red area (about baseball - sized) + sl. raised + mild pain on right deltoid U - site of MENACTRA 3/31/2009I.M. 4/1/2009 injection given on 3/3 al reaction 9X6 cm local ice and Benadryl. Y 3/27/2009 3/28/2009 dministered to left thigh but bruisingYto left shin. Parents stated leg was swollen with bruisingYwent to ER.3/30/2009 3/31/2009 of Rt thigh area after vaccine. Swelling Y started morning after vaccine. Area also has some erythema. Y 4/2/2009 4/3/2009 soreness, swelling. Y 3/19/2009 veloped redness around back of arm about 5-6 inches long and also skin felt hot to touch and Y very itchy.3/30/2009 3/30/2009 9 Received Hep A at approx 2pm. Developed Y hives approx 8p. Took BENADRYL. 3-31-09 noYhives visible. 3/30/2009 C/O itching 3/30/2009 all over. SOLUMEDR s given at 9 months. 3/25/2009 ap/Hib/IPV and HebB/Hib- no sx 4/2/2009 SIZE DARK PINK RAISED AREA AT INJECTION SITE NO PAIN NO TREATMENT Y 4/2/2009 4/2/2009 oke out in shingles 6 days after vaccination Y was administered. Pat She is being treated by her N primary care 3/24/2009 physician 3/30/2009 accordingly. r, strong crying, for many hours, fine the next day. Y 4/2/2009 4/2/2009 ized knot on right arm. Red & warmYto touch. ER MD gave steriod dose pk. & Icc pack U 3/24/2009 3/29/2009 e adn hives were around shot area and on both thighs adn stomach, the areas were itching. YSo mom gave 3/27/2009 benedryl3/27/2009 and repeated it at 9 a.m n left deltoid where Tdap was given. Area hot, red. swollen. Smaller area of redness with heat on right deltoid 4/1/2009 where 4/2/2009 Menactra was given. adverse reaction. Patient received Dtap vaccine instead of the recommended Tdap vaccine.YPatient received 4/1/2009 adequate protection with Dtap d bilateral kidney area pain, increased thirst, increased urination approximately 20 hours after U Hep B #2 was 3/19/2009 given. 3/20/2009 No problems with vacc MOTHER PRESENTED TO HEALTH DEPARTMENT FOR CHILD'S VACCINES. MOTHERYREPORTED 7/17/2008 THAT CHILD 7/17/2008 HAD SWOLLEN RE o weeks after my daughter Y got the 1st Y Gardisil vaccine shot she started having seizures, sheNhas no family 9/3/2008 history of9/18/2008 seizures and has alwa d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate Y the 3/13/2009 child. No adverse reactions have d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate Y the 3/19/2009 child. No adverse reactions have ter developed a large red knot at injection Y site, was raised, size of a half dollar, warm and very Y tender. She 3/26/2009 also had a4/1/2009 severe runny nose. A 0 minutes of patient receiving TdaPYand gardasil, pt had a 30 second episode of stiffening and Y blank staring. 4/3/2009 Since that 4/3/2009 time she has had disease (rash, fever). U 3/23/2009 4/2/2009 TDaP and PNEUMOVAX L deltoid 3/31/09. Reaction of swelling, redness and immobility began U within 24 3/31/2009 hours of injection. 3/31/2009Slow resolution d by Clinic today to report that she developed L lateral arm pain, some numbness/tingling from Y shoulder 3/20/2009 -> fingertips, 3/21/2009 quite significant at tim ring rash in groin and hip area. U 3/27/2009 3/31/2009 x 100.5; redness, induration 2 cm x 2 cm. Y 3/30/2009 3/30/2009 -> redness + swelling at the site of injection - measures 4.5 inches + 4.5 inches. U 3/30/2009 3/31/2009 ea of redness on L thigh ice packs and Y Benadryl. Y 3/30/2009 4/1/2009 ea of redness, warmth and in duration Y on L thigh. Treated with ice packs and Benadryl. U 4/1/2009 4/2/2009 arthralgias / HA (L) shoulder pain with Y t ROM-->Bursitis Rx CALEBREX/NORCO/ROM exercises N 3/29/2009 ed varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 1/21/2008 3/30/2009 ed Varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 4/21/2008 4/2/2009 ort received on 20 January 2009 from a consumer, who is the patient's parent. A 5 month oldY male patient, 4/30/2008 with a history 4/30/2008 of environmental a ort received on 13 March 2008 from Yanother manufacturer, (a report number was not identified). N The initial reporter ### to this ### manufacturer had ort received from a manufacturer on 23 January 2009. The other manufacturer had received the original report from a health care professio ort received on 22 January 2009 from Y a health care professional. A seven-month-old femaleNpatient with no 1/6/2009 past medical 1/6/2009 history, had receiv rmation was received on 19 August Y 2008 from a consumer (patient's mother). A two and a half Y month old 8/11/2008 female patient 8/11/2008 with no reported m ort received on 08 August 2008 fromYa physician. A healthy 2-year-old male patient, had received on 04 August 8/4/2008 20088/4/2008 a fourth intramuscula was received from a health care professional on 09 June 2008. A five-year-old male patient with a history 6/17/2004 of asthma,5/1/2008 chronic ear infections was received from a health professional on 03 June 2008. A 36-year-old female patient wasY accidentally6/3/2008 exposed to6/3/2008 ACTHIB (lot number NG AFTER WAKING, CRANKY, LETHARGIC AND GROGGY X 2 WEEKS AFTER ADMINISTRATION. Y 3/11/2009 LEGS SWOLLEN 3/12/2009 UP TO 4 DAYS s- He had extremely sore legs and Y arms even though vaccines were given only in arms. HeYwas achey 2/19/2009 and felt flu 2/19/2009 like. Then had low grad
ceive.5cc pneumo-vac on 5/3/07 in their Y Right deltoid. On 5/29/07, pt had reported c/o rash on Y face, upper chest, and forerms. Pt was given Fever ~ 101 F, Malaise, Moderate Diarrhea, chills in evening, body aches, 4/3/2009 4/4/2009 08, pt was in clinic and C/O welts onY thigh; Shoulder reaction to flu shot; cough and sore throat. Y ONSET OF SYMPTOMS: ### ### Ongoing since fl as given scheduled vaccination doses Y of: Typhoid, Influenza, and Anthrax on 3/14/09. After about U a week3/14/2009 and a half3/24/2009 later, the patient notice , 4/3/09, I received two vaccines, a Y tdap in the left arm and a pneumococal polysaccharide vaccine N in the 4/3/2009 right arm. Within 4/3/2009 a few hours, I st ter hives around vaccination site later Y and to this date muscle aches, joint pain and skin hypersensitivity. N 3/8/2009 3/10/2009 A and Hep B shots on 4/4/09. Felt sick Y and nauseated at the time. Returned on 4/5/09 c/o inability U to remove 4/4/2009 R arm and 4/4/2009 nausea and vomiti Y Y 0 N serious case was received on 24 February Y 2009 from a health care professional. A nine yearUold patient received ###the2/24/2009 INFLUENZA vaccine ( n has been received from Y a medicalYassistant concerning Y a 49 year 1old female with diabetes, Y chronic obstructive 3/24/2009pulmonary 3/24/2009disease, coron n has been received from a consumer concerning her son with no medical history or drug allergy N who was vaccinated with a dose of MMR n has been received from a consumer concerning a male who, on an unknown date, was vaccinated U with MMR II (lot # not reported). There n has been received from a consumer concerning her 7 year old son who on unspecified date U was vaccinated with MMR II. The patient dev n has been received from a consumer reporting that her nephew now 30 month old male who N in approximately 2006 was vaccinated with M n has been received from a consumer, Y concerning her 17 year old son with a penicillin and CECLOR Y allergy, sulfonamide allergy, drug hyp n has been received from a physician Y concerning a patient who in approximately 2008 "about Y a year ago" was vaccinated 9/1/2008 subcutaneously d fever 3/26/09/ER visit for febrile seizure Y / URI. U 3/25/2009 3/27/2009 ter receiving DTAP, PREVNAR, ROTAVIRUS Y & HIB vaccines child experienced right facial droop involving 2/20/2009 eye, lower 2/20/2009 face & mouth. Symp hought to be febrile seizure, 2 days Y after receiving MMR. Was seen in ER. No labs or test were Y done. Ran 3/24/2009 fever x's 3/26/2009 24hrs. When fever subs 5 minutes after HPV (GARDASIL) vaccine Y lasted about 1 minute with L arm jerking X 3 sec pale Y looking 3/23/2009 referred to ER. 3/23/2009 BP 100/80, HR 78, ped erythematous rash, urticarial type with angiodema which began on 1/29/09 and persistedY throughout1/29/2009 2/13/09-see 1/29/2009 picture. There was s ient said arm slightly sore evening of immunization but next day fine. Patient was given TdapY by mistake since 4/1/2009 it is only recommended at a d hives within 15 minutes of receiving vaccinations. Gave 0.1 epinephrine IM in office. Y 3/27/2009 alized reaction started day after. Increase to redness, swelling. Spreading down R arm hot toUtouch. 3/5/2009 3/6/2009 ma around injection site, non tender induration of muscle about 7cm - L thigh. U 3/31/2009 3/31/2009 KINRIX (DTaP/IPV) Rt thigh on 4/1/09, red, sore, itchy indurated warm spreading rash developed. Y 14x10cm 4/1/2009 likely allergic, 4/3/2009 but AUGMENTI VARIVAX 3/26/09 mom noted a red area on L arm at injection site. Tender to touch, but notYsore with movement. 3/26/2009 73/27/2009 cm by 5 cm warm reac a USAFR female service member, and was on military status on 29 March 2009, when she received N a TDaP 3/29/2009 vaccination 3/29/2009 (0.5 mL, IM, L upp given 3-20-09 AM. Seen in office 3/23/09 Y with 3"x31/2" erythematous, swollen, warm induration U @ site of3/20/2009 Td injection. 3/22/2009 very painful every time I move it. U 2/25/2009 allergic reaction U 4/1/2009 4/2/2009 ak, muscle soreness for 3-4 days two weeks after administration of Hep A and Hep B vaccines. Y Advised3/12/2009 to see his healthcare 3/26/2009 provider. d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/20/2009 reported. 3/20/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/20/2009 reported. 3/20/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/17/2009 reported. 3/17/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/19/2009 reported. 3/19/2009 d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/19/2009 reported. 3/19/2009 clinic, c/o redness and blotching of the Y left upper arm with swelling. Area was warm to touchUand swollen 4/1/2009 from shoulder 4/3/2009 to the elbow. Pt als lled on 4-6-09 stating that patient had a fever of 103.6 for 48 hours. No other symptoms noted. Y 3/26/2009 3/28/2009 ed out as aching 1 hour after vaccination. Client states pain (Left Arm) was at it's worst 1 week U after vaccine 3/27/2009 (04-03-09) 3/27/2009 when she experien 9 the employee went to the ER around Y 10 pm due to swelling in neck, change in voice and difficutly Y speaking. 3/24/2009 States 3/27/2009 he did not have diffic ain of both knees. 4/13/09 MR and Y vax info received from PCP. In for 14 yr WCC with normal U exam 11/11/08. ### Vax given. ### Returned 12/22/ ately 24 hours after the vaccine was received the patient had severe chest pain. The chest pain Y began evening### and lasted### for over an hour ticed on 4/5/08 at 2:00AM, soreness, itching and a knot on left arm where Zostavax was administered. Y Patient 4/3/2009 applied 4/5/2009 alcohol to help with 9am- phone call from parent. Parent reports child right upper arm is red, swollen, & hot to the U touch. Symptoms 3/31/2009 began 4/1/2009 on 4/01/09 and is wo alized papules. No bullae or blisters around site of injection (left upper thigh) Possible folliculitis U but possible 4/3/2009 local varicella 4/4/2009 from vaccine. given 3/31/09 approx. 10:30am. Pt. Y noticed it was tender an swollen 4/01/09 approx. 6:30 pm. U 4/02/09 area 3/31/2009 red, raised, 4/1/2009 hot to touch & incre otavirus) vaccine given vinitial dose at 19 weeeks of age, after the recommended start age of Y 15 weeks,3/20/2009 by mistake.3/20/2009 No physical reaction to ived IPV and DTAP in Right thigh on 4/3/2009. Now has pink/red and hot area to site measuring U 3.5 x 4 inches. 4/3/2009 Painful 4/6/2009 to palpation. Place r shot pt had swollen, painful area at site, 1" red Y circle at site with rash 4 around it. Syncopal episode Y on 4/1. 3/31/2009 Transported 4/1/2009 to hospital by ambu ven Pneumovax vaccine as ordered.YLeft deltoid injection site wiped down with alcohol swab,Yand vaccine 3/2/2009 given. Site 3/3/2009 dabbed w/ cotton ball,
ed sudden and severe hair loss resulting Y in many visits to dermatologists over the last year and N a half. This 7/20/2007 has resulted 9/17/2007 in meds prescribe Clinic on 4-6-09 to report that she had experienced painful, red blotchy raised rash on left upper Y arm which4/1/2009 presented4/5/2009 on 4-5-09 at approxim -Hyporesponsive Episode, onset was about 2 hours after receiving DTaP vaccine, lasted approximately Y 3/14/2009 4 hours 3/14/2009 A TDAP SHOT ON FRIDAY(04-03-09) AND SAT. HE HAD BODY PAIN & CHILLS.LEFT ARM Y WARM AND 4/3/2009 TENDER 4/4/2009 TO THE TOUCH. TOD en, feverish arm where shot was administered. Headache, neck ache, weakness, general feeling Y of tiredness. 4/3/2009 4/5/2009 ome numbness and tingling across the upper back and neck and extending down into his arms Y bilaterally. 4/1/2009 This was resolving 4/1/2009when seen on was reported by a consumer and described Y the occurrence of feels like having a heart attack Y in a 60-year-old 10/1/2008 female 10/1/2008 subject who was vacc 9, pt presented w/ aboutY14 hr hx ofYfever, headache Y and vomiting and 7 20 min of purpuric rash. Y Pt directed 3/20/2009 to ER then 3/30/2009 Peds ICU. CSF incre dmother and mother report that this Y 6-month-oldYinfant has been a bit3 fussy and out of sorts since Y he received 3/17/2009 immunizations 3/19/2009two days ago ve Diarrhea, Vomiting, Back Pain, Body Y Aches,YHA. From 033009 --> 1 033109 To ER Admitted Y Observation. 3/30/2009 Discharged 3/30/2009 040109. To Scho a reddish purplish area on leg not acting sick otherwise. Recommended she watch it for a fewUdays and if3/24/2009 not better to4/6/2009 be seen. at injection site "burning" to left arm, both arms, now legs and eyes. No rash, no swelling and U no fever, VSS. 4/2/2009 Advise;4/4/2009 Monitor. e: onset: 3/10/09-present. OTC MOTRIN Y taken for symptoms. Lower back pain: onset:3/10/09 N x 1day. Fever: 3/9/2009 onset:3/10/09 3/10/2009 x 1day Reported and swelling L leg. Started the day after lZ. Worsened x 24 hours then improved, used ice only. Y 4/3/2009 4/4/2009 9 - School nurse phoned HD and stated Y that student's L upper arm was somewhat red with some U swelling. 3/31/2009 Client c/o4/1/2009 nausea and L arm pai with long periods of crying and inconsolability. Fever 101.8 rectal. Vomiting x 1. decreased oral Y intake. 4/2/2009 4/3/2009 red and swollen. Cellulitis - given antibiotics. Y Went to urgent care - Then follow up and officeU6/23/08. 6/20/2008 6/21/2008 n has been received from Y a Nurse Practitioner Y Y for the Pregnancy Registry for GARDASIL concerning Y an6/18/2008 18 year old female patient with no n has been received from a concerning Y a 50 year old nurse female who was alsoYa nurse was Y vaccinated with a dose of ZOSTAVAX (Oka/ n has been received from a physician Y concerning a patient with milk allergy who was vaccinated U with ROTATEQ vaccine. Upon return for a week after vaccinations - resolved Y after two days. Y Lethargic, irritable 22 Y2-3 weeks Y later for about N two weeks. One### month after ### immunizations, en thigh left - side left day #2 after vaccination. Y ER on 4-5-09 No tx. Y 4/2/2009 4/4/2009 o site with induration x 3-4 days. Left arm. Y 3/26/2009 3/28/2009 shingle shot. Asked nurse if it would hurt, no just like flu shot. It did hurt and burned. 03-19-09 4 AM Difficulties 3/18/2009 Breathing for 1 Hr. Noticed d petechial rash on inner thighs, abdomen, behind knees 5 days after vaccine give. No itch -YNo vesicles.3/17/2009 No rash at3/23/2009 injection site. Platelet c n so had ADACEL vaccine (administered off -site) 10 days later, presented to me with myalgias, arthralgias, headache, 3/7/2009 malaise. Ok to conta DISIL vaccine administered 7/8/08 pt report hives all over body within hours of injection lasting Y 3-4 days. 7/8/2008 Tx with BENADRYL. 7/8/2008 swelling & erythema of entire thigh > 72 hrs Discomfort & ambulation > 48 hrs. Y 11/1/2005 11/1/2005 cm red wheal appeared after 9 month immunizations given. No discomfort/problems noted, but N wheal has2/6/2009 persisted since 2/6/2009 shots (on right th ction right thigh with erythema and induration Y developed nine days after immunizations. AlsoUwith low grade 3/24/2008 temp. (99.9) 4/2/2009 d rash L side neck in dermatomal pattern consistent with VZV. 3/18/2009 3/25/2009 iven 3/19/09, fever developed 3/27/09. Y Rash erythematous macular papule with palms/soles & buccal urticaria 3/19/2009 developed 3/29/2009 3/29. Looks like Y ### ### ed 6 mo. well baby checkup on 2/23/09. Vaccines listed below given. Pt. came in to see MDYon 2/28/09.2/23/2009 Vomiting 2/25/2009 began on 2/25 with Dia lled, c/o erythema (L) upper arm at injection site, Sl. raised "welt" in appearance, "larger than Y half dollar"3/25/2009 in size. No3/26/2009 c/o discomfort, and dec se events recorded 8/2/2006 d to the office on 3/31/09 with c/o rash Y all over body since Sunday 3/29/09. Spreading rash not U itchy. No 3/19/2009 fever. Non vesicular, 3/29/2009maculopapula KINRIX 3/24/09 (R) deltoid. Seen 3/26/09 Y with swelling, erythema, warm to touch no tenderness Y no induration. 3/24/2009 Negative 3/25/2009 node. Ab after vac d headache 5/26/09 Received PCPYmedical records of 12/3/08-5/18/2009. FINAL DX:migraine Y HA; probable 12/3/2008 psychiatric 2/21/2009 illness Records rev maculo papular rash to face, neck, Yarms, chest, abdomen, back and groin blanching and non U vesicular. 3/17/2009 Not itchy, afebrile, 3/27/2009 No V, No D. Po ceived KINRIX as part of 4y.o. physical, in (L) deltoid 4/3/09 at approximately 9:AM; went to school Y after appt, 4/3/2009 picked 4/3/2009 up from school at 5PM ec. Yellow Fever Vaccine - woke upYwith itching mild noc, slight headache - In AM 3/31/09 noted Y rash (hives) 3/30/2009 chest,3/30/2009 neck, arms and legs. D ely following injection pt. became stiff, Y eyes rolled in back of head, bluish + orange around mouth, Y + pt. was 3/31/2009 having jerking 3/31/2009 motions of entire ed of itchy throat 40 minutes after receiving multiple vaccines (TYPHIM VI, HAVRIX and yellow Y fever YF-VAX). 3/25/2009 Administered 3/25/2009BENADYL 50 ness, swelling and firmness Rt 'upperarm' 3"x2 1/2". No fever or chills. Denies cp or SOB. NoYpruritus. ROCEPHIN 3/30/2009 gram 3/31/2009 + IM, KEFLEX 500 m notices red spots on back of neck Y and a lot on stomach. 1-16-09 8AM when woke up this AM, Y red spots 1/6/2009 were all over 1/15/2009 face, back, neck and o pneumonia vaccine given in the left arm (deltoid). Mild pain, redness and streaking from injection U site. 4/6/2009 4/6/2009 Hep B vaccines were given to 70 newborns because the GSK products requires 10 mcg dosage, but MERCK product 2/17/2009 required only 5 mcg f tates he was in his office yesterday, received Pneumonia vaccine in rt arm. Report this was he second pneumonia 3/26/2009 vaccine. 3/26/2009 States approx 3 tion given on 3/27/09 3 hours after going to bed woke up screaming for 5-10 min. did settle some Y fussy till 3/27/2009 TYLENOL 3/27/2009 kicked in temp 103 de d redness around upper arm 2 d after vaccine given-Itchy c/o nausea- Rx BENADRYL, MOTRIN Y -Lasted2/10/2009 3-4 days. 2/11/2009
an two days after shot was given (103F) Y mother gave Tylenol. Child taken to ER with c/o seizure. 3/18/2009 3/20/2009 tion site reaction with mild cellulitis Y 3/31/2009 4/2/2009 X 24 hr, injection site rash, urticaria Y Y 4/1/2009 heat, swelling left deltoid area. Hard in center of redness, approx. ping- pong ball sized Y 3/21/2009 3/23/2009 D with throat itching within 5 min of shot. Y Requiring BENADRYL 25 mg PO + Albuterol Nebulizer Y treatments 3/30/2009 X 2 given 3/30/2009 over 2 hours. ld with spots on body, started 3 days ago along with diarrhea; cough x 4 days temp 98 R 148-38 Y Stuffy 3/10/2009 nose, yellowish 3/23/2009 nasal drainage. A ain, left sided facial flushing, fevers up to 100.8 degrees orally after vaccine given. Also noted Y left supra3/18/2009 - clavicular3/18/2009 lymphadenopathy. Fu and swelling to left upper arm. Y U 4/1/2009 4/2/2009 noticed itching at site of vaccination. Mild tenderness, seen at clinic 3/27. 6X5 cm warm pinkYarea surrounding 3/25/2009 2.5 cm 3/26/2009 area darker pink + mi 5 cm X 5 cm; Swelling + Pallor 8X8 cm; tenderness. U 3/31/2009 Y 4/2/2009 4/2/2009 stomach,head hurt, feet felt prickly Y 3/28/2009 3/28/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 4/10/2008 4/21/2008 3rd dose of Gardasil on 3/31/09 On 4/2/09 she had an episode where she became very angry Y and agitated 3/31/2009 and had 4/2/2009 behavior not like her n d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 6/25/2008 7/8/2008 as given Adacel instead of Infanrix. I have told my superviser and his parents. Y 4/7/2009 sed appt for Well Child Clinic and coordinator Y MaryBeth Hayes RN called to remind parents. Y She spoke with 2/24/2009 dad and 3/1/2009 he said that child had Optic Neuropathy leading to severe loss Y of vision right eye. Treated with high dose Y IV steroids N with no benefit. ### 5/4/09 11/4/2008 Received Optho Clini INTED.ASSESSED MY MD Y 4/7/2009 4/7/2009 owing vaccination, pt. developed generalized Y itching and painful sores on her back. She went U to her doctor 3/30/2009 on the 3rd 4/1/2009 day post-vaccination fic myocarditis. This case was identified Y as part of the H-406-005 Enhanced Surveillance Study (5000005). 2/2/2009 2/18/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 4/29/2008 5/13/2008 ardial infarction (410.7), unspecifiedYsite (410.9). This case was identified as part of a study.U 1/30/2009 2/17/2009 Kinrix innoculations given on 3-17-09, on 3-28-09 (11 days post inocculations) Pt spiked a 102F U temperature, 3/17/2009 which3/28/2009 subsided over the nex ought child in today for assessment of oval shaped 3 inch by 6 inch reddened area on left posterior U lateral4/6/2009 upper arm,4/6/2009 site of VZV sc injectio s after her vaccine was given the following Y symptoms Y were noted: weakness 1 of mouth muscles Y with drooling 2/4/2009 and liquids 2/22/2009 running out of mou d with ACAM2000 during pregnancy. Pregnancy resulted in spontaneous abortion. 1/14/2009 2/2/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 5/16/2008 6/23/2008 ates he got his second injection on Friday and that his rash came back over the weekend and Y stating this3/5/2009 time the rash 3/9/2009 is worse. +Pruritis, d to toe. Not sleeping or eating. - Maculopapular Y rash, condense together in big patches, notUsick, no cough, 3/26/2009 no URI3/27/2009 c/o, measles-like rash. rash with blisters) on lower L back. Y U 3/25/2009 4/5/2009 1/13/2009 erythema L thigh day after immunizations. Continued to increase spread of erythema. MotherUhad given Benadryl 4/3/2009et had 4/4/2009 applied ice to site. 009@09-43 from pt. States he was in this office yesterday, received pneumonia vaccine in rt arm. Report3/25/2009 this was he 3/26/2009 second pneumonia va n has been received from a nurse for the pregnancy registry for HPV concerning a female with Y a history of2/4/2008 vulvar condyloma 2/4/2008with Trichloroa n has been received via an internet blog from a consumer concerning her daughter who wasUvaccinated with a dose of GARDASIL. In the m n has been received from via the physician of aYpatient whose mother 6 found the current case U online. The5/30/2007 current case concerns a female p d focal deficits temporallyY associated Y to receipt Yof the spv. See attached. 20 Diagnosis: Y CEREBELLAR N ATAXIA/menigoencephalitis. 1/5/2009 1/20/2009 Symptom n has been received from a physician concerning a 17 year old female who was vaccinated N with her second dose of GARDASIL, 0.5 mL, IM orts pain & burning sensation to right Y upper arm since flu vaccination. Severe pain started approximately11/4/2008 2 wks after administration. ### She re oid (arm) red and swollen, mother of patient stated that kid had a low grade temp. of 99.4 theYday after vaccine administered. ma & swelling of uvula. Y Y ### ### d swollen warm to touch. Are measures Y 8x6 cm. no pain. Temp 99. Y 3/30/2009 4/1/2009 shingle shot. Asked nurse if it would hurt. No, just like flu shot, it did hurt and burned. 03-19-09 4 AM difficulties 3/18/2009 breathing 3/18/2009 for 1 hr. Noticed ghtly raised, warm to touch pink area @ injec. site post getting VARICELLA vaccine on 3/30/09 U 14.5 cm3/30/2009 X 7cm. Reported 3/31/2009 by guardian on 4 area of blanching erythema around Yinjection site at L upper arm. Started a few hours after injectionU zero 4/1/2009 treatment included 4/2/2009with systemic n has been received from a nurse practitioner, Y for the Pregnancy Registry for GARDASIL, concerning Y a 15 year ### old female 3/1/2008 with iron deficie n has been received from a physician Y assistant concerning a 24 year old pregnant female with Y a history 2/12/2008 of penicillin2/12/2008 allergy who on 12-FEB on arm. Not sure if it was vaccine reaction Y or early cellulitis. U 7/11/2007 7/13/2007 d syncopal episode, shortness of breath, Y headache, throat felt "fuzzy" Injection site swollen,Ured, achy. 8/8/2007 8/9/2007 n has been received from a case in litigation via Litigation Reports concerning a 15 month old N male patient 3/14/2000 who on 14-MAR-2000 3/30/2000 was vacc
was received from a health professional Y on 26 March 2009, via another manufacturer (document number 45215838). A patient received Fl Y Y 2/6/2009 2/9/2009 eveloped. Got in waiting area she began to break out with a pruritic rash and had difficulty breathing. Y 62.53/4/2009 Solumedrol3/4/2009 IM given, 0.2 Epinep ASIL 1-30-09 - At 2nd appt for GARDASIL 4-2-09 pt. described symptoms from first IZ admin. Y stated had 1/30/2009 severe headache 1/30/2009 with vomiting a induration at left thigh elevated white Y blood cell count to 13.7 K Fever to 100.5 U 4/6/2009 4/7/2009 redness, itching and swelling of the upper arm for a week followed by a general feeling of tiredness, Y headaches### and general ###achiness lastin Y 4/2/2009 4/6/2009 lled stating that left arm is red, swollen, warm to touch, has a red splotchy rash and is the size U of a "grapefruit". 4/6/2009 Patient 4/7/2009 denies any pain, bu rned red and slightly raised the evening of the day the shot was given. Y 4/6/2009 4/6/2009 d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 5/24/2008 6/25/2008 the tongue and throat. No acute respiratory distress. complained of mild itching around eyesYand forehead. 4/8/2009 No erythema 4/8/2009 or rash noted in th EAMED ALL DAY RIGHT AFTER SHE RECIEVED THE IMZ. RUN 103 TEMP THE FIRST DAY Y AND 1014/2/2009 TEMP THE4/2/2009 NEXT TWO DAYS. C nt received Tdap vaccine (Adacel) and experienced muscle aches, chills, general malaise, nausea Y and axillary 3/19/2009 lymphadenopathy. 3/19/2009 Symptom U 4/1/2009 4/1/2009 nt received Tdap and experienced nausea, vomiting, chills, low grade temp and a rash beginning Y immediately 3/19/2009 after injection. 3/19/2009Symtoms subs s a Methicillin Sensitive Y Staph Aureus Y left septic Y hip and left abscess 5Y on ankle with presumed U osteomyelitis 3/16/2009 of femur. 3/20/2009 Patient's prenatal cou ite blanched and cool to touch, after the blanching, the injection site had a bluish-tinged appearance. Y Ice 3/30/2009 pack applied 3/30/2009 to injection site, mo nt received Tdap and experienced fever, bodyache and headaches. Symptoms subsided in 4Ydays. 3/19/2009 3/19/2009 nt received the Tdap vaccine and experienced nausea/vomiting, axillary lymphadenopathy, blotches, Y beginning 3/19/1968 8 hours 3/19/1968 after vaccine admin nt received Tdap and experienced chills, diarrhea and vomiting 1-2 hours after injection. TheYsymptoms subsided 3/19/2009in 3/19/2009 2 to 3 days. HPV vaccine Gardisil on March 31, 2009. Y The next day I was feeling soar and tired, but did not N think anything 3/31/2009 about 4/1/2009 it. By Friday evening ( Hep B shot 3-31-09 VLL. On 4-02-09, mom notice it was reddened, hot and hives were appearing Y as well 3/31/2009 as swelling 4/2/2009 on the upper left thig red DTAP instead of Tdap to 11 yr old, administrative error, no adverse event 3/23/2009 9@ 11:05AM, Injection site is red, swollen, Y warm to the touch, and pain in elbow.03/16/2009@ U 3:05Pm, No 3/9/2009 pain, no3/14/2009 warmth, but still swolle ately 48 hours after immunizations her Y left leg at injection site began swelling and turned reddish N purple, swelling 4/3/2009continued 4/5/2009 and covered he a 62 year old African American male Y and recieved Y the flu vaccine on 11 1/12/09. He reported a Uhistory of Diabetes. 1/12/2009 He2/24/2009 was recovering from a ons were received on 04/06/09 (received DTaP, MMR, VZV). On 04/08/09 developed swelling, U itching, redness 4/6/2009 in left 4/8/2009 arm at site just below had a rash on neck and chest. LipsYwere swollen. Itching at rash sites. Also complained of itching Y throat. 4/1/2009 Went to ER4/7/2009 administered Benedr d the months up to March Y there was no local orYsystemic reaction 21 to any Y of the Immunizations N given on 12/19/08. ###On 2/28/2009 March 3 patient came 8HRS DEVELOPED LOCALIZED REDNESS AND SWELLING IN RIGHT ARM, FEVER, MALAISE, U MYALGIAS. 4/6/2009REACTION 4/7/2009 OCCURED A minutes of receiving theYvaccines, patient Y developed Y hives on his head 3 and then experienced U shortness of 4/2/2009 breath, wheezing 4/2/2009and his lips tu er), child went to ER 2-13-09 with LLQ Y pain hadY CT- Showed ovarian 2 cyst was told by ER physicianY was8/25/2008 result of HPV 2/13/2009 immunizations. Lap d immunizations (FLUMIST, HepA/B, Meningococcal, Y MMR, Pneumococcal) 15 on 2/18/09. PerUthe pt he received 2/18/2009 these3/4/2009 vaccinations on 2/19 high-redness, 14x17 cm swelling and discomfort from upper thigh to knee area. Involved thigh Y 2.5cm larger 4/6/2009 in circumference 4/7/2009 - secondary e oday that he had a reaction to RECOMBIVAX HB #2 in October 20008. Y 10/1/2008 10/1/2008 d rash around belly button and on thighs- chicken pox looking rash with temp received varicella Y 2/26/09. 2/26/2009 4/6/2009 redness, 12 cmx8cm. Noticed 4/8/09 @ 0630. Vaccine 4/7/09 2130. Y 4/7/2009 4/8/2009 e began about 3 days after ZOSTAVAX injection. N 3/24/2009 3/27/2009 ticed red welt on site of injection theYfollowing day. In the afternoon around 3 pm. she experienced Y slight3/26/2009 itch on left3/27/2009 arm. The red welt on ri d red itchy mark ant injection site. U 4/7/2009 4/8/2009 ncopal episode after GARDASIL. Did not fall, guided to chair by me & aroused with ammonia Y & cold wet cloth. 4/8/2009 No seizure 4/8/2009 act. Pulse alwa n has been received from a healthcare Y worker concerning a 78 year old female who was vaccinated Y with8/30/2006 a dose of 1/26/2009 ZOSTAVAX (Merck). F n has been received from a nurse practitioner Y concerning a 77 year old female with SULFONAMIDE N allergy 3/1/2007 and no 1/22/2009 known medical history n has been received from a 74 year old female with no known medical history and drug allergies, N who two 1/12/2009 weeks ago 1/23/2009 was vaccinated with n has been received from a registered Y nurse concerning a 77 year old female patient with noNknown allergies 9/27/2007 and no pertinent medical hist n has been received from a registered Y nurse (also reported as certified medical assistant) concerning N a 71 1/20/2009 year old female patient with hiat n has been received from a licensed practical nurse concerning a 55 year old female paraeducator Y (weight 1/2/2009 242 pounds, 1/2/2009 height unknown) w n has been received from a physician Y concerning a female patient who on 23-JAN-2009 wasYvaccinated1/23/2009 with a 0.651/23/2009 ml dose of ZOSTER va n has been received from a Master Yof Science in Dentistry and a Physician concerning herself, Y a 61 year 1/9/2009 old female1/24/2009 patient with pre-osteop n has been received from a registered Y pharmacist concerning an 87 year old female patient U with recurrent1/9/2009 shingles (about every two month n has been received from a registered Y nurse concerning a 63 year old male patient with no pertinent U medical 1/12/2009 history1/15/2009 and no known drug all
n has been received from a physician Y concerning a 65 year old male patient who on 21-JAN-2009 N was vaccinated 1/21/2009 with 1/23/2009 ZOSTAVAX. On 23 n has been received from a physician Y concerning a 73 year old female patient with reflux, osteopenia Y and high### cholesterol 1/14/2009 who on 31-DEC n has been received from a physician Y concerning a 68 year old female patient who on 21-JAN-2009 U was1/21/2009 vaccinated with 0.65 ml of a dose n has been received from a registered Y pharmacist concerning a 69 year old female patient with N herpes simplex 3/5/2008 and1/26/2009 penicillin allergy who o n has been received from a 74 year old male physician with prostate cancer that was treatedUwith radiation 12/1/2007 who in approximately 1/1/2009 Decembe n has been received from a pharmacy Y student concerning an over 65 year old female who on U 28-JAN-2009 1/28/2009 was vaccinated 1/29/2009 with a dose of n has been received from a physician's Y assistant concerning a roughly 60 year old female who U on 20-JAN-2009 1/20/2009 was 1/20/2009 vaccinated with a dos n has been received from a physician's Y assistant concerning a 59 year old female with no drug N reactions or 1/2/2008 allergies 1/2/2008 and a history of breas n has been received from a physician concerning a 79 year old male who on 6-JAN-2009 was N vaccinated1/6/2009 injection with 1/20/2009 ZOSTAVAX (LOT # n has been received from a nurse concerning a 3 year old patient who on 19-JAN-2009 wasUvaccinated 1/19/2009 with a dose1/19/2009 of ZOSTAVAX instead n has been received from a pharmacist concerning a 67 year old female patient with an allergy N to something 1/22/2009 the dentist 1/22/2009 gave her (not furth n has been received from a pharmacy Y student concerning a 65 year old female patient with N hypertension,1/8/2009 hypercholesterolaemia, 1/16/2009 osteopor n has been received from a pharmacist concerning a 80 year old female patient with no known N allergies 1/19/2009 who on 19-JAN-2009 1/21/2009 was vaccina n has been received from a physician Y concerning a female patient who was over 65 year old, N who beginning 11/1/2008 November 12/1/2008 2008, was vaccina n has been received from a physician concerning a female in her 70's who on an unknown date U was vaccinated with ZOSTER vaccine, 0.6 n has been received from a registered Y burse concerning a 71 year old male who on 16-JAN-2009 Y was vaccinated 1/16/2009 with 1/21/2009 a dose of ZOSTAVA n has been received from a physician concerning a 67 year old female who was vaccinated Y with ZOSTER vaccine live (Oka/Merck), lot # n n has been received from a 63 year old male patient with headaches caused from some food N products (unspecified) 9/1/2008 and no known drug all n has been received from a 62 yearYold male patient who on 2-JAN-2009 was vaccinated with N a dose of ZOSTAVAX 1/2/2009 1/4/2009 (No Lot # provided) 0. n has been received from a nurse concerning a 4 year old female who on 23-JAN-2009 wasUvaccinated 1/23/2009 with ZOSTAVAX 1/23/2009 SQ, 0.65ml (lot # n has been received from a physician Y concerning a female patient with diabetes who in February N 2007, was 2/5/2007 vaccinated 1/1/2009 with a 0.65 ml dose n has been received from a 62 yearYold female registered nurse with no known drug allergy N and hypercholesterolaemia 1/13/2009 who on 13-JAN-20 n has been received form a consumer Y concerning his son in law who on unspecified date was U vaccinated with a dose of ZOSTAVAX. Five n has been received from a pharmacist concerning a 70 year old female who on 23-DEC-2008 U was vaccinated### with1/17/2009 a 0.65 ml dose of ZOS n has been received from a licensed Y visiting nurse concerning a 67 year old female with drug N hypersensitivity 1/14/2009 to codeine, 1/17/2009 PPD and ZYBAN n has been received from a doctor of pharmacy concerning a 60 year old male with cholesterol N and hypertension 1/8/2009who 1/18/2009 on 8-JAN-2009 was n was received from a 80 year old male Y patient with allergies to tetracycline; CIPRO; penicillin; N clindamycin; 11/5/2008 erythromycin;### tramadol; metop n has been received from a physician Y concerning a 74 year old female patient with a historyUof splenectomy 1/6/2009 who on1/20/2009 approximately 6-JAN-2 n has been received from a registered Y 35 years old female pharmacist who reported that she N thought her 1/14/2009 right eye could 1/14/2009 had inadvertently n has been received from a Physician Y Assistant concerning an 81 year old female patient with N hypertension, hyperlipidaemia, 1/15/2009 osteoporosis n has been received form a female patient who was vaccinated with ZOSTAVAX (Lot # not reported). U Patient called because she wanted to n has been received from a consumer concerning her 60 year old husband with no pertinentNmedical history 1/19/2009 and no1/19/2009 drug reactions or allerg n has been received from a physician Y concerning a female patient who had an outbreak of shingles U in July 12/1/2008 2008 and 1/15/2009 in December 2008 wa n has been received from a pharmacist concerning a female patient in her 60's who on 2-JAN-2009 U was vaccinated 1/2/2009 with a dose of ZOSTAV n has been received from a medical assistant concerning a 12 month old male patient who on U 13-JAN-2008 1/13/2008 was vaccinated 1/13/2009subcutaneous n has been received from a pharmacy tech concerning a female patient in her late 60s who U on approximately 01-JAN-2009, "approximately n has been received from a physician Y concerning a male patient who was vaccinated with a Udose of ZOSTAVAX (Oka/Merck) (lot # not pro n has been received from a licensed Y practical nurse concerning a 76 years old male patient N with cardiovascular 8/1/2008 disorder, hypertension and n has been received from a licensed Y practical nurse concerning an 87 year old male patient N with kidney 1/15/2009 stone, coronary 1/16/2009 artery disease, dem n has been received from a physician Y concerning a "young child" who was vaccinated with aYdose of PROQUAD ###(Merck).### Subsequently, w n has been received from an 81 year old female with diabetes and a history of nervous breakdown, N and 1/22/2009 no drug reactions 1/28/2009 who on 22-JANn has been received from a physician concerning a 77 year old female who on 05-JUN-2008Ywas vaccinated 6/5/2008 with 0.65 1/20/2009 ml dose of ZOSTER n has been received from a medicalYassistant concerning a 62 year old female patient with no Y known drug1/7/2009 allergies1/16/2009 and VARICELLA as a c n has been received from a registered nurse concerning a 62 year old patient who on 20-JAN-2009 N was1/20/2009 vaccinated1/21/2009 with ZOSTER vaccine n has been received from a certifiedYmedical assistant concerning a 62 year old male patientUwith no known 1/20/2009 drug reactions/allergies with ga n has been received from a pharmacist Y and a medical assistant concerning an 81 year old female N who on 12/8/2008 08-DEC-2008 1/25/2009 was vaccinated su n has been received from a nurse practitioner concerning a 68 year old female with hypertension, U arthritis 1/16/2009 and a history 1/27/2009 of genital herpes. T n has been received from a physician concerning a patient who was vaccinated with ZOSTER N vaccine live 3/10/2008 (Oka/Merck) 1/9/2009 0.65ml (lot number n has been received from a pharmacist concerning a 62 year old female with allergic reaction N to TETRACYCLINE 1/30/2009 and 1/31/2009 PHENOBARBITAL w n has been received from a licensed Y practical nurse concerning a 78 year old female with hypertension, N 2/25/2008 hyperlipidaemia 1/26/2009 and a history of pa n has been received from a physician Y concerning a 67 year old male with colitis ulcerative, gout N and metabolic syndrome 1/26/2009 whose wife was v
n has been received from a certified medical assistant concerning a 76 year old male with hypertension U 1/26/2009 and coronary2/3/2009 artery disease who o n has been received from a pharmacist concerning a 66 year old female with allergic reaction Y to antibiotics 1/29/2009 who at "some 2/1/2009 time last week" w n has been received from a female who on 23-JAN-2009 was vaccinated with ZOSTER vaccine N live (Oka/Merck) 1/23/2009(lot 1/31/2009 number, route and sit n has been received from a 64 yearYold female with no medical history and no drug allergiesNwho on 29-JAN-2009 1/29/2009 was 1/31/2009 vaccinated with a 0 n has been received from a physician Y concerning a 60 year old female with hypothyroidism, N hyperlipidaemia, 1/15/2009 sciatica 1/30/2009 and back problems w n has been received from a registered nurse (R.N.) concerning a 14 month old female with no U relevant medical 2/3/2009 history 2/3/2009 or past drug history n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a dose of ZOSTAVAX (Oka/M n has been received from a 66 yearYold female patient with penicillin allergy, no pertinent medical N history, 1/23/2009 who on 23-JAN-2009 1/30/2009 was vaccin n has been received from a 70 yearYold female patient with blood pressure high, no drug reactions N / allergies, 1/13/2009 who on 1/30/2009 13-JAN-2009 was va n has been received from a 66 yearYold female consumer with no known drug reactions/allergies N and breast 5/11/2008 cancer since 8/1/2008 January 2007, wh n has been received from a medicalYassistant concerning a 63 year old male with diabetes and N no drug allergies ###who 1/30/2009 on 15-NOV-2008 was n has been received from a medical assistant concerning a 14 month old patient who was vaccinated U inadvertently 2/5/2009 with a dose of ZOSTAV n has been received from a physician concerning a male who was vaccinated SQ with a 0.65 U ml dose of ZOSTAVAX (Oka/Merck) at a pha n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml (lot number, route an n has been received from a certifiedYmedical assistant concerning a 66 year old female patient with no known 1/29/2009 drug 1/31/2009 reactions/allergies and n has been received from a registered Y pharmacist concerning a 74 year old male patient with Y no drug reactions/allergies, 2/4/2009 2/5/2009 who on 04-FEB-2 n has been received from a registered nurse concerning a female patient who on an unspecified U date was vaccinated with one dose of ZOS n has been received from a registered Y pharmacist concerning a over 60 year old male with atrial N fibrillation and### a history of### chickenpox and n has been received from a registered Y nurse concerning a 63 year old female who on 25-JUN-2008 N was6/25/2008 vaccinated6/25/2008 SQ with a 0.65ml dose n has been received from a pharmacist concerning a 72 year old female with penicillin allergy N who on 19-JAN-2009 1/19/2009 was 2/2/2009 vaccinated with ZO n has been received from a medical assistant concerning a 77 year old female who on 03-FEB-2009 U was2/3/2009 vaccinated2/7/2009 with ZOSTAVAX (Oka n has been received from a physician concerning himself, a 70 year old male patient, with no pertinent medical history and no known drug n has been received from a healthcare Y student concerning a female who on 3-APR-2008 was U vaccinated4/3/2008 with ZOSTAVAX### (Oka/Merck) (lo n has been received from a physician concerning his father who on an unknown date, was vaccinated U with ZOSTAVAX (Oka/Merck) (lot # n has been received from a physician concerning a female who was vaccinated with a dose Uof ZOSTAVAX (Oka/Merck) (lot number, route n has been received from a physician concerning a patient who on an unknown date, was vaccinated U with ZOSTAVAX (Oka/Merck) SQ (lo n has been received from a physician Y and a nurse. It was reported that a 62 year old femaleNwith type II diabetes, 2/5/2009 hypertension, 2/8/2009 congenita n has been received from a physician Y concerning a male physician who was vaccinated withYa dose of ZOSTAVAX (Oka/Merck) (no lot # p n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub n has been received from a physician concerning a 62 year old female with several autoimmune U diseases, 1/1/2009 who about1/1/2009 a month ago approxi n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTAVAX n has been received from a physician Y concerning a patient who on 10-FEB-2009 was vaccinated with a 2/10/2009 dose of ZOSTAVAX 2/12/2009(Oka/Merck). n has been received from a licensed practical nurse concerning a 79 year old female who onN29-DEC-2008 was ### vaccinated 1/8/2009 with ZOSTAVA n has been received from a pharmacist Y concerning an 89 year old male with allergies to GUAIFENESIN, N 4/14/2008 PENICILLIN 2/13/2009 and SUDAFED, and n has been received from a medicalYassistant concerning an 80 year old female with diastolic N dysfunction, 2/10/2009 hypertension, systolic murmur, c n has been received from a 59 yearYold female with allergic PENICILLIN, SULFONAMIDE and N ERYTHROMYCIN, 1/7/2009 and 1/7/2009 no pertinent medica n has been received from a physician Y concerning a 77 year old female who on 12-FEB-2009Nwas vaccinated 2/12/2009 SQ with 2/13/2009 ZOSTAVAX (Oka/Me n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub n has been received from a physician Y assistant concerning a male with hypertension, osteoarthritis Y and no drug allergies 2/9/2009 whose wife in Dec n has been received from a 61 year old female with iodine (IVP dye) allergy and a history of Nheadaches 1/19/2009 while on therapy 1/20/2009 with DEMEROL a n has been received from a 67 yearYold female with allergic reaction to ERYTHROMYCIN, KEFLEX, N sulfa, FLAGYL, ### BUTALBITAL, ### aspirin n has been received from a physician concerning a patient who on an unspecified date was Yvaccinated with a dose of ZOSTAVAX (Merck) n has been received from a pharmacy technician concerning a 60 year old female patient who N on 17-FEB-2009 2/17/2009 was2/17/2009 vaccinated with a dose n has been received from a pharmacist Y concerning a 78 year old male patient with a previous N cause of shingles 2/16/2009 in October 2/18/2009 2008, who on 1 n has been received from a pharmacist Y concerning an adult female patient who was vaccinated Y with a dose of ZOSTAVAX 1/18/2009 (Oka/Merck) 0.5 n has been received from a pharmacist Y concerning a 70 year old female with allergies to alendronate N sodium 2/16/2009 (MSD)2/18/2009 WAES # 0902USA044 n has been received from a pharmacist concerning an 81 year old female patient with a history N of shingles1/8/2009 on her trunk 2/8/2009 and no known drug n has been received from a physician concerning an over 65 year old patient who on approximately U 20-DEC-2008, ### 2/20/2009 two months ago, was va n has been received from a physician concerning a male who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml2/18/2009 (lot # not reported). Aft n has been received from a nurse practitioner concerning an approximately 70 year old patient U with cardiac failure who was vaccinated SQ n has been received from a pharmacist concerning a female patient with sulfa allergy who on N 18-FEB-2009 2/18/2009 was vaccinated 2/19/2009 with ZOSTAVA
n has been received from a registered Y nurse concerning herself with a history of osteoporosis N and borderline 8/4/2008 elevated 9/1/2008 LDL who on 04-AUG n has been received from an office Y staff in physician office concerning a 63 year old female Y patient with a history of Fibro Myalgia who was n has been received from a nurse practitioner Y concerning a 73 year old female with osteoporosis N and hypertension 2/17/2009 2/19/2009 and no known drug alle n has been received from a 67 yearYold female with penicillin allergy and high blood pressure N who on 1-JUN-2007 6/1/2007 was 2/14/2009 vaccinated with a do n has been received from a consumer Y of 77 year old female with a history of high blood pressure N and drug 2/20/2009 reaction2/21/2009 to niacin and stent put n has been received from a physician concerning a 73 year old female who was vaccinated N with a dose 1/23/2009 of ZOSTAVAX (Oka/Merck) approx n has been received from a pharmacist Y concerning a patient who on 23-FEB-2009 was vaccinated N intradermally 2/23/2009 with 2/23/2009 a dose of ZOSTAVAX n has been received from a physician Y and a licensed practical nurse concerning an 86 year N old female patient ### with hypertension, 2/3/2009 coronary n has been received from a physician Y concerning himself, a 61 year old male patient with a history N of pain 2/16/2009 and vaccine 2/18/2009 reaction and no kno n has been received from a licensed Y practical nurse concerning a 61 year old male patient who U on 5-FEB-2009 2/5/2009 at 13:25 2/5/2009 was vaccinated wi n has been provided from a physician concerning a female patient who on 13-FEB-2009 was Y vaccinated2/13/2009 with a dose 2/23/2009 of ZOSTAVAX vaccin n has been received from a physician Y concerning an 83 year old female patient with osteoarthritis, N elevated 4/22/2008 cholesterol, 2/14/2009 degenerative joint n has been received from a nurse practitioner concerning a 72 year old female homemaker N with no history 2/1/2008 of HSV I or 2/1/2008 II and allergy to aspi n has been received from a registered Y nurse concerning an 79 year old male with type 2 diabetes N mellitus, 11/8/2007 coronary 2/5/2009 artery disease and pro n has been received from a 71 year old female with allergic reaction to FLAGYL who on 20-FEB-2009 U was 2/20/2009 vaccinated 2/20/2009 with a dose of ZOST n has been received from a physician Y concerning a patient who was vaccinated with a singleYdose of ZOSTAVAX 2/1/2008 (Oka/Merck). 1/12/2009 It was repo n has been received from a physician concerning a female in her 70s who "about a year ago" Y was vaccinated with ZOSTAVAX (Oka/Merck n has been received from a pharmacist concerning a 65 year old female who on 29-JAN-2009 U was vaccinated 1/29/2009 with 1/29/2009 a dose of ZOSTAVAX ( n has been received from a nurse practitioner concerning a male patient who at the "beginning Y of December 12/1/2008 2008" 12/1/2008 was vaccinated with ZO n has been received from a 72 yearYold female with diabetes, sulfonamide and a history of tetanus N who about one and 2/8/2009 a half to two years a n has been received from a 71 year old female patient with a history of shingles before receiving N the vaccine 10/2/2008 and blisters 10/9/2008 around her lips si n has been received from physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) on an unspecified date. Subse n has been received from a physician concerning a 61 year old female with diabetes who in N February 2008, 2/1/2008 was vaccinated 5/1/2008with ZOSTAVA n has been received from a pharmacist concerning a 65 year old female who on 21-FEB-2009 Y was vaccinated 2/21/2009 with 2/23/2009 one dose of ZOSTAVA n has been received from a female consumer who was vaccinated with ZOSTAVAX (Oka/Merck). Y The consumer reported my physician did n has been received from a medicalYassistant and a nurse practitioner (N.P.) concerning an N 81 year old female 2/9/2009 patient 2/11/2009 with hyperlipidaemia n has been received from a physician's assistant concerning a girl who on an unspecified date U was vaccinated 2/12/2009 with 2/12/2009 a first dose of VARIVAX n has been received from a 65 year old female with blood pressure and thyroid problem whoYwas vaccinated with a12/1/2008 dose of ZOSTAVAX (O n has been received from a 60 year old female with sulfonamide, morphine, DEMEROL andNCELEBREX 1/2/2009 allergy who1/3/2009 on 02-JAN-2009 was n has been received from a pharmacist concerning a 65 year old male who on 05-Jan-2009 N was vaccinated 1/5/2009 with ZOSTAVAX, 1/10/2009 subcutaneou n has been received from a 60 year old female receptionist who in December 2008, was vaccinated Y with12/1/2008 a dose of ZOSTAVAX 12/1/2008 (Oka/Merck n has been received from a pharmacist Y concerning a 66 year old female patient with no known N drug allergies, 1/12/2009 who on 1/14/2009 12-JAN-2009 was va n has been received from a pharmacy tech concerning a female patient in her late 60's who U on approximately 1/1/2009 01-Jan-2009, 1/1/2009"approximately n has been received from a nurse practitioner Y concerning a 60 year old male patient with a history N of Human 1/2/2009 immunodeficiency virus expos n has been received from a physician concerning a male patient who on an unspecified dateYwas vaccinated 6/30/2008 with a dose of ### ZOSTAVAX (O n has been received from a registered Y pharmacist concerning a 22 year old female employee Y who handles the intact1/1/2009 ZOSTAVAX vaccine ( n has been received from a 65 yearYold female registered nurse, who is the consumer, with Y hypersensitivity and ### allergic reaction ### to antibiot n has been received from a registered pharmacist concerning an 80 year old female with arthritis Y and sulfa 1/2/2009 allergy who 1/2/2009 on 02-JAN-2009 wa n has been received from a nurse concerning Y a 76 or 77 year old female patient who in MaryY 2008, was vaccinated 3/1/2008 12/1/2008 with ZOSTAVAX (Oka/ n has been received from a pharmacy student concerning a patient who about 1 month ago,Nwas vaccinated 12/1/2008 with a 12/1/2008 dose of ZOSTAVAX (O n has been received from an office Y manager concerning a 72 year old male who on 06-JAN-2009 Y was vaccinated 1/6/2009 with 1/6/2009 a dose of ZOSTAVA n has been received from a registered pharmacist concerning a 72 year old female patient who Y on an unspecified date was vaccinated with n has been received from a nurse practitioner Y concerning a male patient who in December 2008, N was vaccinated 12/1/2008with 1/5/2009 a dose of ZOSTAVA rmation has been received from a pharmacist concerning a 77 year old male who on 30-DEC-2008 N was vaccinated ### with 1/9/2009 ZOSTAVAX (Oka/M n has been received from a 68 yearYold female patient with sulfonamide allergy and a historyNof blood pressure high who in ### approximately 2 n has been received from an office Y manager concerning a 62 year old female who on 08-JAN-2009 Y was vaccinated 1/8/2009 with 1/8/2009 a dose of ZOSTAV n has been received from an office Y manager concerning a 66 year old female who on 08-Jan-2009 Y was vaccinated 1/8/2009 with 1/8/2009 a dose of ZOSTAV n has been received from a 68 yearYold female patient with breast cancer, atrial fibrillation, cardiac N valve11/1/2007 leak, neuropathy 11/1/2007 peripheral, sulfon n has been received from a medical assistant concerning a 69 year old female who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck n has been received from a pharmacist Y concerning a 91 year old female who on 12-DEC-2008 U was vaccinated### with a dose ### of ZOSTAVAX n has been received from a 74 year old female with Crohn's disease, penicillin and Keflex allergy N who on 1/8/2009 08-Jan-2009 1/8/2009 was vaccinated with
n has been received from a 62 yearYold female nurse with penicillin and PREDNISONE allergy, N hypercholesterolaemia 1/7/2009 1/8/2009 and osteopenia and n has been received from a pharmacist Y concerning a patient who on approximately 1-JAN-2009 U "last week" 1/1/2009 was vaccinated 1/1/2009with ZOSTAVA n has been received from a healthcare student concerning a male patient who on 07-JAN-2009 U was vaccinated 1/7/2009 with 1/7/2009 ZOSTAVAX (Oka/Mer n has been received from a pharmacist concerning a 62 year old female with PENICILLIN allergy N who on 1/5/2009 05-JAN-2009 1/5/2009 was vaccinated with n has been received from a pharmacist Y concerning a 65 year old female who on 06-JAN-2009 U was vaccinated 1/6/2009 with ZOSTAVAX 1/6/2009 (Oka/Merc n has been received from a nurse concerning a male who on an unknown date, was vaccinated N with ZOSTAVAX (Oka/Merck) (lot# not pro n has been received from an 82 year Y old female patient with no known drug reactions-allergies N and medical history, ### who on ### 16-DEC-2008 n has been received from a 75 year old female with allergic to sulfa who was vaccinated withNa 0.65 ml dose of### ZOSTAVAX 1/2/2009(Oka/Merck) (lo n has been received from an office manager concerning a female nurse with a history of shingles U who on 31-DEC-2008 ### was ###reconstituting n has been received from a physician concerning a patient who on approximately 24-DEC-2008 U was vaccinated ### with ZOSTAVAX (Oka/Me n has been received from a 60 year old nurse practitioner with no pertinent medical history reported Y and12/3/2008 no drug reaction/allergies, ### reportin n has been received from a registered nurse concerning a patient who was vaccinated with Y a dose of ZOSTAVAX ### (lot # not ### reported) by th n has been received from a 63 yearYold female consumer with penicillin allergy who reportedNthat she received 4/1/2008 a single 11/1/2008 dose of ZOSTAVAX n has been received from a nurse practitioner concerning a 66 year old female patient with no N known drug reactions/allergies ### ### and asthma w n has been received from a registered Y nurse concerning a female who on 19-DEC-2009 wasUvaccinated with "one ### dose" of ### ZOSTAVAX (O n has been received from a nurse concerning Y a 68 year old female patient with hypertensionYwho on 08-FEB-2008 2/8/2008 12/9/2008 was vaccinated in her le n has been received from a 61 year old female with an allergy to penicillin and no pertinent medical N history who ### on 19-DEC-2008 ### was vacc n has been received from a pharmacist Y concerning a 63 year old female patient, with no pertinent N medical history ###and no known ### drug react n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith ZOSTAVAX 12/1/2008 (Oka/Merck) 12/1/2008 about two week n has been received from an 81 year old female who in October 2008 was vaccinated with ZOSTAVAX U (Oka/Merck), 10/1/2008 10/1/2008 0.65ml/once, SC Sub n has been received from a pharmacist concerning a 74 year old male with a history of cold U sores, who one year ###ago was### diagnosed with N n has been received from a 62 year old male who "about 8 weeks ago" was vaccinated withUsingle dose of series ###of ZOSTAVAX ### (Oka/Merc n has been received from a male with a history of herpes simplex who was vaccinated with aNsingle dose of ZOSTAVAX ### (Oka/Merck) ### (lot # n has been received from a physician concerning a 15 year old female patient, who on an unspecified U date, was ### vaccinated ###with ZOSTAVA n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith single dose 6/1/2008 of ZOSTAVAX 6/1/2008about 6 month n has been received from a 62 year old female with "numerous reactions to other unspecified U medication" who### on 17-DEC-2008 ### was vacci n has been received from a 85 year old female patient, with codeine and sulfonamide allergy, N who on 15-DEC-2008 ### was vaccinated ### with a n has been received from a 61 yearYold female patient with allergic reactions to antibiotics (had N a reaction once to ERYTHROMYCIN), who n has been received from an 86 year Y old female with blood pressure and a history of shingles N in April 2006, 12/7/2007 who on 07-DEC-2007 ### was vac n has been received from a 71 yearYold female patient with hypertension and no known drugNreaction or allergies, ### who on### 20-NOV-2008, w n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA n has been received from a doctor of pharmacy concerning a patient on an unspecified dateUwas vaccinated with a dose of ZOSTAVAX (O n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA n has been received from a registered pharmacist concerning a 77 year old female patient who Y on 12-DEC-2008 ###was vaccinated ### subcutan n has been received from a registered pharmacist concerning an unknown number of patients U who were12/1/2008 vaccinated12/2/2008 with a dose of ZOSTA rmation has been received from an office Y coordinator and follow up information has been received N from a10/9/2007 physician 10/9/2007 concerning a 59 year ol n has been received from a registered nurse who on unspecified date developed shingles like U blisters from giving ZOSTAVAX to patients. S n has been received from a registered Y pharmacist concerning a 75 year old female patient who N on 23-JAN-2008 1/23/2008was 12/9/2008 vaccinated with a dos n has been received from a physician concerning a 71 year old male who on 09-DEC-2008 was U vaccinated 12/9/2008 with a 0.65 mL### dose of ZOSTA n has been received from a 56 year old male patient with dialysis and allergy to tetracycline N who on 11-DEC-2008 ### was vaccinated ### in the ar n has been received from a nurse practitioner concerning a 65 year old female patient with hypertension N and osteoporosis, ### ### who on 15-DEC n has been received from a medicalYassistant concerning a 60 year old female patient with drug N hypersensitivity 12/9/2008 to DEMEROL 12/9/2008 and no perti n has been received from a doctor of pharmacy concerning a 66 year old patient who on 16-Dec-2008 N was vaccinated ### with ### a dose of ZOST n has been received from a female who on an unknown date, was vaccinated with ZOSTAVAX U (Oka/Merck) (lot# not reported). Subsequen n has been received from a consumer Y concerning her 73 year old male husband with a pacemaker U and a1/2/2008 defibrillator, 11/1/2008 and a history of both n has been received from a female patient who on 26-Nov-2008 was vaccinated subcutaneously N with a dose of### ZOSTAVAX ###(Oka/Merck). O n has been received from a pharmacist concerning a 62 year old female patient with no drugNreactions/allergies, ### who on 12-DEC-2008 ### was n has been received from a nurse concerning a 75 year old male patient with a history of large Y cell lymphoma 11/2/2007 who on 12/5/2008 21-NOV-2007 was va follow-up information has been received Y from 62 year old female pharmacist prone to fever Y blister who on 12/5/2008 05-DEC-2008 12/5/2008 at 10:00 was vacc n has been received from a female physician who on 10-DEC-2008 was vaccinated with a dose N of ZOSTAVAX### (Oka/Merck). ###The physician n has been received from a 65 yearYold female with diabetes who in July or August 2008, was N vaccinated7/1/2008 with a dose 12/1/2008 of ZOSTAVAX (Oka/
n has been received from a physician Y concerning a 78 year old male patient with hypertension, N artery coronary 1/5/2007 disease 10/2/2008 and diabetes and a n has been received from a pharmacist concerning a patient who two to three days ago wasNvaccinated 12/8/2008 with a dose of ZOSTAVAX vaccine n has been received from a health professional concerning a 67 year old female with an allergy N to latex, who on ### 10-DEC-2008 was vaccina n has been received from a registered Y nurse concerning a 61 year old male with hypercholesterolemia Y who on### 10-DEC-2008 ### was subcutan n has been received from a nurse practitioner Y concerning a 13 month old female who inadvertently U on 09-DEC-2008 12/9/2008 12/9/2008 was vaccinated SQ w n has been received from a medicalYassistant concerning a 74 year old female patient who had U an episode 5/1/2008 of shingles prior to receiving ZO n has been received from a nurse practitioner Y concerning an 87 year old female patient withNhypertension, 12/1/2007 hyperlipidaemia 12/7/2008 and hypothyroid n has been received from a store manager concerning a female patient who on 12-NOV-2008 U was vaccinated ### with a dose of ZOSTAVAX ( n has been received from a physician Y concerning a 66 year old female patient with codeine N allergy, hypertension 10/1/2008and 10/1/2008 hypothyroidism who 2 n has been received from a female patient who on an unspecified date was vaccinated with U a dose of ZOSTAVAX (Oka/Merck). Subseque n has been received from a female consumer who on 25-NOV-2008 was vaccinated with a dose U of ZOSTAVAX ### (Oka/Merck). ### On 28-NOV-2 n has been received from a 46 year old male patient with history of drug hypersensitivity to penicillin N and12/3/2008 shellfish based 12/3/2008 medications such n has been received from a consumer concerning her sister, a female patient who accordingUto the consumer she had already had a very b n has been received from a physician concerning a 1 year old patient who on 24-NOV-2008Uwas vaccinated with ###a dose of### ZOSTAVAX (Ok n has been received from a nurse practitioner Y concerning a 67 year old male patient with sleep N apnoea and 9/12/2008 a history 9/12/2008 of head injury recover n has been received from a 64 year old male with high blood pressure and shingles with post U herpetic neuralgia 10/1/2007 (PHN) and ### a history of sten n has been received from a physician concerning a 60 year old female who, "in last week", on U approximately 24-Nov-2008 ### was vaccinated n has been received from a female patient, who in February 2008, was vaccinated with a dose Y of ZOSTAVAX 1/1/2008 vaccine 12/1/2008 (Oka/Merck) (Lot. # n has been received from a 73 yearYold male patient with history of prostatic disorder and noNknown drug11/1/2008 reactions/allergies, 11/3/2008who on appro n has been received from a physician Y concerning a 77 year old female patient who in February N 2007, was2/1/2007 vaccinated with### a dose of ZOST n has been received from a pharmacist concerning a patient who about a year ago was vaccinated N with a dose of ZOSTAVAX (Oka/Merck n has been received from an 88 year Y old female consumer with a blood pressure condition and N no pertinent medical ### history, ###who on 18-No n has been received from a registered Y nurse (R.N.) concerning her father, an 83 year old male N with a history 2/1/2008 of macular 11/1/2008 degeneration and " n has been received from a physician concerning a 74 year old male with hypertension, dyslipidaemia Y and penicillin ### allergy ### and a history of n has been received from a consumer Y concerning her 75 year old mother with leukemia, memory N loss and a history ### of two strokes, and "all n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck) (Lot n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Merck) (Lot not re n has been received from a 54 yearYold female with a history of shingles in right eye in Feb 1998 N and no drug allergies ### who ### was vaccinated n has been received from an 88 year old male with no pertinent medical history who on 15-DEC-2008 N was vaccinated ### 1/6/2009 subcutaneously with n has been received from a 61 yearYold female with sulfonamide allergy and no pertinent medical U history who 1/5/2009 on 05-Jan-2009 1/5/2009 was vaccina n has been received from a 74 year old female with sulfa allergy and allergic to an antibioticsU(unspecified) 1/6/2009 who on 6-JAN-2009 1/8/2009 was vaccin n has been received from a registered pharmacist concerning a patient who was vaccinatedYwith a dose of ZOSTAVAX (Merck) (Lot not re n has been received from a 66 year old male patient with high cholesterol and a history of quadruple N vessel 1/5/2009 bypass graft 1/6/2009 in 1990, shingles n has been received from pharmacist concerning a 73 year old female who on 03-JAN-2009Nwas vaccinated 1/3/2009 with a dose 1/3/2009 of ZOSTAVAX va follow-up information has been received from a registered pharmacist concerning a 75 year N old male patient 1/4/2009 with no 1/4/2009 known drug reaction/a n has been received from a physician Y concerning a female patient who on 05-DEC-2008 was U vaccinated12/5/2008 with a 0.65ml dose ###of ZOSTAVAX n has been received from a female Y Registered Nurse, who "5-6 weeks ago", was vaccinatedNwith ZOSTAVAX ### vaccine 12/8/2008 (Oka/Merck) subcuta n has been received from a 70 year old male with sulfonamide allergy who on 24-DEC-2008Ywas vaccinated with ###a 0.65 ml ### dose of ZOSTA n has been received from a pharmacist Y concerning a 67 year old female patient with hypothyroidism, N arthritis, diverticulitis ### ### and interstitial cy N n has been received from Y a physician Y concerning Y an approximately 030 months old female who Y received 3 doses of PEDVAXHIB 5/1/2008 (lot# not re n has been received from a Doctor Y of pharmacy Y concerning a 79 year 0 Yold male inpatient for N decompensate 4/2/2009 diabetes 4/2/2009 with hypertension, dia n has been received from a registered nurse, for VARIVAX vaccine (MERCK), a Pregnancy U Registry product 3/4/2009 concerning 3/4/2009 a 17 year old preg n has been received from a registered pharmacist concerning a now 66 year old female whoYin approximately 2003 "about 4 to 6 years ago rib cracked went to doctor. Y She prescribed pain pills, week later it went popped again. YearsNwent by without 10/1/2003 problems, breast cancer show a 16-year-old female who presents today with mother. Y The patient states 1 she was with her mom Y earlier getting 3/12/2009 her prom 3/13/2009 dress fitted when s vaccines on 3-16-09. The evening of vaccine she got a fever + slept poorly. In the morningYafter the vaccine 3/16/2009 was disoriented 3/16/2009 + needed he h swollen, red with blisters. Looks like Y a 2nd degree burn. Almost entire thigh swollen. Very tender U to touch. 4/1/2009 Swollen area 4/1/2009 very hard. Receiv dizziness, vomiting low grade fever resolved spontaneously. U 4/1/2009 4/1/2009 d bilateral pulmonary embolisms Y and Y moderateYto severe right ventrical 4 heart dysfunction. Misdiagnosed Y originally ### as "walking ### pneumonia", pain and swelling in arm. HeadacheYand temperature 100.2 degrees 24 hours after vaccine.Y5 cm swelling 3/27/2009 and erythema. 3/28/2009
e course on the vaccines, patient has Y developed debilitating abdominal pain. 4/15/09 MR received U 5/5/08 6/13/2008 to 4/13/09.8/1/2008 15 yr WCC 6/13/08 w at 10:45 am 3/26/09, shaking. PoorYsleep night of 3/25/09. Y 3/25/2009 3/26/2009 PE complete immunization given (DTAP Y IPV MMR Varicella) 415P child started cough. 4:20pm Y wheeze A-P 4/6/2009 lungs. Benadryl 4/6/2009 12.5mg / 5ml S ction lasting 4 days. Y Y 3/30/2009 3/30/2009 d PREVNAR vaccine @ thigh on 4/12/09 at 1021 AM. Awoke from nap approx 3PM & criedYas if in pain. 4/2/2009 Mom noticed 4/2/2009 R leg (thigh->toes) edness and swelling of left upper thigh, plus erythema approximately 12cm. U 4/1/2009 4/1/2009 ceived the Zoster vaccine at the clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed a shingles 2/5/2009 rash approx 2/15/2009 10 days after the vac njection of ZOSTAVAX on 03/25/2009 about six days later developed red spots on my right leg U on the inside 3/25/2009 between 3/30/2009 ankle and knee. The ped rash after vaccines were given. I'm sure of due to Varivax n MMR. 3/24/2009 me to pick up a sticker and she looked pale, lips were white. She said she was tired and laidYdown on the4/8/2009 floor. I picked 4/8/2009 up patient and carr eral scattered vesicles. Some already crusting over. Y 3/10/2009 4/4/2009 roke out on left thigh as soon as theY MMR was pushed. Patient was given BENADRYL 12/5mg Y and thigh 4/9/2009 was observed 4/9/2009 for 15 minutes. Th of redness to the right deltoid, muscle Y aches in right arm patient unable to lift arm above hisNright shoulder. 4/4/2009 Patient states 4/6/2009 " I just do not fee lled 4/9/09 AM to notify us approximately two hrs after vacc. She felt "weak and with headache"; U this morning 4/8/2009 after 154/8/2009 min run she c/o swea LA vaccine (along with TDAP & HEP A, and MENATRA) given 3/31/09 (1388 IM VERIVAX lot) onset (acute) 3/31/2009 Bell Palsy 4/4/2009 VII on 4/4/09. U 4/6/2009 iatric/adolescent dose of Hepatitis A instead of adult dose. Dr notified at 16:04, 3/31/09. Y 3/31/2009 as inadvertently given DTap instead of Tdap. Patient contacted today and has had no adverse Y events. 4/3/2009 elling - Pt reported fever to 101 x 2 days after 2 days on 4/3/09 redness- swelling inner L armY5"X3" - No fever 3/3/2009 - Tx BENADRYL 3/3/2009 and KEFLE Y 3/31/2009 3/31/2009 old female presents with fever starting Y 4 days after Y vaccination. Patient 2 continued to fever for Y 6 days with3/9/2009 102-104.7t 3/12/2009 with no other sympto he dept and left message. Pt was contacted at 2:15pm of 04/07/2009, stated"03/26/2009 gotYinjection in3/26/2009 clinic, started 3/27/2009 to act out on Friday munized with Varivax vaccine on 3/4/09. Over the next 48 hours, she developed redness and Y warmth at 3/3/2009 injection site, 3/3/2009 and surrounding are 1/30/2009 N 4/17/2008 1/30/2009 ar sized redness and warm to touch at administration site. Y 4/8/2009 4/9/2009 elt "woozy,dizzy" when got home. approx Y 1 1/2 hr later had some difficulty breathing along with Y burning sensation 3/18/2009of3/18/2009 face and eyes. did not 2/18/1998 Y Y Y 1 N 1/9/1998 1/19/1998 ent at 10:15am, pt. called 9:15pm complaining of right arm pain, not red, no fever, vomiting and Y stomach3/26/2009 ache; ate out. 3/26/2009 d Herpes Zoster (C5 distribution) 03/21/2009 Y 9/2/2008 3/21/2009 s a softball sized area at the site of administration. Area is painful, red, swollen, and warm toUtouch. Patient 4/8/2009 does not4/9/2009 have a fever or other ver 6 hours after injection. Tylenol given.Fussy. Appetite down and remains down. Awoke whimpering Y with 4/7/2009 high fever 4/7/2009 (10 pm) Temp Recta ceived #2 VZV, #1 HPV, and #1 Tdap (had 5 previous DTP vaccines) 4-1-09 at the HC. At the Y OV on 4-1-09 4/1/2009 patient also 4/4/2009 had a viral gastroe 4/9/2009 N 4/8/2009 4/9/2009 week field exercise, patient was administered anthrax and smallpox vaccine, 05MAR09. Patient Y did follow-up 3/5/2009 note on 3/23/2009 12MAR09 with no pro eved shots at health departmentY behind Y schedule.Received 6 vaccines. Around 8 hours later, Y dad found3/16/2009 child having 3/16/2009 seizure, limp, blue, dr came cranky cried her developed rash on her lower extrimities.Rash lasted for 1 hour patientY consolable 1 n 20 minutes after the administr hours after TD was given pt started Yto run a low grade temp and had swelling of the injection site along with 4/6/2009 a hive. Mom 4/7/2009 was told to use co ceived Kinrix (DTaP,IPV, MMR & Varicella 04/07/09. He was seen in the office this date dueYto pain, itching 4/7/2009 and swelling 4/8/2009 in left arm for 2 da o 102.5, rhinorrhea, and erythematous rash that began on cheeks and spread to neck, trunkNthen extremities. 3/26/2009 Further 3/28/2009 details can be obtain 3/12/2009 N 3/11/2009 3/11/2009 was reported by a physician (also the father of the subject) and described the occurrence ofUvaccine underdose 3/5/2009 in a 3/5/2009 31-year-old pregnant f ped acute abdominal pain - 2 hrs after injectionYof (1) GARDASIL; (2) 1 MENACTRA, (3) TDAP. Y Pt was evaluated 3/25/2009 in ER 3/25/2009 - diagnosis acute UT remic swelling on Rt upper arm at injection site 1"/1'/2" Y 3/19/2009 3/19/2009 9 at 1030 the pt received the TDAP and IPV in her right arm. The pt woke at about 2230 with the sensation 3/25/2009 that her3/25/2009 throat was swelling. T and rash reaction with angioedema. 4/1/2009 4/4/2009 ew minutes client turned pale, stiffened body, arched back, arms curled to chest, eyes rolled Yback, head jerked 4/8/2009 back and 4/8/2009 forth. Lowered clie weakness BP prior to event 114/62, S/P 96/58 pulse 60 normal breath sounds. Blood sugarY = 82. 4/2/2009 4/2/2009 s after receiving vaccine started to "hum" Y fell over backwards hit head on floor, unconsciousUapprox 10 seconds 4/8/2009 -> head 4/8/2009 twitching as in office to have meningococcal but was given a HIB injection instead. 3/30/2009 vaccination on 3/31/09: TDAP and TYPHOID right arm, FLUMIST and AVA #4 left arm. On 1 April 09 pt3/31/2009 noted a 3" 4/1/2009 circle of redness and s
ates she started having cold symptoms and a sore throat starting the day after the immunization. Y 2/21/2009 2/22/2009 ately 2 weeks after immunization, he states his muscles felt tight, and he states he felt more Y fatigued than 2/27/2009 normal. This 3/13/2009 lasted about 5 days mplaining of intermittent sharp mid to low back pain since last night. Pain occurs when getting up from laying down position and forceful ex er vaccine administered had swelling, redness, tender. To RTR- 2" by 2" - raised red & swelling Y to L deltoid4/7/2009 15mm by 4/9/2009 15mm diffuse red. me to our clinic on 4/9/09 at 10:05 accompanied by mother. Patient complains of body aces,Unausea no vomiting, 4/7/2009soreness 4/8/2009 in bilat. arms an rmation was received on 21 November 2008 from a health care professional. A cluster of approximately Y 20 cases of slight bleeding at the s ort was received on 08 December 2008 Y from a consumer (patient's mother). A 4-month-old male U with a history 10/7/2008 of being 10/7/2008 33 weeks premature n has been received from a health professional Y for GARDASIL, a Pregnancy Registry product, Y concerning 3/20/2008 a female3/20/2008 who became pregnant n has been received from a registered Y nurse for Y the pregnancy registry 0 for GARDASIL concerning Y a 17 years 6/1/2008 old female 6/16/2008 patient with no pe n has been received from a consumer Y concerning Y his 18 year old daughter 10 with no pertinentNmedical history 8/28/2008 or no known 9/8/2008 drug allergies, wh n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from a school staff member n has been received from a consumer concerning her now 11 year old nephew who on an unspecified U date was vaccinated with a dose of n has been received from a consumer concerning her now 12 year old nephew who on an unspecified U date was vaccinated with a dose of n has been received from a physician concerning Y a male who on 04-APR-2008 0Y was vaccinated N with a dose 4/4/2008 of ZOSTAVAX 3/1/2009 (Oka/Merck). In ort was received from another manufacturer Y (document number 45216582), who received theYreport from a health care professional, who is n has been received from an 82 year old female patient with no drug reaction/allergies, who Non 23-JAN-2009 1/23/2009 at about 1/24/2009 12:00, was vaccinate reporting disturbed sleep at night secondary to pain at injection site. She is reporting that she U experiences 4/3/2009 some numbness 4/4/2009from shoulder about 4-6 cm left deltoid. warm to touch. Y 4/1/2009 4/2/2009 d rash. She went to the doctor andYit was diagnosed as shingles. She had a fever and flu like U symptoms 3/20/2009 preceding the rash. The rash wa on all my neck for two days, I had fever yesterday, it last only one day and I still have the swelling N of glands 3/30/2009 starting 4/7/2009 yesterday. I haven't vi after receiving the shingles vaccine on April 3, 2009 I had flu like smyptoms. Headache, sleepless Y nights, 4/3/2009 chills, achy 4/6/2009 all over,very weak, f Dtap given, 04/01/09 Pt. had axillary temp of 103, 04/02/09 Pt. had 2-3cm redness at injection U site 3/31/2009 4/1/2009 ction to Dtap (given on 03/30/09), right Y arm swollen and red (4cm). Pt. came back to office onU04/01/09. 3/30/2009 3/31/2009 mins of injections, pain, stiffness, extreme Y fatigue, lethargic . Then experienced cont. Y pain and N soreness,3/23/2009 stiffness on3/23/2009 and off for next week X2 4/29/09 Received Hospital medical Y records Y for 2/8-2/9/2009 & 4/5-4/7/2009. 5 FINAL DX: new Y onset seizures 2/4/2009 Records 2/8/2009 reveal patient expe d area, size of half-dollar, left arm.Swelling Y arm/neck/shoulder. MD diagnosed cellulitis. U 8/18/2008 8/20/2008 ainful red swollen 4 X 3 1/2" area on left arm after vaccination Y 4/25/2008 4/26/2008 mm red raised area at site of injection generic benadryl given Y 4/8/2009 4/9/2009 te, fever, seizure Y N ### ### abdomen/chest/lumbar Y Y ### ### nt shooting pains in right arm, soreness at injection site, no redness or swelling at site U 11/5/2007 11/6/2007 red Tdap and Gardisil, pt.'s head dropped, was unresponsive, arms and legs drew up in seizure-like Y activity, 8/17/2007 pt. was8/17/2007 incontinent of urine, pt redness, warm to touch, itches Y U 8/3/2007 8/4/2007 and high pitched screaming two hours after vaccines given, lasted for 2 hours Y 5/16/2007 5/16/2007 inistration of all 4 vaccines, upon departure and standing, client reported feeling dizzy. Assisted Y client back 4/9/2009 to chair. 4/9/2009 Client fainted. Incohe er MMR vaccination our daughter developed Y a 101 degree fever. The the 6th day our daughter U had a febrile 3/30/2009 seizure due 4/3/2009 to a 104 fever. Sh d vomiting, dehydration and abdominal Y pains. 4/14/09 Y Received hospital 4 medical records of U 4/9-4/12/2009. 3/30/2009 FINAL DX: 4/2/2009 cyclic vomiting; abdo n 02-25-09. States she had pain, swelling and itching lasted 2 weeks after injection (given 11/3/08). Y She11/3/2008 didn't do anything then and about ped a rash on right arm shortly after vaccine administration N 3/9/2009 3/14/2009 redness, very hot, doubled in size on Y the evening of 04/06/09. Mother gave Benadryl and theYnext morning 4/6/2009 pt. woke up 4/6/2009 screaming of pain. M rea of induration over R deltoid with 13x10 cm of erythema, non-tender, no expressible d/c. Received U DAPTACEL 4/9/20094/9/09 4/10/2009 R deltoid 20, 2009 - developed severe headache. Y Seen by PMD on March 23, who diagnosed shingles. Y 3 lesions4/10/2008 on scalp - 3/20/2009 (L) side of head - culture h large erythematous edematous puritic Y patch around site of DTaP & varicella injections -> 5" wide x 4" long; 4/8/2009 To ER 4/8/2009 + office. hing, blinking, facial grimace beginning on day of administration of vaccine and has been ongoing. U Frequency 4/6/2009 about 4x/10 4/6/2009 minutes. itis day 13 after MMR. Y 3/26/2009 4/6/2009 tous discoloration with slight induration approximately 9-10 cm, no c/o pain. Y 4/7/2009 4/9/2009 rythema 15x16cm left thigh, not tender, + warmth and itch. Continue TYLENOL and IBUPROFEN; U BENADRYL 4/8/2009 for itching. 4/9/2009 after the shots, became pale around 5 sec no treatment needed. Y 4/7/2009 4/7/2009 e and pain in all of them, incontinence urinary, memory loss. N 2/10/2003 s and dizziness especially upon standing. Hot feeling in face and head - sweating on face and U head. Fasting 4/10/2009 blood 4/11/2009 sugar 131 (diabetic). Oc ven vaccine IV push instead of subcutaneously pt HR 130's but anxious and getting respiratory Y treatment. 4/11/2009 HR in 70's in 15 min.
as extremely exciteable when his cousin that he hadn't seen in over a year came to visit us, his U grandparents. 3/30/2009 The boys 4/9/2009 love each other, bu is red, no swelling noted, arm is warm, but so is other, painful to touch. Patient was advisedUto put ice on 1/14/2009 arm and alternate 1/16/2009with warm com left upper arm Y U ### 1/26/2009 augh,weak, breathing problems Y Y ### 11/6/2008 us case was received on 01 April 2009 from a health care professional. An approximately 3 week Y old patient (gender ### 6/7/2008 not specified) receive ort received 01 April 2009 from a health Y care professional, who is also the patient. AccordingUto the reporter, they developed the "flu" an uns us case was received on 01 April 2009 from a health Y care professional. 0 A 5 month old male U patient received 4/1/2009 PENTACEL 4/1/2009 (lot number C318 n has been received from a physician Y concerning a 24 year old female with allergies to tomatoes N and pollen, migraine, ### rhinitis ### seasonal, de n has been received from a nurse practitioner Y concerning a 24 year old female who Y on 18-FEB-2009 N was 2/18/2009 vaccinated 2/18/2009 with her second dose n has been received from a physician Y concerning a patient who was vaccinated with ROTATEQ Y (lot number not reported) oral. Subsequen n has been received from a physician Y concerning Y a 2-3 year old patient Y who was vaccinatedUwith ROTATEQ (lot number not reported) oral Full clonic/tonic 1 hr 45 minutes after receiving Y routine immunizations 2 - Family describes today's Y episode the 4/3/2009 same as4/3/2009 in the past (same sei ays after vaccine. Hospitalized 1 week Y after with Y erythema multiforme. 3 2 weeks after in ER with N transient3/17/2009 synovitis and fever. Hospital recor multiforme major possible KAWASAKI's Disease. Y 4/27/09 MR received 5 for DOS 3/24-28/2009 Y with D/C 3/16/2009 DX: Erythema 3/18/2009 multiforme major s/ pasms started on the 3rd day after vaccinations Y Yand progressed. Diagnosed 3 in January 2009, U being treated 10/1/2008 with medications 10/4/2008(TOPAMAX, B welling, induration + erythema at injection site - induration 4X5cm; erythema 12 X 8 1/2 cm with N some bruising 4/3/2009 onset at 4/4/2009 approximately 3hrs a swelling, redness and pain at site 9 hrs after shot. Also vomiting. Patient called MD on 3/25/09 Y regarding 3/20/2009 above instructed 3/20/2009 to take Ibuprofe rs of vaccination, Pt developed "big knot" at the injection site, and the site turned blue. Heart Y rate became2/2/2009 elevated. 2/2/2009 She had bad headach 27-09 with c/o dizziness, pain, racing heartbeat & fever. (did not know how high). Too dizzy Yto stand up.3/26/2009 Person suggested 3/27/2009they go to urge nto clinic after shots for immigration.Y She was given a Tdap and an MMR in left arm. Six days Y later she 3/20/2009 came back 3/26/2009 to clinic with a bruised a a swelling and rash at site of VARIVAX. Y Y 4/7/2009 4/7/2009 eceived PC from Pt states LA started Y itching and swelling this weekend. Tdap was given on Y 1-28-09 states 1/28/2009 applied 3/14/2009 soaks to LA area. On 3/ w/ redness & warmth x 40 hours: then pain in arm radiating to shoulder/neck & elbow -> referred Y to physical 2/6/2009 therapy2/8/2009 on 4-3-09. after receiving vaccine felt itchy, dry mouth, felt generally "bad" - low grade temp 99.1 - Following Y day temp 2/10/2009 is PM 102 2/10/2009 degrees - TYLENOL ed child had a tem up to 102 degrees within 24 hrs (off and on). Soreness, redness, and slight Y swelling to3/31/2009 area where4/1/2009 shot was given (L) Va runcal pruritis (primarily B/L breasts). Sx occurred 24-48 hours s/p vaccine (GARDASIL) # TYand lasted9/23/2008 approx. 4 wks. 9/24/2008 Denies rash/ fever ite - swollen, red, soreness, fever (at the injection site) left leg where DTAP + Polio were given. U 3/16/2009 3/17/2009 ceived ANTRAX and Typhoid on 12 Mar 09. Smallpox on 19 Mar 2009. Patient found out thisY month that3/12/2009 she was pregnant when she recei d with shingles along L4 - L5 distribution today. U 9/10/2008 3/31/2009 eddened, "hst to touch", swollen - taken Y to Urgent care by Mom - 4-1-09 - Placed on KEFLEX Y po tid - arm 3/30/2009 resolved 4-30-09 4/1/2009
ight sweats 3/12/09 + 3/13/09. Y 3/12/2009 3/12/2009 h was red & swollen with some oozing coming from area between both shots. Redness wasYapprox. 14-16 3/27/2009 cm X 14 3/28/2009 cm. Child given BENA erythema, swelling, heat, hardness possible cord. No vesicles. U 3/30/2009 4/1/2009 f 04-1-09 : "Restussness" Morning of 4-2-09: Hives U 4/1/2009 4/2/2009 d injection and by next morning felt Ypain/soreness to area of injection. 48 hours after injection U Pt. noticed3/20/2009 a swelling3/21/2009 an redness starting two advertently received BOOSTRIX instead of KINRIX. No adverse events were noted. MotherYwas notified 4/2/2009 of error ately 5 minutes post injection, Pt experienced syncopal episode lasting 10 seconds. BP 90/62 Y at episode. 4/6/2009 After orientation 4/6/2009 X 3 was re- esta d, hard area with streaking - Pt. dx. in Y ER with cellulitis - Parent reported (L) deltoid Y 4/6/2009 4/7/2009 ht shoulder and right deltoid, red, swollen, hard and warm to touch. Denies pain or fever at this U time. Began 4/10/2009 4/11/094/11/2009 and continues today 4 X6 inch area of redness 2 days after Y VARIVAX. Augmentin 875 mg -125mg - 1 tab Q 12 X 10d. U 4/8/2009 4/10/2009 ped hives at the IPV site. Y U 4/7/2009 4/7/2009 veloped erythema & puritis of left upper Y arm within hours of receiving injection there (10 inchYX 10 inch area 4/25/2008 of erythema 4/25/2008 & slight induration action left shoulder - Swelling, pain, redness, fatigue started day after ADACEL administration - Tx MEDROL, 4/6/2009 Ibuprofen 4/7/2009 d, warm to touch, swollen size of tennis ball. Y 4/6/2009 4/7/2009 Pt received Td & Hep B on both L Delt. Pt. states she has marble size knot under skin @ site. Y 3/11/2009 3/17/2009 erythema R upper arm with vesicles. U 3/18/2009 3/31/2009 red w swelling. Ice packs (treatment). U t itch, redness + swelling at vaccine site starting approximately 8 hours after administration associated Y with 3/30/2009 moderate 3/30/2009 headache persisting a tarted with rash neck + chest 3/20 face, arm leg c/o itching - approx 45 U 3/3/2009 3/19/2009 al body aches, nausea, fatigue, elevated B/P and tachycardia, epistaxis; Serum sickness. Y 4/2/2007 4/2/2009
ter rec vaccine, welts developed onYRt neck, between breasts + underneath breasts, Rt + LtYouter arm proximal 4/11/2009 to elbows. 4/11/2009 C/o headache, r s- erythema on right right arm with calor. There was no induration nor tenderness. Y 4/6/2009 4/6/2009 ash on face day following administration of GARDASIL. Also a cough. Y 3/20/2009 3/21/2009 eruptions treated with BENADRYL / CALAMINE Y 3/27/2009 4/5/2009 was reported by a healthcare professional and described the occurrence of vomiting in a 3-month-old U (almost 3/4/2009 4 month 3/4/2009 old) female subject was reported by a physician via a sales Y representative and described the occurrence of rashNin a 4-month-old 4/1/2009 male subject 4/1/2009 who was vaccin 09 with small induration and some redness. Advised to put cold compress + should resolve in U a few day by 4/7/2009 doctor. 4/8/2009 h with erythema and swelling 8cmx4cm Y are of pinpoint induration for 2 days. U 4/7/2009 4/8/2009 ped 8cm X 4.5 cm warm, erythematous raised lesion on upper arm 2 days after receiving VARIVAX. Y Itchy.4/6/2009 No fever. 4/8/2009 ports a rash - itching - developed 2 days after vaccine given 3/18/2009 - Reports used Neosporin with success 3/18/2009 - Referred 3/20/2009 to PMD or clinic f acting different, restless, low grade fever, crying, Y screaming with sucking, 2 poor appetite, restless Y x 2 days. 3/30/2009 Onset 4/2/09. 4/2/2009 Assessment: Pall was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age 4/1/1999 who was vaccinated with LYME was reported by a lawyer and described the occurrence of arthralgias in a male subject of unspecified U age 5/5/2000 who was vaccinated with LYME 99019267-1 describes joint and muscle pain inYa 58 year-old female0who received LYMERIX. N The vaccinee 6/1/1999 has no known allergies or med ability 8 days after vaccination. Fever lasted 3 days and ranged from 100.3 to 104.2 1 episode U of vommitting 4/4/2009 on day 4/10/2009 3. Treated fever with d 12 days ago with MMR. Had some arm soreness which has resolved. Then on Saturday Y 8 days after vaccine 3/5/2009 - he 3/15/2009 developed subjective after receiving the 1st MMR vaccination Y our daughter developed a fever (highest recorded was 101.3), had 4/3/2009 minor vomiting 4/12/2009 (4 episodes tota CALLED COMPLAINING OF HEADACHE WHEICH STARTED APPROXIMATELY TWO DAYS AFTER RECEIVEING 4/6/2009 4/8/2009 ZOSTAVAX. tHE P eported that son's developed arm blister, redness.local reaction 11 April 2009. Dr. made aware Y and advised 4/10/2009 pt to apply 4/11/2009 cold ice pack,and i ollen area 1" to 2" wide per mom. Y 4/7/2009 4/8/2009 an oval shaped, bright red rash on Saturday morning. As of Monday morning it was resolving. Y Denied pain 4/1/2009 at site or 4/4/2009 itching. ported child was not acting herself atYpreschool that morning, as reported by her teachers. Parent Y reported4/7/2009 paying special 4/8/2009 attention for a po icidal ideation, ever since vaccination was administered. This has continued to worsen. Before N being vaccinated, 3/25/2009 mental 3/26/2009 health was at the VER FACE AND NECK APPROX HOURS AFTER VACCINATION WITH 1ST OF PRE-EXPOSURE Y SERIES 4/7/2009 RABIES 4/7/2009 PCEC VACCINE d 4/8/09, The following day in the afternoon Y the client came to office w/his father and an examination Y of the 4/8/2009 arm was 4/9/2009 made. Red circular ar s in fingers/hands/feet approximately 3 weeks post Y flu shot. Diagnosed 30 with GBS. 4/27/09 Received U hospital medical ### records ### of 11/24-12/1 tion given on 3/31/2009. Child had Y tactile fever for one day on 4/9/2009 with onset of generalized body rash 3/31/2009 which is4/9/2009 still present at time of eved four vaccines on 4/2/09. The client Y parentYrequested all vaccine 4 be given in the same extremity Y due 4/2/2009 to a previous 4/4/2009 injury in the other ar ES HE REC'D PNEUMOVAX ON 4/7/09 AND THAT EVENING HE HAD FEVER FOR TWO DAYS Y AND SEVERE 4/7/2009BODY 4/7/2009 ACHES. PT STAT ld child received Hepatitis A # 1 at 6 months instead of 12 months, per standard, in error. In Y follow up with 3/16/2009 the parent, child has had no adv ticed Saturday night 4/11/2009 a red, Y raised area on left deltoid. seen today 4/13/2009 PM Y in office with4/10/2009 4X4cm area 4/11/2009 with redness and mil ry & Physical. This patient received a Pneumococcal Y vaccine probably 5 on 3-25-09 and we doY not know where. 3/25/2009 Patient 3/28/2009 came to agency on 3 ately 2" induration and redness of upper left arm where VARIVAX was given. Mom contactedYoffice and was 4/7/2009 given instructions 4/8/2009 to give BENA on arm at shot site. It's there a month. Almost gone away. Y 3/13/2009 3/13/2009 perienced a short, 5 second seizure Ylike episode five minutes after receiving the following vaccines Y (Meningococcal 4/6/2009 (Menactra) 4/6/2009 lot#, and PP ceived vaccination on 4-8-09 & called Y pharmacy on 4-11-09 to report that the site of injectionYhad a egg shaped 4/8/2009 lump 4/11/2009 that was red & itchy. the site of injection; next day after immunization, Mupirocin oint TID x 7 days. U 4/7/2009 4/8/2009 given L arm on 4/9/09, Pt returns on 4/11 with Lt arm about 50 cents size red area with some U bruising on4/9/2009 upper aspect 4/10/2009 at injection site, to f ain and edema localized at injection site. Unable to lift arm, unable to touch arm or put pressure Y on arm or 3/27/2009 sleep on left 3/27/2009 side x 72hrs. Gener 09 employee came in to clinic reporting right arm where tdap was adminstired for the last week Y was red, swollen,and 4/1/2009 4/1/2009 painful at site of inject ped erythrematous local swelling at injection site. Y 3/12/2009 3/13/2009 N 4/3/2009 4/12/2009 atigue for one week after vaccine administration. Seen in clinic on 04/14/09. Afebrile, WT 150#, Y BP 130/67. 4/9/2009 HEENT-negative, 4/10/2009 abdomen sof ness, swelling around injection site. U 3/10/2007 3/16/2007 Y Y 3/30/2009 4/7/2009 sodes on day after receiving Y vaccines Y requiringYtransport to PEDS ICU. 7 05/04/09 - Hospital U medical records 3/16/2007 for 03/17/2007 3/17/2007 to 03/23/2007. tarted after 12 weeks. 3/6/2007 Pt. developed red rash all over;itching;14x10 cm red macular rash at injection site on left leg;large U erythemous 3/23/2007 patches 3/28/2007 on chest, back and and hives at injection site within 30 minutes of vaccine administration. Y 6/6/2007 6/6/2007 09 pt. presented to the office with aYrash for 1 day.Exam reveiled approx. 100 vesicular lesions Y scattered6/19/2007 about, primarily 4/6/2009 on the torso. Mild ed, dizzy, especially when standing up, started within 30 min. of vaccination, lasted about 5 days Y 4/3/2009 4/3/2009
signs/symptoms approximately one hour following Tdap immunization. Patient experienced visual Y disturbances, 4/10/2009 including 4/10/2009 blurry vision, Eup D MD VISIT.2 DAYS S/P VACCINE ADMIN OF TDAP, PT SEEN FOR REDNESS/TENDERNESS, U GIVEN 4/8/2009 KEFLEX4/11/2009 RX. call from mom @ 1:29 stating "my son got shots at Southside yesterday now he has a rash all over his body 4/13/2009 and a fever." 4/14/2009 Mom asked wha re varicella (RA-SQ) became very reddened, Y tender and swollen to the size of a silver dollar.UParent was 4/2/2009 going to take 4/13/2009 child to MD for evalu episode about 5-10 minutes after receiving Menactra and Gardasil in L arm and TDaP in R. Y 4/14/2009 4/14/2009 L OVER THE BODY 2 HOURS AFTER Y VACCINE ADMINISTRATION. U 3/19/2009 3/19/2009 NED PREGNANCY Y 3/20/2009 3/25/2009 C URTICARIAL RASH A FEW HOURS Y AFTER PREVNAR AND PEDIARIX VACCINES. U 3/20/2009 3/20/2009 ndurated area on left deltoid at site of Administration approx 4 X 4 inches. Associated pruritis Y 4/13/2009 4/14/2009 REFERS HAVING A RASH ALL OVER Y THE BODY AND A RED EYE. Y ### 12/2/2008 ation site reaction. 2 inch raised welt, red, warm to the touch, painful. Began 12-18 hours after Y vaccination, 3/13/2009 slowly resolved 3/14/2009 on its own over d nausea and vomiting after leaving clinic. Resolved day following injection. Reported soreness Y at injection 12/3/2008 site. Red 12/3/2008 skin discoloration 4 x able crying for several hours continuously. Y 2/13/2009 2/13/2009 veloped Guillan Bare syndrome, 4 days after the Y vaccination. 4/22/09 20 Y MR received for DOSU10/29-11/17/2008### with D/C DX: ### Guillain-Barre perienced 5-6 bouts of diarrhea within 10 months of vaccination. After she was about 18 moUthe bouts of diarrhea ### seemed ### to stop. She wa clinical trial report of allergic reaction with bronchospasm Y has been received 2 from an investigator Y concerning 3/24/2009 a 39-year-old 3/26/2009 male, (subject n was reported by a physician via a sales representative and described the occurrence of hepatitis U A antibody negative3/1/2009 in an adult male subj ness and swelling at the injection site. Took BENADRYL and used ice packs. Y 4/9/2009 4/10/2009 U 4/9/2009 iven in Left deltoid. Redness, swelling, warm to touch. Y 3/4/2009 3/4/2009 redness/swelling/tender 4 hours after Y injection. TYLENOL/BENADRYL/cool compress resolved in a hour 4/10/2009 after TYLENOL/BENADRYL 4/10/2009 @ 11:10 A on 4-13-09 and reports. " I think I have shingles" describes as dime size water blisters U to R arm 3/30/2009 and under4/9/2009 R arm, painful. C/O a t, tender, swollen area right shoulder Y and fever. Seen 4/9 (2 days after) not on pain/fever meds. Y Pt returned 4/7/2009 for PPD reading so its not clea recurrent area on face, Y 9/15/2006 4/10/2009 4-9-09 04-11-09 2/3 of upper thigh Yaround injection site - was red, swollen and child refusedYto walk. Was4/9/2009 not itchy.4/11/2009 Was given BENDARY ash and slight numbness, no swelling of lips or tongues. Y 4/8/2009 4/9/2009 ed reaction on L thigh with warmth (no Y tenderness). Y 4/13/2009 4/14/2009 jection site (large lumps) itchiness all Y over body, headaches, could not lift arms, aches. U 4/9/2009 4/10/2009 rash & VARICELLA appearing rash. Y Y 4/8/2009 4/11/2009 h after receiving Rotavirus vaccine then went away and no distress. Y 4/8/2009 4/8/2009 lled 8 days after DTap was given in right thigh to c/o swollen, hot to touch area at site - unrelieved Y by TYLENOL 4/7/2009 for age 4/7/2009 referred to PCP. ter is 13 yrs old and has received the gardasil vaccine during which before receiving the 3rd vaccine I was notified that 4/1/2009 there would be som dose, there was a very sharp, deep pain at injection site. When I went to leave office I felt dizzy, N nauseous, 2/18/2009 and vision 2/18/2009 started blurring and tion at 2:33 pm on the date above, Rainbow began to experience, dizziness, fever, sore throat, N severe arm pain. Today, 4/10/2009 the next morning, N 2/1/2008 N 4/3/2009 Y N 3/31/2009 3/31/2009 n has been received from a medical assistant concerning Y a female who 0 on an unspecified date U was vaccinated with a dose of GARDASIL ( n has been received from a consumer concerning one of her cousins who was vaccinated with U MMR II. After receiving the vaccine, the pat n has been received from a consumer concerning her husband's uncle who was vaccinated U with a dose of MMR II. The reporter stated that n has been received from a physician Y concerning a 4 year old male who was vaccinated withY the second dose of MMR II "standard dose" ( n has been received from a consumer concerning a male patient who is a member of his wife's N family, who on an unspecified date was vac n has been received from a medicalYassistant, Y for the Pregnancy Registry 0 for GARDASIL, concerning U an 18 year old female ###with sulfa aller U 4/9/2009 t office after getting 4 vaccines. She was standing at window to make another appt. She asked Y for water then 4/9/2009 had a syncopal 4/9/2009 episode with len, warm, painful; he had fever lastY night) Cellulitis L lateral leg that developed 8 days afterNreceiving immunizations; it is immediately ove ea of redness & induration at injection site. 4/8/2009 4/8/2009 ver- Sat morning (3/28/09) all at once Y (10am). Seizure from fever (102.9) (at 1:45PM). (HepYA given on3/19/2009 3/19/09) (MOTRIN 3/28/2009 given even tod Y Y 3/30/2009 4/1/2009 ENADRYL Rash X 24 hours: StartedY 7 days after antibiotic/vaccine *Rash is worse on Right side (thigh) 3/27/2009 at injection site 4/6/2009 where MMR & VAR me in for MD visit 4/8/2009, with complaint Y of on and off neck pain. Patient and pt's mother U feels pain started 8/31/2007 after HPV 9/1/2007 vaccines, HPV vac
reports fever ranging from 100 degrees F - 103 degrees F and vomiting starting 4/3/09 through Y 4/4/09. Also 4/3/2009 reports4/3/2009 body aches. No treat d fever, high 103 degrees after IZS on 4/7/09. F/U in our office on 4/8/09 temp 100.9 taken TYLENOL. U Mom 4/7/2009 states household 4/7/2009 sick. ness & edema left deltoid within oneYwk injection. As redness & edema resolved pain radiated N to left shoulder 1/17/2009 neck right 2/1/2009 shoulder and down ouch and little swelling LD. Y 4/6/2009 4/6/2009 e same day lasted 3 days. Throwing up two days after. Y 3/31/2009 3/31/2009 U 4/9/2009 4/9/2009 served rash arms, hands, face and Y neck woke developing a redness that I first thought was N sun burn. Over 3/31/2009 the course 4/3/2009 of the next two days d shingles vaccine @ approx 9:30 am on 3/12/09. R arm. Pt called 3/17/09 @ 10:30 am to report Y R arm 3/12/2009 soreness and 3/12/2009 pain that wraps arou ash red indurated 1 1/2 inch round red mildly tender area 1/2 inch above injections ; injectionYsite. 3/26/2009 2" duration, warm to touch, swelling. 4/6/2009 4/7/2009 om, he was drinking juice, dropped cup Y & became unresponsive with a blank stare. Eyes rolled Y backward 4/1/2009 & he became 4/4/2009 very stiff. He had b t arm pain, fever, chills and palpitations lasting 24 hours. Y 4/8/2009 4/8/2009 & slight swelling posterior Rt upper arm Y 3/31/2009 4/1/2009 fever the evening of the immunizations Y admitted abdominal pain. As of 4/7/09, she had had Uthe fever 6 days. 4/2/2009 4/2/2009 ame very pale, lightheaded and felt like she was going to faint. Child was also slightly diaphoretic. Y Had child 4/3/2009 lay down4/3/2009 and gave water. multiform - treatment 5 days oral steroids Y 1/2 tsp one daily Y 3/12/2009 3/20/2009 ccine administered to child instead of varicella. No adverse symptoms noted at this time. Vaccine Y was administered 4/15/2009 4/15/2009 4/15/2009 at 10:45 am d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 6/30/2008 7/11/2008 ted Left upper arm was swollen, red, Y and warm to the touch 24 hours after shots received. Child U saw Dr 4/13/2009 4-15-09. Nurse 4/14/2009 noted redness and noted dime size erythemia at SQ injection site of the Varicella vaccine on Left upper arm. OnY04/09/09 at 1215, 4/8/2009 area 4/8/2009 measured 4 x 3 cm an esented to the emergency room 6 hours Y after shots with febrile seizures. Repeat episode of Y febrile seizure4/8/2009 24 hours after 4/8/2009 first episode. er, joint aches Right shoulder very swollen Y and painful Y 4/3/2009 4/3/2009 -hour of Pentacel injection, Y patient returned Y to office inconsolable, copious thick secretions, Y trouble breathing, 4/3/2009 worsening 4/3/2009 of his eczema. ga 9 mother reported child had seizureY1 hr after arriving home from getting vaccines on 12/16/08. U Skin was "very### hot." Child ### was taken to loca lled our office to inform us that she Y had "pumps all over her body and they itch really bad." She Y states that 4/14/2009 she woke4/15/2009 up with the pump and temperature 103.2 F U 4/14/2009 4/15/2009 REA DIRECTLY OVER LEFT DELTOID MUSCLE WHERE VACCINE GIVEN WAS BLISTERED, Y OPEN 4/13/2009 AND OOZING. 4/14/2009 LARGE SURROU HEA SINCE DECEMBER '08. PREGNANCY TEST NEG. MOTHER REPORTS NEVER HAD N A PROBLEM 1/8/2009 BEFORE 1/20/2009 GETTING THE GARD n a shot of PPV Pneumococcal Polysaccharide. Reaction: Runny nose, severe Arm Pain, fever U 99.2 next day from shot, temp 102 second with severe pain yesterday at right upper Y arm injection site. Mom called nurse and discussed. Temp 100.4/13/2009 Redness and 4/15/2009 tight area as big as ne shot on 4/13, 99.4 fever on 4/14, fever of 102 4/15, Stuffed up nose, cough, breathing impacted. U Muscle 4/13/2009 ache, sever 4/14/2009 are pain after shot 3 days after recieving 1st Gardasil dose in LD, she developed a red, dry, itchy skin rash to leftY arm, shoulder 1/20/2009 to knuckles. 1/22/2009 Also present on kn post-vaccination with JE-VAX, client's arm was swollen, red, and itchy from elbow to shoulderYand felt hard4/6/2009 to the touch. 4/7/2009 Topical benadryl du was reported by a healthcare professional and described the occurrence of brainYstroke in aN62-year-old1/12/2009 male subject 2/1/2009 who was vaccinated rash + bruising + oral bleeding 4/10. 4/11 ER - Ytransferred to hospital. 3 IVIG + Prednisone forUthrombocytopenic 3/26/2009 purpura. 4/10/2009 4/21 Link w/3442 01-102. (R) arm erythema and severe Y pain outYof proportion to exam 2 - R/O invasive strep. 4/27/09 Y Received 1/4/2008 hospital1/4/2008 medical records of 1/ p requiring prolonged IVYantibiotics and surgery. Y 5/4/09 Received 14 hospital medical records of Y 11/11/-11/25/20007. 11/9/2007 11/9/2007 FINAL DX: left hip septi ed vaccine 3/31/09. Presented with vomiting, lethargy Y on 4/14/09. Required 4 surgery for Intussusception. Y 3/31/2009 5/14/09 hospital 4/13/2009 discharge summa 04 - Patient received FLU, DTAP, COMVAX, MMR & PNEUM. conj after this did Y not talk, quiet, N sick, tired, fever### (HOT) 3-4### d. ibu. given did mitted to hospital for a bowel obstruction on 3-29-08. Y On 3/29/09 Lap 6 appendectomy performed. Y Pt had RUQ 3/2/2009 intussusception 3/27/2009 reduced usin ly raised sand paper type rash Right cheek, itching. Y 4/8/2009 4/11/2009 red raised itching welts periorbital, both eyes, raised red itching pustules back of both hands. Y Began 3 days 4/6/2009 after vaccine, 4/9/2009 presented to clin rm cellulitis at injection site. Y Y ### rm cellulitis at injection site. Y Y ### 11/1/2008 und neck, hairline and bilateral ears. Y 4/10/2009 4/14/2009 tous rash, swelling of hands, fever
mild - mod fever, nausea, severe pain Y at injection site evening of 3/16/09. Onset of itching + mild Y rash over 3/16/2009 body 3/17/2009. 3/17/2009 with swelling to R deltoid. Y 4/10/2009 4/11/2009 ith fever T 103.8. Y Y 4/13/2009 4/15/2009 hed chart note dated 4-15-09 Patient Y presents today for evaluation of reaction to VARICELLA Y vaccine given 4/13/2009 2 days4/14/2009 ago. Red swollen and e, fever muscle weakness. Y Y 4/9/2009 4/10/2009 n back and on face. U 4/1/2009 +4 HOURS AFTER WE NOTICED THE RIGHT LEG OF OUR BABY REALLY RED (AROUND U WHERE 4/15/2009 THE VACCINS 4/15/2009 WERE DONE). AB n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 19 year old female 1/27/2009 who on 21-AUGn has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 2/16/2009 and no2/16/2009 known drug allergies/d us case was received on 01 April 2008 Y from a health care professional. A 37 year old femaleUpatient with a history ### of2/28/2008 asthma, high blood pr E report received on 04 April 2009. This subjectYis a female infant with 2 no family history of seizures N experienced 8/28/2003 febrile 8/29/2003 seizures while enrolle ness, swelling, fever(101), headache, tiredness, chills, body aches, sore joints, 3" hard massUat injection site, 4/13/2009 sugar spiked 4/14/2009 to 286 (norm has ED LUMP WITH BLISTER L POSTERIOR Y UPPER ARM QUARTER SIZE DIAMETER. PAINFUL U TO TOUCH. 4/2/2009 3 SMALL 4/15/2009 BLISTERS AT L E eported blank stare and unrespoonsive after vaccine, lasting for 30 seconds. Parents never Y sought medical 1/14/2009 attention 1/14/2009 after episode. l pain, irritation, swelling, and decreased Y range of motion within 30 min. of the injection to theUleft arm. Within 4/14/2009 4 hours 4/15/2009 all of that pain radiate lar arthritis within 3days of vaccine administration. Y Infant was admitted 3 with lab samples taken Y from CSF,3/19/2009 blood and3/21/2009 urine. He was given pa pain from Lt shoulder eight hours after Y receiving the tdap boost in the Lt Deltoid muscle. Client U was seen3/30/2009 by her Pvt3/30/2009 MD and dx with tendon ed his vaccination on Monday April 13 Y around noon Y time. A fever began 2 within 6- 8 hours after U shots (102.5 4/13/2009 F), sleepy 4/13/2009 and very irritable thro orts that 3 weeks after receiving Hepatitis B vaccine #1 she developed lymphedema extending U from her left 3/4/2009 neck to 3/25/2009 hip, noticed her left hip er arm swelling, edema and pain. Event occurred within 24 hours of vaccination and resolving Y by 72 hours. 4/7/2009 Treated 4/8/2009 symptomatically with i A, Stiff Neck Temp 100 Y 4/2/2009 4/3/2009 1 minute after administering DTaP, Hep A and Hep B vaccines the patient had stiffening of his Y entire body 4/16/2009 with laryngospasm 4/16/2009 which lasted Anemia, low red and white Y blood cells Y NO FEVER...seizure Y disorder,8 anemia Y neutropenia .. checked U for 3/13/2009 childhood disease 3/23/2009 and disorders... ter vaccination, became overwhelmed with unexplained exhaustion. Had to go to sleep and Y slept for 12 hours 4/15/2009 straight. 4/15/2009 Also next morning h OTARIX AT 6 MONTHS OF AGE U 4/10/2009 4/10/2009 HAD A REACTION ON LEFT POSTERIOR THIGH WHERE VARICELLA VACCINE WAS GIVEN.PATIENT U 4/15/2009 HAS A 4/15/2009 RAISED REDENED AR ven in left thigh, brought back by mom Y two days later with swelling from top of thigh down toYthe knee. Advised 4/14/2009 warm 4/14/2009 soaks three times dai ED REACTION ON (R)UPPER DELTOID AREA PATIENT DENIES ANY DEVER, NO MALAISE; U REPORTS 4/8/2009 SORE ITCHING 4/8/2009 THAN PAIN. ot appeared on infant's right thigh after her shots at 6 month old well check up on 1/29/09. Staff U became 1/29/2009 aware of incident on 3/03/09. DTaP ERYTHEMA, PRURITIS, SWELLING OF ARM Y 3/17/2009 3/17/2009 st vaccination, patient had eruption Y of hives and developed extreme fatigue, arm and leg pain, U and muscle 3/12/2009 weakness, 3/15/2009 severe enough that s swollen size of dollar bill" 7x11 cm raised erythematous plaque on L anterior thigh. N 4/13/2009 4/14/2009 aised erythematous plaque at vaccination site in R arm after 24 hrs. Y 4/6/2009 4/8/2009 , headache, malaise during night time Y fever prolonged dream state grogginess. Resolved byYnext morning 4/14/2009 4/15/2009. 4/14/2009 X given R thigh 4-1-09 per mom. Pt developed fever and "shakes" that same evening - she called 911 - fever decreased 4/1/2009 to 98 - mom called as given the GARDASIL # 1 vaccination Y in her right deltoid muscle. Pt. was advice to sit for the Y injection but 4/16/2009 refused.4/16/2009 Very shortly after the d office 4/16/09 0900 to report a baseball sized, red, itchy but not raised area at left upper arm Y at injection 4/14/2009 site; no respiratory 4/15/2009 involvement, ted to PCP 1 wk after she received Y MMR and VARIVAX in R deltoid with 3-4 cm abscess. U 3/31/2009 4/4/2009 nny nose, itching started evening of Y 4-3-09 along with start of rash. Diagnosed with chicken pox Y on 4-6-094/2/2009 by family physician 4/3/2009 Rash mainly ation of ZOSTAVAX 4-7-09, development of vesiculated, burning, itching lesions of back 4-11-09 U 4/7/2009 4/10/2009 FLUZONE vaccine on 9/16/08. November (date unknown) patient developed abdominal cramps Y & vaginal 9/16/2008 bleeding. 11/1/2008 OB/GYN evaluation r vaccine: Headache, neck and shoulder pain at noon - chills at temp 101.7 at 1:00 o'clock associated Y to stomach 4/1/2009 discomfort. 4/1/2009 No chest pain ea of redness - right thigh cellulitis likely reaction to vaccine. Y 3/23/2009 3/25/2009 ccines were given at about 9:30am, pt woke from nap about 3pm with multiple large urticaria Yover back, lower 4/15/2009 extremities 4/15/2009 and abdomen (no d rash on forearms 7 days after receiving ZOSTAVAX. Y 3/24/2009 3/31/2009 iving shot in AM of 4-7-09 pt c/o shortness of breath in the afternoon at home with mother - *Nurse Y informed 4/7/2009 mom to 4/7/2009 watch patient closely f ZOSTAVAX 1500 on 4/8/09, morning of 4/10 pt awoke with hard, hot, red, itchy lump at injection Y site about 4/8/2009 the size4/10/2009 of a small egg. Pt calle cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009 -stop for at least an hour. Le were red/swollen no special rx given but pt given TYLENOL in office & advised 4/16/2009 to ice X 4/16/2009 24 hours erythema, warmth & induration at vaccine site area involved 12 1/2 cm X 12 cm in size. Received Y 2 vaccines 4/15/2009 in left 4/15/2009 deltoid HEP A #2 - MEN h hot, swollen and red at injection site. Y Y 4/13/2009 4/14/2009
n, slight shortness of breath. Amnesia during and half an hour after receiving vaccination. "Almost" Y passed 4/15/2009 out during 4/15/2009 vaccination. Flu like n has been received from a consumer concerning her first 6 year old child who was vaccinated N with his first dose of MMR II. Subsequently n has been received from an 18 year old female with migraine and no allergies for GARDASIL, Y a Pregnancy 4/1/2007 Registry4/1/2007 product, who in Febru n has been received from an office Y staff member Y concerning a patient 0 who on unspecified dates U was vaccinated with all three doses of RO rated local reaction. U 4/13/2009 4/15/2009 al reaction 10-12 cm, with pain, mildYpruritis. U 4/13/2009 4/14/2009 rning after vaccine T max 103.1. Y Y 4/13/2009 4/14/2009 a DTAP on 4/09/09. Benefits and risks explained - VIS info given. Mom noted fever at 11 PM U 4-9/09, redness 4/9/2009 at site4/10/2009 of injection noted in th ad GARDASIL #2 at approx. 4:15 pm. Y Took CLARITIN in AM for allergies. Also takes CONCERTA Y and ORTHO 3/20/2009 TRICYCLEN low dose. Use ute onset of severe vomiting and dizziness. Lasted into next day. Also began to have leg pain Y & perceived 3/17/2009 weakness, 3/17/2009 tingling. The leg sy Pox with HX of one dose of VARIVAX. U ### 4/13/2009 4/13/2009 ning arm soreness + swelling - ice applied Y 4/2/09 arm increased soreness, increased swelling, Y warmth, elevated 4/1/2009temp 4/1/2009 + not feeling well. To e, bodyache, some nausea. 4/10/09. Advised TYLENOL 500 mg 2 tabs P.O. Q6 PRN. U 4/9/2009 4/10/2009 eg starting swelling right after immunizations were received. Y 3/24/2009 3/24/2009 tomach, chest, genitals U 4/6/2009 swollen, red, and hot to the touch. YPatients arm also had a tight knot under skin. Dr. advised U on 4-11-094/9/2009 that patient4/9/2009 should take BENADR ed to me by ER physician:] After shots, Y went home, took nap about 1 hrs. Went awake, cried U inconsolably. 4/8/2009 Then had 4/8/2009 stiffening, jerking, & vomit, diarrhea, stomach pain. 04/10/09 Y fever (104.7) rash. No GI symptoms except anorexia. U 04/11/09 varicella 4/1/2009 - like4/9/2009 rash. veloped chills overnight after getting the vaccine. Site of injection was Y swollen and red. OnYMarch 29th,3/26/2009 the swelling 3/27/2009 and redness extende l from parent on 4/15/09 @ 10:15am. She reports child's left arm/shoulder is swollen aroundUinjection site. 4/14/2009 Area, red4/15/2009 per report. Mom states ue, headaches, muscle cramps, muscle pain, sound sensitivityafter 1st shot. Increased Y in severity N of all 7/12/2007 symptons. After 9/26/2007 3 rd shot signfican /2009, PT BROKE OUT ON FACE AND Y FOREHEAD Y WITH BLISTERS. 2 WAS DIAGNOSED N WITH HUTCHINSON 2/27/2009 VARIATION 4/12/2009 OF FACIAL nt received the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a Ybig, red, swollen 4/3/2009 area on4/5/2009 her upper arm. She r nt received the Zostavax vaccine on 4/10/2009. After administration of the vaccine, she reported Y a dollar4/10/2009 size red wheel 4/10/2009 around the injection pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 2/19/2009 with COPD Y exacerbation. 11/7/2007 Vaccination 2/15/2009 took place on 11/7/2 ted redness and swelling of Lt arm increasing Y 24 hrs after injection. Increasing at 48hours. No U fever. Marked 4/15/2009 erythema 4/16/2009 and induration of Lt d immunizations and about 5 minutes Y afterwards the school nurse brought pt in to where shots Y were being 4/16/2009 given stating 4/16/2009 that pt was having sized erythema to left thigh . 8 cm raised wheal, old compress was applied for 30 minutes and Y Benadryl 3/26/2009 1tsp given 3/27/2009 po . veloped red "Rash" according to mother on top of both legs on 4/13/2009 and was taken to U doctor on 4/16/2009 4/8/2009 4/13/2009 Tdap vaccination on 4/13/09 in upper left arm. Injection site is still painful on 4/17/09, but real U issue is pain 4/13/2009 caused by 4/15/2009 two pea sized nodule ed I large area around the injection that was fire red and hot to the touch. It was welped up rasied. U About4/15/2009 the size of 4/16/2009 1/2 dollar or little larger and swelling at injection site, by 4/13/09 Y fever of 102, sweats and chills, swelling in jaw, swelling U in R arm 4/9/2009 and joints,4/13/2009 significant drooling, ten adache ,feels warm ,no feverheadache improving headache ,not weak ,no numbness U 4/16/2009 4/17/2009 d some redness appear at the site of the injection >24 hours after recieving the vaccine. Not U raised, slightly 4/14/2009 warm, 4/16/2009 not hard and not itchy. immunizations fine Given four on 4/14/2009. Y Next day 4/15 some tenderness and on 4/16/09 Y noted sweling 4/14/2009 left deltoid 4/16/2009 down to elbow with ARM SWOLLEN AND WARM TO TOUCH. APPRX THE SIZE OF AN ORANGE. PT DENIES U INCREASED 4/16/2009 PAIN. 4/17/2009 NO FEVER. PT FEELS eption 4/29/09 ReceivedYhospital medical Y records Y of 4/13-4/15/2009. 2 FINAL DX: Intussusception, Y enema2/17/2009 reduced Records 4/12/2009 reveal patient e red and swollen and vomiting / 4th time this lot # has been reported Y 4/16/2009 4/17/2009 mmer of 2008, patient had Y many episodes Y of anxiety which she never had before, she also isUmore easily confused; ### 6/1/2008 9/30/08 Dr d with Pneumovax on 3/31/2009. Called office Y on 4/1/2009 stating arm 1 was red. sore and hot Y to touch. Advised 3/31/2009 to come 4/1/2009 in that day. Came hot swelling at injection site with pustules inside the swollen area on the first day of the injection. U Then outbreak 3/30/2009of3/30/2009 pustules scattered over RTS LOCALIZED (R) UPPER ARM PAIN EVENING OF 4-16-2009. REDNESS, SWELLINGUAND TENDERNESS 4/15/2009 TO 4/16/2009 TOUCH NOTED 4/7 on left arm (arm of injection). Appeared 3 days after vaccine administration. Was very red and U itchy however 4/13/2009 not quite 4/16/2009 so bad today. Spec dness and tenderness 6x13cm. Seen Y on 4/17/09, Cephalexin 500 mg PO given. Pt to f/u withUprovider next 4/14/2009 week. 4/16/2009 ea around injection site tender, red Y and warm. No streaking or adenopathy U 4/14/2009 4/17/2009 d = 4x5 cm area of erythema with subcutaneous Y induration at site of Tdap injection; no fluctuance; tender 4/13/2009 to palpation; 4/15/2009 no streaking; no ade vomiting, lethargic, breathing difficulties, Y sunken Y eyes, listless. Baby 1 was brought to hospital, Y they then transferred 12/5/2008 12/6/2008 her by ambulance to an tous, warm 7X7 cm. induration left lateral thigh. Y 4/15/2009 4/16/2009 hema + induration 3X2 cm on L - Deltoid arm. Complained L-arm pain. Plan warm compression. U 4/14/2009 4/14/2009 unization was given pt went to the waiting where she stated she was "feeling like she is going Y to throw up". 3/6/2009 Pt was given 3/6/2009 .30 Epi pen in left
reaction right upper arm + edema + red. No complaint of tenderness. Treated with BENADRYL Y & TYLENOL. 4/16/2009 4/17/2009 Y 4/9/2009 cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009 er followed by generalized seizure - Requiring intubation. 3 seizures back to back. Y called on 4/16/09 & said 4/15/09 pt had red welt size nickel at inj site and then on 4/16 was size Y of a quarter. 4/2/2009 Pts mom 4/15/2009 will give benedryl & arted on GARDASIL series 5/15/2007- 2nd given 7/16/2007. Mom noticed in fall of 2007 thatNabsence type 5/15/2007 seizures began. n has been received through the Merck pregnancy registry from a Physician's Assistant concerning N a female 1/22/2008 who is1/22/2008 social alcohol drinker a n has been received via the Merck pregnancy Y registry, from a registered nurse, concerning aY 15 year old 3/3/2008 female patient, 3/3/2008 who on 03-MAR-2 n and follow up information have been Y received from a nurse practitioner for the Pregnancy Y Registry for 2/15/2008 GARDASIL2/15/2008 concerning 23 year old n has been received from a certifiedYmedical assistant concerning a 16 year old female whoYon 27-FEB-2008 2/27/2008 was vaccinated 2/27/2008 with her first n has been received through the Merck pregnancy registry, for GARDASIL, concerning a 14Yyear old female 4/7/2008 patient with 4/7/2008 attention deficit di n has been received from a certified medical assistant for the Pregnancy Registry for GARDASIL Y concerning 3/26/2008 a female 4/18/2008 who on 26-MAR-200 n has been received from a medical assistant for the pregnancy registry for GARDASIL concerning Y an 18 year### old female ### with no known al follow-up information has been received from a nurse practitioner concerning her daughter aY14 year old female with scoliosis and no previ n has been received for the pregnancy registry for GARDASIL from a nurse practitioner concerning Y a 213/11/2008 year old female 6/2/2008 with no pertinent follow-up information has been received Y from a pediatrician, a physician and a registered nurse Y for the pregnancy 4/21/2008 registry 11/5/2008 for GARDASIL c n has been received from a certified nurse midwife, for the Pregnancy Registry for GARDASIL, Y concerning 6/3/2008 a 17 year6/3/2008 old female with asthm n has been received from a registered Y nurse (R.N.) for the pregnancy registry for GARDASILU concerning1/22/2009 a female patient ### who on an unspe n has been received from a nurse concerning a 9 year old female patient with a history of migraine Y headaches 2/24/2009 and 2/24/2009 no known drug allergies n has been received from a radiologist reported that a gastroenterologist said he had some patients U experience stomach pain after receivin n has been received from a consumer concerning her daughter an 18 year old female with allergy N to (unspecified 2/23/2009medication) 3/6/2009 who on 23-F n has been received from a nurse practitioner Y concerning a 27 year old female with allergy to N thimerosal and no medical 3/9/2009 history who on an n has been received from a physician concerning Y a young adult female 7 who was vaccinatedYwith the first dose of GARDASIL (lot number n n has been received from a nurse concerning a 25 year old female who on 20-MAR-2009 was U vaccinated 3/20/2009 with GARDASIL 3/20/2009 (lot number 659 n has been received from a physician Y concerning a 23 year old female patient with no pertinent Y medical history 8/8/2008 and no 8/8/2008 known drug allergie n has been received from a 21 year old female with hypersensitivity to yeast who on 3-MAR-2009 N was vaccinated 3/3/2009 with 3/17/2009 the first dose of GAR n has been received from a physician concerning a 14 year old female who on 27-MAR-2009 U was vaccinated 3/27/2009 with a first dose of GARDASI n has been received from a physician assistant concerning a "teenager" female who was vaccinated U with GARDASIL 0.5 ml. After getting G n has been received from an employee at a physician's office concerning a couple of patients U who was vaccinated with GARDASIL. The pa n has been received from an office administrator concerning a 19 year old female who on 12-JAN-2009 U 3/18/2009 and 18-MAR-2009 3/30/2009 was vaccinated n has been received from a physician concerning his 22 year old daughter who on Y 12-Mar-2009 Y was vaccinated 3/12/2009 with 3/12/2009 her first dose of GARD n has been received from a RN concerning Y a 15 year old female patient who on approximately N 16-MAR-2009 3/16/2009 was vaccinated 3/16/2009 with the first n has been received from a physician concerning a 15 year old female who on 06-MAR-2009 Y U was vaccinated 3/6/2009 with GARDASIL 3/6/2009 IM 0.5ml. C n has been received from a physician concerning a female who was vaccinated with the second U dose of GARDASIL (Lot not reported). Sub n has been received from an office Y nurse concerning Y a female who12on an unknown date, was U vaccinated with the ###third 4/28/2008 dose of GARDASIL n has been received from a physician Y concerning a female who in 2008, "within the past year", Y was vaccinated with a dose of GARDASIL ( n has been received from a Registered Y Nurse concerning Y a female patient who was vaccinated U with a dose of GARDASIL (Lot # not report n has been received from a physician concerning a 16 year old female who was Y vaccinated N intramuscularly with a 0.5 ml dose of GARDAS n has been received from a physician concerning a 17 year old female who was vaccinated Y with the second dose of GARDASIL (Lot # not n has been received from a nurse concerning Y an 18 year old female who on 20-JAN-2009 was Y vaccinated 1/20/2009 with her 1/22/2009 first dose of GARDASIL n has been received from a consumer concerning her 18 year old daughter with Nail-patellaUsyndrome who 2/23/2009 in 20082/23/2009 was vaccinated with th n has been received for the pregnancy registry for GARDASIL from a certified medical assistant U concerning 1/23/2009 a 15 year 1/23/2009 old female patient wh n has been received from a nurse concerning Y a female who on an unspecified date was vaccinated U with the second dose of GARDASIL. Th n has been received from a certified medical assistant concerning her 17 year old female friend N with no pertinent medical history who in 20 n has been received from a registered nurse concerning a 22 year old female with pertinent N medical history 3/9/2009 or drug allergies/reactions who n has been received from a nurse practitioner concerning an approximately 20 year old female Y with no relevant 3/11/2009 medical 3/12/2009 history, no relevan n has been received from a licensed Y visiting nurse concerning a 13 year old female patient who Y on 16-JUL-2007 3/13/2009was vaccinated ### with the fi n has been received from a nurse practitioner Y concerning a 16 year old female with not sexually Y active and a history ### 1/1/2009 of meningitis as a bab n has been received from a nurse practitioner Y concerning a 23 year old female who was vaccinated N with complete GARDASIL 2/13/2009 series. On 1 n hs been received from a physician concerning a female patient who was on unspecified dates U was vaccinated with1/1/2008 0.5 ml doses of GARD n has been received from a nurse concerning Y a female who patient who on an unspecified date Y was vaccinated IM with her second 0.5 ml
n has been received from a consumer concerning her daughter, a 11 year old female patient, N with no known drug allergies, joint pain and p n has been received from a licensed Y practical nurse concerning an 18 year old female patient N with no pertinent 3/5/2009 medical 3/6/2009 history and no know n has been received from a nurse practitioner Y (N.P.) concerning a 49 year old female with hypothyroidism N 3/2/2009 and gastroesophageal 3/2/2009 reflux dise n has been received from a registered nurse concerning her daughter with eczema and allergies N who in June 3/9/2009 2008 was 3/9/2009 vaccinated with the n has been received from a registered Y nurse for the pregnancy registry for GARDASIL concerning U a 23 year 1/21/2009 old female with ###asthma and no n has been received from a Registered Y Nurse (R.N) concerning her 16 year old daughter with N juvenile rheumatoid 11/1/2008 arthritis,### and allergies to n has been received from a consumer concerning her 22 year old niece who on approximately N 24-FEB-2009 2/24/2009 was vaccinated with a dose o n has been received from a registered nurse concerning a female patient who was vaccinated Y with her second dose of GARDSIL (lot # not n has been received from a registered nurse concerning a 19 year old female with no pertinent Y medical history 11/1/2008 or drug 11/1/2008 reactions/allergies w n has been received from a female who in June 2008 and August 2008 was vaccinated withYher first and 6/1/2008 second dose 6/1/2008 of GARDASIL (lot nu n has been received from a nurse practitioner Y concerning a female patient who on unspecified N dates in 2007 was vaccinated with the first t n has been received from a physician concerning a 14 year old female patient who in approximately Y September 9/1/2008 2008, 9/1/2008 "4-6 months ago" fro n has been received from a physician concerning an approximately 12 year old female who N on approximately 3/6/2009 6-MAR-2009, 3/6/2009 "about a week n has been received from a physician Y concerning a "16 years old" female who was vaccinated U with a third 0.5 ml dose of GARDASIL (lot # n has been received from a consumer concerning her daughter, a 14 year old female with a Nhistory of mononucleosis 3/1/2008 3/1/2008 and no drug reaction n has been received from an 18 year old female with no known drug allergies/reactions and U no pertinent medical history reported who on a n has been received from a healthcare Y worker concerning a 21 year old female with no medical N history and 3/11/2009 drug allergies 3/13/2009 who on 11-MARn has been received from a physician concerning a female with latex allergy who was vaccinated U with a dose of GARDASIL, IM, 0.5ml. Sub n has been received from a consumer Y concerning her 15 year old daughter with allergies to N penicillin and 1/26/2009 other antibiotic 1/26/2009 and no pertinent m n has been received from a nurse practitioner (N.P.) concerning a 24 year old female who on Y 16-MAR-2009 3/16/2009 was vaccinated 3/16/2009with a 0.5 ml d n has been received from a nurse concerning Y a female who was vaccinated intramuscularly N with the second 3/17/2009 0.5 ml 3/17/2009 dose of GARDASIL on n has been received from a 23 year old female with allergy to anything in the "cillin family" and N a history 11/5/2008 of cesarean2/16/2009 section and tuberculos n has been received from a certified medical assistant concerning a patient who in 2007 wasNvaccinated with a dose of GARDASIL. In 2009 n has been received from a healthcare worker concerning a female who experienced groin pain U and a lump in her groin after receiving a do n has been received from a registered Y nurse concerning her daughter, an 11 year old femaleY patient with no pertinent ### medical ### history and n n has been received from a physician Y concerning a female patient with a history of urinary tract U infection who 3/1/2009 in the last couple of weeks wa n has been received from a physician Y concerning a female patient who on an unknown dateUwas vaccinated with the first dose of GARDAS n has been received from a certifiedYmedical assistant, for the GARDASIL a Pregnancy Registry, U concerning 2/2/2009 a 14 year 2/2/2009 old female patient w n has been received from an emergency Y medical technician concerning a 15 year old femaleY with asthma who was vaccinated 9/1/2008 with the com n has been received from a physician Y concerning a registered nurse who was vaccinated with U her first dose of GARDASIL. 6 weeks after h n has been received from a nurse practitioner concerning a 15 year old female patient with no U pertinent 3/17/2009 medical history 3/17/2009 and no known drug n has been received from a physician concerning a female patient who was vaccinated with Ythe first 0.5 ml dose of 11/6/2007 GARDASIL. Subsequen n has been received from a registered nurse concerning an 11 year old female with no pertinent Y medical3/11/2009 history or drug 3/11/2009 reactions or allergi n has been received from a physician Y (OB/GYN) concerning a 21 year old female patient who U on an unspecified date was vaccinated with n has been received from a physician Y concerning a 16 year old female patient with no known Y drug allergies 1/19/2009 who on1/19/2009 19-JAN-2009 was vacc n has been received from a physician Y concerning a 24 year old female with no relevant medical Y history or 3/12/2009 drug allergy 3/12/2009 who was vaccinated n has been received from a registered nurse concerning a 23 year old female with Graves' disease, Y latex allergy ###and poppy ### seeds allergy w n has been received from a registered nurse concerning a patient who on unspecified datesUwas vaccinated with the first and second dose n has been received from a registered Y nurse concerning a female student in her twenties who U on an unspecified date was vaccinated with n has been received from a nurse practitioner concerning an 18 year old female patient withYseveral bug7/16/2008 bites who on 7/16/2008 18-MAR-2008 was v n has been received from a medicalYassistant concerning a female patient who on unspecified Y dates was vaccinated with the first and seco n has been received from a consumer concerning her daughter, who on 20-JAN-2009 was vaccinated U with 1/20/2009 her first 1/20/2009 dose of GARDASIL. Co n has been received from a 19 yearYold female patient with no pertinent medical history whoNa few months ago### received 3/18/2009 the first dose of GA n has been received from a medicalYassistant concerning a 23 year old female patient with no N pertinent medical history 3/20/2009 and no known drug n has been received from a registered nurse concerning an 11-18 year old female who was U vaccinated with her first dose of GARDASIL (lo n has been received from a health professional concerning a female patient between 11-18 U years who on an unspecified date was vaccina n has been received from a nurse practitioner concerning a female with a history of tension headache Y who was vaccinated 3/16/2009 with the third 0. n has been received from a health department nurse concerning a patient who on 04-MAR-2009 U was vaccinated 3/4/2009with3/4/2009 a dose of GARDASIL n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning1/12/2009 a 20 year old 1/12/2009 female with no know n has been received from a physician assistant concerning a 16 year old female on 20-MAR-2009 U was vaccinated 3/20/2009 with 3/21/2009 the first dose of GA n has been received from a physician concerning a 20 year old female with a history of human Y papillomavirus 2/19/2009 high risk. On 11-FEB-2009, t
n has been received from a certified medical assistant concerning a 21 year old female with N dysmenorrhea 9/23/2008 and no known 11/1/2008 drug allergies wh n has been received from a female who in September 2008, was vaccinated with her first dose N of GARDASIL. On an unspecified date, she n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL, 0.5 mL. The patient experience n has been received from a registered nurse concerning a 14 year old female patient with noNpertinent medical 2/6/2009 history 2/13/2009 and no known allerg n has been received from a 42 yearYold female who on 09-FEB-2009 was vaccinated with the N first 0.5 ml 2/9/2009 dose of GARDASIL. 2/9/2009 After vaccina n has been received from a physician assistant concerning a 21 year old female patient whoYon 08-JAN-2009 1/8/2009 was vaccinated 1/8/2009 with the first n has been received from a medical assistant concerning a 20 year old female with no medical N history or3/24/2009 drug allergy who on 24-MAR-2009 n has been received from a physician Y concerning a 12 year old female with no medical history Y or drug allergies### who was vaccinated ### with th n has been received from a physician Y concerning a female who was vaccinated with GARDASIL U (unspecified number of doses) may have n has been received from a physician Y concerning a female patient who on approximately 26-JAN-2009 N ("two 1/26/2009 months 3/16/2009 ago") was vaccinated n has been received from a physician Y concerning a 25 year old female who was received a first U dose of 3/20/2009 GARDASIL3/24/2009 (lot # not reported) in h n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 1/29/2009 a 26 year old female with pain in n has been received from a nurse practitioner Y for the pregnancy registry of GARDASIL, concerning U a 2612/4/2008 year old female 1/15/2009 patient with no pe n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5ml dose of GARDASIL n has been received from a 24 yearYold female, for the Pregnancy Registry for GARDASIL who Y on 16-DEC-2008 ###was 1/19/2009 vaccinated with a firs n has been received from a 25 year old female patient with penicillin allergy who on August N 2008, was vaccinated 8/1/2008 with the first dose of GAR n has been received from a registered Y nurse concerning a 27 year old female patient with noYpertinent medical 1/19/2009 history 1/19/2009 and no know drug al n has been received from a consumer concerning her daughter who was vaccinated with a third U dose of2/19/2009 GARDASIL (lot # not reported) 5 w n has been received from a registered nurse concerning a 19 year old female patient with a N history of mononucleosis 3/16/2009 3/16/2009 at age of 15 who on 1 n has been received from a medicalYassistant concerning her 13 year old daughter with no previous Y medical history ### reported ###who on 17-DE n has been received from a registered nurse concerning a 12 year old female patient with noUdrug allergies 3/9/2009 or medial3/9/2009 history who on 9-MAR n has been received from a physician Y concerning a 20 year old female with egg allergy who Non approximately 3/13/2009 13-MAR-2009, 3/13/2009 two weeks ag n has been received from a nurse concerning a 25 year old female with penicillin allergy whoNon 30-SEP-2008 3/24/2009 was 3/24/2009 vaccinated with her firs n has been received from a physician concerning a female patient who is also the receptionist N in the office 3/20/2009 and on 20-MAR-2009 was vacci n has been received from a physician Y concerning a female patient with no pertinent medicalYhistory and no known drug 3/24/2009 allergies/reactions n has been received from a consumer concerning her daughter who was vaccinated with theNsecond dose of GARDASIL two weeks after th n has been received from a physician concerning a female who in February 2009, was vaccinated U with the third dose of GARDASIL. Subse n has been received from a physician Y assistant concerning a 16 year old female with penicillin N allergy and6/5/2008 sulfonamide allergy who on 05-J n has been received from a Doctor Y of Pharmacy (Pharm. D.) student concerning a 27 year old N female with no medical 3/24/2009 history or drug allerg n has been received from a nurse concerning a 14 year old female who was vaccinated withYall 3 doses of GARDASIL. That after the patie n has been received from a 26 yearYold female who in December 2008 was vaccinated with N a first dose 3/17/2009 of GARDASIL. 3/21/2009 On 17-MAR-2009 w n has been received from a physician Y assistant concerning a 24 year old female with asthmaNand a history 3/25/2009 of urinary 3/25/2009 tract infection who on (3/8" x l-l/8") around injection site. Forgot to check the site of injection until just now. 12:15 PM Y 04/18/2009. 4/16/2009 Zostavax INJ adverently given expired dose of smallpox vaccine. Y 4/18/2009 4/18/2009 atigue (20 hours of sleep for five days)Extreme body ache, confusion, dizziness 4/20/09 Received PCP medical 4/13/2009 records 4/14/2009 of 4/13/2009. FINA d area induration 10- to 15cm with swelling Y and erythema, fine vesicles around the injection U site. po benadryl 4/16/2009 , Po Motrin 4/18/2009 for pain and ceph Y Y N n was received from an investigator for a study concerning a patient who on an unspecified U date was vaccinated with a dose of PNEUMOV n has been received from a consumer reporting that she knew some friends who had their children U vaccinated with a dose of MMR II and la n has been received from a consumer concerning a couple of her friend's children who wereUvaccinated with MMR II (lot# not provided) and n has been received from a 26 yearYold femaleYfor GARDASIL, a pregnancy 3 registry product,Y concerning 2/1/2008 herself with2/1/2008 no pertinent medical h n has been received from a nurse concerning Y a 11 year old female patient who on an unspecified Y date was 7/17/2008 vaccinated 2/9/2009 with the first dose o n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 1/11/2008 22 year old1/11/2008 female with no medical n has been received from a physician via agency concerning a patient who was enrolled in aUstudy. This report was part of a post-marketin n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unknown date, the patient wa n has been received from an investigator via agency concerning a patient with HIV infection Uwho was enrolled in a study. On an unspecified N n has been received from an investigator via agency concerning a child patient with HIV infection U who was enrolled in a study who was vac n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date, the patient n has been received from the agency concerning a patient who entered a study and was vaccinated U iwth a dose of PNEUMOVAX 23. This n has been received from an investigator concerning a patient who on an unspecified date was U enrolled in a study. This report was part of a
n has been received from an investigator concerning a patient who was enrolled in a study. U On an unspecified date, the patient was vaccin very slurred speech, lossYof appetite. Y Vaccine was Y given 7 weeks ago, 12 week by week condition U deteriorated, 2/11/2009 no diagnosis 2/12/2009 made. 7/7/09 Ho ash, left groin area, about 21 papules Y with deep red flat areas around papules alternate burning Y and itching. 4/2/2009 I noticed 4/6/2009 rash on 4/6/09 - 3 day p this am with redness to inj. site, warm to touch and states that area is tender. Y 3/31/2009 4/1/2009 itching to right arm 2d after injection came home from school and mom noticed redness andYswelling to right 4/7/2009 arm. TYLENOL, 4/9/2009 cold compres clinic today with chicken pox - 3/23/09 1st vaccine 7/3/8 2nd vaccine 2/24/9. U 2/24/2009 3/22/2009 states that pt c/o pain with some swelling @ injection site. Mom states following day worse, w/ Y redness, 3/30/2009 swelling and 3/30/2009 tender to touch. Still w e "notice bumps on body and itchy"Yon 4/14/09. Seen by ER physician and prescribed BENADRYL Y by mouth. 4/2/2009 Client4/14/2009 came to clinic today 4/ VAX given on 4/1/09 - had pain that day. Rash developed on 4/2/09 - Seen in our office 4/3/09 Y txd with MEDROL 4/1/2009dose 4/1/2009 pack (5 day tx) and om Pt swollen to Lt thigh. Y Y 4/13/2009 4/13/2009 veloped pain/tenderness to the injected area 8 hrs after the vaccination. The following day developed Y redness, 4/9/2009 swelling 4/9/2009 & nausea symptom sh that developed 10 days after imms Y given, skin rash all over body, 2-3 mm macular, papular Y eruption, non-peticheal 3/30/2009 4/9/2009 in nature, lasting 5 da DTaP noticed red welt on left arm where vaccine was administered about the size of a softball U got worse4/13/2009 (bigger) the4/14/2009 next day, tender, warm Mother brought pt to office w/ c/o redness Y + swelling in the 14cm x 8.5cm left leg at the injection Y site of DTaP. 4/13/2009 He was 4/13/2009 given BENADRYL in 5 doses of the Anthrax vaccine in 1998/1999. I began feeling chronic fatigue andYarthralgia/myalgia N in 2000 1/1/1998 and it has 1/1/2000 gotten increasingly w swelling of face and eyes. Treated Ywith benadryl. Y 4/16/2009 4/17/2009 s after being immunized, patient developed hives in patches all over his body. Y 3/6/2009 3/9/2009 nt stiffness-difficulty in getting out of bed post vaccination Saturday 18ARP2009;feverish;vomiting Y 4/17/2009 4/18/2009 as given Chicken Pox (Varicella) vaccine Y on 3/19/09. On 3/24/09 she developed a 104 degree Y fever, runny 3/19/2009 nose, cough, 3/24/2009 sore throat, lethar ash on left thigh, red patches around injection site about 1 inch around, non tender and no swelling. Y advised 3/10/2009 to give3/11/2009 benadryl q 6 hrs, hydro child reported that child had erythema bilateral arms. Erythem started on 4-17-09 and no longer Y present4/16/2009 on 4-19-09. 4/17/2009 Mother of child stated er after 48 hours of receiving the shot. Y Baby got an armpit reading of 102.5 and was feverishYfor 48 hours,4/2/2009 afterwards4/4/2009 did not eat/drink for 2 admin 01/08/09, pt started with feverY01/09/09 3:00am Y - Mom states3pt was "burning up" andYguessed fever 1/8/2009 at 100 (did 1/9/2009 not measure it). Gav lowgrade fever day of immunization (early evening)- Tylenol admin and effective. loose BM Y , greenish in color 4/1/2009 04/02 4/6/2009 - 04/05/09. Then on 04 hat twice since administration she experienced Y episodes where Left hand became numb and U cold and then 4/13/2009 turned red 4/14/2009 and blue. Upon pres ay after vaccinations, Face SwellingY2 days after, by day 3-4 rash on face Y 4/8/2009 4/9/2009 e of soreness in arm 4/18/09 while performing routine housework. Noticed red, swollen, warm Y 3 in X 3 in4/17/2009 area 3-4 inches 4/18/2009 below injection si eving vaccine, Mariah started Y havingYbouts of rectal Y bleeding and diareah. 36 Y In additin Y to this she N had a very 8/23/2007 loud barking 9/1/2007 "chronic" cough. Mo swelling at injection site. Red and warm Y to upper arm . Y 4/16/2009 4/16/2009 aints-screened Jan 13, 2009 denied being pregnant-Her informed choice HPV#1 and Menactra Y given, states 1/13/2009 due Hept A #2 due after 12 Fe facial redness, itching and swelling 1 day after vaccine administered into left deltoid. Also felt Y lightheaded4/6/2009 day of vaccine. 4/7/2009 3/27/2009 N 3/26/2009 3/27/2009 shingles vaccine on April 13, 2009. On Thursday I had a rash which got worse every day. I went to see Dr. 4/13/2009 Jones today. 4/16/2009 He diagnosed sh miting,malise, headache could not get Y out of bed for 2 weeks after 1st shot. Developed Y periphreal N neurapathy within ### 30 days ###of 1st shot. H 2 degrees F) lasting 36 hours. ChillsYon 4-11-09 pain in both deltoid muscles radiating into neck N area. Dr visit 4/9/2009 on 4-12-09 4/9/2009 given RX for ibupr ction at injection site, left deltoid. Area red, slightly swollen, warm to touch 31/2 x21/4 circumference Y of needle 4/9/2009 site. Area 4/10/2009 described as itchy and swelling at injection site. Fever Y of 101.2 with generalized aches. Injection site a dark reddish Y pink extending 4/8/2009 towards 4/10/2009 elbow, 5" in diame ed with erythematous macular rashY- descendant type at night on 4/11/09 - taken to ER nextYmorning -(not sure if case 4/11/2009 was reported). Child l episode Records recieved 05/06/09 for DOS 04/10/09. Office visit. Post anthrax vaccine c/o Y weakness,4/10/2009 pale, slow4/10/2009 to respond to verbal co at sight of injection. Y 3/30/2009 3/30/2009 ined of severe pain at site of injection, as well as redness and swelling. Also cried for 3 1/2 hours Y after receiving 3/31/2009 injection 3/31/2009 wollen to the knee. No pain has itching. Y 4/11/2009 4/12/2009 ok patient to walk-in vaccine clinic. Obtained Y #2 Hepatitis A dose, #4 Pneumococcal dose (each Y in left thigh), 4/1/2009 and Influenza 4/1/2009 Split virus dose pain, high fever due to mistake. My daughter was given vaccinations by mistake twice. Y 1/9/2009 r and swelling due to mistake, and my son was given vaccination twice by mistake. Y 1/9/2009 X given in (L) deltoid on 4-9-09. OnY4-12-09 swelling of deltoid noted, no redness - (+) tender. Y Swelling resolved 4/9/2009 by 4/12/2009 evening 4-13. Also had njection site within 24 h (as reported by mother) at the time of visit -vesicle 3mm at injection U site with excoriated 4/7/2009 area.4/8/2009 Monitor for infection. was reported via medical records forwarded byYa lawyer and described the occurrence of arthritis U aggravated 4/19/1999 in a 77-year-old 4/20/1999 male subject NAR administered on 4/13/09 instead of 1. Mother called at 11:30 PM on 4/13/09 and statedUhad fever 102. 4/13/2009 Instructed 4/13/2009 to give TYLENOL an s after shot: body aches- hives, no respiration distress. 4/13/2009 4/13/2009 e TDAP vaccine 10-29-08. Later that day after vaccine administration, patient complained of Y weakness, dizziness, ###chills and ### body aches. La
t. noon sudden onset with severe back Y pain & body ache like the flu. Diarrhea started - went Y to bed - 200 4/3/2009 went to ER. 4/4/2009 Received a bag of f of arm at injection site, diarrhea, vomiting, Y fever.YSymptoms began 24 10 hr after vaccine. Erythema, edema of 4/6/2009 Rt deltoid.4/8/2009 BP decreased. 6/24
swelling to the site. Mother states approx. 5X5". Red, hot to the touch. C/o itchy. Painful. Y 4/9/2009 4/10/2009 d 3 seizures following 6 mos vaccines lasting 1 Y 1/2-2 min. 1st was tonic 2 clonic. 2nd was clonic Y with staring. 4/15/2009 3rd was 4/16/2009 a staring spell witnesse er vaccination, patient had about 10 spots of urticaria (red, raised) scattered on wrists, arms Ytrunk & behind 4/15/2009 ear. Relieved 4/18/2009 after bath in the , rhinorrhea started the following day after vaccination, today 4/20/09 saw MD for treatment.Y 4/15/2009 4/16/2009 9 started with cold & cough, gave TYLENOL Y for fever. On 3/26/09 Baby was very irritable RYside of body3/18/2009 hand & leg 3/21/2009 would jerk simultaneo and ulcers over scrotum, trunk and scalp, Y >100 lesions. U 4/9/2009 4/16/2009 ollen feet + hands Y N 4/6/2009 4/17/2009 hours, he had an 11 cm sized area of redness at the injection site that was firm & warm & his U thigh was swollen. 4/7/2009The4/8/2009 area was non tender R) upper arm. Started on KEFLEX - 25x 10 1/2 cm Follow-up in 2 days 4/16/2009 4/17/2009 ox. Patient had vaccine on 11/14/00 N ### 4/15/2009 ction 4x5cm, induration and erythema within 24hrs at MMR site. Advised to apply warm or cold Y compresses, 4/13/2009 TYLENOL 4/14/2009 po, or BENADRY an perienced a seizure approximately minutes Y after vaccine administration. Was taken to emergency U room.4/20/2009 4/20/2009 tient on off dizziness since receiving vaccine on 4/17/09. But complaining on weekend fever U negative, vomiting 4/17/2009 negative 4/17/2009 shingle negative fo post GARDASIL and MENACTRA administration. Y Patient fractured nose during syncope event Y (hit office 4/17/2009 counter during 4/17/2009 fall). d fever approximately 8 hours after vaccine. (105 degrees F). Next AM, joint and muscle tenderness; Y "whole 4/16/2009 body"4/16/2009 5x responded to Ibupr ad fever 100.1 and chills. Student took Advil and an hour later felt fine. T.100.1 BP 130/80 P100 Y 0296904/16/2009 CNRA 4/16/2009 e, nausea after 1st shot, recovered in Y 2 days. Developed rash in a week after 2nd shot. Saw Y dr, dermatologist and allergist finally diagnosed ven VARICELLA & MENACTRA vaccinations and after he walked into lobby he passed out. YPatient set in 4/13/2009 wheelchair 4/13/2009 & assisted by Dr. . B congestion, swallowing freq. weak Y nausea - approx. a minute and half - called mom (parents) Y this AM - 4/17/2009 but was unable 4/17/2009 to get update. 9 Mother called and spoke to call center who then called our office. Child received MMR andYVARIVAX today, 4/16/2009 rash 4/16/2009 developed on face, and d SPV left arm on 4/4/09. On 4/9/09 the pt experienced about 60 min of central chest pressure (2/10). He 4/4/2009 states that 4/9/2009 he felt like his heart r tarted 48-72 hours after Hep A # 2 and no obvious trigger. CLARITIN 5mg/5ml qd prn. U 4/6/2009 4/9/2009 er thigh induration 10x9cm, mild tenderness to left upper thigh. Y 4/15/2009 4/16/2009 nutes of the DTAP, pt had reaction, Y wheezing, sob, tickling in the throat, appeared grayish inYmouth, 2 tsp4/17/2009 BENADRYL, 4/17/2009 alb nebs X 2, SOLU veloped shingles 4/15/09. U 8/7/2006 4/15/2009 er of Pt; Pt arms became tender + painful (@ injection site) approx 6-7 hrs after injections, the Y hands became 4/9/2009 swollen4/9/2009 itching next day Pt re ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/20/2009 female, 2/20/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a 15-month-old 2/23/2009 female 2/23/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious spontaneous report of expired FLUMIST given was received from a company sales representative Y concerning 2/23/2009 a 2/23/2009 47-month-old male. O n has been received from a registered nurse concerning a male who last week was vaccinated U with VARIVAX (Merck). Concomitant therap MENACTRA 4/8/09 at 4:15PM, close Y to that time. Checked the vial for how to administer, it didn't Y state, checked 4/8/2009refrigerator 4/9/2009(see attached) post vaccine -> felt dizzy, diaphoretic helped to sit down no syncope no loss of consciousness Y supine x 4/14/2009 10 min then4/14/2009 sat up received orang ted with Sx of allergic Rxn after shots. Y No food, drink or other exposure noted. Sx started about Y 1 hr after4/9/2009 shots. No4/9/2009 probs w/ previous sho htness of chest next day. Benadryl +Y steroids. Y 4/1/2009 4/2/2009 dasil #3 woke up with shoulder pain L now hands fingers hard to work. Tests for lupus & arthritis N - neg. Now 1/4/2008 very stiff joints hands & knees ace and trunk extremities. Intense itching. Y Y 4/15/2009 4/15/2009 ith vesicular rash on trunk 4/16/09 - rash appeared 4/14/09 on trunk. N 11/3/2000 4/14/2009 hysical with immunization 4/3/09 fever Y to 101 X 24 hrs, then 4/6/09 developed no fever. Developed cough, 3/30/2009 cranky, not 4/10/2009 sleeping seen by Dr n has been received from an investigator via agency concerning a patient who on an unspecified U date was enrolled in a study. This report w y concerning a patient who was enrolled in a study. This report was part of a post-marketingUsurveillance program. On an unknown date the n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. This report was part of a post-marke n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date the patient n has been received from an investigator via DAIDS concerning a patient who was enrolled U in a study. On an unspecified date the patient w n has been received from a registered nurse concerning a 20 year old female with no past drug Y history, 12/6/2008 who on 06-DEC-2008 12/6/2008 was vaccina ort received 07 April 2009 from a consumer Y who was the patient's mother-in-law. A male patient N (age not reported) with a history of sleep d ort received 09 April 2009 from a health care professional. Y A four-month-old 1 male patient withYa history of eczema 4/2/2009and4/2/2009 an egg allergy, had r
episode, fever - 102.7, partial absence Y spell or Yseizure which resulted 1 in some anoxia post ictal Y phase, sign 4/7/2009 tachycardia. 4/7/2009 4/29/09 Received ed child c/o pain, redness and swelling noted to (left) vastus lateralis approximately 3cm x 5 cm. Y 3/31/2009 4/1/2009 ately 15-20 minutes after vaccination Y child became unresponsive, no respiratory distress. Mother Y emergently 4/16/2009 brought 4/16/2009 infant back to office. I 0 min after vaccination given, the patient had a blank stare, turned gray, rapid breathing, gotYstiff eyes, eyes 4/15/2009 rolled back, 4/15/2009 arm and legs stiff a 02 degrees and diffuse urticaria. Began Y the AM after vaccine administered. Given antihistamine U as treatment. 4/15/2009 4/16/2009 4/10/09 left deltoid noted to have about 4" round increased redness, warmth and swelling. Instructed Y to use 4/8/2009 ice packs prn. ived vaccination on 3-27-2009 and came in office with chickenpox on 4-8-09. Y 3/27/2009 4/8/2009 d swelling and hardness at site (L) arm of inj, progressed down arm to below elbow. Described Y as hard, 3/13/2009 warm, very 3/13/2009 tender, entire circumfer hes over body, especially elbows, knees Y and hands with swelling and redness within 5 hrs ofYvaccination. 4/13/2009 4/13/2009 male received vaccines 4/10/09. 2hrs Y after vaccine started develop rash to body, which spread Y the following 4/10/2009 day with 4/10/2009 swelling. Seen in ER cella 4/7/09. At 3:30am on 4/9/09 woke up w / 104 Temp. Used fever control methods. Saw Y PCP at 9:30am 4/7/2009 on 4/9/09, 4/9/2009 temp at 99. Large, r d swelling and pain of injection site >5cm about 8 hours after injection. 12-18 hours after injection N developed 4/9/2009 dizziness, 4/9/2009 nausea and heada me down with shingles within days of receiving Zostavax. Y 3/19/2009 3/24/2009 veloped painful rash with vesicles at site of injection and mid back. Y 3/19/2009 3/24/2009 vaccine administered 04/15/2009; 36 Y hrs. later I had 3.5 cm indurated, red, sore, warm vaccination Y site w/surrounding 4/15/2009 4/16/2009 erythema accompani ived PPD and Flu vaccine 4-15-09.Next day he developed fever.Red rashes developed on forehead.Mom Y gave a dose of benadryl elixir 1 t s following injection of varicella and mmr to left thigh mom returned with child and wanted usUto see left thigh 4/21/2009 reddness 4/21/2009 and swelling. 2 3/4 nd 4/16 baby was cranky and crying, no fever. On 4/18/09 "baby's eyes started rolling back"Uone time. On 4/14/2009 4/20/09 "everytime 4/18/2009 MOB put bab tching and rash on arm where vaccines were given. Benadryl cream prescribed by MD. Y 4/13/2009 4/14/2009 en, hot area where vaccine given Y 4/17/2009 4/18/2009 days after getting Proquad VMMR vaccination Y and Pnem vaccination. My son ran 105 F fever U and I took him to the ER. His temperature w ed disease of the pericardium. 5-000007 Y 4/28/09 Received vaccine & clinic medical records of 3/20/09. FINAL 3/9/2009 DX: pericarditis 3/20/2009 Records rev en, hot area around where vaccine was given Y 4/17/2009 4/18/2009 administration, had flu-like symptoms including chills, aches, and vomited X1. Today (1 dayNafter vaccine 4/20/2009 administration) 4/20/2009 she has a runny n RSE EVENT-MD ORDERED & PATIENT RECEIVED DTaP. THIS VACCINE IS NOT RECOMMENDED Y FOR 9/3/2008 CHILDREN PAST 6 YEARS episode fainted Y 4/21/2009 d tdap and varicella and passed out. Hit forehead on wall and recieved a lacaration steri strips Y were applied 4/18/2009 Pt c/o dizziness 4/18/2009and pain. Pt st ceived a Tdap and 1st Hepatitis A and Y within 5 minutes, broke out in a rash and had trouble Y breathing and 4/13/2009 swallowing. 4/13/2009 Patient reported he following Twinrix vaccine on 4/15, client's Y upper lip began to swell. Swelling continued for several N days. 4/15/2009 Client visited 4/17/2009 primary care physicia rash starting on face and spreading. Tactile temp, fussy. Multiple papules, vesicles Y 2/18/2009 4/13/2009 y aches HA vomitng for 3 days Y U 4/18/2009 4/19/2009 V injection approx. 8:20 a.m., Immediately felt sick and dizzy, thought she was going to vomit. N There were 4/20/2009 two more4/20/2009 incidents during day on diagnosis to vaccine-Hypothyroidism, Y Hashimotos,Acid Y Reflux, Anxiety, 20 Y Depression, OCD and N had occassional 9/20/2007 eye 10/1/2007 tics. Exacerbation of pre was reported via medical records forwarded by a lawyer and described the occurrence of arthritis U in a male subject in his forties who was v was reported by a lawyer and described Y the occurrence of joint pain in a male subject of unspecified N age who ### was vaccinated with LYMER vaccines 4/2, on 4/9 developed Y fevers, sore throat Y - unresponsiveness 21 and encephalitis withNbrain edema4/2/2009 by 4/11. Suspect 4/9/2009 viral encephalit a fever up to 104 with last vaccines Y and screamed for ten hours nonstop. Y 1/28/2009 1/29/2009 ceived DTap and VARIVAX vaccines on 3/18/09 in right thigh. Patient returned to office 3/20/09 U with large 3/18/2009 red circular 3/20/2009 area around injection ceived DTap vaccine in left thigh on 3/16/09. Parent reported large red swollen area around Y injection site3/16/2009 1 day after3/18/2009 injection. Redness and at, difficulty swallowing, hoarsenessYand laryngitis. Told to stop VIVOTIF and use ADVIL. Throat U culture pending. 4/17/2009 4/18/2009 get lesion (7cm x 5 cm) with central clearing. Y Raised, red and warm, but no pain or itching. Y 4/15/2009 4/17/2009 d pain at left upper arm at previous injection site with redness and tenderness (2" x 5" of size). U Pt stated scratching 4/8/2009 area 4/12/2009 after 4 days of injec cold sweats and chills 4-20-09 that evening after the vaccine was administered. Pt also c/o difficult with4/20/2009 forward flexion 4/20/2009 of neck - "mild disc on L thigh with chicken pox lookingYlesions warm compresses + Augmentin x 5 days. Y 4/6/2009 4/17/2009 tous papular and plaque like lesions - very pruritic on extensor surface of upper and lower extremities. U This 4/7/2009 rash developed 4/18/2009 2 weeks after 2 smallpox 31 Mar 09 Lt upper arm, which Y was followed by swelling, redness, and increasing tenderness, Y 3/31/2009 no fever, Pt stated 4/1/2009 she was vaccin ollow-up to a previously submitted VAERS report this 47 year old patient received 4 BIOTHRAX U prior to and 1/11/2003 during his 1/13/2003 deployment in 2003. omiting and diarrhea, subjective fever Y and hematoma to site. Y 4/8/2009 4/9/2009 Y 4/15/2009 4/16/2009 creased appetite, rash, shaky, vomiting in the 24 hours to 48 hours with the vaccine administration N on 4/15/09 4/15/2009 4/16/2009 ines were given the patient hopped off the exam table (she was sitting on it) & fell to the floorY and became 3/16/2009 rigid and3/16/2009 looked blue and unresp
<15min) onset of facial swelling afterYvaccine delivery. Y 4/21/2009 4/21/2009 ely after vaccination, eyes rolled back, Y color became gray/green, leaned to left; mother supported U her - nurse 4/21/2009 attempted 4/21/2009 to assist her to put 08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis Y ofNSacroileitis,7/22/2008 pain Amplification 8/5/2008 syndrome. Pai 9 Patient brought by parents. About 12-18 days after vaccines developed hives on both cheeks N and few scattered on lower legs. uring swallowing; Febrile seizure. Y Y 4/8/2009 4/15/2009 ter immunization. Woke up next AM with severe swelling to face & eyes, very sleepy. Afebrile, Y no SOB 4/10/2009 or difficulty4/10/2009 swallowing. Took 50 m ely after receiving 2nd GARDASIL vaccine along with DTap vaccine, patient fainted. She wasYunconscious 4/17/2009 for 2-3 seconds. 4/17/2009 Awoke with sha is having tingling sensation up and down his left arm, and he stated that his shoulder is sore. U Asked him3/10/2008 is pain severe 4/9/2009 he said that it is eas as given Hep A 1st, then HPV. AfterYHPV was administered pt tensed up and began to looseYher color, she 4/17/2009 then began 4/17/2009 to lean backwards a dness where injection given area approx. 6in long & 4in with with warm areas + pain. Started Y around 12 hours after inj + worsening over 48 fter vaccine with smallpox, awoke with non painful non pruritic 10 cm red patch with multiple U 2-3 mm satellite 4/13/2009 papules 4/13/2009 around path extendin after injection erythematous confluent raised rash appeared on dependent surface of L upper Y arm. 1% Hydrocortisone 4/16/2009 4/17/2009 cream bid, extendin hezia, twice - Fussiness - Constipation Y Y 3/25/2009 4/1/2009 4/15/2009 N 4/15/2009 4/15/2009 erythema, induration at Iz site - VARICELLA Iz right thigh U 4/8/2009 4/9/2009 ne was mixed with sterile water diluent and not HIB diluent. 3/9/2009 n has been received from a 31 yearYold female licensed practical nurse with reaction/allergy Y Nto DEMEROL7/5/2007 and a history 7/5/2007 of function kidney additional information has been received Y from a nurse practitioner concerning a 14 Y year old Nfemale who on 17-OCT-2006 ### 2/1/2007 was vaccinated w n has been received from a physician assistant and a licensed practical nurse concerning a U female who was vaccinated with the first dose n has been received from a physician Y assistant concerning a 20 year old female Y with migraine, N penicillin8/15/2007 allergy and VICODIN 8/1/2008 allergy and a ports child woke up "Sunday night atY 1:30" (April 12) with c/o not feeling well, sore throat andYswollen glands 4/8/2009 on side4/12/2009 of neck. Reports c/o h veloped a skin infection at the site of Y the MMR vaccination. She had low grade fevers for days Y and was in 4/2/2009 discomfort. 4/11/2009 10 days on antibioti IVED DTAP INSTEAD OF TDAP. U 4/13/2009 4/13/2009 arm from just above elbow to shoulder Y joint. Had 4+ edema. Hot to touch, with deeper reddish Y black skin 4/15/2009 discoloration 4/16/2009 below where Kinrix d loss of consciousness after vaccination, associated with tonic clonic motions of extremities. Y Complete4/14/2009 recovery. 4/14/2009 No prior history of seizu ived 2 month vaccines as Pentacel, Prevnar and Rotateq. Vaccines given at 10:30 AM, Infant Y had inconsolable 4/21/2009 crying 4/21/2009 and mild fever (not ceived vaccinations and about 5.5 - 6 hours later experienced weakness, fatigue and fever ofU 102.5 axillary. 4/21/2009 No other 4/21/2009 symptoms other than ARICELLA VACCINE RECEIVED. PREVIOUS DOSES ON CHILD GIVEN ON THESE DATES: U 4/21/03,4/17/2009 04/18/20074/17/2009 rned pale and diphoretic after administration of first Gardasil vaccine. Patient complained of feeling Y like she 4/22/2009 was going 4/22/2009 to pass out. Patient w nderated at injection site. Heat and Y prednisalone Y 4/15/2009 4/16/2009 al reaction from left elbow to over left shoulder including underside of arm. Red, hot to touch,Uskin hard and 4/20/2009 swollen,4/21/2009 painful, no enlarged ax er receiving his 4 month booster vaccines Y patient Y started having seizures 1 Y which have Y resulted N in several9/26/2007 hospitalizations, 9/29/2007 numerous medica 4 HR OF VACCINES, PT GOT RAISED Y RASH ON BOTH ARMS. RX KEFLEX 250MG TID FOR 1 WK. CLARITIN 4/20/2009 RX, 4/21/2009 BENADRYL HS PR OID MACULAR RASH,MILD SWELLING, Y WARM TO TOUCH. CLARITIN RX/BENADRYL RX. RETURN 4/17/2009 IF NOT IMPROVED. 4/21/2009 d large local reaction at site of vaqricella Y vaccine Y 4/17/2009 4/18/2009 was reported by a lawyer and described Y the occurrence of joint pain in a female subject of unspecified U age 5/4/2000 who was vaccinated with LYME was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age 7/8/2002 who was vaccinated with LYMER came dizzy, pale, clammy & sweaty lethargic stated his very tired. Pulse droped into the 50's Y - oxygen @ 4/21/2009 3 liters had 4/21/2009 patient lie down chec telephone call from patient on 4-16-09 stating the she had slight nausea and slight swollen lymph node 4/14/2009 in (L) clavicle 4/15/2009 area. No fever. 4-21SM referred from aid station for left Y facial swelling in temporal association with the receipt ofYAVA and Typhoid 4/7/2009 vaccines. Symptoms: Swel
njection 02/13/2009 @ 4:00pm 36 later Pt states fever of 100, chills body ache L arm, headache. Y 2/13/2009 2/15/2009 n on 4/8/2009. Pt noted symptoms. Flu like achy onset 4/18/09. Stopped 4/21/09. Rash onset 4/21/09 - ongoing. 4/8/2009Rash 4/15/2009 on side of face, nec ccinated with Hepatitis A and Hepatitis B vaccines 15-20 seconds after vaccines administered Y patient fainted. 4/22/2009 Per guardian 4/22/2009 "patient has al large area redness/heat denies itching mildly painful area raised warm area breadth of thigh with central4/20/2009 clearing around 4/21/2009 vaccine site. Ben ng office, parents report baby turned blue, when strapped in her car seat lasted few secondsY-> pinked up on her own. Brought her right ba on 4/17 - Sore, red and itchy, and aYlittle swollen. Saturday swollen and warm.- little fever. Monday 4/20,4/17/2009 still sore and 4/18/2009 warm. Dr. prescribed eft thigh around on a or injection and fever of 100.2 U 4/16/2009 d hives 3 days after getting HPV vaccine for the 1st time. Y 4/16/2009 4/19/2009 n has been received from a nurse practitioner Y for the pregnancy registry for GARDASIL, concerning Y a 23 year old female 5/21/2008 with a history of 2 n has been received from a 22 year old medical assistant who was given the second dose ofNGARDASIL "subcutaneously instead of intram
n has been received from a Nurse Practitioner concerning a patient who on 13-FEB-2009 was U vaccinated 2/13/2009 with an inadequate 2/13/2009 dose of GAR n has been received from a physician concerning a 16 year old female who on 12-JAN-2009Uwas vaccinated 1/12/2009 with the second dose of GAR n has been received from a medical assistant concerning a 11 year old female with a historyYof pharyngitis 2/26/2009 streptococcal 2/26/2009 who on 26-FEB-2 n has been received from a Registered Nurse concerning a 16 year old female who was vaccinated U intramuscularly with her third dose of G n has been received from a physician Y concerning a 19 year old female with penicillin allergyUwho on 19-FEB-2009 2/19/2009 was 2/19/2009 vaccinated IM into t n has been received from a physician Y assistant concerning a 15 year old female who on 27-FEB-2009 U was 2/27/2009 vaccinated 2/27/2009 with a first dose of G n has been received from a 25 yearYold female who on 18-FEB-2009 was vaccinated with her N first dose 2/18/2009 of GARDASIL and the patient had n has been received from a nurse concerning Y a 13 year old female who on 26-AUG-2008 was N vaccinated 11/2/2008 with her first 12/1/2008 dose of GARDASIL n has been received from a physician concerning a 14 year old female patient with no pertinent N medical 2/12/2009 history and2/17/2009 no known drug allergie n has been received from a physician Y assistant concerning a female under 18 year old who Y on unspecified date was vaccinated with her th n has been received from a registered nurse concerning her 16 year old with no pertinent medical U history and no ###drug reactions/allergies ### w n has been received from a consumer concerning her daughter (approximately 17 year old) N with codeine allergy who9/1/2008 had been experiencin n has been received from a registered nurse concerning her 14 year old daughter with frequently Y injection site reaction after unspecified va n has been received from a 41 yearYold female patient with an allergy to "cloricidin" and a history U of bleeding 3/2/2009 during pregnancy 3/2/2009 who on 2-M n has been received from a female who was vaccinated with a first and second doses of GARDASIL U on an unspecified date, respectively. T n has been received from a nurse practitioner concerning a female patient who was vaccinated Y with a dose of GARDASIL. 3/2/2009 On 2-MAR-2009 n has been received from a registered Y nurse concerning a 24 year old female who in approximately Y February 2/1/2009 2009, about 2/1/2009 1 month ago, wa n has been received from a nurse practitioner Y concerning a 20 year old female with no pertinent U medical9/25/2007 history or drug 2/24/2009 reaction/allergies w n has been received from a physician concerning a 14 year old female who 25-FEB-20009 was U vaccinated 2/25/2009 with a dose 2/26/2009 of GARDASIL (lot # n has been received from a radiologist Y concerning her niece (a 14 year old female) who on 08-FEB-2008 Y 2/4/2008 was vaccinated 2/8/2008 with her first dose n has been received from a Nurse Practitioner (N.P.) concerning a female who was vaccinated N with 0.5 ml dose of GARDASIL. The patient n has been received from a registered Y nurse (R. N.) concerning a female patient at one of the U local schools who had an aluminum poisonin n has been received from a physician concerning a female patient who was vaccinated intramuscularly with 0.5 ml dose of GARDASIL. Co n has been received from a mother concerning her daughter who on unspecified dates was U vaccinated with all the three doses of GARDAS n has been received from a physician Y concerning a female teenager who on an unspecified Y date was vaccinated with the first dose of GAR n has been received from a nurse concerning Y a 17 year old female patient who on 28-FEB-2009 N was vaccinated 2/28/2009with 2/28/2009 the first dose of GAR n has been received from a physician concerning a 13 year old female who on 22-DEC-2008 Y was vaccinated with ### her 2/23/2009 first dose of GARDA n has been received from a physician Y concerning a 15 or 16 year old female who was vaccinated U with the second dose of GARDASIL. On n has been received from a registered Y nurse concerning an 18 year old female with an allergy U to naproxen 11/1/2008 who on 23-APR-2008 11/1/2008 was vacc n has been received from a consumer concerning her 23 year old daughter with no pertinentNmedical history 8/1/2008 and no known 8/1/2008 drug allergies o n has been received from a physician concerning a female who on an unspecified dates wasUvaccinated with first and second doses of GA n has been received from a school nurse (registered nurse concerning a high school aged female U who was 7/31/2007 vaccinated with a dose of GAR swelling ANT LT Thigh, delayed onset Y after immunizations 4/9 am, either soft tissue infection U (cellulitis) vs 4/9/2009 delayed and 4/9/2009 severe local reactio m red patch on L thigh 2 days with vaccine Y administration tender + hot no systemic signs or symptoms. U 4/16/2009 4/17/2009 was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a 5-year-old male patient eared over mid back and buttocks 7/30/08. Progressed to localized area over left thigh, clustered, mean spots,### very7/30/2008 pruritic. Area persisted mmunization clerical staff stating client Y had left phone message stating that she had blistersUat the site of 3/1/2009 her shingles shot. Said area was lled Pt. crying, unable to console X90 min. Tylenol given - phone call 4/17/09. Pt doing better, Y cried for 24/16/2009 1/2 hrs. and 4/16/2009 is fine today- had low iving a HEP A injection pt walked to front desk & ran into the exit door. She stated "every thing Y was purple 4/17/2009 because4/17/2009 the shot hurt so much. hema and edema extending 10 cm X 4 cm around injection site. Decreasing edema and erythema Y daily.4/13/2009 4/14/2009 Mom called re: 4 bumps to left thigh Y with redness. 3-13-09 mom brought child to MD with increased Y redness 3/11/2009 and selling. 3/12/2009 3-14-09 ED visit, la A (intense when moves head) aching all over and a slight cough.Tem.101.Advised to see PCP U if T. 102-103 4/21/2009 and if sxs 4/21/2009 not subsided in 48 h ates that a few hours after the patient Y received Y his shots she fed him1and put him down for aYnap. She states 4/20/2009 she went 4/20/2009 in to check on him a NURSE PHONED TO SAY RIGHT ARM RED,SWOLLEN,TENDER--REDNESS EXTENDS U 3CM BELOW 4/20/2009 ELBOW---ADVISED 4/22/2009 TO SEND T ng of 4/22/09, the day after vaccination, parents noted that left arm was swollen above the elbow, Y red and4/21/2009 hot to the 4/22/2009 touch. Child had not co e on 4/15/09 at which time vaccinesYadministered according to CDC recommended schedule. Y Parents report 4/15/2009 that on 4/16/2009 4/16/09 patient develo muscle pain in the deltoid area beginning Y withing days after the shot. It has been 9 months and N the pain 7/15/2008 is only slightly 7/17/2008 better. dose of oral typhoid in the morning of 4-21-09 and began to feel intestinal discomfort the in evening Y of the 4/20/2009 same date. 4/21/2009 Started with diarrhea inistration of a subcutaneous MMR vaccination using a VanishPoint syringe, a black dot appeared U on the site of ### injection. ### nausea w/o emesis and Crampy abdominal Y pain 30+ episdoes of watery diarrhea no blood inY24 hours. Orthostatic 4/22/2009 and 4/23/2009 fatigue. bcutaneous injection of the MMR vaccine using the VanishPoint syringe, a black dot appeared U on the child's left ### arm. ###
D T-DAP 4/1/09 AT BEGINNING OF 12 HOUR SHIFT (0700) AND HER SHIFT EXTENEDED Y UNTIL 0300 4/1/2009 THE NEXT 4/3/2009 DAY. ON THE NIG d severe pain at injection site and upper arm,prickly reddened area around site, dizziness, fever,, U nausea,lymph 4/20/2009 glands 4/21/2009 swollen in axilla minutes after second vaccine injection(HPV) client stated that she felt hot,then did not respond Y to verbal4/23/2009 stimuli, eyes 4/23/2009 open, and body beg 009, arm was sore and red at site ofYinjection. Redness gradually worsened. At time indicated N in number4/20/2009 11, patient4/22/2009 began to feel nauseate rm redness, swelling, fever, skin hot, red rash on arm, pain in arm for one week, egg sized lump. Y Symptoms 4/14/2009 resolved 4/14/2009 on own after one wee e shingles vaccine administered on the 21st of April at 10:00a.m., became very red, itchy andY swollen to 4/21/2009 three inches 4/22/2009 in diameter, 1/2 inch h was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age7/30/1999 who was vaccinated with LYMER was reported by a consumer and described Y theY occurrence of throat0 tingling in a 45-year-oldUfemale subject 9/17/2008 who was 9/17/2008 vaccinated with influe ng office Pt had a delayed fainting spell - Returned to office - No injury. Y 4/23/2009 4/23/2009 ter injection - pain at site -nausea-vomiting 9 hrs- Temp -101.4 - 12 hrs. See attached for detailed Y acct 4/14/2009 4/14/2009 ure starting within 24 hours of injections with lack of appetite & fatigue. Cough developed within 24 hours 3/25/2009 with positive 3/26/2009 strep (rapid test) 3/3 s red, swollen, itchy Y 4/21/2009 4/22/2009 degrees (rectal) on 4/23/09, redness Y and warmth to both thighs U 4/22/2009 4/23/2009 red area on LA last night 4/15/09. School nurse (called 4/16/09). 3/4" wheel - 2" flare -red-hot; Y dermis itching 4/14/2009 - no rash4/15/2009 no resp. problems after vaccines given mom stated pt vomited in bathroom. Once out of bathroom mom statedYpt feet "hot".4/17/2009 Temp was 4/17/2009 99.8 axillary 15 min la d redness, swelling, pain 5/10 and heat stating 4 days after injection. Erythematous and edematous Y area 4/6/2009 9 cm X 7.54/10/2009 cm at injection site. St 9, he was given MMR in right upper arm. Later that evening, he developed a red whelp and Y swelling of the 4/17/2009 right upper 4/17/2009 arm (deltoid area) No cm redness & swelling around site of Y immunization left and lateral thigh Y 4/21/2009 4/22/2009 appeared on arm in vicinity of vaccines - 4 days later on 04/6/09 and 4/20 severe rash on face - 4/21 severe 4/2/2009 generalized 4/6/2009 indurated pink pap eived varicella vaccine on 4/21/09. Y Developed edema of R arm extending from deltoid to mid forearm erythema 4/21/2009 over4/23/2009 deltoid. m to touch, inflammation instructed to give child, children's Motrin or Advil. U 4/21/2009 4/23/2009 r arm is red, hot to the touch and feels hard @ injection site. <- hist Dx Skin is mildly red-notY hard child 4/21/2009 not ill- playful4/22/2009 afebrile. egular shaped welts - No temp. - Itchy on parts of arm/legs and torso - Recommended BENADRYL U _ See 4/21/2009 Dr. if not 4/22/2009 better. iness symptomatic tx Y 4/22/2009 4/23/2009 ling, redness at site of injection (improving 4/21/09) fever & chills over night nausea. Y 4/20/2009 4/20/2009 swelling, heat (L) upper arm and developed several hrs after injection, Rx BENADRYL/VICODIN Y and cold 4/20/2009 packs. 4/21/2009 tching - burning - tired - achy Had emp. health physician check patient Y 4/21/2009 4/21/2009 post pt left boyfriend called back stating pt's tongue was starting to swell & have blisters on tongue. Y Told4/21/2009 boyfriend 4/21/2009 to return to clinic. Dr ex min child had cough, wheezing, difficulty Y breathing, pale Oxy 93-96% on room air then developed Y itchy rash 4/22/2009 all over4/22/2009 the body. Got XOPEN spot at injection site. Y 4/15/2009 4/16/2009 4/22/09 with rash. Y Y 5/30/2006 4/21/2009 ever and erythematous, blotchy rush all over - day after PENTACEL and ROTARIX Y 2/11/2009 2/12/2009 eport that after shots on 2-19-09, pt cried non stop greater than 3 hrs. Y 2/19/2009 2/19/2009 n has been received from a physician concerning Y a 12 month old patient 0 who on 20-JUN-2008, Y 06-AUG-2008 10/1/2008 and 01-OCT-2008 4/7/2009 was vacc n has been received from a physician concerning Y a 17 month old patient 0 who on 20-DEC-2007, Y 20-FEB-2008 4/17/2008 and 17-APR-2008 3/16/2009 was vacci rmation has been received from a physician Y and follow up information has been received from Y a registered 4/14/2009 nurse concerning 4/14/2009a 15 year old ort was received 17 April 2009 from Y a consumer, who is the patient's parent. An 11-year-old male Y patient (also 6/1/2008 reported 6/1/2008 as 12 years of age) ng of the vaccine swelling developed at injection site. The next day she developed a headache, Y chills, nausea 4/22/2009 and sweating. 4/22/2009Today (day 3) nt had a seizure on the Friday after Y getting the vaccine. Patient had a seizure w/u-extension,YLP/UDS. Patient 4/8/2009 had CT 4/17/2009 scan and EEG. The E nt received travel vaccines (yellow fever, Y meningococcal, typhoid) at an outpatient travel clinic Y 4/1/09. He4/1/2009 developed4/1/2009 a headache about 5 m pneumonia vaccine 4/20/09 in left arm. Y Stated it was immediately painful. Localized swellingUoccured over 4/20/2009 the next4/20/2009 6 hours. Swelling incre had slight swelling about 5cm, redness, itching, and pain Y 4/1/2009 4/3/2009 U 4/14/2009 4/14/2009 ceived her 4 month vaccines on approximately Y Y4/12/09 of this year (2 2 injections, 1 to the R thigh U and 1 to4/12/2009 the L thigh4/16/2009 presumably pentacel a s started exactly 2 months after her Y 2nd shot. Started Y with headaches, 1 nausea, vomiting, Y strep N throat and11/7/2008 body aches. 1/7/2009 Continues on with no as vaccinated 4/14. Presented for urgent care 4/23 with three patches of vesicles on left back. U 4/14/2009 4/22/2009 ere muscle pain in lower legs that continued for 7 days, and they are still sore, but not so severe Also after4/8/2009 3 days, I4/14/2009 started to have muscle 9/17/2008 N 9/2/2008 9/2/2008 d shortness of breath, wheezing, Y cold extremities, Y and hives within 5-15 2 minutes after receiving Y four immunizations 4/23/2009 and 4/23/2009 PPD. 5/14/09 hosp perienced two episodes of syncope after receiving vaccines on 4/21/09. First episode immediately Y after 4/21/2009 receiving vaccines, 4/21/2009 then 15 minute minutes of receiving her first Gardasil injection the patient blacked out. SHe was treated with Y smelling salts 4/17/2009 to try and 4/17/2009 rouse her and was p
hrs after receiving the immunizations Y listed below, patient's rt. arm began itching at the varicella Y site, then 3/23/2009 she noticed 3/24/2009 swelling and warmth ed this facility and stated that since she was administered her Td vaccination in the right deltoid on 3/27/09 3/27/2009 she has 3/27/2009 had "pain off and on in s after receiving MMR vaccine subcutaneously, Y developed a 1.5 cm wheal that itched and hurt Y at the site4/23/2009 of this vaccine 4/23/2009 administration. Tre vaccination on April 16th 2009 I noticed at the injection sight his arm was swollen, red and very N hot to the4/16/2009 touch. Everyone 4/16/2009 told me he was f was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified U age who was vaccinated with LYME 4/21/2009 N 4/16/2009 4/21/2009 eption, Bilious vomiting, Irritability, Listlessness. Y YIntermittent vomiting1 episodes starting on 4-12-09. Y Increased 4/7/2009 vomiting 4/12/2009 noted on 4-21-09. D cines emesis about 10 minutes afterYvaccines, developed Y facial and arm rash 20 minutes after Y vaccines, 4/15/2009 Pt sleepy. BENADRYL 4/15/2009 15 mg IM a eption, s/p surgical reduction. Y 4/28/09 Y MR received Y for DOS 4/16-19/2009 3 with D/C dx: Intussusception. Y 4/14/2009 Pt presented 4/15/2009 with vomiting, fussin ter received her second GARDASILYvaccine and had 2 30-45 second seizure 15 minutes after U the injection 4/21/2009 in the doctors 4/21/2009 office on the floor reviewed PROTCOL questions with patient, denied steroid use 4/24/09 - patient came to pharmacy U and4/23/2009 showed pharmacist 4/24/2009shingles-like ra headache, - flu-like symptoms, -nausea; -muscle pain Y 4/22/2009 4/23/2009 iving IM DTaP and IM PREVNAR onY 4/20/09 to (R) thigh, pt. developed red, warm area and Ytemp described 4/20/2009 as "hot"4/21/2009 per mom day after sho t was given a DTaP immunization Y 4/20/2009 swelling, redness, and warmth to immunization Y site (right posterior upper arm). 4/23/2009 4/23/2009 es, shortness of breath, very painfulYwith in 5 hours after injection, Pt states arm very painful Yunable to lift4/21/2009 on 4/22 + 4/21/2009 4/23 area near injection f the she c/o itching at the site - red area appeared 3 days later 15mm x 20 mm now. StartedUsmall welting 4/7/2009 after - no 4/7/2009 fever, no swelling in ar erebral Palsy, 1 seizure periodically Y 12/08, sees Neurologist, EEG 12/08 abnormal, on KEPPRA, U this episode 4/20/2009 = day 4/21/2009 after immunization mom r to elbow swollen twice the size & with erythema. Y 3/11/2009 3/13/2009 ived 2 chicken pox vaccines, chicken pox rash on 4/17/09 Y 6/20/2007 4/17/2009 d hives within 10 minutes of HIB / PREVNAR administration. BENEDRYL given in office. Monitored Y X 20-30 4/2/2009 min 4/2/2009 Y 4/20/2009 0PM Hep A #1 given LA. After injection, Y stated she was dizzy and tip of tongue numb. Color Ypink. 2:35PM 4/16/2009 HR 34 R 4/16/2009 20 BP 110/60 talking w U 2/11/2009 2/12/2009 vaccines - approx 30 mins later father Y returned to clinic stating child c/o "scratchy throat" - no Y SOB - vomited 4/7/2009 x3 - c/o4/7/2009 chest tightness EPI. 3 GARDASIL shot. Approx 3-5 min. later had several vials of blood drawn. After last vial pt. became Y "rigid",4/16/2009 had muscle 4/16/2009 contractions, eyes we by parent, Pt.'s R arm and shoulder Y at injection site became very swollen, child taken to ER.UParents thought 4/14/2009 needle was in arm. Arm X ra warm area without induration occurred 4/19 (2 days after vaccines given). U 4/17/2009 4/19/2009 red ROTATEQ orally before other vaccines - within 1 min of giving oral vaccine, infant mucous Y membranes 4/15/2009 of upper4/15/2009 and lower lips began to here for evaluation of dizziness andYsymptoms that she thinks may be related temporally to the injection 4/14/2009 of a TDAP 4/14/2009 that was given on 4/14/ ht arm within about 4" from injectionYsite bright red, swollen, hard and hot to touch on 3/19/09. Y 3/20/09 signs 3/18/2009 and symptoms 3/19/2009 persist with larg as brought back to office 25-30 minutes Y after injection given complaining that his chest hurt. Patient Y exhibiting 3/13/2009 welts,3/13/2009 wheezing, welt around jection site 2" x 1" redness w/ 2" raised Y areas w/i. No vesicle. No streaky redness. U 4/14/2009 4/24/2009 n in Rt. deltoid about 2-3 hours afterY receiving pneumonia vaccination. Pt could not move her U arm or fingers 3/18/2009 and went 3/18/2009 to the ER. Pt given a st 66, have always had a healthy, active Y lifestyle; have been energetic & chipper Y- hard to keep N me down, 6/10/2008 some favorite 6/11/2008 activities being aer was considered medically important. Information regarding PREVNAR was received from a U healthcare professional 8/3/2004 regarding a male patie was considered medically important. Information regarding PREVNAR was received from a U healthcare professional regarding a patient wh was considered medically important. Follow-up information provided recovery status. Information Y regarding PREVNAR ### was received form a was considered medically important. Information regarding PREVNAR was received from a U consumer regarding her granddaughter who su n regarding PREVENAR was received from a healthcare Y professional 0 regarding a 19-month-old Y male patient who experienced drug ineffec was considered medically important. Information regarding PREVNAR was received from consumer U regarding 4/9/2008 a 15-month-old male patien provided Quality Assurance Y Results. Information Y regarding PREVNAR was received from a N healthcare professional 8/28/2008 9/12/2008 regarding a 3-month-o received provided additional patient details, medical Y history, event details, 0 and test results. Information Y regarding 8/14/2008PREVNAR 10/1/2008was received n regarding PREVNAR was received form a consumer regarding a 5-month-old male patientUwho experienced### multiple seizures. ### The patien n regarding PREVNAR was received from a healthcare Y professional regarding a 12-month-old Y male patient who experienced 10/1/2008 drug ineffecti n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldY female patient who experienced a linear, raise n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldY male patient 9/24/2007 who experienced 11/5/2007injection site a information provided patient demographics, recovery status, concomitant vaccine, and doseYdetails including lot ### numbers.### Information reg n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU male patient 2/15/2008 who developed 2/26/2008 petechia 11 days n regarding PREVNAR was received from a healthcare professional regarding a patient whoUwas administered the vaccine that was stored n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU female patient 6/16/2008 who inadvertently 6/16/2008 was given a
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 6/30/2008 who experienced redness at th information was received that provided patient information and lot number. Information regarding U PREVNAR 7/28/2008 was received 7/28/2008 from a healthca n regarding PREVNAR was received from a healthcare professional regarding a patient who experienced low antibody titers. The patient re mation was received in dose details and source details. Information regarding PREVNAR was N received from a ### mother4/8/2008 and a physician rega n regarding PREVNAR was received from a healthcare professional regarding a 2-month-old patient who 8/14/2008 experienced 8/14/2008 administered improp n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldN male patient9/5/2008 who experienced 9/10/2008rash from head Information provided test results and a possible cause for the reported events. Information regarding N PREVNAR 9/22/2008was received from a healt n regarding PREVNAR was received from a healthcare professional regarding a patient who received PREVNAR that had been frozen on a n regarding PREVENAR was received from a company representative regarding a male patient who experienced decrease in babbling. Th n regarding PREVNAR was received from a consumer regarding a 4-month-old female patient U who experienced ### administered ### the 2nd dose n regarding PREVNAR was received from a patient's mother regarding her 4-month-old sonYwho experienced 4/1/2008 injection site swelling, body t n regarding PREVNAR was received from a healthcare professional regarding a 9-month-oldY patient who experienced facial rash. The pat n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced induration. The patient received t n regarding PREVNAR was received form a consumer regarding a 4-month-old male patientUwho experienced broke out all over with a rash n regarding PREVNAR was received from a pharmacist regarding a 4-month-old patient whoUexperienced5/6/2008 rash and fever. 5/6/2008 At 4 months of a n regarding PREVNAR was received from a pharmacist regarding a 15-month-old patient who U experienced 5/6/2008 fever of 103.9 5/6/2008 degrees. The pa n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient who experienced red swollen l information was received that provided medical confirmation of the events, and also included Y patient demographics, 7/9/2008 7/9/2008 and recovery status. I n regarding PREVNAR was received from a nurse regarding her grandson, a male patient (age U unknown), who experienced reaction on the n regarding PREVNAR was received from a mother regarding her 12-month-old female daughter N who experienced 9/2/2008 swelling 9/3/2008 and redness at n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient9/8/2008 who experienced 9/12/2008urticaria on bo n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient7/3/2008 who experienced 7/8/2008rash from head n regarding PREVNAR was received from a healthcare professional regarding a 13-month-old Y male patient 8/6/2008 who experienced 8/9/2008 hives, extens n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced 10/1/2008 decreased 10/1/2008 appetite and widespre n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced extreme pain when PREVNAR w n was received from a pediatrician regarding a 4-month-old patient who experienced diarrhea. The patient received a dose on an unspecifi n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who U experienced diarrhea. At 6 months of age, th n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who experienced diarrhea. At 6 months of age, th n regarding PREVNAR was received from a pediatrician regarding a 12-month-old patient who experienced diarrhea. At 12 months of age n was received from a healthcare professional regarding a 13-month-old male patient who experienced U injection 2/3/2009 site 2/4/2009 swelling and fever of 1 n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldU male patient2/3/2009 who experienced 2/4/2009injection site sw n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldN male patient 12/9/2008 who experienced 12/9/2008injection site h ped a sore throat and fever 2 days after receiving the vaccine. Fever resolved after 1 day, but U sore throat 4/20/2009 persisted 4/22/2009 for several days. injection site reaction. Softball sized slightly swollen and red injection site area in left arm inYsubcutaneous 4/16/2009 upper tricept 4/17/2009 area. Received in old me today at a sibling's visit that ~2 weeks after patient received her Varivax she developed Y a fever and 4/19/2004 what looked 5/2/2004 like chicken pox lesi edness, swelling, induration, & pain at injection site. unable to lift arm. Started taking TylenolN1000 mg per 4/23/2009 recommendations. 4/24/2009 weating, chills, fainting, pain deep in ears Y 4/24/2009 ours after the vaccine my upper arm began to swell. The injection site had a rash, my entire U upper arm looked 4/24/2009 like a4/24/2009 giant hive. It was very rhea, crying (insolable), stopped eating Y typical foods she liked, needed to be in constant Y motion N (baby jumper)to ### be happy,### didn't want to be (pneumococcal polysaccharide) my husband had swelling at the sight and red and very hot.The Y redness4/20/2009 and swelling 4/20/2009 went down the inside n has been received from a 45 year old female nurse who on 16-APR-2009 was subcutaneously N vaccinated 4/16/2009 with a dose 4/16/2009 of ZOSTAVAX (M n has been received from a consumer Y concerning his now 5 year old son with developmental N delays, who 10/1/2005 at the age 10/1/2005 of 18 months was vac n has been received from a consumer concerning her approximately 12 month old male withNfood allergies and no pertinent 6/1/2007medical history o small pox lot number VV04003a. Pt. Y Developed Rash Covering entire body 6 days after vacination. U poc4/19/2009 fully formed 4/25/2009 then reaction accured ENTS WIH SKIN IRRITATION AND RED SPOTWS ALL OVER BODY SINCE 25 APR 2009YPT SEEN PROVIDER 4/15/2009 ON 4/25/2009 26 SPR 2009. PT A d TD vaccination 18 April 09. C/O increased pain over right deltoid muscle on 19 April. Pt states U that pain 4/18/2009 has been4/19/2009 stable for the past wee es son ran high fever (102 to 103) starting Y "about an hour after the shots" for most of weekend. Y Developed 4/23/2009 severe headache 4/23/2009and "walked in ction at injection site. Redness, swelling heat and hardness extending from injection site at left U deltoid to4/24/2009 just aboce 4/25/2009 the elbow. Injection ad G RIGHT ARM FROM DELTOID AROUND UNDER ARM PIT DOWN TO WRIST, STARTEDY 4/24/09 4/23/2009 4/24/2009 GIVEN TDAP AND MENACTRA AND FAINTED FOR A 15 SEC AND VERBALIZED FEELING Y DIZZY. PT. 4/27/2009 LAID ON 4/27/2009 THE FLOOR AND COL e and fever reported on 4/3/09 via a phone call to the LPN working at the outpatient clinic. No Y treatment noted. 4/1/2009 4/3/2009
er, child started with fever of 103.7 degrees Y Fahrenheit on 4/11/09 and she gave him TylenolYand then temperature 4/7/2009 went 4/11/2009 to 104 degrees so d with severe arthus allergic Y reactionY and pulmonary distress. Treated with high and prolonged U dose of prednisone 3/30/2009 -4/10/2009 ongoing at present.5/4 ather reports elevated temp at home Y 4/23/2009, for which he did administer tylenol. States child Y woke up 4/23/2009 approximately 4/24/2009 5 am 04/24/2009 w eived the flu shot I developed severYnumbness on my extremities witihn 2-3 weeks. Y After thatNI developed severe ###weakness, 11/1/2007loss of motor p 04, not responding to infant Ibuprofen. Up to 1 1/2 days prior, child's personality was a bit off Y (fussy and4/14/2008 not eating 4/21/2008 as well), but no other h ely after receiving her second varivax in her L arm she began to have hives that would comeYand go. She4/25/2009 was given4/25/2009 2 tsp of diphenhydrami uth pain on right leg and itching the Y day after. Five days later gave shingles 4/22/2009 4/27/2009 at site starting at 4/23 increasing toYredness and swelling at the site on 4/24. Headache, diarrhea, U nausea, 4/23/2009 vomiting, 4/23/2009 anorexia beginning on d increased pain that evening and then had red stripe formed below injecttion site- still present U 2 days later. 4/20/2009 Lips became 4/20/2009 swollen for 2 day ne disease fibromyalgia,Yraynods, numbness, Y flushing/sweats, anxiety,headaches, Y exhaustion N to the point9/8/2008 where its12/1/2008 impossible to work, tot ort was received on 21 April 2009 byYanother manufacturer that received the report from a healthcare N professional 2/26/2009on 13 April 2009. A male ort received on 21 April 2009 from the Y patient's spouse. A male patient (demographics not provided), N who has autoimmune reactions to milk mptoms for two to three Yweeks. Numbness Y in feet Y - leg cramps - back 30 Ypain in spinal area - problem U walking (paralysis). ### Hospitalization ### - tes 9 pt came to my office - her VARICELLA vaccine site had a 3 inch circle that was red, hot, painful Y and hard. 4/18/2009 Call to 4/18/2009 mom, ice applied, BENE & swelling after inj. given & cont >4d after inj. while pt on AUGMENTIN for puncture injury 4/23/2009. Y 4/23/2009 4/23/2009 9 pt presented with classic herpes zoster outbreak (R) side torso (not crossing midline). U 10/6/2008 3/24/2009 anus shot in clinic on 4/21/09, seen in Y urgent care on 4/24/09, site of injection upper left arm,Uwarm, red, tender, 4/21/2009 reaction 4/22/2009 first noted by patie /2 hr after immunization given, pt noticed slight nausea. At 5:25 PM she became very nauseated U + vomited 3/26/2009 small amt. 3/26/2009 TPR 99 degrees F area with redness, warmth approximately 6cm X 4cm. No induration temperature 99.4 f (tympanic) U Rx: Apply 4/17/2009 cold compresses 4/19/2009 to site pm Ty called doctors office 4/16/09 @ 1424 Y and left message for doctors office that pt was in ER on Y 4/15/09 for 4/7/2009 seizure episode. 4/15/2009 Records receive -09-09 I started getting a 'burning - itchy' feeling on right (back) thigh - it was painful - itchy for Y about 9 days 3/13/2009 - (and red) 4/9/2009 it was now gone. Flu and PNEUMOVAX 3/24/09 one in each deltoid. Pain since - Limited range of motion, very Y painful. Referred 3/24/2009 to physical 3/24/2009 therapy - Given rent called, red puffy (R) leg - local imm. reaction - 1/15/09 Parent called, fever >101 on 1/14/09. Y Red bumps 1/5/2009 on face, 1/15/2009 neck, belly and arm injection erythema and pruiritis localized to site 1X2 L upper arm. Oral antihistamine and steroid Y cream prescribed 4/20/2009 after 4/21/2009 days with injection. swollen arm, hot tender Y 4/15/2009 4/15/2009 swelling of arm; Hot. 4/15/2009 4/15/2009 sh, few hives occurring after 15 minutes of MENACTRA Admom. Given 37.5 mg BENADRYL Y P.O. 5 minutes 4/16/2009 later c/o 4/16/2009 tight chest - given E d first GARDASIL injection 4/10/09. On 4/12/09, noted 1cm round tender axillary node. U 4/10/2009 4/12/2009 ankles, elbows, arms, and legs. C/o rash being itchy; 0 trouble breathing. U 3/30/2009 3/31/2009 loose stools, fever Tylenol. U 4/15/2009 4/15/2009 itching, Skin Inflammation topical Cortisone, Y Oral Prednisone Ultra violet light N 1/21/2008 ### 4 1/2 hours after patient got the vaccine Y she felt light headed + dizzy and then became unresponsive, Y eyes 4/17/2009 deviated4/17/2009 upwards, slight jerking utes after Pt received 2nd VARIVAX, she started to c/o of sore throat, PF; bilat. wheezing, no Y swelling of4/23/2009 lips; improved 4/23/2009 after Epinephrine 0 cella at VARIAX shot site 1 - 1/2" closed up vesicles on red base. Y 4/6/2009 4/18/2009 9 around 11:30 A.M. had vaccine within minutes felt light-headed and woozy, strong feeling Yabout 2 hrs,4/16/2009 then took 3hr 4/16/2009 nap and gone when omplained of itching at injection site within 5 mins. of administration. Red rash appeared at Y 10 mins Benadryl 4/22/2009 given4/22/2009 to member. vaccine 041409 fever low grade -> Y 101.8 from 041409 -> 042009. Anorexic, personality changes. U Fever4/14/2009 - no response 4/14/2009 to Tylenol or Motrin. eloped on back, abd, arms & leg. Redness Y & itching. 0 sob Symptoms began 4-21-09 p.m. Y 4/20/2009 4/21/2009 break along 2 T-11. Dermatome within 48hrs of receiving vaccine U 4/14/2009 4/15/2009 rted "dime" size swelling- redness at Y inj. site - "nickle" size swelling/redness itchy under injection Y site on 4/13/2009 4-14- Child4/14/2009 to ER R/T swelling/redn after vaccine administration, child felt sick, went to bed early. Awakened in AM with arm pain, swelling, redness 3/30/2009 increasing 3/31/2009 so much that cou vaccine on 4-21-2009. When awoke on 4/22 didn't notice rash. Got to school + noted rash> Y went to school 4/21/2009 nurse who 4/22/2009 stated she has' hives unable to bear weight on left leg). Per Y mom happened after given vaccine. N 4/8/2009 4/9/2009 7:50 PM Mother called to after hours triage and report states that Mom reported 'arm swollenYfrom shoulder 4/20/2009 to elbow, 4/21/2009 mild redness - no red pper arm: L red, warm, indurated. Slightly tender. Y 4/15/2009 4/15/2009 ollowing vaccinations, then labwork (Had vaccines, then labs, then syncope occurred - Nothing Y to eat today). 4/23/2009 4/23/2009 4 cm allergic skin reaction CLAITIN/ZARTAC U OSTAVAX vaccine 4/14/09. Pt developed Y painful case of shingles 4/27/09 requiring treatment U in the ER4/14/2009 (Valacyclovir, 4/27/2009 Vicodin) nd the area itchy, raised area from the Y base and warm to touch, she had Td 10 years ago butNno reaction. 4/17/2009 4/22/2009 hy. Knee pain. Fever. Rash. Y U 4/8/2009 4/12/2009 w hours - splotches noted on both hands Y - Inj given @ 5:15 pm 4/22/2008 1) Eye swollen 2) splotches Y - now 4/21/2009 hives on4/21/2009 chin / both ears/ rash
ved 4/20/09 - Pt states itching and feet swelling started next day - took BENADRYL - helped,Ubut is having 4/15/2009 itching and 4/16/2009 swelling in feet today tenderness & increased warmth at injection Y site. Y 1/19/2009 1/26/2009 n has been received from a consumer Y concerning a her daughter 21 year old with Y penicillin allergy N and no 6/17/2008 pertinent6/17/2008 medical history who in n has been received from a physician concerning Y a male patient who 0 was vaccinated, "within N the last few 4/18/2009 days", with 4/18/2009 ZOSTAVAX (Oka/Me ort received on 15 April 2009 from a pharmacist.Y A 42 year old female 1 patient, who has no known Y allergies,4/8/2009 a history4/11/2009 of hepatitis B infection, us case was received on 20 April 2009 Y from another manufacturer whose initial reporter wasUa consumer. A male patient (age not provided se effects. Received the Tdap vaccination and current age is 69 years. Y 4/27/2009 PED FEVER ON 4/23/09. TOTAL BODY Y RASH(MORBILIFORM) DEVELOPED ON OR ABOUT N 4/24/09.4/15/2009 4/23/2009 8 Client received both Pentacel (DTaP, IPV, HIB) and Pediarix (DTaP, IPV, Hep B) at the same U visit. 4/22/2009 4/22/2009 as very irritable and "not himself" for a duration of 3 days after administration of the second dose Y of Hep A 4/21/2009 vaccine. 4/21/2009 tient recieved four doses of Anthrax between the dates of 02-JUN-08 and 06-AUG-08. U 3/19/2009 3/19/2009 OT SLEEP AT ALL, JOINT PAIN, SWEATS, CHILLS, SWOLLEN ARM Y 4/27/2009 4/27/2009 profuse sweating, disoriented for 10 minutes Y 4/24/2009 4/24/2009 ours of Tdap and Varivax administration, Y patient experienced redness,itching,and swelling ofYLeft upper 4/24/2009 arm.Mom applied 4/24/2009 cool compresses minutes after IPV,Prevnar and Hep A given, child developed 3-4cm hive on right wrist and 2 Ysmaller hives 4/28/2009 on back and 4/28/2009 chest.Wheals noted ctivity taken by ambulance to hospital Y 18 hours after vaccine given. Patient has no previous U events of seizures### ever. 5/4/09 ### MR received fo HAD VACCINE ON 4/21/2009AM, CAME BACK ON 4/22/09PM AND WAS COMPLAINING U OF PAIN AROUND 4/21/2009 THE 4/22/2009 INJECTION SITE, LE ated on a chair in exam room one with mother and younger brother present. Patient given HPV, Y Tdap, and 4/20/2009 Menactra 4/20/2009 vaccines at 4 pm by R ### N ### ### s: hives, vasculitis, joint pain, swelling Y of feet, hands & eyes, extremity pain, fever up to 101. Ufor 3 days. Treatment: 4/15/2009 benadryl, 4/16/2009steroid pack, ped an egg shaped reddened, hot area on the upper back part of her right arm where she got Y her varicella 4/27/2009 shot yesterday. 4/28/2009 It was noted by VEN 4/22/09 IN AFTERNOON. LEFT Y UPPER ARMS SORE REST OF LAST WEEK. EMPLOYEE Y DESCRIBED 4/22/2009 A FIRM 4/27/2009 LUMP AT INJECTI oke out in hives all over her body, which was highly pruritic. Felt some throat swelling but not Y enough to 4/21/2009 constrict airway 4/21/2009 completely. This o ped hives after injection and was seen Y in the ems - f/u at pcp today 4/23/2009 eived the influenza, pneumococcal (PPV23), Tdap, MMR, Hepatitis A, Hepatitis B, and shingles U Vaccine 4/22/2009 at 10:10 a.m. 4/26/2009 at clinic. Client then d Tdap on 4-22-2009, IM in left deltoid swelling stated 3 days later. Redness from top of deltoid U to elbow4/22/2009 and area is4/25/2009 hard and warm to the ates arrived home @ about 11 am. YPt. began having reaction starting @ about 11:30 am. Began Y with swollen 4/24/2009 mouth, 4/24/2009 then right eye, then c C/O PAIN STARTING 8 HOURS AFTER Y SHOT WAS GIVEN. REDNESS ON ARMPIT AND LEFT DELTOID. 4/24/2009 4/24/2009 ived a 4th DTaP and IPV as well as a 5th Hep B when she was given a Pediarix vaccine 4/22/09 Y at less4/22/2009 than 12 mos 4/22/2009 old, 1 Pediarix not on ately 1 minute after receiving the vaccines the patient passed out without any warning - he had Y a mild tremor 4/28/2009 of the arms 4/28/2009 and legs that last tient was quite irritable and slept a lot, maybe for the first three days. The worst symptoms IUsuspect come 4/20/2009 from the4/20/2009 rotateq vaccine, since hange in feeding pattern and marked temporary loss/regression of social milestones approximately Y 1 week 7/20/2007 following7/27/2007 routine 2 month immun eloped bilateral buccal mucosa swelling Y 7 hours following MMR vaccine. swelling is non tender N and only 4/28/2009 from the inside. 4/28/2009 no visible external was reported by a lawyer and described the occurrence of arthralgia in a female subject of unspecified U age who was vaccinated with LYME was reported by a lawyer and described the occurrence Y of arthralgias 0 in a male subject of unspecified U age who was vaccinated with LYME was reported by a lawyer and described the occurrence Y of Guillain-Barre 0 Syndrome Y in an adult N male subject 12/1/1996 who was vaccinated with INFL eption reduced 5/04/09 Received vaccine & PCP Y medical records of1 4/13-4/27 as well as hospital Y d/c summary 4/13/2009 of 4/27-4/28/2009. 4/26/2009 FINAL Yellow fever immunization 3-18-09 prior to trip Y to a foreign country. 3 Developed flashing spells Y 3-29-09. Received 3/18/20093 L3/29/2009 IVF prior to departure. surfaces rash on elbows, knuckles, Y knees. SkinYbx: leukoclastic vasculitis 2 consistent with erythema Y elevatum 7/1/2008 diutinum. 7/26/2008 5/26/09 medical rec h screams for 3 days and for 10 days: Y lethargy (limp) Y - Non reactive - lack eye contact avoid communication Y 3/2/2009 - stopped3/2/2009 feeding - stopped lau Flu Vaccine on Oct. 10, 2008. 5 days Y later began fatigue which progressed to anaphylaxis, Y episode N 1 on October. ### Received ###corticoteroids. aricella #2 9/26/9 (1st dose was 5/03) within 24 hrs flat rash noted on chest, face & neck. Wo Y c/o rash to chest c/o itching on neck, face wit rm swelling red, tender, itchy after vaccines given 2 d ago- progressively worse 4/26/09 afterYpain but mostly 4/23/2009 itchy. 4/23/2009 L arm few small slightly oster type rash developing on R lower leg 6-7 days after vaccination examined today 4-27-09. N No other identifiable 4/13/2009 cause. 4/20/2009 th pain at the injection site 5 1/2 hrs after immunization, low grade fever 18 hrs after injection; Y 24 hrs after 4/24/2009 injection arm 4/24/2009 painful to touch, sw le of erythema on right side of (L) thigh. Y A bit of induration, but no underlying mass and no warmth." Y This4/21/2009 is MD's report. 4/22/2009 Also says "local rea of breath, tingling, sweating. Y 4/28/2009 4/28/2009 es, high fever. At night chills, sweating, sore joints. Symptoms continued until Friday. Sunday U slept late4/23/2009 still had sweating/chills. 4/23/2009 Right now 4/28/2009 nto office + reported vaccine site was red, raised + warm to touch. Presently abscent disappeared Y on its own. Zero intervention needed. s after getting vaccine, arm becameYred, swollen, and described itching at site of vaccine, pain Y to move. 4/24/2009 Applied ice4/24/2009 that evening. Mom stat
d to hospital 4/23/09 with reported edema - redness and tenderness of left deltoid. Treated with Y KEFLEX 4/20/2009 250 mg TidX7days. 4/23/20094/27/09 only s n at injection site beginning 4/13/09 in the evening. States she noticed inflammation, redness, Y and warmth 4/13/2009 at injection 4/13/2009 site on 4/15/09. Relie a of petechiea under right eye within 5 minutes of vaccine adm., approx 1/4" wide X 1/2" wide Y -was crying 4/22/2009 vigorously4/22/2009 prior and during vaccin shakes chills abdominal pain sore throat, headache started at 10 pm on 4/6/09. Y 4/6/2009 4/6/2009 orts rash to inner arms approx. 10 minutes after receiving vaccines on 04/09/09. Clients states Y she began4/9/2009 to experience 4/9/2009 pain in Rt shoulder ools, crying spells, abdominal pain crumps, Y decreased appetite, diarrhea. Per mom Y 2/24/2009 2/26/2009 loped rash behind ears, back of neck and on face then went to arms, torso and legs. Had running nose : raspy 4/6/2009 breathing. 4/19/2009 Saw on 4/23. ack into office. Per mother child had been crying since received vaccine. On examination swelling Y of the4/20/2009 upper R thigh 4/20/2009 warm to touch red a stered VARIVAX and DAPTACEL in (R) Thigh on 4/21/09. On 4/22/09 Pt developed quarter N size area of 4/21/2009 redness, swelling, 4/22/2009 with pruritus. Gi eneralized 2 days after immunizations Y Y 4/15/2009 4/17/2009 en instead of TDAP. Y 9/12/2008 of LA, tender, hot, itchy - 2nd patient with same reaction to same Immunization Y 4/21/2009 4/21/2009 er vaccine developed diarrhea, > 10 times per day initially, some mucus - straining noted, noYblood. No 2/25/2009 fever, no ill 2/28/2009 contacts. ness, itching & induration @ left thigh Y surrounding site of immunization within about 24 hrs. of U vaccines -4/20/2009 treated with 4/21/2009 BENADRYL 4/23/2009 er had bad stiffness on back of neck and then it went down both sides of torso. Called doctor U but said not 10/1/2008 related to vax. Pain on back sub t 8:45am patient was vaccinated at Y the Health Department with Hepatitis A vaccine at 8:47am Y patient fainted. 4/27/2009 Nurse4/27/2009 saw her unresponsive, 4/20/2009 rapid hair loss a month after administration of GARDASIL vaccine 8/1/2008 3/15/2009 eloped 2 days after shot - first on arm where shot was given then all over body. Headache today N - 4-28-09. 4/20/2009 4/22/2009 r HEP A with in 24 hr ATAVAX if needed. Y 4/8/2009 4/9/2009 ad at clinic c/o having reaction - redYrash noted on arms, legs, face - stomach and back approx U 2 min hard 4/28/2009 hot redness 4/28/2009 area noted at injecti dness, edema 3 d after vaccine. 4/21/2009 4/24/2009 Mom reports that client "walks strange, bobs head, hands shake, and coordination is off" afterNseries of hepatitis 7/1/2001 b vaccines 8/1/2001 in 2001-2002. swelling and pain at injection site. Tenderness and slight rash also noted. 4/14/2009 4/15/2009 vaccine on 4/13/09- symptoms began morning of 4/18/09, severe headache - 2 reddened areas N R shoulder; 4/13/2009 one just 4/18/2009 above acromion proce ction at injection site right thigh - warm, red & swollen Rx'd with MOTRIN & warm packs. resolving U 4/23/09 4/21/2009 4/22/2009 esented to clinic on 4/24/09 c/o right arm pain extending to neck and fever. Upon examination, U right arm 4/22/2009 edema from 4/24/2009 shoulder to elbow. Rig hoarse and hives - She lost her voice I was very scare so I took her to her doctor. Y 4/7/2009 unk and back that started about 4 days Y post smallpox VX. U 4/10/2009 4/16/2009 VAX administered right deltoid 4/21/09 after leaving office, pt started to develop pain in rightYupper arm. 4/21/2009 During rest4/21/2009 of day and night, pain i ped hives right after vaccinations and for 1 week has raspy voice - increased vomiting, crankiness Y and episodic 4/15/2009 hives. 4/15/2009 Was treated with 3 d hours, developed fever - 101.8 degree - Aching joints, headache. Treated with Ibuprofen. Duration Y - 12 hours. 4/17/2009 4/18/2009 er, with bulging fontanelle and CT scan Y with prominence of anterior CSF Spans over both frontal Y and temporal 4/6/2009 lobes 4/7/2009 - No hydrocephalic. Th d rash appox. 1 1/2 " X 1 1/2. Very itchy. Pt. observed for one hour post 25mg po Benadryl. Y 4/14/2009 4/15/2009 tous area surrounding injection site 5x5 cm diameter with mild tenderness to palpation no fluctuance. U Will try for possible infection. AUGME e pale after the vaccination, lost consciousness Y for 3 minutes - appeared to have a seizure vital Y signs stable. 4/18/2009 Paramedics 4/18/2009 came and pt. refu ceived BIOTHRAX in 2000. Over the last year his ankles, wrists and knees became inflamed. N He was diagnosed 6/3/2000with4/4/2008 autoimmune hepatiti n has been received from a health care Y professional Y concerning an 311 year old female patient Y who on an12/1/2008 unspecified 12/1/2008 date was vaccinated n has been received from a consumer concerning her now 5 year old son with OMNICEF allergy N and a history 10/1/2004 of bronchiolitis 10/1/2005 at 5 weeks of n has been received from a female Y patient, with iodine allergy and "severe food allergies", who Y on approximately 5/9/197709-MAY-1977, 5/9/1977 at the age n has been received from a consumer concerning her friends' boys who on an unspecified dates U were vaccinated with MMRII. "One week l t was received from a health care professional Yon 16 April 2009, and 1 refers to a serious adverse Y event experienced 11/3/2008 12/1/2008 by a subject participatin ort was received 28 January 2009 from Y a consumer, who is also the patient. A 59-year-old female N patient with 5/1/2007 history 7/1/2007 of a recent black wido ering entire body, swelling of joints, Y benadryl, oral steroids Y 3/9/2009 3/9/2009 min. post injection patient had mood change, redness, swelling at injection site along with legYpain. We watched 4/27/2009 patient 4/27/2009 for a while and then eived Tdap without any symptoms of concern. Then, immediately after HPV vaccine was given, Y the client4/29/2009 complained 4/29/2009 that her arm hurt. She o Tdap, muscle aches, headaches, fatigue. Worst was injection site allergic reaction to pertussus U vaccine. 4/24/2009 Arm was 4/25/2009 very red, swollen, ver a around the Shingles vaccine U 4/27/2009 4/29/2009 eports beginning to feel nauseous 6 hours after receiving vaccine. 18- 24 hours post vaccination Y member4/27/2009 reports nausea 4/27/2009 and 2 incidents of VER WITH NORMAL CBC,PARENT REPORTED 106 DEGREE FEVER THE NIGHT VACCINE Y WERE GIVEN 4/28/2009 4/28/2009
d MMR and Varicella vaccines and immedicately developed redness and swelling at both injection Y sites 4/17/2009 and hives on 4/17/2009 abdomen. No respira oid- 2 days sfter vaccine administration, the injection site is hard, red, warm to touch and tender upon palpation. 4/27/2009 4/28/2009 oster C34 dermatoma Greater than 20 vesicles U 4/1/2009 4/29/2009 igns begin with a pain in my right arm Y three-four Y days after my vaccine. 6 I was not able to raise N it above my head. ### The 11/2/2008 pain moved to my sh RASH THATS GETTING WORSE AND SPREADING U 2/15/2008 4/24/2009 njection in deltoid. developed over next 24 hours swelling, erythema, pain, and fever and general Y mailaise. 4/17/2009 this lasted 4/18/2009 for three days. m injection site a 15x15cm soft nodule appear while appling pressure to syringe with some resistence noted. 4/29/2009 Soft nodule 4/29/2009 with reddnes and n , facial swelling- in pts temples U 4/28/2009 4/29/2009 4/24/2009 N 4/21/2009 4/23/2009 le subject was enrolled in non-GSK study. Medical Y conditions at the0time of the event included U seizure disorder. 8/28/2003 Concomitant 8/29/2003medications i tient consult has been requested onYa 20 y/o WM Y ADSM hospitalized for severe thrombocytopenia U and ITP 4/16/2009 in association 4/23/2009 with the receipt o . Baby presented the day after receiving his immunizations Y with fever, 2 vomiting and diarrhea.Y Baby had been 4/21/2009 having4/22/2009 watery stools 2 to his patient came for a well child Y check, Y immunizations Y given at 9:30AM 3at around 1:30PM patient U woke up from 4/27/2009 sleep cried 4/27/2009 and turned limp, ca usea, HA, sore throat, rhinorrhea, + Ycough. Sx started hours after typhoid vaccine given. Given Y Augmentin 4/17/2009 875mg 4/17/2009 BID x 10d. ction on R upper arm (injection site) with erythema, warmth and mild tenderness. Keflex 500Ymg PO BID4/28/2009 x 7 days BENADRYL 4/29/2009 25 ml after 6 arm was sore for 3 days. Then in a week Y she started having spasms in her arm that continueNto happen at 10/8/2008 night still.10/9/2008 Has gotten a steroid s dministered on 4/23/09. Immediate Y bruising noted 1/2 dollar size. Bruising dissipated over weekend Y but Pt 4/23/2009 developed 4/23/2009 site of erythema, rais udent in nurses office or immunization clinic. Rec'd 5 vaccines - after several min of sitting looking Y @ stickers 4/29/2009 leaned4/29/2009 to (L) an fell out of cha U 4/27/2009 4/28/2009 3-4 lesions with cellulitic area on (L) Y thigh. Topical warm compress and PO Augmentin. Y 4/20/2009 4/28/2009 hematous rash under the skin on the anterior aspect of both lower legs, vaccine site normal. YRash was noticed 4/28/2009 right4/28/2009 after vaccination. Obse wollen and red about 10 cm X 6 cm Y within 1-2 hours after getting vaccine - given oral steroidsU and Antihistamine. 4/28/2009 4/28/2009 ADACEL on 4/16/09 and by 4/18/09 the right arm became entirely swollen and the injection Y site became4/16/2009 indurated, 4/18/2009 reddened, painful and s out in hives face to legs 1 1/2 hour after receiving MMR II vaccine. Parent went to daycare, did Y confirm hives 7/21/2008 with moderate 7/21/2008 wheezing. BEN iven 10:15 A and by 12:00 MN 102 Y deg and 4:00 increased 103.7 vomiting and fever. Seen Y by Dr later in4/20/2009 day 2 pm 4/20/2009 c/o pain (R) shoulder, r meter redness, and warm to touch area Y surrounding shot site. U 4/23/2009 4/24/2009 ed the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a big, red,Uand swollen4/3/2009 area on her4/3/2009 upper arm. She repo received the roto vaccine - by mouth - along with her other 2 month vaccinations - injections-. U She had blood in her4/22/2009 stool and extreme disc er DTAP, arm red & swollen & warmYdeltoid area. No fever. U 4/27/2009 4/28/2009 n has been received from Y a certifiedYmedical assistant concerning a 71 year old male Y who on Y 01-JUL-2008 7/1/2008 was vaccinated 7/7/2008 with PNEUMOV n regarding PREVNAR was received from a healthcare Y professional0regarding a 2-month-oldY female patient 4/27/2009 who experienced 4/27/2009 apneic episo was received from a health professional Y on 07 November 2008, and represents a cluster of Y 20 patients. Twenty ### patients, ### all employees of n has been received from a licensed Y visiting nurse, for the GARDASIL a Pregnancy RegistryYconcerning3/20/2009 a 23 year old 3/20/2009 female with hypothy n has been received from a nurse concerning Y a 36 month old male who on 07-MAR-2006 was N vaccinated4/4/2007 with a first 4/4/2007 dose of PEDVAXHIB n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y27 year old 7/22/2008 female with7/22/2008 cephalexin allergy and stered to patient. Less than 3 minutes Y later patient was leaving clinic and collapsed to floor. Y He did not have 4/29/2009 any trauma. 4/29/2009 He was cold and s udent mistook Menactra as the diluent for the varicella and injected it subcutaneously. No problems Y with4/29/2009 patient therefor 4/29/2009 no treatment need veloped maculopapular rash over entire Y body 14 days after vaccine administration. Patient seen Y 4/18 for 4/1/2009 this rash (by 4/14/2009 MD), and unclear if v ills, Bodyaches, Nausea, Vomitting,Yand local site reaction (redness, tenderness) U 4/27/2009 4/28/2009 9 PATIENT WAS ADMINISTERED THE SMALLPOX VACCINE AS A REQUIRED PROPHYLACTIC Y BEFORE 4/3/2009 DEPLOYMENT 4/20/2009 WITH HIS U ential swelling and redness to right upper Y arm/deltoid, especially near area of vaccine administration, Y +pruritis, 4/28/2009 w/in 4/28/2009 the first 24hrs of vaccine esented to the ER with R arm swelling Y with redness and puritus. Y 4/28/2009 4/28/2009 e severe pain in left arm, 'as though someone just broke it'; headache developed; 24 hours ofNjoint and muscle 2/23/2009 pain;2/23/2009 within weeks, sharp sta WAS GIVEN ALL THREE VACCINES HEP A#1 (RIGHT ARM), MCV4 AND HPV#1 (LEFT ARM) Y IN THAT 4/29/2009 ORDER,4/29/2009 WHEN I WAS APPLYI arm to the touch and red Y 4/27/2009 4/28/2009 aricella rash began 04/28/2009 treating with Y 4/7/2009 4/28/2009 lled me the day after the administration complaining of Headache, Fever, Chills, Loss of apetite. U I explained that she was experiencing a ra .3F and chills and Severe headache Y began at 2:30am. Pt came to health unit at 0830. Pt given Y Tylenol 650mg 4/28/2009 and 4/30/2009 slept. At 11:30 pt report ed today, stating she had just noticed a rash around the site of injection, also c/o itching fromUrash. NO fever 4/23/2009 or other 4/30/2009 symptoms. as seen by this physician three days after administration of Menactra. He was complaining ofU back pain,3/24/2009 shoulder pain, 3/24/2009 headache, lighthea ening, fussiness, constant crying, poor Y appetite, vomiting, skin rash (head, face, neck, ears, Ybehind ears,4/14/2009 abdomen,4/17/2009 back, legs, arms, feet),
4/27/2009 N 4/24/2009 4/27/2009 wn with Evans SyndromeY3/15/09. Seen Y for irritability Y 3/7/09. 5/4/09 19Received Y hospital medical U records of 3/4/2009 multiple admits. 3/15/2009 FINAL DX: throm d neck right arm pain immediately after Y head/neck trauma in Mar 2003; received AVA#4 Y oneNmonth later4/26/2003 with continued neck pain, intermitt veloped severe systemic rash, elevated Y temperature, continuous crying, inabilityYto sleep. ANmonth later patient### stopped smiling, ### and devel h stomach pains, rash on the top and Y bottom ofYboth feet. Stomach14pains were intermittent then Y became2/28/2008 constant. 13/10/2008 year later 2/09 diagno + swelling, heat @ site of injection erythema 130mm X 70 mm - slightly indurated. Y 4/29/2009 4/30/2009 ived above listed vaccines 11-20-08Y at routine WCC visit at 12 noon. Child developed tactileYtemp 11-21-08 around ### 1pm followed ### by pruritu mplained of headache, ringing in ears, + occasion blurred vision. Given a Medrol Dose pack.U 4/22/2009 4/22/2009 warmth to injection site - 4/28/09 @ 8 AM followed with itching, increased heat/swelling on same morning. 4/27/2009 By 9 PM4/28/2009 on 4/28/09, she had a l ports patient complaining of severe headache and (L) arm pain at school today (11 AM) -Become Y unruly 4/27/2009 and "violent" 4/28/2009 with staff at school. T d 12 month vaccinations on 4/18/09. Y She had zero reaction at first, but 1 week after shots pt. Y began having 4/8/2009 a fever.4/20/2009 This lasted 4 days off Hrs of vaccine, pt noted extreme tenderness, and swelling of upper arm. Sx worsened over next N 48 Hrs. 4/27/2009 4/27/2009 x 15 min & c/o HR. No sensitivity to light/sound, dizziness, lightheaded. Pt instructed to take U Tylenol & call 4/23/2009 if symptoms 4/23/2009 persist/worsen. d swollen with erythema over large area. (4" x 3") Y 4/28/2009 4/29/2009 er arm with redness, swelling & warm Y to touch qcm in size Dx with cellulitis. Y 4/21/2009 4/22/2009 wollen, hot, reddened (size of a softYball) hard lump - VARIVAX. Right arm same but the sizeNof an apple4/22/2009 - MENACTRA. 4/23/2009 face and back. Y 1/12/2009 4/25/2009 erythema & swelling extending 3 cmY inferior to lower shot & 1/2 cm above upper injection site Y - supportive 4/16/2009 care ZYRTEC 4/18/2009 1/2 tsp daily prn e slightly lightheaded immediately after receiving GARDASIL #3. She layed down but continued Y talking 4/17/2009 & said she 4/17/2009 felt fine. She walked ou eloped chicken pox disease - in clinic 4-24-09. U 10/2/2008 er injection: lip swelling, nausea, redYinjection site. 48 hrs after injection: larger area of redness Y with central 4/13/2009 bullous lesions. 4/15/2009 Treated for 1 1/2 es 2 days after vaccines patient's eyes Y rolled back in her head, she stiffened out and was "slobbering". Y Denies 4/1/2009 increased 4/3/2009 temperature. Calle miting + diarrhea 48 hours after vaccines Y given. Went on to develop URI sx's - v/d were <24Uhours. 4/22/2009 4/24/2009 use my arm/shoulder, extreme pain & tightness. Unable to work due to some of the requirements N of my3/18/2009 job. I had 3/18/2009 X-rays taken & have be s, odynophalgia, nausea, vomiting, decrease appetite, dizziness. Y 4/20/2009 4/20/2009 immunization site reaction 4cm X 6cm Y erythematous area on upper right arm. Warm, clearlyYdemarcated2/25/2009 area, tender 2/27/2009 to touch, no streakin pain, local reaction seen in office 2/25/09 T97.7 P75 R16 Erythema at injection site rest of exam U normal,2/18/2009 BP 124 / 76 2/18/2009 Wt 215 lbs, 4/7/09 sti was reported by a pharmacist and described the occurrence of injection site pain in a subject U of unspecified age and gender who was vacc was reported by a healthcare professional Y and described the occurrence of wrong route of administration N 1/7/2009 in a 19-year-old 1/7/2009 male subject wh was reported by a healthcare professional Y and described the occurrence of wrong route of administration N 1/7/2009 in a 19-year-old 1/7/2009 male subject wh was reported by a consumer and described Y the occurrence of watery eyes in a 58-year-old male N subject who was ### vaccinated ### with (FLULAV reported by a healthcare professional via a sales representative and described the occurrence U of injection site reaction in a subject of unsp was reported by a consumer and described Y the occurrence of itchy rash in a 75-year-old male N subject who 11/5/2008 was vaccinated 11/7/2008 with (FLULAVA : SM contacted VHC reporting receipt Y AVA #2 on 4/8/2009 (lot# unknown). The next day he U had numbness 4/8/2009 to right 4th/5th 4/9/2009 digits. 4/10/09 th ter was given all three doses Y of Gardasil Y on 8/28/08, Y then on 11/1/08, 3 and the last on 3/7/09.NOn April 11,3/7/2009 2009 my daughter 4/11/2009suffered with t BALL SIZE NODE IN ARMPIT OF SAME ARE ARM AS INJECTION SITE. MADE SLEEPINGUDIFFICULT4/20/2009 AND ARE4/30/2009 MOVEMENT PAINFUL 00.7F, body aches, HA, sore throat, fatigue, dizziness, sore arm Y 4/27/2009 4/28/2009 indegestion, lack of appetite, weightloss, Y dizziness, abdominal pain, fever, fainting, listlessness Y and nausea. 1/7/2009 This lasted 1/8/2009 from date of vacci erythema Left shoulder and axillaryYarea. Lymphadenopathy. Y 4/17/2009 4/27/2009 r chest, back, and arms. ITCHING,YNO DRAINAGE. Y 4/17/2009 4/27/2009 ports client with elevated temperature Y (average 101) following vaccinations,also reports moderate Y cough.4/24/2009 Temperature 4/24/2009 continued elevated ardened red area mid clavicular, leftYside, pea-sized. Vaccinatiion site, left deltoid, erythematous.Keflex Y 500 4/18/2009 mg 1 tab 4/18/2009 4Xday X10 dys mom stated symptoms of redness and Y swelling at injection site on left upper arm developed on Y 4/28/09 in4/27/2009 the evening. 4/28/2009 Arm felt hot to the to dministered on 04/28/2009. Within 24 hours swelling, fever at injection site, tenderness,and N increasing redness 4/28/2009 appeared. 4/28/2009 Within 48 hours stated sylmptoms of redness and swelling @ injection site of left deltoid on 4/29/09 in the morning. Y Arm4/27/2009 felt hot to the 4/29/2009 touch Dr. Knox at No hrs after DTaP pt had fever with seizure. Y He had had a febrile seizure the night before with diagnosis of4/29/2009 ear infection. 4/29/2009 nd Pain at injection site, increasing Y in size. Cramping in stomach with meals. Cellulitis LeftYArm. Keflex 4/18/2009 EQ 250mg 4/30/2009 4 times daily X10 day SEIZURE ON 28APRIL2009, MOTHER Y OF PATIENT CALLED 911 AND WAS TAKEN TO THE Y ER BY 4/20/2009 AMBULANCE 4/28/2009 Erythema Multiforme on back associated Y with puritis and uncomfortable. No respiratory distress. Y Epinphrine 4/16/2009 0.3mg4/30/2009 IM, Benadryl 50mg IM area at site of each injection. N 4/23/2009 4/24/2009 MATELY 3-5 MINUTES AFTER RECEIVING THE VACCINE THE PATIENT SUDDENLY PASSED Y OUT4/27/2009 - SHE HAD 4/27/2009 NO WARNING - SHE
after administration of MMR client noticed reddness the size of 50 cent coin. The following day Y (5/1/09) swelling 4/24/2009 had 4/30/2009 increased to 50mm in s Left legs had cellulitis, redness. DidYrequire IV Yantibiotics for 4 days.1 5/22/09 Received hospital Y medical4/27/2009 records of 4/28/2009 4/29-4/30/2009. FINAL N he day after receiving the vaccine) Y the patient returned to the provider's office with-3 spots ofU maculopapular 4/28/2009 rash on 4/29/2009 9, Pt came in for #2 GARDASIL. Pt had no adverse reaction to #1 dose. Pt had a vasovagalYepisode immediately 4/24/2009after 4/24/2009 vaccine given. Pt ha hours after admin of vaccines began Y vomiting Q 30 min- was taken to ED- called night clinic X2. 4/29/2009 4/29/2009 ea on right deltoid of erythema and induration, noted about 24-36 hours after vaccine. Ice applied. Y 4/29/2009 4/30/2009 ke a size of a baseball hot and red. Y 1/14/2009 1/15/2009 eaded with tunnel vision (compared to distorted vision experienced with ocular migraine headaches Y experienced). 5/1/2009Bp5/1/2009 156/90, pulse and res area red and swollen about half of back arm, hot to touch, hurts to touch and itching. Y 4/29/2009 4/29/2009 on (MD): Pt had dried like zoster rash Y to forehead X 3 days with mild fever only. Now has vesicular (urticaria) 4/16/2009 rash with 4/26/2009 sciatica without feve thy 4 mo. old admitted toY ER statusYepilepticusYand intubated upon 7 arrival. During hosp. hadYposs. aspiration 3/23/2009 pneumonia 4/13/2009 (+) culture Moroxe area right upper arm warm, pink sl. firm. Symptoms decrease today with papular at injectionYsite. No anaphylaxis 4/25/2009sx4/26/2009 - no encephalopathy s m Erythemic warm rash on Lt thigh. Mom putting salve on it. That is helping. Pt mom statesNgot whole body 4/24/2009 rash @ 2 months with vacc. open cut. used rubbing alcohol to clean at home. Has clear liquid at injection site after couple Y of days, then 12/2/2008 it scabbed 12/2/2008 over and got better. welling and redness of whole right upper arm for 3 weeks. Hives and welts everyday for several U months, stomach ### shut down for about 3 we Y Y 4/10/2009 Y U 4/29/2009 4/30/2009 ported severe injection site soreness. Y N 3/12/2009 3/12/2009 rm redness with swelling slight induration 10cm X 8cm. Y 4/22/2009 as given Pediarix vac. but was supposed to get a DTAP vac. 4/27/2009 d region w/ 7x7 cm round, well circumscribed Y erythema. Are defined by rash is tender & indurated. Y Dx cellulitis 3/6/2009 + abscess 3/6/2009 Keflex 500 mg o in a rash that evening. Rash is on the face, neck, both arms legs and abdomen. No temperature. Patient4/24/2009 stated her4/24/2009 Band Aid at home she neralized weakness + malaise. Y 4/20/2009 4/20/2009 vaccine was administered first. Then PENTACEL (IPV-DTAP-HIB) was administered IM in the U right thigh, 4/30/2009 then PCV75/1/2009 administered IM left ocalized redness + swelling, hot to touch, no pain or tenderness. Complaints of itchiness. No Y fever, patient 4/14/2009 took Benadryl 4/18/2009 for allergic reacti action - hives - severe wheezing, breathing, Y throat. U 4/28/2009 4/28/2009 as given HEP & DTAP vaccine in the (L) arm on 4/28/09, 1 day later was noted to have swelling, Y redness4/28/2009 itching on the (L) deltoid area, les ven MMR vaccine instead of MENACTRA. Y 4/27/2009 EP B & MMR given in (L) upper arm. Arm swollen with hive - like rash from elbow to deltoid on U 2/3 of arm4/27/2009 circumference. 4/28/2009 Cold compresses was given MMR & VAR pt started crying. Y When pt was given HEP A. pt started crying and gasping Y for air. 3/23/2009 Pt also sweating. 3/23/2009 multiforme - minor. U 4/17/2009 4/25/2009 r VARICELLA was given on 4-16-09 Pt developed a red swollen area located where vaccineYwas given. 4/16/2009 4/25/2009 s swollen, puffy and red with peelingYof skin and crusting. Y 4/27/2009 4/28/2009 lesion trunk with scabbing and diagnosis of herpes zoster. Y 8/30/2007 4/18/2009 ped a local rxn one day after vaccine DTAP was administered. Also papular lesion developedY on chest area. 4/29/2009 4/30/2009 hours, pain, swelling at injection site. Low grade temperature 99 degree to 100 degree. Myalgias, U malaise. 8/27/2008 At 48 hours 8/29/2008 with squamous eryth called stating child complains of seeing snakes. Anxiety and hallucinations. U 4/30/2009 5/1/2009 rs, ipsilateral axillary pain, fullness. Low grade (unmeasured) fever. Local tenderness, swelling Y at the injection 4/20/2009 site. 4/22/2009 was reported by a consumer, the subject's Y mother, and described the occurrence of swellingNin a 5-year-old 3/31/2009 male subject 3/31/2009 who was vaccina was reported by a healthcare professional Y and described the occurrence of injection site redness N in a 5-year-old 4/9/2009female 4/9/2009 subject who was v was reported by a healthcare professional Y and described the occurrence of erythema i a 4-year-old N female 4/10/2009 subject 4/12/2009 who was vaccinated wit was reported by a healthcare professional Y and described the occurrence of injection site redness U in a 4-year-old 4/13/2009male 4/15/2009 subject who was vac was reported by a physician via a GSK representative and described the occurrence of red N spot at injection 4/16/2009 site in a4/16/2009 4-year-old female sub was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci vaccination 10/30/07; returned to doctor Y with pain Y in left shoulder (same 3 as vaccinated Y arm) Nwithin two months;### began 1/2/2008 experiencing pain, n he, lethartic onset 48 hours after vaccination with guardisil Y 4/24/2009 4/26/2009 er, very tired and rash (skin raised, hot, not itchy, red) on upper left leg appeared. Shot put U in back of left 4/21/2009 arm. 4/27/2009 e rash all over legs and arms appeared 2 days following injection. Rash lasted 8 days and continued Y to leave 4/17/2009 darkened 4/19/2009 spots for over 2 ad
numb for approximately 30 minutes after receiving Anthrax vaccine, event has happened forYthe past 2 doses 4/30/2009 4/30/2009 mptoms, shaking, "bobblehead" mannerisms, Y "dizzy appearing" per parents starting 3 days after U vaccinations. 4/22/2009 Self-resolved 4/25/2009 by 6 days, but LITTLE OVER 24 HOURS. FIRST SIGNS, SEVERE SORE THROAT, NECK PAIN, ARM PAIN, U STOMACH 4/20/2009 PAIN,4/22/2009 A PINK EYE TYPE INF ide of cheeks. Y Y 4/28/2009 4/28/2009 rned to office - stated "my son passed out" - Found seat belted into passenger seat - eye opened Y responded 5/2/2009 by name. 5/2/2009 Asked what happen a tetanus shot for an infection, and received the tdap. I experienced a sort coughing spell within Y 10 hours, 4/30/2009 mild cold 4/30/2009 symptoms the next mor njection 5/1/09 yellow fever vaccine.Y Noted arthralgias, myalgias, swollen hands and fingersUand bilateral5/1/2009 lower leg red 5/2/2009 rash. Specific manu ustular rash extending from L shoulder Y near vaccination site, across back and upper chest, few U lesions on4/22/2009 thighs 5/28/09 5/2/2009 ED records receiv Vision,Blood restal,soryasis Y 6/8/09 Received medical records from 7/20/2006-6/4/2009. Records N reveal patient 4/23/2003 experienced: 6/20/2006exacerbation o n has been received from a TV news Y report and the patient's father concerning his 16 year old Y daughter who 3/1/2008 in March 3/1/2008 2008, was vaccinate n has been received from a consumer concerning her son, an 11 year old male who was born N prematurely and was diagnosed with cerebra n has been received from an 83 year Y old male with no pertinent medical history or no allergyYwho on 31-MAR-2009 3/31/2009 was 4/3/2009 vaccinated with ZO n has been received from a registered Y nurse concerning a 25 year old female with no medical N history or 3/13/2009 drug allergy3/24/2009 who on 13-MAR-2009 n has been received from a registered nurse, for the GARDASIL, concerning a 17 year old female Y patient 3/19/2009 with a history 3/19/2009 of pelvic inflammat us case was received on 21 April 2009 from a health Y care professional. 3 A 29 year old femaleYpatient received 1/26/2009 YF VAX 1/27/2009 (lot number UF428A ort received on 24 April 2009 from aYhealth care professional. A 35-year-old female patient, who U had a concurrent 4/20/2009urinary 4/20/2009 tract infection, had us case was received on 27 April 2009 Y from a health care professional. A female patient (age N not specified) 4/24/2009 with a history 4/24/2009 of high blood pre ated at approx. 0830 4/22/09. Mother Y reports that Y pt. had increased temp 2 starting at 1200 4/22/09. N Mother 4/22/2009 reports to4/22/2009 clinic 4/22/09 with child ven SQ left arm of VARICELLA vaccine #2. Soon after applying band aid pt complained of itching. Y I talked 4/10/2009 to M.D. and 4/10/2009 he ordered 50mg IM ter shot, fever, headaches, chills, body aches, nausea symptoms resolved completely- 4 pmY4/28/09 4/27/2009 4/27/2009 heet - mom reports infant spit up milk Y and some "white" stuff and declared it had to be due toYthe liquid medicine 2/20/2009 we2/21/2009 gave. Had 2 mos shots as given initial dose of ROTARIX @ 28 weeks. Then follow up dose 4 weeks later was given. Y However ROTATEQ 3/24/2009 was given at that point. nal chest tightness without wheezing - within 5 min of HAVRIX (Hepatitis A) & POLIO (IePV)Yvaccine Resolved 4/23/2009 in 204/23/2009 min after liquid BENAD darkened raised area on Pt's left upper arm over deltoid muscle that measures 8 MM X 5 MM. N Pt. C/o dull 5/13/2008 pain when 5/13/2008 spot is touched. Also ived 2 vaccines, MENACTRA and GARDASIL # #3, in opposite deltoids. Within 5 seconds after Y receiving 4/17/2009 the 2nd shot 4/17/2009 child had a seizure er vaccine was administered site was red and "bumpy". Y 4/23/2009 4/23/2009 llowing vaccine, swelling distal to vaccination site - specifically dorsum of hand & wrist (left arm Y only); pain 4/21/2009 and reddish 4/23/2009 (blanching) discolor ost vaccine rash "mini measles" all over Y trunk. Not ill. Y 4/13/2009 4/24/2009 3, start at 9pm & vomited x2. Y 4/27/2009 4/28/2009 d screaming/crying. Y 2/24/2009 2/24/2009 hours of shot fever,paleness, weakness, dizziness,tight chest, hard to breath.Patient remains N sick still after 4/28/2009 6 days with 4/29/2009 contiued fever, dizz nd swelling, painful at site of injection, approx 4 inches in diameter Y 4/28/2009 4/30/2009 pain and swelling at injection site Y 4/20/2009 4/23/2009 ports extreme pain at site of injection Y which began immediately and continues x 11 days. NoUfever, no local 4/23/2009 redness, 4/23/2009 swelling or induration er receiving the for about 4 weeks after the shot I experienced deep aching of my muscle and Y arm and couldnt 2/13/2009 move 2/15/2009 my arm without pain. nd pain at site of injection and medial arm. Redness approx 5-6 inches medial to injection site. Y 4/14/2009 4/20/2009 ceived Zostavax Vaccine on 4-29-09Y and had been warned about the localized red itchy weltUthat could occur 4/29/2009 at the injection 5/2/2009sight and it did the MMR vaccine on 4-20-09. I amYexclusivelyYbreastfeeding a 14 3 week old infant. On 4-29-09 Y she developed 4/20/2009 a fever 4/29/2009 of unknown origin. red yellow fever vaccination to rt deltoid. Y 20 minutes after vaccination, pt. left clinic and reportedly U walked 5/1/2009 to another 5/1/2009 building to complete th 2 HOURS: SEVERE DROWSINESS; Y 24 HOURS: Y VERTIGO, DIZZINESS; 2 36 HOURS: NUMBNESS N &4/30/2009 TINGLING LEFT 5/1/2009 ARM, SHORTNE ted thigh swelling at injection site two days after immunization. Patient was seen in office and Y examined: 4/22/2009 left thigh with 4/24/2009 10x6 cm indurated, ablity and rash about 9 days after the well visit on 04/14/09. Patient seen in office on 04/24/09 Y for rash-4/14/2009 five petechial 4/23/2009 on neck and chest. minutes post injection patient developed redness, swelling, 30 mm in size4 with warmth andYhardness at 5/4/2009 the injection5/4/2009 site. Dr. notified, and on was received on 4/28/2009 in LeftY Arm. Client was brought back in the HD on 05/01 with Y very red swollen 4/28/2009 LA, with 4/29/2009 a temperature of 100 , projectile vomiting, lethargic, dehydration, stopped Y breathing while4sleeping - we were ableYto resuscitate 5/27/2003 him, lips turned 6/1/2003 blue, eaction to right deltoid after Tdap administered Y "started two days after the shot was given." (Hep U B immunization 4/21/2009 was 4/23/2009 administered to patien 00-102 within 24 hours. Muscle spasms Y x5 days now. 4 inch area of swelling around injection U site. Pustule 5/1/2009 at injection 5/1/2009 site. Soreness limi scribed onset of large 'orange sized' hot lump in the area of administration, onset was approx Y 72 hours after 4/29/2009 admin. 5/2/2009 patient stated lump wa d regular vaccines at two months and began spitting up blood for the following 24 hours. AtY4 months we 4/30/2009 administered 4/30/2009 only one vacc/week awoke with severe pain and weakness in Right deltoid. Significant Pain and weakness continued N for 2-3 days.### Then the pain ### decresed to m cellulitis developed at immunizationYsite 2 days after immunization given. Pt initially treated with U Keflex and 5/1/2009 Bactrim but 5/3/2009 cellulitis worsened
9 patient started to develop red rash in which progressively increased in numbers and intensity. Y Rash was 4/16/2009 coalescent. 4/26/2009 Patient seen on 04 king across the leg from the site of Y injection, as well as a swollen, firm leg. She was given injections U today 5/4/2009 with Pentacel, 5/4/2009 HepB, and Prevn after injection - mom noted swelling tenderness and erythema - 36 hours after he has swelling 1.5 inches lareger 5/1/2009 on that 5/2/2009 arm with tendernes N 4/29/2009 sle like red, raised bumps all over body. Y Y 4/8/2009 4/20/2009 RSE EVENTS, SYMPTOMS, OR TREATMENT Y 4/2/2009 TIS LEFT LEG DIAGNOSED IN ER Y MAY 3, 2009. CELLULITIS BEING TREATED WITH SEPTRA ORAL 5/1/2009 ANTIBIOTIC. 5/1/2009 er administration of rotateq child developed fever to 102, and a few episodes of loose stool and Y vomiting-4/27/2009 report being 4/29/2009 filed at mom's reque honed clinic and left a message on 5-04-09. Y Her call was returned and the following information Y was received. 5/2/2009 29 hours 5/3/2009 after immunizations n R hand started 12-24 hours after injections. Y Dizziness - resolved.5/18/09 records received-office N visit 12/28/08 5/1/2009 C/O 5/2/2009 swollen glands, lethar out with 9 blisters on 5-3-09 Mom states looks like chickenpox. Blisters on back and neck. 4/27/2009 5/3/2009 ven 2nd dose of Hep B series at 2:00pm Y 4-13-09 - At 5:00pm noticed a rash around belt line Y - progressed4/13/2009 to entire body 4/13/2009 - He had also recei cellulitis at administration site - Started on OMNICEF. U 4/29/2009 4/30/2009 syncopal episode after taking 2 steps when she got off the exam table - 11 feet and hit headYagainst door frame. BP was low and remained ped shingles 7 days after ZOSTAVAX injection. N 3/25/2009 4/2/2009 ed from stating pt seems to be in severe Y pain; severe hard crying off and on since vaccines received today. 5/4/2009 Pt states5/4/2009 left thigh is slightly sw nted to GARDASIL clinic 7-22-08 to begin series. Completed series 4-17-09 after reporting LMP U 3-26-09.4/17/2009 Presented to health department fo & Lg redness at injection site Y 4/28/2009 4/30/2009 wollen from upper thigh to knee. 3 cm larger than (R) thigh. Area a little reddened. Afebrile. U 4/28/2009 4/29/2009 asting 15 seconds - returned to normal LOC. Y 5/4/2009 5/4/2009 R upper chest welt 3 cm raised macule + dermatographism benadryl given PO - will give benadryl Y + MMR -> #2. ed left upper arm approx size quarter. Pt able to use arm. Y 4/28/2009 4/30/2009 B #3 vaccine given on 4-29-09. Pt. c/o swelling and redness of (L) arm where injection givenYon 4-30-09.4/29/2009 Pt. stated on 4/30/2009 5-1-09 that redness w ld given Hep A vaccine instead of Hep B. No immediate adverse reaction. No treatment given. U 5/4/2009 r vaccine site (deltoid) was reddened, Y warm + itchy on 4/25-4/26 worsened @ 48 hrs after inj. U Patient went 4/24/2009 to ED to4/25/2009 have checked. Now re 0 min after vaccinations (HEP A #1,YVARIVAX #2) child started vomiting and became increasingly Y lethargic, 4/29/2009 No total4/29/2009 LOC. Non discrete urti rts eyes red, puffy & warm red area right upper arm Y 4/21/2009 4/22/2009 ed 6 mon vaccinations at 2 hrs after Yhe ran a Temp of 100.4 and large warm red lumps formed Y at inj sites. 4/27/2009 Tylenol and 4/28/2009 bath given with some rash trunk after 8 hrs. Temps are as high as 101. Maculopapular rash chest abdomen, legsYface. Rash became 4/6/2009cellulitis 4/11/2009 in 240 with contin 4/26 - Rt arm swollen, hot, red. Y 4/25/2009 4/26/2009 es reddened area around injection site Y that goes down arm to elbow. Also reports pain under Y arm sore.4/27/2009 Knot increased 4/28/2009 from under quarte patient returned to clinic 2 days after vaccination to have right arm evaluated. Raised reddened Y area 9 cm 4/27/2009 X 6 cm right 4/28/2009 upper posterolatera 4-17-09, 7 PM. On 4-18-09 upon awakening had eyes swollen shut, face incl tongue puffy and U red, eyes4/17/2009 were also red. 4/17/2009 Facial swelling/redn ash with pain and swelling; fever atYinjection site; cough, red throat; post-nasal drip; bruisingU- treated with 4/17/2009 ZITHROMAX 4/17/2009 antibiotic; cough s ort was received 05 June 2008 from a health care professional. A 54-year-old male patient had U received an 6/3/2008 intramuscular 6/4/2008 right deltoid inject of four cases of injection site swelling, heat and tenderness in addition to large nodule at injection Y site out6/30/2008 of an unknown number of patients ort received from a consumer on 08 August 2008. A 63-year-old female patient received a leftNdeltoid intramuscular 3/20/2008 injection of DECAVAC ( ort received form a health professional on 04 November 2008. A cluster of three cases of flu-like U symptoms 10/1/2008 and injection site tenderness ou old male patient with a history of back pain and previous eye injury received an intramuscular U left deltoid injection ### of11/1/2008 DECAVAC (lot numbe -old female patient, who has medical Y condition of hyperlipidemia for which she takes ZOCOR, Y had received 1/13/2009 a left deltoid 1/15/2009 booster dose of D -old male patient, who had medical Y condition of glaucoma and erectile dysfunction , had received Y a left deltoid ### booster dose ### of DECAVAC ( ort received 27 February 2009 from a health care professional. A 31-year-old female patient had received2/23/2009 an intramuscular right deltoid inje ort received from a health care professional on 23 April 2008. A 21 year old, male patient (with Y no medical 4/16/2008 history) reported 4/17/2008 having symptom ort was received 15 May 2008 from a Y health care provider. A 26-year-old patient had received Y an intramuscular 5/14/2008 left deltoid 5/14/2008 infection of DECA ort was received 20 May 2008 from a consumer, who is also the patient. Additional information Y was also 21 4/1/2008 May 20084/2/2008 from the patient's phy 1 mo after receiving vaccine that beginning night of vaccination nausea and vomiting persisting Y X 2 weeks, 3/20/2009 SOB 243/20/2009 hrs after vaccine, insom d Immunization on 4/22/09. Onset of symptoms on 4/23/09. Nausea, headache, Stiff neck,Narm weakness, 4/22/2009 flushing, 4/23/2009 dizziness, lethargic, fe lt dose of HEP A instead of Pediatric dose Y 4/24/2009 lt dose of Hep A instead of pediatric dose. Y zed inflammation to left upper extremity - no streaking noted. No fever - began morning afterUvaricella SC 4/29/2009 injection. 4/30/2009 s. High pitched crying x1 hour - inconsolable; slowly resolved over next hour - onset = 5 hours Y after injection 4/29/2009 - on follow 4/29/2009 up exam - family rec
accine 4/16/09 - Mother called with complaint of half dollar size of local swelling where shot given. Y Told 4/16/2009 to ice ibuprofen 4/17/2009 or TYLENOL ection site swollen and painful - o/v 24 hrs later. (2) glomerulonephritis (post strep) Dx'd 4/21/09. Y 4/6/2009 4/7/2009 m and itchy area over TRIPEDIA injection Y site. U 4/26/2009 4/29/2009 ameter area of erythema on LT deltoid around immunization site. Instructed to apply cool compresses U and 4/27/2009 call if area 4/28/2009 increases. nted, difficult to arouse (12 sec) utilized Y ammonia to arouse. Patient stopped breathing during Y fainting spell. 4/29/2009 Patient 4/29/2009 cold, pale and clammy ived Kinrix injection in R thigh on 4/27/2009. On 4/28/09 - child seen by doctor diagnosed with U (hives) reaction 4/27/2009 to Kinrix. 4/28/2009 Given Benadryl. 4/30/2009 today 4/29/09 at 12:10 PM to reportYbreaking out with rash around injection site on 4/26/09. Y States has other 4/23/2009 areas 4/26/2009 involved now (legs, face d vaccine on 4/24/09. She called on 4/27/09 to report that later 4/24/09 in the pm she brokeYout with a rash 4/24/2009 that looked 4/24/2009 liked chickenpox an n has been received from a consumer Y concerning her approximately 24 month old Y son with N no medical history 1/1/2006 or drug 1/1/2006 allergies who in Janu n has been received from a physician Y concerning Y a 15 year old female 0 Y who on 13-AUG-1998 U was vaccinated 8/13/1998 with the 4/22/2009 first and only dose o n has been received from a physician concerning a 22 year old female who on 23-APR-2009Nwas vaccinated 4/23/2009 with the 4/23/2009 second dose of GAR n has been received from a registered Y nurse concerning a 19 year old female with no medical Y history and2/5/2009 no known drug 2/5/2009 allergies who on rmation and follow up has been received Y from a nurse and consumer for the Pregnancy Registry Y for GARDASIL 8/22/2007 concerning 3/24/2008 a 17 year old fe site still itches. Recently blistered &Ykeloid. Pt c/o severe itching @ vaccination site. 5/26/09 Received clinic 9/9/2008 medical 10/1/2008 records of 9/3/2008-4 m area of redness 1" diameter No fever. Y 4/27/2009 njection site Benadryl 25 mg PO + triamcinolone cream to site. 1/13/2009 1/13/2009 en lump at injection site (R arm). Benadryl given by mother (day after injection) Y 4/2/2009 4/3/2009 over all of body, tongue + lips. Referred to Dr at Health office. U 4/29/2009 4/29/2009 esions eruption 4/27/09 AM U ### 4/27/2009 ceived both TWINRIX & TYPHOID before Y collapsing on the chair. Immidiately patient startedY to cease. 3/24/2009 Patient was3/24/2009 moved to the floor and came lightheaded, pale, and unresponsive for approx. 1 minute. BP 90/48. Placed on couchYw/ feet elevated. 5/5/2009 Given 5/5/2009 apple juice after alert & oncerned that vaccine (s) have caused Y chronic pain. Has had ulcers and cholecystectomy (abnormal N gallbladder 7/30/2008 scan), 8/26/2008 but persists with ab d Varicella vaccine on 4/30/09. On Y 5/1/09 pt's parent reporting approximately 1" swollen area U around injection 4/30/2009 site. Was 5/1/2009 seen in clinic on 5/ dness + swelling at injection site afebrile; Y no pain; warmth to touch Y 4/29/2009 4/30/2009 swelling @ upper arm - 8" length 5th" width Benadryl/Tylenol. 4/27/2009 4/28/2009 & fussiness 9 days after MMR vaccine given (along with PENTACEL). Patient's fever resolved Y by 48 hours 4/20/2009 and there 4/29/2009 were no other assoc ction swollen redness injection site left T size right to left 25 X 25 mm up and down sore andUhard. 4/21/2009 Rash on Rt leg above knee- both feet - rash is spotty and puffy, worse in AM - better in PM. Took Y Benadryl4/6/2009 4/09 rash 4/6/2009 still present -not as re experiencing rash/hive type symptoms on his arms + legs. This started on 4/25/09 and wasUstill present4/24/2009 on 5/1/09. 4/25/2009 Pt was advised to take ction right arm Y 4/27/2009 4/29/2007 .8 at 5:00 pm day following vaccine. Continued with fever 5/1/09 - sibling sick with otitis started Y on ZITHROMAX. 4/27/2009 4/28/2009 ction left arm Y 4/27/2009 4/28/2009 ur after vaccine administration c/o flushing of face with temp elevation to 99.6 F. Also reported U vomiting. Vomiting 5/4/2009 and 5/4/2009 facial flushing contin ured 9 days after administration of HPV, Y HepA and Varicella vaccines Y 4/22/2009 5/1/2009 on, some lost of vision 1/13/2004 S ADMINISTERED 4-13-09 ON 4-21-09 Y PATIENT DEVELOPED A FEVER AND HAD A SEIZURE Y LASTING 4/13/2009 2 MINUTES. 4/21/2009 TRANSPORTED with heat and edema surrounding injection Y site with erythema ring approx 3-4 cm surrounding Y pale area 4/24/2009 appearing 44/28/2009 days after vaccination ted for pre-travel vaccinations prior to Y travel. Vital signs at presentation were as follows; B/PY120/62, T 97.7, 5/4/2009 R 12 and 5/4/2009 HR 60. Cursory phy from pt. wife stating husband c/o sore throat and one side of his tongue is sore, being tired and Y that injection 4/17/2009 site is 4/18/2009 swollen and warm and i er vax on 2/4/09. Rcvd call from pt.Yon 4/24/09 10:16a. She reports the following: on 3/28, she U experienced 2/4/2009 pain in3/28/2009 scalp and jaw and blur CALLED AND STATED HE HAD SHOTS Y YESTERDAY, WHEN SHE GOT HOME WITH THE Y CHILD HIS5/4/2009 LEGS WERE 5/4/2009 VERY SWOLLEN, owing, swelling, itchiness and pain at site of injection increasing to giant hives on neck, trunkUand arm. Considerable 4/10/2009 4/11/2009 pain, throbbing and itc arre' Syndrom 6/8/09 Hospital Y records Y and DCYsummary received 14 DOS Y 4/03/09 to 4/17/09. Final Y Diagnosis: 3/13/2009 Guillain-Barre 3/28/2009 syndrome. Post ates that he developed diffculty breathing and chest Y pain on 3/18/09 10and went to the Emergency Y room where 3/6/2009 he was3/18/2009 admitted for a pulmon VAX .5 CC GIVEN R DELTOID IM APPROX 10 A.M.. PT STATES THAT EVENING ARM TENDER, Y SOME 4/30/2009 SWELLING, 4/30/2009 WARMNESS AT ived the MMR vaccine and varicellaYvaccine at one time. Developed measles from the vaccine. Y No treatment 4/17/2009 prescribed. 4/26/2009 Began with rash swelling of the site w/ redness and pain Y same day as vaccine. pain, swelling slowly resolved Y over few days. 4/29/2009 No respiratory 4/29/2009 complaints or dy came lightheaded and lost color in her skin. Patient also complained of ringing in the right ear. Y Symptoms5/5/2009 occured approximately 5/5/2009 1 minute ling, itching on back of arm and neck. Also has been vomiting. Y 5/4/2009 5/4/2009 ated area of injection had egg-size swelling the evening after injection. Over the next 2 days,Yswelling appeared 4/29/2009 to spread 4/29/2009 down to elbow ar
ately 4-5 hours after receiving the vaccine, I broke out in hives large about 5 in in diameter and Y raised. These 4/30/2009 were on 4/30/2009 my stomach. I had re was reported by a physician and described the occurrence of rectal bleeding in an infant male U subject of unspecified age who was vaccina was reported by a physician and described the occurrence of rectal bleeding in a 4-month-old Y male subject 4/13/2009 who was 4/13/2009 vaccinated with ROTA fever, 2 days of rash. Had CSF, blood & urine cultures Y & stool culture 3 obtained & viral panel.YGiven CEFTRIOXONE 4/28/2009 4/28/2009 X3 days. 5/18/09 ED mergency Rooms. 6 days Y Hospital Stay. Y 6 daysYIn House Rehab. 5/13/09 12 hospital records received N DOS11/5/2008 12/4/08-12/9/08.### FINAL DIAGNO redness & swelling @ sites of injection, Y diagnosed in ER on 4/30/09 with right thigh cellulitis,Y treated with 4/28/2009 KEFLEX 4/29/2009 & BACTRIM TYLENOL at home. Pt. received MENACTRA Y on R deltoid on 5/1/09. About 30 hours later on Y 5/2/09; mother 5/1/2009 noticed5/2/2009 redness, induration pa 24 after shot, erythema tender (swollen started 3 days after shot , all erythema approximately U 4cm disterl4/29/2009 to shot site. U 4/24/2009 5/1/2009 nd out pregnant 2 wks after receiving vaccinations. Due date of 9/01/09. Client gave permission on 5/1/09 to report ### to VARIVAX registry fo d been diagnosed with shingles on 04/29/2009 U 5/7/2008 4/29/2009 x 5 cm swelling and redness to RPUA. Y 4/22/2009 d swelling, redness, and itching at injection site week after injection. Pt stated sxs was resolving Y without 4/29/2009 tx. 4/30/2009 tion administered - child sitting in chair with mom at side. Approx. 10 min. passed and then finger Y stick hgb. 5/5/2009 done. Child 5/5/2009 uncomfortable with d combination vaccine of DTAP, HEPB, Y & POLIO on 4/24/09. Pt. had no fever or s/s of anyNillness @ time 4/24/2009 of vaccination. 4/27/2009 Pt. returned to c dness, swelling at injection site 9-10 days after vaccine. At time of visit, no fever, swelling subsided Y 4/23/2009 5/2/2009 child called Health Dept 5/1/09 withYcomplaints of redness and swelling in child's arm - childYhad Tdap inject. 4/30/2009 L delt. 4/30/09. 5/1/2009Mother was re child was in the ER last night. AfterYleaving our office @ 2:06 pm. Patient was fussy, throwing Y up, and swollen 4/15/2009 on 4/15/2009 the admin. site. h present on knees, elbows & buttocks. Bx of elbow Y lesion -> herpetiformis 2 dermatitis. Treatment U with DAPSONE 2/15/200825mg 9/29/2008 twice daily - revise e 2008, noticed large ecchymoses on Y left flank. On June 10, a CBC showed platelets to be 36, U 000 (normal 3/11/2008 140, 0006/10/2008 -250,000). Saw hema red 4:05pm. Reacted at 4:20pm with Y anaphylaxis - Left eye swelling, shallow breathing, no airway Y edema,5/5/2009 +tongue swelling. 5/5/2009Given Epineph , Tiredness and poor appetite, Non-Stop Y cry for more than 3 hours, complains of pain in the N nose, Difficulty 5/4/2009 breathing, 5/4/2009 wheezing, paleness, n has been received from a consumer concerning her husband who in approximately 1970, U was vaccinated with MMR II. The consumer rep n has been received from a female consumer who stated that her uncle received on an unspecified U date an unspecified MUMPSVAX (man n has been received from a physician Y assistant concerning a 61 year old female Y patient withNcodeine allergy, 4/20/2009 post menopausal, 4/21/2009 lipid and an n has been received from a nurse concerning a her great-niece 13 year old female with no known N allergies 4/28/2009 or medical 4/28/2009 history reported, who n has been received from a physician Y who reported that a patient's mother told him Y that her U 24 year old daughter, on an unspecified date w rned red, very sore, itchy.erythema Ymedial aspect left uppr arm, none at outer deltoid at sited Y of pneumovax 4/29/2009 injextion.Area 4/29/2009 tender, erythem A vaccine--became dizzy and was lowered to the ground. BP 80/50, color pale. Color returned Y quickly, BP 4/28/2009 110/70 twenty 4/28/2009 minutes later hot child had some congestion, but normal Y temperature. Shot received at 9AM. Fever first noticed Y at 2PM 4/15/2009 (approx. 4/15/2009 101-102 degrees). Tre PRESENTED WITH TEMP OF 104.1, Y STIFF NECK, Y & ELEVATED 2WBC COUNT ONE WEEK U AFTER ADMINISTRATION 4/30/2009 5/2/2009 OF IMMUNIZAT C/O BEING COLD, DIZZY, THEN MOUTH, Y ARMS, AND HANDS STARTING TWITCHING, ALONG Y WITH 5/6/2009 BIG TOE. AMBULANCE 5/6/2009 CALLED female had foot stuck with pin. Had cellulitis and susuptiple to Tetnus. Physician did not have any Td on4/23/2009 hand so administered Tdap off-lab ported to student health services 2 days Y after receiving his Varicella Vaccine (04/08/2009). He Y present with 4/6/2009 right upper 4/7/2009 arm mild swelling an ately 2 minutes after receiving 3rd HPV immunization, client fainted. Client was unconsciousYapproximately 5/6/2009 10 seconds, 5/6/2009 for 3-5 of those se shot in a.m. on Monday 4/29, symptoms started in the late afternoon: fatigue, pain in arm, sudden Y nausea, 4/27/2009 dizziness,4/27/2009 fever of 102 degrees, RTS DIFFICULTY BREATHING 2 HRS AFTER INJECTION. SHINGLES RASH ON HIPS WITHIN N 12 HRS 5/4/2009 OF INJECTION 5/5/2009AND CONTINU after vaccine pt. reports a "different rash at a different spot every morning and at night whenUI go to bed". 4/28/2009 "I have a4/30/2009 red ring and a big knot s after gardasil #1, patient reports left index and middle finger is mildly swollen and difficult toUbend. Vaccine 5/5/2009 was given 5/6/2009 in the same left arm H AROUND INJECTION SITE Y 5/4/2009 5/6/2009 NJECTION-LEFT ARM IS SWOLLEN, WARM TO TOUCH,ITCHES AND HURTS Y 5/4/2009 5/5/2009 ed vaccines listed below at 4:30pm. After receiving vaccines, pt. was walking in the waiting room Y and sat down 5/6/2009 in one5/6/2009 of the waiting room c ours of vaccine child had high fever, red bumps on her face, very lethargic when not screaming, U excessively 5/6/2009 tired. 5/6/2009 eceived TdaP and menactra and felt dizzy and like she was going to faint yesterday. Still feels Y "terrible"4/13/2009 today. Some 4/13/2009 headache but she a us case was received on 23 April 2009 Y from a consumer (patient's mother). A 13 year old female U patient4/20/2009 with a history 4/20/2009 of asthma and gastri ort received on 28 April 2009 from aYconsumer. A female patient (demographics not reported)Nhad received 7/3/2008 on 16 June 2008 a dose of Hep was considered medically important. Information regarding PREVNAR was received from a U healthcare professional ### regarding a male patie n/v fever, headaches 12-24 hours after every AVA Y vaccine, but had 32 episodes cp/sob after AVA #3/SMPX 6/28/2004 vac, wt loss, 6/28/2004 hungry, insomnia.. onsolable. Swelling of thigh (left) knee Y to hip, hot Y to touch. Shots given 1 at about 1040a. Still Y crying presently 5/6/2009 3pm.5/13/09-records 5/6/2009 received mins of receiving immunizations, left warm + nauseous. Stood up + opened door at which point Y fainted. I saw 5/4/2009 her + helped 5/4/2009 her to floor so no vaccine received 24MAR2009. Symptoms began 13APR2009 with lesions on arms, legs, face, Y and trunk 3/24/2009 with clear4/13/2009 discharge. Biopsy was
ely after receiving GARDASIL injection, Y pt passed out with her head on a desk. She quickly Y regained consciousness 5/4/2009 5/4/2009 & required sutures. Y 5/6/2009 cellulitis 5 cm X 5 cm red, warm U 5/4/2009 5/5/2009 cellulitis at administration site. Started on OMNICEF. 4/29/2009 4/30/2009 nch area of redness, warmth and induration Y treated with KEFLEX 500 mg BID x 7d 5/1/2009 5/2/2009 R on 4-29-09 c/o fever nausea and Ydiarrhea and pain left arm - Followed up @ doctors officeY 4-30-09 and 4/28/2009 5-6-09 4/29/2009 g joint pain, numbness (left leg/hand), Y leg coldness, and stroke after AVA #4: 06 Jan 2003 AVA N 1 w/o AE.1/6/2003 AVA2 was given ### 23 JAN 2003 w veloped itching on his back 3 days Y after receiving the vaccine; 1 day later, he developed swelling Y + 3 lesions 4/17/2009 on his4/20/2009 right jaw; 1 day later h Y 4/30/2009 eared at site of vaccination. It was warm Y to touch and slightly itchy. 2 small spots appeared next Y to it. Rash 4/17/2009 lasted 5 4/29/2009 days. after 24 hours and warmth after injection Zero fever. U 5/4/2009 5/5/2009 10ml around injection of chicken pox Vax. Y 5/4/2004 5/6/2009 ed, warm with pain -> treated with KELFEX -> seen next day on 5/5/9 with response to antibiotic Y 5/1/2009 njection site showed redness, warmth, swelling. Area was also tender to touch. Also startedYw/temp 99.35/4/2009 today 5/4/2009 al reaction redness & swelling down into elbow. Clarinex 5 mg Y 3/31/2009 4/1/2009 @ throbbing pain L arm + hand. Info given by son. Pt does not speak English. U 1/29/2009 nt developed shingles on left side back Y and lateral chest wall. Antiviral medication not given as U it was 1 week 4/21/2009 after onset 4/30/2009 of symptoms. The of the Rt upper arm, temp of 101 XY2 days, itching and pain and tender axillary Adenopathy.YPt given Keflex 4/24/2009 500mg4/25/2009 tby mouth QID on 04-2 lling, redness, large circle @ inj site.Y Taken to PCP & informed to switch from Ibuprofen to TYLENOL. U 5/4/2009 5/5/2009 given @ 4:30 pm- Pt C/0 itching @ approximately 7:00 pm. Noticed both legs and R arm hadYhives approximately 4/27/200910:00 4/27/2009 pm. Low grade tem ined of having dizziness, pain at injection site, fever with joint pain. Y 5/1/2009 5/2/2009 ght tricep area with induration, warmth, confluent fine papules Y 4/27/2009 4/28/2009 er erythema 1-2mm vesicle in center - has burst Y 4/27/2009 4/28/2009 n right arm post receiving VARICELLA vaccine. Swelling & reddness began 4/29/09. Tx'd with Y XYZAL 54/28/2009 mg daily. Was already on MINOC 0 minutes after vaccinations (Hep AY#1, VARIVAX #2) child started vomiting and became increasingly Y lethargic; 4/29/2009 no total 4/29/2009 LOC, non discrete -103, rash on face - dry cheeks. Vomited Y once resolved in 24 hour without further fever, rashY on new symptoms. 3/31/2009 4/4/2009 was received from a health professional. A 41-year-old female patient, with a history of asthma, N received3/31/2008 an intramuscular 3/31/2008 left deltoid third ort received from a health care professional in the USA on 23 April 2008. A 21 year old, maleYpatient (with 4/16/2008 no medical 4/17/2008 history) reported havi ar-old female patient, who was hospitalized from 18 July 2008 to 19 July 2008 because she became U confused 7/21/2007 and angry after receiving a fir -serious case received from a healthY care professional on 17 September 2008. A 40-year-old N female patient 9/3/2008 received 9/15/2008 the first three doses rmation was received on 01 December 2008 from a consumer. A 59 year old female patient U with an allergy 9/5/2008 to penicillin 9/1/2008 received an injection -serious case received from a patient Y on 05 August 2008. A 68-year-old female patient experienced N headache, 7/29/2008 forehead 7/29/2008 swelling, sleepless n has been received from a physician Y and a nurse concerning her 13 year old daughter Y withNasthma and4/22/2009 no known 4/22/2009 allergies who on 06-AU n has been received from a consumer concerning her friend's 15 year old daughter who wasUvaccinated with two doses of GARDASIL. Afte n has been received from a pharmacist concerning a 23 year old female who on 08-FEB-2008 Y was vaccinated 2/8/2008 with her second dose of GA n has been received from a consumer Y concerning Y her son with neutropenia, who when vaccinated U with any vaccine including RECOMBIVA ort received 29 April 2009Y from a health care professional. Y An 8-week-old female infant had received U a first 4/27/2009 dose of right 4/27/2009 thigh injection of PE us case was received on 30 April 2009 Y from a health care professional. A 57 year old (corrected U on 05 May 4/21/2009 2009) female 4/22/2009 patient with high was received on 01 May 2009, via another Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study. n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 1/15/2009 who vomited 1/15/2009 blood. The patien ever with chills - arm swollen 4/30 threw Y up. U 4/28/2009 4/28/2009 ere migraine headache unresponsive Y to prescription meds. Onset 10/08. Abdominal pain and N some dizziness. 7/14/2008 Treated 10/1/2008 by pediatrician and 9 Mom called on her son who had shots Y on 4/27/09. His left leg is sore, red and hot today. Y I told mom to 4/27/2009 put ice on4/28/2009 his leg and have him u er flu shot, I developed a rash. This rash was all over my body except my face. The dr's that U treated me10/6/2008 were dermatologist, ### family dr., Al rm was red/irritated no pain no fever didn't feel hot. Y 4/6/2009 4/21/2009 ATEQ vaccine 4-14-09. Developed vomiting on 4-17-09 - lasting 24 hours then had 4 days ofYwatery diarrhea. 4/14/2009 No fever. 4/17/2009 Sibling then develo ver body, swollen and hot. Y 4/20/2009 4/22/2009 102 for 3 days with mild posterior lymph Y node swelling and one left axilla, and neck tenseness gradually resolved. alls the day after immunization was given c/o fever low back and B/L hip pain. States "difficult Y to walk" due 4/28/2009 to pain. 4/28/2009 Symptoms occurred (o reaction 13x26mm induration with redness. Y 5/5/2009 5/6/2009 0 cm length width erythema, edema, Y tenderness, dryness to right arm Y 5/4/2009 5/5/2009
or 5 hours crying, given Tylenol with Y some relief. Y 5/6/2009 5/6/2009 er administration of TDAP vaccine in Y right deltoid, patient developed severe pain and bruising U at injection4/27/2009 site with report 4/29/2009 of chills, nausea. arm red, warm to touch, swollen, indurated Y Y 5/5/2009 5/5/2009 tired, muscle ache lasting 1 1/2 weeks. No treatment. Y 4/9/2009 4/11/2009 patient states patient received vaccine and then "slumped over in chair". Mother left room toYget addional 4/23/2009 help. When 4/23/2009 mother returned to ro Imm given in AM. The following day he woke at 6AM with bilateral eye pruritis. He notices eyelids N red and5/1/2009 whites of eye 5/2/2009 a little red. Pruritis E FUSSINESS AND 103 DEGREE FEVER 24 HOURS AFTER GIVEN. TREATED WITH MOTRIN. Y CBC 5/5/2009 WITHIN NORMAL 5/6/2009LIMITS AND N hest 104.6, hives off and on all over body Y 4/28/2009 5/1/2009 Telephone consult) rash on face andYback of neck, no respiratory distress per mother. AtaraxUq6 hours as4/27/2009 needed. Mother 4/29/2009 instructed to sche ely 28 hours after vaccination the patients Y Right forearm began to have hives on it. The following Y morning 4/30/2009 approximately 5/1/2009 42 hours after va d 5 pox blisters/spots 11 days after vaccination. No other symptoms i.e. fever. Site of injection Y is itchy as4/21/2009 of today. 5/2/2009 4 months and was given vaccine that was for 5yrs and up..... Y 5/1/2009 negative BHCG on 30Mar2009. SM received Anthrax and Smallpox on 2Apr2009. SM tested U positive BHCG 4/2/2009 on 4May2009. 5/4/2009 Last Menstru accines at 11a.m. and returned to clinic Y at 1p.m. due seizure like activity as witnessed by mom. Y Per mom 5/7/2009 pt began drooling, 5/7/2009clenched jaw l accines at 11a.m. and returned to clinic Y at 1p.m. w/ twin sibling. Upon examination pt was found Y to have temp 5/7/2009 of 104.3 5/7/2009 (rectally), content, im aP INSTEAD OF Tdap U 4/24/2009 4/24/2009 proximately 5-10 minutes of vaccineYadministration, pt. c/o momentary changes in vision, was U pale and diaphoretic 5/7/2009 and 5/7/2009 vomitted. VS as fol -umbilical follicultis on 2 May 09. No tx. required. U 4/30/2009 5/1/2009 ness and swelling 4 cm x5 cm Y 5/6/2009 5/6/2009 ncopal episode 15 min after administration of vaccines. Y 5/6/2009 5/6/2009 se event reported. RN gave Tdap instead of a Dtap. Y 5/5/2009 or after getting vaccines. Pt was paleY and staring straight ahead with 2 shakes of head. RN was U able to arouse 5/6/2009 pt and5/6/2009 handed pt to father. A muscle was extremely painful, pain also felt in L side of neck on day of administration. Approx Y 36 hours5/6/2009 later, L deltoid 5/7/2009 reddened, somew ctivity 3-4 hrs after receiving vaccine on 5/5/09,Yseen in ER - Head CT 2 and CBC WNL, admitted U to Hosp. Plans 5/5/2009 for o/c5/5/2009 5/7/09 - Temp in ER up blood, chest pain, and Y acute onset. Y Complete Y heart failure. Two10thrombi Y also Y noted in leftNventricle. Pt has defibrillator ### 1/6/2009 now on Chronic m 11 AM 4/28/09 - taken by ambulance Y to E.R. In-patient Y 2/28/09 - 4/29/09 1 - high fever. 4-30-09 U - Back to Dr. 4/27/2009 office, severe 4/28/2009 diarrhea. 5/18/09 s: 1. Rash 2. local swelling. SuspectY Drug #1 Dosing: one time vaccine dose. U 3/18/2009 3/18/2009 opted at about 7 m/o from a foreignYcountry. Her Y shot records weren't 2 available to us. With consultation, Y 10/1/2008 the recommendations 10/2/2008 was to immu and swelling at injection site/entire upper arm; Left swelling 2-3 times normal size of arm. Fever, U vomiting5/5/2009 5/5/2009 thigh - fever 101.7 given Rx KeflexY5/1/09. Seen in office 5/7/09 - given Rx for Omnicef. FluUoffice visit in 4/30/2009 1 week. 5/1/2009 AM shaking arm when reaching, falling Y over after waking in am by 3/16/09 condition in am + N pm - falling over, 3/9/2009 trouble 3/10/2009 balancing 3/19 - not a & swelling noted at injection site Y 5/4/2009 5/5/2009 degrees. Diarrhea. Vomiting. RashY/ red / swollen right arm. Antibiotics by PCP. Y 4/24/2009 4/25/2009 sicular rash over torso / proximal extremities and fever present x 2 days. U 4/27/2009 5/7/2009 9 - Injection given R shoulder. Client Y describes pain in R shoulder joint, trouble lifting arm. Pain U was immediate 4/29/2009 after4/29/2009 shot then next day, we seizure like episode and stopped breathing Y per mom. Pt was admitted to hospital for observation. Y 5/6/2009 5/6/2009 mo vaccines on 4/24/09. Initially had Y a knot (no reddness or drainage) at site of PCV + VZVYshots. She now has some redness of skin with cm area of erythema with slight induration, Y minimally tender. Y 4/28/2009 4/28/2009 rythema at injection site. Y 4/27/2009 5/4/2009 ccines (shots) for flu, polio, & yellow fever- She also started oral typhoid vaccine on 5/05/09. YShe awoke 5/06/09 5/5/2009@ 6am 5/6/2009 with nausea by 9a vaccination in left arm on April 14, 2009. Y On April 16th, noted tenderness on left hip which spread U to groin. 4/14/2009 Pain continued 4/16/2009 and days later a reas other various locations of diamond shape rash. C/o itching 0 SOB or other signs of distress. Y after vaccination given, patient passed out, lost consciousness for about 3 seconds, then spontaneously Y 4/28/2009 woke up. Patient was given water redness, and warmth. Y 5/4/2009 5/7/2009 - No initial local reaction until 4 day post injection, 0 fever 0 change in appetite, sleep or play.N 9 days post4/6/2009 injection 4/10/2009 site increased size, war ZOSTAVAX was given got warm, swollen & sore. It was the size of a half dollar Y 5/1/2009 5/1/2009 adache and feeling of inside of scull on fire - lasted 3 hr and lifted. Went to ER. Y 4/29/2009 4/28/2009
0 - vaccination administered 0933 - pt. stated "light - headed, clammy, body feels tense, "really Y hot" BP = 5/7/2009 120/80 P = 5/7/2009 76 RR = 20 0945 - "in t a lump on left arm after administration of vaccine, and evaluated 5/1/09. Returned 5/5/09 with U redness/4/20/2009 warmth at 4/20/2009 injection site and compl n has been received from a 24 yearYold femaleYwith citric allergy who 2 on an unspecified dateNwas vaccinated with a single dose of MMR II .
n has been received from a consumer concerning her brother who on an unspecified date was U vaccinated with MMR II and then developed n has been received from a 74 yearYold female registered nurse with no allergiesYand a history N of hip replacement, 6/18/2008 24/24/2009 TIA (transient ischaem was considered medically important. Information regarding PREVNAR was received from aUconsumer, the mother of a patient who experie was received on 01 May 2009, via another Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study. ort received from a health care professional Y on 15 August 2008. A 39 year old, female patient, U with a medical 7/31/2008 history1/23/2009 of no known allergies a er Mother walked into Center. Pt received immunizations 05/04/09. Pt now c/o of dizziness, headache U & chest 5/4/2009 discomfort. 5/5/2009 Follow-up phone rs, significant Local Reaction - Site erythematous, warm to touch - Softball size area. Y 5/5/2009 5/6/2009 9 Tetanus/Diptheria toxoid was given in the left arm along with influenza and pneumonia which Y were given 3/12/2009 in the right 3/12/2009 arm. That night the p sh back of both hands and both elbows since getting small pox 16 Apr 2009. U 4/16/2009 5/1/2009 emperature of 100 F within 24 hours Y of injection as well as tenderness; both were controlledUwith Tylenol.5/6/2009 After 24-hours 5/7/2009 warmth and swelli swelling upper arms 5/7/2009 5/7/2009 EK AFTER SHINGLES VACCINE CLIENT HAD DEVELOPED RASH ON ENTIRE BODY AND Y IT LASTED4/3/2009 FOR ONE 4/10/2009 MONTH. NO FEVER d with ACAM2000 during pregnancy Pregnancy resulted in full term healthy delivery 7/8/2008 7/22/2008 U 4/21/2009 4/21/2009 as given his 2 month routine Vaccines which included the Rotavirus. This was done on Wednesday May 6, 5/6/2009 2009 about 10:30am. On Friday p Lt upper arm at injection site noted Y soon after vaccination 4-3-09. Presented for care on 5-1-09 Y with 2d4/3/2009 history increasing 4/29/2009 size of lump an was reported by a healthcare professional Y and described the occurrence of injection site redness Y in a 4-year-old 4/13/2009male 4/14/2009 subject who was vac ived oral Rotavirus vaccine Y Jan 30 Y 2009. Had some Y nausea, vomiting, 3 fever for 24 Hrs then Yresolved but1/30/2009 5 1/2 wk later 3/5/2009 developed intussus d fever 3/14/09 - 3/18/09 with rash head Y to toe -Yrash eventually peeled. 1 Hospitalized after 2 ER Y visits - had3/4/2009 a/c for Kawasaki 3/14/2009 with cardiology ness pain, swelling at and around injection site. Y 3/20/2009 3/20/2009 circle around shot. Now white circle, swollen arm, 6 inches across red circle. N 4/28/2009 4/29/2009 alized erythema/ induration on left shoulder after vaccines placed Y 5/7/2009 appetite Tremors Loss of mobility Dizzy Y Weight loss. N 1/22/2009 1/29/2009 ven shots on 5-1-09. 45 mins after shots Y started fever, body aches, nausea, on sat started reaction Y around 5/1/2009 shot area5/1/2009 red, very itchy hot to t mpanying note. Y 4/29/2009 4/30/2009 controllably for 5 days after shots given. Y 11/4/2008 11/4/2008 vaccine breakthrough diagnosed by Dr in our office on 5-1-09. Had VARIVAX X 2. Sibling also U has varicella. ### 4/30/2009 Vaccine Breakthrough. Diagnosed in office by Dr. on 5-1-09. Had 30 lesions. VARIVAX X 2. U 11/5/2008 4/29/2009 change. Sleepy day after vaccines. A few days later, more resistant behavior in this easy going Y toddler- irritable, 3/3/2009clingy, 3/4/2009 decrease appetite ates pt has red, swollen, itchy area where shot was given. Left arm, 1/2 dollar size. U 5/6/2009 5/8/2009 eived immunizations (Preona #4 Hep Y A + VARIVAX) then developed raised red itchy rash 5/7/09. Y No fever, 4/29/2009 illness or5/5/2009 fussiness. as lethargic moaned and maintain a fever in excess of 103 degrees for six hours. Unable to U fully wake up. 9/18/2006 9/18/2006 him a shot by annual check up. AndYhe had UGI. 90 minutes later after shot he start havingYhives, itchy, slight 5/5/2009 dyspnea. 5/5/2009 We brought him b rgic reaction, rt arm redness, & swelling Y U sig. facial swelling Benadryl + Epinephrine Y given. Y 5/4/2009 5/4/2009 edness and hardness pt. denied any pain except when someone touches with hand. Mom noticed U 48 hours 5/5/2009 after immunizations 5/7/2009 treatment eived vaccinations @ approximatelyY2 PM 5/7/09 fussy @ 5 PM 8-9 Developed fever 104.0 FY even with TYLENOL 5/7/2009 every 5/7/2009 4 hrs @ 1 am fa g s red, swollen, hot to touch, tender.YRt thigh 2 hrs 6 x 10cm, Lt thigh 8 x 12 cm. Started with U redness + swelling 5/4/2009-> dramatically 5/5/2009 worsening ess-instructed to lay down waited for 15 min and sat up slowly. No further problems. Y 4/21/2009 4/21/2009 mph nodes @ neck, rapid heart rate dizziness, weakness, headache, shake, nervious feeling Y feeling, nausea, 2/9/2009 rash,2/10/2009 body aches, tiredness. after receiving MMR she broke into a rash all over body with hives. She was extremely fussyYand miserable 4/22/2009 for the next 4/24/2009 48 hrs No treatmen ted 6 days after vaccines - lasted 3 days; Temp 104.8 degrees no other symptoms but of above Y from mother 2/2/2009 2/11/2009 ver 102 degrees - 103 degrees axillary, Y cranky saw Dr (PMD) 5/01/09 Rash face, neck, chest, U underarms, 4/21/2009 abdomen 4/28/2009 & back - progressed t vaccine break through. Diagnosed in office by Dr with varicella on 4-28-09. Had 7 lesions. NoYfever. Had VARIVAX ### x4/26/2009 2. multiforme- started 5/2/09. ThoughtYto be hives- nuclear by E multiforme on 5/4/09. BENADRYL Y tried w/o 4/15/2009 relief. 5/2/2009 4/23/2009 4/23/2009 ort received on 02 April 2009 from aYphysician. A 16 year old female patient, with no medicalYhistory, received 3/6/2009 the following 3/8/2009 vaccines in the with Very sore arm (painful to touch in shot area), a general headache (which I normally do not U get), and achiness 5/8/2009 all5/9/2009 over. I had received th eizure lasted 60 seconds self-resolved,seen Y in ED dxed with Bilateral Otitis Media treated with Y Amoxicillin 5/1/2009 5/8/2009 tly serving my 4th deployment since 2003. I received Y 6 doses of the4 Anthrax vaccination between U December 2003 and April 1st, 2009. I n he day the first dose rabies vaccine Y was given symptoms included swolen lymph glands, soreness Y in left 4/20/2009 arm, dizziness, 4/20/2009 exaustion, headach
id with induration, mild erythema, slight itching. 5/8/2009 5/10/2009 swelled up to double its size and was Y very hot and painful. I couldn't lift my arm for two days.YThe day after5/6/2009 the vaccination 5/6/2009 I developed flu li n has been received from a consumer Y concerning her son who on an unspecified date was vaccinated N with the first dose 4/1/2008 of MMRII (lot not follow-up information has been received Y from a consumer concerning a 13 year old Y female with N no pertinent 9/26/2008 medical history and no drug re n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 21 10/2/2008 year old female 11/1/2008 with CECLOR al n has been received from Y a physician's wife concerning her daughter, an 15 year old femaleNwho was on unspecified dates vaccinated with n has been received from Y a physician's wife concerning her daughter, an 11 year old femaleNwho was on unspecified dates vaccinated with n has been received from a nurse practitioner Y through a pregnancy registry for GARDASIL, Y concerning a7/31/2008 20-year-old 7/31/2008 female, with prior hist n has been received from a licensed Y practical nurse through a Pregnancy registry concerning Y an 18 year 8/1/2007 old female who 3/5/2008 in June 2007 and n has been received from a physician Y concerning Y a 15 month old patient who was Y vaccinated U with a dose of ROTATEQ (lot number and ro n has been received from a physician Y concerning Y a 15 month old patient 0 who on YunspecifiedUdates was vaccinated with all three doses of R time of injections noted client flinched Y mildly. 5/6/09 Contacted client after receiving a phoneYcall from his 5/5/2009 employer of5/5/2009 an adverse reaction. ld received immunizations of DTap,Yhepatitis B, rotavirus, HIB, PCV, and IPV on 5/04/2009. YHad 5 minute5/4/2009 generalized 5/4/2009 seizure and when p d patient's father returned to clinic approximately Y three hours after Varicella vaccine administrered Y (administered 5/5/200905/05/09). 5/5/2009 Patient had de ARTED ON 5/10/2009 FROM FACEYCOVERED ALL LIMBS BY 5/11/2009 5/1/2009 5/10/2009 f injections got fussy, then had generalized Y fine shaking. Prior to shaking had episode whereYshe straightened 5/5/2009 out. Spell 5/5/2009 lasted less than 2 d fevers, malaise and headache within 24 of administration of Menactra. Now feeling somewhat better 4 days 5/7/2009 after administration. 5/8/2009 Previou h and/or Hives, swollen feet, hands, Y face and entire Y body. Extremely2itchy. went to the Emergency N room on 4/17/2009 4/20/09 and 4/17/2009 was kept overnight after the injection (5/2), developed injection Y site pain and swelling, shoulder pain. On 5/7 developed U rash4/30/2009 on upper back 5/2/2009 and increase in pa AR bill redness c some swelling and itching on Left Upper Arm subcutaneous Y 5/8/2009 5/9/2009 XN R>L THIGH W/IN MINUTES - BLOTHCY ERYTH. Y 5/8/2009 5/8/2009 administered in school setting on 4/30/09. Y Mother reports that arm appeared ok that night and Y next am.4/30/2009 Child began 5/1/2009 complaining of arm h XN R THIGH W/IN MINUTES WITH BLOTCHY ERYTH. Y 5/8/2009 5/8/2009 0 hours after receiving vaccine, patient developed nausea, vomiting, vertigo, abdominal cramps, Y and temp. 5/8/2009 of 102.5. 5/9/2009 Symptoms lasted appr ates that patient had on left arm- swelling, Y red streaks, knot, fever up to 101 degree after varicella Y injection 1/13/2009 in left arm. 1/14/2009 Went to Dr. Williams ht swelling of the left deltoid muscle with redness, itching and skin warm to touch. Mother verbalized Y that 5/8/2009 patient had5/8/2009 severe headache hou ovitis (L) hip. 6/24/09 Hospital records Y receivedYDOS 5/2/09 to 5/3/09. 1 Assessment: Toxic (Transient) Y synovitis 4/29/2009 of hip.5/3/2009 Patient presents with second dose of GARDASIL. Approximately 16 hours later developed dizziness and fooling fainted and nausea. 5/6/2009 Fever5/7/2009 weakness continued 5/8/2009 ns in left hip with weakness and nausea Y - developed rash on left side of back that radiates toNhip. Received 5/5/2009 ZOSTAVAX 5/7/2009 on Tues - 5/5/09. S ped a right upper extremity tremor sites Y after administration of vaccines persists at 48 hrs. No U other neurological 5/6/2009 findings. 5/6/2009 5/14/09 Receive ported C/o redness and soreness at injection site. Observed slight bruising / redness at injection Y site area 4/14/2009 on 4-30-09. 4/15/2009 s after 3rd dose of GARDASIL, Pt developed, headaches, dizziness, abdominal discomfort, N various aches 2/27/2008 / pain, dairy 6/15/2008 sensitivity, elevated redness, pain. Entire deltoid area was swollen + red warm compress, Benadryl and Ibuprofen Y given w/ good 5/5/2009 response 5/6/2009 decrease swelling. iven instead of VARIVAX (ZOSTAVAX) 5/11/2009 gan around 6pm on 4/28/09 started on her face, 4-29-09 in morning woke up with all over still N with hives4/28/2009 today 4-30-09 4/28/2009 has had 5 doses of er shot arm sore and some swelling. May 7 arm swollen and Erythema 4 inchs aprox. May 8 arm swollen5/6/2009 and " 4 inches 5/7/2009 aprox. May 11 ar ensation in right arm; arm is hot, red,Yswollen; Pt has "extreme fatigue" Blood pressure has been U elevated5/8/2009 about 1S5/11/2009 points has a rash on rig 9 Severe Seizures < 3 days Transported Y by ambulance to renown medical center. OngoingNseizures until 2/23/2009 under control 2/24/2009 with phenoborbitol ction, quarter sized erythema to arm. Blanches, non tender, not raised. Y 5/8/2009 5/10/2009 Swelling itching warm to touch > Onset later that right mom gave BENADRYL & ice over the Yweekend 5/8/2009 5/8/2009 d tender mildly pruritic erythematousYpapules over bilateral hands, dorsal > palmar surfaces,Yonset approximately 4/3/2009184/18/2009 days following receipt hrs following vaccinations c/o swelling, pain + warmth @ injection site Rt deltoid (MENACTRA). Y 5/7/2009 5/8/2009 gave oxygen and checked vitals. Y 5/11/2009 5/11/2009 m area of erythema with slight induration, Y minimally tender. Y 4/28/2009 4/28/2009 pular/macular erythematous rash and Y fever X 2days. U 4/22/2009 lling + tenderness at injection site. 4 days after Typhim developed soreness in arm, tenderness U (no swelling) 4/28/2009 in axilla,5/4/2009 Tingling in L fingers b acular erythematous rash Y U 4/28/2009 c 4:30 p 4/27. Pt went to school 4/28 Y - was fine then. 4/28 night developed red area, hot to touch, U 9x9 cm 4/27/2009 approx at4/28/2009 vacc site. Talked to on ours after shot developed generalized Y arthralgias, headache, hot touch but no fever, chills. Severe Y leg and 4/20/2009 arm pain.4/20/2009 Seen in ED @ hospita local. Myalgias. Arthralgias. Fever >Y 102. Palpitation. Onset hours > vaccine. Pt seen 2 d > vaccine U rx. NSAIDS 5/9/2009 / TYLENOL. 5/9/2009
RICELLA vaccine on 4/20/09 - On 5/9/09 Y developed some itchy spots on truck with eye pain and frontal 4/20/2009 headache - On 5/9/2009 5/11/09 Dx'd with c :10 AM Pt. c/o ears tingling, L side of shoulder, face (L side) feeling slightly numb - No c/o difficulty Y in breathing, 4/17/2009 No 4/17/2009 c/o throat tingling, No c episode - hit head. Y 5/1/2009 5/1/2009 ceived shots on 4-14-09. Returned to clinic on 4-17-09 with report of swelling in right arm and Y face and itching 4/14/2009 starting 4/14/2009 on Tuesday night. HONED 5/5 @ 1 pm. Reports that at 3am. Child awakened screaming & banging head. Head Y hot, no fever 5/4/2009 & remainder 5/5/2009 of body not warm was reported by a healthcare professional Y via a GSK representative and described the occurrence U of diarrhea in a 2-month-old 4/16/2009 male subje N ort received on 04 May 2009 from a Y health care professional. This patient, who is a 54-year-old U male is one 8/13/2008 of a cluster 8/14/2008 of five patients who ACEL, MENACTRA, varicella 3/11/09. Onset 3/20/09 Y - fever, headache, 14 Y lethargy; evaluationNat hospital: 3/11/2009 MRI, LP. Dx 3/20/2009 cerebritis. 5/12/09 VA n has been received from a consumer concerning her three friends' children, who were vaccinated U with MMR II and became autistic. Upon n has been received from a consumer concerning her currently 14 year old niece who as a toddler U was vaccinated with a dose of MMRII. C n has been received from a 21 yearYold femaleYconcerning herself with 7 no medical history orNdrug allergy 1/8/2008 who experienced 5/1/2008 seizures the nex within 1 week change in cognitive abilities & behavior. Within 1st 24-48 hours rash Y over upper N forequarter9/5/2008 resolved within 9/6/2008 2 more days (No n has been received from a nurse practitioner Y concerning Y a 22 week4 male who on 31-JAN-2007 Y was vaccinated 4/23/2007 with 4/23/2007 a first dose of ROTAT t injection site of varicella. ER vs 3xYFri-Sun. Adm Y hosp Sun 5-1-09 4pm through ER. Culture Ydone at injection 4/29/2009 site = staph. 5/1/2009 IV antibiotics wh d 5/1/09, c/o pain. "limping". Temp 103 degrees during the night, shaking, Temp 102 degrees Y am of 5/1/09 4/30/2009 c/o tummy 4/30/2009 ache, gagging, 0 vo 5/6/2009 4/29/2009 induration, fever, chills, myalgia, BP stable, No anaphylaxis. 5/4/2009 5/4/2009 n initially & then recurred with deep muscle pain U 4/23/2009 out in bumps all over his body, is in the nurses office @ school. Some are fluid filled. does not have PCP. 4/29/2009 Instructed 5/3/2009 to go to PCP. ash on R deltoid began 5/4/09 and today 5/6/09 erythema and in eye itchy spread to both forearms U in addition 4/18/2009 3-5m papule 5/4/2009 have appeared ness, fever, joint pains, headache w/in 24 hours of vaccine. Y 5/6/2009 ministration of L arm erythema & firmness 2-3 cm, Local reaction. Noted 5/7/09. U 5/5/2009 5/6/2009 24 hrs after injection site where administered extremely tender, unable to lift arm. 24 hrs after Y fever began 4/23/2009 at 99 degrees, 4/24/2009 extreme fatigue, male was administered VARIVAX onY5/4/09 at Health Unit . On 5/6/09 mother presented to health Y unit with5/4/2009 child to report 5/5/2009 vaccine reaction. eared 3 days after vaccine, with no Y associated signs or symptoms. Rash consistent with erythema Y multiforme. 4/30/2009 Coincided 5/3/2009 with day 7 of AM hours post vaccination: Fever/chills X 3 days; redness/swelling in large area over injection site, Y generalized 3/20/2009 arthrolgias; 3/21/2009 started to resolve r, painful. 3rd day reaction. Swelling at site of injection. Y 5/4/2009 5/6/2009 (2) SOB, (3) Throat swelling, (4) Stiffness Y of upper & lower extremities. Oxygen SAT decreased Y 94% on4/30/2009 RA. Rx: 6 lit 4/30/2009 oxygen, EKG, SOLUM warmth, induration - diffuse tightening Y + pain with touch. Treated with augmentin and will follow U up tomorrow 5/5/2009 05/08/09. 5/6/2009 iven 4/23/09 - Pt began having myoclonic Y jerk seizures about 5 hours later. Pt told to go to ER Y ASAP. LP, 4/23/2009 EEG, MRI, 4/23/2009 CT had all WNL. Curr U 4/14/2009 meter redness, warmth, swelling, with Y superficial oozing of serum. Y 5/1/2009 5/4/2009 eived Td. - Should have received dTap) 4/11/2009 tool noted 4-29-09 5 days after vaccine Y given. Y 4/24/2009 4/29/2009 t weak, lost balance, became pale, eyes rolled around, pulse and blood pressure went decreased. Y With rest, 5/6/2009 a drink,5/6/2009 and a snack patient s oid swelling, heat, pain. Large palpable nodule in right axilla. Rx: Augmentin E S 600mg 1 Y 1/2 tsp po BID 4/27/2009 x 10d. Warm 4/27/2009 compresses to af seizure activity, brief alteration of consciousness. Y Y 1/2/2009 1/9/2009 r followed by seizure 24 after vaccine Y Y 3/25/2009 3/26/2009 arm red, swollen and fevered. Mother Y stated used ice packs, ibuprofen and BENADRYL withUno improvement. 5/5/2009 Advised 5/5/2009 to go to ER or child 0-09) - site irritation only through Sunday 5-03-09 - Rash began Monday AM. Covering - Neck U to back of 4/30/2009 thighs. Covering 5/4/2009 torso. .7 Po since evening after TDAP given until seen in office on day 2. Fatigue + Myalgia X 2 days. U 5/4/2009 5/5/2009 4/29/2009 ling and pain at the site of injection. Y 4/28/2009 5/1/2009 ling & pain at the site of injection. Y 4/7/2009 4/24/2009 st administration child had redness up & down 22 mm left & right 20 mm right thigh upper & slightly Y warm. 4/28/2009 Mom advised 4/30/2009 to watch & use wa ver 11 days post vaccine 4/24/2009 5/4/2009 noticed behind ears, now on stomach, arms fine red rash behind ear papular rash scattered U on thorax + 4/29/2009 extremities - 5/5/2009 2 hours vaccine on 4/2 throat, difficulty swallowing, stiff neck am of 4/25; and R arm pain Sun am 4/26. Fever blisterYlip. Evaluated 4/24/2009 by Dr and 4/25/2009 started on NAPROSY tient received immunization at 11:00 and then developed hives that afternoon, no respiratoryYdistress, gave 5/1/2009 patient Benadryl. 5/1/2009Claritin, and O
ed & hot to the touch. Y 4/28/2009 FTER RECIEVING ANTHRAX VACCINE MEMBER HAD A RING OF RAISED BUMPS AROUND U INJECTION 5/1/2009 SITE THAT 5/4/2009 ITCHED. MEMB ed fever (102.0 degrees F) and soreness at injection site (left deltoid region) 24 hours after Y receiving injection. 4/29/2009 Had4/30/2009 stomach discomfort 2 rent says that patient only slept about an hour and a half last night after his immunizations. Says U that he5/11/2009 cried nonstop 5/11/2009 for 3 1/2 hours unco oticed rash on upper arm and redness size of 50 cent piece. Parents gave Benadryl 1 dose.Y 5/1/2009 5/2/2009 sore, low grade fever, felt tired. Parent unsure which arm was sore. Y 4/29/2009 4/30/2009 low grade fever, fatigue (parent not sure which arm was sore) Y 4/29/2009 4/30/2009 TELY AFTER GIVING MMR SQ ON LT THIGH PT THIGH BECAME RED, SWOLLEN AND Y BLANCHING 5/11/2009 WAS NOTED 5/11/2009 DR NOTIFIED AND and swelling at injection site. Fatigue. Y 5/8/2009 5/10/2009 the patient called the office to say that as of 1/7/09, her arm from the injection site to the elbow Y was red, warm, 1/5/2009 and swollen. 1/7/2009 ceived the vaccination on Monday 5/4/2009. Y Mother called office on 5/5/09 and stated that child's Y Right arm 5/4/2009 where he 5/5/2009 had received his Dta eaming in tantrums which would last 15minutes to one hour off an on. Flailing arms, legs, shaking N head. 5/1/2009 Diarhea, vomiting, 5/1/2009 no fever. Initia hysician varicella rash on back, stomach Y and arms with no fever Y 4/30/2009 5/12/2009 pneumococcal vaccine trial, with severe COPD, Y was admitted to the 10 hospital fro severe colitis Y on 11/8/2008. 9/10/2007 Vaccination 11/8/2008 took place on 9/1 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 8 11/18/2008 with CHF. Y Vaccination 9/10/2007 took place on 9/10/2007. ### Accordin d Tdap injection 3/17/09. 3/24/09 reported Y as walkin to PCP reporting that arm is red and swollen. Y Per NP 3/17/2009 note that3/24/2009 day "left deltoid area ha d no signs of complications Y after birth. Shortly after receiving hepatitis vaccination by the nurse U the baby 5/11/2009 began experiencing 5/11/2009 stopped bre ying, sore arms, couldn't move arms; Y temp 105 degrees F; mother gave Tylenol suppository;Ychild projectile 5/6/2009 vomiting.5/7/2009 Tylenol lowered fever LOPED SIGNS AND SYMPTOMS OF hERPES zOSTER OPHTHALMIC BRANCH OF 5TH YNERVE l SIDE 5/1/2009 4 days after 5/5/2009 receiving Zostavax d lump the size of a blueberry appeared Y behind his right ear (this was diagnosed as lymphadenitis U by Dr.4/28/2009 Chevez) the 4/29/2009 day after his vaccina esday May 13th I visited my primary care physician for a routine physical examination. He recommended Y 5/6/2009 that I receive 5/6/2009 both Tetanus and P ETWEEN 102.5 AND 103.7 FOR 50 HOURS; DIFFICULT TO CONTROL WITH MOTRIN AND Y UNRESPONSIVE 4/28/2009TO5/7/2009 TYLENOL // RASH: P halitis etiology unkonwn.YFive weeksY after administration Y pt experienced 100 Y stiffnessYof neck. Neck N pain, back 8/16/2007 pain, lethargy, 9/19/2007 no appetite fever m, I fainted, had possible seizure, unconscious Y for 1 hour, several months of testings, Y Dr's can't N find what's wrong, ###since vaccine ### have sever warmth & hardness at site, pain at site. Y Y 5/5/2009 5/6/2009 -> Lt scapular pain - gen OXYCONTIN 20mg. ? nerve root. 1/1/09 - shingles --> given FAMVIR N 500mg: PO Q8### hours. ### elling w/ slight tenderness 12 days after Merck vaccine. Lasted approximately 12-24 hours. YCould move 4/8/2009 neck freely; 4/10/2009 R swollen upper arm ion , tenderness left upper arm Tylenol or Ibuprofen cold pack to and comfort. U 5/5/2009 5/6/2009 ssible granuloma. Y U 3/19/2009 5/11/2009 nted after administration of yellow fever vaccine, also received IM vaccines for Havrix & Adacel. Y Lasted 5/11/2009 about 30 seconds 5/11/2009 recovered comp minutes after receiving immunizations Y had syncopal episode and fell onto concrete outside clinics, Y V/s normal, 5/6/2009 hadn't5/6/2009 eaten that day, Dad s child reports that child had redness, swelling and warmth at injection site within only a few minutes U (<30). 4/13/2009 Site remained 4/13/2009 tender to touch un ped urticaria (generalized) after receiving DTP/aP (TRIPEDIA), PREVNAR & HIB. Per mother Y rash quickly 4/24/2009 subsided4/24/2009 within 10 Min & comple into clinic at 10:00 am on 11-3-08. She reported 4-5 hrs after getting vaccines pt noted redness, Y warmth, soreness ### and itching ### on upper le ine give with expired date Lot 00114 Exp 21 Mar 09 - Saw date as 21 May 09. U 5/12/2009 ately 24 hrs post receiving vaccines, pt reported temp of 102 degrees F. Temp went down inYthe evening 5/5/2009 but next afternoon 5/6/2009(48 hrs later, te ite {erythema warm sensation pain} with in 4 hrs of shot; then in 24 hrs --> pruritis + (increased) Y redness4/24/2009 5 treatment4/24/2009 (resolved in 1 wk). ZOSTAVAX injection 5/28/09. Awakened this morning (5-1-09) with a raised, red rash over U "upper chest." 4/28/2009 States the5/1/2009 rash "itches and burn n, loss of eye sight for 2 weeks. Nerve Y pain. Experience - still being treated for nerve pain in U head. 7/9/2008 ### apules + pustuls on back + arms. Y ### 5/12/2009 me 1 1/2 hrs post vaccine & stated Y to faint (Dad is a Dr. (cardiologist) and called it a "near syncopal Y episode 5/11/2009 she also 5/11/2009 felt nauseous & tired. ain and swelling saw Dr 5/9/09 Y 5/6/2009 5/7/2009 tis left arm s/p Tdap placed on Keflex per clinic & now doing well. 5/8/2009 5/9/2009 developed cough and congestion in lungs, Dr prescribed antibiotic (Amox-clav 500 mg) 3 days N later they gave 4/7/2009 no relief 4/8/2009 or made any differen ministered @ thigh on 5-3-09. On 5-4-09 in office for eval -- leg pain & refusal to walk since vaccine Y administered. 5/3/2009 Are 5/3/2009 firm. Are on L thigh ma, pain, redness. Y 4/30/2009 4/30/2009 secondary transmission of vaccinia:YPatient is not vaccinee. VAERS filed on vaccinee. 26 year U old female 4/16/2009 patient whose 4/30/2009 boyfriend received n has been received from a pharmacist Y reported that a 25 year old female Y with no allergies received U PNEUMOVAX 1/31/2009 1/31/2009 (Lot# 662742/1117X), u s a PNA vaccine on 5-2-09 on her left deltoid. Develop a big red mark on the injection site c/o pain and feels 5/2/2009 swollen5/2/2009 then put a marking on around 2100 on 5/2/09; spoke with one RH to report that her (L) arm where they injected Pneumococcal vaccine 5/4/2009 started 5/5/2009 to get swollen. Pt w ingling and respiratory symptoms 4/15/2009
ates awoke to arm red swollen tender to touch. Noted hard spot near tender arm size of prune. Y Patient able 5/8/2009 to use arm 5/9/2009 c/o area itchy. Wil back itchy, especially on ABD. Trunk/Buttocks Y groups of vesicular/ papules/few tiny pustules U on erythem. base. 6/7/1999 Clinically - varicella (status ve hep B (peds) on 5-1-09 vac exp date 4-28-09 5/1/2009 dministered to pt on 4-1-09 after she Y denied any allergies about 6pm. Client states on 4-2-09 Y a red slightly 4/1/2009 raised rash 4/2/2009 developed on neck, length area of redness + local temp - started ? 2cm x 2 in and elevated to 5cm X 5cm overnight. Y Fever 4/29/2009 > 99.8 (A) m area of erythema + warmth -> L biceps. Y U 5/6/2009 5/7/2009 Y Y 4/13/2009 4/22/2009 on, some lost of vision. ### was reported by a lawyer and described the occurrence Y of joint pain0 in a male subject of unspecified N age 8/1/1999 who was vaccinated 11/1/1999 with LYMER o hve severe joint pain Y U 5/11/2009 5/11/2009 as given a Zostavax vaccine as opposed to a varicella vaccine. Contacted patient's mother. Patient is having 5/11/2009 no symptoms. hospital on May 11, 2009 Y with bilious Y emesis, Y and low grade fever. 2She was sent home with the diagnosis 4/3/2009 of acute5/10/2009 gastritis. The patient pr received 2nd dose of Hep A/B TwinRix Y on 5/11/09.She had no problems with 1st dose on 1/12/09. U Within 5/11/2009 an hour of 5/11/2009 receiving the shot, he tions administered at 12:40pm, 12:45pm face red, hives noted on face. Benadryl administered. Y 2:40pm face 5/11/2009 no longer 5/11/2009 red, hives gone. N AS THE VARICELLA AND MMR WAS GIVEN LOCAL REACTION OCCURRED IN THE FORM Y OF WHEAL, 5/13/2009 TWO5/13/2009 OF THEM AND SOME ped a raised red area on back of Left Y arm on Sunday, 4/26 after immunization on 4/16. AreaYwas hot and 4/16/2009 itchy when 4/26/2009 noticed. Presented @ that a couple of hours after taking 1st Y typhoid pill developed rash on wrists with swelling of one eye. No 5/8/2009 difficulty breathing. 5/9/2009 After taking ated she had received a MMR vaccine Y and later that night her jaw appeared swollen and painful. Y She stated 4/14/2009 that she 4/14/2009 felt feverish. She cam n a 102 fever, breathing very fast and Y red cheeks and a very congested nose. Pediatric emergency N number 5/8/2009 advised 5/8/2009 us to go the hospital w to clinic 4/21/2009 with swollen cheeks, Y upper lip and left periorbital areas. Hives on trunk and Y arms since4/6/2009 4/6/2009 when 4/7/2009 he had his vaccin S MOTHER REFERS RASH IN ARMS, LEGS, BACK AND IN THE BACK OF THE NECK. Y 3/9/2009 3/9/2009 s and swelling at site of Varivax and Hep A vaccine, persisting swelling at site for 2 weeks. Y 4/27/2009 4/27/2009 DEVELOPED ITCHY HIVES SIMILAR Y TO VARICELLA LESIONS ON HER FACE AND BODY. U 4/9/2009 5/9/2009 eveloping warts on inside of vagina which had never occured before. Three weeks later they N were still there 4/24/2009 and getting 4/28/2009 uncomfortable so i w CP on 2/4/09 for GYN/PAP and received #1 GARDASIL Y that day. Urine 2 HCG on 2/4/09 was negative. N Pt subsequently 2/4/2009 2/4/2009 had (+) pg test 2/16/0 on 1 week prior to abnormal labs, cough x 1 week, Y nasal congestion1 x 1 week, croup 2 months Y prior to admission 2/24/2009- 3/16/2009 3/16 plts 12,000 receive wing day, noted increased fever, increased rash to chest & arms (red pimples). 3-5Y days later,Ndecreased speech, 1/3/2008clumsiness, 1/4/2008 huge dilated by MD 5-12-09 in Dermatology - note enclosure. Y 4/10/2009 5/8/2009 uration with redness R lateral thigh Y 4/29/2009 5/1/2009 ook child across street to groc store. She was crying when suddenly went limp + eyes rolled Yback in her head. 5/8/2009 She had 5/8/2009 mild inflammation o onds after injection became diophoretic, lightheaded, passed out for 15-20 seconds. C/o swelling Y in throat 5/12/2009 and throat 5/12/2009 soreness, no SOB or days vomiting X 2 days U 5/5/2009 5/5/2009 ness approximately 10mm. Vesicles. U 5/12/2009 5/13/2009 d immediately to VAR + MMR with redness + swelling @ sites, generalized urticaria on legs, Y arms, + back5/13/2009 + abdomen. 5/13/2009 Given 0.2cc of Bena 30mm area of induration on L lateralYthigh. Y 5/1/2009 5/2/2009 se event of symptoms, wrong vaccine given. In clinic 1hr. Past injection with no problems. Y 5/13/2009 dache, fatigue, tremors, arm swelling, myalgias, weakness. U 5/11/2009 5/12/2009 h "milk protein allergy" atY1 month ofYage, developed Y diarrhea about 300 3Y weeks after getting only N dose of ROTATEQ. 10/8/2008 Found 11/5/2008 to have rotavirus hing pain in Rt arm, very tender to the Y touch, very red and very hot. Dr put her on antibiotics. U 4/26/2009 4/28/2009 plaint was neck arm stiffness of left side, Y which continued, confustion (goofy like she was drunk), N conti complaints 5/11/2009of5/11/2009 neck arm, then exhaus n has been received from a nurse practitioner Y concerning Y her 18 year 4 old daughter Y who on 29-AUG-2007 N 8/29/2007 was vaccinated 9/5/2007 with her first dos n has been received from a consumer concerning Y her approximately1 12 month old son with N allergic reaction to antibiotics who in 2001 was n has been received from a consumer concerning, the patient's mother, her son (a twin, whoYalso had the same experiences reported in W n has been received from a consumer, the patient's mother, concerning her son (a twin, whoUalso had the same experiences reported in W n has been received from a Registered Y Nurse concerning a 2 month old male who on 30-APR-2009 Y was4/30/2009 vaccinated 5/4/2009 orally with the first 2 m d with rotavirus on 4/30/09 at 6:38. Was taken to Y hospital by mother1after vomiting & diarrheaYfor 2 days. Was 7/2/2008 admitted 4/29/2009 to hosp & tested for ospitalization for IVIG - extreme weight Y loss. Tripping, Y falling, loss of5 muscle mass, inability to N walk without 11/5/2008 assistance. Now ### is in a wheelch ient seen for F/U s/p hospitalizationY4-5thMay09 Y @ hospital for Acute 2 Myopericarditis following Y receipt of4/22/2009 primary Smallpox 5/2/2009 and Anthrax #1 p with CP and SOB in the early morning Y hours Yon 1/22/09 and got tachycardic 1 and SOB trying Y to climb stairs 1/11/2009 later that 1/22/2009 day. Went to health e on lower lip within 48 hours of injection." Y Upper Y chest pain waking 2 pt. @ 0300 1 wk after injection. Y No cause 4/15/2009 or change 4/22/2009 of routine other tha d, slightly warm to touch, area was Y 1 1/2 inches wide x 3 inches in length. Y 5/5/2009 5/6/2009
o fever 102,less of appetite, and fussiness. Y Y 5/12/2009 5/12/2009 ven Rotarix vaccine. On first dose of Rotarix, my baby had symptoms of vomiting, blood in stools. N These 5/13/2009 symptoms 5/14/2009 stopped after giving ant 5/16/2009 Y Y Y 4 N 5/11/2009 5/12/2009 vaccination on Friday, by Saturday Y evening developed rash at site of injection. Two days later U reaction (rash, 5/1/2009 swelling) 5/3/2009 was appro 2" x 2". A d, hard 2.5 X 3 inch cellulitis, left upper deltoid with left arm pit lymph node involvement. Father U is a MD and 5/12/2009 put child5/13/2009 on Keflex. Child has fe 9 mom called and spoke to nurse, stated Y that son got imm on 5-6-09 and now has a swollenYarea on this 5/6/2009 left thigh that 5/10/2009 is the size of a tenn hours of taking the vaccine, headache,low Y body temperature.next morning, low blood pressure, N nausea, 5/11/2009 body ache, 5/11/2009 stiffness in right arm, th Varicella and Hepatitis A vaccines on Y 5/13/09 at 1500 hr. Around 1830 hr., developed urticaria, Y swelling 5/13/2009 on eyes and 5/13/2009 mouth. He began cou n 786.5 (5-000008) 5/19/09 medical records received Y DOS 1/27/09 to 2/5/09. FINAL DIAGNOSIS: U Atypical 1/6/2009 chest pain, 1/27/2009 Hypertension (Sys nistered Tdap, no previous allergy toY Td, was being Y worked up for allergy 13 - tested + seafood N and almond;4/15/2009 approx 154/15/2009 minutes after vaccine d m, red, bruised spot on the left arm at Y injection site. Prednisone given orally. Y 5/12/2009 5/13/2009 er arm redden and swollen. Child complains of pain. Mother Bendryl. Applied ice. Y 5/7/2009 5/7/2009 esented to the emergency department Y complaining of generalized rash and itching. Patient was Y treated with 4/6/2009 benadryl4/9/2009 and released home a ite red and swollen x 1 day, diagnosed with cellulitis at injection site, treated with Sulfatrim xU10 days 5/12/2009 5/13/2003 e series of 3 injections and after the Ypatient developed Y utis, uris, strep 3 throat 3 times, joint pains, N muscle weakness, ### numbness, ### insomnia, m ports that after receiving shot of gardasil abd menectra on 02/25/2009 she became very sleepy Y but not lethargic 5/13/2009 and5/13/2009 experienced a severe SEEMED TO HAVE PROFOUND HEARING LOSS FOR 2 DAYS AFTER HER VACCINATIONS. Y SHE DID 2/26/2009 NOT RESPOND 5/13/2009 TO HER NAM en hpv vaccine pt was then found to be pregnant Y 6/8/2007 was reported by a healthcare professional Y and described the occurrence of shoulder pain inNa 40-year-old 4/14/2009 female subject 4/19/2009 who was vaccina ations. - Fever, chills. - Local cellulitis. 5/15/09 Y Medical records received 2 (hosp discharge summary Y included) 4/29/2009 DOS 4/29 4/29/2009 and 5/1/09 to 5/3/0 nd decreased appetite started Y after he Y receivedY5/1 immunizations - developed night sweats,Ncold symptoms, 5/1/2009 bruising5/3/2009 - hospitalized 5/11/09 esented to hospital with 1-day history of bleeding, Y bruising and low platelets. 3 History includedY epistaxis, left 4/20/2009 elbow bruise 5/11/2009 and a platelet coun elling, redness within 48 of receivingYDTAP R deltoid. Y 5/9/2009 5/9/2009 d redness, swelling locally in Rt. deltoid Y where administered. Systemic chills without fever, myalgias. Y 5/6/2009 5/7/2009 d Varicella vaccine (lot #0336Y) SCYin L lateral thigh on 5/4/09, as well as Hep A vaccine IM.YSeparate areas 5/4/2009 of induration 5/4/2009 found on L thigh ed vaccines TDAP, Hep A + VARIVAX @ 2:30 pm, Pt waited 15 min after vaccines. Pt was fine. U It was around 5/13/2009 3:07 5/13/2009 pm when Pt came to Do redness, pain, warmth at injection site. Patient seen at clinic and back in primary physician'sYoffice. 5/11/2009 5/13/2009 1/4 inch upper arm redness, blanches, not warm, no streaking c/w immunization reaction Y 5/12/2009 5/14/2009 Erythematous Wheals all over bodyY+ itchiness TX: Benadryl 25mg to tabs PO 4-6 Hrs for itchiness. Y 5/11/2009 5/11/2009 d redness, heat and swelling yesterday. Area red hot, 0 induration noted, minimal swelling toYsite. Approx 5/11/2009 12cm across. 5/10/2009 No itching or pain. Mother noticed L arm red @ injection site. 5/4/09 blisters on L upper arm with redness + tenderness Y at the 4/21/2009 base. Mom 5/3/2009 called child's Dr + h gnant female, ADSM, reports receiving Flu Mist vaccine on 17 October 2008 despite being 38 U weeks gestation. ### The service ###member decid rgic reaction at site of injection. Y Y 4/25/2009 4/25/2009 female presents for walk-in appt, with "itchy, little red bumps that look like mosquito bites" on Y arms, chest, 3/10/2009 abdomen3/16/2009 and back 10-days s/p ale, ADSM, is referred to the Transition Y Unit for several day h/o nausea and vomiting associated U with his receipt ### of Flu Mist ### vaccine on 28 O linic (06May09) re 22 y/o AD WM SM Y w/ 10-12 tiny vesicular lesions surrounding primary SPV Y injection site 4/29/2009 RUE. SM5/6/2009 received primary SP h left arm, swelling, no fever or vomit. Pt was seen today Doctor 5-22-09. U 5/12/2009 5/13/2009 tchiness, redness at site of injection (L deltoid) 5 - 6 cm reaction - round - slightly erythematous U lesion. Slight 5/1/2009 induration, 5/3/2009 no fluctuance. s down on R side of face when crying or drinking. Began 1 week ago (approximately 4/30) ?Nmild Bells Palsy. 4/28/2009 4/30/2009 2" urticarial patch over injection sites on right thigh - started at the MMR site - enlarged to cover Y both sites. 4/24/2009 4/24/2009 ination on way home mom said lips got swollen and child broke out in fine whelps. Gave TYLENOL Y and BENADRYL. 5/7/2009 5/7/2009 On 5-7-09 left arm at swollen lymph nodes under jaw on April 30. N 4/21/2009 4/30/2009 ptoms 2 wk recovery complete physical breakdown felt as if hit by a truck" weak, chills, pain back Y + ribs; chills; 4/2/2009 nausea; 4/24/2009 loss of appetite; che d rash on 1 thigh, warm to touch Y 5/6/2009 5/7/2009 njection given - HEPA. HEPB & INFLUENZA given 0845 - Patient feeling weak, dizzy, chestYtightness, HR60 5/14/2009 blood5/14/2009 pressure 60/40 0850 vaccination: Next few days had increased swelling hardness, heat (hot) Redness cont to spread Y also itching 5/4/2009 + aching5/4/2009 + soreness - spoke w erythema - mom described as the size of a baseball tx with BENADRYL 5/13/2009 5/15/2009 Feverish, C/o "feeling sick" 5-15-09 Employee came to Employee health with pea sized knotYleft upper inner 5/11/2009 arm. lymph 5/12/2009 node also red blot tion (KINRIX) given on 5/12/2009; mom noticed and reported localized swelling of L arm on 5/14/09, U arm5/12/2009 swollen to 5/14/2009 twice the normal size fr hives occurred that pm or next am. Patient has DX of urticaria Dermatitis. HX of local reaction Y to latex band 4/29/2009 aids- only 4/29/2009 RX for this incidence Rt arm inflamed and swollen from shoulder Y to elbow - no pain, no fever - when picked up from U day care. 4/28/2009 4/30/09 - Arm 4/29/2009 unchanged - still no
blisters up both arms. Treated with BENADRYL 25mg x 2 doses and antibiotic cream to blisters. 4/30/2009 4/30/2009 treated with BENADRYL 6.25mg Q4hr prn. Y 5/6/2009 5/6/2009 reaction at IM injection site left deltoid. + redness, swelling and warm to touch. Treated with YTYLENOL, BENADRYL 5/8/2009 5/9/2009 and warm compresses e fever (101), diarrhea, mild irritability starting 48 hours after vaccination. Y 3/19/2009 ness and swelling in L arm 24 hours after injection at site of Sub Q injection of VARIVAX. Y 4/29/2009 4/30/2009 nset one hour after vaccination, at site. Treated with 25 mg Diphenhydramine P.O. . Y 4/29/2009 4/29/2009 Tdap around 9:00-9:30 am at school; Y felt drowsy all day afterwards. Later that evening felt tired, Y weak, dizzy, 5/5/2009 chills and 5/5/2009 fever of 102.6. com ministered 0.5 cc of Tdap to client. Expiration date was checked before administration of vaccine U but still was 5/4/2009 not realized til entered into gr IZ's 4.29.09 - 5-1-09 pale, fever by evening was in Reno all day that day. 5-1-09 Fever increasedY unknown temp as no thermometer. W ->72 hours : 5 x 7 cm erythematous raised area with small papules (no vesicles). RecoveredYwith Rx. Sl.4/27/2009 increased 4/28/2009 color. Afebrile. an at injection sites on right arm. Patient received Varicella and Hep A vaccines in right arm.YHives spread5/6/2009 to legs, groin 5/6/2009 and upper arms. N creased temperature. Seen in Hospital Y emergency room. Y 5/7/2009 - red and swollen with small hard lump. Y 5/5/2009 5/6/2009 ay 8- joint and muscle pain, fatigue Y and lymph node swelling. 2/28/09 Day 9- symptoms became severe,2/20/2009 site painful.2/28/2009 3/3/09 Day 12- evalua site red and swollen x 1 day, diagnosed with cellulitis. Treated with a 7 day course of amoxicillin U 5/12/2009 5/13/2003 brought in for office visit two days after Y immunizations d/t fever and localized rash to L thigh.YDescribed 4/13/2009 by NP as tennis 4/14/2009 ball sized, raised, brought in for an office visit six daysY after immunizations were given for localized rash of R arm Y around injection(s) 4/7/2009 site. 4/12/2009 Was treated for dia vaccine on may 12,2009 at 4:19pm. Later in evening developed body aches, chills and "fever in side". Left 5/12/2009 arm became 5/12/2009 swollen and red. esented to our office on 5/14/09 with a 2.5in circular swelling @ the injection site. She was diagnosed Y with 5/11/2009 either cellulitis 5/14/2009 of the injection si , swollen, hot area on left upper thigh, no discomfort and gait problems Y 5/12/2009 5/14/2009 d her first rabies vaccine on 3/25/09Yand 2 days later had flu-like symptoms, sore throat, "bad" N cough, fever, 3/25/2009 chills, excessive 3/27/2009 tiredness and er aspect of arm extending light redness 100mm radiating from injection site with darker redness N extending 5/13/2009 50mm from 5/15/2009 injection site radially d chest pain and palpations after second Y gardasil vaccine. Cardiac evaluation is underway. 5/26/09 N Medical records ### received ### DOS 12/30/0 ythamatous, tender lesion at injection Y site U 5/13/2009 5/14/2009 ollen and knot the size of a quarter Y at first on5/13/09 pm. Arm s/s increased and pt seen in Y ER and tx with 5/13/2009 Benadryl. 5/13/2009 Mom reported on 5/1 5 yo vaccines today, kinrix, MMR and Y var.ÿ Rash developed about 20 minutes after they leftYthe clinic.ÿ Very 5/14/2009 itchy.ÿ5/14/2009 Started on neck and w as given Gardisil instead of Menactra Y 5/12/2009 n (786.59) 5-000009 6/10/09 Medical records Yreceived DOS 1/21/09 to 2/3/09. CLINICAL IMPRESSION: U 1/13/2009 Palpitations 2/3/2009 resolved. Post vacci ew days of receiving Menactra vaccine, Dylan developed Y toe numbness 10 then headache, nausia, Y followed3/19/2009 by foot dragging, 3/20/2009 impaired joint po esented 24 hours later with redness about the size of a half dollar, with tenderness to the touch. U Recommended 5/14/2009 cool 5/15/2009 compresses and trea ELTS" ON LT ARM TOWARDS THE OUTSIDE-MENACTRA GIVEN IM ON OUTER ASPECT Y OF DELTOID 5/14/2009 MUSCLE 5/15/2009 & HEP A GIVEN TO month old male presents with c/o Skin Check: for 4 days had Immunizations on 4/17/09 and now Y has a red, 4/17/2009 hard, warm 4/19/2009 to touch area below ssion from E.R.,recieved Pneumovax in ER, c/o R tricep swelling, pain, itching, observed swelling, Y edema, 4/16/2009 warmth,redness, 4/16/2009notified Dr. Ea ame in to my office 5/15/09 1350 to report neck stiffness and head pressure that started 5/15/09 U PM. 5/13/2009 5/14/2009 as given MCV4 and Var #2 in her left arm. Mom stated that patient had a history of feeling light Y headed with 5/15/2009 any type 5/15/2009 of procedure/lab test. experienced a short duration of minor pain and redness at injection site each time the vaccine Y was administered. 5/8/2008I was 1/22/2009 pregnant during my lt with swelling and redness within 4-6 hours after immunization Y 5/12/2009 5/12/2009 arm injection site swelling but not painful, with some redness. Y 5/2/2009 5/15/2009 d erythematous rash at site of vaccine. Y 5/15/2009 5/15/2009 day after shot with a rash widespread over the body and some puffiness to her eyes. Urticaria. U 5/11/2009 5/12/2009 ss Criteria: Other- Medically Significant. Y Initial report received from another manufacturer Y (other manufacturer's 4/21/2009 control 4/22/2009 number: WAES 090 9 cm, warm, erythematous area @ previous injection site. Mom states area doubled since injection. N 5/11/2009 5/12/2009 d reaction right thigh. Y 5/5/2009 5/6/2009 was reported by a healthcare professional Y and described the occurrence of fainting in a 13-year-old Y female 5/12/2009 subject 5/12/2009 who was vaccinated wi ceived vaccine 5-8-09; noticed erythema, Y tenderness and warmth 5-9-09 (10x10 cm area at Y injection site).5/8/2009 Doctor visit 5/9/2009 5-11-09. Prescription ced redness @ swelling to right deltoid area this morning. Y 5/14/2009 5/15/2009 of inflammation occurred immediately after injection given at injection site. Red are had pin point Y areas and 5/13/2009 facial areas 5/13/2009 also flushed. MD n red skin in roughly rectangular shape over left anterior thigh surrounding the injection site. About Y 9cm x 5cm. 5/5/2009 Emerged 5/11/2009 6 days after vaccina mplaints of dizziness, Pt put head on desk. At 1:38 pt vomited small amt, color pale, clammy, Y alert oriented 5/15/2009 B/P 100/72 5/15/2009 - Pt states she is h urs after receiving injection size 2X2 inch in circumference pruritus, pain + Erythema Tx Benadryl Y + Cold compress. 5/8/2009 5/9/2009 d 4.5mm x 5mm areas + redness, swelling Y and tenderness at site of injection L upper thigh. No Y significant 5/13/2009 systemic 5/13/2009 reactions due to vaccine
ction Left deltoid; erythema/ edema Y and pain. U 5/13/2009 5/14/2009 red and swollen. Y 4/28/2009 4/29/2009 ves over entire body, headache, itchy throat. Y 5/15/2009 5/15/2009 ed vaccinia with diffuse rash, myalgias, Y fever, and robust take. Treatment with indocin and benadryl.. Y 4/29/2009 5/4/2009 y of the shot, the injection site had minamal Y swelling; however the following starting occuringUthe day after 5/11/2009 the shot, 5/12/2009 Severe swelling of lymp Mom reports body rash for 9-10 days and vomiting 1-2 times daily from 11-28-08 until 12-2-08; Y also "change of### attitude" screams ### loudly at t n has been received from a consumer Y concerning her 24 month old nephew who was vaccinated U with MMR II when he was 18 months old. n has been received from a consumer Y concerning her 2 years old son with a history of cross-eyes N operation 11/1/2005 who in November 4/1/2007 2005, was v n has been received from a registered Y nurse concerning Y a 16 month0 old male with Down's syndrome N and7/1/2008 cardiac issues, 5/8/2009 and a history of a n has been received from a registered nurse for the Pregnancy Registry for GARDASIL concerning Y a 2512/4/2006 year old female 8/30/2007 who is a Guillain B n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL concerning a 22 Y year old patient 9/20/2006 who 9/20/2006 on 20-SEP-2006 was v n has been received from a nurse concerning aY14 month old female 0 who was vaccinated with U all three doses of ROTATEQ (dates, route a n has been received from authors of a published Y literature article concerning Y an 11 year old N male patient who was vaccinated with PNEUM vaccines rec'd 10/18/07 and 11/20/07. Y 3 mos later Y developed Guillain-Barre 5 syndrome/was hospitalizsed Y for acute ### lower 2/5/2008 extr. weakness. 5 4/28/09 after sx has resolved. Stated that 12 hr after Td-had arm soreness, faint pain in knees, Y felt like fever, 4/24/2009 enlarged 4/24/2009 lymph node under (L ches erythematous area on left arm, Mildly elevated. Still present 72 hours after vaccination. U 5/15/2009 @ injection site edema pain. Y Y 5/11/2009 5/12/2009 c received HPV, MENACTRA, Hep A, Tdap - observed pt. 15 min. after vaccinations. Pt. later Y reported she 5/13/2009 couldn't 5/13/2009 quite hear several hour ceived VARIVAX immunization 5/11/09, mom noticed rash on arms, legs and trunk 5/13/09. Y 8-10 small slightly 5/11/2009 raised 5/13/2009 lesions on arm, leg an Y U 4/28/2009 5/15/2009 vaccination, (hours later) redness and Y swelling developed around injection site. At ER, patient U was given 5/13/2009 ibuprophen 5/13/2009 and benadryl. 2 day alergic reaction to left thigh Y 5/12/2009 5/15/2009 apular rash post auricular nodes U 4/24/2009 5/3/2009 esented to the Emergency Room approximately Y 27 hours post vaccination with injection site Ycellulitis. Symptoms 5/13/2009 included 5/14/2009 reddness, heat ven Menningicoccal vaccine at approx. 9 am. at 930 am she started to feel dizzy and was beginning U to get 5/18/2009 a headache. 5/18/2009 Her father was calle 9 Adriana returned to have a TST read. PHN observed right arm triceps area reddened, firmYand warm 5/12/2009 to touch in an 5/13/2009 area 3 1/2 by 2 inche plained swollen area about size baseball Y noted under left arm noticed soreness under arm to U chest area5/14/2009 . This was5/16/2009 first noted on 05162009 erated vaccine well, but upon leaving office (within 5 minutes) was "not feeling well" per mom. Y While in car, 5/14/2009 continued 5/14/2009 to complain of not fee E OUT WITH PIMPLES ON FACE. SLIGHT REDNESS Y 5/18/2009 5/18/2009 slight fever and flu like symptoms and a base ball size knot that was warm and tender and decreased Y ROM 5/8/2009 2 days 5/10/2009 post shot. When pt repo baby on 5/11/09. Got MMR while still Y in hospital on 5/13/09. 2 hours later c/o numbness of tongue. N Later5/13/2009 c/o pain and 5/13/2009 tingling of l neck and d localized swelling at injection site which lasted 48 hrs. Y 5/15/2009 5/16/2009 d hard bump in arm that grew in size. She felt itching in the arm of injection that spread over Yentire body.5/18/2009 She had the 5/18/2009 previous two hepatitis s administered vaccines, before giving Y vaccine client said he had taken some Benadryl recently Y for allergies. 5/14/2009 After receiving 5/14/2009 vaccines client as given Vaccines and 48 hours later began having Y fevers and resultant 3 febrile seizure. HadYan ear infection 5/13/2009 noted 5/16/2009 at the appointment whe 9 the patient was given the meningitis vaccine: Meningococcal (MENACTRA) Polysaccharide Y accination4/28/2009 injection given 4/29/2009 in the left deltoid b atigue, migraines, nose bleeds, muscle Y & joint pain, sensitivity to light, mood swings, irritable,Nbrain fog, dizzy 5/10/2007 spells,6/11/2007 trembles, numbness, b where the vaccine was adminstered, which is the left shoulder, has been extremely sore and N I am unable 4/25/2009 to lift my arm 4/28/2009 up over my head, ne hing began less tan 12 hours after first Y hepatitis B vaccine; no hives/blisters; mother treated Y today for poison 5/11/2009 ivy exposure 5/18/2009 eltoid from Prevnar administered on 05/13/2009. left deltoid 5x4 erythemetous lesion, not indurated, Y nontender. 5/13/2009 ice 5/14/2009 and 12.5mg benadryl tw e of vaccine(prevnar) left deltoid 7x7 indurated erythemetous tender macualar eruption Ice, benadryl Y and5/13/2009 motrin 5/14/2009 e weak and dizzy while walking outside to car. Pt had syncopal episode and fell on sidewalkYoutside clinic. 4/27/2009 Her sister 4/27/2009 reports seeing her st eived Zostavax in am on 05/14/2009. The visit was uneventful. On 05/15/2009 she came back Y to the HD 5/14/2009 stating her 5/15/2009 r. lower arm was sore 1.9), achiness, headache, throwing Y up the morning after the shots, feeling week Y 5/12/2009 5/12/2009 NDURATED AND ERYTHEMATOUS. AREA 5CM BY 10CM STARTING AT INJECTION SITE U AND EXTENDING 5/12/2009DISALY CINE WAS INJECTED ON HER UPPER LEFT LEG. THE AREA WHERE SHE HAD THE VACCINE Y GOT5/4/2009 INFECTED. 5/11/2009 IT WAS PURPLE AN ted 4/15/09, chicken pox. Elevated IGG 1550 on 4/16/09. Transmitted to 9 mon old sib whoUalso tested IGG 4/7/2000 positive. 4/15/2009 after vaccines Y 5/18/2009 5/18/2009 d raised, reddened, approx 4 1/4 in x 3 1/2 in area painful and warm to touch. Left arm Posterior Y subqutaneous 5/4/2009 area 5/7/2009 has reddened area ap ed in clinic Td and Pneumovax injection. Pt states that evening she was ambulanced to ER with U severe body 5/15/2009 aches,5/15/2009 chills, and diaphoresis sh all over body, no urticaria, feels sandpapery Y 5/18/2009
er her first shot patient started having Y episods of what we thought were panic attacks. She had N a hard time 6/11/2008 breathing, 6/12/2008 her heart would race ad dizziness, nausea and vomiting Y on and off since HPV was given 3/16/09, associated withUbody malaise. 3/16/2009 There was 4/2/2009 no reported fever. rst booster injection given (April 8, 2009 Y I think) I experienced left arm itchiness with small bumps U 1 week5/15/2009 post the injection. 5/16/2009 The injection si p at injection site. Sore arm. Achey muscles. Y 5/12/2009 hing, unresponsive. Fussiness, fever, Y decreased Y appetite. 6/3/09 Hospital 1 records receivedYDOS 5/15/09 5/15/2009 to 5/16/09. 5/15/2009 FINAL DIAGNOSIS: d swollen with redness and pain. Y 5/13/2009 5/13/2009 was reported by a pharmacist and described the Y occurrence of decreased 0 oxygen saturationY in a neonate4/6/2009 male subject 4/6/2009 who was inadverte -104 X 2 days Y 5/12/2009 5/14/2009 en/red 2 days after vaccine administered Y (left thigh). Y 5/15/2009 5/17/2009 A and Influenza shot on 4/14/09 and SPV 4/16/09. She returned to the Imm Clinic on 4/23/09 for evaluation 4/14/2009 of SPV4/23/2009 (major take); pt reques g of day of shots - She developed chills vertigo, nausea (still able to drink.) confined to bed - Y missed school 5/12/2009 next day.5/12/2009 Mom states " this sens given in R thigh- 48 hours later, thighY with edema + splotchy erythema. R thigh 33 cm diameter, Y L thigh 29 5/13/2009 cm. At 72 5/12/2009 hours, rash worsened S B #2 (accelerated schedule) given Y 4/15/09 - later on 4/14/09 pt called with "arm burning". YNo other symptoms 4/13/2009advised 4/14/2009 ADVIL/cold comp nflammation 3 cm Rx for Benadryl given. Y 4/21/2009 systemically see clinical data report.Y Y 5/5/2009 5/6/2009 swelling-hard and warm to touch . Left Y upper thigh 8"x5" (redness). Seen at hospital. DX: cellulitis. Y RX: BACTRIM. 5/8/2009 5/9/2009 5/11/2009 Y Y 5/8/2009 5/9/2009 tous, swollen, large local reaction greater then 30cm 1 week after vaccine for DTAP. Y 4/16/2009 4/21/2009 4/14/2009 h red, indurated 1 1/2 - 2" area Y 5/5/2009 5/6/2009 which began a couple of hours after receiving vaccine. U 5/12/2009 5/12/2009 per right arm appeared red, swollen and hard with a measurement of 60mm induration. Patient N denied any itching or difficulty breathing. called back 2 days after ER visit to notify Y us that patient was very weak + had drowsiness, a Y "knot on the4/15/2009 left arm". The 4/15/2009 was patient last dos was reported in a literature article and described the occurrence of hepatitis B antigenemia in Y a 111-day-old subject of unspecified gender me in for Flu vaccine, Right and TDAP, Left. Complaint of pain and swelling next day- c/o very painful. Called 5/1/2009 PMD today-appointment 5/2/2009 mad injection site, right arm. Erythema right Y arm. Taking BENADRYL about every 8 hours. Y 5/8/2009 5/9/2009 d 13X14 CM Swollen, Redness, warm Y to touch. Apply cold compress (ice) every 2 hrs for 15Umin. Then warm. 5/5/2009 5/5/2009 ould have received a Tdap patient was administered a DTaP. No adverse event reported. Patient Y notified 5/11/2009 of mistake. orts that after HPV vaccine given on 2/27/09 she went home, started feeling dizzy, had chestYpain, rapid 2/27/2009 heart rate and 2/27/2009 vomiting for 3-4 day en lump L thigh. Y 5/7/2009 5/7/2009 esicles at injection site, followed by patch Y of erythema & induration expanding to 8 X 10 cm by 5/13/09. Borders 4/28/2009 slightly 4/30/2009 raised, mildly tende ceived VARIVAX vaccine on 12/19/97 and 6/27/08. Exposed to chicken pox vaccine 2 weeksY ago. Developed 6/27/2008 chicken 5/10/2009 pox rash on 5/10/09. iven 5/1/09 pri 5/1 - 5/09 Redness + swelling at site 5/5 - 8/09 no fever/chills. No antibiotics Y given. 5/1/2009 5/1/2009 receiving vaccine, mild swelling and tenderness of left upper arm / L axilla. Y 5/6/2009 5/8/2009
generalized. Benadryl 6.25 BID X 5 days ; weak 2y in Y 5/6/2009 5/11/2009 M ADSM is referred from a study for evaluation of previous local reaction to AVA #2. Symptoms: Y Edema8/12/2007 @ injection8/12/2007 site 50-120mm, Pain, tion to the pertussis in DTAP #5. Became pale approx 15-30 minutes after imm in peds. Returned Y to peds5/5/2009 at Dr.'s direction. 5/5/2009 Place on exam 9 1150/AM.- MMR #2 given. 730/PM. Y Pt had seizure taken to ER s+s unknown. Y 4/28/2009 4/28/2009 received first GARDASIL shot in June 2008. She passed out and hit her head getting a concussion N -the Dr 6/1/2008 believed-. She had to stay in be y MD on 3/13/09. Pt c/o rash in dermatome pattern from right lower flank which extends down U and wraps2/20/2009 around to ant 3/6/2009 thigh. Sx started 7 d n has been received through the Merck pregnancy registry, from a registered nurse concerning Y an approximately 1/20/200818 year old female with n n has been received from a registered Y nurse for the Pregnancy Registry for GARDASIL, concerning N a 222/22/2008 year old female 2/22/2008 who on 22-FEB-2 n has been received from Merck Pregnancy Y Registry for GARDASIL from a health care worker Y concerning2/7/2008 a her 15 year 7/1/2008 old daughter with n has been received from a physician Y and a registered nurse concerning a 10 years old female Y patient who 3/6/2008 on 06-MAR-2008, was vaccina n has been received from a physician's nurse concerning a female who in 01 July 2008, wasYvaccinated with 7/1/2008 GARDASIL 7/1/2008 vaccine (Lot# and n has been received from a registered Y nurse and a 26 year old female with no pertinent medical N history and 2/17/2009 no history of known drug react n has been received from a 20 yearYold female patient with no relative medical history, drug N reactions or allergies 3/1/2009who 3/1/2009 was vaccinated with n has been received from a physician Y concerning a 21 year old female who on 18-MAR-2009 Y was vaccinated 3/18/2009 intramuscularly 3/18/2009 with a first do n has been received from a 28 yearYold female patient with irregular heartbeat and no allergies N who in June 9/1/2007 2007, was 10/1/2007 vaccinated with the
n hs been received from a physicianY concerning a 15 year old female who was vaccinated with U GARDASIL. The patient developed genital n has been received from a physician concerning a either 15 or 16 year old female who wasYvaccinated with a dose of GARDASIL (lot num n has been received from a nurse concerning a 9 year old female with sore throat on 23-FEB-2009 N who 2/23/2009 was vaccinated with her first dose n has been received from a 30 year old female with no medical history reported, who on 24-JAN-2009 N was 1/24/2009 vaccinated 1/24/2009 with a 0.5 mL dose o n has been received from a nurse concerning a 23 year old female with a penicillin allergy who Y on 02-APR-2009 4/2/2009was4/2/2009 vaccinated with GAR n has been received from a nurse practitioner concerning a 19 year old female patient with no Y previous medical 3/27/2009 history 3/27/2009 reported who on 27 n has been received from a physician Y concerning a 13 year old female with a history of cancer N who was vaccinated with a first and second n has been received from a mother concerning her 14 year old daughter, with inflammatory N bowel disease 9/29/2008 and not known drug reactions/al n has been received from a Nurse Practitioner (N.P) concerning a 20 year old female patientNwith no pertinent 3/16/2009 medical 3/26/2009 history and no know n has been received from a registered nurse concerning a female patient who on 30-JAN-2009 U was vaccinated 1/30/2009 with1/30/2009 the first dose of GARD n has been received from an office manager concerning a female who was vaccinated in theUphysician's office with a second dose of GARD n has been received from a consumer who in January 2008, was vaccinated first dose of with U GARDASIL1/1/2008 (dose, route 1/1/2009 and lot number not p n has been received from a registered nurse concerning a 16 year old female with no knownYdrug reaction/allergies 4/3/2009 and 4/3/2009 no pertinent medic n has been received from a nurse practitioner concerning a female patient with allergy to Ceclor, U who on3/31/2009 31-MAR-2009 4/1/2009 was vaccinated wit n has been received from a nurse practitioner Y concerning a 19 year old female patient with no Y pertinent medical 2/4/2009 history 2/7/2009 or no known drug a n has been received from a 27 yearYold female with sulfonamide allergy who "about a year ago", Y in approximately 1/1/2008 2008 1/1/2008 was vaccinated wit n has been received from a physician Y concerning a female who on 22-DEC-2008 was vaccinated Y with the 2/18/2009 first dose2/18/2009 of GARDASIL vaccine. n has been received from a physician concerning a 20 year old female who on 30-MAR-2009 N was vaccinated 3/30/2009 with her 4/3/2009 first dose of GARDA n has been received from a physician Y concerning a 21 year old female patient who on 25-SEP-2007 N was9/25/2007 vaccinated with ### the first dose of G n has been received from a physician concerning a 20 year old female who on 02-APR-2009, U was vaccinated 4/2/2009 intramuscularly 4/2/2009 with third 0.5 n has been received from a physician Y concerning a 19 year old female who on 13-NOV-2008 U was vaccinated with ### first dose of GARDASIL n has been received from a registered Y nurse, for the GARDASIL vaccine a Pregnancy Registry U concerning 3/30/2009 a 17 year old female with sulfa n has been received from a registered Y pharmacist concerning her 17 year old daughter with Nno pertinent4/29/2008 medical history, 5/5/2008 who on an unspe n has been received from a registered nurse concerning a female who on an unknown date,Uwas vaccinated with GARDASIL (lot # not repo n has been received from a licensed practical nurse concerning a female with no drug reaction/allergies Y who was vaccinated with the first 0 n has been received from a Pharm. T. concerning a 23 year old female with sulfonamide allergy N and a 3/16/2009 history of birth 3/21/2009 control who on 16-M n has been received from a female staff member in a physician's office but not healthcare professional U concerning 5/16/2008 her 14 year old daughte n has been received from a nurse concerning Y a 15 year old female patient with no relative medical N history, 3/25/2009 drug reactions 3/27/2009 or allergies who i n has been received from a consumer concerning her daughter, a female patient, who on anUunspecified date was vaccinated with a dose n has been received from a practiceYmanager concerning a 22 year old female patient who on Y 06-FEB-2009 2/6/2009 was vaccinated 2/6/2009with her first d n has been received from a bachelor Y of science in nursing concerning a female who on 03-APR-2009 Y was4/3/2009 vaccinated 4/3/2009 with the second dose n has been received from a registered nurse concerning a 19 year old female patient with anemia, Y herpes type### 1 since July ### 2005 and sulfa n has been received from a registered nurse concerning a 17 year old female who on an unknown N date, received her 3/31/2009 second dose of GAR n has been received from a licensed Y vocational nurse concerning a female who on 04-OCT-2007 N was vaccinated 10/4/2007intramuscularly 10/4/2007 with a firs n has been received from a physician Y concerning a female who was already being treated for U vulvar Condyloma (genital wart) and was vac n has been received from a Registered Nurse (R.N.) reported that in February 2009 an unknown U number 2/1/2009 of patient may 2/1/2009 had received a dos n has been received from a Registered Nurse (R.N.) concerning an 18 year old female who Y on 02-APR-2009 4/2/2009 was vaccinated 4/2/2009 intramuscular n has been received from a physician concerning an approximately 15 year old female patient Y who was vaccinated 3/1/2009 with 3/1/2009 her first dose of GA n was received from a nurse practitioner Y concerning a 22 year old with a needle phobia and Uadmitted to 3/21/2009 passing out3/21/2009 with piercings and tatto n has been received from a physician Y concerning a 26 year old female at a high risk to allergies, U with penicillin 3/23/2009 allergy 3/24/2009 and a history of hosp n has been received from a licensed Y visiting nurse concerning a female with no pertinent medical N history10/4/2007 or drug allergies 10/4/2007 who on 04-OCTn has been received from a physician concerning two 17 year old female who on an unspecified Y date were vaccinated with a 0.5 ml second n has been received from a consumer Y concerning her daughter, a 17 year old female patientYwith no relevant 3/27/2009 medical 3/27/2009 history, drug reaction n has been received from a pharmacist concerning a patient who was vaccinated with a second U and third4/8/2009 dose of GARDASIL 4/8/2009 (lot # not rep n has been received from a physician concerning an unknown number of female patients with U no pertinent medical history or drug allergies n has been received from a Registered Nurse concerning a female who on an unspecified date U was vaccinated with GARDASIL and exper n has been received from a 46 yearYold female with allergies to sulfa and ATARAX and no pertinent N medical 3/30/2009 history3/30/2009 who on 30-MAR-2009 n has been received from a physician concerning a 14 year old patient who on 05-MAR-2009 Y was vaccinated 3/5/2009 with the 3/5/2009 first dose of GARDA n has been received from a physician concerning a patient who experienced heavy menstrual U bleeding about a year ago after receiving a d n has been received from a physician Y concerning a 19 year old female with no medical history N and drugs 3/6/2008 allergies, who 3/21/2009 on 06-AUG-2007 w n has been received from a consumer concerning her daughter, a 15 year old patient with no N pertinent medical 4/7/2009 history 4/7/2009 and no known drug
n has been received from a consumer concerning his 22 year old female wife who on 16-APR-2008 N was vaccinated with the first 0.5 mL do n has been received from a medical assistant concerning her 12 year old daughter with no pertinent N medical 4/6/2009 history reported 4/6/2009and no known n hs been received from a physician concerning a patient who on an unspecified date was vaccinated U with a dose of GARDAIL (dose, route n has been received from a dentist concerning her 13 year old daughter who on 08-APR-2009 N was vaccinated 4/8/2009 with the 4/9/2009 first dose of GARDA n has been received from a physician Y concerning a 15 year old female patient with no known N drug allergies/drug 2/5/2009reactions 3/31/2009 who on 05-FEBn has been received from a nurse practitioner Y concerning a 17 year old female who on 13-AUG-2007 U was 8/20/2008 vaccinated 8/20/2008 with the first dose of n has been received from a healthcare Y worker concerning a 12 or 13 year old female patientYwith no relative 1/22/2009 medical 1/22/2009 history, drug reactions n has been received from a physician concerning a 25 year old female teacher with no knowNdrug allergy 4/1/2009 who on 01-APR-2009 4/5/2009 was vaccin n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 2/26/2009 her daughter, an approximately 1 n has been received from a physician Y and a registered nurse concerning a 19 years old female N patient who 1/7/2009 was vaccinated 3/1/2009 with a complete n has been received from a physician Y and a registered nurse concerning a 27 years old female Y patient who 6/13/2007 was vaccinated 12/5/2007 with a complete n has been received from a physician Y concerning a female patient who was vaccinated with Na complete series of GARDASIL. It was reporte n has been received from a 25 year old female with no medical history and drug allergy whoUwas vaccinated with her second dose of GARD n hs been received from a consumer concerning a 10 year old female who was vaccinated with U GARDASIL. Then the patient started to fee n has been received from a female patient who was a medical assistant and a physician concerning Y the 2/18/2009 patient who2/19/2009 was vaccinated with h n has been received from a registered Y nurse concerning her daughter who 02-FEB-2009 was N vaccinated10/3/2008 with her third dose ###of GARDASIL n has been received from a physician assistant concerning a 21 year old female with no medical N history 1/27/2009 or drug allergies 4/1/2009 who was vaccinat n has been received from a registered Y nurse concerning an 18 year old female with a historyNof cardiac murmur 4/7/2009 who 4/9/2009 on 07-APR-2009 was n has been received from a registered nurse concerning an 18 year old female with asthma Y and no known 4/13/2009 drug allergies 4/14/2009 who on 27-JUN-2 n has been received from a registered nurse concerning a 27 year old female who on an unspecified N dates was vaccinated with the three d n has been received from a nurse concerning a 17 year old female patient who in approximately Y January 2009 (reported as about 3 months n has been received from a pharmacist Y reported that he received a call from a mother concerning N a 14 female ### daughter who was vaccinate rmation was received from a physician, and follow up information from a nurse concerning a Y female patient who was vaccinated with her se n has been received from a Licensed Visiting Nurse concerning a 12 year old patient who onU03-APR-2009 8/6/2008 was vaccinated 8/6/2008 with the first do n has been received from a physician concerning a female patient who "last year" in 2008 was Y vaccinated with her second dose of GARDA n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 19 11/4/2008 year old female 11/4/2008 with no relevant n has been received from a physician assistant concerning a 16 year old female with negative Y medical history 4/13/2009 who on 4/13/2009 13-APR-2009 receiv n has been received from a physician Y assistant concerning a 29 year old female patient whoNon 13-APR-2009 4/14/2009 was vaccinated 4/15/2009 with GARDA n has been received from a registered Y nurse, for GARDASIL, a pregnancy registry product, Y concerning a 6/3/2008 16 year old 3/25/2009 female who on 03-JU n has been received from an office Y manager who stated that she received this report from the U patient's mother. The patient's mother had re n has been received from a physician Y assistant and nurse concerning a 17 year old female who Y on 25-DEC-2008 ###was vaccinated ### with the f n has been received from a nurse practitioner concerning a 24 year old female with KEFLEXYallergy and3/30/2009 irregular heartbeat 4/6/2009 who on 30-MA n has been received from consumerY concerning her 17 year old daughter who"2 or 3 months U ago" was 4/13/2009 vaccinated 4/14/2009 with the first dose of GA n has been received from a physician and his office manager concerning a 25 year old female N with a history 4/11/2009 of bladder 4/13/2009 repair in July 2007 d n has been received via medical record Y from a registered nurse concerning a 16 year old female Y with heavy 3/20/2009 menstrual 3/22/2009 periods (last menstr n has been received from an office assistant and a female patient who on 19-MAR-2009 was N vaccinated3/19/2009 the first dose 3/26/2009 of GARDASIL. Conc n has been received from a registered Y nurse and a licensed practical nurse from patient's report Y and emergency 2/16/2009 room 2/16/2009 (ER) records concer follow-up information has been received Y from a licensed nurse practitioner concerning a female U patient who on an unknown date was vacc n has been received from a physician Y and a licensed visiting nurse, concerning a 11 year oldNfemale patient, who ###on12/1/2008 13-AUG-2008 was va n has been received from a Allergy YTechnician concerning a 14 year old female patient with Nno pertinent medical ###history 12/5/2008 and no drug reacti n has been received from a medical assistant concerning an unknown number of patients whom U were vaccinated with a dose of GARDASI n has been received from a physician Y concerning a 16 year old female who was vaccinated Y with three doses of GARDASIL (Lot # not repo n has been received for the Merck pregnancy Y registry of GARDASIL from a 22 year old female N patient with 2/16/2009 iodine allergy 2/16/2009 and a history of "p n has been received from a physician concerning a female patient who on unspecified datesYwas vaccinated with the first, second and third n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5mL dose of GARDASIL n has been received from a medicalYcoordinator concerning an 18 year old female who on 25-MAR-2009 Y 3/25/2009 was vaccinated 3/25/2009 with the first dos follow-up information has been received from a physician and the physician's office manager Y concerning3/23/2009 a 19 year 3/23/2009 old female who on 23-M n has been received from a nurse practitioner concerning a 25 year old female who on an unspecified N date was vaccinated with first 0.5 mL n has been received from a physician concerning a female patient who was vaccinated with a dose of GARDASIL IM. On an unspecified da n has been received from a Registered Nurse concerning a 25 year old female who in 2006 Y("3 years ago") was vaccinated with her first an n has been received from a registered Y nurse, for the Pregnancy registry for GARDASIL, concerning U a 22 year old female 4/22/2008 with no pertinent
n has been received from a physician concerning an 18 year old female patient who on 22-JAN-2009 Y was vaccinated4/1/2009 with her first dose of n has been received from a physician Y concerning a 26 year old female with no drug reactions N or allergies who in 2008 4/21/2009 was vaccinated with n has been received from a physician concerning three patient who were vaccinated with GARDASIL U and tested positive for a high risk stra n hs been received from a nurse practitioner concerning a 14 year old female student with no Y pertinent medical 9/22/2008 history 9/23/2008 and no known drug n has been received from a physician Y concerning a 11 year old female with bronchospasm exercise Y induced 4/21/2009 who n 4/21/2009 21-APR-2009 was vacc n has been received from a registered Y nurse, concerning a female who was vaccinated withUGARDASIL that was stored improperly at 32 F n has been received from a registered Y nurse (R.N.) concerning a 19 year old sexually activeNfemale who from 10-JUL-2007 3/27/2009 was vaccinated n has been received from a consumer Y concerning her 17 year old daughter with no medical N history and allergies, 4/17/2009who 4/20/2009 on 17-APR-2009 wa n has been received from a physician concerning a patient who unspecified date was vaccinated U with GARDASIL (lot # not reported). On u n has been received from a nurse practitioner Y concerning a 24 year old female who vaccinated Y the first dose of GARDASIL 7/1/2008 on an unspecifi n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL and experienced a vasovagal re n has been received from a consumer concerning her daughter, a 16 year old female who on Y unspecified dates was vaccinated with a first n has been received from a physician Y concerning a 40 year old female who experienced pain U on her shoulders, knees and sometime in her n has been received from a physician Y concerning a 19-20 year old female who was vaccinated N with the first 0.5 ml dose of GARDASIL (no n has been received from a physician's assistant concerning a female patient who on unspecified U dates was vaccinated with the first, secon n has been received from a nurse practitioner concerning a female patient, who was vaccinated U with the3/18/2009 third dose 3/25/2009 of GARDASIL, 0.5ml. N n has been received from a consumer a 28 year old nurse with latex allergy and a history of Yparoxysmal supraventricular 2/23/2009 Tachycardia (PSV n has been received from a licensed Y practical nurse concerning a 22 year old female with a N medical history 3/26/2009 of knee operation 4/8/2009 in 2004 who n has been received from a the doctor's nurse concerning a 25 year old female who on 21-APR-2009, U was 4/21/2009 vaccinated 4/23/2009 intramuscularly with n has been received from a registered nurse concerning that her son's several female friends U developed muscle twitches and tingling sens n has been received from a consumer concerning her 18 year old daughter who was vaccinated U with the first dose of GARDASIL (lot#, rou n has been received from LicensedYPractical Nurse (LPN) concerning a 19 year old sexuallyNactive female 11/1/2008 who in April 4/9/2009 2008, an unspecifie n has been received from a medical assistant concerning a 17 year old female who on 26-FEB-2009 N was 2/26/2009 vaccinated3/5/2009 with the first dose of G n has been received from an office manager concerning a female who was vaccinated with the U first, the 5/11/2007 second and the third dose of GARD n has been received from a licensed practical nurse concerning a 16 year old female who inYSeptember 2/27/2008 2008, was 2/27/2008 vaccinated with GARDA n has been received from a physician Y concerning an 18 year old female who was vaccinatedNwith the first 7/19/2007 dose of GARDASIL 3/13/2009 on 12-JAN-2 n has been received from a physician Y concerning an 18 year old female who was vaccinatedUwith GARDASIL. 6/19/2007 The 9/19/2008 patient had a negative p n has been received from a physician Y concerning a 21 year old female who had a negative pap U smear test 1/15/2008 on 09-JAN-2006. 4/9/2009Patient then re n has been received from a registered nurse concerning a 33 year old female with on pertinent U medical history and no allergies who in app n has been received from a consumer concerning her 21 year old daughter who was vaccinated Y with the first dose of GARDASIL (lot #, rou n has been received from a registered Y nurse and a patient care coordinator concerning a 19Nyear old female 7/8/2008 who in June 2007, was vaccin n has been received from a certifiedYmedical assistant concerning a 21 year old female with N amoxicillin allergy and no 2/1/2009 pertinent medical his n has been received from certified medical Y assistant concerning a 3 year old female patient N with no drug reaction 7/1/2008or10/1/2008 allergies and no pertin n has been received from a nurse concerning Y an "about 20 year old" female who on an unspecified U date was vaccinated 2/1/2009 with third 0.5mL d n has been received from a physician concerning his daughter who on an unknown date was U vaccinated with a dose of GARDASIL and the n has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 2/10/2009 or no known 2/10/2009 drug/allergy reac n has been received from a consumer concerning her 15 year old daughter with no pertinentNmedical history and no known drug allergies/d n has been received from a physician Y concerning a 21 year old female with sulfonamide allergy who on 1/18/2008 18-JAN-2008 1/19/2008 was vaccinated intram n has been received from a physician concerning an 18 year old female who was vaccinatedUwith GARDASIL. The physician reported that rmation was received from a physician and follow up from a licensed practical nurse concerning Y a 20 year old female ### 11/1/2008 who was vaccinated w n has been received from a certified nurse practitioner concerning a female who on an unspecified U date was vaccinated with first dose of G n has been received from a nurse practitioner Y (N.P.), for the Pregnancy Registry for GARDASIL, Y concerning 4/30/2008 a 23 year 6/19/2008 old female with no p n has been received from a 52 yearYold licensed visiting nurse who was splashedYwhile she N was withdrawing 11/1/2008 a dose11/1/2008 of PNEUMOVAX 23 in n has been received from a 69 yearYold femaleYpatient who "2 or 3 years 0 ago" was vaccinated Y with a dose of PNEUMOVAX (manufacturer n has been received from a physician Y concerning his 54 year old wife with allergy to sulfa drugs Y like Bactrim 8/20/1998 and no8/20/1998 pertinent medical histo n has been received from a physician concerning Y an approximately 117 week old male who was U vaccinated 5/7/2009 orally with 5/11/2009 a 2 ml second dose o n has been received from a physician Y concerning Y a patient who on an 1 unspecified dates wasUvaccinated7/14/2008 orally with 5/11/2009 three doses of ROTATE n has been received from a physician Y concerning Y a 12 month old male 3 who on 07-JUL-2008Ywas vaccinated with ###the first dose of ROTATE solated IgA deficiency, administered pneumococcal Y vaccine. 4 days 2before admit she developed Y swelling, 4/20/2009 redness &4/20/2009 fever within 24 hrs of i ort received from a consumer on 08 May 2009, Y who is also the patient's 0 parent. A 37-year-oldUfemale patient 4/21/2009 with an unknown medical histo was received on 13 May 2009 fromYa consumer. A 41 year old female patient received ACAM2000 N (lot number 5/2/2009 unknown) 5/11/2009 in her left arm an
ped pain, swelling and redness at site of vaccine LD after receiving it. Y 5/8/2009 5/9/2009 ates pt received vaccine then had some blood work in office. After ten minutes pt complained Y of dizziness 7/14/2008 accompanied 7/14/2008 with numbness in ng by 8 cm wide erythema & warmth ant/lad @ thigh. 5/13/2009 5/13/2009 set (10-12 hours) post vaccine fever. Y 104 T max. Fever lasted 48 hours, then abruptly stopped, and a lacy 5/13/2009 red rash5/13/2009 appeared head to toe. ven Adacel, Menactra + PPD. Began feeling light headed, sat in chair and became faint. Y 4/20/2009 4/20/2009 er, I awoke with a 3 inch red, hot, itchy, swollen circular patch on my upper right arm. I called Y pharmacist 5/1/2009 and saw my5/4/2009 doctor. Benadryl pre ven MENACTRA 0.5 ml @ deltoid on 5/12/09. On 5/13/09 at approx 7pm pt & parent noted large Y localized 5/12/2009 reaction.5/13/2009 Redness & warmth 5x hours- Left arm (between elbow andY deltoid) became swollen 3x normal size at site of varicella Y vaccine. 5/12/2009 Within 48 hours 5/13/2009 red welted rash d ately 24 post Kinrix vaccination patient had marked non-pitting edema to his right upper leg with Y redness that extended from his right greate IVEN 4-14-09 AND PATIENT REPORTS ONSET OF SEVERE HEADACHE ON 4-15-09. Y 4/14/2009 4/15/2009 02 degrees Body aches.chills,fever, red swollen left arm. Applied ice to left arm, Tylenol Y 5/12/2009 5/12/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile Water. Patient does ceived MCV4 in Left deltoid and Tdap in Right deltoid on 5/12/09. She came in 5/18/09 c/o left Y upper arm 5/12/2009 itching for5/15/2009 a few days (approx sta cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/13/2009 in Sterile Water. Patient does ide effects include: diarrhea, stomach pain, discomfort, cranky behavior, problems with sleep, Y excessive5/14/2009 crying, but 5/15/2009 no fever. The adverse e Y 5/18/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/14/2009 in Sterile Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/12/2009 in Sterile Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile Water. Patient does d baseball size knot with redness, swelling and fever noted. Pt taking benadryl. Y 5/18/2009 5/18/2009 cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/12/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does y administered an expired Hep A vaccine to patient. She did not have any adverse symptomsYat the time.5/19/2009 No treatment 5/19/2009 given. cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does er second gardasil, pt went to ER for Y dizziness, ataxia and severe headache. Skull x ray, ct head Y and lab4/18/2008 work all negative. 4/18/2008 7/2/09 Receive ht immigration form from civil surgeon Y with need for Td, PPV, Varicella (due to neg blood titer) and Zoster. 5/13/2009 I said Zostavax 5/17/2009 not needed beca cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/13/2009 in Sterile 5/19/2009 Water. Patient does cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and U 0.25% phenol 5/13/2009 in Sterile Water. Patient does er receiving vaccines, he had left upper extremity Y swelling, redness,2and warmth. His left thumb U base was 5/13/2009 itching. There 5/18/2009 was left thumb pai ling of nausia. Sycope within minutes of the injections. Fell and hit head. Regained consciousness U within 5/19/2009 a few minutes 5/19/2009 under care of the PLAINING OF VOMITING AFTER VACCINES WERE ADMINISTERED. HE WAS SEEN BY U ANOTHER 5/19/2009 PROVIDER5/19/2009 LATER THE SAME EV pain in arm of injection, inability to move/lift Y arm, extreme stiffness and pain in neck, enlargedYand painful/tender 5/13/2009 touch 5/14/2009 glands in neck. Could hema, vesicular rash in dermatome Y distribution (L/arm). Rx : ACYCLOVIR 800 5x/d. LYRICAU50. tid and 5/13/2009 VICODIN. 5/17/2009 ely post immunizations baby became very pale & lethargic HR 100 initially - increased 120s with Y stimuli pulse 5/13/2009 0 X 965/13/2009 arousable but sleepy g turned 30 min after immunization with hives. Lungs CTA Heart Reg Benadryl 12.5mg given-Ypt observed5/13/2009 x 20 min still 5/13/2009 with hives but active. warmth, erythema approx 10 cm around Y injection site. Y 5/12/2009 5/14/2009 se effects noted per patients father - 5-13-09. Y 5/12/2009 stated that his "arm is sore." No other adverse effects noted, 5-13-09. Y 5/12/2009 ns were given at 2:30 pm; Pt waited in the room for 15 minutes. Waiting then to have lab drawn Y noticed5/12/2009 her right hand 5/12/2009 swelling on the dors was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and n muscles, joints. Felt hot all over, pressure Y in chest. Given IV fluids DILAUDID, ZOFRAN inY ER. 5/6/09 5/5/2009 6 am D/C with 5/6/2009 VICODIN for pain. .5 within 24 hrs of vaccine administration. 5/13/2009 5/14/2009 ack ache in mid + lower back muscles which woke me from sleep. Restlessness + achey thatY night. Gradually 3/30/2009 decreased 3/31/2009 over next 3 days. ruised at injection site - high fever - Paleness, Weak, dizzy - Sore throat, ear ache, sore eyesY - chills 3 days 2/27/2009 MOTRIN 2/27/2009 & TYLENOT given upper pain with 3" swelling, redness, Y heat, hardness. 5-12-09 Went to place @ 6-7 pm.- was Y told "reaction 5/11/2009 to tetanus 5/12/2009 but not bad enough swelling, 6" down arm, 3-4" wide, with heat. No fever. Pain in arm as well. Diagnosis cellulitis Y secondary 4/27/2009 to injection. 4/29/2009 Tx with AUGMENTI hargy, rash started 6 days following vaccination. Some rhinorrhea started 5/8/09 with slight cough Y Fever4/29/2009 > 104 degrees. 5/5/2009 ters branching out / popping up on nose Y area - 7 total so far, patient was contacting doctor. U 5/12/2009 5/15/2009
ped rash behind his leg, forearms and Y few spots on trunk. Describes as itchy, appears dry, Y Flat. Began4/29/2009 approx. 244/30/2009 hours post 2nd dose H y - few hrs. after Gardasil #3. Y 8/18/2008 8/18/2008 en and red at injection site. 5/13/2009 epared for older sister & accidently given to younger child. Y 5/14/2009 ess, malaise, swelling of lymph nodes Y day of injection. Involuntary muscle twitching seizureYon Saturday. 4/30/2009 5/2/2009 ceived Hep A on right arm and HPV on Left arm a few seconds later while nurse in room hadYdazed look5/18/2009 and feeling5/18/2009 a heavy feeling lay bac d Tdap, HPV and Menactra and then slumped over into mother's arms motionless, then jerked Y involuntarily 5/19/2009 and was5/19/2009 layed down with eyes as fatigued a few hours after the injection. About 6 hrs after injections, there was a small rash U around area. 5/14/2009 Fever started 5/14/2009 @ 10:pm, patien m swelling, leg and back - pain. Y Y 5/13/2009 5/13/2009 dizziness, pulse rate 100, low grade fever, sore arm w/hot to touch + tired. These symptomsUstarted about 4/30/2009 12 hrs after 4/30/2009 vaccine was given a nted about 10 minutes after the last shot, falling off the table. ? L.O.C for about 3 minutes. Y 5/18/2009 5/18/2009 t. Extreme fussiness trouble sleeping. only when carried. Y 5/11/2009 5/13/2009 len, warm, painful area to upper right Y thigh 24 hours post vaccination. Approx 24 cm X 19cm. U Also noted 5/12/2009 several fluid 5/13/2009 - filled vesicles at in d high fever to 104 with lethargy on day of vaccinations, after they were given. 2 days later she Y developed5/5/2009 hives that5/5/2009 lasted for 2-3 days. P STAVAX administered; pain at injection site 5/5/09 redness/hardness 3 inches wide & 6 inches U long extending 5/4/2009 from injection 5/5/2009site & down th 5/13/2009 reaction with redness & swelling @ injection site, radiating heat. check non-sotp crying > 3 hours (or more) 5/18/2009 post injection. 5/18/2009 esented shortly after receiving the vaccine Y with slight red rash to all body parts. Benadryl Administered. Y 5/18/2009 5/18/2009 d #2 Hep A vaccine. 3 min. later became dizzy & fell. ? loss of consciousness x few seconds. Y BP- 80/60 3/18/2009 Pulse- regular. 3/18/2009 Skin warm/dry. f 5-8-09. Mom noticed a rash on child. Child has had low grade fever. Decreased appetite U and fluid intake. 5/7/2009 Fussy more 5/8/2009 than usual. Pin h y weekend, use bandages slides off. Y Reaction occurs progressively starting around original vaccination U point 3/10/2009 to upper 4/25/2009 arm. Exam reveals c 5/9/2009 N 5/4/2009 5/9/2009 N vaccine 3/1/09, developed fever chills, Y rigor, malaise, Y pain @ injection 4 site, admitted to hospital Y for cellulitis 3/1/2009 at TD injection 3/2/2009 site. Treated wit ale presented to the office for routine follow up of chronic medical problems. She had a routine physical examination 5/1/2009 5/1/2009 on 8/8/08 at which tim ter - chills - increased pulse - about 15 next 2 days - fever, weakness, sweating. Also noticed Y lower blood 4/14/2009 pressure,4/14/2009 about 20 points. Only d with bruise @ site of immunization + swelling + erythema. Pt very fussy and difficult to console. Y 5/7/2009 5/7/2009 ct identified himself as a cardio-vascular surgeon, Y 22 years in Army.5He was deployed Y to a foreign N country in 1991, at which time he receive Herpes Zoster - began 5-3-09. Y U 11/4/2008 sh "hives" x 3 days; improving after 3 days per mother. Rash started 7 days after vaccinations U in same place 5/4/2009 as administered 5/11/2009VARIVAX. Mo n has been received from a registered Y nurse concerning an approximately 14 year old female U patient who3/7/2008 on 22-AUG-2007, 19-OCT-2007 n has been received from a physician concerning a 15 year old female patient who was vaccinated U with 1/26/2009 the first dose of GARDASIL IM, 0.5 n has been received from a physician concerning a 19 year old female Y with no known medical Y history, allergies 5/17/2007 or drug reactions ### who in Ma n has been received from a office manager Y concerning a 4 year old male patient with no pertinent N medical history ###and no known drug allerg Menactra on 5/13/09 and developed fever, myalgia, and headache on 5/14/09. Seen at office Y and instructed 5/13/2009 to take 5/14/2009 ibuprofen. ceived a Hepatitis B vaccine on May 18th @ 1:37 PM. She recieved a second dose of the vaccine Y on May 5/19/2009 18th @ 12:45 5/19/2009 AM. No known com ceived the HPV vaccine in the late afternoon Y of Wednesday, May 6, 2009. Early on ThursdayU morning she5/6/2009 woke up with 5/7/2009 pain in her right leg er receiving VZV#2, felt cold and had Y sore throat, day 8 or 9 post vaccination, noticed rash to back of neck 5/5/2009 with itching; 5/17/2009 15 days post vaccin ports they were awakened in the middle Y of the night with patient screaming. When they wentYto him, he was 5/19/2009 very hot, 5/20/2009 then he immediately s ported that child's entire left thigh was reddened, swollen, and warm to touch within 25 hoursYof receipt of4/22/2009 vaccines. 4/23/2009 Mom gave motrin and b oyee PE 11/10/08. Received flu vaccine, Y TB test and Hep B vaccine 11/10/08 during employee PE. Then was sent ### to health ###Dept. for Tdap P and IPV vaccines on 4/29/09, came in to office on 5/1/09 with R leg red, swollen, hot and painful Y to touch. 4/29/2009 Diagnosed with cellulitis and tr ection site, difficulty breathing and nausea. Y Y 5/17/2009 5/17/2009 ew months of the vaccination on 12/05/06, I became less stable on my feet, and experienced Y Nsymptoms 12/5/2006 of neuropathy 4/15/2007 including foot drop, l 11, 2009, I went in for aYcheck-up, Y and referralYfor neurological evaluation 1 and saw Dr. I hadYbeen previously 3/11/2008 ill since 3/14/2008 April 2005, and had b perienced chest pain and flushing. EKG was done. Pt felt better. Had subsequent ECHO and Y HOLTER and 4/23/2009 work up4/23/2009 by cardiology. as immunized with Yellow Fever vaccine and dose #2 of Twinrix (HepA/HepB) vaccine on 4/28/2009. U The 4/28/2009 patient reports 4/29/2009 that she develope red spot at injection site; size of baseball; Y red area is hard; Provided Motrin and Tylenol as has U had a fever 5/18/2009 since date 5/19/2009 of shot (Monday, Ma scribed a tightness in chest with difficulty breathing Y within 5 minutes2of getting the vaccine. U Patient was 5/18/2009 given an injection 5/19/2009 of epinephrine s rs after injection, patient developed red, inflamed, warm to the touch, 2" radius reaction at injection Y site. 48 hours after injection site not as Y ###
RM NUMBNESS AFTER RECEIVING VACCINATIONS, THEN 2.5 MINUTES AFTER C/O BECOMING Y LIGHTHEADED 5/20/2009 5/20/2009 AND DIZZY cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009 in Sterile 5/20/2009 Water. Patient does B Vaccine, Dose 2 administered on 5/18/09 @ 3 PM. On 5/19/09 upon awakening in morning, Y patient describes 5/18/2009 itching 5/19/2009 hives over upper ch KIN;CC swelling and redness left upper arm;site of the pneumonia shot ;was given 11/12/08Yin clinic. The patient ###return here ###11/13/08 arm d herpes simplex in the eye, April, 2009. Was treated by Dr. for it. Y 1/14/2009 4/16/2009 ave no known allergies (especially neomycin Y or gelatin which are contraindications for Zostavax) Y patient 5/15/2009 had a significant 5/16/2009 reaction to shingle PED HIGH-PITCHED SCREAMING WHEN LAYED DOWN, ARCHING OF BACK TREMOR AND Y OPEN,1/23/2008 GLAZED EYES 1/23/2009 WITHIN AN HOU equiring 2 doses of IV medication. Y 6/29/09 Y Hospital Y ER records received 2 DOS 6/17/09. Assessment: Y Second 5/19/2009 afebrile5/19/2009 seizure. Patient presen jection administered. Immediately after PEDIARIX given body stiffened, eyes rolled back in head Y and stopped 5/19/2009 breathing 5/19/2009 x 2-3 seconds. Re d swollen, hard, hot & red where vaccine given. 6 cm / 5 1/2 cm. Circ. 23 cm. Y 5/12/2009 5/13/2009 lls, muscle aches. Y 5/14/2009 5/14/2009 5/18/2009 ace, trunk and extremities 5/18/2009 utes after vaccine administered Pt began Y c/o dizziness and weakness in upper extremities. Pt. U then began 5/19/2009 c/o weakness 5/19/2009 in lower extremitie (R) arm- swollen, unable to move. Numbness in fingers, swollen hand. Y 5/19/2009 5/19/2009 t after receiving ADACEL, MENACTRA and GARDASIL. She then became opisthotonic, began Y salivating, 5/19/2009 eyes rolled 5/19/2009 back. Episode lasted wollen, Eye lid, decreased appetite.Y Y 5/19/2009 5/19/2009 vaccinated with SPV around 09 AprY09, approx 24 Apr wife developed a lesion near her eye,Yher arm and4/9/2009 multiple lesions 4/24/2009 on vaginal area. in erythema edema and pruritic sx.Y5/10/09. U 5/18/2009 5/19/2009 accine onset redness @ vaccine site Y 5/11/2009 5/12/2009 R upper extremity treated with oral LEVAQUIN. Y Y 5/14/2009 5/15/2009 lness. - Generalized skin rash (topical Y chicken pox rash). - Bilateral Otitis Media. U 5/5/2009 5/10/2009 n: the day after receiving his first anthrax Y shot, SM developed hives and was seen at the local Y ER x2 because 9/30/2007 hives did not resolve despite panic male, PVT, ADSM reports eruption Y of skin skin rash some 3 weeks after his receipt of U primary SPV4/16/2009 and TYPHOID 5/7/2009 vaccines. Sympto 5 cm slightly tender red swelling on the left thigh. Y 5/19/2009 5/19/2009 Y 4/24/2009 4/24/2009 accine administered - no adverse event Y during 15 min wait. 5/6/09 -Courtesy call follow-up - Y Pt reports rash 5/1/2009 and bumps 5/6/2009 under right breast a red, warm, and swollen crying uncontrollably Y Y 5/20/2009 5/20/2009 me down with shingles anyway, diagnosed Y 5/19/09. Rash and blisters on face...lip and below lip and in eye. 1/14/2009 Spent 5/16/2009 $300.00 on vaccine and ine red rash on both her arms and thighs. Itchy. states started the next day after recieving Tdap. U 5/16/2009 5/17/2009 ped a rash thought to be Shingles approx Y 3 weeks s/p Zostavax administration. Pt treated with U valacyclovir. 2/9/2009 3/4/2009 s were administered to this chld. Immediately after the 5th vaccine, the pt. displayed mild seizure Y activity5/19/2009 lasting about 5/19/2009 5 seconds. She awo HAV and Depo Provera at doctor visit Y on a.m. In p.m. state symptoms of back pain, epigastric Y pain, temp. 2/26/2009 high 105 2/26/2009 degrees ache all over, ur office on 5/12/09 for 4 year old boosters. Y Two days later developed red, swollen left arm. YDiagnose with 5/12/2009 cellulits 5/14/2009 secondary to vaccine a eft deltoid to elbow redness and swelling-fever,headache,and Y aches all over especially legs-relief Y with tylenol-denies 5/15/2009 5/16/2009 rash,hives,shortness pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2 1/29/09 with enterococcal Y prostatitis. 4/14/2008 Vaccination 1/29/2009 took place on 4/14/0 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2/25/09 with Urinary tract Y infection 4/14/2008 - bacteremia. 2/25/2009 Vaccination took plac call from Mom 5/21/2009 R/T patients Left thigh. DTaP injection admininstered 5/18/2009.Red feverish area 5/18/2009 measuring 5/19/2009 7 1/2 x 4 1/2 on Le ped myocarditis. Symptoms developed Y on 27 April. Y Smallpox vaccination 8 given on 19 Apr 09 U 5/28/09 Medical 4/19/2009 records 4/27/2009 received DOS 4/27 red vaccines at 11:40; promptly fainted; Y as she fainted she fell from the chair to the floor; had Y approx 2-35/21/2009 second duration 5/21/2009 seizure with twitc Zoster- Appeared on patient's left arm Y extending linearly from the left clavicle to the left wristY two weeks4/22/2009 after vaccine 4/30/2009 administration. The v SHES, JOINT PAIN , MUSCLE PAIN, U 11/4/2003 11/5/2003 iving vaccinations, patient felt faint lightheaded Y 5/20/2009 5/20/2009 days after receiving Zostavax vaccination, client had painful blisters on her scalp and top of the Y head with 5/12/2009 severe headaches. 5/19/2009 Saw her HCP of rash and swollen on both thighs after MMR and Varicella vaccines. U 5/11/2009 5/11/2009 action - itching - immediate with hives and rash developing over a 3 day time period. Treated Y with 50mg q6h 5/8/2009 benadryl 5/8/2009 and 10mg claritin - r me in on 8/12/08 for Gardasil and Varivax. Patient Y was counseled for 8 pregnancy. Patient called Y on 5/21/09 8/12/2008 and stated 4/27/2009 that she had been turned to clinic two days post vaccination with a red, slightly swollen area to Right upper arm.U Area is circular 5/19/2009 in shape 5/21/2009 and the size of a ha rovider pt seen in ER 5/13/09 pm - 30hr Y after vaccine gen rash + 102 fever. 5/14/09 still has fever + gen 5/12/2009 rash. Given5/13/2009 antibiotics in ER 5/13/2 ated she had localized swelling in left upper arm (injection site) within 24 hours. Been on 5/15/09 U no redness. 5/11/2009 C/o pain 5/12/2009 from left shoulder to ever 101.8, eating ok, not acting sick, no rash, given TYLENOL for fever. Recommended if not Y better in a4/28/2009 few days or 5/21/2009 if worse to be seen
given at about 12:30pm. By 7PM, arm ached - pain in (L) elbow- Daily pain increase in all joints Y and pain 5/12/2009 has continued 5/12/2009 even now. multiforme 4 days after administration. N 5/14/2009 5/19/2009 and tenderness with local swelling at Y injection site; painful to raise arm. Tx'd with NSAIDS. Pt U reports had 5/18/2009 sweats &5/18/2009 chills the evening of im rash, hives around injection site not sure when it started per patient Y 5/11/2009 d (+) erythema and edema - warm Y to touch measuring 3 X 2 inch oval area. 5/18/2009 5/19/2009 Y 5/21/2009 nt fainted immediately (30 secs) after the vaccine, she twitched for 15-20 secs then staring forwards, U and5/18/2009 then started 5/18/2009 crying. PR = 72/min, DASIL injected into left deltoid. Pt became dizzy, visual disturbances, severe stomach crampsY and R hand 5/15/2009 cramped 5/15/2009 up and "felt dead" It too nt turned pale, felt tingling all over, pupil dilated and was blurring over. PR = 80 / mier Bp = 90/60. U 5/18/2009 5/18/2009 is red, swollen, tingling felt in hands and fingers. No fever. Also felt numbness sharp pain when U making 5/20/2009 a fist. No oozing 5/20/2009 or bleeding presen meter erythema/induration at site of VARIVAX - Treated with KEFLEX, ibuprofen Y 5/19/2009 5/21/2009 n (L) deltoid area began promptly, pain peaked at the 1-3 wk period gradually improved beginning Y in May3/20/2009 1 '09. 3/20/2009 ine number 1 given . Syncope 5 minutes Y after vaccine. Fell to floor hit head laceration required Y sutures broken 5/20/2009 incisor 5/20/2009 # 1 Rt upper. upper arm-hot to touch- VARIVAX given 5-13-09. Patient presented with symptoms 5-14-09. Y Treatment:5/13/2009 BENADRYL 5/14/2009 PRN. lled 2 1/2 hours after shot stating she has what look like broken blood vessels all over her body. U 5/15/2006 5/15/2005 a PNEUMOVAX shot on Monday afternoon 4/27 and was well until approx. midnight (8hrs after shot). I woke 4/27/2009 during4/27/2009 the night with a very p pells X 5 lasting approx 3 seconds, each. Y 5/18/2009 5/18/2009 ven varivax 5/8/9. On 5/14/2009 developed pain left lower extremity. On exam today findings U consistent with 5/8/2009 shingles 5/14/2009 in dermatomal distrib iven Approx 6pm on 5/12/09 on 5/13/09 Y L arm has area 3x3cm redness, swelling. 5/12/2009 5/13/2009 d our office on 5-21-09 to report that child received typhoid vaccine at health department 1-2Yminutes after 5/13/2009 vaccine given child fainted. Bec and induration (R) thigh. 5/19/2009 5/21/2009 Q oral vaccine administered. Approx 10 minutes later child's lips noted to be swollen as well as Y the soft tissue 5/21/2009 surrounding 5/21/2009 the lips. Oral muc n has been received from a pharmacist Y concerning a female in her "early 20s" who on an unspecified Y date was vaccinated with third dose o n has been received through a Merck Y Pregnancy registry from a 38-year-old female with no Y medical history 8/16/2004 or allergies 9/13/2004 who on 16-AUG-20 n has been received from a physician and a 35 year old female concerning herself with no pertinent Y medical 6/14/2007 history6/14/2007 and no known drug rea n has been received through the pregnancy Y registry for VARIVAX (Oka/Merck) from a physician's Y assistant 5/1/2007 concerning 5/1/2007 a 34 year old femal n has been received through the Merck Y pregnancy registry and from a male consumer concerning Y his 226/18/2007 year old wife 6/18/2007 with no known allerg n has been received through the Pregnancy Y registry from a registered nurse concerning a 16 U year old female 10/3/2007 with no6/1/2007 medical history or alle n has been received from a registered Y nurse concerning a 14-year-old female with no pertinent Y medical history 5/1/2001 and no drug reactions/allerg n has been received from a physician concerning a patient who on 17-MAR-2008 was inadvertently U vaccinated 3/17/2008 with3/17/2008 VARIVAX (Oka/Merck) n has been received from a physician Y concerning an 11 year old male who was vaccinated with U VARIVAX (Oka/Merck). The patient reporte n has been received from a physician concerning a 9 year old male who on 21-FEB-2008 was Y vaccinated 2/21/2008 (subcutaneous) 2/22/2008 with a second do n has been received from a health department registered nurse who was told by an unspecified U school nurse 4/14/2000 that a3/11/2008 9 year old male on the n has been received from the parent of an approximately 19 month old male patient with a history Y of seizure 3/13/2008 who on3/13/2008 13-MAR-2008 was vac follow-up information has been received from a registered nurse concerning a 11 year old female Y consumer with ###a history 2/22/2008 of asthma. Who n has been received from a pharmacist concerning a male who on approximately 14-MAR-2008 U (reported 3/14/2008 as on an 3/14/2008 unspecified date about n has been received from a physician's assistant concerning a male who was vaccinated with Y a first dose of VARIVAX (Oka/Merck). The pa n has been received from an 89 (also reported as 79 years old) year old retired physician. He U reported that 3/18/2008 he was 3/18/2008 vaccinated with VARIVA n has been received from a physician Y concerning a 36 month old male with an allergy to REGLAN Y who on 3/30/2007 30-MAR-2007 3/30/2007 was vaccinated w n has been received from a physician Y concerning a 21 month old male who, at 12 months ofUage, was vaccinated with a dose of VARIVAX n has been received from a registered Y pharmacist concerning a female who on 24-MAR-2008 U was vaccinated 3/24/2008 with a 3/24/2008 dose of VARIVAX (Ok n has been received from a motherYconcerning her 12 months old son with possibly allergy to N eggs and 5/16/2008 a history of 5/18/2008 febrile seizures and ear n has been received from a mother concerning her 11 year old daughter who"at the age of 1" Y (approximately 1997),3/10/2008 was vaccinated with V n has been received from a physician concerning a patient (age and gender unknown) who,Uon an unspecified date, was vaccinated with a n has been received from a physician Y concerning Y a patient who on an 0 unknown date was vaccinated U with a second dose of VARIVAX (Oka n has been received from a nurse concerning a female patient who was vaccinated with a dose Y of VARIVAX 3/7/2008 (Oka/Merck) 3/17/2008 (lot number, dose n has been received from a licensed Y practical nurse concerning her 8 year old son Y with no known Y allergies, diabetes, ### 4/23/2008 asthma and a history n has been received from a health professional Y concerning a 14 month old 20lb. 15oz. 29 in.Yfemale with 3/3/2008 no known 3/11/2008 pre-existing allergies, b n has been received from a consumer concerning her 9 year old granddaughter with Y no pertinent N medical history or drug 4/7/2008 allergies/reaction n has been received from a physician concerning Y a female between012 and 15 years of ageYwith a history of obesity 2/1/2008 who was vaccinated S n has been received from a physician concerning an 8 year old female who was vaccinated U with VARIVAX (Oka/Merck). The patient report
n has been received from a physician Y concerning a 12-month-old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) and ei n has been received from a physician Y concerning a 12 year old 104 lb. 55 in. female who onY03-Oct-1996 10/3/1996 at the age2/29/2008 of 12 months, was vac n has been received from a physician Y concerning a 12 month old male who on 26-Feb-2008Ywas vaccinated 2/26/2008 subcutaneously 3/14/2008with 0.5ml of n has been received from a nurse concerning a 45 year old, non-pregnant female physician U with probable 3/26/2008 recurrent exposures to wild type n has been received from a health department Y registered nurse who received information from U the patient's mother ### 3/17/2008 concerning a 7 year old n has been received from a physician Y concerning an approximately 5 year old female patientUwith no medical history who was vaccinated w n has been received from a licensed Y practical nurse concerning a 9 year old male child with N no known allergies### or pertinent 3/20/2008 medical history n has been received from a nurse concerning a 3 year old boy with no pertinent medical history N and no history 3/1/2006 of drug 3/20/2008 reactions or allergies n has been received from a consumer Y concerning her daughter with no known drug allergiesYor pertinent2/19/2008 medical history 2/21/2008 who "sometime du n has been received from a licensed Y vocational nurse concerning a 13 month old patient who N on 17-MAR-2008 3/17/2008 was3/25/2008 vaccinated with VARIV n has been received from a consumer concerning a 12 year old male with Penicillin allergy and N a history of chickenpox 3/14/2008 who on 11-March-2 n has been received from a nurse concerning a female who in 2002 was vaccinated with one U dose of VARIVAX (Merck). The patient's moth n has been received from a licensed vocational nurse concerning a 39 month old female who Y on 25-FEB-2008 2/25/2008 was3/11/2008 vaccinated with the firs n has been received from an advanced practice registered nurse concerning a 78 year old postmenopausal U 1/29/2008 female,1/29/2008 weight 142lb, height 59 n has been received from a physician concerning a 18 month old male who on 08-OCT-2007 N was vaccinated 10/8/2007 in right 4/23/2008 arm subcutaneously w n has been received from a physician concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX. Concomitan n has been received from a licensed practical nurse concerning a 9 year old female patient who N on 24-MAR-2008 3/24/2008 was 3/24/2008 vaccinated SQ with n has been received from a physician Y concerning a 17 month old female who two months ago, Y in March 2008, 3/1/2008 was vaccinated with VARIVA n has been received from a nurse concerning a 13 year old female who on 21-FEB-2008 was Y vaccinated2/21/2008 with the second 2/28/2008 dose of VARIVAX n has been received from a certifiedYmedical assistant (CMA) concerning a patient who on unspecified Y dates was vaccinated with two dose n has been received from a physician Y concerning a 12 month old female with no pertinent medical N history 3/16/2008 and no drug 3/26/2008 reactions/allergies, w n has been received from a consumer Y concerning her daughter, a 9 year old girl with no known N allergies4/25/2008 or pertinent 4/25/2008 medical history who w n has been received from a physician concerning a male who's son on 16-MAR-2008 was vaccinated U with a dose of VARIVAX (Merck). Th n has been received from a physician concerning a male patient who developed varicella and U secondary transmission from his son, who ha n has been received from a consumer concerning a 12 year old male with penicillin allergy and N a history3/11/2008 of chickenpox 3/11/2008 who on 11-MAR-20 n has been received from a nurse practitioner (N.P.) concerning a 5 year old male with a soyNallergy and no 5/8/2008 pertinent5/9/2008 medical history who o n has been received from a grandmother Y concerning her 21 month old grandson with eczema N who was vaccinated 5/10/2008 with a second dose of V n has been received from a physician concerning a 7 year old female who on approximatelyY14-MAR-2008 3/14/2008 was vaccinated 3/14/2008 with a second d n has been received from a registered nurse (R.N.) through a Merck pregnancy registry concerning Y a 31 year 5/5/2008 old female 5/5/2008 with no pertinent m n has been received from a health professional concerning a 16 year old female with asthmaUwho on 12-MAR-2008 3/12/2008 3/14/2008 was vaccinated subcut n has been received from a 34 yearYold female who was accidentally exposed to VARIVAX (Oka/Merck). N Concomitant 5/12/2008 therapy included al n has been received from a nurse practitioner Y concerning a male who was vaccinated with aUfirst dose of VARIVAX (Merck). The nurse rep n has been received from a physician Y concerning an approximately 5 year old female who was Y vaccinated with a dose a VARIVAX (Oka/M n has been received from a registered nurse concerning a 15 month old male with no pertinent N medical history 5/8/2008 or allergies 5/12/2008 who on 08-MAY n has been received from a registered nurse concerning a 12 month old female who in the morning Y of 17-FEB-2006 2/17/2006 3/22/2008 was vaccinated with th n has been received from a public health Y nurse concerning a 15 year old female child who inU1999 was vaccinated 10/1/2008 with 1/1/2009 her first dose of VA n has been received from a public health Y nurse concerning a 7 year old male child who in 2002 U was vaccinated 10/1/2008 with 1/1/2009 her first dose of VARIV n has been received from a public health Y nurse concerning a 5 year old female child who in U 2004 was vaccinated with 1/1/2009 her first dose of VAR n has been received from a Registered Nurse concerning a patient who was vaccinated withUVARIVAX (Merck) (Lot # not reported) instead n has been received from a registered nurse (R.N.) concerning a patient who on 30-JAN-2009 U was vaccinated 1/30/2009 with 1/30/2009 a dose of VARIVAX (M n has been received from a consumer concerning her son with reaction to all vaccines and medications Y he has received that contain gelatin n has been received from a physician Y concerning a 10 year old male with no medical historyUwho on 14-APR-2000 4/14/2000 was 1/28/2009 vaccinated with a fi n has been received from a doctor's front desk employee concerning a friend who had a reaction U to VARIVAX (Merck) (lot# not reported). I n has been received from a registered Y nurse concerning a 4 year old female with no known N medical history 9/8/2008 and drugs 2/4/2009 allergies, who on 08n has been received from a nurse practitioner Y concerning a 5 year old female patient, with no N known drug 1/28/2009 reactions/allergies 1/31/2009and no pertine n has been received from a 17 year old female, for the Pregnancy Registry for VARIVAX (Merck), U with asthma 1/23/2009 and 1/23/2009 no drug reaction who on n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX (Merck). "Wit n has been received from a medical assistant concerning a 72 year old patient who was inadvertently U vaccinated with VARIVAX (Merck) in n has been received from a female registered nurse (R.N.). It was reported that a drop of VARIVAX U (Oka/Merck) (lot 2/2/2009 # not reported) splash n has been received from a physician Y concerning a 11 year old female patient who on 27-AUG-2007 U was6/2/2008 vaccinated 1/19/2009 with her first dose of V n has been received from a physician concerning an 8 year old patient who on 11-AUG-2001 U was vaccinated 8/11/2001 with the 1/22/2009 first dose of VARIVA
n has been received from a registered nurse concerning a female junior volunteer who on 19-OCT-1995 U was vaccinated ### with a first dose o n has been received from a nurse practitioner (N.P.) concerning her 9 year old daughter withYno pertinent2/3/2009 medical history 2/7/2009 and drug allergie n has been received from a physician Y concerning an 8 year old female who on 31-MAY-2001 U was vaccinated 5/31/2001 with her 1/30/2009 first dose of VARIVA n has been received from a physician via in a published article, concerning a 11 year old patient Y with a seizure disorder and a history of mil n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wit n has been received from a registered Y nurse concerning a 46 month old female with no pertinent Y medical 6/19/2006 history and2/4/2009 no drug reactions/alle n has been received from a registered Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wi n has been received from a licensed practical nurse concerning a female who on an unspecified U date was 1/19/2009 vaccinated 1/19/2009 with the second dose n has been received from a pharmacist Y concerning a female who on 10-FEB-2009 was vaccinated N with her 2/10/2009 first dose 2/10/2009 of VARIVAX (Merck) n has been received from a consumer concerning her approximately 20 month old son with Y no pertinent 7/25/2008 medical history and no drug reactio n has been received from a registered Y nurse concerning a female who on approximately 30-JAN-2009, U "about 1/30/2009 two weeks 2/5/2009 ago" was vaccina n has been received from a physician Y concerning an approximately 12 year old female withUno medical history or allergy who on 11-SEP-1 n has been received from a physician assistant concerning a 13 month old female child whoNwas vaccinated with VARIVAX (Merck). The ch n has been received from a nurse concerning a 12 to 15 month old male who in 2009 was vaccinated U with a 0.5 ml dose 2/1/2009 of VARIVAX (Mer n has been received from a physician Y concerning a 4 year old male patient who on 11-FEB-2009 N was vaccinated 2/11/2009with 2/12/2009 the second 0.5ml do n has been received from a licensed Y visiting nurse concerning a 12 month old female patientYwith no known 2/10/2006 drug reactions/allergies 3/24/2006 and a n has been received from a physician Y concerning a 15 year old female with no pertinent medical Y history 7/28/2003 and no drug1/16/2009 reactions or allergies w n has been received from a licensed Y practical nurse concerning two patients who on 16-FEB-2009 N was vaccinated 2/16/2009 subcutaneously with the n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009 3 years ago", in approx n has been received from a physician Y assistant concerning a 13 year old male patient with no Y drug reactions/allergies 4/4/2007 2/15/2009 who was vaccinated n has been received from a consumer Y concerning her 13 month old daughter with no pertinent N medical history ### or drug 2/15/2009 reactions/allergies w n has been received from a registered Y nurse concerning a 14 year male with no relevant medical U history1/26/2009 reported and 2/2/2009 no allergies reported n has been received from a nurse concerning a 11 year old male patient with autoimmune disorder U who about 5 years ago, in approximate n has been received from a licensed Y practical nurse concerning a 13 year old female patientUwho on 16-FEB-2009 2/16/2009 was vaccinated subcuta n has been received from a consumer concerning her 24 month old granddaughter. The caller U reported that she had 1/23/2009 shingles about a mon n has been received from a consumer Y concerning her almost 15 month old daughter with noNknown medical 2/5/2009 history who on 05-FEB-2009 w n has been received from a registered Y nurse concerning 9 year old female patient with no previous N medical 8/21/2000 history and 2/23/2009 allergies reported, w n has been received from a health professional concerning a 10 year old female patient withYno allergies at 9/7/1999 time of vaccination and allergic n has been received from a physician concerning a patient who on 05-Mar-1997 was vaccinated Y with the 3/5/1997 first dose of1/5/2004 VARIVAX (Oka/Merc n has been received from a licensed Y practical nurse concerning a 12 year old female patientNwith no previous medical ### 2/23/2009 history and allergies n has been received from a Licensed Practical Nurse concerning a 4 year old male patient who U on 08-JUN-2005 6/8/2005was2/1/2009 vaccinated with first d n has been received from a registered Y nurse (school nurse) concerning a 7 year old male who N in approximately 2008, about 1 year ago, wa n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with the first dose of VARIVAX n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with a second dose of VARIVA n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009 3 years ago", in approx n has been received from a physician Y concerning a 29 year old female with no medical history N who in her teens, was vaccinated with two d n has been received from a pharm D. concerning a 46 year old male with HIV, penicillin allergy N and drug hypersensitivity 2/23/2009 to sulfa and a hist n has been received from a doctor of pharmacy concerning an over 60 year old male physician U with a history 2/25/2009 of chickenpox 2/25/2009 who on 25-FEB n has been received fro a nurse practitioner concerning a 6 year old male who on 15-SEP-2003 U was vaccinated 9/15/2003 with 1/31/2009 a dose of VARIVAX (O n has been received from a medicalYassistant concerning 38 year old female with no pertinent Y medical history 2/12/2009 and no 2/21/2009 known allergies, who n has been received from a physician Y concerning a 13 month old male with no medical history Y or drug allergy who ### on 1/16/2009 31-DEC-2008 was va n has been received from a consumer Y concerning her 25 month old son with allergy to eggsYand oatmeal, 1/21/2009 patient's 1/28/2009 mother with Sjoren's sy n has been received from a office secretary concerning 36 year old mother female who on 27-FEB-2009 U 2/27/2009 was splashed 2/27/2009 in the eye with VAR n has been received from a registered nurse concerning a patient with egg allergy and a history U of chickenpox who on an unspecified date n has been received from a nurse practitioner Y concerning a 47 month old (age estimated) female N who in July 7/1/2007 2007, was 2/1/2009 vaccinated with on n has been received from a physician concerning a 17 year old female who on 13-FEB-2009Ywas vaccinated 2/13/2009 with a 0.5mL dose of VARIVA n has been received from a physician concerning a female between 30 and 40 years old who Y on an unknown 2/11/2009 date was 2/20/2009 vaccinated with a 0 n has been received from a nurse practitioner concerning her 6 year old grand daughter whoNin Summer 2008 6/1/2008 (approximately 2/28/2009 June 2008), n has been received from a registered nurse concerning a female in her late 30's who four toY five weeks1/27/2009 ago was vaccinated 2/1/2009with the first d n has been received from a registered nurse concerning a patient who a couple years ago was U vaccinated with the first and second doses n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated Y with first and second dose of VARIVA
n has been received from a physician Y concerning a 5 year old male who was vaccinated withY a second dose of VARIVAX (Merck). The pat n has been received from a nurse practitioner concerning a number of patient who were vaccinated U with VARIVAX (Oka/Merck). The patien n has been received from a registered Y nurse concerning a 27 month old female with no pre-existing Y allergies, 2/21/2008 birth defects, 2/25/2009 medical conditio n has been received from a registered nurse concerning an 8 year old female who on an unspecified Y date was vaccinated with a second of n has been received from a physician concerning an approximately 17 year old female with Y penicillin allergy and clindamycin allergy who o n has been received from a registered nurse concerning a patient (gender not specified) who U on an unspecified date, was inadvertently vac n has been received from an immunization program officer, concerning an unknown numberYof patients who 7/8/2008 on an unspecified 7/8/2008 date, were v n has been received from a physician and other health professional concerning a 17 month Y old (previously 6/10/2008 reported9/14/2008 at 18) female patient w n has been received from a physician Y assistant concerning a 44 year old male who on 05-SEP-2008 N was9/5/2008 vaccinated9/7/2008 with a first dose of VA n has been received from a registered Y nurse concerning a 16 year old female with no previous N medical history 9/18/2008 reported 9/18/2008 and an allergic rea n has been received from a health care Y professional concerning a 14 year old female who on U 23-AUG-1999 9/19/2008 was vaccinated 9/20/2008with the first do n has been received from a pharmacist Y concerning a female physician who on an unspecified U date was vaccinated with VARIVAX (Oka/Me n has been received from a physician concerning a 11 year old patient with no pertinent medical Y history,11/7/2001 allergies or9/18/2008 drugs reactions, who o n has been received from a patient who on an unknown date was vaccinated with VARIVAXU(Oka/Merck). On an unknown date, the patien n has been received from a pharmacist concerning an adult patient who received the first dose U of VARIVAX (Oka/Merck). Subsequently the n has been received from a registered nurse concerning a 24 year old female who was vaccinated U with 2 doses of of VARIVAX (Oka/Merck n has been received from a physician concerning a 10 year old male with no pertinent medical Y history or9/11/2008 drug reactions/allergies, 9/11/2008 who on 1 n has been received from a health professional concerning a 12 month old male who at 11:00 U am, on 12-SEP-2008 9/12/2008 9/18/2008 was vaccinated SC wit n has been received from a physician Y and a health Y care worker concerning 2 a 16 year old male Y patient who 12/2/2008 on 02-DEC-2008 12/4/2008was vaccinate n has been received from a physician concerning a little over 12 month old patient who was Yvaccinated with a dose of VARIVAX (Oka/Merc n has been received from a health care worker concerning a 15 month old patient who was vaccinated U with a first dose of VARIVAX on an n has been received from a medicalYassistant concerning a three elementary school aged patient Y about the age of 8 or 9 who received the follow-up information has been received Y from aYphysician and a nurse 0 concerning a 5 year old N male patient, 11/3/2008 who on11/4/2008 03-NOV-2008 was vac n has been received from a medical assistant concerning three patients who between June U 2008 and August 6/1/2008 2008 were vaccinated with th n has been received from a physician concerning a 14 month old female with no drug allergies N or reactions a history ### of reactive ### airways an n has been received from Y a physician who heard that an adult female who was vaccinated with U VARIVAX (Oka/Merck) (route and site was follow-up information has been received Y from a registered nurse concerning a 41 year old female Y with no 9/23/2008 pertinent 9/24/2008 medical history and no n has been received from a physician Y concerning Y a newborn baby (DOB 20-Mar-2008) who Y was a sibling of a patient 4/15/2008 vaccinated with VARI n has been received from a registered nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck) subcutaneous n has been received from a physician and a medical assistant concerning a female who on an N unspecified date was vaccinated with a dose n has been received from a physician who was told by another physician, that a patient whoUin the past was vaccinated with VARIVAX (Ok n has been received from a physician Y concerning a 14 month old male with no relevant medical N history or 6/19/2008 allergies who 7/15/2008 on 19-JUN-2008 w n has been received from a licensed Y practical nurse concerning a 13 month old patient who N on 09-SEP-2008 9/9/2008 was vaccinated with VARIVA n has been received from a physician concerning a 24 year old male who on an unspecifiedYdate was vaccinated with VARIVAX. About ten n has been received from a 60 yearYold femaleYwith penicillin allergy0and Y sulfonamide allergyYand a history 8/1/2001 of liver transplant, 8/1/2001 arthritis and g n has been received from Y a physician Y concerning Y a male with positive 1 skin test for egg and soy Y (physician stated ###not a clinical ### allergy to so n has been received from a registered Y nurse concerning a 40 month old boy without medicalNhistory and1/23/2007 no allergy 9/20/2008 who on 23-JAN-2007 w n has been received from a nurse concerning Y a 7 year old female who on 03-MAR-2003 wasNvaccinated SC 3/3/2003 with VARIVAX 9/24/2008 (lot number 643 n has been received from an office Y manager concerning a 13 month old female with no medical N history or 9/23/2008 allergies who 10/1/2008 on 23-SEP-2008 w n has been received from a registered Y nurse concerning a patient who was vaccinated with U VARIVAX (Oka/Merck) instead of ZOSTAVAX n has been received from a physician concerning a 15 month old male with no pertinent medical Y history and 3/5/2009 no allergies 3/5/2009 who on 05-MAR-2 n has been received from a physician concerning a 15 month old female with no pertinent medical Y history3/5/2009 and no allergies 3/5/2009 who on 05-MAR n has been received from a physician concerning a 14 month old patient who on 02-MAR-2009 N was vaccinated 3/2/2009 with3/12/2009 a dose of VARIVAX (d n has been received from a registered pharmacist concerning a 21 year old patient who wasNvaccinated with one or two doses of VARIVAX n has been received from a consumer Y concerning a 72 year old male who was supposed to U received ZOSTAVAX 3/10/2009 (Oka/Merck) 3/10/2009 on 10-MAR n has been received from a pharmacist concerning a child who on an unspecified date was vaccinated U with a dose of VARIVAX (Oka/Merc n has been received from a bachelor of science in nursing concerning her 5 year old daughter Y who in 1995 was vaccinated with VARIVAX. n has been received from a physician Y concerning an 8 year old male with unknown drug reactions, Y asthma 3/12/2009 and a history 3/12/2009 of hives (develope n has been received from a bachelor of science in nursing concerning her 1 year old son who U in 1998 was vaccinated with VARIVAX (Merc n has been received from a physician Y concerning a 9 year old female who on 09-JUL-1999 was Y vaccinated with ### a first dose ### of VARIVAX (O n has been received from a physician concerning a 9 year old male who on 01-MAY-2000 was Y vaccinated 9/26/2008 with a first 9/27/2008 dose of VARIVAX. At
n has been received from a physician concerning a 9 year old male with rhinitis allergic whoYon 08-OCT-1999 6/30/2008 was vaccinated 7/1/2008 with a first do n has been received from a physician concerning a child (age unknown) who was vaccinated U with the first 9/28/2007 and second 6/13/2008 0.5 ml doses of VAR n has been received from a nurse practitioner concerning a female with allergy to "6MP" andUCHRON'S 10/2/2008 disease who on 02-OCT-2008 rece n has been received from consumer, for the Pregnancy Registry for VARIVAX (Oka/Merck), Yconcerning a2/1/2007 34 year old5/1/2007 female who in Janua n hs been received from a physician and a licensed practical nurse concerning a female patient Y who was recently vaccinated with the seco n hs been received from a physician and a licensed practical nurse, concerning a 14 year old Y female patient 9/18/2008 with no pertinent 9/9/2008 medical histo n has been received from a registered medical assistant concerning a 4 year old male who was Y vaccinated with VARIVAX (route not report n has been received from a registered nurse concerning a patient who on 16-OCT-2008 wasUvaccinated with VARIVAX ### (Merck) ### (LOT# 660 n has been received from a pharmacist concerning a 9 year old female who on an unspecified Y date was9/17/2008 vaccinated10/8/2008 with a dose of VARIVA follow-up Information has been received Y from a nurse practitioner, concerning a 15-month-old U male infant with### eczema, who ###on 20-OCT-20 follow up information has been received from a nurse concerning a 43 year old female with Y history of fever 8/15/2008 with previously 8/22/2008 vaccinations wit n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) (lot # not re n has been received from a nurse concerning a 24 month old patient with no pertinent medical Y history who 4/3/2007 on 03-APR-2007 9/30/2008was vaccinate n has been received from a physician Y concerning a 11 year old male with no past medical history N of immunocompromise ### or ### immunosuppre follow-up information have been received Y from a register nurse concerning a 7 year old female Y student with 5/17/2002 no allergies and ###no pertinent m n has been received from a registered Y nurse concerning a 9 year old female who was vaccinated N with VARIVAX (Oka/Merck) intradermally n has been received from a healthcare professional concerning her daughter who in 1996 was Y vaccinated with VARIVAX (Merck). The pati n has been received from a nurse concerning a male who on 07-MAR-2001 was vaccinatedUwith a first dose 7/7/2008 of VARIVAX ### (Merck) 0.5 mL s n has been received from a healthcare Y worker concerning a 12 year old male with no relevant Y medical history 6/28/2007 or allergies,### who on 22-APRn has been received from a allergistYconcerning a patient who in 2007. also reported as last U year, was vaccinated with a dose of VARIVAX n has been received from a healthcare professional concerning a 12 month old female who U on 16-OCT-2008 was ### vaccinated ### subcutaneou follow-up information has been received from a registered nurse and a physician concerningUa 73 year old 10/7/2008 female patient 10/7/2008 who on 05-SEP-2 n has been received from a caller concerning her 12 month daughter with food allergies andYno pertinent 5/1/2008 medical history, 5/1/2008 on 03-JUL-2007 n has been received from a nurse concerning Y a 22 month old male who on 06-MAY-2008 was N vaccinated5/6/2008 with a dose of VARIVAX ### (Merck) n has been received from a pharmacist and nurse midwife concerning an adult female who was U vaccinated with a dose of VARIVAX (Merc n has been received from a physician concerning a 33 year old female pregnant (17 weeks)Npatient with a history of VARICELLA ### at age of n has been received from a physician Y concerning a 7 year old male with hypersensitivity andUasthma and a history ### of eczema who on 11-O n has been received from a registered nurse concerning a female patient who in April 2007, Nwas vaccinated 4/1/2007 with a dose of VARIVAX (Merc n has been received from a licensed practical nurse concerning a 5 year old male patient, with U no known6/18/1997 pertinent medical 6/18/1997 history, or no kn n hs been received from a registered nurse concerning a 64 year old patient who on approximately U 01-NOV-2008 11/1/2008 was vaccinated with VAR n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with the first dose of VARIVAX (Ok n has been received from a registered Y school nurse concerning an 8 year old female patientNwith a history7/2/2001 of shingles (2006) ###and lesions o n has been received from a physician Y concerning a 7 year old female who on 03-NOV-2008Nwas vaccinated 11/3/2008 with the 11/4/2008 second dose of VARIV n has been received from a physician Y concerning a 16 year old male with no pertinent medical Y history who 11/3/2008 on 03-JUN-1998 11/4/2008was vaccinate n has not been received from a nurse Y concerning a 24 month old female who on 15-OCT-2007 N was vaccinated### with VARIVAX ### (Oka/Merck) n has been received regarding a case Y in litigation from a registered nurse concerning a 9 year N old female 9/25/2008 who on 25-SEP-2008 was vaccin n has been received concerning a 7 year old female with no concurrent conditions or pertinent U medical history ### who on 28-OCT-2008 ### receiv n has been received form a registered nurse concerning a 12 year old female with ZITHROMAX Y allergy 7/18/2008 (total body swelling) ###and no illness n has been received form a physician Y concerning a 14 year old male with a history of attention Y deficit/hyperactivity 10/7/2008 disorder 10/8/2008 and possibly ha n has been received from a registered nurse concerning a 39 month old female with no medical Y history, no known ### allergies ### who on 10-OCT n has been received from a registered pharmacist concerning a patient who on 07-OCT-2008 U was vaccinated 10/7/2008 subcutaneously 10/7/2008 with a 0.5 m n has been received from a registered Y pharmacist concerning of a 66 years old white femaleUwho on 10-Nov-2008 ### was vaccinated ### with VA n has been received from nurse concerning a patient who came into office to receive a doseUof ZOSTAVAX (Merck) (MSD) but was given a n has been received from a physician concerning a 3 year old male who at the age of 7 months U (in approximately 2005) was ###vaccinated wi n has been received from a pharmacist concerning a 16 year old female with penicillin allergy N and a history 4/8/2008 of Guillain-Barre 4/18/2008syndrome and n has been received from a Registered Nurse with no known drug reactions or allergies, whoN on 14-MAY-2008 6/16/2008 was vaccinated ### with first do n has been received from a physician concerning her 12 month old daughter who on an unspecified Y date was vaccinated subcutaneously w n has been received from a registered Y nurse (RN) concerning a 13 month old female with eczema Y who on 31-Oct-2008 ### 11/1/2008 was vaccinated sub n has been received from a physician concerning her 2 year and 9 month old daughter who U was "previously" vaccinated with a dose of VAR n has been received from a registered nurse concerning a 20 year old female patient with noYknow drug8/28/2008 allergies, no 8/29/2008 seasonal/environmen n has been received from a pharmacist concerning his granddaughter (14 month old female)Nwho at about8/1/2008 age 12 months 8/8/2008 (approximately A
n has been received from a nurse concerning a 5 year old female who received her first dose Y of VARIVAX 6/13/2007 (Oka/Merck) (lot# ###647719/1248N n has been received from a nurse concerning a patient who was vaccinated with VARIVAX (Oka/Merck) U instead of ZOSTAVAX (Oka/Merck n has been received from a medical assistant concerning a 68 year old male who on 15-OCT-2008 U was vaccinated ### with VARIVAX ### (Oka/Me n has been received from a licensed Y nurse concerning a 12 month old male patient with no known N pertinent medical ### history, and no known n has been received from a licensed Y nurse concerning a 12 month old male patient with no known N pertinent 10/8/2008 medical history, ###and no known n has been received from a physician concerning an adult patient who was vaccinated with VARIVAX U (Oka/Merck) instead of ZOSTAVAX ( n has been received from a licensed visiting nurse concerning a 4 year old female who on 23-OCT-2008 N was vaccinated ### with ### (lot # not rep w-up information has been receivedYfrom a physician concerning a 10 year old male studentYwith no pre-existing 8/5/2008allergies, 8/25/2008 birth defects or m n has been received from a physician Y concerning a boy who was vaccinated with VARIVAX Y(Oka/Merck) 0.5ml (therapy started date, route n has been received from a physician concerning his daughter, a 13 year old female who onN18-SEP-2008 4/18/1997 was vaccinated 4/18/1997 with the second n has been received from a physician and a licensed practical nurse concerning a female who Y was recently vaccinated with the second dos n has been received from a nurse concerning Y a patient who was vaccinated with VARIVAX (Oka/Merck) Y (therapy started date, route, site u n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with VARIVAX (Oka/Merck) when n has been received from a physician assistant concerning a male patient who on 17-NOV-2008 U was vaccinated ###with VARIVAX ### (Oka/Merc n has been received from a healthcare worker concerning a 63 year old male patient, who was U scheduled9/1/2008 to receive 9/1/2008 ZOSTAVAX (Oka/Mer n has been received from a nurse concerning Y a patient who was vaccinated with VARIVAX (Oka/Merck) Y (therapy started date, route, site u n has been received from a physician Y concerning a female patient who on 03-NOV-2008 was U vaccinated11/3/2008 with a 0.5 ml dose ###of VARIVAX (O n has been received from a nurse via a sales representative concerning an approximately 4 Nyear old male1/1/2005 who in 2005 10/6/2008 was vaccinated with n has been received from a 35 yearYold female pharmacist concerning herself with no pertinent N medical 8/15/2008 history who8/25/2008 on 15-AUG-2008 was n has been received from a patient who "a week ago" was vaccinated with VARIVAX (Oka/Merck). U The patient### reported that ###she went to a n has been received from a medicalYassistant concerning a three elementary school aged patient Y about the age of 8 or 9 who received the n has been received from a consumer concerning his daughter, a 5 year old female who in October U 2007 10/1/2007 was vaccinated with VARIVAX (M n has been received from a physician Y concerning her son who was vaccinated with VARIVAX Y vaccine (Oka/Merck) (lot # not provided). Sub n has been received from a certifiedYmedical assistant concerning a 26 month female with drug Y hypersensitivity 9/22/2007 to CEFTIN### and no illness a n has been received from a physician Y concerning a 10 year old female with asthma who on N 22-OCT-1999 9/17/2008 received 10/7/2008 her first dose of VARIV n has been received from a physician Y concerning a 24 month old female who on 23-MAY-2008 Y was vaccinated 5/23/2008 with11/6/2008 her first dose of 0.5 mL n has been received from a physician Y concerning a 11 year old female who on 24-JUN-1998Nreceived her 10/2/2008 first dose10/3/2008 of VARIVAX (Merck) (l n has been received from a registered Y nurse concerning an elementary school aged child patient U with medical history and allergy unspecifi n has been received from a patient's Y mother concerning her 3 year old son, with no pertinentYmedical history 5/16/2007 and no drug ### allergies / drug re n has been received from a physician concerning a 71 year old female with no pertinent medical U history and 5/1/2008 no drug 5/1/2008 reactions/allergies wh n has been received from a health professional concerning an 8 year old female who on 21-OCT-2008 U received ### the second ### dose of VARIV n has been received from a physician Y concerning a 28 month old male (child) who was vaccinated Y with VARIVAX (Merck). Subsequently th n has been received from a Registered Nurse concerning a 38 year old female patient with penicillin N allergy and ### medical history ### unknown, n has been received from a physician Y concerning a 37 year old male who on 10-SEP-2008 received Y the10/9/2008 first dose of VARIVAX ### vaccine (Ok n has been received from a license practical nurse concerning a 12 year old female who on Y 08-SEP-20089/8/2008 received the 9/9/2008 second dose of VAR n has been received from a physician Y concerning a 10 year old female who was vaccinated N with a dose of VARIVAX (lot #### not reported) wh n has been received from a registered nurse (R.N.) concerning a patient who on 28-OCT-2008 U was vaccinated### with a dose ### of VARIVAX (M n has been received from a registered Y nurse concerning a 22 month old male with no known allergies who on an unspecified ### date was vac n has been received from a physician Y concerning a 15 month old male who on 02-JUL-2008Nwas vaccinated 7/2/2008 subcutaneously ### with a first 0.5 follow-up information has been received from a physician concerning a 13 year old male patient Y who on5/22/2007 29-JUN-1998 3/1/2008 was vaccinated subc n has been received from a medicalYassistant concerning an elementary school aged patientYabout the age of 8 or 9 who received the seco n has been received from nurse practitioner Y concerning a 49 year old female patient with hypertension N who 9/11/2008 on 11-SEP-2008 9/11/2008was vaccinate n has been received from a physician Y concerning a 4 year old male patient (his nephew) who U in approximately 8/1/2008 August 11/1/2008 2008, was vaccinate n has been received from a physician Y concerning a female patient who at the age of 12 months Y (date unspecified) was vaccinated with a d n has been received from a Registered Y Nurse concerning an 18 year old female patient withUno pertinent 9/1/1998 medical history or drug reactions n has been received from a Registered Y Nurse concerning a 13 year old white male with unknown Y medical 1/22/1997 history and no known ### drug allerg n has been received from a certified medical assistant concerning a patient who on 12-DEC-2008 U was inadvertently ### vaccinated ### with a dose n has been received from a certified medical assistant concerning a patient who on 15-DEC-2008 U was inadvertently ### vaccinated ### with a dose n has been received from a registered nurse concerning a 4 year old male patient with asthma Y intermittent 4/3/2008 who on 13-APR-2008 ### was vacc n has been received from a physician Y concerning a patient who on an unknown date, received U 2 doses of VARIVAX (Oka/Merck) (lot # not n has been received from a physician Y concerning of his daughter a 25 year old who on an unspecified U date was vaccinated with a dose of V
n has been received from a physician Y concerning a patient (a friend at school of his nephew)Uwho on unspecified date was vaccinated with n has been received from a consumer Y concerning a 28 year old daughter who 13 years ago U(1993) was vaccinated 1/1/1998 with 1/1/2008 a dose of VARIVA n has been received from a female Y licensed practical nurse, with asthma, who on 18-Dec-2008, U splashed a VARIVAX ### (Oka/Merck) ### in her e n has been received from a nurse concerning her daughter with environmental allergy. In 1999-2001 Y when her daughter was 4-6 year old, n has been received from a nurse concerning a 24 month old female with a history of liver transplant Y who was vaccinated with a dose of VA n has been received from a pharmacist concerning a 75 year old patient who on 29-DEC-2008 U was vaccinated### with VARIVAX ### (Oka/Merck) n has been received from a physician concerning Y a 2 year old female with steroid therapy, absence U of corpus callosum ### and ### pan-hypopituita n has been received from a health professional concerning a 10 year old female student who U on 03-SEP-1999 9/3/1999 was 11/6/2008 vaccinated subcutaneo n has been received from a registered Y nurse concerning a 14 month old male patient with noUpertinent medical 10/1/2008 history and### known allergies n has been received from a nurse and Y a medical assistant concerning a 44 month old female N who on 03-MAY-2006 5/3/2006 was 1/1/2009 vaccinated with he n has been received from a nurse concerning a 12 year old female who on 09-JUN-1997 was N vaccination 12/1/2008 with the first 12/1/2008 dose of VARIVAX (O n has been received from a physician a 39 year old male with no drug reactions or allergies U who on 20-Nov-2008 ###was 12/1/2008 vaccinated subcutan n has been received from a registered Y nurse concerning a 43 year old female employee whoUon 01-DEC-2008 12/1/2008 was 12/3/2008 vaccinated with the firs n has been received from a 31 yearYold female patient for the pregnancy Registry for VARIVAX. Y Some time 2/1/2007 in February, 2/10/2007 2007 was vaccina follow-up information has been received Y from a registered nurse who while working part timeN at a high school heard12/3/2008 from an acquaintance n has been received from a physician Y and a nurse supervisor concerning an 7 year old female U with asthma, 4/15/2008 eczema and allergic ### rhinitis wh n has been received from a physician Y concerning an 8 year old female patient who on 03-Dec-2008 Y was12/3/2008 vaccinated12/5/2008 with the second dose o n has been received from a registered Y nurse concerning a 10 year old female patient who onN29-OCT-1999 was ### vaccinated 12/4/2008 with a dose of n has been received from a registered nurse concerning an employee who was vaccinated with U the first dose of VARIVAR (Oka/Merck). Th n has been received from a registered nurse concerning a female employee who was vaccinated U with her second dose of VARIVAX. The p n was been received from a medicalY assistant concerning an approximately 60 year old maleU patient who 12/8/2008 on 08-DEC-2008 12/8/2008 was vaccinated n has been received from a physician Y concerning a 6 year old female patient who either 2003 N or 2004 was vaccinated with the first dose of n has been received from an office manager concerning a 76 year old female who on 03-DEC-2008 U was12/3/2008 vaccinated12/3/2008 with a dose of VARIVA n has been received from a registered Y nurse concerning a 26 year old female patient with noNpertinent medical### history and### no known drug a n has been received from a licensed Y practical nurse (L.P.N.) concerning an 8 year old female Y who was vaccinated 7/14/2008 with 1/5/2009 a first and second d n has been received from a healthcare worker concerning a female patient, who on unspecified U dates, was vaccinated with two doses of VA n has been received from a physician Y and licensed practical nurse concerning a 5 year old female Y patient 3/25/2004 who on 25-MAR-2004 5/31/2008 was vacci n has been received from a licensed Y practical nurse concerning a 51 year old male patient with N Bacitracin and ### Sulfonamide 1/2/2009 allergy and no n has been received from a physician concerning a 7 year old female twin on 02-JAN-2009 was U vaccinated 1/2/2009 subcutaneously 1/2/2009with a 0.5ml do n has been received from a physician Y concerning a 24-month-old female who was vaccinated Y with a 0.5ml dose of VERIVAX (Oka/Merck) ( n has been received from a physician concerning a male child with no pertinent medical history N and no drug allergies ### 1/1/2009 who on 29-DEC-2008 n has been received from a nurse concerning Y another nurse who in 1990 was vaccinated with U VARIVAX (Oka/Merck) (unsure if 1 or 2 dose n has been received from a physician concerning a 8 year old female who on 02-JAN-2009 U was vaccinated 1/2/2009 subsequently 1/2/2009 with a 0.5ml dose n has been received from a physician concerning a 7 year old female twin who on 02-Jan-2009 U was vaccinated 1/2/2009 subcutaneously 1/2/2009 with a 0.5m n has been received from a physician Y and certified medical assistant concerning an 8 year old U patient who was vaccinated with two doses n has been received from a health educator Y concerning a male teenager who on 30-DEC-2008 N was vaccinated### with1/11/2009 VARIVAX (Oka/Merck n has been received from a registered nurse concerning a 43 month old male child who on 05-SEP-2006 Y 9/5/2006 was vaccinated 1/3/2009 subcutaneously i n has been received from a physician concerning an 10 year old patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck) (no lot# n has been received from a nurse concerning Y an 8 year old male with no medical history, noNknown drug9/18/2001 allergies who 1/11/2009 on 18-SEP-2001 wa n has been received from a nurse concerning Y a 28 year old female with no allergy who on 22-DEC-2008 Y was vaccinated ### with ### her first dose n has been received from a nurse practitioner concerning a female who was intended to receive U ZOSTAVAX 1/13/2009 (Oka/Merck), 1/13/2009 was inadvertent n has been received from a nurse concerning Y a 50 year old female who in 1995 was vaccinated U with one dose of VARIVAX (Oka/Merck) (lo n has been received from a nurse practitioner concerning an unspecified number of patientsUwho on an unspecified date were vaccinated w n has been received from a physician concerning an 88 year old male who on an unknown date, Y was vaccinated ###with1/5/2009 the first dose of VAR n has been received from a school registered nurse who heard of a case concerning a child Ywho was vaccinated with one dose of VARIVA n has been received from a nurse concerning Y a 12 month old female who on 22-DEC-2008 was Y vaccinated with ### a first dose ###of VARIVAX (O n has been received from a registered Y nurse concerning a 7 year old female patient with no Y previous medical 4/24/2007 history 4/27/2007 reported, who on 04-A n has been received from a licensed visiting nurse concerning a patient who on 10-MAR-1999 U was vaccinated 3/10/1999 with 3/14/1999 a dose of VARIVAX (Ok n has been received from a consumer Y concerning a her 12 month old son with no pertinent medical N history 9/11/2007 and known 9/15/2007 drug reactions or all n has been received from a bachelor of sciences in nursing concerning a patient who on an U unspecified date was inadvertently vaccinated n has been received from a physician concerning her ex-husband who was vaccinated IM with U VARIVAX (Oka/Merck) (Lot # 659722/1877U
n has been received from a physician assistant concerning a 27 year old male with amoxicillin Y allergy who on 13-NOV-2008 ### ###was vaccinate n has been received from a physician Y concerning a male patient under the age of four yearsYwho was vaccinated wit 1/19/2009 ha dose of VARIVAX n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck). It was n has been received from a certified medical assistant concerning a patient who "one week ago" U was vaccinated 1/16/2009with 1/16/2009 a dose of VARIVAX ( n has been received from a registered Y nurse concerning a 6 year old male patient with no known Y drug reaction/allergies 4/11/2008 1/21/2009 and no pertinent m n has been received from a physician concerning a patient who was intended to receive ZOSTAVAX U (Oka/Merck) (MSD), was inadvertently n has been received from a nurse practitioner concerning a male with no pertinent medical history, Y allergies 10/5/1998 or drug reactions who on 05-O n has been received from a nurse practitioner Y concerning a 13 year old male patient with noYpertinent medical 10/2/1996 history1/9/2009 and no known allergi n has been received from a health professional concerning a 5 year old female patient, who Non 18-OCT-2007 was ### vaccinated with a dose o n has been received from a nurse practitioner Y concerning an 8 year old male with food allergies Y including 7/21/2001 peanuts and no past medical hist n has been received from a nurse practitioner concerning a 4 year old female who on an unknown Y date was vaccinated with a dose of VAR n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof VARIVAX 1/8/2009 (Oka/Merck) 1/20/2009 (lot#661008/1317X). n has been received from a registered nurse concerning a 7 year old male patient with asthma N who on 19-AUG-2002 8/19/2002 1/24/2009 was vaccinated with o n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof VARIVAX (lot# 661008/1317X). Concomitan n has been received from a registered nurse concerning a 4 year old male patient who in approximately Y 2005 was vaccinated 1/1/2008 with the first n has been received from a public health Y nurse concerning a 16 year old female child who inU2004 was vaccinated 10/1/2008 with 1/1/2009 her first dose of VA n has been received from a registered Y nurse concerning a 43 year old male with no pertinentNmedical history 1/23/2009 and no1/25/2009 drug reactions/allergie n has been received from a physician concerning a 9 year old female who at few years ago N was vaccinated injection with VARIVAX (Merck n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the n has been received from a registered Y nurse concerning a 13 year old female with no knownNallergies or7/15/2008 medical history, 7/17/2008 who on 07-AUG-1 n has been received from a licensed practical nurse concerning a 9 year old white female who Y on 25-Aug-2004 8/26/2004 was vaccinated 6/8/2008 SQ with VA n has been received from a physician concerning a male patient, who was vaccinated with the N first dose of VARIVAX (Oka/Merck) on an un n has been received from a medicalYtechnician concerning her 18 month old female daughter, Y with no pertinent 7/16/2008 medical 7/17/2008 history and no drug n has been received from a registered Y nurse concerning a 13 month old male with no relevant N medical history 7/16/2008 and no 7/17/2008 drug allergy who on 1 n has been received from a physician concerning a 35 year old female who 15-Mar-2005 was N vaccinated 3/15/2005 with a first dose of VARIVAX (Ok n has been received from a healthcare worker concerning a 19 year old female with no pertinent N medical4/25/1996 history who on 25-APR-1996 was n has been received from a physician concerning a female teenage patient who on an unspecified U date was vaccinated with the second do n has been received from an office Y manager, in physician's office, concerning an office nurse's U child who on an unspecified date was vacci n has been received from a nurse concerning Y an 8 year old male who on 18-JUN-2008 was Yvaccinated with 6/18/2008 the second 6/19/2008 dose of VARIVAX n has been received from a physician concerning a female patient, who was vaccinated withNthe first dose of VARIVAX (Merck) on an unsp n has been received from a physician concerning an 18 year old female who on 19-JAN-1998 N was vaccinated 7/3/2008 with the 7/3/2008 first dose of VARIVA n has been received from a physician concerning a patient who on 23-Jul-2008 was vaccinated U with VARIVAX 7/23/2008 (Oka/Merck). 7/23/2008The physician n has been received from a licensed practical nurse concerning a 40 month old male, weightU29.5lb height 2/28/2006 35 inches, 6/23/2008 who on 28-Feb-2006 n has been received from a physician concerning an 8 year old male with no know allergies N who on 01-JUL-2008 7/1/2008at6/30/2008 2 PM was vaccinated s n has been received from a physician concerning a 9 year old female with no know drug allergies U who at6/24/2008 11 AM on 6/25/2008 24-JUN-2008 was vacc n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U 2/5/1999 with the second 0.5ml dose of VA n has been received from a physician concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician Y concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5ml dose of VA n has been received from a physician concerning a child with no reactions after the first dose N of VARIVAX 7/10/2008 (Oka/Merck) who on approximat n has been received from a physician Y assistant concerning her approximately 24 month old N son with no pertinent medical 7/23/2008 history nor drug a n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5 ml dose of V n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously U with the second 0.5 ml dose VAR n has been received from a physician concerning an 8 year old male who on 23-JUN-1998 was U vaccinated 6/23/1998 with a first 6/17/2005 dose of VARIVAX (O n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl n has been received from a medical assistant concerning a female who on 08-JUL-2008 was U vaccinated subcutaneously 7/8/2008 7/15/2008 with a 0.5 ml dose n has been received from a registered nurse concerning her daughter, a 3 year old female who Y in approximately 2006 (2 years ago) was va n has been received from a nurse practitioner concerning Y a 12 month old male with eczemaNand egg allergy 7/11/2008 who on7/13/2008 11-JUL-2008 was vacc n has been received from a certified medical assistant concerning a 14 month old female who Y on 29-JUN-2005 6/29/2005 was vaccinated 8/3/2005 with a first n has been received from a physician concerning his 4 year old son who "at age of 1", in 2005 N was vaccinated with a7/1/2008 dose of VARIVAX (O
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl n has been received from a medicalYassistant concerning a 5 year old patient who on 19-JUL-2004 Y was vaccinated 8/14/2006 with VARIVAX (Oka/Me n has been received from a physician concerning an about 7 year old male who on an unspecified U date was vaccinated with VARIVAX (Ok follow-up information has been received Y from a nurse concerning a 17 year old female with Y asthma and 7/17/2008 no allergy who 7/25/2008 on 17-JUL-2008 wa follow-up information has been received from a medical assistant concerning a 12 month oldY male with no 7/18/2008 relevant medical history or allerg n has been received from a consumer concerning her 12 year old daughter with sulfonamideNallergy who7/23/2008 on 23-JUL-2008 7/24/2008 was vaccinated w n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y female twin 8/6/2008 who on an8/7/2008 unspecified date was n has been received from a nurse practitioner concerning a 6 year old female patient who was Y vaccinated with a second dose of VARIVAX n has been received from a healthcare worker concerning an adult female who on 23-JUL-2008 U was vaccinated 7/23/2008 inadvertently 7/23/2008 with a dose o n has been received from a licensed practical nurse and a consumer concerning a 11 year old Y white female 8/6/2008 twin who8/7/2008 on 06-AUG-2008 was n has been received from a nurse concerning a 12 month old healthy patient who on 17-JUL-2008 Y was vaccinated 7/17/2008 with 7/23/2008 a first dose of VAR n has been received from a healthcare worker and the nurse concerning a 63 year old female U who on 02-AUG-2008 8/2/2008 8/2/2008 was vaccinated with a n has been received from a physician concerning a 7 year old female with allergic rhinitis and Y a history of 7/16/2008 "HAO" who 7/17/2008 on 16-JUL-2008 at 11 n has been received from a company representative concerning her daughter a 7 year old female Y with pollen 7/1/2007 allergy 7/1/2008 who in approximately follow-up information has been received from a nurse concerning a 10 year old male who onU13-AUG-2008 8/13/2008 was vaccinated 8/15/2008 subcutaneousl n has been received from a registered nurse concerning her daughter, a 14 year old female Ywho at 4:008/21/2007 pm on 21-AUG-2007 8/23/2007 was vaccinat n has been received from a registered Y nurse concerning a 4 year old female with no known U pertinent medical 8/13/2008 history 8/15/2008 or drug reactions/aller n has been received from a registered Y nurse, concerning her 5 year old son, who on 12-MAY-2004 N was 5/12/2004 vaccinated 8/20/2008 with VARIVAX (Oka/Me follow-up information has been received from a nurse concerning a 10 year old male with mold U allergy and 8/13/2008 reactive8/15/2008 airway disease who on n has been received from a physician concerning a 3 year old male who on 27-FEB-2006 was N vaccinated 2/27/2006 subcutaneously with one 0.5 ml d n has been received from a physician concerning a 15 year old female patient who on 16-AUG-2008, U was 8/16/2008 vaccinated 8/18/2008 subcutaneously into n has been received from a physician Y concerning a 15 year old female patient who on 24-MAR-2008, Y was 3/24/2008 vaccinated 3/24/2008 with a dose of VARIV n has been received from a nursing student concerning her 4 year old daughter who on 22-JUL-2005 Y was 8/21/2008 vaccinated 8/21/2008 subcutaneously with n has been received from a physician Y concerning a 5 year old female who on 07-AUG-2008,Nwas vaccinated 8/7/2008 with her8/9/2008 first dose of VARIVAX n has been received from a female who "last week" (on approximately 15-AUG-2008) was vaccinated U with 8/15/2008 one dose of VARIVAX (Merck) 0 n has been received from a registered Y nurse concerning a 5 year old female with no illnesses Y at the time8/11/2008 of vaccination, 8/11/2008 who on 04-FEB-20 n has been received from a nurse concerning Y a 14 year old patient with allergy to unspecified Y medication who ### on 12-DEC-1999 6/18/2008 was vaccin n has been received from a physician Y concerning a 16 year old male who in 1996 was vaccinated Y with VARIVAX 6/27/2008(Oka/Merck). 6/27/2008 On 27-JUN n has been received from a nurse concerning a 10 year old patient with allergy to unspecified Y medication who ### on 28-Dec-1999 7/1/2008 was vaccina n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA n has been received from a female who a year ago was suppose to get ZOSTAVAX (Merck),U but by mistake 8/1/2007 the prescription 8/1/2007was written fo n has been received from a consumer concerning a 10 year old male son with no previous medical N history 8/19/2008 reported,8/20/2008 who on 19-AUG-2008 n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me n has been received from a nurse concerning Y a 7 year (estimated, age unit was not provided) Y old patient with an ###allergy 7/1/2008 to unspecified med n has been received from a pharmacist concerning an adult patient who was vaccinated withUVARIVAX (Oka/Merck). Subsequently the pat n has been received from a pharmacist, concerning a 67 year old male patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) i n has been received from a registered Y nurse concerning a 14 year old male with no pertinentNmedical history 9/10/1997 who on 10-SEP-1997 was vac n has been received from a pharmacist Y concerning her son who was vaccinated with VARIVAX Y (Oka/Merck) a while ago. The patient deve n has been received from a physician Y concerning a 36 month old female with no pertinent medical N history 8/16/2006 who on 16-AUG-2006 8/25/2008 was vaccin follow-up information has been received from a registered nurse concerning her 18 year oldYdaughter with 8/13/2008 no known 8/13/2008 allergies or pertinent m n has been received from a registered nurse; concerning a friend of hers who developed shingles N 3 days after her children received a boos n has been received from a registered Y nurse (R.N.) concerning a 12 year old female who onN18-DEC-1998 was### vaccinated 8/21/2008 subcutaneously n has been received from a registered Y nurse (R.N.) concerning a 13 year old male who on 25-AUG-2008 U 8/25/2008 was vaccinated 8/25/2008 subcutaneously w n has been received from a nurse concerning a female grandmother of a child who receivedUthe second6/18/2008 dose of VARIVAX (Merck) (Lot # 6 n has been received from a physician concerning an "almost 5 years old" male who in November U 2007, 11/1/2007 was vaccinated 8/22/2008 with his second do n has been received from a nurse concerning Y a 13 year old female who was vaccinated withYa second dose 8/26/2008 of VARIVAX 8/26/2008 (Merck). One day n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Merck). Subsequently the patient developed n has been received from a consumer concerning her 6 year old son, who on 13-AUG-2008Nwas vaccinated 8/13/2008 with VARIVAX 8/23/2008 (Merck), 0.5 mL n has been received from a pharmacist, concerning a 67 year old female patient who was vaccinated U with a dose of VARIVAX (Oka/Merck n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Oka/Merck). Subsequently the patient devel n has been received from a nurse at the health care department who received a faxed reportUfrom a registered 12/3/2007 nurse, 8/20/2008 concerning a case of
n has been received from a physician Y concerning a patient who on an unspecified date was Yvaccinated with a first dose of VARIVAX (Merc n has been received from a physician concerning a patient who on an unspecified date, wasUvaccinated with a dose of VARIVAX (Merck). T follow-up information has been received Y from a nurse and a consumer concerning her 10 year Y old daughter 8/4/2008 who is a8/5/2008 student with an amox n has been received from a physician Y concerning a male who on 28-JUN-2008 was vaccinated U with a dose 6/28/2008 of VARIVAX 8/6/2008 (Oka/Merck) (Lot n n has been received from a physician concerning a male patient with Crohn's disease who on N an unspecified date was vaccinated with VAR follow up information has been received Y from a physician concerning a 9 year old male whoNin 1999, also re was vaccinated with a 0.5 ml d n has been received from a physician concerning a 10 year old female with no known allergies U who on 05-AUG-2008 8/5/2008 8/5/2008 was vaccinated with n has been received from a licensed practical nurse concerning an approximately 12 year old N male patient 8/11/1997 who on 11-AUG-1997 8/18/1997 was vacc n has been received from a physician Y concerning a 4 year old female patient who on 20-AUG-2005, N was8/23/2008 vaccinated8/25/2008 with the first dose of V n has been received from a physician Y concerning a 5 year old female who on 19-AUG-2004Nwas vaccinated 8/19/2008 with a first 8/21/2008 dose of VARIVAX ( n has been received from a registered nurse (R.N.) concerning two or three patients who were Y vaccinated8/8/2008 with VARIVAX 8/10/2008 (Merck) that was n has been received from a physician Y concerning a 12 month old female with no known pertinent U medical 8/16/2008 history or8/18/2008 drug reactions/allergies n has been received from a physician Y concerning an 8 year old female with no pertinent medical U history and no history 7/12/2008 of drug reactions or n has been received from a physician's assistant concerning a 4 year old female who on 20-DEC-2004 U was 8/4/2008 vaccinated 8/4/2008 with the first dose o n has been received from a registered nurse (R.N.) concerning a 9 year old male who on 14-FEB-2000 N was 2/14/2000 vaccinated 8/16/2008 subcutaneously wit follow-up information has been received Y from a physician concerning a female patient whose U son in 1999 was vaccinated 7/28/2008 with a dose of VA rmation has been received from a registered Y nurse concerning her 5 year old daughter who on N 27-AUG-2008 8/27/2008 was vaccinated 8/27/2008 with a dose o n has been received from a health professional Y concerning a 5 year old female with no allergies Y and no medical 2/7/2006 history 9/1/2006 reported, who on 0 n has been received from a pharmacist concerning a patient who an unspecified date was vaccinated with a dose of VARIVAX (Oka/Merck n has been received from a nurse concerning Y a 5 year old male with dextromethorphan hypersensitivity Y 10/8/1996 who on 08-OCT-1996 was vaccina n has been received from a physician concerning an 11-15 year old female who was vaccinated U with a second dose of VARIVAX (Oka/Mer n has been received from an allergist/ Y immunologist concerning a 7-9 year old male "sometime N in mid-July 7/15/2008 2008", on approximately 15-Julfollow-up information has been received Y from a physician concerning a 16 month old femaleNwith a history6/1/2008 of allergic6/1/2008 atopic dermatitis who n has been received from a licensed Y practical nurse (L.P.N.) concerning a 12 month old female Y with no pertinent 8/29/2008medical 9/1/2008 history or allergie follow-up information has been received Y from a physician concerning a 5 year old male patient Y (birth weight 9/8/2008 was 7 pounds, 9/9/2008 11 ounces) with n has been received from a physician concerning a 12 year old female who on an unspecified N date was vaccinated with a second dose of V follow-up information has been received Y from a nurse concerning a 16 year old male who onN22-JUL-1997 8/18/2008 was vaccinated 9/6/2008 with the first dos n has been received from a physician concerning an 11-15 year female who was vaccinatedUwith a second dose of VARIVAX (Oka/Merck). n has been received from a physician Y concerning a 6 year old female with a history of otitis media Y in February 2/7/2004 20048/11/2008 (treated with amoxicillin n has been received from a pharmacist Y concerning a 15 year old male patient with AMOXICILLIN U allergy 9/8/2008 who on 08-SEP-2008 9/10/2008 was vaccin follow-up information has been received Y from a physician concerning a 11 year old female who U on 20-AUG-2008 8/20/2008was 8/20/2008 vaccinated with the f n has been received from a physician Y concerning a 9 year old female who was vaccinated with Y VARIVAX vaccine (Oka/Merck) (route, lot n n has been received from a pharmacist Y concerning a 29 year old female who on 09-Sep-2008 U was vaccinated 9/9/2008 IM with 9/9/2008 VARIVAX (Oka/Merc n has been received form a physician's Y assistant student concerning an 11 year old male with N no known5/23/2007 allergies, who 9/4/2008 on 18-APR-2000 wa follow-up information has been received Y from a nurse practitioner concerning a 7 year old female Y with allergy 8/4/1998 to OMNICEF ### (rash) and no p n has been received from a physician Y concerning a 7 year old male patient who on 21-AUG-2008 U was vaccinated 8/21/2008 with 9/9/2008 a second dose of VA n has been received from a consumer her 12 months daughter with allergy to gelatin, who on N 04-Sep-2008 9/4/2008 was vaccinated 9/4/2008 with VARIVAX n has been received from a physician's Y assistant concerning a female patient who received U two doses two of VARIVAX 9/3/2008 (Merck) at unstated n has been received from a registered Y nurse concerning a 4 year old male with no pertinent N medical history 8/4/2008 and no history 8/6/2008 of drug reaction n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5ml dose o n has been received from a physician Y concerning a 5 year old patient who had been vaccinated Y with a dose of VARIVAX (Merck) in the pas follow-up information has been received from a nurse concerning her 6 year old male grandson U with no 8/16/2008 pertinent medical 9/6/2008 history and no dr n has been received from a Certified Y Medical Assistant concerning a 9 year old female who N on 10-SEP-2008 9/10/2008 was vaccinated 9/10/2008 with a booste n has been received from a nurse concerning Y a 9-year-old female patient who on 30-AUG-2008 N received8/30/2008 the second dose of 0.5ml VARIVA n has been received from a physician Y concerning a 16 month old female with no pertinent medical N history8/8/2008 and no drug 9/8/2008 reactions/allergies, w n has been received from a physician concerning an 8 year old male who on 23-JAN-2001 was vaccinated 1/23/2001 with the first 9/7/2008 dose of VARIVAX n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5 ml dose n has been received from a physician Y concerning a 11 year old male patient who on 21-AUG-2008 U was 8/21/2008 vaccinated with 9/9/2008 a second dose of V n has been received from a physician Y concerning a 9 year old male patient who on 21-AUG-2008 U was vaccinated 8/21/2008 with 9/9/2008 a second dose of VA n has been received from a physician Y concerning a 11 year old female patient who on 21-AUG-2008 U was 8/21/2008 vaccinated9/9/2008 with a second dose o follow-up information has been received from a nurse concerning a 67 year old female with U hypertension9/16/2008 who on 16-SEP-2008 9/16/2008 was vaccin
n has been received from a nurse concerning her 7 year old male grandson with no pertinent N medical history and no 9/6/2008 drug reactions/allergie follow-up information has been received from a nurse concerning a 68 year old male with hyperlipidemia U 9/16/2008 who on 16-Sep-2008 9/16/2008 was vaccina n has been received from a physician concerning an 11 year old female who on an unknownUdate was vaccinated with a second dose of V n has been received from a certifiedYmedical assistant (C.M.A) concerning a 20 year old female, Y weight 7/17/2008 168lb, height 7/18/2008 67 inches, with no pe n has been received via literature article regarding a case in litigation concerning a now 54 year U old female 3/7/2001 with common variable immunod n has been received from a physician concerning a 24 year old female who on was vaccinated U with two doses 4/1/2008 of VARIVAX (Merck) and fai n has been received from a registered nurse concerning an over 6 years old male who on approximately U 7/21/2008 21-JUL-2008 7/21/2008 was vaccinated with n has been received from a physician Y concerning a 12 month old male with no medical history Y or no drug allergies who was vaccinated with n has been received from a pharmacist concerning a male who was vaccinated with VARIVAX U (Oka/Merck). The patient failed to SEROCO n has been received from a physician Y concerning a 12 month old female who on 29-MAY-2008 N was a dose 5/29/2008 of vaccinated with VARIVAX (M n has been received from a pharmacist concerning a 70 year old male who on 14-MAY-2008Uwas vaccinated 5/14/2008 with VARIVAX 5/14/2008(Merck), 0.5 m n has been received from a physician concerning a 7 year old male who was vaccinated withU the second dose of VARIVAX (Merck). One y n has been received from a registered Y nurse concerning a 4 year old boy who on 06-JAN-2005 N was vaccinated 7/17/2007 subcutaneously 5/13/2008 into left arm n has been received from a physician concerning a 60 year old patient who on 30-JUL-2008Uwas inadvertently 7/30/2008 vaccinated 7/30/2008 with VARIVAX (O n has been received from a physician Y concerning an approximately 10 year old patient who N on an unspecified date was vaccinated with a d n has been received from a physician Y concerning a 13 month old female with no pertinent medical N history 4/30/2008 and no allergies 5/11/2008 who on 30-APR n has been received from a physician concerning a 16 month old female with no known allergies N or pertinent 4/21/2008 medical5/9/2008 history who on 21-AP n has been received from a nurse practitioner through a pregnancy registry concerning a 29Yyear old female 4/1/2008 with asthma 4/1/2008 and a possible Ty n has been received from a consumer's Y mother concerning her 24 month old daughter with no N pertinent medical ### history or### drug allergies wh n has been received from a physician Y concerning a 5 year old male who on 19-Jan-2008 was on 19-Jan-2008 1/19/2008 was vaccinated 7/21/2008 with a secon n has been received from a registered Y nurse (R.N.) concerning a 11 year old male with no pertinent Y medical 5/18/1998 history and 5/8/2008 no allergies who o n has been received from a physician concerning a male who's 5 year old son was vaccinated U with VARIVAX (Oka/Merck) on an unspecifie n has been received from a nurse concerning a 55 day old patient who on 16-MAY-2008 was U vaccinated5/16/2008 into the thigh 5/16/2008 with a dose of VARI n has been received from a physician concerning his 5 year old grandson with a history of eczema U (outgrew) 5/1/2008 and no 5/1/2008 known allergies who in n has been received from a consumer concerning her 5 year old grandson who was vaccinated U with at least one dose 4/9/2007 of VARIVAX (Merck) follow-up information has been received from a nursing student concerning a 19 month old male Y with no7/22/2003 known drug 7/24/2003 reaction/allergies or p n has been received from a healthcare worker concerning a 75 year old female who on 16-MAY-2008 U was 5/13/2008 vaccinated 5/16/2008 with a dose of VARIV n has been received from a medicalYassistant concerning a 5 year old male with no pertinentNmedical history 7/30/2008 or allergies 7/30/2008 who on 14-AUG-2 n has been received from a registered nurse (R.N.) concerning a 10 year old patient who was U vaccinated with a dose of VARIVAX (Merck) n has been received from a nurse practitioner concerning a 37 year old female who on 28-SEP-1998 U was vaccinated ### 8/16/2007 with the first dose of V n has been received from a registered nurse concerning an 8 year old patient who was vaccinated U with a dose of VARIVAX (Merck) (dose n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008 U was 7/21/2008 vaccinated 7/21/2008 with a second dose n has been received from a office manager Y concerning a 30 month old female who was vaccinated U with the first dose of VARIVAX (Merck) n has been received from a registered nurse concerning one to two female patients betweenNthe ages 15 to 18 months out of 20 who were n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008 U was 7/21/2008 vaccinated 7/21/2008 with a second dose n has been received from a physician Y and a medical assistant concerning a 5 year old boy with Y no pertinent 5/19/2008 medical5/19/2008 history and no history n has been received from a physician Y concerning a 10 year old female with no related medical Y history and 5/13/2008 drug allergy 5/14/2008 who was vaccinated n has been received from a physician Y concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX (Merck). At t n has been received from a medical assistant concerning a 11 year old male who "about oneY month ago", in April 2008, was vaccinated wit n has been received from medical assistant concerning a 7 year old patient who "about one Ymonth ago" in April 2008, was vaccinated with n has been received from a male dentist concerning his female friend who on 08-APR-2008 Uwas vaccinated 4/8/2008 with VARIVAX 4/8/2008 (MERCK) inste n has been received from a consumer concerning a 48 year old male with high blood pressure U whose 5-year-old son4/9/2007 developed bumps on n has been received from a nurse practitioner Y concerning an approximately 16 month old male Y with no known 1/8/2003 allergies 2/1/2003 or pertinent medica n has been received from a physician Y and a medical assistant concerning a 7 year old female, Y weight 46lb, 12/4/2006 who on 4/27/2008 19-JUL-2001 was vacc n has been received from a nurse concerning Y a 29 year old female who was vaccinated withUVARIVAX (Merck). The nurse reported that th n has been received from a physician's office staff member concerning her daughter, a 4 year Y old female5/16/2008 who on 16-MAY-2008 5/16/2008 was vaccin n has been received from a physician concerning a 12 month old patient who on an unspecified U date was vaccinated with a dose of VARIV n has been received from a physician's office staff member concerning a 4 year old boy whoYon 22-MAY-2008 5/22/2008 was 5/22/2008 vaccinated with the sec n has been received from a physician Y concerning an 8 year old female, weight 39lb, height 48.5 Y inches, 8/23/2007 who on 05-DEC-2000 4/25/2008 was vaccina n has been received from a physician and her first office staff member concerning a 4 year old Y patient who 5/22/2008 on 22-MAY-2008 5/22/2008was vaccinate n has been received from a physician and her office staff member concerning a 4 year old boy Y who on 22-MAY-2008 5/22/2008 5/22/2008 was vaccinated with t
n has been received through the pregnancy Y registry from a registered nurse for VARIVAX (Merck) U concerning 3/25/2008 a 20 3/25/2008 year old female with no n has been received from a registered nurse concerning a 14 year old male with no allergiesYand with Crohn's 4/28/2008 disease 4/29/2008 and who is immunoc n has been received from a registered Y nurse concerning a female in her 30's year old who on Y 19-MAY-2008 5/19/2008 was vaccinated 5/19/2008with a first dos n has been received from a registered nurse concerning one to two male patients between the N ages 15 to 18 months out of 20 who were v n has been received from a registered nurse concerning an 8 year old patient who was vaccinated U with a dose of VARIVAX (Merck) (dose n has been received from a physician Y concerning a 30 month old male with no other medicalNproblems who on an unspecified date had bee n has been received from a physician Y concerning a 13 year old male who was vaccinated with Y the second dose of VARIVAX (Merck) (lot# 6 n has been received from a medicalYassistant and physician concerning a 21 year old female Y with no pertinent 5/13/2008 medical 5/23/2008 history and no drug n has been received from a physician Y concerning a 13 month old male who on 05-MAY-2008 Y was vaccinated 5/5/2008 subcutaneous 5/19/2008with his first do n has been received from a registered nurse concerning a 57 year old female who on 27-MAY-2008 Y was5/27/2008 intended to 5/27/2008 receive ZOSTAVAX ( n has been received from a physician Y concerning an 8 year old boy who on 12-MAY-2008 was Y vaccinated 5/12/2008 with the second 5/26/2008 dose of VARIVA n has been received from a physician Y concerning a 12 year old male who was vaccinated with N a first dose of VARIVAX (Merck). The patien n has been received from a physician concerning a 12 month old female with no known allergies Y and a history 4/23/2008 of cellulitis 5/4/2008 in left leg at 6 mo n has been received from a health professional concerning a patient who was vaccinated with U a dose of VARIVAX (Merck) (lot number, inje n has been received from a physician concerning an 18 month old female who on 22-MAY-2008 Y was vaccinated 5/22/2008with 5/22/2008 VARIVAX (Merck). Th n has been received from a physician concerning a 5 year old male with seasonal allergies who N on 24-JUN-2004 5/14/2008was 5/14/2008 vaccinated subcutan n has been received from a physician concerning a 9 year old male who on 06-SEP-1995 was U vaccinated9/6/1995 with VARIVAX 9/1/2004 (Merck) (lot # not n has been received from a registered nurse, concerning her 13 year old daughter who on 14-JUL-1995 Y 7/14/1995 was vaccinated 5/28/2008 with the first dose n has been received from a physician Y assistant concerning a 30 year old white female with seasonal allergy, 8/1/2008 chronic8/13/2008 sinusitis and anaemia n has been received from a health professional concerning an 18 year old female who on 20-MAY-2008 U 5/20/2008 was vaccinated 5/22/2008 subcutaneously on n has been received from a medical assistant and physician concerning a 10 year old female N with no pertinent 8/11/2008 medical 8/11/2008 history and no allerg n has been received from a registered nurse concerning a 12 month old female who in approximately U 2007, about one year ago, was vacci n has been received from a registered nurse concerning an 8 year old female who on 02-MAR-2001 Y was9/12/2007 vaccinated 5/9/2008 subcutaneous with a f n has been received from a physician concerning an 82 year old female patient living in an assisted U living 8/15/2008 residence8/15/2008 who on 1:30PM, 15-AU n has been received from a licensed Y practical nurse concerning a 5 year old female with no U medical history 5/21/2008 or allergies who on 21-MAY-20 n has been received from a physician concerning a patient who was vaccinated with VARIVAX U vaccine (Merck). The physician reported tha n has been received from a physician concerning a child who was vaccinated with a dose ofUVARIVAX (Merck) in the 4/21/2008 past. Five or six week n has been received from a registered Y nurse concerning a 12 month old female who on 08-APR-2008 Y was 4/8/2008 vaccinated 4/17/2008 subcutaneously in th n has been received from a consumer concerning her daughter, a female who in approximately U 1998 (about 10 years ago) was vaccinated n has been received from a pharmacist concerning a 25 year old female employee of the hospital U who was vaccinated with two doses of VA n has been received from a registered pharmacist concerning her son, a 14 month old male Ywith no pertinent 7/1/2008 medical7/1/2008 history and no known n has been received from a medicalYassistant concerning a 9 year old female, weight 78lb, height Y 58 inches, 5/22/2008 with attention 6/2/2008 deficit/hyperacti n has been received from a physician Y concerning an 8 year old male who on 22-AUG-2000 N was vaccinated 9/1/2006 subcutaneously 5/26/2008with the first do n has been received from a medical assistant and a nurse concerning a 70 year old female who U on 18-AUG-2008 8/18/2008 was 8/18/2008 vaccinated with VAR n has been received from a physician concerning an 85 year old male who on 08-APR-2008Uwas vaccinated 4/8/2008 with a "regular 4/8/2008 dose" of VARIV n has been received from a physician concerning her 8.5 year old daughter who on 24-JUL-2007 U was vaccinated 7/24/2007in7/24/2007 the right arm with a do n has been received from a registered Y nurse concerning a 6 year old male with no drug allergies Y who on5/14/2003 14-MAY-2003 5/24/2008 was vaccinated with n has been received from a registered Y nurse (R.N.) concerning a patient who on 03-JUN-2008 U was inadvertently 6/3/2008vaccinated 6/3/2008subcutaneosly n has been received from a physician Y concerning a male in his 40's with a past medical history N significant5/1/2008 for a thyroid 5/1/2008 disorder treated with n has been received from a certified medical assistant concerning a 13 year old white femaleY with no pre-existing 8/7/2008allergies, 8/8/2008 birth defects, or n has been received from a vaccineYprovider concerning a 9 year old female minor with no pre-existing Y 5/28/2008 allergies, birth 5/29/2008 defects or medical c n has been received from a physician Y concerning a 10 year old male with allergy to OMNICEF Y who on 22-APR-1999 4/22/1999 8/10/2008 was vaccinated with a n has been received from a physician concerning a 4 year old female with no history of recent exposure to 6/5/2005 Chicken pox 6/4/2008 who on 05-JUN-20 n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male with8/12/2008 atopic dermatitis 8/13/2008 on leg behind kn n has been received from a registered nurse concerning a 68 year old female patient with noUpertinent medical history 8/8/2008 or known allergies o t was identified from a line listing obtained Y on request by the company from the FDA under the U Freedom of Information Act. A patient exper n has been received from a registered nurse (R.N.) concerning a 69 year old female who onU11-AUG-2008 8/11/2008 was vaccinated 8/11/2008 with a dose of V n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX vacc n has been received from a physician Y concerning a 9 year old male who in approximately 2000, N "8 years ago", was 8/12/2008 vaccinated subcutaneo n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male who 8/4/2008 on an unspecified 8/5/2008 date was vaccin
n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Oka n has been received from a registered Y nurse concerning a 19 year old female patient with asthma Y and penicillin 8/4/2008 allergy 8/13/2008 which caused breat n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Mer n has been received from a registered Y pharmacist concerning a patient who on 13-AUG-2008 U was vaccinated 8/13/2008 with a8/13/2008 dose of VARIVAX (Me n has been received from a physician Y concerning a patient who on an unknown date was vaccinated U with a second dose of VARIVAX (Mer n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me n has been received from a physician Y concerning an adult male, without a reported history ofUchickenpox and who was VZV negative, who n has been received from a registered Y nurse concerning a 3 year old female with no known N drug allergies 7/28/2008 and no pertinent 8/10/2008 medical history, follow-up information has been received Y from a licensed practical nurse for the pregnancy registry Y for VARIVAX 3/7/2008 (Merck) 3/7/2008 concerning a 15 y n has been received from a physician concerning a male who was vaccinated with a dose ofUVARIVAX (Merck). Subsequently the patient e n has been received from a licensed practical nurse and a consumer concerning an 11 yearYold female who 6/13/2008 on 13-Aug-2008 8/14/2008was vaccinate n has been received from a nurse concerning a patient who on 04-AUG-2008 was vaccinated U with a dose8/4/2008 of VARIVAX (Merck) (lot # 66144 n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007 (Merck)10/1/2007 (lot no., route and site n has been received from a physician concerning a female who on an unspecified date was Yvaccinated with a second dose of VARIVAX (M follow-up information has been received from a nurse concerning an 11-12 year old female Y who was vaccinated 10/1/2007 with 10/1/2007 VARIVAX (Merck) (lo n has been received from a nurse cornering an 11-12 year old female who was vaccinated with Y VARIVAX 10/1/2007 (Merck) (lot 10/1/2007 no., route and site of n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007 (Merck)10/1/2007 (lot no., route and site n has been received from a physician Y concerning a 6 year old male who on an unspecified date U was vaccinated with a second dose of VAR n has been received from a physician's assistant (P.A.) concerning a approximately 23 month Y old white male 2/1/2008 with no3/1/2008 other medical history n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Sub n has been received from a health professional Y concerning a 12 year old male with a historyNof rash for 29/19/2003 days who 6/21/2008 on 19-SEP-2003 was v n has been received from a registered Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Subs n has been received from a physician Y concerning a patient, his child, who was vaccinated with U a dose of VARIVAX (Merck) (lot no., route a n has been received from a physician concerning a 10 year old male, weight 107.8lb height Y 52.5 inches, who 8/3/2005 on 03-AUG-2005 8/27/2007 was vaccina n has been received from a licensed Y practical nurse concerning a 10 year old male with no pertinent Y medical 6/4/2008 history 6/4/2008 and drug reactions/alle n has been received from a consumer concerning her son who on 19-JUN-2008 was vaccinated N with his6/19/2008 booster VARIVAX 6/19/2008 (Merck), 0.5 ml n has been received from a physician Y concerning a 11 year old male patient with no known allergies Y or pertinent 6/16/2008medical 6/16/2008 history who on 16 n has been received from a licensed Y practical nurse (L.P.N.) concerning a 14 month old male Y on 05-JUN-2008 6/5/2008 was vaccinated 6/5/2008 subcutaneo n has been received from a licensed Y practical nurse concerning a 14 month old male patientYwho on 05-JUN-2008 6/5/2008 was 6/5/2008 vaccinated with a d n has been received from a physician Y concerning a 11 year old female who in April 2008, was N vaccinated4/1/2008 with second dose of VARIVAX (M n has been received for a physicianYassistant concerning a 8 year old male patient who on 11-SEP-2001, Y 9/11/2001 was vaccinated 5/2/2008 with VARIVAX (M n has been received from a physician Y concerning a 9 year old male patient with a history of U seizures who was vaccinated with a dose of VA n has been received from a nurse concerning Y an approximately 8 year old male who "about Y 10 years ago" in approximately 1998 was vacc n has been received from a healthcare Y worker concerning an approximately 7 year old female Y with no known 5/16/2001 allergies 2/1/2007 and a history of strep n has been received from a physician concerning a 59 year old male patient who on 15-APR-2008 U was prescribed 4/15/2008 and 4/15/2008 vaccinated with a fir n has been received from a nurse concerning a patient who in 1998 was vaccinated with a dose Y of VARIVAX (Merck) (lot no., route and sit n has been received from a physician concerning a 5 year old female patient with no pertinent Y medical history 4/1/2007 and drug reactions/allergies n has been received from a physician Y assistant (P.A) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) years ago n has been received from a health professional Y concerning a 14 year old female with a history Y of dermatitis, 3/31/2008 rhinitis 3/31/2008 allergic and latex allerg n has been received from a 40 yearYold female with hypercholesterolaemia and a history of female Y genital9/4/2007 operation 9/4/2007 concerning on 04-SEP n has been received healthcare provider Y concerning a 9-year-old male who on 16-AUG-2002 Y was vaccinated 8/16/2002 with a dose 6/1/2008 of VARIVAX (Me n has been received from a licensed practical nurse concerning a 12 year old male who on an Y unspecified8/5/2008 date was vaccinated 8/5/2008 with her firs n has been received from a registered nurse (R.N.) concerning a patient who on 03-APR-2001, Y 4 day early 4/3/2001 prior to the 4/3/2001 patient's first year b n has been received from a health professional concerning an 11 year old male who on 05-JUN-2008 U was6/5/2008 vaccinated 6/6/2008 subcutaneously in le n has been received from a pharmacist Y concerning a 46 year old female with history of morphine N allergy who 6/9/2008 on 09-JUN-2008 6/10/2008 was vaccina n has been received from a medical assistant concerning a 63 year old patient who on 04-JUN-2008 U was6/4/2008 vaccinated6/4/2008 with a dose of VARIV n has been received from a consumer concerning her son a male patient who on 10-JUN-2008 N at 11:006/10/2008 was vaccinated 6/10/2008 with VARIVAX (Me n has been received from a consumer concerning her son who was vaccinated with VARIVAX U (Merck) (Injection site, dose/ frequency and n has been received from a registered Y nurse (R.N.) concerning that during the past few months Y a few patient 5/14/2008 who were 5/14/2008 vaccinated with a s n has been received from a registered nurse (R.N) concerning a patient who on 11-JUN-2008 U was inadvertently 6/11/2008 vaccinated 6/11/2008 with a dose of n has been received from a nurse concerning her child, 4 year old male, with a history of prior N immunizations 6/10/2008 (unspecified) 6/10/2008 who on 10-JUN
n has been received from a nurse concerning a 36 month old male who in approximately 2006 Y was vaccinated with a6/5/2008 single dose of VARIV n has been received from a certifiedYmedical assistant (C.M.A.) concerning a 12 year old female N with no6/26/2008 pertinent medical 6/27/2008 history or known n has been received from a pharmacist concerning a 65 year old patient who on 27-JUN-2008 U was inadvertently 6/27/2008vaccinated 6/27/2008with a single d n has been received from a registered nurse concerning a patient who on 30-Jan-2008 was U inadvertently 6/30/2008 vaccinated 6/30/2008 with a dose of VARIV n has been received from a registered nurse concerning a male with no known pertinent medical U history6/26/2008 who on 26-JUN-2008 was vaccina n has been received from a nurse concerning a 60 year old male who on approximately 30-MAY-2008 U was 5/30/2008 vaccinated 5/30/2008 with a dose of VARI n has been received from a licensed Y practical nurse (L.P.N.) concerning a 4 year old femaleNwith no medical 5/8/2008 history or 5/8/2008 drug allergies who o n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or U her) 70's with 7/1/2008 no pertinent 7/1/2008 medical history, dr n has been received from a veterinarian Y concerning his 24 year old pregnant daughter with aUhistory of chickenpox 6/12/2008 as infant. The patient's n has been received from a physician concerning her daughter who was vaccinated with a dose Y of VARIVAX (Merck). On an unspecified d n has been received from a nurse concerning her approximately 12 month old daughter withUallergies who8/1/2005 in August 2005 was vaccinated n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated U with the two doses of VARIVAX (Mer n has been received from a Merck employee Y concerning a 6 year old female who last week U (between 23-JUN-2008 6/25/2008 6/25/2008 to 29-JUN-2008) was v n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or U her) 70's with 7/1/2008 no pertinent 7/1/2008 medical history, dr n has been received from a licensed practical nurse concerning a 20 year old female patientUwith no pertinent 8/17/2007 medical history who on 17-M n has been received from a nurse concerning a 25 year old female with no pertinent medicalUhistory or history 4/1/2008 of drug4/1/2008 allergies or reaction w n has been received from a nurse concerning a 6 or 7 years old male who was vaccinated with U at least two doses of VARIVAX (Merck). Th n has been received from a licensed Y practical nurse (L.P.N.) concerning a 13 month old female U with no medical 5/30/2008 history 6/24/2008 or no drug allergies n has been received from a pharmacist concerning a patient who on 07-JUL-2008 was vaccinated U with "one 7/2/2008 vial" of VARIVAX 7/2/2008 (Merck) inste n has been received from a health professional concerning a 4 year old female with no pre-existing U allergies, 7/1/2008 birth defects 7/3/2008 or medical condi n has been received from a health care professional concerning an 8 year old female with no Y pre-existing 6/26/2008 allergies, birth defects or medica n has been received from a physician Y concerning a patient who on unspecified dates was vaccinated U with the two doses of VARIVAX (Mer n has been received from a healthcare worker and a physician concerning an 11 year old white Y female with 8/14/2007 no pertinent 8/14/2007 medical history an n has been received from an office manager concerning a 63 year old female who on 08-JUL-2008 U was vaccinated 7/8/2008 in7/8/2008 her left arm with a do follow-up information has been received from a registered nurse concerning a 5 year old male U with no relevant 7/2/2008 medical 7/4/2008 history or allergies n has been received from a certified medical assistant (C.M.A.) concerning a 4 year old female N who on 01-JUL-2008 7/1/2008 7/1/2008 was vaccinated intram n has been received from a registered nurse concerning a 13 year old female with no pre-existing N drug allergies 4/10/1996 and6/27/2008 medical conditions wh n has been received from an office staff concerning a female who in June 2008, was vaccinated U with a dose 6/1/2008 of VARIVAX 6/1/2008 (Oka/Merck) (lot n has been received from a registered nurse concerning a 10 year old female patient who inYapproximately 8/1/1998 August 1998, 6/6/2008 when she was 12 n has been received from a licensed practical nurse concerning a 10 year old male who on 02-FEB-1997 Y 4/10/2007 was vaccinated with the first dose n has been received from a licensed practical nurse concerning an 8 year old female patientYwho on 17-JAN-2001, 4/10/2007 was 7/1/2008 vaccinated with the n has been received from a pediatrics office and a nurse concerning a 12 month old female Y who on 27-JUN-2008 6/27/2008at6/27/2008 1545 was subcutaneo n has been received from a Licensed Practitioner Nurse, concerning a 15 year old female patient, U whose5/27/2008 mother told the LPN that she had n has been received from a physician, Y concerning a male patient who received VARIVAX (Merck) Y (Lot #557099/0453U) 6/5/2007 7/11/2008 0.5 mL SQ on 05-J n has been received from a physician Y concerning a 13 year old female patient who on 24-Mar-2008, Y was3/24/2008 vaccinated3/24/2008 with a dose of VARIVA n has been received from a physician concerning a 12 year old female who on 24-Mar-2008Ywas vaccinated 3/24/2008 SC with 3/25/2008 a second 0.5ml dose n has been received from a physician and a registered nurse concerning a patient who overUthe last one or two weeks 6/1/2008 was vaccinated with n has been received from a medicalYassistant concerning a her 7 year old daughter with history Y of asthma and### no drug 3/13/2008 reactions/allergies, n has been received from a health professional Y concerning a patient who on an unspecified Y date, was vaccinated with a first dose of VARV n has been received from a physician concerning a female with a history of obesity who wasYvaccinated SC with a second 2/1/2008 dose of VARIVA n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity and another male 1/1/2008 (WAES#0804USA n has been received from a registered Y nurse concerning a 9 year old male who on 15-Mar-2000 Y was vaccinated 3/20/2008 into 7/2/2008 his leg with the first do n has been received from a nurse practitioner Y concerning a couple of patient 's who on an unspecified U date was vaccinated with the second n has been received from a nurse concerning a patient who on 10-July-2008 was vaccinatedNsubcutaneously 7/10/2008 with a7/15/2008 dose of VARIVAX (Me n has been received from a consumer concerning her daughter who was vaccinated with a dose U of VARIVAX (Merck). Subsequently the pa n has been received from a physician Y concerning an 8 year old male with no pertinent medical Y history or3/31/2008 drug allergies 4/1/2008 who on 31-MAR-20 n has been received from a health professional Y concerning a 12 year old male who on 22-SEP-1999 Y was 9/22/1999 vaccinated7/3/2008 with VARIVAX (Merck n has been received from a physician Y concerning a 10 year old female who in approximatelyN2007 was vaccinated SC with a second 0.5 m n has been received from a physician concerning his 17-month-old male who was vaccinated U at 12 months of age with a dose of VARIVAX n has been received from physician's office concerning a 7 year old boy with no pertinent medical N history 4/1/2008 who on 01-APR-2008 4/1/2008 was vaccin n has been received from a health professional concerning a 15-month-old female with no medical U history 3/12/2008 who at a 3/21/2008 well check up on 12-MA
n has been received from a physician concerning her 56 year old mother with mild intermittent Y asthma as medical history and no illness at t n has been received from a physician concerning a 7-year-old female with no pertinent medical Y history or 3/25/2008 drug reactions/allergies, 3/26/2008 who on 2 n has been received from a registered nurse concerning a 32 month old who on 25-AUG-2006 N was vaccinated 8/25/2006 with3/30/2008 0.5 ml of VARIVAX (Me n has been received from a physician Y concerning a child who was vaccinated with VARIVAXY(Merck). "In the past couple 3/1/2008 of weeks", in app n has been received from a physician concerning a female in her 70's who on approximatelyU26-FEB-2008 2/26/2008 was vaccinated 2/26/2008 with a dose of V n has been received from a consumer concerning her 11 year old son with a drug reaction/allergy U to soy and peanut,4/2/2008 who on 01-APR-2008 n has been received from a physician Y concerning a 17 year old female with no pertinent medical N history and 4/1/2008 no drug 4/2/2008 reaction / allergies, wh n has been received from a consumer Y concerning his 10 year old daughter who on 04-OCT-1998 N was vaccinated 4/3/2008with 4/4/2008 th first dose of VARI n has been received from a registered nurse concerning her 10 year old son who on an unspecified Y date3/21/2008 was vaccinated 3/28/2008 with the first dose n has been received from a registered Y nurse concerning an 8 year old male who on 03-Nov-2000 N was vaccinated 2/5/2007with 2/5/2007 the first dose of VAR n has been received from a registered nurse concerning a patient who on approximately 01-APR-2008 U was 4/1/2008 vaccinated with a dose of VAR n has been received from a nurse concerning Y a 4 to 6 year old male who on approximately 01-APR-2008 Y 4/1/2008 was vaccinated 4/1/2008 with VARIVAX (M n has been received from a physician concerning an 81 year old female who on 08-APR-2008 U was vaccinated 4/8/2008 with "regular 4/8/2008 dose" of VARIV n has been received from a physician Y concerning a 12 year old male who on the day before Nthe child's first birthday was vaccinated subcut n has been received from a physician Y concerning a 13 year old (previously reported as 11 year Y old) female with ### no pre-existing 4/6/2008 allergies, b n has been received from a physician Y concerning an approximately 36 month old female patient Y with no pertinent medical history who was n has been received from a physician Y assistant concerning a "7 or 8 years old" male who in U September 2007, 9/1/2007 was vaccinated with a secon n has been received from a physician concerning a 4 year old male with no pertinent medical Y history and no drug reactions/allergies, 3/25/2008 who w n has been received from a health professional Y concerning a a 13-year-old female with a history Y of rhinitis 10/2/1995 allergic and 4/1/2008 scoliosis who on 02n has been received from a licensed Y practical nurse (L.P.N.) concerning a 14-year-old female, Y weight 179 4/10/2008 pound, height 4/10/2008 67.5 inch, who on n has been received from a registered nurse concerning a patient who was vaccinated subcutaneous Y with a 0.5 ml second dose of VARIVA n has been received from a registered nurse concerning a 11-year-old female who on 05-JUN-1998 Y was vaccinated 6/5/1998 4/5/2008 SC with a 0.5 mL dose n has been received from a registered nurse concerning a 7 year old male who on 22-Jun-2001 Y was vaccinated 6/22/2001 with 3/23/2008 VARIVAX (Merck) (lot n has been received from a health professional concerning a patient who on 30-NOV-2005 was U vaccinated with ### a dose 4/1/2008 of VARIVAX (Merck n has been received from a registered nurse concerning a 14 year old male child who "withinUthe last two 4/1/2008 weeks" on approximately 01-APR n has been received from a registered nurse concerning a 9 year old patient with a history ofNpremature puberty 4/9/2008 and4/10/2008 asthma and a drug rea n has been received from a physician Y concerning a 4 year old male patient, who on 24-Feb-2005, Y was vaccinated 2/24/2005 with 4/1/2008 VARIVAX (Merck) ( n has been received from a physician Y concerning a 41 month old male with autism, speech delay U and encopresis 9/2/2005who 7/31/2007 on 02-SEP-2005 wa n has been received from a licensed practical nurse concerning a 14 year old female with amoxicillin U allergy who ###on 21-NOV-1997 4/7/2008 was vac n has been received from a registered Y nurse concerning a 15 year old male who was vaccinated U with a dose VARIVAX 4/9/2008 (Merck). On 09-Apr n has been received from a nursingYstudent concerning herself, a 42 year old female with noNhistory of drug reactions ### 3/1/2008 or allergies and poss n has been received from a nurse practitioner and consumer concerning a patient who in March U 2008, was 3/1/2008 vaccinated 3/1/2008 with a dose of VARI n has been received from a registered Y nurse concerning a 14 year old male with asthma andNseasonal allergies 1/15/1996 who4/15/2008 on 15-JAN-1996 was n has been received from a nurse concerning a patient who on 17-JUN-2008 was vaccinated U with VARIVAX 6/17/2008 (Merck). 6/17/2008 The nurse reported t n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity who in 2008 was vaccinated SC with n has been received from a certifiedYmedical assistant concerning a 10 year old female with N allergic reaction 4/14/2008 to ZITHROMAX who on 17-JU n has been received from a veterinarian Y concerning his 18 month old granddaughter with noYmedical history or allergies, who about a mont n has been received from a registered Y nurse concerning a 6 year old male with ringworm of U scalp who was 3/8/2007 vaccinated 4/17/2008 with first and second n has been received from a nurse concerning Y a 7 year old female who on 14-APR-2008 wasUvaccinated4/14/2008 with the second 4/14/2008 dose of VARIVAX n has been received from a nurse concerning Y a 12 month old female with a ear infection andYwith no pertinent 10/6/2003 medical history ### or drug react n has been received from a physician Y concerning a 15 month old male who on 15-APR-2008Y was vaccinated 4/15/2008 with a4/15/2008 dose of VARIVAX (Me n has been received from a registered Y nurse concerning a 12 month old boy with dilated cardiomyopathy, Y 4/9/2008 hypoxic ischemic encephalopath n has been received from a nurse practitioner concerning a 33 year old female who in approximately U June 2004, was vaccinated with VARI n has been received from a physician concerning a female patient who entered an unspecified U study and was vaccinated with VARIVAX (M n has been received from a medical assistant concerning a 75 year old male patient who at U 2 pm on 18-JUN-2008 6/18/2008 inadvertently 6/18/2008 received a n has been received from a physician concerning an approximately 6 year old male with epilepsy Y and seizure 3/26/2001 disorder, 4/1/2006 and no drug reactio n has been received from a company Y representative concerning her 11 year old son with noUpertinent medical 6/16/2008 history, 6/16/2008 drug reactions or alle n has been received from a health professional concerning a patient with reactive airways disease U and a8/25/2004 history of rhinitis 11/5/2005 allergic and otitis n has been received from an employee at a physician's office concerning a 4 year old male patient U with 8/10/2000 no pre-existing 1/25/2004 allergies, birth defec n has been received from a healthcare worker concerning a 12 year old male with no knownYallergies who 6/16/2008 on an unspecified 6/16/2008date was vacc n has been received from an office worker in a physician's office concerning a 8 year old male U with a history 1/5/2000 of adenotansillectomy 5/25/2007 (16-MAR
n has been received from a health professional concerning a 4 year old male with rhinitis allergic U and asthma 3/22/2005 and a history 3/5/2008 of otitis media w n has been received from a health professional concerning a 5 year old female who on 16-JUL-2001 U was 7/16/2001 vaccinated 8/29/2005 with VARIVAX (Oka/M follow-up information has been received Y from a healthcare worker concerning a 9 year old female N with no 6/16/2008 known allergies 6/16/2008 who on 17-OCTn has been received from a health professional concerning a 45 month old female patient with U a history of9/1/2004 premature6/6/2007 twin birth who on 01-S n has been received from a nurse concerning Y a 5 year old male who on 18-JUN-2008, today, U was inadvertently 6/18/2008 vaccinated 6/18/2008 with two doses n has been received from an employee at a physician's office concerning an 8 year old girl with U allergic rhinitis 8/26/1999 who on 4/6/2007 26-AUG-1999 was v n has been received concerning a 10 year old male with allergic rhinitis, asthma and allergy N to peanut butter 3/22/2001 who on3/13/2005 22-MAR-2001 was vac rmation has been received from a registered nurse and follow up information was received from Y the physician 6/9/2008 concerning 6/11/2008 a 12 month old fe n has been received from a medicalYassistant concerning an 18 year old female who on 02-JUN-2008 N was 6/2/2008 vaccinated 6/16/2008 with a first dose of V n has been received from a physician Y concerning a 4 year old male with hypersensitivity andNatopy who on 29-JAN-2004 6/18/2008 was vaccinated w n has been received form a physician Y concerning a 12 month old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) (lot num n has been received from a health professional concerning a 17 month old female with heartUdisease and 9/16/2003 asthma who on ### 16-SEP-2003 wa n has been received from a women from a pediatric office concerning an 11 year old femaleUwho on 02-JUN-2008 6/2/2008 was 6/2/2008 vaccinated subcuta n has been received from a male dentist with a history of being given 2 doses of pneumococcal U 23v polysaccharide 4/8/2008 vaccine 4/8/2008close together n has been received from a physician concerning a female who was vaccinated with a first dose U of VARIVAX (Oka/Merck) prior to pregnanc follow-up information has been received Y from registered nurse concerning an 8 year old male Y child with 4/16/2008 no known allergies 4/23/2008 who on 16-APR n has been received from a registered Y nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck). 4/9/2008 On 09-APR-2 n has been received from a registered Y nurse concerning a 7 year old female with exercise induced Y asthma 4/8/2008 and no known 4/26/2008 allergies, who on n has been received from a nurse concerning Y a 5 year old female with no history of allergiesY(including neomycin 4/29/2008or4/29/2008 gelatin) who on 29-APR n has been received from a physician concerning a 4 year old female who in the afternoon of U 19-APR-2007 4/19/2007 was vaccinated 4/19/2007 in the left arm w n has been received from a registered Y nurse concerning a 5 year old male with Amoxicillin allergy Y who on 6/15/2007 21-MAY-2003 4/2/2008 was vaccinated su n has been received from a healthcare Y worker concerning a 14 month old male with no pertinent U medical4/14/2008 history who 4/28/2008 on 14-APR-2008 was n has been received from a registered Y nurse concerning a 5 year old male with no pertinent N medical history 3/30/2004 who on4/11/2008 30-MAR-2004 was vac n has been received from a registered Y nurse concerning a 15 to 18 month old child patient out N of 20 who was vaccinated with VARIVAX (O n has been received from a physician concerning a 57 year old female patient who on 15-APR-2008 U was4/15/2008 prescribed4/15/2008 and vaccinated with a n has been received from a registered nurse concerning a 77 year old male who on 23-JAN-2008 U was vaccinated 4/29/2008 with ZOSTAVAX (Oka/M n has been received from a licensed Y practical nurse concerning an 8 year old female with allergy Y to pertussis 4/11/2008 vaccine 4/12/2008 (limplegs) and ZYRT n has been received from a consumer concerning her 18 month old daughter with no pertinent Y medical history 10/4/2005 or drug 10/4/2005 allergies who on 04n has been received from 2 nurses Y concerning a 6 year old boy, 66 pounds weight and 47 inches Y height,3/26/2003 with seasonal 4/29/2008 allergies who on 26 n has been received from a physician Y concerning a 30 month old male who on 21/NOV/2006Nwas vaccinated with ### a4/30/2008 single dose of VARIVA n has been received from a physician concerning a 9 year old boy with no history of drug reactions U or allergies 12/6/2006 who4/13/2008 on 30-MAR-2000 was v n has been received from a physician Y concerning a 12 year old female with no pertinent medical N history 10/1/2007 who on 10-JAN-2001 was vaccinat n has been received from a motherYand a physician concerning a 13 year old boy with asthma, N allergy to4/15/2008 penicillin and 4/15/2008 severe allergies to m n has been received from a dermatologist concerning a 20 month old male who on approximately U 10-APR-2008 4/10/2008 was vaccinated with a 0.5 n has been received from a registered Y nurse concerning a 4 year old male with no pertinent Ymedical history 8/28/2001 and no 8/28/2001 known drug reactions/a n has been received from a health professional concerning a 7 year old female child, with noYknown drug4/15/2008 allergies, 4/17/2008 who on 17-APR-2008, a n has been received from a registered Y nurse concerning a 12 month old female with no pertinent N medical4/8/2008 history of 4/28/2008 known allergies who on n has been received from a physician Y concerning a 14 year old female with no pertinent medical U history 7/10/2007 and no drug reactions/allergies wh n has been received from a company Y representative concerning his child's piano teacher's daughter N a 20 3/31/2008 month old4/26/2008 female who in the end n has been received from a physician who between 1996-1997 was vaccinated with her first,Usecond and third doses of VARIVAX (Oka/Me n has been received from a nurse concerning Y a 11 year old male with no medical history of drug Y allergies 6/17/2008 who on 17-JUN-2008 6/19/2008 was vaccin n has been received from a physician concerning a 4 year old male who on 13-MAR-2008 was Y vaccinated 3/13/2008 into the thigh 3/15/2008 with a second dos n has been received from a physician Y concerning a 4 year old male who on 22-APR-2008 was Y vaccinated 4/22/2008 into the thigh 4/22/2008 with a second dose n has been received from a licensed Y practical nurse concerning a 5 year old female with eczema Y on buttocks 5/2/2008 and no5/2/2008 known drug reactions n has been received from a physician Y concerning a male who on 24-APR-2008 was vaccinated Y with his 4/24/2008 second dose of VARIVAX (Oka/M n has been received from a registered Y nurse concerning her friend's child who was vaccinated U with VARIVAX (Oka/Merck) about 6 or 7 yea n has been received from a physician Y assistant concerning her son who was vaccinated with Y VARIVAX (Oka/Merck). The physician assista n has been received from a physician Y concerning a 9 year old patient who on an unspecifiedUdate was vaccinated with VARIVAX (Oka/Mer n has been received from a registered Y nurse concerning a 52 year old female with no pertinent Y medical history 4/4/2008 of allergies, 4/18/2008 who on 04-APR n haws been received from a physician assistant concerning a 19 year old patient who on 15-MAR-2008 N 9/27/1997 was vaccinated 2/7/2008 SQ with a second n has been received from a medicalYassistant concerning a 24 month old female with no known Y allergies who 6/4/2004 on 04-JUN-2004 6/4/2004 was vaccina
n has been received from a registered nurse (R.N.) concerning a 3 year old male who was vaccinated Y with 2/4/2008 the 2nd dose 2/4/2008 of VARIVAX (Oka follow-up information has been received from a physician concerning a 9 year old male withYno pertinent6/12/2008 medical history 6/12/2008 or history of drug n has been received from a certified medical assistant (C.M.A.) concerning a 60 year old patient U who was vaccinated subcutaneously with n has been received from a nurse practitioner Y concerning her 18 month old grandson with no N known relevant 5/28/2008 medical6/4/2008 history who on 28-MA n has been received from a physician concerning a 11 year old female with a history of attention N deficit disorder and no allergies who on 03 n has been received from a registered Y nurse concerning a 12 month old male (the doctor's son) N with no 6/10/2008 relevant medical 6/13/2008 history who on 10 n has been received from pharmacy student concerning a 60 year old patient who was vaccinated U with VARIVAX. The pharmacy student re he had vaccine on May 20. On May 21st - pt. c/o dizziness, joints aching, T. 102, SOB, "heart Y racing". Took 5/20/2009 2 acetaminophen, 5/21/2009 stayed in be n has been received from a physician Y concerning a patient who on an unknown date was vaccinated N with 4/30/2008 a second4/30/2008 dose of VARIVAX. On dm. 3/18/09 for 6 mos. well visit 3/19/09 Temp. 101 degrees per mom Temp. in office 99.7 Y (Ax) Dx: Vaccine 3/18/2009 reaction 3/18/2009 d starting 5/18 that Pt has a rash on arms + legs, no fever. Y 5/13/2009 5/18/2009 breaking out into rash on 5/14/09 around Y 7:00 pm. The rash is red round areas from head to toe. 0 blisters. 5/12/2009 Does not seem to be itching. ters breaking out/popping up on nose Y area - 7 total so far. Patient was consulting doctor U 5/12/2009 5/15/2009 e hypersensitivity reaction to MMR vacc. w/ spreading erythema and urticarial lesion at site ofYinjection. She 5/8/2009 was comfortable 5/8/2009& breathing ea oke out in a rash after ROTOVIRUSYimmunization given within 24 hours. Also had a temperature N of 101. 5/4/2009 Mother gave 5/5/2009 TYLENOL rash was stated - that after thigh vaccine (TDAP) he developed a high fever - and generalized rash. States Y took Benadryl 5/12/2009 + Tylenol 5/13/2009 helped symptoms of arm, redness, severe pain & inability to use arm for 3 days due to pain & swelling Y 5/7/2009 5/7/2009 lar rash appeared on forehead & spread to back of neck 30 min post vaccines given & lastedY48-72 hrs. n has been received from a nurse practitioner and a healthcare worker for GARDASIL, a Pregnancy Y Registry product, ### 3/1/2008 concerning a 23 yea Y 5/15/2009 n has been received from a physician Y concerning Y a 21 year old female with partial Y hearing loss N due to congenital 6/15/2007sensory 6/22/2007 nerve damage, ir n has been received from a physician concerning a 13 year old female with cerebral palsy, hydrocephalus U and shunt which has became oc n has been received from a female concerning her daughter, for a pregnancy registry for GARDASIL, Y who on an unspecified date was vacc vaccine failure. Pt presented 5/18/09 with typical herpes zoster skin lesions. U ### 5/8/2009 n has been received from Y a pharmacist Y concerning a 19 year old female with no pertinent medical Y history who was vaccinated with the sec d irregular breathing with gasping after Y shallow breathing approx 11 hrs after vaccines givenY. Temp was1/29/2009 104. Went1/29/2009 to ER then home and d to R thigh, area hard, red, hot to touch. Y n has been received from a consumer Y concerning her son with no known drug reactions/allergies N and medical 5/1/2002 history who "when about 18 n has been received from a nurse concerning Y a 67 year old female with a diabetes and a history Y of childhood 2/26/2008 chickenpox, 3/19/2009 who on 27-FEBn has been received from a medicalYreceptionist concerning a 76 year old female with no pertinent Y medical 1/13/2009 history and 1/15/2009 no drug reactions/a after vaccine redness & swelling at site. Y Seen at 72 hours after administration. 10 X 8 cm area Y of erythema 5/15/2009 with 2 X5/16/2009 2 cm area induration. n has been received from a 59 yearYold female registered nurse with latex allergy, unspecified N pain medication 9/30/2008 allergy 9/30/2008 and penicillin allergy fever of 102 degrees F orally -Nausea -Severe, violent vomiting -Tenderness/sensitivity of injection Y site. 4/22/2009 4/22/2009 a of severe swelling around the site of injection. Pain to touch and radiates heat Y 5/18/2009 5/18/2009 ation was being injected, became faint. Has not done this with other injections. Once patient Y sat for a few5/22/2009 minutse and 5/22/2009 sipped on Coke, felt umococcal vaccination was given instead of a 1st Hepatitis A. Incident occured 05/21/09 at 1545. 5/21/2009 ction with arm swelling Y 5/20/2009 5/20/2009 ervation: slight diffuse induration in the deltoid area of the right arm. Red and blotchy in the Y area noted. 4/30/2009 Not hot to touch 5/3/2009 and withoug tend administered in Right deltoid. ThreeYinch induration around injection site that is tender and warm U to the touch. 5/20/2009 5/21/2009 n in left arm after receiving her first dose of anthrax. The pain started one day after receivingYthe dose and 4/15/2009 lasted for4/16/2009 3 days. RECEIVED VACCINE ON 5/18/2009 ON THE LEFT ARM ONE INCH BELOW THE TDAP. SHE EXPERIENCED 5/19/2009 FEVER 5/19/2009 OF 102, CHILLS, ely after administering the vaccine, the Y patient experienced near-syncope: pallor, diaphoresis, U hypotension 5/22/2009 and bradycardia. 5/22/2009This lasted ov arted having reaction to vaccine twoYdays after delivery. Rash swelling and itching at injection Y sight. They 5/5/2009 thought patient 5/7/2009 was possibly getti led in on very hectic day wanting to get child with bone marrow transplant revaccinated. They Y were on their 5/18/2009 way home from doctor. Recep mplained of dizziness, nausea and dry heaves. The symptoms lasted approximately 8 hours. Y No treatment 5/20/2009 5/21/2009 ental status per MD Y 1/30/2009 1/30/2009 e and worsening myalgias upper extremities Y and torso. U 5/20/2009 5/21/2009 fter receiving smallpox and anthrax Yvaccine, patient developed fever and chills which resolved Y overnight.5/12/2009 Patient went 5/14/2009 running the next day ven Pneumovax on 5/11/09, pt called on 5/13/09 and spoke to triage nurse asking if the following Y symptoms 5/11/2009 are normal 5/13/2009 after recieving the p miting, eyes rolling to back of head, twitching Y for 1 hour, patient went to ER and then was seen Y folling day.5/19/2009 5/20/2009 d to cinic with herpes zoster rash on back and chest that started 5/19. No known chicken pox before vaccine 1/22/2009 or exposure 5/19/2009 to Zoster or chick
jection site and on the back of right arm. Y 5/19/2009 5/20/2009 ting in chair for injection. approximately 30 seconds after injection, observed color (pale) on face,patient Y 5/22/2009 lost consciousness 5/22/2009 for a moment a er DTAP vaccine his left upper arm began to swell. It got bright red,swollen, hot to touch andYhad a rash.5/15/2009 He was administered 5/15/2009 Qdryl(corn f iving Varicella vaccine on 4/16/09, pt was seen on 5/16/09 with a Dx of Varicella. Y 4/16/2009 5/16/2009 d Rotavirus vaccine on 4/06/09. Pt Y had ER visitYwith Dx intussusception 7 on 4/08/09. pt c/o vomiting/rectal Y 4/6/2009 bleeding, low 4/8/2009 grade fever. Moc + veloped three lesions at 2 days post injection, each approx 3-4" in diameter, within a 10" area U around the 5/19/2009 site of injection. 5/21/2009 Pt applied ice. A ped gradually worsening myalgias and muscle weakness after receiving the Zostavax on 12/22/08 Y and had elevated ### ESR### of 71 consistent brought in today by her mother. Mom reported to the doctor about SXs 30 days after her 1stYdose of ROTATEQ. 3/27/2009Intussusception 4/7/2009 per Dr. . R cal swelling and tenderness developing Y over 48 hours since vaccines given. U 5/19/2009 5/20/2009 d soft node to R/L anterior thigh region. Nurse Practitioner recommended to massage the affected U area5/12/2009 & to apply 5/12/2009 warm compresses PRN d shingles on forehead - red rash with Y discharge 1-2 wks post vaccine, VALTREX ordered U 5/13/2009 5/15/2009 rior arm - 1 area maculopapular 5 cm Y diam. erythema (MENACTRA) (B) Posterior arm - 1 area U maculopapular 5/21/2009 15 cm diam. (VARICELLA) th fever - 103 - last night + then started Y with fussiness @ 2p 5/22 + redness at site + painful Y- Rt thigh. 5/21/2009 5/22/2009 zy about 2-3 minutes after BOOSTRIX was given(MENACTRA given about 2 min earlier). Pt Ytried to lie down 5/22/2009 on exam 5/22/2009 bed but felt from bed per (L) arm: Pain radiates from deltoid to above elbow; to (L) side of neck. Inflammation minimal erythema 5/19/2009 minimal 5/19/2009 veloped firey red rash on both facial cheeks that feels hot to touch. This occurred on may 20. N She received 5/18/2009 an intra-articular 5/20/2009 steroid inject injection (L) arm was swollen, tender and red, T. 103. Loose stool and vomiting also. U 5/20/2009 5/21/2009 degree 6 days later - Chronic febrile Y seizure (Lasted less than 5 min - sent to ER via ambulance Y and recovered 5/15/2009 - Also 5/21/2009 diagnosed with B-O t rash on anterior R thigh, same leg/area Y given DTAP on 5/13/2009 - Rash appeared about 5/18/09 U per 5/13/2009 parent non 5/18/2009 - pruritic. Blanchable e ministered a TD vaccine when this vaccine should only be given to pts 11 yrs & older & the vaccine the pt. 6/24/2008 needed was 6/24/2008 DTAP. V combination given into LT thigh on 5/20/09. Today area is warm to touch. Swollen, reddened N approx 3" 5/20/2009 X 5" area5/21/2009 office for well child visit. Given adult dose (1ML) of HEPATITIS A (HAVRIX) vaccine in error.Y LMH staff 5/22/2009 notified. CDC 5/22/2009 & poison control con 5/19/2009 N 5/18/2009 5/19/2009 val red, raised area at site of injection left arm covered for possible cellulitis inf - Cephalexin Y500mg TID 5/21/2009 x 1 cd 5/22/2009 04 F and whole upper arm inflamed and swollen - ~ 20-24hrs. Y 5/14/2009 5/14/2009 ERS filed Feb 2003. This 33 year oldYreceived her first three ANTHRAX vaccination 02 Nov 1998, N 12 Nov11/2/1998 1998, & 28 Nov 1998. AVA #4 an urticarial plaque on left lateral arm Y 4/21/2009 4/22/2009 n on 5-20-09 Pt came back in on 5-22-09 Rt arm red and swollen within the area of the shot.U(foster child5/20/2009 missed this 5/22/2009 dose) wollen, reddened, tender and hot to touch R upper arm. Afebrile. Received vaccines 5/18/09 - Cellulitis R 5/18/2009 upper arm 5/21/2009 - 2 hours to injection Y 5/22/2009 vacc. approx 1500 5/20/09; approx.Y12-14 hours later woke up with severe muscle/joint pain and fever, seen 5/20/2009 in office 5/21/2009 @ 1530 05/21/09 still and swelling to left arm approximately Y 12-15 hours after injection, warm compress, Allgrax XY48 5/14/2009 5/15/2009 d, warm to touch, red, extremely swollen, Y hard to touch- treated after Keflex. U 5/18/2009 5/19/2009 d, slight swelling, light redness treated Y with Keflex. U 5/18/2009 5/19/2009 ed, swollen at sight of injection reports swelling under left arm since 5-20-09. 6 X 8 cm area;Yredness, heat 5/19/2009 to LUE @ 5/20/2009 injection site; pocket m erythematous indurated circular area. Left upper lateral arm. Patient reports myalgias and Y subjective fevers 5/18/2009 the next 5/19/2009 2 days after injection ed crying for at almost 12 hours interspersed with extreme sleepiness and difficulty rousing from Y sleep, fever 8/24/2007 of 102+, 8/24/2007 red, hot site of injectio ut a cubic inch of muscle, big indentation. No pain just atrophy. I researched and it looks like a side affect of 5/6/2009 the polio5/15/2009 vaccine? Please drop welling at injection site, site was hard, Y red and swollen for 6-7 days. Child had fever of 101 for N 3 days, and was covered in hives. Injection s tachycardia, myalgias, severe arm pain,arm bruising, headaches, lethargy. all symptoms lasted Y about 2.5 5/22/2009 days. worst 5/23/2009 being 24-36 hours a ENTED WITH COMPLAINTS OF CHILLS, BODY ACHES, JOINT PAIN, HEADACHES, VOMITTING Y X 35/21/2009 DAYS. PT5/22/2009 DIAGNOSED WITH UR med area 8 inches by 3 1/2 inches at Y L deltoid (injection site) Injection given on 5/23/09 U 5/23/2009 5/25/2009 uscle pain in shoulder where vaccine Y administered. Very painful to even move arm for 2 days Y and continued 5/18/2009 moderate-severe 5/18/2009 pain for 4 m ay 23rd) after vaccination on May 22nd, 2009, my son developed weakness. Day 3 (May 24, U2009) after 5/22/2009 vaccination,5/24/2009 my son had high fever was reported by a physician and described Y the occurrence of lupus like syndrome in a 42-year-old N female subject who was vaccinated with s syndrome. Received IVIG and ASA. Y 5/26/09 Received H&P w/report. FINAL DX: Kawasaki Y syndrome1/23/2009 Records reveal 1/31/2009 patient experience n has been received from a consumer Y concerning her best friend's son, a approximately 13 N months old male who in approximately 2003 wa n has been received from a consumer concerning a male family member, now 12 years old,Uwho experienced autism after receiving vaccin n SANOFI PASTEUR'S TDAP product before patient was 11 years old. Y 3/24/2009 a of erythema 5" x 5", left upper arm. No fever Y 5/18/2009 5/20/2009 ents with maculopapular pink rash on trunk, 7 extremities (measles-like) and low grade fever.Y 5/13/2009 5/15/2009
er nurse child was seen today by N.P. and had an "erythema , macular rash" on entire trunk Y(front & back)5/1/2009 and forehead. 5/13/2009 Rash started on 5 after receiving vaccines, patient began vomiting. Vomited several times over the next 9 hours. Y No fever; 5/12/2009 no rash. Patient 5/12/2009 seemed much imp reaction to PENTACEL vaccination.Y8x11cm erythematous area to right medial thigh slightlyYwarm to touch, 5/19/2009 erythema 5/19/2009 fades as infant calms nt received vaccines on 3/31/09. Mother called on 4-2-09 morning with adolescent having fever, Y rash all over 3/31/2009 the body. 4/2/2009 However no difficulty -serious case received from a consumer Y on 15 October 2008. A 63-year-old female patient with Y history of diabetes, ### asthma ### and allergies to iven 5/8/09. Fever to 101.5. Syncopal Y episode, pain and swelling of injected arm. SymptomsNbegan day after 5/8/2009 injection. 5/9/2009 Still present but reso wollen eyelid, decreased appetite Y N 5/19/2009 5/19/2009 arm with redness from shoulder down to wrist, also has red streaks to Rt side under arm, soreness U no fever. 5/20/2009 ely after vaccine administration patient briefly (about 3 sec) lost consciousness. Y 5/8/2009 5/8/2009 n has been received from a 62 yearYold femaleYpatient with an allergy 0 to VICODIN and no other N medical5/11/2009 history who5/12/2009 on 11-MAY-2009 was cal reaction 4 X 5 cm Erythema andYind Y 5/18/2009 5/20/2009 sing began to scratch ears & hair. Noticed Y rash all around neck, chin, back, belly. Hives roused U different5/13/2009 sizes, welt5/21/2009 on front, little dots in b Y Y 5/18/2009 5/23/2009 after receiving GARDASIL # 1, developed redness and itching both legs (thigh to ankle). Skin became more 3/16/2009 red with3/17/2009 NIVEA. No fever. Y 5/21/2009 d @12:30 am 5/22/2009 stating child have fever of 101 and body aches. Advised to go to ER. U 5/21/2009 5/24/2009 N 5/22/2009 th fever, irritability and crying for 4 days Y after vaccination. Patient returned solid and slept poorly Y for 5 nights. 5/6/2009 Per parents, 5/7/2009 patient didn't wish ut 12 hours after vaccination, rigor then Y edema. Patchy erythema. No respiratory, no color. Advised U massage, warm compresses, TYLENO ticed increased redness + swelling of L arm @ injection site on 5/21 (PM), worsened on 5/22Ywith increase 5/20/2009 swelling 5/21/2009 ("fist sized" are of swell patient reports almost immediately Yafter receiving vaccine nausea and dizziness, then in theYevening fever 5/7/2009 of 102.8, 5/7/2009 mom gave EXCEDRIN eeks (end of November)Yafter getting Y flu vaccine, Y client began experiencing 10 Y weakness Y in legs N with numbness in### feet and toes. ### He began w s following administration of vaccine, patient with complaints of pruritis, pain, and redness toYsite. Denied5/7/2009 breathing5/11/2009 difficulties. Six days fo lips and tongue 30 min after injection lasting 30 min Y ### ### REFERS THAT THE NEXT DAY OF VACCINE ADMINISTRATION THE CHILD DEVELOPED Y A RASH IN 5/8/2009 THE ENTIRE 5/9/2009 BODY WITH A SL AINTED AT A RESTURANT 30-1HOUR Y AFTER RECEIVING SHOT AND FEELS CHILLS ALL U OVER BODY 5/26/2009 . NOT5/26/2009 FEELING WELL n chest, back, and arms post small pox vaccination on 13 May 09. Followed up with NP on 26 U May 09. As 5/13/2009 of 26 May5/26/2009 09 still has lesions will as healthy at the time she received her Y shots. 10 days later (Friday) she appeared ill with a rash Y that would 6/10/2008 go away6/20/2008 and re-appear. She de Y Y 5/21/2009 5/25/2009 g enterocolitis, symptoms Y started 24Y hrs after Pentacel, Y Prevnar, Hep 10 YB and RotaTec vaccine Y administration, 5/20/2009 diagnosis 5/21/2009 made 3 days after v macules on trunk, extremeties and Y face, began on the morning of 5/26/09, worsened as dayYprogressed. 5/6/2009 No other 5/26/2009 cymptoms veloped mucosal wart inside lower lip 5 days after receiving second HPV vaccine. U 3/30/2009 4/4/2009 ken to facility on 5/21. Report statesYpatient presented Y with rash on 1face, trunk and extremities. U 6/9/09 Medical, 5/19/2009 hospital, 5/21/2009 DC summary rece iving last vaccine MMR noted childs lips pale, no cyanosis observed. Child awake and crying, Y noted child5/22/2009 urinated on 5/22/2009 self per father and wa d a swollen arm that subsided 4 days after ZOSTAVAX vaccine was administered. Pt saw PCP Y were said 5/18/2009 it may be5/19/2009 an allergy. Vaccine adm eveloped chickenpox rash - more than 100 lesions Y 7/16/2002 fter MMR, developed itch rash on face and trunk. 1 day of headache 8 days after (gone now). ately five hours after the vaccination my son was unconsolable for an hour and extremely fussy Y all night. He 1/9/2009 developed 1/9/2009 a rash at the injectio oss, achy muscles and joint pain. fatigue. Symptoms reflecting M.S. and chronic fatigue syndrome. N Symptoms 3/15/2003 are getting 1/1/2005 worse over time. 5/5/2009 N 4/29/2009 5/5/2009 ed. 9/9/09 Rheumatology consultant records received DOS 1/5/05 to 6/17/09. Assessment: Y Rheumatoid arthritis, ###uncontrolled anxiety. Patie 03; diarrhea; lethargy; decrease oral Y intake. Hospitalized Y x 2 days. 26/2/09 ED and inpatient Yrecords received DOS 5/14/09 to 5/16/09. FINA s and pain in arm. No fever, no redness or swelling at sight of injection but tender to the touch. Y Weakness 5/19/2009 and pain lasting 5/19/2009 2 days +. welling with hard middle, itchy, very warm, red and fever 99.5 (my temp. usually runs low). Had Y to go on antibiotics 5/6/2009 for5/8/2009 3 days. Gradually go ceived PEDIARIX, HIB and PREVNAR #2, RV5, hives occurred approximately 24 hours afterY administration. 8/4/2008 10-20-08, 8/5/2008 received PREVNAR eltoid with 100 cm of erythema, swelling & warmth zero damage + tender noted next day really Y increase5/18/2009 later that night. 5/19/2009 ort received on 13 May 2009 from a physician. Subject Y identification 3number: 1-08-06459. This U subject is11/3/2008 participating in a study. A 14-yearand left deltoid dark red, puffy is swollen like a sausage. Could not lift up arm for four days. N Hot to touch.4/29/2009 Size measured 4/30/2009 5-20-09 10 1/2cm ort received on 13 May 2009 from a physician. This Y subject is participating 3 in a non sponsored U Sanofi Pasteur study. ### 11/1/2008 This case involved a 1 en area on deltoid of right arm. Progressed over 48 hours, at exam, measured 1 1/2 inches circular raised 5/13/2009 erythema, 5/14/2009 warm to touch. No stre ort received on 13 May 2009 from a physician. This Y subject is participating 7 in a non sponsored U Sanofi Pasteur 11/4/2008 study. This case involves a 1
ine given, pt complained of tingling along anterior medial aspect L upper arm. Hurt to move Yarm. Also complained 5/14/2009 5/14/2009 of "tingling" going down a of erythema and swelling on arm at Y injection site - 4 1/2 X 6 cm - at 24 hrs post injection LUA. N 5/18/2009 5/19/2009 ess in chest & throat 20 mins after receiving vaccines and ERYTHROMYCIN. Has allergy to YCECLOR, was 5/4/2009 given BENADRYL 5/4/2009 returned to d ng of throat after receiving vaccine and Bicillin, no prior allergy history. Given BENADRYL and Y observation 5/13/2009 - return to 5/13/2009 division. 5/19/2009 ralized tonic - clonic seizure 8 hrs after Y vaccines. CT, labs EEG normal. Y 5/11/2009 5/11/2009 as administered SMALLPOX vaccine during 1st trimester. Currently in 2nd trimester after learning U of pregnancy. 1/12/2009 ports redness at injection site R arm, denies fever, chills. reports pain 3/0 . Right arm, deltoid U are with redness 5/18/2009 measuring 5/18/2009 130 cm length n ema and swelling on Rt deltoid site starting 3-31-09 3/30/2009 3/31/2009 om mom reporting child diagnosed Y with cellulitis (L) thigh @ Urgent Care on 5-14. Has an approx. 5 inch5/12/2009 in diameter 5/14/2009 area of redness & har 10 min. after leaving pharmacy. Y 5/16/2009 5/16/2009 ction - pain, erythema started 5/16 - MOTRIN and BENADRYL given. 5/15/2009 5/16/2009 and exhaustion started 1st week after vaccine and persist. May 1 started body aches, sore throat, temp 101.8 4/6/2009 deg, 4/11/2009 swollen glands in neck, C received from guardian that child complained of headache leg aches, vomiting x 3 and fever Y (felt hot to5/11/2009 touch) did5/11/2009 not check temp after re nt was accidently given HPV 5/11/2009 ped 2 cm erythema at local injection site and scattered rash on body consistent with VARICELLA. U 5/7/2009 5/18/2009 on belly 5-17-09 in AM, 101.7 fever on 5-17-09 at 8:00 AM TYLENOL was administered, fever N went down 4/27/2009 did not appear 5/17/2009 again. 7 chicken with redness, itchiness over 3/4 of entire Y surface upper left arm. Y 5/19/2009 5/20/2009 e attached encounter Y Y 3/13/2009 3/13/2009
sicles at site of injection of varicella #1 - Occurred ~ 2wks after inj.
U
4/9/2009 4/30/2009 5/21/2009 ped diffuse Myalgias approx 12hrs after Pt vaccination given. N 4/27/2009 4/27/2009 mall) of red flat rash in upper arm; tender to touch; started yesterday. U 5/18/2009 5/19/2009 VZV injection site on 5/12/09. No treatment needed. Y 5/12/2009 5/12/2009 ction on left and right anterior, upper thigh, 2 inch by 3 inch red, indurated area. Pain eliated U due to pt. crying 5/18/2009 upon touch. 5/19/2009 No fever. TYLENO lled the office at 230 PM on 5/20/09 to report that child broke out in hives all over 10 minutesYafter she left 5/19/2009 office yesterday 5/19/2009 AM She did not vaccine breakthrough. Had VARIVAX-2 doses. Diagnosed with varicella in our office on 5-19-09. U 6/18/2007 5/17/2009 5/19/2009 5/19/2009 as given twice, no adverse reaction noted. Y 5/26/2009 ports a gradual onset of edema and erythema, first to the vaccine site, then spreading to theYentire arm. 5/21/2009 She reports5/22/2009 the site was warm to th air loss (alopecia) around temples (around Y ear area, mainly in front) and some hair loss around N hair line and crown. Has happened the last d via EMS to Emergency Dept on theY morning of Y 08/11/2006 00:57 actively 1 seizing. Y Symptoms N began 308/10/2006 minutes prior 8/11/2006 to arrival to ED. No ceived the Typhoid Vaccine 0.5ml IM Left Deltoid at Approximately 8:15am. Left Health Center Y approx. 8:30am. 5/27/2009Health 5/27/2009 Center alerted at 9 dom twitches and involuntary muscle movement/spasms in my legs, calves, quads, ankles, feet, N and toes 11/1/2008 and sometimes 2/1/2008 in my fingers and tion red, hot and swollen and tender to touch U 5/27/2009 5/27/2009 ncing flu like symptoms with hot/cold, some sweating, nausea and dizziness. Legs hurting. Y 5/26/2009 5/27/2009 after vaccine administration he presented with widespread urticaria rash. Of note he also finished U a course 5/21/2009 of Bactrim 5/27/2009 the day before rash s First Anthrax vaccination was issued in my left arm. Two days later my arm started to swellYand became 5/4/2009 red at the injection 5/5/2009site. This adv s after experienced fever of 103, chills, Y body aches, chest pain and shortness of breath. U 5/21/2009 5/24/2009 n chest, shortness of breath, EXTREME fatigue, chronic joint pain, muscle fatigue. N 5/4/2008 5/14/2008 OF GRAVES DISEASE SINCE 2006. UNDER TREATMENT AND MEDICATION. NEEDED IMMUNIZATIONS Y 5/27/2009 TO OBTAIN 5/27/2009 JOB TO DO SO ZOSTAVAX 4/16/09. Developed herpes Y zoster 4/26/09 over T9 on right. Y 4/16/2009 4/26/2009 AX given to 5 year old without complications. Called patients mom on 5/23/09 & 5/26/09 Y 5/22/2009 max 103.8. Multiple tonic / clonic seizures Y in 1st 24hrs after vaccine admin. (currently 5). ER:UCT+LP. Still 5/26/2009 febrile lasts 5/26/2009 seizure 1030 am 5/2 n at ED on 5/11/09 for c/o scratchy Ythroat feeling as if was swollen.Had received vaccinations Y that am for HepA/B and meningococcal. Was ted to our clinic by patient's PCP: J.YDohemann MD (415)923-3447. 4 hours after receiving vaccines U pt reports 5/19/2009 fever5/19/2009 of 102 with rigors and after vaccine administration the patient reported experiencing some fever, chills, and muscleYpain at site 5/18/2009 of injection.5/21/2009 5/25 to report severe muscle pain in left arm with limited ROM. Pain started after 2nd dose of Y Twinrix 5/4/09 5/18/2009 but became 5/19/2009 worse after 3rd do ed varicella-like rash, greater than 50 lesions on face, neck, trunk, arms, buttocks, and legs U 5/22/2009 5/27/2009
nally gave expired Pneumovax dated 04/02/2009 Lot#0963U on 5/26/09 5/26/2009 d and forearm had slight swelling Y 5/27/2009 5/27/2009 ias of bilateral feet and lower legs, bilat forearms, R hand and inability to fully extend R indexNfinger; started 5/26/2009 the morning 5/27/2009 after the vaccine; s r 103 F 12 hours later lasting for 4 days with no appetite, listless and not very responsive, would U only take 5/21/2009 some water. 5/22/2009 Followed by 2 days ure 101-103 approximately 24 hrs. post vaccination and loose stools - presented in clinic - noUother symptoms. 5/26/2009 5/27/2009 en- immediately after patient received vaccine he fainted. Y 5/27/2009 5/27/2009 veloped hives about 22 hours after receiving 4yr boosters- DTap, IPV, MMR and VZV. No previous Y reaction, 5/18/2009 no respiratory 5/19/2009 or GI symptoms ceived DTAP, HIB + HEP A ~ 5-11-09. Patient noticed redness + swelling at injection site ~ 24 Y hours after 5/11/2009 vaccination 5/12/2009 (5-12-09). Left thigh me to office 5-26-09 + reported sheYhad warmth + redness to injection site 5-20-2009 which Uresolved; then 5/18/2009 on 5-22-2009 5/20/2009 she began to hav vaccination 2/20/09 - only 2 mo - Between 1st and 2nd dose -should be 6 mo. 4/24/2009 o itching at the site, 5min later started Y coughing. Mom stated he was having an asthma attack, Y but did not 5/26/2009 have inhaler. 5/26/2009 Dr. notified and neb jection site right deltoid (1) day after injection was given. Seen by Dr. 2 day after c/o rash and Y itching BENADRYL 5/18/2009 was 5/19/2009 prescribed by Dr. se event. Mis administration of TDAP. Rt is 9 yrs old - should of been TD. ### was reported by a healthcare professional Y and described the occurrence of joint pain in an adult U female 4/29/2009 subject who 5/1/2009 was vaccinated with B VARICELLA vaccine given into (R) arm 4x4 cm area of erythema and 9x7 cm area of erythema Y surrounding 5/20/2009 injection 5/21/2009 site to: Septra EL and VARIVAX vaccines given into (L) leg. 8 x 11 cm area of erythema and warmth on anterior Y (L) thigh. 5/20/2009 Septra. 5/21/2009 arm next day, took BENADRYL heart flutter was noticed on Thursday (2 days later). By Friday Y arm was swelled 5/19/2009 went5/20/2009 down by Sunday. n has been received from a registered Y nurse (R.N.) concerning a female patient who received U two doses of GARDASIL. The patient had no n has been received from a certifiedYmedical assistant concerning a 17 year old female whoNon 17-MAR-2009 3/17/2009 was intramuscular 4/28/2009 vaccinate n has been received from a physician concerning a 22 year old female with no medical Y history U who was 3/19/2008 vaccinated with 5/4/2009 her first (lot# 6582 n has been received from a nurse practitioner Y concerning a 19 year old female who experienced Y fever a5/13/2009 few hours after 5/13/2009 receiving the first d n has been received from an investigator concerning a 35 year old female with no known drug N allergies, 1/12/2009 with HIV and5/4/2009 alcohol use who ente n has been received from a consumer concerning a male family member, now 8 years old, who U experienced autism after receiving vaccine n has been received from a consumer concerning a male family member, now 10 years old,Uwho experienced autism after receiving vaccin n has been received from a nurse practitioner Y for the Pregnancy Registry for VARIVAX (Oka/Merck) Y concerning 9/26/2008 a 26 year### old female with a n has been received from a pharmacist Y concerning a 62 year old hospitalized Y female with pneumonia, Y urinary 5/19/2009 tract infection, 5/20/2009diabetes, hype n has been received from a licensed Y practical nurse for GARDASIL and MMR II, Pregnancy YRegistry products, 2/11/2009 concerning 2/11/2009 a female patient Y 5/28/2009 5/28/2009 Hives neck back, abdomen arms and leg started 5/21/09 in the evening. Treated with ZyrtecYX 7 days. 5/20/2009 5/21/2009 PD" testing using ANTHRAX Vaccine - 5m experienced area of erythema 3' X 2 1/2: with 1 cm Y central induration. 5/12/2009Tender, 5/13/2009 not hot - Resolve V vaccine ordered by physician and nurse administered it. The child was 5 yrs old and the vaccine Y should 5/26/2009 not have been given, as it is indic aised) rash in crops over the antero-medical aspect of left thigh no erythema. Y 3/26/2009 5/1/2009 at Inj site. Red itchy rash. U 5/20/2009 5/22/2009 ous patch over the vaccine site left upper arm - lateral posterior aspect no warmth; no tenderness; Y full range 5/12/2009 of motion 5/13/2009 nsider this a vaccine failure for him to Y be fully immunized and get pertussis at age 7 Y 5/23/2007 5/1/2009 was administered to left deltoid on Tuesday May 26, 2009. Came to office today to show me Yhis left arm 5/26/2009 which was reddened 5/26/2009around the en zed area of enduration 2-4 inches above right elbow. Nickel-sized area of enduration 2-4 inches Y above 5/13/2009 left elbow. 5/15/2009 Slight erythema to both ad small pox vaccine on the 17th of May. He returned for follow up on the 26th. His skin reaction Y showed 5/17/2009 local redness 5/27/2009 and white blister. H ld probably be considered a vaccineYfailure since the child was fully immunized and was diagnosed Y with 7/18/2007 pertussis at age 6. e fever (not even 100) 5/26 in the evening followed by redness and swelling at the site on 5/27. Y Fever gone 5/26/2009 5/28 although 5/26/2009 redness & swellin ced swelling and redness at injection site 5/27/2009. Prescribed keflex and benadryl. U 5/19/2009 5/27/2009 ONE CALL FROM MOTHER STATING CHILD HAD RASH ON BODY WHICH APPEAR 45 MINS POST 5/28/2009 IMMUNIZATION. 5/28/2009 CLIENT RETURN fter receiving TdaP imm., pt. was sitting Y sewing at approx. 10:30am and had magnified circles Y in front of 5/12/2009 both eyes. 5/14/2009 Vision was not affected reased sensation and decreased strength in the Y left arm. 7/7/09 Hospital 4 records received DOS 5/11/092/12/2009 to 5/15/09. Assessment: Disturbed d rash c/ second injection, but thought it was due to starting a new OTC product. 3rd immunization Y given, 1/22/2009 and rash reappeared. 2/5/2009 numbness, pain, limited ROM and inability Y to perform many normal activities of daily living. Diagnosed N with 4/15/2009 axillary nerve 4/15/2009 dysfunction... put o cines given to pt, Lt leg Varicella was administered, Rt leg MMR and Kinrix administered. Lt leg area 35cm/25cm 5/27/2009red 5/28/2009 and swelling. Rt leg eloped 48 hours after immunization. Low grade temp. U this second HB shot during a 9:30 am appointment on 5-20-09. The first HB shot I receivedYwas from the 5/20/2009 same physician 5/22/2009 a month earlier o d stated Pt had started getting a rash Y to both legs, mom informed to bring back to clinic, then Y mom called 4/24/2009 and stated 4/24/2009 he was getting swolle th reddened raised area at site of VARIVAX injection. Approximately 1/2 hour after injection-Yseen by MD5/28/2009 recommended 5/28/2009 ice and BENADRY
ble crying with head twitching - lasted for about 30 minutes - low grade fever 1st 24 after shots. 5/27/2009 5/27/2009 arm, legs + face. Y 5/26/2009 5/26/2009 ody aches, arm pain. Approx 1 in redness Y @ injection site. - Recommended IBUPROFEN 600 Y mg q 6 hrs5/26/2009 prn. - Went 5/26/2009 to ER - 5-27-09 mplained of "high" fever several hours after injection (although did not have a thermometer).YSweating, could 1/14/2009 not sleep, 1/14/2009 numbness and ting 1; eyes and lips became swollen and Y puffy after leaving office. Returned 30 minutes later; pulse Y 98%, BP 5/27/2009 112/68. BENADRYL 5/27/2009 1tsp po give painful - swelling (L) thigh - 3cm X Y4 cm 1day post vaccination Y 5/26/2009 5/27/2009 4/9/2009 5/26/2009 st 1st dose pt noted flashes in visualY field and fatigue. Inc in flashes after 2nd dose. Reported Y dec in visual 2/23/2005 field 2-3 days post 3rd dose, In Y 4/16/2008 5/27/2009 ed rash developed within past 3 days Y 5/25/09. Blisters - vesicles with fluid - fatigue. Y 5/4/2009 5/25/2009 uscle pain and swelling. Supra clavicular adenopathy Y 5/26/2009 5/26/2009 veloped myalgias in the neck and back within 24 hours of administration of Td booster. AlsoYhad some nausea 5/26/2009 and5/27/2009 some wheezing startin n has been received from a nurse practitioner Y concerning a 22 year old female with unspecified N drug reactions/allergies 4/6/2009 4/30/2009 and medical history n has been received from a pharmacist Y concerning Y an 81 year old male 0 with hypertension, cancer, U diabetes 10/8/2008 and a history 5/5/2009 of heart attack w n has been received from a physician concerning a 9 week old male with no pertinent medical N history reported 5/13/2009 who 5/22/2009 on 13-MAY-2009 was v ed from a consumer the following information on 14 May 2009: A female patient was vaccinated N with Influenza 11/1/2007 virus11/1/2007 vaccine (batch no. or m red ZOSTAVAX vaccine 5/20/09 at 9:30am. Reported she awoke next am with generalized hives N over body 5/20/2009 including 5/21/2009 buttocks and scalp. N nt to ED with swelling to right leg. Red Y and warm to touch. Y 5/7/2009 5/9/2009 firm area on Rt deltoid approx 2minYwide running 1/2 to elbow. Parent reports started 1 afterNadministration 3/31/2009 vaccine.3/31/2009 Mother plans PMD visi back, abdomen, arms, face after vaccine Y (24 hours) no high fever. Mother plans PMD visit due N to current 3/31/2009 ear infection4/1/2009 also. mplaint (1/1): This 12 month old female Y presents today for evaluation of a rash. Rash-Associated Y Signs and 5/22/2009 Symptoms: 5/23/2009 The following chara ed after vaccination and bumped head on floor. Monitored for 50 minutes. Sent home with mom Y to monitor 5/26/2009 s/s concussion. 5/26/2009 BP 94/60, P 72 ax- rash and pain. Treated with BACRIM DS initially and changed to Acyclovir treated x 1 week. Y Treatment 3/30/2009 started 4/094/1/2009 4/24/09. Folliculitu ight thorax returned after 2nd Hep. B vaccine - came to clinic on 5/7/09 - 'Shingles'. Treated U with ACYCLOVIR 5/4/2009 X 3 weeks5/7/2009 5/22/09 still symp VARIVAX 5-21-09, seen in office 5/23/09 arm, red, warm to touch for 2 days. 15 x 14 cm erythemas Y with5/21/2009 4 x 6 cm central 5/21/2009 induration and 59 given VARIVAX, developed erythema with 3 mm central papule vesicle seen on 5/21/09. Y 5/18/2009 5/18/2009 Y U 5/27/2009 5/29/2009 ate 4 minutes after receiving vaccines; I started getting dizzy, nauseated, cold sweat, and a headache. Y There 5/4/2009 was a 5/4/2009 burning in my arm goin ular redness with warmth. no s/s infection. supportive care : compresses and motrin prn. Y 5/27/2009 5/28/2009 ates that he had vaccinations administered on Tuesday and wednesday afternoon around 1:30 Y p.m. he began 5/26/2009 having 5/27/2009 fever and chills. He a ate 2 minutes after receiving vaccines: Y I passed out. Right after I woke up I started throwingYup and the Rn 5/5/2009 clinic was5/5/2009 unable to stop it and utes after i got the 1st shot, body felt warm and tingly. then i had a small seizure according toYthe tech, but did not lose consciousness. the ter given approx 10 am on 5/27/09 r del im. spoke with pt on 5/29 and she reports on 5/28/09 Y she awoke5/27/2009 with headache 5/28/2009 and chills took tem LN,VOMITING,URI.sYMPTOMS STARTED Y IN THE PM AFTER SHOTS. Y 5/28/2009 5/28/2009 y AM 5/19/09 with frequent vomiting and fever. Frequent vomiting lasted until 0700, then final, Y isolated emesis 5/18/2009 at 1700. 5/19/2009 Temp max 103. F her called and reported that Kahlyndra Y c/o not feeling well approximately 2 hours after vaccine Y administration. 5/27/2009 Following 5/27/2009 am c/o nausea, an a pharmacy clinic to receive Zostavax. Pt is s/p renal transplant and on chronic immunosuppression. N Screening 5/1/2009questionnaire used was d ap administered R deltoid. 1-9-09 Soreness reported to Employee Health Nurse. 2-27-09 - Appointment U scheduled 1/2/2009 due 1/9/2009 to report of persiste hrs after vaccination, arm became red, swollen,Yand painful. admitted 2 to hospital 48 hrs afterYvaccine receive, 5/11/2009 and treated 5/12/2009 for cellulitis of arm adm. 2:30pm,Fri.22 May 2009. 3 days later 2am woke up with difficulty breathing, productive N cough with5/22/2009 green phlegm, 5/25/2009 no fever. All day ( eaction distal to injection site(whihcYwas on right deltoid) extending about 6 cm with induration Y to inner bicep. 5/28/2009 Has minimal 5/28/2009 warmth, not too , generalized body aches and chills. Reports that they do not have a thermometer so have not U been able5/28/2009 to take a temperature. 5/29/2009 Some loca , 1991. "Hold up four fingers. That's right, you're four years old!" On patient's birthday Y he was N coming down 8/19/1991 with a cold. 9/20/1991 August 19, 1991. O ted 13 days s/p vaccination of MMR, TDaP & Varicella w/ rubella type rash; pink macular papular U rash involving 5/16/2009 face, 5/28/2009 UE's & torso; Pt also rash on trunk 26 days after Immunization administration, rash non tender, pre eval. Y 5/1/2009 5/27/2009 ceived vaccines at 12:00 at 14:45 became Y hoarse and felt like he was having difficulty breathing, Y also mild 5/28/2009 cough. Developed 5/28/2009 flat, red rash en lethargic, decreased appetite. Bright red rash on cheeks and face. Rash on legs, had slight U rash prior5/26/2009 to administration 5/26/2009 on legs now mor MMR and VARIVAX vaccine 4/3/09. Missed period 4/17/09, did not know was pregnant at time. 4/3/2009 d area on arm; Warm to touch. Swollen Y (1.5X10 cms). Placed on MEDROL DOS-PAK. Dx:YLocalized allergic 5/12/2009 reaction. 5/13/2009 er, redness 2-3 " down arm, warm to Y touch. Ached. 0 Fever. 3rd day stinging, less redness. Y 5/26/2009 5/28/2009 on. mild edema, tenderness, slight erythema. Y 5/28/2009 5/29/2009
ch area around injection site is warm, swollen and red with nodule. Painful. Difficulty raising arm U and lifting 5/27/2009 arm. Recommended 5/27/2009 medical eva as given initial dose of Gardasil vaccine in (R) deltoid. Almost immediately after vaccine wasYgiven she c/o 5/19/2009 dizziness5/19/2009 & then lost consciousn swelling, warmth, bruising with a few hours of administration. Patient + presented with aboveUsymptoms 5/26/2009 in office 725/26/2009 hours later. Temp 96.9 was reported via a statement of injuries received via a lawyer and described the occurrenceUof joint pain in 8/1/2000 an adult male subject who was me in clinic stating that she could no longer move her left arm. Patient had had some Y swelling N in left arm12/4/2007 after a Td 12/4/2007 vaccine on 12/04/07. It on 5/26/09 c/o feeling nervousness. States that it started ~ 3 days after receiving Adacel inj. N which he is still 5/13/2009 having the 5/16/2009 SX. as of appt on 5/ ed-macular rash to left thigh. Warm to touch, swollen. U 5/27/2009 5/28/2009 cine given, Patient with h/o fainting with shots, became weak, laid down, had episode of emesis, Y VSS, patient 5/28/2009 treated 5/28/2009 and recovered, mothe ceived Subcutaneous dose of ZOSTAVAX 5/26/09. Patient returned to pharmacy 5/29/09 with N questions5/26/2009 about localized 5/29/2009 reaction to injectio 0 mm after immunizations were given (Hep A - Varicella - Meningococcal). Pt developed throat Y tingling sensation 5/20/2009and 5/20/2009 dizziness, then collap 5 min after 1 mms given, child dev. hives near injection site, L leg. variable hives on trunk back Y & face. Pt5/21/2009 given diphenhydramine 5/21/2009 10 mg in .7 degrees F, vomiting, irritability, pallor, Y poor feeding, sleepy presented to ED approximately Y 7:30pm on5/22/2009 5/25/2009.5/25/2009 05/18/2009 pt told mom left upper arm Y hurts. Mom noticed left arm red, swollen warm to touch. Mom called 5/18/2009 Dr, she5/18/2009 told mom to put heat o was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v was reported by a healthcare professional and described the occurrence of arm swelling (injection N site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen was reported by a physician and described the occurrence of bruise injection site in a 4-year-old Y female subject 4/9/2009 who4/9/2009 was vaccinated with c was reported by a physician via a GSK Y representative and described the occurrence of armUswollen in a child subject of unspecified gende was reported by a physician and described Y the occurrence of injection site blisters in a 4-year-old U male subject 5/6/2009 who was 5/7/2009 vaccinated with KI was reported by a physician and described the occurrence of rash in a subject of unspecified U age and gender who was vaccinated with KIN ash at vaccine site and on upper extremity Y Y 5/27/2009 5/30/2009 hot;It was not until 3rd day of the Shot . The area of the vaccination became very hot, achedYand red.(Felt 5/25/2009 inflamed)5/25/2009 Two days later the pro 02.7; Headache; Fatigue; Was given tylenol 480 mg every 4-6 hours for 16 hours; slept mostYof the day; drank 5/27/2009 liquids 5/28/2009 but did not eat; no oth a of induration at injection site with swelling Y and pain. Y 5/28/2009 5/29/2009 d gunk in her eyes real bad Y the morning Y of theY10th. She had a fever 14 of 104.9 when we tookUher to the emergency 5/8/2009 5/10/2009 room where they gave as vaccinated with Smallpox on his left arm on 20 May 2009. Pt's Smallpox blister 'popped' in U his sleep the 5/20/2009 night of 30 6/1/2009 May. He noted that rm swelled up to the wrist and is hot to the touch. 5/27/2009 5/28/2009 body aches - Patients relates having fever with pertussis as a child. Y 5/5/2009 for immunizations on 5/28/2009. Child received DTAP, HPAC, IPV & MMR. Mother telephoned Y this morning 5/28/2009 & stated 5/28/2009 that child began to br lled, client had high temperature 103.9. Y Went into convulsions. Sent to ER, diagnosed with UTI. Y Took her 4/22/2009 to pediatrician, 4/24/2009 stated no diagnos rate, fever, vomiting, diarrhea. U 5/22/2009 5/28/2009 d 4/29/09. Mother noticed small "pimple Y like" lesion at site of VARIVAX injection (Left thigh) Y on 5/1/09. Small 4/29/2009 cold sore 5/10/2009 like blister on mouth Typhoid cap appropriately --> 6 hrs. later had dizziness, light-headed followed by nausea andY vomiting assoc. 5/20/2009 with movement. 5/20/2009 Hx of 2 episo swelling pruritus in place of injection. Y 5/15/2009 5/17/2009 14 hours after vaccines administered Y (102 degrees F). Y 5/26/2009 5/27/2009 bout 12:00 patient became weak, pale, Y collapsed to floor, febrile, tachycardia. Patient seen inY ER, monitored, 5/26/2009 labs (CBC, 5/27/2009 BASIC chemistry a area of redness over the skin at the site of injection 7 1/2 x 4 cm. No further reported problems U as of 5/26/09. 5/5/2009 5/5/2009 severe hives. Y Y ### ### mplain of muscle pain in left deltoid muscle. Pain persists one month after injection. N 4/28/2009 4/29/2009 is not to be started after 12 wks of age this pt. is 6 mons old. Y 3/9/2009 3/9/2009 n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with the second dose of GA n has been received via a literature article regarding a case in litigation concerning a male who U in November 11/1/2004 2004, 11/1/2004 was vaccinated with a d turned to clinic on 5-13-09. Lft arm injection site with 4-5 cm area of swelling. Area red and non U tender to5/11/2009 touch. Patient 5/12/2009 reports itching to ar n has been received from a case in litigation from a lawyer concerning a patient who on 19-SEP-2003 U was 9/19/2003 vaccinated with a dose of Hep B d spinning, stomach sore, throat hurt for short time. Patient presents to clinic 4/24/09 at 8:50am, Y report "stomach 4/23/2009still 4/23/2009 hurts" to lower abdom ed redness and swelling began around Y 1500 on 5/20. She applied cool compress around 1700 U applied ice 5/18/2009 pack, at 2000 5/20/2009 applied lotion "aloe x 2 1/2 cm indurated, increased warmth. Fever 39 degrees C. Prescribed Keflex. 5/28/2009 5/29/2009
lling, redness, heat, and rash at injection site. Y 5/20/2009 5/25/2009 nto office and never was immunized. She was going to camp and needed imms. Dr. Asked nurses Y to work 5/29/2009 on seeing5/29/2009 what imms could be g as administered the DTaP vaccine instead of the Tdap vaccine. There has been no known orYreported adverse 5/15/2009 reaction 5/15/2009 to the patient. In the er dose of Rota vaccine given patient developed Y intussuception requiring 3 surgery for repair. Y6/2/09 ER records 3/30/2009 received 4/3/2009 DOS 4/3/09. FINA atient was given the MCV vaccine early. The recommended age to administer is between ages Y 11-12, it 5/29/2009 is approved5/29/2009 for ages 2-55. He was d a 12 year old female who was alert Y and oriented but appeared nervous, comfort measuresYwere taken.5/20/2009 I proceded5/20/2009 to administer the vacc ceived MMR and Varicella vaccine'sYon May 21, 2009 from Merck and Co. Came into office today with rash 5/21/2009 on face 5/31/2009 and chest patient has n elling in lympyh node on side of chest. Site swollen, warm to the touch. Lasted approx. 5 days. Y Doctors perplexed ### at the ### location of the sw photographs the patient developed right sided ptosis and an enlarged pupil between Y September N 1st and 7th. 9/4/2008 The parents 9/7/2008 noticed abnorma e up the night of vaccination (5/26)with Y pain. The Y next morning the mother 1Y noticed a red, round, N hard area 5/26/2009 approximately 5/27/2009 4-5 inches. The c der soft tissue infection with tender Yindurated area central eschar surrounding cellulitis. Treateed with Zithromax and 5/23/2009 Bactrim.Cultured are Tenderness at surrounding injection site (Left Deltoid) U 5/31/2009 5/31/2009 l Saturday 05/30/2009 with headache, stomachache. Also injection site of menactra (r arm) Yred and swollen 5/29/2009 approx.5/30/2009 1cm. wing administration of vaccine the patient developed stomache ache, fever, and headache. Highest U fever5/29/2009 was 101. 5/30/2009 iven on 5/26/09. Day after arm hurt, administration site, red, swollen,firm to touch and warm.YWorsened on 5/26/2009 Thursday. 5/27/2009 Saw Employee Healt post vaccine 2 days ago, no fever, no previous vaccine reaction. Recieved DTaP IM and VZV SQ but reaction 5/27/2009 started 5/27/2009 around DTaP area, p nic Seizure acttivity lasting 2 minutes. Y 6/29/09 Y Hospital records received 2 DOS 5/19/09 to 5/21/09. Y Assessment: 5/18/2009 Acute 5/19/2009 onset seizure second ace torso arms and legs onset 05-29-09. Pt. c/o itching. Parent is giving Benadryl. Possible Fifth Y Disease5/29/2009 5/29/2009 vaccine was administered, the patient Y complained of pain in the right arm, started crying, became U diaphoretic, 6/1/2009 ashen,6/1/2009 and lost consciousnes aculopapular rash on face, exerting,Ytrunk, back starting on 29 May 2009. U 5/21/2009 5/29/2009 over injection site - X 2 days - cool compresses. Y 5/13/2009 at injection site x 2 days. Treatment cool compresses. Y 5/13/2009 5/14/2009 ely following injection patient had syncopal episode for 15 seconds. She had Flailing of arms/YLegs when5/29/2009 she was unconscious, 5/29/2009 as nurse wa on 5/29/09, raised, itchy, painful x 2dY seen in the office 5/29/09: T: 98.2. Exam: dry papules upper Y forearms, 6/26/2007 back, trunk, scattered = 6 = blis at site of injection up to 15 cm. Peak with underlying induration almost entire extent of quad.Y(right). 5/29/2009 5/30/2009 s receipt of third AVA vaccine on 5/2/2009 Y (AVA #1 8/2/05, #2 8/17/05). He reported no problems Y for 2 days. 5/2/2009 5/4-7/2009 5/2/2009 he c/o: 1) a roun ceived Tdap IM R arm on 4-8-09. Right Y arm red and swollen; warm to touch. Good ROM. Pt.Ustate she took 4/8/2009 pain medication 4/12/2009 for discomfort. sented in clinic on 4/3/09 @ 10:45 AM c/o swelling and redness of left arm. Client denies difficulty U breathing 4/1/2009 and negative 4/1/2009 for rashes. Client e and vomiting within a few hours following vaccine administration. Client had a fever and had Y a racing pulse 1/28/2009 the evening 1/28/2009 following vaccine tion were given at 5:25pm. Bil Redness of upper arms noticed at 5:35pm 6:50 redness receding. Chest - 4/8/2009 CTA ; No SOB, 4/8/2009 A&O x 3, NAD, 18 eralized itching right shoulder increased back + legs, welts noted above RD site + upper back Y - Benadryl4/13/2009 12.5 mg 15ml 4/13/2009 PO Given @ 1640. eived Immunization on 3/26/09 (DTAP Y and MMR). Mom states, "Started on TYLENOL and MOTRIN, Y but3/26/2009 spiked temperature 3/28/2009104 on 3/28/09 witnessed seizure on 5/21/09. H/O probable Y seizure Y activity in the past 4 6 wks. After seizure, Y pt has had complaint 5/20/2009of5/21/2009 headache, dizziness, w l cord, right vocal cord, polyps Y cancer. Y Lost of voice. Y Rash in skin complete 5Y body.YPain to joints N complete11/4/2003 body. Gallbladder 11/5/2004 removal with, m 4/14/09, diarrhea, diaper Y rash - rash Y - face, scrotum Y bruised w/infection. 8 7/13/09 Hospital DC summary3/24/2009 received DOS 4/14/2009 4/15/09 to 4/22/09. s in face, body, hands, feet Y BELL's Palsy Y in face. Y Losing ability to walk. 14 Y Low blood pressure readings. Y Kidney (not ###normal 11/1/2008 readings). MRI's ( brile seizure; Negative workup at Hospital. Y 6/22/09 Y Medical records2DC summary received DOS Y 5/20/095/19/2009 - 5/22/09. 5/20/2009 Assessment: Seizure w eloped poor appetite with associatedY vomiting, Y sudden in onset, worsening 1 over a few hours.YChild evaluated 5/13/2009 at office 5/22/2009 exam consistent with U ollen, itchy & hot to touch. Y Y 5/26/2009 5/27/2009 vaccine breakthrough. Diagnosed in office with varicella on 5-26-09. Had over 100 lesions noUfever. 2/11/2009 5/24/2009 + redness at injection site. N 5/20/2009 5/20/2009 n left arm, jaw, left leg for two weeks after vaccination. U 5/15/2009 5/15/2009 veloped an erythematous patch in right Y thigh hours after shot was given. It got indented andYbigger, with some 5/7/2009 induration, 5/18/2009 measures: 3x 1 c veloped furuncle abscess site of vaccine Y about 1 wk after shot given. It is probably unlikely this Y was secondary 5/6/2009 to shot. 5/13/2009 Furuncle was in upp erythema and induration around vaccination site. Reaction probable cause from VARIVAX. Y 5/27/2009 5/27/2009 days after inj pt was seen in ER forYrash that was felt to be eczema. Y 4/28/2009 n has been received from a physician concerning Y a 24 year old female 1 patient who on 26-AUG-2008 U was 5/21/2009 vaccinated 5/21/2009 with the first dose of G was received from a consumer via Y Sanofi Aventis on 20 May 2009. A female patient, with a history of Type II diabetes, Hashimoto's thyroid ately two minutes after injection of vaccines Mom noticed and questioned to nurse about bilateral Y lower extremity 5/21/2009redness. 5/21/2009 Nurse called Dr. 009 24 hours after immunizations were given L upper arm started to swell & redden. They were advised5/26/2009 to use Tylenol 5/27/2009 + cold packs by clin
t a Tdap 5/14/09 and developed cellulitis Y on the (L) upper arm site of the injection. Then was seen at the5/14/2009 doctors office on 5/21/09. d ADACEL 4/27/09- And developedYcellulitis on site of injection. She was seen at ER. Y 4/27/2009 4/29/2009 9 Patient received DTaP #5 and Varicella #2 to the (R) Deltoid by RN and IPV #4 and MMRYII #2 to (L) Deltoid. 4/16/2009 Family 4/17/2009 brought pt to clinic a Y 5/28/2009 5/28/2009 d PENTACEL 3/3/09 @ 2mo. well-child on 3/16/09 called nurse line - (mom) stating child non Y stop screaming. 3/3/2009 This 3/3/2009 office called back 3/9 as given Tdap in error as this has only been studied to age 64 and recommended for ages 11-64. U Patient5/22/2009 having no adverse symptoms per vaccine breakthrough. Diagnosed with Varicella on 5-26-09. Had over 200 lesions. No fever.U 6/7/2007 5/23/2009 and bruising at site with pain. SterileYabscess Lt. leg. Y 5/22/2009 5/23/2009 ingles of L chest and arm 7 monthsYafter vaccine. Zoster/Shingles. Y ### 5/25/2009 5/27/2009 d area developed erythema and edematous swelling 5 1/2 6 1/2 cm. There is also warmth to the area though 5/27/2009 no induration 5/28/2009 or fluctuance of en, hard to touch, painful with bruising Y large lesion 5" X 5" sterile abscess. Y 5/22/2009 5/23/2009 d diarrhea for 3 weeks, fever, speech and motor regression, has been evaluated for autism by N specialist,11/5/2008 results inconclusive. 11/8/2008 MRI and EE Y 11/5/2008 ### e right deltoid since injection. also with small lump. parathesia intermittently radiating down to U right elbow, 5/29/2009 with loss 5/29/2009 of strength to right arm. e and dizziness s/p Tdap and HPV #3. Y Immunization given at 1515, gradual onset of headache U over course 6/1/2009 of the day. 6/1/2009 Patient to ED at 220 ng ataxia with onset approximately 11/08. Y Severe gross motor and fine motor impairment noted. N 6/15/09 Received ### PCP 11/1/2008 medical records fo oss of felling in left arm, hand afterward Y and left arm had chills.There ia a golf ball size swelling Y to the upper 5/28/2009 left arm.5/28/2009 ceived dose #4 of DTAP IM on 5/26/09. Parents report they noted large reddened area with Y mild swelling5/26/2009 at site on 5/27/2009 5/27/09. Client without administered instead of MMR as requested by parents. No adverse event noted. Y 5/29/2009 nt recevied 3rd dose of Rotateq Y on May Y 15, 2009. Y She developed intussusception 1 on May 25,Y 2009. 7/14/09 5/15/2009 Hospital 5/25/2009 records received DOS was administered on 5/26/09. Client had reaction to vaccines on 6/01/09. Came in clinic today Y 6/02/09, 5/26/2009 left deltoit sligtly 6/1/2009 redness and swell oke up the next day with raised, itchy rash all over body except on face, chest and upper trunk. U Took OTC 12/9/2008 medicines and ### rash lasted 3 wee turned to clinic 3 days post vaccination with right thigh erythemic, slightly swollen and warm to Y touch. Mother 5/26/2009 states5/27/2009 that symptoms started d fever 103 with diffuse sweats x 24 hrs, irritability x 48 hrs, 7 days after vaccinations. Rash Y broke out about 5/7/2009 24 hrs 5/14/2009 after fever broke - macu MA, EDEMA AND INDURATION 1.25"X Y 1" TO RIGHT DELTOID. ICE PACKS, IBUPROFEN YAND TYLENOL 5/28/2009 FOR AGE 5/29/2009 PRN. ter fainted and was taken to the ERYto be monitored, after going home she began with a fever... U this is the6/1/2009 day after receiving 6/2/2009 her rd HPV sh was reported by a healthcare professional Y (also Y the subject's mother) 0 and described the occurrence N of cyanosis 9/27/2006 in a9/27/2006 2-month-old male sub izures - 5-20 minutes of seizures - VALIUM Y 2 milligrams Y given - tachypneic 1 spell 5-10 seconds Y recovered 5/18/2009 without ventilation. 5/19/2009 6/12/09 Hosp ccines given Pt c/o dizziness, fan on pt - cool cloth on forehead - B/P checked, decreased 88/46 Y -head of5/18/2009 bed down5/18/2009 - foot of bed elevated. 20/09 Spoke to Dad - baby doing well, no ill effects. Child here for visit, received overdue imms Y / MICR was 5/18/2009 "down" - Child had these imms munizations Thurs. PM 5/21/09, but didn't notice swelling & erythema until Saturday 5/23. Pt Y reports "extreme 5/21/2009 pain" Sat/Sunday 5/23/2009 but feels be idmorning patient developed a fever and sweats (soaked clothes), dizziness and felt like sheYwould blackout 5/20/2009 if stood5/21/2009 up. Also started mens ution-Progressive swelling, tenderness, erythema at a site 5/20/2009 5/21/2009 ped petechiae of lower extremities below knees. (R) greater than (L). These areas appearedYwithin 48 hours 5/19/2009 of vaccinations. 5/21/2009No squeezing ted Saturday 5/23/09 102.2- gave MOTRIN and TYLENOL to help bring fever down. Rash started N on Sunday-was 5/13/2009 flat 5/23/2009 and then red pimple chicken pox lesions- head, trunk, and scalp extremities. Friend broke out 5 days ago. U 5/17/2000 5/24/2009 ed urticarial rash at site L arm Y U 5/21/2009 5/24/2009 Tdap to right deltoid 5/22; developed Y chills and fever and headache that evening. Seen in UC Y 5/24; right5/22/2009 UE was not 5/22/2009 red, warm or tender. O e, too warm, flushing and nausea. Y U 6/2/2009 6/2/2009 HPV she was weak, T.100, decreased eating, hives runny nose & sneezing. Y 6/1/2009 6/2/2009 d muscle and tender pain sustained since TWINRIX injection 05/04/09. U 5/4/2009 5/4/2009 en, shortness of breath. Mom statedYallergic to VARIVAX event though she got MMRV. 5/19/2009 5/21/2009 redness, and soreness left upper arm. 13cm by 14cm. Y 5/19/2009 5/20/2009 ately 3 weeks post ZOSTAVAX, developed 8 lesions, dime sized, left upper arm. A couple ofYweeks later,3/23/2009 developed 4/1/2009 sever, debilitating kne len, cellulitis (TYLENOL). Y 5/18/2009 5/21/2009 and edema, warm to touch, measuring 6x7 cm oval on right deltoid. 5/28/2009 ted 1 day after receiving vaccine. Pt vomited x 1, was lethargic for about 48'. Slight sore throat Y 2 days later. 5/19/2009 5/20/2009 eck, Day 7, c/o some nausea, 2 episodes Y of vomiting. Told to go to hospital ER if couldn't keep Y fluids down 5/22/2009 over weekend. 5/31/2009 Nausea & vomiti tomach", shaky, jittery, chills/hot + "feeling Y just different, not myself" No diff. breathing, swelling U or rash. Patient 5/7/2009 vomited 5/7/2009 while talking with h d bump at the injection site; small red dots from injection site spread to arms, also on torso and Y back 5/11/2009 5/20/2009
adiating to her jaw, shoulder and neck. Y Stiffness lower back painful and stiff making it difficultYto walk. Went 5/7/2009 to PMD on 5/8/2009 Fri 5-8-09. c/o " ever mother at approx. 9 pm on 5/13/09. Pt c/o- H.A.; No relief with ADVIL; 5/14/09 at 11am - Pt. still Y experiencing 5/13/2009 H.A. and 5/13/2009 given 1 TYLENOL by rts child vomited on Thursday pm. Friday Y developed red, raised rash on buttocks which spread U to entire 5/28/2009 body by Sunday, 5/29/2009 MD appointment 5/19, 20 c/o pain lt side of chest & shoulder back c/o bad H/A 5/19 LT deltoid upper arm swollen (9 cm 5/18/2009 10 cm) warm 5/19/2009 to touch. c/o could n s after 3 17-09 injections (not sure which day) noticed decreased mobility of R shoulder and N"lightening bolts" 3/17/2009 down3/20/2009 arm to fingertips. Patien th c/o rash on chest and bilateral arms. Y generalized itching. Y 5/22/2009 5/23/2009 MMR shot on 1/16/09. Diagnosed with Y measles on 1/15/09. Broke out entire body with red bump. Y Fever up 1/6/2009 to 105. Irritable. 1/15/2009 Rash and symp turned to the pharmacy complaining of itching within 10 mins the area was slightly raised, red, Y and hot to5/23/2009 the touch -5/23/2009 it extended about 3" di cal swelling and erythema. Local and distant urtitaria. @ 3rd p shot. N 5/26/2009 5/27/2009 n 5/28/09 patient noticed next day some Y redness then next day redness increased and swelling Y up to 6 inches 5/28/2009 pain 5/29/2009 in area. Itched all over w theaded & thinks she may have fainted (briefly) while sitting in chair 3-4 min. after HPV #3 inject. Y 6/1/2009 6/1/2009 Tdap to R Deltoid 5/22; developed Ychills + fever and headache that evening. Seen in UC 5/24, Y (R) UE was 5/22/2009 not red,5/22/2009 warm or tender. On 5 5 AM on 5/27/09 T 102 Crying unconsolable Y - vomited X T - ate only 5 grapes - Temp 102.6 U ax in office at 5/26/2009 11:30 AM5/27/2009 on 5/27/09. Physical e Y Y 5/19/2009 5/30/2009 ven a TB vaccine while he had a fever Y of 104 and a case of Strep throat. He began to have neurological Y problems ### about 24 ### hours later. (Tro 9 - pt had swelling & redness of the (L) thigh. Pt instructed to Ice area & admin APAP. Pt was U seen in ofc. 5/13/2009 5/15/09. Was 5/14/2009 given XY2al 2.5 m arm became very red, warm to touch, Y tender. Limited ROM with inflammation. TX= P.O. Antibiotics, Y pain 5/13/2009 meds, subsequent 5/15/2009IV antibiotics. n has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning Y a female patient who was vaccinated with n has been received from a registered nurse who heard from another contact concerning a 22 U year old female patient who was vaccinated hile at home developed 104 temp and seziure. Presented Y to hospital4for treatment. Y 5/19/2009 5/19/2009 ENTED WITH COMPLAINTS OF N/V AND ABD PAIN X 2hrs POST VACCINATION. PT TREATED N WITH 5/22/2009 PHENERGAN, 5/22/2009 1 LITER NS, SIQ to clinic 5/29/09 with 1 day of body, joint aches, radiating up from legs, associated with low grade U fever. 5/27/2009 5/28/2009 rs of receiving vaccines pt developed Y localized cellulitis with red dermatitis of fluid filled blisters. Y This occured 5/19/2009 in the5/19/2009 area where the DTaP v d chest pain and was admitted for myocarditis Y on Y 25 May 2009. Admitted 1 to medical center. N Received call 5/14/2009 through call 5/25/2009 center reporting post mitted to hospital with paralysis below the neck. History of GARDASIL vaccination; Y Last dose U 04/17/2008. 4/17/2008 No definite 3/10/2009 diagnosis. Described above is simply the most recent event, one of many Y throughout the past 9 months. This dateUreflects the 8/20/2008 diagnosis given 5/20/2009 by a neurologist o with erythema, mildly inflamed with induration, per pt. it already subsided. Y 5/27/2009 5/28/2009 mmunizations administered at an exam. Y 5/31/09 Fever 100-101 degrees. No or rash. 6/1/09 Fever Y and malaise - no other localizing signs. 6 rash Tylenol given as needed Fever 102 degrees F Diarrhea 11-12 days after vaccinations Y 5/18/2009 5/29/2009 ain in left arm w/tingling sensation inYleft fingers 5/6/2009 5/9/2009 omiting, fatigue. Y 6/1/2009 6/1/2009 daughter to a physician she had never Y been to before. While we were there the nurse suggested my daughter 5/18/2009 get the 5/18/2009 GARDASIL injection. ccinated on 5/28/09, went to schoolYon 5/29/09 and upon return home from school mother noticed Y swelling 5/28/2009 and redness 5/29/2009 on right arm. Patie ng our office, the patient passed outYwith increase tone. Taken to the ER for evaluation of possible Y seizure 6/3/2009 activity. CTScan 6/3/2009 & blood work a er receiving the MMR vaccine, Evan came down with 103 degree fever. The following day (8U days after 5/26/2009 vaccine), his6/2/2009 fever is 104 degrees. d approx 1530 on 6/3/09 stating "my son got shots there yesterday now he is having an allergic reaction."6/2/2009 Mom questioned 6/3/2009 as to what kind fort in abdomen, like cramping or feeling of gas. began approx 8 hours after injection ( 4:30 PM Y ) and lasted 6/1/2009 through the 6/1/2009 night. 2. aching in a RED BUMP FIRST SHOWED ON WEDNESDAY, Y 27 MAY, THEN AS THE DAYS PROGRESSED U THE 5/26/2009 BUMP STAYED 5/27/2009 BUT THE REDNE f right arm where vaccine was given. Y Antibiotics and antihistamines given. U 6/1/2009 6/2/2009 se headaches and fainted and had a seizure. Y 5/29/2009 5/29/2009 ours after receiving the third of three injections of GARDASIL, I began to experience intense muscular pain and headache 5/23/2009 which continued months after being given the GARDASIL Y vaccine. I had a ct scan done, which showed that my lymph nodes 5/7/2007 were enlarged. ###A little over a ay arm (R) became painful - swollen and red. Pt took TYLENOL all day. On Wed 6/309 Pt begins N with "spinal 6/1/2009 pain" body 6/2/2009 aches, headaches edema erythema hyperemia measuring 15X12 cm oval. 6/1/2009 6/2/2009 pprox. 10:45 AM - Pt fainted outsideYclinic in the front passenger side of her car. Revived when Y her arm was 5/29/2009 shook by 5/29/2009 nurse. Ambulance w 5/21/09 LDT - RTC 5/27/09 and large red warm localized reaction to Td. Y 5/21/2009 5/27/2009 hematous, macular rash on her back, trunk. No fever. U 6/2/2009 eral 5 inches x 2 inches tender, erythematous swelling. Y 6/1/2009 6/2/2009 e red rash raised bumps (hive-like) 1 patient sat for 1/2 hr gave Benadryl 12.5 melt tablets (1)Y+ 1 to take home 6/3/2009 (2prn)6/3/2009 = 4 tablets (iced rash ed Health center on 6/3/09 2:20 PM to report flushing, palpitations. Had 2-3 episodes of palpitations U and flushing. 6/2/2009Vaccination 6/3/2009 for Typhoid g wollen arm. was seen a ER & followed Y up with us 5 days after initial shot 3 days after ER vistis. Y 5/28/2009 5/30/2009
ven Pneumovax on 5-26-09. He states Y that he became nauseated within a few minutes, then vomitted. 5/26/2009 The following 5/26/2009 day, he developed b ARICELLA vaccine given all following info received from clinic 5-6 DEPO PROVERA shot - 5-11 U " Lump 4/30/2009 on arm" - Pain 5/11/2009 shoulder to elbow" iving immunizations and walking to office to be checked out he became "light headed" fainted hitting desk.6/1/2009 Small abrasion 6/1/2009 R eye brow + bo 103 for 3 days, loss of apetite, body aches, fast breething, fussiness Y 5/28/2009 5/29/2009 utes of receiving the 1st does of gardisil she was dizzy, pale, light headed, saying that she couldn't Y breathe. 6/3/2009 it sounded 6/3/2009 like she was gaspin F 101.8, ACHY ALL OVER WITH SHOOTING PAINS DOWN ARMS AND LEGS OCCASIONALLY. Y PATIENT 6/2/2009 ALSO6/3/2009 FELT PAIN IN MIDDL minutes cheeks were red and swollen with urticaria Y 5/20/2009 5/20/2009 n has been received from Y a pharmacist regarding a case in litigation concerning a young female Y relative (exact age unknown) of a healthca n has been received from a registered Y nurse concerning Y a child male 0 patient who on approximately Y 27-MAY-2009 5/27/2009 was 5/30/2009 vaccinated with the rmation has been received from a nurse and follow up information from a medicalYassistant who U reported4/21/2009 that a 49 year 4/21/2009 old female was on 2 n has been received from a pharmacist reported Y that a patient was believed 0 to received a dose U of PNEUMOVAX 4/1/2009235/29/2009 in April 2009 but no do ness, swelling and itchy @ site 3cm x 2cm raised rash R upper arm with Sl blistering . Benadryl Y + Ibuprofen 5/26/2009 PRN, cold 5/28/2009 compresses to area ed nodular papular rash 6/3/1996 5/29/2009 swelling, heat @injection site Y 5/3/2009 5/3/2009 on the area of injection 5x8 cm with 2x3 cm of - induration. U 5/27/2009 5/27/2009 vaccine break through. Diagnosed with varicella on 5-29-09 U 2/2/2007 5/22/2009 g motor paralysis 6/9/09 Hospital ER Y records received DOS 5/28/09. Post immunization patient Y c/o shoulder 5/27/2009 pain, knee 5/28/2009 pain, generalized a 5/29/2009 me to the clinic 6-1-09. Stating sheYhad a red area on left thigh. States the red area startedYon Sat and5/29/2009 has gotten 5/30/2009 larger. Band aids are s of chest tightness within 5 min after immunization with HEPA, HPV, TDAP. PPD test done also Y at same5/28/2009 time. Symptoms 5/28/2009 persisted for 3 da being preg. 12/31/08. Had US on Feb'2009 and was informed baby had problems and abortion Y done 3/18/09 ### at OB. 3/18/2009 9 MILD Other - Fatigue, Some dizziness U 6/3/2009 6/4/2009 vaccine 5/27/2009 and seen 5/29/2009 with red very swollen arm treated with BENADRYL, Y ice, Hydrocortisone 5/27/2009 1% 5/28/2009 cream for itching. mildly itching rash, 10 cm, over injection site U 5/27/2009 5/28/2009 Neuropathy. 3-6mo after vaccine. Tests, Y pain medication. Y N ### 1/1/2003 owing vaccination, child developed erythema Y and edema of lower, lateral aspect of upper right U arm, in region 6/1/2009 of subcutaneous 6/2/2009 varicella vacc D TDAP, GARDISIL, MENINGOCOCCAL Y INJECTION, Y TOLERATED 1 WELL, WALKED OUTUOF EXAM ROOM 6/3/2009 AND 6/3/2009 PASSED OUT (5 -7 M HAD PNEUMOVAX ON RIGHT DELTOID Y AREA ON 3/30/09 .ON 3/31/09 HE HAD MUSCLE Y ACHES AND 3/30/2009 ON 4/1/09 3/31/2009 DEVELOPED FEVE STATED THAT SHE EXPERIENCED Y DEEP THROBBING PAIN AT THE SITE OF INOCULATION Y ON 5/20/2009. 5/15/2009 SHE 5/20/2009 SOUGHT MEDICA munization clinic 6/04/09 at 12:30 PM, C/O headache on 6/03/09 (the evening of taking the vaccines.) Headache 6/3/2009worse 6/3/2009 6/04/09 with Naus with rash and fever of 102 on 05/30/2009 and continued with pruritic rash that developed into U red oval shaped 2/2/2006 areas 5/30/2009 with vesicular lesion o d vaccines on 6/2/09. On 6/3/09 after Y pt got home from school, mom called office stating arms N were now6/2/2009 both red at6/3/2009 injection sites and sor ess, swelling at site, started 2 days after injection. Y 6/1/2009 6/3/2009 lling morning after vaccine, no fever, no treatment needed Y 6/3/2009 6/4/2009 symptoms appears one week after receiving Y vaccine. U 5/26/2009 6/1/2009 min after receiving immz, pt appeared Y to have a seizure; loss of consciousness <45 seconds, Y jerky movements, 6/1/2009 urinated 6/1/2009 on self. Ammonia baby check-up and vaccination Y on 4-20-09, Y visited Y physician on 4-23-09 41 Y with N/VYand lethargy. N By that 4/20/2009 evening, she 4/23/2009 was taken to the ED w ding in line 5-10 minutes after the injection Y making an appointment when she lost conciousness Y and suffered 5/29/2009 tonic clonic 5/29/2009 movements for 30 GARDASIL on 5/27/2009 - swelling/ redness started within 24 hours - seen 5/29/09 - treatedY with MOTRIN, 5/27/2009 BENADRYL. 5/28/2009 No previous Rxn fter receiving MMR, patient developed Y measles like rash. Y 5/20/2009 5/30/2009 Y 5/28/2009 5/29/2009 ast PM (about 5-6 hours after injection) very fatigued then this AM 6/4/09 dizzy, nauseated. Now Y slightly better. 6/3/2009 No rash 6/3/2009 - No difficulty breath rash on chest, abdomen, and eyes 6/4/2009 6/4/2009 nced (L) arm pn @ injection site with approximately 1 cm surrounding ecchymosis, arm has U erythema/induration 6/1/2009heat6/2/2009 approximately 115x1 eloped one month after the vaccine Ywas given. Rash is red, bumps, painful on arms and legs. Y Was seen by 2/4/2009 PCP and3/1/2009 given PREDNISONE. d, papular to trunk & limbs 3 days after vaccine - lasted one week - No treatment Y 3/4/2009 3/7/2009 vomiting approximately 8-9 hours after Y vaccines given - administered @ ~1500 on 06/03/09 U Started vomiting 6/3/2009 ~ 0100 6/4/2009 - 0200 06-/04 /09 d immunization 9:05 AM, pt went out to smoke a cigarette, 15 mins later started feeling dizzyYand sweating. 6/4/2009 Pt went inside 6/4/2009 to sit, started to had c/o nausea with emesis after injection by another nurse earlier that day. He was told toYcheck with this 2/5/2009 nurse before 2/5/2009 leaving his shift. EDIARIX given simultaneously Y 5/28/2009 5/28/2009 was reported by a healthcare professional Y and described the occurrence of rash in a 58-year-old U female4/27/2009 subject who5/7/2009 was vaccinated with B
was reported by a physician via a GSK representative, and described the occurrence of a rash Y in an adult 3/30/2009 subject of3/31/2009 unspecified gender wh nduration (R) arm 4/29/2009 4/30/2009 n VYANESE doses after vaccines. YA couple of hours later hyperactive behavior had escalated U more than6/3/2009 normal. Called 6/3/2009 pediatrician but d d shot Fri - Pt brought in Monday to be seen. Noted markedly erythematous area that measures Y probably 5/29/2009 3 x 2 cm.5/31/2009 around that faint redne was reported by the mother of a consumer and described the occurrence of swelling at the injection U site3/25/2008 in a 5-year-old male subject who w was reported by an other manufacturer Y via a nurse and described the occurrence of nauseaYin a female subject who was vaccinated with ( was reported by a physician via a sales representative and described the occurrence of swelling N in a subject 4/2/2008 of unspecified 4/3/2008 age and gende was reported by a physician via a sales representative and described the occurrence of swelling N in a subject 3/19/2008 of unspecified 3/19/2008 age and gende was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende was reported by a physician via a sales representative and described the occurrence of extensive Y swelling 3/18/2008 of vaccinated 3/20/2008 limb in a subject o was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who was reported by a physician and described the occurrence of swollen buttocks in a 4-year-old U male subject 3/25/2008 who was 3/26/2008 vaccinated with INFAN was reported by a healthcare professional Y and described the occurrence of swollen axillary N nodes in a 5-year-old 5/7/2008male 5/8/2008 subject who was va was reported by a physician via a representative and described the occurrence of erythemaUin a child subject of unspecified gender who w was reported by a physician via a representative and described the occurrence of swelling inY legs in a subject of unspecified age and gend was reported by a healthcare professional via a sales representative and described the occurrence U of nonspecific reaction in a subject of u was reported by the mother of a consumer and described the occurrence of nausea in a 4-year-old N male 8/5/2008 subject who8/6/2008 was vaccinated with was reported by a healthcare professional and described the occurrence of injection site reaction U in a subject of unspecified age and gend was reported by a physician, via a GSK sales representative, that described the occurrenceUof swelling at the injection site in an unspecifie was reported by a healthcare professional and described the occurrence of swelling injection Y site in an 18-month-old 8/19/2008 8/19/2008 female subject who w was reported by a healthcare professional and described the occurrence of swelling of injection Y site in a8/19/2008 5-year-old 8/19/2008 female subject who was was reported by a healthcare professional and described the occurrence of swelling injection Y site in a 5-year-old 8/20/2008male 8/22/2008 subject who was vac was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w was reported by a healthcare professional and described the occurrence of crying in a 4-month-old U male subject who was vaccinated with was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe vaccine administered, mother reports Y fever of 99.5, Y then began having 2 myoclonic jerks of arms, Y legs and5/14/2009 head. No 5/14/2009 decrease in level of aro o BPH, intra-cranial hemorrhage 10yrs ago admitted Y on 5/25 with a 41 Ywk h/o HA, fevers, rigors and progressively 5/7/2009worsened 5/13/2009 weakness, with Y N 6/28/2008 0.5 degrees F, achy joints/neck, HAYeyes sensitive to light, numbness in feet/hands. 5/21/09.Y5/27/2009 Follow 5/15/2009 up with 5/20/2009 parent. Parent state KINREX + MMR on R deltoid on 5/29/2009 - came into office 06/02/09 necessary with cellulitis Y + reddened 5/29/2009 @ site. 5/30/2009 minutes after injection Pt became rigid all over, very stiff, and fell down to table. After severalYminutes then6/2/2009 began to arise 6/2/2009 but was very grog degree F fever, body aches, joint pain: Rash at injection site. Symptoms began to subsideYafter 36-48 5/24/2009 hours. 5/25/2009 ected with 2nd GARDASIL inj. About Y 30 seconds later pt fainted fell head first off of bed. Pt hit Y right forehead 5/29/2009 on floor 5/29/2009 and ice was applied. P 30 papules on trunk and groin - No vesicles - very itchy 4/11/2007 5/29/2009 m red whelp to (R) deltoid, not tender to touch, cellulitis. Treatment - BACTRIM DS U 5/27/2009 5/29/2009 ed pt came home form Daycare on Thursday 5-28-09 and c/o pain in (L) arm, Mom also stated Y it was itchy. 5/27/2009 Area was 5/28/2009 reddened, itchy and s rs after receiving vaccines became irritable, crying & inconsolable for 1 1/2 hrs. Left leg hadYnickle sized3/31/2009 bruise at injection 3/31/2009 site. Left thigh l redness, heat, bruising after 3 days. Pt was Pt used cold packs and warm packs Y 5/27/2009 5/28/2009 Q site redness, heat. Pt saw physician Y who prescribed "Steroid Inj and BENADRYL OD Y 5/19/2009 5/20/2009 n arms / legs about 1 hour after receiving,MENACTRA, HPV #1, HEP A #1, on 5/27/09 no other complaint. 5/27/2009 5/27/2009 n has been received from a physician Y concerning Y a female with unspecified 0Y reported drug reactions/allergies U 4/30/2009 with Behcet's Syndrome and a orted in a news magazine article that a male who on an unspecified date was vaccinated with U a dose of MMR II. Subsequently the patient d n has been received from a physician Y concerning Y either 15 or 16 years 0 old male patient whoUon an unspecified date was vaccinated with a n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL ( xperienced swelling in the lymph node of the left armpit. 5/25/09 chills, generalized malaise,YTemp 99.8 5/15/2009 5/26/09 Malaise 5/24/2009 continued, fever a ema and induration at arm injection site. Y 5/26/2009 5/27/2009
thigh red/warm swollen with itching within 24 hours of vaccines given. Y 5/29/2009 5/30/2009 ven dose #2 of GARDASIL, seems to Y tolerate well. No c/o offered - fainted upon preparing to leave facility, 5/13/2009 hitting back 5/13/2009 of head hard on doo and erythema at Lt site of immunization Y 10 days after immunization. No signs of injection - NoY treatment given 5/14/2009 - Local 5/24/2009 reaction presumed to with erythema and purpura skin in large circular area 8cm - no adjacent to but not symptom surrounding U needle 5/29/2009 insertion 5/30/2009 site from vaccinatio
substantial swelling of injection armYfrom shoulder to elbow, skin sensitivity, stiffness - joint pain Y (ankles,4/30/2009 knees, elbows, 5/1/2009 wrists, neck) - feve Multiforme rash started on 5-22-09 started in groin area spread allover started on BENADRYL Y change to5/15/2009 ZYRTEC 5/22/2009 on 5-26-09 PRELONE swelling of R deltoid area. ErythemaYand induration surrounding injection site. Y 5/26/2009 min of receiving JE vaccination, client had a seizure lasting 1-2 min. Alert & oriented after, though Y very pale 6/4/2009 and unsteady. 6/4/2009 BP 122/80 No s ss on neck, arms, legs, about 10 minutes after shots were given, no difficulty breathing, nor Y swallowing, no 6/4/2009 rash noted. 6/4/2009 BENADRYL 25 mg e swollen warm to touch. Swelling from Y knee to hip Y 6/3/2009 6/3/2009 was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 9/4/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/21/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/14/2008 in four child subjec was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 8/20/2008 in four child subjec was reported by a healthcare professional Y via a sales representative and described the occurrence U of erythema 9/15/2008 in a9/16/2008 5-year-old male subje was reported by a healthcare professional and described the occurrence of swollen thigh (injection Y site) 8/22/2008 in a 5-year-old female subject who was reported by a physician, via another health care provider, and described the occurrenceYof injection site hot to 8/29/2008 touch in a 3 year old fem was reported by a healthcare professional Y and described the occurrence of floppy in a 6-month-old Y female subject ### who was ###vaccinated wit was reported by a consumer, the subject's grandmother, and described the occurrence of seizure Y in an infant female 11/1/2008 subject who was vacc was reported by the grandmother of a consumer and described the occurrence of hyporesponsive U reaction (unspecified) in a 4-month-old f was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a was reported by a healthcare professional Y and described the occurrence of swelling injection Y site in a 4-year-old 3/16/2009female 3/16/2009 subject who was v nd swelling in a 6x6 are to Right thigh where MMR vaccine was administered, swollen area was Y hot to touch 6/2/2009 and painful 6/3/2009 d shot Tues afternoon; minor discomfort at injection site. - Started to feel extreme fatigue Weds. Y afternoon6/2/2009 (approx 1300hrs) 6/3/2009quickly followe n 2 days following the injections. It began as a ring about an inch from every injection and onU the next day6/1/2009 had covered 6/3/2009 her whole body exc of malaize approximately 12 hours after Y injection. 36 hours later, muscle pain in the upper inside N of calf of 5/21/2009 lower left5/22/2009 leg. Pain in upper bod rts child developed night terrors and feels it is due to DtaP. Had first night terror night vaccine U given, has5/29/2009 had one again 5/29/2009 2 other times when @9:16am MOC t.c. c/o mild dizziness 1 hours post vaccinations then severed ha, lbp and dizziness U with falling 6/4/2009 this morning 6/4/2009on ambulation d urticaria all over body 3 days after receiving vaccinations. Also on a new med - flonase, and U has tried a 6/1/2009 new food - 6/4/2009 cherries, so etiology u ent had 3 vaccines administered on Y 5/26/09 @ approximately 12:00 pm. Client called @ approx Y 1:25 and5/26/2009 stated "I'm5/26/2009 having trouble breathin , Swelling, Tenderness, fevers, Elevated Y white Y blood cell count. 6/26/2009 3Y MR received for DOS U 6/4-7/2009 6/3/2008 with D/C6/4/2008 DX: Cellulitis. Pt pres MOTHER REQUESTING LIST OFYIMMUNIZATIONS GIVEN AT LAST VISIT ON 05.27.2009 U (MOTHER 5/27/2009 WAS GIVEN 6/4/2009 RECORD THE DAY ived rotateq on 4/3/09 and was admitted to theYhospital for intussusception 4 on 4/9/09. 7/24/09 Y Hospital records 4/3/2009 received 4/9/2009 DOS 4/9/09 to 4/2 n left arm wth mild erythema on the site not likely cellulitis. U 6/4/2009 6/5/2009 mother calls to report that about 3 hours after immunizations received client began feeling "lethargic" U and then 6/3/2009 later in6/3/2009 the evening develope ed Hib and DTP/DTap vaccinations on 04/Jun/2009 and developed pain and sore at the injection N site. He6/4/2009 cried when6/4/2009 I was holding him up, LA FROM VACCINE Y 5/28/2009 6/3/2009 rts child had 1st seizure 6-3-09 at 2030 Y lasting approx. 1 min. taken directly to hospital ER. CT Y of head and 6/3/2009 CXR done. 6/3/2009 Ativan and Tylenol OF DIARRHEA (5 TIMES DAILY), VERY ODOROUS Y 1/5/2008 5/25/2009 days after Hepatitis B vaccine my thumb Y and pointer finger on right hand were numb and i went N to my family 5/16/2007 doctor 5/20/2007 and within the next wee vomiting, headaches, pain in joints,Y backache, aches in the arm that was injected. Bad mood U and sleepnessness. 5/26/2009 5/27/2009 rienced generalized macular papular rash over body with "strawberry toungue" beginning 06/03/09 U afebrile 5/20/2009 6/2/2009 d vaccine on 6-2-09. on 6-5-09 patient still complains of injection site redness, warmth and itch. U i advised 6/2/2009 pt to take some 6/3/2009 ibuprofen for the ak out in hive after MMR and Varirex, the right thigh swell up and swollen where MMR was administered. U Gave 6/5/2009 Benadryl 6/5/2009 2.5 ml po x1 , no re ain in deltoid area, swelling and slight fever. Pain for 3 days. 6/2/2009 6/2/2009 ion site became itchy within 1 hour & Y became very red that evening. 6/4: Site became painful, U swollen, tneder, 6/3/2009 redness 6/3/2009 spread, and she be
U 6/5/2009 6/5/2009 e evening on the day of injection the patient developed a egg sized lump on the back of the right Y arm. When 5/28/2009 the arm5/28/2009 was reassessed in the bed itching during the night and small red dots over her body. She took Benadryl during the am Y and now (6-5-09,1:00pm) 6/4/2009 6/5/2009 reports no S/S. NOTICED ON 06/04/2009 2 SMALL WHITE SPOTS ON ROOF OF MOUTH. NO FEVER, DID U HAVE DAY 6/1/2009 OF IMMUNIZATIONS. 6/4/2009 ANOTH ion site was found to be swollen, firm, red, and hot to touch. Patient temp of 99.00 in the afteroon Y after the 5/25/2009 injection 5/25/2009 resolved by 2300 that s for evaluation of red swollen right thigh. Y Warm to touch. Sore. Treatment advised: supportiveYmeasures. Cool 6/3/2009 compresses 6/5/2009 and Tylenol. ater of administration of the vaccine Pt called the pharmacy complaining of numbness and tingling sensation. 6/3/2009 From the 6/3/2009 talk to Doctor at offi ing, erythema (10 x 10 cm area) itching, Y mild induration directly under injection site (2 x 2 cmUarea). 6/2/2009 6/3/2009 .5 cm erythema around injection site. Warm non tender. U 6/3/2009 6/4/2009 welling, tenderness, redness and warmth Y over right deltoid appeared 2 days after injection. Mild U erythema 6/2/2009 without warmth 6/4/2009 left upper arm. of left arm with edema and erythema. U 6/2/2009 6/3/2009 reaction. Sore and swelling. Y 5/26/2009 5/29/2009 d severe localized reaction to this immunization. N 6/2/2009 6/4/2009 was reported by a healthcare professional Y (also the subject) and described the occurrence Y of U injection site 5/12/2009 pain in a5/12/2009 45-year-old female sub ented to clinic 6-4-09 w. cc "crying a lot", 7 cm reddened swollen LAT at site of 4th INFANRIX. Y Mom advised 6/2/2009 to warm6/3/2009 packs, return to clinic was reported by a consumer (also the subject)Yand described the occurrence 6 of pneumonia Yin a 81-year-old male subject 2/24/2009 who was vaccina of breath and dizziness Y 6/4/2009 6/5/2009 mitted to clinic with warm red areasYon bilateral upper extremities. Pt rec'd vaccines on 6/3/09. MENACTRA 6/3/2009 in (R) arm 6/4/2009 and Tdap in (L) arm meter induration with 2 in wheal on LA surrounding VARIVAX adm site. Normal pulses. bilat.Y 6/3/2009 6/5/2009 2 days after vaccine T. 102 + moreYjerky movements after 3 days of vaccination as per mom less of balance 6/1/2009 and frequent falling lethargy, pain, swelling left arm onset day after Y rec'd VARICELLA vaccine in left arm. Low grade fe. Y T 99.2. 10 X 6/3/2009 6 cm red tender 6/4/2009 lesion below inj s chest & back rash red, bumps mild itching Y x 1 1/2 hrs without fever, general malaise saw MD 5/23/09. 6/1/09 5/21/2009 Blood work 5/23/2009 showed low white ted skin under bandage around vaccination site. Individual, isolated rash clusters under arm & across chest 5/22/2009 and abdomen. 6/1/2009 ped intussusception requiring Y surgical reduction. Y Also had symptoms4 of resolving virus + viralYexanthem 5/28/2009 c/w parvovirus 5/30/2009 (fifth's disease) on t e fever, overall "joint aching" + head "feels too big for her body" 6/3/2009 6/4/2009 scle spasms to arm x 24hrs. Nickel sized area "bullseyes" at injection site. Unable to do promY because pain. 6/4/2009 6/4/2009 oid with erythema and swelling. Y N 6/4/2009 6/5/2009 excessive of arm, shoulder & neck involving Y throat. U 5/31/2009 6/1/2009 and swelling after 6 hours on date ofYvaccine. Then rash that became larger the next day. The Y next she mad 5/29/2009 an observation, 5/29/2009was on 6/3/09 et of wheezing approx 10 minutes post Y vaccine administered nebulized albuterol given. Y 5/22/2009 5/22/2009 d received the Typhoid vaccine first.Y Then she was administered the Hep. A. As soon as theYHep, A was5/21/2009 removed the 5/21/2009 nurse, patient slump Tetanus booster and Hep B shot at 4:30pm on Thursday June 4th. Woke up at 5:30 June 5th Y very dizzy.6/4/2009 Called Dr.6/5/2009 He said to wait it out IN TO RECIEVE ANTHRAX AND SMALLPOX Y VACCINES AT 141 MDG WA ANG. PT RECIEVED Y INITIAL 6/6/2009 ANTHRAX 6/6/2009 VACCINE. HE WA echiae & edema - transient & self resolving. Y 6/2/2009 6/3/2009 in all muscle groups, Fatigue, rectal bleeding. (On initial series 6 doses bleeding remained for Y several months) 6/6/2009 Concurrent 6/7/2009 doses 1-2 week t from a typically developing boy, to full regression in to Autism within one week of Y his MMR N shots. He also 7/18/2000 recieved7/18/2000 the Varicella vaccine o in hives (10/19/07). Developed a allergy Y to peanuts which had not been presentYprior to theNimmunization. Long ### term adverse ### affect PDD thigh was red, warm, swollen Y & itchy shortly after the injections. He was in pain & wanted to U be carried because 6/1/2009his6/1/2009 legs were weak. Arou s after the vaccination, I'm getting weaker and Y weaker. Have cold symptom 6 like. Went to dinner. U After 103/24/2004 minutes, experience 4/6/2004 hiccup. My c ke a huge hive 2 x 3 1/2 inches. It was red and hot and lasted 5 days. (It was on the injection Y site). 5/15/2009 5/15/2009 , swelling and warmth to site whereYvarivax was administered. 5/28/2009 5/29/2009 h rabies vaccine, had progressively worse Y headaches, sweats/chills, facial redness, muscle fatigue, general fatigue, ### uncoordinated, ### confusio mom, states she tried to feed her in the AM and she vomited. Vomiting x 3 from 7:30 Am - 12UN. Refuses to 5/6/2009 eat or drink. 5/7/2009 No fever or diarrhe red swollen area at one injection site (believes to be varicella) running fever. (Right arm siteYof injection). 5/26/2009 5/27/2009 immunizations @ 9AM - broke out in Y rash starting @ 12 N 1 place under eye (looked like blisterY went away5/26/2009 2 under 5/26/2009 neck @ 1:30 they wen ely following administration of GARDASIL she was sitting on exam table, felt lightheaded andYfainted. falling 6/3/2009 to floor. 6/3/2009 Mother in room reporte 2/20/09 ----> mom reports LA (left arm) Y injection sit on 03/03/09 became red, raised, warm toYtouch physician 2/20/2009 diagnosed 3/3/2009 as cellulitis. Paren all area of urticaria @ flexor surface of (R) arm on day of vaccination, but four days later, she Y developed urticaria 5/4/2009over 5/4/2009 entire upper body & n has been received from a medicalYassistant concerning a 17 year old female with a historyYof convulsions 5/28/2009 and under 5/28/2009 the care of an unspe ped severe urticaria over entire bodyY several hrs after administration of several vaccines. This Y resolved with 5/8/2009 BENADRYL 5/8/2009 & PREDNISONE n has been received from a 17 yearYold femaleYwith no medical history or drug allergy who was N vaccinated 12/1/2007 with 1st,12/1/2007 2nd and 3rd doses of G
and induration at injection sites. Pain to touch at injection site. 5/27/2009 5/29/2009 n has been received from a pharmacist concerning a female who "one or two years ago" on Uunspecified dates was vaccinated with the first n has been received from the author of a literature article, title stated above concerning a healthy Y 16 old male who more than 8 years after n has been received from an office Y manager concerning Y a 12 year old 0 female who on 19-MAY-2009 Y was5/19/2009 vaccinated5/19/2009 with a dose of VARIVA m rash 24-36 degrees after immunizations 5X care - tylenol and/or motrin. U 6/2/2009 6/3/2009 RIVAX + PCV given. 5/15/09 Dx Ataxia DM T 100.5. 5/29/09 Ataxia persists. 6/5/09 Child back Y to normal 5/7/2009 no signs of 5/15/2009 ataxia. d, raised, tender, warm to touch area approx 2" x 3" at Varicella injection site. T. 99.3. C/o slight Y nausea, seen 6/3/2009 in our Public 6/4/2009 Health Office at om brought child in, Dr saw a red, hot to touch area to (L) deltoid, measured 5in by 5in in diameter. Y 6/4/2009 6/5/2009 ated 18 hrs after vaccine child was sitting in cart at Kmart and fell over and was very pale andYappeared to3/4/2009 have fainted. 3/5/2009 This lasted 15 min diarrhea, vomiting, fatique, temperature of 100, left work, did not see a doctor Y 5/29/2009 5/29/2009 and itching palms on evening of June Y 1. Some itching Y during the week, 1 with bad hives on evening Y of Friday, 6/1/2009 June 5. Visited 6/5/2009 urgent care clin ollowing vaccination with Anthrax, Smallpox, Y Typhoid (18 May). Pt. with pruritic papular lesions U which started 5/18/2009 on distal6/5/2009 extremities (wrists/an occal vaccine given at 0907 IM prior to discharging. Pt. had no knownYallergies and not allergic Y to eggs. At 5/17/2009 1015 pt c/o 5/17/2009 back and rt flank pai e and diplopia accompanying Y a cerebellar Y hemorrhage occurring within about 24 hrs of an influenza Y vaccination. ### 7/31/09 Hospital ### records r zure lasted 1 min about 2 mon after Ygiving the 0.5 ml IM shot of DT.Tdiphteria-tetanus) Y 6/8/2009 6/8/2009 SED A 12 YEAR OLD FEMALE WHO WAS ALERT AND ORIENTED. THE MOTHER STATED Y THAT THE6/5/2009 CHILD WAS 6/5/2009 DUE HER LAST HP al congestion, lost voice, body aches, rash at injection site Y 5/20/2009 5/20/2009 hours: Significant swelling at injection Y site and redness, 101 - 102 Fever, Chills, Muscle pain.U After 30 hours: 5/29/2009 Wet Cough 5/30/2009 (diagmosed as br administered on Tuesday,6/2/09. On Thursday a 2.5 inch x 2 inch erythematous, raised, tender, Y area noted 6/2/2009 around injection 6/4/2009 site. This area / 6 days post vaccine noticed warmYto touch /redness / swelling / itchy at around injection site Y on left arm. 5/26/2009 6/2/2009 oke up with a very sore arm. The site of the injection was swollen and tender. He complainedYof feeling overall 5/27/2009 weak5/28/2009 and achy. He was runn ely after having vaccines, patient had a seizure that lasted a few seconds. Dr. did a neurologic Y exam 5 minutes 6/8/2009 and 30 6/8/2009 minutes after episod ceived injection on 5/26/09 and was fine until the evening of 5/27 when she had a red spot the Y size of a quarter 5/26/2009 at the 5/27/2009 injection site. The are head ache, nausea, bloating and diarrhea 2 days after taking last of four live virus oral typhoid U vaccine capsules. 5/27/2009 Treatment 6/4/2009 not sought. Imp RECORD OF FEVER x48 HOURS AFTER VACCINATION; "RASH" FIRST APPEARING AROUND Y NECK, 6/2/2009 THEN TRUNK 6/4/2009 TO UPPER AND side of injection swelled significantly, with hard raised lumps, lasting 5 days Y 6/2/2009 6/3/2009 s her arm was very swollen. She had a temp. of 104 degrees and she was in bed for 4 days.Y She did not 2/10/2009 call our office 2/10/2009 or report this to any d a large local reaction at site of DTaP 3 days after the injection. Resolved with ATARAX. Y 6/3/2009 6/6/2009 4 hours, body ache and sore arms x 48 hours. Welts to left arm- (1) anthrax, (1) Tdap >x 5 days. Y 6/1/2009 6/2/2009 hot was given on Friday, June 5th appointment was at 9:15 for a physical. Left arm hurt immediately N after6/5/2009 and began6/6/2009 to swell and was very n has been received from a consumer Y concerning Y his 24 years old fiancee 1 who on 25-MAY-2009 N received 5/25/2009 the first dose 5/25/2009 (0.5ml) of GARDA n has been received from a physician Y concerning Y a 15 year old female 3 patient who Y on 14-NOV-2006, N 16-JAN-2007 6/12/2007 and 3/1/2009 on 12-JUN-2007 w n has been received from a consumer concerning Y his son with general 0 sensitivity to all vaccines U (no specific vaccine or manufacturer given n has been received from a medical assistant concerning a 55 year old female with Y a historyNof chronic obstructive 5/5/2009 pulmonary 5/5/2009 disease and .7, Myoclonic movements, joint pain,Y given ibuprofen, Y TYLENOL, IV 4 ROCEPHIN: adverse reaction U began 5/28/2009 within 1 hour 5/28/2009 of vaccine adminis L vaccine - neuritis (LUE) - thoracic outlet syndrome - no strength (L) arm/(R) arm (decrease U strength)- 4/16/2008 decrease vasc 4/16/2008 (L) arm (with elevat in arms & shoulders. Evaluated by Geneticist & Rheumatologist. 6/9/2008 7/14/2008 n in LDMIM. 30 minutes after shot client upper arm had some swelling, heat to touch and reddened Y raised6/4/2009 area L- 3inch 6/4/2009 W 3inch. Light rash and induration at site injection (L) Deltoid 6x7 cm. Area pruritic. Y 5/27/2009 5/28/2009 ports pain at site, fever, sore throat for 2 days post injection following sores at site, left shoulder U pain and4/15/2009 decreased4/15/2009 strength and range of y urticaria, agitation about 1 hr following Y MMR/VARIVAX increase RR increase HR also, chills. Y BENADRYL, 6/4/2009 EPI, ORAPRED 6/4/2009administered and warmth to left thigh area. About Y 10x10 cm area. Y 6/2/2009 6/4/2009 action to KINRIX DTAP-POLIO- Friday 4-17-09 child had small knot. Saturday 4-18-09 childYhad knot 6 4/16/2009 inches in diameter, 4/18/2009 hot to touch. ceived PENTACEL vaccine on 6/1/09. Leg became red and large amount of swelling on thigh. Y Very fussy,6/1/2009 cried for over an hour. 6/3/09 she noticed onset of itching, redness, Y and that area was (hard). Pt states 12-15 hoursUafter injection6/2/2009 Sx began6/3/2009 to appear. She denies and low grade temperature. Y 4/4/2009 4/4/2009 e temperature and lethargic. Y 6/2/2009 6/3/2009 ven PENTACIL at 9:00 am on 6/1/09. He went to daycare and when mom picked him up in Y afternoon noticed 6/1/2009 area around 6/1/2009 shot on anterior arm swollen below injection site 10 Y by 15 cm. Also complained of chest pain: NL EKG; NL enzymes. Y 5/1/2009 5/3/2009 t states: Left upper extremity is difusely Y reddened, starting around glenohumeral area extending Y towards5/27/2009 elbow. Covers 5/28/2009 area of superior & rash at injection site. Rash is 2-3" long and 2" wide. Patient sought medical attention but only U a hot compress 6/1/2009 was recommended. 6/2/2009
inconsolable crying. DTaP/IPV/HIB/PREVNAR Y and ROTATEQ given at 9:45 am 6/1/09. Crying Y began 9:00 6/1/2009 pm, stopped 6/1/2009 9:00am 6/2/09. e swelling approximately 15 minutes after vaccines. BENADRYL PO given upon return to clinic. Y 6/3/2009 6/3/2009 diarrhea 12-15 x 1 day. Lasting > 2 weeks. All stool studies normal. Y 4/16/2009 4/26/2009 diarrhea 12-15 x 1 day lasting > 2 weeks All stool studies normal. Y 4/16/2009 4/26/2009 nt legs broke out in hives evening of injection 6/1/09. Woke up next AM & hives on arms & legs. Y Patient took 6/1/2009 25 mg BENADRYL 6/1/2009 8 AM on 0 s, fatigue, rapid HR, abd pain, numb legs- sx's intermittent since then and continue. 7/2/09 Medical N records received ### 1/15/2008 DOS 11/11/08 to 6/12 other states that pt was a little feverish the morning following her vaccines and that she had some U redness6/1/2009 at the DTAP 6/2/2009 vaccine site. Yester cry for 4 hrs - hard to console 6/2/2009 6/2/2009 thigh, redness, some pain and getting bigger. Can walk normally. Started later the night of shots. U Treatment, 5/26/2009 warm5/26/2009 compress for swelling a ced hives on torso, no fever and injection site look ok per patient mom. U 6/1/2009 6/1/2009 accines and approximately 4 minutes later skin turned lace like pink and blotchy resembling Y hives. Dr. notified 6/1/2009 eval pt6/1/2009 and given 10 mg Ben ool IZ's 5/26/09, when child came back fur PPD reading father states child's leg had some redness Y we examined 5/26/2009it and 5/27/2009 measured it. Y 5/26/2009 5/26/2009 5 min after 3rd GARDASIL injection - Had received injection then walked on to waiting area Y to get father. 6/2/2009 Fainted after 6/2/2009 return to exam soon -102 rash on 6-3-09 seen in office. Y Y 6/1/2009 6/3/2009 ed rash. Started on 5/30/09 after a fever. Y 5/21/2009 helps, cellulitis treated with BACTRIM. U 5/27/2009 5/29/2009 d to toe entire body on 5/27/09. Started with fever 104 @ 2-3 days prior then rash. ReceivedNMMR immunization 5/14/2009 of 5/27/2009 5/14/09. er arm red, swollen, and warm to touch. Y Measures about 7 inches in length. Mom took child N see APN. APN 5/18/2009 is treating 5/20/2009 area with butt paste, er, T: 99 - 101 degree F from the evening to next day, then started having cough - o/e: Chest: Y some wheezes 5/21/2009 and crackles 5/21/2009 (rales) on base reaction to INFANRIX vaccine in (L) thigh" (MD) Parent "(L) Leg swollen. Onset was Tues. after Y vaccines." 5/26/2009 Rectal temp 5/27/2009 101.5, Tylenol give vaccine break through. Diagnosed in office on 6/2/09 with varicella. Had about 20 pox. U 4/29/2008 6/1/2009 ven HIB that was expired. Y edness pain at injection site x 4-5 days - better slowly over 3 wks but left with residual brachial Y neuritis. 3/26/2009 3/26/2009 6/4/2009 d ENGERIX B vaccine IM in both RYand L deltoids on 5/4/09. At approx 2:30 PM 5/6. Pt wake Y from ncp and 5/4/2009 noted her 5/6/2009 right arm was numbredness, and swelling extending over Y entire upper left arm and shoulder. Began 1 day after N injection. Prescribed 5/27/2009KEFLEX 5/28/2009 x 7 days, Predni dvertently received ZOSTAVAX instead of Chickenpox varicella, CDC called no further f/u. Parent Y informed 6/8/2009 of local reaction to look for. Sup ut after received shot with brief tonic/clonic activity of upper extremities lasted 3-5 seconds. No Y loss of bladder 5/21/2009 control. 5/21/2009 ceived #2 GARDASIL on 5-12-09 and called 5-15-2009 reporting c/o itching / have several hours Y after she 5/12/2009 had GARDASIL 5/12/2009 5-12-09. Pt took thematous indurated lesion on thigh, developed 24-48 after immunization (L thigh). U 6/6/2009 stomach felt queasy; sat down; says her vision was fuzzy; became pale; fainted; assisted toYa lying position 6/8/2009 et fanned; 6/8/2009 regained conscious Y Y 6/1/2009 given 5th HEP B today within 10 min of injection being given in (R)D. Employee noted backNteeth became 6/8/2009 numb on both 6/8/2009 sides upper & low e named patient was seen in my office on February 7th, 2009 with a complaint, which I witnessed one bump on### her shoulder area. Two day cess @ site of injection. Negative Gram Y stain Negative Culture. Y 1/3/2009 2/5/2009 es high temp starting 1 hour after administration Y around 101.3 degrees F. Mom gave motrin Yand temp came 6/5/2009 down to6/5/2009 normal soon after dos NKA, PMH: Dementia, Hypertension, CVA,OA/DJD, hyperlipidemia Patient also has h/o stroke. Y Patient was 2/19/2009 admitted 2/19/2009 for fracture following m d not know she was pregnant at the time of vaccination and was vaccinated with Anthrax andUHPV 6/2/2009 6/2/2009 d meningitic like illness while Y out of Y state. Ultimate Y diagnosis is Acute 7 Disseminated Encephalomyelitis U (ADEM). 5/18/2009 Had5/29/2009 ataxic gait, stiff neck w es after receiving Pediarix on Left thigh.Entire leg became red/purple per mom- bled small amt Y at site. stopped 6/9/2009 with bandaid 6/9/2009-then blotchy/v with 2nd gardasil vaccination, beenYhaving myriad of symptoms. Initial symptoms included N headaches that 12/1/2008 started12/1/2008 after the first vaccinatio s sister also received an immunization and was discussing other shots she'd received in theYarmed forces. 6/9/2009 Client stated 6/9/2009 she felt dizzy. I ha <5 min. after admin of vaccines. From a sitting position while assuming standing position, she Y fell to floor. 6/4/2009 Syncope duration 6/4/2009 <5 sec. First aid Y DEVELOPED HIGH FEVERS 101.5-103 FOR 2 DAYS THAT STARTED 10 DAYS AFTERYSHOTS WERE 5/29/2009 ADMINISTERED. 6/7/2009 OTHER TH s of L facial drooping since 730 am Y this morning. Episodes last about 30 seconds, pt gets glazed over look 6/8/2009 in eyes and 6/9/2009 becomes lethargic. Y 6/8/2009 #1 (1423X) given in right arm on 4/23/09. Y Adverse reactions symptoms began 4/24/09 exhibited N by: dizziness, 4/23/2009 headache, 4/24/2009 stomach pain, nau ness, swelling of about 3 inches. Slight itchiness. Slightly sore. Y 6/8/2009 6/9/2009 re, drooling, swelling of injection site. Y SOB, passed out completely. No response X 10 min. This Y occurred 6/8/2009 several hours 6/8/2009 after the injection w sh on arms and hives + joint pain, left Y arm. Y
hours of vaccine c/o sore throat - light headiness U 6/8/2009 6/8/2009 n with TYLENOL, fussiness, decreased eating U 6/8/2009 6/8/2009 degrees about 12 hours after immunizations Y 6/8/2009 6/9/2009 en 2X NL size, Red, hot vesicules around Y injection site had given Benadryl in ER. Y 6/5/2009 6/6/2009 - large hives at site of injection - myalgias and arthralgias Y 6/2/2009 6/2/2009 r the immunization, child developedY~ 2" red raised tender area surrounding VARIVAX site - Yno vesicules5/30/2009 - now it brown 5/31/2009 skin surrounding s tous swelling, right deltoid area. DayYafter shot was given. Y 6/5/2009 6/6/2009 old male patient received a first time dose of MENACTRA (lot number U2816AA) intramuscularly N in the right 5/5/2009 deltoid on 5/6/2009 05 May 2009. On 0 serious case was received on 08 May 2009 from a health care professional. A 12 year old female Y patient 5/7/2009 received a second 5/8/2009dose of ADAC ted on (L) ear - Spread down face and Y trunk with a fine, flat, red rash that continued down hisY body - No 5/27/2009 fevers noted.6/8/2009 d syncope episode immediately after MENACTRA vaccine + HGB blood draw. Pt was sitting Y on exam table 6/5/2009 and stated. 6/5/2009 I didn't feel good, I Y 11/6/2008 11/6/2008 ours, fever (up to 101 deg. F) headache, bodyaches, redness and soreness at site. Bodyaches, Y fever and 5/29/2009 headache 5/29/2009 intermittent for 2 1/2 m and small purpuric areas on R lower Y leg. Y 5/29/2009 5/29/2009 4-36 hours after vaccine (R) deltoid. Swelling at injection site according to mother- 3 1/2 in high Y 2 1/2 in wide. 5/28/2009 Described 5/29/2009 red firm- like 2 go n has been received from a staff member in a physician's office concerning a 46 Y year old female U who on4/13/2009 13-APR-2009, 4/13/2009 at 9:40, was vaccin n has been received from a consumer concerning two of her friend's children who on an unknown U date were vaccinated with MMR II and d ort received on 29 May 2009 from a Y health care professional. A 58 year old male patient received U DECAVAC 4/28/2009 intramuscularly in the left delto ort received on 05 June 2009 from a health careYprofessional. A 47 year old female patient who N delivered twins 6/3/2009 vaginally on 02 June 2009 r MMR II and HAVRIX vaccine on (R) thigh, and Dtap, VARIVAX and IPV on (L) thigh. Noted N large area of 6/8/2009 swelling and redness on (R) thigh ceived DT on 6/1/09. Started feeling ill 6/2/09; l.g. -HA, fatigue, red sore arm. On 6/3/09 had Ysignificant episode 6/1/2009 of dyspnea 6/2/2009 with headache given 5/26/2009. Left leg appeared red, warm to touch and painful when touched. Mom noticed Y this on 5/26/2009 6/9/09. Subsequent 6/5/2009appt. 6/6/09. all" sized area around injection site. YDr Wright believes it is a shingles lesion. Being treated with Y Acyclovir.6/5/2009 6/6/2009 w fever, broke out in tiny hives (scalp, tummy, back, not legs). Hives light not raised, itchy. Fatigue, Y diarrhea, 6/8/2009 very thirsty. 6/8/2009 Now only has a c e within 2 hours. Had fasting blood test on 6/1/09. Arm was swollen at injection site, lump, fever Y 102, nausea, 5/29/2009 stomach 5/29/2009 ache, vomiting, swol d severe vaso response and faintedYat check out window approximately 8 minutes after receiving Y vaccine.6/8/2009 She fell hard 6/8/2009 and hit the floor w er extremity cellulitis. Swollen, red, warm to touch. Painful to patient at administration site. U 6/1/2009 6/3/2009 ceived Tdap vaccine during school Tdap clinic on 5/13/09. On 5/18/09 PHN received phoneYcall from school 5/13/2009 nurse.5/18/2009 She reports patient's a o right thigh 5 cm around and warm to the touch and redness. Mom stated child had fever as Y high as 1026/8/2009 F - temp today 6/9/2009 98.5. d Hep B #2 dose on 06/08/09. She Y had a little redness at the site and went to bed. She woke N in the middle 6/8/2009 of the night 6/8/2009 with neck pain. The and diarrhea, dehydration. Vaccine given at another Y facility. do not have 2 lot information. 6/18/09 Y ER records 6/1/2009 received6/6/2009 DOS 6/10/09 to 6/11/ led clinic approximately 2 hours after Y receiving Menactra Vaccine stating client complaining Y of headache 6/8/2009 and shaking. 6/8/2009 Advised to follow up 5/28/2009 N 5/26/2009 5/28/2009 s given an adolescent dose of Hep B in lieu of the adult dose. U 6/10/2009 mother reported patient had fevers and Y headache pain since immunizations on 12/15/2008. Patient Y had high fever ### and also ### seemed to be h was given shots 05/06/09. On 5/11/09 Y the mother noticed a rash on her face which she bestY describes as 5/6/2009 looking like 5/11/2009 heat rash. On 5/13/ ed papules. Red base withe yelllowish vesicles. Rash noticed 48 hours ago. Mom was usingYcortisone cream. 5/26/2009 Per Drs 6/8/2009 order patient was to GIVEN ON THURSDAY, JUNE 4, 2009. SUNDAY A.M. WHEN I AWAKENED MY BODY WAS Y HURTING 6/4/2009 ALL OVER, 6/7/2009 AND MY SKIN HUR ERYTHEMA 1"X 2" TO RIGHT DELTOID. Y TX-ICE PACK PRN PAIN AND BENADRYL FOR AGE U PRN ITCH. 5/21/2009 5/22/2009 xis (w/in 30 min, irritability, Y vomiting,Yhives, wheezing). EPI SQ x1, albuterol/atrovent neb, decadron Y IM, prednisolone 6/10/2009 6/10/2009 x5 days. 6/12/09 Me received DTaP and Prevnar vaccine in January at age 16 months, parents state child was often Y quiet, less 1/8/2009 active than 1/8/2009 usual, and often sta given 5/20/09. Vomited starting 5/28. Y Temp to 104.6 Y starting 5/29. Mild 2 rash, cough also. Developed Y severe 5/20/2009 red rash 5/28/2009 5/29 - eventually spre nning on bilateral arms. On and off Yx 1 wk. Rash Y down bilateral legs1and cont. on arms x 3-4Ndays. Began 4/21/2009 with rash4/23/2009 to face and neck 6-8-0 ools 24 hours after administration ofYROTOVIRUS - continuous for 6 d N 6/3/2009 6/3/2009 vaccine on 1-23-09. Since that date until present date pt c/o pain in rt deltoid area- no swelling, U edema or 1/23/2009 temperature 1/23/2009 noted. Juvenile Rheumatoid Arthritis-> seen at medical center. Tx Prednisone, Methotrexate, LEUCOVORIN. N 1/09 started ### 1/14/2009 having back pain, unila owing inj - inj site slowly turned red and swollen "looked like a spider bite" x 1wk- Cont. to get Y red and turned 4/30/2009 into a calloused 5/7/2009 blister appea 0 minutes after receiving vaccine, child Y broke out in rash. It started above his eye lids, and inYthe anticubital 6/9/2009 fossa of both 6/9/2009 arms, then progre ion, redness and tenderness to left Y shoulder area measuring 5cm by 5cm. Pt treated oral Antibiotics. U 6/8/2009 6/10/2009 mins after rec'vg all imm. appeared fine; started to stand then fainted x 20-30 secs. Revived w/cool Y water 6/10/2009 compress &6/10/2009 light stimulation. Rema started (L) thigh increased on 24 hr and worsened in 48 hr, gotten better, no trouble. Y 6/8/2009 6/9/2009
5/13/2009 DIARIX but didn't need a dose of DTaP or IPV. Y 5/19/2009 5/19/2009 -"Kiwi size"- approx. 3-4 in diameter. Swelling - 1/4 in -raised, painful Afebrile. U 6/8/2009 6/8/2009 inic 1 week after vaccine 6-9-09. According to dad 1 day after receiving the vaccine her attitude N changed 6/1/2009 she became 6/9/2009 compulsive, says she next day with increased redness and knot under site. Tx with ice. 6/10/09 Pt was seen in office Y today with6/5/2009 pain left arm, 6/6/2009 firm nodule at injec n: 11/10/98. Received anthrax vaccine Y #1- denies problems. 11/24/98. Received anthrax vaccine N #2- denies 1/8/1999 problems. 12/11/98. Received medical conditions diagnosed since starting Y ANTHRAX Y vaccine series, including fatigue, Y reproducible N arthralgias 1/22/1999 / myalgias, and obstructive Dermatitis, focal Start: 01/2004 Comment: Y Tinea capis. Symptom: Lymphadenopathy, axillary N Start: 09/2004 ###Comment: bilat axillary a ceived FLUMIST and ADACEL vaccines Y on 10/31. She developed severe arm pain and swelling Y in the left shoulder ### and arm a few hours af ceived Tdap into the left shoulder onY 10/31, the arm developed pain, swelling, heat, and itching at the site since### then. Fever start: 10/31/2006 - Comment: Undocumented, no temperature taken. Symptom: Chills Start: 10/31/2003### - Comment: Have occurred n: 37 y/o female developed severe Y right shoulder and arm pain and swelling a few hours after Y receiving ADACEL ###vaccination. Symptom: P old female received DTaP on 12/12/2006 Y at the clinic. Mother noticed child developed a large U erythematous and ###indurated area on the left 11/4/2001 N 6/6/2000 11/1/2001 U 4/19/2009 n has been received from a consumer Y concerning her approximately 36 month old son with N no pertinent medical 4/9/2007history or drug reactions o n has been received from a nurse concerning Y a 23 year old female who on 29-MAY-2009 was U vaccinated 5/29/2009 with the first 5/29/2009 dose of GARDASIL, n has been received from a consumer, for the Pregnancy Registry for GARDASIL concerning Y herself, a 2/12/2008 26 year old 2/12/2008 female, who on 12-FEB n has been received from a physician Y concerning Y a 16-year-old female 2 patient with Y no medical N history who 5/18/2009 was vaccinated 5/28/2009 with the second Y 5/4/2009 5/7/2009 DACEL and MENACTRA 05-12-09 pm., Y Wed pm 5-13-09 adolescent woke up with "baseballYsize knot" -5/12/2009 "hard to touch 5/13/2009 and large red whelp degree and rigor 12 hours after injection - Resolved 12 hours later without treatment. Y 10/3/2008 10/3/2008 ed Urticaria Patient treated with Prednisone Y Y 5/29/2009 5/29/2009 was given to me months ago in my left arm. It was understood that it was result in some soreness N for a while. 2/23/2009 But there is a numbness and m to touch 2x2 circumference. 6/3/2009 6/5/2009 vaccine breakthrough. Diagnosed with varicella in office today. U ### 6/2/2009 r vaccine. Severe local reaction: swelling, erythema, warmth, itching. Given Loratidine. 6/4/09- patient states 3/10/2009 after seeing 3/13/2009 Dr and taking the on 6/5/09 c/o pain in (L) arm with swelling and pain radiating to upper scapulae area. This occurred U when he awoke. T-102 in am. Seen at c er arm area of induration and erythema 156 mm X 75mm. Right upper arm circumference 7Y1/8 "and left is 6/1/2009 6 1/2". T-99.9 6/2/2009 area hot to touch hed side effects which have been checked. Abdomen cramps; ache: joints; aches: whole body; bowels:9/27/2007 irritable, cellulitis; chills, chills feve ceived PNEUMOVAX 23 vaccine in her left deltoid muscle at her place of employment on 04/09/2007. Y She 4/9/2007 experienced 4/9/2007 swelling and pain in n the clinic on 5/20. Mom states that on 5/19/09 pt had fever 105 and rash. Today rash is worst but no fever. 5/18/2009 Red bump 5/19/2009 raised pink on abdo ction with marked erythema, warmth,Y and pain at injection site within 12hrs of administration.USize of affected 5/27/2009 area 12cm 5/28/2009 X 10 cm Treated w on neck after 1st shot (4-5 days later) thought it was from something else, itching also. After Y2nd shot rash 4/24/2009 widespread 4/28/2009 on trunk, neck, arms n after injection (s/s) Pt got hot, very moist feeling, felt nauseated, dizzy. After she sat for about Y 5-10 min 6/9/2009 and had drank 6/9/2009 of H20 she felt bet swelling from shoulder to elbow - MOTRIN - rest- elevation Y 6/9/2009 6/10/2009 red, swollen, bruised, warm to touch. U 6/4/2009 6/6/2009 ven ADACEL instead of DAPTACEL at age 4 yrs 10 mths. No adverse reaction. All other vaccines given in6/2/2009 another state. omiting 24 degrees after vaccines. Advised pedia lyte (5m. am'ts) Then gradually elevated toYformula. Same 6/9/2009 symptoms 6/10/2009 after 1st series of v tchy, warm, sore, rash 6" long x 4" wide went to my doctor, prescribed KEFLEX generic cephalexin Y 500 mg 6/5/2009 twice daily 6/6/2009 for 7 days. was reported via medical records that were forwarded by lawyers and described Ythe occurrence U of polyarthralgia 7/27/1999in an adult male subject w d Tdap vaccine in the ED. The vaccine is to be given to patients between 11-64 years of age.Pt Y reported5/27/2009 to our office6/2/2009 on 6/8/09 that 6 days sician note: "her right arm shows an inflammation, some redness and mild induration at the Y site of her recent 6/6/2009 injection 6/7/2009 when she got her pn r to 101F responded to NSAID's, nausea, sattelite lesions, marked inflammation of shoulder Y with bilateral5/24/2009 swelling of 6/3/2009 axillary and cervical ly eived vaccines MMR, and Hep. B. on Monday 06/08/2009. Called today.Stated on Tues nightYtongue became 6/8/2009 sore and 6/9/2009 swollen. Still sore an erythema, swelling 3-4" in diameter 24 hours after receiving shot. Warm compresses and Benedryl Y advised. 6/9/2009 6/10/2009 ug reaction of head chest back armsY and legs. U 6/9/2009 6/11/2009 ely after vaccine was given, the patient developed pallor and was dizzy. Y 4/6/2009 4/6/2009 HE, DIZZINESS, PROBLEMS WITH SPEECH, NAUSEA, STOMACH ACHE, SLEEPINESS,NNO APPETITE. 5/29/2009 6/12/09 5/29/2009 Medical records rece pular, red in color, blanching, generalized in arrangement U 5/29/2009 6/10/2009 unk and forearms presented after second pill administered. Y
unk and back with some itching. Y 6/9/2009 6/10/2009 e long seizure associated with feverY2 hours after administration of Dtap and Prevnar Y 6/8/2009 6/8/2009 et 6/7/09, duration of 3 days; Eye sensitivity Y to light: onset 6/8/09, duration 1 day; Runny Nose: Y onset 6/7, 5/28/2009 duration still 6/7/2009 ongoing as of 6/11/0 perienced yesterday (6/10/09) on the body from face to upper thigh, fever. Mom gave TylenolU steaspoonsful 6/4/2009 and applied 6/10/2009 Calamine lotion. mm area of induration, warm to touch, erythematous Y 6/9/2009 6/10/2009 nduration, pain, itching, warmth, 14cm x 11.5 cm area surrounding injection site. Local cellulitis Y 6/2/2009 6/9/2009 : Pt. had conjunctivitis in both eyes Yand was tx'd with antibiotic gtts x5 days. 8 May 09: Annual Y physical exam 5/29/2009 was normal. 5/29/2009 Conjunctivitis ha ose of Hepatitis A given by error too early from first dose.CDC called and verified that this dose Y would not 6/11/2009 be valid and 6/11/2009 should be repeated 0 seconds after the first injection myYdaughter became faint and passed out, she then began U having a seizure, 6/11/2009 the entire 6/11/2009 episode lasted app tly, but want to report now. 3 Influenza vac, with identical reactions each time of visual change Y (marked) 11/1/2004 & headache. 11/1/2004 Recovered all 3 times Molluscum after previous dose of PROQUAD. Y 7/31/2006 6/9/2009 rom a nap around 5pm on 6/9/09 and Y noticed (L) arm was red, swollen, and warm to touch. Y Gave TYLENOL 6/9/2009 d/t LG fever 6/9/2009 of 99 per mother, ts with red, raised area on outer Lt thigh + tender to touch, about size of a baseball -SX began this a.m. 6/11/096/10/2009 Area 6/11/2009 is site of KINRIX inj. ter Tdap, Menactra , Varicella vaccines administered - Vital taken rest, fluids, EKG. Y 6/11/2009 6/11/2009 ash within 6 H of administration of PREVENAR Lt - MMR, VARIVAX, HAV 6/11/2009 6/11/2009 eaction. Injection site, swelling, red Y and hot Fever treated with Motrin and Benadryl. Y 6/8/2009 6/10/2009 2 cm red, cellulitic area were INFANRIX given - x2 days - warm compresses-PO AUGMENTIN, Y 400 POBID 6/8/2009 6/10/2009 Y 8/14/2008 5/5/2009 syndrome, headache + fever treatedYwith Keflex 500mg - PO TID X 10 days. Y 6/9/2009 6/9/2009 with blisters on mouth. Y Y 6/7/2009 of the eyelids, dizziness, feel sick. top center of head tender to touch, hurts. "This feeling" will N not go away! 1/9/2009 I called1/10/2009 the Doctors Office the 01) 24 hours after immunizations - red rash on trunk 10 days after immunization U 5/25/2008 6/5/2009 nger rash, erythematous nodules well demarcated. N 5/20/2009 6/3/2009 meter redness no induration or tenderness Y - no cellulitis - no treatment necessary Y 6/5/2009 6/7/2009 ther of the client reported the following Y events occurred after vaccination of client for Yellow U Fever and Typhoid 5/27/2009 VI at5/28/2009 clinic on 5/27/09. 5/28 y swollen upper left arm shoulder toYelbow. No fever good movement in shoulder, elbow, and wrist prescribed 6/4/2009 Keflex6/7/2009 for cellulitis. e out in hives within 24 hrs. Y 6/4/2009 6/4/2009 veloped rash about 1 1/2" in diameter at injection site. White in center. U 6/2/2009 6/4/2009 er vaccine administration, approximately Y 15-25 minutes child had syncopal episode that wasYprolonged with 6/5/2009 noticeable 6/5/2009 pallor, and fluctuan ped redness, swelling & induration of R thigh approximately 48 hrs after receiving vaccines. YMinimally tender, 6/3/2009 no fever 6/5/2009 or other systemic sy MMR, varicella, PREVNAR with Hep A 6/8/09. Began with erythematous rash that night thatYbecame a generalized 6/8/2009 urticarial 6/8/2009RXN the next d spots located on her scalp, forehead and face Lt is bilaterally. Spots itchy. no blistering -Treatment Y - acyclovir 5/15/2009 X 7 5/28/2009 days icellaform rash on chest, back, abdomen, Y buttocks, upper thighs. Treated with diflorasone diacetate N ointment 5/14/2009 for itching. 5/22/2009 Y 6/1/2009 6/1/2009 inistration of GARDASIL patient got dizzy + started perspiring. Y 6/8/2009 6/8/2009 n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning Y a 15 year old### female with ### no medical hist n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Yconcerning6/26/2008 a 17 year old 8/6/2008 female patient with n n has been received from a physician concerning Y a 16 year old female 7 patient who is a tampon U user and who on an unknown date was vac n has been received from a pharmacist Y concerning Y a 69 year old female 0 patient who Y on 11-MAR-2009 N was 3/11/2009 vaccinated 3/15/2009 SQ with 0.65 mL of d vaccines 6/10/09. Had High fever (TMAX 104.1) (6/11/09), given TYLENOL/MORIN; No vomiting, Y no seizures. 6/10/2009Also 6/11/2009 with runny nose, mild and warmth at the site of injection the Y size of a golf ball. Entire thigh was swollen. U 6/10/2009 6/11/2009 ection site. Low grade fever; back pain started 6/4 in pm; lethargic; aches; cough; weaknessYin limbs, decreased 6/3/2009PO6/4/2009 all lasted 2 days. No l on- Red, itchy, warm 2 1/2 U 6/8/2009 6/10/2009 er patient received shots child began Y to run a high fever of 104 - 105 degrees, and developed Y a cough. Stated 6/9/2009 also had 6/9/2009 decrease in appeti VAQTA and MENACTRA. After MENACTRA (approx 1 min) Pt slumped to side and fainted. Recovered Y immediately 6/12/2009 6/12/2009 c/o dizziness and head d vaccines approx. at 2:30 pm on 6-11-09 mom states at 8:00 pm that night pt began with redness Y and itching 6/11/2009 to palms 6/11/2009 of hands. Hands ha tvaccinial lymphadenitis beginning post-vaccine Y day 5, involving left axillary, supraclavicular U and cervical nodes, 6/1/2009 non-suppurative, 6/5/2009 no system 9 developed headaches that progressed to lethargy, Y slurred speech22and imbalanced gait. HeUwas hospitalized 5/6/2009 6/2/09 5/23/2009 (and remains hospital Patients Mother called office and reported Y that Left arm at site where daughter received vaccine U is red, hot 6/9/2009 and swollen. 6/10/2009 Provider Dr. mad cine administered pt became flushed,tachycardia,thick Y tongue.tingleing in lips and throughYout body. Pt 6/10/2009 evaluated6/10/2009 in Occ Health. Remai ted for a few seconds. I held her in chair until she came to and then we got her on the examYtable and let 6/12/2009 her rest for 6/12/2009 about 15 minutes. S
4 hours from the vaccination time patient stated that she had a raised reddened area aroundUthe injection 6/9/2009 site(left deltoid)and 6/10/2009she started ex d sensation in left arm, left arm weakness, and cold left hand U 6/5/2009 6/6/2009 ately 24 hrs after vaccination. Noted left arm swelling and c/o numbness from shoulder to wrist. U After 48 6/10/2009 hrs remains6/11/2009 swollen but no erythem periencing itchy palms and Y also had pressure in his ears. Pt was red and flushed. Pt also had Y itching on the 6/8/2009 back of his 6/8/2009 head. Epi was adm ounding vaccine site was red 2-3 inches Y in diameter in right arm, no induration,no heat present U 6/3/2009 6/3/2009 28 year old male with complaints of hives that started showing up within the first week of getting N home from 5/16/2008 deployment. 5/25/2008 He reports it was immunizations began having neck pain with radiation down back; right arm discomfort and then N later in week 6/4/2009 right knee 6/5/2009 lateral discomfort a developed a maculopapular rash at the varivax injection site, on 5/25/2009. Y 5/15/2009 5/25/2009 ash and swelling noted in left deltoid. Received 2 vaccines on 06/11/09, noticed soreness inULeft arm 146/11/2009 hours later.6/12/2009 Awakened next morni d muscle red/swollen and warm to touch 1 and 2 days after administration. Size of tennis ball. Y Improving 6/10/2009 today on day 6/11/2009 2. ECEIVED VACCINE ON 06/09/09 AT MARYMOUNT PRIMARY CARE AROUND 4PM WENT HOME AND6/9/2009 HOUR LATER 6/9/2009 ARM BECAME S was reported via a statement of injuries received via a lawyer and described the occurrenceUof flu-like symptoms in an adult male subject w ain at injection site (~ 3" inch diameter), oval shape rash /redness. U 6/10/2009 6/11/2009 n with what looked like bug bites - Mom Y stated they appeared with VARCELLA shot + gettingYworse - Mom 5/27/2009 took child5/29/2009 to hospital - trans. Pt t with swelling to right arm. Y 6/10/2009 6/10/2009 hematous rxn to both legs, 6 x 6". Y 6/8/2009 rm and tender indurated area at site of VARIVAX- 7x9cm. Y 6/10/2009 6/11/2009 NACTRA injection. Child had brief syncopal episode. Lasted about 30 seconds, then alert, normal Y neurologically. 6/12/2009 6/12/2009 confluent smooth area L deltoid. Local Rx. Y 6/10/2009 6/11/2009 09 after receiving immunizations the child had Y rhythmic movements1of arms and legs followed Y by lethargic 5/26/2009 periods where 5/26/2009 baby was unresp mplains of headache after 1 hour ofYHep A shot, muscle cramps on the left arm, tingling of the U left fingers. 6/12/2009 6/12/2009 tes she has muscle cramps over both Y shoulders, back neck, these symptoms appeared 15 minutes U after6/12/2009 shot, nausea, 6/12/2009 sweating. 3 hours a reaction at site of VARIVAX. Slightly tender. 6x6 cm. Y 6/10/2009 6/11/2009 esented to office with redness, hot to touch, knot at injection site, and treated with VERIPRED Y 20mg. 6/9/2009 6/11/2009 d ZOSTAVAX vaccine on 6/10/09 - RTC on 6/12/09 C/o pain, red, warm to touch at injectionUsite. Advised 6/10/2009 warm compresses. 6/11/2009 Given RX for elling and redness at injection site. Ice pack applied. BENADRYL given one per day. Y 6/11/2009 6/11/2009 and redness at injection site 1 week Y after administration. Y 6/4/2009 6/11/2009 oid pain with radiating to neck and forearm. Y Paraesthesia in right arm following Tdap immunization. N 6/8/2009 6/8/2009 ad to toe rash. Blisters mostly on chest. 6/12/09 Rash almost gone. 0 blisters. Y 6/3/2009 6/7/2009 , in chest, pale, warm, nauseated. Cold packs were applied, she denied any difficulties breathing Y and recovered 6/12/2009 completely 6/12/2009within a few m f 5/27. arm pain On 5/28. abdominal pain, leg pain; tingling backs of legs & feet. Light headed, Y passed out 5/27/2009 in shower. 5/27/2009 Temp 100.8. at daycare. He took a longer than average Y afternoon nap and woke up a little warm. He wasYstanding at the 6/3/2009 window6/11/2009 with his caregiver whe nization on 5/26/09, had episodic spells Y of rhythmic movements of arms and legs followed by Y lethargic episodes. 5/26/2009Baby 5/26/2009 felt cold to mother d eloped Abnormal Seborrheic dermatitis after vaccination, Y also Failure 6 to Thrive. N 6/7/2007 6/8/2007 MR 10 days post vaccine Y 6/2/2009 6/12/2009 days after my 2nd vaccine, my was swollen and extremely red above the injection site. Soon N after, I developed 6/1/2009 a rash 6/3/2009 (starting on my back d vaccine in the hospital. Approximately 1.5 days after administration RN noticed moderate swelling U and6/13/2009 redness of6/14/2009 right upper extremity w Y 0 N ort was received 04 June 2009 fromYa consumer, who is also the patient. A 67-year-old female U patient with1/1/2008 a history of1/2/2008 penicillin, seafood an ort received on 08 June 2009 from another Y manufacturer whose initial reporter was a health care U professional. A 24 year old female patient n has been received from a physician Y for the Pregnancy Registry for GARDASIL regarding an Y 18 year old female ###with 6/1/2008 depression and a his n has been received from a physician concerning an approximately 80 years old Y female whoNwas vaccinated 8/2/2007 with a 0.65ml 8/2/2007 dose of ZOSTA n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y an 18 year6/13/2008 old female who on 13-JUN-2008 n has been received from a physician concerning a 29 year old female who on 14-MAY-2009 Y was vaccinated 5/14/2009 with VARIVAX 5/14/2009(Oka/Merck) ( n has been received from a nurse, for the pregnancy registry for GARDASIL, concerning a female Y with no7/1/2007 known allergies 5/24/2008 and no pertinent n has been received from Y a physician Y concerning Y a 10 month old female 0 with a history Y of wheezing Y who was vaccinated 12/1/2006 with 3 doses of RE n has been received from a consumer Y concerning Y his 15 year old daughter 0 who was vaccinated U with GARDASIL. After the patient received arted sneezing approx. 20 minutes after gettingYimmunization. Left eye 1 swelling and pt. c/o itching Y - rash 6/10/2009 on thigh. BENADRYL 6/10/2009 40 mg given s (not just in shoulders with shots - though it is worst there), sore lymph nodes (at back of neck), N sore throat, 6/5/2009 aching ears, 6/5/2009 loss of appetite (n AY, JUNE 4TH, RIGHT SIDE OF FACE Y STARTED Y SWELLING. PARENT 5 TOOK HER INTO Y EMERGENCY 6/4/2009 ROOM. BY 6/4/2009 THE TIME THE M.D and briefly passed out a few minutes after vaccines administered. Client laid on exam table and Y given juice. 6/15/2009 6/15/2009
RECEIVED ALL THE VACCINES LISTED Y IN ITEM NUMBER 13 ON 06/10/2009 SHE STATED N HAD AN 6/10/2009 OUTBREAK 6/11/2009 OF HIVES THE FOLL ection patient complained of left arm pain rest of day. Next day had headache, chills, body aches, Y and hives 6/12/2009 to arms6/12/2009 and torso. 2 days late ching under armpits 10/30 red and Y itchy under arms, down side of breasts, on stomach and Y down to the pelvic### area. 10/31### went to stat care anthrax vaccination, member states she had 5 menstration flows in a 6 week period. This reaction Y has never 8/15/2007 happened 8/22/2007 to her prior to vacc ped zoster rash within 24hrs of receiving Y vaccine. Pt was seen in office 6/15/09 and started on U Famciclovir6/9/2009 and Prednisone. 6/9/2009 on given at 9:20 a.m. Patient showed signs of excessive tiredness at 7:45 p.m. Vomiting occured Y beginning 6/12/2009 at 4:00 a.m. 6/12/2009 er receiving DTaP #4 and Hepatitis Y A #1, patient presented to ER with c/o redness and swelling Y at injection 6/9/2009 site. Today 6/13/2009 (6/15/09)mom repo e given on 5/20/09. Shot site got swollen, Y hot and erythematous. Was adv to try ice and Benadryl Y initially. 5/20/2009 Came into 5/21/2009 offc on 5/22/09 & wa w fever INJECTION ON 6/10/09 DEVELOPED A 4 INCH RED BLOTCH ( NO FILLED) ON LEFT Y BACK 6/10/2009 OF ARM AND 6/11/2009 FELT MALAISE x 1 d zoster pain 48 hours after administration Y and classic rash 6 days after vaccine. U 6/8/2009 6/10/2009 extreme swelling to injection site per mom. Witnessed by Dr. at home visit. Y 6/10/2009 6/11/2009 d vaccinations on 6/9/09. He was up most of the night after vaccine with pain in his left thight. U On 6/10/09,6/9/2009 thigh was 6/9/2009 red & still painful. Also pells started in January 2009. They Yoccurred multiple times per day and continued for over 2Nmonths. She 11/4/2008 also experienced 1/9/2009 nausea, dizzin ng, redness, irritation at injection site with little blister bubbles at site. Y 6/11/2009 6/12/2009 ike rash developed 3 days after given Zostavax Y 6/10/2009 6/13/2009 en dots around injection site. Hives on upper deltoid to elbow. Pt to take BENADRYL q 6 hours Y prn call if5/18/2009 worse. 15cm 5/19/2009 hive around injection n site approximately equal to 2 X 2" red swollen, hot to the touch, raised area. The next day injection has 6/12/2009 gotten approximately 6/13/2009 1 " bigger t ddenly fell to the floor about 1 minute after. Y 6/8/2009 6/8/2009 ateral lower extremity edema. Assoc Y with pain that makes walking difficult. Also assoc with malaise Y and 4/17/2009 fatigue. Occurred 4/23/2009 both times she w d erythema multiforme w/in 96' of DTaP, Y Hep A, PREVNAR and MOTRIN. Y 6/3/2009 6/7/2009 was reported by a healthcare professional Y and described the occurrence of labial swelling inYa 16-Year-old 1/22/2009 female subject 1/23/2009 who was vaccin rts she noticed hives on baby's back; Buttocks at 8 PM on 5/27/09 - approximately 4 hours after Y injection5/27/2009 - and a fever 5/27/2009 of 99.9 gone by noo een on 6/9/09 for pap smear - during course of visit she advised provider that she refused any Y further GARDASIL. Stated that apx 3 hours a in waiting area. Y 6/11/2009 6/11/2009 11/11/08 - 1st sore on outer vaginalYarea/left side. 11/12/08 - fever 101. 11/14-18/08 - more Y sores-outer 11/7/2008 left vaginal area. 11/20/08 ### DR. take s red rash, left side of forehead and surrounding Lt eye, consistent with shingles. N 6/2/2009 6/4/2009 .T. Congestion; 6/2/09 Fever, leg pain; Y 6/6/09 headache, Y vomiting;12 6/10/09 - broad-based gait, facial weakness/? 5/13/2009asymmetry. 5/31/2009 7/21/09 Hosp pain, erythema in (whole upper right) arm of injections. Symptoms started within 24hrs. At 4 U days starting6/11/2009 to improve. e on 6/5/09 mother noticed left arm was red and swollen from shoulder to elbow. Afebrile. Cold Y compress 6/4/2009 applied. 6/5/2009 erve palsy "Bell's palsy" Y U 6/11/2009 6/12/2009 cines 6/3/09, started with fevers to 104-105 on 6/4/09, seen in clinic 6/5/09 with fever to 104.4, Y no S/S URI, 6/3/2009 UA dip (-). 6/4/2009 F/U call 6/6/09 fever 9-4AM started vomiting/diarrhea, 11:00AM Y Fever 100.7. By 7:00 PM fever 102.8. ContinuedYto vomit, went 5/28/2009 to emergency 5/29/2009 room. Received I s in wrist, elbow and shoulder of arm ADACEL was administered, began within a few minutes Y of injection. 5/21/2009 Numbness 5/21/2009 was in (R) arm. Full ra ped body aches, myalgias on 5/29/09. Y The next day, she was much better. Y 5/28/2009 5/29/2009 ling R Deltoid Y 6/4/2009 6/8/2009 d rash on hands, chin 6/12 taken to Medical Center Rx for Prednisone 20 mg Qd II tabs 6/15Yspoke with 6/11/2009 mother, patient 6/12/2009 is doing well today. n waiting room. Fell and hit her head on chair in waiting room ~ 5 min after receiving vaccines. Y Possibly 6/15/2009 hit head on6/15/2009 seat cushion or possibl th large area of erythema, warm to touch Y 6/10/2009 6/11/2009 deltoid ~ 3 cm oval shaped area erythema, edema + warmth + induration 0 fluctuation + tender U to palpation. 6/10/2009 given Bactrim 6/11/2009 DS #14, T by mo vaccine adm. on 6/10/09. Mother noted "small red bump" at site yesterday. Larger red round Nspot today. 6/10/2009 (Left triceps6/11/2009 area) (6cm diameter) S ceived her vaccine on 4/20/09 am and began screaming at 4/23/09. She was seen in the ERYafter 2018 on 4/25/09, when abdominal x ray, e headache and swelling RT arm - Aspirin Y TYLENOL. Ice pack initially. (2) Repetition of above U q 2 weeks2/27/2009 with shooting 2/28/2009 pains RT side body he had swelling and pain at injection site. Y 6/4/2009 9 Pt saw Doctor reports received TdYBooster at Hospital on 5/19/09. Left arm erythema induration Y 2 degrees. 5/19/2009 DX: Local 5/21/2009 allergic reaction to within 4 hours, cellulitis picture 48 Y hours later. U 6/9/2009 6/10/2009 d MENACTRA) Tdap 8/407. Head ache /st over time developed fatigue (sleep up to whole day) N and headache 9/19/2007 (1st 10/8/2007 concerning Reaction). ( A on 10/29/08 HA started that he did not have at time of apt & vaccine. Seen 10/31/08 for abd N pain & HA. ### ### red 5/22/09; on Sunday, 5/24/09 Pt developed papular rash on upper back and chest, with itching. Y Both 5/22/2009 itch and rash 5/24/2009 diminished over next n has been received from a physician concerning a patient who on unspecified date was vaccinated U with a dose of GARDASIL (LOT# not r n has been received from a physician Y concerning Y a 19 year old female 0 with sulfonamide allergy, Y allergy to2/2/2007 PEDIAZOLE 2/2/2007 and AUGMENTIN, n has been received from a nurse concerning Y aYfemale with no allergies 0 who on 20-JUL-2007 Y and on 24-SEP-2007 1/25/2008 1/25/2008 was vaccinated IM 0.5
n has been received from a nurse practitioner concerning 3 children who was vaccinated with U GARDASIL. The nurse practitioner reported n has been received from a physician Y concerning a teenage female who within the last two years Y (approximately 2007) was vaccinated IM n has been received for the Merck pregnancy Y registry, from a nurse concerning a female patient, Y who was 9/28/2006 vaccinated with### two doses of GA n has been received from a registered nurse, for the pregnancy registry for GARDASIL concerning Y a 21 1/16/2008 year old female 1/16/2008 with a history of la n has been received from a physician for the Pregnancy Registry for GARDASIL, concerningY a 17 year old female ### with 2/12/2008 no known allergies n has been received from a Nurse Practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 19 5/9/2008 year old 5/9/2008 female with thrombocy n has been received through the Merck Y pregnancy registry from a registered nurse concerning Y a 21 year 4/3/2008 old female with 6/5/2008 no pertinent medic n has been received from a physician concerning four female patient's who were vaccinatedYwith dose of GARDASIL. Subsequently the pa n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 21 year 2/20/2009 old white female with no significant n has been received from a registered Y nurse concerning an 11 year old female who on 11-MAR-2009 U was 3/11/2009 vaccinated 3/11/2009 with GARDASIL (lot n has been received from a registered nurse concerning a 11 year old female who on 24-MAR-2009 U was3/23/2009 vaccinated3/23/2009 with the first dose of G n has been received from a registered nurse for the pregnancy registry for GARDASIL concerning Y a 16 year 5/19/2008 old female, 5/19/2008 who on 26-FEB-20 n has been received from a registered Y nurse, for the GARDASIL a Pregnancy Registry product U concerning 3/20/2009 a 14 year 3/20/2009 old female patient wh Client received MMR and Varicella vaccines. Y Mom was instructed to observe carefully for fever Y 5-12 days5/28/2009 after vaccine 6/3/2009 administration and to Y n has been received from a medicalYassistant concerning a female who was vaccinate with on U unspecified3/3/2008 dates (doses and LOT# were no n has been received from a caller concerning her daughter a 17 year old who became very ill U after receiving 5/1/2008 injection5/1/2008 the first dose of GAR n has been received from a 20 year old female patient with parakeratotic cells evidenced in N previous PAP 4/28/2009 test, who4/29/2009 on 20-APR-2009 was v n has been received from a consumer concerning herself with no previous pregnancies and Nno reported past 5/1/2009 drug history 5/1/2009 who on 01-MAYn has been received from a physician concerning a 17 year old female with no pertinent medical Y history 4/15/2009 reported and 4/16/2009 no known drug allerg n has been received from a nurse practitioner Y concerning a 15 year old female who on 27-Feb-2009 Y was2/27/2009 vaccinated2/27/2009 intramuscularly. 0.5ml n has been received from a nurse practitioner concerning a 16 year old female patient with aNhistory of epstein-barr 5/1/2009 virus 5/2/2009 infection and lymp n has been received from a physician concerning a teenager female who was vaccinated with N the first dose of GARDASIL in April 2007 and n has been received from a physician Y concerning a 15 year old female with PENICILLIN allergy N and no pertinent 11/5/2008medical 1/1/2009 history who was v n has been received from a registered Y nurse (RN) concerning a 17 year old female who on 24-JUL-2008 U 7/24/2008 was vaccinated 12/9/2008 with the first dose n has been received from a mother concerning a her daughter who on 3-JUN-2008 was vaccinated U with her 6/3/2008 first dose of GARDASIL (dose n has been received from a physician concerning a female patient who on 04-MAY-2009 was Y vaccinated 5/4/2009 with the first5/4/2009 dose of GARDASIL ( n has been received from a physician Y concerning a female patient who was vaccinated with YGARDASIL and experienced syncope, the pati n has been received from a consumer concerning her 12 year old daughter who on an unspecified U date was vaccinated with her first dose n has been received from a doctor of Y osteopathic medicine (D.O.) concerning a female who Yon an unspecified date was vaccinated with the n has been received from a registered nurse concerning a 21 year old female with no pertinent U medical history 5/1/2009 or drug 5/1/2009 reactions/allergies w n has been received from a medicalYassistant and the patient's mother, for GARDASIL, a Pregnancy N Registry 4/21/2009 product, 4/21/2009 concerning an 17 ye n has been received from a licensed Y practical nurse, for the Pregnancy Registry for GARDASIL Y (Lot # 659184/0843X), 8/21/2008 8/21/2008 concerning a 25 yea n has been received from a 25 year old female certified medical assistant concerning herselfYthat she was vaccinated IM with the third 0.5 m n has been received from a Certified Y Medical Assistant concerning a 14 year old female withNno pertinent 4/7/2009 medical history 4/24/2009 who on 07-APR-2 n has been received from a healthcare worker concerning her 18 year old daughter who wasUvaccinated11/9/2007 with the third 11/9/2007 dose of GARDASIL a n has been received from a 23 year old female who on 04-MAR-2009 was vaccinated with with N second dose 3/4/2009 of GARDASIL. 5/4/2009The patient ha n has been received from a consumer Y concerning her daughter a 23 year old female with a history N of eczema and Dairy allergies (cause of n has been received from a physician Y concerning a 15 year old female who on 06-MAY-2009 Y was intramuscular 5/6/2009 vaccinated 5/6/2009 with her 05ml d n has been received from a pharmacist who heard from a nurse (mother of the patient) concerning U the female patient who on unspecified d n has been received from a 23 yearYold female with no medical history or drug allergy who on N 01-May-2009 5/1/2009 was vaccinated 5/1/2009with the first do follow up information has been received from a registered nurse concerning a 27 year old female Y with penicillin 3/9/2009 allergy 3/9/2009 and no pertinent me n has been received from a physician Y concerning a female patient about 20 years old who on N an unspecified date was vaccinated with a do n has been received from a nurse practitioner Y concerning a female who in October 2007, was N vaccinated 10/1/2008 with the first 10/1/2008 dose of GARDASIL. n has been received from a nurse manager Y concerning a 25 year old female who on 08-MAR-2009 Y was vaccinated 3/8/2009 with 3/8/2009 GARDASIL. There n has been received from a physician Y concerning a 14 year old female who on an unspecified U date was intramuscular vaccinated with GAR n has been received from a licensed practical nurse concerning her 16 year old daughter with Y DURICET allergy 8/3/2007 and no pertinent medical h n has been received from a female who in 2006 was vaccinated orally with GARDASIL and U just recently had been diagnosed with human p n has been received from a consumer Y concerning her 16 year old daughter with lactose intolerance N and4/22/2009 not other drug 5/9/2009 reactions or allergie n has been received from a physician, Y a consumer and a secretary concerning a 15 year oldNfemale patient 5/8/2009 with no history 5/8/2009 of allergies who n has been received from a medical assistant concerning a 21 year old female with no allergies Y or medical 4/23/2009 history who 4/25/2009 was vaccinated intra
n has been received form a physician Y concerning his 33 year old daughter who had been vaccinated Y with GARDASIL series. During one of n has been received from a physician Y concerning a 17 year old female patient who on 27-Feb-2009 Y was2/27/2009 vaccinated with 3/1/2009 the first dose of G n has been received from a physician concerning a patient who was vaccinated with GARDASIL. U Subsequently the patient experienced co n has been received from a physician concerning a 21 years old female with no pertinent medical Y history 5/6/2009 who was vaccinated 5/6/2009 with GARDA n has been received from a registered Y nurse in a physician's office and a registered nurse inUa county health 2/5/2009 department, 2/5/2009 for the Pregnancy n has been received from a medicalYassistant concerning a 26 year old female who on 08-MAY-2009 Y was5/8/2009 vaccinated5/8/2009 with her first dose of n has been received from a physician's assistant who reports an office had several patients U faint after receiving GARDASIL. It was unknow n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry Product, Y concerning5/4/2009 a 17 year old 5/9/2009 female who was va n has been received from a nurse concerning a 24 year old female who on 11-MAY-2009 was U vaccinated 5/11/2009 with a 0.5 mL first dose of GARD n has been received from a certified medical assistant concerning a 14 year old female with Yno pertinent5/14/2009 medical history 5/14/2009 who on 14-May-20 n has been received from a nurse practitioner Y concerning a female patient who in 2008 started N the series of GARDASIL. Concomitant thera n has been received from a receptionist Y concerning her daughter who on an unknown date was U vaccinated with a dose of GARDASIL (lot n n has been received from a certifiedYmedical assistant concerning a 25 year old female patient N who on 17-APR-2009 4/17/2009 4/17/2009 received the first dose n has been received from a nurse concerning Y a female who on an unknown date, was vaccinated Y IM with the first dose of GARDASIL 0.5m n has been received from a physician Y concerning a 15 year old female with a history of headaches Y who on unspecified dates were vaccina n has been received from a physician and a registered nurse concerning an 18 year old female Y who on 18-Mar-2009 3/18/2009 3/18/2009 was vaccinated with t n has been received from a nurse practitioner concerning a 25 year old female who on 20-OCT-2008 U was 4/16/2009 vaccinated 4/16/2009 with the first dose of n has been received from a licensed practical nurse concerning her 25 year old female friend N who on 18-MAY-2009 5/18/2009 5/19/2009 was vaccinated with he n has been received from a nurse practitioner Y concerning a 16 year old female who was vaccinated U with10/2/2007 the first dose 11/1/2007 of GARDASIL on 02 n has been received from a physician Y Assistant and a Licensed Practical Nurse concerning N a 16 and half 1/9/2009 years old 1/14/2009 female with familial risk n has been received from a physician Y concerning a female who was born on 09-Jun-1988 was U vaccinated8/7/2007 the first dose of GARDASIL (Me n has been received from a Nurse Practitioner concerning a 17-year-old female patient who Yon 07-AUG-2007 7/24/2008 was vaccinated 7/24/2008 with the first n has been received from a physician Y concerning an 11 year old female with no illness at time Y of vaccination 4/8/2009 or pre-existing, 4/8/2009birth defects o n has been received from a licensed practical nurse concerning a female who was vaccinated U with a dose of GARDASIL. Subsequently, th n has been received from a physician Y concerning a 20 years old female who was vaccinatedUwith GARDASIL 4/8/2008 three times: 5/8/2009 1st dose given o n has been received from representative reported experience as reported by a nurse concerning Y a female 5/18/2009 patient who 5/18/2009 on 18-MAY-2009 wa n has been received from a nurse concerning Y a female who was vaccinated with a first doseUof GARDASIL. Subsequently the patient expe n has been received from an office manager concerning a 15 year old female who on 11-NOV-2008 U was vaccinated 5/1/2009 with the first dose of G n has been received from a Registered Nurse (R.N) concerning a female patient who on an U unspecified date was vaccinated with a dose o n has been received from a medical assistant concerning a 23 year old female with not reported Y drug reactions/allergies 3/10/2009 3/11/2009 and medical histor n has been received from a physician Y concerning a teenage female who within the last two years Y (approximately 2007) was vaccinated IM n has been received from a certifiedYmedical assistant concerning a 12 year old female patient U with cystic 5/13/2009 fibrosis, no 5/20/2009 drug reactions/allergi n has been received from a 34 year old patient registered nurse with allergies to IMITREX, COMPAZINE, U 5/21/2009 MACROBID, 5/21/2009 for the Pregnancy R n has been received from a physician concerning a teenage female who within the last year Uwas vaccinated 1/1/2008 with a dose of GARDASIL vac n has been received from a consumer Y for the pregnancy registry for GARDASIL concerning U his 17 year 4/21/2009 old girlfriend4/21/2009 with anemia, irregular n has been received from a physician Y concerning a 16 year old female patient who "a coupleUof months ago" was vaccinated with the first a n has been received from a physician concerning a 25 year old female with a history of miscarriage N before 5/12/2009 the vaccination 5/19/2009 who on 12-MAY n has been received from a physician Y concerning an 11 year old female who on 19-MAY-2009 Y was vaccinated 5/19/2009 with5/19/2009 the second dose of GA n has been received from a mother concerning her daughter who on 31-MAR-2008 was vaccinated N with3/31/2008 first dose of3/31/2008 GARDASIL (Lot # 659 n has been received from a nurse practitioner for GARDASIL, a Pregnancy Registry product,Y concerning a 23 year old 3/3/2008 female with allergies n has been received from a physician concerning a 15 year old female student with no medical U history and 2/25/2009 no known 2/25/2009 drug allergy who on 2 n has been received from a Certified Medical Assistant (C.M.A.) concerning a 24 year old female N patient who 5/1/2009 on 13-MAR-2009 5/27/2009 was vaccin n has been received from a consumer concerning his 16 year old daughter with "brachial plexus" N of her 10/1/2008 right arm which 10/1/2008 was diagnosed a fe n has been received from a Registered Y Nurse concerning a 25 year old female patient with no Y pertinent 5/15/2009 medical history 5/16/2009 and no drug reactio n has been received from a physician concerning a "14 year" old female patient who was hospitalized Y couple days for "Helicobacter pylori" n has been received from an emergency Y medical technician concerning a 15 year old femaleNpatient with5/21/2009 no drug reactions 5/21/2009 or allergies who n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. One or two months after the GA n has been received from a physician concerning a female patient who on an unspecified date N was vaccinated with5/22/2009 the first dose of GARDA n has been received from a nurse concerning Y a 23 year old female patient who on 20-MAY-2009 N was vaccinated 5/20/2009with 5/26/2009 a second dose of GA n has been received from a consumer, Y for the Pregnancy Registry for GARDASIL, concerning Y her 15 year old ### daughter with ###seasonal aller n has been received from a registered Y nurse (R.N.) concerning a female who on 27-MAY-2009 U was vaccinated with a dose of GARDASIL (
n has been received from another physician Y (not the patient's physician) concerning a female U who was vaccinated with a dose of GARDAS n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL vaccine. Subsequen n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa n has been received from a nurse through a representative concerning a female patient whoYwas vaccinated with the first dose of GARDAS n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa n has been received from a nurse practitioner concerning a 11 year old female who on 19-MAY-2009 U was 5/19/2009 vaccinated 5/28/2009 with her first dose of n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a dose of GARDASIL (LOT# n n has been received from a Nurse Practitioner Y concerning a female about 14 years old who Y was vaccinated 5/29/2008 with the5/29/2008 first 0.5 mL dose of GA n has been received from a physician Y concerning an approximately 25 year old female who U on "20-MAY-2009" 5/20/2009 was vaccinated, 0.5 ml, with n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and fainted A ROUTINE PHYSICAL, I WAS GIVEN Y A TETANUS Y AND GARDASIL 2 VACCINE SHOT. APPROXIMATELY Y 6/10/2009 FIFTEEN 6/11/2009 AND A HALF HOUR n has been received from Y a medicalYassistant concerning Y a 9 weeks2old female patient with Y no pertinent5/28/2009 medical history 6/3/2009 and not known alle n has been received from a physician Y concerning Y a 7 months old female 0 with unknown drugYallergies and 4/16/2009 unknown 5/26/2009 medical history who on n has been received from a hospice nurse concerning a 16 years old female withYunknown drug N allergies and unknown medical history who n has been received from a health professional for the pregnancy registry for GARDASIL concerning Y a female 10/7/2007 with a history of atrial septal d Alopecia Areata Universalis beginning three days after receiving third GARDASIL booster, Tetanus with 10/1/2008 Pertussis injection, and Flu vacci the vaccine and a month later was diagnosed with Grovers disease which is a rash Y on the back and chest. 12/1/2007 Seems to me it### very coincidenta en 6/8/09 for 5 year WCC and received MMR, VZV, PV, DTaP, Hib and Hep A. He woke up this a.m. c/o itchy 6/8/2009 red rash 6/9/2009 on (L) upper thigh w ce visit: Red, warm area on left thigh, painful (to touch), Y 6/1/2009 6/3/2009 dedness, dizziness since vaccine series completed one year ago. Fainted 6/4/09. U 4/1/2008 4/1/2008 Y 5/8/2009 5/8/2009 numbness of the Rt fingers & right Y arm & nose 2 weeks seen by 5.26.09. No symptoms after Y 6-12-09 4/24/2009 5/12/2009 ely after receiving vaccine, right armYbecame very sore. Redness developed at 11:00 PM. Warm Y to touch. 6/10/2009 Area is 6/10/2009 very swollen. ain at the injection, Limited movement. Fever, chills, body aches for 2 days. Y nderness and swelling at site. Lasted for 2 weeks. Required medication for several days - ADVIL Y 5/20/2009 me in for office visit - Urticaria on Rt thigh, warm to touch, non-tender. Y 6/1/2009 6/3/2009 fice visit- firm, red, tender, warm area on (L) thigh. Y 6/8/2009 6/9/2009 action rash, swollen area around injection site. Itchy hand etc. Rash is 40mm in length. 6/10/2009 6/10/2009 TIVE ERYTHRODERMA - required Y hospitalization Y due to dehydration. 1 Treated with steroids U for over 2 wks. 5/11/2009 6/17/095/13/2009 Medical record receive cribed area on (R) leg is approximately 1 inch from injection site. 3 inches wide and 2 inches U tall and red and 6/4/2009 hot to touch. Per mom spoke w iven on 6/5/09. On 6/7/09 area on left leg - raised, warm, measuring at 6 x 8 cm. Y 6/5/2009 6/7/2009 s a quarter-sized red area at the injection site that is warm to touch. There is also significantYbruising in a 6/5/2009 3-4 inch area 6/6/2009 surrounding the red PCV-7 in (R) thigh and PENTACEL (DTaP-IPV-Hib) in (L) thigh on June 5 in PM. Increased Y sleepiness rest 6/5/2009 of June 5, 6/6/2009 2009. On 6-6-09 not a 6cm x 3cm erythematous rash on her (R) upper anterior thigh Laterally & anteriorly is the injection U site. 6/2/2009 6/4/2009 woke during night with chills, painful skin irritation. Full body aches, light-headedness, exhaustion, N lack of focus, 6/6/2009 periods 6/7/2009 of mild confusion, re 7cm x 5 1/2 cm warm to touch. 6/3/2009 6/8/2009 g, redness, pain 4/23/2009 5/1/2009 hr. - hives and swelling throat, took BENADRYL - 50 mg, then another 25 mg 6 hrs. later. Ok Y next day. 4/21/2009 4/21/2009 d and swollen 35 mm X 35 mm Y 6/4/2009 6/5/2009 ived PENTACEL, PREVENAR, GENHEVAC B, and ROTATEQ on 5/4/09. On 5/5/09 child dev'd Y factile fever 5/4/2009 and red5/5/2009 maculopapular rash o oid, red, warm to touch. Swollen, raised, Y 6cm x 3cm. Y 6/9/2009 6/10/2009 adache "head pounding" chest tightness and some shortness of breath (although speaking Y normally) and6/8/2009 "feeling cold" 6/8/2009 - visibly shivering. v d Immunisation and then in about 2Yhrs developed so many hives on face, neck, arm, abdomenY had swollen 6/2/2009 upper lip. 6/2/2009 Was seen at emerg ven MENACTRA - Vaccine given 5/28/09 Y redness 5/29 then seen 5/31 in ER Hosp. for right arm Y swelling5/28/2009 shoulder to5/29/2009 hand - Numb/tingling h ed shingles like rash in left T8-9 dermatoma, Y 2 days after receiving the vaccine. 6/11/2009 6/13/2009 days post vaccination seen in office Y for rash. ATARAX Rx. U 6/3/2009 6/13/2009 vd MMR SubQ @ Health Dept. 6-11-09 Y Pt. returned to HD. Exhibits approx 10 mm by 15 mm Y reddened6/2/2009 & inflamed6/5/2009 area upper outer aspe lls, headache, sore throat achy arms and legs. Y 6/1/2009 6/1/2009 Y 7/1/2008 7/2/2008
irritability with green/mucus colored stool with presence of blood, which was Hemacult + andY in office, pt 6/4/2009 improving. 6/6/2009 at 2 AM on 6/9/09 with temp of 101.4 & feeling dizzy. As of 8 am was feeling better, temp gone. Y 6/8/2009 6/9/2009 urred 5 to 7 days after shingles vaccine on sides of neck and other places shingles would appear. N Was 3/13/2009 taking NITROFURANTOIN 3/18/2009 MACRO vaccines 4/21/09. That night he had chills and temp of 100 degrees. Stayed home from school Y on 4/22 AM. 4/21/2009 Had been 4/22/2009 treated with MOTRIN 6/8/2009 m red area with 3x4 cm raised x 6cm area. No drainage - warm to touch. Doctor advised Benadryl cream to 6/2/2009 area with6/3/2009 ice packs. If no better itching, erythema, and swelling about Y 2 days after injection. Improved with BENADRYL administration, Y no 6/9/2009 pain/tenderness. 6/11/2009 ss, swelling, erythema. No treatment necessary. Y 6/11/2009 6/11/2009 m neck back, chills fever sweating. Dizzy, Y nausea, fatigue, muscle weakness. U 5/27/2009 5/29/2009 6/10/2009 /9/09, on 6/11/09 MOC called, stated pt. had red area back of rt. arm, size 1"x2", hurts a little, U not itchy 6/9/2009 6/11/2009 6/9/2009 se reactions previously d fever and a seizure afterwards. Was Y taken to the ER at medical center. Y 6/4/2009 6/5/2009 n and stated that 2 months after ZOSTAVAX, she was dx with shingles. Pt had never had shingles Y disease 3/24/2009 before. 6/1/2009 dema, tenderness, fatigue onset 15 hours after injection. Felt arm pain with movement 15 hours after injection. 6/8/2009 Unable 6/9/2009 to move arm withou
ite is reddened and raised. Circumference is approx. 2 inches in diameter. tenderness, nausea Y
U Y
6/9/2009 6/5/2009
6/6/1999
ough. Chicken pox 6-8-09 Lesions- neck- face. hands + arms. Y 5/28/2009 ng at menactra injection site within Y hours of administration. later same evening pt c/o heat swelling Y redness 6/12/2009 at site pt 6/12/2009 taken to care now dx was given Typhoid at 0915 on 06/06/2009. Y He had onset of localized pain and discomfort at site. Y Approximately 6/6/2009 1 hour 6/6/2009 later his pain spread pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 10/28/2008 with Pneumonia. Y Vaccination 9/22/2008 took place ### on 9/22/2008. Ac pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/21/2008 with atrial fibrillation. Y Vaccination 9/22/2008 took place ### on 9/22/2008 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2 3/26/2009 with vertigo Y and small bowel 6/13/2007 obstruction. 3/26/2009 Vaccination took th and 13th day after receiving the MMR, Client experienced fever (She didn't take her temperature),chils, Y 5/11/2009 sore throat 5/23/2009 and tiredness. These h after injection the patient woke upYwith loss of function in her left arm. Went to ER and for therapy. Y She 6/5/2008 was told it was 7/4/2008 nerve damage, un Was hospitalized with meningococcal meningitis Y and bacteremia. 6/24/09 3 Hospital ER records Y received DOS### 3/29/09. 3/28/2009 Assessment: Menin p given, employee experienced nausea, vomiting, dizziness, palpitations, pain @site. No swelling. Y 5/14/2009 5/14/2009 d smallpox vaccination on June 6, 2009, Y a Saturday. On the following Tuesday, his right armUstarted to hurt 6/6/2009 and gradually 6/9/2009 worsened. On Fr 10 p.m. - phone call from cl reporting he woke up at 3 a.m. this morning with severe muscle and joint pain6/2/2009 in shoulders, 6/3/2009 elbows and hips. E N 6/4/2009 6/5/2009 ollowing 1st gardasil injection patient reports muscle weakness or pain, non-progressing. Also N c/o fatigue. 3/25/2009 Medical records 4/27/2009 received DOS 5 len, Painful, warm to touch. Symptoms started one hr after administration and continued for Y 7 days. 6/10/2009 6/10/2009 as given Hepatitis A vaccine instead of Hepatitis B vaccine Y 6/16/2009 6/16/2009 am: Two days after vaccination, patient reported that site of injection was red, swollen and warm Y to the touch. 6/10/2009 Pt reported 6/12/2009 that size of area o l asleep on the car ride home (very unusual at that time of day). He then became feverish and Y fell asleep6/10/2009 for the night 6/10/2009 at 7:00--two hours af ot his vaccinations on Thursday Y morning. Y Then Y on Saturday night he2was sleeping, started vomiting, U when 5/21/2009 I went to 5/23/2009 clean him up he was sta reddened, swollen and painful some Y itchy. Mother stated notice swelling last evening 6/16/09 Y at about 8.00pm. 6/15/2009 Mother 6/15/2009 did not massage ar ccines on 6-5-09, and on 6-14-09 child began to have a rash that looked like clots on back, Y no drainage or 6/5/2009 raised areas. 6/14/2009 It is now everywhe es child has been seizure free sinceY8/08. Has had 10 seizures since start of rabies vaccine Y series - Has5/28/2009 2 doses left.6/1/2009 1st dose given here o en around 11am 6-12-09. Mom called Y around 2pm- patient crying, unable to console. Eft egYinjection site 6/12/2009 swollen, red. 6/12/2009 Advised to apply he a to injection site- Rt. leg (upper) started 9 days after vaccines. U 6/5/2009 6/13/2009 n has been received from a 63 year old female patient who was on 17-DEC-2008 vaccinatedNwith the first 2/18/2009 dose of GARDASIL 0.5 ML on bu n has been received from a 36 yearYold female patient who in 2006 was vaccinated with the Nthree doses4/25/2007 of GARDASIL. The patient was no n has been received from a nurse concerning her daughter a 14 year old female with amoxicillin Y allergy and 3/6/2008 no other3/6/2008 medical history who in G AND REDNESS ON RIGHT THIGH,LATERAL ASPECT MEASURING 55cm X 70cm. Y 6/10/2009 6/11/2009 Y Y N er had a seizure with vomiting. Date immunization Y given rash on back 1 and abdomen. No prior Y fever. 8/26/09 6/8/2009 Hospital 6/10/2009 records received DO 5/29/2009 N 5/27/2009 5/29/2009
### N ### ### mbness, tingling, burningYof feet, progressing Y toYcalves and near knees. 8 8 days hospitalization. Y N Immunoglobulin 10/1/2008 - 5 days. 12/6/2008 7/13/09 Hospital ep shot on 4-22-09. it was put in my right arm. still today it still hurts and has pain in it. neverUhad a problem 4/22/2009 until i got 4/23/2009 the shot. ng gardasil shots my daughter has complained of frequent headaches, hair loss, and joint pain. ous chills and pain in the left arm with Y swelling and muscle aches. Low grade fever. Large 4x6" U round, raised, 6/8/2009 indurated, 6/11/2009 red warm area aro as sore for the remainder of the day after receiving his 2 shots on 6/12/09. He refused to allow Y me to look, 6/12/2009 and thinking 6/13/2009 he was only sore (a urs after immunizations patient developed Y severe headache. At bedtime patient's mouth wasYdistorted to right 6/4/2009 and was 6/4/2009 numb and tingling. as administered vaccine. Patient then began to have a vasovagal syncope reaction. Patient was Y immediately 6/16/2009 given oxygen. 6/16/2009 Patient was lay after vaccine was given, onset of temperature Y to 102 axillary and diarrhea. Illness resolved inY3 days total. ### ### breath, extreme shortness Y of breath.Has Y never experienced this before. Rash on upper torso. U Patient crawled 3/26/2009 to front 3/28/2009 door and opened do ceived approx 8 hrslater edema andYitching at site. Returned to clinic approx 18 hrs later withY 3.5 x 3.5 cm 6/16/2009 warm, red, 6/16/2009 indurated itchy rather 4) reduced with acetaminophen, but resumed, red/warm/pain at injection site, arm is swollenYand slightly6/12/2009 hard/firm to6/12/2009 the touch. Left brachial neuritis after HPV/Gardasil vaccinations..History of Illness: 1/20/2009 Y - Presented N for initial 8/28/2008 evaluation by 8/31/2008 hand surgeon. By his GIVEN VACCINES BECAME DIZZY AFTERWARD FEET ELEVATED AND GIVEN COOKIE.YDIZZINESS6/17/2009 ABATED AFTER 6/17/2009 FIVE MINUTES veloped bacteremia without focus and tested positive Y for Neisseria meningitidis 2 from her blood. Y 6/24/092/13/2008 Hospital records 3/25/2009 received DOS 3/2 my Zostavax DS PWD #1 ON jANUARY 12, 2009. I feel fine 95% of the time. The other 5% U my shingles 1/12/2009 are on fire.2/1/2009 Kind of like a hot pok r, greater than 103F, axillary. Gave Tylenol Y and Advil with temp remaining elevated next dayUwhen grandparent 6/15/2009 placed 6/15/2009 call to vaccine admin d to wait immediately after vacine. Felt Y ok for a minute or so, got onto the elevator started toYfeel dizzy and 6/17/2009 blacked 6/17/2009 out and face planted in n: Had febrile illness within 24 hours for both vaccines. 1st episode required hospitalization.NDeveloped chronic ### headaches after 2000 dos n: diffuse puritic rash 2 days post anthrax, HBV, and meningococcal vaccines. Comment: Initial VAERS 5/25/2003 completed Oct 03. Symptom: Le n: Diffuse maculopapular rash of both Y UE/LE and trunk within 48 hours of anthrax #2 and yellow fever vaccines. 3/11/1999Symptom: Joint Pain, mu mpetent w/ past - MMR rash. Decreased Y WBC count 1.7, ANC700. Resolved within 1wk. Y 5/29/2009 5/31/2009 received spv, yellow fever, typhoid, and flu vaccines. Y On that day 29 after Y the vaccinations, gradually started to feel ###"exhausted ### and weak" - h n on 06-11-09. Began having an elevated temperature on 06-12-09. Also c/o headache, stomach Y ache,6/11/2009 + diarrhea.6/12/2009 Highest temperature w redness and swelling from injection site to approx. 1 inch of elbow. Client not c/o pain or discomfort. Y 6/15/2009 6/16/2009 and red reaction with induration approx. 10 cm in size less than 30 minutes following vaccination. Y These reactions 6/16/2009noted 6/16/2009 at VARIVAX vaccin a phone call from patient 6-9-09 stating c/o fever, headaches, generalized body aches and nausea hours after receiving Tdap on 6-8-09. d rash on face and upper body. Over in 3 days. Terribly itchy, hives, swelling right side eye-chin-collar Y bone. 6/10/2009 lethargic. 6/11/2009 Took benadryl on 9 grandmother presented to Health YUnit and reported that health care professional went to pediatrician Y today 6/9/2009 & was6/10/2009 sent to E.R. for "high f Y Y 6/15/2009 6/15/2009 accine #1, #2, #3- no problems. 10/06/03- received Y anthrax #4- along 10 with Hep A #2 and Hep U B #2- few 10/6/2003 weeks later ("by the ###end of Octobe seizure that evening after receiving vaccines in office. Dad report stiffening & shaking episode Y < 1 min while 2/17/2009 in highchair 2/17/2009 at restaurant. The Kinrix on 6/11/09, IM/L arm. Mom noted redness + swelling on 6/12/09, arm warm to touch Y in the upper6/11/2009 deltoid area; 6/12/2009 good ROM. Mom re Kinrix on 6/10/09 IM/Larm; mom noted redness + swelling on 6/11/09. No impaired ROM, c/o sore to touch; 6/10/2009 arm red, 6/11/2009 warm swollen from e received ANTHRAX vaccine #1 - no problems 2/27/04 Y - deployed to7foreign country 4/21/04 - received ANTHRAX 4/21/2004vaccine 4/22/2004 #2 and HEP B va e, fever, right hand swelling, arm, leg Y pain. N 6/12/2009 6/13/2009 n: 1/21/05- received primary FLUMIST- no problems. Y 1/23/05- "felt run 2 down". 1/24/05- c/o n/v, U diarrhea,1/21/2005 fever (temp 1/23/2005 not taken), chills and n not around injection site. Rxd Benadryl 25mg 1-2 a day LORATADINE 10mg 1 a day. Y 6/15/2009 6/16/2009 on site erythema, induration, tenderness lasting more than 1 month; worsening after each anthrax vaccination. Right sided axillary adenopa administered 06/10/09 at about 11am. By 2pm child began to scream uncontrollable until about Y 7pm. No6/10/2009 treatment necessary. 6/10/2009 Was adminis oke out on forehead, face and neck. Benadryl 12.5mg/ml given (PO). Y 6/17/2009 6/17/2009 , reproducible arthralgias after each anthrax vaccination. Currently stationed in Qatar. Joint Pain, multiple joints### Start: 5/22/2004 comment: received smallpox vaccine on his left upper arm Y (3 jabs)- denies any 2 problems. 08/27/04 - onset U 0600 while 8/27/2004 sleeping - bilat chest pain ("du tous, non-fluctuant, indurated area. Warm to touch, no exudate or focus of fluctuance or purulence. Y 6/15/2009 6/15/2009 urated, mildly erythematous lesion over deltoid Y 6/15/2009 6/16/2009 ction to vaccine Y 6/15/2009 6/17/2009 d - swollen, red AMOXICILLIN RX started w/DTAP. 6/15/2009 area of erythema/swelling (L) biceps, 2 by 2 cm area of erythema/swelling (R) bicep low grade Y fever x 24 6/15/2009 hours. 6/15/2009 , induration, swelling, itching left deltoid! - treated for cellulitis with Keflex. U 6/15/2009 6/15/2009 hly circular red/warm/itching raised Y patch surrounding injection site. Few clear vesicles (central ) noted started 6/15/2009 less 6/16/2009 than 24 hrs after injectio received anthrax vaccine #1 along with SPV- about a week later, noticed rash on left inner thigh- c/o moderate 1/31/2003 pruritus2/7/2003 was dx'ed with "poi
received from patient on 11/2/04 No problems with first three ANTHRAX vaccines 10/09/03 - received anthrax 11/1/2003 vaccine #4 (foreign country)ve L arm / shoulder pain with weakness. Medical records requested. Symptoms: Joint Pain, isolated start: 6/12/2003 6/12/2003 comment: left shoulde n: 2/3/05- received SPV (3 pokes, left upper arm) along with flu vaccine (right upper arm)- states U was "getting 2/8/2005 over a cold" (only sx= nasal c n: SM developed, N&V, HA, diarrhea about 72 hrs post anthrax vaccination #1, which recurred U with second 7/8/2007 anthrax in Sept. Symptom: Fati le, ADSM, presents as a referral from Y clinic for chest pain after smallpox vaccine. Symptoms:Y Chest pain,5/28/2009 fever, headache, 6/5/2009 general. n : progressive fatigue, cognitive loss, anhedonia, myalgias, arthralgias after each anthrax vaccine Comment: ### med records requested Sym n: This patient reports back pain, knee pain, headache, fatigue, memory loss, sleep disturbance, and hair 3/22/2003 loss since starting ANTHRAX vac n: Headache, arthralgias, memory loss, fatigue, visual change, fever after anthrax vaccine #2. Symptom: Head,### general; Symptom: Joint P ve, persistent bilateral shoulder pain, bilateral UE, numbness / fatigue, diffuse headaches failing to improve with ### NSAID'S muscle relaxants, n: Headache, Myalgias, UE/LE paresthesias worsening after each anthrax vaccine; SX beyond Y 30 days. Symptom: 2/2/2003 Headache, general star n has been received from a medical assistant (MA) concerning a 41-day-old patient who on U 08-Apr-2008 4/8/2008 was inadvertently 4/8/2008 vaccinated with n has been received from a health professional Y concerning a 3 year old male who on 29 OCT U 2007 was vaccinated ### with 0.5 ###ml, a second d n has been received from a physician Y concerning a male with obsessive-compulsive disorder N diagnosed7/23/2007 prior to vaccination on 23-JUL-200 n has been received from a registered nurse concerning a 1 week old infant who on 21-MAY-2008 U was vaccinated 5/21/2008 at 5/21/2008 the pediatrician's offic n has been received from a physician concerning a 11 year old male with no pertinent medical Y history or drug 7/1/2007 allergies who in July 2007, w n has been received from a consumer who is the mother of the patient, reported that her sonUwent in for his 2 month immunization shots an n has been received from a physician concerning a 2 year old male who on 24-JUN-2008 was N vaccinated 6/24/2008 with VAQTA 6/24/2008 vaccine, 0.5 ml, IM n has been received from a nurse concerning a male who was vaccinated with VAQTA. It was U reported that the patient developed hepatitis n has been received from a registered nurse concerning a 36 year old female patient who onU28-FEB-2008 2/28/2008 was vaccinated 2/28/2008 with an 0.5 mL n has been received from a consumer Y concerning Y a approximately 15 1 months old male with Y egg allergy,10/1/2007 peanut allergy 10/1/2007 and beef allergy wh n has been received from a nurse concerning Y a female with allergy to nuts who on 06-JAN-2006 Y was vaccinated 1/6/2006with1/6/2006 the first dose of VAQ n has been received from an office manager concerning a female who on 06-AUG-2008 wasUvaccinated with 8/6/2008 a dose 8/6/2008 of VAQTA. On 06-AUG n has been received from a registered Y nurse with no allergies or medical history who on 26-JUL-2004 U and 1/31/2005 on 31-JAN-2005 8/27/2008 was vaccinated n has been received from a physician concerning a 6 day old patient who was intended to receive U RECOBIVAX 10/3/2008 HB,10/3/2008 was inadvertently adm n has been received from a nurse practitioner concerning a female patient who was vaccinated U with a dose of VAQT. The patient showed n has been received from a physician Y concerning a patient who on 04-NOV-2008 was vaccinated N with VAQTA 11/4/2008 vaccine. Subsequently the p n has been received from a physician concerning a 14 year old female who on 19-JAN-2009Nwas vaccinated 1/19/2009 intramuscularly 1/19/2009with a first dos n has been received regarding a case Y in litigation concerning a 49 year old female who on 19-Nov-2007 N was vaccinated ### with ### first dose of h n has been received from a registered nurse concerning a patient's uncle who on an unspecified U date was vaccinated with MMR II. Subseq n has been received from a physician concerning Y a "very old" female 0 who was vaccinated with U MMR II. The patient recently received MMR n has been received from a physician Y concerning a 14-year-old male with type 1 Ydiabetes mellitus, Y no known 8/5/2008 drug allergies, 8/6/2008and a family hi n has been received from a physician concerning Y a 4 year old male 0with egg allergy and a history U of asthma 8/8/2008 who on 8/8/2008 08-AUG-2008 was vac n has been received from a consumer concerning Y her 32 year old daughter 0 who recently received U a booster dose for MMR II. It was reporte n has been received from a physician concerning a 5 year old female who received her first Y dose of MMR II at 15 months of age (approxim n has been received from Y a physician concerning Y his wife, who as a0child Y was vaccinated Y with Y MMR II. Subsequently the patient experienc n has been received from a consumer concerning her now 6 year old son with "family genetic N history (predisposition) 8/1/2003 8/1/2003 of motor skill problem n has been received from a medical assistant concerning an adult male who was vaccinatedUwith a dose of MMR II as a child. The patient h n has been received from a healthcare worker concerning a nurse regarding MMR II. The nurse U was cut on shattered vials of vaccine recei n has been received from a nurse practitioner concerning a 32 year old male who on 09-DEC2008 N was vaccinated 12/9/2008 with MMR ### II SQ, 0.5ml. n has been received from a consumer concerning her 12 month old son who was vaccinatedYwith a dose of MMR II (lot# not provided) 0.5m n has been received from a physician Y concerning a female with DEMEROL allergy, arthritis, Uosteoporosis,4/3/2006 hyperlipidaemia### and hypothyroid rmation has been received from a pharmacist and follow-up information was received from aUregistered nurse 3/12/2007 concerning 3/25/2008 a 34-year-old fem n has been received from a consumer Y concerning her daughter with no pertinent medical history N or drug8/10/2005 allergies who 3/29/2008 on 01-MAR-2001 an n has been received from a registered nurse concerning a 22 year female health worker withUno pertinent medical ### history 3/28/2008 who, on 16-Sep-1 n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a nurse practitioner (NP) concerning a 19 year old female, with noUprior medical conditions, who was vaccinated n has been received from a PharmD. Y concerning a 5-year-old male with an allergy to porcineY and bovine gelatin who in approximately 2006 n has been received from a pharmacist Y concerning a 19 year old female with a history of convulsions N in childhood ### who on### 19-NOV-2007 w n has been received from a 47 year old female pharmacist reporting on herself with an unknown N medical history and unknown drug allergie n has been received from a physician Y concerning a 1-year-old male with a history of stroke and N heart problems 4/10/2008 who4/10/2008 on 10-APR-2008 was n has been received from a physician Y concerning an approximately 28-year-old female with no medical history or allergies who as a child w
n has been received from a physician concerning a white male who, on an undisclosed date,Nwas vaccinated 8/17/2004 with a10/1/2004 second dose of MMR I n has been received from a physician Y concerning a 15 month old female no pertinent medical N history, drug 4/3/2008 reactions 4/15/2008 or allergies who on 03 n has been received from a registered nurse concerning a now 25 year old male medical student U who on 8/3/1995 10-Apr-2008 8/3/1995 was vaccinated with n has been received from a physician Y concerning a 12 month old male with no pertinent medical Y history, drug 4/3/2008 reactions 4/3/2008 or allergies who on n has been received from a registered nurse concerning a male with no pertinent medical history and no8/24/1999 drug reactions/allergies 4/1/2008 who on 09 n has been received from a physician concerning a 12 month old female who was vaccinated U with MMR II. Concomitant therapy included V n has been received from a physician Y concerning a 14 month old female with a history of urinary U tract infection 4/16/2008 and 4/22/2008 no known drug reaction n has been received from a health professional concerning an adult patient who was vaccinated U with MMR II as a child and had a negative n has been received from a health professional Y concerning a 15 month old female with a penicillin Y allergy 1/31/2008 who on 31-JAN-2008 2/11/2008 was vaccin n has been received from a physician Y concerning a patient who was vaccinated with 2 dosesUof MMR II. Subsequently, 9/2/2003 3/7/2008 the patient develop n has been received from a registered nurse concerning a female allergic to porcine who "atU5 years of age", in approximately 2001, was va n has been received from a pharmacist concerning a female who in the past was vaccinatedUwith a dose of MMR II. Subsequently the patie n has been received from a physician Y concerning a 12 month old male who, in February 2008, Y was vaccinated 2/1/2008 with MMR 2/1/2008 II. Concomitant th n has been received from a physician concerning a patient who on 01-MAY-2008 was vaccinated U with a second 5/1/2008 dose5/1/2008 of MMR II. Concomit n has been received from a registered nurse concerning an approximately 27 year old male N consumer with no known allergies or pertinent n has been received from a consumer concerning a 12-month-old male who, on an unknownNdate, was vaccinated subcutaneous with 0.5 m n has been received from a health professional Y concerning a 5 year old female on 06-MAY-2008 U was vaccinated 5/6/2008with5/6/2008 MMR II (lot number 6 n has been received from a physician Y concerning a 4 year old female, with no pertinent medical N history, 4/25/2008 drug reactions 5/4/2008 or allergies who on n has been received from a pharmacist concerning an approximately 30 year old female whoU was vaccinated with her second dose of MMR n has been received from a physician concerning a 24 month old female who was vaccinated U with MMR. Concomitant therapy included VA n has been received from a physician concerning a 5 year old female who was vaccinated with U MMR II. Suspect therapy included VARIVAX n has been received from a licensed Y practical nurse concerning a 5 year old female with no U pertinent medical 4/25/2008 history or drug allergies who, n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately Y 20-MAR-2008 3/20/2008 ("in the last 2 weeks") n has been received from a physician Y concerning a 12 month old female who, in February 2008, Y was vaccinated 2/1/2008with2/1/2008 MMR II. Concomitant n has been received from a consumer concerning her male son with allergies to eggs, soy, wheat, U mustard, peaches, maple syrup, milk, sh n has been received from a health professional Y concerning a 51 year old female with drug allergies N to penicillin, 2/11/2008 iodine 4/23/2008 and Acetaminophen n has been received from a NP concerning Y a male with no known medical history or allergiesU who on 07-MAY-2008 5/7/2008 5/20/2008 was vaccinated sc with n has been received from a physician concerning a 9 year old male patient who in 2003 wasUvaccinated with 1/1/2003 a second 5/22/2008 dose of MMR II (Me n has been received from a nurse practitioner concerning a 13 month old female with no pertinent N medical 4/28/2008 history or4/28/2008 drug allergies who on n has been received from a pharmacist concerning a patient (age, gender unspecified) who U thought the patient was vaccinated with a dose n has been received from a physician Y concerning a 4 year old male child who on 25-FEB-2008 U was vaccinated 2/25/2008 with4/12/2008 a second dose of MMR n has been received from a physician concerning an "approximately 12 or 13 month old" male Y child with egg 5/1/2008 allergy, 5/1/2008 "very allergic and atop n has been received from a health professional Y concerning a 9 year old male who sometimeUin 2000 was 6/9/2008 vaccinated6/9/2008 with his first dose of M n has been received from a physician concerning a 26 month old female patient who was vaccinated U with a dose of MMR II vaccine and th n has been received from a physician Y concerning her "approximately 2 year old" son who onUan unspecified date was vaccinated with MMR n has been received from a licensed Y practical nurse concerning a male patient with sulfa eyeNdrop hypersensitivity 8/1/1991 and 6/2/2008 a history of migraine n has been received from a health professional concerning an adult patient who was vaccinated U with MMR 1/1/2007 II as a child 1/1/2007 and had a negative n has been received from a health professional concerning an adult patient who was vaccinated U with MMR 1/1/2007 II vaccine1/1/2007 as a child and had a n n has been received from a registered nurse concerning a patient who on 17-JUN-2008 wasUvaccinated IM 6/1/2008 instead 6/16/2008 of SC with a dose of MM n has been received from a physician Y concerning a 4 year old female patient who was vaccinated U with a dose 7/3/2005 of MMR II at 16 months of ag n has been received from a medicalYassistant concerning a 21 month old female child with no Y known allergies, 6/10/2008 or pertinent 6/23/2008 medical history n has been received from an office Y manager concerning a 12 month old male child with no known Y allergies, 6/10/2008 benign 6/14/2008 heart murmur and ecze ported that her daughter experienced fever about 7 days after vaccination with her first doseYof MMR II, injection, when the child was 3 and n has been received from a physician concerning a 19 year old female with penicillin allergyNand AUGMENTIN allergy who had two doses o n has been received from a physician concerning a 13 month old female old female with portNwine naevus 6/23/2008 and sensitivity 6/23/2008 to OMNICEF who n has been received from a nurse practitioner concerning a 4 year old female with a history U of eczema who 9/4/2004 on 04-SEP-2004 was vaccinate n has been received from a health professional Y and healthcare worker concerning a 21 yearUold female who 11/1/1996 on 01-NOV-1996 was vaccina n has been received from a physician Y concerning a female patient with an "autoimmune disease" Y who on 1/5/1998 an unspecified 2/1/2008 date was vaccinat n has been received from a registered Y nurse concerning a 50 year old female employee withYpenicillin and 6/6/2008 codeine allergies 6/8/2008and an unspec n has been received from a physician concerning a 15 month old male patient who in approximately Y July 7/1/2003 2003, was vaccinated 7/1/2003 with a first d
n has been received from a registered Y nurse concerning a 42 year old female patient who onUan unspecified date was vaccinated with MMR n has been received from a medical assistant concerning a female who (on an unreported date) U was vaccinated with7/1/2008 MMR II (Lot # not rep n has been received from a licensed practical nurse concerning a male patient with no known U allergies or pertinent medical history who on n has been received from a pharmacist concerning a patient who received her primary series U received a third dose of MMR II about four ye follow-up information has been received Y from a physician concerning a 4 year old female patient Y with a protease 7/23/2008sensitivity 7/24/2008 and no pertinen n has been received from a CMA and physician's assistant concerning a 38 year old female Nsmoker with6/17/2008 hypertension, penicillin allergy, co n has been received from a pharmacist concerning a pregnant female who is "due any day now" N that was vaccinated with MMR II and is te n has been received from a physician Y concerning a female patient in her "mid 40's" with no allergies N or pertinent 7/7/2008 medical 7/19/2008 history who on 07 n has been received from a consumer Y concerning his adult wife, who was undergoing fertilityUtreatments, whom he believes was vaccinated n has been received from a physician Y concerning a female who has negative titers for Rubella U after she was already given 2 doses of MMR n has been received from a physician concerning a 33 year old male, affiliated with another U unspecified 7/29/2008 practice, who 7/29/2008 on 29-JUL-2008 was n has been received from a pharmacist Y concerning a 46 year old female who on approximately N 19-JUL-2008, 7/19/2008 "about 7/19/2008 3 weeks ago" was vac n has been received from a physician concerning a 5 year old male patient with congenital heart Y disease who was vaccinated at an unspec n has been received from a physician Y concerning a 55 year old female with a history of breast N cancer who 7/29/2008 on approximately 8/7/200829-JUL-2008 w n has been received from a healthcare worker concerning a 1 year old female who, on 06-JUL-2008, U was6/6/2008 vaccinated with MMR II (lot numb n has been received from a certifiedYmedical assistant concerning a 22 year old male who on U an unspecified date ###was 7/1/2008 vaccinated with a fir n has been received from a registered nurse concerning a 45 year old male who on 31-JUL-2008 N was vaccinated 7/31/2008SQ8/3/2008 with the first dose of n has been received from a physician concerning a 4 year old female with no medical historyUwho, in 2004, 7/23/2008 was vaccinated 7/31/2008 with a first dose n has been received from a pharmacist concerning a "post menopausal" female volunteer atUher facility who was vaccinated as a child with follow up information has been received from a mother concerning her son with a history of N premature birth 10/8/2007 who on 08-OCT-2007 ### was vac n has been received from a female Y consumer with penicillin, naproxen and ezetimibe (MSD)Nallergies who "14 years ago" in 1994 was vacc n has been received from a 30 year old female with a history of adhesions in 1997 who on 17-JUL-2008 N 7/17/2008 was vaccinated 7/17/2008 with MMR II (lot# n n has been received from a medial Y assistant concerning a 4 year old male who received theNsecond dose8/4/2008 of MMR II 8/6/2008 (rHA) (Lot # 655380/13 n has been received from a medicalYassistant concerning a 5 year old male patient with no known Y allergies 8/12/2008 or pertinent 8/14/2008 medical history who n has been received from a physician Y concerning a 12 month old female with no medical history N or allergies, 8/5/2008 who on8/15/2008 05-AUG-2008 was va n has been received from a patient's mother concerning a 5 year old female with peanut oil allergy U who in approximately 2006 was vaccina n has been received from a certifiedYmedical assistant concerning an 18 month old male, who Y is otherwise 7/23/2008 healthy, 7/30/2008 who on 23-JUL-2008 at n has been received from a female nursing student who was vaccinated in the past (unsure U of how many doses she was given) with MMR n has been received from a registered Y nurse concerning a 36 year old female with drug reaction U to NORGESIC 8/4/2008 FORTE 7/30/2008 which causes naus n has been received from a consumer concerning a female child who was vaccinated with aUdose of MMR II on an unspecified date. Subse n has been received from a consumer concerning a male child who was vaccinated with a dose U of MMR II on an unspecified date. Subsequ n has been received from a consumer via the internet concerning her healthy toddler child who U on an unspecified date was vaccinated with n has been received from a physician Y concerning Y a now 29 year old female Y patient, who in 1980, Y at age one 1/1/1980 was vaccinated 1/1/1980with the first d n has been received from a physician Y concerning an approximately 5 year old female who inUNovember 11/1/2007 2007 (when 6/1/2008 she was 4 years old), n has been received from a physician concerning a male who on 26-AUG-2008 was vaccinated U with the8/26/2008 first dose of8/26/2008 MMR II. Suspect thera n has been received from a physician concerning a male who was vaccinated with MMR II. The Y patient developed erythema after getting M n has been received from a nurse atY a health department concerning a 39 year old male, who Y on 17-JUL-2008, 7/17/2008 was8/10/2008 vaccinated with MMR n has been received from a nurse concerning Y a male with no known allergies and reported no U pertinent medical history who was vaccinate n has been received from a physician concerning a 23 year old male with no known allergiesUor medical history who 6/6/2006 in approximately 1986 n has been received from a consumer Y concerning a 14 year old female who was vaccinatedYwith a dose of MMR II when the patient was a n has been received from a physician concerning a 12 month old male with a history of kidney Y transplant7/30/2008 waiting list, 7/31/2008 feeding tube, congeni n has been received from a patient's mother concerning her 7.5 year old daughter with no allergies U or pertinent 9/26/2005 medical 8/1/2008 history who was va n has been received from a nurse concerning Y an adult female who on 29-AUG-2008 was vaccinated N with 8/29/2008 a booster9/10/2008 dose of MMR II. On 10 n has been received from a nurse concerning a 42 year old male with allergy to Prozac whoNreceived dose 1/2/2008 1 of MMR 8/18/2008 II as a child tested ne n has been received from a registered Y nurse (RN) concerning a 30 year old female with no allergies U or medical history 9/5/2008 who was vaccinated n has been received from a pharmacy student concerning a 48 year old female with drug reactions/allergies N 6/1/2008 to NSAIDS, lidocaine, morphin n has been received from a consumer concerning her 35 year old son who received MMR IIUwhen he was a young child. It was reported tha n has been received from a registered nurse concerning a 36 year old female who has received U two doses 9/18/2008 of MMR9/18/2008 II in the past (date not r n has been received from a consumer, who is a nurse, concerning her 15 month old male son Y with no medical 9/9/2008 history 9/10/2008 or allergies who on 0 n has been received from a certified medical assistant (CMA) concerning a 5 year old male who N around the 8/1/2008 second9/25/2008 or third week of August n has been received from a physician concerning a 19.5 year old female patient with penicillin N and AUGMENTIN allergy who had two dose
n has been received from a pharmacy Y student concerning a 4 year old male who on 23-SEP-2008 U was vaccinated 9/23/2008 with 9/23/2008 MMR II (lot # 66179 n has been received from a consumer Y concerning her 3 year old son with no pertinent medical Y history or8/27/2008 allergies who 9/3/2008 on 27-AUG-2008 wa n has been received from a licensed practical nurse concerning a 34 year old pregnant female U with seasonal 7/30/2008 allergy8/15/2008 and thyroid disorder b n has been received from a physician concerning a male patient with no medical history andUno drug reactions/allergies who on an unspeci n has been received from a nurse at a physician's office that a "12 month old" patient with noU medical history, 10/3/2008 received a dose ### of MMR II, in n has been received from a physician Y concerning a 12-month-old female who in September N 2008, was vaccinated 9/1/2008 with 9/1/2008 MMR II, Hep A (ma n has been received from a pharmacist concerning a patient who was vaccinated with MMRUII. It was reported that the patient was given M n has been received from a consumer concerning her older son who on an unspecified dateUwas vaccinated with a dose of MMR II (lot num n has been received from a 31 year old female licensed practical nurse with no medical history N or allergies who on an unspecified date whe n has been received from a consumer Y concerning a 1 year old female who on 10-OCT-2008Nwas vaccinated via ### injection with ### MMR II. Seco n has been received from a consumer concerning his son who was vaccinated with a dose of U MMR II. Subsequently the patient developed n has been received from a nurse concerning Y a male who was vaccinated with both doses ofY MMR II and 4/13/2006 subsequently, the ###patient develop n has been received from a patient who was vaccinated with MMR II (route and site not reported). U The patient had a previous experience w n has been received from a patient's Y mother concerning her 15 month old son with hypersensitivity Y to Amoxicillin 1/31/2006who 2/15/2006 on 31-JAN-2006 was n has been received from a nurse concerning Y a patient who in 2007 was vaccinated with a dose U of MMR II, RECOMBIVAX HB (MSD) (lot # n has been received from a nurse practitioner Y concerning a 31 year old female student with Y depression and 9/26/2008 no drug10/7/2008 reaction or allergy who n has been received from a nurse concerning Y a female patient who on 24-DEC-1999 was vaccinated N with a dose ###of MMR II (lot #625634/0 n has been received from a registered Y nurse concerning a male adult patient who on 20-NOV-2007 U was vaccinated ### subcutaneously with a n has been received from a Doctor Y of pharmacy concerning an adult female patient who in September N 2008 9/1/2008 was vaccinated with a dose of n has been received from a registered nurse concerning a 4 year old female with no medicalNhistory who on 10-NOV-2008 ### ### was vaccinated n has been received from a consumer concerning her child with a history of anaphylactic reaction U to latex who on an unspecified date was n has been received from a physician Y concerning a patient who was vaccinated with a dose Uof MMR II "years ago". It was reported that the n has been received from a certified medical assistant concerning an unidentified patient who U on unspecified date in the past "may" have b n has been received from a physician Y concerning a 5 year old "healthy" female with a historyYof skin irritation at### injection site ###(onset 24-OCT n has been received from a pharmacist concerning a patient who was vaccinated with MMRII. U The pharmacist reported that the patient exp n has been received from a caller concerning a 14 year old male patient with allergy to GEODON N and a 12/3/2008 history of slight 12/3/2008 emotional difficultie n has been received from an adult female Y consumer who in her childhood was vaccinated with U a dose MMR II. In approximately 1/1/2009 January 20 n has been received from a consumer concerning her a 36 month old son who, "probable when Y he was 18 7/1/2007 months to 2 1/2 years old", was n has been received from a consumer concerning her son, a 12 month old male with allergies Y to formaldehyde 1/10/2006 and 1/11/2006 fragrance mix and histo n has been received from an office Y manager concerning a 14 month old female who on 13-JAN-2009 Y was 1/13/2009 vaccinated 1/13/2009 with a dose of MMR n has been received from a registered nurse who on 14-JAN-2009 was administering MMR N II and some vaccine splashed 1/14/2009 into her eyes. Th n has been received from a physician Y concerning a patient who "several months ago" was vaccinated Y with a dose of MMR II (lot# not provi n has been received from a registered Y nurse concerning a 30 year old male patient with no pertinent U medical history and no drug reactions n has been received from a consumer concerning her son with reaction to all vaccines and medications Y he 5/7/2001 has received 5/7/2001 that contain gelatin n has been received from a medical assistant concerning an 18 year old female who in approximately U 1991, "when ### she was 1 year of age" n has been received from a physician concerning a 5 year old male with drug reaction to flu Y shot a year ago who on12/1/2008 unspecified date was v n has been received from a nurse practitioner concerning a now adult male who was, on unspecified U date, vaccinated with 2 doses of MMR n has been received from a nurse practitioner Y concerning a now 36 years old male who on unspecified U dates was vaccinated with two dose n has been received from a consumer concerning his 9 year old son with attention deficit disorder U (ADD) diagnosed when he was very you n has been received from a consumer concerning her 4 year old daughter with no medical history Y and drug 1/19/2009 allergies1/26/2009 who on 19-JAN-2009 n has been received from a nurse concerning an approximately 28 year old male student who U was possibly vaccinated with MMR II and ha n has been received from a physician concerning a 5 year old patient who on an unknown date U was vaccinated with the second dose of MM n has been received from a registered Y nurse concerning a 35 year old female with problemsUwith fertility11/5/2008 and a miscarriage### in July 2007 and n has been received from a consumer concerning her son who was vaccinated with MMR II.USubsequently the patient experienced severe n has been received from a consumer concerning his daughter who was vaccinated with MMR U II. The consumer reported that the patient h n has been received from a Registered Y Nurse concerning a patient who was vaccinated withUall three doses of MMR II. The patient's antibo n has been received from a consumer concerning her four and a half year old son with no pertinent Y medical 8/1/2005 history and no known allergies n has been received from a consumer whose husband on an unspecified date was vaccinated U with MMR II and had reactions like fever and n has been received from a physician Y concerning an approximately 12 month old (reported as U "1 year of age") 2/6/2009 patient who on approximate n has been received from a licensed visiting nurse concerning a 30 month old male patient with Y a history2/13/2009 of jaundice2/13/2009 at 3 weeks old who on n has been viewed on the internet concerning a 15 month old female who was vaccinated with U a dose of MMR II. Concomitant vaccination
n has been received from a registered Y nurse concerning a 27 year old female who in 1981 was U vaccinated 9/10/1981 with a first dose of MMR II, in 19 n has been received from a consumer concerning her now a 5 years old son who in approximately Y 2005 ("when he was 1 year old") was va n has been received from a healthcare Y worker concerning a 30 year old male who was vaccinated U with a dose of MMR II when he was a ch n has been received from a registered Y nurse (R.N.) concerning an 8 year old male with 1 sibling Y who on 6/29/2001 29-JUN-2001 2/2/2009 was vaccinated subc n has been received from a consumer concerning his 6 year old son who on an unknown dates U was vaccinated with both doses of MMR II. n has been received from a consumer, Y who is the uncle of the approximately 24 months old N male patient with no previous medical history w n has been receive from a registered Y nurse concerning of himself a 27 year old male with sulfonamide U allergy 8/9/1982 who in 1983 was vaccinated umer reported that 10 years ago, in 1999 her son had a very severe reaction. He experienced Y a seizure and a high fever. The consumer sta n has been received from a health care worker concerning himself. It was reported that in 1947 U the patient was vaccinated with 2 doses of n has been received from a consumer concerning her 8 year old son who was vaccinated with U a dose of MMR II. It was reported that the pa n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with MMR II. It was reported that he n has been received from a registered nurse concerning her daughter with frequently injection Y site reaction after unspecified vaccination wh n has been received from a licensed practical nurse concerning a female with no medical history U or drug allergies 9/1/1983who was vaccinated with n has been received from a nurse practitioner concerning a 12 month old female who on 19-FEB-2009 N was 2/19/2009 vaccinated 2/23/2009 with a dose of MMR n has been received from a nurse practitioner concerning a female infant with allergies to seafood Y and shellfish who was vaccinated with a n has been received from a physician Y and a nurse concerning a 13 month old female who on N 23-FEB-2009 2/23/2009 was vaccinated 3/4/2009 with MMR II. Th n has been received from a consumer concerning her now 4 year old son with an intolerance N to gluten and 1/1/2006 a history 1/1/2006 of "GI Issues" who "wh n has been received from a nurse practitioner concerning a female who on an unspecified date U was vaccinated with a dose of MMR II (dos n has been received from a patient concerning his wife who on an unspecified date, was vaccinated U with a dose of MMR II vaccine. The re n has been received from a consumer concerning her now 15 year old daughter who was vaccinated Y with "one dose" of a MMR II "when sh n has been received from a case inYlitigation for WAES #0610USA022225 from a physician U via medical records concerning a 55 year old fe n has been received from a consumer concerning her 12 month old daughter with no pertinent Y medical history 12/1/2008 or drug 12/1/2008 reactions or allergies n has been received from a consumer concerning her 10 year old son who on an unspecified Y date was vaccinated with a dose of MMR II (L n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with a dose of MMR II. It was report n has been received form a consumer concerning her 5 year old daughter with no pertinent Y medical history 8/1/2005 and no drug 8/1/2005 reactions or allergi n has been received from a physician Y concerning a 12 month old male with no pertinent medical N history 2/25/2009 and no drug3/13/2009 reactions or allergies w n has been received from a consumer concerning her 12 month old son who was vaccinatedNwith a dose of MMR II. Concomitant therapy i n has been received from a consumer concerning her daughter 4 years old who at 15 months U old (2005) was vaccinated with a dose of MM n has been received from a consumer Y concerning her 6 year old son who on an unknown date N was vaccinated with the first dose of MMR I n has been received from a consumer concerning herself (a "37 year old" female) with food N allergies who received MMR II series as a child n has been received from a physician concerning a male patient with unknown drug reactions U and asthma who was vaccinated with a seco n has been received from a pharmacist concerning a patient who was vaccinated with a dose U of MMR II on an unspecified date. Subseque n has been received from a Physician Assistant concerning an 8 week old patient who on 20-MAR-2009 U 3/20/2009 was vaccinated 3/20/2009 with MMR II due t n has been received from a consumer concerning her approximate 14 month old daughter with N no drug allergy 3/31/1999 who on 31-MAR-1999 was v n has been received from a consumer Y concerning a friend's 19 month old daughter "who went Y to the emergency room 1/1/2009 with a 105 degree fe n has been received from medical assistant Y concerning a 35 year old female with asthma, seasonal N allergy 8/28/2008 and tetracycline 3/16/2009 and erythromy n has been received form a consumer via e-mail, who was vaccinated with a dose of MMR IIU(lot# not reported), on 5 different occasions an n has been received from a Registered Nurse concerning a 47 year old male with benign prostatic U hyperplasia 2/20/2009 and no drug allergies who o n has been received from a consumer concerning a male who on an unspecified date was vaccinated U with a dose of MMR II (dose, route a n has been received from a Registered Y Nurse (R.N) concerning her 4 year old son with no pertinent N medical 2/1/2006 history and 2/1/2006 no known drug alle n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. It was repor n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. it was repor n has been received from parents via e-mail concerning their son who was vaccinated with aUdose of MMR II on an unspecified date. The p n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with MMR II. The consumer reporte n has been received from a medical assistant concerning a 13 month old male who on 17-MAR-2009 Y was 3/17/2009 vaccinated 3/17/2009 with MMR II (lot # 66 n has been received from a female consumer who was vaccinated with a dose of MMR II (HSA) U over 20 years ago. Over 20 years ago the n has been received from Y a physician Y concerning a female patient who was vaccinated Y with NGARDASIL. The patient received the first dose n has been received from Y a registered Y nurse (R.N.) Y concerning her daughter nowY18 year old, Y with drug hypersensitivity 6/1/1998 7/1/2008 to PHENERGAN w was received on 09-June-2009 from Y a consumer. A male patient of unknown age received the N following vaccination 6/1/2009 on 6/9/2009 01-June-2009: sma ort was received 11 June 2009 fromYa health care professional. A 35-year-old female patient with a history of chronic hepatitis B had receiv ENTED TO MEDICAL C/O RASH AND SWELLING X 1 DAY. PT STATES THAT RASH STARTED Y APPROXIMATELY 3/18/2009 3/18/2009 5 HRS AFTER HE R
Y 6/16/2009 6/17/2009 oke out with shingles in his eye and Yon scalp 102 weeks after receiving vaccine. Y 6/5/2007 4/22/2009 ceived pneumococcal vaccine on 5/13/09. Y On 5/14/09, developed pain, redness, warmth, erythema Y at injection 5/13/2009 site.5/14/2009 WBC elevated at 11.8 Fainting episodes x2 after vaccinesYgiven. Recovered x1 after glass of water given. Second Y time it was6/17/2009 difficult to 6/17/2009 wake her, shallow breat 6/17/2009 6/18/2009 d vaccine 9/11/08 and became pregnant Y in 2/09. She then had a fetus that "was not thriving"Y and she had 9/11/2008 a D&C done 5/26/2009 5/26/09. Please no ted to our office on 6/18/09 with left Ysided rash. Rash began one day after varivax was administered in the6/9/2009 left arm. 6/10/2009 Rash is present on the after vaccine patient complained to parents Y that her R arm was hot and redness and swellingNwere noted.6/15/2009 She was given 6/16/2009 Ibuprofen and col accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 6/4/2009 hroat 10 minutes after the injection Y got dry and felt like an object was in it, and his left arm atYthe shoulder 6/18/2009 felt like it 6/18/2009 was numb. Had a little h d papule rash and itching face,upper and lower body. I took the vaccine 2/24/09, but since then N as a RN I2/24/2009 have administered 6/17/2009at least 30-40 accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/1/2009 No harm 6/1/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/1/2009 No harm 6/1/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. No harm done to patient. ng of continued pain and soreness in the muscle of the left arm in the deltoid region. Pain with deep palpation 6/7/2009 of the6/18/2009 lymph nodes under the sters on lt arm where varicella vaccine Y was placed. Pt also has erythema/induration of 4cm xY5cm surrounding 6/16/2009 area6/16/2009 where varicella vaccine have the following symptoms about 3 hours following the shot: high Fever, Hallucinations, soreness, Y joint 7/20/2006 pain, aches 7/20/2006 and fatigue. Once th alled stating that he was running a fever up to 101 on day 10 of small pox vaccine and was complaining Y of6/7/2009 discomfort 6/17/2009 under the arms from mergency room twenty-four hours after Y vaccinesY were administered with 1 apenic spells and cyanotic U episodes, 5/22/2009 along 5/23/2009 with fever. 7/7/09 Hosp accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. as entered into the electronic medical record as a female. The nurse gave the patient an HPV Y as indicated 5/4/2009 for female patients. Upon return lls, muscle aches, sore joints, swollen glands, headache, fatigue all started the day after the Yvaccines were 6/16/2009 given. Patient 6/17/2009 had to leave work , body aches, blotchy redness, and severe swelling Y to right upper arm 2 especially near & surrounding N PPSV 6/15/2009 injection6/17/2009 site. 7/2/09 Hospital r walk 5 hours after shot was given. Limped Y on leg where shot was given. Gave tylenol and was Y able to walk 6/17/2009 again after 6/18/2009 2 hours. Expected th dministered, vaccine 2 weeks out of date; No adverse event observed in patient. 6/16/2009 sted that these side-effects be reported. DTAP given at Left Deltoid (IM). Mother reported Left Y arm red, sore, 6/15/2009 had hard 6/17/2009 knot, and warm to to ollen, red, + bump Dxper Dr L leg cellulitis Y vaccine Rxn. Y 6/16/2009 6/17/2009 igh with induration, red 4x4 cm. U 6/16/2009 6/17/2009 OC onset about 10 minutes post injection with 10-15 seconds tonic posturing. Patient recovered Y consciousness 6/18/2009 in less 6/18/2009 than 30 seconds - B arm pain and swelling. Noted arm, area red slight swelling confined to injection site, size of U .50 cents piece. 6/15/2009 Able to6/16/2009 move extremity well. S Y Y 9/23/2008 10/7/2008 and swelling onset 1 day after immunization given. 2/24/2009 2/28/2009 given left Deltoid on 2-7-09 On 2-9-09 pt had small welt at site. On 2-10-09 it had increasedUin size to 4.5"2/7/2009 X 3" with warmth 2/9/2009& swelling at th 01 degrees, - fever at 5:00 p.m day of vaccine given 2/11/09. Next morning 2/12/09 arm very Y sore at site2/11/2009 and hand 2/11/2009 swollen. Had rings cute as in her car seat, after grandparents Y had come out of the grocery store. Grandparents noted Y child was twitching. 12/3/2008 Unresponsive ### & had som n has been received from parents, aY physician Yand a medical assistant 2 concerning a 19 yearUold female 2/20/2009 with anxiety, 2/20/2009 depression, asthma, t ay of vaccine 17 hr HA and arm hurt at injection. Took EXCEDRIN - no relief. No redness at injection U site.6/10/2009 Pain L arm 6/10/2009 with movement at inje and ZOSTAVAX on 5/4/09. Y He started experiencing Y numbness/tingling Y (R) feet and hand with U weakness 5/4/2009 one week5/15/2009 later which has been p nutes of injections, pt became acutely droopy, nauseated and vomited profusely. He was flushed Y and sweating. 6/17/2009 3x4 6/17/2009 cm. Wheal at site of VA ns (seizures) approx. 1 day after shots. 6/26/09 Y Received hospital medical 1 records for 6/18-6/19/2009 U admit. 6/15/2009 FINAL6/16/2009 DX: seizure-like spells ching and drooling Y N 6/3/2009 6/15/2009 ter injection. No adverse affects. Y 5/28/2009 5/28/2009 d, swollen red lesion on Rt, posterior Y upper arm. U 6/16/2009 6/17/2009 er 4 month shots, developed raisedYrash all over body. Change in personality -> lethargic, decrease N in babbling 3/12/2009 and3/14/2009 cooing, screaming, dec LA complications: None - mild illness with rash, no fever 6/19/2002 6/10/2009 aria. ZYRTEC. N 5/6/2009 5/8/2009 d Tdap @ 9:30 am on 6/10/09. At 12 00 pm on 6/11/09 pt developed nausea. Had to lie down Y for 15 hrs6/10/2009 and fell asleep. 6/11/2009 Woke up 3am on 6 oid where Tdap administered on 6/6/09 became indurated, erythematous, swollen, warm, painful. Y On Monday 6/6/2009 6/8 patient 6/6/2009 seen in office and nt received DTaP vaccine IM in left thigh on 6/10/09. Patient was seen in the office on 06/12/09 U with a 3 6/10/2009 cm x 3 cm irregular 6/11/2009 area of redness ticed the injection site was red and swollen Y on 6/16/09, mother marked the swelling with a pen U and over 6/15/2009 the course of 2 days it was increas nting episodes with 1st dose of GARDASIL on 4/7/09. With this 2nd GARDASIL & within seconds Y pt. got6/15/2009 pale, as she 6/15/2009 was laying down her
Y Y 5/22/2009 5/23/2009 me to IMMs complaining of redness rash, itching and soreness under arm of ACAM2000 vaccination site.5/5/2009 me to IMMS complaining of rash, redness, and itching at and around ACAM2000 vaccination site. 5/5/2009 eported "it looked like hives all over"Y - Rash-1wk- after MMR II, VARIVAX, HAVRIX given. Red Y itchy papules 3/18/2009 2mm-1cm 3/28/2009 varying site and loc 7, 2009, I noticed a rash on my back Y (right side). Two days later, the rash was spreading with U blisters and 3/5/2009 itching. Saw 3/7/2009 doctor, confirmed ES EVERY TIME HE RECEIVES ANTHRAX VACCINE SINCE 1999, HE SUFFERS TEMPORARY Y MEMORY 7/11/2008 LOSS. 7/12/2008 HE RECEIVED 5 SER given at about 12:15 PM June 16. Headache began immediately upon leaving the clinic. At 10:00 Y PM her 6/16/2009 R arm began 6/16/2009 significant muscle tw n has been received from a nurse practitioner, for the pregnancy Registry for VARIVAX (Merck), U concerning 7/3/2008 a 25 year 7/3/2008 old female with a his n has been received from a nurse concerning Y a 31 year old male with anaemia macrocytic, Y aNhistory of immune 6/8/2009 thrombocytopenic 6/9/2009 purpura n has been received from a pharmacist Y concerning a 48 year old female who on 08-JUN-2009 Y was vaccinated 6/8/2009 with a6/9/2009 dose of PNEUMOVA n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e n has been received from a consumer concerning his 5 year old son who on 01-JUN-2009 was Y vaccinated 6/1/2009 with a second 6/8/2009 dose of MMR II 0 n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e n has been received from a physician Y for the Pregnancy Registry for GARDASIL concerningYa 22 year old 11/8/2007 female who 11/8/2007 on 06-SEP-2007 wa n has been received through the Merck pregnancy registry for GARDASIL from a registeredYnurse concerning ### a female 2/1/2009 patient who on 17-J n has been received from a physician who heard from the mother of one of his patients that U she was told by a pediatric rheumatologist that n has been received from a 25 yearYold femaleYwith a history of overgrowth 0 bacterial and "ZIPORO" N (therapy 3/1/2009 unspecified) 3/1/2009 allergy who in Ma n has been received from a Registered Pharmacist Y (R. Ph.) concerning 0 a 96 year old femaleUwho was vaccinated subcutaneously with a 0. n has been received from Y a medicalYassistant concerning a 11 week old male patient with oxygen Y therapy 6/12/2009 since birth 6/12/2009 and a history of prem ving client home. Client c/o not feeling well, became hot, eyes rolled back and head went down. Y Mother6/18/2009 called the6/18/2009 EMS. When the squad accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/2/2009 No harm 6/2/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. her called clinic on 6/19/09 after child received third dose of the HPV vaccine on 6/17/09. Per U Grandma,6/17/2009 the child had 6/18/2009 no immediate proble o upper right arm noted that evening . Continued to spread and covered entire upper arm. TxY cool cloths, 6/15/2009 tylenol for 6/15/2009 discomfort. At presen nd swelling at site of vaccination in right arm that started on the day of vaccination. U 6/16/2009 6/16/2009 ness and swelling on site. Tender and Y hard subcutaneous tissue. No other symptoms. Prescribed U Motrin 6/15/2009 and told to 6/15/2009 soak area in warm wate ability, muscle/joint aches, headache, diarrhea X4 days U 6/15/2009 6/16/2009 U 6/16/2009 6/16/2009 welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients within U one week6/16/2009 with reaction 6/16/2009 to Varivax. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. njection site, Left upper arm erythema and edema surrounding and below immunization injection Y site (13.5/10cm) 6/17/2009 6/18/2009 welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients seenUwithin one 6/17/2009 week with reaction 6/17/2009 to varivax accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. dministered 6/16 @ 10am then on 6/17 in late afternoon, pt noticed L head tenderness in hair Y and tender 6/16/2009 glands in 6/17/2009 neck on L side. This oc accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. EACTION TO VACCINE U 6/16/2009 6/18/2009 veloped Shingles on 1st branch right Y trigeminal. Patient has pain, swelling, itching, redness N to right side 6/11/2009 of face and6/14/2009 forehead. Temp 99.0. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/3/2009 No harm 6/3/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. 7 pm on 6/17/09, client had small bruise on R deltoid where 1 of the vaccines was administered. On 6/18/09, 6/17/2009 redness 6/17/2009 was noted to R delto ceived Pneumo vaccine right deltoid mm post alcohol swABBING. c/o small amount reddness Y - @ 1 " in 6/15/2009 area with a6/17/2009 small 1"" track towards accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. 6/4/2009 No harm 6/4/2009 done to patient. ODE ENLARGED ON L INGUNAL REGION ABOUT 1CM IN DIAMETER MMR GIVEN SQ IN L THIGH 6/2/2009 6/19/2009 e of the flu shot there is a 5cm areA of macular erythema with multiple confluent vesicles . Across Y the mid 12/9/2008 chest large patches ### of macular e ollowing administration of Hepatitis A, Meningococccal and HPV vaccine, 6-18-09, patient ran Y a fever of 100.6 6/17/2009 degrees 6/18/2009 F and complained o eceived Havrix (Peds Hep A) vaccine Y on 6/16/2009. Developed fevers to 101+ farenheit thatYevening. Had 6/16/2009 acute mental 6/17/2009 status changes th d varivax on 11-21-1997, pt presented in our office on 6-17-2009 with scattered 10-15 nacular U lesions some sl ### papular 6/15/2009 without vesicles 2 da 6/15/2009 6/19/2009
ed the prescription for the Oral Typhoid vaccine from the Health Dept on 6/15/09. Ct started U the capsules6/16/2009 on Tuesday, 6/19/2009 6/16/09. Ct took her orts back on 6-18-2009, one day after Y receiving dose #3 of HPV, that she now has Knots on back of head 6/17/2009 that are tender 6/18/2009 to touch. No prob IVED VARIVAX ON 1-14-2002 AND 3-3-2009. PT PRESENTED IN THE OFFICE ON 6-17-2009 U WITH 25-30 3/3/2009 SCATTERED 6/15/2009 MACULAR LES R on 6/11/09. Kristin states had bumps on face and right knee 6/15/09 about the size a dimeYwith a little head 6/11/2009 in center. 6/15/2009 Exam on 6/19/09 fe veloped afebrile Seizures Y on 05.23.2008, was Y diagnosed with Infantile 11 Y Spasm. Now Y has Seizure N disorder 5/17/2008 and global 5/23/2008 developmental delay. shot was uneventful. After scab fell off while overseas wound started to heal up. Wound didYnot heal like 8/23/2007 everyone else. 4/1/2008 Scar did not hard came faint, diaphoretic and was eased onto the floor. Her VS stayed normal, she was givenYO2 and within 6/16/2009 1 minute 6/16/2009 was conscious and or vaccine 6/16/09, each day following the site of injection became increasingly redder, more painful U and swollen. 6/16/2009 By 6/18/2009 6/19/09, began itching, rsistent low grade pain since time. No Y functional ROM deficits, pain 1-2 of 10 in nature. Clinical Y exam normal 9/19/2008 w/palpation 4/3/2009 of deltoid. No palp @ 2:30 pm immunization given. 6.17.09 @ ~ 5:30 pm --> fever (1m 104) - Hives @ 11:00 pm.UNo facial swelling 6/17/2009 or difficulty 6/17/2009 breathing. Histor 9 patient felt generalized joint pain. Noticed swelling both ankles. Reported as non-pitting. Denise Y treatment. 6/9/2009 Joint pain 6/10/2009 resolved by 6/11/09 swelling at injection site (lower deltoid at left arm). Recommended Diphenhydramine 25mg and U Ibuprofen. 6/16/2009 6/17/2009 at site of injection - 6/17/09 2hrs. Body ache and joint pains 6/18/09. High fever. Y 6/17/2009 6/17/2009 redness and edema around the injection site, significant swelling of leg even 2 days, later, warm Y to touch 6/17/2009 advised parents 6/12/2009 to put warm com was reported by a physician, Y via a GSK representative Y and described 4 the occurrence Y of intussusception Y 5/27/2009 in a 4-month-old 6/4/2009 male subject who d zoster PCR confirmed. Y Y 9/28/2005 4/9/2009 htness in throat, pale, wheezing Y andYcollapsed Y in clinic lobby. Mom took 1 him right to ER. He Y had anaphylaxis 6/2/2009 to vaccines. 6/2/2009 Received Epinep - 04-24-09 = left arm, shoulder, Y neckY and rib pain Y with muscle spasms. 2 No treatment. 04-27-09 N - severe pain 4/20/2009 in left side 4/27/2009 of my back, more p 6/7/2007 t pain in her back on 6/10/09. Patient Y didn't realize that she had a rash till 6/14/09. The rash U was approx.5/22/2009 6" in diameter 6/10/2009 in a circular pattern VRIX in prefilled syringe in the left thigh with 1" needle. After immunization given, realized that Y it was an adult 6/9/2009 dose. Evaluated child for 20 m swelling at site of injection. Red, swollen, warm to touch. Ranging 3 in by 1 in by 1 in. Encouraged U mother 6/18/2009 to place 6/19/2009 ice pack, give appropria t 6.18.09 Acute URI 4 mo check-up vaccines given see below- Return visit 6.19.09. Fever within 24 hrs of 6/18/2009 vaccine administration 6/19/2009 probably v d 1/2 dollar size hive around area of injection - c/o pain & itching. Y 6/18/2009 6/18/2009 ped localized redness and swelling over (L) Vastus Lateralis sites within 24 hrs. Now 2 wks later Y has an erythematous 6/4/2009 6/4/2009 ring about 10 cm with soon after immunization followed by vomiting some hours later symptoms resolved within 48 Yhours never had 3/4/2009 fever. 3/4/2009 and swelling at injection sites. Fever 99.3. Y 6/9/2009 6/10/2009 hemic area approx 3cm diameter, LYdeltoid. Y 6/17/2009 6/19/2009 d with C. difficile on 2/27/09 and 4/21/09 Y 2/6/2009 2/15/2009 6/11/2009 , Redness around injection site right thigh area, warm to touch. Tx-Infant TYLENOL liquid, Hydrocortizone Y 6/16/2009 0.5% 2x 6/17/2009 a day for few days cough.. mother brought child to car - before leaving child c/o itching all over and turned brightYred. Brought 6/10/2009 back into6/10/2009 office c/o cough sweati welling/redness, pain and blister at the injection site. U 6/17/2009 6/19/2009 ven a DTaP rather than a Tdap. He had no adverse reactions. 5/20/2009 4/29/2009 hargy began 24 hrs after shots. The entire upper R arm swollen, red, hot, tender not localized Y abscess. 6/16/2009 6/17/2009 ular raised red area at (R) thigh. Y 6/17/2009 6/18/2009 opal reaction minutes after vaccination. Hypotensive + bradycardia immediately after near syncopal Y episode 6/17/2009 and cool, 6/17/2009 pale, diaphoretic. La s, started 11 hours after the injection. Fever 101 deg; shaking chills; no localized reaction; noYparathesias.6/8/2009 Severe headache. 6/8/2009 ema (notable lips & (L) eye), SOB. BENADRYL Y & SOLUMEDROL given. Y 6/9/2009 6/11/2009 receiving Pneumovax & Zostavax, pt began having head fullness/pressure, ears tingling, walk Y fatigued. 5/28/2009 Some lightheadness. 5/28/2009 1 wk later st iven 6/4/09. Pt developed within 24 Yhours fever, swelling, chills and generalized hives. She was U seen on 6/9/09 6/4/2009 when6/5/2009 a large erythematous on LUE with YF Vax 2:30pm 6/15/09Yafter screening. At approx. 2:35 pt c/o redness, swellingYand itching6/15/2009 at injection6/15/2009 site- 25 mg BENADRY redness at site one day after vaccine administered. Knot under (L) arm two days after. U 6/12/2009 6/14/2009 swollen to shoulder & down to end of deltoid muscle observed in office. Dad reported red swollen Y - req. Abx. 6/10/2009 therapy. 6/11/2009 at Gyn which came back positive forY high risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 N after receiving 6/18/2007 3 dose 6/5/2009 GARDASIL 8/11/06, 1 6/9/2009 ame lethargic, flushed, diphoretic and vomited. A 3x4 cm eccentric wheal developed at the left Y arm site, followed 6/19/2009 by 6/19/2009 a wheal at the right arm ur hours after the PPV vaccine (administered at 2:00 PM Thursday, 6/18 PCT)or Friday, 6/19Y around 5:00 6/18/2009 PM my temperature 6/19/2009 dropped per ; Severe and continuing headache;YUnusual and continuing sleepiness; Unusual tiredness, Yweakness (sudden 6/18/2009 and6/19/2009 severe); Severe and co e, chills, unwell, slightly swollen glands.
ministered the Anthrax Vaccine Y by the on 2 October 2006 due to the fact I was an Y active duty N service member 10/2/2006 assigned 10/4/2006 to a foreign country. redess within 1 hour of vaccine. Within 2 hours of vaccine, headache and fever of 103 degrees N F. Fever 6/19/2009 and headache 6/19/2009 reduced by Motrin eal hipertension after 1.5 months after Y the secon Y dosis and finally results 8 in neuropatic painY( 1 week after 3/9/2009 the first symptons) 5/25/2009 gerated reaction at site of injection.YRed, swelling, temp. 99.9, painful 6/19/2009 6/20/2009 RECEIVED HEP B, POLIO, PNEUMOCOCCAL DISEAS, DTAP, AND HIB. THE INJECTIONS Y WERE GIVEN 6/18/2009 AT 4 PM 6/19/2009 ON 6-18-2009, WIT ad his 4th dose of DTAP and his 3rd of Polio on June 18,2009 at appr. 3:30pm. He was fine Ybefore the shots 6/18/2009 and the 6/19/2009 evening after. First th n has been received from a pediatrician Y concerning a 15 month old male patient who on 14-APR-2008 N was 4/14/2008 vaccinated 4/22/2008 with a dose of MMR n has been received from a physician concerning a 1 year old female who on 02-OCT-2008 Nwas vaccinated 10/2/2008 with the10/2/2008 first dose of MMRII. S n has been received from a consumer concerning her 6 year old daughter who was vaccinated N with a dose of MMRII (lot number not provid Y Y Y N 12/9/2008 was received from a health professional Y on 09 June 2009. A 49-year-old male patient, with aNhistory of seasonal ###allergies,### received an inje was received from a health care professional Y on 09 June 2009. A female patient received anUinjection of FLUZONE ### SV '2005-'2006 USP (l n has been received from a physician Y concerning Y a 6 month old male 8 patient who on 06-JAN-2009 Y was vaccinated 1/6/2009 with 1/6/2009 one dose of ROTA n has been received from a 17 yearYold female, for the pregnancy registry for GARDASIL, with Y asthma and 3/21/2008 VICODIN 3/21/2008 allergy, who in Janua n has been received through the pregnancy registry for GARDASIL from a registered nurse Y concerning a8/18/2008 14 year old 8/18/2008 female with no pertine n has been received from a consumer Y concerning her approximately 17 year old Ydaughter with N no medical 3/31/2008 history or 9/1/2008 allergies who was vac ng after receiving the vaccine (06/18/2009) she woke up with severe body aches, felt like the Y flu, and Rt.6/17/2009 deltoid warm 6/18/2009 and tender to the tou for doctor's visit and was ordered Gardasil Y vaccination. Patient received vaccination and wasY instructed 6/19/2009 to remain in6/19/2009 waiting are for 20 minu ately 2 to 4 days after 2nd rabies vaccine, pt developed widespread, wheal-like rash to lowerUarms, lower6/15/2009 legs, back6/17/2009 of neck, & upper chest me in 6/22/09 stating that child has been fussy, running a low grade fever and unwilling to take U a bottle since 6/19/2009 vaccines 6/19/2009 given. No fever toda 6/11/2009 N 5/21/2009 6/11/2009 ng of lesions on right wrist, hand, and Y genital region 8 days after small pox inoculation. Instructions U on keeping 6/12/2009 lesions 6/20/2009 convered, good han esented with red, swollen, painful area on arm where vaccine was administered approximately Y 72 hours after 6/8/2009 shot was 6/9/2009 given. We told her to ely after Pt received second vaccine: Twinrix, Her head went forward towards knees. Pt wasYreturned to 6/18/2009 sitting position 6/18/2009 and regained aware amined - tender, urticarial type reaction distal to injection site. Large tender, raised urticaria,Uwith central6/19/2009 dusky discoloration 6/19/2009on forearm, w out 3-4 hours I had a tight chest and nagging cough when I took a deep breath. Little dizzy on N day 2 and6/19/2009 blood spot6/19/2009 in my eye (never had t n 4/07/09- she developed a rash onYtrunk 6 days Y later on 4/13/09-it 2was scattered over her upper trunk area4/7/2009 she called 4/13/2009 Employee Health o a (from knee to buttock) of redness and swelling. Warm to touch. Starte >36 hours after injection Y 6/15/2009 6/17/2009 ved HPV and had fingerstick for hemoglobin. Y left exam room and was sitting alone in conference Y room began 6/22/2009 to feel 6/22/2009 light headed and was 2009, ONE DAY AFTER RECIEVING DTAP, MOTHER REPORTED MODERATE TO LARGE Y AMT. OF SWELLING 6/16/2009 6/17/2009 AT INJECTION SITE. R & throbbing headache Y 6/22/2009 6/22/2009 derness and swelling over posterior Y aspect of left upper arm on 5/28/09 @16:53. Treatment: Y Ice to area 3-4 5/14/2009 times daily, 5/14/2009 Medrol dose pack, tified office approx 45 minutes to 1 hour after vaccination that patient was having chills and was Y shaking.6/15/2009 Denies pain 6/15/2009 in arm. Instructed m pneumococcal vaccine trial, with severe COPD, was hospitalized on 02/23/2009 with COPDYExacerbation. Vaccination ### 2/23/2009 took place on 10/1 ax 23 was given 6/17/09. Within 24 Y hours, he began to feel some discomfort in that arm and Ydeveloped a6/17/2009 macular red 6/20/2009 rash around the injec WAS GIVEN ALONE IN DELTOID YAREA. NEXT DAY PT RETURNED WITH SWELLING, PRURITUS Y OVER 6/15/2009 WHOLE 6/16/2009 DELTOID AREA. as given a HPV injection and within Y seconds she fell over with loss of consciousness and jerking Y movements. 6/9/2009 Fell off6/9/2009 of exam table. Pt. wa o Pneumovax with the sweeling, induration,erythema, Y warthm and pain in the R arm and forearm Y 5/20/2009 d with Win. 9/29/09. Hospital records receivedYDOS 4/8/09 to 4/9/09. Assessment: Idiopathic Y Thrombocytopenic 3/28/2009Purpura. 4/8/2009 Child presents w ned she had warm facial cheeks and red rash on facial cheeks - both facial cheeks - warm toYtouch. Received 6/15/2009 vaccine 6/19/2009 on 06-15-09. MR given Left arm. 2nd in series #/MMR 5/14/09. 6/20/09 Noticed bruising, swelling, tender. 6 inch oblong 6/19/2009 area of redness 6/19/2009 and warm to tou ncopal event after administration of 4 vaccines (see below). Was caught before fell to floor, Ywas sat on chair, 6/16/2009 as soon 6/16/2009 as sat, her eyes ope tavax was administered in the R deltoid area, Ms. Cubelic has had intermittent intense itching in the right arm distal ### to the ### injection site. Th easles vaccination rash. Red, raised areas over all of body. Low Grade temp. Y 1/20/2009 1/29/2009 lling of from deltoid to just above elbow Y with redness and increased heat to palpitation. plus increased Y bleeding 4/3/2009 at injection 4/5/2009 site with subseq 2 days post injection. Left deltoid area became swollen and inflamed with a 1/2 dollar red lump Y that was6/12/2009 painful and6/14/2009 warm. Generalized mu h rash (small red dots) in diaper area 06/19/09) on 06/20 and 06/21/09 had red checks, low N grade temp.6/18/2009 slow progression 6/20/2009 of rash up abd to feeling well. Generalized weakness. Cold hands and goose bumps noted. V/S HR 88/minute Y RR 20; B.6/15/2009 P 90/60. Placed 6/15/2009 in supine position ing dizzy. V/S - HR 100/minute, RR 20, BP 100/60. Pt placed in supine position with feet elevated. Y Observed 4/13/2009 for other 4/13/2009 reactions. Pt reporte ed pain and swelling of 3" x 3" in L tricep Y area. Site showed no redness, duration x 2 days, character U is constant, 6/17/2009alleviating 6/17/2009 factors: nothing came faint for about 15 seconds then woke up fine. Was checked (provider) then discharged. Y Was watched 6/15/2009 for 30-45 6/15/2009 minutes. Pt had clon
se events reported by patient. Y 6/9/2009 cm, overlying cellulitis. U 6/14/2009 6/14/2009 eived MMR and Hep A on 4-10-08,Yat age 2. - Mom noticed increase bruising 1 wk prior to office N visit for4/10/2008 the same. 5/20/2008 She was seen on 5-20n has been received from a healthcare worker who worked with 15 patients with no medical U history who were vaccinated with a dose of MM 3.8) and febrile seizure 12 hours after vaccines administered. Y 6/8/2009 6/9/2009 ult diphtheria/tetanus vaccine on 06/16/2009. The following day experienced headache, muscle and joint6/16/2009 aching, flushing 6/17/2009 of skin, and mala sized red area back of right arm. U 6/9/2009 13 1/2 cm x 17 1/2 cm, swelling at left deltoid, upper arm Y 6/8/2009 6/10/2009 eltoid 10 cm bruise. Warm/Induration, Rash. Y 6/9/2009 6/11/2009 pt states she developed a hive on her face approx 48 hrs after receiving vaccines. Then 12Nhrs later developed 6/12/2009 hive-like 6/14/2009 rash on arms, but 's left deltoid was red + swollen. Redness measured 4cm, swelling measured 3-4 cm. Y 5/28/2009 5/28/2009 8/09. Vaccines were administered and the patient remained in the exam room in a supine position Y for 15 5/28/2009 minutes, with 5/28/2009 an additional 10 minu ys ago. No pain or fever. Itching @ site - no one else has had reaction very large redness & U swelling right 6/15/2009 ant thigh6/16/2009 10.5 cm X 9 cm DASIL given 5/11/09. She called my office on 6/17/09 to say she had itching in her fingers and Y water blisters 5/11/2009 after inj. 5/11/2009 She gets same rxn w his am with shot area painful - per mother. Y U 6/17/2009 6/18/2009 ed LPN to give Hep A and PREVNAR. Y PENTACEL given by LPN instead of PREVNAR. Patient Y recalled 6/15/2009 same day /6/15/2009 stable / no adverse effe ARICELLA left deltoid on 6/15/09 approximately Y 9:30 am, child noticed redness, induration and Y hard bump 6/15/2009 36 hr later 6/16/2009 as he showered, deni 5-8/day) for 2 weeks following the vaccine. Finally changed from Soy to Alimentum and so far Y is better. 6/5/2009 6/5/2009 o 103.3 within 24 hours of 2nd set of immunizations Y 6/16/2009 6/16/2009 he day of the vaccine, had diarrhea for the week after reported to me 6/22/09 Y 4/20/2009 4/20/2009 lands on left side of neck. 6/18/2009 6/22/2009 check-out area stating "i just don't feel right". Skin clammy patient escorted to exam room, had Y her lay down, 6/19/2009 lower 6/19/2009 extremities raised. Oran after PPD placement and GARDASIL Y < 10 second witnessed ?generalized tonic/clonic seizure. Y No post ictal 6/19/2009 no incontinence. 6/19/2009 with dizziness and SOB Y 6/22/2009 6/22/2009 a hospital. I was informed about the meningitis vaccine which is a series of 3 shots. It was suggested that I3/8/1989 have the vaccines. 3/8/1989 After the first as given ZOSTAVAX on May 22, 2009. Developed Zoster from neck to wrist on June 8, 2009. 5/22/2009 6/9/2009 ema erythema hyperemia from elbow extending to shoulder. 6/19/2009 6/20/2009 en; red and 3 in x 4 in area- warm to touch. Today blisters on leg. Using MOTRIN and ice onUleg. 6/19/2009 6/20/2009 er called 6-19-09 reporting redness, swelling and warmth to touch at injection site on right arm. Y She stated 6/17/2009 not sure how 6/19/2009 long, but patient jus B vaccine booster administered @ 3:45 PM. At approx. 8PM, health care worker (HCW) began Y to experience 5/20/2009 numbness, 5/20/2009 tingling @ injectio left arm red and swollen. Treatment - Benadryl 1/2 tsp TID U 6/10/2009 ecking out after check-up appointment Y and fell to the floor, white and pale. After 5 minutes, pt's Y color is good 6/17/2009 and pt6/17/2009 is A and O. Pt's vs norm d rash c/w very mild VARICELLA Y 5/14/2009 5/19/2009 lla given, supposed to be HAV. No reaction seen. 6/22/2009 m red area (L) Thigh. DTaP and Varicella given on 6-19-09. Y 6/19/2009 6/19/2009 d redness/swelling, fatigue 2 days after Y PNEUMOVAX injection. U 6/15/2009 6/15/2009 orted a rash that developed on back, neck and arms. Rash cleared up the same day. Y 6/11/2009 6/12/2009 cine 6/3/09. Fever 101 degrees 6/4/09. 101 degrees-103 degrees 6/5/09. Pain at vaccine site. Y 6/3/2009 6/4/2009 ess starting 6/11/2009. R arm 8cm x 9cm redness, warmth, slight indurated area, faint bruise Y under erythema 6/10/2004 able6/11/2009 to move arm. Ice/tylen dasil 1st dose on Aug 23, 2007, 2nd dose on Oct 23, 2007. I got pregnant in JanY2008. MyNunborn baby then ### diagnosed 1/22/2008 with ring chromos ort was received 10 June 2009 from a newspaper Y article: A female college freshman student had received an unspecified meningococcal va ort was received 10 June 2009 fromYa newspaper article: Two college students (one identified Y as a male and the other unidentified), had rec n has been received from a 21 yearYold female patient with a history of previous miscarriageYand anaemia2/1/2009 who in February 2/1/2009 2009, was vacc n has been received from a physician concerning a 15 year old female with depression who Uin November5/1/2008 2007 was vaccinated 8/1/2008 with her firs n has been received from a pharmacist Y concerning his friend's daughter who on unspecifiedNdate was vaccinated with a dose of GARDASI n has been received from a pharmacist concerning two patients who within the last 30 days U were vaccinated 5/9/2009 with ZOSTAVAX 5/9/2009 (Merck) (sub 103 degrees - diarrhea -Yloss of appetite Y - severe Y stomach pain - weight 3 loss - weak/pale - lasted Y over 75/11/2009 days. Hospital 5/14/2009 stay was 3 days, tre Pt c/o pain in feet; 112508 pain cont, Y now can'tYpick up objects with44 hands; 112608 Y requires Y assist to walk 11/7/2008 into ER; 112708### is now bedboun ceived ZOSTAVAX vaccine on 5/26/09 and began having adverse reactions on 5/28/09 of body U aches, headache 5/26/2009and 5/28/2009 fever. (Dtap) whole arm swollen noticed 6/16/09 received imm on 6/15/09 4pm gave Rx Dermatop Y- watch give6/15/2009 tylenol Benadryl 6/16/2009 as needed. urticarial lesion w/o any systemic symptoms. Non pruritic papular lesion surrounds the punctum U where MMR 6/16/2009 was given. 6/16/2009
eddened, feverish knot with redness going to axillary area. Itchy 3 1/2X2 " knot redness 7 1/2" U X 4 1/2" no 6/16/2009 streaking down arm (bubbly look dministered 6/17. Arm turned pink immediately following, then cleared. Several hours later arm N turned red 6/17/2009 and slightly 6/17/2009 swollen in a 3" diame iven to early per manufacturer. 5/22/2009 TDAP on 6/9/09 noticed hives to injection site and just below injection site to anterior upper Y arm. Had swelling 6/9/2009 blotchiness 6/11/2009 to areas and mu der swelling. U 6/15/2009 6/16/2009 ed and swollen. Y 6/10/2009 d swollen, warm, red and hard to touch-client Y mother encouraged to seek help at MD or ER. No U drainage noted 6/9/2009 at injection 6/9/2009 site. c/o L upper arm redness Y 4/29/2009 5/2/2009 OUR OFFICE FOR 4 YEAR OLD WELL Y CHILD VISIT. RECEIVED 4 YEAR OLD BOOSTERS: Y Dtap, MMR, 6/17/2009 IPV, AND 6/19/2009 Varivax ON 6/17/09. nt is a 46-year-old man who had Pneumovax Y vaccine here on June 17. Within 1 or 2 days, he Y developed6/17/2009 localized redness 6/20/2009 and irritation tha days after receiving MMR, Prevnar Yand Varivax vaccinations. U 5/13/2009 5/22/2009 ceived the shingles vaccine on Monday, and she came back today on 6/11/09 due to allergic reaction. She 6/8/2009 was told6/11/2009 if she had any problem other reports 3 to 4 hours after reciving Y immunizations yesterday, child started running fever U ranging from6/22/2009 99 to 101,6/22/2009 Child very fussy and cr er called pt complained of soreness Y at the site and feeling cold. The next day she c/o her heart Y racing and 6/17/2009 feeling some 6/18/2009 discomfort in her ch by Father, stated school nurse called Y that daughter face was swollen. Father instructed to take U daughter 6/22/2009 to ER. 6/23/2009 a Shingles vaccination at 2:30 PM last Friday (06/19/09) and am STILL experiencing headaches N today, Tuesday 6/19/2009(06/23/09). 6/20/2009 I was told at t e vaccine around 9:00 am, became tired, and went to sleep from 5 to 7pm, then back to bed Y later that night. 6/18/2009 Complained 6/18/2009 of excessive night ble crying, would not nurse or drink. Seen by physician within 4 hours of onset of symptoms.Y Eposide lasting 6/19/2009 24 hours. 6/19/2009 Physican dx pertu dap immunization yesterday. At 1100 Y pm she developed onset of HA/dizziness/chills/ nauseated. Y She also 6/22/2009 reported6/22/2009 to her mom some lowe N OF REDNESS, WARMTH, AND SWELLING TO RIGHT ARM 1 DAY AFTER RECEIVINGYVACCINES. 6/17/2009 REDNESS 6/18/2009 COMPLETELY AROU 2/21/2009 N 2/19/2009 2/21/2009 eloped a few small, raised, red dots on the face and in the hair line area. U 6/23/2009 6/23/2009 er and Grandmother after receiving second series of vaccinations "child will not play as before". U 4/1/2009 4/15/2009 earing Loss and balance problems 5 days after injection. MRI and MRA normal. ETN Y doctors N (started week 5/7/2009 folowing5/12/2009 SHL) put me on sterio /1:32pm-Anthrax vax rec'd IM L. Delt. 13 Jun 09/2:00am-Sore throat/fever/chills/flu-like symptoms Y noticed. 6/12/2009 Went to6/13/2009 ER later in the day wh e fever, polymorphous rash, bilateral bulbar conjunctivitis, cervical lymphadenopathy, erythematous U palms 4/30/2009 and soles, 6/21/2009 swelling of hands and of both ankles, purple/red color on heals. Y Extreme pain in left ankle/ achillies tenden/ lower leg. N Began December 11/6/200808-12/1/2008 Present. Can not stan d the initial left bicep muscle aches to Y a common reaction to injections; however deep throbbing U and aching 9/8/2006 in left bicep 9/8/2006 continued; and eve d a headache shortly after receiving vaccine 3/10/09. He also experience throbbing of the head Y and near 3/16/2009 his left eye 4/12/2009 thereafter. On 04/12 omplains of "severe itching" from head Y to toe. Member given Benadryl + Clairton by Doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" from head Y to toe. Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given Benadryl and Clartin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe" itching head-to-toe. Y Member given BENADRYL & CLARITIN by doctor.Y 6/22/2009 6/22/2009 omplains of "serve itching" from head-to-toe. Y Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009 omplains of "severe itching" head-to-toe. Y Member given BENADRYL and CLARITIN by doctor. Y 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given BENADRYL and CLARITIN byYdoctor. 6/22/2009 6/22/2009 omplains of "severe itching" from head-to-toe. Y Member given BENADRYL & CLARITIN by doctor. Y 6/22/2009 6/22/2009 935 Upon rising client stated "feeling dizzy, laid client down B/P 108/80 P64, R14, skin w/d appropriate Y for 6/23/2009 race, c/o 6/23/2009 legs feeling week", able d c/o pain + swelling (LD) area. Observed Y redness, swelling at area warm to touch. Y 6/17/2009 6/17/2009 hours post administration of HPV 1st seizure - no other risk factors. 7/9/09 Hospital ED records Y received6/15/2009 DOS 6/15/09. 6/15/2009 Assessment: New t- MENACTRA 5/21/2009 ot- MENACTRA 5/11/2009 the typhoid vaccine on 26 May 1982. He was seen Y in the clinic the50 following day Y for a reaction N to typhoid5/26/1982 with a temperature 5/27/1982of 100.6; diagn ot-MENACTRA 5/12/2009 as shaking violently for less Y than 20 seconds accompanied by pallor & diaphoresis. No loss of Y consciousness. 6/23/2009 7/14/09 6/23/2009 Records rec'd from P ately equal to 2 hours after eye and cheek swelling. No dyspnea, no vomiting. Y 6/12/2009 6/12/2009 doses of varicella on 2-17-04 and 2-19-08. Pt dx today with chickenpox. Y 2/19/2008 6/23/2009 tes that after the receipt of all three AVA vaccinations she experienced a "knot" at the injection site the day of the ###vaccination. ### Additionally t induration, redness, tenderness atYinjection site (13 cm), fever 102. Y 6/9/2009 6/10/2000 vaccinations 6/8/2009, developed quarter-sized Y reaction at injection site. Progressed to about Y grapefruit sized 6/8/2009 reaction, 6/8/2009 took BENADRYL a ven at the site of redness and swelling. Y 6/18/2009 6/19/2009
e she received Tdap is red, swollen and warm to touch on Wed 6-17-09. 6/16/2009 6/17/2009 ports an itching bump at site of injection. She says that she didn't notice it until 3 days after U receiving vaccine. 6/18/2009 I advised 6/21/2009 her to use Benadr , 2009 12:04 PM After pt was given TDAP and MENACTRA vaccines he jumped off the bedYand sat next 6/19/2009 to his mother, 6/19/2009 while his brother re other, patient c/o headache on 6/6/09 Y - spent 6/7/09 in bed with nausea, h/a - diarrhea beganYon 6/8 - 6/10. 6/5/2009 Seen in hosp 6/6/2009 on 6/10 - dehydra ntly gave PEDIARIX at same visit as PENTACEL. Infant's mother aware - informed of possible Y increase local 6/18/2009 reaction per CPC, and to repo X given inadvertently @ same visit as PENTACEL. Infant's mother aware. Spoke to her 6/22, Y reports no6/18/2009 adverse reactions, no site redness ogressive body aches. Then weakness + dyspnea. ER visit x1 MD x3. Y 6/16/2009 6/17/2009 t swelling involving the whole L deltoid where vaccine was injected. Y 5/12/2009 5/13/2009 adaches - Given medication for headaches, Y bed rest. Y 6/15/2009 6/17/2009 episode after MMR vaccine and TBYskin test. While checking out of clinic with parent struck tile floor resulting 6/22/2009 in laceration 6/22/2009 to head and 10 ocal erythema of skin approx 10 cm in diameter, no induration. Y 4/1/2009 4/1/2009 elling from elbow to neck. TX - BACTRIM Y 4 tsp po BID. Y 6/17/2009 6/19/2009 , given & explanation of possible Rx. Took infant home & 2 hours post shots started crying almost Y non stop. 6/22/2009 Brought 6/22/2009 back to clinic & right h ~ 2" diameter with corresponding Y axillary lymphadenopathy. Y 6/1/2009 6/2/2009 ollowing vaccine pt - had swelling and Y redness @ injection site with itching. Saw MD. ? cellulitis Y - no tx other 6/17/2009 than cold/hot 6/18/2009 packs, resolved w , deltoid region : 4x6 cm indurated. Pink, non-tender, itchy. 6/16/2009 6/17/2009 ke up screaming @ 2am. Patient had raise red spots over body. They called ER- Couldn't say Y without seeing 6/15/2009 her. They 6/16/2009 put her in Aveno ba utes after intramuscular; injections of PEDIARIX and PREVNAR vaccines to anterior and latYsides of left6/15/2009 thigh, patient's 6/15/2009 left thigh became w ceived VARIVAX 5/21/09 patient had Y rash 6/17/09 was seen in office 6/18/09. 5/21/2009 6/17/2009 econds after vaccines given. Started on L leg extending to Abd (Very mild). Benadryl 12.5 1/2 Y tsp given &6/4/2009 rash resolved 6/4/2009 after 45min period tous circular area around site of injection on (L) deltoid. This rash showed the day after shot Y was given. No 6/9/2009 fevers. 6/10/2009 d lump at injection site. Y 5/11/2009 5/11/2009 macular rash trunk, limbs and face. U 6/19/2009 6/23/2009 ite pain after 20 mins. 2 weeks laterYdevelopedYsevere headaches, treated 1 with percocet. Y gained N 40lbs in1/28/2000 the months 1/28/2000 that followed. extreme ave two knot very swollen and red around the shot site in his two arms and fever 100.7 for two U days. It wont 6/21/2009 go away 6/21/2009 wit tylenol or motrin .w was received from a physician on 18 Y June 2009. A 14-year-old female patient, with no reported U medical3/26/2009 history, received 4/26/2009 the following vacc n has been received from a certifiedYmedical assistant, for the pregnancy registry for GARDASIL, Y concerning a### 20 year 3/31/2009 old female with a hi n has been received from a lawyer Y concerning Yher approximately 6 0year old grand daughter Uwho on an unspecified date was vaccinated wi n has been received from Y a nurse concerning Y aY4 month old female 1who on 15-APR-2009 was Y vaccinated 4/17/2009 with a first6/4/2009 dose of ROTATEQ (L n has been received from a physician Y concerning Y an approximately1514-week-old male patient N who was vaccinated 4/1/2009 with 5/1/2009 the first dose of RO he felt sinus congruent with sore throat, muscle aches allover, Temp, congestion (sinus), general Y malaise6/16/2009 swollen lymph 6/16/2009 Glands @ neck. s legs + arms heaviness arm R where shot administered nausea + dizziness. N 10/4/2007 10/6/2007 o injection site 3x3 round raised. Orapred + Altabax Y 6/11/2009 6/11/2009 ame pale and lightheaded at clinic, Ybut recovered on own. Mother called in this AM to reportYtaking client 6/19/2009 to ER on 6/19/2009 06/19/09 PM near midn warmth and swelling at administration site. Y 6/17/2009 6/17/2009 d with ACAM 2000 (lot VV04-003A)Yvaccinia live virus vaccine on June 12 2009. Normal take U documented 6/12/2009 on June6/22/2009 18, 2009. No adverse s reamed inconsolably for 3.5 hours. Y He also apparently went limp for a few seconds, but did not Y turn blue.3/23/2009 He had a 3/23/2009 fine pinpoint rash and s nt inadvertantly received a Hepatitis A vaccine instead of the appropriate Hepatitis B #1 vaccine Y at 3 months 6/16/2009 of age.6/16/2009 The patient had no ad ceived 4 immunizations in the officeYat approx. Y 3:15 PM. Mother called 1 after hours at7:23 to Yreport the child 5/21/2009 was grey/pale 5/21/2009 and limp. No re en 1st varicella on 06/12/2009 pt returned to the office 6/24/2009 with the c/o spots on belly,Yfever, vomiting. 6/12/2009 Pt was6/24/2009 dx with chicken pox. ceived Rabies Post Exposure Vaccine (Imovax)Yfor Dose #2/Day 3, 6on 6/18/2009 at 10:00 a.m. U At 1:35 am, 6/18/2009 patient 6/19/2009 was transported to hos ght parotid gland without fever. chills, malaise, myalgias or fatigue. Y 6/3/2009 6/18/2009 fter administration of zostavax patient stated she had redness at injection site about the size of a quarter, 6/22/2009 3rd day after 6/24/2009 injection, site is red, edness and swelling approximately 4 inches in diameter. Warm to touch, fever 2 days post vaccination. Y Dr. 6/22/2009 saw pt. Advised 6/23/2009 parents to ice a r i recieved the vaccination i did not Yfeel well and slept all afternoon i recieved the shot in theYmorning. I was 6/18/2009 vomitting, 6/19/2009 almost fainted, swea ng of immunizations he threw up 2 times, Y became chilled, spiked a fever, and began having U breathing difficulty 6/22/2008 similar 6/23/2008 to the reaction at 2 m site the day after immunization. Warm Y red rash extending 5-7 cm around site 6 days after immunization. U 6/17/2009 No fever, 6/18/2009 chills, drainage. Seen i immunizations on 06.16.09. Fever and Y vomitingY started on 6.17.09. 3Ataxia started on 6.20.09. N Hospitalized 6/16/2009 from 6.20.09 6/17/2009 - 6.22.09. Post inf ed Pt developed hearing loss to both ears Dec 07 shortly after completing GARDASIL Y series.UDose #1 1/23/07 8/6/2007 - Dose#2 12/1/2007 3/29/07 - Dose#3 8 009 center was notified by hospital Y of a vaccineY adverse event following 3 involving this patient. Y The event4/29/2009 occurred in5/11/2009 May 2009. Review of r ed Tdap and then GARDASIL. she was sitting on end of exam table talking. She stopped talking Y fell forward 6/24/2009 into my6/24/2009 arms and I laid her bac
ates "bumpy rash" to both arms & legs Y 1 day after vaccine. Followed up with pediatrician & dermatologist N 5/13/2009 who Rx cream 5/14/2009 & rash subsided te male who presented as walk-in to clinic Y reporting development of itchy red rash over bilateral Y hands evening 6/7/2009 of 6/16/2009; 6/16/2009 possibly spreadin . Soreness at site (L arm). Hives/rash - legs & ankles. Stable no other SX. Y 6/23/2009 6/24/2009 3PM increased fussiness & strangeY eye movement. "Out of it" & fever started. 6/20/09 - Tired Y & diarrhea. 6/19/2009 6/21/09 - "Very out of it". Limited rts that approximately 7 hours after vaccine was administered, infant became very irritable and Y cried inconsolably. 6/22/2009 Infant 6/22/2009 only slept 1 1/2 ho n upper arm swelling, warm to touchYwith some induration. Pt c/o some itching, denies pain. Advised Y to use 6/16/2009 cold compress 6/16/2009 and take BENAD PNEUMOVAX (L) deltoid 6/23/09. PtYhad pain later same day (+) redness of skin. Rash spread U (+) tender6/23/2009 (-) drainage 6/23/2009 (+) felt warm (-) chills ash involving mainly the axilla and groin area appearing 48 hrs after vaccine. No associated U fevers. BENADRYL 6/22/2009 3/46/24/2009 Tsp every 4-6 hours. RN at Dr's office called stating pt had Y a Hepatitis B shot at our clinic and now was having a Y reaction. Complains 6/22/2009 of 6/22/2009 nausea, "feeling woozy ened skin from elbow to shoulder onYL UE. Benadryl if needed. Y 6/19/2009 6/21/2009 ed "low grade fever" the evening of 6/19/09 Y -> reported warmth pain and redness at site of the Y PNEUMOVAX 6/18/2009 vaccination 6/19/2009 on 6/20/09. Repo rmth eryth and 1 vesicle just inferiorYto injection site. Itchy, no fever, no malaise. Y 6/23/2009 6/24/2009 ing of day she received vaccines, developed fever, left deltoid redness, swelling and warm to touch and 6/22/2009 soreness. 6/22/2009 vaccine at 830 AM and by 1030 AM left deltoid swollen, hard to touch and soreness. 6/24/2009 6/24/2009 ythematous plaque to L deltoid posterior to injection site. No heat, no streaking, no tenderness, no s/s of6/17/2009 infection. Pt 6/23/2009 denies pain, has FRO pprox 2 pm ZOSTAVAX given approx 1:30 am. Pt experienced rapid pulse of 80-93; BP 146/84, Y went down 6/11/2009 to normal 6/12/2009 after 2 hours, reporte n has been received through the Merck pregnancy registry from a physician concerning a 23Yyear old female 9/10/2007 who on 12-JUL-2007 ### was vac n has been received from a 16 year old female consumer for the Pregnancy Registry for GARDASIL Y concerning 3/19/2008 herself 3/19/2008 who on 19-MAR-20 n has been received from a medical assistant concerning a female in her 20's, who in December Y 2008, was 12/1/2008 vaccinated 12/1/2008 with the first dose o n has been received from a nurse practitioner Y concerning her 13 year old daughter who on 16-JUN-2009 Y 6/16/2009 was vaccinated 6/16/2009 with the first dose oke-like symptoms such Yas muscle Y weakness on Y one side, slurred speech, 3 confusion, Y sent toN Emergency Room ### - Brain scan ###- no stroke, se ven a flu shot on Monday. Y On Thursday, Y pt experienced Y muscle weakness 4 on oneYside, slurred N speech, confusion, 11/3/2008 trouble 11/6/2008 swallowing. He w PNEUMOVAX 0.5 ml IM 6/5/09. Seen Y @ ER 5/7/09. Y DX: cellulitis (R) 3 upper arm. Treated in Y hospital till 6/10/09. 6/5/2009 Discharge 6/7/2009 6/10/09. 7/2/09 o hospital for routine medical check Yup. 14 y/o female no past medical hx. Pt rec'd three immunizations U GARDASIL-Merck 6/19/2009 6/19/2009 Lot 0389U Exp 2 given in high left shoulder 6-8-09. (Patient is 65 and should have received plain DT.) Patient developed general 6/8/2009pain & stiffness in left sho y, cranky, clingy, sl. decreased appetite Y and developed rash on abdomen, neck, legs overall U scattered on6/20/2009 body incl. 6/21/2009 hands/feet consistent w swelling, warm to touch at injection site. Pt also has low grade temps. Y 6/15/2009 6/18/2009 econds after injection, patient became pale, diaphoretic and fainted. LOC about 10-15 seconds. Y Responded 6/22/2009 to stimuli 6/22/2009 and had no other pro h erythema, swelling, warmth to touch Y area of erythema 9x9 inches. 6/18/2009 6/20/2009 and redness, tenderness in area of shots Y on (R) Leg/thigh very large approx. 10x12 cm redness. Y Went to ER-placed 5/7/2009 on 5/8/2009 antibiotics. d patient reports that patient felt depressed about two weeks after receiving GARDASIL. Also N reports that 6/10/2008 she had mood 6/1/2008 swings. Did not se leg pain and refusal to walk 48 hrs after 5 yr vaccines given in legs. Lasted several hours without Y parents 1/16/2009 being able1/18/2009 to see redness, tende akness, SOB on exertion (mild) left arm felt tingling & cold however felt warm to provider, no U edema. 6/17/2009 6/18/2009 d on 5-27 and stated child developed Y rash and fever several days after imm - mom states rash Y was very5/12/2009 bad and on 5/20/2009 May 23 they took him n 6-10-09 c/o headache then at 01:00 Y c/o "whole body shaking" last 1/2 hour then c/o "heaviness Y in the legs 6/9/2009 ". Ran 6/10/2009 low grade fever x 4days exam table - gave MENACTRA im to LD then HPV im RD. A few second later patient feels dizzy Y and passed 6/17/2009 out and 6/17/2009 lying on exam table, f the shingles vaccine hoping it would help me - I have had 2 episodes a year for about 5 years, after the vaccine that accelerated to 5 episo Y 6/11/2009 Y 6/17/2009 Y 6/11/2009 esented with Bell's Palsy on 4/28/09. Symptoms. Symptosm began on the 27th with right sided Y facial paralysis, 4/16/2009 blurred 4/27/2009 vision, excessive te eumococcal vaccine in the ER on 6/18/09 in the Lt posterior arm. Left posterior arm noted with Y red raised 6/18/2009 erthema, swollen and very warm Y 6/15/2009 Y 6/17/2009 d temp 100.3, unable to work, numbness Y of hands & feet pupils dilated, moaning. BP 120/70Y RR rapid 40, 6/17/2009 headache 6/18/2009 (+) Blood sugar 70. P 3/23/2009 N 3/13/2009 3/23/2009 njection site, feels tender and is somewhat reddened but not warm or infected feeling. U 6/2/2009 atient felt some pain in her upper left arm and felt a small bump.Seen at this office 6/25/09. She U has a 1 cm 5/19/2009 soft cyst-like 6/19/2009 nodule which is in 3, 2009, client returned to health department for PPD reading. During visit, she c/o redness and Y warmth in6/1/2009 her left arm. Visual inspection o N RED PATCH ON RIGHT DELTOID. U 6/23/2009 6/24/2009 a 61 year old MALE who presents to Y clinic with a 4 day history of R upper arm pain/swelling Y which started6/8/2009 after he received 6/10/2009 the Zostavax o
ever of 102, vomiting, and congestion. Y Was seen in emergency room 6/18/09 because symptoms Y persisted, 6/15/2009 diagnosed 6/15/2009 with pneumonia.Pat ven VFC DTAP. No adverse reaction. Y 6/15/2009 6/15/2009 recieved 4 vaccines, Hep B, Td, MMR, Y and PPD. 30mins after, she came back complainingYof dizziness6/22/2009 and light headedness. 6/22/2009 Employee red 2 doses of hepatitis B vaccine on the same date of service Y 6/25/2009 6/25/2009 ceived Hep A and Tdap vaccinations. Y Approximately 1 minute later patient complained of nausea U and she 6/25/2009 was pale. 6/25/2009 Patient lost conscious e myalgias after injection. On 6/24/09 Y (6 d after inj). Woke up itchy, indurated, local injection site 4 x 8cm.6/18/2009 (B) wrist edema. 6/24/2009 Hurt with arthralg es listed given at 29 days old. 5/1/2009 KINRIX on 6.22.09. Per mom, noticed Y swelling, increase - after 24 hours - 6.23.09, went to ER Y around 11 6/22/2009 pm. Thought 6/23/2009 insect bite caused s lled @ 10 am 6/24/09 to say pt had large reddened area on R upper arm ~ about 4" in triangular U shape -6/22/2009 indurated and 6/23/2009 sensitive to touch. C asovagal reaction abut 5 mins. after administration. Pt responded immediately to verbal commands. Y She6/16/2009 was oriented 6/16/2009 - kept pt until her mo 6/23/2009 6/24/2009 by T-99. Red, swollen at site. Advised TYLENOL, cool compresses. Y 6/23/2009 6/24/2009 ould present himself off & on with anger outbursts, mood swings & getting in his "zone" whichUwas like he4/22/2009 couldn't process what I said until a of right thigh and bruising. U 6/17/2009 6/18/2009 dness, heat, tender, firm area 5" horiz Y and 3" vert just below site of injection in (L) upper arm....2 U days after 6/9/2009 injection6/10/2009 - (started itching 1 day macular rash started 2 days after vaccine Y was given & a fever of ? degree was reported by U his mother. He had no fever when seen 6/19/09 ve decreased motor skills LE >> VE Dxd - " transverse Y myelitis". 7/2/09 5 Hospital records received U DOS 5/29/09 5/4/2009 to 6/2/09. 5/28/2009 Assessment: Tra ontacted by pt mid-Jun 2009 & reported Y recurrent headache, dizziness, nausea, blurred vision, N & fatigue 3/31/2009 which developed 4/13/2009 about 2 weeks fo after administration of vaccine, patient developed erythema, pain, vesicle at site of innoculation/fever Y of 102 6/16/2009 degrees6/18/2009 approximately 48 hrs a f injection: Chills, Nausea, Diarrhea & fatigue. 2nd day vomiting & fatigue persists. Y 6/10/2009 6/10/2009 Y 6/11/2009 Y 6/15/2009 Y 6/17/2009 lar rash at injection site - (R) SQ-thigh. Y U 6/15/2009 6/24/2009 d AM of 6/25/09 L upper arm redness, induration, swelling, and increase warmth. Suspect cellulitis. N Tx with 6/23/2009 KEFLEX6/25/2009 250/5ml one tsp TID x ceived from a physician on 23-APR-2009 (via a sales representative). The reporter is also the patient. A 3/25/2009 male patient3/27/2009 (initials: EF, age unkn Migraine with loss of central vision. Y Felt sickly. Diarrhea. Slight headache. Fatigue. Chills. Aches. Y Report received ###from a consumer ### on 05-N ceived from a nurse on 03-11-2008. An 80 year-old male patient received AFLURIA 0.5 ml pre-filled U syringe on### 14-Oct-2008. ### Concomitant ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like ### symptoms 11/1/2008 (nasal congestion ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four patients experienced U flu-like symptoms ### 11/1/2008 (nasal congestion, ch ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like### symptoms 11/1/2008 (nasal congestion ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experienced U flu-like ### symptoms 11/1/2008 (nasal congestion ite pain lasting 3 months U ### ### n has been received from a consumer Y concerning her cousin's 15 year old son who was vaccinated N with MMR II (lot number not available) n has been received from a physician Y for the pregnancy registry for GARDASIL concerning aY 22 year old 8/5/2008 female with 8/12/2008 a history of papanicol n has been received from a Physician Y Assistant (P.A) concerning a 15 year old female Y patient Y who on 13-JUN-2009 6/13/2009 6/13/2009 was vaccinated with th information received from the healthcare provider upgraded the case to serious. It also provided U additional 5/18/2007 concomitant 4/9/2009 vaccines, test resu given MMR and Varicella. Y Whelps atY 5 mins after given. Benadryl given, whelps smaller. Sleeps Y no wheeze, 6/18/2009 cry when 6/18/2009 woke 30 minutes afte rying baby in severe pain- can't calm down, mom can't put baby down. Y 6/22/2009 6/22/2009 me to health dept today and reported Y the following: Client left building where she received IZY"body went6/19/2009 stiff, eyes 6/19/2009 were open x 2-3 minute Y 4/22/2009 child spiked temp of 101.4 tues. 6/16/09 after vaccinations received Mon. 6/15/09. Fever broke tues afternoon. 6/15/2009 Symptoms 6/16/2009 include runny no Bright red blood in stool - size: about Y a quarter occurred twice in the evening on the day sheY received her2/9/2009 2 months 2/9/2009 vaccinations. I took he nd throat swelling, chest pain 1 1/2-2 Y hours after vaccine was given IV BENADRYL and PEPCID Y given in6/17/2009 ER. 6/17/2009 phenhydramine N ever, went to ED -> Dx with otitis media. Y Y 5/19/2009 5/20/2009 d elbow and knee burning joint pain. One month after vaccination had Parvovirus infection. Pain Y continues, 2/21/2008 no other3/30/2008 rheumatologic disease pain in left arm after receiving flu shot. U 10/9/2008 ### r reported to me that 3 days ago he started with some numbness to left axilla and lateral upper arm. 6/17/09 5/18/2009 50% better. 6/12/2009 6/22/09 90% bett nny nose, coughing Dx 6/1/09 with pneumonia Y Rx AMOXICILLIN. Y 5/29/2009 5/30/2009 fussy, screaming, inconsolable for 2 days. Mom could not put baby down. Y 6/12/2009 6/12/2009
@ injection site Y 6/17/2009 6/18/2009 ely after varicella vaccine, which was given last, client c/o nausea & dizziness. BP 100/60 x2.YJuice was given. 6/23/2009 Remained 6/23/2009 seated for 15 min unization client developed hives thatYitched until she scratched and drew blood. They covered N neck to toe6/10/2009 of her body. 6/12/2009 fter shot, arm swell up, turn red, working down to forearm, painful ! 6-13-09 Medical office provider: Y PA =6/11/2009 Fexofenadine 60mg = Benadryl = , pt. called & left a message that following having received VARIVAX, she developed a rash Yon her arm.5/21/2009 The message was misplaced, but ted about 6 to 8 hours after HIB and Prevnar vaccine. Temperature 103 degrees. ContinuedYfever 101 to 6/5/2009 103 for 3 additional 6/5/2009 days. Evaluat 6-3-09. Severe pain in arm,shoulders,knees,back Y and fever of 103.7 6-4-09. ER on 6-5-09 was N given Levaquin, 6/3/2009 Vicoden,Ultram. 6/3/2009 6-6-09 pa d symptoms of dizziness with near Y syncope, sensation of throat constriction with tightness atYthe base of6/20/2009 his neck. 6/21/2009 This was then accompa ht hours after vaccine administration, Y at about 4:00 AM, patient experienced sensation of throat Y constriction 6/24/2009 and inability 6/25/2009 to breathe deeply. d nausea and vomiting, insomnia and mild fever approx. 10 hours after vaccine administration. Y Vomited repeatedly 6/23/2009 during 6/24/2009 night. Able to eat esents to clinic at approximately 1745 Y on 6/25/09 for MMR immunization - enrolled in medical Y assistant program 6/25/2009 at local 6/25/2009 school, cannot find s given a Dtap/Polio IM injection in the left deltoid on Wednesday 6/24/2009. Client and mother U returned 6/24/2009 to clinic at 9:00AM 6/24/2009 on Friday 6/26/2 HAD KINRIX ON 06-23-2009.DEVELOPED RED RAISED SWELLING AT INJECTION SITEUON 06-24-2009.SEEN 6/23/2009 6/24/2009 BY DR.KALIL ON 06-2 welt, larger then usual Y 6/25/2009 6/26/2009 a of erythema with a slight hemorrhagic Y appearance, encompassing almost entire L thigh U 6/23/2009 6/23/2009 hy, hard, swollen around the injection site. 4-inch diameter around the injection site. Localized U 6/24/2009 6/26/2009 d swollen area approx 4x4 inches bendryl taken Y 6/19/2009 6/25/2009 ours after receiving Oral RotaRix vaccine, Y 2 month old baby developed fever (100.9-101.2) for U four days,6/22/2009 acute onset 6/22/2009 copious watery non-b hours after the vaccination, I felt my head starting to ache. Then later I felt like there was anNelephant on6/24/2009 my chest. 6/24/2009 I was having difficulty b was swollen all the way down to elbow. It is really sore and she had very back headache and joint pain 6/23/2009 6/23/2009 accine administered inadvertantly. Y 4/17/2009 6/26/2009 accine administered inadvertantly. Y 6/24/2009 6/26/2009 ceived Menactra and varivax injection. Patient fainted 3-5 minutes after injection was given Y while in the elevator. 6/26/2009 6/26/2009 ely following vaccine, patient Y began Y to complainYof mild symptoms (my 5 shoulder hurts, Y my wrist N hurts, look at these ### spots on ### my leg. On the WINRIX 1ml, Tdap 0.5 ml, IPV 0.5 ml, Y MMR 0.5 ml and PPD 0.05 ml. Pt passed out in 1 minute Y and was 4/8/2009 given smelling 4/8/2009 salt and recovered as given an MMR by agency while was 5 weeks pregnant. 6/9/2009 sweats, dizziness. Y 6/24/2009 6/24/2009 ticaria that started about 12-24h after vaccine administration. Treated with diphenhydramine.U 6/22/2009 6/22/2009 ng - 1 1/2 cm circumferential difference, irritable. Shoulder --> wrist, dorsum of hand slight edema. Y 6/23/2009 6/23/2009 er of child: See attachment telephone Y conversation 6/25/09 3:30 PM. Y 5/20/2009 5/20/2009 en 6/24/09. 6/26/09 woke with painful, red and swollen arm. Y 6/24/2009 6/26/2009 s after receiving GARDASIL vaccineY Pt. developed dyspnea, dysphagia, stabbing, sharp pain Y (R) arm and 6/12/2009 hip, neck6/12/2009 pain. Dx: Allergic react minutes of MMR + Varicella vaccines administration child's right thigh became red and indurated. Y 6/25/2009 6/25/2009 3hr prolonged crying episode. Started roughly 3hrs after getting vaccines. Resolved with warm Y compresses 6/23/2009 to the thighs. 6/23/2009 imms. 6/9/09. On 6/10/09 was achy and 102 degrees fever. On 6/13/09 pt again at clinic c/oYnausea, abd6/9/2009 cramping,6/10/2009 and fever. with warmth ~ 6-7 cm diameter no induration. 6/24/2009 6/25/2009 24,2009 received injection of Zostavax Y and byYApril 8th, experienced 15 Yextreame anxiety, inability N to sleep, 3/24/2009 and by May4/8/2009 7th was hospitalized s of appetite, fever as high as 102.9 after having pneumococal conjugate and hepA vaccinesUon 6/23/08.6/23/2009 6/27/2009 thma attack, no fever, sinus infection. Y pt treated with iv decadron followed by po taper of prednisone Y 5/29/2009 6/5/2009 STARTED WITH A FEVER 6/27 ON THE MORNING OF 6/28 BROKE OUT WITH A RASH U WHICH CONSISTED 6/18/2009 OF 6/27/2009 ABOUT 10-20 ERYT n has been received from a healthcare professional through a Pregnancy Registry for GARDASIL Y concerning 4/21/2008 a 17 year 4/21/2008 old female with dep n has been received from a physician concerning an 18 year old female who on 18-JUN-2009 Y was vaccinated 6/18/2009 IM, 0.5 6/18/2009 ml with the first dose n has been received from Y a healthcare Y student concerning a 19-year-old female patient whoYwas vaccinated 4/20/2009 with the 4/20/2009 first dose of GARDAS n has been received from a consumer Y concerning Y his fiancee who on 0 22-JUN-2009 was vaccinated U with6/22/2009 the first dose 6/22/2009 of GARDASIL. Subs perienced two episodes of debilitating inflammatory arthritis after the second andYthird rounds Y of Hepatitis 8/29/2008 B vaccination. The ### interval of ons s, pt experience moderate intense muscle tightness and aching and a sense of limps feeling Ylimp. This interfered 2/9/2009with2/9/2009 her ability to play spo ed Merck first to report adverse effects. Merck faxed notification to agency and nurse calledYto follow up4/28/2009 with pt. Pt had reported to Merck ives...They were first noticed around mid January 2009. We first saw our pediatrician who thought N it was6/11/2008 viral. Then 1/15/2009 we went to see an All pt called to report GI sxs: nausea, upset stomach. Day later, she reported swollen lymph node Y in armpit 6/23/2009 of left arm where 6/24/2009 she got vaccine 7 TO 100.8 FOR 2 DAYS, INCREASE ON SLEEP, INCREASE SPIT UP, RUNNY DIARRHEA/STOOL U 6/25/2009 6/26/2009 started getting red over 24 hrs with lump Y forming underneath skin. By 36 hrs, arm swollen toNsize of tennis 6/25/2009 ball with 6/26/2009 red color & warmth at to
ection site, R leg "hundred-ish tiny bumps with white pink tips"; later rash appeared on face and U neck; T 6/18/2009 max 102 F;6/20/2009 diarrhea. the night of 6 t 4 days after vaccine (2nd) dose...vaginal Y lesions, Y nausea,vomitting, 3 headache -E.R visit diagnosed Y with1/24/2009 herpes, all1/28/2009 subsequent tests nega DTaP, MMR, IPV, Varivax on 6-17-2009. Y Had Yhad brief joint pain and 2 mild rash approx 5 days Y prior and6/17/2009 only faint pinpoint 6/18/2009 macular rash on eived Menactra, Gardisil, Adacel, and, and Havrix. She became pale and nauseated. Her skin Y was cool and 6/29/2009 clammy. 6/29/2009 Her head went down a 2009 CLIENT NOTICED THAT LEFT ARM WAS SORE AND WARM TO TOUCH ALSO REDYAND SWOLLEN, 6/25/2009 INSTRUCTED 6/27/2009 TO TAKE BE hes in joints, especially injected arm. Began severe headache, nausea, vomiting. Body wasUquivering, jaw 6/23/2009 quivering 6/26/2009 bad pretty bad. Did no able crying, arching back and restless Y no sleeping, High fever N 6/25/2009 6/25/2009 ed that she developed hives on both arms and had a headache approximately 1 hour after receiving Y the6/22/2009 vaccine. She 6/22/2009 called her doctor's o HY BUMPS ON BADY NOW SPREADING U 6/30/1999 6/29/2009 ceived Zostavax vaccine on 6/17/09. Y States symptoms of pain in upper thighs began on 6/19/09, U pain then 6/17/2009 elevated6/19/2009 to lower back. Visited er vaccination temp. - sore throat, cough. This lasted 2 1/2 weeks. Then on the 30th of May N I awoke to a5/14/2009 painful left 5/30/2009 knee. This got worse o Right hand swollen, numb - its mainly in my pointer finger, middle finger & thumb now. I've had N my left arm 5/14/2009 go numb5/27/2009 & hurt & ache & feel li by mother: 5/8 Right arm swollen, Y followed by 7 days of hives, swollen knee joints, fever offYand on, puffy5/7/2009 feet". Treated 5/8/2009 by hospital, and p ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in g 2 doses of VIVOTIF, deep pink colored Y rash to face, neck noted. Eyes swollen almost shut, Y c/o pruritic. 5/13/2009 Referred to PCP. Placed on stero mediately suffered syncope episode after injection of GARDASIL. She was pale, clammy to touch Y and non-responsive 6/10/2009 6/10/2009 for approx 1 minute. B ENTACEL, HVB, PCV7, Rota) resulted Y in wheezing, SOB, irregular breathing, fever 104 degrees; Y seen in 6/12/2009 ER. 2nd set 6/12/2009 (PENTACEL, Rota) r ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf minutes after receiving vaccines became Y dizzy. Passed out. Mom states it looked like he was Y having a seizure. 6/9/2009C/o6/9/2009 weakness & being tir ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf d swollen lymph nodes to neck andYburning behind ear drums. 3 days after ADACEL/MMR IINinjection. Pt 5/1/2009 has been to5/1/2009 ER (on 2/22/09 and w ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf nced arm pain and shoulder pain after injection - near inj site. Started days after inj; con't forN~ 2 months. It cleared ### but shortly ### thereafter pt ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an in es, irritation, lack of sweat doing exercise, insomnia, redness in all parts of body, numbness left N lower foot, tingling sensation, weakness: in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an in ed the following literature report on 15 JUN 2009: 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf sh/pustules, RX with NSAIDS/observation Y for possible reaction U 5/27/2009 ed the following literature report on 15 JUN 2009. 15 children between 6 and 59 months of age U were vaccinated for the first time with an inf n instead of DTaP, no reaction to the Tdap. 6/18/2009 6/15/2009 N 6/15/2009 6/15/2009 , swelling, tenderness (all continued after 2 months) 4/6/2009 4/6/2009 dache, the began c/o sensitivity to light. Y On 1/22/09 went to have eyes checked retinas Y inflamed. U Went to 1/20/2009 ophthalmologist 1/20/2009 retinas being tre A, myalgias, back pain, LE pain/neck Y pain, paresthesias, Y N&V, diarrhea. 1 7/23/09 Hospital records N received 6/19/2009 DOS 6/21/09 6/20/2009 to 6/22/09. Asses bout 2 - 3min after receiving vaccine with seizure like activity (probably secondary to fainting)Ypale, nauseous, shaky, low BP. Seemed to re accidently given PCV-7 instead of MENACTRA. 0 adverse reaction Y 6/23/2009 with 4/3" reddened area. Warm to touch. 6/23/2009 6/23/2009 since day after vaccine up to 10x daily for (currently) 18 days. Negative stool studies. U 6/11/2009 6/11/2009 ven dose of TDAP, MENACTRA, VARICELLA, double dose. 1st 6/10/08, MENACTRA, 2nd 6/15/09, Y VARICELLA. 6/15/20091st 6/13/07, 2nd 6/15/09, ven 2 doses of TDAP and Varicella. 1st dose - 6/10/08, 2nd dose - 6/15/09. Y 6/15/2009 on with the Vaccine Healthcare Center Y (VHC) was initiated on 5/23/2008 following reports ofYPt with myopericarditis 5/13/2008 5/20/2008 day 6 post ACAMBIS S n @ ER 3/6/09 Y U 2/27/2009 3/6/2009 mp > 103 degrees F @ 2A 6/21/09 post Y experiencing fever rigors. Temp did not decrease with Y TYLENOL. 6/20/2009 High temp 6/21/2009 X 36 hrs. Fever rigo & swelling size - began 50 cent size - painful, itching enlarged - redness area warm to touch Yabout 2 days 6/22/2009 - decreased 6/24/2009 grade fever aching -
bdominal cramping & pain for 48 hours. Severe vomiting & diarrhea for several hours. No specific Y treatment 1/30/2009 2/3/2009 ite swollen, red, itchy - Pt visited PCP on 6/26/09; MD told Pt the reaction would go away in Y 2-3 days. 6/24/2009 6/25/2009 swelling localized to injection site 3" in diameter. U 6/24/2009 6/25/2009 pt called office 6/25/09 sts. small redY area to vaccine site. Adv. Dad to watch area and if areaY spread and/or 6/24/2009 become6/25/2009 redder, hot or hard to Pt came in today c/o redness on left deltoid had fever X 2d. Used alcohol on area. Redness N & swelling6/24/2009 warmed to 6/24/2009 touch 6" X 4 1/2" U 6/9/2009 6/14/2009 edness of entire circumference of arm. Given IM steroids. 6/22/2009 6/22/2009 persistent pain and mild tenderness to palpation, onset with pneumococcal vaccine to L deltoid N 4/27/09. 4/27/2009 4/27/2009 veloped 10 vesicular rash scattered on his chest, neck, back & scalp on 6/19/09 Y 6/8/2009 6/19/2009 swelling, and a hard lump after receiving the diptheria, pertussis, tetanus shot at my OB-GYN's office. n has been received from a health professional for the Pregnancy Registry for GARDASIL, concerning Y a2/18/2008 16 year old2/18/2008 female with no known n has been received from a consumer Y for the Pregnancy Registry for GARDASIL concerningYher daughter 4/14/2008 a 14 year old female with no kno n has been received from a physician concerning Y a 14 year old female 0 patient who on an unknown N date was vaccinated with the first dose n has been received from a health care Y worker concerning a 15 year old female patient whoYon 12-JUN-2009 6/12/2009 was vaccinated 6/12/2009 with the third n has been received from Y a registered Y nurse concerning Y herself, an080 year old female Y with Y asthma and allergies to codeine 1/1/2009and sulfa who was received from a health care professional Y in country on 18 June 2009. A six-month-old female N patient, 6/18/2009 with no reported 6/18/2009 medical history, ort received 19 June 2009 from a health Y care professional. A 17-year-old female patient with U no known drug 1/2/2009 allergies, had received a first do was retrieved from a newspaper article Y on 22 June 2009. An 11-year-old patient received anUinjection of DTaP (manufacturer, date of adm ped onset of paresthesias (tingling)Yin B/L hands, Y neck stiffness, occas. 8 hand numbness, hipYpain, & feeling 11/4/2008 flushed on eve ### of 11/17/08. Flu en for annual physical 5/14/09 & found Y to be well Y on exam. No labs 3needed. ADACEL Y vaccine N done. 3-45/14/2009 days later 5/20/2009 some symptoms of vagu / h/o recurrent cough w/ wheeze, who Y receivedY1st MMR, VAR & HAV 1 on 6/11/09. Child wasYhealthy that6/11/2009 day. Day after 6/12/2009 woke up w/ face ed called arm red & swollen (? which) home care 2. 6/24/09 Erythema Multi form no explanation Y not sure if6/11/2009 due to vaccines 6/24/2009 tis of the left arm at the site of injection. Y --> Treated with KEFLEX antibiotic for infection. 6/24/2009 6/24/2009 d vaccine on 06/18/2009, by 06/20/09 she was feeling very dizzy and it has been happeningUon and off since. 6/18/2009 6/20/2009 e fever w/ knot in left thigh, erythema to thigh 3cm X 8cm, itch, warmth. Y 6/19/2007 6/19/2007 r arm weak & numb x 6 days from deltoid to elbow. Reoccured with Gardasil #2 - (RT) arm, Y marked pain6/18/2009 + weakness 6/18/2009 - RT upper arm - 5 da VAX given @ 0900 on 6/23/09. At 1530 on 6/23/09, pt. seen in office for increased swelling U and erythema 6/23/2009 to site. Circular 6/23/2009 edema 5" width, Vaccine given. 6/12/ - 6/14 - Sore arm. Itching started 6/13 on arm 6/15 Itchy wrists 6/16 - U headache, dry 6/11/2009 heaves, 6/15/2009 rash developed on tors ately 24 hours after vaccines pt started with crying and that has lasted for 2 more days. He has N also has 6/18/2009 a temp to 101 6/19/2009 degrees F and mild sed syncope vs possible seizure. Found down with ?shaking, ? apnea. Reportedly with someYconfusion briefly 6/18/2009 afterwards 6/19/2009 and then fully rec ed red papular rash every- where on body except face and palms. U 6/22/2009 6/23/2009 a to right thigh. Size smaller than a pea, no redness or swelling. Treatment: warm compresses Y and massage. 6/22/2009 6/22/2009 - Hot flush - 5-28 - red raised welt egg shape/size - hot - 5-29 - still warm -ache shoulder - elbow Y - swelling 5/27/2009 gone - no 5/28/2009 energy - 6-8 - arm sh d 20cm X 25cm area of redness after administration of DTAP + itching. Treating with cool compresses + 6/22/2009 Benadryl. 6/23/2009 d 105 cm x 70 cm area of redness at site of MMR, & itching. Treating with cold compresses & BENADRYL. 6/22/2009 6/24/2009 n Lt deltoid 6/20/09 - no previous reaction reported - over 10 yrs on tetanus. Called 6/24/09 -YPt reports lightheadedness, 6/20/2009 6/21/2009 fever x2 days - up dacel - recommended for ages 17-64. LOT# C3098AA EXP 9/1/2011 L deltoid Y 6/24/2009 n area of injection site. Lasted about 5-6 days. Y 6/4/2009 6/5/2009 N was in box labeled PPD therefore. 1cc was given ID in pt left arm. Dime sized slightly reddened U area noted 6/12/2009 at injection 6/12/2009 site. r after immunization (10:30 am) recipient Y c/o headache, nausea, shortness of breath. Tx with Y Tylenol. Nausea subsided - other Sx continu d c/o pain and swelling (LD) area. Observed Y redness, swelling and area warm to touch. Y 6/17/2009 6/17/2009 9 received Hep A and MCV-4 in L arm Y and HPV in R arm. Overnight pain and redness @ injection Y site. Increased 6/23/2009 pain 6/24/2009 and redness on 6-2 arm, red tender and hot. Measures 90x80 millimeters - Area involved is slightly below the injection Y site 6/22/2009 6/23/2009 rm, redness, hardness pain. Y 5/13/2009 5/14/2009 rted fever 103 + irritability all night. Offered an appt by myself and Doctor. Mom refused apptUX 2. 6/24/2009 6/24/2009 t local reaction on L arm, red and swollen 6 cm in size encompassing the whole arm. Y 6/23/2009 6/23/2009 local to inject - fussy and fever - Treated Y with tx Y 6/22/2009 6/24/2009 n, joint pain, diarrhea, high blood pressure, Y rash. Prostate cancer we do not receive, never adverse U reaction 2/17/2003 of this vaccine when administer tender, sore, red, warm to touch x 3days. Keflex 500mg 1 tab Po TID X 7 days. N 6/17/2009 mp, itching, hot to the touch. - Warm compress, gentle massage, BENADRYL if needed for itching. Y 6/3/2009 6/9/2009 ulder pain for a couple of weeks now, no injury or trauma. Pain and pressure to the area andUwith overhead 6/1/2009 activities. 6/15/2009 Right shoulder bother
white and became sick/feel nauseated after getting Hep A and Yellow fever , which came onY several minutes 6/25/2009 after 6/25/2009 YF given then she fainte e, nausea, fatigue U 6/26/2009 6/27/2009 t local reaction. - *see attached. - Y Y 6/22/2009 6/23/2009 was reported by a physician and described Y the occurrence of difficulty breathing Yin a male subject Y of unspecified age6/1/2009 who was vaccinated acks out - low blood pressure. Extreme Y pain in Ylegs and body. Body7jerks Y no concentration Y brain N fog. Rashes, joint ### pain 11/1/2007 Fatigue, constipatio Y 6/5/2008 n w/ rash all over body on 6/19/09, pt Y also had low grade fever x 2 days. Y 6/5/2009 6/19/2009 t leg, high fever, refused to walk a.m. after injection given U 6/25/2009 6/26/2009 aving bloody noses at approx 1 am 6/26; Y has had 8 between then and 7:15 am 6/30. He hasNnot had bloody 6/26/2009 noses before, 6/26/2009 and he has not b ic with mom approx 5 minutes after Y being seen in clinic ear pain at 2:30 pm and also received Y four immunizations 6/29/2009including 6/29/2009 HPV (Gardasil), office to report approx 12 hours following vaccine administration she developed widespread, Yintense muscle 6/29/2009 spasms, 6/29/2009 vomitting, hands and dministered 6-22-09, 2nd dose of Hepatitis A vacccine. That evening headache, myalgias, chills, U low grade 6/22/2009 fever 99.3. 6/25/2009 Evening of 6-25-09, , edema, hives, lymphadenopathy, treated with prednisone Y rash onset 6/28/2009 and was seen in office. pt had varicella vaccine 6/18/2009. Y 6/18/2009 6/28/2009 mediatley with slight jerking motion. B/P 80/40, pulse 60. Woke a couple seconds later veryYcold, shaky, 6/30/2009 80/50. Very 6/30/2009 diaphoretic, pale, we d vaccines ~ 1230 pm. Pt. toleratedYwell. Received Tdap, MMR, Varicella, and ppd. Asked pt. Y if I could procede 6/29/2009 with 6/29/2009 obtaining blood - at w ates that Right arm became swollen and painful, then began to hurt deep inside the muscle from N the injection 5/12/2009 site to5/22/2009 the wrist, patient still ha ssed out in the hallway about 3 minutes Y after receiving vaccines. Mother was with him at theUtime. She reports 6/30/2009 that 6/30/2009 he fell face first and hit nt experienced hives 1 week after receiving Y the Zostavax vaccine on 5/1/2009. She went to urgent N care and 5/1/2009 had her rings 5/7/2009 cut off because o ceived Rotateq 6-12-09, on 06-15-09 Y mom called Y and state pt was unconsolable, 2 crying, pushing Y away from 6/12/2009 mom and 6/15/2009 had vomited x 3. Ad ure elevation 104 degrees F Y 6/29/2009 6/30/2009 se reaction noted. Verified with patient and mother. 6/2/2009 administered around 4:15 June 29th. Y Pt woke up at 6 a.m. the following day crying in pain, headache rated 6/30/2009 10 on scale 6/30/2009 of 1-10. She had a ziness", stomach pain within seconds of administration. Pt closed eyes at this time. Pt placed Y in supine 6/30/2009 position with 6/30/2009 knees raised to chest close right eye, facial numbness, drooling from right side of mouth Dx: Bells Palsy Y 2/11/2009 6/4/2009 ceived Varivax, Gardasil, and PPD. Within in minutes she fainted. Y 6/30/2009 6/30/2009 iven on 6-18-09 & patient Y had to undergo Y surgery Y for intussusception 5 on 6-22-09. 9/8/09 Hospital Y records 6/18/2009 received 6/21/2009 DOS 6/21/09 to 6/25/09 d swelling of the eye's, lip's and ear's. Also had an episode of vomiting. some difficulty breathing.Patient Y 6/30/2009 was given 6/30/2009 vaccines and had left th ceived two vaccinations, Hib and HepB. He did not need either one of those shot. I found out U when I compared 6/30/2009 the6/30/2009 shot record that they ga evaluated on 6/30/09 and noted to have confirmed case of diffuse varicella. Child's rash involved U dozens of varicella ### 6/27/2009 lesions on trunk, back developed bright red macule about 3 in. diameter at the site which was itchy and also developed Y generalized 6/25/2009 hives. 6/28/2009 Both noted about 3 day ours after vaccine administration, patient's wife called and reported the patient experiencing Y dizziness, nausea, 6/19/2009 and6/19/2009 slight fever. I spoke wi r,lethargic,shakes,chills,no appetite Y Y 6/29/2009 6/29/2009 n, myocarditis treated with IVIG. 7/31/09 Y Hospital Y records received DOS 3 6/28/09 to 7/1/09. Assessment: U 6/24/2009 Myocarditis. 6/27/2009 Patient presents with excellent health prior to service entry in May 2009. Y 13 May 2009 - Pt7 received multiple vaccines N - See Vaccine 5/13/2009 History. 6/2/2009 The total number of er shot 2 areas of large blisters, 2" long (reported by mom) - arm hot, swollen - bright red - client Y denies 6/19/2009 fever or pain 6/20/2009 and redness of right arm. Y 6/22/2009 6/24/2009 brasion/ shield ulcer follow up OD- pt Y states no pain, feels it is resolved, using e-mycin ohs, VIROPTIC Y q2h, 6/19/2009 and VIGAMOX 6/25/2009 qid. minutes after vaccination became pale, unresponsive lasted 3-5 minutes. See enclosed note. Y Pt is in today 6/25/2009 for her pre-kindergarten 6/25/2009 physic Started with multiple small vesiclesYon bottom. 6/26/09- Seen in office had started on trunk Y as well, some 6/18/2009 vesicles "blistered" 6/25/2009 culture done. ew hours of receiving TDAP. Pt c/o hourly diarrhea X 10 or 12. Denies fever, bloody stools,Yrash, nor v, or 6/5/2009 other sx. 6/5/2009 Stomach was "sensitiv p in arm swelling & pain Y ### ### was reported by a physician and described Y the occurrence of injection site cellulitis in a 5-year-old N male subject 6/1/2009 who 6/4/2009 was vaccinated with c eak/ shakey. Chest was tight and felt a warm sensation going thru body like a dye from a cat-scan. U Bad6/30/2007 headache.6/30/2007 stridor, cough and shortness of breath. Y 8/3/09 Y ER records received 1DOS 6/23/09 Assessment: Y Allergic reaction, 6/23/2009vaccine 6/23/2009 adverse reaction, owing ROTATEQ vaccines. Developed fever & diarrhea U 6/18/2009 6/24/2009 n, mood swings, change in menstrual cycle ( increase to 2X monthly), cramping, loss of hearing, U infection 2/14/2008 eye + ear.9/15/2008 Redness, Soreness 6cm X 6cm. Y N 6/22/2009 6/23/2009 lls, cold hands, pain in legs, weak, headache, Y stomachache, shortness of breathe Y 6/3/2009 6/4/2009 ort was received 25 June 2009 fromYanother manufacturer (document number 45220797), who received the report from a health care profes n has been received from a Certified Medical Assistant (C.M.A.), for the Pregnancy RegistryYfor GARDASIL, 6/17/2008 concerning 8/26/2008 a 26 year old fema
ort received 25 June 2009 from another Y manufacturer (document number 45220198), who received Y the report from a consumer, who is the n has been received from a registered Y pharmacist concerning a 53 year old female on chemotherapy Y who6/5/2009 on 05-JUN-2009 6/6/2009 was vaccinated ent's Hepatitis A immunization, Y she began Y languishing Y and eventually 1 turned jaundiced. AfterNa liver biopsy, 6/28/2007 she was 9/1/2007 diagnosed with autoim as given inital dose of Tdap on 06/04/09 and was give a 2nd dose on 06/29/09. Y 6/29/2009 6/29/2009 d syncope immediately following injection of Tdap. Patient sitting, depressed head between knees, Y passed 6/29/2009 ammonia6/29/2009 inhalant briefly under h vaccine breakthrough. Diagnosed in our office on 6/29/09 with Varicella. Had over 100 lesions. U No fever. 1/10/2008 6/26/2009 Pt presented to the emergency room for a cat bite. Y Patient recieved 11a tetanus diptheria toxoid U because hers 6/12/2009 was out 6/16/2009 of date. 6/17/09 - Pt p d breathing and had a cardiac arrest. Y CPR required. 7/23/09 Hospital records received DOSY7/1/09 to 7/2/09. 7/1/2009 Assessment: 7/1/2009 Syncope vasov 09 pt received Tdap.That same evening pt noticed her upper left arm at the location the immunization Y was 6/19/2009 given became 6/19/2009 red, painful and s MT REPORTS CHILD FELT HOT, COMPLAINED OF HEADACHE & PAINFUL LEFT ARM. ARM SWOLLEN 6/29/2009 &HOT6/30/2009 6/30 & WORSE 07/01/ EACTION TO L UPPER ARM--SWELLING (FIRM INDURATION) AND WARMTH OF L UPPER U ARM FROM 6/29/2009 SHOULDER 6/30/2009 TO JUST ABOVE OSE OF HEPATITIS B WAS GIVEN TWICE. NO ADVERSE REACTIONS AT THIS TIME. Y 6/15/2009 min after Varivax vaccine was administered Y patient began with throat itching, hives, lower lip Y swelling and7/1/2009 throat tightening. 7/1/2009No audible wh ENT PAIN IN LEFT DELTOID. NO LUMP, REDNESS OR SWELLING. FIRST SOUGHT TREATMENT U 5/26/2009. 5/11/2009 RECOMMENDED 5/16/2009 HEAT vax on 5/29/09. Reports she developed generalized papulovesicular rash on 6/17/09 @ 1600. Y On 6/19/09 5/29/2009 States 10 6/17/2009 "bumps on face, 2 on rea (1 3/4"x1 1/4") of mild erythema to posterior right arm with smaller central area of erythema. U Warm to 6/29/2009 touch. Developed 6/30/2009 on the night of g last injection (which was gardasil) she said she felt like she was going to pass out then slumps Y into my arms. 7/1/2009 She 7/1/2009 opened her eyes again of swelling/induration around injection Y site with associated pruritus. Y 6/30/2009 7/1/2009 watery diarrhea, nausea, stomach ache. U 6/22/2009 6/23/2009 anges after AVA 1 and 2. AVA 1 had Y black vision X 3-6 sec with needle injection. 1 hr later c/o U difficult focusing 4/3/2009 on letters/numbers 4/3/2009 being u #2 dose of VARICELLA on 6/23/09Yin right thigh on 6/25/09 mom noticed bruise and red swelling Y -> saw 6/23/2009 MD 6/25 and 6/25/2009 MD circled induratio immunizations 6/29/2009 AM. On morning of 6/30/2009 noted red hard spot on Right thigh 7/1/09 U Exam6/29/2009 11 x 20 mm 6/30/2009 area of erythema indu skin reaction. Red raised irregular border 10cm x 8cm. Fading center/clearing. Y 6/23/2009 6/26/2009 :45 pm pt. c/o tingling in arms after injections Y of MENACTRA and HPV. Pt also given Tdap. Pt Y asked to wait 6/30/2009 twenty 6/30/2009 minutes to make sure s ve episode - pallor & unresponsiveness Y 4 hrs after 1st set of immun on 2/5/09 - labs normal,YBP low, fine 2/4/2009 after. 2/4/2009 6/29/2009 n, redness and swelling. Y 6/29/2009 6/30/2009 rted to -us on 6-30-09 that 24 hours after receiving vaccines pt had a fever of 104 for 48 hours. Y 6/25/2009 6/26/2009 ed around March 12 and to this date the illness persists. The reaction is the loss of sensitivity N in the thumb 3/12/2009 and later3/12/2009 in the index finger. It l mix the DTaP IPV solution with the Hib Powder for the PENTACEL vaccination. Gave the DTaP Y IPV part 6/29/2009 of the PENTACEL pt's mother notif S GIVEN GARDASIL 1 ST DOSE ON 16/6/2009 AND SHE HAS THYOID SWELLING WHICH IS PATCHY 6/16/2009 BY DOPPLER 7/1/2009 CONFIRMATION so given T-DAP- MENACTRA, HEP YA Pt was given GARASIL (LA), within 30 sec. Pt becameYpale. unresponsive 6/29/2009 arms 6/29/2009 & legs became rigid, re if the lateral neuropathy of my daughters left leg is related to the GARDASIL vaccine, Y but N after reading7/29/2008 reports of numbness I feel obligat oid area of redness, heat, and induration. Y MOTRIN, ice, Benadryl advised Y 6/3/2005 6/4/2005 4/9/2009 6/27/2009 blisters on hand. Tender to touch on 6/28/09. Tx: VALTREX 1GM take 1 tablet 3x day # 15 ORF. U 6/24/2009 6/28/2009 around site and down media aspect of leg; no edema or induration or other rash. Developed day of immunization 6/22/2009to6/22/2009 next day. Reevaluated ely following immunization child lost Yconsciousness and experienced tonic-clonic movementsYof arms, upper 6/30/2009 body and 6/30/2009 neck movements. Pla as been hurting since injection 1 week Y ago. Today (7/2/09) patient woke up in tears and hurts U really bad6/25/2009 into her shoulder 7/2/2009 and has hard tim prior to 11:30 AM 7/1/2009. Represented Y in office with rash at 6:00pm Y 7/1/2009 7/1/2009 light headed, fever, nausea, vomiting, joint pain, headache. Y 6/23/2009 6/24/2009 len. Hard lump at injection site radiating into shoulder (Right). Mother was giving TYLENOL and Y BENADRYL 6/26/2009 and applying 6/28/2009 ice to site. d pain, swelling and decrease ROM in both wrists one week after receiving Typhoid injection.NShe was told 4/20/2009 at a Sports 4/27/2009 Medicine facility that N n has been received from a physician concerning a female "in her 70s" who was vaccinatedUwith a dose of PNEUMOVAX 23. The patient u was reported by a healthcare professional Y and described the occurrence of seizure in a 5-year-old Y male6/24/2009 subject who 6/24/2009 was vaccinated with H ater in the day, respiratory problems,Y chest pain and severe headache-slept all day 4/21/09 and Y condition4/20/2009 worsened.4/20/2009 4/23/09 taken to emer as given Immunizations on 6-22-2009 (Pentacel, Y Engerix-B, Prevnar,2 & Rotarix). He was hospitalized Y on6/22/2009 6-25-20096/22/2009 when mom reported at riencing itchiness--Thumb side of both arms; top of both thighs; back of neck; scalp; lower belly. U I do not 7/1/2009 see any rash 7/2/2009 (more than 3 weeks) mucous in stools; persistent Y belly pain; required 2 hospitalization of 2 days; Y diagnosed 1/23/2008 with COLITIS; 1/28/2008 could no longer b ported temperature of 104.8 the morning Y of 7/1/09. Low grade temperature the evening of the Y immunization. 6/30/2009 Treated 6/30/2009 with Motrin every 6 h
an 6-4-09 with small red area per Mom. Increased reddness 6-5-09. 10cm x 12cm red, hot, tender, Y swollen 6/3/2009 deltoid area. 6/4/2009 No ecchymosis. A ying, hard to console, on awakeningYthis morning Y 6/30/2009 7/2/2009 ain in upper arm at site of injection for 6 days. Swelling and inability to lift arm overhead. PainYwent down 6/26/2009 both arms and 6/26/2009 across shoulders. T e rash - chicken pox lesions, severeYitching, it's been 3 month since symptoms began and still ongoing 4/8/2009 4/10/2009 d rash at injection site developed 24 hr after injection. Treated with ice bag and TYLENOL. Subsided Y after 6/24/2009 another 24 6/26/2009 hrs. or Adagio visit, HPV # 3 due. Pt. states at this time she had reaction to HPV vaccine # 2, and Y didn't want # 3. ### Pt. reports she ### developed fe U 6/29/2009 6/30/2009 t. to clinic to receive HPV #2. Pt described symptoms after receiving first GARDASIL IZ within Y 2 hours after 4/9/2009 injection experienced 4/9/2009 fever, gas n the whole length of the Rt upper arm L elbow + use referred KINRIX and VARIVAX on thisYarm. 6/30/2009 7/1/2009 as received last AVA, noted sharp,Ystabbing, burning Y type pain (not like Y pain r/t inguinal hernia) N ?doubled 9/18/2003 over, couldn't 9/18/2003 sleep. Sought eva here he received MENACTRA is red & swollen 3-4" in diameter. Itchy, hard. U 7/1/2009 7/1/2009 ministered, then MCV - 4 given & second Y after this injection Pt. stated "I'm dizzy". Pt be came Y weak & pale. 7/2/2009 Checked7/2/2009 blood pressure & was ed vaccines Monday 6/29/09 and mom notice swelling and redness Wednesday morning on U 7/1/09. Pt. not 6/29/2009 complaining 7/1/2009 about arm, he said d bumps- Red on arm and legs. Itching Y and spreading, no fevers. Cramping two weeks ago.YDx Erythema 6/19/2009 Multiforme. , edema, tenderness at injection site, sm area of induration. Y 6/24/2009 6/26/2009 & redness left arm @ site of VARICELLA -> cellulitis Y 6/22/2009 6/24/2009 inistration of albuterol nebule, hepatitis a and varicella vaccines, patient developed rash on body Y and tingling 6/10/2009 in the 6/10/2009 back of her throat 06/10 ved dtap on 7\2\2009 was seen in office 7/3/2009 for site that was red, warm to touch, swollen, Y and painful. 7/2/2009 7/3/2009 ately 45 minutes after the DTaP shop was given to my daughter we arrived home from the doctor Y and she 6/25/2009 was floppy 6/25/2009 in my arms, would on ed HPV vaccine for 1st time on 6-17-09 at approximately 16:35 as part of P.E. (Pt. had received Y PPD in other 6/17/2009 forearm 6/17/2009 5 min. prior). At 16:4 and redness at injection site. Y 6/30/2009 oster involving the left side of face. Y U 6/30/2009 7/3/2009 etanus shot and was diagnosed with Y cellulitis 2 days later, being treated with cephalexin 500mg Y 3x a day 7/1/2009 for 5 days 7/3/2009 as unusually sleepy the day of and the Y day after the vaccinations; I noticed twitching in arms Yand legs, esp. 7/2/2009 hands; she 7/2/2009 moved wrists up and Y 6/24/2009 7/4/2009 per arm, where the injection was given, became very hot, achey, and swollen. The entire area N became red 7/3/2009 and extremely 7/3/2009 sensitive to touc nt received gardisil #1, Tdap and meningococcal Y conjugate vaccine 3 (ACYW-135) on 01June N 2009 -- administered 6/1/2009at6/23/2009 Pediatrics in facility. O n has been received from a 23 years old female for the Pregnancy Registry for GARDASIL who N on 16-MAY-2008 5/16/2008was 5/16/2008 vaccinated intramus n has been received from a registered Y nurse through the Merck Pregnancy Registry concerning Y a 16 year 3/28/2008 old female 3/28/2008 patient who on 28-MA follow-up information has been received from a Nurse Practitioner for the pregnancy registryYfor GARDASIL 8/18/2008 From a8/18/2008 nurse practitioner conc n has been received from a physician Y concerning a 22 year old female with no pertinent medical N history who 6/9/2009 on 06-APR-2009 6/13/2009 was vaccina n has been received from a physician Y assistant concerning a 15 year old female who on an U unspecified date was vaccinated with the first 0 n has been received from Y a physician Y and her Y office manager concerning a 19 years Y old female Y with no drug 7/1/2007 reactions 7/1/2008 and a history of ane n has been received from a physician Y concerning a 14 year old female patient with seasonalYallergies who 6/11/2008 on 11-JUN-2008 6/11/2008 was vaccinated n has been received from a study for Y ROTATEQ Y concerning a 17 week 0 old male who was vaccinated U with a second dose of ROTATEQ. Ei n has been received from a study for ROTATEQ Y concerning a 17 week 3 old male who was vaccinated U with a second dose of ROTATEQ. Th n has been received from a physician concerning a now 29 year old female patient who wasYdiagnosed with Bell's palsy 2 days after receiv veloped fevers about 2-3 days postYvaccination. Y 7/1/2009 7/4/2009 6/30/09 FOR 16 YEAR OLD WELLYCHECK. RECIEVED VARIVAX # 2. ON 7/1/09 WOKEYUP WITH RED, 6/30/2009 SWOLLEN 7/1/2009 TO TOUCH, WAR orts on Sat., July 4, 09, she noted aYmild rash at site of injection. Denies itching at this time and N had no other 6/29/2009 complaints. 7/4/2009 Reports that she diaphoresis, early analphylaxis, given Y diphenhydramine and epinephrine. observed in emergency Y room 7/2/2009 7/2/2009 ter recieving immunizations.Turned pale. Fell to the floor. Patient passed out for 10 seconds.YStated that she 7/6/2009 felt dizzy 7/6/2009 when she came to. after infection, by 7:00 p.m. 6/17/09, Y had high fever chills, muscle aches, pain down spine. YSevere muscle 6/16/2009 aches, 6/17/2009 child sobbing. Took to cieved shots, walked out of room feeling fine. Walked over to the check out desk after standing Y there for a7/6/2009 few seconds 7/6/2009 knees gave out and DEVELOPED ATRIAL FLUTTER/FIBRILLATION Y IN JUNE 2009, AND 3 WAS CONCERNED Y THAT IT MAY 2/24/2009 HAVE BEEN 6/12/2009 CAUSED BY VAC iving both vaccines, patient complained of the following symptoms later in the evening;EntireYmouth and lips 2/3/2009 were swollen 2/3/2009 and blistered, Pa and swelling at injection site left deltoid. Y 7/1/2009 7/2/2009 site approx 3 hours post injection. Approx. 9cm by 4cm. Pt crying and retracting RIGHT legYwhen leg touched. 7/2/2009Was7/2/2009 taken to the doctor a sh developed by 7/1/09. rash got worse Y by 7/2- rash was on hands, between fingers and on arms N and feet. 6/29/2009 right hand7/1/2009 was swollen and puff COMPLAINS OF SWELLING AND PAIN IN LEFT ARM ON 7/3/09 AFTER GETTING IMMUNIZATIONS U ON 7/2/2009 7/2/09. STATES 7/3/2009 SHE FELT H 50 mg prednisone x 3 days, angiodema with admission Y to hospital 6/19/2009, 2 benadry,discharged Y on 6/21/2009 5/27/2009 with6/16/2009 hydroxizene 25 mg 3/d
03 degrees started at 6pm, rash started at 5pm and crying from 10pm - 2am Y 7/2/2009 7/2/2009 ts to the clinic with 3 day hx of headache, joint pain, low grade fever, nausea, aphtous stomatitis. U Tx with 7/2/2009 SoluMedrol7/3/2009 125mg IM injection an to inform PHN that approx 24 hrs after receiving Tdap, Hep A and Hep B. Pt L arm where Tdap Y was given 5/29/2009 was tender 5/31/2009 for 24 hrs. Pt c/o upp warmth, tenderness to left upper thigh Y began approx. 24 hours after injection. Erythema measuring 10.56/29/2009 cm in diameter. 6/30/2009 Advised to apply c d flared urticaria scattered throughout her body. Pt seen today in office for rash for 4 days. Treated U with BENADRYL 7/2/2009 at 7/3/2009 home and prescribe e here today with Aunt (who has legal custody of child.) to show nurse Rt arm - Local reaction Y back of Rt6/30/2009 arm red, raised, 6/30/2009 swollen area mea ed up after it was given. Required BENADRYL for about two days. Y 7/5/2007 7/5/2007 area of erythema but no induration, Y (R) thigh Y 6/23/2008 6/23/2008 d office 9:10 am 6/29/09 regarding Hepatitis A shot received in office on 6/26/09 - States child Y developed 6/26/2009 fever- 1026/28/2009 degrees Saturday 6/27 9, we have this 20-month old her 4th DTAP, her 4th H flu, and her second Hepatitis A. 10 days U later she6/11/2009 developed a L nerve palsy in her L identally received RUBELLA vaccine in addition to HEPATITIS B vaccine Y 7/3/2009 identally received Rubella vaccine in addition to Hepatitis B vaccine Y 7/3/2009 e fever, nausea, headache Prior medical diagnoses: Hyperlipidemia dysmetabolic syndrome, Y diabetes, 6/23/2009 hypertension 6/23/2009 AP vaccine 6/29/09 @ Lt thigh and developed redness, swelling, and hardness 7/1/09 per Pts. N mother 6/29/2009 7/1/2009 swollen, warm to touch at site of injection. Y 7/3/2009 7/4/2009 p X 2 days 1 1/2 dollar size. Itchy/ rash U 6/29/2009 6/29/2009 ed area to right upper arm. There was Y some soreness to the arm as well. Patient developed worse Y URI s/s 6/17/2009 on 6/30/09 6/30/2009 as well. was reported by a physician and described Y the occurrence of vasovagal response in a 15-year-old U female 6/25/2009 subject who 6/25/2009 was vaccinated with 9 mother put infant to sleep on his back Y at 8:30Ypm. She then checked 1 him at 9:00 pm and found Y him face 6/19/2009 down and 6/21/2009 not breathing. Grandp bear full weight. Fever, R thigh erythematous swelling Y --> Dx: R thigh 1 myositis at site of injection, Y ultimate 6/24/2009 rebound with 6/24/2009 supportive cares. 9 L. Redness, swelling area hard around vaccine. Had open heart surgery 6/27/09.YSuffered brain U injury. Lactic 6/20/2008 acids6/20/2009 raised to brain, abnorm one week later sleepiness, Y weakness. Y By 2 wkYafter the vaccination 200she Y developed bilat legNweakness and could ###no longer ### walk. She was n has been received from a certifiedYmedical assistant concerning a 7 year old female patient N who on 25-JAN-2003 6/29/2009 6/29/2009 was vaccinated with the n has been received from a certifiedYmedical assistant concerning a 9 year old female patient Y who on 16-Jun-2001 6/29/2009 was 6/29/2009 vaccinated with the n has been received from a physician Y concerning a 72 year old female patient who on 10-JUN-2009 N was6/10/2009 vaccinated6/24/2009 with ZOSTAVAX (Mer n has been received from a pharmacist concerning two patients who within the last 30 days Y were vaccinated 5/1/2009 with ZOSTAVAX (Merck) (sub n has been received from a 24 year old female, for the Pregnancy Registry for GARDASIL, concerning Y the 2/4/2008 24 year 5/21/2008 old female who in Dece rmation has been received from a physician Y concerning a 14 year old female patient Y who received Y the second 9/4/2008 dose of GARDASIL and expe n has been received from a female patient who on an unknown date was vaccinated with GARDASIL. U "15 months from the completion of th n has been received from a licensed Y practical nurse, Y for GARDASIL,0 a pregnancy registry product, Y concerning 6/4/2007 a 243/18/2008 years old female patien orted in a newspaper article that an 18 year old female who was vaccinated with GARDASILU(dose, route and lot numbers 3/1/2008 unspecified). On n has been received from a physician Y concerning Y a female patient with 0 asthma who Y on an unknown N date, was vaccinated 2/1/2009 with the first dose ort received on 24 June 2009 from aYhealth care professional. An 11 year old patient receivedY a first time6/24/2009 dose of DECAVAC 6/24/2009(lot number U2 es infant started having diarrhea, vomiting, fever Y up to 102 on 4-15-09. 2 Was put in hospital on Y 6-19-09 for4/13/2009 dehydration. 4/15/2009 Received IV fluids an mitted to hospital on 4/13/09 for intussusception Y Y after receiving vaccines 2 on 3/23. 7/7/09 Received Y vaccine 3/23/2009 & PCP 4/12/2009 records which include E d GARDASIL Injection and was diagnosed Y with Ytransverse myelitis and is being treated with steroids. U Pt has 6/24/2009 LE weakness. 6/25/2009 7/17/09 Medica Y 6/29/2009 6/29/2009 came very fussy and developed fever Y to 102 after the immunizations. Patient did not want toYeat and fussiness 6/29/2009 lasted 6/29/2009 more than 3hours. F ue reaction Left arm and Right arm. VARIVAX and MMR SQ x 2. 6/24/09 at 10:00AM. Treatment Y ice and6/24/2009 TYLENOL.6/24/2009 No temperature. (Reco injection had raised, red, hard blotch at injection site. Slightly itchy. No temp. per pt. 5 days later Y pt reports 6/24/2009 all sx almost 6/25/2009 resolved. Feels fine whole body maculopapular rash with some areas of confluence and papa measure 2-13 mm N in size. One6/13/2009 large patch6/22/2009 34 cm on post (L) arm iven 1st GARDASIL shot today. Pt. passed out after feeling faint and sick to stomach. Pt. was Y pale but opened 6/29/2009 eyes6/29/2009 and was alert after Am uration over entire left outer thigh with central clearing with slight fluish like. U 6/25/2009 6/26/2009 ministering vaccines MMR and Varicella, Y patient began immediately having redness start @ injection Y site 6/29/2009 and spread6/29/2009 to about a 50% area a that the next day. After the shot in the Y late afternoon she started itching on her right arm in the area of the 6/23/2009 shot. States 6/24/2009 noted a rash with a tous blanchable rash on trunk, neck, face and head several hours after PENTACEL and PREVNAR Y injections. 6/30/2009 6/30/2009 ced pain in (L) hip on 6/23/09 - thenYstarted with egg sized red area with heat - progressed to U 11 X 5 cm6/22/2009 area - upper: 6/23/2009 illiac crest - Pt prese eadache, itching, rash, chest discomfort, Y tongue swelling, difficulty breathing. 8/14/09 MR received N from3/12/2009 pcp for DOS 4/21/2009 3/12/09. HPV#1 give er administration of vaccine. Pt hadYtight sided upper back pain which then radiated to her shoulder, N neck 6/15/2009 + head. Also 6/18/2009 developed erythema f 6/23 pt whole body turned red, arms & legs had red spots. Pt had 101 fever - Mother gave Y child TYLENOL. 6/23/2009 Pt was6/23/2009 taken to ER - temp the dness, swelling, warmth, soreness Y below sight of varicella immu Dx "Mild Superficial Cellulitis". Y Rx KEFLEX 6/23/2009 500 mg6/24/2009 po BID x 10d. 6/25/09
veloped bruising at injection site after withdrawal of needle, after 15 minutes had a small hematoma Y that6/22/2009 improved with 6/22/2009 direct pressure for 1 ash typical of rubella. Y Y 6/19/2009 6/26/2009 pm pt. felt dizzy (6/30/09) and cont to Y do so. 4:30 AM 7/1/09 oral temp of 101 degrees F. TYLENOL administered. 6/30/2009Incoherent 6/30/2009and fatigued a d a area - 10 cm- area of indurationYwith erythema and pain. Central area of erythema with surrounding Y 6/23/2009 area of lighter 6/24/2009 erythema. ythema and induration at site of injection 8.5cm x 6cm left arm. Y 6/23/2009 6/24/2009 fter vaccination postular rash on hands/feet Y No systemic signs/symptoms, vaccine site healed Y normally. 6/10/2009 Treated with 6/24/2009 ANTIHISTAMINE. 3 cm area of tan/lt. brown pigmentation of thigh where shot administered U 5/29/2009 6/1/2009 uption of pustules on erythematous base Y diffusely (out scattered), worse around head. Lesions U were in different 6/5/2009 stage 6/23/2009 of healing. Atypical fo en, painful, hard felling (solid) area around injection site. 1 and 1/2 inch in diameter. Recommended Y cold6/26/2009 compress,6/27/2009 instructed to call MD or and induration Y 6/30/2009 7/1/2009 ceived HPV #2 @ 4 pm 6/29/09. Developed Y generalized urticarial rash 6/30/09 @ 8 pm. 6/29/2009 6/30/2009 veloped a red raised area around injection Y site. It itches, is about 1" x 3". It developed between Y an hour 6/23/2009 or two after6/23/2009 injection. Patient waite d that immediately after the PENTACEL shot, child had 3 raised scratch areas. Then received Y PREVNAR. 6/22/2009 Developed 6/22/2009 erythema multiforme er 102-103, body aches, swelling atYinjection site , headache starting ~ 6 hours after injection of vaccine.6/26/2009 Took NSAIDS 6/26/2009 + Benadryl. Fever m erythematous induration area on upper arm. Received DTaP A/ DTap reaction Y 6/22/2009 6/23/2009 tous, swelling at site of injection no fever Y no systemic symptoms. No other sign. N 6/27/2009 6/28/2009 ceived the varicella vaccine on 06/26/09 (2nd dose). On 06/28/09 the parent notified the office Y that patient 6/26/2009 developed 6/28/2009 a three inch welt at th nted, went white, no treatment patient recovered fine with no ADR reported Y 6/3/2009 6/3/2009 vere HA, myalgias followed by hyperventilation & paresthesias, no fever or focal neurologic changes Y on exam 6/22/2009 * improved 6/23/2009 with MOTRIN. sized area of redness over (L) lateral Y thigh with mild warmth to touch, now tender, no fluctuance Y noted. 7/1/2009 7/3/2009 swollen & hot to touch 7/3/09 at injection site. Tender, painful. Pt would not put pressure x2d. Y Resolving today 7/3/2009 7/6/097/3/2009 swelling decreased (+ 2/09, Redness, fever, nausea, vomiting, Y swelling, pain. AUGMENTIN; BACTRIM DS, VICODIN, N IBUPROFEN. 6/20/2009 16 x14 6/20/2009 cm erythematous wa ew hours of vaccination the pt experienced pruritus at the injection site (VZV). Within one day Y she had developed 6/26/2009an itchy, red, swollen left Y 6/29/2009 Hep B dose # 2 of 3 at approx 11:30 AM 6/30/09 w/o incident mom called at about 16:40 reporting Y that his 6/30/2009 ears turned 6/30/2009 bright red and swoll ted at site of injection within 24 hrs & Y spread to bilat upper ext's. Macula/papular/ erythematous. N Most intense 6/25/2009 at inj. 6/26/2009 site w/bumpy, almost co d ACAM2000 on 6/25/09. Experienced Y robust take - 15mm. noted on 7/2/09. On 7/4/09, pt called with c/o 6/25/2009 of chest pain, 7/4/2009 SOB, pain in arm a mation at deltoid but very stiff neck & torticollis within 24h. Lasted 72 hour left trapezius & subscapular Y pain. 5/20/2009 5/21/2009 d ZOSTAVAX vaccine administered on Thursday, July 2nd. States that since then has beenUsore and arching 7/2/2009 from the 7/2/2009 waist down especia s after receiving DTaP, developed cough, wheezing, SOB followed by red flush and hives. Resolved Y with 7/7/2009 DECADRON, 7/7/2009 epinephrine IM, ora d vaccine on 6/26/09. On 6/28/09 ptYc/o chest tightness, shortness of breath, chest congestion Y & tightness. 6/26/2009 DX with6/28/2009 asthma flare per ER M tous swelling at site of injection (-) fever Y (-) systemic symptoms. No other signs. N 6/27/2009 6/28/2009 DTaP on 6/30/09. c/o pain at injection Y site approx 4-5PM. Redness began approx 6-7P 6/30/09. U Seen in6/30/2009 office on 7/1/09 6/30/2009 approx 11AM - sw s after receiving started with hives, they last one day and went away. Pt left with a reddenedYone inch around 7/2/2009 hard spot. 7/5/2009 Advised to use wa and swelling of arm. Y 6/17/2009 6/19/2009 notified of dose given outside of recommended guidelines. 0 reactions reported. Y 6/25/2009 Vaccination (itch, no fever); 5/16/09 - 1 spot (arm); 5/18/09 - 5 spots (arm, hip, leg); 5/19/09 = Y 10-20 (arm, 5/14/2009 hip, leg, back); 5/16/2009 5/20/09 - 30-40 s mp, reddened ongoing after 5 days. No pain. U 7/2/2009 7/2/2009 came extremely pale, lightheaded, experienced "bloody" taste in mouth immediately after having Y MCV4 administered. 7/6/2009 7/6/2009 Patient was monitore icella injection site became red, warm to touch, and raised the day after injection. Diameter Ysize as big as7/2/2009 approx. 3 7/3/2009 inches. came to work at 7am with temp over the next three hours of 99.8 to 99.9. At 11am fever became N 100.2 and 7/2/2009 employee 7/4/2009 was sent home from ates has red spots with a white center Y on left shoulder, left side of back of neck, on her lowerUscalp and 36/29/2009 spots under7/5/2009 her left armpit. Paren one conversation w/ grandmother on Y 6/12/09. Patient had swelling to left arm w/blisters (<50). U w/fever. Intended 6/10/2009 to seek medical attention w vaccine breakthrough. Had varivax x2. Diagnosed in our office on 6/30/09 with varicella. Had U over 100 6/27/2007 lesions. 6/28/2009 Dr. reported that patient had syncope Y x 2, tiredness, dizziness, swollen/rash on face on 7/1/09 Y at 1630. Pt. 7/1/2009 passed out 7/3/2009 and injured self. Dr ates at 7 pm infant began an unusual, Y ugrent screaming. Y Her breathing 1 became shallow, bluish Y color noted 5/5/2009 around mouth. 5/5/2009 Infant taken to H minutes after vaccines were given patient Y developed hives, right facial swelling, and gurgly resperations. Y 5/5/2009 Pt's mother5/5/2009 called into clinic, was extremity swelling from the knee to the thigh, warm to touch, temperaure to 102, upset stomach Y 4/23/2009 4/24/2009 nced swelling and redness at the site. Y This worsend into itching and then pain. pt went to theYER and had7/1/2009 a follow up7/1/2009 appt with us the next and swelling of left arm two days following Y getting vaccinations.RX of Sulfamethoxazole-Trimethoprim Y 200mg-40mg/5ml 6/24/2009 6/26/2009 oral suspension. 5 adache, Syncope Y Y 7/2/2009 7/3/2009
ion was given on May 1, 2009. Approximately 1 week after receiving the patient's third injection, N the patient 5/1/2009 developed 5/7/2009 small warts on her h vaccine break through. Had 2 doses of varicella vaccine. Diagnosed with varicella in office onU6-25-09. 8/13/2008 6/21/2009 c-clonic seizure with left facial, eye twitching Y lasting Y 2 minutes. Seizure 3 began the evening onY the day when 6/30/2009 vaccines 6/30/2009 were given, Patient ta n with headache, pain in lower back, hands and feet where tingly. Could not feel face. Pt was U complaining7/6/2009 of headache 7/7/2009 2 days prior of vacc d 2 chickenpox like rashes. 1 on lower left arm and other below neck Y 6/30/2009 7/2/2009 MMR where given on 06/29/09 in right thigh. On 07/02/09 pt accompanied mother.Complained U of red raised 6/29/2009 spot on6/30/2009 right thigh 9cm x 8cm. shots app 11 days ago now with redness to right thigh at site of shot and child with low grade Y fever and 6/25/2009 fussiness today 7/6/2009 mom noted small ng at injection site - red from shoulder to elbow warm to touch. Y 6/17/2009 6/19/2009 nd weakness days before menstrualYcycle begins since first dose on 5/14/08. Seizure on 07/07/09. U Has never 3/31/2009 had a seizure 7/7/2009before. Is not o g required doses of the Anthrax Vaccine -NUNK- myself and a majority of Soldiers I have spoken U with have 7/20/2004 described 7/20/2004 decreased ability to ter was encouraged to have the Vaccination GARDASIL at our local doctors surgery. She had U the first injection, with4/26/2009 no side effects, after th The patient had a mild fever the day after injection then developed a few vesicles on his back. U Symptoms:. 5/19/2009 1. Mild fever 5/20/2009 and a few vesicles note on 5/11/09- Patient here today as walk in to clinic complaint of reaction to shingles injection. States he has been 5/11/2009 symptomatic with scr ort received on 30 June 2009 from aYhealth care professional. A 47-year-old female patient, who U has a history 6/30/2009 of migraine 6/30/2009 headaches and a N N n has been received from a physician concerning a female who was vaccinated with the firstYand second dose of GARDASIL on unspecifie se events or treatment needed--adult dose given. Per CDC no further action required 6/29/2009 S Zostavax and within an hour the area of the inocculation on the right arm, was sensitive toUtouch and ached. 2/23/2009 By the 2/23/2009 next day the area wa d Hepatitis A & typhoid @ 1:30pm her Y mom called @ 3pm stated her daughter was having aYreaction c/o 7/7/2009 sob,headache 7/7/2009 dizziness, nausea Y Y 6/10/2009 6/18/2009 veloped jerking movements of armsYthe evening following administration of vaccine and the U jerking episodes 7/1/2009 persisted 7/1/2009 at least 5 days. Als y paralysis. 7/9/09 Hospital records Yreceived DOS Y 5/29/09 to 6/1/09.3Discharge Diagnosis: Lower Y extremity 5/29/2009 weakness, 5/29/2009 probable Guillain-Ba ving inj. pt sat down and passed outYin waiting room. Out for approx 45sec, pt taken to treatment Y room here 7/8/2009 in clinic and 7/8/2009 seen by attending ceived TDaP injection to left deltoid Y6/9/09. On Y6/11/09 patient called4 clinic to complain of n/vYduring the 24h 6/9/2009 following 6/10/2009 immunization and de accine given inadvertantly. Y 5/11/2009 7/8/2009 outer and anterior upper arm which has confluent erythema, induration, and tenderness overU12x6cm extending 7/6/2009 down 7/6/2009 to lower portion of bi as given Boostrix instead of Tripedia No further treatment required Y 7/8/2009 7/8/2009 cieved vaccinations at the health department Y on Monday. Patient came into our office todayYwith a fever, 7/6/2009 reddened, warm 7/7/2009 to touch, swollen as looking at wheni was calling his name and he stop talking 8-year-old intern in biostatistics who is here with left upper extremity pain, post a TDAP shotYthat she got 5/5/2009 on May 5. She 5/8/2009 had just arrived, w other called stating that she took her Y daughter to her doctor on 07/01/2009 after her arm developed Y a hard 6/30/2009 red area where 7/1/2009 she got her vacc amed and cried for two full days without sleep and then slept for two full days. When doctor Y was contacted 9/16/2006 and said9/16/2006 as long he isn't seizing eaction five days after injection. Large Y red rash covering entire deltoid area. Rash was hot, Yitchy and bright red with a white/yellow lump in 8 PM (Less than 24 hours after vaccine) developed red, itchy, swelling at IPV injection site, since then has 7/6/2009 had red itchy 7/7/2009 papules appear on cination given IM route. U 7/7/2009 zure. Febrile seizure- evaluated at hospital Y 4/8/09. Y 4/7/2009 4/8/2009 ceived ZOSTAVAX vaccine on 6/10/2009. Y Reported shingles-like symptoms on 6/13/2009 and went to her 6/10/2009 physician. 6/13/2009 Pt received medicatio ain at injection site. Y Y 7/6/2009 7/6/2009 6/26/2009 Varicella 7/1/09, 7/6/09 noted develop few rash on face / trunk / neck 2 mm--> 6 mm diameter U of papule vesicle 7/1/2009 lesions. 7/6/2009 hest, back and legs. Y Y 5/13/2009 5/13/2009 umbness. TX: CT of head. Blood work; Y no medicine. N 5/21/2009 5/27/2009 isters at various stages of healing on arms, legs and face, some excoriated. U 6/29/2009 7/1/2009 ted to office one day after receiving Yinjection with left arm hurting and rash on arm about sizeYof baseball. 7/1/2009 Pt then went 7/1/2009 to urgent care on 7er arm, redness, swollen, warm to touch. Y 6/29/2009 7/1/2009 was reported by a physician and described Y the occurrence of injection site cellulitis in a 5-year-old N male subject 6/1/2009 who 6/4/2009 was vaccinated with K n has been received from a consumer Y concerning her 12 year old student daughter Y with no known N drug allergies 8/8/2007who9/1/2007 on 09-MAY-2007 wa n has been received from a consumer concerning her son, a 15 month old male patient whoNon 04-NOV-2005 11/4/2005 was vaccinated 11/7/2005 with a 0.5ml n has been received from a 62 year old male with no pertinent medical history reported and N no known drug 2/21/2009 allergies, 4/15/2009 who on 21-FEB-2009 n has been received from a paper and poster presented at the Conference on Vaccine Research. U Four real-time polymerase chain reaction
ort was received 01 July 2009 from aY health care professional. A 14-year-old female patient U with a history 6/30/2009 of vomiting 6/30/2009 following a prior vacci ort received on 02 July 2009 from a Y nurse. A 63-year-old female patient, who hasYa current medical N history 6/18/2009 of lupus, 6/24/2009 had received an intram n over 2 weeks since my last guardasil shot and my left arm is still sore at the injection site. Feels Y like a 6/19/2009 sore muscle. 6/19/2009 Y 7/8/2009 7/8/2009 DISCHARGE AT INJECTION SITE,YSWOLLEN GLANDS, HEAVY NOSE BLEED, LARGE BLOOD U CLOTS 7/2/2009 inistration of vaccines. Client complained of lightheadedness. Nurse observed client to be pale, Y cold,clammy 7/8/2009 with buccal 7/8/2009 cyanosis client nev week, develops water filled blister which then pops. Several lesions on arms, trunk Y 6/24/2009 7/1/2009 ted after receiving immuizations as follows: IPV, Tdap,MMR,Hep A, Hep B. The temperatureYoutside was 7/2/2009 103degrees, 7/2/2009 the client stated she ely 15 minutes after vaccine administration client c/o, tingling of her upper lip and a hive forming Y above her 7/8/2009 left eyebrow. 7/8/2009 Shortly there after hours of immuniation Child called to Mom and was found in a crawling position able to talk but Y unable to move. 7/6/2009 His mother 7/6/2009 picked him up a redness and warmth at injection site. Approximately 2-3 inches in diameter. Hard knot at sight. Y Used ice7/7/2009 to injection7/7/2009 site. S/S X 2 days. d Tdap 0.5ml Im in left deltoid on 6/30/09. Y She called that evening to complain of pain at injection U site. Used 6/30/2009 ice and6/30/2009 took ibuprofen with so d HPV vaccine on 14 Apr 09. Pt went Y to urgent care clinic on 24 Apr 09 complaining that herNright hand had 4/14/2009 been numb 4/18/2009 for the past 6 days a call from son-in-law of patient stating that patient has two small fluid filled spots on patient Nforehead and7/6/2009 that his eyes 7/7/2009 are puffy. He state vaccine given at 1:35PM. At 1:45PMYitching, facial swelling, difficult breathing, signs of shockYbegan. Taken 6/25/2009 to Beverly 6/25/2009 hospital emergency r iven in Right deltoid. Next day hot to Y touch, redness, and swelling measuring 40 X 19 cm Y 7/7/2009 7/7/2009 onset of pain in joints on injection side arm immediatly after injection, this progressed to joint N pains in wrists 6/3/2009 bilaterally6/4/2009 x 6 weeks since injec 10cm x 10cm Flat with raised middle, reddened and warm to touch. Advised pt to apply cool compress and 7/7/2009 massage7/9/2009 every 20 minutes doses of DTap and IPV were given on 12/8/08 to this patient due to confusion re contents ofUnew combination 12/8/2008 vaccine 12/8/2008 being used at Clinic atigue (sleeping 20-22 hours per day). In Jan. Y she started to throw up, 2 on 1/19 she had a migraine N symptom 12/2/2008 that was 12/7/2008 painful and affected , trouble breathing, loss of Y voice, malaise, Y crying, headache, chest discomfort, pain Y at injection N site with swelling, 6/14/2007dizziness, 6/14/2007 abdominal pain welling, induration, pain and fever locally. 7/7/2009 7/8/2009 ss than a minute after vaccines, Y heYcomplained of lightheadedness followed by unresponsiveness, Y pallor 7/7/2009 and rolling 7/7/2009 of eyes, lasting for abo around injection site "hardness" warmth Y to touch. Injections given on Wednesday. Father didYnot notice symptoms 6/24/2009 until 6/26/2009 Friday morning. Fat dministered on Wed. 2. Thursday - dizzy - low fever by evening, very cold. 3. Friday am feverU- dizzy - feeling 6/24/2009 faint. Friday 6/26/2009 by 12:00 very cold h (injection site) with 4 in x 7 in red, Y indurated, warm to touch, antibiotic (po. given to tx cellulitis. 6/29/2009 6/30/2009 AX was administered on 6/9/09. Pt got Y a fever on 6/10 and then a shingles rash on 6/21. She U was diagnosed 6/9/2009 with shingles 6/10/2009 on 6/24/09. and erythema. Y 6/16/2009 6/17/2009 , nausea and vomiting - patient wasYsent to ER. Y 6/11/2009 6/12/2009 ceived GARDASIL and DTaP in left arm. Patient had allergic reaction to GARDASIL, come inY on 7-29-096/30/2009 to report. small 7/2/2009 red rash and soren ped Varicella infection; < 50 lesions Yall over body, oral lesions, with fever; but crop of 10-15 vesicles U grouped 6/18/2009 around6/21/2009 vaccine site in thigh. cm swollen right upper arm and 2 by 2 cm lower right arm lateral aspect. Y 7/2/2009 7/3/2009 yellow fever vaccine on 7/1/09 no complications. 7/4/09 c/o: nausea, vomiting, severe stomach Y ache, diarrhea, 7/1/2009 low grade 7/4/2009 fever and flat ras swelling R arm deltoid. N 7/7/2009 7/8/2009 redness and pruritus. Marked induration/erythema entire left upper arm. 7/7/2009 7/8/2009 esical 2" X 1" surrounded by hot, red Y area 6" X 8" (injection site left arm) itching, painful. Symptoms began 7/6/2009 24 hours7/7/2009 after receiving vaccin ived vaccination 7-7-09; child awoke Y 7-8-09 with redness and pain on right thigh area of vaccine Y administration, 7/7/2009 mom7/8/2009 took child to MD offic ed MMR and VARIVAX subcutaneous to right upper leg. Within 5 minutes developed large red Y hive to area 7/7/2009 of injection. 7/7/2009 Pt was given oral B a of erythema at deltoid area, no fever, non-tender, no cellulitis. Y 7/7/2009 7/9/2009 erile abscess with 5 X 3 cm redness and 2 cm non tender subcutaneous knot. N 7/7/2009 7/7/2009 erythema ~2 1/2 inches oval with warmth Y about 24 hrs after imm. 48 hrs-72 hrs later the redness N increased 7/3/2009 to 17 x 13 7/4/2009 cm oval on (R) uppe eg, knee pain. 7-3-09 - Numbness, Y low grade temp, chills - saw MD - labs done - tested negYfor strep/flu 6/30/2009 - sore throat.7/2/2009 7-4-09 - No strength 15 mos vaccines. Developed swelling and erythema, first noticed by mom the following day Y at 11:00AM.6/30/2009 Approx 5x9 7/1/2009 cm swelling and eryth swelling at site of injection (thighs) with refusal to walk 2 days later day. Pt seen & was able to Y bear weight 6/24/2009 but refused 6/26/2009 to walk next morning Y Y 7/7/2009 7/7/2009 ed, swollen, tender to touch in small area. U 7/6/2009 7/7/2009 rm swelling, temp and pain. On day Y2 after immunization given. U 6/16/2009 ately 12 hours after administration of hepatitis A vaccine, pt developed hives over entire body. Y No other known 7/6/2009 cause7/6/2009 for hives. ort received on 02 June 2009 from a health care professional. A 16 year old female patient with U allergies 5/28/2009 to Augmentin 5/29/2009 and Ampicillin receiv ella vaccination administered to the patient has resulted in chickenpox. At this time, I could not U determine 7/1/2009 how severe7/8/2009 the effect on a one ye izure 3:38 am after vaccine admin previous Y day. Y 6/30/2009 7/1/2009
n has been received from a nurse concerning a "12 year old" female who was vaccinated with U her 1st dose of GARDASIL, 0.5ml, IM. The n has been received from a 72 year old female,Ywho on an unspecified 0 Y date "couple of months N ago", was vaccinated with a single dose of Z n has been received from a physician Y concerning a 65 year old male patient withYdiabetes, gastrooesophageal N 6/23/2009 reflux7/4/2009 disease (GERD), alle n has been received from an 89 year Y old female patient with arthritis who was vaccinated Y with N ZOSTAVAX 7/1/2008 (Merck) one 1/6/2009 year ago approxim xis - Vaccine given @ 1:45 Y pt went home Y started @ 5:00 pm with hives then 7:00 pm chest tightness, U SOB7/8/2009 then went7/8/2009 to ER. Pt went home tions followed about 4-5 hours by fever Y and febrile Y sz witnessed lasting about 10 10 min. Pt also Y with (L) otitis 7/8/2009 media. No sequelae. 10/20/0 veloped approx 12 raised blistered. very puritic. no treatment necessary. Y 6/17/2009 6/19/2009 tion given on 6/30/09. Parent called 7/01/09 to report child had no problems on 6/30/09 but when Y he awakened 6/30/2009 on 7/01/09 7/1/2009 he complained o eling nausea and dry heaves in beginning, then dizzy and diaphoretic. Mat brought in and patient Y assisted 7/10/2009 to floor and 7/10/2009 blood pressure taken veloped a bright red, irregular shaped, Y warm, slightly itchy, bumpy, firm and slightly raised area U around her 7/6/2009 second Varicella 7/8/2009vaccine, abou urning & itching, extensive swellingYelbow to neck, pounding headache, muscle pain, joint pain, N low fever,7/2/2009 nauseous.7/2/2009 Treatment: tylenol, b redness and swelling left arm ~ 12 hrs after receiving pneumovax taking Motrin with effectY 7/8/2009 7/9/2009 SS AND SWELLING, SLIGHT REDNESS LEFT ARM FROM ELBOW TO SHOULDER ~12 HRS Y AFTER RECEIVING 7/8/2009 7/9/2009 PNEUMOVAX I ine administration the pt was standing waiting w.his mohter for the vaccine record, he fall backward Y hit the7/9/2009 wall w.his 7/9/2009 head and slide down t c'd vaccines 7/8/09 and on 7/9/09 had Y an event that starting with high pitched scream then patient Y went stiff 7/8/2009 and eyes7/9/2009 rolled back and rema usculostreleted pain and weakness.YSkin desquamation Y @ fingers;20 Dermatitus Y @ head. 7/23/09 N Received6/6/2009 hospital 6/15/2009 medical records for 7/418 y.o w/m administered a Tdap IM:(lt)Deltoid Y (Boostrix)Glaxo-Smith-Kline:lot Number AC52B039BA Y Immediately 7/10/2009 after 7/10/2009 injection pt. became h Mother who has noticed no difference in the childs behavior or in the injection site. Informed U mom of error 7/9/2009 and told her that she might noti n around the smallpox site. With a diameter of 8cm. With No fever, No chills, No chest pain, Y No nausea, No 7/2/2009 vomting, 7/10/2009 No night sweats, No h 4 days after Rotateq (6/26/09). Change Y in formula before vaccine to Prosobee. Seen for gastritis U 6/30/09-diarrea 6/22/2009 x 3d. 6/26/2009 esented with redness, warmth, swelling and pain of right arm surrounding injection site in area U measuring 7/7/2009 12 cm x 7 cm. 7/9/2009 Treated for possib nd evening after patient received the Varicella vaccine, my husband called me at work to tell U me patient told 7/8/2009 him to look 7/9/2009 at his arm because AVA #3 and Tdap on 6/29/09 as routine Y vac update. (He denied any recent or current URI symptoms.) Y That 6/29/2009 evening6/29/2009 he noted onset of fatig se event/pregnancy outcome report of vaccines inadvertently administered during pregnancy AVA and TYPHOID 8/14/2008VICPs administered on 14 2m vaccination with oral Rotavirus on 6/30/09. Aphthous ulcer - onset 5 days after ROTATEQ. Y 6/30/2009 7/5/2009 ter receiving vaccine pt c/o H/A dizziness and nausea that lasted 5 hours. Y 6/11/2009 6/11/2009 r GARDASIL developed fever, myalgias, swollen eyes; diagnosed with "mono". Monospot (+) Y however EBV 6/26/2008 titers all6/27/2008 negative. Never felt co h after vaccination, child developed 11cm diam red tender indurated lesion on right deltoid centered Y at varicella 7/9/2009 injection 7/10/2009 site. By 48h, increa slight), looks reddish (as if hit by tennis ball on left arm. U 7/9/2009 7/11/2009 ed patch ~ 1cm above MMR injection site in right arm, occurred almost immediately after injection. Y Child observed 7/9/2009for7/9/2009 ~20min. Rash enlarge O x3. HPV given L deltoid. Pt passed out 1-2 secs after vaccine given. Pt arousable. A and OY x 3. Vital signs 7/9/2009 stable. Pt 7/9/2009 tearful and pale. Pt s ness and swelling 4 days after vaccines R arm- TDAP 5 1/2 - 6cm. L arm- MENACTRA 4x4 5cm. Y 7/6/2009 blistering of arm. 6/18/2009 6/20/2009 e and Anaphylactic reaction reaction 10 minutes after vaccination patient presents, generalized Y swelling, erythema, 7/8/2009 cough, 7/8/2009 shortness of bre PNEUMOVAX in left deltoid. Skin gotYred, hot, erythematous. Pain in arm started within 2 hrsYof getting shot. 7/8/2009 Using ice7/8/2009 prn, otc Benadryl 25m dministration error HIB vaccine mixed with Merck DILUENT for MMR DILUENT Lot # 4060XYExp Dec 2010 6/8/2009 veloped a 3cm erythematous, warm, circular area at site of injection the morning after she received U it. Treatment 7/9/2009- Benadryl 7/10/2009PO prn, Motrin started burning itchy area on site area Y that night and next day Rtc - got more down arm - saidY took BENADRYL 6/17/2009 2 days 6/17/2009 that helped - so didn oreness, tenderness, knot @ site, no redness. U 7/9/2009 7/10/2009 ter given, sudden onset head ache stomach pressure and nausea, last 2 hours with suddenYrelief. Also during 7/9/2009 this time 7/9/2009 family noted Pt had arm is red, swollen from deltoid to elbow warm & tender to touch. Referred to PMD. & this office to follow7/8/2009 up with mother 7/9/2009 on Monday 7-13 at injection site, left deltoid, measuring approximately 4cm. long, 3cm. wide. Warm to touch, no pain, knot 7/7/2009 approximately 7/9/2009 2cm. round, itching X WAS GIVEN AS PPD. 0.1 ANTHRAX GIVEN INSTEAD OF TST. U 7/11/2009 MEMBER GIVEN ATHRAX 0.1 ML INSTEAD OF TST. U 7/11/2009 head have hurt enough to prevent sleep. Some 30 hours after innoculation chills and fever were U experienced 7/9/2009 for about 7/10/2009 an hour. 30PM on 7/10/09 and at 8:30am while asleep. 8/5/09 Primary care provider medical recordsYreceived DOS 7/7/2009 6/17/097/10/2009 to 7/14/09. Includes po ustules at site of inoculation spreading to Pt's neck, chest and arms. Sore throat with minimalUexudate on 7/1/2009 (R) tonsil, 7/11/2009 difficulty swallowing, mi ALSY(RIGHT SIDE) DAY AFTER ADMINISTRATION NO OTHER COMPLAINT REFERD BY U PT. NO FEVER 7/7/2009 GENERAL 7/8/2009 MALAISE OR HE 7th my 5 week old daughter was given a Hepatitis A vaccine by a medical assistant in my doctors Y office. She 7/7/2009 was supposed to get the seco hird vaccine of GARDISIL i stoped getting my period, now if i dont take birth controls i wont get U my period. 10/1/2007 1/1/2008 at 0200 with pounding headache, and Y took excedrine. Came into clinic this morning for followYup after receiving 7/11/2009 2 vaccines 7/12/2009 yesterday. Pulse
algias, headache all started aroundY11pm last night. Also had a "few drinks" last evening. Chief Y complaint 7/11/2009 today: headache, 7/11/2009aches. Denies fter Tdap vaccine, awakened with painful, hands and feet, malaise, fatigue. Initially would occur N as frequent 3/13/2007 episodes. 4/5/2007 Pain was symetrical n has been received from a physician concerning a 63 year old female with no known Y drug allergies N and2/20/2009 who was first 2/27/2009 diagnosed with herp n has been received from a registered nurse concerning Y a female who 0 on an unspecified date U was vaccinated with a dose of GARDASIL (d n has been received from a consumer Y concerning her 17 year old daughter with no pertinentNmedical history 8/1/2007 and no known 8/1/2007 drug allergies/d ort received on 06 July 2009 from a Y physician. A 57-year-old female patient, who has allergy U to bee stings7/2/2009 and pesticides, 7/2/2009 but no known dru was reported by a healthcare professional Y via sales representative and described the occurrence U of cellulitis 5/19/2009 in a 5-year-old 5/21/2009male subject w was reported by a healthcare professional via sales representative and described the occurrence U of cellulitis 5/19/2009 in a 5-year-old 5/21/2009female subject ven Mon., 7/6/09 at 3:30 pm. 7/7/09-around Y 4 am headache started; by 4 pm vomiting and hot. Y 5:30 pm fever 7/6/2009 104ø. Took 7/7/2009 to ER at 6 pm. Tx Vaccine breakthrough. Had varivax on 3/10/05 and 4/8/08. Diagnosed in our office on 7/6/09 Y with varicella. 4/8/2008 Fever for 6/30/2009 72 hrs starting on 6/3 mplaining of dizziness and nausea the date of injection with a knot and redness at the injection U site that has 7/8/2009 increased 7/8/2009 to a size of a baseb COMPLAINED OF AN ITCHY RASH ALL OVER HER BODY. THE RASH BEGAN SEVERAL Y HOURS AFTER 7/2/2009 THE VACCINE 7/2/2009 WAS ADMIN th fever >102.0 less than 12 hrs after receiving immunization. Patient resolved in 48 hrs without Y specific intervention. 7/8/2009 7/8/2009 hts sweats, weight loss, Yaches, pneumonia Y 7/16/09 ICD-9 Codes: 486 (pneumonia unspecified U organism, 515### (postinflammatory 12/1/2008 pulmonar ED ON MONDAY (7/13/09) MORNING Y AND SAID THAT SHE AWOKE ON SUNDAY (7/12/09) U WITH A "BREAKOUT" 7/8/2009 7/12/2009 ON HER STOMACH ess of R arm, mild swelling near injection site, chills, sweats, body aches, nausea, mild erythema Y at injection 7/7/2009 site. Seen 7/7/2009 in clinic 7/9, vac adm d red, hot, raised, itchy blotch under the left arm (shot injected into left arm) and also left upper U chest above 7/8/2009 nipple area. 7/9/2009 Patient took Bena S WITH EDEMA AROUND INJECTION Y SITE IS LEFT DELTOID APRROX. 5X4 INCHES IN YSIZE. CHILD7/8/2009 WAS EVALUATED 7/9/2009 AND TREAT ear-old female was brought Y in by ambulance Y with Y a one-day history11 of Ytrouble eating Y that sheNdescribed as difficulty ### chewing food secondary 01, redness, raised bump, and severe soreness at injection site. U 7/10/2009 7/10/2009 ports having an MMR vaccine 90 days before conception of pregancy. No complications from Y the vaccine were reported. 6/30/2009 Fetal sonogram d dose Varicella, 48hrs later injection site red & swollen, then painful red welts on entire body.YPatient also6/2/2009 experienced 6/4/2009 nausea and dizzines with a rash on buttovk, sides, thighs, Y sow spreading, was told it is granuloma annulare. Appeared N after vaccine. 5/27/2008 Stil5/30/2008 having shingles, not as vaccine without incident at 1630 on 7/8/09, on following day [7/9/09] child almost passed outYabout 1100 hours 7/8/2009 in am.7/9/2009 Reportedly child sat nduration (+) erythema, warm to touch. Rx for tylenol/benadryl given. Y on site indurated, erythematous 99.2 Temp. Body aches. Y 6/20/2009 6/21/2009 oke up this morning (7-13-09) w/small lesions (rash) approximately 12 lesions between breasts, U slightly oozing 7/10/2009 0, size. 7/13/2009 efore injection. Syncopal episode after injection recovered after lying down. Mom reports nausea Y for few hours 6/26/2009 after.6/26/2009 07/11/09 Swelling & cellulitis from left Y elbow up to his neck including entire upper arm - with multiple Y blisters 7/8/2009 at injection 7/10/2009 site seen 7/11/09 R es Fevers- per pt. None while seen Y at the office. N 6/18/2009 6/19/2009 irregular rash on upper L arm - erythematous swollen area with mild tenderness. N 6/29/2009 7/1/2009 ear old male reported receipt of ANTHRAX Y vaccine 8/26/1998 while stationed at AFB, as an N airfield management 8/26/1998journeyman. 1/1/2007 He reported alaise, weakness, low grade fever, headache Y - Painful rash across left breast. Y 7/8/2009 7/9/2009 rash - additional sores. Pt with erythema 8cm diameter around wound / small pustule (3mm)Yon opposite6/24/2009 R lat. elbow, questionable lesion o P/Menactra in (L) Deltoid on Wed 7/1/09, on 7/2/09 had headache, on 7/3/09 headache goneYbut had rash, 7/1/2009 redness, 7/3/2009 swelling & hot to touch iving MMR shot at age 1, patient lost her words. About 1 month later, she startedYmaking eeee U sounds. At 4/9/2007 18 mo, she 4/9/2007 had 2nd HEP A sho pain, swelling localized to injection site that started one day after injection given. Treated with Y AUGMENTIN 6/18/2009 with complete 6/19/2009 resolution. with rash 5/26/09. Mild fever began 5/27/09. Denies any other problems. Denies difficulty breathing, Y swelling 5/14/2009 around 5/26/2009 lips/throat or hives. Ra 5 immunizations. After receiving last immunization c/o not feeling well, passed out + hit head Y on floor. 6/5/2009 6/5/2009 hed Notes. See back. Client in today for immunization and PPD. Client very apprehensive Y upon entering 6/19/2009 immunization 6/19/2009 room. MENACTR 6-19-09 spoke with RN c/o having reverse reactions to vaccines given 6-16-09. Pt. stated she was told to 6/16/2009 call back Monday 6/19/2009 6-22-09 if she d ceive injection - next day began developing local reaction - red, hot, painful R deltoid. That night developed7/8/2009 flu - like Sx 7/9/2009 - exhausted, body a ely after the 2 vaccines were given, patient complained of not feeling good. Pallor and sweating Y noted; also 7/13/2009 complaints 7/13/2009 of nausea- then vom h over abdomen and extremities. Y 7/7/2009 7/9/2009 eport change of affect of patient -> seems "lethargic" per parent. Also c/o pain in left leg where U he received7/9/2009 vaccination. 7/10/2009 O/E patient had lim welling/induration of deltoid region persisting 5 days after immunization. Y 7/8/2009 o rash on arms torso chest for 4 days after getting VARICELLA #2 vaccine given 4 days priorUto rash. 6/29/2009 e fever since immunizations. On 7/8/09 Y at app. 5 AM temp increased 102 and pt had seizure. EMS called 7/6/2009 to home. Pt7/8/2009 evaluated by pediatric r vaccines, right thigh grossly swollen, Y indurated, red lacey rash over anterior thigh. Pt with decreased Y range 7/7/2009 of knee 7/7/2009 motion. Received DEC Y 7/2/2009 sating pain in shoulder radiating to back Y 6 hrs post vaccine. No redness or swelling. UnableYto sleep 2 hour 6/18/2009 pain. Much 6/18/2009 better post 24 hou
n has been received from a physician concerning an 84 year old female with allergic to medications Y who1/20/2009 on 20-JAN-2009 1/24/2009 was vaccinated w n has been received from a registered nurse concerning a 57 year old female patient with bipolar N disorder, 2/23/2009 hypothyroidism, 2/23/2009 penicillin allergy n has been received from a pharmacist concerning a 79 year old female patient, who on 20-FEB-2009, N was 2/20/2009 vaccinated 2/23/2009 with ZOSTAVAX (M n has been received from a physician concerning a 66 year old female who in 2008, "a few months U ago", was vaccinated subcutaneously w n has been received from a registered Y nurse concerning an 87 year old male who was vaccinated Y with a dose 3/1/2007 of ZOSTAVAX 3/1/2007 (Merck) on an n has been received from an office manager concerning a 76 year old female who on 10-FEB-2009 Y was subcutaneously 2/2/2009 2/2/2009 vaccinated with a n has been received from a medicalYassistant concerning a 63 year old female patient with allergy Y to tetanus 1/1/2009 shot and 2/1/2009 a history of bowel irr n has been received from a physician concerning himself over 60 year old who was vaccinated Y with a dose 2/12/2009 of ZOSTAVAX 2/15/2009 (Merck) (specific n has been received from a certifiedYmedical assistant concerning a male with hypertension N and sleep apnea 2/23/2009 and no 2/24/2009 allergies reported who n has been received from a physician concerning a 71 year old female who on 24-FEB-2009, Y was vaccinated 2/24/2009 with a2/25/2009 dose of ZOSTAVAX (M n has been received from a registered pharmacist concerning a female patient "over 60 years Y of age", who was vaccinated with a dose of Z n has been received from a Nurse Practitioner Y (N.P.) concerning a 73 year old female patient Y who "last year" was vaccinated 2/23/2009 with a 0.65 m n has been received from a registered pharmacist concerning a male patient who on 25-FEB-2009 U was 2/25/2009 vaccinated 2/26/2009 with a dose of ZOSTAV n has been received from a physician Y concerning a 75 year old female who in May 2008, was N vaccinated 5/1/2008 with ZOSTAVAX 5/1/2008 (Merck) (lot no. n has been received from a nurse practitioner Y concerning an "over 60" year old female patient Y with hypertension 1/9/2009and 1/23/2009 cholesterol high, who n has been received from a Licensed Y Practical Nurse concerning a 64 year old male patient Uwho on 16-JAN-2009 1/16/2009 was 1/21/2009 vaccinated with a do n has been received from a physician Y concerning a 67 year old male with a hypertension and Y hypothyroidism 2/27/2009 and a history 3/2/2009 of multiple nonn has been received from a registered Y pharmacist concerning a 66 year old female with allergies N to Ibuprofen 2/26/2009 and CEFTIN 2/28/2009 who on 26-FEB n has been received from a registered pharmacist concerning a 72 year old female patient with Y a history1/25/2009 of hypertension 1/25/2009 who on 25-JAN-20 n has been received from a pharmacist Y concerning an approximately 60 year old female whoN on 25-Feb-2009 2/25/2009 was vaccinated with ZOSTA n has been received from a pharmacist concerning a 71 year old female with allergic reaction N to ZITHROMAX 3/2/2009 who on 3/3/2009 02-MAR-2009 was v n has been received from a physician concerning a 60 year old female banker with a historyUof type II diabetes 1/21/2009 mellitus 2/25/2009 and no acute illness n has been received from a licensed Y practical nurse concerning a patient with no known drug N reaction/allergies; who on an unspecified date n has been received from a consumer Y concerning her 86 year old husband with diabetes and N hypertension and### a history of brain tumor. No n has been received from a pharmacist concerning a 42 year old female patient with chronicYshoulder pain, asthma ### and unspecified ### allergie n has been received from a registered Y pharmacist concerning a 63 year old female patient with U penicillin, 3/2/2009 sulfonamide, 3/3/2009 codeine, MOTRIN, a n has been received from a physician concerning a female who was vaccinated with a 0.65 N ml dose of ZOSTAVAX (Merck) on an unspecif n has been received from a Doctor of pharmacy concerning a 67 year old female patient with N no drug reactions/allergies 2/18/2009 2/19/2009 and hypercholeste n has been received from a pharmacist concerning a 67 year old female with no drug allergies N who on 03-MAR-2009 3/3/2009 3/3/2009 was subcutaneously n has been received from a pharmacist concerning a 65 year old male patient who on 03-MAR-2009 N was 3/3/2009 vaccinated3/3/2009 with ZOSTAVAX (Mer n has been received from a physician concerning a 71 year old male patient who on 27-FEB-2009 U was vaccinated 2/27/2009 with 3/5/2009 one dose of ZOSTA n has been received from a pharmacist concerning a 73 year old female with penicillin allergy, U sulfa allergy, 12/1/2008 allergy codeine, fish allergy and n has been received from a 71 yearYold female who on 05 -JAN-2009 or 06 -JAN-2009 was N vaccinated with 1/5/2009 a dose of1/5/2009 ZOSTAVAX (Merck) n has been received from a registered nurse with no known medical history and drugs allergies, Y who on 03-May-2009 3/3/2009 3/3/2009 was vaccinated with n has been received from a physician concerning a 70 year old female who was subcutaneously U vaccinated with a 0.65 ml dose of ZOSTA n has been received from a consumer concerning a 62 year old female who on 03-MAR-2009 U was vaccinated 3/3/2009 with a 3/4/2009 dose of ZOSTAVAX ( n has been received from a pharmacist concerning a 79 year old female patient with allergicNreaction to neomycin 3/3/2009 who 3/3/2009 on 03-MAR-2009 w n has been received from a pharmacist concerning a 74 year old male patient who on 03-MAR-2009 N was 3/3/2009 vaccinated3/3/2009 with ZOSTAVAX (Mer n has been received from a consumer concerning her husband, a 75 year old male patient, with N no known 2/24/2009 drug reaction/allergies 3/3/2009 and with n has been received from a 78 yearYold female consumer with PENICILLIN allergy who in approximately N January 2009, was vaccinated wit n has been received from a physician concerning a 65 year old female patient who on unspecified Y date was vaccinated with a dose of ZOS n has been received from a pharmacy student who heard second hand that a patient was vaccinated U with a dose of ZOSTAVAX (Merck). C n has been received from a registered pharmacist concerning an "over 65 year" old female patient N who on3/4/2009 04-MAR-2009 3/6/2009 was vaccinated w n has been received from a registered nurse concerning a 67 year old female patient who "3Nmonths ago" 12/1/2008 in approximately 12/1/2008 December 2008 n has been received from a Nurse Practitioner Y (N.P.) concerning a 71 year old female with hypertension N and 2/5/2008 no drug 3/10/2009 allergies who on 05-F n has been received from a consumer concerning herself who on 10-MAR-2009 was vaccinated N with a dose 3/10/2009 of ZOSTAVAX 3/11/2009 (Merck). On 11 n has been received from a medical assistant concerning her mother (a 63 year old female) Y with diabetes who had a shingles outbreak "un n has been received from a registered pharmacist concerning a female patient who on an unspecified U date was vaccinated with ZOSTAVA n has been received from a 67 year old female patient with no drug reactions and "shingles N 10 years ago"3/5/2009 "1 week ago" 3/5/2009 on approximately 0 n has been received from a veterinarian concerning her mother, a female in her eighties, who U in December 12/1/2008 2008 was 12/1/2008 vaccinated with ZOS n has been received from a physician concerning a female who was vaccinated with ZOSTAVAX Y (Merck) 0.65ml. The patient had herpes a
n has been received from a nurse practitioner Y concerning a 50 year old nurse female who experienced N eye and face3/13/2009 exposure to ZOSTAVA n has been received from a 70 year old female patient with sulfa allergy who on 31-JUL-2008 Y was vaccinated 7/31/2008 with a7/31/2008 single dose of ZOSTA n has been received from a physician Y concerning an approximately 64 year old female who Y in May 2008,5/27/2008 was vaccinated 3/10/2009 with a dose of ZO n has been received from a physician Y concerning an approximated 75 year old female with no Y known drugs 2/24/2009 allergies 2/24/2009 and medical history, w was reported by a healthcare professional and described the occurrence of cut hand in a 56-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated w n has been received from a 82 female Y with sulfa allergy and antifungal drugs allergy who onY30-DEC-2008 was### vaccinated 3/15/2009 SQ with 0.65 m n has been received from a physician concerning a 61 year old female with hypertension, arthritis, N imbedded 7/11/2008 rose thorn 10/1/2008 removed from left a n has been received from a physician Y concerning a female patient who on 02-MAR-2009 was U vaccinated 3/2/2009 with a dose3/2/2009 of ZOSTAVAX (Merc n has been received from a physician concerning a 70 male with no reported allergies, who Y on 20-JUN-2008 6/20/2008 was vaccinated 6/20/2008with a 0.65mL n has been received from a consumer Y concerning her 66 year old husband with no known drug N reactions/allergies 1/8/2008 with 2/25/2009 hypercholesterolem n has been received from an 91 year Y old female with atrial fibrillation, diabetes and drug reaction/allergies Y with### cortisone shot, ### who " 3 mon n has been received from a female physician with no pertinent medical history or drug reactions N or allergies 3/17/2009 and was 3/17/2009 not pregnant concern n has been received from a physician concerning another physician's patient who was vaccinated U with a dose of ZOSTAVAX (Merck) on an n has been received from a Nurse Practitioner Y (N.P.) concerning a 63 year old female with hypertension, N 3/11/2009 acid reflux and osteoporosis as w n has been received from a registered Y pharmacist concerning a 64 year old male patient who U on 06-MAR-2009 3/6/2009 was vaccinated 3/8/2009 with a 0.65 n has been received from a registered pharmacist concerning a 64 year old female with no medical Y history 3/16/2009 or a drug3/18/2009 allergy who on 16-Mar n has been received from a 57 yearYold female with a history of shingles and drug allergies to N penicillin, 3/16/2009 erythromycin 3/16/2009 and "vycodine" who o n has been received from a female Y consumer who on 23-FEB-2009 was vaccinated with a 0.65 U ml dose2/23/2009 of ZOSTAVAX 2/25/2009 (Merck). Lot# was n n has been received from a pharmacy Y technician concerning a female patient who on 20-MAR-2009 U was3/20/2009 vaccinated with ZOSTAVAX (Mer n has been received from a 68 yearYold female consumer with penicillin and erythromycin allergy N who in12/1/2008 December 3/18/2009 2008, was vaccinated w n has been received from a physician Y concerning a 61 year old male who six days ago, on approximately N 3/14/2009 14-MAR-2009 3/14/2009 was vaccinated wi n has been received from a registered Y nurse concerning a 69 year old female patient with asthma N and allergic 2/17/2009 reaction 3/30/2009 to antibiotics (CIPR n has been received from a physician Y concerning a male patient who in 2006 was vaccinated Y with a dose of ZOSTAVAX 9/1/2008 (Merck) (lot not re n has been received from a physician Y concerning an 85 year old female, who on 27-FEB-2007 Y was vaccinated 2/27/2007 with ZOSTAVAX 2/5/2009 (Merck). O n has been received from a physician Y concerning an 82 year old male patient who on 26-SEP-2007 Y was9/26/2007 vaccinated with 2/4/2009 a dose of ZOSTAV n has been received from a pharmacist Y concerning a 59 year old female with latex allergy and U no pertinent 3/20/2009 medical history, 3/1/2009 who on 20-MAR n has been received from a nurse concerning an approximately in her 70's who on 17-MAR-2009 Y was vaccinated 3/17/2009with 3/18/2009 ZOSTAVAX (Merck) n has been received from a pharmacist Y concerning a 70 year old female patient with penicillin N allergy who 3/20/2009 on 20-MAR-2009 3/1/2009was vaccinated n has been received from a physician Y concerning a 73 year female who in November 2006, U was vaccinated 11/1/2006 subcutaneously 3/20/2008with 0.65 ml o n has been received from a 64 yearYold female consumer with high blood pressure and highNcholesterol 2/19/2009 who on 19-FEB-2009 2/26/2009 was vaccina n has been received from a nurse concerning Y a 70 year old female with blood pressure high,Ndepression1/14/2009 and history3/23/2009 of shingles (unspecifie n has been received from a Registered Nurse (R.N) concerning herself with no pertinent medical N history3/17/2009 and no known 3/17/2009 drug allergies/drug n has been received from a pharmacist concerning a male "over 60" year old who on an unspecified U date was vaccinated SQ with a 0.65m n has been received from registered pharmacist concerning a female patient who on an unknown Y date was vaccinated with a dose of ZOST n has been received from a 75 year old female patient with drug reaction to CELEBREX whoNon 16-MAR-2009 3/16/2009 was3/25/2009 vaccinated with single n has been received from a 66 year old female patient with "allergy to sulfa drugs" who on 24-MAR-2009 N 3/24/2009 was vaccinated 3/24/2009 with "one dose" o n has been received from a physician concerning a 74 year old female patient who "1 week N ago" on approximately 3/18/2009 18-MAR-2009 was vacc n has been received from a 77 year old male patient with no pertinent medical history or drug N reaction or 5/1/2008 allergies who 2/1/2009 in May 2008, was va n has been received from a 75 yearYold female consumer with hypertension, who was also the N patient, who 3/5/2009 on 05-MAR-2009 3/12/2009 was vaccinat n has been received from an 83 year old female who in approximately 2008 was vaccinatedNwith ZOSTAVAX vaccine 3/18/2009 (Merck). Concomitan n has been received from a pharmacist concerning a 78 year old female with no drug reactions N or allergies 3/4/2009 who on 04-Mar-2009 3/4/2009 was vacci n has been received from a nurse practitioner (N.P.) concerning a female who on an unspecified U date was vaccinated with a dose of ZOST n has been received from a physician Y concerning a 66 year old male who in June 2007, wasUvaccinated with 6/1/2007 the first2/1/2009 0.65 ml dose of ZOST n has been received from a physician concerning a 61 year old female with hypertension and N hyperlipidaemia 3/26/2009 and no 3/26/2009 drug reactions or alle n has been received from a 65 yearYold female with high blood pressure and allergic to sulfaNwho 0n 11-MAR-2009 3/11/2009 3/19/2009 was vaccinated with a d n has been received from a consumer concerning her 76 year old husband who on an unspecified U date was vaccinated with a dose of ZOS n has been received from a licensed Y practical nurse concerning a male with no medical history Y or drug allergy 1/15/2009 who on 15-JAN-2009 was va n has been received from a physician concerning a 70 year old female who on 12-MAR-2008 U was vaccinated 3/12/2008 SC with 3/9/2009 a 0.65 ml dose of ZO n has been received from a female Y patient with no drug allergies/reactions and arthritis who N on 18-MAR-2009 3/18/2009 was vaccinated 3/18/2009 with ZOSTAV n has been received from a registered pharmacist concerning a female patient who on 18-FEB-2009 N was 2/18/2009 vaccinated with ZOSTAVAX (Me n has been received from a patient Yvia of a letter who was vaccinated with a dose of ZOSTAVAX N (Merck) on an unspecified 2/15/2009date. On 15-F
n has been received from a nurse practitioner Y concerning a 62 year old female with morphine Y allergy and 3/26/2009 medical history 3/26/2009 of breast cancer w n has been received from a female with a medical history of Shingles, high Cholesterol and N high blood pressure 1/1/2009 who2/1/2009 was vaccinated with a n has been received from a medical assistant concerning a patient who was vaccinated withYZOSTAVAX (Merck). The patient developed a n has been received from a pharmacist concerning a patient who was vaccinated with ZOSTAVAX U (Merck). The patient experienced a mus n has been received from a Registered Pharmacist (R. Ph.) concerning a 60 year old femaleNwho on 09-MAR-2009 3/9/2009 3/16/2009 was vaccinated subcut n has been received from a registered pharmacist concerning a 60 year old female with "being U sensitive3/30/2009 to things" but 4/1/2009 no allergy to gelatin n has been received from a consumer concerning "friend of a friend" who was vaccinated with U ZOSTAVAX (Merck) a long while ago. The p n has been received from a consumer concerning "friend of a friend" who was vaccinated with U ZOSTAVAX (Merck). On an unknown date t n has been received from a registered Y pharmacist concerning a female who on approximately N 12-MAR-2009 3/12/2009 was vaccinated with a 0.65 m n has been received from a physician Y concerning a 55 year old male patient with abnormal aneurysm, N hypothyroidism, 1/1/2009 1/1/2009 undefined anemia a n has been received from an advance registered nurse practitioner concerning a male patient N who on 03-MAR-2009 3/3/2009 3/24/2009 was vaccinated SQ wi n has been received from a nurse concerning Y a "over 60 year old" male who was vaccinatedUwith ZOSTAVAX (Merck). In 2008 the patient n has been received from a 66 year old female with reaction to BENEDRYL and reaction to N cisplatin (+) 3/31/2009 doxorubicin (+) 4/1/2009 etoposide (+) vincri n has been received from a medical assistant concerning a 38 year old male patient who was U inadvertently vaccinated with ZOSTAVAX (M n has been received from a 90 year old female consumer with no pertinent medical history and U no known 3/13/2009 drug allergies, 4/1/2009 who on 17-MAR-2 n has been received from a Medical Assistant concerning a female patient who on 02-APR-2009 U was accidentally 4/2/2009 vaccinated 4/2/2009 with ZOSTAV n has been received from a physician concerning a 78 year old male patient who in JanuaryN2008, was vaccinated 1/1/2008 with 3/1/2009 a dose of 0.65 ml Z n has been received from a female patient with no known drug reactions/allergies and no pertinent N medical history, ### who 1/1/2009 on 18 18-DEC-200 n has been received from a 73 yearYold female nurse practitioner with penicillin, codeine andNMOTRIN allergies 3/27/2009 who 4/1/2009 on 27-MAR-2009 were n has been received from a female patient who was vaccinated with a dose of ZOSTAVAX (Merck) U (Lot# not provided). Subsequently the p n has been received from an 81 year old female patient with no pertinent medical history and N no known 3/31/2009 drug allergies, who on approximate n has been received from a 67 year old female with no pertinent medical history and no known Y drug allergies, 3/30/2009 who on4/2/2009 30-MAR-2009 was v n has been received from a medicalYassistant concerning a 51 year old female patient with osteoporosis N and 4/1/2009 sulfonamide 4/2/2009 allergy, who on 0 n has been received from a Registered Y Pharmacist concerning a "over age of 65" female who N on approximately 3/27/2009 27-MAR-2009, 3/28/2009 " about 1 w n has been received from a physician Y concerning a female in her 60's who was vaccinated with N a dose of ZOSTAVAX (Merck) (Lot number n has been received from a Certified Medical Assistant (C.M.A) concerning a 64 year old male N with gastroesophageal 4/6/2009 4/6/2009 reflux disease and n n has been received from a Nurse Practitioner Y (N.P.) concerning a 70 year old female who inU February 2009 2/1/2009 was vaccinated 2/1/2009with a dose of n has been received from a Nurse Practitioner Y (N.P.) concerning a 62 year old female who on N 03-APR-2009 4/3/2009 was vaccinated subcutaneous n has been received from a physician Y assistant concerning a female patient with fibrocystic breast Y and without 3/2/2009 drug allergy 3/3/2009 who was subcu n has been received from a physician with allergy to penicillin who on 06-APR-2009 was administered U ZOSTAVAX 4/6/2009 (Merck) 4/6/2009 (lot # not availa n has been received from a pharmacist Y concerning a 65 year old female with blood pressureNhigh who on 3/20/2009 20-MAR-2009 3/20/2009 was vaccinated wi n has been received from a registered pharmacist concerning a 67 year old female patient with Y hypertension, 4/2/2009 hypercholesterolemia 4/6/2009 and no n has been received from a physician concerning a 64 year old male consumer who got the N ZOSTERVAX4/3/2009 (Merck), unknown 4/5/2009dose and freq n has been received from a 59 year old female with a history of perforated ulcer and no known N drug allergies, 2/18/2009 who on 2/18/2009 18-FEB-2009 was va n has been received from medical assistant concerning a female patient who on an unspecified N date was vaccinated with a dose of ZOSTA n has been received from a Registered Y Nurse (R.N.) concerning a 62 year old male who on N 19-FEB-2009 2/19/2009 was vaccinated 4/9/2009 subcutaneously n has been received from a physician Y concerning a 63 year old female patient who on 25-MAR-2009 N was 3/25/2009 vaccinated 3/23/2009 with ZOSTAVAX (Me n has been received from a nurse concerning Y a patient with unknown history of shingles prior N to receiving4/2/2009 ZOSTAVAX 4/9/2009 (Merck) who was va n has been received from a Nurse Practitioner (N.P.) concerning a 68 year old patient who U on 03-APR-2009 4/3/2009 was vaccinated 4/13/2009 with a dose o n has been received from a health care professional concerning a 63 year old male patient who U on an unspecified date experienced a poss n has been received from a physician Y concerning a patient who on 18-MAR-2009 was vaccinated U with ZOSTAVAX 3/18/2009 3/20/2009 (Merck). The physician n has been received from a consumer Y and a Registered Pharmacist (R.Ph) concerning a 77Nyear old male 1/26/2009 patient with 2/15/2009 a history of "Dental n has been received from a 67 year old female patient allergic to aspirin and sulfa drugs, and N with thyroid disorder ### who 4/8/2009 on 16-DEC-2008 w n has been received from a physician concerning a 65 year old female with no known drug reactions/allergies, Y 1/5/2009 who 1/19/2009 on 05-JAN-2009 was v n has been received from a medical assistant concerning a 16 year old patient who "last week" U was accidentally 4/8/2009 vaccinated 4/8/2009with ZOSTAVA n has been received from a medical assistant concerning a 60 year old male patient who about U 2 weeks ago 4/2/2009 was vaccinated with ZOSTAV n has been received from a medicalYassistant concerning a female who on 31-MAR-2009 was N vaccinated 3/31/2009 with a dose 4/10/2009 of ZOSTAVAX (Merc n has been received from a 73 year old female patient who was vaccinated with a 0.65 ml dose N of ZOSTAVAX (Merck) 4/9/2009 (lot# was not provid n has been received from a doctor of pharmacy concerning a 65 year old female with blood Y pressure high2/1/2009 and a previous 3/1/2009 small pox vaccina n has been received from a nurse (at the physician's office) concerning a patient who was vaccinated U with ZOSTAVAX (Merck). The patien n has been received from a healthcare worker concerning a 25 year old patient who on 16-APR-2009 Y was4/1/2009 vaccinated4/1/2009 with ZOSTAVAX vac
n has been received from a physician concerning a patient who was subcutaneously vaccinated U with a 0.65 3/31/2009 ml dose of ZOSTAVAX (Merck n has been received from a physician Y concerning a 66 year old male with no pertinent medical N history and4/2/2009 no known 4/10/2009 drug allergies/drug rea n has been received from a 61 year old female consumer with no pertinent medical history and N no known 4/15/2009 drug allergies, 4/16/2009 who on 15-APR-2 n has been received from a registered nurse concerning a 63 year old male who on 05-JAN-2009 U was vaccinated 1/5/2009 with 1/5/2009 a dose of ZOSTAVA n has been received from a nurse practitioner concerning a 70 year old female who on 13-APR-2009 N was 4/13/2009 subcutaneously 4/15/2009 vaccinated with n has been received from a 65 year old female registered nurse with no pertinent medical history Y or drug4/17/2009 reactions or 4/17/2009 allergies reporting he n has with allergies to PENICILLIN, CEPHALOSPORIN, non-steroidal anti-inflammatory drugs N and silver 8/7/2007 containing4/13/2009 compounds who on 07 n has been received from a pharmacist Y concerning a greater than 70 year old female who on N 11-JUN-2008, 6/11/2008 "last summer", 4/10/2009 was vaccinated n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX Y (Merck). On approximately 4/6/200906-APR-2009 n has been received from a 76 yearYold female, with no known drug reactions/allergies and no N pertinent medical history, 4/1/2009 who in approximat n has been received from a consumer Y concerning himself who on 20-JUN-2008 was vaccinated N with a dose 6/20/2008 of ZOSTAVAX 6/22/2008 (Merck). Two d n has been received from a medicalYtechnologist concerning her 65 year old husband with idiopathic N thrombocytopenic 4/13/2009 4/15/2009 purpura and no dru n has been received from a registered pharmacist concerning a 77 year old female patient with N no medical 4/16/2009 history or 4/17/2009 allergies who had 2 p n has been received from a physician Y concerning a 72 year old patient with diabetes who onU28-JAN-2008 1/28/2009 was vaccinated 4/22/2009 with a dose of Z n has been received from a physician Y concerning an 85 year old female who was vaccinatedNwith a dose 4/3/2008 of ZOSTAVAX 12/1/2008 vaccine (Merck) 0 n has been received from a physician Y concerning her 65 year old mother who was vaccinated N with a 0.65 10/1/2008 ml dose of 10/1/2008 ZOSTAVAX (Merck) ( n has been received from a physician Y concerning a 63 year old male who on 16-APR-2009 was Y vaccinated 4/16/2009 with a 0.65mL 4/21/2009 dose of ZOSTAV n has been received from a pharmacist concerning a 68 year old female with sulfonamide allergy N and a 4/21/2009 history of uterine 4/23/2009 cancer, cervical c n has been received from a physician Y and a Licensed Visiting Nurse concerning an 83 year N old male patient 4/20/2009 who on4/20/2009 20-APR-2009 was vac n has been received from a registered Y pharmacist concerning a 67 year old female patient who N on 19-APR-2009 4/19/2009was 4/24/2009 vaccinated with ZOS n has been received from a consumer Y concerning herself (a 61 year old female) with no medical N history 4/21/2009 and drug allergies 4/22/2009 who on 21-APR n has been received from a 67 year old female with arthritis, osteopenia, high cholesterol, high N blood pressure 10/1/2008 as well 4/20/2009 as allergy reaction to n has been received from a physician concerning a "74 year old" female who in April 2007, was U vaccinated 4/1/2007 with a single 4/10/2009 dose of ZOSTAVA n has been received from a pharmacist (from a drug information center) concerning a male patient U who received 4/19/2009approximately on 19-APR n has been received from a physician Y concerning a 64 year old male patient with type 2 diabetes N mellitus, 4/24/2009 hyperlipidaemia, 4/25/2009 hepatitis C antib n has been received from a Licensed Y Practical Nurse (LPN), a 69 year old female concerning N herself, she was### vaccinated 4/20/2009 in the arm with o n has been received from a physician concerning a 63 year old female who on 17-APR-2009Nwas vaccinated 4/17/2009 with ZOSTAVAX (Merck) (lot# n has been received from a registered Y nurse concerning a 70 year old male with a history ofNherpes simplex 4/22/2009 treated4/24/2009 with VALTREX and ac n has been received from a 69 yearYold female patient with hypertension, arthritis, drug hypersensitivity Y to 12/7/2007 "NASOTEC", Prednisone, ### Pipera n has been received from a consumer's husband concerning his wife with no pertinent medical N history and 3/1/2009 no allergies 3/1/2009 who in approximate n has been received from a pharmacist concerning a 67 year old female with no known allergies N or medical 4/24/2009 history reported, who on 24-AP n has been received from a pharmacist Y concerning a 60 year old female with liver disorder and N no known allergies, ### who on 18-DEC-2008 w n has been received from a pharmacist concerning the pharmacist's 66 year old mother withYno pertinent 3/5/2008 medical history who on 05-MAR-2 n has been received from a physician Y concerning a 78 year old female who on 03-MAR-2009 Y (also reported 3/3/2009 as 30-MAR-2009) 3/7/2009 was subcuta n has been received from a physician concerning a 62 year old male who on 25-FEB-2009 was Y subcutaneously 2/25/2009 vaccinated 3/2/2009 with a 0.65 ml d n has been received from a Registered Y Nurse (R.N.) concerning a 61 year old female with migraines, U hypercholesterolaemia 4/14/2009 4/15/2009and allergy to n has been received from a Registered (R.N.) concerning a female with a history of 2 cases N of childhood chickenpox who was vaccinated w n has been received from a nurse practitioner (N.P.) concerning a male who on an unspecified N date was vaccinated ### 4/13/2009 SC with a 0.65 ml dose n has been received from a 71 year old female patient with history of shingles before vaccination Y and no known 1/1/2009 drug2/1/2009 allergies/drug reaction n has been received from a physician concerning his 80 year old mother in law, who was vaccinated N with a dose of 2/22/2009 ZOSTAVAX (Merck). A n has been received from a pharmacist concerning two patients who on an unknown date were U vaccinated 4/21/2009 with a dose of ZOSTAVAX (Mer n has been received from a 63 yearYold male consumer with no pertinent medical history reported N who on 8/23/2007 23-AUG-2007 4/27/2009 was vaccinated w n has been received from a nurse practitioner Y concerning a female who was vaccinated withUa dose of ZOSTAVAX (Merck). The patient de n has been received from a 66 yearYold female with no pertinent medical history and no drugNreactions or 4/17/2009 allergies won 4/17/2009 on 17-APR-2009 w n has been received from a nurse concerning Y a 82 old female patient with unspecified drug reactions/allergies Y and medical history who was n has been received from a pharmacist concerning a 60 year old male with chest pain, obesity, N gastrooesophageal 4/13/2009 4/25/2009 reflux disease, vitamin n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTER v n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTAVA n has been received from a pharmacist concerning a 65 year old female who is the mother of U an other healthcase 4/22/2009 professional 4/22/2009 in the same n has been received from a retired 72 Y year old female registered nurse with no medical history N and drug allergy 7/1/2007 who4/22/2009 in July 2007 was vacc n has been received from a registered nurse concerning a 65 year old (also reported as 64 year N old) female 4/27/2009 with hypertension, 5/1/2009 gastrooesop
n has been received from a registered pharmacist concerning a 63 year old female who wasUvaccinated with ZOSTAVAX (Merck) and expe n has been received from a physician who was vaccinated with a dose of ZOSTAVAX vaccine Y (Merck). Two weeks later after receiving the n has been received from a physician concerning himself who on 30-APR-2009 was vaccinated N with ZOSTAVAX 4/30/2009(Merck) 4/30/2009 by the intramuscu n has been received from a 73 year old female patient with sulfa allergy who in July 2008, was N vaccinated7/1/2008 with a dose 4/25/2009 of ZOSTAVAX (Mer n has been received from a licensed Y practical nurse concerning a 72 year old male patient with N chronic obstructive 3/30/2009 pulmonary 4/20/2009 disease, arth n has been received from a registered nurse concerning a 57 year old patient who on 04-MAY-2009 U inadvertently 5/4/2009 received 5/4/2009 ZOSTAVAX (M n has been received from a 67 year old female with allergies to estrogen, and FLUORENOL, post herpetic neuralgia and arthritis and a his n has been received from the doctor's nurse concerning a 61 year old female who on 01-MAY-2009 N was vaccinated 5/1/2009 5/1/2009 subcutaneous injection n has been received from a nurse practitioner concerning a 15 month old male who on 05-MAY-2009 Y was5/5/2009 inadvertently 5/5/2009 vaccinated with a d n has been received from a physician Y concerning a 74 year old female patient with no pertinent N medical 4/22/2009 history and no drug reactions or al n has been received from a doctor of pharmacy concerning a 64 year old female who in January N 2009 was 1/1/2009 vaccinated 1/1/2009 with a 0.65ml dose o n has been received from a 90 year old male who on 05-MAR-2007 was vaccinated with a dose N of ZOSTAVAX 3/5/2007 (Merck). 4/29/2009 There was no con n has been received from a registered nurse concerning a medical assistant who had been administering U ZOSTAVAX (Merck) for the past n has been received from a 58 yearYold female physician concerning herself with history of shingles N while in her 20's4/10/2009 who following her hus n has been received from a medical assistant concerning herself, a 24 year old female with N a history of chickenpox at5/4/2009 her 5 years old who o follow-up information has been received from a physician concerning a 68 year old female patient N with hypertension, 4/30/2009 5/1/2009 osteoporosis and DEM n has been received from a Registered Pharmacist (R.Ph) concerning a 66 year old female patient N who used 5/4/2009 KENALOG 5/5/2009 about 1 to 2 week n has been received from a pharmacist Y concerning a 65 year old male with type 2 diabetes, N other unspecified 5/1/2009 medical 5/1/2009 conditions and a mil n has been received from a 65 year old female registered nurse concerning of herself with hypertension, N hypercholesterolaemia, 5/5/2009 5/6/2009 allergic re n has been received from a registered Y nurse concerning a 89 year old male with chronic obstructive N pulmonary 4/28/2009 disease, 5/3/2009 hypertension, ana n has been received from a physician concerning an approximately 55 to 70 year old year old Y male with rheumatoid arthritis who on 2008 w n has been received from a pharmacist concerning two patients who on an unknown date were U vaccinated 4/21/2009 with a dose of ZOSTAVAX (Mer n has been received from a physician Y concerning a patient who was vaccinated with a dose Yof ZOSTAVAX 4/28/2007 (Merck).4/29/2009 The patient developed n has been received from a 62 year old female with cholesterol high and breast cancer diagnosed N in June 4/30/2009 2006 who 5/7/2009 on 30-APR-2009 was n has been received from a pharmacist concerning an approximately 74 year old female whoN on 06-MAY-2009 5/6/2009 was vaccinated with ZOSTA n has been received from the doctor's Y employee concerning an over 60 year old male who "recently" U was4/1/2009 vaccinated4/1/2009 with ZOSTAVAX (Me n has been received from a pharmacist concerning his 68 year old wife who unspecified date N was vaccinated SQ with ZOSTAVAX (Merck) n has been received from a Licensed Y Vocational nurse concerning a 52 year old female withUallergies to4/14/2009 codeine and 4/15/2009 DEMEROL and histo n has been received from a doctor of pharmacy concerning a 62 year old male patient with diabetes N and4/24/2009 no known 4/28/2009 drug allergies /drug rea n has been received from a nurse practitioner Y concerning a 71 year old female patient with no N known drug 2/20/2008 allergies, 5/4/2009 hypertension, hyperlip n has been received from a medicalYassistant concerning an 86 year old male with unspecified N drug reactions 9/1/2007 / allergies 5/7/2009 and medical histor n has been received from a physician Y concerning a 79 year old male with a history of chickenpox U (when was 5/5/2009 child) who 5/7/2009 on 05-May-2009 w n has been received from a physician concerning a 60 year old female with unspecified allergy Y who in May 5/1/2009 2009 (last5/1/2009 week, date unspecifie n has been received from a licensed practical nurse concerning an 82 year old male patient N with chronic obstructive ### 5/11/2009 pulmonary disease, hy n has been received from a physician Y concerning a 72 year old male patient with no pertinent N medical history 5/5/2009 and with 5/7/2009 seasonal allergies w n has been received from a pharmacist Y concerning a female who on 04-MAY-2009 was vaccinated Y subcutaneously 5/4/2009 with 5/8/2009 a 0.65 ml dose of n has been received from a pharmacist concerning a 65 year old female who on 11-FEB-2009 U was vaccinated 2/11/2009 with 2/15/2009 a 0.65 ml dose of ZOST n has been received from a nurse concerning Y a 60 year old male with hypothyroidism and hyperlipidemia N 4/29/2009 as well as4/30/2009 no drug allergies who o n has been received from an Adult Nurse Practitioner (A.N.P) concerning an 86 year old female N patient with 5/12/2009 hypertension 5/13/2009 and sulfonamide n has been received from a 60 year old female consumer with 'allergies to some chemicals in N perfumes'5/13/2009 and a history 5/14/2009 of shingles in March n has been received from a female patient who on 15-MAY-2009 was vaccinated with a dose U of ZOSTAVAX 5/15/2009 (Merck). 5/16/2009 On 16-MAY-2009 the n has been received from a pharmacist concerning a female patient in "late sixties" with no allergies N or medical 5/11/2009 history who "last week" on a n has been received from a registered pharmacist concerning a approximately 65 years oldNmale who on 2/13/2009 13-FEB-2009 2/15/2009 was vaccinated wit n has been received from a physician Y concerning a female who on an unspecified date was N vaccinated with a dose of ZOSTAVAX (Merck) n has been received from a consumer concerning her husband a 91 year old male who on unspecified U dates was vaccinated subcutaneous n has been received from a registered nurse concerning a 14 month old patient who on 19-MAY-2009 U was 5/19/2009 vaccinated 5/19/2009 with ZOSTAVAX (M n has been received from a certifiedYmedical assistant concerning a 69 year old female patient N with allergic 5/4/2009 reaction to 5/5/2009 CECLOR and AUGM n has been received from a physician's Y assistant concerning an 88 year old male patient with N hypertension, 2/14/2008 hyperlipidemia, 5/20/2009 arthritis, aortic n has been received from a pharmacist concerning a female with blood pressure high and "some N kind of eye 1/1/2007 disease" who "1 or 2 years ag n has been received from a medicalYassistant concerning an 84 year old male with ischaemic N cardiomyopathy 4/20/2009 and diabetes 5/16/2009 and a history o n has been received from a pharmacist concerning a 66 year old female with unknown drug Nallergies and 5/13/2009 unknown 5/15/2009 medical history who "la
n has been received from a physician concerning an over 60-year old female who on an unspecified N date was vaccinated with a 0.65mL do n has been received from a consumer concerning her husband a 62 year old male with neuralgia N from phantom 5/18/2009 limb 5/19/2009 pain who on 19-MAYn has been received from a consumer Y concerning her sister, a 63 year old female who in May N 2007, was 5/1/2007 vaccinated 3/1/2008 with ZOSTAVAX (Mer n has been received from a physician concerning a female patient in her early 60s with unspecified N drug allergies and 5/13/2009 no pertinent medical n has been received from a 58 yearYold female consumer with no known drug allergies and a U history of genital 2/1/2008 herpes 2/1/2008 who in February 200 n has been received from a pharmacist Y concerning a patient with unknown drug allergies and U unknown medical 4/30/2009 history who "about 3 weeks n has been received from a 61 year old female patient with hypothyroidism and no drug reactions N or allergies 5/20/2009 who on 5/21/2009 20-MAY-2009 was va n has been received from a Nurse Practitioner (N.P.) concerning herself with no pertinent medical Y history and with penicillin allergy who on n has been received from a physician concerning a 60 year old female patient who on 22-MAY-2009 N was 5/22/2009 vaccinated 5/22/2009 with a dose of ZOSTA n has been received from a 68 year old female with early heart beat; arthritis and thrush from N an antibiotic3/6/2009 who on 06-MAR-2009 3/27/2009 was vacci rmation received from a health careYprofessional on 31 July 2008. An 18-year-old male patient Y with a history 7/30/2008 of seasonal 7/31/2008 allergies received , shortness of breath edema of eyelids, Y erythema, tachycardia. Y 7/9/2009 7/9/2009 n Thursday - 6/18/09 approx. 9:30 AM. Y Mother Yreports Friday 6/19/09 4 AM - had increase temp Y of 100.8 -6/18/2009 never went6/19/2009 higher then that - gave eption requiring surgical Y reduction. Y Y 3 Y 5/28/2009 6/15/2009 has adverse reaction to Gardasil, she has had continuous fever 104 07/10/09 nausea Dr thought might be strep, however 7/2/2009 strep test negativ hild was given her 1st dose of ROTATEQ. She immediately vomited. It was repeated within minutes, + she vomited5/4/2009 again. Today, she wa n has been received from a certifiedYmedical assistant concerning a 17 year old female patient Y who on 18-JUN-2009 6/18/2009 6/18/2009 was vaccinated with 0 rday, swollen knot on right wrist Monday - painful. Swollen clavicular node and cervical nodes U Wednesday6/13/2009 painful (Right). 6/15/2009 Swollen tissue in well child visit, pt. was given Live Oral ROTAVIRUS vaccine & she vomited soon thereafter. Y It was repeated 7/10/2009 within minutes, 7/10/2009 & she again vo egion of erythema and edema, on left buttock began only 60-90 minutes after vaccine administered, Y BENADRYL, 7/9/2009ice,7/9/2009 CORTAID cream. n has been received from a nurse concerning Y aY63 year old female nurse 3 with borderline hypertension N and 4/22/2009 hypersensitivity 5/21/2009 to DILANTIN, "P 009 MMR, Varicella, PCV7, and Hep A given on 6/22/2009 pt seen in office Dx with herpes simplex Y without 6/12/2009 mention6/22/2009 of complication. Then Y 6/29/2009 7/9/2009 aricella given in (L) upper/outer thigh. 19th +- cm raised, red + hot to touch area around w/ bruising Y injection 6/26/2009 sights 2-3 6/27/2009 days after receiving 30 minutes after vaccine, felt numbness and pain in Lt arm. Stated after vaccine also felt numbness U from 6/11/2009 Lt shoulder 6/11/2009 to hip. 2 weeks follow mmunization pt had fever 102- 103 and screaming x 2 hrs increased x 2 days. Parents very Yconcerned. 5/11/2009 No tx was given 5/12/2009 by our office. iven 5-26- AM. Symptoms noticed 5-27-AM after taking shower. Left upper arm became reddened Y from5/26/2009 shoulder to5/27/2009 elbow. Skin had a bu ms at inj. site - warm to touch. T. 98.3 Rx with pain mid - ice. Y 6/29/2009 6/30/2009 had an episode of dizziness after receiving GARDASIL and VARIVAX #2 fainted for <1 minute Y (20 seconds) 7/3/2009 but recovered well right away. was reported by a healthcare professional Y and described the occurrence of cellulitis in a 4-year-old Y male6/19/2009 subject who 6/21/2009 was vaccinated with ER Hospital for elevated temp/ generalized Y rash, Y cathed urine negative/chest 2 x-ray negative/YInfluenza A6/16/2009 negative. 6/23/096/22/2009 MD's office. vom e light headed. Blood pressure 70/40 but elevated to 90/60 within 15 minutes. No other adverse Y effects observed. 7/6/2009Remained 7/6/2009alert and orien esented today to emergency department Y approx 12 hours after her Day 3 RabAvert dose complaining Y mostly 7/10/2009 of feeling 7/10/2009 anxious, having sub s after receiving vaccine client experienced headache. She took ibuprofen but didn't receiveNany relief until 7/13/2009 second 7/13/2009 dose taken 4 hours late at injection site and severe fatigue lasting two days post vaccine. Y 6/30/2009 7/1/2009 ness, bumpy, warm, itching area around injection site Y 7/10/2007 7/11/2007 ed that she experienced chest tightnes Y accompanied Y by shortness of 2 breath and acelerated heart rate on6/8/2009 Tuesday morning 6/9/2009 6/09/09. She re patient received Prevnar, Hib, Varicella, Y and MMR vaccinations. On 7/10/09 patient motherUreported that7/8/2009 the child 7/10/2009 has been taken to the E D WITH A RASH ALL OVER BODY,YIT SWELLED, HE HAD WHELPS ON FACE, BRUISING, U AND A PURPLISH 7/10/2009RASH. 7/12/2009 WAS SEEN AT U GENERALIZED RASH AND URTICARIAL Y REACTION INVOLVING FACE WITH PRURITUSN 7/9/2009 7/9/2009 Mom noticed rash upon awakening on the 14th of July after vaccine administered on the 13thYof July. Pt. 7/13/2009 given Prelone 7/14/2009 x 3 days and Zyrtec ash and spots on chest; increased in 24 hours; resolved without treatment Y 6/18/2009 6/29/2009 vaccination 7/1/09; 7/2/09 the patient reports fever, chills, muscle aches, then red tender sore arm at injection 7/1/2009 site. 7/2/2009 WAS ADMINISTERED AT 6 MONTHS OLD. Y 5/28/2009 5/28/2009 rm previously healthy female received Y her 6 month Y shots on 06/02/09 3 exactly 12 weeks afterYher 4month 6/2/2009 rota vaccine. 7/6/2009 On 07/6/09 the pati adache,soreness in arms nausea. U 7/14/2009 7/14/2009 min of vaccines being given, patient presented with bilateral erythema with single urticarial lesion U at sites of7/2/2009 injection. 7/2/2009 Dose of BENADRYL g enderness (L) Deltoid, warm + Red + Tender, firmness also noted. (L) arm circumference 31.5 cm (R) arm 6/25/2009 circumference 31 cm. Given Hy m to touch, red area stated by mom left thigh. d headache p.m. of 7/2/09 - 7/6/09 with Y relief from ADVIL. Awakened during sleep on 7/6/09 with continued 7/2/2009 headache, 7/2/2009 lightheaded + little d dministered 7-10-09, pt reported swelling the size of a grapefruit and pain on 7-11-09 in pm.YPt did not seek 7/10/2009 treatment. 7/11/2009
dministered 9/10/08 and noticed swelling Y of face, neck, nose and lips next day. Reports thatYshe had difficulty 9/10/2008 breathing. 9/11/2008 Reports that she w ed that she took client to PMD because Y her arm was red and swollen. Dr stopped client fromYtaking TYLENOL. 4/28/2009 Continue 5/1/2009 to use cold packs ven MMR II, RECOMBIVAX HB, BOOSTRIX, MENACTRA injections. Pt was talking with nurse Y and mother 4/25/2009 when he4/25/2009 slumped over to the lef 7/7/2009 , crying, fussy, red rash over entire body - Maculopapular rash. 7/7/2009 swelling, tenderness on left thigh atYsite of vaccine that was noticed 2 days after receiving vaccine. U 7/7/2009 7/9/2009 5-10 min after vax bright red + hot both legs top to foot - lasted 1/2 to sevl hrs. Y 7/14/2009 7/14/2009 dma- patient got a "pimple like" mark on arm where Tdap was given. Patient was swimming Y in a pool and 7/7/2009 at the beach. 7/7/2009 Bump gone 2 days seconds after administering HPV in R delt pt felt "dizzy" pulse 58 and BP 98/52 w/anxiety and Y orthostatic7/13/2009 hypotension. 7/13/2009 After 30 min pt felt m d red knot on arm and leg on 7-1-9 Y- C/o sore, hot to touch and can't walk good - Warm compress Y tid, BENADRYL, 6/30/2009 ELOCON 7/1/2009 cream ite was red, tender, itchy. Had high temperature, some diarrhea. Little rash around site. S/S Ypersisted about 6/23/2009 1-2 hrs,6/24/2009 resolved. t. presented to doctor with (R)axillary swelling. Area felt boggy. No warmth or redness. Y 7/9/2009 7/9/2009 d child, new to area, no vaccinationYrecords. Parent - non language speaking but Pt is fluent.UPt reports that 7/7/2009 about 1 hour 7/7/2009 after receiving va assed out, in the lobby on their way out home. Became pale, non responsive, US taken & showed Y for few7/13/2009 minutes as 7/13/2009 inquiry noted. MD not ain and inability to lift arm headache, stomachache, nausea pale, dizzy, weak, dry mouth & throat. N This lasted 7/9/2009 3 days,7/9/2009 missed (1) day of wo wollen, red right arm. Y Y 7/1/2009 7/2/2009 eling sluggish on 6/27/09, then got a migraine on 6/29/09 pain still on right side. started having N right ear 6/26/2009 pain on 6/30/09 7/2/2009 and woke up on 7/ DTAP, HIB and PREVNAR on 6/29/09. Fever occurred several hours later - sleepy that dayU& fussy that6/29/2009 evening. 3 6/29/2009 loose stools & 1 emes r up to 104.8 (R) for 3 days till seen. Y 7/2/2009 7/3/2009 d reddish area at site of injection - No induration. No pain. Y 6/30/2009 7/1/2009 and induration. Y 5/28/2009 5/29/2009 m red mildly tender area around theYinjection site. U 7/4/2009 ite red, itchy, hot to touch, approx 1 1/2 inch swelling. Y rritated, itchy Injection site. Swelling of entire upper arm, painful. Y ling with 5cm induration/swelling tx with antibiotic KEFLEX. Y 4/14/2009 4/14/2009 miting, fussiness/irritability began several Y hours after vaccine, resolved in 48 hrs. Y 7/8/2009 7/8/2009 Y Y 6/18/2009 6/23/2009 n has been received from a nurse concerning a patient who was vaccinated with a 0.65ml dose U of ZOSTAVAX (Merck) instead of VARIVAX n has been received from a pharmacist concerning a patient who was vaccinated with ZOSTAVAX U vaccine (Merck). The pharmacist report -old female patient had received a left Y deltoid intramuscular injection of ADACEL, lot numberYC2965AA and 5/14/2008 one day5/15/2008 later, she developed a ort was received 29 May 2008 from a Y health care provider. A 74-year-old female patient with N a history of 5/22/2008 shingles (March 5/27/2008 2008) and diverticu serious case was received from a health professional on 11 June 2008. A 29-year-old femaleNpatient, with 4/21/2008 a history of 4/21/2008 sulfa drug allergy and ort received on 24 June 2008 from a health care professional. A 20-year-old female patient whose U past medical 4/15/2008 history includes the current ort received on 07 July 2008 from a Y health care professional. A 57-year-old female patient, who Y has a past 6/17/2008 medical history 6/19/2008 of "blood clotting -serious case received from a Healthcare Y Professional on 21 July 2008. A 58-year-old female Y patient developed 7/16/2008 a general 7/17/2008 feeling of not fee ort received from a health care professional on 01 December 2008. A 43-year-old female patient Y who had stepped ### on a nail ### and who had a serious case was received from a physician on 08 December 2008. A 60-year-old male patient, Y with no reported 12/4/2008 medical history, received a ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular ort received from a healthcare professional on 08 December 2008. an adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular d ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular ort received from a healthcare professional on 08 December 2008. An adult female patient (age Y not reported) 9/23/2008 received 9/24/2008 a first intramuscular rmation was received on 16 December Y 2008 from a health care professional. A 38 year old female Y patient with### no known ### allergies received ort received on 05 February 2009 from a health care professional. A cluster of 10 to 15 patients Y out of an unspecified number of vaccines h ort received 19 February 2009 from Y a health care professional. A 31-year-old female patient with U known allergies 2/6/2009 to Penicillin 2/6/2009and Cephalos serious case was received on 24 February 2009 from VAERS (reference number 331469) viaY a search of the agency ### database. ### A 58 year o was extracted from the VAERS database via QSCAN on 24 February 2009 (reference number U 332974).11/5/2008 A 42-year-old 11/5/2008 female patient recei serious case was received on 24 February 2009 from VAERS (reference number 334283) viaY a search of11/5/2008 the QSCAN 11/5/2008 database. A 34 year was extracted from the VAERS database via OSCAN on 24 February 2009 (reference numbers 336106 and 335552). ### A 26-year-old female serious case was received on 04 March Y 2009 from a health care professional. A 74 year oldNfemale with2/27/2009 a history of rheumatoid arthritis, hy of 3 patients who received ADACELY(lot number C3068AA), and developed injection site reactions. Y Initial2/27/2009 report received 3/12/2009 on 17 March 2009 ort received on 20 March 2009 from a health professional. A 42 year old female patient, with Y no medical history 3/20/2009 other3/20/2009 than seasonal allergie
serious case was received on 01 April 2009 from a health care professional. A 40 year old female Y patient3/24/2009 received ADACEL 3/28/2009 (lot number UF serious case was received on 06 April 2009 from a health care professional. A 28 year old female U patient3/30/2009 received ADACEL 4/6/2009 (lot number C3 old female patient with a history of migraines received an initial dose of Adacel (lot number C3097AA) N intramuscular 4/24/2009 4/25/2009 in the left Gluteal and was received from a consumer on 11 Y June 2008. A 58-year-old patient, with a history of Lyme N Disease, reported 6/5/2008that6/6/2008 she received in intram ort received on 22 September 2008 Y from a consumer, who is the patient. A 54 year old female, N with no medical 9/16/2008 history, 9/17/2008 received on 16 Sept serious case was received on 03 March Y 2009 from a consumer. A 49 year old female patientNreceived a first 1/1/2009 time dose of ADACEL (lot not t was received from a consumer on 09 March 2009. A 47-year-old female patient received an N injection of 3/5/2009 ADACEL (lot 3/6/2009 number not reported rmation was received from a health care professional on 07 August 2008. An 11 year old female patient with 5/4/2007 no reported 5/7/2007 past medical histo old male patient, with no medical history, Y received on 23 September 2008 a 0.5 ml right deltoid N injection9/23/2008 of IPOL (lot9/23/2008 number "A0273"), a 0. eived from a healthcare professional on 26 September 2008 under the local reference number Y 08-0447. This 9/23/2008 case deals 9/24/2008 with a cluster of 5 m of 2 adult patients who received TUBERSOL, lot number C2910AA, and developed injection Ysite redness9/16/2008 and induration 9/22/2008 four days after the -old female patient who was known Yto be pregnant at the time, had received a 0.5 mL intramuscular Y left deltoid 8/21/2008 injection 9/29/2008 of ADACEL (Lot# C -serious case received from a healthcare Y professional on 16 October 2008. A 61-year-old female U patient developed ### a 7.5cm ###by 9cm area o rmation was received on 27 OctoberY2008 from a health care professional. A 54 year old female Y received an intramuscular ### ### left deltoid inject ort received from a health care professional on 29 October 2008. A 37-year-old pregnant female Y patient had 8/11/2008 received a left deltoid intramus G, REDNESS AND WARMTH ON THIGH. Y 7/8/2009 7/11/2009 ausea; weight loss over 20 Y lbs; dizziness; Y balance Y problems; impaired concentration; vertigo;Ninflammation of esophagus; ### 1/5/2009 abdominal pain, e n was extracted from his discharge Ysummary on Y 8/31/08: "7 month13 old boy, previously Y healthy N who had diarrheal 6/27/2008illness 8/27/2008 1 week ago...found veloped small lump at site of injection Y which persisted unchanged for 2-3 mo. Then during the Y month of 3/10/2009 June. Lump6/20/2009 elevated in size. Pt wa days ago. Cellulitis 6.5 cm surrounding Y blister. Doxycycline 100mg 2X a day. Y 6/25/2009 7/3/2009 econdary to smallpox vaccination. Y 6/17/2009 6/21/2009 & swelling at site. Mostly resolved before Y pt back to office. Crying a lot, but consolable. Y 7/9/2009 7/9/2009 N 3/22/2006 ed 2 vaccines @ approximately 9:20am. Had fainting episode @ 9:30am fell off exam table. Y Mother had 911 7/7/2009 called- did 7/7/2009 not transport to ER. n has been received from a health professional Y Yconcerning a 15 years 0 old female who was vaccinated N with 7/1/2009 GARDASIL 7/1/2009 last week, approxim redness, warmth of right upper arm + shoulder began eve 7/8/09. Decreased but persistent am U 7/9/09. 7/8/2009 7/8/2009 mps, severe weakness, decreased urine output the first day despite drinking lots of H2O. C/o Y "contractions 6/26/2009 inside" 6/26/2009 vagina similar to contra n has been received from a physician Y concerning a 23 year old female patient who on an unknown U date was vaccinated with a dose of GA developed hives within 48 hours of her first HPV. She had no other obvious cause for her hives. Y 6/26/2009 n has been received from Y a Physician Y AssistantY concerning a 12 year old femaleYpatient withNpertinent medical 7/15/2008 history 3/1/2009 reported as none an 6/22/2009 6/22/2009 n has been received from a physician Y concerning Y a male patient who 0 was approximately fiveYyears old was vaccinated with MMR II a few m o 106 degrees and irritability following Y vaccines, brought to ER by parents approx 12 hours following immunizations. 7/7/2009 7/8/2009 Was observed and tre elling > 2 in width & length, red, hard, hot to the touch & days after vaccine given. Ice compress U tx. 7/7/2009 7/8/2009 n has been received from a registered Y nurse concerning a 45 year old female with sulfa andYDEMEROL 5/29/2009 allergies who 6/15/2009 on 29-MAY-2009 wa thur reaction at right deltoid injection Y site N 7/13/2009 7/14/2009 cine reaction. Left arm extensive. Y 7/7/2009 7/9/2009 ing at injection site. No sign of systemic reaction. Y 6/1/2009 6/3/2009 se reaction. MMR II given 1wk after VARIVAX (3/23/09). Y 3/30/2009 ny symptoms-soreness, fever etc. Y 7/6/2009 ion of optical, nerves + muscles weight loss, excessive urinating and thirst, tiredness, rash, blurry vision. See 3/9/2009 attached letter! Swelling at site of injection and distally approx. 7 inches. U 6/30/2009 7/4/2009 er admin of ZOSTAVAX pt noted asymmetric, tenderness over (L) scalp/neck. When seen 7/7/09 Red rash (not vesicular noted) posterior s s "severe pain" in muscles, knee joints, ankle joints, extreme fatigue, feeling feverish ((no confirmed Y fever6/12/2009 per pt). Severe 6/16/2009 shaking beginning miting x 2 in waiting room- 20 min after Y receiving HBV, + with acute onset LLQ pain. Pt diaphoretic, U pale.6/12/2009 B/P 122/82. 6/12/2009 Pt laid down in exam 7/2/09 stating he became "achy with over all achyness & mostly back aching 5 days after receiving Y vaccinations. 6/25/2009 He6/30/2009 had a fever of 100 Deg able crying/screaming x 3-6 hours. Fever of 101 x 24 degrees. Rash on (Rt) leg and torso < than Y 24 degrees. 4/24/2009 4/24/2009 after receiving vaccine patient developed Y swelling at site, diffuse urticaria, and noisy breathing. Y He was given 7/8/2009 ATARAX 7/8/2009 then EPI PEN whic ed, round- approx. 2 inches in diameter area on pt's L thigh. Home care - included ice to area + Motrin, continued 6/24/2009home 6/25/2009 care >cold compres ed pruritus. Fatigue. Myalgias. U 7/2/2009 7/4/2009
ema 4cm X 6cm at injection site on L thigh, tenderness, normal gait. Rec: ice, ibuprofen. Matthew's Y mother 7/9/2009 wanted this 7/10/2009 reaction reported to ately 42 hours post Zostavax vaccination I began to have itching, redness, soreness and swelling Y at the injection 7/6/2009 site 7/8/2009 (about 2 inches in diam male brought in by his mother with Yacute onset of vomiting and fever to 104 @ 4am 7/14/09.U Recieved Hepatitis 7/13/2009A 7/14/2009 vaccine 7/13/09. Has ha our of administration patient became Y nauseated, fatigued and light headed. Nausea increased Y to vomiting7/9/2009 & inability 7/9/2009 to keep food or liquid varivax booster on Monday July 13,2009 and yesterday he felt sore. His R arm is swollen, red N and sore. 7/13/2009 He is c/o HA 7/14/2009 and backaches too. H eveloped generalized vaccinia U 7/8/2009 7/9/2009 veloped a burning sensation in rightYarmpit within an hour after receiving vaccine. Two hoursUlater developed 7/13/2009 a lump7/13/2009 in the same area. By t ater: dizziness, malaise followed byYrapid atrialYfibrillation at day 3 requiring 2 overnight stay inYthe hospital6/29/2009 10/16/20096/30/2009 received records from immunization, experienced deltoid pain and headache. Deltoid pain experienced for 72 hours Y and had 7/10/2009 poor range 7/10/2009 of motion causing a dis given a double dose of Varicella vaccine. Y Once when he was 15 months old, then again when N he was 57/13/2009 years old (7/13/09). 7/13/2009 On his left le 0cm Circular, swollen leasion on lt upper thigh. Red, hard, and tender Y 7/13/2009 7/14/2009 hest pain, asthsma, diarrhea. 7/17/09 Medical records received DOS 7/13/09 to 7/17/09. PAP U test and Gardasil 7/13/2009 administered. 7/13/2009 Next day pat me swollen down to elbow.hard......red.....hot to touch..........DR verified more than normal reaction Y to vaccination;took 6/16/2009 6/16/2009 course of Doxycyclin (Rabies vaccine)#1 given 6/24/09. Pt. Y had no reaction. Rabavert #2 given 7/1/09. On 7/2/09Yclient had sweating, 7/1/2009chills (T97.9), muscle/join S AND SWELLING AROUND SITE Y Y 7/8/2009 7/9/2009 e tender to touch where vaccines were Y given. No lumps, just erythema. Y 7/14/2009 7/15/2009 , child developed raised pink areas on face, legs, arms, torso which increased by 7-7-09. Denies Y fever or6/25/2009 swelling; continues 7/5/2009to eat and urin ped local reaction to vaccine. pt had warmth & erythema at vaccine site measuring 12x7cm. no U pain/ fever. 7/13/2009 7/14/2009 er receiving her Gardasil, patient felt Y a little bit tachycardic (did not report this until later). She Y walked up7/10/2009 to the desk7/10/2009 at the nurse's station to with head ache, slight nausea, feeling exhausted. Felt as if heart was pounding/racing. Pt feeling Y fine by 6/30/2009 Thursday 7/1/09. 7/1/2009 Both pt and spou e felt poorly last night. He felt as though Y he had a fever and was being stung by bees. He also Y felt dizzy7/14/2009 and SOB. 7/15/2009 He has hx of COPD an month vaccines including Pediarix, Prevnar, Y oral Rotavirus, and ACT-Hib. 4 hours later she was Y lethargic,5/18/2009 was felt to5/18/2009 be hot to touch, was se er taken at 2:15 a.m. on 4/20; 1 tsp Motrin Y immediately administered; drove to emergency room; N 1 dose of 4/17/2009 Tylenol given 4/20/2009 at 3:00 a.m.; fever was reported by a lawyer and described the occurrence of chronic inflammatory demyelinating U polyneuropathy 5/17/1999 in an adult### female subject w at 10pm father noticed eye lids swollen Y + red. Taken to ER - Benadryl liquid given. Y 7/2/2009 7/2/2009 s of Bells Palsy returned. This included facial droop and pain in L side of face. Is taking Prednisone N for symptoms. 7/13/2009 7/14/2009 pule, erythema at site of VARICELLA Y vaccination, Approx 3cm X 4 cm. Y 7/13/2009 7/14/2009 up with chest pain that got worse asYthe day wore on, 8/10. Went to the ER at 2100 that night Y and had normal 6/24/2009 EKG per 7/3/2009 SM. Was told his ch oped chest pain that lasted approx one Y day and resolved without treatment. Approx 10 days Y later c/o of SOB 6/17/2009 when laying 6/20/2009 down at night. coughing, wheezing, lethargic, increased heart rate & pale 5 minutes after shot. ALBUTROLY breathing treatment/ 7/14/2009 Nebs. 7/14/2009 Epi jr. pen injectio ea red and swollen, hot to touch. Area Y of redness covers most of upper thigh and 3/4 of circumference. N TX: 7/13/2009 antibiotics 7/15/2009 and BENADRYL for i tender swelling at site of injection. Left lateral arm. N 7/9/2009 7/13/2009 aricella red + swollen + itching 18mm x 40mm. Y 6/3/2009 6/5/2009 and induration in right thigh 2 days after administration, measuring 3.5 x 3.0 cms. No tenderness. Y Patient c/o 7/2/2009 some itching. 7/4/2009 BENADRYL has , child complained of rt cheek/jaw hurting, Y small amt. of swelling below rt ear/jaw. Called CDC Y to see if mumps 5/26/2009 was 6/20/2009 a possibility - CDC conf usea, diarrhea, itchy Skin/Hives. Joint pain, Myalgia. Trouble Swallowing. N 5/20/2009 6/20/2009 AX administered 7/7/09. Pt called on 7/9/09 reporting redness, swelling, itching at injection site. Y Described7/7/2009 site as oblong 7/8/2009 red red spot -silver an 24 hours after vaccination pt developed Y urticarial lesions diffusely over body- oral antihistamines/ N He blockers 7/2/2009 / cool 7/3/2009 compresses. Still wit called on 6/2/09 to let us know that his mother has been recently diagnosed with A.D.E.M atU Hospital, possibly 4/8/2009 related 5/1/2009 to exposure to child nt cyclical crying/ screaming with knees drawn up to chest about a few mins. X about 3 hours Y post ROTATEQ 5/11/2009 given5/11/2009 hing of arms & legs for a few seconds Y at a time Yrepeatedly through evening. 1 Seen by RN in ED Y - concern for 6/5/2009 infantile 6/5/2009 spasms. Admitted ove partial seizure, head nodding, eyes blinking slowly, not responding for 20 seconds or so. Fifteen Y minutes -7/1/2009 hour of abnormal 7/6/2009 behavior. Five ately 10-15 min after vaccine given. Patient called and c/o tingling in her fingers of the arm that U she received 7/13/2009 her vaccine 7/13/2009 the use of her muscles, Yblood pressure Y unstable, Y could not control44 eye Y movement or controlYbody temp. My 4/2/2009 child could 5/1/2009 not breathe on her dy tremor/spasmed (seizure) starting with arms and legs with head nodding. Afterwards, screaming U more, 6/26/2009 low grade6/29/2009 continuous grunting ins d moderate swelling R deltoid, TTP. LT prescribed BENADRYL 25mg q6hrs for TX. 7/6/2009 7/7/2009 began on LFT side (where vaccination was administered) 5 days after vaccination. The painYtraveled to6/13/2009 LFT shoulder 6/17/2009 and upper arm, then ted 10 d. after vaccines with >3cm smallpox lesion, mild to moderate erythema, subj. c/o SOB N on exertion, 6/26/2009 fatigue, malaise, 7/4/2009 intermittent che mited at home x 3 and had diarrhea x 3 1/2 wks - parents feel it is from the Rotavirus vaccine.Y 3/27/2009 3/27/2009 c'd Hep A and VZV #2 on 7/6/09. She was fine until 24 hrs later when she noted a red rash on U L arm. 7/6/2009 7/7/2009 00. Received call from pts mother stating that child began with red, raised, maculopapular rash Y covering entire 7/2/2009 body 7/2/2009 approx. 30 min post re
ost bumped in the door as she left the office after the 1st GARDASIL and felt dizzy but got betters Y quick. Today 7/9/2009 after 7/9/2009 the 2nd GARDASIL - s temp of 104.3 degrees F, headache, weakness onset this evening. Also c/o SOB + wheezing. Y Treatment 7/7/2009 - Ventolin.7/7/2009 No acetominophen o d varivax vaccine sc in left arm. Patient Y was seen in Emergency Room on 07/10/09 for redness Y at site on7/9/2009 left arm. Treated 7/9/2009with Keflex. S ed child had a rash to both arms andYhas complaining of itching. Subjective data. Mom stated child had a7/9/2009 fever. Mom 7/11/2009 called children's hea slight elevation. Y 7/6/2009 7/7/2009 skin rash, diarrhea, soreness @ inj.Ysite, headache, back pain, myalgia. Y 6/22/2009 6/23/2009 n has been received from a consumer concerning her nephew who was vaccinated with MMR U II (therapy date, dose, route and lot# not rep was reported by a pharmacist and described the occurrence of fainting in a 30-year-old maleY subject who 6/12/2009 was vaccinated 6/12/2009 with TWINRIX (G was reported by a pharmacist and described the occurrence of fainting in a 30-year-old maleY subject who 7/13/2009 was vaccinated 7/13/2009 with TWINRIX (G was reported by a physician and described the occurrence of facial palsy in a 18-year-old male U subject who 7/7/2009 was vaccinated 7/8/2009with BOOSTR et of 9:00pm on 7/14/09, by 3:00pm on 7/15 temp was 101.7 oral and patient called HD. Patient U also c/o7/14/2009 body aches, 7/14/2009 tired and dizziness. swelling, redness and itching U 5/19/2009 5/27/2009 ter receiving IPV vaccine, patient developed Y fever Y above 102 and uncontrolled 2 vomitting thatYled to dehydration 6/17/2009 and6/17/2009 necessary hospitalizat ear old received the following vaccines on 5/6/2009. HPV Lot # 1129X, HAV Lot # 0932X, and Y Varivax Lot5/6/2009 # 0050Y. 5/6/2009 The primary medical d sented to clinic 2 days after receiving Zostavax injection with an approx 40x48mm red raisedNindurated area 6/23/2009 at the injection 6/24/2009 site, it felt mildly es that pt had a nose bleed 4 days post gardisil #1. States pt has never had nose bleed int the Y past "It gushed 7/3/2009 and woke 7/7/2009 her up-we got it to ter received the HPV Vaccine Gardasil on Tuesday, July 14th at 6pm. On Wednesday July Y 15th she woke 7/14/2009 up with pain 7/15/2009 at the injection site er, patient experienced an all over body rash 2 1/2 hours after vaccination of VZV and Hepatitis U A on 07/14/2009. 7/14/2009Denied 7/14/2009 fever. Denied itc 09 Patient came home with Y chills and Y fever; started Y vomiting during night. 5 Fever was up to 103.5. Y Also had7/7/2009 lower back7/8/2009 pain and headache. V ng, redness, pain, itching Y 7/14/2009 7/15/2009 reddened area on left arm. C/O itching 7/14/2009 7/15/2009 swollen at sight of injection with redness and pain U 7/14/2009 7/15/2009 VE REEDNESS AND PAIN BEGINNING THE DAY AFTER THE SHO PERSISTING OVER HEREE Y WEEKS. 6/24/2009 iTCHING 6/25/2009 BEGAN 5 OR 6 DA Varivax and had a local reaction at the site approximately 11.5 cm wide by 12.5 cm high Seen Y by pcp 7/14/2009 no treatment 7/15/2009 except for Tylenol for treaks from scratching irritation from adhesive bandaide Y 7/14/2009 7/14/2009 patient received following vaccinations: Y L leg - IPV and Varicella. R leg - MMR and DTaP.UGrandma reported 7/8/2009 that 7/8/2009 the evening after vacc Varivax on 7/13/09 on 7/14 at injection site a mild erythemia appeared as approximately 4cm Y circle. no7/13/2009 treatment needed 7/14/2009 lled office at 8:30 am on 7-15-09 reported Y that her daughter had fever of 104 F that morningY(approx 24 7/14/2009 hours after 7/15/2009 vaccines). Mother gave as vaccinated on July 14, 2009, Developed reaction with in 12 hours of vaccines given, Meningococcal U IM 7/14/2009 left deltoid7/15/2009 muscle and Varicella S er came back too low on 5/27/09.6/12/09 I received the first of a two-part series MMR vacination. Y 6/15/097/14/2009 I noticed a7/15/2009 raised,red,hard,warm, minutes after pneumococcal vaccine at 1125 a.m., pt c/o dizziness. Pt's face turned red. Pt c/o Y chest tightness 7/16/2009 and back 7/16/2009 pain 11/10. Doctor s, shakiness, nausea, joing pain, overall teirdness/feeling of sickness Y 7/14/2009 7/15/2009 and profuse sweating for approximately 20 minutes Y d vaccine on Mon 7/13/09. Pt called on 7/16 saying that Tues afternoon after playing golf she Y noticed her 7/13/2009 arm was swollen, 7/14/2009 red, itchy, , had d GARDASIL #2 on 7/10/09. No complaints Y at visit. Phone call to clinic Mon 7/13/09 08:10am. N Pt reported 7/10/2009 to RN pains 7/11/2009 swelling and unab onset of fever and child complaining Y of pain taken to doctors. June 20th taken to ER for high U fever 103.76/11/2009 and examined. 6/16/2009 Illness continued. ounding injection site reddened, tender Y to touch and slight swelling Y 7/13/2009 7/14/2009 7/10/2009 "startle reflex" every few seconds X 30 min sticking tongue out and increased salivation. Fussy Y and pale.7/1/2009 Refusing to7/1/2009 eat. As reported by p ught child to clinic 7 days after shots she had viral exanthem & hives. Present to allergist for Yfinal dx & recommendation. 6/9/2009 6/17/2009 le ADSM is referred from a researchYsite with c/o recent diarrhea, decreased appetite, dehydration U and chest 7/9/2009 pain. Symptoms: 7/13/2009 Dizziness, c acular rash on trunk - antihistamine - steroid injection 40mg DEPOMEDROL - 2mg DECADRON Y IM 7/14/2009 7/14/2009 n the shingles vaccination as part of my physical examination - recommended. It was administered Y along5/22/2009 with the pneumonia 5/22/2009 vaccination ven TDAP and VARIVAX vaccines on 6/26/09. Reports that on 6/27/09, she began to have body aches, low 6/26/2009 grade temp 6/27/2009 up to 99.8 and nec ely after giving vaccines - VARIVAX, in right arm subcutaneously deltoid area, patient developed Y urticaria7/15/2009 at injection7/15/2009 site, had itching. Bena er injection outer aspect of (R) arm from deltoid to just above elbow red, warm and swollen Y 7/14/2009 7/16/2009 ollen at injection site. Ice packs & ibuprofen as treatment. Y 7/1/2009 7/3/2009 es hot, red and painful induration larger than the "palm of her hand" Y 7/14/2009 7/15/2009 on 7/16/09 self reported event. Stated she thinks she had a reaction to the PNEUMOVAX vaccine. U she had 7/13/2009 swelling7/14/2009 under her arm, sorene sode of nausea then vomiting about 10 - 15min after receiving HAVRIX Y 7/15/2009 7/15/2009 around injection sight, erythema andYhives just distal to shot sight. U 7/14/2009 7/16/2009
and redness of left upper arm and elbow. Y 7/14/2009 7/14/2009 er injection arm became extremely swollen Y & painful. Saturday was started on PREONISONE. U Monday swelling 7/2/2009decreasing 7/3/2009also taking NA -old male, with no illness at the time of vaccination, Y received a first dose of YF-VAX (Lot number Y UF30AA;7/8/2008 route/site7/12/2008 of administration not re rmation was received on 03 December Y 2008 from a health care professional. A 22 year old male Y patient received ###a right arm ###subcutaneous ort was received 03 December 2008Yfrom a health care professional. A 56-year-old male patient Y with no known### allergies and no past medica was received from a health care professional Y on 09 March 2009. A 29-year-old patient received U a subcutaneous 3/6/2009left arm injection of YF-Va serious case was received on 27 March 2009 from a health care professional. A 21 year oldUmale patient3/16/2009 received IPOL 3/23/2009 (lot number B0476 serious case was received on 24 April 2009 from a health care professional. A 22 year old female Y patient4/21/2009 received IPOL 4/22/2009 intramuscularly in t lasted 2 days straight. Even with children's Y motrin and tylenol, fever reached 104.8 at 4 am Ytwo days after 7/14/2009 shots were 7/15/2009 received. The fifth sh - Reported to the ER with headache Y pain (10/10) Y and fever (max 102.8). 4 Admitted to hospital Y for 6 days6/15/2009 (discharged 6/24/2009 30 June 2009). During and swelling up to 5" in place of injection. Pain, fever 100.4. N 7/6/2009 7/7/2009 abdominal, face, legs, and arms X 2 days later probably viral reaction Y 7/7/2009 7/9/2009 HPV vaccine 5 days later pt experienced Y swelling (lump) and hotness at injection site. ReccUcold compresses 7/8/2009 7/13/2009 -old male patient received vaccination with smallpox Y vaccine on an unknown 1 date. The manufacturer U and lot number of the vaccine were no t clinic was reported by mom to be "acting drunk" unsteady gait, saying inappropriate things.YWas then sleepy. 6/16/2009 Episode 6/16/2009 lasted about 4 hour m (upper) was reported as red and swollen. Rx BENADRYL and warm compresses. 7/12 - redness Y spread 7/10/2009 to wrist but 7/10/2009 swelling decreased an ours after shot - swelling redness lump under tissue 1.5cm. Cont x 4 days came in - Tx ice toYarea (5 minutes 7/7/2009 intervals! 7/8/2009 and BENADRYL 25 aised, red, hot area around injection site. ort was received 14 July 2009 from a consumer,Ywho is also the patient. 56 A 36-year-old femaleNpatient with3/25/2009 no medical5/6/2009 history and no concur hild received 4 immunizations at Dr Y office. 7-15-09 site of MMR was red, hot and raised, no fever, Y no malaise, 7/13/2009 child acting 7/15/2009 normally. Went to n has been received for the pregnancy Y registry for GARDASIL from a master of science in nursing Y concerning 5/19/2008 a 26 year 7/1/2008 old female with no arm below injection site is red\swollen\hard\hot. Approximately 11cm in length and 9 1/4 cmYacross. Given 7/15/2009 BENADRYL 7/16/2009 and tx with antibio d at injection site red\swollen\itchy area approximately 1" across and 4" down. No rash or anaphylactic Y reaction 7/13/2009 noted. 7/14/2009 Instructed to give BE n has been received from a consumer Y concerning her 19 year old daughter with no medical Y history and drug 5/28/2009 allergies, 6/25/2009 who in approximatel er arm swollen, warm to touch, pinkish color. Y 7/15/2009 7/16/2009 dose of Hep B given to adult on 7/6/09, followed by adult dose given on 7/9/09. No adverse s/s. Y 7/6/2009 ssure both lower legs (calf) and behind knees: helped by resting (in recliner). Makes worse: walking. 3/9/2009 3/14/2009 ooster given on: DECAVAC - 1-26-07 - correct Booster as last Booster was 1997. DECAVAC Y - 1-8-08. DECAVAC - 1-9-09. No adverse sym . 2 Red papules L thigh, surrounding redness, one with pustule no streaks. U 7/3/2009 7/7/2009 r, chills, diarrhea, weakness, dizziness. Supportive care, Tylenol. Y 6/26/2009 6/26/2009 scribed dizziness, vision disturbance, shortness of breath and severe fatigue. Onset of symptoms U about7/13/2009 3 hrs after 7/13/2009 vaccination. Pt. stated s n and swelling to R arm several hours Y after admin. PNEUMOVAX. Pt returned to clinic 7/16/09 U for eval. Pt 7/14/2009 still had redness 7/14/2009 to injection site was reported by a healthcare professional Y andYdescribed the occurrence 0 of itchyYhands andNfeet in a female 6/5/2009 subject 6/6/2009 of unspecified age wh d four shots right arm (Meningococcal, Y TDaP, MMR, and Varicella). Had Hyperimmune response Y with shaking, 7/10/2009 chills, 7/10/2009 and temp of 100.6. P ever 103 and nausea 6-27-09 Tingling Y and numbness of all extremities and shortness of breath Y 6/22/2009 6/24/2009 nt pain, headache, nausea, stomach pains, low grade fever. Treated with appropriate fever lowering Y agent 7/16/2009 7/16/2009 ing and redness at the injection site.YRequired topical treatment and Tylenol. Y 7/14/2009 7/16/2009 CAME TO HEALTH DEPARTMENTY FOR COLLEGE IMMUNIZATIONS. NERVOUS ABOUTNSHOTS. DETERMINED 7/17/2009 7/17/2009 NEEDED Tdap(FOR ction, red, swollen, hurts, no temp. Shots on Tuesday, reaction gone on Friday. Did not see Y doctor. Used 6/23/2009 cold compress 6/24/2009 at sight. ction, red, swollen, hurts, no temp. Shots on Tuesday reaction gone on Friday. Did not see Y a doctor. Used 6/23/2009 cold compress 6/24/2009 at injection site. nt received a Dtap in the left arm, and about 36-48 hours later, had onset of induration, swelling, U warmth,7/15/2009 and erythema, 7/17/2009 resembling celluliti ay is declining 3rd Gardasil Still having shoulder pain from 2nd inj. Day of 1st inj and after no N sx. 2nd inj: 3/30/2009 day of inj3/30/2009 headache ,nausea, so m, raised area at vaccine site for one week. 2.5cm in length. Denies fever, pain, or other symptoms. Y Treatment 7/12/2009 given, 7/13/2009 tylenol and benedryl. L HOURS AFTER RECEIVING THE VARICELLA VACCINE, THE PATIENT EXPERIENCEDYBLISTERS 7/14/2009 ON HER BODY. 7/14/2009 THE BLISTERS R welling of joints(knees and elbows). High fever, rash all over back and abdomen. Motrin andNTylenol given 1/19/2009 for the pain 1/27/2009 and inflamation. E 24 hours after vaccinations were administered Y patient had redness around both eyes with facial Y swelling. 7/15/2009 7/16/2009 an on 7/16/2009, 8 days after MMR vaccine. Fever up to 102.5 on 7/17/2009. Eating and drinking U well, playing 7/8/2009 and7/16/2009 responsive to parents.T erythema, warmth to touch, tenderness Y at injection site. Pt. reported fever developed the day U after vaccine 7/13/2009 was administered. 7/14/2009 Pt. was seen M CALLED TODAY TO REPORT THAT PT HAD RXN TO TDAP VACCINE RECIEVED YESTERDAY. Y REPORTS 7/16/2009HEADACHE, 7/17/2009 NECK/JAW vaccines 7/16/2009. Reports that at 11:30 this am (7/17/09) she started with lower facial tingling U and family 7/16/2009 member 7/17/2009 says that when the c redness surrounding vaccine site. Itchy and a little sore. Started about 24hrs after vaccine. U 7/15/2009 7/16/2009
ped acute arm pain at the site of injection & the following day spread to both arms & legs; diffuse N muscle 5/1/2009 pain throughout 5/2/2009 developed over 1 vaccine resulted in a case of shingles. Y U 7/13/2009 7/13/2009 after injection with chills, malaise, warm, Y red urea at site. Woke next am with pruritic rash onUlegs. 7/15/2009 7/16/2009 wny edema area on right upper arm.Y Y 7/14/2009 7/16/2009 m noticed swelling adn redness at inj. site. In clinic 7-17-09 upper arm red with hard knot and Y swelling of7/16/2009 right arm at 7/17/2009 inj. site.Area of 2 1/2 4 hours after vaccination, injection area began swelling, ultimately to the size of a large orange; Y erythema, 7/10/2009 pruritis, tenderness, 7/11/2009 very hard an ceived Zostavax vaccineYfor shingles Y on 2-2-2009. Patient lost hearing in right ear, Y developed N swollen neck 2/20/2009 glands and 2/20/2009 growth in nasophary fever, hoarseness, paleness, weakness, and dizziness. started 9:30 pm on July 14, 2009, and U ended 1:30 6/14/2009 am July6/14/2009 17, 2009. treatment:ibp d male received MMR #1, Varicella #1 Y on 6/15/09. Presented with c/o rash all over body, seen Y at ER, Measles 6/15/2009 IgM, IgG 7/8/2009 titers sent from ER, a on back of left arm. Red, swollen, Y and warm. Y 7/15/2009 7/16/2009 eltoid swollen noticed 7.16.09 unsure fever, felt hot mom gave 1 dose of TYLENOL induration U 8 cm x 7 cm 7/15/2009 Red & Hard 7/16/2009 as per mom the ind @ vaccine sites 0 anaphylaxis, 0 emesis, 0 resp distress, supportive care only. Y 7/16/2009 7/16/2009 njection, 2 hours later L arm red and worn from site down to L hand. U 7/16/2009 PV given in lower mid Lt thigh where Y bled after injection VARIVAX then swelled and becameYred / Lt posterior 7/14/2009 arm was 7/14/2009 in injected 3x / keep crying with loss of appetite since administration of vaccines (PENTACEL, Hep B, PREVNAR U & ROTATEQ) 7/14/2009 on 7/14/09. 7/14/2009 d stools with bloody mucus, foul odor Y 5 days after ROTATEQ given - ? anal fissure (not clearly seen). No 7/7/2009 elevated stool frequency irritability en 6 shots on 7-14-09. Received call today stating she is 6 months pregnant. Will see physician U on 7-21-09. 7/14/2009 n has been received from a consumer for the Pregnancy Registry for GARDASIL concerningYher 18 year3/24/2008 old daughter who on 24-MAR-200 n has been received from the pregnancy registry for GARDASIL vaccine from an 18 year oldYfemale consumer, 5/1/2008 who 7/7/2008 started therapy with G n has been received from the pregnancy Y registry for GARDASIL via a nurse practitioner, concerning U a 22 4/25/2008 year old female 4/25/2008 with a history of a n has been received from a physician, Y for the Pregnancy Registry of GARDASIL, concerningYa 24 year old female ### with 1/7/2008 anxiety and depress n has been received through the Merck pregnancy registry for GARDASIL vaccine from a registered N nurse 5/19/2008 concerning 7/1/2008 a 20 year old female n has been received from a physician for the Pregnancy registry for GARDASIL, concerningYa 25 year old 7/16/2008 female with 8/6/2008 no drug allergies and n has been received from a medical assistant through the Pregnancy registry for GARDASILYconcerning9/17/2008 a 17 year old female with no previ n has been received from a physician for the Pregnancy Registry for GARDASIL, concerningY a 15 year old 9/17/2008 female with bicornuate uterus a n has been received from a healthcare worker concerning a 20 year old female with no known drug reactions/allergies 4/25/2008 8/20/2008 and no pertinent me n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning Y a female ### who in1/1/2007 approximately 2007 w n has been received from a registered Y pharmacist concerning a "teenager" female who in February U 2008, was vaccinated with the First dos n has been received from a patient's Y mother concerning an 18 year old female with no allergies Y who on 08-JUN-2009 6/8/2009 6/8/2009 was vaccinated with n has been received from a physician Y concerning a 25 year old female patient with a historyUof vaginosis bacterial 6/2/2008 on 19-MAR-2009 who on n has been received from a physician concerning a female who was vaccinated with a 0.5 mL U dose of GARDASIL, intramuscularly. 5/1/2009 A mont n has been received from a licensed Y practical nurse concerning a 23 year old female with noNmedical history 5/1/2009 and drugs 5/28/2009 allergies, who in No n has been received from a physician concerning a female patient. It was reported that in January U 2007 12/1/2008 the patient's5/9/2009 pap smear was norma n has been received from a nurse concerning Y a 11-year-11-month- old female patient who was N vaccinated 5/27/2009 with the first dose of GARDASIL n has been received from a physician Y concerning her daughter, an 18-year-old female, who Yin July 2008 was vaccinated 7/1/2008 with the first dose n has been received from a physician who has heard of a couple of female patient's who were U vaccinated with dose of GARDASIL. The pa n has been received from a consumer Y concerning her "teen" daughter who was vaccinated with N three doses 3/1/2009 of GARDASIL 3/1/2009 as follows: 1st i n has been received from a 72 year old female consumer with blood pressure high, cholesterol U and Oesophageal 6/6/2009Reflux 6/6/2009 acid reflux concer n has been received from a consumer concerning her 12 year old daughter with seasonal allergy N who in October 2/1/20092008 2/1/2009 was vaccinated with n has been received from a registered nurse concerning a 23 year old female patient Y with noNpertinent medical 3/26/2009 history 3/26/2009 or allergies who on 2 rmation has been received from a nurse practitioner, for GARDASIL, a pregnancy Registry product, Y concerning 10/8/2008 a 1710/8/2008 year old female with as n has been received from a registered Y pharmacist concerning a 14 year old female with no medical N history 5/6/2009 and no allergies who on 06-MAY n has been received from a physician concerning a 22 years old female with unknown medical U history who 6/9/2009 on 09-JUN-2009 6/10/2009mid morning w n has been received from a registered Y nurse concerning a 22 year old female who on 25-MAR-2009 N was 6/2/2009 vaccinated 6/2/2009 with the first dose of G n has been received from a physician Y concerning a female who was vaccinated with a dose Uof GARDASIL. Subsequently the patient exper n has been received from a registered nurse concerning a 19 year old female who on an unspecified Y date was vaccinated with third dose o n has been received from a physician concerning a 19 year old female who about a year ago Y (in approximately 2008) was vaccinated with n has been received from a physician concerning his 24 year old daughter with no Y pertinent Ymedical history 5/4/2009 reported5/4/2009 and no known drug al n has been received from a physician's assistant concerning a 15 year old female who on 14-APR-2009 Y 4/14/2009 was vaccinated 4/14/2009 with second dose n has been received from a 22 yearYold female patient who on 20-FEB-2009 was vaccinatedYwith the first 2/20/2009 0.5 mL dose 2/20/2009 of GARDASIL. Ther n has been received from a physician concerning her daughter, a 26 year old female who onN11-JUN-2009 6/11/2009 was vaccinated 6/12/2009 with the first do
n has been received from an office Y manager concerning a 17 year old female patient who onU15-JUN-2009 6/15/2009 was vaccinated 6/15/2009 IM with a dose n has been received from a registered Y nurse concerning a female patient who "3 weeks ago"Y on approximately 5/12/2009 26-MAY-2009, 5/12/2009 was vaccina n has been received from a pharmacist concerning a female with unspecified drug reactions/allergies Y and4/1/2009 medical history, 4/1/2009 who "a couple m n has been received concerning a 23 year old female with latex allergy and no pertinent medical Y history 5/20/2009 who on 03-DEC-2008 5/21/2009 was vaccina n has been received from a pharmacist Y concerning a female who in June 2009, was vaccinated U with a dose 6/1/2009 of GARDASIL (lot number, rou n has been received from a nurse practitioner concerning a 17 year old female with no pertinent Y medical6/13/2009 history who 6/13/2009 on 13-JUN-2009 was n has been received from a certified medical assistant concerning a 26 year old female patient Y with penicillin, 3/27/2009 amoxicillin 3/28/2009 allergy and (PERC n has been received from a 24 year old female with no pertinent medical history and no drugNreactions/allergies 6/11/2009 who6/12/2009 on 11-June-2009 was n has been received from a health professional concerning a 11 year old female patient whoYon 23-APR-2008 6/12/2009 was 6/12/2009 vaccinated IM with the f n has been received from a nurse practitioner concerning a 22 year old female with no drug N reactions or5/22/2009 allergies who on 22-May-2009 wa n has been received from a physician Y concerning an "around 12 year old" female with unknown U allergies and unknown medical history who n has been received from a physician Y concerning a female patient who about a week and a Y half ago approximately 6/1/2009 June 6/1/2009 2009, was vaccina n has been received from a physician Y and company representatives concerning a 14 year old N female who8/1/2008 in approximately 9/1/2008 August 2008, w n has been received from a physician concerning a female who was vaccinated with her second N dose of GARDASIL (site and route of adm n has been sent from a consumer concerning her daughter who on unspecified date was vaccinated U with the second dose of GARDASIL (l n has bee received from a physicianY concerning a female who was vaccinated with a dose of U GARDASIL. Subsequently the patient was tak n has been received from a nurse practitioner concerning a female who was vaccinated withUGARDASIL. Subsequently the patient went co n has been received from a physician concerning a female who was vaccinated with the firstUdose of GARDASIL. The patient developed ra n has been received from a 21 year old female with no medical history who about 2 months N ago in approximately April 2009, was vaccinate n has been received from a licensed practical nurse concerning a 13 year old female who onY03-AUG-2007 8/3/2007 was vaccinated 8/4/2007 with a dose of n has been received from a consumer concerning a 15 year old female who on 13-JUN-2009 N was vaccinated 6/13/2009 with the 6/14/2009 first dose of GARDA n has been received from a physician Y concerning a female patient who on a unspecified date Y was vaccinated with a dose of GARDASIL (lo n has been received from a nurse practitioner concerning a 22 year old female with a historyYof vasovagal 6/16/2009 responses, 6/16/2009 but not as a reaction n has been received from the mother Y of the patient concerning a 14 year old female who onYan unspecified day in February 2007 was vacc n has been received from a physician concerning a 14 year old female patient who on an unknown Y date was vaccinated with the second do n has been received from a nurse practitioner Y concerning a 17 year old female patient with aYbroken toe6/17/2009 who on 17-JUN-2009 6/17/2009 was vaccina n has been received from a nurse concerning a 17 year old female patient who "has a history Y of passing6/17/2009 out, even if6/17/2009 you just draw blood". O n has been received from a physician concerning a female with unknown medical history and U unknown drug allergies who received all thre n has been received from a registered Y nurse concerning a 22 years old female with unknown Y medical history 6/16/2009 and unknown 6/16/2009 drug allergies w n has been received from a physician Y assistant concerning a female patient who on unspecified U dates was vaccinated with all three 0.5 ml n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL. Subsequently the patien n has been received from a physician concerning a female patient who in September 2008 and U November4/2/2009 2009 was6/7/2009 vaccinated with the fir n has been received from a nurse practitioner Y concerning a female patient who was vaccinated Y with GARDASIL. Subsequently the patient n has been received from a 32 year old female consumer with sulfa and shellfish allergies and N a history 6/16/2009 of endometriosis 6/19/2009 who on 16-JUN-2 n has been received from a nurse concerning Y a 19 year old female with a history of a "severe N reaction to6/12/2009 an unspecified 6/18/2009 meningitis vaccine n has been received from a certified nurse practitioner concerning a 22 year old female withUoveractive bladder 5/22/2009 and5/26/2009 allergies and no illness n has been received from a physician Y concerning a female patient who was vaccinated with Ya dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning Y a 25 year old with a history of asthma female N who on 18-JUN-2009 6/18/2009was 6/19/2009 vaccinated intramus n has been received from a physician concerning a 13 year old female who at time of vaccination N with unspecified sickness was vaccinated n has been received from a pharmacy Y technician concerning a female with a history of premature U who in January 2009, 1/1/2009 was inadvertently v n has been received from a consumer concerning his 22-year-old daughter who was vaccinated N with all three 7/1/2007 doses6/15/2009 of GARDASIL (dose, r n has been received from a consumer concerning her 16-year-old daughter with no medical N history nor drug 4/1/2009 reactions/allergies 4/1/2009 who was va n has been received from a consumer concerning her daughter who on 22-JUN-2009 was vaccinated U with 6/22/2009 the first dose 6/22/2009 of GARDASIL. On n has been received from a physician Y concerning an 18 year old female with no pertinent medical U history5/27/2009 and no drug 5/27/2009 reactions or allergies orted in an internet article, concerning a female who was vaccinated with GARDASIL (date, U dose, route not reported). The author of the ar n has been received from a consumer concerning her daughter, a 15 year old female who on U 04-APR-2009 4/4/2009 was vaccinated 6/6/2009with the first do n has been received from a registered pharmacist concerning a 17 year old female patient who U on an unspecified 6/17/2009 date had been vaccinate n has been received from a registered Y nurse concerning a 26 year old female with penicillin Y allergy and sulfonamide 6/23/2009 6/23/2009 allergy and a history o n has been received from a health professional concerning an 18 year old female with prophylaxis U who on 15-NOV-2006 was ### vaccinated w n has been received from a registered nurse concerning a 13 year old female who on an unspecified Y date was vaccinated with second dos n has been received from a certified nurse midwife concerning a female patient with sulfonamide Y allergy who on an unknown date was vac
n has been received from a Registered Nurse concerning a 16 year old female patient who on U 23-MAR-2009 5/28/2009 was vaccinated 6/16/2009 with a first do n has been received from a physician's assistant Y who reported that 0a patient came into the office U and reported that a friend of hers, who wa n has been received from a consumer mother concerning her daughter with no pertinent medical N history and no known drug allergies who i n has been received from a licenseYpractical nurse concerning her 19 year old daughter withNno pertinent1/20/2009 medical history who on 20-JAN-2 n has been received from a nurse practitioner concerning a female patient who on an unspecified Y date was vaccinated with GARDASIL (lot n has been received from a physician concerning a 12 year old female who on 24-JUN-2009Ywas vaccinated 6/14/2009 intramuscularly 6/24/2009with the 0.5 m n has bee received from a consumer concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (d n has been received from a physician concerning a 17 year old female who on an unspecified U date was vaccinated with a dose of GARDAS n has been received from a registered nurse concerning 3 female patient who were vaccinated U with a 0.5 mL third dose of GARDASIL, intr n has been received from a licensed practical nurse concerning her daughter with no medical N history of allergies, who in October 2008, wa n has been received from a Physician Assistant concerning a 9 years old female who on 22-JUN-2009 U was 6/22/2009 vaccinated 6/23/2009 with the first 0.5mL n has been received from a nurse practitioner Y concerning her 15 year old daughter who wasNadministered 11/2/2007 all three dose 12/9/2008 of GARDASIL, and n has been received from a nurse practitioner student concerning a 12 year old female with U allergy to ROCEPHIN 6/23/2009 and 6/23/2009 no past medical hist n has been received from a physician Y concerning a 23 year old female with no known pertinent Y medical 6/19/2009 history, who6/19/2009 on 19-JUN-2009 was n has been received from a nurse concerning a 19 year old female who received all 3 dosesUof GARDASIL 7/12/2007 (on 27-DEC-2006 was vaccinat n has been received from a office assistant Y concerning a 14 year old female with unspecifiedY drug reactions/allergies ### 8/1/2008 and medical history, w n has been received from a physician Y concerning a 22 year old female who "four months ago" Y in approximately 2/1/2009 February 2/1/2009 2009, was vaccin n has been received from a nurse concerning a 21 year old female who on 11-MAY-2009 was U vaccinated 5/11/2009 with the first dose of GARDASIL n has been received from a physician Y concerning an 11 year old female who on 18-JUN-2009 U was vaccinated 6/18/2009 with 6/23/2009 the first dose of GARDA n has been received from a nurse concerning a female who on an unspecified date was vaccinated U intramuscularly with a 0.5mL dose of G n has been received from a physician concerning a female who was vaccinated IM, 0.5 ml, with Y a dose of GARDASIL and then fainted. The n has been received from a registered nurse concerning a 26 year old female who on 25-JUN-2009 N was6/25/2009 vaccinated6/25/2009 with the first dose of G n has been received from a nurse concerning Y a 22 year old female who in April 2009, was vaccinated U with4/1/2009 her first dose 5/1/2009 of GARDASIL inje n has been received from a medical assistant concerning a 15 years old female who on 10-JUN-2009 Y was 6/10/2009 vaccinated 6/10/2009 intramuscular admin n has been received from an 18 year old female patient with a history of fainting but no drugUreactions or allergies 6/8/2009 who 6/8/2009 on 08-JUN-2009 wa n has been received from a physician concerning a 14 year old female with a history of passing U out from5/26/2009 other shots5/26/2009 (name manufacturer u n has been received from a physician Y concerning a 11 year old female patient with no pertinent U medical 6/17/2009 history and6/20/2009 no drug reactions or al n has been received from a Nurse Practitioner (N.P.) concerning a 16 year old female patient N who "about 6/22/2009 one week6/22/2009 ago" (on approximately n has been received from a physician concerning a 45 years old female with no medical history N and drug11/1/2006 allergy who 11/1/2006 in November 2006, w n has been received from a registered nurse concerning a female who two months ago was Nvaccinated with 4/29/2009 the first 5/1/2009 dose of GARDASIL. A n has been received from a registered nurse concerning an 18 year old female with no pertinent Y medical6/22/2009 history or allergies 6/22/2009 who on 22-JUN n has been received from a physician concerning a female patient who was vaccinated with Ua dose of GARDASIL. Subsequently the patien n has been received from a nurse concerning Y a 23 year old female who on 09-UN-2009 wasUvaccinated with 6/9/2009 the first6/9/2009 dose of GARDASIL (6 n has been received from a nurse concerning a 13 year old female with AMOXICILLIN allergy Y who on 05-JUL-2009 7/5/2007 was 7/5/2007 vaccinated with th n has been received from a Licensed Practical Nurse concerning a female patient who on anUunspecified date was vaccinated with a first d n has been received from a nurse concerning Y a 16 year old female patient who on 29-JUN-2009 Y was vaccinated 6/29/2009with 6/29/2009 a dose of GARDASIL n has been received from a physician Y concerning a female patient in her mid teens with a fear U of needles6/8/2009 who on approximately 6/8/2009 08-JUN-20 n has been received from a physician Y concerning a female patient who was reported to be "14-16" Y year old who on an unspecified date wa n has been received from a physician concerning a 20 year old female patient who on unspecified Y date was vaccinated with a second dose n has been received from a nurse concerning a 16 year old female with no medical history or Y drugs allergies, 9/1/2008 who in 9/1/2008 September 2008, was n has been received from a physician's assistant concerning a 23 year old female patient with U hallucinations 6/22/2009 induced 6/28/2009 by steroids who on 22 n has been received from a nurse concerning an approximately 14 to 15 year old female who U was vaccinated with what the nurse thought w n has been received from a physician concerning his 11 year old son with a history of numerous N unspecified unimmunisations who was pos n has been received from a nurse practitioner concerning a 24 year old female with no pertinent Y medical6/27/2008 history reported 6/27/2008 and no known dru n has been received from a physician concerning a 24 year old female with no pertinent medical Y history reported and no known drug allerg orted in an internet article, concerning a female who was vaccinated with GARDASIL vaccine U (date, dose, route not reported). The author o n has been received from a physician concerning a female patient who on an unspecified date Y was vaccinated with the first dose of GARDA n has been received from a physician concerning a patient who was vaccinated with GARDASIL. U After getting the vaccination the patient e orted from an article, published Y on 29-JUN-2009 that there were "hundreds" of life-threatening U reactions said to be associated with GARDA n has been received from a physician concerning a 13 year old female patient with no pertinent Y medical 2/28/2008 history who2/28/2008 on 28-FEB-2008 was v edness swollen and tender to touch. U 7/16/2009 7/16/2009
m I had the 3rd gardasil shot and about 10 minutes later I was feeling sick, nausea,diarriah, stomache U pains, 7/17/2009 insomnia, 7/17/2009 heart palpatations,fe njection 7-6-09 at 5 pm. Beginning the next day, pt had severe headache and temperature ofN100 degrees, 7/6/2009 extreme fatigue, 7/6/2009 and severe pai of gardasil administered in check inYroom in left upper arm. Allowed to go, walked around the U corner to check 7/16/2009 out and 7/16/2009 my daughter's eyes Abdominal pain, nausea, Yvommiting,Yprolonged Y weekness, dizziness,3low Y bp, tachycardia,required N 911 call7/7/2009 on side of7/11/2009 highway, in Woodbury n has been received from a registered nurse for the pregnancy registry for GARDASIL concerning Y a 16 year 9/24/2008 old female 9/24/2008 who on 24-SEP-20 n has been received from a physician Y concerning Y a 14 year old female 4 who on 25-JUL-2007 Y Nwas vaccinated 6/4/2009 with the6/4/2009 first dose of GARDAS n has been received from a nurse practitioner. Y The nurse practitioner reported that Y "she wasNsent an email 7/23/2008 by one of 7/25/2008 her patient's mothers n has been received from a consumer Y concerning her 15 month old son with no pertinent medical U history 9/1/2002 and drug allergies 9/1/2002 who in Septem n has been received from a registered pharmacist concerning a 61 year old male with no medical N history7/10/2009 who on 10-JUL-2009 7/11/2009 was vaccina n has been received from a physician Y assistantYconcerning a 6 month 2 old male patient who on Y 25-FEB-2009 4/24/2009 was vaccinated 7/2/2009with a first dos ort received on 08 July 2009 from a Y health care professional. A 29-year-old male patient, whoYhad no concurrent 7/7/2009 illnesses, 7/7/2009 but who has med ye contact, words, repetitive odd behaviors, Y crying, sick, diarrhea. Pt was given 18Y vaccines until U 18 months. 11/3/2006 Pt was 11/3/2006 born with a twin-his sist d GUILLAIN BARRE Syndrome - MILLER FISHER Y Syndrome after multiple 3 vaccinations in Basic N Training. 2/25/2009 Symptoms: 3/27/2009 Neuropathy, Weakn 8/10/2007 Y 12 N 7/23/2007 7/28/2007 en area measuring 4 1/4 " x 3" wide. warm to the touch. Y 7/16/2009 7/17/2009 an to have emesis around 6/2/08 and progressed neurologically to vent. curd ICU for a time.NDr diagnosed 3/17/2008 with acute6/2/2008 demyelinating enceph rted blister at injection site on left leg. States slightly red. states fever 99.9 on 7/7/09. No fever or other symptoms 7/7/2009this7/8/2009 am. Giving TYLENO area of redness at vaccination site 15 minutes after vaccine (L arm). 15 mg ATARAX given. Y 7/14/2009 7/14/2009 was reported by a healthcare professional Y and described the occurrence of urticaria in a 29-year-old N female 7/6/2009 subject who 7/6/2009 was vaccinated w ogist - gave Valtrex 16m + clobetasol Y ointment. Headache, rash, blisters open with liquid coming out . 3 day fever to 101.9 . Left ear - canno d severe headache on 7/12/09 that Y resolved with Motrin 200mg + sleep. Mild headache off and N on Monday 7/8/2009 - Wed. Uneven 7/12/2009 pupils size 7/13 nausea, episode of fainting the following Y day, 7/14/09. Y 7/13/2009 7/14/2009 ation site became red & swollen 7 days after administration (area apx 60 mm X 120 mm) U 7/7/2009 7/14/2009 len, clear runny nose. Swollen nasal Y mucosa. Y 7/14/2009 7/14/2009 13/2009- Seizure activity- fever 102.3 at OHI- at home- seizure lasted 3-4 min. Mother brought Y baby to clinic 7/8/2009 2:43 pm. 7/13/2009 120mg acetaminoph ying inconsolable the day that Pt received vaccines and does this everyday lasting 20-30 min even it Pt's5/27/2009 sleep 5/27/2009 LEG RED AND SWOLLEN/ QUICKLY INCREASE SWELLING WITH WARMTH/ ABLE TO U BEAR WEIGHT 7/14/2009 BUT STIFF 7/15/2009 LEG WITH WALK vaccine July 10, 2009 with no adverse Y reactions in left upper arm. Pt called our facility July U 20 to report 7/10/2009 that in the AM 7/19/2009 July 19 started to fe ostrix on 7/17/09; reports vomiting, hives, arms feel heavy, wheezing, back burning, swelling Y at site on 7/20/09 7/17/2009 Advised 7/17/2009 benedryl Y ### 7/10/2009 ay his leg was blistered, really red and Y hot dont know if it was from shots or the broken needle Y i found in7/14/2009 his leg 7/15/2009 9 noted lethargy, headache when moves around too much. No elevated temperature, no vomiting. U Encouraged 7/13/2009to 7/19/2009 give Tylenol or Ibuprop ped marked thrombocytopenia 4 weeks Y after receiving MMR, varivax, and Hep A. Pt was given IVIG in emergency 6/17/2009 department 7/17/2009 on 7/17. ands, elbows, and chest. contact dermititis Y at site of injection U 6/30/2009 7/15/2009 ceived Pentacel, Prevnar, & Rotateq on 7/13/09. Within minutes, patient developed 2 small Y hives on feet7/13/2009 & legs. No 7/13/2009 breathing dificulties o Y 5/7/2009 Y 6/4/2009 of vessicular rash in L5/S1 distribution Y - burning pain with rash consistent with zoster. Occured U at non-vaccination 7/16/2009 site 7/17/2009 1 day after zoster va scribes receiving Tetanus/Pertussis shot on 7/10/09 in left arm. On 7/11/09 around 2 pm, started Y to feel7/10/2009 weak, lightheaded 7/11/2009 and body ache reported that approximately one week after she recieved the vaccine that she noticed a redYarea around 7/1/2009 the injection7/6/2009 site that "itched". Sh her 1st Varivax 7/6/09 in her left thigh. It started to become red that day and became the size Y of a nickle.7/6/2009 The site was 7/6/2009 red, no tenderness rash, itching, left upper underarm 11X12cm Y red, warm, 4cm area of blisters, oricedyre: 2 blisters Y opened 7/14/2009 for Zoster7/15/2009 culture and lg blister po eived a Menactra on 7/20/2009. She had a previous meningitis vaccine (type/ brand unknown) Y on 8/23/2007 7/20/2009 in another 7/20/2009 county. virus vaccine was ordered due to a non immune varicella titer result. the pharmacy dispensedY a Zostavax7/16/2009 vial in a ziplock bag that was labe ion site began to itch, turned hot and Y grew to about 5 inches or more in diameter within 24 hours, Y and has 7/17/2009 remained7/18/2009 for 3 days. Benadryl d pneumococcal vaccine trial, with severe COPD, was diagnosed with stage 3A carcinomia of the right lung 6/25/2007 that as of5/15/2009 June 2009 has spread tender erythmatous area at immunization Y site. Y 7/13/2009 7/14/2009 ediatric dose of Hep B instead of the adult dose. The patient did not suffer any adverse reactions. Y I contacted 7/20/2009 the patient 7/20/2009 and reported my Y 6/15/2009 7/12/2009 dministered Friday afternoon, July 17, by physician. Saturday afternoon had uncomfortable Yskin soreness 7/17/2009 on left shoulder. 7/18/2009 Examined to fin who works in Dental school received MMR vaccinatioin on 5/20/2009. Screening questions U asked regarding 5/20/2009 pregnancy 7/17/2009 or plans to become
7/2/2009 N 7/2/2009 7/2/2009 days c/o headache, nausea, emesis - persistent c/o anorexia and mild nausea for 2 - 3 wks.Y 6/30/2009 temperature 105 degrees/ seizure Y activity. Fever started day of vaccine 6/26/2009 seizure started Y 6/27/2009. 6/26/2009 6/26/2009 noted severe redness, erythema, tenderness & swelling Recommended ice packs to area &YMOTRIN 7/14/2009 7/15/2009 ceived VARIVAX IM instead of Sub-Q. Y 7/15/2009 insect bite like sensations on arms/legs/back & will have appointment w/ MD to examine perUcase in case 6/26/2009 he is developing 7/15/2009 shingles. re for physical with foster mom (her aunt). Denied sexual activity; LMP 6/20/09. Office protocol is to do a preg 7/7/2009 test if receiving HPV. HepA, :35 AM - Patient received MENACTRA and ADACEL vaccine. Patient is placed in chair to beYobserved for 7/14/2009 15min. Patient 7/14/2009 fainted and fell ou and swelling on the left arm around the deltoid area - Prescribed/ advised to take BENADRYL U and ibuprofen. 7/8/2009 Reaction 7/8/2009 on the arm then got ills, body aches began 2 hours after TDAP administration and lasted 4 days" Y swelling, warmth & streaking of redness Y to left arm. Pt denies fever. Is going to urgent care. Y SWM contacted 7/10/2009 & notified. 7/13/2009 Pt given copy of at injection site, knot in arm, pain, Pt. c/o not being able to move his arm. Rash around injection N site 7/15/2009 7/16/2009 24 hrs, acute onset, on back & some Y on face her anterior & extremities "too many to count" NRecommended 8/11/2003 TYLENOL 7/19/2009 & topical BENADR min after vaccines administered patient became pale, diaphoretic, and complained of abdominal Y discomfort. 7/20/2009 Also complained 7/20/2009of being light h ven Adult dose of Hep A - no Adverse Reactions. U 7/16/2009 an to have emesis around 6/2/08 with progressive to vent / trach and diagnosis of acute disseminating N encephalomyelitis. 5/16/2008 6/2/2008 Still being treated mplained of pain in injection site and when examined in the office her left upper arm had approximately Y a7/16/2009 10cm x12cm 7/17/2009 red circular area wit ted on shoulders and then spread all over. Started 7/7/09 same evening received shots hives Y continued to7/7/2009 AM, mom7/7/2009 notified MD of hives. R erythematous, hot, 3/12 cm. TX: KEFLEX, BENADRYL. Cool compresses. Y 7/7/2009 7/8/2009 ent's upper arm, where vaccine was administered, became red and swollen. Remained so for Y 4-5 days. 6/29/2009 ustule on right thigh. Y 7/6/2009 7/15/2009 urated - pruritic 12 X 6 cm swelling of Y leg just inferiorly to DTAP injection one day after administration 7/9/2009 7/10/2009 Y U 7/13/2009 7/13/2009 vaccine 6/29 - developed reddened, tender area where vaccine was given that night. Area is larger, still6/29/2009 tender 7/11/09. 6/29/2009 Given rx for Cefad n has been received from a physician concerning a female in her "mid 60's" who in 2008 (reported Y as "6 months to one year ago"), was vac ort received on 16 September 2008 Y from a healthcare professional. A 31 year old female, with Y no medical9/11/2008 history and 9/11/2008 who was using Nuvar 7/2/2009 Y Y N 5/8/2009 6/22/2009 n has been received from Y a consumer Y concerning Y a 14 years old female 5 with a history Y of tubes N in ears when little ###and 12/7/2007 adenoids removed at n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL (dose, ro n has been received from a physician Y and a certified Y medical assistant 6 concerning a approximately Y 18 week old ### male2/1/2009 with dermatitis from 0 n has been received from a registered Y nurse concerning Y a male with0 no patient medical Y history N who on approximately 7/7/2009 7/13/2009 07-JUL-2009 "one w r the first few weeks, panic attacks,Ylow body temperature, difficulty swallowing, unable Y to digest N food properly, 7/13/2007 regurgitation, 8/6/2007circadian rhyth e received pneumococcal vaccine in left deltoidYon 7/7/09. Later that2evening he called the medical U center 7/7/2009 complaining 7/7/2009 of pain, warmth, and minutes of giving KINRIX, VZV and MMR, the child Y developed coughing, hives and swelling ofYthe lips. 7/8/2009 7/8/2009 Reports crying x 2/2 hrs after vaccine Y administration. G. mom "thinks child not breathing normal". Y Examined 7/2/2009 in office 7/2/2009 5 hr > administration o ythematous somewhat confluent papules that covered anterior upper chest only-itchy. OTC steroid Y cream.7/8/2009 7/9/2009 patient started running a fever, thatYnight ok on 7/4. The fever stopped. On 7/5 patient brokeY out with "spots". 6/22/2009 She had 7/3/2009 several - all over "th Y 7/16/2009 redness, pain and itching at site of TRIPEDIA injection- (RIE suggested). Dr. stated to mom-mild reaction. 7/15/2009 Called 7/17/09 7/16/2009 12N Mom says sl m - Received care from MD's office Y stating, pt. there with c/o "redness and knot" in right deltoid Y area - child 7/14/2009 had school 7/15/2009 booster at Health De at the site of injection. Measuring 15L mm x 12mm w. Redness around the site 30mm x 15mm. Y Excess crying 7/16/2009 x 1 hr.7/16/2009 ceived Zostavax vaccine on 07/10/2009. Y She returned to the office today with a rash on herNback and left 7/10/2009 side, painful 7/15/2009 for six days. Shingle red adult dose of Hep B vaccine to client in error vs. adolescent dose. No adverse event noted Y at time of7/20/2009 administration of vaccine. two doses of Tdap. First dose 6/11/2009 and second dose today, 7/21/2009. No adverse reactions at this 7/21/2009 time. mplained of right swollen arm and slight temp of 99. She also complained of a headache. This Y was initially 7/17/2009 relieved7/18/2009 with aspirin and Benad vaccine given 7-18-09 in Left arm subcutaneous. Sat 10 minutes in office, no problmes at that Y time. Mother 7/18/2009 states child 7/18/2009 had a small red circ he night of immunization he felt shaky all night. next day he was pale, elevated heart rate, weakness, Y difficulty 7/10/2009 breathing. 7/10/2009 After taking Bena ately seven hours after receiving immunizations, Y patient had 7-10 minute episode of unresponsiveness Y and 7/13/2009 being "limp". 7/13/2009 Episode followed p G REDNESS AND EXTREME SWOLLEN. Y WENT TO ER. EVER SINCE THE SHOT SHE HAS Y HAD PAIN. WAS GIVEN BENADRYL ORIGI deltoid starting the day after injection. Today which is six days after injection she has quarter-sized Y area7/15/2009 of redness7/16/2009 over injection site with ived IM on 7/16/09. Employee states Y symptoms of nausea, vomiting, diarrhea, chills, hives, Y abdominal pain 7/16/2009 (10, low7/18/2009 grade temp started on
ports fever last evening. Marked swelling of left upper arm with redness and several bumps Y on the skin. 7/20/2009 Area is warm 7/20/2009 to touch. Area outline th history of cluster headaches. Recently started on topamax. Headaches controlled. Approximately Y three 7/21/2009 minutes7/21/2009 after administration of h at site, swelling at site, diarrhea, generalized joint pain Y 7/16/2009 7/20/2009 inflammatory irritation with proximal radial to shoulder perceived redness and warmth. Well circumscribed Y 7/20/2009 and mild 7/20/2009 palpable fever over late U 7/21/2009 7/21/2009 ely after administration of HPV patient fainted. Dr. reassessed patient for injury and reaction.YAfterwhich patient 7/14/2009 was7/14/2009 o.k. arm rash/pain starting 1 day after vaccine. Y Y 7/14/2009 7/16/2009 ED FACIAL SWELLING, TONGUE SWELLING, SLURRED SPEECH, DYSPHAGIA, ARM AND U FEET TINGLING, 7/6/2009 HEADACHE, 7/6/2009 NAUSEA. at 6:00 pt c/o soreness. On the next Y am noted redness, paiful to touch, warmth and edemaYrt arm. Applied 7/13/2009 ice packs 7/13/2009 and OTC Benadryl g GIVEN ON THE 10 OF JULY, CAME BACK ON JULY 20TH OF 2009 FOR A POSSIBLE REACTION U TO 7/10/2009 AMOX AND 7/20/2009 DR. KING ALSO SU vaccines at 2:30 pm office visit on 5-13-09. Y By 8:30 pm child had facial swelling and eyelid swelling. Y Poor 5/13/2009 feeding, swelling 5/13/2009 of injection site. dministration, dizziness for 30minutes (rapid heart). Itching and soreness and redness. Chief complaint redness 7/13/2009 increasing 7/13/2009 in size. ped chills Monday evening with Temp 102.4 that night. Parent treated temp with Ibuprofen alternated Y with 7/13/2009 TYLENOL. 7/13/2009 Child slept a lot 7/14/ mmunization began having brief (about Y 30 mins) periods of dizziness and nausea. EpisodesUare self - limited. 7/14/2009 Exam 7/16/2009 is normal. fter child received rotavirus vaccine, she developed Y bloody diarrhea.2 Initial blood culture wasUpositive but 7/8/2009 repeat neg.7/9/2009 Even several days lat ble crying last evening (7-15-09) x 4 to 5 hours. Would not walk at that time. Y 7/15/2009 7/15/2009 received rotavirus vaccine, she was difficult toYfeed, felt cold. The next 1 day she had BMs with U frank blood.7/8/2009 She was admitted 7/8/2009 overnight, BM 04, body aches, nausea. Y 6/25/2009 weakness, had to stop usual activities at school and went home. Was pale and clammy when Y the mother 5/27/2009 picked him 5/28/2009 up from school, the s erienced dizziness, fainting, vision disturbances, Y and fatigue beginning the morning after vaccination. U Pt was 7/9/2009 advised 7/10/2009 to go to doctor immed ely after shots were given Pt became Y unresponsive. Had small seizure lasting only few seconds. We opened 7/5/2009 airway 7/15/2009 and laid her flat. She ca ea red-warm-swollen-tender to touch. (varicella like) raised area about size of silver dollar-red U area about7/15/2009 3" wide and 7/16/2009 4 1/2-5" long- Recom d hives after KINRIX immunization. Came into office 7/16/09. Put on BENADRYL 1 1/2 tsp TID Y and PERIACTIN 7/14/2009 1 tsp 7/15/2009 TID, no fever or distr vaccine given subcutaneous left upper Y arm 7-9-09. Developed erythema, tenderness, swelling, U and warmth 7/9/2009 at injection 7/10/2009 site on 7-10-09. Sa ainful, papular rash of hands, spreadinig Y to arms, then legs. U 7/1/2009 7/4/2009 xis: Child presented with hives, itching and redness on face, also c/o feet itching at 1456 hrsY- 7 minutes7/14/2009 after receiving 7/14/2009 immunizations. He large amount of swelling at injection Y site. Y 7/10/2009 7/11/2009 en on 7/10/09 Pt in to U.C on 7/12/09. Left thigh swollen (1/2 of thigh) redness approx 3 inches U in diameter. 7/10/2009 Tender7/12/2009 to touch. Gait normal nic seizures, 3 hours after vaccinations 7/10/09.Y 7/22/09 MR received 3 for DOS 7/9-13/2009 with Y D/C DX:7/10/2009 Seizure Disorder. 7/10/2009 Pt presented se stated that pt developed flat round disc shaped lesion 6 days post MMR & Hib adm. Lesions U nickel sized 6/17/2009 on hand +6/23/2009 leg. as given Tdap immunization on 7/1/09. Y Returned to our clinic on 7/8/09 c/o redness & itchingY around injection 7/1/2009 site. Large 7/8/2009 reddened, hot ar ven GARDASIL vaccine upon checkout Y Pt fainted. Lost consciousness for ~ 5 sec. Fell and hit N head on floor. 6/26/2009 Sent to6/26/2009 ER for CT scan, IV. lled 7-6-09 c/o (L) arm stiffness from Y ADACEL. Advised to use ice and ibuprofen. Saw PCP on 7-7-09 advised 7/2/2009 to continue 7/6/2009 ibuprofen - Note elirious - severe headache - memoryY loss - couldn't speak certain words - couldn't rememberYwords he was 7/20/2009 trying to7/20/2009 say - "kind of out of it". dness & swelling to injection site right arm advised to give BENADRYL & MOTRIN & apply cool Y compresses. 7/20/2009 7/21/2009 m rash - generalized - Rx calamine - BENADRYL. Y 7/6/2009 7/16/2009 + itching at site, has persisted for several days. After 8 days after immunizationn rash and itching U is dissipating, 7/13/2009 approx 7/14/2009 size 1inch by 1inch, d urticaria, angio edema, throat itching Y Y 7/21/2009 7/21/2009 (erythematous & edematous at vaccine site) upper arm. Apply ice, BENADRYL. Y 7/20/2009 7/20/2009 redness, severe itching at site of vaccine beginning day of vaccine, worsening for 3 days, then Y improving. 7/13/2009 7/13/2009 TDAP before age 11 yrs. Y 6/19/2009 with Pt blurring of vision after GARDASIL. Few minutes later. She was short of breath > Briefly. Y 7/21/2009 7/21/2009 iefly after immunization: in this order Y 1 MENACTRA, 2 ADACEL, 3 GARDASIL. Referred to ER Y because7/21/2009 of continued 7/21/2009 dizziness. as given GARDASIL on 7/20/09 at 1430 and seconds later patient stated she was not feelingYwell and asked 7/20/2009 for water. 7/20/2009 Patient then turned p ghtheaded and nauseous after receiving vaccine and walking to play room; sat in chair, still Y lightheaded,7/21/2009 BP low, pulse 7/21/2009 weak and laid pt. do Sleep & H/A 7-19-09 - H/A & hallucination (while awake) -> was taking food from ref. & thought Y it was falling 7/17/2009 on her.7/19/2009 About 2 PM (took me es about 4o after shot his arm got red Y and swollen, warm to touch and hurt when he moved U it. He stated7/15/2009 he had temp 7/15/2009 of 100.8. Went to ER injection site - egg size, red swollen; tender area on left mid-arm, hives in area with itching and N pain. Advised 7/17/2009 BENADRYL 7/18/2009 1 teaspoon ever rsistent left arm pain since TD injection. No signs of infection U 5/9/2009 5/9/2009 ed, red rash, itchy, ice 15 mins on 15 mins off 2 days, headache, felt sick tired, took antihistamine Y 4 to 6 hrs 3 days 1cm red area surrounding injection site. Minimal warmth, no blisters, no hives on L thigh. 7/14/2009 7/15/2009
ever, began vomiting, & shaking. Feet Y turned blue & turned gray around mouth for over halfYan hour. 7/13/2009 7/13/2009 n has been received from a physician Y concerning a female patient who was vaccinated with Ythe first and only dose of GARDASIL when she nt had what were described as low-grade Y fevers (up to 101) the night after receiving her immunizations. Y 7/20/2009 The parent7/21/2009 witnessed a generalize ow 11 wks old received 2 Y mos vaccinations and one day later experienced apnea, brady's, desats U resulting 7/16/2009 in intubation. 7/17/2009 spots to back, arms,chest, torso with a fever. N 7/8/2009 7/16/2009 eived the ZOSTAVAX vaccine. The next day I had redness, pain, itching, warmth and swelling at the injection 7/1/2009 site. My 7/2/2009 arm had a red swolle rash 3 x 7 cm at injection site that lasted more than 4 weeks. No vesicle, or bulla. Non tender. Y No Rx - This 7/10/2009 was at ZOSTAVAX 7/10/2009 site. was reported by a pharmacist and described the occurrence of vaccination adverse reactionYin a female subject 5/8/2009 of unspecified age who wa Slurred speech, Dizziness, muffled Y hearing, blurred vision, involuntary joint movement, Y easily N frustrated,3/30/2007 muscle spasms, 7/13/2007 taste and memory seminated encephalomyelitis (ADEM): Y leg weakness; Y left face, arm, 5and leg sensory symptoms; U no fever or 7/1/2009 other viral7/8/2009 illness symptoms; inc mpy, itchy rash at injection site about 4 in diameter with a few stray bumps around the elbowYstarting a few 7/15/2009 hours after 7/15/2009 vaccination. Bumps RTS WAKING WITH HEAD ACHE, NAUSEA, FEELING EXHAUSTED. THURSDAY 7/2 PT Y REPORTS FEELING 6/30/2009OF7/1/2009 HEART POUNDING, ates child c/o right arm pain Sunday 07/19/2009. Parent states right upper arm was red, swollen U and warm 7/17/2009 to touch. 7/19/2009 Parent applied cold pac nt secure message (email) to primary care physician: "I had a rather (for me) severe reactionYto the PNEUMOCOCCAL 7/17/2009 7/17/2009 vaccine I was given perienced change in sense of tasteYand change Y in facial sensation within 2 12 hours of his 6thUAnthrax and 6/10/2009 3rd Typhoid 6/10/2009 vaccination. The sym ceived a gardasil vaccine injection. Appeared fine, walked to front office to check out. Was Y speaking with 7/16/2009 the check-out 7/16/2009 person and withou esents with redness and warmth at site of zoster vaccination recieved 06/25/09. Y 6/25/2009 6/27/2009 ection red, swollen, with pain for 2 days U 7/20/2009 7/21/2009 7/22/2009 N 7/17/2009 7/22/2009 arm wheal measured at 5cm x 6cm; erythematous & warm to touch. Puncture site noted atUcenter of inflammation. 7/20/2009 7/22/2009 Slight induration note ceived telephone call from mother, Y pt. had received vaccines-Hep A #1;MMR #2 & VaricellaY#2 on 5/11/09. 5/18/2009 On 5/18/09 5/19/2009 pt. received Td boo LASTED 10-30 SECONDS; WENTYTO ER; NO TREATMENT INITIATED. AFTER BLINKING Y EYELIDS7/13/2009 BUT RETURNED 7/13/2009 TO NORMAL A swelling, redness, and warmth Rt. deltoid U 7/21/2009 7/22/2009 ports vaccination site with red mark "rash" for 12 days past vaccination concern for extremityUachiness day 7/10/2009 3-12 post 7/13/2009 vaccination 9 pt received varicella and hep. a #1 Y injection while in the office. In late afternoon on the 14th Y noted redness, 7/14/2009 edema, 7/14/2009 pain, and warm to tou ER on 6/26/09. Pt states he woke up and felt like Y he was drunk. Pt 5had dizziness, confusion, Y trouble with6/9/2009 gait. Pt c/o 6/26/2009 muscle spasm on left Rash entire body. Fever to 102 degrees on day 13 post MMR. With possible insect bite day N of rash. 7/7/2009 7/20/2009 ported erythema swelling + temp of Y104F. 7/20/2009 7/22/2009 f vaccines, pt developed rash on extremities Y -hands, feet throat felt funny - next day rash cont Y - today rash 7/20/2009 is just to7/20/2009 biceps no temp - no loc 7/22/2009 swelling, erythema <48 hours after vaccine Y administration. Seen in ER for I & D, cultures obtained Y and (-).7/6/2009 Placed on 7/8/2009 P(o) ABTx x2 for 7 day ately 4 days after vaccination, patient reported increase pain, swelling and redness at site of Yinjection. Seen 7/9/2009 by Infectious 7/14/2009 Disease MD. No a eats, nausea, vomiting & shortness of breath within a few hours after injection & seen the next Y AM 20 hours 7/20/2009 post injection 7/20/2009 with no fever, GS n on 20 Jul 09 to receive VARIVAX. Pt mom stated Monday nite. Patient became itchy, swollen, Y and warm 7/20/2009 to the touch 7/20/2009 at site of injection. 2 arm over Tricep with 3x4cm redness with mild swelling, mild warmth shin with redness. Y 7/7/2009 7/7/2009 post injection, site of VARIVAX vaccine was red and firm, with residual bruising. Y 7/1/2009 7/8/2009 after injection, at site of VARIVAX vaccine, red, hard, tender lumps had developed. Y 7/2/2009 7/10/2009 e, dizziness AP 89 reg R-20 BP 104/64. Rested flat recovered after 15 minutes. Y 7/21/2009 7/21/2009 ack to clinic after 15 min c/o tightness in her chest, she had audible wheezing. She was treated Y with 50mg 7/21/2009 BENADRYL 7/21/2009 (IM), albuterol via N dministered on 6/22/2009 Left leg redness left leg pain, fever on 6/23/09. Continued rednessUleft leg on 6/24/09 6/22/2009 decreased 6/23/2009 pain, decreased n has been received from a nurse concerning a female patient who on unspecified date wasUvaccinated with the first dose of GARDASIL va ed of feeling faint, lightheaded 2 minutes Y after receiving 1st dose of vaccine. She sat down in Y chair, nearly 7/13/2009 fainted, then 7/13/2009 threw up. She felt n has been received from a physician Y concerning a male smoker patient with chronic Y obstructive U pulmonary disease who in 2008 was vacc n has been received from a consumer who was the mother of the patient. The mother reported U that her son stopped talking after receiving was received from a health professional Y on 10 July 2009, and involves a subject enrolled in an investigator-sponsored ### study. ### Subject ID: 1 ined of thirst after receiving vaccines, fainted , clammy, pupils dilated, double vision, After about Y 15 min.7/21/2009 pt recovered. 7/21/2009 ter injections-pt became moody-cried all evening- didn't know why he was crying-seems quiet Y and ok the7/21/2009 next day. 7/21/2009 d said she wanted it documented that pt had a reaction after the GARDASIL site was sore also Y came out 7/13/2009 in hives underarm 7/15/2009gave BENEDR t# 0171U, exp 6/29/09 was given to pt. on 7/2/09. This vaccine was expired by 3days. SinceYthis was first7/2/2009 immunization, and will receive #2 HPV # 3 on 7/15/2009. This vaccine expired on 6/29/09. Parents contacted. Will receive on Y additional 7/15/2009 HPV vaccine in 4 hrs to insure effic HPV #3 on 7/15/09. This vaccine expired on 6/29/09. Parents contacted. Pt will receive an additional Y HPV7/5/2009 vaccine in 4 months to insure eff
HPV #2 7/21/09. This vaccine expired on 6/29/09. Parents contacted. Pt will receive an additional Y HPV vaccine 7/21/2009 4 months after she receives area of redness and edema. First noticed on 7-19-09. - itching. 7/20/09 7 X 3 1/2 cm. Redness Y noted 7/15/2009 ice packs, BENADRYL 7/17/2009 rm swelled up and appeared cellulitic Y 24 hrs after receiving KINRIX in right deltoid arm. Y 6/15/2009 6/16/2009 oor post GARDASIL vaccine #2, 10 minutes post vaccine. Alert, responsive, pale. BP 70/50 Y- 78/60 - 86/60 7/17/2009 - 92/70 7/17/2009 - 98/70 - (Bumped L he in severe rash left side neck, upper shoulder back & front. Went to doctor - prescribed PREDNISONE. Y 6/16/2009 Rash subsided 7/8/2009 after 2 days. Sore ports child began having rash 7/15/09 which progressed to include neck, back, shoulders, abdomen, Y (R)7/13/2009 hip to (R) leg 7/15/2009 and calf, both feet. P deltoid area reddened, swollen, warm to touch, sore Y 7/16/2009 7/17/2009 ness over body, -Rash, -Itchy bumps, -Stuffy nose Y 7/6/2009 7/7/2009 m, swollen "2x2 " tender cold compresses applied left arm. 7/15/2009 7/15/2009 itching, and induration around injection site. Warm to touch. 7/16/2009 7/16/2009 swelling, and pain surrounding injection site. Redness from right shoulder to right elbow and warm to touch. 7/15/2009 7/16/2009 NACTRA, TDAP, vaccination, HEP AYgiven 2min, Pt looked dazed, then arched neck and body, Y hands and 9/23/2009 arms curled 9/23/2009 in. 7/23/09 - came to clinic to report pt got rash on arms, thigh after receiving vaccines. Pt took N BENADRYL,7/10/2009 used topical 7/10/2009 lotion for poison Ivy ike activity noted on 7-22-09 -> patient Y taken to ED. CT done patient had received VARIVAX Y and HAVRIX 7/20/2009 vaccines7/22/2009 on 7-20-09 rived at ED 17 Jul 2009 @ 2300 with Y left sided facial swelling. Onset was 3 hours prior to arrival. Y She was 7/16/2009 given Benadryl 7/17/2009 25 mg orally @ 0 papular rash 1 day after vaccine. Y U 7/21/2009 7/22/2009 hema, induration, warmth, and tenderness Y to L upper arm from shoulder to elbow. U 7/21/2009 7/22/2009 ox like rash/hive like, occuring mostly Y at nite. treated with anithistamine, may need steroid.. N 7/15/2009 7/16/2009 welt at site of vaccine. Pain at site. U 7/22/2009 7/23/2009 to left tricep area started day after varivax vaccine administered on 7/20/09. Bactrim prescribed Y x10days. 7/20/2009 7/21/2009 er shots, had joint aches and muscle Y soreness. Lasted 2 weeks. Also, injection site L arm was Y hot, red and 6/2/2009 swollen.6/5/2009 Went to MD on 6/24/0 2/14/2009 N ### 2/14/2009 er arm with large red, indurated area that is tender to touch and palpitation x 2 days. Used Benadryl Y and7/13/2009 cold packs7/15/2009 e with nausea and vomiting that started 3 days post vaccination with Zostivax. Symptoms resolved N after6/17/2009 24 hours 6/22/2009 vacccine: first and second days, just some swelling. But on the third day I spent time in the sun Y with ths ite6/6/2009 exposed. The 6/9/2009 site became very r RTED FEVER AND PAIN,SWELLING AND REDNESS AT INJECTION SITE Y 7/10/2009 7/10/2009 ceived 2nd Varivax on 7/21/09. Site became red, painful and hard. Came in to the office forYphysician to7/21/2009 see. Prescribed 7/21/2009 an ABX to start i able crying for 3 and 1/2 hours. Very high pitched scream type cry in an infant that normally Y does not scream 7/22/2009 when 7/22/2009 crying. 1 cm red, warm, localized reaction from vaccine. Y 7/20/2009 7/22/2009 turned to District Health Office 48 hours post vaccination with swollen, reddened area 60mmYby 50mm on 7/21/2009 back of right 7/23/2009 arm. RETURNED TO CLINIC FOR SKIN TEST READING AND SHOWED PHN SITE OF VARICELLA Y VACCINATION. 7/21/200980X60 7/23/2009 MM AREA OF ER sh to arms and legs, seen by dermatologist Y who determined rash was probably Giannoti Crosti caused by 7/15/2009 Hep B vaccinee. 7/20/2009 ported experiencing wide-spread redness and tenderness over entire upper left arm shortly after U immunization. 7/16/2009 She7/16/2009 presented to pharmac N ARM, FEELING LOTS OF PAIN Y U 7/22/2009 7/22/2009 a transverse myelitis which resulted Y in temporary Y paralysis of legs and 9 on-going loss of sensation N of body10/3/2008 from above the nipple-line ### to the b es after receiving immunizations, patient got up from sitting on exam table to standing. Fainted Y after taking 7/22/2009 2 - 3 steps 7/22/2009 towards the door to l ed, swollen with heat. Warm moist compress 4x a day. Y 7/21/2009 7/23/2009 ncopal episode post receiving VARIVAX Y 7/22/2009 7/22/2009 redness with 3 cm x 2 cm red area L post 1 cat aspect Y 7/21/2009 7/22/2009 was initially reported by a nurse on 16.Jul.2009. The female patient was vaccinated with oralUVIVOTIF (Batch 7/16/2009 no.: UNKNOWN) 7/16/2009 on 16.Jul.2 n has been received from consumers concerning their "teenager" daughter who started to receive Y GARDASIL series over a year ago. The d progressive lower extremity weakness/numbness Y requiring intubation 33 6/30 for respiratory failure. U EMG/MRI 6/9/2009 consistent 6/27/2009 with GUILLAIN-BA verse event, but I have had a 5 personal zoster outbreaks in people previously immunized persons and know of 2 others in our community nic attack (shortness of breath, confusion) 20 minutes after administration of meds. No hives Yon swelling 7/11/2008 noted. 7/11/2008 ale, white - bluish lip - one minute event in a very warm store (2) "Fainting" duration 5 minutes Y with in 5 hrs. 3/18/2009 of vaccine 3/18/2009 en in left arm 7-13-2009. Pt states arm became red, hot, swollen, tender to touch. Pt started Y taking Tylenol 7/13/2009 on 7-14-09. 7/15/2009 Pt went to ER on 7Y Y 7/10/2009 7/10/2009 se events. I gave a Hepatitis A inj instead of DTAP. Y 7/7/2009 len left deltoid, warm to touch 5" X 4.5". Y Mom advised ice 30 minutes QID/ TYLENOL and MOTRIN Y for pain 7/13/2009 7/14/2009 all dark bump around right ribcage. Y 7/2 - Bumps became overlapping welts. - Saw Dr. - SaidNit looked like6/24/2009 shingles. 7/10 6/30/2009 - Saw Dr. began ag cm erythema, red, tender warm to touch Y Y 7/15/2009 7/16/2009
er injection, vomited bilious materialYand had abdominal / cramp. Y 7/6/2009 7/10/2009 ceived MMR vaccine on 7/6/09. Pt did not know if she was pregnant. She stated there couldUbe a chance 7/6/2009 of her being7/9/2009 pregnant. Pt was retu ent received SUB-Q injection, patient began to stiffen his body while collapsing to the floor. Skilled Y nurse 7/14/2009 assisted him 7/14/2009 to the floor with no inc 9 per parent, client got out of bed atY9:00 Am, without eating or drinking went to use bathroom. Y Client felt6/18/2009 dizzy (told6/20/2009 this to Dad), then pass 2007 client had his first convulsive seizure Y following immunizations. Mother reported 1 hr. 15 Y min. post vaccines ###(HIB, MMRV ### and Pediatric t lightheaded immediately following vaccinations. Sat Pt down, used smelling salt, gave pt sips Y of ice tea, 7/23/2009 had pt sit 7/23/2009 an additional 20 minute s after taking pill # 1 - back & stomach Y cramps & diarrhea. @ two hours later, client went to hospital E.R.7/16/2009 with "severe 7/16/2009 "stomach pain (ULQ Y 6/23/2009 puffiness + warm to touch @ injection site above 30mm of redness. Site is tender to touch @ Y site of Varicella 7/15/2009 injection. 7/16/2009 redness < 24 hrs after administration Y of HEP A vaccine right upper arm/ warm compresses TYLENOL Y PRN 7/14/2009 7/15/2009 lo-vesicular rashes all over trunk and buttocks, some are extra-pruritic since yesterday; someY of the lesions 2/10/2009 are now7/21/2009 crusted. Supportive me tchy and a lump at the site. Y 7/14/2009 7/15/2009 wallowing began 15 minutes after injection was administered Pt. was given BENADRYL. Patient's Y condition 7/23/2009 has improved 7/23/2009 d with Health Dept today, 7-24-09 at 10:30 am, with very red, raised, swollen, hot and tenderYarea approx7/22/2009 13cm in diameter, 7/23/2009 around VZV inj and redness/induration (R) upper arm at site of inj measuring 7cmX7cm. 7/21/2009 7/22/2009 nted directly after administration of HPV. Mom and nurse slid her to floor where she regained Y consciousness. 7/23/2009 (This 7/23/2009 was 3rd of 4th shots giv erated the HPV vaccine injection well. However 5 minutes after the vaccine was given she fell Y to the floor 7/24/2009 she was awake 7/24/2009 and alert and aw kin, right sided chest pain, headache, Y nausea, dizziness Y 7/23/2009 7/23/2009 S AND SWELLING 3CM BY 3CM AT SITE OF INJECTION TREATED WITH MOTRIN BENEDRYL U AND7/22/2009 KEFLEX RECOMMENDED 7/23/2009 APPL a flu shot at this clinic on Nov 9, 2007 Y and 2 weeks Y later my hands23 started becoming numb,Uthen my arms 11/9/2007 and by the next### morning my legs ction at injection sites, redness and swelling. Swelling of tongue and complaints of tongue "itching". Y Patient 7/22/2009 seen in7/23/2009 office 24 hours after ad d large, swollen, firey red and hot localized Y reaction around injection site. Patient was reffered Y to urgent7/14/2009 care where7/16/2009 cellulitis was ruled out nt's mother, baby had 4 days of "not being herself, staring off into space. We thought she just Y had become 4/27/2009 autistic, but 4/27/2009 then it went away an ite swollen to softball size, hard, redYand warm to touch. Went to ER and was discharged toYhome with prescriptions 7/21/2009 7/21/2009 for Crphalexin 500 mg ely after receiving Tdap, Menactra, and HPV at 3:15 pm patient reported feeling dizzy, weak.Y Pale, sweating, 7/23/2009 no loss 7/23/2009 of contiousness, pt. p lands around neck, breast and armpit Y area where injection was adminstered. The area was very N tender. 7/17/2009 7/19/2009 Given vaccines. Started with rash on right thigh that mom says is slowly getting bigger. No N fever or no other 7/21/2009 symptoms 7/21/2009 d 2 episodes of seizure-like activity,Ysecond episode Y lasting 20 minutes. 3 patient went to ER U and had full7/20/2009 sepsis workup 7/21/2009 over 4 days, CSF, u Patient received Hep a, Menactra approx. Y at 3PM. Mother reports trip to ER around 5:30 due N to hives and 7/9/2009 itching. States 7/9/2009 received Benad administered on 7/22/09. Noticed red/bumpy silver dollar sized @ site. 7/24/09 came to HD measured 6cm/8cm 7/22/2009 red/bumpy/warm. 7/23/2009 tient had a red, swollen, warm to the touch area where the varicella was given in the back ofNher left arm, 7/2/2009 that lasted 7/7/2009 about a week. Starting 7/17/2009 ated at ER for steam burn and received Y a Td shot. Later that day, arm swelling, general malaise, Y diarrhea, 7/15/2009 nausea, chills, 7/15/2009 fever onset. The ED SHAPE RED RASH(PATCH)slightly rasied 10.5cm in width and 13.5cm in height on rightYthigh; patient 7/22/2009 reports itching 7/23/2009 and feeling warm uiac stool 1 day after rotavirus vaccine given Y 7/23/2009 7/24/2009 ater started continuous shaking in legs, had chills, and felt feverish. Symptoms lasted another N day. Today 7/22/2009 still very7/22/2009 spacy, feverish, and w redness at site and upper arm day after injection;No fever but felt warm day after,No fever no Y chills 2 days 7/21/2009 after injection 7/22/2009 WAS GIVEN 2 DAYS AGO. PT CAME TODAY TO CHECK ON A PPD BUT ALSO HAD REDNESS Y AND 7/22/2009 INDURATION, 7/24/2009 PRURITUS, HEA 102.1 FOR TWO DAYS. STARTEDY 5 HOURS AFTER VACCINE ADMIN. OFFICE VISIT NEXT Y DAY SHOWED 7/16/2009 NO7/17/2009 OTHER SOURCE OF ed redness at site and low grade fever Y lethargy next am, edema of left arm and red blotchy rash U kind of 7/21/2009 like hives but 7/22/2009 not raised in the left u eport (at 4 mo visit) excessive crying after 2 mo shots. Stopping breathing and eyes rolling. Paramedics Y were 5/11/2009 called, baby 5/1/2009 was not transport of thigh, development of erythema 14cm wide. U 7/20/2009 7/21/2009 veloped a debilitating headache requiring 0 days bedrest. Patient stated headache was veryYsevere. 7/22/2009 7/22/2009 poor feeding, fever to 103.5 - Given TYLENOL. Rapid recovery this AM. Y 7/22/2009 7/22/2009 d, warm to touch, red rash covering deltoid down to halfway mark of upper arm. 7/22/2009 7/24/2009 ing while receiving vaccinations, upon administering MENACTRA to PD; client became quiteYupon assessment 7/24/2009 client 7/24/2009 flaccid B/P 70/40; imm 300 client became pale, L head, wk, eyes rolled, shook 10-15 secs., SZ, laid client down - raised Y legs, P56 7/24/2009 66, B/P 102/60, 7/24/2009 1222, client ans mmediately after MENACTRA. This was the third vaccine given. Patient lied flat and recovered Y completely 7/25/2009 within 20 7/25/2009 minutes. ceived ZOSTAVAX on 7-13-2009. He reported to his family physician with shingles on 7-21-2009. U Patient 7/13/2009 did not mention 7/21/2009 a current shingle ythema around injection site L leg. Positive Y tenderness, warmth, edema. U 7/21/2009 7/23/2009 d Inflammatory Diarrhea with 24 hours of vaccine. No fever. Now has chronic Diarrhea for 8 weeks. 8/24/09 5/26/2009 Medical5/30/2009 records received DOS
t was given Hep B vaccine at his 10:15 Y AM visit. Y Began twitching of 1left leg and arm upon arriving Y at home. 7/17/2009 Parents 7/17/2009 called Rescue Squad a rythematous, slightly warm localizedYreaction to right SQ right arm. Erythema 2.5 inches in diameter. U 7/22/2009 7/23/2009 s after injection pt started with redness, Y swelling & knot at injection site. Seen in office 48 hrs Y after injection 7/21/2009 Dx'd with 7/21/2009 mild cellulitis. Pt pres on to vaccine in left deltoid approx 24-48 hrs after administration. Y 7/21/2009 7/22/2009 was reported by a pharmacist and described the occurrence of jaundice in an infant male subject U whose11/5/2008 mother was vaccinated with FLUA was reported by a healthcare professional and described the occurrence of vaccine exposure U during pregnancy 6/4/2009 in a 32-year-old female su swelled that the shot was received in; I put cold compress on 10 minutes of every hour for the Y entire day 7/22/2009 after the shot; 7/23/2009 the 2nd day, I put c hour of the shot (took place on Wed 7/22), very cranky. For next 48 hrs would not sleep more N than 40min7/22/2009 an hour 7/22/2009 at a time for naps, and njection site, lasted 4 wks(tiny nodule still present today), swelling at injection site, extremelyYcranky, unable 6/24/2009 to sleep, 6/24/2009 awoke many times du (14cm X 15cm), itchiness, tender, hot to touch, induration (6cm X 6cm), blistery beginning on 7/23/09. Treated 7/22/2009 with7/23/2009 warm packs, Keflex, & ing at injection site immedicately after administration, left upper outer arm. Within a few hours Y the site was 7/17/2009 still itching, 7/17/2009 also slightly painful a and itching at injection site at time of injection. Twenty four hours later all signs of redness & Yitching disappeared. 7/23/2009Day 7/23/2009 2 Redness and itchin post shingles vaccine, I began to feel multiple pain issues - sharp pain at bottom of buttock/top N of thigh, 12/6/2007 burning in both 5/20/2008 shins, tingling in on vomiting, abdominal pain, joint pain, Y numbness Y & tingling in hands 2 & feet, fatigue, weight loss. N Unable to 6/9/2008 eat certain6/22/2008 foods. Developed alle arre Syndrome developed Y 8 days after Y receiving Y the vaccine, resulting 203 Yin 2 months Y ventilation, N 7 months hospitalisation, ### subsequent ### hetero iefly after - body was shaking - Immunization Y in this order: (1) MENACTRA - (2) ADACEL - (3) Y GARDASIL 7/21/2009 7/22/2009 ped red lesions with itching itching 24 Y hours after immunization, lesions started an ankles legs Y then both 7/16/2009 wrists and lower face. ports,7/17/09 Pt. had redness, swelling, tingling of left arm approximately from elbow to slightly Y below shoulder, 7/16/2009 area was very hot. Pt. was d high pitched screaming and crying (unconsolable) day following immunization Y 7/20/2009 7/21/2009 TDAP 4/21/09. At 7/7/09 visit c/o achy left shoulder to fore arm with increased pain with movement U since 4/21/2009 injection. 4/21/2009 Stated when she was a spots to back, arms, chest, torso with a fever. 7/8/2009 7/16/2009 ving painful needle like pricks in nerve endings in various parts of my body. After a couple ofNdays of this,5/22/2009 the feeling5/29/2009 continued mostly in my ld, chills, achy, arm pain T 99.4. By Y7/16/09 progressive loss of strength both arms T increase Y 100.4. Saw 7/14/2009 MD 7/17/09 7/14/2009 sent pt to ER for tes perienced severe adverse reaction Y to PENTACEL given 7-17-09 left arm. Had swelling, pain, Y huge bullae 7/17/2009 which when 7/19/2009 pressed caused ves ash 4 x 4 cm surrounding injection site. Myalgias B/L posterior neck pain, ache 7/10, non radiating. Y HA developed 7/2/200912 7/3/2009 hrs post injection, reso ne was to prevent further outbreaks of shingles. I have now had two outbreaks of shingles since Y the vaccine 1/8/2009 and Dr. suggested I let your d mild fever X 2 days started 15July2009 1 day after the shot. Pt was advised to see provider,Ypt called for7/14/2009 telephone7/15/2009 consults. m X 4 cm patch of erythema posterior upper LEFT arm were varicella vacc. was given. Mild warmth Y - Tenderness 7/14/2009to 7/15/2009 palpation, no sign of inf n has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning Y a 25 year 3/1/2009 old female patient with no perti n has been received from a consumer concerning Y her 19 or 20 year0old niece with no knownNdrug reactions/allergies and no pertinent med n has been received from a registered Y nurse concerning a female patient who on an unknown U date was vaccinated IM "either with the first d with Idiopathic thrombocytopenic purpura on Y 7/24/09; platelet count 5 = 0. 8/17/09 Hospital records received 7/15/2009 DOS 7/24/09 7/23/2009 to 7/29/09. Asse all outbreak of pox with fever of 103 degrees. Y 6/22/2009 7/16/2009 d - MENACTRA - large swollen red area from shoulder to mid upper arm - felt feverish and hot Y to touch - 7/23/2009 painful. (L) 7/24/2009 deltoid - BOOSTRIX - s given 7/20/09 right deltoid; Pt states Y"later that eve" site with redness edema pn. Sxs cont'd and U increased. 7/20/2009 Pt presented 7/20/2009 to clinic 7-23-08 f ds head & hands shaking. Y 5/11/2009 5/11/2009 02 degrees F nausea, vomiting -> (severe) Y dizziness, rapid heartbeat, rash, aches/pain in legs, Y knees, ankles, 7/21/2009 weakness/ 7/21/2009 extreme fatigue. ems, sleep difficulties, physical ailments. 3/1/2003 Q given 12/17/07. 12/19/07 infant had blood flecks in stool on & off for 3 days, in about 1/2 of Y BM's. He is breast ###fed and has ### about 19 stoo immunization 9/11/08- PEDIARIX, HIB, PCV7,ROTATEQ. On 9/18/08 baby had diarrhea and Y blood in stool 9/11/2008 x 4. Day9/18/2008 before had increased (R) 2 days after immunization. Required Y ER visit. Y 7/17/2009 7/19/2009 eceived VARIVAX and TDAP and MENACTRA on 7/9/09 - developed Zoster lesions 7/11/09Y 7/9/2009 7/11/2009 ness, swelling, blanching, pain, itching, migratory pleuritic type chest pain. Y 7/22/2009 7/24/2009 n 7/20/09 - Developed, 2 days later Y a 3X3.5 cm area of light pink induration with surroundingYblanching. 5x7cm area of mod. erythema no VARIVAX #2 on 7/22/09, developedYa 2x2.5 inch, firm, erythematous, warm area at injectionYsite. (Lot# 0694Y) 7/22/2009 7/24/2009 t started hurting right away and continued to hurt over next 2 days. On the night of the 23rd.YPt began to7/21/2009 look red + 7/21/2009 felt warm. No fever. Pt c s hands shaking w/ head shaking Y 7/23/2009 7/23/2009 5 to right arm, around injection site. Warm to touch with slight edema. Y 7/24/2009 7/25/2009 emperature with diminished responsiveness within 24 hours of vaccines. Y 7/1/2009 7/1/2009 , heat, mild edema, pain Y 7/9/2009 7/9/2009 cheeks, chest, arms & legs Y Y 6/30/2009 6/30/2009
n has been received from a Nurse Practitioner Y concerning a 17 year old female with a history Y of neuro- surgery 7/22/2009 in 2001 7/22/2009 for malformation an n has been received from a registered nurse concerning a 19 year old female who on 04-APR-2007 U was vaccinated 4/4/2007 with first dose of GARD Dose 07.15.09 Throbbing behind ear. Post second dose 07.17.09 Hives all over body swollen Y hands & feet. 7/15/2009 7/17/2009 3 d"; cried for more than 3 hrs straight without sleep or feedings per mom's report. Y 3/2/2009 3/3/2009 highs BENADRYL and Aloe Vera N 2/17/2009 2/17/2009 n has been received from a registered nurse concerning a now 24 months old male Y who in October U 2008, 10/1/2008 at the age 10/1/2008 of "15 months old" wa n has been received from a registered nurse concerning a 13 year old patient who was believed U to be vaccinated with MMR II and was beli ort was received 20 July 2009 from aY consumer in the country, who is also the patient. A 50-year-old U female 7/11/2009 patient with 7/11/2009 a history of a stray n has been received from a nurse concerning Y a 22 year old female patient with penicillin Y allergy Y who on 7/13/2009 07-JAN-2009 7/13/2009 was vaccinated with n has been received from Y a physician concerning a 26 year old female with no known allergies Y or reported 1/7/2009 medical history 4/8/2009 who on 07-JANates she had fatique, weak and nausiated. Had diarrhea over the weekend following administration. Y Patient 7/13/2009 followed 7/14/2009 up with PCP 1 week a swollen, nodule, tender to touch left thigh injection site of Dtap vaccination on 7/15/09 back Y in office for reevaluation 7/15/2009 7/16/2009 on 7/17/09 and treatm after immunization, Left arm red,swollen Y and is painful and itchy. Left upper arm redness andYinduration(7cm). 7/22/2009 Slightly 7/23/2009 tender. Treatment: co HONE CALL WE MADE TO CHECK PATIENT STATUS ON 10/18/2005 PATIENT MOTHER YSTATED THAT THE ###PATIENT WAS DOING F d on 7/15/09, on 7/16/09 at 3 a.m. adolescent Y began to c/o of numbness and tingling along with Y weakness 7/15/2009 in both upper 7/16/2009 extremities elbows 4th vaccine was given (menangitis), my son almost fainted. His vision became tunnel vision and Y he said his 7/21/2009 ears felt7/21/2009 plugged...his arms wer EA OF ERYTHEMA, WARMTH, AND TENDERNESS AT THE SITE OF VACCINATION. SYMPTOMS Y WERE 7/22/2009 CONSISTENT 7/24/2009WITH CELLU IVEN TWICE U 7/24/2009 7/24/2009 esented to the ER the following dayYwith signs of malaise, joint pain, redness at injection site,Y nausea, vomitting, 7/6/2009 fever 7/8/2009 and chills of the right arm where the Varicella was administered has some edema which is approximately Y the size of 7/24/2009 a ping pong 7/25/2009 ball. The area has s oyee of the hospital received her TDaP Y (right) and Hep B (left) vaccines on 7/21/09 around 1530. Y Awoke7/21/2009 in the middle 7/22/2009 of the night with feve ted swollen lymph nodes in groin and Y neck. 7/23/2009 7/26/2009 3 inch indurated area with nodularity under the injection site approximately 3 cm by 3 cm. Very Y TTP, with7/23/2009 Rubor 7/23/2009 atient came in with 4 x 5 inch area of erythema surrounding injection site. On 7/26/09 patientUreturned 5 7/23/2009 x 5 inch, dr.7/25/2009 diagnosed cellulitis ately 30 minutes after Tdap immunization employee reported by phone that both hands wereYswelling by7/24/2009 base of thumbs. 7/24/2009 No airway involve after injection developed a welp. Within Y 48 hours arm swelled up to size of "grapefruit" per patient. See 7/23/2009 at UTC 72 hours 7/24/2009 after and given m L OVER BODY Y 8/21/2002 7/27/2009 the Shingles vaccination on May 26,Y 2009. Onset of Shingles on July 6, 2009. It was strongly U recommended 5/26/2009 that I take 7/6/2009 the shot, so I finally , hot and itchy patch or 4" to 5" diameter at the injection site Y 7/24/2009 7/25/2009 ne in series was given on 6/12/09. Patient felt light-headed after receiving Twinrix and typhoid Y injectable6/12/2009 shots. The 6/12/2009 patient rested and dra se #2 given on 7/13/09. Patient experienced another episode of light headedness and briefYsyncope (for 7/13/2009 a few seconds) 7/13/2009 within 5 minutes o perienced problems breathing deeply, had definite wheezing per her mother and then lips started Y to tingle. 7/23/2009 Mother said 7/23/2009 the event probably copal episode in the parking lot. Received Y HPV, Hep A and TDAP. Told mom that she hadYringing in the 7/23/2009 ears and 7/23/2009 felt dizzy leaving the off h ~ 2 inches in length and 1 inch in width down back of arm at injection site. Patient said thatUis appeared 7/21/2009 slightly red 7/27/2009 shortly after injection, emities became stiff immediately after receiving DTaP/IPV/MMR II/VARIVAX fainted within 2Ymins of first7/23/2009 injection lips 7/23/2009 cyanotic. No drooling red and raised Y 7/23/2009 7/25/2009 LA - redness / swelling 7/10/09 GARDASIL Y - Dizziness, light headed - almost fainted, fever X Y 48 - 72 hours 7/9/2009 7/9/2009 hives, erythema, itchy within 5 min Y of injection. BENADRYL 25 mg IM given - symptoms relieved Y within 7/23/2009 15 min of BENADRYL. 7/23/2009 t MMR #1, VARICELLA #1, DTAP#4 , PRENVAR#4 + HIB#4. after 10 minutes, mom noted redness Y ~ the 7/15/2009 night of the 7/15/2009 MMR, a few minutes er DTaP Imm. infant sleepy for 24 hrs Y with taking only few oz. of formula - Afebrile developedUerythematous 7/23/2009 rash on 7/27/2009 thigh surrounding shot , firm erythematous mild ascending Yweakness to legs & arms neck pain back pain nausea HA. Y 7/21/2009 7/22/2009 ection given on Monday. Wednesday morning noted rash to arms. Late evening it spread to Y legs. Rash is7/20/2009 red blotchy 7/22/2009 and itches. Rash on a ped enlarged left inguinal node on same Y side that vaccine was given. Y 6/22/2009 - Soreness proximal to injection site.Y 7/23/2009 7/23/2009 edema, warmth entire right upper arm urticaria over entire body. No breathing distress and fever 100.4. Y U 7/20/2009 7/21/2009 was reported by a healthcare professional and described the occurrence of cut hand in a 56-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated w was reported by a physician and described Y the occurrence of swelling injection site in a 77-year-old N female 6/23/2009 subject 6/23/2009 who was vaccinated wit ine started having severe shin pain (B), sternal painU 7/14/2009 7/15/2009 ed / or passed out after vaccination 2) Vomiting (x1) afterwards. Y 7/21/2009 7/21/2009 izure the night after immunizations given. Y Y 7/21/2009 7/21/2009
ministering vaccine patient asked to lay down for shots for fear of needles. After giving vaccines Y patient sat 7/22/2009 up looked 7/22/2009 i felt fine, stood up an minutes of administration, had syncope or possibly an akinetic seizure witnessed by MD. Collapsed, Y somewhat 7/22/2009tonic, 7/22/2009 prolonged recovery. on 7/19/09. - Acyclonir Y U ### 7/19/2009 and heat at vaccine sites. Silver dollars sized area of redness per mom @ VARIVAX site. Slight U redness,7/21/2009 hot and sore 7/22/2009 - smaller area to R I r 102 degrees F, sleepy, lethargic, diarrhea X 3 da. MOTRIN alternating with TYLENOL 9 4Y- 6 9m. 7/17/2009 7/21/2009 ated RA swelled and reddened, area measured 3"x6" with said red streak in it." Took child toYER observed 6/11/2009 + reminded 6/11/2009 to not get Varicella # accinated on Monday 7/20/09 with ADACEL by LPN. Returned Tuesday 7/22/09 with redness & swollen 7/20/2009 on the injection 7/22/2009 site. Notified docto eft forearm and trunk, Sat & Sunday itched, red vesicles Y 7/16/2009 7/17/2009 ped shingles like rash across left cheek Y of face approximately 6 days after receiving vaccine.UPt received6/30/2009 2 Rx's from7/6/2009 Dr. VALTREX and V ter GARDASIL (HPV) vaccine, awoke Y with leg pain, numbness, Tachycardia, orthopnea & nausea. Y Developed 7/16/2009 shortness 7/17/2009 of breath. Labs n rxn with redness, warmth and swelling (about the size of golf ball). We never saw rxn. Spoke Y to mom on 7/13/2009 phone. Instructed 7/14/2009her to do warm ever, fussy x 1 day. c/o swelling- symptoms began last night. U 7/21/2009 7/21/2009 d office and stated child was given immunizations in left thigh, stated leg swollen hip to knee, Y warm to touch. 7/17/2009 7/18/2009 entire upper arm) edematous, warmYto touch, Blotchy red patches- pt took BENADRYL. Y 7/21/2009 7/22/2009 . Swollen cheeks, hot and red cheeks - Peeling, itching cheeks on face. Shingles shot. Y 3/2/2009 3/4/2009 allergic to AVELOX. Developed sinus infection 2 days after vaccine administration, started 2N- pack. The 7/15/2009 next day she 7/18/2009 noticed her arm wa er ZOSTAVAX - began with low grade Y fever. 7/9 - backache & blisters on shoulder blade. Blistering Y & pain 6/29/2009 continued 7/9/2009 with blisters moving malaise began day 1 followed by fever > 102 degrees F / Headache/ myalgnas & chest discomfort Y all day7/21/2009 7-22-09 - Took 7/21/2009 Ibuprofen 600 mg rted posterior right arm, 1 1/2 inch diameter, red, hard and itchy after receiving vaccines 7-15-09. Y Onset7/15/2009 of symptoms; 7/16/2009 7/16/09. Still with s d area, long, around injection site, somewhat itchy. Y 7/1/2009 7/2/2009 2 mo vaccines at 11 AM on 7/22/09. Returned to clinic at 6:15 PM stating "(R) leg swollen &Ypainful when 7/22/2009 touched".7/22/2009 Examined by NP who a vaccines (Tdap, MMR, HEP B & A). blood drawn for lab work. Loss consciousness for 8-10Yseconds. Pt7/20/2009 pale & clammy. 7/20/2009 Pt to take deep br 1.2 B.P. elevated @ 160/98 H.R. elevated 125 skin site warm to touch, red, slightly swollen. Y 7/15/2009 7/16/2009 Left leg where vaccine was given redness on area, reaction on same day as vaccine was given, Y pt will put 7/22/2009 cold compresses 7/23/2009 for 10 min. 3-4 r 102 degrees, about 3 days. Vomited, about 11 PM. Shot was 3:00 ish. Body ws inflamed w/ U redness about 3 days, eyes sunkin in. ief (< 1 minute) syncopal episode after receiving GARDASIL. Had been given HEP A & HEP Y B prior to GARDASIL. 7/17/2009 7/17/2009 ort received on 07 July 2009 from a Y health care professional in the country. A 10 year old female Y patient received 7/7/2009ADACEL 7/7/2009 (lot number C30 n has been received from a physician who attended a program. The reporting physician stated U that during the process of the discussion an n has been received from a pharmacist concerning a 73 year old male who on 11-JUN-2009Nwas vaccinated 6/11/2009 with a 6/13/2009 first dose of ZOSTAVA KINRIX on 7/23/09, grandparent noted localized reaction 24 hrs later. Came into the office on 7/26 for unrelated 7/23/2009 issue 7/24/2009 & showed us her arm KINRIX on 7/21/09, parent noted localized reaction 24 hrs later. Called to office 7/23/09 to report that arm 7/21/2009 was red,7/22/2009 swollen, warm to touch ncing erythema, warmth, and tenderness Y at injection site - R arm where varicella vaccinationUgiven. Sx x7/13/2009 3days not 7/13/2009 improving. + varicella given wed. 7-22-09, + over Y course of the day patient presented to clinic on 7-24-09 Y with itching, 7/22/2009 swelling,7/23/2009 + redness on both del ely after shot pt felt light headed and dizzy when walking sat in chair and had a 5-10 sec longYtonic seizure, 7/27/2009 afterwards 7/27/2009 pt was hypofebrile an gan having swelling pain, bruising, Y and redness to right arm 3 days after TDAP given. Bruising Y occurred 7/2/2009 July 6. No 7/5/2009 fever. Went to MD pre on on 07/24/09. On 07/24/09 swelled. On 07/25/09 severe HA, chills, site hot, nausea, hard Y lump size 7/24/2009 of tennis ball. 7/24/2009 On 07/26/09 contin o health dept. by Dr. for yellow feverY and typhoid vaccines. Stated after receiving typhoid shot Y on 7/20/09 7/20/2009 she broke 7/20/2009 out in hives. She boo n for five days following vaccine. Patient unable to raise arm above shoulder level due to pain. U Headache 7/22/2009 not responsive 7/22/2009 to conservative m was given a Dtap instead of a Tdap. This vaccine was given in the afternoon on 7/27/09. The Y child was given the vaccine for preventative nd redness right leg dtap #5 was given and ipv #4 on right leg/ varicella mmr on left leg. vacccines N GIVEN 7/20/2009 ON: 07.20.2009 7/21/2009 pt f/u on 7.22 veloped fever, seizure, Left Y arm weakness Y the Yfollowing morning and 30 was hospitalized. MRIYshowed Right6/5/2009 Middle Cerebral 6/6/2009 artery infarct. P sh to abdomen. treatment Acycolvair, Y Valtrex Y 6/22/2009 7/16/2009 lling at site of injection on Rt. upper Yarm, lethargy, nausea , fever,body aches and pains, vomiting, Y loss of7/20/2009 appetite,headache. 7/20/2009 t to Left Arm Constant pain for over 2 weeks. Pain still there but not as intense. Patient believes nerve was hit during reciept of shot. swelling and tenderness 12x11cm on LD assessed by RN.Patient advised to place ice pack and motrin for 7/23/2009 pain. 7/25/2009 icella, MCV4, & Gardasil were completely Y administered at approximately 1:50 p.m. on 7/28/09; Y When the7/28/2009 family was7/28/2009 checking out at the cle nts mom, patient complained of Headache Y 10 mins postvaccination. Developed Bilateral armYredness, sore 7/20/2009 and warm 7/20/2009 to touch getting large injection site (left upper arm). No treatment. Y 3/2/2009 3/3/2009 allergic reaction to vaccine administration Y site approximately 10-12 hours after administration, Y impressive 7/27/2009 swelling, redness, 7/27/2009warm and pain pper extremity with ~ 4 cm area of blanching erythema with smaller area firmness palpated subcutaneously Y directly ### below.### ped systemic hives, pruritis, and throat Y numbness. Pt was seen in the ER. Y 7/27/2009 7/27/2009
t site of injection; c/o left sided facial numbness approximately 20 minutes after injection, stillUwith some numbness 7/26/2009 left 7/26/2009 upper lip and left sid elated varicella (skin rash) Y 7/13/2009 7/20/2009 fever for 2 weeks (intermittent), had fever 4 days Y before his one year 4 immunizations June 29, Y 2009. Developed 6/29/2009 petechiae (July 11) on legs Y 5/14/2009 m though no fever. Edema in handsY / feet skin all over body was sensitive to touch. Steroids N started 7/28/09 7/27/2009 and ZANTAC. 7/27/20099/1/09 PCP re iven: 7/21/09 - Fever day (1) 101.7 Y - MOTRIN q 6-8 hrs given - Child c/o soreness to arm - Headache, Y nausea, 7/20/2009 stomach 7/21/2009 aches and pain, di vomiting irritability Clingy. Y Y 7/1/2009 7/2/2009 25-09 with "mild achy". Worsened on 7/27/09 -> fever (subjective), body aches, nasal congestion U cough 7/23/2009 & chest congestion, 7/25/2009arms & legs a en instead of TD. No adverse reaction. 7/13/2009 eruption at injection site diagnosed cellulitis. U 7/22/2009 7/23/2009 ort received from a consumer on 29 March 2009 via the ACAM2000 Hotline. A male military service Y member 3/19/2009 who received 3/28/2009 smallpox vaccine was received on 05 May 2009 from a consumer/patient. A 41 year old male patient receivedNthe following 4/27/2009 vaccinations 5/2/2009 on 27 April 2009: A ions at 11:20 am on 7-27-09. FeverYof 103.5, rapid heart rate, body aches, hallucinations, rapid U speech in 7/27/2009 a high pitched 7/28/2009 voice, vomiting, an 09 I received ZOSTAVAX -Merck # 971651. No immediate side-effects except mild erythema at site. On3/20/2009 5/28/09 I had 5/28/2009 attack of severe vert ntracted Chicken Pox disease. Y U 7/14/2009 7/18/2009 les vaccine injected on 7-8-09 at 1:30 P.M, had a couple of spots on my stomach that night (thought that 7/8/2009 were bites) 7/9/2009 - Thurs A. M. (7-9-09) AX vaccine injection side effect. Approximately 3 inches in diameter red, swollen, warm, tender U area surrounding 7/21/2009 the7/22/2009 injection site on arm. S after - can't lift arm (left) - headaches - fever - aches (whole body) - nausea - mental sluggishness Y + fogginess 6/3/2009 [ A extra 6/4/2009 strength Tylenol + A st MMR/VARIVAX administration child Y developed a fever. Went to ER same day and received Y AMOX for5/21/2009 OM. 2d after 5/27/2009 ER visit developed r o lightheadedness, "feeling faint" directly after vaccination (had no c/o after 1st shot) Pt. became Y diaphoretic, 7/21/2009 pale-reclined 7/21/2009 with feet up, coo 009 right arm became swollen, red Y and warm and symptoms have progressed. Mom gave children's Y TYLENOL 7/21/2009 from7/22/2009 7/22/2009-7/24/2009. n has been received from a registered Y pharmacist Y concerning a 78 year 0 old maleYwith no pertinent Y medical 5/30/2009 history who 6/5/2009 on 30-MAY-2009 w n has been received from a physician Y concerning Y the physician's daughter 2Y with not reportedNdrug reactions/allergies 6/8/2009 and medical history wh n has been received from a nurse practitioner Y concerning a 20 year old nurse practitioner female Y (her daughter in law) with no reported dru just after 9 AM. Left office Y 930. Eyes Y itchy, throat scratchy 10-1030. She called office. Reported Y face swelling. 7/22/2009 Got to 7/22/2009 ER 1147 and treated rectal temp of 101.4 F and episodeYof going limp, Y eyes rolled back for 1 < 1 minute. Child taken Y to hospital7/15/2009 in post-ictal 7/16/2009 state, then transferred 0 minutes after receiving vaccines mom noted blanching small red macules on dorsum of feet; Y child otherwise 7/2/2009 well; given 7/2/2009 8 mg of BENADR VARIVAX #2 on 7/27/09 - erythema, Y pruritis, sl. tenderness, 4-5cm diameter elevated area. Y 7/27/2009 7/28/2009 three weeks of moderately severe diarrhea (occult blood pos) after 2 month vaccines. Y 4/22/2009 5/1/2009 waiting area after administration of Hepatitis Y A vaccine. Vasovagal syncopal episode with tonic/clonic Y movement 7/16/2009 x 10 seconds at approx. 3 d fainting episode shortly after the shot. Y She fell and hit her R shoulder and R ear--she was Y placed lying7/27/2009 down on exam 7/27/2009 table. Given water physical this year 7/22/07, Uncle and patient reported that 1 week after her first HPV VaccineYwas administered 7/21/2008 on 7/21/08, 7/28/2008 she began havi ports she noted large red warm induration measuring 10 cm across left deltoid at the injection U site and temperature 7/27/2009 7/28/2009 of 100.8 degrees Fahre ceived Varivax on 7/27/09. Mother called the office the next afternoon stating that were the child Y received 7/27/2009 the injection 7/28/2009 was raised and abo eption. 8/24/09 Hospital records received DOS Y7/21/09 to 7/24/09 Assessment: 3 Dehydration,Yviral gastroenteritis. 7/6/2009Ileocolic 7/21/2009 intussusception. ceived 2nd Varivax on 7/27/09. Within a 24 hour period the injection site became red and swollen Y to the7/27/2009 size of approximately 7/28/2009 a half dollar. MA, WARMTH AND TENDERNESS SURROUNDING INJECTION SITE, STARTING DATE OF Y VACCINATION. 7/27/2009 7/27/2009 oke up with several large and swollen Y bruises as Y well as smaller bruises 3 on parts of her body:Y her right foot, 6/29/2009 left and right shins, right flank, c ess without ill contacts, GI symptoms. 3 cm circular erythematous patch with slight papulovesicular Y surface 7/16/2009 at/near7/26/2009 varucekka vaccune sig ceived vaccine at pharmacy with no side effect/reaction even after 30 minutes post administration. U Mild 7/25/2009 skin reaction 7/26/2009 (approx 1.5 inches x 1 HPV #3 on 7/22/09. About 1 week later Y developed swelling of lateral part of lower lip. No skin U rashes 7/22/2009 7/28/2009 (0561Y/4131x)administered on Tuesday, 7/21/09 to LA without incident. Pt. called office on U 7/27/09 reporting 7/21/2009 sore & 7/25/2009 swollen Lt shoulder jo minutes following meningococcal immunization, client had syncopal episode with mild seizure Y activity for 7/22/2009 a few moments. 7/22/2009 Recovered with to the school to lift weights the nextYday after receiving the Tdap vaccine. His eye started swelling Y shut, his 7/23/2009 lips got swollen. 7/24/2009 He was wheez ea of swelling, hard, red, hot to touch at injection site. First appeared within 24 hours of injection. Y Course 7/23/2009 of 4 days.7/24/2009 Treated with ice packs Y 3/5/2009 3/6/2009 WAS ADMINISTERED A SECOND DOSE OF ROTOTEQ AT 11 MONTHS OF AGE U 7/29/2009 WAS GIVEN SECOND DOSE OF ROTOTEQ AT 11 MONTHS OF AGE U 7/29/2009 - silver dollar size - at administration site 2 days after shot which went down after a few moreNdays, then 7/21/2009 7 days after7/23/2009 shot patient woke up s sized rash and swelling at injection site. Patient was told to report back if it hasn't improved Uin one week. 7/21/2009 7/23/2009 evere pain in arm from shoulder to wrist. Mostly centered at elbow with swelling of site of injection, N elbow7/22/2009 and wrist. Raised 7/24/2009 bump at injection
.9, chills, body aches, mild headacheY started 10:30pm. on 7/28/2009. Called Dr. at 11:15pm. U Gave motrin 7/28/2009 and tylenol 7/28/2009 overnight. Hives -st dministered day 0, 1000. Low fever and headache, beginning day 1 1600 lasting through day Y 2 2200. Treated 7/27/2009 with NSAIDs. 7/28/2009Skin sloughing zure (new onset) 19 AprY2009. AfterYextensive Y work-up there is no indication 3 for an underlying U cause. Pt concerned ### 4/19/2009 that seizure developed was reported by a healthcare professional Y and described the occurrence of passed out in a Y 16-year-old 7/14/2009 male subject 7/14/2009 who was vaccinated B was reported by a healthcare professional Y and described the occurrence of passed out in a U 10-year-old 7/23/2009 female subject 7/23/2009 who was vaccinated was reported by a healthcare professional and described the occurrence of passed out or vomiting U in approximately 7 to 8 subjects of unsp d vaccine - at above clinic on 7/9/09Y- - 7/20/09 start with H/A sore throat - - to high fever - around U 102. Rash 7/9/2009 - to blister 7/20/2009 covering body. 9 presented with rash on face then spread to entire body. Had a high temp 7/25/09 seen at E. R. 7/21/2009 7/25/2009 t dizzy, 30-60 minutes after school while out shopping. Felt unsteady, mother gave her OTCYprevacid, Gatorade 5/11/2009 and 5/11/2009 sugar. She denies be at site with swelling and skin was hot to the touch pt also had a fever of 99.8. U 7/27/2009 7/28/2009 high swollen and erythematous - no Y c/o pain and able to ambulate without difficulty. Y 7/24/2009 7/25/2009 ed back to clinic after receiving vaccines with bilateral swelling in eyes. Y 7/29/2009 7/29/2009 R vastus lateralis Y U 7/28/2009 7/29/2009 ceived HPV vaccine (3rd dose) in series on 7/22/09. A few minutes after receiving vaccine she Y felt dizzy 7/22/2009 and drop in7/22/2009 BP to 81/46 from 106/7 r injection #1 Gardasil. 1 1/2 hr after given vaccine- hives developed- pt has hlo hives and they Y did resolve 6/22/2009 after 2 6/22/2009 doses of Benadryl. inistering vaccines listed below, patient continued to sit in chair and after approximately 2 minutes Y patient7/28/2009 stated she7/28/2009 felt dizzy. After about ds after immunizations administered child became unconscious and fell back on the exam bed. Y Her respirations 7/29/2009 were 7/29/2009 22/sec HR was 88 BP swollen area (approx 31/2"0 left thigh. Pt. was advised to continue cold pack and BENADRYL. If condition 7/17/2009 worsens to 7/18/2009 to E.R. ports that he spent Sat. night 7/25/09 Y (afebrile) with gmo. No rash noted Sat. night but Sun. AM Y (9:00AM) 7/23/2009 child woke7/26/2009 up with red "bumps" o ayed 3 days after 2nd dose and 6 days after 3rd dose. Parent requested this be reported. Y 7/16/2009 .7, febrile seizure, eyes running. Y Y 7/23/2009 7/23/2009 m, rash, redness & from prior area irritates her. Y 7/21/2009 7/24/2009 posterior area red; very swollen warm to touch, very tender to touch, some pain with movement. Y 7/27/2009 7/28/2009 d 7/24/09. 7/25/09 evening (5pm) started Y w/ shortness of breath, chest tightness, palpitations. Y Went to 7/24/2009 ER on Sunday 7/25/2009 7/26/09 around 9:30 legs - Bumpy rash with fever vaccines given 7/27/09 reaction 7/28/09. 7/27/2009 7/28/2009 n has been received from a physician Y concerning a female who was vaccinated with Y a dose Nof ZOSTAVAX 9/25/2007 (Merck).10/4/2008 On an unknown date, n has been received from a registered nurse who was also the patient's mother concerning aY 44 day old3/25/2009 male patient 3/26/2009 who on 25-MAR-2009 007 couldn't walk right - Ytook him toYER they admitted Y him to hospital 240 at that time.Yhis condition N kept getting 3/16/2007 worse - 5/26/2007 May 28, 07 he went Co iving the new shingles vaccine, ZOSTAVAX, I had an outbreak of herpes, type 1. I had not had an incident 7/15/2009 of an outbreak 7/20/2009 of herpes, type 1
e fever, muscle aches, site erythema and tenderness, increase resp mucus. Pos - vax adverse Y reaction, 7/23/2009 pos mild URI 7/23/2009 and premenstrual con d rash on neck, legs, arms "looks like chicken pox!" Y 7/16/2009 7/19/2009 ed, warm 31/2X4cm area on Rt. upper Y arm, where DTaP was given. 7/20/2009 7/21/2009 ed, hot, tender to touch. Left upper arm. Y Y 7/24/2009 7/25/2009 welling at injection site day after cellulitis. 8/10/09 Y ER records received 2 DOS 7/25/09. Assessment: U Cellulitis 7/24/2009 surrounding 7/25/2009 injection site. Patie ure 102 - 103 x 2 days 4 hours after vaccine. Crying non stop x 4 day. Talked to PediatricianYDr. Continued 5/13/2009 TYLENOL, 5/13/2009 no office visit. Pedia d some chest discomfort on the night Y of the 20th Y and thought it was only indigestion. Went toY bed and woke 7/10/2009 up a few 7/20/2009 hrs later with severe c s after immunizations, pt. developedYa vomiting episode. He became very pale and his breathing Y slowed.7/15/2009 He passed7/15/2009 out. Mom called an am RIX on 7/22/09 in left upper arm. On 7/24/09 came into office with redness on left upper arm. U Warm to touch. 7/22/2009 7/24/2009 veloped an unexplainedYon 07-20-09, Y followedYby a generalized seizure 3 and respiratory failure Y & RUL collapse. 7/7/2009 Baby 7/20/2009 was mechanically ve ain felt sick on Sat. and Sun. Mon woke Y up with cluster of blisters on hands + feet. Tues. Chicken Y pox started. 6/24/2009 Legs,6/27/2009 arm, back, saw dermat ld was given pediatric HEPATITIS A vaccine. Y 7/24/2009 fainted - ice pack, counseling Y 7/27/2009 7/27/2009 er receiving vaccine, while sitting on table she became ashes in color, used ammonia inhaler Y but she passed 7/24/2009 out to7/24/2009 lying down position on eloped to the medical area of left deltoid. Began this am area is the size of 1/2 dollar, warm to touch. Painful. 7/23/2009 No swelling. 7/24/2009 Will treat with BE ther reports that approx. 13 hours after Y receiving Y vaccines that the patient 1 developed a feverYof 105. She 7/27/2009 was evaluated 7/27/2009 by the ER, No tre rm: (cm) 11x9 erythematous slight raised Y macule. Y 7/22/2009 7/24/2009 dministered to upper L arm on 7-16-09 area 7" X 5". Became hot, dark red, swollen with 1 pustule U in center. 7/16/2009 Pain level 7/16/2009 7 by evening of 7-1 s given a TDAP and should have received DTPLAP. Y 7/27/2009 eived VARIVAX 17 days after MMR and the interval should have been 28 days. Y 7/6/2009 lips and tongue Dr. prescribed Mycostatin Y (7/14) 2ml 4x day. He is improving. (never had thrush before!)7/8/2009 7/10/2009
was recieving a routine series of vaccinations while on a military deployment. A corpsman administered Y a7/25/2009 0.5 cc dose of anthrax vaccine, bu sting thirty seconds, followed by unresponsiveness Y lasting for thirty seconds. He was also hypotensive Y for 7/29/2009 about five 7/29/2009 minutes. He was trea RETURNED TO ADULT CLINIC FOR PPD READ ON 7/30/09 (IMPLANTED ON 7/28/09) WITH N C/O OF ROUND 7/15/2009 MACULAR 7/18/2009PAPULAR RA swelling, itching, hardness U 7/27/2009 7/28/2009 ely following administration of vaccines, client became pale, hot, and dizzy. BP 74/40. Had client Y place head 7/24/2009 between 7/24/2009 knees, cold pack app ite pain to the point where he refuses to walk or move at all without being held. He wouldn'tUeven sleep 7/29/2009 by himself, 7/29/2009 he had to sleep on my or Gardisil #3. Layed down before shot administered to right arm. After 5 mins patient experienced Y syncope 7/27/2009 episode7/27/2009 while laying on table. F cedived vaccines. While patient was leaving the building she fainted. Patient quickly awakened, Y but was7/21/2009 confused 7/21/2009 for a short time. Patien cieved DTaP, MMR, IPV in the left deltoid on 7/28/09 and developed redness, swelling and tenderness U from 7/28/2009 the AC7/29/2009 joint to the area just pro o knee pain x 1 week then went to ER Y and dx w/ ataxia at Medical Center. Seen by Peds ID.U 6/19/2009 7/22/2009 yncope x 2 events. Syncopal events separated by ~5 minutes. Pt. complained of severe dizziness Y for ~40 7/27/2009 minutes 7/27/2009 after immunizations. was given Tdap by me (MN, RN) on 07/22/2009. At the time of vaccine administration, I did not realize 7/22/2009 that he was beyond the age recom ceived her 2nd Varivax on 7/27/09. Mother call on 7/29/09 to report that a red area the size Y of a ping pong 7/27/2009 ball had 7/28/2009 developed. Tx was for RETURNED TO CLINIC FOR PPD READ (IMPLANT ON 7/28/09) WITH C/O OF LDT PAINFUL N SWOLLEN 7/28/2009 MESURING 7/30/2009 50MM DIAMETER; RECEIVED VZV ON 7-21-09 AND Y DISCOVERED SHE WAS PREGNANT ON 7-30-09. U 7/21/2009 7/30/2009 ECEIVING MMR INJECTION ON 7/17/09, Y PT DEVELOPED REDNESS,SWELLING, PAIN AT U AND AROUND 7/17/2009 THE 7/24/2009 INJECTION SITE 7 DA not state on the screening tool that she was asthmatic was immunized with Zoster and Pneuomococcal Y 7/30/2009 -23 and left7/30/2009 the clinic for about five d wheezing, swelling of lips, albuterol Y nebs, epinephrine 1:1000 0.15 cc, and decadron 6 mgYIM given, patient 7/20/2009 transported 7/20/2009 to hospital in sta area of erythema of about 37mm presented Y with in 15 min of administration. Three seperate U raised areas 7/16/2009 were noted 7/18/2009 with in the area of e 8 hours later right leg itching, burning and pain U 7/29/2009 7/29/2009 M SWOLLEN, REDDNESS AND COPLAINS OF PAIN. PATIENT WAS TREATED WITH ANTIBIOTICS U 7/27/2009 CLINDAYCIN 7/28/2009 150 MG. ported to our facility on 4/6/09 that she has been experiencing pain to Right Upper ExtremityNsince Zostavax 1/30/2009 injection4/6/2009 given on 1/30/09. Pat ministered Tdap and Menactra in left deltoid with separate syringes on 7/29/09 without apparent U difficulty. 7/29/2009 Pt returned 7/29/2009 to Clinic on 7/30/09 D PHONE CALL FROM PATIENT. PATIENT COMPLAINED OF FEVER AND NAUSEA 6 DAYS Y AFTER7/22/2009 VACCINATION. 7/30/2009 PT ALSO, COMP ent into his Primary Care Physician the Y day after the vaccines were adminstered when the Nurse Y Practioner 7/27/2009 was told7/28/2009 by the parent about th eaction,cellulitis L arm, pt. treated with Keflex Y 7/28/2009 7/28/2009 02.7, extreme weakness to the point Y of barely being able to walk or talk. Extreme Swelling & U pain on a scale 7/23/2009 1-10 at 7/24/2009 10 on the arm of the i minutes of administration pt has itching of faceYand neck and dry cough. 1 Whelps on body with Y hive reaction 7/29/2009 (2 on neck 7/29/2009 and 4 on body) Give ve vesicular eruptions on trunk and abdomen. Y 7/23/2009 7/30/2009 len, itchy, hot to touch. Lt deltoid. 7/30 only minimal tenderness, no itch. Y 7/21/2009 7/22/2009 ness, raised semi solid knot X 1 week. Area 10mm rechecked 7/30/09. Much improved LE pain Y 7/22/2009 7/23/2009 al nodule, pain L axilla x 3-4 days. 7/30 no edema, no redness, slight tender when palpated. Y 7/21/2009 7/22/2009 o doctors office on 7/25/09 with a 2 inch X 2 inch area of red, raised and warm area @ site ofY VARICELLA 7/23/2009 vaccine -7/24/2009 posterior upper right ar fter injection, chronic urticaria. For date... one year, 8 mo. N 11/6/2007 ### , began to become red/swollen. Slight itch, 2 1/2 round swollen area. Y 7/28/2009 aised red area. Pt treated with Diphenhydramine 25mg Hydrocortisone 1% cream. Y 7/23/2009 RA given from Lot #U2867AA Exp 3-5-10. Doctor notified no new orders. Local Health Dept staff Y notified.7/27/2009 Follow up call made to parent at 1 most fainted. Y 7/29/2009 7/29/2009 ine given, no adverse events but patient returned for 2nd injection & said was pregnant when Y got 1st dose 4/22/2009 upper chest. BENADRYL a few times Y 7/22/2009 7/23/2009 given on 07/23/09 at clinic - Pt was seen in office for WCC on 7/29/09 and told us about the Y reaction. Pt's 7/23/2009 (R) arm was swollen from should male, developed unexplained bruising Y over medial right forearm & right lateral elbow, paresthesia N from right 7/20/2009 elbow to7/20/2009 fingertips right hand, m swelling, warmth, tenderness onset 7-29-09 applied warm compress TYLENOL given - tenderness, Y warmth. 7/28/2009 Worsened 7/29/2009 7-30-09 gave BEN ates when client woke up 7/29/09 @ 8:30 AM, the back of her (L) arm was red with rash + swollen U the size 7/28/2009 of 1/2 dollar. 7/29/2009 Reports putting co welling and redness at injection site,Ycellulitis. The day after injection given. Y 7/22/2009 7/24/2009 oped HA approx 4 hrs after receiving a booster dose of anthrax on 7/13/09. Went to bed withY the HA and7/13/2009 woke up with 7/13/2009 the HA. No N&V or hrs after receiving his most recent AVA vaccine, SM developed a HA, unlike any other HA he's ever had.7/13/2009 On the date 7/13/2009 of his phone intervie oped redness, swelling, pain, induration at site of ANTHRAX injection. Symptoms resolved within 72 hrs.9/20/2006 Symptoms: 9/20/2006 Erythema, Edema @ ed skin color, loss of motor coordination, feeling of drunkness Y 5/12/2009 5/12/2009 9. Large local reaction lasting 2 weeks, Y sick 2 1/2 weeks with N+V, temp 99-100.8, Y terrible H/A, Y back pain. 1/14/2009 This was1/14/2009 followed by polyneural wing day my throat was swollen making it hard to speak, breath, and eat. My speech was a little Y slurred and 7/24/2009 I felt sick 7/25/2009 to my stomach. I thre
ver body x 6 days. Fever off and on.Y Treatment - Benadryl for rash / itching. Supportive careYTylenol / Motrin 7/13/2009 for fever. 7/19/2009 und injection site - size of 50 cent piece, itching of arms + lower legs for days. Arms had goose Y bumps, raised 6/30/2009 patches. 6/30/2009 It seems 3 weeks no d Tdap in Rt deltoid on 7/24/09. I received a call from his mom on 7/27/09 stating that over the Y weekend7/24/2009 around the7/25/2009 inj. site it became red, 7/14/2009 ess and slight swelling on both arms (deltoid area). U 7/23/2009 veloped multiple pruritic erythematous 1-2mm papules on (R) lateral thigh 1 day after immunizations. Y Seen 6/12/2009 by MD and 6/13/2009 prescribed hydrocor d female became dizzy and fainted Yafter administering GARDASIL vaccine was taken to theYhospital where 7/14/2009 she got7/14/2009 staples on her head. tous Edematous and firm area on left upper arm from shoulder to lower 1/3 of humerus, warm U to touch. 7/28/2009 7/29/2009 , warm sore area on Lt. deltoid (upper arm). Swollen, tender. Y 7/17/2009 7/18/2009 omiting, dizziness. Y 7/24/2009 7/24/2009 L) arm 6 d ago. Next AM noted disc (L) axillary this AM with discomfort about medical episode/ U (L) elbow.4/14/2009 No erythema 4/19/2009 - No fever - No syste on neck and legs. Y 7/23/2009 7/26/2009 Y N n to have fever 8 days after - Imm ofYMMR II fever was 104.5 rectal - irritable Y 7/15/2009 7/23/2009 N and redness from elbow to shoulder of arm in which vaccines were administered; DTaP and PCV7 Y were administered 7/22/2009 7/23/2009 to left deltoid which is 8, redness at the site of immunization shot given anterolateral thigh. Y 7/20/2009 7/21/2009 er - 7/25/09 A.M. had fever 101 withYjerky movements in sleep, breathing labored. Clenched Y teeth when trying 7/24/2009 to give 7/25/2009 TYLENOL, crying, eye n has been received from a medical assistant concerning a female patient who was vaccinated N with GARDASIL (vaccination date, dose nu circle where vaccine was given. Severe itching. U 7/29/2009 7/31/2009 9 PATIENT RCD VARICELLA IMMUNIZATION. Y 24 HOURS LATER HE BEGAN TO BREAKU OUT IN A 7/20/2009 RASH. AFTER 7/21/2009 7 DAYS OF NOT C pain, lack of back range motion; treatment, Y PT which didn't work; seeking further medical treatment. Y Have had### this pain since ### Dec. 2008 low grade fever yesterday, but it has gone up since then. Fever is now about 102. Has been U on Motrin,7/29/2009 but fever went 7/30/2009 up even on the Mot 09 patient was brought in my mother with lower extremities on left thigh with palpable mass with U 1.5 cm erythema 7/27/2009on7/28/2009 the higher injection sit dministered Varicella vaccine to left arm subcutaneous on 7/28/2009, without adverse event.UClt returned 7/28/2009 to facility on 7/29/2009 7/29/2009 with onse ccured 7-30-09. After administration of HPV and Varicella vaccine,client was escorted to a chair Y to be obserbed 7/30/2009 for 7/30/2009 15 min. While seated in linic for kindergarten immunizationsYwith DTAP #5 administered to right deltoid. Mother reports Y no symptoms 7/7/2009 or complaints 7/9/2009 to site till 2 day given 7/22/09. Child developed erythemic, Y annular rash day after shots were given, 7/23/09.YMother reports 7/22/2009 child had 7/23/2009 low-grade fever. Exac AL RASH, AS WELL AS RASH ONYLEGS, & WAIST - DESCRIBED AS A ALLERGIC REACTION. Y NO BRUISING 7/23/2009 OR 7/23/2009 PAIN, JUST ITCHIN ceived hpv vaccine on 7/29/09 on right Y arm. Reaction on 7/30/09 about 24 hours after vaccine U was administered. 7/29/2009 Area 7/30/2009 has swelling, is red in hives all over her body around 7:45pm Y the day of the shot given..about 4 hours after...took N patient to ER 7/30/2009 around 7/30/2009 9:15 pm due to being a ceived Gardasil immunization at approximately 12:15 pm. Stayed at doctor's office for 20 minutes Y following 7/31/2009 the immunization. 7/31/2009 At approxima the injections in my left arm and hadY symptoms for over 3 months after the injection. I could Y not lift my left 1/10/2009 arm above 1/10/2009 my shoulder, had num swelling, warm to touch, pain at leftYupper arm. Ice put on site, tylenol, mortin.Pt seen in office U told to do7/29/2009 warm compress, 7/30/2009 benadryl and call ythema muscle hot to touch x 2 days after vaccine injection. U 7/27/2009 7/28/2009 ately 5-10 minutes after injection, pt.Yfelt weak, faint, had syncopal episode in car in parking lot. Y Returned7/31/2009 to exam room 7/31/2009 and monitored for > Y Y 2 Y 7/24/2009 7/30/2009 pular rash erupted 6/17/09 after receiving varicella vaccination on 5/29/09. No fever. All areas Y crusted over 5/29/2009 by 6/25/09. 6/18/2009 me down with Varicella 8 days afterYreceiving Varivax. U 7/23/2009 7/30/2009 after vaccination pt noticed that area around vaccination site became red, swollen, hard and Y itchy. This spread 7/16/2009 down 7/17/2009 her arm to her wrist a d not have any initial problems following Y vaccine administration. Two days following the vaccine U administration 7/28/2009 patient 7/30/2009 presented to pharma ceived 12 mo vaccinations on 7/20/2009, Y at site of vaccine patient with 4 cm area of erythema, U induration, 7/20/2009 pain, and7/21/2009 warmth on right upper ven the following injections: Adacel (Tdap), Gardasil (HPV), and Hep B. She c/o's feeling suddenly Y light-headed/dizzy/nauseated. 7/31/2009 7/31/2009 She was RM HAS A 13CM RED IRRIATION & SWOLLEN. 4CM HAS WATER BUBBLES & DRAINAGE U CLEAR. CENTER 7/29/2009OF 7/30/2009 BUMP MEASURES 1 THER STATED THAT ABOUT 24HRS AFTER ADMINISTRATION OF VACCINE, SHE NOTICED Y REDNESS 7/30/2009 AND SWELLING 7/31/2009 AT VACCIN mesis (x7) 24 - 30 hours following DPT. Y Unclear if could have been unrelated event such as Y gastroenteritis. 7/29/2009 Partner not ill. Patient fully r day after vaccines given, pt's mother reported high fever and talking to herself as if delirious Y for approx 57/24/2009 hours. Called 7/25/2009 on call physician, b ld male had had upper extremity Y movements Y 2-3 Y wks prior. He received 2 vaccines 7-21-09 inYAM. He had7/21/2009 a generalized 7/22/2009 seizure 16-20 hrs a given at 2:40 pm. 2 hives right ant thigh at 2:44 pm - Gave 3/4 tsp. BENADRYL. Hives resolved Y - never reoccurred. 7/22/2009 7/22/2009 o clinic 2 days after receiving MMR, area with erythema, swelling, warmth, and tender to palpation. U Pt diagnosed 7/20/2009 with 7/22/2009 cellulitis, treated with 7/28/2009 7/29/2009
r 2 sec. - Paleness in face * Treatment -> lay down with elevated legs Y 7/20/2009 eadaches evening of vaccine, emesis (4) next day, fatigue + malaise, normal exam. U 7/30/2009 7/30/2009 d golf ball size swelling at site, tenderness X8 days. Evaluated 7/31/09 unremarkable, no pain, Y no redness, 7/21/2009 no swelling. 7/22/2009 given 29JUL2009. Mom reported swelling/redness at bilateral deltoid areas AM of 31JUL09.URt deltoid area 7/30/2009 worse. Pt. 7/31/2009 evaluated by Dr. and ved her vaccines 1 week ago, 7/22. YHas been seen now 3 times for sx's fatigue, fever, nausea, headaches, 7/22/2009 swollen7/23/2009 glands, body aches an d shot on Wed 7/29/9. On Thurs. called to say redness, swelling & itching at injection site. Counseled U on7/29/2009 proper procedure 7/30/2009 (BENADRYL/TY accine admin after approp. screening. Y 7-29-09 Pt. arm sore. Red & warm to touch. Minimal swelling. Y 7-30-09 7/28/2009 Called7/29/2009 HD. Arms swelling. En and headache. U 7/22/2009 7/22/2009 oday for TBST reading C0838. Nurse noted that pt's (L) deltoid area 2 1/4" x 2 1/2" slightly firm U swelling reddened 7/28/2009 areas 7/28/2009 with injection site n ted to clinic 2 days after injection. Site red, swollen and hot. Pt was diagnosed with cellulitis and U given KEFLEX 7/29/2009 500mg 7/31/2009 QID x ten days. nt received a 1st Hep-B vaccine on 8/1/2009 10am without any difficulty at the time however,Uthe patient reported 8/1/2009N/V, 8/1/2009 abnormal pain with b starting - few hours after vaccination. Persisted for 2 wks. Evaluated by EMT. Y ter vaccination of HAVRIX #1 c/o dizziness, weakness - GI distress - cold, clammy, B/P 80/60 Y P. 60 R. 28, 7/31/2009 administered 7/31/2009 epi 0.5 ml + 50 mg s at 10:30. Fell asleep, woke approx 3am screaming and crying, face looked like a balloon, very Y irritable,7/29/2009 screamed7/30/2009 at the touch of the shot d VZV and Hep A immunizations on 07/29/09. Mom called to office on 07/31/09 stating had Y swelling at injection 7/29/2009 site.7/30/2009 Pt brought into office a was reported by a healthcare professional and described the occurrence of adverse reactionUin a subject of unspecified age and gender wh was reported by a healthcare professional via sales representative and described the occurrence Y of injection 7/1/2009 site reaction 7/3/2009 in a 5-year-old m was reported by a healthcare professional via sales representative and described the occurrence Y of injection 6/9/2009 site reaction 6/11/2009 in a 5-year-old fe was reported by a healthcare professional Y via sales representative and described the occurrence Y of injection 5/21/2009 site reaction 5/23/2009 in a 5-year-old m was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a physician via sales representatives and described the occurrence of injection U site reaction in a subject of unspecified ag was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a physician via sales representative and described the occurrence of injection U site reaction in a subject of unspecified age was reported by a healthcare professional Y and described the occurrence of swelling injection N site in a 5-year-old 7/20/2009male 7/20/2009 subject who was vac was reported by a physician, via a GSK representative and described the occurrence of fever U in a subject of unspecified age and gender w hours of receiving vaccine developed low grade fever 100. Cold like symptoms runny, stuffyUnose. 72 hrs7/28/2009 began dry7/30/2009 cough. mark at injection site U 7/28/2009 7/30/2009 ped large area of firmness, pain andYswelling of left arm and shoulder 1 days after receiving vaccines U 7/31/2009 8/1/2009 urs, Jonah became lethargic, sickly, pale, fever. After the fever subsided 4 days later, Y my son N was then displaying 7/3/2008 autistic 7/3/2008 symptoms like lo gardasil shot on 03/27/08 my symptoms Y included: Pain in my arm, dizziness, acute pharyngitis, N sore joints 3/27/2008 and mucles. 3/27/2008 After my 2nd Garda Y 7/28/2009 7/28/2009 d-low eye contact, unresponsive to name being called, head-banging, stims like arm Y flapping, U lining up objects, 6/29/2006 inappropriate 6/30/2006play with toys mergency room, transferred Y 60 miles Y to ICU in Y a bigger hospital. 3 days 4 in ICU, 7 units of blood Y given in transfusion. ### Total ### 4 days in hospita welling on 7/24/09 - site of 2 immunizations andYa bug bite, swelling 2increased became hard Y and hot to touch 7/23/2009 called 7/24/2009 PMD on 7/26. Went to E eption, diarrhea, vomiting, dehydration. 8/17/09YHospital records received 1 DOS 7/30/09 - 7/31/09. U Assessment: 7/24/2009 Ileocolic 7/30/2009 intussusception. P d out, 1 day laid back on table shook and sat up direct. Pt. was laid back. Dr notified Dr. visited Y with pt and 7/31/2009 pt mom was 7/31/2009 given soda and rest ately 5 minutes after being vaccinated the patient started feeling lightheaded and nauseated,Yshe then had8/3/2009 a syncopal 8/3/2009 episode. When she r ed this morning by mother - first noted Y on left thigh spreading to trunk, forearms and head getting Y more spots 7/30/2009 as day7/31/2009 goes on. Child fussy, w ng in chair while vaccines administered within 2-3 minutes, while still sitting, client rolled his eyes Y back, stiffened 7/6/2009 arms7/6/2009 and fell back in chair d fever to 101-102. Pt reported arm swollen at site of injection. Y 7/28/2009 7/29/2009 d no adverse event. Patient received VARIVAX 7-15-09 and that evening developed temp 99-100 and fine 7/15/2009 bumpy 7/15/2009 rash and she continues d left arm swelling, redness, itching below injection site around (L) bicep - Given BENADRYLU25 mg tablet 7/22/2009 every 6 hrs 7/22/2009 prn and HC 1% crea id rash both legs @ immunization sites. Y U 7/23/2009 7/26/2009 ing and red patch of skin bilateral thighs at injection site and swelling. Right thigh: Red areaU13 X 12 cm.7/20/2009 left thigh 10 7/22/2009 X 8.5 cm red area. degrees --> 12 hr. after vaccine administration. Emesis multiple times at night (2-8 hr later).U 7/27/2009 7/27/2009 n has been received from a Registered Nurse (R.N) Y and a Physician0 for the pregnancy registry Y for GARDASIL 3/1/2008 concerning 9/10/2008 a 17 year old fem n has been received from a registered Y nurse concerning a 16 year old female patient with a Y history of acne 7/27/2009 and no known 7/27/2009 drug allergies wh n has been received from a physician Y concerning an 82 year old male patient (180 pounds and U 67 inches), 7/14/2009 who on 14-JUL-2009 was vacci Y Y 7/15/2009 7/16/2009 d the menactra vaccine on 7-29-09.Her Y arm was very sore,on 8-1-09 at approx 6 pm she complained U of 7/29/2009 sore lymph nodes 8/1/2009 in her neck radia ately 24 hours after pneumonia vaccine, Y my husband's arm swelled significantly, became very Y red from the 7/30/2009 shoulder7/31/2009 to the elbow, and there
ch sized red/hot painful swollen area at site varicella vaccine starting on 8/1/09. Ice was applied Y intermitently 7/31/2009 and by8/1/2009 8/3/09 area was no lo accine administered to Right arm 7/16/2009. Parent noted red swollen area on right arm 07/26/2009. U To 7/16/2009 clinic 7/29/2009 7/25/2009 - area red and war Y Y 3/23/2009 3/23/2009 ter got her MMR and Varicella vaccination Y on 7/17/09 and started with symptoms on 7/26/09Nwhere she 7/17/2009 developed 7/26/2009 a rash with raised bump Y Y 6/30/2009 ed local health department on 7/31/09 and reported that after she received the Td booster onY 7/28, she left 7/28/2009 the clinic7/28/2009 and when she arrived lation with the following skin reactions: blanching Y erythroderma on 10 back and chest that is drying U and flaking 7/22/2009 with extension 8/1/2009 in a lacey fashio occurred 5 minutes after immunizations. C/O nausea, dizziness. B/P 138/60. Pulse 88. Oxygen Y saturation8/3/2009 96% room8/3/2009 air. veloped a 4 inch are of redness and inflammation on her right arm (site of administration). The U vaccine 7/31/2009 was administered 8/2/2009 on Friday 7-31, t episode occurred 2 minutes after immunization. Assited to supine position with legs elevated. Y B/P 84/60. HR 8/3/2009 64. Oxygen 8/3/2009 saturation 98%. C re with mother for ppd reading,mother showed Left arm,noticed tenderness,redness and swelling Y on LD.mother 7/30/2009 advised 8/1/2009 to place ice pack a wo after his vaccination for shingles my father began experiencing periods of dizziness and vertigo Y when7/28/2009 he stood from 7/30/2009 a sitting position or veloped hives after second Hep A vaccination. Y The patient was treated in our office with RxYfor Benadryl. 7/24/2009 7/24/2009 THER REPORTS CT VOMITING 4 HOURS AFTER RECEIVING VACCINE ON 7/31/09 FOLLOWED Y BY7/31/2009 REDNESS,7/31/2009 SWELLING, FEVER ( mplained of jaw pain, dizziness and nausea with emesis X's 1 of bile looking substance. Patient Y also complained 7/29/2009of7/29/2009 sweating, heart poundi a rash on arms and joint pain in wrists and knee. U 7/20/2009 8/1/2009 veloped a large red and swollen area at the vaccination site approximately 4" x 7" in size U 7/28/2009 7/28/2009 f imm. (07/23)developed redness, soreness and swelling right arm from elbow to shoulder. Worsened Y the 7/27/2009 next day7/27/2009 (07/24) and also c/o fee ports no known drug allergies. patient called on 8/3/09 to report the following effects following Y vaccination: 7/31/2009 raises whelps 8/1/2009 & itching at the ad ports no drug allergies. patient called on 8/3/09 to report the following side effects after administration Y of 7/27/2009 vaccine: raised 7/28/2009 whelps and itching ped cellulitis in his right upper arm the Y day after receiving 4 year old vaccinations. He was treated Y with antibiotics. 7/31/2009 8/1/2009 after administration of Vaccine Y 1/7/09, Y Patient Y was discharged and14 upon Y arriving at home became Y incoherent 1/5/2009 and unresponsive 1/7/2009 to verbal c to Dr. Lee's report, "VACCINE REACTION: Within 10 minutes of receiving vaccines, patientYdeveloped erythematous 8/1/2009 8/1/2009 macules and patche very shortly after injection. Fell forward Y off table & broke her nose. 7/23/2009 7/23/2009 orso told to leave t-call with PCM. Y 7/13/2009 7/13/2009 min after injections, became pale, nauseated, dizzy, + felt "hot". Vital signs stable. After 15" Y up to chair.7/28/2009 Denied nausea 7/28/2009 or dizziness, colo s after vaccination, pt developed hives on (R) wrist, and her tongue became swollen, over the Y next day; 6/26/2009 Hives spread 6/26/2009 to both arms from wr e up during the night from a really bad Y sharp pain in chest. She barely touched it and the sharp N pain would return ###same 1/1/2009 with shoulders. 7/22 ite visible. Redness is 8-9 cm below site and is irregular. Redness extends from outer to inner Y aspect of 7/28/2009 arm and ends 7/29/2009 in a hive approx 3-4 ported symptoms began in the evening the day of injection. She developed chills and fever up Y to 104 degrees 7/16/2009 that night. 7/16/2009 Swelling of arm t Y 6/23/2009 omiting, diarrhea, fever. Mom states she had same reaction after first dose Hep A. Y 7/23/2009 7/23/2009 d his 3rd AVA booster on 27 MarchY2009. Within Y 8 hours of vaccine4receipt, pt noted rhinorrhea. N He denies 3/27/2009 any itching 3/27/2009 eyes, hives or rashe d Tdap, MCV, & Varicella 7/30/09. Developed Temp 101.7 the evening of vaccines. Also c/oYskin feeling7/30/2009 sensitive at7/30/2009 injection site. Mom rep r report taken, pt. had c/o cellulitis on R. upper arm which was tender, hot to touch, itchy andYfirm to touch. 6/30/2009 Area affected 7/1/2009 was 4-5 in diamete and redness of rt arm. Tx cold compress. 1 1/2 tsp. BENADRYL. U 8/3/2009 8/3/2009 mother of client on 6/30/09. Pt received Y shots 6/29/09 and hasn't slept much - cat naps off and Y on. Can't get 6/29/2009 fever under 6/30/2009 control. Mom called Y Y 7/30/2009 arden area, 7cm x 7cm red, warm toY touch, redness has been decreasing. 7/28/2009 7/29/2009 r upper torso and fever Rash - macular, red and warm - No treatment except TYLENOL for fever. Y 7/24/2009 7/29/2009 .4 7-29-09.7-28-09- Seen in ER 103.0. Y Fever 101.9 -7-30-09 Y 7/28/2009 7/28/2009 immunization was given instead of the DTaP to a 18month old boy in error. U 8/3/2009 noted on arm same day after vaccineY administration. Patient was seen in ER on 7/31/2009 and Y was admitted 7/29/2009 at hospital 7/29/2009 for possible celluliti ceived a 4th dose of DTP when he was Y 6 years old. His mother related that he had an abscess Y and fever7/28/2009 from it and7/29/2009 was hospitalized for 2 vaccinations approx. 345pm. Approx Y 650pm baby woke up screaming, high pitched scream Yfor several hours 7/27/2009 (until 7/27/2009 approx 10pm). Nothing two welt sites one aprox. 4 cm & improving 2nd site 6 cm & warm to touch & red. with discomfort Y lasting 7/27/2009 2 days - improving 7/28/2009 with MOTRIN n on 07/31/09 for vaccines. Discussed med hx of seizures. Father stated that his son has seizures Y with stress 7/31/2009 or fevers. 7/31/2009 He stated that last throat & some mild swelling in glands and low grade fever for 24 hours. Y 7/30/2009 7/30/2009 , edema, induration at injection site Y >4 cm. No response to BENADRYL/ice. Response to AUGMENTIN. Y 7/11/2009 7/12/2009 vaccine admin 7-30-09. Family report Y that blister appeared either the next day 7-31-09 or 8-1-09. Y To Dr. 8/2/09. 7/30/2009 Dx with 7/31/2009 bacterial infection & Y 8/3/2009
Y 7/23/2009 7/25/2009 eft thigh big red welt at site size of softball & 7/31 looks smaller. Mom advised to give BENADRYL Y & to call 7/29/2009 us back7/30/2009 if redness worsens or s throat nasal congestion cough with mid epigastric pain - pain for 2 days - sore throat 2 days N - nasal congestion 7/28/2009 cough 7/29/2009 persist. give a little history on this patient. She Y was a cheerleader, majorette, and was in a weight lifting N class. She 7/14/2009 was very active 1/1/2009 and athletic. I did ool reported she was very weak - 03/09 Y leg weakness/tired 03/09 pain started. Please see attached. N Patient continuity ### 1/8/2009 codes to 353037 an Hep#2 only 4 months after HepA#1. U 7/28/2009 pain, swelling, itching, and heat radiating Y around the injection site, over the next several days U swelling and 7/31/2009 redness grew 8/1/2009 into the whole upp g fine after first after first Yshot, received Y 2nd series Y and next day went 2 to dr. from school Y complaining N of blurred 1/2/2009 vision, 3/11/2009 sick to stomach, and n has been received from a physician Y concerning Y a "6 month old" female 0 who in "July 2009",Uwas vaccinated 7/1/2009 (oral administration) 7/1/2009 with the t follow-up information has been received Y from a nurse, for GARDASIL, a Pregnancy RegistryYproduct, concerning 6/12/2008a 8/15/2008 23 year old female who n has been received from a physician Y concerning Y a female who in January 2 2009, was vaccinated N IM with the second ### 0.5ml ### dose of GARDA n has been received from a physician Y and a certified Y medical assistant, 0 for GARDASIL, a Pregnancy N Registry 5/21/2008 Product, 5/21/2008 concerning her 17 y n has been received from a 23 year old femaleYpatient with no pertinent 0 medical history and Usulfonamide11/6/2008 allergy who 11/6/2008 on 06-NOV-2008 was eption 4 mo after completing 3 doses ROTATEQ. Y 9/23/09 Medical records 2 received for date Y of service 7/22/09 2/10/2009 to 7/23/09. 7/22/2009 DX Intussuscepti was reported by a consumer and described the occurrence of autism in a 1-day-old male subject U who was 6/26/2003 vaccinated 6/26/2003 with ENGERIX B, (G arted night after vaccine. Fever lasted 16 days.YParainfluenza type 15 B sputum. Lt lower lobe pneumonia Y with 5/6/2009 positive rise 5/6/2009 in mycoplasma ant smallpox vaccination on 7/21/09. Subsequently Y Yhad blisters all over3his back and chest. He was Y taken to7/21/2009 Emergency8/2/2009 Room and admitted fo dness, itchy and painful for 1 wk. Y 7/15/2009 7/16/2009 Y 7/14/2009 7/15/2009 d swollen X 2 days; tender - Fever Y increase 101.0. - Will treat KEFLEX 500mg #30 T po tid for 10 days.7/27/2009 7/29/2009 was given IM rather than Subq. 7/27/2009 following immunization. Pt was sitting in chair during administration & fainted following 4th vaccine. Y Pt was 7/30/2009 still in chair 7/30/2009 when he fainted. P ands and feet (blisters) sores in mouth. Y Treated with ZYRTEC and BENADRYL mouth washYmixture. 7/20/2009 7/24/2009 y 09 child received 3rd HPV vaccineYin left arm. On 28 July 09 a lump was seen over injection Y area. Was7/27/2009 seen on 297/28/2009 July for a check up ag ke up on 7-11-09 and her eyes were puffy both the top + bottom lids. No itching or burning. N Eye eyes are 7/10/2009 still puffy 7/11/2009 2 wks later. ches pm. 7/7 Body aches, Temp low grade, chills. Y 7/6/2009 7/7/2009 ness, Headache, Extreme sweating, chest pain, diff. Breathing, and feeling faint. Y 7/24/2009 7/25/2009 :00 PM Mom called to report daughter's Y (R) arm was red, swollen and real sore. She also couldn't Y pick up 7/24/2009 her arm very 7/27/2009 high. Mom called ba turned to clinic after 30 min from receiving vaccines reporting an allergic reaction. Patient presented Y with7/30/2009 macular papular 7/30/2009 rash on left cheek 0 Syncope, diaphoretic with within normal vs: BP 116/76, HR:84, RR:18. Treated for Vasovagal Y symptoms 7/29/2009 and monitored 7/29/2009 vitals. after MMR/Varicella developed full blown Y TIP w/ platelets down to 4K! Referred to Hematologist. U 7/2/2009 7/22/2009 to parents woke up next day with leg Y pain then had trouble breathing - taken to hospital ERU- Dx Hyperventilation 7/23/2009 according 7/24/2009to MD. ar redness-itchy and painful to touch for 1 week. Y 7/15/2009 7/16/2009 mmunization mac/pap rash of face and neck with some swelling of face with erythema and itching. Y Resolved 1/26/2009 in 2 weeks 1/26/2009 time with Zyrtec. No dministered to pregnant female approximated 3 weeks gestation. Report LMP 5/5/09, deniedUsexual activity. 5/27/2009 EDC 2/4/10. secondary innoculation to genital area. Y Mutiple vesicles with crusting to penis. 7/16/2009 8/4/2009 w hours the injected arm upper muscles Y ached when lifting or raised. Following day flu-like symptoms Y - achy, 7/27/2009 slight fever. 7/27/2009 Next day fine...on S SHOT WAS GIVEN ON LEFT ARM, UPPER LEFT SIDE OF PATIENT'S LIP STARTED TOUSWELL.BY 8/3/2009 10 PM HIS 8/3/2009 ENTIRE UPPER LIP W ther called at 9:30am this morning reporting that the child had nausea and vomiting during the U night. She 8/3/2009 stated child8/3/2009 vomited once during esented 8/3/2009 concerned and with a larger than expected rash and warm, palpable, approximately U 2 7/30/2009 to 3 cm nodule 8/2/2009 at the area of admi after vaccine, arm had slight itching and faint redness (0.75" x 1.0" oval) where vaccine was Y administered. 7/27/2009 Itching and 7/28/2009 redness have gone a episode 2 minutes after immunizations. Fell to floor. B/P 98/64; Pulse 83; Oxygen sat 98%. YLegs elevated. 8/4/2009 Recovered 8/4/2009 without incident; d swellling and induration over the Left Y upper arm from the shoulder to mid-upper arm. Tender U to palpation. 7/30/2009 No fluctuance 8/2/2009 ately 1 week prior patient was admitted Y into theYhospital after a 2-story 2 fall that subsequentlyUrequired her 8/1/2009 to undergo 8/1/2009 a splenectomy on 7/27 ombo vaccine of Dtap/IPV. Pt contacted. No adverse s/s reported by pt. Y 8/3/2009 ately 1 month after receiving the second Y dose of Y the Gardasil vaccine 6 (manufactured Y by Merck N - I am unable 8/31/2007 to load that in### the information s eizure 2:00 a.m. the following morning. Y Went to Crestwood Hospital Emergency room for evaluationY phone 7/24/2009 256-429-5177. 7/25/2009Did not require aches and muscle cramps day after recieving anthrax. The cramping continued for 3 days after. U 7/27/2009 7/28/2009 oster Rash on trunk on the Right side in Dermatomal Distribution.Seen at clinic for rash and diagnosed N on 6/13/2009 07/29/09.As 7/26/2009 of 8/3/09 per telepho d second Hep A vaccine about 4pmYin pediatrician's Y office without immediate 1 effect. The next Y day at about 7/20/2009 6 pm (26 7/21/2009 hrs later) pt had a gen e minute after shot Kayla became dizzy. She told me numerous times that something was wrong Y and and7/31/2009 that she did 7/31/2009 not feel good. She tu
6 month shots at 11:00am. There was no food given besides formula after shots. At 18:30 rapid U rash developed 7/23/2009 over 7/23/2009 the baby. Starting on ministered at 2:30 p.m. appointment which include TD and Meningococcal. Patient felt fine going U into appointment 8/4/2009for 8/4/2009 vacines. Later at 9:00 eption 7/20/09 - symptoms Y began. Required surgical Y reduction 7/22/09. 8 8/31/09 Hospital records Y received7/9/2009 DOS 7/20/09 7/20/2009 to 7/28/09. Assess OOSTRIX given -> mild soreness/ swelling post injection Lt arm. A "few days later" developed U " electrical 6/23/2009 sensation" 6/25/2009 in arm -> Palm of han tory of seizures. Has C.P. She developed grand mal seizures the day after BOOSTRIX given. Y 7/15/2009 7/16/2009 dizzy, nausea, rash on face, neck. U 8/3/2009 8/4/2009 F x 2 days of markedly swollen (L) arm, shoulder and elbow x 4 days. C/O decreased appetite Y and lethargy 7/30/2009 x 2 days. 7/31/2009 03.1 a few hrs after getting vaccines. Given Ibuprofen by his mother. N 8/3/2009 8/3/2009 ction left upper arm 7/23-7/30/2009.YOn 7/31/09 patient developed skin lesion right ankle andUlower leg; clustered 7/23/2009vesicles 7/31/2009 in annular shape redness, swelling, tenderness at site of vaccine approx. 24 hours after receiving. Pt had slight Y itching at7/31/2009 site, redness 8/1/2009 approx. 2" across. ling "off", dizziness, red local reaction, Y tender to touch (L arm). Y 7/15/2009 7/16/2009 coughing and hives within 3 minutesYafter shot given BENADRYL PO and EPI 0.1mg given SQ. Y Began having 7/13/2009 decreased 7/13/2009 (88%) and O2 app min of receiving HPV #3 in a semi-lying Y down position she started having some tremors and passed Y out. B/P 7/31/2009 at that time 7/31/2009 was 102/59 with a arm on right side, swollen and red. U 7/29/2009 patient came to our office on 7-29-09. Y He stated that patient was given a vaccine in our officeY on 7-1-09 and 7/1/2009 he had to be taken to the emer n 2/+ pain in L elbow on 8-4-09. Pt Y relates she had pain and swelling at injection site on 7-21-09 U and now 7/20/2009 the pain and 7/21/2009 swelling at injection swelling and pain in R arm where vaccine Y was administered. Flu like symptoms w/o fever orYchills. 8/3/2009 8/3/2009 at injection site, pain at injection site, achy and Y tender to touch/hot to touch at injection site, itching/no Y fever 7/29/2009 or chills 7/30/2009 Y 7/28/2009 7/28/2009 9 MODERATE Other INDURATION 3CMX 5CM/NO CELLULITIS ssy after the vaccines were given. Y Y 8/3/2009 8/3/2009 9 MODERATE Other. FATIGUE RASH Y STARTING ON L EAR. CONTINUING TO BE ON FACE AND MIDSECTION 7/20/2009 7/23/2009 SAW PHYSICIAN ON eceived vaccinations. 7/15/09 c/o aches/pains, dizziness, H/A bruise arm. No fever went to chiropractor N 7/10/2009 3 X after last 7/15/2009 3 wks. 7/29/09 - Calle arm was slightly swollen & pink surrounding site of injection (yellow fever). C/o itching over Y body but no7/30/2009 hives (Reported 7/30/2009 7/31/09 - advised nted after administration of Tdap (ADACEL) shot. Y 8/3/2009 8/3/2009 U 7/30/2009 welts on inside portion of left upper arm, away from the injection site. U 7/27/2009 7/29/2009 tch developed and got worse not resolved Y with BENADRY tabs/cream. Unable to go to MD.U7/1/09 Dr. - 6/8/2009 evaluated.6/23/2009 7/1/09 - Itching and h vere erythema localized & developed hives. No respiratory difficulty. Y 7/22/2009 7/23/2009 d VARICELLA Disease (chicken pox) Pox to left arm, stomach & legs. rest, fluids, TYLENOL. Y 7/13/2009 7/26/2009 warm, 7 cm X 7 cm U 7/27/2009 7/29/2009 red and warm to touch. Y 7/24/2009 7/26/2009 with immediate itching and soon to follow Y redness, swelling & warmth. BENADRYL given & Ibuprofen. U Seen 7/31/2009 in office 7/31/2009 on 8/3/09 for eval. Mo parents reported increased screaming; Y fever 102 degrees with diff. reading temp.; shaking;Ytaken to Hospital 4/14/2009 Dx vaccine 4/14/2009 reaction. n has been received from the husband Y of a 63 Yyear old female with 0"heart condition" who was U vaccinated with a dose of PNEUMOVAX 23 n has been received from a registered Y nurse (R.N.), for the Pregnancy Registry for GARDASIL, Y concerning 4/28/2008 a 22 year6/5/2008 old female who was i n has been received from a consumer concerning his 25 year old god-daughter who, 4 or 5 N months ago, in 2/1/2009 approximately 2/1/2009 February 2009, w n has been received from a consumer concerning one of her co workers who was vaccinated U with a dose of GARDASIL (date, route and si n has been received from a physician concerning his 76 year old wife with Crohn's disease and N a history of 7/7/2009 pancreatitis 7/23/2009 with the use of PUR n has been received from a physician Y and a nurse Y concerning a 61 0year old male patient who U on 08-JUL-2009 7/8/2009 was 7/14/2009 vaccinated SQ with a 0 izure. 8/21/09 ERrecords received for Y DOS 7/17/09 Y with dx: Acute fever 1 and seizures recurrent. Y Generalized 7/17/2009 tonic-clonic 7/17/2009 seizures following ort was received 27 July 2009 from another Y manufacturer (reference number WAES 0906USA04755), Y who 5/11/2009 received5/11/2009 the report from a health ort received on 27 July 2009 from another Y manufacturer whose initial reporter was a consumer. U A unidentified male patient received INFLUE ort was received from another manufacturer Y (document number 45221964) who received the report from a health care professional. A fema an anthrax shot at 0830 on 01AUG09. Y As lunch time drew near, I began getting a terrible headache. Y I ate 8/1/2009 lunch and8/1/2009 the headache persist on administered in left deltoid. Left axillary pain and fever one day following vaccination. Large Y bruise developed 7/22/2009one 7/22/2008 day later. Left forear ESS OF BREATH, CHEST PRESSURE, HIVES, AND SORES Y 7/28/2009 7/28/2009 mplained of rash, redness at injection site and itchy all over. Mild rash noted on patient's chest Y as well. 7/22/2009 7/24/2009 ely after receiving vaccines patient had Y full body seizure. Did not void. Remained unconscious U over five minutes, 8/5/2009 until8/5/2009 revived with ammonia en at site of injection U 8/3/2009 8/4/2009 were given at about 1030am 8/5/09. Patient was without symptoms when she left the office. YFamily stopped 8/5/2009 at a fast 8/5/2009 food restaurant after l
vaccines on 7/13/09. Family contacted Y health department on 8/3/09 stating that child had a rash U that began 7/13/2009 early am 7/30/2009 on 8/3/09 after severa ely after Hepatitis B vaccination only on 6-30-09 dose 1 and 8-30-09 dose 2 pt was pale, dizzy Y and lightheaded. 8/3/2009 Observed 8/3/2009 patient both time blister, scab forming after U 7/30/2009 7/31/2009 s, body aches, joint pain, headaches, fatigue, overall feeling of being out of it and in a lot of pain. N So far, 7/24/2009 this has lasted 7/29/2009 12 days and is not g iving MCV4, while seated, client moved forward, passed out, slipped to the floor. Patient was Y lying prone7/31/2009 on floor, arms 7/31/2009 at sides, with jerkin e, Nausea, Vomiting, Chills, body aches, tiredness, Y difficulty breathing, 1 paleness, weakness, N dizziness, redness 8/3/2009 and tenderness 8/4/2009 at injection ought child to HD office 8/3/09 PM to report that child's arm became tender, with redness over Y deltoid spreading 7/31/2009 to just 7/31/2009 aboeve the elbow P after the vacination of Gardasil, I has Y a reaction.Y My legs swelled and 2 I had small red bumps N all over my legs. 9/9/2008 I couldn't 9/13/2008 walk because of the week, I had begun to experience severe Y left sided pain in my face. I was treated for different causes N (all wrong) 6/8/2009 when6/15/2009 finally on Aug 2nd, I w stating that 7days after vaccine was given child has "throat spasms", dizziness for 4days,right side pain 7/22/2009 in shoulder,eye,foot. 7/29/2009Also stating b ter received a DTAP vaccination on 7/31/09. She experienced significant swelling, redness,Upain, and heat 7/31/2009 at the injection 8/1/2009 site in an area a fingers feeling numb. Body hurts. Head hurts. Nausea, vomited x2. Fatigued. Lethargic. N Loss of appetite. 8/3/2009 Chest 8/4/2009 pain across top of che and pain at injection site for 3 days. Improved now. Some swelling present.Now has muscleYaches, shaking, 7/16/2009 weakness, 7/19/2009 lightheadness, and ema and warm to touch - adecel over right deltoid on 7/30 - developed erthema today morning, U slightly larger 7/30/2009 over time 8/5/2009 - 8x8 cm area of in diarrhea, fever of 102 x 2 days Y 7/27/2009 7/28/2009 edness/swelling/warmth at site starting two-three days after injection. Denies fevers, chills. Ibuprofen U relieves 7/21/2009 pain around 7/23/2009 site. Area by shot ceived Pentacel vaccine component DTaP IPV and second dose IPV during routine 4 yr-old Y immunizations. 8/5/2009 Mom was made aware of incide EEN IN EMERGENCY ROOM FOR Y FACIAL SWELLING AND WHEEZING. VACCINE APPOINTMENT Y AT8/5/2009 1:45 PM VACCINE 8/5/2009 GIVEN APRO ax administered at approx 1100. Pt called at 1500 to report severe pain in her shoulder. I examined U her on 7/29/2009 8/3/09. At 7/29/2009 that time she was una red, warm , tender, inflammed 20 cm oval around right posterior upper arm 2 days s/p injection Y with single8/3/2009 dose of "tetanus 8/5/2009 and pertussis" omach pain and weakness. Very tired and barely able to get out of bed. Kidney pain. 7/30/2009 7/30/2009 d vestibular neuritis 12 days after receiving the shingles vaccination. ### 1/11/2009 ciousness with skin pallor, abnormal extremity movement & incontinence of bladder. EpisodeYlasted approximately 7/22/2009 <30 7/22/2009 seconds. out size of baseball) Lt thigh red & hard area around injection site. Area improved over the wk. Y 6/19/2009 6/19/2009 w days of the initial vaccine, red bumps, itching & weakness in my left hand & arm occurred. Y Now, 1 year & 3/5/2008 5 months3/10/2008 later the site still is red radiation to skin years ago for mycosis fungoides, was given ZOSTAVAX in right arm -sq- 7/24/2009. U Two 7/24/2009 days later 7/26/2009 she complained of pa (PENTACEL, PREVNAR & ROTATEQ) were given on 7/28/09. Baby developed moderate fever Y (up to 102 7/28/2009 degrees)7/28/2009 & intermittent mild rash y of the vaccine was given, the patient developed chills, lightheadedness, dizziness, weakness Y and body6/30/2009 aches. She 6/30/2009 also complained of sh ven GARDASIL vaccine about 4:00 PM. At about 4:10 PM patient states throat swelling, unable Y to breath,8/4/2009 nausea. Patient 8/4/2009 out in supine po 07, SM received AVA (2), TYPHOIDY (VICPS), and TWINRIX vaccines. He recalls increasedNtenderness at vaccination ### 1/1/2008 sites lasting < 48 ho er of 102.5, left arm red, swollen and warm. U 7/24/2009 7/24/2009 s 8/4 L thigh swollen red + warm to touch,cover front of thigh + hurts to walk. U 8/3/2009 8/4/2009 ported fever, left arm pain, swelling and redness, nausea, vomiting approximately 2 days after Y vaccination 7/29/2009 with ADACEL 7/31/2009 & PNEUMOVAX. up from exam table fell forward, brushed head on wall and was caught by staff. Laid down, vitals U stable, woke up and was able to drink flui , hot, fever, blister pustules poppingY- oozing liquid. U 8/4/2009 8/4/2009 ine given mom then tells RN patientYhad the chicken pox. RN explained he may have someYreaction to vaccine 7/16/2009 and7/17/2009 if she had told RN or D ed vaccines. Mom stated pt. had seizure in car. PMC staff did not witness any seizure activity. Y Pt. walked 8/4/2009 back to bus8/4/2009 with mom. vs stable/o arm, shoulder pain, swelling and redness to vaccine site, few small blisters to area; 4 1/2 inYdiameter of7/30/2009 redness. Treatment 8/1/2009consisted of ib N 7/9/2009 8/3/2009 ash on her wrist, arm, chest and back, mostly on her right side. She got the vaccine in her leftUarm. The rash 7/24/2009 on her back: 7/30/2009 looks like chicken o upper arm fever 102 degrees-103.9 for 3 days pain in upper arm. Took TYLENOL and BENADRYL. Y 7/27/2009 7/28/2009 redness, swelling, warmth and induration noted by patient the following day after vaccination.Y Treated with 3/19/2009 KEFLEX3/20/2009 and Hydroxyzine. xis ~ 1/2 in after receipt of IPV and Y DTAP Y 8/5/2009 8/5/2009 presented to clinic at 4:05 pm stating Y began feeling tingling over all of body, difficulty speaking, chills, pain8/5/2009 to bilateral8/5/2009 hands since 3:00pm. 9 received a T booster F and first Hepatitis B vaccine- 3 days later hot red itchy urticarial rash Y - this spread 7/20/2009 from torso 7/23/2009 out to limbs. No othe ular pruritic rash around site on upper Y arm. Began the day after admin, peaked 5 days after.U 7/29/2009 7/30/2009 g weakness all over, unable to sit up Y in bed. Once on edge of bed & assisted standing legs Y would not / could 8/3/2009 not step. 8/3/2009 As if would not liste without systemic symptoms occurring 3 days after the vaccination. With intense pruritis initially. Y Begining 7/16/2009 with the shoulder 7/20/2009 then to trunk, gro 3rd, I received a shingles vaccine at the local pharmacy. Early morning, March 5, I had chills, N a fever of no 3/3/2009 more than 3/5/2009 100 and urine urgen d a reaction to VARIVAX immunization on 6/20/09 which was erythema but no induration or pain measuring 6/19/2009 12.5 x 6/21/2009 8 cm outer area and 5x given at top of left shoulder Y causing Y electric shock type jolt down left arm while needle Y was U being forced in by ### nurse. Symptoms ### progresse
ter had serious problems with her period had toYbe put on birth control, 0 and now she is in theUhospital with depression 7/30/2009 at 14 years old she n ceived Immunizations, went Y to the parking Y lot - and returned with facial swelling, vomiting, coughing, Y wheezing, 8/5/2009 SOB.8/5/2009 BENADRYL 25 mg po xis - instant hives - lip swelling, Y itching, Y throat closing, nasal congestion within 5-10 minutes of Y administration. 7/30/2009 Treatment: 7/30/2009 BENADRYL, Epin warm redness to vaccine site, swelling. 7/28/2009 7/29/2009 was received from a health care professional on Y 30 July 2009. A 72-year-old 18 male patient, with U a history4/22/2009 of codeine allergy, 5/1/2009 received an int e week of vaccination the client had a sore swollen arm and also developed hives along bothYlabias and swollen, 5/4/2009 tender 5/10/2009 inguinal lymph glan vaccines, episode of syncope followed by brief seizure 2-3 seconds. Recovered fully withoutYmeds. 7/23/2009 7/23/2009 ation, hives. Went to ER, BENADRYL, Y Steroids. Y 7/23/2009 7/23/2009 ness 103.5 Bronchiolitis possible. Y 7/22/2009 7/27/2009 d shingles 3 days after vaccination same Y side of body, different site. Treated with acyclovir. Y 7/24/2009 7/27/2009 n has been received from a MedicalYAssistant coworker concerning a 60 year old female with N a drug reaction 2/5/2009 to PERCOCET, 2/12/2009 that produce 8/1 (2 days later) with swelling erythema, tenderness & warmth at left triceps area where VARIVAX was placed. 7/30/2009 8/1 7/31/2009 Rx - PREDNISODONE n has been received from a 76 yearYold female with chronic UTI, blood pressure high, drug hypersensitivity N 3/24/2009 and penicillin 5/1/2009 allergy who on 24 n has been received from a physician Y concerning a female in her eighties who was Y vaccinated U with a dose of ZOSTAVAX (Merck) (0.65ml, n has been received from a consumer concerning her 16 year old daughter allergy Y to cinnamon N and with 8/1/2007 a history of 8/1/2007 an allergic reaction (e scle weakness, body aches, fever, soreness Y at injection site, headache and nausea reportedUby patient.7/23/2009 Onset of S/S 7/24/2009 24 hours after admin with 5 X 5 cm erythema distal to injection Y site, 0 tx at this time. U 7/29/2009 7/31/2009 ea of pruritic angioedema surrounding site of Tdap. Y 7/27/2009 7/29/2009 tigue and soreness. U 6/10/2009 t to ZOSTAVAX, bright red around injection, pain, itching, swelling, very hot, went from injection site to elbow. 7/30/2009 7/30/2009 NTACEL given (never had this combo before) and within 2-3 minutes area red & swollen, 30 X 45 mm no SOB, wheezing ice applied on & ceived 3 vaccines MENACTRA, ADACEL and VARICELLA. When she stood to leave she had Y a syncope 8/5/2009 episode and 8/5/2009 was lowered to the fl per outer arm red, warm 40 x 40 mm, slightly raised no pain, itching. 8/6/09 Area red, warm not Y raised slight 8/4/2009 itching 50 8/5/2009 x 60 mm. d, swollen and painful. Fever 102, 10cm Y circle of raised erythema, edema and warmth with central Y punctate 7/30/2009 eschar.7/31/2009 Evaluated by provider by lab confirmed rabid fox - had traveled Y out of state. Pt reported to ER in other state for tx.Y Rcvd RABAVERT 7/31/2009 #1 &8/3/2009 2 ml HRIG on 7-31-09 ction with swelling of thigh muscles. U 7/31/2009 d Hep A local erythema induration (-) (-) drainage. 7/28/2009 7/29/2009 client became nauseated and fainted aproximately 5 minutes after receiving vaccines. AfterYthe incident patient 8/5/2009 rested 8/5/2009 in the clinic for 30 m patient came by clinic at 8pm 8/5/09, patient is not with her. She reported that patient had headache Y and8/4/2009 fatigue all day 8/5/2009 requiring him to ta red a pediatric Hepatitis A to a 19 y.o. Y 8/5/2009 e up three days after vaccines were given with swelling on the forehead spreading, spreading Y over the left 7/31/2009 eyelid to left 8/3/2009 ear. Worsened a da was administered to the left arm sq. YThe child's mother called on the 14th of july and stated pt Y running fever 7/13/2009 >101. and 7/14/2009 the arm was red and e on 7/31/09 for 15 month Well Child Check and was given DTAP, HIB and Prevnar vaccinesUthat were due. 7/31/2009 Pt developed 7/31/2009 fevers on evenin rabies pre-exposure #3 on 8/5/09 atY1030. Around 1930, she had fever to 105.3 and felt chills. Y Took tylenol 8/5/2009 and cool 8/5/2009 bath. Was seen in ER ents to clinic with a 4cm x 4cm round, red, area to left upper arm, that is warm to touch. No pain U to area when 8/4/2009 touched. 8/5/2009 Informed pt to apply ceived vaccination of Tdap on 08/04/2009 Y and had local redness and swelling to left deltoid.YParent stated8/4/2009 that patient 8/4/2009 had fever ranging fro STATED AREA WHERE VARICELLA Y WAS GIVEN WAS SWOLLEN, RED AND TENDER TO TOUCH SINCE 8/4/2009 WEDNESDAY 8/5/2009 MORNING. MATELY 2 MINUTES AFTER RECEIVING IMMUNIZATION PT BE CAME WEAK AND DIZZY. Y ACCORDING 8/6/2009 TO FATHER 8/6/2009 PT "SLUMPED rash and swelling at injection site on left leg. Y 7/29/2009 7/30/2009 ame in to HD c/o side effects since vaccination. Symptoms: dizziness (7/16/09), vomitting (7/22/09), U passed 7/16/2009 out (7/23/09), 7/16/2009 hives on chest, r omitting at noon 8/4/09 and again at 8pm. Had fever 99 degress off and on 8/4/09. C/o body Y aches 8/4-8/5. 8/4/2009 Tylenol given 8/4/2009 at 12pm 8/4/09 an 8/6/2009 N 8/5/2009 hurday a.m., 7/30/09, with scatteredYred itchy rash all over body. Pt. taken to clinic and givenYa steroid shot 7/29/2009 for allergic 7/30/2009 reaction to something HER PHONED OFFICE STATED Y PT. HAD REACTION FROM VARICELLA VACCINE. INSTRUCTED U MOTHER 8/4/2009 TO RETURN 8/5/2009 TO OFFICE, ays after vaccination, rash, red cracked bleeding Y lips, bright red feet5and hands, swollen hands Y and feet,7/17/2009 blood shot 7/19/2009 eyes, crying. Fever las 08, pt went about her day as normal, Y but became very tired quite suddenly around 5:00 in the U evening. She went ###to bed to ### rest (something after Tdap, client had pain and swelling Y at injection site which increased to Baseball size red,Nhard painful 8/3/2009 area with radiating 8/4/2009pain to left sid uit on day 24 of his training was brought in for syncope. Was told he passed. States Y he has N been having6/17/2009 F/C, night 6/28/2009 sweats, coughing up blo Pneumovax 23) was administered on Y 8/5/09, and several hours later patient reported pain atUsite with associated 8/5/2009weakness 8/5/2009 of arm, nausea aP given to client who is a close contact Y to confirmed Pertussis case in this County. First prophy-dose Y of Z-Pak 8/4/2009 taken8/5/2009 @ 6:30 pm. Client wa was reported by a consumer (also the Y subject)Yand described the occurrence 0 of swelling at injection N site in a 31-year-old ### male subject who
was reported by a healthcare professional via sales representative and described the occurrence Y of injection 7/1/2009 site reaction 7/3/2009 in a 5-year-old m on (MMR & DTaP) 8/3/09 24 hrs later parent noted redness 48 later child c/o pain at injectionUsite w/noted 8/3/2009 spreading erythema 8/4/2009 no assoc fev ffect fever 100.8, myalgias, redness @ injection site after administered. 6x8 cm area. U 8/4/2009 8/4/2009 cm area of induration, warmth, erythema Y at the (R) deltoid area, Non-tender to touch. Treatment prescribed: 8/4/2009 ATARAX8/5/2009 10mg tid x 4 days Ora ale 5 min after injection. Legs elevated. Fainted in chair. Eased down to floor by staff x 2. Easily Y aroused,8/6/2009 oriented. BP 8/6/2009 107/62. Skin warm, an a few hours after immunizations-Yreached 104. 1. Y 8/4/2009 8/4/2009 e, (leg, neck, and back pain) fever 103, Y tachycardic, Redness and Swelling in Right upper arm Y around injection 8/3/2009 site. 8/3/2009 ceived vaccines- KINRIX, MMR, Varicella. On 7/28/09 morning: Developed red rash on the left Y cheek same 7/28/2009 day in the 7/28/2009 afternoon (approx. 1 eezing & swelling of face within one hour of receiving vaccination. C/o nasal congestion and rhinorrhea, pt. 8/4/2009 has remote 8/4/2009 h/o asthma- and w m, pt was at a restaurant, felt lightheaded, Y and was trembling. She stood and passed out. Upon Y awakening 8/5/2009 pt kept repeating 8/5/2009herself over a multiforme minor Y 7/29/2009 8/4/2009 sh to face, torso, buttocks. U 8/5/2009 8/5/2009 ollen, hot touch. Onset Aug 4th 2009. Tx-apply ice prn. Y 8/3/2009 8/4/2009 with 12cm macule, warm to touch Y 7/31/2009 8/1/2009 DTAP shot (5th shot) on 8-3-09. On 8-4-09, arm was very swollen about 4 inches long with red U and white8/3/2009 in the middle. 8/4/2009 No drainage, tende vaccination Pt. experienced rednessY and swelling at site of injection, the following day the redness extended 6/1/2009 to her right 6/2/2009 elbow with swelling d to urgent care clinic with shortnessYof breath, pale, lightheadedness, labs drawn, IV normalUsaline 500ml.8/6/2009 8/6/2009 n has been received from a physician Y concerning a 76 year old female patient with Y food allergy N to mango and no other medical history who n has been received from a nurse concerning Y a 66 year old female with no pertinent Y medicalNhistory and no known ### drug allergies ### who on 1 n has been received from a physician Y concerning a 97 year old female patient with Y no pertinent N medical history who was vaccinated with a n has been received from a physician Y concerning Y a 19 year old male 0 patient with rheumatoidUarthritis who on 17-OCT-2008 ### ### was vaccinated n has been received from a 49 yearYold male a ph. D. with an allergy to clindamycin Y and penicillin N and asthma ### who on 10-OCT-2008 ### was v n has been received from Y a physician Y concerning a male who was vaccinated with a first dose Y of PNEUMOVAX 0.5 mL. Concomitant vacc n has been received from a pharmacist concerning Y an 81 year old female 0 Y inpatient (acute ischemic Y MI) with 10/1/2008 diabetes, 10/2/2008 hypertension and hyp n has been received from a certifiedYmedical assistant Y concerning a261 year old male patientUwith coronary 10/7/2008 artery disease, 10/8/2008 hypertension, de follow up information has been receiving Y from a healthcare worker concerning a Y 27 year oldYfemale patient 11/1/2008 with a hypothyroid 11/3/2008 and a history n has been received from a healthcare worker Y concerning a patient 0(gender not specified) who N on an unspecified date was vaccinated with n has been received from a pharmacist Y concerning Y a 79 year old female 0 who on 03-NOV-2008 N was vaccinated 11/3/2008 with11/4/2008 PNEUMOVAX, Lot num n has been received from a pharmacist Y concerning Y an 85 year old male 0 who on 04-NOV-2008 N was vaccinated 11/4/2008 with 11/5/2008 PNEUMOVAX Lot no. 6 follow-up information has been received Y from aYphysician concerning 2 a 70 year old female with Y no known 11/4/2008 allergies or 11/6/2008 drug reactions and no follow up information has been received Y from a healthcare worker concerning a 36 Y year old Y female patient who### on 30-OCT-2008 11/3/2008 at 09:55 w n has been received from a registered Y nurse concerning a 49 year old female patient Y with cancer Y and no11/3/2008 drug reactions 11/3/2008 or allergies who on n has been received from an office Y manager concerning Y a female who 3 on 26-NOV-2008 wasYvaccinated with a### dose of PNEUMOVAX ### 23 (l n has been received from Y a physician Y and a licensed Y practical nurse0 (L.P.N.) concerning a 71 N year old male 1/2/2009 with hypertension, 1/2/2009 diabetes an n has been received from a pharmacist Y concerning Y a 41 year old female 0 with breast cancer U and morphine 1/30/2009 allergy who 1/30/2009 on 30-JAN-2009 was n has been received from a consumer Y concerning Y a patient who was 0 vaccinated with a doseUof PNEUMOVAX 23 (lot #662018/1332X). Sub n has been received from a registered Y pharmacist Y concerning a 46 year 4 old male with penicillin Y allergy. On 3/8/2009 07-MAR-2009 3/8/2009 the patient was h n has been received from a pharmacist Y concerning a 66 year old female Y who on 24-JUL-2008 Y was vaccinated 7/24/2008 with 7/24/2008 a dose of PNEUMOVAX follow-up information has been received from a certified medical assistant concerning a 1 year U old male 2/15/2008 patient, who 2/15/2008 on 15-FEB-2008 at 11 follow up information has been received Y from a physician and a licensed practical nurse concerning Y a 685/28/2008 year old female 5/29/2008 patient with drug n has been received from a pharmacist concerning a 67 year old male with adverse drug reaction/allergy N 6/3/2008 to ADVIL, who 6/4/2008 was hospitalised fo n has been received concerning a patient who on an unspecified date was vaccinated with PNEUMOVAX U 23 (lot# not provided). Subseque follow up information has been received from a registered nurse concerning a 70 to 80 yearUold male patient 6/11/2008 who on 6/11/2008 11-JUN-2008, was va follow up information has been received Y from a nurse concerning a "70 - 80 year old" femaleNwho is a patient 6/11/2008 in a rehabilitation 6/11/2008 hospital, wh n has been received from a physician Y concerning a 70 year old female who on 12-JUN-2008Uwas vaccinated 6/12/2008 with a6/13/2008 dose of PNEUMOVAX n has been received from a physician Y concerning a 64 year old female who on 16-JUN-2008Uwas vaccinated 6/16/2008 with a6/18/2008 dose of PNEUMOVAX n has been received from a pharmacist concerning a related who was vaccinated with a dose Y of PNEUMOVAX 23. Subsequently, the patie follow-up information has been received from a physician concerning a 69 year old female with Y a history5/21/2007 of vaccination 5/21/2007 with BCG in the left n has been received from a pharmacist Y concerning a 71 year old female with an allergy to lipstick, N heart 6/19/2008 disease congenital, 6/20/2008high blood pre follow-up information has been received Y from a physician, concerning his 61 year old, female Y retired wife 6/26/2008 with gastrooesophageal 6/26/2008 reflux dis follow up information has been received from a registered nurse concerning a 71 year old white N female with 6/26/2008 hypertension, 6/27/2008 dyslipidemia, se
n has been received from a pharmacist Y concerning a female who on 04-MAY-2009 was vaccinated N subcutaneously 5/4/2009 with 5/8/2009 a 0.65 ml dose of n has been received from a licensed practical nurse concerning a 60 year old female who was U vaccinated 6/27/2008 with PNEUMOVAX 6/27/2008 (date not rep d follow up information has been received from a licensed practical nurse and a physician concerning Y a 78 5/13/2008 year old 5/13/2008 male patient with hyper follow up information has been received from a certified medical assistant concerning an 87Yyear old female 6/25/2008 with no6/27/2008 medical history and no follow up information has been received from a physician and from a health professional and Y concerning6/24/2008 a 35 year 6/24/2008 old male with no known n has been received from a pharmacist concerning an adult female who a long time ago wasUvaccinated with PNEUMOVAX (lot # not repo n has been received from a health professional concerning a 72 year old male with no known Y drug allergies 6/24/2008 and no 6/24/2008 previous medical histor follow up information has been received from a physician concerning a 65 year old female patient Y who on 6/26/2008 26-JUN-2008 6/26/2008 at 10:00 AM was v n has been received from a physician Y concerning a 68 year old female who on unspecified date N was vaccinated into shoulder of the arm (u follow up information has been received from a registered nurse concerning a healthy female Y infant who7/17/2008 on 17-JUL-2008 was inadvertently n has been received from a 60 year old female consumer with hurting joints, non-specific connective N tissue disorder and THIMEROSAL alle n has been received from a physician Y concerning a 69 year old female with no drug reactions Y or allergies 7/9/2008 and depression, 7/9/2009 asthma and a hi follow-up formation has been received Y from a physician concerning a 35 year old female patient N with allergies 7/18/2008 (unspecified), 7/18/2008but no known n has been received from a physician Y concerning a 66 year old male patient with no known drug U allergies 7/14/2008 who on 14-JUL-2008 7/14/2008 was vaccin n has been received from a female consumer (age unknown) who on an unspecified date was U vaccinated (route unknown) with a dose of P follow up information has been received from a physician and a certified medical assistant concerning Y a 65 5/5/2008 year old female 5/7/2008 patient who on n has been received from a licensed practical nurse Y (L.P.N.) concerning 0 a 94 year Y old female Y who on 16-JUL-2008 7/16/2008 7/16/2008 was vaccinated with a d n has been received from a licensed practical nurse concerning a 55 year old male who on 16-JUL-2008 Y 7/16/2008 was vaccinated 7/16/2008 with PNEUMOVA n has been received from a registered Y nurse concerning a patient (age and gender not reported), N with concomitant 7/22/2008 medications, pertinent m n has been received from a pharmacist concerning a patient who on 27-Jul-2008 was vaccinated N with PNEUMOVAX 7/27/2008 7/27/2008 23 (lot# 662042/0622 n has been received from a pharmacist concerning a patient who on 27-JUL-2008 was vaccinated N with PNEUMOVAX 7/27/2008 7/27/2008 (Lot # 662042/0622X n has been received from medical records Y regarding a case in ligation with rofecoxib (WAES# N 0590USA03739)### concerning ### a male patient ( n has been received from a consumer concerning her 84 year old mother who received PNEUMOVAX U (lot # not reported) while she was in n has been received from a physician and a nurse practitioner concerning a patient who about U a month ago, July 2008, was inadvertently v n has been received from a licensed Y practical nurse concerning a female (age not reported) Ywith drug reactions/allergy 12/1/2004 12/3/2004 to RELAFEN and S follow up information has been received from a pharmacist concerning a retired male patientYwith no known 8/10/2008 allergies 8/10/2008 and status post hip re n has been received from a certifiedYmedical assistant concerning a 57 year old female with N unknown allergies 8/7/2008 who8/12/2008 on 07-AUG-2008 was v n has been received from a physician's Y assistant concerning a 62 year old female with a history U of immunodeficiency 4/1/2006 who in approximately n has been received from a medicalYassistant (MA) concerning a 76 year old male patient with Y no known7/29/2008 drug allergies, 7/30/2008 hypertension and a n has been received from a physician concerning a female in her 50's with diabetes who "one Y year ago", was vaccinated with her first dose n has been received from a medicalYassistant concerning a 72 year old female with hypertension Y and sulfonamide 7/22/2008 allergy 7/23/2008 who on 22-JUL-2 follow up information has been received from a 60 year old male physician concerning Y himself, Y who in September 9/16/2003 2002 9/16/2003 and 16-SEP-2003 n has been received from a registered nurse concerning a 6 month old male who on 18-AUG-2008 N was 8/18/2008 vaccinated 8/18/2008 with a dose of PNEUMO n has been received from a physician Y concerning a 65 year old female (weight 150#, height Y63") with drug 8/15/2008 allergies8/15/2008 to MIACALCIN, NAPRO n has been received from an approximately 61 year old female consumer with no allergies/drug Y reactions and no pertinent medical history n has been received from a registered nurse concerning an approximately 38 year old female N who on 25-AUG-2008 8/25/2008 8/25/2008 was vaccinated intram n has been received from a pharmacist concerning a 76 year old patient who on an unspecified U date was vaccinated with PREVNAR instea n has been received from a registered Y respiratory therapist concerning a 58 year old femaleYwith drug reaction/allergy 7/23/2008 7/24/2008 to flu vaccination, wh n has been received from a registered Y respiratory therapist concerning a 56 year old male with N no drug reactions 8/1/2008or allergies who in 2002 w n has been received from an office manager concerning a 60 year old female with hyperlipidaemia, U hypothyroidism 8/26/2008 8/26/2008 and drug hypersensitivi follow-up information has been received from an office manager concerning a 44 year old female with seizure disorder, severe mental reta n has been received from a health professional concerning a 13 year old female patient whoYon 18-AUG-2008 8/18/2008 was 8/19/2008 vaccinated intramuscula n has been received from a healthcare worker (office manager) concerning a 5 year old female N with no allergies/drug 8/27/2008 8/28/2008 reactions and no pert n has been received from a 67 year old female consumer with a sulfonamide allergy, who onY28-AUG-2008 8/28/2008 was vaccinated 8/28/2008 with a first dos n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX. Subsequently the patie n has been received from a pharmacist concerning a 28 year old female patient with diabetes, N osteomyelitis 9/2/2008 and anxiety 9/2/2008 disorder who on 0 n has been received from a physician and the Clinical operations manager concerning a 4 month U old female 9/3/2008 who on 9/3/2008 03-SEP-2008 (also rep n has been received from a registered nurse concerning a 48 year old male with no drug reactions/allergies N 9/5/2008 who on 05-SEP-2008 9/6/2008 was intra n has been received from a physician concerning a female patient who was vaccinated with Ya dose of PNEUMOVAX 23. Subsequently the n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified U date was vaccinated with a dose of n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified N date was vaccinated with a dose of
n has been received from a consumer concerning her 4 year old daughter with down's syndrome, N drug reactions/allergy 9/15/2008 to KEFLEX and str n has been received from a female consumer (age unknown), who, on an unspecified date, U was vaccinated with a dose of PNEUMOVAX ( n has been received from a pharmacist and an assistant director of nursing concerning a male N nursing home patient who was vaccinated b follow up information has been received from a physician concerning a 47 year old female xYray technician 9/9/2008 who on 09?-SEP-2008 9/9/2008 was vac n has been received from a 63 year old female registered nurse with drug hypersensitivity toYCECLOR, high 9/18/2008 cholesterol 9/18/2008 and osteoporosis w n has been received from a physician concerning an approximately 32 year old female who U on 17-SEP-2008 9/17/2008 was vaccinated 9/17/2008 intradermally n has been received from a pharmacist and an assistant director of nursing concerning a male N nursing home patient who was vaccinated b n has been received from a pharmacist and an assistant director of nursing concerning an approximately N 97 year old female nursing home n has been received from a female 72 year old retired registered nurse (R.N.) with drug hypersensitivity Y to9/1/2007 PRAVASTATIN 9/1/2007 sodium, AMOXI n has been received from a physician concerning a patient (gender not specified) who was vaccinated Y with a dose of PNEUMOVAX. The p n has been received from a pharmacist concerning a 74 year old patient who on an unspecified U date was vaccinated with PREVNAR instea n has been received from a registered Y nurse concerning a male who on 20-June-2008 was vaccinated Y via 6/20/2008 subcutaneous 6/20/2008 route with a first d n has been received from a registered Y nurse concerning a 86 year old male who on 26-AUG-2008 Y was vaccinated 8/26/2008 via 8/27/2008 subcutaneous route n has been received from an approximately Y 69 year old female who reported that approximately Y "9 or 10" years ago, she was vaccinated w n has been received from a physician Y and an advanced practice nurse concerning a male over Y 50 years9/10/2008 old with diabetes, 9/10/2008 who on approxim n has been received from a Licensed Practical Nurse 1 concerning a male patient who was U vaccinated With a dose of PNEUMOVAX. Conc n has been received from a consumer concerning her 65 year old husband with an allergic reaction N to sulfa 9/8/2008 drugs and 9/9/2008 no pertinent medical n has been received from a registered Y nurse concerning a patient (age and gender unknown) Y who in June 8/26/2008 2008, was 8/27/2008 vaccinated SQ with a n has been received from a registered nurse and a health professional concerning a 44 yearYold female 9/18/2008 with allergic9/18/2008 reaction to antibiotics ( n has been received from a nurse practitioner Y concerning a 46 year old female with chronic N obstructive pulmonary 9/22/2008 disease 9/22/2008 and a sulfonam n has been received from a physician concerning a 31 year old female with asthma who on U approximately4/1/2008 01-APR-2008 was vaccinated w follow-up information has been received Y from a certified medical assistant concerning a 69 year Y old female 9/15/2008 with penicillin 9/15/2008 allergy and allerg n has been received from a nurse practitioner student concerning her 61 year old father whoYin July 2008,7/1/2008 while hospitalized 7/1/2008for another co n has been received from a registered pharmacist concerning a female who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a registered nurse concerning a patient who on 26-SEP-2008 were N vaccinated9/26/2008 with PNEUMOVAX 9/26/2008(lot # 659487/ n has been received from a registered Y nurse concerning a 65 year old female with penicillin,Ycodeine, sulfa, 9/30/2008 DARVON, 10/4/2008 DEMEROL, morphin n has been received from a nurse concerning Y a 56 year old male with glaucoma, headache,Udepression 9/30/2008 and diabetes who in 2003 was vac n has been received from a registered nurse concerning a 66 year old female with chronic fatigue Y syndrome, 10/3/2008 hyperthyroidism, 10/3/2008 arthritis, stre n has been received from a nurse concerning Y a 60 year old male with gout, thalamic syndrome, N gastroesophageal 10/3/2008 reflux 10/6/2008 disease, benign p n has been received from a nurse concerning Y a 64 year old male with diabetes, low back pain, Y knee pain and hypertension and no allergies n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified Y date was vaccinated with a dose of n has been received from a license vocational nurse (LVN) concerning a patient who on an unspecified U date was vaccinated with a dose of n has been received from a physician an approximately 66 year old female who on an unspecified N date was vaccinated at the health depar n has been received from a certifiedYmedical assistant concerning a 49 year old female with N PENICILLIN10/8/2008 and SULFONAMIDE ### allergies and n has been received from a registered nurse concerning a 65 year old female with no major U medical history, 3/1/2008 who in March 2008, was vacci n has been received from a medical assistant concerning a 65 year old female with hypertension N and no10/8/2008 allergies who 10/9/2008 on "08-OCT-2008" w n has been received from a registered pharmacist concerning a patient who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a medicalYassistant concerning a 66 year old female patient with arthritis, Y chronic 9/30/2008 back pain, 10/2/2008 hyperthyroidism and n has been received from a registered pharmacist concerning a patient who on an unknownUdate was vaccinated with a dose of PNEUMOV n has been received from a physician concerning himself, a 60 year old male with no pertinent N medical history 9/26/2008 and no 9/26/2008 drug reactions or alle n has been received from a healthcare Y worker concerning a female who on 26-SEP-2008 was N vaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 23 (lot #6580 follow-up information has been received Y from a registered nurse concerning a 23 year old female U patient9/26/2008 who on 26-SEP-2008 9/26/2008 was vaccin n has been received from a registered Y nurse concerning a 29 year old female patient who onU26-SEP-2008 9/26/2008 was vaccinated 9/26/2008 with a dose of P n has been received from a medicalYassistant concerning a 6 month old patient who on 29-SEP-2008 U was 9/29/2008 inadvertently 9/29/2008 vaccinated with PN n has been received from a nurse concerning an adult in 50s, who in October 2008 ("past week") Y received 10/1/2008 a first dose 10/1/2008 of 0.5 ml PNEUMOV n has been received from a physician Y concerning an approximately 52 year old female patient U with asthma who during the past few months n has been received from a Registered Nurse (R.N) concerning a patient (gender not specified) U who was vaccinated 8/1/2008 with a dose of PNEUM n has been received from a Registered Nurse (R.N.) and a Registered Pharmacist (R.Ph) concerning U a 71 year old female patient who was n has been received from a registered Y pharmacist and a registered nurse concerning an approximately U 66 year old female patient with no p n has been received from a registered Y nurse and the child's mother, concerning an approximately N 2 year old male child with heart abnorma n has been received from a nurse concerning an adult in 50s, who in October 2008 ("past week") Y received 10/1/2008 a first dose 10/1/2008 of 0.5 ml PNEUMOV
n has been received from a pharmacist and a nurse concerning a 65 year old female patientNwith allergic reaction to10/1/2008 penicillin, erythromycin follow-up information has been received from a pharmacist concerning a 65 year old femaleYwho on 10-OCT-2008 ### was vaccinated ### with the n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX. The physician reporte n has been received from a physician concerning a male patient who was vaccinated with a Ydose of PNEUMOVAX nine months prior. The n has been received from a 66 years old female patient who with sulfonamide allergy concerning Y that in 2007 she received the vaccine for n has been received from a physician concerning a male who was vaccinated with PNEUMOVAX U and a day later he experienced body ach n has been received from an office Y manager concerning a 64 year old male who on 14-OCT-2008 N was vaccinated ### with a dose ### of 0.5 mL PN n has been received from a 63 year old female who in October 2007, was vaccinated with PNEUMOVAX N 23 (lot ### # not provided) ### 0.5ml. On n has been received from a physician concerning a 65 year old male with no drug allergies who Y on 06-Oct-2008, 10/6/2008was 10/8/2008 vaccinated with PNE n has been received from a pharmacist Y concerning a 66 year old male with a history of kneeNreplacement 2 months ### ago who ###on 14-OCT-20 n has been received from a physician Y concerning a male who was vaccinated with a dose ofUPNEUMOVAX vaccine (route not reported). A n has been received from a physician Y concerning a 49 year old female with a history of asthma N who on 30-SEP-2008 9/30/2008 10/1/2008 was given a 0.5ml do n has been received from a registered nurse concerning an 11 week old child who was vaccinated U with one dose of PNEUMOVAX (lot # no n has been received from an unknown source concerning a 36 year old male who on 30-SEP-2008 U was9/30/2008 vaccinated9/30/2008 intradermally with PNE follow-up information has been received Y from a physician concerning a 73 year old male who Y on 26-SEP-2008 9/26/2008 was9/26/2008 vaccinated with PNEUM n has been received from a healthcare Y worker concerning a male who on 26-SEP-2008 wasNvaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 (lot #658074/0 n has been received from a nurse concerning an 82 year old retired female with high blood pressure, Y thyroid 10/3/2008 issues10/3/2008 and possible hydrochlo follow-up information has been received Y from a healthcare worker concerning a 26 year oldNfemale who10/1/2008 on 01-OCT-2008 10/3/2008 (previously repo n has been received from a registered nurse concerning a 4 month old male who on 08-OCT-2008 U at about 10/8/2008 12:00 was 10/8/2008 vaccinated with a do n has been received from a nurse concerning Y a male adult over 50 years old, who in October Y ("past week") 10/1/2008 received10/1/2008 a first dose of 0.5 ml P n has been received from a registered Y nurse concerning a 66 year old female with allergy toN"sulfa" and penicillin ###who on 14-OCT-2008 ### wa n has been received from a registered Y nurse concerning a female patient who in 2003 was vaccinated Y with 9/11/2008 a dose of 9/12/2008 PNEUMOVAX and ha n has been received from a registered nurse concerning a 56 year old female who on 09-OCT-2008 Y was10/9/2008 vaccinated with PNEUMOVAX ### 23 n has been received from a registered Y nurse concerning a 66 year old female who on 08-OCT-2008 Y was10/8/2008 vaccinated with PNEUMOVAX ### va n has been received from a pharmacist Y concerning a 60 year old male with penicillin allergy N and allergic reaction ###to antibiotics ### who on 13-O n has been received from a nurse concerning an 88 year old female patient with hypertension N and reflux and no ### known drug ###allergies who n has been received from a physician concerning a 53 year old female with rheumatoid arthritis Y who on 22-AUG-2008 8/22/2008 was vaccinated with n has been received from a health professional Y concerning a 64 year old female received a Y dose of PNEUMOVAX 23 vaccine (lot # 662020 n has been received from a laboratory technician concerning a female patient who was subcutaneously N 10/7/2008 vaccinated with a### standard dose of n has been received from a certifiedYmedical assistant and a healthcare worker, concerning N a 63 year old female ###patient who ### in October 20 n has been received from a registered nurse concerning a 52 year old female co-worker withNno known allergies ### or pertinent ###medical histor n has been received from a 43 year old female with allergic reaction to tetracycline who in the N fall of 2003 was ### vaccinated ### with the first dose n has been received from a retired 70 Y year old nurse with no medical history and drug reactions/allergies N who ### on 15-OCT-2008 was vaccin n has been received from a health professional concerning a 57 year old female who on 26-SEP-2008 U was 9/26/2008 vaccinated 9/26/2008 with PNEUMOVAX, n has been received from a laboratory technician concerning a female patient who was subcutaneously U vaccinated ### with a### dose of PNEUMO n has been received from a pharmacist Y concerning a female with shellfish allergy and latex allergy Y who on unspecified dates was vaccinate n has been received from a physician Y concerning an 87 year old female who on "on Friday",U17-OCT-2008, was ### vaccinated ### with PNEUMOV n has been received from a physician and a nurse practitioner concerning a 85 year old female Y retired without ### illness at time ###of vaccination n has been received from a pharmacist Y concerning a 70 year old female patient with niacin, Y cephalosporin and CODEINE allergies, who ab n has been received from a physician Y concerning a 50 year old female who on 26-SEP-2008Uwas vaccinated 9/26/2008 with PNEUMOVAX 9/26/2008 (lot # 659 n has been received from a health professional Y concerning a 36 year old female who at 11:00 U am on 26-SEP-2008 9/26/2008 9/26/2008 was vaccinated mistake n has been received from an health care worker in a physician's office concerning a 57 yearUold female patient 9/26/2008 who9/26/2008 on 11AM of 26-SEP-20 n has been received from a nurse concerning a 70 year old female with a history of hypertension, N coronary artery ###disease, osteoarthritis an n has been received from a certified medical assistant concerning one adult female patient who Y on an unknown ### date was vaccinated with a n has been received from a registered Y nurse concerning a 43 year old female who at 11:00 AM U on 26-SEP-2008 9/26/2008was 9/26/2008 vaccinated with PNE n has been received from a physician Y concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a certifiedYmedical assistant and a health care worker concerning Y an 82 year old 10/8/2008 female who 10/9/2008 in October 2003, wa n has been received from a certified medical assistant and a health care worker concerning N a 61 year old 10/8/2008 male patient who on 08-OCT-200 follow-up information has been received from a 63 year old female with allergic reaction to antibiotics, N SULFONAMIDE ### and ### "others unspec n has been received from a healthcare worker concerning a female who on 22-OCT-2008, "yesterday", N was vaccinated ### with ###a dose of PNE n has been received from a physician concerning a 64 year old female patient who on 22-OCT-2008 Y was vaccinated ### intramuscularly ### with a
n has been received from a healthcare worker concerning a male who on 22-Oct-2008 was N vaccinated subcutaneously ### with ###the first dose o n has been received from a registered nurse (R.N.) concerning a 48 year old male who on 21-Oct-2008 N was vaccinated ### with ###a dose of PNE n has been received from a medicalYassistant concerning a 66 year old female who on 13-Oct-2008 U was vaccinated ### with PNEUMOVAX ### va n has been received from a medicalYassistant concerning a 61 year old female who on 14-OCT-2008 U was vaccinated ### with### PNEUMOVAX 2 n has been received from a medical assistant concerning a 67 year old female who on 08-OCT-2008 U was 10/8/2008 vaccinated 10/9/2008 with PNEUMOVAX 2 n has been received from a medical assistant concerning a 65 year old female who on 20-OCT-2008 U was vaccinated ### with### PNEUMOVAX (L n has been received from a physician concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a physician concerning a 60 to 65 year old male patient who on 20-OCT-2008 U was vaccinated ### with ### PNEUMOVA n has been received from a certified medical assistant concerning an adult female patient who N on an unknown 9/29/2008 date was vaccinated with a n has been received from a certified medical assistant concerning an adult female patient who N on an unknown### date was vaccinated with a n has been received from a physician concerning one patient who was vaccinated with PNEUMOVAX Y (Lot#1295X, therapy date, route, site n has been received from a physician Y concerning a 66-year-old female with a history of hypertension, U heart conditions, ### anxiety ### and bleedin n has been received from a physician Y concerning a patient who was vaccinated with PNEUMOVAX U vaccine (dose and route ###not reported). n has been received from an office manager concerning a 55 year old male who on 22-OCT-2008, Y "Wednesday ### of last week", ### was vaccina n has been received from a 65 year old female with allergy to sulfonamide and "gluten" whoNon 17-OCT-2008 was ### vaccinated ### with PNEUM n has been received from a nurse concerning Y a female who on 21-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot # 660717/02 n has been received from a nurse concerning Y a female who on 13-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot # 660717/02 n has been received from a physician concerning a female who on 19-OCT-2008, "10 days ago", U was vaccinated ###with a dose ### of PNEUMOV n has been received from a female who in November 2002, was vaccinated with a 0.5 mL dose U of PNEUMOVAX 11/1/200223. 12/1/2007 In December 2007, th n has been received from a physician Y concerning a 66 year old female with diabetes, hypertension, N lipids high ### and drug allergy ### to CIPRO, W n has been received from a medicalYassistant concerning a female who on 28-OCT-2008 was Y vaccinated with ### PNEUMOVAX ### 23 (dose and n has been received from a physician concerning a 74 year old female who on approximately Y 12-OCT-2008 was ###vaccinated ###with PNEUMO n has been received from an adult female certified medical assistant who on an unknown date N was vaccinated### with a dose of PNEUMOVA n has been received from a consumer concerning a co-worker who on 13-OCT-2008, the patient N was revaccinated ### with PNEUMOVAX. ### Co n has been received from a physician and a nurse concerning a female who on 17-OCT-2008 N was vaccinated ### with PNEUMOVAX (lot #660 n has been received from a physician, Y concerning a 60-year-old female patient with chronic Y cervical radiculopathy, ### lumber### radiculopathy, d n has been received from a physician, Y concerning a 51-year-old female patient with sinusitis,Y hyperlipidemia and ###no known ### drug allergies, w n has been received from a physician concerning a 70 year old male with no medical historyYwho on 27-OCT-2008 ### was vaccinated ### with PN n has been received from a nurse concerning Y a 53-year-old female patient who on 27-OCT-2008 N was administered ### a dose of PNEUMOVA n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot # 6606 n has been received from a physician Y concerning a 69 year old female with drug hypersensitivity Y to IMURAN (caused ### by diffuse ### swelling), l n has been received from a physician concerning a 69 year old female who at 9:26 am on 22-OCT-2008 Y with a### first dose of ### PNEUMOVAX n has been received from a pharmacist concerning a 20-year-old female patient, who on 28-OCT-2008 U was vaccinated ### with a dose of PNE n has been received from a physician Y concerning a female patient over 60 years of age whoUin October 2008 was ### vaccinated ### with PNEUM n has been received from a physician concerning a female patient over 60 years of age whoUin October 10/1/2008 2008 was vaccinated with (Lot #66 n has been received from a physician concerning Y a female who on 27-OCT-2008 was vaccinated N with (lot #660685/0619X). ### In October 200 n has been received from a medicalYassistant concerning a male patient with no known drugUreactions/allergies, 11/3/2008 who 11/3/2008 on 03-NOV-2008, wa n has been received from a registered pharmacist concerning a female patient who is also her U student with an allergy to eggs who was vac n has been received from a physician concerning a female who on 29-OCT-2008 was vaccinated N with PNEUMOVAX ### vaccine ### (lot #660685 n has been received from a medical assistant concerning a patient who was vaccinated withUa dose of PNEUMOVAX (lot # 659148/1382U) n has been received from a nurse concerning a female who on 30-OCT-2008 was vaccinated N with PNEUMOVAX ###vaccine### (lot #662599/107 follow up information has been received Y from a physician concerning a female patient who no U 03-NOV-2008 11/3/2008 (1:30 PM) 11/3/2008 was vaccinated wit n has been received from a physician Y concerning a 76 year old male with heart disease, elevated N cholesterol, 11/4/2008 atrial11/4/2008 fibrillation, enlarged pro n has been received from a pharmacist and a hospital employee who was the brother of a female U patient who on an unknown date was vac n has been received from a female with penicillin allergy, sulfonamide allergy and LEVAQUIN Y and certain1/1/2005 drops allergy 1/1/2005 who in 2000 was va n has been received from a nurse concerning a male who on 30-OCT-2008 was vaccinated N with PNEUMOVAX### (Lot #62599/1076X), ### 0.5ml n has been received from a physician Y concerning an under 65 year old female with diabetesNwho was vaccinated with PNEUMOVAX vacci n has been received from a nurse concerning a 50 year old female who on 05-NOV-2008 was U vaccinated with dose of PNEUMOVAX (lot n n has been received from a physician concerning a female who was vaccinated with PNEUMOVAX U (lot # not provided). Secondary suspec n has been received from a registered Y nurse concerning a female patient who on an unspecified Y date was vaccinated with a dose of PNEU follow-up information has been received Y from a nurse concerning a 63-year-old female patient Y with asthma, 11/3/2008 arthritis, 11/4/2008 and drug allergies we
n has been received from a womanYat a medical clinic concerning a 63 year old female who Yon 26-SEP-2008 9/26/2008 was vaccinated 9/26/2008 with a first do n has been received from a 76 yearYold female with a rapid heart beat and allergic reaction to N erythromycin 11/4/2008 and tetracycline 11/4/2008 who on 04-NO n has been received from a pharmacist concerning herself, a 59 year old female with latex, iodine, N HIBICLENS 11/3/2008 and11/3/2008 Neomycin allergies, wh n has been received from an inventory Y manager concerning a female nurse who on 03-NOV-2008 U was vaccinated 11/3/2008 with 11/3/2008 PNEUMOVAX 23. O n has been received from a healthcare worker concerning a 52 year old female with allergy to Y soy products, sulfa, ### BACTRIM, 11/1/2008 CIPRO and L n has been received from a nurse concerning a 63 year old female with cholesterol high, blood Y pressure high, 1/1/1999 lupus,1/1/1999 arthritis, seizures and n has been received from an adult female who was vaccinated with PNEUMOVAX 23 (routeNnot reported) in her left arm 1 week after recei n has been received from a pharmacist concerning a 67 year old female who on approximately N 03-NOV-2008 11/3/2008 was vaccinated with PNEUM follow-up information has been received Y from a physician concerning a 65 year old female with Y hypertension and ###joint discomfort ### who in De follow-up information has been received Y from a physician concerning a 70 year old female patient Y with reflux and ###hypertension ### who on 17n has been received from a physician concerning a female who on an unknown date was vaccinated U with PNEUMOVAX 23 (Lot # 660685/ n has been received from a nurse practitioner concerning a 65 year old female who in 2000 Y was vaccinated with the first dose of PNEUMO n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX 23 in the past. S n has been received from a registered Y nurse concerning a 53 year old female patient with a N medical history of ### cancer and### no known drug re n has been received from a pharmacist, Y an adult female with a history of splenectomy at 28 N years of age resulted from a car accident, who n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX 23 (lot#662100 n has been received from a medicalYassistant concerning a 73 year old female patient who on Y 03-NOV-2008 11/3/2008 was vaccinated 11/3/2008with PNEUMO n has been received from a licensed Y practitioner nurse concerning a 72 year old female patient N with diabetes, allergies ### to ### prednisone, cortis n has been received from a registered nurse concerning a 13 year old male with asthma andYallergies to amoxicillin ### and CEFZIL ### who on 23 n has been received from a medical assistant concerning a 2 month old infant who on 11-NOV-2008 U was vaccinated ### with PNEUMOVAX 23 n has been received from a registered Y pharmacist concerning a 60 to 65 year old male patient, N with no known 11/7/2008 allergies, who ###on 07-NOV-20 rmation has been received from a healthcare worker and follow-up information was receivedYfrom a physician concerning ### a 46 year old fem n has been received from a physician concerning her father who on 10-NOV-2008 was vaccinated N with a dose### of PNEUMOVAC. ### Later that n has been received from a registered nurse concerning an approximately 81 year old male N with sulfonamide allergy ### and history ### of cardiov n has been received from a physician Y concerning a 64 year old female patient who on 04-NOV-2008 U at 10:00, 11/4/2008 was 11/4/2008 vaccinated with a dose n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a dose of PNEUMOVAX (lot # 662100/0 n has been received from a pharmacist and a registered nurse concerning a patient who on N an unspecified date was vaccinated with PNEU n has been received from a pharmacist and a registered nurse concerning a patient who on Yan unspecified date was vaccinated with PNEU n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot #6606 n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX (lot # 6606 n has been received from a health professional concerning a patient who on unknown datesUwas vaccinated with PNEUMOVAX. Lot numb n has been received from a pharm D. concerning a 59 year old female who in approximatelyY2006 "about 2 years ago" was vaccinated with n has been received from a registered nurse (R.N.) concerning a 71 year old female with noNmedical history or### allergies who ###on 13-NOV-20 n has been received from a medicalYassistant /office manager concerning a 6 month old female U who on 14-NOV-2008 ### was### inadvertently va n has been received from a nurse concerning a 53 year old female with DARVOCET allergyNhistory and no medical ### history### who on 13-NOV n has been received from a nurse concerning a 35 year old female with allergy to nortriptyline N and no pertinent 11/3/2008 medical 11/3/2008 history who on 03-N n has been received from a nurse concerning Y a 62 year old female with sulfonamide allergy,Nallergy to tetanus 11/4/2008 toxoid and no pertinent med follow-up information has been received from a pharmacist concerning a 70 year old femaleYwho on 20-OCT-2008 ### was vaccinated ### IM with n has been received from a pharmacist Y concerning a patient who was vaccinated with PNEUMOVAX. U A nurse told the pharmacist that the n has been received from a consumer concerning his 30 year old wife with asthma and seasonal N allergies who### on 14-NOV-2008 ### was vacci n has been received from a physician Y concerning a 65 year old female with hypertension, lipids N increased, osteoporosis ### and ###penicillin allerg rmation has been received from a healthcare worker and follow-up information was receivedYfrom a physician concerning ### a 84 year old fem n has been received from a registered nurse concerning a mid thirties old female patient withU no pertinent medical ### history ### and no known all n has been received from an office Y manager concerning a 7-year-old female patient with no Yrelevant medical 11/5/2008 history nor drug allergies, who n has been received from an office Y manager concerning a 6 year old female patient with asthma, Y no drug reactions/allergies, ### ### not immunoco n has been received from a registered nurse concerning two patients who on an unspecifiedUdate were vaccinated with a dose of PNEUMO n has been received from a certified medical assistant concerning a 67 year old male patientNwith hypertension, Raynaud's syndrome, arthr n has been received from a physician Y concerning a male patient in his late 40's to late 50's with Y asthma and chronic obstructive pulmonary t was received from Sanofi Aventis concerning a patient who on an unknown date was vaccinated U with PNEUMOVAX (site and route of ad n has been received from a physician Y concerning a male patient in his late 40's to late 50's who Y was vaccinated with PNEUMOVAX (lot # 6 n has been received from a licensed Y practical nurse concerning a female patient with asthma Y and graves'9/1/2008 disease and 9/1/2008 no known drug aller
n has been received from a physician assistant concerning a 67 year old female patient whoUon an unspecified date was vaccinated with a n has been received from a nurse concerning Y a 49 year old female patient with immunosupression U who on 11-NOV-2008 ### ### was vaccinated w n has been received from a licensed practical nurse concerning an unidentified patient with asthma U who was vaccinated with a dose of PNE n has been received from an office manager concerning a 73 year old female patient with hypertension U and hypercholesterolaemia ### ### and a h n has been received from a registered Y nurse concerning a female patient who on an unspecified N date was vaccinated with a 0.5 ml single d n has been received from a licensed Y practical nurse concerning a 17 year old female patientUwho in November 11/1/2008 200811/1/2008 ("this week") was vacc n has been received from a consumer concerning a "72 year old" female patient with penicillin N allergy and codeine ### allergy and a history of " n has been received from a registered nurse concerning an 80 year old female with allergiesYto PENICILLIN, iodine ### and CODEINE ### and a h n has been received from a nurse concerning a 60-year-old patient who on 18-NOV-2008 was U vaccinated with### a dose of 0.5 ###ml PNEUMOV n has been received from a pharmacy Y student concerning a 6 month old patient who was vaccinated Y with a dose of PNEUMOVAX. The pa n has been received from a healthcare Y worker concerning a 69 year old female patient who Y had experienced an unspecified ###allergic reactio n has been received from a nurse concerning Y a 61 year old male patient with an allergy to LIPITOR, N cholesterol 12/1/2008 high, 12/1/2008 peptic ulcer disease, n has been received from a licensed Y practical nurse concerning that two patients developedNlocalized reactions### after received ### PNEUMOVA n has been received from a pharmacist Y concerning a 67 year old female with penicillin and quinolones N allergies, ### who on 17-NOV-2008 ### was n has been received from "mid to late Y fifties" year old male who, "in early November 2008", on Y approximately 01-NOV-2008 ### ### was vaccinated n has been received from a pharmacy Y student concerning a male on 10-NOV-2008 was vaccinated U with PNEUMOVAX ### (lot ### number 662662 n has been received from a healthcare worker concerning a 70 year old female patient who Y on 24-NOV-2008 was ### vaccinated ### intramuscula n has been received from a healthcare Y worker concerning a 77 year old female with hypertension, Y cholesterol,### thyroid disorder, ### sulfonamid n has been received from a licensed Y practical nurse concerning an approximately 50 year old N female with drug### hypersensitivity to thimerosa n has been received from a medicalYassistant concerning a 69 year old female patient who on Y 01-OCT-2008 10/1/2008 was vaccinated 10/2/2008with the first d n has been received from a medical assistant concerning a 3 year old female who on 24-NOV-2008 U was mistakenly ### vaccinated ### IM with PN n has been received from a registered Y nurse concerning a male patient who on unspecified N date was vaccinated with a 0.5 ml single dose o n has been received from a medicalYassistant concerning a 62 year old male patient who onN01-DEC-2008 12/1/2008 was vaccinated 12/1/2008 intramuscularly n has been received from a health care Y professional concerning a 65 year old male patient with Y no known drug### reactions/allergies, ### cardiac n has been received from a registered Y pharmacist concerning a 42 year old male who on 31-OCT-2008 Y (also reported ### as "31-DEC-2008") w n has been received from a registered Y pharmacist concerning a 31 year old female who on 30-OCT-2008 Y was ### vaccinated ### with PNEUMOVA n has been received from a registered Y nurse concerning a female patient who was vaccinated U with a dose of PNEUMOVAX (lot number no n has been received from a nurse concerning an unidentified patient who was vaccinated with U a dose of PNEUMOVAX. It was reported tha n has been received from a doctor of Y pharmacy concerning a female patient who on approximately N 04-NOV-2008 11/4/2008was vaccinated intramus n has been received from a pharmacist concerning himself who was given a second dose ofNPNEUMOVAX on### 25-NOV-2008 ### and on 26-NO n has been received from a certified medical assistant concerning a 73 year old female patient Y with hyperlipidaemia, 9/9/2008 9/10/2008 hypertension and AVE n has been received from a nurse concerning a 56-year-old patient who on 17-NOV-2008 was Y vaccinated with### a dose of 0.5 ###ml PNEUMOV n has been received from a certifiedYmedical assistant concerning a 53 year old female patient Y with diabetes, 9/8/2008 seizure disorder, chronic fatig n has been received from a healthcare worker concerning a 50 year old female patient with N hypercholesterolaemia, 12/4/2008 12/4/2008 hypothyroidism, CODE n has been received from a Registered Y Nurse concerning a female patient in her 70's who on Y approximately 14-NOV-2008 ### ### was vaccinated n has been received from a pharm D Y that a medical assistant stated that a 17 year old female Y patient who on 21-NOV-2008 ### ###was vaccinated n has been received from a medicalYoffice coordinator, concerning a 17 year old female patient U who was vaccinated with a dose of PNEUM n has been received from a registered nurse concerning a patient who was vaccinated with Y a dose of PNEUMOVAX 11/4/2008 11/4/2008 23 on an unspecified d n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of PNEUMOVAX on an unspecified date n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of PNEUMOVAX on an unspecified date n has been received from a physician concerning a 50 year old healthy male patient who received U PNEUMOVAX at age of 50 and also rec n has been received from a registered Y nurse (R.N.) concerning a 64 year old female with thyroid N disorder and antihistamine ### ### allergy who wa n has been received from a doctor of Y pharmacy concerning a male patient who on approximately U 04-NOV-2008 11/4/2008 was vaccinated intramuscu n has been received from a Licensed Vocational Nurse concerning a 24 month old patient who U on 10-DEC-2008 ###was vaccinated ### with both n has been received from a doctor of Y pharmacy concerning a female patient who on approximately Y 04-NOV-2008 11/4/2008was vaccinated intramus n has been received from a medical assistant concerning a male patient who on an unspecified U date was vaccinated with a dose of PNEUM n has been received from a 56 year old physician reporting herself with a history of asthma who N in the AM 12/5/2008 of 05-DEC-2008 12/5/2008 was vaccinated n has been received from a medicalYoffice coordinator concerning a 71 year old male patient, U who on unspecified date was vaccinated with n has been received from a healthcare Y worker concerning a 65 year old male patient who had Y experienced an unspecified### allergic reaction n has been received from a healthcare Y worker concerning a 66 year old female patient who Y had experienced 9/30/2008 an unspecified 10/2/2008allergic reactio n has been received from a pharm D Y that a medical assistant stated that a 71 year old male Npatient who on 21-NOV-2008 ### ### was vaccinated w
n has been received from a medicalYassistant concerning a 70 year old female with penicillinYallergy who on 17-NOV-2008 ### ### was vaccinated n has been received from a certifiedYmedical assistant, concerning a 52 year old male with no U medical history 12/7/2008 or allergies, 12/9/2008 who on 07-DECn has been received from a healthcare professional concerning a female patient who on 16-Dec-2008 was vaccinated ### intramuscularly ### with follow-up information has been received Y from a registered pharmacist concerning a 53 year N old female patient### who on 15-DEC-2008 ### was v n has been received from an office manager concerning a 52 year old female patient who onY 10-DEC-2008 was ### vaccinated with PNEUMO n has been received from a physician Y concerning a 52 year old female patient with fibromyalgia U who on 12/1/1999 approximately 12/1/1999 December 1999, 9 y n has been received from a registered Y nurse concerning a 43 year old female who on 17-December N was vaccinated ### IM with the second do n has been received from a registered Y nurse concerning a 57 year old female who was vaccinated U with the first### dose of PNEUMOVAX ### (LO n has been received from a 74 year old female with a previous reaction to Tetanus shot andUallergy to egg whites, yeast who recently was n has been received from a physician concerning a his mother who on 15-DEC-2008 was vaccinated N with a dose ###of PNEUMOVAX ### (manufa follow-up information has been received Y from a registered pharmacist concerning a 55 year U old male patient who ###on 15-DEC-2008 was vac n has been received from a nurse concerning a 75 year old female with hypertension, hypercholesterolaemia, U ### osteoporosis ### and no allergy n has been received from a nurse concerning a 71 year old female with hypercholesterolaemia, U coronary artery ### disease, aortic ### valve steno n has been received from a physician Y concerning two patients in their 50 who on approximately Y 09-DEC-2008 12/1/2008 ("last12/1/2008 week") were vaccinate n has been received from a physician concerning a 58 year old white female patient with allergic Y reaction to KEFLEX ### and ### sulfonamide aller follow-up information has been received from a registered pharmacist concerning a 51 year N old female patient### who on 15-DEC-2008 was v n has been received from a certified medical assistant concerning a male patient who on anUunspecified date was vaccinated with a dose o n has been received from a certified medical assistant concerning a female patient who on an U unspecified date was vaccinated with a dose n has been received from a certified medical assistant concerning a male patient who on unspecified U date was vaccinated with a dose of P n has been received from a healthcare worker concerning a 12 month old patient who on 15-DEC-2008 U was vaccinated ### with ###a dose of PNE n has been received from an office manager concerning a 66 year old male patient who on 12-NOV-2008 Y was### vaccinated with PNEUMOVA n has been received from a registered nurse concerning a patient who on an unspecified date, U was vaccinated with PNEUMOVAX, intrade n has been received from a 66 yearYold female, 188 pounds and 66 inches in height, with allergic N reaction 12/5/2008 to ACE inhibitors, 12/5/2008who on 05-DE n has been received from a physician Y concerning an 83 year old female patient with chronicNobstructive pulmonary ### disease and arthritis an n has been received from a physician Y concerning two patients in their 50 who on approximately Y 09-DEC-2008 12/9/2008 ( " last 12/9/2008 week") were vaccinat n has been received from a 71 year old female healthcare worker with hypertension, hypothyroidism, Y tinnitus, latex ### allergy, ### iodine allergy a n has been received from a healthcare Y worker concerning a male patient who on 11-DEC-2008 U was vaccinated ### intramuscularly ### with a 0.5 m n has been received from a physician Y concerning a 12 month old female with a history of bronchiolitis N at 3 month ###of age, reactive ### airway iss n has been received from a nurse and a 55 year old male physician who on 02-JAN-2009 was N vaccinated1/2/2009 with a dose 1/3/2009 of PNEUMOVAX (Lo n has been received from a physician and a licensed practical nurse concerning a 62 year old N female patient with ###ibuprofen ### and penicillin a n has been received from a physician concerning a female who was vaccinated with a dose Yof PNEUMOVAX. Subsequently, the patient de n has been received from a physician's Y assistant (P.A) concerning a 24 months old male patient N with no known 1/9/2009 drug 1/9/2009 reactions/allergies and n has been received from a licensed Y practical nurse (LPN) concerning a patient who was vaccinated Y with PNEUMOVAX ### (lot # not provided n has been received from a physician Y assistant (P.A.) concerning a 24 months old female patient N with no 1/9/2009 known drug1/9/2009 reactions/allergies an n has been received from a licensed Y practical nurse (LPN) concerning a patient who in November Y 2008, was vaccinated ### with PNEUMOVAX n has been received from a licensed Y practical nurse concerning a patient who on 12-JAN-2009 U was vaccinated 1/12/2009 with PNEUMOVAX (lot num n has been received from a licensed Y practical nurse concerning a patient who on 23-DEC-2008 Y was vaccinated 1/8/2009 with PNEUMOVAX (lot num n has been received from a licensed practical nurse (LPN) concerning a patient who on 08-JAN-2009 Y was 1/12/2009 vaccinated with PNEUMOVAX ( n has been received from a nurse concerning an 81 year old female who on an unknown date, Y was vaccinated with PNEUMOVAX (lot# no n has been received from a nurse concerning a 53 year old female who on an unknown date, Y was vaccinated with PNEUMOVAX (lot # no n has been received from a nurse concerning Y a "over 65" year old female who in December Y2008, was vaccinated 12/1/2008 with 12/1/2008 a dose of PNEUMO n has been received from a physician Y and a nurse practitioner concerning an 80 year old female U who on1/12/2009 12-JAN-2009 1/13/2009 was vaccinated with n has been received from an office Y manager concerning a 79 year old female patient with asthma Y and allergic 1/14/2009 to morphine, penicillin and su n has been received from a nurse and a medical assistant concerning a female patient who Y in December12/1/2008 2008, was12/1/2008 vaccinated with a dose n has been received concerning a 69 Y year old female patient, who weights 210 pounds and Y is 64 1/4 inches tall, ### and has no ###pertinent medi n has been received by a drug wholesaler Y representative concerning a patient who on 20-JAN-2009 Y was1/20/2009 vaccinated1/20/2009 with a dose of PNEUM n has been received from a medicalYassistant concerning a 75 year old female with allergic reaction Y to penicillin 1/9/2009 and1/10/2009 LEVAQUIN and aspirin n has been received from a medicalYassistant concerning a 32 year old female patient with no Y pertinent medical 1/20/2009 history, 1/21/2009 who on 20-JAN-20 n has been received from a medicalYassistant concerning a 65 year old female patient with no Y pertinent medical 1/16/2009 history 1/16/2009 and no known drug n has been received from a medicalYassistant concerning a male patient who was vaccinated N with PNEUMOVAX 23 (Lot # 661529/0868X) n has been received from a medicalYassistant concerning a patient who in January 2009, was U vaccinated 1/1/2009 with a dose1/1/2009 of PNEUMOVAX (65
n has been received from an immunization coordinator concerning a female patient with rheumatoid N arthritis 1/23/2009 who on1/23/2009 23-JAN-2009 was vac n has been received concerning a 58 year old male patient with mixed hyperlipidaemia, diabetes Y mellitus, 1/12/2009 gout and 1/12/2009 hypertension who on 12 n has been received from a medicalYassistant concerning three patient who in January 2009,Uwere vaccinated 1/1/2009 with a 1/1/2009 dose of PNEUMOVAX n has been received from a consumer concerning herself (a 72 year old female) with fibromyalgia, N short 1/26/2009 gut syndrome, 1/26/2009 history of diarrhea, n has been received from a physician Y concerning a 50 year old female with PENICILLIN allergy Y and "a lot of medications" ### ### allergies and a h n has been received from a physician concerning an 85 year old female with heart and lung Yproblems, arthritis, 10/7/2008 penicillin allergy, ### sulfa allerg n has been received from a physician Y concerning a 78 year old female with type 2 diabetes,Ychronic obstructive ### pulmonary### disease and hyp n has been received from a physician Y concerning an 83 year old male with chronic obstructive Y pulmonary 7/28/2008 disease heart 7/29/2008 problems and no k n has been received from a consumer concerning his 84 year old sister who was vaccinatedUwith her first 1/1/2009 dose of PNEUMOVAX 1/1/2009 vaccine w n has been received from a physician Y concerning an 84 year old male patient with iodine and N NEOSPORIN 1/26/2009 allergy,1/28/2009 osteoporosis and osteo n has been received from a physician Y concerning a 65 year old female patient with allergic reaction N to AUGMENTIN 1/27/2009 1/28/2009 and clindamycin and o n has been received from an office Y manager concerning a 32 year old male who on 04-EC-2008 Y was vaccinated 12/4/2008with 12/4/2008 a dose of PNEUMOV n has been received from a health professional Y concerning an 81 year old female with rheumatoid Y arthritis, 1/19/2009 allergic reaction 1/21/2009 to vancomycin, n has been received from a medicalYtechnologist concerning a 43 year old female with a sulfonamide N allergy and ###a history### of arthralgias, al n has been received from a office manager Y and a physician assistant concerning a 36 year old U female who 1/21/2009 on 21-JAN-2009 1/21/2009was vaccinate n has been received from an office manager concerning a 32 year old male who on 01-DEC-2008 Y was vaccinated 12/1/2008 with PNEUMOVAX 23 (l n has been received from an office Y manager concerning a 65 year old female who on 19-NOV-2008 Y was vaccinated ### with a### dose of PNEUM n has been received from a 65 yearYold female with SULFONAMIDE allergy who on 26-JAN-2009 Y was vaccinated 1/26/2009 with 1/26/2009 a 0.5 ml dose of PN n has been received from a pharmacist Y concerning a female inpatient at his hospital who was U given a dose 1/31/2009 of PNEUMOVAX 1/31/200923 intravenou n has been received from a semi-retired Y physician concerning his 67 year old wife with asthma N and CODEINE 1/13/2009 allergy 1/16/2009 and a history of atopi n has been received from a physician Y concerning a male patient who on an unspecified dateYwas vaccinated with ###a dose of ### PNEUMOVAX n has been received from a physician Y concerning a patient who on unspecified date was vaccinated U with a dose ### of PNEUMOVAX. ### Subseq n has been received from a physician Y concerning a male who in approximately October 2008 U was vaccinated 10/1/2008 with a10/1/2008 dose of PNEUMOVAX n has been received from a 57 yearYold male physician who on 03-FEB-2009 was vaccinated Y IM with a dose 2/3/2009 of PNEUMOVAX 2/3/2009 23. On 03-F n has been received from a medical assistant concerning a female who was vaccinated withYa dose of PNEUMOVAX 23. Subsequently the n has been received from a physician concerning an approximately 60 year old female who Y was vaccinated 2/5/2009 with a dose 2/5/2009 of PNEUMOVAX 2 n has been received from a physician concerning an approximately 50 year old male who was Y vaccinated with a dose of PNEUMOVAX vac n has been received from a physician Y concerning a 4 year old female who was vaccinated with Y a dose of PNEUMOVAX 23 in her thigh. La n has been received from an office manager concerning a patient who on an unknown date,Uwas vaccinated with PNEUMOVAX 23 (lot# no n has been received from a registered pharmacist concerning an 8 month old female child who N on 11-FEB-2009 2/9/2009 was 2/11/2009 vaccinated with PNEU n has been received from a medical assistant concerning a 36 year old female patient with BACTRIM Y and 2/10/2009 BIAXIN allergy 2/10/2009 and no known me n has been received from a retired registered nurse concerning her 43 year old daughter with N "MELOXOCAM" 2/9/2009 allergy 2/10/2009 and arthritis and sco n has been received from a physician Y concerning unspecified number of patients who "aboutUa year ago" were vaccinated with PNEUMOV n has been received concerning a male physician who on 13-FEB-2009 was vaccinated withUPNEUMOVAX 2/13/2009 vaccine 0.5ML (lot# 659922/16 n has been received from a registered Y nurse concerning a 67 year old female with mitral valve Y prolapse,2/16/2009 elevated lipids, 2/16/2009 diverticulitis, irritab n has been received from a nurse concerning Y an 81 year old male who on 13-FEB-2009 wasY vaccinated2/13/2009 SQ with a 2/13/2009 dose of PNEUMOVAX n has been received from a nurse and Y a certified medical assistant concerning a 12 month old U male, who 2/23/2009 on an unknown 2/23/2009 date was vaccina n has been received from a healthcare worker concerning a 46 year old female patient, withNno known drug 2/19/2009 reactions/allergies 2/20/2009 and with a h n has been received from a physician Y concerning a 75 year old patient with hypothyroidism, Nno known drug 10/1/2008 allergies2/16/2009 and a history of depre n has been received from a pharmacist concerning a female who on 25-FEB-2009 was inadvertently U vaccinated 2/25/2009 with 2/25/2009 one dose of (PREVEN n has been received from a nurse concerning a male physician with hypercholesterolemia who N in approximately 2/24/2009 2002, 2/24/2009 "about 7 years ago" n has been received from a registered Y nurse concerning a female office receptionist who onN24-FEB-2009 2/24/2009 was vaccinated 2/24/2009 IM with the seco n has been received from a registered Y nurse concerning a female office medical assistant who N on 24-FEB-2009 2/24/2009 was 2/24/2009 vaccinated IM with the n has been received from a physician concerning a 69 year old female who on 21-JAN-2009Ywas vaccinated 1/21/2009 with a1/22/2009 0.5mL dose of PNEUM n has been received via Novartis (manufacturer control # S2009US02845), from a female that Y received a dose of PNEUMOVAX (manufact n has been received from a registered Y nurse concerning a 77 year old female patient with ULTRAM N and2/24/2009 PENICILLIN 2/24/2009 allergy, who in 1998 w n has been received from a pharmacist concerning a 65 year old male who on 26-FEB-2009Nwas vaccinated 2/26/2009 with the 2/26/2009 first dose of PNEUMO n has been received from a physician Y assistant concerning a male over 60 year old who on U an unknown date was vaccinate with an unspe n has been received from a physician Y and via medical records. A 45 year old male with gastroesophageal N 2/5/2009 reflux disease, 2/5/2009 irritable bowel syn n has been received from a registered Y nurse (R.N.) concerning a female who was vaccinated Y with a dose of PNEUMOVAX (lot # not report n has been received from a medicalYassistant concerning a 6 year old male with no pertinentYmedical history 3/4/2009 and no 3/7/2009 reported allergies, who
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with PNEUMOVAX (lot # not provid n has been received from an office Y manager concerning an 18 month old female who was vaccinated Y with PNEUMOVAX vaccine, instead n has been received from an office Y manager concerning a 71 year old female with drug hypersensitivity Y 2/27/2009 of lisinopril 2/27/2009 and AUGMENTIN, oeso n has been received from a healthcare worker concerning a 67 year old female patient with Y diabetes; hypertension; 3/10/2009 3/11/2009 hypercholesterolaemia n has been received from a manager Y and physician concerning a 65 year old Caucasian female Y worker 2/12/2009 with diabetes; 2/12/2009 hyperlipidaemia and n has been received from a registered nurse concerning a 2 month old female who on 16-MAR-2009 U was 3/16/2009 vaccinated 3/16/2009 with a 0.5 mL dose of n has been received from a physician concerning a male who on 23-JAN-2009 was vaccinated N with "one1/23/2009 dose" on PNEUMOVAX 1/27/2009 23 (lot nu n has been received from a nurse practitioner Y concerning an 81 year old male patient with arthritis who in 3/10/2009 1998 was3/10/2009 vaccinated with a dose n has been received from a licensed practical nurse, concerning a 72 year old female with hypertension, N chronic 3/3/2009obstructive 3/4/2009pulmonary dis n has been received from a pharmacist concerning a female nurse who was vaccinated withUPNEUMOVAX 3/18/2009 23 (Lot 3/18/2009 number 0980X). The ph n has been received from a physician Y concerning a patient who was vaccinated IM with the Y second 0.5ml dose of PNEUMOVAX. After gett n has been received from a pharmacist concerning a male physician who was vaccinated with Y a dose of PNEUMOVAX (662663/0980X). It n has been received from a pharmacist concerning a male physician who was vaccinated with Y a dose of PNEUMOVAX (lot # 662041/0612 n has been received from a pharm.YD. concerning a 62 year old male who was vaccinated IM U with a 0.5 3/10/2009 ml dose of 3/10/2009 PNEUMOVAX 23 (lot # n has been received from a Pharm.YD. concerning a 60 year old female who on 04-MAR-2009 U was vaccinated 3/4/2009 IM with 3/4/2009 a 0.5 ml PNEUMOV n has been received from an office manager concerning 8 patients who were vaccinated with U PNEUMOVAX (lot # 662599/1076X). It was u n has been received form an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX (lot # 662599/1076X). It was u n has been received from an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX ( lot # 662599/1076X). It was u n has been received from an office Y manager concerning 8 patients who were vaccinated with U PNEUMOVAX (662599/1076X). It was unspe n has been received from a licensed Y practical nurse concerning a female patient, who on 11-MAR-2009 N 3/11/2009 was vaccinated 3/13/2009 with the first dose n has been received from a licensed Y practical nurse concerning a patient, who on 18-MAR-2009 N was vaccinated 3/18/2009with 3/20/2009 the first dose of PNEU n has been received form an office Y worker concerning a 19 year old female with allergies to N bees, FLEXERIL 3/25/2009 and CECLOR 3/26/2009 who on 25-MA n has been received from a registered pharmacist concerning a 75 year old female with penicillin Y and KEFLEX allergy and no pertinent me n has been received from a physician Y assistant concerning a 48 year old female with common Y variable immunodeficiency 5/6/2008 5/6/2008 and sulfonamide n has been received from a physician Y assistant concerning a 33 year old female with niacin Y allergy 01-Jan-2009 2/4/2009 who2/8/2009 on 04-FEB-2009 was n has been received from a physician concerning a 26 month old male patient, with no known Y drug reactions/allergies 4/2/2009 4/2/2009 and no pertinent med n has been received from a 59 yearYold female with asthma, high blood pressure, migraines,Nheart problem 4/6/2009 and penicillin, 4/6/2009 tetracycline, cont n has been received from a Doctor of Pharmacy concerning a 40 year old (also reported as N 44 year old)4/11/2009 female with4/11/2009 diabetes who on 11-A n has been received from a physician Y and a health professional concerning a 71 year old male Y patient (weight 2/26/2009 224 pounds, 2/27/2009 height 70 inche n has been received form a medicalYassistant concerning a 67 year old female who on 03-APR-2009 N was4/3/2009 vaccinated4/3/2009 with her second dose n has been received from a case in litigation (WAES#0610USA13557) from a physician via medical U records concerning a male who on uns n has been received from a medicalYassistant concerning a patient who was vaccinated withYa dose of PNEUMOVAX 4/13/2009 4/13/2009 (lot number 662785/1 n has been received from a medicalYassistant concerning a patient who was vaccinated withUa dose of PNEUMOVAX 4/2/2009 4/2/2009 (lot number 662785/1 n has been received from a registered nurse concerning a 51 year old female who on 15-APR-2009 U was4/14/2009 vaccinated4/14/2009 with a single dose of P n has been received from a doctor of pharmacy concerning a patient who was vaccinated with U a dose of PNEUMOVAX. The patient experi n has been received from a MedicalYAssistant (M.A.) concerning a 17 year old male patient with N migraine4/16/2009 and sinus4/17/2009 infection who on 16-AP n has been received from a physician Y assistant concerning a 64 year old female with low immunoglobulin, Y 8/6/2008 diabetes, hypercholesterolaemia 8/6/2008 n has been received from a consumer Y concerning his 73 year old wife with no previous medical N history reported ### who on 26-DEC-2008 ### was n has been received from a healthcare Y worker concerning an approximately 56 year old male N with no pertinent 4/1/2009 medical history who in early n has been received from a physician Y concerning a patient who on an unspecified date was N vaccinated with PNEUMOVAX (lot # not report n has been received from a registered nurse who in approximately 2008, about one year ago, Y was vaccinated with the second dose of PNE n has been received from a physician concerning a 27 year old male patient with diabetes who N on 22-APR-2009 4/22/2009was 4/22/2009 vaccinated with a dos n has been received from a nurse concerning Y a 65 year old female who on 20-APR-2009 was N vaccinated 4/20/2009 with a 0.54/24/2009 ml dose of PNEUMOV n has been received from a 65 yearYold female consumer with ALLEGRA, household cleaning N products,4/24/2009 kiwi, nuts, and 4/24/2009 preservatives in eye n has been received from a physician and the office manager concerning 19 patients who were U vaccinated 1/23/2009 with PNEUMOVAX 1/23/2009 instead of (P n has been received from a medicalYcare administrator concerning her 60 year old mother (physician), N with 4/26/2009 a rheumatoid 4/26/2009 arthritis with sulfa n has been received from a 47 year old male consumer with allergy to water pills who in MayN2008, was vaccinated 5/1/2008 in 5/1/2008 the left arm with first n has been received from a physician concerning a patient who on 24-APR-2009 was vaccinated Y with a 4/25/2009 dose of PNEUMOVAX 4/26/2009 (lot number n has been received from a physician Y concerning a 29 year old female patient with no pertinent N medical 4/28/2009 history an no 4/28/2009 known drug allergies n has been received from an immunization Y coordinator concerning a 72 year old female withYdepression4/30/2008 who in 20015/1/2008 was vaccinated with t n has been received from a licensed practical nurse concerning an 18 month old male with aYhistory of immunization 5/2/2009 5/1/2009 who on 02-MAY-2009
n has been received from a Registered Nurse concerning a 21 year old male student who onY 01-APR-2009 4/1/2009 at 8:30 at4/1/2009 a well visit was vacci n has been received from a physician concerning a patient who on an unspecified date was Yvaccinated with 4/29/2009 a dose4/30/2009 of PNEUMOVAX vacci n has been received from a physician Y assistant concerning a 74 year old male patient with diabetes N and4/30/2009 aspirin allergy 4/30/2009 who on 30-APR-200 n has been received from a female nurse concerning herself who "recently" in approximatelyYMay 2009, 4/30/2009 was vaccinated 4/30/2009 with a dose of PNE n has been received from an office manager concerning a 54 year old female patient with noYpertinent medical### history and### no known drug a n has been received from a nurse concerning Y a 33 year old female patient with rhinitis allergic, N recurrent upper### respiratory### tract infection, d n has been received from a physician and the office manager concerning an 18 week old male U patient who 3/27/2009 on 27-MAR-2009, 3/27/2009 was vaccinat n has been received from a physician and the office manager concerning a 7 month old female U patient who 1/22/2009 on 22-JAN-2009, 1/22/2009 was vaccinat n has been received from a physician and the office manager concerning a 12 month old male U patient who 3/19/2009 on 19-MAR-2009, 3/19/2009 was vaccinat n has been received from a physician and the office manager concerning a 9 week old maleUpatient who on 4/3/2009 03-APR-2009, 4/3/2009 was vaccinated n has been received from a physician and the office manager concerning an 8 week old female U patient who 3/19/2009 on 19-MAR-2009, 3/19/2009 was vaccina n has been received from a physician and the office manager concerning a 19 week old female U patient who 3/17/2009 on 17-MAR-2009, 3/17/2009 was vaccina n has been received from a physician Y concerning a female of chronic cougher who on 04-MAY-2009 Y was5/4/2009 vaccinated5/6/2009 with the first dose of P n has been received from a physician and the office manager concerning a 6 month old female U patient who 3/12/2009 on 12-MAR-2009, 3/12/2009 was vaccina n has been received from a pharmacist Y concerning a female who on 05-MAY-2009 was vaccinated N intramuscularly 5/5/2009 with 5/5/2009 a dose of PNEUMO n has been received from a physician and the office manager concerning a 12 month old male U patient who 4/1/2009 on 01-APR-2009, 4/1/2009 was vaccinate n has been received from a medical assistant concerning a female who on 07-MAY-2009 was N vaccinated5/7/2009 with a dose5/8/2009 of PNEUMOVAX (Lo n has been received from a pharmacist concerning an approximately 82 year old patient who Y was vaccinated with a dose of PNEUMOVAX n has been received from a physician and the office manager concerning an 8 month old male U patient who 3/30/2009 on 30-MAR-2009, 3/30/2009 was vaccinat n has been received from a physician and the office manager concerning a 12 month old female U patient 3/12/2009 who on 12-MAR-2009 3/12/2009 was vaccina n has been received from a Registered Y Nurse (R.N) concerning a female patient with latex allergy Y who "three years ago" was vaccinated w n has been received from a pharmacist concerning an approximately 58 year old patient who Y was vaccinated with a dose of PNEUMOVAX n has been received from a Certified Y Medical Assistant concerning a 78 year old female patient N with no known 5/11/2009 drug5/11/2009 allergies/drug reactions n has been received from a physician and the office manager concerning a 58 day old female U patient who 3/24/2009 on 24-MAR-2009, 3/24/2009was vaccinate n has been received from a certified medical assistant concerning a 64 year old female whoNwas vaccinated IM with a dose of PNEUMOVA n has been received from a pharmacist intern concerning a 24 hours old male who on 14-MAY-2009, U was 5/14/2009 vaccinated 5/14/2009 with PNEUMOVAX (d n has been received from a consumer concerning her father-in-law who on 18-MAY-2009 was U vaccinated 5/18/2009 with PNEUMOVAX. 5/18/2009 It was report n has been received from a physician and the office manager concerning a 61 day old female U patient who 3/27/2009 on 27-MAR-2009, 3/27/2009was vaccinate n has been received from a Nurse Practitioner Y (N.P.) concerning a 64 year old female with sulfa, N penicillin 5/26/2009 and food5/28/2009 allergies who on 26-MA n has been received from a 71 year old male patient with a history of an "unspecified cardiology-related U 5/28/2009 surgery recently" 5/29/2009 who on 28-MAYn has been received from a licensed Y practical nurse concerning a 49 years old female with asthma N and colitis 4/1/2009 who on4/2/2009 01-Apr-2009 was vac n has been received from a physician and the office manager concerning a 6 month old male U patient who 3/10/2009 on 10-MAR-2009, 3/10/2009was vaccinate n has been received from a female who was vaccinated with PNEUMOVAX. The patient reported U that when the pharmacist was taking air o n has been received from a physician and the office manager concerning a 9 week old female U patient who 3/25/2009 on 25-MAR-2009, 3/25/2009 was vaccinate n has been received from a physician and the office manager concerning a 12 month old female U patient who 3/5/2009 on 05-MAR-2009, 3/5/2009 was vaccin n has been received from a physician and the office manager concerning an 18 weeks old female U patient 3/10/2009 who on 10-MAR-2009, 3/10/2009 was vacci n has been received from a physician and the office manager concerning a 6 month old male U patient who4/2/2009 on 02-APR-2009, 4/2/2009 was vaccinated n has been received from a physician and the office manager concerning a 61 day old male Upatient who on 4/1/2009 01-APR-2009, 4/1/2009 was vaccination n has been received from a Registered Nurse (R.N) concerning a 4 month old female patientUwho on 25-NOV-2008 ### was vaccinated ### with a n has been received from a nursingYsupervisor concerning a male in his middle 50's who on Uapproximately 4/15/2009 15-APR-2009, 4/15/2009 two to three wee n has been received from a consumer concerning her son who on an unspecified date was vaccinated N with a dose of MMR II. It was report n has been received from a physician concerning a female with a history of experiencing aura Y of blindness 7/6/2009 and prevaccination 7/6/2009 anxiety after ember reports that in Jan '86 he developed severe pain, numbness and weakness Y in the leftNshoulder, arm, 3/1/1999 and hand4/1/1999 that lasted for weeks n the 10th, Left thigh into knee swollen and sore Y on 11th, Right knee3 down to mid top foot swollen, N red and 7/10/2009 feverish7/11/2009 on the 12th (pt. could n AX administered 2/18/08. Hearing loss in Rt ear approximately 10 days later. 8/11/09 Y Otolaryngology N consult 2/18/2008 records 2/26/2008 received DOS 2/05/0 Y 7/24/2009 d seizure. Disoriented. Difficulty talking Y ~5 minutes. Y 7/21/2009 7/29/2009 ven zoster vaccine 7/10/09. She presented 7/23 w/ bilateral blisters on 1st & 2nd digit of hand. U She was 7/10/2009 referred to derm. Will be seeing 8/1 all dots on neck U 7/30/2009 8/1/2009 hingle shot - 4 days later broke out with chicken pox - all over body - arms - legs - vagina. Back corner of 7/14/2009 eye. I was 7/17/2009 a mess - headache - f arm red warm to touch. BENADRYL, HC ointment U 8/3/2009 8/4/2009
AP vaccination in the (L) arm 7/29/09. Y Following morning she had swelling and a hard lump Yin the (L) upper 7/29/2009 arm. The 7/30/2009 site was itchy and pa h 6d after ZOSTAVAX injection - arm, abd, leg-Rt. Y 7/7/2009 7/12/2009 d immunizations at 0800 at 2100 developed restlessness and extreme aching pain from head U to toe. Took 7/29/2009 2 ASA and 7/29/2009 3 hr later took 2 ibup er the night of injection, headache, nausea, slight redness at injection site. Y 8/6/2009 8/6/2009 7/19/2009 N 7/15/2009 7/19/2009 was reported by a physician via a GSK Y representative, and described the occurrence of cellulitis U in a child 7/17/2009 female subject 7/17/2009 of appropriate ag ng erythema and swelling upper L delt R arm 39cm L arm 42.5 19x16cm L deltoid. Y 8/5/2009 8/7/2009 given 8/5/09 - 48hrs later, seen in office Y with 3-4cm circular cellulitic rash at injection site. Y 8/5/2009 8/7/2009 thigh dime size red swollen warm area noted. Approx 2 1/2 cm x 2 cm. Y 8/6/2009 8/7/2009 ZOSTAVAX on Friday, July 31. When Y she removed bandage later that day she noted a hardYlump about7/31/2009 2" by 1" at7/31/2009 the injection site over n eloped day of immunisation- Monday 8-3-09. Felt ill on Tuesday. Swelling deltoid, redness and Y warmth decreased 8/3/2009 on8/3/2009 Fri. Here in office Frid at the site of injection. Antihistamine and Hydrocortisone ointment. Y ort received on 14 July 2009 from a consumer. A 19 year old female patient with an allergy toNfish and beans 7/7/2009 received7/9/2009 MENACTRA (lot num aches all day long. N 7/14/2009 7/15/2009 d bronchospasm gave Racemic Epi 1/2 vial in 2cc NS via nebulizer. Pt responded well- No stridor Y after tx.8/7/2009 8/8/2009 d some arm swelling that she stated was about the size of a lemon. Patient returned to pharmacy Y on 8/8/09 8/1/2009 and swelling 8/2/2009 had gone down. face, trouble breathing 3 PM vomited Y denies diarrhea. Given PREDNISONE at RCH per mom. U Gave Dehydration 8/6/2009 Protocol 8/7/2009 this AM. after receiving BOOSTRIX and VARIVAX vaccines. LOC < 30 sec. Y 8/5/2009 8/5/2009 ne administered less than one month apart. Y ### t was received from a health care professional on 28 July 2009. A 13 year old female patient N received MENACTRA 7/27/2009 7/28/2009 (lot number U2926AA) and poor feeding in the 1st 12 hours, Y late very irritable, high pitched, nonconsolable crying. Septic Y work up8/3/2009 done. after vaccines (8/4/09), teen developed pruritus all over body at about 1pm. Five days after Yvaccines, teen 7/31/2009 developed 8/4/2009 red, itchy, warm, swo ss, inflammation, runny nose, sl. temp. Itching x3 days. Y 7/16/2009 7/16/2009 to L deltoid with edema no induration, tender to palpation placed on Orapred and Benadryl. U 8/4/2009 8/6/2009 eft arm- inflammation and tender still sore and swollen 2 days later. Pain in arm started on way home from8/5/2009 clinic after 8/5/2009 Varicella given. d cough and shortness of breath. No Y cyanosis. No use of accessory muscles of respiration. Y On exam RR8/6/2009 24/min, O28/6/2009 sat 99% in room air, B 4 inch erythematous on (L) arm. Y 8/4/2009 8/5/2009 l thigh SC with 3 inch in diameter indurated, erythematous, warm circular reaction site. U 7/29/2009 7/30/2009 rge masses of lymph nodes over skull. 8/3/2009 8/5/2009 redness and swelling at injection site Y with hives and itching. Y 8/3/2009 8/4/2009 pper medial side swollen, tender, red, painful. U 8/5/2009 8/6/2009 Hepatitis A #1 vaccine on 8/5/09 in L arm around 7PM complains of tingling in R hand. Woke U on 8/6/09 with 8/5/2009 red rash8/6/2009 on face that extended have maculopapular rash 1 day after Hep B administration on L deltoid area. itis B administered 7 weeks after 2nd dose Y ### nes administered less than a month apart. Y 9/17/2004 erythema at site of VARIVAX Palp heat Y 8/3/2009 8/4/2009 VARIVAX instead of ZOSTAVAX given IM instead of SQ Y 8/5/2009 hema at site of VARIVAX Palp heat Y 8/3/2009 8/4/2009 reaction with warmth, discomfort and induration. Y 8/6/2009 8/6/2009 in area vaccinated not warm to touch, feels well TYLENOL PRN, warm compress. Prn. U 8/4/2009 pe, Hypotension, diaphoresis Y 8/3/2009 8/3/2009 d staff physician, active duty and in Ygenerally excellent health, predeployment, who finished Y the 4-dose oral 7/9/2009 typhoid7/14/2009 vaccine (starting 9 Jul 0 n has been received from a nurse concerning Y a "70 - 80 year old" female with "unknown allergies" U and is6/13/2008 a patient in a rehabilitation hospita ound red spot size of a baseball on her Y arm. Middle was hard to the touch and very warm. This Y was in her 7/30/2009 left arm in 7/31/2009 the area of Chicken P seen @ urgent care) 2" diameter ofYredness around a knot - hard area decreases toward knee Y area with7/31/2009 egg size lump 8/1/2009 per parent. veloped redness and swelling of L thigh Y 24-48 hours after administration of vaccine. Pt. gotYhis 2nd Hep7/22/2009 A vaccine too early. (4 months af iven 8/4/09; Seen on 8/6/09 with 12cmx9cm Y localized reaction- red, swollen, warm with central urticaria. 8/4/2009 8/5/2009 sed erythema on L thigh, slightly tender to palpation. No fever, otherwise acting normal. Y 8/3/2009 8/4/2009 ECEIVING VACCINES, CLIENT FELT DIZZY. PATIENT OFFERED WATER AND HAD HERYHEAD DOWN 8/7/2009 BETWEEN 8/7/2009 HER LEGS AND C rash on trunk, shest, and upper back Y Y 4/28/2009 5/16/2009 d syncope ~ 10 min after receiving the vaccine. At the same time was watching her sibling having Y blood7/28/2009 drawn. 7/28/2009
DaP placed in Travel Clinic. Approx. 4 hrs later client began to feel "ache-y" and inj. site begab Y to swell and 7/29/2009 become7/29/2009 painful. Temp. 101 deg ceived Tdap on 07-31-09. Presented first on 08/03/2009 with fever 99.8 and local site erythema, N induration 7/31/2009 and mild soft 8/3/2009 tissue swelling. Fe ported that she received Zoster vaccine Y and developed redness around the site of injection. UShe reported7/6/2009 that three7/27/2009 weeks after receiving ion of Engerix B: 04/17/02. SecondYinjection: 05/16/02. Y Demyelinating 2 event:07/04. Y Emergency N room visit. 4/17/2002 CT scan and 7/7/2004 MRI with contrast. ived Menactra 8/6/2009am. At 2am on 8/7/2009 became suddenly ill with a high fever, chills,Yrapid breathing, 8/6/2009 and bad 8/7/2009 nausea. Family gave ness and diarrhea. Later, chills, rapid heart beat, fever, aches and pains. On the 6th, diarrhea, Y head ache. 8/4/2009 On 7th diarrhea 8/5/2009feeling better. pneumococcal vaccine trial, with severe COPD, Y was hospitalized for thoracic spine compression Y fracture 1/2/2008 (T8). Vaccination 1/15/2009 took place on 1 pneumococcal vaccine trial, with severe COPD, Y was hospitalized for left leg fracture. Vaccination Y took place 1/2/2008 1/2/2008. 5/10/2009 According to the ph pneumococcal vaccine trial, with severe COPD, Y was hospitalized for COPD exacerbation. Vaccination Y took 3/31/2008 place on 7/12/2009 3/31/2008. According pneumococcal vaccine trial, with severe COPDY was hospitalized for pneumonia. Vaccination Y took place on 10/13/2008. ### 6/1/2009 According to the p 6 mo immunizations on 7/28/09, mother called on 7/29/09 due to temp of 100.9 and red areaY on right thigh 7/28/2009 at site of7/29/2009 injection. pneumococcal vaccine trial, with severe COPDY was hospitalized for community-acquired pneumonia. Y Vaccination 1/15/2009 took 4/15/2009 place on 1/15/2009 Prevnar on 7/28/09, on 7/30/09 was seen in this office due to erythema around injection site,Yarea continuuing 7/28/2009 to spread 7/30/2009 and is hot and ten pneumococcal vaccine trial, with severe COPDY was hospitalized for community-acquired pneumonia. Y Vaccination 4/14/2009 took 5/29/2009 place 4/14/2009. A pneumococcal vaccine trial, with severe COPDY was hospitalized for small bowel obstructionYwith perforated cecum and peritonitis/Ventilato r ranging from 101.5-104 degrees fahrenheit, Y mild rash across back and neck and at point ofYinjection sight, 7/22/2009 decreased 7/29/2009 appetite, severe dro ceived Tdap. Approximately 5-8 minutes after receiving the vaccine, patient told mother sheYcould not see8/7/2009 or hear and 8/7/2009 she was dizzy. She after injection, arm became extremely painful, pt unable to move arm due to pain. Achy fromYhead to toe. 8/3/2009 Fever. These 8/4/2009 symptoms began to 0cm erythematous induration on leftYlateral thigh, non-tender to touch slightly warm. TreatedNwith clindamycin. 8/5/2009 Recheck 8/6/2009 in three days. after receiving Tdap client developed body aches, chills, fever of 102.2, headache, diarrhea. YSymptoms lasted 8/4/2009 about8/5/2009 9 hrs. round injection site. Hives day after injection. Y 8/4/2009 8/5/2009 .5, headache, chills, nausea, body aches, joint pain, fatigue, 2 days Y 8/4/2009 8/4/2009 e had a reaction, it was the size of aYgolf ball at the site of inj. and the size of grapefruit with big U whelps outside 7/29/2009 the inj. point. She said it wa leaving clinic after receiving Gardasil and varicella- event happened in clinic Y 8/6/2009 8/6/2009 follow-up information has been received Y from a medical assistant and medical records concerning N a 67 5/20/2008 year old female 5/20/2008 with arthritis in the n has been received from a certified medical assistant concerning an adult female patient who Y on an unknown### date was vaccinated ### with a n has been received from a registered Y nurse concerning a 67 year old female with asthma, cholesterol Y high, type ###2 diabetes ###mellitus, arthri n has been received from an RN concerning 70 year old female who on 16-Oct-2008 was vaccinated Y with a first ### dose of PNEUMOVAX ### 23 was reported by a healthcare professional andYdescribed the occurrence 1 of intussusception Nin a 2-month-old 7/8/2009 female7/15/2009 subject who was vacc was reported by a physician and described the occurrence of fussy in a 4-month-old femaleNsubject who was 7/2/2009 vaccinated 7/2/2009 with ROTARIX, (G was reported by a physician and described the occurrence of diarrhea in a 2-month-old female N subject who 6/26/2009 was vaccinated 6/27/2009with ROTARIX was reported by a physician, via a GSK representative and described the occurrence of vomiting U in a 3-month-old female subject who was was reported by a consumer and described the occurrence of diarrhea in a 2-month-old female U subject who was vaccinated with live attenu was reported by a consumer and described the occurrence of diarrhea in a 2-month-old female U subject who was vaccinated with ROTARIX was reported by a healthcare professional and described the occurrence of vomiting in a 4-month-old U male 7/20/2009 subject 7/20/2009 who was vaccinated wi ad fevers of 102 for 3 days. a rash on both legs and stoamic. stoamic pain. weakness, hoarse.and Y a little7/10/2009 wheezing. 8/3/2009 hurt, body red and itchy, mouth itchy, Y throat felt constricted. Reacted within 15 minutes after Y injection. Treated 7/31/2009 in ER7/31/2009 with epinephrine, Bena rritability several hours after administration, accompanied by pallor and clammy skin, poor feeding Y and sleeping. 8/3/2009This 8/3/2009 lasted for at least 48 d vaccination on a friday and had a Yhigh fever from Y friday until Monday 2 morning. He was staring Y into space 7/31/2009 body limp 7/31/2009 no reaction.doctor co chills, headache, head Ycongestion,Yblurry vision, Y dizziness, chest 12 pain, Y heart palpitations, Y congestive N heart 11/1/2006 failure, 11/2/2006 tinnitus, postural tachyc avoring right leg. Limitation at flexion Y and rotation of right hip due to pain. Y 8/4/2009 8/7/2009 nd numbness in both hands and feet for over 12 hours. Soreness at the injection site continues. Y 8/3/2009 8/4/2009 IENT'S FAMILY, PATIENT C/O TINGLING Y ON LOWER EXTREMITIES AND BEING VERY WEAK. N FAMILY 4/4/2009 CALLED DOCTOR OFFICE T Y Y vaccination (Hepatitis B) - Colic, sleeplessness, irritability. Same following next several Y vaccinations, N followed by ### cognitive### skill delays, spee t 6, 2009 my son recieved the Pneumococcal Vaccine. Four hours later he devolped a fever Y which lasted8/6/2009 for 2 days8/6/2009 and ranged from 101 eived 1st GARDASIL and 2nd VARIVAX Y vaccines afternoon of 8/5/09, experienced swelling Y of face, eyes,8/5/2009 throat, itchy 8/6/2009 and tingling in mouth rvous prior to receiving vaccinations and after 5th immunization pt stated "I feel weak". ColorYfrom lips went 8/6/2009 pale. Gave 8/6/2009 pt orange juice. Pt's eveloped hives all over her Y body. Her legs and hands are swallon. The hives are slowly spreading U to her face. 8/5/2009 Temperature 8/8/2009 since 08/08/08 n has been received from a physician concerning a 19 female patient who on 12-JUN-2009 U was vaccinated 6/12/2009 with the second 0.5ml dose of n have been received from the register Y nurse and Y a hospital central 15service technician, for GARDASIL, N a6/23/2009 Pregnancy7/22/2009 Registry product, conc
n has been received from a focus group researcher concerning a 17 year old female who was N vaccinated with GARDASIL. 4/1/2009 In April 2009, th n has been received from a physician Y concerning Y an approximately 17 year old female who N in 2007 was vaccinated ### IM with ### the first 0.5 ml n has been received from a consumer Y concerning her 18 year old daughter with no drug reactions/allergies N 6/16/2008 who was 10/1/2008 vaccinated with the fir n has been received from a Registered Y Nurse (R.N.) concerning herself (a 62 year Y old female) N with hypothyroidism 6/29/2009 7/10/2009 and no drug allergies w n has been received from a 73 year old femaleYpatient with blood pressure 0 high and sulfonamide N allergy10/1/2007 who in October 3/1/2008 2007, was vaccina n has been received from a 73 yearYold male patient with gastrooesophageal reflux disease N who on 24-JUN-2009 6/24/2009 was 7/23/2009 vaccinated with ZOS n has been received from a female registered nurse with reflex sympathetic dystrophy, Y cystitis N interstitial, allergic reaction to cefaclor and s n has been received for the Merck Pregnancy Y Registry from a physician for VARIVAX (Merck) U concerning 2/22/2008 a 33 year old 4/1/2008 female with cardiac ort received on 29 July 2009 from a Y health care professional. A cluster of two five year old patients U with a7/27/2009 history of speech 7/27/2009 delay and autism ort received on 29 July 2009 from a Y health care professional. A cluster of two five year old patients U with a7/27/2009 history of speech 7/27/2009 delay and autism administration of DTaP-IPV vaccines Y patient developed Y agitation and 1 difficulty breathing. She Y had been 7/30/2009 extremely combative 7/30/2009 during the im swelling 3 hour after Immun. Gave BENADRYL - No further swelling within next 1 hour. No Yrespiratory distress. 5/22/2009 5/22/2009 7/21/2009 unization, patient developed paresthesia Y of all limbs. 8/19/09 Neuro consults received dated N12/15/2008 with dx: ###Paresthesias ### of the hands & off X 4 days, rash on back and neck Y X 1 wk and spreading. Y 1/13/2009 7/27/2009 d 35 days post vaccination that sheYhad been diagnosed with chickenpox. Zosters cover body, Y concentrated 6/26/2009 on trunk, 7/31/2009 non-febrile. Treating ale fainted for seconds and fell back post vaccine admin. - head hit floor when fell - RequiredYlying in exam 8/4/2009 room until8/4/2009 able to get up withou LA lesions erupted 8/3/09. U 9/12/2000 8/3/2009 multiforme skin RXN. Y N 7/30/2009 8/2/2009 ther phoned at approx. 3:50 PM - States that after arriving home, patient was pale - "White as Y a ghost" & 8/3/2009 clammy. No 8/4/2009 hives, no problems b e - Induration at site of injection 5cm X 2cm - Erythema, tissue edema total area 10 cm X 10 U cm at injection 8/3/2009 site. 8/4/2009 ports pain at injection site and tight muscle since 7/25/09. No redness, no warmth, no swelling. U Patient advised 7/25/2009 to return 7/25/2009 to clinic or see PCP e, neck, back pain, nausea, fever, starting Y 12 hours after vaccine. U 8/4/2009 8/5/2009 eddened warm to touch, & with pain; swelling Pt stated "I am feeling better". "I did have a fever". U T 97.0. 7/30/2009 7/30/2009 welling, left arm bumps. Y 8/1/2009 eived MCV4 on 8/4/09 in left deltoid. On 8/5/09 client's left deltoid is sore, swollen and warm to touch. 8/4/2009 8/4/2009 nted and fell to the floor, soon after receiving immunizations. Y 2/13/2009 2/13/2009 d ZOSTAVAX on 7/16/09. Within seven days, she states she developed a blistery rash on both Y sides of7/16/2009 her face. Pt 7/24/2009 did not seek medical given on Aug. 4, 2009, went home started to have bilateral Jaw pain. Pain behind his eyes, zoning out per 8/4/2009 mom. 8/4/2009 followed by tingling in the arm/ hand. She then developed numbness/ tingling on some side Yface. Resolved 8/4/2009 overnight. 8/4/2009 len upper/forearm, warmth of arm of right arm lasted for 3 days - Swelling and redness started Y treatment7/31/2009 20 hours after 8/1/2009 immunization: cool es 7/27 went to ER CXR NL U/A - CxY negative - Went to clinic u/c 7/27 sent to another clinicY seen by doctor 7/24/2009 7-29-09 7/27/2009 - Hives under neck, d ea of redness, warm to touch right deltoid Y area at Tdap injection site, redness just noted today Y 8/7/09. Area 8/5/2009 of 11.5 mm 8/6/2009 x 12 mm area of re with assistance to floor. Posterior head was struck on fridge. Pupils dilated approx 7mm - ptYwas not following 8/4/2009 commands 8/4/2009 to squeeze hand ter received her 1st dose of GARDASIL IM. We then went to check out at the receptionist's window. My daughter fainted 8/4/2009 or had a stiffening chy muscles, fever warmth, a general feeling of weakness. Some fuzziness in my head. Drinking water and 8/4/2009 taking ADVIL. 8/4/2009 d/ raised area. Warm to touch with tenderness - ADVIL given by caretaker - Warm compressYapplied - reaction 8/5/2009 appeared 8/6/2009 8-6-09 to left arm. ped nausea, paleness, diaphoresis @ time of injection of VARICELLA #2. developed redness, Y swelling, warmth 8/5/2009 with tenderness 8/7/2009 and severe mild itchy scattered pruritic macules progressive increased until day of eval on 7/30/09 R armUinjection site7/7/2009 redness/includes 7/10/2009 multiple scatter ite red and swollen - Advised this is nl. U 8/3/2009 8/5/2009 d diffuse macular rash and chest pain. Positive cardiac enzymes along with normal ECG thought U developed 7/31/2009 myocarditis. 8/2/2009 Treatment was pa AFTER VACCINES- FATIGUE,FEVER,CHILLS, SLEEPING 12 HRS A DAY X 2 WKS, DOUBLE Y VISION 24/6/2009 WKS LATER, 4/7/2009 (R) PERIPHERAL rts that Friday (8/7/09)evening patient Y began itching her feet. She didn't make much of it and Y went to a friends 8/7/2009 to swim. 8/7/2009 She spent the follo d just received Tdap, Hep A, MCV4, MMR, & Varicella vaccines. He was sitting down waiting Y while his sister 8/6/2009 sat on the 8/6/2009 exam table waiting ts to HD 08/10/09 @ 800am with c/o of redness and itching, burning at site of varicella vacination Y to LPUA8/7/2009 SQ site from 8/7/2009 shot given 08/07/09 indications to vaccine on screening. Client give Tdap vaccination with father present and immediately Y reported 8/10/2009 dizziness. 8/10/2009 Her color was pi eft arm-deltoid area-was seen in ERYon Sunday, Aug 9th. Mother states was hughe yesterday. Y No c/o fever. 8/7/2009 Full ROM 8/7/2009 of proximal and dist N IPV AND MMR RIGHT ARM ON 08/05/209, Y RETURN BACK 8/06/20009 C/O TENDERNESS U AND WARM 8/5/2009 TO THE8/7/2009 LEFT ARM. BENADR high pitched crying x 3 days Y 6/10/2009 6/10/2009 swelling measuring 3.5 inches in diameter Y on left thigh. Y 8/5/2009 8/5/2009 redness measuring 6.5 in x 5.5 in, tenderness, Y and mild swelling. Y 7/28/2009 7/28/2009
-14 hours after immunization on 8-7-09; she experienced redness and inflammation at injection Y site, pain from 8/7/2009 ear down 8/8/2009 to wrist,fever,nause aised red welt formed the day after the shot, now gone down a bit but spread to 3X6 inches, N "almost elbow8/7/2009 to shoulder". 8/8/2009 Still a little warm to inutes after shots were given, client began to complain of "feeling funny with ringing in his ears Y and headache, 7/31/2009 diaphoretic 7/31/2009 and pale. Cool c days after the vaccine was administered the patient reports that she broke out in hives, all over Y her body6/22/2009 but consentrated 6/24/2009 on the abdomen Gardasil dose #2. Walked to waiting room and fainted. BP 118/60. Given ginger ale to sip.Y Denied dizziness. 8/10/2009 BP8/10/2009 recheck 5 minutes late vaccination Zostevax received Fri, 11AM, 8/7/09. Evening of injection, slight fever, muscle ache U down arm8/7/2009 to hand and 8/7/2009 up neck behind ear dministered May22, 2009. LMP June 14, 2009. Confirmed Pregnancy August 5, 2009 - 7.5Yweeks gestation. 5/22/2009 8/5/2009 crying for more than 4 hours non consolable Y and Swelling + erythema at the site of injection Y for PEDIARIX. 6/8/2009 iness, difficulty breathing, severe weakness, Y sleepiness, tremors all over the body, trembling, U electricity-like 7/17/2009 motions7/17/2009 all over the body, swo vaccine administered on 7/23/2009. First chicken-pox noticed on 8/07/2009. Subsequent chicken-pox Y developed 7/23/2009over 8/7/2009 the next 4 days on t ely following HPV#2 and Varivax #2 (10:45 am) patient fainted and fell forward off of the exam Y table and 8/10/2009 hit her Left 8/10/2009 cheek, ear and knee on d papular rash over entire body later on 08-06-09. No itching with rash. No redness, swelling N or inflammation 8/6/2009 noted at 8/6/2009 injection sites. Bena with mild erythema, 3cm with slight induration, Y non-tender. Y 7/20/2009 7/21/2009 vaccines on 07/29/09, Varicella on Y the right arm. 07/31/09 right arm is red, hot, swollen and Y painful, patient 7/29/2009 vomited,7/31/2009 dizzy and started to fa or 3 days left side around rib area, did drain some last PM. There has been some slight extension Y of lesions 7/30/2009 toward the 8/7/2009 back over the last c was reported by a lawyer via a statement of injuries and described the occurrence of neck pain U in a female subject of unspecified age who ythema, warmth, tenderness, slightly Y raised- "like Y skin was burning off", 2 Fever. 8/27/08 Hospital Y records7/31/2009 received DOS 8/1/2009 8/5/09 8/6/09. Asse rm, armpit, down side from armpit. 0 swelling. 0 fever. Pain started in arm - spread over the last couple 8/7/2009 of days. 8/8/2009 male ADSM/Specialist is referred toY FBVHC by SRC physician for smallpox vaccine inoculation Y site concerns. 7/31/2009 R/O satellite 8/6/2009lesions versus 9 Mild, other. Redness. 3 inch diameter, tender to touch. U 8/7/2009 8/9/2009 p R thigh covered by bandaid, red area (also raised) 39mm x 23mm @ widest point above and Y medial to7/27/2009 inject. site.7/28/2009 Inj. site sl. red (11x11 m Bradycardia - pulse < 40. Given oxygen. Y 7/27/2009 7/27/2009 given 7/20 including ROTAVIRUS. On 7/21 called about blood in the stool. Seemed well otherwise. Y 7/20/2009 pt rec'd KINRIX on L arm and VAX/MMR R side SQ, pt RTC for PPD reading 8/7/09 motherYshowed me L8/5/2009 arm stated8/6/2009 "It was worse, startin al notes: 19 y/o male who developedYmildly pruritic skin lesions over bilateral hands, primarilyYknuckles &1/29/2009 right palm, 2/14/2009 & bilateral elbows appr onset of LE and buttock purpura on Y8/5/09. Pt has developed subsequent hematuria. Pt hs been U diagnosed 7/27/2009 with HENOCH 8/5/2009 SCHONLEIN Pu accine in R DM. approximately 5 mins Y later pts inj. site turned red and had a dime size induration. Y Pt was 8/10/2009 then seen 8/10/2009 by Dr. me sized induration, quarter sized redness Y to R arm injection site, no dyspnea no SOB or swelling Y to other 8/10/2009 sites. 8/10/2009 indurated area @ site of vaccinationYleft thigh. Hives/ urticaria on 8/6/09. U 8/4/2009 8/5/2009 ost vaccine increase itchy rash red. No evidence infection 30 cm diameter circular. No rash Y other area. 6/29/2009 No joint pain. 7/9/2009 scribed red swollen extremity in R leg where vaccines were administered, pt had 4th DTaP and Y Hep A #27/1/2009 in R LE. Mother 7/6/2009 first reported to p m, swollen extremity where 4th dtap given, also fever and a hoarse cough (per mother) for one Y night. The7/1/2009 redness, swelling 7/6/2009 lasted several w nd was nauseated 7/29 eve. Continued with HA 7/30 and not feeling well. Pt had 2" red, swollen Y area at 7/27/2009 injection site 7/29/2009 with itching and vesic pneumococcal vaccine in office on 5/15/09. Y Calls office on 5/17/09 and is seen in Urgent Care. U Experiencing 5/15/2009 redness 5/17/2009 Lt deltoid, warmth rep t 5 PM lips started swelling. Called Y hospital at 5:30 had to leave message. 6:10 PM. Hospital Y nurse called 6/10/2009 treatments. 6/10/2009 Take 1.50 mg BEN icaria, and extreme erythema full body Y 1 day after Hep A immunization. Pt had no other abnlYpo intake. 8/3/2009 8/4/2009 rts swelling & redness in right shoulder within an hour. HEP A given there. Had low grade fever, Y next day 7/28/2009 102, went 7/28/2009 to school, come in 2 d X 14 cm red, warm to touch rash developed Y 24 hrs after injection to HIB & DTAP. Y 8/3/2009 8/4/2009 vaccine administered with 5/8" needle to left upper arm @ approx 11:10 AM. Pt left exam room Y @ approx 8/4/2009 11:20 AM and 8/4/2009 used bathroom. Pt d nasal swelling, throat clearing, pruritus Y Y 7/22/2009 7/22/2009 ul. States on 7/2 her Lt. arm (deltoid) was twice as large as other arm, very red, very itchy. Came Y to Employee 7/1/2009 Health7/2/2009 7/3 - we were closed hours the pt. developed erythema at the site of injection- (R) tigh. The erythema increased inUsize to 12x10cm 8/3/2009 with small 8/4/2009 area of induration redness, warmth @ site of VARICELLA - pt denies tenderness - warm compress applied perYmom 8/5/2009 8/6/2009 n has been received from a consumer Y regarding a case in litigation concerning herself (a female N patient of unknown age) with no drug aller n has been received from a physician Y via medical Y records concerning 0 a 20 week old premature U (WAES #0707USA01443) 11/7/2007 1/1/2008 male with a histo 8/3/2009 N 7/28/2009 8/3/2009 - admitted 7/31/09 for 24 hour ear infection. Y Treated Y with oxygen, albuterol, 1 atrovent, steroids Y and amoxicillin. 7/25/2009 9/8/09 7/31/2009 Hospital records rec MR given with Hep A, Hib, DTaP, PCV-7, VZV - 5/28/09 - Rash after fever - 6/02/09 - Vaccine Y reaction noted 5/15/2009 with rash, 5/15/2009 fever. en an MMR vaccine 2 days prior to being administered Yellow Fever. No adverse s/s. Will do U Yellow Fever 6/17/2009 titer in 30 days (one month) wh slightly red and tender. 8/4/2009 8/5/2009 shaking chills X 16-17 hrs after vaccinations Y given. Y 7/31/2009 8/1/2009
ccine on 7/31/09 in late afternoon. Pt. Y then started Y with fever and had 2 febrile seizure early 8/1/2009. Y 9/4/09 7/31/2009 Received 8/1/2009 ER records of 8/1/20 wollen, tight 24 hours. Y 8/4/2009 8/5/2009 Y 8/3/2009 8/3/2009 s post immunizations pt.'s face and Yeyes began swelling. Hives on chest. Taken to ER. Given Y IV fluids. 8/3/2009 Prescribed8/3/2009 PREDNISONE & BEN eft hip pain at injection site which restricted ability to walk for 4 days then moderated. Chills, Y hot flashes for 7/26/2009 7 days. 7/27/2009 Did not experience feve area (4 cm X 6 cm) below needle site Y (left upper arm) - Slight bruising (1 X2 cm) beneath needle U site warm 8/1/2009 to touch, 8/3/2009 slight swelling of red a and slight swelling below area of injection (not warm to touch) "slightly painful", says Pt. 8/1/2009 8/4/2009 Sick call with headache after Small Pox Y Vaccine 4 wks ago and papular rash all over body x 6Udays. No fever 7/2/2009 / chills.7/26/2009 Ibuprofen for headache h department, in car-driven by sister and their way home. Pt stated didn't feel good, sister noted Y body stiffened 8/3/2009 - muscle 8/3/2009 became tight and s ithin 2-3 minutes after given vaccine, Y observed here for 60 minutes the sent to E.R. 8/6/2009 8/6/2009 09 approx 10:10 AM vaccines administered Y tolerated well - nurse assisted client and motherYto supply room 8/4/2009 to receive 8/4/2009 health information m d "tiny red bumps" on arms, legs - None Y on back or stomach - itching - Unknown fever - to ER Y 7-25-09 - Rx 7/17/2009 Amox. 500mg 7/22/2009 tid x 21d. vomiting, grey skin tone. Syncope lasted Y ~20 sec, patient came to and combative, then began Y vomiting intermittently 7/29/2009 7/29/2009 and skin tone grey X 01 degrees F, myalgias, chills, headache, Y and arthralgias N 8/4/2009 8/5/2009 hrs after receiving vaccine (R) upper arm became swollen, warm, red, and itchy. It continuedYto progress7/30/2009 and pt returned 7/31/2009 to MD to evaluate algias, rash 24 hours post injection. Tx'd with PREDNISONE - developed fever & myalgias - Y After 1 wk resolved 7/27/2009 except 7/30/2009 left wrist pain. ped marked redness and swelling at injection site (about 10cm X 5 cm) Y 8/4/2009 8/5/2009 es, fatigue, blisters inside mouth, swollen Y glands, sores on lips and gums, swollen lips. 8/4/2009 8/5/2009 ollen, red, hot over entire arm; developed within 24 hours after vaccine. Y 8/7/2009 8/8/2009 MENACTRA 7/24/09. Felt bad the next Y A.M, with headache. -Progressing to HA - with feverY103.0 degrees 7/24/2009 F orally.7/25/2009 Went to ER on 7/26/09 arrhea w/in 48 hrs. of 3rd vaccine, vomiting, Y chronic fatigue, headache, abdominal pain, heart N palpitations, 6/25/2009 sensitivity6/27/2009 to light & noise. All ex d HEP A & VARIVAX on 7-29-09. On Y 7-30-09 Pt went to ER for a 5 X 2 cm wheal where VARIVAX Y was7/29/2009 given. Pt was 7/30/2009 afebrile. It resolved ying episode lasting > one hr, refusal to feed X 4-5 hrs. Pain - type cry, no coloration changes Y (occurred7/30/2009 4 hrs post 7/30/2009 vaccines). TYLENOL a 9, Pt. was administered tetanus tox. 0.5ml to (R) deltoid tolerate well. Pt. RTZ on 8-3-09 withYc/o inj. site 7/27/2009 was swollen,8/3/2009 red, tender. Noted 9c mild erythema of injection site left upper arm (6 cm X 6 cm). No fever. Very tender. Suspect Y edema closer 7/14/2009 to injection 7/15/2009 site of DTAP. ted to clinic today one day post PPD plant and varicella vaccine, with multiple large area of edema Y that appeared 8/5/2009to be 8/6/2009 mosquito bites, pos ped large red area around injection site -MOC describes as the size of a tennis ball. U 8/4/2009 8/4/2009 loped fever 103.4 given AX TYLENOL Y + a bath + noticed jerking spell x 2 lasting 2-3 seconds. Y Taken to 5/4/2009 ER w/ temp 5/24/2009 103.4 in ER had a se swelling, redness, itching in arm. Just above injection site to the elbow, inside of arm is veryNitchy. Mild fever 8/1/2009 & very8/1/2009 tired. Slept for 12 hou around injection site. Swelling. Probable Y cellulitis. Rx: KEFLEX 250 /5ml one tsp po TID #105. Y 7/30/2009 7/31/2009 , Pt was brought in by her mother. Pt had a red & swollen arm. L arm. She had her immunizations U on 8/4/09. 8/4/2009 8/5/2009 ediately c/o light headedness and tingling of both hands. Became semi responsive. BP 70/50, Y O2 applied, 7/27/2009 clammy and 7/27/2009 pale. 1135 was to w accine administered Friday, July 31st, 2009 normal burning sensation, discomfort experienced immediately. 7/31/2009 Next day,8/1/2009 Saturday AUG 1st, n 15 minutes after receiving vaccines child told mother, thet had already left the clinic, that herYthroat huet 8/10/2009 and she was 8/10/2009 having trouble breath deltoid, 7x7" distal, increase heat at injection site, central area large. Tx: Benadryl spray, claritin U 10 mg oral, 8/3/2009 ice to area 8/5/2009 hot and red on anterior left thigh approx. Y 5" x 3" in diameter. Seen at ER, given Benadryl andUBactrim. 8/4/2009 8/4/2009 ted redness, swelling, and itching of child's right upper arm a day after receiving vaccinations. Y Called MD.8/8/2009 Instucted to 8/9/2009 put ice on area and as given vaccines in AM and later inYevening developed fever to 104.9. Also had some abnormal Y "twitching" 8/10/2009 of body8/11/2009 that was able to be su sodes of numbness and tingling of left arm and leg unrelated to the site of administration. thisYshot was given 8/7/2009 in the right 8/9/2009 arm. It was her 4 t 2Pm Shots. Fever - mid. of night (not Y extreme acc. to Mom). Total of 4 doses tylenol from shots Y til morning 7/29/2009 of 7/30/09. 7/30/2009 Then did not need 03, tachycardia, flushing of face within Y 1 hour of vaccine administration. No hives, wheezing, Y angioedema, 8/11/2009 vomiting, 8/11/2009 or hypotension. Trea g on arms and legs. Fine red rash seen on tops of arms. Y 8/11/2009 8/11/2009 ed body aches, elevated temp of 102 Y to 102.5 began @ 2am after receiving tdap; 1 gm Tylenol U initially brought 8/10/2009 temp8/11/2009 down to 101.0; pt then and erythema at the injection site beginning Y within 24 hours after the injection and subsidingU 4 days after8/7/2009 the injection, 8/8/2009 though still present. 104.8 starting ~36 hours after vaccine Y administration, febrile seizure ~48 hours after vaccineYadministration. 8/7/2009 8/9/2009 patient. States had pain right away from Y TDap vaccine. Awoke next day with swollen lymph nodes. U Now 88/3/2009 days later pain 8/4/2009 is worse in arm. C d HPV4 vaccine injection on 8/7/09 at about 4:30pm. She developed a 4-5 inch diameter area Y if hives around 8/7/2009 the injection 8/7/2009 site at about 9pm ven kindergarden immunizations, ( did not even cry) we talkesd about what she was going to do now . I left 8/11/2009 the room8/11/2009 as I was finished. fathe odes of malaise, headache, nausea,Yfever, joint pain starting about 8 hours after vaccine administration. N 8/10/2009 Second vaccine 8/10/2009 was given with Be and very warm to touch. small amount Y of swelling. Fever of 101 degrees F. Girl just wantsUto lay on couch 8/10/2009 states8/11/2009 mother. Rapid Heart Rate, Excessive Sweating, Y Shortness Y of breath. Dehydration. 1 Had to go to hospital and have 11/3/2008 my baby11/7/2008 montored as I was pre
hepatitis B vaccine at employee health Y and 15 minutes later developed urticaria. Was treated Y at the ED which 7/22/2009 is adjacent 7/22/2009 to employee heal h day after shot patient ran fever during Y the day and very high fever during the night. 10th day U after shot7/31/2009 she began to 8/8/2009 have a rash along w 3-4 MIN AFTER ADMINISTRATIONYPT STATED SHE WAS DIZZY THEN SLUMPED OVERY HER CHAIR 8/11/2009 FOR 5-10 8/11/2009 SEC. SAT BACK UP Bile stained. AbdominalY pain. Anorexia. Y Air contrast Y enema + Abd.1X ray + Abd ultra-sound.Y 8/24/09 Hospital 7/31/2009 records 8/6/2009 received DOS 8/6/0 of hours after 1st shot, my left knee (which I've had 9 surgeries on, synvisc injection, and is arthritic) Y swelled 7/27/2009 up very7/27/2009 large far 5 days straigh cm left arm swollen with redness - ice arm every 2 hours per provider - RX given (TYLENOL). U 8/8/2009 8/10/2009 ter vaccination pt developed a feverYand her tongue and throat began to swell." TX: "Prednisone, Y cimetadine". 8/3/2009 - Pt tx8/5/2009 in ER. - Pt reported th ately 24 hours after receiving both TDAP and MENACTRA in left arm patient presented to clinic U with 8 cm 7/28/2009 X 8 cm area 7/29/2009 of induration, warmt ite reaction- 1/2 dollar sized, warm to touch, itchy. U 8/3/2009 8/5/2009 ite reaction - 2.5 inch diameter, hot, itchy, red. U 8/4/2009 8/6/2009 ythema of head, chest, arms and swelling of lips within 10min of receiving vaccine. He was given Y 20mg BENDRYL 8/10/2009 p.o. 8/10/2009 and EPI-PEN JR 0.1 15 min's developed hives at the injection sites. Resolved with ice and BENADRYL. Y 8/10/2009 8/10/2009 pper lat leg - VARIVAX - 4 d ago. Redness- serpentigenous. U 8/7/2009 8/8/2009 erythema/induration w/ spread. Y 7/29/2009 7/30/2009 7/31/09- R. arm hives that spread to back and around down legs. Sat and Sunday felt nauseous Y and feverish. 7/31/2009 No documented 7/31/2009 fever. Mond tous, indurated are 4.5 x 4.5" on R arm with no tenderness. No fluctuence. Y 7/29/2009 7/30/2009 arted coughing, wheezing, had facial swelling, hives. Pulse 0X 93%. Given 1 1/2 Tap BENADRYL, Y ORAPRED 7/31/2009 2 TAP 7/31/2009 X1, EPINEPHRINE hematous swelling of the left arm. Y Y 7/27/2009 7/28/2009 redness at injection site. Fever X one day and body aches. Y 7/13/2009 7/15/2009 edema/erythema. Y 8/5/2009 oped swelling of and erythema around injection site on right thigh. Swelling at maximum ~ 5 Y inches by 4 inches 8/5/2009 on 8-7-09. 8/6/1999 Erythema began ately 5 minutes after vaccines were Y given, child collapsed to the floor. She took a hard blow Yto the back 7/23/2009 of her head.7/23/2009 Regained consciousn vaccines on left arm (DTAP, IPV, VARICELLA) 7/28/09. Mom reported one day later adverse reaction. 7/28/2009 Nurse practitioner 7/29/2009 examined and n ain at injection sight in left arm. Arm Y red hot to the touch. This occured after 36 + hours after initial N injection 8/10/2009 of vaccine(s). 8/10/2009 Nausea and contin vaccine on 10-18-26 onYthe adviseYof my Doctor. Y I noticed no adverse 40 Y effects until 01-17-2007, U when my wife### discovered 1/17/2007 me down on the ised splotches appeared on babie's chest and abdomen exactly one hour or so after the vaccine Y injection 8/10/2009 on babie's8/10/2009 left front thigh. The sp but pain from the shoulder joint to wrist of the arm the inj. was given. difficult to lift coffee cupUthe next morning. 8/11/2009 pain8/12/2009 is a 7 on a scale of 1-1 LTOID 6 X 8 CM OF ERYTHEMA, WARMTH, IRRITATION (PRURITIC), AND INDURATIONYSURROUNDING 8/3/2009 TDAP 8/5/2009 INJECTION SITE. PT Varicella vaccine on June 22, 2009. Was diagnosed with Shingles on August 7, 2009. U 6/22/2009 8/4/2009 utes after injection client experienced itching at injection site. After about 2 hours had itching Y all over and8/3/2009 had rash on 8/3/2009 cheeks. Took bath i n has been received from a physician Y concerning Y a 14 year old female 1 with no pertinent Y medical N history 1/10/2009 and no known 5/4/2009 drug allergies (NKD n has been received from a nurse concerning Y a child with asthma who on 06-AUG-2009 wasUvaccinated with 8/6/2009 a dose 8/6/2009 of VARIVAX (Merck) ( , dizzy, nausea weak next day. 8/5/2009 8/6/2009 ted to clinic on 8/11/09 with history of Y blisters X 2 d. Fever 100 - 101 AX. Exam revealed approx. U 80 - 100 2/19/2009 vesicles primarily 8/9/2009on the torso. use swelling/redness of (L) arm within Y 24-48 h after vaccines. Seen in ED for evaluation. Y 8/6/2009 8/7/2009 eadache and low grade temp lasted approximately 24 hours. Sx started about 12 -15 h after shot Y 7/30/2009 7/31/2009 imately 2.5 + 2.0 erythematous indurated Y area around injection site from evening of injectionUat site of PREVNAR 8/4/2009administration. 8/6/2009 2) 48 hou n before realizing patient had one on 8-18-08. Y 8/6/2009 ven 4 go shots (DTAP, IPV, MMR, VZV KINREX) 2 days ago L arm developed redness and induration Y with 8/3/2009 elevated warming 8/4/2009with mild tend o injection sites 2 1/2 cm. Increased T. Y 7/30/2009 7/31/2009 ye doctor = pt thought she had another stye, but eye doctor told her he thought it was shingles Y because 7/24/2009 it was past the crease in her eye fo swollen, warm to touch. Skin very tight. U 8/4/2008 8/5/2009 swelling thigh - 10 cm swelling to (L) thigh - 20 cm swelling to (R) thigh - BENADRYL susp. 3/4 Y tsp PO - SOLUMEDROL 7/30/2009 7/31/2009 0.38cc IM of four patients (patient identifiers were not provided) received ADACEL (lot number UF452AA) Y on an unspecified 8/13/2008date. 8/14/2008 All patients develop of four patients (patient identifiers were not provided) received ADACEL (lot number UP452AA) Y on an unspecified 8/15/2008date. All patients develop serious case was received on 30 April Y 2009 from a health care professional. A cluster of fourYpatients (patient 8/14/2008 identifiers 8/15/2008 were not provided) serious case was received on 30 April 2009 from a health care professional. A cluster of fourYpatients (patients 8/11/2008 identifiers 8/12/2008 were not provided veloped severe and longlasting yeast infections after first and second dose of Gardasil. Doses Y were given 8/11/2008 2 months8/26/2008 apart. Gardasil #1 08/ vaccines were given, pt was taken to hospital for seizures. Hospital states that they do not believe Y that the 6/18/2009 seizures6/19/2009 are related to the vacc d Zostavax on 08/10/09 at 9:30am. She noticed area of injection site was red and itchy on 08/11/09 U in AM. 8/10/2009 Today (08/12/09) 8/11/2009she has eryth ates the child had "vomiting, slight fever, and alot of bleeding". Grandmother called in on 8/11/09 to report. 8/10/2009 Grandmother 8/10/2009 not sure if she will
to parents child had decreased babbling after admin of PCV7 vaccine. Resolved on its own.YNot witnessed 4/24/2009 by anyone 4/24/2009 in this office th symptoms c/w partial seizure vs. hypotonia, Y hyporesponsiveness.1 Almost immediately after Y recieving her 8/7/2009 6 mo immunizations, 8/7/2009 episode w c'd 6 immunizations here in clinic. After standing waiting about 4 min. she felt dizzy, sat down, Y rested, wet8/6/2009 paper towels 8/6/2009 on face and neck. R immunizations. Waiting for the 15 minutes with his sister. He saw her get dizzy as nurse sat Yher into chair,8/6/2009 then he fainted, 8/6/2009 bumped his hea arms, trunk, back, neck U 8/3/2009 8/4/2009 swelling at injection site, exteding 2 inch diameter. Mild tenderness U 8/10/2009 8/10/2009 ven Zostavax to LUE on 08/06/2009Yand presented to office 6 days later on 08/12/2009 w/ possible U shingles 8/6/2009 lesions8/12/2009 to RUE. Pt presented a ow-grade fever (100.2 orally) that night, Y then thigh pain the next day, then rash and swelling Ythe day after8/10/2009 that. I examined 8/11/2009 him 8/12/09 and 00.0,joint pain, body aches Y 8/10/2009 8/11/2009 as sent to the nurses station to receive Y a Gardasil, Menactra, and Tetanus shot. She received Y all three, and 8/12/2009 was asked 8/12/2009 if she felt okay, rep ssed out about 5 minutes after receiving both Gardisil #3 and Hep B #2 immunizations. Came Y to rather quickly 8/5/2009 after cold 8/5/2009 compresses were perienced vomitting approximately 10 mins after recieving vaccines. Vaccines were administered Y at approximately 8/12/2009 8/12/2009 12:30 pm. WOKE UP LAST NIGHT, 08/11/2009, TEMP OF 104.0 C/O HEAD, NECK AND MUSCLE PAIN 8/11/2009 8/11/2009 GIVEN AN EXTRA IPV NAD TDAP BEFORE DUE Y 8/6/2009 er receiving Zostavax patient came to the pharmacy with 3 shingles at the injection site and U 1 shingle on her 8/7/2009 belly. 8/10/2009 Patient said they aren't e shaky and nauseuos within a few minutes. She got 3 hives. BP 125/65 pulse 93, No wheezing Y or trouble 8/12/2009 breathing. 8/12/2009 25 mg of benadryl w eizure 8-11-09 Seen in ER and air lifted Y to Hosp. Y 8/28/09 MR received 2 for DOS 8/12-13/2009Uwith D/C DX: 8/10/2009 Convulsions 8/11/2009 NEC. Neurologist d ed 2 days post vaccination for ppd reading with erythema, edema, heat and site pain. advised U cold compress 8/10/2009 for 10m 8/10/2009 on and 10m off x4 h s very red and swollen. It is also under Y the area. Two areas are effected. This happend the last U time he got 8/10/2009 shots. It8/10/2009 is also painful. It felt lik was reported by a physician, via another Y manufacturer Y (Amgen, # KDL345560) 0 and described U the occurrence ### of bone 4/23/2009 marrow failure in a 2 te abdominal pain then syncope with decreased Y body temp (95). In 4ER, LP and bloodwork concerning Y for shock, ###no infection ###found. Stayed pain at site of vaccine 8/6/09 - Seen 8/11/09 - (L) anterior thorax- diffuse erythema with vesicles. U 8/4/2009 8/6/2009 iving 4 mos. vaccines child developed hives - Mom gave 1/2 tsp BENADRYL x 1 dose hives Ydisappeared8/11/2009 came in for 8/11/2009 office visit on 8/12/09 er, called this RN at 12:15pm and stated Y that daughter's left arm from shoulder to elbow is red, swollen,hot 8/10/2009 to the touch 8/12/2009 and the skin looked dness; Itching and warmth around MMR vaccination site. N 8/10/2009 8/11/2009 icaria appears 2 days after completion of oral typhoid vaccine. Patient started oral vaccine or U at home on7/22/2009 8/1/09. 8/10/2009 njection site with vesicles, warmth redness. 8/10/2009 8/11/2009 @ injection site by day 2 after administered Y HEP A & VARIVAX on same thigh developed redness, Y welt's, 7/30/2009 itching; developed 7/31/2009into cellulitis b administered R upper arm, after a few Y minutes later client slumped over, non responsive, body, Y arms became 7/31/2009 rigid, hand 7/31/2009 fisted with some tr lump to site fever 103.4. Rash all over left leg. 8/10/2009 8/11/2009 d DTaP left deltoid at hosp on 8/9/09 Y c/o redness 3in x 3in with swelling at site of injection. Assessed U by PA, 8/9/2009 local allergic 8/9/2009 reaction. Treatme n has been received from a nurse and Y the patient's mother concerning a 24 year old female Ywith migraine 6/29/2009 & depression, 7/30/2009 no known drug all n has been received from a consumer Y concerning Y her 14 year old daughter 4 who was in the remission N of rheumatoid 6/9/2009 arthritis, 6/9/2009with allergies n has been received from a physician concerning a 22 year old female patient who was vaccinated U with the series of GARDASIL, 0.5 ml an n has been received from a physician concerning a 23 year old female patient who was vaccinated U with the series of GARDASIL, 0.5 ml an was received from a health professional Y on 31 July 2009. SERIOUSNESS CRITERIA: OTHER-MEDICALLY Y 7/18/2009 SIGNIFICANT. 7/19/2009A 37-year-old ort received on 07 August 2009 fromYanother manufacturer who received the original information Y from a consumer through their call-in cente eption. Vaccine give 7/22/09, 8/3/09Y- decreased Y p.o intake, vomiting, 2 temp 99.8. 8/5/09 - persistent Y vomiting, 7/22/2009 no stool8/3/2009 --> to Emergency Ro was administered, patientYbecame dizzy 30 seconds after shot. Patient was pale, diaphoretic Y & nauseous. 8/4/2009 Symptoms 8/4/2009 lasted about 45 min ately 20 seconds after the GARDASIL with no warning she passed out and became unresponsive Y for 10 seconds. She was very pale, diap d out in lobby after receiving vaccine, Y pt. said hit head on floor. Sent to ER for treatment. Y 7/30/2009 7/30/2009 d PCR positive for pertussis 7/28/2009 Y 10/2/2007 7/28/2009 quired pertussis (positive PCR on 7/16/2009) Y 4/25/2007 7/16/2009 ped pertussis (PCR positive) on 7/23/2009) 7/2/2008 7/23/2009 quired pertussis and was PCR positive on 08/10/2009. Y 1/5/2009 8/10/2009 ately 5 minutes after injection, pt began Y complaining Y of shortness of 2breath Y and her throat closing U up. She 8/12/2009 was brought 8/12/2009 back to the exam ro d pertussis and was PCR positive on 08/10/2009 Y 9/11/2006 8/10/2009 quired PCR positive pertussis on 8/6/2009 Y 5/11/2006 8/6/2009 ately 5 minutes after receiving injection, Y patientYbegan complaining of 2 shortness of breath and Y that her throat 8/12/2009 was closing 8/12/2009 up. She was brou t site of injection (right shoulder): 2- or 3-inch diameter raised area of redness, soreness, tenderness. Y 7/21/2009 7/23/2009 patient reported some swelling afterYfirst day, which progressed to the left upper arm down to Y mid forearm 8/10/2009 swelling 8/11/2009 with edema. Pt was see
ped shingles 8/12/09. N 3/10/2009 8/12/2009 ported to us on 8/5/09. She had a seizure Y 2 mins after 2nd GARDASIL Injection. Y 8/13/2007 11/1/2007 e of injection became hard, swollenYand very hot to touch. Rash all over body with high fever. Y 4/10/2009 4/12/2009 d 8/5/09. Projectile vomiting 8/6/09. Listless behavior 8/7/09. U 8/5/2009 8/6/2009 ed area on left upper thigh tender to Ytouch, warm. 8/5/2009 8/5/2009 er admin - diffuse trunk papular rash - no vesicle no itchy; pt opted for antihistamine Rx alone Y - no steroids. 7/31/2009 8/6/2009 perienced dizziness and nausea appox: 5 minutes after vaccination. Patient was placed on Yback w/legs7/23/2009 raised for 15 7/23/2009 minutes. Nausea an high fever (104 Rectal), headache, Y pt seemed "out of it" per mother. Started through the night Y 7/14 to 7/15/09. 7/14/2009 Went to ER for Eval on 7/15 Tdap & Varicella L arm 7/29/09. Developed Y pain & swelling to the size of a baseball per mom Y seen in ER 7/29/2009 with diagnosis 7/29/2009 cellulitis. Put on C diameter erythema with minimal edema feels hot. Suggested TYLENOL every 4 hours prn Y & cold compresses. 8/5/2009Mom does not want to use . Mother called Health Dept. today to Y report that child had been checked at hospital after calling Y nurse hotline 8/6/2009 after hours. 8/6/2009 Evening of vaccin tions listed below given in the afternoon Y of 8/5/09. The next morning child reported a headache, Y stomach8/5/2009 ache, was 8/6/2009 febrile (mother did not me in on 7/27/09 c/o soreness left arm, neck and back. She said swelling, muscle soreness,Yfatigue, low7/24/2009 grade fever, 7/25/2009 no energy. I looked a m red papules with surrounding erythema scattered in a 3 cm patch on right upper thigh; itching. Y 7/24/2009 7/31/2009 ZOSTAVAX injection at a pharmacy. In a few hours, I got a terrific headache that lasted until 8/7/2009. The 7/27/2009 right top7/27/2009 of my head felt extreme the ZOSTAVAX on April 18, 2008. Two months ago, I started feeling a burning sensation in the skin on 8/18/2008 the left side of 4/3/2009 my back. It progress hours after DTaP + IPU given in leftYarm, it became swollen, red, hot, indurated approximately Y 13 x 13 cm.5/1/2006 No fever.5/2/2006 adace and stomache slef resolving after 24 hours Y 8/10/2009 8/10/2009 ceived 4 immunizations on 8/7/98. Mother called after hours nurse on 8/8 to report her daughter Y had developed 8/7/2009 a reaction 8/8/2009 on her right leg. Tmax of 103, soft tissue swelling, erythema, and warmth of overlying skin at site of vaccine administration. Y 8/11/2009 +Fatigue.8/11/2009 ed feeling lousy, muscle aches, andYtemp of 102.3 10 days post vaccination. On day 11, presented Y to immunization 7/30/2009 8/9/2009 clinic with temp of 100 sh and swelling, similar to a hive, silver-dollar sized...appeared at least within 48 hrs of immunization U 8/11/2009 8/13/2009 swelling, cool compress. Y 7/20/2009 7/23/2009 & swelling of arm. Cool compress 7/20/2009 7/23/2009 d a 4x4 in erythematous, warm area with vesicles noted centrally no fever. 8/10/2009 8/11/2009 of HEP A gave pt. "severe stomach cramps and diarrhea". Symptoms lasted 2 days per mother. Y 2nd dose 8/5/2009 gave patient 8/5/2009 the same stomach vaccine given @ 12 months, and PCV7 #5 given @ 15 month of age. (Accidental extra PCV7 Y administration). 7/17/2009 r, accelerated heart rate, muscle aches over whole body, swelling under arm, vomiting, headache, Y some diarrhea. 8/5/2009 Felt 8/5/2009 better after 3 1/2 day came very dizzy, nauseous immediately Y after vaccines given, eyes fluttering back. Her syncope Y lasted >15 8/11/2009 min; EMS 8/11/2009 called transported to called health center on 8-11-09 stating child had reaction to immunization. Red with swellingNper provider 8/10/2009 informed 8/10/2009 pt mother to apply ice to ite reaction- erythema, warmth and swelling 3cm induration, non tender to palpation and notUpruritic. 8/12/2009 8/13/2009 vaccine given in left arm and Hep A given in left deltoid IM on 6/15/09. Presented 5 days laterY with itchy bumps/ 6/15/2009 vesicles 6/20/2009 starting on arms, th mmunization and within five minutes had localized swelling and redness. Had provider examine U pt ordered 8/10/2009 Ice to arm 8/10/2009 applied x20 minutes. ness right upper arm. Y 8/11/2009 8/12/2009 hroat scratchiness Y 8/8/2009 8/8/2009 k was done as a routine physical one Y year after vaccine was distributed and the patients blood U platelet count 7/27/2007 was at1/12/2009 a low of 90 (normal ran ceived third dose of series for RabAvert vaccine due to rabies exposure. Patient had no reactions Y to first8/10/2009 two doses.8/10/2009 On third dose, patient of lesions on body 7/24/2009 8/7/2009 the following vaccinations today (at approximately 1545)including Tdap, MCV4, HepA, Varivax Y and HPV.8/13/2009 The patient 8/13/2009 stood up from exam t 9 Caregiver noted a red area on R arm Y when doing morning cares this am. Presented to HDUwith reddened 8/6/2009 area with 8/13/2009 irregualr borders betw ven Smallpox vaccine and Anthrax vaccine. Pt did not know that she was pregnat at time of vaccine Y 7/15/2009 8/7/2009 er 1-09 4 month shots of DTaP(with Hib/IPV/Prevnar/Rotatec) had about 48 hours of neurologic Y symptoms 1/8/2009 (namely poorly 1/9/2009 responsive, no s rm, Muscle Aches, 100 F Temperature, restless sleep. Y 8/12/2009 8/12/2009 swollen & red. U 8/11/2009 8/11/2009 s swollen & red. U 8/11/2009 8/11/2009 d office child screaming (uncontrollable) High pitched cry. Y 8/11/2009 8/11/2009 Swelling of left arm where shot was given: local inflammatory reaction to DTAP #4, r/ ocelliclitis. U 8/10/2009 8/12/2009 ew seconds body stiffened face flushed. Y 7/13/2009 7/13/2009 ight arm, right leg and abdomen. 2 days after vaccine given, given BENADRYL by mother, hives Y confirmed 8/10/2009 by their 8/12/2009 specialist. Not seen by theaded and was pale. Y 8/13/2009 8/13/2009 ed, Warm, Size -->1.5 in diameter Y 8/12/2009 8/13/2009
ction: swelling, redness, warm to touch; Y 5 cm in diameter - left arm. Y 8/10/2009 8/11/2009 low grade temp and red spots, treated with Zovirax ointment. Y 3/27/2007 8/13/2009 PM- vomited - (crying since receiving vaccines). 3:45 PM- redness around mouth. 3:50 PM- Ybreathing S.O.B. 8/12/2009 4:40 PM8/12/2009 lips swollen. 7:15 P Y 7/22/2009 ived immunization 1 on 8-11-09 & mother reports on 8-12-09 in AM (L) thigh became red & inflamed Y a injection 8/11/2009 site.8/12/2009 Child would not move r (trapezius muscle) enlargement. Y U 8/11/2009 8/13/2009 ely following HPV injection, pt. experienced syncope. Pt. was seated, fell to the to the right side, Y and struck 7/29/2009 the right 7/29/2009 side of her head on the ought pt into clinic on 7/24/09 (9 days Y after vaccines were administered) c/o bruise and lumpUon R upper 7/16/2009 leg down to back of knee. Dr and n swollen & red. U 8/11/2009 8/11/2009 me in with ~24 hr history of rash, starting Y at L abd, then increased and spread central to extremities. U Pt : multiple vesicles (>200), primarily ound injection site swelling onset day Y after injection. Y 7/30/2009 7/31/2009 Pt returned with reddened nodes allYover the body. Seen at ER. Please. see accompanying ER Y records. 8/11/2009 Per Dad, Pt8/11/2009 is getting better nodes ear old USAF services member reported Y receiving five Anthrax (AVA) vaccinations in 1999 with Y no remembered 5/13/1999 adverse 11/1/2000 events. He reporte d with R OM 7/22/09, put on Amoxicillin. Had Hib and Hep A boosters 8/3/09. Developed redYrash, hives 8/5/09, 8/3/2009 progressed 8/5/2009 to petechiae an ious spontaneous report of wheezing and fever has been received from a nurse concerning U a four-year-old 9/3/2008 male subsequent 9/3/2008to FLUMIST. ious spontaneous report of vomiting has been received from a registered nurse concerning aUfour-year old patient ###subsequent ### to FLUMIST labeled spontaneous report of fever, headacheYand non-serious body 1 aches, cough and vomiting Y has been received ### from ### a nurse for a nine ious report of expired dose of vaccine administered was received from a physician concerning Y a five-year-old 2/5/2008 female.2/5/2008 No medical history o ious spontaneous report of stuffy nose, headache, sneezing, and malaise has been receivedUfrom a consumer, 8/8/2008 concerning 8/9/2008 a 14-year-old fe ious spontaneous report of accidental exposure while administering drug and asthma attack Uhas been received from8/20/2008 a nurse concerning a 3 ious spontaneous report of NOSE BLEED was received from a physician concerning a seven-year-old U male 8/12/2008 subsequent 8/17/2008 to FLUMIST. The ious spontaneous report of shaking, nasal passage irritation, sweating, chills, headache, andUnausea has8/22/2008 been received 8/22/2008 from a consumer c ious spontaneous report of GENERLIZED RASH as been received from a nurse concerning N a 13-year-old 8/21/2008 male subsequent 8/21/2008to FLUMIST. N ious spontaneous report of shaking, fever, muscular chest and back pain, chills, headache, cough Y and fatigue 9/2/2008 has been 9/2/2008 received from a co ious spontaneous report of FLUMIST inadvertently given to a 52-year old male was receivedYfrom a pharmacist. 9/29/2008The 9/29/2008 patient's medical histo ious spontaneous report of viral syndrome, flu symptoms, gastroenteritis, myalgias, and neckY pain has been 8/19/2008 received 8/26/2008 from a nurse in a phy ious spontaneous report of expired FLUMIST inadvertently administered was received from a Y registered 9/11/2008 nurse concerning 9/11/2008 a seven-year-old ious spontaneous report of pneumonia, sleeping a lot, fever, asthma and coughing was received U from a mother 8/1/2008 concerning 8/1/2008 a six year-old fe erious spontaneous report of administered two doses of vaccine in two day period has been Y received from 8/27/2008 a nurse concerning 8/29/2008 a 5-year old ious spontaneous case of inadvertent administration of FLUMIST to an asthmatic and coughYhas been received 9/11/2008 from 9/11/2008 a nurse in a 12-year-o ous spontaneous report of headache, nausea, vomiting, and diarrhea has been received from Y a consumer 9/13/2008 concerning 9/15/2008 a 40-year old male s ious spontaneous report of headache, nausea, vomiting, and diarrhea has been received from Y a consumer 9/13/2008 concerning 9/13/2008 a five-year old male ious spontaneous report of rash and whelps was received from an office manager of a doctor's Y clinic concerning 9/17/2008 a 31-year-old 9/19/2008 female healt ious spontaneous report of swelling under left eye, flat red itchy rash, and hives has been received Y from 9/19/2008 a nurse and9/19/2008 a physician concernin ious spontaneous report of wheezing was received from a physician concerning an 11-year-old U male subsequent 9/24/2008to9/24/2008 FLUMIST. The patient ious spontaneous report of nose bleed was received by an employee in a pediatric office, concerning Y a five-year old female subsequent to ious spontaneous report of swelling of right lower eyelid was received from a father concerning N his 5-year-old 9/23/2008 male child 9/24/2008 subsequent to FLU ious report of administration of FLUMIST to a nine-year-old male on daily ASPIRIN was received Y from a 9/26/2008 consumer. 9/26/2008 The patient's medical hi ious, spontaneous report of aching, hot then cold, headache, nausea, sinus infection and stomachache Y was 9/24/2008 received 9/24/2008 from a consumer con report of vomiting, diarrhea, and abdominal Y pain has been received from a physician and a consumer U (patient's 9/8/2008 mother) 9/9/2008 concerning a nineious unlabeled spontaneous case of impetigo with redness and irritation under the nose hasYbeen received 9/26/2008 from a physician 9/26/2008for a five-year ious spontaneous report of accidental exposure and headache has been received from a female Y medical assistant (date of birth 01-May-19 ious spontaneous report of hives has been received from a registered nurse concerning a 7.5-year N old male 10/6/2008 patient 10/6/2008 subsequent to FLUMIS ious report of administration of expired FLUMIST was received from a health care professional Y concerning 10/6/2008 a 19-year-old 10/6/2008 male. The patient ious report of administration of expired FLUMIST was received from a military non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional an ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FluMist was received from an Air Force non-commissioned Y officer10/6/2008 and a health 10/6/2008 care professional in ious report of administration of expired FLUMIST was received from a healthcare professional Y concerning 10/6/2008 a 21-year-old 10/6/2008 male. The patient' ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious, spontaneous report of sore throat, fever, body ache, runny nose and congestion was received N from9/29/2008 a consumer, 9/30/2008 concerning a five ye ious labeled, spontaneous report of sneezing has been received from a nurse for a seven-year-old Y female, 10/6/2008 subsequent 10/6/2008 to receiving FLUMIS
ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer/health 10/6/2008 care 10/6/2008 professional concer ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from a military non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional con ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 concerning 10/6/2008 a 22-year-old male. ious report of administration of expired FluMist was received from a non-commissioned officer Y and a health 10/6/2008 care professional 10/6/2008concerning a ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received from an Air Force non-commissioned Y officer 10/6/2008 and a health 10/6/2008 care professional ious report of administration of expired FLUMIST was received for a health care professionalYconcerning10/6/2008 a 20-year-old 10/6/2008 male. The patient's ious, spontaneous report of pleurisy, chest pain, shortness of breath and fever was receivedYfrom a pharmacist 10/1/2008 concerning 10/6/2008 a 24 year-old fe ious spontaneous report of administered expired FLUMIST was received from a consumer concerning Y a 10/2/2008 female greater 10/2/2008 than five-years-old. ious spontaneous report of administered expired FLUMIST was received from a consumer concerning Y a 10/2/2008 female greater 10/2/2008 than five-years-old. enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev enty-one cases: A nonserious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non - serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The e enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 from a registered 10/3/2008nurse. The ev ate dose of vaccine administered. One of twenty-one cases: A non-serious, spontaneous event Y of a half10/3/2008 dose of FLUMIST 10/3/2008 administered wa enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of half dose of FLUMIST administered was Y received 10/3/2008 from a registered 10/3/2008 nurse. The event enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administeredYwas received 10/3/2008 fro ma registered 10/3/2008nurse. The ev enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose to FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious, spontaneous event of a half dose of FLUMIST administered Y was received 10/3/2008 from a registered 10/3/2008 nurse. The eve enty-one cases: A non-serious spontaneous event of a half dose of FLUMIST administered was Y received10/3/2008 from a registered 10/3/2008 nurse. The even ious spontaneous report of inadvertent administration to an 85-year old was received from aYphysician concerning 10/9/2008 an 10/9/2008 85 year old female pa ious, spontaneous report of positive for type A influenza virus, productive cough, sore throat,Urunny nose,9/29/2008 chills, body 10/5/2008 ache and malaise wa ious spontaneous report of post-nasal drip taste, bad cold, sneezing, and running nose has been U received from a female patient of unknow ious, spontaneous report of "dosage to left nostril never misted/sprayed" was received from Y a consumer,10/9/2008 concerning10/9/2008 a 48 year-old male pa ious Spontaneous report of partial dose was received from a nurse practitioner concerning aY45 year old female. ### On 13-Oct-2008, ### the patie ious, spontaneous report of "gave half of vaccine" was received from a nurse concerning a 28 Y year-old female ### subsequent### to FLUMIST. Th ious, spontaneous report of sore and stiffness in back, neck and shoulders was received from N a consumer, concerning ### a 43 ### year-old female ious spontaneous report of "gave half of vaccine" was received from a nurse concerning a seven-year-old Y male. ### The nurse### forgot to remove ious spontaneous report of received FLUMIST vaccine via parental (IM) injection has been received Y from a physician ### and ### a combat medic c ious spontaneous report of received FLUMIST vaccine via parenteral (IM) injection has beenYreceived from a physician ### and ### a combat medi ious, spontaneous report of FLUMIST sprayed in the eye was received from a nurse, concerning Y an eight-year-old ### male patient ### while recei ious, spontaneous report of asthmatic patient given FLUMIST was received from a physicianYassistant concerning ### a seven### year-old female ious, spontaneous report of vaccination of 52-year-old was received from a consumer, involving Y a 52-year-old 10/6/2008 male 10/6/2008 patient subsequent to F ious, spontaneous report of administered FLUMIST to an adult greater in age than 49, was received Y from10/1/2008 a physician, 10/1/2008 involving a a 69-year ious report of inadvertently given FLUMIST has been received from a health department representative N concerning ### a 16-year-old ### female, s ious spontaneous report of "FLUMIST should not have been given" was received from a registered nurse concerning ### a 56-year ### old male pa ious, spontaneous report of secondary transmission of flu, muscle cramps, headache and chills U has been 10/9/2008 received from a consumer conce
ious, spontaneous report of administered FLUMIST to adult greater in age than 49, from a physician Y involving 10/1/2008 a 76 year-old 10/1/2008 patient subseq ious, spontaneous report of gave 62-year old female FLUMIST, was received from a health professional, Y subsequent ### to FLUMIST. ### There w ious, spontaneous report of vomiting was received from a Registered Nurse concerning a seven U year-old male### patient, subsequent ### to FLUM ious report of Henoch Schonlein Purpura, abdominal pain, joint pain, and rash below the waist N line has been 9/27/2008 received 9/27/2008 from a nurse concern ious, spontaneous report of FLUMIST misted into eye of male child between six and twelve years Y of age was received ### from ### a nurse. There ious report of runny nose and fever was received from a consumer concerning a five-year-old Y female. No medical ###history or ### concomitant me ious spontaneous report of received FLUMIST vaccine via parenteral (IM) injection has beenYreceived from a physician ### (patient's ### father) an ious, spontaneous report of administration to asthmatic was received from a pharmacist, concerning Y a ten year-old ### female### patient, subsequ ious, spontaneous report of full dose of FLUMIST in one nostril was received from a consumer, Y concerning a nine ###year-old### patient. The pha ious spontaneous report of generalized hives has been received from a Registered Nurse concerning U a 12-year-old ### female, ### subsequent to ious spontaneous report of severe headache has been received from a nurse concerning a 13-year-old Y female,### subsequent ### to FLUMIST. N ious spontaneous report of a 50-year-old male patient who experienced arthralgia and malaise Y subsequent 9/18/2008 to FLUMIST 9/18/2008 has been received ious spontaneous report of "patient received only half a dose" was received from a registered Y nurse concerning### a 34-year ### old male patient. ious spontaneous report of a second dose of FLUMIST given two weeks after first dose wasYreceived from a registered ### nurse ### concerning a ious, spontaneous report of inflammation of the face iwth swelling and itching was received from U a nurse, concerning ### an eight ### year-old male spontaneous report of paralysis on the right side of his face was received from the mother ofNthe patient concerning ### a 13 year-old ### male sub ious spontaneous report of administered expired FLUMIST was received from a health care Y worker concerning### an eight year ###old child. No m ious spontaneous report of received half dose of FLUMIST was received from a Registered Nurse Y concerning a### 34 year-old ### male. The divid ious, spontaneous report of rash was received from a pharmacist/consumer concerning a 37Nyear-old female subsequent ### ### to FLUMIST. Neit ious report of swelling of the glands has been received from a certified medical assistant (CMA) U concerning a six-year ### old ### male patient, sub ious spontaneous report of secondary transmission, fever, chills and malaise was received from Y a 35-year-old female physician ### concerning ious, spontaneous report of should not have gotten two doses this season, in a nine year-oldYmale patient was### received from ###a health profe ious spontaneous report of FLUMIST was administered to a 50-year-old was received from aYregistered nurse ### concerning ### a 59-year-old ma ious, spontaneous report of fever, congestion, muscle aches and sore throat was received from N a consumer, concerning ### an ### adult female su ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to a 58 year-old female was received from a Registered Y Nurse concerning a 58 year-old patient. ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of aches, fever and sore throat was received from a consumer concerning U a 30 year-old ###female subsequent ### to FL ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of croup and cough was received from a physician concerning a five-year-old U male, subsequent to ### FLUMIST. No m ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to pregnant female was received from a Registered U Nurse concerning ### an adult female. ### The patie ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of fever and vomiting has been received from a consumer concerning Y an 8-year-old male, ### subsequent 11/2/2008 to FLUMIST ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of fever of 104, aches and pain was received from a physician, concerning Y a five-year-old ### 11/1/2008 female subsequent to F ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco
ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious, spontaneous report of fever of 104 and hives was received from a consumer, concerning Y a six year-old female ### 11/1/2008 subsequent to FLUMIS ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FluMist administered was received from a physician concerning an adult Y patient. Neither medical history nor concomi ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient. Neither medical history nor conco ed report of expired FluMist administered was received from a patient. Neither medical history Y nor concomitant medication have been repor ious report of expired FLUMIST administered was received from a physician concerning an adult Y patient.11/1/2008 Neither medical 11/1/2008 history nor conco ious spontaneous report of administration to a pregnant female was received from a nurse practitioner U concerning ### a 24-year ###old female. Th
ious, spontaneous report of achiness and joint pain was received from a physician concerning N a 27 year-old female ### subsequent ### to FLUMIS ious spontaneous report of accidental exposure, influenza, fever exhaustion, coughing, headache U and sneezing was received from a femal ious, spontaneous report of pain in leg, stomach pain, fever and nausea was received from aY nurse, concerning 11/4/2008 an 11/4/2008 11 year-old female subs ious spontaneous report of migraine headaches and abdominal pain was received from a medical N assistant 11/3/2008 in a physician's 11/3/2008 office concernin ious spontaneous report of FLUMIST syringe portion broke and caused town cuts on finger was Y received from a Registered 11/4/2008 Nurse in conce ious spontaneous report of itchy rash has been received from a certified medical assistant concerning Y an11/5/2008 eight-year11/5/2008 old male patient subse ious, spontaneous report of rash on forehead and upper half of face was received from a pharmacist, U concerning 11/5/2008a 11/6/2008 seven-year-old female, ious spontaneous report of administration to a 54 year-old was received from a 54 year-old female Y consumer subsequent to FLUMIST. The ious, spontaneous report of fever blister on the lip, "felt bad" and runny nose was received from U a nurse concerning ### an adult ###female, subseq ious, spontaneous report of hives all over her body was received from a nurse, a 41 year-oldYfemale subsequent 11/4/2008 to 11/4/2008 FluMist. The patient's p ious spontaneous report of sore throat, body aches and low grade temperature has been received U from a11/5/2008 consumer11/5/2008 concerning a 43 year-o ious spontaneous report of fever has been received from the mother of the patient concerning Y a seven year-old 11/7/2008 male, 11/7/2008 subsequent to FLUM ious spontaneous report of headache, chills, and stomach upset has been received from a Doctor Y of Pharmacy 11/8/2008 concerning### a 17-year-old fe ious spontaneous report of half the total dose of FLUMIST was received from a physician concerning Y a female 11/6/2008 child,11/6/2008 subsequent to FLUMIS ious spontaneous report of half the total dose of FLUMIST was received from a physician concerning Y a female 11/6/2008 child11/6/2008 subsequent to FLUMIS ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ate dose of vaccine administered (Incorrect dose administered). A non-serious spontaneousYreport gave11/6/2008 half the total 11/6/2008 dose of FLUMIST wa ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUIST was received form a physicianYconcerning11/6/2008 a male child, 11/6/2008 subsequent to FLUM ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a female11/6/2008 child, subsequent to FL ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUIST was received form a physicianYconcerning11/6/2008 a male child, 11/6/2008 subsequent to FLUM ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU ious spontaneous report of runny nose and sneezing was received from the consumer concerning U an eight year-old ### female, ### subsequent to ious spontaneous report of expired FLUMIST administered was received from a nurse concerning Y a six-year-old ### female. No ### medical history ious spontaneous report of "administration to a 57 year old" was received from a pharmacistYconcerning a 57-year-old ### female. ### The pharma ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a ten-year-old 12/2/2008 female. 12/2/2008 The patient receiv ious report of administration of half dose of FLUMIST was received from a consumer concerning Y a 31-year-old### female. No ### medical history ious, spontaneous report of root canal, ear infection, sinus infection and nasal congestion was Y received from a### nurse/parent, ###concerning a 1 eous non-serious report of burning the nostril, hurting and administered of half dose has been Y received from a### nurse practitioner ### concernin ious spontaneous report of arthralgia has been received from a health care worker concerning Y a 10 year-old female, ### subsequent ### to receivin ious unlabeled spontaneous report of right arm pain has been received from a health care worker Y concerning a### nine-year-old ###female, subse ious spontaneous report of full dose of FLUMIST in one nostril has been received from a registered Y nurse 12/2/2008 concerning 12/2/2008 a seven year-old mal ious spontaneous report of was received from a nurse concerning a 52-year old female. Information Y on FLUMIST use in ages 50 to 64 year eous non-serious report of pregnancy was received from a nurse practitioner concerning a 34 U year old female ### patient. The ### mother of one o
ious, spontaneous report of vomiting and diarrhea was received from a consumer, concerning Y a 35 year-old female ### subsequent ### to FLUMIS ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a12/4/2008 12-year- old 12/4/2008 female. The patient's eous non-serious report of inadvertently administered FLUMIST to a 55 year old male has been Y received 12/5/2008 from a nurse. 12/5/2008 Medical history an ious report of fever, vomiting, chills, sore throat, and runny nose has been received from a nurse U concerning a ### 10-year-old### female, subsequ ious spontaneous report of bright red rash has been received from a nurse concerning a 48 Y year old female, subsequent ### to ### receiving FLUM ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a 46-year-old ### of unknown ### gender. N ious spontaneous report of gave half the total dose of FLUMIST was received from a physician Y concerning 11/6/2008 a male child, 11/6/2008 subsequent to FLU levant medical history nor concomitant medications were reported for this patient. The patient Y received FLUMIST ###on 28-Nov-2008, ### intranas ious, spontaneous, report of vomiting, nausea and diarrhea was received from a consumer, Y concerning a nine-year-old ### female ### subsequent ious spontaneous report of administered expired FLUMIST has been received from a nurse Y concerning a12/5/2008 42-year old 12/5/2008 male. The patient's m eous non-serious report of scabies was received form a nurse concerning a six year old female N patient subsequent ### to FLUMIST. ### Medical h eous non-serious report of scabies was received from a nurse concerning a nine year old male Y patient subsequent ### to FLUMIST. ### Medical h ious spontaneous report of Henoch-Schoenlein purpura and upper respiratory infection was Y received from a physician ### 12/1/2008 concerning a 6 yearious spontaneous report of vomiting was received from a consumer concerning a nine year-old U (gender not reported), ### subsequent ### to FLUM ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a seven-year-old ### male ious, spontaneous report of gave FLUMIST to a 54 year-old was received from a pharmacist,Y concerning a 54 ### year-old female ### subsequent eous non-serious report of coughing and hives has been received from a patient's father concerning N a five year old female patient subsequ ious spontaneous report of FLUMIST given to a pregnant female has been received from a Registered Y Nurse 10/2/2008 concerning 10/2/2008 a 26-year-old fem ious spontaneous report of expired FLUMIST given was received from a registered nurse concerning Y a 49 year-old ### female, ### It was discovere eous non-serious report of administration to pregnant female, fever and stomach ache has been U received 12/5/2008 from a nurse concerning ### a 14 ye eous non-serious report of "glassy looking eyes, red eyes, eye discharge and nasal congestion Y has been received ### from a ### consumer conce ious spontaneous report of FLUMIST sprayed in the eye was received from a registered pharmacist Y concerning### a 22-year-old ### female. Med xposure during pregnancy. A spontaneous non-serious report of administration to pregnant female U was received 9/30/2008from 9/30/2008 a nurse concerning a ious, spontaneous report of administration of expired product was received from a registeredYnurse concerning### a 6-year 11### month old male ious spontaneous report of hives, red blotchy skin/redness, both hands swelled and 55-year-old Y administered 10/8/2008 FLUMIST 10/8/2008 has been received ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a 6 year ### old female w ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of administration to a pregnant female was received from a consumer U concerning a 24-year-old ### female. ### The patien eous non-serious report of administration of extra dose has been received from a nurse practitioner Y concerning### a five year### old male patient eous non-serious report of administration to pregnant female has been received from a health U care professional 11/7/2008 concerning 11/7/200828 year old fem ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### a female ### employee "in ious spontaneous report of expired FLUMIST given to this patient was received from a certified Y medical assistant ###concerning ###a six-year-old ious spontaneous report of administration of expired product to a 52-year-old was received from Y a Nurse concerning ### a 52-year-old ### female. ious spontaneous report of administered expired FLUMIST was received from a Registered Nurse Y concerning a ### 14 year-old-male. ### FLUMIS ious spontaneous report of gave expired FLUMIST to an 11-year old was received from a Nurse Y Manager concerning ### a 11-year-old ### male. T ious report of administered expired FLUMIST was received from a Registered Nurse concerning Y a seven-year-old ###male. Medical ### history an ious, spontaneous report of "gave expired FLUMIST" was received from a registered nurse concerning Y a nine-year-old ### male ###subsequent to eous non-serious report of administration of expired product has been received from a nurseYpractitioner concerning ### a 14 ### year old male pa ious spontaneous report of administration of expired FLUMIST was received from a registered Y nurse concerning ### a 15-year-old ### male. Neithe ious spontaneous report of administration of one-half dose of expired product was received from Y a certified medical ### assistant ###concerning a ious spontaneous report of expired FLUMIST administered was received from a registered nurse Y concerning a### 13-year-old### female. The chil ious report of expired FLUMIST administered was received from a registered nurse concerning Y a 17-year-old female. ### Neither ###history nor co eous non-serious report of hives, itching, leg pain, bruising and attention deficit/hyperactivityUdisorder (ADHD) 9/24/2008 has been 9/24/2008 received from man ious spontaneous report of "29 patients ( 26 children & 3 adults) received expired FLUMIST Y "was received1/6/2009 from a physician 1/6/2009 concerning a 1 ious report of expired FLUMIST given was received from a registered nurse concerning a 29-year-old Y male. 12/4/2008 On 04-Dec-2008, 12/4/2008 the patient w ious report of administration of expired FLUMIST to two patients was received from a pharmacist Y concerning 1/6/2009 a 43-year-old 1/6/2009 female. The pat ious report of administration of expired product has been received from a Registered Nurse concerning Y a 1/8/2009 22-year-old1/8/2009 female who received ious, spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/7/2009 a five1/7/2009 year-old male subseq ious, spontaneous report of administration of expired product was received from a nurse concerning Y a five1/7/2009 year-old female 1/7/2009 subsequent to F ious, spontaneous report of administration of expired product was received from a nurse concerning an eight 1/7/2009 year-old1/7/2009 female subsequent to
eous non-serious report of administration of expired product was received from a nurse concerning Y a twelve 1/7/2009 year-old1/7/2009 male subsequent to F ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a five-year-old 1/1/2009 patient (gender 1/1/2009unknown). Th ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a 10-year-old 1/1/2009 patient (gender 1/1/2009 unknown). The ious spontaneous report of administration of expired product has been received form a Registered Y Nurse concerning ### a 15### year old male wh ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a five-year-old 1/1/2009 patient (gender 1/1/2009unknown). Th ious spontaneous report of administration of expired product has been received from a Registered Y Nurse concerning ### an 18 ### year old female ious spontaneous report of administration of expired product was received from a registeredYpharmacist concerning two patients (patients' d eous non-serious report of "six patients received expired FLUMIST" was received from a nurse Y concerning 1/1/2009 a six-year-old 1/1/2009 patient (gender u ious, spontaneous report of administration of expired product was received from a registeredYpharmacist concerning 1/5/2009 1/5/2009 an adult (sex unknown ious spontaneous report of expired FLUMIST administered was received from a healthcare professional Y concerning ### a five ### year-old female. ious, spontaneous report of administration of expired product was received from a nurse concerning Y a ten year-old ### female### subsequent to F ous, spontaneous report of administration of expired product was received from a nurse concerning Y an 11 year### old female### patient subseque ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a five-year-old ### female who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a five-year-old ### male who rec ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/2/2009 a five-year-old 1/2/2009 female who re ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/2/2009 a five-year-old 1/2/2009 female who re ous spontaneous report of administration of expired product was received from a registered Ynurse concerning 1/2/2009 a seven-year-old 1/2/2009 male subse ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a six-year-old 1/5/2009female who re ious spontaneous report of administration of expired product was received from a nurse practitioner Y concerning 1/6/2009 a 9-year-old 1/6/2009female subseq eous non-serious report of administration to a pregnant female was received from a physician U concerning a 26### year old female ### patient. On ious spontaneous report of cold like symptoms has been received from a consumer concerning U a 12-year-old 1/6/2009 female, 1/13/2009 subsequent to FLUM ious spontaneous report of administration of expired FLUMIST to two patients was received Y from a pharmacist 1/6/2009 concerning 1/6/2009 a nine-year-old f ious spontaneous report of asthma attack and accidental exposure has been received from aY Registered Nurse concerning a 33-year-old fe ious spontaneous report of fever, fatigue, nasal congestion, and sneezing has been receivedYfrom a nurse 1/14/2009 concerning a 20-year-old female ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a 13-year-old 1/5/2009male who rece ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009male. The pat ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 male. The pa ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 40-year-old 1/6/2009female. The p ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009 a seven-year-old 1/5/2009 male who r ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician concerning 1/6/2009 a 16-year-old 1/6/2009female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 female. Th ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 female. Th ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a seven-year-old 1/6/2009 male. The ious spontaneous report of FLUMIST administration to pregnant female was received from aNphysician concerning ### a 27-year-old ### female pa ious spontaneous report of administration of expired product was received from a consumer Yconcerning a1/7/2009 13-year-old1/7/2009 female. There was n neous, non-serious report of GERD and ulcer has been received from a mother concerning aUnine-year-old 1/19/2009 male patient 1/26/2009 subsequent to FLU ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of "29 patients received expired FLUMIST" was received form a physician Y concerning 1/6/2009 a six-year-old 1/6/2009female. The p eous, non-serious report of FLUMIST given to 59-year-old was received from a nurse. ThereYwas no adverse event ### associated ### with this me ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a five-year-old 2/2/2009male. 2/2/2009 The patient's conco ious spontaneous report of "29 patients received expired FLUMIS" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a eight-year-old 1/6/2009 female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 female. The p ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 35-year-old 1/6/2009female. The pa ious spontaneous report of administration to pregnant female was received from a physicianUconcerning a2/2/2009 30-year-old 2/2/2009 female who received eous, non-serious report of dizziness, lightheadedness, ear infection, sinus infection, stomach N ache, fever, body ### aches, sore ###throat, conges eous, non-serious report of administration of expired product was received from a nurse concerning Y an adult 1/20/2009 female1/20/2009 patient. On 20-Jan-20 ious, spontaneous report of administration or expired product was received from a nurse concerning Y a 36 2/3/2009 year-old female 2/3/2009 subsequent to FL ious spontaneous report of administered expired FLUMIST was received from a nurse concerning Y a six-year-old 2/5/2009 female. 2/5/2009 FLUMIST that exp
ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a 11-year-old 1/6/2009male. The pati ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a five-year-old 1/6/2009 male. The pa ious spontaneous report of "23 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009female. The p ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a six-year-old 1/6/2009male. The pat ious spontaneous report of '29 patients received expired FLUMIST" was received from a physician Y concerning 1/6/2009 a nine-year-old 1/6/2009 female. The ious spontaneous report of erythema multiforme, blisters on both legs and a few on arms and Y sore in right 10/9/2008 nostril and upper lip has both leg ious spontaneous report of positive influenza A test was received from a physician concerning U a 14 year-old 10/1/2008 male, subsequent 2/9/2009 to FLUMIST ious spontaneous report of administration of extra dose was received from a physician concerning Y a 10-year-old male 2/11/2009 who received FLUMI ious, spontaneous report of administration of expired FLUMIST to a 65 year old was received Y form a nurse 1/19/2009 practitioner 1/19/2009 concerning a 65-yea ious, spontaneous report of administration of expired FLUMIST was received from a nurse practitioner Y concerning 1/17/2009 a1/17/2009 42 year-old female su ious spontaneous report of "gave expired FLUMIST" was received from a nurse concerning a Y eight-year-old 2/19/2009 male. No 2/19/2009 medical history was r ious, spontaneous report of sore throat and fever was received from a physician, concerningYan 11 year-old male ###subsequent ### to FLUMIST. ious spontaneous report of "gave expired FLUMIST" was received from a nurse concerning an Y eight-year-old 2/19/2009 male. 2/19/2009 No medical history was ious, spontaneous report of administered expired product was received from a nurse concerning Y a 24-year-old 2/17/2009 female, 2/17/2009 subsequent to FLUM ious spontaneous report of "gave expired FLUMIST" was received form a nurse concerning an Y eight-year-old 2/19/2009 male. 2/19/2009 No medical history was ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old 2/17/2009 female, 2/17/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a seven-year-old 2/20/2009 male, 2/20/2009 subsequent to FLU ious spontaneous report of eye pain, headaches, body ache, muscle ache, and sinus pain has N been received 1/1/2009 from a 1/1/2009 parent concerning her ious, spontaneous report of administered expired product was received from a nurse concerning Y a nine-year-old 2/20/2009 male, 2/20/2009 subsequent to FLUM ious, spontaneous report of snoring and nasal congestion was received from a consumer concerning N a five-year-old 1/27/2009 2/24/2009 female subsequent to ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 1/1/2009 male. 1/1/2009 Neither medical h ious, spontaneous report of administered expired products was received from a nurse concerning Y a six-year-old 2/20/2009 female. 2/20/2009 Subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a six-year-old 2/20/2009 male, 2/20/2009 subsequent to FLUMI ious, spontaneous report of administered expired product was received form a nurse concerning Y an eight-year-old 2/26/2009 male, 2/26/2009 subsequent to FLU ious, spontaneous report of administered expired product was received from a nurse concerning Y a six-year-old 2/26/2009 male, 2/26/2009 subsequent to FLUMI eous, non-serious report of administration of expired product has been received from a certified Y medical3/13/2009 assistant concerning 3/13/2009 an 11-year-o ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/1/2009 male. 2/1/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 41-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 22-year-old 1/27/2009 1/27/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 1/27/2009 1/27/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 2/2/2009 female. 2/2/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40 2/5/2009 year old male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40-year-old 2/5/2009 male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 39-year-old 2/5/2009 male. 2/5/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/5/2009 female. 2/5/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 40-year-old 2/6/2009 female. 2/6/2009Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y an adult 2/9/2009 male. 2/9/2009 Neither medical histor ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y an adult 2/9/2009 male. 2/9/2009 Neither medical histor
accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a2/9/2009 nurse in the 2/9/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 2/9/2009 female. 2/9/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 2/9/2009 female. 2/9/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 2/9/2009 male. 2/9/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 2/9/2009 male. 2/9/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/23/2009 2/23/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 48-year-old 2/1/2009 male. 2/1/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 22-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 34-year-old 2/24/2009 2/24/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/24/2009 a nurse in 2/24/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/24/2009 2/24/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/26/2009 a nurse in 1/26/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 31-year-old 2/24/2009 2/24/2009 female. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/24/2009 a nurse in 2/24/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 2/24/2009 2/24/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 2/25/2009 2/25/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/25/2009 a nurse in 2/25/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 29-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 25-year-old 1/12/2009 1/12/2009 male. Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 2/26/2009 2/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/10/2009 of unknown 2/10/2009 age. Neither med accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/10/2009 of unknown 2/10/2009 age. Neither med ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 27-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 43-year-old 3/2/2009 male. 3/2/2009 Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 49-year-old 3/2/2009 male. 3/2/2009 Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 3/2/2009 male. 3/2/2009 Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/12/2009 1/12/2009 female. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 19-year-old 1/12/2009 1/12/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning a 40-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 43-year-old 3/2/2009 female. 3/2/2009 Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/12/2009 a nurse in 1/12/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 1/12/2009 1/12/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a3/2/2009 nurse in the 3/2/2009 military concerning
ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 1/12/2009 1/12/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 36-year-old 2/11/2009 2/11/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 37-year-old 1/26/2009 1/26/2009 male. Neither medical ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 21-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male 2/17/2009 of unknown 2/17/2009 age. Neither med erious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a1/26/2009 23-year-old 1/26/2009 male. Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from1/26/2009 a nurse in the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 33-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 44-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse report Y of administration 2/17/2009of2/17/2009 expired FLUMIST was ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 24-year-old 2/1/2009 female. 2/1/2009 Neither medica accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from a nurse in the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 35-year-old 2/1/2009 female. 2/1/2009 Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse inYthe military 1/26/2009 concerning1/26/2009 a 20-year-old female. N ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 1/26/2009 1/26/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 45-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/17/2009 2/17/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse inYthe military 2/17/2009 concerning2/17/2009 a 26-year-old male. Ne ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 35-year-old 2/20/2009 2/20/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 26-year-old 2/20/2009 2/20/2009 male. Neither medical h accine used. A non-serious spontaneous report of administration of expired FLUMIST was received Y from2/23/2009 a nurse in 2/23/2009 the military concerning ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 46-year-old 2/23/2009 2/23/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 2/17/2009 2/17/2009 female. Neither medica ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 30-year-old. 2/17/2009 2/17/2009 Neither medical history ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a male. 2/18/2009 Neither 2/18/2009 medical history nor c ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 38-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 28-year-old 2/18/2009 2/18/2009 male. Neither medical h ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 23-year-old 2/18/2009 2/18/2009 male. Neither medical h ious report of positive influenza A test has been received from a registered nurse concerningUan eight-year-old 10/1/2008 female 5/19/2009 subsequent to FLUM n has been received from a physician's Y assistant concerning a 26 year old female with no past Y history of6/26/2009 seizure and 7/10/2009 no drug allergies, who n has been received from a licensed Y visiting nurse Y concerning a female 0 who was vaccinatedYwith a dose of GARDASIL (dose, route and lo n has been received from a lawyer Y concerning a minor male patient who on 30-DEC-2003 Y was U vaccinated with### a dose of MMR II. The lawy n has been received from a 64 year old femaleYwith thyroid disorder,0 a history of shingles two N years ago 10/1/2008 and no allergies/drug 12/1/2008 reactions wh n has been received from Y a licensed Y practical nurse concerning a 79 year old male patient with U no known drug reactions/allergies and with ted on 14 Aug 2009 for clinic visit for adverse reaction to immunization. Right thigh from hip Yto just above 8/12/2009 knee red,8/13/2009 swollen, and hot to tou post Pneumococcal Vaccination, patient developed pain and swelling at injection site. Area was Y 16 cm x 8/12/2009 12 cm and 8/13/2009 warm to the touch. War s of muscle soreness at injection site today which is over a month after receiving TDAp B. There U is no redness 7/10/2009 or muscle 7/14/2009 induration. Comp d a fever with rash on face/arms/chest- Mom notes small raised red lesions, no blisters. -Recommended TYLENOL 8/4/2009 8/13/2009 for fever, BENADRYL f d shots stayed in office for appx 20mins Y after. Pt left and returned about 45 mins later. EyesYblack, face swollen, 8/5/2009 hard8/5/2009 to breathe and swea eadache 2-3d after vaccine and erythema, swelling, tenderness at left leg injection site. Y 8/9/2007 8/9/2007 (T max 103.2) began within 13 hours of receiving the vaccines (Tdap X MENACTRA). (2) R U arm sore. No8/11/2009 treatment.8/12/2009 PREVNAR given, child within seconds had a seizure lasting no more than 15 seconds. He had Y another 7/14/2009 seizure several 7/14/2009 hours later and with ure of 104.5 R. Y 8/6/2009 8/6/2009 surrounding injection site starting 12 hours after. At 72 hours site is 11x7cm right thigh. U 8/7/2009 8/9/2009 ccine given IM L deltoid. Red flushing Y occurred across back and L ear and chest. No hives - Y No SOB. No8/12/2009 coughing. 8/12/2009 No swelling. No wheezi ive 8-13-2009 approx. 11:00 am. byYevening, pt arm too sore to lift, red, swollen, painful. came U in to office 8/13/2009 8-14-09. 8/13/2009 approx 4" swollen, raise pain, swelling, unable to move right arm for 24 hours. Took Tylenol, aspirin and Soma at different Y intervals, 8/12/2009 drank liquids 8/12/2009 and applied heatin
of erythema, warm to touch, and firm of 5cm x 6 cm on upper left arm where Hepatitis A and Y Varivax injections 8/13/2009 were 8/14/2009 given r on day after shots was given on 08/06/09 but was told by nurse to refer to the VIS sheet forYchickenpox 8/6/2009 for reaction 8/13/2009 and to treat with Tylen S AND SWELLING AT INJECTION SITE ON RIGHT ARM MEASURING 110MM OUTSIDE RING U AND INSIDE 8/12/2009 RING 8/13/2009 40MM. BENEDRYL veloped fever to 102 per mother approximately Y 11 hours after vaccine given, vomited once, Y and had seizure 7/27/2009 about 7/28/2009 9 hours after fever note lled stating son had Tdap injection Monday, Y 7/27/09 and today (7/29/09) has a hard quarter U to golf ball size 7/27/2009 knot with 7/27/2009 redness and pain. as diagnosed in our office with Erythema Multiforma on 7/20/09. Rash started 7/18/09 on leftYdeltoid where 7/13/2009 DTaP has 7/18/2009 been given on 7/13/0 on 8/13/09 with a temp of 103 degrees F. Parents have given Motrin and fever has gone down. U Grandmother 8/12/2009 calls at 8/13/2009 5:15 pm on 8/13/09 a ved from mom 8/13/09, states pt has swelling/hardness the size of a "drink coaster @ the site of the injection 8/12/2009 on right 8/13/2009 arm with rash @ site. ft arm that began as soon as injected. Felt med burn when injected. Pain has continued x 18 U days. Has7/27/2009 slightly improved. 7/27/2009 Middle of uppe s: Circular swelling 3"x3", redness, vomit, itchy. Treatment: Rocephin Inj. 500mg. Instructions Y to parent:8/10/2009 Warm compresses 8/11/2009to area. ped high fever one day after immunization Y andYthen developed prolonged 4Y seizure after two days. Y Pt. then 8/12/2009 needed Anti-Seizure 8/13/2009 medicines erythema/edema affecting Y left upper Y extremity and axilla beginning 24-48h after vaccine administration. Y Progressed 8/5/2009 to 8/7/2009 lip/tongue angioede es that pt had cracked lips 4 days after Y vaccination. The whole lips became swollen and hadUblisters which 8/3/2009 peeled. They 8/7/2009 saw their physicia 03 axcillary with 2 minutes of stiffening, Y erythimical jerking of arms, legs during sleep withoutYrespiratory6/18/2009 problems. Seizures 6/18/2009with fever. Fev of leftside of lower lip occured approx. 15 min. after receiving Tdap vaccine. Pt. had already left Y clinic took6/30/2009 25 mg. of 6/30/2009 Benadryl at home. Retu Grace had a seizure that lasted under Y 10 seconds. Her head and torso "shivered" and she was Y non-responsive. 8/5/2009 8/5/2009 ates that the child began to have sorness Y at the area of vaccination about an hour after she received U the8/13/2009 vaccines. The 8/14/2009 following morning th redness, warm and slightly tender. Y Y 8/12/2009 8/14/2009 r for 6 days, Full body rash, itching, lethargy, lack of appetite, drowsiness. Treated with tylenol, Y cold compresses, 7/22/2009rest,8/7/2009 luke warm baths. ater, fever, headache, neck pain, chest pain, shortness of breathe, abdominal pain. Y 8/13/2009 8/14/2009 o vaccine site, tenderness and swelling. Y Patient complain of pain and itching to area. Y 8/11/2009 8/14/2009 OD NOTICE SWELLING, REDNESS, WARN TO TOUCH ON 8/11/09 EVENING. GAVE IBUPROFEN Y BEGAN 8/10/2009 ITCHING 8/11/2009 ON 8/12 GAVE BE accine (varicella #2). 8/12/09: L arm Y swollen, not feeling well overall, some neck & upper back Y discomfort. 8/11/2009 8/13/09:8/12/2009 arm swelling increased and swelling to vaccine site. Warm Y to the touch. Y 7/20/2009 7/21/2009 S AND SWELLING AT INJECTION SITE OF KINRIX (LD IM) PATIENT COMPLAINED OFUPAIN WHEN 8/12/2009 PARENT8/13/2009 TOUCHED ARM. SIT and swelling to vaccine site. Pain toYarea. Y 7/31/2009 8/1/2009 n erythematous raised lesion 8mm in Y diameter at the right temple area. Asymptomatic( no pain, N no itching). 8/3/2009 Started 2-3 8/6/2009 days after Shingles EIVED HPV AND VARICELLA IMMUNIZATIONS. UPON LEAVING, WHILE WALKING IN HALLWAY, Y MOTHER 8/14/2009 STATES 8/14/2009 THAT PT. LOOKE redness, edema, and itching at injection site. (4x4cm) Y 8/13/2009 8/14/2009 ped a red circular rash on the 13th, Y his rash was hot to the touch and his arm was sore. On the U 14th, the8/12/2009 rash had doubled 8/13/2009 in size was still h area reddness and swelling L upper Y arm 36 hours after injection Y 8/12/2009 8/14/2009 iving gaurdicil, lauren fainted while walking out of the doctors office. Completely blacked out,Y head hit the8/6/2009 floor, fainted. Now (I am an RN) er receiving vaccines patient Y became Y diaphoretic with grunting, nasal closing and retractions. Y Poor air exchange, 8/14/2009Sats 8/14/2009 89%, Pulses thready after taking the Tdap I had a fever of 103.8, I started Y getting migraines, 0 and my back by my U kidneys hurt extremely 8/3/2009 bad, 8/3/2009 it got worse throug ar size redness - Site is warm to touch but doesn't bother her. Her PCP rec. ice pack @ site Y and ZYRTEC 8/11/2009 for the response, 8/13/2009 but she used a d HR 100, temp. 100 degrees F, redY blotchy rash around eyes, pale face, sore throat @ 0800 on 8/14. Pt. 8/13/2009 reported8/13/2009 to provider 8/14 @ 2:3 Left herpes zoster ophthalmicus without Y involvement of The globe. U 8/3/2009 8/5/2009 thema, slight warmth, slight induration R thigh. Y 8/13/2009 8/14/2009 at hospital on 8/4/09 for Intussusception, Y was discharged the same night after reduction. 9/14/09 Y ER/Hospital 7/13/2009 Records 8/4/2009 received DOS 8/4/ ately 15 minutes after immunizationsY child c/o breathing difficulty. Mother took child home and Y gave her a8/12/2009 breathing 8/12/2009 tx and BENADRYL. The am after injection Pt started with cough, chest pain, swollen eyes. Was given 1.5 SC Epinephrine, Y BENADRYL 8/14/2009 25 P.O. 8/14/2009 10 minutes after bro o left deltoid at injection site encircles entire upper arm. Mom described as red, hot touch, and Y hard. Area 8/4/2009 the size of 8/5/2009 baseball. Swollen Warm to touch } injection site. Treatment: Amox. POT CLAVULANATE take 8ml BID U for 10 days 8/12/2009 400-57 mg/5ml 8/13/2009 Susp. Received s inadvertently given a Tdap along with MENACTRA. Was already given Tdap on 4/26/06. Spoke Y to VFC8/14/2009 and talked to parent about high ris ates "At 6:30 pm pt c/o numbness. Weakness tingling on side of body where vaccine was given. Y Face (side) 8/13/2009 and lip 8/13/2009 tingling, numb and droo Reading on GARDSIL and thinks childs Y Medical problems may be related to GARDASIL. Last U GARDASIL 4-16-07. ### Back 12/1/2006 pain started Dec-2 er MENACTRA L deltoid of pt developed itching erythema of site. Pt seen 8/12/09 noted ~ 8Ycm area of 8/10/2009 erythema no 8/12/2009 warmth. d hives 24 hours after MMR , Hepatitis Y A. Seen at an urgent care, no change 30m after BENADRYL. Y Sent 8/10/2009 to ER for 8/11/2009 observation. Discharge ambulance. Got epi pen by paramedic. Y Given steroids at ER. Discharged on prednisone. Y 8/12/2009 8/12/2009 ied 7:02 (Numbness in tongue) reported Y to staff by Pt. VS taken BP 07124/80 P- 86 O2 98. 07:04 Y Pt now8/13/2009 complains8/13/2009 of numbness in upper her reports scattered hives on abd & legs. Child was given BENADRYL & hives resolved over Y next 24 hours. 7/21/2009 7/23/2009
ate child became very listless after Y leaving office and getting home. Y 8/10/2009 8/10/2009 papules on erythematous base and surrounding pallor on arms, shoulder and neck pain on U side of injection, 8/12/2009 arm "tingling" 8/12/2009 on side of inject ight cheek and both upper thighs were vaccines were administered Y 8/11/2009 8/12/2009 p a rash consistent with erythema multiforme Y minor approximately five days after receiving his Y two month7/10/2009 immunizations. 7/15/2009 opathy, severe malnutrition and hairloss, ADD, ADHD, vitamin deficiency, memory Y loss, concentration N problems, 5/4/2007 burning 5/4/2007 in head, acute "ele ccine administered @ inappropriate initiation. Y ast shot in early November 07, been sick sense. November 20 Fainted in store multiple times. N Perfectly 11/1/2007 normal healthy happy ### teenager bef e week of receiving the first shot (10/24/2007), I experienced flu-like symptoms, fever, and such N severe vaginal 3/17/2008 discomfort 3/17/2008 that I went to the g well two hours after vaccine. Threw up about 3 hours after. Threw up after dinner. Dry heaves Y and temp 8/14/2009 up to 103.7 8/14/2009 during night. temp cellulitis following ADACEL - minor Y- tx: BIAXIN 500mg 1 POBID X 10d. U 8/14/2009 8/14/2009 n has been received from a registered Y nurse concerning a 16 year old female who was vaccinated Y with the 7/27/2009 "first dose" 7/27/2009 of GARDASIL (injec n has been received from a consumer Y concerning Y her 14 year old daughter 8 with no pertinentYmedical history and ###no1/15/2007 known drug allergies w n has been received from a head nurse Y concerning Y a 12 month old 0 female who on 17-JUN-2009 N was vaccinated 6/17/2009with 6/17/2009 a dose of MMR II (lot n has been received from a physician Y via medical records concerning a 14 week old inpatient N baby girl with anaemia ### 1/13/2009 of prematurity, chronic n has been received from a consumer concerning her 36 month old son with no pertinent medical N history 3/1/2007 reported and 8/1/2007 no known drug aller n has been received from an approximately Y 73Yyears old female patient 0 with unspecified medical N history, who "about6/1/2009 one or one and a half n has been received from a consumer Y concerning her 77 year old husband with neuromuscular Y N disorder and 4/1/2009 no known 5/1/2009 drug allergies who i was reported by a healthcare Y professional Y and described the occurrence of difficulty breathing Y in a 5-year-old 7/28/2009 female subject who was vacc was reported by a healthcare professional Y andYdescribed the occurrence 0 of pneumonia in a U child subject of unspecified age and gender wh chronic flu like symptoms, Y progressive fatigue, joint & muscle pain-severe pain throughout Y bodyN headaches 5/11/2000 & throbbing, 5/11/2000 brain fog, body t nted to clinic Aug. 04/09 - Symptoms had started 2 days prior - fever, chills, cough. PE - (+) Left Y lower lobe 7/30/2009 rales - treated 8/2/2009 with BIAXIN XL, A iving Tdap, VZV, MENACTRA (in this order), client immed. lost consciousness, color very pale, Y had posturing 7/28/2009 of upper 7/28/2009 extremities followed ze lump R. leg sm Lump on L Leg. Temp. 101.8 very cranky. Y 8/13/2009 8/13/2009 d TDAP 8/4/09 @ 3:50 PM. On 8/6/09 flu like symptoms (dizzy, fever 101). Symptoms cleared Y same day. 8/4/2009 Similar reaction in past (per mo eling dizzy, ears felt plugged, then started with headache, + started having breathing difficulty. Y EPIPEN 8/12/2009 given 0.3 ml 8/12/2009 @ 1:44 PM vitals P-10 daughter back today. Patient (R) arm red, swollen, hot, hard to touch. Mother states patient U has allergies 8/3/2009 to NEOSPORIN 8/4/2009 down latex? 100 arm swollen, redness, warm, mainly on underside, but on outer aspect as well - elbow to shoulder; N somewhat 8/10/2009 hardened 8/11/2009 to touch - compar 5 cm X 4.5 cm Red Raised area Right arm deltoid area noted 8/11/09 12:30 PM - Ibuprofen as U needed for 8/10/2009 pain - Cool 8/10/2009 compresses as need Reddened with lump under skin. Bruise in center. Fever of 100. Y 8/11/2009 8/12/2009 bed dots upper R arm. Y 8/10/2009 8/13/2009 vaccine 2/1/8 but developed shingles Y 7/8/9 anyway. Y 2/1/2008 7/8/2009 story hives like rash, fever, watery blisters Y mostly above waist & watery blisters down throat.YSeen in ER 6/3/2009 6/12/09 flu6/12/2009 & strep negative. g pain, limping, unsteady gait - refusing to walk. N 7/17/2009 7/17/2009 warm. TX: KEFLEX, BENADRYL, cool compress. Y 7/10/2009 7/11/2009 ver 6 hours after vaccines of over 105 Y degrees & was seizing. Parents took child to E.R. where Y fever & seizures ### were controlled ### & child wa o clinic today, 8/3/09, c/o (L) upper arm swelling and heat. Upon assessment, (L) upper armYswollen, hot7/31/2009 to touch, and 8/1/2009 client c/o pain only w orts left arm started swelling and turning red 1 day (7/21/09) after MCV4 and VARICELLA administered. Y 7/20/2009 Reports slight 7/21/2009 pain to left arm. Ca oted 2 days prior to visit - described as different crops of lesions at one time from papular and Y urticaria - 5/28/2008 like to vesicles, 8/12/2009 some popped out a o developed rashes with different lesions at the same time from papular, to vesicle to crusts Y it pock lesions. 5/10/2006 runny nose 8/13/2009 & sore throat also n lesions together w/crusted over and new papular and some urticaria-like lesions all over trunk, Y few on neck, 4/4/2007 and all 8/11/2009 over leg X 6 days now. ated 8-5-09. Onset 8-6-09 with headaches Y sore throat, nausea and congestion. On 8-11-09Useen at local8/5/2009 walk-n clinic 8/6/2009 now complaining of Fever, unable to swallow or breatheY for a minute or two. 28th July, Unable to swallow/breathe U for a minute 6/18/2009 or two after 7/19/2009 lying down. Coughin er I got the chills (6pm) by 8pm I had a fever. About 3 AM came the upset stomach- The fever Y lasted until 7/30/2009 8:30 AM 7/31/2009 of the 1st of August. A great deal of swelling (right arm looked as if a had a huge tumor hanging off it!!), (lasted approx. Y 4 days).7/20/2009 I took a BENADRYL 7/21/2009 1 tablet each d swelling in same side upper body to include neck shoulder with enlarged glands within 24 U hrs after IZ, worse 8/7/2009 at 48 8/7/2009 hours after IZ. Seen 72 adverse reaction. Tdap administered along with MMR, Varicella, Hep A, PCV7, to soon forUvaccines. 8/4/2009 s after injection patient got warm, vision blurred, then nausea. Pt was laid down with cool wash Y cloth + 8/10/2009 given juice.8/10/2009 Pt was slowly sat up a diarrhea - watery. X 2/ 8-10. X 3 + 8-11. Anorexic. Y 8/7/2009 8/9/2009 o redness. Swelling and sore are left lower arm 8/8/09. Area on left lower arm red and raisedY3 inches in length 8/6/2009 and 18/7/2009 1/2 inches wide. Calle vaccine administered 8/7/09. That evening had fever/chills - slight redness at site. Over next 48-72 hours redness 8/7/2009at site 8/7/2009 increased, swelling WHOOPING COUGH LIKE SYMPTOMS),HEADACHE,HOARSENESS FOR HALF A DAY,COUGHING N MORE,LITTLE 8/12/2009 8/13/2009 SMALL BUMPS AR
ash, erythemaos, macular, papular,raised,urticarialand Y fever 101.3F. Onset occurred acutely U 08/12/2009.7/24/2009 9/14/09 ICD-9 8/12/2009 Codes: 782.1 Rash e ordered and TDAP give in errorl Y 8/17/2009 8/17/2009 came light headed, dizzy w/ nauseaY& vomiting. Shock-like reactionl. Light pulse w/ blood pressure U 98/66. 8/17/2009 8/17/2009 02. Body aches. Both starting around midnight. Treatment - alternating Tylenol and Advil every Y 2 hours until 8/10/2009 fever resolves. 8/11/2009 pletion of vaccinations patient slumped Y on exam table, and then began to convulse with eyesUrolling in the 8/17/2009 back of his 8/17/2009 head. His arms raise area in SQ tissue on back of upper arm from below deltoid to elbow, firm, raised, red and very Y warm to touvh. 8/9/2009 Also tender 8/11/2009 to touch. with wrong solution. No adverse reaction. DOB was listed on hardcopy form as 07/10/1980 Y for a child with 7/23/2009 a patient age of 2 years. mately 2100, Pt complained of pain to his left arm where he stated he received a Pneumonia Y Vaccination 7/21/2009 during the7/22/2009 previous shift. His nur eloped fever with 24 hours of vaccine. Two days Y after vaccine developed 4 ataxia. Was admitted Y to hospital 7/16/2008 for ataxia 7/20/2009 and had multiple febri t skin reaction at site of injection. Started 24 to 36 hours after receiving injection. 3 inch circumference Y site 8/13/2009 with raised 8/14/2009 hardened red skin. A chest pain intermittently since the vaccine administration consistent with costochodritis, patient U has a mvp7/18/2009 that appears 7/18/2009 to have worsened w - Red, swelling, warmth to touch, 3"Ydiameter R thigh, 1" L thigh - Treatment 12.5 mg Benedryl Y 8/12/2009 8/14/2009 s a reddened area at injection site that is slightly itchy. U 8/14/2009 8/14/2009 veloped rash approximately two inches in are on right deltoid one day after receiving the Anthrax U immunization. 8/12/2009 Patient 8/13/2009 stated that are was ates that she suffered from posterior headaches describes as heaviness, nausea, diarrhea, and N fatigue. 8/13/2009 Thinks she 8/13/2009 may have had a low gra iving 2nd injection (MMR) the client Yslumped over in the chair, his eyes rolled in the back of his Y head, he8/17/2009 started to shake 8/17/2009 similar to a seizur painful hard lump with Pneumovax. Fever of 101.8. Vomiting Y 8/15/2009 8/15/2009 ECEIVING 1ST GARDASIL VACCINE, PT AND MOTHER RETURNED TO CHECK-OUT WINDOW Y AND8/17/2009 STATED THE 8/17/2009 PT "COULDN'T SE veloped a fever, headache, stomach ache, lethargy and loss of appetite approx. 40 hours after Y receiving 8/6/2009 vaccination.8/8/2009 The fever lasted for IAL LESIONS ON FACE, EXTREMETIES Y (+)PRURITUS ON SET OF RASH < 24 HOURS WITH Y VACCINE 8/5/2009 ADMINISTRATIO. 8/5/2009 NO HISTOR l thigh was swollen, red, firm to touch Y and painful area 9cm x 7.5cm in size. Fever up to 102F Y the evening 8/12/2009 after injection 8/13/2009 8/12/09 and the n 9 about 6:00pm child developed fever Y and was taken to ER where parents were told his fever U was 104.5 8/13/2009 degrees fahrenheit. 8/15/2009 Child was tes inflammatory reaction of skin. No systemic manifestations. Y 8/5/2009 8/16/2009 Y 8/14/2009 ter receiving Zostavax, onset of erythemic maculopapular lesions and erythemic patches to left N neck, bilateral 7/27/2009 lower chest, 8/3/2009 right lower abd, ENT PRESENTED WITH DIARRHEA Y ON AUGY11, 2209. BECAUSE 3 OF PERSITENT DIARRHEA, Y PATIENT 7/30/2009 WENT 8/11/2009 TO ER AT HOSPITAL x 6.0 cm wider. U 8/15/2009 8/16/2009 d blotchy rash at site of injection. 8/10/2009 8/17/2009 nd red left arm. U 8/12/2009 8/12/2009 n 8-7-09. 8-10-09 elevated temp 104, Y nausea, vomiting (x1) severe nausea sore. No diarrhea. Y No local reaction. 8/7/2009 Swollen 8/10/2009 glands. BRAT die given GARDASIL, had 20- second ser. tonic - clonic sz with mild postictal phase > 10m after. Y 8/17/2009 8/17/2009 ot swollen up and pt had a red spot in the bottom of both eyes. 8/13/2009 8/14/2009 02 or above and headache x3 days after. U 8/14/2009 8/15/2009 ter immunization of HPV given, patient Y swayed back + then fell to Rt side. Mother + myself called Y her name 8/11/2009 with no8/11/2009 response for @ 3 seco fter receiving vaccines awoke with c/o a headache 'in the back of her head' - headache persisted Y for 2 days, 8/3/2009 better with 8/4/2009 TYLENOL/MOTRIN d. 8/18/09 spoke w/pt says had swelling under left armpit to include chest, triceps and a red spotty rash across 6/26/2009 chest,7/6/2009 symptoms went away 0 min after administration pt states felt "hot" returned to Hospital at 4:05. Noted face slightly Y flushed, B/P 104/64. 8/7/2009States 8/7/2009 legs weak. 4:20pm tion given IM in R deltoid. Immediately Y after pt c/o pain at site. 2 minutes after injection pt was Y sitting in 8/11/2009 chair. Unresponsive 8/11/2009 to verbal stim ely became pale and fainted - revived in at 15 seconds but couldn't remember what happened. Y 8/12/2009 8/12/2009 hard tricep, inflamed large area. 4/23/2009 4/23/2009 eft leg is swollen, red, and warm to touch. Y 7/29/2009 7/31/2009 Nausea / emesis shaking headache BP 110/78 sent to ER Home and feeling was hot seen atYER. was taking 8/7/2009 to long. 8/7/2009 24 hours post imm started with armYpain on R. Nausea, vomiting. Achyness all over and fever Y 1st to 101 8/3/2009 --> TYLENOL 8/4/2009 --> 103.4 seen in o both cheeks, chin and forehead and under right arm with redness, itching and slight swellingUthe next day 7/24/2009 after vaccines 7/25/2009 were administered ived DTAP, VARAIVAX vaccine 8-11-09 Y (L) deltoid. At scheduled visit 8-13-09 to primary care. U Injection8/11/2009 site was warm, 8/13/2009 red and tender. Tre o R deltoid area. 8/14/2009 8/16/2009 received MMR vaccine 5/18/09. Presented Y with rash trunk and extremities. Referred for evalY and trt positive 5/8/2009 pruritis.5/21/2009 Treated with BENADR f tremors X approx. 30 sec and c/o light headedness, Immediately subsided when placed in Y Trendelenburg. 7/13/2009 Then got 7/13/2009 up in chair smiling an U 8/14/2009 8/15/2009 PER ARM REDNESS WIHT SLIGHTY INCREASED WARMTH. Y 8/5/2009 8/6/2009 mom 9:00 am- completely recovered per mom- Mom left clinic without having pt scheduled. Y Pt rec'd Varicella 8/14/2009 to (R) 8/14/2009 arm. Immediate wheal
U 8/17/2009 action from the chicken pox booster. Hives that were burning hot down my daughter's arm. UThis lasted 8/15/2009 all day and8/16/2009 through the night. She izure on evening. Y Y 8/4/2009 8/5/2009 bruise on leg Rt red Y 8/7/2009 8/10/2009 reaction large 12cm x 9cm, swollen hard, nodule formed near/around injection site. Pt instructed Y to use 8/10/2009 ice, TYLENOL, 8/10/2009 and BENADRYL if breakouts hives, rashes, red spots. Small little bumps. Arms, stomach, back, face, legs. And Y where he7/23/2009 got his shots. ious spontaneous report of administration of expired FLUMIST was received from a nurse concerning Y a 20-year-old 1/26/2009 1/26/2009 male. Neither medical n has been received from a dentist concerning his 62 year old wife with macular Y degeneration N and penicillin 8/5/2009 allergy who 8/8/2009 on 05-AUG-2009 w n has been received from Y a 70 year old female patient with no prior history of cancer Y who onUan unspecified date was vaccinated with one n has been received from a nurse practitioner, Y for the Pregnancy Registry for VARIVAX (Merck), Y concerning 2/19/2009 a 17 year old### female with no p n has been received from a physician Y concerning Y a 27 day old male4with a history of premature, N respiratory 1/15/2009 distress,2/10/2009 bruising of face, jaund n has been received from a physician Y concerning a "17-18 years old" female who "about twoYweeks ago"7/27/2009 (approximately 7/27/2009 28-JUL-2009) was n has been received from a physician Y concerning a 17 year old female with childhood seizures N from age 5-11 8/5/2009 years old 8/5/2009 and had been seizu n has been received from a physician concerning a 16 year old female who in approximatelyYJuly 2009 (about 7/1/2009 1 month 7/1/2009 ago), was vaccinate ort was received on 07 August 2009 from an attorney Y who is representing 0 the patient's parents. N A female2/21/2007 patient had 3/3/2007 received an injection o ffice visit vomiting, diarrhea. 2-24-09 dehydration, Y vomiting, diarrhea. Hemocult (-) Rota (+), Y C-diff (+). ### 2/23/2009 er receiving Hepatitis A Y and Tdap vaccines Y had dyspnea and coughing along with redness of Y neck and tingling 8/12/2009 tongue 8/12/2009 - used ALBUTEROL eadaches, belly pain, bilateral feet-legs Y tingling Y numbness, legs aching 14 while walking, weakness N in upper5/11/2009 and lower extremities 5/25/2009 - happened d vaccine site swollen, erythematous, Y warm to touch. Evaluated 8/14/09. Area nontender now. Recommend 8/12/2009 warm compress. 8/13/2009 Localize vacc cribes child as "limp" "weak" just did not feel "solid" when she held him almost immediately after Y shots and 8/11/2009 through the 8/11/2009 evening - cried incon ausea x 2 days - vomiting - headache - oral rehydration and MOTRIN for treatment. U 8/8/2009 8/8/2009 m RN Supervisor received t/c from patients Y spouse. Reports Patient went to ER had difficultyU breathing and 8/11/2009 chest pain. 8/12/2009 Had EKG, Labs an n site of administration 18mm W X 15mmL. Redness around Hive. Y 8/11/2009 8/11/2009 DaP < 10 yrs of age. No adverse reactions noted or reported. No treatment indicated. 8/5/2009 soreness, swelling and itching in arm from site of injection toward the elbow covered area about Y 1 1/2 inches 8/5/2009 by 3 inches. 8/6/2009 Period of dizzine edness, soreness -swelling - itching - Resolved within a few days-. Patient wanted to report Y it. 7/24/2009 area, swelling, 8/13/09 8:00 AM. Treatment diphenhydramine 1/2 tsp TID. 8/11/2009 8/13/2009 min after receiving the below 3 immunizations, pt. slumped fwd from sitting position on exam table, Y losing 8/11/2009 consciousness. 8/11/2009 M.D. caught upper given 6-26-2009 - Also given TDAP and Varicella Booster on 6.26.09. Mother states that evening Y he developed 6/26/2009 redness 6/26/2009 on R deltoid. Feve 8-11-2009 vomited, upset stomach, Ydizzy, tired, cough. Thought would get better continues to Y have symptoms. 8/11/2009 8/11/2009 Client called Health Department at approximately Y 3:40 with complaints of severe abdominal pain Y and "white 7/29/2009 foam coming 7/29/2009 from her mouth, a njection- large area of erythema and Y swelling, multiple vesicles @ site and pt c/o pruritus (L U arm varicella 8/4/2009 site) 8/10/2009 hours after HPV & HEP A she had red glassy eyes, fever to 102 for 2 days, weakness, (generalized), Y arms 7/31/2009 weak & thighs, 8/1/2009 decreased appe ived MMR and VARIVAX on 8-5-09. 8-11-09. Child started with a rash on 8-12-09 child wasNbrought into Health 8/6/2009 Dept 8/11/2009 with rash on face, he 3 3/4 red raised area at site of injection with small blisters through out area - No itching - burning Y etc - Temp 8/4/2009 97.8. 8/10/2009 er, called this RN at 12:15pm and stated Y that daughter's left arm from shoulder to elbow is red and swollen 8/10/2009 and "Hot8/12/2009 to touch" Instructed he er called RN at 12:15 pm and statedYthat daughter's left arm from shoulder to elbow is red, swollen, hot to8/10/2009 the touch 8/12/2009 and the skin looked "str eruption c/u varicella Zoster - S/p ZOSTAVAX. Y 6/30/2009 7/1/2009 orso- anterior ! Posterior ! Itching. Referred to PCP for assessment. Client given Benadryl and Y PCP office. 8/11/2009 SX resolved 8/11/2009 by the next morning matoma approximately 2 in diameter rash - demarcated erythema approximately 5 in diameter. Y 8/7/2009 8/8/2009 came light headed and momentarily fainted 15 minutes after receiving TDAP injection. An ammonia Y capsule 8/12/2009 was used 8/12/2009 and she immediatel VRIX #1 in (L) arm and patient said she felt light headed and started to fall, I lowered her to chair. Y 8/12/2009 8/12/2009 ollowing day awoke with bad headache. 8:00 am felt faint, sore muscles in arms and legs, (ADVIL) Y hurt to 7/29/2009 open eyes. 7/30/2009 Shot site slightly red. on's football game pt started to have Y low grade temp chest feels tight, joint swelling, tongue swelling, fever 8/11/2009 102.8. Pt 8/11/2009 advised to go to neare @ approximately 3:15 pm patient had vaccinations by 5:00 pm developed fever, aches, nausea, N tired. At 8/10/2009 6:15 throat 8/10/2009 felt sore. 8/11/09 - at r area is erythematous, mild swollenY& not Tender skin feels hot to Touch. Y 8/10/2009 8/12/2009 GARDASIL 6/4/2007, 7/31/2007, 12/28/2007 - Normal PAP 6/13/2006, 6/14/2007, 3/26/2008 U - ASCUS HPV 6/4/2007 + 8/3/2009. elling to vaccine site. ABX given from Y ER seen at PCP site. U 8/15/2009 8/15/2009 t red rash around injection site and bruising he following day with c/o fever >102, Y body aches, chilling and cough, encouraged Tylenol around Y the clock 8/11/2009 for the next 8/12/2009 24 hours and push ven a DTaP on August 6th at 1430.YOn 08/18/09 his mother called the clinic. She stated that Y his arm was8/6/2009 swollen from 8/6/2009 the injection site to
Vaccine received 08/13/2008 and 09/16/2008. Five days post second administration I developed N neuropthay 9/16/2008 including 9/21/2009 tingling with pins and 03 for 28 hours, with continued redness Y of injection sight, 48 hours later started wheezing, gasping U for breath 8/14/2009 and coughing 8/14/2009 continued for 36 following vaccination, patient notedYbody aches, chills and progressive left deltoid pain. By the Y following8/12/2009 morning the 8/12/2009 patient was noted to hours of the vaccination had debilitating Y stabbing pain (occipital, cervico, brachial)crescendoNepisode lasting 1 ### hour 40 minutes. ### On a scale h on arms and chest 24 hours after Yreceiving MMR Booster. Treated with Triamcinalone 0.5% Y cream and 8/12/2009 Benadryl.8/13/2009 Prescription given for ceived MMR and Varivax boosters. Y10 minutes later he vomited 3-4 times, had a bowel movement Y (on the 8/18/2009 toilet), and 8/18/2009 had a near syncopal here because he had his shots Friday and that evening he developed a huge red area in the Y vicinity of the 7/17/2009 shots. It7/17/2009 was itchy and his thigh episode following Tdap vaccine. Incontinent of urine. Y 8/18/2009 8/18/2009 seconds of vaccine, I got tunnel vision, and i leaned over in my chair to allow the blood to return U to my head. 8/18/2009 I black8/18/2009 out completely, and so D 4 MO SHOTS 1PM @ HEALTH DEPT. Y 2 HOURS LATER NOTICED "HIVES" BOTH LEGS. Y ER LAST8/17/2009 PM. GIVEN 8/17/2009 BENADRYL 1/4TSP d varicella vaccine 08/17/09 to RPUA SQ. Pt presents to PCHD today with 25w X 30l erthythematous raised 8/17/2009 area to 8/18/2009 site of vaccination sta t generalized tonic-clonic seizures the Y next day. Had full workup, including CBC, electrolytes,Y lumbar puncture, 8/13/2009 head8/14/2009 CT, EEG, all negative ter had been suffering from Y extremeYfull body Uticaria Y for three years Y and had been Y treated with U benadryl,3/4/2008 allergy medications, 4/15/2008 hydrocortiso of 100 degrees F.; headache; severe Y body aches and loss of energy; U 8/9/2009 8/15/2009 as found walking outside relative's house at 4:30 AM. She was found by police. Per mom, patient Y "seemed 8/13/2009 out of it" 8/14/2009 and "didn't want to answ a of erythema at site of MENACTRA injection. Y 8/14/2009 ction to left shoulder/deltoid with erythema, warmth and tenderness. No systemic symptoms.Y 8/12/2009 8/13/2009 arm redness and swelling. 8/17/2009 8/18/2009 ports 7pm Pt C/o throat discomfort, heat, itchy leg- swelling and induration at injection site started Y in AM soon 8/17/2009 after injection 8/17/2009 per mother 1x 2 ndurated, erythematous, swollen, hot and painful. Child more fussy than visual! exacerbationYof asthma x1 8/14/2009 day. Treated 8/15/2009 with Ibuprofen. Now fever to 103.5 headache "both arms hurt" redness at injection site and frequent cleaning of throat. U Encouraged 8/17/2009 to increased 8/18/2009po fluids, TYL upper arm c/erythema - lasting more than 72hrs. Y 8/12/2009 8/12/2009 vaccines, woke up feeling weak andYfaint. Sat down, and passed out. He had generalized seizure Y activity8/14/2009 > 20-30 sec. 8/15/2009 He was tired but not degrees & some delirium the day after Y vaccination small red area Rt deltoid at injection site,Ytender painful 7/27/2009 - Pain is mild moderate. Const away react w/ hives. U 8/13/2009 8/13/2009 accine @ 11am - went home - at 1 PM Y developed hives & itching (generalized) & shortness Y of breath - Mother 7/31/2009 gave7/31/2009 child BENDRYL oral & t. given Tdap injection during an OV to be seen due to a cat bite. 5/7/09 Pt. returned to officeUwith symptoms 4/29/2009 of left upper 5/5/2009 arm pain which be sterically. Lips and hands turn blue. YShaking, fever 103.7 2 days after shots. Y 1/12/2009 1/14/2009 e on Tuesday August 11, 2009, mother reports lump on L leg near injection site, still presentYtoday. 8/11/2009 8/12/2009 of warmth and itching on R thigh on day # 2 after shots. Y 8/7/2009 8/10/2009 after the Hib vaccine my son had high Y fever fluctuating Between 101.6 to 100.7 for the next 5Ndays. He became 7/20/2009 lethargic 7/25/2009 at night developed hot and red to the touch. And arm muscles felt jiggly." X 2 days. Y 8/6/2009 8/7/2009 minute after inj. patient stated inj site Y was itching. Area was slightly red, irregular in shape approx Y 10mm8/12/2009 in size and8/12/2009 warm to touch. 0817 c elling, erythema and bruising after injection. Erythema was approximately 10 inches area, small Y bruise about 8/4/2009 2 cm (18/6/2009 inch). - of neck, trunk, arms. Y Y 7/30/2009 7/31/2009 at injection site, red with fever. Y 3/16/2009 3/26/2009 er, bellyache, tired with MOTRIN temp Y came down, bellyache resolved Y 8/18/2009 8/18/2009 n after receiving Hep A vaccine, patient passed out. Quickly recovered and was awake and Y alert within seconds. 8/17/2009 8/17/2009 was reported by a healthcare professional Y and described the occurrence of injection site redness Y in a 22-year-old 5/19/2009 female 5/21/2009 subject who was the 1st round of Gardasil Y July 7, 2008. Towards the end of August 2009 a lesion formed on N my tongue. I 7/7/2008 have been8/16/2008 diagnosed with Oral C omiting, low grade fever x 2-3 days reported by mother (no office visit). Gave pain reliever, sx Y resolved. 5/5/2008 5/5/2008 6/23/2009 Y Y 2 N 5/30/2009 6/1/2009 was received from a health care professional Y via another manufacturer (case ID number 2009S1013958), on 13 August 2009. A 14-year-o n has been received from a medicalYassistant concerning a 79 year old male with a history ofY stroke, anaemia, 6/12/2009 dementia, 6/19/2009 hypersomnia, alz n has been received from a nurse concerning Y a 20 year old female who on 13-AUG-2007 was Y vaccinated 8/13/2007 intramuscularly 11/1/2007 on her left deltoid es and temp. 99 started 8/7 red, hard, swollen area at injection site (approx 10 cm in circumference and down 8/6/2009 arm form 8/7/2009 inj site - started to s ensation and pain in shoulder, lower legs and feet started morning of 8/11 and increased in intensity Y as day 8/10/2009 progressed. 8/11/2009 Lasted until 1 AM 8 ht headed & weak at 01:00 on 8-8-09 Y - went to Hospital ER & stayed until 05:00 on 8/8/09. Low Y grade temp 8/7/2009 - 99.7 (o)8/8/2009 Had IV fluids & dose o flu vaccine Nov. 2008 - within weeks Y of injection, noticed changes in movement of arm (left) N - positive stiffness 11/7/2008 with limited range of motion. R arm soreness, immed. after shot. Hep A + Typhoid Increase T=100 to the 8th- 101 to theY8th 08.18.09 8/17/2009 @ 8 am. 8/17/2009 en, itching in arm, warm to touch at 2:30 PM. Around 5:30 PM face was itching and arm wasY itching. Arm 7/20/2009 swollen in 7/20/2009 4" diameter. Nausea
were given, pt tolerated well. The following morning pt found quarter sized area of redness with Y a whelp at 8/4/2009 area of injection 8/5/2009 site - area is red as given PNEUMOVAX morning approximately equal to 10 AM 8/4/09, by that afternoon armYbecame sore8/4/2009 with diminished 8/4/2009 R.O.M. following a site of injection - dime size SubQ Y mass. Y 7/30/2009 7/31/2009 report of lymphadenitis has been received fromYa study investigator2concerning a female child U participating in a### post-marketing ### study for FL report of septic arthritis has been received fromYa study investigator3concerning a 39-month-old U female participating ### in a post-marketing ### stu report of hearing loss/deafness has been received Y from a study investigator 1 concerning a four-year-old U male 11/8/2008 participating 12/5/2008 in a post-marketi report of trauma has been received from a study Y investigator concerning 1 a four-year-old female U participating 12/4/2008 in a post-marketing ### study for F report of urinary tract infection and bacteremia Yhas been received from 2 a study investigator concerning U a12/1/2008 44-month-old male ###participating in report of trauma has been received from a study Y investigator concerning 1 a four-year-old male U participating 9/26/2008 in a post-marketing ### study for FL report of nail disorder has been received from aY study investigator concerning 1 a 44-month-old U female participating 12/7/2008 in a post-marketing ### stud report of trauma has been received from a study Y investigator concerning 1 a 41-month-old male U participating in a### post-marketing 11/7/2008 study for FL report of sleep apnea and tonsillitis has been received Y from a study 1investigator concerning U a 43-month-old 1/9/2009 female 1/16/2009 subject participating in a report of congenital anomaly has been received Y from a study investigator 1 concerning a 37-month-old U male 12/2/2008 (subject number ### 29395693) par report of sleep apnea and pneumonia has been Y received from a study 3 investigator concerning U a four-year-old 11/4/2008 female 12/4/2008 participating in a post report of encopresis has been received from a Ystudy investigator concerning 2 a four-year-old U male participating 1/8/2009 in a post-marketing 1/30/2009 study fo report of congenital anomaly has been received Y from a study investigator 5 concerning a four-year-old U female 11/7/2008 participating 11/9/2008 in a post-marketin report of abscess and postsurgical state/complication Y has been received 1 from a study investigator U concerning 11/7/2008 a four-year-old ### female partic report of congenital anomaly and epilepsy has Ybeen received from a1 study investigator concerning U a 26-month-old 11/4/2008 female### subject participa report of abdominal pain and vomiting has been Y received from a study 1 investigator concerning U a 30-month-old ### male participating ### in a post-m report of trauma has been received from a study Y investigator concerning 1 a 36-month-old female U participating in### a post-marketing ### study for F as in waiting room about 10 to 15 minutes after vaccination and was waiting to leave the building Y when patient 8/10/2009 began 8/10/2009 to complain of 'feeling izure like activity after the vaccination, this was her third dose, she had no adverse reactionsYwith the previous 8/18/2009 two. 8/18/2009 She remembers feeling ion of Garadsil was given to my daughter Y on July 21, 2009. A few weeks later her hair has begun N to fall7/21/2009 out severely.8/8/2009 She has not had any ting Heart rate 52 pale poor cap refill, dizzy and nausea. 8/17/2009 8/17/2009 7, DTaP vaccine was given instead of TDaP. U 7/18/2007 d edematous area at site of injection, measuring 6 cm. in width and 5.5 cm. in lenght. Left upper Y arm. 8/18/2009 8/19/2009 nt came in to see the doctor with a case Y of the shingles. Patient was advised to apply cold compresses U 4 times### a day 8/14/2009 for 20 minutes to relie S MOTHER STATES THAT CHILD HAS HAD DIARRHEA ALL DAY, FEVER OF 101, AND U SWOLLEN ARMS 8/17/2009 8/18/2009 hours after receiving vaccine patientYhad a generalized seizure lasting under 5 minutes. TheYseizure was8/5/2009 witnessed by 8/5/2009 his mother and siste pathic autoimmune hemolytic Y anemia Y accompanied Y by high fever, fainting, 7 jaundice, irregularYheartbeat. 6/18/1998 8/21/09 Hospital 7/1/1998 records received ry skin, extreme fatigue, light headed, Y headache, increased menstrual cramps, Raynaud's Y disease, N weight6/3/2008 loss, hair6/21/2008 loss, joint pain, facial r ng, earlobe swelling and eyelids, vomited. Y SomeY drop in BP. Seizure1- post-ictal. 8/31/09 ERY/ hospital records 8/17/2009 received 8/17/2009 DOS 8/17/09 to 8/1 d sudden onset of rolling of eyes, unable to hold Y head, and unresponsive 1 10 minutes after vaccination. Y Pt 8/17/2009 was at home 8/17/2009 and went to ER; fro Y Y 8/17/2009 8/19/2009 upperarm onset redness 1 day after imm. Y 8/13/2009 eported intermittent hives since first HPV vaccine. N 5/27/2009 d ocular viral, herpes infection right Y eye. N 8/1/2009 8/18/2009 ated she received the ZOSTAVAX on 8/14/09 and on Sunday 8/16/09 the injection site started Y to itch and8/14/2009 noticed a 8/16/2009 blister near injection site ated first vesicle rash on arm - also had fever. Pt's fever was in control, but developed more vesicle N rash 7/28/2009 on head, body 8/15/2009 and extremities abo ed following inj./ After 15 minutes pt appeared to be having seizure activity. Observed until able Y to leave 8/18/2009 with grandmother 8/18/2009 of her own accor , slight tenderness @ injection site 1 day after immunization; OTC Ibuprofen for pain and edema; U warm compresses. 7/20/2009 7/22/2009 d female complains of facial skin rash Y and pruiritis after AVA and Typhoid vaccines. Symptoms: Y Swelling, 8/17/2009 Rash, focal, 8/17/2009 Pruritus. x -Mod/Severe local with opportunistic Y bat. infection - SEPTRA susp 2 tsp PO Q12 hrs x 10days - Redness 8/17/2009 13 cm length 8/18/2009 12 cm with 2 cm x erythematous, indurated area of local Y reaction 13cm diameter. 8/13/2009 8/14/2009 e temp (<105 degrees F), erythropoiesis Y became papules all over next day. U 8/17/2009 8/18/2009 after injection and had probable vaso vagal response with full body tremor, lips turned pale, eyes Y rolled back, 8/17/2009 assisted 8/17/2009 to exam table tremor re 7/25/09. Had Mri & Ct scan & blood Y work. In August diagnosed with Hashimoto ThyroiditisN& compensated 4/21/2008 hypothyroidism. 7/25/2009 10/6/09 PCP ter is going into junior high and received Y her tetanus shot along with the first shot of 3 for Gardasil. U That 7/28/2009 was three weeks 8/18/2009 ago. Yesterday m eadaches that come on suddenly (side Y and front of brain). Have witnessed joints, bones that U hurt to the point 8/14/2009 that the8/14/2009 child can not walk, com sore, headache, fever/chills, leg aches Y 8/17/2009 8/18/2009 fter receiving her MMR vaccine, Y the patient developed Y fever, rash and 20 convulsions, requiringUadmission to 6/10/2008 the pediatric 6/20/2008 ICU. Her developm
ed that she felt a tingling funny sensation on her left cheek about two hours after the vaccine.She N had visible 8/18/2009 swelling 8/18/2009 of left cheek and face ALSY DIAGNOSED BY PERSONALY PHYSICIAN. U 8/18/2009 8/19/2009 llowing vaccine administration pt developed Y fever, myalgias, anorexia for approximately 36 hours. Y Temp8/18/2009 to 104.4. Also 8/18/2009 developed localized hot was given, pt. has had severe headaches Y and acute nosebleeds. She has received two N does, and will 5/19/2009 not receive 5/19/2009 a third. I was never m Fever, Seizure. 8/25/09 Hospital records Y received Y service dates 8/18/09 2 to 8/21/09. Assessment: Y Fever,8/18/2009 febrile seizure, 8/19/2009 vomiting. Baby wok red four vaccines during immunization clinic visit. Within five minutes of injection, client became Y very pale, 8/18/2009 c/o of dizziness 8/18/2009 and lightheaded s all over body appeared day after vaccination and continued for 3 days. Mom treated day 1Ywith benadryl 8/12/2009 then oral8/13/2009 steroids when didn't re chin, arms, legs, caps of shoulders Y U 8/14/2009 8/14/2009 her reported that the fever that developed Y post vaccination was as a result of vaccines given.Y Prior to vaccine 8/17/2009 administration, 8/18/2009father stated t le pain, severe headache, bad bone pains, neck pains, exhaustion, runny nose, stuffy nose, sore irritated 8/17/2009 throat, This 8/18/2009 has lasted now for 2 LAINED THAT INJECTION SITE WAS Y BOTHERING HER ON 20 AUG 09. REDDENED AREA Y MEASUROING 8/17/2009 30MM 8/19/2009 X 65MM ON MEDIA d the Gardasil series of Y shots on July 20, 2007, Sept. 26,2007 and Feb. 20, 2008. In Jan. 2009, N she told2/20/2008 me (her mother) 1/29/2009 about a large lum UG 09, PT COMPLAINED TO MOTHER Y THAT INJESCTION SITE HURT AND ITCHED. REDDENED Y WITH 8/17/2009 INDURATION 8/19/2009 NOTED ON LEF n has been received from a physician, for VARIVAX (Merck), a Pregnancy Registry product,Yconcerning a4/1/2008 female who 4/1/2008 in the first week of A diagnosed Sensory Guillain Barre - YJan 08 IVIG relapse May 2008 IVIG relapse June Y 2008 high N dose of PREDNISONE ### 12/1/2007 tapering down rela miting, bloody diarrhea. Seen in ER.YSeemed toYbe in pain - bright red 2 blood in diaper, massYpalpable in abdomen. 8/6/2009 Ultrasound 8/13/2009 suspicious fo xis, admitted to hospital. YBegan 10 min Y after admin Y of meds. Received epinephrine, BENADRYL Y and steroids. 8/4/2009 8/4/2009 1/2 weeks after receiving, patients pupils became unequal. Evaluation by pediatric ophthalmologist N revealed 10/5/2007 no other pathological ### findings h, swelling of most of arm where injection Y was given, seen in ER next day given Rx for ORAPRED. Y 8/17/2009 8/18/2009 HPV vaccine 2/10/09; starting 3/24 begin with itchy rash over feet which spread to much of torso. N By 4/09 2/10/2009 developed 3/14/2009 muscle weakness & m theaded/dizzy - No LOC, no nausea - Pt remained in supine position, then sitting position over 20 min. 8/17/2009 8/17/2009 day of injections, got low grade fever 24 hours later and very tired. By 5 pm did not want to walk Y or eat and 8/3/2009 fever 102. 8/4/2009 Fever came down 48 rea with redness - 3X3 center with light Y purple area, no tenderness or warmth. No treatment just observe.8/13/2009 8/17/2009 firm-warm to touch Rx for Augmentin Tsp BID x 10days. U 8/10/2009 8/11/2009 d warm, red, swollen, painful, 7 cm Y X 8 cm. Y 8/11/2009 8/11/2009 hour post injection, pt. came back with red, firm, warm knot approx. 2 1/2 in X 2 1/2 in. Denies Y any other symptoms ### @ this ### time. No tx @ esented to our ER with an injection injury. Y Received a Tdap. According to pt arm swelled upYsize of basketball, 6/8/2009 red, blotchy, fever. Seen in vaccine given in right arm- Redness, Y warm to touch, swelling where shot was given 8.0 cm X Y 8.5 cm in size. 8/13/2009 8/14/2009 rly morning with shallow breathing, fever of 102 degrees & rapid heart beat. After nursing, breathing Y remained 5/4/2009 shallow 5/5/2009 & heartbeat became ate DTAP given (extra) and HEP A given at inappropriate interval. (3 months instead of 6). Y 8/4/2009 es pt felt tired yesterday, light headed dizziness, fell out & lost conciosness for 30 seconds today! Y 8/12/2009 8/14/2009 of hours after first shot, my left knee (which I've had 9 surgeries on, synvisk injection, and is arthritic) U swelled 7/27/2009 up very7/27/2009 large and constantly fo hree daughters to their doctors for the GARDASIL shot. One daughter was fine, no reaction.UThe youngest 7/11/2009 daughter7/11/2009 -11 years old- felt nau other called clinic stating child developed Y "upper respiratory infection 1 week after administration Y of vaccine" 8/4/2009 was treated 8/10/2009 with antibiotics as EACTION, FEVER, CHILLS, MYALGIAS, NAUSEA, Y VOMITING, PNEUMONIA. 1 8/25/09 Received Y ER records 8/7/2009 of 8/16/2009 8/15/2009 to 8/25/09. FIN ministering MMR vaccine patient flinched arm and needle came out a little and some of the medication Y got 8/18/2009 into the right 8/18/2009 eye of the administr ss of hair. Then dizziness and nausea Y with vomiting and severe abdominal pain. After 20 months N of multiple 5/21/2007 doctor 6/15/2007 visits, Nina was diagnos ction within 24hrs. But lasted for nearly a full week. Red, firm, about 6-7cm in diameter, withYsome surface 8/7/2009 vesiculation. 8/8/2009 Initially given Kefle weeks after I received the MMR vaccine Y on July 20, 2009 I developed a low grade headache, Y nausea and 7/20/2009 diarrhea. 8/6/2009 The night of August 5 arted vomiting and having diarrhea at 4:30 p.m. on 08/19/2009. She reports visualizing blood U in her stool8/19/2009 on 08/20/2009 8/19/2009 at 6:00 a.m. ation was on 07/15/08, she began having Y muscle Y cramps primarily in 4 legs. 2nd vaccination was N 10/8/08 10/8/2008 and muscle cramps ###extended throu eloped fever of 100, vomiting and red spots on chest (Size of a fist)the evening of immunizations. U Rash disappered 8/19/2009 8/19/2009 by the next morning, ho to back of left arm the size of mom'sYfist with a rash going down the arm towards the elbow, Y warm to the touch. 8/6/2009 8/8/2009 AREA LARGE SWELLING, REDNESS, TENDER, AND WARM TO TOUCH. Y 8/10/2009 8/11/2009 ernight after receiving vaccine, did not sleep well. Next morning mom noticed area of blanching U red macules 8/18/2009 and papules 8/19/2009 on right knee. T d Vaccinations at 8 am with no symptoms Y or complaints denied any allergy except benadryl.At U 1053am 8/20/2009 patient came 8/20/2009 back to clinic complai temperature leading to seizure. Temp Y 104.1 at Y Hospital Emergency 2 Room. Transferred viaYambulance8/17/2009 to another 8/18/2009 Hospital. 9/1/09 ER rec th a fever on 8/13/09 rash started 8/16/09 mostly on his truck and right side of his face BIG RED SPOTS..8/5/2009 He now sores 8/13/2009 in his mouth, red d first Gardisil injection at her pediatric clinic without complications approximately 1 year ago. Y Gave 2nd Gardisil 8/7/20090.5ml 8/7/2009 injection in L Deltoid ROTATEQ 06/25/2009 AND PRESENTED Y TO OFFICE 7/10/09 WITH COMPLAINTS OF BLOODY U STOOL. 8/13/2009 AT THAT 8/20/2009 TIME WAS THOUG 24 hours after vaccine admin. pt had stiff neck, fever to 100F and body aches. U 8/17/2009 8/18/2009
hours after DtaP vaccination patient was observed to have 3 seconds of staring and trembling Y of whole body 8/17/2009 including 8/20/2009 arms and head. Per ed having "seizures" or "staring episodes" Y and her Y eyes started getting 3 blurry or double Y visionNat times in 1/16/2008 June 2008.3/27/2008 She was so sick she w mited and then became lethargic for 5 minutes. Did not lose conciousness. Y 8/20/2009 8/20/2009 tenderness at the injection site and scattered vesicles. Advised cool compresses to area andUTylenol for 8/13/2009 discomfort.8/19/2009 itchy read rash on face, arms, legs, chest and back. Started 2-3 hours after injections of : Depo N Provera, 7/29/2009 TD and Hepatitis 7/29/2009 A/B (Twinrix). varicella, TDAP, MCV4 on 081809. Returns to clinic 082009 with edema, inflammation,hot to U touch, pain 8/18/2009 at varicella 8/19/2009 injection site on right F 105 ON 8/8/09 WENT TO ER, CXR, Y BLOOD TEST NEGATIVE. THEN FEVER ON 8/10/09 102.2-TYLENOL 8/7/2009 & MOTRIN 8/10/2009 FOR FEVER, IN d itchy scattered vesicles 7 days after receiving Varicella vaccine U 8/13/2009 8/19/2009 1 had shot. On July 26 passed out Y4 times at the fair. August 3 blacked out but she said didn't N pass out7/21/2009 all the way.7/26/2009 Aug 10 not feeling we veloped a hive appearance rash on 1 side of the face approx. 2 hrs. after receiving her 1st dose Y of gardasil. 8/13/2009 The following day rash deeper G, DIZZYNESS HEADACHE , STARTED Y THESE FAINTING SPELLS AFTER THE 2ND SHOT U THAT WAS 1/22/2009 IN 6/09 7/15/2009 HAS FAINTED 6 TIMES minutes post-vaccination: syncope, racing pulse, uncontrollable crying Y 8/19/2009 8/19/2009 e syncope 5min post vaccination. Mother reported child shaking, however, when nurse arrived Y child was8/14/2009 awake and8/14/2009 talking to mother. Moth s given Tdap, Hep A, Menactra, and HPV. Syncope episode 10 min after vaccine adm. Child Y was assisted 8/17/2009 to the floor. 8/17/2009 Was responsive as Y 8/18/2009 8/19/2009 lu-like symptoms ~4 hours after reciept of vaccine (e.g., myalgia, malaise, fatigue). Onset ofUbilateral red8/19/2009 eyes with 8/19/2009 some pruititis, sore thro AREA LOA, APPROX.70MM X 70MM . NO OTHER SYMPTOMS. U 8/12/2009 8/12/2009 with diarrhea (day 0 only); variable low grade fever (day 2-10 ); cold-like symptoms (day 2-7):Yclear runny1/30/2009 nose, sneezing, 2/8/2009 watery eyes; whin al reaction noted 2 days after vaccination Y in the L deltoid. Erythema, induration, pain at the site. Y 8/18/2009 8/19/2009 redness X 1 day Y 8/12/2009 8/13/2009 er receiving third dose of immunization, my daughter began to demostrate unusual psychological N behavior. Atmosphere 10/1/2008 of self-destructive conds of receiving vaccine, I felt likeYI was going to pass out, nurse instructed me to lie downYon table, she left and ### I passed ### out. This occur seizures to reappeared. Hadn't had any seizures for months until vaccinnation was administered. Y Seizures 8/11/2009 lasted for 8/11/2009 most of the week. Se t might have been reported by doctor as requested by patient. Patient received a yellow fever N vaccine VF-Vax-uf081AA 10/9/2007 10/9/2007 on Oct. 9, 2007 an he same reaction to GARDASIL on both shots. The first shot I initially forgot about, on account of I was injected 8/15/2009 with8/15/2009 three vaccines at once. fter the vaccination, she developed Yshaking chills and soreness at the injection site + fever to U 100, two days 8/17/2009 after vaccination 8/18/2009 (today), has H oster, R side breast (under) to approx Y T10. Acyclovir 800mg with 4hrs x 10 days. Y 8/18/2009 8/19/2009 esented with vesicular lesions to Rt side of Rt leg at VARIVAX injection site. Y 8/17/2009 8/18/2009 d swelling & redness. 3 X 4 cm mildY induration. Y 8/18/2009 8/19/2009 8, 2009, patient came for a well child check and she was given DAPTACEL as catch up - last U imm given8/18/2009 at 15 m/o. 8/18/2009 d Hep B #1 in her left arm at 1500 on 6/23/09. The pt waited in the clinic 15 min (felt fine) and drove home 6/23/2009 (which is very close to the clinic eloped herpes zoster in T3 dermatome. He has no history of varicella disease. He received VARIVAX Y at 12 months7/24/2009 and 12yrs of age. elled/ made swallowing difficult/ food & drink would not go down. Y 8/11/2009 8/11/2009 ived varicella vaccination 7/31/2009. 1 week later, she developed a swollen, red area at the injection site. 7/31/2009 2 weeks after 7/31/2009 the vaccination, sh 7/16/09, Date of event 7/21/09, Severe generalized Rash - entire Body steroid given medial dose pacal.7/16/2009 7/21/2009 rm significant edema, redness, heat, Y mild pain + itching R lateral neck moderate redness + edema. Y 8/17/2009 8/18/2009 aches, Right arm numbness, R arm severe pain, nausea, agitated, hurts to swallow, emotional Y after HPV8/19/2009 vaccine. 8/19/2009 en left deltoid about 11:30 AM. 1:00 PM developed blotchy, itchy rash left side of chest and Y left shoulder. 8/20/2009 No respiratory 8/20/2009 involvement. Had administered (L) deltoid 8/17. Intense Y (L) upper deltoid pain 8/18 - current. 8/17/2009 8/20/2009 ver 99.0 - C/o SA last night, vomited x 2. Vomiting has stopped @ 4:00am 8/20/09. U 8/19/2009 8/20/2009 spreading into armpit/breast with soreness Y + hard area/cellulitis U 8/17/2009 8/18/2009 nset left sided chest pain and pleurisy Y like symptoms approximately 4 hrs after vaccine. Y 8/19/2009 8/19/2009 welling one day after vaccine - improved Y by day of doctors visit on 8/19/09 left arm is 4 cm greater Y diameter. 8/17/2009 Received 8/18/2009 two, immunizations s - not noticed until visit 4:00 pm following Y day Red, swollen, hard (cellulitis) pt jerked duringNinjection (needle 8/18/2009 reinported) 8/19/2009 8.20.09 still red s 8/18/09 left arm red swollen with heat and "rash" at injection site with itching at site of injection. Y Mom denies 8/17/2009 other symptoms 8/18/2009 and symptom ination mom reports the pt was veryYlethargic. Arm was swollen and had a white spot whereYvaccine was8/18/2009 given. Eyes 8/18/2009 were sensitive to ligh esented to Doctor 8/20/2009 complaining/existing hives. U 8/9/2009 8/11/2009 20 X 18 cm swelling / warmth / itching. 2 cm increase in left thigh circumference. U 8/18/2009 8/18/2009 9 Other Red raised rash. U 8/10/2009 8/20/2009 erythematous wheal U 8/11/2009 8/11/2009 ction site left deltoid. Area is raised & red with heat. Approx size of golf ball. Advised symptomatic tx with 8/18/2009 MOTRIN. 8/19/2009
tool no Tx given. 1 wk post Rotateq. Pt well at time of exam. Y 8/12/2009 8/20/2009 rash, Dx: chickenpox . Y U 8/31/2007 8/18/2009 lands on side shot administered only Y . Tonsil on side shot administered was swollen, bleeding Y and piece of 8/8/2009 flesh were8/9/2009 falling off the tonsil. F U 8/17/2009 8/18/2009 at the injection site. Lumps, welt, & rash at site. Y 8/18/2009 8/19/2009 p to 101 x 72 degrees - Swelling of leg - Swelling & erythema 3cm in area of shot. U 8/17/2009 8/18/2009 lled stating son broke out in hives all over body. Day after getting HIB. No new foods or dye, U No impaired 7/30/2009 airway. 7/31/2009 Rx'c BENADRYL - told n has been received from a consumer Y concerning her 24 month old son who on approximately N 17-APR-2006 4/17/2006 (reported as### when he was 18 n has been received from a physician concerning a 25 year old female who on 07-AUG-2009 Y N was vaccinated 8/7/2009 with a dose 8/7/2009 of GARDASIL (lo n has been received from a nurse practitioner Y and Y a nurse concerning 0 Yone of her patient's friends N who on unknown date was vaccinated wi n has been received from Y a registered nurse and a certified medical assistant concerning a 16 Y year old female 7/27/2009 with 7/28/2009 migraine headaches an n has been received from a physician concerning a 63 year old female patient who on 11-JUN-2009 U was6/11/2009 vaccinated6/11/2009 with a single 0.5ml do n has been received from a registered Y nurse concerning an 81 year old female patient Y already N deaf in left 7/28/2009 ear with hypertension, 8/8/2009 diabetes, ort received on 17 August 2009 fromYa health care professional. A 46-year-old female patientYwho had metal 6/8/2009 in her eye, 6/15/2009 had received an int ave Pentacel inadvertently when I should have given Hib. The parent was notified of mistake U by Dr. 8/6/2009 fter varicella vaccine developed defused smaller varicella papule some with vesicles trunk + N head shortly 8/3/2009 after fever8/17/2009 to 103-104. e up on left leg swollen. Allergic reaction Y to vaccine - polio shot. Y 8/10/2009 8/11/2009 o thigh quarter sz. 8/13/09. Warm compresses. 8/14/09 site not as red per mom. Y 8/12/2009 8/13/2009 minutes of receiving vaccine, Pt c/oYabrupt severe H/A 0 SOB 0 hives 0 local reaction. Y 8/14/2009 8/14/2009 U 8/14/2009 8/15/2009 ceived MMR injection left deltoid onY8/14/2009. States she developed a rash starting at the injection site 8/14/2009 which was 8/14/2009 covered by a band aid. r, nausea, stiff neck 103 degree fever according to mother. Did not go to ER, treated at home. Y 8/12/2009 8/13/2009 r rec GARDASIL, HAVRIX & VARIVAX inj - pt became pale, lightheaded - nausea ringing in Years - pt laid8/17/2009 on exam table 8/17/2009 recovered. mostly on chest - arm and head. This lasted 3 weeks small bumps and uneven skin. Y 7/15/2009 7/16/2009 right eyelid swollen. No other symptoms. Instructed by MD to monitor. Y 8/12/2009 8/12/2009 edness, warmth of left arm from shoulder to elbow. Swelling also present. Mother stated leftY arm looked8/14/2009 much better 8/15/2009 than it had on 08/15/ ite swollen and warm to touch redness Y about 2 inches in diameter. Y 8/18/2009 8/18/2009 adache, increased heart rate. Y Y 8/17/2009 8/18/2009 est and along shoulder blade on left side, red & warm to the touch. Y 8/19/2009 8/20/2009 l syncope w/in 2 minutes of GARDASIL administration. Y 8/12/2009 8/17/2009 nd eye vomiting, nausea; paresthesia of right fingertips, aching in thighs; No treatment. Y 8/14/2009 8/14/2009 as crying for about 6hrs; Right thigh was red and warm. Y d area noted to LT injection site Y 7/29/2009 7/30/2009 Y 8/14/2009 8/14/2009 lump - tennis ball size at site of injection. Site red, hot and itchy. U 8/13/2009 8/14/2009 d PPV23 in his right arm on 08/17/09 at 2:40 p.m. On 08/18/09, pt was complaining of redness, Y pain, and 8/17/2009 swelling to 8/18/2009 right arm where vacci ted a history of eczema on the screening form. The provider reviewed medical records bothYhard copy and 8/13/2009 digital and found no documenta of wide spread urticarial eruption, very pruitic,covering her torso and upper thighs and upperYextremities. 6/3/2009 Treated with 6/5/2009 oral anti-histamine a my fourth rabies booster shot, I developed a large red lump in the same arm later that day. N It was sore, but 8/6/2009 did not itch. 8/6/2009 It was further dow ad urticarial pruitic rash. No respiratory difficulties or systemic symptoms. Y 5/27/2009 6/3/2009 re 3 days after vaccines given Y Y 7/16/2009 7/19/2009 E SATELLITE LESIONS OVER BACK Y & FACE & ARM 3 WEEKS AFTER VACCINATION 7/30/2009 8/19/2009 ery dizzy immediately after vacinne. Nurse had to catch her and help me put her in chair. She Y sat there for 7/1/2009 awhile. Then 7/1/2009 I took her into the ap and varicella shots 6/1/09. Pt's mom reported to me yesterday that pt had bad diarrhea the U day after the 6/1/2009 vaccines6/2/2009 were given. Had see mother reports that at 2:00 AM on 8/19/2009, patient had what appeared to her to be a possible Y seizure. Mother 8/17/2009 called 8/19/2009 our office around 8:3 t with severe left arm induration and erythema extending from elbow to left shoulder with painful Y ROM. Tx'd 8/15/2009 with Medrol 8/15/2009 dose pack and Be tially vaccinated for smallpox on 08 Jul 09. he had an equivocal take so he was revaccinated on 12 Aug8/12/2009 09. pt presented to the clinic 20 A med child was on Zithromax day immunization Y given. Deferred kindergarden shots but gave Y HIB. Thought 8/19/2009 4th Hib needed 8/20/2009 as only 3 doses e Tdap and varicella vaccines administered reported to have a reddened, hard, warm, soft-ball sized lump 8/17/2009 at site of 8/18/2009 Tdap injection. Also re Pt. came to medical center presenting with a rash on his face, torso, back, and legs. Raised,Ured, itchy rash 8/13/2009 noted. 8/20/2009 Preceded by 2 days of t beat,weakness of the left arm and leg,troubleYbreathing,severe chest 3 pain, pain in the arm Y and leg, large 8/13/2009 red welts8/14/2009 on left side of neck and
GIVEN THIRD HEP B TO SOON. OTHER VACCINES WERE ADMINISTERED AT THIS VISIT ALSO. MOM 8/20/2009 WAS CONCERNED BECAUS d swelling, pain, erythema; hypotension Y with fever to 102F. Y 8/17/2009 8/19/2009 nausea, vomiting starting 4-5 hrs after Y shot and lasting for several days. On 8/21/09, orthostatic hypotension 8/18/2009 noted, 8/18/2009 temp 99.2. Viral illne vaccines at 4:30 pm. At 11:00 pm she rolled over in bed and head felt heavy. At 5:30 am she Y woke up dizzy 8/19/2009 and the8/19/2009 room was spinning. W ven the vaccine at 4:00 PM on 7/30/2009. Y He returned to the clinic on 8/1/2009 with a localized Y area of 7/30/2009 errythema and 8/1/2009 edema at the injecti ng from elbow to shoulder, skin redness, Y itching and fluid-filled blisters at injection site. Y 8/10/2009 8/12/2009 ay after Shingles shot, I developed stiffness and pain on movement of my left shoulder which has persisted 5/22/2009 from 5/23/09 5/23/2009 to the present. P ded, dizzy, and nauseous immediately Y after vaccination. Since vaccination: headache, Y severe N fatigue, numbness/tingling 7/24/2007 7/24/2007 in extremities, sha and swelling from site of injection past elbow. Started approx 24 hours after injection given and U has progressed. 8/19/2009 Denies 8/20/2009 any temp. was reported by a healthcare professional and described the occurrence of group b streptococcus U in an infant### male subject who was vacci was reported and described the occurrence of mild ulcerative colitis in a 52-year-old female Ysubject who was vaccinated with influenza viru was reported in a literature article and described Y the occurrence of 0 severe exacerbation of ulcerative Y colitis in a 52-year-old female subject le subject was enrolled in Y a prophylactic open study. Y On 26 June 2009, she received the dose N of MENINGOCOCCAL-TETANUS 6/26/2009 8/12/2009 TOXIOD. hen went to bed last night redness and small bruise. Came to clinic and FNP noted small amount U induration, 8/20/2009 erythema 8/21/2009 and small contusion oid area was a little pale 8/21/2009, elevated intensity/swelling 8/22/09, cool compress, Cephalexin Y 250/5 8/20/2009 mg's i tsp8/22/2009 QID. port soreness to right deltoid and right arm swollen. Y 8/13/2007 or - pale, fainted. V/S taken 430p 94/68 P 64 R 18. 435p 98/70 64 - 18. Y 8/20/2009 8/20/2009 ed (1) Tdap in (L) arm then MENACTRA Y and VZV Rt arm. Then immediately had projectile vomiting. Y Pt. then 8/21/2009 fainted8/21/2009 and vomited again whi ction (L) upper arm/tricep area. 4 cm x 4 cm mildly erythema, swollen, no TTP. BENADRYL is Y given by mouth. 8/20/2009 8/21/2009 vaccine reaction started 24 hours after Y receiving Varicella on 8/19/09. Pt reported itching prior Y to swelling8/19/2009 and tenderness. 8/20/2009 Induration area 5 accine about 11 o'clock, Ate lunch about noon. At approx 1 PM reported, diarrhea X 2, severe Y nausea, feeling 8/21/2009 faint.8/21/2009 Placed in recliner IV flu ) arm 1 1/2 inch circle. Y 8/20/2009 8/20/2009 client called reporting that arm site where Y VARICELLA vaccine was given become swollen &Yhad hive like 8/17/2009 reaction. 8/18/2009 Client was seen by PM S 8-20-09, began wheezing by 10 pYthat eve - worsening by am 8-21-09. Arrived for tx / received U DUONEBXL 8/20/2009 plus 8/20/2009 5 mg ALBUTEROL with V #1 12-16-08- No reaction. HPV #2 2-16-09- 2 wks after- severe abd pain, decreased facialYswelling, lips and extremities swollen, no resp m pt developed swelling slight left arm Y redness advised to apply ice and take BENADRYL. AtY8:30 pm pt 8/18/2009 became very 8/18/2009 shaky & diaphoretic red swollen warm to touch around injection site. Keflex ZSO/5. 5ml PO BID; possible cellulitis. U 8/19/2009 8/20/2009 d fever, pain, redness & swelling at Y area of injection site day after immunization - treated withUMOTRIN &8/18/2009 antibiotic. 8/19/2009 Y Y 8/17/2009 8/18/2009 time of vaccination until about a month Y after, I experienced moderate pain in my left arm at the N injection site 8/23/2008 and in the 8/23/2008 entire arm and had p Y Y 8/19/2009 8/21/2009 s after the shot, he started to wake in the night crying as if in pain and he was inconsolable. Y NHe has always 5/14/2009 been a 5/16/2009 good sleeper and had p nd received the vaccinations Y while standing Y was Y asked how he was 3feeling he said ok was then U sent to the 8/19/2009 hallway 8/19/2009 of the emergency room hours after the shots my son became Y lethargic complaining of severe body aches, throbbingY headache,8/21/2009 pain at injection 8/21/2009 sites, blurred visio ven shot on 08/18/09 in Left deltoid IM. Y He was sitting in a chair. Approx 1-2 minutes after injection Y his left 8/18/2009 arm was flexed 8/18/2009 toward body his l ter shot: Tremors,vertigo,hot flushing, Y pallor, nausea,headache,lower back pain,fatigue & dehydration. Y Pulse 8/10/2009 and respiration 8/10/2009 was high, blo 03, complaint of headache almost immediately, Y sore/dry throat, very irritable, soreness at sight, N feet twitching, 8/18/2009 vomiting 8/18/2009 the next morning af ness never went away after vaccination. Y At first could not raise left arm straight up to to side without N pain.1/19/2009 Range of motion 1/19/2009 gradually decrea ven vaccin afternoon of 8/21/09. She bgan itching "everywhere" abou 8pm that evening. At 9pm she began 8/21/2009 to notice8/21/2009 a generalized rash. Ab ves, itching, wheezing with Y prolonged Y reaction resulting in "flare ups" for weeks with anylphylaxis. N Recently 6/26/2009 escalated 6/27/2009 to a systemic reaction zziness cuasing inability to walk without Y assistance occurred approximately 4 hours post administration N of 8/19/2009 vaccination. 8/19/2009 Dizziness so severe red just prior to discharge Y from hospital Y on 4/1/08. Y Immediate pain10 at site of injection. In theYearly hours of 4/1/2008 the morning 4/1/2008 of 4/2/08 blood pre ever of 102.7 F taken under arm at 11 pm, Saturday, August 22. The highest temperature ofU103.6F was8/20/2009 taken under 8/22/2009 arm at 2 am, Sunday @ 2130--urticaria bilat hands, elbows et knees approx. 0015 (08/23/09). Macular rash bilat upper Y extremites 8/22/2009 with edema 8/23/2009 present approx. 01 d with Type 1 Diabetes Mellitus Y 10 days Y after receiving Y 3rd dose of GARDASIL 2 vaccine Y made N by Merck. 8/25/09 ###PCP records ### rec'd. WCC rain injury after a possible Y averted SIDS Y event.YFive hours (approx.). 60 Receiving Y second Y series of vaccines. 4/17/2009 9/9/09 Hospital 4/17/2009 records received ived both vaccines in right thigh at the Y same time. Within 48 hrs. site became large, red, andYwarm. No signs 8/4/2009 of systemic 8/5/2009 reaction. Treated Shingles Vaccine ZOSTAVAX 7/21/09. After 48hrs, had rash on chest and under breasts. Returned N to doctor 7/21/2009 8/4/09. 7/23/2009 No diagnosis. Given f of shingles Post Vaccine Rash, painYR jaw. Saw MD Tx Famvir 500mg TID x 7 days. N 6/19/2008 7/29/2009 for well check up at 09:30. He had history Y of mild Y cough and normal1exam. He had vaccinesYand went home. 8/19/2009 He took 8/19/2009 a nap and awoke wit ely following vaccine (about 4 mins) Ypatient passed out - hit her head on a table then concrete Y floor. health 7/28/2009 Unit called 7/28/2009 emergency and she w
der pain, decrease ROM after injection Y of vaccine. Pain on palpation of shoulder 3 days later. U 8/14/2009 8/15/2009 ness - firm - Golf ball size tender to touch- greater than 48 hours later. Y 8/5/2009 8/6/2009 had no feeling/wd not support weight. Y Dizzy/Light Headed. Blacked out. U 6/29/2009 8/15/2009 pprox Received Pentacel vaccine. By three hours later, the leg was red, swollen, very tender Y to touch. 8/18/2009 Redness and 8/19/2009 swelling disappeared x 6" width. Redness, with heat at injection site. Rec' pt use ibuprofen for pain 6-8 hours. Up to U 800mg, ice8/19/2009 packets for 8/19/2009 comfort. nd dizzy 1 hour after shot given. Y n has been received from a nurse practitioner concerning a 56 day old breast fed male who N on 08-JUN-2009 6/8/2009 was vaccinated 6/8/2009 with the first d n has been received from an office manager concerning Y a male physician 0 who on 11-AUG-2008 N was vaccinated 8/11/2008intramuscularly 8/12/2009 into the le n has been received from a consumer concerning a "3.5 year old" male patient with no pertinent N medical history and no drug allergies, who n has been received from a physician Y and an other medical professional concerning a 13 year Y old female 6/18/2009 with no pertinent 6/18/2009 medical history n has been received from a medicalYassistant concerning her 15 year old sister with no known N drug reactions/allergies 8/8/2009 8/8/2009 and no known pertin n has been received from a respiratory therapist concerning a herself who on an unspecifiedYdate was vaccinated with a dose of GARDASI severe fatigue, lethargy, chills, heart Y racing. Y 8/11/2009 8/12/2009 injection site with large X erythematous reaction. Slight tenderness, positive blanching of body Y skin color. 7/29/2009 Flu-like sxs with body aches, feve reaction to left thigh. Y 8/17/2009 8/18/2009 given on 8/11/09 (Tdap, MCV4 & Varicella). Y Mother called on 8/12/09 to report swelling, increased U (abnormal) 8/11/2009 discomfort 8/12/2009 to back of left arm ates he developed a rash to lower legs Y on 8/8/2009, intermittent itching. Pt went to foreign country Y from 7/14/2009 July 29 through 8/8/2009 August 8, 2009. H t. returns with c/o malaise, pallor, diaphoretic, hypotensive with no Sxs of SOB or resp. distress. Y V/S: B/P8/13/2009 96/. 10:458/13/2009 EKG performed; read se reaction noted to extra dose of ROTARIX given one month after 2nd. Y 8/19/2009 ng into nursing school, received varicella Y vaccine 8-4-09. On 8.15 and 16 took home pregnancy U test which8/4/2009 confirmed pregnancy. She had s ess t max 103. Severe myalgias. Redness Y at site. Y 8/13/2009 8/15/2009 duration & erythema at site of DTaP/IPV on (L) deltoid. Y 8/18/2009 8/19/2009 & swollen where immunization was given. Y 8/17/2009 8/19/2009 ction: red, swollen, hard to touch. Went Y to Dr. Dx with early cellulitis - put on antibiotics 8/19/09. U 8/17/2009 8/18/2009 tes child began favoring leg yesterday. Y Today, child's leg has 3 1/2 x 2 1/4" area of redness,Uswelling and 8/18/2009 warmth. MOTRIN 8/19/2009given. d syncopal episode & fell to ground in office after immunizations with VARIVAX. BP decreased Y pulse decreased 8/22/2009 not8/22/2009 cyanotic or pale had h arm 2in x 2in reddened hard area warm to touch. Denies pain c/o. Y 8/17/2009 8/20/2009 was reported by a healthcare professional and described the occurrence of arm Y swollen in aN11-year-old8/18/2009 male subject 8/19/2009 who was vaccinated was reported by a healthcare professional Y and described the occurrence of intussusception Nin a 6-month-old 7/17/2009 male subject 8/18/2009 who was vaccin ll erythema for 2 days, resolved. subsequent Y cellulitic erythema at site and proximal/distal began 5 days8/14/2009 post vaccination. 8/19/2009 given antibiotics vaccinations around 12:30 p.m. andYstarted feeling ill around 8:30 p.m. Fever of 103, stiff neck Y and neck8/21/2009 pain, back8/21/2009 pain, headache and bo Left Deltoid swelling, erythema, warmth. Y Onset day after immunizations (Tdap, MMR in left Uarm). Treated 8/19/2009 with ice,8/20/2009 anti-inflammitories, ant utside of FDA approved age limits. Pt is 9 and youngest limit is 11. No reported adverse reaction Y or illness 8/24/2009 reported 8/24/2009 by patient or family. P dministered 08/20/2009. Client had nausea and vomiting on 08/21/2009. Client had rash to YL arm accompanied 8/20/2009 by8/21/2009 fever of 101.5 and fatig ent received the immunizations (Kinrix, MMR, Varicella, Hep A) he left the building with his mom Y and sister. 8/19/2009 After they 8/19/2009 got in the car, his siste 1/25/2009 N 1/25/2009 1/25/2009 p, difficulty breathing, tired, pain in arm upset stomach Y 8/18/2009 8/21/2009 ports fatigue and complaints of chest pain, abdominal pain. Y 7/31/2009 8/1/2009 4 year vaccines on 8-20-09. Mom noticed Y L arm swollen on 8-22-09 and on 8-23-09 patientYarm was swollen, 8/20/2009 she complained 8/22/2009 of itching an ew days of the vaccination, pt. began to throw temper tantrums every day screaming at the top N of her lungs. 5/14/2009 She will 5/16/2009 not listen. She starts first hep b shot and IPV shot on the morning of August 20, 2009. By 11pm had high fever that Y lasted until 8/20/2009 August 22. 8/20/2009 Also had muscle ach cines to pt while she was lying flat on the exam table. Approximately 30 seconds later, she passed Y out and 8/21/2009 had several 8/21/2009 jerky upper body m given on 08/20. Approx 3" in diameter red rash. Rash was hot, tender and swollen as presented Y on 08/22. 8/20/2009 No other 8/21/2009 signs or symptoms. N e dizzy 20 min. after first Gardasil injection. Y 8/24/2009 8/24/2009 with rash all over extremities, trunk, face, bottom of feet 8/12/09. Has had fever of 100, lethargic, U lossof7/16/2009 appetitie. 8/12/2009 On 8-14-09 some spots all of left foot extremely sore, painful and remained sore, red painful as of 8-17-09 but improving Y 8/14/2009 8/14/2009 TES AFTER RECEIVING H. ZOSTER VACCINE EXPERIENCED WEAKNESS, LIGHT HEADEDNESS, Y FATIGUE, 8/23/2009 DIZZINESS, 8/23/2009 CONFUSIO mplained of continued muscle soreness and pain in left deltoid area 8 days after receipt of Hepatitis U A/B8/13/2009 vaccine. Physician 8/21/2009examined. No eceived phone call from pt reporting red, warm area on (L) deltoid. States started about 3-4 hrs after receiving 8/19/2009 the vaccine 8/19/2009 on 8/19/09. Instr omplaining of muscle fatigue ever since the immunization. He lacks energy. He had itching N that is now resolved. 7/2/2009He7/3/2009 had headaches that a d an increased heart rate of 118 with an average of 90. Pulse rate prior to receiving Adacel was U 60-70 beats 8/16/2009 per minute. 8/18/2009 Symptoms began
G AND REDNESS TO LEFT ARM U 8/21/2009 8/23/2009 m chronic nausea, chronic abdominal pain, face Yrash, anxiety, fatigue, 1 depression, weight loss, N loss of appetite, ### tremors, 5/20/2009 foaming of mouth... ng headaches, chronic fatigue, dizziness and light headedness. Received symptoms shortlyUafter receiving 7/23/2009 first Anthrax 8/6/2009 vaccine on 23 July petite & 102 degree fever; treated with tylenol U 8/17/2009 8/24/2009 y.o. Received immunization Booster at medicalYcenter. Returned 8/12/09 3 for mild irritation vs cellulitis (L) arm 8/7/2009 at site8/12/2009 for varicella. AUGMEN redness, and itching of the right deltoid after receiving TDAP vaccine. Y 8/19/2009 8/19/2009 8 he developed a tremor and stopped Y walking. Tremor persisted through 8/24/09 10/01/09 U PCP medical 9/22/2008 records, consults 9/28/2008 received DOS 9 Rash (small) on the tummy. Went to Y clinic 8/13 was tested for mono: negative. 8/22/09 got worse: U increased 8/4/2009 rash, increased 8/10/2009 fever, headach n 8/19/09 -Weds- Onset of soreness/hot to the touch-FRIDAY-SATURDAY-8/21-22. Saw patientY 8/24/098/19/2009 Monday-Small 8/21/2009 knot in muscle-sl parent of "nodule" developing months after injection (at general vaccine site) - developed sensitivity U & darkening. 8/18/2008See 12/1/2008 copy of parent's lette er HPV #3 and MENACTRA leg pain Y - left upper only - more muscular than bony, increased U CRP difficulty 8/10/2009 walking, 8/17/2009 missed day of school. 9 eloped 8 days after vaccination papular/morbilliform rash- developed 8 days after vaccination. Y 8/12/2009 8/20/2009 d reddened - size 8cm x 4cm slight reddish pink mild induration pain on touch. Y 8/22/2009 8/24/2009 nset left sided chest pain and pleurisy Y like symptoms approximately 4 hrs after vaccine. Y 8/19/2009 8/19/2009 h true urticarial rash on 8/19/09. Then Y developed joint swelling over entire body. BENADRYLYwas given 8/18/2009 every 4 hours. 8/19/2009 ed, hard, hot. U 8/18/2009 8/19/2009 s following shot pt became pale sweaty, not feeling well. Weak & tired on exam she was pale, Y sweaty, pulse 8/18/2009 rapid BP 8/18/2009 OK. Pt was given wa h and soreness developed on 8/22/09 Y AM went to the ER in evening as it was spreading - Was Y put on LEVAQUIN, 8/20/2009 Prednisone 8/22/2009 and ATARA loped swelling of face/hands/feet. Lab work consistent with (illegible)/nephritis. 10/2/09 Hospital N records,8/13/2009 allergy/immunology and neurolog urated dark red. 6cm total - lighter pink surrounding area. Itchy. Y 8/18/2009 8/20/2009 1/2 cm x 3 cm area of redness R upper Y arm. 8/19/2009 8/21/2009 circumferentially 2/3, length is 1/3 - Induration 5 cm on left upper arm. U 8/18/2009 8/19/2009 d VARIVAX and HAV; left office andYthen returned with difficulty breathing shortness of breath, Y cough, Red 8/24/2009 itchy palms 8/24/2009 given EPINEPHRIN Y 8/12/2009 eeling bad" about an hour after the shot. Had breakout of "blisters" starting on 8/22/2009 + more on 8/23/09, 8/20/2009 located mostly on chest, abdo ccine given at 11 am - 8/14 - Late afternoon felt "ill", headache, tired, no fever, noted rednessUand swelling 8/13/2009 at site - 8/15 8/14/2009 - No energy, arm w e temp (100 degrees F) and eryth raised Y blanching papules all over next day. U 8/17/2009 8/18/2009 upper thigh. Red and raised warm toYtouch. Per chuck speed pt given 1 tsp Benedryl. Y 8/21/2009 8/24/2009 d #2 varicella on 7/28/09. Developed clinical varicella on 8/07/09. Y 7/28/2009 8/7/2009 isters above sight where Immunization Y was Given. Y 8/18/2009 8/18/2009 egs. One leg shape of a triangle. Having HA's and abdominal cramping, fatigue. N 8/11/2009 8/12/2009 booster dose of AVA 18 Aug in rt arm. Y He premedicated 30 min prior with ADVIL 600 mg and Y BENADRYL 8/18/2009 50 mg. He 8/19/2009 took one dose of ADV 8/14/2009 N 8/11/2009 er my son received MMR and Hep A on 10/28/08 he had high fever, inconsolable, Y listless, lethargic U for two weeks. ### He is now ###receiving ther ely after vaccines started to cough, wheeze Y - got Y hives. 9/8/09 Hospital 1 records received DOS Y 8/20/09 to8/20/2009 8/21/09. Assessment: 8/20/2009 Anaphylacti eption 2 wks after receiving 2nd ROTATEQ. Y 9/1/09 Y Hospital records1 received DOS 6/28/09 Y to 6/29/09. Assessment: 6/12/2009 6/28/2009 Intussusception. Patie seeing black shapes, said it was trying Y to kill her, Y refused to go to sleep, 7 said if she did she wouldn't U wake8/17/2007 up, she was 7/29/2009 put in hospital for 7 d nt has been diagnosed with PDD-NOS, Mood disorder Y (depression/anxiety), 0 ADHD, is s/p neuroblastoma U 3/23/2009 in 2001 and 3/24/2009 has issues with obes was given two injectionsYof GARDASIL and shortly Y after was diagnosed 5 with auto immune disease N MG which 5/28/2008 means9/1/2008 grave muscle. She ha my daughter and two of my nieces received theYGARDASIL vaccine. All three have in the past U two months been hospitalized 8/18/2009 with seizure l n has been received from a nurse concerning Y her approximately 14 year old granddaughter Y N with no pertinent medical ### 1/1/2008 history and no known n has been received from a physician concerning a female who a couple of years ago was vaccinated U with 0.5 ml of GARDASIL (Lot # was n has been received from a registered pharmacist concerning a 63 year old male physician with N diabetes 8/3/2009 and hypertension and a history of n has been received from a registered Y pharmacist Y concerning a 69 year 0 old female with sulfonamide N allergy 4/20/2009 and a history of mild anxiety w n has been received from a 71 yearYold femaleYwith allergy to morphine 0 and a history of previous Y stroke 6/19/2009 who in December 6/19/2009 2008, and on 19 en area (Lt) thigh, no fever. Y 8/18/2009 8/19/2009 ately 38 hrs after administration of MENACTRA and HPV vacc, pt developed and was wokenYby "severe"8/15/2009 headache,8/17/2009 T 102 degrees, jaw/ha ons given on 8-10-09, screening questionnaire without "yes" answers. On 8-17-09 phone call received to8/10/2009 this office from mom regarding con et hives about 40-44 hrs after vaccines, generalized including fever with mild puffiness around Y eyes/lips 8/11/2009 no respiratory 8/13/2009 difficulty. (+) itching, ZOSTAVAX (shingles vaccine) on 8/13/09 at 4PM, noticed rash to (L) shoulder, (L) neck area U on 8/18/098/13/2009 with head8/18/2009 & eye sensitivity. Pt ca sized" lump at injection site starting 8-20-09. Bright red in color, no pain, only slight itch. Pharm N recc. ice.8/18/2009 Pt icing. 8/20/2009
ness in mouth, unable to eat without gagging, Dysguesia. N 8/17/2009 8/18/2009 nset pain, redness swelling over 3 days Y since Tdap administration. Day 2 with subjective fever, N malaise8/17/2009 Dx: Cellulitis 8/19/2009 Tx: Rocephin 1G 1M ure of 103 F and fever like symptoms 8/5/09. Telephone call from patients spouse stating temp U now 101 F. Nausea followed by emesis of p njection site - difficulty breathing - vomiting. Given Epi-OK after about 15 min. Y 8/17/2009 8/17/2009 induration right deltoid. Myalgias. N 8/11/2009 8/12/2009 ined of "mild" shortness of breath and Y dizziness. Went to E.R. was given BENADRYL and discharged Y to8/19/2009 home. F/u 8/19/2009 next day pt states comp d varicella vaccination on 8-19-09. Ypt presented to office on 8-20-09 with 7cm x 7cm RA wheal. Y Site was 8/19/2009 raised, warm 8/19/2009 to touch, red and fi d varicella vaccine sub-Q in left armYon 8/20/09. Pt presented to office on 8/24/09 with history U of redness8/20/2009 on 8/21/098/21/2009 and s/s getting worse ned to clinic 2 days after vaccinationY with erythema of upper left arm (where vaccine was given), Y tenderness 2/4/2009 and inablity 2/4/2009 to sleep on left sid shing, back pain, shortness of breath, and elevated blood pressure. Y 8/10/2009 8/10/2009 started on July 31 - had some wheezing, tachycardia, temp 103.6, severe myalgia, difficulty sleeping Y due7/30/2009 to agitation7/31/2009 despite taking zolpide m began to swell x 3 days after vaccination, Y reported to our worker's comp advisor. At that time, N she went 8/14/2009 to ER and8/15/2009 dx as bursitis and slin al temperature, Headache, Nauseous, Y abdominal discomfort, loose bowels, dizzyness/lightheadedness. U 8/21/2009 ER Visit per8/23/2009 primary physican. Fev er getting vaccine, arm became swollen, red, very tender, had difficulty raising arm. Had sweats U today. Had 8/22/2009 some mild 8/24/2009 itching until he took TIS, BUTTOCKS AT INJECTION SITE, ABX THERAPY Y STARTED ON 3 ADMISSIN 8/23/09 9/30/09 Y MR received 8/21/2009 for 8/23/2009 DOS 8/23-26/09 with d ceived Menactra vaccine in early afternoon Y and left with her family. Her color was pink and she Y was walking 8/24/2009 and talking 8/24/2009 without difficulty. I after client received5 vaccinations she became diaphoretic, pale, nauseated, faint, this continued Y for about 8/24/2009 15 minutes, 8/24/2009 kept for observatio vaccine received on 08/11/09. Lesion Y appeared on 08/18/09. Diagnosed as shingles on 08/24/09. U 8/11/2009 8/18/2009 4/1/2009 N 3/25/2009 3/31/2009 pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 2/14/2009 for COPD exacerbation. Vaccination ### 2/14/2009 took place on 12/11/2 r vaccinations, she had 2 shots, stood up so her brother could sit and get his when she vomited Y X 3, pale, 8/24/2009 diaphroetic, 8/24/2009 comfort measures w th moderate to severe pain, swelling, and warmth in arm w/in 24 hours after receiving Pneumovax. U Am treating 8/24/2009 with8/24/2009 Keflex, ice (alternating vaccine on 9/5/08. On 10/29 I wokeY up numb on Y right side of abdomen. 4 Thinking it was a pinched N nerve 9/5/2008 I allowed it to go### on for several da mother on 8/25/09. States "pt. had a reaction to his vaccines." Relates that on 8/19/09 around Y 8 pm (bath 8/18/2009 time) she 8/19/2009 noticed his left arm was ed her Adacel booster and 1st doseYof Gardasil on Wednesday August 19, 2009 @ the Health Y Department. 8/19/2009 She began 8/21/2009 to ran a temp of 10 ed on 8/24/09 that she has blisters with white dots under her tongue and her lips that she had Y the same 8/21/2009 outbreak two 8/23/2009 to three days after sh male received the Oral Rotavirus Vaccine on 8/18/2009 under FDA IND #13843. Patient tolerated U vaccine 8/8/2009 well. Patient 8/22/2009 had follow-up clini swelling and tenderness of the left deltoid N 8/24/2009 8/24/2009 astritis, weakness, wt. loss.Nausea,Yvomitting ,diarreha, Y anal spasms, 2 vagal reflex responses, Y & paleness. 6/27/2007 9/17/09 GI 7/26/2007 Consult records DOS sneezing, and eyes got very wateryYand red, he started coughing a lot, and then the face got Y all swollen.8/17/2009 8/18/09 Pt8/17/2009 came in for F/U and he vaccine 08-24 PM. C/O dizzy, faint, & headache 08/25. Improved by late afternoon, but still resting. Y 8/24/2009 8/25/2009 d generally healthy male who received Y DTaP and Varicella vaccines at PCP's office (Health Y Center) today 8/25/2009 and developed 8/25/2009 "sternal pain" and rash on inner upper thigh of Left leg stated that it was itichy and had a tingle feeling just likeUwhen she had 8/18/2009 shingles before post injection, high fever (mom did not check temp) lethargy, abd pain, achy, looked sick for Y 3 days. sibling 8/19/2009 with same 8/20/2009 symptoms but only fo after injection had fever really high(temp not taken) lethargic, nauseous, for 24 hours.mom felt Y it was due8/19/2009 to the mercury 8/20/2009 in the shots. dness, warmth and swelling. Y 8/12/2009 8/13/2009 ocal reaction - red firm area size of egg - Proceeded w/ peripheral redness for 6" around the Y bump, itchy,8/13/2009 hot. Onset8/14/2009 in <24 hr - treated with minutes of injection of ZOSTAVAX pt experienced dizziness and tingling of her lips/bad taste Yin mouth. 8/19/2009 8/19/2009 action after giving HPV vac. Pt complain of having headaches, dizziness, numbness on L arm U and weakness 8/11/2009 on both 8/18/2009 legs. Pt was seen by D ouple of minutes of giving vaccines pt developed swelling and redness around injection site.YThere was8/17/2009 also visible8/17/2009 swelling and redness d Y 8/13/2009 iving MENACTRA and Hep A injection. Pt c/o light headed, faint, nausea- Pale. Pt laid downY- elevated feet 8/18/2009 - recovered 8/18/2009 - did fine. wollen and red from elbow to shoulder - No other sign of illness. BENADRYL and Ibuprofen. Y 8/14/2009 8/15/2009 vaccination for the shingles, but it came back. The only difference was the lack of pain post-herpatic Y pain. 6/1/2009 I also had6/10/2009 more shingles erupt. I give IM in the dorsogluteal, should be given in the deltoid. 1st dose must be repeated. Y 8/13/2009 8/13/2009 and around injection site and a hive off to the side of injection site - after running in place forY5 minutes. 8/19/2009 8/19/2009 ion at injection site - Eye ache, headache Y 8/5/2009 8/12/2009 d hives 2 days after shot that turned her skin white and caused her skin to sag. Y 7/22/2009 7/24/2009 d shingles L facial (V- 1 nerve root)Yfew days after ZOSTAVAX. Y 7/30/2009 7/31/2009 tient - 2hrs after vaccines - developed Y numbness in arms, hands, felt lightheaded and heart rate U speeding. 8/11/2009 Rescue was 8/11/2009 called and taken to call from mother. Says about 1/2 hr. after shot he was nauseated \ dizzy. These have gone but Y has HA. 8/25/2009 now. Taking 8/25/2009 him home from schoo
ccine - shortly after got light headed, flushed, nausea - not feeling well prior to shot. P.E. neg, Y U.S. nml. 8/20/2009 8/20/2009 ates after receiving vaccine was covered in hives, felt warm, chest pain and lip swelling. Given Y BENADRYL, 8/21/2009 came back to office and exam generalized non-febrile seizure 5-1/2 Y days after getting MENACTRA and ADACEL vaccine. U No etiolology8/7/2009 found for 8/13/2009 seizure. en on 8-11-09 Hives on 8-13-09 Benadryl + Zyrtec. U 8/11/2009 8/13/2009 night noticed a red/pink knot at site of injection. No itching, a little sore, no fever. Did not takeUanything or8/23/2009 put anything 8/24/2009 on. ed red rash at site of injection - intensely itchy - suggested hydrocortisone of BENADRYL to Yapplied 8/10/2009 8/11/2009 TWINRIX #3) Administered 6-2-09 (other doses= (1)5-28-08, (2) 11-17-08) Pt complained of N sore muscle in 6/2/2009 left deltoid 6/2/2009 since administration. d a lump Rt upper arm. It has continued Y to grow, is red, warm to touch with an mild induration U about 4-5 8/17/2009 cm in diameter 8/18/2009 - Advised to use ice d blister link rash over both thighs and Y had fever. This all happened approximately equal to 24 Y hours after 8/14/2009 receiving 8/15/2009 6 shots. Y Y 2/10/2009 2/11/2009 facility on 8-15-07. Rash erupted 8-17-09 - Presented in office with rash/pox's on 8-25-09. Y ticed stinging during injection. Stinging progressed to pain and around 5 PM he noticed redness, U swelling, 8/18/2009 fever. Left 8/18/2009 deltoid. As of today, s minutes of injection of all 3 vaccines, Y pt returned wheezing (mild) and facial hives. WheezingYreversed with 8/24/2009 Albuterol. 8/24/2009 ed to office approximately 30 min after Y injection of all three (3) vaccines with periorbital edema, Y urticaria and 8/19/2009 wheezing. 8/19/2009 Received BENADRY Hepatitis B vaccination (ENGERIX B) on 7-14-09. Returned for dose #2 Hep B today 8-14-09. U That's when 7/14/2009 the patient showed nurse a pap e pale approx 1/2 min after injection. Asked if he was OK and he did not answer. Assisted toYexam table 6/10/2009 to lie down.6/10/2009 Gave cool compress. P Y 8/19/2009 8/22/2009 n has been received from a mother concerning her son with seasonal allergies and no otherUpertinent medical history who vaccinated with Y 8/25/2009 8/25/2009 perienced fainting, and nausea. Y 8/25/2009 8/25/2009 blanching rash with pruiritis lower extremity. U d red, swollen and painful. Y 8/12/2009 8/14/2009 multiforme, seen on 8/24/2009 for Urticarial rash pharyngitis, treated with Loratadine and epipen Y given. 8/20/2009 8/24/2009 s after shot pt. complained site being itchy, swelling felt very hot. Y 8/24/2009 8/24/2009 hot Sat 830A. Returns at 930A with urticaria all over body, no difficulty breathing. Given 1/2cc Y CELESTONA 8/20/2009 IM and8/20/2009 1tsp BENADRYL PO. 1 vaccination, pt. and his mother walked to the front desk. Child walked towards exit door to lobby and knees 8/10/2009 buckled8/10/2009 and child fell forward. F warmth, firmness to upper left arm for 2 days. N ema ("puffy eyelids"). Increased blood Y pressure. Y 8/20/2009 8/20/2009 er vaccines patient developed fever to 101 degrees, arthralgias, and localized reaction at shot U sites, red,8/20/2009 warm about 8/23/2009 6 am. DTaP, IPV in left arm 8/5/09. Was brought Y to office on 8/7/09, noted redness 10 cmx8 cm inUleft upper arm 8/5/2009 with warmth 8/7/2009 and tenderness in DTaP given, patient recovered 5 am large induration with localized redness @ injection site. Y 8/18/2009 8/21/2009 an a few hours after vaccine. Had a seizure about 36 hrs after vaccine. Y 8/19/2009 8/19/2009 eous non-serious report of FLUMIST squirted into a child's eye has been received from the patient's Y mother who ###is a nurse ### concerning a 6 e out on her body - Hyperactive andYplaying. N ry alway clearing her nose, in the hot Y weather she get sexual acting. Can learn but do it veryNslow. Shrinking 3/6/2001 eyes. mptoms every time. Folded bowel movement. Y Very hard for him to breath. U 8/30/2005 8/30/2005 diarrhea, rocking back and forward. Skin flare up picky, pulling out the hair, very fusses. Needed N BENADRYL. 3/7/2006 3/7/2006 wel movement, vomiting and diarrhea picky skin, dry up hair needed BENADRYL. N mptoms, picky skin, thinning of the Y hair, very fussy. Need BENADRYL. N ### ### ### Y Y Y 17 Y Y N 9/9/2008 10/1/2008 er vaccinated: broke out of cold sores in places on the face where 2 had before had a cold sore. Y Have had 3 outbreaks in nostrils (nose). mors; upset agitated; not quite awake. 1-2x/night. N 8/17/2009 8/17/2009 ated smallpox 8/8/09; left arm. Pt referred Y to clinic with POS erythema and rash with circumfererencial Y distribution 8/3/2009to8/16/2009 torso, arms, thighs and of arm at injection site with warmth and Y erythema. Injected arm 7.5 cm larger than non injected U arm 18.5 8/18/2009 cm vs 25 cm 8/19/2009 arm circumference. for 1st 2 sets of shots for 48 hrs including his single PREVNAR vaccine #3. With last set #4Yhe ran fever 7/29/2009 for 7 days7/29/2009 102 & greater. He did left thigh red, sore, fever. Y 8/19/2009 8/21/2009 hours: High fever, irritability, drowsiness, Y loss of appetite, rash (Fever 102.3 Tmax). For 72 hours: Y Interference 7/16/2009 with 7/16/2009 limb movement (shaky ite is warm to touch, red & swollen -Yright arm. Y 8/24/2009 8/24/2009 m rash of trunk. Y 8/11/2009 8/22/2009 out after receiving vaccines- 15minYafter vaccines given. Put in sapine position, gave OJ + Y crackers, responded, 8/25/2009sat 8/25/2009 up and then again be min post vaccine became nauseated. 10 min later, requested to go to restroom. Stated he felt Y faint. Was 7/21/2009 assisted 7/21/2009 to floor, eyes closed. W
g with TETNUS shot, fever of 103.5, he 'acted strangely'; did not recognize his mother, upsetYcrying & disoriented. 8/10/2009 8/12/2009 ort received on 13 August 2009 fromYa physician. A 33 year old female patient, who had no concurrent U illnesses, 10/1/2008 but who has allergy to NEO ort received on 14 August 2009 fromYanother manufacturer (document number 45222761) who U had received the original report from pharma n has been received from a physician Y concerning a 17 year old female patient who Y on 05-AUG-2009 N was8/5/2009 vaccinated8/6/2009 intramuscular with the n has been received from a consumer concerning Y her 19 year old daughter who Y in Summer N 2007 was vaccinated 11/6/2007with 7/31/2009 the first dose of 0.5m n has been received from a Nurse Practitioner Y (N.P) concerning a teenager female patient who U on an unspecified date was vaccinated with UT IN OOZING SENSITIVE RASH ON FACE, SWELLING IN LEFT ARM AND LYMPH NODES, U INCREASE 8/25/2009 HEART8/25/2009 RATE, SWELLING OF ped swelling and itching at injection site after administration of Tdap Y 8/22/2009 8/22/2009 Seizures starting at 10pm Y on 08-24-09. Y They lasted Y about 45sec. He was having a seizure every U 2 hours, 8/24/2009 But they 8/24/2009 have been every for ho dual received the flu shot in the am of 8/24/09. About 1 hour later, he developed sneezing, aYrunny nose,8/24/2009 and a sore8/24/2009 throat. The following d riticariae Shoulders. Raised red area Y to back and shoulders. Y 8/25/2009 8/26/2009 e pale,weak c/o dizziness and began Y vomiting after anthrax vaccination. Y 8/26/2009 8/26/2009 vent onset was 8-08-09 - Client noticed Y a knot and soreness at injection site on (L) arm. By U the next day, 8/7/2009 soreness, swelling, 8/8/2009hardness, and ew days I became ill withYa sore throat and fever, then a cough and wheezing. MyYcough became N worse,9/13/2005 I began to 9/16/2005 have heart burn, sores pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 11 6/29/2009 for pneumonia Y with small cell lung ### cancer. 6/29/2009 Vaccination took n the night of his immunizations he started to get redness and swelling, progressively gotten Uworse, he has 8/24/2009 been receiving 8/24/2009 Tylenol at regula mcir the night before didn't look at it that day ,look in the chart they need the shots but after looking at mcir 8/20/2009 noticed that they recieved the sh er vaccination I experienced fatigue and muscle aches. There was no fever or injection site Y swelling or pain. 8/21/2009 8/25/2009 ceived Rotarix oral vaccine on 08/20/09.Taken Y Yto East Tn Children's3Hospital ER on 08/24/09 U with vomiting. 8/20/2009 Diagnosed 8/24/2009 with intussusceptio r syncopal episode at time of vaccination Y on 7/30/09. Approximatley 8/11/09, she began to have N intermittent 7/30/2009 problems 8/11/2009 with easy bruising, t eadaches/migraines which cause sleeplessness, Y Y stomache aches, painful 1 menstrual periods,Nnausea, always 9/4/2007 tired and feels ### like sleeping al mp 101, febrile sz, seen by pmd, dxYwith viral illness. 2nd sz 7/31, still fever, seen in ED, noYworkup, dx 7/20/2009 viral, sent home. 7/30/2009 d client report at this vist (today) that approx. 2 days after the last vaccination (6/4/09), clientYdeveloped "a6/4/2009 bump" with 6/6/2009 "water" to left arm, p d dizziness, high-fever (103), and headache approximately 19 hours after administration of Menactra U and8/25/2009 Adacel. We 8/26/2009 treated the patient w d swelling in the back of the left upper arm and left deltoid. The back of the left upper arm appeared U red8/25/2009 and raised8/26/2009 (approximately the size en on Humira and methotrexate since Y at least 10/2006 6/6/2008 - Herpes zoster vaccine given U Rash started 6/6/2008 late August/early 9/1/2008 September 9 w minutes patient lost consciousness; hit head on Y table ; unable to rouse; 2 phoned 9-1-1 for EMS transport 8/25/2009 to Hospital;patient 8/25/2009remains hospi ction to LT posterior upper arm; Redness, swelling & warmth. Moderate relief noted with Motrin Y and ice pack. 8/21/2009 8/23/2009 ated 7/31/09, His mother, broke outYin a fine raised rash on her right index finger about 1 to U 1.5 weeks later. 7/31/2009 Pt. never had a rash or otherw minutes of vaccination, pt complained of trouble breathing and an itchy throat. within a few more Y minutes 8/26/2009 the patient 8/26/2009 was completely cover nt received the Tdap vaccine on 1/7/09. Y It had been 11 years since she last received the TdYvaccine. However, 1/7/2009 prior1/7/2009 to her last Td vaccine e schizophrenic episode (disorentation Y and hallucinations)occurred 3 days Y after HPV Y vaccination. N Required 4/7/2009 hospitalization 4/10/2009 and continues to veloped 2 inch red circle around injection site. Did not look to be a rash, although patient reported U irritation 8/24/2009 and minor 8/25/2009 itching. vaccine administered to right arm 8/24 Y 09. Mom reports that his rt arm was painful that entireUday. They8/24/2009 noticed swelling 8/24/2009 of the arm with inc d vaccine on 8/24/09. Pt started c/oYof itching, reddness and swelling at injection site on 8/25/09. Y 18X12cm 8/24/2009 wheel noted 8/25/2009 to left posterior arm RECEIVED THIS VACCINATION DURING Y A NEW HIRE HEALTH EXAM. SHE CONTACTED U ME 1 WEEK 8/11/2009 LATER8/26/2009 TO REPORT THAT SH ved the flu vaccine on 8-12-09, and Ythat pm felt very sore and swollen at injection site, soreness U increased 8/12/2009 and she 8/12/2009 stated she could not sle and swelling, the size of golfball withYpain at vaccine Y site. Temperature 2 as high as 104 with vomiting. U 9/17/09 8/22/2009 Hospital 8/23/2009 records received DO local reaction U 8/25/2009 8/26/2009 ne at approx 9:30am felt slightly feverish the entire day.. (Not concerned)However the following U morning,8/25/2009 woke at 5am 8/26/2009 after about 1/2 hr I w and swollen area around the site of injection. Patient reported it was painful and itchy. U 8/18/2009 8/20/2009 nt c/o nuasea after vaccine MCV4; stated "I need to throw up"; BP was 70/40. Placed in a supine Y position 8/18/2009 with feet 8/18/2009 elevated; BP 110/80; si d shingles in nose the next day which Y got progressively worse. The doctor thought that I hadYa staph infection 8/14/2009 until 8/15/2009 the culture came back a uscle weakness. Pain in deltoid muscle Y 7/10=best. Swelling and joint stiffness in right hand, N wrist, fingers. 8/24/2009 Muscle8/24/2009 spasm in neck and sho fter primary Varicella vaccination, pt.Y (age 2) developed URI symptoms with nasal congestion Y and mild fever 7/30/2009 (99.5). 8/20/2009 The next day he devel RA shot given in LD Wednesday afternoon - that night arm was red & swollen & also still Thursday Y morning. 8/19/2009 Thursday 8/20/2009 night she felt nausea with swelling to R Deltoid. U 8/24/2009 8/26/2009 dness, warmth, swelling. U 8/24/2009 8/25/2009 prolonged crying, redness/swelling of left thigh, patient was brought back to doctors office later Y in the afternoon, 6/18/2009given 6/18/2009 Tylenol, and sympto ne- When I called to his home- per family member that speak a little english. U 7/28/2009 ne - when I called to his home - per family member that speak a little English. U 7/28/2009
ash that resembles Rubella. U 8/18/2009 8/24/2009 ays after vaccine with progressively enlarging red, blanching rash 5 x 6 cm mildly tender, 1 x U 1 1/2 cm induration 8/17/2009 @ site 8/17/2009 of injection. No othe orted by parent". Y 8/20/2009 erior thigh) 10 x 10 cm erythematous warm plaque with blanching. U 8/20/2009 8/21/2009 es, swelling around eye. No respiratory distress. Y 8/25/2009 8/25/2009 d shot 8pm on 8/24/09. Awoke at 6:30am on 8/25/09 with headache that lasted 3 hrs. Y 8/24/2009 8/25/2009 len X 4 days. U e. Momentarily passed out (opened her eyes and talked once laid down from slouching after Y covering shot 8/21/2009 with bandaid). 8/21/2009 Vomit, sweat said swollen to (L) deltoid. Y 8/24/2009 8/25/2009 & mild pain at site of DTaP injection. Y 8/24/2009 8/25/2009 Y Y 8/21/2009 8/21/2009 ort received on 21 August 2008 from a health care professional. A 2 months old male patientYreceived on6/19/2008 19 June 2008 6/19/2008 at 11:30 hours the f serious case was received from a health professional on 22 October 2008. A 28-year-old male Y patient received 6/2/2008 a booster 6/2/2008 of IPOL (lot numb ort received from a health professional on 03 December 2008. A 61-year-old female patient received Y a dose of ### FLUZONE ### (lot number U275 serious case was received on 06 February 2009 from a non health care professional. A 5 year Y old female2/4/2009 patient received 2/5/2009 DAPTACEL (lot nked with case 2009-00558. Y 2/7/2009 2/7/2009 t was received from a health care professional on 19 February 2009. A four-year-old female,Uwith a history 2/16/2009 of asthma 2/16/2009 and thrombocytopenia serious case was received on 06 April Y 2009 from a health care professional. A 4 and a half year Y old female4/2/2009 patient received 4/4/2009 DAPTACEL (lo ort was received 16 June 2009 fromYa health care professional. An 18-month old patient had Yreceived an injection of DAPTACEL and an inje was received from a health professional on 18 June 2009. A four-year-old male patient, withUno reported 6/5/2009 medical history, 6/9/2009 received the follo ort was received 18 July 2008 from a health care professional. A 28-year-old female patient had Y received7/17/2008 a subcutaneous 7/17/2008 left forearm inject ort received on 25 August 2008 from a health care professional. A 4 year old female patient, Y with no medical 8/21/2008 history,8/22/2008 received on 21 August was received from a health professional on 03 September 2008. This case represents on inYa cluster of 8/29/2008 two patients.9/1/2008 A four-year-old male was received from a health professional Y on 03 September 2008. This case represents one in Y a cluster of8/26/2008 two patients. 8/27/2008 A two-month-old fem rmation was received from a health Y care professional on 16 September 2008. A four month old U female patient 9/5/2008 with no9/9/2008 reported past medica rmation was received from a health Y professional on 16 September 2008. A two month old female U patient with 7/3/2008 no reported 7/8/2008 past medical histo -serious report received from a health Y care professional on 06 November 2008. A four-year-old N female patient 9/30/2008 received a left deltoid intramu ort was received 19 November 2008 from a health care professional. A six-month old male patient Y had received 2/6/2006 a dose of FLUZONE SV an ort was received 17 December 2008 from a health care professional. A five-year-old male patient Y had received 8/25/2008 an injection of IPOL, lot num was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/29/2009 patients;4/30/2009 the other two patients' was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/28/2009 patients; the other two patients' was received from a health care professional on 01 May 2009. It was reported as one of a cluster Y of three 4/28/2009 patients,4/30/2009 the other two patients' ths old male patient received on 30 January 2009 at 15:00 the third dose of ACTHIB (lot# UF578AB, Y corresponding 1/30/2009 to lot# B0395-1) and th ent after incident. 1550- Became pale, lightheaded - became unresponsive immediately following Y injection 8/18/2009 . Assisted 8/18/2009 with lowering head to N n has been received from a cardiac surgeon concerning a female who was vaccinated Y with aUdose of GARDASIL (lot #660618/0572X). Sub n has been received from a pharmacist Y concerning a 17 year old female with unspecified Y drug N reactions/allergies 7/1/2009and medical history, who follow-up information was received from a physician and a cardiac surgeon concerning Y his 15 N year old daughter 12/3/2008 with2/1/2009 no known drug allergi n has been received from a healthcare Y worker concerning a male who in 2003 was vaccinated U with PNEUMOVAX and developed what wa ort received on 17 August 2009 fromYa consumer. A 54-year-old female patient, who has history Y of allergy10/1/2007 to latex, thimerosal, PCN and sul ort received on 21 August 2009 from a health care Y professional. A 13-year-old 4 female patient,Uwith unknown 8/11/2009 medical8/12/2009 history, had received a d Hodgkins lymphoma. We Y diagnosed Y patient'sYcancer in August, 2008, 20 Y and she is continuing U chemotherapy. 5/15/2008 She will8/1/2008 have a stem cell tran hours after vaccine administration, patient developed several large about 5 X 6 cm confluent, Y pruritic erythematous 8/13/2009 8/13/2009 papular plagues on upp area 5x5cm red in duration. Y 8/5/2009 8/7/2009 ss, redness, warm to the touch. Y 8/20/2009 8/20/2009 muscle ache throughout entire body, extreme left arm pain; generalized joint pain & fatigue. UNote: Had 8/18/2009 previous dose 8/19/2009 of Tdap 3/5/2009 (p ain at injection site & arm (left) feels like hot pokers in muscle & joints. Last two fingers in left N hand are numb. 8/14/2009 Fever,8/14/2009 some dizziness. Canno erythema & swelling of Dermis & sub Y dermal skin at site where VERICELLA & MMR Imm. were Y given. No 8/12/2009 fever or size discomfort. after injection, pt developed redness, swelling, hot to touch on Rt arm. Seen in office on 8-19-09, Y recommend 8/17/2009 apply8/18/2009 ice, use BENADRYL. soft tissue abscess. Y 8/5/2009 8/12/2009 p at 4:30 AM with my Rt jaw swollenYon the inside & my Rt. ear is killing me. I have only a wisdom U tooth 7/15/2009 on that side.7/23/2009 I don't think it's the to
cal reaction (L) arm (2) C/o mild swelling Y of bottom lip, redness and swelling noted at site of U injection and7/27/2009 arm warm7/28/2009 to touch - (3) Mom stat 1st GARDASIL 8/13/09; mom reports 8/15/09 c/o headache lasting 2 days & vomiting. Had fluids Y & rest,8/13/2009 no ER or follow-up 8/15/2009 visit. Family his tes after shots, patient had a brief syncopal episode lasting 30-45 seconds; complete recovery. Y 8/25/2009 8/25/2009 lump as large as a baseball, red, hot, and painful. Advised pt to see her primary care physician. U 8/17/2009 8/18/2009 9, day following vaccinations, redness, warmth, tenderness both anterior thighs today, 8/19/09, Y just right8/17/2009 thigh has redness, 8/18/2009 warmth, tender warm\pink\non-tender; 2x3cm induration centrally (R arm) Y 8/19/2009 8/21/2009 er shot-BOOSTRIX mom returned to office with patient. She said he got nauseated in the car, Y became pale, 8/24/2009 flailed with 8/24/2009 his arms & passed o d Tdap and GARDASIL then stood up. Was helping sister get shots then felt lightheaded and Y fainted. 8/21/2009 8/21/2009 arted to experience warmth, pain and Y redness at injection site. Also erythematous area measuring U 7.5 cm 8/18/2009 X 6 cm. 8/20/2009 Given CEPHALEXIN 50 veloped tenderness, redness at injection Y site. Induration measuring 3cm by 3cm. AmoxicillinUgiven 12ml8/13/2009 BID 400mg/5ml. 8/14/2009 ite shows a swollen lump 1 1/2" in diameter tender, itchy. Arm is weak, child fatigued. U 8/17/2009 8/19/2009 swelling, and tenderness at injection Y site. Slight induration to area. Given CEPHALEXIN 500 mg three times 8/3/2009 a day. 8/4/2009 eceived varicella vaccine. 8-11-09 Site became red and swollen and stayed that way. Area involved U in oval 8/10/2009 shape-approx 8/11/2009 1 1/2 x 2 1/2 inch ately 20 hrs after administration of DT pt felt fuzzy & according to grandmother who witnessed Y the following 8/19/2009 pt c/o lightheadedness 8/20/2009 felt dizzy arm at vaccine site that did not disappear. Y N 4/5/2008 6/1/2008 22 yr old Female, inprocessing received Y a G6PD blood draw with no complications. Pt. received U a TwinRix 8/27/2009 # 3 vaccination 8/27/2009 to the R-Bicep, i Vaccine administered on 21 AugustY2009, on 26 August 09, mother of baby reported blood in Y baby's stool, 8/21/2009 returned8/27/2009 to clinic, occult blood p e to be discharged after Yundergoing cardiac catherization. Per chart, pt became restless and Y nonverbal 5-10 minutes ### after### receiving pneum Y 8/10/2009 8/11/2009 REFERS THE PATIENT PRESENTED Y WITH VOMITING, ITCHING AND RASH IN SKIN WHICH U GOT WORSE. 4/9/2009THE 4/11/2009 DERMATOLOGIST 20 SECONDS AFTER RECVING HPV VACCINE #2 & HEPA #1 CHILD REPORTED FEELING Y NAUSEA 8/27/2009 & DIZZINESS, 8/27/2009 BECAME PALE eloped on face and neck within approximately 18 to 20 hours following administration of the N injection. Treating 8/25/2009 with8/26/2009 Benedryl. Loss Consciousness with tonic/clonic Y episode; Temp 96.1 Y 8/18/2009 8/18/2009 along with IPV was administered today Y 8/27/2009 8/27/2009 N 8/26/2009 8/26/2009 t clinic after vaccinations and had a mild nose bleed while walking to car. Parents brought child Y back into8/26/2009 clinic immediately 8/26/2009 and nosebleed hardness & swelling, mildly unconfortable left deltoid - mother describing as on side of arm not posterior aspect 8/25/2009 - mother 8/27/2009 will apply ice pack. COMPLAINING OF PAIN AT INJECTION Y SITE, LEFT UPPER ARM. REDNESS AND SIGNIFICANT U SWELLING 8/5/2009TO 8/6/2009 LEFT UPPER ARM. D zed erythema 7 X 5.5 cm with central more erythematous area about 3 cm Y 8/17/2009 8/18/2009 ORE, TENDER, ITCHING, WARM TO TOUCH Y 8/24/2009 8/25/2009 U VACCINE @9AM. @ 10:30AM SAME DAY BEGAN TO BREAK OUT IN HIVES [5] ON THE Y SAME ARM 8/27/2009 AS VACCINE 8/27/2009 WAS ADMINIST swollen, red, hot,itchy and Axillary Y lymphadenitis. U 8/25/2009 8/26/2009 d fever 101 degrees 12 hrs following vaccine without other symptoms. Resolved 24 hrs. Y 8/24/2009 8/24/2009 administered on 8/10/2009 without difficulty. Y On 8/14 broke out with herpes zoster severe involvment Y on8/10/2009 left side T5-T9 8/14/2009 dermatomal patter ARM (DELTOID AREA) BUT ENTIRE UPPER ARM HAD GENERALIZED SWELLING, REDUAND WARM 8/25/2009 TO THE TOUCH. 8/25/2009 THE PATIENT s had moderate to severe headaches Y and nausea ,as well neck and upper back pain since N her second 7/22/2009 injection.Patients 7/24/2009 father is a physic izure, temp 104.3(temporal). Skin rash Y on trunk. Y Y 8/13/2009 8/26/2009 r (102.2) and Fever Seizure 7 days post Y MMR and Chicken Pox vaccine. Spotted rash underYeyes and accross 8/17/2009 bridge 8/24/2009 of nose 10 days post ut 10 minutes after receiving the injection Y my arm got hot and very itchy. Shortly after that I started Y to get8/25/2009 itchy and flushed 8/25/2009 on my face and h LED BACK REPORTING PAIN ANDYSWELLING IN ARM WHERE SHE GOT INJECTION. SHE Y SAID PAIN 8/17/2009 WAS 10/10 8/17/2009 YESTERDAY AND nted to clinic for second MMR on 08-18-2009. Reported pregnancy with EDC 12-18-2009 Y 7/10/2009 D ITCHING COVERING WHOLE BODY Y LASTING UNTIL THE NEXT DAY. Y 8/26/2009 8/26/2009 male/employee who presented todayYdue to two 1cm eythematous macule in thr right shoulder/deltoid/axillary Y 8/19/2009 area.It8/20/2009 appeared last night aft ing tender, warm and slightly swollen R shoulder. Afebrile, no erythema, signs of infection, severe Y allergy8/3/2009 symptoms.8/3/2009 He had Pneumovax HIGH RED, SWOLLEN ANT-LAT. 12CM X 16CM. INDURATED NOT TENDER, WARM Y 8/25/2009 8/26/2009 s of atrial fibrillation (newYonset) theYweek after vaccine administration, one episode required ER visit. 9/14/09 8/20/2009 ER records 8/21/2009 received 8/21/09 e: 11/28/08; Rash on hands appeared soon after, seen by Dr. on 12/7/09 for rash; 2nd vaccine: N 2/7/09; 3rd vaccine: ### 5/1/09 ### followed by extr G AND REDNESS WITH INDURATION AT INJECTION SITE Y , hips, neck weakness, muscle pain. N 7/20/2009 7/27/2009 upper thigh 13x13 cm, light eryth/purple circle rash with central sl darker purple area with pinpoint Y noted8/24/2009 centrally. Mild 8/25/2009 warmth to touch. (-) s a rash at rt side T5 & T11 area. T5 Y area started on 8/22/2009, T11 area started on 8/24/09. U Shingles in7/24/2009 Rt T5 & T11 8/22/2009 distribution. VALTRE
d ADACEL vaccine on 8/25/09: Lot #C3248AA Sanofi Pasteur. The pt called on today 8/27/09 Y to report headaches 8/25/2009 8/25/2009 since receiving vaccine m redness, swelling & discomf. Ibuprofen & BENADRYL topical admin. U 8/25/2009 8/26/2009 arm red swollen, itchy area size of baseball. Told mom to administer BENADRYL PO and ice-pack U to area. 8/25/2009 8/26/2009 red erythema. Decreased at this moment. U 8/25/2009 8/26/2009 of 1 cm diameter at site of injection (induration still present 3 wks later). N 7/31/2009 8/1/2009 , swelling, pain to site of injection. Advice to tx with warm compress and BENADRYL. Y 8/24/2006 8/26/2009 3 minutes after shots were given, patient felt nauseous, became weak and fainted on the exam Y table. She 8/25/2009 responded 8/25/2009 immediately to ammo subsequent headache dizziness for Y 1 week (+). N 8/18/2009 8/18/2009 8/12/2009 ceived MENACTRA and VARIVAX on Y 8/12/09, at 12 year check-up. Had no problems after getting Y shots8/12/2009 in office. Seen 8/26/2009 at ER 8/26/09 for s slight swelling, hot to touch around injection site (right arm). U 8/24/2009 8/26/2009 Y U 8/25/2009 8/26/2009 Was shaking and off balance "dizzy" Y after shots. Noted all the way to bedtime - didn't stop - Then Y 8/26/098/25/2009 had febrile8/25/2009 symptoms - Went to ER mmunization; pt developed erythema & edema to right upper arm at injection site. Y 8/24/2009 8/25/2009 local redness and pruritis. Encouraged to use ice at site and BENADRYL po. U 8/24/2009 8/25/2009 slight swelling, hot to touch around injection site (right arm). U 8/24/2009 8/24/2009 red DTAP instead of intended TD. Patient notified and states no adverse effects. Y 8/25/2009 ecreased O2 saturation, Y 70's. Copious frothy trach secres, oral secres. Rx - suction, increased Y FiO2 (4:558/26/2009 - 6:20 pm8/26/2009 - back to room air). No ve type rash widespread. Y Y 7/14/2009 ht warm area to left leg. Y U 8/24/2009 8/26/2009 ceived MENACTRA & TDAP. Became faint after. Diaphoretic & pale. Had client sit with head Y down till color 8/13/2009 returned. 8/13/2009 About 15 min. Left ceived Tdap and MENACTRA. Shortly after he became diaphoretic, pale and had a syncopalYepisode. Helped 8/13/2009 client8/13/2009 to seated position, hea was 103.5, Vomiting, Rash U 8/17/2008 8/26/2008 n has been received from a physician concerning Y a 6 months old male 9 who on 04-AUG-2009 U was vaccinated 8/4/2009 with the 8/10/2009 third dose of ROTAT n has been received from Y a medicalYassistant concerning Y an 8 weeks 2 Yold male patient who on Y 25-JUN-2009 6/25/2009 was vaccinated 8/5/2009with a first dos n has been received from a physician Y and a licensed practical nurse concerning an 18 year Y old female who 8/18/2009 on 11-OCT-2006, 8/18/2009 21-FEB-2007 n has been received from a Nurse Practitioner Y concerning a 26 year old female patient Y with Y no pertinent6/12/2009 medical history 6/21/2009 and no known drug n has been received from a physician Y concerning an unspecified age female who in "JUN-2007", U in "AUG-2007" 9/1/2008 and9/1/2008 in "SEP-2008" was va n has been received from a physician concerning a patient who was vaccinated with Y GARDASIL. U Subsequently the patient experienced at .8 later on day of vaccine. About 48Yhr after shot Y developed cyanotic 0 apneic episode. Seen at Y ED then transferred 8/11/2009 for 8/13/2009 obs at another hospit breathing & getting air" R ear & neckYtenderness. Received IV BENADRYL in ambulance with Y relief. Observed 8/26/2009 - E.R. 8/26/2009 X 2 1/2 hours. Takin th hives on wrist, itching all over body; Y swelling right arm @ Y.F. vaccine site; tenderness R Y side of face,8/26/2009 neck, ear. 8/26/2009 BENADRYL PO & ZAN ose of GARDASIL given to left deltoid Y muscle along with PPD to forearm. About 5-10 min after Y shot, became 8/21/2009 pale fell 8/21/2009 forward, hit floor, 3 c episode after receiving TDAP, MENACTRA, FLUMIST, HEP A. Regained consciousness after Y few seconds. 8/25/2009 8/25/2009 ound 1:30pm after I gave pt GARDASIL injection, noticed that she wasn't feeling well. I asked Y if she had8/24/2009 had lunch 8/24/2009 and she said no. I went h on left upper arm, warm to the touch. Triamcinlone 40mg IM, antihistamine 8/24/2009 Pt was given Tdap, HPV, & Meningococcal Y Vaccine while sitting on exam table. Pt stated she Y felt "lightheaded" 8/21/2009 following 8/21/2009 injections and was ceived FLu Mist on 25Aug09. Before administering vaccine patient submitted a negative pregnancy Y test.8/25/2009 28Aug09 patient 8/28/2009 took a second tes veloped fever later in the day following vaccinations, which continued daily ranging from 101-103. Y Patient8/10/2009 also experienced 8/14/2009 decreased appe lled stating child had red swollen area and increased soreness to 2" below injection. MotherYwas advised 8/10/2009 to take child 8/11/2009 to PMD. Was presc Associate reports cold sx , no fever.Y7/17/2009YAssociate received14 Tdap Y vaccine. 8/26/2009NAssociate reported: 7/17/20098/1/2009 8/1/2009 onset of hands called and says that expierenced pain and some swelling at site of injection as well as feverU(?), headache, 8/26/2009 tiredness, 8/26/2009 chills, body aches an ted to clinic 2 days after administration Y of Tdap. Pt complains of redness in Left arm, swelling and pain. 8/26/2009 Patiens arm8/26/2009 has visible erythema w eats, body aches, light-headedness, nausea Y 8/27/2009 8/27/2009 pneumovax at about 10am. started Yfeeling chills and possibly low grade temp and sweats 10pm. U subsequently 8/26/2009 developed 8/26/2009 swelling and incr veloped hives and itching all over body 30 minutes after HPV vaccine given. Patient called Y our office and 8/24/2009 reported 8/24/2009 this 1-2 hours after hive se events noted to date. Y 8/26/2009 ed at present. But client got 2 doses of Hepatitis B pediatric vaccine on this day, one dose in YPediarix, and 8/28/2009 another with 8/28/2009 Hep. B pedi given s se Events to date. Y 8/26/2009 epy after vaccines. 2 am - child's fever Y at 104F - awoke from sleep with jerking, vomiting. Mom Y gave Motrin 8/25/2009 alternating 8/26/2009 with Tylenol. Arous esented on 8/27/09 with redness and Y blisteringYover left upper arm. 1Mom reports the redness Y began on 8/25/2009 8/26 and began 8/26/2009 to spread, the blist
RSE EVENTS TO DATE Y 8/26/2009 t the office and came immediately back Y in complaining of a burning throat and eyes,a racingUheart and feet 8/27/2009 that were 8/27/2009 itching. He immediate of Left arm & shoulder and very hot to touch. Areas itching for 48 hours - elevated temp (101F) U for 72 hours. 8/11/2009 Child sleeping 8/12/2009 more than 12 h eved Pnuemovax 23 Rt arm on 10/27/2009 Y at 1035 am. reports that afternoon she began having arm discomfort 8/28/2009and 8/28/2009 swelling at site of inje ok 2nd dose of Vivotif on empty stomach. Y Went to exercise class. After exercise class felt dizzy, U headache, 8/26/2009 and loss8/27/2009 of balance. Called clini n and off for about 20 minutes. Had difficulty moving hands at one point. Got client on a bed Y to lay down, 8/28/2009 applied cold 8/28/2009 compress, and enco noticed itching, 3:00 noticed hive, 4:30 Y hive bigger called dr, 6:00 seen and given Hydroxyzide Y 8/20 8/19/2009 arm still swelling, 8/19/2009 9:00 went to ER a NUTES AFTER RECEIVING KINDERGARTEN VACCINES CHILD C/O L ARM BURNING.ARM Y BECAME 8/11/2009 RED AND 8/11/2009 BEGAN TO WHELP tructure on the arm where the zostavax was given. Lasted 3 days and was a little painful. Generalized Y nerve 7/31/2009 pain randomly 7/31/2009throughout he U 8/24/2009 mvax vaccine was administered IV instead of IM by mistake at approximately 0830. The patient Y became 8/28/2009 febrile (from 8/28/2009 37.1 C prior to vaccine ss, pruitic, macular rash at injection site (right arm). Y 8/26/2009 8/28/2009 ination parent and child left the clinic. Y Mom and child returned shortly afterward and mom stated Y that pt.8/26/2009 had a seizure 8/26/2009 in the car. She stat ed EIPHD on 8/27/09 reporting symptoms of fever, body aches, redness and tenderness at site Y of injection. 8/25/2009 Visited 8/26/2009 EIPHD on 8/28/09 statin : VZV#2 given SQ to Right Arm. Patient c/o pain and soreness that night. On 8/26/2009 Patient U went to 8/25/2009 school and 8/26/2009 started to feel pain to ri eft leg pain withing hours after having the injection (in her arm) and her quadriceps were soreU the next day 8/25/2009 she felt 8/25/2009 complete weakness and shot 2 and 3 started having chest pains Y and racing heart. Went to ER. After shot 3 started having N daily headaches 6/2/2007and blackouts. Mis-diago nt was seen 2 days after the immunization Y Daptacel Dtap R thigh. His right thigh was swollen U and tender8/21/2009 and there 8/22/2009 was a rash noted aroun d migrane headache Y Y 8/26/2009 8/26/2009 ministered Hep A and VZV Y to (L) arm at an IZ only visit. 1610 pt. left clinic. 1650 pt. returned to Y clinic with 8/27/2009 extensive urticaria 8/27/2009 on entire skin su Pt seen in office for vomiting and abd. Y distention Y - sent to ER for eval4 R/O intussusception orYbowel obst-9/12/2008 transferred to hospital ### for admit to ed by grandmother; states pt has a red swollen mark - on upper arm and a quarter sized bruise. U Instructions 8/24/2009 given to8/27/2009 monitor area/pt. Warm veloped ASCUS PAP and high risk HPV detected following 3 GARDASIL vaccines given 2008/2009. N 1/27/2009 e out with pox-like rash a few hours (about 4 hrs) after MENACTRA, Tdap and chickenpox vaccine. U Pox-like 8/26/2009 spots covered 8/26/2009 back of thigh, m as given ADACEL first without incident pt was then given GARDASIL vaccine and immediately Y lost consciousness 8/18/2009 for 8/18/2009 2-3 minutes, followed noon- pt received vaccines evening-Ysent by nurse to ER with severe joint pain, nausea and U lethargy. 8/25 8/24/2009 Pt still in8/24/2009 pain and vaccine sites d low grade fever and headache for 2 days following injections. Patients symptoms cleared Y on the third day. 8/25/2009 8/26/2009 t measuring 4x3 on back of right upper Y arm where VARIVAX shot administered. Y 8/17/2009 8/18/2009 ling to include digits, knees, elbows.Y Y 8/21/2009 8/23/2009 d woke up next morning after getting Tdap & HPV vaccines afternoon before she felt itching Yon her neck, 6/5/2009 both sides.6/6/2009 Glands felt swollen pe e night of 25 Aug 09 she developed redness, swelling and some pain in posterior left upper and Y now redness 8/25/2009 is also8/25/2009 going down the medial rythematous w/ clearing patches esp. Y on lateral aspect. Borders are not well demarcated. Interval Y clearing 8/19/2009 (+) point8/22/2009 of entry. (-) tender to pa asal flu mist. Fell back in waiting room Y ? Fainted. Y Hit back of head on1floor. Sent to ER by ambulance, Y then 8/27/2009 to another 8/27/2009 hospital. 9/8/09 Hosp ceived MENACTRA 0.5cc in LD then Tdap 0.5cc in RD. Immediately after receiving Tdap, ptYfainted for 68/28/2009 seconds and 8/28/2009 awoke with a convu area of well demarcated erythema Y over R deltoid area. Warm to touch. Small papules on the N surface- Treated 8/26/2009 with8/27/2009 KEFLEX. d swelling, red, hot touch. Y 8/25/2009 8/25/2009 rs following vaccine he awoke with severe Y dizziness. He was still dizzy at 6 am that AM. He went Y to ER and 8/24/2009 was given 8/25/2009 VALIUM and Rx Mec case of Zost 2 wks after - amin of vaccine. o- (L) letal trunk. U 8/12/2009 8/23/2009 inistration GARDASIL pt was kept for Y 15 minutes we then proceeded to our check-out desk. YShe then had 8/17/2009 a syncopal 8/17/2009 episode and hit her h red on 5/2/09 and was administered on 5/6/09. 5/6/2009 red 5/2/09 and was administered on 5/6/09. 5/6/2009 red on 5/2/09 and was administered on 5/4/09. 5/4/2009 rpes zoster outbreak. U 8/12/2009 mph nodes under right arm pit. Injection site tender. U 8/26/2009 8/27/2009 vaccines on 8/24/2009; came down Ywith rash 2 days later just on upper thighs where shots given- non vesicular, 8/24/2009 pinpoint, 8/26/2009 papules, itchy welling and redness down arm of where flu shot given. BENADRYL. U 8/26/2009 8/28/2009 ne sore. Bump on left side of neck. C/o of pain with intensity x 2 days. Y 8/17/2009 8/18/2009 swelling next AM redness, hot to touch. Y Went to ER. Swelling continued then getting larger. N Seen @ office, 8/19/2009 continued 8/20/2009 thru afternoon. W ved vaccines in office. When in parking lot, fainted. Mother able to hold up. No injuries noted!YResponded8/27/2009 immediately. 8/27/2009 rythema, swelling at site. Temp 100.1, left thigh 4.5" x 3.75" raised erythematous macule, warm Y to touch.8/17/2009 8-19-09 increased 8/18/2009in size, no itch after vaccination the patient developed reddness, swelling and itching at the vaccine site. Y 8/25/2009 8/26/2009
ained that he wasn't feeling well at approximately 12 pm 8-26-2009. He started shaking and was Y dizzy. He 8/25/2009 stated that 8/26/2009 his right arm, chest a ceived the vaccine today at 9:30 am at 7 pm the patient called the pharmacy and stated thatUthey had broken 8/29/2009 out in8/29/2009 a rash at the bottom of Y Y 8/28/2009 8/29/2009 inting, dizziness and seizures starting Y in 10/08 and lasting until seizure were under control inU3/09 while taking 7/22/2008 trileptal. 10/8/2008 There were a few fa thigh swollen to softball size hard, red, Y & warm to touch. No itching no pain. Y 8/17/2009 8/18/2009 tingling in right hand. Redness and swelling of arm down to the elbow. Low grade temperature U for first 128/19/2009 hours. Temperature 8/19/2009 of 103 to 104 ceived Dexamethasone IM and Benadryl po. Y 8/26/2009 8/26/2009 NOv. 24th did not have energy, Y tired.YWeek of Dec. Y 8th. had weird feelings 7 in hands and toes.(felt Y like I had 11/1/2008 needles in my ### hands and feet.) was given on a Wednesday. On Thursday Y left eyebrow felt itchy. By Friday I noticed a few hairs N had fallen.5/6/2009 By Saturday 5/7/2009 half of my eyebrow d 8/28/09 about 4 p.m. First hematuria observed on Sunday, 3/30/09 at home in late morning U urination. 8/28/2009 BP+ 120/808/30/2009 Afternoon, hematuria accine used (expired drug administered) A non-serious spontaneous report of administrationYof expired FluMist 2/26/2009 was 2/26/2009 received from a nurse c accine used (Expired drug administered). A non-serious spontaneous report of administrationY of expired 1/12/2009 FLUMIST was 1/12/2009 received from a nurs was received from a health care professional Y on 28 July 2009. A 70-year-old female patient,Nwith a history5/7/2009 of Bell's Palsy 7/1/2009 one year ago, rec ort received on 18 August 2009 fromYanother manufacturer (report number WAES 0907USA05484, U document number 45223472) who had rmation received on 19 August 2009Yfrom another manufacturer whose initial reporter was a health care professional. A male patient receiv ort was received 19 August 2009 from another manufacturer Y (doc number 0 45223759), who received the report from a health care profession ort was received 24 August 2009 from Y another manufacturer (document number 45223857) who U received 8/5/2009 the report from 8/5/2009 a health care prof n has been received via internet concerning a 16 year old female who on unspecified dates U was vaccinated with the first two doses of GAR n has been received from a consumer Y concerning Y her daughter (a 15 2 year old female) with food U allergy and 4/16/2007 asthma "who received all three mittent headaches, fatigue, lethargy. Y Hospitalized Y 07-1-09 thru 07-6-09. 6 Y IV TORADOL/COMPAZINE/BENADRYL U 5/11/2009with 5/26/2009 no relief. Currently b vaccines and left office to go to car Yin parking lot. Y Began c/o shortness 1 of breath, throat tightness. Y Came6/15/2009 back inside6/15/2009 office. Vomited thick, w ter had the series of GARDASIL vaccination onY10/3/2007, 12/14/2007 and 4/25/2008. Starting in October, 4/25/2008 2008 she 10/1/2008 started having pain in ter received all three injections Y of GARDASIL. YSince receiving the last injection, Yshe has been U hospitalized 6/19/2008 with severe 4/21/2009 kidney infections a s of pt's record 7/31/09. Y8/20/09 Spoke Y by phone Y to mother of patient 60 Ysays that patient received Y #1 HPV7/10/2009 on 9-19-08.7/24/2009 On Oct/2008 patient w ness & swelling at injection site day after injection, aches. Day #2 - Dramatic redness & swelling U (11 X 12 8/24/2009 cm) headache, 8/25/2009 nausea. ays after shot around site received PO Benadryl then rash to L thigh site injection of VARIVAX Y went down. 8/13/2009 8/18/2009 e started shortly after injection given - Medium headache persists yet today 8/27/09. During 1st night after 8/24/2009 injection, 8/24/2009 woke up during night pe to swell on (LF) leg. Y 8/25/2009 8/27/2009 eived MCV4 and TDAP. Approx. 1-2 minutes after became pale - had client sit down - had syncopal Y episode 8/26/2009 that lasted 8/26/2009 < 1 min. Client did 50 + hrs after injection with Erythema multiform (minor) rash primarily within 6 inches from injection Y sites - anterior thighs & few lesions left nt TD by mistake. Should have given client DTAP. Client called on 8/28/09 and message left. Have not8/18/2009 heard from client since the family l d fever of 100 last night and had left sided abd pain on Wednesday. 8/26/09. Woke up this U AM 8/27/09 8/24/2009 with rash on 8/26/2009 back of legs and wais d "rash on abd and groin area that is itchy". U 8/14/2009 8/15/2009 Rx BENADRYL 25 mg P.O. Y 8/21/2009 8/21/2009 n R thigh, redness - tenderness. Involves Y entire thigh. U 8/25/2009 8/26/2009 Barre syndrome. Respiratory Y problems. Y Weakness Y and fatigue. Therapy. 7Y U 12/2/2008 ### pruritic and painful papular lesions on Y hands and fingers 12 days post vaccination followed 2Ydays later by 6/30/2009 the appearance 7/13/2009 of lesions on rt e a of erythema and blisters covering Y thigh Hep A vaccine given. Y 8/26/2009 8/28/2009 esented in the office on 8/27/09 three Y days post-administration of Menactra and her first Gardasil U with myalgia. 8/24/2009 She 8/27/2009 was brought in after ex hematous edematous patch surrounding the smallpox vaccine site,with slightly pustular plaque Y representing 7/1/2009 the vaccine 7/30/2009 site itself. Multiple e, Fever, Facial Swelling, HematuriaY N 8/27/2009 8/28/2009 ion a few days after vaccination. Diagnosed with Y vasculitis. Hospitalized 2 for two days with pelvic N and joint 7/9/2009 pain. Blister 8/15/2009 on abdomen. Bilat. s with orange peel texture, swelling, induration >6 inches, itching, pain at site and left extremity. U Headache,8/27/2009 extreme tiredness, 8/28/2009and fever of 1 ed left arm. hot sensation with pain U 8/28/2009 8/30/2009 0 minutes after receiving Tdap injection, client became pale, and felt like he was going to "pass Y out" . Client 8/28/2009 lied down 8/28/2009 with feet elevated. B/ g reaction; Severe dehydration, vommitting, Y diarhea, stomach cramps, muscle cramps, difficulty Y breathing. 8/20/2009 Symptoms 8/20/2009 lasted for 4 days. numbness in arm 8 hours after vaccination, Y lasting 3 days. Sore throat, body aches, headache Y and mild 8/27/2009 fever 24 hours 8/27/2009 after vaccination las ame lightheaded, pale and lost consciousness for 30-60 seconds while sitting on the examination Y table. 8/31/2009 Client was 8/31/2009 layed flat for approx 5 m ceived vaccination at primary care appt. Y 7/14/09, was called with lab f/u on 7/15/09 when theYpatient reported 7/14/2009 her arm 7/14/2009 was swollen from abo eaction to Shingles vaccine-(Zostavax) -10 pk. As soon as injection, started gradually and intensified U to feel 8/27/2009 tingling,8/27/2009 burning, itching in right started 45 minutes after Tdap given. Started itching and scratching, broke out in hives, worse Y on legs and 8/24/2009 buttocks.8/24/2009 Took Benadryl and co
S AFTER SHOTS SHE BROKE OUT Y IN HIVES. GAVE BENADRYL EVERY 4 HOURS WITHOUT U IMPROVEMENT 8/26/2009 8/27/2009 SO WENT TO ER ON after vaccination patient developed HA, weakness, body aches which lasted 1-2 days. Developed N redness, 8/24/2009 swelling,8/25/2009 warmth and pain at in hour after receiving immunization child broke out in rash that covered his trunk and extremeties. Y Was given 8/28/2009 benadryl 8/28/2009 and rash began to cle er vaccines were given patient had Y a feverile seizure. Lasted nearly 5 minutes....temp went Y extremely high. 8/6/2009 Was take 8/12/2009 by Ambulance to Me eceived 08/24/09 @ 10:30 a.m. Sore Y throat developed that evening @ approx. 8:30 p.m. Developed Y headache, 8/24/2009 body 8/24/2009 aches, and low-grade er receivcing vaccinations, patient went Y to stand up and states that he felt a "little woozy" and Y sat back down. 8/27/2009 Patient 8/27/2009 then started complain f lower lip, soreness of throat, and itching on Left forearm and left bicep U 8/29/2009 8/29/2009 heat, swelling and discomfort within 24 hrs. Severe local reaction. Y 8/27/2009 8/28/2009 ceived vaccine on 8/17/09. According to parent: pt started vomiting on 8/25/09 at school andYsent home;8/17/2009 developed8/25/2009 rash on right side of bo TIS RIGHT THIGH. KEFLEX 250 MG Y 8/26/2009 8/27/2009 t the site of injection. the redness area is 2" X 1". It is also a pink area srounding that which is U 4" X 2.5". 8/29/2009 the area is 8/30/2009 warm. But no fever at th pular rash of trunk and extremities with some vessicles. Vessicles painful if broken. NoticedYabout two weeks 7/22/2009 after vaccine 8/6/2009 - clearing by fo ash 5 minutes following Prevnar, Rotavirus, Pentacel Y 8/19/2009 8/19/2009 apules on trunk, not itchy, otherwise normal exam Y 8/20/2009 8/30/2009 Y 8/21/2009 8/21/2009 REPORTED CHILD HAD ONSET OF Y MIGRANE HEADACHES, LEFT ARM NUMBNESS AND U SOME BLURRED 7/29/2009 VISION. 7/30/2009 ONSET OCCU mplains of severe pain in arm the injection was given. Shootin pain all the way down her arm Y to fingertips. 8/31/2009 8/31/2009 ats, body ache, difficulty sleeping Y 8/27/2009 8/28/2009 iving vaccine daughter c/o pain to injection Y site for days. c/o headache, dizziness, "stomache U ache", fatigue 7/18/2009 and general 7/18/2009 malaise. Intermitt h, dizzy, HA, backache, chills fever 102 degrees, Pt. just started monthly menstruation. Water, Y ice one head, 8/26/2009 ibuprofen. 8/27/2009 e, tiredness, nausea, diarrhea, body aches, joints aching. Y 8/17/2009 8/19/2009 nd injection site red & bumpy on R/th where varicella given. BENADRYL prn. Y 8/17/2009 8/18/2009 mother phoned, client ok evening of 8/27, woke up 8/28 feeling "poorly", high fever. Friday evening Y with quarter 8/27/2009 size round 8/28/2009 reddened areas yalgia - fatigue - started 8/22/09. Y Y 8/10/2009 8/22/2009 d vaccine on 8-26-09 on 8-27-09 onset redness, edema L upper arm, site of vaccine. Y 8/26/2009 8/28/2009 03 F with shaking chills day after vaccination. Also warmed patch (10cm) anterolateral arm that Y has not 8/28/2009 resolved. 8/29/2009 Y 8/26/2009 8/27/2009 eloped edema, redness/purple discoloration to lower exts. As well as a few red patches to back. Y No resp. 8/28/2009 distress.8/28/2009 Clear lung sounds. Cr administered 8/28/09 to Rt arm. Saturday, Pt woke with baseball size redness to vaccine site. Y C/o small8/28/2009 amount of 8/29/2009 itching and mild rednes swelling & induration at injection site, Y 14cm long x 9.5cm wide. Questionable secondary cellulitis. U No fever 8/26/2009 or other 8/27/2009 systemic s/s. Injection s ite reaction (redness; about size of a quarter) developed about 48 hours after injection. Patient U states it isn't 8/24/2009 as red 8/27/2009 or as large as it was. ately 36 hours after vax admin, parent noted child to have large, reddened, swollen area at DTaP Y injection 8/12/2009 site. 8/14/2009 having rash on leg administered. Rash Y spreading. Pt mom told to give BENADRYL & TYLENOL. U 8/25/2009 8/26/2009 e, fatigue. Local swelling, redness, & pain to site of injection. Y 8/27/2009 8/28/2009 ed to clinic 20 minutes after vaccineYwith vomiting, abdominal pain, and urticaria. Lung sounds Y clear. Continuing 8/21/2009 discomfort 8/21/2009 & worsening. Ad Y Y 8/18/2009 8/20/2009 .4, chills, H/A, swollen lips, pains & tingling in arms/legs. Treated with BENADRYL 25 mg PO Y and TYLENOL 8/24/2009 1000 8/25/2009 mg PO. ine fever. Temperature elevation began Y 4-5 h after vaccine administration. Duration approx. Y 30 h. Tmax 8/20/2009 104 F (rectal). 8/20/2009 Appetite decreased, mother, pt. started experiencing extreme fatigue/weakness and some nausea in morning on 08/21/2009. U Pt. 8/17/2009 was taken 8/21/2009 to PCP and Hgb che en and instructed to use cold packs to site if soreness, redness, or inflammation occur. Pt. stopped Y by health 8/20/2009 dept. on 8/21/2009 8/26 c/o pain in neck, of chicken pox. Y N nge sized, red, hard, warm area around injection site 24 hours after shot. 8/4/09. Reluctant to U walk due to8/3/2009 pain. On AM 8/4/2009 of 8/5/09 mom note Hematocrit leading to severe diaperYdermatitis. N 8/11/2009 8/14/2009 d TDAP (BOOSTRIX) on 16 JUN 09 developed rash on 17 JUN 09 was evaluated by provider Y on 24 JUN 6/16/2009 09 + Txed6/17/2009 with ZANTAC + PRED lled our office 4 hours after receiving vaccine with c/o severe headache. 8/25/2009 8/25/2009 haking, "locked up" (2 minutes) unresponsive, Y hypotension. 911 called ER Dx: Syncope vasovagal. Y 8/11/2009 8/11/2009 09 around 3:30 pm there was an approximately Y 3" X 5" area on the L upper forearm that wasNred, raised8/20/2009 and swollen 8/21/2009 and warm to touch. P o 105 degrees duration 2 days - Rash. Y 8/19/2009 8/19/2009 PV, Hep A, & Verasella. Symptoms were dizzyness, nausea, hot flash, blurry eyes & tinglingYears, pt layed 8/24/2009 down for8/24/2009 15 min w/ ice pack. of LA, red, hot. Y 8/25/2009 d to office with rash - Began on chest Y spreads to arms -8/27/ rash began. Y ### 8/27/2009
& swelling upper arm (16 cm) - to arms Y elbow. Circumference 23 cm vs 20 cm other arm. Pt reports chest 8/25/2009 pain X 38/25/2009 days after injection. & swelling 6x7 cm. Requires BENADRYL Y one tsp q 6 hours PRN. U 8/26/2009 8/27/2009 VAX 8/17/09 developed high fever that night with shaking chills vomiting the next day right arm was also8/17/2009 very red and 8/17/2009 sore left arm fine. Fe d Hep A vaccine on 8/25/09. Mother reported generalized red itchy rash first noticied 8/25/09 U in the evening, 8/25/2009 and swollen 8/25/2009 eyes 8/26/09 in A d suddenly around 21 May 08 profound Y fatigue, and sleeping 12-14 hours at a time and awakening N unrefreshed. 4/25/2008 Also 5/21/2008 had increase in HAs, inch erythematous area. Occurred/started 8/21/09 and continued to be red & swollen still today U 8/24/098/20/2009 with a measurement 8/21/2009 of 5.5cm x 6c miting. 5 cm swelling and erythema Y at injection site, right thigh. Y 8/7/2009 8/13/2009 miting, diarrhea, and fussiness. 3 cm Y of swelling and erythema at injection site. - Right thigh.Y 8/7/2009 8/13/2009 elling and redness to injection site. Y Y 8/24/2009 8/25/2009 grade fever, fatigue, headache lossYof appetite. VARIVAX given 8/17/09. Symptoms started Y 1 week later. 8/17/2009 Came into 8/24/2009 clinic. Quick strep n degrees. Lt thigh swollen. Y Y 8/18/2009 8/20/2009 ter flu like symptoms, lethargy, feverY to 100, initial insomnia for 4 days, tired, arthralgias, andNheadache. 6/25/2009 Week 2 had 6/28/2009 had swollen node in b inistration of GARDASIL vaccine patient felt like she was going to pass out. Her blood pressure Y dropped8/10/2009 to 90/52 and 8/10/2009 pulse dropped to 48 yed redness at the site of injections, several minutes after administration. Provider monitoredY pt. for any 8/18/2009 other adverse 8/18/2009 reaction after admin ollowing vaccination pt developed fevers, Y chills, sweats, fatigue, decreased appetite, & 2 similar Y pox lesions 8/11/2009 on the right 8/19/2009 cheek. Appear to b Y 8/6/2009 8/11/2009 Pt in for HEP B #3 - Reports "I had a reaction to the TETANUS". TDAP given 04/01/09 rightYarm IM. Pt states 4/1/2009 initially 4/2/2009 had some "redness" ven MENACTRA before he was at the recommended age to receive MENACTRA. Pt age 10,Y 2 1/2 months 8/13/2009 early per CDC recommendation gh pain within 24 hrs after vaccination. N 8/23/2009 8/24/2009 N 6/15/2009 7/1/2009 ported increased swelling in the (L) arm, both upper & lower 2 days after a DTaP & Hep B (DAPTACEL Y &8/18/2009 ENGERIX8/20/2009 B). It improved after 2 d Vaccine on Left arm: 1st day no problem. Y 2nd day 1" red area; sore, warm to touch. 3rd day 2"hard Y red area 8/26/2009 with 2" 8/27/2009 red welt around; hurt, h n. 8/21/09. Noticed reaction 8/22/09Yin evening 8:30pm. Rt thigh swollen increase to hip area Y down to ankle 8/2/2009 0 hard 8/22/2009 warm to touch - taken to became red and swollen one day after Y DTaP. Worse on second day . Plus warmth plus edema. No induration 8/25/2009 no tenderness. 8/26/2009 after vaccine broke out in rash - dime size red bumps. Itchy throat and extremities. Treatment: Y BEANDRYL, 8/10/2009 ice, cold8/11/2009 bath, MEDROL dose p d, raised - to chest, back, stomach, inner thighs. Mom treated with BEANDRYL 1 X 4 days. Mom Y states this 8/3/2009 happens 8/3/2009 every time with immun Y 6/3/2009 6/5/2009 taneous case was received from a health Y care professional on 26 August 2009. A 48-year-old N female patient, 8/20/2009 with a8/21/2009 history of asthma and a n has been received from Y a physician Y concerning a 9 year old female with latex allergy Y and histories Y of congenital 8/24/2009 disorder, 8/24/2009 clubfoot, myelo n (L) arm - site of where vaccine was Y placed; (+) swelling; (+) tenderness; (-) warmth; (-) induration; U erythema. 8/24/2009 8/28/2009 n has been received from a consumer Y concerning her 6 year old son with no pertinent medical N history and no known drug allergies who wa 10:00pm on day of immunization patient stated had headache and nausea. Drank SPRITE, laid N down and 8/14/2009 symptoms 8/14/2009 resolved about 2 hou ines administered in same arm (notYstated if L or R deltoid). Upper arm became warm, red &Y painful. Steroid 8/3/2009 administered 8/3/2009 @ clinic on 8/4. d to clinic 4/30/07 with 2d menorrhagia. Orthostatic Y with HCT 28.5. Admitted 5 to hospital. Required Y D&C to4/23/2007 stop bleeding, 4/28/2007 IV estrogen didn't w ates patient ran a fever of 104 degrees for 8 hours and developed hives fever and hives resolved Y after 8 8/20/2009 hours, but patient 8/20/2009 continued to be n has been received from a pediatric resident physician Y concerning 0an approximately 6 month U old patient who on an unspecified date was ping nights, fever, irritability, very fussy. Y SleepyYbut would not sleep21 but 4 a min his Y cry changed. N Seizures3/5/2009 (But we did 3/24/2009 not realize what they 7/31/2009 d Varicella vaccination about 3:30 pm. Y His mother Y drove him to football 15 Y practice. About 5:00UPM he took8/19/2009 a very hard8/19/2009 hit. 15-30 minutes late n has been received from a physician Y concerning a 19 year old female patient who at the time Y of vaccination 12/2/2008 was with 12/2/2008 fever and congestion Hep A VFC, instead of Hep B, VFC. She had already received 2 Hep A 's. Y 8/26/2009 d vaccine on 8/14/09. Pt developedYfever (101-102) on 8/23/09 with generalized tonic clonicYseizure. 8/14/2009 8/23/2009 out in a rash, swelling, vomiting, lethargic. Y Pt. was administered BENADRYL, EPI-PEN JR. and Y escorted8/25/2009 to Emergency 8/25/2009 Dept. Anaphylaxis 02, night of GARDASIL #2, Varicella #2, and MENACTRA - reduced with TYLENOL, no other Y symptoms.7/7/2009 7/7/2009 02, night of GARDASIL and 2 Varicella 2 MENACTRA., resolved with Tylenol, no other symptoms. Y 7/7/2009 7/7/2009 8/25/2009 Y 6/23/2009 d hep A (L deltoid) and ADACEL (RYdeltoid) on 8/25 @ about 10 AM. By 8/26 @ about 2000 pt had marked 8/25/2009 swelling8/25/2009 of L deltoid with erythe and swelling of injection site. BENADRYL and anti inflammatories given. N 8/21/2009 8/21/2009 s between shoulders and elbows "whole Y back muscle swollen" : T increase. Returned to clinicY on 8/4. Oral8/3/2009 steroid administered 8/3/2009 and 'cream' the shingles vaccine on 22 Aug 07. I was diagnosed with shingles on 2 Jul 09. I had hurt and had breakouts 8/22/2007 for several 7/2/2009 weeks prior to susp
accinated with GARDASIL. Shortly after she developed Colitis, inflammatory bowel disease, an autoimmune 8/17/2008 disease. 10/1/2008 d with ZOSTAVAX for shingles prevention in upper arm under flesh. Developed extreme swelling U & fever8/28/2009 at the area. 8/28/2009 This morning, aching eeling hot. Placed patient on floor, resp, pulse were normal limits. Pt recovered quickly, keepYlying down 8/17/2009 for 15 minutes. 8/17/2009 No adverse affects ADACEL 8/27/09 - 8/28/09, seen atYED for site of vaccine, (L) arm swelling with pain, 3/10, pain Y level (x'd 8/27/2009 I.V. Vancomycin, 8/28/2009 stopped due to 9 - 7 pm client taken to ER by ambulance Y c/o difficulty breathing. Temp 103 degrees. Tx 1000 Y cc NS IV -8/10/2009 ROCEPHIN 8/10/2009 1 gram IV piggy back ril 2009 he received AVA #2 to left deltoid. Y He again experienced site burning and soreness.YWithin 6-8 hours he ### was 4/27/2009 awakened from sleep ear old AD US Navy officer received an annual FLUMIST administration on 05 October 2006. (DEERs records 10/5/2006 receipt of both ### IM and nasal se symptoms noted. Y 8/31/2009 edness pain warmth of left shoulder.Y Y 8/28/2009 8/28/2009 our child developed angry outburstsYand increase in self abusive behavior which has grown U progressively6/1/2009 worse. We6/1/2009 consulted a neuro ps ped chills, fever, SOB after ADACEL administration on 8/24/09 - Evaluated on 8/26/09 - Tx OTC Y TYLENOL. 8/24/2009 8/24/2009 e call from parent reporting trip to urgent Y care on evening of 8-24-09 because pt was "sick." Parent Y stated8/24/2009 H.C.P instructed 8/24/2009 mom to call pub after receiving vaccine, began to feel bad. Muscle ached. Large red rash appeared and is still N visible 5 days 8/21/2009 later, although 8/22/2009 it seems to be and inflammation onset appr 24 hours after injection; at 48 hours post injection - (L) anteriorUthigh with 11x15.5 8/21/2009 cm 8/25/2009 area of erythema, warm min - 1 hr after vaccines pt began toYdevelop rash and whelps all over body. Also c/o itching.Y Pts mom gave 8/11/2009 him BENADRYL, 8/11/2009 but it did no ut. Stomach pain. Y 8/27/2009 8/27/2009 ope - some chest pain & dizziness nausea. 2nd episode 19th/8/09 (same SX). 9/3/09-records Y recived-date 8/18/2009 of service 8/18/2009 8/25/09-2 episodes stiffness, myalgias and pain. U 8/20/2009 8/22/2009 d <12 erythematous papular lesions. 2-3 were at injection site. Others widely distributed. Developed Y from8/11/2009 2-17 days8/11/2009 after vaccination. No ac se #3 given at age 8 wks but should be given at 24 wks. Y 8/27/2009 nflammation, bruising, warm to touch. Lt arm bruising/ pale halo ring around site - IM site 13Ucm X 8.5 cm 8/25/2009 - Sub Q site. 8/27/2009 warmth, slight bruising to the right thigh. Y Y 8/24/2009 8/24/2009 d area redness, itching within 4-5 hrs about 4x8cm. Y 8/25/2009 8/25/2009 ut. Stomach pain. Y 8/27/2009 8/27/2009 ersensitivity reaction to MMR. Right leg at site of vaccine began with swelling, redness (borders U ill - defined) 8/26/2009 within minutes 8/26/2009 of administratio ox developed on right foot 09 Aug 09, likely focal auto inoculation (vs localized vaccine). Y 7/27/2009 8/9/2009 eadache with fever 100 degrees F on 7/23/09. Y 7/16/2009 7/22/2009 /19/09. Next day large red area around site small pimples within red area. Pain, swollen & very Y itchy. Had 8/19/2009 shingles8/20/2009 - 10 yrs ago after deat was reported by a healthcare professional Y and described the occurrence of passing Y out in aY20-year-old6/25/2009 female subject 6/25/2009 who was vaccinate ceived HPV #3 on 07/13/09. No immediate Y adverse Y events noted. Patient 3 presented to ER on Y 08/01/09 with 7/13/2009 syncope8/1/2009 and again on 08/24/0 (within 10 minutes of FLU vaccine admin.). Y Fainted (between 10-15 minutes of administration). Y Paramedics 9/1/2009 said that 9/1/2009 the patient had an e multiforme within 24 hours of receiving Y shots. N 8/31/2009 9/1/2009 hours after vaccines L side of patient's Y face became swollen & lip on L side is real swollen. Pt Y states he 8/31/2009 became a little 8/31/2009 mucosy & coughed urse gave vaccines to young patient. Vaccines were meant to be given to a 4yr old child. The Y student got 8/21/2009 confused. She thought that she atigue- persistent, preceded by respiratory viral symptoms started 2 weeks after MENACTRA. N 6/29/2009 7/15/2009 sh, itching, 12 days after vaccination. Y TYLENOL, antihistamine as needed. U 8/19/2009 8/31/2009 ported high fever and frontal headache the night of receiving the listed vaccines. Mother reported Y fever resolved 8/31/2009 but headache 9/1/2009 remained th 0-20 minutes after receiving MMR &Yvaricella vaccines pt started coughing. He was auscultated Y & found8/31/2009 to be wheezing. 8/31/2009 Pulse ox 97% on pain; numbness in injection site and weakness distal to site, 1 month s/p immunization. N 7/31/2009 7/31/2009 s of feeling overheated, tachycardiaYand shortness of breath began approximately one hour after Y receiving 8/31/2009 vaccine. 8/31/2009 Emergency room admin iving her shots pt c/o shortness of breath. She recovered on her own before paramedics arrived. Y 8/31/2009 8/31/2009 days of receiveing menactra vaccine he had little pus filled bumps all over the top of his head Y in his hair. The vaccine is the only thing I ca nt and mother, Shad felt "funny" laterYin the day after receiving varivax. Noted dizziness and wheezing U when 8/20/2009 running8/20/2009 at football and had to s pounds, 7 oz; 31 inches) had his 12 month checkup on 28-AUG-2009 at 9:30am and received N 4 vaccinations8/28/2009 MMRII, 8/28/2009 hep B, Prevnar and a eption. Failed reduction. Required surgical resection. Y 9/14/09 Hospital 4 records received DOS Y 8/27/09 to 8/14/2009 8/31/09. Assessment: 8/27/2009 Intussuscep d high fever spikes of 104 and 103 Y degrees F. He also had sever muscle pain in the leg of the Y injection. 8/26/2009 The injection 8/26/2009 site was WITHOUT r ee days had head to toe rash, itching, Y no temp, no known exposure to disease. Given Tylenol Y prn 8/25/2009 8/28/2009 to mom approximately 5-6 hrs after recieving her Hep A and Varicella vaccines the pt. c/o her Y stomach 8/25/2009 hurting and8/25/2009 she started throwing-up d hives around injection site less than 24 hours after given. U 8/31/2009 9/1/2009 and MMR vaccines given on 8-18-09. Child developed mild redness at site of Varicella vaccine Y only on 8-19-09, 8/18/2009 called 8/19/2009 our office about it on daughter's 4mo check up and shots Y she remained more calm (as if sedated) than usual with spouts N of screams 5/5/2009 here and 5/5/2009 there. I assumed i
vaccineson 8/4/09. On 8/6/09 she was Y lethargic, runny nose and diarrhea. On 8/8/09 she wasU listless with 8/4/2009 the other symptoms 8/6/2009 too. No fever y (unilateral). 9/2/09 Consultant record received Y DOS 8/31/09. Assessment: 1 Bell's Palsy. Patient U presents 8/22/2009 with sudden 8/22/2009 onset (L) facial pals nted and fell to floor hitting head onYexam stool. LOC was approximatedly 10 seconds, BP 90/60, Y P 56, arms 8/12/2009 jerking, 8/12/2009 laceration on left side Hep A and Flumist, left room and pt.Y became diaphoretic, fell at hit front of head, seized andUwas transported 9/1/2009 to ER. 9/1/2009 ived TD, IPV,HEP A,MMR and VARICELLA on 8/31/2009. Within 5 mins. of receiving vaccines U client got8/31/2009 up and loss 8/31/2009 consciousness and fe occured about 2 min after administration of 3 IM vaccines -- MCV4, Hep A, and Tdap. Child Yc/o headache 8/31/2009 and dizziness, 8/31/2009 and a couple of s pneumococcal vaccine trial, with severe COPDY was hospitalized for3 Unicompartmental RT Knee Y Replacement. 8/5/2008 Vaccination 6/23/2009took place on 8 g cramps in the calves U 8/31/2009 9/1/2009 ports a rash, fever and headache that started on Friday and continued until Sunday. The fever Y and headache 8/28/2009 were8/28/2009 relieved with acetamino h with blisters over some parts of body. Temp. of 101 degrees on Friday night. Then rash over Y body. Mom 7/29/2009 gave tylenol 8/21/2009 for fever,gave baths me to clinic on 8-17-09 complaining of rash on body. Was examined by attending Dr. who isYan infectious8/6/2009 disease doctor 8/17/2009 and it was determ 9 Mother reported child had extreme dizziness- Felt dizzy a short time after vaccine and during Y day and 4/14/2008 night had difficulty 4/14/2008 standing due to .5cm mild erythema left arm. Nontender, no discharge and no cellulitis. Y 8/17/2009 8/19/2009 owing varicella administration patient noted to have red, non tender puritic area Y 8/26/2009 8/27/2009 twinrix vaccine (3rd dose) lot #AHABB131AB administered to left deltoid at approx. 2:30 pmYon 8/31/09.8/31/2009 She states 8/31/2009 that about 4 hours lat hematous oval shaped area over left tricep. No pain. Y 8/10/2009 8/12/2009 ministered Hep A and HPV vaccine.Y Sat in clinic room 10-15 minutes. Stated felt fine, color good. U released 8/26/2009 to check8/26/2009 out. stood 1-2 minutes ately 10-12 hours after receiving the vaccine, I developed flu like symptoms-fever, chills, nausea, Y muscle8/31/2009 and joint pain. 9/1/2009 I also developed s ellite lesions 1/2 an inch to the left and Y right of the original vaccination site. All three lesion were healing8/21/2009 well with scabbing. 9/1/2009Pt woke up th and aching muscles, chest pain, racing Y heart, aching Y leg (both), aching 2 arm (both), shortness N of breath, 8/13/2009 dizziness, nausea, 8/28/2009 rash, seizure-lik VER 102.4, HEADACHE Y Y 8/31/2009 9/1/2009 d flu shot on left arm,and pneumovax ,and decavac on the right arm at 11 am on 8/28/09.theYnext day,she 8/28/2009 called ,and 8/28/2009 complained that she arm(on which vaccine was administered) Y was inflammed and swollen and she developed a Yrash within 1-2 8/24/2009 days. She 8/25/2009 also had a mild temp hours after receiving MMR and Chickenpox Y vaccine child developed a rash all over chest, back, U arms, diaper 8/12/2009 area and 8/12/2009 face. Was given Be nd stomach cramps beginning ~24 hours after injection and lasting for ~2 hours. Second boutNof vertigo ~72 8/29/2009 hours after 8/30/2009 injection, which is s l skin reaction occurred the day after administration of vaccine (PENTACEL). 0 treatment. Y 8/28/2009 8/29/2009 Y N 8/20/2009 8/27/2009 did physical & came out the room, handle me the chart, I look at the chart & saw the #2 underY age and assumed 8/24/2009 pt was 2 mths & needed 2 spontaneous report of medication error, bronchospasm Y and exacerbation 0 of asthma has been Y received 8/10/2009 from a physician 8/11/2009 concerning a two ed area - Warm & itchy rt upper arm. N 8/24/2009 n has been received from a physician Y concerning a 72 year old female patient who Y on 28-JAN-2008 N was1/28/2008 vaccinated1/28/2008 with a dose of ZOSTA n has been received from a physician Y and an office manager concerning a 12 year old female Y patient with 8/26/2009 amoxicillin 8/26/2009 allergy (AMOXILIN) w 2 of the 3 HEPATITIS BYVaccines after Y the first mild achiness after the 2nd my Rt Y leg & armNwent numb 7/11/2008 - vision disturbances. 7/28/2008 Can't see we n, seizures, rapid heart rate, Y brain damage, Y weakness, Y no sleep, 123 changing Y skin color Y & textures, N pain, numbness. 6/5/2007 9/14/09 7/22/2007 Hospital records and erythema to site; extended to allYarm - Hot to palpation - Dx: Cellulitis to (L) arm. 8/25/2009 8/26/2009 iving immunizations at office visit, while ambulating in hall reported dizziness, then had a brief Y loss of consciousness 8/28/2009 8/28/2009 and was lowered to th Y 8/26/2009 8/26/2009 ent to ER 8/13/09 with complaint of swelling Y in arm, redness and fever. ER visit 8/13/09 temperature Y = 100.1, 8/10/2009 BP 106/74, 8/11/2009 patient was placed dia, arrythmias, heart block, syncope, Y chest pains. Y Taking 3 kinds of medicine daily. Has plenty N of follow ups 6/3/2008 with cardiologists, ### possibly put normal bleeding at time of injection (pt. not on blood thinners etc.) 5-10 min. after injection, Y arm felt "asleep". 8/28/2009 About8/28/2009 30 minutes post-injecti ma 8 cm on right posterior arm. S/S started following the vaccination. Y 8/5/2009 8/6/2009 ma noted in right posterior arm. Y 8/4/2009 8/5/2009 on right arm - posterior 3 X 5 cm area red, raised, & warm to the touch. Y 8/19/2009 8/20/2009 ll, muscle pain all over, bone (hip) pain 3-4 days. 3rd after immunization redness around injection Y site spread 8/18/2009 wide to 8/21/2009 elbow: red, hot, ache. air loss. Headaches. 10/14/09 PC note servce dates 12/18/09 to 8/6/09. Patient's hair is falling U out. ### 5/1/2009 in rash on 8/18/09, seen in ER withYincreased rash, T - 102 degrees on 8/19/09. Started onUPREDNISIONE. 8/14/2009 Phone 8/18/2009 call from mom on 8-2 ped chickenpox 10 days after vaccine. Y Y 8/7/2009 8/14/2009 len, eyes swollen, itching all over body. Y N 8/1/2009 8/1/2009 ccine administration, patient had episode Y of going limp, eyes rolling back & difficulty breathing. Y Patient w/fever 8/21/2009 100.4 8/21/2009 at the time. Patient re reaction at site of injection. Cellulitis. (right thigh). Y 8/24/2009 8/26/2009 2 hrs after HEP B vaccine, parents reported episode of head twitching. Not seizure. Brief, lasting U seconds, 8/19/2009 alert. No 8/19/2009 further episodes that
general malaise - Temp up to 102 degrees. Y Didn't feel good, shaky, anxious, palpitations, frequent urination, fecal evacuation. Y changes with in 1-2 days. Aggressive, combative, argumentative with friends, staring off intoYspace, enough 7/9/2008 that it bothered 7/10/2008 mom. Lasted 1 HING, REDNESS AND SWELLING AT SITE OF INJECTION. ALSO EXPERIENCED DIZZINESS, Y NAUSEA, 8/27/2009 WEAKNESS, 8/29/2009 DIARRHEA AN hours of flu shot injection the injection site was red, swollen, and heated. After 24 hours, theUentire upper 8/28/2009 arm and shoulder 8/29/2009were affected omiting, throat tightness within 24 hours Y of vaccine administration. patient seen by Interbal medicine Y practive, 8/27/2009 subsequently 8/28/2009 sent to ER for e of the vaccination, she felt a burning sensation down to her wrist, daily pain with radiation of U pain down8/12/2009 back and neck. 8/12/2009 Site never got red evening of vaccination. Woke up 4am, vomiting, chills, fever. Lasted 12 hours and symptomsY subsided. No 8/31/2009 treatment9/1/2009 neccessary developed large welped, reddenedYarea from top of left deltoid extending down to mid-biceps Y area and 8/31/2009 around back9/1/2009 of arm but not circumf fter vaccine was administered she developed itching and buring around eyes and some edema. U She took 8/31/2009 2 benadryl9/1/2009 at around 17:30 and ed tonic clonic seizure as per parents Y which lasted Y 45 to 50 sec. Temperature 1 was 99.3 deg YF. Outpatient 7/20/2009 was seen7/22/2009 by neurology and exam shot in clinic around 2:00 p.m. Around 4:00 p.m. my eyes started burning and felt like I had Y sand in them9/1/2009 - by the time 9/1/2009 I got home at 5:30 p perienced wheezing and chest tightness Y 2 hours after receiving the flu vaccine 8/31/09. She has not felt8/31/2009 well since 8/31/2009 this episode began and red PENTACEL vaccine in error, Patient was supposed to receive KINRIX. No adverse reaction Y noted. Patients 9/1/2009 last Hib vaccine was 2006 Soreness of Right upper arm, 8/9/2009 Y Injection site sore with redness, 8/11/2009 increasingYredness and8/5/2009 soreness, 8/9/2009 went to Urgent Care a NJECTION IS SWOLLEN WITH REDNESS AND PAIN ALSO THE ARM FEELS HOT. Y 8/31/2009 9/1/2009 advertantly innoculated spouse 4 weeks status post vaccination. Patient admits scratching off U scab at week 7/28/2009 3 due to8/28/2009 pruritis at vaccine site. Tdap in L deltoid on 08/29/09. SheYnoted swelling at injection site on 08/29/09. Reported toYEmployee Health 8/29/2009 on 08/31/09 8/29/2009 via phone. She and redness/swelling in area where injection given. Warm to touch.Arm sore above and below Y area where 9/1/2009 injection given. 9/1/2009 ticaria after receiving DTaP and Hib vaccines. Recieved diphenhydramine prn, and urticariaYresolved after8/4/2009 one day. 8/4/2009 th pustular lesions on erythematous base beginning on lower legs and spreading below kneeUas well as few 8/6/2009 lesion on 8/29/2009 back and chest 3 wee uffered severe reactions the night he received his 9 month shots. He spiked a 103-104 Y fever N that lasted6/15/2006 3 days with6/15/2006 explosive diahrea that minutes after receiving Gardasil, patient Y syncopized Y with tonic-clonic 1movements, described an Y aura and had 8/31/2009 a brief post-ictal 8/31/2009period. She w of pruritic small papules on thighs, trunk, arms, face, beginning about two days after Varicella Y vaccine; no 8/24/2009 fever or malaise 8/26/2009 were given and we left Dr office and placed baby in car and drove away. At that time baby had Y no symptoms. 8/25/2009 When8/25/2009 we got to our destinatio ports that she had a Shingles Vaccination. Y Within Y a day, she experienced 4 suprapubic pain. YThen her diverticulosis 8/7/2009 got 8/8/2009 worse. She was ho d "headache,chills, fever of 102.7,vommitting," "light red rash on arms, chest", described as "sunburn Y like". 8/31/2009 symptoms 8/31/2009 have not completely r ped 5 painful, fever blisters on skin between nose and lips approximately 24 hrs after Zostavax Y injection.8/25/2009 She reports8/26/2009 history of herpes simp d pneumovax 9 am on 8/28/09, began Y feeling achy by 1 pm, warm in evening. By the morning N of 8/29 his 8/28/2009 temperature 8/28/2009 was 101, going to 1 veloped fever of 104 in the eveningYon 8/26/09.Y Was seen in office on 3 8/27/09 for fever. Admitted Y to hospital 8/26/2009 on 8/28/09 8/26/2009 for paleness and u veloped abdominal distension & increased frequency of apneic & bradycardic Y events requiring Y vigorous 8/11/2009 stimulation.8/11/2009 Abdominal xrays were number of apneic and bradycardic events requiring intervention (stimulation Y for same PPV xY2), increased 8/13/2009 work of breathing 8/14/2009and baseline O & redness in right arm. Y as given 0.5 mL of flu vaccine on 8-31-09. On the afternoon of 9-1-09, patient came to me with Y a red, hot to 8/3/2009 touch spot 9/1/2009 on left arm. Area is 3 u shot (told to hang around store for approximately equal to 10 minutes for signs or symptoms Y of allergic reaction). 9/2/2009 Patient 9/2/2009 and her mother veloped large rash that she described as hard, warm, slight itch and somewhat painful. Reported N to us on 8/26/2009 8/31. Patient 8/27/2009 was instructed to ta 1/09 vaccines administered. Fatigue & listlessness ensued & increased within few hours. Late Y that day &8/3/2009 into night8/31/2009 vomiting & headache 2 warmth in shoulder and spreading across Y upper torso. Also implied that she was diagnosed Uwith pneumonia 8/31/2009 as a result of vaccinations. swollen tender to touch. Y 8/28/2009 8/29/2009 usea & vomiting after GARDASIL vaccine. U 8/31/2009 red, swollen. U 8/31/2009 9/1/2009 RDASIL # 3 given as injection; approximately 5 mins later stood up; was walking out of roomYand fainted. 9/1/2009 Pt also had9/1/2009 blood drawn as well a , edema, hyperemia measuring 10 xY12 cm on deltoid area. 8/1/2009 8/1/2009 nny nose congestion sneezing feverYoff and on x 3wks. Albuterol solution 0.083%. Y 8/15/2009 8/16/2009 ay- Saturday had fever 102, headache, swelling at MENACTRA injection site with pain shoulder Y to elbow,8/28/2009 fatigue. Fever 8/29/2009 resolved Monday. NSET 9/1 at 9PM,CHILLS, THROAT Y PAIN, VOMITING TODAY 9/2. General Malaise. U 8/29/2009 9/1/2009 able since 7/01/09 noc ; decrease appetite did TYLENOL. 7 /09 2nd day after vaccine fussyYand decrease 6/30/2009 po 3rd day7/2/2009 OK 4th day after vac ministered PCV, Hep A, and DTaP on 9/1/09. Within a few hours patient noted to have hive Ylike rash on body. 9/1/2009 By 9/2/09, 9/1/2009 rash all over body es, tongue swelling, itching. Y 9/1/2009 9/1/2009 ately 1/2 hr. after receiving vaccine pt. Y developed hives. Pt. put on RONITIDINE & BENADRYL. Y 9/1/2009 9/1/2009 and swollen right arm. AUGMENTIN 87mg one twice a day, BENADRYL 25 mg one every 6 Y hrs. 8/24/2009 8/26/2009
le, US Army AD PFC, developed papular Y lesions single & in small plaques over bilateral hands U (dorsal>palmar 7/13/2009 surfaces), 8/1/2009 bilateral elbows, k ted. Was given TDAP. When nurse gave MMR she inadvertently reconstituted MMR with the Y meningococcal 8/14/2009 vaccine. Pt was checked on of joints. Stiffness of extremities. Tx: Y Steroid, anti-inflammatory. Y 8/17/2009 8/19/2009 Y 8/21/2009 8/31/2009 , vomiting, diarrhea. Negative fever. Y 8/26/2009 8/26/2009 Hep B vaccine IM @ 08:30 7/28/09Y- Presented to ED @ noon with rash, SOB, pressure to chest Y and diaphoresis. 7/28/2009 TX: 7/28/2009 BENADRYL and SO nt was febrile to 102.1 with otherwise normal vital Y signs. He had 24 2hrs of myalgia, fever, and U vauge lower 8/28/2009 abdominal9/2/2009 pain prior to presenta lips, red eyes, hives on arms, back Yof head, chest tightness. Patient took BENADRYL. Rx for prednisone8/27/2009 taper. 8/27/2009 n has been received from Y a consumer Y concerning Y a his father, a 72 0year Y old maleY patient who N "one month 7/28/2009 ago" (approximately 8/14/2009 28-JUL-200 n has been received from a physician Y and the medical assistant concerning a 19Yyear old female Y with no 8/7/2009 known drug8/7/2009 allergies who "two we n has been received from an approximately Y 25Yyear old female patient with "cysts in the ovaries N that were not a### problem",### papilloma viral in n has been received from a health care Y professional concerning a 19 year old female patientUwho on an unspecified date was vaccinated w was received from a health care professional, via another manufacturer (reference Y number WAES N 0906USA00846), 3/3/2009 3/22/2009 on 25 August 2009. T 8/9/2009 N 7/15/2009 8/9/2009 ETURNED WITH MOTHER ON 9-2-09 DUE TO C/O OF HEART BEATING FAST, DIFFICULTY Y BREATHING, 9/1/2009 TURNED 9/1/2009 GRAY IN THE FAC Influenza and PPV23 vaccines on 08-31-2009. Began to have swelling and redness at injection U site of PPV23 8/31/2009 vaccine 9/1/2009 initially and then red menactra on june 24 2009. She hadYseizure during the night bit tongue severely. Went to doctor N next day, 6/24/2009 said to watch 6/24/2009 her. She had anoth ing the child became congested and had a fever. Continued to have worsening "cold" symptoms, U but fever 8/28/2009 stopped.8/28/2009 4 days later fever of 99 iving Hepatitis A vaccine patient fainted and had some seizure activity, including eyes twitching, Y tonic-clonic 9/2/2009 movements 9/2/2009 of arms and legs a veloping symptoms approx. 4 hrs. following administration of flu vaccine. Began coughing,&Yhaving chest9/2/2009 tightness. 9/2/2009 Developed 101 tempe ed and very hot at site of shot for three Y days and very cranky, followed by abdominal pains, then U fever and 8/28/2009 felt sick to8/29/2009 her stomach on the 4t in throat, radiating to chest, coughing, Y high blood pressure (173/109). Symptons began at 4:20pm Y and continued 9/2/2009until 9/2/2009 steroid were adminis aims that she felt lightheaded after standing for 10 mins and she had to be assisted with walking. Y She also 8/13/2009 claims that 8/14/2009 after feeling lighthead was administered the Anthrax vaccine on 24 Aug at approximately 0930 am in the Left upperYarm (IM). She 8/24/2009 experienced 8/24/2009 the normal burning ticed a small red rash around the injection site on Wednesday morning 9/2/09 two days afterYshingles shot 8/31/2009 was given. 9/2/2009 The rash was red an Y Y 9/2/2009 9/3/2009 und erythromatous indurated area around injection site. U 9/1/2009 9/3/2009 nt received the flu shot on 09/01/09 Y at 1450 and withtin 15-20 minutes she started having symptoms. U The9/1/2009 patient complained 9/1/2009 of dizziness, ng on exam table. While lying on exam table she fainted and arms flailed up. Nurse called patients Y name8/31/2009 and she immediatley 8/31/2009 opened her e SWOLLEN, WARM TO TOUCH RIGHT Y DELTOID. MYALGIAS, STIFF, PAINFUL NECK AND U SHOULDERS. 9/2/2009 HEADACHE, 9/2/2009 FATIGUE AND ME PALE, WEAK AND DIZZY AFTER ADMINISTERING HPV VACCINE. PT REPORTED FEELING Y COLD 9/3/2009 AFTER ADMINISTRATION. 9/3/2009 PT ed and hot at the site, cried continuously Y for an hour or more, 4 days latter, she started throwing N up out of1/2/2009 nowhere then 1/2/2009 that night she star ceived Pneumovax injection. Had immediate swelling/pain upon arriving home. Used ice, heat, N massage, 8/12/2009 NSAID's8/12/2009 for the past 3 weeks wi edness, pain at site of vaccination. YGeneralized malaise, fatigue, body aches and pains (quite Y severe). 8/31/2009 Fevers. 9/1/2009 ME PALE, WEAK AND DIZZY AFTER ADMINISTERING HPV VACCINE. PT WAS SITTINGYAT TIME ON9/2/2009 INNOCULATION. 9/2/2009PT REPORTE Jonathan experienced a rash on his trunk and extremities with some itching. 09/02/2009 HeYstarted coughing, 8/31/2009 wheezing 9/1/2009 and has nasal con ped rash on whole body, itchy, cranky, Y and low grade fever on 8-20-2009. Saw family physician U on 8-25-2009 8/17/2009 Dx MMR 8/20/2009 vaccine reaction a re aporx 1 month after having the 2nd Y hpv vaccine. since then have been suffering from dizziness, N sometimes 7/1/2009 sore achy 9/8/2009 left arm. Weaknes patient's mother (temp not actually taken; was 97.2 orally on 8/31/09), generalized rash, lossY of appetite,8/17/2009 lethargy. 8/29/2009 Mother noticed these s/ eeks after vaccine administered, theY patient developed severe joint pain and myalgias. MostUaffected joints 7/28/2009 were knees, 8/13/2009 elbows and hands swelling warmth to L thigh, almost to knee measuring about 6x4" irregular bordered, no drainage. U Pt triaged 9/1/2009 with RN9/2/2009 appt. Enc cool paks swollen warm "band" posterior to lateral arm measuring about 3x5". No drainage. No fever,U no other s/s 8/26/2009 of illness 8/28/2009 t tricep 1 hour following shot-over the Y course of 12 hours increasing severe muscle aches inNjoints, back,8/31/2009 feet, shoulders, 9/1/2009 head,chest pains. old female came in to the clinic to and stated that has some discomfort to right arm where she Y was given8/26/2009 a shot. Also9/3/2009 stated she noticed br nt developed a headache and a swelling of the face 1.75 hours after vacc. administration (in U addition to soreness 9/3/2009of the 9/3/2009 arm). The swelling administered to left Deltoid 9/1/09, upper Y arm became swollen/red very tight and painful. Taken Y to Emergency 9/1/2009 Room 9/1/2009 by mother 9/2/09 (as c te of injection swollen red and painful per patient. Swelling extends inot axilla, U 9/1/2009 9/2/2009 7/9/2009 N 7/7/2009 7/9/2009 started within 2hrs after vaccination. Also became Y pale and lethargic0about the same time. Poor U appetite throughout 9/2/2009 the 9/2/2009 night. Brought to cl & swelling around site of injection after 24 hours 6 centimeters. VARICELLA vac only. Y 8/31/2009 9/1/2009 lls, aches, hard to move, headache. U 9/2/2009 9/2/2009
day. Itching, vomiting x 1. 7.5 cm x Y 5.0 cm mild erythema and mild induration on left arm. N 8/31/2009 9/2/2009 VARIVAX # 2 on 08/31/09, injectionYarea has become red, swollen, painful, area of erythema, Y well circumscribed, 8/31/2009 slightly 9/2/2009 warm, mild pain & h Erythemic rash with few vesicles initial and put on KEFLEX 250mg for 10 days. Y 8/24/2009 8/26/2009 esented to office on 9/1/09 at aboutY10:00 am with c/o SA; "shaking", fever. T- 102.6 ear noted., Y V x 1 in8/31/2009 office, injection 9/1/2009 sites- clear, none r soreness to left deltoid on 9/2/09, fever 101 degrees, child was very weak, tired, HA on 9/2/09, redness am 9/1/2009 of 9/3/09.9/2/2009 Area 5 1/2 cm x 5 cm d reaction to shots give on 8/31/09. KINRIX 6x9 1/2 cm red and feverish whelp in right thigh no pain. VAIRIVAX 8/31/2009 4x6cm 9/1/2009 left subq red feveris h at injection site, radiating warmth about 8 inches in diameter. Muscle weakness in legs, from U hip down.8/28/2009 Patient also 8/29/2009 had headache. /27/09 8/29/09 Urticaria swollen eyes, nose, lips. Given EPINEPHRINE 0.15 mg IM and BENADRYL U 12.5 8/27/2009 mg orally. 8/29/2009 ze hive at site of VARIVAX. No other signs or symptoms. BENADRYL given. 9/3/2009 9/3/2009 ze hive @ site of Varicella vaccine. No other signs or symptoms. BENADRYL given. 9/3/2009 9/3/2009 h all body with no SOB or wheezing pulse OX 100% BENADRYL PO every six months. Y 9/3/2009 9/3/2009 on left side of neck and then when she turned neck she developed numbness on neck that is still present.9/3/2009 9/3/2009 d syncopal episode after receiving vaccine Y and was unresponsive and hypotensive for 5 mins. Y Patient improved 9/3/2009 after9/3/2009 rest and juice. hurts, patient says can't lift arm above the shoulder. Arm throbs, no swelling. After 2 hours post U injection no 9/3/2009 swelling 9/3/2009 or redness of site - jus ed, hot area - hard to move upper arm. U 8/25/2009 8/25/2009 e seizure on 9/12/2009. Lasted approximately Y 2 minutes per mom. Eyes rolled back. ArmsYand legs jerk 8/24/2009 9/2/2009 03 degrees, stomach-ache, muscle aches. U 9/1/2009 9/3/2009 phone call from mother, concerned Ybecause son had broken out in a rash all over body about Y five hours8/31/2009 after injections 8/31/2009 received. Child aler eneralized reaction at injection site redness, Y swelling & inflammation. Pt also experienced fever, U malaise.8/28/2009 Followed up 8/30/2009 with doctor visit. Even onset of fever, chills & all-over body aches on 8/30/09, injection was given 8/28/09. Y 8/28/2009 8/30/2009 e today complaining of swelling, redness, Y pain, and itching over bilateral upper arms, where Y immunization 8/31/2009 shots were 8/31/2009 given yesterday. Pt s tions were given 8-28-09. Child presented Y on 9-1-09 with fever (104.2 Rectal), nasal congestion, Y cough 8/28/2009 and restlessness. 8/31/2009 Y 6/17/2009 orted feeling weak and unable to feel her body. Afterwards client began to fall backwards onto Y the exam table 7/1/2009 and was 7/1/2009 limp for approx. 2-3 swollen, red, and warm to touch. Y 7/27/2009 7/28/2009 n in left deltoid at approximately 11:30 Y am. Client left with no complaint after shot & went to restaurant. 4/14/2009 Mom then states 4/14/2009 child complained ction with varicella vaccine redness/blisters Y to arm. Y 8/28/2009 8/29/2009 10 mm X 8 mm red, inflamed, warm to touch. 8/31/2009 8/31/2009 e fever started last night rectal temp today was 100 given Tylenol today. Left upper thigh is 3/4 an inch diameter 9/1/2009 larger 9/1/2009 than right thigh. 5/D y or two of vaccine started having "muscle spasms almost like vibrating" seemed to notice especially Y as he 6/24/2009 would fall6/25/2009 asleep; just not himse round the injection site. Pain at injection site. Y ed area where varicella vaccine was given. Warm to the touch & tender. U 8/11/2009 8/13/2009 9- morning Pt noticed a swollen area on her left deltoid measuring 2 1/2 diameter. Y 8/28/2009 8/29/2009 m turned black/blue first night - pain Y woke me up all night worse second day - third day 7/30 upper Y arm covered 7/28/2009 w/ hives 7/28/2009 - large and in a circ erythema warmth around site of injection Y extending 4cm. 3 days later with T 100 and erythema U extending8/24/2009 distally about 6cm. -105 w/in 24hrs of receiving Y immunizations Y - fever Y above 101 for 5 days 3 unconsolable crying, U pain, diarrhea, 6/5/2009 about 56/5/2009 days. 9/14/09 Receiv e myelitis of acute onset on 8/29/09.Y VaccinesYgiven 8/12/09. DC'd from Y hospital 9/25/2009,UDC DX 323.52 8/12/2009 Myelitis8/29/2009 following immunization hrs I had a red rash at the injection site which increased in size for 7 days ending up being about Y 2" x 4".8/17/2009 2 days post 8/18/2009 injection I was placed d MMR vaccine on 8/19/09 and began Y to fill pressure, pain and developed pain behind ears.U Pt also with 8/19/2009 nodules at8/27/2009 site of pain. oid swollen, red, warm to touch (61/2 Y cm x 7 1/2 cm). Reminded father to apply ice pack Q2Uhrs for 15 min. 8/25/2009 Then warm 8/26/2009 compress @ 24 hr ening. Child had redness, pain and swelling at injection site. The next day pt had fever to 103. Y Chills, sore 8/6/2009 neck & body 8/6/2009 aches. By 818 fev ed. 9/15/09 PCP Medical records received DOS 8/12/09 to 9/8/09. Assessment: Muscle pain/Myalgia. Y Patient 8/12/2009 c/o decreased 8/25/2009movement left ema, redness to (L) lateral/posterior forearm. No fever, no SOB, received ZOSTAVAX 8/27/09. U 8/27/2009 8/28/2009 our of receiving the injection, the patient Y complained of painful arm. Within a few hours, the Yarm was swollen, 8/18/2009 more8/18/2009 painful and patient com out while in hall after receiving vaccines. Y Hit back of head- small 1/4 " laceration. Given juice Y to drink &8/31/2009 allowed to8/31/2009 recover with feet up. S sed with shingles 9-1-09. Rash left Y upper thigh. Crusted over vesicles, painful. W/L/Q & LLNback pain. ### 8/13/2009 r vaccines petechial rash neck and shoulders - resolving in 24 hr. Y 8/31/2009 8/31/2009 d redness and itching at the injection site for days following immunization and reported it to me Y 8/29/09. 8/21/2009 8/22/2009 ash beginning 2 days after ADACEL injection, treated with oral PREDNISONE and BENADRYL U 8/31/09.8/21/2009 8/23/2009 ported hive-like eruption around neck, at injection site, on thighs immediately following injection. Y Child also 8/14/2009 stated some 8/14/2009 difficulty breathing of upper arm & few vesicles at the site Y of VARIVAX administration. U 8/31/2009 9/1/2009
slight shortness of breath. Y Y 8/6/2007 on 8/28/09 along with PPD. Came into office 8/31 for reading PPD. C/o area of Td: (+) red (+) Y hot (+) hard 8/28/2009 area extending 8/29/2009 from deltoid to ba rash - 17 days post vaccination consistent Y with varicella. Y 8/10/2009 8/26/2009 12 month immunizations on 8/28/09. Y Next day Y presented to ER with4temp 103.2 and seizures. Y Was hospitalized 8/28/2009 in PICU. 8/29/2009 Treated with ATIV 8-19-09 pt c/o eye lids being swollen. 8-15-09 - 8-19-09 pt c/o tension like headache. Pt tookYTYLENOL 8/14/2009 and BENADRYL. 8/14/2009 Talked to pt on 8 a of redness surrounding injection site approx 2 inches in diameter, warm to touch, mildly sore Y & raised, 8/25/2009 no other symptoms - occurred with ss, diarrhea - 24 hours after vx given. Y 8/21/2009 8/22/2009 ccine. 8/3 = swollen lymph nodes. 8/13-8/15 Y = headaches/body aches. 8/6 = changed bandage. Y 8/7 = lesions 7/27/2009 in genital 8/3/2009 area. 8/10 = swab a n has been received from a lawyer regarding a case in litigation, which was reported in a published U article, 11/7/1996 title as stated above, concerning eived Intranasal Influenza Vaccine at approximately 3:15 PM on 9/3/2009. By approximatelyU6:00 PM on 9/3/2009. 9/3/2009 Travis' 9/3/2009 complained of hi perienced a deep aching pain in leftYarm, bad taste in mouth, body ache, fatigue on the nightUof the injection. 8/25/2009 The pain 8/25/2009 has become severe iving the Hepatitis A vaccine he left Y our clinic and was in the bathroom of the hospital. He reported Y he felt 8/28/2009 dizzy then8/28/2009 awoke on the floor fee PPER THIGH ERYTHEMA, BLOTCHY, BLANCHING RASH. NO HARDNESS, TENDERNESS Y OR WARMTH 8/31/2009 9/1/2009 ported a 2 inch area surrounding injection that is pink and slightly swollen. "Like a small raised Y knot". She9/2/2009 reports it is9/3/2009 sore and slightly war as given Day 14 HDCV 1cc IM into right Y deltoid on 8/30/09. Reports of localized redness and swelling to 8/30/2009 area. Evaluated 8/31/2009 by MD on 9/2/09 a E ONSET WAS ON 9/2/2009, CLIENT NOTED SOME REDNESS AT INJECTION SITE VERY U LITTLE SWELLING 9/1/2009 NOTED 9/2/2009 ON RIGHT DEL ceived Day 14 HDCV 1cc IM to RT deltoid Y 8/31/09. Area became red and itchy. Seen by PA Yat the Lifetime 8/31/2009 health AfterHours 9/1/2009 on 9/3/09 for lled on 09/04/09 to report moderate swelling redness with red streak from injection site to elbow U RT arm.8/31/2009 Advised patient 9/1/2009 to apply cool cloth d Shingles about 9 months after receiving Zostavax vaccine. SX: (3) 2" shingles Ylesions - pain 10/9/2007 at sites - 7/15/2008 Duration: Appx 2 mon m very swollen, red and hot to touch. So swollen ithe bandage left an indentation and a blister U came. 9/1/2009 9/1/2009 lled this am c/o pain and redness at injection site late last night after recieveing Pneumococcal Y vaccine 8/25/09@ 8/25/20091130 8/25/2009 am. after the injection my son had a tempature of 102 and we could not get it down. He was veryNmiserable and 3/12/2009 fussy and 3/13/2009 would not eat or slee white areas on fingertips and between fingers, some raised others flat, all fluid filled. Areas open N on their8/13/2009 own, drain 8/20/2009 clear fluid then dry up. A ceived Gardasil HPV vaccine. After Y receiving vaccine patient was standing and waiting to sign U in for blood9/4/2009 work when9/4/2009 she passed out, fallin vaccine at primary care physicians Y office on 9/02/09. Y Presented to 6 Hospital on 9/04/09 with Ufever and leukocytosis. 9/2/2009 9/3/2009 Infectious disease phy Tdap on 8/28/09. Reports the areaYwhere the vaccine was administered was red, swollen, and U warm to 8/28/2009 touch all weekend. 8/29/2009He also compl ng following FLUMIST (Flumist not Y an option as a vaccination in #13). Y 9/3/2009 9/3/2009 Tdap and Hepatitis A vaccination on Y 8/27/09, patient started losing his auditory processing ability. U He answered 8/27/2009all8/27/2009 questions with a standa d pustules/papules different sizes, stages on head, chest, arms, legs, trunk and diaper area. Y 5/27/2009 8/31/2009 6 times a day for 2 weeks Y 6/25/2009 6/27/2009 #1, Hep A #1, Menactra and flu given Y 10/5/07. Patient seen 5/12/08 and reported vomiting several N times10/5/2007 a week since thanksgiving ### (about N 2.5-3 INCH DIAMETER, REDNESS AT SITE, ITCHING SUBSIDED AFTER 9/3, STILL REDNESS N AND 9/2/2009 HARD "BUMP" 9/3/2009 AT SITE tes that his daughter became ill theYnext day after vaccination. Within 24 hours he was nauseated U and dizzy. 9/1/2009 She has 9/1/2009 what is called migrat ceived Flulaval Vaccine IM on 9-3-09. Pt experienced soreness at injection and a "knot" developed U almost9/3/2009 immediately. 9/3/2009 24 hours later, pt. r dministered 8/19/09 at 09:05am. Patient reported back to nurse approximately 10-15 minutes Y later complaining 8/19/2009 of feeling 8/19/2009 hot and red. The a vaccine received this morning has made me very sick. The pain at the injection site is severe and similar 9/4/2009 to the pain 9/4/2009 I had when receiving arted to feel numbness in arm down to her hands approximately 2 hours after recieving vaccine U in her left8/31/2009 arm which8/31/2009 lasted for few hours. A 8/19/2009 N 6/22/2009 6/23/2009 was reported by a physician and described Y the occurrence of joint pain in a 39-year-old female Y subject who 8/17/2009 was vaccinated 8/18/2009with BOOSTR turned to office on 9/2/09 at 2:52pm.Y Swelling around injection site and previous surgery scars. Y Pt. also complained 9/2/2009 of9/2/2009 itching on hands and me in to office on 9/2/09. Patient received Y DTaP and Varicella in right thigh and MMR and Polio Y in left thigh. 9/2/2009 On 9/3/09 9/3/2009 patient returned to o local), pain, fever. Husband is a physician. Monitored condition. Lasted 3 days. Y 7/23/2009 7/23/2009 ction (R) arm, red, swollen & itchy. Slight fever x2 days. Tx: Ice, TYLENOL and BENADRYL. YF/u in office8/29/2009 PRN. 8/29/2009 at 3AM on 9/2/09 & felt very weak then Y developed fever up to 101.5, bad headache, vomiting, Y light sensitivity, 9/1/2009 4-5 hours 9/2/2009 later. R arm pain a n 8/25/09. Taken to ER on 9/2/09 with Y high fever (103.5) and febrile seizure. Child had convulsions, Y stopped 8/25/2009 breathing 9/2/2009 and turned blue. t reports pt fainted while at band practice at school approx. 3 1/2 hrs after immunizations were Y given. 9/3/2009 9/3/2009 ains of pain and swelling in hands and feet. Both vaccination sites still warm to touch. 9/9/09 USpoke with pt9/1/2009 who did not 9/3/2009 see any treating MD ved vaccine on Friday 9-4-2009. Injection site became swollen and dark, came back to pharmacy U to have 9/4/2009 other family9/4/2009 member to get immu lled in. Itchy rash to upper back & shoulders. States no SUA or any other sx. Rash does not go past mid back 9/6/2009 or above 9/7/2009 shoulders or on arm ceived vaccines (FLUVIRIN & PNEUMOVAX) on 9/3/09 at 130pm. FLUVIRIN in right arm, and U PNEUMOVAX 9/3/2009 in left arm. 9/3/2009 I advised her that er FLUVIRIN administered patient complained Y of dizziness, shaking & pallor. BP taken at 87/59. U Patient informed 9/4/2009us9/4/2009 at this point of previou
after receiving PNEUMOVAX and FLUVIRIN, pt. complained of hotness all over & tingling on Y her tongue.9/1/2009 EMS were9/1/2009 dispatched. BP & puls f soreness in the whole arm but mostly from elbow to the wrist, slightly itchy, looks like sunburn Y but not hives. 9/4/2009 Advised9/4/2009 to use cold compress o pharmacy states she woke up today Y with rash on the body (trunk). Consult pt to take 2 BENADRYL U and9/4/2009 contact or seek 9/6/2009 medical attention had vaccine injected was swollen & painful. Pt. had fever and some heavy breathing. Pt took Y some TYLENOL 9/2/2009 and BENADRYL 9/2/2009 and got be n receive influenza, pneumococcal Y vaccine. 9/3 nauseated, achy. Thursday pm - redness (L)Uupper arm. 9/5 9/2/2009 seen here 9/3/2009 large cellulitis. ed rash now itching at injection site. Y 9/1/2009 9/3/2009 at injection site - swelling from injection site, down arm almost to elbow, arm is tender & hot to U the touch. Patient 9/3/2009 advised 9/5/2009 to seek medical ca warm. Aches - all over especially neck, Y jaw. U 9/4/2009 9/4/2009 ped chicken pox after having 2 varicella vaccines. U 12/5/2006 9/4/2009 peared okay after flu vaccine was administered. Y About 10 minutes after vaccine administered, U he complained 9/4/2009 of pain9/4/2009 in the arm, abdomen red vaccine at 1:15pm on 9-3-09. Symptoms were reported at 6:00pm. Red face going downUneck splotchy 9/3/2009 rash, flushed 9/3/2009 feeling. Skin hot to eceived vaccines shortly after got nauseated, Y warm. Dizzy - laid in supine position. Ice to back Y of neck. BP 9/3/2009 (L) arm sitting 9/3/2009 104/60 pulse 60 s r vaccine had area at site of vaccine administration that measured 5cm in diameter and wasYred, raised, warm 9/2/2009 and painful. 9/3/2009 & eyes after vaccine - sneezed for hrs. eye swollen. No wheezing. U 8/31/2009 9/1/2009 ARIVAX was given (subcutaneous) was Y hot to touch, swollen, red, and itchy. She was put onYXYZAL every 8/31/2009 day. 9/1/2009 ted with large red area surrounding Y injection site. Varicella vaccine given 9/1/2009 in (L) deltoid. U No fever.9/1/2009 Other vitals9/2/2009 stable. Pt started on Y U 9/1/2009 9/1/2009 d vaccines on 8/31/09. Patient returned Y to office on 9/2/09. Patient's right arm swollen and tender Y to touch. 8/31/2009 Feverish 9/2/2009 around injection site. "dent" on his upper arm - the area where Y he was shot with vaccine. The skin has discoloration. U The affected 6/25/2009 area is 7/19/2009 about 2 inches long. He d immunization 8/27, 8/30 started to swell at mid/upper thigh swollen, blotchy, warm to touchYto (R) upper 8/27/2009 knee. Size 8/30/2009 of swelling is almost d e fever. Multiple bumps bilateral legs & arms. Y ### 9/3/2009 8 hours ago - got 3 shots GARDASIL, VARICELLA, MENACTRA. 9/3/2009 9/4/2009 r induration 2-3 cm X 3-4 days comfort measure. Advil - resolution of symptoms. Y 9/1/2004 9/3/2009 hat was very sore on 9-3-09 (day after administration). The muscle under the site of injectionY on (L) arm is9/2/2009 the size of9/3/2009 a baseball with swelli as ordered to get meningococcal on 8/14/09 and nurse gave pneumococcal. Y 8/14/2009 Y 9/2/2009 9/2/2009 eving the Gardasil vaccine, about 3-4 Y ours later she had severe abdominal pain that did not stop. Y I gave her 8/4/2008 motrin but 8/4/2008 it didnt help. After sh rom ankles to knees, worse at 12 hours post injection, now improved but still an issue for patient. U 9/2/2009 9/3/2009 mately 9:00 pm, my left arm began to ache. I went to bed about 10:30 pm and awoke aboutY12:00 am with 9/1/2009 my left arm, 9/1/2009 left shoulder and le Administered 08/26/09. He started having Y high fever on 09/01/09. He began to become extremely U fussy 8/26/2009 and some nausea. 9/1/2009 Fever continued ritability for 6 days. chronic low grade Y fever continues at this time. N 8/27/2009 8/27/2009 ollen,stiff and really red at the injection site 9/4/2009 9/4/2009 er redness and now has a bump the size of a dime on her right arm. U 8/28/2009 8/29/2009 or injection became inflamed and swolen within an area of 2.5 inches in circumfernce. The area Y was noticably 9/3/2009 re and 9/3/2009 enlarged. The injectio ter was adminstered GARDASIL (I cannot find it in your list of vaccines below/ Ch.-B.: Y NE51780, N NE51790, 1/14/2008 NF56940) 7/15/2008 on May 5, 2007, July after receiving Zostavax vaccine I had swelling and fever in my arm at injection site. 6 days after Y receiving 8/31/2009 it my chest9/1/2009 broke out in little bum a shot given while patient at osu. site Y where shot given hot red painfull and very swollen. Growing bigger every 9/3/2009 day. On 9/4/2009 3rd day body aches 4 HOURS PATIENT DEVELOPED Y SEVERE EMESIS AND DIARRHEA WITH A HIGH GRADE U FEVER OVER 9/1/2009 105F.9/2/2009 PATIENT WENT TO D reathing. Rapid Heart Rate. Y 9/9/09 Y ER records received DOS 9/4/09. Assessment: Atrial flutter Y with rapid 9/1/2009 ventricular 9/3/2009 rate and cardioversion pneumovax and influenza at 11:40am on Sept 5. By 9pm had sore arm. Next day, awoke with U redness spreading 9/5/2009over 9/5/2009 entire deltoid area o A AND FEVER BEGINNING 48 HOURS AFTER VACCINATIONS AND CONTINUING FORUMORE THAN9/2/2009 72 HOURS; 9/4/2009 pain, extreme swelling & bruising atYinjection site. Headache, fatigue, chills & sweats on 8/30/09. Y By that8/29/2009 evening and 8/30/2009 into 8/31/09, fast hea red 8/11/09 for pre-employment. Last Td vaccine received 2005. First time receiving Tdap. Approximately Y 8/11/2009 6 cm x 4 8/12/2009 cm red area at injection oned the pharmacy to complain of injection site reaction on 09/06/2009. I was not in so the U pharmacist on 9/3/2009 duty instructed 9/6/2009 the patient to ca accinations administered @ 4:30 p.m. Y 9/2/2009, was taken by ambulance to Hospital, @ 7:00 Y am on 29/3/2009. 9/2/2009Diagnoses, 9/3/2009 seizure. 10/7/ us behavior, tantrums, regression incontinence when previously potty trained,bowel pain,lossNof functional5/5/2008 language, 5/5/2008 ic pain (tingling, numbness, shooting pain in arms, hands, legs, and feet; some facial nerve U sensations);8/31/2009 started with 9/2/2009 numbness in feet on 9 n has been received from a physician Y via medical Y records concerning 5 a 7 day old male who N on 06-NOV-2008 11/6/2008 was vaccinated 11/7/2008 with a first do n has been received from an 18 year old healthy female who on 13-OCT-2008 was vaccinated Y with the first 10/7/2008 dose of10/7/2008 GARDASIL (Lot # 6603 n has been received from a nurse inY the physician's office concerning a female patient who on U 14-JUL-2009 7/14/2009 was vaccinated 8/31/2009with the secon n has been received from a 24 yearYold femaleYwith family history of1blood clots, her grandmother Y and mother 6/1/2009 were factor 7/6/2009 5, and no drug re
n has been received from a office nurse concerning a 15 year old female. The nurse reported U that the patient who was not a patient of the n has been received from Y a health professional Y Yconcerning an 18 year 1 old female patient who U in January 1/1/2009 2009, was vaccinated 4/1/2009 with a dose n has been received from a case inYlitigation concerning an approximately 6 month old female U who on 26-MAR-2001 3/26/2001 3/28/2001 was vaccinated with a n has been received from a consumer Y concerning Y her son with allergies 0 to wheat, dairy, eggs Y and nuts who was vaccinated with the secon n has been received from a registered nurse concerning a physician who in 2001 was vaccinated U with VARIVAX (Merck) (Lot number was urting and then swelling. Pain is deep in arm and hurts from shoulder to elbow. 9/1/2009 9/2/2009 chest pain, SOB, cough -Y2/09. CT chest Y 2/11/09 Y - R pulmonary artery 6 occlusion secondary to N massive PE. 2/11/2008 2/12/09 R 2/11/2009 atriotomy removal of R U tness - monitored a little lightheaded. Y 9/8/2009 9/8/2009 swelling, redness and induration of the entire leg (upper) in which vaccine was given, Right U leg. 9/1/2009 9/2/2009 d severe and prolonged allergic rash/hives Y required multiple office visits/medication. Y 8/28/2009 9/1/2009 d Cellulitis after MENACTRA vaccineY administration (at injection site). 8/31/2009 9/1/2009 Y Y 9/3/2009 9/3/2009 dministered 8/27/2009, On 9/7, developed calf pain, refusal to walk, and then rash. Seen in U clinic with typical 8/27/2009 rash of Henoch Schonlein Pu tion 9-1-09 and on 9-2-09 mother noted non-vesicular rash on neck and itching. Left arm andYshoulder are9/1/2009 red and warm 9/2/2009 to touch today (9ed swelling to L thigh from injection Y site to knee. Skin warm; mottled ant. thigh, back of thigh nl. 9/3/2009 9/3/2009 aneous nodule noted approx 4cm x 4cm sl. erythema. Y 8/18/2009 8/21/2009 mplained of dizziness, lightheadedness, blurred vision and numbness of face 20 minutes following Y immunization. 9/1/2009 Patient 9/1/2009 sat down with he ated that on Saturday (8-29-09) sheYfelt fever, chills, swelling and pain from her left arm to her U left arm pit, 8/28/2009 seen by doctor 8/29/2009 - Cephalexin 500m ven GARDASIL and ADACEL 100m /office approximately 10 minutes after injection, was found Y outside the9/1/2009 building by9/1/2009 police. Had syncope. en on 8-10-09. Mom noticed redness Y down to elbow on left deltoid and swelling beginning inYam, increasing 8/10/2009 swelling8/11/2009 through out the day. edema induration is warmth X 3 days after vaccines - OTC SX relief. Y 8/28/2009 8/29/2009 pt arms and legs retracted, unable to Y stand pupils dilated, rapid breathing, pulse 92 @ 12:55Ypm. Started 8/10/2009 he was having 8/10/2009 difficulty breathing or arm reddened. Y 9 on right arm injection site developed a rectangular red, slightly raised area 1" X 2". The area U itches and 8/12/2009 is warm to 8/17/2009 touch. Advised to con h started on lower buttock and spread to belly and back and by 8/12/09 was also on both legs U thigh area7/29/2009 both legs. Today 8/9/2009 8/14/09 rash rem eyes and lips, and all over the body.YAnd can walk. And it come and go. On this day is starting. N 1/31/2008 2/7/2008 agreed to receive the HEPATITIS B vaccine in HEPATIITIS B Vaccination Program. 7/10/2009 Y 10:00 am 7/10/2009 Employee 7/10/2009 received the HEPATI p 9/1 - clingy, didn't eat, listless, spacey, low grade temp. Knew sister's name but couldn't remember Y her8/31/2009 brother's name 9/1/2009 morning & afterno d type 1 diabetes. 9/16/09 MR received from PCP. Initially presented 2/1/08 withYc/o increased N thrist and8/19/2003 elevated BS. 1/1/2008 DX: Latent autoimm vaccination, arm sore, muscles sore. Y Next morning felt warm, fatigue, nausea, headache. Y Took Motrin. 9/2/2009 Taken to ER 9/2/2009 in evening. Flu test es after varicella vaccine was administered Y patient broke out in total body hives, had severe Y itching and mild 8/6/2009 expiratory 8/6/2009 wheezes but in no r RSE EVENTS NOTED AT TIME OF COMPLETING THIS FORM. Patient was given 0.5ml ofY Fluzone on 9/2/2009 26-Aug-2009 and then again on 0 warmth, swelling, left deltoid. Streaking noted approximately 2 inches from site, extending 1Uinch. 9/3/2009 9/3/2009 c'd T/C from MGM, advised client developed enlarged node Left side of her neck,close to the N clavicle on8/11/2009 8-21-09. States 8/21/2009 client has been ve ed vaccine on 8/17/09 11:28. Pt. returned to clinic (where she received vaccine) @ 7:30pm 8/17/09. Y THe 8/17/2009 following 8/17/2009 is note left in chart by F and itchiness at injection site. Within 48 hours, swelling and redness had grown to a 3" diameter Y and patient 9/2/2009 became 9/4/2009 achy and sick feeling. , difficulty breathing, chest and throat Y tightness, Y 9/2/2009 9/2/2009 p 3days post flu mist administrationYwith Pells Palsy. Left side of face was affected. Received Y treatment with steroid ### through ###civilian provide as administered Pneumovax on 9/2/09. On 9/4/09, patient presented to the pharmacy with cellulitis Y around 9/2/2009 the site of9/4/2009 injection. She had vi reddened area left anterior thigh, afebrile, Y Orapred 3tsp. in officethen 11/2tsp. daily for 4 days. Y Recommend 8/21/2009 cool compresses 8/22/2009 and Motrin f ported low grade fever, aching all over, "just like I was getting flu" about 24 h after admin lasting Y for 12-16h9/6/2009 relieved with 9/7/2009 ibuprofen d rash 3 days after recieving MMR vaccine Y 9/1/2009 9/4/2009 m at inj. site became swollen, red, itchy. Pt. also had hives on his face & neck, (about 20). U 9/4/2009 9/5/2009 t vaccine site. Seen at ER. Given 10 Y days of Keflex. Y 9/4/2009 9/5/2009 CHING, BLEEDING AT INJECTION SITE. Y 8/25/2009 8/25/2009 ted to facility after recieving the Pneumovax Vaccine at the medical clinic, prescribed by Dr. with U pain, redness, 9/4/2009 swelling 9/6/2009 at injection site. Dr sodes on significant crying and apnea. Y Pt also Yexperienced difficulty1 feeding so he was admitted Y for observation 9/1/2009 overnight. 9/1/2009 9/25/09 Medica dministered about 5:30 PM. Phone call at 7 PM stating edema in left arm from elbow to fingers. U Some mild 9/8/2009 pain in fingers 9/8/2009 (had to remove scribed "pain in arm with striations."YPatient was diagnosed with Pneumonia on 9/07/09. U 9/5/2009 9/8/2009 e, dizziness and shortness of breathYfollowing vaccine, then left sided numbness to ear, face,Uhand and arm 8/31/2009 x 1 week. 8/31/2009
ma-like" attack, body aches, chills, "violent Y coughing", says lungs felt like they were on fire. Y 9/3/2009 9/3/2009 nced "heart racing" followed by "jittery/nervous felling". Pt took alprazolam, which helped calmed Y her and9/7/2009 heart. Symptoms 9/7/2009 returned next m cm raised erythematous dermatitis over right deltoid. Treatment: BANADRYL elixir. Y 8/31/2009 9/1/2009 muscle joint pain, fatigue, nausea. States Y reaction 4-5 days post vaccine x 5 years. Onset within Y hours after 8/24/2009 flu vaccine. 8/25/2009 ived vaccine on 9/1/09. At 1:30 am 9/2/09 child had "throat closing, audible wheezing and difficulty Y breathing. 9/1/2009 Benadryl 9/2/2009 given & symptoms ported sharp pain in left arm 30 min after injection. She took OTC pain tabs and used an ice Y pack. Pain started 9/7/2009 to go 9/7/2009 away 15 to 20 min. lat and pain in upper deltoid area upper Y arm above elbow and trunk. 8/31/2009 9/3/2009 s after patient received injection she stated that the area where she was injected itched a little Y bit. We had 9/8/2009 her wait another 9/8/2009 5 minutes or so ss of appetite, fatigue, vague weakness Y of joints, anxiety. U 8/26/2009 8/29/2009 ss, wheezing, weakness, difficulty breathing. Y Sent employee to medical center for evaluation. Y TX with steroids. 9/4/2009 9/4/2009 ped hives 1 day later on inner elbows of both arms. They are currently fading. Pt did not seek Y medical tx & took no medications. aised silver-dollar sized area aroundYinjection site with 2 finger size striations on arm + 1 into N side of neck. 9/2/2009 Sore to the9/3/2009 touch. d serum sickness with hives, fever. Y 8/17/2009 8/20/2009 m area of redness & swelling at site of injection of VARIVAX. Y visit on 1/23/09, child had single words and could point to indicate wants. No animal Y names or N noises. Rec. 1/23/2009 increased 2/23/2009 reading to child. MMR ort was received 10 August 2009 from Y a health care professional. A 14-year-old male patientYhad received8/6/2009 a first dose8/8/2009 right arm injection of adache, injection site pain 8/13/2009 8/14/2009 rmation received on 18 August 2009Yfrom health care professional. A 17 to 18 years old female N patient received 8/14/2009 MENACTRA 8/15/2009(lot number u ort was received 20 August 2009 from Y a health care professional, who is also the patient's parent. A 17-year-old 8/18/2009 female 8/19/2009 patient with no conc ate schedule of vaccine administered. Initial information received on 25 August 2009 from aNhealth care8/19/2009 professional. A male patient with was reported by a healthcare professional and described the occurrence of vomiting in a 2-month-old Y male 5/20/2009 subject 5/21/2009 who was vaccinated wi was reported by a healthcare professional and described the occurrence of vomiting in a 4-month-old U male 8/27/2009 subject 8/27/2009 (reported as less than 2 ported that he had not receive Pneumo vaccine in the past. Patient received Flu vaccine (left Y arm) and Pneumo 9/4/2009 vaccine 9/4/2009 (right arm) on Frid 9/2/2009 9/4/2009 eared within 6 hours of vaccine admin. Responded to BENADRYL liquid but continued to recur Y for 48-72h. 9/4/2009 1 episode 9/4/2009 of tightness in chest n has been received from a physician Y concerning a 64 year old male anesthesiologist who on Y an unspecified 9/17/2008 date was 9/17/2008 vaccinated with a do n has been received from a health professional Y concerning a 5 year old male student with a U delayed delivery 8/22/2009 who on 8/27/2009 27-AUG-2009 at 10:0 n has been received from a physician Y concerning a 65 year old male with no significant Y medical N history who 8/8/2009 on 08-AUG-2009 8/9/2009 was vaccinat n has been received from a physician Y concerning Y a patient "who just0 came out of hospital received U series of three PNEUMOVAX vaccines n has been received from a registered nurse certificated concerning a 22 year old female patient Y with no9/19/2008 significant past medical ### history an n has been received from a physician concerning a 17 year old female who was Y vaccinated N with a dose of3/6/2008 GARDASIL. Two years ago, the n has been received from a health professionalYconcerning a 28 year old female who on 28-AUG-2007 U was 2/25/2008 vaccinated with the first dose o had scratchy throat, coughing, Y the symptoms Y went Y to thrush, fever, high 6 blood pressure, loss/slurred U speech, loss ###of appetite, ### fatigue. I saw ts given PENTACEL, MMR, PREVNAR, Y Hep A,YHep B, Varicella. 1915 1 parent stated child, limp, Y rash, convulsions, 9/2/2009 low 9/2/2009 temperature. 2000 c after 4 month check, presented to office with unusual Y movements for 4 several days. Y Quickly U recognized 9/19/2008 as infantile 9/19/2008 spasms in the office. Ad and bruising at injection site. Pt was shaking. Y 9/2/2009 9/2/2009 his AM for flu vaccination. Approximately Y 2 hrs later (12 noon), pt developed persistent coughing, U no wheezy, 8/28/2009 dyspnea, 8/28/2009 truritis, mucose sw p day after injections with small red nodule at site of injection, was sent to school and when Y arrived home, 8/27/2009 area had8/28/2009 gotten bigger with mult ght in 2 children for vaccines - baskets/containers were side by side - 5 yr old was kicking & Yfighting - grabbed 9/1/2009 the wrong 9/1/2009 basket & administ P fever 101.7 temp. TYLENOL alt. after Ibuprofen per Dr. 9-2-09 no fever. Y 9/1/2009 9/1/2009 30 PM fever 100.9 temp - very quiet - decreased activity - TYLENOL alt. with Ibuprofen per Dr. Y 9-2-09 no 9/1/2009 fever - Sx's9/1/2009 resolved. ed urticaria 6 days after receiving vaccines Y Tx - BENADRYL 25-50mg every 6 hours prn. U 8/26/2009 9/1/2009 after administration of ZOSTAVAX, I developed burning sensations in skin on left side of back N extending4/18/2008 into left breast, 5/15/2009 including sharp bu rted hives over entire body on 8-28-09 which lasted until 9-2-09. No fever. States child seemed Y more tired 8/18/2009 then usual 8/28/2009 on day before hives MMR administered approx 48 hrs ago. 24 hrs ago upper left arm red & swollen now 2x2 inch erythema, Y no 8/24/2009 fever child8/25/2009 active & playful. 2-3 days (102.0). - Alternate TYLENOL/MOTRIN. - Swelling to injection site. - Push fluids. -Headache Y x 28/25/2009 days. - Vomiting 8/26/2009 x 1-2 days. U 8/24/2009 seizures and developmental delays. Onset Feb. -12, 2001 9 months after vaccine.Y 10/6/09 PCP N medical records, 5/2/2000neurology 2/12/2001 consult, service nd swelling up left arm, itchy / redness of eyes. Pt given Benadryl 25mg Po 9/3/09 at 1430. Y 9/2/2009 9/3/2009 came in this morning c/o hard, red Yswelling on arm at the site of injection from 2 days ago. Pt Y says it started 8/25/2009 yesterday 8/26/2009 morning, getting wo ates fever of 101 degrees X 3 days beginning 09-01-09. Also states woke up 2 X on 09-01-09 Y stating "can't 9/1/2009 breathe".9/1/2009 Did not take to PMD
Tues evening using ice packs. Worse on Wed swelling. Same on Thurs. Redness worse andNpuffing on Fri. 9/1/2009 Y 8/17/2009 8/17/2009 on received his booster shot for chicken Y pox, within 6 months he had got shingles. He also ran Y a high temp. 3/12/2009 with the 7/6/2009 shingles..... and inflammation at the injection site. Itching patient is going to apply ice and take antihistamine. U 8/29/2009 8/30/2009 @ 7:30 pm - lower right thigh red - dime Y size, upper right thigh slightly red, low grade fever, pain 9-1-09 PREVENAR 8/31/2009 8/31/2009 @ 7 am - red, nickel siz Syncope immediately following vaccine. Y Recurred again within 24 hrs. Flushed, nausea, dizzyY when standing 9/2/2009 with orthostatic 9/3/2009BP changes. N d fever to 103. Painful swelling of arm. The vaccine was given in H.A., arthralgias, nausea. UNo rash no oropharyngeal 9/1/2009 9/1/2009 swelling. No dyspn nted after administering HPV vaccine for about 1-2 mins. Vital sysm. stable. Mom witnessed Y some arching 9/1/2009 moves. 9/1/2009 Blood pressure WNL w , red, swollen, warm to the touch area Y on L upper arm. Advised BENADRYL, warm compresses N and monitoring. 9/1/2009 9/1/2009 veloped dizziness after administration of GARDASIL (2nd dose). Y 9/2/2009 9/2/2009 allergic reaction. Y Y 9/3/2009 9/3/2009 breathing, rash development, dizziness. Y U 9/2/2009 9/3/2009 ined of left arm swelling / red/ warmYto touch at injection site that measured 18cm x 12cm onY8/26/09. Pt8/24/2009 given Benadryl, 8/26/2009 Motrin and ice. Y 7/27/2009 7/27/2009 mins of receiving flu shot, patient experienced nausea and dizziness. Symptoms lasted a fewYminutes & Patient 9/2/2009 was able 9/2/2009 to walk out. 3/3/2009 3/5/2009 Mild Fever). 8-30-09 & 8-31-09-(Chills & Fever oF 102.5 on & oFF). 9-01-09-Redness on armNcovered all8/29/2009 of arm above 8/29/2009 elbow-9-1-09 saw D episode immediately following vaccine administration. Patient was seated, no fall sustained.YBlood pressure 9/1/2009 dropped9/1/2009 to 76/48, recovered to chronic headaches 21/2 month following HPV #2 Diagnostic w/u (-). N ### scles are sore. My back hurts. I feel "stiff" all over. N 8/27/2009 8/27/2009 ain @ injection site within 2-3 hours of injection lasting 16-18 hrs. Followed by all over body ache Y & extreme 8/27/2009 fatigue.8/27/2009 & Redness 8-6-09 R arm. Y Y 8/5/2009 8/6/2009 Wed 8/26/09 fever next day. Friday - rash, splotches 3-4" across, worse, chills spreading. Saturday Y & Sunday 8/26/2009 - hives 8/28/2009 upset stomach Satur the face, swelling of lips; then 25mg diphenhydramine IV was administered. When no relief,Yand additional 8/28/2009 itching of 8/28/2009 throat, famotidine 20m fter administration of Gardisil, patient Y developed severe chickenpox. 1 week of fever, 3 weeks Y of rash. Patient 7/9/2009 still 7/23/2009 has severe scarring of f er MMR shot, Patient stopped sleeping Y and complained of sore stomach. First week, Y major behavior N change. 8/21/2009 On day 8/22/2009 10, patient's eyes got d welts around injection site. Approx 1x2cm in size. Y 9/2/2009 9/3/2009 at about 3:50pm at the waiting area after blood drawn and vaccination, she felt dizzy then passed Y out for 9/5/2009 less than 19/5/2009 min. Code blue was c lling, lump on arm at injection site. Y Y 8/27/2009 8/27/2009 N NOTED POST VACCINATION HANDS RED AND ITCHING Y 9/2/2009 9/2/2009 iving vaccine, pt states her entire upper arm swelled and she was not able to move arm all weekend. Y The 9/4/2009 under arm region also broke out i ported 1 day following vaccination (8/12/09), child's arm (from Shoulder and to just above elbow) Y increased 8/12/2009 redness, warmth to touch, and h reported progressively worsening throat Y tightness after receiving flu vaccine. Vaccine received Y at approximately 9/8/200912:30pm 9/8/2009 on 9/8/09. Soug ed a few days after receiving Tdap &Y Varicella in the left arm and MMR and Hep B in the right Y arm two lymph 4/14/2009 nodes in the left side of her ne arm was very swollen, red rash, appearance Y of cellulitis, and required medical attention. Pt Ywas given vaccine 7/29/2009 on day 7/30/2009 of discharge (7/29). ERYTHEMA ON UPPER LEFT ARM APPROX. 3 CM IN DIAMETER WITH MILD INDURATION. Y NO PUSTULE. 8/31/2009MOM 9/2/2009 NOTICED AREA O Tdap & MCV4 9/8/2009 @ approx 1500. Per mother child "Went to bed @ approx 2130 withY c/o sore arms. 9/8/2009 Woke up 9/9/2009 @ approx 0200-030 minutes of vaccination, Pt c/o dizziness. Dropped to the ground and tapped head on side of plastic Y chair. Instantly 9/5/2009recovered. 9/5/2009Drank water & welling- inflammation around site- 5" long. Right arm- 4" wide and 3" long swelling and inflammation Y and8/26/2009 tenderness. 8/27/2009 ent's mother, he started complaining that his left arm was in pain from the moment he received U the shots,8/26/2009 and that he 8/26/2009 could not move it bec the seasonal flu shot around 4 p.m. I woke up the next morning very itchy and developed hives Y all over my 9/4/2009 body. I took 9/5/2009 Benadryl every 4 vere crying and localized Redness toY the left thigh. Reaction lasted several hours. Pt was given Y Zyrtec and9/8/2009 Decadron 9/8/2009 IM. site when arm moved up high U 8/29/2009 8/29/2009 alized swelling, urticaria (generalized) Y within two or three minutes of vaccine. 1 tsp children'sYbenedryl given 9/1/2009 at the time, 9/1/2009 patient was monito e was no pain when shot was given, the next day there was a lot of pain in the arm at the injection U location. 9/8/2009 9/9/2009 d fever 103 2 days after vaccination . resolved without any sequelae Y 9/4/2009 9/6/2009 redness(softball size), swollen, itchy, Y warm to the touch, sore started on 9-5-09. Pt used benadryl U and calamine 9/3/2009lotion 9/5/2009 starting on 9-6-09 er receiving his scheduled 2 month Y shots, DTaP, Y Hep B, Hib, Polio, 8and Prevnar, patient began U having seizures. 7/25/2006After 7/27/2006 numerous tests, blo LAINED OF HER THROAT FEELING LIKE IT IS ON "FIRE". 9/9/2009 9/9/2009 ndrome. Autoimmune hemolitic Y anemia Y + idiopathic Y thrombocytopenic 10 Ypurpura. Coombs positive U (warm Ab). 3/17/2008 Hb=6 & plts. 20,000. ### Differenti ax 100.6 within 12 hrs of administration responding to tylenol diarrhea, vomiting within 24hrsU 9/8/2009 9/9/2009
Difficulty, body ache, chills apprx 36 hours. U 9/1/2009 9/2/2009 ild redness on Saturday. Each day Y noted progression down arm further, no fever, redness noticed Y on inside 9/2/2009 of bicep 9/5/2009 down to elbow area, w D, SWOLLEN AREA FROM SHOULDER Y TO BELOW DELTOID MUSCLE. SEEN BY PHYSICIAN Y 9/9/09.9/8/2009 ENCOURAGED 9/8/2009TO DO ICE CO fter vaccination pt. developed 5 red Ypatches on chest and back. Maximum size 3 cm. MD noted Y central7/15/2009 flat erythemtous 8/9/2009 area surrounded b , induration and warmth over right deltoid area, approximately 6cm diameter. U 9/2/2009 9/4/2009 ntense myalgias, fever, diarrhea Y 8/10/2009 8/19/2009 ite red & hot inflammation grew in size over 6 days to 9cm x 6cm, and is still present. We took N digital photos 9/3/2009 in case you 9/3/2009 want sent for stud ed the expected redness, swelling, etc. About four days later, as swelling was subsiding, the deltoid muscle 8/31/2009 in the upper 9/1/2009 arm began to exp d KINRIX IM and Varicella Subq in R arm and MMR in L arm. Was sitting in childrens chair waiting Y while sibling 9/8/2009 got shots. 9/8/2009 Pat fall to floor a d w/ juvenile rheumatoid arthritis 1/09. Symptoms have been progressive since 2007. Also has U asthma, scoliosis 3/13/2008 and5/3/2008 migraine HA. 9/25/09 e numbness *Sx's gone @ 2pm L arm numbness/tingling in fingertips tongue- numbness. Going Y away after 9/8/2009 20 min of9/8/2009 report. RICELLA vesicles symptoms started 8/29/09. Treatment supportive - over the counter medications. Y 8/19/2009 8/29/2009 ensation heavily on tongue and face, Y also all over body. Body feels warm, with no sweating.Y Metal taste8/31/2009 in mouth. 8/31/2009 almost immediately became fussy and then had a fever for 24 hrs reaching 104. I had called Y the clinic they8/4/2009 suggest ER 8/4/2009 but I knew to alterna st inj pt had large localized inflammation Y redness, swelling, heat. Spread to elbow. Day 5 pt went Y to urgent8/8/2009 care; suspected 8/10/2009 infection howev U 8/24/2009 8/24/2009 cold" with intermittent congestion, sinus drains age, head aching beginning 7/13; on 7/25 "stayed in bed all 6/8/2009 day "and frequent diarrhea, sam Lethargic after 5 minutes following Y the administration of flu shot. Paramedics arrived 15 minutes Y later. Checked 9/2/2009 the BP 9/2/2009 it was 9?/6?. Was r after immunization (flu) c/o itching all over body. 11:30 am self-medicated - Benadryl 50 mg. Y Symptoms subsided. 9/9/2009 9/9/2009 esented with swollen, inflamed (L) arm down to elbow - and low grad fever T99.5. (R) arm 3cc Y inflammation 9/1/2009 9-3-09. CBC 9/2/2009 and IM Decadron ministered 09/04. Reports pruritic rashY diffuse on 09/08. 9/4/2009 9/8/2009 cm x 3.5 cm red, raised, hot oval. Lt arm 5 cm x 5.5 cm red,raised hard hot oval (Both were given Y with an injection 9/2/2009gun). 9/3/2009 Pain when touched s and paresthesias in arm and leg on same side of site of injection. N 9/3/2009 9/4/2009 ost vaccine, reported red blotchy rash Y ant. abdomen, upper and lower arms bilaterally and mild Y itchy throat. 9/9/2009 Benadryl 9/9/2009 50mg po and Albutero several seconds after HPV shot, recovered after several minutes (out X approximately 30 sec) Y took approximately 8/19/200910 8/19/2009 min to feel better. of entire left arm. Pressure and pain, red, and warm. Treatment by ice and Benadryl 25 mg qN6 h. 9/8/2009 9/8/2009 given @ 1635 on 9-1-09. At approxY2000 that evening that evening notice swelling in bilat hands U and ankles. 9/1/2009 Seen in 9/1/2009 clinic 9-2-09 at 1525 upper arm very sore 8/26/09 - 8/28/09 Y without swelling or redness. 8/29/09 Had migraine HA. Developed8/26/2009 hives 8/30/09. 8/29/2009 (L) arm feels numb ver legs and arms 9/2/2009 vaccine 9/3/09 and called the next day with c/o rash on scalp, arms with itching to rash areaUand ears. No9/3/2009 other s/sx. Advised to take Bena ure following vaccine < 1 minute. NoY fever. No sequelae. Y 8/24/2009 8/24/2009 iphtheria vaccine given 5/01/09 to patient with poorly controlled Parkinson's disease. She called N office 5/11/09 5/1/2009 with twisting 5/2/2009 sensation in leg s a 5 in. x 4 in. raised, red, hot reaction around the injection site. He was given the injectionYof varicella vaccine 9/2/2009 in his 9/3/2009 Lt arm SQ at 1000/A 2 hrs after receiving vaccine patient Y c/o dizziness blurred vision. Also nausea, vomiting x2- local Y reaction8/17/2009 at site to include 8/18/2009 redness, swelling sh surrounding polio and hib vaccine Y sites, also rash to trunk, legs, arms, immunization givenY 24 hours previously. 8/18/2009 8/19/2009 1 degrees), myalgias, redness @ injection Y site. U 8/19/2009 8/20/2009 tetanus injection on 8/28/09 in E.D.YReturned on 8/30/09 c/o arm/neck pain. Dr diagnosed ptUwith acute 8/28/2009 allergic reaction to tetanus injection d rash on L arm & body cluster on abd. Y Red pimples 8-27-09. Y 8/26/2009 8/27/2009 ed home - made bagel and began to "hurt" "bottom stomach". "Ate bagel" - mom suggested to Y go to bathroom 9/5/2009 - no improvement. 9/5/2009 Returned ely after receiving varicella vaccine large red knot. Localized allergic reaction. Y 9/9/2009 9/9/2009 all red papulopustules. Y 1/29/2001 9/9/2009 d AVA in his right arm on 21Aug09 in the am. At the time he had burning at the injection siteUand his arm8/21/2009 was sore--nothing 8/22/2009 unusual for get r followed by rash. Platelets & WBCYdropped to a dangerous level, then went extremely high.Y Six weeks 7/31/2009 following vaccination, 8/14/2009 WBC & plate ed varicella-like eruption which subsequently led to scarring. Y 7/30/2009 8/6/2009 R. Voice hoarse, throat swelling, difficulty Y breathing within 5 minutes of vaccine administration. Y Neb treatment 9/8/2009 with Racemic 9/8/2009 Epi; BENADRY was reported by a physician and described the occurrence of aggression in a 4-year-old Y male N subject who 8/18/2009 was vaccinated 8/20/2009 with KINRIX (Gl ory reaction to DTaP in Rt deltoid. Redness and swelling. No pain or tenderness. Reaction started U within 6 9/1/2009 hours of vaccine 9/1/2009 per mom. Repo rash in S2 dermatome - R leg. Started a day after receiving varicella vaccine in left leg. Y 9/2/2009 9/3/2009 reaction to flu shot. 5:25PM 9/9/09. Swelling at site. Applied ice and observed. Pt had no pain U no dizziness 9/9/2009 no S.O.B.9/9/2009 Observed 45 minutes ceived influenza vaccination on 9/3/2009. On 9/4/2009 arm was red, warm to touch at site. No Y hardness felt 9/3/2009 itchy to patient 9/4/2009 took BENADRY e arm, swelling, itching was the last thing. Headache, fainting, nausea, diarrhea, chills, very sleepy. Y These 8/20/2009 symptoms 8/27/2009 were very strong the f
n has been received from a physician concerning an approximately 14 year old female who Y on 31-AUG-2009 8/31/2009 was vaccinated 8/31/2009 intramuscula ort was received 26 August 2009 from Y a health care professional, who is also the patient. A 46-year-old U female 8/21/2009 patient with a history of asth es. 9/27/09 Hospital records received DOS 8/31/09 Y to 9/2/09. Assessment: 2 Headache. Patient Y presents 8/25/2009 with headache. 8/25/2009 Normal neurologica MENACTRA & Tdap on 6/3/09. HadY a seizure on 6/12/09. Eyes rolled back, she stiffened and U turned blue6/3/2009 around the 6/12/2009 lips. Vomited & unres rs of receiving AFLURIA 0.5ml IM vaccine, patient reports she had several areas of large flatYblotchy areas on her face and neck. Also repo 13-09 - Groups of raised red areas with white edges. Fever - 100 on 8-12-09 - Fever resolvedU 8-12-09. Fatigue/malaise 8/11/2009 8/12/2009 on 8-12-09. Resolve ld given inactivated flu vaccine 0.25ml (for 6 months - 36 months age range). Correct dosingYbut 2 month 9/3/2009 early. Weight at time of visit = 12 ight of day of injection. Face swollen next morning. U 9/2/2009 9/2/2009 yalgias, fatigue, nausea, sweating for approximately 36 hours, with onset approx. 5-10 hoursUafter receiving 3/14/2009 vaccines. 8/15/2009 Rash developed 8/17 eadache and dizziness after Gardasil Shot! 9/29/09 Medical records received from dates of service U 2/2/09 2/1/2009 to 8/24/09 PCP, 2/1/2009 Allergist, ENT, N unwitnessed). Date. Several wks after vaccine. Y 8/24/2009 8/31/2009 ports feeling nauseated approx 2-3 hrs after flu vaccine. Vomited from 3AM 9/3 - 6AM. Also Y complained of9/2/2009 headache.9/3/2009 Self resolved no furth opal episode at home. Fell - stoppedYbreathing x20 seconds. Then was "postictal" x20 seconds Y - ? primary9/9/2009 seizure vs9/9/2009 breath-holding episod mp 102.3, fussy-given steroids & BENADRYL, Y 9-10-09 pt had diarrhea, doing well on 9-10-09. Y 9/9/2009 9/9/2009 minutes developed wheezing and itching. Y Gave patient nebulizer tx and 2 IV BENADRYL. Symptoms Y resolved. 9/3/2009 9/3/2009 ne at 6p, dry cough and headache by 9p, chest tight/sore throat,chills, sweating and fever ofY102 degrees9/9/2009 all night, woke 9/9/2009 with nasal conges ated child's Left arm very red, swollen Y and tender to touch. Stated child never complianed until Y mother touched 9/3/2009 his arm. 9/4/2009 ely after receiving Gardasil#3 injection, patient fainted, loosing consciousness for approximately Y 30 seconds. 9/9/2009 Easily revived 9/9/2009 with changing o s rt upper arm and upper back, bilateral forearms (back side) and bilateral upper legs/thighs Y 9/9/2009 9/9/2009 a flu shot from walk-in facility. TheyYgave me Fluzone. I have never before had a reaction toUflu vaccines,9/9/2009 but the flu vaccines 9/9/2009 that I had we grade temp (99F) treated with tylenol within 3 hours of injections. Within 10 hours, high tempYof 103. Extreme 9/9/2009 restlessness, 9/10/2009 rapid breathing ter has passed out TWICE since receiving these injections and experiences increased headaches U while 7/10/2007 the finishing 9/29/2007 up the series. She has ation was given to me on Sept 1st. YOn Sept. 7th, I became extremely dizzy and nauseated.UThe symptoms 9/1/2009 contined9/7/2009 until Sept 9th. I mad mplained of pain and tingling between shoulder blades. U 9/4/2009 9/9/2009 to clinic 9-9-09 with a red raised vesicles rash in dermatomal distribution on left lower back radiating around 9/2/2009 to center9/7/2009 of lower abdomen. O alized swelling to left deltoid; stiff and limited ROM from left shoulder to left elbow. Y 9/4/2009 9/5/2009 ven double dose of flu vaccine. NextYmorning complained of arm pain radiating into breast area. Y Sent to Occupational 9/9/2009 9/9/2009 Health facility for follo ouble dose of flu vaccine-no adverse reaction. Y 9/9/2009 9/9/2009 ouble dose of flu vaccine-no adverse reaction. Y 9/9/2009 9/9/2009 8 HOURS FEVER OF 105 DEG. F. YCollapse and shock. Persistant Crying lasting for 4 hours Y w/in 48 hours. 2/1/2006 Prolonged 2/1/2006 seizures 2 weeks ollen,red,hard and hot to touch. ?cellulitis started on septra U 9/9/2009 9/10/2009 9/12/2008 N 7/21/2008 9/12/2008 atus changes starting 7 days Y after immunization Y Ywith fever, headache, 5 lethargy, inability to walk, N discoordination, 5/27/2009 signs 6/4/2009 of autonomic instabil n fever of 100-102 for 3 days. Treated successfully with Tylenol. Moderate rash appeared onNday 5 after8/26/2009 onset of initial 9/6/2009 fever. Rash covered 0 minutes after injection, felt "wave" of dizziness which then lead to extreme blurriness, some Y difficulty breathing, 9/10/2009clammy 9/10/2009 skin all over. Ext ately 4 hours after vaccine administered Y patient reported:Visual changes including letters appearing Y in different 9/9/2009 sizes,9/9/2009 unsteady gait, muscle as sitting receiving vaccinations - immunizations for Typhoid Fever, Yellow Fever, and Hepatitis Y A on September 9/8/2009 8, 2009 9/8/2009 when he fainted a s and chest. No hives or bumps.Benadryl 25 mg, PO given. Y 9/10/2009 9/10/2009 d TDaP and varicella in L arm on Tuesday Y 9/8. Pt reports significant HA and low-grade feverUthat night; itching 9/8/2009 started 9/9/2009 on morning of 9/9 an shot was received at 3:25 pm. Around Y 5:30, a cough began. Around 6:30 hoarseness and aY "funny feeling" 9/9/2009 began in9/9/2009 the throat. By 7:30 w and soreness at site Y 9/9/2009 9/10/2009 nausea, diarehha, chills, body aches, Y headaches within four hours of receiving vaccine Y 9/9/2009 9/9/2009 s began with hair loss two Y months after first shot, progressed to stomach problems, indigestion, N bloating, menstrual ### 12/1/2006 irregularities, PMS Sym was reported by a pharmacist and described the occurrence of elevated liver enzymes in a subject U of unspecified 8/31/2009 age 9/3/2009 and gender who was as given 0.5ml of Influenza vaccine, IM @ 1405 in L deltoid. Patient was starting to leave clinic Y and said she 9/10/2009 felt "lightheaded 9/10/2009and dizzy", @ after administering FLUENZA patient loss (1:00pm) consciousness for approximately 3 minutes. Y She was 9/6/2009 non responsive 9/6/2009 for 1 minute and n ed, warm to touch bilateral arm injection sites. Size of 'Golf ball'. 9/8/2009 9/9/2009 esented child for flu vaccination. Mother reports that she takes flu shot annually, with no previous reaction.9/9/2009 Vaccine administered. 9/9/2009 Child beg d region became erythematous, warm & induration following immunization. Systemic fatigue. Y Began to improve 9/1/2009 48 hours 9/1/2009 later. Pt believes ain 2 days after injection- neck & leftYside of upper body down arm into elbow, symptoms/painUare continuing 9/8/2009 to increase 9/10/2009 & travel down arm. with 3 areas of raised pink sersiginous raiser border and flat center and left buttock with larger Y 2 inch confluent 9/8/2009 raised pink module; smaller
ythema at injection site left arm. No temperature, swelling at injection site. Y 9/9/2009 9/10/2009 swelling, soreness bilateral upper areas & slight itching (L) upper arm. Swelling started 9/8/09 Y pm & has 9/8/2009 increased. 9/8/2009 Taking MOTRIN PRN ve shot, his arm immediately swelled up, local irritation + redness w/ minimal bleeding. Pt. did Y not feel dizzy 9/10/2009 or have9/10/2009 any other adverse effe m had a fever 103. Diagnosed with Ycellulitis. Gave antibiotics in IV and was given LEVAQUIN Y and Doxycycline 9/7/2009 is recovering. 9/7/2009Also had swo tes in approx. 2005 while working on the postpartum ward as an RN she received a FLUMIST vaccination. 1/3/2005 Initially, the 1/3/2005 pt reported that she at, swollen tonsils, T 100.2, body aches Y and cough, Txed with PREDNISONE and TAMIFLU. 9/3/2009 9/6/2009 d area silver dollar size hot to touch. Y 9/9/2009 9/9/2009 both arms within 5 minutes. Resolved with BENADRYL. Y 9/9/2009 9/9/2009 d 9/2/09. States child had positive adverse Rxn 3 days after vaccination on 8/28/09. Client with Y rash had spike - no fever 99 to 101 mtn. Re n has been received from a published article. A 4 year old child was vaccinated with VARIVAX U (Merck) (lot number, route and site not repo n has been received from a certifiedYmedical assistant concerning a 4 year old male patient N with a history9/2/2009 of surgery 9/2/2009 (unspecified) and no k n has been received from a nurse for Y GARDASIL, a pregnancy registry product, concerning U an 18 year old 4/1/2008 female patient who in April 2008 n has been received from a physician Y concerning Y a 19 year old female 8 Y patient with no pertinent Y medical history 1/1/2009 and no 5/1/2009 known drug allergy n has been received from a physician Y concerning an 11 year old female who was vaccinatedYwith the second 5/8/2009 dose of8/3/2009 GARDASIL (dose, ro n has been received from a pharmacist Y concerning a female patient with a history of "aversion" U to the needles 8/29/2009 who 8/29/2009 was vaccinated with the ng, eyes swollen shut, red itching eyes, stomach aches, body aches, cough hoarness, sore throat, U runnning 9/10/1966 nose. 9/10/1966 concentrate, cognitive difficulty, malaise Y 9/8/2009 9/9/2009 ed rash and puritis developed approximately Y 90 minutes after recieving a dose of FluMist. Y 9/10/2009 9/10/2009 cieved Gardasil on 12/19/07, secondY dose on 2/20/08, and last dose on 6/23/2008. Extremely U tired and at 6/23/2008 times seemed 9/1/2009 slow to respond.O ceived vaccine on 8/25/09 Y and 2 days Y later sheYpresented to the ED6with emesis and currantYjelly stools.8/25/2009 She was found 8/26/2009 to have an intusse ce, vomit x1 on the way home. Mom reports she was pale and complaints of nausea and then Y vomit x1. 9/9/2009 9/9/2009 veloped redness, swelling, pain at injection site. Was seen and diagnosed with cellulitis andUwas treated with 9/8/2009 antibiotics. 9/9/2009 arm was swollen whole bicep about a 1/4 inch around. It was sl red and warm as well, after swelling Y went down 9/3/2009 entire9/3/2009 area was bruised. Pt M RED,WARM TO TOUCH AND SWOLLEN U 9/9/2009 9/11/2009 hat her left arm started hurting to the point she couldn't move it. The night of injection she 'felt Y like she had 8/20/2009 been hit 8/20/2009 by a truck' she ached a loss of appetite. Body chills and aches. Headache and significant fever. Beginning six hoursYafter shot administered 9/10/2009 9/10/2009 and worsening over ne 6 PM started screaming and grabbing Y at rt. leg, at 12:30 AM noticed swelling of fist size on rt.Uleg from above 9/8/2009 shot to 9/8/2009 below knee. 9/9/09 no st experienced headache and posterior Y neck pain that lasted approximately 48 hours. Following Y that he developed 9/3/2009 severe 9/3/2009 cervical neck pa meter redness, slight swelling and warmth at site Y 9/9/2009 9/11/2009 d Flu vaccine and pneumovax in right Y arm. Not sure which site was which vaccine. The lower U injection site 9/9/2009 has a reddened 9/9/2009slightly raised, (inside bicep) was slightly swollen and red, approx 2 inches in diameter. No itching. Patient U could not move 9/9/2009 arm past 9/10/2009 shoulder height. Pain is diagnosed after second vacc.(8/10)Was Y seen by PCP on 7/29/09 for general malaise, dizziness, Y nausea. 6/30/2009 Seen also 7/23/2009 on 8/10, 8/19&20 fo ad fever 99.1 degree last night after received the flu shot. I gave him Tylenol around 9pm. InNthe midnight, 9/10/2009 he developed 9/10/2009 fever again. I gav have any reaction to the vaccine he was just given a third menningitis vaccination. Has received Y one every year since 9/2/2009 2007. I was instruc welling and fever at injection site on left leg, as well as bruising. The swelling and fever wereYimmediate. Within 7/2/2009 a day, 7/2/2009 he broke out in rash S,SWELLING, INDURATION 10MM,YNECK AND L SHOULDER PAIN 6/10, BODY ACHES. NORMAL TEMP 9/9/2009 98.6.SENT 9/10/2009 TO URGENT CAR n Right arm from deltoid to hand lasting for 2 days. Y 9/9/2009 9/9/2009 was considered medically important. Information regarding PREVNAR was received from a U physician regarding an 18-month-old male pati rmation received on 31 August 2009Yfrom a health care professional. A three year old male patient U received either DAPTACEL or TRIPEDIA taneous case was received from a consumer Y on 03 September 2009. A 29-year-old female patient, U with 8/13/2009 no reported8/31/2009 medical history and no nted to E.R. on 7/27/09 after falling at Y home - was Y admitted - EEG was 2 positive for seizure, neurologist Y believes 6/30/2009 Tdap 7/27/2009 could have caused se arre Syndrome - LE Weakness, visual disturbance. Y 6 Y N ### ### izure 7 days after HIB and FLUMIST. Y Y 9/1/2009 9/3/2009 ella given accidentally. Previous dose, #1 not properly recorded, discovered previous count 3Ygiven. shot around 2pm 9/2. Approximately 6pm experienced numbness in mouth & throat for approx. Y 3 hrs. Also, 9/2/2009 then developed 9/2/2009 runny nose, so ack on 9/3 (1 day later) with rash throughout Y body. Pt also complained of warmness thru the Y night of 9/2.9/2/2009 Pt went to9/2/2009 clinic on 9/3 & was gi AP in R thigh. 9-3-09 mom noted red Y raised area R thigh. 9-4-09 MD appt. Tx with ice + TYLENOL. U 9/1/2009 9/3/2009 welling, hives, itching, flushing. Y 9/3/2009 9/3/2009 "rash" on trunk that spread to both legs in one week. Patient had about 30 "scabby" rash. Slightly Y itchy.1/19/2004 8/27/2009 low - fluid went into tissue. Red, itching & raised. Pt went to doctor - doctor stated vaccine given Y too low - 9/1/2009 pt will recover 9/2/2009 and is immunized. day 102 & increasing. Localized rash size of 1/2 dollar coin. Redness & warm to the touch. Y 8/14/2009 8/15/2009
9 Patient received TDAP vaccine. The patient circled no for pregnancy on the screening form. Y On 7-30-09 7/28/2009 the patient reported and stated pneumonia shot at 3:30 pm on September 1, 2009 on right arm. About 6 pm arm started to get Y red and swell 9/1/2009 and hurt. 9/1/2009 Patient cannot lift ar & Warmth 2-3 hours after injection Y 8/19/2009 8/21/2009 swelling (quarter size), redness warm to the touch fever x 2days 101 increase. 8/24/2009 8/26/2009 g dysfxn and annuciation difficulties, for 3-5 days post INFLUENZA vaccination. Y 9/5/2009 9/6/2009 ZOSTAVAX vaccine 8/28/09 per her Y request - 9/3 developed a "rash" along left rib and backYarea - Saw8/28/2009 Dr. in clinic on 9/3/2009 9/4 with large area te developed 28 hours spread to other areas 48-96 hours after vaccine. Y 8/21/2009 8/22/2009 y- inconsolable through most of night. U 9/9/2009 9/10/2009 ensation of (L) arm lasted approximately 21/2 - 3 hours after flu vaccine was given. Y 9/2/2009 9/2/2009 Y Y 9/9/2009 9/9/2009 and swelling of entire (R) thigh, Tx with Y BENADRYL and TYLENOL; increased warmth of extremity. Y 9/1/2009 veloped urticaria/lesions following administration of varicella vaccine. U 8/13/2009 8/31/2009 ormer 28 wk gest infant was Y on peds floor prior to discharge. He had been Y fed 45 min beforeNevent. Monitor 9/2/2009 alarm for9/3/2009 bradycardia HR 78. R soriented and dizzy within about 2 hours. Severe swelling at vaccination site within 12 hours,Ywith skin very 7/15/2009 hot to touch 7/15/2009 for about one week pneumococcal vaccine trial, with severe COPDY was hospitalized for4 Gastroenteritis, viral. Vaccination Y took 1/16/2008 place 1/16/2008. 8/24/2009According to t re throat, extreme red eyes, body aches, temp of 101.1, headache, chills, dry cough, hoarseness. U Took holistic cold?flu medication and we ccine was given after strong encouragement Y from MD. The next day my finger, hand and knees Y bilaterally 7/23/2009 were swollen, 7/24/2009 stiff. and uncomfo RIENCED PAIN,REDNESS AND SWELLING AT INJECTION SITE AND ITCHING.REDNESS U MEASURES 9/9/2009 APPROX. 9/9/2009 6 CENTIMETERS. W m,William came in with a red raised patchy and papular rash of axilla bilat. and wrists bilat. Very Y itchy.Also 8/31/2009 throat felt8/31/2009 swollen and hoarse, lip ports feeling "fine" after injections. Around Y 11 AM she became dizzy and lightheaded while driving. Y She 9/10/2009 hit a light pole 9/10/2009 as a result of mome swelling, and warmth at site, site is painful to palpation Y 9/9/2009 9/10/2009 STATES CHILD "NOT ACTING THE SAME" AS USUAL, WHEN ASKED TO CLARIFY, MOM N STATED 9/10/2009 SHE IS "NOT 9/10/2009 ACTING RIGHT." cH swollen area on right arm. Red area Y is hard and warm to the touch. First seen by mother on N Thursday 9/10/2009. 9/9/2009 9/10/2009 Went to urgent care ev weakness and tingling in Left arm 24Yhous after receiving flu vaccine. The vaccine was administered U in the 9/4/2006 Left arm. 9/5/2009 The weakness occurr ely after receiving the Td vaccine I began to feel the vaccine course through my body, affecting U my joints/muscles. 9/10/2009 Feeling 9/10/2009 stiffness, pain a eeling dizzy right after administration but it passed. Next day (during the night or within 12 hours Y of administration) 9/2/2009felt9/3/2009 chills, sore throat des e of administrtion, patient stated," My god, this hurts a real lot" She states she made that statment Y as the vaccine 9/2/2009was9/2/2009 being administered. perience swelling/warmness on the injection arm NOT at the injection site, swelling and redness U occurred 9/10/2009 lower on the 9/10/2009 arm than where the pruritis in the area 9/10/09, redness and tenderness noted soon afterwards. No history of other U injury to the 9/9/2009 area. Exam 9/10/2009 reveals 70mm X 8 . Troubles breathing. Sweating. t feeling well after receiving vaccine. Y Patient advised to sit down and RPH tended to patient.Y911 was called. 9/11/2009 EMS came 9/11/2009 and monitored pat n face and legs and generalized itching, patient took BENADRYL 25mg Tablets - 1 tab q 4-6Yhr. prn : Recovered 9/8/2009 in two 9/9/2009 days. orming a ring approximately 4 inches below site of injection on left arm. No fever, no difficulty N breathing. 9/9/2009 L arm is swollen 9/9/2009 & itches. Recom aims her blood pressure has elevated Y since the flu shot and she first reported this to me 7 days U after the shot. 9/3/2009 9/10/2009 n 8/13/09 rash on lower torso 8/20/09 - Pain. Saw Dr. on 8/21/09 received Acyclovir and PERCOCET. Y Missed 8/13/2009 vacation 8/20/2009 - Better now 9-10-0 ported diaphoresis, tachycardia, and tingling bilaterally in arms about 5 minutes after vaccineYadministration. 9/12/2009 We monitored 9/12/2009 B.P. and within 3PM - Patient received inactivated a 0.5 ml FLUZONE in L arm right after that Pt c/o of swelling Y and redness. 9/13/2009 Pt complaint 9/3/2009 of arm being hea ness, warmth & tenderness at injection site approximately 1 1/2 cm diam by 2 days after injection. 9/9/2009 9/10/2009 s a localized reaction also right lower Y thigh red-slightly raised 1 & 1/2 cm with satellite lighterYpink/red one 8/29/2009 measured 9/7/2009 1.4x1cm. Patient was edness and swelling developed within 2 days of vaccine (3x5 cm in diameter). Went away and U 10 days later 8/26/2009 recurred8/28/2009 with vesicles suggestiv wing immunization, not uticarial. Y 9/10/2009 9/10/2009 ceived FLUVIRIN flu shot on 9-8-09 and had no adverse reaction. He became swelling on next Y day 9-9-09. 9/8/2009 He went to 9/9/2009 ER & was given PRE wing immunization, patient's sister reported Y pain, mass, and erythema at site of injection. That U evening symptoms 9/11/2009spreading 9/12/2009and pt went to ection site followed with achy arm, rash on trunk, legs and neck. Patient says he has never had Y a reaction9/3/2009 to a flu shot. erythema, pruritus (L) deltoid - BENADRYL and CEPHALEXIN X 1week 9/10/2009 9/11/2009 eeling of coldness and weakness. Same reaction on 02/12/2009 but vaccine was given with other four. 9/10/2009 9/11/2009 dministered 09/01/09; On 09/07/09 pt. noticed red patches on hands + thighs which felt itchy N + "tight", pt 9/1/2009 seen 09/10/09. 9/7/2009 n face, legs, torso - improved w/ BENADRYL in 24hrs. Y 9/9/2009 9/9/2009 d hotflush, passed out and became unconscious, when patient came to, felt nauseated, wasYclammy to 9/11/2009 touch and hot. 9/11/2009 Pt was given water u shot in the pharmacy at 6:45 PM on Y 09/10/09 and had no symptoms of allergy. When pt got Y home and 9/10/2009 took Lisinopril 9/10/2009 at 10AM on the sam Y 9/8/2009 9/10/2009
tion on 9/9/09. Mom noted quarter-sized erythema and warmth on 9/10/09. On 9/11/09, 9cmUx 10cm area9/9/2009 of warmth9/10/2009 and erythema on R thi got some itchy hives developed 2 hours Y later, and it got worse overnight. He took BENADRYL Y for 2 days9/4/2009 then he went 9/4/2009 to his primary care ge Pt was not aware she was pregnant Y at time of vaccine Pt was 5-6 wks pregnant at time of vaccine. H/o 7/23/2009 prior miscarriage 9/3/2009 about 1 yr ago. elling in L upper arm. Y Y 9/9/2009 9/10/2009 o pneumonia vaccine -arm red - hot - hard - scabbed - client ran fever - achy - felt poorly - started Y within 24 9/1/2009 hours of 9/2/2009 receiving vaccine - mis VARIVAX injection subcutaneously in Y left arm. When she returned to office area 3cm x 3 1/2cm Y red, blistering, 9/1/2009 hot to touch. 9/2/2009 fter vaccine admin. pt c/o dizzy --> sat down c/o ears ringing, blurred vision & seeing spots, nauseous Y & diaphoretic 9/9/2009 --> 9/9/2009 lasted approx 10 m er pt. experienced hallucinations, diaphoresis Y and vomiting late afternoon on date of receiving Y Tdap immunization. 9/9/2009 9/9/2009 ry apprehensive re flu vaccine. ToldYto wait 15 min since it was 1st time to get shot. LPN noticed Y pt. starting 9/9/2009 to slump9/9/2009 in chair. RN came to a ng, face red, no breathing difficulty. Mom gave a dose of BENADRYL + advised to observe. U 9/2/2009 9/2/2009 t about 30 minutes after she received Y a TDAP has been unable to move arm well. Good movement to fingers. 9/9/2009 Arm and 9/9/2009 fingers has tingling d all over, tenderness + pain at the injection site- lasted for 2 hours. Now still c/o redness, swelling N + pain. 9/10/2009 9/10/2009 .9, no appetite. Y Y 9/8/2009 9/9/2009 ceived PNEUMOVAX on 9/11/09 developed Y swollen lymphnodes on her right arm (injection U site), arm severely 9/11/2009 hurt,9/12/2009 fever of 100.7 degrees Y 8/28/2009 8/29/2009 - injection site red and swollen. Y 9/9/2009 9/10/2009 redness, tenderness, to left upper arm, measures -approx, - 50x22 cms. Symptoms appeared 9/5/09. Redness 9/4/2009 - measured 9/5/2009 approx - 50x42c to Dr's office on 9-4 arm was inflamed, Y swollen + warm. Dr stated localized topical reaction.YTx w/ BENADRYL 9/2/2009 - O.T.C Follow up on 9-8 r d immunizations (FLUMIST, HepA/B, Meningococcal, Y MMR, and Pneumococcal) on 7/1/09. N He denied any 7/1/2009 local reaction. 7/20/2009 The pt was seen warmth, soreness at swelling site about 2-3 inches across. U 9/10/2009 9/11/2009 t irritability, back pain, muscle aches, difficult toYconsole - started morning 1 after vaccine administration, Y required 9/10/2009 office 9/11/2009 visit, ER visit, hospita n under the arm, odd spot to begin with...the arwa surrounding the injection site has grown toUa welt the size 9/10/2009 of 3" by9/10/2009 2" and is red, itchy and s and tingling in arm where injection given, dizziness, lightheadedness. 9/12/2009 9/12/2009 ps on upper left chest and back. Few Y other similar bumps located on lower arms and right shoulder. U 8/31/2009 9/10/2009 as given vaccination at about 1:55PM Y with no problem. Husband told me following morning around Y 5:00am 9/11/2009 she experienced 9/12/2009 nausea, feet sw ed numbness in arm where he received vaccine from shoulder to elbow about 20 minutes after U receiving9/12/2009 vaccine 9/12/2009 ed, swollen, and hot from top of shoulder to elbow extending halfway around the arm. Pt is also Y complaining 9/11/2009 of a slight 9/12/2009 wheeze approximat ness after first shot on 5/11/2009. My Y daughter had mild dizziness and headaches on and offNafter shot but 5/11/2009 the first week 7/1/2009 of July she had se hter received the "MIST" in the nose for seasonal influenza. Live, Intranasal Influenza Vaccine Y immediate8/17/2009 clear runny 8/17/2009 nose, fever of 102 wit at 1:00 pm on thursday sept 10th 2009 at pharmacy by pharmacist. 30 minutes after shot started profuse9/11/2009 sweating and 9/11/2009 feeling like my stom nd joint pain all over, fatigue and general weakness. U 9/12/2009 9/13/2009 feel dizzy and light headed. Went to bathroom and for almost 10 minutes my body went intoYa full sweat.9/13/2009 I was soaking 9/13/2009 wet feeling either l er vaccine administered; 8/27 a pock Y sore on L forehead; 8/28 L forehead & cheek tingling &Yslightly numb; 8/21/2009 8/29 tingling/numbness 8/27/2009 spread d sore, (R) arm mild-moderate edema. Y Fever at 100-101 deg. F, inappetence, HA, dry mouth,Ygeneralized 9/8/2009 discomfort.9/9/2009 Breathing not affected ed the following information from the literature article on 02 SEP 2009: A female adult patient Y had suffered from exacerbation of ulcerative ed the following information from a literature article Y on 02 SEP 2009: 0 A female adult Y patient N with ulcerative colitis had been managed with 6 ort received on 02 September 2009 from a nurse. Y The nurse had received the information from N a friend of8/21/2009 the patient. 8/31/2009 A 44 year old male pa n has been received from Y a licensed Y practical nurse concerning a 62 year old male patient with N no medical 9/8/2009 history or9/8/2009 allergies who on 08-S n has been received from a consumer concerning her 5 year old son with no drug allergies who Y on 11-JAN-2005 1/11/2005was2/1/2005 vaccinated with a 0.5 n has been received from a 22 year old female consumer with no pertinent medical history or Y drug reactions 9/17/2008 or allergies, for ###the Pregnancy n has been received from a nurse concerning Y aY20 year old female with 0 no drug allergies and U no pertinent1/1/2006 medical history 1/1/2008 who in 2006-200 n has been received from a nurse practitioner Y concerning a 21 year old female with no known Y drug allergies 8/27/2009 or pertinent 8/27/2009 medical history wh immunization clinic. Besides giving unusual vaccines, it was first day opened to public for flu shots. I grabbed TDAP and gave to 18 mont R 6/17/09 0200 for chills, fever, bodyaches, Y chest pain, dizziness, nausea. Asthma type s/s Y starting <12 6/16/2009 hrs after Tdap. 6/17/2009 -No rash-. Reports ped redness and itching at vaccine site. Initially resolved after 3-4 days then recurred in 1 wkUafter vaccine 8/27/2009 was administered. 9/5/2009(R) thigh. as injected with Fluvirin instead of Afluria. Patient is Pregnant. U 9/3/2009 n (Lt) lower back. While driving home had received flu vaccine prior to pain also noted staring N in abd. and8/31/2009 numbness8/31/2009 lower (Lt) abd and left warmth and pruritus at injection siteY(right deltoid). Y 8/31/2009 9/1/2009 n Influenza on 8/31/009, stated left arm from shoulder to elbow painful for a few days. StatesYhad small reddened 8/31/2009area 8/31/2009 at site of injection no e given (Lt) upper arm , noted pain and burning sensation down arm and joint pain wrist, (Lt)Ythumb and8/24/2009 elbow. Tender 8/25/2009 to touch unable to e cm raised erythematous dermatitis over right deltoid. Treatment: BENADRYL elixir. Y 8/13/2009 9/1/2009
s, patient returned within a few minutes with hives on face, and small papules and swelling ofY cheeks and9/9/2009 lips. No swelling 9/9/2009 of tongue. Occ VARICELLA vaccine 8/17/09. On 8/28/09 broke out in VARICELLA -like- rash (spots, 0 vesicles). U 8/17/2009 8/28/2009 d 9/2/09. States child had possible adverse RXN 3 days after vaccination on 8/28/09. Client Y# 972517, had 8/28/2009 spike a 8/31/2009 fever 99 to 101 . Relie ycliver 200 1/2 tp to qil 45D. ### 9/8/2009 L vaccine was noted at temperature that was out of normal range. Y 4/15/2009 L vaccine was stored at temperature that was out of normal range. Y 6/15/2009 L vaccine was noted at temperature that was out of normal range. Y 6/18/2009 L vaccine was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was not stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was stored at temperature that was out of normal range. Y 6/22/2009 L vaccine was stored at temperature that was out of normal range. Y accine was stored at temperature that was out of normal range. Y 6/16/2009 L vaccine was stored at temperature that was out of normal. Y 6/19/2000 accine was stored at temperature that was out of normal range. Y 6/15/2009 accine was stored at temperature that was out of normal range. Y 6/10/2009 accine was stored at temperature that was out of normal. Y 6/8/2009 L vaccine was stored at temperature that was out of normal range. Y 6/8/2009 L vaccine was stored at temperature that was out of range 6/8/2009 L vaccine was stored at temperature that was out of normal range. Y 6/5/2009 L vaccine was stored at a temperature that was out of range. 6/5/2009 L vaccine was stored at temperature that was out of normal range. Y 6/5/2009 accine was store at temperature that was out of normal range. Y 5/18/2009 L vaccine was stored at temperature that was out of normal range. Y 3/18/2009 L vaccine was stored at temperature that was out of normal range. Y 5/19/2009 L vaccine was stored at temperature that was out of normal range. Y 5/19/2009 L vaccine was stored at temperature that was out of normal range. Y 5/20/2009 L vaccine was stored at temperature that was out of normal range. Y 5/27/2009 accine was stored at temperature that was out of normal range. Y 5/27/2009 L vaccine was stored at temperature that was out of normal range. Y 5/27/2007 accine was stored at temperature that was out of normal range. Y 5/27/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/1/2009 OULDER AND DELTOID 3" IRREGULAR TENDER FROM MIDDLE RED. LOCAL REACTION U TO VACCINE 9/11/2009 9/14/2009 o 4 mm rash inceased, progress to Y groin, back, and chest. Was seen yesterday 9/13/09 andUgiven Zyrtec, 8/31/2009 today 9/14/09 9/10/2009 follow up with PA. rts pt developed jaundice on Thursday am by Aunt who is a nurse. Pt's sclera was visibly jaundiced. U That 9/8/2009 was the 9/10/2009 only symptom. Mom de ecame very red and swollen the next day after the DTaP injection there U 9/9/2009 9/10/2009 ntacted the health dept this morning. Reports onset of symptoms 9/9/09 with swelling and redness at injection 9/8/2009 site. Warm 9/9/2009 to touch. Has bee ceived Tdap instead of Dtap for age 4yr. old on 09/12/2009 U 9/12/2009 9/14/2009 er vaccine administration, Y she developed a fever Y to 103.7 and subsequently 8 diffuse rash. Worse at site of9/5/2009 injection with 9/7/2009 large patch. Admitte esented 24 hours following vaccine Yadministration with fever of 102.8. Patient denied any symptoms Y other 9/9/2009 than malaise 9/10/2009 which she attribute Yellow Fever Vaccine (Lot UF 583 AA EXP 15 APR 10) around 4:15 pm on Monday August Y24, 2009. Around 8/24/2009 8:458/24/2009 pm that evening my thr icella vaccine, within 2 hrs of vaccine, he developed fever. About 13-14 hrs after vaccine had N developed9/11/2009 pox. Mother 9/11/2009 reports child has over t dizzy 30 minutes after the chot was given. She sat for 20 minutes then left. Y 9/14/2009 9/14/2009 d injection on the 11th, she states she came down with a migraine that pm. She also c/o joint Y pain and generalized 9/11/2009 9/11/2009 body aches. She had husband described: within 2 hrs developed itching, burning of skin at site of vaccine. Continued Y with redness, 9/8/2009 burning9/8/2009 for 5 days. Symptoms gan complaining of sore throat from the Flu Mist, immediately. Saturday and Sunday had loss U of appetite9/11/2009 and abdominal 9/12/2009 pain. Monday beg nning fever, almost immediately. Continued running fever of 100.6 - 101.3 for next two days. Y 9/11/2009 9/11/2009 NING AND REDNESS LEFT THIGH, Y GOT IMMUNIZATIONS THURS 9-10-09.FRIDAY CHILD Y LIMPING9/10/2009 AND LEG LOOKED 9/11/2009PURPLE AND
@ 1400 client called me and notified me of the following information...9/3/09 @0630 client states Y woke up9/2/2009 with tingling 9/3/2009 pain in bilateral lowe accine was stored at at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 L vaccine was stored at temperature that was out of normal range. Y L vaccine was stored at temperature that was out of normal range. Y 6/2/2009 accine was store at temperature that was out of normal range. Y 6/3/2009 chiness at site and into joint area 9/10/2009 9/11/2009 orted 4" X 11/2" area of induration that started near the injection site and spread distal the site. Y Reported 9/9/2009 area was 9/10/2009 red. Denied itching. To fter receiving the Pneumovax vaccine, Y red & splotchy rash on upper arm away from injectionYsite, pain, tenderness, 9/1/2009 warm 9/2/2009 skin. Next day re grape-sized nodule above collarbone. Painful and swollen. Y 9/8/2009 9/9/2009 er (104 degrees), dizziness, loss of appetite, moderate lethargy. Fever developed within 6 hours Y of vaccinations. 9/8/2009Fever 9/8/2009 and symptoms did after nasal flu mist vaccination-became ill with severe headache, fever of 102.5 under armpitYand continued 8/29/2009 for 4 days 8/31/2009 (missed 4 days of sc whole body was shaking.YHe would Y not sleep. He was gasping for air. He wouldn't eat and when Y he did he6/8/2009 spit it back 6/19/2009 up. When I went back N,REDNESS ON VACCINE SITE U 7/31/2009 7/31/2009 oulder pain beginning ~2 hrs after vaccination. Y YProgressed to cause 4 immobility of shoulder U joint with excruciating 8/27/2009pain 8/27/2009 on any range of mot vomitted 4 hours after receiving influenza vaccination Y 9/14/2009 9/14/2009 L vaccine was stored at temperature that was out of normal range. Y 6/3/2009 accine was stored at temperature that was out of normal range. Y 6/3/2009 NEUMOVAX vaccine (SC) on his left upper arm. After 2-3 days, mom called here and told heUgot swelling8/30/2009 (L) arm and diagnosed with celluli ver, feels warm all over Benadryl 20 mg PO @ 9:45 self administered. Y 9/14/2009 9/14/2009 osing" - itching, hives - Lot# 092040D exp02/2011 Westward epinephrine 5.3 cc SC @ 10:30 Y AM (R) forearm9/14/2009 11:15 9/14/2009 AM spoke to Doctor's s given vaccines. Cried, and then became very pale and limp about 60 seconds later, lethargic. Y Color improved 9/14/2009 over9/14/2009 10 minutes. Infant rem nt developed erosive lesions that oozed 48 hours after the receipt of 4yo immunizations (including U VARIVAX). 9/2/2009 Initially9/4/2009 began on the nose an flu shot and Hep A. 3 minutes laterYstanding at check out counter, fell backwards onto floor.Y Hit back of head 9/9/2009 on ground. 9/9/2009 Some twitching ash all over body. U 9/9/2009 9/10/2009 4.5cm x 4.5 cm, erythema, warmth at injection site. Y 8/19/2009 8/20/2009 erythema, warmth at injection site 7x6 cm size. Y 8/19/2009 8/20/2009 inutes after vaccine patients arms and legs went stiff and patient passed out. Patient recovered Y shortly after. 9/14/2009 9/14/2009 ter immunization, left deltoid red, hard Y and egg shaped lump. Told pt to ice and use APAP call Y if worse. Patient 9/3/2009 went to ER next day - Dr. s aspect of arm swollen with about 50mm by 50mm of protrusion. U 9/12/2009 9/12/2009 U 9/12/2009 9/12/2009 n, 20 minutes. Y f apparent limpness, lethargy occurring during car ride home after vaccinations, lasting several Y minutes. 9/10/2009 Normal exam 9/10/2009 when subsequently r flu shot on 9/1/09 by 1200 on 9/2/09 right deltoid developed a silver dollar welt it was red, hard Y and painful. 9/1/2009 She took9/2/2009 Benadryl, Tylenol and g a nickel size welt appeared at injection site. It was red, swollen, and hard. Plan: Watch. Gone: Y By Friday 9/1/2009 Sept. 4,9/1/2009 2009. ter size welts on left deltoid. Welt is red, hard. Treatment: Watched until it was gone Friday 9/4/09. Y 9/1/2009 9/2/2009 size welt on (L) deltoid. Welt was red, tender and hard. Treatment: watched until gone - Gone Y by Friday 9/4/09. 9/1/2009 9/2/2009 toid burned on injection and keep burning". It became hard to move by the next morning it was Y swollen and 9/1/2009 red. Treatment9/1/2009 watch applied h course of 2 days developed rednessYand swelling on left arm that itched and was blotchy. OnY9/3/09 went 9/1/2009 to Clinic to 9/2/2009 see physician. She sta d redness and started to itch on 9/3/09. Y Continued to get worse want to Dr. on pt had hives down Y left arm.9/2/2009 Plan-CLARITIN 9/3/2009 x 30 days. PRED the flu shot on 9/2/09 at 08AM. By Y 21:00 on 9/2/09 she noticed hives on left arm and bilateral Y thighs. The 9/2/2009 hives were 9/2/2009 red, raised, and whit in the evening face and ears began to itch, overnight the itching got worse. Nothing seen. PtY takes CLARITIN 9/2/2009 for seasonal 9/3/2009 allergies, so too id shortly after vaccination had following sx: 1. Blurry vision, 2. Numbing forearm, 3. Numbing Y arm and leg 9/14/2009 (left) vision 9/14/2009 got better shortly afte ceived Boostrix one month prior to 10th birthday. 9/14/2009 eeling well prior to shot (nauseated). 2hrs after shot, vomiting and sweating a drop in temp. (96.1F) Y continued 9/8/2009 for 3-4 9/8/2009 days. Patient feels this approx 18 hours after vaccination with Y (R) upper arm (elbow to over shoulder area) red and Y hot. Pt did not9/8/2009 complain to 9/9/2009 father other than pru d on 09-12-09 at 9:30 AM noted raised, warm area on (L) arm where was vaccine given. Stated Y as day progressed 9/11/2009 9/12/2009 noted itching under skin ost vaccination 5 episodes of dizziness followed by nausea lasting about 2 minutes. Patient noticed N reaction 9/4/2009 on 9-4-09. 9/4/2009 These episodes con munized in am, a few hours later, patient presented with rash all over body, mom called concerned U patient 8/12/2009 has no problems 8/12/2009breathing, gav
began 7/30 with swelling on R deltoid. Ibuprofen has been used - Patient states it seems to have Y helped 7/29/2009 with ice. Current 7/30/2009 7/31: 5 - 6" vertica ccinated 8-4-09, pt presented with rash Y on chest, cheek, foot on 8/11/09 along with fever, given Y instructions 8/4/2009 for IBU/TYL 8/11/2009 alternating. 8/16/2009 welling of entire L thigh to knee. Blotchy Y erythema. Y 8/12/2009 8/14/2009 swelling, not itching, very sore, ripple around red area. Y 9/11/2009 9/11/2009 e throat. Aches & pains in joints whole Y body. Started with symptoms with in 1 1/2 to 2 hoursYafter vaccine. 9/2/2009 Took TYLENOL 9/2/2009(symptoms las vaccine @ 08:40, @ 10:00 becameYdizzy with elevated blood pressure. Y 9/4/2009 9/4/2009 ng home from a friends house and lost sight in my right eye. It just went black. This was about Y 4 or 5 hours 9/11/2009 after I got 9/11/2009 my flu shot & my sig ng, large red streak, itching. Y Y 9/10/2009 9/10/2009 o itchiness after taking 3rd oral typhoid capsule, no rash noted at that time. After taking 4 dose Y on 9/9/09, 8/28/2009 again became 9/4/2009 itchy & noticed ras hour experienced numbness of the entire arm where he received the vaccine. The numbness Y went away in few hours. er vacinnation with Gardasil, patientYdeveloped Demographia, an auto-immune disorder for Y which she takes 7/3/2007 prescription 9/10/2007 meds, and has be ours after vaccine was given I began to vomit intractably for 2 1/2 hours. Also had mod abdominal Y pain at9/8/2009 the same time. 9/8/2009 I have continued Samllpox vaccine along with Anthrax and Hep Y B vaccine on 8/25/096and 2 days later had node Y under rt.8/25/2009 arm, 7 days 8/26/2009 later had flu like symp on back of left arm. Cool pack and BENADRYL. Y Y 8/31/2009 9/2/2009 itching, swelling @ site (RA. SQ.). N 8/17/2007 8/17/2007 ck of Lt arm red, > than golf ball in size, Y hot to touch & feels swollen inside. Per Dr. Ok to give Y BENADRYL 9/2/2009 & cool compress 9/3/2009if tender or imp s post vaccination, swelling of eyes and Left hive rash (urticaria). Y 9/4/2009 9/4/2009 M rash developed/itching on both arms from arm pit to elbow, interior arm started 7:30 A advised U patient 9/14/2009 to notify MD 9/15/2009 and take antihistamin red FLULAVAL 0.5ml to him by im (FLULAVAL is for age equal to or greater than 18). Y 9/9/2009 days after varicella immunization client and mother reports she had a red, swollen, welted area Y approx. 6/10/2009 4-5 inches that 6/13/2009 was itchy. 4-5 days n has been received from a consumer Y concerning Y her mother, an 850 year Y old female patientNwith lymphoma 7/2/2009 since 2005 7/2/2009 and last radiation o n has been received from a physician Y concerning a 6 year old female with erythromycin Y ethylsuccinate Y (+) 7/21/1997 sulfisoxazole 10/7/1998 acetyl allergy and r n has been received from a nurse for Y GARDASIL, a pregnancy Registry Product, concerningYa 19 year old 2/29/2008 female who 2/29/2008 on 29-FEB-2008 wa e licensed for 18 yrs and up was given to an 8 year old. No signs of symptoms noted. Y 9/4/2009 9/4/2009 ers, sweating, severe pain R arm (4"x 7") w/ swelling, redness, pt. couldn't use R arm, systemic Y deep muscle 8/25/2009 pain, rapid 8/26/2009 temperature shifts d DTaP 9/1/09 came into clinic on 9/3/09 c/o redness,swelling, warm to touch on injection site. 9/1/2009 9/2/2009 9/9/2009 apular rash starting on face spreading Y to trunk extremities, started day following vaccine administration Y and 9/9/2009 itching. No 9/10/2009 other systemic symp nt received the flu shot R deltoid, became pale, emesis x1, no loss of consciousness. Able to Y ambulate. 9/9/2009 9/9/2009 nt became lightheaded about 5 minutes post injection. No acute breathing distress or hivesY@ 1040. 9/9/2009 9/9/2009 nt received a flu vaccination walked back to chair in the waiting area and fainted in her chair.Y Immediately9/9/2009 arrousable9/9/2009 with spirits of ammon erpes infection Y U 8/2/2009 9/3/2009 w grade fever, vomiting, nausea flu shot given 9/2/09. 9/2/2009 9/3/2009 me back to our pharmacy 2 days after administering of flu vaccine and complaint Tuesday her U arm was sore. 9/8/2009 I examined 9/10/2009 her arm and note toid - injection of PNEUMOVAX vaccination - Localized edema / no pain/ no systemic symptoms. Y 9/8/2009 9/8/2009 d FLUMIST at about 14:25. No history of egg allergy. Pt then went to soccer practice. No Hx Y of trauma9/10/2009 per parent.9/10/2009 At 1930 pt's mom call area of injection down to elbow on left arm with hives/rash upset stomach 9/8/09. U 8/31/2009 9/2/2009 lled 9-15, reported itching, redness about 4 inches appearing one evening at the injection site U after receiving 9/11/2009 the ZOSTAVAX 9/11/2009 given 9-11-09 l febrile Seizure. Y Y 9/11/2009 9/11/2009 swollen throat and face swollen busted, Y lips, tongue swollen. Y GARDASIL left deltoid on 9/27/09. On 9/8/09 Pt developed numbness under left upper arm/axilla. N Exam8/27/2009 normal except 9/8/2009 paresthesia under l red GSK to < 18 yr old. Y 9/14/2009 red GSK to < 18 yr old c/o stomach upset, vomiting 7 hours after vaccine no fever. Y 9/14/2009 9/14/2009 e from injection site to top of head (48 Hrs). Headache (24 Hrs). Slight memory loss/cognitiveYability (2 wks). 8/19/2009 8/20/2009
apular blanching pink rash on trunk more Y than extremities & face. Post occipital nodes. No distress. N No8/28/2009 fever. 8/30/2009 cm wheal. 25mg BENADRYL given & ice applied. Y 9/10/2009 9/10/2009 all around site of shot pronounced/pain veins in my left leg burning/painful & continues to be.U Veins in my 8/20/2009 arm are normal 8/23/2009 again at this time e up crying with a headache, a flushed face. Mother gave TYLENOL by mouth at 7:00 AM. YTemp 1 hr after 8/26/2009 TYLENOL 8/27/2009 100.8. ection 1100 am. 2-Tylenol at 100 pm - arm tender 300pm- tightness in chest - unease 310pm Y - Diarrhea 9/8/2009 /ABN Cramp/ 9/8/2009 Nausea -vomit dizzi
ile seizure 11 days after MMR and VARIVAX given Y at well visit. Also8had otitis media. Was intubated Y overnight 9/3/2009 and 9/14/2009 very unresponsive - goo er skin at site of injection - (patient remained on premises for 20 min.) Called patient @ 1:15 YPM & she said 9/15/2009 her arm9/15/2009 was fine and knot had n flu shot, patient immediately explained Y a soreness in neck & swelling in throat, "swollen glands". U Asked 9/11/2009 pt to take 9/11/2009 slow deep breaths, she approx. 4 inches in diam. on Lt. upper arm. Sl. swelling. Y 9/9/2009 9/11/2009 rom elbow upwards, mild pain, red, itchy & puffy arm. Reaction happened the next day after Y the shot. Pt.8/28/2009 was itchy & itched hard with her fin oted malaise, headache, sore throat?, decreased appetite. Y 9/1/2009 9/1/2009 and cellulitis at sight. Y 9/2/2009 9/4/2009 rea around injection site. Tender, warm 10cm x 4cm. U 9/2/2009 9/5/2009 2 hours after ZOSTAVAX vaccination, patient developed 103.7 degree F temp, chills, myalgias, Y headache, 8/31/2009 prostration, 9/1/2009 and heavy sweats, la ke on 9/4/09. Aphasia. Hemiplegic. Y N 8/27/2009 9/4/2009 inflammation, hardening of inj. site, feverish. Y 9/2/2009 9/3/2009 elling, nose & eyes, 12 hrs after mist. Y Y 9/8/2009 9/9/2009 le who had a syncope spell about a mt after receiving HPV #2. Y 8/31/2009 8/31/2009 e in mouth that happened immediately & subsided in 1/2 hr. Lightheadedness/dizziness, slightly Y nauseous. 9/4/2009 9/4/2009 rm was in pain the evening of administration Y and then in extreme pain to where she couldn't move it. The 9/1/2009 following day 9/1/2009 she saw PCP who d rnoon the day the vaccine- client became dizzy, throwing up ran a fever of 101. It lasted approx Y 1 1/2 days. 7/19/2009 Client used 7/20/2009 TYLENOL. of Blistering Hives" to L arm. Recommended Y Benadryl and Urgent Care Visit. Urgent Care Treated Y and Steroidal 8/24/2009 Medication. 8/27/2009Next Day Still stinging, itching, at and above site (injection Y given at 45 degree angle downward) she asked Y me to palpate 8/27/2009 a lump (which I could not discern muscle pain on L side arm, up into neck, jaw & shoulder blade. Ran a fever of 101. Severe HA, Y sensitive8/28/2009 to light. Upset 8/30/2009 stomach lasted thr els like she has a cold coming on. Patient said she was going to take some over the counterUTYLENOL. 9/1/2009 9/2/2009 ported redness, swelling, hives, itching in right arm (opposite arm from vaccine administration). N Symptoms 9/2/2009 presented9/5/2009 3 days after vaccine our after receiving flu shot, patient'sYthroat started swelling. She felt sick. About 2 hour she Y reported itchy 8/31/2009 throat, cough, 8/31/2009 but no shortness o eats, headache, swollen/red L arm 3 days. Y 9/8/2009 9/9/2009 ps in AM after - Treated w/BENADRYL. Y 9/3/2009 t in lung on 4-12-2009 and Y will haveYto be on blood Y thinners rest of her 5 life. She is Y currently N on 15mg of warifin 8/21/2007 daily4/12/2009 to keep her blood thinn red immunization to patient @ 3:30. At 3:40, patient c/o itching and scratching on face, arms, Y legs and trunk. 8/17/2009 Welts8/17/2009 around mouth and on ain, reddness and swelling of injections site. Reports area of edema as 50 cent piece sized U one day after 9/11/2009 injection with 9/12/2009 pain level of 6/10. that she didn't feel well after vaccines were given. Nurse had her lay her head down on desk. She then9/14/2009 said she was 9/14/2009 feeling worse, she d on September 12th, 2009 onset of fever Y continued Y until 4:10 a.m. September 2 13th when child Y became unresponsive 9/2/2009 9/12/2009 and stiff with shaking s given a Tdap on 2/6/09 and 9/14/09 Y 9/14/2009 9/14/2009 d Pneumovax 0.5mL IM R deltoid on Y August 26. She presented to clinic on August 27 with R Y upper arm8/26/2009 red, warm,8/27/2009 swollen, and tender to wo vaccines were no extreme signs,...just Y some minor ones like light headed, but after the 3rdNvaccine the 9/7/2007 problems 10/1/2007 started within the follow -swollen, red, sore, nausea, loss ofYappetite. Y 9/10/2009 9/11/2009 swelling, warm to the touch at injection site. 9/10/2009 9/12/2009 ceived yellow fever vaccine on Monday Y 8/24 just prior to departure on 8/25. He became ill with N high fever8/24/2009 (104.5) and 8/29/2009 myalgia, (more specif her/guardian reports headache every Y day for 4 days after 1st HPV dose on 04/01/2008. Menactra U also given 4/1/2008 that day. Then frequent head Hypotension,Blurred Vison,Quickly Recovered Y 9/14/2009 9/14/2009 t flu vaccine, pain in leg - Received Y benadryl and ibuprofen Y 9/11/2009 9/11/2009 ceived an subcutaneous injection of yellow fever vaccine for a trip, on 9/2/09. On 9/8/09 he Y states that he9/2/2009 started to experience 9/8/2009 fatigue, ma d the 1st shot of Gardasil Y on 3/17/2008, Y she had Y the 2nd shot of Gardasil 2 on 5/19/2008. Y SheNdid not have 3/17/2008 the 3rd shot. She stated having t mother reported to staff on 9.8.09 that Y pt seen in ER on 9/5/09 for L thigh redness & swelling.Y 9/2/2009 9/5/2009 htness, chest congestion , chest pressure. Y Y 9/4/2009 9/4/2009 ately 2 hours after receiving the vaccine the patient reported tingling down her arm. Md told U her the tingling 9/1/2009 was probably 9/1/2009 from her tensing given 8/24/09 - red swollen, area developed on upper right arm the next day. Y ER SAID A KNOT DEVELOPED ON LT THIGH A DAY AFTER THE VACCINATIONS WERE Y DONE . IT WAS 9/2/2009 LARGE 9/3/2009 SWOLLEN AND HO xillary lymphadneopathy 4+ nodes Y 9/8/2009 9/10/2009 minutes of shot, became dizzy with Y nausea and headache. left arm, hand and both feet wentN numb. nausea 9/15/2009 and headache 9/15/2009ended within fe king, approximately every 5 minutesYlasting hours at a time. Mother stated, "it looks as if he is U trying to shake 8/24/2009 off a bug". 9/4/2009 Mother also reports about dosage. Child given .5cc of FLULAVAL Adult vaccine in the office. Concerned about reactions Y for9/15/2009 the patient.9/15/2009 Concerned about adje events reported. Concerned about dosage. Child given .5 cc of FLULAVAL Adult vaccine inYoffce. Concerned 9/15/2009 about9/15/2009 reactions for the patie caria) from head to toe appeared onY June 11, within two weeks of patient's tdap vaccination.Y It started on 5/29/2009 a small area 6/11/2009 of his neck and then
g given a Hep A vaccination Y and the Tetanus Shot patient had a grand mal seizure. Has been U very tired post 9/15/2009 seizure9/15/2009 but no other symptoms d cheeks, forehead, nose and especially upper lip within 5 minutes of recieving MMR, Varicella Y and Hep 9/14/2009 B. Was given 9/14/2009 Benadryl 12.5mg via on arm, soreness of arm, fever up toY101.4. Became red and sore 2 days after the shot, called Y the Dr on 8/26/2009 Friday and 8/28/2009 told nurse arm was red 8 patient given GARDASIL #2 and MENACTRA. Y Within 5 min. experienced joint pains. No arthritis Y developed, 12/1/2008 but arthralgia 12/1/2008persisted x 3 m tion patient started turning pale, then complained she didn't feel well, then passed out. Pharmacist Y caught9/8/2009 her before9/8/2009 she fell and called he -21-09 nausea, headache not feeling well began vomiting 12:45 am which continued throughout Y the night 8/21/2009 given ondansetron 8/21/2009 ODT 4 mg tab Y Y 2 Y 8/27/2009 9/13/2009 ed, warm, and swollen the size of a 50 cents piece coin. Child complains and exhibits signs of Y trouble walking, 9/1/2009 cries that 9/2/2009 it hurts to be touch Y 9/1/2009 9/1/2009 ulitis-Rx Keflex 500 QiD< 10 days # 40 no refills 9/11/2009 ported CHill, panic, Racing, Heart at ~2am on 09/10/2009. Pt said she talked to Hospital ER Yand was told 9/9/2009 told to take9/9/2009 Benadryl. Pt got bette Y Y 9/4/2009 9/4/2009 Y U 9/15/2009 9/15/2009 weakness 10 minutes after injection.YChecked BP 30 minutes after injection 120/75. Pt. still felt U weak/tired. 9/8/2009 Rash Began 9/8/2009 to develop 1 Hr Afte mplaint of nose bleeding and felt like drunk the next day when she woke up in the morning. YHowever, after 9/14/2009 talked to 9/15/2009 Ms at 5pm on 09/15/0 turned three days after vaccination complaining Y of fatigue, rash on back. Presentation similarYto shingles. 9/1/2009 Recommended 9/4/2009 she see doctor. P jection site area - Erythema and induration at 10 cm X 10 cm at the (L) deltoid area. WarmthYand mild tender 9/8/2009 to touch. 9/10/2009 t. had 0.5ml of FLUVIRIN in left deltoid. Pt had swelling at injection site. Pt had no asthma symptoms. Y Contacted 9/15/2009 Dr9/15/2009 and follow up with patie V given 2 months after 4th dose. DTAP (TRIHIBIT given 12-6-08) Y 2/23/2009 2/23/2009 @ injection site [redness] body aches, fever. U 9/13/2009 9/13/2009 oke out all over red, raised areas, no blisters, itches. U 6/18/2009 9/11/2009 VAR and said he had previously had a flu shot. Gave pt flu shot, and within about a minute pt. Y said he was 9/12/2009 light headed. 9/12/2009 I told him to rema en on injected (L) arm, beginning with 2 hours. Next morning, headache, slight fever, site hotNand swollen 9/8/2009 to touch and 9/8/2009 episodes of syncope DIARIX, MMR, Chickenpox, PCV7. Inappropriately wrong sister, wrong age appropriate vaccine. Y 9/15/09 9/14/2009 Called mom, states no unusual r 3rd dose HPV vaccine in office this Yam, then went to school and within 1 hour developed severe Y HA. Then 9/15/2009 complained 9/15/2009 could not see out o ined of right forearm tenderness, redness, Y swelling with below elbow circumference 26.5 cm on (R) arm.9/10/2009 Left arm below 9/11/2009 elbow circumferen car a few minutes after shot, returned to office. Recovered with rest and crackers. Hadn't eaten Y all day.9/14/2009 9/14/2009 aised bump at the injection site, Temp, and fussy. Pt is also teething. Y 9/1/2009 9/1/2009 n throat & cough for approximately 2 hours post vaccine. Resolved without medical therapy. Y 8/31/2009 8/31/2009 ery swollen, red, hot to touch. Weak, feverish, severe headache, diarrhea. Missed afternoonYof 8/14, 8/17-8/21, 8/14/2009 tried 8/14/2009 to return to work 8/24 ame swollen & warm & painful 1 day 5 Kinrix. Pt. Rx'd Amoxil po, Motrin & cold compresses.U 9/1/2009 y of allergy to getatin of Neomycin. Patient called said had 24 hour fever 2 days post injectionY and 6 inch diameter 9/3/2009redness 9/5/2009 & swelling at inje njection (IM) on 7-7-09 & received call 7-8-09 from pts mom c/o area Lg red & painful. "Can't Y raise his arm". 7/7/2009 I made Appt 7/8/2009 today with PA-C. veloped a bump with redness measuring 2"Length 2 1/2" width on the left thigh. N 9/10/2009 9/10/2009 ticed numbness below elbow on day of receiving vaccine. It is slowing improving but not completely U resolved. 9/3/2009 9/3/2009 en 9-1-09. On 9-2-09 at 2:30 AM woke up & headache. Headache not relieved & Tylenol or Ibuprofen U as reported 9/1/2009to me 9/2/2009 9/3/09 TC to suppo shingles vaccination 7/15/09. Have Yhad itching and burning on parts of my body. Mostly on stomach N and7/15/2009 on side of 8/10/2009 the torso with sometime azed appearance for 4 hrs from 7-11 PM. Slept 11 PM - 3 AM, whining/crying just wanted to Ybe held from4/13/2009 3-7 AM. (Completely 4/13/2009 NL from 8 A ot shingles vaccine. On 8-30-09 Developed marked pain right breast . Three days later developed N brilliant 7/29/2009 red blotches. 8/30/2009 Two days after that ame red & sore, face red, breast sore Y (L). Wheezing, tightness in chest, pain inside & upper back. Y 2 hours9/8/2009 after receiving 9/8/2009 flu vaccine. Pt too o 103.4 & Headache x 4 days. Tylenol & Alka-Seltzer. Y 9/8/2009 9/8/2009 hours after receiving TDAP pt c/o red, swollen and itchy eyes. Lasted Rest of day. Appt hereY @ office was 9/3/2009 around 9:23 9/3/2009 AM. Pt called 9/4/0 nurse administered the vaccine and left the room, I turned to my daughter to see if she was ready Y to go. The 8/12/2009 look on8/12/2009 her face was very stran nted after receiving flu vaccine. RPh called 911, patient then woke 30 minutes later. 911 emergency Y was 9/4/2009 cancelled patient 9/4/2009 was fine. vaccine same time as husband. No eating or drinking in between shot and problems. Had severe Y diarrhea 9/12/2009 about 459/12/2009 minutes after receiving pper extremity numbness and weakness Y started 9/11/09 At 11:00am. O/E : decrease sensation Y in L thumb 9/10/2009 and tremor 9/11/2009 of L hand. Rx with AT s of blurry vision, R knee pain, fatigue. Started after 1st HPV vaccine 3-10-09. HPV# 2 5/12/09. U HPV#3 9-15-09. Not seen by MD until 9/24 dvertently given KINRIX for 4th DTAP and 4th POLIO. 9/14/2009 9/14/2009 swelling and itching of R arm and legs, Y (-) SOB, syncopy (-) wheezing warm now spreading down N her arm.9/9/2009 9/9/2009 follow-up information has been received from a physician's assistant concerning a patient's U family member who on an unspecified date wa arm local reaction with erythema, swelling, Y low grade fever, malaise. Erythematous area measures Y 8.5 x9/9/2009 15cm on 9-11-09 9/10/2009 T 99 orally.
t received 3rd GARDASIL vaccination approximately Y equal to 1:10pm. Approx. 4 hours later,Ybegan to "feel 9/9/2009 funny" and 9/9/2009 was making "non-lu r shot felt nauseate pale for a few hours. Y 9/8/2009 9/9/2009 and tenderness to left upper arm. DTAP, Y HEP B given on 9/8/09. Erythema . Symptoms resolved Y in 48 hours. 9/8/2009 9/8/2009 ped oval rash adjacent to site of vaccine. Believed there is not a causal relationship but informed Y parents8/19/2009 would report. 8/23/2009 ves and pruiritis- onset 2hrs after vaccination. Duration, 48hrs Tx'd with Benadryl and Hydrocortisone Y cream 9/3/2009 with good 9/3/2009 results. given Rt arm SQ on 9/14/09. Onset: 9/15/09 4.5 cm long by 4 cm width with reddeness, warm Y to touch. SM. 9/14/2009 amount9/15/2009 swelling noted. d pain, redness and blister to left deltoid at injection site. Pt reported itching all over body. PtUadvised to take 9/4/2009 BENADRYL 9/5/2009 for symptoms. nstriction, stomach pains & diarhea, Shaking chills, Extreme exhaustion, Red eyes, itching, rash Y on forearms, 9/15/2009 confusion 9/15/2009 enza & Pneumoccal shot at same time. Take Influenz every year with no reaction ever. I became Y aware 9/14/2009 things were9/14/2009 not right aboput five ho tchy eyes, upper back pain, sore throat, Y fever. U 9/15/2009 9/15/2009 called my office to report symptoms after receiving the Flumist 9/9/2009. States on 9/11/2009 Y she developed 9/9/2009 flu-like 9/11/2009 symptoms including h flu shot at 0900 am September 15, 2009. At 8 pm that night started getting a bad headache.YAt 9 pm felt9/15/2009 as if I had 9/15/2009 fever and chills. Severe , JOINT PAIN, NUMBNESS IN EXTREMITIES, Y FEVER OF 103. ONSET 2 DAYS AFTER VACCINE U ADMINISTRATION. 9/10/2009 9/12/2009 SEEN IN OFFICE G BECAME SWOLLEN AND RED, ITCH, BLOTCHY VERY UNCOMFORTABLE Y 9/14/2009 9/16/2009 ated that she had fever, chills achiness Y all over and muscle type pain in her throat when she Ytried to swallow, 8/25/2009 similar8/30/2009 to a muscle spasm for D VACCINES AT APPROX 1430 ON Y 09/09/09 APPROX 11 HOURS LATER PATIENT SENT Y TO ER FOR 9/9/2009 POSSIBLE 9/10/2009 SIEZURES. NO PR minutes of immunization, patient noted palpitations that lasted approximately 40 minutes. TheYpatient noted 9/15/2009 arm soreness, 9/15/2009 but no swelling, d MATELY 40HRS AFTER Y RECIEVING Y FLUMIST VACCINATION, PATIENT WOKE UP WITH YSORE THROAT 9/11/2009 AND SWOLLEN 9/13/2009 TONGUE. A states that after 2 hours of getting the Flu Vaccine she had blurred vision which lasted for aYfew minutes. 8/28/2009 8/28/2009 iving the seasonal flu shot on 9-14-2009 That evening, night and all the next day I had arthritis Y like pain in 9/14/2009 all the joints 9/14/2009 in the arm of the vac ported a hive-like rash to arms 1 hour after receiving 2nd Guardasil Vaccine on 09.15.09. Rash Y lasted 10 9/15/2009 minutes &9/15/2009 resolved without treatm the flu shot around 4:30-5:00 on 9/15/09. Y Around 9-9:30 that night, I started experiencing adverse Y symptoms 9/15/2009 that included: 9/15/2009 coughing, whee nted and was assisted to the floor by parent & Vaccine Administrator. Ammonia inhalent wasY used & she8/14/2009 responded8/14/2009 approxiamtely 1 minut alf an hour, I began to sweat profusely and feel lightheaded/dizzy followed by a headache. I felt disoriented. 9/15/2009 By several 9/15/2009 hours later, my ar dministered 9/14/09 at 2:00 p.m. School Y nurse reported that patient had a dime size red round U reaction 9/14/2009 yesterday (9/15/09). 9/16/2009 Today has a t VZV/Tdap/MCV 4, and was sittingYon bench for about 5 minutes for observation. on gettingUup, he experienced 9/16/2009syncopal 9/16/2009 episode, hit the nfluenza vaccine 9/14/2009 @1200 L deltoid . developed redness, tenderness , itching at site U within 24 hours. 9/14/2009 Symptoms 9/15/2009 subsiding at time atigue, tingling of left arm (especially ring & pinky fingers treated with Aleve Y 9/15/2009 9/15/2009 esented with rash 1 month after admin of zostavax Patient declined treatment rash is resolving. Y 8/6/2009 9/10/2009 tarted soon after the shot on 9/14/09. Y Arm is itchy and sore. 9/16 arm is very itchy and sore, U it feels like9/14/2009 it's in her shoulder. 9/14/2009She feels hot shot on Sept 14 at 1:30PM in left arm. Y A few hours later arm was sore. The next morning, entire N arm& hand 9/14/2009 felt like9/14/2009 it fell asleep. The armp receive Gardasil #1, Fluvirin, and Menactra. She did receive Gardasil and Fluvirin but was given U Prevnar9/10/2009 in error. Had 9/11/2009 soreness of both arm er receiving her 2nd varcilla vaccination, Y patient developed a small erythematous papule on U her abdomen.9/8/2009 Over subsequent 9/13/2009several days mplained of agitation, tremors of hands and headache. Required a quiet place to sit. Determined U this was 9/16/2009 not her usual 9/16/2009 behavior. Provide veloped redness, warmth, tenderness at injection site Y 9/15/2009 9/16/2009 nt developed high fever >102 the night Y of vaccination 9/11/09. The patient, over the course ofY 72hrs, developed 9/11/2009 cellulitis 9/11/2009 at site of injection s after shot she developed the worst headache Yof her life 10/10, swollen 4 glands in her neck, N malase, significant 8/12/2009 hypersensitivity 9/5/2009 to touch, my er, pt awoke on Saturday, 7/18/09, with Y pain in right arm and neck with lumph node swollen like Y cyst. Per7/16/2009 mother, pain 7/18/2009 pt had shooting pain ccasions in the two years since the vaccine, Y pt has developed severe burning, pruritus and PHN N type symptoms 7/17/2007 in the 8/16/2009 shoulders, especially , swelling, redness and raised temperature Y at injection site (left leg) developed to 4" by 3" area U less than9/10/2009 24 hours after 9/11/2009 injection. No treatm INJECTION SITE CONSISTENT WITH SIZE OF BANDAGE;MOVEMENT OF LIMBS (ARMS U & LEGS) CAUSES 9/15/2009PAIN; 9/15/2009 PELVIC AREA PA the injection around 10 am and within an hour felt feverish- sweating, dizzy, blurred vision, fatigue. Y When 10/7/2007 I got home 10/7/2007 about 5 pm I was runn 9/15/09 at 6 or 7 PM EST patient reported hurting in her back and stomach. Chills and a fever N (100 degrees 9/14/2009 F), vomiting, 9/15/2009 diarrhea at 5AM mplained feeling slight faint and thirsty; Y withheld fluids to monitor. Patient later complained ofY tickle in throat 9/16/2009 but said9/16/2009 no problems breathing a call from a patient requesting to speak with NP. Pt c/o of vaccine reaction after receiving Td Y vaccine. 9/15/2009 States symptoms 9/15/2009 started 8pm 09/1 r vaccine administered bled a small amount and then swelled to a small hard lump. Pt waitedUin store for9/16/2009 35-40 minutes 9/16/2009 and looked to have injection 10:30am within one hour nausea, aching, burning cough. 7:00 returned to clinic with Y symptoms.9/14/2009 Conferred9/14/2009 with Dr, Motrin 400mg welling of upper arm, shoulder and right Y abdomen. Limited mobility of right arm. U 9/15/2009 9/16/2009 ling at injection site. lasting 4-5 days dizziness for 1 clay. Y 9/9/2009 9/12/2009 0-40 min after receiving a influenza vaccine, the patient's mother noticed bilat swelling aroundY eyes. No other 9/16/2009 hives 9/16/2009 noted. No redness or s ceived vaccine 9/14/09 & developed left arm/chest T2/T4 distribution shingles like syndromeUs/p injection9/14/2009 in left arm.9/15/2009 He received vaccine a
& swelling to site. Doctor visit. Dx cellulitis Y approximately Tx AMOXIL 500 T TID X 7 days. Y 9/9/2009 9/10/2009 d our office later in the day today to report that pt has hives. The only thing mom reported that Y is different 9/15/2009 today is that 9/15/2009 he received his 4thY 9/10/2009 UZONE vaccine injection on 9-4-09; family came in to clinic on 9-10-09 and received flu vaccine Y injection9/10/2009 again a 2nd time. dizziness (Patient received a dose of GARDASIL 1st dose on 3/22/09, 2nd dose on 7/31/09 similar N symptoms 7/31/2009 after each 8/3/2009 of these doses). d 9-12-2009 @ 3:15PM. Sat 9/12 patient reports "he slept lousy". Sun 9/13 didn't feel right. Kind of a sore 9/12/2009 throat. Mon 9/12/2009 - Wed 9/14-9/16 snif ined of severe arm pain. Stated thatYthe vaccine was given very high by shoulder. Pain unrelieved N by pain 9/10/2009 med. MD9/10/2009 wants to see her. M (4 hrs after injections/ pt went to ER Y with SOB, pain and inflammation (RT) arm. F/u with primary Y on Friday 9/1/2009 9/14/09.9/1/2009 Pt forgot he had pneu nced unusual swelling and muscle pain/ache. Refused to go to hospital, but MD was contacted Y by patient. 9/15/2009 Left deltoid 9/15/2009 experienced swelling ness & swelling at site, R arm swelling Y of lips. Developed blisters in mouth at time of visit, esophageal Y restriction, 9/12/2009dysphasia, fatigue, tachyc 1/2 - 3 hours after injection, faint like s/sx; felt throat "closing". EMS called - VSS, BB 245, patient Y wanted transport to ER. Was told she w ped redness of about 3 1/2 inches in length and 2 inches wide. Site was hard, hot to touch, and Y also very 9/14/2009 painful. 9/15/2009 scess and cellulitis on upper L thighY4x4cm 11x15cm. U 9/14/2009 9/15/2009 nd vomiting s/p flu vaccination, afebrile (a 1 hour duration, 2-3 hours s/p injection). Rest and Ufluid recommended 9/9/2009 treatment, 9/9/2009 call back if sxs w ceived FLUZONE shot - about 15 minutes Y later, patient & her mother returned to pharmacy because Y patient 9/15/2009 felt dizzy. 9/15/2009 Patient turned pale a EL, PREVNAR and ROTATEQ administered Y at approximately 1000 on 9/1/09. Mother noted Y transient mottling 9/1/2009 flushing, 9/1/2009 mottling and red hiv flu shot patient relied complaining of numbness in her left side and hoarseness in her throat.YI referred her 9/11/2009 to ER since 9/11/2009 the phone # on VIS 9-14-09; patient experienced erythema, Y at site. Pain, fever 9-15-09 - reported 9-16-09. Examined Y by Dr.9/14/2009 - no treatment 9/15/2009 indicated other tha 9 pt developed nausea, then hives to left back in the evening. Pt also reported itching all over Y on 9-15-09. 9/14/2009 On 9-16-09, 9/15/2009 all symptoms resolv ful shot ever gotten, walked home afterwards arrived by noon and started shaking all over chills. U Put blanket 9/14/2009 on, could 9/14/2009 not life glass of wate Hep A and Flu Mist on 12/11. Next Y day ( 12/12 noticed involuntary hand jerking a few times Y during day. Noticed ### again following ### day 12/13. al reaction, 3x4 cm wheal, developed within 18 hours of vaccine adminsitration. No systemicYor airway symptoms. 9/16/2009 Treated 9/17/2009 with Benadryl a congestion for 2-3 days prior to imms. Y Then the Y night after the imms 2 developed fever and rapid Y breathing 9/11/2009 and was 9/12/2009 assessed in the ER and n has been received from a registered Y nurse concerning her daughter who had been Y vaccinated N with three 8/14/2007 doses of10/1/2007 GARDASIL and after t rmation from a consumer with follow up information from a secretary at a physician's office, concerning U a8/24/2008 24 year old female with warts and n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning N a 16 year 6/15/2009 old female 7/1/2009 with no pertinent me n has been received from a physician Y assistant concerning several "30's" female patients who U were vaccinated with GARDASIL series on u n has been received from a physician's Y assistant concerning a 14 year old female with a history Y of a seizure 8/21/2009 when she 8/21/2009 was 10 years old wh rmation was received on 04 September Y 2009 from a consumer. A female patient with no reported U past medical history received an influenza ort received on 08 September 2009 Y from another manufacturer, report # WAES0908USA04708 N whose initial 8/26/2009 reporter8/26/2009 was a health care prof ort received on 10 September 2009 Y from a consumer. A 3 year old female patient finished her fourth dose of DAPTACEL (lot number, route ceived Varicella Vaccine on 9/2/09 and Y came down with low grade temp and numerous bumps Y on 9/12/09.Went 9/2/2009 to Dr. 9/12/2009 and diagnosed as C d stuffy nose lasting more than two weeks so far; fever of 102.4, severe headache U perienced nausea and runny nose within 24 hours of vaccine administration. Y 9/14/2009 9/15/2009 STATES THAT ON 9-14-09 AT ABOUT 8PM HER RIGHT ARM BECAME SORE AT INJECTION N SITE, 9/14/2009 THE FOLLOWING 9/14/2009 DAY SHE STAT -101.4 developed approx. 18 hours after vaccine. Had the fever for 2 days. Muscle and joint aches for 29/11/2009 days. Slept9/12/2009 an unusual amount for with erythema and edema and itching Y from deltoid to wrist, began within 48 hours of KinRix adminsitration Y 8/24/2009 to left deltoid. 8/26/2009 Treated as allergic ined 3 days post influenza vaccine, demonstrated neutropenia (ANC 650) and mild thrombocytopenia U (plt 9/11/2009 150). Patient 9/14/2009 otherwise well and a 2:30 p.m. Inluenza injection given. Y Approx. 3:30 p.m. client reports began feeling short of breath. Y Approx. 9/16/2009 4 p.m. client 9/16/2009 returned to our offic ped Graves Disease an autoimmune disorder (rare for pt's age group) that was not diagnosed N officially until 4/20/2007 Spring of 5/18/2009 2009. 9/28/09 PCP m after vaccines given child felt light-headed, sat down on front steps.When I was notified child was in back 9/17/2009 seat of cab 9/17/2009 and back to normal c ately 2 minutes after receiving Tdap, MCV4 and HPV, client was observed with an unsteady Y gait. Client 9/16/2009 hit the side 9/16/2009 of a hallway wall with ri pneumonia vaccine 9/14/09. Returned to clinic 9/16/09. Arm sl swollen. c/o soreness. No Y redness at injection 9/14/2009 site, 9/15/2009 however, a 2 inch wid at injection site which got worse on 9/16/09 then better on 9/17/09. Also itching around the injection Y site. 9/14/2009 9/14/2009 Fatigue, Nausea, migratory joint pain, Y joint swelling, abnormal TSH,T3,T4, headaches U 8/10/2007 9/13/2007 vaccine administered at 7:30 am. By Y 10:00 am developed sore throoat, cough, progressed toY chest tightness 9/16/2009 difficulty 9/16/2009 swallowing by 11:30 04 degree noted by school nurse. Y 9/10/2009 9/11/2009 g/clawing at eyes crying 9/16/2009 9/16/2009 zziness, nausea, vomiting, hot sweats. Occurred a little over 20 hrs & lasted 24 - 48 hrs. NoYfever. min after vaccination, pt c/o dizziness, feeling like he was "blacking out". Pt was able to lay down Y with feet9/11/2009 elevated. BP 9/11/2009 was taken. Felt bette l changes, agitation, obsessive compulsive Y behavior starting within 2-3 days of receiving DAPTACEL N #5,8/20/2009 MMR II #2, 8/23/2009 IPOL #4, Varivax #2.
t crying for 3 hrs, with fever". "Also short of breath & irritability". Child had previous immunizations Y in another 9/2/2009 country 9/2/2009 but did not have reco len, heat in area, hard knot. Erythemic flap 2 inch from clavicle to elbow. Painful, itching withYvesicles -->9/10/2009 3cm diameter. 9/10/2009 ning: red blister/rash 1" long rt shldr. Next 5 days: burning, very red at injection site (injection Ysite was back 8/20/2009 of left arm) 8/21/2009 2" diameter welt at in ellulitis on vaccine site. U 9/9/2009 9/11/2009 at injection site approx 19-20 hours after PNEUMOVAX injection. About 2" around site. Warm U to touch. 9/14/2009 Dr's office 9/14/2009 contacted patient told to h to under knee of left leg swollen 2x's normal size-warm to touch. Y 9/10/2009 9/11/2009 all over. Fever coughing runny nose. Y 4/30/2009 9/12/2009 9/8/2009 9/9/2009 d Shot Thur and reported "some reaction Sat. to MD. Dr. Keith reassured patient. School nurse and mom9/3/2009 report the side 9/5/2009 polio was received d mother report - after HPV #1 patient skip one period. After HPV #2 skipped 2 periods and now menstrual 8/28/2008 cycle irregular. er stated swelling, red and hot on the Y area vaccine was given. Y 9/9/2009 9/9/2009 after receiving the guardisil shot in her left arm she awoke with a painful lump above her leftNclavicle. Ten 8/13/2009 days after 8/18/2009 the lump, she saw the ternational student from China. Was given her 1st of 2 reguired doses of MMR on 09/14/09 UsubQ in her9/14/2009 left arm. A9/15/2009 mantoux test was also njection on tuesday here in her R arm. Y she noted some reaction that started a little that nightYand then more 9/8/2009 on wednesday 9/11/2009 wiht redness an T/C from Carole Chiv. States received Flu vaccine on Monday, September 14, 2009 in left deltoid. Y States 9/14/2009 immediately 9/14/2009 felt a pain in her lef hin, abdomen, and both arms. Lips Y began to swell. patient took 2 doses of benadryl liquid. Y swelling of lips 9/11/2009 did not decrease, 9/11/2009so she went t got Zostavax shot. By the time she Ygot home, she noticed her feet and ankles swollen. SheYcalled us to9/16/2009 report the 9/16/2009 side effects and called h after recieving vaccine, client passed out and hit his head on counter. Loss of conciseness for Y appox 1 minute. 9/17/2009 Client 9/17/2009 did recover, alert and 2 hrs after vaccine I started shaking uncontrollablly, and was extremely cold, I could not warm Y up. Temp.9/10/2009 was 98.6. Put 9/10/2009 8 heavy blankets on h and low fever. Y 9/8/2008 9/10/2008 oke out in hives/rash within minutes of administration. No respiratory distress or edema noted Y by physician, 9/14/2009 no other9/14/2009 complaints of symptom ng at the site of injection immediatatley Y after injection. 1 hour later: c/o headache, numbing at Y mouth/lips, 9/11/2009 pale progress 9/11/2009 to thighness in che ft Shoulder where vaccine was given. Soreness, red, swelling at injection site (hive). Pain lasting Y two days 9/14/2009 and counting. 9/14/2009 Notes JOSEPH LURIO 9/16/09 01:56 Y PM Signed Billie A Bernard is a 4 year old female brought N by father 9/10/2009 presenting 9/12/2009 with drug reaction. O and swelling from the shoulder to the elbow U 9/16/2009 9/16/2009 er anthrax vaccination to the right deltoid, patient reported 2 episodes of right arm carpal spasms Y that lasted 9/15/2009 for several 9/17/2009 minutes. Denies an eived HPV, HAv, MCV4. Advised to stay seated. Stated she wanted to go to lobby and went.Family Y started 9/17/2009 to walk9/17/2009 to WIC clinic. Started f ibed by employee as "swollen 3-4 inches Y below injection site, red and warm to touch" Y 9/15/2009 9/17/2009 subject is a 13-year-old female withYa history of reactive airway disease and nasal allergies U who received 8/28/2009 Fluzone through 8/28/2009 our school-base monia (fever 101-102 x 3 days, started Y 3 days after vaccination; productive cough). PNA diagnosed U by PCP 9/8/2009 6 days9/11/2009 after vaccination after C ticarial reaction N 9/15/2009 9/16/2009 after recieving smallpox vaccine to right arm, patient noted numbness of left tricep area. Over the next few 8/28/2009 days he experienced 9/5/2009 pruritis of mid clavical to upper arm and warmth in Deltoid began 24 hours after injection, with crescendo Y for 24 hrs, 9/10/2009 then gradually 9/11/2009 decreased pain. dministered without any noted problems or concerns. 9/16/09 soreness noted. By 9/17/09 noted swelling9/15/2009 ~2" diameter, 9/16/2009 redness, heat over d itchy rash all over body about 8 hours after vaccine. Responded to Benadryl. No egg or other Y vaccine reactions 8/28/2009have 8/28/2009 been noted prior to veloped chest tightness/pain with associated shortness of breath and bilateral lower leg numbness U on 9/10/09. 9/4/2009 Symptoms 9/10/2009 persisting but n 9/8/2009 N 9/1/2009 9/8/2009 o patient reported onset of a stomach Y ache withY5-6 hours of crampy2abdominal pain mid May Y 2009 w/o any 5/8/2008 associated 5/20/2009 symptoms (fever, di not clear. Suggested pt. contact physician. Y N 9/11/2009 9/12/2009 eceiving PNEUMOVAX, pt had rashYon injection site w/c progressively increased in size prompting Y ER consult. 9/8/2009 Rx CEPHALEXAN 9/8/2009 and PRE und mouth, and on angle of mouth where vaccine drip down, vomiting, diarrhea. Retaining. Irritability, Y diaper 7/9/2009 rash. After 7/10/2009 ROTATEQ. rec'd flu vac 9/1/09. 4:00 pm LA aches, pain, 8:15 pm redness, fever 101 degrees. Pain up into neck. Pt.9/16/2009 took TYLENOL 9/16/2009 9/16/09 then agai ale received MMR, IPV in right deltoid. About 5 hours later she developed significant abdominal pain and8/26/2009 achiness of8/26/2009 her arms and legs. 36 ately 10 minutes after vaccine administered, pt felt nauseated and hot and had syncopal episode. Y Pt "woke 9/11/2009 Up" drenched 9/11/2009 in sweat. Y 7/20/2009 7/20/2009 cellulitis at site of injection starting on Y day of injection 9/15/09, patient given BACTRIM DS TBID Y X 7 days 9/15/2009 and DECADRON 1cc. iven on 9-16-09 @ 245/PM. Pt. developed "severe headache & vomiting overnight" (per mother) 9/16/2009 9/16/2009 given 9/11/09 on 9/17/09 pt reported arm was red near injection site and slightly raise where vaccine was9/11/2009 given. Patient 9/13/2009 also states she got e, nausea, achy, numbness in fingers, clammy. U 9/16/2009 9/16/2009 e received @ 10:30-within 15 minutes Y became itchy-rash began to developed and progressed Y seen in ER~12 9/16/2009 and received 9/16/2009 IV Benadryl & weak, tired, feeling cold. 9/15/2009 9/16/2009
crying, irritability. Resulted in return Y to MD office and referred to E.D. Abdominal X-rays (R/O Y intussuscaption) 9/16/2009 and9/16/2009 urinalysis done (R/O U puffed or swollen, abut size of a baseball, Y soreness, difficulty swalling, glands in the neck swollen, almost 9/15/2009 Blacked out, continued dizziness s & tingling of hands & extremities immediately Y following injection. Shortness of breath shortly Y after but had 9/15/2009 continued 9/15/2009 to notice increased s noticed red rash on left arm (10x7) Ywent to clinic gave shot of DEPO-MEDROL and ZYZAL.YEither allergic9/7/2009 to flu or Pneumonia 9/7/2009 shot. ollowing administration of varicella vaccine Y a 3.n. diameter of redness + swelling was noticedNby pt. on the9/9/2009 adminis. 9/10/2009 area. Mother of pt. took Y 9/11/2009 9/14/2009 flu shot 9/10/09 @ mid morning (AM). 10:00 PM: Itching of arms & legs -> hives, raised all Y over body shortly 9/10/2009 thereafter. 9/10/2009 Heart racing. Pul ceived shot at approximately 3pm 9/10/09 and started feeling ill in the evening. He has suffered Y chills and 9/10/2009 numbing 9/10/2009 of the lips, and has also Heat radiation aft swelling of vaccination site. Y 9/10/2009 9/10/2009 tes after FLUVIRIN injection, pt felt dizziness, skin itchy and slight difficulty breathing. Pt used Y personal Proair 9/12/2009 HFA 9/12/2009 inhaler and felt better w r, vomiting, SPLITTING headache and slept a lot. Thank the lord. U 8/29/2009 9/3/2009 e and red, firm warm area 60 mm round noted on left deltoid. Used ice. Advised to follow-up Y with PMD. 9/9/2009 9/9/2009 n left arm in area of injection -sore -Not feeling well; fever on 9/8/09 U 9/2/2009 9/5/2009 IPV administered in R thigh on 9-9-09 Mom noted redness, swelling and pain around injection Y site R thigh 9/9/2009 on 9-11-09. 9/11/2009 KEFLEX 250/5 2 ts n & swelling following immunization from injection site to hand. 15 weeks post administrationNleft hand continues 5/28/2009 to 5/28/2009 swell, loses grip with gr lling, lungs filling up, swollen feet, fever Y within 5 mins. Within 24 hours. wollen area entire upper arm with temperature of 102 F. Y 9/8/2009 9/8/2009 scribed extreme achiness in his muscles & joints. Most prominent in hips and both biceps, beginning N a few 9/3/2009 days after 9/6/2009 his flu shot. No resp one call 9/14/09, pt received HPV #2Yon 6/12/09. Went to ER 6/13/09 for fatigue & body aches, Y unable to6/12/2009 hold 3 mo6/13/2009 old son. Per pt. given ded, itchy eyes, red eyes, throat felt Ytight, difficulty swallowing (not severe). Seen in ED givenYPrednisone9/15/2009 60 mg po,9/15/2009 prescribed Prednisone red and swollen around injection site. Y Patient was Rx-KEFLEX and Prednisone. Y 8/25/2009 8/26/2009 h swollen, red area around injectionYsite. Hives followed 3-5 days later. 8/28/2009 9/10/2009 s next day, swelling started 9/15/09 and has gotten worse 9/16/09, red, hard, measuring 3 1/2 Y length 4" 9/14/2009 wide, tiredness, 9/15/2009 fussy. Y 9/16/2009 hat within 8 hrs of receiving the FLULAVAL vaccine she developed "inflammation" and erythema Y to L upper 9/3/2009 arm, along 9/3/2009 with thoracic back sp per arm - Red, warm, slight enduration no treatment. U 9/14/2009 9/15/2009 a shot given Sept 14, 2009 at 11:30. Wed morning noted bright red, feverish, hard, terrible achy Y feeling,9/14/2009 hurt all over, 9/16/2009 difficulty moving arm e evening of the vaccine temp wentYup, fever, chills, weakness, also nausea. When he cameY to ER 8-22-09, 8/20/2009 temp was 8/20/2009 101.9, fever, chills, ain developed locally at injection siteYabout 6 hours after injection lasting about 72 hours. cine Wed 9/2/09 and had soreness at injection site. Thurs next day onset of nausea, diarrhea, Y fever, itchiness, 9/2/2009 headache 9/3/2009 and malaise. n has been received from a female Y registered nurse with no pertinent medical history Y who onN 03-SEP-2009, 9/3/2009 was vaccinated 9/3/2009with the secon n has been received from a physician Y concerning a 73 year old male patient withYdiabetes and N no known6/12/2009 drug reactions/allergies 6/16/2009 who on a d pneumonia vaccine 9/16-called 9/18 to report big red blotches - swelling, soreness painfulYto touch - shoulder and front of forearm- advise shot on 9-11-09 approx 11:00. At 17:00 her temp was 101.4. No sore arm at that time. By 19:00 U R arm was 9/11/2009 swollen.9/11/2009 By the next morning R U 9/11/2009 9/11/2009 hours of receiving varicella vaccine in R arm, pt. developed erythematous, pruritic, hard induration Y approx.9/9/2009 10 cm x9/10/2009 10 cm. Prescribed LO nutes of the administration of the vaccines pt became pale and felt lightheaded. She began c/o Y numbness 7/21/2009 in her hands 7/21/2009 with her hands feeli ates that she was not able to form her words or speak the day after vaccination. She states Y that the event 9/15/2009 eventually 9/16/2009 subsided and she did ated -migraine starting about 6 hours Y after vaccination, low grade temperature - swollen lymph U nodes under 9/8/2009 arm, neck, 9/8/2009 groin area. Terrible on left and right hand- Itching, dry skin, tightening of skin at both wrists - For four days - Took Y antihistamine, 9/1/2009 used CLARITIN 9/3/2009tablets. was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age4/14/2000 who was vaccinated with LYMEri er receiving VARIVAX and IPV on (L) Y arm, patient Y developed induration and vesicles, spreading N all the way 9/15/2009 below (L) 9/17/2009 elbow, required IV an ythematous, hot, edematous from shoulder to elbow. (+) nausea and low grade fever. U 9/19/2009 9/19/2009 Severe swelling and redness at site. Y Extends to approximately 4 inch circular diameter surrounding U injection 9/16/2009 site. Painful 9/16/2009 when using. Tigh after receiving my vaccination, I started breaking out in hives around my neck, shoulders andNa couple on9/16/2008 my right hand 9/17/2008 (shot was administ 009 patient called me to report injection site causing discomfort and pain in her (L) shoulder.YStated, "I feel 9/9/2009 the injection 9/10/2009 was given too high at site on right arm, down to midarm. Site swollen, red, hard warm to touch for 2 days. Symptoms Y decreasing 9/16/2009 on the 9/16/2009 third day. more than usual shotsSOB x 1 1/2 days HA, muscle aches, swelling and redness at site x 3 days Y 9/5/2009 9/5/2009 at onset; SOB, muscle aches, HA lasting 1 1/2 days; swelling and redness at site lasting 3days Y 9/5/2009 9/5/2009 nted 24hrs post immunization with an Y approx. 6cm in diameter red, blotchy urtsicarial region surrounding Y 9/16/2009 area of admin. 9/17/2009 in L thigh. Raisedm with some itching appeared on hands, arms, and legs (about 25-30 raised bumps). NoticedUthis two days 9/14/2009 after Flu shot. 9/16/2009
CALLED THIS AM TO REPORT THAT LAST EVENING CHILD'S LIPS AND LEFT SIDE OFYFACE STARTED 9/17/2009 TO SWELL. 9/17/2009THE LEFT DE , unconsolable crying all night, fever x 24 hours Y 7/20/2009 7/20/2009 ght rash, and facial flushing approximately 4 hours after influenza vaccine received. She took Y po Benadryl 9/17/2009 which provided 9/17/2009 some relief of itc 10 cm swelling and induration on L Y arm surronding the Kinrix injection site U 9/16/2009 9/17/2009 ves, headache, sore throat, nasal stuffiness after receiving LAIV. She took some Benadryl. UHives are gone, 9/17/2009 but itching 9/17/2009 still present as of 9 ODE SWELLING AND PAIN IN AXILLARY REGION OF ARM THAT VACCINE WAS ADMINISTERED Y 9/10/2009 9/12/2009 Sep 09. Pt states the left side of her face was numb, drooping, and drooling. It resolve spontaneously Y by 9/16/2009 0530 on 17 9/16/2009 Sep 09. swelling to left deltoid area. Left upper Y arm tricep/bicep area with redness and swelling. Spoke Y with patient 9/14/2009 today she 9/15/2009 states that her arm is STATES INSIDE ARM AND COLLAR BONE AREA INFLAMMED AND REAL SORE. RECIEVED Y FLUVIRIN 9/16/2009 AND PNEUMOCOCCAL 9/17/2009 VAC the Flu shot on 15 Sep 2009. Ibegan Y breaking out with a severe rash all over my body., This Y first began 9/15/2009 to appear9/17/2009 on September 17th,...W administered at 11am 11 Sept 09. By Y that evening I started experiencing severe heart rhythmn N problems, 9/11/2009 irregular 9/11/2009 heartbeats, skipping be EAR LEFT ELBOW 45 MINUTES AFTER RECEIVING VACCINATION. Y 9/14/2009 9/14/2009 when vaccine was injected she experienced dizziness "metallic taste in mouth" H.A. mid on forehead U - States 9/10/2009 was also 9/10/2009 seen black spots in ematous - "hive like" - area distal to injection site - (2 cm lower) area is sl warm to touch - approx Y 6 cm X 9/17/2009 3 cm - Otherwise no other untowar day 2 after KINRIX (DTaP/IPV) given Y with 9 cm length X 7 cm width area of inflammation/erythema, U slight 9/15/2009 central swelling 9/17/2009 and warmth to to izure 9 hours p shots. Y Y 9/9/2009 vesicular rash/eruption at vaccine injection site, calamine lotion topically, no further treatment Y warranted.9/16/2009 9/18/2009 t lightheaded and needed to sit down. Paramedics called, patient evaluated. Y 9/18/2009 9/18/2009 hours of administration, mom notesYredness and swelling of eyes-eyes swollen shut. U 9/16/2009 9/17/2009 increasing redness and swelling onYR arm beginning 9-17-09. Warm to touch. Mild sorenessY noted. 9/16/2009 9/17/2009 edness at HIB vaccine site of flu vaccine Y site. U 9/16/2009 9/17/2009 local reaction, redness, mostly, mild tender to R lateral thigh, likely site of TRIPEDIA injection. U 9/9/2009 9/10/2009 red, tender area around injection site. Pain up to shoulder, symptoms first noted 9/16/09. U 9/15/2009 9/16/2009 ovartis FLUVIRIN vaccine (UT97840P1, Y exp 5/10) in Rt arm. Pt immediately complained of dizziness, U then 9/18/2009 dry throat 9/18/2009 and cold feeling/tingli ured capillary immediately after injection. Y Seen by Dr. He said blood pressure was fine, no issues Y breathing. 9/17/2009 Patient9/17/2009 told him she has issue ldly raised erythematous papules with clear halo surrounding them. U 9/14/2009 9/15/2009 wk of vaccination rash began on fingers, hands, toes and feet. Bumpy rash, itchy. Did not seek medical treatment. 8/6/2009Is8/12/2009 resolving and areas are swollen. No redness or warmth to the touch. Y 9/15/2009 9/15/2009 ven JE-VAX yesterday at a facility/clinic at Kings Bay. He woke up today with swelling around eyelids and9/17/2009 urticarial rash 9/18/2009 to arms and hips. N Y Y 9/16/2009 9/18/2009 erythemic, pruritic, round and oval plaques,lesions approximately 4 inches x 3 inches appeared Y on inside 9/17/2009 of upper right 9/17/2009 arm extending from the vaccine at 12, about 15 minutes after the injection began to have itching eyes, face hot, Y bil ear pain and 9/18/2009 throat and 9/18/2009 chest tightness was red,swollen, and warm to touch. Patient complained of arm itching and pain. U 9/17/2009 n in clinic for routine Tdap referred from prework physical. Denied any immunizations in last Y10 years. Wehn 9/10/2009 Tdap put 9/10/2009 into MCIR, it shows c ates she had pain, redness at site of injection, hives, fever, joint pain-occurred same day of injection. Y 9/15/2009 9/15/2009 warmth- left arm. Y 9/9/2009 9/10/2009 eaction occured at about 1:30 pm. Pt Y felt light headed, experienced pain on both sides of abdomen, U and9/18/2009 began experiencing 9/18/2009trouble breath rm above elbow to below elbow volar red tender and warm to touch. 9/15/2009 9/16/2009 urs after receiving immunization started to have body aches and chills, Temp rose to 101 F, developed Y profound 9/16/2009 sense 9/16/2009 of exhaustion and d after second Varivax she developedYa 3 1/2 x 3 1/2 red hot warm papule on her right arm that U was swollen 9/14/2009 and puritic. 9/15/2009 Parents were afraid 630 patient was in her usual Y state of health when Y she received the 14 flu vaccine from the ClinicUlocated inside 9/16/2009 a supermarket. 9/16/2009 Approximately H DTAP TO A 2YR OLD U 8/24/2009 8/24/2009 Tdap and Varicella and Menactra on 8/14. Started with soreness in Left shoulder soon after.U Soreness 8/14/2009 and pain with 8/14/2009 movement continued ed Pnueovax in right deltoid area SQ: the area was red, warm to touch, with about 2+ edemaYat site. 9/17/2009 9/18/2009 vaccine 9/1/09 at 6:44pm. Symptoms Y began 9/2 at 8:00am and I still have them. Periods of N severe vertigo 9/1/2009 where entire 9/2/2009 room is spinning. ight upper arm became very sore later that evening and then became red, hot and swollen. The N entire upper 9/16/2009 arm was 9/16/2009 swollen. She also ex ter had the flu shot given to her on 9-16-09 at 4:45 pm, she had severe pain in the arm and at U 8:00 pm she 9/16/2009 developed 9/16/2009 a low grade 100.3 fe . Bilat. upper extremity weakness, achiness Y all over (muscle). 9/15/09 T 101-102 degrees F, U tightness in 9/14/2009 throat. 9/169/14/2009 MD visit decreased joi cine after lunch. Since she receivedYthe injection she felt bad. Swelling of her tongue, tenderness Y in neck. 9/17/2009 Took BENADRYL 9/17/2009then came to over body, neck and face, itching. Y Y 9/16/2009 9/16/2009 ter shot arm pain. 24 hours fever, body Y aches. 72 hours still fever, arm red, welts, warm to touch. Y This arm 9/14/2009 received9/14/2009 PNEUMOVAX.
udent given a second MENACTRA vaccine. 1st MENACTRA given 4/24/08 9/18/2009 ds occurring spontaneously-began one weeks p vaccination-occur several times a week-lasting few minutes-has 9/4/2009 not9/11/2009 needed to seek medic me to pharmacy for Pneumovax vaccine. Y Vaccine was administered in left deltoid. Patient called U back to9/10/2009 pharmacy 9/10/2009 7 hrs later with complai IPV given at 3:15 pm. Pt c/o chest & Y back pain, then started to become nauseated at 3:20 pm, pt expectorated 9/18/2009 clear 9/18/2009 phlegm. Feet started break-through Varicella infection. Y 9/3/2009 9/14/2009 ore. By 9pm felt nauseated, both shoulders and upper arm began to hurt as the night progressed U pain moved 9/17/2009 down9/17/2009 his back and hips. Nau ng shortness of breath, weak, dizzy,Y and felt like passing out and vomiting. My hands became Y tingly and9/16/2009 sweaty, I was 9/17/2009 taken to the emerge arditis treated with NSAIDs. PatientYis currently located and was vaccinated abroad. BP 133/85, HR 63,9/10/2009 RR 12, temp 9/19/2009 98.2, O2 99% on roo mmunization generalized malaise and Y myalgias and pain and 4 cm swelling at injection site,Unausea and9/18/2009 vomiting and 9/19/2009 mild reported vertigo omiting, fever of 101 degrees, pain Yat injection site, swelling at injection site, diarrhea, stomach Y ache, headache 9/16/2009 9/16/2009 xacerbation: wheezing, difficulty breathing. Y Epinephrine (1:1000 1 mg/ml) 0.5 mg sq given, 8Umg Decadron 9/19/2009 IM, albuterol/atrovent 9/19/2009 respiratory ceived the rotavirus vaccine on 9-11-09 approx. 4pm. The next morning he developed a fever U and it became 9/11/2009 high (103.5 9/12/2009 degrees F)and th vaccine given on same day as, or close to time of, receiving other vaccines such as hep B and Y other travel5/1/2006 vaccines -5/7/2006 maybe typhoid. Seve ed body itching, progressed to hives and low grade temp (100.3) over a period of approx 10Yhours. Took 9/17/2009 2 over the9/18/2009 counter Benedryl for th 9 when making a follow-up call to patient, the patient reported: Approx. 6 hours after receiving N vaccine, 9/17/2009 she felt "bronchitis-type" 9/17/2009 symptoms ORTY HOURS AFTER THE SHOT SHE DEVELOPED A FEVER THAT LAST ABOUT THREE U HOURS<9/14/2009 SHE THEN 9/16/2009 DEVELOPED A SPO iving the flu vaccine at work, I started coughing about 2 hrs afterward. At approximately 6 hrsNafter the vaccine 9/17/2009 my left 9/17/2009 hand and especially a flu vaccination around 10:00Am on Thursday 17 September by 4:30 PM I was experiencing Y dizziness9/17/2009 and muscle 9/17/2009 aches. By 6:00 pm I w nza vaccine approx 1:30 pm. About thre hours later, eyes began to swell, red and itching. Approx Y 1/2 hr 9/18/2009 later lungs9/18/2009 felt congested, face flu ot at 6pm. 10 pm felt throat itchy & Ywoke up at midnight with swollen lower lip & tongue, some Y wheezing9/16/2009 and loose 9/16/2009 BM. Took two motrin. S pain at injection site, unable to move arm. Extreme flu like symptoms, all muscles in pain, migraine U that won't 9/18/2009 go away, 9/18/2009 chills, vomiting, fever ccine was given intranasally to apparently healthy Y child on 8.17.09. 0Approximately 48 hoursUlater, developed 9/17/2009 fever,9/19/2009 sore throat, nasal cong as administered LAIV even though patient Y was contraindicated due to aspirin therapy. LAIV Y administered9/17/2009 on 09/17/2009; 9/20/2009 on 09/20/2009, at fever (100.5F), diarrhea initially normal color and explosive, turning to green and chunky within N 24 hours. 9/15/2009 9/15/2009 symptoms within a few hours: aches,Y chills, fever (to 103F), foggy thought processes (troubleUarticulating9/20/2009 thoughts), 9/20/2009 flushed face, minor cou across chest. U 9/19/2009 9/20/2009 d swelling and itching at site of injection. Parent reported no breathing problems and was told Y to apply a9/19/2009 cold compress 9/19/2009 to site. at the injection site. U 9/20/2009 9/20/2009 came light headed, dizzy, pale and complained of trouble breathing, 911 was called and EMT's Y arrived. 9/18/2009 Symptoms 9/18/2009 resolved and patient did ven PNEUMOVAX on 9/14/09 at 12:00 in left deltoid. Y Patient called 9/16/09 11:35 - fever 102.4 - c/o headache 9/14/2009 and 9/15/2009 chills- left arm pain. 9/1 eived Hepatitis B vaccine following birth on 7/30. Resident ordered Hepatitis vaccine again on 8/4/09 at 09:35, 7/30/2009 RN requested 8/9/2009Hepatitis vacc male vaccinated with ROTATEQ-R- vaccine on 8/18/09 under FDA IND #13843. Patient tolerated Y vaccine. 8/18/2009 On 8/25/09 8/21/2009 follow-up visit, moth 4-29-09: Dry hives - headaches - tightness in chest - 05-13-09 Dr. Nausea/headaches- spleen pain/swollen4/27/2009 weakness/fatigue 4/27/2009 - Dr - 6-16-0 sted DPT vaccine but received DPT + Polio Vaccine -KINRIX-. Patient did not receive the vaccine as the RN double8/29/2009 checked the drug conte after immunization, child developed redness and swelling of R deltoid are. Came to office andUwas prescribed 9/9/2009 ZURTEC 9/10/2009 prn and Cephalexin apular rash on Bilat upper and lower extremities. Pruritic and bright red about 12 days from vaccine. Y 9/2/2009 9/14/2009 d 5 1/2 cm wide to 4 1/2 cm long red, raised knot. Itching. Mom described 0 pain. (Warm toYtouch). Mom 9/15/2009 informed9/16/2009 to apply warm compre oose, mucousy stools x 10, some blood- probable fissure. 10/9/2009 MR from PCP for visit 9/18/2009. Y Patient 9/17/2009 received 9/17/2009 vaccine 9/17/2009, 9/15/2009 mplained of tingling in left arm, spreading Y to side of body. Lips maybe felt funny. Y 9/15/2009 9/15/2009 t 4 yo imms in May in another state. 9/14/09 We did physical and had no data gave again. Y 9/14/2009 eft pupil dilated 60" after injection. Went Y to ophth - resolved with PILOCORPINE & sent to ED Y for neuro work 9/4/2009 up CT, CTA 9/4/2009 work up was inco d 9-9-09 PM. Lt. leg a little red & sore Y on 9-10. On 9-11 Lt. leg red & swollen, hot to touch. YChild wouldn't 9/9/2009 walk. Lt.9/11/2009 leg swollen & red to kn e fever noted @ "bed time" 9/3/09. Temp 102 degrees F @ 7:15am 9/4/09. Child had been given Y TYLENOL: 9/3/2009 Ibuprofen 9/4/2009 night before and in m eft arm red, hot, tender no increase Yin size on 9/2/09. Rx: ORAPRED, BENADRYL, cool compresses. Y Rev 9/1/2009 9/3/09 - Resolving 9/2/2009 local Rxn . de a phone call to clinic on 8-31-09. States she received HBV #2 & TDAP vaccine on FridayY8-28-09. Last 8/28/2009 night, 8-30-09, 8/30/2009 developed a ras 9 clients aunt called clinic @ approx 16:30 stated client was c/o "abd. pain & discomfort." Stated "she was 9/15/2009 feeling "pukey". 9/16/2009Denied fever. ceived all 5 doses of Rabies vaccination series at one time. Y 9/13/2009 was a little over 1yr old he received 4 shots- one in each extremity. He stopped saying "MD" and "DA" did it and saying words again until 3 y n has been received from a physician's Y assistant concerning an approximately 1 Yyear old female N patient who 4/8/1999 on 08-APR-1999 ### was vaccina d her second injection of the Gardasil Y Shot in June 2009 and since then she has lost most ofNher hair. She 6/2/2009 is also getting 7/21/2009 scabs on her hea
eveloped a low grade fever from 99.5-100. degrees. He had chills, a severe pounding headacheN where he 9/16/2009 was grabbing 9/17/2009 his head in pain w d 6 days after immunizations to sayYthat child's face was swollen and that he had hives. Started Y on Friday, 9/8/2009 Septmeber 9/11/2009 11, 2009. Instructe ven 3 immunizations and was being Yinstructed by MA to remain seated when pt had an episode Y of vasovagal 8/11/2009 syncope 8/11/2009 and fell off exam tabl ven pre-kindergarten immunizationsYwhile seen for well child exam on 09/08/09. Pt then returned Y 09/10/099/8/2009 and was seen 9/10/2009 by Dr. with c/o ind atient in the hospital for a cellulitis onYmy left leg and was on Bancomyacin IV. I was given theUpneumonia9/14/2009 vaccine in9/15/2009 my right outer thigh wh operly screened and identified, at 1120 Y AM anthrax #2 was administered IM to the left deltoid. Y Within 209/21/2009 seconds the 9/21/2009 patient began to feel ys of receiving Fluvirin patient experienced Y sore arms, difficulty raising arms and bruising. HeNreceived a 9/12/2009 fluvirin injection 9/12/2009 in each arm in erro atigue, mono, chronic strep throat, Hashimoto's, Y extreme face and body swelling, aching muscles. N Got first 7/10/2008 vaccine 7/10/09### Lot 0072X in co ot was administered via injection into Y left upper arm. Immediately my face began to burn myYears turned bright### red, I got dizzy ### and sick to m hours of the vaccination, I noticed hives on the inside of both of my thighs. I had the vaccineNon 9/18 and9/18/2009 today is 9/21 9/18/2009 and the hives are st cieved flu shot at approximately 6am on 9/15/09. Approximately 2-3 hours later (per the patient) Y both arms 9/15/2009 became9/15/2009 red and blotchy from e was reported by a physician via sales Y representative and described the occurrence of injection U site redness in an unknown number of subj was reported by a healthcare Y professional Y and described the occurrence of anaphylaxis Y in aU23-year-old9/17/2009 female subject 9/17/2009 who was vaccinate at night with hot flashes, stomach abdominal pain, Y nausea, fever. Taken 1 to ER 8/15 discharged with heat stroke 8/6/2009 diagnosis, 8/15/2009 given Motrin. 9/1 len about 4-5 inches below injectionYsite. FeverY100 degrees C for 14day. Problems mainly arm; Y unable to 9/15/2009 lift. MD prescribed 9/15/2009BACTRIM and ter vaccination she was not lucid and spiked a Y high fever. Admitted4to hospital. White bloodYcount 0. Liver 9/15/2009 function9/15/2009 affected. Diagnosis an went to ER. Received 4 doses of ATIVAN and 1 Y dose of DILANTIN. 1Admitted to PICU. Y 9/16/2009 9/17/2009 after vaccine administration patient was Y seen in urgent care w/Dx of arm pain, and referred to U or the further 9/10/2009 evaluation. 9/12/2009 Patient complained m hurts from shoulder to wrist. U 9/21/2009 9/21/2009 te after receiving vaccine pt. claim to Y feel sick in stomach, started to breath heavily then became Y dosing 9/21/2009 off and not 9/21/2009 responsive. Gave 0.3m mptoms, chest congestion Y 9/17/2009 9/18/2009 of breath, lightheadedness, chills, later Y tingling of fingers, hands, arms, and tingling on legsYfrom knees 9/19/2009 down. Patient 9/19/2009 went to ER, vital sig x with Celadrin 4mg, antihistamine and Y Orapred. U 9/17/2009 9/20/2009 ates she had a rash 2 days after vaccination lasting 2 days. She reportedly applied a cold compress Y to alleviate 9/14/2009 the 9/16/2009 itching. The raised rash at injection site with little red (2-3 inch around) bumps around it, itching. Y 9/18/2009 9/19/2009 a couple of hour after receiving the shot she experienced pain. Each day it has increased. Now at 10 days. 9/11/2009 She fells9/11/2009 it under her arm - trave of bottom lip with repetitive licking (possibly Y due to itching). 9/18/2009 9/18/2009 given a VARIVAX and MENACTRA on L arm. Medical assistant left the room and within secYmom called9/17/2009 for help when 9/17/2009 the physician return ccination- No symptoms. 2nd day -edema, redness, hardening at site. 3rd day- All symptomsYintensified.8/24/2009 4th day all 8/25/2009 symptoms intensified. 5 ined of dizziness, light headiness, became pale, sweaty, fainting hot 15 minutes after vaccine Y administered. 9/21/2009 9/21/099/21/2009 pt placed in supine po perienced lightheadedness and decrease Y in blood pressure (76/53) after vaccination with FLUVIRIN. Y 9/20/2009 9/20/2009 ed hot left arm where flu shot was given (from shoulder almost to elbow). N 8/16/2009 8/17/2009 arm cellulitis - Itching and stinging the Y day after immunization 9/17/09. Y 9/16/2009 9/17/2009 lump noted in arm on 9-20-09. ThenYdeveloped fatigue, lethargy, HA, nausea. Seen at urgent U care @ 830PM 9/18/2009 ON 9-20-09. 9/20/2009 Woke at 3AM on ed blotches on arms + legs on Thurs. afternoon. Patient was at the beach earlier in the day.Y Small, red9/16/2009 bumps on the 9/17/2009 arms + legs. Patien d bright red blotches on both arms + legs starting Friday morning. Has not fully resolved yetNas of Sunday 9/16/2009 afternoon. Patient was in the su 9/18/09 patient returned to pharmacy to report deltoid muscle pain after 9/4/09 has not diminished. U Hurts to 9/4/2009 move right arm especially painfu ntacted clinic the 17th stating she developed small hives and redness and itching 2 1/2 hrs after Y vaccine9/16/2009 given. Stated 9/16/2009 she applied HC crea right upper arm. Warm non tender. 9/14/2009 9/16/2009 hour after receiving vaccine, mom noted Y patient to be unresponsive in back seat of car. Patient's Y eyes rolled 9/19/2009 back in9/19/2009 head, tongue was han eling tenderness, pain in hands, arms, Y low grade fever muscle weakness in upper extremities; general muscle 9/12/2009 weakness 9/13/2009 all over. Follow up ng to bed extremely sore arm. 9/15Y- 5 AM to urgent care Rx pain MED. 9/15 - Small amount Y of redness9/14/2009 - pencil eraser 9/14/2009 size. 9/16 - silver d lling at inj site. Y 9/16/2009 9/18/2009 of seven patients who all received FLUZONE Y SV 2009-2010 (lot number U3186AA): One patient Y experienced 9/4/2009 blurry vision, 9/4/2009 ringing in ears, a ort received on 09 September 2009 Y a nurse practitioner. A 33 year old female patient with a history Y of asthma, 9/1/2009 allergies 9/1/2009 to penicillin, sulfa, la d arm being sore at end of day. Cannot raise arm above shoulder today. Patient complainsUtoday of nausea 9/8/2009 but not9/8/2009 sure if attributed to he ic, felt faint, numbness in R arm. Y U 9/14/2009 9/14/2009 ined of numbness in arm down to tips of fingers from vaccine site immediately after administered. U 9/18/2009 9/18/2009 9/14/2009 induration at injection site with edema. Y 8/17/2009 8/18/2009 area on rt arm is inflamed and hot. Pt reports feeling feverish and generally ill two days later. U Today is9/15/2009 improving but 9/15/2009 area is still getting la
ema, painful to the touch, sob, hoarseness, Y aches, pain, palpitations. U 9/11/2009 9/13/2009 een the spine and shoulder muscle stiffness on left side - neck down to the shoulder. From rate 1-10 (Pt9/18/2009 says 8-9) experienced 9/19/2009 pain after 3 er vaccination, pt's neck (both front & back) start to swell and it last about 48 hrs after recovered Y there is no 9/4/2009 residual effect. 9/5/2009 e, Fever, Arm Swollen, Arm Pain, Rash. Y 9/10/2009 9/11/2009 es as a result of vaccine. Diagnosed with on 9-11-09. Received VALTREX 1GM- 21 Pills on 9-11-09. 9/4/2009 9/9/2009 rythema and induration noted on the Y day after the DTAP administration involving the lower 1/2 Y of the left8/12/2009 upper arm. Full normal range of m ff @ 2:30p (showing swelling/reddness) Y tired + in pain @ location. At midnight fever/hives. Visited Y ER @ 9/10/2009 9:30AM 9-12-09. 9/11/2009 Tx with KEFLE , induration, fevers, myalgias, cellulitis, red - orange urine. Y shot developed severe left shoulder pain & used Ibuprofen lasted 20-30 min site ok - used ice Y pack. 9/14/2009 9/14/2009 Y U 9/3/2009 9/7/2009 shot given on 9/10/09 at 2:30p woke up on 9/4/09 10 am broke out with spot on L upper arm Y30x40 mins.9/10/2009 Given BENADRYL, 9/11/2009 TYLENOL, C "Screaming" "inconsolable" X3 hrs Y (starting approx. 1-2hrs after vaccination) vomiting X1 approx Y 4 hrs after 9/9/2009 vaccination. 9/9/2009 after shot, there was swelling redness at shot sight. After about 5 days the red area was about Y 1 1/2 X 3 9/1/2009 or 4 inches.9/3/2009 There was a pink ar egs, knees & forearms. Used BENADRYL gel. Y 9/9/2009 9/11/2009 n has been received from a pharmacist Y concerning Y a 66 year old male 0 patient with Y no pertinent N medical 9/15/2009 history and9/15/2009 no known drug allergie n has been received from Y a medicalYassistant concerning a 17 year old female with no medical Y history or9/15/2009 drugs allergies, 9/15/2009 who on 02-JUL-20 ase of cellulitis (according to Dr) that Y required an Y E.R. visit on Thursday 0 or Friday 9/17 or 9/18 U that progressed 9/15/2009 to require 9/16/2009 hospitalization. Pt w/ SCID s/p 1 dose ROTATEQ at 2 months of age admitted to hospital Y for failure to thrive 10/08 N transferred 7/28/2008 to another hospital in 11/08. F tachycardia presenting as poor feeding and decreased Y responsiveness. 2 10/5/09 Hospital records, Y DC summary, 7/1/2009received 7/1/2009 DOS 7/2/09 to 7 urs of receiving vaccines,Ypatient crying, Y weak, Y low grade fever (99.41rectal), and hypotensiveY (65/31) with 9/10/2009 pale episode 9/10/2009 (pallor). Another ch zure - new onset 1 week after varicella vaccine.Y 5 Y 9/2/2009 9/4/2009 m pt. was asleep in mom's arms 20-30 Y minutesYafter a normal feeding. 1 Made a strange, quietY cry, lost color 9/15/2009 and tone, 9/15/2009 unresponsive. No unu 2009 pt received Inactivated INFLUENZA on left deltoid IM. Pt came 9/16/09 and stated sheYstill had a dull 9/2/2009 pain, or soreness 9/2/2009 in her arm. Th eaded about 5 minutes after vaccination. She laid down and passed out for about 5 seconds. Y Rescue squad 9/4/2009 checked9/4/2009 her over and she left n, trouble breathing, rapid heart beat, Y abdominal pain, numbness in leg, numbness in jaw, sweating, N paleness, 8/7/2009 headaches, numbness in ar administered 9/11/09 LT Anterior thigh. Mother reported swelling and redness of LT AnteriorYthigh 9/14/09. 9/11/2009 Evaluated 9/14/2009 9/14/09 12 x 12 cm a she hasn't been able to move her arm since receiving the vaccine. U 9/15/2009 9/15/2009 lasting < 24 hours 5 days after vaccination, Y no fever but felt warm. Now back to normal. No Yother s/s illness. 9/3/2009 9/8/2009 mmation with erythema 8-10cm now spreading down upper arm from site of vaccination (gradual U increase9/14/2009 erythema 9/14/2009 spread over 2 days sinc cm area of erythema with a 6.5 x 5 cm area of induration around punctures sites on R upper U outer arm, mild 9/14/2009 tenderness 9/15/2009 to touch, warm to to hot, and pt started bleeding. Then almost immediately, hard, big lump at injection site formed. U Gave pt ice 9/17/2009 pack! 9/17/2009 n 7-29-09 for travel, was given oral Y Typhoid, 1st dose TWINRIX. On 7-30-09 wife called stating Y the previous 7/29/2009 evening, 7/29/2009 day of immunizations out in hives shortly after the vaccine was administered. Pt mom gave her BENADRYL and it Y went away. 9/14/2009 9/15/2009 minutes of shot he felt lightheaded & dizzy, sat down and almost passed out. Also felt "numbness" Y all over, 9/18/2009 sat for 10 9/18/2009 minutes, still felt numb 9 I took my son to his primary Y care doctor Y for the Y following symptoms: 7 fever, headache, weakness, Y pain in8/4/2009 arms and8/18/2009 legs, loss of appetite, n eaction, left arm turned red. That same day in the evening was prescribed Tylenol for pain and Y to apply cold 8/6/2009 compress. 8/6/2009 e left shoulder and arm 8-19-09 - Blister on middle finger and palm of left hand 8-22-09 - Blisters N on palm8/13/2009 left hand -8/19/2009 painful 8-24-09 - also r out in hives on arms, neck, chest, and Y abdomen. Pt reported to PCP who prescribed a MEDROL U dose pack 9/16/2009 & topical 9/17/2009 BENADRYL. e today with low grade fever 100 degrees and red/raised rash on her truck (back, shoulder blades, Y abd). 9/3/2009 Rash is itchy. 9/4/2009 Mom treating with T ed of soreness L arm with touch and movement. Has persisted x 2 weeks lasted longer thanYexpected. 8/18/2009 rythema, very itchy, red and raised around injection. Lesion continued to increase in size. Rechecked Y 249/10/2009 hour later, 9/11/2009 put on KEFLEX. 2 days redness, and warmth in arm several hours after receiving PNEUMOVAX. BENADRYL was given U to the patient. 9/14/2009 9/14/2009 e given @ 0922 AM. Onset of chills (shaking) followed by fever to 102 degrees. C/O nausea, Y diarrhea and 9/15/2009 muscle9/15/2009 aches. Also c/o fingers ceived self limiting left sided facial edema, with no shortness of breath, rash, LOC, etc. The reaction Y occurred 9/11/2009 several 9/11/2009 hours after administra d sandpaper appearance to rash. Itch to site of KINRIX (DTAP/IVP) right deltoid. Y 9/8/2009 9/9/2009 d arm swelling and "bruise" where she received influenza vaccination (at 3:58 PM 9/16/09). YFirm swelling 9/15/2009 1" diameter) 9/15/2009 surrounding arm site PNEUMOVAX & FLUVIRUI in same arm at same time b/c pt s/p mastectomy and no lymph nodes Y in right9/11/2009 arm. Pt experienced 9/11/2009 3" X 3" in fla injection, patient reported redness and Y swelling of arm around injection site. Throughout day, Y worsened and 9/2/2009 pt went9/2/2009 to emergency room w vaccines 8/31/09. Fever 101 9/3/09.YFussy, cranky, poor eye contact. 9/4/09 listless, T 103+,Ulethargic, bad 8/31/2009 rash (mac. 9/3/2009 pap. L leg & trunk) t Sept. 10 6pm - vaccine; 11 pm - stomach discomfort; 3 am- vomiting - 3 times; Fri - Sun - dull Y headache, 9/10/2009 severe diarrhea, 9/10/2009 unable to do an of breath, coughing, lightheaded, nausea. Y Running nose. Y 9/17/2009 9/17/2009
given in Lt arm. Patient reported tingling & itching running up it. Arm to Lt side of face. Welting Y observed. 9/17/2009 Throat also 9/17/2009 tingling. FNP calle lled 9/18/09 @ 1:46p to report symptoms of: sore throat, sneezing, cough, headache, fever, Uachy, no appetite. 9/15/2009 Mom9/18/2009 states "He gets this ev N vaccine administered in Rt arm 9/16/09 Y @ 3:30pm and overnight developed swollen, red, hardened U left9/16/2009 side of neck. 9/17/2009 Came back to pharm 9 this volunteer for hospital presented with erythema and "tenderness" to her right deltoid, which U progressed 9/16/2009 since receiving 9/16/2009seasonal flu va ever, headache - 30 degrees C - took TYLENOL - Fever lasted one day - Headache lasted 2days. Y 9/4/2009 9/5/2009 tetanus shot 9-14-09. That night had chills, dizziness, shortness of breath and chest tightness. Y Had fever9/14/2009 101 in am.9/14/2009 No caryza, cough, sor Tdap, she is over 64 yrs. of age. Y 9/15/2009 ated child developed 2X3inch red area on deltoid, where vaccine was administered. No otherYsymptoms 9/11/2009 were noted.9/12/2009 On 9/15, redness 50% mph node swollen on left side the next day. U 9/17/2009 9/18/2009 y up to 102 degrees 1 day later. The patient came today at 5 years of age with complaint of Y elevated temperature 9/10/2009 for 2 days it has resolve ction 3 - cm - Redness and tenderness no fever. 9/10/2009 9/12/2009 everal times bit. 7 & 10:30 PM on 8-20, vomited 1X during noc., once AM of 8-21 & once eve. Y of 8-21, +8/20/2009 once on 8-22. 8/20/2009 Was "hyper" + laug ported fever, pain, redness and heat to his right biceps 48 hours after injection. N 8/31/2009 9/2/2009 ng, erythema 8x6 cm, induration 3 1/2 Y x 4 cm. 9/8/2009 9/9/2009 ven on Thursday, Sept. 17, 2009. Symptoms started Saturday with sore throat and a little drainage. U By 9/17/2009 Monday, Sept. 9/19/2009 21, low grade fever HOURS POST VACCINE. LATER, SAME Y DAY RASH ON FACE. NEXT DAY, RASH FROM HEAD Y TO FEET 9/19/2009 AND FACIAL 9/19/2009 EDEMA. WENT nted to the clinic with redness and swelling Y in left arm. swelling extended down into elbow, red U and warm9/15/2009 to touch. dr 9/18/2009 fears ordered bactrim RECEIVED PNEUMOVAX VACCINEYON 09/15/2009 AND REPORTS EXPERIENCING LOW-GRADE Y FEVER, 9/15/2009 REDNESS, 9/16/2009 ITCHING, TEND nd a half after getting a regular flu shot(1040am) my heart rate suddenly increased and my blood Y pressure 9/17/2009 dropped (1210pm). about 4:00p n bilateral thighs where injections were Y given-patient taken to ER-given Keflex po x 7-10 days Y 9/14/2009 9/18/2009 0 MINUTES AFTER RECEIVING THE SEASONAL FLU VACCINE, VICTIM NOTICED SHE Y WAS SLIGHTLY 9/17/2009 DIZZY9/17/2009 AND THAT SHE HAD 0, 2009 patient received only one vaccine: Y Chickenpox. Y On July 22,52009 he was rushed to Y the hospital 7/10/2009 with high fever 7/21/2009 and Seizure. At the am client called and returned to clinic to have RN check "vaccine reaction". Left anterior deltoid Y visibly red, 9/17/2009 with swelling 9/18/2009 around injection s OT NEEDED U 9/16/2009 9/16/2009 in red flat rash on inner aspect of upper Y arms within minutes of receiving vaccines. Flushed, Y no shortness 9/21/2009 of breath. 9/21/2009 Given Epinephrine IM arted swelling on Sat.am 8/15/09 - blisters Y started Sat pm. Sun.am 8/16/09 R thigh was red,Yswollen, hot8/14/2009 and painful. 8/15/2009 Taken to ER, started hour of vaccine administration c/o pins Y and needles in fingers and arms and had difficulty breathing Y seen 9/22/2009 by Dr in Medical 9/22/2009 clinic recieved 5 cted with the flu vaccine Y on Friday, September Y 18, 2009 at approximately 2:30 pm. I woke upUon Sunday9/18/2009 morning with 9/20/2009 a big bump on my to ys muscle still tender after 1 week. pt tried an aspirin and an aleve tablet. pt applied topical theragesic N cream...still 9/16/2009 sore. 9/17/2009 Arm does not feel w t in car after receiving shot Y at Dr's office. Y Fell asleep Y in car on the way 3 home & making odd U motion with 9/21/2009 mouth. Left9/21/2009 in car for a few minute Y Y 9/16/2009 9/22/2009 n about 1 hour after shot given- whelp Y type rash to trunk/extremities with swelling of eyes/face; Y benadryl9/21/2009 given; c/o abdominal 9/21/2009 pain & low gr ash eruption 2 weeks after vaccine administration Y U 8/25/2009 9/17/2009 ely following injections, patient "passed out", arms and legs became stiff. Eyes rolled back and Y patient lost 9/11/2009 bladder control. 9/11/2009 Immediate Docto d cough, throat/chest tightness, itchy Y eyes 2-4 hours after administration of flu vaccine. Sent Yfor treatment 9/22/2009 to urgent 9/22/2009 care facility. ced extreme dizziness after the vaccination. Y 9/18/2009 9/20/2009 ped a red rash around the injection site that measure 1&1/2 inches in length. No pain or irritation Y noted. 9/16/2009 9/19/2009 ted with swollen, firm upper arm withY a red splotchy rash. Pt reported pain when moving arm.U Pt developed 9/17/2009 first day9/18/2009 post shot followed by t njection site was warm, red and very swollen Y 9/15/2009 9/17/2009 D FEELING WEAK ABOUT 10 MINUTES AFTER SHOT; FELT WARM; HAD A DULL ACHE YIN HER HEAD; 9/22/2009 WAS SHAKY 9/22/2009 WHEN SHE WA o hours of vaccination, the left arm had begun swelling, with associated pain, and fever. ThisUwas post work 9/14/2009 hours, and 9/14/2009 had already gone h 7/17/2009 N 7/7/2009 7/7/2009 Rec'd Tdap, varicella at Health Dept. 9/18/09- c/o arm, hand spasms, mild difficulty breathing,Ygeneral malaise. 9/17/2009 Injection 9/17/2009 site; no redness, sw s after injection patient reported 2 inch red circle painful to touch U ined of itching, redness of both arms and feeling that the tongue is thick. Felt light headed but Y no SOB. Pt 9/21/2009 got the new 9/21/2009 Flu shot Afluria 1 ho after vaccine, general feeling of malaise, weakness. Progressed over next 12 hours to headache, U neck ache, 9/21/2009 myalgia 9/21/2009 ( generalized ) and ge d chest/throat tightness, flushing, low Y grade fever, cough within 3-4 hours of receipt of seasonal U influenza9/22/2009 vaccine. To 9/22/2009 ER, albuterol nebuliz ter receiving seasonal influenza vaccine developed sharp and throbbing pain at the injectionYsite which radiated to the outer elbow, 6-8/10. eningitis vaccine on 09/15/2009 Pt father called on 09/16/2009 b/c pts arm/shoulder area wasY red, painful9/15/2009 and swollen 9/16/2009 at the injection site. S 9/19/2009 N 9/14/2009 9/19/2009 ely after receiving flu vaccine, Y patient Y complained Y that she felt "funny" 1 and that her tongue feltY tingly. She9/16/2009 stated that9/16/2009 she did this sometime
some itching appeared on trunk and left arm (admin arm) on 9/18/09 around 3 hours after injection. Y Treatment 9/18/2009 antihistamine. 9/18/2009 dy itching, esp. of scalp and legs with raised red bumps on legs (serous fluid with crusting) developed Y 2-3 9/17/2009 hours after 9/17/2009 vaccination received. umbness down arm and in hands immediately. Apply ice pack this diminished. Then proceeded U to weekness 9/22/2009 in knees 9/22/2009 and tingling on brid 1 pm started coughing and wheezing it stopped after I inhaled Flovent. The next event happened N around9/21/2009 1:30 am I woke 9/21/2009 up with shivers, he ox rash 10 days after vaccine administered. Y U 9/11/2009 9/21/2009 er taking the vaccine she developed type I juvenile diabetes and also later had toYhave her gall N bladder removed 5/14/2008because 2/9/2009 it was not functio ght arm from elbow to forearem U 9/18/2009 9/19/2009 munization on Friday and developed macular-papular rash of arms, legs, torso on third day accompanied N 9/18/2009 by itching.9/21/2009 No change in persona ode left side of neck. U 9/16/2009 9/18/2009 nt received a flu shot on Wed 9/16 and came back for the pneumonia vaccine since she can Yonly have shots 9/17/2009 in one arm. There were multip 9/20/09 and complained of being in pain from Friday (9/18/09). Ever since she received the flu Y vaccine she 9/18/2009 has been9/18/2009 feeling "Pins and Need oint retractable syringe 25G x 1" used. The needle retracted with the first push (bypassed theYmedication9/22/2009 administration) 9/22/2009 and the full dose d ately 1-2 hours afterwards, the patient Y went to ER due to swelling/ redness at the injection site Y & flu like symptoms. 9/16/2009 9/16/2009 Per patient WBC count 2 needle over 240 lbs noticed resistance. Y Pulled Back & injected. Felt some resistance Pt. U reported some 9/21/2009 discomfort, 9/21/2009 said she had some id she was experiencing swelling in the back of the throat and difficulty swallowing. Y 9/21/2009 9/21/2009 d FLUZONE on 9/15/09 at 15:00. She began to feel ill by 21:00 that same day. She c/o chills, Y body aches 9/15/2009 x 24 hours. 9/15/2009 On 9/18/09 she awok ollen, warm. 5 cm long, 3 cm wide. BENADRYL otc. Y 9/16/2009 9/18/2009 episode, lightheaded, nausea, dizzy, seeing black fuzzy spots, flu-like symptoms (sweaty, chills). Y Pt rest 9/18/2009 for 15 mins.9/18/2009 and got better. as breathing very deeply. Patient was very sweaty. Did not respond to my voice or shaking.YContinued 9/22/2009 to shake the 9/22/2009 patient and he came t of >103 and projectile vomiting. Y 9/15/2009 9/16/2009 V, soreness at site within 15 min. after Y vacc. U 9/21/2009 9/21/2009 4 hours after vaccine admin. 1. Significant Y pain in L arm. 2. Arm weak & not able to lift it. 3. Y Severe Diarrhea, 9/20/2009 body 9/20/2009 cramping. 4. Swolle pain - right side of neck with muscle fullness. Questionable reaction to HeP A. Motrin every 6Uhours today. 9/21/2009 9/22/2009 ved at home, from Dr office, having diarrhea, Y vomiting and temp 101. Took to ER. Diagnosed with "stomach 9/21/2009 virus" per 9/21/2009 mom. Giving TYLENO difficulties started about 3 hrs. post flu vaccine, severe coughing, headache, sinus pressure,Yeye drainage, 9/21/2009 weakness 9/21/2009 in right hand, throat f er vaccination, pt's neck (both front & back) start to swell and it last about 48 hrs after recovered Y there is no 9/4/2009 residual effect. 9/5/2009 een the spine and shoulder, muscle stiffness on left side - neck down to the shoulder. From rate 1-10 (Pt9/18/2009 says 8-9) -9/19/2009 Experienced pain after perienced chest pain immediately after receiving vaccine. Chest pain lasted about 2 hrs. Vaccine Y left a9/14/2009 large bruise9/14/2009 on right deltoid about ports swollen leg. Y did not hurt but 5-10 mins later he said Y he felt dizzy and his arm started to hurt (the arm which Y he received 9/10/2009 the injection 9/10/2009 in). His blood press inic 9/17/09 with L arm injection site swollen, red, hot, 25 x 50 mm. C/o pain radiating to postUneck and jaws 9/15/2009 bilaterally 9/17/2009 increasing with hand when vaccine was injected she experienced dizziness "metallic taste in mouth" N.A. mid forehead. U States9/10/2009 was also 9/10/2009 seeing black spots in e e hour after injections of polio, MMR and chickenpox, child's face was swollen, purplish spotsYunder eyes. 9/4/2009 9/4/2009 NACTRA, GARDASIL, Influenza Vaccines. Y Approximately one minute after administration, adolescent, Y while 9/14/2009 sitting9/14/2009 down, had syncopal ep jection AREA Erythema and induration @ 10 cm x 10 cm at the L deltoid area. Warmth and Y mild tenderness 9/8/2009 to touch. 9/10/2009 ot flu & pneumo shots on Wed 9-9-09 Y at flu shot/vaccination clinic at Kroger Pharmacy #825 Y-2 days later 9/9/2009 (on 9-11-09), 9/11/2009 patient's wife noted of progress note. Y Y 9/11/2009 9/11/2009 d wheezing & cyanosis after receiving immunization Y chest - markedly diminished breath sounds Y with wheezing. 8/27/2009 HR8/27/2009 120/min. EPINEPHRIN ious, spontaneous report of fever was received from a consumer concerning a 47-month-oldYfemale patient 8/17/2009 subsequent 8/17/2009 to FLUMIST. This c ious spontaneous report of eye exposure to FLUMIST was received from a registered nurse Yconcerning 8/27/2009 a four-year-old 8/27/2009 male. The patient's ious spontaneous report of fever has been received from a consumer in the United States concerning N a four 8/17/2009 year-old 8/17/2009 female. This case is s ous spontaneous report of spaces out; not sleeping well; cranky; whiney; fever and decreased U appetite 8/17/2009 has been received 8/17/2009 from a parent c ious spontaneous report of "inadvertent administration" and Fever has been received from aUnurse concerning 8/18/2009 a 19-month-old 8/18/2009 male, subse
NUMDAYSLAB_DATAV_ADMINBY V_FUNDBYOTHER_MEDS CUR_ILL HISTORY PRIOR_VAX SPLTTYPE Unknown OTH OTH Unknown Unknown WAES0812USA04456 0 Unknown OTH OTH Unknown Unknown WAES0812USA04542 126 Ultrasound,OTH 07/14/08, with OTHnormalVitamins limits; Serum (unspecified) alpha-fetoprotein, Atypical squamous 06/23/08, cells negative WAES0808USA02610 of undetermined significance 15 Erythrocyte,OTH normal; Serum OTH C-reactive, ADVAIR; normal; SINGULAIR Environmental Serum rubella Dermatitis allergy; IgM, atopic normal Asthma WAES0812USA04870 OTH OTH Unknown Unknown WAES0812USA05315 1 PVT UNK None None None 15 PVT UNK None None Allergic to wheat, peanuts, eggs, peas. Hx of Dermitits - Ec 0 UNK PVT 1 PVT UNK None None None 1 PVT UNK PULMICORT None 0.25 MG/2 POLYDACTYLY, ML NEB SUSPENSION extra thumb ; AMOXICILLIN 250 MG/5 ML O 1 PVT UNK None None Non 0 PUB PUB Taking BirthNone Contol Pills NKA; anemia when younger 1 PUB PVT 0 PUB PVT 1 PUB PUB none None. Information none in #14 entered in error. No vaccinations given wit 1 PUB PUB None None NOne 1 PVT UNK None None MACROCEPHALY 2 PVT UNK None None Hypotonia, underweight, developmental disorder (mixed) 6 PVT UNK ALBUTEROL None 90 MCG/ACTUATION DYSMENORRHEA, AEROSOL Possible INHALER allergyEPIPEN to avocado 0.3 MG/0.3 M 54 ekg, eeg, cat UNK scan, mri,UNK blood tests. Labs andnone Diagnostics: none EKG PMH: WNL. frontal EEGH/A. WNL. Low Normal back pain imaging x 1 yr. studies. Brain M 1 UNK PVT Prilosec, multi-vit None 10 PVT PUB NONE NONE 1 PVT UNK None PUB UNK none none none none~ ()~NULL~~In Patient 2 UNK UNK None Previous heart attack (coronary artery disease) 10 PVT PUB Febrile Seizure 0 None PUB PUB Lorazepam;None Levothyroxine; Allergic Famotidine; to PHENERGAN. PRILOSEC; daily vitamins 1 OTH PUB None Asthma 31 PUB UNK No No 0 PUB PUB None None None 4 PVT PVT None NKDA; DM; HTN; Increase lipids 26 OTH OTH Insulin No Diabetic; no allergies 19 ER 11/29/08/. OTH Not seenOTH by MD. None No No No~ ()~~0~In Sibling|No~ ()~~0~In Patient 0 None OTH PVT PO: Calcium Nowith D; vitB12; Naprosyn. BCG (latex None~ treatments allergy ()~~0~In forruled blood Patient|None~ outcancer: 2008 by OCT-> dr ()~~0~In notes NOV->DEC per Sibling tes 13 3 x-ray; CT;OTH Lab tests; OTH IV None None None 10 None OTH OTH ALEVE; TRISPRINTEC None None 5 None OTH UNK None No Sulfa & Amoxicillin Allergies OTH OTH 2 None OTH OTH None (Tylenol) No allergies (polyps on sinus surgery) 9 OTH OTH None None None 6 None OTH OTH ADVIL prn None None 13 PVT PVT 9 None OTH OTH No Allergy to PCN NONE~ ()~~0~In Patient|NONE~ ()~~0~In Sibl 6 None PVT PUB COLOSTRUM; NYASTATIN; Pilonidal multivitamin; dimple; Jaundice MIRILAX 1 PVT PVT None None 7 None PVT PVT Lisinopril Hetz None , L-Thyroxine None 1 None PVT PVT None None None 0 n/a PVT PVT n/a; Had allergic History rhinitis/viral of Asthma/Allergic syndromeRhinitis on 12-02-2008 3 Visual verification UNK of Shingles PVT lession. n/a Shingles none started on none side and went around the torso following a typical patern 0 PVT UNK he is allergic to all childhood antibiotics, watermellon.
0 PVT UNK 0 UNK UNK None None 0 UNK UNK Coreg Cr 20mg, Benazepril Intermittant 20mg, AWarfarin Fib 5mg, Zetia 10mg, Lipitor 20mg 3 WBC, 12.4 OTH on admit; Troponin, PVT WNL; ATENOLOL CK-MB,None WNL; 50mg blood daily; Organic Lipitor cultures, heart 10mg NGdisease,s/p, daily; x2 days; GLYBURIDE urine CABG; culture, Hypertension;Hyperlipid 5mg<1000 PO BID; colonies/nl NORVAS L 0 1/7/09-records PVTreceived-Chest PVT x-ray LEVAQUIN; infiltrate No atLOPRESSOR; left acute lungillness base Pernicious and NEURONTIN; possible anemia;infiltrate CAD; ELAVIL MI; right Lumbar upperdisc lobe.disease; Periph 2 EEG; LP; CT PUB scan; Blood PUBculture -None all negative None 3/3/09-records None received-Head CT normal. 1 PUB UNK PROTONIX; BP meds 2 PUB PUB No No No 0 OTH PVT None None None 2 PVT PVT 6 PUB PUB 1 OTH PVT Unknown None Asthma 0 None OTH UNK COREG; VYTORIN; None ALTACE; Cholesterol; vitamins high and blood supplements pressure; and a weak heart due to 3 PVT UNK No No 1 PVT PVT None None 33 lab work done PVTLABS: ANA UNKneg. RA Nofactor <20(N). No CRP No 1.8(H). ESR 31 (H). WBC 11.5(H), lymphs 17%(L). 0 None PUB PUB None Cochlear implant 3 PVT PVT synthroid None 0 MIL MIL Unknown Patient denys None prior Known illness 0 MIL MIL Unknown No illness reported No alergies/prior medical conditions reported 8 PVT UNK None None None 9 PVT UNK None None None 1 N/A PVT PUB NONE NONE NONE 1 PVT UNK None None Non 1 PVT UNK None None None 2 PVT UNK None None None 16 NONE - OBSERVATION MIL MILAT THISNONE TIME NONE NONE NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 PVT UNK None None Non 16 MIL MIL none none none 3 PVT UNK NONE None Premature infant; 33 weeks 7 PVT UNK None None HEMANGIOMA - SKIN 1 PVT UNK None None MOLLUSCUM CONTAGIOSUM 0 PVT PUB none none none 7 PVT UNK None None Colic 2 Rule out Lupus. PUB PUB None Fiber Myalgia, Diabetes 62 UNK UNK None None HPV #2 given 3/24/08, lot # 1446U, LA. 0 CBC BMP Urinalysis PVT PVT Metadate None Attention Deficit Disorder none PVT PVT lisinopril and noaspirin HTN 16 PVT PVT allergic to milk, seizures~DTaP eggs, peanuts; (no developed brand name)~3~1~In seizures from Patie D 0 PVT PVT Not reported. PVT PVT The patientThe had patient a runnyhad nose a runny at the nose time ### of at vaccination. the time of vaccination wi Diagnostic results: OTH 05 May OTH2000: B. burgdorferi Diverticulosis; Ab (IgG and Broken Gastroesophageal IgM)nose; by Western Cat scratch Blot Reflux A0759678A negative. fever, Disease; Ex-smoker; B. burgdorferi HiatalThe Hernia subject Ab scree sm 50 Barium enema PVTshowedPVT intussusception, BIAXINnon given surgical Vomiting on 12/15/08 reduction and None blood forfor intussusception, left in chronic otitis diarrhea illness on PMH: 12/24/08 ear infection LABS:12/15 abdominal treated x-r 0 OTH PVT Blood pressure PMH: HTN.~Tetanus anxiety. Toxoid Depression. (no brand Allergies name)~UN~0~In to PCN, sulfa, P 25 muscle biopsy; PVTMRI separate. PVT Dx clinical myositis None Iron-deficiency anemia 0 UNK UNK Seasonal allergies; Patient was very healthy before this sh 2 None PUB PUB None TYLENOL 0 WBC, 16.3;PVT AST, 48; ALT, PVT 75; CRP, 73; SED,No 37 Asthma, GERD, has Sulfa Allergy 0 No testing done. PVT PVT None HTN; DM; Gout; Bladder Cancer; Carotid Stenosis 0 None OTH OTH CARDOZE None 190mg daily; Hypertension ISOSORBID 60mg; METOPROLOL 25mg daily. 0 PVT PVT No Asthma; Migraines; Anxiety
1 1 1 9 0 1 None 2 None 12 None 0 4 0 1 None 10 1 None 1 None 0 None 7 0 None 0 None
OTH UNK None Prematurity PUB PUB None None None OTH PUB None None None PVT UNK BUMEX 2mg PUB PUB None None PVT PUB None Allergic to Nuts PVT PVT PAXIL None None PVT PUB MIL MIL None None None MIL MIL PUB PUB None None Known PVT PVT NAPROXEN; None Multivitamin; Breast flu cancer; shot allergy to LETROZOLE PVT PVT Zantac, Sodium NoneFluoride, Ge Prevacid Reflux, Pre mature 34 1/7wks. PUB PUB KALETRA; No BUSPAR; TRUVACH HIV positive PVT PUB None None None PVT PVT FLUOXITINE None Anxiety Disorder PUB PUB Unknown None Unknown OTH OTH PVT PVT completed OMNICEF RecoveringAMOXICILLIN; this AM Stomach cramps; Hives OTH OTH None None Asthma- no meds; Sleep apnea PVT UNK 12/3/07: A/IPVT note: DueOTH to the patient's denied clinical symptomsseasonal after receiving allergies the flu shot I would recommend that the pa 5 MIL MIL None AMOXICILLIN 1 OTH PVT Unknown None Unknown 2 PVT UNK 10 7/2004: spongiotic MIL psoriasiform MIL chronic dermatitis Denied per MD Denied notes family (actualhx bxasthma results unavailable). 10 MIL MIL Patient denies 1 None at ourOTH facility OTH None 1 X-ray of shoulder; OTH MRIOTH No None now 0 None PVT PVT SULFA; PCN; Seafood 1 PUB PUB GA08088 8 No. Consulted PUBDR, continue PVT with series, METOLPROLOL; notify if reaction CYMBALTA; Allergy worse. toHCTZ; sulfa; HBP; MARZIDE; Depression; GA08090 PREVACID; Ulcer;VALTREX; HSV; ADD DEPO 1 PUB PUB GA08091 1 None PUB UNK None None None GA08092 1 PUB PVT SYNTHROID Diabetes; hypothyroidism GA08093 1 PUB PUB None None None GA08095 1 PUB PVT GA08096 0 UNK UNK GA08097 0 UNK UNK None None No allergies diagnosed yet by doctor prior to immunization 0 RH Arthritis;PVT Lupus PVT 2 My physician PVT did no testing. PVT LIBRA X TID None prn->ID ; Allergy VALTREX to: Sulfa; Never 500 mg Erythromycin; had daily; a problem LISINOPRIL Morphine; with vaccines~ 10 mg Biaxin daily; ()~~0~In ADVAIP 0 OTH PVT 8 None PVT PUB None None None 3 PUB PVT None HTN 6 PUB UNK None Penicillin 0 BPS, 8:10 92/54 PUB P60, PUB 8:15 98/72 P64, 8:18 None 96/64 sitting None P72, 8:20 112/68 P64 PVT PUB Sinus/congestion None PVT PUB QVAR; XOPENEX; None CLARITIN None known 0 None OTH PUB ROCEPHIN; Cat PERCOCET; scratch;RAD; cellulitis fluticasone; HSV; Tinnitus; salmeterol; Septra AUGMENTIN; flunisolide; ALB 0 PVT PVT 2 OTH OTH
0 MIL MIL PPD; manufacturer None Sanofi Photo Pasteur; Sensitivity lot number C2912AA; route/site left forearm, 0 PUB UNK None None None 2 None PVT UNK METOPROLOL; Not reported aspirin; Known simethicone; intolerable venlafaxine to Penicillin and ceftriaxone 0 None OTH OTH None Pregnancy NOS (LMP = 9/19/2008); WAES0811USA03496 Penicillin allergy Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0812USA05190 Drug hypersensitivity 95 Unknown OTH OTH None Termination of pregnancy WAES0812USA05011 - elective 2 computed axial, PVT within OTH normal limits; Unknown WBC count, over; blood Unknown culture, negative WAES0812USA00348 0 diagnostic laboratory, PVT negative PVT blood albuterol; examinations aspirin; Chronic ADVAIR; obstructive ULTRAVATE; pulmonary hydrochlorothiazide; disease; WAES0811USA02209 Penicillin allergy; ZESTORETIC; Allergic reac pr 3 None OTH OTH CRESTOR None WAES0812USA05099 31 LP, lab work, UNK venous doppler UNK L LE, MVI, Xray prenatal LLE None LABS: Vitamin, CBC Codeine, Vit&Echemistry Valium, WNL. Sodium Left leg Pentathol, x-ray WNL. Sulfa, PCN, metal alle 10 UNK UNK None None None 0 PVT PUB MultivitaminNone with fluoride allergic and Loratadine rhinitis PRN 4 UNK PVT crestor 10 mg. none daily : asa none 81mg 0 PUB PUB advaiar, Synvastatin, None Levothyroxine, Hypertension, Amitriptyline, hypothyroidism, Zoloft, mildCorig, asthma, OTC GERD. heartburn Know m 3 Pt had an LP, UNK MRI, Chem UNKpanel, CBC Acidofolis Sed rate, None CRP, 1/7/09-records TSH None and1/7/09-records a chest received-Viral NA~x-ray. ()~~0~In received-Constipation Guillainillness Patient Baree' with fever waswith r/o. from vomiting Labs birthwere with 2-3 0 N/A PVT PVT Tylenol, Nystatin Diaperointment rashNONE on buttocks 1 UNK UNK OMEPRAZOLE Chronic 20 MG vomiting Allergic CAP,assoc DELAYED to pollen, with history chronic RELEASE ofvomiting. esophageal SOLIA 0.15 dilatation. MG-30 MCG TA 1 PVT UNK Symbicort dry cough xCeliac 3 months, Sprue hospitalized doctor prescribed with fever Symbicort of 105~Measles + Mump 7 UNK PUB COUMIDIN,NONE OTHERS UNKNOWN 3 unknown. Labs UNKand Diagnostics: UNK Rotavirus Ag none (+). Urine, reflux, stoollactose and blood intolerance. cx (-). VA09:001 UAPMH: (+) forGERD 15 ketones, samll blood 1 (see 1500+UNK pages of medical UNK records) Labs and newborn Diagnostics: PMH: Direct IUGR.Coombs Maternal (+). smoking CBC, blood cx and lytes all WNL 12 PVT PVT 2 N/A PVT PVT 1 PUB UNK None. None. 1 UNK UNK Inderal, Ativan, Prevacid, Septo-Optic Ventolin inhaler Dysplasia, Asthma, GERD 14 AntinuclearOTH antibody, 16Mar1999, OTH negative; Antinuclear Unknown antibody, Allergies; 17Jul1999, Arthritis; Asthma; negative; A0730257A Depression; Antinuclear Fatigue; antibody, Gastroes 06Oc 0 OTH OTH Concomitant drug (s) not reported MEDI0007688 33 1/9/09-records PVTreceived-Urine PUB culture None negative. None Lumbar 1/6/09-records puncture Crytorehism increased received-two (rt) protein ME00109 week of history 317, increased of rhinorrhea opening andpres cou 1 Many labs and PVTtests. Labs UNKand Diagnostics: TOPROL extended CT None scansrelease; (-). High EKG blood NORVASZ; abnormal. pressure DIOVAN; CBC . PMH: withAmiloride; WBC HTN, 10.9, A-fib, LEXAPRO; RBC Sleepand apnea-on Hct Aspirin sl loC 0 OTH PVT OMEPRAZOLE; No D allergy, Asthma; SINGULAIR; environmental kidney CYMABALTA; failure~Vaccine allergies; calcium laryngeal not specified + D; reflux; multi-vitamin (no depress brand 0 PVT UNK no no 0 CXR showed PVT inflammation UNK 0 No PVT UNK no no 3 No lab data;PUB MD performed PUB - neurological THYROXINE; tests None toParoxetine rule outHypothyroidism other causes. 0 PUB PVT COMBIVENT Fingers inhaler injury 1 PVT PVT BACTRIM DS; DayTYLENOL prior with None food poisoning x 1day 1 01/05/2009PVT Pt seen inUNK office for L deltoid submandibular None noted Lymphadenopathy 1 None PUB OTH Birth control; NoVitamin B-12 None 0 PVT UNK Fever Chest x-ray;OTH Sinus serves PUBordeal, Muscinex 1/5/09 Asthma Tinritus; NKDA 1 State examiner PVT case pending. PUB Pt seen 12/27/08 Prematurity with c/o 34 spitting wks. PMH: up blood 34 week and sneezing. premie Dx with thru 7 Patient stated OTH that his doctors PVT believe Unknown this to believe None an autoimmune Unknown response to the vaccine. PUB PUB None None None 1 OTH PVT EVISTA; PRILOSEC; None AMPICILLIN SYNTHROID; DAYPRO; PROZAC; LIPITOR Chorionic villi UNK sampling:UNK 31/Mar/2006; COMBIVENT; Serologies:PULMICORT; 15/Feb/2006: Past medical Prenatal Blood history Type Vitamin A+; included antibody ### asthma, negative; obesity rubella (BMIimmune 40), va 204 03 November OTH 2005, 02OTH May 2006:Prenatal B+, antibody Vitamins negative,No HBsAg history- Negative, of tobaccoHIV-negative, or drug ### use. BMIRubella 23.7, Immune, 2 ETOHSyph drin 193 The patientUNK had a normal UNK alpha feto ALBUTEROL; protein test on prenatal 07 June Regarding vitamins 2006 and thenormal currentserology pregnancy, ### testing the on date 03ofMay the 2006 patient's with 234 Alpha Feto UNK Protein: 31/May/2006 UNK -AUGMENTIN; normal; Serology: ALBUTEROL; 16/May/2006 The patient FLOVENT; - had A+; antibody a history Prenatal -ofnegative; Vitamins body ### mass Rubindex - immune; (BMI) -Gr/Ch 24, a The patientUNK had serology UNK testing on VICODIN; 23 May 2005 PEPCID; and 05 Prenatal The September patient Vitamins has 2005 history that were of severe normal ### chronic with O+, lowRubella back pain, Imm, ga 03/Jan/2006: UNK Genetic screening UNK - Prenatal CF gene Vitamins mutation negative. The patient Serology had- aAB history (+), antibody of body ### mass - negative; indexRub (BMI) - immun - 19.7, 86 16 March 2006, OTH all normal OTHserology LABETALOL; testing showed, prenatal Parvovirus The vitamins patient IgG, had 5.7, a Parvovirus history of IgM, hypertension(controlled ###negative, A+, Rubella with IM, L
-115 13/Dec/2005, OTH normal serologies, OTH O+, Prenatal antibody,neg; vitamin, SYNTHROID HBsAg, Patient neg;had Syph a history IgG, neg; of humeral Gc/Chlam, ###muscular neg, HIV-NR; dystrophy 4/Jan/20 "auto 86 16/Mar/2006: OTH parvovirus OTH IgG 5.7, parvovirus Labetalol; Prenatal IgM negative; vitamins None Rubella Imm, NBsAg-NR, HIV-NR, ### antibody-negative. 0 1 None reported. UNK UNK The patient had no past medical ###history or use of other me PVT UNK 3 Diagnostic Laboratory OTH OTH Analgesic (unspecified); Depression,Thyroid Penicillin Aspirin; operation; Lipitor; allergy;Restasis; Sulfonamide Thyroid WAES0812USA05247 cancer Nexium; allergy; Lunesta; Allergic Synthroid; reaction B to 3 None MIL MIL PCN 9 PUB PVT none none 2 PUB PVT herbal remedies none and vitamins fibromyalgia, for fibromyalgia allergies tosymptoms. codeine, PCN, Novacaine, E-myc 1 Negative blood PVTcx's. Negative UNK CXR. None Normal white Nonecount, None mild anemia, negative strep and RSV. 0 UNK PVT lisinopril 30None mg po qd 1.seasonal HCTZ 25 pollens mg po 2.hives qd with symvasatin unknown etilogy 10 mg po qd 0 PVT PVT none none pertussis allergy 0 UNK UNK 0 PVT PUB none none nkda 0 UNK UNK 0 UNK UNK none reported none reported none reported none~ ()~~0~In Patient 1 none PVT PUB Albuterol MDI none and Flovent asthma MDI 1 NONE UNK UNK VALTREX, NO CLARITIN, ACUTESTEVEN-JOHNSON AVAREX ILLNESS. DEVELOPED SYNDROME STEVEN-JOHNSON SYNDROM 1 None PVT PUB Vyvanse None ADHD and obesity 4 CBC W/Auto MIL Diff Site/Specimen MIL allergra Monocytes D S/P BLOOD lesion biopsy Iodine 0.70 (H) on allergy, Right cell(s)/mcL depression forearm (0.11-0.59) and joint pain 1 PUB PUB None None None 48 UNK UNK None none 4 UNK PVT Diagnostic tests: OTH 16 February OTH 1998: MagneticBrain resonance lesion; Ankle imaging Carpal Fracture; tunnel of brainsyndrome; Carpal showed A0761134A tunnel no closed evidence release, headCheilitis; ofinjury; acoustic Corneal Deviated neurom dys S 3 PVT PVT Codeine; Prednisone; Avelox; ASA; sulfa 0 Had CXR PVT UNK no no 4 None reported. PVT PVT MultivitaminNone The patient had a nut allergy. ### 1 PUB UNK None None 9 4/14/09-records UNK received-CT UNK scan brain normal. 4/28/09-records 4/14/09-records receivedreceivedRapid strep Allergies:amoxicillin. negative. Assessment: Obstructive Acu 13 None OTH PUB None None None 1 PVT UNK 1 OTH PVT XOPENEX Ibuprofen + USN ON PVT 7-31-08 with OTH 10W4d on 8-11-08-patient None had increased AMOXICILLIN risk downs/on ULTRACET, patient chose termina 0 None PVT UNK 0 None PVT PVT None None 1 Patient wasPVT sent to ERUNK for observation and treatment None if needed. 0 UNK UNK Not reported. ### Not reported UNK UNK Not reported ### 0 Not reported UNK UNK The patient was healthy prior ### to January 2001 when she b 0 PVT UNK Month B-4 Have None aPMH: pace DM2, makerhyperlipdemia, installed obesity, anxiety, angina 0 CT (-); CSFPVT (-) initial studies. PUB Labs and Diagnostics: None Head PMH: CT WNL. recentCXR fall abnormal. EEG WNL. CBC with WBC 1 1 PUB PUB None None, healthy Extra digit both hands at birth - tied; H/O drugs use in, chil 16 1/12/09-records PVT receivedPUBGlucoseNone 486. Glucose urine 4+. Had neonatal hepatitis at 7 wks, recovered, born at 36 wks 1 PVT PVT 2 None OTH PUB None None Allergic to cats and dust 0 MIL MIL 0 PVT PVT None None 0 PUB UNK ENALAPRIL; Renal Folicfailure; acid; Iron; Peritoneal calcium; dialysis EPOGEN; since AR0845 NORVASC;SYNVISC 2 months ago, cause unknown 2 PUB PUB None None 0 Swollen leftUNK arm, pain UNK Cellulitis MIL MIL PROSCAR;None NEURONTIN; Large CELEBREX; prostate; H/O PROTONIX tumor in bioduct (benign) 361 None UNK UNK None
3971 None UNK UNK 521 Lab culture UNK ordered, but UNK unfortunately an HSV culture was performed rather than VZV culture. The HSV culture wa 380 None UNK UNK None 523 None UNK UNK PUB UNK UNK UNK cervix HPV OTH DNA assayOTH - positive None None WAES0811USA00270 36 none PUB PUB Depo Provera none Allergic to sulfa, black cherries, SC0827 PeptoBismol 1 None performed. UNK MIL Diphenhydramine, None Naproxen Aspirin Swelling~Anthrax (Biothrax)~5~40~In Patient 6 PVT PUB 1 None PVT PVT No illness atPatient time ofisvaccination allergic to Penicillin 0 PVT PVT None None 45 PUB PUB Librax, Vytorin, hyperlipidemia, MicardisHCT colon polyps none reported~ ()~NULL~~In Patient 0 PUB PUB 1 UNK UNK None None 1 PUB UNK None at time Constipation Constipation 4 Pt. stated aPVT visit to her UNK PCP the day followingNone the stated reported possible None reported vaccine reaction by patient. 0 PVT PVT Asthma - stable, no current meds 14 Monoscreen: UNK negative,UNK CRP & thyroid Lisinopril/HCTZ screen:None. within 10/12.5 normal Allergies: mg, limits. Zetia codeine, 10 mg (discontinued Medical conditions: 12/8), hypertension, Amitriptyline 75 hype mg 0 PUB PUB none nonr unknown VA09:002 0 None done UNK yet. UNK Ortho Tri-Cyclen No. Lo oral None. contraceptives. 1 CBC drawnPVT PVT Synthroid 100mg In for annual Zocor Hypercholesteremia, PE 40 mg Baby ASA ASHD 1 LABS: MRI UNK c-spine c/wUNK disc protrusion, Wellbutrin spinalXL None stenosis, neural Penicillin foraminal allergynarrowing, PMH: head facet trauma, arthrosis. hypercholesterolemi 1 PUB PUB None She is allergic None~ to Amoxcillin ()~NULL~~In but she Patient|None~ outgrew it ()~NULL~~ 0 PUB UNK none no none 12 SEEN BY ENT; MIL DERMATOLOGY MIL ALENDRONATE AND OPTHAMOLOGY NONE70MGGERD NO WEEKLY C&S OSTEOPOROSIS OR ALLOPURINOL LAB OR SEROLOGY PROSTATE 300MG DAY CANCER NIASPAN HYPER 750 M 62 2/25/09-records UNK receivedUNKLumbar puncture elevated none 2/25/09-records protein 2/25/09-records 76, normal receivedglucose received-PMH:Coronary Viral 77, gastroenteritis 29 red blood with cells, artery abdominal 75,000 disease. whi di h 6 PUB PVT none Penicillin; asthma 5 x-ray on 10-07-08 UNK LABS: UNK CXR revealed None significant None. bilateral Eczema. pneumonia PMH: Temp. w/right hospitalized 101 for pleural 2 days~Measles for effusion. significant CBC bilateral + of Mumps 10/22 pneum +plts Rub 4 16 PVT PVT None None except Pre-maturity runny nose 11 UGI; small bowel PVT follow, PUB then, multiple NoneKUB- see None hosp records, None LT, LP, Urine, LAB 1/14/09-records received-Upper 0 OTH OTH Benzoate 200 None mg, Paxil Penicillin, CR 25mg, codeine, Nasonex, highLotrel, bloodHCTZ pressure 25mg 18 PVT PVT 0 PVT PVT HCTZ; Verapamil; Appt forBupropion nevi HTN; Hypothyroidism; HRT Depression 0 None PUB PVT 1 PVT UNK 0 PVT PVT None 0 Stool heme,PVT negative PVT None None None Whole blood OTH lead test, OTH inordinate level; Unknown Serum mercury test, Noneinordinate level WAES0901USA00094 45 Beta-humanOTH chorionic,OTH positive folic acid; vitamins (unspecified) Drug hypersensitivity WAES0805USA00247 0 Diagnostic laboratory, PVT STD OTH testingUnknown LABS: pathergy Vulval ulceration; test neg. MouthESR West ulceration; 32(H), Nile viral CRP Canker infection WAES0812USA02633 10.5(H). sores oral; CBC,Viral chemistry, infection LFTs PMH: WN 1 Diagnostic laboratory, OTH 12/12/08, OTH enzyme None levels over 800 None LABS:PMH: CT scan Foreign & UStravel WAES0901USA00056 abdomen 7/08. abnormal Family hx: w/pancreatic IBS. & Urine beta-human, OTH 04/02?/08, OTH positive; Unknown Erythrocyte Pregnancy ABOLoop NOS antigen, electrosurgical (LMP AB=positive; 2/25/2008); excision Serum WAES0804USA02244 Epilepsy hepatitis procedure; B, Negative; Gastroesophagea Rapid p 1 None UNK UNK None 0 OTH PUB None None None 0 MIL PUB 0 PUB PUB NA NA NA OTH PUB None None 0 MIL UNK No No 3 PUB PUB None None None 0 None PVT PVT Yasmin No
429 Unknown OTH OTH Unknown Hypertension; Obesity; Diabetes mellitus; WAES0812USA02385 Drug hypersensitivity 0 None PVT PUB None None 0 None PVT PVT BUSPAR; ASMAVET; No GERD; PATENOL allergies; central serous retinopathy 0 PVT PUB None 8 PVT UNK 1 None PVT PUB None None PVT PVT None None 0 OTH OTH NADOLOL;None AVIANE Heart palpitations 97 Ultrasound,OTH 06/02/08, within OTH normal None limits; Colposcopy, Pregnancy03/13/08, NOS (LMP cervicitis, = 1/16/2008) focal WAES0803USA00533 HPV changes; Cervical smear, 02 MIL MIL 2 PVT PVT 1 PUB PVT Insulin One week before IDDM - had a 'virus' 1005 MIL MIL MIL MIL MIL MIL UNK UNK MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL 0 None UNK PUB Old med: "birth nonecontrol depression pills" New Meds: "generic Prozac and Ambien for 6 week 28 Numerous laboratory, UNK radiologic UNK and None other at time tests None ofofvaccination. patient, None as he Several continues none~ since ()~~0~In tothis be in time very Patient|none~ related serious to condition ongoing ()~~0~In medical inSibling our ICc 0 PUB PVT None none 0 Arterial Blood UNK Gas / Chest UNKXRay (findings None unknown). None Labs None. and PMH: Diagnostics: C4-C5CXR fusion. WNL. hiatal CKhernia 46 WNL. repair. CKMB NKDA. 1.9. La 0 Soft TissuePUB Infection/Cellulitis PUB None None None MS132008 31 BLOOD WORK, UNK XRAYS UNK AT UVA, FONTAINENONE RESEARCH NONE. CENTER. PMH: Labs 30 lband wt loss Diagnostics: 2' to stress Anti-CCP (+), CRP 1 22 BLOOD CULTURE PVT 01/03 PVTGREW POSS. NONE HAEMOPHILUS NONE NONE BETA LACTAMASE NEGATIVE IDENTIFICATION TO F 3 UNK UNK No illness noted 2 UNK PVT METOPROLOL,CRESTOR NONE NKA 125 LABS: EKGUNK abnormal w/biatrial UNK enlargement Orthotricyclen no w/RV prescribed strain.PMH: Troponin 10/23/07 BCP since 2.13(H). 10/07. Chest Preemie CT scan w/NICU c/w large & intubation. bilateral PE IT 2 PVT UNK None None None 1 Unknown UNK UNK Unknown None NKA, Last Menstrual Cycle :"12/22/2008" per mom and cli 1 none...did not UNK seek clinical UNKevaluation by primary care physician 17 PUB PUB Asthma 0 PUB PUB TYLENOL AS NONE NEEDED NONE 1 MIL MIL gabapentin,see omeprazole, above prostatitis, oxycodone, chronic rosuvastatin, neck pain,docusate hyperlipidemia 0 Pending Immunologist UNK UNK appt. none none 04/07 milk allergy, N/A~ ()~~0~In 10/08 GERD Patient|N/A~ ()~~0~In Sibling 13 UNK UNK Nuvaring 1 PUB UNK slight cold celiac Unk PVT PVT Unknown Concomitant medications A0762584A and relevant medical history wer Unknown PVT PVT Unknown A0762713A UNK PVT PVT Unknown A0762719A 20 UNK OTH PUB No concurrent Unknown medication The subject has no relevant A0762729A medical history and no history 1 Labs and Diagnostics: PUB OTH EKG (+) for Quinapril; IRBBB. LIPITOR; None MetforminHypertension; Pt's meds No allergies. PMH: HTN, High cholesterol. 1 N/A - Per telephone PVT RD PUB advised avoiding None Tetanus None until 4-6 None y.o. PVT PUB Nothing 1 PVT OTH AVELOX; CYMBALTA; NeuropathyAnxiety; DIFLUCAN; Depression; FLONASE; Diabetes; gabapentin; Dysphagia; LISINOPRIL; Gastrointestina METFO
0 None PUB PVT None None Seasonal allergies-hay fever 9 None PVT PUB AMOXIL Otitis None 1 PVT PUB Abdominal pain(viral illness) 0 PVT PUB PROZAC; NUVARING None AMOXICILLIN 35 PVT OTH None None None 0 None OTH OTH None None None 10 Labs and Diagnostics: PVT PVT CT brain scan Epi-Pen, WNL2except pak,0.3mg1; None evidence Eczema Albuterol of old inC6 childhood; 90mcg/inh cervical wrist 2 fx.puff(s), CTA fracture, WNL. QID 12/04; prn; MRI FLOVENT, (+)allergic for mild rhinitis, HFA, paran 0 PUB UNK 3 PVT PVT METFORMIN; None LIPITOR; Heart lanolin; disease; PROTONIX; gout; HTN; LOPRESTOR; Hyperlipidemia; ALLOPUNRIL; sarcoidosisCOU 3 PVT PUB allergic rhinitis; obesity 3 PVT UNK None None 1 PVT OTH 1 PVT PVT None None 0 PUB PUB Ear infection a week before vaccine (1/7/09) 1 PVT PVT Seasonale,None zoloft 50mgNone 1 UNK PVT The patientPer did patient, mentionUnknown she some was medications not sick at but timethey of vaccination. are not on file at our pharmac 73 PVT PVT Two or three dermatofibromas on legs 0 PUB PVT none none none fever~Influenza (no brand name)~UN~2~In Pat None MIL MIL None None Seasonal allergies 0 Yes. Received UNK2008 flu UNK vaccine atNone. Hospital in. None Youknown. can Allergic find manufacturer/lot to the erythromycin there. family (Previously of anti-biotics. have received Recently flu v 1 X-ray of hand PVT 7 Jan 09UNK Lotril, Effexor None SR, Ambien, Depression, Metformin, Type Wellbutrin, II diabetes Synthroid, Zocor, Zyrtec 2 normal result. UNK Labs andUNK Diagnostics: noneFlu (-) pain in the arm none. ,then PMH: a sever noneflu start after one day from getting the sh 0 UNK PVT None None 1 PVT UNK none perfectly healthy 0 Blood pressure, OTH 54/30.OTH Labs and Diagnostics: Unknown Pregnancy CBC, Chem PMH: NOS and (LMP none EKG=all 10/21/2008) WNL. Serum WAES0901USA00339 B-HCG (-). Unknown OTH OTH Unknown Unknown WAES0901USA00354 body temp, OTH high fever OTH Unknown Upper respiratory Unknown tract infection WAES0901USA00096 4 diagnostic laboratory, OTH rotavirus OTH test: positive Unknown WAES0901USA00389 0 PVT PVT No Allergy; Asthma; Hypertension; Obesity; BPH 07/27/04; Sp 1 MIL MIL ZANTAC; Folic NoneAcid; FLONASE; 12 weeks pregnant Multi vitamin 0 OTH PVT NORCO; SOMA 2 days ago Allergies over Strep to throat PNC; degenerative disc disease. 0 PUB PUB PVT PVT Solodyne None None 1 PUB UNK None None that we are aware of. 392 PVT PUB 0 None OTH OTH Avalide, Synthroid, MVIAllergy Calcium, to Sulfa, Atenol,Macrodantin ASA, Welbutron 0 PVT PUB None None None 8 Rubeola Titer, PUB12/17/08PVT 0.82; Equival ULTRAM; Varicella SOMA; None Titer,20 12/17/08, LOFT Chronic0.90, backNegative pain; Osteoarthritis 1 PVT PUB 6 None PUB PUB None At PE appt had small rash anteriorTN08042 hand R arm - 15 mm site 2715 PVT UNK None None 2 PVT UNK None Eczema-Atopic LA090101 1 None PUB PUB TB Test PPD None JHP Pharm. None 85857 ID/L Forearm 3 No Lab testPVT have beenUNK performed None or suggested. None None 0 OTH PVT FLUVIRIN left None arm; EVISTA None in; ELAVIL in 0 PVT PVT None None 0 PUB OTH Herpes Simplex Virus (oral) 1 PVT OTH None None None 159 N/A PVT PVT None 10 PVT PVT CONCERTA Stepped onADHD nail (no illness) 11 PVT PVT
0 PVT UNK 29 Abdominal PVT series LABS: PVT Stool guiaic None neg. abd x-ray & US GERD abnormal. PMH: recent BMP WNL. OM. 0 BP: 130/84 PUB P:80 PUB None Hyperglycemia, depression, allergies 5 PVT PVT GERD/IBS/Allergic Rhinitis 0 PVT PVT MACROBID, EMYCIN,Patient PABA, has DEMEROL, several allergiesCATAPRES, sulfa,TEQUIN, vibromycin, CELEBRE 0 Chest X-ray; PVT Cardiac Enz; PVTSMA 22; Triad/ PTT/INR; HCTZNone CBC; 37.5 Qday; U/A None - no Estradiol significant Faint~Influenza 1mgfindings Qday; fluoxetine (no brand 20mg name)~UN~0~In - one Qday. Pat 0 WBC 15,000 UNK on 11/5/08, UNK neutrophils citalopram 10.1 on 80 None 11/5/08, mg daily, mono no mirtazapine previous 1.3 on 11/5/08, allergies. 15 mgrest qhs, PMH ofgabapentin CBC includes WNL.mood 800 Temperature mg disorder, q6h, metform 98.9 hypero 14 White countUNK 3000 with UNK differential showing 40% segs, 12% monos, 45% lymphs. Sodioum 139, Potassium 3.7, chl 1 PUB PUB none cough allergy to unknown antibiotic SC0901 2 n/a PUB PVT N/A NONE NONE 0 none PUB PVT headache, high fever, loss of apetite, vomiting~ 1 PUB PVT OCP none reported Seizure hx - no current therapy PVT UNK none none none 0 UNK UNK 1 PVT PVT no no continuous supressed WBC. now normal .Immune dysfunc 0 PVT UNK none none 1 NONE MIL MIL NO ILLNESS NONE 2 PVT PVT Remeron DepressionDepression (treated, stable) 3 MIL MIL 1 n/a PUB UNK unknown unknown unknown. n/a~ ()~NULL~~In Patient 0 PUB PUB Multivitamin, None Aspirin 81mg Seasonal allergies None~ ()~NULL~~In Patient 227 SHINGLESUNK 053.9 UNK N/A 1 None performed PUB UNK Valtrex 500None mg bid; Activella NA 0 Rapid Physical MIL exam/ Oxygen MIL via None facemask /None benedryl given Noneat urgent care facility. Nothing more given due to pati 1 UNK UNK NOne None MIL MIL None None None 0 CXR-normal; PUB CT scan,PUB n/non contest Augementin except for 1yr 200mg; ethmoid 9mo Bid None sinitis x 10 days 1 PUB PVT PPD SanofiNone C2901BCNone left arm 1 CBC; ChestPUB X Ray PUB PHENOBARBITOL Cold Sx;daily Dx Seizure Pneumonia Disorder next day 3 Nasal swabOTH and blood PVT drawn; Swab None was positive No None 3 Nasal swabOTH rapid for flu PVT + None No None 0 PUB PVT TESRETOI;byPEROCET; PM had headache DEXYCY; PREMARIN; CADUET; ELAVIT; FOLIC ACID Unknown OTH OTH Unknown Unknown WAES0811USA03767 0 Unk OTH OTH Unknown A0763055A 0 UNK OTH PUB Thyroxine sodium; Acid reflux; Indapamide; The Arthritis; subject Hypertension; Omeprazole; had previously A0763069A Potassium Hypothyroidism received chloride influenza vaccinations 2 Blood work PVT performed PVT on an unspecified No concurrent dateUnknown was medication normal. The subject has not previously A0763072A received flu shots and has 1 PUB UNK No No 0 PVT UNK TRAMADOL None & SOMA Allergies: PENICILLIN; brother~Diphtheria SULFA;Toxoids ERYTHROMYCIN; (no brand name)~U MORP 0 PVT PVT None None None 1 OTH PVT Excedrin Penicillin, Ibuprofen 0 OTH PVT Previously fainted fainting~Vaccine after receiving not specified vaccinations (no brand name) 0 Unknown OTH OTH Unknown Ankylosing spondylitis WAES0811USA03927 1 Autopsy - report PVT not available. PVT None None 33 week premature twin PMH: 33 week preemie twin, NIC 1 Labs and Diagnostics: PVT UNK CXR (+) for likely atelectasis. None CT Cutis chestLaxa; (+) forcongenital marked volume disorder loss of LGlycosylation. lung. pH probe PMH: (+) for Aum 0 None PVT PUB No No No 4 12/12/08 Lab PUB showed low PVTyellow fever Unknown antibody None titer. Unable to separate IgG and Igm. 0 PVT PVT None Reactive Airway Cleft lip/palate Exacerbation; URI 1 PVT PUB None None 0 None PVT PVT ORTHOCYCLIN None None 10 None MIL MIL None None 0 PVT PVT Trazodone;None Methacarbenol Injectable iron; Celiac Disease; Fibromyalgia
4 PVT OTH Hx of breast (L) CA not same arm. 0 MRI, 11/29/08; PUBEMG, 12/10/08 PUB Levothyroxine; None Restasis; Low Dicyclomine Thyroid 1 PVT OTH 4 PVT PVT FEXOFENADINE None 180 Recurrent mg daily urinary Fainting~HPV tract infections. (no brand name)~2~18~In Patie None PVT PUB None Eczema None 0 OTH PVT None None 0 PVT PVT 2 PVT UNK None None 1 None PVT PVT ZYRTEC None None 7 OTH OTH None CT Contrast dye X-rays; EKG PUB UNK None None 0 Unknown OTH OTH Unknown Unknown WAES0901USA00781 2 diagnostic procedure, OTH balancing OTH testing Tylenol; Amoxicillin; Upper respiratory Diazepam; tract Xalatan; infection; Prinivil; Hypertension; WAES0901USA00809 Aleve Glaucoma 0 ultrasound, OTH 12/08/08, Pregnant. OTH 22Unknown weeks, 1 day Pregnancy NOS (LMP = 8/1/2008)WAES0901USA00452 1 None PVT UNK eczema, tonsillar Eczema hypertrophy (not infected) 1 Mild elevation PVT of CK toUNK 257. none Allergies to Fish and Shellfish 856 PVT PUB None known. None. 0 UNK UNK BENADRYLPT PRESENTED ALLERGIC TO OFFICE NA~ RHINITIS, ()~~0~In FOR ALLERGY-INDUCED APatient|NA~ PHYSICAL.()~~0~In PT C/O ASTHMA Sibling|NA BEING "T 0 none UNK UNK Phenobarb Upper 10 ml once Respiratory Epilepsy a day, Diastat Infection Seizure~DTaP 2.5 - went mg rectally to Dr. + HepB and prn was for + IPV seizures, diagnosed (Pediarix)~2~0~In 3/4after tsp mo bei 2 UNK UNK NONE NONE. PTECZEMA SEEN FORNA~ ROUTINE ()~~0~In PHYSICAL. Patient|NA~ ()~~0~In Sibling|NA 1 None UNK PUB None None none 3 PVT UNK None None None Fever, wheezing, irritability~DTaP + HepB + IP 1 PVT PVT metformin none 0 NA PUB PUB tylenon <0.4none ccs 2 times none on 1/7/09; 1 timeon 1/8/09 VA09:003 1 contact me UNK in a week and UNKI'll let you know Labs none and Diagnostics: Allergic toInsulin many none~ (H) things ()~~0~Patient 35.3. so much C-peptide that 4.5. the tests otherwise continue WNL. to c 0 Pending perUNK hospital. Labs UNK and diagnostics: Tox contact screen dermatitis none. (-). Chemistry PMH: none unremarkable. EEG WNL. 0 UNK UNK tYLENOL NONE NONE ~Pneumo (Prevnar)~~0~In Sibling|FACE FLUS 1 EEG - negative. UNK CT of UNK head - readReglan, as negative. Zantac, LABS: Topical skeletal GERD, Nystatin survey Upper Respiratory WNL. CT ofInfection head revealed at (afebrile) bilateral at time mastoid of 2 CSF: 57 wbc: UNK 66% LYMPHS; UNK CSF GLUCOSENONE 114; CSF MED PROTEIN ALLERGIES: 115 3/3/09-records CIPRO, ZOCOR, receivedZESTRIL, Electromyography LOTENSIN 0 NONE UNK UNK ESTROGEN, NONE TESTOSTERONE ALL: SULFA CREAM, (ANAPHYLAXIS); VOLTAREN,GENTAMICIN, CALCIUM, GLUCOSAMI TETRACYC 1 N/A PUB PUB Bentyl 20 mg None IM x 2 days No prior in Right Dlt to vaccine. 1 UNK UNK citlopram, felodipine,hctz, none none diovan, lovastatin 0 PVT PUB NA na 1 N/A PVT UNK None None 0 I called the PVT afterhours nurse UNK hotline Pamelor and told 50. her None Effexor my symptoms XR Allergy 150. and Prevacid to sulfa, she said Type 30. Corgard toIIget Diabetes, to 120. ER now. Chronic Glucophage I asked migraines, what XR 2000. they Chro co V 0 n/a PVT PVT n/a n/a n/a 2 None PVT PVT Minocycline,none celexa, Nuvaring none Headaches~HPV (Gardasil)~1~18~In Patient 1 n/a PVT UNK None None. Given None as part of treatment for fall/blunt trauma. No VIS given to 523 12/16/08, Positive PVT HSVPUB culture genitalia Cephalexin;None Allergy Augmentin fainted~Tdap (no brand name)~6~14~In Patien 66 Labs and Diagnostics: PVT UNK PAP smear (+) for ASCUS None and HPV. NoneCT PMH: brain none scan WNL. Pelvic US . ECG reported as no 3 CBC; Hytes; PVT Glucose;UNK TSH; Calcium, normal;None CT head PMH: 6/08; EKG, none 8/08; Holter 10/08 Labs and Diagnostics: PAP 3 Labs and Diagnostics: UNK UNK PAP smear (+) for ASCUS and HPV. PMH:CT none brain scan WNL. Pelvic US . ECG reported as no 1 None UNK PVT None Allergic to AMOXICILLIN (medicine) PVT PVT Allergies PCN; Cortisone; Tetanus per pt. 3 Strep test (-); PVT RSV (-);PVT flu A+B (-);PULMICORT; CBC None ZYRTEC RAD; AP 2 None PVT PVT None None None 12 None PUB UNK None No Cow milk allergy. 2 PUB PUB NC09005 1 All WNL perPUB pt PUB NUVARING 2005 - Anemia Hx: of Ovarian NC09003 and breast Cyst 1 PVT UNK None None 1 None PVT PVT None None None
0 None PVT PVT None Controlled asthma 0 PUB PVT No 1 PUB PVT No 0 PUB PVT No 0 PUB PVT No 1 PUB PUB LIPITOR, FOSAMAX, None ATENOLOL, Seasonal Allergies; Sore LEVOTHYROXINE, Arm~Influenza Hypothyroid(no Ca+ brand name)~1~73~In None OTH UNK Vitorin; BENICAR; None Known ZOLOFT Allergy to NIACIN 3 PVT PVT 0 PUB PUB None NC09002 1 Ultrasound;PUB WBC PUB None None None NC09001 1 PVT PVT Hx Asthma 0 None PUB PVT HCTZ 25mgNone qd; LipitorAllergies: 10mg oneMorphine qd. Unknown OTH OTH Unknown Unknown WAES0806USA02506 57 Body temp,OTH 6/27/2008,OTH 102.7, F Unknown WAES0807USA00576 Unknown OTH OTH Unknown Unknown WAES0807USA02893 0 None OTH OTH Milk allergy WAES0807USA04603 0 Unknown OTH OTH Sepsis WAES0808USA01657 1 Unknown OTH OTH Aspirin; calcium Osteoporosis; (unspecified) Hypothyroidism; (+); domperidone; Gastroparesis WAES0810USA05385 SYNTHROID; ACIPHEX; FORTE 306 1/29/09-records UNK received-COD-undetermined. UNK krk 6/23/09-pathology No medical problems-report received: no allergies autopsy -- No tissues drug without use, alcoho evide 5 See attached. PVTLabs and PUB Diagnostics: Tylenol CBC with None 43K WBCs None. withPMH: 20% none. atypical lymphs. CT brain scan (+) cerebral e -190 UNK UNK HSV encephalitis. Seizure. PVT PVT None None, Well None Visit 0 None PUB OTH None None None I don't knowUNK Positive PPD UNK No allergies; No history of hives; non-smoker; limited alcoh 414 UNK UNK UNK UNK 0 Allergic rx toUNK Pneumovax UNK 0 UNK UNK 0 blood pressure, PVT 01/05/09, PUB102/60;Unknown total heartbeat count, 01/05/09, Unknown OK WAES0901USA00898 2 Unknown 2/2/09-records OTH OTH received-Renal Unknown ultrasound 2/2/09-records normal. None receivedLabs 2/2/09-records WNL. Dysuria, MRI brain receivedWAES0901USA00986 left normal. flankPMH: pain times GTC 5 seizure days. After at 8 yea fir 27 X-ray, negative; OTH WBC count, OTH negative Unknown WAES0901USA01014 blood pressure, OTH 11/28/08, OTHsystolic Unknown around 89;Osteoporosis; computed axial, Watery Seasonal showed diarrhoea allergy no evidence WAES0812USA03732 of different abscess formation; 1 PUB PUB None 0 1/7/09 RightPVT humerus X-ray PVT AP and Lateral No None Known 34 U/A, CXR, CBC, UNK CMP,UNK Head CT-done Dayquil, in the Nyquil, ER none 12/29. Benadryl, 1/15/09-records 1/15/09-records noneTylenol 1/21/09 receivedrecords receivedCough received-PMH: MRI times negative. week. Kidney CT Patient normal. stone. wasDiverti Urine diagn 0 PUB PUB dilantin/ritalin/steroids. none Seizure disorder/chronic hepatitis C 1093 We do not have UNK data. UNK She died at Hosptial. According to1/21/09-records the State healthreceived-PMH: dept, the case mononucleosis was meningitis 2serogroup months a 14 SAW 2 DOCTORS UNK BECUASE PVT THOUGHT IT CANCER WAS A TOOTHACHE. REMISSION DENTIST SENT HER ON TO ANOTHER DOC 1 MIL MIL n/a NONE Swelling leg~DTP (no brand name)~1~1~In Sib 2 PVT PVT NONE CONTACT DERMATITIS~Hep A (Havrix)~1~4~ 1 NONE PUB PUB NONE NONE NONE 0 PVT PVT none none None 1 n/a PVT PVT advair 500/50, none allegra60-120mg nkda 1 PVT PUB Ranitidine GER fever~DTaP + HepB + IPV (Pediarix)~2~0~In P 0 none PUB PVT Loestrin 24-one nonedaily, Nexium acid reflux, 40mg-one pvc's, migraines, daily viral meningitis 3 weeks prior 1 PVT PUB NONE NONE NONE 1 Pending labs UNK currently UNK are CBCPD, Bactrim COMP, forCRP, no ingrown 2/9/09-records c3, c4, toenail no UA2/9/09-records 2/9/09-records received-Currently Measels~Measles receivedreceived-CRP onMeasles Bactrim + Mumps increased after for+ingrown Rubella first.9,MMR. lymphocte toenail. (MMR II 0 UNK PVT no Client states he takes allergy medication for environmenta 1 UNK UNK Motrin 800 None mg TID, Lamictal Allergy100 to Ceclor. mg BID Dx with Cerebral Palsy and followed by 0 UNK UNK none penicillin-all siblings have had reaction, told to avoid by ph meter, blister broke am 1/14/09 no fever, PUB no headache, PUB nonone problems with noneany other hypertension anaphylaticand type hypercholestalema reaction. Requested that if fever deve
0 none PUB PUB no no allergic to Amoxycillin 0 PUB PVT none none none 0 none PVT PVT none reports multiple allergies when skin tested at local allergist 0 None PUB PVT none none 0 none PVT PVT Cutivate 0.05% none1 app 4x per day prn Temovate 0.05% 1 app NovoLog Penfill 1 0 UNK UNK Diovan HCT 80/12.5 - tab once daily, levothyroxin tab50 mcg - once daily, simvas 624 Physician made UNK diagnosis UNK 26 NERVE CONDUCTION, UNK UNK MRI, BARIUM SWALLOW NONE TEST, NONE 1/16/09-records received-CSF: protein 77, glucose 52.N 0 PVT PVT 3 12/24/07 LABS, MIL CBC, normal; MIL Comprehensive No daily script None Metabolic Meds prior Allergies: profile, to vaccination. normal; To PCN; Epstein Sulfa;Barr Benadryl; virus studies: Tetracycline; Positive NoIgG chron te 3 None known UNK UNK None None None 6 PVT UNK Hypothyroidism; HTN 0 OTH PUB No No 1 PVT PVT Tylenol given Just after gotinjection over a cold and mild diaper rash. None PUB PVT TEGRETOLNone Unknown 1 None UNK UNK None None 2 PUB OTH None None None 1 PVT PUB None large lump on thigh~Measles + Mumps + Rube 1 PUB UNK Well check 1 PVT PUB None None 4 PVT PVT Mononessa 28's; Naprosyn Mild GERD; Dysmenorrhea 139 Gastric emptying MIL studyMIL positive forNone gastroparesis; Nonetestosterone, None 178; free testosterone, 16.1 454 MRI/MRA ofMIL brain, 1/19/08, MIL Abnormal Nonewith and None without contrast, None PMH: with findings hospitalized that w/food are of concern poisoning for2001. primary or sec 0 PVT PVT Glucophage, None Lotrel, Caltrate Diabetes 2 , HTN, HLD 0 None PVT PVT None No Diabetic 0 OTH PVT Patient stated she was allergic to CECLOR 1 OTH UNK None 1 OTH PVT None None 0 None PUB PUB PPV 23, Merck; Nonelot # 0981X; None Route/Site LVL; No. Previous Doses, 1 None PUB PUB None None None 41 PAP tests after UNKGARDASIL: UNK 11-20-07 = ASCUS; 5-21-08No = Known ASCUS; 12-3-08 = Normal 0 PVT OTH Allergic to most Noneanti biotic Allergic to most Dizziness~Varicella anti biotics (no brand name)~1~5~In P 7 None MIL MIL 12/20/2007 Adverse effect caused in therapeutic use, sma MIL MIL childhood h/o allergies to dust, pollen, pet dander EKGMIL MIL SINGULAR; ZYRTEC; RAD; PRN ALBUTEROL seasonal allergies inhaler MIL MIL MIL MIL h/o allergies which were skin when he was younger MIL MIL eczema MIL MIL MIL MIL MIL MIL none MIL MIL none none MIL MIL anthrax and typhoid given on same day as SPV Unknown OTH OTH Unknown Unknown WAES0901USA01153 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA00384 33 Unknown. Labs OTH and Diagnostics: OTH Unknown Abd US (+) for IS. Barium Unknown. enemaPMH: (+) fornoneWAES0901USA00993 IS 47 UNK PVT OTH Tuberculosis Unknown vaccine; Unknown; No relevantBlood medical pressure history. A0763485A medication No adverse events were repo 4 US LABS: PVT air contrastPVT BE unsuccessful as reducing No IS. Stool c/s neg. 0 OTH OTH Unknown 1 PVT PVT 0 PVT PVT None
0 PUB PUB None History of malarial yes~Hep infection A (no brand 11/08name)~1~0~In Patient 1 None PUB UNK Contraceptive None patch None 2 UNK UNK 0 CBC normal; PVT Lamictal PVT level pending, TYLENOL; as mother None PRN takes thisNone medication and is breastfeediing 1 PVT PUB 0 PUB PUB UNK UNK no 1 PUB PUB 4 blood work,UNK nerve conduction UNK study. Lyrica, LabsAmytriptyline, andNone. Diagnostics: Entocort, Idiopathic CBCBirth with Anaphylaxis, control WBC 13,940, pill,Fibromyalgia, Ultram RBC 5.28,GERD. Hgb 15.4. PMH: HctNKA. 46.1. UNK UNK none hypertension, none hyperthyroidism, noted.~ ()~NULL~~In osteoarthritis Patient 0 PVT UNK none none 2 MIL UNK none 0 none UNK UNK Zoloft None sensitivity to Erythromycin and Bactrim and Iodine dye 1 None UNK MIL none None hayfever 2 PVT UNK none none 1 UNK UNK Flovent, Albuterol, new patient Zovia, Allergies: appt Zyrtec, in practice Epinephrine Xanax, Ibuterol (heart palpitations), Lexapro + Kiwi 12 LABS: WBCUNK 20.9, ANCUNK 17.8(H), lymphs 10.3%(l). Creatinine PMH:0.3(L), URI s/s ALK x 1 150(L), mo. Recurrent AST 58(H). OM & CTear brain tube abnormal. insertion.P 0 PUB PVT No acute orN/A chronic illnesses 8 N/A UNK PVT levothyroxine,dyazide,arimidex, oro-labial Herpes, mild clonazepam,vitamin D, verapamil 190 start of vaccine UNKseries 09/13/2006,2nd UNK dose 10/18/2006 none and hypothyroidism, 3rd and finalmigraine dose 2/14/2006 headaches. Blood PMH: workthyroid drawn 5/10/2 proble 0 None PVT UNK Prevacid 15None mg. twice Ulcer, a day GERD siezure like symptoms, projectile vomiting, arch 3 PVT UNK None Laceration of finger 737 unknown PVT PVT none at thepossibly time double-ear none infection and earlier that month had sinusitis 0 BP, 100/60;PVT Pulse 0X, PUB 100%; HR, None 90's; RR, 26 None None 1 None PVT PUB None None None 0 None PVT PUB Mycology cream Diaper rashHx single umbilical artery 0 PVT PUB Well child checkNone up 0 None PVT PVT None 1 PUB PVT None 2 PUB PVT Benicar, Flonase None Ragweed, HTN 1 PUB PUB None None Over weight 0 V.S stable PVT PVT Unknown None Known None Known PUB PUB None None 0 None PVT PVT PROZAC 20 None mg; VYVANSE ADHD,30 insomnia, mg allergic rhinitis, major depression 2 OTH PVT MIL MIL 0 None PVT PVT None None depressive disorder, obesity 2 Taking BENADRYL, PVT using UNKhydrocortisone UDRecovering AROM 0 PVT PUB Abnormal newborn screening; Hgb electrophoresis; refer t 0 BMP creatinine PUB0.3 mg/dl; PUBHgb 12.1 g/dl; Hct None 36.7%; CXR None = WNL; UA-bacteria moderate; CBC - WBC 12.7 x/cmm; PVT UNK Exposure to rabies 0 PUB PUB Oral contraceptives, None Celexa Asthma, xanax, Anxiety, Ambien, Depression, Singular,OCD Pulmicort, Zephanal 1 PUB PUB None None None 0 PVT UNK No No 8 PVT PVT Sinusitis 3 PVT PVT Tylenol, Motrin None Keratosis plans low fever~ ()~UN~0~In Patient 1 PVT PVT 1 None Developmental Delay 315.9 0 PUB PUB 40 LABS: Blood PVT work 1/20/09: PVT ESR 32(H). YASMINE CRPNone <0.5. CBCNone & chemistry PMH: UTIs, WNL.HA, ANA dehydration, neg. IgA 73, contraception IgG 1532, igM irregula 105 1 None PUB PUB None None None 0 PUB PUB None Penicillin and buckwheat per patient
PVT UNK Attached with allergiesAttached 6 Stool culture, PVT negative PVT None None 3 PVT PVT 1 UNK PVT None None 0 None PUB PVT None No 1 PUB PVT lacerated upper Penicillin lip 0 Unknown OTH OTH Unknown Unknown WAES0712USA08098 Unknown OTH OTH Unknown Unknown WAES0901USA01220 Unknown UNK UNK PAROVEN; garlic Unknown WAES0901AUS00036 0 None OTH OTH Hormonal contraceptives None WAES0901USA01109 1 plasma creatine OTH kinase, OTH elevated 2/17/09-records Unknown received-MRI None brain normal, MRI WAES0901USA01201 cervical spine minimal bulge at C 0 Unknown PVT OTH Unknown WAES0901USA01203 2 VZV strain, OTH 01/??/09, positive OTH for VARICELLA Unknown zoster virus Unknown 2/3/09-records 2/3/09-records received-MRI WAES0901USA01139 received-PMH:subarachnoid brain normal, Lumbar punc intra Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA00290 0 n/a PVT UNK 0 n/a PVT UNK 0 n/a PVT UNK 0 PVT UNK RECEIVEDNONE PPD TESTNONE WITH VACCINE ON SAME HAND PUB UNK 0 None PVT PUB None None None 0 PVT PUB NONE ORDERED, PUB HOWEVER PUB CONTACTED PT RECEIVED VIRAL MEDIMMUNE PPD INFECTION TEST 784.7DURING FOR EPISTAXIS, 079.99 STABILITY N/A~ SAME ()~NULL~~In V40.3 WELL STUDIES BEHAVIORAL CHILD Patient|N/A~ AND VISIT. ADDITIONAL PROBLEMS ()~NULL~~In INFOR NEC S 1 1/5/09 Patch UNK tests performed UNK wereNone negative. Nasal Telephone congestion Sulfa, interview Td without -conducted told 8 days fever not of to soreness 1/16/09. take Td unless to arm~ she ()~UN~0~In had an injury. Patien De 0 UNK UNK NONE NONE NONE 1 UNK UNK N/A N/A N/A 0 PUB PVT allergic to PCN 4 none PUB PUB 1 Diagnostic X-Ray UNK doneUNK at Medical Center 11/07/2008 Vaginitis positive Augmentin, for acute Morphine, pneumonia. Percocet Chest X-Ray 1/7/2009 done at 0 PUB UNK 41 N/A PUB PUB None None None AZ0901 0 CBC - normal, UNKMRI - normal, UNK initialNone bicarb at15 time but Mild ofthis vaccination upper resolved respiratory None to 20 infection, on recheck, no UA sorenegative, throat Utox negative 2/17/0 0 PUB UNK none none none Unknown OTH OTH Vaccination adverse reaction; WAES0901USA00619 Stroke; Generalised raised r 0 None OTH OTH Unknown None WAES0901USA01342 9 Unknown PVT OTH Unknown Ulcer WAES0812USA05078 Unknown OTH OTH Unknown Unknown WAES0901USA01615 Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH07600409 was not provided. 19 UNK OTH OTH Unknown Cartilage tear in knee A0763805A UNK OTH OTH Unknown The subject's medical history, A0605304A concurrent conditions and co -24 A lyme titerOTH dated 20 May OTH2000 was 163. Alcohol abuse The subject's medical history, A0603918A concurrent conditions and co Diagnostic results: OTH 05 February OTH 2003, Lyme disease Hypercholesterolemia; screen, Bursitis 2.59elbow; LIV, Hypertension; positive; Gout; Gouty A0603038A Lyme synovitis arthritis disease IgG and IgM Western UNK OTH OTH Unknown The subject's medical history, A0600456A concurrent conditions and co UNK OTH OTH Unknown The subject's medical history, A0599980A concurrent conditions and co 2 Autopsy pending PVT PUB None None Heart murmur PUB OTH None Unknown 0 will be seeing PVT allergist UNK No Neurofibromatosis - type 2 1 None PVT PUB UTI; Rx Septra suspension 1 PUB UNK 23 VZV, real time, PVTPCR, positive PVT ATACAND; CELEBREX; PRINVIL furosemide; LANOXIN; PREVACID; synthroid; TOPROL 0 None PVT UNK Tubersol skin None test; Manufacturer, Allergic rhinitis/asthma Sanofi Pasteur; lot # C2908AA; Route/site ID, L 35 PUB UNK None Allergic to Penicillin & Sulfa
1 None OTH OTH High blood None pressure meds; Amoxycillian stomach/Penicillin/ meds Stomach Stufflon (medication); Hig 10 May 2006 MIL 1110; Collect_Sample: MIL Abscess; Bacteriology Results: Light growth of Coagulase negative; Staphylo 0 PVT PVT None None Allergic ICN, Augmentin 0 OTH OTH None 0 None PUB PUB None Eczema; insect Nonebites 0 PVT PVT None 1 CBC normal; PVT UA normal PVT Chronic eczema MIL MIL None Seasonal allergies MIL MIL 2 (Local reaction PVTvs cellulitis) PVT None No No 2 PVT PVT None None 0 None PVT OTH None None None PVT PVT Rash OTH OTH Concomitant medications A0754685A were unknown. It was unknown Hepatitis B OTH antibody, 7000mIU OTH Unknown Concomitant medications A0754688A were unknown. It was unknown 2 UNK PUB PUB Unknown No concomitant medications A0755872A or relevant medical history. N Hepatitis B OTH antibody, Jan2008, PVT negative; ATENOLOL; Hepatitis Unknown PENOFIBRATE; B antibody, No adverse Oct2008, ESOMEPRAZOLE events negative were A0757769A reported with previous vaccinatio UNK OTH OTH Unknown A0753558A UNK OTH OTH OBESE A0753422A 1 PVT OTH Unknown A0752850A 0 OTH PVT Unknown Ear infection; The subject A0752481A drinks two to three drinks per we UNK OTH OTH Unknown A0751461A 0 UNK PUB PUB Epoetin alfa; Dialysis; VENOFER; Hypertension TheEsomeprazole; subject has noAmitriptyline; history A0751452A of adverse Calcium events acetate following pre UNK OTH OTH Unknown A0750849A is the same A0750849A subject as Havrix report A073350 The subject's OTH hepatitis OTH B titer was negative Unknown A0749315A Hepatitis B OTH surface antigen OTH Aug2008 positive Unknown Polymerase Bite;chain The subject's reaction medical Aug2008 A0748855A history, low positive history of adverse even Hepatitis A PUB antibody, 2008, OTH negative; Multivitamin Hepatitis Unknown B antibody, The1998, subject negative; had a non-cancerous Hepatitis A0748000A B antibody, abnormal 2008, papnegative smear 10 0 Unk OTH PVT Unknown The subject had no medical A0747300A history, nor any history of adv 0 UNK OTH OTH Unknown A07466B1B is a suffix A0746681B case. Please reference report A074 0 OTH OTH Unknown A0746681A has a suffix A0746681A case. Please reference report A0 31 Hepatitis A PUB IgM, 28Aug2008, OTH negative; Hepatitis Premature B antibody infant The negative, subject was 28Aug2008, premature A0746640A negative; infant, who Hepatitis had been B surface hospitaliz a 3850 Hepatitis B OTH Aug2008 Negative OTH Unknown The subject's medical history A0746630A and concomitant medications 1 Unk PUB OTH Obesity, Possible The subject Arthritis, hadSuspected a history A0746159A ofTendonitis alcohol use, but no history of 12 Alanine aminotransferase MIL MIL 26Aug2008 Multivitamin; 390unknown VIRAL Ibuprofen HEPATITIS The Alanine subject C aminotransferase had a history A0745772A of substance 28Aug2008 abuse 462unknown and viral he OTH OTH Unknown This report was received A0744258A when the subject, now 11 years o Body temperature OTH 102F OTH Unknown The subjectA0744039A developed malaise and frequent di 21 PVT PVT Unknown The subject had no medical A0743134A history, nor any history of adve 3 Hepatitis B PVT antigen, 04Aug2008, PVT positive; Hepatitis Hemodialysis; B antigen The Hypertension; subject 18Aug2008, had a history negative Renal A0742679A failure of renal failure, hypertension, an 3 Hepatitis B PVT antigen 04Aug2008 PVT positive Hepatitis HEMODIALYSIS, B antigen The subject Type 18Aug2008 had 2 diabetes typenegative 2A0742674A diabetes and was on hemodialysis 5 Hepatitis B PVT antigen, 28Apr2008, PUB negative; EPOGEN;Hepatitis ZEMPLAR; Diabetes; B antigen, Renal The CYMBALTA; subject failure 05May2008, isNEXIUM; hoping Positive. to A0742525A LYRICA; receive The aREQUIP subject kidney transplant was and negative RENAGEL becau for UNK OTH OTH No concurrent Unknown medication The subject has no relevant A0741415A medical history. OTH OTH No concurrent Unknown medication The subject has no relevant A0741414A medical history. OTH OTH No concurrent Unknown medication The subject has no relevant A0741411A medical history 1 PVT PVT TOBRAMYCIN; Unknown MUPIROCIN Allergy; At the same appointment, A0740993A the subject presented w Body temperature OTH 102 OTH F Unknown The subjectA0740779A developed malaise and frequent di 0 UNK PUB OTH Unknown A0740560A Hepatitis B PVT antibody, negative; OTH Hepatitis B antibody, Unknown <9 A0740177A 1 Hepatitis B PVT surface antigen PVT po, 11Jun2008, Positive. UnknownThe The subject subject hadhad a Hepatitis no medical A0739438A B surface history,antigen nor anytest history performed of adve Unk OTH OTH Unknown The subject had no medical A0738699A history. The physician reporte 0 PVT PVT Unknown A0738217A was one ofA0738217A three cases reported by the same 0 UNK PVT PVT Unknown A0738216A was one ofA0738216A three cases reported by the same
0 UNK PVT PVT Unknown A0738213A was one ofA0738213A three cases reported by the same 3 A hepatitis B OTH screen performed OTH onHemodialysis the subjectRenal 02 June failure 2008 was negative. On A0737058A 19 June 2008, the hepatitis screeni Unknown OTH OTH Unknown A0736984A HEPATITISOTH B antibodyOTH June2008 negative Unknown The subjectA0735030A completed a three dose series of H UNK OTH OTH Unknown This event occurred in A0734385A two subjects (two physicians) with c Unknown OTH OTH Unknown This event occurred in A0734383A two subjects with this case, A07348 UNK PUB OTH Unknown The subject had no medical A0728389A history, nor any history of adve 2332 Hepatitis B OTH antibody, 12June2007, OTH Unknown negative A0728370A was one ofA0728370A three cases reported by the same UNK OTH OTH Unknown Concomitant medications A0726130A and relevant medical history wer 0 Blood glucose, OTH03Oct2005, OTH 94mg/dL, MULTIVITAMIN, 74, 106;Unknown Blood IBUPROFEN pressure, 03Oct2005, 140/100; A0725646A Blood pressure, 03Oct2005, B Hepatitis B PVT antibody, negative OTH Unknown The subject's mother isA0725392A HBV positive. 1 UNK OTH OTH Unknown The reporter was not aware A0725103A of any adverse events followin 0 UNK PVT PVT Unknown Subject was healthy and A0724678A was receiving no concurrent med HEPATITISOTH B surface antigen OTH 08Apr2008 positive DIALYSIS, HEPATITIS Subject RENAL takes B surface FAILURE alot of antigen concurrent A0724634A 15Apr2008 medications negative; by the Lab nurse work Did not develop OTH a positive OTHtiter to be considered Unknown a responder to the series. A0724370A Hepatitis B OTH antibody 12500 OTH ; Hepatitis B antibody Unknown <5; The subject recently tested A0724182A and had Hepatitis B antibody leve 149 Hepatitis B OTH antibody 27MAR2008 PUB negative Unknown A0722946A UNK OTH OTH Unknown A0722933A Blood drawn PVT for unknown PVTreason Unknown No known adverse events A0721988A following previous vaccinations. 0 Unknown UNK UNK Inhaler Unknown The subject had a history A0721445A of allergy to seafood. Concomita Hepatitis B PVT antibody Mar2008 PVT negative Obese The subjectThe hassubject no history A0721436A hadofcompleted adverse events a vaccination following series pre 0 Unk OTH OTH Unknown A0719021A UNK OTH OTH Unknown A0718735A A titer was drawn PVT following PVT the second No concurrent dose of Unknown ENGERIX medication The B. The subject titerhad wasno negative. relevant A0718733A medical history and experienc HEPATITISOTH B surface antigen OTH positive Unknown Concurrent medications A0718131A and relevant medical history was Hepatitis B OTH surface antigen OTH positive Dialysis A0717408A HEPATITISOTH B antigen OTH positive Unknown The nurse also reported A0715568A another subject who experienced 3 Hepatitis B OTH antigen 26Feb2008 OTH positive Unknown The reporter also reported A0715564A another subject that experience Unk OTH OTH Unknown A0714402A 0 Unk OTH OTH No concurrent Unknown medication The subject has no relevant A0714361A medical history and no history 1 Unknown PVT OTH Ortho Tri-Cyclen, Unknown Ethinyloestradiol No relevant medical + Norgestimate history A0712781A + Oral contraceptive place b 0 PVT OTH Cyanocobalamin; Unknown Multivitamin Gastric Bypass A0712779A UNK OTH OTH Thyroxine sodium; Unknown Blood Gastric pressure bypass; medication; Pedal A0712491A edema; Ascorbic Tummy acid; tuck; Calcium History: salt; small Thyro 3 Hepatitis B OTH antigen 12 OTH Feb 2008 Positive; Epoetin Hepatitis Alfa, Bladder Paracetamol, B Cancer, antigen Bypass Warfarin 18 Colon Surgery FebCancer 2008 sodium negative. Hemodialysis, Allopurinol A0712014A The subject Omeprazole, Hypertension, testedVitamin, negative Pacemak Alp fo 31 HEPATITISOTH B surface antigen OTH Feb2008 positive; Unknown The subject The subject was HEPATITIS traveled toA0712004A BCambodia core antibody after negative receiving"the his first entire d 5 Hepatitis B OTH surface antigen OTH 06Feb2008 PYRIDOXINE positive; Unknown hydrochloride Hepatitis B surface +; Nicotinic antigen acid15Feb2008 A0710599A +; Thiaminenegative; hydrochloride A hepatitis +; Ribofla Ba 151 Hepatitis B PVT surface antigen PVT 07 Feb(Prilocaine 2008 positive, Unknown Hydrochloride+Ligncaine) Hepatitis B surface antigen Metoprolol 21 A0710597A Feb Flurazepam 2008; A Hepatitis Hydralazine B antigen Fexofe te UNK OTH OTH Hepatitis B Unknown immunoglobulin The subject decclined to A0708836A provide medical history, concomit Results: Reporter OTH did not OTH know what type of testing Unknown was done Concurrent or anymedications quantitative A0708165A and values medical for thehistory subject's waslevels. unknown Re 2 Hepatitis B PVT surface antigen, OTH 11/30/2007, positive; Unknown Hepatitis Reflux B surface symptoms antigen, (NOS) negative; A0706423A Hepatitis B surface antigen UNK OTH PVT Unknown A0706119A UNK OTH OTH Unknown A0704397A UNK PUB PUB Unknown A0703420A 0 UNK OTH OTH Unknown A0702463A Results: hepatitis OTH B antibody OTH titers show no immunity Unknown to hepatitis ReporterB. is at an academic A0702226A health center and report's that Seroprotective OTHtiter of anti-hepatitis OTH B surfaceUnknown antigen antibody Unknown in December 2007 A0700837A showed inadequate protection. 0 HEPATITISOTH B surface antigen OTH ne Nov2007 neg Unknown Relevant medical history A0700836A and concomitant medications we 91 UNK PVT PVT Unknown A0700825A Laboratory OTH diagnostic study OTH performed and titer Unknown was negative. IMMUNOCOMPROMISED A0700017A 0 Unk OTH OTH CLARITIN-D Unknown Allergy, Penicillin Allergy, A0699078A Smoker, Social Alcohol Drinker 1 UNK OTH PUB Unknown No relevant medical history A0698379A and no concurrent medications
UNK OTH OTH Unknown The healthcare professional A0698375A reported a previous case, see UNK OTH OTH Unknown The reporter also reported A0698191A "one-third" of her hepatitis C pa UNK OTH OTH Unknown Unknown A0697307A Six weeks after OTHcompleting OTH the ENGERIX B series, Unknown the subjects Unknown had titers drawn A0697086A which showed no antibodies. Unknown OTH OTH Unknown At the time of reporting,A0697027A the subject's relevant medical hist Unk PVT PUB Unknown HEMODIALYSIS, RENAL A0696124A FAILURE 0 UNK OTH OTH Unknown The subject was born to A0696084A a hepatitis B surface antigen nega 2 OTH OTH Unknown The subject was born to A0696035A a hepatitis B surface antigen nega 0 Hepatitis B PVT surface antigen, PVT 19Nov21007, >1000 Unknown Healthy adult. A0695425A 1 Unknown PVT PVT None Unknown None A0751468A 1 UNK PVT PVT Unknown The subject had no medical A0750456A history and no history of adver 0 UNK OTH OTH Unknown The subject was reportedly A0749271A healthy. 1 UNK OTH OTH No concurrent Unknown medication The subject has a history A0748018A of seizure which occurred this pa UNK PVT PVT Unknown A0747988A UNK PVT PVT Unknown A0747109A UNK OTH OTH Unknown A0746432A UNK OTH OTH Unknown A0746367A 0 Unknown PVT PUB Unknown None A0744305A 1 UNK PVT OTH Unknown The subject at two months A0742470A of age had no history of advers bject of unspecified gender Body who temperature wasPVT vaccinated 103 PUB degreeFahre with PEDIARIX. ; White Concurrent blood Unknown cell vaccinations count A0742011A abnorma given was onone the of same A0742011A threedate cases as PEDIARIX reported byincluded the same A Body temperature PVT 103 PVT Degrees Fahrenheit ; White Unknown bloodThe cell subjects count abnormal were allUnknown treated A0742010A with at least one dose of RO 0 UNK PVT PVT Unknown A0741213A 0 In the emergency PVT room, PVT the subject Nowas concurrent evaluated Unknown medication with EEG, The subject EKG and haschest no relevant x-ray, A0739957A all medical of which history the physician and no history repor Unk PVT OTH Unknown A0738514A 1 UNK PVT PVT No concurrent PENICILLIN medication The Allergy subject has a history A0735433A of allergy to penicillin. The subje 27 UNK PVT PVT Unknown The subject had no medical A0735392A history, nor any history of adve 0 Unk OTH OTH CYSTIC FIBROSIS The subject's medical history A0733440A included cystic fibrosis. The s Unk OTH OTH Unknown The subject had a history A0731257A of fever, screaming, and fussine 3 Unk OTH OTH Unknown No adverse events were A0725174A noted following previous vaccinat 0 Body temperature, PVT 28Mar2008, PVT 102-103degrees MontelukastAllergic sodium; F; Body Rhinitis Ranitidine Gastroesophageal temperature, hydrochloride 29Mar2008, reflux. A0723471A A0723471A 102-103degrees was one F; Body of three tempe ca 0 Unknown PVT PVT GASTROESOPHAGEAL A0723470A was REFLUX one ofA0723470A three cases reported by the same 0 Unknown PVT PVT NASAL CONGESTION None A0723466A Unk OTH OTH Unknown A0722898A UNK OTH OTH Unknown A0721428A 0 Unk PVT OTH MultivitaminUnknown The subject has not previously A0717381A received any flu shots. No 0 Body temperature PVT increased, OTH 103 Unknown The subject has a history A0707255A of an occasional fever. 0 UNK PVT PVT Unknown Relevant medical history A0705229A and concomitant medications we Body temperature, OTH >103.0 OTH Unknown A0703677A 3 PUB PUB Unknown A0702795A 0 Unknown PVT PVT Unknown dietary and dermatological A0701309A sensitivities 0 Unk PVT OTH Unknown No relevant medical history A0694582A and no adverse events followin UNK OTH OTH Unknown A0691523A 992 Hepatitis B PVT antibody 6/12/2007, PVT negative Unknown A0728351A was one ofA0728351A three cases reported by the same 0 OTH OTH Concomitant drug(s) not reported MEDI0007575 0 OTH OTH Concomitant drug(s) not reported MEDI0007579 UNK UNK 2007: Patient had similar MEDI0007590 reaction when the mother's room 0 PVT OTH MEDI0007604 0 OTH OTH MEDI0007613 0 OTH OTH MEDI0007614 0 OTH OTH MEDI0007622 0 OTH OTH MEDI0007637
53 Influenza A,PVT B, 12/15/08, PVT influenza A, positive; Rapid Strep Enterovirus, test, 12/15/08, 11/04,negative; (unreported MEDI0007658 Urinalysis,12/15/08, year) Large Ket 0 OTH OTH MEDI0007660 0 OTH OTH MEDI0007662 0 PVT OTH MEDI0007667 0 OTH OTH MEDI0007674 0 PVT OTH MEDI0007683 0 OTH OTH MEDI0007685 Unk OTH OTH Unknown A0759842A 2 UNK PVT 3 UNK UNK Epilepsy 0 None done UNK - I did not go PVT to the doctor Atenolol, but will Methotrexate, None show her the Penicllin, premarin, scaredKeflex area celebrex at myhydrocholorothiazide, next appointment in February. valtrex 2 PUB UNK None None None 0 UNK OTH OTH Unknown In follow-up, it was reported A0752844A by the subject that he received 27 Labs and Diagnostics: UNK UNK Head CT (-). Paxil, ANA Kolonipin (+).None. CSF cell 2/18/09 count Anxiety. OV WNL from PMH: except 11/22/05 Anxiety/? (+) RBCs. received depression. CSF from glucose PCP. L breast Pt 133. reportedly cyst-remove Blood gluc "do 2 none PUB UNK None None none~ ()~NULL~~In Patient 22 PCOS LABS: UNK video EEG, UNKMRI brain & spine none WNL. CPKAllergy WNL. Alk penicillin phos severe 51(L). PMH: fatigue~HPV Asthma, PAP smear (Gardasil)~1~16~In strepWNL. throat. Patien 1 A blood testUNK was done UNK at the urgent yazcare birthoffice control none for any abnormality none and results were okay. 0 PVT PVT Tylenol mild nasal congestion none crying spell~DTaP + HepB + IPV (Pediarix)~1~ 2 UNK PVT 0 PVT UNK 0 N/A UNK PVT NO IBUPROFEN, SULFA, CODEINE, MACRODANTIN, MILD 2 UNK PVT 4 none PVT UNK Yasmin none nkda 0 PUB UNK none none none fever, chills, SOB, pallor~Smallpox (no brand n 8 PVT PVT none none none 0 MRI showed UNK R hemisphere UNK ischemic None stroke LABS: None MRI None brain abnormal w/right hemisphere ischemic stroke & brain 16 Pt had mid UNK LAD lesion UNK on coronaryNone catherization None requiring None mid Left anterior descending TAXIS(drug eluting) stent p 9 Diagnosed UNK with AutismUNK at the YaleInfant ChildTylenol Study NoCenter's illnesses, Developemental None, no fever developingDisabilities normally Clinic using Mullen Scales of E 1 UNK UNK none none omnicef, peanuts, birth mark left forward(dime size), Medic Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH07625309 was not provided. 7 Labs and Diagnostics: PVT PUB CXR (+) forNone R pneumpthorax, None - normal pneumomediastinum, ? slight allergy 6-10-08; and probable Hx otitis media L pneumothorax. . PMH: PCP record 58 Ultrasound PVT (+) intussusception UNK with recurrence None and surgical None reduction. Secondary Payers patches. 1/21/09-records PVT PUB None None 0 PVT PUB None None NKA 25 PUB OTH SYNTHROID 500mg daily Allergy to Cipro, Pyridium (HYPOTHYROID past) 3 None PVT UNK None None 1 None PVT PUB None None None 1 OTH PVT None listedUnknown; Penicillin; Sulfa; Allergic to bees 0 Dr doing MRI OTH of deltoidPVT to see cause Albuterol, of painADVAIR, and weakness. Spiriva, Asthma; Furosemide, hypertension Alprazolam 6 ESR-22; neutrophils PUB (low) PVT METFORMIN Diabetes 500mg qd Diabetes 0 PVT PVT 0 None PVT PVT None 3 OTH OTH No None 0 CT scan leftMIL upper armMIL 11 days after HCTZ, vaccination lisinopril, None was zocor negative HTN, DM, HLP 2 N/A PUB PUB Vitamin, generic none Zyrtec, seasonal oral contraceptives allergies MO-2009-01 0 None UNK UNK None None None 1 Had two minor UNKoutbreaks PVT of shingles None in 2008,None so dermatologist None recommended vaccine even though I'm not 60. PUB PUB prenatal vitamins client pregnant 0 PVT PVT NONE ZOCOR (MYALGIA), LISINOPRIL (DIZZY), LORATIDINE 0 Development UNK Pediatrican UNK diagnosed encephalopathy None 3/17/09-records none 3/17/09-records received-EEG received-PMH: normal except mild GE for reflux, slow waves exce 17 Her pediatrician UNK has checked UNK her vital Motrin signs, as needed sent noneher for none blood work, did an ultrasound on her heart, and a CT scan
1 Labs and Diagnostics: UNK UNK CT of Chest-no orthocyclenno PE, Hgb 8.3 (L), Hct PMH: 26.2 Obesity, (L).n/a~ WBC hypertension, ()~~0.00~Patient 12.6 (H), 17.0 congestive (H), 16.8 heart (H), failure, 16.0(H), asth RD 1 MIL MIL Unknown None Unknown 1 N/A MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown 1 Unknown MIL MIL Unknown None Unknown NONE UNK UNK I HAVE NO OTHER INFORMATION ABOUT THIS PATIENT OR THE 1 N/A UNK PVT UNKNOWNNO 1 Not Applicable PVT PVT NA NA NA 0 NONE PVT PVT TOPICORTECZEMA HX OF UTIs 1 NONE PVT PVT PROZAC NONE NONE KNOWN 5 Chest x-ray,UNK Breathing UNK not normalAlso acts listed similaraSmall to Rocephin asthma? sinusYes 11/17/2008 passages.Asthmatic she has Maliea and hadalso alot Mainaaupo~Hib at symtoms. of birth difficulty an epidural breathing. (no brand with She name)~4~1~ Duramax. may have Ne 9 none UNK UNK none none none 352 Varicella Zoster UNK virus IgG UNK = 2.49 Pos Varicella Zoster virus IgM = <0.91 Neg 9 LABS: CBC: PUB WBC 13.5, PUB ALC 5500, ANC 6400. NoH/H 13/48, Noplts Family 287,000. Hx: Mom CMP, w/several ESR, ANA, MRSA(+) CRP, RA abscesses WNL. 28 CT scan; EEGs PUB (3); MRIs PUB(3); spinal tap 2/19/09-neurdiagnostic Slight cold report received-abnormal III awake and asleep ele 7 CT Brain, OK MILLABS: CPK OTH1085(H). CK-MB 2.7(N). None LFTs None WNL. Magnesium 2.1. CT head WNL. MRI brain revea 1 Lab - ANA; PVT CBC; Sed rate; OTH X Rays as follows...CXR None + Ultra Chronic sound, sinus Cervical spine AR0901 + Lt shoulder. PVT PVT None 3619 PVT PVT None Eczema 74 PVT PVT PPD Tuber None Sol C2803AA None right PMH: lowerpneumonia, arm 0 doses, bilateral Ferrous forearm Sulfate fractures, varice 1 PVT PVT None None None 0 PVT PVT TAZ NO 1 None PVT PUB None None None None~ ()~~0~In Patient 3 PVT PVT Hypothyroid; chronic pain; fibromyalgia; N; S; fatigue 0 None PVT PVT None None None 1 None PUB PUB None 0 None PVT UNK 1 None PVT UNK None COPD; Hx CVA; Seizure 0 PVT UNK SECLIST CholesterolNone Check up only 24 Labs and Diagnostics: PVT PVT CT scan (-). BIAXIN EKG WNL. Sinusitis Echo WNL. PMH: EEG kidney WNL.reflux MRI/MRA as toddler. of brain T&A WNL. ageGlucose 4. Ovarian tolerance cyst. m OTH PUB ADHD; neuro fibromatosis, type I 0 PVT PUB None No None known 1 PVT PVT OTC for eczema Eczema 0 None PVT PVT None 0 None PVT PVT None None None; previous fainting on blood w/u 9 None PUB PUB None 0 PUB UNK LA090102 33 ANA, ASO,PVT CRP, 3.5; RFU, UNK negative; VaU, negative; None CGB Laryngitis dip, negative; cough,CMR, 4/07 negative; PMH: Mononucleosis. ESR, negativefamily LABS: hx:CB a OTH PUB PVT PUB None None 0 CT of head,PUB WNL; CBC; UNK CMP; X-ray, WNL None None 0 Tx lyme began PVT1/20/09;PVT mono 1/16/09 None None None ~Varicella (Varivax)~2~7~In Patient 0 UNK UNK MIL MIL ASA 0 PVT PVT 3 None PUB UNK Birth controlNone None 0 Unknown. Labs OTH and Diagnostics: OTH Unknown Stress test -no evidence Unknown for EIA PMH: or cardiac Mono disease, WAES0812USA02570 12/07. but tonsillectomy borderline 6/08. VE and Allergy VC O2 to Pap test, abnormal. OTH The OTH patient has Unknown HPV Unknown WAES0812USA02379 Unknown OTH OTH Unknown Unknown WAES0812USA02368 Unknown OTH OTH Zyrtec; Advair; DrugSingular hypersensitivity; Fish allergy;WAES0812USA02360 Shellfish allergy
-12 diagnostic laboratory OTH 12/03/08 OTH - complete DEPO-PROVERA metabolic Asthma;mg panel Otitis media plasma recurrent; TSH 12/03/08 Allergic WAES0812USA02344 -reaction complete toblood antibiotics; cell 12/03/08 Drug hy 0 Unknown OTH OTH Unknown Unknown WAES0812USA02177 0 Ultrasound OTH normal - Prenatal OTH testing Repliva including 21/7, Pregnancy ultrasound Zofran, Vitamins Surgery NOS has been (LMP= normal. 1/27/2008) Diagnostic WAES0810USA05371 Drug hypersensitivity: laboratory 04/11/08 Crohn's - norma dis 34 Ultrasound,OTH 04/23/08, Routine OTH test-Within normal Pregnancy limits; Ultrasound, NOS (LMP=07/07/08, 2/9/2008Routine WAES0809USA01795 test. Within normal limits; Ur 0 Ultrasound,OTH 5/2/08 OTH Unknown Pregnancy NOS (LMP= 11/21/2007) WAES0805USA00593 75 ultrasound, OTH 9/12/08, within OTHnormalMETHYLDOPA limit; ultrasound, Pregnancy mg; 07/28/08, PROTONIX NOS within (LMPmg = normal 3/11/3008) limitWAES0804USA04002 Hypertension; Dyspepsia None PVT PUB None WAES0804USA00010 245 Ultrasound,OTH BiophysicalOTH profile, within Allegera-D; normal Pregnancy limits; Meclizine; Ultrasound, Smoker Vitamins Nos (LMP 10/14/2008, = 1/30/2008); within WAES0803USA00972 Asthma; normal Sulfonamide limits, small for allergy; dates,Sea P 40 Diagnostic laboratory, OTH pre OTHnatal care Unknown panel; Ultrasound, Pregnancy Cholecystectomy; 02/07/08, NOS (LMP5 =week 12/18/2007); 6/7 Smoker; day; WAES0802USA04664 Amniocentesis, Asthma Glioblastoma multiforme 04/25/08, 17 w 0 None OTH OTH Unknown Unknown WAES0812USA03380 0 None OTH OTH Asthma WAES0812USA03339 31 Unknown OTH OTH Unknown Unknown WAES0812USA03231 21 None OTH OTH WAES0812USA03225 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0812USA02823 None OTH OTH None Drug hypersensitivity WAES0812USA02818 0 body temp -OTH fever of 102.6F OTH Pregnancy NOS (LMP = Unknown) WAES0812USA02787 0 Unknown OTH OTH Unknown Unknown WAES0812USA02632 diagnostic laboratory OTH -OTH DNA negative NUVARING for HPV diagnosticNone laboratory - 11/??/08WAES0812USA02627 - HPV test positive Pap test - no Unknown OTH OTH Unknown Unknown WAES0812USA02624 Pap test 10/01/08 OTH - abnormal; OTH Pap Unknown test - 2ndPregnancy pap smearNOS results (LMP are=pending Unknown) WAES0812USA02612 0 Unknown Labs UNKand Diagnostics: UNK CBC WNL. CRP (-). LPUnknown. with normal PMH: cell noneWAES0812USA02603 count, protein and glucose. CSF cx (-). M Unknown OTH OTH YAZ Allergic reaction to antibiotics WAES0812USA02593 0 Unknown OTH OTH Unknown Unknown WAES0812USA04118 8 None OTH OTH None None WAES0812USA04111 0 None OTH OTH None Penicillin allergy WAES0812USA04110 0 None OTH OTH None None WAES0812USA04104 0 Unknown OTH OTH Unknown Unknown WAES0812USA03784 6 None OTH OTH None None WAES0812USA03782 None OTH OTH None Idiopathic thrombocytopenia WAES0812USA03779 0 EndoscopyOTH OTH Hormonal contraceptives. Unknown WAES0812USA03770 Unknown OTH OTH Unknown Unknown WAES0812USA03750 0 Colposcopy, OTH 12/03/08,OTH results showed Unknown high risk HPV Unknown WAES0812USA03738 233 Unknown 2/4/09-records OTH OTH receivedUnknown HA. Holter monitor normal Unknown EEG normal withWAES0812USA03713 mild swelling of background. Chem None OTH OTH Hormonal contraceptives. None WAES0812USA03685 Urine beta-human, OTH Negat OTH Clindesse Seasonal allergy WAES0812USA03609 Unknown OTH OTH Unknown WAES0812USA03414 None OTH OTH None Unknown WAES0612USA03385 Unknown OTH OTH Unknown Unknown WAES0812USA04585 Unknown OTH OTH Unknown Unknown WAES0812USA04584 Unknown OTH OTH OMEGA-3, vitamins (unspecified) Unknown WAES0812USA04554 None OTH OTH None None WAES0812USA04543 Unknown OTH OTH Unknown Unknown WAES0812USA04513 0 Unknown OTH OTH Unknown Unknown WAES0812USA04291 4 Unknown OTH OTH Hormonal Contraceptives Dermatitis contact WAES0812USA04284 0 Complete blood OTH cell OTH Influenza virus Sickle vaccine cell anemia WAES0812USA04280 0 Unknown OTH OTH Unknown Unknown WAES0812USA04272 50 Magnetic resonance; OTH diagnostic OTH laboratory, None blood tests; electroencephalography; None WAES0812USA04270 cerebrospinal fluid Unknown OTH OTH Unknown Unknown WAES0812USA04263 0 None OTH OTH Unknown None WAES0812USA04143 0 blood pressure OTH- was low OTH None WAES0812USA04134 Unknown OTH OTH Unknown Unknown WAES0812USA04131
Unknown OTH OTH Unknown Unknown WAES0812USA04119 1 OTH OTH None None WAES0812USA05232 Unknown OTH OTH Unknown Unknown WAES0812USA05223 39 Unknown. Labs: OTH StrepOTH test (-). CBC Vitamins and Chem (unspecified) unremarkable. TSH normal at 2.13. WAES0812USA05222 AM Cortisol low at 7.1. Lyme (0 None OTH OTH Unknown Unknown WAES0812USA05150 1 None OTH OTH Thyroid Hypothyroidism WAES0812USA05125 15 Serum beta-human, OTH 12/??/08, OTH Positive None Papanicolaou smear abnormal WAES0812USA05115 106 Magnetic resonance, OTH ?/?/08, OTH negative results; computed Penicillin axial, ?/?/08, allergy negative PMH:WAES0812USA05114 constipation. Yaz contraception. A Unknown OTH OTH CLONAZEPAM; Depression YASMIN; METHYLPHENIDATE; WAES0812USA05103 TRAZODONE HYDROCHLOR None OTH OTH None None WAES0812USA05034 0 None OTH OTH ALBUTEROL; Asthma ADVAIR WAES0812USA04902 Unknown OTH OTH Unknown Unknown WAES0812USA04828 1 None OTH OTH LEXAPRO None WAES0812USA04823 None LABS: OTH MRI & US OTH of bilateralNone breasts c/w right cystNone PMH: Asthma inWAES0812USA04815 childhood, appy, umb. hernia repai Beta-humanOTH chorionic,OTH 12/04/08, positive, Unknownhome Pregnancy, pregnancy NOS (LMP= unknown)WAES0812USA04777 0 None OTH OTH None None WAES0901USA00023 Unknown OTH OTH Unknown Unknown WAES0901USA00012 Unknown OTH OTH Unknown Unknown WAES0812USA05266 0 None OTH OTH Unknown Unknown WAES0812USA05263 0 None OTH OTH Ocella Asthma; Hirsutism; Polycystic WAES0812USA05239 ovarian syndrome -6 Unknown OTH OTH Unknown Unknown WAES0901USA00735 0 Unknown OTH OTH Unknown WAES0812USA04863 Unknown OTH OTH Unknown Unknown WAES0812USA04847 79 diagnostic laboratory OTH - OTH ClostridiumUnknown difficile test; negative;Birth diagnostic weightlaboratory low -WAES0812USA04810 Rotavirus test: positive for rotavirus 0 Unknown OTH OTH Unknown Unknown WAES0812USA04738 0 Unknown OTH OTH Unknown WAES0812USA02697 0 physical examination, PVT well PVTchild Unknown Unknown WAES0812USA02608 Unknown OTH OTH Unknown Unknown WAES0812USA02152 0 Unknown OTH OTH Unknown WAES0812USA02054 stool analysis OTH - Rotavirus OTH was detected Unknown Unknown WAES0812USA02028 0 Unknown OTH OTH Unknown Unknown WAES0812USA01781 0 Unknown OTH OTH Unknown None WAES0812USA01749 4 Unknown OTH OTH Respiratory distress; Apgar WAES0812USA01223 score low; Hyperbilirubinaemia 2 N/A PVT UNK N/A None None 0 UNK UNK Including: some cross-pollen allergies to food thought to be PVT PVT PVT PVT PVT PVT 1 PVT PVT NONE ORDERED, PUB HOWEVER PUB CONTACTED PRESCRIBED VIRAL MANUFACTURER DURING INFECTION DENIES VIST SALINE 079.99 FOR N/A~ STABILITY NASAL ()~NULL~~In SOLUTION STUDIES Patient|N/A~ 0.65%, AND ADDITIONAL ()~NULL~~In NASALLY, TIN S NONE ORDERED. PUB HOWEVER, PUB CONTACTED CHILDREN'S OTITIS MEDIMMUNE TYLENOL MEDIA DENIES 160/5ML 382.9; FOR N/A~ GENU STABILITY ()~NULL~~In VALGUM STUDIES 736.41 Patient|N/A~ AND ADDITIONAL ()~NULL~~In INFO S PUB PUB None MIL MIL active eczema back of neck 264 n/a MIL MIL None No illness just N/Anormal reaction to smallpox 2 UNK UNK Meds Stan NONE Takes: Flomax High 0.4mg blood pressure, one daily.benign Benicar prostate, HCT 20/12.5 high cholesterol. one daily. Ge 3 MIL MIL NO NO PCN 2624 NONE PVT PUB NONE NONE 178 PVT UNK unknown none none 4 PVT PVT Iron supplement 0 PUB PVT No No None No~ ()~NULL~~In Patient 2 NONE PVT PUB NONE NONE NONE
0
PUB PVT Ursodiol 300mg none PO reported tidfatty liver allergic-Ceclor NONE ORDERED, PUB HOWEVER, PUB CONTACTED N/A n/aMEDIMMUNE ventricular MFR.sept n/a~ FORdefect ()~NULL~~In ADDITIONAL 745.4 Patient|n/a~ INFORMATION ()~NULL~~In ON STAB S 1 EEG, CBC/diff/CA/Magnesium/Neurology PVT PVT Zantac 15/1 appt. none 0.9ml tid Gastroesophageal Reflux 0 myoclous seizures; UNK CTUNK scans, MRI, full body X-ray, None eeg; None nerve 2/6/09-records conduction None~ test ()~~0~In received-PMH: (pending Patient 1/23/08) fibromyalgia, 2/6/09-records hyperlip re 0 PVT UNK zyrtec, topamax No Dubowitz Syndrome,developmental delay, seizure disorde 1 PVT UNK None None 1 LABS: WBCUNK 13.1(H). ESR UNK 4(N). none none allergy to Bactrum Lindseyand D Hawkins~HPV Ceclor PMH: (Gardasil)~2~25~In bronchitis, pneumoniP 0 None PVT PVT 2 PVT PVT n/a n/a n/a 1 none UNK UNK none asthma SC0902 0 PVT PVT None No None 240 4/7/09-pathUNK report received-multiple UNK Nasonex tissues (Pseudovent with Went extensive in for Seasonal sinisitus, 400 autolysis substituted and allergies. none~ and had bacterial for()~~0~Patient|none~ aEntex sore Nonethroat. overgrowth. 400 other. 120 She capsule),Claritan, had Molecular ()~~0~Sibling bad sinus evidence allergie Triam 5 None yet -- PVT EEG ordered PVT None None Possible previous milk allergy. Pre-auricular skin tag. 1 none PVT PUB dysuria none vaginitis - refused exam 1 CBC; WBCPVT 19.7 PVT Allergy ZITHROMAX UR1 - Allergic given 1/7 rhinitis. FORURX 2 Referred toMIL neurology for MILevaluation. None None None 0 OTH PVT HYTRIN; MOBIC; Inflammation; MEDROL; None HTN(p/u at time of vacc) 0 PUB PVT None 1 PVT PVT None RAD (seasonal) 0 PVT PVT PVT UNK 0 PVT PUB None None NKDA 0 PVT PUB None None known None Known 1 PVT PVT Physical DKA?; Hypothyroid; fibromyalgia; erythromycin; penicillin; 0 Ultrasound,OTH 07/31/08, 10 OTH week 5 day Adderall gestational tablets; Pregnancy age Hormonal fetus NOS with contraceptives (LMP positive = 5/15/2008); cardiacWAES0901USA01598 activity; Penicillin Diagnostic allergy laboratory, 07/3 17 Beta-humanOTH chorionic,OTH 04/15/08, positive None Pregnancy NOS (LMP = 3/3/2008)WAES0804USA03264 67 Stool Giardia OTH lamblia, 12/23/08, OTH negative; None WBC count, 12/18/08, None. PMH: 7.3 thou; noneRed WAES0901USA01174 blood cell count, 12/18/08, 4.73 mill 2 Unknown OTH OTH Unknown WAES0901USA01835 Unknown OTH OTH None None WAES0901USA01603 unknown OTH OTH Unknown Unknown WAES0901USA01746 5 None PVT PVT Iron None Anemia 4 OTH OTH MARLME; ZPAK; CHERUTUSSIN 4 None PVT PUB Allergies 8 PVT PVT None KNDA, HTn 0 diagnostic laboratory, OTH showed OTH a small Noneblood clot None WAES0901USA01749 30 CBC with diff, PUB ESR all pending. PUB 2-EPIPEN; ANA; AntiKRH; DNA; None PENICILLIN; CPK; Allergy Chem screening Penicillin; Allergy Bee Bee LABS: Allopry sting; all WNL Asthma out grew PMH:multip 0 PVT OTH LIPITOR; ACCUPRIL; HTN; PREVACID; GERD;ASA GLUCOSE intolerant; TB exposure; PT conv 0 Febrile seizure; OTHURI, day PUB of immunization URI, minor 0 None PVT PUB None None 1 None PUB UNK None None None 1 PVT UNK None None 0 Unknown OTH OTH Unknown Unknown WAES0901USA01755 4 Unknown OTH OTH Unknown Unknown WAES0901USA01301 ation to underarm; motion was abnormal OTH seen at MIL TMC by medical PPD; Sanofi provider None Pasteur; 16 Jan C2912AA; 09- Rx BENADRYL Right Forearm; & Ibuprofen 13 Jul 2000; 5 Jan 2009 9 T, 98.8 degrees, OTH oral MIL 7 X-rays, normal PVT PVT None None 0 beta-humanOTH chorionic, OTH positive Unknown Pregnancy NOS (LMP = 12/1/2008) WAES0901USA00165 OTH OTH LAMOTRIGINL; NoneCONEPRAZOLE; None None LITHIOM; prior to L-THYROXINE; now~ ()~~0~InTOPOLINAX Patient 61 UNK OTH OTH Unknown R0001587A 9 OTH MIL None NKDA 1 CBC, WNL;PUB Blood C+S, PUB Pending; TYLENOL; BMP, WNLNo MOTRIN 1/29/09-records None received-RSV negative. Influenza A and B negative.
12 Abdominal PVT X-rays; blood PUB count; blood NoneculturesNone (Emergency Congenital Room). talipes 1/29/09-records equinovarus ME00209 received-CT 1/29/09-records scan demonstrat received-P 2 2/5/09-records PVTreceived-EEG PUB positive Nonefor abnormal Dry cough left temporal 2/5/09-records None 2/5/09-records partial UTI~Vaccine received-Rhinorrhea, seizurereceived-PMH: activity. not specified MRI brain congestion UTI (noand normal. brand seen for name)~1~ CBC in 1 day ED WB fo a 1 UNK UNK The patient had surgery to remove ### cysts (location not spec Unknown OTH OTH Unknown Unknown WAES0901USA02129 0 Unknown OTH OTH Unknown Unknown WAES0901USA02073 0 None OTH OTH None None WAES0901USA01962 Unknown OTH OTH Unknown Unknown WAES0901USA01834 2 None OTH OTH HYDRODIURIL; Hypertension PRINIVIL WAES0901USA02001 0 Unknown OTH OTH None Pregnancy NOS (LMP = 3/24/2008) WAES0901USA01992 116 LABS: pH 6.8(L), PVT CO2 UNK 5(L), K 5.3(H), glucoseNone 487, CT head NoneWNL. PMH: URI, allergic rhinitis, impetigo. 6 MRI showed UNK numerousUNK small white Cymbalta matter T2 - uncertain lesions. ANA dates History positive, and ofdoses depression. elevated D-dimer, PMH: RAD. normal Seasonal CSF. Labs allergies. and Diag de 0 UNK UNK NONE NONE NONE 1 PUB PUB NO 610 Stool 1/27/09-records UNK received-Blood UNK culture negative. Fecal leukocytes positive with some bloody yeast cells.Stoo 1 none PVT PVT Current medications:Ultram,Allegra none D 1 UNK PVT 8 None performed. UNK UNK Simvastatin,Minor Fosamax, cold with Hyperlipidemia, Lisinopril, nasal congestion multiple hypertension, vitamin, calcium osteoporosis with vitamin D 2 As listed above, UNK all tests UNK returned Infant's negative. acetaminophen Allergist None performed None given no after tests. immunizations. Tri-Vitamin (Rugby), given onl 0 PUB PUB None No Illness at NONE time of Vaccination NONE~ ()~NULL~~In no illness prior Patient to Vaccination. No pre None MIL MIL Pt is pregnant- 33+3 weeks 0 Went to family UNKchiropractor UNK for adjustment and also to ob/gyn for breast exam 0 monitored blood UNK pressure UNKand heart none rate and none monitored behavior none 1 UNK PUB 0 PVT PUB none. PVT PUB Tylenol .3mlnone PO Child under age of , received wrong vaccine sh 0 Chest X-rayMIL MIL None Common cold-afebrile No previous allergies 8 none PVT PUB none none none 0 PUB PUB 1 PVT PVT 2 none PUB PUB none SC0903 1 PVT PVT 0 None None None PVT PVT LEXAPRO;Otalgia LODRANE-D allergies Depression; Amoxicillin Allergy 11 PVT UNK 1 None PUB UNK Zantac None 3371 PVT PVT 2 None PVT PUB CLARITIN; None ALBUTEROL None 13 PVT PUB None NKA 0 Reaction toPVT MMR vs. viral PVTillness None None None 0 None UNK UNK None 8 PVT PUB Recurrent fevers 1 PVT PUB Fluoride None h/o bronchospasm in the past but no recent flares. 1 URI- No labs PVT PVT Cough & URI - 12-23-08 otherwise neg. None PVT PVT None None None 1 OTH PVT None Thyroid, allergies to grass, high blood pressure 11 MIL MIL Denies 0 Cx oral Trach PVTsecretions PUB where green stain Mg No (mixed flura Gotticweb only). + Tractu story 2 PVT PVT None MINOCYCLINE (rash) 0 PVT PVT None, Routine None 0 PVT PVT None None 0 CAT scan; ER PVT PVT None Stress overSeizure last several disorder; months migraines, non in 15 years; multiple med 0 PVT PVT None
0 CBC; Bld CX; PVT UA; UCX; PVT CXR 3 MIL MIL denies denies None OTH OTH ZOLOFT; FLEXERIL; None CONESTA; None REFLEN 0 12.4; 3.5; 40.2; PVT 353; 76,s; UNK22,L; 2,M BACTRIM Infected ankle left leg swelling~DTaP (no brand name)~5~5~I PVT PVT 1 PUB PUB None None 0 PUB PUB None None None OR200901 None PVT PVT None None None PVT PVT None None None 1 OTH PVT None notedNone known 1 OTH PVT Unknown LABS: OTH H/H 11.8/32.7(L). OTH Unknown Chemistry WNL. Prolactin Unknown 37.46(H). PMH: Family VideoWAES0901USA01809 EEG hx: seizures. WNL. 0 Diagnostic laboratory, OTH 01/15?/09, OTH rapid Ciprofloxacin influenza Urinary test tract negative; infection Diagnostic laboratory, WAES0901USA02024 01/15?/09, mononucleosis te 0 Unknown OTH OTH Unknown Unknown WAES0901USA02577 0 Stool culture, OTH 01/08?/09, OTH positive for rotavirus Gastrooesophageal reflux WAES0901USA01952 disease 3 Stool occultOTH blood, positive; OTH Stool rotavirus antigen, positive Unknown WAES0901USA02002 Spinal tap, OTH ?/?/97, diagnosed OTH withUnknown multiple sclerosis; serum None measles Ab, ?/?/97,WAES0901USA02731 negative; serum mumps Ab, ?/?/9 0 EpinephrinePVT given IM @ PUB 1615 Hx milk prior-allergy None~ ()~~0~Patient asID08048 infant resolved. Lx ALTR cano w/r PUB PUB None Redness, Swelling~Measles ID08041 + Mumps + Rubel 1 None PUB PVT PDD, Sanofi None Pasteur, C2908AA, None ID, LMF, 0 ID08042 0 PUB PUB None Enviro. allergies / diabetic D08043 0 EKG done- PUB No abnormal UNK results reported to patient Denies Later ID08044 0 PUB UNK None None ID08046 1 N/A PUB PVT CRESTOR None None 1D08047 1 None PUB OTH None None None PMH: left axillary abscess, resolved; left ankle swelli 2 OTH PUB None 0 PVT PVT None None except codeine. 0 CBC, Pt, PTT PVT labs ordered PVT to check None for platelets None & clotting. None See attached lab report. 0 PVT PVT Prevacid 15mg None1 pkg oral Gastric bid Ulcer Hospitalization~Hep - GERD - Failure toBThrive (no brand name)~NULL 1 none UNK UNK None None None 2 UNK UNK Oral birth control-not None. specified. NKDA. Lyme Dz at age 16. No residual effects at time of PVT PUB NONE 1 UNK UNK 0 PVT UNK none none PR-09-01 1 n/a UNK MIL None None None 0 UNK UNK N/A N/A None none PVT PVT none none none 0 PVT PVT none none none 2 RIFA-neg. pulse PVT ox 98% PUB none URI/left otitis preemie media 57 surgery for UNK intussusception UNK LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS. 0 PUB PVT Vitamins only:Time-released None Pt saysMultiple she hasVitamin, a condition D3, Niacin, she refers Glucosamine, to as a compromise Calcium 1 None UNK UNK None None reported NKA None reported~ ()~~0~In Patient 8 PVT UNK no 4 See recordsPUB from hospital UNKLABS: None Initial: sodium Well171(H), infant Prematurity BUN/creatinine PMH: 86/1.4(H), 36 weekPT/INR preemie, 21.9/2.4. no prenatal ABGcare. abnorm Fa 5 PVT UNK None None None PVT UNK None None 1 PVT PUB 1 None PUB UNK FLUOXETINE,10mg; TRAZADONE, NKDA 50mg 11 not known OTH PVT None None OTH OTH None 6 None PVT UNK ADHD, Asbeyer's, Edema
0 None 1 None 10
PVT PUB None None None PVT PUB Zithromax, Zantac GERD, Febrile Seizures PUB OTH None (except None vitamins)Diagnosed with Lupus about 10 years ago PVT PVT None None UNK UNK 1 The patientUNK reported a UNK shift in WBC (white blood cell) count. The patient had received a typhoid ### shot eight months ago. Not reported UNK UNK The patient had no known history ### and had not been ill at th 3 None UNK UNK COUMADIN; Lisinopril;No TOPROL Known XL; allergies. ZETIA; History TRICOR; of### atrial simvastatin; fibrillation;and hyperchole Sertralin 0 Not reported PUB PVT LOVASTATIN; ACTONEL; The patient MVI; Calcium had a medical supplement history ### of hyperlipidemia, osteop 1 None OTH OTH The patient had not been taking ###any concomitant medicati 1 No tests where PVTdone atUNK the time. no no no 0 Patient states UNK no tests PVT or labs done. Metoprolol er None 50 mg High blood Hydrochlorothiazide pressure 12.5mg 0 CAT scan -UNK Neg. UrineUNK - neg Numerous different N/A blood tests Milk allergy done inand both acid ERreflux. and doctor's PMH: GERD. office - Cow's negative milkFlu sens te 0 Labs: CBCUNK with WBC UNK 13.4-89% neutros. Glucose 167. AST PMH:55. none Alk phos 155. CPK 1119. 0 NA PUB PVT Unknown No Unknown 11 No test done. PUB UNK Tricor, Lipitor none none 9 UNK UNK none none 1 Not reported OTH OTH History of tonsillectomy. ### 0 See enclosed PUB labs andPVT MD report None None Allergies: MSG, aluminum hydroxide, PCN, ASA, Sulfa, Eg 1 MIL MIL Insulin; multivitamin; No ZOCOR Flu shot & pneumonia Extreme fever shot; almost diabetes; hospitalized~Influenza high BP & Cholester (n 11 UNK UNK Patient has a history of non-Hodgkins Lymphoma, but it wa UNK UNK Had the shingles vaccine-ZOSTAVAX-around 1/7/2009-had outbreak on arms ch PVT PVT 1 None PVT PVT None None None 0 PVT PUB None PMH: allergy to Flu vax. PUB PVT AVANDAMET 3 PVT PVT LOVAZA; ZETIA; None BENICAR High Cholesterol; HTZ Triglycerides, High Blood pressure; MS, 11 PVT PVT None None 1 None PVT UNK Allergic rhinitis; Diabetes; HTN; esophageal reflux 0 PVT PVT None Chronic Otitis Contact MediaDermatitis + Esophageal Reflux 14 PVT PVT 1 PVT PUB 3 PVT PVT None None 0 None PVT PVT Aspirin; atenolol; Knee osteoarthritis; CELEBREX; Pulmonary VYTORIN; atrial toxicity fibrillation; THYROXIN; WAES0812USA00347 paroxysmal COUMADIN atrial tachycardia 2 Unknown OTH OTH Atenolol; ADVIL; NASONEX; Unknown TRAZODONE hydrochloride WAES0901USA02460 0 None PUB PVT Anti-Itch Cream None Itchy Rash~Pneumo (Pneumovax)~2~69~In Pa 0 Refused PUB PUB none no none 1 PVT PVT none none 0 UNK PVT None No PMH: None ALGS: PCN, SULFA, Keflex 0 PVT PUB UNK PVT None 4 EEG, ChestUNK X-Ray, Blood UNKpanel, urine all normal None 3/3/09-records None received- Bicarb 17, labs WNL, chest x-ray norma 174 chest x-raysUNK and cbc LABS: UNK CXR abnormal &n/a c/w LLL consolidation. amoxycillin and Blood augmentin c/s neg.PMH: pneumonia x 2. last one 0 None UNK PUB None None NKDA Heart murmur and asthma dx 2007 2 PUB PVT 1 PVT PVT 3059 NONE PVT PVT NONE NONE NONE 27 LABS: CSF:WBC UNK 1, glucose UNK 76, protein unknown 52(H), no c/s known neg.illness CBC: lymphs unknown PMH: 100%. HTN.CT PUD, chest/abd/pelvis esophageal stricture, abnormal. empyem Stoo 2 Labs and Diagnostics: UNK UNK NCS?EMG WNL. urine toxic metals PMH: WNL. Pineal Urine tumor. Mg++ B12 high Deficiency. at 230 andHypothyroidism. 307. allergy tests Fatig ( 0 Was told it was PUBprobably PUB due to Rotateq none reports none na 0 PVT PVT Pulmicort 2None puffs Inhaled Asthma, one hour Atopic before dermatitis, vaccination. sinusitis, Claritin migraine readitabs headaches 1 hour bh
2 None PUB PVT Unknown None known Unknow 1 UNK UNK sore throat, afebrile, Strep test negative. 0 UNK PVT 6 Referred toUNK her Personal UNK Physician HCTZ, Omeprazole Mild uri allergy to Sulfa, Hypertension 0 EKG in ERUNK showed IRBBB UNK and tachycardia. None at theNone Echocardiogram time of vaccination. None. and PMH: CXR EIA. negative. T&A. allergic Labs and to beestings. Diagnostics: EP study 0 None/2009PVT PVT None None None 1 PVT UNK None 1 MIL OTH Synthroid, Sera Vent, Singular, Asthma Metformin PVT PVT None PVT UNK None 1 None PUB UNK None None 1 None PVT UNK None None 2 None PUB PUB None None 1 None PUB OTH None None None None PUB PVT None None 0 CAT scan and PUBMRI, negative UNK None 0 None PVT PVT None None 11 None PVT PVT None Rad, Pneumonia, Constipation PUB PUB TB skin test; Aventis; C2679AC; Jaundice of L Fore newborn/Anemia Arm, 1 Dose.S/P I & D at age 8m 0 PUB PVT None Seen by physician - possibility KS200825 of egg allergy VS viral illnes 1 None PVT PVT Advil 800 TID; Recovering LISINOPRIL NKDA from10 leftmg rotator QD; cuff Simvastatin surg. KS200823 40 mg QD; METFORMIN 500 0 PUB PVT None None KS200822 1 None PUB UNK None Allergic to Penicillin KS200816 1 PVT PVT None None KS200815 0 None PUB PVT None None None KS200814 2 None PUB PVT None None None KS200813 2 PUB PUB No other medications None None KS200811 0 PUB PVT fainting Fainting at sight of blood K5200810 None PVT PVT None None None 1 Pt states basic OTHlab test,OTH viral load and Synthroid; thyroidLexapro Puncture evaluationwound by Allergies: Dr.(R) foot Levaquin; due to PMHX: a fishingHypothyroid; hook 2 daysAnxiety prior 1 PVT PUB None None Allergy to Codeine - both KS200809 Birth defects - medication 0 November 15th PUB 2008 (+) OTH Pregnancy Dec test 1 2008 (1st test) KS200826 0 PUB PUB None None KS200824 3 None PUB PVT Lipitor 1/2 TAB None None KS200821 0 None; BP, 109/66; PUB P, 56 PUB KS200820 0 PUB PUB KS200819 1 PUB PUB None KS200818 0 PUB PUB None None KS200817 0 PUB PUB None None KS200812 1 UNK PUB KS200808 0 PUB PVT None None KS200807 PUB PUB None None KS200806 1 PUB PVT None None None KS200901 0 Chest X rayPUB - RSV- Neg PUB Marked No KS200902 104 None PVT PVT OrthocyclinNone None 523 PVT PUB None None None None PUB PUB None None None 0 PVT PVT None None 11 OTH PVT No No No 1 PVT PVT None PVT PVT
PVT PVT None GERD 1 PUB PUB None None Fainting~HPV IA090001 (no brand name)~1~15~In Patie 0 PUB UNK Mantoux, Sanofi HIV+ Pasteur, HIV+ C2920AB, L forearm, no previous doses; MOTRIN, PR 1 OTH PVT None 0 PVT PVT None None None PVT PVT Multivit; Calcium None & D; Fish NKDA oil 2 PVT UNK synthroid, verapamil, Hypothyroidism lisinopril no physician as a result diagnose of a thyroidectomy, allergies; thyroidectomy high blood pressure. in the early 0 Unknown PVT PVT ENALAPRIL It was unknown if the subject had ### any illness at the time of 7 MRI, CAT scan OTHand "numerous OTH testing PRILOSEC procedures"; however The patient no results hadwere no concurrent provided.### illnesses LABS: MRI at the head/orbits time of vacc do 0 Oxygen SatPVT 98% on room PUBair. The patient had no illness at the ###time of vaccination and no 5 Unknown LABS: OTH CT brain OTHc/w cerebral edema. MRI brain Unknown abnormal & c/w ADEM. WAES0901USA02427 MRA head & neck & MRI of spi 158 LE cell, positive OTH for lupus OTH Unknown Unknown WAES0901USA03131 5 Unknown 2/9/09-records OTH OTH received-Laboratory Unknown tests WNLUnknown except for2/9/09-records potassium elevated. WAES0901USA03143 received-History Fecal leukocyte of formula stainintole nega diagnostic laboratory, OTH elevated OTH deoxyadenosine Unknown ADA nucleotides deficiency Recurrent and homozygosity respiratory tract WAES0901USA02676 for the infections; Leu 107>Pro Oral candidiasis mutation inrecu AD 8 CT head, slit MIL lamp evaluations, MIL fluorosein advair, albuterol, staining none prestiq asthma 0 UNK UNK 0 3.6 wbc, 12.8 UNK hg, 38.8 UNK hct, 383 platelets, alt 18, ast 35. hypospadias, ambiguous genitalia. PMH: hypospadias. c 0 PUB PUB 0 PUB PUB none listed none listed Mom reports sibling SulfaElizabeth~Tdap allergy (Adacel)~1~16~In Siblin 78 Bloodwork in UNK October and UNKDecember Armour 2008Thyroid, and n/aJanuary Yasmin, Hypothyroidism 2009 Nuvaring by Dr. Records Familyreceived hx: DM.05/07/09 HPV #2 -Lot LABS: # 0570X, Thyroglo giv 4 PVT PVT 0 PUB PUB none listed none listed Mom reports sibling-Kathryn~Meningococcal history of Sulfa allergy from childhood (Menactra)~1~ 0 PVT UNK zoloft, metformin, no diovan 1. Type II diabetes mellitus 2. Dyslipidemia 3. Osteoarthriti 1 None UNK PUB Aspirin 81mg., nasal Oscongestion. Cal Allergies: 500mg. every Aricept, day,CardizemCD Azulfidine, Past 120mg.every history of Gluten day, Lexapro Sensiti 0 UNK UNK none none none 0 UNK UNK none none none 5 UNK UNK Positive for MIL PregnancyMIL Nuvaring, Sertraline NONE HCL Allergies of Restoril, and wellbutrin. History of Depression 2 UNK UNK no Known no known no known 22 quit taking all PVT other medications PVT and adderall symptoms 20 none mg still xr persisted. and femcon none labfework was done to draw igE levels to diagnosis sh 0 PVT UNK Not the administrator none ofnone~ the vaccine. ()~NULL~~In May have Patient been reported by the v 2 None PVT PVT Toprimal Cariva NoneBCP None NC09008 PUB UNK 1 None OTH PVT None None None 0 PUB UNK None PVT OTH 2 None PUB UNK None None None 1 None PVT PVT None None AMOXYCILLIN 1 CBC, Normal; PVTStrep, Negative UNK None 0 None PVT UNK None None 2 PVT PUB NO NO 3 Stool was negative PVT for PVT salmonella, shigella, rotavirus, campylobacter, and e. coli 2 UNK PUB None UNK UNK 1408 none PVT PUB none none knownnone 307 Unknown PVT OTH Unknown Unknown WAES0901USA03149 10 magnetic resonance, PVT Left OTH shoulder; suggested Drug degenerative hypersensitivity; changes Diabetes mellitus; WAES0811USA02650 Asthma; Hypolipidaemia; Go 0 Unknown OTH OTH Unknown Rhinitis allergic; Asthma WAES0811USA02652 Unknown OTH OTH Unknown Hospitalisation WAES0901USA03112 0 Serum beta-human, OTH positive OTH CLARITIN, Pregnancy 10 mg NOS (LMP = 4/8/2008)WAES0807USA01140 Pap test, ?/?/08, OTH abnormal OTH Unknown Mental handicap NOS WAES0901USA03330
13 October OTH 2000: BrainOTH MRI ATTNVenlafaxine IAC's withUnknown and hydrochloride; withoutAnxiety; contrast: Alprazolam; Automobile Revealed Clonazepam accident; noA0599585A gross Depression; abnormality within Whiplash the injury IAC/C CBC, 21Jun2000, OTH normal; OTHCBC, 25Jun2004, Unknown normal; CBC, The28Jun2005, subject's medical normal;history, A0599980A Chemistry concurrent NOS, 25Jun2004, conditions and norm co CBC, 28Jun2004, OTH normal; OTHDiagnostic Venlafaxine Results:Depression; hydrochloride; 31 July 2001, Rheumatic Fatigue; CT ADDERALL of Sinus the fever; abdomen problems The subject's A0602347A and CTmedical of the pelvis, history, Negative concurren stu 3 Glucose SERUM, MIL 156 MIL mg/dL; Urea VYTORIN; Nitrogen SERUM, ATENOLOL; None 13Hypercholesteremia; mg/dL; FLECAINIDE; CreatinineASA; SERUM, CHF; MAXIDE; HTN; 0.8, mg/dL; LISINOPRIL; COPD; Sodium Obesity; LASIX; SERUM, DM;KC 0 Unknown PUB PUB None known None known Unknown 0 UNK UNK 2 OTH OTH Seroquel, Lexa Fatigue pro, Xanax PCN et met for min, Spiractin 0 PVT PVT 1 None OTH PUB Levothyroxine; None acyclovir; NKDA; furosemide; DX, fibromyalgia; warfarin; gabapentin; hypothyroidism; TRAZODONE; intermittentULTR pulm 7 PVT UNK None None 5 Shingles UNK UNK no 2 NONE PVT PVT METFORMIN, NONE RAMIPRIL NKA 107 MRI, blood UNK work and spinal UNK tap 3/4/09-records Ortho Tri Sprintec Virus receivedthat lasted n/a MRI2/17/09-records brain, for 4 weeks cervical then spine received:horse theshow onsetmultiple of MS. allergy-anaphylaxis. white matter lesion m 1 2/11/09-records UNK received-WBC UNK 14.0. None None None 1 UNK PVT premarin vaginal none creamnone known 1 UNK UNK reflux none PVT PUB none none none PVT PVT None None 2 MIL MIL none morphine same,but no rash~Anthrax (no brand name)~1~ 13 NONE PVT PUB POLY-VI-SOL NONE ANEMIA 0 UNKNOWNPUB PUB NONE NONE NONE 2 PVT PUB NONE NONE 8 Seen by SFGH PUBDermatologist PUB whoClonidine made diagnosis none none PVT PVT Possible early herpes lesion to anterior lip 0 MRI, XRAYS, MILAND PATIENT MIL FILES. NONE NONE 7 Hearing Tests, UNKSpeechUNK Evaluation, Behavior Evaluation, ear infection, PMH: blood cold wok Colds testing sincegenetics, birth. Earurinalysis, tubes occupational therap 0 Hematoma PVT on left arm PVT @ injection site. None None 0 None PVT PVT Flagyl 500mg None bidX7d None 0 None OTH PVT None None None 1 Physical Exam PVT PVT None Hypothyroidism on RX 6 Some lab work PUBdrawn at PVT hospital ER, None showedNone increased None WBC, states mother 1 PVT PUB Tinea capitis 0 PVT UNK See attached No known allergies; DX emphysema, 786.09,786.05 1 PVT PVT None None 0 PVT PVT Lobster claw hand, (left) 0 PVT PUB None None None 12 OTH PUB Heart bypass; kidney cancer 0 2/13/09-records MIL received-MRI UNK of head and c spine Atrial Fibrillation no abnormalities. 2/13/09-records Routine received-PMH:atrial blood work appeared fibrillation, normal. sleep Hospita apen 6 See above MIL comment. MIL See above comment. Labs 2004and Hypertension, Diagnostics: 02/08/2008 Essential ESR Pain,30. Chest NOS CK(Active) NEC 185-232. (In remission); CKMB 3.13. Allergy Troponin to PC T 92 Flu test positive UNK for influenza UNK B (date not provided) It was not reported whether the ### patient had any concurren 5 Unknown PVT PVT The patient had no concurrent### illnesses, pre-existing medi 8 blood pressure, OTH 12/18/08, OTH115/6; electrocardiogram, HIBICLENS; Nasal CLEOCIN; congestion 12/18/08, Methicillin-resistant hydrocortisone; norma; bodymupirocin; temp, staphylococcal WAES0901USA03219 12/18/08, SULFATRIM aureus 102.1 F, infection; 2-3 hours cold; follo Unknown OTH OTH Unknown Unknown WAES0901USA03646 0 Unknown. Labs OTH and diagnostics: OTH CT Unknown abdomen (+) for ? liver Unknown. bilomas. PMH: Transvaginal Congenital WAES0901USA03508 US malformation (+) for dilated andL lack Fallopian of rotat Tu Unknown OTH OTH Unknown None WAES0901USA02709 16 Clinical exam UNK only, no UNK serologic testing, no cultures Hyperchol.; Reflux; Osteopenis. No alcohol or drug use. 0 None UNK UNK None 3 PVT PVT None None None 0 Unknown PVT UNK Voltaren, Hydrocodone, 3 WKS Post-op High Niacin, R Bp, knee High Synthroid, Arthroscopy Chol, Norvasc, Hypothyroid Citalopram 2 Unknown PUB PUB None None 54 Lyme titers UNK negative UNK Luride 0.25None mg po qhsGERD, Croup, Hypertonia as infant resolved
0 NONE UNK UNK NONE VIRAL UPPER ALLERGIES: RESPIRATORY NUTS GIVES INFECTION PATIENT ANDHIVES PHARYNGITIS 0 PVT PUB NONE NONE 0 MIL MIL 2 cbc,cmp,tsh,glucose UNK finger UNK stick,CT lamictal, scan. synthryoid, Labs none and Diagnostics: zyrtec epilepsy, hypothyroid Head CT WNL. , allergic CBCrhinitisis. & CMP unremarkable. PMH: remote Gra hx 3 seen in clinic PUB todday 1/30/09. PUB stool sent for culture. none none 0 PUB UNK None None None 0 EKG, Urinalysis, UNK BloodUNK test performed. N/A LABS: N/A WBC 3.9,N/A Chemistry, CPK, CKMB, Troponin, CXR & EKG all WNL. 0 UNK UNK Acid Reflux AL0901 1 n/A UNK PUB none none none known 6 PVT PVT none peanuts 0 MIL PVT none none none MO-2009-02 0 MOC reported PUBlast night PUB to this RNnone that reported an EKG none hadreported been Born done, however premature, pulsechild ox not and is being sure otherhow treated tests. early. for No orthopedic Small definite fordiagnosis....m age, condition club fe 2 PUB PUB None None None 0 None UNK PVT Robitussin PRN COPD Depression Allergies Bees, Weeds,Ivory Soap,Wool 4 PVT UNK 0 none none 0 2/4/09-records PVTreceived-CXR PVT mild bronchial thickening, otherwise 2/4/09-records negative. received-History WBC 23.9. Urine of spitting culture up.no growth. 2 PVT PVT None None Referral to neurologist PVT UNK None NKDA 0 PVT PVT 0 UNK UNK None None None PVT PVT VIAGRA; ALBUTEROL; Bronchitis HTN; ADVIL; Gout; ?; Psoriasis SOLITANE; ?; ATENOLOL; NORVASC 9 None PVT PVT None None None 4 PVT PVT Baby ASA, None Lipitor, Finasteride, NKDA, Increased Flomax, Flaxseed, lipids, Embolic CA, CQ10, CVA, BPH, Selenium, ED, Tubular GlucosaA 1 PVT PVT Levoxyl; Nulev; NoneFemring; Provera 1 PUB UNK None 2 PVT PUB Alb MDI; PRILOSEC None Asthma; GERD 0 PVT PVT 0 PVT PVT It was notedOTH that the subject OTH underwent Anti-inflammatory; bloodBack tests,pain x-rays, Unknown; TheEMG subject Aspirin; studies, hasNaproxen anerve history A0765709A conduction sodium of a calcium studies deposit andon MRIs his elbow to ev 1 Labs and Diagnostics: PVT PUB Abd U/S (+) for IS. Abd None X-ray abnormal. None. PMH: BE abnormal. none 4 Bact'l cultures PUB (-). ViralPUB panel (-). DFA (-). MRI c/w acute None disseminated PMH: hypocalcemia encephalomyelitis resolved; LABS:WBC fever requiring 7.9(N),hospit lymph OTH UNK Unknown 45 MIL MIL MVI None PCN allergy PMH: acne, contact dermatitis 10/2008, chick 1 Autopsy is being PVT performed PVT None None None 0 PUB PUB None Allergic, PCN; HX, anemia PUB PUB Depo Provera None 150mg IM + PPD 10mm 9/8/08 Chest X-ray Negative 0 PVT PUB 0 PVT PVT None None None 0 PUB PVT None None None PVT PUB None None NKA 12 1/29- Pt's blisters OTH werePVT cultured- results None Known not back None yet. None Known 11 PVT UNK Cough; diaper PCN rash allergy 0 OTH OTH None None reported None reported or documented by parent 2679 Lesion cultured PVT to test UNK for varicella zoster 0 None PVT PVT Tylenol None None 1 PUB PUB 3 None PVT PVT None None None 0 MONITORED UNK BLOOD UNK PRESSURE NONE AND EKGNONE - WELL ALLERGY CHECKTO NONE~ PHYSICAL SUPRAX; ()~~0~In NO Patient|NONE~ OTHER HEALTH ()~~0~In ISSUES Sibl 0 UNK UNK ND0901 0 none MIL MIL na vaccine withheld none noted today 0 PUB PUB
1 None required MIL MIL None None None 6 per PMD UNK UNK none none none known 1 PVT PVT sinus infection asthma, allergies (dust, dogs) 41 BLOOD TEST UNKSHOWED UNK HE HADMEMBER A CRITICALLY GOT NONE #2 LOW DOSE NONE PLATELET OF HEP PMH: COUNT BGERD, ON 1-10-2009 OF CVA, 2000, skinAFTER cancerTHAT surgery, THEY cardiac ADVIS ca 1 none PUB PUB None None None 6 Blood test which UNK showed UNK indication Simvastatin of rheumatoid None 40 mgs. arthritis. qdHypercholesterolemia Pt. did not know name PMH: of test. sinusLABS: & colon RApolyps, factor (+), mitral ANv 1 CBC, CMP,UNK BLOOD CULTURE. UNK TYLENOL ABNORMAL ERVALUESDX WITH NO MCVRIGHT 69.9L, OTITIS MCHC-L, MEDIAGLUCOSE 146- H, SODIUM 134 0 None UNK UNK Diovan 320None mg 1 PO daily; Allergy Zetia to Codeine 10 mg 1 (reaction: PO daily, rash), Simvastatin Hypertension, 20 mg PO Type daily, II D -9 None PUB PUB URI Asthma 0 PVT PUB None Rocephin 1 UNK PVT ambien no no 1 PVT PVT URI Asthma 1 None PUB PUB None None 1 Labs: CBCUNK with WBC UNK 16.7. Blood cx (-). PMH: newborn jaundice 1 UNK PVT 2 none MIL MIL HCTZ, loratadine, none nexium, hypothyroidism, tylenol, zocor, vit asa, D deficiency, atenolol hyperlipidemia, DM, GER UNK UNK Pregnancy pregnant at time of vaccination. LMP 20 May 2008, vaccin 7 PVT PVT none 0 Normal Ct of UNK brain, normal UNKchest film and normal no LP and normal CBC and blood cultures were negative LABS: CT 9 PVT UNK Avapro Glipizide none Metotopol diabetes L. type Thyroxine(synthroid) 2 Began taking insulin Lipitorjust Fortamet 1 weekJanumet ago. 0 Body temperature, PVT 101.6 OTH Unknown No relevant medical history A0765333A was reported. The subject had 1 OTH PVT ZOLPIDEM, 5mg; ropinorole 0.25mg 0 PVT PVT None ADHD 1 PVT PUB None Allergy to Amoxicillin + Erythromycin 1 NIT PVT PUB 17 None PUB UNK For high cholesterol; None HBP; NoneMETHYLIN, for narcolepsy 1 PUB PUB 2 None PUB PVT None None NKA, None 0 None PVT PVT None Smashed finger None 0 none OTH OTH KEFLEX (for puncture puncture wound None wound) AE0801 0 None OTH OTH None None - Routine NoneBooster AE0802 4 Unknown OTH OTH none routine booster. no drug allergies AE0803 2 unknown OTH OTH PAXIL, SYNTHROID, routine booster. BENICAR hypertension, anxiety, AE0804 depression, hypothyroidism; h/o cilli 7 MRI; EEG; OTH Ultrasound;OTH Carotid Studies unknown chronic limeChronic diseaselime disease; no AE0805 allergies 1 none OTH OTH none none hay fever, recurrent sinusitis AE0807 0 unknown OTH OTH Unknown Persistent cough Unknown past 2 to 3 wks &AE0808 malaise 4 unk OTH OTH NAPROXAN injury and to HYDROCODONE leftnone hand AE0809 4 unk OTH OTH ADVIL Injury from none a needle AE0810 2 OTH OTH Ciprofloxacin; Fracture Clindamycin; injury Diabetic; toPROXEN his no right allergies hand AE0811 7 OTH OTH an antibioticbooster none AE0812 1 unk OTH OTH none none none AE0813 1 unk OTH OTH none none none AE0814 0 X-rays, PPD OTH test OTH Blood pressure Chest medication pain;Arthritis Cough; Congestion; AE0815 Diffic. breathing 0 none OTH OTH none none none AE0816 0 OTH OTH none none none AE0817 0 OTH OTH None None None AE0818 0 OTH OTH none unknown none AE0819 3 unk OTH OTH none unknown none AE0820 0 unknown PVT OTH TB, lot # C2908AA, none PPD/right Allergy to arm, antibiotics unknown AE0821 0 unknown OTH OTH unknown none unknown AE0822 0 Unknown OTH OTH Unknown None Unknown AE0823
1 unknown OTH OTH unknown unknown unknown AE0824 0 unknown OTH OTH unknown none none AE0826 0 Unk OTH OTH BENADRYLNone Migraines, mitral none~valve ()~~0~In AE0827 prolapse, Patient|UNK~ No ACL in ()~~0~In left knee, Sibling tumo 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759188A medical history. The subject h 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759183A medical history. The subject h 0 Body temperature, OTH 100.3 OTH Unknown No concomitant medications. A0759008A The subject had no relevant 0 An MRI wasPVT conductedPUB approximately OMEPRAZOLE, two weeks ANXIETY, following BUPROPION GASTROESOPHAGEAL SHOULDER the onset HYDROCHLORIDE, of DISLOCATION, the event A0757991A (date REFLUX CLONAZEPAM, The not subject provided) DISEASE haswhich previously QUETIPINE showed re 0 UNK PVT OTH LETROZOLE, Unknown ATORVASTATIN BREAST CANCER, CALCIUM,HIGH THYROXINE A0757768A CHOLESTEROL, SODIUM,THYROID ANTHIHISTA PR 1 UNK PVT OTH Unknown No relevant medical history. A0757735A The subject had previously re 2 UNK OTH OTH Unknown The subject has previously A0757719A received flu shots with no repo 2 UNK OTH OTH Unknown The subject has previously A0757718A received flu shots with no repo 2 UNK OTH OTH Unknown The subject has previously A0757717A received flu shots with no repo 0 UNK OTH OTH Unknown The subject has previously A0757716A received flu shots with no repo 2 UNK OTH OTH Unknown The subject previouslyA0757715A received flu shots with no reported 2 UNK OTH OTH Unknown The subject has previously A0757694A received flu shots with no repo UNK PVT PVT Ibuprofen Unknown The subject has no relevant A0757689A history and has not previously 0 UNK OTH OTH Unknown The subject had previously A0757324A received influenza vaccinations UNK OTH OTH Unknown A0757298A UNK OTH OTH Unknown A0757118A 0 UNK OTH PVT Unknown Concomitant medications A0756602A were unknown. No relevant med UNK OTH OTH Unknown A0756589A 0 UNK OTH OTH Unknown A0756078A 0 UNK OTH PVT Unknown A0755869A 0 UNK OTH PVT Unknown A0755868A 0 17 December OTH 2008, Skin PVT allergy test, Atenolol; glutaraldehyde Lovastatin Hyperlipidemia; (glutaral Shoulder Hypertension - testreplacement; score 5), kathon A0755860A The subject (test score has17), no relevant neomycin medica (test The subjectMIL underwentMIL a biopsy on Efalizumab; an unspecified Hypertension; Crinorectic date to The (Hydrochlorothiazide determine Psoriasis subject has in the norash history A0755844A +was Enalapril ofcaused adverse maleate) byevents bacteria, following virus or pre fu 2 UNK PVT PVT Latex allergy; Sore throat A0755289A 1 UNK PVT PVT Unknown The subject had previously A0754849A received influenza vaccinations UNK PVT PVT Unknown No concomitant medications A0754696A or relevant medical history. T 0 UNK PVT PVT Unknown No concomitant medications A0754693A or relevant medical history. T 0 UNK PVT OTH Esomeprazole; Asthma; HYZAAR; Food Theallergy (Hydrochlorothiazide+Losartan subject has a history A0754692A of numerous potassium+potassium food allergies. It was 0 Body temperature, PVT 10/19/2008, PVT 95LEXAPRO; degrees, FUnknown Tretinoin; Diphenhydramine Acne; depression;HCl TheA0754502A subject had no adverse events follo 0 UNK PVT PVT No concurrent Unknown medication No relevant medical history. A0754333A UNK PVT OTH Unknown Linked cases include: A0752107A, A0754297A A0752229A, A0752230 1 UNK PVT PVT Metoprolol succinate; Unknown Atorvastatin Allergy to BIAXIN; calcium; cholesterol; Aspirin A0754167A hypertension The subject h 1 UNK PVT PVT Unknown No allergies. The subject A0754164A uses alcohol socially and no toba 1 UNK PVT OTH Diltiazem hydrochloride; Unknown Reaction Metoprolol to preservatives. succinateA0753586A This subject had no adverse ev 0 UNK PVT OTH Thyroxine sodium; Unknown Gabapentin No relevant medical history. A0753954A The subject had no adverse e 0 UNK PVT PVT Warfarin sodium; Abdominal Atorvastatin Allergies: pain; urinary calcium; water tract pill ATENOLO; infection; caused A0753917A aAlprazolam; rash in past.Ciprofloxacin The subject had HC UNK OTH OTH Unknown A0753779A 2 UNK PVT PVT NSAID Chronic back The pain subject has chronic A0753700A back pain is under the care of pain 0 UNK OTH PUB Bee allergy;No Erythromycin concomitantallergy; medications. A0753594A unknown Thereaction, subject had Peanut not allergy previous 0 UNK OTH OTH No concurrent Unknown medication The subject has no relevant A0753417A medical history. 0 UNK OTH OTH Unknown A0753416A 0 UNK OTH OTH Unknown A0753411A 0 UNK PVT PVT Topiramate;Unknown Propranolol The hydrochloride; subject has previously Pantoprazole; A0752929A received Atorvastatin flu shotscalcium with no histo UNK PVT PVT Unknown The reporter stated thatA0752837A this event occurred in three additio UNK PVT PVT Unknown The reporter stated thatA0752836A this event occurred in three additio UNK PVT PVT Unknown The reporter stated thatA0752835A this event occurred in three additio 4 UNK PVT PVT Unknown The reporter stated thatA0752833A this event occurred in three additio 0 UNK PUB OTH No concurrent Unknown medication The subject had no relevant A0752564A medical history and no known
UNK UNK UNK UNK UNK UNK UNK UNK UNK
OTH OTH Unknown A0752498A was one ofA0752498A two cases reported by the same h OTH OTH Unknown A0752492A was one ofA0752492A two cases reported by the same h OTH OTH Unknown The subject has no history A0752279A of allergies. PVT OTH Unknown Five additional subjectsA0752233A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752232A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752231A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752230A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752229A experienced similar symptoms. Lin PVT OTH Unknown Five additional subjectsA0752107A experienced similar events. Linked PVT PVT Unknown The subject has received A0751413A flu vaccine previously with no rea PVT PVT Unknown The subject has received A0751412A flu vaccine previously with no rea 0 UNK OTH PVT No concurrent Unknown medications The subject has no relevant A0751369A medical history. UNK PVT PVT Thyroxine sodium; Unknown Spironolactone; The subject has Desonide; no relevant A0760091A Clindamycin; medical history. LEXAPRO; She Zolpidem has prev 3 UNK PUB OTH SumatriptanMigraine succinate The + Naproxen subject has previously A0760086A received flu vaccine and exper 0 UNK OTH OTH Unknown A0759673A 0 UNK OTH OTH Birth controlDrug allergyThe subject reported that A0759372A she is allergic to sulfa (rash all o UNK PVT PVT Unknown A0759350A UNK PVT PVT Unknown A0759349A UNK PVT PVT Unknown A0759348A UNK PVT PVT Unknown A0759347A UNK PVT PVT Unknown A0759344A 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759190A medical history. The subject h 0 UNK MIL MIL No concurrent Unknown medication The subject had no relevant A0759189A medical history. The subject h 3 UNK UNK None known none known 0 MIL MIL NONE NONE NONE 1 UNK UNK None None Known Seizure~Yellow PMH: Family fever hx: childhood (no brand seizures. name)~1~5~In 1 UNK UNK Patient waschest takingcongestionAmoxicillan none wheezing-taking for ear infectionAlbuterol (Dr. checked as needed ear and stated ear in 1 PVT PVT simvastatinNone 20 mg, lisinopril NKDA, 10mg hypertension, hyperlipidemia 0 Spinal Tap UNK protein 159UNK very high. Labs none and at time Diagnostics: none of vaccinaion (never Never CSF been protein been ill) very ~HPV illincreased, healthy (Gardasil)~2~0~In until thenGARDISL repeat Patient CSF WNL. Anti-thyro 0 Several tests, PVT includingUNK extensive At blood the work; time,None just Cat oral Scan; contraceptives None MRI; and Lumbar 2/17/09-records puncture. 2/17/09-records received-Current received-CSF medication h other problems, and on assessment UNK appeared UNK to have chicken pox. Had been exposed to family member w/ severe case of chicken pox PUB UNK None LA090103 2 PVT UNK None PVT PVT None None 1 PVT PVT Singular Asthma 0 PVT PUB Slightly congested 0 PVT PVT Began 5 hour None after injcetion 0 UNK UNK 47 UNK UNK 4 The patient's PVT neurological OTHexam was SERTRALINE; normal, therefore XANAX noThe neurological patient hastests no known were performed. allergies, ### and Thehad patient no illnesses had an X o 197 Unknown OTH OTH None Pregnancy NOS (LMP = 4/19/2008) WAES0901USA03970 Unknown OTH OTH Unknown Unknown WAES0901USA03979 Diagnostic laboratory, OTH rotavirus OTH test Unknown came back negative Unknown WAES0901USA03957 5 X-ray, Sigmoid UNKdilatation, UNK no gas on None rectum, "Champagne Diarrhoea cup" WAES0901MEX00007 1 UNK UNK insulin none diabetic pain in arm/neck~Influenza (Fluzone)~3~53~In 1 PVT PVT cialis, avapro, none avodart, purosemide, allopurinol, prilosec, cartia, flomax, viagra, ci 1 n/a PVT PVT none none Ezcema, Penecillin, Exercise Induced Asthma 1 ALLERGIC UNK REACTIONUNK TO VARICELLA VACCINE NONE NONE 1 none UNK UNK None None None None~ ()~~0~In Patient|None~ ()~~0~In Sibling 1 PVT UNK 0 PVT UNK none codine
0 PVT PVT none none heart murmur 0 n/a PUB PUB mom denied none any illness 9 none PVT PVT n/a early URI 0 None UNK PVT None None None None~ ()~NULL~~In Patient 13 Blood test drawn PUB by MD. PVTClient has NONE not heardHealthy from DR. on NONE results. Reported 8 MIL PUB - HYDROCORTISONE/PRAMOXINE None, routine Hyperlipidemia annual f/u exam 1% COPD rect for hx -Anemia IPRATROPIUM of elevated Elevated BP,BROMIDE hyperlipidemia, BP readings 17MC NiC 0 PVT UNK Insulin pump; Yasmin; Type Frova.1 DM, Phenergan endometriosis, 25 mg every migraine 4 to headache, 6 hours as IUP, needed 70kg fo 1 PVT PVT 0 None PUB PUB None None 9 None PUB PUB None None None 0 PVT PUB None No Asthma, (mild persist.) 0 PUB PUB 2 PVT PVT None Drug allergy - Oxycontin 0 PVT PUB None None None 1 None PVT PVT Pneumococcal None vaccineNone 0 None PVT PVT None None None 0 Evaluated by OTH orthopedist PVT to get physical therapy. URI Alopecia 1275 PUB PUB 0 PVT PVT Levothyroxine; None FLOMAX; NKDA; ALAVERT neuropathy; hypothyroidism's; nephrolithiasis; Pitui 92 All neg - c/wOTH Bell's UNK Cold High chol; MI 1 UNK. Labs:PVT Tox screen PUB (-). Blood cx (+) for Strep Unknown salivarius No concomitant (contaminant). medications Lower A0766166A respiratory were noted cx in (+)chart for moderate by parent 1 LABS and DIAGNOSTICS: PVT PVT CT scan of Head No with Contrast. NKA 1 None PVT PUB None None Benign murmur 0 See attached PVT OTH FOCALIN XR, None 20mg Bipolar disorder 0 None PVT PVT 1 None PVT PVT 3 (+) Rotavirus PVT antigen test PVTLABS: CBC, chemistry None& UA WNL. CXR c/w bronchiolitis. Stool analysis (+) rotavirus. 0 Unknown OTH OTH Pregnancy NOS (LMP = Unknown) WAES0901USA03921 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0901USA03924 24 Colonoscopy; OTH Computed OTH axial; Ultrasound; LUPRON Laparoscopy, DEPOT Endometriosis; Laparoscopic 09/??/08; Drug hypersensitivity Complete surgeryblood WAES0901USA03994 PMH:cell anxiety, LABS: gastric CT & band US neg. surgery Unknown OTH OTH Unknown Unknown WAES0901USA04190 Unknown OTH OTH Unknown Unknown WAES0901USA04478 2 Unknown PVT PUB Unknown WAES0812USA02105 Unknown OTH OTH Unknown Unknown WAES0901USA03562 0 Unknown OTH OTH Unknown Unknown WAES0901USA03312 Unknown OTH OTH Unknown Unknown WAES0901USA03564 Unknown OTH OTH VALTREX, Pregnancy mg; Vitamins NOS (unspecified) (LMP = 2/18/2008); WAES0901USA03679 Herpes simplex type II; Pregnan 18 beta-humanOTH chorionic, OTH positive Pregnancy NOS (LMP = 11/8/2008); WAES0901USA01798 Penicillin allergy; Psoriasis 4 Unknown LABS: OTH Abdominal OTH US neg. Unknown CT abdomen c/w pneumonia. Unknown PMH: KUBT&A. revealed WAES0901USA03674 Tension constipation. HAs. Allergy: Upper PCN, endoscop rash. F 7 computed axial, OTH normal; OTH electrocardiogram, None normal; electroencephalography, None normal; WAES0901USA03680 stool occult blood, positive 0 Unknown OTH OTH Unknown Unknown cardiac disorder~HPV WAES0901USA03777 (Gardasil)~1~14~In Sibli 0 UNK UNK Not reported ### 1 MIL MIL 0 None that I UNK know of, noUNK blood taken, or other Itests came perfomed. to the none ERI to filled have in a type smallofhair vaccine removed in item from 13my in order eye. to subm 2 n/a UNK UNK Bactrim once n/aa day Vescouretal Reflux, GE reflux, possible milk allergy 4 UNK UNK 6 Labs and Diagnostics: UNK UNK CRP 16.2 down to 0.7none by d/c. Fecal prematurity. occult blood PMH: (+).Premie-31 WBCs 17.4. wks. H&H 45 day downNICU to Hgb stay. 9.9NKD an 1 PVT PVT AndroGel none none 26 none ordered UNK UNK dilantin, gabpentin, none atenolol allergies: asa,HCTZ, Simvastain, crestor Chronic health probl 1 None PVT PUB Zantac GE Reflux None 0 PVT UNK
825 none 2
PVT PUB none none none PVT PVT none none Celiac Disease PVT PVT MULTIVITAMIN, NONE, GLUCOSAMINE, WAS HTN, IN FOR BPHWELL HERBAL VISIT/HEALTH PROSTATE MAINTENANCE SUPPLEMENT 1 PT WENT TO PVT ER FORPVT EVALUATION OF ABOVE HX OF STATED HTN, NKDA, DIABETES-NO SYMPTOMS, NO BIRTHFEVER IT DEFECTS, WAS OR DETERMINED COLD HX OF HTN, BYDIABETES THE ER PHY PVT PUB LEVOTHYROXIN 0 N/A PUB UNK n/a n/a nkda 0 LABS: CT head UNK WNL. UNK WBC 10.8(N), neutros 76%(H), lymphs 13%(L). Alk phos 339(H), total bilirubin 1.5(H), BUN 2 LAB WORK, UNK AND URINE UNKTESTS UNKNOWN LABS: CBC, NONE BMP & UA NONE WNL.PMH: Abdominal SAME anxiety SYMPTOMS~HPV x-ray c/w constipation. (Gardasil)~1~12~In CT abdomen/ 0 PUB UNK N/A UNKNOWN 12 PVT UNK tylenol infant upper drops respitory, dr did 0 not think it was important so she didnt even tak 4 Vision screening, UNK CT Scan, UNK MRI, blood Minocycline tests. none Labs and Diagnostics: none PMH: none MRI/MRA brain WNL. EKG abnormal-borderli 0 I visited theUNK Health Center UNKand they hydrocodone, advised that Lacerated stool my reaction softner,concerta kidney asthma was severe andand singular should be reported. 13 Jan 2008: elevated MIL ASO MILtiter (1:4NAPROXEN; or 800 IU/ML), None FLEXERIL; mild anemia NoneAMBIEN; with normal TRAZADONE; platelet count, OTC; mildProtein proteinuria supplements initially w 8 PVT PVT None Hypertension; Hyperlipidemia; NKA until now 2620 None UNK OTH None None Allergy: PCN 122 None UNK UNK No prior allergies 7 OTH UNK High cholesterol PUB PUB 1 Unknown UNK UNK None known None known None known 0 PVT PUB ZANTAC None None NC09009 None (EEGPVT pending) PVT None None None None MIL MIL None Allergic to TETVACYCLINE. 2 None PUB PUB None None None 0 UNK UNK Not reported UNK UNK Not reported ### Not reported PVT OTH The patient had a history of respiratory ### problems. 4 EEG; Speech PVTtherapy;OTH Occupational NonetherapyNone evaluationUndescended testes UNK PUB URI 0 CBC, normal, PVT 2-4-09 PVT FLOVENT Food allergies, apples, peas, milk; mild asthma 1 OTH PVT 0 + Flu test inPVT ER on 1/30/09 PUB Constipation History anemia 1 PUB PUB 0 PUB PUB Ibuprofen; ATENOLOL; None High LASIX; blood DIOVAN; pressureK+ CHL; PREVACID; DELLADENNA 0 URI - not needed OTH diagnostic PUB test None soon Seasonal at time allergies; NoCT200901 allergies or medical conditions. 1 None OTH PVT No Bee sting allergy Seizure~Pertussis (no brand name)~UN~0~In S PUB PUB None None 5 None PVT UNK None NKDA 0 PVT PVT FLUXRIDENone Systolic murmur 2 Stool cultures PVT done by PVT primary care Zantac physician. for GI None Gastroenterologist reflux GI reflux repeated as well as lactoferrin stool 0 PUB PUB n/a n/a n/a MO-2009-3 1 Autopsy found UNKno otherUNK cause of death. febrile seizures in past 2/17/09-records received-history of 1 none MIL PVT Chest Pain codiene MI and morphine 0 none PVT PVT none none PR-09-02 3 none PVT PVT None None none 0 None PUB UNK NKDA 0 Wound andUNK blood cultures PUB- no growth. omeprazole, Elevated none albuterol, WBC identified (14.5). migraine, ASA, alendronate, seizure disorder, mirtazapinte, anxiety, levetiracetam, alcohol/tobacco topiramate use, d 1 PVT PUB 3 EMG showed UNK asymmetric UNKmotor>>sensory None axonal>demyelinating None None known neuropathy. 2/23/09-records CPK 620. received-PMH: CSF proteinasthma, 62, otherwis atten 1 NOne PUB PUB Denies None 1 N/A PUB PUB N/A NO N/A N/A~ ()~NULL~~In Patient|N/A~ ()~NULL~~In S 8 PVT PVT unknown None indicated None
0 PATIENT HAD PVTPREVIOUS PVT SEIZURE/VASOVAGAL INCIDENT H/O EXERCISE DURING INDUCED DENTAL PROCEDURE, ASTHMA WE ARE REFER 379 UNK UNK COPD CC OF BENDADRYL Q 6 HRS ANDUNK F/U TOMMOROW. PUB IF WORSE SWELLING RUNNY NOSE KNDA ER, NO CONSIDER TEMP STEROID 0 PVT PVT None none none 0 UNK UNK none none 1 PVT PVT no no reccurent otitis media in the past None-observation PVT by clinician PVT andNone-children's parents Otitisvitamins Media-very None early none~ and mild ()~NULL~~In Patient|none known~ ()~N 0 OTH UNK Unknown 0 None OTH UNK None None None 0 None PVT UNK Insulin; CARDURA None cream; Diabetes; lovastatin Hypertension; Hyperlipidemia 0 PVT PUB NKDA; Asthma; Allergic Rhinitis 0 Pending UNK PVT Anterior epistaxis 0 None PUB PUB ZYRTEC Runny nose; HXunproductive heart murmur mild cough local reaction~Varicella (no brand name)~ 2 None at thisOTH time OTH Oral contraceptive; None Multi-vit None 1 None PVT PUB None ADHD on Concerta PVT PUB 0 UNK PVT PVT Unknown A0765349A UNK PVT OTH Unknown A0763996A 2 Unknown PVT PVT Unknown The subject was reportedly A0762590A healthy. Linked cases include A 1 UNK PVT PVT Unknown The subject was reportedly A0762589A healthy. Linked cases include A 1 UNK PVT PVT Unknown The subject was reportedly A0762587A healthy. Linked cases include UNK OTH PVT Unknown The subject has previously A0760407A received flu shots with no react 1 chest X-ray,OTH no active disease; PUB body temp, 12/06/08, Reactive103 airways Premature F; nasopharyngeal disease; birthSeasonal RSV, WAES0812USA01983 allergy; negative Asthma None OTH OTH Effexor Multiple sclerosis WAES0902USA00048 0 Unknown OTH OTH Unknown Unknown WAES0901USA04400 0 I have a positive UNK bloodUNK test from the Unknown labs for March cytolysis, 1987 high Itohave May rh and never 1987 sedsmoked rates, and or drank a falsealcohol. positiveIfor have Hepatitis never been C. I fi 8 EMG/NCV consistent UNK with UNKGBS 2/6/09-records received-CSF protein 386, RBC 43. CSF gram stain and culture no PUB UNK EKG - WNLUNK UNK Prior allergies: AMPICILLIN None UNK UNK Mentally handicapped 2 PVT UNK 0 PVT UNK None None None 0 MIL MIL none notednone reported Eggs Allergy 0 PUB PUB No No 2 PVT PVT Given PPD none in same arm none - at patients request - at same visit 57 Mild leukocytosis UNK with left UNK shift, blood None cx-neg, None influenza panel-neg, None PMH: strep breastfeeding. screen-neg, RSV-neg, BMP-norm, UA-nor 1 PUB UNK 4 Ultrasound UNK and contrast UNK enema showed iliocolic intussusception, PMH: newborn complete jaundice. small bowel wt loss. obstruction, recent URI ascites. Labs a 2 NONE PUB PUB NONE NONE NONE PERNONE~ PARENT ()~NULL~~In Patient 1 PUB PUB none knownnone None known 2 UNK UNK None Reported None 0 per pt the rash PVTis getting PVT better. Flonase, Synthroid, no Yasmin NO 0 PVT PVT Desogen 1 UNK PVT yearly physical arthritis,lower back pain 0 none PUB PUB none none 0 UNK UNK 0 Chest Xray,UNK pulse ox, UNK none none none, patient adopted no birth information available. 5 CBC: WBCPVT 7.6 (18S, 2B, PUB 63L, 17M, None "many atypical Intermittent lymphs). None. fever ESR over Had6.several mild Comprehensive plagiocephaly. days but no metabolic fever forprofile 2 days negative. (per paren UA 0 PVT UNK C/O UTI; BACK PAIN, AND CYST ON RIGHT SHOULDER 1 OTH PVT None PVT PUB None None
1 2
PVT PUB None NKDA MIL MIL None None None PVT PUB Asthma 0 None PVT PUB None None NH0815 384 None PVT PUB None Impetigo None 1 PVT PVT YAZ; SYNTHROID; Laceration PAXIL left Treximet, hand Hypothyroidism 0 CSF culture; PVT Blood culture; PUB Urine culture; None CT None Head and Shunt Hydrocephalus Series; Allwith normal. VP shunt. Labs and PMH: Diagnostics: CongenitalCT Hydrocep head W PVT UNK NONE Asthma 8 1/28/09 Viral UNK culture ofUNK conjunctiva (OD) and skin Unknown lesin positive Unknown for Poxvirus. 6 Referred toOTH primary care PVT provider.Coumadin, None Cozaar, known Lipitor, HTN,and highZetia cholesterol, CAD 2/17/09-records MIL received-UGI MIL 7/2/08-large sliding Nonehiatal hernia None 2/17/09-records without significant received-PMH: gastroesophageal chronic reflux. back pain. MIL OTH None None None OTH OTH None None WAES0811USA01317 Measles tire, OTH neagtive.OTH Unknown Unknown WAES0807USA05579 Measles titers: OTHSeronegative OTH Unknown Unknown WAES0807USA01777 8 Unknown OTH OTH Unknown Unknown WAES0807USA01095 0 Body temp,OTH 04/29?/08,OTH fever Vaccination adverse reaction; WAES0805USA00246 Fever 4101 Serum measles OTH Ab, 04/25/08, OTH Negative Unknown Penicillin allergy Hepatitis B WAES0805USA00144 Unknown OTH OTH Unknown Unknown WAES0801USA03341 None OTH OTH None None WAES0804USA02904 7 None UNK UNK None Milk allergy WAES0804USA02907 10 None UNK OTH None None WAES0804USA02908 10 None OTH OTH None None WAES0804USA04868 48 2/17/09-records UNK received-Negative UNK tests except for mild hypokalemia. 126 diagnostic laboratory, PVT Blood OTH test; neurological, VICKS NYQUIL Cold; Blood SINUS; Colitis testPMH: ulcerative; LABS: hormonal ulcerative CBC, contraceptives Scoliosis CMP, colitis. CRP WAES0901USA03519 contraception, & UA WNL. HA. Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA00303 7 UNK UNK URI rted. Patient just reports a historicalUNK allergy. UNK 1 NA UNK UNK Birth Control None Chronic Gastritis 1 None PVT PVT Crestor Lovaza None NKA 1 None PVT PVT Zyrtec, Nasonex None None ~ ()~0~~In Patient 0 unknown UNK PUB Unknown history of anxiety and depression, no known allergies Blood work UNK done but inconclusive UNK Zyrtec as he was - prnNone not in a flareNegram up at the (Nalidixic time. Last Acid) shot was Mar 08 and blood work do 0 none PUB PUB none none none 3 PVT PUB 1 LABS: Blood UNK c/s neg. UNK WBC 18.5(H), H/H 9.8/28.6(L). ESR 10. CRP 9.4(H). x-ray thigh WNL. US doppler of thigh 0 N/A UNK UNK Celexa, depakote, none trazodone NKA 0 none done PVT PVT Triaminic Chest Rhinitis Congestion - clear Medical nasalHistory: d/c the child was born at about 37 weeks ges 1 CAT Scan,spinal UNK tap, blood UNK cultures None and bloodwork. None --EEG, NoneMRI, PMH: andc-section bloodwork. dueLABS: to breech CBCpresentation, WNL. Chemistry 36 wkab p 6 She was given UNKand MRI UNK both types, none CT scan,no EEG, bloodnowas taken and a urine sample. All tests came back norm 1 PUB PUB none reported none SC0904 3 n/a PUB PUB 0 UNK PUB Type 2 DM, GERD, BPS, s/p surgery, depression, hx. of c 0 PVT PUB NONE UPPER RESPIRATORY UNDERWEIGHT--WT/HT,3%, NONE~ INFECTION, ()~NULL~~In COUGH MILD Patient FOR ANEMIA--HGB 3 WEEKS 10.0, 0 MRI, CAt scans, UNK ambulatory UNK EEG,birth thyroid control tests,blood nons pills lexapro tests. PMH: Labs Anxiety and seizures~HPV Diagnostics: & depression/ (Gardasil)~3~22~In Ambulatory Bipolar d/o. EEG EIA.(+) T&A. Patient for frontote Ear tub 236 LABS: CBCUNK done 7/9/08: UNK WBC 20.8, Birth bands control, 25%(H), none acne medication lymphs none15%(L). Monospot neg. 1 PVT UNK none none none 0 n/a MIL MIL none none none erythema~Anthrax (Biothrax)~7~22~In Patient 1 EEG - spikes PVT in R topical UNK area LABS: NoneCT head None WNL. MRI None head abnormal w/several ependymal nodules & multiple 13 OTH PVT HYZAAR; Glucosamine/chon; None No medical ASAconditions OTH PUB None None
0 None PVT UNK None None 2 None PVT PVT None None Healthy 1 PVT PUB None No No 9 None MIL MIL None None 07/28/2008 Dermatitis, contact secondary to clear, occlusi 40 MIL MIL Hyoscyamine None 0.125 1-2 05/14/2008 tabs qd SLRedness/Swelling prn; IBS flares 50-120mm - Not extending 5 None MIL MIL None None Allergies: No known allergies. No birth defects. Medical c 8 CXR: pneumonia MIL MIL Multivitamins None None 52 CT Abd/Pelvis MIL(29 JulyMIL 2004) withFLONASE small bilateral nasal None effusions, spray05/16/2008, (pm splenomegaly, Spring for Rhinitis, Seasonal mildallergic retroperitoneal Allergic NOS,Rhinnitis) (Assumed & bilateral inactive); groin ade 07 1 PPD read as MIL "0mm" onMIL 5-23-08. Pt. ORTHO-TRICYCLEN received None annual PPDs 28 05/23/2008 and neverRash, has experienced oth nonspecific a local skinreaction eruptionor(Resolved) a rash. 0 MIL MIL MUCINEX Cold 1 Hemoglobin, PVT normal; Abdominal PVT ultrasound, None normal; Stool None culture, no growth 0 None PVT PVT Pulmonic stenosis; Eczema;aUmbilical cyanotic hernia 0 PUB UNK 0 PVT PUB 1 None PVT PVT Has not taken No it - Treximet Allergic , 1-26-2009 to Codeine ; Omeprazole-; + Ampicillin ASA; Maxalt-MLT; Celexa 21 PVT PUB None No No 1 PVT PVT No Febrile Seizures 0 EMG; MRI PVT L Humerus/shoulder. PVT Allegra Referred D toInOrthopedist for well-adult Seasonal checkAllergies up 1 None PUB PUB AMOXICILLIN L Otitis media None MIL MIL None None 1 Vaccine reaction PVT OTH CONCERTA; None Lithium Carbonate; No allergies RISPERIDONE; previously; Psychiatric MOXAIR dx Autohale 2 PUB PUB Mononucleosis 1 PVT PVT EFFEXOR NO XE FOCALIN ADHD, RAD 0 localized reaction, PVT cellulitus UNK None ~Pneumo (no brand name)~1~69~In Patient 8 n/a PVT UNK none none none 0 PVT PVT None None ADHD, Raynaud's None~ ()~NULL~~In Syndrome Patient 2 CBC normalUNK UNK none none allergy to cephalexin - rash 1 MIL MIL none Had a normal UNK blood test UNK before shot, Yasmin, and after albuteral, none shot tested singular Asthma, for immune allergies deficiencies. (not to food LABS: or medications) CT head WNL., ANA 1: Not reported. UNK UNK Not reported. ### not reported. OTH OTH Patient has a history of diabetes, ### asthma, and an allergy to 693 physical examination PVT PVT Calcium; PREMARIN; Sulfonamide SYNTHROID; allergy ACIPHEX; WAES0902USA00378 COUMADIN 1 None OTH OTH Unknown Sulfonamide allergy WAES0902USA00259 230 blood pressure, OTH 212/1 OTH HYZAAR; levothyroxine Shingles sodium; lisinopril; omeprazole WAES0901USA04389 spinal tap, 12/11?/97, OTH bloody OTH spinal Unknown fluid, evidence of a possible Unknown cerebral hemorrhage WAES0902USA00158 None OTH OTH None None WAES0902USA00475 Unknown OTH OTH Unknown Unknown WAES0902USA00481 Unknown OTH OTH Unknown Unknown WAES0902USA00103 Unknown OTH OTH Unknown Unknown WAES0902USA00026 Unknown OTH OTH Unknown Autism WAES0901USA03633 Unknown OTH OTH Unknown Unknown WAES0902usa00465 7 None OTH OTH None Allergic reaction to antibiotics WAES0902USA00416 222 ultrasound, PUB 10/02/08, normal PUB 19.6Vitamins weeks; urine (unspecified) Pregnancy beta-human, NOSpregnancy; (LMP= 4/9/2008)WAES0809USA02697 serum alpha-fetoprotein, 11/25/08; fetal d 31 Allergic/immunologic UNK symptoms UNK RAST Nonetest 12None Jan 09 equivocal None result to soybean otherwise neg. 7/17/00: CT: Hea UNK UNK 0 None UNK UNK Smokes 5-7 cigarettes a day. PMH: smoker 0 OTH PVT ZOCOR qdNone NM0209001 2 None PUB PUB None None None 0 None PVT PVT None No No 1 MIL OTH None None 0 PVT UNK OSCAL 500; None BAYER 81mg; AllergicLISINOPRIL to fire ants (have 2.5mgreceived injection monthly for 28
1 None PUB PUB None Very dry skin Had and seen rash. derm for skin rash and to see again after 1 year 2 PUB PUB Recently completed None antibiotics None for01/28/2009~HPV strep throat. (Gardasil)~2~11~In Sibling 2 PUB PUB None None None 01/28/2009~HPV (Gardasil)~2~17~In Sibling 0 PUB OTH None Aches in joints None 1 PUB PVT OR200904 1 None OTH UNK None Iodine; Sulfa; adhesives 269 PVT PVT 0 UNK PUB none none 0 none PVT PVT no augmentum,bactrim, titanium 1 UNK UNK Insulin none Diabetes 902 PVT PVT 7 NONE UNK UNK NK NONE NONE KNOWN 0 EKG, HCG,UNK CBC Labs:UNK CBC WNL. Yasmine HCG (-). none Neuro exam none WNL. PMH: none 2452 PVT PVT none asthma 460 Examination PVT by physician, PVTclassic lisinpril shingles symptoms. none borderline hypertension n/a~ ()~NULL~~In Patient 20 Pt was evaluated PVT by Physician PVT none none none Lerch, Fred~Influenza (Fluarix)~0~48~In Patien 42 rpr=non-reative,lyme UNK disease=negative, UNK Synthroid CSfQD, studies none Diovan as well QD hypertension, as serum protein and hypothyroidism, electrophoresis chronic unremarlable back pain other s/p th m 2 None yet.. will PVTobtain inPUB 48 hours ifoccuflox not improved eye conjunctivitis drops none 6 n/a PVT PVT n/a n/a n/a no know reaction~ ()~NULL~~In Patient 0 None were UNK taken. UNK NONE NONE 0 Chest xray UNK & Head CTUNK WNL 2/7/09. CBC w/ diff none & CMP WNL Penicillin 2/7/09. allergies. Tingling TSH reflex Lumbar & Numbness~HPV andpain Vit after D serum motor-vehicle (Gardasil)~1~18~In tests from accide 2/9/09 1 UNK UNK NA None specified Nonebyspecified MOC or by noted MOC onor immunization noted on immunization record. record. 276 PVT UNK 1 UNK PVT None Shingles, recurrent every year or two. 7 PVT PVT extreme prematurity PVT PUB PRN TYLENOL None None 0 PVT PUB 17 None PVT OTH Lisinopril None Dust allergy; HTN 0 PUB PUB None Runny nose, None cough 0 PVT PVT None 1 CBC, CMP,PVT CT Brain Scan PVT all normal None History of GE reflux 0 None PUB PUB Unknown None Unknown 5 CBC; CMP OTH + Lipid panel PVT done on None 1/26/09 None Allergies to Penicillins 0 MONS screening PVT (-); Strep UNK Cx (-); 13.1 12/35Denied 265; 44P; by pt; PRENOTOL 18B; suspect 24L; 10M; drug1RL; exposure 2G; alche 20 x AL7 36 4 None donePUB PUB (very sensitive skin); hives occasionally 0 PVT PVT 3 None PVT PUB None None None 0 None PVT PVT None None 1 PVT OTH LEVORA; Fluoxetine; None DEMEROL 0 none PVT UNK BCP (Trinessa None 28 0.035 None mg ) 0 Saw in office PVT 2/2/09 forPVT Rx. to be reseen Dyazble; of Ater; continues Celexz; to grow. Omeprozole; Lidoderm; Parate; Solsate; Zocor; Altac 4 CXR negative OTH OTH ALBUTEROR ADVAIRNeosporin INHALER,- NAPROXEN, causes rash, Asthma, PRILOSEC DJD - knees, Anemia, L 0 None PVT PVT None NP dye allergy; DDD L spine; work up pending for RUB p PVT PVT None None 15 Abdominal OTH ultrasound, OTH 09/??/08, without Unknown pathologies; Pollinosisdiagnostic laboratory 09/??/08, WAES0902USA01054 without pathologies 8 Labs and Diagnostics: MIL MIL Echo with TYLENOL mild mild mitral, Fevertricuspid, - chest pain and -pulmonary anxious regurg. Audiology test (+) for conductiv 2 Stool culture OTH taken during OTHhospitalization None wasNone positive forNone ROTAVIRUS. PMH: 34 wk LABS: preemie, CO2 foster low, Kcare, 5.2, CL maternal 124, repeat drug ab CO 0 MRI completed: PVT resultsPUB pending. Labs and Diagnostics: Not MRIreported. brain WNL. PMH: none noted ### 0 Ct scan, 31/Jan/2009: OTH OTH normal, CBC: normal, metabolic panel: Patient normal, has a BC history pending. of environmental ### allergies. 106 Electroencephalography, OTH OTH negative;Unknown Computed axial, negative; Unknown. Neurological, 9/11/09 Hospital negative WAES0902USA00587 records 3/16/09-records received DOS received-EKG 8/27/09 Unknown OTH OTH Unknown Unknown WAES0902USA00564
Unknown OTH OTH Unknown Unknown WAES0902USA00449 Temperature OTH measurement, OTH ?/?/06, None 104 Penicillin allergy WAES0902USA00464 38 physical examination, PVT classic PVT herpes None zoster by Hypertension; visual exam Chickenpox right osteopenia; t 10-11 rhinitis distribution WAES0812USA00471 allergic; asthma; chronic back pain 0 UNK UNK beginning to spread to the Thisinside child has ofUNK the recovered child'sUNK leg. from abnormal the PENTACEL flu and shape, common similar - 2/3/09 cold/ear to 4:30 the infinity infection pm shape. 3 weeks shotprior site came to receiving to a head the and shot.was Child warm wasto 24 PVT UNK Intermittent 6 01-27-09 Rotavirus PVT detected PVT by EIA (enzymeNone immunooscopy), PMH: 34-wk UGI (-),preemie. Barium enema (-) LABS: Stool c/s (+) for ro 1 PVT UNK CONCERTA Psoriasis; ADHD 2 PUB PUB None None 1 PVT OTH None No Milk - protein sensitivity 2 CT; MRI. Labs PVTand Diagnostics: OTH CT PROZAC; scan (+)Doxycycline; None for sinus disease. Seasonal ASTELIN; MRI allergies. NASONEX; brain WNL. PMH:CLARINEX ADD. Asthma. Seasonal allerg 0 OTH PVT (Birth control) IMPLANON Grass, trees, outside molds 1 Cerucal PVT PVT Singular 4 mg No P.O. Illness Tabs Cough~DTaP (no brand name)~5~54~In Patien N/A UNK UNK N/A N/A 1 daughter diagnosed PUB onPUB Monday Feb. 9th withnone Influenza known A. 0 none PVT PUB zantac none none extreme fussiness~DTaP + HepB + IPV (Pedia 0 PUB PUB 10 MIL MIL N/A N/A N/A 1 N/A PUB UNK Amoxil 400 Resolving mg/5 ml Oral ear None Suspension: infection 2 tsps PO BID x 10 days 3 PUB PVT Benadryl None None 0 MIL MIL dapsone, predisone no (for not 2 sure, weeksstill lastbeing part evaluated of december for first a form partofoflupus. january). 51 none PVT PUB none none none 0 PVT PVT 9 pathology including UNK flow UNK cytometrydoxycycline of LNs were none 40mg negative. PO q none 3/11/09-records day received-pathology report no abnormality 0 Work-up in UNK progress. Labs UNKand diagnostics: albuterol and UC flovent (+) for Group Amoxicillin. B strepPMH: and Easthma, coli. GCbladder (-). Chlamydia infections. (-).Allergies UA abnorm to 12 Not sure. Diagnostics UNK and UNKother labs Lamictal done at None hospital. reported 2/11/09-records Codeine allergy, received-CT epilepsy 2/11/09-records head normal, MRI received-History spine negati 0 Per Allergy-Immunology UNK UNK Services,None skin test done None once member None released from acute care. Recommendation made 0 PVT UNK Synthroid, Buspar n/a 8 n/a PVT PVT slight runnyonly nosehas and one congestion, ear canal.dr said it was ok to have shot. 0 Still have not UNK received UNK any orders for testing. None He has symptoms GERD of seizure Drowsiness~DTaP still - especially (Acel-Imune)~2~0~In at night - and I worry Patien tha 13 Nerve conduction UNK studies UNK compatible NO with GBS NO Allergy to Ampicillin Sulbactam 39 12 April 199: OTH Thoracic OTH spine showed Esomeprazole; osteophytosis Alcoholic; Clopidogrel and Ulcer mild Fractured kyphosis. (unspecified) bisulphate; collar 02bone; Atenolol; May 2000: A0767211A Fractured Celecoxib; Radiology Hand; LEXAPRO; exam Sinus of problems; the Alfuzosin left sho To 0 PUB PUB None Slight cold None 2 None PVT PUB Vulvoraginitis NKDA 1 PVT UNK Cough 4 RSV (+).' Labs PVTand Diagnostics: PUB RSV Ag (+).Loss CBCofWNL. appetite; PMH: Globulin nausea viral low rash. Xat12.1. dayAlk Phos 203. AST 36. Total protein 33 Unknown - PVT Done through PVT ED LABS: None US of abd None c/w IS. Attempted None BE x 2 failed. Surgical pathology: 2 perforations 113 Head CT Scheduled PVT for PVT 2/13/09 None None 0 None PVT PVT None None None 0 PVT PUB None 2 None PVT PUB None Allergies: Erythromycin 0 PVT PUB 31 None. The service MIL member MIL is currently None pending None a dermatology Allergies: appointment. CEFTIN (rash); No history of congenital defects; 0 PUB PUB Zyrtec 1 mLURI daily - no fever None 1 None PVT PVT None None History of allergies, Celiac disorder 1 OTH OTH SIMVASTATIN; None VERAPAMIL Hypertension, hyperlipidemia PVT UNK None None 1 PUB PUB None None 1 Note: ChildPVT wil FU withOTH Pediatrician None PUB PVT None premature, cerebral palsy, developmental delay, V-P shun 1 PUB PUB Orthotrycycline NoneLow None
1 Physician Examination OTH OTH None Allergies to EBYTHROMYCIN 0 UA; CBC; CMP. PUB See attached PUB lab results. None None Known 0 Dr. done throat UNKcultures. UNK Hospital done blood None work and said None she has mono. (No one else in house got sick) 0 Temperature OTH measurement, OTH 102.5None F, for 3 days Hay fever WAES0902USA01032 Diagnostic laboratory, OTH several OTH unspecified Unknowntests None WAES0902USA01057 110 Serum Al OTH OTH LOESTRINAllergic 24 FE reaction to antibiotics; sulfonamide WAES0902USA01069 allergy 33 Unknown OTH OTH ORTHO TRI-CYCLEN None LO WAES0902USA01095 467 Unknown LABS: OTH WBCOTH 12.6, H/H decreased. Unknown Glucose 200 None (H).PMH: HgA1c BCP. 7.1(H). Amblyopia WAES0902USA00873 CSF: WBC in childhood. 8 & RBC 06/06/2008 3540(H), prote Re Unknown OTH OTH Unknown Unknown WAES0902USA00919 0 ultrasound, OTH normal; ultrasound, OTH normal; diagnostic laboratory, Urinary 06/27/08, tract infection; byophysical WAES0901USA00170 Infectious profile mononucleosis 1 ultrasound, OTH 06/25/08, possible OTH brachycephaly; Unknown Pregnancy amniocentesis, Varicella NOS (LMP=Unknown); 08/27/08, no brachycephaly, WAES0804USA05621 Behaviour disorder beta-human chorionic, 0 Unknown OTH OTH FOSAMAX;Hypertension; atenolol; PRINIVIL Drug hypersensitivity WAES0902USA00860 Seeing ophthalmologist; PVT PVT check titers 4 CBC with 14k PVT wbc & neutrophila PVT + Blood culture Bilat. Heel pain 1 CBC and CMP, PVT WNL PVT Fatigue; Post back surgery 1 none PUB PUB none~ ()~~0~In Patient|none~ ()~~0~In Sibling 1 None PVT PUB None None None 0 NP exam, repeated PVT vitals, PVTno studies. None 0 OTH PUB ADVAIR; Albuterol Asthma; Allergic Asthma; rhinitis Allergic rhinitis 0 PVT PVT None None GERD PVT PUB None none none 536 UNK OTH EPIPEN for food allergies; AllergiesAsthma; shellfish MAXAIR; and Albuterol strawberries 0 none PVT PVT none OCC cough, none sneezing 1 None PVT PUB None None None 0 PVT PVT Seen for follow-up Allergy to of ISONIAIDE Hypertension, none~ ()~~0~In Diabetes Patient& Hyperlipidemia 2 None PVT PVT None No No 1 PVT PVT Amitriptyline; CELEBREX; Adenocarcinoma; VALTREX; OXYCONTIN; LymphnodesELOXATIN dissection (R) 0 PVT OTH None No Asthma; Allergic; Rhinitis 2 PVT OTH 1 2/10/09 - PtUNK wearing Holter PVT Monitor. DIOVAN; Will have NEXIUM; None clinical test TRICOR; Allergic Mon and ZOCOR; to PCN; Tues -heart ALLEGRA; injectstent isotopes. in Multi 2000 Has Vits; it closed premature Ca; Fish 6 months Oil but Drlate do 1 None PVT PVT None 1 none UNK UNK Depo-provera no injections none q 3 months 1 PUB PVT none no no 1 Done at physician's UNK office UNKto exclude arthritis.None Results unknown Patient said to me ~Measles that except she is for + "healthy" Mumps report that + Rubella they were (no brand "negative." name) 1 PVT PVT NONE NONE 0 n/a UNK UNK none none no known allergies, no documentation of any birth defects 0 PVT UNK none none none none~ ()~NULL~~In Patient 1 PVT UNK 1 N\A PVT PUB N\A NONE NKDA- SPEECH DISORDER 3 PVT MIL none epilepsy controlled on Depakote 4 Rotazyme negative, UNK stool UNK culturesNone pending5/09 None 2/25/09- None WBC increased 18.4, hematocrit 28 MCV 82 showing ane 1 PVT PVT Just over "stomach flu" and cold. 5 none PVT PVT avandamet,altace, none lipitor, Diabetes Humulin mellitus 70/30and BIDHyperlipidemia 35 MRI of brainUNK consistentUNK with A.D.E.M. 4/24/09-records None received-MRI Adjustment reaction abnormalwith signal depressed in brainstem moodwithout 2/24/09-records regional 0 PVT PVT 77 487.1 2/13/09-records UNK UNK received-Chest x-ray showed bronchiolitis 2/13/09-records with superimposed received-PMH:Developmental left lower lobe pneumonia. delay. PPS RS 0 none UNK PVT None Known None none known 0 NONE UNK UNK NONE NONE ALLERGY TO AMOXICILLIN 2 PVT PUB 0 UNK UNK cold symptoms noneat time of 2nd flu shot 2 UNK UNK none Diaper rashNone
11 MIL MIL Allergy to PCN Reaction 2 None days later 0 immediatelyPVT after episode: PVTBP 112/48, noneHR 91,none O2 98% 5renal min glucosuria after episode: fainting~Varicella BP 104/52, (Varivax)~2~13~In HR 90, O2 99% Sibling1 1 none PUB PUB none none penicillin 0 We have had UNK 2 E.E.G's, UNK a MRI, an EKG, an echocardiography NONE NONEof the heart, an Upper G.I with Contrast, tons of bloo 0 NONE PUB PUB NONE NONE NONE 77 BLOOD WORK UNK AND PHYSICAL UNK OBSERVATION None NONE 2/13/09-records NONE received-CBC normal. 2 Elevated glucose UNK on Chem-16, UNK likely NONE secondary ? fever to seizure, representative none Negativeoffluother screen, illness negative or secondary RSV screen, to vaccination, normal CBC sus 1 none MIL UNK None, routine None requirednone everyever~ 10 years ()~NULL~~In in military.Patient had td shot in 1999 14 Elevated lymphocytes, UNK UNK an elevatedNone ANA, andNone, an abnormal prophylactic None antibody response. EEG and Rheumatology consult ar 10 The subjectPVT had abnormal PVTcerebrospinal fluidUnknown (CSF) laboratory The subject valueshad indicative no concomitant A0767750A of meningitis. medications, All cultures relevant were med neg 1 Speech language PVT assessment UNK None Healthy temp None. 99.1PMH: (R) none. 0 PVT PVT None (Hx ofNone Reglan) GERD; Eczema; 1 MIL UNK Hypothyroidism; Cervicalgia 1 UNK UNK Mild cold symptoms None 6 stool rotavirus OTH RNA, 01/26/2009, OTH positive Unknown WAES0902USA01092 Unknown OTH OTH Unknown Unknown WAES0902USA01085 19 Labs: BS 195. UNK ABGs UNK abnormal. CBC with WBCs COPD 10.9. CXR PMH:(+) COPD. for LLLemphysema, infiltrate andhypercholesterolemia, atelectasis. EKG WNL.L colon Phos 0 PVT PUB NONE NONE NONE 0 UNK UNK none none PCN and erythromycinSC0905 and states history--Tsf causing "ba 0 PUB PVT 1 PUB PUB Zantac (generic) none mom reports hx of acidSC0906 reflux 1 referral for allergy PVT testing PVT to determine Flovent, possible Singulair sore egg throat, and allergy Allegra asthma cough but but afebrile no none allergy to eggs 2 Blood drawn PVT for testing. UNK No HTN, hyperpipidemia 0 PVT PVT synthryoid - simvistatinseasonal - multivitamin allerigies - glucosomine - diverticulitis - zantac - hyatil - biotin hernia - hypothyro 11 PUB PUB none none none 0 LABS: EKGUNK & Holter monitor UNK WNLConcerta 27mg, NoneFexofenadine seasonal30mg, allergies, Flonase ADD PMH: acne, irregular heavy mens 10 None UNK UNK FurosemideClient 40 mg. denies daily, Hx.being Pantoprazole of hypertension ill 40 and mg. diabetes BID, Metformin 500 mg. one BID, 2 stool culturePVT and rotavirus PVTwere negative. Zantac Gastroesophagel None refluxdiarrhea~Rotavirus (Rotateq)~2~0~In Patient 2 N/A PUB PUB Birth controlNone pills None known PVT PVT AMOXICILLIN OTTITIS 400MG/5ML MEDIA 1 TSPSMALL BID X10 RASH~Influenza DAYS STARTED (Fluzone)~1~1~In ON 11/24/2008 Pa MO 4 PVT PVT none no 6 Cardiac echo UNK after recovery: UNK No change Aspirin,from atenolol, prior.Flonase, Vestibular FLovent, dysfunction glucosamine/chondroitin, Mitral valve prolapse/mitral lisinopril, loratidine, regu 0 UNK UNK 1 All bloodwork PVT normal; heart PVT rhythmFish normal; oil, calcium, echocardiogram None trazadone, Lownormal; thyroid; aspirin,brain PCN levothyroxin, scan allergy. normal; niacin. urinalysis I was on normal. a low-carb Adrenal diet 0 PUB UNK 0 PUB UNK NONE 1 UNK PUB none None NKA 16 CSF - neg. UNK CBC - WNL UNK UA -1.WNL, Amitriptyline + fornone Tricyclics 10 mg.scoliosis, 1CT/head pill p.o. headaches, -night no acute before muscle intracranial event.spasms 2.abnormality. Flexeril in lumbar 10 mg. Labs area. q8and hrs. PMH Dp 1 PVT PVT none none none same irritation to DTap~DTaP (no brand name) 1 PUB OTH No other medications Unknown MA20090232 1 LABS: CXROTH w/infiltrates. PUB WBC 170,000, CLONIDINE; HgbNone 4.1(L), ALBUTEROL; reported pltsAsthma; 10K (L). MONTELUKAST ADHD; Potassium MR (H), PMH: Uric intrauterine acid 10.5(H). growth Creatinine retardation, 1.3 0 PVT PUB Here for c/o HA's 1 None PVT PVT Albuterol; BENADRYL; None None TYLENOL 1 UNK PVT 0 None PVT UNK None None H/o exercise induced asthma; Congenital abnl kidney - rem 1 PVT PUB No; 2/12/09,Asthma; Bronchitis Allergic rhinitis 1 2/11/09 - CBC, PVTNormalUNK None 0 PUB PUB None Abnormal gait. 0 PVT PUB None 1 PUB PUB 0 PVT OTH None None None
3
PUB PUB Albuterol MDI URIassymptoms needed Asthma, Allergic rhinitis PUB PUB None None PUB PUB None None PVT PVT 4047 None PVT PVT None None 0 PVT PVT FLEETS enema Nonedaily Imperforate anus 0 PVT OTH None Previous reaction similar when reaction~Hep given FLUVIRIN B (no brand and name)~1~0~I Hepatitis B 0 PVT PVT 10 Hives OTH OTH HYDROCHLOROTHIAZIDE None None 25 mg; VALTREX; Gabapentin 100 mg; LIDODERM 1 PVT UNK None None 469 Colposcopy, OTH high grade OTH squamousUnknown epithelial lesions; Cervical PMH:smear, anorexia-past. High ascus grade pap hernia WAES0902USA01061 squamous; smear. repair Labs: Papilloma PAP (+) viral for infection ASCUS On 22-Nov-2008 OTH test results OTH were:Concomitant antibody test The medications (results: patient'sReported concurrent were not byreported. illnesses physicianUSWYEH08126209 include -Serotype ear 14 infections - 1.26, child (recurrent showed prio 1 General Chemistry, UNK Comprehensive UNK None MetobolicNone Profile, CRP, None. General PMH: Hemotology, none UA, Viral Culture, Aerobic Cultur 7 UNK UNK Zyrtec, Proair, none Cymbalta Mild intermittent asthma 2 PUB PUB AMLODIPINE,CRESTOR,FLOMAX, HYPERTENSION, TEMAZEPAM HERPES QQ10,FISH ZOSTER. OIL, VITAMINS. 0 none UNK UNK None noted but recent episode of croup and bilateral OM which was r 0 UNK UNK Birth controlNone (depo provera) none 1 urinalysis showed PUB onlyPVT concentrated lisinopril urine lovastatin none hypertension none~ hypercholesterolemia ()~NULL~~In Patient 1 none PUB PUB Tylenol none none 0 UNK UNK Asthma 1 PUB PUB ALL to Cipro Labs and diagnostics: UNK CSF UNK WNL. CSF cx (-).None CBC unremarkable. None PMH:seizures~DTP none. Fam hx (no of brand febrilename)~~1~Patient sz in mom 1 UNK UNK 0 PVT UNK no none~ ()~NULL~~In Patient 1 PUB PUB Tylenol prnnone none SC0907 1 UNK UNK None None None 0 N/A UNK UNK None None 24 MRIs, BoneUNK Scan, X-Rays, UNK Echocardiogram, NONE NONE Bloodwork.NONE. Labs: CRP, PMH:ESR, noneANA, noted. RF,allergy mono,toComplement PCN C3 and C 1 PVT PVT fluoride multivitamins none none high fever (104 )~Influenza (no brand name)~N 1 BMP PVT PVT none none none diarrhea/vomiting 10 days~Rotavirus (Rotateq) 1 EKG x3 andUNK Chest x-ray UNK x2 None None None None~ ()~~0~In Patient|None~ ()~~0~In Sibling 12 Per epidemiologist UNK blood UNK test showed positivePer IgM. screening questionnaire stated that child had no fever, but did hav 0 none UNK UNK none none none. no previous reaction to flu shots 3 none PVT UNK URI No allergies; Migraine headaches 1 PVT UNK 0 PVT PUB 2549 PVT OTH Unknown PVT UNK SINGULAER 10 mg daily Asthma; Heart murmur 0 PVT UNK ENALAPRIL MALEATEDiabetes 5 MG ormellitus tabs; METFORMIN type 2; nondependent HCL 850 MG alcohol or tabs; abuse; GLYB tob 1 None PVT PVT Multiple Consult for PROCHLORPERAZINE, pain management AVELOX, TORADOL, PNU-IMUN 9 Neg - Throat PVT Culture PVT IBUPROFEN URI-cold FEBRILE SEIZURE 1/14/09 4 None PVT PVT TYLENOL None None 0 PVT PVT B/P medicine None known None known 0 PUB PUB None OR200904 0 West Nile virus PUBtesting-PVT Fall 2008 positive test April/May Bells 2004palsy actualRT illness West Nile OR200903 Virus 1 None PVT PUB None 0 PUB PUB MOTRIN, PRN None None felt bad~Td Adsorbed (no brand name)~UN~0~ 1 PVT PUB CT200902 0 PVT PUB CT200903 1 None OTH OTH synthamch,None niacia, VALUIM, Macrdintin HYPTOMIDONOSE, Bactrim CALCIUM, SENSELIFT, EVIS 560 PVT PVT
0 PVT PVT None None None 4 MRI pin pt PUB PVT denies denies Reitens disease 1 PVT PUB None otitis media None PVT PVT ALBUTEROL Noprn VSD, ECZEMA, RAD, recurrent URI, sinusitis/som 0 autopsy was UNK performed, UNK SIDS wasNone listed as cause Very healthy of death. None 4 month LABS: Birthold Micro Hx:baby uncomplicated & tox boy.screensc-section. all neg. 16 Large battery UNK of tests performed UNK by Medical Center None. .Seen Labs None 2/4/08 and PMH: diagnostics: for c/o none congestion, Duodenal H/A, bxfever (-). Stomach and abd bx pain. (+)Asses for ch 0 Dr doing bloodwork, UNK noPVT results yet none Heart disease, Fever~Td hypertension, Adsorbed hypercholesterolemia (no brand name)~UN~~In 5 UNK UNK None None Clubfoot 1 UNK UNK None None 9 LABS: EMG/NCS UNK abnormal. UNK CSF: protein (N). none MRI brain, none c-spine &none~ l-spine()~~0~In WNL. Patient|none~ ()~~0~In Sibling y body. Literally, I felt as though if I UNK were to take UNK one more step I would collapse. I did not have the energy to put my hand up and ask the c UNK UNK ### 1 UNK UNK Migraine, unspecified, without mention of intractable migra 3125 PVT PVT 2929 PVT PVT 399 PUB PUB 392 PVT PVT 0 PUB UNK None None Grass; Trees; Dogs; Cats; Dust mites 2 PVT PUB 1 None PVT PVT As stated No No 0 None PVT PVT Advair, Singulair, Atenolol, Hx tachycardia, Ativan prn aortic valve dz post rheumatic fever, Hx as 31 EEG, EKG,UNK CT Scan, MRI, UNK X-ray of Oral back, contraceptives extensive blood Allergic and urine to Penicillin. work-up.Seasonal Video x24allergies. hours with 2/27/09-records EEG. 2/27/09-r re 127 Rapid Influenza PVT Test PVT nonoe none spina bifida occulta 0 CBC, CMP UNK - ALT=85, glucose=337, UNK Metformin MRI ordered. NoneLabs and Diabetes Diagnostics: mellitis, CBC bicuspid WNL. AV&AI, bloodreports glucose 'cold' 337.1-2 ALT weeks 85. 2 N/A UNK PVT FISH OIL, ECOTRIN, N/A DIGOXIN, IRRITABLE ALLEGRA, BOWEL SYNDROME, CENTRUM SILVER, DIVERTICULITIS, FOLIC ACID LYM 51 flu test, CBC, UNK Chem profile. UNK Labs and Synthroid Diagnostics: 50 none mg CXR Penicillin, WNL. T4 Advil high at PMH: 15.4.OCs. CBC WNL. 0 PVT PVT None N/A NKA 0 PVT PVT 0 UNK UNK 28 LABS: UA, UNK US abd WNL. UNKAbdominal x-ray c/w None constipation. PMH: Food partial allergy seizures testssince neg. 2 yo, remission since 10/06;m 0 U/S - normal; PVT UNK 0 Urine sample. UNK UNK Zovia NA NA PMH: abnormal pap smear; LEEP/LEETZ; bilat breast 19 CBC; Mumps; PVTIgG; IgM MILAntibodyNone Panel None None ~Mumps (no brand name)~UN~0~In Patient UNK OTH OTH Hepatitis C;ItSeizure was reported disorder Seizure~Hep that theA0768715A subject's B (Engerix-B)~1~0~In seizures can be Patient stress in 54 NCV/EMG; PVT MRI PVT Bronchitis 1 PVT PVT 0 None UNK OTH Unknown Unknown Unknown PVT PUB 4 Labs and Diagnostics: PUB PUB CXR (-). CT METOPROLOL; abd initially (-) Allopurinol; then (+) HTN; forglaucoma; ASA; diverticulitis. MVT gout; ECG skin (+)Ca. for PMH: atrial fibrillation. gout. HTN. CBC hyperlip with 18 None PVT PVT None None 2 PVT PUB 0 Temp 97.8;PVT BS 93; Pulse UNKOX 96% DDAUP None Enuresis None PVT PVT SPRINTECNone None 0 None PVT UNK ORTH TRI CYCLEN No No 1 None. MIL MIL 0 Unknown OTH OTH Unknown Unknown WAES0902USA01640 90 electorencephalography, OTH OTH abnormalNone LABS: CBC WNL, plts None 423(H). PMH: CO2 chronic 14(L),HAs, total WAES0902USA01693 shaking/jerking protein 5.7(L) episode EEG abnormal. 4/08, AD None OTH OTH Unknown PENICILLIN allergy asthma~Measles WAES0902USA01522 (no brand name)~UN~~In Sib 0 Computed axial, PVT myofascial PVT swelling Alprazolam;Penicillin Fluoxetine; Allergy; Omeprazole; Sulfonamide FLOMAX; allergy WAES0901USA03436 Tramadol hydrochloride 27 Unknown OTH OTH Unknown Unknown WAES0902USA02156 0 Beta-humanOTH chorionic,OTH positive Pregnancy NOS (LMP = 10/19/2007) WAES0711USA06688
168 Electroencephalography, OTH OTH 10/??/08, Aviane negative; Electromyography, None PMH: 10/??/08, aching, forcramping,numbness, lower WAES0902USA01700 extremities: negative; tingling Magneti of LEs w Unknown OTH OTH Unknown Penicillin allergy; Joint disorder; Drug hypersensitivity Ear disorder WAES0902USA01836 plasma ironOTH assay, extremely OTH highUnknown Unknown WAES0902USA01121 95 White countPVT 21.9, H H PUB 13.8/38, platelets 364, 23 segs, 45PMH: lymph's, none 10 monos, Chemistries sodium 139, potassium 8 PUB UNK No No 0 PUB OTH None Allergies: animal dander; dust mites; codeine; MEPERGAN PUB PUB TB test, SP,Hepatitis C29078A. C None Known 0 None PUB PUB Allergic to sulfa 1 PVT UNK None None NM020902 0 PVT PUB none none 1 NONE PVT PVT None None None 1 PUB PUB CARDIAZEM NONE NKA/ HYPERTENSION 26 MRI,Spinal UNK Tap,CT scan, UNK EEG, Echo N/A gram, EKG Noneand multiple None other PMH:Encephalitis~HPV tests. Family She hx:has epilepsy been (Gardasil)~1~14~Patient hospitalized. LABS: CBC 19 MIL MIL unknown 0 PUB PVT 32 MIL MIL NONE NONE KNOWN 249 UNK PVT 0 PUB PUB 4 UNK UNK Tylenol none none none~Hep B (no brand name)~1~0~Patient|non 1 PUB PUB PREDNISONE 20 MG PO TAB 10 0 2/17/2009 Class: Print 2 none PVT UNK Patient was seen for physical/no illness 2 UNK UNK 9 None PVT PVT AMOXICILLIN Ear infection PVT UNK allergic to PCN, Sulfa, NORVASC 0 Patient coming PVTin todayPVT 2/17/09 atLAMICTAL; 4:45pm forNo TOPAMAX office visit.Partial seizures; headaches 0 PUB PUB TRILEPTAL"cold" 300 mg runny dly Epilepsy nose (2.5ml BID) 2 None PUB PVT None None 0 PUB OTH Unknown None MEDI0007813 0 PVT PVT Concomitant drug (s) Not Reported MEDI0007801 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007798 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007796 1 OTH OTH Concomitant Drug (s) Not Reported MEDI0007795 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007788 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007766 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007760 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007756 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007755 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007750 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007749 0 PUB PUB Concomitant Drug (s) Not Second Reported vaccination with MEDI0007740 FLUMIST 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007734 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007733 0 PUB PUB concomitant Drug(s) Not Second Reported vaccination of MEDI0007724 FLUMIST 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007723 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007722 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007721 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007711 0 PVT PVT Concomitant Drug (s) Not Reported MEDI0007710 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007701 0 Kept child for PUB 24 hr observation PUB in None hosp LABS: None head US None WNL. 0 None- suspect PVTgastroenteritis UNK (seeing ZANTAC many15 patients None mg/cc today .9 cc GERD tid with vomiting & diarrhea)
1 UNK UNK Oral contraceptives; Acne Allergies: topicalragweed & oral & oak trees 0 None PVT UNK None None Two prior events of brief fainting after blood draws in 2005 0 None UNK UNK None None None PMH:latex induced dermatitis. 136 Increased ANA; PUB 6/15/09 OTH Received vaccine & PCP medical None records Medical of 7/16-11/8/2008. records received LABS: 4/6/09 Endocrine PMH: acne, Labs allergie Abno 1 LABS: LUEPVT US c/w edema. PVT No Insulin Resistance and Polycystic Ovary Syndrome PMH: 1 Stool Cx, rotavirus PVT Ag orderedUNK results AMOXICILLIN never Right received stated otitissame mediaday 1 EEG nl per PVT report LABS: PVThead CTPoly scanVisol WNL. with None CSF: Fe, MYLICON WBC Benign 2, RBC extra 1, protein axial fluid 18,collections glucose 68, of gram childhood. stain neg. PMH:Bloo lacr 7 Diagnosed PVT with AutismPVT on 08/31/2007, None Age 2y, None 4 month None 818 Labs: BloodMIL glucose 122 MIL Upset Stomach 3 Labs and Diagnostics: PVT PVT Abd X-ray (+) for obstruction. None BENone. (+) forPMH: IS. none 14 Has seen PCPPVT Rheumatologist UNK per LEVOXYL work up. PVT PVT 53 EMG; CT scan; PUB MRI; Chest PVT x-ray; None Abd. x-ray.None Labs and Diagnostics: Flu vaccinesore Allergy Head on CT mouth~Influenza . PMH: WNL.migraines. LP WNL. (noMRI anxiety. brand spine name)~UN c-sec. (-). EMG Alle 2 Labs and diagnostics: MIL MRI MIL brain (-). None X-ray at the spine None time (+) for dextroscoliosis. Depression. PMH: KneeLupus. X-ray (+) Mild forcognitive ? quadreiceps impairment. tendinosis Tin 3 elevated protein UNK in spinal UNK fluid; positive None EMG/NCV. None Labs None and Diagnostics: . PMH: noneCXR (+) for R lung apex consolidation. E 4 Cardiac enzymes PVT and ECG PVT neg/normal. None LabsNone and diagnostics: None Troponin 0.04. EKG WNL. Echo WNL. 0 PVT UNK 7 OTH UNK None None 0 PVT PVT No No 0 Labs and Diagnostics: PUB OTH UGI (+) for Gastroesophagela None reflux Possible and mild failure pylorospasm. to thrive (poor CBCweight with platelets gain). PMH: 605K.poor WBC wt1 0 All in ER UNK PVT HYDROXYUREA Thombocytosis 500 mg; -GEMFIBROZIL blood disorder;600 Emphysema mg; RANITDINE 150 mg 0 attached. Labs: PVT Hgb 8.9. PVTHct 27.8. Sodium BUN chloride; 20 Post by d/c. Cardioversion Diphenhydramine Creatinine PMH: Wolff-Parkinson-White 6.1 down hcl; to lorazepam; 1.9. INR 2.2. Midazolam paroxysmalhcl; atrial Morphine arrhythmia sulf 22 See above.PVT CBC otherwise PUB normal. None 2/27/09 records No received-Platelet None count 5000 and other cell lines normal. 0 None PUB PUB None None None 9 Ultrasound;PVT numerous PVT blood tests.Yaz Doppler (1st pack) ultrasound 2/26/09-Last demonstrated 2/26/09-records week C/O sore 2/26/09-records receivedthroat, cervical Recently received-Left lymphadenopathy, started lower oral contracept extremity excess Radiology interface; PUB XPUB rays on leftNone arm. Stiff left arm & neck 0 CT Scan - NCNS; MIL Diagnosis: MIL Sympathetic vasovagal None episode. None 4/6/09-records received-EEG vast majority normal, i 181 3/9/09-records PVTreceived-WBC PVT 17.3. 5/7/09-records Bloodclot~HPV received-5/7/09-records (Gardasil)~3~13~Patient received-office visi 4 PVT PVT None None None 7 4/2/09-records PVTreceived-Sweat OTH chloride test normal. Chronic ear infections 4/2/09-records received-lactose into 12 MRI; EMG;PUB Blood tests PVT 2/20/09-records received-EKG None normal, Penicillin; CAT Low scan thyroid; of head Elevated no evidence cholesterol of intracranial 2/26/09-record hem 79 3/27/09-records PVT receibed-Barium PUB enema None unsuccessful None inNone reducing intussusception. 3 KUB/Abdominal PVT ultrasound UNK 2/24/09-records None received-pneumatic None None 2/24/09-meconium enema reduction aspiration. unsuccessful. Head CT normal. C 1 None PVT OTH None None None 0 MIL UNK 2 None PVT PVT See list See list 2 EMG-neg PUB PVT None No 8 PVT PVT None R knee instability, positive ANA, hypermobility 0 PVT PVT Lo Ovral No Pt has Hx of fainting with injection 0 OTH OTH None None PVT UNK No 1 PVT PVT INDERAL, PAXIL Mild sore throat Percocet + Postnasal -> urny. dip migraines, hyperlipdemia 2 PVT PVT 1 PVT PUB None None None 0 PVT PVT None Thick nasalNone d/c 1 None PVT OTH None None Under birth wt baby - NKDA - Delayed speech 0 PVT OTH YAZ ? antibiotic Nonefor URI 2 OTH PVT retention end 0 PVT PUB None None None 0 Unknown OTH OTH Unknown Hip replacement; Hospitalisation WAES0902USA02357 2 PVT PVT NONE NONE
75 OTH OTH None None Disclosed 0 None MIL MIL None None 73 Unknown LABS:CBC OTH & OTH CMP WNL. Unknown CT head reported as Unknown WNL, noPMH: reportirregular available. WAES0902USA02190 menses, dysmenorrhea, genital 2 Kt level = 2.9 PUB (potassium) UNK SYNTHROID, None ZYRTEC, NKASINGULAIR, hypothyroidism ALBUTEROL, - asthmaFIOVENT 0 Unknown OTH OTH Unknown Unknown WAES0902USA01791 PUB OTH Newborn None Unknown OTH OTH Unknown Unknown WAES0902USA02174 0 PUB PUB Taking CLINDAMYCIN Tooth infection NKA for tooth /12/08infection. Kidney & Spleen removed due to cancer. 8 Unknown OTH OTH Unknown Arteriosclerosis; EyelidDiabetes twitching WAES0902USA02257 1 X-ray OTH PVT None None Ovarian Cancer-2001 (cured) 1 PVT OTH NEXIUM, CELEBREX None None 2188 PVT PVT None None 0 None PVT PVT NKDA 1 None PVT UNK None None None 0 MIL MIL Hypertension no and known ch pain allergies 1 PVT UNK None None 0 PUB PUB None None None known 7 Referred toPVT Dermatology PUB None None None PUB PVT None 14 PVT PVT None 2 MIL MIL 2 None PVT PVT None None Cefdinir 1 PUB UNK None None Stool culture PVT (-) bacterial UNK pathogen. 8 PVT PUB None None Amoxicillin Allergy (no recent exposure) 367 PVT PVT None None None 10 None PVT PVT NONE fever and rash NONE 0 PVT PUB None None 0 Cardiology PVT consult LABS: PVTEKG WNL. Tilt table test. None 7 UNK UNK 0 Pt. with typePUB II diabetes. PUB Novalog Insulin Anxious, 70/30 nomix Diabetes illness 48 units type 9AMII, PinsinHips Metaformin AL0902 2003 100mg at HS Reg. insulin p 2 normal tsh, PVT cbc, cmp UNK hctz, lipitor,gerd, nexium bph, htn. nonehad other a minor than gerd, dog bite bph, to htn R wrist 2d prior 9 No laboratory MILtest. MIL None None 1 na PUB PUB na well none na~ ()~NULL~~In Sibling2|na~ ()~NULL~~In Pa PVT PVT None 3 Unknown UNK UNK None statedunknown none MIL MIL none none none 2 none MIL MIL none none none 3 PUB PUB No Client had an eye infection a few weeks before. Was on E1 MIL MIL none none 0 NONE UNK UNK NONE NONE NONE 5 4/6/09-records UNKreceived-WBC UNK 27.53. Ultrasonography no illnessshowed documented none well defined heterogeneous collection in subcutaneo 1 PVT PVT 5 PUB UNK PROAIR HFA N/A90 MCG/ACTUATION Iodine INHL QVAR 80 MCG/ACTUATION INHL AE 1 None PVT PVT None Rash None 2 none UNK PVT UNKNOWNNO ALLERGY TO oxycontin 48 allergist hasUNK performedUNK general bloodwork 4/13/09-records none none received-Skin 4/13/09-records testing receivedpositive.PMH:seasonal allergies. 1 PVT UNK Was tx 1/9/09 None with Known Amox 400 mg/5 ML; T tsp PO BID X 10 days for O 1 PVT UNK Multiple Maintenance Meds Multiple Sclerosis; Denies~Atrial ()~~0~In Fibrillation; PatientHypothyroidism; HTN occult bloodPVT (-) UNK PVT PVT None None
12 None PVT OTH PRILOSEC;None PULMICORT Acid Reflux 0 PVT UNK 1 Mumps titerPVT (-) 10/08; PVT Rubella, Rubeola titersNone (+) 10/08 0 PVT PVT Mild URI Atopic Derm 0 MIL MIL None None 0 PVT PVT Children's Tylenol None None 2 CBC diff, pltPVT 322, 12.4/35.7 PVT 9.1, 77 None S, 16 L, 7URI M, Chemistries Sx Umbilical normal hernia 0 PVT PUB vein of Galson anomaly & Chiari malformation Type 1, VP 9 PVT PVT None None None 1 PVT UNK None None None 3 PVT PVT No Hernia Diagnostic tests/labs PVT related UNK to swelling ADVAIR; at the ZANTAC; ADACEL Prenatal injection The patient Vitamins; site:denied "None TUBERSOL any needed. illnesses Swelling ###at thelasted time of 1 day." the vaccina Prena 1 UNK UNK Antibiotic Vaginal Inft on ATB's 0 MIL MIL Similar reaction in bootcamp, after vaccinations 3 chem panel;MIL CBC; glucose; MIL tox screen none known asthma, controlled; 26 Free T4, 1.04; PVTT3, 109.8; PVT TSH, 2.16; Thyroglobulin none Ab, neg; noneThyroperoxidase AB, neg; 21 EMG/NCV: PVT Possible CIDP; PVT Spinal Fluid increased Noneat 58. None. Labs and PMH: Diagnostics: mild cold sx EMG/NCS abnormal. MRI brain an 0 PVT PVT None None 0 EEG scheduled PVT PUB No Sl oeformity of thums 1 PVT UNK No Ceclor Med. 1 None takenPVT OTH None 0 None OTH OTH None Only pilonickl None cyst 3 PVT PVT Amoxil 400mg L otitis BIDmedia 5 CBC, ESR,PVT EBV titer, PUB Herpes virus SYNAGIS, 6 -> all WNL No 01/05/09; measles Levoxyl, Down IgM 80; syndrome, Reglan, IgG 622 Zantac, hypothyroidism, Amoxil, Albuterol, BPD, GERD; Pulmicort 1 UNK UNK Tuberculin Parkdale 45270 Intra dermal left inner arm 1 None DonePUB PUB None None None PVT PUB Hospitalized for fever/Resp distress with mild jaundice 11/1 0 PVT PUB No No 5 PVT UNK None None Allergic - augmentin Bleeding~Hep B (no brand name)~2~6~In Pati 4 PVT UNK NONE NO Allergic Augmentin Swelling~DTaP (no brand name)~4~5~In Patie 0 PVT UNK None None None rash~ ()~~0~In Patient 5 None OTH PUB None None None 1 None PVT PVT None None None 1 OTH PUB None None amoxicillin (rash) 0 PVT PUB 0 None PVT PVT None epistaxis 0 PVT PUB AMOX 1 PVT OTH No None 6 PVT PUB 1 Pt told to take PVT BENADRYL PVT 25mg every 6 hrs None and apply ice. 0 OTH OTH Lisinopril; insulin; Niacin; ASA; saw palmetto; Multivitamin; Coenzyme Q-10 1288 PVT PVT AUGMENTIN resolving otitis None media 2 PVT PVT 0 None PVT PUB PRILOSEC;Allergies ATARAX Asthma PVT UNK None Allergic - Penicillin 3 MIL MIL None None 1 None PVT PUB None None 1 PVT PVT None H/O Galactosemia 0 None PVT PUB None No 4 None OTH PVT None None None 1 PUB PUB
1 stool culturePVT (-); GiardiaUNK (-); CBC OK; (+) blood None in stool 4/28/09-records None received-Stool culture negative. 1 PVT PVT PPD mild wheezing Allergy-ASA 0 OTH PVT None None PCN, Suprax; None~ mild()~~0~In heart murmar Patient 1 OTH OTH None None 2 No PUB PVT 1 PVT PVT ulcerative colitis; MIL narcolepsy MIL None None None 1 none MIL MIL No chronic None meds, noneAtopic at time dermatitis, of vaccination. chronic bronchitis, seasonal allergies, an PUB UNK 0 PVT PUB None None NKDA 4 PVT OTH LANTUS; HUMALOG; Allergy: SYNTHROID; Chocolate CORTEF; flavoring; FLUVINEF Med cond: Type I Diabetes, A 0 None PUB PVT None None PCN allergy 2 PVT PVT 1 PVT PVT 0 PVT OTH None 0 None UNK UNK LOTREL; LIPITOR None 10 elevated mg po D,blood diuretic reaction pressure, to meds~Vaccine elevated cholesterol not specified (no bra 2 None PVT PVT TAPAZOLE; None PRAVASTATIN Hyperthyroidism; Hyperlipidemia None PVT PVT Polyvisal without med congestion iron Foliate Hemoglobin E- Pothal 0 PVT PVT HTN; COPD; NKDA; Back Hypothyroidism; and hip pain COPD; HTN 0 PVT PVT Synthroid None Codeine Allergy FLU (extra lethargic)~Influenza (no brand name 8 PUB UNK ~Tetanus Toxoid (no brand name)~UN~49~In P 1 OTH PUB amoxicillin otitis medianone incl. no previous wheezing 1 PUB PVT None Neck Cancer PUB UNK None None 5 2/18/08 Anachoice PVT screen; OTH Ferritin; At timeRheumatoid None NoneFactor; Healthy None Creactive PMH:protein; Family hx: CBC; juvenile PIT; idiopathic Differential; polyarthritis. Chest x-ray. 0 BP 50/80, 98/60 PUB when PUB leaving No No No 2 PVT OTH None None None 1 None PVT PVT None None None 1 PVT UNK PVT PVT FLONASE nasal None allergic rhinitis 1 None PVT PUB None None None 1 None PVT PUB None Healthy None 12/20/08~Varicella (Varivax)~2~14~In Sibling 1 None OTH PVT None Recent laceration None (Seasonal of finger Allergies) 0 None PVT PUB STRATTERA; None AlbuterolADHD; Allergic rhinitis; Asthma 10 None PUB PUB Unknown None Unknown 77 PVT PVT PEPCID; EXCEDRIN; None None OSCAL 1 MIL MIL 7 Normal: BMP, PVTCBC, CK, PVT ESR, Strep Fluvoxamine screen, ASO OCD; maleate; Titer; AcneOCD; RA; Benzaclin ANA; Acne HS-CRP, LYME; Antibody, Mono Screen, CMP, 28 PVT PVT EFLEXOR XR; VALTREX, Allergies SEASONIQUE - Benzol Peroxide 2 None PUB UNK None None None PVT PVT None None 0 None PVT UNK YASMIN; PAXIL; None ALLEGRA Intolerant PM;AUGMENTIN; TYLENOL ES;depression MOTRIM; TYLENOL PM 0 None PVT PVT None None 15 PVT PVT PLAVIX; METOPROLOL; Had Heart attack Heart ZOCOR; attack 9/18/08LISINOPRIL 0 None PUB PUB 1/29/09 KEFLEX None and Prednisone Asthma prescribed None PVT PVT None None 6 PVT PVT LISINOPRIL, ASA, MVIinterstial SIMVASTATIN, fibrosis redness/swelling~Pneumo lung, CATincreased VIT D chol, HTN, (no brand Osteopenia name)~1~ 0 PUB PUB None None 0 PVT UNK 0 PVT UNK 0 PVT PVT None None None
0 CSF culture; PVT CBC; urinalysis; PUB chem None 7; viral PCR/unremarkable None Premature labor, 3 weeks early 129 None PVT PUB None None None PVT UNK ADDERAEL; None RESPERDAL ADHD, Anxiety 7 PVT PUB Unknown none known 2 child examined PVT1/10/09PUB & 1/12/09 None - finding of None acute tonsillitis None1/12 rapid No~strep ()~~0~In test negative Patient|No~ ()~~0~In Sibling 1 None PVT PUB Hydrochlorothiazide None milk/wheat 73 Rotazyme PVT OTH None Sun 0 PVT UNK None Double ureter (L); Hx: UTI x1 / VCUR gr 3 (L) 1 MIL MIL 0 None PUB PUB None None None 5 None PUB OTH None Environmental 1 OTH PVT None Patient has history of double mastectomy. 142 PVT PVT ACTONEL;None WELLBUTRIN; Clorazepate; SOMA; IMITREX; AMBIEN 0 None PUB UNK None None 1 PVT UNK 1 None PUB PVT None None "Lives with chronic fatigue" 1 see reverseOTH OTH Metmorphin; Magnesium oxide; Potassium; Omeprazole; Oxybutynin; Furosemid 16 MIL MIL None Non-Contributary 1 None PVT PVT None None None 1 None MIL MIL ZOLOFT; TRAZODONE None Depression/PMDD PVT PUB None None 0 OTH PVT Lorazepam;None ALTACE; Heart PRAVACHOL; problemsBETAPACE; - 2 stents; irregular PLAVIX; heart CEREFOLIN; beat; High BENT blood 0 None PVT PUB Multi Vitamin with Iron. UNK PVT EVISTA Penicillin allergy 0 PVT OTH None None Diabetes; Hyperlipidemia. 0 None PUB UNK None None Seasonal allergies; Morphine UNK UNK 0 Allergic reaction PUB causing OTH anxiety reaction None Allergic to yellow dye, antibiotics, sodium phosphate 0 PUB PUB Hx syncope with vaccination 14 None OTH OTH 0 EMG-WNL OTH PVT No None 1 PVT PUB diarrhea(mild) Laryngomalacie/GERD 480 PVT PVT None None None 2007~Varicella (Varivax)~1~0~In Sibling 0 MIL PVT 358 PVT PVT SULFA None PVT PVT None 2 None PVT PVT None None None 1 PUB PUB Unknown None Unknown 0 None5AA MIL UNK None None 1 PVT PVT None None 0 PUB UNK None None 1 None PUB PUB None Just over skin None staff infection 0 PVT PUB None None None 0 Blood sugarPVT normal @UNK ER Febrile seizures 1 PUB PUB PRILOSEC;None TENEX; AUGMENTIN; BUSPAR; MIRALAX; CECLOR; ONDANSETRON; Dx OSA; Asthma; ZYRTEC; Constipation; ADD 3498 None PVT PVT None None None done PVT for reaction.UNK Had (-) UA none and Chronic; culture None for AUGMENTIN non-specific ASD; Chronic as abdominal above Abdominal pain pain 2 OTH PUB None 1 OTH PUB 5 PVT PUB Allergic-PENICILLIN, diabetes, increased cholesterol 0 PVT PUB ZANTAC 15mg/ml nasal congestion GERD
UNK UNK 16 PVT PVT None None 0 CBC-sed Rate PVT& Uric Acid PVT- within normal, Blood culture - neg. 0 PVT PVT TRIVORA; None ZETIA IBUPROFEN; NAPROSYN; ASA; Theodore/Hyperlipidem 2 02-12-09 CMP; PUB ALK PHOS PVT 147; CXR: Viral Pneumonia;Type CBC1 Diabetes normal; Rapid FUL-neg.; HybAIC-normal 0 PUB PUB None None None 0 NA PUB PUB None None None 1 None PVT PUB URI Asthma; allergies. 1 Positive pneumonia PVT onPVT CXR; increased None total bili None 2/11; 2.8, None 2/12/09 0 OTH OTH Mild Crohns disease 0 None PVT PVT 14 MIL MIL None Known Allergies: Aspirin; Pollen; Mold. 0 Possible Allergy PVT Testing PVT MOTRIN, Poly None VIFLORNKA 0 PUB PUB lead PVT UNK None N/A 1 None PUB PUB None None None 1 None PVT PVT None None None 0 PVT OTH AUGMENTIN Otitis MediaNone 0 Diagnostic urinalysis, OTH within OTH normal PREVACID; limits. REGLAN;Gastrocesophageal ZANTAC reflux WAES0901USA00323 disease; Respiratory syncytial v 0 Unknown OTH OTH Unknown WAES0901USA00324 Unknown OTH OTH Unknown Unknown WAES0901USA01206 Stool analysis, OTHpositiveOTH for rotavirus. Unknown Unknown WAES0901USA01951 1 None OTH OTH None None WAES0901USA01953 0 OTH OTH Unknown Unknown WAES0901USA01966 4 Unknown OTH OTH Unknown Unknown WAES0901USA02430 Unknown OTH OTH Unknown Unknown WAES0901USA02433 0 None OTH OTH ZANTAC Gastrooesophageal reflux WAES0901USA02724 0 None OTH OTH PREVACID Gastroesophageal reflux WAES0901USA02746 0 Unknown OTH OTH Unknown Unknown WAES0901USA03061 Unknown OTH OTH Unknown Unknown WAES0901USA03138 0 None OTH OTH None None WAES0901USA03733 Unknown OTH OTH Unknown Unknown WAES0901USA03797 0 Unknown OTH OTH Unknown Unknown WAES0901USA04170 Unknown OTH OTH Unknown Unknown WAES0902USA00407 Unknown OTH OTH Unknown Unknown WAES0902USA00406 Unknown OTH OTH Unknown Unknown WAES0902USA00083 Unknown OTH OTH Unknown Sulfonamide allergy WAES0902USA00068 0 Unknown OTH OTH Unknown unknown Unknown WAES0902USA00031 0 None OTH OTH None WAES0902USA00020 0 Unknown OTH OTH Unknown Unknown WAES0901USA04442 0 Unknown OTH OTH Unknown Unknown WAES0902USA04426 0 Unknown OTH OTH ALBUTEROL; Asthma SINGULAIR WAES0901USA04422 Unknown OTH OTH Unknown Unknown WAES0901USA04407 61 Unknown OTH OTH Unknown Unknown WAES0901USA04393 Unknown OTH OTH Unknown Unknown WAES0901USA04391 Unknown OTH OTH Unknown Unknown WAES0901USA04385 0 temperatureOTH measurement, OTH 98.4 degrees MIRCETTE; F 4/9/09-records Polycystic vitamins (unspecified) ovarian Excessive received-CBC syndrome sweating WNL. 4/8/09-records WAES0901USA04376 received-PMH: T2-T4 s 0 Unknown OTH OTH Unknown Unknown WAES0901USA04368 5 None OTH OTH None None WAES0901USA04367 Unknown OTH OTH Unknown Unknown WAES0901USA04253 None OTH OTH None Dysmenorrhea: Pelvic WAES0901USA04188 pain
0 Unknown OTH OTH Unknown Unknown WAES0901USA04169 Unknown OTH OTH Unknown Unknown WAES0901USA04124 496 head computed OTH axial, negative; OTH diagnostic Unknownlaboratory, metabolic Unknown panel, PMH: negative; reflux.Wcomplete AES0901USA03986 blood cell, negative; Lym 0 ultrasound -OTH To confirmOTH pregnancyZOFRAN Pregnancy NOS (LMP = 11/13/2008) WAES0901USA03895 Allergic reaction to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0901USA03981 1 None OTH OTH Unknown Unknown WAES0901USA03962 -366 None OTH OTH HORMONAL Hypersensitivity CONTRACEPTIVESNo Relevant WAES0901USA03954 Data~ ()~~0~In Patient None OTH OTH None Drug hypersensitivity; Allergic reaction WAES0901USA03943 to antibiotics None OTH OTH None None No Relevant WAES0901USA03940 Data~ ()~~0~In Patient None OTH OTH Albuterol; BACTRIM Asthma; hypersensitivity; penicillinWAES0901USA03934 allergy; allergic reaction to antibioti Unknown OTH OTH Unknown Unknown WAES0901USA03906 0 Body temp,PVT 99.9 F PVT DIFFERIN; Fever DORYX; FEMCON Unknown FE WAES0901USA03830 0 None OTH OTH CLARITIN None WAES0901USA03709 None OTH OTH None Sulfonamide allergy WAES0901USA03695 Unknown OTH OTH Unknown Unknown WAES0901USA03688 Unknown OTH OTH Unknown Unknown WAES0901USA03572 0 Unknown OTH OTH Unknown Attention deficit disorder; Depression WAES0901USA03670 0 None OTH OTH None None WAES0901USA03669 1 None OTH OTH None None WAES0901USA03655 Unknown OTH OTH Unknown Unknown WAES0901USA03654 89 Unknown. 6/19/09 OTH Medical OTHrecordsUnknown received DOS 4/4/08Unknown. to 5/08/09.6/19/09 LABS and Medical WAES0901USA03641 Diagnostics: records received Spirometry. DOS CBC 4/4/08 - WN to 0 Serum tissue, OTH 01/26/08, OTH positive; Unknown Serum tissue, 01/07/09, Unknown positive; Western blot WAES0901USA03640 HIV-1, 01/07/09, indeterminate; W 0 Unknown OTH OTH Unknown Unknown WAES0901USA03550 Unknown OTH OTH Unknown Unknown WAES0901USA03543 Unknown OTH OTH Unknown Unknown WAES0901USA03541 0 None OTH OTH Unknown Allergy to vaccine; Gastroesophageal WAES0901USA03523 reflux disease 0 Unknown OTH OTH Unknown Unknown WAES0901USA03516 1 None OTH OTH None Unknown WAES0901USA03509 Unknown OTH OTH Unknown Unknown WAES0901USA03506 138 Cervical smear, OTH 01/14/09, OTHhigh riskNone HPV. None WAES0901USA03501 Unknown OTH OTH INFLUENZA VIRUS VACCINE Unknown WAES0901USA03498 0 Unknown OTH OTH HAVRIX, FLUMIST Passed outNo Relevant WAES0901USA03494 Data~ ()~~0~In Patient 14 Unknown OTH OTH Unknown Unknown WAES0901USA03441 Pap test, abnormal OTH OTH Unknown Unknown WAES0901USA03440 0 None OTH OTH PREVACID None WAES0901USA03437 0 None OTH OTH Unknown Unknown WAES0901USA03348 1 None OTH OTH None Acne WAES0901USA03315 0 Tuberculin purified OTH protein. OTH Unknown WAES0901USA03292 diagnostic laboratory OTH - OTH specified they None took test but did notNone provide what type of test WAES0901USA03289 0 Unknown OTH OTH Unknown WAES0901USA03288 Unknown OTH OTH Unknown Unknown WAES0901USA03159 0 None OTH OTH Unknown WAES0901USA03127 0 Unknown OTH OTH Unknown Unknown WAES0901USA03113 Unknown OTH OTH Unknown Unknown WAES0901USA03100 Unknown OTH OTH Unknown Unknown WAES0901USA03098 Unknown OTH OTH Unknown Unknown WAES0901USA03097 Unknown OTH OTH Unknown Unknown WAES0901USA03093 0 None OTH OTH YAZ None WAES0901USA03077 0 None OTH OTH Lexa pro ; Seasonale Graves disease WAES0901USA03066 0 Unknown OTH OTH Unknown Unknown WAES0901USA03059 0 Unknown OTH OTH Unknown Unknown WAES0901USA03056
Unknown OTH OTH Unknown Unknown WAES0901USA03051 Unknown OTH OTH Unknown Unknown WAES0901USA02938 0 None OTH OTH None Unknown WAES0901USA02772 0 None OTH OTH Unknown None WAES0901USA02752 0 None OTH OTH None None WAES0901USA02751 0 None OTH OTH DEPO-PROVERA None WAES0901USA02738 Unknown OTH OTH Unknown Unknown WAES0901USA02737 0 Unknown OTH LABS: EKGOTH WNL. Unknown Unknown PMH: cholelithiasis, WAES0901USA02713 wheezing, UTI. Allergy: se 0 None OTH OTH None Penicillin allergy; Drug hypersensitivity WAES0901USA02707 0 None OTH OTH Unknown None WAES0901USA02700 Unknown OTH OTH Unknown Unknown WAES0901USA02699 139 hematology,OTH for auto immune OTH disorder, ADVAIR vitamin Asthma deficiency, PMH: Lyme asthma, diseaseHep C WAES0901USA02690 0 Allergy testMIL OTH None Allergy to vaccine WAES0901USA02575 None OTH OTH Unknown Pregnancy NOS (LMP No = Unknown) Relevant WAES0901USA02567 Data~ ()~~0~In Patient Unknown OTH OTH Unknown Unknown WAES0901USA02535 10 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02502 Data~ ()~~0~In Patient 0 None OTH OTH None None WAES0901USA02494 0 Unknown OTH OTH Unknown No Relevant WAES0901USA02463 Data~ ()~~0~In Patient Ultrasound OTH - subcutaneous OTH small bruise YASMIN / postDrug inflammatory hypersensitivity Convulsion; change No Family Relevant history WAES0901USA02390 Data~ of cancer ()~~0~In Patient Cervix HPVOTH DNA assay, OTH Positive None WAES0901USA02385 Unknown OTH OTH Unknown Unknown WAES0901USA02384 50 Unknown OTH OTH None Pregnancy NOS (LMP=11/20/2008) WAES0901USA02133 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02114 Data~ ()~~0~In Patient 0 unknown OTH OTH Unknown Unknown WAES0901USA02093 380 Unknown OTH OTH Unknown Unknown WAES0901USA02043 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA02042 Data~ ()~~0~In Patient 7 Unknown OTH OTH None Unknown WAES0901USA02018 145 Diagnostic Laboratory OTH OTH - Syphilis negative; Vitamins Diagnostic Pregnancy Laboratory NOS (LMP=6/27/2008) - prenatal screen WAES0901USA02008 Drug ; Serum hypersensitivity HIV-1 and/ or 2 10/08 0 Unknown OTH OTH Unknown Unknown WAES0901USA01986 Unknown OTH OTH KLONOPIN;Contraception; FEMCON FE Anxiety disorder; Histrionic WAES0901USA01979 personality 367 Pap test, 12/??/08, OTH - Abnormal; OTH Cervix HORMONAL HPV DNA CONTRACEPTIVES assay, None 12/??/08, -No wasRelevant positive WAES0901USA01978 Data~ for high ()~~0~In risk HPV Patient Unknown OTH OTH Unknown Unknown WAES0901USA01971 1 None PVT PVT Unknown Penicillin allergy Rash WAES0901USA01963 0 None OTH OTH None None WAES0901USA01947 Unknown OTH OTH Unknown Unknown WAES0901USA01860 4 None OTH OTH None None WAES0901USA01832 Unknown OTH OTH Unknown Unknown WAES0901USA01823 0 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA01820 Data~ ()~~0~In Patient 0 Unknown OTH OTH Unknown WAES0901USA01813 Unknown OTH OTH Unknown Unknown WAES0901USA01810 0 None OTH OTH None Unknown WAES0901USA01808 2 None OTH OTH CIPRODEX tablets Unknown WAES0901USA01796 0 Unknown OTH OTH Drug hypersensitivity No Relevant WAES0901USA01793 Data~ ()~~0~In Patient 9 Unknown OTH OTH Unknown Unknown WAES0901USA01766 0 None OTH OTH LEVORA None WAES0901USA01758 None OTH OTH None None WAES0901USA01741 Unknown OTH OTH None None WAES0901USA01731 0 LABS: Pap OTH smeal 6/08OTH WNL. UA YAZ neg for pregnancy, c/s(+) None e. coli. WAES0901USA01652 biopsy OTH OTH Unknown Unknown WAES0901USA01631 Unknown OTH OTH Unknown Unknown WAES0901USA01626 0 None OTH OTH None None WAES0901USA01623
Unknown OTH OTH Unknown Unknown WAES0901USA01616 397 Unknown OTH OTH Unknown Psychiatric disorder NOS; No Relevant Restless WAES0901USA01610 Data~ legs syndrome ()~~0~In Patient None OTH OTH None None WAES0901USA01588 Unknown OTH OTH Unknown Unknown WAES0901USA01517 Unknown OTH OTH Unknown Unknown WAES0901USA01508 Unknown OTH OTH Unknown Unknown WAES0901USA01340 Unknown OTH OTH Unknown Rash Insect bite NOS WAES0901USA01321 Unknown OTH OTH Unknown Unknown WAES0901USA01318 0 None OTH OTH LO/OVRAL None No Relevant WAES0901USA01310 Data~ ()~~0~In Patient 0 Blood pressure, OTH 12/24/08, OTH100/5; Electrocardiogram, Calcium (unspecified); 12/24/08, None DESOGEN; normal. vitamins Laboratory (unspecified) WAES0901USA01304 results - Blood glucose, 12/24/0 Unknown OTH OTH Unknown Unknown WAES0901USA01294 0 Unknown OTH PVT Unknown Laryngitis; Sinusitis Unknown WAES0901USA01258 Unknown OTH OTH Unknown Unknown WAES0901USA01227 21 Unknown OTH OTH Unknown Unknown WAES0901USA01221 0 Unknown OTH OTH Unknown Unknown WAES0901USA01181 Cervical smear, OTH 12/30/08, OTHpositiveYAZ; CONCERTA Attention deficit disorder WAES0901USA01176 2 None OTH OTH BENADRYL; Drug YASMIN hypersensitivity WAES0901USA01148 Unknown OTH OTH Plan B Unknown WAES0901USA01143 Unknown OTH UNK Unknown Unknown WAES0901USA01142 3 None OTH OTH None Drug hypersensitivity No Relevant WAES0901USA01138 Data~ ()~~0~In Patient 0 None OTH OTH Hormonal contraceptives Unknown WAES0901USA01134 151 Unknown OTH OTH Unknown Pregnancy NOS (LMP WAES0901USA01128 = 12/5/2008) Unknown OTH OTH Unknown Unknown WAES0901USA01027 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA01024 Data~ ()~~0~In Patient 4 Unknown OTH OTH YASMIN WAES0901USA01020 153 None OTH OTH None None WAES0901USA01008 1 Head computed OTH axial OTH None Unknown WAES0901USA01005 Unknown OTH OTH Unknown None WAES0901USA00984 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA00872 Data~ ()~~0~In Patient 0 Unknown OTH OTH Unknown Unknown No Relevant WAES0901USA00856 Data~ ()~~0~In Patient 0 None OTH OTH None Allergic reaction to antibiotics. WAES0901USA00808 diagnostic laboratory OTH - OTH negative; head hormonal computed contraceptives, axial - negative; None vitamins PMH: magnetic No (unspecified) Overweight, Relevant resonance WAES0901USA00803 Data~ appendectomy - ()~~0~Patient negative & LABS: cholecystectom Echocardi 0 Unknown OTH OTH Unknown Unknown WAES0901USA00802 5 Diagnostic microbiology, OTH OTH 05/??/08.Unknown Culture lesion confirmed Unknown Varicella Zoster virus WAES0901USA00796 149 Pat test, 03/12/08, OTH abnormal; OTH PapHormonal test, 09/16/08, contraceptives; normal.Unknown ALDACTONE tablets WAES0901USA00457 96 None OTH OTH Pregnancy NOS (LMP No = 12/6/2008) Relevant WAES0901USA00375 Data~ ()~~0~In Patient 0 None OTH OTH None None WAES0901USA00366 0 Unknown OTH OTH Unknown Syncope WAES0901USA00365 Unknown OTH OTH Unknown Vaccination adverse reaction WAES0901USA00353 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 11/1/2008) WAES0901USA00352 0 Unknown OTH OTH Unknown Unknown WAES0901USA00349 525 urinalysis - OTH positive for OTH protein; urine YASMIN beta-human Pregnancy 12/22/08 Tonsillitis NOS - negative; (LMP = Unknown) urine beta-human WAES0901USA00342 Urinary 12/29/08 frequency; - positive Obesity; Hyper 0 Unknown OTH OTH Unknown Unknown WAES0901USA00341 Unknown OTH OTH Unknown Unknown WAES0901USA00318 OTH OTH Unknown Flu Unknown WAES0901USA00315 0 Unknown OTH OTH Unknown Unknown WAES0901USA00309 0 Unknown OTH OTH Unknown Unknown WAES0901USA00308 Unknown OTH OTH Unknown Unknown WAES0901USA00307 Unknown OTH OTH penicillin (unspecified) Latex allergy WAES0901USA00289 Unknown OTH OTH Unknown Unknown WAES0901USA00200 0 body temp 06/10/08 OTH - 102 OTHbody temp None - 103 Labs None. and Diagnostics: 7/27/09 Medical EKG WAES0901USA00188 records WNL. received, CPK 44. including Troponin cardiolo I 0. 7/27
Unknown OTH OTH Unknown Unknown WAES0901USA00173 2 None OTH OTH None None WAES0901USA00154 10 Pap test, 10/20/07, OTH ASCUS; OTH Pap test, hormonal 05/21/08, contraceptives ASCUS;None Pap test, 23/03/08, normal WAES0901USA00061 5 beta-humanOTH chorionic, OTH 10/08/08, urine pregnancy Pregnancy test: negative; Pregnancy; NOS (LMP Pap=Delivery; test, 10/14/2008); 10/13/08, Pregnancy WAES0901USA00052 Asthma ASCUS: termination positive, HRHPV 7 Diagnostic Laboratory OTH OTH 12/23/08 - Mononucleosis None Unknown WAES0901USA00041 19 diagnostic laboratory, OTH 12/23/08, OTH -; ALESSE, ultrasound, INFLUENZA Pregnancy 01/07/09, -NOS VIRUS FHR(LMP 135; vaccine, No 1= weeks 11/18/2008) Relevant MENACTRA 0 days; WAES0812USA04853 Data~ Hiccups urine ()~~0~In beta-human, Patient12/18/08 0 None OTH OTH None Pregnancy NOS (LMP=8/5/2008) WAES0811USA02352 ultrasound, OTH 11/24/08, IUP OTHat 6w 2d, Unknown pelvic pain, Pregnancy rupturedPapanicolaou NOS corpus (LMP luteal = 10/9/2008); cyst smear abnormal WAES0811USA02127 Penicillin allergy; Hypersensitivity 76 Ultrasound,PVT 04/07/2008, PVT SLIUP SN VENTOLIN 4d. US due Pregnancy (ALBUTEROL); to bleeding/EDC Motor NOS PROZAC; (LMP=2/28/2008); vehicle 04-DEC-2008; accident; ADVAIR; WAES0810USA02628 Diagnostic Arm Asthma; ironfracture; (unspecified); Penicillin laboratory, Renalallergy; injury; ZOLOFT; 05/27/08, Splenec Anxiety vita 12 14 diagnostic laboratory, OTH 03/10/08, OTH - routine pregnancy Pregnancy workNOS up; ultrasound, (LMP = 2/11/2008) 03/31/08, WAES0810USA00870 - 1st trimester routine within no Ultrasound OTH 05/14/2008OTH - EDC 12/11/08; None routine Pregnancy dating 9W6D NCS (LMP = 3/4/2008)WAES0806USA02226 0 Diagnostic Laboratory OTH OTH 04/16/08 - cystic Vitamins fibrosis negative;Cesarean Ultrasound section; 06/12/08 Papanicolaou -WAES0802USA06329 CWO normal smear anatomy; abnormal; Beta-huma Ex-toba 0 ultrasound 01/14/08 OTH - within OTH normal allergenic limits; ultrasound extract Pregnancy 03/24/08 NOS (LMP - within = 11/13/2007 normal limits; WAES0802USA00364 Hypersensitivity Apgar score 8/9 0 diagnostic hematology OTH OTH 11/29/07 - None Tonsillectomy WAES0712USA00292 9 PVT PVT None None 0 None MIL MIL Sinus infection 4 OTH OTH Hydrochlorothiazide; Patient stated Diclofenac highpossible blood pressure; cold no allergies 6 PVT PVT EFFEXOR depression Hives, with anxiety arthralgia.~Measles + Mumps + Rubella 1 PVT PVT TUBERSOL, None SANOFI PASTEUR, Similar~Td C3026AA, Adsorbed INTRA DERMAL (no brand R FOREARM, name)~UN~27 01/ 0 None-Awaiting PUBneurology OTH referral Zinc oxide ointment; Diaper Dermatitis NYSTATIN None ointment 0 None PVT PVT None None None 14 PVT OTH 6 Ultrasound,PVT MRI UNK None None 0 PVT PVT No 0 None PVT PVT None cimetadine; CECLOR none PVT PUB none none 0 None performed. PVT Pt referred PVT to ER. None None MIL PUB None 1 PVT PVT 0 PVT PUB None None 8 None donePVT OTH None None None 2 cellulitis OTH OTH None None None 0 Neg RST PVT PVT None None 2 PVT PVT None None 0 PVT PUB Immediate outbreak Hives~Pneumo of facial (Prevnar)~3~1~In hives after ROTATEQ, PatientPEDIA 1 CT - Lab work PVT- UA PUB NKA 1 None PUB PUB None None None 411 PVT PUB none none none PUB PUB unk None Known denied allergies to meds or food 0 UNK UNK LIPITOR; LOTRIL History of hypertension and hypercholesterolemia. ### Has ha 48 MRI/MRA; EMG, PVT labs: PVT B12; ANA; Levothyroxine; ESR; HCG No ORTHOHx, NOVUM metastatic papillary cancer of thyroid s/p thyroidectom 0 PUB PVT 0 PVT PVT None None Atrial Septal Defect; Scoliosis PVT PUB 1 None OTH PVT FLAX seed;calcium; No magnesium; No vitamin B complex; Niacin; Omega 3; COENZY 0 PUB UNK 7 Cellulitis USPVT L arm PVT SYNTHROID; None QUESTRA; HTN;BENICAR hypothyroidism; hyperlipidemia 1 PVT PVT ACTOS; ALTACE; EFFEXOR; Diabetes;GLUCOVANCE; Obesity; HTN DARVOCET -26 OTH PVT Psoriasis 0 None PVT PVT SINGULAIRNone 0 PVT PVT Lisinopril; Amlodipine; Sertraline; IMITREX 1-31-09~Tdap (Adacel)~1~51~In Patient
2 PUB PUB 0 PVT OTH gastronitis None 0 MIL MIL Montelukast; None Atomoxetine; Asthma ADVAIR 0 PVT PVT ADDERALLNone XR 20mg;ADHD TQD 0 PVT PUB 0 PUB PVT Recovering from fx heel since 4/08 1 PVT PUB No Allergy to chicken pox vaccine 0 CMP; CBC;PVT UA; CT of PUB head None None None Unknown OTH OTH Unknown Unknown WAES0902USA02263 1 Unknown OTH OTH Unknown Unknown WAES0902USA01655 0 HB screen drawn PUB (L) antecubital PUB just None prior to HB No vaccine illness None dose given. 93 OTH PVT Multivitamin; None PREMARIN Drug allergy - PERCODAN; Menopause; uterine fibroids 16 Labs and Diagnostics: PVT PVT Brain MRI (+) for ventriculomegaly URI s/pand NEC; prior25 grade weekII premie. hemorrhage, PMH: repeat 25 wk (-) premie. for brainstem o 0 PUB PUB 26 None UNK UNK DILANTIN; gabapentin;seizures; atenolol;HTN; ASA hyperlipidemia; R carotid stenosis; bronchi 1 None PVT PVT LURIDE, TRI-Y-SOL Otiti - MediaNone - Amox 2/1 - 2/11/09 0 PVT PUB None None None 0 PVT PVT None None Seizure~Influenza (Fluzone)~1~6~In Patient 1 Temp 98.9 UNK - arms equal UNK size 7 None MIL MIL Depo shotsPt denies Pt denies 11 cbc bmp sed MIL rate rpr MIL none None nkda sm has back acne 1 Tests done PVT blood work,UNK xrays and flu swab. INone believe oneAsthma of the test was for mono, which came back negative, xra 15 Labs and diagnostics: UNK LP UNK with WBCs Yaz122-100% none monos, none. CSF protein PMH: OCs 109, glucose 57. HSV PCR (-). EEG abnorma 1 n/a PUB PUB none no none 6 MIL MIL Took KeflexNone and Percocet Allergic 02-15-09 to penicillin till 02-17-09 ,Ampicillin, after Paracetamol cosmetic surgery 2-05-09 0 PUB PUB None PCN, Tylenol, "Heart Meds", Steroids. Pt. denied allergy t 0 the DTaP was PVTfrom Glaxo UNKSmith exp None date 8/03, None the Hib was None from Aventis autism~DTaP exp date+11/02, HepB the + IPV IVP(Pediarix)~4~0~In was from Connau 0 PUB PUB no NKA 5 Chest X-ray, UNK venous blood UNKdraws,Levenox, CAT Scan, two Mother Nuclear injections says contrast Hx. daily two ofweeks anxiety for test,three and before and weeks many four Thanksgiving, other then yearsdiscontinued, tests ago but diagnosed patient mother Coumadin hadcan having cold not sympto Throm daily, reme 1 MIL MIL none HTN, HLD, GERD, OA, DM; allergy - metronidazole (urtica 31 TSH 0.50 1/2008 UNK PVT none hypertension, xerosis, eczema,hypothyroid, 1 MIL UNK None None PVT PUB PVT PUB PVT PUB Eczema UNK PVT 1 None PVT PUB None None None 0 After extensive PVTphysical PVT exam, referred None to neurology None for eval Noneand EEG. Likely benign rolandic epilepsy. Still waitin 0 PVT PVT Rota given none Po and Manufacturer none for Pentacel is Sanofi unable to enter above 4 OTH OTH No other medications Unknown MA20090270 UNK OTH OTH Thyroxine sodium; Unknown Fluvoxamine Hysterectomy; maleate; kneeRosuvastatin pain; A0769208A the subject calcium; under Chromium went twosalt; surgT 0 Unk PVT PVT Ofloxacin Unk It was reported that it was A0724362B unknown if the mother was preg 0 UNK PVT PVT Ofloxacin Unknown Pink Eye; The reporterA0724362A stated that the subject was very ea 116 OTH OTH Healthy PVT UNK None None 1 None PVT PVT None None None 9 None PUB PUB None None 1 Seen in ERPUB doctor- BENADRYL PUB given per mother None None 1977 OTH OTH Pan Hypopituitarism 7 PVT PUB Started 2-17-09 Augmentin 65 600mg/ 5 cc 3.5 cl po BID for 10 days 6 Parvovirus PVT and Measles PVT titers. 7/7/09 MedicalNone records received None DOS 12/26/07 to 6/23/09. LABS and DIAGNOSTIC
0 UNK OTH PVT 0 CBC; Platelets PVTand AutPVT Diff No Known Medications 17 2-4-2009: skin PVTlesion Giemsa PVT stain, DUAC, negative; RETIN-A pt Tzanck reported smear, Mild onsetnegative; facial of recurrent acnevesical single base HSV HSV lesion Ag DFA, lowernegative; lip on same vesica day OTH PUB None Allergy to CECLOR 0 multiple ABG UNK (hypoxic);MIL chem; CBC; ASA, CXR dig;(atelectisis LASIX; URI SYNTHROID; RUL, This consolidation), 9 month Polivisol old male etc.; vit; TYLENOL was negative born RSV; by emergency infl A/B Ag; c-section C3 low aa 0 OTH OTH TYAESON SUPERFICIAL PUNCTATE KERATITIS EKG NSR w/arrhythmia, MIL MIL inverted T waves, CK HBP, 179 prostate (55-170),problems Troponin I <0.38 (0-0.08, CKMB 2.43 (0-2.37), chem, diagnostic laboratory, OTH negative OTH pneumococcal penicillamine Wilson's antibodydisease; titer; immunoglobulin Immunoglobulins GWAES0902USA02409 index, decreased decreased body temp, OTH 104 degr OTH Unknown Unknown WAES0902USA02177 Unknown OTH OTH Unknown Unknown WAES0902USA02440 1 PVT PUB SYNAGIS, Not MedImmune, ill at time 35of 08A624, wkvaccines preemie; upper Twin; rightReflux thigh, (GERD); 2 previous NBdoses hearing screen ( 0 UA -trace bacteria; PUB WBC, PUB 16.9; Hgb, Depo 15.5; Provera Drug None screen (+) NKDA; Cannabis. Hx of abdominal See attached AR0903 gun- labs shot 2/27/09-records at age 9. 2/27/09-record received 46 LABS: Abdominal PVT x-rayPVT & KUB abnormal. Segs None 47%(H),None plts 457(H). PMH: Currently Creatinine w/OM 8(L),&albumin being tx5.0(H), w/oral globulin antibiotics. 2.1( 9 PVT PUB developmental delay None, but primary OTH carePVT physician evaluated Genfibrozil; &None HCTZ no Tx. Hypertension; Hyperlipidemia 0 UPT - neg PVT PVT ORTHO EVRA None Patch reported NKDA 1 UNK PUB SINGULAIREczema 10 mg, ATORAX Cat, dogs, 1 1/2 dust tsp(NKDA) Eczema, Ocular albinism, Hx of P 2 PVT PVT 0 None PUB PUB LYRICA, ULTRACET, None None ONNORRIS, SASTLINE OTH OTH None Asthma 0 Glucose, finger PUBstick, 102 PVT None None None severe reaction~Yellow fever (no brand name)~ 119 Influenza Test, MIL positiveMIL 114 Influenza Test MIL- Positive MIL 117 Influenza Test MIL- Positive MIL 59 Influenza Test, MIL positiveMIL 0 PUB PVT None None 0 PVT PVT None None None 2 None PVT UNK None None known 0 PVT PVT No Ceolliouprath decreased tone UE 0 PVT PVT Quinapril; HCTZ; None EFFEXOR SIMVASTATJN XR; NIASPAN > URTICARIA, DX: HTN, Depression, and 1 None PVT UNK No No 1 OTH PVT Unknown CHF, arthritis/ All: PCN, Sulfa, TOLECTIN, TCN, ZOLOFT 575 Diagnosed MIL as ShinglesMIL on 2-10-2009 No No 13 MIL OTH UNK UNK 1 PUB UNK None None None AR0905 1 PVT PVT SYNTHROID; CutPAXIL; DAYPRO; None AMBIEN; DARVOCET; Lorazepam; AUGMENT 0 OTH PVT AX and other NounknownNeurocardiogenic meds. syncope; seizures 0 PVT OTH FLOVENT HFA; Possible ATROVENT; pneumonia asthma DELTASONE; AMOXICILLIN; VICODIN; STNTHR 0 MIL MIL 1 PVT UNK None sensorineurial hearing loss 0 PUB PUB PAXIL, BUSPAR, None IMITREX Migraines, eggs, Vomiting~Influenza milk, PCN - Depression (no brand name)~1~32~In 0 none PUB UNK None None None 0 UNK UNK Patient hasPatient Cystic Fibrosis. has Cystic Fibrosis. 1 None PVT PUB Penicillin allergies 0 PUB PUB 0 none PUB PUB none none asthma none~ ()~NULL~~In Patient 0 PVT PVT Hx Eczema 1 None PUB UNK Atenolol, HCTZ, NoneOcella, IBS Zyrtec, and allergies Primrose None~to()~NULL~~In oil, dust, Vit E, mold, Multivitamin, and Sibling1|None~ Sulfa Zifaxan, ()~NULL~ Erythroc 0 none UNK UNK none none none PMH:Arm ear pain~HPV ache & tonsillitis. (Gardasil)~2~16~In Patient 1 NONE PUB PVT PREDNISONE NONE 5MG BID; RHEUMATOID IBUGESIC 400MG ARTHRITIS
1 EEG scheduled UNK 2/25/09 UNK prior to event Prevacid per Dr 3mg/ml no note on - 1.5 2/17/09. Wolf-Hirschhorn ml BID, Hydrochlorothiazide Syndrome / 10mg/ Sickle ml Cell- 5Trait mg /BID, Chronic Tri-Vi-S Ren 2 UNK UNK none no none 0 Labs and Diagnostics: UNK UNK Holter monitor None with frequent None -PVCs. wellHx baby CXR blocked exam WNL.lacrimal Echo WNL duct,for Dxage withwith Failure small toPFO gain noted weight, with va 1 PVT PVT None None None 0 2 MIL MIL Similar reaction Shortness in bootcamp of breath~Vaccine after mass vacination not specified and(no ca 2 Brain CT scan, UNKbrain MRI, UNKFactor 5 blood test,none FISH blood none test,PMH: lyme disease, migraine CBC, HA x 3 Evoked yrs. Vertigo. potential Factor test. VLABS: LeidenP 11 None PVT UNK None None None no~ ()~NULL~~In Patient 13 PVT PVT none none 0 UNK UNK NONE none NKA, Rt. eye ptosis, recet meatal stenosis correction 1 UNK UNK NONE NONE 0 MIL MIL UNK UNK 19 UNK UNK none none none 0 PUB PVT -0unk 1471 PVT UNK None VonWillebrands 0 PVT PUB no none 0 PVT PUB 1 UNK UNK NONE NONE mild asthma 1 None MIL MIL Lessina Optic Neuritis HSV 16 PVT PUB Atopic dermatitis History of congestion and runny nose, Atopic dermatitis 21 Staph Aureus; PVTInfl B positive; PUB X ray chest diffuse None pneumonia NoneLABS: Admit labs: WBC 0.9(L), plts 41K(L) CRP 26.6 29 MRTs and CTs; OTH multiple OTH lab test; Spinal tap LABS: No MRI PMH: brain 12/31/08 PSVT, HTN, abnormal. hypertensive MRI c-spine cardiovascular abnormaldisease. w/multile 1 PUB PUB PPD, ID, 1, 2-19-09 UNK UNK 0 OTH PVT TYLENOL 1 PUB OTH unknown Reported no allergies 2 OTH PUB none none Skin biopsyUNK done, pathology UNK -> 10/30/2008 shows none squamous knownHypertension, cell CA. diabetes, hyperlipidemia MRI/CT negative. PVT Blood UNK Work negative for any None neurological None indications/infections/ cardiovascular disease". 0 PUB PUB None 10/08 surgical excision of staph infection lower abd. 2 PUB UNK SYNTHROID; None PREMPRO Hypothyroidism 1 Unknown - PUB Pt sent for M.D. PUB evaluation Noneon 2-13-09. Mom reports None - mild dry cough 1 None PVT UNK None CAD, DMII, HTN, glaucoma 0 None PUB PUB Well Child NKA 1 PVT PUB 1 PVT PUB 3 OTH PVT None None 0 Allergist no PVT allergy testing PVT None None None 0 None PVT PUB None NKDA 0 None PVT PVT None None; NKDA 0 PVT PVT None None reported None 0 PVT PVT none none none 0 None PVT UNK He was given None some known children's None. tylenol (I think?) immediately prior to his vaccinatio 0 the doctor that PVTI saw two PVT days latertri-cyclen, (2-19-09)and red Dr.cephalexin(given bumps/rash Castro is none calling itteh ansame allergic day reaction as the border two vaccinations) line infection 0 Encephalitis, UNK Autism, Roseola UNK Roseola with high fever 3 months prior. PMH: eczema 1 PVT PUB NONE CYSTIC HYGROMA L SIDE OF NECK 0 MIL UNK N/A SULFA DRUGS 0 none UNK PVT n/a none allergy to codeine 0 none PVT UNK infant tylenol None aprox. 30None minutes prior to injections. 0 PVT UNK eczema 0 MIL MIL MOTRIN 800, States PO none QD allergic PCN, Taenia
1 UNK UNK none none 2 Any test were UNK not doneUNK until almost TBthree test months (PPD-mantoux)10/31/2007 noneafter shots. noneEarly PMH:intervention fever c-section 102~Measles w/nuchal program+cord, diagnosed Mumps decreased + Rubella him with heart +aVaric 7rate mo UNK UNK 1 PVT UNK none high blood pressure. no other 0 CHEST XRAY, PVTCBC, RSV UNKSWAB,Zantac, STREPReglan TEST runny noseacid reflux 9 PVT PVT Amlodipine,Diabetes, Levemir, Hypertension, Glucophage, None Glucotrol, Hyperlipidemia, ASA, HCTZ, Obesity, Zocor, Perforated Lotensin, nasal Byett se 0 None OTH OTH Concerta Pregnancy NOS (LMP = 5/19/2008); WAES0901USA03717 Penicillin allergy; Attention defici Unknown OTH OTH Unknown WAES0902USA02626 49 diagnostic laboratory, OTH 11/15/08, OTH unspecified Zyrtec; Allegra lab Allergic tests respiratory symptom WAES0902USA02661 Unknown OTH OTH Unknown Unknown WAES0902USA02666 Unknown OTH OTH Unknown Unknown WAES0902USA02698 0 None OTH OTH ACIDOPHILUS; Drug VENTOLIN hypersensitivity (ALBUTEROL); SYMBICORT; WAES0902USA02926 PREMARIN; CENTRU 1 Unknown OTH OTH Lisinopril Hypertension Immunisation WAES0902USA02933 0 Unknown OTH OTH Unknown Unknown WAES0902USA02939 2 Unknown PVT PUB LIPITOR; FLEXERIL; Diabetes; Hypertension; AVAPRO; CALAN Dyslipidaemia SR WAES0902USA02882 UNK UNK 6 EKG, normal; PVT Chest X-ray, PVT showed not bronchitis at time of None 3/16/09-records vaccination allergicreceived-WBC to Amoxicillin 3.2, Hgb 14.9, neutrophils elevated 7 UNK UNK I've never had an allergic reaction to any medicine in previ 49 LABS: Blood UNK c/s, CRP,UNK PT/PTT all WNL. She does have allergies PMH: asthma, seasonal allergies 10 None PUB PUB TYLENOL; None MOTRIN, PRN None 0 None PUB PUB none stateddenied OR200905 1 None PVT UNK None Right sided plagrociphely > treated & resolved 408 None PVT UNK None 0 - Physical exam PVT - normal, PUBon day of None shot (2/17/09) Cradle and captoday only (2/18/2009) 2 None PUB PVT None None None OR200906 2 PUB PUB OR200908 2 Allergy elimination, PUB so PVT far not allergic to gelatin Noor neomycin No 0 TSH, CBC PUB PVT None None None 1 Neuropathy,OTH abnormal PUB EMG and nerve NORVASC, conduction No NEXIUM, illness studyTOPROL, Arrhythmia, 2/09/2009.SYNTHROID, Physical migraines, therapy, hypothyroidism, BENICAR, blood labs, ALDACTONE, hypertension, (CBC), (ANA) PREMA dege ord 0 None PVT UNK None 0 Not Preformed PUB PUB None 1 None PVT PVT multiple meds None Heart attack x 2; type 2 diabetes; penile cancer 3 None PUB PUB None None None 1 PUB PUB MIL MIL BC (OCP) None PVT PVT None None None 0 PVT PVT None Known 4 None MIL MIL None None None 0 None PVT PUB Sinusitis; allergic All: INVEGA; rhinitis crab meat; med; conditions: ADHD; Bipolar d 0 None PVT PUB None Dermatitis None ~Rotavirus (Rotateq)~1~2~In Patient 0 None PVT PUB None Nasal Congestion None copious drainage 0 PUB OTH None Known or indicated on IMZ record 1 None PUB OTH None None None 0 Service member MIL has had UNK tetanus and influenza None vaccines in the past w/no adverse events. He had not had meningo PVT OTH State Vaccine No None 8 None PUB PUB None None Using Soy milk, regular causes diarrhea 0 CT chest, neg PVTfor P. E.PUB None No Benign Murmur UNK UNK 0 No test done PVT related toPVT this event.Multivitamin; None, FLOVENT s/p TAllergy and MDI;AAUGMENTIN; to 4 days CEFZIL; possible PREVACID, immune 15mg, disorder; BID reactive airw 0 PUB PUB None OR200907 3 PUB PVT None Known None
0 0
PUB PVT No No MIL UNK ACIPHEX, 20mg; None HCTZ NKA MIL MIL Allergies 19 VZV strain discrimination PVT OTH None None None 0 PVT PUB Cough slight swelling and soreness~Pneumo (no bran 6 None PVT PVT SYNTHROID; Asthma; TOPAMAX Epilepsy; Migraine WAES0902USA03903 0 PVT PVT 2 PUB PVT aspirin 0 PVT UNK Kidney-wellURI per Mom Proteinuria 0 NONE UNK PUB NONE NONE NONE PR 09 03 1 PVT UNK none none 0 NONE UNK UNK COMMON COLD AND RASH IN THE PR0904 FACE 1 UNK UNK 0 UNK UNK None None None 0 none PVT PVT Pulmocort, none albuterol bonchiolitis in past 1 NONE UNK UNK 4 PUB PUB Not applicable Amoxicillin 2 UNK PVT error on previous report...should have been reported as Zoster and no 2 UNK PVT 7 NONE UNK UNK Caduet None Had Shingles approx July 2008 0 PUB PUB none none 0 PUB PUB none no PCN same~HPV (Gardasil)~2~15~In Patient 14 None at thisPUB time - Client UNK referred None to private MD None for evaluation. None 4 PUB PUB Tylenol none 9 2/17/2009 EEG UNK at Hospital, UNK Neurologist none appt.none 2/18/2009stroke in-utero, seizures first 3 days of life from high fevers 1 PVT PVT None HTN 0 None PVT PVT 0 None - pt went PVTto hospital PVTemergency None room None None PMH: bipolar, asthma, anxiety, suicidal ideation hist 1 MRI->ADEM UNK LABS: MRI UNK brain abnormal. Neutros None 65.6%(H), known PMH: to us lymphs strep throat 26.2%(L). 12/08CRP & recurred 0.07(N). 1/09. ESR 33(H). CSF: p 1 OTH PVT Unknown None Unknown 0 3/11/09-records PVT received-white PUB count of 13,000 and urine3/11/09-records revealed white receivedcells and red Allergy cells. to Augmentin reaction w 0 UNK PUB PUB Asthma The subject had no adverse A0769858A events following previous vac UNK OTH OTH Zolpidem tartrate Hand tremor; High Insomnia; Cholesterol Osteopenia A0605302A 9 PUB OTH NUVARING 0 PVT OTH Fluoride drops None ex - 34 week preemie PVT UNK see note None 3 ultrasound, OTH abnormal; urinalysis, OTH 12/15/08, negative; urine None. culture, PMH: 12/15/08, NICU for negative; WAES0902USA02413 TTN. nasopharyngeal RSV, 12/15 2 diagnostic microbiology, OTH OTH 02/16/09,aspirin; lesion culture: LIPITOR; result calcium; pending Unknown PREVACID; DILANTIN; WAES0902USA02932 ACTONEL Unknown OTH OTH Unknown Unknown WAES0902USA02974 Unknown OTH OTH Unknown Unknown WAES0902USA03097 diagnostic laboratory, OTH CF OTH profile negative; REGLAN; diagnostic ZOFRAN; Pregnancy laboratory, vitamins NOS (LMP (unspecified) 1st trimester = 10/2/2007) usWAES0711USA01322 screening within range Unknown OTH OTH Unknown Unknown WAES0902USA01674 0 clinical immunology, OTH multiple OTH sclerosis Unknown negative; Lyme disease Unknown assay, negative WAES0902USA03098 Unknown OTH OTH Unknown Unknown WAES0902USA02699 Sed rate, CRP, OTHRheumatoid OTH factor, ANA, liver function panel, Patient all had normal a history findings; of IGA Lyme, deficiency ### Monospot, andASO, allergies all negativ to am 13 Lumbar puncture. PVT LabsPVT and Diagnostics: MESTINON CXR WNL. EKG Myasthenia WNL. Spinal Gravis tap(since with normal 1968). CSF PMH:glucose Myasthenia and protein Gravis 0 OTH MIL 6 Pavoo Vn and PVTMcarda PVT titra None None None 0 PVT PVT None None None 0 None PVT PVT None None None seizure~ ()~~2~In Sibling 2 PVT PVT CELEXA, ALBUTEROL, None Emphysina FLOVENT, - Breast DIAZEPAM Cancer - Anxiety
11 9
PUB PVT PVT UNK None Cough None PVT PVT Annual physical HTN; Hyperlipidemia; Sulfa allergy 1 OTH PVT None None 112 Flu A + PVT PVT None None 0 Seeing allergist PVT in TWLPVT no testing done yet. No Cleft palate 0 Ordered EEG MIL MIL None None None/ Healthy No previous Baby adverse event~ ()~~0~In Patient 12 Rubeola lgG PVT lgM; lgM OTH rubeola positive None None NKDA; Hx sinusitis; Otitis Media 0 LABS: EKGPVT WNL. H.pylori PVT (-). TRINESA; OMEPRAZOLE Possible stomach None ulcer 0 PVT PUB NUVARINGNone Allergy: Chocolate 1 None PUB PUB None None 352 + Pertussis PVT serology 01/26/09 UNK Physical exam 0 None PVT OTH No None 0 EKG: Normal OTH sinus rhythm. OTH Ectopic None beats. Premature No atrial Nonecontractions. Normal pulse. Normal QRS complex. N 1 PVT PUB 1 PVT PUB Digoxin; ALLEGRA; Cervical spinal LEXAPRO Ibuprofen stenosis - CHF (C2-C7); Cardiac Dysrhythmia (scheduled for 2 No PVT PVT No No Mild varicella~Varicella (no brand name)~UN~1 3 UNK UNK 88 PUB UNK No PVT PVT Cold temp 99.9 NKMA deg F 1 PVT PUB BENADRYL 5 None PUB PUB ERYTHROMYCIN Congestionophth None Conjuntivitis oint TID; AMOXIL 400 BID 0 Referred toPVT NeurologistPVT NASONEX None PROTONIXNone - CLANTIN 4 Not applicable PVT PVT HCTZ, FELODIPINE, No ASA hypertension,high cholesterol, elevated PSA, sulfa allergy None PVT UNK None None 0 None PVT PVT None IBUPROFEN -> itch 0 PVT OTH SYNTHROID; Pancreatitis, ATIVANIVP R/O Dye, MI shellfish; Papillary stenosis; emphysema 1 OTH PVT None None None 0 Addendum:PUB Appt to seePUB allergist today TamoxofenNone statedHx CA; Allergies: Naproxen; PCN; Sulfa; Zithromax; Pinea 0 OTH PVT Increased Chol; Dyslipademia; mild headache murviogenpic occasional hemotursa 1 PVT OTH None None 0 PVT PVT 1 Clinic follow-up PVT with physician PVT for monitoring 5 PVT UNK none none none 0 PVT PVT Lotrel, Zoloft, None Xanax High Blood Pressure, depression due to daughter's suicide 1 N/A PVT PVT NONE NONE NONE 0 UNK PUB none none none 1 PVT PVT Robaxin, Veramyst, NA Miacalcin, Allergy toFluocinonide Sulfamethazole Solution, Prempro, Carpal Fosamax, TunnelCelebr Syndr PVT UNK 2 N/A UNK UNK "cough med" cough none known 0 none PVT UNK none none 1 nonw PVT PVT Aspirin 81 mg none by mouth Dyslipidemia Daily Take an aspirin Hypertension daily for 21 daysAcute to reduce Coronary the risk Sy 1 Home temperature UNK on UNK day prior toTYLENOL hospital admission PRN NoneFEVERS of 101.9 nkda, previously degrees F.hospitalized ER admit temperature x3 days in was Sept100 2008 with for afeve pe 0 Autopsy done UNK - LABS:UNK 12/18/08: CBC, Tylenol-was BMP,Chronic CXR told to WNL. take bronchitis Premature 1/12/09: prior to per vaccinations LABS: infant, pathologist WBC 3 oldper who 30.3, healing MD did segs the rib 9.97% fractures autopsy lymphs found16.9%. at autop 1 N/A PVT PUB 1 PVT PUB 0 PVT PUB None. Patient None was here for wcc 0 none UNK PVT NONE NONE 1 PVT PVT NONE 1 PUB UNK Ventral Hernia Allergy repair to Abilify on 2/3/09, - dysphagia, discharged hand 2/6/09. tremors. Presented back to 0 LABS: EEG, UNK MRI brain,UNK spinal x-ray None WNL. Genetic None testsHernia WNL. at eight weeks old PMH: mild language & motor de
PVT PUB none none 0 None MIL MIL Singulair, Flonase None Egg allergy; asthma; Peanut allergy; shellfish allergy 0 1/10/09 WBC's PUBincreased UNK 23.5 k/ulAlbuterol per PCP.Nebulizer; Labs: WBC Hx12-30-08 taking 17.9, 26% ZANTAC DXlymphs, with RSV; 59.9% 7-20-08 neutros. DX with Flu (-). GERD; Strep1/10/09 (-). CXR A 0 PUB PUB None None 12 Pending complement MIL studies MIL None Hypothyroid; cervical dysplasia 1 Stool Culture PVT PVT None None 2 PUB OTH 2 PUB PUB DARVOCET; MOTRIN, PO; COLACE; TYLENOL 3 3 PUB PUB COLACE, MOTRIN, VICODAN 2 CBC with Diff; MILESR; TSH-sensitive; MIL Ibuprofen CMP; HIV-1 800 None mg AB; po RPR tid NKDA. with food; Patient EXCEDRIN had recent prn (10FEB09) for HA's; OTC Allergy Super work-up, B-Comp whi 3 OTH PVT 5 PUB PVT None None None 10 OTH PVT No 0 CBC TO BEPVT DONE PVT 1 None known PUB PUB No No 0 PVT UNK LIPITOR; DIOVAN; None ATENOLOL; None CARDIZEM; FLOMAX ASA 1 PVT PUB 0 None PVT PVT None None None 1 None PVT PUB None None None 0 PVT OTH 0 PVT UNK None None None 1 MIL UNK None None X-ray of leftPVT arm: negative PVT The patient had a history of a ### pulled muscle in the left arm Unknown OTH OTH Unknown Unknown WAES0902USA03575 Serum hepatitis OTH B, low OTH Unknown Unknown WAES0902USA03396 107 PUB PVT None None HPV #2 given 10/17/07, LA, 0469U; HPV #3 given 2 2 PVT PVT None 1 None MIL MIL none none none 1 none performed UNK PVT nexium none allergic to fentanyl. has acid reflux 10 PUB PUB none, per parent none, per parent none, per parent 0 EEG scheduled PVT PVT none none 1 CT, MRV, confirming UNK Transverse UNK Sinus Ortho Venous Triclyclin none Thrombosis....UTC Lo andNKDA, multivitamin none records none~ only 3/9/09-records ()~~0~In of beingSibling|none~ placed received-PMH:migraines. on Keflex ()~~0~In and Predniso Sibling| Ora 10 MRI Brain and UNKSpine: areas UNK of demyelination none none of cervical spine none 3/16/09-records and brain. CSF received-Allergic studies negative for to penicillin. infection, autoim 0 PUB PUB Albuterol inhaler child in good Hx. health of asthma 0 None MIL MIL None None None 0 PVT PVT none n/a point that it kept patient up at night. Told PVT mom to PVT do cold compresses none none and motrin none call if symptoms worsen. 1 PUB UNK Traumatic injury - stepped on nails in board. 0 Blood woork-3 PVTdirrfert test, UNKallegery none skin test,,C1 none functionional none test, hormone none~ ()~NULL~~In test,cbc -blood,c4,serum Patient|none sister~ trytose,swolle ()~NU 2 She was given UNKfosphenytoin UNK and started on maintenance Patient hadUnderlying congestion IV fluids. Head medical and CT rhinorrhea conditions was done fiveand including days noted prior. congenital as3/6/09-records stable. CMV, Blood m c 21 Unknown PUB UNK Unknown Unknown Unknown 1 PVT PVT None GI upset, fever, myaligias less severe~Td Adso UNK PVT Coumadin, Synthroid 0 PVT UNK None. None. None. I would like to see CDC mandate that drug manufa 0 none PVT PVT none notedsulfa allergy none knownPVT UNK Unknown None known 6 UNK UNK None none No PMH/PSH 7 PUB PUB 1 NONE KNOWN PUB PUB NONE REPORTED NONE REPORTED NONE REPORTED Magnetic resonance, OTH normal; OTH computed Unknown axial, normal; electroencephalography, Convulsion WAES0902USA02176 normal 2 3/5/09-records PVTreceived-EEG OTH abnormal, subtle None focalknown cerebral None of dysfunction. known at time, CTpossible showed reoccurring subdural hematoma brain bleed withfrom mi
7 3/9/09-records PUBreceived-Electrocardiogram PUB None at time normal. None of vaccine 2D echo None with 3/9/09-records color flow and received-PMH:bronchitis Doppler normal with trace andtricuspid whoopi 0 PUB PUB None None 1 OTH PVT None None 0 PVT PUB None None apricots caused rash 1 PVT PVT Eczema, asthma 2 PVT PVT None OTH OTH 0 None PVT PUB None None 1 PVT UNK 15 PVT PVT None None PVT OTH 3 None done PVT here - (vaccine PVT clinic for, CLARATIN; international diabetic Vitamins; travelers - says ALLEGRA; Diabetic controlled - says ZOLOFT; controlled albuterol; and able to travel 1 PVT PVT Pulmicort, Albuterol, Swallowed Tylenol Reactive foreign body Airway in alimentary Disease tract 0 PVT PUB ATARAX 52 UNK PUB None None HSM 12/07 -1/08 0 PUB PVT No illness Seasonal allergies 1 PVT PUB none none 1 All "negative" PUB per Mother. PVT1-22-09None EKG; CATNone Scan; multiple Allergies: bloodBrazil tests;nuts Urine (Anaphylaxis tests. 1-23-09 in 1987); TestingPecans, for Lupus; Waln "a 1 TSH= 0.01 PVT on 2/18/09 PVT SYNTHROID, None 50mcg Hypothyroidism NOS; Hyperlipidemia; elevated LDH 0 OTH OTH Latex; Gluten; Cotton; Parbein; Oris root. 2 PVT PVT None None 3 None PVT OTH Mom to giveNo BENADRYL No before next immunization PUB PUB Unknown None None 0 PUB PUB None No No 60 PUB PUB PREDNISONE 1/2 mg Arthritis qod OR200909 1 PUB UNK 31 EEG; Sleeping PUBEEG; Holter PUB monitor x 1 month; thyroid panel; Arthritis; Blood heart unresponsive~DTP sugar; murmur Braincaused scan; MRI from (no brand . Lyme Labs:name)~1~0~Sibl disease. CBC andPMH: Chem 2 UNK UNK Perimenopausal, otherwise no significant medical history. 1 None PUB PUB None Allergic rhinitis; Mild intermittent asthma 4 PVT PVT B6, B12, CAL, PhySt John's NKA Wart 0 MIL MIL None Allergies - Ty lox, Darvocet, Tagament 0 PVT PUB None 0 PVT PVT None None None 0 PVT OTH nausea and severe vomiting 0 UNK UNK 1 None PVT UNK Did not want None to reveal med None 0 PVT UNK none 16 NONE PVT PVT NONE NONE NONE 0 Client was on PUB Bactrim DS PVTfor sinusBactrim infection. DSDx He with was sinus given none infection a 10 day and dose, onhe 10has dayone regime day of left2xofday 10 day Bactrim, dose.with o 2 UNK PVT 2 eeg PVT UNK none none None UNK UNK given ibuprofen swelling, 800mg warm No and -tonormal ultram the touch, 50mg reaction pain onper 26 Dr. Feb 09 by Dr. 13 Spinal taps,UNK CT scans,UNK MRI's, Numerous prevestatin blood None 40work mg ups,None ECG's, PMH: tests none~ hyperlipidemia, for Guillain ()~~0~Patient Barre, jaw myasthenia movement disorder, gravis, HIV, shing L 1 PUB PUB None unknown 9 LABS: MRI UNK spine WNL.UNK CSF: RBC none 2, WBC 5,none protein 77(H), Penicillin glucose allergic 69, c/s neg. 1 PUB UNK 2 At ChildrenUNK Labs and Diganostics: UNK CSF WNL. CSF cx (-). PMH: HSVnone PCR (-). RSV/Flu (-). CBC and Chem WNL. Head 1 None PUB UNK Pt was not currently None onSeasonal any otherand medications none~ dairy ()~NULL~~In allergies. at time of Patient|none~ vaccinations.()~NULL~~I Patient als 0 PUB PUB none none 1 None PVT UNK HCTZ 25 mg None1/2 tab Seen inHTN the for welcome am/Asa81tomg Medicare one daily/Vit examD 400 mg one daily/Calciu 3 none PUB UNK none none
1 ESR, ASO,UNK FT4, TSH, UNK ANA TITER, none ANTI-DS-DNA, none EBV none AB PROFILE PMH: acute ACTpharyngitis, WKST: FANA, HA,STOOL, acute sinusitis, URINE,cough, CARD 1 none PUB PUB none none none 1 none PVT UNK Ziac, lisinopril, none asa 2 CBC; DIFF;MIL UA; Chemistry; MIL AdmitConjugated to hospital None estrogen LABS: EEG, cream None MRI BID PMH: brain36 WNL. wk fraternal twin A, SVD, vertex. Preterm 1 PUB PUB None Known No known No 2 PUB PVT Chlorphenir;Upper MIDRIN; respiratory TESSALON Smoker; infection. Migraine PERLES headaches. 0 PVT PVT Allergies- Morphine, adhesive tape, HCTZ, Verapamil 707 PVT PVT PVT PUB RITALIN 10None mg daily started Amblyopia 1-5-2009 OD 0 PVT PVT 0 PVT PUB None None Exercise-induced None~asthma ()~~0~In CA080024 Patient|Unknown~ ()~~0~In Si 4 None PVT OTH Estradiol; Spironolactone; None PMH Albuterol low platelet count 0 None PVT UNK None Kiwi 1 None PUB PVT None No None 1 PVT PVT 0 PVT PVT None None 4/6/09-records received-Has held breath before. 9 None PUB PUB None None None 1 No adversePVT reactions after PVT receiving Concerta HPV #1. 54mg None PI for Motrin ADACEL ADHD. prn - headache states PMH:the premie-34 study reports wks. RAD, headache T&A.inStrep somepharyngit for 14 da 1 PVT PVT 0 ultrasound, OTH 10/14/08, 27 OTH weeks gestation Unknown RCA; Pregnancy cervical smear, NOS (LMP ASCUS = 4/7/2008) HPV +;W beta-human AES0810USA02517 chorionic, 10/14/08, p Unknown OTH OTH Unknown Unknown WAES0902USA03537 Unknown OTH OTH None None WAES0902USA03735 Unknown OTH OTH Unknown Unknown WAES0902USA03764 68 neurological, OTH normal LABS: OTH CBC,None CMP, UA, BNP & urine None drug HPV screen #2 all given WNL. 12/6/07, WAES0902USA03784 Prolactin28.27(H). Lot # 0928U, IM/RA; Potassium HPV3.3 #3 Unknown OTH OTH Unknown Unknown WAES0902USA04026 Unknown OTH OTH Unknown Unknown WAES0902USA04035 Unknown OTH OTH Unknown Unknown Diarrheoea~Rotavirus WAES0902USA03761 (no brand name)~UN~0~ 0 PUB PVT None None 0 PUB PUB No No No 0 PVT PUB None None 7 None OTH PVT METOPROLOL 100MG, Diabetes PO, Daily; Mellitus SPIROLACTONE type II; Hyperlipidemia; 25 mg, PO,HTN; Daily;Rosacea ZOCOR PVT PUB None None None 1 PUB OTH None None None 0 PVT PVT None 545 None PVT PVT None None Asthma; Pyloric Stenosis @ 16 days old 6 None MIL MIL None None Seasonal allergies 1 Unknown PUB PUB Unknown none hx of headaches 0 PVT UNK Anxiety None 0 PVT PVT NKDA, 6 wks post partum 1 OTH PVT PROZAC; TRAZADONE-SINTHROID; None Depression, anxiety, CLONIPIN; GravesCARBIDOPA disease, asthma 1 PUB PVT Asthma Allergy Flu like soreAspirin, throat, Penicillin, nasal congestion Sulfur PVT PVT head laceration NKA 1 PVT PVT None None None 0 MIL MIL NONE Cold x 2-3 months. Congestion off and on. 4 none PUB PUB none NKA 0 MIL MIL NONe Cold X 1 mo, Cough rhinitis 0 MIL MIL NONE RecoveringAmoxicillin from respiratory Shellfish infection X 3weeks. 7 Available onMIL request. MIL Birth controlNone (pill or Nuvaring), Seasonal Claritin allergic asrhinitis needed 0 PVT PVT Singulair, Symbicort, none and Patient Albuterol has a history of environmental allergies and asthm It has been UNK so long I don't UNKknow if They anyone hadcan allI must help "required" me. give Icredit; vaccines was told refused thethere from doctor a birth was copy would to nothing of18 the not months. boys vaccinate wrong records. with I then if they my saw children. ill,what but did was PMH dur go 1 TSH "normal" UNK UNK Enalapril 20none mg po daily Allergy: "tranquilizers" diagnosis: hypertension
17 PVT PUB none 31 None Atypical UNK chest pain UNK with tranthoracic Ortho Tri-Cyclin echocardiogram NoneLo Allergy-Minocyclin; unremarkable. None~ ()~~0~Patient|None~ Exercise Induced Asthma; ()~~0~Sibling Lyme Disea 0 MIL UNK 21 2/26/09 CT PVT of UE/thorax OTH with high supraclavicular LAD/cellulitis. 1 PVT PUB Pt had shingles PVT after receiving PVT 1stNone VARIVAX @ None age 1 yr.Scoliosis; Alcohol prep pads 32 No PVT PVT No None 0 CT of abdomen PVT (neg); PVT CBC; CMP; amylase; lipase. Labsamoxicillin. and Diagnostics: 7/11/08~HPV PMH: Allergies Monospot (Gardasil)~1~13~Patient to (+). Pertussis, CBC WNL. Amox. CMP, L ankle amyla pi 1 none PVT PVT MAXAIL; ALLEGRA; none NEXIUM; PCN; Mold; PULMICORT; Sulfa; ZITHROMAX-Allergies; SINGULAIR; MVI Asthma; GERD 1 PVT PVT None None None 0 MRI showed UNK tenosynnovitis. UNK EMGAllegra normal.60 mg, None Flonase, Seasonal Orthotrycyclen allergies 7 1. Urinalysis: UNK negativeUNK for all tested Nexium 2. 20mg CBC none granules, w/lites: 3/16/09-records born normal Poly-Vi-Sol at 303.weeks, receivedCT with scan: iron eosinophilic URI normal 2mL symptoms esophagitis, 4. times EEG:1normal severe week 5. acid Tem ref 0 PVT PVT None None 0 Diagnosed UNK with: Thrombocytopenia, UNK none Pancytopenia, none Ammenorrhea, none 3/18/09-records Hypothyroidism, received-Recurrent Anemia, low blood sinusitis, pressure, statusA 0 none PVT PVT Synthroid 175mcg, None daily; Prozac, Prinzide hyper none~ 20/12.5mg, feeling ()~NULL~~In daily; Aspirin Patient 81mg, daily; Hydroco 1 PUB PVT Augemntin, Clindamycin 2/09 Client recently hopitalized for facial abcess. 0 UNK PUB azithromycin 4 none PUB UNK none no hx neck surgery, secondary AZ0902 to bone spurs; trigeminal nerv 20 Labs and Diagnostics: UNK UNK MRI (+) optic neuritis. NONE CSF with 10 ASTHMA, WBCs, glucose PMH: asthma. 111, normal epistaxis. protein NKDA 28. CSF cx (-). 1,25 1 PVT UNK Lamictal, amiloride. None amlodipine, Bipolar, Hypertension, prilosec, simvastatin, hypercholesterolemia, hectorol. lithium-induc 11 PVT PVT GERD 3 PUB PUB NONE NOTED 16 None PUB PUB None No None 11 MIL MIL 0 none PVT PUB none none none 12 neutropenicUNK since admission UNK currently onpatient vancomycin, felt well no meropenem, pre-existing at the time conditions. ofacyclovir, the headache flagyl, AML diagnosed caspofungin 5 days after va 14 PVT PVT 5 Chest x-ray,OTH 12/24/07, OTH considering technical factors Rash erythematous; chestNervous is unremarkable; system Bronchiolitis; disorder; Chest WAES0902USA04226 Upper x-ray, Brain respiratory 01/10/08, malformation; tract no radiographic infection Cardiac mu 34 15/Nov/2008: UNK Lumbar puncture; UNK CPR undetectable; Sed The rate patient (17); Gentamicin suffered trauma therapy to### was her left stopped knee/leg due while to subseq wres 40 none OTH OTH Concerta; Clonidine; Risperdal; Patient has Zoloft a history of asthma ### and ADHD (attention defic cardiac monitoring, OTH heart OTH rate is inUnknown the 30 range Unknown WAES0902USA03436 Unknown OTH OTH Unknown Unknown WAES0902USA03722 Unknown OTH OTH Unknown Unknown WAES0902USA04183 19 March 1999: OTH Chest:OTH No focal infiltrate or evidence Unknown of acute Allergies, cardiopulmonary medical The vaccinee history, A0344260A disease.; "noticed and concomitant 03some September pain" medications (site 1999: notLym spe we 0 PUB PUB None None 0 PVT PUB Autism; sensory integration problems 16 PVT PVT Resolving URI NKDA or medical conditions 3 None PVT PVT None Cough 1 None PVT PVT None None 27 PVT PUB None None None 15 PVT PVT None None PUB PUB UNK None None 0 PUB OTH Estradiol; Armour None Thyroid Hypothyroid 0 None PVT PVT None None None 1 Vaccine route MILgiven intra MILdermal IPPD C2910AA , ID , 2None , 20 Jan 09. 9 Throat culture PVTto lab today UNK3/2/09 3344 Clinical observation PVT PUB none none none 0 None PVT UNK None known allergic to my mycins. 0 PUB PUB none no fever~DTaP (no brand name)~1~0~In Sibling None PUB PUB Denies by Grandmother None None 1 PVT PVT No No Developmental delay- hypotonia
21 Pending PTOTH visit to 1 hour OTH Tretinoin 0.1% cream since Sulfa - 8/27/08 2 PVT OTH MIL MIL Unknown 1 PVT PVT none none none 0 None PVT PVT None None 1 PVT PUB None none known 0 PVT PVT none reported Bee stings 1 PUB PUB None 0 None PUB PUB None None None MI2009001 UNK UNK Feb 13, 2009 emergency None room treatment 0 UNK UNK None 1 EEG and saw PVT neurologist OTH 1 None PVT OTH None Codeine; penicillin ; generic drops; egg 1 None PVT PVT None None history of febrile seizures; mild asthma 2 PUB PUB None None 15 Unknown OTH OTH Unknown Unknown WAES0902USA04059 0 Unknown OTH OTH Unknown Unknown WAES0902USA04441 19 Unknown OTH OTH Unknown Unknown WAES0902USA04580 26 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA04384 155 Unknown OTH OTH Unknown Miscarriage WAES0902USA04455 None. OTH OTH None ### none OTH OTH At the age of 5yrs the patient suffered ### severe chest pain a 8 Unknown 3/12/09-records UNK UNKreceived-Labs ZYRTEC; WNL. TETRACYCLINE; CT scan The abdomen patient MULTIVITAMIN; and hadpelvis a past normal. history TYLENOL; ### of environmental ALLERGY SHOTS allergies a 2 none OTH OTH ### 0 PVT PVT Birth controlNone pills Child hood food allergies- was treated & outgrew them. PM 8 Allergen level PVT high 3/18/09-records OTH none received-Septic none workup none negative. CT scan normal. EEG normal. ANC 450. Blo 1 80 cc tan, thick OTHfluid- gm PVT (+) cocci No chronic illness; no known drug allergies 3 Widened pulse MIL pressure OTH of 177/82, Allergy pulse TABS92, None non-specific Loratadine None. changes PMH: onseasonal ECG. Diagnosed allergies with acute pericarditis with Level II ultrasound PUB planned PUB at hospital high risk Pregnancy, clinic None non complicated 2 OTH PVT SINGULAIR; Stable Albuterol asthma Amoxicillin as rescue allergy 7 PUB PUB None 1 None OTH OTH None None None 7 Lab works: PVT blood draws OTH & skin biopsy by Drs.None NKDA; HTN; Increase Cholesterol & HRT. Had positive PUB influenza UNK nasal swab with next visit 1 PVT PVT Cold Sx None 142 PVT PVT None None PVT PVT No 5 PVT UNK PVT OTH PVT OTH LORAZEPAN; NoneLEVOXYL; SEPTRA; PRAVASTATIN; ZOLOFT; PAXIL; Fish oil;EFFEXON; CLOMIPRAMONE; WELLBETRIN; ASPIR 592 PVT PVT None Known None Known RSV + as infant- PE tubes 4/07- Numerous ear infections 5 PUB PUB none knownnone known 0 None PVT PVT None None None 11 PVT PVT 0 No MIL MIL IBUPROFEN NoAND FLEXERIL None 10 None PUB PVT Unknown Unknown History of prostate cancer 13 none MIL MIL none none none 0 PUB PVT metoprolol, none omeprazole, learning advair,disability, rhinocort,HTN, sertraline, depression, hydrochlorothiazide asthma, rhinitis, rena 1 NOne. Antibotic PUB given PVT to patient from Prozac, family Maxide, physician. none birth control, Hypertension over the counter motrin as needed 0 PUB PUB synthroid 75mg n/a q1 graves disease, thyroid removed 3 PUB PVT Patient does have a history of herpes simplex around her m
1 Chest XrayUNK UNK NONE Patient has seasonal allergies and h/o asthma 0 PVT PUB nONE None 1 PVT PUB None 3 PVT PVT None PUB PUB vertigo GERD 1 none PVT UNK none none 2 3/2/09 tilt table UNKtest. Mother UNK statesStarte all other Fludrocortisone tests None neg., butNone 1mg unsure QD PMH: whatHA, tests appendectomy, done. LABS:asthma. ECG WNL. Family Echocardiog hx: CAD 0 PVT PVT 1 PVT PVT 0 MIL MIL NONE NONE 3 Chemistry, PUB 02/09/09, Pending; PUB Echoencephalogram, Concomitant Drug(s)02/09/09, Not Reported. Pending; EEG,MEDI0007972 01/12/09, Abnormal activity on left 5 OTH PVT none 0 PVT PUB None 1 PUB PUB None None 1 Prior VZV Titer PUB2/26/09UNK Equivocal. None Fx Coccyx - Bulging Disc 1 none PVT PVT none none none 1 3/18/09-records PVT receivedPVTEKG sinus ORTHOTRICYCLEN tach otherwise None normal. LO Acne; CTHistory brain negative. of depression Lymph 5/07 % low 9.0, gran % increase 0 PUB PUB none WV0901 2 OTH OTH 0 PVT PVT none knownScarlet fever Reaction?~Smallpox as child age 5 (no brand name)~UN~20~ 1 PUB PUB None No None 3 PVT PVT LOVASTATIN; ZETIA; Hyperlipidemia; DIOVAN; HCT HTN; Osteopenia; NKA 1 Stated on antibiotics PVT after PVTseen in None ER None None 2 Lab work (blood); OTH ANA,PVT Negative No other medications None Systemic lupus erythematosus; 08AV00126SP Von Willebrand's disease None OTH PVT SINGULAIR, None Nasal Spray 08AV00285SP 2 Unknown MIL OTH Unknown Unknown Unknown 08AV00718SP 0 None OTH PVT No other medications None None 08AV00691SP 0 None OTH PVT No other medications None Allergy to grass,Allergy08AV00597SP to plants; Allergies to PCN, ASA, D 1 10/10/2008,OTH Chest x-ray PVT Normal, Normal Topamax, per Anaprox ER None physician Migraine to patient; headaches; 10/10/2008, Drug 08AV00596SP EKG, hypersensitivity, Normal, Normal allergy pertoER Amo ph 1 OTH OTH No other medications None 1 History of Psoriasis or 08AV00447SP eczema like condition until age 10 1 None OTH PVT Prilosec None GERD Gastrooesophageal 08AV00436SP reflux disease; Allergies to: PC 0 None OTH PVT Claritin, Diazide, None Nexium, Allergies Enalapril, hypersensitivity; Pulmacort08AV00396SP inhaler Asthma; High blood pressure Hy 3 EKG,Negative; OTHChest X-Ray, PVT Negative; Oral Contraceptive UrineNone PregnancyNone Test, Negative; Blood 08AV00395SP test, Negative Unknown OTH OTH Unknown Unknown Latex allergy 08AV00332SP 3 None OTH PVT No other medications None Environmental fever~Measles Allergies 08AV00331SP Hypersensitivity; + Mumps + Rubella Heart(no murmur brandas n 1 None OTH PVT Centrum, Lutera None None 08AV00286SP 0 Unknown OTH OTH Unknown Penicillin allergy WAES0902USA04394 184 Unknown OTH OTH Unknown Unknown WAES0902USA04440 9 HematologyOTH OTH Hormonal contraceptives Hypersensitivity WAES0902USA04545 6 Unknown. Labs OTH and Diagnostics: OTH Unknown MRI (+) for increased signal Unknown on T2. PMH: EEGfxWNL. ankle. WAES0902USA04564 Echo asthma WNL. MRI/MRA WNL. MCV 0 Not reported PVT PVT The patientSyncope~Influenza had no past medical ### (Fluzone)~~8~In history and had Sibling|Sy not been 0 Not reported UNK UNK The patientSyncope~Influenza had no past medical ### (Fluzone)~UN~9~In history. The patientSibling had o Not reported UNK UNK Not reported ### Child has exercise PVT induced OTH Asthma- Symptoms None above noted Syncopal prior to Episodes HPV inj 4/14/09-records received-Normal cran 2592 PVT UNK 1 PVT PUB 1 N/A PUB PUB allergic to penicillin andSC0908 erythromycin 420 3/11/09-records UNK received-. UNKChest x-ray no acute COPD abnormality. 3/11/09-records Sputum culture receivednonrevealing. PMH: COPD-lung WBC 17,900. reduction Neutroph sur 760 3/11/09-records UNK receivedUNKECG abnormal butCOPD stable. Enzymes 3/11/09-records normal. Adenosine received-PMH:coronary sestamibi scanartery negative bypass for isch gra 280 LABS: CT head UNK WNL. UNK EKG abnormal w/inverted COPD T-waves. PMH: T-cell lymphoma, CAD, CHF, COPD oxygen depend 1 UNK UNK
260 3/11/09-records UNK received-ECG UNK normal. Arteriogram COPD with 3/11/09-records angioplasty to right received-PMH:breast lower extremity. cancer status post r 2 PUB PVT none 1 NONE MIL MIL NONE NONE NONE 0 EEG, CT Scan UNK, x-raysUNK all performed Topamax the same 25 Left mg day eaar daily, to eveluate infection Pineal Imitrexinjuries Cyst, 50 mg Venous from as needed, the Angioma fall.Depo 3/9/09-records 3/9/09-records Prevera Injection received-X-ray received-PM every 3 1 PUB PVT 1 None PVT PVT Unknown None Unknown None PVT PVT Unknown None None 0 PVT PUB None Mild URI GERD None PVT PVT Birth controlNone pills (unknown Nonebrand) 1 None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown 17 4/15/09-records UNK received-MRI UNK consistent withPatient bilateralrecently optic Allergy-induced neuritis. had strep MRA throatand normal. sometimes about MRI a week brain exercise-induced and priorspine to vaccinations. normal. asthma Neg None PVT PVT Birth controlNone pills (brand None unknown) None PVT PVT Unknown Unknown Unknown None PVT PVT Unknown Unknown Unknown 15 was administered UNK compazine UNK and birth benedryl control byNA oral iv None 3/6/09-records received-PMH:long history of migrain 0 Blood work UNK on 12/18/08 PVT revelead Mumps AlbuterolVirus Treatment None AB (IGG)NKA, 0.97 History L. Presense of Asthma, or Absence S-section of Mumps in yr 2005. IgG AB can notb 1 PVT PVT 2 None PVT PVT None None None 40 GGT, 21Jan2009, PVT 120;OTH GGT, 12Feb2009, Aspirin 268; Unknown HepatitisThe viralsubject test, Nov2008, was reportedly negative; A0771189A healthy Hepatitis with viral a history test, of 21Jan20 unspe White bloodOTH cell count,OTH Mar2007, low. Septra Diagnostic DS; Bump Sulpha; results: onIVIG the15 thigh, February Pseudomonas 2007: A culture A0771378A Infection was taken from the bump on UNK PVT OTH Unknown A0771383A 25 Ultrasound,PUB stool culture PUB 3/11/09-records received-US None demonstrated None intussusception and x-ray with air enema redu 1 None PVT PVT XOPENEX Wheezing Neb Tx Mastocytosis 0 None PVT PVT None None 2 nothing done PVT in our office UNK none none none 1 NA PVT OTH TYLENOL, None BENADRY,Allergy PRN to OMNICEF. Also has Dx allergies and eczema 1 None PVT PUB None None Develop Mental Delayment 1 PVT UNK None None 0 None OTH PVT Lisinopril 20None mg qd; AMBIEN High blood 10mg pressure; pHS Allergies - penicillin; Cephalosporins; 1 None PVT PUB None None None 0 None PVT PUB none none none 0 Monospot, negative; PVT CBC UNKw/differential None negative/normal None Allergies: Penicillin; KEFLEX; OMNICEF; AUGMENTIN 2 None PVT UNK Eczema Eczema; NKDA 0 none PUB UNK None None Heart Murmur UC; CXS PVT PVT Mild cold symptoms immune disorder; dev delays nec 3 12/29/08 Xray OTH (L) shoulder; OTH BloodTYLENOL work. MRI PM None (L) shoulder/arm Pr; Calcium; "D" (inVitamins; and "SELDANE" neck;GERITOL; hadora "CLARITIN-D" procedure Folic acid; to "deaden ASA makes 81mg; heart nerve" LIPITOR flutter); 0 PVT PVT HCL tabs PVT PVT No known drug allergies PVT OTH None 0 PVT PVT 0 PVT UNK None None 0 PVT PVT TYLENOL for fever 1 PVT PVT CLARITAN as neededSeasonal allergies 360 Unknown PVT PVT LIPITOR; NORITATE; Rosacea Lung PRILOSEC operation; Lung neoplasm WAES0902USA01641 malignant; Chickenpox 62 Unknown. Labs OTH and diagnostics: OTH 11/11/07None MRI T-spine None. WNL. PMH: MRI brain obesity. (+) for scoliosis. WAES0903USA00102 CSF attenuation folliculitis. in L mild cerebellopon SAR/RAR UNK OTH OTH Unknown A0769209A UNK OTH OTH Unknown A0768721A 4 UNK. Labs PVT and Diagnostics: PVT Abd The X-ray subject (+) for Unknown had dilated no concomitant bowel The loops. subject medications. BE had (+)no forconcomitant persistant A0767773A filling medications, defect. Abd relevant US c/w med I UNK PVT PUB Unknown Linked cases include A0770472A, A0770476A A0770473A, A077047A
UNK PVT PUB Unknown Linked cases include A0770473A, A0770472A A0770474A, A0770475 0 UNK PVT PUB Unknown Linked cases include A0770472A, A0770475A A0770473A, A0770474 0 UNK PVT PVT Unknown Linked cases include A0770472A; A0770474A A0770473A; A0770475 0 UNK PVT PUB Unknown Linked cases include A0770472A; A0770473A A0770474A; A0770475 12 The first GARDASIL UNK injection UNK was in OCT 2008, the 2nd None was in Dec. 2008. I have not received the third vaccination 48 Elevated protein PVT in CSF; PVT Demyelinating DEPAKOTE; pattern None LIPITOR; on NCS/EMG Migraines; LEXAPRO LABS: asthma; Allergic~Influenza EMG/NCS osteoarthritis; abnormal (no brand hyperlipidemia & c/wname)~1~23~Pati acute polyneurop PMH: IB 0 CBC; glucose; PVTLytes; LFT's; PVT Ca 2/12/09 PREVACID; normal None Polyvisol except KPrematurity 6.1; Cl 107;(30 Lytes weeks). normal Prolonged 2/13/09 (K hospitalization 5.6, Cl 106). for (K cons apne 4 Labs and Diagnostics: PUB PVT CXR (+). CT LIPITOR scan (+) and None forVESTRAL lung fibrosis/bilateral cholesterol. PMH: pneumonitis. HTN. Hyperlipidemia Cocci IgM (+), IgG (-). Mycopla 0 None OTH PUB None None None UNK UNK only allergy is VICODEN 1 none PVT PUB none none none 1 See attached PVT PVT None None 0 PUB UNK Autism OR200914 0 Mother withPUB similar Sx PUB beginning 48-72 None hoursNone before patient; Nonemother - per report received no OR200912 immunizaitons. 0 PUB UNK OR200913 3 OTH UNK None reported None reported 1 CBC, CMP PVT both normalUNK None Family ill prior None to patient given vaccine 0 none PVT UNK none none none MIL OTH None 1 UNK PUB None None None 1 PVT PVT None None Vertigo~Influenza (no brand name)~UN~32~In 11 None PVT PVT Unknown Unknown Unknown In Daughter Varicella~Varicella (no brand name 1 PVT PVT 1 None PVT PUB None None None 0 L. Leg venous PVTdoppler UNK lower extremity arterialAllergic dopplesRhinitis - ANCA Benignscreen, HTN, Hypelipidemia Sedrate Immuno Globulin A - proteinase -3 7 PUB PUB None None 75 echocardiogram UNK UNK none none none PMH: smoker. 14 TZANCK Prep: UNKpositivePUB for viropathic Duoneb, changes Cardizem No ofacute multinucleated CD, illness. seizures, Lasix, Boniva, giant COPD, cells.Herpes Synthroid, parkinsonism, zoster. Coumadin, osteoarthritis, Vitamin osteoporosi D, Protonix, 0 N/A PUB UNK Children's Motrin None None 1 PVT UNK 1. Albuterol, cold, twocoughHTN, puffs everyasthma, 4-6 hours HL, asSeasonal needed for rhinitis, wheezing. depression, 2. Bupropion degenera s 1 none MIL PUB no non 2 MIL MIL OCP (LEVLEN) NONE NONE 0 PVT PUB none otitis medianone 1 PUB PUB UNK UNK HCTZ 25 mg Nothing 1 qd; Atenelol acute 50 mg 1 qd; Simvastatin 40 mg qd 0 PUB PUB 0 PUB PUB Otitis media and URI UNK UNK None reported unknown 0 None PVT PUB None None History of reactive airway disease 0 PUB PUB None None 2 PVT PVT None None 0 UNK PVT fosamax, lipitor, none 81 mgosteopenia aspirin, calcium, multiviramin 0 None PUB PUB None No 2 MIL UNK 1 PVT OTH 636 CT scan w/o PVT contrast inPVT ER; EKG,None Labs in ER; None MRI headNone w/o and with contrast referred to Neurologist. Labs and D 1 PVT PUB none none none 3481 PVT PVT none well child check 0 None PVT PUB None None 16 Ultrasound,PVT negative; 2UNK MRIs; blood none work; spinal nonetap showed allergic elevated to penicillin. proteinPMH: level;Osteoarthritis. nerve conductivity Hip surgery. test. Labs Alle a 2 PVT PVT
0 PVT PVT 2 OTH PVT SYNTHROID, none 88 mcg NKA q day 20 UNK PUB Mild Asthma, hypertension 20 Serum beta-human, OTH negative OTH None Pregnancy NOS (LMP = 1/18/2009) WAES0902USA03994 29 urine beta-human, OTH 02/16/09, OTH negative; Albuterol serumPregnancy beta-human, NOS 01/26/09, (LMP Vaccine =16; Unknown); serum exposure WAES0902USA04266 beta-human, Asthma during;02/03/09, Cramp~HPV <5; beta-hu (Gardas 66 Diagnostic laboratory, OTH 01/??/09, OTH blood Unknown work: no leukemia; Unknown Diagnostic laboratory,WAES0903USA00062 09/??/08, positive for mononucleo 1 Unknown OTH OTH Lamictal Epilepsy 3/19/09-records received-PMH: WAES0903USA00104 Epilespy on Lamictal. 24 Unknown LABS: OTH EEG OTH abnormal. Unknown MRI WNL. Repeat LPUnknown done 10/3:PMH: wbc chronic 42(H),WAES0903USA00467 protein sinusitis, & glucose strep throat, (N), c/s IBS, neg. encop Ini 3 Unknown Labs OTH and diagnostics: OTH Abd PRILOSEC US (+) for ileocolicGastrooesophageal IS. Abd X-ray (+) for reflux; WAES0903USA00374 SBO.Omphalitis Air enema. (+) PMH: for IS. lingual WBCfrenu 18 1 LABS: coronary PVT angiogram PVT abnormal PMH: recent negative cardiac stress test, DM, hypercholes 0 EKG; CBC;PVT LMP; TSH PVT LABS: EKG None WNL. CBC, NoneTSH, CMP Bicuspid no results Aortic Valve available. 0 PVT UNK PPD C2805AA 3/2/6 (RATD) upper area 7 Unknown OTH PVT Unknown Unknown 1 PVT UNK AMOXICILLIN; Sinusitis ALBUTEROL Neb Solution; BUDESONIDE Inhalants 95 Influenza AMIL positive MIL 7 None PVT PVT None Mild head cold Mild eczema PVT PUB PVT PUB CBC; RF; CPK; PVT C3-C4;UNK ANA; ESR All normal; X-ray of spine Nonenormal 0 Diagnosed PVT by Dr. UNK KARIVA none none 1 EmergencyPVT room bloodPVT gas test & EKG 1 None known PUB PUB Allergy, morphine 0 Normal CBC. PVT T4 Potassium, PVT BMPTOPAMAX Negative mono Dizziness screen. Amblyopia, Mild intolerance Migraines, to tiltdizziness, table test.patellofemoral LABS: rapid strep syndrome neg. 5 PVT PVT none none congenital diaphragmatic hernia - surgery @ 2 days - fine 2 None PVT PVT Albuterol HFA Coughing, diarrhea obesity, hypertension, high cholesterol 0 PVT PVT 2 PVT PVT 0 PUB UNK 10 None PVT PVT ALBUTEROL 2/12 Q4O RSV PRN 0 Allergies, 29-30 wk gestation. 0 BP - 100/70; PVT Pulse 76 PVT None None None 1 PUB PVT None None None UNK UNK Surgical pathology UNK report UNK confirmed rubella antibodies None UNK UNK 0 PVT PUB OMNICEF Productive AMOXICILLIN cough, nasal drainage 0 PVT PVT BIAXIN; ROLEPHIN; Chronic serous AUGMENTIN Dacryostenosis; Otitis GERD; Sleep disturbance; Otitis Media; C 1 PVT PVT None None 1 PVT UNK None None 1 Strep screen PVT - results neg. PVT None None 2 PVT UNK BETOPTIE;None CELEBREX; PCN; CALCIUM; RA; Glaucoma; NEXIUM; Sarcoidosis MVI 1 PVT UNK None tetanus toxoid 1 PVT OTH 2 PUB PUB 1 PVT UNK NKDA 2 Followed upPVT at her homeOTHunknown Aspirin low None dose 81 mgLactose tablet enteric Intolerance coated 1 tablet by mouth; Calcium Citrate + 1 PUB PUB hx of asthma, uses no meds. Allergic to shell fish 1 None MIL MIL PrescriptionNone Claritin Dog Allergies 14 PVT UNK none none none skin rash/fever~Measles + Mumps + Rubella (M 0 UNK UNK non non ~Meningococcal (Menomune)~~0~In Patient 1 UNK UNK 2 none UNK PVT unknown None noted
1 PUB PVT None None PCN, Sulfa, Cipro, Iodine, Compazine, adhesives, fish 2 PVT PVT NONE SISTER~Meningococcal (Menactra)~1~11~In S 10 Doctor diagnosed PVT rashPUB as measlesn/a n/a n/a 2 UNK UNK NONE 0 No testing was UNKcompleted. UNK This was None a clinicalNone diagnosis Allergic by a Nurse to Sulfa Practitioner 18 N/A PUB PVT COZAR, PREDNISONE N/A HTN, (18 S/P MG/D), MI, ASA, TEMPORAL BETA BLOCKER ARTERITIS(WIFE UNABLE TO HIGH GLUCOSSA, UNK HIGH UNKCHOLESTEROL. NONE SHORT NONE RANGE MEMORY RECALL ( NOT TESTED PER PHYSICIA 3 3/4 CBC (0100) UNK WNL with UNKslightly Zithromax elevated neutro (previously Sinus@ infection 7.6,received No segs significant (receiving of 288, courses) lymphs PMH Zithromax) and PMH: of 12; unknown seasonal BMP WNL antihistamine allergies. beside glucose NICU with multip x elev 2w 1 N/A UNK UNK Migraine headaches none controlled on topamax 0 UNK PVT none unknown 0 none PVT PUB NONE NO NONE 1 rapid flu-negative PUB monospot PUB negative CBC none absence seizures no medications 13 None PVT UNK HTN; Diabetes; HTN;high DM;Cholesterol; High cholesterol; osteoporosis Osteoporosis 0 None PVT PUB None None None 1 None PVT OTH No No PVT PUB Given wrong age group vaccine 1 PVT UNK Cold rash on lg~DTaP + IPV + Hib (Pentacel)~2~0~I 0 None PVT PVT WELLBUTRIN None None 0 PVT PVT None None None 1 PVT PVT OMNICEF R Otitis Media None 8 None MIL MIL None None None 8 None MIL MIL BLP None None 0 None PUB PUB None None OTH UNK None None 0 None PUB PVT None None 12/01/2008 DX with pneumonia. TX with antibiotics 7 UNK UNK Advil None None 0 CBC:Hb13.0g% PUB Hct 38% UNK WBC13,400 Chlorpheniramine PMN68% L20% Eo10% Mo1% atypical lymphocyte 1% Plt. 301,000/mm3 20 Blood test done PVT checking PVTfor LimeNone Disease, Lupus, None PorvoNone Virus, and Rhumatoid Arthristis: all negative 0 OTH OTH None Allergy to PCN 0 ultrasound, OTH 02/08/08, posit; OTH beta-human chorionic, Pregnancy posit NOS (LMP = 9/29/2007) WAES0803USA03327 diagnostic laboratory, OTH fetus OTH had spinal Nonebifida Pregnancy NOS (LMP = Unknown) WAES0903USA00423 1 Physical examination, PVT 01/20/09, PVT see FOSAMAX; narrative;Osteopenia; NEXIUM; Physical examination, ZOCOR Gastrooesophageal 01/20/09,relux WAES0901USA03522 Neuromuscular disease; Dyslipidaemia examination, see n 1 Unknown PVT PUB Unknown Unknown WAES0812USA05084 Not reported UNK UNK Not reported ### 0 None LABS: PVT CBC, metabolic UNK panel, UA, CPKNone all WNL. None PMH: leg length discrepancy; tonsillar hypertrophy. 0 PUB PUB ORTHOCYCLEN None Febrile seizures as a child. TN09002 1 PUB PUB None None None TN09001 1 None PUB UNK 2/25/09 CRESTOR; No Received NKA; Hypercholesterolemia TB skin test left MI2009002 arm. 53 Influenza AMIL positive MIL 97 Influenza A,MIL positive MIL 0 PVT UNK Soreness shoulders/neck 0 Labs: CBC,PVT CMP, CRPPVT Advil 200mg NoPRN None 0 PVT PVT CLARITIN; None IBUPROFEN Obesity; Environmental allergies 0 None PUB OTH None None None 0 None PUB OTH None None Allergic :PCN Syncope~HPV "hives" per mom (no brand name)~1~11~In Siblin 2 EEG 1/29/09 PVT (-) UNK TYLENOL; None PRN for fever 1 PVT UNK No None 1 none done PUB at clinic PUB Took SINGULAIR 2/19/09 allergic, in AM dust for mites; sinus congestion dogs, TN09003 no medical conditions per mom 3773 PVT UNK 0 WBC 24.6 with UNK78% neutrophils UNK and Plavix, 7% bands, Zocor, chest temp Levothroid, pain 101.7, with Allergies: Lexapro, abnormal BP 98/50. erythromycin Aspirin, stress Labs: test WBCs multivitamin, (rash) 24.6K-78% Intolerance: Wellbutrin, neutrophils, codeine Prempro, (nause 7%By ba 1 PUB PUB none none SC0909
0 PUB PUB Synthroid 100 Other mcg family daily, PCN members client Recent reported have newbeen hot DX flashes Hypothyroidism MO-2009-04 ill with with GI (vomiting/diarrhea) RX 48 hou 0 Positive Urine UNK HCG UNK n/a Pt was pregnant 1 PUB PUB no no MO-2009-05 2 PUB PUB MO-2009-06 1 patient will be PVT seen by PVT neurology and albuterol have nebulizer anpatient eeg inwas solution thege near seen reflux pulmicort future by treated dr wheeler nebulizer with(pulmonologist) prevacid solution plastic zithromax on bronchitis 2/19/09 prophalaxis no 1/09 current previ pre 0 PUB UNK None None Aortic Stenosis and allergy to milk products 1 PUB PUB NONE NONE NKDA, NONE 0 UNK PUB 1 None PUB PVT Synthroid 10 Sinusitismcg QD, onSulfa HCTZ day allergy, 525 of mg treatment Hypothryoidism, QD, Centrum with Augmentin 1 tab HTN, QD,hearing Calcium impaired supplemen 8 PVT PVT none no no vomitting, irratibility~Rotavirus (Rotarix)~1~0~In 1 PVT PUB None None None 1 PUB PUB NONE NONE NONE 3 UNK PVT Elmiron fibromyalgia, fibromyalgia, intersticial cystitis, IBS. interstitial IBS cystitis 0 Concurrent PUB with Viral Syndrome PUB Astham, Viral Asthma Syndrome 7 None PVT PVT None None None 33 Suggested PVT he be seenPVT by a neurologist None None None inflammed blood vessels~DTaP (Daptacel)~2~ 1 None MIL MIL None None None None DonePVT PVT None 1 None PVT PUB Tinea corporis None 0 Did blood work PUBup 5 significant OTH findings. None Everysick test3-4 returned days None before as normal. got fluEKG shot.done. Bronchitis like symptoms/ cough/no 0 none writer OTH aware of. UNK none NKA nor any pre- existing conditions 3 PUB PUB None 3 PUB PUB PUB PUB 1 Pending food PVT RAST panel. PUB Unknown Unknown None 0 PVT PVT None Serous otitis Milk leftallergy ear. None PVT UNK elevated temp None 2 UNK PVT None None 1 None PVT UNK None None 0 None PVT PVT None 1 PVT PUB TYLENOL 2 PVT PVT None No None 12 None PVT PUB None R otitis media Vesico-ureteral reflux 3 None PVT PVT ARICEPT, 10 Nomg; BENADRYL, No 25 mg; FOSAMAX, 70 mg; Hydrochlorothiazid None OTH PVT 1 None donePUB PVT Singular; Levothyroxine; none Asthma albuterol Measal rash after receipt of MMR~Measles + M 10 None PVT PVT None None None 0 None PVT PVT None None None 2 PVT PUB none none 0 None PVT PVT Finger laceration 0 Negative, flu PVT PVT CELEBREX; LOTREL;HTN; LIPITOR High cholesterol 14 Lumbar puncture(s), UNK CT UNK scan(s), MRI(s) 3/25/09-records none none received3/16/09-records EEG demonstrated received-Similar epileptiform episodes activityoccurred in right f Unknown OTH OTH Unknown Unknown WAES0903USA00787 Unknown OTH OTH Unknown Unknown WAES0903USA00750 4 None OTH OTH aspirin; CARDIZEM Hypertension; CD; COZAAR; cholesterol simvastatin WAES0903USA00745 15 ESR 72 mm/hr. PVT Labs and PUB Diagnostics: None UA WNL. upper UC respiratory (-). None CK 70. PMH: infection. CRP none. 0.16. URIAlk at Phos time of 240. vaccinations Total protein 9.0. Albumi MRI; EEG;PVT Heart monitor; PUB BloodNone work.5/18/09 5/18/09 None medical hospitalAsthma records recordsreceived receivedDOS DOS12/1/08 3/5/09 to 4/8/09. 3/6/09. benzaclin, LABS and albute DIAGN 0 BP 130/80; UNK pulse 70 LABS: UNK CBC, TSH & cardiac enzymes Do WNL. not have Potassium this information 3.3(L), calcium PMH:hypothyroidism, 8.4(L), BUN 25(H). anxiety 0 none PUB PUB unknown none none None PUB PUB None None None 22 Labs: CBC PVT WNL. Chem UNK WNL. Drug LEXAPRO; screen (-).NEXIUM PMH: Tourrette's syndrome. GERD. Depression. Allergy
0 PVT PVT 2 Neg PVT PVT No GERD 0 PUB PUB None same~DTaP + HepB + IPV (Pediarix)~2~1~In P 1 PVT PVT CHANTIX; ASA; None Folic Acid; Hyperlipidemia; MELOXICAM; Sinusitis; TRICOR; fatigue; METHOTREXATE RA; onychomycosis 1 Received Iontophoresis OTH PVT on 3-4-09;HCTZ; GivenZOCOR; By Occupational NoneFEMARA; Breast Therapist Lisinopril; Cancer SYNTHROID survivor 0 OTH PVT No OTH OTH 19 Physician told OTH ice compresses PVT 33 UNK UNK 0 UNK UNK Allergies; PCN, Sulfa, Codeine Motrin, Compazine. Can ta 8 PVT PVT SINGULAIR; ADVAIR; Asthma; ZEBETA;ZOFRAN BCP allergy 2 PVT PVT EMBREL; METHOTREXATE; FEMCON 1 PVT PVT 1 None PUB PUB None None None 4 MIL MIL NYSTATIN;Diaper Zinc oxide rash 0 OTH PVT None No No 31 None PVT PVT None Diabetic 0 None PVT PVT None None None 0 PVT PVT DMII, HTN, COPD, DYSPNEA, ANEMIA, LE VARIX, LE E 5 None PVT PVT None Codeine / Flexeril 1 PVT UNK No No UNK OTH OTH Blood clot inFibula eye; fracture; Eyelid disorder; Fractured A0600639A Pressure finger; in Motor groin. vehicle accident; UNK OTH OTH Bilateral Hearing Ankle Loss; fracture; Carpal Carpal Tunnel Tunnel A0600143A Syndrome; Syndrome; Chronic The subject Rhinitis;unde De 1 Two MRIs of UNK the brain UNK - Visual field None test - EEG None - follow-up None with Neurologist PMH: condyloma, scheduled actinic 26keratosis, March. LABS: hyperlipidemia, WBC 21.6 0 PVT UNK none none none same~Hep A (no brand name)~1~9~In Patient 0 UNK UNK hypo thyroidhypothyroid, and client states allergy to eggs. 0 NONE PUB UNK NONE NONE PR-09-04 0 PVT PUB none none none 0 PUB PVT none unknown 0 UNK PUB passed out~HPV (Gardasil)~NULL~~In Patient -8 Currently being UNKtreatedUNK by Dr. at our family physician's none 4/1/09-records office. none 4/1/09-records received-Began none~ ()~~0~Patient|none~ received-Allergies:amoxicillin. 2 months ago()~~0~Sibling|none followed by cough 2 PVT PVT NONE NONE NONE 1 Patient hadUNK an EEG and UNK CT scan None all results were Nonenormal.None 3/16/09-records received-EEG normal. 1 NA UNK UNK 148 UNK UNK COPD 232 UNK UNK COPD PMH: COPD, HTN, CAD, MI, palpitations, stroke, coronary PVT UNK None None 38 20-Feb-09: UNK WBC 10,700; UNK Granulocytes/100 Not knownWBC Not known 26.8 (Low); Not known. Lymphocytes/100 PMH: noneWBC 60.8 (High); Monocytes/100 0 UNK UNK None 0 PVT PUB 10 none PUB PUB none 0 None UNK UNK Ibuprofen none knownnone known 0 none needed PVT PVT none None--stepped noneon nail the day before, which preempted the vaccine. 28 None PUB PUB None None known 0 PVT PUB 0 PVT PVT INFANTS TYLENOL SEIZURE~DTP (no brand name)~1~0~In Siblin 12 PVT PVT Multi Vitamin None None 0 PVT PVT Trivasol infant no vitaminsno red hive-like rash~ ()~1~0~In Patient 1 PVT MIL None 1 None PVT PVT None None None 1 PUB PUB None Breast Ca (R) 16 yrs ago, DEMEROL allergy
1 CBC, normal; PVT pt advised UNK no pertussis in future 1 OTH PVT None Known Pt allergic to Bovine Serum 1 PVT PUB None None None 7 Ultrasound PUB - Slightly hypoechoic OTH region VALTREX apparently prn None withinNone deltoid 14 PVT PVT Varicella~Varicella (Varivax)~1~16~In Patient 1 PVT PVT LIPITOR; PREMARIN; Cough Osteoarthritis; EVISLA; TUMS; Pure Aspirin; hypercholesterolem Multivitamin; Fish oil; RESTASIS Unknown OTH OTH Unknown Unknown WAES0903USA00963 0 Unknown OTH OTH Unknown Unknown WAES0903USA00563 Unknown OTH OTH Unknown Unknown WAES0903USA00757 Unknown OTH OTH Unknown Drug hypersensitivity WAES0903USA00933 5 Computed axial, OTH 03/30/08, OTHnormal;Unknown Diagnostic laboratory,Unknown. 03/30/08,7/31/09 normal;Neurology Electrocardiogram, WAES0903USA00740 consultantnormal; recordsMagnetic receivedre UNK PUB OTH Unknown Linked cases include A0772419A A0772416Aand A0772420A. Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH08449409 was not provided. 0 On 11 December PVT 2008OTH the patient went to the neurologistNot who reported. ordered a cervical MRI ### (Magnetic resonance imagin 0 MRI's MIL OTH PREMARINNone 0.625 None swollen arm~Typhoid Vi Polysaccharide (no br 2 None PVT PVT None Asthma 1 PUB OTH No illness; 3/6/09 normal vag delivery 2 PUB PUB 81 mg ASA;None Vitamins; Cholesterol B12; CINACOR 6 COMPLETEMIL BLOOD COUNTS: MIL 2/18/09: None WBC NONE 4.0, HGB/HCT REPORTED ALLERGIES: 14.1/41.6, +SULFA PLT 191k; (HIVES), 3/6/09: NOWBC BIRTH/CONGENTIAL 3.9, HGB/HCT 13 0 none PVT PUB none none no known allergies; Hx, heart murmur; cleft lip; cleft 356 Tested for Influenza PVT & PVT Strep throat in office - all healthy negative. 0 Did strep which PVT was Negative; PUB CBC; No MP; urine No& mono Allergy to milk & soy 1828 None PVT PVT ZANTAC gerd Parent severe fever~DTaP (no brand name)~1 1 PVT PVT 1 PVT PVT Pulmacort No Asthma / RAD PVT UNK PVT PUB MOTRIN 10 None PUB UNK Cellulitis None 0 None PUB OTH ZANTAC No GERD - on meds (ZANTAC) 0 PVT UNK RespiratoryNone Infection 0 None PVT PVT QVAR; PROAIR None Asthma allergic rhinitis 0 None OTH PVT Enlarged heart; S/P Angioplasty 2 yrs ago; High Choleste 0 None UNK PUB Suprax (R) OM NONE 1 None PVT PUB None None None 0 PVT PUB None No None NC09010 0 PUB PUB Interferon and HepRIBASPHERE C being Hep Tx C illness NC09011 0 CAT Scan; OTH blood urineMIL test BP medication; NoneHCTZ 25m Allergy, morphine; hypertension 9 None PVT PUB Bronchiolitis 4 PVT UNK Singulair; Loratidine; None Miralax; AsthmaProair; spots~Varicella Albuterol neb. (no brand name)~2~7~In Patie 4 PVT UNK TOPAMAX;None MIRALAX Med dx- epilepsy Sister spots~Varicella (no brand name)~2~7~In 10 OTH PVT Diabetes; Hypertension; Thyroid disorder 0 PVT PVT ZANTAC None Failure to thrive PVT UNK No No PUB PUB None Acne 1 OTH PVT Penicillin; sulfonamide; NEOSPORIN (topical) 2 None PVT UNK None None PUB OTH None 1 None PVT PVT HCTZ; TOPROL; None Naproxen; Allergies, PREVACID; Hydrocodone; CENTUM Cervical SILVER radiculopathy; tabs; Vitamin Neck C;pain Zinc 0 None OTH OTH None None None 0 PVT PVT Rash on abd, None not listed new per provider; born by C- Section d/t placental a 7 UNK UNK None None
1 none PVT PVT none none none 91 calcium ionized, UNK CPK, UNK total, gammaglobulin, none lyme nonedisease none AB,3/19/09-records Tissue transglutamin, received-environmental Gliadin Antibody, 25-OH allergies. Vitam NOT SEN IN UNK DOSTORS UNK OFFICE NOR ED, SUPPORTIVE 0 PUB UNK 1 CT scan of PUB head negative, PUBdiastolic none blood pressure none = 40 asthma mmHg. 1 n/a MIL MIL n/a n/a n/a 12 PUB UNK zoloft, diovan, albuterol, norvasc, protonik, allopurinol ND-09-02 1 UNK PVT 12 None PVT PVT No HTN, hypothyroid 4 UNK UNK none none none none~ ()~~0~Patient 1 UNK UNK NONE NONE 19 Barium enema UNK- negative UNK for intussusception None None 3/31/09-records Nonereceived-Barium enema demonstrated retained feces 0 UNK UNK none no no 0 none PVT PUB 2 PVT UNK none none h/o Right inguinal none~ abscess ()~NULL~~In 2/09 Patient 0 NONE UNK UNK 139 4/2/09-records UNKreceived-Unremarkable UNK no CMP, no normal white nocount, low hemoglobin 10.5, unremarkable differential. B 0 NONE MIL MIL NONE NONE NONE PVT UNK OTH OTH None 0 PVT PUB PUB PVT 26 3/18/09-records PVT receivedPVTMRI of head negative. UTI,Spinal culture, tap Penicillin; negative showing LORTAB 3/18/09-records elevated3/18/09-records leukocytes, received-Right mostly received-Allergic lymphocytes inner ear infecti to butPe a 8 Referred toPVT neurologist:PVT MRI & EEG PEPCID video completed No @ GER medical 3/23/09-records center 3/23/09-records received-PMH:hypoxic received- Brain episode scan norm at bi 0 Labs: CBC PUB WNL. BS 126. UNKECG WNL. No None PMH: GERD. MIL OTH none no allergies; no medical conditions 1 none PVT PVT none none none 18 PVT PUB Occasional cough 8 None donePVT PVT None None UNK UNK ### of a cluster. A child (exact age not reported) UNK experienced UNK itching and redness at the injection site after receiving ### an intramuscular injection of a cluster. A child (exact age not reported) UNK experienced UNK itching and redness at the injection site after receiving ### an intramuscular injection 0 Not reported PVT UNK Not reported ### 1 PVT PVT No known allergies. No medical ###history, no concomitant m 1 None PVT UNK No known allergies or past medical ### history. 0 None PVT UNK The patient had no concurrent### illness, no concomitant med UNK UNK ### 1 PUB OTH VITEX No medical conditions. Allergic ### to : gluten, DIMOTIL, HYC None PVT UNK The patient had a history of neurogenic ### bladder, reflux, an 5 Pregnancy UNK Test: positive UNK The patient's medical and obstetric ### history were unknown 31 Workup in progress UNK UNK The following were reported to### be unknown: concomitant 55 None UNK UNK DIFFERIN The patient had a history of acne, ### bronchitis, and pneumon 0 Chest radiography, UNK numerous UNK laboratory testing No including other illness None. CBC, atPMH: the ESR. time. None~ tachycardia. Labs: Information ()~~0~Patient|None~ WBCsIntersticial 20K. regarding Bicrbcystitis. 19. manufacturer, ()~~0~Sibling|Non Phosphorus Smoker lot0.9 nu 2 Ultrasound;OTH ComputedOTH axial; Magnetic FOSAMAX; resonance; Contrast LASIX; Electrocardiogram media Potassium Varicose allergy vein; (unspecified) Spinal fracture WAES0903USA01427 Unknown OTH OTH Unknown Unknown WAES0903USA00564 0 RespiratoryOTH rate, 01/19/09, OTH 14; Total Albuterol heartbeat Asthma count, 01/19/09, 90 WAES0903USA00934 0 Hearing test, OTH fine; Diagnostic OTH laboratory, None vision test was fine; NoneDiagnostic laboratory, WAES0903USA00921 seizure test was fine 6 PVT PVT None notedNone notedTreated for ear infection 12/23/08 amoxicillin x 10 days. 12 Blood Panel/other OTH Blood PVT tests: TSH/Vit. LEVOTHYROXIN B-12/Vit. NoneD; 75mg Brain allergy: Scan/MRI; 1Xd; penicillin/med. SIMVASTATIN Physical Exam.; condition: 20mg Lung 1Xdmitral X-ray; valve (Sedimentation prolapse; hypB 3589 OTH OTH Unknown Unknown 2 PVT PVT
0 None
OTH PVT MIL MIL 1 None PVT OTH None None None OTH OTH 4 PUB PUB ALEVE qd -None has taken None for approximately 2 wks. 0 Rast to Eggs PVT (negative)PVT FLUORIDENone 0.25 mg daily None Hives~Influenza (no brand name)~4~2~In Patie 11 PVT OTH No No No 1 None PUB PUB None 0 None PVT PVT None None None 793 PVT OTH 4235 OTH UNK 9 PVT PVT None None None 0 PUB UNK None None 2 PVT UNK None No 0 PVT PVT None 1 none PUB PUB asthma, allergic rhinitis 1 As per attending UNK physcian UNKat hospital: PPD HEAD PLANTED CAME CT SCAN ON INRIGHT FOR -NORMAL; WELL PHYSICAL FOREARM. CHILD. MRIPMH: EXAM. - NORMAL MANUFACTUERnone Labs andSANOFI Diagnostics: PASTEUR; EEG aL 2 PUB PUB None Known NO illness None known NO ADVERSE UNKEVENTUNK COUGH AND NKA CHEST CONGESTION 0 CXR- NEGATIVE UNK UNK None Bronchitis and None Asthma known. No food allergies known. 2 None UNK PVT MultivitaminNone known. Allergy to Darvocet. No other medical conditions. 0 none PUB PVT none denies denies 0 N/A PUB PUB None None None N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In 0 absent DTR's UNK progressing UNKmuscle weakness and Nonefatigue.Guillain Labs and Barre. Diagnostics: PMH: GBS LDH (?).(L) knee at 191. surgery CBC unremarkab 0 Optometry Evaluation/Referal MIL MIL None None 0 UNK PVT None None PVT PVT Synthroid, Prilosec, Wellbutrin, Asthma, Deplin, chronic Singulair, sinusitis, anemia, Paxil, Tofranial depression, hypothyroid 3 UNK PVT None Allergic to Pennicilin 8 LABS: US abdomen UNK x UNK 2 (+) IS. Stool OB (-). mild BE unsuccessful. diarrhea None for 2 days NO ADVERSE PVTEVENTPUB WELL CHILD NKA VISIT NONE GIVEN 14 CBC, SED UNK RATE, PT AND UNK PTT - OF SIGNIFICANCE UPPER RESPIRATORY WAS A PLATELET INFECTION COUNT OF 6,000. LABS: plt ct 6K. 1 PUB PUB 19 Examination UNK by physician UNK on 3/5/09. None Chronic bronchitis 0 3/18/09-records UNK receivedUNKBUN/creat ratio increased COUGH28.0. 3/18/09-records 3/18/09-records received-Mild received-PMH:abdominal upper respiratory pain, symptoms H. pylori,al 1 PVT PVT Suture's needed for cut hand 30 Labs: Fasting PVTglucosePUB 247. UA (+) None for glucose None andnotedNone. mod ketones. PMH: Hgbacne. A1C 11.1%. 1 Hosp notesPVT enclosed. UNK 5/26/09 medical records None received Acne - multiple ED visits DOS 11/5/08 to 11/28/08. LABS and D 1 CBC -> 9.3,PVT 33.4 < 371; PUB ESR, 15; CRP, 24.4 No hx of febrile SZPMH: 4/8/09-records received- febrile seizu 1 None PVT PUB None None None 0 PVT PVT None Hyperlipidemia; Gerd; Menopausal syndrome; Obesity; Co 10 PVT PUB None None PVT PVT ASA; LORATADINE; None TYLENOL Obesity; HTN; Hyperlipidemia; Hypothyroid; Tetracycline 1 None PVT PUB None Eczema Recent ring worm 3/05/2009 2 None PVT PVT None None None 1 PVT PUB None developed viral illness 2 days later 2 None PVT PVT None None 7 PVT PUB 1 None 3/17/09-records PVT UNK received- EKG normal.None None 0 PVT PVT None 0 PVT PUB 1 PVT PVT None None Exercise induced asthma; allergies (seasonal)
2 PVT UNK 1 UNK UNK 3 09 Mar 2009; UNK Sodium WHOLE UNK BLOOD, None VENOUS, None 141 mmol/L; None Potassium WHOLE BLOOD, VENOUS, 4.3 mmol/L 0 PVT PVT Metoprolol; None Lisinopril; EVISTA Allergy -Iodine - alcohol 0 None PUB PVT None 0 Done on 3/11/09, PVT CBC,UNK CRP, IgE None - pending None None 2 UNK PVT NONE 1 PUB PUB 0 PVT PVT None Diabetes mellitus 1 PVT PUB None - wellNone child PVT PVT None None 1 nl CBC; abnl PVT urinalysisPVT Estrostep None None Unknown OTH OTH Unknown Unknown WAES0903USA00835 10 None OTH OTH Unknown None WAES0712USA08457 OTH OTH Unknown WAES0801USA05057 Unknown OTH OTH Unknown Unknown WAES0801USA01143 Not reported UNK UNK Not reported ### 38 None reported PVT OTH PRILOSEC No known allergies and no reported ### illness at the time of v 0 None PVT UNK BICILLIN The patient had a history of mitral ### valve prolapse. Concom 0 Lab work was OTH completed, OTH no further details provided. not reported ### 0 PVT OTH Penicillin allergy. No medical ### conditions, no concomitant d 0 None PVT PVT Premature baby: Hyperbilirubinaemia; WAES0712USA08565 Fever; Injection site 0 None OTH OTH None WAES0712USA04824 2 Diagnostic laboratory, OTH blood OTH work;Unknown chest X-ray; Drug urinalysis hypersensitivity WAES0712USA08834 2 WBC count,OTH 12/12/07, OTH elevated; Erythrocyte, Unknown 12/12/07, elevated; Unknown Serum immunoglobulin WAES0712USA09091 M, 12/12/07, negative fo Serum Hib OTH PRP antibody, OTH.96 Unknown Ear infection; Nasal congestion WAES0801USA00319 Unknown OTH OTH Unknown Unknown WAES0801USA00333 0 Unknown PVT PVT Unknown Unknown WAES0801USA00950 6 Unknown PVT PVT Peanut allergy WAES0801USA01636 0 Unknown OTH OTH AUGMENTIN Cold; Ear infection Unknown WAES0801USA02463 1 Body temp,OTH 01/27/2008, OTH 102F None None WAES0801USA05671 0 None OTH OTH None None WAES0801USA05750 1 Ultrasound,PVT 11/??/07, no PUB results reported; X-ray, 11/??/07, Unknown no results reported;WAES0801USA05767 Body temp, 11/17?/07, 104.7F. 314 Unknown OTH OTH Unknown Unknown WAES0802USA04639 Unknown OTH OTH Unknown Enterovirus infection WAES0802USA05318 0 None OTH OTH None None WAES0803USA01282 OTH OTH Unknown WAES0804USA01172 0 OTH OTH Unknown WAES0804USA01932 53 Monocyte count, PVT 03/05/08, OTH17%; WBC TYLENOL; count,Gastrooesophageal ZANTAC 03/05/08, Congenital 5.7 K/uL;reflux Body genital disease temp, malformation 03/05/08, WAES0804USA05095 female; 102.9; Body Stenosis temp, of03/05 nasol 0 None OTH OTH Murmur functional WAES0805USA00195 -46 body temp 03/17/08 OTH 98.7; OTHbody temp 03/10/08 Pregnancy 99 ; bodyNOS temp(LMP 01/04/08 = Unknown); 97.7 WAES0806USA02567 Drug hypersensitivity 7 Renal ultrasound, PVT 06/05/08, OTH follow up renal ultrasound; Ear infection; Nasopharyngeal Respiratory Nasal congestion. syncytial RSV,virus WAES0808USA04750 04/22/08, infection; posit;Hospitalisation; Body temp, 04/22/0 Weig 23 Unknown OTH OTH Unknown Plagiocephaly; Upper Cadidiasis respiratory tract WAES0809USA01524 infection; Constipation. 41 Unknown OTH OTH Unknown WAES0809USA03003 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0809USA04523 51 Unknown PVT OTH Nasal congestion; Constipation WAES0811USA00853 1 None OTH OTH Protein allergy Premature birth WAES0811USA02934 14 None OTH OTH PREVNAR Jaundice; Group B betahaemolytic WAES0812USA02271 streptococcal , positive OTH OTH BERNA20080106 OTH OTH BERNA20080226 1 UNK PVT OTH No concurrent Unknown medication The subject has no relevant A0772597A medical history. It was indicate
9 PVT UNK None None None 17 LABS: ESRUNK 48(H), CRP UNK 2.1(H), ANA 6/9/09 1:320 Medical homogeneous None records6/9/09 recieved pattern, Medical DOS RF neg, records 12/21/07 DS-DNA recieved to 2/26/09. neg.DOS Serum Synthroid, 12/21/07 proteinto Flexeril, electropho 2/26/09. V None PUB OTH None per MOC None per MOC 8 2-5-09 HEPPVT B S Ag - NR, PVTHEP B SNone Ab <5 nonNo immune &No HEP B core Ab - NR 1 None OTH PVT None 1 PVT UNK None None 1 PVT UNK None Cat scratchNone of eye 30 None OTH OTH Unknown Parkinson'sCataract; disease; Anaemia Hypertension; WAES0903USA00952 Gastrooesophageal reflux disease 0 hematology,OTH blood work OTH vitamins (unspecified) Pregnancy NOS (LMP = 12/6/2007) WAES0802USA00806 0 urine beta-human, OTH 04/17/08, OTH positInsulin Pregnancy NOS (LMP = 12/7/2007); WAES0804USA04091 Type 1 diabetes mellitus; Sulfona 145 Not reported OTH OTH None ### 1 NONE PVT PVT NONE NONE NONE 1 MIL MIL NONE NONE 1 PUB PUB 0 None PUB PUB None No Congenital cleft lip and palate 0 PUB PUB NONE NO NONE 0 NONE PVT PUB NONE NONE 161 VIRAL CULTURE PVT PENDING PUB NONE NONE NONE 7 PUB PVT None None known 1 NONE PUB PUB NONE NO NONE 0 Evaluated by PVT Pediatrician, PVTreferredYaz-oral to and evaluated conceptive None by dermatologist. Migraines;Tonsillar hypertrophy 1 Blood work UNK done and showed UNK that I had a lowWBC. none what I hadso none been evertotally healthy before I was asked o take the flu sho 1 UNK UNK 2 UNK PVT None noted 0 NONE PUB PUB NONE NONE NONE 1 PVT PVT ventolin inhaler None Allergy to aleve and contact solution preservative. tching during fever. Child was difficult PVT to keep awake UNK for 2 days. Significantly None decreased None appetite for 1 month. 1 LABS: WBCPVT 12/3(H), H/H PUB11.3/33.3(L), ZANTAC plts 635(H), None UA WNL, GERDBMP WNL, RSV neg. 0 PVT UNK None 1 None PVT PUB None None None 367 OTH UNK NKA None OTH PVT 442 PUB UNK 1 None PUB PUB None None None 2 None PUB PVT None None None 12 -> None yetPVT pt. to seekPVT medical evaluation ibuprofen3/13/09 1 None PVT UNK None None None 0 None PUB PUB No None Similar situation with 1st doses of same vaccina 1 None PVT PUB None None None 2 PVT PVT 0 No wheezing. PVTPeak flow PVT 400. PVT PUB OTC; Vitamin None C None 1 PUB OTH None None None 0 PVT PVT Heart Murmur 1 PUB UNK Ortho Tricyclen No Allergy to pertussis crying, red~Pertussis vaccine - Born(no w/out brand spleen name)~UN~0~ 0 None PVT UNK No Mild thoracic back pain 1 None PUB PUB None None PVT UNK No No 0 PUB PUB None Mother states 04/10/2008~Varicella fish & peanut allergies (Varivax)~2~3~Patient 10 MIL MIL NONE NONE NONE 0 none PVT PVT given tylenol none or Motrin penicillin, in anticipation possible of shot animal dander
24 Labs and Diagnostics: UNK UNK Head CT (+) for paranasal none sinus mucosal none. PMH: disease, Asthma. otherwise Trigger WNL. finger EEG release WNL-except symm 1 HSV PCR (-) UNK Right temporal-occipital UNK T2 flair on MRI LABS: PMH: Pap HA,smear TMJ, c/w factor HGSIL. V Leiden Vagdeficiency, c/s (+)candida. GERD, Abdomin asthma 15 On hospitalUNK admission UNK MRI of the Levoxyl T-Spine 50mcg, revealed NoneVitamin abnormality Hypothyroidism D 1000 from IU,T5 Tamadol to (controlled), T10 50mg consistent Obesity, PRN,with Bactrim Vitamin myelitis DS, Dbut Zyrtec Deficiency not diag 10m 0 labs and Diagnostics: UNK UNK Pneumocardiogram (+)none for mild GER. nonepH probe (+). blood and urine cx (-). head CT (-). EEG 33 pityriasis PVT PVT genertic yaznone (birth control none pills) 1 UNK PVT unsure None inactive rhuematoid arthritis, hblood pressure 1 PVT UNK None Seasonal allergies; Eczema Not reported UNK UNK The patient had a history of penicillin ### allergy. 0 chest x-ray,PVT 12/15/08, No PVTacute cardiopulmonary ECOTRIN; Diverticulitis TENORMIN; processMalaria identified; LANOXIN;absolute ZOCOR;neutrophil, WAES0812USA03381 COUMADIN 12/15/08, 13% low; lymph 0 Unknown PUB PUB Unknown Asthma WAES0903USA00854 Unknown OTH OTH Unknown Unknown WAES0903USA01644 17 1/15/09 LABS: PVTabdominal PUBx-ray neg. ZANTAC US abdomen forNone GERD (+)2IS. None; Air contrast except GERD barium2enema PMH: unsuccessful. RSV bronchiolitis None PUB PUB None RH Baby per mom's report 3 None PVT PVT None None None PUB PUB 13 PUB PUB took EXCEDRINE Hyperlipidaemia migraine PCN,@ SULFA Doctors prior to NC09012 onset 5 None PVT PUB None urticarial lesions None 5 days later 0 PVT PUB None 0 ER diagnostics PVTwill follow. PVT In office: None pulse ox=98; NoneBP = 110/70; None and blood glucose = 103 3 PUB PUB 1 PVT PVT Poly Vi Vitamins Slight nasalChronic congestion rhinitis T99.2 2 PUB PUB None None None 1 None PVT PUB None Healthy None 7 CBC, WNL;PVT CPK, WNL; PVT ESR, 21; None CRP, 2.86 None None 355 UNK UNK None UNK UNK 0 UNK UNK 0 PUB UNK None None None 0 None PVT UNK None None None 0 PVT UNK none None transposition hives~ of great ()~UN~0~Patient vessels; ASD; VSD; previous rxn to i 501 PVT PVT Congestion, cough, fever PVT PVT 1 PVT UNK None High blood pressure, Diabetes, seasonal allergies 0 CBC, Metabolic PVT panel done PVT prior to Singular injection 10mg; 3/9/09. NoneSimvastatin Borderline 20mg;Thyroid; CaltrateOsteopenia; with / D; VIT.D No known 400 IU;allergies VITC 500MG; to me MIL MIL 2 labs and Diagnostics: UNK UNK CBC with WBCs None 26K. Stool None hemeIn (+). utero KUB HIV(+) exposure for bowel - patient dilitationc/w on AZT SBO. for 6US weeks (+) for and IS.ha 9 PVT PUB no no no 0 PUB PUB MO-2009-07 8 none knownPUB PUB none no none 1642 none PVT UNK unknown unknown unknown 0 none UNK UNK Singulair prn none none 3 PUB PUB Unknown None per screening None known questionnaire 6 None UNK UNK Fluoxetine None Allergy to Sulfa 9 MIL MIL None 9 MIL MIL None 1 PUB UNK None None Allergic Rhinitis 2 PVT PVT Effexor XR-75mg, Gastritis/GERD Protonix Shellfish, 40mgIodine 1 None PUB PUB Atenolol, Lisonopril, None and Hypertension, Lipitor, Aspirin hypercholesterolemia 11. AdversePVT event onset: PVT unknown when pain and numbness Unknown began 7 PUB UNK UNKNOWNNONE UNKNOWN 1 PVT PVT Eucerin (topical) None Mild eczema
0 N/A UNK UNK FLONASE, NONE AZMACORT, ASTHMA PATADAY, RELATED CLARITIN,PRILOSEC, TO SEASONAL ALLERGIES IBUPROFEN FOR P 1 None PVT UNK 1 PUB PUB None 7 CBC; CMP;OTH throat CX, OTH neg ORTHOTRICYCLEN none LO NKDA; no birth defects; or medical conditions 0 PVT PVT none none 0 PUB PUB mild cough allergic sneeze to before Beesinjections per mother 1 No vaccinesPUB and URI- PUB ear and throat virus circulating in our asthma; community. uses rescue Our M.inhaler D. local only health office also notified. 2 None Ordered PUB OTH NKDA 0 PUB PUB None None 0 CBC; CMP;PUB UA PUB None None heart murmur 3 PVT PVT None 0 None PVT OTH None None None 2467 OTH OTH PVT UNK LOESTRINNo FE; Steroids Allergy, latex, Betadine. PMH: Allergies: Betadine, latex. 0 none PVT UNK no GERD 2 None PVT PUB Allergic reaction None 0 PVT PUB Egg and milk allergy; Asthma 14 CT - Head negative. PVT Labs PVTand Diagnostics: ZOLOFT; ATIVAN Head CT WNL. Hyperlipidemia, MRI head WNL. G.A.D.; Panic Disorder. PMH: hyperlipide 8 none PVT PVT Was on amoxicillin Upper resp, at time none illness/cough of reaction 2 PVT PUB 1 PVT PVT None None None 92 Positive, ANA PVT UNK None 0 None PUB OTH None None None Unknown OTH OTH Unknown Unknown WAES0902USA04090 Unknown OTH OTH Unknown Unknown WAES0902USA03978 0 Unknown OTH OTH Unknown Unknown WAES0902USA03082 0 Unknown OTH OTH Unknown Unknown WAES0902USA02902 199 stool rotavirus OTH antigen OTH 08/06/08 - positive; None stool culture 08/06/08 None - heavy entericWAES0902USA02647 flora, no white blood cells 0 Unknown OTH OTH Unknown Unknown WAES0902USA02385 diagnostic laboratory OTH - OTH tested positive Unknown for rotavirus Unknown WAES0902USA02251 Unknown OTH OTH Unknown Unknown WAES0902USA02243 201 stool rotavirus OTH antigen OTH - rotavirus positive Unknown Unknown WAES0902USA02170 Unknown OTH OTH Unknown Unknown WAES0902USA01794 Unknown OTH OTH Unknown Unknown WAES0902USA01704 Unknown OTH OTH Unknown Unknown WAES0902USA01652 Unknown OTH OTH Unknown Unknown WAES0902USA01525 0 Unknown OTH OTH Premature birth WAES0902USA01491 0 Temperature OTH measurement, OTH 12?/??/08, Unknown 103 degrees. Unknown WAES0902USA01091 Unknown OTH OTH Unknown Unknown WAES0903USA00060 0 Unknown OTH OTH Unknown Unknown WAES0903USA00014 0 Unknown OTH OTH Unknown Unknown WAES0902USA04196 1 Unknown OTH OTH None Unknown WAES0902USA04614 35 None OTH OTH None None WAES0902USA04623 473 diagnostic laboratory OTH 12/??/07 OTH - HPV None Test normal; diagnostic Nonelaboratory 02/16/09 WAES0902USA04624 - Positive for high and low risk HP Unknown OTH OTH Unknown Unknown WAES0903USA00004 2 Unknown OTH OTH Unknown Unknown WAES0903USA00009 0 None OTH OTH Unknown Unknown WAES0903USA00013 Unknown OTH OTH Unknown Unknown WAES0903USA00033 Unknown OTH OTH Unknown Unknown WAES0903USA00052 Unknown OTH OTH Unknown Unknown WAES0903USA00057 1 None OTH OTH None None WAES0903USA00076
0 Body temp OTH 01/26/09 101.5 OTHNASONEX Rhinitis Allergic WAES0903USA00096 0 Unknown OTH OTH albuterol; ALLEGRA; Raynaud'sDIFLUCAN syndrome; Hypertension WAES0903USA00106 2 Unknown OTH OTH None None WAES0903USA00120 Unknown OTH OTH Unknown Unknown WAES0903USA00502 Unknown OTH OTH unknown Unknown WAES0903USA00274 0 Diagnostic laboratory, OTH 02/26/09, OTH neurological None exam: negative None for findings. WAES0903USA00134 Unknown OTH OTH Unknown Unknown WAES0902USA04579 0 Unknown OTH OTH NUVARINGPregnancy NOS (LMP = Unknown) WAES0902USA04576 Unknown OTH OTH Unknown Unknown WAES0902USA04551 None LABS: OTH PAP smear OTH WNL. None None PMH: PUD, depo-provera WAES0902USA04538 contraception. OTH OTH None None WAES0902USA04537 0 None OTH OTH None None WAES0902USA04531 Unknown OTH OTH Unknown Unknown WAES0902USA04526 Unknown OTH OTH Unknown Unknown WAES0902USA04519 Unknown OTH OTH Unknown Unknown WAES0902USA04518 Unknown OTH OTH Unknown Unknown WAES0902USA04517 Unknown OTH OTH Unknown Unknown WAES0902USA04500 0 blood pressure OTH01/08/09 OTH 114/6 - ; None neurological examination None 01/08/09 - within normal WAES0902USA04481 limits; total heartbeat count 01 0 ultrasound 02/10/09 OTH - dw, OTH 22 week, Unknown EDC 6/12/09 Pregnancy NOS (LMP = 9/5/2008)WAES0902USA04477 38 None OTH OTH Unknown Unknown WAES0902USA04453 Unknown OTH OTH Unknown Unknown WAES0902USA04362 Medical records OTH received OTH w/LABS:None EGD 12/08Endometriosis (+) gastritis. 9/4/09 ESRMedical 9, ANArecords 1:80 speckled. WAES0902USA04356 receivedRF w/PMH: neg. Allergy: amoxicill 5 None OTH OTH Unknown Unknown WAES0902USA04044 Unknown OTH UNK Unknown Unknown WAES0902USA04071 None PVT PVT Unknown None WAES0902USA04072 Unknown OTH OTH Unknown Unknown WAES0902USA04176 31 Magnetic resonance, OTH everything OTH was fine. PENICILLIN allergy WAES0902USA04180 None OTH OTH hormonal contraceptives None WAES0902USA04190 Unknown OTH OTH Unknown Unknown WAES0902USA04195 Unknown OTH OTH Unknown Unknown WAES0902USA04198 Unknown OTH OTH Unknown Unknown WAES0902USA04249 Unknown OTH OTH Unknown Unknown WAES0902USA04250 Unknown OTH OTH Unknown Unknown WAES0902USA04252 50 Unknown OTH OTH None None WAES0902USA04343 5 None OTH OTH Unknown None WAES0902USA04346 42 None OTH OTH Vitamins (unspecified) None WAES0902USA04350 0 None OTH OTH None None WAES0902USA04032 429 Unknown. 6/17/09 OTH ER OTH records received Unknown DOS 11/22/07. LABS Unknown and DIAGNOSTICS: Medical records WAES0902USA04019 Beta received Hemolytic 6/19/09 Strepptococci PMH: works C a 0 Herpes simplex OTH virus, negative OTH Unknown None WAES0902USA04004 0 Unknown OTH OTH None None WAES0902USA04000 0 None PVT PVT None None WAES0902USA03917 0 None OTH OTH albuterol; ZYRTEC; Asthma; Sulfonamide VERAMYST; Brachial plexus allergy ADVAIR; injuryhormonal WAES0902USA03801 contraceptives; SINGULAIR 0 None OTH OTH None WAES0902USA03797 Unknown OTH OTH Unknown Unknown WAES0902USA03770 0 None OTH OTH None None WAES0902USA03739 None OTH OTH Unknown Unknown WAES0902USA03734 1 None OTH OTH None None WAES0902USA03713 42 Body temp,OTH 02/27/07, OTH 101; Erythrocyte, ASTELIN; 02/27/07, RHINOCORT; negat;None Body ALESSE temp, 03/26/07, WAES0902USA03633 101.5; Complete blood cell, 2/27/ 0 None OTH OTH None Back pain; Pain in hip WAES0902USA03603 Unknown OTH OTH Unknown Unknown WAES0902USA03589 Unknown OTH OTH Unknown Unknown WAES0902USA03555
0 None OTH OTH Unknown Unknown WAES0902USA03553 0 Diagnostic laboratory, OTH pregnancy. OTH ALBUTEROL; Pregnancy XOPENEX; NOS SINGULAR (LMP = 8/1/2008); WAES0902USA03545 Asthma 0 Cervical smear, OTH abnormal OTH Hormonal contraceptives Unknown WAES0902USA03544 Unknown OTH OTH Unknown Unknown WAES0902USA03536 Unknown OTH OTH Unknown Unknown WAES0902USA03528 0 Unknown OTH OTH Unknown Unknown WAES0902USA03115 10 Unknown OTH OTH Unknown WAES0902USA03112 0 None OTH OTH Unknown Unknown WAES0902USA03108 0 Unknown. Labs OTH and diagnostics: OTH Brain YAZ MRI (-). Sinus CTUnknown. (-). Head CT PMH: (-). heavy CT abd WAES0902USA03107 periods, (+) for possible sinusitis, gastroenteritis. H/A P 0 Unknown OTH OTH LEXAPRO;Pregnancy PREVACIDPapanicolaou NOS (LMP = Unknown); smear abnormal; WAES0902USA03106 AnxietyLoop disorder electrosurgical excis 0 urinalysis 02/16/09 OTH - revealed OTH the Unknown presence ofHypertension protein. WAES0902USA03105 1 None OTH OTH Unknown Unknown WAES0902USA03094 None OTH OTH SUDAFED Unknown WAES0902USA03093 Unknown OTH OTH Unknown Injury WAES0902USA02975 344 Unknown OTH OTH None Cervical dysplasia WAES0902USA02682 0 Unknown OTH OTH Unknown WAES0902USA02694 156 Unknown. OTH 5/27/09 medical OTH records PROVENTIL; LABS: BUN/creat FLONASE. ratio Unknown. 24(H). 5/29/09X-ray 5/27/09 Neurological of right medical WAES0902USA02704 wrist consult records WNL. records 5/29/09 PMH:recieved tension Neurological vascular DOS 1/2 co Unknown OTH OTH Unknown Unknown WAES0902USA02705 0 None OTH OTH None WAES0902USA02709 Pap test - inflammation OTH OTH Unknown Unknown WAES0902USA02879 None OTH OTH None None WAES0902USA02904 0 Ultrasound,OTH possible unspecified OTH fetal None abnormalities. Pregnancy NOS (LMP = 8/18/2008) WAES0902USA02914 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0902USA02929 None OTH OTH Unknown Unknown WAES0902USA02935 0 None OTH OTH None None WAES0902USA02937 0 None OTH OTH None Penicillin allergy Asthma WAES0902USA02962 l virus infection) as a child who wasUNK vaccinatedUNK with the first 0.5 ml dose of GARDASIL. Respiratory Subsequently syncytial virus the WAES0902USA02969 patient infection experienced asthma. On Unknown OTH OTH Unknown Unknown WAES0902USA02669 Unknown OTH OTH Unknown Unknown WAES0902USA02388 100 None OTH OTH None Drug hypersensitivity HPV #3 2/11/2009, lot WAES0902USA02175 # 1311X Unknown OTH OTH Unknown Unknown WAES0902USA02184 5 None OTH OTH None None WAES0902USA02194 None OTH OTH None None WAES0902USA02197 0 Unknown OTH OTH None Hypersensitivity WAES0902USA02212 Pap test, 12/19/08, OTH mild OTH cervical dysplasia; Hormonal Pap contraceptives test, 05/22/06, None negative. WAES0902USA02237 Unknown OTH OTH Unknown Papilloma viral infection; Cervical WAES0902USA02269 pap smear abnormal; Genital wart. 7 Unknown OTH OTH Unknown Unknown WAES0902USA02274 31 Serum TSH,OTH normal; Serum OTH ANA,ADDERALL normal; Erythrocyte, Attention tablets; deficit/hyperactivity CELEXA Depression normal; Completedisorder blood WAES0902USA02276 cell, normal; Laboratory test, com 61 Unknown OTH OTH Unknown Unknown WAES0902USA02390 Unknown OTH OTH Unknown Unknown WAES0902USA02426 0 None OTH OTH Unknown None WAES0902USA02649 1 body temp 02/05/09 OTH 101 OTH Unknown Unknown WAES0902USA02167 Unknown OTH OTH Unknown Unknown WAES0902USA02030 Unknown OTH OTH Unknown Unknown WAES0902USA01667 0 Unknown OTH OTH Unknown Irregular periods WAES0902USA01676 None OTH OTH None None WAES0902USA01682 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0902USA01699 0 Unknown OTH OTH aspirin; WELLBUTRIN;Unknown YASMIN; ALLI; TOPAMAX; WAES0902USA01707 vitamins (unspecified) Unknown OTH OTH Unknown Anaemia WAES0902USA01775 None OTH OTH Unknown Unknown WAES0902USA01813 Unknown OTH OTH Unknown Unknown WAES0902USA01815
0 Unknown OTH OTH Unknown Unknown WAES0902USA01871 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP= unknown)WAES0902USA01879 0 Blood pressure, PVT 12/29/08, PVTlow None WAES0902USA02003 0 Unknown PVT PVT Unknown WAES0902USA01614 0 serum immunoglobulin OTH OTH E - significant Unknown elevated level of IGE Unknown WAES0902USA01435 None OTH OTH Unknown Unknown WAES0902USA01468 Unknown OTH OTH Unknown Unknown WAES0902USA01470 None OTH OTH Unknown Unknown WAES0902USA01481 0 Unknown. 7/7/09 OTH PCP OTH MR received. LEVOTHYROXINE Labs andSulfonamide Diagnostics: SODIUM Acne allergy Culture 7/23/09 of Medical papular records lesion WAES0902USA01500 (-). received X-ray RDOS foot,6/20/08 B ankles, to wr 6/2 217 Diagnostic laboratory; OTH OTH "hormones"LOESTRIN normal; Thyroid Asthma 1.5/30 function test, normal; Serum WAES0902USA01507 prolactin test, normal. 0 None OTH OTH NECON Drug hypersensitivity WAES0902USA01517 Unknown OTH OTH Unknown Unknown WAES0902USA01531 Unknown OTH OTH Unknown Unknown WAES0902USA01588 0 Blood pressure, PVT result PUB not provided; Unknown Total heartbeat count, Unknown result not provided. WAES0902USA01615 Unknown OTH OTH Unknown Unknown WAES0902USA01625 0 None OTH OTH hormonal contraceptives Allergic reaction Mitralto valve antibiotics prolapse WAES0902USA01635 554 Pap test, 01/16/09, OTH abnormal OTH without ORTHO HPV TRI-CYCLEN test; Papanicolaou Pap test, 01/??/06, smear abnormal abnormal which WAES0902USA01636 was positive for high risk HPV cervix HPV OTH DNA assayOTH - negative;Unknown cervix HPV DNA assay Unknown - positive WAES0902USA01653 0 None OTH OTH None None WAES0902USA00928 Unknown OTH OTH Unknown Unknown WAES0902USA00931 Unknown OTH OTH Unknown Unknown WAES0902USA00934 0 Unknown OTH OTH Unknown Unknown WAES0902USA00935 Cervical smear, OTH ?/?/06,OTH abnormal Unknown ASCUS PAP smear; Cervical Atypicalsmear, squamous ?/?/07, cells ASCUS; WAES0902USA00938 of undetermined Cervical smear, significance 11/??/07, h 0 None OTH OTH None Dermatitis contact WAES0902USA00942 1 None OTH OTH ATARAX; ADDERALL Diabetes; Heat tablets; sensitivity; NEXIUM; Penicillin insulin WAES0902USA00951 allergy Unknown OTH OTH hormonal contraceptives Unknown WAES0902USA01036 0 Unknown OTH OTH Unknown Unknown WAES0902USA01062 0 Unknown OTH OTH hormonal contraceptives Unknown WAES0902USA01064 Allergen skin OTH test OTH Hormonal contraceptives None WAES0902USA01080 Unknown OTH OTH Unknown Unknown WAES0902USA01104 289 None. 6/8/09 OTH Rheumatology OTH records MINOCYCLINE. received DOS6/8/09 2/7/09 None. Rheumatology to 3/30/09. 6/8/09 LABS Rheumatology records and WAES0902USA01115 DIAGNOSTICS: received records DOS received 2/7/09 UrineDOS to- cloudy, 3/30/09. 2/7/09 RM 17 None OTH OTH OCELLA No WAES0902USA01120 Unknown OTH OTH Unknown Appendicectomy; Cholecystectomy WAES0902USA00924 Unknown OTH OTH Unknown Unknown WAES0902USA00894 2 PVT OTH YAZ; ALDARA Allergic reaction Injection to antibiotics; site reaction Penicillin WAES0902USA00485 allergy 40 None OTH OTH None None WAES0902USA00488 Unknown OTH OTH Unknown Unknown WAES0902USA00535 Unknown OTH OTH Unknown Unknown WAES0902USA00570 0 Ultrasound OTH 02/02/09 - 31 OTH weeks pregnant; UnknownUrinalysis Pregnancy 02/02/09 Nos (LMP - positive = 7/1/2008)WAES0902USA00575 Unknown OTH OTH Unknown Unknown WAES0902USA00579 1 Unknown OTH OTH Unknown WAES0902USA00589 1 Unknown OTH OTH Unknown Unknown WAES0902USA00619 0 Unknown OTH OTH Minocycline None WAES0902USA00628 2 Unknown OTH OTH Unknown WAES0902USA00849 228 diagnostic laboratory OTH - OTH Cushing's disease None test: normal; serum Nonebiotin test - a littleWAES0902USA00858 low on Biotin; thyroid function test 1 None PVT PVT Unknown Unknown WAES0902USA00881 12 Unknown OTH OTH Unknown Unknown WAES0902USA00883 Unknown OTH OTH Unknown Unknown WAES0902USA00476 0 Unknown OTH OTH Unknown Unknown WAES0902USA00470 Pap test OTH OTH Unknown Unknown WAES0902USA00462 0 serum prostatic OTHacid - abnormal OTH PAP-low Unknown grade Squamous Unknown Intraepitheliel Lesion WAES0902USA00461
None OTH OTH None None WAES0902USA00455 Pap test, ?/?/09, OTH HPV positive OTH Unknown Unknown WAES0902USA00450 None OTH OTH Unknown Migraine WAES0902USA00427 0 Cervical smear, OTH 01/15/09, OTHpositiveHormonal contraceptives; NoneVitamins (unspecified) WAES0902USA00426 Unknown OTH OTH Unknown Unknown WAES0902USA00425 OTH OTH Unknown Unknown WAES0902USA00287 Unknown OTH OTH Unknown Unknown WAES0902USA00281 0 Unknown OTH OTH ADDERALLAsthma; tablets; Bipolar PROZAC; Obesity; disorder; Varicella; LAMICTAL; Sulfonamide Bulimia WAES0902USA00256 LITHIUM; allergy; SEROQUEL; Drug hypersensitivity RESTORIL urinalysis, presence OTH of OTH leukocyte, None protein, butPsychiatric no blood; urine Pyelonephritis disorder culture, NOSnegative WAES0902USA00221 0 PVT PVT None Private Doctor Private / Hospital Funds WAES0902USA00215 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 12/2/2008); WAES0902USA00185 Sexually transmitted disease; Inf 106 ultrasound, OTH 08/20/2008, OTH sonographic None markersPregnancy for trisomy;NOS ultrasound, (LMP = 12/18/08, 3/20/2008) WAES0805USA03343 normal; beta-human chorionic, 05/1 0 None OTH OTH ZOLOFT Pregnancy NOS (LMP = 11/19/2007) WAES0712USA08122 0 ultrasound, OTH 03/05/08 - OTH INP; urine beta-human Unknown Pregnancy - positive; serum Depression; NOS (LMP alpha-fetoprotein, =Anxiety; 1/10/2008) Papanicolaou WAES0804USA01176 05/01/08 Bipolar disorder; - smear within Smoker normal abnormal; limits Loop 73 Ultrasound,OTH 04/02/2008, OTH 6.4 weeksABILIFY; IUP; Beta-human WELLBUTRIN Pregnancy chorionic, NOS SR;(LMP SEROQUEL 03/24/2008, = 2/15/2008) positive WAES0805USA02898 Bipolar disorder; Allergic reaction Chromosomal OTH analysisOTH ?/?/08 posit Tylenol, - Down's Multivit syndrome; Pregnancy Platelet NOS (LMP count = 4/28/2008) ?/?/08 - Decreased WAES0805USA05753 Hypertension; Smoker 0 ultrasound, OTH 7/15/08, 12W OTH 4D; serum ZITHROMAX, alpha-fetoprotein, vitamins 08/13/08, Papanicolacu (unspecified) negative; smear abnormal; WAES0805USA05935 Smoker 0 Ultrasound OTH 07/07/08 - Within OTH normal doxycycline limits; Beta-human Pregnancy 100 mg chorionic Early NOS (LMP=5/7/2008) onset - positive of delivery WAES0806USA03410 Chlamydial infection 210 Ultrasound,OTH 08/25/08, normal OTH twins; None serum alpha-fetoprotein Papanicolaou 09/15/08,smear normal. abnormal WAES0807USA01851 0 ultrasound, OTH 06/18/08, normal OTH embryo vitamins (unspecified) Pregnancy Premature NOS (LMP labor; = 5/2/2008); Premature WAES0807USA03262 Smoker rupture of membranes 0 ultrasound, OTH 06/19/08, 10.1 OTHweeks vitamins gestation;(unspecified); ultrasound, Pregnancy 08/22/08, NOS vitamins (LMP (unspecified) routine: = 4/9/2008); No problems WAES0807USA04636 Asthma; seen Penicillin allergy Unknown OTH OTH Unknown Unknown WAES0901USA03966 0 ultrasound 11/??/08 OTH - 5OTH weeks andLEXAPRO 6 days gestation Pregnancy at time Depression NOS of (LMP vaccine; = 10/5/2008) ultrasound WAES0901USA04179 Smoker 11/16/08 - 7 weeks gestation; se 1 PVT UNK none none Unknown OTH OTH Unknown Unknown WAES0903USA02000 Unknown OTH OTH Unknown Unknown WAES0903USA01794 Unknown OTH OTH Unknown Unknown WAES0903USA01668 31 Erythrocyte,OTH 34; SerumOTH cyclic citrulline, Prinivil; 250 Mevacor Thyroid disorder; Glaucoma Sulfonamide allergy; WAES0903USA01845 Drug hypersensitivity; Hyperten 1 None OTH OTH None WAES0811USA00715 Unknown OTH OTH Cystic fibrosis Renal transplant; Shoulder WAES0903USA02039 operation Unknown OTH OTH Unknown Unknown WAES0903USA01841 Unknown OTH OTH None None WAES0903USA02062 273 diagnostic laboratory, OTH 08??/06, OTH diagnosed Unknownwith Gastric autismdisorder; Reflux gastritis WAES0903USA02038 1 Chest X-ray; PVT CT of head; PUB Blood work; Lumbar puncture; 34 Urine week culture. preemie 4/6/09-records 4/6/09-PMH:former received-Infectious 34 week preterm workupinfa n 1 Serum Sickness PVT LABS:WBC OTH 15.85(H), amoxicillin, lymphs Cough Day 22.0(L), 10(lingering) neutros none PMH: ("sinusitis") 72.4(H). recent ESR sinusitis 5(N), & CRP<0.5(N). on amoxicillin Complement at admit. Hive C3 0 EEG; CT Head; PVT Neurology PVT consult; None Spinal tap; Well Cultures; Visit hx Blood RSVwork PMH: LABS: RSVCBC: infection, WBCintubation, 24(H), hematocrit NICU x 130.4(L), wk. Re 1 UNK UNK 0 UNK UNK None MIL MIL None None 0 PVT PVT No No 1 none PVT PUB None Egg & yeast allergies, sickle cell trait, Incontinentia pigmen 1 None PVT PUB UNK UNK 12 None PVT PVT ZOCOR None None None~ ()~~0~Patient 4 UNK UNK NIL NIL 0 PUB OTH None High Blood pressure; Seizure medicine; central sleep apne 1 PVT PVT 0 None needed PVT PUB None None Except new onset HTN 1 Former HODGKINS; OTH had PVT splenectomy WELLBUTRIN; Levothyroxine; Former HODGKINS; Vit Red D; Low hot dose nodule~Tetanus Allergic ASAto cats Diphtheria (no brand 0 Influenza test PUB negative;PUB Strep test None negative None Allergies - Amoxicillin, Grasses; Adenoids removed for slee 0 None MIL MIL slight fever decreased 101~ ()~~0~In Sibling
7
PUB PUB No PVT PUB 1 PVT PVT Birth controlnone pills none 2 PVT PUB None None PVT PVT None None 0 MIL MIL None PVT PUB none none 12 OTH PVT None None None Not applicable. PVT OTH none 0 MIL MIL None reported Ulcerative Colitis GI upset~Tetanus Diphtheria (no brand name)~ 1 PVT PVT none none 0 Physician inPUB clinic areaPUB examined patient 108 MRIs Labs UNK and Diagnsotics: UNK HLA B27 (+). Alk phos (L) none 34. Lyme PMH: (-).none. RF (-). ANA (-). 19 EKG, ChestUNK X-ray, CT UNK Scan, MRI,Flouride, Lymes Disease, Poly None Vit-Sol and (Iron Chromosomes NoneVitamin) PMH: recurrent were all bilateral analyzedAOM. and showed Left middle normal earresul effus 0 NONE UNK UNK NONE NONE REPORTED NONE KNOWN 0 none UNK UNK NONE NONE ALLERGIES: PCN, SULFA, SILVADENE -2 NONE PVT PUB NONE ECZEMA NONE~ ()~NULL~~In Patient 20 PVT PVT None 7 PVT PVT NONE NONE NONE KNOWN 1 Abnormal nerve PVT conduction UNK velocities Crestor : 3/16/09 5mg. None Equivocal RhinocortAvelox 1MRI spray/ findings - drug nostril/ eruption. :3/16/09 qd. Fish Oil capsules. MVI. asa 325mg. 0 PUB PUB 0 UNK UNK none PCN 0 PUB PUB Unknown meds statespatient headaches hx brought of menorrhea with her from Burma/Thailand for allergies and m 11 Pregnancy UNK test was negative UNK Nuva-ring (birth None, control) manufacturer back ache, of bursitis, the vaccine tendonitis. is Baxter PMH: Healthcare eczema. Corporation. 0 Labs and Diagnostics: UNK UNK Head CT (+) for subarachnoid none bleed. none X-ray PMH: Repeat none CT (+) for evolution of frontal parenchym 16 See autopsy PVT report opinion OTH and clinical See clinical records None report; fromKnown clinic. simvastatin; see medical metformin; records ASP; - If I recall COZAAR she did have other medica 31 06 Nov 2008, MILSERUM,MIL Creatine Kinase, None 565 None (H*) IU/L; 08 NKDA, Nov 2008, no history SERUM, of chronic Proteinconditions Electrophoresis; Albumin, 4. 0 None PVT PVT None None AR (Allergic Rhinitis) 1 None PVT PVT none none none 3 OTH OTH None 5 5/21/09-records PVT received-Echo PVT abnormal. REGLANUltrasound none diagnosis Down's of Syndrome; intussusception.. AV canal;LABS Reflux and (G-E); DIAGNOSTICS; Myeloproliferat Th PVT PVT Furadantin None 25mg/5ml Grade I vu reflux R; Grade 3 L vu reflux 0 PVT PUB None LAR Cleft lip+palate UNK UNK 1 PUB PVT DIGOXIN; FOLIC Anemia; ACID; CHF Promethazine; Levothyroxine; Mechanical Lorazepam; valves: Morphine; Pulmonic; ADVAIR; Tricuspid; SPIRIVA Mi 0 PVT UNK Recent "allergy" Hypertension, symptomsDM, to unknown hyperlipidemia, allergen fibromyalgia, cervical C 9 chest x-ray PVT - bronchial PVT inflammation 0 PVT PVT Takes Claritin None redi - tabs None 11 Negative strep PVTtest 3-17-09 UNK Left otitis media - Afebrile 3741 PVT OTH Troponin (results: OTH revealed OTH significant Relevant troponin-1 medical Unknown level history elevation) Concomitant was not was provided. done medications on an USWYEH08499209 unspecified were not reported. date. 0 hematologyOTH OTH None General physical health deterioration WAES0903USA02047 1 Unknown OTH OTH Unknown WAES0903USA02042 Unknown OTH OTH Unknown Unknown WAES0903USA01872 Unknown OTH OTH Unknown Unknown WAES0903USA01804 None OTH OTH NUVARING None WAES0903USA02071 91 Unknown 3/27/09-records OTH OTHreceivedNone EGD, colonscopy and None capsule 3/21/09-records study showed received-PMH: WAES0903USA02043 chronic ileitisasthma and esophageal and GERD. ca 30 Unknown OTH OTH Unknown Migraine WAES0903USA01837 Unknown OTH OTH Unknown Unknown WAES0903USA01470 6 UNK UNK Healthy individual. 0 PUB PUB None NKDA
1 PUB PUB None None GA09001 0 PUB PUB PRILOSECNone 20 mg 48 units; Allergic HIOMULIN to DEMEROL; 70/30GA09002 CODEINE; 25 units; ZOCOR GLUCOPHAGE; 20 mg daily; NEUR ZOL 4 CT Scan; EKG; PUB Labs PVT None None None GA09004 0 Cerebrospinal OTH fluid testOTH results (date not specified) Unknown indicated It was clear reported aspect, that density theA0773653A young 0.005,subject ph of 8, was glucose the result 55, prote of a h UNK OTH OTH No concurrent Unknown medication A0773852A Body temperature, OTH low;OTH Eosinophils, 59%; White Unknown blood cell count, 23.7x10^9/l B0564949A PUB PVT None None 1 PVT UNK None None BACTRIM; Angioedema 2 PVT UNK None None 8 MIL MIL None None None 1 None PVT PVT BACTRIM DS; RashTAC on thighs Cream None 0.1% 7 PVT OTH TYLENOL None Prematurity(fever, - smallredspots baby on face + body~Measles + Mu 0 None yet. PVT UNK None Allergy: CODINE (anaphylaxis); No known birth defects. 7 None PVT PUB 197 None MIL MIL ADDERALLNone None 0 N/A MIL MIL N/A NONE ADHESIVEALLERGIC AND ANTHRAX REACTION~Anthrax VAAINE AND HEPATITIS (Biothrax)~1~ BV 0 N/A PVT PVT N/A N/A N/A N/A~ ()~NULL~~In Patient 1 PUB PVT 2 N/A PUB PUB Birth Control None Pills None known Erythema, itching, bruising~Measles + Mumps 1 PVT PVT None None Migraine Headaches with Aura 1 PVT UNK None None 0 PUB PUB not physician diagnosed allergy to dial soap 0 PUB PUB 0 PUB PUB none 5 Premature menopause UNK UNK 4/2/09-records nonereceived-Pelvic none ultrasound none 4/2/09-menarche WNL. DHEA 154 began normal.Estradiol at age 11 and23, everyother LH 32.3 m an 7 PUB PUB None None None 1 none at thisUNK time. UNK diagnosed with OM on 3-6-09 and only recieved amoxicillin that was s 2 PVT PVT Norvasc, Celexa, No Metformin, AllergicArin to Sulfa drugs. Currently diagnosed with HTN and 1 none UNK UNK none none 1 UNK UNK None None None 7 Was seen by PVT pediatrician UNK 3/18/2009 None No milk allergynone in prior~ ()~NULL~~In Patient|n/a~ ()~NU 0 PVT PVT no 2 vital signs taken PUB and allUNK stable .Mother instructed noneto give zyrtec 1/2 tsp daily and re-check in one day. 2 vitals takenPUB and all wnl.PUB Mother was instrctednone to give 1/2none tsp Zyrtec and return to clinic for re check on following day 0 several biopsies; UNK performed UNK by twothe dermatologist doctors all office of(specialist); the is showing side none; effects regular my twodaughter started other dermatologist; shots at was theTd time very Adult plus of healthy the lot#c2775ap regular vaccination anddoctor athletic; its and visits; hard sothe to health and rea skiu 4 none UNK UNK none none none 1 PVT PVT none 2 Unknown date: OTHRoutineOTH sequenceConcomitant analysis: type Cerebral Drug(s) B influenza palsy; Not Neuromuscular Reported virus Seizure; (FLUMIST Microcephaly disorder; strains); MEDI0008055 Taking NI, anti-epileptic NI, NI medication 0 PUB PUB PPD None Allergic to: PCN family; Hydrocodone; Flexeril; Ibuprofen; L 1 None PVT UNK None None 0 PVT PUB none no, healthyNKA; HX, HSV infection, cutaneous only; HSV meningitis, 0 chest x-ray,MIL normal; CBC, MIL normal;None Chem-7, normal None None 0 PVT PVT Vitamin D; ZINC; no calcium possible chew;ulcer; vitamin colitis; chewmultiple sclerosis 0 MIL MIL None None 1 None PVT PUB cough - viralNone illness 1 None OTH UNK None URI None Diagnostic Test: UNK pelvicUNK u/s (12/04)TRI-LEVLEN mult. leiomata TRIPHASIC max 2.8cm; metromenorrhagia endometrial biopsy; Labs: plts(1/02)-271K' plts(10/04 0 PVT PUB Allergic rhinitis NKA PUB PUB ALBUTEROL NebulizerAsthma; Eczema; Sickle Cell trait 0 PVT UNK 39 22-Nov-2008, OTH Rapid fluOTH test, Negative; Concomitant Blood culture, Drug (s) 11/??/08, Not TheReported subject Sterile; has Chest a history X-ray, MEDI0007935 of 11/18/08, fever and Consistent cough for approxima with right
0 0 0 0 0 0 0 0 0 0 0 0 0 0
OTH OTH Concomitant Drug (s) Not Reported MEDI0008002 PVT PUB Concomitant Drug(s) not Past Reported Disease: Ear infection; MEDI0007971 Ear tube insertion PVT PUB MIRALAX Constipation; Tubes Ear infection in ears due to ear MEDI0007922 infections OTH OTH Concomitant Drug(s) Not Reported MEDI0007907 MIL OTH Concomitant Drug (s) Not Reported MEDI0007901 MIL OTH Concomitant Drug (s) Not Reported MEDI0007891 MIL OTH Concomitant Drug(s) Not Reported MEDI0007884 MIL OTH Concomitant Drug(s) Not Reported MEDI0007881 MIL OTH Concomitant Drug(s) Not Reported MEDI0007879 MIL OTH Concomitant Drug(s) Not Reported MEDI0007874 MIL OTH Concomitant Drug(s) Not Reported MEDI0007872 OTH OTH Not Reported MEDI0007857 OTH PVT Concomitant Drug(s) Not Reported MEDI0007856 OTH PVT Concomitant Drug(s) Not Reported MEDI0007855 magnetic resonance, OTH ?/?/94, OTH multiUnknown - brain MRI General Symptom WAES0901USA00098 27 magnetic resonance, OTH 10/14/93, OTH abnor, Unknown Brain-see narrative Unknown WAES0812USA03330 14 Unknown OTH OTH Unknown Back injury WAES0812USA03312 Unknown OTH OTH Unknown Unknown WAES0901USA00317 Unknown OTH OTH Unknown Unknown WAES0812USA04898 24 Unknown OTH OTH Vocal cord Tracheostomy paralysis; Hypotonia; Laryngomalcia; WAES0812USA03569 Lung disorder; Malai Unknown OTH OTH Unknown Unknown WAES0812USA03314 None OTH OTH None None WAES0812USA02004 32 Physical examination, OTH 06/30/08 OTH , normal Unknown Circumcision; Family history WAES0812USA01523 of cancer Unknown OTH OTH Unknown Unknown WAES0812USA00544 Unknown OTH OTH Unknown None Injection site WAES0812USA00480 erythema, pruritus, rash, swelling, 1 Skin biopsy,OTH "possible drug UNK reaction" Furosemide; Hypertension ATIVAN; BENICAR WAES0812USA00053 0 Unknown OTH OTH Unknown Unknown WAES0811USA03029 40 Unknown OTH OTH Unknown WAES0811USA02988 4 None OTH OTH None None WAES0811USA02844 Unknown OTH OTH Unknown Unknown WAES0811USA02841 50 Unknown OTH OTH Unknown Hospitalisation WAES0811USA02798 3 Diagnostic radiology, OTH 07/22/08, OTH gastroesophageal reflux;Unknown Total serum bilirubin, 06/16/08, WAES0811USA02544 1.7 mg/dL, high; Serum di 1 None OTH OTH vitamins (unspecified) None WAES0811USA02179 Unknown OTH OTH Unknown General symptom WAES0811USA01659 Diagnostic laboratory, OTH 8/??/1997, OTH abnormal Unknown liver Acne WAES0811USA01658 0 Ultrasound,08/07/08, OTH abdominal OTH - no evidence Pregnancy of hypertrophic NOS (LMP pyloric= stenosis, Unknown); WAES0811USA00783 pedialyte Talipespasses smoothly through 3 Unknown OTH OTH Unknown WAES0811USA00635 62 OTH OTH Unknown WAES0811USA00563 2 None OTH OTH None None WAES0801USA03990 3 None OTH OTH Hormonal contraceptives PENICILLIN allergy WAES0810USA03139 hearing testPUB - passed; body OTH weightNone measurement 08/27/08 None 11.8 pound -; body weight WAES0810USA03070 measurement 07/08/08 7.4 p Unknown OTH OTH Unknown Unknown WAES0810USA02502 51 vital sign 08/20/08 PVT - Temp OTH- 99.8, pulse 145, respiration's Diaper rash 28; WBC count 08/20/08 WAES0810USA02436 14.20 - ; hemoglobin 08/20/08 1 2 hearing testPVT 06/14/08 -OTH left ear - pass; AQUAMEPHYTON, hearingProphylaxis test 06/13/08 IM, 0; -Erythromycin right ear - pass; Ophthalmic Apgar WAES0810USA02427 score 06/12/08 - 9 and 9; body Unknown OTH OTH Unknown Unknown WAES0810USA01821 Unknown OTH OTH Unknown Unknown WAES0810USA00820 2 Unknown OTH OTH Digoxin Paroxysmal supraventricular tachycardia WAES0810USA00425 OTH OTH Unknown Unknown WAES0810USA00194 OTH OTH Unknown Unknown WAES0810USA00177 OTH OTH Unknown Unknown WAES0801USA00075 Unknown OTH OTH Unknown Unknown WAES0810USA00002
Unknown OTH OTH Unknown Unknown WAES0808USA05347 0 None OTH PVT None SULFONAMIDE allergy; PENICILLIN WAES0808USA03602 allergy 0 None OTH OTH WELLBUTRIN; Thyroid ADVAIR papillary Renal DISKUS; carcinoma; cyst LEVOTHYROXINE Asthma; WAES0809USA04880 Drug SODIUM hypersensitivity 31 ultrasound 07/12/07 OTH - pregnancy; OTH diagnostic laboratory Mongolian03/13/08 spot; Jaundice Torticollis - neonatal newborn screen WAES0809USA04315 - negative; venipuncture 03/13/0 14 Unknown OTH OTH Jaundice neonatal WAES0809USA03422 3 diagnostic laboratory OTH 04/23/08 OTH - endocrine None disorders - normal; Jaundice diagnostic laboratory WAES0809USA03006 04/23/08 - hemoglobinopathies 20 Unknown OTH OTH Cleft lip Jaundice; Blood bilirubin WAES0809USA01661 abnormal; Infantile spitting up Unknown OTH OTH Unknown Unknown WAES0809USA01605 Unknown OTH OTH Unknown Unknown WAES0809USA00797 21 diagnostic laboratory PUB - OTH full rheumatologic Unknown workup DepressionHepatitis negative C WAES0808USA05345 Unknown OTH OTH Unknown Unknown WAES0808USA04151 1 None PUB PUB PERCOCET; LEXAPRO; Hypersensitivity ALEVE WAES0808USA03995 3 hepatic function OTH tests, 03/17?/02, OTH Unknown liver enzymes were fiveUnknown to six times the normal WAES0807USA05660 limit; hepatic function tests, 01/12 Unknown OTH OTH Unknown Bulimia WAES0807USA05790 None OTH OTH Unknown None WAES0808USA03092 Unknown OTH OTH Unknown Unknown WAES0808USA02804 11 Unknown OTH OTH SYNTHROID; TAPAZOLE Hypothyroidism; Drug hypersensitivity WAES0807USA05683 Unknown OTH OTH Unknown Unknown WAES0807USA05549 Unknown OTH OTH Unknown Dialysis WAES0807USA04094 Unknown OTH OTH Unknown Unknown WAES0807USA04037 Unknown OTH OTH Unknown Unknown WAES0808USA04836 Unknown OTH OTH Unknown Unknown WAES0807USA02498 Unknown OTH OTH Unknown Unknown WAES0807USA01576 0 None OTH OTH KLONOPIN;Migraine; RELPAXPENICILLIN allergy; Hypersensitivity; WAES0807USA01112 SULFONAMIDE alle 3 Computed axial; OTH 01/07/2008, OTH negative; Unknown Diagnostic laboratory, Motor 01/07/08, vehicle accident; negative WAES0810USA01573 Back injury Unknown OTH OTH Unknown Unknown WAES0801USA02974 26 Unknown OTH OTH Unknown Upper respiratory Unknown tract infection WAES0802USA05298 1 None OTH OTH None None WAES0801USA03311 1 body temp, OTH 01/16/08, 102 OTHF, feverNone None WAES0801USA04102 Serum Hepatitis OTH B coreOTH ?/?/95 posit Unknown - ; Serum Hepatitis BSurgery; core 12/??/07 Blood donor WAES0801USA04436 1 diagnostic laboratory, OTH failed OTH to seroconvert Unknown Unknown WAES0802USA02695 28 Unknown OTH OTH Unknown Unknown Febrile convulsion~Varicella WAES0802USA03013 (Varivax)~1~1~Pa 64 diagnostic laboratory PVT 10/31/07 OTH - Negative LIPITORtiter mg; Drug for fexofenadine RECOMBIVAX hypersensitivity Lipidshydrochloride; increased HB; diagnostic fluticasone WAES0802USA03149 laboratory propionate; 12/??/07PATANOL - Negative tite Unknown OTH OTH Unknown Unknown WAES0803USA01725 None PVT PVT None No adverseWAES0803USA03063 event~Hep B (Recombivax HB)~2~ 11 Unknown PVT OTH Unknown WAES0903USA04159 Unknown OTH OTH Unknown Drug hypersensitivity Coeliac disease WAES0804USA00190 81 hematocrit 10/22/07 OTH 16.5 OTH -; body height measurement 10/22/07 Unknown 24.25 -; body temp WAES0804USA00205 10/22/07 98 -; body weight mea 11 None PVT OTH None NONE WAES0804USA02481 9 Unknown OTH OTH Cardiac murmur; Varicella WAES0804USA03139 OTH OTH Unknown Unknown WAES0807USA00728 OTH OTH Unknown Unknown WAES0805USA00046 OTH OTH Unknown Carpal tunnel syndrome; Numbness WAES0805USA00042 in hand 0 Unknown OTH OTH DEPAKOTESulfonamide allergy WAES0804USA03842 34 body temp, PVT 08/24/07, 98.7, OTH -; bodyERYTHROMYCIN; temp, 10/07/07, 96.8, PHYTONADIONE None -; vital sign 10/07/07, mg 144, WAES0805USA00927 -, heart rate; vital sign, 10/07/0 Unknown OTH UNK Unknown Unknown WAES0805USA04759 Unknown OTH OTH Unknown Unknown WAES0805USA04852 Unknown OTH OTH Unknown Unknown WAES0806USA00720 Unknown UNK OTH Unknown Hypersensitivity WAES0806USA00825 magnetic resonance PVT 05/07/08 OTH - Tear aspirin of anterior 81 mg; Hypertension; talofibular LISINOPRIL Allergy ligament Hyperuricaemia; 10tomg; vaccine; and LISINOPRIL associated Hyperuricaemia Hypercholesterolaemia; WAES0806USA02494 20 ankle mg; effusion; omega-3blood marine Hepatic pressure triglycer steat0 Unknown OTH OTH Unknown Unknown WAES0806USA03414
0 Unknown OTH OTH Unknown Unknown WAES0806USA08376 None OTH OTH None None WAES0807USA00061 OTH OTH Unknown Unknown WAES0807USA00802 1 An EKG was PVT performed PVT on an unspecified Oral contraceptives date Unknown (followingThe thesubject subject's has episode a history A0717385A of dizziness) of irregularwas heartbeat negative. with negati 0 Blood pressure, PVT 02Feb2008, PVT low; CBC, 11Feb2008, Unknown normal; MRSA CTInfection. scan, 11Feb2008, History: A0709448A MRSA normal; infection Chest x-ray, of the 11Feb2008 skin. No kn 2 A physical examination PVT PUB performedAmoxicillin by an allergist Otitisonmedia 28 March 2008 was normal. A0708192A The event of rash was resolved w OTH OTH Unknown A0713347A 0 Body temperature, PVT 27Feb2008, PVT 103.6degrees AZITHROMYCIN Unknown F Allergic Rhinitis; Allergy A0717375A to AMOXICILLIN; Asthma; Reac Body temperature PVT increased PVT 89.1 No concurrent Unknown medication The subject had no relevant A0729978A medical history 0 PUB PVT Unknown The subject has no relevant A0728841A medical history. 3 UNK OTH PVT Unknown The subject had no medical A0728382A history and was not taking any OTH PVT Unknown No allergies and occasional A0724174A motion sickness. No history o UNK PVT OTH Unknown The subject's medical history, A0722972A history of adverse events fol 0 PVT OTH No concurrent Unknown medication The subject has a history A0722966A of sinus issues every now and th PVT PVT Unknown The subject's relevant A0719018A medical history, concurrent medicat The subjectOTH recently took OTH an HIV test which "came Unknown up inconclusive". A0718748A 0 PUB PUB No concurrent Unknown medication The subject had no relevant A0718377A medical history and no advers 0 UNK OTH OTH Unknown No known drug allergies. A0718132A No adverse events following prev 10 UNK PVT PVT Atenolol; Atorvastatin Gastroesophageal calcium; Allergy to reflux Pantoprazole Morphine. disease; The A0717934A High subject bloodhas pressure; had tetanus High vaccine choleste Unk OTH OTH No concurrent Unknown medication A0717658A 0 UNK PVT PUB Unknown A nurse reported, via an A0730977A agency sales representative, that UNK OTH OTH Unknown A0732272A UNK OTH OTH Unknown These events occurredA0732515A in a number of different subjects fro UNK OTH OTH Unknown These events occurredA0732528A in a number of different subjects fro OTH OTH Unknown These events occurredA0732533A in a number of different subjects fro 6 PUB OTH Unknown No relevant medical history A0735235A was reported for this subject a 0 UNK PVT PVT SalbutamolUnknown sulphate The subject has no relevant A0735402A medical history. Follow-up info 1 UNK PVT PUB LANSOPRAZOLE Borderline Diabetes; The subject's Gastroesophageal medical history A0735410A Reflux included Disease borderline diabetes 1 UNK PVT PVT Unknown The subject has medical A0735415A history of not gaining weight very 0 PVT OTH Blood pressure Highmedication Blood The Pressure subject had a history A0735441A of high blood pressure and no hi UNK PVT PVT Unknown A nurse reported, Via aA0736316A GSK sales representative, that an 0 PVT PVT No concurrent Private medication Funds The subject has no relevant A0737561A medical history, no history of r 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0737565A medical history, no history of r 0 Heart rate, PVT 4/2/2008, 150's PVT Oral contraceptives Upper respiratory The subject infection had no history A0738496A of adverse events following pre 0 PVT PVT Unknown The subject had no medical A0739138A history and was not taking any UNK MIL MIL Unknown The reporter expressedA0741172A concern over the quality of the vac UNK MIL MIL Unknown The reporter expressedA0741173A concern over the quality of the vac The subject's PVT blood pressure PVT remained No concurrent withinUnknown 90/50 medications (his The normal subject is 110/55). has noAfter relevant A0742501A 20 minutes medicalhe history felt better and no and history was 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0742657A medical history and no history UNK OTH OTH EGG Allergy, Peanut Allergy A0744953A 0 UNK PVT OTH Unknown The subject has a possible A0746398A history of seasonal allergies an 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0749650A medical history and no history 0 UNK PVT PVT Thyroxine sodium Unknown The subject had a bad A0755886A reaction to Codeine which resulted 0 UNK PVT PVT Unknown No concomitant medications A0757320A or relevant medical history. N 3 UNK PVT PVT Unknown Unknown High blood pressure; High A0758194A cholesterol; No adverse events 0 UNK PVT OTH Unknown No concomitant mediations A0758584A or relevant medical history. No 0 Unknown PVT PVT Unknown No concomitant medications A0758810A or relevant medical history. N 0 UNK PVT PVT Unknown It was reported that theA0758842A subject is prone to allergies, but sp 0 UNK PVT PUB Unknown Allergic rhinitis; reflux unspecified; A0759192A No known drug allergies UNK OTH OTH Unknown A0762179A Unknown OTH OTH Unknown Unknown WAES0903USA02330
Not reported UNK UNK Not reported ### 1 05/Mar/2009: PVT "spinal catheterization" OTH and blood cultures The that patient were negative. has no family 06 March history ### 2009: of epilepsy, A urine test andrevealed had no c" Unknown OTH OTH Unknown None WAES0903USA02361 1 Echocardiography, OTH 03/06/09, OTH normal Tylenol; left ventricular Albuterol; Hypertension; systolic Proair HFA; Obesity; function; Aspirin; Diabetes; Magnetic Zyrtec; resonance, Atherosclerosis; WAES0903USA02096 Vytorin; Fluticasone; 03/07/09, Asthma; left Ibuprofen; shoulder Cardiac In min Unknown OTH OTH Unknown Autism WAES0903USA02102 Unknown OTH OTH Unknown Unknown WAES0903USA02288 Unknown OTH OTH Unknown None WAES0903USA02340 Unknown OTH OTH Unknown None WAES0903USA02644 Beta-humanUNK chorionic,UNK 05/27/08, positive Pregnancy NOS (LMP = 4/23/2008); WAES0806USA01608 Attention deficit/hyperactivity dis 0 ultrasound, OTH 08/06/08, looks OTH okay vitamins (unspecified) Pregnancy NOS (LMP = 5/1/2008); WAES0807USA00388 Penicillin allergy; Attention deficit/ 0 PVT PUB ELOCON 0.1% 5yr PE prnvisitNKA 3/20/09-records received- PMH:eczema. 0 No tests performed. PVT PVT 2 None PVT PVT PPD; SanofiNone Pasteur; C2921AA; None Left forearm; ID 6 Lab work - lymes PVT / thyroid PVT/ anemia; ETC NEG None / MRI'S 4 to date w/ lesions not causing this but to be repeated in Ap 77 INFLUENZA MIL B PositiveMIL 0 When takenMIL to hospitalUNK on Feb-3-09 Nodoctor took None blood waswork very No and healthy stated None and there happy other were than until allthis vaccines the one~ electrolism was ()~~0~In given found, Patient which w 10 MIL MIL FINASTERIDE; None CRESTOR; Allergy HCTZ. to PCN. 1 None UNK PUB None None None 0 Had full setPVT of labs, echo-cardiogram, OTH & stressNone test, urinalysis ALPHAGAN Solu, Iodine Solu, Shellfish PVT PVT None None None PVT PVT None None 1 None PVT PVT none none seasonal allergies; CEFZIL PUB PVT 0 None PVT OTH SIMVASTATIN None None None PVT PUB 2 PVT PVT None None Possible allergy to bees - never tested 0 None PVT PVT None None None 11/07/2008~Varicella (Varivax)~1~1~Patient|11 1 Unknown UNK UNK hormonal contraceptives Unknown (unspecified); MerckWAES0903USA00042 Sharp & Dohme; lot number 66055 237 Pap test, 02/23?/09, OTH Positive. OTH None Asthma WAES0903USA00043 0 none done UNK UNK Lasix, Labetalol, Lotrel,Allergy Baby ASA, to compazine-tardive Omega 3, Zrytecdykenisia; Pt has hx of HTN, 1 PUB PVT NONE NONE NONE FEVER~DTaP ND-09-03 (no brand name)~4~5~In Patien 185 ROTAVIRUS PVT AG, EIA PVT TESTED POSITIVE STOOL CULTURES NEGATIVE AND FECAL WBCS NEGATIVE 1 PUB PUB 1 PVT MIL toperol, lilitor none High blood pressure, high cholesterol PVT PUB na na 0 No cause for UNK development UNKof atrialprenatal flutter was vitamins, none found.vitamin Normal twinD, echocardiograms, pregnancy zantac, none~ colace ()~~0~Patient|none~ normal blood cultures, ()~~0~Sibling|none normal EKG 0 PVT PUB None Speech Delay/ADHD 0 NONE PUB PUB NONE NONE NONE 1182 Pertussis DNA PUB(PCR) positive PUB on 3/13/2009 Received HIB, IVP, MMR,Varicella,Prevnar, Hepatitis A, Hepatitis B 0 None MIL MIL None slight runnyNone nose 0 PVT UNK None None None 0 None PVT UNK None noted.Unknown. 0 none UNK UNK R otitis media febrile andsz afebrile 0 None. PVT UNK None noted.Unknown. 11 ASAP TROPONIN UNK I, 6.14 UNK H; CK, 450 noneH; MMB, none 14.9 H*; GLUCOSE, none PMH: 96; Allergy: UREA PCN, NITROGEN, anaphylactic 10;reaction. CREAT, 1.3; BUN 7 n/a PVT PVT none none supraclavicular lymphadenopathy~HPV (Garda 12 Blood, urine, PVT MRI, CT scan PVT all normal. generic Paportho-tri-cyclen test none taken sixnone months after none~ initial()~NULL~~In dose revealed Patient|none~ abnormal cells ()~NULL~~I in mode 7 None LABS: PVT all WNL. PVT 9/5/08 Urine LEXAPRO; c/s (+). Drug DepressionDepression ABILIFY; screen WELLBUTRIN; neg. KLONOPIN 2 Received TYL PVTalso 0 reaction PVT None 1 PVT PUB 14 PVT UNK Diarrhea
1 None performed PVT PVT Amoxicillin;Earache; LORATADINE; OM NKDA SINGULAIR 1 None PVT PUB None None Possible Allergy to AMOXICILLEN. 0 OTH UNK ALBUTEROL None MD1 (Pollen; Trees; Roaches; Dust); DX, Asthma 1 PUB PUB None Questionable asthma PUB PUB TYLENOL; None FLUORIDENone 2 UNK PUB No No 0 None PVT UNK canidal regression; neurogenic bladder; malrotation; club f OTH PVT Unknown 0 PVT UNK Cough; URIAtopic dermatitis; Milk allergy (red spots on mouth) 1 PUB PUB 1 PVT PUB 99 PVT PVT OME; URI Hx takes x 2; speech delays; OME 1 None PUB OTH None None 0 Unknown PVT PVT Unknown Drug hypersensitivity; Diabetes; Hypertension; WAES0903USA02427 Hyperlipidaemia; Obes 0 Ultrasound,OTH normal; Ultrasound, OTH normal; QVAR;Ultrasound, fluticasone; Pregnancy normal; SINGULAIR Hospitalisation NOSUltrasound, (LMP = 4/28/2008); normal WAES0807USA00609 Asthma; Hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA02931 ultrasound, OTH normal; beta-human OTH chorionic, 12/05/07, Pregnancy positive; NOS serum (LMP =alpha-fetoprotein, 8/10/2007); WAES0801USA00529 Nausea normal Unknown OTH OTH Unknown Unknown WAES0903USA02626 0 None OTH OTH Unknown None WAES0903USA02913 Unknown OTH OTH Unknown Unknown WAES0903USA02548 0 None OTH OTH None None WAES0903USA02604 Unknown OTH OTH Unknown Unknown WAES0903USA02370 0 Unknown OTH OTH None WAES0903USA02366 344 Unknown OTH OTH Unknown None WAES0903USA02364 None OTH OTH None Hypersensitivity WAES0903USA02363 Unknown OTH OTH Unknown Unknown WAES0903USA02306 Unknown OTH OTH Unknown Unknown WAES0903USA02292 1 None OTH OTH Unknown Unknown WAES0902USA03560 UNK OTH OTH Unknown A0774199A 1 Abdominal PVT X-ray series, PVT normal; CBC, nonenormalnone none. PMH:none t number not reported) on notanreported unspecified OTH date.OTH 24 hours post vaccination the patient experienced a temperature ###of 100 degrees Fahrenhe 1 None OTH OTH None None None 1 CBC. BloodPVT and urine cultures PUB None Few red papular None scattered on chest 1 PVT PVT 0 OTH OTH Resolving URI None 0 PUB PVT Same~Pneumo (Pneumovax)~1~0~Patient PVT PUB Slight Cough PUB UNK TOPOMAX; SEASONALE Allergy to ASPIRIN; Chiari malformation 1 PVT UNK Same~HPV (Gardasil)~UN~16~In Patient 5 Testing by private PUB physician PUB unknown Unknown None Unknown 156 PVT PVT Lisinopril; TOPROL; none Pravastatin; Penicillin; Sulfa Vit; Calcium allergies; High BP; Epilepsy 0 PVT PVT SINGULAIRNo Demerol; CEFZIL; Hives~Measles MMR #2+vaccination; Mumps + Rubella (MMR vacc (MMRper II)~2 M 0 None PVT PVT Zyrtec None Environmental allergies & foods also 1 None PVT PVT Allegra None None 0 None PVT PVT PCN allergy, rash~Varicella gold sodium thiosulfate (Varivax)~2~10~Patient 0 PUB PVT No reactions prior or since but we switched to D 0 CBC; CMP PVT PUB None "stuffy nose" GE Reflux 1 PUB PVT ID09002 1 None PVT PUB None None PCN IDO9003 0 Blood & urine OTH tests were PUB "negative"; DAQUIL Positive forstrep Sore cold throat, throat (sore AUGMENTIN throat) 2Cough X 3/7/09 causes rash ID09004 1 PVT PVT ERRIN .35 mg tablet; CLARITIN; FLONASE; ASTELIN; IBUPROFEN
OTH PVT PCN allergy 1 PVT PVT none none 2 None PUB PUB None None None 585 PVT PVT 2568 PVT UNK 1 MIL MIL HETHATREX; rheumatoid COMADINE; Arthritis PREDNISONE; PLAQUINIL; FOLICACID 1 PVT UNK 2 Referred toPUB PMD and/or PVT Allergist for PPD; eval. On "allergy shots" Mult. environmental allergies: Incl. "Molds and dust" 8 None PVT PUB None 10 Viral cultures MIL for small MIL pox were sent none by myself nofor the health seasonal department allergies 2 PUB PVT Ear surgery 1 PUB UNK dimetap, half cold recommended none dose of tylenol 2 PVT PVT Flovent NONE Asthma/allergies Hep B surface PUBAb on 3/10/2009 PUB was Unknown "negative" No Unknown 4 none MIL MIL None Not previous NKDA to the vaccine Hep B surface PUBantibodyPUB (post-vaccine) Unknown drawnNo on 3/10/2009 Unknown was "negative" 1 UNK UNK none uri 2 none PVT PVT none none none 0 PVT UNK penicillin allergy 0 PVT PUB 2 UNK PVT Slight cold Sulfa, Zithromax, Keflex 1 UNK PVT Tramadol, HCTZ, None notedPenicillin Trazodone, Simvastatin, and Sulfa allergies Minocycline, Gabapentin, Meloxicam 1 NA PUB PUB None None NKDA 1 UNK UNK None None 0 N/A MIL MIL N/A N/A 7 PVT PUB No No 1 MIL MIL None. None. None. None.~ ()~NULL~~In Patient 13 PVT PVT none minor cold or none cough 88 Spinal tap, OTH 21 or 22; No OTH reflexes in feet and legs None 20th. Labs Lowand back Diagnostics: surgery 10/2006; LP with High normal blood cell pressure; count, glucose Gout. PM an 0 PVT PVT None None allergy to azithromycin - vomiting PMH: hives approx 6 mo 1 PVT PUB Vitamin D deficiency; CA breast; CA colon 0 none PUB OTH Rash on body none 0 PVT PVT none none 1 Migraine released OTH fromPVT ER at 7:45pm None None 7 None PVT OTH None 0 none PVT UNK TYLENOL 3; none BENADRYL Sulfa; NSAIDS; food allergies 2 PVT PUB PUB PUB No Allergic to PCN, Erythromycin PUB PUB No PUB PUB No PUB PVT No No PUB PVT No Seasonal Allergies PUB PVT no PUB PVT No Allergic to CECLOR, CLARITIN; AUGMENTIN 1 PVT PVT None None None 0 None. PVT OTH pancreatic pseudocyst 0 blood test showed PVT no sign PUBof any kidney None problems None None 3 EmergencyUNK Room visitUNK on March 20, 2009. Blood Nonework and None CTPMH: scan were GC &performed. chlamydia vaginal All testsinfections came back 11/08. inconclu Fa 9 LABS: segsUNK 67%(H), urine UNK pH 5.0(L), BUN 19(H), none Bloodnone c/s neg, PMH: throat recurrent c/s neg, earinfluenza infections. c/s neg. CXR WNL. 5 N/A UNK UNK SIMVASTATIN NO -10MG ANNUAL QD, DYSLIPIDEMIA PHYSICAL OTC ASA 81MG QD, MULTIVITS, OTC CALCIUM 365 Labs and Diagnostics: UNK UNK EMG/NCS c/w motor neuron none disease. none MRI PMH: abnormal. ALS~Hep none noted B (no brand name)~3~35~Patient
0 none, as patient PUB only recently UNK reported unknown this. was none notnotedunknown assessed at theleft time. arm pain~Pneumo (Pneumovax)~1~58~In P 0 Called the nurse UNK this morning UNK andtakes statedno there medications none was nothing pt. had theynone couldofdo. these I asked about blood work and stated tha 1 CT, MRI negative UNK LABS: UNK WBC 10.7(N), None MCVNone 61.5(L), MCH None 20.1(L), PMH:RDW anemia. 19.0(H), plts 467(H), polys 33%(L)L. To 19 RSV Ag positive. UNK Influenza UNK A/B AgNone negative. CBC NoneWBC 21.9k. None PMH: Electrolytes none and Calcium normal. UA normal. Head Unknown OTH OTH Unknown Unknown WAES0903USA01874 Magnetic resonance, OTH 01/25/99, OTH MRI None of brain showed negative, None abnormal signal WAES0903USA01790 in upper cervical spinal cord 181 Tenzyme Test: UNKone patient UNK confirmed as Type B. Not reported ### 0 UNK UNK Fioricet No known allergies, no medical ### conditions. Had an upper r none OTH OTH ### 0 Unknown PVT PVT Unknown Hypertension; Overweight; Hypothyroidism WAES0903USA02848 0 X-ray, 12/19/08, OTH unremarkable OTH None Arthritis; Enlarged prostate (benign); WAES0903USA02914 Hypertension; Hyperlipidaemia; p 42 diagnostic laboratory, OTH Stomach OTH empty Nonetest - No results available; None. PMH: computed none.axial, NKDA WAES0903USA02570 No results available; diagnostic la Unknown OTH OTH None WAES0903USA02249 Unknown OTH OTH Unknown Immunisation; Fever; Swelling WAES0903USA02300 Unknown OTH OTH Unknown Unknown WAES0903USA02305 magnetic resonance, OTH 01/??/00, OTH results not reported; Gastrointestinal electroencephalography, disorder 01/??/00, WAES0903USA02329 results not reported; diagno Unknown OTH OTH None None WAES0903USA02563 1 Unknown OTH OTH Allergy to metals Fever WAES0903USA02567 Unknown OTH OTH None None WAES0903USA02860 Unknown OTH OTH None None WAES0903USA03197 Unknown OTH OTH None None WAES0903USA03220 126 Flu A cultured; PVTIVP, brain, UNKheart 5/20/09-records None received-CXR Ventral negative. Septal Defect 5/20/09-records received-Clinical his 0 none PVT PUB none none none -7 None PVT PVT None None None 1 OTH UNK None reported None None known 14 1) Herpes lesion PUB rapid OTH culture w/typing None2) Herpes No lesion typing (3) wound culture 9 None PVT PVT None None known None known 10 PVT PVT None known. 10 24 Feb 2009 MIL WBC BLOOD, MIL 11.4 (H) x 10(3)/mcL;RBC Pt had dental BLOOD, none surgery 5.20 one X10(6)/mcL; day after receiving Hemoglobin the SPV. BLOOD, Was15.8 treated g/dL;w 1 PVT PVT None None None None PVT PVT Iron None None 0 PVT PVT None None 0 PVT UNK 7 PVT PVT None Breast CA; gallstone None PVT UNK Concerta, Clomidine, None Albuterol, ADHD, Asthma, Flovent,Psoriasis Alclometasone 4 specimen sent PVTto lab for PVT PCR analysis LOPRESSOR, of lesions. DYNZINE, AODM, METFORMIN, HTN, ASHD, CAPOTEN, Hypercholesteremia AVANDIA, LIPITOR, K + m 22 See MRI reports OTH #7. Hepatic PUB function PERCOGESIC; test andNone CBCINDOCIN on 11-10-08; ReactiveCMP PPD on 2-17-09; CBC with diff. on 12-5-08; B-12 0 Ultrasound,OTH first came OTH back normal. Pregnancy NOS (LMP = 8/25/2008); WAES0902USA01705 Yeast infection. 0 None OTH OTH Hormonal contraceptives None WAES0902USA01848 14 ECG performed MIL 02/10/09--Normal MIL 5000001 0 PVT PVT Trazadone, NSAID, Darvacet-N-100, ASA, Celebrex, Ultra 10 ECG performed MIL 01-22-09, MIL abnormal results; Troponin I performed 01-22-09, abnormal 5000002 result. 13 Troponin I performed MIL 12/19/08; MIL ECG performed 12/19/08; MRI performed 12/22/08 5000003 11 Troponin I preformed. MIL MIL ECG performed. Shortness of Breath 5000004 7 Diagnosed UNK with Postural UNK Tachycardia noneSyndrome noneLABS: PMH: electroMVP, physiology SVT, herniated study abnormal disc. Allergy: w/atrial latex. tachycardia & a 0 None PUB PUB NONE Child not ill NONE but younger sibling had been diagnosed with pertusis and 12 member was MIL given a prescription MIL for allegra 180 mg daily 10 None UNK PUB Allopurinol 100mg None bid, NKDA. gemfibrozil Problem 600mg listbid, includes: lisinopril hypertension, 40mg daily, hyperlipidemia metolazone 2 2 No testing. PUB PVT Synthroid, Zoloft, None. Voltran. Hypothyroidism, depression, arthritis in shoulders and han 9 PHYSICAL UNK EXAM BY MD PVT XALATAN OPHTH SCIATICA DROPS NERVE GLAUCOMA AND PAIN COSOPT AND SCIATICA OPHTH DROPS, NERVE LEFT ETODOLAC LEG OCCA 4 N/A PUB UNK NONE N/A NKDA
5 None PVT PVT Pt was not ill DM, at time Sarcoidosis of vaccination 3 PUB UNK N/A none NKDA 1 PUB PUB none none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 27 Liver PanelUNK ALT+Alk Phos+Albumin+TBili+AST+GGT UNK None at theNone time Site/Specimen None 22 Jul 2008 0757 Units Ref Rng Alanine Ami 0 PUB PUB none known Nausea/Vomiting~HPV (Gardasil)~1~18~In Pa 1 PUB PUB none none none 11 UNK UNK Altace, Coreg None. CR, Lipitor, Heart Plavix, attack Synthroid. in 2006 resulting in 2 stents implanted in LAD 16 Neurologic PUB Examination; PVT Labs including heavy metal, vitamin allergic deftoand penicillin; auto immune; I have endometriosis, MRI brain scan. All test were n 1 PVT UNK None Lyme 18 PVT PVT Heart mm; patent foramen ovale vs atrial septal defect 21 UNK UNK None Pregnancy OTH test was positive OTH per Dr. None None reported. 1 PVT PUB Exercise induced asthma; Anemia. 0 PVT PVT None 0 MRI - Pending. MIL MIL None None 0 None PVT PUB None None None 6 None PVT PUB None None None 2 PVT UNK Dog bite. 0 PVT PUB None None PVT PVT None None None 2 PUB UNK No Antibiotics & occ eczema the laboratory UNK said his UNK LIVER get little damage 0 PUB MIL None. None. None. 0 Diagnostic laboratory, OTH 02/??/09; OTH Beta-human Unknown chorionic, 02/??/09, Pre-eclampsia; positive Bell's palsy WAES0902USA00596 Unknown OTH OTH Unknown Unknown WAES0903USA02949 Unknown OTH OTH Unknown Unknown WAES0903USA03341 Unknown OTH OTH Unknown Unknown WAES0903USA03254 Unknown OTH OTH Unknown Hypersensitivity WAES0903USA02086 Unknown OTH OTH Unknown Penicillin allergy WAES0903USA02561 Unknown OTH OTH Unknown Unknown WAES0903USA02926 Unknown OTH OTH Unknown Developmental delay WAES0903USA02954 Unknown OTH OTH Unknown Hospitalisation WAES0903USA03241 21 Unknown OTH OTH Aspirin; Lipitor; Calcium Unknown (unspecified); Iron (unspecified); WAES0903USA02618 Synthroid; Prilosec; Dio 7 LABS: KUBUNK revealed dilated UNK central Prevacid bowel loops Yes,&URI paucity GERD of gasPMH: in LLQ. constipation. Abdominal US (+) IS in LLQ. Air contras 8 UNK PVT furosemide 40mg, metoprolol 25mg 0 no lab test obtained PVT onPUB 3/5/09. Pt.none had positive tinea strep corposis testnone on 3/23/09. 1 none UNK PUB none none allergy to PCN 0 PUB PUB Synthroid None 2 PVT PVT Zyrtec, flovent, n/a advair seasonal allergies, asthma 218 UNK UNK COPD PMH: COPD, interstitial cystitis, HTN, diverticulosis, fibrom 0 NONE PVT PVT NONE NONE NONE 0 UNK PUB 11 Clinical diagnosis PVT PVT Prenatal vitamin none None 1 PVT PVT pantoprazole rash niacin,PCN 2 CBC normal. PVT EBV serologies UNK normal. NoneChest None x-ray and neck Noneultrasound exams were normal. 1 PVT UNK None NO 4 Extensive Blood UNK work up, UNK LactoseFoclin intolerance XR20Ittest, -isdiscontinued hard Allergy to ADHD tell testing, which November - beginning CT vaccine scans 2008 was 2006 ofdue abdomen the 5/7/09-records do most paindamaging and medicine pelvis, received-PMH: but (no Upper I school canGI, tell3atte AD yo E 1 PVT UNK none no no 4 none PVT UNK Candidal diaper rash; contact dermatitis 1 PVT PVT None Allergy- Sulfa, Bactrim 1 None PVT PUB None None None
8 PVT PVT None None NKDA 8 PVT PUB 1 None MIL UNK None Pt discontinued allergy shots one month ago. 0 PVT PVT None None Esophageal3 Reflux, hours Crying~DTaP URI (no brand name)~1~0~P 1 none UNK UNK None None 1 OTH OTH Dermatitis, back of neck 1 None OTH PVT ALLEGRA; None HCTZ; SINGULAIR; Asthma; Hay ATARAX; None~ fever()~~0~Sibling|None~ Fishoil; Calcium; Vitamin ()~~0~Patient 1 none PVT PVT none no PFAPA syndrome UNK OTH OTH Unknown The subject's medical history, A0774872A concurrent medical condition 2 MRI of IAC's PVT with gad. PVT neg for Acoustic neuroma None or otherHigh tumor blood or abnormality; pressure; High Hearing cholesterol, test - nocontrolled significant with hearing med 0 CT Scan (2), OTH OK; LabsPVT showed decrease None K+ None which Dr. said None wasPMH: due to Recent an underlying bronchitiscondition & was on they oralare antibiotics monitoring wh 0 None donePVT PVT None None None 0 PVT PVT None None 8 PVT PVT NC09013 379 EEG; occipital PVTspike and PVT wave, started Noneon DEPAKOTE URI; Headache None 2 PVT PVT 0 PVT PVT 1 None PVT PUB none none 1 Normal CBC, PVT diff. ; 2 FTS, PUBmuscleNone enzymes; ESR None16; monospot Allergic to and peanuts strep cultures and treenegative. nuts. 1 None PVT PVT None None 1 PUB OTH Vesicare; need Foodtopoisoning check Drug w/hospital Allergies- Penicillin & Sulfa 0 PVT PUB None None None 5 PVT PVT 1 PVT PUB None PVT PUB None None 0 My MD opted UNK not to test UNK me for any adverse reactions since I falsely she says tested"It's positive been for a month, HPV two I just years don'tprior seeto it."receiving 0 None OTH OTH Estrogen Patch None None 1 PVT OTH None 1986~Influenza (no brand name)~1~32~Patien UNK UNK UNK UNK 2 PVT PVT Diovan, Fultron, NoneSimvastatin, HTN, Hypothyroidism, Celebrex, Metoprolol, Hyperlipidemia, HCTZ, Calcium Obesity None PVT PVT none 0 none OTH PUB none mother stated "it's happened before", non spec 1 PVT UNK None None 0 PUB PUB BENADRYLNone night before; Hx of vitamins lightheadness with BM last summer; hx of of hives 7 PVT PUB Torticollis at birth, 1 week premie, secondary to preaclamp 2474 PVT UNK 1 PVT PVT None ~DTaP + Hib (no brand name)~4~1~Patient 1 Developed PVT Cellulitis L thigh PVT Tx with None antibiotic None - Duricet None 2 PVT PVT None UNK UNK 21 LABS: Urine PVT c/s of 2/17PVT no growth. UA 2/24 WNL. 0 OTH OTH PVT PUB Diaper Rash None 2 OTH OTH 0 MIL MIL 1 PVT PUB Scalp hematoma 1 NONE PVT PUB ZANTAC, 1ml NONE BID; REGLAN, NONE 1ml QID 1 PVT PVT None None None 0 No PVT PVT none none none 0 None PVT PVT ZPACK S/p otitis media Ragweed/dust "swelling/itching"~HPV mites/cats- Hyposensitization (Gardasil)~1~20~Patien Tx.
0 PUB PUB Seasonal allergies Heart Murmur (Infant) 0 none PVT PVT SINGULAIRnone Asthma; Eczema 7 PVT OTH PRILOSEC;None KEPPRA; Acid FEMARA; reflux;FOSOMAX; brain aneurysm; ZOCOR; remission AMBIEN breast cancer; oste 10 unknown UNK PVT Non reported Non onreported VAR on VAR 0 None PUB PUB SIMVASTATIN None Allergy to PENICILLIN; Cholesterol 2 None reported. PVT OTH Not reported. ### diagnostic laboratory, OTH H. OTH influenzae Unknown was isolated form blood Early with onset serogroup of delivery; B WAES0903USA02034 Bronchopulmonary dysplasia 0 diagnostic laboratory, OTH results OTH pending; Unknown urine beta-human, Pregnancy NOS 02/03/09, (LMP positive = 1/4/2009)WAES0902USA00936 0 None OTH OTH Calcium (unspecified); Pregnancy NOS Iron (unspecified); (LMP = 12/28/2007) Vitamins WAES0809USA04651 (unspecified) 12 Labs and Diagnostics: PUB PUB US spleen WNL. Bone None marrow bx None c/w PMH: plateletmigraine, destruction. AR0909 hysterectomy Flow cytometry with bladder with non-specif suspens 0 Pt was seenPVT in ER PUB O yaz Oc's None Allergy to Antihistamines 1 None PUB PUB None None None AR0910 0 None PUB PUB None None None AR0907 0 OTH OTH None None None UNK UNK 2 None PVT PUB None Hypertension; Hypercholesterolemia; Allergic; Amitriptyline PVT PVT None None 0 PUB PUB MO-2009-08 0 PVT PVT Vyvanse None None 0 PUB PUB history of fluAutism type A 2-3 weeks prior to vaccination 3 MRI (1/20/09)UNKpineal cyst UNK- neurosurgeon N/A validated None this was No pre-existing not impacting diagnosed any vessels issues which 3/26/09-records would cause received headac 20 UNK UNK Current meds: none 1. Toprol PMH: XL 200 DMII, mgHL, po HTN, daily 2. CAD, Aspirin Gout, 81Status mg po post dailymultiple 3. Plavixlacu 75 5 PUB PUB Yaz birth control None None None~ ()~NULL~~In Patient 1 UNK PVT None None Multi allergies - patient does not 10 24MAR09, UNK WBC, 9.0; NA, UNK140; BUN, Motrin 12;-CA, seenone 8.5; #7 HBG, 13.2; none K, 4.1; C CR, 0.9; MG, 1.5; HCT, 39.2; CL, 97; GLU, 2 UNK UNK NONE NONE NONE 1 Physician's UNK visit 3/25/09. UNK Client's mother nonestated notedshe none andreceived mother noted and denies oralmother Tylenol any.denies after the any.immunizations were giv 2 4/13/09-records UNK received-WBC UNK 11,400. Aspirin, Cultures Nexium, No negative. Carafate, Allergies: Stool Plavix, forCodeine, Clostridium Amiodarone, amoxicillin, difficile Metoprolol, negative. vancomycin, Furosemide, Verelan, Diovan, Altac 0 4/29/09-records UNK received-CXR-large UNK toprol mediastinal none mass with allergic tracheal to penicillin. displacement patient associated has history in of past high with blood retrogoite press 1 PVT PUB 10 6/18/09 Hospital UNK and outpatient UNK records received None DOS 3/23/09 6/18/09toHospital 5/4/09. LABS and outpatient and DIAGNOSTICS: records received Echocardiogra DOS 3/2 not applicable PVT PVT none none none 2 PVT UNK 12 PVT UNK cerebral palsey, environmental allergies, PTSD, multiple m PUB PUB none at clinic. None Parent reported None giving acetaminophen prior to visit. Dose not know 2 Positive ANA UNK - 3/23/09.UNK Cardiac procedure. 0 MRI of thoracic, UNK cervical UNK and lumbar Lisinopril spine. 5MRI No, mg of but Completed brain. getting High Blood over Bactrim blood tests sinus pressure for for infection sinus Lyme,infection thyroid, two Vit Dweeks deficiency, prior and comp 2 PVT PUB rash on hands Penicillin 1 None PUB PUB none none seasonal allergies NJ200901 1 PUB PUB 3 PUB PUB None H/O metal allergies 3 CBC-resultsPVT pending OTH UTI Allergies to penicillin and intravein dye, dx: myalgia in 2008 PUB PUB None None PVT PVT AMLOCLIPINE; None BENAZEPRIL; HTN; Hyperlipidemia; ATENOLOL; Depression; ALLOPURINOL; Colonic FENOFIBRATE Polyps; Hear 0 PVT PUB None None Lazy Eye L 1 CBC 12,000; PVT Sed rate PVT 70 1 See attached UNK PVT No known illness NKA 0 PVT OTH On Singulair Son 5mg was QDnot Asperger's, sick prior Asthma , Seasonal Allergies Unknown OTH OTH Unknown Unknown WAES0903USA03963 0 OTH OTH Unknown Pregnancy NOS (LMP = 12/31/2007); WAES0803USA04511 Foster care 49 ultrasound, OTH 03/16/09, blighted OTH ovum Unknown and no gestational Pregnancysack NOS (LMP = Unknown) WAES0903USA00408
1 Blood pressure, OTH 03/01?/09, OTH 94/54 RECLIPSEN; LEXAPRO Unknown WAES0903USA02617 0 Unknown OTH OTH None Pregnancy NOS (LMP = 4/8/2008)WAES0903USA03061 97 Unknown OTH OTH None Termination of pregnancy WAES0903USA04267 - elective Unknown OTH OTH Unknown Unknown WAES0903USA03605 Unknown OTH OTH Unknown Unknown WAES0903USA03764 UNK UNK Not reported. ### 1 MRI; MRA; PVT CT 4/8/09-records PVT received-WBC None None increased 11.4, Nonehemoglobin decreased 11.1 and hematocrit decrease 2 Blood work MIL LABS: BUN UNK 24(H). HBA1C 6.0(H). Flat feet-Mallet Hightoe blood pressure; Right wrist destroyed cartilage; Chro 1 LB - Lumbar PVT puncture all PVT tests nl; EEG None- WNL;None MRI brainNone. - nl; CBC, PMH:Blood recent Culture, fall without Urine apparent - nl Labs:injury LP WNL. Head 1 PVT PVT NKDA 0 PUB UNK 1 None - Allergy PVTto Questran UNK ALLEGRA; None SINGULAIR; WELLBUTRIN; YASMIN; AMBIEN; ALBUTEROL INH. 545 PVT PVT None None None 1 PVT PVT LIPITOR None None PVT PUB None NKA, Short stature 1 PVT PVT LIPITOR; SYNTHROID; None ASA; VOLTAREN UNK UNK 4 PVT UNK None 0 PUB OTH Albuterol 0.083%; Otitis media Nebulizer Tx 3 None PVT UNK None Ears-PE tubes placed for frequent ear infections All labs WNL MIL and testing MILWNL None None None 287 No labs performed UNK UNK None noted 4 Doctor's office PVTadvisedPVT none wereFinished availableatocourse None him. of AMOXICILLIN None 2 weeks prior to vaccination 2 PUB OTH AMOXIL; ZYRTEC; (R) earache PREVACID; NKDA Vitamins; Albuterol 0 PUB OTH ALBUTEROL Otitis nebulizer Media 1 PVT UNK 1 None PVT PVT None 0 None MIL MIL None None None 0 None MIL MIL None None None -41 ultrasound 7/28/08 OTH - normal, OTH second Unknown trimesterPregnancy NOS (LMP - 3/11/2008) WAES0804USA02884 0 Diagnostic Laboratory OTH OTH 04/04/08 - routine Vitamins prenatal Pregnancy tests WNL; Cannabis NOSDiagnostic (LMPabuse; = 2/20/2008); Laboratory Papanicolaou WAES0805USA01280 Tobacco 07/22/2008 smear abuse; abnormal - routine Nicotine prenatal depend t 0 diagnostic laboratory OTH - OTH prenatal screening test: WNL; diagnostic Asthmalaboratory - QUAD WAES0805USA02022 screen test: WNL; ultrasound 0 UNK UNK 4/1/09-records Lidocaine, received-Cough Fish 4/1/09-records prior to vaccine. received-PMH: food allergie 1 None. PUB PUB 1) Glucosamine Nonechondroitin reported. 1) Knee POpain BID,(client 2) Cymbalta runs 4560 - 50 mgmiles/week). PO QD. 2) Anxiety a 0 PUB UNK NONE 0 N/A MIL MIL Diazepam 5mg N/A daily, Atorvastatin Hypertension, 10 Hypercholesterolemia, mg daily allergic to adhesive t 0 PVT UNK None None 0 PVT PVT methylphenidate, Excessive daytime none sleepiness 0 UNK UNK SINGULAIR 0 UNK UNK MultivitaminNone General allergies 6 None PUB UNK None statedNone stated, None however, noted.client had received a very large tattoo (solid bl PUB PVT Levemir, novolog, substance asa abuse, 81 mg,diabetes lsinoprl, metformin type 2, hepetitis C, GERD 0 UNK UNK Reflux (GERD) None Crying~DTaP (no brand name)~NULL~~In Sibl 0 PUB UNK Premarin none Diabetes controlled by diet 1 Labs at ED UNK visit showed UNK slighty elevated Xanax as WBC needed, Had count...remaining rash Flovent over asthma, forearms Rotadisk labs, depression vomiting~Hep and inhaler including backasof liver needed, neck B (Recombivax function of Serevent unknown panelHB)~1~34~In Diskus were originnormal. prior inhaler toPa re La 8 SEEN BY NEUROLOGY PVT PUB PHYSICIAN MOTRIN AND NOTED THAT PATIENT HAS SIGNIFICANT IMPROVEMENT HAS BE 1 Saw MD, unknown UNK UNK None Known None Known 0 UNK UNK None known None None known 0 None MIL MIL None No None 0 Diagnosed PVT with TMJ. Full PVTblood work-up shows signs of Epstein Barre none PVT PUB
0 26 March 2001: PVT MRI ofPVT cervical spine showed HEART moderate MURMUR, AUTOMOBILE cervical MIGRAINE, spondylosis ACCIDENT, PALPITATION, more A0756654A prominent CARPALTENSION TUNNEL to the left HEADACH RELEASE of midline 23 October PVT 2001: LymeOTH Elisa TiterGarlic; IgG: less Fishthan Back oil; Cod-liver 80; Pain Lyme Hernia oil; Western Calcium Blotsalt IgG and A0765787A IgM were negative; MarDx Weste 27 MRI and Lumbar PUB puncture PUBon 12/7/08 Aspirin at hospital. 81mg's No daily Medical 5/22/09 Flat center-Lyme Feet Hospital 5/22/09 titre, records Hospital Influenza MA0903 received records testing DOS received 5/22/09 12/7/08 DOS Hospital - 12/12/08. 12/7/08 rec2 4/17/09-records PVT received-Westergren PVT sed rateNone increasedNone 28, C-reactive protein increased 4.9. 0 LABS: CXRPVT WNL. EKG UNK w/incomplete right BBB. No Cardiac Diabetes; enzymesHypertension; neg. CMP WNL. Chronic WBC airway 10.5 obstruction PMH: 6 LABS: CSF: PVT WBC 4(N), PVT RBC 267(H), NoneproteinPossible 36(N), glucose start Brain of 104(H), cold anomaly perneutros mom left hemisphere; 27%(L), lymphs ASD; 13%(L)bands Hypotonia; Intrauteri 47%(H 19 PVT PUB Fluoride (+) BOM nkda 1 CBC + CXRPVT PUB Cough None 1 None PVT PVT None None Intravenous drug abuse; Seasonal affective disorder; Depr -27 None PVT PUB None None 1 none PVT PVT Multivitamins; none calcium;ADHD ST JOHNS WORT 1 None PVT PUB None None None 3 none-all perPVT pt PVT CLARITIN; none PANTOPRAZOLE; Osteopenia; ESTRIVG; hx ovarian Vitamin neoplasm D + calcium 2 PVT OTH Autism 0 PUB OTH Pt states none. No NK 1 PVT OTH None HTN / Dermatitis 5 OTH PVT ATENOLOL; RELPAX 0 PUB OTH MOTRIN 600 mg Allergic to tetanus, DM, HTN PVT PVT None None None 0 none PVT PVT none none 1 UNK UNK TENEX 1mg None OD; RISPERAL ADD; ADHD 25 mg 1 BID 1 PVT PVT Rt Otitis Media NKMA PVT OTH HTN; Triglycerides; reflux; myopathy; pelvic pain 0 UNK UNK None None 0 PVT UNK None None 0 Unsure of ER PUB reportedUNK this event None 1 None MIL MIL None. None. None. 0 PUB UNK none none 29 Pap test; Cervix OTH HPV DNA OTHassay, Unknown positive Pregnancy NOS (LMP = 1/14/2008); WAES0803USA00457 Penicillin allergy beta-humanOTH chorionic, OTH 01/??/08, positive None Pregnancy NOS (LMP = 1/15/2008) WAES0803USA03393 0 Pulse Oximetry OTH03/05/09, OTH 78 ; Pulse Unknown OximetryHypersensitivity 03/05/09, 92-93 WAES0903USA03647 Unknown OTH OTH Unknown Unknown WAES0903USA04016 Unknown OTH OTH Unknown Unknown WAES0903USA03176 2 PUB UNK Pickles (allergy) LA090301 None OTH OTH Unknown Disbacteriosis; Penicillin allergy; General WAES0903USA03666 symptoms Unknown OTH OTH Unknown Unknown WAES0903USA03958 Unknown OTH OTH Unknown Unknown WAES0903USA04509 PUB UNK LA090302 8 PVT PUB 0 None OTH PUB Tubersol, Sanofi none Pasteur, none C2921AA, R forearm, 1 previous dose 13 None PVT OTH None None None 367 PVT PVT None PCN 2 None PVT OTH None Allergic Rhinitis injection site redness + swelling~DTaP (no bran 1 PVT OTH None Heart Murmur Injection site reddness, swelling~DTaP (no bra UNK UNK None None UNK UNK None None was reported PVT via phonePUB 3-23-09 to adverse reporting. 0 None PVT PVT None URI; Fever None 0 None PVT PUB None Tinea Corporis None 0 Rapid streptMIL Positive 3-2-09, MIL ESR-Zyrtec 51, C reactive proteinPenicillin 73.9, Flu A&B negative, myoglobin 81, CBC WBC 12,100 88 Guillain Barre UNKLABS: ESR UNK13, CRP 03/05/2009 0.76. Sodium NONE lEVAQUIN 129, chloride NONE 750, IBUPROFEN TO 96(L), MY NONE~ creatinine KNOWLEDGE 800 ()~~0~Patient|UNKNOWN 02/27/2009 0.5(L).PMH: Liver MIRAPEX, back enzymes pain,TO FLUTICAS depression WNL. ME~CS ()~
645 NONE PVT PUB NONE NONE NONE 0 EKG, MRI, UNK Bloodwork,UNK Urine Analysis. OrthoTriCyclin Labs and No Diagnostics: Lo. I have Allergic been Head to onNuts, Health CT it since (-). Latex,Cats Problems Cerebral August 2005 MRA and including Seasonal and (-). MRI never Fainting~HPV brain Plants. experienced (+)PMH: for(Gard L ma pr L 2 PVT PVT none Dep-Provera, adhesive tape, endometriosis, migraines 3 PUB PUB UNKNOWNNONE NONE 28 LABS: CBCUNK WNL. Sodium UNK 127(L).rosuvastatin, CSF: protein none cyclobenzaprine, 130 (H),diabetes, glucosenaproxen, hypertension, 78(H), WBC doxazosin, 33(H), hyperlipidemia, lymphs finasteride 26%, degenerative neutros 73%, jointR 4 NONE PVT PVT NONE PUNCTUE PCN,LATEX,CODEINE WOUND TO FINGER 1 UNK PVT no allergies: penicillin, swelling codeine, in hands morphine, and face; flu-like cefoxitin, sickness~Te tetanus, m 7 PVT UNK none no none 1 CT Scan, blood MIL work, chest MIL x-ray. None None 5 LABS: WBCUNK 29.3, segsUNK 42%(H), monos none 11%(H), no plts 118(L). none LDH 1394(H), Triglycerides 242(H), HDL 17(L), AST 0 None ordered UNK at that time UNK None None No known allergies. None~ ()~~0~In Ear infections PatientJan 2009. 1 LABS: CT abd/pelvis UNK abnormal UNK c/w diverticulitis diverticulitisallergy & possible abscess to aspirin and Tolectin PMH: HTN, hyperlipidemia, 1 MIL UNK no allergies 0 N/A UNK UNK none none Hx: febrile seizure. Allergies: PCN and Amoxicillin 0 PUB PUB unknown unknown unknown 1 Blood tests,UNK spinal taps, UNK EEG's and others. Labs none and Diagnostics: EEGs abnormal. MRI brain WNL. Holter WNL. U 1 PUB PUB None None Redness~Varicella (no brand name)~1~1~Patie 1 None PUB PUB None Not known OTH OTH Phenobarbital, Allergy Tenor to chemicals; Min, Blood Lisinopril, arsenic Weight Avinza, increased decreased; Simvastatin. MA20090648 metal poisoning; pain; Distur None PVT PUB None 1 None PUB PUB Asthma 753 None OTH OTH None; afebrile NKDA; questionable Asthma hx 0 CBC; SMA;PVT U CX; Blood UNK culture LABS: TYLENOL CBC,None metabolic Sp tests recent & UApyloric WNL. stenosis Blood c/s repair. neg. PMH: GERDs/p pyloric s 2 No test done PVT PVT No known illness NKA 0 None PUB PUB None None None 0 PVT PVT PREM Pro 2 ? degree mcg; PERCOCET partial Codeine thickness Sensitivity 5/325 burn mg -> leftTachycardia foot 1 PVT UNK Albuterol, HFA No inhaler Asthma, Carisoprodol HBP350mg, Menest 0.625 1 PUB PVT No None Stated None Stated 3 PVT PVT None None None PUB PUB NONE NONE Allergies 10 None PVT PUB None None None 0 OTH OTH FOSAMOX;None LOVASTATIN None 2 PVT UNK 1 PVT PUB SYNAGIS, MedImmune, 31301723 4/11, IM, Rt thigh, 2; Polyvisol 0 PUB PUB None None 2 PUB UNK PPD Sanofi,None C3036AA, R-LT 0.1CC 0 PUB PVT No known illness NKA 1 OTH PVT None None OTH PVT None 0 PVT PVT None None None 0 PVT PUB LANTUS; NOVOLOG; none TI insulins DM; no known Urticaria~Influenza allergies but positive (no brand eosinophils name)~2~7~Patie 11 None OTH UNK MOTRIN; TYLENOL None Dermatitis 1 OTH PVT none PVT UNK None 1 CBC; CMP;PVT ESR; CPK;PVT UA Labs: CK 456, otherwise WNL. ADD PMH: ADHD 1 Labs; 05FEB2009; PVT Egg, PVT white 703Unknown 0/I; Egg, yolk denied 451 neg;seasonal Egg, whole and Hives/rash~Hep 604 food0/I; allergies GelatinB (Bovine) (no brand 237, name)~1~0~Patie neg; Latex 487 1 Unknown MIL MIL denied denied 0 N/A UNK PUB N/A No illness atNo time known of vaccination. pre-existing diagnoses or medical conditions. 0 PVT PUB UNKNOWNNONE N/A DIZZINESS~HPV (Gardasil)~2~15~In Patient 6 3/4/09 TRADITIONAL UNK BLOOD UNK WORKUPS NONE. 6/4/09 FOUND NONE Hospital ELEVATED 6/4/09 records Hospital LIVER received NONE~ ENZYMES, records DOS ()~~0~Patient 3/20/09 received ANEMIA,ELEVATED toDOS 5/9/09. 3/20/09 Several to BLOODP 5/9/09. antibioti P 6 see above -PVT ESR 7, WBC PUB7.0 withpulmicort 2 Bands, and 36 none SEGS or albuterol and Asthma 43 lymphnone~ and 14()~NULL~~In MONO. HgbPatient 12.9
1 none PVT PUB 0 UNK UNK None Allergic to cats and history of asthma 0 UNK UNK None Cronic hay fever 1 Tsh <0.005,PVT tt4 and tt3-nl, UNKthyroglobulin none antibodies-elevated none none at 26. Thyroid us-nl, RAIU-markedly low. 1 UNK UNK none htn, chf, hypothyroid, hypoglycemic, arthritis, anemia,gerd. 6 Labs and Diagnostics: UNK UNK EEG 2/3/09 WNL withnone bacgroundnone slowing. PMH:EEG none3/4-5/09 abnormal (+) seizures. MRI brain 1 UNK UNK Possible viral Clubfoot infection (R).(clear nasal drainage, didn't feel well, nothing s 140 09/Mar/2009: PVT InfluenzaPVT virus A&B IgG, IgM and IgA ABS,Not Influenza reported. A: From IgG, (4.94), information IgM### (1.09), received IgA17 (1.4); March Influenza 2009, th B Not reported UNK UNK The reporter's niece experienced ### serious seizures followin Not reported UNK UNK The reporter's son experienced ### a seizure following DTP va 1 OTH OTH PHENERGAN; nonetopiramate; hypothyroid; SEASONALE; depression/social ROBAXIN; anxiety B12 injections; disorder;EPI insulin PEN;res P 1 MIL PUB none none NC09023 5 None PVT UNK None 3 Had first dose PUB of varicella PUB before first birthdayBrother (7-9-97)(age 10) had outbreak of varicella 2wks prior to patients outbr 1 UNK UNK PPD, SanofiNone Pasteur, C2908AA, None Intradermal L forearm 5 PUB PUB 2 None donePVT PVT Unstable angina CAD; HTN; ASCVD S/P; STENTS; CHRONIC DEPRESSI 2 PUB PVT 0 PVT UNK No No 1 PUB OTH None None None~ ()~~0~Patient 22 Unknown OTH OTH Unknown ### 1 CT Scan (Computed OTH tomography), OTH EEG (electrocardiogram) NKAwere normal. ### None OTH OTH None None WAES0903USA04260 Hematology, OTH results not OTH reported Unknown None WAES0903USA04265 diagnostic laboratory, OTH ?/?/07, OTH rubella Unknown titers was very highNone WAES0903USA04534 0 Unknown OTH OTH Unknown WAES0903USA04681 Unknown OTH OTH Unknown Oesophageal acid reflux; Autism; Penicillin WAES0903USA03608 allergy; Environmental alle 0 ultrasound, OTH 04/29/08 OTH Vitamins (unspecified) Pregnancy NOS (LMP = 12/10/2007) WAES0805USA01355 0 Unknown OTH OTH None Pregnancy NOS (LMP = 5/17/2008); WAES0808USA02136 Anaemia 7 PUB PVT 10 OTH PUB Otitis Media 1 None PVT PUB 0 DATE OF0VACCINE illness seasonal ml allergies 0 None PVT PUB None Mild gastroesophageal reflux symptoms - not treated 2 PUB PUB GA09011 1 PUB PUB none reported GA09010 5 PUB PVT Denies None GA09009 0 PUB PUB GA09008 1 PUB PUB NO NO NO GA09007 0 PUB PUB none none allergic, yellow dye GA09006 0 NONE PUB PVT ATENOLOL; NoBP pill; Lisinopril Hypertension; high cholesterol GA09005 Diagnostic Results: OTH 09 OTH August 1999: Lyme ABUnknown IgM Interp., Lyme EIADisease. was positive; The subject's Lyme A0605475A IgGmedical and IgM history, Western concurrent Blot werec 1 none PVT PVT no no no 0 PVT UNK Atenolol, Isosorbide, H+P R hand Cal PCN, Ulner withDarvon, Vit nerve D, vit (Numbness) Demerol; B12, ASA, CAD, MVI, HTN, Prilosec hyperlipidemia 1 None PUB PUB None 0 PUB PUB none knownUnknown Unknown, MD checking MI2009003 for underlying conditions. 0 None PVT PVT None Laceration ,Drug left hand allergies, codeine, Hydrocodone, mycins, sulfa 0 Normal PVT PVT 0 PUB PVT none none none 1 UNK UNK NONE 0 UNK UNK NONE None Gardisal was the vaccine given on 3/27/09. It wasn't listed 0 UNK UNK METOPROLOL NoneSUCCINATE Allergies 100MG - NKDA; SAPast TABMedical - ONE-HALF History TAB - osteoarthrithis, DAILY; NAPRO hy
3 PUB PUB Lanisporil HCT none Borderline High-Blood Pressure 7 Unknown 4/2/09-records UNK UNK received-Labs Unknown WNL.Unknown Unknown 1 NONE NEEDED PVT PVT ESTROGEN, NONE MULTIVITAMINS, HEALTHYCALCIUM WOMAN NONE~ ()~NULL~~In Patient 3 PUB PUB None None 0 PVT UNK Levothyroxine None Hashimoto's; ulceritive colitis 1 PVT UNK 81 mg aspirin, none vitoryin, diovan, multi vit, vit c 0 PVT UNK prilosec None mild hay fever, mild asthma, irritable bowel, stomach ulcer 31 UNK PVT 81 Source undetectable MIL through MIL imaging Denies studies.Denies 4/13/09-records Deniesreceived- CSF opening pressure low. MRI demonst 1 PVT PUB None None None 0 None PVT PVT None None 0 PVT PUB 1 ESR; CBC;PVT Troponin;PVT Creatine Kinase copy enclosed (copyHere attached) for physical Problem list enclosed PVT OTH Edema; Redness 0 PVT PVT OCUFLOX mild eye drops upper respiratory none infection; conjunctivitis 0 PVT PVT NKA PUB UNK 23 PVT OTH 18 Confirmed to OTH be vaccine, PUB associated rash via None culture/sequencing Profound mental retardation; CT200906 seizures; cerebral palsy; scol 0 OTH OTH ACTONEL; CA+ Supplement; HRT; Glucosamine PVT OTH 2 PVT PUB TYLENOL UNK UNK N/V; shingles PVT PVT AURAGLAN, Left ear otitis drops media 12 ultrasound, OTH 01/31/08, 7w5d, OTH reason Unknown for test: Dates; diagnostic Lactose laboratory, intolerance 01/31/08, WAES0803USA01775 routine laboratory tests for preg Surgery, 3/19/09; OTH Temperature OTH measurement, Unknown 3/??/09 Unknown WAES0903USA04013 Unknown OTH OTH Unknown Unknown WAES0903USA04572 3 Electroencephalography, OTH OTH came back 6/4/09 normal; DC and Convulsion Computed hospital6/4/09 axial, disorder records came DCreceived and back hospital normal; DOSWAES0903USA04669 records 3/28/09/ Magnetic received to 3/29/09. resonance, DOS Depo-Provera 3/28/09/ negative;toC3 315 Unknown. LABS OTH and DIAGNOSTICS: OTH Unknown PAP Smear - Negative Unknown for Intraepithelial WAES0903USA04692 Lesion or Malignancy. Gen probes f 636 diagnostic laboratory, OTH Rotavirus OTH test: Unknown positive Unknown WAES0903USA04586 0 hematologyOTH OTH None WAES0903USA03246 Unknown OTH OTH Unknown Unknown WAES0903USA03954 Unknown OTH OTH Unknown Unknown WAES0903USA04221 Unknown OTH OTH Unknown Unknown WAES0903USA04679 Unknown OTH OTH Unknown Unknown WAES0903USA04682 Unknown OTH OTH Unknown Pyloromyotomy WAES0903USA04714 0 Unknown OTH OTH Unknown WAES0903USA04713 Unknown OTH OTH Unknown Unknown WAES0903USA04843 Unknown OTH OTH Unknown Unknown WAES0903USA03663 Magnetic resonance OTH imaging OTH (MRI) was performed, including The patient T1, T2 had fluidno attenuation history of inversion antecedent ### recovery febrile (FLAIR), illness, tra a Not reported OTH OTH Not reported ### 0 WBC: 14.2;PVT Hb: 10.9; Platelets: OTH 249; Segs: 61; None Lymph:30; Asthma; Eos:2; Chronic Sed rate:constipation. 27; Sodium:PMH: 140; Potassium: asthma. constipation 3.2; CP: 1 62 Misdiagnosed PUB as foot fungus PVT in May 2008. Misdiagnosed None PMH: in Oct.borderline 2008. Diagnosed HTN. ITP in Feb. 2009. Labs: Platele 12 Troponin: records MIL say MIL 'elevated' but LISINOPRIL awaitingNexact one reading HTNfrom PMH: civilian HTN, records; shoulderCardiac surgery. Cath: Family 12 Feb hx: CAD 09 "small OTH OTH Unknown No per mother Unknown 1 Pt diagnosed PVT with the Flu PVTA positive Singulair on 3-28-09 5mg, Zyrtec, Asthma, Pulmicort,allergies Xopenex (seasonal) eczema. 1 None PVT PUB OMNICEF ABD. Pain None 3 PVT PVT GLUCOSAMINE Unknown Hirsuitism 1 PVT PVT 0 PUB PVT None none none 0 PVT UNK Upper Respiratory No Injection
1 X-ray, right PVT shoulder; CBC PVT none PVT PVT none none 2 None PVT PVT None None Allergic to AUGMENTIN PVT PVT 0 None OTH PVT None 1 PVT PVT none 15 EKG; CMP;PVT CT; MRI; (Results UNK pending). diarrhea 2 PVT PVT Glucophage, None Accuretic,NKDA Zetia, Amaryl, Aspirin & Nexium 1 PVT OTH None None PVT PVT None None None 2 PVT PUB 605 11/10/06 VARICELLA OTH ZOSTER PVT IGG ACTONEL test -> negative None 35 mg. 1/wk.; Horse CELEBREX derived products; 100mg. 2/Day; Paper COSAMIN tape; Lactose .05 intolerance; 2/day; CRESO 2 PVT PVT FLEXERILL; None FENOFIBRATE; Ace inhibitors ODOCET; DYAZIDE; K-DUR; ATENOLOL; CITALE 1 UNK UNK None febrile seizures 2 PVT UNK MAKIDE; VYTORIN; none ASA none; prostate ca; CAD; HTN 0 PVT UNK none none COPD; Mitral valve prolapse 0 None PVT PVT NONE NONE 12 None PVT PUB None Expressive language disorder, 315-31 2 See attached PVT PVT None None None 0 NI KP 3/25/09 OTH PVT FLEXERIL N/A 10 TID, KP 3-25-09 INDERAL migraines, 40 mg pinched BID, PROMETHAZINE nerve in back, allergic 25 mg to PRN, AMOXICILLIN AMITRI 0 NI KP 3-25-09 OTH PVT Birth controlNone pills allergic - PCN - AMOXICILLIN - BACTRIUM MIL MIL 15 MIL MIL OTH UNK None 0 PVT PVT 1 None PVT PUB POLY-VIT-FLUOR None 0.25 Milk mgDigestaut allergy 0 Hospital records UNK pending, UNKexpected gabapentin, to includeAcute lisinopril, culture exacerbation and Nexium, Coronary sensitivity simvastatin, ofartery chronic datadisease bronchitis metoprolol, s/p PTCA, Plavix, COPD, Azmacort, hypertension, Zetia, Ac 1 None PVT PVT Levothyroxine, Zyrtek 1 office visit confirmed PVT urticarial PVT rash on trunk and neck 0 none PUB PUB N/A None None N/A~ ()~NULL~~In AZ0903 Patient 34 an ultrasound UNK and MRIUNK were obtained noneprior tono surgery eczema, perinatal HIV exposure NO PVT PVT NO KNOWN NO MEDICATION ILLNESS ALLERIC TO PENICILLIN AND SULFUR ABOUT THE AG 1 None Available UNK4/10/09-records UNK received-Abdominal None Known None known ultrasound None known negative for intussusception. Stool guaiac negative 3 None PVT PVT NONE PMH: Allergy to PCN, Hereditary Hypertension 0 PVT PVT 0 No known tests/lab PUB data. PUB Asthmanex,No Nasonex, known illness Asthma.Allery Singulair, Albuterol to Penecillan inhaler and Cefzil. 1 NO TESTSPVT DONE. PVT NONE NO ILLNESS CHICKEN-POX ON 1/4/07 ALLERGY TO AMOXICILLIN 3 0 Blood drawn UNK on 03-31-2009. UNK Tests None ordered unknown.MRI None known Reports of head eczema on 04-01-2009 and icthyosis. 4/6/09-records Allergies received-TSH, to nuts, crab, and CB 0 PVT PVT None known None known 3 UNK PUB 1) ESCITALOPRAM 5mg Problems: 2) EZETIMIBE Depression 10MG/SIMVASTATIN Hearing Loss Valvular 40MG Heart 3) FENO Disea 1 none PVT PUB Tylenol None None 15 See Above....Toxicology UNK UNK test wereVisad, deniedAminophylline, by See DR. that Above help 2Anemic, ortypes 3we positions will Thrush head be Stopped happy in was medication, care Dolicephellic, to Breathing ofapprove child Am and and realese Had this Poor blood was ofFeeding~Hep entire a transfusion, conflict medical of inte BSe h (n 1 abdominal scan UNK reveals PVT several enlarged None lymph None. nodes. Wassecond None in very scan goodtaken healthtwo months later, reveals lymph nodes PVT OTH None None Eczema 4 None PVT PUB PPD Pasteur None C2920ABNKDA; L forearm None 1 1 PVT PUB None None None 0 OTH PUB None PUB UNK None None None 2 None PVT PVT PVT OTH Calcium; Iron; FLONASE; Celiac LEVORA; dis.; Allergies; Loratadine Pollen; Chocolate; alcohol; talcum po 1 PVT PUB None None
0 OTH OTH PCN - hives 0 None PVT UNK None - Healthy baby 4 CBC - CRPPVT - mono - negative; PVT H simplex; urine none culture; strep for A; labia cx - negative 5/21/09 Medical records rec 10 PUB OTH none none 0 PVT PVT None URI 0 None MIL MIL None 1 None PVT PVT 0 UNK UNK UNK Unknown A0774690A 0 UNK UNK NO NO NO 28 body weightOTH measurement, OTH 10/09/08, 4.6 IB; body Bottleweight feeding; Diaper measurement, Colic rash; Head 10/07/08, discomfort; WAES0903USA04224 5 LBNasal 12 ounce congestion; Runny no None OTH OTH None Milk allergy WAES0903USA04860 Unknown OTH OTH Unknown Gene mutation WAES0903USA04869 Unknown OTH OTH Unknown Unknown WAES0903USA04886 0 Ultrasound,OTH 03/20/08, dating; OTH Beta-human Vitamins chorionic, (unspecified) Pregnancy positive Low NOSgrade (LMP squamous = 2/4/2008); intraepithelial WAES0803USA01840 Sulfonamidelesion allergy 0 ultrasound, OTH 02/03/09, 6OTH weeks 3 days Noneintrauterine Pregnancy gestation NOS (LMP = 11/12/2008) WAES0901USA02732 0 None OTH OTH MOTRIN None WAES0903USA04863 Unknown OTH OTH Unknown Unknown WAES0903USA04907 Serum prostatic OTH acid, positive OTH Unknown Unknown WAES0903USA04916 1 4 MRI's & EMG OTH4/13/09-records OTH received-EMG None demonstrated None presesence of devervation in deltoid muscle. MRI of 1 None PUB PUB None None Seizures as infant - up to age of two; traumatic birth. 19 None UNK UNK METROPROLOL SUCCINATE PMH significant 100MGforSAHistory TAB; NAPROXEN of MI - 2years 500MG ago with TAB; 1 stent SIM 6 Rotavirus - PVT Stool positive PVT 1/14/09 0 None OTH OTH FluconazoleNone start 3/25;DILANTIN; HCTZ; Simvastatin HTN; Chronic ; PSA;back Pantoprazole; pain; Obesity; GERD None PUB UNK None NKDA 1 PUB PUB None Rash on face Mom states last month treated at hospital for rash on thigh 1 Went to Walk-in OTH ClinicPUB today - Dr Metoprolol said reaction 50; Rash with Digoxin; going his COUMADIN up Warfarin arm 0 PUB PUB NONE NONE 6 UNK UNK vitamins none none fever,headach,vomiting, upset stomach,sore th 0 PVT PVT Metoprolol XL Chest 50 mg painQD, Sulfa NOS Hyzaar drugs100 mg QD, Crestor 10 mg QD 28 MD tested for UNK Lyme disease UNK and other NonevectorNo diseases--all None negative. Had CT scan that ruled out any tumors. MD 8 PUB PUB NO NONE NO~ ()~NULL~~In Patient 0 PUB PUB Cough 0 NONE PUB PUB NONE NONE NONE DIZZINESS~ ()~NULL~13~In Sibling1 1 N/A PUB PVT Triamterene, None allergy serum Allergies shots to1Xweek, Rash/itching/joint trees, grasses, multivitamins, weeds pain~Zoster in supplements SE LA; (nomild brand hyperten name) 0 no diagnoticUNK tests UNK Albuterol MDI No inhaler acute illness NKDA, Exercise induced asthma 0 NONE PUB PUB NONE NONE NONE FAINTING~ ()~NULL~12~In Sibling1 1 Cellulitis UNK UNK 1 PVT PVT NONE OSTEOPENIA; LUNG CANCER NEARLY 5 YEARS AGO; 0 none PVT PVT NO LEFT EAR DEFORMITY 1 PUB PVT Hypertension 0 None PUB PUB 1 PUB PUB None None known. PDA closure 04/09/2006 1 PVT PVT n/a n/a Less mobility - major bumps in legs~DTaP + IP 0 PVT UNK Vitamin K Injection, None Erythromycin Unknown Eye Ointment 1 UNK UNK HCTZ, amlodipine, unknown/none levothyroxine, Pt had lumpectomy alendronate 3 years ago. 1 UNK UNK 3 2-Nov-2008, OTH CT scan head, OTH normal; Concomitant Platelet count, Seizures; Drug(s) 11/02/08, Febrile Not Abnormal Reported 271; seizure WBC, development: 11/02/08, MEDI0008057 at 11.2 2 years had developmental leve 0 8/5/09 Medical PVTrecordsPVT received DOS 3/27/09. None LABS and8/5/09 DIAGNOSTICS: Medical records CT Brain received w/o Contrast DOS 3/27/09. - Moderate Asthma, ethmo ex 0 PVT PVT None None None 5 PVT OTH 1 PVT PVT
1
PVT UNK None None PUB PUB Steroids drops - eye surg 1 None PVT PVT LOESTRINNone 24 Known NKDA 0 CBC; NL WBC PVT UNK ESTRADERM Recent PATCH; pneumonia Hypothyroid; SYNTHON; with relapse. Fibromialgia; LYRICA: LEXAPRO: HTN; DMII; HCTZ; Sciatica; TYL #3; Neuropath LISINE; 0 PVT PVT None No None 0 None PVT PVT None No None 2 Viral culturePVT - POS varicella PUB / Zoster Antigen None None Pap test, positive OTH for carcinoma OTH inUnknown situ; PAP test, Papilloma clear viral infection; Sexually WAES0903USA04905 active Pap test; cervix OTHC.; urine OTH beta-human None Pregnancy NOS (LMP = 2/12/2009) WAES0903USA03214 Unknown OTH OTH Unknown Unknown WAES0903USA04710 Unknown OTH OTH Unknown Unknown WAES0903USA04678 Unknown OTH OTH Patient has a history of seasonal ###allergies. 1 UNK UNK Methylprednisolone; Loratadine Allergies-IOVERSOL; IODINATED INTRAVASC CONTRA 1 CommunityPVT Hospital - virus UNK syndrome NoneLABS:None Neutros 83.5%, None lymphs PMH: HTN, 9.1%.CKD, H/H pneumonia, 13.0/28.1(L).chronic BMP, BNP, SDH s/p troponi hea 12 5/11/09 hospital MIL records MIL received None for DOS 12/14/08-1/6/09. None None LABS and DIAGNOSTICS: On admission: Normal WBC 6 PUB UNK none none PVT PUB None None PVT PUB None None Allergic Rhinitis/one episode of RAD. 1 None PVT PUB No No 0 PUB PVT Pt stated that he was sick after receiving shot. 0 None PVT PVT ALLEGRA D No known PVT PVT None None None PUB PUB None None 1 PUB PVT None None 0 None PVT PUB None None Seasonal allergic rhinitis 0 None PVT PVT None None None 1 PVT PUB none none 1 CBC; Blood PVT Culture; C-reactive PUB protein None None 2 OTH PVT DEPO-PROVERA None Hx shingles age 8 1 PVT PVT MELOXICAM; IMITREX Allergies, PCN; CEDON; LODINE; BEXTRA None PVT PUB None None None 10 MIL UNK None None Allergic to PENICILLIN 0 PUB PUB 385 PVT PVT none no no 0 EEG Pending PVT PUB 1 strep, flu (both PUBnegative) PUB none reported TN09004 1 None donePUB OTH metformin 500mg; complaining Levacor Naproxen;Diabetic of nausea/diarrheatypeTN09005 II;Osteopenia none PVT PVT PPD Strept throat - on Amoxicillin 1 MIL UNK 1 CRP; CBC,PVT pending PUB 0 none OTH PVT none none none stated UNK UNK 0 MRI; Bloodwork PVT LABS:PVT Lymphocytes 46.2%(H). NoneAnion gap None 5.0(L). Family CThx: head stroke WNL. & DM. 0 None MIL UNK TB test THBESOL, None Sanofi RADPasteur, (Asthma), C2909AA, esoph reflux, Left Venous DARROSTENOSIS forearm, 0, 17MAR09 2 PVT PVT 2 numerous labs PVTwere done. UNK Sulfa; Demerol; no medical conditions 3 PVT PVT 20 PVT PVT None None None 1 PVT PVT DILTIAZEM ER; TOPROL Superficial XL; LISINOPRIL; phlebitis; HX COUMADIN; of syncope;FUROSONIDE; Diabetes, HTN,MECL Hype 2 Doppler U/SUNK normal. X-rays UNK of legsBenzaclin normal. topical 3/2/09 None gel WBCAcne 13.0 (N80,L14,M5,E1, CRP 154.8 mg/L, ESR 70 mm/1hr 7 PUB PUB NONE NONE
PUB PVT HCTZ, Xanax, Irregular Valiam, heart Aspirin, Metoprolol, rythm, Eggs hypothyroidism, Fexofenadine, (diarrhea, cramps) vertigo, Synthroid, Sesonal Scopolamine allergy transd None. PVT UNK None noted.None noted. 0 PVT PUB Flonase; zyrtec nasal allergies PDD, nasal allergies, constipation 1 None PUB PVT Unknown None Allergy to CAT Scan dye: flushing and swelling; General a 4 PVT PVT DeAllergy no tetanus had reaction to tetanus and was told never to g PVT UNK none prematurity, apnea of prematurity, hyperbilirubinemia 0 PVT PVT DeAllergy No Tetanus Had reaction to tetanus and was told never to g 4 UNK UNK None 0 None. PVT UNK Unknown. Unknown. 0 GAVE 4TH UNK PEDIARIX PUB NONE NONE 2 PUB PUB NONE NONE UNDERWEIGHT AT BIRTH-6LB 13OZ 0 UNK PVT n/a 2 None. MIL MIL None Local reaction. None. Local reaction to anthrax.~Anthrax (Biothrax)~2 0 An influenza UNK swab wasUNK done results none came back none negative.none 4 vials of blood was drawn all of which came back negati UNK UNK N/A N/A 21 Normal upper UNK GI, normal UNK colonscopy, None. normal 5/26/09 None upper Hospital endoscopy, None. records 5/26/09 negative received highHospital fever, red EDblood and abdominal records inpatient count, received pain, normal DOS dizziness, ED 9/18/07 blood andwork. inpatient to pale~HP 11/19/ 5/26 UNK OTH OTH Unknown A0776700A 0 UNK OTH OTH PINDOLOLHigh Blood The Pressure subject had no allergies. A0776466A The subject had no adverse 335 UNK OTH OTH Ibuprofen; Fexofenadine Unknown Allergies; hydrochloride; Tonsillectomy; Mometasone A0599605A Varicocele; furoate; The Arthrotec; subject reported Triamcin 95 Unknown no UNK data available UNK None None PMH: HTN, GERD, high cholesterol. Allergy: latex. 0 PVT PVT METOPROLOL; 3/9/09LEVOTHYROXINE; - bronchitis hypertension LISINOPRIL; SIMVASTATIN PVT OTH none none none 1 PVT PUB 0 PVT PUB None None Asthma, ear infections 0 PVT PUB none none none 1 PUB PUB 0 None PUB PUB TYLENOL None None 0 PVT OTH respiratory infection 0 PVT PUB Anemia Asthma 2 Injection reaction PVT PVT LEVOTHYROXINE; URI FLUOXETINE Allergic to PHENERGAN 2 none PVT PVT 0 PUB PUB ATENOLOL; SIMVASTIN; HTN;BUPROPION; HIGH CHOLESTEROL HYDROCHLOROTHIRZIDC 2 PUB PUB Allegra, 180mg., no one qd; NKDA Nasocort, Astilin, Ipratorium Bromide All Nasal Sprays; 1 MIL OTH BUSPRINE; LEXAPRO; CELEBREX; SINGULAIR; Qvar prn; PROAR prn; Ortho 550 Unknown OTH OTH Cardiac disorder WAES0903USA05210 None OTH OTH Unknown None WAES0903USA05205 324 rectal biopsy, PVT 03/05/09,PUB condylomaUnknown Unknown WAES0903USA01463 191 Unknown OTH OTH None Drug hypersensitivity WAES0903USA05483 0 MRI; CT; X-rays; OTH BloodPVT tests; Lumbar Too puncture. many to None list Labs: VZV Type IgGI Diabetes c/w immunity. PMH: VZV diabetes. IgM (-). VZV PCR (-) for both w 2 None WBCMIL increased MIL CLOBETASOL, Lupus; HYDROXYZINE Nephritis Lupus; Nephritis HCL, ZOLPIDEM, PMH: ESRD. HYDROCORTISONE, Lupus nephritis. renal SIMVA tran 11 3/19/D Dimer UNK 532(H) (ref:>230ng/ml UNK None H); 3/19/09 None 1903:Trop None I 0.31H, CK 151 (range 30-200 IU/L); 3/20/09 0155: Tro 32 Varicella Zoster PVT Virus IgA; OTHVZV IgM Albuterol 4/10/09-records MDI Asthma 2 puff received-Chest exacerbation Q6hr Asthma; prn asthma x-rayexacerbation/ increase interstitial bronchitis markings at time suggestive of vesicul 0 PUB PUB None None Sinus bradycardia UNK UNK 2 PVT OTH None-well visit None 0 None PVT PVT None None 0 OTH PUB None known None known None 0 Xray, forearm PVT PVT None None None MIL UNK none none 5 no PVT PUB LOZARTANnone 50mg Hypertension redness, hot, hard~Measles + Mumps + Rubell 0 PVT UNK No No No
0 none PVT PVT none none none 0 OTH PVT 15 minutes Fluctuating from vaccination BP per Pt None PVT PUB 2 PUB OTH LA090303 3 PVT PVT Xanax, citalopram Cellulitis of toe 2 None; *Please PUBrecommend OTH course of action for Scabies * future 11 None y.o. Tdap. None PVT UNK Poor weightNone gain 1 PVT PUB None None None 1 None PVT PVT No No 1 PVT PVT none None None 1 PVT PUB PVT UNK None CAD; Diabetes 0 PUB PUB 0 PVT OTH EFFEXOR NONE XR; YAZ; ABILIFY Amoxicillin; Naproxen PVT PVT None None PUB PUB none 0 PUB PUB NONE NONE ECZEMA 6 n/a UNK PVT Unknown except Mild cough. no cortisone, None Patientprednisone, completed ZPak steroids treatment or anti-cancer 1 day prior drugs. to vaccinat 0 None PVT PVT None None Fever and fussiness~DT+IPV+Hib+HepB (no b 5 PUB PUB Chron's Chron's allergic to benadryl AL0903 0 none PUB PUB none none seasonal allergies onlyMO-2009-09 1 PVT PVT Urinary Incontenance None UNK UNK None notedAsthma 1 UNK UNK Benicar 20 none mg daily, Lopid hypertension, daily elevated cholesterol 0 PUB PUB UNKNOWNNONE NOTED UNKNOWN 15 My daughter UNK has received UNKcat scans.EEG's and Labs andPMH: Diagnostics: 36 wk premie. EEG abnormal Family hxxof 2.seizures Brain MRI in WNL. paternal Head aun na PVT PUB Hydrocortisone noneCreamnone 1% none PVT PUB Acetaminophen none neo-natal jaundice 6 PVT UNK none 0 PVT UNK 10 OTH PUB No No 0 PVT PVT Supplements only. 1 None OTH OTH COUMADIN; None DARVOCET Allergies; N 100;Skin ESTRACE; cancer; Menopause; LIPITOR; TRICOR; High cholesterol; WELLBUTRIN; Anxi 4 none PVT PVT ASA; Simvastatin; none Atenolol; Cardiac Sulfasalazine cath 0 PVT PVT 1 None PVT PVT None Allergy to OMNICEF, AUGMENTIN; allergic rhinitis; obesit 2 No PVT PVT No None 1 PVT UNK Albuterol, Singulair None Peanut allergy None OTH OTH TRAMADOL/CELEBREX/LIPITOR None Arthritis/Seasonal Allergies/Hyperlipidemia 434 PVT PVT ZYRTEC None Peanut Allergy, Varicella~Varicella Eczema, Allergic (Varivax)~2~8~Sibling Rhinitis 346 PVT PVT ZYRTEC None Asthma, Allergic ~Varicella Rhinitis, (Varivax)~2~11~Sibling Eczema 0 PVT OTH Environmental and food allergies. ### No known drug allergie 1 UNK UNK Concomitant medication was none. ### Past medical history w om a health care professional HAEMOPHILUS who had UNK called INFLUENZA their UNKnational TYPE service B titercenter. of 0.96 A (range three-year-old The 1.00 patient and greater). female had medical patient, condition who ### hasofchronic chronicear earinfections infectionsa 0 Unknown PVT PVT The patient had no illness at the ###time of vaccination and sh 0 None reported. PVT PVT No past medical history was reported. ### 0 None PVT PVT None The patient had no illnesses, pre-existing ### medical conditio 1414 01/May/2008: PVT titer lessOTH than 0.15 ALBUTEROL; FLOVENT; History VERAMIST; of asthma, Anitbody SINGULAIR; chronic test~Hib ear### (ActHIB)~3~0~Patient STEROIDS infections, sinus infections, 0 None reported. PVT PUB ADVIL None reported. ### 1 PVT PUB NONE NONE 0 Swabbed for PVT flu which UNK was negative
PUB PUB ALBUTEROL Osteoarthritis, 90/IPRATROPIUM, NKA hypertension, CITALOPRAM, obesity, depression, DILTIAZEM, smoking, ETODOLAC, and transi FUR 1 None UNK PVT Synthroid 114 None mcg 3 PUB PUB HYDROCHLOROTHIAZIDE, HYPERLIPIDEMIA, NKA SIMVASTATIN, DJD, Erectile Dysfunction, IBUPROFEN,Obesity, LYSINEHypertension 10 UNK UNK None None None 0 PUB PVT Lopressor, None amlodipine,Diabetes, Ranexa, Singulair, asthma, hypertension, Asmanex, Xopenex, cardiac aspirin, syndrome ranitidine X, mul 2 MIL MIL 0 MIL MIL CLARITIN D None BENADRYL; HTN Unknown OTH OTH Unknown Unknown WAES0903USA05627 96 Not reported. PVT From information PUB received 24 March 2009,Not a rapid reported. flu testFrom was information performed### in received the doctor's 24 March office.2009, th 0 OTH OTH Albuterol; Proair Diabetes; HFA;Chronic Aspirin;obstructive Docusate sodium; pulmonary WAES0903USA04882 Vasotec; disease; Fluoxetine; CoronaryAdvair; artery dis Me None OTH OTH Unknown None WAES0903USA05206 None OTH OTH None None WAES0903USA05533 Unknown OTH OTH Unknown Unknown WAES0903USA05489 Unknown OTH OTH Unknown Unknown WAES0903USA05181 allergen skin OTH test, 11/15/07, MIL flaredZYRTEC up Penicillin allergy; Anaphylactic Sulfonamide reaction allergy; WAES0801USA05565 Latex allergy; Allergic reaction None OTH OTH Unknown Unknown WAES0901USA02454 2 PVT PUB No 0 PVT PVT 2 none PVT PUB none none 0 EKG-WNL, PVT AccucheckPVT 99. ER Labs: CBC Normal, BMP normal except glucose 192 0 (+) increasePVT AST 90; Increase UNK ALT None 56; Increase NoneLDH 1,045; FAAZ(-) Heterozygous food allergy panel; A/B-thal-Anexies CRP (-); IgE 8.9g/dl 4,92(11/26/08) ng/ml ; U/A none PUB PUB none exceptnone aspirin (patient daily none had stepped on nail 3/31/09) None. PVT PVT See 3/24/09Possible for hivesfood allergy 1 MIL MIL 0 None PVT PUB TYLENOL None None 2 PVT PVT 1 PVT PVT None None 0 Not available MIL at this time MIL None Prednisone 2 PVT UNK None None None PVT OTH None 1 PVT UNK no none 14 PUB PUB None NKA 0 none PVT PUB Nystatin ointment, none Albuterol Wheezing - Albuterol 0 none PVT PUB Nystatin Suspension Thrush none 0 none PVT PUB Zantac, Prevacid none GERD 0 none PVT PUB none none none 0 PVT PUB Nystatin Thrush none 2 NA UNK UNK Metformin and None Apri notedAllergic for birth control to penicillin 2 UNK UNK None 0 none PUB PUB Centrum Multivitamin denies with undiagnosed iron seasonal allergies 3 4/2/09 Mumps UNKIGG >5.00 UNKMumpsLisinopril, IGM <1.10 minoxidil, None amlodipine, Hypertension, Vit. Dkidney failure with dialysis. 7 CBC, diff, sed UNK rate, ANA UNK ASO RF Advair, Lyme allAlbuterol normal. Asthma, Singulair Labs: Foot PMH: Rapid injury asthma. strep (-).foot Fluinjury (-) CXR WNL. MCV 29.3 (H). RF (1 PUB PVT none none none 2 none PUB PVT 1 PUB PUB none per parent none per parent none~ ()~NULL~~In AL0904 Sibling1|none~ ()~NULL~~ 1 PVT PUB history of prior skin infections 1 PUB PUB none none AL0905 0 None done.PUB No adverse PUB reaction occurred NA to Healthy the infant following None the Adverse Event. 3 PVT PVT albuterol, pulmicort Asthma 1 LABS: WBC UNK 20.0(H), neutros UNK 17.7(H), Pt hadUS taken rightPrednisone arm abnormal ASA 50mg - w/significant breathing x3 on 3/24 difficulties soft as a tissue prep PMH: edema for an HTN, MRI. asthma. Family hx 1 PUB PUB PPD also placed at same visit, on lower left arm.
59 ContinuousUNK and ongoing UNK lab/bloodClobex work toand determine None luxiq foam cause Hives for hair of when fatigue, loss.taking Ifmono-like no meds results, illnesses containing the nextand step redextreme dye. is cortisone PMH: hair loss. Plante shotsL 4 None UNK PVT None None None 0 PVT PUB 1 ADVERSE PVT SKIN REACTION PVT NONE NONE NONE 2 PUB PVT Aciphex 20 COPD mg x1 Hydrochlorothizide COPD 12 « mg Allegra 150 Mg. x 1 a.m 0 None PVT PVT none epistaxis bony occipital lump 0 UNK PUB OTH LISINOPRIL Allergy (NOS); TheHigh subject blood hadpressure no reaction A0776925A after her first flu shot and had 10 Blood and CSF PVT Cx's neg; PVTPCR on blood and CSF None(+) done None for PMH: serotype none (B) N. meningitides Labs: CBC with WBCs 2 EEG and CT PVT scan (head) PUB normal Multivitamins LABS: Oxygenation None with Fl;95% Desonide Eczema on RA. cream PMH: CBC: URI. WBC C-section, 31.1(H), neutros uncomplicated. 71.7%(H), lymphs 0 See Attached PUB 4/15/09-records PUB received-Influenza Unknown NoneA and B None negative. known 4/15/09-records received-PMH: seasonal alle 13 none PVT PUB none Otitis media, none with effusion 2 PVT PVT MIRALAX 1 None PUB PUB None Denied Denied Convulsion~Polio CA090001 Virus, Inact. (no brand name 1 PVT OTH None None None 1 PUB PUB None None Known None Known 1 None PVT UNK None 1 UNK UNK ZYRTEC - over WCC; the anxiety counter NKA disorder cervical smear, OTH07/??/08, OTH normal None Pregnancy NOS (LMP = Unknown) WAES0904USA00158 OTH OTH Unknown Unknown WAES0904USA00372 OTH OTH Unknown Milk allergy WAES0904USA00334 7 MRI; MRV; PVT CT Scan; Spinal UNK Tap. Labs and diagnostics: Cold virus MRI Nonespine PMH:WNL. noneCBC with WBCs up to 19.8. RBCs 3.44. H 2 PUB PUB Asthma 2 none PUB PUB none none UNK UNK Pat allergies: SULFA DRUGS (SULFONAMIDES) 6 Platelet count UNK 3/23/09:UNK 273 Aspirin; enalapril; NEXIUM; OtherFish allergies oil; Vitamin - Contrast D. (CT Scan) - Ate crab 3 days prio None UNK UNK Fibromyalgia; allergic rhinitis/asthma; IBS 0 PVT UNK None None 0 PVT UNK None None 0 PUB PUB 374 None PVT OTH PREDNISONE None 0.25 mg/kg Resolving hypereosinophilia 7 Varicella Zoster PUB HSV & OTH VZV-PCRCOZAAR; Dermal - DNA CRESTOR; No detected. HTN; NORVASC; Hyperchol; CLARITIN; Osteoporosis FOSAMAX 10 PVT PUB None None 0 PUB UNK None 2 None PVT PVT None NKA/ heart murmur dx'd 9/3/08. 1 None OTH PVT None None known OTH PUB None None Esotopia, intoeing, foster care 10 PVT PUB None None None 1 PVT PUB None None None 80 Neg: CBC; PVT metabolic profile; PVT Lyme antibody LABS: None MRI,PMH: MRA migraine & MRV brain HA. WNL. FamilyEBV, hx: MS. CRP WNL. ANA done 4/6 10 None PVT PUB None None None 0 None PVT PVT LURIDE 0.5(L) mg, acute chewable otitis None media tablet 0 None DonePUB PVT None None None 0 Blood Sugar PUB 108/Pt. toPVT local ER for Claritin precautionary check.Hay Fever 0 None UNK UNK None None Seasonal allergies 1 None OTH PVT PRILOSECNone OTC; FLONASE; Reflux esophagitis; Loratadine; Albuterol ExercisedInh. induced asthma-stable/cont 9 PVT OTH ORAJEL; Camilia None teething Protein relief allergy drops(as infant); Azithromycin (Feb 2009) 0 None PVT PVT TYLENOL no None None UNK UNK None None 0 UNK UNK 0 None PVT PVT None None teething 1 None PVT PVT Penicillin prophylaxis None (s/p Eczema; APR) allergies (dust, cat, dog, pollen) S/P acute rheum
2 CT Brain WO PVT ContrastPUB None 2 None PVT PUB None No None 4/13/09-records PVT receivedPUB SMXTMP None - Well visit 2 PVT PVT Suicidal Sulfa 0 Prior lateralPVT RAST (-) PUB DETROL LA; None NURALAX Spondylo costal Rash~Measles dysplasia; +RAD Mumps + Rubella (no brand n 13 None PUB PUB None Known Not known No 0 PVT OTH Claritin PRNNone rhinitis None 1 CBC PVT PVT none none none 1 0 Lab (was PVT on AUGMENTIN PUB 500mg for cat bite) None (on antibiotics No knownfor allergies cat bite) PVT UNK Temp 98.9 0 n/a PUB UNK n/a none none 0 UNK UNK 11 MIL MIL none unknown 2 PVT PVT Brevoxyl and None Duac None 13 UNK MIL none unknown none PVT UNK none none none~DTaP (Tripedia)~5~~In Patient 5 PUB PUB none reported none 4 5/11/09 Received UNK OPHUNK office records Effexor DOS 11/4/08-12/1/09. None Anxiety/depression LABS: TemporalMedical artery biopsy records WNL. stateMRI PMH: brain allergic WNL.rh 0 PVT UNK 2 PUB PVT Detrol La, prevacol, prilosec, calcium, niacin, fish oil, baby asa 16 Troponin I drawn MIL 02-12-09/abnormal. MIL ECG performed 2-18-09/Abnormal. 5000005 14 MIL MIL none unknown 18 Troponin I drawn UNK 02/11/09-Abnormal UNK High blood pressure; Psychiatric 5000006illness 11 ALSO INOCCULATED PVT UNK WITH KINRIX ON SAME DAY, YOU DONT' lathargic SHOW Afor LISTING 8 days~FOR ()~~1~Patient THIS. 0 PUB PUB none none knownnone 18 Labs and Diagnostics: UNK UNK CBC WNL.Flonase, EKG Sinus Fosamax, No. rhythmFexofenadine with NKA. PACs, Cerebral Head HCL, Palsy, CT Hexavitamins, (-).spastic Carotidquadriplegia, DuplexOscal, Colace, no significant multiple Vitamin joint steno D, co 19 MIL MIL none unknown 38 MIL MIL none unknown 4 MIL UNK ferrous sulfate, Dysphagia, calcium/vitamin sulfa-drugs Bilateral D, cataracts, aspirin, senna, Remission, docusate, Carcinoma, polyvinyl Basal alcohol/NaC cell, se 1 None PVT PUB AUGMENTIN; L ear NASONEX; infection NoneMOTRIN; TYLENOL 11 PUB PUB OTH UNK None None 1 None PUB OTH None None None 1 UNK UNK 0 Ultrasound,OTH 03/17/08, normal; OTH Ultrasound PRENATE; 07/22/08, Pregnancy phytonadione normal; Kidney NOSultrasound, (LMP stone = Unknown); 09/19/08, WAES0810USA00442 Vulval normal; wart; Chest Prenatal X-ray,care; 10/04?/08 Can Unknown OTH OTH Unknown Unknown WAES0904USA00519 Unknown. OTH 06/04/09 Neurology OTH received Unknown. DOS 06/04/09 7/24/09Neurology toUnknown 9/18/07.received LABS and DOS DIAGNOSTICS: WAES0904USA00310 7/24/09 to 9/18/07. NerveFerrous Conduction sulfate, St 15 Elevated WBC MIL and protein MIL in CSF-None see attached. NoneOther None normal/negative: serum O&P; Plasmodium antigen; Prot Unknown OTH OTH Unknown Unknown WAES0904USA00203 14 None OTH PUB Ibuprofen 800 None mg prn; Hypertension; DILTIAZEN 249 Hxmg of Rheumatic approximately fever; X day allergic PO; to TRIAMT/HC SULFA X None PVT UNK None None Allergies 2 Etiology of allergic OTH reaction OTH unclear. Vit B-12 injection Environmental allergies 2 PUB PUB None None None 0 UNK UNK Pt allergies: Sulfonamides 1 PVT PUB 1 PVT PUB 95 Serum beta-human, OTH 05/16/08, OTH pregnant None Pregnancy NOS (LMP = 3/1/2008); WAES0805USA03810 Iron deficiency anaemia 0 Urine beta-human, OTH 02/26/08, OTH positive; vitamins Glucose (unspecified) tolerancePENICILLIN test, 08/01/08, allergy; 83mg/d depression; WAES0803USA00673 Endoscopy; Ex-smoker 2 OTH OTH None 1 PVT OTH Bronchitis 16 magnetic resonance, OTH most OTHconsistent Unknown with demyelinatingUnknown process of immune etiology WAES0904USA00488
UNK UNK ### 3 OTH PVT None as answered None None 0 PUB PUB None At age 1 open heart surgery 0 OTH OTH None 1 CBC with diff PVT PUB No No 1 none MIL MIL None None None 4 None PVT PVT Unknown None None 1 UNK UNK 0 PUB PUB No 32 MIL MIL none unknown 0 PUB PVT None No None Reported 0 PUB PUB NONE NONE 0 None PUB UNK none none 0 NONE PUB PUB NONE NONE NONE 0 PUB UNK none 4 Methicillin sensitive UNK staph UNK aureus septic hip and ankle with presumed osteomyelitis (radiological diagnosis pending 0 PVT PUB Runny noseAsthma x 1 week 0 MIL UNK none 0 PUB UNK 0 PVT UNK none 1 Pelvic examUNK noramal, UNK palpation ofI take swollen lo estrin glands, No 24 labds daily,Seasonal including No other allergies, daily a cbc-home results have medications, not been back, reciebing pelvic No other allergy sonogrammedications shots norma weew 2 PUB PUB No Allergy to Augmentin MO-2009-10 PUB UNK none none none MO-2009-11 5 UNK UNK None Diabetes 2 PVT PVT None None 43 Labs and diagnostics: UNK UNK MRI brain (+) for infarct. mild Head coldCTDiabetes (+) for infarct, PMH:ALT HTN, 90,DM2, glucose GERD, 176,high carotid cholesterol dopplers (-) fo 2 N/A PUB PUB none none unknown 6 PUB PVT Considerations: Patient had also started taking Oral Typho 71 May fax if needed UNK copies UNK of labs and none reports 4/16/09-records No Nonereceived-Transaminases known elevated. Needle biospy sh 1 PVT PVT NONE PHENERGAN, MORPHINE 0 Blood, results UNK not all inUNK yet. FutureNone skin/scratch None tests. 4/20/09-records None 4/20/09-records received-WBC received-PMH: 14.6, 26 neutrophils, eczema. 63 lymph 172 CT LABS:WBC PVT 15.0(H). PUB CT scan abdomen/pelvis None abnormal. PMH: kidney reflux w/2 ureters on left. 14 13 Mar 2009 UNK 2221, Mycoplasma UNK sp. None Ab IgG, 3.07 None(H); Mycoplasma Environmental sp. Ab allergies IgM, 166; Family Streptococcus hx: bipolar. pneumoniae Ag 1 None PUB OTH None 0 Hep titer ordered PUB 4/8/09. PUB None known None 39 PVT PUB Eczema present Eczema 1 PVT OTH LANOXIN; CHF KDUR; PLAVIX; Allergic:LASIX; ASA, Hx COREG; gastritisCAPOTEN AMBIEN, CORDAX. 3 None UNK UNK Back pain Autoimmune hepatitis 1 OTH OTH 1 OTH OTH 0 PVT PVT OCP None Has history of fainting 880 VZV strain, OTH VZV WILD OTH TYPE STRAIN. Unknown PENICILLINChickenpox allergy WAES0901USA03661 693 None OTH OTH calcium (unspecified); SULFONAMIDE estrogens allergy (unspecified); WAES0901USA03665 SYNTHROID; COUMADIN 11 None OTH OTH XANAX None WAES0901USA03667 None OTH OTH None None WAES0901USA03668 Unknown OTH OTH aspirin 81 mg; Arthritis; calcium Drug Helicobacter (unspecified) hypersensitivity; pylori (+); chondroitin infection; Glaucoma; WAES0901USA03677 Breath sulfate Hiatus shortness sodium hernia;(+); Hyperlipidae NEXIUM 0 Unknown PVT PVT Unknown Penicillin allergy WAES0901USA03836 0 Unknown OTH OTH Unknown Unknown WAES0901USA03902 15 None OTH OTH EVISTA; vitamins Osteopenia; (unspecified) Chickenpox Cholesterol WAES0901USA03955 Unknown OTH OTH Unknown Shingles WAES0901USA03956 3 complete blood OTHcell OTH niacin None WAES0901USA03965
2 Unknown OTH OTH Unknown Unknown WAES0901USA04130 14 Unknown UNK UNK PREMARIN; Oesophageal CRESTOR reflux; Osteopenia; Cholesterol WAES0901USA04150 high Unknown OTH OTH Unknown Unknown WAES0901USA04153 327 Unknown OTH OTH Unknown Penicillin allergy; Herpes simplex WAES0901USA04173 397 Unknown OTH OTH Unknown Prostate Cancer Radiotherapy WAES0901USA04306 1 blood glucose OTH 01/29/09OTH 400 Unknown Unknown WAES0901USA04404 0 Unknown OTH OTH Unknown Unknown WAES0901USA04396 0 Unknown OTH OTH None Breast cancer WAES0901USA04370 14 Unknown OTH OTH Unknown Unknown WAES0901USA03135 0 Unknown OTH OTH Unknown Unknown WAES0901USA03157 0 None OTH OTH None Hypersensitivity Thyroidectomy WAES0901USA03303 8 Unknown OTH OTH FOSAMAX;Hypertension; CALCIUM(UNSPECIFIED) Hypercholesterolaemia; (+); LISINOPRIL; WAES0901USA03307 Osteoporosis; SIMASTATIN; Sulfonamide VITAMIN alle 2 None UNK UNK VALTREX Shingles WAES0901USA03329 30 Unknown OTH OTH Unknown Unknown WAES0901USA03333 Unknown OTH OTH Unknown Unknown WAES0901USA03341 5 temperatureOTH measurement, OTH 97.2; temperature ICAPS; OSTEO-BI-FLEX; measurement,aspirin; 97.3; VZV diclofenac; strain, VZV WAES0901USA03446 VYTORIN; WILD TYPE hydroxyzine STRAIN hydrochlori Unknown OTH OTH Unknown Unknown WAES0901USA03447 None OTH OTH PRILOSECHeadache; Food allergy WAES0901USA03463 2 None OTH OTH AVODART None WAES0901USA03466 0 Unknown OTH OTH Unknown Unknown WAES0901USA03540 696 Unknown OTH OTH insulin; interferon Diabetes; (unspecified); Multiple Chickenpox sclerosis COZAAR; TOPROL WAES0901USA03649 XL tablets; ACTONEL; SAN None OTH OTH calcium (unspecified); Hypercholesterolaemia PEMPRO; VYTORIN; FLAGYL WAES0901USA03095 Unknown OTH OTH Unknown Unknown WAES0901USA02961 25 Unknown OTH OTH CIPRO Unknown WAES0901USA02833 3 Unknown OTH OTH Unknown Drug hypersensitivity WAES0901USA02800 10 None OTH OTH amlodipine,5 Cholesterol; mg; VYTORIN, Hypertension 10-20 mg;hydrochlorothiazide WAES0901USA02715 (+), 12.5-2 mg; metfo 5 None OTH OTH Lisinopril; FLOMAX Allergic reaction (MORINFLUMATE); Shingles; to antibiotics; Skin reactionWAES0901USA02708 PRAVACHOL Sulfanomide allergy; Drug hypersensiti 14 Unknown OTH OTH Unknown Splenectomy WAES0901USA02698 0 None OTH OTH None None WAES0901USA02650 None OTH OTH aspirin; LIPITOR; Hypertension; PLAVIX;Hyperlipidaemia; LOPRESSOR; PRILOSEC; Osteoporosis; WAES0901USA02589 ACCUPRIL; Gastroesophageal ACTONEL reflu Unknown OTH OTH Unknown Unknown WAES0901USA02579 0 None OTH UNK None None WAES0901USA02573 45 Unknown OTH OTH Unknown Shingles WAES0901USA02537 Unknown OTH OTH Unknown Unknown WAES0901USA02505 366 Unknown OTH OTH Unknown Unknown WAES0901USA02101 Unknown OTH OTH Unknown Unknown WAES0901USA02381 Unknown OTH OTH Unknown Unknown WAES0901USA02397 Unknown OTH OTH LIPITOR; colchicine; Cardiovascular LASIXdisorder; (FUROSEMIDE); Hypertension; WAES0901USA02403 TOPROL Gout XL TABLETS; ZOCOR; 1 None OTH OTH FOSAMAX,Kidney ECOTRIN, stone; LIPITOR, Coronary NEUROTONIN, artery disease; WAES0901USA02404 RAZADYNE, Dementia; Renal NAMENDA, disorder;CEN Hy 1 Unknown OTH OTH Unknown WAES0803USA02373 6 None OTH OTH Diabetes Nervous breakdown; Shingles WAES0901USA04418 229 Unknown OTH OTH BONIVA Unknown WAES0901USA04420 9 Unknown OTH OTH VAGIFEM VARICELLA; CHICKENPOX WAES0901USA04430 1 Unknown PVT PVT Unknown Drug hypersensitivity; Cervical cancer; Seasonal Hepatitis; allergic WAES0902USA00018 Osteopenia rhinitis; Darier's disease None OTH OTH DEPAKOTE; Arthritis; CARDURA; Depression; NEXIUM; Diabetes; METFORMIN; Diverticulitis; WAES0902USA00136 NABUMETONE; Gastrooesophageal ZOLOFT;reflu ZO 48 VZV strain 01/28/09 OTH - NEGATIVE OTH NORVASC;Drug HYDRODIURIL; hypersensitivity; LEVOTHYROXINE Drug hypersensitivity; WAES0902USA00195 SODIUM; Penicillin COZAAR allergy 11 None OTH OTH VALTREX; Hypertension; DIOVAN; AMBIEN Genital Arthritis; herpes Drug hypersensitivity; WAES0902USA00207 Allergic reaction to antib 305 Unknown OTH OTH Unknown Chickenpox WAES0902USA00208 1 None OTH OTH DICYCLOMINE Allergic HYDROCHLORIDE; reaction to antibiotics; METHADONE Drug WAES0902USA00225 hypersensitivity HYDROCHLORIDE 336 None OTH OTH Unknown Hypertension; Palpitations hyperlipidaemia WAES0902USA00269 None OTH OTH BalsalazideColitis disodium; ulcerative; OMEPRAZOLE; Gout; Metabolic PAROXETINE WAES0902USA00292 syndrome
8 Unknown OTH OTH Unknown Hypertension; Coronary artery disease WAES0902USA00421 3 None OTH OTH None Allergic reaction to antibiotics WAES0902USA00435 8 Unknown OTH OTH ALVESCO Unknown WAES0902USA00443 2 None OTH OTH FLOVENT; hormones (unspecified); None vitamins WAES0902USA00474 (unspecified) 15 diagnostic laboratory OTH - OTH RA: normal;statin diagnostic (unspecified) Hypothyroidism; laboratory - HLB27: Hyperlipidaemia; normal; serum WAES0902USA00486 Back creatine disorder kinase 1020 - ; serum as 0 Unknown OTH OTH None WAES0902USA00505 Unknown OTH OTH Unknown Unknown WAES0902USA00546 7 None OTH OTH LIPITOR; COUMADIN Penicillin allergy WAES0902USA00561 17 None OTH OTH Unknown Blood pressure high WAES0902USA00562 82 diagnostic laboratory OTH - OTH came backUnknown fine; biopsyBreast - negative cancer Arm discomfort; Swelling WAES0902USA00594 arm; Pustule 76 complete blood OTHcell - normal; OTH rapid Streptococcus Diabetes - negative WAES0902USA00857 Unknown OTH OTH Lactose intolerance WAES0902USA00947 Unknown OTH OTH Unknown Unknown WAES0902USA00952 Unknown OTH OTH Unknown Unknown WAES0902USA01008 2 blood pressure PVT02/10/09 PVT 134/7 -; total ALBUTEROL; heartbeat Asthma; count ALBUTEROL Hiatus 02/10/09 Upper hernia; SULFATE respiratory - regular; Sinusitis; DOSE; body tractNasal WAES0902USA01029 temp infection; AZITHROMYCIN congestion; 02/10/09 Chest98.8 pain; Cough; 250 F Diarrhoea - oral; mg Hypersen tab; respira AZ infe 1 None OTH OTH None Unknown WAES0902USA01040 Unknown OTH OTH Unknown Unknown WAES0902USA01078 0 tuberculin skin OTHtest 11/21/08 OTH None Atrial fibrillation Chickenpox; Shingles WAES0902USA01108 0 Unknown OTH OTH Unknown Unknown WAES0902USA01461 14 None OTH OTH ginkgo; hydrochlorothiazide Penicillin allergy (+); levothyroxineWAES0902USA01473 sodium 4 Unknown OTH OTH Unknown Unknown WAES0902USA01476 story and no known drug allergies, UNK who in "Spring UNKof 2008"ASPIRINE; was vaccinated VYTORIN with aNone dose of ZOSTAVAX (Oka/Merck) WAES0902USA01488 subcutaneously. Conc 255 Unknown OTH OTH Unknown Unknown WAES0902USA01627 Unknown OTH OTH Unknown Unknown WAES0902USA01630 Unknown OTH OTH Unknown Unknown WAES0902USA01656 Unknown OTH OTH Unknown Unknown WAES0902USA01663 3 VZV strain -OTH VZV WILDOTH TYPE STRAIN Unknown Unknown WAES0902USA01665 diagnostic laboratory, OTH lesion OTH test negative Unknown form Varicella Unknown zoster virus WAES0902USA01744 Unknown OTH OTH Unknown Unknown WAES0902USA02379 0 Unknown OTH OTH own Autoimmune disorder WAES0902USA02384 Unknown OTH OTH Unknown Unknown WAES0902USA02441 2 laboratory test, OTH2/16/09, OTH positive VZV Unknown Unknown WAES0902USA02652 10 Unknown OTH OTH alendronate sodium; ALTACE; None ZOCOR; sotalol WAES0902USA02660 hydrochloride 305 Unknown OTH OTH Unknown Drug hypersensitivity; Penicillin allergy; WAES0902USA02679 Drug hypersensitivity. None OTH OTH ALBUTEROL; Diastolic ASPIRIN; dysfunction; LIPITOR; Hypertension; OPTIVAR WAES0902USA02680 OPHTHALMIC Systolic murmur; SOLUTION; Cholesterol CLONI high 0 None OTH OTH PENICILLIN allergy; SULFONAMIDE WAES0902USA02684 allergy; Allergy reaction to anti 1 Unknown OTH OTH Unknown None WAES0902USA02713 Unknown OTH OTH Unknown Unknown WAES0902USA02787 Body temp,OTH 02/09?/09,OTH 99, maximum. OMEGA-3; Hypertension; PRILOSEC; Chickenpox TIMOPTIC; Osteoarthritis DIOVAN; WAES0902USA02901 vitamin b complex; vitamin d (u 1 None OTH OTH ASPIRIN; Iodine BUMEX; allergy Calcium (unspecified); LEXAPRO; WAES0902USA02954 NEXIUM; BYETTA; G 1 None OTH OTH Unknown Allergic reaction Shingles; to antibiotics; Gastric disorder Sulfonamide WAES0902USA02966 allergy; Drug hypersensiti Unknown OTH OTH Unknown Unknown WAES0902USA03055 0 Unknown OTH OTH Unknown Unknown WAES0902USA03099 2 Unknown OTH OTH Unknown Shingles WAES0902USA03124 None OTH OTH Unknown Unknown WAES0902USA03186 2 Unknown OTH OTH Unknown Drug hypersensitivity; Penicillin allergy WAES0902USA03535 31 None OTH OTH CYMBALTA Shingles WAES0902USA03564 62 Unknown OTH OTH Unknown Unknown WAES0902USA03736 Unknown OTH OTH Unknown Unknown WAES0902USA03747 Unknown OTH OTH Unknown Cardiac failure WAES0902USA03762 1 Unknown OTH OTH Unknown Sulfonamide allergy WAES0902USA03787
28 magnetic resonance UNK - normal UNK withFOSAMAX; "ptosis" listed; LIPITOR electronystagmography Osteoporosis; Low density WAES0902USA03808 lipoprotein increased Unknown OTH OTH Unknown Fibromyalgia WAES0902USA03809 2 None OTH OTH FOSAMAX;Osteoporosis; aspirin; calcium, Hypertension (unspecified); EVISTA; WAES0902USA03811 triamterene; vitamins, (unsp 624 Unknown OTH UNK hydrochlorothiazide; Penicillin allergy; RAMIPRIL High blood pressure WAES0902USA04034 1 None OTH OTH ASPIRIN; METOPROLOL; Blood pressure Stenthigh ZOCOR; placement VitaminsWAES0902USA03984 (unspecified) Unknown OTH OTH Unknown Unknown WAES0902USA03991 0 Unknown OTH OTH Unknown Unknown WAES0902USA04015 810 Temperature OTH measurement, OTH 96.9 AmitriptylineHypertension; hydrochloride;Coronary NORVASC; arteryLIPITOR; disease; WAES0902USA04081 METOPROLOL Hyperlipidemia; Drug hyper 2 diagnostic laboratory OTH - OTH FLOMAX (MORNIFLUMATE) Pain; Vaccination SIMVASTATIN adverse WAES0902USA04091 reaction 0 Unknown OTH PVT Unknown Unknown WAES0902USA04093 10 Unknown OTH OTH NEXIUM; PLENDIL; SYNTHROID Unknown WAES0902USA04102 298 None OTH UNK Unknown Osteoarthritis; Cholesterol levels raised; WAES0902USA04107 Degenerative joint disease; H 0 None PVT PVT HYOSCYAMINE; Drug hypersensitivity; PRILOSEC; ACTONEL Osteoporosis; WAES0902USA04109 Irritable bowel syndrome; Gastro 455 None OTH OTH aspirin; ATENOLOL; Type 2 diabetes LIPITOR; mellitus; CYANOCOBALAMIN; CoronaryWAES0902USA01793 artery disease; AVODART; Prostate VASOTEC; cancerGL 0 None OTH OTH TEKTURNA; Allergic AMLODIPINE; reaction to ASPIRIN; antibiotics NEXIUM; WAES0902USA04181 TRICOR; COZAAR; METOPRO 346 diagnostic laboratory, OTH negative OTH varicella Unknown zoster HASHIMOTO's virus; diagnostic thyroiditis; laboratory, Autoimmune positive WAES0902USA01812 todisorder herpes zoster virus Unknown OTH OTH Unknown Unknown WAES0902USA04193 0 Unknown OTH OTH Unknown Unknown WAES0902USA01851 0 Unknown OTH OTH Unknown Unknown WAES0902USA04217 Unknown OTH OTH Lantus; Metformin Diabetes; Sulfonamide allergy; Penicillin WAES0902USA02162 allergy; Allergy to vaccine 7 Unknown OTH OTH None Shingles; Blister WAES0902USA02166 serum herpes OTH simplex,OTH positive; serum Unknown herpes simplex, positive Unknown WAES0902USA02178 90 allergy test,OTH multiple tests: OTHresults Unknown negative Diabetes WAES0902USA04397 2 Unknown OTH OTH Unknown Unknown WAES0902USA04401 Unknown OTH OTH Unknown Unknown WAES0902USA04516 2 None OTH OTH FOSAMAX Hyperlipidaemia; PLUS D; CELEXA; Osteoporosis; DYAZIDE; ZOCOR; Hypertension; WAES0902USA02189 SULINDAC Osteoarthritis; Drug hy 0 Unknown OTH OTH Unknown Unknown WAES0902USA02244 None OTH OTH Unknown Blood pressure Swelling abnormal; arm ThyroidWAES0902USA02253 disorder 1 Unknown OTH OTH PLAVIX; fluconazole; Sulfonamide DIAZIDE; Shingles allergy; omeprazole; Drug hypersensitivity WAES0901USA01764 PRILOSEC; simvastatin; VALTREX 5 None OTH OTH None None WAES0901USA01762 0 None OTH OTH Unknown Unknown WAES0901USA01761 2 None OTH OTH Unknown Unknown WAES0901USA01750 0 Unknown OTH OTH Unknown Unknown WAES0901USA01748 None OTH OTH Acyclovir Human immunodeficiency WAES0901USA01737 virus exposure 141 viral culture,OTH culture of OTH vesicular culture influenza negative virus for vaccineNone virus and bacteria; WAES0901USA01730 Unknown OTH OTH Unknown Unknown WAES0901USA01717 0 None OTH OTH glucosamine Hypersensitivity; sulfate Flu Allergic reaction to WAES0901USA01639 antibiotics 0 None OTH OTH None Arthritis; Sulfonamide allergy WAES0901USA01575 275 Unknown OTH OTH lovastatin; vitamins (unspecified) Unknown WAES0901USA01561 0 None OTH OTH Unknown Unknown WAES0901USA01560 0 None OTH OTH Unknown None WAES0901USA01471 Unknown OTH OTH Unknown Unknown WAES0901USA01366 35 Unknown OTH OTH MEDROL DOSEPAK Unknown WAES0901USA01337 10 Unknown OTH OTH Unknown Unknown WAES0901USA01333 Unknown OTH OTH Unknown Sulfonamide Blood allergy pressure high WAES0901USA01302 0 None OTH OTH Unknown None WAES0901USA01470 0 None OTH OTH Unknown None WAES0901USA01289 0 echocardiography, OTH results OTHnot reported None Breast cancer; Shingles Atrial fibrillation; Cardiac WAES0901USA01288 valve leak; Drug hypersensitiv Unknown OTH OTH Unknown Unknown WAES0901USA01231 13 None OTH OTH Unknown Unknown WAES0901USA01219 0 Unknown OTH OTH PLAVIX, Pramipexole Crohn's disease; dihydrochloride, Penicillin allergy; ZOLOFT, WAES0901USA01207 Allergic AMBIEN reaction to antibiotics
1 Unknown PVT OTH LIPITOR; LEXAPRO; Hypercholesterolaemia; ZETIA; Shingles BONIVA Osteopenia; WAES0901USA01184 Penicillin allergy; Drug hypersen 0 Unknown OTH OTH Unknown Unknown WAES0901USA01183 0 Unknown OTH OTH Unknown Unknown WAES0901USA01182 0 Unknown UNK UNK PENICILLIN allergy WAES0901USA01161 0 Unknown OTH OTH Unknown Unknown WAES0901USA01154 Unknown OTH OTH Unknown Unknown WAES0901USA01151 14 None OTH OTH SYNTHROID; TOPROL None XL tablets WAES0901USA00075 4 Unknown OTH OTH LIPITOR Sulfonamide allergy WAES0901USA00062 0 Unknown OTH OTH Unknown Shingles WAES0901USA00038 Unknown OTH OTH Unknown Unknown WAES0901USA00028 11 None OTH OTH calcium (unspecified); vitamin None D (unspecified)WAES0812USA05244 0 Unknown PVT PVT Unknown Articulation problem WAES0812USA05241 214 Unknown OTH OTH NEXIUM Penicillin allergy Welts; Gastroesophageal WAES0812USA05203 reflux disease 7 None OTH OTH ADVAIR Asthma WAES0812USA04879 3 Unknown OTH OTH Unknown Unknown WAES0812USA04852 305 body temp, OTH 97.5 F OTH aspirin; hydrochlorothiazide; Hypertension Chickenpox lisinopril WAES0812USA04849 0 None OTH OTH LIPITOR Penicillin allergy WAES0812USA04830 0 Unknown PVT PVT None None WAES0812USA04714 0 Unknown OTH OTH Unknown Unknown WAES0812USA04643 0 Unknown OTH OTH Unknown Unknown WAES0812USA04568 1 Unknown OTH OTH Unknown Non-Hodgkins lymphoma; WAES0812USA04555 Cold sores 61 Unknown OTH OTH Unknown Unknown WAES0812USA04552 0 Unknown OTH OTH acyclovir Herpes simplex WAES0812USA04530 0 Unknown PVT PVT None WAES0812USA04509 0 Unknown OTH OTH Unknown Unknown WAES0812USA04273 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0812USA04260 1 Unknown OTH OTH Unknown Drug hypersensitivity; SulfonamideWAES0812USA04142 allergy None OTH OTH None Allergic reaction to antibiotics WAES0812USA04112 375 diagnostic procedure, OTH 12/16/08 OTH - diagnosed DIOVAN with Blood neuropathy pressure Shingles in her legs and feetWAES0812USA04103 1 None OTH OTH aspirin; LEVOXYL; Hypertension lisinopril; WAL-ITIN; EFFEXOR WAES0812USA04087 XR Unknown OTH OTH Unknown Unknown WAES0812USA04037 Unknown OTH OTH Unknown Unknown WAES0812USA04036 Unknown OTH OTH Unknown Unknown Unknown WAES0812USA04035 3 Unknown UNK UNK WAES0812USA03774 1 Unknown OTH OTH Unknown Left inguinal hernia; Surgery WAES0812USA03763 0 VZV strain, OTH 12/19/08, VZV OTHWILD TYPE CHANTIX STRAIN Hypothyroidism; Hormone replacement WAES0812USA03704 therapy; Sulfonamide allergy; Unknown OTH OTH Unknown Unknown WAES0812USA03607 321 Unknown OTH OTH Unknown Unknown WAES0812USA03603 6 Unknown OTH OTH Unknown WAES0812USA03597 0 None OTH OTH Unknown Dialysis; Allergic reaction to antibiotics WAES0812USA03386 1 None OTH OTH FOSAMAX;Hypertension; CYMBALTA; PRINZIDE Osteoporosis WAES0812USA03374 0 None PVT OTH calcium (unspecified); Chickenpoxvitamin Drug hypersensitivity d (unspecified)WAES0812USA03371 0 Unknown OTH OTH Unknown Unknown WAES0812USA03349 Unknown OTH OTH Unknown Unknown WAES0812USA03315 304 Unknown OTH OTH Knee arthroplasty; Hip WAES0812USA03240 replacement; Cardiac pacemaker in 0 OTH OTH Unknown WAES0812USA03215 1 None OTH OTH Unknown Unknown WAES0812USA03191 399 None OTH OTH NORVASC,Hypertension; LIPITOR, PRILOSEC, Disseminated Drug hypersensitivity; PAXIL, large cell MYSOLINE; WAES0812USA02814 lymphoma; Sulfonamide vitamins Anemia allergy; (unspecified) Gastroesop 0 None PVT PVT LIPITOR; ZOLOFT; Fever blister COUMADIN WAES0812USA02780 0 Unknown OTH OTH Unknown Unknown WAES0812USA02628 153 Unknown OTH OTH LIPITOR; ACTOS Diabetes WAES0812USA02621
636 Unknown OTH OTH Unknown Hypertension; Chickenpox; Diabetes; Lipids Coronary increased WAES0812USA02617 artery disease Unknown OTH OTH unknown Unknown WAES0812USA02596 Unknown OTH OTH Unknown Latex allergy WAES0812USA02350 0 blood pressure, PVT 12/10/08, PVT120/8; blood (therapy pressure, unspecified) Hypercholesterolemia 12/10/08, 120/8; vital sign, 12/10/08, WAES0812USA02325 normal; total heartbeat coun 0 None PUB PUB None WAES0812USA02200 Unknown OTH OTH Unknown Shingles WAES0812USA02144 372 None OTH OTH SYNTHROID; Hypertension; ACTONEL Hyperlipidaemia; hypothyroidism WAES0812USA02139 Unknown OTH OTH Unknown Unknown WAES0812USA02115 0 None OTH OTH None Hypertension; Hypothyroidism; Drug WAES0812USA02032 hypersensitivity Unknown OTH OTH Unknown Unknown WAES0812USA02055 3 body temp, OTH 100.4 degrees OTH Unknown Unknown WAES0812USA01823 0 None OTH OTH None Drug hypersensitivity WAES0812USA01782 Unknown OTH OTH Unknown Shingles WAES0812USA01775 0 Unknown OTH OTH Unknown Unknown WAES0812USA01655 0 erythrocyte OTH - was initially OTH 77 and later LIPITOR 7 Sleep apnoea Head injury WAES0812USA01630 50 None OTH UNK NORVASC;Blood PLAVIX pressure Stenthigh; placement Shingles; Post WAES0812USA01604 herpetic neuralgia Unknown OTH OTH Unknown Unknown WAES0812USA01189 335 Unknown OTH OTH Unknown Chickenpox. WAES0812USA00539 2 None OTH OTH (therapy unspecified) Prostatic disorder WAES0812USA00393 660 None OTH OTH Unknown None WAES0810USA00373 Unknown OTH OTH Unknown Unknown WAES0812USA00362 7 HematologyOTH - came outOTH OK Therapy unspecified Blood pressure abnormal WAES0812USA00358 274 Unknown OTH OTH COUMADIN Neuropathy; Macular degeneration WAES0812USA00054 4 Unknown OTH OTH Aspirin; FENOFIBRATE; Hypertension; Chickenpox QUINAPRIL Dyslipidaemia; hydrochloride; Penicillin WAES0812USA00050 allergy ZOCOR; vitamins (unspecifi None OTH OTH COUMADIN; Leukaemia; PAXIL; VALIUM Stroke Memory loss; Sulfonamide WAES0812USA00009 Allergy; Immunosuppression Unknown OTH OTH Unknown Unknown WAES0901USA01076 Unknown OTH OTH Unknown Unknown WAES0901USA01075 0 None OTH OTH Unknown Shingles WAES0901USA01009 22 Unknown OTH OTH Unknown None WAES0901USA01004 0 Unknown UNK UNK FOSAMAX mg; Calcium (unspecified) mg; Chondroitin WAES0901USA01001 sulfate sodium +; Vitamins 2 Unknown OTH OTH Unknown Sulfonamide allergy; Allergic reaction WAES0901USA00990 to antibiotics Unknown OTH OTH Unknown Unknown WAES0901USA00804 1 Unknown OTH OTH LIPITOR; ENALAPRIL CholesterolQuadruple MALEATE; high vessel ZETIA; bypass METOPROLOL WAES0901USA00790 graft; Shingles; TARTRATE Adverse drug rea 0 Unknown OTH OTH ACTONEL Unknown WAES0901USA00787 0 None OTH OTH Unknown Unknown WAES0901USA00333 7 Unknown OTH OTH Unknown Unknown WAES0901USA00314 14 Unknown OTH OTH Unknown Unknown WAES0901USA00196 0 diagnostic laboratory, UNK results UNK unknown simvastatinSulfonamide allergy WAES0901USA00135 1 Unknown UNK UNK BUFFERIN;Hypothyroidism; BIOTIN; SYNTHROID; Arthritis;potassium Diverticulitis; WAES0901USA00132 (unspecified) Cystitis interstitial Unknown OTH OTH Unknown Unknown WAES0904USA00201 Unknown OTH OTH Unknown Unknown WAES0904USA00198 0 Unknown OTH OTH NORVASC;Diabetes; GLUCOTROL; Hypertension; insulin; PRINIVIL; Hypercholesterolaemia; WAES0904USA00475 GLUCOPHAGE; Hospitalisation ZOCOR 0 Unknown OTH OTH None Pregnancy NOS (LMP = 2/13/2009) WAES0903USA03642 Unknown OTH OTH Unknown Unknown WAES0904USA00186 Test CT-CTPVT abdomen Oct. PVT 17-2006 AVAPRO; w/wo LABS:breast Insulin; crackedEXTRADIOL; rib Brice biopsy happen Windsor c/w after ALLEGRA ~Influenza cancer four PMH: or five DIDDM, (nodays brand asthma, later name)~UN~0~Patient URI, ganglion cyst, d 1 EKG-Normal PUB limits. Labs PUB and Diagnostics: UnknownHead None CT WNL. None. CBCPMH: WNL.Febrile Chem seizures. WNL except On CO2 OCs low at 20.2. EKG W 0 None OTH PVT TYLENOL No No 0 PUB PUB Bactrim Resolved UTI None 0 PVT UNK Minor syncopal event with vaccination GARDASIL 10/18/0 7 DNA test; CT PVT Scan; Echocardiogram; PVT BirthBlood control tests; None pills X-ray;PMH:anorexia, Positive Factorwt V Leiden stable x LABS: 2 yrs. Protein OCP since C functional 11/08. Allerg 166% 1 PVT PVT none Asthma; Allergies; Swelling~Tdap Eczema(no brand name)~5~11~Patient
49 ULS, CT scan, PVTblood work PVTall normal. Labs and Diagnostics: PMH:KUB Mono-LLQ (+) (+) for tenderness scybala. 5/5/08 UC (+)with for 100K liver and colonies. spleenCo p 1 CBC PVT UNK VENTOLINNone HFA Exercise- Induced Bronchospasm 0 640 pm- t/cOTH to ER indicated UNK child stable PPD planted None R forearmNone 0 PVT PVT 0 CBC -> WBC PVT 12,200 H/H PVT11.0/33.7 None plt 472 None None 0 PVT PVT Baby ASA daily Well child Atrial septal defect, (ASD) repair 2/09 10 None UNK UNK ALLOPURINOL 100mghypertension, bid, GEMFIBROZIL hyperlipidemia, 600 mg bid, gout,LISINOPRIL PVD, CAD, 40 diabetes mg daily 5 UNK UNK PVT UNK 0 OTH PUB 25 PVT PVT AMOXIL-Dx-OM Othis Media 0 PVT PVT None None None 2 None MIL MIL FLONASE; None ALLEGRA NKDA 0 PUB PUB Mefloquine None Allergies, Eggs, wheat, corn (starches) 4 Exam consistent PVT was Bell PUBPalsy. None None None PUB UNK PUB PUB Exposure toNone Hep A patient none PUB PUB none none none 0 PVT PVT Metformin; Glipizide; Unknown Simvastatin; Unknown Lisinopril. MIL MIL 0 UNK UNK 3 Blood and CSF UNKcultureUNK NEGATIVE. None. HSV 1/2None. DNA CSF <80 Exceptionally copies/ml healthy, NEGATIVE; no illnesses. wbc 9.0 (45 Currently gran, 36 breast lymph) feedin >8 1 N/A PUB PUB 0 PUB PVT unknown None Allergic to Demerol ~ ()~3~~In Patient 288 UNK UNK COPD 1 N?A atthis time PUB PVT None No Spleen removed in 1998 0 "DR at ER told PUBme I was PUB allergic to Flu vaccine"tx NONE with prednisone Per vaccinee:allergy and pepsid-to"found codiene, allergic Morphine,oxycodone,sulfa to pepsid" see allergi 10 Autopsy was UNK done UNK no No premature, no~ "hole" ()~~0.00~Patient|no~ in heart that was healed ()~~0.00~Sibling|no~ PMH: preemie, 0 none UNK UNK none acne none 200 Zoster as above. PVT PainPVT requiring tylenol none with codeine none none 1 PUB UNK acute pancreatitis 0 PVT PVT teething topFever tooth and fussy see #19~ x 3 days ()~NULL~~In with 4 month Patient injections. Fussy a 3 none UNK UNK Afebrile, gastroenteritis No known allergies 1 Newborn Screen UNK - normal UNK Mild congestion/ none cold symptoms 18 UNK UNK Benadryl. None. Patient had chickenpox approximately 4-6 years of age. 0 CXR, UA, bloodwork UNK LABS: UNK WBCnone 14.2(N), neutros none 51.9%(H), Premature, lymphs low 43.1%(L). birth weight, Creatinine born at 0.24(L), 30 weeks BUN/creat gestationratP None PVT PUB None None None 1 PVT PVT claritin, multivitamin, none known epipen lots ofas food needed allergy's, on all peanut meds allergy's, penicillin 1 none PVT PUB NO None none~ ()~NULL~~In Patient 2 UNK UNK none none none 0 Neg PVT UNK Lipitor; Altace; Flomax;CAD; Coreg; COPD; Spironolactone HTN; Hyperlipidemia; CHF 0 UNK PVT OTH No concurrent Unknown medication A0774135A 0 Increased CBC; PVT UA; Blood PVT cultures None negative None 6/15/09 - well Received H.O. exambenign that hospital day brain medical tumor records (resected for2007); 3/27-3/28/2009 peritoneal&shunt ER r 0 PVT UNK 0 None UNK UNK No No None 3 PVT PVT 0 PUB PUB None statedNone reported None noted 0 PVT UNK Well child 0 Pending OTH OTH None None None PVT UNK NKDA 1 none UNK UNK ALLOPURINOL None gout; bilateral shoulder bursitis
1 OTH PVT 14 OTH PVT wn position and forceful exertion. PUB PUB None 2 None doneUNK PUB None None Hx of seizures as school aged child. 1 None performed PUB PUB Mother denies None reported PVT OTH Not reported ### 0 None reported. PVT OTH The patient had a history of milk ###protein intolerance and w 0 diagnostic laboratory, OTH 03/20?/08, OTH posit -; ultrasound, Pregnancy 03/26/08 NOS (LMP - pending; = 1/10/2008) urine betaWAES0804USA01379 human, 03/20?/08 posit - eryth 15 ultrasound, OTH 02/02/09, revealed OTH a normal None pregnancy Chlamydial infection WAES0902USA01068 11 hematologyOTH LABS: WBC OTH 1.5(L), ANC None 400, H/H 4.7/13.2, None plts 3,000. PMH:Bone asthma, marrow pneumonia WAES0904USA00618 biopsy. xStrep 2 2006 && mono 2008, c/soral neg. co Unknown OTH OTH Unknown Unknown WAES0904USA01122 Unknown OTH OTH Unknown Unknown Autism~Measles WAES0904USA00236 (no brand name)~UN~0~Sibli Unknown OTH OTH Unknown Unknown Autism~Measles WAES0904USA00813 + Mumps + Rubella (no brand 331 Unknown OTH OTH Unknown Unknown WAES0904USA00610 Not reported UNK UNK The patient had a known pertussis ### exposure. 1 None OTH OTH aspirin; buspirone hydrochloride Unknown mg; ZETIA mg; WAES0901USA03627 LOVOTHROID mg; TOPROL XL 1 UNK PUB not known no not known 1 PUB PUB Pulmicort BID Wheezing (slight) Asthma allergy to mulberry MO-2009-12 UNK UNK none. diabetes 8 PUB PVT none none I am allergicnone~ to sea()~NULL~~In food and penicilline. Patient 3 UNK UNK 1 PVT PUB 1 PVT PVT none none none 0 Tests done UNK on 4-8-09, UNK show high SED rate and none lowalso blood received PMH: iron levels. Irregular TBALl test/neg LABS: major menses. H/H reactions Juvenile 9.7/29.0(L). to first osteoporosis. two ESRpertussis, 30(H).Heart CMP, then muTs 4 ABG, CBC,UNK CMP, CXR,UNK head CT, none brain MRI,right EEG, conjuctivitis, LABS: none CT PMH: rhinitis head,V/D, CXR,fever, BMPcongestion, WNL. 24-hour Family EEGhx: abnormal. childhoodM 2 PUB PVT NTG,Zetia,Loustation,Atenolol,Glucophage,Bentyl,Lexapro,HCTZ,Sancatana,Adv Allergies:Keflex,Iodine,Cipro,Ancef, Biaxin,Amoxicillin HX: 1 PUB PUB none 1 This is the second PUB report PUB this week with reaction from same lot number 1 MTI, EEG PVT UNK none none laryngomalacia-resolved 0 none PUB PVT none nasal congestion none 1 PUB PUB 0 PUB PUB none none sulfa allergy 1 PVT PUB none none none 0 PUB UNK none none none 0 none PUB PUB none none Born with heart murmurSC0910 4 PediatricianPVT has confirmed PVT that symptoms areNone from MMRNone vaccination. 3 CBC; CMP;PVT U/A; Abdominal PVT X-rays None and CT Scan Noneall WNLHistory LABS:ofWBC abdominal 13.9(H), migraines plts 524(H), PMH: neutros cyclic 73.0%(H), vomiting & lym ab OTH PUB None None 5 PVT PVT None None 0 PVT PUB Ibuprofen, Tylenol, Getting over Benadryl None a cold 1 PVT UNK None Bronchiolitis; Ear infections 344 PUB OTH None Allergies, feathers, dust; Osteoarthritis, knee replacement; 0 PVT PUB 0 None PVT PVT None none none 11 PVT PUB None None None fever~DTaP (no brand name)~2~0~Patient 2 PVT PVT none none 1 None PVT PVT None None NKDA 0 None PVT PVT None None None Laboratory UNK from hospital, UNK reveal low Sulindac testosterone 200mg Noneinand the Tramadol patient. unknown Head 50 hcl50 Dr. continuous mg tab with treatment, and still lookin 1 PUB PVT Cymbalta, Lisinopril, None but Prilosec recently AllergicOTC recovering to Prednizone (3 weeks) and Nizoral from unknown GI infection tha Chest x-rayPVT negative UNK LOVENOX;Asthma VICODIN; exacerbation Asthma PRILOSEC; SOLMEDROL; ADVAIR; XOPENEX;SINGUL
10 I know of noUNK tests, the UNK recommendation for ADD none was - Ifmade this Colds, isn't by his the tonsilitis teacher. correct Aggressive venue behavior to report towards this, please mother~ let me ()~UN~8 know 2 UNK UNK allergies: Zocor, Crestor, Lopid, fire ants 93 UNK UNK none 16 X ray, CT Scan, UNK Lab, Bronoscpy UNK 205 none reported OTH OTH not reported ### No testing had UNKbeen performed. UNK Not reported ### 0 none reported PVT OTH PREVACID NKA ### 0 Serum C-reactive, OTH 01/??/09, OTH slightly Antimicrobial elevated Food 5/26/09 (unspecified); allergy; Received Gastrooesophageal Pollen ORTHO rheumatology allergy; TRI-CYCLEN; Nasal reflux consult WAES0903USA04563 septum disease; ADVIL DOS deviation; 1/13/09. WisdomProphylaxis; LABS teeth remova and DIA A 0 X-ray, ?/?/09, OTH negative;OTH magnetic resonance, Unknown ?/?/09, reabsorption Unknown.inPMH: the humeral condylomata WAES0904USA00862 head and acuminatum. a tiny partial Lumbar thickness disc Unknown OTH OTH Unknown Unknown WAES0904USA00866 Unknown OTH OTH Unknown Unknown WAES0904USA00886 0 LABS: H/H PVT 8.8/28.4(L),PUB plts 574(H). Was CTon head Phenobarbital severe WNL. developmental Developmental 30 mg TID delay up until delay (from 3 wks and birth); ago seizures seizures (ran out (epilepsy); of - beginning med)severe at age men2 CBC & ESRPVT LABS: WBC PVT13.6(N),Amoxicillin segs 79.4%(H), No lymphs PMH: 18.3(L), urticaria H/Hx14.1/42.3(H), 3 wks prior, unknown plts 497(H). cause. Sodium RAST 131(L), testin 2 Labs: EchoPVT WNl. CBCPUB with normal WBCs Hgb No8.5-9.4. Hct No 26.6-29.3. PMH: noneMCV 57 (L). MCH 18 (L). Platelets 502. UC 3 abnormal EEG. PVT Labs and PVTDiagnostics: Brain None MRI with ? None. lack ofPMH: gray-white none matter noted differentiation in temporal lobe an 1 PVT PVT ZOCOR 10 Q day; NASONEX PCN, Sulfa, 2 Q Hypercholesterolemia AM; Pseudophedrine 30 2 Q AM; VISINE dry 0 PUB PUB no OR200916 0 PUB PVT VERAPAMIZ No ATRIAL FIBKnot at injection OR200915 site common after vaccines~ ( 1 PUB PUB No No No OR200917 6 None PUB PUB None None 0 PVT PVT None OMNICEF; PCN 45 None donePUB UNK None Penn; Sulfa 2 UNK OTH No No 0 None OTH OTH None None Allergy to Sulfa drugs 1 PVT OTH None 1 PVT PVT KEPPRA 500 None mg one BID Seizure Disorder/NKDA 1 PVT OTH None None Positive Pregnancy MIL Test MIL ALLEGRA None None 202 PVT PVT None None None 2 None OTH PUB None None None UNK UNK 0 OTH PVT None None None 1 None MIL MIL None 2 PVT PVT Atenolol; Aurlide; None Detrol None 1 PVT PVT None Otitis Media - Started AMOX X 10 days on 3-20-09. Histor 1 None PVT PVT None None None PVT PUB None None None (Pt. is in the process of behavioral / eval. 0 Syncopal episode PVT 90/62 PVT (BP reading) None : Discharged No from None clinic 96/64 1 PUB PUB None Known None None Known 1 None PVT PVT 2 None PVT PVT 0 PVT PVT None 0 OTH OTH METOPROLOL; NORVASC; Osteoarthritis; LISINOPRIL; HTN; NAPROXEN; diabetes; obesity; OXYCODONE/APARSU sleep apnea; hyper 1 OTH PVT CHANTIX; EFFEXOR; None None LIPITOR; MIRAPEX 1 PVT PVT No 6 PVT PVT None None 13 None PVT OTH RSV Broncholitis PVT UNK 0 None PVT PVT None None None Flu like~Tdap (no brand name)~UN~11~Patien 16 PUB UNK AR0911 731 None PVT PVT BACTROBAN; NoneBENICAR/HCTZ; Type II Diabetes; ~Tdap DIFLUCAN; HTN; (Adacel)~1~50~Patient Elevated SIMVASTATIN; Lipids; TAC; Obesity; Vitamin GERD D
0 PUB UNK None None Hypertension / Possible allergy to PCN 0 PVT PUB 1 OTH UNK 9 PVT PVT ZANTAC None Ex 28 wk preemie / well child 0 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0773093A medical history and no history 0 UNK PVT OTH No concurrent Unknown medication The subject has no relevant A0777610A medical history and no history 1 OTH PUB None No None 1 None PUB OTH None 2 PVT PUB 2 None at thisPUB time PUB None None None 3 LP, 0 cells; PVT Glucose, 34; PUB Pr 4; CRP < 0.2; WBC, None 9; Lym, None 6.8; ESR, PMH: 15;nasolacrimal RSV, Neg duct LABS: stenosis; CSF WNL. spitting Segs up 22%(L) & form AntinuclearOTH antibody, 31Jan2000, OTH Thyroxine negative; Erythrocyte sodium; Anxiety;Venlafaxine Back sedimentation Rotator pain; cuff Depression; hydrochloride; tendinitis; rate, 31Jan200, Hypothyroidism Shoulder A0600422A Anxiolytic; 111mm/hr; dislocation; Progesterone Hematocrit, Shoulder impi 31J Diagnostic tests: OTH 12 March OTH2002: HLA-DR4 DIGOXIN;present. Warfarin Allergy Lyme tosodium; red Atrial disease dye; fibrillation; OMEPRAZOLE Cardiac screen valve Hand 1 31disease; A0605477A surgery; LIV (positive). Lumbar Fatty liver Lyme spinal disease fracture; IgGTho an AntinuclearPVT antibody, Aug1999, PVT negative; Multivitamin Erythrocyte Herpes Simplex sedimentation Mitral1;valve Hyperlipidemia; prolapse. rate, Aug1999, The A0308640A Immunologic vaccinee 44mm/hr; has findings; Rheumatoid no known Macular allergie factor, DeA 6 PVT UNK none 10 34256 - MEASLES PVT ANTIBODY, PVT (IGM) noneTest Name no Resultnone Flag(s) Reference Range Reported Date Footnote MEAS 9 Daughter was UNK taken toUNK Hospital onInfant 4/12/09 Motrin after None. orthe Infant rashTylenol None. became Daughter (aspronounced needed was during examined and teething started onspreading. episodes). 4/3/09 andDr. Rarely was diagnose deeme more 2 UNK PVT NONE LISTED NONE ALLERGY TO DOXYCYCLINE AND SULFA 1 None UNK UNK PPD None Healthy 1 None PVT PVT Flovent None 3 UNK PVT none notedLevaquin, Sulfa, PCN 1 Had CT scan PUB done in ER PUB on 4-8-09. N/A N/A None known 1 UNK UNK lamotrigine 0 N/A UNK PVT RABIES VACCINE NONE DILUENT NONE NOVARTIS LOT 802011 1 UNK UNK Nasal Drainage: clear 21 LABS: CSF:UNK WBC 1, RBC UNK2, protein 37.5, glucose unknown 63. Potassium NKDA PMH: 3.2(L), DDD sodium c-spine. 133(L). Endometriosis ANA(+), SSA w/surgery. 193(H). Fam W 9 None donePVT PUB Amoxicillin upper respiratory none infection 2 Blood work UNK and a spinal UNK tap were None performed Known. in None the hospital. None Labs Known and PMH: Diagnostics: ChronicMRI H/Abrain x 9 months. WNL except Bellsmaxillar Palsy 7 0 UNK PUB NONE DM II,HTN, DYSLIPIDEMIA, LOW BACK PAI-L2 FX, ALLE None PUB PUB Eucerin cream Cough or Aquaphor None; History of delayed immunizations 1 PVT PVT 3 LABS: WBCUNK 3.2(L). PotassiumUS UNK of right arm c/w edema PMH: vs cellulitis dermatomyositis, w/o abscess. interstitial CXR abnormal. lung disease, X-ray pulmonary right hu 1 None PVT PVT None none GERD as an infant 0 OTH PVT 0 OTH PUB PPD SanofiNone Pasteur C2912AA None ID/RA 3 OTH PVT PRAVOSTATIN None40mg NKA 1 PVT PUB VFC (Vaccine None for children) Asthma. 1 PVT PVT 0 PUB MIL advair, singulair, None zyrtecAsthma, Latex sensitivity 0 None UNK UNK NUVA RING N/A HEP A IN 1991, TB test positive due to adminstration to BC 1 N/A PVT UNK 9 MIL MIL NONE NONE NONE 1 TSH, CBC, PVT BHCG, mono PVTspot depo provera diarrhea sulfa 6 PVT UNK none 8 PUB PUB none none no~ ()~NULL~~In Patient 1 LABS: Blood UNK tests WNL. UNK MRI WNL. none EEG abnormal. none premature birth PUB UNK Synergist RSV 5 CBC, rapid PVT strep test (negative) UNK clarinex started allergic dayrhinitis of asthma vaccinations 0 PVT PUB none none 657 none PVT PUB Fever100-101.Headache none 0 PVT PVT
0 None PVT PVT Lamictal Denied. Allergy to Dilantin, Cipro, Benadryl. Pt. has history of epile 3 PUB PUB 1 PUB PUB n/a n/a n/a 11 PUB PUB N/A N/A N/A 0 none PVT PUB none none none 0 PUB PUB GENERAL NONE RASH PR-09-05 5 POS PREGPVT TEST 03/25/09 PUB NONE KNOWN NONE 0 NONE PVT UNK NO PR-09-06 1 none ice bag PUB PVT vertigo 4 NONE PUB PVT NONE 1 none PVT UNK none none none 0 PVT PVT Nexium, toprol XL, benicar BenadrylHCT, insomnia, combiventhypertension, inhaler. ND-09-04 GERD 0 PVT UNK Tri-Vi-Sol reactive lymphadenopathy, None. cephalohematoma(birth injury) 3 Paatient with UNK lymphoma, UNK had radioation Fluxoetine on 10/3, 20mg; left arm lastdexameethsone dose wasAllergic weak of a 26 torqadiation PCN 4mgPMH: course. non-Hodgkin diagnostic lymphoma work upleft 10/28, axillainc 2 736 PUB PUB 2 26-Mar-2009 UNK CT angiogram UNK of chest: Percocet; no evidence Tylenol Smoker; of pulmonary Back Pastpain Disease: embolism; Tooth right ache; MEDI0008275 lower Ruptured lobe lung diverticulum; nodule not Colosto visualiz UNK OTH OTH Unknown The subject was reported A0775224A to be "considerably large". 1 None PVT PVT ALEADRONATE-SODIUM; None Hypertension SIMUASTATIN - Hyperlipidemia - Osteoporosis PVT OTH None WNL None WNL 0 None PVT PVT ADDERALLNone XR ADD 0 PVT PVT 10 PUB PUB Prednisone; unknown compute Emphysema - O2 dependent. none PUB PUB PPD none none of significance - pityriasis alba; Asthma; Obesity 938 PVT PVT None None 2 none PUB PUB Loratadine none allergic rhinitis 1 None PVT PVT ORTHO EVRA None None 1 None PVT PVT Allegra, Tylenol, None Nasonex None 1 OTH PVT ATENOLOLNo 50 mg; HCTZ No 25mg; NITEDIAC 30mg ER tabs 3 N/A warm compress PVT & PVT PO KEFLEX 0 PVT UNK 0 PUB PUB UNK UNK 0 UNK UNK UNK UNK Unknown OTH OTH Unknown Unknown WAES0904USA00644 Unknown OTH OTH Unknown Unknown WAES0904USA00515 0 diagnostic laboratory, OTH aOTH group A strep in the blood sore throat was found. PMH: 4/24/09 Labs foot PCP 4/1/09: swelling. records CBC Sickle-cell received WAES0904USA01011 with WBCs which trait. 11.1 reveal 73% 11yr segs, WCC 13.1% 3/3 Unknown OTH OTH Unknown Unknown WAES0904USA00594 Unknown OTH OTH Unknown Unknown WAES0903USA00682 Unknown OTH OTH Unknown Unknown WAES0904USA01136 Unknown OTH OTH Unknown Unknown WAES0904USA01186 Unknown OTH OTH Unknown Unknown WAES0904USA01349 Unknown OTH OTH LORATADINE Pregnancy NOS (LMP = 11/29/2008); WAES0904USA01164 Sulfonamide allergy PVT PVT 0 UNK PUB DEXAMETHASONE 4mg, PROMETHAZINE 23 mg PO antibiotics PVT+ warm UNK compresses. None None 0 PVT PVT ACTOS 45mg tablet; Freestyle test invt strip; METFORMIN 500 mg oral tablet; 9 Bloodwork; PVT Xray of chest; OTHFlu & strep; Urine None None 2 PVT UNK None None 10 None PVT UNK AMOXICILLIN Otitis MediaNKA or problems 1 12/28/2007PVT x-ray cervical OTH spine done. None1/3/2008 None MRI cervical None.spine 5/26/09 done. Medical Neurology records consult received done, DOS seen 2/3/07 12/31/200 to 5/7
0 OTH PVT LISINOPRIL; None SULFAMETH-TRIMETH; Strawberries; None~ Chronic TOPROL; ()~~0~Patient bladder APRIM; infections; MOTRIN hypertension; pu 0 PVT PUB TYLENOL after Cough; 12 Congestion NKDA 15 CBC; CK; LYMES; PVT ANA; UNK RHF; EMG LIDOCAINE; 4/8/09 positive Dog CLINDAMYCIN; bite muscle PCN damage BACTRIM 0 PVT PUB 0 None OTH PVT None Headache~HPV (Gardasil)~1~0~Patient 0 PVT OTH 3 Red & Itching OTH Rash onOTH Both Forearms, BENICAR/HCT hands,None Face, - 40/25, Neck Allergic SIMVASTATIN to pollens,- 40, grass, TRILIPIX etc., Sulfa, - 130LISINOPRIL 0 PVT OTH Epigastric Pain Basal Cell Ca, hyperlipidemia, hypertension, osteoarthritis None PVT UNK None None 1 PVT PVT SINGULAIRNo No 3 PVT PVT TRIVIFLORNone-but fell None and hit head on floor -> no LOC at home 0 PVT PVT No No 1 PVT PVT Obesity Obesity 0 Sent urine culture PVT and PUB throat culture (urine dipNone + rapid strep (-)). 0 PVT PVT None None 8 None Performed PVT UNK AMOXICILLIN 3-9-09 3-9-09 Sinus to Reflux 3/19/09; infection PREVACID started AMOXICILLIN FN 10 days 0 PUB PVT 11 MIL MIL none unknown 1 None UNK UNK None None None 0 None PUB UNK Levothyroxin, None Advair, Ibprofen, Allergies:Cloratab Percocet, Edema, itching, Ultram, erythemia~Influenza Augmentin; Asthma,(no Hypothy brand 0 UNK PUB amoxicillin Bronchitis 0 PUB PVT None None None 0 Medical records UNK state: UNK LABS: RAST atarax, testing zantac, (+) No. formiralax. milk, wheat, Eczema, prn: topical egg, moderate-severe peanut steroids & dog for eczema dander. MedicalSkin records test for reveal: soy allergy PMH: 0 PUB PVT None known 1 NONE UNK UNK NONE NONE NONE 1 PUB UNK No. No. No. 1 PVT PVT 12 PREG TEST PUB - NEG PUB NONE NONE PVT PVT Advair, pro None Air Asthma ~ ()~1~~In Patient Unknown 2 UNK UNK Has cold with Chronic no fever sinus None~ infections ()~~0~Patient|None~ stopped after T ()~~0~Sibling and A. Underdeve 1 None PVT PVT Advair, Singular None Asthma Fever, Muscle Ache, Head ache, stuffy nose~P 2 N/A UNK UNK lutera none N/A 1 N/A PVT PVT Zoloft None Allergic to sulfa and bee stings - has current prescription fo 20 UNK PVT PUB Cold; Diabetes No other vaccines wereA0778584A given on 12 January 2009. The su 15 Platelet count, PVT3000 LABS: PVT Head CT WNL. Mild FinalURI plt ct None 26K(L).PMH: evaluation 3 mo prior for macrocephaly WNL. 0 Bld Cx, NG;PVT ESR, 25; Plt, PVT188; HgB, KEFLEX 13.0; HCT, 500 Nomg 38.0; tid WBC, None 10.2; PMH: P, 71; allergies, L, 22; s/p M, 3; T&A. E, 4 Family LABS:hx: Segs allergies. 71%(H), lym 0 unknown - treated PVT at hospital. PVT LABS: ZYRTEC WBC 31.7(H), No bands ZITHROMAX 22%(H), segs allergy 57%(H), PMH:lymphs tracheomalacia, 11%(L). ESR pneumonia, 47(H). CR b 13 Abdominal PVT series; UGI;PVT air contrast None enema; exploratory None surgery Hospitalized 5/14/09 2/13/09; hospital RSV; discharge Bronchiolitis summary recieved DO 0 PUB PUB None None - URINone just done PMH: fever & cold s/s; viral syndrome w/rash; recur 25 u/s at hospital PVTLABS: plts PVT514(H), bands 14%(H), NonelymphsNone 32%(L), monos 19%(H). Abdominal US (+) x 2 for IS in R 3 Pt receivedPUB vaccine because UNK he was a case contact None None 3 Pt receivedPUB vaccine because UNK he was a case contact. None None PVT PUB SINGULAIR; NoCLARITIN; Asthma ADVAIR 1 PVT PUB VYVANSE No ADHD; Allergies (Environmental) 4 MIL MIL None None 3 PVT PVT PVT PUB None None 0 PUB PUB PPD SanofiNone Pasteur LFA 0 5 Instructed client PUB to seePVT Allergist - prior to another None dose ofKEFLEX Hepatitis: B. Sun Given phone IA090003 number of only Allergist in area. 0 PVT PUB 2 No flu like symptoms; OTH Lymph UNK node normal
1 1 None 2 1 1
PUB PUB Hydrochlorothiazide None Allergic to flu Rash~Influenza vaccine containing (no brand Thimerisol name)~UN~0~Patie PVT PVT None None PVT PVT Tylenol Upper respiratory None infection PVT PUB ALBUTERAL Wrist PRN; fracture QVAIR Asthma Inhaled daily; FLONASE inhaled daily PUB PUB None OTH OTH 0 PVT UNK NONE NONE Beta-humanOTH chorionic,OTH ?/?/09, pregnant Unknown Pregnancy NOS (LMP = 1/27/2009) WAES0903USA02289 0 Unknown OTH OTH Unknown WAES0904USA01356 105 Results were UNK not provided UNKfor the following: TYLENOL;12 At Pre November the natal timevitamins; Patient of2007: vaccination has glucose Essential a history the tolerance fatty patient ofacids asthma, was test,### self 06 high December treating bloodwith pressure 2007 Tylenol alpha-f (both for 1 29 August 2003: OTH CBC;OTH urinalysis; chem Phenobarbital; 7; dilantin; DilantinHistory and phenobarbital of congenital were normal seizures.### 1 PVT UNK MetphorminDiabetic None 13 UNK UNK STUFFY NOSE FOR 4 DAYS WITH SLIGHT COUGH 0 None MIL MIL none none none 1 PVT UNK Cenestin 1.25 None, mg otherwise PO daily Allergy healthy to sulfa and pen V-K. No birth defects. Had endom 2 normal CRP, UNK ESR, complement UNK and none rheumatoid None factor LABS: None CBC, FamilyRF hx:WNL. parentCSF: w/DM. glucose 50, protein 32 (both 0 none PUB PUB THYROID MEDICATON no Tendonitis AND MULTI dx NA~ ofVIT. ()~NULL~~In Rt elbow in 2007 Patient following tx with cipro by 0 No sign of viral UNKor bacterial UNKinfections. No other TestsMeds as Noofillness Thursday as none a noon matter are of inconclusive. fact they checked 5/14/2009 him before hospital theyrecords gave the rece s 21 PUB PUB None Currently. No ClientClient had ahad PPDa administered Right radical mastectomy 2/4/09. in 2003 which includ 1 none PVT UNK 1 PUB PUB Benyaclin gel to face B/D 0 None PVT PUB None NONE No previously diagnosed seizure disorder, but parent state 10 03/24/2009UNK Hgb 5.9, MCV UNK82.8, Retic none0.1, ANC none 1.39 glucose, none.Urinalysis, PMH: neonatal Spinal jaundice Tap, CT Brain, Xray chest, MRI, EE 0 UNK PVT none none none 0 NONE PUB PUB NONE NONE NONE 0 THIS IS THE PUB THIRD REACTION(DOSE) PUB NONE (SAME NO SYMPTOMS-SIGNS) FROM THE SAME LOT NUMBER (18 DOS 0 examined by PVT physicianPUB none 0 NONE PUB UNK NONE NONE NONE None. PVT UNK None. None. None. 0 MIL MIL 3 CBC, CK-muscle, UNK ESR,UNK ANA pending N/A Labs: WBC N/A 4.2. CK History 91 (WNL). of thyroid ANA nodule; (-). (no ESR Raynaud's done) syndrome. PMH: H/A 1 PVT OTH 2 PVT OTH 0 PVT PUB None Asthma 4/9/09, WBC, UNK 20.60; SGOT, UNK 113; SGPT, 121; P/T, 569; Blood culture, negative; U/A, positive leuk; positive blood; B 0 None PVT PVT ACYCLOVIR None 400mg None None~ ()~~0~Patient 1 None PVT PVT None None None 4 Wound cx negative OTH OTH None None 1 None PUB PVT PROZAC; ATIVAN None None 3 PVT UNK Darvocet Novacaine Preservative in locals. 46 OTH PVT None Clinical None Research Trial 0 MIL MIL No No 2 PVT PUB NC09014 0 none PVT PVT none eczema 7 PVT PVT None 0 PVT PVT Gastroesophageal None told. Reflux (GER) 2 OTH PVT 1 None PVT PVT 0 PUB PUB 0 PVT PVT TYLENOL; None CLARITIN None 1 PVT UNK none none
0
PVT PVT None None Allergies: AMOXICILLIN; hx: Asthma and seasonal allergie Unknown OTH OTH Unknown Unknown WAES0904USA01876 0 Beta-humanOTH chorionic,OTH ?/?/07, pregnant Vitamins (unspecified) Pregnancy NOS (LMP = 5/9/2007); WAES0904USA01551 Migraine Unknown OTH OTH Unknown Unknown WAES0904USA01347 2 PVT PUB none 1 PVT PUB None Eczema; Amoxicillin; Sulfa allergy 1 PVT PUB None mild cold ??None 1 PVT PUB PUB PUB CONCERTA; CLARITIN; ORTHO TRICYCLEN low dose 0 None PVT UNK None None 3076 OTH OTH None Unknown None Chicken pox~Vaccine not specified (no brand n PUB UNK 0 Blood cultures OTHneg. WBC PVT11.7 Cymbalta; BP. None Med; Phenobarb; Allergy - grass, diazide;Synthroid; mold; seizureanti disorder; inflamma hypothyroidism; ele 1 None PUB PUB None None 2004 Hodgkins Lymphoma 0 UNK UNK PVT PVT Leg pain Herpes 0 PVT PUB BENZOXL PEROXIDE Rash gel 0 PVT PVT 0 fever sl fine No(viral) exanthen 8 PVT PUB None None None 1 6/17/09 Hospital UNK records UNK and DC summary loratadine,received dalteparin, none - in DOS hospital indomethacin, no3/25/09 allergies, for to aortica 3/30/09. birth lisinopril, valve defects, LABS disorder. insulin orand medical aspart, DIAGNOSTICS: conditions. acetaminophen, Echocard 6/17/09 hep H 1 none PUB PUB none none none none~ ()~NULL~~In AL0906 Patient|none~ ()~NULL~~I 76 Positive sacroilitis UNK 10-08.MRI UNK 12-08 Mircette,multi Diagnosed Seasonal migrains, vitamin,allergies, zantac. acne, chronic GERD, 6/1/09 acne fatigue, Allergic Rheumatology depression ceftin, 4-09 dioxicillian. records 5/27/09 DOS 6/1/09 Rheumatology 2/18/09 Rheumatol to 5/27r 44 HERPES SWAB UNK SENTUNK TO MAYOVERAPAMIL, LABS 04/16/2009 NONE BENICAR, AND NO IS LEVOTHYROXINE, KNOWN PENDING. ALLERGIES. HSV (-). LOVASTATIN HX HYPOTHROIDISM, HYPER 2 UNK UNK 0 UNK UNK 466 UNK UNK COPD PMH: severe COPD, on home O2 & in hospice care since 1 MIL MIL NONE NONE 0 None PUB PUB NONE UNKNOWN 1 PUB UNK none none 5 Doctor submitted UNK note UNK to school stating Insulin"Patient (Hemolog) None hasknown a skin Juvenile rash on Diabetes his legs called Granuloma Annulare. It is not co 2 PVT PVT N/A N/A N/A 1 None yet I showed PVT ladyPUB at clinic and Keppra, told her Neurontin, Ino wouls fill Ultram, out Allergy this Enablex,Topamax form. to Sulfa drugs and benedryl. Epilepsy 4 unk at this time PUB UNK crestor none unk 1 na PVT PVT no no no na~ ()~NULL~~In Patient|na~ ()~NULL~~In Sib 2 UNK PVT Unknown, patient No has never Unknown had medications filled here. 2 none UNK UNK none none none 1 PVT UNK 0 0 0 54 Air Enema UNK UNK None None 1 PUB PUB none none 226 elevated liver UNK enzymes,UNK elevated wbc, decreased no rbc, lowered seasonal hct,allergies 16.8 rdw,PMH: lowered chickenpox, segs, raised seasonal lymphs, allergic raisedrhim 1 labs and Diagnostics: UNK UNK EKG NSR. Nexium, Venous dopplers Cardizem, Afib, cyst (-)Lasix, for onAfib, DVT. back, Atenolol, DM, ESR DM HTN, 19. Warfarin, COPD, Glucose ASA CVA. 1138. PMH: BUNHTN, 33. Creatinine A-fib, ovarian 1.4. CA A 0 PVT PVT poison ivy on Allergic elbowto penecillin 1 NONE PUB UNK NONE NONE NONE 3 UNK PVT patient has No only this vaccine Unknown on her profile at giant eagle pharmacy 2 UNK UNK Allergic to Ciprofloxacin 3 UNK UNK CephalexinGERD, 500mg,pantoprazole Obesity No known Ec allergies 40 mg, Fluoxetine 10 mg 2 UNK UNK loradine 10 environmental mg,albuterol, No fluticasone,benedryl known allergies, medication obesity allergies 25 mg,sertraline 50 mg,premarin 0 1 chest x ray UNK Labs: CBCUNK with WBCs 22.1-77%segs, cold 17% lymphs. none PMH: Platelets none 671. UA (+) for mod blood, (+) nitrites, M 1 PVT PUB TMPS 5 MLSerous B.I.D. Otitis Media 0 PVT PUB None None 0 MIL MIL None UNK
1 None
PVT PVT None None None MIL MIL none none none (CPAP; nebulizer at birth to 3 months) 1 None PVT PVT All cultures PVT were negative PUBBld CSFNone throat, CTNone scan normal, None FHD seizure cultures 13 None PVT PUB None None None CBC & Chem PVT 7, nl; EEG, PVT 9/08, nl for ADDERALL age but 1-2 XRspike-wave 25 mgADHD d/c that suggest predisposition to seizures 0 None OTH OTH None Pregnancy NOS (LMP = 12/1/2007); WAES0802USA04952 Social alcohol drinker; Smoker 0 hearing test, OTH 06/05/08,OTH failed right albuterol; hearing test; FLOVENT Pregnancy hearing test, Bacterial NOS06/06/08, (LMP infection = Unknown); faileddue right WAES0803USA00880 to Eczema; hearing streptococcus, test; Asthma; hearing group Congenital test, B; Vaginal 02/24/2 club 0 ultrasound, OTH 03/06/08, wnl; OTHultrasound; PRENATE beta-human Pregnancy ELITEchorionic, NOSpositive (LMP = 1/19/2008) WAES0803USA01292 0 beta-humanOTH chorionic -OTH positive ZITHROMAX Pregnancy 1 gm; DOXYCYCLINE; NOS (LMP = 1/25/2008) ORTHOWAES0803USA01406 TRI-CYCLEN Cervical dysplasia 0 ultrasound, OTH 06/02/08, normal; OTH diagnostic RITALIN laboratory, Pregnancy 11/05/08, NOS (LMP normal; = 2/6/2008); beta-human WAES0805USA04750 Attention chorionic, deficit results disorder not reported 23 diagnostic laboratory, OTH group OTH B strep None positive (baby); Pregnancy beta-human Normal NOS (LMP delivery; chorionic, = 4/18/2008); Vaginal 06/10/08, WAES0806USA02242 disorder; Asthma; positive; Disease Anxiety Apgarcomplication score, 8/9, ba 0 fetal monitoring OTHtests, normal OTH anatomy Nonesurvey:Pregnancy 20 weeks NOS EGA;(LPM urine=beta-human, 10/1/2007) WAES0807USA03038 01/18/08, positive; urinalysis, GB Apgar score, OTH 9/9 OTH Pregnancy NOS (LMP = Unknown); WAES0807USA03843 Scoliosis 83 None OTH OTH PHENERGAN; Pregnancy vitaminsNOS (unspecified) (LMP = 6/2/2008); WAES0808USA04369 Nausea 198 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 1/25/2008 WAES0808USA04377 0 Diagnostic laboratory, OTH prenatal OTH labs; Albuterol; Diagnostic Nasalcrom Pregnancy laboratory, NOS 12/??/08, (LMP =CT 3/30/2008); cultureWAES0809USA01360 positive Asthma; Hypersensitivity; Obesit -41 Ultrasound,OTH 03/09/09; Blood OTH pressure, DTP 102/58Pregnancy Chickenpox NOS (LMP = 12/12/2008); WAES0902USA01505 Cramp; Allergic to dogs; Allergi 0 Unknown PVT OTH Unknown Migraine WAES0902USA04263 Unknown OTH OTH Unknown Unknown WAES0903USA01086 11 None OTH OTH Drug hypersensitivity WAES0903USA01403 Unknown OTH OTH None Drug hypersensitivity WAES0903USA05482 Unknown OTH OTH Unknown Unknown WAES0903USA05497 0 None OTH OTH XANAX Unknown WAES0903USA05499 0 None OTH OTH None None WAES0903USA05512 14 None OTH OTH Hypersensitivity WAES0903USA05548 Unknown OTH OTH Unknown WAES0903USA05559 Unknown OTH OTH Unknown Unknown WAES0903USA05566 Unknown OTH OTH Unknown Unknown WAES0904USA00004 12 Unknown OTH OTH Unknown Unknown WAES0904USA00014 0 None OTH OTH None None WAES0903USA02293 0 None OTH OTH Unknown Unknown WAES0904USA00051 0 Unknown OTH OTH Unknown WAES0903USA02323 Unknown OTH OTH Unknown Unknown WAES0904USA00085 130 Unknown Labs OTH and Diagnostics: OTH Unknown alk phos (H) at 137. AST Unknown 112. ALT PMH: 131.ADHD MRI Wbrain AES0903USA02643 WNL. ANA (+). CSF WNL. Unknown OTH OTH Unknown Unknown WAES0904USA00089 Unknown OTH OTH Unknown Unknown WAES0903USA03984 Unknown OTH OTH Unknown Unknown WAES0903USA04598 Unknown OTH OTH Unknown Unknown WAES0903USA01645 2 OTH OTH Unknown Unknown WAES0904USA00097 0 Unknown OTH OTH hormonal contraceptives Pregnancy NOS (LMP-1/19/2009)WAES0903USA01677 Nail-patella syndrome 0 Unknown OTH OTH Vitamins (unspecified) Pregnancy NOS (LMP = 12/27/2008) WAES0903USA01999 Unknown OTH UNK Unknown Unknown WAES0903USA02061 None OTH OTH None Unknown WAES0903USA02101 None OTH OTH None None WAES0903USA02285 1 Unknown OTH OTH Unknown Unknown WAES0903USA02333 -150 Unknown OTH OTH Unknown Unknown WAES0903USA02337 73 Unknown OTH OTH None Not sexuallyMeningitis active WAES0903USA01421 cervical smear, OTH02/13/09, OTH HPV positive, Unknown had atypical cellsNone WAES0903USA01423 Unknown OTH OTH Unknown Unknown WAES0903USA01428 Unknown OTH OTH Unknown Unknown WAES0903USA01434
Unknown OTH OTH None Arthralgia; Bone disorder WAES0903USA01443 1 None OTH OTH YAZ None WAES0903USA01445 0 None OTH OTH SYNTHROID; Hypothyroidism; PRILOSEC; vitamins Gastroesophageal (unspecified) WAES0903USA01457 reflux disease 0 None OTH OTH CLARITIN Eczema; Hypersensitivity WAES0903USA01595 -89 ultrasound, OTH 03/06/09, Bicornuate OTH Uterus albuterol and fluid Pregnancy filled cyst; NOSbeta-human (LMP = 10/24/2008); chorionic, WAES0903USA01609 positive Asthma; Cervical dysplasia 60 Unknown OTH OTH None Sulfonamide allergy; Allergic reaction WAES0903USA01611 to antibiotics; Potato allergy; All beta-humanOTH chorionic, OTH was positive Unknown Pregnancy NOS (LMP= unknown)WAES0903USA01628 Unknown OTH OTH Unknown Unknown WAES0903USA01631 0 None OTH OTH None None WAES0903USA01637 0 Unknown OTH OTH Unknown Unknown WAES0903USA01639 None OTH OTH Unknown Unknown WAES0903USA02345 0 Unknown OTH OTH Unknown WAES0903USA02346 0 Unknown OTH OTH Unknown WAES0903USA02349 Unknown OTH OTH Unknown Unknown WAES0903USA02354 0 Unknown OTH OTH LOESTRIN FE Infectious mononucleosis WAES0903USA02374 None OTH OTH None None WAES0903USA02555 2 Unknown OTH OTH None None WAES0903USA02593 Unknown OTH OTH Unknown Latex allergy WAES0903USA02852 0 Unknown 5/13/09 OTH medical OTHrecordsNone received DOS Penicillin 1/26/09 allergy; 5/13/09 to 3/31/09. Allergic medical LABS reaction records andWAES0903USA02886 toDIAGNOSTICS: received antibiotics DOS 5/13/09 1/26/09 CBC medical - to MPV 3/31/09. record 7.1 fL 0 Unknown OTH OTH Unknown Unknown WAES0903USA02903 0 Unknown OTH OTH Unknown Unknown WAES0903USA02907 103 beta-humanOTH chorionic, OTH positive; Mantoux isoniazid; test, pyridoxine Pregnancy positive Cesarean NOS (LMPsection; = 2/16/2009); TB exposure WAES0903USA02927 Penicillin allergy; PPD skin test p pap test, ?/?/08, OTH normal; OTH pap test, Unknown ?/?/09, abnormal Unknown WAES0903USA02993 Unknown OTH OTH Unknown Unknown WAES0903USA03188 0 None OTH OTH None None WAES0903USA03192 Unknown OTH OTH Unknown Urinary tract infection WAES0903USA03221 Unknown OTH OTH HAVRIX Viral infection WAES0903USA03230 0 urine beta-human, OTH pregnant OTH Pregnancy NOS (LMP = 1/1/2009)WAES0903USA03231 Unknown OTH OTH Unknown Asthma WAES0903USA03237 computed axial OTH OTH Unknown Unknown WAES0903USA03242 0 None OTH OTH ORTHO-CYCLEN None WAES0903USA03245 Unknown OTH OTH Unknown Unknown WAES0903USA03247 0 None OTH OTH None None WAES0903USA03252 Unknown OTH OTH Unknown Unknown WAES0903USA03626 0 Unknown PVT PVT Unknown Unknown WAES0903USA03643 0 Unknown OTH OTH Unknown None WAES0903USA03665 0 Unknown OTH OTH Unknown Graves' disease; Latex allergy; Food WAES0903USA03945 allergy Unknown OTH OTH Unknown Unknown WAES0903USA03970 Unknown OTH OTH Unknown Unknown WAES0903USA03974 0 None OTH OTH None Arthropod bite WAES0903USA03975 Unknown OTH OTH Unknown Unknown WAES0903USA03979 0 Unknown 5/15/09 OTH Medical OTHrecords received DOS 1/19/09Unknown to 1/20/09. LABS andWAES0903USA03982 DIAGNOSTICS: None 149 cervical smear, OTH03/18/09, OTH positive None for hpv None WAES0903USA03986 Unknown OTH OTH None None WAES0903USA04004 Unknown OTH OTH Unknown Unknown WAES0903USA04033 Unknown OTH OTH Unknown Unknown WAES0903USA04036 Unknown OTH OTH Unknown Tension headache WAES0903USA04255 0 Unknown OTH OTH Unknown Unknown WAES0903USA04259 0 None OTH OTH None Pregnancy NOS (LMP = 1/7/2009)WAES0903USA04271 1 Unknown OTH OTH YAZ Unknown WAES0903USA04275 Unknown OTH OTH azithromycin Infection susceptibility Upper respiratory increased tract WAES0903USA04281 infection
39 None 5/13/09 OTH medicalOTH records received YAZ; FAMVIR DOSDysmenorrhea 2/3/05 to 3/26/09 HPV #2LABS givenand 11/24/2008, DIAGNOSTICS: WAES0903USA04302 Lot # 0571X CHEMHPV - ALT/SGPT #3 given 1/2 8U None OTH OTH Unknown Unknown WAES0903USA04310 Unknown OTH OTH Unknown Unknown WAES0903USA04317 7 None OTH OTH None None WAES0903USA04511 0 Unknown OTH OTH Unknown Unknown WAES0903USA04517 0 Unknown OTH OTH Unknown Unknown WAES0903USA04527 None OTH OTH None WAES0903USA04889 10 None OTH OTH None WAES0903USA04897 diagnostic laboratory, OTH 1-2 OTH HIV false Unknown positive Unknown WAES0903USA04899 49 Unknown OTH OTH Unknown Unknown WAES0903USA04903 4 Unknown OTH OTH Unknown Unknown WAES0903USA04909 beta-humanOTH chorionic, OTH 3/26/09, pregnant NAPROXEN; Pregnancy ranitidinePapanicolaou NOS (LMP= unknown); smear abnormal WAES0903USA04915 Shoulder pain; Gastroesophageal 42 diagnostic laboratory, OTH 2/23/09 OTH Pregnancy NOS (LMP= 1/15/2009) WAES0903USA04528 Unknown OTH OTH Unknown Unknown WAES0903USA04536 34 ultrasound, OTH everything OTH looked normal Unknown Pregnancy NOS (LMP= 1/19/2009) WAES0903USA04922 hematologyOTH OTH None Penicillin allergy WAES0903USA04544 0 None OTH OTH None None WAES0903USA04924 Unknown OTH OTH Unknown Unknown WAES0903USA04933 0 Unknown OTH OTH ZOVIA Pain menstrual Infectious mononucleosis WAES0903USA04982 0 None OTH OTH None WAES0903USA05175 0 Unknown 5/15/09 OTH Medical OTHrecordsDIFFERIN received DOS 5/15/09 5/15/09 3/9/09 Medical Medical Unknown to 5/5/9. records records LABS 5/15/09 received received andMedical DIAGNOSTICS: DOS WAES0903USA05202 DOSrecords 3/9/09 3/9/09 to to received None 5/5/9. 5/5/9. vaginal Monostat, DOS 3/9/09 discha Ben to 0 body temp, OTH 3/??/09, 101F OTH Unknown Egg allergy WAES0903USA05288 0 None OTH OTH Unknown Penicillin allergy WAES0903USA04553 Unknown OTH OTH Unknown Unknown WAES0903USA05321 None OTH OTH None None WAES0903USA04559 Unknown OTH OTH Unknown Unknown WAES0903USA05328 Pap test, positive OTH for high OTH risk HPVUnknown Unknown WAES0903USA04582 Unknown OTH OTH None Penicillin allergy; Infectious Sulfonamide mononucleosis allergy WAES0903USA04594 None OTH OTH None None WAES0903USA04609 OTH OTH Unknown Unknown WAES0903USA04725 4 None OTH OTH None None WAES0903USA04851 0 Unknown OTH OTH Unknown Asthma Urinary tract infection WAES0903USA04853 UNK UNK None 0 None MIL MIL NONE NONE NONE 1 LABS: intestinal UNK biopsy. UNK CBC WNL. Lipid profile(H). Amylase/lipase PMH: depression/anxiety. WNL. US of abdomen WNL. 2 none PVT UNK Expressive language disorder Unknown OTH OTH Unknown Unknown WAES0904USA02014 Unknown OTH OTH Unknown Unknown WAES0904USA02004 Unknown OTH OTH Unknown Unknown WAES0904USA02281 Unknown OTH OTH Unknown Unknown WAES0904USA02052 0 ultrasound, OTH ?/?/08, normal; OTH beta-human None chorionic, Pregnancy 03?/??/08, NOS positive (LMP = Unknown) WAES0904USA01867 207 Unknown OTH OTH Unknown Unknown WAES0904USA02046 0 Apgar score, OTH 09/14?/08, OTH 9&10 (BABY); None body weight Pregnancy measurement, NOS (LMP09/14?/08, = 12/24/2007) 2785 WAES0801USA05068 gram (BABY) OTH OTH Unknown Unknown WAES0904USA02013 OTH OTH Unknown Unknown WAES0904USA02011 Unknown OTH OTH Unknown HIV infection WAES0904USA02010 OTH OTH Warfarin Unknown PMH: on warfarin MA20090925 Unknown OTH OTH Unknown HIV infection WAES0904USA02003 Unknown OTH OTH Unknown Unknown WAES0904USA01998 Unknown OTH OTH Unknown Unknown WAES0904USA01997 Unknown OTH OTH Unknown HIV infection WAES0904USA01993
Unknown OTH OTH Unknown HIV infection WAES0904USA01992 1 Blood tests;PVT Ct scan; PUB MRI; Spinal tap; EEG.Fell 7/7/09 and Hospital cutHigh handB.P.; records COPD; received Bi-polar; DOSEmphysema. 3/25/09 to 4/4/09. 7/7/09LABS Hospital andr 4 None PUB OTH None None 1 None PVT PUB None None None NKDA ID09005 2 None PVT PUB None None NKA 26 PVT PUB None noted None noted ID09007 0 None PVT PUB None No None ID09009 12 PUB OTH No None 0 None PVT OTH None None No pre existing allergy 0 None PVT PVT Tuberculosis URI test, Pasteur, NoneC2920AB, LA, 0 0 None PVT PVT Physical appt/HTN PCN AR 10 PVT UNK None None NKA; Prenatal hydronephrosis, eczema 1 PVT PUB 0 PVT PVT None None None Swelling, redness, hard lump x2-3 mos~DTaP 730 None yet UNK UNK None No 1 PVT PVT NOne None 3 None PVT UNK None No None 1 None MIL MIL None None Lyme Disease age 16, Ixodes Scapularis, tx Amoxicillin 50 5 UNK UNK none None healthy None Typically very healthy 1 PVT PUB 1 PUB PUB 2 Blood and urine PVT test were PVTdone - test confirmed a virus and a white blood High Fever~DTaP cell count that (Daptacel)~1~0~In indicated he was Patient fighting i 1 Labs: UC (+) UNK for mixedUNK growth. UA unknown (+) for blood, noneRBCs, reported none 2-4 WBCs, reported many PMH: bacteria, RAD trace ketones and 30 protein. B 5 PUB PUB none reported none reported none reported 1 PUB PUB 1 PVT PVT Zyrtec Prn Seasonal allergies 1 N/A PUB PUB Ibuprofen 400 mg BID Allergies: Latex, Vibramycin, Bananas, Strawberries, Nect 9 Labs: Hgb UNK 9.7. KUB WNL. UNK WBC 19.8. ESR none and CRP elevated. none PMH: Platelets Env allergies. 583. CT (+) PCN. for Tonsillectomy. bowel obstruction. US GB 0 PVT PVT none none none none here UNK UNK none knownnone knownnone known-screening all NO 1 PVT UNK citalopram, none implanon depression 1 UNK UNK Synagis Given NA 03/26/2009 Left Leg IM Lot#31301568 Manufacturer MedImmune 3 PVT PVT septra D, amoxicillin, Illness~Smallpox codeine.(no adhesive brand name)~1~5~In tape. Arthritis ,Pat lob 0 EKG, HolterUNK Monitor, EEG, UNK Sleep lo-ogesterl, Studies, Heavy hypoglycemia, vitamins, Metalmetanx, test, mold, PCOS, CBC, cockroaches, glucophase, Urinalysis, depression smoke, prozac, Upper dust, GI, trazadone, Stool dustsample, mites, spironlactone trees, Hepatitis grass,p tes 0 none PUB PVT AVAPRO; ATENOLOL none Defective heart valve, surgically corrected 1 None OTH PUB SEPTRA DS Left BID; toeTRAZADONE; infection none SEROQUEL; REFAMPIN; RISPERDAL; REME 2 NONE PUB PVT None None None None PVT PUB Amoxicillin 250 (R) Otitis mg/5ml media None - taking 6ml po BID X 10d for Otitis 0 MIL MIL 0 PVT PUB None None None 0 PVT OTH Wheezing at Anxiety Night- D/O; Cough Depression; Palpitations. 1 None PVT PUB None None 0 None MIL MIL None None None PVT PVT Fever, pain, swelling PVT PUB Pain; fever; swelling 3 None PVT PVT None None None 1 None PVT PVT None None None 1 Diagnostic results: OTH 20 April OTH1999: X-ray Enalapril showed maleate Arthritis; degenerative Cervical Laminectomy; changes Spondylosis; of family theHypertension; lumbosacral history A0779397A of arthritis spine Lumbar (mother). withStenosis significant deg 0 None PVT PVT None None 0 PVT PVT None None PCN allergy; RAD; SUT 0 None PVT PVT LEXAPRO depression None
1 CXR - Normal; PVTEKG - normal; UNK D - Dimer SYNTHROID - Normal; No112 BP miqrogramms elevated, Hashimota's was daily; retching disease EVISTA; CBC, --> Thyroidectomy, MVI, electrolytes, FISHOIL,K-3 BABY Non-Hodgkins ASP, CALC lym 2 X-rays - tissue PUBedema,UNK and also CT tissue edema; Laceration Lactate, of None left 4.0hand 6/24/09 Hospital ER record DOS 4/6/09 and Inpatie UNK UNK 1 PUB PUB No No Red swelling itchy~DTaP (no brand name)~2~2 1 MRI (-); LPPVT (-); CBC (-); PVTEEG after. LABS: CBC, None BMP, None CSF WNL. PMH: Blood, MSPI(milk urinesoy c/sprotein neg. CXR intolerance). initially thought Familytohx 3 OTH PUB None 1 OTH UNK Minor Hay fever 3 PUB UNK None None None 7 PVT PVT CLEOCIN, rash 11 PVT UNK None None None 1 None OTH UNK Runny nose; Conjunctivitis; Diarrhea 1 PVT UNK HA and Onychomucosis 3074 OTH OTH 1 PVT PVT Nothing Known No Nothing known 0 PVT PVT 0 None can'tPVT read next OTH until NKA None 0 Xray of nasal PVT bones PUB none 0 PVT PVT MOTRIN 600mg Sinus Headache NKDA muscle + joint CT200907 tenderness~Tdap (no brand nam 0 PVT PVT None None Thyromegaly Biopsy, diagnosed PUB withPVT Lichen Planus CENESTIN; PROMETRIUM, Mint hrt 0 None PVT UNK STRATLERA None 80 mg ADHD 0 PVT OTH 0 PVT PVT None None None 5 4/13/09: D Dimer: UNK <200ng.ml UNK (<230); None Troponin None I <0.010ng.ml; None CK 40IU/L (30-200); CK-MB 0.3ng/ml (0-6.6); 4/13/09 3 708.9 Urticaria PVT PVT Well child None 1 PVT PVT Reaction, shot 0 PVT PVT 5 yr well child Food exam allergies - cows milk, egg, peanut, shellfish, fish, tree 982 PVT PVT 0 PUB PUB None None reported None CA090002 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008077 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008075 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008073 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008072 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0008036 OTH OTH Unknown WAES0904USA02081 1 PVT UNK None 0 None PUB PUB None None None 0 PUB PUB None Allergic reaction None 1 PUB PUB No No None PVT PVT None None None 0 No testing only PVTinjections PUB given DEPO MEDROL, none 40mgNKDA; IM at 12:25pm; H/O hay fever; DECADRON, asthma; seasonal 4mg, DM allergies at 12:25pm; ALB 3084 None PVT PVT None Unknown None 11 PVT PUB None Unknown OTH OTH Unknown HIV infection WAES0904USA02000 OTH OTH Unknown Unknown WAES0904USA02001 Unknown OTH OTH Unknown Unknown WAES0904USA02002 Unknown OTH OTH Unknown WAES0904USA02009 Unknown OTH OTH Unknown Unknown WAES0904USA02012 0 None OTH OTH None Pregnancy NOS (LMP = 1/1/2009)WAES0904USA01725 EEG-withinPVT normal limits; PVT CT Scan of head - normal The patient had a history of sleep ### disorder. The patient ha 0 Unknown UNK UNK The patientPast had a medical concurrent history condition included of### eczema eczemaand at the egg time allergy. of vacci
0 Chest X-ray; PVT CBC; Chem PVT7; RSV; None influenza Records received 5/6/09 - ED DOS 4/7/09 LAB: Strep Screen +, RSV 1 NONE PVT OTH None 0 EEG ordered PVT PUB None None Family History of seizure disorder 0 PVT PVT ADDERALL, 30mg, po, QD 1 none PVT PVT none upper respiratory none infection PVT PVT 12 PVT PUB None None None 0 OTH PVT Birth control; None B12 q/od Allergies: in (L) arm;Codeine;PHENERGAN None~ PAXIL 10 ()~~0~Patient mg qd po. 0 PVT PVT none none 0 None OTH OTH None None None 2 UA & CBC -PUB Results normal. PUB Had a Mantoux No TB testNo W / in 4 weeks 0 none PVT PVT none none none 5 PVT PVT None 5 UNK UNK None 1 PVT PVT Benicar, simvastatin, None Lotemax Allergieseye to ingested drops, Cosopt, or injected Restasis, iodine,Optivar latex, morphine, Al none PUB PUB no no 0 visual examPUB done PUB none none 4 None UNK UNK Tri Vi Sol None None 1 PVT PVT None Penicillin allergy (Rash) 1 PVT PUB UNK UNK 11 Troponin 1 UNK 19 March 2009 UNKAbnormal PMH: smoker. 5000007 1 PVT PVT 0 None PVT PVT Oral contraceptives None None PVT PVT none PUB PUB None None None 0 PVT PVT vitamins none was here NKDA forno well past child medical visit history 0 n/a PVT PVT Albuterol inhaler, None Epi Pen Milk(as allergy needed), Triamcinolone Cream, Benadryl (as need 2 Will meet with PVT allergist PVT on 4/28/09 client is taking none diovan for none high listed blood pressure 54 PVT PVT none none 1 PVT PVT finger laceration none 0 This is the second PUB day UNK so there have Seasonique not been No (sp)? any tests. A birth Penicillin, control no medicine birth defects. Multiple ear infections, tubes in 11 Brain MRI, UNK EEG-normal; UNK bloodwork Synthroid, done 5/13/09 Zoloft, no Received Nexium Hypothyroidim, at hospital time ofdischarge vaccine Acid Reflux, summary Hashimotos, DOS 1/22/08-2/8/08. Anxiety, Depress LAB Diagnostic results: OTH 15 November OTH 2001: Magnetic Arrhythmia; resonance InDiabetes 1993, imaging the Mellitus subject (MRI) Type offell lumbar A0779693A eight 2; Hyperlipidemia; spine feet from showed a tree Hypertension; mild anddegenerat hit his bu S AntinuclearOTH antibody, 31Dec2007, OTH negative; Erythrocyte Coronary artery Angioplasty; sedimentation disease;degenerative Increased rate, 17Oct2002, A0603034A cholesterol disc disease; 6mm/hr;Heart Erythrocyte problems; sedim m 7 6/10/09 Hospital OTH records OTH and DC summary received DOSNo. 4/10/09 6/10/09 toFever, 4/12/09. Hospital yelling~DTaP LABS recordsand andDIAGNOSTICS: (no DCbrand summary name)~2~0~Pa received CSF - To D 1 CBC PVT PVT Down Syndrome 2 PVT PUB Allergy, amoxicillin (rash); sickle cell trait 2 PVT PUB NKA; Prematurity 1 Strep cx, inPVT office, negative; PVT throatADDERALL cx, pending None XR; ADDERALL Penicillin, rash; ADHD 2 None PVT PVT 4 None PUB OTH None NKDA 0 None PUB UNK None None 11 PVT PUB 11 Skin biopsy:PVT 12/3/09 Spongiotic UNK dermatitis with eosinophils None - done after Skinfirst rash~HPV rash/2nd(Gardasil)~2~12~Patient HPV vaccine 1 MIL MIL Negative Negative 2 MIL MIL none denied knee problems, elev triglyceride 1 PVT UNK none none 1 None PVT PUB None None 1 None PUB PUB None None None 0 PVT UNK None None
0 PVT PVT None Cleft lip 0 mother tookPUB to urgent care PUBand was Prozac referred 10; to None Dexedrine hospital ED; None had MRI which was "clear"; was told that it was seizure 14 Negative HLA-B27; PVT 9-11-08 PVT Hg 12.5, FOLIC Wbc5 ACID; 100; None METHOTREXATE; Normal H/O LFTS; "Burning" U/A;PREVACID; IgG, sensation A, ME,TRAUIADOL; C3 of feet C4; ANA; 5/19/08-records ENBRIL DNAA; RF receivedASO; Au None PVT PUB None None None 7 PVT PVT 0 None PVT PVT ADALATE None Allergic to bee stings- Iodine-Shell fish-mushrooms-molds0 PVT PUB 395 OTH PVT None None None 0 EKG; O2 Saturation; PVT BP; OTH Blood sugar None None PVT PUB Allergies-cough 0 None MIL MIL WELLBUTRIN None None 1 None UNK UNK COPD; Pneumonia NKDA 7 Hemoccult PVT positive X3 PVT on 4/6/09 My Kidz Iron None None 0 Unknown OTH OTH None WAES0904USA02836 1 PVT PUB PVT UNK 0 magnetic resonance, OTH 07/12/07, OTH 2 cm None hematoma Drug in hypersensitivity the bone Function marrow kidney decreased WAES0904USA02298 107 serum ANAOTH protein, 04/18/07, OTH 1/80; ZYRTEC serum rheumatoid factor, Unknown. 04/24/07, 6/19/09 24.7; Rheumatology serum WAES0904USA02303 C-reactive, consultant 04/24/07, medical 2.7;recor seru Unknown OTH OTH Unknown Unknown WAES0904USA02789 352 Unknown 5/19/09 OTH medical OTHrecordsascorbic receivedacid; 4/9/07 Migraine; vitamin to 4/16/09. Penicillin E; Pneumonia vitamins LABS allergy; (unspecified) and 5/19/09 Drug DIAGNOSTICS: medical hypersensitivity WAES0904USA02794 5/19/09 records medical None. received records 4/9/07 received to 4/ 4 4/13/09--negative UNK strepUNK test; 4/14/2009 Singular Negative forNone Asthma Mono test Asthma and Negative Mumps 9 Physical examination PVT by UNK doctor none none 0 NO TEST WAS PUB ORDERED PUB PPD SKIN TEST N/A ORDERED CHRONIC ABDOMINAL PAIN/CONSTIPATION 1 None PUB PUB None None None none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 None required PUB PUB None None None 0 none PVT PUB none none 0 none PUB PUB Tubersol PPD none skin reported. mantoux nonemom known givendenies in right that forearm. patient was previously ill 0 NONE ORDERED PUB PUB n/a n/a well child n/a~ ()~NULL~~In Patient 0 PVT PVT nuvaring na previously has had syncopal episodes with injections and u 1 PVT PVT 1 None UNK UNK MultivitaminNone None 3 EEG's, MRI's, UNK bloodwork UNK 05/8/09 ED N/Arecords None received forJaundice DOS 10/1/07-10//2/07 at birth LABS & DIAGNOSTICS: CBC - pl 1 PUB PUB 4 PUB PUB 1 PVT PVT none none none Diagnostic Results: OTH 21 OTH September 1999: Lyme Chronic IgM IFA Neck negative. Cervical Pain; Lymphadenopathy; Lyme Clinical Western depression; A0599614A Blot Congenital IgG Hypertension; non-confirmatory. Kidney Hypothyroidi Anomaly; 30 SepC Diagnostic results: OTH 04 November OTH 2003: LymeHyperlipidemia; IGG Western BENIGN Blot Nodular was PROSTATE positive prostateand HYPERTROPHY A0600454A Lyme IgM Western Blot was equi 0 PVT UNK NKDA 1 PUB PVT None None MIL MIL None URI symptoms Allergies: None; Medical conditions: None; Birth defects PVT UNK 2 PVT PVT None 7 None OTH OTH No None 0 PUB PUB NONE NONE NONE 1 PVT PVT None None Pulse ox = 97-98 UNK % PVT Vit D None None significant 1 CholesterolOTH UNK Glimepiride; Gabapentin; Omeprazole; Clonazepam; Metaproterenol PVT UNK None None 3 PVT PUB Medroxyprogesterone Amenorrhea ultrasound, OTH 07/22/08, confirm OTH dating; serum alpha-fetoprotein, Pregnancy Terminations NOS (LMP 09/18/08, = 5/21/2008); of within pregnancy WAES0807USA04419 normal Asthma - elective limits; Apgar score, Baby: 8/ Unknown OTH OTH Unknown Unknown WAES0901USA03372
0 Unknown OTH OTH Unknown Unknown WAES0902USA02446 Unknown OTH OTH Unknown Unknown WAES0903USA00415 0 Unknown OTH OTH Unknown Pharyngitis streptococcal WAES0903USA00427 None OTH OTH Unknown Unknown WAES0903USA00454 0 None OTH OTH Unknown Penicillin allergy WAES0903USA00457 0 Unknown OTH OTH Unknown Unknown WAES0903USA00536 beta-humanOTH chorionic, OTH Negative Unknown Unknown WAES0903USA00539 29 urine beta-human, OTH 3/3/09, OTHnegative; None serum beta-human, None 3/3/09, pending WAES0903USA00547 5 None OTH OTH None None WAES0903USA00572 Unknown OTH OTH Unknown Unknown WAES0903USA00589 0 None OTH UNK None None WAES0903USA00747 None OTH OTH None Drug hypersensitivity WAES0903USA00761 Unknown OTH OTH Unknown Injection site reaction WAES0903USA00774 0 Unknown OTH OTH levothyroxine Pregnancy sodium Hemorrhage NOS (LMP=12/22/2008); in pregnancy WAES0903USA00792 Hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA00860 Unknown OTH OTH Unknown Unknown WAES0903USA00891 0 Unknown OTH OTH Unknown Unknown WAES0903USA00901 518 diagnostic laboratory, OTH 2/24/09, OTH positive NoneHPV test None WAES0903USA00904 1 Unknown OTH OTH Unknown Unknown WAES0903USA00914 4 Unknown 5/21/09-ultrasound OTH OTH of abdomen None. 6/4/09 2/19/09-impression:bulky Consultant Unknown. records received 6/4/09 prominence Consultant DOS WAES0903USA00926 of2/12/09. pancreatic records Prilosec, received head. Claritan, 4/8/09-impress DOS 2/12/0 Yaz, B Unknown OTH OTH Unknown Unknown WAES0903USA00928 Unknown OTH OTH Unknown Unknown WAES0903USA00936 ml dose of GARDASIL. Concomitant Unknown OTH therapy included OTH HAVRIX. The patient developed Unknown a fever 2 days after WAES0903USA00937 she received the vaccine. The fe Unknown OTH OTH Unknown Unknown WAES0903USA00956 Unknown OTH OTH Unknown Unknown WAES0903USA00962 0 None OTH OTH Unknown Unknown WAES0903USA00966 63 Unknown OTH OTH None None WAES0903USA01098 Unknown OTH OTH Unknown Unknown WAES0903USA01124 0 magnetic resonance, OTH negative; OTH chest NUVARING X-ray, negative; Drug hypersensitivity electrocardiogram, negative; WAES0903USA01138 metabolic marker test, normal; e 0 None OTH OTH None None WAES0903USA01155 Unknown OTH OTH Unknown Unknown WAES0903USA01367 Unknown LABS: OTH CBC,OTH CMP & USUnknown of abdomen WNL. Strep Unknown ID test (+). WAES0903USA01378 0 PUB OTH None (Ibuprofen None after immunizations) None 1 None PVT PUB None None Antibody test OTH (results: no OTH antibodies Concomitant from vaccine) The medications patient's was done concurrent were on 10-Apr-2009. not reported. illnesses USWYEH08942909 included asthma and seasonal aller 253 Skin biopsy.PVT PVT None None None known PUB PVT None known Allergic SULFA; PERCODAN; ATARAX; CODIENE; DE 0 PVT PUB None None None 0 PVT UNK None 1 None PUB UNK FB in foot None 1 CBC PUB PUB No Asthma 0 PUB PUB none Allergic to Sulfa 0 4/28/09-records UNK received-CXR UNK normal. Cold like symptoms None 4/28/09-records 4/28/09-records received-Family received-Possible history bronchitis of asthma prioa 2 UNK PUB NONE NONE KNOWN NONE KNOWN 1 n/a PUB PUB None Slight cold symptoms None - runny nose, cough 1 None. UNK UNK None. None None 2 Dr. visit PVT PVT Lopressor, None zoloft, prilosec None 1 None PUB PVT Claritin None Allergy to ceclor 0 None. PVT UNK Unknown. Unknown. Unknown. 1 MIL MIL OCP None None 0 None. PVT UNK Unknown. Unknown. Unknown.
2 MIL UNK NONE 1 PVT PVT ASA, MVI,B12, UTI ATENOLOL, CARDIOLYTE, TAZADONE, AUGMENTIN FLAX SEED, FEM RING, TRAMADOL 0 PUB PUB none 2 none. Though PVT this information PVT is singulair, not requested, foradil, nonemy asmanex, maternal asthma trilevlin, grandmother and environmental synthroid, also loratidine hadallergies cellulitis(pets, after apollen, pneumonia molds); va 0 None PVT PVT ASA, Coumadin, none Diltiazem, A fib/flutter, Metoprolol, HTN,Simvastatin hyperlipidemia, ASD repair, psoriasis, br 1 PUB PVT toprol xl, sythroid, none-good zocor-all codene health, three except alergy taken high daily. bp Diagnostic tests: OTH 06 March OTH2000: Electromyography Aspirin; Atorvastatin Elevated showed calcium; Blood The evidence subject Pressure; Risedronic has ofHyperlipidemia; a acid; history mixed A0601415A Metformin sensory/motor of basal Type cell hydrochloride; 2removal Diabetes peripheral in Azithrom the polyneu 1970 0 Blood glucose, PVT17Oct2008, MIL 77; Electrocardiogram, Metformin hydrochloride; Unknown 17Oct2008, Gestational Cenestin; normal; Diabetes; Thyroxine On unspecified Restless A0768930A sodium;dates Legs Aspirin; Syndrome; theCo-careldopa; subject Shingles; had anHR EK 0 PVT UNK 0 PVT UNK None - Annual exam 1 Positive strep PUB test UNK No Hx of RSV & pneumonia 1 None PVT PUB None None None 1 None PUB PUB None Ibuprofen-rash 1 None OTH PUB None None None known 0 UNK PUB None 4 PVT UNK ADVAIR; VitAsthma D; Multivits exacerbation; NKDA; Asthma; coughFDC; Osteopenia 0 PVT UNK had viral URI gets butwhelps afebrileif 98.0 gets poison ivy per custodial guard 1 PVT PVT 4 PVT OTH None None 2 PVT PVT 2 PVT PVT None 1 PVT UNK None 1 None OTH PVT 1 CBC PVT UNK None None 0 PVT PVT SINGULAIR; LIPITOR Fibromyalgia, DM Type II 1 PVT UNK 0 OTH OTH None PCN-SULFA-Strawberries 0 Pt examined PVT by Dr PVT MANTOUX,None Pasteur, C3026AA, None right intradermal, 0 0 PVT PUB PULMICORT; Allergic XOPENEX; rhinitis; RashSINGULAIR; Stable -BENADRYL ringworm CLARINEX; (per Mom);ACIPHEX house dust; per allergist. 1 None PUB UNK None None None 1057 PVT PUB None None None 1 None UNK UNK None Rash with eggs 0 PVT PVT No No 188 Unknown OTH OTH Unknown Unknown WAES0904USA03237 333 Unknown OTH OTH Unknown Unknown WAES0904USA03291 0 diagnostic laboratory, OTH 04/14/09, OTH blood Nonedrawn None WAES0904USA02392 0 Allergy testing PVT PVT Tuberculin PPD The patient had a history of milk, ###egg and dairy allergies. T 0 PUB UNK None None 9 Patient hadUNK CT scan, an UNK EEG, and is to have None an MRI that and we None follow knowup of.with Dr. 0 PVT PVT 0 PVT UNK None Unknown 2 dr evaluated PVT arm PVT Prevacid, lipitor,paxil none none 0 NONE PUB PUB NONE NONE NONE 4 R thigh ultrasound UNK negative UNK for abscess/loculation. none Blood none culture pending on 4/24. 7/24/09 Hospital records receiv 61 blood work,UNK head CT scan, UNK lumbarNone CT scan, 5/20/09 chest None EDx-ray, records None head received MRI, PMH:None~ spinal multiple Family tap ()~~0~Patient hx: DOS 5/18/09 depression 1/7/09 Received to&1/12. manic-depression. Hospital Phenergan, LABS Ativ of 8 None PVT PVT Diovan (VALSARTAN) None Hypertension 40 MG (40MGElevated TABLETcholesterol Take 0.5) PO Hypothyroidism BID Ecasa (ASPIR ocula 6 PVT PVT 0 labs on 9/16/08: UNK Hb/HCT UNK9.7/29, ocygen, WBC 6.42, ? chronic platelets lung355, Chronic disease sodium lung on oxygen disease 140, potassium on oxygen 4.2,therapy, chlorideretinoopathy 101, CO2 31, of B p 0 No radiographs UNKdone. UNK Received dexamethasone, QVAR (beclomethasone), None.epinephrine, Previously albuterol aerosolized seen MDIbyfor albuterol, anasthma; allergist and history ondiphenhydramine 9/16/2005 of EpiPen and atdiagnose home with IV (fo 0 PUB PUB NO NO Allergic to mold and history of asthma.Patient is not taking 0 PVT PVT
1 UNK UNK Paxil daily None Allergy to erythromycin; dx of fibromyalgia & depression 0 PUB PVT stated "no" stated "no" 0 None, but allergy PVT testing PVT is pending None None Large local reaction to mosquito bites,mild eczema 0 PUB UNK none none none Diagnostic Results: OTH 16July OTH1996: MRI SUMATRIPTAN of the Head: Migraine; SUCCINATE; No evidence Uveitis The subject ofOESTRADIOL; multiple was in sclerosis a motor A0600424A SPIRONOLACTONE; vehicle plaques. accident Small area in 1970 MINOCYC of enhanc and w 5 PUB UNK None None AR0912 5 Abdominal PVT US & X-ray;PUB XR enemaNone for intussusception Runny nose LABS: None x 1 day abdominal PMH: 37 wk x-ray gestation, & US abnormal. no complications. GERD. 0 6/1/09 Hospital PVTrecordsUNK received DOS PPD;4/16/09 ATARAX None to 5/6/09. 6/1/09 Hospital Allergy LABS and referral records DIAGNOSTICS: r/oreceived rash related DOS None dairy; 4/16/09 documented. eczema. to 5/6/09. 6/1/09 benydry Hosp 1 Labs and Diagnostics: PVT PVT Abd US (+) IS. BE (+)None for IS. AbdNone. X-rayPMH: (+) for GERD. paucity air. Perianal CBC abscess./ WNL. 0 A neurologist UNK had received UNK her results today I have to goShe see is him learning in the office disabled, to find sheout haswhere apraxia, we go sensory from here. integraW 1 OTH PVT 1 OTH PVT Azithromycin; MALARONE; Acetazolamide 1 PVT PUB TYLENOL prn; allergic ZYRTEC rhinitis None prn with nasopharyngitis None PVT PUB None None Known 0 PVT PUB No No 0 None PUB PUB None None None 0 red area near PUB KINRIX site PUB- 1 cm from needleNone puncture fish allergy 1 No additional PVT EEG at this PVTtime KEPPRA Cerebral Palsy; one seizure 12/08 2 None PVT PVT CARNATOR; FOCALIN; Allergy: B-COMPLEX; eggs/milk/peanuts; COENZYME Mitochondrial Q10 disorder; RAD; 667 Chicken pox PVT rash + 50PVT lesions 0 PVT PUB ZANTAC PVT OTH 0 OTH PUB None None None yes~HPV (no brand name)~1~12~Patient 1 - ESR = 22.PVT Rest normal. PVT None None 0 PVT PVT None Nocturnal Enuresis 1/9/07 - resolved 0 PVT PUB " X ray neg"PUB PUB Unknown Cough NKA 2 None PVT PVT None None Overweight; allergic rhinitis 0 PVT PVT 0 None donePVT PVT 1 PUB PUB ASPERGER SyndromeLA090402 - diagnosed Sept 2008; Synesthes 0 no labs done PVT PUB none none Congenital hydrocephalus with VP shunt 10 PVT PVT ~Varicella (no brand name)~1~1~Patient 0 MIL MIL SYNTHROID; None ZOCOR;NKDA FOSAMAX; Pentoxifylline 1 Please see PVT the attached PVT lab reports. LIPITOR LABS:- Lupus currently None anticoagulant suspended; High Cholesterol (+), vitamins ANA PMH: (+), RF childhood (-), Coombs epilepsy, (+), ASO LBP.(+), Extensiv cardio Blood test (results: UNK TheUNK 14 serotype Concomitant blood workmedications showed inadequate Relevant were not medical immune reported. history response USWYEH03073208 was not withprovided. antibody concentrations None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH03548808 was not provided. On 23-Feb-2008 UNK test results UNK were:Concomitant antibody testmedications (results:Relevant Serotype were not medical 1 (1) reported. <0.2 history Serotype USWYEH03681408 was not 3 (3) provided. 0.6 : Serotype 4 (4) 2.3 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04296708 was not provided. None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04528208 was not provided. Laboratory UNK test (results: UNK bacterial pneumonia) The patient was was not done taking Relevant in 2008. any concomitant medical history medications. USWYEH05814408 was not provided. 15 Physical examination UNK (results: UNK head Concomitant circumference: therapy 39.8included Patient cm) waswas PENTACEL, done a full on term, 28-Aug-2008. ROTATEQ, USWYEH06016808 previously On and healthy 13-Sep-2008 H-B-VAX. baby. test resu 48 Oxygen saturation UNK (results: UNK 80's) was Concomitant done inThe Oct-2008. therapy patient's included Culture The concurrent patient (results: PREVACID. has illnesses anasal past swab: USWYEH06837608 include historyresistant of rhinitis premature allergic, pneumococcal) baby bronchial (bornwas at hy3 2 None provided. UNK UNK Concomitant The medications patient's Past concurrent were history not of reported. illness urinary includes tract USWYEH07924509 infection upper respiratory (requiring hospitalizat tract infecti Blood culture UNK (results: pneumococcal UNK Concomitant bacteremia) medications was done Relevant were in Oct-2008. not medical reported. history USWYEH08151809 was not provided. None Provided. UNK UNK Unknown USWYEH02943808 42 Culture wound, UNKnegative, UNK it was done on an unspecified Nasopharyngitis. date USWYEH03187808 21 Bacterial culture UNK (results: UNK no organisms Concomitant found) Injection medications was done siteinabscess were Dec-2007. not (LLT: reported. Injection USWYEH03233908 site abscess) 11 UNK UNK Concomitant medications Normal werebirth; not reported. no familyUSWYEH03505308 history of hematologic disorders None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH04031908 was not provided. 0 None provided. UNK UNK The patient is a healthyUSWYEH04518208 child.
None Provided. UNK UNK Concomitant The therapy patient's included concurrent TYLENOL. illness includes USWYEH04931508 gastroesophageal reflux dise 0 No relevantUNK tests performed. UNK None. None. Past therapies included USWYEH05291208 PREVNAR at 2 and 4 mont ibody titers. The patient received a UNK dose on anUNK unspecifiedConcomitant date. The patient medications experienced Relevant were not low medical reported. antibody history USWYEH05671008 titers. wasThe not patient's provided.outcome is unkn 1560 On 08-Apr-2008 UNK test results UNK were:Concomitant blood immunoglobulin The therapy patient's included Aconcurrent (results: HEPless B/HIB. illnesses than 7 USWYEH05768608 include LN); blood coaliac immunoglobulin disease, hypersensi E (resu 0 None provided. UNK UNK Relevant medical history USWYEH05845108 was not provided. 5 None Provided. UNK UNK Concomitant medications Thewere patient nothas reported. a past USWYEH06087008 history of rash after being administe Physical examination UNK (results: UNK normal Concomitant (Language/Speech, medication Relevant Emotional/Social, were not medical re history Fine/Gross USWYEH06142508 was not Motor provided. Skills, Cognitive thin that had been frozen on an unspecified UNK date. On UNK an unspecified Concomitant date, the medications patientRelevant received were not medical a dose reported. history of PREVNAR USWYEH06525108 was notthat provided. had been frozen (med decrease in babbling. The None patient Provided. received UNK theUNK second dose Concomitant on an unspecified medications date. Relevant were Afternot medical receiving reported. history theUSWYEH07048708 second was not dose provided. of PREVENAR thera 0 Body temperature UNK (results: UNK102.5 deg. Concomitant F) and white medications bloodRelevant cells were urine not medical (results: reported. history elevated) USWYEH07245708 was not were provided. done in Dec-2008. Bo None provided. UNK UNK Concomitant The medications patient's concurrent were not reported. illness includes USWYEH07792109 hypersensitivity (multiple alle None provided UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH03223308 was not provided. None Provided. UNK UNK Concomitant medications Thewere patient notpreviously reported. USWYEH03552408 experienced injection site induration None provided UNK UNK Concomitant The medications patient's Noconcurrent were reaction not after reported. illness theincludes first USWYEH03902108 dosehypersensitivity of PREVNAR at (toage "everythin 2 mon 0 None provided UNK UNK None Unknown USWYEH04143508 0 Body temperature UNK (results: UNK 103.9 Concomitant degrees) wasmedications done onRelevant 06-May-2008. were not medical reported. history USWYEH04145908 was not provided. Body temperature UNK (LLT: UNK Body temperature), Concomitant 102therapy deg. F.included None Polio Vaccine "Pasteur" USWYEH04201308 (poliomyelitis vaccine inac 0 Body temperature UNK (results: UNK(7PM) Concomitant 100 degrees medications Fahrenheit) Relevant and werebody not medical reported. temperature history USWYEH05005108 was (results: not provided. (At night) 103.0 degrees None provided UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH05293308 was not provided. 1 None provided. UNK UNK None None USWYEH05941708 4 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06035908 was not provided. 5 None Provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06036008 was not provided. 3 Physical examination UNK (results: UNK head circumference - 34 cm, Relevant lengthmedical - 53.5 cm, history Normal USWYEH06290608 was milestones, not provided. normal physical g 0 None provided UNK UNK None reported None provided USWYEH06552508 UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH06660208 was not provided. ed a dose on an unspecified Nonedate. provided. The UNKpatient experienced UNK None diarrhea. No additional None information was available USWYEH07067108 at the time of this report. See Not provided UNK UNK Relevant medical history USWYEH07073908 was not provided. ea. At 6 months of age, the None patient provided. received UNK a dose UNK on an None unspecified date. The patient None experienced diarrhea. USWYEH07074008 No additional information wa hea. At 12 months of age, None theProvided patient UNK receivedUNK a dose on Concomitant an unspecified medications date. The Relevant were patient not medical experienced reported. history USWYEH07074108 No diarrhea. was other notvaccine provided No additional was administered information 1 UNK UNK Tuberculin PPD (manufacturer None unknown), 03-Feb-2009 USWYEH08110709 1 Body temperature, UNK 103UNK deg. F., 04-Feb-2009. None None USWYEH08120209 0 None provided. UNK UNK Concomitant medications Relevant were not medical reported. history USWYEH08336009 was not provided. 2 UNK UNK 1 UNK UNK unknown none none 13 None UNK UNK Fluoride None None 1 UNK PVT Yasmin birth None control pills, Environmental Allegra, sudafed allergies PVT UNK 0 PVT PVT None Graves disease. Restless leg syndrome 0 UNK UNK N/A NO N/A FEVER~Varicella (no brand name)~UN~1~Pat 0 MIL MIL none sulpha 0 None OTH OTH ARIMIDEX;Immune calcium system (unspecified); Breast disorder cancer; ZOCOR; Chemotherapy; vitamin WAES0904USA03213 D Herpes (unspecified) zoster exposure 0 temperatureOTH measurement, OTH 104 degr None Developmental delay WAES0904USA03207 Unknown OTH OTH Food allergy WAES0904USA02827 6 lab tests running MIL at thisMIL time amoicilian. sinus infection 10 MIL MIL 1 None MIL MIL N/A None 0 mom statesPUB all labworkPUB and lumbar puncture done none in known ER none were known negative 1 none UNK UNK Unknown None Diabetes 1 NONE PUB UNK NONE NONE NONE REACTION TO PERTUSSIS~DTaP (Acel-Imun 0 NONE PUB PUB NONE NONE NONE 2 None UNK UNK ADRs to macrolides. Sjogren's syndrome, PTSD, asthma,
4 Bloodwork, UNK including white UNKblood cells Nonewhich mother None states Allergic was normal. to penicillin Chest x-ray & strep screen which mother a 11 IgE, Liver &UNK Kidney Panels, UNK Glucose Simvastatin, & Chem,Allerted RA, Xyzal, Sed to Singulair, Rate, alergies Asthma, etcVentolin, 5/4/09-records allergiesAdvair, to foodreceived Nasonex and in environment Asthma control test 20 an 1 Temp in ERUNK was 100.4UNK axillary None None to knowledge None. Family of administrator. reports child's Was grandmother later informed andby aunt child's having ca 15 Lumbar puncture UNK 2 times UNK within 9 omeprazole months interval Hyperlipidemia , Simvastatin. was negative Medical 5/28/09 , GERD for records possible Medical received MS records panel. DOS received Four 3/11/08 more DOS toBrain 2/2/09. 3/11/08 MRIs Orchidec towere 2/2/ 7 None PVT PVT None None 0 PVT PUB none none Patient Penicillin was seen -hives for pre-op Codeine-stomach clearance for bloating tonsillectomy and ade 5 None UNK UNK None Diabetes Type none~ #2 ()~NULL~~In Hyperlipiglcerdemia, Patient hepatitis C Antibod 0 Clinic visit on PVT 4/25:Elevated PVT WBC Wal-Zyr, 15,000, Sed Ethinyl NONE rateestradiol/levonorgestrel 46. ER Medication visit on 4/26:WBC allergies: Ceftin, 12,000,Penicillin Sed rate 48. Return to clinic 0 PUB PUB none knownNKDA 84 positive antiUNK nuclear antibody UNK blood pentoxifllyne, test. Labs: ANA 1:640. PMH: RF scoliosis. (-). Anti-DNA tonsillectomy (-). Echo WNL. CXR WNL. US R LE ( MIL UNK ### No reportedUNK UNK Autoimmune reactions to milk.### 68 Hospitalization PUBand Tests OTH 1-21-09 4/29/09-records None received-UA 4/29/09-records None 4/29/09-records glucose received-recent 1000 and receivedmore viral than respiratory PMH:testicular 80 ketones tractcancer. and illness 100m 2-3 Ch 0 UNK UNK None notedNone noted 0 PVT PVT On AUGMENTIN see # 7 on ABx Nonefor punctures 169 PVT PUB None 1 PVT PUB No No 0 None OTH PVT None None None 2 PVT PUB Fluoride Cheealsles None None 8 Brain CT/MRI/LABS PVT Records PVT recieved 05/06/09 - LAB: WNL. Dust/pollens/molds ECG, EEG, WNL. Records received 05/06/09 PMH: Rece 27 None PVT OTH None None allergic to Penicillin; Codeine; Sulfur 0 PUB PUB RisperidoneHTN 2mg; HYLO Liquid #3 Iodine (X-ray contrast) 10 None PVT PVT None None None 1 PUB PUB None 0 Immunization PVT ReactionPUB Keflex 250 None mg/ 5 ml 1 1/2 NKDA tsp 0Bio X ~DTaP 7 days(no brand name)~1~5~Patient 0 Reaction toPVT Immunization. PUB Given KEFLEX Cough 250mg/5ml x 2 days NKDA 1 None 1/2 PO ~DTaP B/D (no x 7 days. brand name)~1~4~Patient 0 None PVT PVT None ADHD 2 None OTH PVT Depo Provera None Beta Blockers, asthma, migraine with auva 1 PVT OTH SIMVASTATIN Physical Drug allergy: PCN 0 PVT PUB None Penicillin 297 Biopsy - of OTH skin = lichen PUB planus Lipitor, Omeprazole None , Lelexa 0 Ct Scan head, PVTCXR, EKG, PVT Labs- normal BCP- YAZ Labs None and Diagnostics: Being worked Glucose Temp up 166. for 104~HPV Neurofibromatosis ALT 29 (no(L). brand Head name)~1~0~Patient . CT PMH: (-). none Drug noted scree 0 None PVT PUB None None None 12 PVT PVT transient neutropenia at birth, resolved 0 Info I overate OTH thinking blood OTH sugarNot lowyet butthat it was None morning becauseNiacin; of vaccine. Diabetic (take pills) 0 PVT PVT None None 0 Doctor notified PUBby RN PUB 1 PVT OTH 1 Visual diagnosis, PVT Dermatologist PVT consult to confirm 1 PUB UNK None None 1 PVT PVT None None Von-Willebrand's Prolonged (Dx on pain~HPV 4/2001) (Gardasil)~1~0~Sibling 1 PVT PVT Albuterol HEA None MDI PRN Mild Asthma 1 ER Done XUNK Ray (not sure UNK reason) Per mom not Wheezing able to bear of Infancy. weight 1 PVT PVT SINGULAIRNone PRN or ALLEGRA Torticolis;PRN PE tubes; asthma; allergic rhinitis 0 none. PVT OTH 0 OTH PUB None UNK UNK B-12, American Regant, 8796, IM Right deltoid, 0, 4-14-09 13 PVT OTH ASA 81 mgNone daily None 5 PVT OTH None Pt. physical 4 CBC - normal PUB plts. OTH Levothyroxine Sodium hypothyroidism 0.75 mg daily; PREMARIN 0.3 mg oral daily 0 Pt @ ER with PUB IV: Benadryl OTH/ Prednisone @ home PO Benadryl 25mg 1g + new X 2days Prednisone 50 mg 1 X 1 da
1 PUB PVT 7 PVT PVT URI CODEINE; MORPHINE; CHLOROMYCET; XANAX; OIL O 0 Diagnostic laboratory, PVT Blood PVT test checked in her Penicillin stomach allergy; 6/8/09-records and her Menstruation gall bladder; received irregular; Chest WAES0901USA00777 for DOS X-ray, Cyst; 8/12/06 Bowel 03/03/09, only. discomfort; slight Seenhyperin inDiarr offi 0 Unknown OTH OTH Unknown Unknown WAES0904USA03453 3 CAT scan of PVT head without OTHcontrastZOCOR; and of the Belladonna; abdomen,Levothyroxine; The chestpatient x-ray, has blood/urine ZANTAC; no known cultures, Ciprofloxacin; allergies ### urinalysis (NKDA), Cephalexin and Sjogren's lumbarsyn pu not reported. UNK UNK not reported ### PVT UNK None None 8 UNK PUB XOPENEX NO NEBU KNOWN 0.63MG/3ML ABNORMAL ILLNESS ATAT 10AM WEIGHT TIME BEFORE OF LOSS VACCINATION. COMING AS OF 4/15/09. INTO DOCTOR small for ges VI 0 unknown PUB PUB Albuterol asnone needed forAsthma asthma s/s 0 PVT UNK 0 None MIL UNK none none none 0 PVT UNK SIMVASTATIN NO NO 0 PUB PVT no no no excessive crying~DTP (no brand name)~NULL 0 PVT PUB none Left foot pain NKDA 0 PVT PVT no known illness Amoxicillin/Augmentin 1 eeg, cat scans, UNKmri of brain. UNK To have noneeeg repeated none at vanderbilt none. PMH: university diarrhea in xJune 1 week. LabsAppy. and diagnostics: On birth control CBC an 1 STILL WAITING UNK FOR RESULTS UNK FROM N/A NEUROLOGIST NONE 1. ANXIETY/DEPRESSION N/A 2. BRONCHIAL ASTHMA 3. O 0 UNK UNK None None 1 Coroner's report UNK conludes UNKhe diedLamictal as the result - 100 none ofmg/day artherosclerotic artherosclerosis, as of 9/14/07; and hypersensitive-type Zocor obesity, 20 mg/day; mild epilespy, also cardiovascular onCAD Vytorin with10/20 disease, mildlyp.o el 1 UNK PUB none none none 1 none PUB PUB NONE TIREDNESS REACTIVE AIRWAY DISEASE 5 PUB UNK ANNUAL TST NONE GIVEN THAT PENICILLIN SAME DAY IN RIGHT FOREARM 0 MIL MIL None None PVT PVT Claritin torticollis ALL in remission 4 UNK UNK N/A N/A 1991 client N/A~ had an ()~~0~Patient|N/A~ allergic reaction to()~~0~Sibling|N/A~ codeine; gave client () 3 none PVT PVT celexa, synthroid, Cat bitesingulair none none~ ()~NULL~~In Patient 0 NA UNK UNK no no no VA09004 0 PUB PVT NONE NONE 0 UNK UNK None None 0 UNK PUB ALLERGIC RHINITIS 0 UNK UNK Nystatin oral, thrush infant mylicon 7 None. Neurology PVT consult UNK obtained.None at time None of vaccines. Hydronephrosis, grade 2. Resolved without intervention. 0 none PVT UNK none Right Eye Cataract 04 September OTH 1998: EKG OTHwas normal; 07 December Unknown 1999: The subject's Dexa Bone medical Density history, A0600400A Study: concurrent There was conditions evidenceand of os co Diagnostic results: OTH 26 June OTH 2000: Lumbar Spine Unknown MRI: 1. The Minor subject's multilevel medical degenerative history, A0602351A concurrent changes theconditions discs lumbosac and co UNK OTH OTH Unknown The subject's medical history, A0780839A concurrent medical condition 13 Abdominal PVT ultrasound; PVT XR fluoro air None enema. 6/8/09 None Hospital Nonerecords DC summary received DOS 4/27/09 to 4/28/0 11 None Labs PUB and diagnostics PVT (as reported None by pt) None WBCs 12K. None EKG PMH: WNL.none Echo noted WNL. CXR-? fluid. No LP was done. 25 Skin bx 5/26/09 MIL medical UNK records recieved DOS 5/26/09 5/8/09.medical skin biopsy records 6/15/09 recieved medical DOSrecords 5/8/09. received urinary orLABS: chlamydial Biopsyin 0 Normal PVT UNK ZANTAC; REGLAN Just a little light cold GERD 20 FBC; TestsUNK for Autoimmune UNK disease; in all 37 tests from October 30 - January 5th 2009 5/8/09 - Medical records re PUB PUB None None 0 PVT PUB Well visit. 7 None PVT PVT LEVOTHYROXIN; No Calcium Sulfa supplement. allergy; Hypothyroid; Allergic rhinitis. 0 None PVT PVT None None None 1 None PVT PUB None None None 0 PVT PVT None None 0 PVT PVT JANUMET;Rash LIPITOR; in scalp TRIPIUX diabetes, high cholesterol. PVT UNK None None PVT PVT Routine FUNKDA; COPD; Asbestosis. 0 None PVT PVT ADDERALL, XR 20mg.ADD
3 PUB PUB None Known 0 PUB PUB NC09016 0 PVT UNK None Allergy to MUCINEX 0 CBC Strep PUB flu mono negative UNK - all None None Renal reflux NC09017 0 None performed PUB at Graham PUB County None Dep. of public NoneHealth by report Allergy to PCN / Dilaudid NC09015 per client 2 PVT PVT None None None 13 PUB PUB None Premature 9 weeks, body cardia 0 PVT PUB None 1 PVT UNK None None - Anxiety to immunizations deferred till now. 2 PVT PUB None PUB PUB None None None 0 PVT PUB None None None ~DTaP (Daptacel)~1~4~Patient 3 None PVT PVT None None 1 PVT PVT ZYRTEC 5 mg every day Seasonal allergies UNK UNK PVT PUB Cintrold, redNo yeast rice.Hernia in stomach. Flu like symptoms~Influenza Allergic to VICODEN;(no TAXOL; brand name)~ TALWIN 0 PUB UNK Allergy Med. None ZYRTEC;Seizure NASALCROM. right after she was born UNK UNK 226 Normal physical UNK examination UNK 03/01/2009. None 2 PUB PVT None None None 1 PVT PUB URI week earlier esotropia - corrected 0 None PUB PUB Unknown None None 3 PUB UNK 31 MRI & EEGUNK per mom (unable UNK to locate ALBUTEROL EEG) Asthma M.D. records "Cerebral attached. palsy; Pervasive SC0911 Dev Delay; Asthma" per mom 1 PVT MIL None None 5 OTH PVT None None Hx of asthma - no s/s since 2007; NKA ; recently changed 1 PVT PVT Lactulose pin; None ALBUTUAL NoneNEB PIN local reaction~Pneumo (Prevnar)~2~0~Patient 2 PUB PUB ORTHO TRICYCLEN none. lo ovarian cyst. PUB UNK 6 None MIL MIL None None None 0 PVT OTH HCTZ 25 mg None daily Recent bout of vertigo - one month ago 0 UNK PVT None Pt developed None hives 1 PVT PVT PPD, Sanofi, None C2803AA, None SQ forearm, no previous doses, 3/20/09 1 LP -CSF normal; PVT HeadUNK CT 1 Rash, Urticaria PVT OTH PPD sanofi,None C3060AA,None ID leftknown Foreman, PVT PVT None 0 PVT PVT Oral contraceptive None None Pt. later says she sometimes "faints" with shots 2862 03/12/2009,MIL Absolute Lymphs, OTH 0.59, LIPITOR; Low; 01/23/2009, Multivitamins; None ADDS, Myalgias; Minerals 432,Felt positive, nauseated; greater 09AV00058SP Hypotension than 200 strong positive; Alani 0 Unknown OTH OTH Unknown Unknown WAES0904USA03689 365 None OTH OTH Vitamins (unspecified) Allergic reaction Bronchiolitis to antibiotics WAES0904USA03576 0 Unknown OTH OTH None Iodine allergy; Food allergy WAES0904USA03788 Unknown OTH OTH Unknown Unknown WAES0904USA03416 28 02/Dec/2008: UNK CT of theUNK abdomen revealed a normal proximal Previously appendix; healthy. the distal portion ###of the appendix could no 61 Unknown PVT OTH Patient had a spider bite in May ###2007 and a long history of 0 PVT PVT none none 0 PVT PVT none Strawberries 0 PUB UNK Given Acetaminophen None known A 650 llergic mgstoatPollens 10:58 a.m. (hayfever-like symptoms) and Tomatoes 1 PVT UNK A deep dogsee scratch 18 sent me to clinic for booster of tetanus. I have ch 2 MIL UNK 0 MIL MIL Mirena- IUDSore ThroatSeasonal 0 CBC PVT PUB
0 none PUB PUB amoxicillin, R erythromycin otitis media none eye and ointment,acetominophen, bacterial conjunctivitis saline nasal drops 1 PVT PUB 4/13/09- amoxicillin 4/13/09- acute 250mg nonepharyngitis chewnone~ tabs ()~NULL~~In Sibling1|none~ ()~NULL~~ 28 None performed PUB PUB None at vaccination none time 4 Mono Test UNK negative; Completed UNK allNone blood tests, None Lyme Disease Asthma Negative; from None~ 5-13 Heavy years ()~~0~Patient Metal of age. Negative, AllergicHIV to penicillin, Negative,solum Bra 434 PVT PUB COUGH,RUNNYNOSE,RASH ON LEGS 1 PVT PVT synthroid none bee sting allergy, severe. carries epi pen 0 PUB PUB none none 1 PUB UNK none none none 2 5/11/09-records PVT received-H&H UNK 8.6 and 26.7, Na Wheezing 133, K 10.8, 5/11/09-records Gastroesophageal ABG 6.6. CXR received-Seen reflux; severe Croup; bilateral in Dehydration ED airspace and PCPdisease 5/11/09-rec office multip wor 1 UNK OTH OTH Phenobarbitone; Seizure Phenytoin Disorder B0571719A 7 Platelet counts: MIL 4/26/09: MIL 1K; 4/27/09: None 16K; 4/28/09: None 34K.None; 7/14/09 NKDA. Hospital 7/14/09 records Hospital received records DOS received 4/27/09DOS to 7/8/09 4/27 1 Stool spec -OTH neg for Rotavirus PUB 5/18/09 Hospital records received 5/18/09 Hospital DOS 4/22/09 records to received 4/24/09. LABS DOS 4/22/09 and DIAGNOSTIC to 4/24/09 0 CSF c/s negative PVT to date; PVTBlood c/s negative Rhinitis to date 5/13/09 Nonehospital records received DOS 4/27/09 to 4/30/09 LA 0 PVT PVT None None None 1 PVT PVT 1 OTH PVT 0 PVT PUB 0 None OTH PUB None Known None None Known 1 None PVT UNK 8 None PVT PVT 0 Advised skin PVT testing prior PVT to futureNone doses. None None 0 PVT PVT SYNTHROID; Seasonal ALEVE:allergies HTN; HCTZHypothyroidism 2 OTH PVT Received PPD None same day, Allergic was to: negative. Artificial sweeteners and was fit tested that day 0 Documented PVT moderatePUB "allergy to egg Resolving URI Egg allergy; Eczema 0 CBC and Strep OTHperformed, PUB test WNL. No None No Swelling arm~Vaccine not specified (no brand n 1 PVT PVT 0 UNK UNK UNK UNK 1 PVT PVT 6 chest X-ray,PVT 07/28/08, PVT see narrative; amlodipine chest X-ray, Rhinitis; besylate, 08/05/08, Upper 10 mg; see respiratory atenolol, narrative; 50 tract chest mg; infection; WAES0809USA04176 LIPITOR, X-ray, Coronary 08/11/08, 40 mg; artery see HYDRODIURIL, narrative; disease;com Ao1 0 Unknown PVT OTH concomitantUnknown medications Nowere history notofreported. allergies.USWYEH09133809 0 Not reported PVT PVT PEPCID; Prednisone The patient had received a flu### vaccine (trade name, manuf 0 ultrasound, OTH 04/06/09, IUP OTHearly vsLevothyroxine MAB. Reason: Pregnancy sodium, spotting; Ectopic NOS microgm ultrasound, (LMP pregnancy = 3/3/2009); 04/09/09, WAES0904USA03645 Hypothyroidism Result: Cardiac activity. Reason: 0 Unknown OTH OTH Unknown Unknown WAES0904USA03992 0 urine beta-human, OTH 07/26/08, OTH pregnant LEXAPRO,Pregnancy 10 mg; ACIPHEX NOS (LMP = 6/18/2008); WAES0808USA00962 Allergic reaction to antibiotics; D 0 UNK UNK lorazepam 0.5 None mg at night Insomnia, (1/2 nights GERD per week), Prilosec OTC 20mg PRN gastric 0 none PVT PUB none none none 13 None. UNK UNK None until started none known on amoxicillin Hospitalized for for earrule infection out sepsis on 4/8/09. 8/08 and for bronchiolitis 1 1 MIL MIL Hydrocortisone NoneCream,HTN, Lisinopril, Hyperlipidemia Local Atorvastatin site Reaction~Anthrax (Biothrax)~2~27~I 17 Bacterial Wound MIL Culture MIL 4-28-09 Viral WoundNONE Culture 4-28-09 N/A CBC 4-28-09 Full Layer Punch Biopsy (2mm) 4-28-0 0 n/a MIL MIL n/a None None, except patient has a hx of +reaction to TST (PPD) in 0 N/A MIL MIL N/A NONE NONE 0 Hyda Scan UNK for suspected UNK gall bladder Focalin, issues, 10mg/day; had no problems just aciphex, recovered Acid noted; Reflux 10mg/day; from MRA diagnosed the is 12 scheduled hour in stomach August, for May 2009; flu13th which medication forshe suspected hadhelped on Fe MA 0 NONE UNK UNK NONE NONE ALLERGIC RHINNITIS (SEASONAL ALLERGIES) MOM S 1 PVT PVT none 21 PVT PUB n/a n/a Will discussUNK with physician PVT after her visit today. None known. None known. 2 Quick Vue Influenza PVT rapid PVTtest completed. NOne Negative None results. NKDA 7 PUB PUB Client had pierced finger with fork, trying to take apart froz 0 CBC and CMP UNKtests were UNKbasically None normal. None reported Documented history of depression and ADD, no allergies o 3 None PVT UNK Zantac GERD GERD, Ezcema, Eosinophilic Esophagitis
3 PVT PUB None None 11 Multiple including PVT thrombocytopenia PUB None LABS 3/15/09: No initial None plts 5K. Family Coombs hx: Parent (+) LABS w/ulcerative 4/10/09:colitis, Plts <5K, migraines US of abd cervical x-rays; MIL C-spineMIL MRI; brain MRI/MRA;none thermogram; knownprior bone neck scan injuries 1982, 1993, Mar 2003 1 Lab test showing PVT viral encephalopathy, OTH None chronic Child colitis, sick;mercury 9/12/06-Hep No poisoning ~DTP B given + IPV + Act-Hib (no brand name)~1~0~P 11 Crohn's disease; PVT Upper/lower PVT US;None Endoscopy/colonoscopy; at theNone time of theNone vaccine Abdominal abdominal CT Scan pain~HPV LABS: abdominal (Gardasil)~2~15~Patient US w/right ova 1 PUB PUB 1 CBC, 11-20-08, PVT WBC, PUB 4.9, RBC, 4.31, EPIVIR; plate, KALETRA; 203K, HIV-VLR50; Hb,ZERIT; 11.3, HIV-Perinatal; CD4Hct, TMP/SMZ Abs35.8, 1221 Neonatal Lymph, 68.8%, drug exposure; Mono, 3%, NKA N, 13.9%, E, 52 0 PVT PVT None None 1 None PVT PUB T tsp BENADRYL None q night Seasonal allergies, Asthma, severe Bilateral Kidney Reflux 1 PUB PUB Unknown None Psychological problems 12 None PVT PVT None None 0 PVT PVT None None None CT200908 0 No PVT OTH 1 PVT PUB history of febrile seizure 1 PVT PVT ADVIL 200mg 1 PVT PVT MultivitaminNone None 103 PVT UNK None None 2 PVT PUB None 0 PVT OTH LOESTRINNo 24; FLORINEF None PUB PUB None None Failure to thrive 2 Viral and bacterial PVT cultures PVT negative ZOLOFT 100mg None OD None except depression NOS 2 PUB PUB none none none 2 PVT PVT None None None 0 4/20/09- Had PVT to see a specialist PVT & he confirmed None my pain None is from the vaccination. 0 None PVT PVT Birth controlNone pill. None dizziness~HPV (Gardasil)~1~18~Patient 2 PUB PUB Proteinuria Obesity 0 None done PVT at this timePVT None UNK OTH OTH Unknown A0768956A 0 Unknown PUB PUB Drug allergy; The Smoker subject has knownA0763053A allergies to amoxicillin, penicillin an 0 UNK PUB PUB No concurrent Unknown medication The subject has no documented A0763059A history of adverse events 2 According to PUB the reporter, PUBall diagnostic tests Unknown so far haveThe been subject negative; has no hadglaucoma fluA0765124A vaccinations and no in blocked the past, tearbut ducts. is uns UNK OTH OTH Unknown Medical history and if there A0765338A were any adverse events follow 2 UNK PVT PVT Aspirin; Lisinopril; High blood Lovastatin; Pneumonia; pressure; Doxycycline High It was cholesterol reported A0777619A by the subject that he has had 1 pending, MRI MILbeing arranged MIL by PCP denied. at home none hx shoulder/neck pain with normal x-rays otherwise none 35 Cat, MRI, EEG, UNK Blood UNK work 6/17/09 None Hospital ED None records None received DOS 4/23/09. LABS and DIAGNOSTICS: EEG 10 UNK UNK 1 PUB PUB Unknown None None 1 Ultrasound,UNK Endoscopy, UNK Blood tests None and stoolNone sample 5/5/05 Lactose Records intolerance, received nocternal DOS 1/7/09 enuresis, to 3/7/09. hypothyroidism LABS: MCV 10 Seen by infectious UNK disease UNK specialist None None 10 MIL MIL No None 0 PUB PUB none 0 MIL MIL None None 1 PUB PUB none local reaction SC0912 diagnosed as cellulitis~DTaP (Inf 0 N/A UNK PVT Benicar HCT None 40mg/12.5mg High Blood none~ Pressure ()~NULL~~In Patient 2 PUB PUB local reaction SC0913 with dx of cellulitis~DTaP (Infanri 0 PVT PUB otitis media 12 MIL MIL Np None 8 NONE MIL MIL RUNNY NOSE NONE ONLY 14 MIL MIL No None 1 None PUB UNK Trivisol None 0 UNK PUB DYSMENORRHEA
6 n/a PUB PUB none none 1 Unknown UNK UNK N/A None N/A Allergy: cephalosporins, septra. Unknown OTH OTH Unknown None WAES0904USA03499 1 None PVT PUB On AMOXICILLIN Mild pneumonia since None 4/16/09 0 None PVT PVT None None Environmental allergies 0 PVT PUB None None 1 PVT PUB NASONEX;NO TYLENOLNone 1 PVT PUB None PPD - Hep A 0 PVT PVT Rabies IG 4/24 None 0 PUB PUB 10 PVT PVT PREVACID;None LIPITOR Throat Ca 2005 without tx last 4 yrs; well 2006-200 21 EEG x3; LPPUB x3; MRI head; PUBEchocardiogram; None. 6/1/09 Encephalopathy Hospital records Nonesecondary receivedunknown DOS 4/13/09 etiology. to 4/20/09. 6/1/09 Phenobarbital, Hospital recordd 1 PVT PVT OMNICEF 300mg None q. 12h ? Tdap for ? (MENACTRA sl. cellulitis ~DTaP (no sxheld brand by name)~4~2~Patient Dr) PUB PUB Entire body rash~Pneumo (Prevnar)~1~0~Patie 0 UNK PVT None None PVT UNK PVT PVT None 1 PVT PUB None Peanuts, Eggs - had anaphylaxis once but now eats them 0 PVT PVT Birth controlNone None None PVT PUB None None PVT UNK 0 PVT PVT VENTOLINNone HFA; OMEGA-3 Asthma350 mg capsule 0 PVT UNK sore throat Phenergan; codeine 0 PVT PVT None None 1 PVT PUB Mild URI 4 PVT PVT Stepped on nail 0 PVT UNK None Asthma PUB UNK PVT UNK 1 None OTH PUB None None 0 PVT UNK 8 PVT OTH None 9 PVT PVT 1 BMP- 139/39/107/19/CO2; PVT PUB CBC 9.8, None 12.2, 36.4, None 433 Eczema, Allergic Rhinitis 597 None PVT PVT None None 1 None PVT PVT Healthy Child None 2 None PVT PVT VOLTAREN(R) hip lateral Notear drug allergies 1 PVT PVT none No None 2 None PVT PVT Clonazepam; Pain Fluticasone and swelling No known nasal; SINGULAIR; drug allergies; ZYRTEC; PMHx Allergic MEXAR rhinitis; anxiety. 0 PVT PVT CORTISONE; Unknown DIPHENHYDRAMINE The subject had HC1; no relevant Ibuprofen A0777867A medical history or any advers 0 UNK PVT PUB No concurrent Unknown mediations There was no relevant A0779458A medical history. The subject had no 2 UNK PVT PUB No concurrent Unknown medications Hearing loss; Otitis Media; A0779487A The subject had not experience 2 UNK PVT PVT Penicillin allergy A0780206A 0 UNK PVT PVT Unknown A0780790A UNK OTH OTH Unknown A0780793A UNK OTH OTH Unknown A0780845A UNK OTH OTH Unknown A0780846A 64 MRI, Blood UNK Work, CT Scans, UNK Lumbar Puncture, Heel Neurological Pain Seasonal examinations. allergies 5/14/09 Hospital records received DOS 2 PVT PVT None None 6 UNK UNK 2 PVT PVT rash, fever~Varicella (no brand name)~1~2~In
0 MIL MIL None None None See Above~ ()~4~23~In Patient 3 None PVT UNK None Questionable None mild cold symptoms in the week prior; none noted on da 2 PUB PUB 0 PVT PVT none noAll allergic reaction to amoxicillin 0 None OTH OTH None Known None None 0 UNK UNK 1 none PVT PVT none none 10 CBC and HIV UNK test pending UNK 5/28/09 none. ED records 5/28/09 no received ED records patellofemoral DOS received 5/3/09.DOS LABS syndrome, 5/3/09.Allegra, and DIAGNOSTICS: seasonal doxcycline, allergic CBC rhinitis fluomethelon - Pending. H 1154 UNK UNK medical records state PMH: psoriasis, low back pain 0 Unknown OTH OTH Unknown Unknown WAES0904USA04339 Unknown OTH OTH Cerebral palsy Premature baby WAES0904USA04222 3 Unknown OTH OTH Terazosin hydrochloride None WAES0904USA04218 11 None OTH OTH None WAES0903USA04872 0 Urine beta-human, OTH 03/19/09, OTH positive Unknown Pregnancy Pelvic NOS (LMP inflammatory = Unknown); disease WAES0903USA03976 Oligomenorrhoea 1 EKG, labs, PVT 2 D echocardiogram UNK all normal. None ### 0 CBC - Lymphocytes PVT 50.8% OTH DIFLUCAN;AtLORTAB the time 5The of vaccination patient hasonallergy 20 April to penicillin 2009 ### the that patient causes had a concurre rash. She 0 not reportedUNK UNK Flonase; Loratidine; Benzopril; History ofZoloft; high blood Hydrochlorothiazide pressure### and no known allergies. 0 Mother reports PUBdx of secondary PUB staph None R/T immunizations. None None. 6/29/09 6/29/09 Hospital Hospital ER AR0914 records ER records received received DOSDOS 4/24/09 4/24/09 to 4/ 0 PVT OTH No No No 0 PUB UNK None None Dust - pollen - smoke 1 PUB PUB none AR0913 None PVT PVT SYNAGIS None 0 None PVT PVT ALLEGRA; None WELLBUTRIN; Allergy TRAZADONE; to oak pollenBENADRYL-PRN and honey 0 PUB PUB PPD, C2806AA, None ID/LA,DARVOCET no previous and doses PERCOCET on file; HCTZ; allergy; ZOCOR; Has sarcoidosis PRILOSEC 0 None doneOTH PUB Headache- likely tension 0 PVT PVT 2 None PVT PVT None None 11 None PVT PUB None 1 see attached PUB PVT None None Premature 34 wk 0 None PVT PVT None None 1 UNK UNK 2 PVT PVT given PPD none at same time 3 PVT PVT no no 0 N/A PUB PUB Ogen and HCTZ None reported hypertension 2 PUB PUB I had just had none a c-section diabetic 6 PVT PVT no 3 Dr. appt. UNK UNK Citalopram none 40mg;known Zolpidem medication at time 5mg; of vaccination allergies listed:PCN, Sulfa, Opioid 9 CBC , UA/UC, UNKbloodculture, UNK CRP none all normal--none these testsnone were done on my breastfed infant LABS: CBC wnl excep 0 5/15/09 EDUNK records received UNK DOSNONE 5/1/09 LABS NO.and DIAGNOSTICS: NONE ECG - WNL 1 ALL TESTSUNK AND LABS UNK WNL. 6/2/09 NONE HospitalNONE records received 6/2/09 Hospital DOS 5/2/09 records to 5/3/09. received LABS DOS and 5/2/09 DIAGNOSTICS: to 5/3/09. Kid C 2 NONE PVT PUB ALUBUTEROL NONE ASTHMA; NO KNOWN ALLERGIES 9 PVT PVT 0 UNK UNK azythromycin None for otitis and NoneURI 1 Mother wasPUB unsure what PUB test was None run, she didNone not see notedNone a culture done, or any blood work drawn. 5 UNK UNK cold asthma - diagnosed right after 6 months shots. Breathing p 2 Last Td administered UNK 08/20/1999; UNK Patient no adverse reported None reactions takingreported. Allergies no other to medications animal dander. on 06/13/2008 Patient also reported, "I had an 0 PUB UNK Zoloft None Polycystic Ovarian MedicineSyndrome, solidified in Endometriosis arm requiring surgical rem 3 UNK PVT none none 0 None PVT PUB None None None 1 none UNK PUB Seasoniquenone - birth control Metatarsis Maxalt adductis - bilaterally 2 PVT MIL none none none
10 0 1 none
PVT PVT PUB PUB none no Previous non-displaced skull fracture with associated subd PVT PVT pulmicort and none veramystasthma, allergies PUB PVT 12 N/A PVT PUB N/A N/A N/A N/A~ ()~NULL~~In Patient PVT PVT NONE NONE NONE 0 PVT PUB NONE NONE NONE 2 na PVT PVT none none 1 UNK UNK unknown none unknown 1 5/18/09-records PVT received PVT Epstein Barr virus BCA None IgM 1.42, EBV-Mono IgG 2.841/18/09 6 PVT UNK 0 None known PUB PVT Tb test, Sanofi None Pasteur,KEFLEX; C3060AA, Contrast L Forearm dye; IODINE; VOLTAREN; ? Anti-inflam 1 None PVT PVT - BP 102/60PVT lying; 80/70 PUB sitting. Albuterol prn none asthma 8 UNK PVT 0 None PUB PUB None None None None PUB PUB None None None 2 P/A PUB PVT 1 None PVT PUB None None None 0 None PVT UNK None Well child visit No PVT PUB None None 2 None PUB UNK Generic DrugsNoneAllergyAllergies OTC; ALEVE OTC 1 OTH PVT None None None None. PVT PVT None None None 1 None PUB OTH ATIVAN H/S; None LEVOTHYROXINE None 0 PVT UNK None None 1 PVT PVT Shellfish 1 None PUB PUB None None None 5 PVT PVT None None 1 None PVT PVT Clonidine. None None 1 PUB UNK 1 None PUB OTH None None reported 0 Quick viral strep OTH (-); U/A PUB dipstick; SC, MOTRIN 1015;on ph None. 4-17-09; 6; TrTleuk; 98.3 4-19-09; Blisters Tr protein; on 4-20-09; soles Smallof 4-21-09 blood feet 2' running (mild) 0 Rapid strepPVT screen - negative PVT None None None 1 OTH OTH The patientno had pre-existing no illness medical conditions ### and had not been taking Unknown PVT UNK It was unknown if the patients### were taking concomitant me None PVT PVT The patientThe had patient no illness hadatathe history timeofofseasonal vaccination ### allergies, allergies to None UNK UNK Unknown ### 2 None. Per follow-up PVT information, PVT CBC/ESR/CMP OXYCONTIN and UAPatient performed had on a history 03 December of back pain 2008 ### and were a previous normal. eye injur 2 None PVT PVT ZOCOR; ibuprofen; None BENADRYL The patient has a medical condition ### of hyperlipidemia for w 1 None PVT PVT Cialis, Eye Drops The patient had medical conditions ### of glaucoma (uses eye Not reported PVT OTH She had not received any other ### vaccines within four weeks 1 PVT PVT None ### 0 None PVT PVT The patient had no concurrent### illness, no pre-existing med 1 HbA1C in April PVT2008: 11.5 OTH LANTUS No illness atThe time patient to vaccination. has a history of hypertension, ### diabetes and ha 0 Being followed PUBat clinicPUB LEVORA oral None contraceptive None 1 CBC; Sed-rate PVT WNL OTH None Asthma; Allergic rhinnitis. None PVT PUB AUGMENTIN None UNK UNK 1 PVT PVT None None 0 PVT PVT PREVACID Reflux same as above~DTaP + IPV + Hib (Pentacel)~
1 None 1 3 None 1 0 1
PUB PUB None None None PVT PVT None None PVT PUB None None PVT UNK Well visit PUB PUB None None None Known PVT PVT None UNK UNK 3 PUB PUB None None None 0 None PUB PUB None None None 0 diagnostic laboratory, OTH was OTHdiagnosed Unknown with autistic spectrum None WAES0904USA04467 3905 VZV strain, OTH 04/??/09, positive OTH for varicella Unknownzoster virus; Enterovirus Unknown PCR, 04/??/09, WAES0904USA04614 negative. 0 Unknown OTH OTH Unknown Unknown WAES0904USA03962 0 ultrasound, OTH 03/26/09, 7OTH weeks OB;FLINTSTONES ultrasound, Pregnancy 04/08/09, MULTIVITAMIN Caesarean NOS confirmed (LMP SAB section; = 1/25/2009); Early WAES0903USA05524 Smoker; onset of delivery Papilloma viral infection 215 urine beta-human, OTH positive OTH Unknown Premature baby WAES0805USA06266 22 MIL MIL PROSCARNo PMH: acrochordon, gingivitis, muscle spasms, alopecia. F None PVT PVT No No 0 PVT PUB 1 PVT PUB 0 None PUB PUB None Known 920 PVT PVT None None None 0 MIL MIL 0 None PUB PUB None None None 27 CMP; CBC;PVT TSH; CRP;PVT ANA; RA normal. Albuterol;LABS: Enalapril; had been Chest Zyrtec having CT wasscan s/p some surgery WNL. chest TSH forpain endometriosis 0.033(L). ER cxr PMH: & ekg, Asthma, Holter allergic monito 1 PUB PUB None allergy to AMOXICILLIN 1 PVT PVT No None 1 PUB UNK None NKDA 9 PVT PVT AMOXICILLIN Right acuteotitis media UNK UNK PPD, Paredule; 84833;` intradermal left forearm; 0 PVT PVT Lamactil - Increased dose Anxiety fromattacks 50 mg only. to 75 No mgallergies. 1 PVT OTH BACITRACIN Burn to faceNone -729 PUB UNK None None 1 PVT PVT None None None 1 PVT OTH 0 PUB PVT Denied illness Penicillin, at the time Typeof2vaccinations. DM, IBS Reports contact with some 9 visual diagnosis PVT PUB minocin acne vulgaris acne vulgaris MIL UNK none at time none of vaccination 8 PVT PVT NONE NONE NONE 4 PUB PUB 0 None accomplished UNK in UNK emergencyNone room. None Prior hx of infantile febrile seizure and PCN allergy. Pt oth 1 not applicable UNK PVT none reported no prior hx of shingles; PMH: stent placement; cardiac "pro 52 unspecifiedUNK blood testsPVT reported as was "normal" placedunknown on prednisone PMH:Prior then cortisone Shinglesointment x2; polyps; headaches; skin lesions 0 NONE UNK UNK NONE NONE NONE 1 PVT PVT lisinopril 10mg None Aspirin, Penicillin, Poison Ivy, Fire Ants, Polyurethane 15 unknown (done UNK in Westchester UNK Medical 6/8/09Ctr). Hospital none 6/8/09 records Hospital fibromyalgia. andrecords DC summary and 6/8/09 DC received Hospital summary DOS records received 4/03/09 andDOS DC to 4/17/09. summary 4/03/09 Lyric torec 4 12 5/18/09 Hospital UNK records UNK received Protonix DOS 3/18/09 None to 3/20/09. GERD, LABSPhlebitis and DIAGNOSTICS: 5/18/09 Hospital EKG records - nonspecific received T-wave DOS 3c 0 NONE UNK PVT NONE 9 n/a PVT UNK none none peanut allergy 0 none PUB PUB carvedilol, enalapril, none furosemide, afib, chf, lumbar simvastatin, radiculapathy, amlodipine, htn,methocarbamol, hyperlipidemia tramad 0 PVT PVT Wellbutrin SR, not Triphasal applicable not applicable 0 PVT PUB none 0 She received UNK blood testUNK to rule out infection and test was negative. No infection found.
0
UNK UNK Triameterene, Constipation Levothyroxine, Gabapentin UNK OTH OTH Unknown A0781881A 0 UNK OTH OTH No concurrent Unknown medication The subject was reported A0782027A to have no relevant medical histo 0 CSF culturePVT (-), Blood Cx UNK (-), UCX:None contaminate, None VRP (-),None stool Cx - pending 5/18/09 ED records received DOS 4/2 13 5/13/09 hospital PVT records OTH received DOS 12/4/08-12/9/08. Ear fullness, High LABS sinus blood and pressure DIAGNOSTICS: pressure 5/13/09 LPhospital - glucose records 76 mg/dL received (H), DO CS 1 PVT PVT Asthma & cough Asthma 1 None PVT PUB None Per mother; maybe at age 4 y/o, similar reactio None performed PVT PVT None Hyperthyroid 7 None PVT PVT Mild URI symptoms None PUB PVT None None 357 MIL MIL Unknown Osteoporosis, Dyslipidema ; cut b diffciency; DJO. PVT PVT Demerol 1 OTH PVT CLEMASTINE Unknown 0 None PVT PVT 3 Appointment PVT made withOTH immunologist None Allergic Rhinitis None 9 None PVT PUB None None 1 None UNK PUB None None Known 0 HemoglobinPVT = 11.4 / Lead UNK= 1.5 Diaper Rash/Swelling R Thigh 227 Elbow Bx, 9/29/08, UNK strongly UNK positive HCTZ; transaminases KCL; Folic >100; acid;8/7/09 Vit Endoscopy D2;Hospital CLIMARA Bx,records 12/19/08, patches received strongly DOS positive inpatient transaminases 11/25/08 to 91 CBC valuesUNK for Platelets: UNK DEC. 2007 Lisinopril - 242, 20 000mg/day; / uL; JUNE Metoprolol, Pre-existing 10, 2008 50Hx - mg/day; 34, Hypertension; 000 LIPITOR, / uL; JUNE Angioplasty 10mg/day; 12, 2008with -Finasteride, 37,stent 000 (DEC / uL; 5m 0 PVT PUB None. None. None. 0 PVT UNK Childrens Claritin none & Childrens seasonal Sudafed. allergies. Unknown OTH OTH Unknown Unknown WAES0904USA04537 Unknown OTH OTH Unknown Unknown WAES0901USA00303 1 None OTH OTH BUSPAR; ESTRATEST Postmenopause; H.S;Lipids ZOCOR abnormal;WAES0904USA04464 Anxiety disorder; Drug hypersensit 0 None OTH OTH None None WAES0904USA04459 muscular biopsy, OTH muscle OTH contain aluminum Unknown Unknown WAES0904USA04521 0 PUB PUB hctz/lisinopril, none metoprolol, htn,terazosin, gerds, gilbert's lanzoprazole disease, sarcoidosis 0 none PUB PUB none knownnone none none~ ()~NULL~~In AZ0904 Patient 0 A chest x-ray PVT and flu swab PVT were conducted None and Some were nasal negative. Penicillin congestion. No diagnosed illness or temperature. 2 SPINAL TAP UNK & BLOODWORK. UNK 6/15/09 Hospital NONE records DC summary received DOS 5/5/09 to 5/7/09. LABS and D 0 5/8/09 ED records UNK received UNK DOS 5/5/09 LEXAPRO, LABSRESIPRODRO & DIAGNOSTICS CYSTIC -FIBROSIS, None reported. DEPRESSION AND ASTHMA PVT PUB 1 UNK UNK None No Giant Uticaria onset 06/01/1995, GI reflux onset 04/01/200 0 PUB PUB Client had been NonetakingNone, Yaz fordenied the last a history year. of seizures, mom stated client pass 0 PVT UNK 1 NONE REPORTED PUB TOPVT HD UNKNOWNRECOVERED NONE RECENTLY LISTED FROM SHINGLES 2 None PUB PVT Paxil, Metoprolol, None Orthoestrin,Simvistatin None Protonics? 1 no testing done, PVT advisePVT NSAIDs/ice/rest prn. At none thisnotednone time, patient noted understood instructions and did not feel finger pai 2 PVT PUB 1 PVT PUB 0 Random blood UNKsugar from PUBglucoseNone. analyzer -None. 100 None. 0 PVT UNK none none none lethargy, excessive crying~Hib (OmniHIB)~1~0 0 UNK UNK URI 0 None reported. PVT OTH Albuterol inhaler Patient has a history of asthma ### and gastric reflux. Not reported UNK UNK Not reported ### Antibody test OTH (results: Pneumococcal OTH Concomitant serotype Unknown levels: medications serotype Relevant were 1--0.2, not medical reported. 12S--0.2, history USWYEH09094309 7s--0.2, was not14--0.9, provided. 3--0.2, 8--0.2, 18C 0 not available MIL5/8/09 medical UNK records None recievedDenied DOS 10/2003-2006. Denied LABS and DIAGNOSTICS: Initial thyroid labs: 0 5/13/09-records PVT receivedPVTNeutrophil % increased None54.4. urine Noneculture 5/13/09-records no growth.received-PMH: heart murmur since 0 None PVT PUB None None None 20 Punch skin MIL biopsy fromMIL R arm - "Highly suggestive of orthopox virus/ vaccinia infection."
0
PVT PVT PVT UNK 1 PVT PUB 1 PVT PVT 1 PVT UNK FLONASE; Allergic CLARITIN rhinitis NKDA-seasonal allergies 1 PUB PVT None 653 7/10/1991: MIL EKG NSR; OTH 12/21/2004:See Homocysteine note Chronic 9.9 DDD, (4-12);LBP, 5/16/05-7/13/2005: radiculopathy left Homocysteine leg total: 7.3 (4-12), An 3 OTH OTH None Allergy > Codeine; Diabetes; COPD; HTN; Hypothyroidis None donePVT PVT ESTRNCE;None ASA; Multiple Chlopropamide vitamins; LEVEXYL; NOVALAG; LEITHIN 12 Visited doctor PUB to rule out PUB chicken pox. NoneNo lab None work done Penicillin 1 None PVT OTH None 1828 None PVT OTH None PUB PUB 0 None PUB PVT diarrhea 1 CBC - eos 0.5; PVTSed rate PVT - 42 ASA 81 mgNone - 1 qt, Flomax 0.47mg - 1qt PUB PUB Iron Pill, VitParkinson'sNo D + Calcium, Baking Soda 9 PVT PVT Zolpidem; ZOCOR; None lisinopril; Penicillin ESTRACE; allergy LEXAPRO 1 Red area from PVTshoulder PVT to elbow. Maxalt 10mg None PRN, Yasmin None3mg TQD 1 PUB OTH No No 0 PVT PUB Wellbutrin Pt denies Celebrex, Cefzil , Cipro, Bees 1 PUB UNK None None 1 None PVT PVT None None 1 PVT PVT Jan 06 head injury with complete loss of memory - continu PVT PVT MINOCYCLINE; SINGULAIR; ZOLOFT 0 PVT OTH None None 4 None PVT PUB None None 0 UNK UNK Asthma No adverse effect~Rabies ### (no brand name)~1~ 1 PVT PVT None ### PVT OTH Unknown Unknown Confused~Rabies ### (no brand name)~1~18~Pati 12 17/Sep/2008: PUB Temp 97.1 OTH F (oral); pulse 72; respirations The 14; BP patient #1 162/100; had a history and BP of high #2 ### 150/110. blood pressure. The pati -4 On 19 November PVT 2008,PVT the patientDiazepam; went to the Gabapentin; doctor's and The Fish had patient oil; a thyroid Vitamin; had atest penicillin Calcimate completed, allergy. ###results were Ft4 1.17 and 0 None PVT UNK ASA Finger infection; The patient ear infection; palpitations~Rabies had a history Sinus infection of allergies ### (no brand to cephalosporins name)~~0~Patie an 0 diagnostic laboratory, OTH 04/24/09, OTH kidney ADVAIR; profile PATANASE Asthma normal; diagnostic PMH: EIA. laboratory, 04/24/09, WAES0904USA03995 liver function test normal; dia Unknown OTH OTH Unknown Unknown WAES0905USA00040 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0802USA03044 Unknown OTH OTH Unknown Neutropenia WAES0904USA04193 0 Blood culture PVT and sensitivity, PVT negative; CSF culture Rhinitisand sensitivity, No past medical negative history. The patient ### had not received any 1 None reported PUB UNK TUBERSOL; TOPROLThe XL patient has a history of the ### high blood pressure. UNK UNK Not reported. ### 0 Unknown PVT PVT Concomitant None therapy included RelevantPEDIARIX medical history andUSWYEH09225809 Haemophilus was not provided. B Conjugate Vaccine 0 PUB UNK Pulmicort, Albuterol None Cardiac arrest X 2 @ birth 79 Brain MRI, PVT abdominal scan, PVT and sinus Nonescan. None All clear. Labs: None.Lyme PMH:(-).Strep MRI pharyngitis, brain WNL. mild MRAasthma. WNL. MRV Family WNL. hx of CTm 1 None PUB PUB None No No 5 (Reaction toOTH preservative PUB in flu shot. LUMIGAN THIMEROSAL) (FLU NoneGLAYCOMA) Dermatopathology report log # 08: 044052 medical labs. 11-2 15 None UNK UNK None Pt. allergic to SULFA/ BACATRACIN 3 PVT PVT No No None 2 None UNK UNK NWDA PVT PVT None None None 0 Advised herPUB to see physician. PUB On flu about 5 None hoursApparent later,Allergypt. states BENADRYL she called a pharmacy hotline & was told this w 1 PUB PUB 1 PVT PVT Cough Asthma
0 None PVT PUB None 32 Weeks Premature 2 CPK, Serum PUB creatinine,PVT CBC Pending Dysthymia 0 PVT PUB NC09018 2 PVT UNK ALENDRONATE; None, wellness ASPIRIN; AUGMENTIN; visit Fish oil;ZYBAN; AMBIEN; Collagenous Multivitamins. colitis; Osteoporosis; 0 None. PVT PUB Haldol, Depo-Provera None Shot No Known Allergies 1 Bilateral eyelid UNKrednessPVT with fine scaling. Atenolol, NoHCTZ, edema. Hypertension Amlodipine, Conjunctiva Lisinopril injected bilateral. Palpebral conjunctive does have 1 COMPLETEPVT BLOOD CELL PUB COUNT AND URINALYSIS SLIGHT COUGH DUE TO PROBABLE ALLERGIES 3 nothing PVT PVT none none none 2 MIL MIL contact dermatitis, Eczema, Congenital ear deformity, hea 1 None PUB PVT Lyvothyroxine No Vasotec,None Vytorin, Aleve, Multi Vitamin 11 PVT PVT Yaz none none PVT PUB NA 32 As noted above MIL MIL Prenatal Vitamins NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In S 0 CBC done in UNK office prior UNK to vaccinenone admin. Results no illness WNLsymptoms twin birth w/ prematurity (34 6/7wks) 0 CBC done in PVT office prior PUB to vaccinenone admin. - results no illness WNL sxtwin, noted premature birth 34 6/7wks 0 NONE PUB PUB NONE NONE NONE 0 PUB PUB Denied Reported by patient's parent: PCN allergy 1 none MIL UNK unknown no no 0 PVT PVT None 0 Blood Glucose-98; UNK Vital UNK signs stable none none UNK UNK NONE NONE NONE 0 unknown UNK UNK UNKNOWNNONE UNKNOWN 1 PVT UNK Sinus condition with post nasal drip 0 CBC; HeadPUB CT. Labs and PUBdiagnostics: Labs unremarkable. PMH: CBC none. with WBC 12.7. Head CT (-). 9 Echo; Cardiac MILCath; BNP; MIL CT Scan MOBIC 5/26/09 15mg Hospital None QD 6/2/09 records Right Hospital received shoulder inpatient DOS pain 5/26/09 1/12/09 records Hospital to received 1/22/09. records DOS LABS 1/11/09 received and DIAGNO 1/21/0 DOS 1 CT scan - baby PVT had seizure; PVT BloodNone test; ChestWell-Baby X-Ray. 5/18/09 Check None (None) HospitalCheck records upreceived good DOS 4/28/09 to 4/29/09. 0 UNK UNK 1 Essential nlPVT MRI as reported PUB by Peds Fluoride Neuro. drop None CT (+) for calcification Positional plagiocephaly (L) medial Lt occipital/parietal 5/7/09-records received-Adopted region - neuro ha 0 PUB UNK Possible immune Multiple problems medical issues. Chronic ear inf; sleep apnea; FF 1 PVT PVT Runny Nose 1 MRI head - PVT normal urine PUB test/ creatinine + 3 catecholamines - normal 200909 1 OTH PUB 1 PUB UNK None BPD; Gastroesophageal Reflux; Graves Disease 10 PVT PUB None None 0 None PUB PVT None No Allergic SUPREX 0 None Available PUB PUB None None None None PVT PUB None None NKDA 0 PVT UNK No 7 None PVT PVT FOSAMAX; Calcium; ASA; Osteopenia; MVT H/O Fibroids; Hyperlipidemia 1 PUB UNK None None 2 OTH UNK None Sulfa; Allergy None PVT PVT None No known Allergies PVT UNK 3 PUB PVT None 4 Ultrasound PVT of left thighPUB - no mass lesion None notedNone None 0 OTH PVT -1 PUB PVT None None None UNK UNK 0 BP 132/86, UNK P = 76 UNK DEPAKOT,None PAXIL, HCTZ Hx of hypertension & seizures (no seizures for 12 years) 0 PVT UNK Synthroid, HCTZ, No Atenolol, HTN Elmivoin, hypothyroidism, Citalopram Fibromyalgia, Hyperlipidemia, allergi diagnostic laboratory, OTH upper OTH and lower Unknown GI tests: Hypersensitivity Crohn's disease WAES0904USA04566
Unknown OTH OTH Unknown Unknown WAES0905USA00320 310 None OTH OTH ASPIRIN; LIPITOR; Calcium Hip replacement; (unspecified); Transient WAES0905USA00386 PLAVIX; ischaemic Cranberry; attack; BENICAR; Chickenpo Vi Unknown OTH OTH Concomitant Unknown medications Relevant were not medical reported. history USWYEH09242809 was not provided. UNK UNK Not reported. ### 176 Pregnancy UNK test: 14 August UNK2008 - positive No known allergies. Gestational ###diabetes. 1 BP-90/60 P-90 PUBR-20 T-98.6 UNK Denies Denies Denies 1 PUB PVT None None None 0 UNK UNK 15 none-Bx pending MIL MIL NONE NONE NONE 1 None that this UNK reporterUNK is aware ofDesogen, or reported MTV, None fromAlberterol patient. None prn, Flexiril prn 0 none UNK PUB 7 NONE PUB PVT ZOCOR/BENICAR MILD UPPER HYPERTENSION RESPIRATORY INFECTION 14 MIL MIL none unknown 0 NONE PUB PVT NONE NONE NONE PVT PVT None None None 26 None yet UNK PUB Synthroid and None Lamisil NKDA, has hypothyroidism and onychomycosis 1 UNK PVT PVT Penicillin Allergy There were no concomitant A0780206A vaccinations or medications. T 34 5/21/09 ERPUB medical records UNK LABS:None UA abnormal w/protein None & ketones. 5/21/09CMP medical WNL. records WBCPMH: 20.8(H), ear plts infection 532(H), 1/09. neu 10 CBC; ECHO; PVT pictures; PUB BMP labs and None Diagnostics: (L) otitis EKG None, WNL. CBC PMH:WNL. none.CRP and ASO (-). No echo done. 0 None PVT PVT None 1 OTH PVT Actonel, HCT2 None Lipitor, Hypertension, Nasone, Trazodone Hyperlipidemia, Osteopenia PVT PUB No No None 7 MRI of neckPVT down; CatOTH scan; Test COUMADIN; for blood clotNORVASC; in legs;Allergic X rayt LANOXIN of to back aspirin Shingles~ & chest. ()~1~70~Patient Lots of blood work. 0 PUB PVT None No PENICILLIN 1 PUB PUB Healthy OR200918 0 PVT PUB Cold Symptoms Similar to above only reported after this event.~ 188 PVT PVT No No None 175 PVT PVT no no no 1 None PVT PUB No No 2 PUB OTH None None 6 PVT PUB None 0 None PVT UNK None known None of known 0 Allergic reaction PVT to ADACEL. PVT PVT PVT 0 PVT PVT None None None 2 None PVT PUB None 0 PUB PUB None Reactive Airway Disease 1 None PVT PUB None No No 0 PVT UNK 12/23/2008~HPV (Gardasil)~1~15~Patient 1 PVT PVT None None None 2 PVT PUB Mild Congestion No 9 PVT PVT FEVER~ ()~UN~1~Patient 7 PUB PUB 1983 PVT PVT SINGULAIR; noRYNATAN; asthma ALBUTEROL 17 None PVT PVT None Corn allergy; food protein induced proto colitis 0 PVT UNK 2 Viral and throat OTHcultures: OTH Negative; Blood work-up: Within No normal medicallimits. history, concomitant ###medications, or illness at 1 PVT PVT 7 PVT PVT None None Failure-to thrive ESR/Sed Rate: UNK1st=47,UNK 2nd=68 I'm being medevaced None this None week, May 13-15, 2009 0 Phenobarbital UNK levels were PVTwithin aPhenobarbital, good theraputic nonenexium range.Mild and controllable epilepsy since age nine. Acid reflux.
2 0
PVT PVT none UNK PUB Atenolol, ramipril, None lipitorAllergic to codeine, sulfa and the horse serum in the tetanu electroencephalography OTH OTH Unknown Unknown WAES0905USA00584 Unknown 5/18/09 OTH PCPOTH medical records AMITRIPTYLIN LABS: CBC, mg; CMP, ibuprofen None TSH, 5/18/09 6/1/09 T4, EBV, PCP Neurology med monospot, WAES0905USA00372 records consultation IgG HPV all #1 WNL. records given BE received 3/13/08, swallow, DO Loa 30 amniocentesis, OTH02/19/09, OTH trisomy 18; None diagnostic Pregnancy procedure, NOS 3.1(LMP cm, No = 11/1/2008); Cul test:WAES0905USA00360 suggested Allergic reaction a congenital to antibiotics anomaly Unknown OTH OTH Unknown Unknown Cyanosis; Dizziness; WAES0905USA00344 Headache; Haemorrhagic Unknown OTH OTH Unknown Unknown Cyanosis; Dizziness; WAES0905USA00188 Headache; Haemorrhagic 0 ultrasound, OTH 10/02/08, 12"/ OTH7W.; ultrasound, YAZ 12/11/08, Pregnancy 22"/NOS 17W. (LMP = 7/12/2008); WAES0809USA03554 PPD skin test positive 217 Ultrasound,OTH 04/28/08, Viable OTH fetusUnknown with and EDD Pregnancy of 02-DEC-2008; NOS (LMPUltrasound, = 3/5/2008)W 11/12/08, AES0712USA08104 Male baby weighing 6 po Unknown OTH OTH Unknown Unknown WAES0905USA00497 Unknown OTH OTH Unknown Unknown WAES0905USA00367 0 UNK UNK 5/6/09 Client reported having major surgery on his right sh 0 CBC with WBC PUBcount of PUB 8,900. RP of 1.2. Had Mild blood URIand None urineknown culture performed, which were both negative. 0 UNK UNK None. None reported. 9 PUB PUB INFANT TYLENOL DIAPER,RASH HYDROCORTISONE ALLERGY TO PENICILLIN CREAM 0 PVT PVT 1 None PUB PUB none None 0 5/26/09 Hospital UNK records UNK received 5/26/09 DOS 4/23/09 Hospital NONE to 4/25/09. records CHOLELITHIASIS received LABS and DOS DIAGNOSTICS: 4/23/09 FATTYtoLIVER, 4/25/09. Ultrasound OBESITY benadryl, Abdomen (BMI solu-medro MORE - gallsT 2 UNK UNK Parmarin .3mg nonedaily, ASA allergic 81 mg to PCN Vits Beestings. BBlockers cause asthma sympt 1 adverse reactions MIL locally MILon left upper Will submit arm.Meds upon given request. for Attapulgite, itching Zyrtec Kaopectate 10mg TID or as needed 0 N/A PVT PVT N/A N/A N/A SISTER~Polio Virus, Inact. (Ipol)~3~4~In Siblin 1 None UNK UNK no none VA09005 0 N/A PVT PVT N/A N/A N/A BROTHER~DTaP (Daptacel)~4~4~In Sibling1| 1 none UNK UNK seasoniquenone oral contraceptive reported PCOS and pillschildhood asthma 1 titer PUB PUB none none AL0907 0 N/A PUB PUB N/A N/A Borderline Diabetes 4 Hip ultrasound/xray/bloodwork. PVT PVT 6/24/09 None Hospital None records (R) received Inguinal DOS Hernia. 5/2/09 6/24/09 to 5/3/09. Hospital LABSrecords and DIAGNOSTICS received DO 1 UNK UNK Allergic to PENICILLIN in the past, since young age. UNK UNK 2 OTH OTH ACTONEL; NEXIUM, NORVASC; Sulfa / PCNOmeprazole, ZOCAR; ASA; ANTIVERT 0 PVT PVT None None 1 PUB PUB None None reported 109 Rheumatology PUBtest negative PUB MRI negative. No. 5/21/09 5/20/09 No medical medical records No.records 5/20/09 received ~Pertussis (consultation) medical DOS records 8/6/08. (no IA090004 received brand Pepcid, (consultation) name)~1~0~Patient DOS Midrin, 9/9/08 received Beconase, LABSDOS and Na9 1 PVT UNK PVT PVT None None None 0 PVT PUB Allergic; Rhinitis/eczema ME00509 1 PVT PVT Multivitamins; Sinus SINGULAIR; infection Sulfa FEMART; CRESTOR; Vit D 4000u; MUCINEX D; 3 OTH UNK Unknown No 1 MRI 5-2-09PUB Negative; EEG, PUB EKG 3-7-09 normal, Recovering Repeat EEG's from a normal minor Seizures~DTP cold- onset 0+were Hib (no before brand - no name)~3~1~Sib fever 2 None required. PVT PVT VYVANSE;None FOCALIN ADHD 0 PVT PVT No No 15 4/23/2009 tissue MIL bx dorsal MIL surfaceMultiple hand: SUPERFICIAL Vitamin None None PERIVASCULAR LYMPHOCYTIC INFILTRATE WITH EO 1 None PVT PVT None None Penicillin 0 PVT PVT None None 0 PVT UNK No PVT PVT 6 None PVT PVT Celebrex, Neurontin None - Has , Clonazepram, Pain depression syndromeCymbalter in R leg following traumatic fracture. Rosac PVT PVT None h/o asthma lexzene 1 None PUB PUB 0 See ED report PVT PVT PRILOSECnone none 0 PVT UNK allergic rhinitis; migraines
19 PVT PVT 0 OTH UNK Thyroid; Lisinopril; No reported PAXIL History illness.of Low Thyroid disease; HTN; and taking PAXIL fo 0 PVT UNK 0 PUB PUB 1 None PUB PUB None None None UNK OTH OTH Unknown A0780644A Unknown OTH OTH Unknown Unknown WAES0905USA00539 1 Not reported UNK UNK Not reported ### 9 See hospital PVT summary.PVT 6/4/09 Hospital 6/4/09records Hospital None received recordsADD. DOS received 6/4/09 3/23/09 DOS Meningoencephalitis~DTP Hospital to3/23/09 4/6/09. records to LABS 4/6/09. received andDaytrana. DIAGNOSTICS: (no DOS brand 3/23/09 Acyclovir, name)~5~ CBC to dox 4/6Unknown OTH OTH Unknown Unknown WAES0905USA00506 Unknown OTH OTH Unknown Unknown WAES0905USA00582 114 Unknown 6/10/09 OTH Hospital OTH medical YASMIN records LABS:EEG Contraception abnormal. 6/10/09 Hospital MRI, CT medical scan, WAES0905USA00550 records MRA/MRV PMH:allergic all neg. 5/15/09 rhinitis,Med BC 1 PVT OTH None None. 6/9/09 Medical records DOS 7/10/06 to 3/10/09. Hy 0 Unknown. 7/13/09 OTH Hospital OTH records received DOS 4/20/09 Unknown to 4/23/09. LABS and WAES0905USA00526 DIAGNOSTICS: Ultrasound Abdo 2 culture 5/13/09 PUBhospitalPUB records received None DOS 5/2/09 to 5/6/09. None known LABS and DIAGNOSTICS: CBC - MCHC 35.5 G/D 0 PVT PUB Several URI's Fevers with immunization~ ()~UN~0~Sibling UNK UNK UNK UNK 0 Flu screen negative. PVT PVT Diabetes Mellitus, obesity (morbid) PVT PVT 4 PUB PUB Zero meds No None 16 None MIL MIL None None NKDA, Conditions None PVT PVT HYDROCORTISONE 1% Sulfa PULMICORT; allergy; Asthma, SULFAIR Keratosis 2%; pilaris; PROVENTIL Acne;Inhaler. Convulsion 1 None OTH PVT ALLEGRA Puncture Wound None 1 none PVT PVT metformin; hydrochlorothiazide; Diabetes;lisinopril hypertension 1 None PUB PUB BENADRYL; None MOTRIN reported Allergy to shellfish/iodine 3 PVT UNK AMOXICILLIN Otitis mediaNone 1 PVT PVT DIOVAN; LIPIDOR; LISINOPRIL; METOPROLOL; B12 upper right arm 12 pervio 2 PVT PVT SIMVASTATIN; ESTRADIOL; PCN; CODIENE; LEVOXYLSULFA; MORPHINE; ACETAMINOPHEN 0 Checked EKG, PUBTransferred UNK to ER (1) DM - II NKOA 1 None PVT UNK 4 Yo well child None exam 0 LP, CT, MRI, PVT EEG, blood OTH work WNL. None None UNK PUB 1 Zoloft ; 2 MVI nutrition; 3 Claritin 3 PVT PVT Speech delay, obesity None PUB UNK F (splinters PCN in foot) - Rash; Ear tubes; Seasonal allergies/Asthma. 5 Stool + for blood PVT & Rotavirus. PVT None Cough & Congestion None since birth 0 Does not apply PVT PVT none none 0 None PVT PUB None None None 7 EEG, normal; PVTMRI, normal PVT No No 1 None PVT PUB None No No 0 PUB PUB 4 PVT PVT Meloxicam;2SINGULAIR; days no rash; Sulfa Tamoxifen; Bladder drugs; Red infection ADVAIR; shellfish; CIPRO BONIVA; prednisone; taken LUNESTA; before BENADRYL noELAVIL; reaction CLA 1 Rapid flu test PVT A+B on 5-6-09 PVT Ibuprofen, Vita, BurnLovazu, to Lt arm NKDA Lisinopril Hypertension + Hyperglyceridemia UNK UNK 3 PVT PVT 17 PVT PVT 2 UNK UNK PPD, JHP Pharmaceuticals; No lot number 84833; route L F/A; 0 pervious doses; da 10 Exam only PVT UNK 6 PVT PVT 1 OTH PUB None None Known None 0 None PVT PUB None Otitis MediaAllergy withouttofever Amoxil
OTH UNK 3 MIL MIL NO NO HAYFEVER 1 None PUB PVT None No known illness Allergies related to asthma 0 UNK UNK none none - had none a well baby exam after immunizations that day 1 PVT PVT 1 UNK UNK NONE No No 1 UNK UNK NONE No NONE 0 NONE UNK UNK MILD URI WITH H/O IUDE RHINORRHEA NEONATAL ABSTINENCE SYNDROME, OM, C 2 UNK UNK Trisprintec None 2 none PVT PVT avalide 320/25, nonelopressor acuteallergies 100 mg, to unknown~Influenza sulfa, hydroxyzine ct dye, 25 fiorinal, mg,(no actigall flu brand shot300mg, name)~NULL~~I medical conditi 1 UNK UNK 0 PVT PVT none none 12 PUB PUB none none 425 UNK UNK COPD PMH: COPD, HTN, ex-smoker. 435 LABS: Echocardiogram UNK UNK abnormal & c/w. Cardiac COPD cath c/w PMH: 3-vessel recentdisease; bowel obstruction, depressed LV resection function; & colostomy; pulmonary CO HT 7 UNK UNK ALLOPURINOL 100MG/day; htn gout AMLODIPINE T4 ASIA A paraplegia 10mg/day;Chronic ATENOLOL Stage50MG IV decubitus bid; FE 0 Abnormal CT UNK scan revealed UNK Pt has been placed no known on Anticonvulsant. illness none. atNB theadmission Labs time and of vaccination Diagnostics: shows mec stained Head CT fluidWNL. present MRI atbr d 1 n/a PUB PUB none none normal seasonal allergies AZ0904 4 PVT PVT 1 n/a PVT UNK n/a no n/a 0 N/A PVT PVT Atarax for the Crohn's event, Conmeds only seasonal included allergies Asacol for Crohn's and Remeron for inso 9 PVT PVT NONE NONE 34 During hospitalization PVT complete PVT workup None performed: 5/20/09 None EDLabs, and None hospital spinal5/13/09-records infections records Sept '07~HPV received disease, received-PMH: (Gardasil)~2~12~Patient DOS genetic 9/22/07 Hx ITP. etc.. to 4/12/09 5/13/09-record Keppra 1 Blood work;PVT urine tests;OTH CT scan; MRIs; None echocardiogram; None asthma; Stress test; 2 herniated EKG; EEG discs(electroencephalogram) in lumbar spine L4, L5-S1. LabsPMH and 1 OTH UNK No No 10 12/31/08, Chest OTH X-ray OTH - no intrapleural pred lesion ?QD for how longRheum Arthritis/osteoarthritis 2 None PVT PVT None No None 1 PVT PVT 53 PUB PUB 0 None OTH PVT None Latex allergy 0 Blood Sugar MIL 120mg/dl MIL after event None None None 0 He saw PCP PUB on 5/5/09OTH None None Allergic to cinnamon Irritable didn't spiceeat as well possible bacteria infe 0 PUB PUB (L) acute otitis NSAwedie NC09019 0 PVT PVT OTH PUB None 1 PVT PVT None PCN; sulfa; Red dye 0 None PVT PVT CRESTOR TRICOR CA Allergy , METOPROLOL, = CECLOR; HTN; LISINOPRIL, hyperlipidemia/osteopenia 3 PUB PVT Ct. states she none takes reported nonone medications. or reported documented or documented 134 Positive PVT OTH None None None 3126 Clinical observation OTH OTH Conjunctivitis None 0 PVT PVT None None None 1 PVT PVT 1 PVT PVT 1 PVT OTH None None 0 PVT PVT ZYRTEC No Allergic rhinitis 0 PUB PVT Levothyroxine; DoxepinPCN; Sulfa; PERCODAN 14 HSV cultureMIL - negative;MIL PCR and cultures Vaccinee: forNo Unknown vaccinia meds; -Contact/PT: positive Vaccinee: 6/4/09 Review BCPs. ER6/4/09 of records available ERreceived records records DOS received on 5/5/09. vaccinee DOS LABS 5/5/09. onlyan -n 0 Unknown PUB PUB CHROMAGEN DrugCAPSULES; hypersensitivity; Surgery COLACE; Hospitalisation DILAUDID; WAES0902USA00071 TORADOL; PHENERGAN (P 0 UNK UNK 1 None UNK UNK Skin CA; CHF; C-diff; CAD. A flutter; Allergies: Antibiotics ( Admitted toUNK ER then unit UNK and discharged next day. History of Asthma; Allergy history of almonds, shampoo, g
1
PUB UNK None None This isn't anPVT adverse current UNK vaccine event but rather a vaccine X 2 failure. PUB PUB 1 PUB PUB No No No 12.2/ 12.9 /PVT 38.9 / 523 OTH Gr- 52% LmNone 48% None Constipation 1 PVT PVT No No 9 PVT PVT None None None MIL UNK 92 AntinuclearOTH antibody, 08May1999, OTH Warfarin negative;sodium Erythrocyte Cardiac Valvular Anxiety; sedimentation Defect Aortic rate, valve08May1999, replacement; A0599591A 4mm/hr; Back injury; Rheumatoid Cervicalfac sp 0 PVT PVT PVT PVT 37 6/15/09 Hospital UNK records UNK received no DOS 5/12/09. no LABS and newborn DIAGNOSTICS: jaundice Reduction of intussusception with air c 0 UNK UNK MultivitaminNone Allergic to Cipro eye drops and seasonal allergies. 0 PUB UNK hypospadias 0 NONE PVT PUB NONE NONE NONE NONE~ ()~NULL~~In Sibling2|NONE~ ()~NULL 10 PUB PUB none none none SC0914 1 UNK PVT None None None 0 UNK UNK Nexium and Prilosec 0 none availbale PVT UNK none none 1 UNK UNK None 0 PUB PUB ALLERGIC TO SOY. PR-09-08 0 PVT PUB URI Sm intervening weeks after vaccination 30 NONE PUB UNK NONE NONE NONE 4 PVT PVT lexapro, birth nocontrol 0 PVT PVT None None None 20 platelet counts MIL 3/16, 12,000; OTH 3/17,Unknown 24,000; 3/24, unknown 367,000;KNA, 4/28,not 235,000 known5/26/09-records 5/26/09-recordsreceivedreceived-Ear WBCinfection 16.04, pla 1w 1 Labs showing PVT encephalopathy, PVT gastric dysbiosis, No 7/24/09 and mercury Allergic MR received poisoning. to PCN. increased from 8/4/09 8/4/09 PCP. temp/rash, Medical Medical On date records records diarrhea~Measles of vaccine received received 1/3/08 DOS DOS +noted Mum 6/2 6/2 28 Pending VARICELLA PVT &PVT Herpes cultures CLL/SLL CLL Allergy Norvasc 2 OTH PUB 0 PVT PUB No 0 None PVT PVT Yez 3 - 0.02mg Nonepo daily Zero allergies previously/history of anxiety 0 PVT PVT 1 PVT PVT No No 0 PUB UNK 1 OTH PUB None PUB PUB None None 1 None OTH UNK None No 28 Rotavirus strain PVT is identical PUB to WC3 None strain of bovine-human Milk protein7/10/09 allergy rotavirus better Hospital found with records inNUTRAMIGEN ROTATEQ received (publication DOS 11/10/08 pending). to 2/24/0 7/10 2 PVT PVT Dirt bike wreck ~Td Adsorbed (no brand name)~1~4~Patient 0 Came out fine, UNKshe is still UNK displaying generic symptoms raglan none 2 for days nausea/headaches after mvp, vacinnations. viral mennigitis prescibed Hadatto5leave or by6ER. yrs work and of and age. motrin/ibrophren school 5/15/09 due medical to chill by d r 7 Unknown OTH OTH MENACTRA Unknown WAES0905USA01139 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0905USA01070 None OTH OTH None Penicillin allergy WAES0905USA01035 diagnostic laboratory, OTH genetic OTH blood None work Penicillin allergy WAES0905USA01034 4 Unknown OTH OTH Unknown Unknown WAES0905USA00720 301 See attached. PVT8/3/09 Hospital UNK records No received NoDOS 4/29/09 None.to8/3/09 4/30/09. Hospital LABS records and DIAGNOSTICS: received DOSUrinalysis 4/29/09 to- Ke 4/3 40 Lowered bilateral PUB muscle PUB tone, acute Diabetic inflammatory medicine Diabetes andIIdemyelinating Only diabetes ~Influenza polyradicular 6/9/09-records (Seasonal) neuropathy received(no brand and PMH: Guillain name)~UN~57 DM type Barre-s II, 10 5/18/09 Hospital MIL records MIL received None DOS 5/4/09None to 5/5/09. None LABS5/18/09 and DIAGNOSTICS: Hospital records Cardiac received Enzymes DOS 5/4/09 - troponin to 5/5 1. 11 1/22/09, CPK, MIL426; CPKMB, MIL 21; Troponin, 5/26/09 medical 8.6; none negative records 5/26/09 CXR received 5/18/09 medical DOS ED records 1/22/09 and hospital received to 2/3/09. records DOS Indocin. 1/22/09 receivedtoDOS 2/3/09. 1/22 U 7 Full cardiacMIL work up/ Records MIL not ZOCOR; yet available SYNTHROID; None for hospital Allergy Lisinopril 5/26/09-records to PCN 5/26/09-records received-CXR received-PMH:hepatitis negative, EKG normalA, si 1 PUB OTH none none
0 CBC PVT UNK None None 1 Stool Test -PVT Routine UNK Antibiotics -Blood Flox (Norflox); in stools, Taxim-o loose motions after taking milk 1 8/14/09 Hospital UNK records UNK received DOS 5/12/09 - 5/16/09. 8/14/09 LABS Hospital and DIAGNOSTICS: records received EEG DOS flat and 5/12/09 consistant - 5/16/09. with 2 none ordered PUB by hospital PUB none Cerebal palsy 1 None PUB PUB 4 UNK UNK 0 no tests performed, PUB went PUB to see a doctor, wasno asked illness to take nonepainkiller. 0 None PVT PVT None Allergic colitis in newborn period, Atopic Dermatitis 21 Troponin I UNK 27-Jan-09 UNK normal 5/19/09 medical ECG 26-Jan-09 records Hypertension received normalDOS 5/19/09 5/19/09 1/27/09 medical medical 5000008 to 2/5/09. records records ibuprofen, received received guaifenesin DOS DOS1/27/0 1/27/ 0 LABS: ANAUNK 1:640 w/diffuse UNK pattern. prn asthmalong historyallergy asthmarecently dx almond and seafood PMH: asthma, SV 1 Pt given Prednisone PVT UNK PrednisoneSore 10 mg throat.none Symptoms include runny nose, sore throat, pain with swa 0 PUB PUB 3 G6PD WNLMIL MIL Prenatal vitamins, None reported acyclovir. NKDA, Review Noneofknown~ systems()~NULL~~In normal. Lab Patient|Unknown~ test on 11 May 200 -2191 PVT PVT None None 6 Head Mri-normal, UNK Cat scan UNK body-normal none except Mono for mild diagnosed degenerative none. 5/2006 7/21/09disc -Medical shot disease given records of 12/2006 thereceived thoracolumbar at pediatrician's DOS 1/24/08 junction,ly urging to 4/ 0 PVT PVT Enlarged right kidney dx at birth, Hearing loss to right ear, 76 NONE PVT PUB NONE NONE NONE NONE~DTaP + IPV + Hib (Pentacel)~NULL~~I UNK UNK 5 CBC, 17Apr2009, OTH highPVT norm; Erythrocyte Salbutamol sedimentation Unknown sulphate; Calcium Asthma; rate, 17Apr2009, salt; Graves' Multivitamin Disease; high norm; A0780611A SAD; An ultrasound The subjectofhad the not left recei shou 0 WBC, 12.5;PVT NML Electrolytes; PVT (-) blood BONIVA cx Q 5/15/09 None month;Medical ASAOsteoporosis; 81records mg QD; received MVT GerdQD; (hosp 5/15/09 Ca++ discharge Medical with vit D summary records QD 5/21/09 received included) Hospita (hoD 2 WBC, 388,000; PVT (+) blasts; PVTHg, 11.3; None plts, 42,000 None None PMH: probable developmental delays. 21 Platelet count: PVT5/12 - 5,000; OTH 5/13, 35,000; 5/14 None - 49,000. URI, 8/3/09 earHospital infection, records bumpreceived on head.DOS 5/12/09 to 5/14/09. 0 None PVT PVT None None None 1 None PVT PVT Aspirin 81 mg None daily; METROPOTOL Valvular heart 05/07/2009~Pneumo 12.5 disease, mg BID Ventricular (Pneumovax)~1~65~Pati septal defect 0 OTH PUB 0 PUB PUB None Overweight, Vision Problem 2 None PVT PVT No None 2 PVT PUB 0 None OTH OTH None None None -1 None PVT PUB 12 None PUB PUB Motrin + Tylenol Cold SxS (infant 0None fever dose) 0 None MIL MIL None None Normal pregnancy @ 38 weeks gestation Allergies: NKDA 0 OTH PUB 6 None MIL MIL Ambien None Asthma a child /exercise induced - uses Albuterol inhaler p 6 Normal CBC, MIL Chemistry, MILUrinalysis, Nexium, Pancreatic Phenergan, None Functioning, Allegra, No birth andFish defects; negative oil capsules, No three known way Zocor, drug, abdominal Naproxen, food, or series medication Rozerem, X-Rays.Melo allerg 7 MIL MIL ALBUTEROL None SULFATE Exercised 90mcg (PROVENTIL induced bronchospasm; HFA), Inhaler allergy 2 PFtoQID insects; PRN Lyme exerc 1 PVT PVT None 2 PVT PVT 2 PVT PUB None Chronic congestion 0 PVT OTH 0 PUB PUB None None None 9 PUB PVT Not aware of Seasonal any allergies 22 PUB PUB Please call None for med. List None if needed 1 None/076/200 PVT PVT None None None 0 MIL UNK No Aspirin 0 OTH OTH Fosamax None None 2 PVT PVT NKA 1 PVT PVT None 2 none PVT PVT none none history RAD; eczema; febrile seizure 2008 0 OTH OTH BACTRIM; CLARITIN Rx Urticaria Dermatitis; Southern IL dermatitis 1 PUB PUB None None
0 0 1 none
OTH OTH PVT OTH PVT PUB none none PVT PVT none none none 1 PUB OTH None None 0 PUB OTH None None Sulfa 0 Influenza A/B, OTH AG, EIA;OTH urine dip stick No micro; No Influenza; negative; ZANTAC;UA, Amoxicillin positive protein PUB PUB None None None PUB UNK None Pre term 6-5-08~Rotavirus (Rotateq)~1~0~Patient 1 PVT PVT 0 PVT UNK PUB PUB LEVAQUIN;Sinusitis ZOCOR; QUINIPRIL HTN; increased lipids; ED; recurrent sinusitis; allergic rhini 1 NONE PVT PVT NONE NONE 8 PVT OTH None None None 7/1/09 ER medical records received PMH: back pa -2191 PVT PUB 1 PVT PVT 5 PVT PVT 34 wk twin 0 PUB UNK Denies useNone Denies 3 UNK UNK Claritin None Allergy to pollen and cats 2 none PVT PVT zyrtec eczema andnone seasaon rhinitis 2 PUB PUB 2 Minor cellulitis PVT PUB Amoxicillin and tunafish 10 chest xray, UNK cardiac echo, UNK holter moniter, none ekg none 5/26/09 Medical none. records 5/26/09 received Medical records DOS 12/30/08 received - 5/13/09 DOS 12/30/08 LABS and - 5/ 1 none PVT PVT Zyrtec none none 0 UNK UNK none none 0 UNK UNK none mild uri sx none PUB PUB no meds chronic abdominal persistant pain strep nonepharngitis known~ ()~NULL~~In -scheduled tonsillectomy Patient|known 6-2-09 know 21 Troponin I UNK 15-Jan-09 UNK normal 6/10/09ECG Medical 15-Jan-09 records UNK. abnormal received 6/10/09 DOS 6/10/09 Medical 1/21/09 Medical records 5000009 to 2/2/09. records received received DOS 1/21/09 DOS 1/21/0 to 2/ 1 MRI normalUNK CSF: Protein UNK222 WBC none 13 Elevated noneintracranial none pressure. (Paternal uncle 7/1/09has Hospital MS) records received DOS 4/30 1 UNK PUB none sulfa, penicillin and codeine allergies 1 PUB PUB NONE 2 PVT PVT none None Medical History: born at term via vaginal delivery. no signif 0 MIL PVT Left Leg weakness 1 PUB PUB OCPs 0 none PVT PVT none 259 PUB PVT ValacyclovirNone hcl(valtrexPatient 500MGdx: Tab) Hitnal Hernia, Thyroid Nodular Goiter, and aller 0 PVT PVT none Impetigo seasonal allergies 13 None PUB PUB None None 0 None at present PVT PVT none known 1 none PVT PVT 1 "unknown" UNK UNK SYNTHROID; Diabetes; NOVOLOG; hypothyroidism; LANTUS sulfonamide allergy; ### penicillin allergy. 1 Zyrtec, Benadryl PVT oral, Topical PVT Benadryl None creamNo None 1 PVT PVT SINGULAIRNone @ H.S. Hx asthma 0 UNK PVT PVT Unknown A0784405A 1 OTH OTH None 1 PVT PUB Pt is allergicMom to eggs, stated peanuts, sibblingZhad throamax, a reaction erythromycin did not repo 0 PUB UNK Per mother possible diagnosed allergies and asthma. 6 PVT PVT 0 PUB PUB None 1 Erythema PVT PVT Prilosec, Pravachol, None MVI NKDA, Fosamax, Hyperlipidemia, Vesicane Osteoporosis Citracal Gerd, varicose veins 0 PVT PUB Augmentin,1Flonase, SinusitisSingulair 2Multi Immune + eggdeficiency allergy
1 none PVT PVT 1 PVT PVT Penicillin 0 PUB PVT Veramyst, claritin none and albuteral Sinusitis,as GERD, needed mild asthma 5 ECG and cardiac MIL enzymes MIL were normal. None PA/lat None CXR was Nonormal. past medical CBC none~ showed history, ()~NULL~~In elevated no known Patient|none~ lymphocyte allergies. count ()~NULL~~I 1 bloodwork came UNK back normal, UNK BUN and Iron level a little allergies, on the lowasthma, side. Also, migraines had chest x-ray which came back no 1 UNK UNK none none 8-08 bilateral ear tubes Unknown OTH OTH Unknown Unknown WAES0905USA01427 516 electroencephalography, OTH OTH abnormal; vitamins magnetic (unspecified) resonance,Strabotomy; inconclusive; Surgery urine Al,WAES0905USA00689 2/7/09, 140 311 Unknown OTH OTH PEPCID; REGLAN Down's syndrome; Atrial septal cardiac defect; disorder Ventricular WAES0905USA01449 septal defect 269 ultrasound, OTH 02/08/07, unengaged; OTH vitamins serum alpha-fetoprotein, (unspecified) Pregnancy NOS 03/06/07, (LMP = negative 11/22/2006); WAES0905USA00483 Guillain-Barre syndrome 0 Fetal nonstress OTHtest, history OTH of renal Irondisease; (unspecified); Pregnancy Apgar Vitamins score, NOS 06/05?/07, (LMP (unspecified) Vaccine = 9/10/2005; 9/9 exposure WAES0707USA01442 Renal during~HPV disorder (Gardasil)~2~25 Unknown OTH OTH Unknown Unknown WAES0905USA01250 Magnetic resonance, OTH left OTH hand showed Unknown diffuseSickle edema celland SCmild disease heterogeneous WAES0905USA00574 enhancement of the left first metaca 77 MRI Brain/Spine, PVT EEG PUB NL 5/19/095/19/09 hospital hospital records PARONYCHIA records received Developmental received &DOS CERUMEN 2/13/08 DOSD/O-Hearing; 2/13/08 IMP to 2/18/08. to 2/18/08. ?'s LABS 2 mos-screen and Amoxicillin DIAGNOSTICS: passed; No C 0 None PUB PUB CLARINEX; PREVACID; Allergies; SKELAXIN; Asthma; Clavicular YASMIN; HBP; lymph Migraine; SINGULAIR; nodes~Influenza Chiari ADVAIR; malformation; (noVERAPAM brandsin na PVT OTH ALBUTEROL; CETRIZINE Environmental and red dye allergies 1 None PVT PVT None None None 0 None PUB PUB No Similar experience with TYLENOL 2 PVT PVT 17 MIL MIL none 0 None PVT UNK none none spherocytosis, amoxicillin allergy 3 PVT UNK none none Augmentin 9 PVT PUB 1 n/a PVT PVT Upper respiratory COPD infection 0 PVT PVT Minocyclene none ACNE 1 PUB PVT Wellbutrin none Depression 2 PUB PUB none none known 0 none PVT PVT none no, well check History up of syncope. evaluated by cardiology and neurology 0 MIL MIL ERYTHROMYCIN 2 N/A PUB UNK Vicodin, Ibuprofen, None, preventive Vitamin Hepatitis care C,appt. depression. NKDA. 0 PVT UNK Motrin Post partumAllergic to Reglan (itching) 1 MIL MIL none Penicillins, Lovofloxacin, Sulfa Drugs 0 PVT PVT metformin and metoprolol hypertension and diabetes type II 0 PUB PVT Benadryl none none 3 EEG, EKG UNK within normal UNK limits 5/21/09 5/21/09 Hospital Hospital Otitis records records Mediareceived received DOS DOS 5/16/09 5/16/09 to to 5/18/09. 5/18/09. LABS Tylenol, and Versed, DIAGNOSTI Omn 1 5/2/09: WBC PVT 14.9, segPVT 84%, bandnone 4%, lymphnone 3%, mono allergy 9%; SGOT to over 41,the SGPT counter 66; mono triple antibiotic spot negative ointment 5/4/09 listed - CXin 32 EEG's, CT scan, PVT Utrasounds, PVT GI problems, none none 3 PUB UNK 7 none PUB PUB none poison ivy exposure none treated 5 May 09; trichomonas vaginitis treated 9 1 PVT PUB none none Rash left arm~Pneumo (Prevnar)~3~3~In Siblin 1 PVT PUB bilateral mild/mod rash leftsensineural arm~DTaPhearing (Daptacel)~NULL~4~In loss. Sib 0 None UNK UNK None Healthy None 1 none UNK UNK none no s/s of illness allergy to Penicillin and sulfa 0 Influenza APUB and B bothPVT negative albuterol Strep inhaler None screen p.r.n. stated. negative Allergic to Penicillin. Possible history of asthma. PVT PVT 7 NONE PVT UNK 2 HEART MURMURS.THE ARE GONE BY NOW. 3295 PVT PUB 0 PVT PVT 3 UNK PUB Abilify, Lithium None 0 UNK UNK pt states she was not feeling well none PVT UNK
1 6/25/09 Hospital UNK records UNK and DC summary received none DOSnone. 6/4/09 6/25/09 to 6/9/09. seizures~HPV Hospital LABSrecords and (Gardasil)~~15~Patient DIAGNOSTICS: and DC summary Total received Protein 17 7/3/09 ER records UNK received UNK DOS 5/15/09. LABS Sheand hadDIAGNOSTICS: a sore 7/3/09 throat ER records noAll fever. labs received rapid normal. strep DOS Throat assay 5/15/09. cx was (-)Seasonal negative and Allerg so 1 PUB UNK None Latex, Lactose N/A MIL MIL None None None 0 None. FINAL PVT DIAGNOSIS: PUB Inconsolability None. 6/3/09 after None Hospital immunizations. records None. LABS 6/3/09 received and Hospital DOS DIAGNOSTICS: 5/15/09 records to received 5/16/09. Limited DOS Prevacid, Abdominal 5/15/09 Zanta Ultra to 5/ 0 PVT UNK None 0 UNK PVT PUB Unknown There were no concomitant A0784617A medications or relevant medic 2 None PVT PVT Proventil HFA None Pulmonary disease from pre maternity 2 PVT PVT 9 Pregnancy OTH Test Qual 23 UNK Apr 2009None 1038; hCGNone SERUM POSITIVE None (H); Chlamydia + Gonococcus DNA Panel NAAT 0 OTH PUB None Known None Reported None Reported -1 PVT PVT None 1 PVT PVT None No None PVT OTH AMOX 11 (L) Otitis media None 1 PUB PUB None None AR0915 1 Blood culture, PVT pending;PVT CBC with diff; increased WBC, 13.3 UNK UNK 1 PVT PVT none none none 5 PVT PVT None None None PVT PVT 1 PVT PUB 0 PVT PUB Conjunctivitis None PVT UNK No sx of an illness, unknown 0 PUB PUB Weakness "knot" to Lt arm LA090502 Hepatitis B OTH surface antibody, OTH Negative; Hepatitis Multiple B surface blood antigen, transfusions; Negative; Prematurity Hepatitis B0573907A B surface antigen, Positive 1 PVT PUB None None LA090503 1 PVT PVT No None 0 None PVT OTH Unknown Unknown PUB PUB See med list None None OR200920 0 None PUB PVT None None Allergy to Penicillin OR200919 0 PVT PUB 2 None PVT PVT None None None Arm swelling~DTaP (no brand name)~5~5~Pat 317 PVT PVT 0 None PVT PVT None None 2 None PVT PVT None None Mild Asthima UNK UNK TB; Pharmceticals; 84835; Neg; 0.1 mL 5 PVT PVT 0 None MIL MIL None None NKDA; No medical conditions; No birth effects. 0 None PVT PVT PPD None Peanut, egg 0 PUB PUB None None Seizure disorder; ~DTaPAllergic (no TN09008 brand to cats name)~2~1~Patient I will report UNK back in oneUNK week once we receive test results. NONE. Perfectly healthy before this! 14 UNK UNK Capsaicin; Flunisolide;Calculus HCTZ 50/Triamthrene; of kidney s/p (L) Hydroxyzine open partialpamoate; nephrectomy; Lisinopril; Anxie M Urine beta-human OTH OTH Pregnancy NOS (LMP = 12/22/2007) WAES0803USA00777 0 None OTH OTH None Pregnancy NOS (LMP = 1/28/2008) WAES0803USA02222 145 Apgar scoreOTH - 8/9 OTH NAPROSYN Pregnancy 500 mg; vitamins Hip NOSsurgery (LMP (unspecified) = Unknown) WAES0903USA03226 Hip dysplasia Pap test, 03/06/08, OTH atypical OTH squamous Unknown changes, HPV positive; Unknown Pap test, 09/??/08, WAES0904USA00156 atypical squamous changes, HP 0 Unknown OTH OTH Unknown Unknown WAES0904USA00174 Unknown OTH OTH Unknown Unknown WAES0904USA00178 0 None OTH OTH OCELLA None WAES0904USA00185 0 Unknown OTH OTH Unknown Unknown WAES0904USA00225 30 None OTH OTH None Heart rate irregular WAES0904USA00234
Unknown OTH OTH Unknown Unknown WAES0904USA00246 Unknown OTH OTH Unknown Unknown WAES0904USA00248 Rapid streptococcus, OTH 02/23/09, OTH negative Unknown Sore throatUnknown WAES0904USA00267 0 None OTH OTH None None. 7/23/09 Past Medical WAES0904USA00325 Records received DOS 8/17/2 0 OTH OTH XANAX; LAMICTAL; Penicillin allergy GEODON WAES0904USA00379 0 None PVT PVT YAZ Acute lymphocytic leukemia WAES0904USA00380 with a reaction to chemothera Unknown OTH OTH unknown Cancer WAES0904USA00409 diagnostic laboratory OTH - OTH Inflammatory ALBUTEROL; markers Inflammatory were NASONEX abnormal bowel disease WAES0904USA00429 10 None OTH OTH None None WAES0904USA00456 0 Unknown OTH OTH Unknown Unknown WAES0904USA00469 OTH OTH Unknown Unknown WAES0904USA00480 366 Unknown OTH OTH Unknown Unknown WAES0904USA00484 0 None OTH OTH None None WAES0904USA00575 1 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0904USA00581 3 None OTH OTH None None WAES0904USA00584 0 None OTH OTH ADVAIR; EFFEXOR Sulfonamide allergy WAES0904USA00585 0 Unknown OTH OTH Unknown Unknown WAES0904USA00586 4 OTH OTH Unknown WAES0904USA00590 30 Unknown OTH OTH Unknown Unknown WAES0904USA00591 0 Unknown OTH OTH Unknown Unknown WAES0904USA00592 Unknown OTH OTH Unknown Unknown WAES0904USA00596 Unknown OTH OTH Antimicrobial Pregnancy (unspecified); NOS(LMP CLARITIN = Unknown); WAES0904USA00604 Sulfonamide allergy. 6 Unknown . OTH Labs and Diagnostics: OTH None EKG 5/26/09 abnormal Unknown (5/2008 WNL, PMH: 6/7/08 Von Willebrand's WAES0904USA00606 EKG borderline Disease, abnormal OCs but may Unknown OTH OTH Unknown Unknown WAES0904USA00630 Unknown OTH OTH Unknown Unknown WAES0904USA00631 5 None OTH OTH YAZ Sulfonamide Contraception allergy WAES0904USA00634 Unknown OTH OTH Unknown Unknown WAES0904USA00852 2 None OTH OTH None None WAES0904USA00874 Unknown OTH OTH Unknown Unknown WAES0904USA00883 0 Unknown OTH OTH Unknown Unknown WAES0904USA00972 0 Unknown OTH OTH Unknown Unknown WAES0904USA00982 61 Unknown OTH OTH hormonal contraceptives; Anaemia; Herpes VALTREX simplex type I; Sulfonamide WAES0904USA01003 allergy None OTH OTH Unknown Unknown WAES0904USA01004 0 Unknown OTH OTH Unknown Unknown WAES0904USA01016 Unknown OTH OTH Unknown Genital wart WAES0904USA01018 0 Unknown OTH OTH Unknown Unknown WAES0904USA01025 0 None OTH OTH Unknown WAES0904USA01030 0 None OTH OTH None Unknown WAES0904USA01032 0 Unknown OTH OTH Unknown Phobia WAES0904USA01113 1 Unknown OTH OTH Unknown Penicillin allergy; Hospitalization Sulfonamide allergy; WAES0904USA01121 Highly allergic 0 None OTH OTH None None WAES0904USA01123 Unknown OTH OTH Unknown Unknown WAES0904USA01148 0 Unknown OTH OTH None None WAES0904USA01149 0 Unknown OTH OTH Unknown Unknown WAES0904USA01169 Unknown OTH OTH Unknown None WAES0904USA01183 Unknown OTH OTH Unknown Unknown WAES0904USA01198 0 None OTH OTH None Sulfonamide allergy; Drug hypersensitivity WAES0904USA01201 0 Unknown OTH OTH Unknown Unknown WAES0904USA01260 OTH OTH Unknown Unknown WAES0904USA01342 380 diagnostic laboratory OTH test, OTHreflex HPV NUVARING testing and DNA HPV None probe positive; PapWAES0904USA01354 test, positive 0 None OTH OTH None None WAES0904USA01367
None OTH OTH None None WAES0904USA01427 0 None OTH OTH None WAES0904USA01436 Unknown OTH OTH Unknown Unknown WAES0904USA01437 1 Unknown OTH OTH Unknown Unknown WAES0904USA01514 54 Unknown OTH OTH Unknown WAES0904USA01519 0 Unknown OTH OTH hormonal contraceptives Unknown WAES0904USA01528 0 None OTH OTH None None WAES0904USA01902 4 OTH OTH Unknown Unknown WAES0904USA01837 Diagnostic Laboratory, OTH OTH ?/?/09, pregnancy; Zithromax; Beta-human Cough, cold, Pregnancy chrorionic, Sexually NOS and(LMP flu transmitted therapies ?/?09, = 1/26/2009); pregnancy disease WAES0904USA01907 Headache; Penicillin allergy 53 Pap test, 3/??/09, OTH atypical OTHsquamous Unknown changes/HPV positive; Unknown Pap test, 04/??/08, WAES0904USA01849 negative 175 Pap test, 12/05/07, OTH lowOTH grade atypical Unknown squamous changes. Unknown A lesion may have been WAES0904USA01850 present; Pap test, 12/06/06, ne Pap test, atypical OTH squamous OTH changes/HPV Unknown positive Unknown WAES0904USA01851 Unknown OTH OTH None None WAES0904USA01864 Unknown OTH OTH Unknown Unknown WAES0904USA01868 1 Unknown OTH OTH None Penicillin allergy WAES0904USA01952 14 Ultrasound,OTH 10/17/08, aOTH few cysts Allegra; on the ovaries Hormonal but contraceptives nothing Noneelse; Vaginal ultrasound, WAES0904USA01877 02/02/09, negative; Compute 64 None OTH OTH hormonal contraceptives None WAES0904USA01895 2 Rapid plasma OTH reagin 04/07/09 OTH - syphilis None was positive; serum Cardiac TPPA murmur 04/07/09 - positive WAES0904USA01986 with an assigned titer level o 1 None OTH OTH WAES0904USA02036 None OTH OTH Unknown Unknown WAES0904USA02039 None OTH OTH Unknown Anxiety WAES0904USA02071 Magnetic resonance, OTH C-spine PVT andUnknown brain: Normal; Diagnostic Unknown laboratory, PMH:Diagnostic migraines, WAES0904USA02076 laboratory, daily HA since Lyme5/07, disease palpitation testeUnknown OTH OTH Unknown Unknown WAES0904USA02301 0 Unknown OTH OTH Unknown Unknown WAES0904USA02305 Unknown OTH OTH Unknown Unknown WAES0904USA02308 0 Unknown OTH OTH Pregnancy NOS (LMP = 6/7/2008WAES0904USA02324 0 None OTH OTH None None WAES0904USA02753 1 Unknown OTH OTH Unknown Unknown WAES0904USA02326 295 Blood pressure, OTH 03/25/09, OTH157/1; Blood Unknown pressure, Pregnancy 03/25/09, NOS 146/9; (LMPBody = Unknown) weightWAES0904USA02771 measurement, 06/03/08, 256 poun Unknown OTH OTH Unknown Unknown WAES0904USA02777 0 Unknown PVT PUB Unknown Unknown WAES0904USA02792 7 Unknown OTH OTH Unknown Allergic reaction to antibiotics; Heart WAES0904USA02800 rate irregular 1 Unknown PVT PVT None tonsillectomy; adenoidectomy WAES0904USA02904 2 Unknown OTH OTH None Bladder repair; Blood transfusion; WAES0904USA02972 Breast cosmetic surgery 2 blood pressure, OTH 03/22/09, OTH110/6; blood Unknown pressure, Bleeding 03/22/09, menstrual Osteomyelitis 120/7;heavy respiratory rate, WAES0904USA03132 03/22/09, 18; total heartbeat co 7 cervix biopsy, OTH 03/02/09OTH - clear; pap LEXAPRO test, 03/31/09 - genital Unknown herpes; pap test, 01/13/09 WAES0904USA03214 - Pt. at high risk for HPV 0 computed axial, OTH 02/16/09, OTHCT of the None head wasAllergic normalreaction to antibiotics WAES0904USA02907 OTH OTH Unknown Unknown WAES0904USA03407 35 Unknown OTH OTH Unknown WAES0904USA02911 21 diagnostic laboratory, OTH 01/09/09, OTH 3.2, Lymphatic number. None Was High; diagnostic laboratory, WAES0904USA02916 01/09/09, 47.2%, Lympha Unknown OTH OTH Unknown Unknown WAES0904USA03412 Unknown OTH OTH Unknown Unknown WAES0904USA03414 0 Urine beta-human, PVT positive OTH Unknown Pregnancy Uterine NOS (LMP disorder = Unknown); WAES0904USA03419 Iodine allergy Unknown OTH OTH Unknown Unknown WAES0904USA02944 Unknown OTH OTH Unknown Unknown WAES0904USA03425 0 Unknown OTH OTH Unknown Unknown WAES0904USA03434 0 None OTH OTH hormonal contraceptives None WAES0904USA02949 Unknown OTH OTH Unknown Unknown WAES0904USA02953 L IM. On an unspecified gynecological, date the patient OTH"dysplasias" had a OTH pelvic examUnknown and it showed that theUnknown patient developed "dysplasias". WAES0904USA03612 It was unknown if this wa None OTH OTH None None WAES0904USA03620 Ultrasound OTH ?/?/09 - Pregnancy OTH was normal toPlan dateB;with vitamins marginal (unspecified) placenta previa. ; Pregnancy WAES0904USA03626 NOS (LMP= 1/2/2009)
Unknown OTH OTH Unknown Unknown WAES0904USA03644 diagnostic laboratory, OTH positive OTH for high Nonerisk strain Cervical of HPV; dysplasia colposcopy with biopsies. WAES0904USA03444 Waiting for results. diagnostic laboratory, OTH positive OTH for aUnknown high risk strain of HPV Unknown WAES0904USA03729 1 None PUB PUB Unknown None WAES0904USA03746 0 Vital signs, OTH 4/21/09, normal OTH Bronchospasm WAES0904USA03456 Unknown OTH OTH Unknown Unknown WAES0904USA03790 cervical smear, OTH04/09, OTH high risk Unknown Sexually active WAES0904USA03798 3 None OTH OTH None None WAES0904USA03458 Unknown OTH OTH Unknown Unknown WAES0904USA03523 hormonal contraceptives OTH OTH hormonal contraceptives Unknown WAES0904USA03811 Unknown OTH OTH Unknown Unknown WAES0904USA03815 Unknown OTH OTH Unknown Unknown WAES0904USA03556 Unknown OTH OTH Unknown Unknown WAES0904USA03816 Unknown OTH OTH Unknown Unknown WAES0904USA03824 Unknown OTH OTH Unknown Unknown WAES0904USA03927 7 Unknown OTH OTH YAZ Acne WAES0904USA03959 OTH OTH CYMBALTAParoxysmal supraventricular Tachycardia; WAES0904USA03961 Latex allergy 13 Unknown OTH OTH hormonal contraceptives Knee operation WAES0904USA03985 2 None OTH OTH Unknown Unknown WAES0904USA03990 Unknown OTH OTH Unknown Unknown WAES0904USA04012 Unknown UNK UNK Unknown Unknown WAES0904USA04212 159 Unknown OTH OTH ORTHO TRI-CYCLEN Sexually active WAES0904USA04242 7 Unknown OTH OTH Unknown Unknown WAES0904USA04245 Unknown OTH OTH Unknown Unknown WAES0904USA04370 0 Unknown OTH OTH Unknown WAES0904USA04423 603 diagnostic laboratory, OTH 03/13/09, OTH positive Unknown high risk HPV; diagnostic Unknown laboratory, 03/07/08, WAES0904USA04430 HPV negative; diagnostic la 458 Diagnostic laboratory, OTH 06/22/07, OTH negative Unknown HPV test; Diagnostic Unknown laboratory, 09/19/08, WAES0904USA04435 positive high risk HPV; Diagno 450 diagnostic laboratory OTH 08/21/07, OTH negative Unknown HPV test; diagnostic Unknown laboratory, 04/22/08, WAES0904USA04437 negative HPV test; diagnostic la Diagnostic laboratory, OTH 03/??/09 OTH - positive; None Pap test, 03/??09 None - negative WAES0904USA04458 Unknown UNK UNK Unknown Unknown WAES0904USA04514 None OTH OTH Hormonal contraceptives; None CLARITIN WAES0904USA04522 colposcopy,OTH 04/28/09, OTH endocervical None curettage;Penicillin Pap test,allergy 01/01/09, atypical cellsWAES0904USA04530 of undetermined significance 92 None OTH OTH None None WAES0904USA04552 Unknown OTH OTH Unknown Unknown WAES0904USA04573 Unknown OTH OTH Unknown Unknown WAES0904USA04574 0 None 6/5/09-records OTH received-urinalysis OTH None 3/17/09 2+ ketones None and 6/10/09-records trace leukocytes, WAES0905USA00001 received-PMH:ashtma. urine culture no growth. Allergy 6/10/09 to c None OTH OTH None None WAES0905USA00009 1 OTH OTH APRI Sulfonamide allergy WAES0905USA00054 Cervical smear OTH- positive OTH Unknown Unknown WAES0905USA00061 344 Unknown OTH OTH DIFFERIN; Acne; ORTHO Contraception TRI-CYCLEN; minocycline WAES0905USA00065 Unknown OTH OTH Unknown Unknown WAES0905USA00074 50 urine beta-human, OTH 08/05/08, OTH positive None Pregnancy NOS (LMP = 6/19/2008) WAES0808USA00976 0 diagnostic laboratory, OTH valley OTH fever;WELLBUTRIN; chest X-ray, Sinusitis clear hydrochlorothiazide WAES0904USA00481 Unknown OTH OTH Unknown Unknown WAES0905USA01285 0 None OTH OTH Zyrtec; Premarin Sulfonamide allergy WAES0905USA01663 4 Unknown. OTH 6/12/09 Hospital OTH records Unknown and DC summary received Unknown. DOS 6/12/09 5/11/09 Hospital t0WAES0905USA01445 5/12/09. records LABS andand DCDIAGNOSTICS summary rece 301 Unknown LABS: OTH KUB OTH abnormal. Unknown. Air contrast 6/4/09 enema Hospital reduced Unknown records IS. 6/4/09 11/12/08 received Hospital received DOS WAES0905USA01453 records 5/11/09. flu vaccine, received Motrin. SPDOS lot #5/11/09. UT2782C L diagnostic laboratory, OTH rotavirus OTH (+)Unknown Unknown WAES0905USA01673 0 WBC, 13.5;PVT neutrophils, UNK 58; band, 13; lymph, 3; monos, 16; IgA platelets, deficiency6/5/09-records 351 6/5/09-records receivedreceivedPMH:IgA WBC 13.5, deficiency neu MRI - "didn'tUNK show anything" UNK Unknown ### 9 MIL MIL ###
1 PVT UNK None Allergy: Sulfa, Amox, Codeine; elevated chol, HTN, Ostepa 0 EKG; EEG;PVT Cardiology PUB evaluation RITALIN LANone 20mg 1 gdADHD 0 PVT UNK None None None ~DTaP (no brand name)~4~2~Patient 0 CBC PVT PVT Ingrown toenail. None 0 PVT UNK PPD SanofiNone C3060AA None LFA 3 None UNK OTH LANTUS; LIPITOR; Multiple sclerosis, LYRICA; Pronated LOZAUR; diabetes, flat hives~ feet,Arthritis, METFORMLIA; ()~1~0~Patient hay fever, Acid penicillin Reflux, GLYBURIDE; high blood METROPO pressure 1 PVT PVT None 1 PVT UNK none none none N/A PVT PUB CHILDRENS NONE IBUPROFEN MILD ANEMIA NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 MIGRAIN PUB PUB MIDRIN DENIED COMPLAINTS MIGRAINS OF ILLNESS 0 PVT PVT None Site check 6-10 MIL days after MIL administration to see viability of vaccine 3 none UNK PUB none none Site check 6-10 MIL days after MIL administration to see n/aviability of vaccine 1 no PVT UNK no no no None PUB PUB None known None None known Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 0 UNK UNK none 7 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 8 Site check 6-10 MIL days after MIL administration to see A/Aviability of vaccine 0 none UNK PUB none None Per patient: allergy to Sulfa medicines 8 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 0 ct head, skull UNK xray, cbc,UNK chem 12, none ua, urine tox none, all negative healthy none check Medical Medical at records thatrecords timereceived with received normal LABS: PMH: vision, CBC, frequent hearing CMPHA, WNL. andthigh urine Dru a 4 Unknown UNK UNK None reported No None reported 8 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 8 Site check 6-10 MIL days after PUBadministration to see N/Aviability of vaccine 6 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine Patient is deployed MIL andMIL was unable to check n/A Site at 6-10 days after administration to see viability of vaccine 5 5/19 wbc count UNK12.6, BUN UNK10 Creaibuporfen, 1.04. LUEbc. none Venous 6/2/09 ultrasound: ED hypertension. and inpatient slow6/2/09 flow hospital atED confluence records and inpatient received of lefthospital IJDOS and left records 5/19/09 subclav rec to 0 PVT UNK NONE NONE Allergy to Sulfa 0 PUB PUB NONE NONE 1 Went back PVT to see on-call UNK nurse who BCP, stated Levothroxine she None did not know Hypothyroid if it was an adverse reaction to vaccine or not... later c 4 OTH OTH 0 PVT PUB None GER 0 None PVT PVT None None 2 None PVT PUB None None UNK PVT None UNK PVT None None None 0 None PVT UNK Sinusitis GERD; Allergic Rhinitis; NKDA Bicarbonate, PUB 11-12 PUB Unknown Cow milk protein allergy A0784664A Bicarbonate, PUB 11-12 PUB Unknown Bloody diarrhea; Cow milk A0784664B protein allergy; The subject had 1 CBC/diff; CK; PVT urine; FLU PVT A & B; - all GUAIFONESIN; neg. URI, HA, ALBUTEROL cough Cephalosporin, inhaler; bees, FLONEST pineapple inhaler 1 None PVT PVT None 1 OTH OTH SYNTHROID 10 Hypothyroid 0 PVT PVT None None None 1 None PVT PVT None None None 2 None OTH PUB None No Asthma NC09021 6 PVT PUB 3 OTH PVT None that I am aware
1 0 Lyme (-)
PVT OTH None None None PVT UNK None None PUB UNK None PUB PVT 2 Phenobarbital OTH level - Normal PVT EEG-NEXIUM; unchanged PHENOBARB Epilepsy no seizures Epilepsy in 15 years. 0 None PVT UNK None Cough; Nasal None congestion 0 Accucheck PVT - 131 PVT None None 0 None PVT PVT None None Asthma 0 PVT PVT See list See list / physical NKA before this 0 PUB PVT None No illness atNone time 0 none PVT PVT None None None 2 None PVT UNK None None 1 PVT PUB None None None 0 PVT PVT none none 1 OTH PVT UNK UNK 0 PUB PUB None None 0 PVT PVT NKA swollen arm~Td Adsorbed (no brand name)~UN 0 PUB PUB None None WV04 1 PUB PVT PREDNISOL None 15 mg once daily X 10 days was done 5-6-09. 46 None MIL MIL None 5 Not reported PUB UNK Imogam Rabies-HT; At the time lotThe of# vaccination, 26nc8x1 patient had 9/1/09 illness no ER known was records allergies reported ### received and as "bitten he DOS had by 5/4/09. not a bat". been Admta Unknown OTH OTH Unknown Unknown WAES0905USA01825 1 LABS: CXR, PVT UA, CPK,PVT blood & urine c/w WNL. EKG w/nonspecific PMH: HTN,Twave hyperlipidemia, changes. impaired 7/13/09 fasting Hospitalglucose,mono records rece 0 None UNK UNK SURGERY: ILEAL RESECTION, TONSILLECTOMY AS C 0 None PVT OTH Took blood None pressure pill Allergic AMLOD/BENAZEPRIL to PENICILLIN 5/20 0 PVT PUB Tylenol 0 None None NM0509017 03/12/2009,MIL Brain CATMIL Scan, normal; No other 03/24/2009, medications None Brain None MRI, Abnormal, Diarrhea, abnormal, peripheral 09AV00176SP MRI edema~Anthrax shows scattered (Biothrax) small foc Varicella-zoster OTH virus IGG OTHAB, 3.67 7 None at thisPVT time OTH L conjunctival w/ohemorrhage craniotomy s/p epidural hematoma; skull fx Unknown OTH OTH diphtheria toxoid (+); MENACTRA Unknown WAES0905USA01925 Unknown. 7/21/09 OTH Medical OTHrecords received DOS 5/31/08 None. to 6/27/09. Strep throat LABS pharyngitis. andWAES0905USA01680 DIAGNOSTICS: CBC - WBC 3.4 x 209 None OTH OTH None Pregnancy NOS (LMP = 4/1/2007)WAES0812USA03680 Unknown OTH OTH Unknown None WAES0905USA01298 1 PVT PUB NO NONE NONE 0 N/A PUB PUB N/A N/A N/A 1 Normal Ultrasound UNK of the UNK bilateral 6/4/09 lower extremity Hospital records venous6/4/09 received system. Hospital Normal DOS records 5/7/2009 comprehensive received and 5/18/09. DOS metabolic 5/7/2009 Motrin. panel, Tylenol. andnormal 5/18/0 Sev 12 PVT PVT Ampicillin 1 Labs were drawn UNK at ER, UNK but all tests Parents were administered negative none (CXR Tylenol none negative prior fortopneumonia, vaccine, then strep Ibuprofen and flu after swabs the were vaccine. negati 1 none PUB PUB none none none 7 CBC, Sed rate PUB(NL), done UNK1/09/2009 at Blessing no Hospital. no5/02/09 Sed rate elevated @ 25, ANA Positive, ANA tite PVT PVT None None MRSA (leg abscess) 3/08, Kabuki Syndrome 0 MIL MIL Birth Control None (Yaz 28) None 131 On observation, UNK I haveUNK disturbing gait skelaxin, abnormalities nexium, none lunesta, with nausea difficulty arthrotec, when with none~ heel taking metroprolol, ()~~0~Patient|none~ and codeine toe cyclobenzaprine, walking. related Received medications ()~~0~Sibling arthrotec, an MRI on flex1 3 6/4/09-records UNKreceived-Abnormal UNK electrocardiogram Recovering prolonged Tested from unknown positive QT interval immune for Gluten and ST deficiency &segment Wheatsymptoms. Allergy. depression 6/4/09-records suggestiv 0 UNK PUB sinemet and exelon - delirium and feeling irritable. 1 None were PUB ordered at this PVTtime Malarone prescribed No knownfor illness Nothis known international allergiestravel or medical episode. conditions. 1 PVT PVT None. Daughter No allergies. was healthy. No birth defects. No pre-existing medical co 1 6/4/09 Hospital UNKrecordsUNK received DOS Paxil5/18/09 20 mg, cough to Benicar 5/21/09. non20 productive hyperlipidemia, LABS mg, Tricor and DIAGNOSTICS: 145mg, hypertension, Plavix 75Diphtheria peripheral mg, Lovaza, Ab vascular Valium IgG 0.03 disease, 10IU/mL mg, UNK PVT na PVT PUB na slight nasalpremature crusting, possibly newbornviral with transient tachypnea and jaundice
0 PVT PVT NASAL SPARY N/A AND QV4 N/A 9 Site check 6-10 MIL days after MIL administration to see N/Aviability of vaccine 1 UNK UNK Zyrtec Seasonal pollen Seasonal allergies pollen allergies. 1 PVT UNK None reported. No know Had heart allergies stent previously placement before 7/2008,hypertension,CAD the pneumovax. 92 UNK UNK Altace None Hypertension, Prostate Cancer 1 UNK PVT No daily maintenance none notednone meds noted taken.by Uses patient; sumitriptan no chronic 100mg illnesses tabs as perneeded patientfor m 366 PVT PVT 0 EEG PVT UNK None None. 6/29/09 Hospital ER records received DOS 6/17/09. 0 PVT PUB None Known 1 Circ returned PVT to 18 cm PUB Bilat. ND swelling ZYRTECor redness None Dev. delay, Speech delay, A.R. 0 I think he developed PVT a PVT sinus infection unrelated None to TDap.Deviated septum; allergic rhinitis PVT OTH PVT PUB None NKDA or any other allergies/conditions 0 5/26/09 EDOTH records received OTH DOS 5/19/09. LABS and DIAGNOSTICS: WOLFE-PARKINSON-WHITE None syndrome6/5/09-records rec 0 None PUB UNK None None None 0 Pt to have EEG PVT PUB None ~Meningococcal CT200910 (Menactra)~1~0.00~Sibling|~H 0 Glucose fingerstick PVT 73,PVT 02 Sat Rd None = 98% RR=14 None BD 128/None 80 HR= 64 15 Vaccinia PCR+ MIL MIL Unk Unk Unk 1 UNK UNK 1 None OTH PUB None None 1 ED - visit, antibiotic PVT treatment OTH None None 5 Disseminated PVT chicken PUB pox MIL MIL none none 21 None MIL MIL MultivitaminNone No birth defects; No allergies; No chronic medical conditio 0 None PVT PVT None None None 0 None PVT OTH 5 OTH PVT No immunosupressant None reported meds by pt. 0 PVT PUB None None 122 PVT PVT PENECILLLIN, BEE STINGS 1 PUB PUB 23 PUB PUB Dicyclomine, None loratadine, notedNKDA. omeprazole. IBS, GERD. 0 PUB PUB 0 strep and mono UNK UNK Depo givennot 2/26/09, knownother (denies) NA not known nausea, dizziness~HPV AL0908 (Gardasil)~1~15~Patie 2 NONE PVT PVT 1 u/a done byPUB PMD-clientPUB says negative-no rx'shealth and recommended history allergy negative tono tetracycline furthur immunizations by PMD 290 8/7/09 Clinical UNK Research/Hospital UNK records received COPDDOS 8/7/09 2/25/09Clinical to 2/27/09. Research/Hospital LABS and DIAGNOSTICS: records received Hematocrit DOS 2 317 UNK UNK COPD 1 PVT PVT NONE 8 EKG, treponin:0.97 UNK (increased),cbc: UNK 5/28/09 CreatMedical 1.6, noCK illness records 445.noted CL Noreceived 96, previous cardiac DOS illnesses panel: 4/27/09 ckmb noted. to 15.3, 5/21/09. 5/28/09 myogl Naproxen, Medical 228, chem records omeprazol 10,rece ech 0 Primary care UNK provider will UNK follow upNone with parent NoregardingHeadaches; status/appt seasonal allergies; 8 none PVT PVT none none none n/a~ ()~NULL~~In Patient|n/a~ ()~NULL~~In S 1 UNK MIL SICK, RASHES, JOINTSICK, PAINRASHES, , MUSCLE JOINT PAIN PAIN , MUSCLE PAIN 0 PUB PUB No No No 7 None - MD PUB diagnosis PVT Lipitor 10 mg None qd, Timolol None 0.5% 1 gtt None~ each ()~NULL~~In eye qd, Actonel Patient|None~ 150 mg qd each ()~NULL~~ month 0 UNK PUB TYLENOL INFANTS 80 MG/0.8ML SUSP (ACETAMINOPHEN), Benadryl 4 cc 0 MIL PUB fibroneurolgia, no previous depression know allergies 258 UNK UNK None Denies anyClient illnessstates at time she of has vaccination. an allergy to Ibuprofen but no other m 2 PUB PUB 1 PUB PUB 1 PVT UNK ALEVE Rheumatoid arthritis 23 None PVT PVT None None None
0 None 5 None 0
OTH PVT None None None PVT PVT None None PVT PUB PVT OTH Allegra; Nasonex 1 UNK UNK PUB UNK No No 0 PUB OTH 0 PVT PVT Yes None Penicillin Allergy 0 PUB OTH 0 None PUB UNK BENADRYL; NONE TYLENOL NONE 2 None PVT PVT None None 0 ProthrombinPUB time was 15.8; PVT Chemistries and Hct Urosepsis remained normal; INR 1.6 day of vaccination 0 glucose finger PVTstick, 80+; PVT None 1 PVT PUB No NONE -365 Advise patient PVTto go to UNK ER or follow up with primary NONE care physician. 0 UNK UNK I do have allergies to dust, pollen, etc. No food allergies. 0 PVT PUB None None 6 None doneUNK UNK History of type 2 DM, HTN, high cholesterol. Not on immu 1 None PUB OTH None None None None PUB OTH None None PCN; Cat; peanut and seasonal allergies 2 PVT UNK Dermatitis bilat None axilla 0 PVT PVT Swollen lips Unknown OTH OTH Unknown Unknown WAES0904USA02063 28 ultrasound, OTH 12/07/04, normal; OTH serum MICRONOR alpha-fetoprotein Pregnancy NOS (LMP = 8/12/2004); WAES0409USA01336 Rhesus antibodies positive 0 None OTH OTH None Pregnancy NOS (LMP = 5/20/2007) WAES0706USA04214 0 serum immunoglobulin OTH OTH M, 1.12, elevated Unknown Pregnancy NOS (LMP= unknown)WAES0708USA01924 0 ultrasound, OTH 03?/??/08,OTH oligohydramnios; vitamins urine (unspecified) Pregnancy beta-human, NOS posit (LMP = Unknown) WAES0708USA02965 -124 Ultrasound,OTH 10/12/07, Normal OTH fetalCalcium development; (unspecified); Pregnancy Beta-human NOS Iron (unspecified); (LMP chorionic, = 6/1/2007) 10/03/07, Vitamins WAES0710USA05607 Positive; (unspecified) Serum alph-fetoprotein Unknown OTH OTH None None WAES0803USA03034 0 Unknown OTH OTH Unknown Unknown WAES0803USA03040 Unknown OTH OTH Unknown Unknown WAES0803USA03056 1 Unknown OTH MIL Unknown Unknown WAES0803USA03075 2888 Unknown PUB OTH Unknown Unknown WAES0803USA03503 0 None OTH OTH (therapy unspecified) Convulsion WAES0803USA03627 90 temperaturePVT measurement, PUB 02/22/08 Unknown - results low grade Asthma fever 99 WAES0803USA03170 0 None OTH OTH Unknown Unknown WAES0803USA03645 Unknown OTH OTH Unknown Unknown WAES0803USA03699 0 Unknown OTH OTH Unknown Unknown WAES0803USA03716 0 Unknown OTH OTH Unknown Drug hypersensitivity WAES0803USA03316 Unknown OTH OTH Unknown Unknown WAES0803USA03806 0 Unknown OTH OTH Unknown Unknown WAES0803USA03909 2 None OTH OTH ZANTAC; BACTRIM Egg allergyFebrile convulsion; EarWAES0805USA04042 infection Unknown OTH OTH Unknown Unknown WAES0803USA03335 Unknown OTH OTH Unknown Unknown WAES0803USA04047 Unknown OTH OTH Unknown Unknown WAES0805USA03728 10 None PVT PVT None WAES0803USA04131 2736 VZV strain, OTH 05/06/08, VACCI OTH albuterol; FLOVENT; Asthma; Diabetes ADVAIR; Upper respiratory mellitus insulin insulin-dependent tract WAES0805USA00361 infection; Viral infection 8 Unknown PVT PVT Unknown None WAES0803USA03372 diagnostic laboratory, OTH 04/09/08, OTH it None is clear None WAES0804USA02505 Unknown OTH OTH Obesity WAES0804USA00432 Unknown OTH OTH Unknown Unknown WAES0803USA04185
Unknown OTH OTH Unknown Developmental disturbance WAES0804USA00234 4166 Unknown PVT PVT Unknown Unknown WAES0803USA03375 17 Unknown OTH OTH Unknown Unknown WAES0803USA04192 Unknown OTH OTH None Chickenpox; ExposureWAES0803USA04437 to communicable disease 2313 None PUB OTH None None WAES0803USA03502 Unknown OTH OTH None WAES0803USA04442 3045 None OTH OTH None None WAES0803USA04497 750 None OTH OTH None None Rash erythematous~Varicella WAES0803USA04509 (Varivax)~1~0~S 2 None OTH OTH None None WAES0803USA04513 8 Unknown OTH OTH Unknown Unknown WAES0803USA04643 None OTH OTH diphtheria toxoid Immune (-) system pertussis disorder MENACTRA WAES0805USA01178 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0805USA01256 (Varivax)~1~3~Sibling 15 Unknown OTH OTH Unknown Ear infection Unknown WAES0803USA04691 0 Unknown PVT PUB (Therapy unspecified); Osteoarthritis; Aspirin Postmenopause; mg; LIPITORHearing WAES0803USA04699 mg; ZESTORETIC decreased; mg; Hypertension; OXYBUTY 198 Unknown OTH OTH None WAES0805USA01387 Unknown OTH OTH Unknown WAES0805USA01692 0 None PVT PVT Unknown Unknown WAES0803USA04721 Unknown OTH OTH Unknown Unknown WAES0805USA01842 7 Unknown OTH OTH Unknown Seasonal allergy WAES0803USA04722 Unknown OTH OTH Unknown Unknown WAES0805USA01972 10 None OTH OTH None None WAES0803USA04954 0 Unknown OTH OTH None None WAES0850USA01975 Unknown OTH OTH Unknown Unknown WAES0803USA04973 Unknown OTH OTH Unknown Unknown WAES0805USA02046 0 None OTH OTH Penicillin allergy Chickenpox WAES0803USA05043 1 None OTH OTH None Hypersensitivity WAES0805USA02125 Unknown OTH OTH Unknown Eczema WAES0805USA02311 0 Unknown OTH OTH Unknown Unknown WAES0803USA05062 0 beta-humanPVT chorionic, OTH 05/11/08, positive None Pregnancy NOS (LMP = 4/1/2008)WAES0805USA02345 2 None PVT PVT Unknown Asthma WAES0804USA00134 None OTH OTH (therapy unspecified) None WAES0805USA02351 Unknown OTH OTH Unknown Unknown WAES0804USA00167 Unknown OTH OTH Unknown Unknown WAES0805USA02862 4 Unknown OTH OTH Unknown None WAES0805USA02918 764 Unknown PUB OTH Unknown Unknown WAES0804USA00214 92 Unknown OTH OTH Unknown Unknown WAES0902USA00004 92 Unknown OTH OTH Unknown Unknown WAES0902USA00005 Unknown OTH OTH Unknown Unknown WAES0902USA00006 Unknown OTH OTH Unknown Unknown WAES0902USA00010 0 Unknown OTH OTH Unknown Unknown WAES0902USA00021 Unknown OTH OTH Unknown Hypersensitivity WAES0902USA00178 3211 Unknown OTH OTH Unknown Unknown Unknown Chickenpox~Varicella WAES0902USA00932 (Varivax)~1~8~Sibling Unknown OTH OTH Unknown Unknown WAES0902USA00937 149 None OTH OTH None None WAES0902USA01026 3 None OTH OTH None None WAES0902USA01058 0 Unknown OTH OTH None Pregnancy NOS (LMP = 12/1/2008); WAES0902USA00203 Asthma Unknown OTH OTH Unknown Unknown WAES0902USA00246 Unknown OTH OTH Unknown Unknown WAES0902USA01103 Unknown OTH OTH Unknown Unknown WAES0902USA00298 231 Unknown OTH OTH Unknown Unknown WAES0902USA00420 2721 Unknown OTH OTH Unknown Unknown WAES0902USA00423
Unknown OTH OTH Unknown Unknown WAES0902USA00601 4 None PVT PVT None None WAES0902USA01524 2801 Unknown OTH OTH Unknown WAES0902USA00865 Visual acuity OTH test, 20/30 OTH OD, and 20/20 Levetiracetam OS; Ophthalmological Convulsion Eczema disorder exam, corneal sensation WAES0902USA01617 was normal in both eyes; In Unknown OTH OTH Unknown Unknown WAES0902USA01622 961 None PVT PVT Unknown None WAES0902USA01929 Unknown OTH OTH Unknown Unknown WAES0902USA01623 0 Unknown PVT PVT Unknown Unknown WAES0902USA01660 0 None OTH OTH None None WAES0902USA01711 None OTH OTH None WAES0902USA02200 6 Unknown OTH OTH Unknown Unknown WAES0902USA02265 serum varicella OTHzoster,OTH <0.90 None None WAES0902USA01828 Unknown OTH OTH Unknown Unknown WAES0902USA01864 Unknown OTH OTH Unknown WAES0902USA02333 1 None OTH OTH Unknown Unknown WAES0902USA02410 42 None OTH OTH None Eczema WAES0902USA02447 1999 None OTH OTH None None WAES0902USA02690 Unknown OTH OTH Unknown Unknown WAES0902USA03691 None OTH OTH Unknown Birth twin Chickenpox~Varicella WAES0902USA03715 (Varivax)~1~4~Sibling 683 VZV strain, OTH 02/21/09, VZV OTHWILD TYPE Unknown STRAIN Seasonal allergy; Seasonal allergic WAES0902USA02913 rhinitis; Acne 48 None OTH OTH None None WAES0902USA03795 7 None OTH OTH None None WAES0902USA03986 Unknown OTH OTH Unknown Autoimmune disorder WAES0902USA03109 Unknown OTH OTH Unknown Unknown WAES0902USA03137 Unknown OTH OTH Unknown Unknown WAES0902USA03989 Unknown OTH OTH Vitamins (unspecified) None WAES0902USA03138 3108 Unknown OTH OTH Acyclovir; Augmentin WAES0902USA04049 Unknown PUB PUB Unknown Allergic reaction Hivesto antibiotics WAES0902USA03509 2497 Temperature OTH measurement OTH 100 f Unknown Unknown WAES0902USA03510 4120 None OTH OTH None None WAES0902USA04063 1334 Unknown PVT PUB Unknown Unknown WAES0902USA03512 Unknown OTH OTH Unknown Unknown WAES0902USA03573 Unknown OTH OTH Unknown Unknown WAES0902USA04096 Unknown OTH OTH Unknown Unknown WAES0902USA04099 None OTH OTH Unknown Birth twin chickenpox~Varicella WAES0902USA04167 (no brand name)~1~4~Si Serum varicella OTH zoster,OTH negative Unknown None WAES0902USA04172 None OTH OTH SUSTIVA, lamivudine, HIV infection; Herpes COMBIVIR, Penicillin zoster allergy; and ZANAFLEX Sulfonamide WAES0902USA04213 allergy 0 None OTH OTH Unknown Chickenpox WAES0902USA04374 1965 Unknown OTH OTH Unknown Unknown WAES0902USA04533 9 None OTH OTH None None WAES0902USA04540 34 None PVT PVT None WAES0902USA04599 7 Unknown OTH OTH Unknown Egg allergy;Hot Food flushes allergy facial; Limping; WAES0903USA00002 Urine output decreased; Loo 0 None OTH OTH None None WAES0903USA00050 Unknown OTH OTH Unknown Egg allergyChickenpox WAES0903USA00130 581 None OTH OTH None None WAES0903USA00325 Unknown OTH OTH Unknown Unknown WAES0903USA00365 9 None PVT PVT Unknown Unknown WAES0903USA00401 272 Unknown OTH OTH Unknown Unknown WAES0903USA00419 5 laboratory test, OTHAntibody OTH titers. NoUnknown results available Unknown WAES0903USA00571 serum varicella OTHzoster,OTH negative Unknown Unknown WAES0903USA00610 Unknown OTH OTH Unknown Unknown WAES0903USA00789
Unknown OTH OTH Unknown Unknown WAES0903USA00790 Unknown OTH OTH Unknown Unknown WAES0903USA00893 370 None PVT PVT Unknown None WAES0903USA01183 Unknown OTH OTH Unknown WAES0890USA02671 Unknown OTH OTH Penicillin allergy; Allergic reaction WAES0809USA02688 to antibiotics Unknown OTH OTH Unknown Unknown WAES0809USA03225 0 Unknown PVT PVT Penicillin allergy; Sulfonamide allergy WAES0809USA03272 96 None PVT PVT Unknown None WAES0809USA03440 2 Unknown OTH OTH Unknown Unknown WAES0809USA03452 0 None OTH OTH None Allergic reaction to bee sting WAES0809USA03499 1 None OTH OTH None None WAES0809USA03816 Unknown OTH OTH Unknown Unknown WAES0809USA03869 2507 Unknown OTH OTH Unknown None WAES0809USA03897 Unknown OTH OTH Unknown Unknown WAES0809USA03909 Unknown OTH OTH Unknown Unknown WAES0809USA03920 VZV strain, OTH low antibody OTH titers; serum Unknown hepatitis B, negative Unknown WAES0809USA03925 0 None PVT PVT None WAES0809USA04059 6 Unknown PVT PUB Unknown WAES0809USA04165 2 Unknown PVT PVT Unknown Penicillin allergy WAES0812USA01769 Unknown OTH OTH Unknown Unknown WAES0809USA04304 Unknown OTH OTH Unknown Unknown WAES0809USA04569 Unknown OTH OTH Unknown Unknown WAES0809USA04612 1 wound culture, OTHnegative OTH for a reaction Unknown to varicella Unknown WAES0811USA00877 Unknown OTH OTH Unknown Unknown WAES0809USA04621 1 Chest X-ray, OTH 10/22/08,OTH negative; Diagnostic laboratory, 10/22/08, Reactive negative; airways disease; Complete WAES0810USA05270 Rhinitis blood cell, 10/22/08, negative Unknown OTH OTH Unknown Unknown WAES0810USA02178 1 None PUB PUB None WAES0809USA04626 Unknown OTH OTH Unknown Varicella~Varicella WAES0810USA02126 (no brand name)~UN~2~Sib Unknown OTH OTH Unknown Unknown WAES0809USA04655 Unknown OTH OTH Unknown Unknown WAES0809USA04657 Unknown OTH OTH Unknown Unknown WAES0810USA00203 26 laboratory test, OTHlow immune OTH levels with low levels of hepatitis None WAES0807USA05344 Unknown OTH OTH Unknown WAES0810USA00210 Unknown OTH OTH Unknown Unknown WAES0801USA00386 0 diagnostic laboratory OTH OTH (therapy unspecified) PENICILLINLiver allergy; transplant; SULFONAMIDE Arthritis; WAES0807USA02635 Gastrectomy allergy 0 Allergen Skin OTH test, positive OTHto eggs; Unknown Blood pressure, Egg allergyCleft 50s palate WAES0806USA07544 606 None OTH OTH None None WAES0810USA00430 2032 Unknown OTH OTH Unknown WAES0810USA00436 8 Unknown OTH OTH Unknown None WAES0810USA00472 Unknown OTH OTH Unknown Unknown WAES0903USA01626 0 None OTH OTH None None WAES0903USA01816 0 None OTH OTH None None WAES0903USA01817 10 Unknown OTH OTH Unknown Unknown WAES0903USA02317 serum varicella OTHzoster,OTH negative antibody Unknown titers Unknown WAES0903USA02365 0 OTH OTH Unknown Unknown WAES0903USA02553 Unknown OTH OTH Unknown Unknown WAES0903USA02592 Unknown OTH OTH Unknown Unknown WAES0903USA02948 0 Unknown OTH OTH SINGULAIRDrug hypersensitivity; Hives Asthma Hives~Measles WAES0903USA03185 (no brand name)~2~0~Patient Unknown OTH OTH Unknown Unknown WAES0903USA03573 1 Unknown PVT PVT Unknown WAES0810USA02135 1 Unknown PVT PVT Furuncle; Insect Unknown bite NOS WAES0810USA02142
1 Unknown PVT PVT CLARITIN Rhinitis allergic; Cough WAES0810USA02144 259 Unknown OTH OTH Unknown Unknown WAES0810USA02460 UNK UNK CIPRO CHROHN'S disease; Drug hypersensitivity WAES0801USA02468 89 diagnostic laboratory, OTH 0.474, OTH ADIGG, None not detectible Pregnancy (titer NOS test to(LMP= check5/1/2007)WAES0810USA02478 immunity) Unknown OTH OTH Unknown Unknown WAES0810USA02490 -9 None PVT OTH Unknown None WAES0810USA02491 Unknown OTH OTH Unknown Unknown WAES0810USA02775 0 Unknown OTH OTH Unknown Unknown WAES0810USA03250 21 VZV strain, OTH 10/31/08, inadequate OTH specimen, None negative forNone B-globin, no strain identification WAES0810USA05257 10 None OTH OTH Eczema WAES0810USA05259 7 None OTH PUB Fever; Vaccination adverse WAES0810USA03306 reaction serum VZV-specific, OTH negative OTH Unknown Unknown WAES0810USA05327 546 None OTH OTH None None WAES0810USA03346 1 None OTH OTH None WAES0810USA03365 2358 None PVT OTH None WAES0811USA00032 Unknown OTH OTH Unknown Unknown WAES0811USA00045 Unknown OTH OTH Unknown Unknown WAES0811USA00196 100 Unknown OTH OTH Unknown Unknown WAES0810USA03366 488 diagnostic laboratory, PVT Culture: PVT lightNone growth staphylococcus None WAES0811USA00209 allergy test OTH OTH Unknown Unknown WAES0811USA00253 14 Unknown PVT PVT Unknown Unknown WAES0811USA00275 0 Unknown PVT PVT Unknown Unknown WAES0811USA00279 0 None OTH OTH Unknown Food allergy WAES0810USA03381 177 viral cultureOTH OTH Unknown Unknown WAES0811USA00282 Unknown OTH OTH Unknown Unknown WAES0811USA00520 biopsy - Don't OTH seem to OTH be characteristic Unknown of anything; biopsy VARICELLA - giant cells, not multinicleated, WAES0811USA00620 Herpes simplex virus - N serum VZV-specific, OTH confirmed OTH seroconvert (therapy unspecified); Hypersensitivity; cough, Eczema Asthma cold, and flu therapies; WAES0810USA03753 inhaled corticosteroid None OTH OTH Unknown Unknown WAES0810USA03770 0 Serum varicella PVT zoster,PVT 11/10/08, 6.58, None positive. None WAES0811USA00674 Unknown OTH OTH Unknown Unknown WAES0811USA00711 Unknown OTH OTH Unknown Unknown WAES0811USA00736 2661 Unknown PVT OTH Unknown Shingles WAES0810USA03910 1 Unknown OTH OTH Unknown WAES0811USA00878 1 Unknown PVT PVT None Allergy to vaccine~Hep WAES0811USA00949 B (no brand name)~UN 366 None OTH OTH None Unknown None WAES0810USA03915 Unknown OTH OTH Unknown Unknown WAES0810USA03963 3 Unknown OTH OTH Unknown Unknown WAES0811USA00986 101 Unknown PVT OTH Unknown Drug hypersensitivity ZITHROMAX allergy, total WAES0811USA01187 body swelling 1 Unknown PVT PVT MOTRIN; TYLENOL; codeine Attention deficit disorder WAES0810USA03983 742 None PVT PUB Unknown None WAES0811USA01304 0 Unknown OTH OTH Unknown Unknown WAES0811USA01326 0 Unknown PVT PVT Unknown Unknown WAES0811USA01329 OTH OTH Unknown Unknown WAES0810USA03995 Unknown OTH OTH Unknown Unknown WAES0811USA01618 10 Unknown PVT OTH CELEXA; gabapentin; Autism; Penicillin Guillain-Barre MOTRIN; allergy; ZANTAC; Acute syndrome RISPERDAL inflammatory WAES0810USA04022 demyelinating polyradic 147 Serum VARICELLA OTH ZOSTER OTH 11/10/08 XANAX; negat PREMARIN; LASIX Unknown (FUROSEMIDE); WAES0811USA01815 ZOLOFT; TRAZODONE HYDROC Unknown OTH OTH Unknown Chickenpox~Varicella WAES0811USA02164 (no brand name)~UN~3~ 1 None PVT PVT Tylenol Eczema WAES0811USA02212 Unknown OTH OTH Unknown Unknown Rash~Varicella WAES0811USA02274 (no brand name)~UN~1~Sibling 1 serum varicella OTHzoster,OTH positive immunity Unknown (1.3) Unknown WAES0810USA04025 7 OTH OTH Unknown Unknown WAES0810USA04135
497 None
PVT PVT None None WAES0810USA04137 OTH OTH Unknown Unknown WAES0810USA04155 0 Unknown OTH OTH Unknown Unknown WAES0810USA04174 None OTH OTH None WAES0810USA04356 9 None OTH OTH None WAES0810USA04357 Unknown OTH OTH Unknown Unknown WAES0810USA04483 0 None OTH OTH Unknown WAES0810USA04487 20 Unknown PVT PVT Unknown Unknown WAES0810USA04509 Unknown OTH OTH Unknown Unknown WAES0810USA00546 0 Unknown OTH OTH Unknown WAES0810USA04513 Unknown OTH OTH Unknown Unknown WAES0801USA00557 Unknown OTH OTH Unknown Unknown WAES0810USA00560 Unknown OTH OTH Unknown Unknown WAES0810USA00824 0 OTH OTH Unknown Unknown WAES0811USA02843 0 OTH OTH Unknown Unknown WAES0811USA02852 Unknown OTH OTH Unknown Unknown WAES0810USA01021 11 Unknown OTH OTH Unknown Unknown WAES0811USA03030 1374 Unknown OTH OTH Unknown Unknown WAES0810USA01157 10 Unknown OTH OTH None None WAES0810USA01158 0 Unknown OTH OTH Unknown Unknown WAES0811USA04005 Unknown OTH OTH Unknown Unknown WAES0810USA04557 Unknown OTH OTH Unknown Unknown WAES0810USA01539 Unknown OTH OTH Unknown Unknown WAES0810USA01665 399 body temp, PVT 99F PVT Drug hypersensitivity WAES0810USA04738 20 None OTH OTH None Asthma WAES0810USA01668 167 Unknown OTH OTH Unknown Unknown WAES0811USA04023 1 None OTH OTH None None WAES0810USA01701 Unknown OTH OTH Unknown Unknown WAES0810USA01718 558 None PVT PVT Unknown None WAES0811USA04139 0 None OTH OTH LEXAPRO None WAES0810USA01841 0 Unknown OTH OTH Unknown Unknown WAES0810USA04869 Unknown OTH OTH Unknown Unknown WAES0810USA01850 10 None OTH OTH FEMCON FE Penicillin allergy WAES0811USA04150 17 None PVT PVT None None WAES0810USA04909 1 Unknown PVT PVT None WAES0810USA02115 Unknown OTH OTH Unknown Unknown WAES0810USA04948 0 Unknown OTH OTH Unknown Unknown WAES0810USA04953 Unknown OTH OTH Unknown None WAES0812USA00343 112 Unknown OTH OTH Unknown WAES0810USA05081 284 None PVT PVT Unknown Unknown WAES0812USA00513 Unknown OTH OTH Unknown Unknown WAES0810USA05179 0 complete blood PVT cell 11/07/08 OTH - within Unknown normal limit; Hypertension blood chemistry 11/07/08 - within WAES0812USA00536 normal limit; serum C-reactive p 92 Unknown OTH OTH Unknown Unknown WAES0812USA00568 Unknown OTH OTH Unknown Unknown WAES0812USA00579 serum VZV-specific OTH - low OTH titer None WAES0812USA03195 4317 Unknown PVT PUB Unknown None WAES0812USA03263 0 Unknown OTH OTH Unknown Unknown WAES0812USA03384 0 Unknown OTH OTH Unknown Unknown WAES0812USA03602 251 None PVT PUB Unknown Asthma WAES0812USA04027 serum VARICELLA OTH ZOSTER OTH - negative Unknown Unknown WAES0812USA04091 Unknown OTH OTH Unknown Unknown WAES0812USA01179
Unknown OTH OTH Unknown Unknown WAES0812USA01180 3652 serum VARICELLA OTH ZOSTER OTH ?/?/08 Unknown - not have Pregnancy immunity NOS to VARICELLA ( LMP = Unknown) WAES0812USA04107 0 Unknown OTH OTH Unknown Asthma WAES0812USA04116 None OTH OTH Unknown Environmental allergy WAES0812USA04526 Unknown OTH OTH RAPAMUNE Liver transplant WAES0812USA04560 0 Unknown OTH OTH Unknown Unknown WAES0812USA05110 18 Serum VARICELLA OTH ZOSTER OTH 11/11/08 (therapy - positive; unspecified) Fever; VZV Hypernatraemia; strain mg; TYLENOL; 11/13/08Sodium - LOTRIMIN; VACCINE increased; WAES0812USA05278 STRAIN hydrocortisone Steroid therapy; mg; pyridoxine Corpus c 3352 Unknown PVT PVT Unknown WAES0901USA00086 86 None OTH OTH PREVNAR None WAES0901USA00142 974 Unknown OTH OTH Unknown Unknown WAES0901USA00325 0 None OTH OTH None None WAES0812USA01212 11 None OTH OTH Therapy unspecified Unknown WAES0812USA01225 2 None OTH OTH None None WAES0812USA01586 9 Serum varicella PVT zoster,OTH ?/?/06, negative Vitamins (unspecified) Pregnancy NOS (LMP = 2/10/2007) WAES0812USA01614 Unknown OTH OTH Unknown Unknown WAES0812USA01644 229 None OTH OTH ALBUTEROL; Asthma; ZYRTEC; Eczema; FLOVENT; RhinitisCLARITIN; allergic WAES0812USA01656 SINGULAIR 2 None PVT PVT Unknown None WAES0812USA01784 3324 None OTH OTH None None WAES0812USA02011 Unknown OTH OTH Unknown Unknown WAES0812USA02022 Unknown OTH OTH Unknown Unknown WAES0812USA02023 0 Unknown OTH OTH Unknown Unknown WAES0812USA02159 None OTH OTH Unknown WAES0812USA02785 0 Unknown OTH OTH Unknown Unknown WAES0812USA02789 1 None OTH OTH None None WAES0812USA03185 175 Unknown PVT PVT Unknown Unknown WAES0901USA00326 Unknown OTH OTH Unknown Unknown WAES0901USA00337 1528 None PVT PVT None WAES0901USA00774 23 None OTH OTH None Sulfonamide allergy : Hypersensitivity WAES0901USA00798 0 Unknown OTH OTH None Birth twin Dizziness~Varicella WAES0901USA01025 (Varivax)~UN~7~Sibling|In Unknown OTH OTH Unknown Unknown WAES0901USA01040 3 Unknown OTH OTH Unknown None WAES0901USA01048 serum antistreptolysin OTH OTH O, negativeUnknown Unknown WAES0901USA01127 0 Unknown OTH OTH None Unknown WAES0901USA01283 0 Unknown OTH OTH None Birth twin dizziness~Varicella WAES0901USA01284 (no brand name)~UN~7~Si Clinical serology OTH test - OTH negative forUnknown chicken pox Unknown WAES0901USA01303 12 Unknown OTH OTH Unknown WAES0901USA01324 851 Unknown PVT PVT Unknown Unknown WAES0901USA01525 clinical serology OTH test, negative OTH for Unknown chicken pox Unknown WAES0901USA01552 2672 None OTH OTH None None WAES0901USA01596 9 None PUB OTH Unknown Unknown WAES0901USA01608 0 Unknown OTH OTH Unknown Unknown WAES0901USA01625 serum varicella OTHzoster,OTH negative Unknown Unknown WAES0901USA01722 Unknown OTH OTH Unknown Unknown WAES0901USA01763 21 skin biopsy,PVT positive forOTH chickenpox Unknown ; serum varicella zoster, Unknown showed that he had WAES0901USA01975 never had chickenpox Unknown OTH OTH Unknown Unknown WAES0901USA01993 0 None PVT PVT None WAES0901USA02045 3 Temperature OTH measurement, PUB 01/16/09, None97.6F, Tympanic None WAES0901USA02473 4 Unknown OTH OTH Unknown Unknown WAES0901USA02496 4 bone marrow OTH biopsy, normal; OTH WBC count, low; erythrocyte, None high; neutrophil count, WAES0901USA02572 very low; serum granulocyte, po Unknown OTH OTH Unknown Unknown WAES0901USA02711 Unknown OTH OTH Unknown Unknown WAES0901USA02740
3 None PVT PVT Unknown Penicillin allergy WAES0901USA03087 serum immunoglobulin OTH OTH M - zero; serum Unknown immunoglobulin G Unknown - zero WAES0901USA03310 Unknown OTH OTH Unknown Unknown WAES0901USA03332 0 Unknown PVT OTH Unknown Acute alcoholic hepatitis; DiabetesWAES0901USA03381 mellitus; Gastritis; Duodenitis; Hyp 285 None PUB OTH None None WAES0901USA03444 Unknown OTH OTH Unknown Unknown WAES0901USA03477 None OTH OTH None None WAES0901USA03497 4482 None OTH OTH None WAES0901USA03507 Unknown PVT OTH Unknown Unknown WAES0901USA03656 None OTH OTH Unknown Peanut allergy; Food allergy WAES0901USA03678 Unknown OTH OTH Unknown Unknown WAES0901USA03712 12 Unknown PUB OTH Unknown Penicillin Allergy WAES0901USA03751 2350 Unknown OTH OTH Unknown Asthma WAES0901USA03923 Unknown OTH OTH Unknown Unknown WAES0901USA04117 Unknown OTH OTH Unknown Unknown WAES0901USA04155 92 Unknown OTH OTH Unknown Unknown WAES0901USA04409 2 Serum varicella OTH zoster,OTH showed noNone immunity None WAES0901USA04419 Unknown OTH OTH Unknown Unknown WAES0901USA04421 Unknown OTH OTH Unknown Unknown WAES0807USA03549 Unknown OTH OTH Unknown Unknown WAES0807USA03550 2 None OTH OTH None None WAES0807USA03577 1382 Unknown PVT OTH Unknown Unknown WAES0807USA03721 None OTH OTH Unknown Unknown WAES0807USA03815 1 None OTH OTH None None WAES0807USA03817 1 None PVT PVT tuberculin purified protein None WAES0807USA03862 Unknown OTH OTH Unknown Unknown WAES0807USA04012 serum varicella OTHzoster,OTH negative hormonal contraceptives None WAES0807USA04064 Unknown OTH OTH Unknown Unknown WAES0807USA04317 Unknown OTH OTH Unknown Unknown WAES0807USA04320 1 Unknown OTH OTH Unknown Unknown WAES0807USA04417 None OTH OTH Unknown Unknown WAES0807USA04481 0 None PVT OTH MIRALAX Unknown WAES0807USA04575 0 Unknown OTH OTH Unknown Unknown WAES0807USA04602 846 Unknown OTH PUB Unknown Public Funds WAES0807USA03035 -1 Unknown PVT OTH Unknown None WAES0807USA03059 1 None PVT OTH Unknown None WAES0807USA03067 Unknown PVT PVT Scoliosis; Hypersensitivity WAES0807USA03136 Unknown OTH OTH Unknown Unknown WAES0807USA04794 Unknown MIL OTH Unknown Unknown WAES0807USA04949 Unknown OTH OTH Unknown Unknown WAES0807USA03137 Unknown OTH OTH Unknown Unknown WAES0807USA04950 None OTH OTH None None WAES0807USA05051 Unknown OTH OTH Unknown Unknown WAES0807USA03138 Unknown OTH OTH Unknown Unknown WAES0807USA03139 2551 Unknown OTH OTH Unknown Unknown WAES0807USA03193 Unknown OTH OTH Unknown Unknown WAES0807USA03201 7 Unknown OTH OTH Unknown Unknown WAES0807USA03258 Unknown OTH OTH Unknown Unknown WAES0807USA05129 2 Unknown OTH OTH Eczema; Egg allergy WAES0807USA03325 35 Unknown OTH OTH Unknown Unknown WAES0807USA05163 Unknown OTH OTH Unknown Unknown WAES0807USA03367
Unknown OTH OTH Unknown Unknown WAES0807USA03548 Unknown OTH OTH Unknown None WAES0807USA05182 Unknown OTH OTH Unknown Unknown WAES0807USA05202 8 diagnostic laboratory, PUB lesion PVT culture- no growth Asthma WAES0807USA05281 body temp, PVT 99-100 PVT None WAES0807USA05354 1 Unknown OTH OTH Sulfonamide allergy WAES0807USA05376 1 Unknown PVT PVT Unknown WAES0808USA03476 Unknown OTH OTH Unknown Unknown WAES0807USA05521 0 Unknown OTH OTH Unknown Unknown WAES0807USA05538 1 Unknown/2008 PVT PVT Unknown Injection site WAES0808USA03477 erythema, pruritus, swelling~Varic 6 physical examination, PUB 07/28?/08; OTH body temp, 07/28?/08, Unknown 102 degrees F; body temp, WAES0808USA00277 07/31?/08, 99.4 degrees F 0 Unknown PVT OTH Unknown Unknown WAES0808USA00495 1 None PVT PVT None Rhinitis allergic General physical condition WAES0808USA00964 366 None OTH OTH Unknown Pollen allergy WAES0808USA03615 2 None OTH PUB Tuberculin purified protein None WAES0808USA03651 2 Unknown UNK UNK Drug hypersensitivity WAES0808USA04116 2 None OTH PUB none WAES0808USA03664 1561 Unknown OTH OTH Unknown Unknown WAES0808USA04170 2 None OTH PUB tuberculin purified Mycoticprotein allergy; Reactive Injection airways site WAES0808USA03770 disease erythema; Injection site pruritus; In Unknown OTH OTH Unknown Unknown WAES0808USA04209 2 Unknown PVT OTH Unknown Unknown WAES0808USA03954 0 Unknown OTH OTH ADVIL None WAES0808USA03964 0 None OTH OTH None WAES0808USA04357 2 Unknown OTH OTH Unknown WAES0808USA03968 Unknown OTH OTH Unknown Unknown WAES0808USA04359 0 PVT PVT Unknown Unknown WAES0808USA03987 3094 None OTH OTH Unknown Drug hypersensitivity WAES0808USA04413 0 OTH OTH HAVRIX Unknown WAES0808USA04011 3108 None OTH OTH Unknown WAES0808USA04415 Unknown OTH OTH Unknown Unknown WAES0808USA04419 0 Unknown OTH OTH Unknown Unknown WAES0808USA04038 1 None OTH OTH None None WAES0808USA04423 Unknown OTH OTH Unknown Unknown WAES0808USA04427 2405 None OTH OTH Unknown Drug hypersensitivity WAES0808USA04442 Unknown OTH OTH Unknown Unknown WAES0808USA04450 Unknown OTH OTH Unknown Unknown WAES0808USA04634 Unknown OTH OTH Unknown None WAES0808USA04849 OTH OTH Unknown Unknown WAES0808USA05003 740 Total heartbeat OTHcount, OTH 08/26/08, 128; acyclovir Body temp, 08/26/08, Otitis 97.7 media F; RespiratoryWAES0808USA04850 rate, 08/26/08, 18; VZV strain, 08/2 0 Unknown PVT PVT None WAES0808USA05051 urine bloodOTH OTH Unknown Unknown WAES0808USA05052 3534 None PVT PUB Unknown Unknown WAES0808USA05234 0 Unknown OTH OTH Unknown Unknown WAES0808USA05326 Unknown OTH OTH Unknown Unknown WAES0808USA05342 295 Unknown OTH OTH Unknown Unknown WAES0808USA05343 0 None PVT PVT None Allergic reaction to antibiotics WAES0808USA05355 VZV strain, OTH confirmed recombination OTH Unknown of vaccine strain and Unknown wild type varicella zoster WAES0808USA05366 virus 10 None OTH OTH None None WAES0808USA05407 Unknown OTH OTH Unknown Unknown WAES0809USA00001 VZV strain -OTH confirmed OTH recombination of vaccine strain and Unknown wild type VARICELLA WAES0809USA00002 ZOSTER virus 261 Unknown OTH OTH Unknown Unknown WAES0809USA00004
Unknown OTH OTH Unknown Unknown WAES0809USA00022 Unknown OTH OTH Unknown Unknown WAES0809USA00025 1 None PVT PVT Astelin, Zyrtec, Asthma; Advair, Penicillin Singulair allergy WAES0808USA01202 39 Unknown OTH OTH Unknown Unknown WAES0808USA01282 Diagnostic laboratory, OTH 0.43 OTH Immunotherapy Crohn's (unspecified) disease WAES0809USA00050 Unknown OTH OTH Unknown Unknown WAES0808USA01309 0 None OTH OTH None None WAES0808USA01368 7 None OTH OTH None WAES0809USA00313 2 Unknown OTH OTH Unknown Unknown WAES0809USA00328 2 None OTH OTH None WAES0809USA00335 2 None PVT OTH None WAES0809USA01407 2 None OTH OTH None None WAES0809USA00352 None OTH OTH None WAES0808USA01378 0 Unknown OTH OTH Unknown Unknown WAES0808USA01388 3106 None PVT OTH Unknown Unknown WAES0809USA01418 Unknown OTH OTH Unknown Unknown WAES0808USA01647 0 Unknown OTH OTH Unknown WAES0809USA00367 206 None OTH OTH None None WAES0809USA01435 e of VARIVAX (Oka/Merck) Serum (lot number, varicella OTHinjection ZosterOTH - negative site and route Unknown not reported). TheUnknown Pharmacist reported that WAES0808USA01650 a physician called and reported None OTH OTH Drug hypersensitivity WAES0809USA01455 Unknown OTH OTH Unknown Unknown WAES0809USA01502 Unknown OTH OTH Unknown Unknown WAES0809USA01549 0 None PVT OTH Unknown Dermatitis allergic WAES0809USA00471 3 None PVT PVT Unknown None WAES0808USA01573 1 None PVT PVT Penicillin allergy WAES0809USA01575 Unknown OTH OTH Unknown Unknown WAES0809USA00528 19 Unknown PVT PVT Unknown WAES0809USA01579 Unknown OTH OTH Unknown Unknown WAES0809USA01648 1647 None OTH OTH Otitis media WAES0809USA00743 2 Unknown OTH OTH None Penicillin allergy WAES0809USA01745 0 Unknown OTH OTH Unknown Unknown WAES0809USA00753 Unknown OTH OTH Unknown Unknown WAES0809USA01778 0 None OTH OTH Unknown WAES0809USA01790 470 None OTH OTH None Unknown WAES0809USA00773 2329 body temp, UNK 12/21?/04,UNK 102.9 Allergic reaction Rash to antibiotics WAES0809USA00867 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA01837 (Varivax)~2~11~Sibling 0 None OTH OTH Unknown Food Allergy WAES0809USA01223 Unknown OTH OTH Unknown Unknown WAES0809USA01951 2 None OTH OTH None None WAES0808USA01671 Unknown OTH OTH Unknown Unknown WAES0809USA01380 None OTH OTH Unknown Unknown WAES0809USA01975 21 None OTH OTH None None WAES0809USA01980 0 Unknown OTH OTH Unknown Unknown WAES0809USA02014 None OTH OTH None None WAES0809USA02162 31 None OTH OTH None WAES0809USA02177 2784 VZV strain, PVT 09/08/08, no PVT virus isolated Unknown Unknown WAES0809USA02297 Unknown OTH OTH Unknown Unknown WAES0809USA02316 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA02379 (Varivax)~2~7~Sibling 19 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0809USA02380 (Varivax)~2~11~Sibling 19 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0809USA02381 (no brand name)~2~9~S 0 Unknown PVT PVT aspirin; DYAZIDE; Hypertension vitamins (unspecified) WAES0809USA02483
None OTH OTH None None WAES0809USA02576 0 Unknown PVT PVT Aspirin; Lipitor; Hyperlipidaemia Vitamins (unspecified) WAES0809USA02598 Unknown OTH OTH Unknown Unknown WAES0809USA02664 1 None PVT PVT [Therapy unspecified] None WAES0807USA05568 Unknown OTH PVT Unknown Immunodeficiency Diarrheacommon functional variable (due WAES0807USA05664 to spastic colon) Unknown OTH OTH Unknown Unknown WAES0807USA05694 0 None OTH OTH Unknown WAES0807USA05699 None OTH OTH Unknown None WAES0807USA05735 serum VARICELLA OTH ZOSTER OTH - negative Unknown Unknown WAES0805USA02934 Unknown OTH OTH Unknown Unknown WAES0807USA05738 0 None OTH OTH Unknown None WAES0805USA03403 Unknown OTH OTH Unknown Unknown WAES0807USA05739 301 None OTH OTH None None WAES0805USA03488 0 Unknown OTH OTH Unknown Unknown WAES0807USA05754 Unknown OTH OTH Unknown Unknown WAES0805USA03651 11 None OTH OTH None WAES0805USA03659 18 Unknown OTH OTH None None WAES0805USA03797 0 Glucose tolerance OTH test,OTH 3 degrees,Advair; within normal Mucinex Pregnancy limits; Ultrasound, NOS (LMP 06/24/08, = 4/1/2008); within WAES0808USA00063 Asthma; normal Drug limits; hypersensitivity Ultrasound, 07/3 7 None OTH OTH None None WAES0805USA04502 184 Unknown OTH OTH Unknown WAES0808USA00081 3643 VZV strain 05/19/08 PVT - positive OTH None WAES0805USA04544 Unknown OTH OTH Unknown Unknown WAES0808USA00094 0 Unknown OTH OTH Unknown Unknown WAES0805USA03823 0 None OTH OTH None Eczema (outgrew) WAES0805USA03860 Unknown OTH OTH Singular Asthma WAES0805USA04691 2 None PVT PVT None None WAES0808USA00101 3 None PVT OTH Unknown None WAES0805USA04055 0 None OTH OTH Unknown None WAES0808USA00147 Unknown OTH OTH Unknown Unknown WAES0805USA04395 3211 Serum varicella OTH zoster,OTH 08/16/07, less Unknown than 0.91 Unknown WAES0805USA04744 Unknown OTH OTH Unknown Unknown WAES0805USA04396 0 Unknown OTH OTH Unknown Unknown WAES0808USA00206 Unknown OTH OTH Unknown Unknown WAES0805USA04785 Unknown OTH OTH Unknown Unknown WAES0805USA04398 0 Unknown OTH OTH Unknown WAES0808USA00207 0 None OTH OTH None None WAES0805USA04786 1 Unknown OTH OTH Unknown None WAES0805USA04400 Unknown OTH OTH Unknown WAES0805USA04838 Unknown OTH OTH Unknown Unknown WAES0805USA04489 Unknown OTH OTH Unknown Unknown WAES0805USA04874 0 Unknown OTH OTH Unknown Unknown WAES0805USA04876 Unknown OTH OTH Blood pressure high WAES0805USA04930 24 None OTH OTH None None WAES0805USA04967 510 Unknown PVT PVT Unknown Chickenpox~Varicella WAES0805USA05060 (Varivax)~~8~Sibling|Ch OTH OTH Unknown Unknown WAES0805USA04998 0 Unknown OTH OTH Unknown WAES0805USA05068 Unknown OTH OTH Unknown WAES0805USA05058 0 Unknown OTH OTH Unknown Unknown WAES0805USA05071 246 Unknown PVT PVT Unknown Chickenpox~Varicella WAES0805USA05059 (no brand name)~1~7~S 0 Unknown OTH OTH Unknown Unknown WAES0805USA05072 0 Unknown OTH OTH Unknown Unknown WAES0805USA05073
0 urine beta-human, OTH 03/25/08, OTH negative ORTHO TRI-CYCLEN Pregnancy NOS LO (LMP = 2/29/2008) WAES0805USA05105 1 None PVT PVT mercaptopurine Crohn's disease; Immunosuppression WAES0805USA05122 0 None OTH OTH Unknown Unknown WAES0805USA05128 Unknown OTH OTH Unknown Unknown WAES0805USA05445 Unknown OTH OTH Unknown Unknown WAES0805USA05499 None OTH OTH Unknown None WAES0805USA05592 None OTH OTH None Unknown WAES0805USA05615 10 WBC countPVT 05/23/08 7.8 PVT None None WAES0805USA05620 14 None OTH OTH Unknown Unknown WAES0805USA05622 0 Unknown OTH OTH Unknown Unknown WAES0805USA05644 14 OTH OTH None Unknown WAES0805USA05627 Unknown OTH OTH Unknown Unknown chickenpox~Varicella WAES0805USA05950 (Varivax)~2~11~Sibling 11 Unknown PVT OTH Cellulitis of leg WAES0805USA05955 Unknown OTH OTH Unknown Unknown WAES0808USA02799 0 Unknown OTH OTH Unknown Unknown WAES0805USA05977 0 None OTH OTH CLARITIN Seasonal allergy WAES0806USA00627 3283 Unknown OTH OTH Unknown Unknown WAES0808USA02801 4702 None OTH OTH None None WAES0805USA06174 12 Serum VARICELLA PVT ZOSTER PVT - IgG iron equivocal; (unspecified); Seasonal serumCLARITIN VARICELLA allergy; Anaemia; ZOSTER Chronic 9/12/08 WAES0808USA02808 sinusitis - IgG equivocal 2 Unknown PVT PVT Unknown Unknown WAES0805USA06432 0 None OTH OTH None None WAES0808USA02844 Unknown OTH OTH Unknown Unknown WAES0806USA00003 240 Unknown OTH OTH Unknown Unknown WAES0806USA00008 0 Unknown OTH OTH Unknown Unknown WAES0808USA02857 None OTH OTH None None WAES0806USA00648 Unknown OTH OTH Unknown Unknown WAES0806USA00077 Unknown OTH OTH Unknown Unknown WAES0806USA00316 9 None PVT PUB Unknown Feeling of warmth Unknown WAES0806USA00650 diagnostic laboratory, OTH 08?, OTHdid notUnknown have any immunity Unknown WAES0808USA03096 Unknown OTH OTH Unknown Unknown WAES0806USA00326 0 None OTH OTH None None WAES0808USA03110 11 body temp, PVT 06/02/08, 99.4 PUBF CONCERTA Attention deficit/hyperactivity disorder WAES0806USA00672 633 Unknown OTH OTH Unknown Unknown WAES0806USA00699 0 Unknown PVT OTH Unknown Unknown WAES0808USA03124 0 Unknown OTH OTH Unknown Unknown WAES0806USA00991 0 Unknown OTH OTH Unknown Unknown WAES0806USA00616 1837 None OTH OTH Unknown Unknown WAES0806USA01000 0 Unknown OTH OTH Unknown Unknown WAES0806USA00625 0 Biopsy 08/15/08 OTH - fixedOTH drug reaction Thyroid Thyroid disorder WAES0808USA03213 1 None PVT PUB None None WAES0808USA03225 1 None PVT PVT None WAES0806USA01006 3398 Unknown OTH OTH Unknown Drug hypersensitivity WAES0808USA03245 1095 body temp 98.5 OTH OTH Unknown WAES0806USA01035 1 Unknown PVT PVT Unknown Asthma; Hypersensitivity; EczemaWAES0808USA03473 Unknown OTH OTH Unknown Unknown WAES0808USA01959 Diagnostic laboratory OTH -OTH the test result Unknown of the whole batch Unknown test was unknown. WAES0808USA02047 0 Unknown OTH OTH Unknown Unknown WAES0808USA02146 Unknown OTH OTH Unknown Unknown WAES0808USA02179 VZV strain PCR, OTH positive OTH for vaccine Unknown strain VZV None WAES0806USA01077 Diagnostic laboratory OTH -OTH swabbed the Unknown rash Unknown WAES0808USA02181 1 Unknown PVT PVT Unknown Unknown WAES0808USA03474
VZV strain, OTH positive forOTH vaccine strain Unknown VZV None WAES0806USA01078 9 None PUB OTH None Asthma; Penicillin Hives; Breath allergy shortness WAES0808USA02427 VZV strain, OTH positive forOTH vaccine strain Unknown VZV None WAES0806USA01079 0 Unknown OTH OTH Unknown Unknown WAES0808USA02457 Unknown OTH OTH Unknown None WAES0806USA01090 Unknown OTH OTH Unknown Unknown WAES0808USA02461 VZV strain, OTH positive forOTH vaccine strain Unknown VZV; VZV strain, negative None WAES0806USA01091 13 None OTH OTH None None WAES0808USA02475 0 ultrasound, PUB 08/13/08, no OTH problems;None ultrasound, Pregnancy 09/17/08,NOS no problems (LMP = 01/03/2008) WAES0808USA02606 Unknown OTH OTH Unknown Unknown WAES0808USA02627 62 None PVT PVT Unknown None WAES0808USA02671 None OTH OTH None WAES0808USA02721 0 Unknown OTH OTH Unknown Unknown WAES0806USA08049 Unknown OTH OTH Unknown Unknown WAES0806USA08138 0 Unknown OTH OTH Unknown Unknown WAES0806USA08305 0 Unknown OTH OTH Unknown Unknown WAES0806USA08306 0 Unknown OTH OTH Unknown Unknown WAES0806USA08307 Unknown OTH OTH None Unknown WAES0806USA08331 29 None PVT OTH None None WAES0806USA08400 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0806USA08402 (no brand name)~1~0~S 1737 Unknown PVT PUB Unknown Rash WAES0806USA08695 Unknown OTH OTH Unknown Unknown WAES0806USA08741 Unknown OTH OTH Unknown Unknown WAES0806USA08832 754 None PVT PVT None None WAES0806USA08878 0 None PVT PVT None None WAES0806USA01092 0 None PVT PVT None WAES0806USA08935 0 None PVT PVT Seasonal allergy WAES0806USA08942 0 None OTH OTH Unknown WAES0806USA01107 0 None OTH OTH Unknown WAES0806USA01151 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0806USA01251 (Varivax)~1~12~Sibling 2425 Body temp OTH 97.7 degrees OTH F - ; VZVDIGITEK; strain - nopropranolol amplified VZV hydrochloride None DNA; inadequate lesion, WAES0806USA01287 negative for B - globin, no stra Unknown OTH OTH Unknown Convulsion WAES0806USA01294 Unknown OTH OTH Unknown Unknown WAES0806USA01300 2087 None OTH OTH None Streptococcal infectionWAES0806USA01311 0 Unknown PVT PVT Unknown Unknown WAES0806USA01497 Unknown OTH OTH Unknown Unknown WAES0806USA01502 None OTH OTH Unknown None WAES0806USA01539 Unknown OTH OTH Unknown Unknown WAES0806USA01568 0 Unknown PVT PVT Dermatitis; Rhinitis allergic; WAES0806USA01606 Latex allergy; Drug hypersensi 0 Serum varicella OTH zoster,OTH 06/05/08, negative Calcium (unspecified); Hypercholesterolaemia Female Fatty acids genital (unspecified); operation; WAES0806USA01976 LOVASTATIN; Vitamin d (unsp 2116 None OTH OTH Unknown Unknown WAES0806USA01981 0 Unknown PVT PVT Unknown Unknown WAES0808USA03475 0 Unknown OTH OTH Unknown Unknown WAES0806USA01988 1 Unknown PVT PUB Unknown Unknown WAES0806USA02200 1 Unknown OTH OTH Ginkgo; Prinzide; Drug hypersensitivity Omega-3; Pravastatin sodium; WAES0806USA02231 Vitamin D (unspecified); Vitamin 0 Unknown OTH OTH Unknown Unknown WAES0806USA02238 0 Unknown OTH OTH Unknown WAES0806USA02254 Unknown OTH OTH Unknown Unknown Unknown WAES0806USA02400 0 Unknown OTH OTH Albuterol Asthma WAES0806USA02442 0 Unknown OTH OTH Unknown Unknown WAES0806USA02462 0 body temp, OTH 06/10/08, 103 OTHF Unknown Immunization WAES0806USA02464
Unknown OTH OTH Unknown Unknown WAES0806USA08984 1 Unknown OTH OTH None WAES0806USA09014 0 Unknown OTH OTH Unknown Unknown WAES0807USA00017 0 Unknown OTH OTH Unknown Unknown WAES0807USA00054 None OTH OTH None None WAES0807USA00089 0 Unknown OTH OTH Unknown Unknown WAES0807USA00128 0 None OTH OTH None WAES0807USA00349 0 None PVT OTH Unknown None WAES0807USA00665 Unknown OTH OTH Unknown Chickenpox WAES0807USA00666 Unknown OTH OTH Unknown Unknown WAES0807USA00669 Unknown OTH OTH Unknown Hypersensitivity WAES0807USA00691 Unknown OTH OTH Unknown Unknown WAES0807USA00809 0 Unknown OTH OTH Unknown Unknown WAES0807USA00967 0 None PVT OTH Unknown None WAES0807USA01026 laboratory test, OTHvzv antibody OTH titer negative None Unknown WAES0807USA01040 0 serum varicella OTHzoster,OTH 05/??/08, negative None None WAES0807USA01145 Unknown OTH OTH Unknown Unknown WAES0807USA01292 25 None OTH OTH None WAES0807USA01373 0 Unknown OTH OTH Unknown Unknown WAES0807USA01397 2 Unknown PVT PVT Unknown WAES0807USA01406 Unknown PVT PVT Unknown None WAES0807USA01410 Unknown OTH OTH Unknown Unknown WAES0807USA01429 0 None PVT PVT None WAES0807USA01517 0 Unknown OTH OTH Unknown Unknown WAES0807USA01574 2 abdominal ultrasound, PVT PVT 07/10/08, mesentery Unknown adenitis; WBC None count, 07/10/08, 6.91 WAES0807USA01785 thou/; red blood cell count, 07/10/ 0 None OTH OTH None Unknown WAES0807USA01649 4461 Unknown OTH OTH Unknown None WAES0807USA01841 0 Unknown OTH OTH Unknown Unknown WAES0807USA01850 3597 Unknown OTH OTH Unknown Unknown WAES0807USA02218 Unknown OTH OTH Unknown Unknown Chickenpox~Varicella WAES0807USA02223 (Varivax)~UN~8~Sibling 448 Unknown OTH OTH Unknown Unknown WAES0807USA02243 0 Unknown OTH OTH Unknown Upper respiratory Unknown tract infection WAES0807USA02376 serum varicella OTHzoster,OTH 09/04/07, 0.13, Nonenegative Chickenpox WAES0807USA02470 402 None PVT PVT None WAES0807USA02504 0 Unknown OTH OTH None WAES0804USA00300 1 Unknown OTH OTH Unknown WAES0804USA00377 Unknown OTH OTH Unknown Unknown WAES0807USA02643 2330 diagnostic laboratory, OTH 03/24/08, OTH onNone 24-MAR-2008 Confirmed: Asthma Herpes zoster WAES0804USA00398 OTH OTH Unknown WAES0804USA00423 Unknown OTH OTH Obesity WAES0804USA00444 Unknown OTH OTH Unknown Obesity WAES0804USA00447 104 Unknown PVT OTH Unknown WAES0807USA02754 Unknown OTH OTH Unknown Unknown WAES0804USA00882 5 Unknown OTH OTH Unknown Unknown WAES0807USA02921 Unknown OTH OTH Unknown Unknown Inappropiate WAES0807USA03007 age at~Zoster (Zostavax)~UN~11 1 None PVT PVT albuterol None WAES0804USA00888 3207 Unknown OTH OTH Unknown Unknown WAES0807USA03021 Unknown OTH OTH Unknown Unknown WAES0804USA00920 Unknown OTH OTH Unknown Unknown WAES0804USA00995 0 None OTH OTH ZOLOFT None WAES0804USA01011 9 Unknown PVT PVT Unknown None WAES0804USA01013
body temp, PVT 100F OTH Unknown Asthma WAES0804USA01062 1 None PVT PVT None None WAES0804USA01096 583 Unknown OTH OTH Unknown Unknown WAES0804USA01264 Unknown OTH OTH Unknown Unknown WAES0804USA01337 0 Unknown OTH OTH Unknown Unknown WAES0804USA01438 Unknown OTH OTH Unknown Peanut allergy; Hypersensitivity WAES0804USA01494 1 None OTH OTH Seasonale, Ibuprofen None WAES0804USA01495 1 diagnostic laboratory OTH 04/05/08, OTH C-reactive Unknownprotein elevated Unknown WAES0804USA01711 7 Unknown OTH OTH Unknown Unknown WAES0804USA02209 0 None UNK UNK None None WAES0804USA02212 Unknown OTH OTH Unknown Unknown WAES0804USA02081 0 Unknown OTH OTH Unknown WAES0804USA02228 0 Unknown OTH OTH Unknown Unknown WAES0804USA02242 Unknown OTH OTH Unknown Unknown WAES0804USA02299 542 Unknown PVT PVT Unknown None WAES0804USA02106 Unknown OTH OTH Unknown Unknown WAES0804USA02328 Unknown OTH OTH Unknown Unknown WAES0804USA02143 None OTH OTH None None WAES0804USA02144 4565 None PVT PUB Unknown Rhinitis allergic; Scoliosis WAES0804USA02202 0 Unknown OTH OTH Unknown Unknown WAES0804USA02516 Unknown OTH OTH Unknown Unknown WAES0804USA02538 3592 Unknown OTH OTH Unknown Unknown WAES0804USA02743 2466 Unknown OTH OTH Unknown Unknown WAES0804USA02747 853 PVT PVT Unknown Unknown WAES0804USA02816 Unknown OTH OTH None Unknown WAES0804USA02879 1 None PVT PVT WAES0804USA03185 1132 Unknown PVT OTH Unknown Unknown WAES0804USA03118 697 None PVT PVT Slight feverAutism; Slow speech development; WAES0804USA03201 Encopresis 3790 Unknown PVT OTH Unknown Penicillin allergy WAES0804USA03231 Unknown OTH OTH Unknown Unknown WAES0804USA03236 1593 clinical immunology OTH test, OTH 03/??/08,None less than 0.91; clinicalChickenpox immunology test, 09/??/06, WAES0804USA03282 1.25; clinical immunology tes 0 Unknown OTH OTH Unknown WAES0804USA03508 4474 None OTH OTH SYMBICORT; Asthma; ZYRTEX; Seasonal FLONASE; allergySINGULAIR; WAES0804USA03602 MAXAIR 0 Unknown OTH OTH Unknown Unknown WAES0806USA03399 Unknown OTH OTH Unknown Obesity WAES0804USA03682 None UNK UNK None Allergic reaction to antibiotics WAES0804USA03766 Unknown OTH OTH None None WAES0806USA03425 406 Unknown OTH OTH GriseofulvinRingworm of scalp WAES0804USA03793 0 None OTH OTH None None WAES0804USA03730 4 None PVT PVT antimicrobial Ear (unspecified) infection WAES0806USA03727 0 Unknown PVT PVT Unknown WAES0804USA03861 Unknown OTH OTH Dilated cardiomyopathy; Cardiac arrestHypoxic encephalopathy; WAES0804USA03907 Spastic quadripare Serum varicella OTH zoster,OTH 06/??/08, 0.91, Unknown negative Unknown WAES0806USA03742 Unknown OTH OTH Unknown Unknown WAES0804USA03960 0 Unknown PVT OTH Unknown Unknown WAES0806USA03746 1832 None OTH OTH [therapy unspecified] Epilepsy; Convulsion WAES0804USA04000 0 None OTH OTH None WAES0806USA03794 437 Unknown OTH OTH Otitis media; Rhinitis Reactive allergic; airways Otitis disease media WAES0804USA04032 chronic 1263 None PVT PVT Acetaminophen, BENADRYL None WAES0804USA04033 0 None PVT PVT ADDERALL TABLETSNone WAES0806USA03803 2697 None OTH OTH Benadryl Adenotansillectomy WAES0804USA04034
1079 None PVT PUB Otitis MediaAsthma; Rhinitis allergic WAES0804USA04035 1505 None PVT PUB None WAES0804USA04040 0 None OTH OTH None None WAES0806USA03808 1008 None MIL MIL Premature birth WAES0804USA04042 0 Unknown OTH OTH Unknown Unknown WAES0806USA03822 2780 None PVT OTH Rhinitis allergic WAES0804USA04044 1452 Unknown PUB PUB Unknown Rhinitis allergic; Asthma; Food allergy WAES0804USA04045 2 Body temp PVT 06/18/2008,PUB 99-100 De F None WAES0806USA07561 14 None OTH OTH Unknown Unknown WAES0806USA07744 None OTH OTH Unknown Hypersensitivity; Atopy WAES0806USA07770 Complete blood OTH cell OTH Unknown Unknown WAES0806USA07877 57 Unknown PVT PUB Cardiac disorder; Asthma WAES0804USA04047 0 Body temp,OTH 03/09/08 101 OTH Unknown Unknown WAES0806USA07882 0 Unknown OTH OTH Unknown Unknown WAES0804USA04050 Diagnostic laboratory, UNK negative UNK titer Unknown as 0.91 Unknown WAES0804USA04223 7 None PVT OTH KELFEX Skin infection None WAES0804USA06300 Unknown OTH OTH Unknown Unknown WAES0804USA04630 18 None PVT OTH Albuterol Asthma Exercise induced WAES0804USA06332 0 None PVT PVT Unknown None WAES0804USA06409 0 None PVT PVT Unknown Unknown WAES0806USA07918 292 Unknown PVT PUB Penicillin allergy WAES0804USA04788 14 Unknown OTH OTH None Unknown WAES0804USA06413 1473 Unknown PVT PUB Unknown None WAES0804USA04790 Unknown OTH OTH Unknown Unknown WAES0804USA04795 0 Unknown PVT PVT Unknown Unknown WAES0804USA04809 Unknown OTH OTH Unknown Unknown WAES0804USA06420 1 None PVT PUB None Autism; Allergy Muscular to vaccine; weakness Muscular Drug weakness~Pertussis hypersensitivity WAES0804USA05242 (no brand name 0 None OTH UNK None None WAES0805USA00081 1861 None OTH OTH None Seasonal allergy WAES0805USA00205 526 None OTH OTH Unknown Unknown WAES0805USA00268 494 None OTH OTH Unknown Unknown WAES0804USA05266 Unknown OTH OTH Unknown None WAES0805USA00288 0 None OTH OTH SINGULAIRMilk allergy; Meat allergy; Asthma;WAES0804USA05432 Penicillin allergy. Unknown OTH OTH Unknown Unknown WAES0805USA00323 0 None PVT OTH None WAES0804USA05960 2 Unknown PVT PVT Unknown Unknown WAES0804USA06103 20 None OTH OTH Unknown None WAES0805USA00372 Unknown OTH OTH None None WAES0805USA00409 26 Unknown OTH OTH Unknown Unknown WAES0805USA00451 Diagnostic laboratory OTH 05/02/2008 OTH 0.85 Unknown IgG VZV antibodyUnknown titer. WAES0805USA00509 2 None PVT PVT Unknown None WAES0805USA00557 2 Unknown OTH OTH Unknown Unknown WAES0805USA00588 0 Unknown OTH OTH Unknown Unknown WAES0805USA00591 0 None PVT PVT Eczema WAES0805USA00592 Unknown OTH OTH Unknown Unknown WAES0805USA00651 Unknown OTH OTH Unknown Unknown WAES0805USA00670 Unknown OTH OTH Unknown Unknown WAES0805USA00818 VZV strain Vacci, OTH VZV OTH OKA/MERCK Unknown VACCINE STRAIN Unknown WAES0805USA00862 14 Serum immunoglobulin OTH OTH G 04/23/08, None negative; serum immunoglobulin None M 04/23/08, WAES0805USA00871 negative 3785 Serum varicella OTH zoster OTH 02/07/08 no, Unknown serum varicella zoster Unknown 04/29/08 unequ WAES0805USA00964 0 None OTH OTH Unknown None WAES0805USA01014
0 Unknown PVT PUB Unknown Unknown WAES0805USA01073 0 Unknown PVT PVT Unknown None WAES0806USA02948 Unknown OTH OTH Unknown Unknown WAES0806USA03064 7 Laboratory OTH test OTH None WAES0806USA03065 None OTH OTH Clonidine, RITALIN Attention deficit disorder. WAES0806USA03076 3 None OTH OTH None WAES0806USA03113 Unknown OTH OTH Unknown Unknown WAES0806USA03360 1 None PUB OTH None None NotedNone 0 Diagnostic laboratory, OTH specimens OTH Therapy from the unspecified, rash Autism; was sent Allergic FOCALIN to the reaction CDC for to PCR antibiotics analysis. WAES0806USA01075 0 PVT PVT None 5 PVT PVT None None PVT PUB Zinc Oxide None Ointment None 3 OTH PVT None that I am aware 0 None PVT PVT None None None 1 None PVT OTH None None 1 PUB OTH None None Seasonal Allergies 0 PVT PVT None None PVT PVT None None 127 Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0905USA01493 PUB OTH 7 Unknown. 7/9/09 OTH Medical OTH records None received DOS Nerve 6/5/07 damage; to Gastric 10/5/07. Irritable ulcer LABS bowel perforation and syndrome; Diagnostics: WAES0905USA02258 Partial All pending. hearing loss; PAP,Gastro GC, V Unknown OTH OTH Unknown Cerebral palsy; Premature Shunt occlusion; baby Hydrocephalus WAES0905USA01937 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0905USA01916 574 None PVT OTH ATENOLOLNone 25mg qd Lansoprazole; clarithromycin; amoxicillin Unknown UNK UNK None None WAES0905USA01868 0 CBC; BMP PUB culture; (-)UA; PUBCXR allVitamin performed (Tri-Vi-Sol) None & OK None PVT UNK None Prematurity diagnostic laboratory, OTH Blood OTH work-Results poliovirus not vaccine reported inactivated Unknown WAES0905USA01999 387 viral culture,PVT 03/19/09, PVT negative forGLUCOPHAGE VZV, Varicella Diabetes and HSV Chickenpox WAES0903USA04278 2 Unknown PVT OTH FOSAMAX; hydrochlorothiazide; None DYAZIDE; NAPROSYN; WAES0901USA02736 EVISTA 1 PVT PVT 0 X-ray; diagnostic OTH laboratory; OTH magnetic albuterol; resonance, VALIUM; Latexarm allergy; ASMANEX MRI;Specific ultrasound, allergy of arm; (drug); WAES0902USA02392 diagnostic Penicillinlaboratory, allergy nerve test: co 0 None OTH PVT Denies Denies Denies 0 PVT PVT 0 PVT PVT PUB UNK 0 n/a PVT PVT n/a n/a n/a 3 PVT PUB None None None 1 PVT PUB none none none 1 MIL MIL Good healthLatex Allergy 0 PUB PUB WISDOM TEETH COMING OUT 0 UNK UNK Vyvanse - not no acute taken illness. onallergy day of 7/7/09 to vaccine fruit; ERattention-deficit records received disorder; DOS 5/22/09. Kawasaki LABS disease and 2 MIL PUB PUB PUB Vaccines being repeated as client had bone marrow transplant. 5/22/0 1 None PUB PUB No Hypoglycemic Allergic to sulfa 0 UNK PUB aspirin, etodolac tinnitus x 4 months; h/o CVA 1 None PVT PVT 1. Abilify daily. None2. Risperdal ALLERGIES: daily. 3.ASPIRIN KlonopinWHICH daily. 4.CAUSES Atenolol RASH, as needed. HIVES, 5. A 2 ECG showed MILan incomplete MIL right bundle Ferrousbranch sulfate None block; 325mg ESR, Iron po daily deficiency cardiac troponin, anemiaand D-dimer normal; graded exercis 2 N/A PVT PVT Metformin 850mg no no 1 flu test: negative PVT UNK NA NA NA 117 none PVT PUB Cough - thought none to be viral, otitis media
1 PUB PVT Avapro none high blood pressure 0 PUB PUB none none 0 He had blood PVT work andUNK urine testsFlovent that day2 with puffs none his a day physical. multiple I was food toldallergies(peanut,treenuts,eggs,soy,fish,cocon blood work was normal. He had had other b 30 NONE UNK PUB NONE KNOWN NONE KNOWN NONE KNOWN 2 Sent in ER UNK for KUB, 2 view UNK (paucity NONE of bowel KNOWN NONE gas in lower KNOWN, NONE quadrants), SEEN KNOWN FOR thenFamily IMMZ send to ONLY. hx: radiology TB, currently for airbeing contrast/enema tx. 2 N/A UNK PVT N/A When reporting the incident the patient remarked that she 1 ESR elevated UNK at 71 (3/17/09), UNK CPK Flomax normal0.4 atNone mg 99 QPM NKDA 11 Reduced with PVT air contrast PVTenema. None. 6/5/096/5/09 Medical None Medical records Known records received received DOS 4/30/09 DOS 4/30/09 to 5/1/09. to 5/1/09. CHEM: Ondansetron, CL 107 MMOL/ LM 1 Severe local PVT Rx PVT Nifedipine; None ASA; TOPROL; AorticHCTZ valve stenosis 0 PVT PUB TYLENOL @ URI Phen (runny PMNone nose & sneezing) 2 PVT OTH HYDRODIURIL; Routine FOLIC Physical Prinivil ACID; - tendonitis; DIOVAN; Multivitamins some shoulder pain. PVT UNK None None 1 None PVT OTH None None 0 BP, decrease PVT 88/51; HR, PVT decrease 36; BP, increase None 116/81 None after 20minutes. 0 PUB PVT None 2 OTH OTH PROPRANOLOL; None PANTOPRAZOLE; No PRIMIDONE 1 None PVT PUB None None Eczema; Food allergies. 6 PVT PUB Well visit 5 None MIL MIL None None None known 0 PVT PUB 1 PVT PUB 0 well child visit 0 None PUB OTH None 01/08 - RSV, Birth - corrected great vessel transposition, 0 1 PUB PUB None None None AR0916 1 PVT PVT None None 0 None PVT PVT Concerta None ADHD 4/10/2009: MIL Evaluation by MILthe agency None and dermatology None noted Noneseveral active areas of scattered fine red slightly raise 1 PVT PUB ZYRTEC 10 mg qd 2 PVT PUB PROZAC; CLONIDINE; No Depression IMIPRAMINE 3 PUB PUB Rxs given 5/18/09 L. earache; - CLARITIN; NKA; SinusMyopia; congestion; ZADITOR Obesity; Red ophthalmic HTN; itchy eyes; Allergic dorps Feet Rhinitis/Conjunctivitis aches. None PVT PVT SIVASTIN None None 1 PVT PVT YAZ Iron No Iron def, anemia 1 PVT PUB 1 None OTH PUB unknown None None 1 None OTH PUB Unknown None None 1 None PUB PUB LISINOPRIL; None HCTZ 10/12.5 None ml qd; TYLENOL Sinus PRN 1 PUB OTH PREPRIN; No Levothyroxine NKDA; Hypothyroidism; Hysterectomy 0 Below: the manufacturers PVT UNKare correct, previdid but I am colitis, unsure reflux ofcthe olitis, subheadings reflux for DTaP and Hib. The nurse's writing is 9 PVT PUB A mistake was made, I was given a TB tested injected instead of subcue??? Cou PVT PVT none none none Hives, Fever, reaction at injection site~Measles 1 PUB UNK 1 CLINICAL MIL MIL NONE NONE 2 PVT PVT Zithromax and sinusitis Mucinexnone and diflucan prn 0 None MIL MIL None None None Severe muscle pain~Anthrax (Biothrax)~3~25~ 2 PVT UNK Zertec for allergies NONE Had allergies before vaccination UNK PVT PVT Unknown There were no concomitant A0785336A vaccinations and no relevant m 8 Discharge summary PVT included PVT LABS: None WBC 9K None segs 51%,bands None 9%, lymphs 22%. Plts 502K. Sterile pyuria. CRP Unknown OTH OTH Unknown None WAES0905USA02502 Unknown OTH OTH Unknown Unknown WAES0904USA03617 PVT PVT None None None 2 PVT PUB 2 PVT UNK none
12 PUB PUB None None None 0 PVT PUB NONE NONE NONE OR200921 0 none PVT PVT none none 2 None PVT PUB None None 0 Not reported. PVT UNK CORGARD;None Vitamins The patient had a history of diabetes, ### asthma and allergies 1 none PVT PVT ACTOS; ZOCOR; none FLONASE NIDDM; high cholesterol; multi nodular 0 Glucose finger PVTstick 73,PUB o2 Sat RA=98%, None RR=14 None BP 128/80 None HR=64 None PVT PVT TUBERSOL 0 Pulse ox, 98% PVT UNK No 1 Electrocardiogram; OTH Electrocardiogram; OTH KLONOPIN; Cardiac Drug LEXAPRO exercise hypersensitivity; Low blood pressure WAES0905USA02285 2 None PVT PVT None None None 8 PVT PVT No No No 5 CBC, in office PVT 5/26/2009 PVT (ER labs, UA/CBC, 5/23/09) diarrhea NKDA; Entopic dermatitis, 11/17/08 1 PUB UNK PVT PVT None Bananas; adhesive; Allergies only PVT UNK Autopsy by PVT Medical Examiners OTH office Keppra 0.5 None mg PO daily S/P Cardiac arrest; S/P stroke; R hemiparesis; S/P ALTE 1 PVT PUB None None None UNK UNK 1 None PVT PVT PATANOL drops; None ZYRTEC; AllergicPREVACID rhinitis; GER 0 Patient given OTH DEPO MEDROL PUB injection and steroid None doseHx pack of asthma 22 Medical records UNK from Hospital UNK included NONE(will be NONE faxed to VAERS) NONE 5/27/09-records SC0915 received- WBC 12.5. Positive mo 4 PVT UNK no no no 0 none UNK PVT SINGULAIRnone DAILY knownAllergic to dust,cats,horses and pollen/Asthma 1 PVT UNK BENADRYL PR-09-09 0 PUB PUB 13 5/29/09 Medical UNK records UNK recieved zyrtec, DOS 5/01/09 allegra NONE to 5/27/09. pecans, LABS red anddye DIAGNOSTICS: None. 10 UNK UNK N/A N/A N/A N/A~ ()~~0~Patient|N/A~ ()~~0~Sibling|N/A~ () 4 normal PVT PVT iron Iron deficiency 1 stoolcx, serial UNK abd films, UNK blodcx, electrolytes, none stool none for viral none cx 6/11/09 Medical records received LABS: CBC, CMP, 20 PVT PUB adenopathynone only, no other symptoms 5 PVT PVT none none 2 6/9/09 Medical, UNKhospital, UNK DC summary 6/9/09 received Medical, DOS hospital, 5/22/09 DCtosummary 5/23/09. received LABS and DOS DIAGNOSTICS: 5/22/09 to 5/23/09. Ultrasound Tylenol, He 0 PUB PUB None None None 1 UNK PVT Bacitracin allergy NKMC. None PVT PVT None None None PVT UNK NKDA 0 PVT UNK None None None 658 none MIL MIL flu like symptoms 6 PVT PUB None known None None 9/9/09 Rheumatology PVT consultant UNK records received NoneDOS 1/5/05 9/9/09 to Rheumatology 6/17/09. LABS consultant and DIAGNOSTICS; records received PPD DOS (-) Ches 1/5 (-) Blood, Urine PVT culture;OTH (+) stool Rotavirus test 6/2/09 ED and inpatient records received DOS 5/14/09 to 5/16/09. 0 PVT PVT Vitamin C; PREVACID; GERD; PostAllergic Multivitamin nasal drip rhinitis 2 PVT OTH None Chronic fatigue syndrome but no previous reactions to vac 1 none PVT UNK Cow's milk allergy; atopic dermatitis 1 None PVT PUB kindergarton Dx 30 November UNK 2008 to 02 UNK December XOPENEX 2008: Urine drug screen A healthy was male negative. with no Anrecent MRI with/without ### history of trauma contrast or on substan 01 D 1 PVT PVT None Lingering coughNone improving 14 X-ray of theUNK mandible was UNKunremarkable, DEPAKOTE; and serology SEROQUEL; studies The subject Metformin; for Epstein has "ZOCOR"; a Bar history virus ofSYNTHROID; and bipolar ### Bartonella disorder, PROZAC; henselae benign Simva familia were 1 None PVT PVT none None A urine drugUNK screen was UNK negative LITHIUM; and her TSH RISPERDAL; level (1.64 The CONCERTA; mcU/ml) subjectwas hasZOLOFT normal. a historySerum of bipolar ### lithium disorder, level was oppositional within thed
0 Exam: on 5/14OTH pt reluctant PUB to move None arm afterMild vaccine cold beginning +None L digits known cool. On 5/18 - normal exam. 1 PVT PVT None Asthma 0 MIL MIL E-mycin - not taken yet 0 MIL MIL BICILLIN; BENADRYL UNK UNK 0 CT; LumbarPVT puncture; PVT electrolytesNone normal No None MIL MIL Pregnancy NKDA 0 PUB PVT None Asthma; Diabetes; Hyperlipidemia; Osteoarthritis; Alcoh 1 PUB UNK None 2 PUB UNK None None 0 OTH PVT 1 None PVT PVT None None None 5 Influenza A&B, PUB5/11/09-neg; PVT Monospot, EFFEXOR 5/19/09-neg None 150mg QD Psoriasis; Arthritis; Localized PMDD reaction~Measles + Mumps + Rubell 0 None/patient PUB did not make PUBappt with RITALIN private provider. None reported. Non-known-per guardian PVT PVT None None None 11 OTH OTH ZANTAC NONE GER, DD, ASTHMA, ANISOCARIA, FEEDING DYSFUNC 20 PVT PUB Cold, runnynone nose 1 UNK PUB Well child visit None 0 MIL MIL UNK UNK 21 PUB UNK None No No UNK UNK 0 CBC Pending PVT PVT Unknown No NKDA 1 PVT PVT Known hypertension All PCN; codeine 0 PVT PUB none None None 1 UNK UNK Amoxicillin 125 Recent mg/5ml bilateral 6.4 ml Otitis TIDMedia-treated-improving; (last dose) Dermatitis 0 PVT PVT None None Amoxicillin,Hives gluten& fever x2 weeks~Measles + Mumps + R 699 PVT PVT None None None UNK UNK UNK UNK MIL MIL none none 1 UNK PVT imipramine,none Plavix, Lantus, nonemetformin, Pt reports Diovan, getting meloxicam, the smallpox mirapex, vaccine amlodipine, three di blood tests PUB - endocrinologist UNK and gynecologist, several visits to dermatologists - had cortisone shots in temples 1 CT Head/Brain UNKwithoutUNK contrast- Normal, None CBCD, None Blood Culture, Premature BMPbirth wnl. at 32 EEG-wnl. weeks gestation. 7/15/09-records Delivered received-CX by C/S s 0 none UNK PVT none none oral allergy syndrome: apples, Penicillin, allergic rhinitis/s -274 7/1/09 Consultant UNK OB-GYN UNK records 7/1/09 received Consultant DOS 5/28/09 OB-GYN 7/1/09 to 6/9/09. records Consultant LABS received OB-GYN andDOS DIAGNOSTICS: records 5/28/09 received to 6/9/09. PAP DOS test Oral(-), 5/28/09 contrac Prog 0 UNK UNK 1 PUB UNK none none 6 none PVT PUB none current, recovering was on bactrim from recurring OM prior OM,hypertrophic to rash tonisils 1 none knownMIL MIL NONE KNOWN NONE KNOWN NONE KNOWN 3 PVT UNK None None None 10 N/A MIL MIL None N/A None, member started Wellbutrin for depression but AFTE 0 PUB PUB NASONEX GRAVES DISEASE 10 PVT PVT ATENOLOL; None LIPITOR;Hypertension; NEURONTIN;Coronary CELEBREX; disease; DETROL; Neuropathy; DYAZIDE; Osteoarthrit FOSAM PVT UNK Diplopia; Astigmatism 0 CBC WBL 5.9, PVTCT-NML PVT None None None. Febrile seizure 2/2009. O2 sat-96%PUB on Room air. PVTB/P 119/57 Temp 99.0 Pulse 85 history of tick bite 3weeks prior to immunizations . Reporte 0 blood culture PVT drawn 5/22/09-neg, PVT WBC levothyroxine 14/rbcnone 4.55/hct 39.0/PLT vicodin allergy(rxn 303, neut 80/lymp unknown), 10/mono shoulder 10/eos tendonitis, 0/basothyroid 0/ aneu 3 UNK UNK None Penicillin adr 1 None PUB PVT None None Gout, Arthritis 5 N/A PVT PUB N/A none none
UNK PUB simvastatinnone and atenolol known 0 PUB PVT HTN, DM II 1 5/29/09 Medical UNK records UNK received ortho DOS 5/27/09. tri-cyclen fatigue LABS lo due and none to DIAGNOSTICS: undiagnosed condition CBC WNL. CHEM WNL. TSH WNL. 1 PUB PVT none none Fever & Rash~Measles + Mumps + Rubella (no 1 PVT PUB None None Bronchiolitis 5-15-09 0 PUB PVT none none none 1 PVT PUB None NKA 1 None PVT PVT Suprax Acute OtitisNone Media 2 PVT PVT None PVT PVT ZANTAC; REGLAN; None MARAX GERD 0 PUB PUB PPD test, skin none none 1 PUB OTH PPD SKIN TEST None None PUB PUB None 2 Blood work PVT to test for rheumatoid PVT arthritis YAZ; FIORICET; mayLACTATION havePrenatal beenMIGRAINE; performed. vitamins The A biopsy subject's A0783241A wasalcohol not done. use was social and she 1 None PUB PVT 1 None PUB PVT 1 PUB PUB fish; codeine Unknown OTH OTH Unknown Unknown WAES0905USA02514 42 Magnetic resonance, OTH negative OTH None None WAES0905USA02266 411 cervical smear, OTH05/04/09, OTH diagnosed None with high grade squamous Unknown intraepithelial lesion WAES0905USA02293 carcinoma in situ 0 Unknown OTH OTH Unknown Unknown WAES0905USA02211 112 Mammography, OTH 04/16/09, OTHabnormality Truvada; in R breast/highly Loestrin; Alcohol Kaletra use;suspicious Acquired immunodeficiency for ductal carcinoma WAES0905USA01582 syndrome in situ; Biopsy, 05/04/09, c Unknown OTH OTH Unknown Unknown WAES0904USA03943 Unknown OTH OTH Unknown unknown WAES0904USA03942 31 Serum beta-human, OTH 10/27/08, OTH positive ALBUTEROL Pregnancy NOS (LMP = 6/1/2008); WAES0810USA05176 Asthma 1 Unknown OTH OTH Levaquin; Vancomycin Pneumonia; Urinary tract infection;WAES0905USA03263 Diabetes; Hypertension; Coronary 0 urine beta-human, OTH 02/??/09, OTH Positive Pregnancy NOS (LMP = 1/1/2009)WAES0903USA01606 0 None PVT PVT Birth controlNone None 1 None PVT UNK 1 None MIL MIL None None PVT PUB 36 PVT PVT None 2 UNK UNK 1 None PVT PVT ADVAIR none Asthma, obesity 709 PVT UNK unknown unknown 0 PUB PUB none nka 2 none PUB PUB none none none SC0916 10 None MIL MIL Gout PCR positive PVT 05/19/2009 UNK unknown unknown 0 UNK PUB 8 None. PUB PUB none none none 0 PUB PUB 2 Physician did UNK blood tests UNK and looked in eyes with Noneopthalmoscope. Pt. had breast cancer 10 years ago, had bilat. mastectomy MRI C-Spine UNK & MRA Brain/brainstem UNK are normal. no 7/7/09 none. Hospital 7/7/09 records Hospital received records DOSreceived 5/11/09DOS to 5/15/09. 5/11/09LABS to 5/1 14 UNK UNK hyperlipidemia, generalized anxiety d/o 0 MRI PVT UNK 1 PVT PUB none none none Rapid strepPVT DNA UNK 2 History of asthma PVT PVT lipitor, advair, none flonase, seasonal prilosec allergies, dust and pet dander allergies 0 None PVT PUB None None None 0 none PVT PUB Poly-Vi-Flornone 31 week premie
0 PVT PVT None None 0 PVT PUB None None 0 None PVT PVT None Physical Exam No known allergies, Has Breast cyst & osteopenia. 0 OTH OTH Low-ogestrel Possible URI none 0 PVT PVT PREVACID; OLOVAT 1 PUB UNK 47 PVT PUB 7/31/09 Medical MIL records MIL received denies DOS 6/13/06 Viral to 2/27/09. illness7/31/09 LABSMedical and DIAGNOSTICS: records received Pulmonary DOS 6/13/06 function to 2/27/09. tests - M 406 Clinical Observation PVT PUB None Unknown None 21 PVT PVT None 0 None PVT PVT FLONASE; None XYZAL; VENTOLLIN No 1 none PVT PVT none stepped on prior nail; history neededofTd local booster reaction to Td, no systemic reaction hi 24 None. 6/2/09 OTH Medical records OTH received Adderall DOS tablets; 2/13/09 Hormonal to 5/27/09. Nonecontraceptives. 6/2/09 LABSMedical and Diagnostics: 6/2/09 records WAES0905USA03370 Medical received Pending records DOS - CBC, received 2/13/09 monospot toDOS 5/2 209 Unknown OTH OTH COMBIVENT; Hypertension; OS-CAL;Heart PLAVIX; Diabetes; attack fentanyl; Cancer LASIX; WAES0905USA03234 insulin; IMDUR; metoprolol; FL 9 Unknown OTH OTH Unknown Unknown WAES0905USA03404 0 OTH OTH No other medications Unknown MA20091372 1 None PVT PVT PRAVASTATIN; None NEXIUM; History LEXAPRO of Penicillin allergy 2 PVT PUB None 0 PUB PUB No None None AR0917 1 PUB PUB None ear infectionNone un-dx AR0918 1 None PVT PVT Fluoride None None 0 BP 94/60; PPUB 72; PERRLA, PUBresponsive Noneafter about None1 minute denies 2 None MIL MIL No No No 3 PVT PVT 0 PVT PVT 0 PVT MIL 2 UNK PUB None 0 PVT PVT None 1 none MIL MIL zyrtec; albuterol; no flovent asthma; seasaonal allergies 1 None. PUB PVT None. None. None. NKD/FA 0 PVT PVT None MIL MIL 1 UNK PVT 0 STREP TEST PVTAND CBC PVT PERFORMED TYLENOL TODAY Temp 102,vomiting,uri~ ()~NULL~1~In Patient 1 None UNK PVT Flonase nasal None spray and History allergy of eye left brachial drops plexus injury at birth, Seasonal aller 0 PUB PUB none none none n/a~ ()~NULL~~In Patient UNK UNK NONE s/p Renal transplant 5/4/2007 7 None PVT PVT Throid medication/Vitamins None reported Allergy to "Floxin" None reported~ (muscle spasms) ()~NULL~~In & allergy Patient to "Sulfa" (hiv 1 WBCs 14.3.UNK Labs: WBCs UNK14.3. Hgb 10.1. UA hospitalized with tracenone. blood. for perforated PMH: bloodHTN. and viscus Urine diverticulosis.hyperglycemia. cx (-). s/p intesti 3 PUB PUB None None Nothing in last 10 years.Did use inhaler in youth for a few y 0 n/a PVT PVT none allergy to diflucan 1 PVT PVT Yasmin None 32 UNK UNK Cold and cough. Autism PMH: LostColic language & irritable and in potty infancy. training~Polio Multiple ear Virus, infec O 12 None at thisPVT point PVT BP med and none DM med from DM2the (notPhillipines compliant), htn; no known allergies 26 PVT PVT None None Strabisme 0 None PVT PVT none none Sensitivity to sunscreens, skin rash 0 None PVT PVT Slight papular None rash. OTH PVT 1 PVT PVT A-FIB; HTN; Asthma; Allergies. 2 PUB PVT None None 1 PVT UNK None S/P MV repair 12/28
0 None PUB PUB None None Egg intolerance; VICODIN reaction 0 PUB PUB Birth controlNone pills None Known felt faint~Hep B (no brand name)~UN~0~Patien 0 PVT PVT 10 FebruaryOTH 2005: MRI OTH of the Brain with andUnknown without Contrast: Partially empty A0785349A sella. Right frontal venous angioma 0 None available PUBat this time. OTH Patient's ppdMD (skin requested test) none 12/04/07 listed that patient sinus left forearm. allergies. have an6/8/09 6/8/09 MRI done, Medical Medical however, records records itreceived has received not been 3/27/08 3/27/08 done. toto5 3 PVT PVT Milk thistle None 1 PVT PVT none none 0 None PVT PVT No No No 3 OTH PVT none none 0 MIL MIL 0 OTH UNK Resolving upper resp infection. Taking abuterol. 3 Rotavirus antigen PVT detected PUB in stool 5/27 None Staphlococcal impetigo in diaper area at 2 w.o. - resolved. 0 PVT PVT UNK PUB PUB Unknown There were no concomitant A0780868A medications, relevant medical UNK PUB PUB There wereUnknown no concomitant Theremedications. were no concomitant A0780875A medications, relevant medical UNK PUB PUB Unknown There were no concomittant A0780876A medications, relevant medica UNK PUB PUB Unknown There were no concomitant A0780877A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780878A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780879A medications, relevant medical UNK PUB PUB Unknown There were no concomitant A0780880A medications, relevant medical 0 UNK PVT PVT Unknown The subject had no relevant A0782620A medical history, and had expe UNK OTH OTH Unknown A0784358A 1 Unk OTH OTH Unknown There were no concomitant A0785071A medications. UNK UNK UNK Unknown A0785075A 3 PUB PUB none none 0 UNK PVT None - Hip None replacement Surgery 5 weeks ago 1 PVT UNK MultivitaminNone with Fluoride None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 None PVT PVT None None None 2 6/15/09 Received UNK PCPUNK medical records LABS: none, CXRnever done sick 5/10inWNL. her life Bronchoscopy up until the vaccines w/mucous plug; echocardiogr 12 UNK UNK none none none 1 PVT PVT No PVT OTH Allergies-penicillin and Relpax - migraine, IFG, PMDs 0 None PUB PUB None None None Known, KNA 2 PUB PUB NONE 6 PVT UNK Orapzed; Omnicef; Pneumonia Zithromax 11 PUB PUB none stated OR200922 0 None PVT PVT Levoxyl; VitNone D Hypo-thyroid 2 PVT UNK No Sulfer / decongestants 1 No labs done. PVT UNK URI (Cold sx) Eczema 1 CBC, WNL;PVT U/A, WNL;OTH Basic chemistry, TYLENOL WNLgiven Healthy None 0 None OTH PUB Tramaedol;None Seroquel; Levothyroxine Mild heart murmur; Migraines 0 PVT PVT 1 UNK UNK NONE- physical exam 0 PUB PUB No Unknown OTH OTH Unknown Unknown WAES0905USA03626 0 Unknown UNK UNK Unknown Unknown WAES0905USA03333 1 PUB OTH None None Allergic to sulfur; Based LA090505 antibiotics and Neomycin Unknown UNK UNK Unknown Unknown WAES0905USA03323 0 Received 2nd PUB DEPO PROVERA PUB prior DEPO to Immunization PROVERA LA090504 2 PUB PUB None None AR0918 1 PVT PUB None
5 None PVT UNK Atenolol 50None mg, Potassium Allergic:Sufa. Chloride Hx 20 mg, diabetes, Enalapr/HCTX High Blood 10-25 Pressure, mg, Diclofenac tachycard 0 none PVT UNK none none none 0 N/A PVT PUB n/a n/a n/a 4 heme positive UNK stool, positive UNK barium none enema 6/2/09 none ER records Reactive received airway DOS disease 4/3/09. and LABS eczema and DIAGNOSTICS: C 0 PVT PUB n/ n/a n/a 0 UNKNOWNUNK UNK NONE KNOWN NONE KNOWN 10 N/A PVT UNK none none none 1 PVT UNK none none none 3 See above.UNK 6/11/09 Neurology UNK records received DOS 3/10/09 febriletoseizure 5/18/09. at LABS 14 mos. and DIAGNOSTICS: CHEM - Biliru 1 5/28 CBC done-WBC's UNK UNK 11.3 , elevated On insulin bloodpump glucose, ketones Diabetes in urine. Mellitus. 7/7/09 PMH: Hospital Diabetes records Typereceived I. Persistant DOShyper 6/1/0 UNK UNK 0 PUB UNK D5W1/2NS,Diverticulitis Pregabalin, Tramadol, Zofran, Ciprofloxacin, Heparin 1 PUB PVT Headache,fever, stomach ache~Meningococca 1 none completed PUB PVT none none Headache, fever, stomache ache, and injection 1 PUB UNK LEVOTHYROXINE NONE 100NONE MCG ONCE Sore DAILY arm with prior tetanus~Tetanus Toxoid, ad 0 PVT PUB PRESCRIBED NONE ON 5/27/09 INGUINAL CEPHALEXIN, HERNIA, AND W/O HYDROXYZINE MENTION OF OBSTRUCTION 1 CT of Head,UNK EEG bothUNK normal. 6/29/09 Hospital records received DOS 5/19/09 to 5/21/09. LABS and DIAGNOSTIC 0 none PVT PVT Benadryl N/A NONE KNOWN 0 FS glucose:UNK 97 UNK 8 Derm Consult MIL MIL PPD Sanofi Pasteur C3149AA None Known Lt Forearm yearly 5/7/09 None PVT PUB None None 1 PVT PUB none none none 0 PVT UNK None, Dr Appointment PVT PVT None Heart murmur resolved 6/02 (perimembranes VSD) 1 None PVT UNK None None None 0 MIL MIL GABAPENTIN None for DDDDDD shoulder and neck 4 PUB PVT none Anti-inflam Drugs GA09019 0 PUB OTH None GA09018 0 PUB PVT None None Allergy to Codeine; Latex GA09017 sensitive 0 PUB PUB None No GA0R016 0 None PUB PUB None No NKDA, HX pneumonia GA09015 2 weeks earlier 2 Seen in ERPUB PUB None GA09012 1 EEG: 5/22/09, PVTirregularUNK diffuse spikes, polyspikes, No generalized Near-syncope synchronized episodes. spikes PMH: suggestive Allergyof togeneralized Amoxicillin seizu 367 Labs and diagnotics: MIL Vocal MIL cord bx (+) for CA PMH: Chronic sinusitis. Allergy to PCN. dematophytosis. G 21 7/13/09 Hospital MIL DC summary UNK received AUGMENTIN DOS None 4/15/09 ESknown 600 to 4/22/09. N on one 4-6-09 Known. LABS .7 ml 7/13/09 and twice DIAGNOSTICS: aHospital day for records 8 d CT received Head - abnormal, DOS 3/22 14 Urine samples; PVTSurgeryOTH to insert shunt; see other MRI's; side No Spinal tap;ankylosing Plasma Phoresis; spondylitis; blood-work. neuropathy; 6/22/09 hypertension. Hospital records 6/22/09 D 1 Lumbar puncture; PVT blood PUB cultures; negative None workup Mild non-bloody including None EEG diarrhea. and MRI. 6/22/09 6/22/09 Medical Medical records records DC summary DC summary receir 9 KUB dose at PVT office/air enema PUB at medical RANITIDINE center None 6/3/09 6/3/09Hospital Hospital Gastroesophageal records recordsreceived received Reflux DOS DOS Disease 5/22/09. 5/22/09.Reglan, LABS and Zantac. DIAGNO OTH OTH 1 PVT PUB None Hashimotos; UTI's; Add-on Adderall 102 PVT PVT No No No 0 Negative PVT PVT SPIRONOLACTONE; None Menclopramide DIAZEPAN; LIPITOR; HCL + Sulfa LASIX; allergies GLUCOPHAGE; LISINOP 0 PVT PVT None Epstein Barr; Hx of Hypothyroidism, Allergy to Morphine T 11 None OTH OTH None None None 7 Culture of fluid PVTfrom furuncle OTH --> MRSA 0 MIL MIL None None Atrial septal defect Referred toPVT derm as PMD PUBnot sureNone this is an INj None reaction None 0 None. 6/9/09 UNK Hospital UNK records received DOS 5/21/09. LABS Noneand DIAGNOSTICS: WAES0905USA03247 CHEM - Sodium 143 mml/L (H) C UNK UNK Lantus; Dhea; Glucosamine Patientsulfate; had history Gymnema of Type sylvester; II Diabetes, ### HMFHashimoto's PWD; EPA-DHA thyroie 0 None PUB PUB None Rash - eczema None 1 PVT UNK
PUB PVT pt had a laceration ID09012 2 OTH PVT None Smoker, Hx of bronchitis ID09011 1 PUB PUB -Inhaler PRN; No -Nebulizing NKA; TxHistory PRN of Asthma ID09010 0 PVT PVT 0 PVT PUB No PVT PVT ESTRACE;No CLINORIL; - AnnualQuinidine SYNTHROID; Exam MAXZIDE; ZESTRIL; ASA 716 PVT PVT AMOXICILLAN Resolving otitis No media 1 PVT PVT 221 PVT PVT UNK UNK 1 Physical Exam PVT PVT 1 PUB PVT 3 MRI brain nlPVT 1/8/09, Awake PUB and drowsy EEG nl 1/13/09 35 week twin gestation, IUGR, h/o maternal chlamydia and 22 None PVT PUB 35 week twin Asgestation, above~Varicella IUGR, maternal (Varivax)~0~1~In chlamydia Sibling2| and tob 0 none MIL MIL synthroid 100mcg none dailyna 0 unknown UNK UNK none notedPMH: fainting w/immunizations. Acne on doxycycline. Alle 372 Currently undergoing UNK numerous UNK neurological none testing: CT none scan, PMH: MRI, MRS, anemia. muscle Family testing. hx: early LABS: death MRIsecondary brain, EKG, to 0 None PUB PVT Birth Control,Meds On Job injury 6-01-09 None 5-26-09 Nasal Abrasion spray,Omeprazole of the forehead(910.0) 40 mg,Triamterenl 37.5-25 1 PUB PUB none listed none listed PVT UNK none none 10 air contrast UNK enema. 7/14/09 UNK Hospital records received none DOS none 5/25/09 to 5/26/09. LABS and DIAGNOSTICS: Abdomi 6 PUB PVT Client is on None INH 300 mg NKDA. PO QD Anemia. and B6Latent 25 mgTB POInfection QD for LTBI 1 PUB PUB 1 PUB PUB albuterol, pulmicort None notedDevelopmental Delay, strabismus, microtrigonocephaly, st 7 NONE PVT PUB NONE NONE NONE 1 NONE PUB PUB NONE NONE NKDA/NONE 1 7/21/09 ERUNK records received UNK DOS 6/2/09. LABS None and DIAGNOSTICS: None Neutrophils 89.4% (H) Lymphocytes 4.8% (L 0 UNK PVT PVT Unknown There were no concomitant A0787216A medications. The subject had 1 EEG - waiting PVT for results. PUB6/12/09 Hospital records None and DC None. summary 6/12/09received HospitalDOS records 5/19/09 and to DC5/20/09. summary LABS received and 0 EKG per MD PVT order PUB Ibuprofen for cramps monthly prn PVT PVT None 2 None PVT UNK None None 1 None PUB PUB SYNTHROID; No CONCERTA thyroid condition; Attention deficit disorder 1 None PVT PVT None None 2 None PVT PVT None None 10 none PVT PVT TYLENOL none none 3294 PVT PVT 3 PVT PVT BENADRYL prn Asthma 0 PUB PVT None None 0 OTH PVT None None None 1 None PVT PVT None None None 0 OTH UNK LEXAPRO,none 10mg, qd none 2 PVT UNK Allergic to Varicella upper respiratory~Varicella (no brand name)~1 1 PVT PVT NONE 9 PUB PUB UNITHROID; NoRAMIPRIL; PCN; Metoprolol; Sulfa; Caffeine; HCTZ ASA 3 OTH OTH PVT PVT 1 Rapid strepPVT (-); Throat PVT Cx sent, (-)None None None 9 OTH OTH None None None 0 PUB UNK None PCN; No birth defects or medical condition. 9 PUB UNK None None
1 Unknown PUB OTH 0 PUB PUB None None None 1 PUB PUB 1 PUB PUB None None None/NKA 3 none yet PUB PVT None None NC09022 1 PVT PVT LOTAGEN;None KEFLEX; PAXIL; DM; CKD; PRILOSEC; HTN; COPD; Elavil; PVD; DITROPAN; Hyperlipidemia; ASA anemia; GE 9 PVT UNK None Heart murmur Temp 105-06~Pertussis (no brand name)~1~0~ 0 OTH UNK Unknown Unknown Unknown 1 None PVT PVT None None Septra --> rash 1 None PVT OTH KCL; FOSAMAX; upper respiratory ALLOPURINOL; HTN infection SYNTHROID; Vitro; TOPROL; HCTZ; glucosa 0 None PVT PVT None None None 0 PUB PVT None None 1 CBC 11.9 11.3 PVT35.1 249 PVT L 3.4 G 7.4 FLOURIDE; ZYRTEC 11 PVT PVT 1 Diminished PVT grip tilt test-PVT autonomicAmoxil nerve 800mg damage Strepsweat throatN testoneautonomic nerve damage. 1 None PVT PVT None None 2 PVT PVT Been seen None for needle Known stick Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0905USA03655 Unknown OTH OTH Unknown Unknown WAES0905USA04021 0 Febrile seziure UNK UNK NA Presented to NAclinic with out moderate to severe illness, low grade feve 0 CLINICAL MIL MIL NONE NONE NONE 1 UNK PVT YAZ oral contraceptive none all - penicillin, sulfa 0 PUB PUB none none none rash~DTaP (Infanrix)~5~5~In Patient 11 25 May 2009 MIL 1411, Serum: MIL Troponin Possibly I Cardiac Doxycycline Unknown 3.31 (H*)(Rx Shin ng/mL; written splints; Creatine onTobacco 5/14/09 Kinase for Use; MB predeployment) NKA. 29.407/10/09 ng/mL;Hospital Myoglobin outpatie 109.3 327 MRI spine w/o UNKcontrastUNK 3/10/09; Angio DESOGEN; Arch Cervicocerebral Clindamycin 3/18/09; Angio Carotid External Bilateral 3/18/09 273 EKG; Echo UNK cardiogram; UNK Blood work; notChest known. x ray, Achilles 8/4/09 done PCP tendinitis. with My medical nothing daughter records notable was received a seen; healthy Blood DOS teenwork 8/20/08 female forwith to thyroid 10/25/08. stable levels weight Etod wer 1 PUB PUB Dm Type 2, UTI CBC, UA, Chemistries OTH PUB - see attached. None None None found 11 None PUB PUB None None Asthma; Allergies - dogs 3 UNK UNK None None 0 None PVT PVT None None 0 6/9/09 Medical UNKrecordsUNK received DOS 6/9/09 5/18/09 Medical to 5/20/09. records6/9/09 received LABSMedical and DOS DIAGNOSTICS: records 5/18/09 received to 5/20/09. Urine DOS -Tylenol blood 5/18/09 (+) CBC to 5/20/09. - Lymp 1 Child also had UNKtuberculin/PPD UNK implanted no known in right no known foream. no Lotknown # C2907BA 0 CT Scan ofPVT head...normal PVT Bloodwork/lytes...normal none none Post-concussion 7 PVT PVT Seasonal allergies, mild asthma 1 UNK UNK N/A N/A 0 PVT PVT 1 UNK UNK BrOnchitis Patient informed technician administering the anthrax vacc 1 PVT PVT none none none 0 PVT PUB none none none UNK UNK 568 6/15/09 Oncology UNK records UNKreceived DOS 12/23/08 to 5/5/09. 6/19/09 LABS PMH andrecords DIAGNOSTICS: received. PMH: CT Scan Appy, - paratracheal, ankle fx, ovar p 1 PVT PVT BENADRYL; None SOLUMEDROL; Seasonal Prednisone allergies 1 PVT PVT 0 PUB PUB None notedNo known illness None noted on screening questionnaire 6 PUB PUB BP Meds None Hypertension None at thisPVT time. UNK None None 1 PVT OTH Triamcinolone; Rhinitis NASONEX None rash~Measles + Mumps + Rubella (MMR II)~2~ 0 PUB PUB None NKA / No Related 1 None PVT PVT None None Allergy to Amoxicillin ant Erythromycin 2 Unkn PVT PUB None None None swollen arm~ ()~~0~Patient
0 Cultures (viral PVT & bacterial) PVTat sores pending Left arm pain 11 Unknown PUB PUB Unknown/None None None listed in PCHD records or chirp registry 0 None PUB PVT None None 1 PVT PVT None fever~Measles (no brand name)~0~1~In Patien 0 PVT PVT none had transvesmylitis- attacked the nerves in her rt leg 10/04 1 PUB PUB NONE NONE KNOWN NONE KNOWN NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 0 None PVT PVT ZYRTEC; MIRALAX; Diarrhea xAXID; 2AUGMENTIN; -dayFluoride before shot dairy; wheat; soy; egg; peanut; banana; ecz Unknown OTH OTH Unknown Unknown WAES0905USA04048 3 stool rotavirus OTH antigen,OTH positive Unknown Unknown WAES0906USA00249 0 Unknown PVT PVT Unknown Unknown WAES0904USA03633 58 Unknown OTH OTH Unknown Unknown WAES0906USA00042 2 None PVT PVT Flovent, Albuterol None Known inhaler Asthma 4743 PVT UNK None None 0 CBC PUB OTH Ibuprofen None None 0 PVT UNK NO NO 840 PVT PVT Albuterol Pulmicort No > Nebs. Asthma 1 Possible Rxn PVT to Menactra PUBvaccine PUB OTH 1 PVT PUB 0 None UNK UNK None Spinal fusion for scoliosis at 11 yrs old 77 PUB UNK None None None 1 PUB PUB None None 1 None PVT UNK None None 1 PVT PVT Fosamax, calcium none none 20 exstensive PVT list UNK none none PN~Lyme (LYMErix)~2~38~In Patient 1 None PVT PUB None 3mm splinter None in right hand; removed at office visit. No erythema or str 0 TO EMERGENCY UNK ROOM UNKFOR EVALUATION. NONE 23 HOURACNE, OBSERVATION BACK-MILD IN HOSPITAL, CONCUSSION.CT HEA 1 ROS : ALSO PUB LL CRAMPS PUB EXAMFexofenadine/Glucometer/Atorvastatin/Atenolol/Oxaprozin : WD, WN, WM T 97, AllergyP 65, RR Sulfa 16, BP Drugs 118/71 Medical RIGHT conditions: ARM : AREA Diabetes/Hyperte OF REDNE 5 NONE PUB UNK UNKNOWNNONE PATIENT STATES THAT SHE HAS DIABETES 0 PUB PVT NO NO 1213 PVT PUB none none, this was N/Ayears after varicella~Varicella vaccine (Varivax)~2~4~In Patient 1 None UNK UNK ALBUTEROL nose SULFATE bleed CROUP (evening (2.5 MG/3ML) [464.4] - day before POSTCONCUSSION 0.083% appointment IN NEBU; and FEXOFENADINE SYNDROME morning - day [310.2 HCL of a 2 PVT PUB none none 1 none PVT PVT none none none 6 Shingles UNK PVT allegra, nexium, none trazadone none except hay fever type allergies 0 Medical Center UNKdid lab UNK work and CT unknown scan, perNone parent known unknown None of. known results.of.Medical Parent records advisesstate no previous LABS: CT adverse head signs WNL 3 Between 4/24/09 UNK and 6/4/09 UNK she received Zyrtec and approx red Fluoride rash 8 CTtoscans, none neck and 1 CTA, trunk none~ 1 CT()~~0~Patient|none~ angiogram, 1 cerebral ()~~0~Sibling|none angiogram, 1 MR 0 Normal EEG PVT and Echocardiogram PVT None None None - local reaction to bee stings 1 None PVT UNK None None 10 PVT PVT None None None 1 PVT PVT Nuvaring None None 0 PVT PVT 0 On steroidsUNK and BENADRYL UNK none NKDA ~ ()~~4~Patient 1 None PVT PVT None None None 25 PUB PVT No 3 PVT PVT 1 PVT PUB Allergies to Rocephin insect bites Ceftriaxone eyes swollen 0 OTH PVT None None None 0 OTH OTH Unk No Unk seizure~Hep B (no brand name)~UN~0~Patien 0 PVT UNK None 10 UNK OTH OTH Loratadine Unknown Poison Ivy; The subject A0784219A had consumed tuna fish and wore
1 UNK PVT PVT Atenolol Unknown CARDIAC ARRHYTHMIA A0785145A 1 UNK UNK None None 0 PUB PUB VYANESE,No VANTEX Asthbergers, Asthma, food (milk, soy, peanut, wheat, corn 2 PVT PVT None None An immunology OTH screenOTH performed by a pulmonologist UnknownonThe an unspecified subject haddate some prior A0718745A upper to the respiratory 5th dosecongestion of INFANRIX thatsho be UNK OTH OTH Concurrent Unknown medications Pertinent were unspecified. medical history A0721690A was unspecified. 1 UNK PVT PVT Haemophilus Unknown Influenzae This + event occurred in A0722975A four different subjects. The reporter 0 UNK PVT PVT Unknown This event occurred in A0722979A four different subjects. The reporter Unk OTH OTH Unknown This event occurred in A0722980A four different subjects. The reporter UNK OTH OTH Unknown This event occurred in A0722981A four different subjects. The reporter 2 UNK PVT PUB Unknown Concurrent medications A0723483A and relevant medical history were UNK PVT PVT Unknown Concomitant medications A0725470A and relevant medical history was UNK PVT PVT Unknown Concomitant medications A0725480A and relevant medical history was 1 UNK PVT PVT Unknown No concomitant medications A0726359A or relevant medically history. 1 UNK PVT PVT Unknown The subject was born at A0729267A 39 weeks gestation. The newborn UNK PVT OTH Unknown A0730297A UNK PVT OTH Unknown A0740764A UNK OTH OTH Unknown A0740770A 1 UNK PVT OTH No concurrent Unknown medication Following vaccination with A0742478A PEDIARIX in April 2004, the su UNK OTH OTH Unknown A0744175A UNK PVT PVT Unknown A0744483A 0 UNK PVT PVT Unknown The subject had no medical A0745500A history, nor any history of adve 0 UNK PVT PVT Season trival Unknown Influ Dresd; TheParacetamol subject had no medical A0745514A history, nor any history of adve 2 UNK PVT PVT Season trival ALLERGIES, Influ Dresd The ECZEMA subject had a history A0745523A of allergies (unspecified) and ecz UNK OTH OTH Unknown A0746380A UNK PVT OTH Unknown A0746407A UNK PVT PVT Unknown A0746417A UNK PVT PVT Unknown A0746425A UNK PVT PVT Unknown A0746426A UNK PVT PVT Unknown A0746427A 0 UDS (-); 140/5.4 PVT / 110/19 PUB / 12/0.2;PULMICORT; 98 6/8/09Middle Hospital Albuterol; earrecords effusion Follow Amoxicillin; received up and otitis RAD ZYRTEC. media. DOS 5/14/09. 6/22/09 6/8/09LABS: Hospital Finger records Stickreceived GlucoseD 6 head CT c/w PVT small R. frontal PVT ICH. Vancomycin/Ceftazidime/FLAGYL/Ampicillin/Acyclovir On labs, WBC None 9.2 on admission, BPH, intra-cranial LFTs, electrolytes hemorrhageWNL, 10yrsCSF ago(5/26) (on antibio Seen on ultra UNK sound before UNK birth seen received laboratory 3rd injection had labs when During done 2 pregnancy weeks found no preg genetic no didother not defect/instructed know medication about or pregnancy vaccine to register given/re at this on thti 5 Parent reports PUBno lab work UNKwas done. None Denies any pre existing conditions. 1 PUB PUB None None 0 None PVT PUB None None 1 PVT PVT None 0 UA; UOS; CT PVT head/brain PUB w/o contrast, Trinessa Chest 28d None Birth Control None 779 PVT PVT 2 PVT OTH None 1 None PVT UNK None None 0 PVT PVT Tylenol No No 1 OTH PVT Pen; Morphine allergy 1 OTH OTH None None None 0 PVT PVT None None Unknown OTH OTH Unknown Bechet's Syndrome Colitis WAES0906USA00244 Unknown OTH OTH Unknown Unknown WAES0905USA04140 Unknown OTH OTH Unknown Unknown WAES0906USA00013 electrocardiogram, OTH longOTH QT interval Unknown Unknown WAES0905USA03885 9 None performed OTH Pt. never PVTfelt thatLORATIDINE he requiredNo being seen Noby a physician. 1 None PVT PVT None None
1 Exam 0 10 None 1 None
PVT PUB None None None UNK UNK 7/13/09 Hospital ER records NKDA;received Non smoker; DOS No 5/13/09. chronic Shot conditions; of "Depo". Father states s PVT PVT None None PUB UNK None None UNK UNK 1 PVT PVT CLARITIN; None SINGULAIR; Allergies WELLBUTERON; general, asthma VENTALIN INHALER 7 Labs done by PVT children'sPVT hospital ERNone normal None Allergic AMOXIL None OTH PUB Fluoride pills - daily 0 PUB PVT CELEXA 20None mg/ day; - Travel MELOXICAM vaccination15 mg/ day X 1 0 PVT UNK None 0 None PVT PVT None None UNK PVT PVT Unknown A0746428A UNK PVT PVT Unknown A0746429A UNK PVT PVT Unknown A0746430A UNK PVT PVT Unknown A0747164A UNK PVT PVT Unknown A0747167A was one ofA0747167A four cases reported by the same h UNK PVT PVT Unknown A0747168A was one ofA0747168A four cases reported by the same h UNK PVT PVT Unknown A0747169A was one ofA0747169A four cases reported by the same h 1 UNK PUB PUB Poly-Vi-FlorAllergic (Sodium Rhinitis salt+;Fluoride The subject has salt;aVitamin history A0749667A of E+; seasonal Vitamin allergies A; Ascorbic andacid no hist +; P UNK PVT PUB Unknown The subject had no medical A0750362A history and no history of adver UNK PVT PVT Unknown A0752555A was one ofA0752555A five cases reported by the same h 0 UNK OTH OTH Unknown No concomitant medications A0763451A or relevant medical history we Electroencephalogram, OTH OTH 11Mar2009, NoNormal concurrent Unknown medication The subject had no relevant A0769820A medical history or allergies. UNK OTH OTH Unknown A0770288A UNK PUB OTH Unknown Linked cases include A0772416A A0772419Aand A0772420A UNK PUB OTH Unknown Linked cases include A0772416A A0772420Aand A0772419A. 0 UNK PVT PUB No concurrent Unknown medication. The subject has no relevant A0774207A medical history and no history 1 PVT PUB 1 no tests MIL MIL Rx for: Cymbalta None 60mg, Err:508 Concerta Severe 18mg, Acyclovir, reaction (Similar Claratin, asFloNase above; no medical 2 PUB PUB 400 mg augmentin none 3x anone day 1 Ultra soundUNK of legs to rule UNKout blood Lovstatin clot. Contact 20mg/day; NoneDr. for Tarka Elevated test 2/240 resultLipids mg/day and record @ 210ofand office intermittent visit. cardiac arrhythmia 0 none PVT PUB NONE no 0 pending with PUB pmd PUB nothing perno MOC per mocnothing per MOC 3 None PVT PVT Flonase None Allergic rhinitis 0 UNK UNK Acutane, OCP None 1 work up in progress. UNK (Blood UNK cultures, Metoprolol, Urine cultures, Syncope HyzaarCXR). PMH: Rule HTN. out other sources of infxn Labs and Diagnostics: 8 UNK UNK HAD JUST JUST FINISHED FINISHED TUBES ZITHROMAX TXINFOR EARS FOR EAREAR INFECTION. ND0905 INFECTION (TUBES RECENTLY PU 6 7/24/09 Hospital UNK records UNK received DOS 4/9/09 to 4/27/09.7/24/09 LABS and Hospital DIAGNOSTICS: records received Abdominal DOS 4/9/09 X-ray -toPossible 4/27/09.In 1 none PVT MIL none sulfa drugs 0 none PUB PUB None known none 0 N/A PVT UNK 6 none PVT PUB None None None 0 CT of head,UNK CXR. EEG UNK results not available.Mom reports PCN had ear infection and medication was antibiotic was stop 506 STOOL STUDIES: PVT POSITIVE PVT ROTAVIRUS ROTATEQ NONE ALL 3 DOSES NONRECEIVED 9/2/2008, 11/14/2008, 01/05/2009 4 MRI UNK UNK none n/a migraine headaches 1 PUB UNK Vomiting, head aches, body aches, dizziness, b 13 none UNK PUB none none NKA, no history of birth defects or medical conditions 1 UNK UNK 0 UNK PVT Benadryl 2.5 ml po x1 0 PUB UNK 0 UNK PVT none none none
0 NONE PUB PUB NONE NONE NONE 0 PVT PUB 1 PUB PUB Unknown Not applicable Unknown 3 NONE PVT PUB TYLENOL NONE 0.4 GIVEN NONE 0 PVT PUB 2 UNK UNK Right Otitis None Media 0 UNK UNK PNC 1 None PVT UNK None None Overweight 1 PVT PUB Cough; URINone 2 PVT PUB 1 PVT OTH Cellulitis~ ()~~0~Sibling 3 PVT UNK Well 2 PVT UNK Well 0 UNK PVT PVT TRIAMTERENE; Unknown MAXIDE; The subject MULTIVITAMIN had not experienced A0788374Aadverse events following 1 PUB PUB None None UNK PVT OTH LISINOPRIL; Chronic Warfarin obstructive Allergy sodium; topulmonary CEFPODOXIME; Diltiazem disease hydrochloride A0788583A Allergy to CIPRO; Allergy to S 1 PVT UNK none 1 PVT UNK Started OMNICEF Sinusitisnight of 6/3/09 only had one dose 2 PVT PUB CBC - CXRUNK Normal; B/Cx; UNK U/A -UCX pending. None RAD - cough 1 None PVT PUB 2 Blood work PVT 5/23/09 - result PVT = low WBC SINGULAIR presently. None for asthmaAsthma 10 MIL MIL None None 2 Contrast enema PVT 6/16/09 PVT Medical none records LABS: viralBE exanthem, diagnosed noneprobable IS but unable Fifth disease to reduce. 1 PVT PVT None Seasonal allergies 0 PVT PVT Flovart HFAAcute pharangitis ALL: Amoxil, sulfa/acne, migraines, GERD; IBS; asthma 1 none PVT PUB 1 OTH OTH Sulfa, PCN Asthma 0 None PVT OTH None None Denies 0 None PVT UNK None None 0 Normal things UNK like, Temp, UNKpulse, BP and then blood workLow wasBlood done.pressure 1 PVT UNK allergic to molds, pollens, etc. 0 MIL MIL NO MEDS SYNCOPE NONE NONE~ ()~NULL~~In Patient 1 Normal CBC; PVT P.T. & PTT PVT None None 1 Colonoscopy MIL from previous MIL eventsZoloft, concluded Triglide, No noillness abnormal Multi-vitamin Light events seasonal (some Rectal allergies. hemrroidal Bleeding~Anthrax tissue) (Biothrax)~3~3~In Pa 0 UNK UNK reflux meds...reglan, not sick...just zantac none reflux 8/24/09 exsema, Medical hyperactivity~Pneumo records received PMH: (noGERD, brand nam URI 9 EmergencyUNK room records UNK from 10-19-07. none Pddnos No diganose. unknown 5-8-09.Rash~Hep Labs and diagnostics: B (no brand name)~UN~0~Patient audiology exam WNL. 0 None. 6/9/09 UNK Medical records UNK received ZyrtecDOS & Tylenol 6/1//09 Patient prn 6/3/09. hadNone seasonal LABS and allergies DIAGNOSTICS & a scratchy - None. throat. 13 9/10/09 LABS MILand DIAGNOSTICS MIL None only - received DOS 6/1/04 to 4/24/06. PT 45.9 sec (H). PTT 44.9 (H). INR 1.8 ( 0 OTH PVT Sulfa drugs; hay fever 1 PUB OTH None None 0 OTH OTH EFFEXOR None X; MOTRIN; Closed NEURONTIN; head injury; TYLENOL Allergic to erythromycin. 1 PUB UNK None None MI2009004 1 UNK UNK None None None OR200923 0 PVT PUB No None AR0920 0 None PVT PVT None None Overweight 11 PUB UNK None None Reflux (Gastric) "seizure MI2009005 disorder) 0 PUB PUB No No 0 None OTH OTH Yaz Convulsion WAES0906USA00554 0 PUB PUB NO NO 0 Unknown. 7/23/09 OTH Hospital OTH records Unknown received DOS 6/25/08 Unknown. to to 4/18/09. 6/12/09 LABS Medical WAES0906USA00298 and DIAGNOSTICS: records receivedUrinalysis DOS 2/7/08. - Clo H
2 NONE PVT PUB NONE NONE Unknown OTH OTH Unknown Unknown WAES0906USA00048 Unknown OTH OTH Unknown None WAES0906USA00056 0 Unknown OTH OTH Unknown Unknown WAES0906USA00039 1 None PVT UNK Mild URI sxNone 8 PVT PUB 1 None PUB PUB None None Allergy to; Pertussis, PENICILLIN, IA090006 AMOXICILLIN 1 None UNK UNK None None 1 PUB UNK None none none AL0909 0 MIL MIL Tricor, Lisinopril, none HCTZ, Hypertension, Fish oil, multivitamin High triglycerides Aventis Pasteur 4 6/10/09 ERUNK records received UNK DOSMicroGestin 6/6/09. LABS None B120 andbirth DIAGNOSTICS Penicillin. control 6/10/09 - None ER records received DOS 6/6/09. Melan 18 none MIL MIL none no no 0 9/14/09 Hospital UNK records UNK received DOS 5/15/09 9/14/09 to 5/18/09. Hospital No LABS known records and allergies. DIAGNOSTICS: received 9/14/09 DOS Hospital 5/15/09 EKG -to records No5/18/09. Change. received Assessme CXRDO -N 1 CT Head 11/Moderate UNK UNK amount of acute hemorrhage Dermatitis layering Possible within Marfan. superior 7/31/09 sulci of Hospital both cerebellar records received hemispheres. DOS 1N 0 PVT UNK none allergic rhinitis 0 NONE UNK UNK NONE NONE NONE 0 None UNK PUB unknown none psoriasis, seasonal allergies 1 Doctor requested PVT lab tests. PVT Will get After datavaccination backno in illness a few anddays. prior bronchitis avoids to vaccination. antihystamines symptoms none thatstarted: i know - experienced of~ 25 mg ()~NULL~~In azithromychin dizzinessPatient|none in the (greenst past 2 PUB PUB Denies 7 none PVT PVT none Keflex None~ ()~NULL~~In Patient 1 UNK UNK none none 0 GLUCOSE-105 UNK UNK FLOVENT, NONE ALBUTEROL, ACID SINGULAIR REFLUX, ALLERGIES 1 none UNK PVT none knownnone knownAmoxicillin rash/redness~Influenza (no brand name)~1~56 8 n/a PUB UNK Lopid, Lotrel, none and asprin. hypertension 2 NONE PUB UNK none. None. none~ ()~NULL~~In Patient 1 PUB UNK none none none 0 PVT PVT 3 None PVT PVT None None 1 OTH OTH Seasonal None Known None Known 1 PUB PUB low grade fever 99.7 0 Unknown OTH OTH None None WAES0906USA00012 628 Unknown. 8/14/2009 OTH MR OTH rec'd from Unknown PCP. Labs and Diagnostics: Unknown EMG 8/14/2009 abnormal. MR WAES0906USA00536 rec'd CSFfrom protein PCP. increased. Allergy to9/1/09 CeclorH Unknown OTH OTH Unknown Fever; Reaction to previous WAES0906USA00524 exposure to any vaccine 0 None PVT PVT PRINIVIL ; Meclizine Chronic obstructive pulmonary WAES0905USA00702 disease 0 Labs: Bacterial PVT testingPUB (-). CSF culture None (-), gram Nonestain with None. rare8/3/09 WBCs, Hospital no organisms. records received CXR (+) DOS perihilar 5/29/09 thickening to 6/1 0 None. 6/25/09 PVTPCP records PVT received None DOS 5/4/09 Noneto 6/15/09. NKDA; LABS No med and DIAGNOSTICS: conditions Ultrasound Pelvis - Abnor 35 PVT PVT 0 PUB PUB TIAZAC 240 None mg; Hydrochlorothiazide High blood pressure 25 mg; SEPTRA DS 160-800 m as needed 1 PVT PUB Obesity 0 PUB UNK 0 OTH OTH 2 PVT PVT none none allergic to shellfish, dairy, Histex 2 UNK UNK PVT PVT 1 MIL MIL Multivitamins 0 MIL MIL NONE NONE 1 NONE PVT PUB None No No 0 PVT PVT None 2 All normal MIL MIL None None 1 OTH OTH None None 1 None Known OTH PVT None Known None PENICILLIN
0 none PVT PUB TYLENOL, none infant none 0 PUB UNK None Spina Bifida; VP shunt; Club feet 10 Stool culture; PVT Fecal leukocytes; PVT O&P; Giardia;None Rota All neg Preterm 34 wks 10 Stool culture, PVT Fecal leukocytes PVT Otp, Giardia, Rota Noneall neg.Preterm 34 wks 0 UNK UNK Bronchitis, Asthma TYLENOL exacerbation with CODEINE 29 7/2/09 Medical PVTrecordsPVT received DOS 11/11/08 None to 6/12/09. None LABS and DIAGNOSTICS: Ultrasound abdomen - PCO 1 PUB PUB None 0 None PVT UNK None None 0 PVT PUB 0 PVT PVT None None Eczema, 3/30/09 0 MIL MIL None None Milk allergy? --> causes emesis using formula 1 None PVT PUB None No No 0 PVT OTH Injury 0 PVT UNK None Exercise induced RAD 2 PVT PUB No PVT PVT Albuterol soln for NEB 2 PVT OTH ADVIL; GLUMETZA; phenol D.M. 13 Given Zyrtec PVT + Atarax on PVT 5/23/09 Hydrocortisone No 25% BID No Rash~Measles + Mumps + Rubella (MMR II)~1 2 none PUB PUB ever VAZOL none 1/2 tsp poSeasonal Bid allergies 0 None PVT PVT None Healthy - noNone illness 1 PVT PUB None None None 398 PVT PVT no no no PVT PUB 0 PVT PVT UNK UNK 2 Unknown what OTHlab work OTH was doneIsosorbide, in ER no report None ASA of Sodium abnormal Chronic Bicarts, lab renal work. Gemfibrozil, failure, onCaduet hemodialysis , Corey, Hydralazine, Lantu 1 PVT UNK Metformin; amitriptyline; Codeine, IMITREX (nose bleeds) PUB UNK None None 0 PVT PVT None Passed out once before, after venipuncture and once after 0 PVT UNK Orthonovum None 1/35, Metformin, Asthma,Effexor Seasonal XR,Allergies Nexium, Clarinex D. None PVT UNK ZYRTEC, SINGULAIR, None Allergic MVI rhinitis 0 PUB PUB None None None IA090007 PVT PVT 0 See by PCPPVT 6/9/09 continues UNK with symptomsNone Referred toAllergy neurology. to Pork, BENEDRYL, VALIUM, SULFA. PVT PVT 33 Aspirate culture PVT no growth. PVT LacerationsNone 0 PUB PUB 0 see above UNK PUB Roxanol, Percocet, Please see Saline NKA PMH flush underfor ADE admin description times please see ADE description 0 HCG positive MIL MIL No other medications No illness atNo the medical time - no problems illness 11 MRI Head showed UNK demyelinization UNK None typical of ADEM. None but Lumbar developed Pectus puncture Excavatum significant showed (mild) pneumonia normal PMH: Glucose recent two to pneumonia three and Protein. days later. CSFHa W 0 none PVT PVT none none 0 ** Date indicated UNK in date UNK of vaccination OrthoisTri-Cyclene 3rd none and final Low, dose Seasonal Midrin of gardasil allergies none~ vaccination ()~~0~Patient|none~ only 6/26/09 when Received existing()~~0~Sibling symptoms medical records severe 0 PUB PUB 0 None PUB PUB None None None None~ ()~NULL~~In SA0901 Patient|None~ ()~NULL~~ 9 PVT PVT NONE NONE 1 PVT UNK None PVT UNK None None None~ ()~NULL~~In Patient 1 CBC with diff/ UNK plt, C-reactive UNK protein, Lexapro SED rate, Healthy electrolyte OCD. panel, 6/17/09 Epstein Medical Barr AB and panel immunization 6/17/09 Medical recordsand received immu 1 PVT UNK Hyperlipedemia; No NKA;NKA Seborrheic Keratosis; Non inflamed. 0 PVT UNK None allergic reaction PVT OTH CYMBALTA; none ACIPHEX; NKMA MIRAPEX; baclofen; Lisinopril; PREMPRO; NEURONTI
0 CBC; BMP;PVT Influenza; PUB Strep; monospot-negative None None Allergic to codeine 0 PVT PUB None None Sm colon syn, chronic constipation, R10 cystic fibrosis, Hd 1 None PVT PUB No None 1 PVT PUB No 0 None PVT PVT KLONOPIN; ACTIVELLA; Anxiety; WELLBUTRIN; osteopenia;BONIVA; with postBaclofen; menopausal; B2 migraine HA's 1 PVT PUB 1 PVT PVT 1 None reported PUB OTH None ### 1 None PVT UNK Patient denies medical history.### 12 PUB PUB None None 0 PVT PVT 0 MIL UNK None None 0 None PVT PVT Daily vitamins; Autoimmune Nifedipine; Penicillin's Hepatitis Naproxen 0 WBC 1-8.3,PVT 44/50; Hgb, PUB 12.6; Plt, 260K; Bld Cult None neg 1 PVT OTH Pt takes SINGULAIR 2-3 d after vaccineqd; Many ALBUTEROL environmental started SxPRN ofallergies; enterovirus Allergic rhinitis; Asthma 0 Unknown PVT PVT Unknown Unknown WAES0906USA00344 Unknown OTH OTH Unknown Unknown WAES0906USA00895 not reportedOTH OTH Patient has a history of "bp". ### PUB UNK MOTRIN; PITOCIN; TYLENOL The patient WITH hadCODEINE a vaginal delivery ### on 02 June 2009 and de PUB UNK KEFLEX None None 1 CBC; CMP PVT all WNL. PVT Finger laceration None 10 Cellulitis 682.6 PVT/ No labPVT test preformed TYLENOL; NO MOTRIN No preexisting NKDA 1 Acyclovir OTH PVT None None 0 PVT PVT Budeprion SR; No at LEVOXYL; doctorMetabolic forPREMARIN; general syndrome physical CYTOMAX; X; thyroidhydrochlorothiazide; deficiencies; hysterectomy; multivita 0 UNK PVT VALIUM; FLEXERIL; Broken neck TOPAMAX; Stroke (2 years Rd hightwice ago); dosesize~Influenza pain PEPCID; medication ZOCOR; (noallergy; brand AMBIEN; name)~UN~ on speech CELEXth 0 PVT PVT None 2 PT/INR andPVT RUE doppler PVTto rule out Altace, DVT.Fortamet, Both No negative. acute Lantus, illness. Allergy Prednisone, Patient to Penicillin. has Folic history Acid, See of #18 Darvocet, DVT, for medical Rhematoid Vicoden, history. Arthritis, Baby asprin IDD 5 UNK UNK none VA09006 1 MIL MIL N/A RECOVERING N/A FROM EAR INFECTION - MD VISIT PRIOR TO VACC 0 UNK UNK 5 stool positive UNK for rotavirus. UNK6/18/09 ER records none received DOS none.6/10/09 7/02/09 vomiting,diarrhea,dehydration~ toMedical 6/11/09. records LABS received and DIAGNOSTICS: 6/1/09 ()~~0~Patient to 6/16/09. Urine 0 Head X-rayPUB PUB Takes Orthotricyclen Denies qd Denies 2 UNK UNK None None Hypertension that was currently under control and was not PUB PUB None None none none~ ()~NULL~~In Patient 0 UNK UNK ADHD, Bunion No Known Drug Alleriges 5 see numberUNK 7 UNK Patient hadVery antibiotics, mild cold none butincluding had finished runny them nose 2 days prior to shots. 13 none PVT PVT none molluscum none 3 UNK UNK 1 NONE PUB PUB NONE NONE NONE 0 none. 6/12/09 UNK Medical UNK records received none DOSnone 6/8/09. LABS atopic andderm, DIAGNOSTICS: pectus excavatum, Hgb 10.3 RAD, g/dL.urticarial milk allergy 0 None PVT PUB None None None but hemangioma right upper back 8 Negative testing PVT for HSV; PUB EBV; CMV; 7/16/09 ViralHospital DFA; Ear mycoplasma; infection. records 7/16/09 received Negative Hospital DOStesting 5/31/09 records fortoHHV6; received 6/1/09.(+)Amoxicillin. DOS test for 5/31/09 Rhinovirus; to 6/1/0 M 2 Immunocap. PVT 7/24/09 ER UNK records received None DOS 6/3/09 and 7/24/09 6/22/09. ER LABS records and received DIAGNOSTICS: DOS 6/3/09 CHEM and 6/22/09. - Postassium Ch 0 CBC, with diff; PVTPT; PTTUNK None No 0 None as of PVT 6/10/09. OTH PREMARIN;MVI; None Calcium; Environmental ALAVERT;allergies; LYRICA;chronic ALLEGRA; OA; Menopausal KENALOG im prn. 27 Elevated ANA; PUBElevated PUB Rheumatoid None Factor. None 8/4/09 Rheumatology None. 8/4/09 consult Rheumatology records CA090005 received consult records DOS 3/5/09 received to 5/15/0 DOS 7 PVT PUB None None Tiny patent foremen ovale with left to right shunting 0 None PUB PUB None Eczema 2 PVT OTH 0 PVT PUB None None None 1 None PVT PVT ZYRTEC; VERAMIST None Seasonal allergies; Allergic Rhinitis
UNK UNK 0 PUB PUB None 0 None PVT PVT None. This No washxa medical well-childconditions check 8 an MRI of brain PVT was ordered PUB - child none referred tonone mental health noneclinic 1 PVT PVT Diagnostic Tests: MIL 6/14/05, MIL MRI Lumbar NEURONTIN spine- unremarkable; 100 mg 1Congenital TID;6/13/05, ADVIL flat200 Electromyography, feetmg prn Abnormal study. These e Diagnostic Tests: MIL mostMIL recent: L spine Cyclobenzaprine MRI (9/03) L4/L5 10 mg; None stenosis Percocet-5/325; R>L disc bulge; Elavil 10 R knee mg; Albuterol MRI (10/02) 90 mcg; chondromala Prinivil 4/19/05, CBC MILwith diff-WNL MIL exceptPt.HCT=44.9 denies (32.7-44.1); Pt. 2/22/05, denies LFT-WNL; 1/21/05, Occult blood x3-negative; None UNK MIL Multivitamins only Allergies: CODEINE None MIL MIL Birth control pills NKDA; No medical conditions or birth defects. None UNK UNK None NO birth defects; NKDA; No medical conditions. None UNK MIL Aciphex Allergies: IMITREX; Birth defects: None; Medical condition None MIL MIL None None; NKDA; No birth defect or medical conditions. 513 Blood cultures, UNK#1 Enterobacter UNK cloacae, None MND; None #2 Klebsiella Nonepneumoniae, (in infant) MND; #3, Bacillus species, MND (not B. PUB PUB Unknown Unknown Unknown OTH OTH None None WAES0906USA00687 0 Unknown UNK OTH Unknown Unknown WAES0906USA00544 0 Beta-humanOTH chorionic,OTH positive ZOLOFT Pregnancy NOS (LMP = 1/6/2008)WAES0802USA05190 10 Unknown 6/22/09-records OTH OTHreceived-Two DEPO-PROVERA weeks prior platelet Nonecount 6/22/09-records of 26. Rheumatology receivedWAES0906USA01158 labs PMHnegative. Depo Provera. 3 None MIL PUB mesalamine 1 mg qid, HTN, Vitmain Crohn's D, Calcium 1 PUB PUB None Bees/Wasp; BIAXIN; OMNICEF 0 None PVT PVT None None None 0 PVT PUB None None None MIL OTH 2 PVT OTH None None 229 PVT PVT ZYRTEC; ADVAIR; None PROVENTIL Asthma 3 PVT UNK See list included None None None PUB PVT Chantix pac Pt medical Hx of blood transfusion. 1 PVT PUB Zyrtec 5mgNone OTC after AM None MIL UNK None Flat Foot 0 UNK UNK The patient is a nonsmoker with occasional alcohol use an 1 PUB PUB None None None 1 None PVT OTH Albuterol Muscular dystrophy 4 PUB PVT None 0 OTH UNK 1 PVT PVT None None 2 None PVT PVT None PVT UNK None None 1 PVT PUB None None 1 OTH UNK ACTONEL None Osteoporosis AntinuclearOTH antibody, 26Nov2008, OTH 35AU/mL; ALLERGY Diagnostic TO FAMILY Results: STEROIDS; HISTORY 05 February PENICILLIN OF2002: A0784372A ARTHRITIS MRI ALLERGY of the head: 1. No area 6 UNK UNK none none none 1 NA PUB PUB Cymbalta 60mg Bloody daily, Stools, Aricept Cataract Rule10mg Out Extraction, GI daily, bleed, Zocor Bunionectomy, possible 10 mgpneumonia daily, Hysterectomy, Timoptic 0.5% Cholec 1 dro 10 Pt responded MILin a day MIL or two to Motrin See #400mg 12. None. Benedryl 25 None. mg, keflex 500 tid x 10 days, ciprofloxin 500 bid x 2 day 1 PUB PUB 1 PVT PVT None~ ()~NULL~~In Patient 2 PVT PVT none fever a few none days before. 0 PVT PVT none known 0 CBC, TSH 6/12/09 UNK Medical UNK records received DOS NO 9/14/2006 NO to 6/4/09. LABS and PR0910 DIAGNOSTICS: Thyroid Functio 12 None PVT PVT None None Concurrently UNK taking Chloroquine UNK Phosphate Chloroquine for None Phosphate anti-malarial Nut 250 prophylaxis allergy mg (One and dose Idiopathic for travel four reasons. days Shortprior) Stature and Nutropin AQ 1.6
1 PVT UNK Insulin, Trazodone, None Metaformin, Diabetes and Aspirin, None~ ADHD Chlorquine ()~NULL~~In Phosphate, Patient Ramapril, Glimep 0 UA with WBC PUB clumps but PUB Urine Culture none was negative none umbilical hernia 10 PVT UNK 6 PVT UNK 1 N/A PUB PVT Depo Provera None Sickle Cell Trait 7 n/a UNK UNK none None none 0 29 May 09: UNK cardiac ultrasound UNK waslast normal. medication conjunctivitis, 29pt.May had09: None: taken otherwise CBC was Pt. was has onthe normal. 24 nopt. May history was 09: inof400 completely seizures. mg ibuprofen She normal does for state menstrual have of a good his 0 PUB PUB None None None 0 UNK UNK NONE NONE MILD SCOLIOSIS. 7/29/09 Consultant records received D 0 No PUB UNK 1044 PVT PVT None None 34 WK GA Twin birth 0 PVT PUB ADDERALL; clonidine ADHD; ; RISPERDAL Bipolar disorder 1 None PVT PVT Singulair, Claritin None + Albuterol Asthmainhaler 0 EKG - normal. PVT PVT None None None 0 OTH PUB URI RSV 4/09 2 PVT PUB None None None 2 PVT PVT 264 none PVT PUB None None None 0 PVT PVT None None VALTREX PVT OTH 1 Checked forUNK vertigo, by: UNK Dr. said: no vertigo! Headaches, Back, hip, neck, left leg pain, tremors 376 None PVT PVT None None None Fever~Hib (no brand name)~1~0~Patient|Feve 14 MIL UNK None None 2 PVT PVT None None Penicillin; Peanut allergies (Peanuts no longer per allergist 1 None PUB PUB Currently had None a medication Nonetopically for ring worm 3 PVT PVT None None None 0 PUB PUB 2 OTH PVT None None 0 EKG, normal, PVT 6-8-09 PVT None Allergies to AMOX ; ZANAX (rash). Initially did not pass ne 2 None PVT PUB None None None 0 None PVT PVT None None 13 PUB UNK None 8 None PVT OTH Vitamin D, Lipitor, None Vitamin None E, Verapamil, Cod liver oil, Citalopram HBC 0 PVT PVT None None None 0 None PVT PVT None None None 0 urine beta-human OTH OTH None Pregnancy NOS (LMP=11/20/2007 WAES0801USA05575 41 ultrasound, OTH LMP was 06-AUG-2008; OTH INSULIN; diagnostic SYNTHROID Pregnancy laboratory, NOS OB(LMP profile: = 8/6/2008); all resultsWAES0901USA03065 in Diabetes; normal limits; Hypothyroidism ultrasound, 12/24 Unknown OTH OTH Unknown Unknown WAES0906USA01328 4 diagnostic laboratory, OTH shingles OTH Unknown Unknown WAES0904USA02912 1 None PVT UNK ZYRTEC Allergic rhinitis None 1 PVT PVT No 1 PVT PVT 2 PVT PVT None No Known No Known 0 None PVT PUB None None Jaundice at birth 0 BP 110/70.PUB PUB None None None 0 PVT PVT Duaces; Econazole; None Strattera; Asthma;Symbicort; ADHD; Tourettes Xopenex disorder 4 MIL MIL none none pulmonary nodules of unknown etiology 17 MRI -6/3/09UNK 1. MULTIFOCAL UNK AREAS noneOF SIGNAL none ABNORMALITY none 6/26/09 AND none~ Medical EDEMA ()~~0~Patient|none~ records IN THE received BASAL()~~0~Sibling PMH: GANGLIA, nose &SUBC wris 1 UNK UNK 0 MIL MIL lescol norvasc no pen vonwillingbrand yes~Vaccine disease not specified (no brand name)~NU 0 PUB PUB fainting~HPV (Gardasil)~1~17~In Patient
1 PUB PVT SYNTHROID 50mg Hypothyroidism, Asthma, and allergic reaction to Influenza 1 xray of cervical PVTspine (pt. UNK has known Albuterol bulgingInhaler,Cyclobenzaprine, cervical Sinusitis,disc Allergic Asthma, problems) Rhinitis allergic Prednisone, rhinitis Sronyx, Zyrtec 1 MIL MIL NONE 0 MIL MIL none none poultry allergy 0 PUB PUB 9 None to date UNK - will perform UNKscreening Prilosec for hivesNo illness at the time 1 Sedimentation PVTRate, Creatine PVT kinase Ibuprofen labs drawn None on 6/12/2009. No known Already Drug had Allergies; normal sugar, liver, anemia, thyroid te 10 N/A PUB UNK None reported. None reported. 1 PUB PUB OrthoTricyclen None 1 PUB PUB none knownno no 0 XRAYS, BLOODWORK PVT UNK SHOWS WBC RESPIRDOL,CLONODINE,ZYRTEC,SINGULAR,ALBUTEROL HIGHNONE ADHD,IMMUNE DEF,ASTHMA,BIPOLARINHALER OTH OTH Unknown A0790455A 1 OTH OTH Penicillin; FELDENE; diphenhydramine 2 Low Platelets PUB Count PUB No 0 PVT UNK None PVT OTH 1 PVT PVT no none 0 PVT PVT 1 PVT PUB SINGULAIRNone Seasonal allergies 0 CBC; CMP PUB normal. 6/22/09 PUB Hospital Zantac records 0.2 None ml DOS (3mg); 5/28/09 Liquidation; Reflux to 5/29/09. 6/22/09 Mylicon; LABS Hospital Tylenol andrecords DIAGNOSTICS: DOS 5/28/09 CHEM to 5/29/09. - SodiumC 0 OTH PVT 0 OTH PVT 1 No PVT PVT 2 PVT PUB 1 Possible early PVTabscessPVT L upper arm. No None 0 PVT PUB 7 PVT OTH 0 PVT PVT CELEXA; YAZ No Depression with anxiety 4 PUB UNK 0 OTH PVT None None 0 PVT PUB None h/o fainting - saw Ped neuro - No chronic dx. 8 CBC, bloodPVT culture pending PUB None No allergies, healthy child 0 None PUB PUB Runny Nose, None but no fevers 1 PVT PVT NONE NONE eczema & failure to thrive~Hep B (Engerix-B)~2 10 none PVT PUB 2 PUB PUB allergic to erythromyocin 1 RN outlinedPUB area and will UNK cont to follow. No further Bilateral intervention lower NKAextremity prior needed to this cellulitis at incident. this time. beingCAD treated andwith chronic vancomycin venous stasis and le Alanine Aminotransferase, OTH OTH12 IU/L, Normal; Aspartate Aminotransferase, Atrial fibrillation; Chronic 16 IU/L,Obstructive Normal; ### Haematocrit, Pulmonary24%, Disease; DeprH 1 Not reported PVT UNK SYNTHROID; CRESTOR The patientHives~Tetanus had a history ofToxoid penicillin ### (noallergy, brand name)~~0~Si seafood aller UNK UNK ### 153 Urine beta-human, OTH 05/31/08, OTH negative; [Therapy Urine unspecified] Pregnancy beta-human, Attention NOS 06/03/08, (LMP deficit =positive Unknown); disorder WAES0806USA00890 Depression 0 Unknown PVT PVT Unknown Unknown WAES0906USA00708 beta-humanOTH chorionic, OTH positive Unknown Pregnancy NOS (LMP = Unknown) WAES0806USA08747 0 beta-humanOTH chorionic, OTH 06/03/09, positive Pregnancy NOS (LMP = 5/1/2009)WAES0906USA00865 328 None OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0805USA05079 Unknown OTH OTH None Wheezing WAES0906USA00696 Unknown OTH OTH Unknown Unknown WAES0906USA01783 0 6/29/09-records PVT receivedPUBCBC WNL, basic metabolic None profile Azithromycin; WNL. CEFTIN - rash 0 PVT UNK none acetaminophen 0 SEE ABOVE UNK FOR MED, UNK MRI, BLOODWORK,NO SPINAL TAP. NO 7/1/09 NONE~ Hospital()~~0~Patient records received DOS 6/6/09 to 6/10/0 0 PUB UNK
1 NONE AVAILABLE PUB PUB CLIENT WAS DENIED NOT TAKING ANY DENIED ILLNES ANY ANY MEDICATIONS ATPRE-EXISTING THE TIME OF ATVACCINE CONDITION THE TIME INJECTIONS OF VACCINE IN 0 PVT PVT Fluoride None None 3 UNK UNK 7 MIL MIL NONE NONE 0 none PVT PVT HCTZ, Diltiazem, None Gemfibrozil, HTN, Hyperthyroidism, Warfarin, Methimazole GERD, Gout, A-fib, prostate CA, H 0 PVT UNK none knownnone diagnosed, although patient may have a digestional 4 PVT PUB none none none 1 PVT PUB Flovent, Singulair, Coughing Miralax NKDA; hx of wheezing, asthma, allergic rhinitis, constipatio 1 PUB PVT NONE SHRIMP-CRAB 2 Clinical Exam PVT UNK lortab, norvasc, nonemonopril, Afib,levoxyl, Back Pain, amiodorone, HTN, Anxiety restoril, xanax 1 UNK UNK None None None 0 None PVT PUB None Not noted None 66 PVT PVT none infection induced asthma, sulfa allergy 1 PUB PVT N/A Penicillin; Non-Steridal anit-inflammatory; Flagyl; Adhesive 3 PVT PVT zyrtec, aspirin,fosamax, None NKDA, zantac, HLP, simvastatin, osteoporosis flonase, calcium, multivitamin 1 None PVT OTH None None 1 PVT PUB 0 None PVT OTH Abscess, L Allergic arm Rhinitis 6 Doppler U/SOTH on legs (-)PUB Methotrexate; None OXYCONTIN; Polymyositis; Leucovorin; Same~Hep NKDA. PLAQUENIL A (no brand name)~1~36~Patient 4 PVT PVT MOTRIN after vaccine 1 Potassium hydroxide PVT preparatio, OTH 20Apr2009 ZIANA; ORTHO -ACNE, ve yeast TRI-CYCLEN DYSMENORRHEA, The subject LO; had TYLENOL no HEAVY known A0780629A NO. PERIOD drug 3; antibiotics; allergies. The lignocaine subjecthydro was 0 PUB PUB None None PVT PUB None notedHypothyroidism; Depression; Hx of overdose 2005; ETOH 0 PUB PUB 4 Blood tests;OTH Results; 11/20/08, OTH Varicella LIPITOR; Zoster Atenolol/Chor.; None virus antibodies None Levothyroxine; - 1.65; 12/11/08, KLOR Varicella CON; Aspirin; ZosterCalcium; virus antibodies Vitamin; -P 2 None PVT OTH 18 elevated CSF PVT protein; Head PVT CT and MRI normal. None7/21/097/21/09 Hospital Hospital recordsrecords received received 6/11/096/11/09 to 6/23/09. to 6/23/09. LABS and AllerD None OTH OTH 1 PUB OTH 1 CT - scan PVT PUB Yes~Varicella (no brand name)~1~10~Sibling 1 PVT OTH MOTRIN/TYLENOL 1 Blood work PUB normal; UAPVT normal None None 0 None PVT PVT None None None 1 UA wnl PVT PVT EFFEXOR; ZOCORT NKA 4 PVT UNK No 1 None PUB UNK None 0 None PUB PVT None None Allergies: Bactrum, Horse hair, Cat hair. 1 None PVT OTH PPD, 02990AB, NoneLA, 0 None 1 PVT UNK 1 PUB PUB None None PVT UNK None "Almost never happy" per parents, since age 3-4 wk. 1 None at adverse PVT eventOTH SYNTHROID; Arthritis Vitamins L hip Hypothyroid; Arthritis; Allergies; mold; dust; trees - pollen None PVT OTH DM 2 PVT OTH 1 PVT OTH None 19 see attached PVT PVT 0 See attached PVT PVT No see sheet B~Vaccine not specified (no brand n 2 PVT PVT None Unknown OTH OTH Unknown Unknown WAES0906USA00130 0 Unknown OTH OTH Sulfonamide allergy; Allergic reaction WAES0905USA03639 to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0905USA02240
Unknown OTH OTH Unknown Unknown WAES0905USA00980 Unknown OTH OTH Unknown Unknown WAES0906USA00258 78 ultrasound, OTH 05/02/07, within OTH normal Unknown limits; serum alpha-fetoprotein, Gestational04/04/07, diabetes negative mellitus WAES0707USA01443 0 urine beta-human, OTH 01/06/08, OTH negative; Noneurine beta-human,Cholecystectomy; 02/04/08, positiveCesarean WAES0803USA00128 section 47 Unknown OTH OTH BENTYL, 10 Pregnancy mg; ORTHO NOS TRI-CYCLEN, (LMP = 2/12/2008); 0.025 WAES0804USA02086 mg; Depression; ZOLOFT,Iron 25 mg deficiency anem 0 ultrasound, OTH 08/22/208,OTH screening; azithromycin; diagnostic laboratory, Pregnancy vitamins chlamydia NOS (unspecified) (LMPpositive = 4/8/2008) X2; W urine AES0806USA08328 beta-human, positive; platelet 63 ultrasound, PVT 06/26/08, EDC=02-FEB-2009; OTH BENADRYL; urine Pregnancy MACROBID; beta-human, Pyelonephritis NOSvitamins 06/05/2008, (LMP = (unspecified) 4/20/2008); positive; WAES0807USA00352 Seasonal serum alpha-fetoprotein, allergy 08/21/ Unknown OTH OTH Unknown Unknown WAES0903USA00005 Unknown OTH OTH Unknown Concurrent Conditions: PregnancyWAES0903USA01240 NOS (LMP = 1/12/2009) 0 Unknown PVT PVT LUPRON Unknown WAES0903USA01849 0 Unknown PVT PVT Unknown Unknown WAES0903USA04686 0 diagnostic laboratory OTH 01/18/09 OTH - Group vitamins B Streptococcus (unspecified) Pregnancy :Polycystic NOS negative; (LMPdiagnostic ovaries = Unknown) laboratory WAES0904USA00153 Penicillin- gestational allergy diabetes: neg 0 urine beta -OTH human - positive OTH hormonal contraceptives; Pregnancy NOS BACTRIM (LMP = 2/23/2009) DS TABLETS WAES0904USA01441 6 PUB PUB DIASTAT prn None childhood febrile seizure disorder PUB PVT None No parasite identification, OTH false OTH positive Unknown Unknown WAES0905USA00193 0 None OTH OTH None None WAES0905USA00220 1 Unknown. OTH OTH Unknown Parakeratosis 7/13/09 Medical notes WAES0905USA00239 received DOS 4/28/09 to 6/30/09 0 Beta-humanOTH chorionic,OTH positive None Pregnancy NOS (LMP= 4/25/2009) WAES0905USA00270 1 None PVT PVT None None WAES0905USA00342 0 None OTH OTH Ortho Evra; Singulair None WAES0905USA00366 1 Unknown OTH OTH Unknown Epstein-Barr virus infection; WAES0905USA00380 Lymphadenectomy Unknown OTH OTH None None WAES0905USA00383 57 Serum ANAUNK 04/24/09 -UNK negative; serum FLONASE rheumatoid Penicillin factor allergy 7/13/09 04/24/09 Medical - negative; records WAES0905USA00387 urine received drug screen DOS 4/24/09 04/24/09 to 5/4/09. - negativ P 138 Diagnostic laboratory, OTH 12/16/08, OTH Blood Nonework results Dizziness; normal; Fatigue; Unknown Physical Influenza examination, like illness WAES0905USA00500 12/16/08, diagnosed fatigue and Unknown OTH OTH Unknown Unknown WAES0905USA00510 0 None OTH OTH None Unknown WAES0905USA00521 Unknown OTH OTH Unknown Unknown WAES0905USA00528 Unknown OTH OTH Unknown Unknown WAES0905USA00529 None OTH OTH Unknown Unknown WAES0905USA00538 0 None PVT PVT ascorbic acid; calcium None (unspecified); cyanocobalamin; WAES0905USA00561 SEASONIQUE; store bran 0 Ultrasound,OTH 05/04/09, positive OTH for pregnancy; None Pregnancy Urine beta-human, Ovarian NOS (LMP cyst 04/21?/09, = 3/26/2009); negative; WAES0905USA00563 Depression Urine beta-human, 05/04/09 0 None OTH OTH None Pregnancy NOS (LMP + 7/22/2008) WAES0905USA00570 Unknown OTH OTH Unknown Unknown WAES0905USA00572 17 None OTH OTH None None WAES0905USA00707 0 Unknown OTH OTH Unknown Unknown WAES0905USA00733 61 None OTH OTH Unknown None WAES0905USA00944 Biopsy, negative; OTH Diagnostic OTH laboratory, Omega-3 testmarine for sexually triglycerides Eczema; transmitted Food diseases-negative; allergy WAES0905USA00950 Skin and/or subcutaneous, 0 Unknown OTH OTH None WAES0905USA01104 Unknown OTH OTH Unknown Unknown WAES0905USA01112 0 Diagnostic laboratory, OTH blood OTH work,Flagyl pregnant ;Pregnancy Urine beta-human, NOS (LMP) 05/01/09, = Unknown negative WAES0905USA01140 0 None UNK UNK None Penicillin allergy WAES0905USA01261 Unknown OTH OTH Unknown Unknown WAES0905USA01306 0 Unknown OTH OTH Unknown Unknown WAES0905USA01307 0 None OTH OTH None None WAES0905USA01432 Unknown OTH OTH Unknown Unknown WAES0905USA01443 Unknown OTH OTH None Drug hypersensitivity WAES0905USA01447 Unknown OTH OTH Unknown Unknown WAES0905USA01464 17 None OTH OTH None Lactose intolerance WAES0905USA01625 0 Unknown OTH OTH None WAES0905USA01633 2 None OTH OTH None None WAES0905USA01662
None OTH OTH Unknown Unknown WAES0905USA01665 2 None OTH OTH None None WAES0905USA01684 Unknown OTH OTH Unknown Unknown WAES0905USA01721 0 Unknown UNK UNK TYLENOL None WAES0905USA01879 0 Ultrasound,OTH 03/05/09, EDC OTH 10/19/2009; None Diagnostic Gestational laboratory, diabetes 03/05/09, Prenatal WAES0905USA01888 lab work(results not reported); Pl 0 skull x-ray, OTH 5/8/09, no fracture OTH Unknown Unknown WAES0905USA01902 Unknown OTH OTH Unknown Unknown WAES0905USA01923 5 beta-humanOTH chorionic, OTH 05/14/09, positive None Pregnancy NOS (LMP = Unknown) WAES0905USA02012 None OTH OTH Unknown Unknown WAES0905USA02013 0 None OTH OTH None None WAES0905USA02018 serum Herpes OTH simplex,OTH positive; serum CELEXA; Herpes ADVAIR; simplex, hormonal positive None contraceptives;WAES0905USA02021 ATIVAN Unknown OTH OTH Unknown Unknown WAES0905USA02029 0 Unknown OTH OTH ZYRTEC, hormonal Drug hypersensitivity; contraceptives, House NASONEX dust WAES0905USA02230 allergy; Pollen allergy Unknown OTH OTH Unknown Unknown WAES0905USA02247 Unknown OTH OTH Unknown Headache WAES0905USA02253 0 Unknown OTH OTH None Unknown WAES0905USA02260 0 OTH OTH Unknown Unknown WAES0905USA02572 1 Unknown OTH OTH None Penicillin allergy WAES0905USA02728 30 Serum stimulated, OTH 04/??/09, OTH Adrenal Unknown Insufficiency. Unknown WAES0905USA02843 5 computed axial, OTH 01/16/09 OTH - normal;ALASE electroencephalography, Familial risk6/23/09 factor; 01/16/09 Contraception Medical - abnormal; records WAES0905USA02892 received underlying PMH: predisposition Tonsillectomy for and seiz None. 6/25/09 OTHMedicalOTH records received None DOS 12/28/09 to None. 12/24/08. 6/25/09 LABS Medical andWAES0905USA02921 DIAGNOSTICS: records received Chest DOS 12/28/09 X-ray negat to 0 None UNK UNK None None WAES0905USA02951 0 None PVT PUB None WAES0905USA03183 Unknown OTH OTH Unknown Unknown WAES0905USA03218 395 Pap test, the OTH specific type OTHof HPV ORTHO has not been TRI-CYCLEN determined None WAES0905USA03240 0 blood pressure, OTH 05/18/09, OTH115/68 YAZ Syncope WAES0905USA03248 Unknown OTH OTH Unknown Unknown WAES0905USA03257 None OTH OTH DEPO-PROVERA None WAES0905USA03276 Unknown OTH OTH Unknown Unknown WAES0905USA03359 1 None OTH OTH None None WAES0905USA03367 Unknown OTH OTH Unknown Unknown WAES0905USA03371 7 None OTH OTH Unknown Cystic fibrosis WAES0905USA03380 0 Unknown OTH OTH RHOGAM Pregnancy NOS (LMP = 10/31/2008); WAES0905USA03385 Drug hypersensitivity Magnetic resonance, OTH demyelinating OTH lesions Unknown WAES0905USA03402 0 Urine beta human, OTH 05/05/2009, OTH showed None she was Pregnancy pregnant. Nos (LMP= 3/27/2009)WAES0905USA03625 Anaemia; Irregular menstrual cycle Unknown OTH OTH Unknown Unknown WAES0905USA03635 7 None OTH OTH None Miscarriage WAES0905USA03670 0 electrocardiogram, OTH 05/19/09, OTH sinus tachycardia, HR 140 Unknown to 150 WAES0905USA03677 0 Unknown OTH OTH None WAES0905USA03692 Unknown OTH OTH NECON 1/35, Pregnancy EFFEXOR Attention NOS (LMP deficit = 3/2/2008) disorder; WAES0905USA03695 Sulfonamide Depression;allergy; Anxiety; Allergic Obesity react 0 Unknown PVT OTH None WAES0905USA03777 26 None OTH OTH None Unknown WAES0905USA03812 0 Unknown OTH OTH Unknown Brachial plexus lesion; Drug hypersensitivity WAES0905USA03847 1 electrocardiogram, OTH 05/19/09 OTH - normal, SEASONALE diagnostic laboratory, Unknown 05/19/09 - lab work: WAES0905USA03861 normal; beta-human chorionic, 05 Unknown OTH OTH NEXIUM Hospitalisation WAES0905USA03862 0 None Medical OTHrecordsOTH received 6/22/09 sertraline LABS hydrochloride Yeast and infection DIAGNOSTICS: Medical records STDreceived Screen WAES0905USA03865 (-). 6/22/09 PMH: Anxiety Disorder G Unknown OTH OTH Unknown Unknown WAES0905USA03883 Unknown OTH OTH Unknown Unknown WAES0905USA03904 6 Unknown OTH OTH Unknown Unknown WAES0905USA03905 0 urinalysis, 05/01/09, OTH positive OTH Unknown Pregnancy NOS (LMP = 3/26/2009); WAES0905USA03906 Seasonal allergy Unknown OTH OTH Unknown Nervousness WAES0905USA04039
Unknown OTH OTH Unknown Unknown WAES0905USA04056 Unknown OTH OTH Unknown Unknown WAES0906USA00009 Unknown OTH OTH Unknown Unknown WAES0906USA00010 Unknown OTH OTH Unknown Unknown WAES0906USA00011 Unknown OTH OTH Unknown Unknown WAES0906USA00103 Unknown OTH OTH Unknown Unknown WAES0906USA00112 9 Unknown UNK OTH Unknown Unknown WAES0906USA00118 Unknown OTH OTH Unknown Unknown WAES0906USA00135 0 Unknown OTH OTH Unknown Unknown WAES0906USA00139 Unknown OTH OTH Unknown Unknown WAES0906USA00143 Unknown OTH OTH Unknown Unknown WAES0906USA00242 Unknown OTH OTH Unknown Unknown WAES0906USA00243 1 TWO BLOOD UNK WORK-UPS, UNK CT SCAN, NONE MRI, EEG NONE6/16/09 NONE Received 6/16/09 NONE~ medical Received ()~~0~Patient|NONE~ records medical for LABS: records CT ()~~0~Sibling|N for head, PMH: CBC, steroty CM 6 stool culture, PVT 06/04/09,PVT rotavirus antigen positive; Skin stool tags occult blood, 06/04/09, positive; WAES0906USA01449 body temp, 06/03/09, no te 40 Unknown OTH OTH Unknown Unknown WAES0906USA01742 Unknown OTH OTH Unknown Unknown WAES0906USA01436 Beta-humanOTH chorionic,OTH positive None Atrial septal defect repair WAES0805USA01495 Physical examination UNK by UNK health care Corticosteroid provider andinjection examination Female into bald and with spots; treatment latexsteroidal allergy. from cream specialist applied - dermatologist. to bald spots. 11 8/6/09 Dermatology UNK consultant UNK records received DOS 7/25/06 8/6/09toDermatology 3/13/09. LABS consultant and DIAGNOSTICS: records received Multiple DOSBiops 7/25 1 None PVT PVT Speech delay 2 PVT PVT Vitamin with iron; ALBUTEROL CODEINE, Hairy Nevus - got referred to derm 0 PVT PVT None Migraines 0 PVT UNK 18 PVT PVT None None None 0 PUB PUB Oral contraceptive (unable Asthma; to recall) Received cochlear implant on 05/18/2009 PUB UNK Fibromyalgia Fibromyalgia PUB PUB None None None 2 PVT PVT Vitamin with Iron. 1 PVT PUB Vitamin C; fe Salicylic acid Obesity 6% 0 MIL MIL 2 Skin culturePVT - nL flora PUB None No. 6/17/09No Medical record received DOS 6/1/09. At time of immuniza PVT UNK DEPAKOTE; ZYRTEC;Seizure NASONEX D/O 2 PVT PVT NASONEX; SINGULAIR 1 OTH PVT Codeine; Sulfa; latex 1 PVT PVT None None None 2 Child beingMIL treated for MIL cellulitis. None None None 1 MIL MIL 5 PVT OTH Thyroid, Birth Control 8 MIL OTH Birth Control None No 0 None OTH PUB None Hay fever only 1 None PVT PUB None None Amoxicillin; Tetralogy of Fallot 1 UNK UNK None BronchiolitisNone 1 None PUB OTH None None None 0 for headache MIL stated work MILplace was "very cold" Prostatitis and he felt better since arriving. " A little nervous" after receiving 3 0 Seen at ERPVT on 6/21/09PUB and was diagnosed with None allergic reaction. NKDA NoCBC birth9defect; x7 13137.4 NC09024 H/O Bronchial 2gl; N 42.5; asthma Lym 37.4/ Ess, 12 1 PVT PVT PROVENTIL; Acute ADVAIR extrinsic rotator/Tendonitis 2 PVT PVT GLUCOVANCE; was having metoprolol; DM-2; pain inPLAVIX; HTN; someobesity; area ALTACE; Psoriasis; SINGULAIR; COPD; VYTORIN; AS CAD. SPIRIVA 10 none exceptPVT rapid strepPVT screen & culture None None PENICILLIN ALLERGY 3 6/29/09 Medical PUB records PUB received None. DOS 8/07/08 6/29/09 NotoMedical 4/08/09: PCN records LABS allergy received and Chills DIAGNOSTICS: fever~Tdap DOS 8/07/08 (no PLT tobrand 4/08/09: 457 K/uL name)~UN~0~Pat Aleve (H). CHEM: A 0 Rapid Flu test PVTnegativePVT None None 1 UNK PVT None None None
2 Hemacult, Positive PVT X2,PVT Dates 6/6/09 None and 6/8/09 None None 1 PVT PVT ALLEGRA 30 None mg; ORTHOTRI-CYCLIN Anemic 5 Allergy testing PVTshowedOTH no allergiesNITROFORANTOIN to foods, just dust mites MACROCRYSTAL; AMOXYCILLIN; Erythromycin; EVISTA Gantrisin; Osteoporosis 1 PUB PUB None None None UNK UNK 1 PVT PVT Atenolol; Levoxyl; ASA;Cephalosporins; HCTZ; LisinoprilPCN; Risedronate; Azathiopine 2 PVT PUB None None 0 PVT PVT NKDA 2 PVT PUB None Penicillin; Bee sting UNK UNK 2 PVT PVT None Exercise-induced RAD UNK UNK UNK UNK 1 PVT PVT ALBUTEROL PRN 69 MIL MIL None None 1 PVT UNK No menopause UNK UNK None PVT PUB None Penicillin -3652 None PVT PVT None None PVT UNK PVT PVT 0 PVT PUB prednisone,none fluorinef congenital adrenal hyperplasia 0 Member had MIL lyme disease MIL antibody IGM wasMember negativehad immunoglobulins none been known biten by was a tickalso 5 days negative. prior inMember the rightrecovered upper back. com 36 UNK UNK COPD PMH: COPD 90 UNK UNK COPD PMH: COPD 652 UNK UNK COPD PMH: COPD, anxiety, depression, HTN, hypothyroidism, la 12 NONE COMPLETED PUB PUB Unknown NONE UNknown 29 UNK PVT none no none 533 Blood and CSF UNKspecimens UNK collected Insulin 3/29/2009 were culture Diabetes positive mellitus. for Neisseria 7/8/09 Hospital meningitidis records serogroup received C. DOS 6/24/0 3 0 PUB PVT EffexorXR, None NaturThroid, Sulfa Seasonelle 3 UNK UNK none pt states allergy to spiders and bees 1 PUB PUB PCN MO-2009-13 1 - derm biopsy UNK pending,UNK - CBC originally none normal. none repeat known CBC Err:508 shows ANC 200-3rd CBC normal . repeat CBC pendi 33 cbc, cmp, esr, UNK arthritis UNK panel all normal. allegraMedical D, veramyst. Allergic records rhinitis Oral NKDA. received contraceptives. only.Chickenpox. DOS 5/27/09 Medical to 6/16/09. records LABS received and DIAGNOSTI DOS 5/27/0 0 PVT PVT 0 PVT PVT none 2 none UNK PVT calcium, Vitamin Sore throat,nasal D, Thyroid High cholesterol, support congestion (herbal thyroid andthyroid post problems nasal supplement) drip. 0 UNK UNK 2 MRI and Catscan. UNK 6/29/09 UNK Hospital none records received None DOS None. 5/24/09 6/29/09 to 5/25/09. Hospital LABS records andreceived DIAGNOSTICS: DOS 5/24/09 CT Head to 5 0 UNK UNK 9 PUB UNK None None 4 None PVT PUB CARBATROL No 300 mg Seizure bid disorder 0 CBC; Chem PVT panel ordered PVT 6-15-09 None None None 8 PVT PVT daily vitamin None OTH OTH Aspirin; Calcium (unspecified); UnknownOmega-3 marine WAES0905USA00985 triglycerides; Prilosec; Paxil; Evi Diagnostic laboratory, OTH HPV OTH positive; Unknown Diagnostic laboratory, Unknown ?/?/07, HPV: negative WAES0905USA01063 0 Unknown OTH OTH Penicillin allergy WAES0905USA01064 1 MIL MIL NONE Unknown OTH OTH Unknown Coronary artery bypassWAES0906USA02086 2 8/26/09 Hospital PUB records PUB received DOS 6/10/09. Rash LABS on back and No.DIAGNOSTICS: and 8/26/09 abdomen HospitalCBCrecords WBC received 40000 DOS K/mm3 6/10/09. (H) PLT Multip 479 2 PVT UNK None IA090008
2 PVT UNK None IA090009 66 GUILLAIN BARRE OTH syndrome. PVT 7/13/09 Lisinopril; Hospital Lovastatin None records received 7/13/09 Hospital DOS 12/26/09 records toreceived 1/3/09. LABS DOS 12/26/09 and DIAGNOSTIC to 1/3/09 1 PUB PVT PVT UNK none none 3 PVT PVT Ibuprofen PRN, nonemultivitamin daily, Vicodin PRN, Valium PRN, Fluconazole 1 tabl 1 PVT UNK none 3 days of high fever after shots given~ ()~NULL 0 none UNK UNK none none none SC0917 0 NONE MIL MIL NONE NONE NONE 1 Patient hadPVT subsequent PUB vaccines none at age 6 months none with no none sequelae, including Pentacel, Prevnar, and Rotateq. 2 UNK UNK Norvasc 2Xday(5mg), None HCTZ Emphesyma 1day(25Mg) & Spiriva Stopped 0 PVT PUB 0 UNK UNK lisinopril, multivitamin, No St. elevated John'sPSA, Wort, None~ aortic fish ()~NULL~~In oil, valve aspirin, insufficiency, simvastatin, Patient hypertension, hctz. hyp 3 EMG datedUNK 2/06/2009 UNK revealed a left anterior interosseous nerve syndrome. 7/27/09 Consultant medical records re 0 PUB PUB NONE 406 Blood culture UNK positive for UNK N. meningitidis. 6/24/09 Unknown. Hospital Unknown records received Unknown~Meningococcal DOS 3/27/09 to 4/3/09. (Menactra)~1~0~Pat LABS and DIA 20 N/A UNK UNK Clarinex, Armor NoneThryo None tab, BonivaN/A~ ()~~0~Patient 0 PUB PUB 0 PUB PVT None None 8/24/09 Medical PVT records PVT received None w/LABS: CT sinus c/w None chronic8/24/09 sinus disease. Medical records CT chest received c/w pulmonary w/PMH: nodules. lactose in Diagnostic Tests: MIL allergy MILskin testing None - NEG for aeroallergens; None peak flow-wn) Labs: none. Diagnostic Tests: UNK MRI's UNK and plainTENORMIN films of hands 50 knees mg; HYDROCHLOROTHIAZIDE feetDermatitis; negative NOS; except History for surgical of 25optic mgchanges neuritis from 1988.plantar fasc 2 See above PUB PVT None None 0 Diagnostic Tests: MIL Request MIL for medNone records sent; Labs: Request Denies for med records sent. 6/23/09 Medical records rec 1 PVT OTH None None NKA or medical conditions 1 PUB UNK None None None 0 None PVT PVT None None ceiving Tdap on 6-8-09. None PUB PVT 1 PVT PVT ASACOL; Vitamin No supplements. Ulcerative colitis in remission. Allergies. Seasonal & Sulfa 1 None (Reports PUBmother)UNK None (Reports None mother)None 0 PVT PUB Tylenol None NKDA None 25 CXR revealed UNK "infiltrateUNK in the rightPREVACID middle lobe30which mg; ZESTRIL was Active consistent Hypertension 40 mg;with NAPROSYN pulmonary essential 500 hemorrhage"; NOS; mg; ItHydrochlorothiazide appeared UA, revealed that his ex h5 0 EEG, Neurology PVT consult PVT pending None None None (35 wk pre term newborn) 1 None PVT PVT LURIDE chewable None tab Born at 37 weeks; Allergic rhinitis 1 None PVT PVT None None None 1 7/12/04, CXR, UNK nl PA and UNK Lat; 7/26/04, Zomig Brain 5 mg; MRI, Albuterol nl; 8/5/04, Asthma Sulfate LFTs, 90 asWNL; mcg/inh; a child; 9/15/04, Lyme Ibuprofen disease CBC 800 withmg diff, lytes, lipids, and U 1 UNK PUB None None NKDA 2 Diagnostic Tests: UNK 1/27/05 UNK Echo: Normal MOTRIN LV 800 systolic mg PRNAllergic function withrhinitisEF 65%; 1991 Small anteriorly located pericardial effus 1 None PVT PUB None Asthma; Sleep disturbance ght sided axillary adenopathy; Diagnostic no constitutional Tests: UNK Pending; UNK symptoms. Labs: Pending TYLENOL Muscle Pain with Start: CODEINE 9/17/2004 NONE #3, 300 - Fatigue mg-30 Start: mg; 9/17/2004 INDOCIN, -25 Lymphadenopathy, mg; CLARITIN, 10axi m 0 None PVT PUB 0 Well child immunizations PVT PVT Tylenol 2 hours Noneprior toNone immunizations Diagnostic Test: UNK pending; UNK Labs: pending None 08/27/2004,UNK EKG, NSRUNK with left axis None deviation; Echo, Borderline Pt. Denies LV size with normal wall thickness and contractility 0 PVT PVT None None None 1 PVT PVT None None None 2 PVT UNK Asthma/Influenza PVT OTH 0 PVT PVT NOVOLOG,Well LANTUS, Type MACRODANTIN II Diabetes, Pyelonephritis, allergic to codeine PERC 0 PVT PUB None None 1 PVT PUB Warts 7 Labs/08/04,UNK CBC with diff; UNKESR = ZANTAC, all WNL 150 150 mg;None BENADRYL, 25 mg; CLARITIN, 10 mg
Labs: 5/5/04 UNK ESR= 22 UNK (H) (0-15) lyme Pt. denies antibody = (H) (1.00) Hyperlipidemia, RF, HbA1C, Pt. TSH, allergic vitamin to Daypro B12, folate - WNL, ANA- neg Diagnostic Tests: UNK requested; UNK Labs:None requested ; Patient has None been lost to follow-up. Diagnostic Tests: MIL HeadMIL CT (without TYLENOL contrast)with = nl;Codeine Labs: Herpes 2/10/05, #3 300Simplex Lyme mg-30disease mg screen= 2/46 H (<1.0); Lyme disea CBC W/DiffMIL Site/Specimen MIL 09 Jul birth 2007control 0805 Units pill Ref Rng; noneWBC BLOOD 9.9 x10(3)/mcL (4.4-11.0); RBC BLOOD 8 Troponin- Negative MIL (6/11/09), MIL CPKNone Level - Negative None (6/11/09) None pending UNK UNK Ibuprofen 400 mg; Vitamin NoneE 400 iu; Vitamin C 500 mg; Vitamin B Complex Vitam Diagnostic Tests: UNK L spine UNK flims-posFlexeril HNP at10mg; L4/L5;Floricet bone scan Influenza 325 mg-50 pelvicvaccine-itching flims-neg; mg-40mg;abdom/pelvic/U/S Wellbutrin 100 mg; and Klonopin CT-pos1liver mg; hP Diagnostic Test: UNK awaiting UNK records None ; Labs: awaiting records. X-rays (shoulders UNK cervical UNKspine) -None Neg; bone scan - Neg;None MRI cervical / thoracic spines- NEG Diagnostic tests: UNK N/A , UNK Labs: N/A ,None Medical records requested. None 0 Unknown OTH OTH Unknown Unknown WAES0804USA02211 0 None OTH OTH Unknown Unknown WAES0805USA00117 Unknown UNK UNK Unknown Obsessive compulsive disorder WAES0805USA00253 0 Unknown OTH OTH Unknown Unknown WAES0805USA04761 allergy test,OTH negative OTH Unknown None WAES0906USA03749 Unknown OTH OTH Unknown Unknown WAES0806USA08382 0 None OTH OTH None WAES0806USA08842 Unknown OTH OTH Unknown Unknown WAES0807USA04110 0 Unknown OTH OTH Unknown Unknown WAES0807USA04415 0 Unknown OTH OTH [therapy unspecified] Egg allergy; Peanut allergy; Food WAES0808USA00305 allergy 0 None OTH OTH None Allergy to nuts WAES0808USA01129 0 Unknown OTH OTH Unknown WAES0808USA03172 1304 serum hepatitis OTHA IgM, OTH 08/27/08, titer None negative None WAES0809USA01568 0 Unknown OTH OTH Unknown Unknown WAES0810USA00555 diagnostic laboratory OTH - OTH "blood work" Unknown unspecified Unknown WAES0810USA04484 Unknown OTH OTH Unknown Unknown WAES0811USA01825 0 Unknown OTH OTH Unknown Unknown WAES0901USA02697 40 None OTH OTH Unknown Unknown WAES0902USA04490 Unknown OTH OTH Unknown Unknown WAES0805USA01028 Unknown OTH OTH Unknown Unknown WAES0807USA01622 1 Serum Glucose, PVT 08/06/2008, PVT 183 Insulin Type 1 diabetes mellitus WAES0808USA04266 0 urine glucose, OTH 08/15/08, OTH diagnosed Unknown with diabetes Egg allergyAsthma WAES0808USA04659 Unknown OTH OTH Unknown Unknown WAES0809USA03250 Unknown OTH OTH Unknown Unknown WAES0811USA02717 Unknown OTH OTH Unknown Unknown WAES0812USA02364 0 Unknown OTH OTH Unknown Movement disorder WAES0811USA00271 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0812USA03761 Unknown OTH OTH Unknown Unknown WAES0812USA04292 7 None OTH OTH Unknown Unknown WAES0812USA04527 Unknown OTH OTH Unknown Unknown WAES0812USA05081 954 Serum mumps OTHIgG antibody OTH 11/12/08 LIPITOR; - negative; LEVOTHYROXINE Drugserum hypersensitivity; rubella SODIUM IgGArthritis; 11/12/08Osteoporosis; - positive; WAES0812USA05090 serum Hyperlipidaemia; rubella IgG 11/12/08 Hypoth 379 serum hepatitis PUBC, 03/25/08, OTH pending; serum rubella IgG,Unknown 03/25/08, 4.13; serumWAES0804USA00374 varicella zoster, 03/25/08, 2.05; se 962 None OTH OTH None WAES0804USA00375 5979 Serum mumps OTHIgG antibody, OTH 03/28/08 None- just adequate; Serum None rubella IgG, 03/28/08 WAES0804USA01041 - adequate; Serum measles Ig Unknown OTH OTH Unknown Unknown WAES0804USA01249 diagnostic laboratory, OTH titer; OTHbody temp, Unknown 98 Unknown WAES0804USA02195 Unknown OTH OTH Unknown Hypersensitivity WAES0804USA02356 35 Diagnostic laboratory, OTH 24-dec-2007, OTH Unknown pt underwent severalConvulsion unspecified in outpatient childhood. WAES0804USA02566 tests; Neurological examination, n serum rubella OTH IgG, negative; OTH serum Unknown rubella IgG, negative;Unknown serum rubella IgG, negative WAES0804USA02684 0 Unknown OTH OTH Stroke; Cardiac disorder WAES0804USA02805 diagnostic laboratory, OTH ?/?08, OTH titersNone were equivocal; diagnostic Nonelaboratory, 80?, titers WAES0804USA02851 were equivocal
45 None PVT PVT None None WAES0804USA03127 12 None OTH OTH None None WAES0804USA03762 0 Diagnostic laboratory, OTH 03/25/08 OTH - negative measles, mumps, Unknown and rubella titer; Diagnostic WAES0804USA03905 laboratory, 05/16/2008 - m 0 Unknown OTH OTH Unknown None WAES0804USA04024 3143 serum measles OTHAb, 04/??/08, OTH posit, None serum mumps Ab, 04/??/08, None negat; serum rubella WAES0804USA04732 IgG, 04/??/08, posit Unknown OTH OTH Unknown Unknown WAES0804USA04855 6 Streptococcus OTHagalactiae, OTH04/22/08, Unknown negative Urinary tract infection WAES0804USA04886 diagnostic laboratory, OTH 12/??/07, OTH negat, Unknown rubella antibody titer; Unknown diagnostic laboratory, WAES0804USA04958 ?/?/07, negat, rubella antibody t 11 None PVT PUB Penicillin allergy; Hives Viral infection WAES0804USA04963 1648 diagnostic laboratory, OTH positive OTH for mumps; Unknowndiagnostic laboratory, Unknown 03/07/08, 0.32,WAES0804USA05045 mumps titer; diagnostic laboratory, Unknown OTH OTH Unknown Drug hypersensitivity WAES0804USA05494 Diagnostic laboratory, OTH not OTHimmuneUnknown to rubella Unknown WAES0804USA05945 0 Unknown OTH OTH Unknown WAES0804USA06452 0 Unknown OTH OTH Unknown WAES0805USA00604 serum mumps OTH Ab, negat OTH Unknown None WAES0805USA00963 Unknown OTH OTH Unknown Unknown WAES0805USA00472 0 Unknown PVT PUB Unknown Unknown WAES0805USA01259 9 completed blood OTH cell. OTH None WAES0805USA01301 serum rubella OTH IgG, negative OTH rubella Unknown titer ELISA Unknown WAES0805USA01724 Unknown OTH OTH Unknown Unknown WAES0805USA02007 Unknown OTH OTH Unknown Unknown WAES0805USA02008 None PVT PUB None WAES0805USA02851 Unknown OTH OTH Unknown Unknown WAES0805USA03043 Unknown OTH OTH Unknown Unknown WAES0805USA03044 0 Unknown OTH OTH Unknown WAES0805USA03443 Unknown OTH OTH Unknown Egg allergy; Allergy to grains; Allergy WAES0805USA04017 to nuts; Fruit allergy; Milk allerg 72 Magnetic resonance, OTH pendi; OTH electromyography, ZYRTEC Drug pendi; hypersensitivity; diagnostic laboratory, Penicillin pendi, allergy; WAES0805USA04028 comprehensive Iodine allergy metabolic pane 13 None OTH OTH vitamins (unspecified) None WAES0805USA04742 1968 Serum mumps OTHIgG antibody OTH 05/22/08 Unknown 1.9 - elevated; serum Unknown immunoglobulin G 05/22/08 WAES0805USA04823 < 0.8 - negative; serum am 0 None OTH OTH None None WAES0805USA05616 serum mumps OTH Ab, negative OTH mumps Unknown titer; serum measlesUnknown Ab, acceptable titer; serum WAES0806USA00334 rubella IgG, acceptable titer 47 ultrasound 04/12/08 OTH epidi OTH Unknown Unknown WAES0806USA00655 0 Unknown OTH OTH Unknown Atopy; Hypersensitivity; Egg allergy WAES0806USA01349 0 None OTH OTH Unknown None WAES0806USA01956 Serum mumps OTHAb, Titer OTH is negative Unknown for mumps. Unknown WAES0806USA01991 Diagnostic laboratory, OTH MMR OTH titer - Unknown did not respond to oneUnknown of the components WAES0806USA02474 6150 serum mumps OTH IgG antibody, OTH 06/02/08, nortriptyline; 0.97, 0.91 Sulfonamide IMITREX to 1.09Migraine; considered allergy; Drug Hypersensitivity; equivocal hypersensitivity WAES0806USA03069 (low); Sleep serum disorder hepatitis B core, result 0 diagnostic laboratory OTH 12/??/07 OTH negat Unknown - rubella antibody titer; Unknown diagnostic laboratory WAES0806USA03246 01/??/07 negat - rubella antibody 0 Diagnostic laboratory, OTH 12/??/07, OTH neg rubella antibody titer; Unknown Diagnostic laboratory, WAES0806USA03247 ?/?/07, neg rubella antibody titer 15 None OTH OTH Unknown None WAES0806USA03736 serum mumps OTH Ab, Low; OTH serum measles Unknown IgG, Adequate; serum Unknown rubella IgG, Adequate WAES0806USA08308 13 diagnostic laboratory, PVT 06/23/08, PVT "no, amoxicillin "blood work"; Otitis body media; temp, Upper 06/23/08, respiratory low,tract atWAES0806USA09015 the infection physician's office; body temp, 0 4 None PVT OTH None Eczema; Cardiac murmur WAES0807USA00301 None OTH OTH Unknown Respiratory tract infection WAES0807USA00647 viral diagnostic laboratory, OTH low OTH mumps None titer Penicillin allergy; Allergic reaction WAES0807USA01282 to antibiotics 0 None OTH OTH [therapy unspecified] Port wine naevus; Allergic reactionWAES0807USA01385 to antibiotics diagnostic laboratory OTH - OTH antibody blood Nonetiter negative Egg allergyEczema for mumps WAES0807USA01390 serum rubella OTH IgG, negative; OTH serum None hepatitis B Ab, positive, None within range WAES0807USA01882 3679 serum albumin, PVT 02/20/08, PVT3.3 G/DL, Unknown low; mean Autoimmune corpuscular, disorder; 02/20/08, Colitis 32.8ulcerative G/DL, WAES0807USA02212 low; RDW, 02/20/08, 17.0 %, hig 2 biopsy, 11/25?/08, PVT it was PVT not contagious PLAQUENIL; and Penicillin could APLISOL be viral allergy; in nature; Drug hypersensitivity serum mumps WAES0807USA02259 Ab, 08/08/08, posit 0 OTH OTH Unknown Unknown WAES0807USA02929
serum rubella OTH IgM, negat OTH Unknown Unknown WAES0807USA03594 serum measles OTHAb, negative; OTH serum Unknown mumps Ab, able to seroconvert; Unknown serum rubella WAES0807USA04023 IgG, able to seroconvert; serum serum rubella OTH IgM, negat OTH None None WAES0807USA04121 diagnostic laboratory, OTH non-reactive OTH Unknown mumps titer Unknown WAES0807USA04834 1 None PVT PVT None Hypersensitivity WAES0807USA05192 serum measles OTHAb, 06/10/08, OTH <0.91, hydrochlorothiazide; negative;Hypertension; serum mumps lisinopril Cervical Condyloma; Ab,conisation; 06/10/08, Immunisation; <0.91, Cervical WAES0807USA05497 negative; dysplasia Fibromyalgia; serum rubella Penicillin IgG,alle 06 Unknown OTH OTH Unknown Pregnancy (LMP = Unknown) WAES0807USA05524 12 chest X-ray,OTH 07/28/08, OTH within normal limits; complete blood Unknown cell, 07/??/08, Normal; WAES0807USA05530 body temp, 07/19/08, 103 degre serum measles OTHAb, normal; OTH serumUnknown rubella IgG, Infertility normal; serum mumps Ab, low WAES0807USA05546 diagnostic laboratory, OTH negative OTH titers Unknown for Rubella Unknown WAES0807USA05695 0 Unknown OTH OTH Unknown Unknown WAES0808USA00136 0 Unknown OTH OTH Unknown Unknown WAES0808USA00284 Unknown OTH OTH Unknown Heart disease congenital WAES0808USA00678 9 WBC count,OTH 05/??/08, OTH 5000; WBCUnknown count, 08/08/08, Breast 2000; cancerWBC count, 08/12/08, WAES0808USA01310 5500 Unknown OTH OTH Unknown Unknown WAES0808USA01337 3878 serum measles OTHAb, 07/01/08, OTH Non-reactive None WAES0808USA01347 3 Unknown1/2008 OTH OTH Unknown Unknown WAES0808USA01675 8 None OTH OTH None WAES0808USA01729 diagnostic laboratory, OTH no OTH titers Unknown Postmenopause WAES0808USA01806 10 Unknown OTH OTH Unknown Premature birth WAES0808USA01821 Unknown OTH OTH NEXIUM; PENTASA; Penicillin allergy; ENJUVIA Drug hypersensitivity WAES0808USA01953 0 beta-humanOTH chorionic, OTH 08/12/08, positive Unknown Adhesion WAES0808USA02149 2 None OTH OTH None None WAES0808USA02648 2 None PVT OTH None Asthma Premature birth WAES0808USA02658 10 body temp, OTH 08/15/08, 101.9 OTH F None WAES0808USA03170 Unknown OTH OTH Unknown Peanut allergy WAES0808USA03536 7 body temp, PVT 07/30/08, 102; PVTbody temp, None08/02/08, Penicillin 36.9 Callergy Vomiting WAES0808USA04342 serum measles OTHIgM, low OTH measles Unknown titer Unknown WAES0808USA04672 -5 diagnostic laboratory, OTH 07/30/08, OTH titers-negative Unknown Drug hypersensitivity WAES0808USA04970 Unknown OTH OTH Unknown Unknown WAES0903USA01084 Unknown OTH OTH Unknown Unknown WAES0903USA01085 Unknown OTH OTH Unknown Unknown WAES0903USA04716 0 Unknown OTH OTH Unknown Unknown WAES0903USA04868 213 magnetic resonance, OTH normal; OTH computed axial, normal; electroencephalography, Unknown WAES0808USA04990 abnormal 0 None OTH OTH Unknown WAES0808USA05346 Unknown OTH OTH Unknown Unknown WAES0809USA00020 24 serum mumps OTH IgG antibody, OTH 4.41;Unknown serum mumps IgM antibody, Salivary80 gland disorderWAES0809USA00264 serum measles OTHIgG, >0.91 OTHU [therapy unspecified] None WAES0809USA00311 serum measles OTHIgG, 06/06/06, OTH negative None None WAES0809USA00514 body temp, OTH 107 F OTH Unknown Unknown WAES0809USA00720 1 OTH OTH Renal disorder Feeding tube insertion;WAES0809USA01166 Congenital genitourinary abnormal 1040 Diagnostic laboratory, OTH 08/08, OTH titer test revealed not protected Nonefrom mumps. WAES0809USA01376 12 Unknown OTH OTH Unknown Unknown WAES0809USA01587 229 Diagnostic laboratory, OTH negative OTH for rubella titers; Drug diagnostic hypersensitivity laboratory 08/18/08,WAES0809USA01970 rubella titer still negative. Serum umps OTH Ab, 09/05/2008, OTH negative. None None WAES0809USA02105 Erythrocyte,OTH increased OTH from the 60's to 188 Glaucoma; Breast Depression; mass Insomnia;WAES0809USA02613 Drug hypersensitivity; Food allergy Unknown OTH OTH Unknown Unknown WAES0809USA03791 0 Serum measles OTH IgG, low OTH titer; Serum Unknown mumps IgG antibody, Unknown low titer; Serum rubella WAES0809USA04333 IgG, low titer. 1 None OTH OTH None None WAES0809USA04517 55 None OTH OTH Unknown Unknown WAES0809USA04525 diagnostic laboratory, OTH low OTH mumps None titer Penicillin allergy; Allergic reaction WAES0809USA04597 to antibiotics
0 Unknown OTH OTH None WAES0809USA04616 7 None OTH OTH None None WAES0810USA00010 16 pelvic ultrasound, PVT normal; PVTurine beta-human, FLONASE; Pregnancy positive ibuprofen NOS (LMP = 8/15/2008); WAES0810USA00544 Seasonal allergy; Thyroid disord serum measles OTHAb, adequate; OTH serum None mumps Ab, adequate; None serum rubella IgG,WAES0810USA01976 negative or low 13 None OTH OTH Unknown None WAES0810USA03413 0 Unknown OTH OTH Unknown Unknown WAES0810USA03422 Unknown OTH OTH Unknown Unknown WAES0810USA03729 Unknown OTH OTH Unknown Unknown WAES0810USA03787 None OTH OTH None None WAES0810USA03948 8 Unknown OTH OTH Unknown Unknown WAES0810USA04143 Unknown OTH OTH Unknown Unknown WAES0811USA00283 924 serum mumps PVTIgG antibody, PVT 10/25/08, Unknown positive; serum mumps None IgM antibody, 10/29/08, WAES0811USA02891 positive; serum mumps IgM Unknown OTH OTH Unknown Unknown WAES0811USA03062 15 OTH OTH Unknown Drug hypersensitivity WAES0811USA04133 Unknown OTH OTH Unknown Unknown WAES0812USA02053 11 None OTH PVT Citalopram,Depression Olanzapine WAES0812USA02331 Unknown OTH OTH Unknown Unknown WAES0812USA02373 serum measles OTHAb, 02/24/08, OTH negat; Unknown serum measles Ab, Unknown 04/30/08, negat WAES0812USA02572 Unknown OTH OTH Unknown Unknown WAES0812USA02587 7 None OTH OTH None None WAES0812USA02768 body temp, OTH 104 degrees OTH Unknown Latex allergy Anaphylactic reaction WAES0812USA02808 Unknown OTH OTH Unknown Unknown WAES0812USA03174 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0812USA03218 4 Unknown PVT PVT Injection site irritation WAES0812USA03515 Unknown OTH OTH Unknown Unknown WAES0901USA00128 0 None OTH OTH LAMICTAL;Drug SEROQUEL hypersensitivity Emotional problems WAES0901USA00177 serum rubella OTH IgM, 01/01/09 OTH - low Unknown titer WAES0901USA00190 None OTH OTH None Unknown WAES0901USA00321 1 None OTH OTH None Drug hypersensitivity; Tonsillar disorder Hypersensitivity WAES0901USA01341 0 Unknown PVT PUB None WAES0901USA01725 Unknown OTH OTH Unknown Unknown WAES0901USA01824 Unknown OTH OTH Unknown WAES0901USA03456 diagnostic laboratory, OTH rubella, OTH mumps Noneand rubeola titers None WAES0901USA03472 0 Unknown OTH OTH Unknown Hypersensitivity WAES0901USA04120 Unknown OTH OTH Unknown Unknown WAES0901USA04183 None OTH OTH Drug hypersensitivity WAES0902USA00262 Unknown OTH OTH Unknown Unknown WAES0902USA00430 serum mumps OTH Ab, negative OTH Unknown None WAES0902USA00441 Unknown OTH OTH None Attention deficit disorder WAES0902USA00453 7 None OTH OTH None None WAES0902USA00468 Unknown OTH OTH Unknown Unknown WAES0902USA00612 Unknown OTH OTH Unknown Unknown WAES0902USA01084 25 Diagnostic laboratory, OTH rubella OTH non immune; Ultrasound, Pregnancy01/23/09, Miscarriage NOS (LMP 7 weeks = 11/30/2008); 3 days WAES0902USA01110 gestation Fertility decreased Unknown OTH OTH Unknown Unknown Asthma~Measles WAES0902USA01776 (no brand name)~UN~5~Sibl Unknown OTH OTH Unknown Unknown WAES0902USA01784 diagnostic laboratory, OTH antibody OTH response Unknown to MMR is negative Unknown WAES0902USA01858 None OTH OTH Unknown None WAES0902USA01880 Unknown OTH OTH Unknown Unknown WAES0902USA02376 Unknown OTH OTH Unknown WAES0902USA02405 0 None OTH OTH Unknown Jaundice WAES0902USA02482 Unknown OTH OTH Unknown Unknown WAES0902USA02618
serum measles OTHAb, 0.98, OTH negative;Unknown serum rubella IgG, positive; Unknown serum mumps Ab, WAES0902USA02792 positive Unknown OTH OTH Unknown Unknown WAES0902USA02907 Diagnostic laboratory, OTH rubella OTH titersUnknown were normal; Serum measles UnknownAb, negative; WAES0902USA02944 Serum mumps Ab, normal 2775 Unknown PVT PVT Unknown Unknown WAES0902USA03071 Unknown OTH OTH Unknown Unknown WAES0902USA03102 Unknown OTH OTH Unknown None WAES0902USA03118 serum mumps OTH Ab, negative OTH Unknown Sulfonamide allergy WAES0902USA03602 Unknown OTH OTH Unknown Unknown WAES0903USA00343 serum mumps OTH Ab, negative OTH Unknown Unknown WAES0903USA00538 body temp, OTH 105 OTH Unknown Unknown WAES0903USA00594 Unknown OTH OTH Unknown Unknown WAES0903USA00746 Unknown OTH OTH Unknown Injection site reaction WAES0903USA00892 Diagnostic laboratory, OTH negative OTH forNone rubeola antibody titersNone WAES0903USA00918 4 Unknown OTH OTH Unknown Unknown WAES0903USA00923 None OTH OTH None Seafood allergy; Shellfish allergy WAES0903USA00967 9 Unknown OTH OTH Unknown Unknown WAES0903USA01091 0 diagnostic laboratory OTH OTH None Gluten intolerance Gastrointestinal discomfort WAES0903USA01096 Unknown OTH OTH Unknown Unknown WAES0903USA01408 Unknown OTH OTH Unknown Unknown WAES0903USA02001 None OTH OTH None None WAES0903USA02076 Unknown OTH OTH CYANOCOBALAMIN, Pernicious SYNTHROID anaemia; Hypothyroidism; WAES0903USA02227 Back surgery 0 None OTH OTH None None None WAES0903USA02298 Unknown OTH OTH Unknown Unknown WAES0903USA02334 Unknown OTH OTH Unknown Unknown WAES0903USA02338 0 Body temperature, OTH 08/??/05, OTH high Unknown fever None WAES0903USA02344 16 None OTH OTH None None WAES0903USA02357 Unknown OTH OTH Unknown WAES0903USA02558 Unknown OTH OTH Unknown WAES0903USA02571 body temp, OTH 104 OTH Unknown Unknown WAES0903USA02669 serum rubella OTH IgG, 03?/??/09, OTH lowUnknown levels of immunity Pregnancy NOS (LMP = Unknown); WAES0903USA02918 Food allergy Unknown OTH OTH Drug hypersensitivity; Asthma Breathing difficult~Varicella WAES0903USA03186 (Varivax)~UN~8~P Unknown OTH OTH Unknown Unknown WAES0903USA03661 0 Unknown OTH OTH Unknown Unknown WAES0903USA04009 Body temperature, OTH overOTH 105 degrees Unknown Fahrenheit Unknown WAES0903USA04524 Unknown OTH OTH Unknown Unknown WAES0903USA04535 200 Serum measles OTH Ab, 03/16/2009, OTH negative. Albuterol; Veramyst; Asthma; Seasonal Trazodone allergy; hydrochloride AllergicWAES0903USA04550 reaction to antibiotics Unknown OTH OTH Unknown Unknown WAES0903USA04711 Serum measles OTH Ab, negative OTH PROSCARBenign prostatic hyperplasia WAES0903USA04728 Unknown OTH OTH Unknown Unknown WAES0903USA04776 0 None OTH OTH None None WAES0903USA04855 Unknown OTH OTH Unknown Unknown Adverse event~Measles WAES0903USA04857 + Mumps + Rubella (n Unknown OTH OTH Unknown Unknown fever~Measles WAES0903USA05410 + Mumps + Rubella (no brand n Unknown OTH OTH Unknown Unknown WAES0903USA05433 Unknown OTH OTH Unknown Unknown Waes0903USA05610 0 Unknown OTH OTH Unknown WAES0904USA00002 Unknown OTH OTH Unknown Unknown WAES0904USA00009 Unknown OTH OTH Unknown Cardiac septal defect WAES0906USA01886 3683 Unknown OTH OTH None Drug hypersensitivity WAES0906USA02262 8 Not reported MIL MIL Medical history not reported ### CT Scan - revealed UNK lesions UNK in liver The patientNo hadadverse a history e~Japanese of chronic ### hepatitis Enceph. B. (J-VAX)~1~0 It was unk 0 CLINICAL MIL MIL NONE NONE NONE
1 PUB PVT 687 UNK PVT none 1 05/14/2009:UNK WBC 11.8UNK H /cumm RBC ALBUTEROL 5.0 M/cumm None 90MCG HGB(CFC-F) PMH: 16.4 GERD, g/dL 200D HCT low ORAL 46.8 back INHL MCV pain,INHALE 93.6 chronic fem/l 2airway MCH PUFFS 32.7 obstruction, BYpic MOUTH 35.0% al 0 PUB PUB UNK NONE NONE 1 UNK UNK 257 PUB PVT None reported Allergic to Dimetane History of Infectious Mononucleosis 1 1 PVT PVT none none none 1 PVT PVT none history of fever seizure 0 UNK UNK NA NA NA 0 MIL MIL Mobic, Claritin, No GenericAllergic Prozac, toCentrum penicillian, Siver hayfever 113 UNK PUB 0 UNK UNK 0 UNK UNK UNK UNK 11 MIL MIL 0 None PVT PUB None Known 5/18/09: Chronic Amoxilcough 6/8/09: Pnuemonia. 6/16/09: A 0 N/A PVT UNK Advair & Albuterol No Allergies to pollen and pet dander, asthma 10 MIL MIL 1 7/7/09 Hospital UNKrecordsUNK received DOS ALBUTEROL 5/5/09 N/A 5/9/09. NEBULIZER LABS RSV and SOLUTION BRONCHILOITIS. DIAGNOSTICS: 7/7/09 RSV (+) Hospital Leukocytosis. records received D 0 UNK UNK N/A PUB PUB None None No known allergies 1 PUB PVT no but sleep deprived and stressed (patient works night shifts) 2 CT scan ruled UNK out postUNK op infectionPropanolol, as sourcefollowing Alavert of fever.D, laparoscopic 7/2/09 Codeine, Darvocet, Hospital aspirin. Xanax, None~ cholecystectomy records 7/2/09 Wellbutrin, ()~~0~Patient|None~ received Hospital Bayer DOS records vitamin 6/18/09 ()~~0~Sibling|Non received to 6/20/09. DOS 6/L 1 PVT PVT None None PVT UNK 2 none UNK UNK none none none 1 None PVT PUB After event None on CEPHALIXIN None 1 None PVT PUB Well Child GER 0 No further testing PVT donePVT None Congenital Nystagmus 1 None PUB PUB None None Child is a twin 14 10/08/08 EEG; PUB02/12/09 PUB EEG & MRI None None None KS200903 4 PVT PVT KS200907 2 PVT PVT BACTRIM Sinusitis Allergies to PCN, CEPHALOSPORINS KS200906 0 None PUB PVT None KS200905 7 Spinal Tap PUB to check forPUB meningitis. Test came None back negative. None KS200904 0 electroencephalography, UNK OTH results not hydromorphone; provided;Anxiety; full blood SINGULAIR; Depression; chemistry, Spinal fracture ZOLOFT Asthma; results not Twitching; provided WAES0906USA02278 Tremor 0 PVT PVT YASMIN. 11 Nerve conduction PVT study, PVT positive for TOPROL acute axonal XL; None PLAVIX; injury. CAD; 7/8/09 Aspirin; peripheral consult COZAAR records neuropathy; ; ZOCOR received HTN; DOS gout; 11/3/08 Hyperlipidemia; to 6/13/09. A L 0 OTH PUB Benadryl given None Hosp VSD repair/transfusion required. 1 6/26/09 Received PVT medical PVTrecordsTYLENOL; LABS: EEG None ZANTAC WNL. CTGERD head WNL. 6/26/09 Osseous Received survey medical x-rays records neg except PMH: Parainflue for right c 12 EEG PVT UNK Allergic rhinitis / cough 0 PVT PVT 1 PVT PVT None None 2 MRI; EEG PVT UNK Yes, had abnormal CBC 2548 PVT OTH Unknown None 2 None PVT OTH PPD Cold; urticaria Cold Aug URI '06Aug '06~Vaccine not specified (no br 1 None donePUB PUB None diabetes 0 PVT PVT None Pure Hyperglyceridemia None 1 PVT PVT None Prematurity; stenosis of nasolacrimal duct None PVT PVT MOTRIN; KEFLEX; None BENADRYL Ectopic testes; Atopic dermatitis 0 No 9/22/09-records PVT receivedPVT EKGNone sinus arrhythmis. None EEG None normal. Labs ~HPV WNL. (Gardasil)~1~17~Patient
1
PUB PUB None Fussy, increase gas on Similac advance- Doing well on Si OTH MIL OTH MIL 10 None PVT OTH None Conjunctivitis None 2 See attached OTH documentation. UNK Dyazide; Zoloft; NoneNasacort Allergies AQ; Travatan (mold, dust); High blood pressure; Glaucoma 1 NONE MIL UNK NONE UNKNOWNNONE 0 PVT UNK none 0 ultrasound, PUB 09/01/08, OK OTH vitamins (unspecified), Pregnancy NOS tab (LMP = 5/5/2008)WAES0810USA02712 1 chest X-ray,OTH 06/10/09, OTH negative; diagnostic None laboratory, Immune-mediated 06/10/09,thrombocytopenic negative for influenza; WAES0906USA02119 purpura; diagnostic Anaemia urinalysis, macrocytic 06/10 1 Unknown UNK OTH Unknown Unknown WAES0906USA02577 Unknown OTH OTH Unknown Unknown Autism~Measles WAES0906USA02082 (no brand name)~UN~0~Sibli 7 None OTH OTH Unknown None WAES0906USA02085 Unknown OTH OTH Unknown Unknown Leukaemia~Measles WAES0906USA02257 (no brand name)~UN~0~S 0 Ultrasound,UNK 12/21/07, positive UNK None Pregnancy NOS (LMP = 10/29/2007) WAES0802USA04905 100 Unknown OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0906USA02049 Unknown OTH OTH Unknown Predisposition to disease WAES0906USA02099 0 Unknown OTH OTH NASOCORT; Drug erythromycin; hypersensitivity Overgrowth NASONEX; bacterial neomycin WAES0906USA02310 Unknown OTH OTH Unknown WAES0906USA01892 0 Unknown OTH OTH None Oxygen supplementation. Premature baby6/23/09 less than WAES0906USA02328 Medical 26 weeks; records Intensive received care DOS 6/12 0 PUB PUB 0 UNK UNK 0 UNK UNK 0 UNK UNK 0 UNK UNK 1 none at time PUB of this report PUB none reported no none reported 0 none UNK PUB protonix, toprol, nonesynthroid NKA 0 PVT PVT none none eczema 0 N/A MIL MIL N/A None None 1 PUB PVT None None None 0 none PUB PUB None overweight 0 PVT PVT NO 0 UNK UNK 1 PVT PUB VITAMINS N/A 0 PVT PVT none none 0 UNK UNK 1 none UNK PVT Lipitor, Metoprolol none allergy to Plavix and pollen. Medical condition includes hea 0 UNK UNK 2 PUB PUB COUGH ASTHMA 3 None PVT UNK Zocor, Sinemet, NoneTriamterene/HCTZ, Hyperlipidema,Cimetidine, RLS, HTN,Etodolac GERD, DJD, 0 UNK UNK 0 UNK UNK 0 none PUB PUB MOTHER STATES NONE NONE MOTHER STATES N/A~ ()~NULL~~In NONE Sibling1|N/A~ ()~NULL~~In 2 PVT UNK Norvasc none NKDA; HTN; pre- DM 0 UNK UNK 0 UNK UNK 17 PVT PVT 1 CM INGUNAL REGION~Measles + Mumps + 1 PVT UNK WARFARIN, NONE TRAZODONE, DILTIAZEM COMBIVENT, - NAUSEA/VOMITING METOPROLOL, SIMVASTATIN, LAS 1 PUB PUB None No No 1 N/A PVT PVT none none none 4224 PVT UNK 4 NONE PVT PUB NONE THIS IS A FOSTER CHILD MOTHER WAS ON DRUGS A
3 UNK UNK Ct rcvd Rx for n/aTy21a and n/aChloroquine from health dept on 6/15/09. Ct purchased 1 UNK UNK 104 PVT UNK 4 n/a PVT PVT NONE N/A N/A 6 6/29/09 Medical UNK records UNK received DOS 1/15/08 Acute to 8/20/08. Diarrhea Diarrhea LABS and for 2DIAGNOSTICS: weeks, watery mucousy, Stool - Fecal greenish. Reducing 6/29/09 SubsM 222 MIL MIL none none none 0 na PVT PVT no None 2 UNK UNK oral Hydrocortisone, see #19-NO Synthroid, Addison's ACUTEOxycodone ILLNESS Disease, Lymph nodes Cushing's CR, in Oxycodone neck Syndrome, on side IR, of Valium SEVERE injection 2mg, fluid terribl Xan re 196 PVT OTH None 0 PVT PUB None 3 wks URI Sx 1 None OTH PVT None None None 1 OTH PVT None 0 PUB PVT Fever, JointH/A pains -5 PVT PUB 8 UNK. 7/9/09PVT Hospital records PUB received DOS 6/5/09 Unknown to 6/7/09. The subject LABS and wasDIAGNOSTICS: completely A0792059A healthy Hemoccult prior to vaccination. (+). X-ray Che H 1289 (+) PCR OTH OTH 0 CBC; INR normal. PVT 7/7/09 PUBHospitalAspirin; recordsSotalol; received Enalapril; DOSComplex 6/0/09 COUMADIN tocongenital 6/3/09. LABS heartand defect; DIAGNOSTICS: s/p surgeries; CBCHx ofRBC SVT5 7 thrombophilia PVT evaluation OTH is entirelyLORAZAPAM negative. 9/17/09 None Hospital None.records PMH 9/17/09 received Hospital DOS 4/27/09 recordsto received 4/28/09.DOS LABS 4/27/0 and MIL MIL 19 None. OTH PUB TOPROL XL None 25 mg one Hypertension; once daily; HCTZ Hypercholesterolemia 25 mg one once daily PUB PUB None None 1 PVT PUB 1 Acute URI 465.9; PVT Viral PUB Syndrome 079.99 Viral Syndrome; NoneAfebrile 0 None PVT PVT None None 0 PVT PUB None 0 None PVT PVT None None None 1 PVT OTH none none 2 UNK UNK 9 Stool for C.PVT difficile toxin PVT (both times None was positive). None None OTH OTH None None None 1 None PVT PUB None None Right ear canal obstructed birth defect (Atresia) 0 PVT PUB MIRALAX 2 PVT PUB PPD No No None PVT PVT None None UNK UNK 1 None PVT PVT No None 1 None PVT PVT None None 0 PUB PUB ZYRTEC; RANITIDINE Denied Seasonal/pollen allergies 0 PVT PVT None None 2 PVT PUB SUDAL 12; SINGULAIR Unknown 0 None PVT UNK None Sulfa ASA allergies; Reiter's syndrome; Anxiety; Spastic co 1 PVT PVT Synthroid, 0.100 None mg. Zyrtec None 10mg. qd 0 PUB PVT at visit BENADRYL None known 25 N mg one po, known 50 mg IM 2 none PVT OTH None None None 1 Dad req. Abx. PVT therapy PVT (1) given ZYRTEC 10mg None QD x7 day Asthma - (2) Cefadroxil 250mg 1 1/2 tsp BID x10d. 718 PAP smearPVT PUB CONCERTA None 27mg None OTH OTH 0 PVT PUB None None VSD, surgically completely repaired 1 PUB UNK None - tookNone baby aspirin None and Lovostatin later in the night 1 UNK UNK EMSAM (Transdermal None Allergic Selegiline) rhinitis Dose associated is 6 mg/24 withhours environmental EMSAM allergies is an MA UNK UNK
2 I am seeingUNK a board certified UNK rheumatologist who None can confirm allergies my diagnosis. to sulfa drugs and barbiturates 0 PVT UNK none none 77 colagenosisUNK estudies( c3 PVT c4 anas),NONE RMN ANDNONE ANGIO-RMN, NONE EMG, VDRL, PCR , LUMBAR PUNCTION WITH DIFF 1 PVT PVT none allergic to peanuts 1 NONE AS OF PUB YET. UNK NONE REACTS TO NONE~ AMOXICILLAN ()~NULL~~In Sibling1|NONE~ ()~NULL 1 PVT UNK none none none 8 body temp, OTH 4/22?/08, 103; OTHbody temp, 4/22?/08, 104 Unknown WAES0804USA05245 0 Unknown OTH OTH Unknown Unknown WAES0810USA02860 Unknown OTH OTH Unknown Unknown WAES0903USA03639 Unknown OTH OTH Unknown Renal insufficiency; Diabetes;Hypertension; Asthma; Myocardial WAES0906USA01827 Coronary infarction artery disease 2 MIL OTH Medical history Cardiac included diso~Influenza multiple ###seasonal (Fluzone)~~0~Patient allergies. OTH OTH Cardiac diso~Influenza ### (Fluzone)~~0~Patient 0 Stool for fecal, PVT03/08/09, PVT not seen; Nasopharyngeal RSV, Unknown 03/08/09, negative for WAES0904USA04516 RSV antigen; Nasopharyngeal hu 0 beta-humanOTH chorionic, OTH "positive" albuterol Pregnancy NOS (LMP= 2/15/2008); WAES0807USA03017 Asthma; Drug hypersensitivity 0 urine beta-human, OTH 08/18/08, OTH positive None Pregnancy NOS (LMP = 7/29/2008) WAES0808USA03705 154 magnetic resonance, OTH fine; OTHhead computed axial, fine; hematology, None PMH: immune scoliosis, system WAES0906USA02285 costochondritis, is compromised. sinusitis, Labs:pahryngiti Spirome 1 none PVT PUB none none 0 CBC, BasicMIL Metabolic Panel, MIL CT Scan Unknown of head None and HCGNone Ql test performed. Blood test normal with only elevation in 2 N/A PUB UNK Albuterol Inhaler, N/A Augmentin Allergies: (start Aspirin 6/07, end (GI distress), 6/17), Atorvastatin, Propafenone Coenzyme (dysrhythmia Q10, 0 none PVT PUB none no none 21 UNK UNK 8 UNK UNK None notednone 1 UNK PVT Sanctura, furosemide, Advair, Zetia, Midodrine, Glipizide, Simvastatin 0 PUB PUB none pt had not eaten no prev. all day. nka It was late afternoon 0 NONE PVT PVT NONE NONE NONE 0 PVT PVT no no no no~ ()~NULL~~In Patient 6 7/30/09 Hospital UNK records UNK received Prednisone DOS 6/17/09 none and 6/19/09. Plaquenil none. LABS 7/30/09 and DIAGNOSTICS: Hospital records Chest received X-ray DOS No evidence 6/17/09 for 6/19 a 2 PVT PVT NONE NONE 0 PVT PVT none none none 1 PVT PUB 0 PVT PUB on concerta & clonidine 0 None PVT UNK None Alergies: Prozac 0 Possible allergic PUB reaction PVT given Benadryl None by mouth None by mother, Allergic fully to Penicillin/shoulder recovered within several (R) surgery hours.3 weeks. 136 UNK UNK COPD 3 UNK UNK none He said that he is allergic to cephalosporins which he had 1 PVT PVT 0 N/A PVT UNK N/A No UNK UNK None none 11 CBC Platelet UNK count 8,000. UNKHospitalNone records received None DOS Hospital 4/8/09 records to 4/9/09. received LABS and DOS DIAGNOSTICS: 4/8/09 to 4/9/09. CBC Allergies - Plate 4 OTH OTH None No information provided 0 NONE PUB PVT NONE NONE NONE 0 UNK UNK None No None 8 UNK UNK aspirin 81 mg, none vitamin iodine D, multiple and shellfish vitamin allergies 9 None PVT PVT TYLENOL/PRN 2 None donePVT UNK None 2 PVT PUB Drug allergy, sulfa 2 None PVT PUB no meds. used Currently 0 CBC; CMP;PUB lipid panel;PUB urine pregnancy; Varicella titers None 0 PUB PVT 0 None MIL MIL Fluocinonide, None 0.05% Allergies : iodine; shellfish 0 none PUB PUB none asthma
- none -
OTH OTH PPD - None - - None 0 OTH OTH well child none 40 Plt count 26,000, PVT low; decrease PUB platelet count; ITP; stillBruises waxing from and waning; Low Platelet She has count chronic idiopathic thrombocytopen Unknown OTH OTH Unknown None WAES0906USA02596 1 CBC - 19.2 PVT > - < 446 UANME PVT None None None 1 None UNK UNK Hypertension; Degenerative joint disease; Peripheral neu PVT PVT NONE None NONE 2 None PVT PVT Icepack; MOTRIN None None 2 None PVT PVT Cold compress; NoneTYLENOL None 2 Rapid Strep-Negative. PVT PVT 0 MIL PVT Seasonal allergies only. 0 PUB PUB ORTHO CYCLEN none allergic to horses OR200924 1 PVT PVT 0 PVT OTH none Pt states sulfa allergy 1 PUB PUB Poor wt gain Developmental delay; Cerebral Palsy 0 PVT PUB None 1 None PVT PVT ALLEGRA None DQD all year Seasonal Allergies X 2 none~ ()~~0~Sibling 0 Stool culture, PVT negative PVT None None 0 PVT PVT None Hemoglobin C trait 0 None PVT PVT None None 4 OTH PVT ADVIL none reported none reported other than allergy to BACTRIM 0 PVT PVT 0 PVT OTH PPD 0 UNK UNK 0 UNK UNK 18 None UNK UNK None, extremely healthy 90 year old. 1 PVT PVT 1 PVT PUB SINGULAIRNone RAD 2 PVT PUB none no Per mother sensitive skin, reacts to insects 0 PVT PVT none PVT PVT None Well visit 0 BP: 100/70;PVT Sp02: 99 PUB PULMICORT, none-well 0.5 mg child in asthma nebulizer BID 5 PVT PUB No No PVT PUB 0 PVT PVT Well Child 0 PVT PVT None 1 None 6-18-09 OTH PVT None 6-18-09 None 6-18-09 Seasonal Allergies 1 None PVT OTH None None 1827 None PVT PUB None None None 91 Baby with ring UNK chromosome UNK 21 by mutation. Both husband none and wife carry normal gene. Not reported UNK UNK Not reported ### Not reported UNK UNK Not reported ### 0 beta-humanOTH chorionic, OTH result negative None Miscarriage; Anaemia WAES0906USA02881 92 Electroencephalography, OTH OTH normal; Magnetic LEXAPROresonance, Depression10/19/09 normal Neurology consultation WAES0906USA02971 records received, service Unknown OTH OTH Unknown Unknown WAES0906USA03450 0 Unknown OTH OTH Unknown Unknown WAES0906USA01707 3 stool testedPVT positive forPUB ROTATEQ virus. Severe reaction to Rota vaccine. 7/22/09 Hospital records received 5/18/0 17 Dx: Guillain-Barre PUB Synd; PUB Electromyography; None CXR, NoneMRI Spine; NIDDM; Lumbar HTN PMH: puncture HTN. LabsDM. andTachycardia.Sinus diagnostics: LP traumati surger 2 OTH OTH Unknown none none 1 PVT PVT WCC 0 PVT UNK None Cows milk intolerance, eczema, atrial septal defect, benign
PUB UNK None NotedNone Noted 0 OTH PVT None Allergy to Lipitor UNK UNK 2 None PUB PVT None None None 1 PVT UNK None PVT PVT None Peanut allergy 0 PUB PUB 3 PVT PVT None None 2 PVT PVT NONE NONE NONE 3 PUB PVT none known 9 Chest x-ray,PVT blood andPVT urine cultures Fungal cream Yeast infection Imbilical hernia 3 UNK UNK 0 Unknown atUNK time of thisUNK reporting. LevetiracetaNone Sol. 0.4 mlMother Bid. child has a seizure problem and was found to be h 1 PUB PUB none none none~ ()~NULL~~In Patient 1 unknown. PUB PUB none none none 1 I just sent aUNK note to Kaiser UNKstaf today. Protonix (40mg Noneonce aNone day); Fluoxetine (10mg twice a day) 0 None PVT PVT None no known None 0 N/A PUB PUB None None None Mother~DTP (no brand name)~NULL~~In Patie 0 PVT PVT 1 PVT PVT NONE NONE NONE 2 UNK UNK NONE NONE 34 WEEK PREMATURE DEVELOPED SOME GRUNTING 0 N/A PUB PUB Topical cortisone None cream Client for seborrhoeic diagnosed by dermatitis pediatrician with seborrhoeic dermatit 14 PUB PUB N/A None None 5 7/2/09 Consultant UNK records UNKreceived DOS 5/22/09 none6/2/09. none LABS and DIAGNOSTICS: Videonystagmography abnorm 1 Blood testing MIL at Emergency MIL Room, also X-Rays no known were taken. illness noneresults noted at timeunknown. of vaccination 52 esr and crpPVT elevated. echocardiogram PUB normal.none cradle-cap 25 MRI of left footUNKrevealed UNK bursitis and Ortho bone Tri-cycle marrow None. edema Allergy to lefttocalcaneus amoxicillinand andtalus. cefzil. CT scan of left foot- normal. 0 MRI of Left/Right UNK Shoulder UNK(Note: MRI was not None of the bicep Allergic muscle to sodium which was pentathol where the pain was); EMG of Left/Ri 27 Patient hadOTH his vision checked PVT by SIMVASTIN opthalmologist. None 20mg None 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 PUB PUB ALBUTEROL None occasionally. lethargic/fever~Varicella (no brand name)~1~5 0 MIL UNK None None Allergies to; ASA, Codeine, Benadryl, Latex 0 Went to ER.PUB had CT scan PUB& blood7/9/09 tests. Hospital 7/9/09 None Hospital ED records None. ED records received 7/9/09received Hospital DOS 6/15/09. DOS ED records 6/15/09. Ultramreceived LABS and DOS DIAGNOST 6/15/09. H PVT PUB PVT PUB 1 LABS and DIAGNOSTICS: MIL MIL Sigmoidoscopy None - Abnormal. None Gram None stain of stool - many white blood cells and several ty PVT PUB 0 PVT PVT 0 none acceptPVT sx mostly OTH resolved atNone evaluation.None None NC09025 490 PVT PUB 0 None UNK UNK None None Seasonal allergies -3286 PVT PUB None 0 PVT OTH None at time none of vaccination knownnone known 1 PVT PUB None None None
1 None PVT PVT None Fibromyalgia 3 OTH PVT None 0 PVT UNK Pt was hereNKDA for physical - Dermatophytosis of foot 1 Mono; Strep; PUB EKG PUB None No Recurring Mono, elliptocytosis NC09026 since birth None PUB PUB Unknown None None None PUB PUB Unknown None None 1 AST/ALt 74PVT each; LP negative; UNK CK-1232. None None 1 PVT PUB None None 2 MIL MIL None None 0 Transfer to OTH hospital; CTPUB scan at hospital TB Skin testNone Unknown Known None Known 0 None PUB OTH None None obesity; heart murmur 2 PVT PVT 0 None PVT PVT None None None 1 Labs i.e. CBC PVTwith diff PVT HCTZ; ASA; Simvastatin; Ibuprofen Redness and NJ200902 swelling in past with vaccines.~V 1 PUB OTH 1 PVT PVT 1 PUB PUB Vitamins None None 0 None PVT PUB None None 27 PVT PVT None None 0 PVT PUB None None None 1 None PVT PUB 0 UNK UNK 4 PVT PUB PREVACID;none MYLOCON knownGERD (simethicone) 0 t2- normal, UNK mri unknown UNK result, blood None tests ok.None 7/16/09 ER None. and 7/16/09 Hospital ~Anthrax ER records and (Biothrax)~UN~0~Patient Hospital receivedrecords DOS 6/11/02 received to 6/18/02. DOS 6/11 0 PUB PVT none highfever , cried for 3 hours~DTaP + IPV (KINR 31 PVT OTH No pre-existing medical conditions; ### was recovering from a 526 serum beta-human, OTH 06/08/09, OTH pregnant None Migraine WAES0906USA02582 Complete blood OTH cell, low OTH Unknown Unknown WAES0906USA02844 48 Unknown. 6/25/09 OTH Medical OTHrecords received DOS 5/22/09. Unknown. LABS and 8/6/09 DIAGNOSTICS: Hospital WAES0906USA03651 records C. Difficile received Toxins DOSA&B 6/03/09 not dt 30 Unknown. 8/21/09 OTH Hospital OTH records Unknown including extensive lab Unknown testing received DOS WAES0906USA03729 6/8/09 to 6/23/09. LABS and DIAG 0 LacerationsPVT PVT facial laceration 2 PVT UNK None None 0 None PVT PUB None None Known 0 N/A. UNK UNK None. None. None. 0 PVT PVT 10 Biopsy performed UNK of satellite UNK lesions 1. benadryl on June no 23, 25 illness mg 2009. 1 or at 7/16/09 no 2time tabs known ofMedical po vaccination diagnosed q 6 hrs records 2. Claritin allergies. received po7/16/09 3. DOS Zyrtec 2/08/08 Medical 10 mg torecords 7/15/09. po bid.rec 7 0 PVT PUB No Croup on 3/16/09, given decadron 0 Not Applicable PVT PVT None None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 0 7/30/09 Hospital UNK records UNK received None DOS 5/21/09 None to 5/24/09. None. MRI7/30/09 and EEG Hospital normal. records LABS received and DIAGNOSTICS: DOS 5/21/09Ches to 5 12 PVT PVT none fever,vomting,spots none onemmaleigh belly and back noah~Measles + Mumps + Rubella 1 8/26/09 Hospital UNK records UNK received Danazol 6/19/09 to 7/8/09. None reported LABS None andreported. DIAGNOSTICS: 8/26/09 Blood Hospital Alcohol records 250 received (H). Urine 6/19/09 Drug 15 PVT UNK none None None 2 PUB PVT fexofenadine, no tizanadine seasonal prn allergies, allergic to tree mold, cats, pseudephed 1 UNK UNK none 1 Medical records UNK received UNK 6/29/09 LABS: WBCNone 14.1(H), ANC None12.13(H)lymphs Medical records 8%(L). received 6/29/09 PMH: nasal fx. A 1 2 view CXRPUB PUB Zyrtec dailyRunny noseTracheomalacia, that he has had ASD, all spring Potential related asthma to allergies 1 none PVT PVT Lasix, Atenolol, nonePravastatin, no allergies; fish oil,hypertension, Calcium and D hyperlipidemia 1 UA, negative; PVT urine culture, PUB negative; None lactic acid; None MRI brain, Developmental abnormal; UA Delay; organic Warts; acids, Sebaceous results pending, nevus. ammonia 7/7/09 Ho 117 failed school PVT hearing test PVT ADDERALLacne; XR finger7/8/09 injury Medical records received DOS 8/6/07 to 6/24/09. A 12 5/13-15/2009: MILESR 66-75 MIL(high), CRP None10-12 pt (high), reported WBCquestionable "chest 3000 congestion" range history (low), xHct mild 3 weeks 31-32 chronic antecedent (low), leukopenia, Plt 65-74 to vaccination; thrombocyto (low); norma w 0 None PVT PVT CRYSELLE-28 sore throat None
1 information PUB not provided UNK to me None None 9 6/17/2009, MIL HSV1/2 IgM/G MIL both negative; oral contraceptives VSVnone Ab, immune none 1 None at present PVT PVT None None None PVT PVT None None Left clavicular hemangioma; Preterm twin 3 1/2 wks 0 PVT PUB none none 0 PVT PVT FLONASE 50mcg/ACTUATION Pt allergicQD to BACTRIM 0 Pt. evaluated PVT by primary PVT care physician HCTZ; Metoprolol; None Lisinopril; Hypertension; WELLBUTRIN; asthma;Senna; GERD;Polyethylene h/o breast cancer; Glycol;Anxiety/d PRILO 2 None PVT OTH None None 0 PUB PVT ZOLOFT; SYNTHROIDSulfa and Erythromycin allergies. 2 Patient evaluated PVT by primary UNK care physician Cough, improving PCN, "Cillins", latex, Naprosyn 1 OTH OTH None None None 1 Varicella culture PVT is pending OTH None None 0 PVT PVT 0 PVT PVT 6 No prior H/oPVT allergic reaction OTH to Td. Denies Denies any medical problem. NKDA. 1 normal pulse OTH 56-62; BPPVT of 116/60 mastectomy 95 complete blood OTHcell; serum OTH progesterone vitaminstest; (unspecified) Pregnancy HIV antibody NOS screen; (LMP Rapid = 12/14/2007) plasma WAES0802USA00127 reagin; serum rubella IgG; serum 0 beta-humanOTH chorionic, OTH 03/19/08, positive Unknown Pregnancy NOS (LMP = 2/25/2008) WAES0803USA03943 0 Unknown OTH OTH Unknown Apprehension; Nervousness WAES0906USA03355 0 Unknown. 8/10/09 OTH ER OTH records received Unknown DOS 6/16/09. LABS Unknown and DIAGNOSTICS: WAES0906USA03836 CT - Right frontal scalp hematom 74 MRI; Brain scan PVT 7/13/09 UNK Hospital records received DOS Milk; 12/28/01 Penicillin; to 12/31/01. CMT. 7/13/09 LABS and Hospital DIAGNOSTICS: records received NerveDO C 3 6/26/09 Hospital PUB records OTH and DC summary MAALOX,received ATIVAN,DOS LOXITANE, CMT; 11/07/08 Allergies ZYPNEXA, to same 11/10/08. to as milk above~Hep COGENTIN and LABS penicillin; and B (no DIAGNOSTICS: Schizophrenia. brand name)~3~19 MRI PMH: B 2 Cellulitis (R)OTH upper arm.PVT Labs and Birth Diagnostics: controlNone pills; WBC Clindamycin 14,900. None. RUE No started known US (-). 6/10/09 allergies. Echo (-).PMH: blood none cx (-). 0 PPD UNK UNK PVT OTH LANTUS; COZAAR; diabetes, FLUOXETINE;GEM poorly controlled FIBROZIL; METEPROLOL; GLYBURID 1 None PVT PUB None None hemangioma x 2; eczema 3 PVT PVT 0 PVT PVT none none 2 PVT PVT none knownnone 1 PVT PUB None None obesity -9 PUB PUB none none none 2 Throat cult.PVT 1/16/09 (-) PVT for GABS. Motrin for sore PharyngitisNone throat at time of physical. 1 None MIL MIL ALEVE, BCP None None 8 Mother states PUB "some kind PUB of bloodNone test" None 1 PUB PUB Bees OR200925 0 None UNK UNK None None hat accelerated to 5 episodes in 2008 UNK and 3 this UNK year with the last only 2 weeks apart so it made things worse and the back nerve pain is in PVT OTH None None PVT OTH None None None None PVT OTH None None None 11 EBV titers were PVT c/w previous PUB infection; NoneIGM was None <0.2. Strep Allergic culture to PCN was(moderate negative. non-specific An MRI of the rash). brainAllergic was ordere rhin UNK UNK None PVT UNK DRYSOL None None None PVT OTH None 1 Drug screenPVT neg for street PVTdrugs/ Influenza CLARITINA10mg None for swine 1 po,neg 6/29/09 METHYLIN labs.ER 6/29/09 records 20 mg Medical FR received (3po) records DOSreceived 6/18/09:DOS ADD6/18/09 LA 10 UNK UNK None known Preterm twin infant (34 weeks gestation), SGA, hypoglycem PVT PVT 31 none UNK UNK none none None UNK UNK None known. None known. None. 1 PVT UNK NO NO NKDA 2 NONE UNK UNK Albuterol MDI, none bupropion, - yearly COPD, check-up etodolac, new-onset fexofenadine, hypertension, hydrocodone/APAP, chronic low backlisinopril, pain, no
0 PUB PVT Dura Med slight congestion urinary tract infection 0 None UNK UNK 0 N/A UNK UNK N/A NONE NONE NONE~ ()~~0~Patient|NONE~ ()~~0~Sibling|N 0 None PVT PUB None None 0 Asthma PVT PVT Proventil, Ventolin None NKDA 6 OTH OTH Allegra; Lipitor None 40 mg; PCN-rash, Singulair 10mg; Ceclor-rash Atacand 16mg Inappropriate PVT Immunization UNK 1 PVT PVT 1 PUB PUB None 0 None PVT PVT None 1 PVT OTH None None 1 PVT PUB none none PVT PVT mood swings~Measles + Mumps + Rubella (no 1 PVT PUB 1 OTH PVT None None Rapid strepPVT negative PUB None None None 24 5/29 MRI head PVT& spine.PVT LABS and DIAGNOSTICS: Mild URI 7/2/09 1-2 Unilateral week Hospital prior Cryptorchidism records illness received - CF DOS carrier. 5/29/09 to 6/2/09. MRI S 13 5/6/2009: hCG, MIL UA neg; MIL 5/8/2009:None Non-contrast None brain MRI None negative;H/Al 5/9/2009; blurredVA, vision; IOPS, nausea; chemistry/hCG/CXR fatigue onset within norm 2 None PVT PVT None None 0 Unknown PVT PVT NKA None PVT OTH PULMICORT; None AlbuterolAsthma sulfate (NEB) None PVT OTH Albuterol sulfate None inhalerNone None PVT OTH None None None 9 PVT PVT none no 2 PVT PUB 2 UNK UNK ### 0 MRI of Brain OTH and orbital OTH Sockets; CBC; SYNTHROID; Ferritin None level MOBIC;History PREMPRO of migraines; Hypothyroid; ### Arthritis-osteo 7 OTH OTH PRILOSEC ### 3 OTH OTH ### 3 OTH OTH ### 3 OTH OTH ### 3 OTH OTH None None None ### 0 OTH OTH COUMADINStroke in Dec Minor 2008 back surgery in Nov 2008; ###Fractured pelvis in Nov 2 Unknown OTH OTH Unknown Unknown WAES0906USA04131 7 serum beta-human, OTH 09/02/08, OTH positive Papanicolaou smear abnormal; WAES0809USA00445 Cervical dysplasia 0 vital sign, 06/13/09, OTH normal; OTH bloodNone glucose, 06/13/09, normal None WAES0906USA02614 692 Chest X-rayOTH (results: no OTH infiltrates,Unknown vascular congestion, The patient's pulmonary concurrent nodules illnessorincludes pleural USWYEH09220209 effusions.) gastroesophageal and antibody reflux test dise 0 PVT PUB None None None 0 PVT PVT None None 0 PUB UNK None None None PVT PUB No Heart - mitral valve pulmonary stenosis 1 PUB PUB None None 0 PVT PVT Children's Tylenol She had a cold approx 1 month prior. 0 None-referred PVTto Allergist PVT None None None None PVT UNK None None 1 None PVT PUB None None None 38 Parvovirus PVT B19 Ab, IgGPVT S, 4.57; Parvovirus None at time B19 None ofAb, vaccination IgM,Osteoporosis; S, 0.20 skin CA 1 PUB PUB CADUET and None ZANTACHypertension 25 6/13/09 CT PVT of neck- C-spine UNK normal. None No None 1 Chest X rayOTH 6/1/09 OTH None Had viral URI Allergythe week peanuts. prior - was getting better. 0 UNK UNK
1 None UNK PVT None None 0 1530 spokePUB to mom and PUB mom stated "she is doing None fine". 2 Unknown OTH PUB None None PVT UNK PVT PVT BCP (KANVA); no CLARITIN; allergies XANAX to sulfa, prn amoxicillin, PCN, ZITHROMAX 0 6/25/2009 WBC UNK 14.2 with UNK17 neut, 80 lymp, 2none eos, 1 baso; none Hb 10.3 now but had dropped to 8.9 and 9.2. Platelet co 0 all labs apparently PUB negPVT Pt. had surg. p. 5-15-09 is on a B/P for bladder med andrepair. Neurontin. no illness Has at hxtime of kidney/bladde of vaccinatio 1 Antonio wasPUB taken by ambulance UNK to Brandywine none Hospitalnone in Coatesville, PA. Labs include CMP and urine tox scree 1 UNK UNK N/A none none 1 UNK PUB Nuva Ring No Penecillin allergy, Hx migraine headaches 0 unknown UNK PVT Claritin-D 24 Patient hour once reports Cervical daily, full loestrin recovery cancer24 (surgically from Fe, recent Nasacort, excised sinus Singulair, infection, 2003, no Advair reports recurrence), Diskus feeling 1a 0 UNK UNK None None None 1 PVT PUB CBOM CBOM 1 UNK PVT none none none 0 PVT PUB 2 MIL MIL none none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 6 PUB PVT 0 Rotavirus Antigen UNK in stool UNKpositiveNone on 6/25/09None (3 days - one after None soft vaccine). stool - healthy in Stool morning termculture/O infant prior to&vaccination, P are pending. but not 7/30/09 watery, Hosn 0 UNK UNK xanax,prozac,hyrochlorithiazide,lipitor,metformin,trazodone,lisinopril no crohns disease, hypertension, arthritis, diabetes 0 PVT PVT 70 None required. PUB UNK 2 None required. PUB UNK None. 0 PVT PVT None 2 Blood work UNK of DNA, ANA, UNKcomplement Nonelevels.None Urine analysis. None.X-rays PMH:Periodic ofnone. ankles. Sib swelling Later with oligoarticular of didlipHistone and eye~HPV tests juvenile which (Gardasil ideopath indica 0 None MIL MIL None None None (+) preg testPUB 6/10/09 UNK 0 MMR titer was PUB3.5 "took PUB MMR shot." None None Fever~Measles + Mumps + Rubella (no brand 0 none PVT OTH none none none 0 PVT OTH sinusitis NKDA Leg swelling, irritable.~DTaP (no brand name)~ 0 see attachment OTH OTH None per mother None per mother 2 PVT PUB None None 0 Albuterol nebulizer PVT tx inPUB office for bronchospasm. None None 0 OTH PVT None None 0 None PVT PVT PREVACID;none TAMIFLU Gastroesophageal reflux 1 PVT PVT 1 PVT PVT None Latex 15 PVT PVT Metformin 2000 Nonemg. daily, Allergic Glipizide to bee10stings, mg. daily, TypeActos 2 Diabetic 45 mg. daily, Lantus Solo 4 PVT PVT 7 UNK UNK enalapril 20ptmg, hadlovastatin told vaccinator asthma 20mg symbicort about an appointment 160/25, nasonex with ent for a recurring si 9 NONE UNK UNK NONE NONE NONE 0 Unknown OTH OTH ABILIFY; PROZAC; Pregnancy TRILEPTAL NOS (LMP = 8/8/2008); WAES0810USA01631 Depression; Attention deficit disor 0 Blood pressure, OTH 06/18/09, OTH90/60; Blood Hormonal pressure, contraceptives; 06/18/09, Vaccination 118/6 SOLODYN adverse reaction WAES0906USA03812 0 None OTH OTH None Unknown WAES0906USA04118 0 Unknown OTH OTH Unknown Unknown WAES0906USA04162 48 Negative rheumatoid UNK factor UNK and CCP Diclofenac; antibody,Codeine; 05/11/2009 LIPITOR Pt has labs:a20mg history CRP 2.3. daily; of Guillian-Barre HLAB27 XALATAN andeye HLADR4 Syndrome, drops; (-). Medroxyproges 1986 ANAPMH: weakly G 0 None PVT PVT None No None Pt did not seek UNKtreatment UNK for symptoms. albuterol/ipratropium No acute illnesses mdi Atrial (combivent); fib; chroniccarvedilol systolic heart 3.125failure; mg BID; history loratadine of (hx)10 MI,mg h 218 UNK UNK No Allergic to Bioxin 1 PVT PVT none none 1 N/A PVT PUB N/A N/A N/A 1 UNK UNK Left leg laceration infected
2 PVT PVT chronic rhinitis/cough 4 MRI, CAT Scan, UNK Lumbar UNK puncture,birth blood control,prozac. tests. none 7/16/097/16/09 Medical 7/16/09 Medical records Medical records received records received received DOS 7/25/07 DOS DOS 7/25/07 to 7/25/07 7/08/2009. to to 7/08/2009 7/08/200 LABS 1 ESR 36, CRP UNK 1.4, WBC UNK 10.9 7/6/09 Hospital Rash records received DOS 6/21/09 0/23/09. LABS and DIAGNOSTICS: C 0 PUB PUB none none none known 2 NONE PUB UNK ? NONE HTN & A-FIB, NO~ ALLERGIC ()~NULL~~In TO CODEINE Patient|?~ ()~NULL~~In Sib 3 PUB UNK Z-Pac Exposure toNone Pertusus -work related- no illness 0 Seeing physician PUB on 6/30/2009 PUB at 2:50 PM. Still none not doing Had well previous crying reaction and high at 2 mo fever~DTaP+IPV+HepB+Hib shots when he received sin (n 0 none PUB PVT none 3652 UNK UNK 2 unknown UNK PVT unknown none reported latex allergy 16 PUB PUB None None 13 PUB PUB ACOLATE OD; InhalerAsthma - ALBUTEROL 1 PVT PVT Unknown None None OTH OTH No other medications Unknown MA20091692 PUB PUB None Cough; respiratory infection, antibiotic taken. Resolved when he took 0 PUB PUB None Allg.; PCN 0 Not done PUB PUB None Fever and respiratory~DTaP + IPV + Hib (Pent OTH OTH No other medications Unknown MA20091708 OTH OTH No other medications Unknown MA20091709 OTH OTH No other medications Unknown MA20091710 0 None UNK UNK None None LA090602 OTH OTH No other medications Unknown MA20091712 OTH OTH No other medications Unknown MA20091713 OTH OTH No other medications Unknown MA20091714 OTH OTH No other medications Unknown MA20091715 0 PUB PUB OTH OTH No other medications Unknown MA20091716 1 NCS/EMG 2/16/09 PVT OTH DIOVAN; HCT; suspected COLCHILINE gout spherocytosis/HTN/ flare mild CKD/gout OTH OTH No other medications Unknown MA20091717 OTH OTH No other medications Unknown MA20091718 L-4, L5 Anterior MIL Spend;MIL loss, moderate Please toreview marked None vaccine central Prior None 4:on canal; applications canal 11 narrowing listed record above~Anthrax (PHS - 731(no REV brand 1-82)name)~UN~ OTH OTH No other medications Unknown MA20091719 OTH OTH No other medications Unknown MA20091720 OTH OTH No other medications Unknown MA20091721 None MIL MIL None OTH OTH No other medications Unknown MA20091722 PUB UNK None None 0 None PVT PVT None None None 0 UNK UNK 0 Many-beingPVT treated forUNK last 5 months. Medical None records received 6/30/09 7/7/09 Received LABS: medical Bartonella records benselae PMH: appendectomy, (+) s 1 Head CT; LP; PVT CBC & other OTH labs reported YAZ 0.02mg/3mg normal None by hospital. 1 qd;Codeine VOLTAREN 7/23/09 allergy Hospital 75mg 1records po bid PRN received DOS 6/21/09 to 6/2 None PVT UNK None ADHD; Ocular Highalbinisim fever~DTP (no brand name)~4~2~Sibling PVT PUB Started DDAVP same day of Imms 0 PUB PUB none none 0 Negative stool PVTstudies UNK - Stool cx, *Rotavirus ag None None PUB OTH NONE None PUB OTH None None 7 Laboratory MIL studies included: MIL 5/20/08 None WBC 15; CK 1358; 7/7/09 CKMBER neg; records Trp neg. received 5/21/08 DOS CK 5/22/08 917 withtopositive 1/7/09.troponi Episod 7 PVT OTH None Allergy to all sunscreens. No ### other medical conditions and 1 None PUB OTH ibuprofen PRN. Had been treated none in ER for deep laceration to right hand 2 None - wasPVT given CEPHAXRIN PVT on 6/26/09 06/29/09 - less None redness & swelling
4 None 1 1 None 1 0 5 0 0 None 11 None
PVT PVT YASMIN; ALDAETONE None Hidradenitis UNK PVT PVT UNK None None PVT PVT SINGULAIRNone 4mg daily None 0 PUB PUB Gyn Exam PVT PVT ZOVIA 1/35; None RETINA Sulfa .05% -> hives PVT PVT Codeine; PCN PVT PVT No None relevant, Pain/notenderness~Pneumo meds. (no brand name)~1 PVT PUB None cow's milk UNK UNK 0 urine beta-human, OTH 02/18/08, OTH negat; None urine beta-human, Pregnancy02/27/08, NOS (LMP posit, = 1/16/2008) 6 weeksWAES0804USA01051 pregnant; serum beta-human, 02/2 diagnostic laboratory, OTH 04/14/08, OTH pregnant; Unknowngynecological, Pregnancy NOS 04/14/08, (LMPpregnant = 3/12/2008) WAES0805USA00039 Unknown OTH OTH Unknown Unknown WAES0906USA04964 0 Unknown OTH OTH Unknown Unknown WAES0906USA05053 arterial blood OTH O2, 01?/??/09, OTH 87 PREMARIN; Asthma; thyroid Drug hypersensitivity WAES0906USA05010 0 PVT PVT None. ### Positive Mono PVTand Lyme's OTHdiseaseTubersol test results. The patient had not received any ### other vaccines within fou UNK UNK Not reported. ### 13 LABS and DIAGNOSTICS: OTH PVT NCS - None abnormal. at time Total None of vaccination CPK known is None 91. -> Alkaline known currently orPhosphatase specified on METOPROLOL. . PMH: is 97,back SGOT pain, 128, right SGPT tibia301, / fibu 6 glucose, 263. PVT 7/1709 Hospital PVT records not prior received (currently NoDOS NOVOLOG) 5/24/09 allergic to 5/26/09. rhinitis especially LABS and cat; DIAGNOSTICS: mild seasonal Serum glucos 1 CXR #1 w/ PVT air trapping;UNK #2 w/ interst infiltration, decreased Recurrent air trapping; cough NL&CBC wheezing. & CMP 7/20/09 Hospital records 13 Strep test =PVT negative PVT No No 0 PVT PUB 2 PVT OTH RELPAX Wellness exam NKDA 0 None MIL MIL None None None 0 PVT PVT 0 pulse oximetryPVT 100% PVT Penicillin, ZOLOFT s/p splenectomy @ 5 yr 4 Biopsy of rash PVTon torsoOTH TRAMADOL None BID Arthritis in Lumbar leg paralysis~Polio back Virus, Inact. (no brand nam 1 CXR: normal PVT UNK TRIAMCINALONE mild runny as needed nose None/Eczema and cough 1 PVT PVT none History of vasovagal vasovagal~DT+IPV+Hib+HepB syncope last in 2004 (no brand name 1 PVT OTH 0 UNK PUB None None 1 OTH PVT 1 PUB PUB Albuterol ; Flovent None Asthma Local Reaction~Measles + Mumps + Rubella (n 2 PUB PUB All Natural None Asthma local reaction~DTaP (no brand name)~5~7~Sib 1 OTH OTH None Lt ear pain/Eustachian None tube dysfunction PUB UNK None None 1 None PVT PVT ASA; THYROXINE; None CRESTON; None except METOPROLOL; CAD LISINOPRIL 0 PUB PUB NO NO None PUB UNK None None 0 PUB UNK NONE NONE Allergies to; ASA, Codeine; BENADRYL, Latex 1 PVT PUB GEODON; Clonidine; anemia; allergic Lithium; bipolar; rhinitis LAMICTAL; ADHD; Hypothyroid NASONEX; Levothyroxine 1 PUB PVT None None Allergic to tomatoes and turkey 1 PUB OTH None 0 PVT PUB None 0 PVT PVT none none none local reaction~DTaP (no brand name)~4~1~Pa 2 None PVT PVT None None None MIL UNK PVT UNK None 6 PVT PVT Simvastatin;None Metoprolol/HCTZ; HTN; enlarged Fish Oil; thyroid; CO QID NKDA 14 MIL MIL none
0 UNK UNK None None 1 None PVT UNK None None 1 PUB PUB Unk PVT OTH Unknown Concomitant medications A0794348A and relevant medical history wer 10 7/20/09 Hospital PVT records UNK received None. DOS 7/18/08 BirthNone control to 7/13/09. pills. None. LABS 7/20/09 and DIAGNOSTICS. Hospital recordsUpper received GI Series DOS 7/18/08 Normal.toAb 7 None PVT PVT None None 14 None PVT PVT None None 1 PVT OTH 0 none PVT UNK none none none 0 Radiology skull PUBfilms 2 PUB view, CT Scan otitis medianone with rupture noted of TM 0 n/a PVT PVT none none none 3 PUB PVT Rx fish oil; Nasonex None prn Hypertriglyceridemia; None~ ()~NULL~~In seasonal allergic Patientrhinitis PVT PVT acetaminophen Mononucleosis 10 none , just phyiscal PVT exam. PVT was on amoxil none forday om,ofnone but vaccines rash started varicella~Varicella before use of (Varivax)~0~1~In med. onset 6/27/2009, Patient and m 0 none PUB PUB fainting, vomiting~HPV (Gardasil)~NULL~14~In 0 UNK UNK Pt. denied Pt. denied Pt. Denied 10 none PUB PUB none none NONE 0 UNK UNK NKDA 6 blood tests UNK on 6/29/2009 UNK Inderal, Tricor, None Diovan, Singulair 3 Abdominal UNK ultrasound. UNK 7/27/09 Hospital Mylicon records drops None received and Infant None DOS Tylenol 6/15/09 to 6/16/09. LABS and DIAGNOSTICS: Abdo 1 None PVT PVT None None PVT PVT Sulfa drugs 0 Strep test and PVTblood work UNKwas normal. None none Allergy to Bactrim, rash 0 MIL MIL none none none 113 None PVT PUB none Had mild back none pain and facial acne. Was seen the following day by o 0 PVT PVT None Narrow QRS Tachycardia. Pt had an ablation 7/08 3 9/8/09 Hospital UNKrecordsUNK received DOS NONE 6/21/09NONE to 6/25/09.NONE. LABS9/8/09 and DIAGNOSTICS: Hospital recordsKUB received - Abnormal, DOS 6/21/09 distended to 6 0 PVT PVT Mortin givenNo prior illness to injections. atAsthma, time of Benadryl seizure vaccination disorder, given approx diaphragmatic 45min after hernia injections s/p repair, adm 0 PVT UNK 218 PUB PUB 3 PVT PVT Amoxicillin resolving sinusitis none none~ ()~NULL~~In Patient 0 UNK PVT Aciphex 20mg qd, BENAZEPRIl/HCTZ hypertension, reflux 20MG/12.5MG disease qd 0 vaccinationPUB for hepatitsUNK A none none none fever~Hep A (no brand name)~1~1~In Patient 3 troponin 6.0UNK elevated heart UNK CK. 7/31/09 Hospital nonerecordsnone. received PMH: DOS 7/31/09 6/28/09 Hospital to 7/1/09. records LABS received and DIAGNOSTIC DOS 6/28/0 20 6/1/09, CXR, MIL WNL; 6/11/09, MIL EMG/NCD ZITHROMAX; - Summary SUDAFED; interpretation: None; MUCINEX; NKDA 1. TheTYLENOL right median, (initiated ulnar,after radial, vaccine sural and administr supe 1 None PUB PUB None None None IA090010 2 PUB OTH 6 PVT PVT ? Depression and overweight 0 Heart rate 75; PVT O2 saturation's UNK 95-100% 7 Culture of vesicular PVT lesion. OTH Right Otitis Media 0 None PUB PVT Baby aspirin N/A No allergies known 1 PVT UNK Swelling hard lump pain~Hep B (no brand nam 3 Unk PVT OTH Unknown Enlarged tonsil; streptococcal A0790451A throat 0 PVT PVT 0 X-ray soft tissue PVT neck c/w UNKmild edema. NoneLABS None and DIAGNOSTICS: None X-Ray Neck - minimal subglottic tracheal narrow 6 Stool Rotazyme PVT > positive PUB 214 CBC; Thyroid PUBtests- negative PUB results reported by mother. 1 MIL MIL None None None 1 PVT UNK Not reported UNK UNK Not reported ### 70 None OTH OTH hormonal contraceptives Pregnancy NOS (LMP = 8/26/2008) WAES0810USA00881
Not reported UNK UNK The patient had a history of unspecified ### reactions to many 1 Unknown OTH OTH Unknown WAES0906USA02593 65 Initial bloodwork UNK revealed UNK liver enzymes in thenone thousands. none Liver biopsy none~ revealed ()~~0~Patient|none~ significant scarring ()~~0~Sibling and damage. 0 PUB PVT hctz 25mg po qd lisinopril 10mg po qd naproxen 500mg 0 PUB PUB 533 PVT PVT Resolving URI 4 7/2/09 Hospital UNKrecordsUNK received DOS Amlodipine, 6/12/09Cat Augmentin, to 6/29/09. bite, upper Hypertension, LABS Atenolol, respiratory andTricor, DIAGNOSTICS: Vascular infection Hydrochlorothiazide, surgery, CHEM hysterectomy, - Glucose Fish oil 111 rightmg/dL carpa 0 7/23/09 Hospital UNK records UNK received Atarax DOS 7/1/09none to 7/2/09. Formaldehyde EKG. LABS and and DIAGNOSTICS: Quaterium 15 allergies. Troponin 7/23/09 I <0.01 NG/ML Hospit 0 WBC 5.2 onPVT 06/22/09 UNK 1 NONE PUB PUB NONE NO NO NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL 1 NONE PVT UNK PVT PUB NONE BILATERAL PNEUMOTHORACES AND PNEUMONIA 0 UNK UNK Cataprese 0.1mg No illness two patient tabs Patient at was bedtime waswell born with pulmonary artery atresia congenital 5 PHYSICAL PUB EXAM DONE. PUBPAIN WITH NONE RANGE NONE OF MOTION. NONEDISCOMFORT REPRODUCED WITH DEEP PALPA 19 none collected UNK PVT Advil/Tylenol Denied. PRN Stated NoneNegative Medical Hx 1 None PVT PVT Adderall 0 None PVT PUB None 1 PVT PUB None 1 CBC/diff; CMP; OTHHgbA1C UNK Insulin; Thyroid 0 Ophtomist advised MIL hadMIL slight myopia None; correctable PRNNone eyetodrops 2020None for (lasik seasonal surgery allergies had vision at 20/10) with no corneal lesions 2 None PVT PVT None None None 1 PVT UNK None None known 3 examined by PUB the nursePUB None None 0 PVT PVT ZITHROMAX - Sinusitis 6-30-09; ZOFRAN in the ER 0 All less - WNL PVT PVT No No None OTH OTH None None None 1 WBC 5,900PVT PVT Citalopram;None ibuprofen; None BENADRYL 1 PUB OTH 0 None PUB PUB None None None OTH OTH 15 ESR 17T3 1.5 PVTAND T4PVT 8.75 AND NO TSH 1.74 NO NO 0 PVT PUB neuro testing UNK 5/2009. 7/7/09 UNK NCS report received DOS 4/8/09. None. LABS 8/18/09 and PCP DIAGNOSTICS: medical records NCS received DOS 7/21/06 1 PVT PUB 79 PVT UNK 4 OTH OTH Unknown Allergic Rhinitis; hyperlipidemia; hypertension; DM type II 0 PUB PUB none 0 PUB PUB None None None 7 None yet OTH PVT unknown NONE NONE 0 PUB UNK none allergy to PCN 1 PVT PVT 2 PUB UNK None None None 7 CRP = 2.87;PVT ESR = 23;OTH RF - neg; ANA = neg;None Lyme = neg; No Lupus allergies studies or birth pending. defects; Oa Minocycline; RETIN A; Ac Unknown OTH OTH Unknown Unknown WAES0906USA05296 Unknown OTH OTH Unknown Unknown WAES0906USA05217 0 UNK OTH PVT Unknown No concomitant vaccines A0794805A or medications. Relevant medic 0 UNK UNK None per client asthma-no report other conditions or allergies. 9/1/09 ER records 0 Labs and diagnostics: UNK UNK CXR abnormal. None BloodNone cx (-). EEGNone. WNL.PMH: physiological jaundice as newborn. 1 UNK PVT Lithium, synthroid, none prilosec bipolar; no thyroid, itching~Zoster hemochromotosis (no brand name)~1~69~In Patie 5 COLITIS from UNK stool sample. UNK 7/13/09 none Hospital none records received none. 7/13/09 DOS 3/6/08 Hospital to 3/7/08. records LABS received and DIAGNOSTICS: DOS 3/6/08 to 3/7 A 0 Influeza A and PVTB negative. PUB none none none
1 PVT UNK None 2 normal physical PVT on examination PUB none none 0 none PVT PUB NONE NO NO 2 UNK PUB none none none 2 OTH PVT PREVACID;None Amoxicillin; None Clarithromycin 0 None; Unable PVT to find documention PUB in EHR to None document this, no ED visit 1 UNK UNK None None Obesity BMI = increased 97%; Speech/articulation problem 0 OTH OTH NKDA 1 PVT PUB 0 9/15/06, Antigliadin MIL Ab,MIL IgG, 3; Antigliadin None at time Ab,None IgA, of vaccination 2; Endomysial Diagnosed Abwith IgA,angiomyolipoma Negative; 11/13/06, at age Duodenum 16; No previous Bx, no ho pa 0 PVT UNK 0 Done at ERPUB PUB HISTATAD;Sinus OMHICEF infection None 2 PVT PUB TYLENOL Speech impediment OTH PUB 2 PVT PVT ALBUTEROL; none LASIX; ACTIFED; Hyperlipidemia; ZONEGRAN; PAM; Sleep MS CONTIN apnea 2 None PVT PVT None None None 0 PUB PUB Cough, allergic nose, enlarged tonsils and wheezing. 1 none PVT PVT none none none none~ ()~NULL~~In Patient 0 PVT UNK None None None This was her first vaccine~ ()~NULL~~In Patien 0 HR 70 BPM; OTH BP 110/70 PUB -> after event None PVT PVT Eczema; Macrocephaly 3 PVT UNK None None None 2 PVT UNK lo ovral birthnone control irritable bowl syndrone 0 UNK UNK no allergies to milk and soy protein, congenital cataracts, nyst 10 none PUB UNK none none none 0 PVT PVT n/a 22 Brain MRI showed UNK periventricular UNK none white matternone hyperintensities, eczema. one PMH: with biliary enhancement. atresia with Visual Kasaiacuity procedure, in the right oral se 0 beta-humanOTH chorionic, OTH positive; beta-human Unknown chorionic, Pregnancy05/16/08, NOS (LMP=4/20/2008) negative WAES0805USA04794 0 None OTH OTH None Pregnancy NOS (LMP = 3/28/2008) WAES0806USA07772 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 6/17/2008) WAES0812USA02378 4 Magnetic resonance, OTH normal; OTH Vascular Unknown imaging, normal None WAES0906USA04956 electroencephalography, OTH OTH some "activity" Unknown Unknown WAES0906USA05043 366 Unknown OTH OTH Unknown Anaemia; Colitis ulcerative WAES0906USA05205 0 Unknown OTH OTH Unknown Seasonal allergy WAES0906USA05705 ultrasound, OTH ileocolic intussusception OTH Unknown Unknown WAES0906USA05211 Ultrasound,OTH intussusception OTH Unknown Unknown WAES0906USA05214 Unknown OTH OTH None None WAES0906USA05672 3 CBC, CMP,PVT Strep, Monospot, PVT Influenza none none none 1 PVT PVT BENZACLIN NONE NONE 5 none reported PUB PVT Armour thyroid Denies 60mg illness, daily; Allergies only Diovan issue include: itching~Zoster 80mg withamoxicillin, daily; fingerBumex (Zostavax)~~77.50~Sibling doxycycline, 0.5mg daily; macrobid clorazepate and bd 0 none PVT PUB none none none 0 PVT PVT 1 PUB PUB None None MO-2009-14 0 PVT PVT 108 EKG: SHOWED UNK ATRIAL UNK FLUTTER MULTIVITAMIN, WITH RAPID NO RATE. METAMUCIL NONE NORMAL TSH. ECHOCARDIOGRAM SHOWED LVEF 4 0 UNK PVT Syntheroid 1 PUB PUB 0 none PUB PUB none none none 2 PUB PVT treximet taken none on 7/2 for asthma migraine (mild), none~ allergic ()~NULL~~In to shrimpPatient|none~ ()~NULL~~I 1 NONE PUB PUB NONE NO ALLERGIC NONE~ TO SULFA ()~NULL~~In Sibling1|NONE~ ()~NULL 20 Complement UNK Antigen C3, UNK Complement total CH50,Cultures NONE None. of Blood 9/23/09 none~ 2 sets Hospital ()~~0~Patient|none~ at 2 sites. records Normal received results ()~~0~Sibling|none DOS for6/19/09 all. 9/23/0 to 6
0 NA PUB PUB None NA NA UNK~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In 1 PUB UNK 2 OTH PVT LAROXYL 0.75 None; mcgm arthritis Breast PO D; Vitamins Cancer ~Influenza Survivor(no NJ200903 - Rbrand breast name)~3~60~Patient Lumpectomy 1 PVT PUB SINGULAIRNone Seasonal allergic rhinitis 1 None PVT PVT None at time None of immunizations None 0 None PUB PUB None None None 0 PVT PVT On site swelling None 0 None PVT PVT None None 2 PUB PUB None None per Mom NK allergies - Has short urethral tube - Freq U.T.I's Seen by anPVT ophthalmologist. UNK The eye itself is None normal. To None scheduled for an MRI 6/30/09. 7/2/09 MRI normal. PVT UNK None None PVT UNK None None 0 PVT OTH METFORMIN Weight HCI 1000 management VICODIN; MG TABS; MORPHINE; ATIVAN 2 MG ALBUTEROL; TABS; CRESTOR AMOXICILLEN; 5 MG TABS CO 2 Unknown OTH OTH Unknown Unknown Unknown 1 PVT PVT None 0 OTH PUB 13 PVT PVT YAZ; MAXALT;BACTRIM UTI 6-17-09; 6-30-09 DS, give URI, at time started of injection XYZAL 0 UNK PVT PVT Unknown No concomitant medications A0795082A or relevant medical history. N 2 EKG on 6/22/09 PVT withinPUB normal limits No PMH: eczema 0 Ultrasound PVT (R) thigh; No UNK abscess; Positive edema of softneurofibromatosis. tissue. 9/4/09 Hospital 9/4/09records Hospital received recordsDOS received 6/25/09. DOSLA 6 365 Lost all metabolic PVT ability. PVT None Hole in heart ASD 43 EMG; lumbar OTH puncture;PVT neurology consultation None 8/27/09 Medical Hypertension; recordsT2received DM; atrial w/LABS: fibrillation; InitialCHF CSF:8/27/09 proteinMedi (N). 0 blood pressure, OTH "good";OTH venous blood Nonepo(2), "good" None Syncope~Varicella WAES0906USA05684 (no brand name)~2~9~Sibli 0 Unknown OTH OTH None None convulsion,WAES0907USA00006 Dizziness, Stomach discomfort, we 14 None OTH OTH Unknown Unknown WAES0906USA05165 Unknown OTH OTH Unknown Unknown WAES0907USA00183 107 ultrasound, OTH 09/23/08, normal, OTH routine None anatomy Pregnancy scan; beta-human NOS (LMP chorionic, = 5/23/2008) positive; WAES0807USA03163 serum alpha-fetoprotein, 10/1 Unknown OTH OTH Unknown WAES0906USA05239 Unknown OTH OTH Unknown Unknown WAES0906USA05566 288 Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0906USA05633 Unknown OTH OTH Unknown Unknown WAES0906USA05780 Unknown OTH OTH MAXAIR Asthma WAES0907USA00186 0 none reported PVT OTH ### 2 Stool culture; PUB Blood work PUB Labs: ClNone 109 (H), Ca++ None 10.6 (H), None Platelets PMH: LGA, 616, MPV neonatal AR0922 7.2 (L). hypoglycemia. Rotovirus (+). RSV 20 Blood w/u; KUB; PVT LABS:PVT abdominalNone x-ray, abdominal None US both Noneabnormal. 1 7/17/09 Medical PVT records UNK received DEPO-PROVERA DOS 6/25/09. None LABS and BeeDIAGNOSTICS: stings. 7/23/09 Hospital Monofilament records feels received different DOS on 6/30/0 left. CB 0 None PVT UNK 0 None PVT UNK None None GERD 0 CBC, normal PVT PUB TYLENOL; PharyngitisHx ZITHROMAX of OM LA090603 1 NO PVT PVT No 9 MIL MIL Amoxicillin,10-11 11Jun09; Jun Mefloquin, 2009, Seasonal fevers allergy weekly; ZIRTEC 10 mg 0 PVT PVT None None 1 Pt started on PVT oral ABX.PVT None None 0 PUB PUB LORATADINE None 5mg 1 Pt. stated that PUB MD wasn't PUB sure of the None reaction No but there was No no oozing. 0 None PVT PVT 1 OTH OTH None Penicillin; eggs 40 CT Brain Normal, PVT WBCUNK 13800, 65%, 5, 6% Mono, 17 EOSIN, Type 8/24/09 II DM HxER HPV records allergy received "Mold" cheese. DOS 4/21/09 8/14/09 - 4/22/09. MR rec 3 none PVT OTH Citalopram; Pravastatin; Levothyroxine; PPV, Merck, 1117X, LA. 0 PVT PVT None None 1 Mild Superficial PVT Cellulitis; PVT CBC WNL None None Allergic Amoxicillin
0 NONE PUB PUB ASA 7 None PVT PUB None None None 0 PVT PVT Allergic, NYASTATIN, CECLOR, sulfa, CLARITIN; AUGME 1 PVT PUB 1 none PVT PVT none none 14 MIL MIL None None 3 PVT UNK 18 none PVT PVT ELIDEL Cream; ATARAX Dermatitis syrup; VENTOLIN - sand paper HFA rash over skin, peeling of wrists, a 1 PUB PVT Simvastatin;None Metoprolol; NKA Triamterene/ HCTZ 1 PUB PUB None None 1 None OTH PUB None None None 0 None PVT PVT Levothyroxine; alendronate; Vit B; Simvastatin 0 DX with ERETHEMA PVT multiforme PVT 6/25/09 None None None 0 None PVT PVT Veramyst; Maxifed; None Singular; Recurrent Saline sinusitis, nasal non-allergic rinse rhinitis, eustachian tube dy 1 PVT PVT PVF no no 1 PVT UNK No 2 PVT PUB 08/20/2004~DTaP (no brand name)~5~5~Patie 0 OTH PVT 1 PVT PVT 2 vaccinated PVT reaction PVT None 0 PVT PVT None None 0 PVT PVT Albuterol; CLARITIN; nasal congestion; FLOVENT; sneezing RECLIPSEN None PUB PUB ALBUTEROL None PRN (NotAMOXICILLIN used for 2 mo); -> PPD, Severe APM, rash;Lot asthma Number - mild C3149AA, intermittent Route PVT OTH none 0 NONE PVT PVT NONE hives per mom NONE 1 PVT PVT Red ear (?bug Allergic bite?) Rhinitis 9 7/17/09 EROTH records received OTH DOS 7/4/09. LABS and DIAGNOSTICS: 7/17/09 ER records Chest received X-ray - NoDOS acute 7/4/09. radiographic Palpitations abnorm sinc 1 None PVT PVT None None 0 OTH OTH Amlodipine; DIOVAN; PREMARIN; Carvedilol; HCTZ; Simvastatin; Zolpidem 0 Saw allergist PVT - evaluation PVT negativeAmoxicillin/BACTRIM after prior OME problem Prior reaction anaphylaxis~Pneumo after receiving PENTACEL, (Prevnar)~2~0~Patient|a PREVNAR, ROT 2 PVT PVT MAXIFED; None DEXAMETHASONE; asthma, allergic ADVAIR; rhinitis, SINGULAIR; chronic sinusitis PEPSID; VENTOLIN; AS 1 None PVT UNK None No 0 PVT PUB None None None 3 none PVT PUB Had experienced hives 2 weeks before. 2 PVT PVT NO Hypertension; Cardiac arrhythmia PVT PVT None None 2 PVT UNK TOPROL XL None High blood pressure 0 PVT PUB none 0 none PUB PUB none none none 1 PUB PVT None to knowledge None reported None reported 2 None donePVT UNK None None None 6 none PUB PUB none none none UNK UNK None None stated 903 732 PVT PVT 2 Unknown UNK UNK NONE UNKNOWNUNKNOWN 0 None. 7/7/09 UNK Hospital records UNK received DOS None 5/5/09 to 5/6/09. None.LABS 7/7/09 0~ and Hospital ()~~0~Patient|0~ DIAGNOSTICS: records received ()~~0~Sibling|0~ WBC 20.1 DOS(Elevated). 5/5/09 ()~~0~Si to 5/6/ Ot 0 PVT PVT Healthy Peanut Allergy, Eczema, GI Reflux 1 PUB PUB 0 PVT UNK no no 2 None PVT PUB Loratadine Allergies 5mg/5ml 1 PVT PVT None None None known
6 PVT UNK Yasmin 28 None Allergic to Penicillin, Warts on Suprax, Hands and Biaxin. Fingers~HPV Patient has (Gardasil)~2 Pre-existi 312 PVT PVT 0 CSF, bloodUNK and urine cultures UNK negative. 7/17/09 None HospitalNone. records 7/17/09 received Hospital DOSrecords 6/30/09received to 7/4/09.DOS LABS 6/30/09 and DIAG to 7 1 Influenza swab UNKA & B (pending) UNK Headache x 2 days 2 none UNK PVT unknown none reported none reported none known~ ()~NULL~~In Patient 1 PVT UNK flovent-Pro mild air asthmamild asthma persistent 11 none PVT PVT 2 PVT PVT hypertension; Parkinson; osteoporosis; GERD; high choles 98 Head CT, chest UNK xray, urine UNK and blood. NoneNegative. No 8/4/09 Medical None. records Seizure~HPV received DOS (Gardasil)~2~13~Patient 7/8/09 to 7/15/09 LABS and 0 Across all ages UNKand race. UNK Pt was taken UNK to the Hospital UNK the day of the seizure, 26th Pt April lived 2009, most and of she her life wasingiven the foreign an ECG country, and a just CT Scan. returned W 1 NONE UNK UNK Past medical history includes hyperlipidemia; back surgery UNK UNK None Past medical history includes Diabetes mellitus; Gastroes 0 None PVT OTH The patient was takingThe concomitant patient had medications no reported of illnesses TOPAMAX, ### at the FLONASE time of vaccin and P Unknown UNK UNK Unknown Unknown WAES0907USA00328 Unknown UNK UNK Unknown Unknown WAES0907USA00329 Unknown OTH OTH Unknown Unknown WAES0907USA00233 n/a UNK PVT none none none none~ ()~NULL~~In Patient 0 blood work,PVT Cat skans,UNK UA vagefem, Furosemide,Lonazapam, none sesaonal allergies, none~ nexium, ()~NULL~~In spastic Nifedical vessel XL, Patient inAdvar, bottom Vytorin, of heart, Midrin high(P c 0 Mother stated PUB her daugher PVT had a CT none scan in ER none and a number none of tests to rule out appendicitis,tests came back nor 8 578.1 PVT PUB 0 Scheduled PVT to have evaluation UNK by neurologist singulair, albuterol with allergic possible rhinitis Penicillin EEG. allergy, allergic rhinitis, wheezing 0 ct head/routine UNKblood tests/ UNK refused NONE spinal tap. NONE 7/9/09 Hospital HEARING records LOSS received DOS 5/29/09 to 6/1/09. LABS and 0 MIL MIL just released from hosp for unknown reason 1 UNK UNK Calcitonin nasal, Depression, MVI, ASA, Breast HTN,simvastatin, ca vaginal s/p lumpectomy wallcalcium, bleeding. July08, vit D, levothyroxine, s/p radiation 9/08. fish oil, Also lisin 58 None required. PUB UNK None. 0 N/A PVT PVT Grave's dz, hyperlipidemia, IBS, GERD, osteopenia, HTN, 0 PVT PUB None None None 0~ ()~NULL~~In Patient|0~ ()~NULL~~In Siblin 1 CBC drawnUNK with normal UNK results. UNK UNK 3 We arranged UNK for her toUNK have a left brachial plexus NoneMRI performed. None This showed a mild localized superficial bone m 1 NONE PUB PUB None NO NONE 0 UNK UNK PUB PVT none occasional migraines with vision loss 1 None PUB PUB None None Atopic Dermatitis, Possible allergic Rhinitis UNK MIL Unknown Unknown 1 PUB UNK DX w/ fever; febrile SZ; pneumonia 3/27/09 evaluated and 3 OTH PVT 0 CBC, CMP PUB PVT Metformin ER Pt here - 500mg for 1 DM2 - month BID; MVTfollow-up daily PVT UNK Rabies Ig (6 vials), Talecris, 26N9R61, IM deltoid 5 MD Dx Varicella PUB vaccine PUB induce chicken None pox None (1) Rhinitis; (2) FTT; (3) Atopic dermatitis 0 Rast panel PVT PUB NC09027 6 CT of head;PVT Blood workOTH no illness; pre exposure 2 none PVT PUB 0 PVT PVT Hyperlipidemia; Prediabetic syndrome. 2 PVT PVT No None 3 UNK PVT OTH Unknown Enlarged Tonsil; Streptococcal A0790451A throat 24 X-ray, negative; PVT magnetic PVTresonance, Unknown negative; computed None axial, negative; sleepWAES0907USA00275 study, negative; electroencephalog 3 Unknown OTH OTH None None WAES0906USA05681 53 electromyography, OTH There OTH are some TENORMIN; interferences MAXIDE; of transmission None AMBIENof the nerve impulses WAES0907USA00456 in the muscle of the upper a cerebrospinal OTH fluid, for OTH genotypingUnknown Unknown WAES0906USA05714
0 Not reported PVT OTH Vomiting~Tdap (Adacel)~UN~11~Patient ### 6 A chest x-ray PUB was completed PUB that was negative. TheApatient CBC (complete has concurrent blood count) medicaland condition Chemistry ### of lupus, paneland were prior complet to va 0 PVT PVT none 0 PVT PVT PUB PVT UNKNOWNUNKNOWNUNKNOWN 0 None PUB PUB None None known None 7 PVT PUB None None None 0 PUB PVT None None Patient stated after fainting that she had fainted before but 0 PUB PVT Crestor,Zoloft,Levethroxin,Metrafumin,Glipizide, No Allergic to: Sulfa, Compuzine, & Actos IV Iodine. Medical condition 0 Normal head PVT CT and EEG PVT none none At 4 and 6 months he had episodes of curling in 0 PVT PVT N/A N/A 0 From ER CBC: UNK4,200 WBC(L), UNK H/H NuvaRing, 12.1/35.1,Ativan Was grans in0.5mg for 45.6 annual Penicillins, (L), lessMonos exam. thannone situational 5/month 12.1(H), Lotsreported~ of stress CMP stressunremarkable ()~~0~Patient|unknown~ from recent death of her father ()~~0 4 C-spine x-ray MILthat was MIL resulted asnon normal per patient none per patient none per patient none~ ()~NULL~~In Patient|none~ ()~NULL~~I 1 PUB PVT sbiriba, travatan, none trusodt, glaucoma simvastatin, eye none~ surgery ()~NULL~~In 2008. treatment Patient for tuberculosis in 2 0 PUB PUB 0 PVT PVT None None 1 arthritis panel UNK pending PVT Hep C txn none Sulfa allergy, HEP C 2 UNK UNK 0 PVT PUB Benadryl Rash - contact NKDA derm vs viral exanthem 5 9/22/09 PCP UNK medical records UNK received YAZ (drospirenone DOS 12/02/08&toethinyl 9/22/09 6/19/09. estradiol) PCP LABS ~HPV medical and (Gardasil)~~0~Patient DIAGNOSTICS: records received CHEM DOS-12/02/08 Glucose to 101 6 0 LABS: CXRUNK WNL. UNK None none 1 UNK UNK 0 7/10/09 Medical PVT Records PVT receivedMantoux DOS 7/7/09. PPD LABS and 7/10/09 DIAGNOSTICS: Medical Records Mantoux received (-). EKG DOS and7/7/09. unspecified Fainting/di labs 2 PUB PUB 2 Scheduled OTH for MRI on 7/16/2009 OTH None at theNone time None 1 PVT OTH 1 UNK PVT Unknown None None shingles~Zoster (Zostavax)~1~61~Patient 1 PUB PUB None None 1 None PVT OTH None Fibromyalgia; hypertension; asthmatic bronchitis; esophag 2 PVT PUB 3 PVT PUB None 1 PVT PVT 3 none PVT PVT SYNTHROID none Hypothyroidism 1 PVT PUB PPD skin test, Aventis Pasteur, C2920AB, Lower Lt Arm, 2 previous doses 1 None OTH OTH ALBUTEROL; None QUAR inhaler. Dx cellulitis 1 PVT PVT ZIAC 10/6.25 None Hypertension 1 PVT PVT FLOVENT inhaler; None SINGULAIR; Allergies, SINGULAIR, NASONEX spray NASONEX, FLOVENT; Asthma 0 PVT PVT 2 PVT PVT 0 None PVT PVT None 1 none PVT UNK 2 Sed rate; UA, PUB Tr protein; UNK EKG; CAT PROCARDIA scan; CXR; Thyroid HTN - all WNL; BMP, WNL; CBC, WNL 1 none PUB PUB None None None 2 PVT PVT None None 0 see att. emerg PVTroom data OTH 7/8/09 ADDERALLnone knownnone known 1 OTH UNK PCN; Codeine; Bimatoprost WBC- normal PVT OTH None None None 0 None PVT OTH Multi vitamin None None 1 PVT PVT The patient has allergies to Augmentin ### and Ampicillin. No 7 PVT UNK no none none 1 None, seenPVT in ER PUB None None None
Unknown OTH OTH Unknown Unknown WAES0907USA00248 Unknown OTH OTH Unknown Unknown WAES0907USA00445 11 Unknown OTH OTH NEXIUM Diabetes; Gastrooesophageal Oesophageal operation reflux WAES0907USA00680 disease; Contrast media allergy; 189 Unknown OTH OTH CELEBREXArthritis WAES0907USA00756 0 7/23/09 ERPVT records received PUB LABS: all WNL. None Sulfa; PCN; Contrast dye; CT200911 OMNICEF; cats; mold. 7/23/09 Labs with increased PVT WBC, PUBNL CT None head 10/20/09: None Hospital None. records 10/20/09: and andischarge Hospital records summary and discharge received for summar dates 2 none PVT PVT none history of hypertension allergies to bee stings,shellfish, 1 none PUB UNK none none none AL0910 0 N/A PUB PUB N/A N/A 2 UNK UNK None Occasional use of albuteral inhaler--like once a year 0 PVT UNK 1 PUB PUB 1 PUB PUB 0 PVT PVT none none none 1 PVT PVT none none 9 7/23/09 Received UNK hospital UNKmedicalEnalapril records forNone 7/4-7/10/2009. HTN. LABS: 7/23/09ESR Received & CRPhospital increased. medical ANArecords reactiveforbut 7/4-7/ insig 0 None UNK UNK MOTHER AND NONE/DENIES PATIENT NONE/ DENIES DENIES ANY OTHER MEDICATIONS. PVT PVT 8 None MIL UNK None None NDKA, None 4 Stool for Rotavirus UNK PUB Well Child visit. None Known 2 None. PVT PVT Effexor, Estrace None.vaginal Macrobid cream, Veramyst allergy-anaphylaxis. nasal spray, calcium and vitamin D sup 1 UNK UNK Occasional None. use of However, Betamethasone Small patient areas on ofcomplained psoriasis small areas on of head. of congestion headTubes for psoriasis the in day earsafter when the you v 0 none MIL MIL none none none 8/25/08: Positive UNK serumUNK HCG None None 5 Bacterial cultures; PVT viralOTH cultures none none 0 PUB PUB Penicillin 1 PVT PVT None None None 1 None PVT PVT None None None 2 None. OTH OTH MVS; HYZAAR; NoneMetoprolol; HTN -Simvastatin; Controlled Meloxicam; ASA 81mg 0 None PVT OTH 0 PVT PVT Spina Bifida Occulta; acne; Headache; asthma; allergies None PVT UNK None None None 2 PUB UNK PPD TEST None - JHP Pharmaceutical; Lot Number 78539, Route/site Left forearm; N 0 PUB PUB No No Certmaxone05/12/2009~Vaccine allergic reaction not specified (no brand na 0 None PVT PVT No Iodine (Swelling / Hives); Erythromycin (Tinnitis) None PUB PUB None None None DC20091 1 PVT UNK None None 0 PVT OTH Hives: PCN; sulfa; cephalexin; Hives 1 PVT PVT Folliculitis NKDA, HTN, Arthritis, Cancer 0 PVT PVT None No Allergy to Salicilates 1 PUB UNK None No None 2 DNA PVT PUB Hormones None Allergy to Tesslon pearls NONE MIL MIL NONE CLINDAMYCIN, DACON'S SOLUTION NONE MIL MIL NONE NONE MOTIN/IBUPROFEN EYES 1 UNK UNK Fosinopril, Zetia, none Prilosec 3 8/5/09 Medical UNKrecordsUNK received DOS 6/17/09Prior to 7/14/09. seizure seizure LABS disorder and disorder DIAGNOSTICS: complex partial Ironseizures. 12 ug/dL7/31/09 (L) UIBC Neurolo 388 u 10 MIL MIL None None NKA 1 NONE PVT PVT NONE NONE NONE UNK UNK 92 Went to dr, PUB and got myUNK anual check Birth up control, everything n/aadvil was normal, club foot, butsinus, if i stop food taking allergies my birth control i dont get my per 1 none MIL MIL None Denies PCN
0 None MIL MIL NONE Denies NONE 23 PUB UNK klonopin, flonase, asthmabiestrogen, testosterone. caltrite, 7 None OTH OTH aspirin; simvastatin; Herpes zoster VALTREX ophthalmic WAES0907USA00916 Unknown OTH OTH Unknown Unknown WAES0907USA00189 0 Unknown 9/15/09 OTH Received OTH medical None records w/LABS: monospot None 9/15/09 (+). CTReceived brain WNL WAES0907USA00372 medical except records for mildw/PMH: diffuse viral brainme at 0 Unknown UNK UNK LIPITOR The patient has allergy to bee### stings and pesticides; howe 2 UNK PVT PVT Unknown Concomitant medications A0796478A and relevant medical history wer 2 UNK PVT PVT Unknown Concomitant medications A0796480A and relevant medical history wer 1 PUB PVT None. None. Hyperglycemia, asthma, allergy (pollen). 448 PVT PVT 0 PUB PVT None None 0 PUB PVT NONE NONE NONE 0 PVT PVT 6 PneumoniaUNK was non resolving UNK through April 2009. None Bronchoscopy Elevated cholesterol. and biopsies8/28/09 on 03/12/09 Hospital revealed records elevated received leve DO 4 UNK PVT UNKNOWNNONE 0 UNK UNK none none 1 None MIL MIL Lisinopril 20mg nonedaily, Simvastatin hypertension, 80mg hyperlipidemia, daily, aspirinceliac 81mgsprue daily 1 UNK UNK NONE NONE NONE White bloodUNK cell count UNK 4.1, H&H 13.6 MAXIDE, and 40.3, PROTONIX, platelets Past 280, ENTEX, medical MCV SINGULAIR, 96,history: lymphsGastroesophageal 37, CIPRA, neutrophils VICODIN, 30,reflux PREDNISONE. Sodium disease, 136, pot hyM 0 UNK UNK none none none~ ()~NULL~~In Patient UNK UNK 2 Patient still MIL requires theMIL 2nd dose None of varicella No Father~Varicella (no brand name)~NULL~~In P 3 biopsy of Area, MIL being tested MIL for diabetes unknown unknown 1 na PUB PUB childrens multivitamin none none OTH OTH 1 PVT PVT FOSAMAX;Superficial Pravastatin; rash Lovastatin; Metformin; resolving Back Clindamycin abdpain; Dyslipidena; DMTZ; Osteoporosis 3 OTH PVT None 0 PVT PUB 2 PVT PVT Fluoride None None Developed Pertussis~DTaP (no brand name)~1 1 None UNK UNK 2 None PVT PUB None None None 3050 A punch biopsy MIL (11/18/1998) MIL identified Nonechanges None consistent hx with pseudofolliculitis psoriasiform barbae spongiotic (neck) dermatitis. 1997-98 1 None PVT UNK None Xray contrast = rash; NEURONTIN = "numbness"; DILANT None MIL MIL None None 2 PVT PVT None None None 0 PVT UNK runny nose PMH: and cough RAD, URI 1 PVT PVT 12 None PUB PVT No None GA09021 0 PUB PUB No No No GA09023 0 PUB PUB PPD placedNo in (L) forearm. No GA09024 3 PUB UNK Allergy to penicillin-takes GA09025 Kt for leg cramps 1 PVT PVT Diazepam Prn; H/O Pro asthma Air Erythromycin MDI Prn - GI SE; Percocet - visual Sx 0 PUB PUB None None None 2 PVT PVT No 1 OTH OTH None None PVT UNK None None PVT UNK None known 2 Strep test inPUB office 7/8/09, PUBnegativeNone per mom No None, NKA 0 None PVT PUB TRILEPTALNone Seizure disorder PVT UNK No Fish; Flaygl; Macrodantin 0 PVT OTH ZETIQ; LIPITOR; FOSAMAX Mitral regurg, Hx colon cancer; Allergies; PCN; NIACIN; Xe
4 Unknown OTH OTH Unknown Drug hypersensitivity WAES0902USA04530 0 Unknown OTH OTH Unknown Bipolar disorder; Mastectomy; Drug hypersensitivity; Breast cancer WAES0902USA04535 Penicillin allergy; Hypothyroidi 3 Unknown OTH OTH Unknown Unknown WAES0902USA04539 Unknown OTH OTH Unknown Unknown WAES0902USA04588 0 Unknown MIL OTH Unknown Cardiac failure congestive; WAES0902USA04590 Atrial fibrillation 0 None PVT PVT None None WAES0902USA04615 31 None OTH OTH BONIVA; SYNTHROID Allergy to vaccine Intestinal functional disorder; WAES0903USA00011 Colon spastic; Seasonal aller 3 body temp, PVT 02/15/09, 102 PVT None None WAES0903USA00012 1 Unknown PVT PVT albuterol; AGGRENOX; Hypertension;LIPITOR; Sleep apnoea; enalapril Asthma maleate; WAES0903USA00036 ADVAIR; PROTONA 1 PVT OTH Unknown Hypertension; GastrooesophagealWAES0903USA00039 reflux disease; Fibrocystic breast; D None OTH OTH Unknown Unknown WAES0903USA00069 Unknown PVT PVT Unknown Unknown WAES0903USA00118 1 None OTH OTH Unknown Unknown WAES0903USA00287 0 Unknown OTH OTH Unknown Unknown WAES0903USA00290 14 chest X-ray,PVT 02/17/09, PVT normal; eosinophil atenolol;count, LIPITOR; Hypertension; 02/20/09, PAXIL8%, Cholesterol high; serum high;EBV Sulfonamide WAES0903USA00421 early antigen, allergy; 02/20/09, Depression; 10.2 U/mL Hyp 5 Unknown OTH OTH Unknown Unknown WAES0903USA00439 3 Unknown PVT PVT allopurinol; Hypertension; aspirin; hydrochlorothiazide; Cancer Hypothyroidism of skin (excl SYNTHROID; melanoma) WAES0903USA00561 COZAAR; verapamil; vitam 2 Blood pressure, OTH 03/03/09, OTH128/7 mmHg Unknown Drug hypersensitivity; Allergic reaction WAES0903USA00573 to antibiotics 0 None PUB PVT Atenolol; Hydrochlorothiazide; Depression; Blood pressure Lisinopril high WAES0903USA00597 Unknown OTH UNK WAES0903USA00722 1 None OTH OTH Unknown Allergic reaction to antibiotics WAES0903USA00741 35 Unknown PVT OTH Sterile diluent Type 2 diabetes mellitus WAES0903USA00872 Unknown OTH OTH Unknown Unknown WAES0903USA00898 Unknown OTH OTH Unknown Diabetes; Hypertension Brain neoplasm; Shingles WAES0903USA00899 0 None OTH OTH VICODIN Shoulder pain; Asthma; Hypersensitivity WAES0903USA00953 1 Unknown OTH PVT Unknown Penicillin allergy; Sulfonamide allergy; WAES0903USA00989 Drug hypersensitivity Unknown OTH OTH Unknown Unknown WAES0903USA01130 1 None OTH OTH Hypercholesterolemia WAES0903USA00954 0 Unknown OTH OTH Unknown Unknown WAES0903USA01131 0 Unknown OTH OTH Unknown Unknown WAES0903USA01135 6 Unknown OTH OTH Unknown Unknown WAES0903USA01140 None OTH OTH ALLOPURINOL; Penicillin PREMARIN; allergy; Sulfonamide LASIX (FUROSEMIDE); allergy; WAES0903USA01405 Drug hypersensitivity; PLAQUENIL; SYNTHR Fish al 0 None OTH OTH None None WAES0903USA01407 0 None OTH OTH Activella; Hydrochlorothiazide; None Lisinopril, Protonix WAES0903USA01425 Unknown OTH OTH Unknown Unknown WAES0903USA01438 1 Unknown OTH OTH Unknown Unknown WAES0903USA01462 0 Unknown OTH OTH Unknown Allergic reaction to antibiotics WAES0903USA01586 0 Unknown OTH OTH Unknown Unknown WAES0903USA01587 7 None OTH OTH Aspirin; Carbidopa + Levodopa; Simvastatin; WAES0903USA01594 Terazosin Hydrochloride None OTH OTH Unknown PENICILLIN allergy WAES0903USA01610 Unknown OTH OTH Unknown Unknown WAES0903USA01648 Unknown OTH OTH aspirin; ADVAIR; lisinopril; Unknown metformin WAES0903USA01842 2 Unknown OTH OTH Unknown Unknown WAES0903USA01846 0 Unknown OTH OTH Unknown Unknown WAES0903USA01847 399 None PVT PVT None Hypertension WAES0903USA01848 1 Unknown OTH OTH Unknown Unknown WAES0903USA01854 Unknown OTH OTH Unknown Shingles Diabetes WAES0903USA01878 Unknown OTH OTH Unknown Unknown WAES0903USA02069 0 None OTH OTH FOSAMAX Shingles WAES0903USA02079 0 Unknown OTH OTH Unknown Unknown WAES0903USA02271 Unknown OTH OTH Unknown Herpes virus infection WAES0903USA02296
Unknown OTH OTH Unknown Unknown WAES0903USA02321 0 body temp, PVT 98.6 OTH PLAVIX; TRICOR; Sulfonamide metoprolol allergy WAES0903USA02331 287 Unknown PVT PVT calcium (unspecified), MyastheniaZYRTEC, gravis; Ptosis ACTIVELLA,WAES0903USA02342 TOPROL XL TABLETS, BENICAR 0 VZV strain; PVT VZV wild type PUBstrain. LIPITOR; PLAVIX; Drug hypersensitivity; PRINIVIL; Chickenpox TOPROL ArthritisXL tablets. WAES0903USA02559 0 UNK PVT PVT Unknown Concomitant medications A0794475A and relevant medical history wer 75 None PVT OTH Calcium (unspecified); SulfonamideVitamins allergy; (unspecified) Drug hypersensitivity WAES0903USA02580 82 thyroid function OTHtest, Normal; OTH metabolic CELEBREX; marker Hypertension; lisinopril test, Normal Surgery Arthritis WAES0903USA02594 0 None OTH OTH Unknown Unknown WAES0903USA02605 0 None PVT PVT UROXATRAL; Drugaspirin; hypersensitivity; Chickenpox; ROCAL; NEXIUM; Iodine Thrombocytopenia allergy FEOSOL; WAES0903USA02612 SINGULAIR; potassium (uns 414 None OTH OTH VYTORIN; Hypercholesterolaemia; Ibuprofen; Lisinopril; CIALIS; Hypertension Triamterene WAES0903USA02633 0 None OTH OTH LIPITOR; INSULIN; Atrial fibrillation; LORAZEPAM; Diabetes;METOPROLOL; Drug hypersensitivity. WAES0903USA02637 COUMADIN. 0 None OTH OTH None None WAES0903USA02894 Unknown OTH OTH Unknown Unknown WAES0903USA02917 None OTH OTH FOSAMAX;Hypertension; ATENOLOL; Oesophageal NEXIUM acid WAES0903USA02940 reflux; Osteoporosis; Penicillin alle 2 Unknown OTH OTH Unknown WAES0903USA02950 2 None OTH OTH Drug hypersensitivity; Osteopenia;WAES0903USA03624 Migraine valve prolapse; Spondylo 0 None OTH OTH None Penicillin allergy; Shingles Allergic reaction WAES0903USA03646 to antibiotics; Drug hypersensitivity 2 None PUB OTH PREVACIDCardiac disorder; Osteoporosis; Colonic WAES0903USA03653 tubulovillous adenoma; Stres Unknown OTH OTH Unknown Unknown WAES0903USA03948 107 None OTH OTH ZETIA; ZOCOR Penicillin allergy; Allergic reaction WAES0903USA03949 to antibiotics 0 Unknown OTH OTH Unknown Unknown WAES0903USA03956 41 spine X-ray,OTH spinal x ray OTH have been Unknown negative,Asthma; does seem Allergic "neuropathic"; reaction toX-ray, antibiotics lung WAES0903USA03992 x ray have been negative, does Unknown OTH OTH Unknown Unknown WAES0903USA04008 709 Unknown OTH OTH Unknown Unknown WAES0903USA04010 497 Unknown OTH OTH Unknown Unknown WAES0903USA04014 -19 None OTH OTH Unknown Latex allergy WAES0903USA04241 1 Unknown OTH OTH Unknown Unknown WAES0903USA04286 -19 None OTH OTH Unknown Penicillin allergy WAES0903USA04311 505 Unknown OTH OTH Unknown Unknown WAES0903USA04319 7 computed axial, OTH 03/24/2009 OTH Unknown Blood pressure high; cholesterol high WAES0903USA04510 68 None OTH OTH TEKTURNA; Blood aspirin; pressure lovastatin; Shingles high; NAMENDA; Depression EFFEXOR WAES0903USA04531 XR 0 Unknown OTH OTH Unknown Unknown WAES0903USA04539 Unknown OTH OTH Unknown Unknown WAES0903USA04567 Unknown OTH OTH Unknown Unknown WAES0903USA04625 9 Unknown OTH OTH Unknown Drug hypersensitivity WAES0903USA04687 0 Unknown OTH OTH aspirin; ZETIA; Sulfonamide propranolol allergy hydrochloride; simvastatin WAES0903USA04690 Unknown OTH OTH Unknown Chronic obstructive pulmonary disease WAES0903USA04712 276 None OTH OTH LANOXIN; AVAPRO; TOPROL None XL TABLETS;WAES0903USA04895 COUMADIN 7 blood pressure, OTH 03/??/09, OTH190/9 Unknown Hypertension WAES0903USA04920 OTH OTH COREG Unknown WAES0903USA05193 0 Unknown OTH OTH Unknown Unknown WAES0903USA05208 Unknown OTH OTH Unknown Unknown WAES0903USA05211 611 Unknown OTH OTH Unknown Unknown WAES0903USA05220 0 None OTH OTH Unknown Hypertension; Hyperlipidaemia WAES0903USA05292 8 None OTH OTH COMBIVENT, Hypertension; 90-180, Osteopenia; puff; Essential aspirin, Hyperlipidaemia; hypertension; 325 mg; ALLEGRA, WAES0903USA05388 Allergic Stress 180 rhinitis urinary mg; due FLONASE, incontinence; to pollen; 0.05 H blood pressure, OTH 180/9 OTH Unknown Unknown WAES0903USA05479 None OTH OTH Unknown None WAES0903USA05503 362 Unknown OTH OTH Unknown Unknown WAES0903USA05528 0 Unknown OTH OTH alprazolam;Arthritis LIPITOR; AMOUR THYROID TABLETS WAES0903USA05531 Unknown OTH OTH Unknown Unknown WAES0903USA05560 Unknown OTH OTH Unknown Unknown WAES0903USA05631
0 None PVT OTH None Drug hypersensitivity Breast cancer WAES0904USA00007 31 Unknown OTH OTH Unknown CholesterolShingles high; Hypertension WAES0904USA00023 Unknown OTH OTH Unknown Unknown WAES0904USA00033 Unknown OTH OTH Unknown Unknown WAES0904USA00055 7 None OTH OTH Unknown Unknown WAES0904USA00219 2 Unknown OTH OTH Unknown Hypersensitivity WAES0904USA00226 Unknown OTH OTH Unknown Unknown WAES0904USA00358 Unknown OTH OTH Unknown Unknown WAES0904USA00359 Unknown OTH OTH Unknown Unknown WAES0904USA00362 0 Unknown OTH OTH Unknown Abdominal aneurysm; Hypothyroidism; WAES0904USA00365 Anaemia; Scleroderma 21 Unknown OTH OTH Unknown Unknown WAES0904USA00366 Unknown OTH OTH Unknown Unknown WAES0904USA00370 1 None UNK UNK aspirin; RHINOCORT; Drug hypersensitivity CLARINEX; niacin WAES0904USA00382 Unknown OTH OTH Unknown Unknown WAES0904USA00411 19 None OTH OTH None None WAES0904USA00419 0 Unknown OTH OTH Unknown Unknown WAES0904USA00478 425 Unknown OTH OTH Unknown Unknown WAES0904USA00483 14 None OTH OTH None None WAES0904USA00572 5 None OTH OTH None Penicillin allergy; Drug hypersensitivity WAES0904USA00611 Unknown OTH OTH Unknown Unknown WAES0904USA00619 None OTH OTH PROTONIX; LYRICA; REQUIP None WAES0904USA00622 3 None OTH OTH Unknown None WAES0904USA00635 1 Unknown OTH OTH VICODIN; cephalexin; Osteoporosis; BONIVA; Sulfonamide lovastatin allergyWAES0904USA00640 1 Unknown OTH OTH Unknown Unknown WAES0904USA00641 Unknown OTH OTH Unknown Unknown WAES0904USA00859 0 None OTH OTH Calcium (unspecified); Gastrooesophageal Omega-3reflux marine disease triglycerides; WAES0904USA00879 PROTONIX; Vitamins (uns 0 Electrocardiogram, OTH 02?/??/09, OTH normal. Unknown Unknown WAES0904USA00891 Unknown OTH OTH Unknown Unknown WAES0904USA00894 1 Mammography PVT03/06/09 PVT - begin findings Unknown in the Fibrocystic left breast, breast two abnormal appearing WAES0904USA00978 lymph nodes in the left axilla; U 0 Unknown OTH OTH Unknown Penicillin allergy WAES0904USA00985 0 Culture rash. PVT OTH PRINIVIL. Blood pressure high. WAES0904USA01027 4 None OTH OTH LIPITOR; lisinopril Hypertension; Hypercholesterolemia WAES0904USA01139 2 Unknown OTH OTH Unknown Melanoma, Chemotherapy WAES0904USA01268 0 endoscopy OTH OTH FOSAMAX; aminopyrine; Perforated VASOTEC; ulcerLovastatin; WAES0904USA01351 omeprazole Unknown OTH OTH Unknown Unknown WAES0904USA01359 49 Streptococcus OTHgroup A,OTH strep test Unknown proved negative. Penicillin allergy Chickenpox WAES0904USA01543 -2 upper extremity OTH X-ray, OTH 04/13/09 Unknown Pain WAES0904USA01885 7 diagnostic laboratory, PVT 04/11/09, PVT Tzanck FOSAMAX; test =positive Disease aspirin; complication for atenolol; Cholecystectomy; zoster;calcium VZV strain, (unspecified); Chickenpox; 04/11/09, WAES0904USA01886 ESTER-C; no Breast varicella-zoster cancer chondroitin virus sulfate dete 10 Unknown OTH OTH Unknown Unknown WAES0904USA01894 Unknown. OTH OTH Unknown Unknown WAES0904USA02021 2 Unknown OTH OTH Unknown Unknown WAES0904USA02055 20 None OTH OTH lisinopril; simvastatin Penicillin allergy Dental implantation WAES0904USA02065 113 Pap test, 04/08?/09, OTH HPV OTH positive.Thyroid medication. Allergic to aspirin and sulfa WAES0904USA02072 drugs; Thyroid disorder. 14 None OTH OTH CELEXA; NEXIUM; TARKA Unknown WAES0904USA02087 0 Unknown OTH OTH Unknown Unknown WAES0904USA02306 Unknown OTH OTH Unknown Unknown WAES0904USA02311 10 Unknown OTH OTH REMICADE Unknown WAES0904USA02319 Unknown OTH OTH Unknown None WAES0904USA02348 28 Unknown OTH OTH Unknown Blood pressure Immunisation high; Scar WAES0904USA02359 Unknown OTH OTH Unknown Unknown WAES0904USA02785 0 Unknown PVT PVT Unknown None Unknown WAES0904USA02790
Unknown OTH OTH Unknown Unknown WAES0904USA02807 8 None OTH OTH None None WAES0904USA02906 1 None OTH OTH None None WAES0904USA02915 0 Unknown OTH OTH Unknown Unknown WAES0904USA02938 2 Unknown OTH OTH Unknown Unknown WAES0904USA02969 0 None OTH OTH vitamins (unspecified) None WAES0904USA03184 615 None OTH OTH DOXYCYCLINE, Penicillin PREMARIN, allergy; Drug HYDROCHLOROTHIAZIDE, hypersensitivity; WAES0904USA03188 Hypersensitivity; DILAUDID, Allergic ACTONE react 303 Unknown OTH OTH Unknown Unknown WAES0904USA03195 Unknown OTH OTH Unknown Unknown WAES0904USA03273 None OTH OTH None None WAES0904USA03450 2 Unknown OTH OTH Unknown Unknown WAES0904USA03566 2 complete blood OTHcell, 66000 OTH levothyroxine Idiopathic sodium;thrombocytopenic prednisone purpura WAES0904USA03598 1 Unknown OTH OTH Unknown No medical history or allergies; WAES0904USA03629 Shingles. 84 Unknown OTH OTH Unknown Diabetes WAES0904USA03693 242 Unknown OTH OTH Diltiazem-HCL; NEXIUM; A history aspirin,ofmg; chickenpox CENTRUM; WAES0904USA03793 as youngster; Calcium (unspecified); Allergy to sulfa; Vitamin rofe 0 Unknown OTH OTH Unknown Unknown WAES0904USA03804 5 None PVT PVT ZOCOR None WAES0904USA03835 2 None OTH OTH FOSAMAX;Sulfonamide VITA C; ASPIRINE; Uterine allergycancer; chondroitin Cervical sulfate WAES0904USA03950 cancer; sodium Appendicectomy (+) levoglutamide; SY 0 Unknown OTH OTH NEXIUM Unknown WAES0904USA04005 5 Unknown OTH OTH Unknown Shingles WAES0904USA04009 1 None OTH OTH HYDROCHLOROTHIAZIDE None WAES0904USA04015 201 laboratory test, OTHscraping OTH of the bumps FOSAMAX; negative Arthritis; CELEBREX; Osteopenia; BENTYL; Cholesterol TOPROL high; WAES0904USA04025 XL TABLETS; Blood pressure ramipril; high; simvastatin; Iodine al 740 Unknown OTH OTH Unknown Unknown WAES0904USA04180 Unknown OTH OTH Unknown Unknown WAES0904USA04185 1 VZV strain, OTH 05/05/2009, OTH VZV WildUnknown Type strainType 2 diabetes Hepatitis mellinus; C Hyperlipidaemia; WAES0904USA04196 Hypertension; Erectile d 143 None OTH OTH None WAES0904USA04201 Unknown OTH OTH Unknown Unknown WAES0904USA04209 2 Unknown OTH OTH albuterol Herpes simplex WAES0904USA04211 3 Biopsy - cellulitis PVT OTH Xanax(unspecified) Hypertension ; Estrogens(unspecified) Gastric ; Arthritis; bypass Drug hypersensitivity; ;WAES0904USA04215 Minerals (unspecified) Contrast media ; Vitamins allergy; (u 0 None OTH OTH Evista None WAES0904USA04216 None OTH OTH None None WAES0904USA04235 Unknown OTH OTH HYDROCHLOROTHIAZIDE; Chronic liver disease LORAZEPAM; PROPRANOLOL WAES0904USA04249 HYDROCHLORID None OTH OTH None Unknown WAES0904USA04250 4 abdominal computed PVT axial, PVT 03/07/09, Unknown and pelvis: Drugsee hypersensitivity; narrative; Rash erythematous; bodySulfonamide temp, 98.6, Rash WAES0904USA04379 allergy; max papular; Anaemia; Hysterectomy; CoronaryAppend artery 5 Unknown OTH OTH Unknown Unknown WAES0904USA04390 1 None OTH OTH IMITREX Migraine; Allergic Intraocular reaction melanoma to bee sting; WAES0904USA04398 Allergy to vaccine; Hyperchol Unknown OTH OTH Unknown Chickenpox WAES0904USA04433 501 Unknown OTH OTH NORVASC;Hypertension; AVALIDE; NIASPAN Benign prostatic hyperplasia; WAES0904USA04449 Aortic stenosis 31 None OTH OTH PREMARIN; levothyroxine Shingles sodium; lisinopril; lovastatin; WAES0904USA04519 KLOR-CON Unknown OTH OTH MICARDIS Blood pressure Varicella high zoster WAES0904USA04551 Unknown OTH OTH Unknown Unknown WAES0904USA04563 613 Unknown OTH OTH None None WAES0904USA04571 Unknown OTH OTH Unknown Unknown WAES0905USA00012 0 None OTH OTH LOTREL None WAES0905USA00026 Unknown OTH OTH Unknown Unknown WAES0905USA00030 12 VZV strain, OTH 05/05/09, inadequate, OTH alprazolam; negative forChest aspirin; B-globin, pain; cyanocobalamin; and Knee Obesity; noarthroplasty; strain Dumping was ferrous identified Adverse syndrome; WAES0905USA00047 sulfate; drug Tremor; gabapentin; reaction; Post-traumatic Stomach omeprazole; discom stre pr Unknown OTH OTH Unknown Unknown WAES0905USA00053 Unknown OTH OTH Unknown Unknown WAES0905USA00055 0 Unknown OTH OTH Unknown Unknown WAES0905USA00183 661 None OTH OTH None None WAES0905USA00208 4 None OTH OTH Atenolol; RHINOCORT Hypertension; Anaemia (BUDESONIDE); Gastrooesophageal SYMBICORT; WAES0905USA00222 reflux disease; NEURONTIN; Drug hypersensitivi Hydrochlo
Unknown OTH OTH Unknown Unknown WAES0905USA00229 Unknown OTH OTH Unknown Unknown WAES0905USA00231 0 Unknown PVT PVT Unknown None WAES0905USA00233 298 Unknown OTH OTH furosemide;Sulfonamide lisinopril allergy WAES0905USA00346 21 Serum varicella OTH zoster,OTH positive; Body NEXIUM; temp,DIOVAN; 97; Chronic Bodyobstructive Allopurinol; temp, Elevated 98. pulmonary Simvastatin. liver enzyme disease; WAES0905USA00353 levels;Arthritis; Gastric disorder. Hypertension; Hyper 0 Unknown OTH OTH Unknown Unknown WAES0905USA00356 gia and arthritis and a history of a fall UNK on her left UNK side a couple aspirin; of years OXYCODONE Post agoherpetic and shingles Shingles; neuralgia; who FallArthritis; on 04-APR-2009 Drug WAES0905USA00376 hypersensitivity was vaccinated with ZOSTE 0 None OTH OTH Unknown Unknown WAES0905USA00393 0 Unknown OTH OTH Unknown Unknown WAES0905USA00515 None OTH OTH None None WAES0905USA00519 0 Unknown OTH OTH Unknown Unknown WAES0905USA00552 786 Unknown OTH OTH None Unknown WAES0905USA00564 Unknown OTH OTH Unknown Unknown WAES0905USA00580 serum varicella OTHzoster,OTH 04/17/09, 3.04 None- IGG Chronic fatigue Shingles syndrome WAES0905USA00638 None OTH OTH None Chickenpox WAES0905USA00700 1 Body temp,OTH 98.9; VZV UNK strain, inadequate TENORETIC; specimen, Hypertension; BONIVA; no strain Chickenpox Omeprazole; Osteoporosis; identified Potassium DrugWAES0905USA00860 hypersensitivity (unspecified) 1 None OTH OTH Unknown Skin disorder WAES0905USA00940 0 Unknown OTH OTH VASOTEC;Type glipizide; 2 diabetes DICHLORTRIDE; Toothmellitus; disorderAllergy metformin; to WAES0905USA00949 vaccine ACTOS; ZOCOR 1 None OTH OTH aspirin; LIPITOR; Hypertension; PREMARIN; Hypercholesterolaemia; glucosamine; hydrochlorothiazide; WAES0905USA00952 Allergic reactionDAYPRO; to antibiotics; pota 5 VZV strain, OTH 05/13?/09,OTH VZV wild type Senna strain. syrup, Chronic mL; Metoprolol, obstructive Hyponatraemia; mg; pulmonary Fluticasone Methicillin-resistant disease; WAES0905USA00965 inhaler, Hypertension; microgm; staphylococcus multi Anaemia; vitamins aureu Chro (u Unknown OTH OTH Unknown Rheumatoid arthritis WAES0905USA00983 Unknown OTH OTH Unknown Unknown WAES0905USA01036 732 None PVT PVT None Prostate cancer WAES0905USA01058 7 None OTH OTH calcium (unspecified); Cholesterolomega-3 high; Breast marine cancer triglycerides; WAES0905USA01069 ZOCOR; tamoxifen citrate; v Unknown OTH OTH Unknown Unknown WAES0905USA01098 0 Unknown OTH OTH Unknown Unknown WAES0905USA01101 Unknown OTH OTH Unknown Unknown WAES0905USA01253 1 Abdominal PVT ultrasound, PVT 04/21/09, See Unknown narrative; Urinary Serum tract albumin, Migraine infection; 04/20/09, Drug hypersensitivity 4.1 gm/dl; WAES0905USA01255 Erythrocyte, 04/20/09, 37 mm 4 None OTH OTH Tricor; Ferrous Diabetes sulfate; Lasix; Glyburide; Lisinopril; WAES0905USA01271 Minoxidil; Cialis 439 temperatureOTH measurement OTH98.6 - Maximum aspirin; hydrochlorothiazide; temperature Diverticulitis; Breast Hyperlipidaemia; LEVOXYL; cancer; Knee lisinopril; Hypertension; arthroplasty; WAES0905USA01287 lovastatin; Hypothyroidism; Chickenpox INDERAL Anaem 614 None OTH OTH Unknown Unknown WAES0905USA01301 2 VZV strain -OTH VZV wild type OTHstrain Aspirin; Atenolol; Synthroid; Chickenpox Lisinopril; ViagraWAES0905USA01312 0 None OTH OTH Zyrtec Hypersensitivity WAES0905USA01422 543 None OTH OTH Unknown Chronic obstructive Nephrectomy pulmonary disease; WAES0905USA01423 Hypertension; Cardiac failure 2 None OTH OTH FLONASE; Seasonal VIAGRA allergies WAES0905USA01465 4 VZV strain 05/13/09 OTH - Sample OTH adequate: Unknown VZV WILD TYPE Unknown STRAIN WAES0905USA01623 4 Unknown OTH OTH CIPRO Unknown WAES0905USA01656 1 VZV strain; OTH 05/14/2009, OTH VZV WildVYTORIN; Type Strain. Hypothyroidism; Fenofibrate; Hydrochlorothiazide; Hyperlipidaemia;WAES0905USA01657 Drug LEVOXYL; hypersensitivity. SINGULAR. 1 None OTH OTH lisinopril; meclizine Hypertension; Sulfonamide allergyWAES0905USA01842 1 None OTH OTH Premarin Perfume sensitivity Shingles WAES0905USA02008 1 Unknown OTH OTH Unknown Unknown WAES0905USA02208 None OTH OTH None None WAES0905USA02276 2 Unknown OTH OTH ZETIA; PROZAC; Promethazine; Unknown CRESTOR. WAES0905USA02488 Unknown OTH OTH Unknown Unknown WAES0905USA02517 X-ray - Something OTH on his OTH lung Unknown Unknown WAES0905USA02520 0 Unknown OTH OTH Unknown Unknown WAES0905USA02523 1 None OTH OTH Unknown Allergic reaction to antibiotics. WAES0905USA02846 461 None OTH OTH Celebrex; Lasix; Hypertension; Hydrocodone; Hyperlipidemia; Zocor; Coumadin. Arthritis; WAES0905USA02876 Aortic valve disease; Fruit alle Unknown OTH OTH Unknown Blood pressure high; Eye disorder.WAES0905USA02917 26 None OTH OTH GLIMEPIRIDE, Ischaemic HUMULIN, cardiomyopathy; Defibrillator/pacemaker METFORMIN, Diabetes TOPROL WAES0905USA02926 insertion XL TABLETS, VIAGRA, DIO 2 Unknown OTH OTH Unknown Unknown WAES0905USA02944
Unknown OTH OTH Unknown Unknown WAES0905USA02976 1 PPD OTH OTH Phantom limb pain; Neuralgia. WAES0905USA02979 305 Unknown OTH OTH Unknown Unknown WAES0905USA03099 Unknown OTH OTH Unknown Unknown WAES0905USA03224 0 None OTH OTH Unknown Genital herpes WAES0905USA03226 hemoglobin,OTH 7 OTH Unknown Unknown WAES0905USA03236 1 None OTH OTH LEVOTHYROXINE Hypothyroidism SODIUM WAES0905USA03363 None OTH OTH None Penicillin allergy WAES0905USA03373 0 None OTH OTH Unknown Unknown WAES0905USA03378 21 OTH OTH None Heart rate irregular; Candidiasis. Arthritis. WAES0905USA03386 1 None. PVT PVT APLISOL, 62418, At the time ID Forearm The of vaccination patient left, had 0 previous henoreported known doses allergies. feeling ### tired. His past medical histo 0 UNK UNK Anemia Allergic to shrimp 1 Labs: CRP PUB 1.6. urine tox PUB (-). CBC unremarkable. Na+ 139. CSF WNL. Head CT LA090702 WNL. 18 PVT PUB None Well check None up/constipation UNK UNK None UNK UNK This is a very healthy infant with no medical problems. 0 electrocardiogram, OTH 06/18/09, OTH normal; None blood pressure, hematoma 06/18/09, Unknown under 2normal. toe nails Labs and WAES0907USA00742 Diagnostics: CT brain (-). EEG 2 Reviewed by PUB Doctor atPUB Hospital Current Metoporal 50 mg; Hypertension Flonase 0 None PVT UNK None - veryNone healthy - Hx baby &AtPx 2 mo. -> Completely & 4 mo.~Rotavirus healthy infant (no brand name)~2 0 PVT PVT Multiple infections varicella~Varicella (no brand name)~1~1~Patie 29 Unknown. OTH 6/25/09 Labs OTH and Diagnostics: COLACE; EEG LEXAPRO; Hepatic normal. cirrhosis; estradiol; Transfusion. CSF WNL. Borderline LASIX (-)Penicillin oligoclonal (FUROSEMIDE); hypertension; WAES0907USA01157 Allergy. bands. Multiple Hepatitis MRI MIRALAX; brain Drug C; Hypersensitivi with allergies RESTORIL someand mild 10 PVT PVT none none 10 PVT PUB 1 visual examination PVT of injection PUB site by PA 06/27/2009~Measles + Mumps + Rubella (no b 0 PUB OTH Birth Control Pills Lactose intolerance; Allergic to grass and hay 1 PVT PVT None None L Conjunctival Protuberance 1 PVT PUB NKDA Wolfe-Parkinson-White syndrome 1 PUB UNK PPD; Sanofi Pasteur Ltd; C3150AN; Right Forearm, ? PVT PVT None epilepsy 2 UNK PUB PUB Unknown Asthma; Concomitant medications A0796705A unknown. No adverse e 6 9/24/09 Medical PVT records PVT received None for date of service No 6/22/09. 9/24/09 Diagnostics/Labs: Medical recordschest received xray for findings: date ofasymmetric service 6/22/0 inc 0 PUB PUB No 0 UNK UNK Advil None None None~ ()~~0~Patient 0 PUB PUB none none 1 PVT UNK Retin A 0.05% None top cream, Ulcerative Fluocinonide proctitis 0.05% top cream, Canasa 1,000 MG Rec 1 UNK PVT celebrex, lipitor, none actonel, none levoxyl 1 CXR: poor inspiratory UNK effort, UNK infiltrate left lowerNO lobe COMPLAINTS base,ASTHMA resolving OR Obesity infiltrate. ANY OBVIOUS Labs: WBC SIGNS/SYMPTOMS 16.6(H),Auto ANC14.6(H) 2 None PVT PVT None None None 2 PVT PVT AUGMENTIN OM NONE KNOWN 0 NONE PVT PUB NONE NONE 1 None PVT PUB Otitis MediaNKDA Pt. had Nonot medical taken problems any other medications prior to or on day 11 None PUB PUB none none none AZ0906 1 Treated for UNK cellulitis at UNK the vaccination site no 0 PUB PUB 34 inutssusception. UNK 7/30/09 UNK Clinic records none received none DOS 6/2/09 noneand 7/30/09 7/6/09. intussussception~Rotavirus Clinic LABS records and DIAGNOSTICS: received DOS (Rotarix)~3~1~Pat 6/2/09 CHEMand - Anion 7/6/ 0 PVT PVT adderall, proair 11 yr phy astma,allergic rhinitis,adhd 0 Referred toPVT allergist to PVT evaluate forNone possible gelatin None allergy Premature infant None PVT PVT None PENICILLIN PVT PUB 0 Doctor instructed PUB to hold PUB dose of Typhoid None vaccine Nonex 1 dayNone & call if symptoms worsen. 1 None MIL MIL CETIRIZINE None HCL NKA, no birth defects, no medical conditions
1 3 0 None
PUB PUB None None AR0923 PUB UNK None None None AR0924 PUB PUB None None None AR0925 UNK UNK None None PVT UNK None None 2 None PVT PVT Swelling None 0 PVT PVT Tylenol prior None to vax. None 0 PVT PVT 0 Vitals PVT PVT PCN; Cephalosporins 1 PVT PUB None None None NC09028 1 PUB UNK ALLEGRA; Fish oil; NORVASC; Hypertension; LOVAZA;NEXIUM Hyperlipidemia; NC09029 GERD; Allergies OA 0 PVT PVT 0 Unknown PUB PUB None Known None No Known allergies 0 None OTH OTH None 0 None PVT OTH None None None 1 PUB PUB METFORMIN HCL; GLYBURIDE; DM; Hyperlipidemia; DIPHENYDRAMINE. Esophageal reflux; Allergic Rhinitis; 6 neuro checkPVT PVT no Migraine headaches 0 PVT PUB None Teething -> Molars 1 PVT UNK None Twin- 33 wks gestation with gastroesophageal reflux. 1 PVT OTH None None None 1 PUB UNK None Undescended (L) testicle None PVT PUB None None PVT PUB PVT PUB 0 PVT PUB 0 PVT PVT Captopril; Digoxin None except Congenital for chronic heart condition disease 5 Spinal Tap,PVT MRI PVT None None allergy to CECLOR Unknown OTH OTH Unknown Unknown WAES0903USA02916 OTH OTH Unknown Unknown WAES0903USA04731 1 Not reported PVT UNK FLONASE; ATENOL; The ADVAIR; patientSINGULAIR had no illness and### no known drug allergies at 5 None PVT PVT Aspirin The patientThe had patient no illness hadatathe history timeofofdiverticulosis; vaccination. ### Shingles, March 0 PVT OTH Lithium, LOMENTIL History of sulfa drug allergy and ###bipolar disorder. The patie On 09 JuneUNK 2008 serology UNKtestingPrenatal was completed vitaminsthat was Thenormal. patientOn has22a July history 2008 of pollen an### ultrasound allergy. was Obstetrical completed histo 2 No relevantPVT diagnostic PVT tests/laboratory data were performed. The patient had no illnesses at### the time of vaccination on 1 1 PVT PVT LEXAPRO;ItSYNTHROID; was reported Medical CEFTIN; that history the patient Omega of hypothyroidism had 3; Vitamin sinusitis ### C; atand Vitamin theallergy timeE;ofto Vitamin vaccination AUGMEN B 2 Not reported. UNK UNK NORVASC;Illnesses MOTRIN; atFLEXERIL There the time were of vaccination no known allergies. were cough ### Concomitant and staple medications in the patie UNK UNK None reported. ### 1 None UNK UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK The patient had no illness at the ###time of vaccination. 1 None PVT UNK Not reported. ### 1 None reported. PVT OTH ZYRTEC; BENTYL No known allergies. ### Not reported UNK OTH ### 0 Not reported PUB UNK Birth control pills The patient had no illness at the ###time of vaccination and ha 1 None OTH OTH None ### 0 UNK UNK ### 0 not reportedOTH OTH none ### UNK UNK ### None PVT PVT FOLIC ACID; CRESTOR; History SYNTHROID; of rheumatoid DIVON; arthritis,ASPIRIN; ### hypothyroidism, CYMBALTA hypertensio 13 16/Mar/2009: PVT Cultures PVT - no growth Medical history and concomitant ###medications were not rep 0 Not reported PVT OTH No known allergies. No medical ###conditions other than seas
4 none OTH UNK Sudafed none ### 7 not reported. OTH UNK ### 1 None PVT OTH Topamax, Maxalt Patient has a history of migraines. ### Concurrent therapy incl 1 PVT PVT HRT Lyme Disease ### 1 PVT PVT ASA; Vitamins No medical history. Last Td vaccination ### was 20 years ago. not reported. PVT From information OTH received 19 March 2009, History no testing of hypothyroidism performed for the andevent; ### an allergy only routine to antibiotics. lab work The fo 1 UNK UNK SYNTHROID; Sinus LISINOPRIL; infection History without ALDACTONE; of high fever blood at the METFORMIN; pressure, time of### vaccination. metabolic FOL-TX; syndrome, CALTRATE; fibrom 3 none reported. UNK UNK Not reported. ### 0 None. PVT PVT Multivitamin; TUBERSOL No medical conditions. No known ### allergies. No illness at tim 1 None PVT UNK No illness at the time of vaccination, ### other medications unk 6 OTH OTH TUBERSOL 5 TU No medical history, no known ### allergies, no concomitant me 39 Not reported. PUB Follow-upPVT information prenatal received vitamins; on 13 November PPDRefugee SKIN2008 TEST whose indicated past obstetrical the following: ### history An ultrasound is "unknown." performe The 4 None reported PVT OTH ACIPHEX; Fluoxetine; The LUNESTA; patient had CELEBREX a history of allergy ### to CELEXA. It was indi 1 None reported. OTH OTH None reported. ### Patient reported PUB havingUNK "tests" (notCELEXA; specified). Prenatal From information vitamins; HistoryZOFRAN; includes received an PHENERGAN on allergy 09/Feb/2009, to penicillin ### the patient and one had previous the follow p 3 MIL MIL 6 Numerous -PUB labs normal; PVT brain MRI Vitamin essentially C 500 Had normal mg cold daily. per dxExertional but 7/29/09 neurosurgeon; deemed Consultant compartment stable gallfor bladder medical flu syndrome shot HIDA records 12/30/08 -scan bilateral received essentially fasciotomy. DOSnorma 6/30/0 7 61 Extracted from PVTD/C on OTH 08/31/08 and None Neurology None Consultation Not Applicable Report to PCP - None following 09/23/08 F/U visit. CT head-N 102 Culture sentPVT on fluid drained PVT from abscess were None negativeNone - no aerobic or anaerobic bacteria present. 8 none MIL MIL none No illness none 4 MIL MIL 0 None PVT PVT Unknown OTH OTH Unknown WAES0907USA00699 0 None PUB PUB Singular; Claritin Asthma 0 Unknown OTH OTH Unknown Unknown WAES0907USA01326 0 PVT PVT None Well Child None 0 OTH PVT Knee laceration None Unknown OTH OTH Unknown Unknown WAES0907USA01296 None PVT PUB None None None 229 Unknown. OTH Medical records OTH received Morphine; DOS 7/15/08 PRILOSEC; to 7/7/09. None. prednisone LPMedical recordsWAES0907USA00930 received DOS 7/15/08 to 7/7/09. Ea PUB PVT None None PUB UNK None None Unknown OTH OTH Anaphylactic Anaphylactic reaction WAES0907USA01222 reaction~Varicella (Varivax)~UN~ 1 PVT PUB None None 1 PUB PUB None Asthma. 17 body temp, PVT 06?/??/09,OTH 101 F VICODIN; fentanyl; Sulfonamide SEROQUEL allergy; Drug hypersensitivity; WAES0906USA02621 Smoker 1 None PVT PVT 2 None PVT PUB None None 2 PVT OTH Cough; sleeplessness PUB PUB None None PVT PVT No Osteoporosis See I-693, Report PUB of Medical UNK Vaccination Record A cold attached. Pollen See+copy unspecific of I-693! food additive allergies 4 None PUB UNK myalgia NKDA esicular noted) posteriorNone scalp red raised PVT lesion UNK (L) neck. 4 none PUB PUB denies denies denies 0 None PUB PUB None Not prior to None vaccination 5 PUB PVT No Sulfa drugs allergy 0 PVT PVT None None None 0 PVT PVT none Growth delay-? Allergies; Eosinophilic Disease; Eczema; E 1 None MIL MIL PPD, SanofiNo Pasteur, C2681AA, ID/ Left arm; Zyrtec 2 OTH PVT Metoprolol 50 mg; Allopurinol Gout; High 300 BP; mg; BPH Lisinopril 10 mg; Doxazosin 4 mg
1 None PVT PVT None No No 2 PVT PVT Xanax XR, healthy Paxil, Zyprexa, seasonal, Provigil, Lamictal Advairand Diskus, Diflucan Flonase, allergies; Singulair, CeliacCalrinex, disease,U 1 PVT PUB none none 0 None PVT PVT None None None 1 ECG-normal PVT PVT Lovastatin, None Zyrtec, Nexium No known allergies 1 MIL MIL implanon no reportedno illness reported illness or pertinent medical history 0 PUB PVT No Diabetic 1 Labs: CBC,UNK CMP , PT,UNK PTT, TSH,metformin, Magnesim,diovan, no Phosphorous januvia, hypertension, alllipitor, normal. lisinopril, diabetes, D-dimer nexium high hyperlipidemia at 0.56 Dx PMH: studies/Xrays: OA, HTN, CXR DM 0 None. MIL PVT Cabergoline, None Zyrtec, Motrin PCOS, Allergic Rhinitis, elevated prolactin. Has had tende 0 PVT PVT none no born with B pneumo-thorax - resolved 1 UNK PUB None Known None known None known 0 UNK UNK accutone none 7/17/09 Medical site soreness~HPV records received (Gardasil)~1~25~Patient DOS 7/13/09 to 7/17/09. 0 UNK UNK PCN;Sulfa;MS;Cephalosporins;codeine;Negram;Vinegars, PUB PUB Allergic to Monostat 1 N/A PVT PVT 1 PUB PUB Tylenol URI-viral, Rash Eczema 10 none PUB PUB n/a no no AZ0907 1 none PVT PVT none none 0 UNK UNK Hydrochlorothiazide 25MG, Primary 1 tablet Hyperoxaluria BID; Pyridoxine HCl 100MG, 5 Tablet daily; U 1 none UNK UNK none nkda 1 UNK UNK ALBUTEROL NONE 90MCG (CFC-F) NONE 200D ORAL CITALOPRAM HYDROBROMIDE 20 0 PVT PVT Prevacid, Metoclopramide 10 days of cold GE reflux symptoms 3 culture taken PVT in ER to test PVTfor respiratory None infections None - all cultures born with returned Bi-lateral None~ negative ()~NULL~~In club foot; otherwise Patient|Unknown~ no other pre-existin ()~NUL 3104 UNK OTH OTH Unknown A0796729A 0 PUB UNK None None 1 MIL MIL Bell's PalsyBell's Palsy resolved one month prior 1 PVT PUB No 9 7/7/09, Creatine MIL KinaseMIL SERUM 88 none (22-269);none Troponin Tnone Cardiac SERUM 0.028(0.00-0.029); Creatine Kinase MB 3 Creatine Kinase MIL MB SERUM MIL 2.050 ng/mL (0-6.73), None Troponin NoneT Cardiac SERUM <0.010 ng/mL (0.00-0.029), Creati 0 None PVT PUB None Reactive airway disease & allergic to some milk, tomato so 2 None PVT OTH TRI-VI-FLOR None / WCC None 4 PVT PVT 2 None OTH OTH None None None 2 PVT PUB 25 PVT PVT At birth, pectus excavatum (mild); mild umbilical hernia 31 None PUB PUB None Latex; Erythromycin; Sulfa 1 OTH OTH None None 1 PVT UNK SINGULAIR 4mg, 9 hrsEnvironmental Allergies 23 None done PVT / available PVT None Serious Otitis environmental media seizure~DTaP allergies + HepB + IPV (Pediarix)~2~0~S 0 None PVT PVT None None None 0 EEG normal. PVT LABS and UNK DIAGNOSTICS: Liquid multivitamin CBC, None MetabolicHealthy; Profile. full-term baby 5 PVT PVT None Fever 102-103 None 24 hrs after for 24-48 hrs 0 PUB PUB none asthma 29 Nerve test; PVT Lumbar puncture. OTH 9/3/09 Hospital None records received No. PMH: DOSBirth 5/5/09 at 34 to weeks, 5/6/09. APGAR LABS and was DIAGNOSTICS: 8 becoming 9. C H 3 PUB UNK none none 1 MIL MIL PPD 4 OTH OTH HUMALOGNone in pump; Phenobarbital Diabetes- Type Neck/shoulder -seizure 1; seizure control; pain.~Pneumo disorder; 81 mgHiatal Aspirin (no hernia; brand RTname) bund 8 see above MIL UNK ALEVE PRN None None 0 MIL MIL None None 1 None PVT OTH None Allergic Rhinitis 0 PUB PUB Completed None AMOXIL poSulfa X 10 days, 2 wks prior to immunization
0 PVT OTH None Dizziness.~HPV (Gardasil)~1~12~Patient 0 None PVT PVT None Asthma; CODEINE; VICODAN; TYLENOL; IBUPROFEN 0 PVT PVT None None None 2 PUB UNK No None 1 PVT PVT Nut; Animal dander 1 None OTH PUB COZAAR None Hypertension Unknown OTH OTH Unknown Unknown WAES0907USA01302 0 UNK PVT OTH Unknown Concomitant medications A0796919A were unknown. No known releva 0 UNK PVT OTH Unknown Concomitant medications A0796919B were unknown. No known releva 1 UNK OTH OTH Unknown A0796945A 0 UNK UNK Prozac none otherwise healthy 8 UNK UNK 0 All diagnostic UNK bloodwork UNK results were Allegra, negative Nasonex None and/or normal. Asthma, 7/17/09 food Hospital and seasonal records allergies. received 7/17/09 DOS 6/18/09 Hospitaltoreco 6/ 0 none UNK UNK none allergies / rhinitis 1 none PUB PUB Vesicare 5 No mg qd, aspirin amoxicillin 81mg qd, nasonex prn 4 None PVT PVT none No None 1 PVT UNK 0 PUB UNK None None 1 Elevated WBC UNKand Low UNK platelets. None 7/22/09 Hospital None records None. received 7/22/09 DOS Hospital 7/11/09 records to 7/15/09. received LABS DOS and7/11/09 DIAGNOS to 7 1 none PUB PUB prescribed keflex none NKA, Contact Dermatitis 1 PUB PUB 1 PVT PUB none none 1 PVT PVT LOPRESSOR. FLIC ACID. EVISTA 1 PVT PVT None None 0 UNK UNK 0 No testing done. PVT PUB None. HadSee tonsilitis otherone medications, Prior week allergies prior,above. treated to Ceclor, with cefzil, zithromax. omnicef (vomiting, vomiting 1 none PVT PVT None None None 1 Mother reports PUBchest x-ray PUBnegative, None CBC negative None None 1 UNK UNK Patient wasNone healthy known no illness 1 PVT UNK Metformin 500mg none bid,aspirin diabetes 81mg typeqd II 0 Normal EKG PUB PUB synthroid, nexium, mesenteric heparin, percocet, adenitis flagyl, zithromax, cipro, colace, codeine, senna erythromycin, lidocaine, hyd 1 UNK UNK none none none knownnone~ ()~NULL~~In Sibling1|none~ ()~NULL~~ OTH PVT 1 OTH OTH None NKA 1 None PVT PVT Prenatal vitamins; None CLARITIN; Irregular Given menses Rx/ for selfProAir reported: HFAoccasional 7/10/09. asthma; Infer 5 ER did urinary PVTtract infection UNK test that None was negative; None told None by Dr. no blood Patient tests has could had be varying donedegrees to determine of reactions if child w to 1 Visual examPVT PVT None Allergy to sulfa PVT PUB 0 Physical exam PVT PUB None None None 8 MIL MIL None None 4 CBC, negative; MIL CHEM MIL 20, negative; Vitamin Cardiac D-Calcium enzymes, None Complex negative None twice daily 0 CBCt, 67.8 PVT lymphocytes, PUB 7/1/09 (Viral TYLENOL; URI) None ZITHROMAX; Chronic RYNATAN BAUM;syrup ETD; OME 0 UNK UNK I had an allergic reaction to PROPOFOL for my colonosco 1 UNK UNK 0 PUB PUB No 2 PVT PUB 2 CBC PVT PVT None None 1 PVT PVT None None NKDA 1 PVT PVT None Allergic to Lisinopril/HCTZ 0 None PVT UNK None None 2 PVT PUB Allergic Rhinitis Allergic Rhinitis, Allergic Conjunctivitis
0 PUB UNK None 1 Ultrasound PVT of upper extremity; OTH CT of shoulder & upper arm CF; Diabetic; GERD; Gastroparesis; Allergic Rhinitis; Chro 4 Report indicated UNK AST value UNK was 82 and ALT value was 171 Theon patient 12 July had2008. not been On 15 taking July ###any 2008concomitant ALT was 100. medicati 2 None PVT OTH None. ### From information PUB received PVT29/Dec/2008, no relevant laboratory The patient and diagnostic had no concurrent tests were ### illnesses, performed. no known allergie PVT PVT Allergies to Keflex and Ortho Tricyclen ### 7 Unknown UNK UNK Unknown ### 1 OTH OTH none ### 1 UNK UNK na na One week prior to having the shots, patient had a febrile s 9 June 27th -MIL CSF: Testing MILfor gramNone negative bacteria None wasNKDA negative. CSF testing for PCR< IgG and IgM pending per 1 PVT UNK none none fever, swelling~Tdap (no brand name)~UN~11~ 2 PVT PVT 5 PVT UNK Nuvanna healthy temperatureOTH on initial evaluation OTH in the Emergency Room:Medical 39.2 degrees history Celsius; not reported Initial### troponin I: 0.16 mg/dL; CK a 0 none PVT OTH none none none 0 PVT PVT 1 PVT PVT none none none; history spasmadic bronchitis PVT PUB 42 Not reported UNK UNK Birth control pills The patient had not received any ### other vaccines within fou 2 none PVT UNK none none 43 urine beta-human, OTH positive; OTH serumMOTRIN; beta-human, vitamins Pregnancy positive (unspecified) NOS (LMP = 7/1/2008); WAES0808USA04839 Allergic reaction to antibiotics 1 none PVT PVT none none 1 none PVT PVT none none 28 Computed axial, OTH 06/25/09, OTHnegative; ADACEL; Mantoux HAVRIX; test, 07/16/08, FLUMIST; None. negative. 9/11/09 tuberculin 7/21/09 Medical purified WAES0907USA01273 ER records records protein received received DOS DOS 7/16/08 6/25/09. to 7 1 PVT PUB NONE NONE PVT PVT 5 OTH UNK No meds; calcium; no multivitamin none PVT PUB None None 4 PVT PUB 0 MIL MIL Omeprazole, None 20 mg Gerd Flu- like illness~Influenza (no brand name)~UN 0 None PVT PVT Unknown None injury to left shoulder 0 OTH PVT None - newDM2, patient Hyperlipidemia visit 1 UNK OTH OTH Hydrochlorothiazide Unknown Relevant medical history A0796970A was unknown. No adverse even 0 Patient hadMIL urinalysis test MIL conducted. None reported None reported 2 Unknown PUB PUB none MO-2009-15 0 none PVT PVT none None- patient None states she was feeling great 2 None. PVT PVT none Asthma, Obesity 0 7/24/09 ERUNK records received UNK DOS 7/17/09. LABS NO.BUT and AFTER DIAGNOSTICS: NO. 7/24/09 THE INCIDENT ER EKG records WNL. PATIENT received Urinalysis SAYS DOS - Cloudy, SHE 7/17/09. HAS Leukocytes Phobia PASSED of 1 None PUB PUB NONE NONE NONE LOCAL REACTION~Tdap (Adacel)~1~12~In S 1 none PUB PUB NONE NO NONE LOCAL REACTION~DTaP + IPV (KINRIX)~5~5 2 PVT PVT none none none 0 none PVT UNK Levothyroxine none 150 mcgnone daily, Celexa 40 mg daily, fish oil, flaxseed oil, evening p 1 PUB PUB none asthma 0 NONE PUB PVT NONE NONE NONE 8 Bloodwork PVT PVT None 1 PUB UNK Wellbutrin, None Crestor, Levoxyl Medication allergies- ceclor, penicillin, Levaquin 8 PUB PUB 1 UNK UNK Reglan 1 NONE. PUB PUB PCN- FINISHED ALLERGIES, 10 DAYS NONE. COUGH AGO. MUCINEX, NYQUIL PRN. 1 UNK UNK NONE KNOWN NONE KNOWN 1 None PVT PVT None None Obesity
1 7/21/09 Medical PVT records UNK received DOS 5/1/09None to 6/08/09.7/21/09 LABS and Medical DIAGNOSTICS: records received EKG DOS - WNL. 5/1/09 CBCto- Lymphoc 6/08/09. A 0 PVT OTH None Hay fever; CAD 1 PVT OTH Allergies - Doxycycline 2 PVT UNK 1 PVT PVT Well Child 1 None UNK PVT Effexor 150None mg per day; Drug Phentermine allergy to all 30forms mg. per of codeine day 0 CAT scan; PET UNK scan, bone UNK marrow Fosamax. biopsy, echocardiogram; 7/24/09 None Medical Allergic records finetoneedle sulfa; received have biopsy; DOS glaucoma; two2/20/09. surgical osteoarthritis. Voltaren, biopsies carteolol 7/24/09 oph Me 0 UNK UNK 23 Rubella IgM, PVT IgG titers PUB -NoneNoneNone 1 PVT PUB Dexamethasone None 1 mg None 1 tab at bedtime 1 PVT PVT 0 PVT PVT PVT PVT None 0 None PVT PVT None None 0 Being evaluated PVT at hospital PUB on 7/17/09 None None None PVT UNK PUB PUB 6 months pregnant Physical examination, OTH 12/19/08, OTH postpartum Unknown exam: Pregnancy full normal NOS (LMP exam;= 2/9/2008) Beta-human WAES0804USA01770 chorionic, positive 67 None OTH OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0805USA02346 0 Beta-humanOTH chorionic,OTH positive; Urine Unknown beta-human, 04/25/08, Asthma negative WAES0805USA04045 84 Unknown OTH OTH Wellbutrin Pregnancy NOS (LMP= 1/7/2008)WAES0807USA04408 Anxiety; Depression 43 Beta humanOTH chorionic, OTH positive. Insulin Pregnancy NOS (LMP -7/1/2008);WAES0808USA01387 Juvenile diabetes 21 Ultrasound,OTH 12/04/08, normal OTH ; Ultrasound, Vitamins (unspecified) 01/08/09, Pregnancy normal NOS; (LMP=8/6/2008) Ultrasound, 03/27/09, WAES0810USA02180 normal ; Diagnostic laboratory Ultrasound OTH 10/15/08 - Normal UNK Vitamins (unspecified) Pregnancy NOS (LMP=8/16/2008)WAES0810USA03304 ultrasound, OTH 10/18/08, patient OTH has aNATELLE bicornuatePregnancy uterus Chickenpox NOS (LMP = 9/1/2008); WAES0810USA05202 Bicornuate uterus 117 ultrasound, UNK Fetal ultrasound: UNK positive; BACTRIM ultrasound, DS Pregnancy TABLETS 10/07/08, NOS 6 weeks (LMP =08/20/2008) days; spotting, WAES0811USA03512 pain; ultrasound, 11/19/08, 2 49 urine beta-human, OTH 02/08/07, OTH positive Unknown Termination of pregnancy WAES0905USA04071 - elective Unknown OTH OTH Unknown Unknown WAES0906USA01687 0 None OTH OTH drospirenone (+) ethinyl Unknown WAES0906USA01721 Pap test, was OTH negativeOTH prior to beginning Unknown the vaccines; Pap Vaginosis test, Demonstrated bacterial WAES0906USA01741 "high risk HPVA DNA detected" Unknown OTH OTH Unknown Unknown WAES0906USA01763 27 Pap test, 05/28/09, OTH atypical OTH cells ofNone undetermined significance None with high risk HPV WAES0906USA01774 include HPV 16 and 18 159 Cervical Smear, OTH 03/??/08, OTHnormal Unknown ; Cervical Smear, 05/09/09, Unknown low grade CIN, HPV WAES0906USA01895 positive; Cervical Smear, 01/?? None OTH OTH Unknown Unknown WAES0906USA01909 Unknown OTH OTH Unknown Unknown WAES0906USA01913 Unknown OTH OTH Unknown Unknown WAES0906USA02001 0 Unknown UNK OTH Unknown Unknown WAES0906USA02050 0 Diagnostic Laboratory UNK OTH - unspecified Aspirin; blood Lipitor; work, Blood results Citracal pressure notD;provided. Felodipin; high; Cholesterol Centrumhigh WAES0906USA02051 silver; / Oesophageal Omega-3 marine Refluxtriglyceride acid reflu 0 None OTH OTH prednisone;Seasonal triamcinolone allergy acetonide WAES0906USA02057 0 none OTH OTH None None WAES0906USA02088 0 Unknown OTH OTH Albuterol; Ibuprofen, Pregnancy200 NOS mg.(LMP=6/10/2008)WAES0906USA02122 Asthma serum directOTH bilirubin, increased OTH inNone bilirubin None WAES0906USA02126 1 None OTH OTH Unknown Unknown WAES0906USA02135 0 Unknown OTH OTH Unknown Unknown WAES0906USA02136 Unknown UNK OTH Unknown Unknown WAES0906USA02262 Unknown OTH OTH Unknown Unknown WAES0906USA02639 Unknown OTH OTH Unknown Unknown WAES0906USA02641 0 None OTH OTH PROZAC None WAES0906USA02645 0 Unknown OTH OTH Unknown Unknown WAES0906USA02647 0 None OTH OTH None None WAES0906USA02655 1 Unknown OTH OTH Unknown Unknown WAES0906USA02657
0 Unknown OTH OTH Unknown Unknown WAES0906USA02879 0 Unknown OTH OTH Unknown WAES0906USA02895 0 Unknown OTH OTH Unknown Unknown WAES0906USA02901 1 body temp, OTH 5/21/09, 102 OTH degrees SEASONIQUE Latex allergy WAES0906USA02915 Unknown OTH OTH Unknown Unknown WAES0906USA02926 0 Unknown OTH OTH None WAES0906USA02932 1 Unknown OTH OTH Unknown Penicillin allergy; Drug hypersensitivity WAES0906USA02937 1 Unknown OTH OTH None Unknown WAES0906USA02949 0 Unknown OTH OTH Unknown Unknown WAES0906USA02300 None OTH OTH ZYRTEC; FLONASE; Hormonal Unknown contraceptives; WAES0906USA02302 DETROL Pap test, positive OTH OTH Unknown Unknown WAES0906USA02309 0 None OTH OTH Unknown Unknown WAES0906USA02313 31 Unknown OTH OTH Unknown Unknown WAES0906USA02318 OTH OTH Unknown Unknown WAES0906USA02962 Unknown OTH OTH Unknown Unknown WAES0906USA02991 Unknown UNK OTH Unknown Unknown WAES0906USA02514 None OTH OTH Unknown WAES0906USA03285 Unknown OTH OTH Unknown Unknown WAES0906USA03335 None OTH OTH Hormonal contraceptives None WAES0906USA02576 1 Unknown OTH OTH Unknown Unknown WAES0906USA02623 1 Unknown OTH OTH Unknown Unknown WAES0906USA03361 Unknown OTH OTH Unknown Unknown WAES0906USA03372 0 None OTH OTH Unknown Vasovagal reaction WAES0906USA03400 Unknown OTH OTH Unknown WAES0906USA03422 Unknown OTH OTH Unknown Unknown WAES0906USA03424 0 Unknown OTH OTH Unknown Fractured toe WAES0906USA03428 0 Unknown OTH OTH Unknown Passed out WAES0906USA03431 Unknown OTH OTH Unknown Unknown WAES0906USA03718 0 Unknown OTH OTH MUCINEX Unknown WAES0906USA03719 Pap test, ASCUS; OTH PapOTH test, high risk Unknown HPV (the second PAP Unknown test) WAES0906USA03736 Unknown OTH OTH Unknown Unknown WAES0906USA03745 66 None OTH OTH Unknown Unknown WAES0906USA03753 Unknown OTH OTH Unknown Unknown WAES0906USA03754 3 None OTH OTH NORTREL Sulfonamide Endometriosis allergy; Shellfish allergy WAES0906USA03807 6 None OTH OTH None Anaphylactic reaction to WAES0906USA03821 vaccine 4 Unknown PVT PVT ZYRTEC; FLONASE; Overactivehormonal bladder; Hypersensitivity contraceptives; WAES0906USA03965 DETROL LA Unknown OTH OTH Unknown Unknown WAES0906USA04017 1 Body temp,OTH 06/18?/09,OTH 101 F Unknown Asthma WAES0906USA04076 Unknown OTH OTH Unknown Sickness Unknown WAES0906USA04091 Unknown OTH OTH Unknown Premature baby WAES0906USA04097 715 Unknown OTH OTH None Unknown WAES0906USA04116 0 None OTH OTH None None WAES0906USA04127 0 Unknown OTH OTH Unknown Unknown WAES0906USA04136 0 None OTH OTH None WAES0906USA04137 Unknown OTH OTH Unknown Unknown WAES0906USA04269 63 Unknown OTH OTH Unknown Unknown WAES0906USA04379 Unknown OTH OTH Unknown Unknown WAES0906USA04389 0 None OTH OTH None Penicillin allergy; Syncope Sulfonamide allergy WAES0906USA04393 Pap test, 10/27/08, OTH abnormal; OTH PapDESOGEN test, 06/15/09, abnormal Unknown WAES0906USA04724 Unknown OTH OTH Unknown Unknown WAES0906USA04739 OTH OTH Unknown Sulfonamide allergy WAES0906USA04750
19 Unknown OTH OTH Unknown Unknown WAES0906USA04767 Unknown OTH OTH Unknown Unknown WAES0906USA04859 None OTH OTH None None WAES0906USA04941 Unknown OTH OTH Unknown None WAES0906USA04949 Unknown OTH OTH Unknown Unknown WAES0906USA04961 10 None OTH OTH None None WAES0906USA04977 Unknown OTH OTH Unknown Unknown WAES0906USA04981 Unknown OTH OTH Unknown Unknown WAES0905USA04982 Unknown OTH OTH Unknown Unknown WAES0908USA04987 None OTH OTH None None WAES0906USA04995 1 Unknown OTH OTH None Unknown WAES0906USA04998 403 electrocardiogram, OTH normal OTHLABS and Unknown DIAGNOSTICS: ECG Unknown - WNL. Thyroid Studies WAES0906USA05000 WNL. Throat culture (-). Skin 0 Unknown OTH OTH None Drug hypersensitivity WAES0906USA05017 0 None OTH OTH Unknown None WAES0906USA05019 Unknown OTH OTH Unknown Unknown WAES0906USA05048 -81 Unknown OTH OTH STRATTERA Attention deficit / Hyperactivity disorder WAES0906USA05055 0 diagnostic laboratory, OTH full OTH work up Unknown including a blood workUnknown up: the patient was fine WAES0906USA05091 Unknown OTH OTH NUVARING; MACROBID Unknown WAES0906USA05163 5 Unknown OTH OTH Unknown WAES0906USA05171 Unknown OTH OTH Unknown Unknown WAES0906USA05329 None OTH OTH Unknown Unknown WAES0906USA05189 0 Unknown OTH OTH XANAX; ADDERALL TABLETS; Unknown CLEOCIN; NUVARING; WAES0906USA05359 ZOLOFT;AMBIEN 30 Pap test, 05/??/09, OTH abnormal OTH Unknown Unknown WAES0906USA05192 0 Unknown OTH OTH Unknown WAES0906USA05197 0 beta-humanOTH chorionic, OTH positive None SYNCOPE WAES0906USA05225 0 Unknown OTH OTH Unknown PASSED out WAES0906USA05369 3 Unknown OTH OTH MENACTRA None WAES0906USA05392 0 Unknown OTH OTH Unknown Unknown WAES0906USA05615 0 cervix HPV OTH DNA assay,OTH 07/??/06, None negative; cervix HPV DNA Noneassay, 06/15/09, positive WAES0906USA05616 2 Unknown OTH OTH Unknown Unknown WAES0906USA05627 0 Unknown OTH OTH Unknown None WAES0906USA05641 Unknown OTH OTH Unknown Unknown WAES0907USA00009 0 None UNK UNK LODRANE None WAES0906USA05666 0 None OTH OTH None PENICILLIN allergy WAES0907USA00012 Pap test, abnormal OTH OTH Unknown Unknown WAES0907USA00019 0 Computed axial, OTH 06/29?/09, OTH CT scan None of the head Unknown WAES0907USA00034 0 Unknown OTH OTH Unknown Fear of needles WAES0906USA05668 None OTH OTH Unknown Unknown WAES0907USA00043 None OTH OTH Unknown None WAES0906USA05674 0 None OTH OTH None None WAES0907USA00064 6 None OTH OTH None Drug-induced hallucinosis WAES0907USA00070 Unknown OTH OTH Unknown Unknown WAES0906USA05677 Unknown OTH OTH Unknown Immunisation WAES0906USA05702 0 None OTH OTH hormonal contraceptives None WAES0907USA00075 None OTH OTH None None WAES0907USA00097 Unknown OTH OTH Unknown Unknown WAES0907USA00122 Unknown OTH OTH Unknown WAES0907USA00144 Unknown OTH OTH Unknown Unknown WAES0907USA00182 Unknown UNK UNK Unknown Unknown WAES0907USA00330 0 Unknown OTH OTH None None WAES0907USA01092 0 UNK UNK Lidocaine
0 PVT UNK anxiety n/a stmoache pains~HPV (Gardasil)~3~26~In Patie 0 PVT UNK Wellbutrin, Celexa, Trazedone, Latex,Penicillin, HCTZ, Sulfa,Prozac Diclofenac. 0 CT scan, blood PVT sugar level UNK (84), blood and urine None taken (not None sure what soreness was checked) at injection site and headaches~HPV 4 CAT Scan; UNK MRCP; blood UNK work at Underwood-Memorial none Hospital 7/24/09 (Woodbury, Hospital records NJ). received 7/24/09 Hospital DOS 7/11/09. records Gastrodu receive 0 Unknown OTH OTH Vitamins (unspecified) Pregnancy NOS (LMP = 8/29/2008) WAES0810USA02010 0 Unknown. 8/31/09 OTH Hospital OTH records Unknown received DOS 6/24/09 Unknown. to 6/28/09. 8/31/09 LABSHospital and WAES0907USA01994 DIAGNOSTICS: records received CSFDOS - WNL 6/24/09 MRI 2 spinal tap, no OTH permanent OTH damage Unknown Unknown WAES0907USA02007 0 diagnostic laboratory, OTH 09/01?/05, OTH Autosomal None Dominant OPITZ None Syndrome WAES0907USA02018 1 None OTH OTH None None WAES0907USA02011 69 Unknown OTH OTH Unknown Unknown WAES0907USA01687 0 None PVT OTH The patientAt has theconcurrent time of vaccination medical conditions on 07 ### Julyof2009 allergy thetopatient pollen,was dus 0 RegressivePVT autism - GIOTH issues. 7/21/09 Medical none, records otherreceived no. than 7/21/09 immune, DOS Hep Medical 11/14/05 born B~Measles with records tocompromised 6/20/08. +received Mumps LABS DOS +immune Rubella and 11/14/05 DIAGNOSTI system (no brand to 6/2 (sw 30 Autoantibodies MIL positiveMIL indicating See Millerattached Fisher None Variant. but URI See None following attached. PMH: vaccination, URI Seeatattached time of see vax note. attached Labs and Diagnostics: M 5 08 August 2007, OTH Computed OTH axial tomography Warfarin sodium; Unknown (CAT)Lisinopril; scan: Cataract; diagnosis Ascorbic Hearing subdural acid;loss; Unknown hematoma A0797113A Pacemaker of the (Atrial brain. Fibrillation); Qua 1 PVT PUB 77 A lot of lab.PUB MRI +ve forPUB ADEM. None at theNone time Dyslexia 1 PUB PUB Vitamins C none ICU x 5 days-possible LA090703 bacterial infection-low blood sugar 0 PVT PUB Area of redness.~DTaP (no brand name)~5~5~ 0 UNK PUB PUB Unknown There was no concomitant A0797402A medication and no relevant me PUB UNK No Syncope, Neuropathy 4 PVT PVT 1 none PVT PVT none none 7 None PVT PVT None None Penicillin - Generalized hives 0 Sent to A/I for PVT eval. PUB None None None 5 None OTH OTH None None NKDA 0 None PVT PUB None None None 1 N/A UNK UNK PT WAS PUT N/AON KEFLEX H/O ECZEMA 250/5, BENADRYL, AND SKIN AND BOILS IBUPROFEN 9 PVT PVT 81mg Aspirin, none 12.5 mgneuropathy, metoprololpneomovax~Pneumo tartrate, irregulargabapentin heart rate, 100mg B-12 (Pneumovax)~1~59~In deficient, 1 cap TID, Vitamin B-12 D 1m P 0 PVT PVT enalapril, metformin,maxzide, none codeineproventil, allergy; morbid advair obesity, hypertension, asthma 4285 PVT PVT None None None Shingles~Varicella (Varivax)~1~14~In Patient 1 doctor did culture PVT on the UNK site of the shots no optic nerve hypoplasia 6 none at thisPUB time PUB none none Asthma, allergy to oats, cow's milk, bees 30 Normal CBC PVT except forPUB plt count 10,000 none on 7/17 none then 13,000 noneon 7/19. 15 n/a MIL MIL none none none 0 N/A PVT PVT none none none N/A~ ()~NULL~~In Patient none UNK UNK none none none none UNK UNK none listed none none listed 1 PVT PVT SYNTHROID, NOLIPITOR, Bactrum LISINOPRIL, hctz 1 Patient did UNK not notift PVT Prescribed Flagyl 250 mg NKDA, bid on History 7/09/09 of Depression and question of polycystic ov 5 None PVT PVT Depakote 250mg, None Yasmin none 0 None PVT PVT None None None 1 2 blister opened UNK for Zoster UNKculturealendronate - positive result 70mg 1 q wk, verapamil 80mg 1 qd, simvastatin 5mg 1 qd 0 PUB PUB None None NKA 6/16/2009 negative PVT varicella PVT titer prior to vaccination V-Z AB IGG EIA : V-Z IGG AB EIA Negativ 1 PUB UNK Novolog none type 1 diabetes swelling, red hot spot~Influenza (no brand nam 690 UNK UNK COPD 1 NONE PVT PVT NONE NONE CEFZIL, SULFA DRUGS 0 PUB PUB 27 UNK UNK 1 PVT UNK none none none none~ ()~NULL~~In Patient 58 UNK PVT
0 Unknown PUB PUB None Unknown CBC; CMP;UNK Amylase, u/A UNK 0 PVT PVT 1 None PVT PUB No None PUB UNK none 19 OTH PVT Positive pregnancy PVT testPUB 0 PUB PUB 0 PVT PUB Redness - swelliing~DTaP + IPV (KINRIX)~UN None Known PVT PVT Lyrica 3 OTH PUB ACIPHEX; NIFEDIPINE; No All:FOSAMAX; PCN; Gerd, Red, SYNTHROID HT; swollen Osteoarthritis arm~Zoster Prevention; (Zostavax)~1~75~Pa Hypothyroid 1 PUB PVT ALBUTEROL None Asthma 2169 PVT PUB 0 PVT PVT None ADHD UNK UNK 17 A lot of lab PVT done. MRI positive PUB for None ADEM. at theNone time. Dyslexia 1 none PVT PVT none none none 0 PUB PUB None None 1 none PVT PUB Physical None PVT PVT None None None 9 None donePVT PVT None None 7-14-09~Varicella (no brand name)~1~1~Patie 1 None PVT OTH None None 0 None PVT PUB None None 0 PUB OTH Unk None Unknown OTH OTH Unknown Unknown WAES0905USA02043 0 PVT UNK Nuvaring No known allergies. No medical ###history. No concomitant m 45 head computed UNK axial tomography, UNK None 06/22/2009, HIV see infection narrative; Migraine; spinal Amphetamine tap, 06/23/2009, WAES0907USA01529 abuse; seeBell's narrative; palsyspinal tap, 06/2 24 Spinal tap, OTH there was protein OTH in theNone spinal fluid. 8/6/09 Multiple Ear tube hospital insertion; inpatient, Adenoidectomy. WAES0907USA01998 DC summary, 8/6/09 andMultiple ER records. hospita LA Unknown OTH OTH Unknown Unknown WAES0907USA02337 33 ultrasound, OTH 05/29/09, showed OTH no evidence Hydrocortisone of Dermatitis recurring intussusception; 7/30/09 HospitalKUB records X-ray, WAES0907USA02033 received 05/18/09, DOS showed 5/18/09 intussuscep to 5/24/09 6 Unknown OTH OTH Unknown None WAES0907USA02071 24 TSH 1.074PUB (N) OTH None None Depression; generalized anxiety disorder; acid reflux disea 0 UNK UNK 0 PVT PVT None per Mom None None 0 None PVT PUB ZANTAC 1ml Bid GERD Mother as reported by g.mom (similar reaction 1 PVT PUB PPD intradermal None givenNone 7/8/09, no mm 11 None PUB PUB None seasonal UNK PVT 1 PUB PUB 1 None PUB OTH ZYRTEC; FLONASE None nasal Hx "allergies" spray 0 PUB OTH None None 5 NONE PVT PVT NEXIUM, PRAVACHOL, NONE HYPERTENSION, SINGULAIR, METFORMIN, ALLERGIES, LISINOPRIL HYPERCHOLESTEROLE HCT PUB PUB None. None. PVT PVT Tylenol for cold Coldprior timesto2receiving weeks. vaccines. 1 evaluation only UNKper patient's UNK husband None NKA 0 PUB PUB None None None 0 PVT PVT none no none 0 None PUB PUB none none none DID NERVEUNK TEST. IT IS UNK POSSIBLE THAT THE EXTREME NEEDLE ALLERGIC HIT THE NERVE. REACTION PT HAS WITHPOSSIBLE PAIN, RASH, REPORT AND INTENS LIKE A 1 PUB UNK ibuprofen 200mg, pruritic wellbutrin rashdarvocet, on hips xl 150mg and codeine chest BID 2 Blood work,UNK Urinalysis,UNK Flu test. None No illness None
0 PUB UNK Prozac 20mg abdominal 3 tabs daily, pain klonopin, benadryl malaria 25mg pills qhs prn, vitamin D 1000mg daily 0 PVT PVT Fioricet, Topamax, Vicodin, Cluster hydroxyzine, Headaches,HCTZ, HTN, Synthroid, Obesity omiperazole, Atenolo 4 none MIL UNK none none none 0 UNK UNK Rx-Xopenex Bronchitis MDI II Halations Anxiety,q4hrs depression, prn. Tessalon Hx of diverticulitis. perles 200 1 NKDA q8hrs po prn cou 0 UNKNOWNPUB PUB NONE NONE NONE 0 UNK UNK none none 2 N/A MIL MIL Levothyroxine .15, simvastatin Sulfa drugs .40, phenytain 100, Fosama .35 0 UNK UNK NONE NONE NONE 0 CBC and UA PVT obtained PVT prior to injection Clartin PRNno - pt did notseasonal take dayallergies of injection - pt premature at birth with resp. problem 10 PVT PUB EAR INFECTION ON BOTH EARS 0 none PVT UNK AXID, 150 mg/10 none ml-Take none2ml po BID 0 UNK PVT None None 0 PVT PUB 2 PVT PVT 1 stool culturePVT negative. UNK 7/30/09 Hospital POLYVISOL records None with received iron Prematurity DOS 7/9/09(28 to 7/10/09. wks) twin.LABS 7/30/09 andHospital DIAGNOSTICS: records receive 4+ fec 0 PVT PUB TYLENOL Infant None dropsNone 0 Stool culture PVT negative. UNK 7/30/09 Hospital Polyvisol records With None received Iron prematurity DOS 7/9/09(28 to wks) 7/10/09. twin.LABS 7/30/09 andHospital DIAGNOSTICS: records receive 4+ Fe PVT PVT No 1 None PVT PUB DEPAKOTE; NoVitamin CSeizure supplement, disorder "EMERGEN-C"; quiescent; Autism SEROQUEL 1 PUB PUB NONE NONE NONE 10 PUB PUB None None 1 None PUB UNK None None Allergy to PNC- beestings (carries EPI-PEN) 1 None PVT PVT None None None 1 OTH PVT Tetracycline; Hypercholesterolemia; Thrombocytopenia fo 3 MIL MIL Nicotine gum None None 0 MIL OTH RISPERIDONE 0.25 mg; Allergies: one QHS OMNICEF; CLINDAMYCIN; SEPTRA; PCN'S; D 1 PVT PVT BACTRUM;Puncture AUGMENTIN wound None 2 PVT OTH None None Swelling & Ped~DTaP (no brand name)~3~15~ 0 HospitalizedPVT 7/10-7/13/09 PVTfor recurrent Phenobarbital sz. Labs None and diagnostics: Seizure disorder EEG abnormal. (known). PMH: seizure 6 PUB PUB None None. Father Unknown states mosquito bite on arm. 7 None PVT OTH ASPIRIN 81None mg; CLARINEX Allergic5mg; rhinitis. FOSAMAX; LEXAPRO; Multivitamin. 0 CT head and PVT facial bones(6/26/09), PVT Seasonique MRI brainNone (7/14/2009) None 4 MRI pending. PVT PVT DEPO-PROVERA None known~ ()~~0~Patient 0 PVT PVT None None Microcephaly; Craniosystosis. 1 PVT PUB ZYRTEC 10 mg QD PCN; CEFZIL; Redness/swelling~Tdap CELOXIN; TETNUS (TDAP) (no brand name)~1~12 10 None needed. PUB PUB TYLENOL None None NKDA 1 OTH PVT No 0 PVT PUB Allergic rhinitis Ellis - Van Creveld syndrome 0 PVT PUB 0 None OTH PVT None PVT PUB 0 PVT PUB None None 0 PVT PVT None None 0 PVT OTH Sertraline, 50 Syncope mg 1.5 take NKDA daily - No other birth defects/medical conditions I'm awar 0 No PVT PVT No breakfast None 2 PUB PVT TETRACYC 0 PUB OTH Just for Allergies Has a cough None from cold 1 PVT PUB none 0 PVT OTH None Skin Avulsion None PVT UNK 1 None PVT PUB None None
0
OTH UNK None None None Unknown OTH OTH Unknown Sickness Unknown WAES0906USA01923 1 None MIL MIL None None 1 PUB UNK 8 none PVT OTH none none 1 UNK UNK I am allergic to penicillin and erythromycin. 0 PVT OTH UNK OTH OTH Allergy to aluminum; Details regarding Allergy to tobacco yeast; A0793154A or Anxiety alcohol use were not known. 105 MRI, Multiple UNK EEG, Multiplte UNK Doctor N/A Visits, 7/28/09 all N/A from Medical having records N/A to traveling 7/28/09 received N/A~ Medical long DOS ()~~0~Patient|N/A~ distances. records 5/30/07 7/23/09 received to 1/29/09. ()~~0~Sibling|N/A~ Consultant DOS Oral 5/30/07 contraceptiv records to 1/29 () re 7 MRI brain and UNK spine showed UNK multiple enhancing No white matter PMH:lesions; none Allergies: CSF showed none 40 wbcs, 2 rbc, prot 41. 9/14/09 0 MIL MIL None NA NA 1 NONE UNK PVT NONE NONE 2 PUB PUB None None 0 None PVT UNK none 0 MRI demonstrated UNK a solitary, UNK 1 cmNone ring enhancing NonelesionHistory in the right of musculoskelatal cerebellar region pain and (elbow, 2 small lumbar), enhancing no PMH lesiona 0 PVT UNK 2 MIL UNK 1 PVT PUB No illness atnothe time of vaccination 5 7/23/09 Medical UNK records UNK and DC summary received. None LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CB 2 PVT UNK Intermittent Chest Pain 1 none UNK UNK no no no 0 ORDEREDPVT LABS UNK NO PREVIOUS RIGHT HISTORY INGUINAL OF HERNIA CHILDHOOD ND_09_06 REPAIRED ILLNESS 1 none PVT PUB none rash-multiple none mosquitonone~ bites ()~NULL~~In Patient 3 hx of celiacPVT disease UNK 0 UNK UNK no no Allergies to Ceftin and Zithromax 17 Labs and diagnostics: PUB EEG PUB WNL. MRI brain No abnormal, MRA No PMH: WNL.none LE duplex studies (-). Echo WNL. TEE (+) for 13 CBC RockyPUB Mtn Spotted PUB fever, lgG, IBUPROFEN, 1, M None TYLENOL Known None Known 2 PUB UNK None None Reported None Reported 0 PVT PVT none none PVT PVT TYLENOL 100mg None PO Systolic Murmur 2 All cultures PVT (-) of site. PVT FOSAMAX None None Localized reaction 6/1/09~Hep A + Hep B (no b 5 PVT PVT None 0 None PVT PVT then Ophth.Corneal Sacortin, Abrasion 2None g hr pid TD 0 MIL MIL None Asthma 0 PVT PVT 7 None PVT PVT None None None 8 Presented with PVTfaint macular-papular PVT NONE rash on NONE torso 7-15-2009 Reaction tovomiting, flu vaccine fever~Influenza 12/08; GERD (no brand name)~1~1 0 None PVT OTH None 0 MIL MIL PPD; Albuterol InhalerIodine 1 None PVT UNK None No None Unknown OTH OTH Unknown Unknown WAES0906USA03421 0 PVT PVT None None-Very None healthy, active 11 year old Unknown OTH OTH Unknown Chronic obstructive pulmonary disease; WAES0907USA02055 smoker Unknown OTH OTH Unknown Unknown WAES0907USA02939 27 UNK UNK ### 0 PUB PUB 0 PVT UNK 2 PVT UNK No PVT PUB None None PVT PUB PVT PVT None None
PVT PUB None None 2 None PVT PVT BEMCIN 40None mg; LIPTON Sulfa 10 Antibiotic mg 1 PVT PVT None Penicillin allergy 0 Monitored q5 PUB minutes; PUB dischargedNone w/parent 10:45 None None 22 PVT PVT CELEBREX; None FOSANOSE; high PROTONIX; blood pressure; VESICZRE; GERD; Arthritis BENICAR; CLONIDINE 2 Strep throatPUB culture only. PUB None. Antibiotic Noneused in Lyme Junedisease 2009 forinLymes past 2 disease yrs. 1 PVT PUB 1 PVT PUB 0 PVT PVT Immunodeficiency 0 PVT PVT 1 PVT PVT 0 PUB PUB None 0 PUB PVT None None Sinus allergies - non specific 7/25/09; pregnant EDC 1/6/0 2 CT of head;PVT CT of spine; PVT CBC; Chem BACTRIM panel; DS; Drug UTI ABILIFY screenNKA; 20 mg; VUR; RITALIN depression; 10 mg; Acne FOCALIN x 2 10 mg; PROZAC; 1 None UNK UNK None None None 1 None PVT OTH None None None 1 PUB PUB None None NKDA 1 PVT PVT asa;calciumnone with d;insulin sulfa N and R;lopressor;others 1 none PUB PUB none none none 1 PVT PVT no amoxicillin 3 Client states UNK had liver function, UNK other Nexium screenings, 5-10 None mgallevery normal Allergic morning; results. to Penicillin; low dose ASA Typedaily; II DM; Amlodipine/Benazepril Hypertension; Sleep5/10 apn 53 Autopsy unknow/undetermined, UNK UNK did not fit SIDS. None Planning further review decreased of autopsy levelby of private consciousness~DTaP pathologist, hopedull (Dapt 2 none UNK UNK none Asthma visitAsthma and well child N/A~check ()~NULL~~In Patient|N/A~ ()~NULL~~In S 5 none PVT PVT fosamax, premarin, none provera,zinc,calcium, sulfadiazine - allergy Vitpyridium D allergy 3 UNK PVT 0 N/A UNK UNK 0 None PVT PVT BENADRYLNone IM None 0 PUB PUB none none 2 PVT PVT none Dairy allergy 2 PUB PUB NONE NONE 2 PUB PUB CECLOR NONE NONE 5 PVT PVT none none Asthma 0 UNK PVT TRIAMCINOLONE NONE KNOWN ACETONIDE PENICILLIN 0.1ALLERGY, % CREAM, DEPRESSION, CALCIUM 1200 HYPERLIPIDEMI PO, GLUCOSA 0 NONE PUB PUB NONE NONE NONE 58 8/14/09 Hospital UNK records UNK recieved DOS 11/30/2008 None/experienced to 12/03/08. None. 8/14/09 flu-like LABS and symptoms Hospital DIAGNOSTICS: records approxrecieved 2 wks MRIafter Spine DOSvaccination 11/30/2008 - Abnormal 0 Neuro assessment PUB withPUB assess forNone injuries; BP None 110/70, known P80, None R16 known 1 minute after falling to floor; contusion to Rt front 2 PVT PUB None None None 0 PVT OTH 1 None PVT PVT None None PCN 0 UNK UNK BERNA20090222 Unknown OTH OTH Unknown Unknown WAES0907USA03043 18 MRI/EMG: demyelinating PVT PVT process LAMICTAL consistent with SoreGuillain-Barre/axonal throat/fever absence seizures. damage 8/10/09 8/17/09 PCP medical Medical records records received received 2 others in our community who had the UNK shinglesUNK vaccine and still got shingles. Does this shot really work? Is my experience unusual. I have 0 None PVT PVT None None 0 None PVT PUB ~DTaP + IPV + Hib (Pentacel)~2~0~Patient 2 PUB PUB Nadolol- 40No mg Hypertension 0 PVT PVT None UNK UNK 1 PVT PUB None NKDA 6 None PUB PVT None None 1 None PVT PUB SINGULAIR; None ALBUTEROL; Asthma; FLOVENT; Eczema;TRIAMCINOLONE; IgG deficiency BETAMETHASONE
4 None 3 None 0 None 2 EKG 0 10/11/07: 0 0
OTH PVT HTN, elevated HTN, lipid elevated lipid PUB PVT No Could be pregnant nothing PUB PUB SIMVASTATIN none20mg Atypical seizure D/O; Depression, S/p meningioma resecti PUB PUB None None None MI2009007 Seen PUB at General PUB Hosp ER: CT andNone lab work reported normal. None reported No information noted. 10/19/07: Seen at children PUB PUB None None None PUB PUB ADVAIR; NASOCORT Denies Asthma, Ibuprofen PUB PVT ACTOS; AMARYL; Laceration Metformin; (R) Diabetes foot. BENICAR; Mellitus. BYETTA; CIPRO 1 PUB UNK None None None 1 PVT PUB PENICILLIN allergy 161 None PVT PUB None None None 1 PUB PUB None None 0 MIL MIL None None None 1 PUB PVT No Amoxicillin, Ceclor, Septra + Codeine 1 None PVT PVT None None None 0 PUB PUB None None 0 PVT PVT 0 PUB PUB none asthma 1 N/A PUB UNK Nasonex, claritin, None singulair Allergic rhinitis, Hx of MRSA 13 EMG { not sure UNKof all the UNK other test they gave me} Would8/24/09 have toHospital getN/A~ hospital ()~~0~Patient|N/A~ records records. recieved 8/24/09 DOS ()~~0~Sibling|N/A~ Hospital 11/21/07 records to 12/02/ rec () 1 none PVT PUB none patient wasnone treated known with topical anibiotic for multiple insect bites 2 Unknown UNK PVT Unknown None reported No known drug allergies. All others unknown. 0 n/a UNK UNK none knownnone none known 0 None PUB PUB None None None 0 PUB PUB none none 2 PVT PVT None No 0 NONE PUB PUB NONE NONE NONE 1 Chem-20 normal, UNK CBCUNK normal, CRP none 10.55, ESR 28. Labs PMH: and Diagnostics: reflux 2' to overfeeding. Head CT WNL. CBC with WBC 12.5 ( 0 none PUB PUB none none Allergies to:none PCN,reported~ Sulfa, Omnicef ()~NULL~~In Patient 1 UNK UNK None None 5 none PUB PUB NONE NONE Seasonal allergies PVT PUB N/A N/A N/A 0 None known UNK UNK Unknown Steam burnUnknown to arm @ different site 1 MIL UNK NONE NONE NONE NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S 1 positive guiac PVT PVT 0 N/A PUB PUB Effexor Synthroid None Hormone ThyroidPatch nodules 1 MIL MIL aspirin, multivitamin, None, routine fish Nooil, annual known moloxicam, clinic allergy, follow valsartan, hypertension, up visitsimvastatin,hydrochlorothiazid hyperglycemia, PTSD, hy 2 NO PVT PUB NONE NO ADHD NO~ ()~NULL~~In Patient|NO~ ()~NULL~~In S 1 CBC, UA, RAPID PVT STREP PVT NONE NONE POSS. ALLERGY HIGH FEVER TO Td OF 104, HEADACHE, ACHY AR 1 PUB PUB NONE REPORTED, not known -10 None PVT PUB None None None 1 PVT PVT None Mild asthma 0 OTH UNK ZOLOFT; WELLBUTRIN; Allergy COMTRIN; to penicillin; SINIMET; Parkinson's LOMETIL; Disease AZILECT; KLONOPIN 0 None PVT PUB None None None 2 PUB UNK 0 PUB PUB None None None 0 PUB PUB None None HX: SZ's 5yrs, age. 0 PVT PVT SINGULAIR, None XYZAL, SYMBICORT, asthma, allergic VERAMYST, rhinitis, acne DUAC 8 OTH PVT METFORMIN; No ZOCOR;NKDA LUMIGAN; ELIPIZIDE; DOLETASOL cream 2 PVT PUB 4 Stool Cultures PVTNeg - Rotavirus PVT Ant (-), (+) Fecal None leukocytes. PMHLABS - Tongue and DIAGNOSTICS: tied at birth, neonatal Stooljaundice. Test for Blood (-) Sto
0 neurologist PVT consulted EEG PVT - normal none Labs andno diagnostics: illness (sickle EEGcell WNL. trait)WBC possible 17.3. PMH: blood none cx (-). noted 1 PVT UNK Omnicef - rash 0 PVT PVT SINGULAIRNone 5 mg Asthma; Allergies 1 PVT PUB None None UNK PUB PVT Unknown A0758212B Unk PUB PUB Blood pressure Unknown medication No known adverse events A0794397A were reported with previous vac 1 PVT PVT none none none 0 None yet. PVT PVT none none none Swelling at site for 4 wks (nodule still present), 0 none PVT PVT NONE NONE NONE 1 N/A PVT PVT None None Likely Peach Allergy 0 N/A PUB PVT Lipitor 10mg None daily, calcium High600mg cholesterol 2x a -day, controlled Vitamin D 400IU 2x a day, Aspriin 81 0 UNK PUB 166 Multiplle blood PVTand mris; PVT lumbar puncture. lipitor, nexium High none protein count, none hi alpha 2 gobulin. IMM, IMG 13 Small bowelUNK biopsy with UNK intraepithelial lymphocytes. Labs: Pectus EBV Excavatum IgG (+). 10/8/09 PMH: abdominal Hospital records pain. 10/8/09 3/16/09 Hospita to 3/18/ 7 UNK UNK Recovering from acute laryngotrachiitis 1 Referred toPVT hospital ENMIL bec. continued dizziness. None None None PVT UNK None Allergies; Sulfa; Sotalol; Naprosyn PUB PUB Food allergy - Citrus 1 PVT PUB None None None 0 PVT PVT None known CODEINE, DEMEROL; SULFA; Erythromycin 8 None PVT OTH None None 7 PVT UNK MELOXICAM None as needed, back HYOSCYAMINE pain as needed, HYDROCORTISONE VAL 0 MRI; CAT Scan; PUB Labwork; OTHSpinal Tap Hypothyroidism 2 PVT UNK 5/09/06~DTaP (no brand name)~4~2~Patient|2 1 None MIL MIL None None Allergic RxnCellulitis to tetanus Fever~Tetanus vaccine Diphtheria (no brand n OTH OTH 1 Rash/light fever, MIL MIL EUCERIN Eq Rash cream; the next Acetaminophen. None day 1 PUB OTH Erythema NKDA Unknown OTH OTH None Pregnancy NOS (LMP = Unknown) WAES0907USA03354 Unknown OTH OTH Unknown Unknown WAES0907USA03373 Unknown OTH OTH Unknown Unknown WAES0907USA03589 8 Plt = 0; HgbPVT 12.0; WBCPVT 7,900. LABS and DIAGNOSTICS: No NoPTT 35.6 (H) Thrombin Time 18.0 (H) CBC - WBC 6.7 k 24 PUB PUB None None None known 1 PVT PVT None 7-18-02 MMR 07/26/2002~Measles reaction. + Mumps + Rubella (no b 0 None PVT PVT ATENOLOL; None TRIZADONE; Chronic SERTILINE depression chronic neck Pn HTN 0 PVT PVT None None None 0 PVT OTH None Asthmatic MIL MIL None 2 PUB PUB 7 PUB PUB Tylenol No No 2 Fever - CBC PVT BID cult. PUB CXR -see ER NYSTATIN note. None. cream Given for diaper None at WCC rash. 2 PVT UNK None None None 2 PVT PUB Hx - Astrocytoma (surgery) PVT PVT 2 PVT UNK 0 PVT PVT Singulair; MV;Albuterol; None Neb PRN 0 PVT PVT None None None ~DTP + IPV + Act-Hib (no brand name)~2~0~P 1 PVT PVT CLARITIN None 0 None PVT UNK ZYRTEC None None 0 None PVT PVT No No 0 Per allergistPVT - Acute urticarial PVT reaction Well child VIGOMOX eye GHS; OMNICEF, BACTRIM
0 None OTH OTH None Surgery; LaparoscopicWAES0907USA03631 surgery; Convulsion Unknown OTH OTH Unknown Unknown WAES0907USA03652 2 None OTH OTH None None None 1 None PVT PVT None None None AR0928 0 PUB PVT 0 Unknown OTH OTH Unknown Unknown WAES0907USA03060 Unknown OTH OTH Unknown Unknown WAES0907USA03359 0 Blood work PVT (not specified) UNK Z PACK antibiotic; ZYRTEC; Bitten by TOPROL a stray XL; cat (date Albuterol not ### reported). inhaler; CARDIAZEM The patient had a 0 Unknown OTH OTH None Penicillin Allergy; Contraception Anxiety WAES0907USA02308 91 Unknown. 8/10/09 OTH ER OTH Records received NECON DOS 1/354/9/09. LABS Unknown. and DIAGNOSTICS: 8/10/09 ER WAES0907USA02326 Records Venous received DopplerDOS Study 4/9/09. - Abnorma Alco 1 none PVT PVT none allergy-Bactrim,h/o asthma and diabetis 1 n/a UNK UNK n/a none none none~ ()~~0~Patient|none~ ()~~0~Sibling|none 1 PVT PUB Behavioral concerns POISON CONTROL UNK CONTACTED UNK 10/17/2005 FEVER AND STATED OFPARENTS 101.00 TOF.HAVE HAD BROUGHT MOTHER WATCH PATIENT FOR INTO LOCALIZED THE E.R. REA AT 1 Neurological PUB exam only, PUB mom states None no known lab test None or X-rays notedAllergy: per performed. mom PCN 0 PVT UNK None None None 2 PVT PUB NONE SAN FILIPPO SYNDROME 0 NONE PUB PUB NONE NONE NONE 2 MIL MIL 1 PUB PUB HPV/Gardasil none 1312X allergies 1 WBC 16.4 PUB UNK none unsure none 3 PUB PUB 0 PVT PVT None Known None Known 2 PVT PVT 0 none PUB PVT none none none 1 UNK UNK actone, aloeNone vera cap, HTN, asa, benadryl, Polycythemia, cartiaosteoarthitis; XL, prevacid,Allergies: glucosamine, Altace, dramami daypro 2532 UNK UNK 41 EmergencyUNK room visit on UNK July 19 because Methotrexate/weekly I was Rhuemation in a great injection Arthritis deal ofSalsalate--750 pain and had been mg since 2 dailytheLevothyroxine first outbreak on 50 Jul mc 1 MIL MIL Celebrez; plaquenil; none Prylosec; Systemic Lisinopril; Lupus; hypertension; Prevastin; ASA; reflux Calcium with D 0 None PUB PVT Daily multivitamin None None A0796919A 0 None PUB PVT Daily Multivitamin None None syncope~Hep A0796919B A + Hep B (Twinrix)~1~~In Patie 0 Patient's visit UNK was for aUNK routine physical 2 Extra exam Strength None. whichTylenol included ThisNone was administered apatient's really. negative Mom annual at urinalysis, physician's toldphysical. me fingerstick patient officehad prior hemoglobin upset to vaccine stomach of admin 13.7 wheg 0 Blood pressure UNKat 15:32 UNK in the office None for physical None blood pressure was 143/71, after KS200908 episode and back in office B/P w 6 UNK UNK Singulair 10mg noneQD; reported Lipitor sulfa by 10mg and patient iodine QD none~ ; Evista allergies ()~NULL~~In 60mg QD; Patient|none~ Benicar 20mg ()~NULL~~I QD; K-Cl 0 Scheduled PVT for EEG @ PUB Hospital No meds None 2 PVT PVT None 0 PVT PUB None None None 0 None PVT PUB None None None 0 CBC done that PVTday right PUB after shots None was not done. None None ~Measles + Mumps + Rubella + Varicella (no b 4 None PVT PVT None None None 1 PVT UNK 2 OTH OTH None None None Ultrasound PUB -> EnlargedUNK lymph node. None 0 UNK UNK DIOVAN; SYNTHROID; NoKEFLEX (Temporary) PVT PUB None 1 UNK UNK 0 UNK PVT PVT Unknown Concomitant medications A0794475A and relevant medical history wer 0 UNK OTH OTH Simvastatin; Warfarin sodium; The subject Digoxin; had previously Risedronic A0794688A received acid; Loratadine; influenzaOmeprazole; vaccinations 1 None PVT PVT 0 None PVT OTH 0 CXR; CBCPVT done @ hospital. PVT None None None
0 Blood pressure: PVT 115/73PUB after fall 0 Meds 0 Temp 97; Blood PVT sugarPVT 140 None None 607 PVT UNK Premature 25 wks. 1 PVT PVT None None Allergy to Aspirin; Learning disability 4 PUB PUB None None 0 PUB PUB None None 2 MIL MIL 1 MIL MIL None None (School None phy) 6 Unknown OTH PVT Rash Sulfur; PCN allergies 1 PVT PVT Oral Contraceptive None No 1 PVT PUB 0 PVT PVT TYLENOL 1 PVT PVT 1 none PVT PVT no no 2 PVT UNK None None 3 PUB PVT No Alg 9 CODEINE / OXYGODONE; AVELOX; Breast cancer 10 VARICELLA PUB ZOSTER PUB & Neg lab test for Herpes simplex 1 & 2 0 PUB PVT Hx asthma Fever~DTP (no brand name)~UN~0~Patient 1 None PUB UNK ADDERALLWell X 20check mg. None 1 OTH PVT None None 0 PVT PUB TYLENOL None None 0 EKG - sinusPUB bradycardia PUB with sinus None arrhythmia None with nor. variant allergies ofPCN ECG 1 PVT PVT See attached Lymphedema See attached 1 PVT PUB PUB UNK No No 0 PUB UNK 0 None PVT PVT CLARINEX; NASONEXHistory of seizure disorder as ### a young child which resolved Unknown OTH OTH Unknown WAES0907USA03112 2 None OTH OTH Unknown Unknown WAES0906USA02656 1 None PVT PVT 1 None PVT PVT FLUORIDENone None 0 PVT PUB MENTAX; DIFLUCAN NC09031 1 PVT PUB SINGULAIR; None NASONEX. 0 SP O2 = 98PVT % RA; BPPVT as low as 85/70. Hematoma (R) groin 3 PUB PUB None No None NC09030 0 PVT OTH None None None 0 NA UNK UNK unknown none at visithistory of hepatitis C and VA09:007 HIV positive; CHF 0 none MIL MIL none none none None at thisUNK time. UNK Claritin, Singulair, no Xopenex Reactive Airways None~Disease ()~~0~Patient 1 none UNK UNK none excessive wt. 1 MRI showing UNK thrombosis UNK of the Right none middle cerebral No artery. bronchiolitis, Positive blood mastocytoma. culture for8/10/09 S. Aureus. Hospital 8/10/09 records Hospital receir 24 PVT PVT singulair none none chronic rash rhinitis fine~Hep A (Havrix)~1~6~In Patient 0 UNK PVT Tylenol 325None mg as needed Hypertension, every fourHepatitis hours C ring reciept of shot. UNK UNK none None none 2 PVT UNK NONE 0 PUB PUB 0 None PUB PVT Patient on Birth NoneControlHistory pills per of mom. Scoliosis. 1 MIL MIL Zyrtek, Flonase, someNuva cold symptoms, environmental Ring pre-existing allergies surgical wound that re-opened repe 0 PVT PUB None None None 1 PVT UNK none none none 0 UNK UNK Ibruprofen, None Hydrocodone/APAP Nafitine HCL.
0 7
UNK PVT prevera, abilify, nonenexium, evista PVT PUB none none Platelet Counts: PVT 7/11, 7; UNK 7/12 at 1:35, 22; 7/12None at 18:00, 2; No7/13, known 11;allergies. 7/14, 23;8/10/09 7/15, 98Hospital 8/10/09records Hospitalreceived recordsDO rec PVT PVT SIMVISTATIN; None ANAGRELICLE; PCN; Copp; ADVAIR; ATN, Gerd HCTZ Hypothyroidism ALBUTEROL; PREMIDONE; PR 0 PVT PVT No No PMH: Bee sting allergy. Obesity. Plantar fascitis. swe 1 PVT PUB 1 PVT UNK 2 PVT PVT None None None PVT PVT 1 Aerobic Bacterial PVT CX DX PVT cellulitis ordered None 7-24-09 9 None MIL MIL No medical history reported. ### 5 Not Reported MIL MIL reported recent sprained ankle: ### onset 21-April-2009. 1 UNK UNK Miralax daily, None. Cyproheptadine Chronicas constipation, needed forG-tube, weight gain mild (none hypotonia given that day) 69 None UNK UNK Allergy to erythromycin, seasonal rhinitis, breast cancer su 4 PVT PVT 1 Took 7 vilesUNK of blood on UNK 7-10-09, do not know results. Had chickenpox as a child and took shingles vaccines as p 1 none UNK UNK none 1 PUB PVT None Thyroid - med taken daily for total thyroidectomy 11/07 6 None PVT OTH candida diaper Neonatal area; sepsis Eczema post birth 0 OTH PVT None 1 PUB PUB 6 Unknown OTH OTH Unknown None WAES0907USA04214 Unknown OTH OTH Unknown Unknown WAES0907USA03645 laboratory test, OTH"bunchOTH of test in ER" Unknown Unknown WAES0907USA03675 0 7/29/09 Hospital PVT ER records UNK DOS GEADON; 7/22/09. LABS LEXAPRO; No and DIAGNOSTICS: asthma; ABLUTEROL; mood CBC disorder; MDI;-Polyhistefante Mono allergic 11.5% Rxn (H)toHCT BENADRYL-swells 35.3% (L) MCV 1 This child had PUB similar episode PUB after 2nd PEDIARIX, None PREVNAR, None. 8/20/09 HIB Seizure~Hib andHospital ROTA. records 8/20/09 (no brand received Hospital name)~1~0~Patient|Sei records DOS 7/16/09 received to 7 0 None PVT PUB PRILOSECMild erythematous Laryngomalacia; patch GER 1 PVT UNK 9 5/8/09 - Stool PVT studies
0 UNK UNK none none none hives~HPV (no brand name)~1~15~Patient 1 MIL MIL allergic to Ceclor fever, and headRocephin and body aches~Smallpox (ACAM2 188 8/4/09 ER records MIL received UNK DOS 5/29/09. None CTNone and MRI ofNone. brain; 8/4/09 All metabolic Hospital and records infectious received disease DOS work-up. 5/29/09.LABS Anx 0 UNK PVT PVT Unknown A0798931A 0 Unk PVT PVT Unknown A0798941A UNK OTH OTH Unknown A0798942A 11 Saw Dr on 4/23/09; PUB NoOTH lab work - Issued Rx Doxephen - None Told patient had chicken pox 4 PUB PUB None None 0 None PVT PVT Alesse OCP; None Prevacid Allergic OTC; Retin-A Rhinitis; topical, Acne Allegra 1 Pt was given PVT ADX KEFLEX PVT 500mgCLARITIN 1 QID x 610 None days. mg 1PO Seasonal QD allergies. ~Meningococcal (Menactra)~1~20~Patient 1 PVT PVT Swelling and redness.~DTaP (no brand name)~ 0 PVT PUB None None 1 PUB PUB Diarrhea 37 week gestation; SGA (sm. for gestational age) 0 BP after recovery PVT 91/56; PUB initial BPalbuterol 106/73; BP 90Dizziness after mcg/ACT dizziness aerosol Asthma; 81/46 solution NKDA Dizziness.~HPV (Gardasil)~2~18~Patient 0 PVT PVT PRN asthma Noinhaler. complaints Asthma; hlo hives. 0 OTH PUB BACTRIM IA090011 0 None PVT PUB None None None; Has had near -syncope before once or twice. 1 PUB UNK PCN 3 Mom says hospital PUB ER PUB did test to R/o None staph. None 7 weeks premature-d/c from hospital at 2 wks. old. PUB UNK None None 0 PVT PUB None Well check None 3 PVT PUB 1 PUB PVT Vitamins; CLARITAN; BENADRYL 1 PUB OTH Vidal Dot None Old herniated disc L4-5 1 PUB PUB No No No 375 Unknown PVT OTH Unknown Urinary tract infection; Hypothyroidism; WAES0906USA04063 Hypertension; Gastrooesopha 1 Unknown OTH OTH Unknown WAES0907USA03334 71 Labs and Diagnostics: PVT OTH Head CT (-). EEG abnormal. high BP EMG Blind c/winpost-infectious left eye; loss of neuropathy/GBS. hearing left ear; High CSF BP. glucose PMH: 120 C 5 UNK UNK UNK UNK 0 None PUB PVT None None 3 PUB UNK 1 None PVT UNK None Innocent heart murmur. 1 PUB PUB None 1 CBC; ultrasound PVT right thigh. PUB 8/10/09 ER records No receivedNone. DOS 8/10/09 7/25/09.ER LABS records and DIAGNOSTICS: received DOS 7/25/09. Ultrasound Allergies of r 0 PUB PUB T103~Vaccine not specified (no brand name)~1 10 Troponin T MIL Cardiac SERUM, MIL 0.041 None (H*); Creatine NoneKinaseNone SERUM, 127 U/L; WBC Blood, 10.0 x10(3)/mcL; RBC Blo 0 Abdominal PUB an chest X-Ray; PVT BloodNone work, all normal None None 2 None PVT PVT None None None 13 Head CT; EEG; PVT blood culture. PVT 8/27/09 Hospital None records received None. 8/27/09 DOS 7/20/09 Hospitaltorecords 7/22/09. received LABS and DOSDIAGNOSTIC 7/20/09 to 7 3 None PVT PVT Levoxyl 0.1 Atenolol 50 2x simuvastatin 40 hct 225 PUB PUB None None 0 PUB UNK 0 None PUB PUB NK NK NK 1/2/09~HPV (Gardasil)~1~16~Patient 1 PVT PUB None None 0 8/13/09 Hospital PVT records PUB received DOS 8/5/09None to 8/6/09. Tuberous LABS andSclerosis. DIAGNOSTICS: 8/13/09EEG Hospital activities records of wakefullness received DO 2 PVT PUB 0 UNK UNK PUB PUB None None PUB PUB 2 PVT UNK None None None
none required MIL MIL NONE NONE NONE 0 PVT PUB none none none 3 UNK UNK STRATTERA DENIES 40 MG BID DENIES 1 PVT UNK 0 PUB PUB 0 PVT UNK egg allergyhigh fever~DTaP (no brand name)~4~2~In Pat 0 none PVT PVT no no no 0 PUB PUB none knownnone known MO-2009-16 1 PVT PUB 33 none UNK UNK None RAD 0 PVT PVT None Reactive Airway Disease UNK UNK 1 None PVT PVT None None - in for None check-up 2 N/A PUB PVT DENIES DENIES DENIES 9 PUB PUB 7 RASH/CELLULITIS PUB PVT UNKNOWNNONE UNKNOWN 0 UNK UNK no just that as shestated failedtoto911 report staff that sheshe was was asthmatic asthmatic 0 PVT PUB claritin, albuterol nebs,latex, multivitamin, egg, milk reglan, allergy, pulmicort, growth hormone nystatin, deficiency glycolax, flouride 2 PUB PVT Client denied NKDA. any acute Diabetes. illness at time of vaccine. 0 none PVT UNK insulin none DM-I 1 NONE PUB UNK NONE NONE NONE 66 After examination PVT fromPVT Dr. Janet Kerrigan, she None is not sure None if this is neuropathy type pain from Zostavax or more of m 0 unknown atPUB this time PUB Ortho tricyclin none lo Pierre-robin symdrome 8 PVT PVT 1 PUB UNK None reported None reported None reported 0 CBC 7/29/09 PVT with elevated PVT WBC 13.85 Aggrenox,Norvasc, DiabetesMetformin, type No II, known Hypertension, Simvastatin, drug allergies Prostate Casodex, Cancer Hytrin, Hydrochlorthiazide 1 PUB UNK None None None 0 PVT UNK CIPRODEX;None BACTRIMCornelia deLange Syndrome; Reactive airway dz 9/4/09-re 7 PVT OTH 1 PVT PVT None None known 1 None PVT PVT None None known. 1 PVT PVT None None Known 1 None PVT OTH None NKA, none 9 Blood; BoneOTH marrow bio; PVT Urine; Scans (Alleged (All after neg. None event) NEXIUM; None - BPH AMBIAN none PVT PVT none none enuresis OTH OTH OTH PUB Albuterol 2.5 mg per neb Asthma as needed; Prednisone 5mg every day for 5 days. 0 PVT PVT No No PUB PUB Prenatal vitamin None 1 PVT PVT Insulin pump Diabetes None PUB UNK None None NKDA 0 CBC, normal, MIL7/25/2009; MILCBC, PT, None PTT, INR,None normal, 7/27/2009; None; butTetanus family history toxoidof Abpenicillin IgG pending. allergy, so has never t 1 PUB PVT PRO-AIR IN; SINGULAIR Asthma; 10mg;allergy ADVAIR - PCN 250/50 1 PUB PUB None None Allergic to Latex; Lactose intolerant 2 PVT PUB No None 0 MIL MIL ELAVIL None Anxiety 0 UNK UNK None None None 0 MIL MIL OCPs no none 0 MIL MIL None 0 EMG; CBC;PVT MRI's; Vascular OTH studies; MIRAPEX; B12; Folate; Lisinopril; NA; K;NEXIUM; PCN Cl; CO2; (rash, KLONOPIN; anion tempgap; andCa; inflammed ZANAFLEX; BS; BUN; lymph LASIX; Creatinine; glands); SINGULAIR; GFR; EPI (LOC T.P.; SY 1 MIL MIL None None
6 0 1 None
PVT UNK None None None OTH PVT Thyroid Aciphex; Arthrotec Hi BP; Tylenol, cat scan dye; connective tissue disorder PVT PVT None None None PVT PVT None None None PUB PUB VYVANASE 40 mg QDIntermittent for 6 years asthma-last attack 2 months ago 1 None OTH PUB None None 0 PVT UNK None 1 None PVT PVT None None None 1 None PVT PVT ANSAID; FLONASE; None PREMPRO Arthritis; Seasonal allergies 0 OTH PVT None None dizziness~Vaccine not specified (no brand nam 5 MIL MIL None None None ~Anthrax (no brand name)~2~41~Patient 3 PUB PVT High fever~DTaP (no brand name)~1~0~Patien blood pressure, OTH 100/42OTH mmHg; chest Unknown X-ray, revealed Asplenia;right Pulmonary Urinary lung haziness; tract fibrosis; infection; computed Chronic WAES0907USA03866 Sepsis; alcoholism axial, Pneumonia abdomen and pelvis sho 8 PVT UNK None None Unknown OTH OTH Unknown Unknown WAES0907USA05047 1 None PVT PVT None None 1 None PVT PUB None None None 1 PVT OTH Rhinorrhea x 1 week Unknown OTH OTH Unknown Unknown WAES0907USA04814 2 UNK UNK 1 NONE PVT PVT NONE NONE NONE 0 Exray - 7/30/09 PVT normal.UNK MRI to be done none, pain in hypothyroid shoulder 1 PVT UNK None None 1 PVT PUB GERD [Gastroesophageal Abnormal neonatal reflux screening disease] GERD [Gastroesophageal 1 PUB PUB 0 PUB PUB unknown n/a unknown 2 PUB PUB GuanfacineNone reported ADHD with med Guanfacine per mother for treatment; His 1 PVT PUB None None None 0 UNK PVT 1 Not known PUB at this time UNK No medications No illness takenat by No time client existing of vaccination illnesses 0 UNK UNK 0 None PVT PUB None None Pre-existing asthma and allergies causing anaphylaxis afte 0 PVT UNK None None None 1 none PVT PVT tylenol, mortin none AR/RAD localize reaction~DTaP (Daptacel)~5~6~In Pat 1 None PUB PUB None None None 0 Vitals WNL;PVT BS 130; PUB None None 6 KUB: findings UNK which suggest UNK an intussusception with the leading edge in the left transverse colon. The air in the rig 20 Not applicable PVT PVT None None None Known 7 None needed. PVT PVT Artane and None Klonipin Cerebral Palsy 1 UNK PVT 2 UNK PVT None None Pt allergic to Iodides, Sulfa and Cipro 1 none PUB PVT none none none 0 NA PVT UNK NAUSEA, VOMITING, NA DIARRHEA, HEADACHE 1 NONE PVT PUB N/A NONE N/A 1 UNK UNK NONE HX OF ASTHMA. DENIES ANY OTHER ALLERGIES ARE none. WasPVT clinically dehydrated PVT by lipitor vital signsnone Pcn, Erythromycin 1 PVT PVT None None Cleft Palate, s/p repair 1 EEG - NL; Blood PVT tests UNK - WNL. 8/17/09 Hospital records received 8/17/09 Hospital DOS 7/22/09 records to 7/23/09. receivedLABS DOS and 7/22/09 DIAGNOSTIC to 7/23/09 0 PVT PVT None None None 2 PVT PVT 1 PVT PVT Asthma
PUB OTH NKDA 0 PVT PVT None None None 1 PVT PVT None None known 1 MIL MIL PPD, C3149AA, None ID-Lt forearm, None 1 previous dose 1 F/u test, Strep PVTscreen, PVT 7/24 were negative; PHENERGAN CBC, 25 CMP, mg essentially Tab No known - Quantity: normal; drug10 allergies. tablets, mono screen, Sig:1/2negative. tablet every See8 attached hours as n 1 OTH PVT No No 1 PUB PVT Poison ivy -Ovarian off steroids cysts; x2Shellfish/iodine wks allergies 0 None PVT PUB H/o headaches None(+) 0 PUB OTH None No Pt. stated NKDA. 2 holes in heart at birth ASD & VSD whic 2 PVT PVT None 0 OTH OTH None None None PVT UNK 0 PVT PVT Non-Hodgkin lymphoma; LASIX; ALACOL; Carvedilol; ART 1 Allergy testPVT PUB ATARAX; OTC NoneeczemaSevere creameczema; dry patches Allergies of redness, inconsolable crying~DT 1 PVT PUB Well visit BIAXIN; ADD UNK OTH OTH Unknown A0795567A 2 Unk PVT PVT Unknown Concomitant medications A0796476A and relevant medical history wer 2 Unk PVT PVT Unknown Concomitant medications A0796479A and relevant medical history wer 2 UNK PVT PVT Unknown Concomitant medications A0796481A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796720A and relevant medical history wer UNK OTH OTH Concomitant medications A0796722A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796723A and relevant medical history wer UNK OTH OTH Unknown Concomitant medications A0796724A and relevant medical history wer 0 UNK PUB PUB Allergy medication Unknown There was no relevant A0798874A medical history. The subject had n UNK OTH OTH Unknown A0798883A 2 PVT UNK N/A N/a N/A 2 PUB PVT n/a n/a n/a 1 none PVT UNK none 0 None at thisUNK time. UNK None None None 0 pap smear,leep UNK biopsy,UNK colposcopy, Birth CBC control wasnone pills normal thats butnone. it.Glm filtration 8/5/09 PCP Rate, medical Es was records 70 normal received is 60,strep DOS 08/16/06 screen 0 CBC PVT UNK None Hx lung CA 1 Hospital Psychological PVT PVT Assessment Given 1/8/2008; Tylenol None Numerous prior to vaccination(s) None Hair/Urine/Stool analysis tests. 0 CBC; Serum PVT Iron; CMP; PVT PT; PTT; NONE stool guaiac; NONE urinalysis; NONE. Blood8/12/09 transfusions. Hospital 8/12/09 records Hospital recieved records DOSrecieved 11/23/08DO to 1 CBC with diff PUB -> WNL. PUB 8/17/09 Hospital None records Well received Allergy DOS 7/26/09 to amoxicilin; to 7/28/09. whenLABS has bug and bites DIAGNOSTICS: arm swells-sensi Blood 6 Referred toPVT hospital. 8/17/09 OTH Hospital recordsIntussusception; received DOS 7/30/09 diarrhea. - 7/31/09. LABS and DIAGNOSTICS: X-Ray A 0 PVT PVT 0 PVT PVT syncope~ ()~UN~17~Patient 1 MIL MIL None 0 PUB PUB 1 PVT PVT Sinusitis 0 None PVT OTH None None Geographic tongue. 0 None PUB PUB HTN; elevated cholesterol. 3 None PVT PVT 2 PVT PUB None None None 0 None PVT PVT None None 193 Apgar score, OTH 06/01/09,OTH 7, at the first vitamins minute; (unspecified) Apgar Pregnancy score,NOS 06/01/09, (LMP=9/10/2008); 8, at 5 minute; WAES0907USA04864 Heavy Apgar smoker; score, Anaemia 06/01/09, 9, at 10 0 None OTH OTH tetracycline Acne WAES0907USA04871 Unknown OTH OTH Unknown Unknown WAES0907USA05126 1 n/a PVT PVT n/a GERD 3 UNK UNK mononessanone no. 1 UNK UNK Lisinopril, generic None Paxil, Hypertension Ambien
1 N/A PUB PUB none no none 9 PUB PVT None per parent 0 PVT PVT none none none 9 no tests were PVT ordered. UNK None. None. MIL MIL Fever 12 hours noneafter administration 0 None UNK UNK None None 10 blood culture, MILwound culture MIL none none none 0 PUB PUB None None 2 n/a UNK PVT none 0 PUB PUB None None 2 PVT UNK NONE 2 PUB UNK Cardizem cd none 120 MG, none baby aspirin 0 None PUB PUB None None None 0 PUB PUB 0 N/A PatientPVT did not seek PVT medical intervention Paroxetine Patient 30 for mg; her illness. came Synthroid Charcot into 112 clinic Marie-Tooth mcg's; for a med Fosinopril20 type check. 2 neuropathy; mg; Prednisone Arthritis5mg; neuropat Triam 12 6/29/09 - not PVT immune to PVT rubella Imatrex, VitNone D known Rosacea, Migranes Unknown~ ()~NULL~~In Patient|Unknown~ ()~ 0 UNK PVT UNKNOWNUNKNOWNUNKNOWN 0 UNK UNK none no Dx with asthma rash since over several age 6 orareas~Hep 7, no problems B (no for brand 2-3 name year 1 UNK UNK none reported 1 UNK PVT none 1 MIL MIL 2 Spinal Tap,UNK Bacteria Negative, UNK Virology: CurrentnoMeds: results, Swollen Prednisone MRI/CAT Tonsils Open5mg with Scan. Heart 2tabs elevated LABS Surgery poand BID,Albuterol White 7/2001, DIAGNOSTICS: Blood Pituitary Cell 1.25mg Count, Surgery Spinal 1 vial indicative Tap 12/2006, via neb - CSF ofq4h Di InP 0 PUB PUB DENIES~ ()~NULL~~In Patient 0 X-ray of nasal PVTbones PVT None known None known 0 MIL MIL NICU respiratory distress from birth until 7 days old; chorio 0 PVT UNK None known None 0 PUB PUB ENJUVIA 1.5mg No QD None OR200926 79 Please see PVT attached PVT none heart murmur 1 PVT PVT Epi-pen; Fluticasone, 50 mcg; Omeprazole 20 mg 0 None PVT UNK None Hypertension; Allergic Rhinitis PUB OTH VERAMYST nasal spray 0 None PUB PUB None None None Nausea, Fever~Hep A (Havrix)~1~1~Patient 0 18 Apr 2009, MIL Glucose,MIL 133; BUN/Cr, None 23/1.1; Na+, None147; K+, NKDA; 4.3; Cl-, Around 106;age CO2, 6, pt 22;was Anion hospitalized Gap, 22.3;x2Ca++, for pneumoni 10.3; C 0 OTH PUB None None None 1 PUB PUB Started Cephalexin None 7/2/09 Autism; Asthma; Obesity OR200929 0 PVT PUB MOTRIN (Children's) 1 1/2 tsp @ 830 1 PUB PUB OR200930 PVT PVT 1 PVT PVT None None red swollen~Varicella (no brand name)~2~9~P 5 None PVT PUB None None noted 0 None PUB PUB None None None PVT OTH None 0 PUB PUB Methotextrate 12.5 mgCROHN's PO weeklydisease 1 None PUB OTH None None None ~DTP (no brand name)~4~6~Patient 0 none PVT OTH none none none 1 PUB PUB Allergy to Sulfa 0 None PUB PUB None Seizures with stress and fevers. 0 Assessed by OTH medical center UNK None Seasonal allergies none specific 1 None PVT PVT None None 1 None PUB UNK None None None PUB PVT None None
2 PVT PUB None None 1 None PVT PVT Multivitamins None None Hard spot, red, fever~DTP + IPV (no brand nam 1 None OTH UNK None Mild ulcerative colitis -194 see attached PVT PVT none heart murmur weak, fatigued~HPV (Gardasil)~2~15~Patient 10 Labs: CSFPVT WNL. ESRPVT 38. EKG WNL. 10/8/09 None service Heart dates murmur 8/14/09 SeePMH: toattached~ 10/1/09. low K+. LABS ()~~0.00~Patient 10/8/09 and DIAGNOSTICS: service dates 8/14/09 CDC PVT PVT 1 PVT PVT No No No 68 ITP/Evans Syndrome... UNK UNK Will eventually Noneturn into NoLupus. LABS allergies andtoDIAGNOSTICS. penicillin. 'Easy 1/2/09 bruiser". to 3/18/09: PenicillinPlatelets allergy. 'Ear 63 ( 0 Unknown OTH OTH Unknown Unknown WAES0907USA05038 64 Ultrasound,OTH normal; Echocardiography, OTH LEXAPRO 05/01?/08, Pregnancy fetal normal; NOS (LMP Blood = 8/15/2008) pressure,WAES0907USA03319 05/08/09, pregnancy induced hype 33 Unknown. 8/7/09 OTH Medical OTH records Unknown. received DOS 8/7/09 8/7/09 11/12/08 Medical Medical Unknown. torecords records 7/28/09. 8/10/09 received received LABSHospital and DOS DOS WAES0907USA04234 DIAGNOSTICS: 11/12/08 11/12/08 records to received to7/28/09. 7/28/09. Mantoux. DOS 'B12 C/O 12/26/0 8/10/09 pills' heartb 0 head computed OTH axial, 06/18/09, OTH baby: "vastly Pregnancy abnormal"; NOS ultrasound, (LMP =06/18/09, 6/1/2008)W baby: AES0907USA04345 "vastly abnormal" 0 Unknown OTH OTH NEXIUM Sulfonamide allergy WAES0907USA04362 162 09/23/09 Medical PVT Records PVTreceived for date ofNone service 7/22/09 None. to 8/20/09 7/23/09 Vaccine ultrasound: records intussusception received. Pneumo RUQ./ Air Wyeth con 0 UNK OTH OTH No concurrent Unknown medication The subject had a broken A0799772A collar bone with birth. Apgar sco 0 8/6/09 Hospital PUBrecordsPUB received DOS 5/15/09none to 5/24/09. notedSpina LABSbifida. and DIAGNOSTICS: 8/6/09 Hospital records Chest CT received positive. DOS Mycoplas 5/15/0 12 PPD, 7/2/09. MIL 8/17/09 Hospital MIL records received None DOS 8/2/09 8/17/09 to 8/5/09. Hospital LABS records and DIAGNOSTICS: received DOS 8/2/09 CBC to - Eos 8/5/09. 8.6%E 1 PVT PUB None Tinea pedis;Same Acne;asChronic above~HPV knee pain; (Gardasil)~1~14~Sibling Overweight 1 None PVT PUB None None None 2 PVT PVT None None PVT PVT 0 PUB OTH None None - per mom 4 PVT PVT none none 1 MIL MIL ZYRTEC; XOPENEX; BENZACLIN Allergy to cats. 1 PVT PVT AZITHROMYCIN None 250mg Episodic annual pleurisy Sx 1 PVT PUB HTN; Dust mite allergy 1 None PUB PUB DEPO-PROVERA None UTI; Migraines 3 PVT PUB 0 PVT UNK None None 0 None MIL MIL No No 20 Plts count 4,000 MIL UNK None None None 1 PVT PVT 1 PVT PUB Benzyl peroxide none 10% Gel acne; overweight same as above~HPV (Gardasil)~1~16~Sibling 0 None OTH PUB None None Allergic to pollen Rash forehead~Varicella (no brand name)~2~9 Pregnancy OTH verified by ultrasound PUB 7/14/09. None Pregnancy unknown at time of administration. 19 UNK UNK none none 0 PUB UNK levothyroxine none 50mg excercise induced anaphlaxis food allergy to shrimp and lo 0 PVT UNK NKDA 0 none PUB PUB unknown none none 3 N/A UNK PVT Lipitor 40mg 1 PVT PVT simvastatin tab 10mg, mulitvitimans 0 PUB PUB nONE nONE 3 PUB UNK 0 8/2/09- Fever UNK 104, Heart UNK rate 104 Seroquel, bpm, BP 80/60mmHg, Fioricet, status-post Effexor, Anxiety, splenectomy and Klonopin, marked migraines, leukocytosis. after Vicodin, fall andfrom Oxycontin, endometriosis WBC2 story24,000 Ambien balcony /L,8/31/09-record RBC 2.77 mil/ N/A PUB UNK No illness reported 55 A multitudeUNK of blood tests UNK were done, along with none MRIs, x-rays, none and a lumbar puncture 8/24/09-records received-JC 1 Available upon PVTrequestPVT from Crestwood Hospital. 06/29/2009 pt had bilateral cochlear implants inserted at C 1 CK:(55) WNL, MILCMP: WNL MIL Flonase and None Zantac None 43 MIL MIL None None 1 Normal CT UNK of head, lumbar UNK puncture/CSF None analysis, none inblood/urine/CSF the none weekPMH: beforecx. febrile or EEG week seizures normal. after Labs and diagnostics: CXR0 nothing wasPVT done. dr never PVT even came to seenone. her as was nurse healthy said at these timeweren't of shot.usually side effects of this shot.
0 PVT PVT 0 UNK UNK ~Tetanus Diphtheria (no brand name)~NULL~~ 11 8/31/09 Hospital PVT records PVT received DOS 7/20/09 None to 7/28/09. None LABS and DIAGNOSTICS: EEG - WNL. CT Scan Head 2 PVT PVT LISINOPRIL; None SINGULAIR; Hypertension; CLARITINIncreased D. cholestoral; NKDA 1 Lab work - drug PVT levels PVT C..P; Seizure C.P. disorder 1 PVT PVT None 1 PVT OTH 0 None PVT PVT None Drug and food allergies, Dyes, Zithromax, Cefzil, melons a 8 PVT PVT Boniva None Sulfa 1 PVT UNK None None 1 PVT PVT Yasmin; Lexapro; Mild allergic Nasonex PCN rhinitis allergy; Palpitations 0 Seen by allergist. PVT RAST PUB testing, 0.61 Amoxicillin (class I -Seen positive) Onset by7/13/09; dentist to PMH egg white. same Albuterol - Palate dayrepair; as for needed; a lesion Bilateral Budesonide on PE righttubs; buccal Cleft as mucosa. needed. palate. 0 None PVT PVT TetracyclineNone 500mg cap None twice a day; PPD PVT PUB Unknown OTH PUB None disclosed Noneby disclosed parent Noneby disclosed parent by parent 1 None PVT PUB Depo Provera No Morphine 0 PVT PVT Simvastatin; Benicar / Hct; HTN,Protonix; AAA, Carcinogen Celexa renal, renal cyst and fatty liver dise 1 PVT PVT ORTHO-NOVUMM None 777; None FLOVENT; PROAIR; VIACTIV CHEW 0 Benedryl Given PVT PVT None None None PVT PVT None None 0 PUB PUB None Known 3 PUB PUB None No No 5 Blood work PVT medical Eval PVT None None None 0 PUB UNK 0 PVT PVT None NKA UNK UNK 2 PVT OTH 15 OTH PVT 6/21/09 started Noneon MAXICLEX Allergies:eye Fish; drops PCN; SULFA; CODEINE; DILAUDID; Arthr 1 PVT PVT No None 13 OTH OTH None None None 2 PVT PUB No 2 PVT PUB None None 0 None PVT PVT None None None 0 Unknown PUB PUB None notedMom transfusion during pregnancy- Soy formula infancyUnknown OTH OTH Unknown Cardiac disorder WAES0907USA04758 38 ultrasound, OTH 09/03/08, results OTH wereUnknown normal andPregnancy 12 weeks NOS gestation; (LMPserum = 6/15/2008) alpha-fetoprotein, WAES0810USA04728 10/13/08, normal 0 magnetic resonance; OTH diagnostic OTH laboratory, None various testsNone for MS 10/2/09 Medical WAES0907USA05405 records received for Neurologist c Unknown OTH OTH Unknown Unknown WAES0908USA00003 16 Unknown OTH OTH Prednisolone Crohn's disease Pancreatitis; Adverse drug WAES0907USA04071 reaction 6 Unknown OTH OTH Unknown Unknown WAES0907USA05644 0 Labs and diagnostics: PVT PUB BS 138-242. None head CTNone WNL. Febrile seizures. Same~Influenza PMH:ID09014 Seizures (no brand with vaccines name)~1~1~Patien at 12, 15 a 0 Electroencephalography UNK UNK (EEG) and Unknown blood work were performed, None results not reported ### UNK UNK ### Not reported UNK UNK Not reported ### 0 8/24/09-records UNK receivedUNKLabs WNL. noneALT 108 none and AST none 41, A/G ratio 1:1, lymphocyte % 63.3. -365 PUB PUB None Allergic to phenergan 0 NONE PVT PVT CLEOCIN-T; NONE RETIN-A NON CREAM; BENZOYL PEROXIDE ND-09-07 WASH 2 No lab testsPVT were obtained. PVT Detrol LA 4mg; NoneLevothyroxine reported. Allergies: 0.025mg; Tetracycline; KCL 10meq; Prinivil; Atenolol/chlorthyladone Cipro; Augmentin; Clindam 50/ 0 PUB PUB NKA none none fainted~Tetanus Diphtheria (no brand name)~6 1 none PVT PUB NONE N/A Seizures at age of 6 months 0 history of severe PVT food allergiesPVT egg, flovent, milk, albuteral squash no prn, floridel, allergies, synthroid asthma, food allergies, hypothyroid
17 PUB PUB None none 0 None PUB PUB None Known None None Known 1 MIL MIL concerta not ill n/a 5 PUB PVT N/A Allergy to Penicillin 0 None PUB PVT 1 8/6/09 Hospital UNKrecord UNK received DOS 8/4/09. LABS and DIAGNOSTICS: Sulfa. Chest X-ray - Normal. Urinalysis - pH 8.0 ( 0 None PUB PUB NONE NONE NONE REPORTED 4 in the skin biopsy UNK we found UNK that i had none hsp. kidney none.biopsy 8/17/09 none. showed PCP 8/17/09 medical protein PCP and records medical scarring. received records it was DOS received all un 8/12/08 normal. DOS to 7/13/09 8/17/09 8/12/08 7 Movement tests PVT of my PVT forehead muscles, mouth, I have and a normal closing tests of myoftrachea, holdingand my arms have a out stent straight in place determined keepingthat my 7 child seen in PVT urgent care UNK had head ct with normal noneresultsnone 1 PVT PVT Children's multivitamin; None None Children's fish oil; Bioplasma cell salts 1 UNK UNK unknown none none knownnone~ ()~NULL~~In Patient 3 PVT PVT flax seed oil swelling~Td Adsorbed (no brand name)~NULL 6 UNK PVT none none 1 PVT PVT Benicar, levothyroxine,erythromycin Lexapro allergy, anxiety, hypertension, hypothyroidism 2 PVT PVT Fosamax, Dovonex allergic to iodine, latex. Psoriasis, osteoarthritis UNK UNK None None 0 PUB PUB MOTHER DENIED UNKNOWN ANY ILLNESS AT THE TIME OF VACCINES ADM 0 None PVT PUB CREST Syndrome, Allergies:HTN, Nifedipine, None~ Asthma, ()~NULL~~In Keflex, Osteoporosis, Adalat, Patient Tomentin, Osteoarthritis, Clinoril, Hype 2 none UNK UNK none 0 UNK UNK 11 It was first believed UNK I had UNK an inner ear problem. An ENT Do whonot specializes smoke or in drink inner butear dosent haveme fibromyalgia to a neurologist. non specif I wa 0 PUB PUB Parent (father) who was accompanying ID09017 child stated they got home fro 0 PVT PUB ID09015 5 MIL OTH None 2 UNK UNK remote history of radiation to skin for mycosis fungoides 0 PVT PUB None None Congenital hypertrophic pyloric stenosis - surgically resolv 0 none PUB UNK no specific obesity illness 0 PVT PVT BENTYL 2O None mg IBS 17 Blood work UNK completed UNK in LRMC - C-RP; None TSH;None B12; Lyme; GERD, RPR; 2003 heavy- metals; Sought protein evaluation electrophoresis for chest pain. andHad A1CUGI. -e 0 UNK UNK 1 None PVT PVT None None 2 None PVT OTH BENAZEPRIL; None CITALOPRAM; None TRICOR; METFORMIN; CLONIDINE UNK UNK None 0 MIL UNK none none 1 PVT PVT PATADAY eye No drops; NASONEX Environmental nasal allergies spray; ALLEGRAL 80 mg d/y 0 VS: 94/65 right OTHarm; BP PUB 20, oriented x3 no no per mom dates age unknown~ ()~~0~Patient 2 none PVT PVT none none none 25 PVT PUB No 6 PVT PVT BONIVA; CYMBALTA;Depression; Folic Acid;TRINSICON; esoph. reflux; Zinc; osteopenia; Vit B; Multivitamin; plantar fascitis; Omepraz tinn 1 none PUB OTH none none none none~ ()~~0~Patient 1 PVT OTH NONE NONE NONE 0 None PVT PVT None Multiple Allergies 0 BP, 130/88;PUB RBS, 120;PUB Temp 98 degrees; Prenatal NST vitamin reactive NKA 3 seen in office PVT 7/29/09 OTH None No None 1 PVT UNK None None 0 MRI; Blood PVT work PUB ZOCOR; DETROL None None; Pacemaker inserted 4 wks prior 4 MIL MIL None None 2 8/4/08, TSH, UNK 1.94; 2/25/09, UNK TSH, 1.74 before vaccine and Heart fever; patient: 3/27/09, mechanical TSH, 0.04, mitral extreme valve,change, controlled after with vaccine high 2 PVT PUB none exercise induced asthma; ID09016 allergic rhinitis 0 X-ray; MRI PVT showed questionable OTH result; Physical None therapyPenicillin couldn't restore Allergy.to8/17/09 normal;PCP Bone medical scan. records received D
UNK UNK None 0 PVT PVT 0 None at thisPVT time - referred PVT to Allergist None None None 1 PVT PVT None CECLOR and BACTRIM 9 PVT OTH CRESTOR; Triamterene; Allergic NIASTAN; to codeine. HCTZ;InASA; addition, METROGEL; ### the patientRanitidine; was takingZETIA the f 6 None PUB UNK No No OR200931 0 PVT PVT YAZ 0 Allergy testing PVTperformed PVT 7/27/09 PRN ZYRTEC NONE Severe food sensitivities; previous EEG; not allergies, has 5 PVT OTH Cough 3 None PVT PVT None Tetracycline 7 Unknown PVT PVT PROZAC; trazodone Hypersensitivity hydrochloride WAES0906USA04748 1 PVT UNK Allergic to bee sting 38 None OTH OTH Antimicrobial Chronic (unspecified); UTI; Blood Hydrazide; pressureToprol high;WAES0907USA05669 Drug XL tablets hypersensitivity; Penicillin alle Unknown OTH OTH Unknown Unknown WAES0907USA05682 0 Unknown. OTH 8/24/09 Consultant OTH records Nonereceived Allergic DOSreaction 8/20/08 Eye redness. to antibiotics; 8/4/09. 8/24/09 LABS Food Consultant and WAES0908USA00058 allergy DIAGNOSTICS: records received Complement DOS 8/ 1 1 CBC = normal; PVTInfluenza PVT A + B = negative None None 2 PVT PUB Global Developmental Cellulitis~DTaP Delay (no brand name)~4~3~Patient 2 PVT PVT none none UNK UNK asthma; allergies 0 UNK UNK ZOSTAVAX, ONE SHOT, 7/30/2009 wheezing ice applied on & off to sitePVT X 20 minutes. PVTLess redness Infant TYLENOL and None no increased None swelling noted 30 X 45 mm. Infant TYLENOL 0.4 cc giv 0 PVT PUB PROVENTIL Asthma and FLOVENT Asthma both used as needed only 1 None PUB PUB None None None 1 PVT PUB None 3 PVT OTH HRIG 7-31-09; None Lot number NKDA; B0886-5; NKFA; Route/Site, 0 conditionsRt Gluteus ; No Previous Doses CBC normal; PUB ESR 16 UNK None 1 None PVT PUB None None None same~Hep A (no brand name)~1~12~Patient 0 none UNK UNK none none none none~ ()~~0~Patient|none~ ()~~0~Sibling 1 None doneUNK UNK none reported none none None Reported~ ()~~0~Patient|None Reported PUB PUB none Penicillin allergy 3 N/A MIL PUB NONE NONE NONE 1 PVT PUB NONE NONE NONE, HEALTHY 0 CBC resultsPUB indicated low UNKwbc andNone low platelet, None chest xray None normal, UA normal, child has follow up appt on 8/7/09. P 0 PVT PVT none none hives from red fever,nausea, dye. Had hives vomiting~Rabies 2 months ago (RabAvert)~2~8 from unknown 1 none PUB UNK None reported 0 None MIL MIL Multivitamins None None 1 PVT PUB NONE ALLERGIC TO PCN. PT. HAS DX: ADHD AND IS TAKING 0 INITIAL VITALS: UNK B/P 104/59 PUB HR 33 None R 14 SPo2 None 98% -HEART None MONITOR SHOWED NORMAL SINUS RHYTHM. P 1 PVT PUB NONE NONE 0 None PUB PUB none none AL0911 0 None PUB UNK AL0912 UNK UNK NONE N/A N/A 1 UNK UNK none no AL0913 1 UNK UNK NONE NONE-GOOD DX:HEALTH CEREBAL PALSEY HAS LIMP ON RT. SIDE SECON 2 9/14/09 Hospital UNK Records UNK DOS 7/24/09 to 7/27/09. No LABSNo and DIAGNOSTICS: Echocardiogram - Normal. Urinalysi 34 Lab tests performed, UNK allUNK with normal results: Monospot, None EBV Nonetiters, CBC, urinalysis, pancreatic enzymes. Many oth 1 PUB PUB 11 18Jul09- Non UNK contrast UNK head CT- NO EVIDENCE fever, OFchills, ACUTE None night INTRACRANIAL sweats, coughing HEMORRHAGE up blood-quarter ORsize PARENCHYMA amount of b 0 Follow-up exam UNK on 8/6/09 UNKshowedAugmentin myalgia atcystitis 875mg site of (afebrile) of BID, injection diabetes metformin (Lmellitus deltoid), 500mg type but BID, 2, nobenazepril carpal erythema/pus/swelling/induration tunnel 5mg syndrome qd 1 UNK UNK Z-Pak Zithromax None None UNK PVT OTH Blood pressure HIGHmedication BLOOD SEIZURE PRESSURE DISORDER;A0800464A The subject had experienced adve
2 UNK PVT PVT ASTHMA Concomitant medications A0796476A and relevant medical history wer 1 PVT PVT None None None 0 None PVT UNK 1 PVT PVT None NKDA, no preexisting illness/conditions 0 PUB PUB None None Pediazole 0 PVT PVT NYSTATIN None Oral Suspension; None Multivitamin 0 EKG; CBC;PVT UA; RSTR; PVTComp LANTUS None Splenectomy age 10; Diabetes 0 None PVT PUB None Had recent None cough, resolved 0 PVT PUB ADDERALL; Nasal CLONIDINE congestion; AMOXICILLIN Rhinorrhea 0 PVT PVT None Atopic dermatitis. Hx absence Rash sz. under Seizure. nose. 6 PVT PVT 0 None PUB PVT None None 1 PVT PUB 1 PUB PUB See question # 7 1 PVT PUB No Coxsackie virus NKDA 1 6/5/09 CT Scan PVT (R) upper PVTarm inflam. GABAPENTIN changes, No fascitis 300mg;Migraine 2 BID; PRN; headaches; AXERTIntermittent sinusitis 0 BUN, CBC,PVT CREAT, Electrolytes, OTH Glucose Unknown Unknown None OTH OTH Unknown Fruit allergy WAES0810USA03151 0 None OTH OTH None WAES0810USA03209 None OTH OTH None WAES0810USA03324 0 Unknown OTH OTH ENBREL; NAPROSYN Rheumatoid arthritis WAES0810USA03681 0 magnetic resonance, OTH on OTH elbow ADVAIR; pravastatin Allergic reaction sodiumto antibiotics; Penicillin WAES0810USA03742 allergy; Asthma Unknown OTH OTH Unknown WAES0810USA04978 1 complete blood OTHcell OTH LIPITOR; LOVENOX; Latex allergy; LEXAPRO; Stroke; Drug Acute hypersensitivity; NEXIUM; myocardial GLUCOTROL; WAES0810USA05305 Hypertension; infarction KEPPRA; Hypothyroidism; SYNTHRO D 1 body temp, OTH 10/10/08, 103.6 OTH F; body aspirin; temp,bupropion 10/11/08, Coronary hydrochloride; 101 artery F disease; KLONOPIN; Hypertension; WAES0811USA00059 COZAAR; Depression; nefazodone Hyperlipidaemi hydrochlori 2 Urinalysis, (+) PVT blood, leukocytes OTH Hypothyroidism Ovarian cyst; Gastroenteritis WAES0811USA00680 Unknown OTH OTH Unknown Unknown WAES0811USA00890 1 Unknown OTH OTH Unknown WAES0811USA00896 1 Unknown OTH OTH Unknown WAES0811USA00903 2 anion gap, 11/07/08, PVT 16; PVT serum glucose, FOSAMAX; 11/07/08, CADUET; 91 mg/dl; None aspirin; serum AMBIEN blood urea,WAES0811USA00907 11/07/08, 16 mg/dl; serum creatinin 4 Unknown OTH OTH Unknown WAES0811USA01139 0 physical examination, PVT mechanical PVT darbepoetin purpura, upper Anemia; alfaextremity: Cancer; erythema Asthma;around Thrombocytopenia; the WAES0811USA01642 right biceps; Macrocytosis; tenderness;Colitis blood ul p 2 WBC count,PVT 11/28?/08,PVT 33000; WBC count, 11/28/08, 25.4; Unknown WBC count, 11/29/08, WAES0812USA00522 17000 0 WBC count,OTH 18000 OTH Hypertension; Right Diabetes cataract extraction WAES0901USA00144 0 Unknown OTH OTH Unknown Breast cancer; Drug hypersensitivity WAES0902USA01799 Unknown OTH OTH Unknown Unknown WAES0903USA01440 0 WBC count,OTH 03/10?/09,OTH 20.1; body temp, 03/08?/09, Penicillin 103F allergy; Surgery; Hospitalisation Back disorderWAES0903USA03638 0 Unknown OTH OTH Unknown Hospitalisation; Alcoholic withdrawal WAES0903USA03645 symptoms 0 Unknown PVT OTH Unknown WAES0802USA03729 1 urinalysis, 05/??/08, PVT results OTH not reported; (therapybody unspecified); Drug temp, hypersensitivity 05/??/08, calcium100.6 (unspecified); LESCOL WAES0806USA00286 80mg; glucosamine; LACT 1 Unknown PVT OTH Unknown Hospitalisation; Adverse drug reaction WAES0806USA01049 Unknown OTH OTH Unknown Unknown WAES0806USA01241 0 Unknown OTH OTH Unknown Unknown WAES0806USA02894 0 Unknown OTH OTH Unknown Unknown WAES0806USA02898 1 Unknown OTH OTH Unknown Unknown WAES0806USA07565 2 Unknown OTH OTH Unknown Unknown WAES0806USA07568 Unknown OTH OTH Unknown Unknown WAES0806USA07732 0 Unknown PVT PVT Unknown Penicillin allergy Immunisation WAES0806USA07736 1 None OTH OTH LOTREL; ATENOL; Blood pressure TAXUS Cholesterol high; Heart raised; disease Breast WAES0806USA07821 congenital; cancer Hypersensitivity reacti 0 chest X-ray,PVT 06/26/08, OTH no evidenceFOSAMAX; of acute cardiopulmonary Gastrooesophageal NEXIUM; estrogens abnormality; reflux (unspecified); disease; diagnostic WAES0806USA08865 Cholesterol ZETIA; urinalysis, ACTONEL high; 06/26/08, Osteoporosis; normalH1 None OTH OTH Fosamax; Lexapro; Hypertension; Synthroid; Dyslipidemia; Lisinopril;Senile Zocor; WAES0806USA09012 dementia; Detrol LA;Depression; Tuberculin purified Osteoporo pro
4 VZV strain, OTH 5/13/09, sample OTH adequate: Unknown VZV WILD TYPE STRAIN WAES0905USA01623 0 Unknown OTH MIL ZIAC; PREVACID Unknown WAES0807USA00408 0 Unknown PVT OTH Bio Atenolol; Hypertension Casodex;Prostate Lupron; cancer; Hexal Lisinopril ColonWAES0807USA00831 cancer; Colectomy; Bone spur 2 None UNK PUB None None WAES0807USA00845 0 None OTH OTH None WAES0807USA01192 Unknown OTH OTH Unknown Unknown WAES0807USA03005 0 None OTH OTH None None WAES0807USA03096 0 Unknown OTH OTH Unknown Unknown WAES0807USA03097 OTH OTH Unknown Unknown WAES0807USA03320 Unknown OTH OTH Unknown None WAES0807USA03677 Diagnostic laboratory, OTH high, OTH testedNone high on anti-nuclear Arthralgia;antibodies Connective tissue disorder; WAES0807USA03837 Drug hypersensitivity 365 None OTH OTH albuterol; PROZAC Depression;Breast Asthma cancer WAES0807USA04021 0 Unknown OTH OTH ALBUTEROL; Hypersensitivity ALLEGRA-D; NASONEX; SINGULAIR WAES0807USA04071 0 None OTH OTH aspirin; atenolol; fexofenadine Unknown hydrochloride; WAES0807USA04073 FLONASE; hydrochlorothiazide (+) Unknown OTH OTH Unknown WAES0807USA04128 2 Unknown PVT PVT None Unknown WAES0807USA04404 0 Unknown OTH OTH Unknown Unknown WAES0807USA04828 0 Unknown OTH OTH Unknown Unknown WAES0807USA04830 None OTH OTH Unknown Unknown WAES0807USA04938 0 Unknown OTH OTH Unknown Unknown WAES0807USA05269 0 Unknown OTH OTH Unknown Unknown WAES0807USA05671 1 Unknown OTH OTH Unknown Unknown WAES0808USA00513 Unknown OTH OTH Unknown Hospitalisation WAES0808USA00992 Unknown OTH OTH Unknown Unknown WAES0808USA01259 2 None OTH OTH FOSAMAX; PREMARIN; Hypersensitivity PRAVACHOL WAES0808USA01705 0 Unknown PUB OTH Unknown Hip replacement WAES0808USA01940 5 chest X-ray,OTH Results not OTH back as yet Unknown Unknown WAES0808USA02145 diagnostic laboratory, OTH ?/?/08, OTH low titers Unknown Immunodeficiency WAES0808USA02583 1 Unknown OTH OTH atenolol; CASODEX Hypertension Prostate cancer WAES0808USA02621 Unknown OTH OTH Unknown Diabetes WAES0808USA02641 1 Unknown OTH OTH Hydrochlorothiazide Hypertension; Sulfonamide allergyWAES0808USA02675 0 Unknown PVT PVT Unknown Unknown WAES0808USA03612 0 body temp, OTH 08/18/08, 104 OTH Unknown WAES0808USA04048 0 PVT PVT Unknown Drug hypersensitivity WAES0808USA04242 None OTH OTH None None WAES0808USA04684 0 None OTH OTH Unknown Unknown WAES0808USA04828 Unknown OTH OTH Unknown Unknown WAES0808USA04971 1 Body temp OTH 102 OTH None Allergy to vaccine WAES0808USA05316 Body temp,OTH 103 OTH Unknown Unknown WAES0808USA05370 0 Unknown OTH OTH ASPIRIN; PREMARIN; Hyperlipidaemia; Gastrooesophageal SYNTHROID; Hypothyroidism; ZOCOR reflux WAES0808USA05487 Drug disease; hypersensitivity Kidney stone; Atrial fi order, severe mental retardation, high UNK cholesterol UNKand no drug reactions Convulsion or allergies disorder; or illness Mental at time retardation; ofWAES0809USA00032 vaccination Cholesterol who inhigh 2005 was vacci 1 None OTH OTH None None WAES0809USA00048 1 body temp, OTH 08/28/08, 102 OTHdegreesUnknown None WAES0809USA00085 0 None PVT OTH ARMOUR THYROID Sulfonamide TABLETS allergy; Drug hypersensitivity; WAES0809USA00331 Allergic reaction to antibio Unknown OTH OTH Unknown Unknown WAES0809USA02160 0 total blood O2, OTH09/02/2008, OTH 90% Unknown diabetes; Osteomyelitis; Anxiety disorder; WAES0809USA00337 Hospitalisation; Diarrhoea; 0 Unknown OTH OTH Unknown Unknown WAES0809USA00805 1 None OTH OTH Unknown WAES0809USA01236 Unknown OTH OTH Unknown Unknown WAES0809USA02521 Unknown OTH OTH Unknown Unknown WAES0809USA02624 Unknown OTH OTH Unknown Unknown WAES0809USA02626
diagnostic laboratory OTH - OTH "Strain" - Result Unknown not reported Down's syndrome; Immunisation; AllergicSkin reaction tagWAES0809USA02630 removal; to antibiotics; Pneumonia Hypersensitivity streptococcal Unknown OTH OTH SYNVISC Unknown WAES0809USA01415 Unknown OTH OTH Unknown Unknown WAES0809USA02766 0 Unknown OTH OTH Unknown Unknown WAES0809USA01447 0 None PVT OTH BONIVA; CRESTOR Drug hypersensitivity; Osteoporosis; WAES0809USA03151 Cholesterol high 0 OTH OTH Unknown Unknown WAES0809USA03172 Unknown OTH OTH Unknown Unknown WAES0809USA03215 Unknown OTH OTH Unknown Unknown WAES0809USA03216 0 Unknown OTH OTH FOSAMAX; CRESTOR Drug hypersensitivity WAES0809USA03819 Unknown OTH OTH Unknown Unknown WAES0809USA01583 Unknown OTH OTH Unknown Unknown WAES0809USA01662 0 Unknown OTH OTH Unknown WAES0809USA03863 1 Diagnostic radiology, OTH for OTH right hand-negative Unknown WAES0809USA03866 Unknown OTH OTH Unknown WAES0809USA01821 0 ultrasound, PVT 09/12/08, left OTH upper extremity Unknown venous Diabetes; doppler Disability; evaluation: Drugnohypersensitivity evidence WAES0809USA01855 of DVT; diagnostic laboratory, 09 Unknown OTH OTH Unknown WAES0809USA01935 1 None OTH OTH Sulfonamide allergy WAES0809USA01945 1 Arteriography PVT 08/29/08,OTH See narrative; Unknown Body temp Peripheral 08/27/08, ischaemia; Embolism 103F; Complete Ulcer Haemorrhage blood WAES0809USA03888 cell 08/29/08, normal; Hemoglo 0 laboratory test, PVT09/18/208, PVTmetabolic AUGMENTIN, panel (normal); coldLEXAPRO, symptoms; WBC Rash; count, mg; Allergic Adverse NASONEX; 09/18/08, reaction reaction slightly SINGULAIR, toWAES0809USA03927 antibiotics elevated mg; PATANASE 0 None OTH OTH PROAIR HFA; Chronic CYANOCOBALAMIN; obstructive pulmonary VERAMYST; disease; WAES0809USA04150 Sulfonamide ADVAIR; SYNTHROID allergy OTH OTH Unknown Asthma WAES0809USA04166 0 Unknown PVT PVT Unknown Penicillin allergy; Reaction to ASPARTAME; WAES0809USA04173 Drug hypersensitivity 0 Unknown OTH OTH Unknown Hospitalisation WAES0809USA04197 Unknown OTH OTH Unknown WAES0809USA04522 0 None OTH OTH Unknown Unknown WAES0809USA04643 4 None OTH OTH SYNTHROID; Drug aspirin; hypersensitivity calcium Penicillin; (unspecified); codeine; sulfa; vitamins WAES0810USA01827 DARVON; (unspecified) DEMEROL; morphine Unknown OTH OTH NEURONTIN; Glaucoma; Glyburide; Headache; LANTUS;Depression; Metformin; WAES0810USA01844 Diabetes ZOLOFT 0 Body temp,OTH 103f OTH Aspirin, calcium Chronic (unspecified); fatigue syndrome; PREMARIN; Hyperthyroidism; PLAQUENIL; WAES0810USA01845 Arthritis; PREVACID; Stress; LEVOXYL Incontine 3 PPD Skin test, OTHpositiveOTH Metoprolol; Gout; Allopurinol; Thalamic Bladder Omeprazole; syndrome; cancerLIPITOR; Gastroesophageal WAES0810USA01854 Amlodipine; reflux Ascorbic disease; acid/vitamin Benign p Unknown OTH OTH LOTREL; Aspirin; Diabetes; FLEXERIL; Low backGLUCOVANCE; pain; Hypertension; WAES0810USA01859 Hydrochlorothiazide; Knee pain MOTRIN; Ny Unknown OTH OTH Unknown Unknown WAES0810USA01995 Unknown OTH OTH Unknown Unknown WAES0810USA01996 Unknown PUB OTH influenza virus vaccineUnknown WAES0801USA02006 2 None OTH OTH Hormonal contraceptives PENICILLINSplenectomy allergy; SULFONAMIDE WAES0810USA02028 allergy Unknown OTH OTH calcium (unspecified) (+)' None vitamins (unspecified) WAES0810USA03065 1 None OTH OTH AMOXICILLIN; Enalapril Hypertension maleate; SIMVASTATIN WAES0810USA02030 Unknown OTH OTH Unknown WAES0809USA04790 2 Unknown OTH OTH albuterol; benazepril Arthritis; Chronic hydrochloride; back pain; CELEBREX; Hyperthyroidism; WAES0810USA02038 PREMARIN; Hypertension; felodipine;Drug hydroch hyp Unknown OTH OTH Unknown WAES0809USA04791 0 None OTH OTH Unknown None WAES0809USA04852 0 Unknown OTH OTH Unknown Unknown WAES0809USA04922 0 None PUB PUB Unknown Unknown WAES0810USA02075 0 None UNK UNK Unknown Unknown WAES0810USA02076 0 Unknown OTH OTH Unknown WAES0809USA04968 0 Unknown OTH OTH Unknown Unknown WAES0810USA02124 Unknown OTH OTH Unknown Asthma WAES0810USA00198 Unknown OTH OTH Unknown WAES0810USA00321 Unknown OTH OTH Unknown WAES0810USA00443 electrocardiogram, UNK Result UNKnot reported; serum potassium, None Result not reported; serum WAES0810USA00448 glucose, Result not reported Unknown OTH OTH Unknown Cardiac disorder; Epilepsy; WAES0810USA00482 Chronic pulmonary heart disea 0 Unknown OTH OTH Unknown Unknown WAES0810USA02125
Unknown OTH OTH Penicillin allergy; Immunisation Allergic reaction WAES0810USA00486 to antibiotics; Sulfonamide allergy 1 None OTH PVT Unknown Unknown WAES0810USA02187 Unknown OTH OTH Unknown Unknown WAES0810USA00524 Unknown OTH OTH Unknown Immunisation WAES0810USA00525 Unknown OTH OTH None Sulfonamide allergy WAES0810USA02394 Unknown OTH OTH influenza virus vaccineUnknown WAES0810USA02479 0 Unknown PVT PVT VOLTAREN EMULGELUnknown WAES0810USA02695 0 Unknown OTH OTH PROTONIX; ALTACE; Unknown ZOCOR WAES0810USA02778 2 diagnostic urinalysis, OTH 10,08/08, OTH positive for nitrites and protein; Unknown negative for leukocytes WAES0810USA02784 and blood; WBC count, 10/0 0 Unknown OTH OTH Unknown Knee arthroplasty WAES0810USA02797 Unknown OTH OTH Unknown Unknown WAES0810USA02891 1 None OTH OTH ALBUTEROL; Asthma ADDERALL TABLETS; NECON; WAES0810USA00547 FLONASE; ADVAIR; SINGUL OTH OTH Unknown Unknown WAES0810USA00645 0 Unknown OTH OTH Unknown Unknown WAES0810USA00701 0 WBC, 21800 PVT PVT Amyl nitrite;COPD GLUCOPHAGE; exacerbation Unknown Paroxetine; Lisinopril WAES0810USA01153 0 Unknown OTH OTH Unknown Unknown WAES0810USA01200 0 None PVT PVT albuterol; LOTREL; Blood pressure aspirin;high; ZYRTEC; Thyroid ARTHROTEC; disorder; WAES0810USA01683 Drug doxepin hypersensitivity; hydrochloride; Pseudoc MAX 2 None PVT PVT None Unknown WAES0810USA01715 0 Unknown OTH OTH Unknown Unknown WAES0810USA01762 0 Unknown OTH OTH Unknown Unknown WAES0810USA01813 0 None OTH OTH Unknown Sulfonamide allergy; Penicillin allergy WAES0810USA03140 1 Unknown PVT PVT Unknown Unknown WAES0810USA03150 1 Unknown PVT PVT Unknown Parkinson's diseases; Osteoporosis WAES0810USA03163 2 Unknown PVT PVT Hypertension; Atrial Gastroesophageal fibrillation reflux WAES0810USA03172 disease; Hyperlipidaemia 0 Unknown OTH OTH Penicillin allergy; Allergic reaction WAES0810USA03232 to antibiotics 0 None OTH OTH None Hypertension; Oesophageal acid WAES0810USA03238 reflux Unknown OTH OTH Rheumatoid arthritis WAES0810USA03312 Unknown OTH OTH Unknown Unknown WAES0810USA03314 3 Unknown OTH OTH Unknown Unknown WAES0810USA03338 1 Unknown OTH OTH Unknown Unknown WAES0810USA03352 1 None OTH OTH Unknown None WAES0810USA03399 0 None OTH OTH Allergic reaction to antibiotics WAES0810USA03401 None OTH OTH None Unknown WAES0810USA03423 0 Unknown UNK UNK Unknown Unknown WAES0810USA03561 3 Unknown OTH OTH Unknown Unknown WAES0810USA03616 Unknown OTH OTH None Shellfish allergy; Latex allergy WAES0810USA03664 0 OTH OTH ATENOLOL; ZOCOR; Unknown thyroid; vitamins (unspecified) WAES0810USA03673 3 Unknown PVT OTH Unknown Unknown WAES0810USA03713 None OTH OTH None Drug hypersensitivity WAES0810USA03803 0 Unknown PUB PUB Unknown Unknown WAES0810USA03858 0 Unknown PUB PUB Unknown Unknown WAES0810USA03859 0 Unknown PUB PUB Unknown Unknown WAES0810USA03865 None OTH OTH Unknown Hypertension; Coronary WAES0810USA04002 artery disease; Osteoarthritis; Gas Unknown OTH OTH Unknown Unknown WAES0810USA04020 0 Unknown PUB PUB Unknown Unknown WAES0810USA04111 2 Unknown OTH OTH Unknown Unknown WAES0810USA04158 1 Unknown OTH OTH Unknown Unknown WAES0810USA04316 Unknown OTH OTH Unknown WAES0810USA04317 0 None OTH OTH Unknown Allergic reaction to antibiotics; SULFONAMIDE WAES0810USA04320 allergy; Hypersensitiv 0 Unknown OTH OTH Unknown Unknown WAES0810USA04324 0 Unknown OTH OTH BISOPROLOL FUMARATE None (+) CYMBALTA; TIZANIDINE WAES0810USA04337 HYDROCHLORIDE
0 OTH OTH Unknown Unknown WAES0810USA04352 1 None PVT PVT Anaemia Family history of cancer; WAES0810USA04363 Progression of prostate cancer; H 2 Unknown OTH OTH Unknown WAES0810USA04371 2 Unknown OTH OTH Unknown Unknown WAES0810USA04374 1 Unknown OTH OTH Unknown Unknown WAES0810USA04396 1 Unknown OTH OTH Unknown Unknown WAES0810USA04401 2 Unknown OTH OTH Unknown Unknown WAES0810USA04477 2 Unknown OTH OTH Unknown Unknown WAES0810USA04478 Unknown OTH OTH Unknown Unknown WAES0810USA04592 Unknown OTH OTH Unknown Unknown WAES0810USA04594 Unknown OTH OTH Unknown Unknown WAES0810USA04685 0 OTH OTH ASPIRIN; LESCOL; METOPROLOL; Hypertension; Cardiac TOPROL WAES0810USA04783 disorder; XL TABLETS; Anxiety;SINGULAIR; Bleeding tende OM Unknown OTH OTH Unknown Unknown WAES0810USA04903 0 None OTH OTH Unknown WAES0810USA04918 0 OTH OTH [therapy unspecified]; Allergy to grains; dietarySulfonamide supplement; allergy; estradiol; WAES0810USA04920 Hypersensitivity FLOVENT; FLONASE; SYNT 0 Unknown OTH OTH Unknown Unknown Unknown WAES0810USA04935 0 Unknown OTH OTH Unknown Unknown WAES0810USA04944 10 Unknown OTH OTH Unknown WAES0810USA05190 1856 Unknown OTH OTH Unknown Unknown WAES0810USA05083 0 None OTH OTH aspirin; calcium Diabetes; (unspecified) Hypertension; (+); insulin, Drug biphasic hypersensitivity; WAES0810USA05120 isophane; Lipids lisinopril; NOS lovastatin; high 0 Unknown PVT PVT Anxiety; Menopause; Irritable bowel Rhinitis syndrome allergic WAES0810USA05159 0 Unknown OTH OTH Unknown Unknown WAES0810USA05164 Unknown OTH OTH Unknown Unknown WAES0810USA05228 0 Unknown OTH OTH Unknown WAES0810USA05286 Unknown OTH OTH Unknown Unknown WAES0810USA05310 0 blood culture, PVT negative;PVT complete blood MAXZIDE; cell, 17,00, Cervical ibuprofen; CBC radiculopathy; levothyroxine count was 17,00 Lumbar sodium; with radiculopathy; the metoprolol; WAES0810USA05337 left shift potassium Depression; (unspecified) Hyperlipid 0 Unknown PVT PVT FLONASE; Hyperlipidaemia; Vitamins (unspecified) Sinusitis WAES0810USA05340 0 None OTH OTH Unknown None WAES0810USA05362 Unknown OTH OTH Unknown Unknown WAES0811USA00039 Unknown OTH OTH Unknown Unknown WAES0811USA00048 0 chest x-ray,PVT 11/07/08, pulmonary PVT fibrotic calciumchanges (unspecified); Drug hypersensitivity; oxygen; Swellingvitamins Lupus (unspecified) erythematosus; WAES0811USA00069 Pulmonary fibrosis; Coug 0 None PVT PVT None WAES0811USA00073 Unknown OTH OTH Unknown Unknown WAES0811USAD0127 3 Unknown PVT OTH LIBRAX capsules, Chronic5/2.5 abdominal Rib mg; fracture; Vitamin pain;Sleep Knee D (unspecified); disorder; pain; WAES0811USA00159 Irritable Kidney Ascorbic bowel stone syndrome; acid; Omega-3 Constip ma Unknown OTH OTH Unknown Unknown WAES0811USA00160 Unknown OTH OTH Unknown Unknown WAES0811USA00161 0 Unknown OTH MIL Unknown WAES0811USA00699 Unknown UNK UNK Unknown Egg allergy WAES0811USA00709 0 Unknown OTH OTH Unknown Unknown WAES0811USA00162 Unknown OTH OTH Unknown WAES0811USA00873 1 Unknown OTH OTH Unknown Unknown WAES0811USA00236 0 Unknown PVT PVT Unknown Unknown WAES0811USA00879 0 Unknown OTH OTH Unknown Heart disease; Stroke Elevated cholesterol; WAES0811USA00900 Atrial fibrillation; Enlarged prosta Unknown OTH OTH Unknown Unknown WAES0811USA00906 0 Unknown OTH OTH Unknown Penicillin allergy; Sulfonamide allergy; WAES0811USA00940 LEVAQUIN; certain drops aller 1 Unknown OTH OTH Unknown Unknown WAES0811USA00238 Unknown OTH OTH Unknown Diabetes WAES0811USA00943 Unknown OTH OTH Unknown Unknown WAES0811USA01068 Unknown OTH OTH Unknown Unknown WAES0811USA00242 Unknown OTH OTH Unknown Unknown WAES0811USA01092 1 None PVT OTH ALBUTEROL; DrugAmitriptyline hypersensitivity; hydrochloride; Asthma; Arthritis PEPCID; WAES0811USA01101 AEROBID; PLAQUENIL;
0 Unknown PVT PVT calcium (unspecified) Arthritis; Bursitis; (+); PREMARIN; Fatigue MOBIC; WAES0811USA00476 omega-3 marine triglycerides; tra 0 None OTH OTH SYNTHROID; Allergic TOPROL reaction XL TABLETS to antibiotics; High WAES0811USA01339 pulse rate 0 None OTH OTH Latex allergy; Iodine allergy; Allergic WAES0811USA00502 reaction to antibiotics; Hypersens 0 Unknown OTH OTH Unknown WAES0811USA00506 1 None PVT PVT albuterol Drug hypersensitivity; SulfonamideWAES0811USA00510 allergy; Allergic reaction to antibio 0 None OTH OTH Unknown Cholesterol high; Blood pressure high; WAES0811USA01345 Lupus erythematosus; Arthritis Unknown OTH OTH Unknown WAES0811USA00542 None OTH OTH None WAES0811USA01387 0 Unknown PVT PVT [therapy unspecified]; Hypertension; TENORMIN; Discomfort LIPITOR; in jointsWAES0811USA00642 hydrochlorothiazide 1 Unknown PVT PVT Calcium (unspecified); Reflux oesophagitis; hydrochlorothiazide Hypertension 25WAES0811USA00643 mg; TOPROL XL TABLETS; PRILO Unknown OTH OTH Unknown Unknown WAES0811USA00651 Unknown OTH OTH Unknown Unknown WAES0811USA01388 Unknown OTH OTH Unknown Unknown WAES0811USA01636 0 None OTH OTH Unknown Cancer WAES0811USA01648 Unknown OTH OTH Unknown Automobile accident; Splenectomy WAES0811USA01664 None OTH OTH None Unknown WAES0811USA02061 0 blood pressure, OTH 11/05/08, OTH130/7 mmHg; Unknown respiratory Drug hypersensitivity rate, 11/05/08, 16 breat; temperature WAES0811USA02120 measurement, 11/05/08, 0 None OTH OTH Diabetes; Drug hypersensitivity WAES0811USA01674 0 None PVT OTH albuterol; SINGULAIR Penicillin allergy; Asthma; Drug hypersensitivity; WAES0811USA02128 House dust mite aller Unknown OTH OTH Unknown WAES0811USA01681 3 Unknown OTH OTH Unknown WAES0811USA01713 Unknown OTH OTH Unknown Unknown WAES0811USA01735 -365 Unknown OTH OTH Unknown Unknown WAES0811USA01826 0 Unknown OTH OTH COUMADINSulfonamide allergy; Cardiovascular WAES0811USA01830 disorder 0 Unknown PVT PVT Unknown WAES0811USA01870 None OTH OTH None Unknown WAES0811USA02060 Unknown OTH OTH Unknown Unknown WAES0811USA02172 Unknown OTH OTH Unknown Unknown WAES0811USA02173 Unknown OTH OTH Unknown Unknown WAES0811USA02271 Unknown OTH OTH Unknown Unknown WAES0811USA02272 Unknown OTH OTH Unknown Unknown WAES0811USA02273 Unknown OTH OTH Unknown Unknown WAES0811USA02309 0 None OTH OTH None None WAES0811USA02318 0 Unknown OTH OTH Unknown Unknown WAES0811USA02329 0 None OTH OTH Drug hypersensitivity WAES0811USA02349 0 None OTH OTH Drug hypersensitivity WAES0811USA02350 None OTH OTH Sulfonamide allergy; Allergy to vaccine WAES0811USA02359 0 None OTH OTH Unknown Unknown WAES0811USA02382 Unknown OTH OTH Unknown Unknown WAES0811USA02543 3 Unknown OTH OTH ALBUTEROL; Asthma; PULMICORT; Seasonal SINGULAIR; allergy MAXALT WAES0811USA02643 0 Unknown OTH OTH FOSAMAX;Hypertension; lisinopril; lovastatin; Lipids increased; potassium (unspecified) Osteoporosis; WAES0811USA02665 Penicillin allergy Unknown OTH OTH Unknown Unknown WAES0811USA02784 0 None OTH OTH None None WAES0811USA02871 None OTH OTH None None WAES0811USA02908 2 None OTH OTH None Asthma WAES0811USA02951 Unknown OTH OTH None None WAES0811USA02985 Temperature OTH measurement; OTH 100 degrees Unknown Hypertension; Raynaud's syndrome; WAES0811USA03043 Arthritis; Hypercholesterolaemi Unknown OTH OTH Unknown Asthma; Chronic obstructive pulmonary WAES0811USA03056 disease Unknown OTH OTH Unknown Unknown WAES0811USA03116 Unknown OTH OTH Unknown Unknown WAES0811USA03416 0 Body temp,OTH 101F OTH ADVAIR; LEVOXYL; Asthma; Graves' NASONEX disease WAES0811USA03461
Unknown 0 Unknown None 0 None Unknown 0 Unknown None 1 None 1 Unknown Unknown Unknown 0 None 0 None 0 Unknown 1 Unknown 0 Unknown 1 Unknown 1 None None 1 None 0 Unknown Unknown 0 Unknown 1 None Unknown 1 Unknown None Unknown Unknown 1 Unknown 1 None 3 None None 0 None 1 Unknown 0 Unknown 0 None Unknown Unknown Unknown 0 Unknown Unknown 0 Unknown Unknown Unknown 0 Unknown Unknown Unknown 2 Unknown 0
OTH OTH OTH OTH OTH OTH OTH PVT OTH OTH PVT OTH PVT OTH PVT OTH OTH OTH OTH PVT OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH OTH PVT OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH PVT PVT OTH
OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT PVT OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT PVT OTH
Unknown
Unknown WAES0811USA03502 Immunosupression WAES0811USA03556 Asthma WAES0811USA03663 FOSAMAX;Hypertension; amlodipine; Thyroid aspirin; Hypercholesterolaemia nodule; ALTACE; Lung ZOLOFT; nodule WAES0811USA03709 ZOCOR Unknown WAES0811USA03726 Unknown Unknown WAES0811USA03758 [therapy unspecified]; Penicillin allergy; PROCARDIA Raynauds; Drug Emphysema hypersensitivity WAES0811USA03825 ECOTRIN, Bronchiectasis; calcium (unspecified), Hypertension; PENICILLIN BONIVA, Osteoporosis allergy; LABETALOL WAES0811USA03827 Iodine allergy; HYDROCHLORIDE, Drug hypersensitiv BE Unknown WAES0812USA00288 Unknown Unknown WAES0812USA00370 Unknown WAES0812USA00525 Aspirin; WELCHOL; Cholesterol TIAZAC; high; Peptic TRICOR; ulcerniacin disease; WAES0812USA00529 Coronary artery disease; Hype ZETIA; hydrochlorothiazide; Coronary artery disease; insulin; ACTOS; Diabetes;WAES0812USA00532 potassium Hypertension; (unspecified) Atrial fibrillation Penicillin allergy; Drug hypersensitivity WAES0812USA00573 Cardiac disorder WAES0812USA01254 Unknown Unknown WAES0811USA03896 LIPITOR Unknown WAES0812USA01580 thyroid Hypertension; Cholesterol; Sulfonamide WAES0811USA03949 allergy; Thyroid disorder; Dru FIORICET with DrugCodeine; hypersensitivity Graves' atenolol; disease desipramine WAES0811USA03950 hydrochloride; LEVOXYL Sulfonamide allergy WAES0811USA03983 Unknown Unknown WAES0811USA03987 Unknown WAES0811USA03990 Unknown Unknown WAES0812USA01584 Aspirin; PRINIVIL; CardiacNiacin murmur; Hyperlipidaemia WAES0811USA04022 Unknown Unknown WAES0811USA04098 Unknown Unknown WAES0811USA04099 Unknown Unknown WAES0811USA04160 Unknown Unknown WAES0811USA04174 Unknown Unknown WAES0812USA01645 Unknown Unknown WAES0812USA00016 Unknown Hyperlipidaemia; Hypertension; Coronary WAES0812USA01762 heart disease; Diverticulitis; Unknown None WAES0812USA00035 Unknown Diabetes; Convulsion disorder; Chronic WAES0812USA01763 fatigue syndrome; Drug hyper OS-CAL, NEXIUM, Hypercholesterolaemia; SYNTHROID, PRAVACHOL Hypothyroidism; WAES0812USA01791 Drug hypersensitivity; Food Unknown Unknown WAES0812USA01792 Unknown Unknown WAES0812USA01793 Influenza virus vaccineUnknown WAES0812USA01802 Unknown Asthma; Penicillin allergy; Allergic WAES0812USA01977 reaction to antibiotics Unknown Unknown WAES0812USA01978 Unknown Unknown WAES0812USA01979 Unknown Unknown WAES0812USA01999 (therapy unspecified); Sinus infection; vitamins Thyroid (unspecified) disorder; Drug WAES0812USA02021 hypersensitivity Unknown Unknown WAES0812USA02078 Unknown Unknown WAES0812USA02327 Unknown Unknown WAES0812USA02079 Unknown Unknown WAES0812USA02089 Unknown Asthma WAES0812USA02094 Unknown Unknown WAES0812USA02104 Unknown Unknown WAES0812USA02109 Unknown Unknown WAES0812USA02110 Unknown Unknown WAES0812USA02135
1 Unknown OTH OTH (therapy unspecified); Hyperlipidaemia; alendronate Sleep sodium; apnoea; citalopram; Osteopenia; WAES0812USA02383 omeprazole; Insomnia; Oesophageal simvastatin; 2 None OTH OTH PROTONIX None WAES0812USA02597 1 Body temp OTH 12/17/08 102F OTH Unknown Unknown WAES0812USA03787 1 Unknown OTH OTH Unknown Unknown WAES0812USA04089 Unknown OTH OTH Unknown Unknown WAES0812USA04095 0 Unknown OTH OTH Unknown Fibromyalgia WAES0812USA04096 Unknown OTH OTH Unknown WAES0812USA04278 3 Unknown OTH OTH Unknown WAES0812USA04279 None OTH OTH Unknown Allergy to vaccine; Hives Egg allergy; Hypersensitivity WAES0812USA04296 0 Unknown PUB OTH Unknown Unknown WAES0812USA04338 Unknown OTH OTH Unknown Unknown WAES0812USA04345 0 None OTH OTH FOSAMAX;Hypertension; ZOCOR Hypercholesterolaemia; WAES0812USA04556 Osteoporosis 0 None OTH OTH ZETIA; COUMADIN Hypercholesterolaemia; CoronaryWAES0812USA04557 artery disease; Aortic valve stenos 0 temperatureOTH measurement, OTH 12/10/08, Unknown 102 Degrees None WAES0812USA04696 1 Unknown PVT OTH Lung cancer stage IV; Allergic reaction WAES0812USA05189 to antibiotics; SULFONAMID Unknown OTH OTH Unknown Unknown WAES0812USA05265 Unknown OTH OTH Unknown Unknown WAES0812USA02772 Unknown OTH OTH Unknown Unknown WAES0812USA02773 Unknown OTH OTH Unknown Unknown WAES0812USA02774 0 Unknown PVT PVT Unknown Peanut allergy; Environmental WAES0812USA03238 allergy Unknown OTH OTH Unknown Unknown WAES0812USA03261 Unknown OTH OTH Unknown Unknown WAES0812USA03345 0 None OTH OTH carisoprodol; Drug NEXIUM; hypersensitivity; gemfibrozil; Sulfonamide SYNTHROID; WAES0812USA03347 allergy CLARITIN; TOPROL XL Table None OTH OTH Chronic obstructive Mastectomy pulmonary disease; WAES0812USA03348 Arthritis 0 temperatureOTH measurement, OTH 12/09/08, Unknown 102 Degrees Drug hypersensitivity WAES0812USA03357 0 None OTH OTH ASTELIN; fexofenadine Hypertension;hydrochloride; Hypothyroidism; fluticasone Tinnitus; WAES0812USA03741 propionate; Latex allergy; SYNTHROID; Food allergy; KLO Io 2 body temp, OTH 12/13/08, 104, OTHFahrenheit Unknown Unknown WAES0812USA03769 0 None PVT PUB Unknown Bronchiolitis; Reactive WAES0901USA00067 airway disease 1 None OTH OTH None None WAES0910USA00145 0 None OTH OTH Unknown Drug hypersensitivity; Meningitis viral Penicillin allergy WAES0901USA00153 Unknown OTH OTH Unknown Unknown WAES0901USA00828 0 None OTH OTH None Wrong vaccine WAES0901USA01300 administered.~Pneumo (Pneum Unknown PVT PVT Unknown Unknown WAES0901USA01573 0 None OTH OTH None Wrong drugWAES0901USA01583 administered~Pneumo (Prevnar)~1 Unknown PVT PVT Unknown Unknown WAES0901USA01937 Unknown OTH OTH Unknown Unknown WAES0901USA01938 Unknown PVT PVT Unknown Unknown WAES0901USA01939 Unknown PVT PVT Unknown Unknown WAES0901USA01940 Unknown OTH OTH Unknown WAES0901USA01996 Unknown OTH OTH Unknown Unknown WAES0901USA02375 0 Unknown OTH OTH Unknown Unknown WAES0901USA02407 1 Unknown OTH OTH Unknown Unknown WAES0901USA02438 None OTH OTH VICODIN; albuterol; Asthma; Drug LIPITOR; hypersensitivity; captopril; carvedilol; Penicillin WAES0901USA02510 ADVAIR; allergy; Sulfonamide LAXIS (FUROSEMI allergy 0 Unknown OTH OTH Unknown Unknown WAES0901USA03048 0 None PVT PVT Unknown None WAES0901USA03163 0 Blood pressure, PVT 01/29/09, PVT130/7; Total Unknown heartbeat Hypertension count, 01/29/09, 76; Temperature WAES0901USA03327 measurement, 01/29/09, 98.2 1 None PVT PUB Calcium (unspecified); Allergic reaction Chondroitin to antibiotics; sulfateDrug sodium WAES0901USA03349 hypersensitivity (+); Lovastatin; Ramipril; Vitam 1 Unknown PVT PVT ALBUTEROL; PULMICORT; Unknown Hormonal contraceptive; WAES0901USA03350 ZOLOFT 0 None PVT PVT Calcium (unspecified); Drug hypersensitivity CELEBREX; PROZAC; WAES0901USA03377 Iron (unspecified); SINGULAIR; C None OTH OTH Unknown Unknown WAES0901USA03452 0 Unknown OTH OTH Unknown Unknown WAES0901USA03520
0 Unknown OTH OTH Unknown Rheumatoid arthritis WAES0901USA03673 0 Unknown PVT PVT Unknown Mixed hyperlipidaemia; Diabetes mellitus; WAES0901USA03820 Gout; Hypertension 0 Unknown OTH OTH Unknown Unknown WAES0901USA03840 0 Unknown OTH OTH Unknown Fibromyalgia; History Short-bowel of diarrhea; syndrome; Rotator WAES0901USA03911 Allergies cuff surgery; to penicillin; ShinglesSulfa; Ne 2 Unknown OTH OTH Unknown PENICILLINGastrostomy allergy; Drugtube hypersensitivity insertion; WAES0901USA04143 Gastrointestinal disorder 3 None OTH OTH Unknown Lung disorder; Cardiac disorder; Arthritis; WAES0901USA04159 Penicillin allergy; Sulfonami 8 None OTH OTH None Type 2 diabetes mellitus; Chronic WAES0901USA04168 obstructive pulmonary disease; Hyp 1 None OTH OTH Unknown Chronic obstructive pulmonary disease; WAES0901USA04200 Cardiac disorder 0 Unknown OTH OTH Unknown Unknown WAES0901USA04309 2 Unknown OTH OTH Unknown Osteoporosis; Osteoarthritis; Iodine WAES0901USA04436 allergy; Hypersensitivity 1 Unknown OTH OTH Unknown Osteoarthritis; Allergic reaction to WAES0901USA04445 antibiotics; Hypersensitivity 0 body temp, PVT 102.9 OTH Unknown Unknown WAES0902USA00017 2 Unknown OTH OTH Unknown RheumatoidNonspecific arthritis; Allergic reaction reaction toWAES0902USA00036 tuberculin to vancomycin, test streptomycin, p 1 None OTH OTH VICODIN; vitamins Sulfonamide (unspecified) Arthralgia; allergy Alcoholism; WAES0902USA00040 Hepatic failure; Adverse drug react 0 Unknown UNK UNK Unknown Unknown WAES0902USA00041 Unknown OTH OTH Unknown Unknown WAES0902USA00044 1 Unknown PVT PVT Unknown None WAES0902USA00045 0 Unknown OTH OTH estrogens (unspecified), Sulfonamide vitamins (unspecified) allergy WAES0902USA00061 0 Unknown OTH OTH Unknown Hospitalisation WAES0902USA00187 3 None OTH OTH ALBUTEROL; Asthma; Calcium Drug Dermatitis gluconate; hypersensitivity atopic CELEBREX; WAES0902USA00459 PREMARIN; ADVAIR; ATROV 1 Unknown PVT PVT Unknown PneumoniaUnknown WAES0902USA00588 0 Unknown PVT PVT Unknown Bronchitis Unknown WAES0902USA00853 0 Unknown OTH OTH Unknown Unknown WAES0902USA00953 0 Unknown OTH OTH Unknown Unknown WAES0902USA01462 Unknown OTH OTH Unknown Unknown WAES0902USA01664 0 Unknown PVT PVT Unknown Hypertension; Hypothyroidism; Hypercholesterolaemia WAES0902USA01696 Unknown OTH OTH Unknown Unknown WAES0902USA01697 Unknown OTH OTH Unknown Unknown WAES0902USA01706 Unknown OTH OTH Unknown WAES0902USA01832 2 Unknown PVT PVT Unknown Unknown WAES0902USA02181 0 None PVT OTH hormonal contraceptives Sinusitis recurrent; Sulfonamide allergy; WAES0902USA02382 Allergic reaction to antibiotics 1 Unknown OTH OTH Unknown Arthritis; Scoliosis; Hypersensitivity WAES0902USA02406 Unknown OTH OTH Unknown Unknown WAES0902USA02686 Unknown OTH OTH Unknown Unknown WAES0902USA02934 0 None PVT PVT aspirin; PREMARIN; Mitral valve ZETIA; prolapse; PREVACID; Lipids NOS NASONEX; WAES0902USA02973 high; Diverticulitis; NIASPAN;Irritable DITROPAN bowel sy 0 Unknown PVT PVT Sulfonamide Stent allergy; placement Terazosin allergy; WAES0902USA03742 Hyperlipidaemia; Hypertension 0 Unknown OTH OTH Unknown WAES0902USA03983 1 None OTH OTH Unknown Polycythaemia; Phlebotomy WAES0902USA04040 138 None OTH OTH CYMBALTAHypothyroidism Depression; Breast cancer WAES0902USA04076 0 Unknown OTH OTH Unknown Unknown WAES0902USA04437 0 None PVT OTH TRICOR; MICRO Hypercholesterolaemia K WAES0902USA04524 0 Unknown OTH OTH BENICAR, PROTONIXUnknown WAES0902USA04569 0 Unknown OTH OTH diuretic (unspecified), hormonal Unknown contraceptives WAES0902USA04573 1 None PVT PVT Unknown None WAES0902USA04600 Unknown OTH OTH Unknown Unknown WAES0903USA00003 0 None OTH OTH ASPIRIN; DIAZIDE; PENICILLIN Levothyroxine allergy; Drug sodium; hypersensitivity WAES0903USA00065 ZOCOR 0 None OTH OTH Influenza virus vaccineUnknown WAES0903USA00082 Unknown OTH OTH Unknown Unknown WAES0903USA00278 0 Physical examination, PVT 02/10/09, PVT normal; Unknown Blood Polycythaemia; pressure,Hernia 02/10/09, Gastroesophageal repair 110/70; Blood WAES0903USA00443 reflux pressure, disease; 02/10/09, Irritable130/80; bowel synd Tota Unknown OTH OTH Unknown Unknown WAES0903USA01102 3 OTH OTH Glucosamine; Naprosyn; None Saw palmetto; Vitamins WAES0903USA01420
Unknown Unknown 0 Unknown 1 None 0 Unknown 0 Unknown 4 Unknown 0 Unknown 1 None 0 Unknown Unknown Unknown Unknown 0 Unknown 0 Unknown Unknown Unknown Unknown Unknown 2 None 2 None 1 None None 0 None 4 None 0 None 0 None 0 1 Unknown 0 Unknown Unknown 0 Unknown 0 Unknown 0 Unknown Unknown 1 Unknown 0 Unknown 1 None Unknown Unknown Unknown 0 Unknown 4 Unknown 0 Unknown 0 Unknown 0 None 0 Unknown 1 Unknown 0 Unknown 1 Unknown -1 Unknown
OTH OTH PVT PVT UNK OTH OTH OTH PVT PVT OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH UNK PVT PVT OTH PVT PVT PVT OTH OTH OTH OTH UNK OTH OTH OTH MIL OTH PVT OTH OTH OTH OTH OTH OTH
OTH OTH PVT PVT UNK OTH OTH OTH PUB OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH UNK OTH PVT OTH PVT PVT PVT OTH OTH OTH OTH UNK OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH
Unknown Unknown WAES0903USA01608 Unknown Unknown WAES0903USA01623 Unknown Drug hypersensitivity; Oesophageal WAES0903USA02278 reflux; Hypertension; Venous insu ASPIRIN; SYNTHROID; Diabetes; Hypertension; QUINAPRILHypercholesterolaemia; HYDROCHLORIDE; WAES0903USA02295 RANITIDINE Hypothyroidism. Unknown Diabetes; Hyperlipidaemia; Hypertension WAES0903USA02434 Unknown Unknown WAES0903USA02557 Unknown Unknown WAES0903USA02865 CLINORIL Arthritis WAES0903USA02960 BENADRYL; Hypertension; SYNTHOID; Lung Chronic SINGULAIR neoplasm obstructive malignant WAES0903USA03208 pulmonary disease; Hypothyroidism Unknown Unknown WAES0903USA03612 Unknown Unknown WAES0903USA03623 Unknown Unknown WAES0903USA03641 Unknown Unknown WAES0903USA03649 Unknown Unknown WAES0903USA03650 Unknown Unknown WAES0903USA03655 Unknown Unknown WAES0903USA03944 Unknown Unknown WAES0903USA04218 Unknown Unknown WAES0903USA04219 Unknown Unknown WAES0903USA04220 Unknown Unknown WAES0903USA04244 Unknown Unknown WAES0903USA05142 Albuterol Allergic reaction to bee sting; Allergic WAES0903USA05498 reaction to antibiotics, Drug hyp XANAX Penicillin allergy; Allergic reaction WAES0904USA00034 to antibiotics Albuterol Immunodeficiency Pneumonitis common variable; WAES0904USA00220 Sulfonamide allergy YAZ, SINGULAIR, Drug hypersensitivity propranolol Pneumonia hydrochloride,WAES0904USA00258 VALTREX None WAES0904USA00577 Azithromycin Asthma; Penicillin allergy; Blood pressure WAES0904USA01355 high; Migraine; Cardiac diso docusate sodium; Diabetes; LOVENOX; Hospitalisation; FLONASE; Pneumonia MUCINEX; WAES0904USA01566 LEVEMIR; ATROVENT; CL Unknown Sinus congestion; Drug hypersensitivity; WAES0904USA02040 Diabetes ESTRADIOL; Drug Hydrochlorothiazide; hypersensitivity; Type GLUCOPHAGE; 2 diabetes WAES0904USA02058 mellitus; NAPROXEN; Nausea; ACCUPRIL Rash; Hyp Unknown Unknown WAES0904USA02253 aspirin; calcium Type(unspecified); 2 Diabetes mellitus; TRICOR; Hypertension; PRAVACHOL; WAES0904USA02733 Hyperlipidaemia vitamins (unspecified) aspirin; ASTELIN; AllergicSYNTHROID reaction to antibiotics; Nausea; WAES0904USA02734 Vomiting; chronic obstructive p Unknown Unknown WAES0904USA02780 Unknown Unknown WAES0904USA02893 ASTELIN, WELLBUTRIN, Migraine; SinusLEXAPRO, infection ALLEGRA-D, WAES0904USA03163 ZOFRAN, PROTONIX Glimepiride;Immunoglobulins HUMALOG; Recurrent GLUMETZA; decreased; infection CRESTOR Diabetes; WAES0904USA03182 Hypercholesterolaemia; Drug Hospitalisation; Pneumonia WAES0904USA03405 Unknown None WAES0904USA03422 Unknown Unknown WAES0904USA03586 Unknown Unknown WAES0904USA03813 Unknown Diabetes WAES0904USA03823 Unknown Unknown WAES0904USA03974 Unknown Drug hypersensitivity; Hypersensitivity; WAES0904USA04192 Fruit allergy; Allergy to nuts; R Unknown Unknown WAES0904USA04343 ENBREL; SYNTHROID Rheumatoid arthritis; SulfonamideWAES0904USA04462 allergy None Hypersensitivity; Convulsion; Pancreatic WAES0904USA04500 disorder TYLENOL; BENADRYL Unknown WAES0905USA00187 hormonal contraceptives None WAES0905USA00215 Unknown Depression WAES0905USA00359 Unknown Immunisation WAES0905USA00375
0 Unknown PVT OTH Unknown Unknown WAES0905USA00444 1 Unknown OTH OTH TYLENOL; BENADRYL Unknown WAES0905USA00491 0 Unknown OTH OTH LIPITOR; ZYRTEC; Diabetes;glucosamine; Drug hypersensitivity lisinopril; metformin WAES0905USA00504 0 None PVT PVT Unknown None WAES0905USA00509 1 None OTH OTH None None WAES0905USA00517 0 Unknown UNK UNK EPIPEN; XYZAL; Rhinitisphentermine allergic; Cough; Drug Nasal hypersensitivity; congestion WAES0905USA00546 Pruritis; Dermatitis allergic; Upp 0 Unknown PVT PVT Unknown Unknown WAES0905USA00663 0 Unknown PVT PVT Unknown Unknown WAES0905USA00664 0 Unknown PVT PVT Unknown Unknown WAES0905USA00665 0 Unknown PVT PVT Unknown Unknown WAES0905USA00666 0 Unknown PVT PVT Unknown Unknown WAES0905USA00667 0 Unknown PVT PVT Unknown Unknown WAES0905USA00668 2 Unknown OTH OTH TYLENOL, Chronic Z-PAK, BENADRYL cough WAES0905USA00697 0 Unknown PVT PVT Unknown Unknown WAES0905USA00669 0 Unknown OTH OTH Unknown Unknown WAES0905USA00962 0 Unknown PVT PVT Unknown Unknown WAES0905USA00670 1 None OTH OTH Unknown Unknown WAES0905USA01065 Unknown OTH OTH Unknown Unknown WAES0905USA01086 0 Unknown PVT PVT Unknown Unknown WAES0905USA00671 0 Unknown PVT PVT Unknown Unknown WAES0905USA00672 Unknown OTH OTH Unknown Latex allergy WAES0905USA01282 Unknown OTH OTH Unknown Unknown WAES0905USA01415 0 None OTH OTH Unknown Unknown WAES0905USA01468 0 Unknown PVT PVT Unknown Unknown WAES0905USA00673 Unknown OTH OTH Unknown Unknown WAES0906USA01560 0 OTH OTH Unknown WAES0905USA01941 0 Unknown OTH OTH Unknown Unknown WAES0905USA02311 0 Unknown PVT PVT Unknown Unknown WAES0905USA00674 2 None OTH OTH None Sulfonamide allergy; Penicillin allergy; WAES0905USA04069 Food allergy 1 None OTH OTH Unknown Hospitalisation Surgery WAES0906USA00003 1 OTH OTH Advair Asthma, Colitis WAES0906USA00104 0 Unknown PVT PVT Unknown Unknown WAES0905USA00675 Unknown OTH OTH Unknown Unknown WAES0906USA00127 0 Unknown PVT PVT Unknown Unknown WAES0905USA00676 0 Unknown PVT PVT Unknown Unknown WAES0905USA00677 0 Unknown PVT PVT Unknown Unknown WAES0905USA00678 0 Unknown PVT PVT Unknown Unknown WAES0905USA00679 0 Unknown PVT PVT Unknown Unknown WAES0905USA00680 0 Unknown OTH OTH Unknown Unknown WAES0905USA00686 0 Unknown OTH OTH Unknown Unknown WAES0905USA00993 diagnostic laboratory, OTH negative OTH titers Unknown to MMR Unknown WAES0908USA00374 0 Unknown OTH OTH Ibuprofen Vaccination adverse reaction; WAES0908USA00060 Aura; Blindness; Anxiety; Pe 31 Described in MIL HPI narrative. MIL 8/14/09 None Medical at the records None time received None.1/27/1986 8/14/09 Medical to 8/3/09. records LABSreceived and DIAGNOSTICS: 1/27/1986 to EMG 8/3/0 1 Done in hospital. PVT 8/12/09 UNK HospitalCLARITIN; records received none SINGULAIR DOSAsthma; 7/12/09 MEDS:Seasonal to Septra, 7/14/09. 8/12/09 allergies. LABSHospital and 8/12/09 DIAGNOSTICS: records Hospital received records Perpheral DOS rece7 8 Visit with Dr. PVT ENT one UNK week later. 8/11/09 8/11/09 Otolaryngology Otolaryngology None Hypertension; consult consult records records deafness~Zoster GERD; received received Atherosclerosis; DOS DOS (Zostavax)~1~84~Patient 2/05/02 2/05/02Arthritis. to to 7/21/08. 7/21/08. 8/11/09 Atenol LABS O None PVT PVT None None 8 PVT PVT No Febrile seizure seizure~Vaccine not specified (no brand name) (-) varicella PVT - viral swabUNK from lesion None Myeloproliferative Dz; Increased lipids; Depression; HTN; T 2 OTH PVT Unknown None None 3 PVT UNK None 1 None PUB PUB None None Capillary hemangioma
1 PVT PUB NKDA 5 PVT OTH none none 0 PUB UNK Wheat sensitivity; MoldIA090012 allergies; Tree pollen 0 PVT UNK None 4 UNK OTH OTH Unknown 10/5/09 Medical records A0800503A received w/PMH: left clavicle fx at 0 UNK PVT OTH Unknown Concomitant vaccines,A0800582A medications and relevant medical h 2 PVT PVT HMV 2 PVT PVT 1 None PVT PUB None None None 0 OTH PVT Advair; Pentoxifylline; Chronic bronchitis, Combigan Allergiesno toClaritin; acute codeine, illness Combigan chronic bronchitis, glaucoma. 0 None PUB UNK Calcium; Vitamin D None None PVT UNK None 2 PVT PVT Patient is allergic to fish and beans. ### 1 OTH UNK None None 1 PVT UNK None Esophageal reflux 1 OTH PVT None 1 PVT PVT TYLENOL prior Noneto vaccinations. Preterm (35 weeks); NKDA 0 None PVT PUB None None None None PVT PUB None None None Over vaccination~Varicella (no brand name)~1 1 PVT PVT Patient has a history of allergies. ### Complete negative PVT septic PUB work up None 4 OTH PUB None None None 0 PUB PUB None None 2 None PVT PVT Claritin; Tylenol Allergic Rhinitis None Erythema edema~Vaccine not specified (no bra 0 None PUB PVT No illness DM2 0 PUB PUB Tuberculin PPD, 84839, Allergic RFA, 3conjunctivitis; previous doses Allergic rhinitis 1 PVT PVT PPD, C3059AA, R arm, 1 previous dose 1 None PVT PVT None None 2 CBC -WNL-PVT UNK 1 PVT UNK 1 PUB UNK Infected insect No bites 1 PVT PVT Depakote None Seizure disorder all -Tegretol (hives) MIL MIL PVT PUB None PVT PVT None None None 1 UNK UNK Pt. was he for PVT ZOSTAVAX PVT vaccine - none None DM, Hearing loss, Arthropathy. 1 PVT PVT 0 None PVT PVT None ERYTHROMYCIN allergy N/A PVT OTH None None Unknown 0 PVT PUB DDAVP 1 degree Nocturnal Enuresis 5 CRP, 1.032MIL (H), 22 Jul,MIL now normal; none LDH, 894 none (H), 28 Jul; ankylosing ALT, 237spondylitis (H), 24 Jul, 137 on 28 Jul; AST, 276 (H), 22 Ju Unknown OTH OTH Unknown Hypersensitivity WAES0806USA02901 1 No PUB OTH No No 1 PVT PVT No PVT PUB 1 None PVT PVT None None None 1 NA PVT PVT NA NA NA 0 NONE PUB PUB NONE NONE 18 none notedMIL MIL None notedNone noted 0 PS OX = 100% PVT Blood glucose UNK = 79mg All. Rhinitis
0 PUB PUB Unk None None 3 None yet. CBC UNK and diff PUB ordered. Ibuprofen, Tylenol Not apparent History but viral of Ovarian illness with Cyst,high Dysmenorrhea,Enviromental temp going around other stude Aller 21 PUB PVT None known None reported None reported 812 CT scans, MRI's, UNK Visual UNK Evoked Potential Imipramine: test, none 25 eeg, mg.sleep-deprived daily, ADD, Lipitor:10 familial eegs, mg. typespinal daily 2 hyperlipidimia. tap, video electronystagmography, 8/20/09 ER records re 1 PVT PVT Claritin None 1 UNK UNK none allergies:sulfa drugs, penicillins, morphine Medical: MS, 379 UNK UNK COPD 494 UNK UNK COPD 468 UNK UNK COPD 231 UNK UNK COPD 1 PVT PUB Prilosec no none known 90 UNK UNK COPD 2 None PVT PUB Zantac None None 45 UNK UNK COPD UNK UNK COPD 7 no tests done UNK UNK none none none 0 none PUB PUB Prozac, Adderall, none Topamax ADDHD, Migraines, and History of seizures as infant, 1 PVT PVT None Diabetes 1 UNK UNK none none 1 None PUB PVT Lissinopril none none 1 MIL MIL No mom states pt allergic to artificial preservatives. 0 PVT UNK none seasonal allergies unknown UNK UNK 0 none PVT PVT none none none 0 blood pressure, OTH 05/31/08, OTH104/6; serum FOSAMAX; C-reactive Arthritis; PRILOSEC; protein, Gastrooesophageal Herniated trazodone 05/31/08, disc; 0.06 hydrochloride; Wrist mg/dl; reflux surgery; WAES0807USA02924 disease; erythrocyte, RETIN-A De Sleep Quervain's 05/31/08, apnoea; tenosynovitis 16 Osteopen mm/hr; 0 Unknown OTH OTH Unknown Unknown WAES0810USA04593 0 None PVT PVT Asthma; Cholesterol Pneumoniahigh; Type 2WAES0812USA00052 diabetes mellitus; Arthritis; Penic 0 None OTH OTH Ambien None WAES0812USA02349 7 UNK. 10/2/09 PVT Hospital PVT records, DC summary,Unknown received DOS There 7/16/09 were no to 7/17/09. reportedA0799191A LABS concomitant and DIAGNOSTICS: medications orUltraso releva 0 Body temperature, PVT Jul2009, PVT 99.6 Unknown A0796973A 1 UNK PVT PUB Ranitidine hydrochloride Gastro Esophageal Reflux A0797376A OTH OTH Unknown The subject's medical history A0797394A was unknown. UNK OTH OTH Unknown A0798920A UNK OTH OTH Unknown A0798921A 0 UNK PVT OTH No concurrent Unknown medication The subject had no adverse A0799188A events following previous vac 24 no tests were PVT done. I couldn't PUB get her back in none to the dr. They nonewere over shebooked had a bad andreaction couldn'tto see vaccine~Varicella her (no 0 Uvula slightly PVT swollen initially. UNK Pulse/oxygen Singulair, Advair, rate None normal. Flonase Extremely Blood used pressure daily. allergic ProAir normal. (still--at inhaler Temperature 14 and yrs old) Allegra to normal. milk taken andonly eggas prote ne 0 PVT PUB NOne None NOne 0 blood work UNK stool culture UNK spinal tap eeg xray allnone normal. 9/21/09 none. 9/21/09 HospitalHospital records records receivedreceived DOS 8/3/09 DOSto8/3/09 8/5/09. to LA 8/5 1 Comprehensive UNK metabolic, UNKDNA, infectious, None and None. chemicalNone. bloodBabesiosis testing, echocardiogram, (babesia duncani). CT scans, 8/11/09MRI's, Cardiology heavycm 3 PVT PUB 1 PUB PVT n/a none none PATIENT WENT PVT TO CHINA PVT FOR MEDICAL WORK UNKNOWN UP UNKNOWN PVT UNK pulmicort, prevacid no asthma, eczema, multiple food allergies, GER 1 8/21/09 Psych/Autism UNK consultation UNK none records received none DOSnone 9/12/07. LABS socialand withdrawl/speech DIAGNOSTICS: delays/conitive Autism Diagnostic delays~ O 0 PVT UNK none 1 PUB PUB Eczema 0 Vital signs, PUB within normal PUB range None None None 3 UNK UNK Allergra halfNo tspillness. 2x a day Illness allergies; (5ml)and at time milk, hives baby of soybean, immunization: or Vitamin rashes wheat, drops all over Child eggs, 1.0ml her given nuts,sesame once bodymilk aexcept day product seed, her fac acf Unknown OTH OTH Unknown Unknown WAES0908USA00379 29 Unknown. 8/24/09 OTH Hospital OTH records received DOS Pregnancy 7/23/09 8/24/09 NOS to 8/10/09. (LMP Hospital = LABS 5/1/2009) records and WAES0908USA00387 DIAGNOSTICS: received DOS 7/23/09 Ultrasound to 8/10/09 - Preg
Unknown OTH OTH Unknown Unknown WAES0908USA00562 1 echocardiography, PVT 10/25/07, OTH traceZYRTEC; tricuspid regurgitation; LEXAPRO; Infected toe; ZANTAC Tonsillectomy. electroencephalopathy, Sulfonamide allergy; 9/15/09WAES0907USA02626 Allergic Neurological 10/25/07, reaction short consult tobursts antibiotics; records of left receiv Seas tem 107 electroencephalography, OTH OTH 05/05/09, abnormal; magnetic resonance, None. 8/12/09 05/12/09, PCP records right WAES0908USA00064 frontal received matter DOS hyperintensity. 6/16/08. Torn8/2 A 11 Unknown OTH OTH BUSPAR; PROZAC; Hypothyroidism levothyroxine sodium WAES0908USA00613 152 cardiac exercise, UNK showed UNK she hadAZOR a slight heart Blood attack; pressure hematology, high; Sulfonamide showed she WAES0908USA00359 allergy had a slight heart attack 29 computed axial, UNK 07/25/09, UNKnegative; ECOTRIN; electrocardiogram, Gastrooesophageal LIPITOR; PLAVIX; 07/29/09,ACIPHEX; reflux negative disease vitamins WAES0908USA00349 (unspecified) Unknown OTH OTH albuterol; XANAX; Reflex sympathetic ELAVIL; Bronchiectasis FLEXERIL; dystrophy; ADVAIR; Allergic WAES0908USA00602 RELAFEN; reaction to NASACORT antibiotics; Sulfonam 39 beta-humanPVT chorionic, OTH home pregnancy Unknown test; Pregnancy beta-humanAbortion NOS chorionic, (LMP spontaneous =home Unknown); pregnancy WAES0803USA00547 Cardiac test;murmur serum varicella zoster, 0 0 PVT PVT History of autism and speech ### delay. 0 PVT PVT History of autism and speech ### delay. 0 O2 Sats monitored. PVT PVT ZYRTEC; albuterol none used allergies. prn (eggs; p-nuts) 9/14/09 Hospital records received 0 None PVT PUB BENADRYLTakes BENADRYL Otitis Media for "red X 2 eyes". by age 9 mo. PVT UNK 3 EMG reveals OTH a sensoryPUB peripheralCLARITIN; neuropathyNone LIPITOR; Labs andFLONASE; Allergies, diagnostics: Arthritis, BENADRYL EMG Asthma, abnormal. Migraines Protein PMH: electrophoresis dyslipidemia, WN 195 None PVT PVT None 35 OTH PVT Lisinopril; QVAR 0 PVT PVT 3247 PUB OTH Unknown Unknown Unknown 3 CBC done at PVT 8/3 visit. UNK Diaper rashDiaper medication, rashHxNYSTATIN 1 Bro crib Rash~DTaP death HC1%1 Zinc wk(no after oxide brand DTAP. name)~UN~0~Sibling|R 1 None PUB UNK None None reported 1 PVT UNK None None 0 OTH PVT None None None 1 Strep (-); Flu PVT (-) PVT 0 None OTH PUB PNEUMOVAX Pain0.8 in right ml DM; knee; NKA DM None PVT PVT None None None 0 PUB PUB None None 0 Head CT Scan; PUB Head MRI; OTH EEG; Neurology consult; None Cardiology Previousconsult. history of fainting episodes 8 None OTH PVT Unknown but None no medications Unknown that- but would no interact contraindications w/vaccine.to ZOSTAVAX. 0 PVT OTH None None None 0 None PVT PVT None None 1 PVT PUB 3 PVT PVT TYLENOL; None None 1 PVT PVT none 0 PUB PUB CT of her head UNKwas negative UNK for subdural hematoma, EKG healthy was NSR 12 year old female 0 OTH OTH None None Penicillin; sulfur based antibiotics. 1 None PUB PVT None None 2 None PUB PVT ALBUTEROL Inh (pen) 3 PVT PVT None 2 None PVT PVT None None 2 ECG, ne MIL MIL BACTRIM Had mild cellulitis Exercise of induced leg asthma 1 NONE UNK UNK NONE NONE SC0918 0 n/a UNK UNK n/a No illness reported NKA 0 none UNK UNK none no Past medical History of epilepsy, but no seizures or meds 0 UNK UNK none KS200910 0 Vitals and neuros PUB within PUB normals limits; unknown no pain none redness or none injury noted on exam of scalp. 0 PUB PUB none known-just bug bites 2 LEFT ARM UNK INDURATION UNKAFTER IMMUNIZATION NONE NONE 0 None PVT PVT Ranitidine GER None 0 PVT UNK 0 PVT UNK
1 UNK UNK Advair 250/50 None Asthma 1 UNK PUB on Keflex for had bronchitis possible Asthma and bronchitis albuterol went inhaler to doctor for asthma for 9 days prior, got antibitic for 0 PUB PUB egg allergy 2 PUB PUB Prenatal vitamins none (pt. postpartum) wellbutrin allergy 0 none PVT PVT none none none 0 none UNK UNK zantac; premarin; none lisnopril asthma (with water none~ pill); ()~NULL~~In allegra; nasonex; Patientazmacort; pro air 75 MIL MIL NA UNK PUB Tylenol none small perimembranous VSD 0 Echo, spidometry PUB test PVT I was recovering Allergyfrom to penicilline, a mono virus. sulfaI was drugs. diagnosed with mono on Ju 15 PVT PVT 0 UNK UNK antibiotics s/p mildwisdom URI with None tooth runny extraction nose for5 one daysday. prior. I don't know what they are as 0 PVT PUB None None Allergic to medications: Cefzil & Naldecon 1 none PUB PUB none none none 2 PUB PUB Cymbalta none none 8 NONE PVT PVT Zyrtec only seasonal beta allergies thalassemia minor Diagnostic Results: OTH 30 OTH November TOPIRAMATE 2001: Non HEADACHE Contrast CT of the Brain: Normal study. A0632485A 11 August 2003: Right ribs U 1 Normal WBC. UNK 8/27/08 UNK Hospital records received DOS 8/5/09 8/27/08 8/6/09. Hospital LABSrecords and DIAGNOSTICS: received DOS 8/5/09 CAT Scan 8/6/09. L Shou Con 1 PUB PVT ZOLOFT; CLARITIN No No 6 None MIL MIL None None NKDA; No birth defects; No active medical illnesses 2 PUB PVT None No NONE slight redness~Varicella (no brand name)~1~5~ 1 None PUB PUB None None None KS200909 0 EKG, PulsePVT ox, blood glucose PVT None None None Stool CX - PVT PVT 1 PUB PUB None ADD?; Speech problems 16 2/20/2009, MIL HSV1, AbIgG MILpos; HSV2, None AbigG neg; NoneVZV, AbIgM None 1.13 (pos); VZV, AbIgG 1.49 (pos); 2/20/2009 Tissue 9 PVT PVT None None None 0 None PVT UNK None None 0 None PVT OTH None None 1 None PVT PVT None None Rash/fever~Measles + Mumps + Rubella (no b 10 PVT PVT None 5 PUB PUB 5 PUB PUB 2 PVT PVT MultivitaminNone Allergic to AMOXIL and CEFZIL - hives 2 PVT OTH Albuterol, RHINOCORT; None in nurse Allergies Omeprazole; summary to ADVAIR, Simvastatin; Ibuprofen, RedPERCOCET, Yeast Rice; Fish PARAFON oil; Calc F 0 None PVT UNK None Asthma; severe allergic reaction to all nuts; tree nuts; seed 1 PVT PUB ZURTEC Otitis media-resolved; Allergic Rhinitis; Conjunctivitis 0 None PVT PVT No No 1 None PVT PVT Constipation None 0 BP 101/55; PUB P69 PUB None Reported None reported None reported 0 PVT PVT None None None 1 None PVT PVT None None None 1 None PVT PUB None Autism 1 None PUB OTH none @ time None of inj per Allergies; mom or 1 Asthma wk prior or previous. visual acuityOTH test, was told OTHno vision acyclovir; in her left COSOPT; Herpes eye virus prednisolone infection; Glaucoma WAES0907USA05691 55 chest X-rayOTH 01/16/08, unremarkable; OTH KUB X-ray, 01/16/08, Premature negative,baby; Fall, no free irritability, Diarrhoea; airWAES0908USA00771 or foreign laceration Fungal body, dermatitis; of face, no intestinal Otitis Circumcisio media, dilatio 6 None PVT PVT None Known 6 9/8/09 Hospital PVTrecordsPVT received DOS 7/31/09None to 8/1/09. Milk, LABSegg, andpeanut DIAGNOSTICS: and soy allergies; BP 121/81 eczema. mmHg (H) Apical H 0 PVT PVT None Eczema Eczema Will do Yellow PUB Fever titer PVT in one month None Sulfur; Milk 1 PVT OTH None No No 1 None PVT PVT FLONASE Cold the week Celiac prior disease; ( resolved Faceallergic swelling~ per parents) rhinitis. ()~UN~0~Patient
1 9/17/09 Hospital PVT records PVT received TYLENOL DOS 8/9/09No toillness 8/11/09.None LABS9/4/09 and DIAGNOSTICS: Received medical CTrecords Head - w/PMH: Unremarkable. Family MR hx 1 None PVT PUB None None 0 None PVT PVT None None 0 PUB PUB None Tremors - unknown Iteology. 1 None PUB OTH TOPROL XL; Laceration FENTANYL of High forearm patch Blood25 (RT) pressure; mg Severe lumbar spine scliosis + DJD 2 OTH PVT TRICOR 45NONE mg; CRESTOR NKDA;10DM mg(250.01) ICD-9 3 OTH UNK None 24 None MIL MIL None None 0 None PUB PUB None None None 0 Head CT, negative PVT in ER PVT None 0 None PUB PUB None None None 5 UnavailablePUB - Mother reports PUB child eval. for Lyme None diseaseNone - Tick site the end of June or early July. 0 PVT PVT Hematuria Vasodepressor Syncope 1 None PVT PVT None None None None~ ()~~0~Patient 1 PVT PVT None None ~Varicella (no brand name)~2~7~Sibling 3 ESR - 60; nl PVT CBC PVT None Appendectomy 17 d before. 1 None PVT UNK None None 1 PVT PVT None None 1 PVT PVT None None 1 None Known PUB PUB None Known None Known None Known 2 CBC; sed rate PVTchecked; PVT mono test; LEXAPRO-20mg; Lymes disease; abdominal VYVANSE-30mg; allergicultrasound. to mites, YAZ molds, Labs and agedDiagnostics: cheeses. PMH: EEGADD, WNL.Anxie Na+ 1 negative; N/A PVT PUB 0 OTH OTH None None 7 None PVT PVT KEFLEX; CELEXA; Skin D/O;Lisinopril; Electrolyte/fluid NKDA; Hyperlipidemia; HLCTZ 20/25mg; HTN; MEDOTAR; Arthritis; KLOR-CON; Back pain MOBIC 1 None PVT PUB None 1 PUB PUB ALBUTEROL None INHALEN Astha Hx; Pneumonia; UTI 0 PVT PVT None Asthma 20 WBC 7,170;PVT Blood cultures PVT had no growth. 0 None MIL OTH None None ~Anthrax (no brand name)~3~32~Patient|~Anth 1 PVT OTH 1 None PVT UNK None None 0 UNK UNK None None 1 MIL UNK None None 0 PUB PUB 2 PVT PVT celebrex prn, synthroidallergic 88 mcgto vicodin 0 Mild cellulitis UNK UNK None None None 1 none. 10/6/09 UNK PCP medical UNK records none 2/10/02 to none 9/09/09. reported LABS none. and 10/6/09 DIAGNOSTICS: PCP medicalEEG records - Abnormal. 2/10/02 to CT9/09/09. Brain - No Su 1 CBC, Strep,PVT and urine PVT all WNL none 2 latest lab values UNK done 8/10/09 UNK were bcps within normal here limits for a follow-up except depression/anxiety/panic forexam neut%73.9(H) and attacks lymph%20.1(L) 1 None PUB PUB Tylenol No No 0 None PVT PVT Flouride drops, None. triamcinolone No fever, Kawasaki URI cream syndrome symptoms, None~ ()~NULL~~In diagnosed GI symptoms. 3/2007. Patient|None~ Urticaria ()~NULL~~ pigmento 0 UNK UNK BCP, Clonozepam none Latex allergy 1 PVT PVT Aspirin 80mg Pt daily, in office Multivit for NKDA HME. daily;Ongoing Omeprazole probs20mg include delayed recurrent release left sided daily chest 1 UNK UNK None IBS, Migraine HA 2 None PVT UNK Tylenol for fevers None None 1 UNK UNK Yaz, albuterol. noneVaccine lactose givenintolerance was Adacel from Sanofi Pasteur 0 PVT PVT Yasmin. Qvar. Albuterol. Amoxicillin. Asthma. 0 UNK UNK Fainting~DTaP + IPV (KINRIX)~1~5~Patient 0 PVT PVT lessina-28, none sertraline, singulair, Depression, zolpidem, migraines, zyrtec, UTI, Proair asthma 1 UA done through PVT the clinic PUB none none none hives~Pneumo (no brand name)~2~1~In Patien 4 PVT UNK none no none Arrythmia, Rapid Heart Rate, Excessive Sweat
0 PUB UNK none none HISTORY OF BENZONATE (TESSALON PEARLS) INDU 8 UNK UNK 0 UNK UNK NONE UNKNOWN 6 1) Air contrast PVTenema. PUB 2) Abdominal x-ray; 3)URI Abdominal (AM of NP vaccination) ultra-sound. Reflux LABS and DIAGNOSTICS: Barium Air Contra 0 PVT UNK CELEBREXNone 9 knee surgeries on meniscus/cartilage; Arthritis present 2 OTH OTH None None None 2 OTH PVT ASA; LIPITOR; NoneNORVASC hypertension; hyperlipidemia 1 None PUB UNK None Overweight. 2 OTH OTH 2 OTH OTH 0 None PVT PUB Albuterol; AUGMENTIN mild chronicasthma; allergies; allergic asthma rhinitis 0 PUB PUB None Left ear infection 1 PVT PVT MIRALAX 1 None PVT PVT None None 0 TB PPD. PVT OTH None None 1 PVT PVT None None None 0 PVT PVT No 1 PVT PVT None/ annual Hypertension; check up. Hyperlipidermia; Osteoporosis; Osteoarthrit 2 PVT PVT None None PVT PVT -3652 PVT PVT None None None Localized swelling.~Varicella (Varivax)~1~1~Pa 0 PUB PUB None None Oppositional Mom defiant stated disorder. this has happened before. No furth 1 Bacterial CX PUB -> normal;PUB Viral CX herpes None simplex No & VZV -> None prelim report negative. 0 PVT PVT none none mild asthma, eczema 91 I had extensive UNKlab work UNK done, blood, noneurine, xrays, none etc failed back syndrome, chronic pain syndrome, alergic to m 0 I am not sure PVT of the lotPUB number forNone the vaccine. None However,None the babies first two doses of the Hep B vaccine was actua 1 PUB PVT none none, allergy to pen and sulfa 2 NONE PVT PVT NONE KNEE ARTHRITIS, RBBB, VARICOSE VEINS ON LEFT W 43 PVT PVT Faxil mild anxietyNone for about 10 years 0 None PUB PUB TriSprintec No oral daily (oral BC pill) MO200917 114 Computed axial, OTH 05/04/09, OTHnegative; Electroencephalography, None. 05/19/09, HPV #3 given abnormal, 5/14/09, WAES0908USA00614 showing Lot # 1312X, spikes inLA. the8/14/09 left anteri PC 0 Unknown OTH OTH Unknown Asthma WAES0908USA01032 1 PUB PUB 171 None PVT PUB None none/well checkup. None 1 PVT PVT None Chronic (R)None neck lymph node 1 None PVT UNK None None None 2 None PVT PUB TYLENOL None seen PUB PUB Not known None None 1 None OTH UNK None None None 1 UNK OTH Wellness check Not PVT PVT Stye on eye; Allergic Nasal to congestion metformin; HTN; DM; Hypothyroid; Hyperlipidem 366 PVT UNK None None None 1 None PUB OTH Came in forNone a wellnessNone~ V-up; No ()~~0~Patient illness 1 None PVT PVT None None ### None PVT PVT ### 1 None PVT PVT None ### 1 None PVT PVT None ### 15 vaginal exam PVT and wet prep PVT N/A None None 1 PVT PUB 1 None UNK UNK None Allergic to Bactrim, Biaxin, Amoxil, Epinephrine 0 PUB UNK NONE REPORTED NONE REPORTED
0 none PVT UNK none none none decreased babbling~Pneumo (Prevnar)~2~0~I 0 CBC, BMP,UNK prolactin within UNK normalnone limits. 10/8/09 noneLABS and noneDIAGNOSTICS Service dates 8/8/09. Urinalysis - clou 0 UNK UNK None None None known 0 UNK UNK None None None known 1 N/A PVT PVT Trentnoid sulfacelamid None None oint/Erythromycin-acne 0 none PVT PVT none none none 6 None PVT UNK Calcium w/ None Vitamin D; No Epipen knowprn; drug Flonase allergies; Nasal Peanut Spray; and Flaxseed; Sesame Glucosamine Oil Allergies 1 PVT PUB None. None. None. 1 PVT PVT synthroid None reported none reported 0 UNK UNK Vitamin supplements, vertigo no none prescriptions 0 None. PVT PUB None none 0 PVT PVT none none none 0 PVT PVT NO NONE PUB PUB NONE N/A NEW PATIENT 3 UNK UNK Simvastatin,NONE Metoprolol, none Plavix, Fosamax plus D, Aricept 0 PVT UNK Was given Depo None at theAllergic same time to imitrex IM Prozac 1 Labs and Diagnostics: UNK UNK MRI brain NONE WNL. EEGNONE WNL (except PMH: increased neonatalbeta jaundice 2' to medication). CSF culture/grams s 0 PUB PUB none at time none vaccination at time non vaccination was at time given n/a~ vacccination to was pt. ()~NULL~~In given to was pt given Patient|n/a~ to patient. ()~NULL~~In S 0 The area isUNK very red and UNK swollen. none It is also under skin the reaction, area. HeTwo pain, hadareas aitching, reaction Alexander arefever. effected. on 4-10-08 Gardner~Tetanus hugeThis in as diameter. also well.happend Diphtheria the last (notime bra 181 Blood albumin, OTH05Nov2008, OTH belowParicalcitol; 5mcg/L; Blood Alcohol Calcium bicarbonate, use; acetate; Biopsy Arteriovenous 05Nov2008, Prednisone; kidney; Central fistula; 17mEq/L; Amlodipine; A0801390A line Bone placement; metabolism Blood Heparin; chloride, Chest Cyclosporin; disorder; 01Apr2008, tube insertion Chronic Dex9 2 WBC 23.26;PVT Anion GapUNK 24 (increased); CO2 17; none Glucosenone. 60 9/22/09 Medical office note received DOS 6/08 to 6/ 2 PVT PVT MCTZ None S/p Lumpectomy (L) breast, radiation 8/08 - 10/08 0 None PVT PVT Recently finished No AMOX None for ear infection 2 PUB UNK Denies None None 1 MIL MIL 19 PVT OTH None 1 None PUB OTH AUGMENTIN No None 1 None PVT UNK No No 0 PUB OTH Reaction toDifficulty hepatitisbreathing~Hep A vaccination -Adifficulty (no brand breathing name)~2~ 1 CBC PVT OTH Insect bitesNone resolving ~DTaP (no brand name)~4~1~Patient 0 None PVT OTH none none 31 Unknown PUB OTH WELLBUTRIN; Migraine; LOESTRIN Depression Convulsion WAES0908USA00799 0 Computed axial, OTH 07/21/09, OTHliver: normal; None Upper Rheumatoid GI seriesPregnancy X-ray, arthritis; 07/21/09, Allergic 9/25/09 normal; reaction Received WAES0908USA01092 Computed to antibiotics; medical axial, records Drug 07/21/09, hypersensiti w/PMH: kidne JR Unknown OTH OTH Unknown Unknown WAES0908USA01451 Unknown OTH OTH Unknown Unknown WAES0908USA01533 1 UNK UNK ADDERALL-XR; Levothyroxine ### Not reported UNK UNK Not reported ### 12 Air contrastPVT enema - reduced PUB transverse none colon none intussusception none 10/02/09 10/2/09 Medical records received w/LABS: w/PMH: 41 stool Pree gu 0 PVT PVT 8/20/09 PCP note received DOS 8/4/09 Never experienced PUB UNK 0 Unknown PUB PUB Not Known No No 665 PVT PVT asthma, migraines, reflex neurovascular dystrophy, chiari m 813 PVT UNK 386 PVT PVT 217 PVT PUB 0 UNK UNK None None Congenital hearing loss. Pt has cochlear implant in right e 1064 PVT PUB 1183 PVT PVT 0 8/19/2009 Hospital UNK DCUNK summary received Singulair,DOS Zyrtec, None 8/12/09 Veramyst to PCN 8/14/09. allergy. LABS Patient and has DIAGNOSTICS: congenital hearing EEG Results loss. She Pendi ha 2 PUB PUB none none none Fever, soreness~DT Adsorbed (DECAVAC)~3~ 1 PUB PUB NONE NONE NONE KNOWN, 1ST TIME SEEING PATIENT.
155 PVT UNK HTN 80 2 - MRI's, 2PVT - EEG's. 2 UNK EKG's, 24 hour YASMIN; EEG birth ->; None All control were pills. negative. None 2 PVT PVT None 1 8/7/09 PHNPUB referred mother PUB to local none clinic for none assessment. 0 Just finished PVT ZITHROMAX, UNK KEPPRA PCN; Epilepsy ~DTaP (no brand name)~5~5~Patient|~Varicel 6 None PVT PVT PRARASTATIN, None HCTZNone 0 MIL MIL EmergencyPVT Dept Dx: Fever PVT by history, Clindamycin possiblePhosphate Viral Syndrome SpeechorDelay; reaction Mother ?Asthma; to feels immunization ptAspergers gets sickshots. after D/O all his shots~ ()~ 0 PUB PUB None Known None Known None PVT PVT None None None 0 none PUB PUB none notednone notednone noted 1 None PUB PUB None None Seasonal allergies (hay fever) 1 PUB PVT PPD None Known None Known 7 None PVT PUB None None 0 UNK UNK The only thing I've been allergic to is NAPRASYN -spelling 228 UNK UNK 1 None PVT PUB None No No 0 UNK UNK 1 None PVT PVT None None In for None check-up 0 None; History PVT and Physical PVT exam only None 10 Unknown MIL MIL Yaz BCP None None 2 MIL MIL plavix, naproxen,hctz, none inderal, penicillin, zorcor, sulpha, simikliar low-dose erthromyacin, reaction aspirin,effexor to scheduled anythingXR made allergy prilosec, with shots~ molds vit D, () 3 RXn (L) deltoid; PVT redness PVT None None 3 PVT PVT None None 1 PVT UNK None RDHD 0 PUB PUB None None None OTH PUB None None 0 PVT UNK none 0 ALCUV glucose PVT -80 OTH None None None 0 OTH PUB None None None 1 PVT PUB Singulair 4mg None 5 MIL MIL None None 0 OTH PUB None None None 1 PVT PVT none 0 UNK UNK Adderal, ocella none none 535 Blood work PVT done everyPVT 1-4 months, as well as a bone marrow mitro-valve biopsyregurgitation 0 PUB UNK Motrin prn None None 14 culture of facial UNKlesionsPVT sent none 0 none UNK PUB Sertraline 25 none mg, Singulair seasonal 5 mgallergic rhinitis, in foster care since 2/6/09 7 PUB PUB unknown Unknown Unknown 23 MIL MIL Pre natal 1 PVT UNK None None 0 PVT PUB Lipitor, Diovan/HCT, None Toprol, SulphaAspirin Allergy 0 None PVT PVT Back Pain 0 None PVT PUB PPD; PAST; Well C3036AA; baby LA 0 PVT PVT None None None 2 PVT OTH Swelling of arm 08/12/09~DTaP (no brand name)~4~5~Patient 0 Vital signs stable PVT PVT Multivitamins None Previous Vaso-vagal and blood draw 2 none PVT PVT none Type I diabetes 0 PVT PUB 1 PVT PUB No WCC No
1 870 0
PVT OTH CELEXA 40None mg. Allergy to peanut; CEFTIN; CONIERTA. PVT UNK BronchiolitisVaricella~Varicella (no brand name)~1~3~Patie PUB OTH Captopril 2ml x 3 daily Hypoplastic 9A 3P 9P; ZANTAC left heart1syndrome ml x 2 daily 9A-9P; 1/2 Baby ASA x None PVT PVT None None 1 PUB OTH 2 PVT PVT None None None 0 None PUB PUB None None WV0906 Wound culture PUBof 7/28/09 PUB from hospital None shows Known None Streptococcus Known Nonepyogenes By parent (Groupreport A) pt had a bad bruising on R leg 0 None UNK UNK Well baby PVT PVT None None None 1 PVT UNK None None 0 None PUB PUB None NKDA 538 Head CT 7/21/1999 PVT documented PVT sphenoid None sinus None mucosal Hxdisease cluster normal. headaches since AVA #3 2 CBCD; plts;PVT Barp PVT Amoxicillin;Otitis MOTRIN MediaNone 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007106 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007310 1 Blood cultures, PVT10/28/08, OTH negative;Concomitant White bloodDrug(s) cell count, Not No Reported 10/28/08, allergies; 24,000 No prior medical MEDI0007353 history 0 PVT OTH Concomitant Drug (s) Not Reported. MEDI0006522 1 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007064 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007079 5 OTH OTH Not Reported MEDI0007080 0 OTH OTH Not reported MEDI0007031 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007082 0 OTH OTH Concomitant Cold Drug (s) Not Reported. MEDI0007098 0 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007160 7 OTH OTH LAMICTAL; BUSPAR; Allergy EFFEXOR; to aspirin CYMBALTA MEDI0007111 0 PUB OTH Concomitant Drug (s) Not Reported MEDI0007118 0 OTH OTH Concomitant Asthma Drug (s) ( 10003553) Not Reported MEDI0007120 2 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007121 0 PVT PVT Concomitant Asthma Drug (s) Not Reported MEDI0007124 2 OTH OTH Concomitant Drug (s) Not Reported MEDI0007139 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007141 2 OTH OTH Concomitant Drug (s) Not TheReported patient has no known MEDI0007144 allergies to food including eggs, 0 PVT OTH Concomitant Down's Drug (s) syndrome Not Trigonocephaly Required (10013616), Hypothyroidism MEDI0007146(10021114), Alopecia 0 OTH OTH Concomitant Drug(s) Not TheReported patient has no history MEDI0007152 of asthma, wheezing, or allergie UNK UNK Concomitant Drug(s) Not Medical Reported history not reported MEDI0007158 1 OTH OTH Concomitant Drug(s) Not TheReported patient has no eggMEDI0007159 or milk protein allergy nor asthma; 0 OTH OTH ASPIRIN Medical history not reported. MEDI0007161 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007164 1 Abdominal PVT X-ray, ??/??/08, PVT normal; FOCALIN Stool analysis, XR ADD; 2) ??/??/08 Constipation MEDI0007168 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007176 OTH OTH LEVOTHYROXINE; Migraine CYMBALTA; SINGULAIR. MEDI0007179 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007181 0 MIL OTH Concomitant Drug (s) Not Reported. MEDI0007182 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007183 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007184 0 MIL OTH Not Reported MEDI0007185 0 MIL OTH Concomitant Drug (s) Not Report. MEDI0007186 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007187 1 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007188 0 PVT OTH Concomitant Drug (s) Not Reported. MEDI0007189
0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007190 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007191 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007192 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007193 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007194 0 MIL OTH Concomitant Drugs(s) Medical Not Reported history not reported MEDI0007195 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007196 0 MIL OTH Not Reported MEDI0007197 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007198 0 MIL OTH Concomitant Drug(s) Not Reported MEDI0007199 0 MIL OTH Concomitant Drug (s) Not Reported. MEDI0007200 5 06-Oct-2008-Chest PUB X-ray, OTHunknown Birth result; control 06-Oct-2008-EKG, unknown result;MEDI0007201 06-Oct-2008-Blood work, unknow 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007204 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007205 0 OTH OTH Concomitant Drug (s) Not 7th Reported. grade female. MEDI0007210 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007211 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007212 0 OTH OTH Concomitant Drug (s) Not 8th Reported. grade female. MEDI0007213 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007214 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007215 0 OTH OTH Concomitant Drug(s) Not 8thReported grade female MEDI0007216 0 OTH OTH 8th grade male MEDI0007217 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007219 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007221 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007222 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007223 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007224 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007225 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007227 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007228 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007229 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007230 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade male MEDI0007231 0 OTH OTH Concomitant Drug (s) Not 8th Reported grade female MEDI0007232 0 PVT OTH Concomitant Drugs (s) Not Reported MEDI0007237 6 Influenza serology, MIL 10/09/2008, OTH Positive Concomitant for type Drug A influenza (s) Not Reported virus MEDI0007242 OTH OTH Concomitant Drug (s) Not Reported. MEDI0007243 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007246 0 OTH OTH Concomitant Drug (s) Not Required MEDI0007254 0 OTH PVT Concomitant Drug (s) Not Reported MEDI0007293 0 PUB OTH VYVANSE MEDI0007255 0 OTH PVT Concomitant Drug (s) Not Reported MEDI0007294 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007296 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007299 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007300 0 OTH OTH Concomitant Asthma Drug(s) Not Reported MEDI0007277 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007301 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007302 0 PUB OTH Concomitant Pregnant Drug (s)(10036586) Not Reported MEDI0007279 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007284 UNK UNK Concomitant Drug (s) Not Adult Reported female with second MEDI0007304 hand exposure to FLUMIST
0 PVT OTH 0 PVT OTH 0 OTH OTH 0 Urine test- Unknown PUB PUB 0 PUB OTH 2924 OTH OTH 0 MIL MIL 0 OTH OTH 0 OTH OTH 0 PUB PVT 0 CAT Scan, PVT 10/14/2008,PVT Negative 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 PVT OTH 8 Lyme's Disease: OTH Negative OTHtest 0 OTH OTH 0 OTH OTH 0 OTH OTH 1 OTH OTH OTH OTH 0 OTH OTH 0 OTH OTH 2 OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL OTH OTH 0 MIL MIL 0 MIL MIL 3 OTH OTH 0 MIL MIL OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 OTH OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL 5 OTH OTH 0 MIL MIL 0 MIL MIL 2 PVT OTH 0 MIL MIL 0 MIL MIL 0 MIL MIL 0 MIL MIL
Concomitant Drug (s) Not Reported MEDI0007305 Concomitant Drug (s) Not Reported MEDI0007307 Concomitant Drug (s) Not Reported MEDI0007308 Concomitant Drug (s) Not Reported medi0007313 Concomitant Drug (s) Not Reported MEDI0007285 Concomitant Drug (s) Not Reported MEDI0007291 Concomitant Drug (s) Not Reported MEDI0007292 Concomitant Asthma Drug (s) Not Reported MEDI0007316 Concomitant Drug (s) Not Reported MEDI0007317 RITALIN ADHD, Epilepsy Brother or sister experienced MEDI0007318 hives with the diphtheria, teta Concomitant Drug (s) Not Reported MEDI0007319 Concomitant Drug (s) Not Reported MEDI0007320 Concomitant Drug (s) Not Reported MEDI0007329 Concomitant Drug (s) Not Reported MEDI0007330 Concomitant Drug(s) Not No Used known allergies or history MEDI0007331 of hypersensitivity. FLONASE Allergy MEDI0007333 Concomitant Drug (s) Not Reported MEDI0007334 Concomitant Drug(s) Not Reported MEDI0007337 Concomitant Drug(s) Not Reported MEDI0007342 Concomitant Drug(s) Not Reported MEDI0007343 Concomitant Drug(s) Not Reported MEDI0007345 Concomitant Drug(s) Not Reported MEDI0007349 Concomitant Drug(s) Not Reported MEDI0007350 Concomitant Drug (s) Not Reported MEDI0007352 Concomitant Drug (s) Not Reported MEDI0007376 Concomitant Drug (s) Not Reported MEDI0007377 Concomitant Drug (s) Not Reported MEDI0007378 Concomitant Drug (s) Not Reported MEDI0007379 Concomitant Drug (s) Not Reported MEDI0007380 Concomitant Drug (s) Not Reported MEDI0007356 Concomitant Drug (s) Not Reported MEDI0007382 Concomitant Drug (s) Not Reported MEDI0007383 Concomitant Drug (s) Not Reported MEDI0007357 Concomitant Drug (s) Not Reported MEDI0007384 Concomitant Drug (s) Not Reported MEDI0007360 Concomitant Drug (s) Not Reported MEDI0007385 Concomitant Drug (s) Not Reported MEDI0007386 Concomitant Drug (s) Not Reported MEDI0007387 Concomitant Drug (s) Not Reported MEDI0007362 Concomitant Drug (s) Not Reported MEDI0007388 Concomitant Drug (s) Not Reported MEDI0007389 Concomitant Drug (s) Not Reported MEDI0007390 Concomitant Drug (s) Not Reported MEDI0007391 Concomitant Drug (s) Not Reported MEDI0007363 Concomitant Drug (s) Not Reported MEDI0007366 Concomitant Drug (s) Not Reported MEDI0007369 Concomitant Drug (s) Not Used MEDI0007370 Concomitant Drug (s) Not Reported MEDI0007371 Concomitant Drug (s) Not Reported MEDI0007392 Concomitant Drug (s) Not Reported MEDI0007393 Concomitant Drug (s) Not Reported MEDI0007394
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0
MIL MIL Concomitant Drug (s) Not Reported MEDI0007395 MIL MIL Concomitant Drug (s) Not Reported MEDI0007396 MIL MIL Concomitant Drug (s) Not Reported MEDI0007397 MIL MIL Concomitant Drug (s) Not Reported MEDI0007398 MIL MIL Concomitant Drug (s) Not Reported MEDI0007399 MIL MIL Concomitant Drug (s) Not Reported MEDI0007400 MIL MIL Concomitant Drug (s) Not Reported MEDI0007401 MIL MIL Concomitant Drug (s) Not Reported MEDI0007402 MIL MIL Concomitant Drug (s) Not Reported MEDI0007403 MIL MIL Concomitant Drug (s) Not Reported MEDI0007404 MIL MIL Concomitant Drug (s) Not Reported MEDI0007405 MIL MIL Concomitant Drug (s) Not Reported MEDI0007406 MIL MIL Concomitant Drug (s) Not Reported MEDI0007372 MIL MIL Concomitant Drug (s) Not Reported MEDI0007373 MIL MIL Concomitant Drug (s) Not Reported MEDI0007374 MIL MIL Concomitant Drug (s) Not Reported MEDI0007375 MIL MIL Concomitant Drug (s) Not Reported MEDI0007407 MIL MIL Concomitant Drug (s) Not Reported MEDI0007408 MIL MIL Concomitant Drug (s) Not Reported MEDI0007409 MIL MIL Concomitant Drug (s) Not Reported MEDI0007410 MIL MIL Concomitant Drug (s) Not Reported MEDI0007411 MIL MIL Concomitant Drug (s) Not Reported MEDI0007412 MIL MIL Concomitant Drug (s) Not Reported MEDI0007413 MIL MIL Concomitant Drug (s) Not Reported MEDI0007414 MIL MIL Concomitant Drug (s) Not Reported MEDI0007415 MIL MIL Concomitant Drug (s) Not Reported MEDI0007416 OTH OTH Concomitant Drug (s) Not Reported MEDI0007417 MIL MIL Concomitant Drug (s) Not Reported MEDI0007418 MIL MIL Concomitant Drug (s) Not Reported MEDI0007419 MIL MIL Concomitant Drug (s) Not Reported MEDI0007420 MIL MIL Concomitant Drug (s) Not Reported MEDI0007421 MIL MIL Not Reported MEDI0007422 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007423 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007424 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007425 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007426 MIL MIL Concomitant Drug (s) Not Reported MEDI0007427 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007428 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007429 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007430 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007431 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007432 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007436 MIL MIL Concomitant Drug(s) Not Reported MEDI0007437 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007438 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0007439 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007440 MIL MIL Concomitant Drug(s) Not Reported MEDI0007441 MIL MIL Not reported MEDI0007442 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0007443 0 Pregnancy OTH test, 10/23/08, PVTPositiveMultivitaminNo (Prenatal) illness at2 the weeks timegestation of vaccination; at the MEDI0007444 time of FLUMIST administration;
0
OTH OTH OTH OTH 0 PUB OTH 0 OTH OTH UNK UNK 0 PVT PUB 1 OTH OTH OTH OTH 0 PUB UNK 0 PUB OTH 0 OTH OTH 0 OTH OTH 3 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 0 OTH OTH 2 OTH OTH 0 PUB PUB 0 OTH OTH 0 PVT OTH 0 PVT PVT 2 PVT OTH 0 OTH OTH 32 A scheduled PVT MRI was cancelled. PVT 29 PVT PVT 0 OTH OTH OTH OTH 0 OTH OTH
Concomitant Drug (s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported
MEDI0007449 MEDI0007450 MEDI0007451 MEDI0007454 MEDI0007455 Concomitant Drug(s) Not reported MEDI0007459 Concomitant Drug(s) Not Reported MEDI0007460 Concomitant Drug (s) Not Reported MEDI0007461 Concomitant Drug(s) Not reported MEDI0007464 Not reported History of hives of unknown MEDI0007457 etiology with trips to emergenc Concomitant Drug(s) Not Reported MEDI0007468 Concomitant Drug (s): None Not reported MEDI0007469 Concomitant Drug(s) Not Past Used Disease: Headache MEDI0007472 Concomitant Drug (s) Not Reported MEDI0007473 Concomitant Drug(s) Not reported MEDI0007475 Concomitant Drug(s) Not Reported MEDI0007476 Concomitant Drug(s) Not Reported MEDI0007477 Concomitant Drug(s) Not Reported MEDI0007478 Concomitant Drug(s) Not Reported MEDI0007479 Concomitant Drug (s) Not Reported MEDI0007480 MEDI0007481 Concomitant Drug(s) Not Reported MEDI0007482 Concomitant (s) DrugsNone Not Reported MEDI0007483 Concomitant Drug(s) Not Reported MEDI0007484 Concomitant Drug(s) Not Reported MEDI0007485 Concomitant Drug(s) Not Reported MEDI0007486 Concomitant Drug(s) Not Reported MEDI0007487 Concomitant Drug (s) Not None Reported MEDI0007488 Concomitant Drug(s) Not Reported MEDI0007489 Concomitant Drug(s) Not Reported MEDI0007490 Concomitant Drug(s) Not Reported MEDI0007491 Concomitant Drug(s) Not Reported MEDI0007492 Concomitant Drugs(s) Not Reported MEDI0007493 Concomitant Drug (s) Not None Reported MEDI0007494 Concomitant Drug(s) Not Reported MEDI0007495 Concomitant Drug(s) Not Reported MEDI0007496 Concomitant Drug(s) Not Reported MEDI0007497 Concomitant Drug(s) Not Reported MEDI0007498 Concomitant Drug(s) Not Reported MEDI0007502 Concomitant Drug(s) Not Reported MEDI0007517 Concomitant Drug (s) Not Reported MEDI0007531 Concomitant Drug (s) Not Reported MEDI0007544 Concomitant Drug (s) Not Reported MEDI0007580 Concomitant Drug(s) Not Reported MEDI0007549 Concomitant Allergy; Drug(s)Asthma; Not IgG2 Used deficiency; Skin granuloma OtitisMEDI0007581 infections Concomitant Drug(s) Not Reported MEDI0007552 Concomitant Drug(s) Not Experienced Reported right arm MEDI0007582 pain after the 2007 dose of FLUMIS Concomitant Drug (s) Not Reported MEDI0007583 Concomitant Drug(s) Not Reported MEDI0007584 Concomitant Drug(s) Not Reported MEDI0007587 Concomitant Drug(s) Not 11/2008: Reported Pregnancy confirmed MEDI0007554 2 weeks after FLUMIST do
0 0 0 1 0 0 0 1 0 0 0 0 5 0 0 0
PVT OTH SYNTHROID Hypothyroidism; Asthma; Gestational MEDI0007555 diabetes; Gastroesophageal ref PUB PVT Concomitant Drug (s) Not Reported MEDI0007593 OTH OTH Concomitant Drug(s) Not Reported MEDI0007598 PUB PUB Concomitant Drug(s) Not Reported MEDI0007559 PUB PUB Concomitant Drug(s) Not Reported MEDI0007552 PUB PUB Concomitant Drug(s) Not Reported MEDI0007564 OTH OTH Concomitant Drug(s) Not Reported MEDI0007585 PVT OTH Concomitant Drug(s) Not Used MEDI0007566 PVT OTH FLONASE Seasonal allergy Sensitive stomach withMEDI0007567 vomiting; nasal allergies; OTH OTH Concomitant Drug(s) Not Reported MEDI0007603 OTH OTH Concomitant Drug (s) Not Reported MEDI0007605 OTH OTH Concomitant Drug(s) Not Reported MEDI0007606 PVT PVT Concomitant Fungal Drug(s) infection Not At the Reported time he receivedMEDI0007611 FLUMIST the patient had mild skin OTH OTH Concomitant Drug(s) Not Reported MEDI0007572 OTH OTH Concomitant Drug(s) Not Reported MEDI0007615 OTH OTH Concomitant Drug (s) Not Reported MEDI0007620 PVT OTH Concomitant Drug(s) Not Reported MEDI0007576 0 PUB PUB Prenatal vitamin; Asthma Albuterol Gravida 9, terms birthsMEDI0007578 4, premature births 1 (set of twins b 0 PVT PVT Concomitant Drug (s) Not No medical Reportedhistory obtained. MEDI0007621 5 Urine Pregnant OTHTest, 12/10/08, OTH positive Concomitant Drug(s) Not Past Reported Disease: Psychiatric MEDI0007628 disorder NOS 1 PUB OTH Concomitant Drug(s) Not Reported MEDI0007629 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007630 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007670 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007671 0 OTH OTH Concomitant Drug(s) Not Used MEDI0007632 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007676 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007635 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007677 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007642 2 PUB PUB Concomitant Drug(s) Not Reported MEDI0007644 0 OTH OTH Concomitant Drug(s) Not reported MEDI0007645 0 PUB OTH Concomitant Drug(s) Not Reported MEDI0007657 0 OTH OTH Concomitant Drug (s) Not Sibling Reported also received expired MEDI0007687 FLUMIST 0 PVT PVT Concomitant Drug(s) Not Reported MEDI0007661 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007689 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007690 0 OTH OTH Concomitant Drug(s): Not Reported MEDI0007663 0 PVT OTH Concomitant Drug (s) Not None Reported MEDI0007693 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007665 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007668 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007694 0 PVT PUB Concomitant Drug(s) Not Reported MEDI0007695 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007669 0 OTH OTH ADDERAL Precocious and ADDERALLL No puberty known XR,allergies. 20 mg MEDI0007707 0 MIL OTH Concomitant Drug (s) Not Reported MEDI0007709 0 PVT PVT Concomitant Drug(s) Not No Reported medical history information MEDI0007713 collected. No allergies to F 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007717 0 OTH OTH Concomitant Drug(s) Not Reported MEDI0007726 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007727 0 PVT OTH Concomitant Drug(s) Not Reported MEDI0007728 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0007729
0 0 0 0 0 0
PVT PUB PUB PVT PUB PVT OTH 0 PUB 0 OTH 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PVT 0 PUB 7 OTH 0 OTH PUB PUB 0 PVT 0 MIL 0 MIL 0 MIL 0 MIL 0 PVT 0 MIL 0 MIL 0 MIL 0 MIL 0 OTH 0 OTH 7 OTH 0 MIL 0 MIL 0 PVT 0 MIL 0 OTH 0 MIL 0 MIL 0 MIL 0 MIL 0 OTH 0 MRI, normalOTH 0 OTH 0 PVT 0 OTH
OTH PUB PUB OTH PUB OTH OTH PUB OTH PVT OTH OTH PVT PVT PVT PVT PVT PVT OTH OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH PVT OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH OTH
Concomitant Drug (s) Not None Reported MEDI0007730 Concomitant Drug(s) Not Reported MEDI0007738 Concomitant Drugs(s) Second Not Reported vaccination with MEDI0007739 FLUMIST Concomitant Drug (s) Not Reported MEDI0007696 Concomitant Drug(s) Not Reported MEDI0007741 Concomitant Drug(s) Not Reported MEDI0007697 Concomitant Drug (s) Not Reported MEDI0007699 None Second vaccination with MEDI0007742 FLUMIST Concomitant Drug(s) Not Reported MEDI0007704 Multivitamin MEDI0007705 Concomitant Drug(s) Not Reported MEDI0007751 Concomitant Drug (s) Not Reported MEDI0007752 None None MEDI0007753 Concomitant Drug(s) Not Reported MEDI0007754 Concomitant Drug(s) Not Patient Reported is one of a set of MEDI0007757 twin girls Concomitant Drug (s) Not Patient Reported is one of a set of MEDI0007758 twin girls; None None MEDI0007759 None None MEDI0007761 Concomitant Drug(s) Not Reported MEDI0007765 Concomitant Drug (s) Not PastReported obstetrical history:MEDI0007768 Para 1, Gravida 1, Premature 0, S Concomitant Drug(s) Not Reported MEDI0007769 Concomitant Drug(s) Not Reported MEDI0007776 IMURAN; PROVENTIL Asthma; Colitis Asthma (since childhood); MEDI0007780 Colitis Concomitant Drug(s) Not Patient's Reported first flu vaccination MEDI0007791 Concomitant Drug (s) Not Reported MEDI0007797 Concomitant Drug (s) Not Reported MEDI0007878 Concomitant Drug (s) Not Reported MEDI0007880 Concomitant Drug (s) Not Reported MEDI0007882 Concomitant Drug (s) Not Reported MEDI0007883 Concomitant Drug (s) Not Reported MEDI0007799 Concomitant Drug (s) Not Reported MEDI0007890 Concomitant Drug 9s) Not Reported MEDI0007893 Concomitant Drug (s) Not Reported MEDI0007896 Concomitant Drug (s) Not Reported MEDI0007897 Concomitant Drug (s) Not Reported MEDI0007812 Concomitant Drug (s) Not Reported MEDI0007821 Concomitant Drug (s) Not Reported MEDI0007822 Concomitant Drug (s) Not Reported MEDI0007898 Concomitant Drug (s) Not Reported MEDI0007899 Concomitant Drug (s) Not Reported MEDI0007841 Concomitant Drug (s) Not Reported MEDI0007902 Concomitant Drug (s) Not Received Reported first dose 4 weeks MEDI0007850 ago Concomitant Drug(s) Not Reported MEDI0007904 Concomitant Drug (s) Not Reported MEDI0007905 Concomitant Drug (s) Not Reported MEDI0007906 Concomitant Drug (s) Not Reported MEDI0007908 Concomitant Drug(s) Not Reported MEDI0007852 Concomitant Drug (s) Not Reported MEDI0007853 Concomitant Drug(s) Not Reported MEDI0007854 Concomitant Drug (s) Not Reported MEDI0007858 Concomitant Drug(s) Not Reported MEDI0007869
0 0 0 0 0 0
MIL OTH Concomitant Drug (s) Not Reported MEDI0007873 MIL OTH Concomitant Drug (s) Not Reported MEDI0007875 MIL OTH Concomitant Drug (s) Not Reported MEDI0007876 MIL OTH Concomitant Drug(s) Not Reported MEDI0007877 MIL OTH Concomitant Drug (s) Not Reported MEDI0007909 MIL OTH Concomitant Drug (s) Not Reported MEDI0007910 The patientPVT had an eight-year-old PVT MUPIROCIN brother vaccinated on the same day who did MEDI0007911 not experience any events; 131 09-Feb-2009 PVT InfluenzaOTH A test positive Concomitant Drug (s) Not Reported MEDI0007918 OTH OTH Concomitant Drug (s) Not Reported MEDI0007926 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007996 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007997 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008006 1 OTH OTH Concomitant ADHD Drug (s) Not Behavioral Reported problems: MEDI0008056 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008007 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008074 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008008 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0008026 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008076 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008027 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008078 28 OTH OTH Concomitant Drug (s) Not Reported MEDI0008030 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008044 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008079 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008080 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008081 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008082 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008109 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008121 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008122 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008123 0 MIL MIL Concomitant Drug(s): Not Reported MEDI0008124 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008125 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008127 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008128 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008129 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008130 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008131 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008132 0 UNK UNK MEDI0008133 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008134 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008135 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008136 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008137 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008138 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008139 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008140 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008141 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0003142 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008143 0 MIL MIL Concomitant Drug (s) Not Reported MEDI0008144 0 MIL MIL MEDI0008145
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL
MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL MIL
Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported None None Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug (s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported None None Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported Concomitant Drug(s) Not Reported
MEDI0008146 MEDI0008147 MEDI0008148 MEDI0008149 MEDI0008152 MEDI0008153 MEDI0008154 MEDI0008155 MEDI0008156 MEDI0008157 MEDI0008158 MEDI0008159 MEDI0008160 MEDI0008161 MEDI0008162 MEDI0008163 MEDI0008164 MEDI0008167 MEDI0008168 MEDI0008169 MEDI0008170 MEDI0008171 MEDI0008172 MEDI0008173 MEDI0008174 MEDI0008175 MEDI0008176 MEDI0008177 MEDI0008178 MEDI0008179 MEDI0008181 MEDI0008182 MEDI0008183 MEDI0008184 MEDI0008186 MEDI0008188 MEDI0008190 MEDI0008191 MEDI0008192 MEDI0008193 MEDI0008194 MEDI0008195 MEDI0008196 MEDI0008199 MEDI0008200 MEDI0008201 MEDI0008202 MEDI0008203 MEDI0008204 MEDI0008205 MEDI0008206
0 0 0 0 0 0 0
MIL MIL Concomitant Drug(s) Not Reported MEDI0008207 MIL MIL Concomitant Drug(s) Not Reported MEDI0008208 MIL MIL Concomitant Drug (s) Not Reported. MEDI0008209 MIL MIL Concomitant Drug(s) Not Reported MEDI0008210 MIL MIL Concomitant Drug(s) Not Reported MEDI0008211 MIL MIL None None MEDI0008212 MIL MIL Concomitant Drug (s) Not Report. MEDI0008213 MIL MIL Concomitant Drug(s) Not Reported MEDI0008214 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008215 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008216 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008218 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008219 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008220 MIL MIL Concomitant Drug(s) Not Reported MEDI0008224 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008225 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008226 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008228 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008230 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008234 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008236 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008237 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008238 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008239 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008241 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008242 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008243 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008249 0 MIL MIL Concomitant Drug(s) Not reported MEDI0008250 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008252 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008253 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0008254 0 MIL MIL Concomitant Drug(s) Not Reported MEDI0009255 230 UNK UNK Concomitant Drug(s) Not Reported MEDI0008390 14 None OTH OTH None None WAES0908USA01558 Unknown OTH OTH Unknown Unknown WAES0908USA01559 Unknown OTH OTH Unknown Unknown WAES0908USA01660 61 Unknown OTH OTH None Thyroid disorder Shingles WAES0908USA01537 None OTH OTH TYLENOL with Codeine Heart #3; atorvastatin enlarged; Rheumatic calcium; WAES0908USA01584 VOLTAREN; fever SINGULAIR; vitam 1 MIL MIL none per mother none per mother delayed speech 1 PUB UNK 4 None. PUB PVT None known. None Occasionally Nonetakes ibuprophen. 9 PVT PVT None 0 Pt has recovered PUB doingPUB great. NKDA Pt at clinic for school shots only checkup. 0 None PVT PVT None None Healthy Child 1 QBC in office PVT did not show PVT active illness None Fever, R arm soreness 0 Scheduled PUB to see neurologist PUB . Mild "common Patient cold"foramen ovale 0 None PVT PUB None None 2 PVT UNK None None 0 Hep A vaccine PUBgiven toPUB sibling on same visit. None Sibling hadper no reaction. mother possible seasonal allergies 0 PVT PVT 0 PVT PVT Actonel 150Postop mg, Levothyroxin, L4L5 Allergic Laminectomy to Neurotin, mold Severe and May Maxide, swelling, dust. 7, 2009. Have Carisoprodol some Fractures 3 ureters. pain &prn, ofoozing~DTaP sacrum. Osteoporosis, Advair, Calciu (n
1 PUB PUB 7 PUB PUB unknown none history of allergies mother states. 1 PUB UNK NONE NONE 1 UNK PVT daily multivitamin No Febrile seizures bruising X2 at site~ age 3()~NULL~~In Patient 0 PUB PUB NA "serum sickness" (to cephalosporin VA09:009 antibiotic) 2 years ago 5 PVT PVT 1 PUB PUB 1 UNK UNK No Environmental Localized allergies reactions to previous vaccinations~ ( 0 Has not been PUB seen by PUB clinition. possibly Prozac, none not taken allergic daily to PCN, Demerol, Codiene, Percocet....depression 1 Dx CellulitisPVT (682.9) PVT None None Astma 1 LP: normal UNK CT of Head: UNK normal All none cultures:none normal/no none growth. 8/17/09 Hospital records received DOS 8/13/09 to 2 Skin testingUNK to vaccine UNK and gelatinTricor, pending. epipen Prior None.complement NSAID/Cox-1 studies,inhibitor CBC, CMP, induced TSHangioedema/allergy; normal in 2008. LABS dyslip an 4 UNK UNK none none tree pollen allergy guillan barre~Influenza (no brand name)~~7~S 0 CBC, throatPVT culture, urinalysis, PVT blood none culture, none chest xray, none flu screen, lyme titer, EBV AL0914 titer, metabolic profile. 0 none UNK UNK none none none AL0915 0 UNK UNK none no none 1 None. PUB PUB Singular, Synthroid, Chronic illnesses Naproxen, The mother listed Tylenol, states in pre-existing Albuterol, that the conditions child Calcium, has been Fish section. Oil having No increasin acute illn 2 PVT PUB None Asthma 16 PUB UNK NONE NONE NONE~ ()~NULL~~In Patient 1 PVT PVT seasonal allergies and asthma 3 PVT PUB None None 1 PUB PUB 1 cbc, cardiacMIL enzymes, MIL x-ray & ultrasound none pcn, sulfa, ees, flagyl, dilaudid, iv iodine 1 PVT PUB None None 1 PVT UNK KARATOSIS KARATOSIS PILARIS AND PILARIS ECZEMA AND ECZEMA 1 PVT PUB None None 3 none UNK UNK flomax, ASA, none-acuteDM( ultram, Lipitor,diet Omeperazole, controlled), metoprolol, HTN, CAD, advil GERD. 0 NONE PUB PUB NONE MOTHER STATES NONE-REPORTED NONE NONE~ ()~NULL~~In BY MOTHERPatient|NONE~ ()~NULL 1 PVT PUB none none 1 None UNK UNK Concerta 27mg nonedaily none 2 PVT PUB PVT UNK lexapro no allergy sulfa 0 Pulse ox 89% PVT initially PVT Flovent; Albuterol None Allergy to MUCOMYST; Has cerebral palsy; asthma; dysph 0 PVT UNK nail puncture bee 8/2/09 allergy only 2 OTH PVT SIMVASTATIN, NoneALENDRONATE, hyperlipidemia, LEVOXYL hyperthyroidism, decreased Bone density 0 PVT PUB None No illness- seen Nonefor well child eval. 2 PVT UNK none none 1 PVT PUB 22 9/14/09 ER/Hospital PVT Records PUB received DOS 8/4/09 None to 8/5/09. None.LABS 'Full body and DIAGNOSTICS: allergy' etiology Stool unknown. Heme-Positive. Abd 0 PUB PUB none none milk allergy and asthma 0 PVT OTH None None 1 PUB PUB None None None 1 None OTH PVT No NKDA PUB PUB No none 0 PUB PUB None None 52 9/15/09 LABS PVTand DIAGNOSTICS UNK received. Oral NonePathology Reactive Report Airway DOS disease, 2/13/08 -possible Biopsy Mandible Asthma. 9/24/09 right side Infecti - abn 2 none OTH PUB none None Mild asthma 1 WBC 20,100; PVT No infection PVTfound in exam none none 0 PVT PVT none none History of wheezing 0 PUB PUB ORTHO NOVUM irregular 1/35 menses None 1 po qd 2 PUB PUB
0 None PVT PUB None None None 0 none PVT UNK none none Overweight; dry skin 1 PVT UNK 5 UNK UNK no no 0 MRI, Heart-stress PVT test,PVT chest x-ray, blood tests (mercury, liver electrolytes, thyroid tests) PVT PUB None None None 19 IBS,post dramatic UNK mono UNK syndrome, None Anxiety. at thenone time of vaccination. none 0 Endoscopy,UNK CT Scan, MRI, UNK Transvaginal daily multivitamin ultrasound, none IgGnone and IgE allergy fatigue, testing, menstrual thyroid irregularities, tests, blooddigestive lipids, metabo issue 0 PUB PVT 0 PVT PVT None PCN; Codeine 0 blood pressure, OTH 07/27?/09, OTH fine; diagnostic laboratory, 07/27?/09, Unknown heart rate: fine WAES0908USA00788 26 Unknown Labs OTHand Diagnostics: OTH Gastric None Emptying study None (+) forPMH: decreased wrist surgery, bowel WAES0908USA00793 transit shingles, time. pertussis Hepatobiliary rxn./ scan W 0 magnetic resonance, PVT 06/17?/09, PVT normal; electroencephalography, Fruit allergy 06/17?/09, abnormal WAES0906USA03683 - see narrative; urine cultur 23 Blood pressure, OTH 01/21/09, OTHsystolic blood pressure Anaemia - 90 -of100s; Foetal prematurity; Renal distress; ultrasound, Hospitalisation; Premature WAES0908USA00966 01/21?/09, baby; Bronchopulmonary Bradycardia; mild dilationNeonatal ofdysplasia left rena re 153 Unknown OTH OTH None None WAES0908USA01712 Unknown OTH OTH NEURONTIN Unknown WAES0908USA01582 30 biopsy, 05/??/09, OTH diagnosed OTH with bullous Unknown pemphigoid Neuromuscular disorder (NOS) WAES0908USA01901 UNK OTH OTH No concurrent Unknown medication It was notedNo that reaction the subject A0802324A with the received first injection breathing of HAVRIX.~ treatments UNK OTH OTH No concurrent Unknown medication A0802329A 0 8/27/09 PCP PVT medical records OTH received AMBIEN; 8/7/03 CLARITIN to 10/03/05. asSeasonal needed LABS and allergies; DIAGNOSTICS: Anxiety RBC 3.72 mil/UL (L) HCT 36 3 CXR - (+) Left OTH lower lobe PVT infiltrate;None Positive Fluid None in majorNone; fissure(+) per Ptradiologist; had had one WBC prior8.9 episode after ATB. of wheezing 0 None PUB PUB None Known None Known None Known 0 PVT PUB No No None PVT PVT 0 None PUB PUB None None 1 None PUB PUB No No 1 OTH PVT Prozac No None ` 0 PVT PVT 1 PUB OTH None None 3 PVT PVT 523 PVT PVT 9 Flu negative/ PUB Strep negative. PVT None 0 See attached PVT PUB None 1 None PVT PUB TB; JHP Pharmaceuticals; Physical NoneLot number 111056; Route/site, Left forearm; Previou 0 PUB UNK AR0929 1 PUB PUB LA090802 1 PUB PUB None None reported LA090801 441 None; only PVT clinical exam UNK 1191 PVT PUB 860 Clinical exam PVT only PVT 1 Negative Strep PVT OTH None None Dymenorrhea Headaches~HPV (no brand name)~2~14~Patie 31 28th July, Nasendoscopy PVT UNK at hospital None None 1 PVT PVT None None 1 PUB UNK 0 None PVT UNK None NKDA, No chronic medical diagnoses PUB UNK None None None 0 PVT OTH Pt on LOESTRIN NKA PCOS 2 Wt loss 11-08 OTH --> 11-06PUB Acetaminophen Nonedrops None; 35 wk premature 1 PUB PUB None None 0 PVT UNK CLARITIN D None as needed None 1 PVT UNK NO FOOD ALLERGIES
19 Platlets 149, UNK Sodium 134, UNKC-Reactive NoneProteinnone 3.66 10/2/09 none Received medical records w/LABS: CRP 3.66(H). plts 0 none PVT PVT 0 UNK PVT Naprosyn None None 1 PVT PUB None None 0 MIL MIL 2 PVT PVT Not Applicable PUB PUB Not Applicable Not Applicable Not Applicable 1 N/A UNK UNK 1) ACETAMINOPHEN 59 YO M with Hypertension, TAB R subdural 650MGhematoma chronic PO Q6H alchol pain. s/p abuse, R2)craniotomy ALBUTEROL GERD,on cigarette 7/2/09 INHL,ORA 2/2 smok g 369 HHV6 PCRUNK positive-roseola UNK infection none8/24/09none Medical records febrile received seizures LABS: 8/24/09 HHV-6 Medical PCR(+). recordsVirus, received: CSF,PMH: bloodf 1 None. UNK PVT Unknown None reported. Allergic to penicillin 0 echocardiogram PUB pending UNK Yasmin, OCP no ADHD 2 None PVT PUB None None None 0 UNK PVT Simvastatinnone none 1 MIL MIL 0 n/a PVT PVT None givenPatient at clinic. denies No drug allergies. Patient has medical conditions of hypoth 0 PUB PUB none none none 0 PVT UNK ALBUTEROL NONE ASTHMA FEVER~Measles + Mumps + Rubella (no brand 0 GLUCOSE PVT 89 PVT NA NA OCCASSIONAL MIGRAINES 2 None PVT UNK Ethedent None None 0 N/A PUB UNK N/A N/A 1 no tests performed PVT PVT NA None Known NA 2 PUB PUB NO NO NO 11 PUB PUB none none none PUB PVT 7 n/a; UNK PVT Benicar, naproxen, none; Boniva, HTN,levothyroxin; osteopenia/porosis, hypothyroid; 12 CBC, BMP,UNK STOOL FOR UNK ROTAVIRUS, Ba ENEMA none STUDY. none9/3/09 Hospital records received DOS 8/11/09 to 8/14 1 PVT PUB 7 PVT PVT None None 0 PPD PVT PUB 3 PVT PVT None None None 0 None PVT UNK None None 1 PVT PUB None 1 PVT PVT None None None 0 PVT PUB None None None 1 PVT UNK None Alopecia; PICA; Eczema 10 None stated. MIL PUB MOTRIN; PRN None None 0 PUB PUB Astapron Veramist; Nasal Environmental Spray for sinus allergies 0 Pt sent for MRI PVTof brain; PUB EEG and ADVAIR; CMP (results ALBUTEROL; None pending)Trees; PREVACID; Grass; Mite; AllergyCat; injections; Molds (receives VERAMYST; allergy ZYRTEC shots) 0 None PVT PVT None 0 UNK UNK 2 PVT UNK Loratadine None 0 PVT PVT None NKDA - Healthy 1 none PVT OTH none penicillin, sulfa, milk, migraines 1 none PUB UNK 2 PUB PUB None None 2 PVT PVT None None 13 OTH PVT None Latex allergic 0 None; per pt PUB doctor states PUBanxiety. None None None~ ()~~0~Patient 1 PVT PVT ENULOSE; BACTRIM; hydrocortison; 8/15/09~Varicella albuterol (Varivax)~2~8~Patient 1 NONE PVT PVT ALEVE NONE NONE 0 PVT UNK ADHD
PVT OTH 1 UNK UNK 1 PVT PUB None None Eczema 3 MIL MIL 0 PUB OTH Acetaminophen-Codeine#3; Alprazolam; COZAAR; Diclofenac sodium; Fluoroura PUB PUB Cold beforeNone shots 0 MIL MIL Concomitant Drug(s) Not None Reported MEDI0008227 3 Unknown OTH OTH ascorbic acid; Macular OCUVITE; degeneration; aspirin; calcium Penicillin (unspecified); allergy WAES0908USA01904 hydrochlorothiazide (+); C Unknown OTH OTH Unknown None WAES0908USA01599 -69 Unknown PUB OTH Pregnancy NOS (LMP = 10/26/2008) WAES0902USA03594 26 Pulse oximetry, OTH03/10/09, OTH 94; Pulse Unknown oximetry, 03/10/09, 84, Premature on admission; baby; Respiratory Chest WAES0908USA01696 X-ray,distress; 03/10/09, Bruising atelectasis of face; or pne Jau 0 head computed OTH axial, 07/27/09, OTH negative None None WAES0908USA01728 0 electrocardiogram, OTH negative; OTH diagnostic Unknown laboratory, "CMP" Convulsion urine analysis; in childhood hematology, WAES0908USA01924 genetic blood tests negative 0 None OTH OTH Unknown Unknown WAES0908USA01957 10 15/Feb/2007: UNK Cultures UNK (+) Pseudomonas; SEPTRA; 02/Mar/2007: SULPHA DS"Strip"and The patientFlu had tests a bump (negative); on the ### Low backwhite of her blood left thigh cell count which 73 Hemocult (-); PVT Rota (+); PUB C-diff (+) 0 Pulse ox. inPVT ER 100% PVT SINGULAIR; None PULMICORT; AllergicZYRTEC; to milk, peanuts, CALCITRATE tree nuts, fish, shellfish, mold, du 14 LABS and DIAGNOSTICS PVT PVT6/10/09 to 6/14/09:Healthy Lumbar Puncture Seasonal - elevated allergies protein 207 mg/dL. MRI - Abnormal sig 1 None PVT PUB ADHD 0 PVT PVT Congenital imperforated anus, repaired; 35 wk gestation 0 None PUB PUB None None None 1 PVT PUB None Reported Shell fish; MSG 0 PUB UNK None PUB PUB None reported None reported None reported 1 PUB PVT None Bruise & swelling~Tetanus Diphtheria (no bran OTH OTH 2 Clinical Exam PVT PUB None Chronic disease of tonsil & adenoids 0 PVT PVT None 0 PVT PUB No No 0 CBC-4.7>15.0, PVT44.8, <221 UNK; Mono% 8.7(7), Eos% None7.2(7) None 0 9/2/09 ER records PUB received PUB DOS 7/29/09. None reported LABS None and reported DIAGNOSTICS: NKDA; AllergyUrine to crabs pregnancy and mites; test no (-).other conditions repo 6 PUB PUB None None None 1 PVT UNK None UTI 5 PUB PUB Motrin for fever None None Rash~Measles + Mumps + Rubella (no brand n 6 None PVT PUB None None None 2 PUB UNK Denies None None 2 PUB UNK None None None 1 Varicella_Zoster PVT IgG Ab, UNK >1.10, OD Ratio - positive, indicates past or current VZV infection, Immune; Ratio Interpre 0 PUB PUB None None None 1 PVT PUB 0 None PUB PUB None None None 0 PVT PVT None known 1 MIL MIL 0 PVT PVT 0 Rapid influenza, PUB Neg PUB 100mg Sertraline Healthydaily DepressionFever~Vaccine not specified (no brand name)~ 2 PVT PUB None None known Normal PAPPVT 6/13/2006, UNK 6/14/2007, 3/26/2008; None ASCUS HPV +, 8/13/2009 0 None OTH PUB None None None UNK UNK 1 H1N1 negative PUB PVT none NKA 0 UNK UNK
370 MRI by neurologist PUB - reported UNK reaction flonase, to employer birth None control November None 2008 0 exam by er PVT doctor UNK had tylenol none 1 hour before Allergic doctor to appt amoxicillian, to help with double shotpnuemathorsis pain at birth, ven 0 None. The PVT left deltoid PVT muscle is the none site of immunization with Vaqta/Hepatitis A vaccine. 1 CRT Scan showed UNK no PVT aneurism orBisoprol other structural Tab None generic problems. for Borderline ZIAC Followup 5/6.25MG hypertenson NRI with and and without watching contrast variousofunusual brain show neu 1 PVT PVT none knownNone Allergic to Penicillin 0 None in office. UNK UNK Flovent 44 2 None puffs bid Seasonal allergies, sore throat, Reactive eyelidAirway swelling~Influenza Disease (no brand 0 995.3-ALLERGIC PVT REACTION UNK 7/17/09 VACCINE no (Hepatitis asthma/ A vs measles, mumps, rubella) 1. Use a heating pad. 0 PUB PUB None No None 0 Blood pressure MIL was taken MIL and heart None. rate recorded. None. None. None.~ ()~NULL~~In Patient 0 PUB PUB 1 UNK UNK Advair none Asthma, allergy to nuts 1 See above UNK 9/24/09 Discharge UNK summary received NONE for datePREMATURITY of service 8/15/09. (31-32 EEG WEEKS and CTEGA) head9/24/09 normal,Discharge CBC, Elec 42 too many toUNK list. would UNK have to get medical records. consistant 8/24/09 extreme Same PCP asfull and #18. body oncology 8/24/09 Uticaria PCP medical andrecords oncology received medicalDOS records 4/15 6 PVT PVT none 1 None UNK PVT Patient received none "sedation nonemedicine" none~ from()~NULL~~In the dentist before Patient|unknown~ coming for well ()~NUL child PVT PUB None Seizure Disorder 1 PUB OTH None Asthma 1 PVT PVT 0 PVT PVT Claritin last None dose per 8/16/09; Parent Night Multivitamins; shades grass, Probiotic wheat,acidophilus; dairy, sugar,Grass eggs and weed m 1 None PVT OTH Pulmicort; Singulair; Stable asthma Albuterol Asthma; Alpha thalassemia 1 PUB PUB 0 None PVT PVT None Amoxicillin allergy 1 EKG Nl. Head PVTCT Nl. Comprehensive PVT Metabolic None Panel : Na Seasonal 132; o/w allergies Nl; CBC with diff Nl Cellulitis RtPVT upper arm.UNK KEFLEX 250 LANTUS; mg TidNOVOLOG; X 10 days warm Type GLUCAGON; compress I diabetes; Focalin; twice Aspergers daily. Glucose disorder 0 PVT PVT 0 PUB PUB Asthma 6 PVT PVT cat bite NKA 2 PVT UNK None GER; Eczema 1 PVT OTH None None None 3 PUB PUB 5 None PVT OTH None None None speech delay~Measles + Mumps + Rubella (no 1 PVT MIL 0 PVT OTH ARMOUR PO QD Allergies to AXID and Sulfa 2 none PVT PUB None None 1 PVT PUB 10 PVT PVT None None 0 PVT PUB Fever 103 0 PVT PVT 2 UNK PVT PVT TriNessa (Ethinyloestradiol Penicillin allergy; The subject +Sulfa Norgestimate) allergy had no alcohol A0786137A or tobacco use and there were 40 Dr Visits, Biopsy, UNK CT/PET UNKScans. 8/20/09 GYN none medical records none. 9/8/09 received. HeadAnnual & Neck PAP Clinic Smear. consultation 9/8/09 Head records & Neck DOS 0 None PVT PUB None None None Known Same as above~HPV (Gardasil)~1~11~Patient 2 CSF culturePVT (results: Positive OTH for Streptococcus Concomitant Unknown medications pneumoniae) 9/1/09-records Thewere patient andnot blood has reported. received-Upper culture a past USWYEH10544309 history (results: respiratory ofPositive wheezing for viral (during Streptococcus infection the wint 2w UNK UNK Not reported. ### 7 Unknown OTH OTH Unknown Stroke; Anaemia; Dementia; WAES0908USA02407 Hypersomnia; Alzheimer's dis 80 Electroencephalography, OTH OTH 11/??/07, YASMIN negative; Magnetic resonance, None 11/??/07, negative; WAES0908USA02226 Electrocardiogram, 11/??/07 1 PUB PVT None None None 1 PUB PVT None None None 1 None PVT PVT None None None Left shoulder PUB X-ray PVT LEVOXYL None Allergy to Sulfa - HX: decreased THYROID. 0 None PUB PVT NKA None None 0 PUB PUB TOPROL; DOXYCYCLINE; No Allergy BENTYL; to shellfish. Mother SHELAXAN allergic NC09032 to>TETANUS X 2 yrs. vaccine~Tetanus
1 PVT OTH None None NC09034 0 PVT PVT Lisinopril/HCT; None ASA 81HTN; mg; AMBIEN dyslipoproteinemia; Osteoporosis 1 PVT PUB None None None NC09033 38 OTH OTH Concomitant Drug(s) Not Reported MEDI0008737 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008739 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008740 24 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008742 18 OTH OTH Concomitant Drug(s) Not Reported MEDI0008744 21 OTH OTH Concomitant Drug(s) Not Reported MEDI0008746 4 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008747 15 OTH OTH Concomitant Drug(s) Not Reported MEDI0008748 7 OTH OTH Concomitant Drug(s) Not Reported MEDI0008750 21 OTH OTH Concomitant Drug (s) Not Reported MEDI0008752 30 OTH OTH Concomitant Drugs(s) Not Reported MEDI0008753 22 OTH OTH Concomitant Drug(s) Not Reported MEDI0008754 2 OTH OTH Concomitant Drug(s) Not Reported MEDI0008755 20 OTH OTH Concomitant Drug(s) Not Reported MEDI0008756 24 OTH OTH Concomitant Drug (s) Not Reported MEDI0008757 27 OTH OTH Concomitant Drug(s) Not Reported MEDI0008758 1 OTH OTH Concomitant Drug(s) Not Reported MEDI0008759 0 Glucose=95PVT Pulse= 82 PVT and regular NONE BP= 102/60, NONEbrachial, WELL Patient CHILD sitting has seasonal allergies. 0 PVT PVT Tenex Tic disorder, OCD, Anxiety disorder 18 No tests have UNK been performed UNK yet. Visit to the none pediatrician. noneNo9/4/09 diagnosis crying Medical given uncontrollably~DTP records yet. Dermatologist received(no w/PMH: brand appt.pertussis name)~1~ schedulev 0 PVT PUB none near faiting PUB PUB 1 PUB PUB none none 266 PVT UNK Simvastatin,None Niaspan, Flonase Hyperlipidemia, Nasal Spray Obesity 1 NO LABS DONE. PVT PATIENT PVT EVALUATED NO OTHER BYNO MEDICATIONS NURSE ILLNESS AT NKA, 5:30.FEVER AT NO TIME BIRTH OF OF VACCINATION DEFECTS, 99, INJECTION NO MEDICAL SITES BARELY COND NOTIC 0 Head Ct, MRI, PVTEEG, bloodwork, PVT toxicology screen None allergic to erythromycin per mom 13 Coombs test, UNK CBC, others. UNK 8/21/09 none Hospital records none received none DOS 6/26/98 to 7/3/98. LABS and DIAGNOSTICS: C 18 Systemic Lupus PVT Erythematosus; UNK Raynaud's. 9/16/09 Rheumatology records received DOS 4/28/09 to 9/9/09. LABS 0 Head CT normal; PVT Chem PUB normal. 8/31/09 Children's ERMOTRIN Slight / hospital cough records Hx of seizures. received 8/31/09 DOS 8/17/09 ER / hospital to 8/18/09. records LABS received and DIAGN DO 0 EEG pending; PVTEKG normal; PUB BMP normal; Magnesium normal; PMH: CRP rash on normal cheeks, Labseczema and diagnostics: EKG WNL. K+ 6 2 PVT PUB None None None UNK PVT None None None PVT UNK 17 unknown OTH PUB METOPROLOL 50 BID; IMOUL 20 AD; LIPITOR 50 QHI; ADVAIR L50 150 1 puf 2 PVT OTH PREVENTATIVE 18 PVT PUB 0 None PVT PVT None administered None Seizure disorder 2 PVT OTH 0 None MIL MIL Benadryl None No medical conditions; No Congenital Defects; Allergy: Sh 1 PUB UNK None None 1 PVT OTH Imuran 50mg None Ulcerative Proctitis 1 None low grade PVT temp (< PUB 105 F), erythropiesis None None None 0 none PVT PVT none none none 460 10/6/09 PCP UNK medical records UNK received Flonase DOS 7/30/08 None to 8/27/08. LABS Seizure; and DIAGNOSTCS: Hashimoto Thyroiditis; CBC - RBC compensated 3.84 Mill/uL h 21 UNK UNK Soreness atNone injection site from Gardasil. 0 none PUB UNK no no allergies seasonal 1 UNK UNK none no none 10 8/31/09 Hospital UNK records UNK received Keppra DOS 2/5/09None to 2/16/09.History LABS of and seizure DIAGNOSTICS: with febrile EEG illness, - Abnormal. was prolonged, Chestthus X-ray
0 none PUB UNK Client states Client nonestates none 1 UNK UNK 0 CBC wbc 7.9, PVT ly 29.0, gr PVT 59.3, hct/ hgb 40.6/13.9, mild URI plt 248 0 UNK UNK none 1 8/25/09 Hospital UNK records UNK received None service dates None 8/18/09 Developmental to 8/21/09. LABS Delay. and DIAGNOSTICS: 8/25/09 HospitalCHEM records- Glucose received 14 s 0 None PUB PUB None notednone latex 1 PVT PUB celexa 40mg none social difficulty, borderline Aspergers. 0 PUB PVT mild lactose intolerance, previous temporal aneurysm 1 PUB PUB Running nose RSV and 12/28/07; cough Asthma 6/25/09; Bronchiolitis 6/25/09 1 PVT PVT none none none same as this time~Influenza (no brand name)~ 2 MIL MIL ALERGY TO AMOXICILLIN AND NICKEL 344 CBC, CMP,UNK CT, PET, supraclavicular UNK lymph node biopsy.9/1/09 9/1/09PCP PCPmedical medicalrecords recordsreceived receivedDOS DOS7/15/08 7/15/08toto1/19 1/1 2 MIL MIL 0 urine beta-human, OTH negative; OTH beta-human Unknown chorionic, Pregnancy positive NOS (LMP= Unknown)WAES0804USA01984 19 Jan. 2, 08 -PVT Blood CBCUNK - ESR; Jan. DIOVAN; 2, 08, Comprehension SIMVAS None Hypertension; CMP, TSH, ANA Hyperlipidemia; and Rheumatoid Shellfish; factor, Prinivil. Neurological 8/27/09 N e 7 Ultrasound PVT suggestive PUB of intussusception. Contrast enema Milk diagnosed/reduced protein intoleranceintussusception. WBC 20.9 0 CBC/RASTPVT UNK Penicillin allergy; History of incarcerated (L) inguinal hernia 10 MRI (normal); PVT chest X-ray PVT(normal). None None Environmental allergies; dairy intolerance. 1 PUB PUB None None 32 Err:508 PVT UNK No Insulin dependent + Diab Mellitus Type 1; Celiac Sprue; P 0 PPD/Mantoux, PVT ID Lt forearm PVT None None 1 None donePVT PVT Pt is on ZYRTEC None for seasonal None allergies Only low fever~ ()~~0~Patient 4 PVT PUB None None 1 PVT OTH Same 0 PUB OTH QVAR; SINGULAIR; KOPENEX; ALVESCO 0 None PUB OTH None Demerol PVT UNK 1 BENADRYL; PVT TYLENOL PVT BENADRYL; TYLENOL 1 None PVT OTH None None None None OTH PUB None known None NKA or conditions 2 UNK UNK VYVANSE None 20mg; ABILIFY None5mg 0 UNK UNK 0 None UNK UNK My oldest daughter has seasonal allergies, ovarian cysts, 6 not known PUB PUB none denied none 8 Normal CBC, UNK CHEMISTRY, UNK MILDLY none ELEVATED noneLIVER none EMZYMES, NORMAL CK 8/25/09 Medical records receive 0 None PUB PUB None None we are Did aware not receive of. full dose~Measles + Mumps + R 25 Tilt table test UNK and echocardiogram. UNK 9/29/09 PCP No medicalnone. records 9/29/09 and multiple PCP medical consultations recordsreceived and multiple DOSconsulta 7/18/05 1 PVT PVT none Cefizil - hives 17 UNK UNK OmeprazoleNone 20mg/daysulfa, penicillin 0 PUB PVT None Denies illness None at time of None~ vaccination. ()~NULL~~In Patient|None~ ()~NULL~~ 12 Lab results PVT found elevated PVT muscleNone enzymes, at thatNone sed time rate, etc. None Muscle at that Biopsy Muscle time. performed 8/27/09 Cramps~HPV Hospital at Hospital (Gardasil)~1~15~Patient records in Jan received. 09 resulted DOS 0 none PUB PUB no 2 PVT PVT 1 PVT PVT 1 none PVT PVT none none none 0 MIL MIL none Benadryl ALLERGY 1 North Kansas PVT City Hospital: OTH BloodNone test. Children's None MercyNone Hospital: CT scan, lumbar puncture. 9/1/09 ER records r 8 pending UNK UNK none none none 0 PVT UNK Possible dehydrationNo Allergies, patient Migraine told headaches, EMT's that she Smoker. had not had anythin 7 HEMOCCULT PVTPOSITIVE PUB NONE NONE STOOL NONE SENT FOR CULTURE 1 None PVT PUB None no allergic to penicillin (gives rash)
3 PVT PVT Recent wheezing/ viral uri...had resolved by date of vaccination 71 3/27/08 urinalysis UNK w/o 6/21/08UNK CT.9/17/09 6/22/08 EREcho, records transthoracic received 9/17/094/5/08 (2D), ER records to doppler, 5/27/09. received cardiography NuvaRing. 4/5/08 to color 5/27/09. flow velocity Thyroidma cy 0 PVT PVT URI mild nasal NOne congestion mild cough no fever 6 None PVT PUB No None 0 PUB PUB Depo-Provera None None 1 none PUB PUB ORAL CONTRACETIVES DENIES DENIES -ORTHO TRI CYCLEN LO 3 PVT UNK 6 None PVT PUB None No None 5 She was told UNK she has pots UNKdisease. none Urin andnone blood worknone and EKG 9/15/09 were Received good. Heart medical raterecords goes way w/PMH: up when Allergy: sittinP PVT PVT Seafood-hives, sudafed-hyperactive, metal-rash. 174 EEG, EKG,PVT CAT SCAN, UNK HEART HALTER BIRTH CONTROL MONITOR, NONE - YAZ TILT NONE TABLE TEST BLOOD WORK 0 PUB PUB 2009PH01 0 PUB PVT No Mother was surprised that child fainted with vaccinations b 0 PUB PVT N/A 1 hemoccult positive PVT PVT none 0 none PVT PVT none none Allergies: Sulfa, exacerbation clarithromycin, of dishydrotic mango eczema~Yellow fev 0 NONE PUB UNK NONE NONE NONE 9 n/a PVT PVT none. none. Left lower neck/shoulder cavernous hemangioma. 1 PVT PVT Desogen No Depression 1 MIL MIL None No None PVT UNK Concerta No ADD, Premature(28 week gestation) 0 PVT UNK Sprintec 28-day Epilepsy - age 4-8, then diagnosed with syncope. Allergic 0 PVT PUB none seizures, developmental seizures~Hepdelays, B (Genhevac hypotonia, B)~1~0~In scoliosis Patient 0 UNK UNK Lyme Disease PMH: DM, HTN, Hypothyroidism Allergies: 0 I have not had UNKany relevant UNK tests done to support my claims, I have because no other it was relevant always history. late at I don't nighthave whenany mydrug problems uses 1 None PVT PVT LISINOPRIL None-Well 5mg + qd;visit/annual NKMA TRAZEDONE 50mg + @ hs 1 None OTH OTH Byetta , Gabapentin. None Imipramine, Diabetes hypothyroid; OmeprazoleGERD anxiety; Depression. 1 None PVT UNK Well child visit Juvenile Rheumatoid Arthritis 1 PVT PUB None 0 PVT PVT None None None~ ()~~0~Patient None. O2 Sat UNK(room air) UNK 100% None Latex allergy PVT UNK 0 OTH PUB None 0 UNK UNK Baby is allergic to disposable diapers. 5 UNK UNK Allergies: MORPHINE, PERCOCET, CODEINE 1 PVT UNK None Colon polyps; 32 weeks Gest age at birth; Seasonal Aller 0 PVT PUB None None Stress hyperglycemia 0 PVT PUB Bee Stings 3 None PVT PVT None None None 1 None PVT PVT None None None 1 CBC; Blood PVT cultures OTH None Reflux; Hypothyroidism; Allergy to DEMORAL 0 PVT OTH No None 1 PVT PUB None None None 1 PVT PUB No 1 PUB PUB 0 PVT PVT None None 2 OTH OTH ENALAPRIL - LEXAPRO - FEXOFENADINE- LOVASTATIN - COMBAVENT 0 PVT PUB None None 10 PVT PVT 0 PVT PUB Keratosis 1 None PVT OTH SINGULAIRNone None
8 Hemoccult + PVT UNK None None 718 PVT UNK 1 MIL MIL None Extensive back surgery 1 12 mo WCC PVT UNK None None Milk allergy; Reflux; Hydrocele Bilateral 1 None PVT PVT NASONEX;None FLOVENTAsthma HFA; SINGULAIR 1 None PVT PUB None None None 1 None PVT PVT None None Flat foot, exposure to lead - no lead level done 214 whole bloodOTH mercury, results OTH cameNone back fine; serum Al, results None came back fine WAES0908USA02717 0 Unknown OTH OTH None None WAES0908USA01951 Unknown OTH OTH Unknown Unknown WAES0908USA02263 1 cardiac monitoring, OTH results OTHwere fine; ORTHO total heartbeat EVRA Migraine; count, Drug 8/28/09 07/29/09, hypersensitivity ER records 200, beats received WAES0908USA02768 per minute; DOS 7/29/09. total heartbeat Caffeine. count, 0 temperaturePVT measurement PVT 6/11/09, Unknown 100 deg None WAES0906USA04117 11 hearing test, OTH 08/??/09,OTH results not LIPITOR; provided; COREG; otic Deafness procedure, digoxin; unilateral; Dialysis 08/??/09, NEXIUM; Hypertension; "ear LASIX popper" (furosemide); WAES0908USA02786 Diabetes; Coronary LANTUS; artery HUMULIN; disease 7 Not reported UNK UNK The patient has no known allergies ### and denied any medica None PUB PUB None None Child had a seizure at birth. MI2009008 14 None PUB PUB none none 1 PVT PVT No Right brachial plexus. 1 PVT PUB None None None 0 Sent to ED PVT PVT 1 Lyme titre; CBC; PVT ESR all PUB pending Amoxicillin 0 PVT OTH None None Adhesive 1 PVT PVT None None None 0 PVT PVT None 1 PVT PVT None Allergies Hives~ ()~~22~Patient 0 None PVT PVT Poly-VI-SOL/Iron None solution None 1 None PUB PUB None None None Known 0 PUB PVT 1 PUB PUB 1 PVT UNK No No 5 None PVT PUB None None 0 None OTH OTH None None None PVT UNK None None 1 PVT PUB None None AMOXIL 0 None OTH OTH Blood pressure Nonemed Latex 1 PVT PVT None No No 1 Cellulits of the PVTarm PVT aricept, furosemide, aspirin, remeron, metoprolol, levothyroxine, humalog, insulin MIL MIL Nothing noted in record 2 None PVT PVT Synthroid, ibuprofen No Hypothyroidism 0 UNK UNK 7 None PVT PVT Aspirin None None 3 none PVT PVT none none none 20 MIL MIL NONE ACNE 0 UNK UNK None 1 PVT PVT none none none 2 No testing done. UNK Patient UNK evaluatedNONE by Dr. Fraschetti. NONE NONE 0 N/A PVT PVT Kaletra, Truvada, Needlestick, Norflex PCN, BBF andIodine, exposure, Prilosec Shellfish work related N/A MIL MIL 1 PUB PUB Zithromax for Yes, ?infection on Zithromax for infection. No fever. 1 PUB PUB 7 None Known UNK UNK Unknown Non reported 8-20-09 A neuro-muscular disorder was reported by the m 1 MRI of spine PVT and headPVT normal, ionized calcium none 1.10, WBC none 13.89, CPK 114, creatinine 1.1,Na 147
UNK UNK NONE NONE NONE~ ()~~0~Patient 2 PVT PVT PrednisoneNone 2.5 mg daily; Bechet's Zantacdisease 150 mg daily; Calcium/Magnesium one daily 0 N/A PVT PVT 0 PUB PVT Allegra no allergic to Penicilen and sulfa; history of passing out 2 UNK UNK The patient is on albuterol, flonasse and flovent 2 PVT UNK NONE 1 UNK UNK 0 Positive ANA, UNK PostitiveUNK EEG. LABS and DIAGNOSTICS: none none. Lumbar Chronic Puncture lower-back Normal. pain.MRI Seasonal Head and allergies. Spine Bilatera - Norm 1 PVT PVT FORTICAL None NASAL SOLN Alergy ASPIRIN to Cipro None~ 81 & MG Macrobid ()~NULL~~In LEVOTHROID HYPOTHYROIDISM Patient|None~ 75 MCG TABS ()~NULL~~ OSTEOP CYA UNK PUB OTH Prenatal vitamins Unknown (Potassium iodide + Potassium A0758632B sulphate + Calcium salt + Phos Colonoscopy, OTH Normal; OTH Sigmoidoscopy, Mercaptopurine; Abnormal Bloody Sulphasalazine; Mucus; Rectal;Prednisone Bleeding; Ulcerative B0589174A Proctitis; Uveitis UNK OTH OTH MERCAPTOPURINE Unknown Bloody mucus; Leukopenia; B0589174B Loose stools; Rectal bleeding 47 Unk OTH OTH Unknown R0005824A 1 OTH PVT Lisinopril; ASA None Low dose; Benign Multivitamin; heart murmur. Glucosamax; Chondroitin 2 PVT PVT MVI None None Rash~Vaccine not specified (no brand name)~ OTH PUB 0 PUB UNK None None None 0 None PVT PVT None None None 1 PUB PVT None None None 1 None OTH OTH None None 0 PVT UNK BENTYL; Birth None control Irritable pills; VALTREX bowel 0 PVT PUB None None None 1 PUB PUB No No 0 PUB PUB July o9 ? Asthma~DTaP + IPV (KINRIX)~9~5~ RAST testing PVT for latex-PVT Negative 6/29/09 None None 0 OTH OTH CITALOPRAM None None 1 None PVT PVT None None None 1 None PUB OTH None 1 PVT PVT BENADRYLNo None 0 Upon arriving UNK at the ERUNK at Medical Center, prior Moderate to seeing pain Asthma, theatdoctor, injection seasonal Pain, thesite nurse dizziness, allergies. took severe my 9/1/09 vitals headaches, ERand records noticed received vision-shak that one D 2 PVT PVT none cardiomyopathy, hyperlipidemia, a-fib, hypothyroidism, div 2 PVT PVT none none none tantrums/irrational~DTaP + IPV (KINRIX)~UN~ 0 8/31/09 Received PUB medical UNKrecordsLISINOPRIL LABS: CT none scan 2.5mg brain none abnormal. 8/31/09 Received medical records PMH: HTN 0 PVT PVT None asthma 0 UNK UNK none none 0 Was in the PVT ER with vitals PVT monitored. None We don'tNone have the data. None Hospital None~ could ()~NULL~~In not do bloodwork, Patient said sample was c 0 UNK UNK NO Allergic to trees, ragweed0 Blood tests PVT 7/14/09 (allUNK normal) including UPS Thyroid aldolase, None CBC Hypothyroidism; w/Diff;CPK;C-Reactive Allergies: Protein;Sed Pencillin, Rate. Sulfa MRIs drugsdone 8/80 0 UNK PVT Microgestinnone none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 1 UNK UNK latex, amphicillin, depo provera PMH: seasonal allergies, 0 Clinical lab PUB tests performed UNK at ED;81MG unknown ASPIRIN as NONE to what DAILY specific AMPICILLIN tests were performed but ED Attending indicated al 0 blood, urine, PUB analysis of PUB fluid from Verapamil, bursa sac General Acidophilus, ill health, Ankylosing Ciprofloxacin bacterial Spondylitis, overgrowth hypertension, in small intestine. mesenteric ischemia 2 PVT OTH None None None known 1 N/A PVT PVT synthroid, lasix, N/A zestril,Asthma, singulair,flexeril,megadose Hypertension, post-thyroid vit. D, Ca,K,Fe CA and B12 20 12/30/09 Lab PVT glucose 348; OTHSodium 136; Potassium None 3.5; Chloride None 103; CO2 9; Urea Nitrogens 14; Creatinine 1.0. 9 0 See attached. PVT9/9/09 Hospital UNK records received None DOS 4/17/09 Noneto 5/6/09. LABS and DIAGNOSTICS: Urine and plasm 1 OTH OTH none none none 2 PVT UNK PropranololNone 160; lovastatin 40mg 405 PUB PUB None Scoliosis; Allergy to Molds Fungus 0 Lateral neckPVT X-ray; Direct PVTlaryngoscopy None by ENT Milddue URI toby clinical None history concern of epiglottis (ruled out). 8/31/09 Hospital m 0 Did X-Rays;PUB CAT scansUNK None None None
1 No erythema. PVTDecrease PVT shoulder ROM. PainNone on palpation. None 1 None PVT OTH None None Per mother sick~Varicella may have had(no reaction brandto name)~1~0~Patient previous varicella 47 Had EKG; PVT Blood test; PVT Inner Ear, None sit, stand testsNoneEverything Nonecame back normal. 1 None PVT PVT None None 0 None PVT OTH None None None None PVT PVT None None None 0 diagnostic laboratory, OTH 07?/??/08, OTH normal; Unknown stool culture, 07?/??/09, Unknown no bacteria found WAES0908USA02573 366 Echocardiography, OTH 08/??/08, OTH Negative; Unknown Body temp, 08/12/08, Unknown 104 F; Blood culture, WAES0908USA02787 08/??/08, Negative; WBC cou Unknown OTH OTH Unknown Ear infection; Gastrointestinal disorder; WAES0908USA02477 Adverse event 0 Unknown OTH OTH None WAES0908USA02404 0 Unknown Labs OTHand diagnostics: OTH MRI brain WNL. EEG WNL. None MRI c-spine with WAES0908USA02799 bulging cervical discs Unknown OTH OTH Unknown Pregnancy NOS (LMP=Unknown)WAES0908USA03124 1 None PVT PVT None None None PVT UNK 1 None PVT PVT None None 1 PUB PUB Unknown None None reported 25 PUB PUB None None None, NKA 0 EKG (=) normal PUB OTH Food allergies-pizza, corn None MIL MIL None None None PUB PUB Stop BC 2 weeks at timeprior; unknown None Birthpregnancy Control; MOTRIN PRN 1 week ago; OTC - since me 2 PVT PVT COPAXONE; PRONGIL; Multiple GABAPENTIN sclerosis 1 PVT UNK No None 2 None PVT PUB PPD None None 1 PUB OTH None None 1 vital signs; measured PVT redness PVT None None 0 None PVT UNK DEPAKOTENone 250mg 3 tablets Known PO seizure BID disorder x4 yrs ago 3 PVT PVT 1 UNK PVT PVT No concurrent Unknown medication The subject has no relevant A0803375A medical history. A no reported 32 UNK Labs and PVTdiagnostics: PUB Abd US No (+) concurrent mass, Unknown ? medication IS. Contrast The subject enemahas (+) no for relevant ileocolic A0803583A medical IS. Repeat history US (-) and no history 5 PVT UNK Zocor, Allegra, None Vitamins Peripheral vascular disease 0 Was testedUNK for the flu during UNK doctor visit and was nonenegative. asthma 1 na PUB PUB none none 0 none PVT UNK none no none 1 PUB PUB none notednone noted 0 PVT PVT Zyrtec prn slight stuffynone nose, cough 0 PUB PVT List includes anaphylaxis PRN meds Allergy (immediate) / standing to ace orders inhibitors over (swollen one month lips,hospital a sign of stay:Tylenol angioedemP 3 some temp,PUB difficulty breathing, PVT tired, none pain in arm noneupset stomach none 1 EKG and Chest UNK X-ray within UNK normal limit results no none SC0920 2 None UNK UNK none none none SC0919 2 PVT OTH none none Regression~DTaP + HepB + IPV (Pediarix)~UN 0 MIL MIL None None none~ ()~NULL~~In Patient 0 PUB PVT 1 n/a UNK PVT n/a 0 N/A PVT PVT N/A N/A N/A 27 PUB PUB no none MO200918 0 N/A PUB PUB none no medications, no medical MO-2009-19 conditions 0 NONE UNK PVT NONE NONE 8 PUB UNK None known PCN 0 PUB PUB Denied Denied Neuropathy 1 Throat swab UNK negative from UNK KU Watkins None Clinic. at theNone time at theSeasonal time. allergies; ADD; acne 2 Was evaluated PUBby heart PUB monitor atNone her office of None employment None (Dr. Sinnathamby). NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S
2 PVT PVT N/A N/A 212 urine tests(2x); UNKfull blood UNK work (2x), naupper/lower na GI; stoolpenicillin cultures (2x); CT scan Urinalysis: PH 5.0 (L), Blood 1+ (H 14 Had blood drawn MIL from UNK Lab on 24 August 2009, None located at the Thomas Moore Clinic. Doctor scheduled a consult to 7 PVT PVT 5 MRI negative. PVTLABS and PUB DIAGNOSTICS: MOTRINCHEM - Postassium H/O asthma/RAD; 5.1 mmol/L (H) Previously CO2 29worked mmol/Lup (H). forCBC incontentia - MCV 70 pig 0 PVT PVT 6 HVA; VMA.PVT LABS and PVT DIAGNOSTICS: AMOXIL Urinary 400mg/5mL; Eczema HVA (-) VMA MUPIROCIN Eczema. (-). MRI Ear Brain 21 tubes.- Normal. X-ray Femur - Normal. 6 PUB PUB No No Unknown - none of conditions on screening form for teen i 2 OTH PVT 105 Seen by dermatologist PVT PVT - elsewhereNone None None 7 CK fractionated, PVT CBC, PVT aldolase, ESR None all nl; CRP None 1.2. LABS None. and9/23/09 9/23/09PCP PCPrecords recordsreceived receivedDOS DOS8/10/09 8/10/09toto8/30 8/3 8 None PVT PVT None None None 2 PUB OTH 0 CXR normal, PVT CBC normal; OTHEKG rhythm NL None None 1 PVT PVT None at time None of vaccination 1 PVT PVT PPD None 0 None PVT UNK None None 2 No tests were OTH done PVT PROZAC; BUSPAR Sinusitis Sulfa; Amoxicillin Proteinuria/Hypoalbuminemia. PVT PVT 10/2/09 DULAPRED Hospital None now records, None. allergy/immunology 10/2/09 Hospital andrecords, neurology allergy/immunology consults, receivedand DOS n 2 PVT PVT 2 PVT PVT No No 1 None PVT OTH None None 0 Rast test forPVT latex and PVT gelatin allergy in 4 wksNone (of 2 wks.)club foot, cloacae exstropory, latex allergy None PVT PVT None Cough; Runny Nonenose; SL. fever OTH OTH None 1 WBC=13.0 PVT with 84% Neutrophils; PVT NASONEX; On steroids;None CELEXA CRP>0.3,40 Penicillin; Sed mg;Rate ELAVIL; Migraines =10 IMITREX; Multi vitamins; Naproxen; TRISP 1 none PVT PUB none none none 3 None PVT PUB None None None 10 None PVT UNK None None 0 PVT UNK Unknown Similar blisters with insect NC09035 bites 1 PVT UNK None None 1-7-08- Allergic / 12-13-05 NC09036 allergic Rhinitis 1 none MIL MIL ibuprofen denies denies Large local reaction to AVA # 7 admin in April 0 PUB PUB ZANTAC None GERD 2 None PVT OTH None. Zantac. None None 0 9/8/09 Hospital PVTrecordsPVT received DOS 8/20/09 to 8/21/09.Eggs; LABSPenicillin. and DIAGNOSTICS: 9/8/09 Hospital IgErecords 2564.5 received IU/ML (H). DOS Heart 8/2 16 Ba Enema reduced PVT intussusception. PVT None 9/1/09 Hospital None records Nonereceived DOS 6/28/09 to 6/29/09. LABS and DIAGNO 712 DepressionPVT - anxiety disorder PUB 1 Due to behavioral PVT decompensation, PVT BUPROPION; he was referred CLONIDINE; to neurologist Obesity; FLUOXETINE; Sleep and geneticist. and aggression CONCERTA; Genetic evaluation SYMBYAX;currently TOPOMAX und 96 8/27/09 Hospital UNK records UNK received DOS 2/23/09 to 2/28/09. LABS and DIAGNOSTICS: CBC - RBC 4.00 m/uL (L) M 10/2/09 Medical UNK records UNK received for date of service 9/2/09 10/2/09 Diagnostics/Labs: Medical records CT,received EKG, CXR for Normal. date of service CBC w/diff9/2/09m 69 None Labs OTH and diagnostics: OTH pelvicNone US WNL None WAES0908USA03209 Unknown OTH OTH Unknown Unknown WAES0908USA03257 None OTH OTH LIPITOR; DIAZEPAN; Diabetes; Hypertension Brain glyburide; neoplasm lisinopril; JANUVIA; WAES0908USA03151 AMBIEN Unknown OTH OTH alprazolam;Sulfonamide hydrochlorothiazide; Anxiety allergy SYNTHROID; WAES0908USA03203 potassium (unspecified); quinapri 0 None OTH OTH COSAMIN DS; DrugCENTRUM hypersensitivity Stroke SILVER; omega-3WAES0908USA03208 marine triglycerides; ZOCOR 1 None PVT PUB None None None 2 None PVT PVT Pauciarticular JRA None PUB PVT No Dx at age 6yrs with GBS 2 None PVT PVT MULTIVITAMIN/TYLENOL None None 5 Pt verbalizes OTH understanding OTH to follow NIASPAN; up with TOPROL Rash his physician. with blisters None to (L) shoulder 2 None OTH OTH none
1 2
PVT UNK Hepatitis B PVT UNK Prenatal multivitamin; None Seasonal PARLODEL Allergies; Hyperprolactinemia PUB PUB 0 PVT UNK Albuterol Inhaler; PYRYDIUM 1 None PVT UNK None Congenital heart condition 0 None PUB UNK None 0 PVT PUB None None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 PVT PVT Zyrtec, motrin,Tylenol none started none Keflex 500mg TID on 8/24/09 0 none PUB UNK SIMVASTATIN none80MG TAB none Sig: TAKE ONE-HALF TABLET BY MOUTH AT BED 0 MIL UNK BPH, hyperlipidemia, tinea unguinum, GERD, Ischemic He 1 MIL MIL alprazolam 1 mg 3 times morbid a day; obesity; amlodipine connective 10 mg tissue daily; cyclobenzaprine diseases; esophageal 10 mgme 1 Ultra soundPUB venous doppler UNK report,n/a radiology,None blood workDiabetes incl: CBC, CMP, CPK. 2 UNK PVT Levoxyl, Flonase, none sinusitis 2 none UNK UNK NO NO 2 Labs: WBCs UNK 17K-23K UNK with decreased SYNTHROID, lymph% POST-OP and BABY increased ASA, VAGINAL UTERINE NEXIUM,SULINDAC grans%, SURGERY, PROLAPSE WNL byUTERINE d/c. PMH: UAGERD. (+) PROPLAPSE blood, Uterine 1+ leuk prolapse est, 6-10 jus 0 During phone UNK call, mom UNK said that "we're waiting None. on test results, None per butmom so farafter everything I asked has her been routine fine." screening question 0 PUB PVT No No No 7 UNK PVT amlodipine none besylate 5mg none tamyl 6 none besides UNK the histology UNK of the heart. None None, maybe jaundice several days after birth 65 OTH OTH COPD 0 PUB PUB no no no 0 N/A PUB PUB 1) Pantoprazole None40mg No daily known 2) Metformin allergies.500mg Medical daily conditions: 3) Benicar Diabetes, Hctz 40-25 Hyperte daily 54 Lumbar puncture UNK negative, UNK blood work none negative. NoneMRI- lesion Mitralmyelin Valve cervical. Prolapse.2nd 9/8/09 MRIHospital now shows records 2ndreceived lesion onDO th 1 N/A UNK UNK N/A N/A Premature with Bradycardia and Intracranial Hemorrage. C 2 UNK UNK None None listed 2 PUB UNK Nexium, Ultra none MT 12, Calcium, high cholesterol omega3, sameand as anti-inflamatory above~Hep acid reflux A and + Hep antiB (Twinrix)~1~10 cholestrol 14 None UNK UNK None None NKDA, No medical conditions 0 None PVT PUB none none none 29 Endoscopy,colonoscopy, UNK UNK multiple none stool specimens, none blood8/31/09 tests ,Ct PCP scans,& none~ Note()~~0.00~Patient x-rays. DOS 2/9/07. LABSFever, and DIAGNOSTICS: nausea. Cough.End Or 0 PVT PUB was prescribed nonePULMICORT; here for - none vaccines -EPI PEN; only Prednisolone; BENADRYL 1 PVT PVT none knownnone none 0 UNK UNK none no Mild asthma PUB PUB levothyroxine none hypothyroid 1 none PVT PVT none no none 1 none PVT PVT none no none 1 PVT UNK 1 PVT PVT ASA; Metformin; None Lisinopril; Diabetes; Verapamil; No allergies HCTZ; Simvastatin; GLUCOTROL. 0 None OTH OTH None None 7 UNK PUB PPD None 9/3/09 PCP medical records received DOS 4/1/08 to 8/18/ 0 PVT PVT None ~Pneumo (Prevnar)~2~0~Patient|~Rotavirus (R None PVT PVT None None None 0 none PVT UNK none none none 1 None PVT PUB None 9 PUB PVT Lisinopril; BONIVA; ZOCOR 0 PVT PVT 0 None PVT UNK Albuterol None None 7 OTH OTH PRILOSEC;None Hydrochlorothiazide; None Provocol 2 Not known PUB PUB Possible spider bite AR0930 1 Shingles dxPVT confirmed PUB at uregent care; Aspirin; Neg Lisinopril; eye None exam. Metformin; Diabetes; Metoprolol; CAD; Hypertension; PLAVIX; Pravastatin; Hypercholesterolemia; VIAGRA BPH 0 In ER and Hospital. PVT 9/9/09-records PVT received-CT normal. 0 PUB PUB
0
PVT PVT None None None none UNK PVT none h/o mollusctum none 6 Had normalPUB blood and OTH urine tests None day of seizure; None EEG is Hx stillfebrile pending. seizure 2 PVT PVT Hives~DTaP (no brand name)~4~2~Patient 1 UNK UNK No Allergy to sulfa + Lisinopril 1 UNK OTH None 0 PUB PVT None None 1 None PVT UNK None None 1 PUB UNK None None 1 PUB OTH None None None PVT PVT None None 0 PVT OTH Lisinopril HCT; None CIALIS;No Metoprolol; drug allergies; Simvastatin; High Cholesterol; Fenofibrate; Diabetes; Amlodipine; SleepVitamin apne 0 PVT PUB None None ~DTaP + IPV (KINRIX)~2~5~Sibling 0 PVT PUB Mild URI ? allergy to ~Measles cashews + Mumps + Rubella (MMR II)~2~5~S PUB PUB No No 0 PUB PVT None No No syncope~Vaccine not specified (no brand name 3 PVT PUB Atropine eye None drops None Unknown OTH OTH Unknown Seasonal allergy Insomnia, Mental WAES0810USA00371 disorder transient, Movement 0 PVT UNK None None Known 0 PUB PVT None None PVT UNK None 2 PUB PUB 4 PVT PVT None 0 Allergic Reaction PVT UNK None NKA 0 PVT PUB No 0 Glucose 86.PVT Child observed PVT x 30 mins. None Normal None exam. BPNone 96/60 prior to d/c home. Sign/symptoms of TD PVT UNK Seasonal allergies 0 PUB PUB diabetic Diabetes (DMII); HTN 3 OTH PVT MAXIDO; RUNITIDO UTI h/o Breast cancer 2 PVT PUB 3 PVT PUB None 10/05 Had reaction to DTaP or LPV or HIB 0 PVT PUB No No 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0007546 PUB PVT Hives Suffer badly with eczema Not to my knowledge. PUB PUB 0 Started to become UNK sexual; UNKcannot be in to much Flu heat like symptom; or have sugar breathing problems; hyperacted sexual 0 Setting stage PUB for early PUB Autism Early stages of Autism Cannot be in PUB to much heat, PUB or have sugar. Flu like syndrome 0 Setting early PUB stages of PVT Autism. None Hives; Crying/Headaches; Hyperacted; Breathing problem 22 See med. records PVT - tooPUB numerous.FLOMAX; 9/11/09 Hospital ASPIRIN; Diabetes; records LOPID; Renal Diabetes; received failure TORSEMIDE; Diabetic DOS 10/6/08 neuropathy; LYRICA; to 10/21/08. QUINAPRIL; Renal disease; LABSDIOVAN; and Stroke. DIAGNO ZOC 9/1 none PUB PVT none no none ~Zoster (no brand name)~UN~84~Patient 0 UNK UNK 13 MIL MIL 1 PVT PUB 0 CBC & diff -PVT NL PUB None No Atopic Dermatitis Fever 48 hr~ ()~UN~0~Patient 2 PVT PUB None None None 0 None PVT PVT None None None Red bumps all over body~Vaccine not specified 0 PVT PUB No No 11 NA - Px exam PVTonly PVT None 0 EKG = Normal PUB PVT None None 0 PUB PUB CEFZIL
2 None PVT PVT None None None Not reported OTH OTH The patientThe had patient no concurrent has allergy illnesses, to NEOSPORIN, or ### use of other and medication a history ofat c Not reported UNK UNK Not reported ### 1 computed axial, OTH 08/18/09, OTHnegative; ADVAIR laboratory test, 08/18/09, None negative 9/3/09 Medical 9/3/09 records Medical WAES0908USA03202 received records received w/PMH: right w/LABS: kneeC 633 hematology,OTH 11/??/07, OTH normal; platelet hormonal count, contraceptives 10/03/08, 190,0; Unknown platelet count, 07/30/09, WAES0908USA03204 21,00 Unknown OTH OTH Unknown Unknown WAES0908USA03468 0 UNK UNK 0 UNK UNK 0 9/9/09 ED records UNK received UNK DOS 8/25/09. Also none Labs fromFebrile 8/28/09. seziures LABS Mom and DIAGNOSTICS: and Dad hx of childhood CBC - MCH seziures. 26.7 PG 9 0 none PUB PUB None None None 1 PUB UNK 0 MIL MIL Smallpox vaccination na 1 None at thisPUB time - referred PUB to Urgent None Care forNone evaluation - Client None onDenies 8-26-2009. illness @ time of Vaccination 3 Post vaccinal UNK acquiredUNK auto immunity-clinical No hypothyroidism, illnessesHiatalliver hernia, disease, prolopse probable valve.auto PMH: immune. previously I have healthy had MR 200 9/2/09 Hospital UNKrecordsUNK received DOS 6/29/09COPD to 7/10/09. LABS and DIAGNOSTICS: Bronchoscopy with Biopsy - A 0 PVT PVT NO Asthma UNK UNK 4 none PVT PUB HCTZ, Pantoprazole, none Lescol, no allergies. aspirinHypertension, hypercholsterolemia, colon po 4 CBC, stool UNK for blood and UNK culture, KUB Nystatin and oral abdominal Thrush susp ultrasound None 9/3/09 Received medical records w/LABS: Abdom 12 cbc - WNL; UNK glu 85; ekg:UNK sinus bradycardia; other Nonelabs pending History 9/25/09 of pyelonephritis Medical records 9/25/09received Medicalw/LABS: records received (+)ASO 41 9/29/09 PCP UNK records received UNK DOS Doxycycline 1/5/07 tonone. 8/7/09. 9/29/09 LABS allergic PCP and DIAGNOSTICS: to records cats. 9/29/09 received PCP Rapid DOS records Strep 1/5/07Test received to 8/7/09. (+). CBC DOS Depressio -1/5/07 WBC 10 none PVT PVT none diarrhea, rash no 2 PUB PUB NONE denied none 1 PVT PVT none None None None~ ()~NULL~~In Patient|None~ ()~NULL~~ 1 none PUB PVT antihypertensive none hypertension 87 PUB PUB Humira andRheumatoid methotrexate None arthritis Rash~Zoster (no brand name)~0~76~In Patien 0 8/26 EEG- pending; UNK CTUNK spine- no none fractures; CT DENIED head- normal; DENIED Hx of back problems/cortisone injections X 1 year 2 N/A PUB PVT Unknown NO NKDA CBC;RPR; UNK Igm; IgG; Varicella UNK None None None 0 PVT PVT none none 0 None UNK UNK Multi-vitamins None None 3 PVT PVT Trileptal, Concerta Bipolar Disorder, BipolarADHD Disorder, ADHD, Allergic to Amoxicillin 1 UNK PVT 0 UNK UNK none 1 no lab test obtained UNK UNK none none JIA 15 XRAY OF AFFECTED PVT PVT ARM WASYAZ NEGATIVENONE HISTORY OF HERPES 0 PUB UNK levothyroxine no Zithromax 1 9/17/09 Hospital UNK records UNK received DOS 8/24/09 Noto 8/27/09. Insects LABSand andstings. DIAGNOSTICS: 9/17/09 Hospital Bloodrecords culture -received No growth. DOS U 1 none PUB PUB none none 1 UNK UNK none none none known 2 UNK PVT 0 N/A PUB PUB none No none AZ0908 1 PUB PVT 0 PUB UNK Ciproflaxin Puncture wound Ampicillin allergy 21 None UNK UNK None None None Intra-arterial injection resulting in brief vasculitis 1 PVT PVT ~DTaP (no brand name)~UN~0~Patient 2 None PVT PVT None None RAD 1 PUB OTH None None None 0 None PVT PVT None None None None PVT PUB No illness NKDA; No condition on other None PVT PUB No illness NKDA, no condition on other
6 0 None
PVT PUB None None None PVT PVT No No PUB PUB None None 1 PVT PUB None No None 0 UNK UNK KBH exam Asthma; developmental delays 1 OTH PVT None None None PVT PVT None None Allergic rhinitis 0 Father and OTH patient refused PVT to be taken to hosp. She Spoke said ittowasn't patientbad & dad (hurtful) at 7:30pm then slouched 8.21.09 &soon 8.22.09. after. 1 PVT PUB None 1 None PVT PVT No None 0 PVT PVT None Dairy, Torticollis, Fever Bronchiolitis ongoing~Polio Virus, Inact. (no brand na 0 PVT PVT ### 0 Titers were OTH drawn on 30 UNK June 2008 (negative); 07 July 2008 History andof28 three August doses 2008. of IPOL### as a child. Other pre-existin 0 None reported OTH OTH The patient had many unspecified ### drug allergies. The patie 1 None PVT OTH The patient had previously received ### DTAP and IPV vaccin 0 Not Reported PVT PVT At 6 monthsFever~DTaP old, received(no DTAP brand ###dose name)~3~0.60~Patient 3 and experienced f 0 PVT OTH Desowen lotion, RHINACORT History of AQ, asthma Albuterol, and thrombocytopenia; ZYRTEC, ###PULMICORT allergies to sulfa 2 None reported PVT OTH CLARITIN None Reported ### Not Reported UNK UNK Not Reported ### 4 UNK UNK No know allergies or medical conditions. ### 0 No labs completed. PVT OTH The patient had no concurrent### ill and had not been taking 1 PVT PVT No medical~Polio history,Virus, no concomitant Inact.### (Ipol)~1~0.00~Patient|~Poli medications, and no ill 3 None performed PVT UNK None reported. From information ###received on 29 Septemb 1 PVT UNK None The patient had no concurrent### illnesses or use of other me 4 None reported PVT OTH The patient did not have any known ### allergies or medical co 5 None reported. PVT OTH The patient did not have any know ### medical conditions or a Not reported PVT PVT The patient~Influenza had no known (Seasonal) allergies ### (no or brand pre-existing name)~UN~0. medica Unknown OTH UNK ### Not reported UNK UNK The patientInjection had no known site~Influenza allergies. ### (Seasonal) (Fluzone)~~ 1 PVT OTH No medical history reported, no ### known allergies. PVT OTH No history of medical conditions, ###no known allergies. 2 UNK UNK Possible allergy to amoxicillin,### no other medical history. PVT PVT The patient had slight runny nose ### at the time of vaccinatio 0 None PVT PUB No No No Unknown OTH OTH Unknown Unknown WAES0908USA03961 Unknown OTH OTH Unknown Unknown WAES0908USA04182 Unknown OTH OTH Unknown Unknown WAES0908USA03811 60 magnetic resonance, OTH 03/18/09, OTH venus Noneand arterial phaseNone which was negative; magnetic WAES0907USA00788 resonance, 05?/??/09, neg Unknown OTH OTH Unknown Unknown WAES0908USA03465 Not reported UNK UNK ATENOLOL The patient is allergic to latex,### thimerosal, PCN, and sulfa. 1 On 20 August UNK 2009, the UNK patient had a "spinal tap" (lumbar It was puncture unknown test) ifperformed; the patienthowever had ### anythe illnesses, results pre-existin were not r 78 9/28/09 Hospital PVT records PVT received, multiple admissions none-preventative and None. outpatient 8/27/09visits, PCP DOS medical 8/22/09 records to 9/09/09. receivedLABS DOS 4/16/08 and DI 0 None PVT PVT None None None 2 None PUB PUB 0 PVT PUB None None 1 PVT PVT None None 0 PUB OTH PPD None Had reaction nottoconsidered previous tetanus serious~Tetanus booster Toxoid (no bra PVT PUB No No 1 PVT PUB None 7 None PVT UNK LOTREL 5/10 Well visit/physical HTN; Obesity; Tobacco UN 8 UNK PUB PROTONIX;Acid PRN Reflux TN09011
1 Referred toPUB minor emergency. OTH TYLENOL TN09012 2 None PVT PVT None None None family hx of migraine headache 0 None PVT PVT PPD; KEPPRA; NoneLEXAPRO; Seizure ZONEGRAN; disorder Amityiptyline; YAZ 1 OTH PUB unknown unknown 1 PVT PVT 2 None PVT PVT None None None 0 EEG PVT PVT None None 0 None PVT PVT Birth controlNone None 2 PVT OTH 1 PVT UNK 2 PVT PUB None None 1 PVT OTH 1 PUB PUB None None None 1 None PVT PVT None 8/19/09 hadAllergy laceration to eggs. left AC. "upset Sutural stomach. "Fainting spells". 57 Lab pathology MILstates, "...organism MIL none reaction such none. as vaccine none. injection and infection, sarcoidosis. In this case we thi 0 UNK UNK NONE NONE NKA 6 Occult blood UNK positive on UNK 26 AugustNone 09 and onNone repeated study Noneon 27 August 09. Stool study + for WBC/RBCs, H&H 0 10/7/09 Medical UNK records UNK an DC summary Lasix, Coreg, received post KCl, cardiac forCozaar dates post catherization 12/25/08 cardiac catherization to 1/14/09. Diagnostics/Labs: 10/7/09 Medical records Left heart ancath, DC 1 UNK PVT Nexium, Xyzal, nonetriamterene, none synthroid enablex, magnesium, biotin, Vit D, red wine 2 PVT UNK ASPIRINE 81mg DAILY EPSTEIN ANOMALY SKIN RASH (HEART PR-09-11 AND VOMITING~HPV MURMUR) (Gardasil)~ 0 EKG DONEPVT , REPEATPVT HR=60,B/P 94/61, RR=18, NO 02 SAT=100%. ( PREV. HX OF DIZZINESS W/ EXERTION) RE 1 UNK UNK None 0 PUB PUB NONE DIABETES 0 N/A PVT PUB None None 0 NONE PVT PVT NONE NONE HEART MURMUR, GERD, FAILURE TO THRIVE 0 PUB PUB Bloody nasal discharge noted on exam. 2 PUB UNK hx of seizures never given vaccine w/pertussis component 1 MESSAGE UNK LEFT WITH UNK ANSWERING SERVICES NONEREGARDING NONE FOLLOW UP. NO RETURNED CALL AFTER 2 A 1 PVT PUB Asthma 1 UNK PVT THYROID, NONE FOSAMAX, FOLIC ACID 0 N/A PUB PVT ZOLOFT N/A BEE STINGS 1 None PVT PUB None No None 0 none PUB UNK none none 4 PVT PVT caduet, provera none hypertension, dyslipidemia, osteoarthritis, hard of hearing 0 PUB PUB NO NO 2 Lymnes titrePVT was equivocal PVT but theLoEstrin24 Weatern Block NONE Fe, Tindamax was negative. NONE CBC,Sed Rate and CT Scan negative 13 CBC,Strep,Urinalysis,and PVT PUBInfluenza None testing done No in the ER. No 7 UNK UNK none none Reactive Airway Disease (Remission) 0 UNK UNK Zyrtec None None 0 UNK UNK Norinyl, Cyclobenzaprine, none penicillin, bupropion, flunisolide, montelukast, allergic omeprazole, rhinitis, asthma fluticasone, zolm Pt. instructed PUB to informPUB OB/GYN of vaccines Pt. reported LMP 06-26-2009, taking BCM. Pt. was advised regarding 0 MIL MIL NONE NONE NKDA/NONE 1 UNK UNK none none none 0 UNK UNK Venlafaxine, none prazosin, clindamycin, sodium fluoride, keflex, combivent, asthma, oxycodone, allergic rhinitis bupropion, diclofe 1 NONE PVT PVT NONE NO LEFT HYDRONEPHROSIS @ BIRTH SURGERY 7/30/20 1 9/14/09 ERUNK records received UNK 8/21/09. alprazolam, LABS and None, Micardis, DIAGNOSTICS: UTI Vytorin, 5/09 PACs/arrhythmia, multivitamin, Systolic BP melanoma Flecainide 150 mmHg in situ, (H).basal Peripheral cell carcinoma, Pulse Rat 0 Patient hasUNK had numerous UNKblood tests, Noneskin priorbiopsies, to none 5/1/09muscle 9/1/09 biopsies. PCP medical Musclerecords biopsy received conducted DOS by University 2/3/09 to 8/19/ of Io PVT PVT NONE NONE NONE 7 Elevated CRP PVTand Sedimentation PVT Multi rate. - vitamin No No 1 none PVT OTH none none 29 PVT OTH None PATANOL; ALLEGRA
0 none 1 1 None 1 1 1098 0 0
PVT PVT none none - was none here for P.E. PVT PUB None None None PVT PUB LAMICTAL; CLONIDINE; Stable TRAZODONE bipolar; ADHD; anxiety disorder; stable allergic rhin PVT PVT Done 4 days Over priorillness ADVAIR; Asthma Prednisone; Albuterol PVT OTH None None None PVT PVT None none PVT PVT LAMICTAL 25mg; PROZAC Depression 10mg daily PVT UNK None None PVT PVT None 14 CT head negative PVT 8/26/09 PVT Albuterol prn Pneumococcal meningitis, 1/17/1998; Asthma; PCN allerg 2 PVT PUB 1 None PVT PUB Sinus infection No 0 None PVT PVT TYLENOL; None PRN None 1 None OTH PUB None None None 1 PVT PVT Unknown no unknown 0 PVT PUB PVT UNK Left thumb Hypertension; laceration hyperlipidemia; NKDA. 0 TEGRETOLOTH and comprehensive PUB metab ALDACTAZIDE; panelNone doneFURADANTIN; 8/27 Congenital - results pending. Multivitamins Myopathy; 8/31/09 Trach w/ Fluoride; PCP Tube; medical Ventilator-depend; TEGRETOL; records 7/2/07 Potassiu Gto none PVT PUB diaper dermatitis none 2 None OTH PVT ZYRTEC; SINGULAIR None Allergies; taken daily. Asthma 0 PUB PUB None None None 0 PUB PUB none none none 9 PUB PUB 6 Unknown. 9/22/09 OTH Hospital OTH records Unknown received DOS 8/13/09 Unknown to 8/22/09. LABS and WAES0908USA03925 DIAGNOSTICS: Chest X-ray -Abn 41 Unknown. 9/8/09 OTH Hospital OTHrecords received DOS 8/3/09 to None 8/5/09. LABS and DIAGNOSTICS: WAES0908USA04230 Urine culture (-). Urin 0 Blood pressure, OTH 08/18/09, OTH110/7; Blood pressure, 08/18/09, Syncope 102/6; Arterial blood WAES0908USA03108 O2, 08/18/09, 98%; Arterial blood 9 Unknown. 9/14/09 OTH Medical OTHrecordsHormonal received contraceptives DOS 8/25/08 None. to 8/27/09. 9/14/09LABS Medical andWAES0908USA03802 records DIAGNOSTICS: received DOS Colonoscopy 8/25/08 to -W 8 0 Magnetic resonance OTH OTH Unknown Unknown WAES0908USA04086 Unknown OTH OTH Unknown Unknown WAES0908USA04199 2 Negative EEG; PVTNegative PUB MRI None None None 0 None PUB PUB Seasonal BCP's. None No known allergies. hives~Yellow fever (no brand name)~1~28~Sib 0 None PUB PUB Birth controlNone pills (yaz).ASA; NSAID's; ModPCN. local reaction~Tdap (no brand name)~UN 0 History of anxiety. PVT PVT PREVACID & PEPCIDGall AC bladder removed 5/09. 0 PVT PVT None Hx of Strat 15 pills. has glasses. 0 PVT UNK PVT UNK Aspirin 0 R Wrist x-ray UNK UNK NONE Crohn disease-controlled, pt complains of vomiting approx 3 Positive Pregnancy MIL Test MIL 4 CBC UNK UNK NONE 1 none PUB PUB none allergic to penicillin; febrile VA09:009 seizures 15 8/4/2009 CtUNK of head - negative. UNK 8/6/2009 Toprol XlGlucose 150m Upper p.o. 96, respiratory b.i.d., BUN Supraventtricular 8, Xanax. creatinine infection with 0.6, tachycardia dry sodium cough 140, with around potassium cardiac Julyablation 4,3.8, 2009. chloride 2004 evalu a1 0 UNK UNK Albuterol prn none Food allergies, asthma 0 PVT UNK 0 PUB UNK None None 0 none PVT PVT lipitor, citracel, none centrumacoustic silver, nasonex, neuroma, cellulitis~Pneumo ventolin, s/p gamma allegra (Pneumovax)~NULL~72~In knife xrt, obesity, hypercholP 0 PVT PVT OrthocyclenNone None PVT PVT BENADRYLPOISON IVY POISON IVY-CURRENT; URI-RESOLVED, STREP PHAR 0 None PUB PUB None None None PVT PVT ZYRTEC CONSTIPATION ALLERGIC RHINITIS-CONTROLLED 1 PUB PUB none none reported VA09:010 1 CBC WBC 13,000 UNK CRP UNK 2.5 ESR 40. 9/17/09 no Hospital none records received DOS 8/27/09 to 8/28/09. LABS and DI
PVT PVT MOTRIN OTITIS MEDIA OTITIS MEDIA, 0 PVT PUB None None None 1 none available PUB PUB none none reported none VA09:011 0 UNK UNK Xanax, Lipitor, None Paxil, Flexeril,& Anxiety &Atenol-chlor high cholesterol 1 PUB PUB Multivitamins/minerals s/p mastectomy for breast cancer allergies - Sulfa, perhap 0 PUB PUB 0 angioedema, PVT hives PVT fracture of radial head, asthma 0 PUB PUB NONE NO NO 0 PVT PVT levoxyl, lisinopril, none tetracycline, HTN, hypothyroid, zanaflex, paxil anxiety None PUB UNK NONE 0 See above PUB (#7) UNK amitriptyline, Patient citalopram, admitted Allergies enoxaparin, for possible include estradiol, penicillin, pyelonephritis gemfibrozil, walnuts andand levothyroxine, respiratory cats which infection. all nicotin caus 2 PUB PVT HCTZ, metoprolol, Watery nose, Singulair, Hypertension, soreTylenol, throat, glaucoma, dry Calciu+Vitamin mouth, allergic (chronic). D rhinitis, 0 UNK UNK 1 PUB PUB 1 PUB PUB N/A None Not Known 0 UNK UNK nuva ring. Phenteramine. none Poss PCOS, hirsutism, obesity, tobacco abuse, MVP. App Chest x-rays/ PVT MRI/ EEG UNK / Echo cardiogram / Tilt none Test / allergic to dust, maple, cock roach 1 none UNK UNK none none none unknown~ ()~~0~Patient|unknown~ ()~~0~Sibl 0 PVT UNK None 0 None PVT PUB None None Post-op surgical repair of both atrial septal defect and pulm 49 10/31/08 Abd PVT x-ray; USPUB of abd.; Barium Multivitamin enema None (Peds) for reduction Noneof intussusception. 3 PUB UNK No No Pap 8/13/09UNK UNK 0 None PUB PUB none no allergies, birth defects or medical condition 0 PVT PVT None None None 0 PVT PUB None None Penicillin allergy; Lumbar spondylolysis 1 None PVT PVT None None None 1 none PVT PVT none none 2 PVT PVT None None 1 None donePUB PUB None None No known allergies; No birth defects; No med. condition 0 None OTH OTH SYNTHROID; None CELEBREX; statedPCN;ADVAIR Tetanus-toxoid; Hives~Tetanus inhaler; GERD; Miacalcin Toxoid hypothyroidism; nasal (no brand spray; name)~1~0~P ZANTAC; Asthma; Art CA 3 PVT PVT 0 9/8/09 Hospital PVTrecordsPVT received DOS 8/27/099/8/09 to 8/29/09. Hospital CTrecords Scan - Subarachnoid received DOS Bleed. 8/27/09LABS to 8/29/09. and DIAGNOSTIC Poison sum 0 OTH UNK None None None 1 Exam PVT PVT None None 0 PVT PVT 1 OTH PVT Unknown None reported Heart disease; Hypercholesterolemia 11 UNK UNK LIPITOR, ATA, CALCIUM AS / hyperlyedemia 0 PVT PVT Heart MurmurSyncope~Varicella benign (Varivax)~1~15~Patient|Syn OTH PUB No No No OTH PUB No No No OTH PUB o Yes URI No PVT UNK 1 PVT PVT Simvastatin;none lisinopril; estradiol; HTN; Highamitriptyline; Cholesterol Naproxen 2 UNK UNK None None 2 PVT PVT UTI RAD; PVD; HTN; Hyperlipidemia 1 X-ray left shoulder PVT & clavicle PVT None None cyst rem. left clavicle above noted site 3 years ago 1 Blood culture/ PVT CBC with UNK diff. None None ~DTaP + IPV (KINRIX)~1~5~Patient 0 PVT PUB 1 PVT PUB none none 1 PVT PVT none none none
1 None UNK UNK none none none 0 UNK PUB Timolol , lisinopril high blood pressure pcn Glucoma 1 none PVT UNK ibuprofen none none 78 9/15/09 Neurology UNK consult UNKrecords received DOS 6/10/09. 9/15/09 LABS Neurology and DIAGNOSTICS: consult records EEG received - ABNORMAL. DOS 6/10/09. MRI - N 1 None PVT PVT None None None 0 PVT UNK none Grade IV IVH at birth with ensuing diagnosis of Cerebral P 0 PVT PUB None Cleft Lip and Cleft Palate 23 9/8/09 Hospital UNKrecordsUNK received DOS no 12/26/08 none to 1/03/09. no.LABS 9/8/09and Hospital DIAGNOSTICS: records received Lumbar DOS Puncture 12/26/08 / CSF to 1/03 - Ly 1 UNK UNK none none none 2 Patient aliveUNK and typingUNK this report at this time.None, Sunday, except August probable helminthes 30,penicillin 2009, infection. and allergey, willBeing report see treated to below Veteran's for fordual conditions Administration heart valve (dual 0 MIL MIL Not reported MEDI0008180 0 MIL MIL Concomitant Drug(s) Not reported MEDI0008185 55 Specific laboratory PUB tests PUB performed"ANATRIPTALINE"; were unknown; however Herbal History the Medications; of patient Bells had Palsy Vitamins anone x-ray year of### the ago.shoulder, From new EMG information and MR Not reported UNK UNK The patient stated that she is ### allergic to a lot of different co UNK UNK ### Not reported UNK UNK Not reported ### 0 Not reported UNK UNK The patient had a history of a ### milk allergy. Unknown OTH OTH Unknown Unknown WAES0908USA03993 Unknown. 9/4/09 OTH Hospital OTHrecordsDEPO-PROVERA, received DOS Asthma; 8/12/08 Vicodin. Food 9/4/09 to allergy 8/14/08. Hospital LABS records ANDWAES0908USA03159 received DIAGNOSTICS: DOS 8/12/08 MRI Foot to 8/14/08. (at othe 15 Metabolic panel; PVT Thyroid; PVTCT; MRI; CXR; MRA; Cough; MRV;Wheeze. CBC NONE. and platelets; 9/29/09 Neurology Coccidioides Consult antibody; received EBVDOS panel; 7/1/09 Mycop to 0 PVT PVT Singulair 4mg Rhinorrhea; daily Eggs; Just over Peanut bronchitis butter; Jelly beans (anaphylactic react)PMH 159 UNK UNK 9/1/09 PCP medical records DOS 10/03/07 to 4/25/09. Ba 306 CAT Scan; UNK Pharmaceutical UNK agents; Hospitalization; Seeing None a surgeon on 8/28/2009 to remove a mass on her he 14 PUB PUB ORTHO-TRICYCLEN None No known allergies; yes~HPV No (no LA090807 med. brandcondition name)~1~16~Patient 1 PVT UNK None None None 5 PVT PUB Zithromax PCN-Sulfa- Keflex 0 PUB PVT TOPROL; SULAR; None known AVAPRO; Heart condition; PRILOSEC; Hypertension; NORTRIPLINS; Post Hx ASA Ulcers. 81 mg. 2 UNK UNK 0 PUB PUB None None PVT OTH Rash on AMOXICILLIN PUB PUB None known None None known 2 None PVT PVT None 1 None PVT UNK None Amoxicillin Rash~ ()~~0~Patient 0 UNK UNK None 1 None PVT PUB None None None 15 PUB PUB None None None 13 15 Jul: ViralMIL cultures and MILVacciniaNone PCR, neg; None 15 Jul: Punch bx-shows epidermal spongiosis, focal mounds of parak 2 PVT PUB Albuterol via Noneb-PRN;Anemia; ChildrenObesity MVI 3 Labs drawnUNK 8/27/2009:UNK CPK 8784;Concerta CKMB 31.1; None AST 186;PMH: ALT 72; learning Serum disability. Protein 8.9; menstrual Serum H/A. Albumin metabolic 4.7; Globulin syndr 29 WBC- 8.0; rprMIL non-reactive; MIL None None None 1 Hematuria. PUB CBC, CMP,UNK Complement, Plavix, ESR Crestor, pending. Coronary Lisinopril, Artery None HCTZ, Disease, metoprolol Hypertension, Hypercholesterolemia 37 9/3/09 Hospital UNKrecordsUNK received DOS none8/24/09none to 8/26/09none and 9/2/09 9/3/09 to Hospital 9/3/09.records LABS and received DIAGNOSTICS: DOS 8/24/09 Ultrasou to 8/2 1 PUB UNK nONE CODEINE, MORPHINE 2 PVT PUB none none unknown 0 UNK UNK Unsure of name none of newHx medication of asthmafor when migraines younger. started Father today reports no meds for it 0 PUB PUB Asthma; Allergies Vommitting~Hep to NSAIDs,BCodeine, (no brandhydrocodone, name)~1~39~In oxycP 0 Strep test negative. PVT UNK Plaquenil - Patient 400mg daily, hasPre-existing: a Celebrex history of,- and Mixed 200mg is currently Connective as needed being Tissue treated Disease; for, mixed Allergies: conn 0 PUB PUB NONE NONE NONE 0 DATE/TIMEMIL TEMP PUBPULSEAPAP/hydrocodone, RESP BP gastricPAIN pain, estrogens previous testing WEIGHT ordered, conjugated, allergic PULreactions previous OX trazodone, 7/15/09 with diarrhea, @ airway venlafaxine,fluticasone 1955 now constriction only 97.3loose 79 tostools azith 20 na 0 UNK UNK Rampril no illness high blood pressure 0 PUB PUB MO-2009-20
1 NO TESTSPUB DONE PUB SEASONALJUST ALLERGIES SEASON NONE~ WAS ALLERGIES ()~NULL~~In ON CLARITIN Patient|NO~ ()~NULL~~I 1 PVT PVT Fosamax, Evista, None Dyazide, Osteoporosis, K-Dur,None Calcium+Vitamin hypertension, Known~ ()~NULL~~In hyperlipidemia, D, Centrum Patient Silver hypokalemia 0 None PVT PVT None None None 6 did several UNK tests at ERUNK to include:Strep test, Chest na xrays, blood culture, urine culture, etc. 0 none PUB PUB Prozac none depression 0 UNK UNK Vyvanse; Celexa; no anusol Allergy suppository to morphine; microscopic colitis; mononucleosis req 0 N/A MIL MIL NONE NONE KNOWN NONE~ ()~NULL~~In Patient|NONE~ ()~NULL 1 None donePVT PUB NA none eczema NA~ ()~NULL~~In Patient|NA~ ()~NULL~~In S 8 none PUB PUB DENIES Bactrium 1 ULTRASOUND PUB PUB 1 none UNK PVT 15 MIL PUB Celebrex 100 None mg -daily Prostate Cancer - No known drug allergies 0 PVT UNK 10 PVT PVT 0 none UNK PUB none no none no~ ()~NULL~~In Patient|unknown~ ()~NULL~ 1 PUB PUB NONE NOTED NONE 0 UNK PVT None None None~ ()~NULL~~In Patient 1 UNK UNK 0 CT scan, EKG, UNKlumbarUNK puncture, chest Yaz, Minocycline, xray, CBC, none CMP, (albuterol, asthma, sed rate, advair, acne. drugflonase 9/9/09 screen,precscribed PCP UA medicalbut records not being received used DOS at tim 1 PUB UNK No None 2 None PVT PVT Symbicort None None 1 PVT PUB None None 1 PUB PUB None None RSV; Rotavirus (RSV 10 mths) and (Rota 18-24 mths) 12 CRP - 1.4, 1.6 PVT(up); ESR PVT -1; CBC ZOLOFT; - ok; UA-ok; NUVARING none WBC notedAllergic - 9.3 and 5.2; rhinitis; T- 37.0; Allergies: Chest VICODIN; x-ray-negative Amoxicillin; Aspirin 2 OTH OTH None None None 1 None PVT PVT None Bad reaction to smallpox vaccine 1 None UNK PUB None None 0 PUB OTH None No No No~ ()~~0~Patient 1 PVT PVT Redness~Smallpox (no brand name)~1~34~Sib 1 None PVT PVT None None BMI greater than 95th percentile; Voiding dysfunction 3 OTH MIL 2 None PVT PVT No None 1 PVT PUB none none none 1 None PUB PUB No No 0 PUB PUB None None 2 PUB PUB None 1 Quick flu negative PVT PVT Birth Control None - type unknown None 0 None PVT PUB None None None 4 HemoglobinPVT performedPVT on 8/21/09None - normal result Noneper pts.Allergic mom. Influenza to sulfa, KEFLEX, test - result DURICEF pending. 1 None PUB PUB Current Tx Physical for low back therapy pain for & rt. pain hipinpain rt hip & low back PVT PUB None None 1 Milk and egg PVT IGe confirmed=3/09 PVT ZYRTEC 3 Stool cultures; PVTRotavirus PVT antigen none 1 MIL MIL rash~Tdap (no brand name)~UN~44~Patient 0 PVT PVT ORTHO TRINone CYCLEN None 1 tab daily 0 PVT PVT None 1 None PUB OTH None None Unknown~ ()~~0~Patient|Unknown~ ()~~0~Sib 0 PUB UNK None None 0 OTH PUB Treatment- UNK TAC oint %PUB Keflex 3 tsp BID x 10 None days. NKDA 2109 None PVT UNK None None
0 PVT PVT 1 PVT PUB 0 No PVT PVT No HTN; GERD; High Cholesterol; Osteoporosis 0 PUB OTH Pt takes CENENTA Unknown54mg ADHD Daily; CELEXA 08/19/2008~Hep 20mg Daily; A (noKLONIDINE brand name)~1~0~Pati 0.1mg Daily 26 CBC, ChemMIL 24, Thyroid, MILimmune ZOLOFT; studies all Cabergoline normal. None Prolactinoma-controlled; PTSD-Controlled 1 PVT PUB None None None 6 PVT OTH OR200935 6 PVT OTH OR200934 1 PVT PVT none; Redness, swelling to arm 7 Quick strepPVT neg; ThroatPVT CX pos. None None None 2 PVT PUB None None 3 CBC, UA < MIL CHEM 24, MIL Immune studies, None RF allNone negative. None No objective symptoms on exam. Rheumatology consult 0 PVT UNK None None None 0 None PUB UNK No NKA; No medical conditions 8 MIL MIL None None None 5 PVT PVT Vaginal yeast None infection 1 PUB PVT None indicated None indicated None indicated OR200933 None PUB PUB ALBUTEROL None Inh;known PRN. Exercise induced asthma OR200936 1 OTH OTH VYTORIN None None 16 PUB OTH Blood pressure No High Blood pressure 2 PUB PUB no 1 PVT PVT None COPD, Asthma, heart mummur, pneumonia 20 PVT PVT None 1 NONE PVT PUB None Balanitis None 1 PVT UNK None 0 Did not seek PUB med. attention PUB ~ ()~0~0~Patient 2 EEG #1 Poss PVT Abnormality; PUB EEG #2 Normal None None 1 PVT UNK PROVENTIL; TUSSINEX; PastXOPENEX; history of asthma; SYMBICORT allergies ###to cats and smoke. 0 Unknown OTH OTH Unknown Latex allergy; Exomphalos; Genital disorder Congenital female WAES0908USA04275 clubfoot; Meningomyelocele 4 OTH PUB NKDA Unknown OTH OTH None None WAES0908USA04511 0 OTH PVT None None None 0 Non PVT PVT None Deltoid swollen~Influenza SA0906 (Seasonal) (no brand 5 H/H as above. PVT9/18/09UNK Hospital discharge summary None received Precocious w/LABS: Puberty Pelvic US abnormal. Hgb 6.2(L). Initial von 0 PVT PVT Question of shrimp and tree nut allergies Unknown OTH OTH Unknown Unknown WAES0908USA04691 19 Resp. Failure; PVTBronchitis; PUB CerebralPROAIR; edema ZITHROMAX Teething; Fever ~DTP (no brand name)~1~0~Patient PVT PVT 0 MRI has revealed PUB a small PUBclot in his Nomedulla. No 9/22/09 Hospital None records Known. received 9/22/09 Hospital DOS 8/20/09 records to received 9/4/09. LABS DOSand 8/20D 0 None OTH OTH None Fever; Respiratory Unknown tract congestion WAES0908USA04714 PUB UNK none none 9 Done @ Hospital PVT PVT None 0 PVT UNK 0 None PVT PVT None None None 0 None PVT PVT None None No UNK UNK None PVT PVT VERAMYST Allergic Nasal rhinitis Spray DX:477.9 0 PVT UNK None Short stature. 0 PVT OTH None 0 none PVT PVT none Deltoid swollen.~Influenza SA0905 (Seasonal) (no bran 680 UNK UNK
45 UNK UNK No preexisting medical condition. 0 UNK UNK 0 None PUB PUB None None WV0907 1 None PVT UNK None None Pt. previously (couple yrs ago reported (L) arm weakness 0 PUB PUB None None 131 Neurology (17 MILSept 2009) MIL diagnosed none post-vaccination none myelitis none which was slowly resolving. Reflexes were all norma 25 2007, elevated UNKTSH 5.08 UNK (0.27-4.20); Thyroglobulin None Ab 53 None (0-20) and thyroperoxidase 537 (0-35); normal FT4 and PVT PUB None None None 0 Clinical improvement PVT with UNKobservation. No None 0 No correlation PVTexcept onset OTH of symptoms FLOVENT was44 None w/in X 21/hour. daily; Autism/ FLONASE dev delay/ 2 sprays asthma/ daily.seasonal allergies. 0 None OTH PVT NUVA ring (Lt) Calcaneous Nonesuperficial laceration 0 Unknown 11:45 PUB PUB Unknown 1 UNK PVT None None 4 PUB PUB None None None 0 0 test performed PUB by MD. PUB None None 0 Moms reports had RSV LA090806 as an infant. 0 NKA 0 PVT UNK Yes~Meningococcal (Menactra)~1~12~Sibling| 0 PVT PVT No No 9/3/09-records received- Mom has history of panic atta 2 None PVT PUB None Migraine headaches 0 PVT PUB No None PVT PUB None 2 None PVT PVT 0 PVT OTH none none none 0 none PVT PVT 0 PVT PUB Yes~Meningococcal (Menactra)~1~12~Sibling| 0 None PVT OTH None None Yes~Measles + Mumps + Rubella (no brand na 13 MIL MIL None None 6 None PUB PUB None None None 1 OTH PVT Diabetic 2 0 UNK PVT OTH No concurrent Unknown medication A0805211A 19 LABS and DIAGNOSTICS: PVT OTH CT - Negative. None X-rays Noneof C-spine, Nonechest, abdomen, pelvis - Negative. CHEM - Glucose 0 D F/U w/pt OTH 7:20 pm - She's PUB doing Unknown well; said it None wasn't seizure. Seizure (10 yrs ago). 1 none PVT PVT none environmental allergies 0 PVT PUB None None Asthma; NKDA None PUB PUB None None None 16 Neg for mono, PVTstrep, etcPVT None None 12 None OTH PUB None None None 1 None PVT PVT none None None 0 pulse oximetry-normal UNK UNK at 97% on room Multivitamin air None with fluoride except None common wart on (L) 4th finger 0 None PVT PVT 0 EmergencyPVT room-physician PVT assessment Pre-natal vitamins; none SYNTHROID NKA; hypothyroidism; 1st trim. pregnancy 0 OTH OTH ADVAIR; SPIRIVA COPD COPD PVT PVT bumps in hair~Meningococcal (Menactra)~1~1 0 n/a PVT PUB no no NKA, in 2003 exercise he hadinduced a respiratory asthma~Varicella illness with wheezing (Varivax)~2 an 0 none PVT PVT Poly-vi-sol vitamin, none probiotics cat allergy, strawberry allergy 13 LABS and DIAGNOSTICS: UNK UNK Abdominal Sonogram None- Abnormal. None.Abdominal 9/14/09 Hospital X-ray -records Abnormal. received CHEM DOS - Bicarbonate 8/27/09 to 28 0 None PVT UNK Qvar, Multivitamin, Rhinocort Patient has asthma, eosinophillic esophagitis and hypoalb 3 None PUB PUB None None ODH 0 PVT PVT Pt. takes singulair none and just zyrtec seasonal allergies 1 Food allergy PVT testing drawn PVT on 8/31/09. Flovent,Albuterol None Asthma 1 PVT UNK None No Mild asthma 0 PUB PVT ECZEMA (CHEEKS)
2 Stool sample PUB on 8/12/09 PUB and bloodwork on 8/18/09. Unknown Poor weight what specific gain tests performed. 0 MRI brain normal. UNK 9/2/09 UNK Consultant No record received None DOS No8/31/09. 9/17/09 Hospital records received DOS 8/31/09 0 PUB PVT 0 CT scan PVT PVT none no none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 PUB PUB NONE NONE KNOWN NONE KNOWN 0 PVT PVT none none - came none in just for vaccines 322 9/4/09-records UNKreceived-X-ray UNK confirmed degenerative COPD arthritis 9/4/09-records primarily received-PMH: affecting medialCOPD, compartment. dyslipidemia, MRI advanc GERD 1 PUB PVT 0 N/A UNK UNK N/A N/A 23 PUB UNK none had allergies to pollen AL0915 11 UNK UNK None None None 0 none PUB PUB none none none AL0917 2 None PUB PUB FeSO4, unknown unknown antihypertensive Has h/o anemia, med,hypertension, unknown sedative sleep disorder 1 PVT MIL 0 PUB UNK allergy to codeine 2 PVT PUB Albuterol 0 9/22/09 Medical UNK records UNK received w/LABS: CTNone Headknown - Abnormal. none known CBC9/22/09 - WBC 14.8 Medical 3/uLrecords (H) RBC received 4.05 6/uL w/PMH: (L) Hem Le 1 UNK UNK Paxil, Flax seeds-1 NONE TBSP Allergies ground, to PCN Vitamin andD,Bactrim Caltrate, Ambien CR, Simvastatin, 11 UNK UNK 15 EKG (results UNK were normal), UNK checked None oxygen level None(resultsSinusitis were 100%), and. 10/14/09 blood levels ED and wereHospital checkedrecords (potassium received wass 1 PVT PVT NONE NONE NONE 0 UNK UNK none none 1 UNK UNK none 0 PVT UNK None None None 1 PUB PVT fluoxetine, finasteride, loratadine, famitodine 1 None PVT PUB None None None 7 PUB PVT UNK PUB None None None 1 PVT OTH Concomitant Asthma Drug(s) Not Reported MEDI0008788 PUB PUB ABILIFY; PROZAC None Soft tissue mass - neck - 4 wks; depression. 0 Unknown PVT PVT Unknown Chickenpox WAES0908USA00396 0 computed axial, OTH 08/26/09 OTH Labs and Unknown diagnostics: Penicillin CT brain allergy PMH: WNL.allergy CBC/CMP to Amoxicillin/ WNL. WAES0908USA04708 drug screen (-). EEG abnormal. 17 PUB OTH None None None autism~Vaccine not specified (no brand name) 47 9/14/09 Hospital PVT records PVT received DOS 3/13/08 None to 7/15/08. Type LABS I DM;and Mild DIAGNOSTICS: cerebral palsy but Thyroid was Ultrasound an honor student. - Norma 9 1 CBC and diff PUB + within normal MIL limits. None None None~ ()~~0~Patient 0 PVT PUB 0 PVT PVT None None 1 none PUB PVT ZOLOFT; podacly; none clonazepam; Hx of highOTC cholesterol; MUCINEX panic attacks; Depression 160 EKG; Echocardiogram; PVT OTH Tilt table test; None EEG; Bloodwork. No LABS None.and 9/25/09 DIAGNOSTICS: ER records reeived EKG - Abnormal, DOS 11/10/08 sinusand bradyca 11/2 0 none OTH PVT none none None 1 CBC & CRP. PVT PUB None None 1 CBC & CRPPVT PUB None None Amox allergy; asthma. 1 None PVT PUB ZYRTEC; FLONASE None 3 PVT UNK MIRALAX; 81mg None ASA;MACROBID ZOCOR -> chest pain, short of breath 134 blood work PVT 8-14-09 to check PUB for cause Noneof hairNone loss None 4 Unknown PUB PUB None Motrin 7 PVT PUB 0 OTH OTH Thyroid med. No No 0 8/26/09 CBC PUB n except PUB thrombocytolysis; CMPNone normal. Eczema 2 PVT UNK 0 PVT PVT None None None
OTH PVT OTH PVT No Sensitive to Latex 1 PUB UNK CLARITIN Seasonal allergies; allergic rhinitis 2 PVT UNK NONE NONE NONE 1 PVT UNK Azithromycin ear infectionAmoxicillin, cephalosproins 1 PVT UNK No nkda 0 PUB UNK coumadin, sertraline, none albuterol, Leiden Factor singular 1 MIL MIL Yaz No None 1 na UNK UNK Singulair, Premarin, no Advair asthma, Norvasc, COPD, Demadex hypertension, anemia 1 PUB UNK zyrtec none latex, melon, sulfa meds, bactrim 2 comprehensive UNKmetabolic UNKpanel, cbc, urine analysis NONE,and HAD GERD. urine VIRAL culture, 10/13/09 URI 2blood WEEKS Hospital culture, PRIOR, records, stoolWHICH culture, DC summary WAS giardia MANAGED received and crypts 0 N/A PUB UNK Prozac - daily None vitamin that I N/A was aware of 0 PUB PUB None Hypertension, Hay Fever PVT PUB None None 4 PVT PVT None None None 1 PVT PUB none none 31 Varicella IgG/ UNK IgM (Patient's UNK spouse NONE - reports NONE childhood Varicella NKDA infection) NONE~ ()~~0~Patient|NONE~ ()~~0~Sibling|N 0 PVT PVT Metformin, Mobic, none reported Nexium, Diabetes Seraquil, none ASA, reported~ Provigil,()~NULL~~In Vitorin, Effexor Patient 0 None PUB PVT NA Cardiac disease, Adult Onset Diabetes 0 None PVT PVT None None None 23 HIV Ab 13 AUG MIL 2009 Negative MIL Ranitidine none none none~ ()~NULL~~In Patient|none~ ()~NULL~~I 0 UNK UNK hypothyroidism fever,diarhea~Influenza 9/8/09-records received-PMH: (Seasonal)hypothyroid (no brand n 0 NCHCT reportedly PVT wnl,PVT ChemistryNone and CBC wnl. noneEEG performed none results pending and pt will receive and MRI 2 PUB PUB seasonal rhinitis 0 Pt has scheduled PVT allergy PVT testing Sept. polyvitamin 21, 2009. none drops Dr. with has none suggested fluoride.25 continuing mg vaccines one at a time, not grouping 1 CT scan etcUNK 9/25/09 Medical UNK records receivednofor DOS 8/12/09 no 9/25/09 to 8/16/09. MedicalDiagnostics/Labs: records received CT for DOS scan 8/12/09 consistant to 8/ w 0 PVT UNK Levothroid, No spironolactone, allergies omeprazole to:cephradine,erythromycin, clindamycin,penicillin 1 none PUB PVT Metoprolol for None hypertension Hx of latent Herpes Simplex virus Hypertension - controlle 0 Chest x-rayUNK on 8/31/09UNK which showed aspirin mild 81right mg chronic daily, basilar gingivitis, doxepin infilatrate. none 10 dietmg The controlled daily patient hypertension, is in the study diet and controlled had coincidently hyperchh 0 CBC; BloodPVT culture; Urinalysis; UNK Lumbar puncture. None10/15/09 None. Received 10/15/09 Medical Received Records Medical and Records Discharge and Summary Discharge fo 0 Blood Cx: no PVT growth; Urine PUB Cx: noCaffeine; growth; CRP: Multivitamins Prematurity; 7.16; CBC: Prematurity; with Cholestasis 7.3, Fe;9.6, Folic Cholestasis; 28.8, Acid;66; Vit28% D;ELBW; Bicitra; Segs,Rickets; 11% Phenobarbital; Bands, Respiratory 45% Actigall; Lymph DistA 1 1156am 8/14, PUB CRP, 13.79 PUBmg/L; 11.9, Caffeine; 12, 35, Citrate; No 175; 43S, Vitamin BPD; 16B, D; 26L, Apnea MVI 13M; with of Fe; prematurity; caffeine, Actigall; 10.9; Vit Grade E; 8/15 Albuterol II6am, IVH with CRP, VM; 22.67 PDA mg/ lig PVT PUB None 29 None PVT PVT SYNTHROID None None 0 OTH PVT Unknown Unknown 1 OTH PVT 28 None PUB PUB None None None (FX 3 Proximal fingers - 8/29). OTH PUB 1 PVT UNK Right shoulder pain None PVT PUB Nausea & vomiting Was already having nausea & vomiting. 1 PVT PUB none none none 0 PVT PVT On birth control None(TRI-PHASIL) None 0 PVT PVT 1 None PVT PVT None 1 PVT PVT None None Known 3 THROAT CULTURE PUB OBTAINED PUB 9/2 NONE NONE NONE 2 none PVT PVT None None Torticollis 0 None, clinical PVT PVT TYLENOL PRN URI (viral); None runny nose; sneezing 0 PVT UNK 0 PVT UNK Nine None None Known 2 None PUB PVT
19 None
MIL MIL Unknown Unknown PUB PUB 2 None PUB PUB None None None 10 None PVT UNK None 0 None PVT UNK None Hashimoto's; Hypothyroid. 0 none UNK UNK none NKA 5 WBC countUNK was 9.2 x 10^9 UNK cells/L with 91% granulocytes. None None AST was elevated at 245 U/L. A urinalysis was without 0 OTH PUB none none none 17 cerebrospinal OTH fluid; blood OTH culture Unknown Unknown WAES0908USA04882 0 computed axial, OTH 08/08/09, OTHNormal Unknown WAES0908USA04339 0 diagnostic laboratory, OTH Blood OTH test Normal. DEPO-PROVERA 9/14/09 Ovarian PCPcyst; medical Caesarean Papilloma records section. viral received infection; 9/14/09 WAES0908USA04943 DOS Hypersensitivity. PCP 9/7/07 medical to 10/18/07. records 9/14/09 LABS received PCP an Unknown OTH OTH Unknown Unknown WAES0908USA05014 19 UNK UNK Birth Control Focal Pills seizures Acne ### 25 PUB PUB none none reflux 0 EKG-NORMAL, PVT PFT-NORMAL, PUB HGB-12.6, NONE RANDOM NONE BS-100 NONE 1 None PUB PVT No COPD,Asthma, 0 blood work PUB cat scan and UNK is scheduled for mri none and eeg onnone september 18, 2009. 0 PUB PUB same symptoms, "cold"~DTaP + IPV + Hib (Pe 0 Vital signs were PUB stable PUB when responsive N/A afterN/A incident, Accucheck Did report 86. previous episodes of fainting and seizures with 0 none UNK UNK calcium 600none mg. bid Penicillin none~ ()~NULL~~In Patient 1 Had a urinePVT test, throatPVT culture and blood tests everything came back Sister~DTaP negative + Hib (no brand name)~3~1~In S 0 N/A PVT UNK Ortho-Cyclen No None N/aA~ ()~NULL~~In Patient 1 PVT PVT HYPOTHYROIDISM 0 NONE UNK MIL One A Day None Vit Allergie to Nuts 2 none UNK PVT Xopenex HFA, noneNeurontin, Hypertension, Ativan, whole Nicardipine, diabetes, arm swelled~Pneumo Metoprolol, cholesterol,Fexofenadine, allergies, (no brand stroke, name)~ Fenofib COP 1 PVT PVT Synthroid None Hypothyroidism 2 None. PVT PVT None. No. None. 0 unknown UNK UNK Rebif 22 mcg NONE Multiple sclerosis x 10 years; patient's disease has been w 0 UNK PUB none none no fainted~HPV (Gardasil)~1~17~In Patient 0 NONE PVT PVT ESTRADIOL NONE 1MG, PRILOSEC NONE 20MG, FLEXERIL 10MG, FISH OIL, CALCIUM/V 0 PVT PUB NONE NONE NONE 0 PVT PVT Not sure, she had ear infections Sister~DTaP on and (no brand off andname)~5~4~In had been on amoxicila Sibling1 0 none PVT PVT Aspirin 325mg. N/A.qD He was Hypercholesterolemia here for physical exam. 1 PVT PVT 1) IbuprofenBronchitis 200 mg Tablet, None 3 Tablet(s) by mouth 2) Pseudoephedrine-DM-Guaif 0 PVT PUB NONE NONE NONE 1 None PUB PUB None Start of a cold None 3 None PUB PUB None None None 69 UNK UNK monofeme Cold (oral contraceptive)ventolin durig first asthma. vaccine - feltinhaler fine for(asthma) 2nd. 12 None UNK UNK none None noted/assessed. None noted. Patient was in clinic for sports physical. 16 CBC, ESR,PVT CRP, ANA,PVT RF, ASO, CMV, Parvo titers, all negative. 1 None UNK UNK None Well appearing child interactive awake alert 2 None at thePVT time of visitUNK Unknown Well appearing child 1 Not yet-no tests PUB PVT None None PCN, Fibromyalgia, flu-like symptoms~Influenza osteopenia, (Seasonal) (no bra 8 N/A UNK UNK n/a None Per patient taking high blood pressure medication 0 PVT PVT None None, None. 0 none PUB PUB none none none 1 PVT PVT Albuterol, Adderall, None Symbicort None 2 Autopsy was PVT performed. PUB 9/11/09 Autopsy Prevacid; received Tylenol None DOD Failure 07/09/2009. to thrive; LABS GEand Reflux; DIAGNOSTICS: Ht. murmur; Pre-maturity. Negative Radiog 9/11 0 PUB PUB None Omphalocele 1 PVT OTH None None None 0 OTH PVT None None
2 none PVT UNK CLARITIN; Well Albuterol child MDl check-up HTN; Psoriasis; Asthma; Obesity 2 PVT UNK 2 UNK UNK 1 PVT PUB Amoxicillin, allergic 1 PVT UNK 1 PVT UNK 1 OTH PVT lisinopril; LIPITOR; none PRILOSEC rxn to injectable dye; HBP; high cholesterol 2 PVT PVT None None None 0 None PVT UNK None No No 0 None PVT UNK None None 0 PVT UNK No 0 None OTH PVT None None Denies 0 PUB PUB none none 0 none OTH OTH Amitriptyline; None Levothyroxine; None Fluoxetine; Naproxen; Simvastatin 0 UNK UNK None PCN; Seasonal sameallergies symptom~Td Adsorbed (no brand name) 9 CT (head) PVT PUB None None None 2 None PVT PVT None 0 PUB PUB None None None 2 OTH OTH ALLEGRA D None 24 HOUR; Asthma DUAC GEL; DIFFEREN GEL 2 UNK UNK None None 0 OTH PUB Put on ibuprofen None & diphenhydramine No known for rxn 3 CBC - Urinalysis PVT - Flu test PUB- Strep test. T - 100.4 Rectal - runny nose - nasal cong. (+) urine HCG PUB (preg. test UNK later performed afterNone vaccine given) None GA09026 0 BP 113/67; PUB HR 68; Resp. OTH 18-20; Pulse None Ox 100% None Anemia GA09 1 None PUB PUB None None Erythromycin GA09028 0 PUB PUB None Known None Known GA09029 1 None PVT PUB None None 0 None PVT PVT None None Known 0 PVT PVT 1 No testing PVT PUB None None None None PVT PVT 2 PUB UNK No No GA09030 1 PVT PVT Meloxicam,None 15mg; Byetta Elevated 5mcg/0.02; laceration Celebrex on right 200mg; hand.Trazodone Hcl, 150mg; P 0 PVT PVT PREMARIN; None Simvastatin; Iodine; Acyclovir TYLENOL; TESSALON PERLE; Penicillin; Sulfame PVT UNK 0 9/14/09 Received MIL medical MIL recordsTYLENOL w/LABS: ALT/AST for None fever (H). None. Influenza, 9/14/09 blood, Received urine hospital & CSF c/s medical neg. records CSF glucose for 6/8/0 &p 17 Labs at hospital PVT pending. PVT None 1 OTH PVT PREMARIN; Vitamin E;Allergy-Codeine ACIPHEX; Vitamin C; CALTRATE; Multivitamin; Magnes 8 PVT OTH None PCN allergy 1 PVT PVT Unknown None 0 None PVT PVT None 13 PVT UNK 9/15/09 PCP Medical records received DOS 8/12/09 to 9/8 1 None OTH OTH CARDENE;None ENALAPRIL; Blood Simvastatin; clot; A-fib Methylxyleprene 0 BP 104/67; PVT HR 58; O2 PVT Sat: 99% on R.A. None None 0 PVT PVT 1032 PVT OTH None 0 None donePVT PUB 1 OTH PVT None None 2 None PVT UNK CITALOPRAM None HCTZ Amoxicillin 0 PUB PUB None 1 PVT UNK None
MIL MIL None None Eczema; Food allergies; Allergic to amoxicillin 1 PVT PVT PPD School physical None 16 PVT PUB CONCERTA; Joint STRATTERA; pain-wrist 719.40/314.01/477.9 SINGULAR 1 9/24/09 Discharge PVT summary PUB and medical Amoxicillin; records Bilateral TYLENOL received Otitis 9/24/09 for Media date Discharge of service summary 8/30/09 and to 9/3/09: medical Diagnositics/Labs: records received 0 PUB PVT none none none PVT UNK 1 PVT PVT POLY VI SOL vitamins 7 MIL MIL No None Unknown OTH OTH Unknown Unknown WAES0908USA05166 0 None PVT UNK None None None 0 PVT PVT synthroid and Eczema estrogenallergies-cortisone, patch neosporin, progesterone 0 Head CT WO PVT contrast PVT (negative), Cervical spine None4 viewsAllergy ( negative) to Augmentin 1 N/A PVT PVT N/A N/A PSEUDOESTROPIA/MYOPOC ASTIGMATISM 1 None UNK UNK NO KNOWN NONE OTHER MEDICATIONS 1 PUB PUB 1 REFER CLIENT PUB BACKPUB TO PRIVATE NONE MD IF INJECTION NONE AT THE N/A SITETIME GETS OFWORST ADMINISTERING VACCINES 1 PUB PUB 1 PUB PUB None none 280 NONE PVT PVT none Exercise hypertention, chronic renal failure (moderate), hy 0 PUB PUB 0 UNK UNK none related none to vaccination no known allergies 1 UNK PVT None 7 none PUB PUB none none Allergic to amoxicillen 0 9/16/09 ERUNK records received UNK DOS9/16/09 9/4/09. ER LABS records and DIAGNOSTICS: received Lamictal. DOS 9/16/09 9/4/09. CBCER - Trileptal, Neut records 77.2% Abilify, received (H) Lamictal. Lymph DOS 17.3% 9/4/09.(L). Asper CH 1 Flu A Antigen-negative. UNK UNK Flu B Antigen-negative. atenolol, calcitriol, No. WBC-13.8. calcium None. acetate, LABS 9/24/09 and clonidine, Hospital 9/24/09ferrous records Hospital sulfate, received records hydralazine, received DOS 9/4/09 DOS lantus, to 9/4 9/1 1 UNK UNK He was notNone feeling well, but was not running a fever or had specific co 0 N/A UNK UNK Keflex Dermatitis None 0 UNK UNK Valtrex, Nystatin,Diflucan, None Autism Strattera, Loss Celexa of auditory processsing~Measles + Mump 96 PVT PVT unknown none 2 PVT PVT Torticollis, GE reflux 51 carnitine level UNK low, scope UNK nl, fasting micronor blood sugar, atwell timeb12, of vaccination. folate, menorrhagia. heavyNow metal none~ PMH: onscreen, lo ovral, ()~~0~Patient|none~ Menorrhagia. sleep ponstel, study, ankle zofran, ekg ()~~0~Sibling pain. all carafate, nl as farlactaid as I 1 UNK PVT LOW-OGESTROL, PERCOCET 0 PUB PUB severe migraine requiring ER visit.~HPV (Gard 0 UNK PUB HYPERTENSION 0 n/a UNK UNK none none none 0 UNK UNK NOne I am a type I diabetic (diagnosed 30 years ago). 0 0 UNK PUB 1 Cardiolyte stress PVT test; chest PVT CT scan; ASACOL; pulmonary Calcium; Primary function sclerosing Vitamin None testing; D; cholangitis Aspirin heart catheterization; open lung biopsy 1 UNK PUB PVT Unknown In follow-up it was reported A0802994A that the subject has not experie 0 PVT PVT No medications Internal mass on left side of head - has VP shunt 1 PVT PVT 0 None OTH PVT VYTORIN; None Lisinopril; Estrogen; BYETTA; MTV 0 PVT PUB None None None known 1 PVT PVT No migraine~Tdap (Adacel)~UN~13~Patient 8 Had CBC, Blood PVT culture PVT and CRP at ER None-Ear infection None at ER 9/2/09 0 PVT PVT none none 2 PUB PUB No No 0 OTH PVT No No No 1 Requested OTH patient to return PVT to clinic AMARYL; but she refused. LANTUS; None She Levothyroxine; Diabetes; plans to see Hypothyroidism; Hydrocodone her PCP. Chronic pain 0 UNK OTH None 0 OTH PVT Unknown None Controlled seizure disorder
0 OTH PUB Unknown None Hypertension; Hypercholesterolemia 0 OTH PVT None Percocet allergy 2 OTH OTH No Codeine 0 OTH PVT None None 1 PVT UNK No HTN; Back & neck injuries 2 site reactionOTH PUB None 2 OTH OTH NEXIUM; PERCOCET; None XANAX; OXYCONTIN; COMBIVENT 0 OTH PUB SINGULAIR; None PIROXICOM; High blood pressured med 1004 None PVT PVT None None RAD 0 OTH UNK Oxycodone/APAP 5/325mg NKA 0 OTH PVT None 0 E Room gave PUB IV BENADRYL UNK - no BCP rash present None None 1 PVT PVT MIRALAX None notedADHD; Constipation 1 PVT PVT None None None 1 PVT PVT None None 1 None PVT PUB None None 0 PVT UNK 2 PVT PUB 24 pending visit PVT with neurologist PVT None Body ache;Seasonal pain on left allergies arm - not in treatment at this time 3 PVT PUB None None - WCE NKA (physical) 646 PVT PUB None Unknown Asthma 1 PVT UNK No No 1828 UNK UNK 1 PVT UNK Tetanus & diphtheria localized reaction~Pneumo toxoid; Pneumococcal (no brand - onset name)~1 7-16-2 PVT PVT 0 PVT PVT none none none 0 They diagnosed UNK her with UNK constipation none& pain in nonelower she abdomen. went none.in9/28/09 for This annual isER notschool records a correct check-up received diagnosis, DOSmy 8/4/09 daughter to 8/5/09. was n 1 none UNK PVT Unknown Unknown Unknown unknown~ ()~NULL~~In Patient 0 UNK UNK Propranolol 20mg twiceAllergy daily to mold and mildew. Recent injuries in car acciden 6 PVT UNK NOne food allergies:Milk, Wheat, Soy, Nuts. Allergic reaction to A 0 None performed PVT as of yet PVT none none none none~ ()~NULL~~In Patient 0 PUB PUB also recieved dtap shotwas reffered loss to aofspeech appetite,redness,stiffness therpist at the injectio 1 PUB PUB swelling in the injection site, redness, fever, bu 0 UNK PVT synthroid,cymbalta,provigil, None Nonemultivitamins,calcium, d, Preservision 183 The RA diagnosis UNK has UNK been established None at (after theNone time examination Hashimoto and blood (Thyroid) tests) on July 22, 2009 by Dr. at the Hospital 1 UNK UNK none 1 PVT UNK singular, prednisone, syncopy advair, pcn, erythromycin, cymbalta, nexium, ceftin, pepcid, codeinexyzal 1 PUB PVT NONE 2 Atrial Flutter, UNK increase UNK in enzymes. 9/9/09 ERnone records received congestive DOSheart 9/4/09. andLABS afib. and 9/9/09 DIAGNOSTICS: ER records received CK-MBDO 12 0 Received flu UNK vaccine and PUB pneumovax Atenolol/Diovan in left arm NONE atand 11:40am CNONE on Sept.5. By night had arm pain and by morning had 2 NONE PVT PVT Runny nose-minor asthma coldSevere symptoms Diarrhea~Rotavirus (no brand name)~3 1 PVT PVT Synthroid, antibiotics Absess on Left Hypothyroidism leg 1 PUB UNK None None None 3 not applicable UNK PVT unknown none none 1 Seizure 10/7/09 UNK ER record UNKreceived None for date 9/3/09 None Diagnostics/Lab: None Seizure~HPV CT scan of head, (Gardasil)~3~16.00~Patient UA. 0 UNK UNK 2 PVT PUB Toprol XL 25mg/da, None Fosamax C5-6 disc 70degeneration, mg/wk, Sertraline spondylosis; 25 mg/da, L3-5 glucosamine lumbar spinal 1500 s 1 urine bilirubin OTH test, 11/10/08, OTH Neonatal bilirubin: Circumcision 9.5 ug/dL; urine bilirubin test, 11/07/08, WAES0908USA04685 Neonatal bilirubin: 12.6 ug/ 0 Unknown OTH OTH Unknown Pregnancy NOS (LMP = 9/15/2008) WAES0810USA04754 48 head computed OTH axial, normal OTH Unknown Unknown WAES0909USA00007 35 Ultrasound,OTH ?/?/09, results OTHnot provided; hormonal Factor contraceptives. V activityUnknown. test, 9/18/09 ?/?/09, 9/18/09 Hospital results Hospital records not WAES0909USA00201 provided. records received 9/18/09 received DOS 7/8/09 Hospital DOS to 7/8/09 record 7/9/09 t
Unknown OTH OTH Unknown Unknown WAES0909USA00202 90 Unknown. 9/18/09 PVT Hospital/medical OTH Unknown records received DOS Unknown. 4/16/09 9/18/09 to 8/24/09. Hospital/medical LABS WAES0909USA00324 and DIAGNOSTICS: records received CBCDOS -W 2 Unknown OTH OTH Unknown Unknown WAES0908USA05165 Unknown OTH OTH Egg allergy; Allergy to nuts; Food WAES0909USA00028 allergy Unknown OTH OTH Unknown Unknown WAES0909USA00354 1 OTH OTH None Sulfa Drugs 366 2/11/09, CTPVT chest; 2/11/09, PVT D dimer none 1960. 9/11/09 none Hospital beerecords sting allergy; received L5-S1 DOS disc 2/11/09 herniation; to 2/17/09. LymeLABS 8/06. 9/11/0 and D Liver function OTH test, abnormal OTH Unknown There was no information A0798512A available regarding concomitant 0 OTH OTH 1 None PVT PVT None None Swelling~DTaP (no brand name)~1~1~Patient 4 Allergic reaction OTH PUB None Allergy to shellfish; Hx asthma 1 PVT PUB YAZ None None 0 PVT PVT Pt takes YAZ UA pendingPVT UNK None None 1 None PUB PUB None None Seafood -Shrimp 0 PVT PVT none none none 3 OTH OTH None None 0 BP 150/80; OTH pulse 68. After PVT 30 minUnknown 128/76; pulse Unknown/ 60. none Unknown mentioned 1 PUB UNK Pain in rightDID shoulder, right shoulder back and and neck. cervical thoracic 0 PVT PUB WCE Asthma 1 ER Dr. cellulitis PUBinfection. PUB AMOXICILLIAN No tid X No10 days. Merca OR200938 1 None PVT OTH None AMOXICILLIN allergy, Asthma. 0 ER - dx anxiety PUBattack.PUB PCP referred CONCERTA to neurologist, No appointment Penicillin next allergy, mo.bee stings, OR200937 mosquitoes, ADD. PVT UNK No None 5 PUB UNK LIPITOR; BP NoRX; PROZAC; Increased Hormone cholesterol; replacement MI2009010 BP; depression. therapy. 11 PUB PVT Been on this None 10 years,Asthma; SYNTHROID, Hypothyroid None~ .1mg/x/day ()~~0~Patient controlled MI2009009 with medicine 7 PUB UNK 0 OTH PVT None Resolving poison Allergicoak. to bees, penicillin, outdoor allergies. No history of 1 None PUB PUB None None Known 1596 Labs: Hgb A1C UNK7.5 BSUNK 400. FBS Lisinopril 190. UA trace HTN ketones.HTN. Glutamic PMH:acid HTN, decarboxylase dyslipidemia.antibody insomnia(+). 2' to 09/22/09 shift work reco Fa 0 URI; viral infection PUB by ER PUB none none none VA09:012 0 Varicella vaccine PVT givenPVT 8/6/09 andadvair, on 9/3/09 singulair patient none and had albuterol asthma, food epicutaneous allergic rhinitis testing with Control no Wheal no Flare PATIENT WAS PVT GIVENPVT 0.5ML OF FLUZONE ECZEMA ON 26-AUG-2009 N/A AND THEN AGAIN GIVEN 0.5ML OF FLUZONE O 0 PUB PVT 10 9-8-09 T/C UNK to parent, states UNK she has not taken client to Urgent care due to cost. State she doesn't have a PCP, doe 0 NA UNK UNK none no eczema 2 PVT UNK Daily asthma None. inhaler (symbicort), Asthma, facial zyrtec, tics.and guanfacine. 0 N/A PUB UNK Hormones, no vitorin N/A 3 MIL MIL Denies Denies Denies 2 N/A UNK PVT Unknown None No known allergies 1 PVT PUB Claritin None known Rhinitis 1 none PVT PVT none none none 3 PVT PUB 1 PVT PVT None None None 1 UNK UNK 0 NONE PVT PVT 2 995.2 UNK UNK Altrace, Clonidine, none toprolol, potassium 0 9/25/09 Medical PVT records UNK received for DOS 9/1/09 Noneto 9/2/09 Heart Diagnosis/Labs: murmur; Respiratory MRSA negative distress at birth 9/25/09 Medica 0 OTH OTH None None 3 Waiting for OTH patient call-back PVT with more information. Sulfa; Codeine; Quinolones; Nifedipine 0 PVT PVT None None None
0 PVT PVT None Pregnant 0 OTH OTH allergies: Varenicline; Tramadol; VICODIN; conditions: Os 1 PVT PUB BENADRYL 1 CBC; C-reaction PVT protein; OTH None None Save Symptoms~Influenza (Seasonal) (no bran 1 PUB PUB None Stuffy noseNo only 0 UNK OTH 3 PUB PVT TB test, Sanofi None Pasteur, C3060AA, IM Left arm 0 OTH PUB 3 Chemistry, PVT HematologyOTH - and Lyme titer - negative. None None 0 OTH OTH ZOLOFT 100mg qd Asthma stable for yrs per pt. OTH PVT None None 1 PVT PVT ADVAIR PharyngitisAsthma 3 None PVT PVT None None PVT UNK No 31 See attached PVT pre & post PVT charts, EINone evaluation,None Genetics evaluation Mild expressive - see speech attacheddelay. Labs No andreceptive Diagnostics: delay.Chromos PMH: m 2 None completed PVT UNK Concurrent illness: none. The ### patient had no known allergi 1 OTH OTH ### 1 UNK UNK NO known allergies. ### 1 CBC and sed PVT rate wasUNK to be performed None None None ### UNK UNK The patient had an unknown past ### medical history. The pa 1 UNK PVT OTH The subject had no adverse A0799188B events following previous vac 0 UNK OTH OTH Unknown There were no known concomitant A0805392A medications. 0 UNK PVT Lisinopril, Toprol none XL, Klonopin, Lovastatin, shivering,Levothyroxine, chills~PneumoTriamterene/HCT, (no brand name)~NU Alev 2 PUB PUB 0 PVT UNK Sulfa 0 diagnostic laboratory, PVT 05/05/09, OTH lesion LORTAB; type: aspirin; vesicle; MOTRIN; diagnostic Chickenpox TOPROL laboratory, XL05/05/09, tablets WAES0907USA05837 rash type: herpes vesicular; V 5 Unknown PVT PVT Unknown Delayed delivery WAES0909USA00325 1 Unknown PVT PVT Unknown None WAES0908USA01926 Unknown OTH OTH Unknown Unknown WAES0909USA00049 42 ultrasound, OTH 01/20/09, Single OTH Live Intrauterine None Pregnancy Pregnancy,NOS 12 weeks, (LMP =2 10/31/2008) days; diagnostic WAES0905USA01040 laboratory, 08/08/09, Cord p Unknown OTH OTH None WAES0909USA00206 magnetic resonance, PVT 05/01/09, OTH abnormal. ALESSELABS and DIAGNOSTICS: Unknown 9/16/09 CT Brain Received WAES0909USA00318 - Abnormal. medical MRI records Brainw/PMH: - Abnormal. Aller 41 12/6/07 - ER PUB - Spinal Tap OTH and CT Lisinopril scan - 12/7/07 None - MRI - High All blood blood work pressure 0 Unknown 9/25/09 PUB Medical PUBrecordsnone received stated DOS Prior by mom 9/2/09 to vaccination to 9/3/09: Latex - Bandaids none Diagnostics/Labs: stated 9/25/09 Medical CBC, records Chemistry, received CRP, DOS UA W9 0 EEG- Hypsarrhythmia PVT PVT Labs and Diagnostics: Septra 1/2 tsp Right EEG POabnormal-hypsarrhythmia. otitis BIDmedia Cleft lipBox and18: palate purulent PMH: Auditory earcleft drainage Evoked lip/palate-with Potentials repair. abnorma 36 we 0 MIL MIL Insulin; AMOXICILLIN;Acetaminophen; DILTIAZEM Swelling~Influenza HYDROCHLORIDE; CODEINE; DEMEROL; (Seasonal) SALMETEROL MORPHINE. (no brand XINAFO name 0 Referred toPVT EmergencyOTH Dept. for further None evaluation None and treatment. No 1 PVT PVT None None 0 PVT PVT 0 None PVT PUB None Sulfa, PCN 0 None PVT PUB None Sulfa PCN. 6 None PVT PVT None None Eczema 392 OTH PVT ZOLOFT, PROTONIX, None None CRESTOR, CARDIZEM, MultVita plus Vita B and C, Ome 10 None PUB PUB None None Seasonal allergies Fever 102 up degrees to 18 months X 2d of hives age.X 1d~Hep B (no 1 None PVT PUB None None 1 None PVT PVT None indicated None indicated None OTH PUB ALBUTEROL None Inhaler as Noneeded. 286 10/6/09 medical PVT records OTH service dates 2/10/02none to 9/09/09. none. LABS 10/6/09 andSeizure.~Measles DIAGNOSTICS: medical recordsEEG +service Mumps - Abnormal. dates + Rubella 2/10/02 CT(no Brain tobran 9/0 1 PUB PUB None None 1 PUB PUB 0 PUB UNK
None
OTH PUB PRILOSEC,No FCL, HCTZ, NoMethotrexate, Bupropion, LIPITOR, Betamethasone Dip 0 MIL MIL 116 PVT UNK None None 1 None OTH PVT ASACOL 400 Ulcerative mg 8 tabs Colitis daily; SIMVASTATIN 20 mg 1 tab at bedtime; ALENDRO 0 PVT PVT None None Latex Allergy 1 PVT PVT OCP-levonorgestrel Mild cough -EES; Dysmenorrhea; illness; DRYSOL menstruating prn hyperhidrosis topical 0 WBC 12,100; PVT82%. PRN; PVT Hgb 14.6; FLONASE Platelets LAMISIL None 203,000; PO Bili LEVAQUIN; 250 2.21; mg;Disect ALLEGRA Aspirin. .26; LFTS 80 mg; WNL BinBif PULMICORR. 13 Cr 1.1. 0 PVT PUB None 0 None PVT PUB None None None 0 PVT PVT None None None 0 PVT PVT None None None ~Hib (no brand name)~2~0.30~Patient 1 PUB PUB 2 PVT PUB None Augmentin 0 MIL MIL BICILLIN None 0 None OTH UNK None/Unknown None 2 PVT PVT 0 UNK UNK Levothyroxine, None Metroprolol No 0 PUB PUB PVT PVT None 0 None PVT PVT Ibuprofen None 0 None PUB UNK None 1 PVT UNK None None 2 PVT PVT 0 none PUB PUB ibuprofen, acetaminophen, no illnesses. nopatient allergies acetaminophen wasorvaccinated medical with conditions post-delivery codeine, docusate, of babyprenatal vitam 14 N/A PVT PUB clindamycinacne, gel, salicylic dandruff unknown acid topical, benzoyl peroxide 1 UNK UNK none none none 1 PVT PVT none none 0 PUB PUB 0 PVT PVT 0 PVT UNK OTH UNK Acyclovir; HYZARR; Fever; Swelling; TRAVATAN Unknown redness; Z per welts. profile PUB PUB No meds No illness No pre-existing redness, conditions warmth,hardness~DTaP or allergies noted by + HepB parent.+ IP 0 None PUB UNK Lotrel 10mg-20mg Hypertension, capsule shellfish-Hives Colon po daily, Cancer, last does s/p recent 9/7/09treatment PUB PUB 1 None UNK UNK tylenol, asa,UTI dulcolax, clonidine, Pt. was allergic B12, doripenem, to PCN, andlovenox, cephalosporin levaquin, morphine, M 2 NONE PVT PVT NONE NONE NONE 1 None PUB PUB None Known No None Known 0 "Pt is fine". PUB PUB 1 none PUB PUB none none PCN, Codeine, Sulfa 0 None. PUB UNK None. None. None. 1 PUB PVT None None None 0 PVT PUB 0 UNK PVT None None 0 Food allergy PVT (egg) panel PUB pending.No NONE other testing NONE HEMANGIOMA - NECK 1 PUB PVT 2 pt developed PVT a fever of PUB 103 2 days none after vaccination. none Fever none resolved after 36 hrs . vomited x 1 2 None PUB PUB Remicade Infusions None last Rheumatoid 7-22-09, Vitamin Arthritis, C, Osteo Calcium Arthritis, Citrate,Hearing Promethazine, and Balance Aza 2 None of theUNK tests that patient UNK has none endured have none determined none a cause for the seizures. 10/20/09 Medical record rece 0 PUB PVT SUDAFED ACTIFED ASTHMA 228 CBC's.Coobs UNK test. Bone UNK marrow aspirate None. Atand the None BM time biopsy. of vaccination. Short ANA.Stature Retic Treated count. 9/28/09 with LDH. Medical Growth Complements. records Hormone and Chest from DC age summary x ray. 10-13 Sero re 1 none PVT UNK remission from crohns crohns disease disease
1 MIL UNK Fibromyalgia; Arthritis; Depression; Chronic Pain; ETC. 3 PVT PVT Garlic; FishNone oil; ASA 81None mg 0 NONE PVT PUB None None None 25 State Lab ran UNK PCR for UNK Vaccinia onNone trunk scraping/swab No &Elevated oral lesion Serum swab. Albumin/Globulin Negative. Alsoratio negative - Recurrent for Herpes - Norm by 2 PUB PUB 9 Myositis with PVT Elevated PVT CPK of 4,164. Synthroid, ANA, RF ctomel, Nonegatiive Bioidentical Pseudocholinesterase hormones deficiency 0 NO TESTSUNK PERFORMED UNK QVAR, XOPENEX, NONE. Seen TIZANIDINE4MG, Note for in fluabt shot, 2002 for had a prna diuretic pneumonia rx invaccine case of with edema an injectio occure 1 UNK PVT None applicable None Allergy to pre-exposure rabies vaccine given in 1968 (arm 0 None PUB PUB None None None; was born premature 51 LABS and DIAGNOSTICS: PVT PVT Rheumatoid Factor Asthma; 28 (+).Scoliosis; Anti-Saccharomyces Pistachio; Migraine reaction HAto Cerevisiae valium. Received Antibody2(ASCA) doses Hep (+). X-ray A vac 0 OTH UNK 10 None PVT PVT None None None 0 MIL MIL 0900 am started Allergic tingling to SULFA 0 PVT PUB capillary hemangioma on lip 2 OTH PVT Unknown Asthma 0 PVT PVT None None PVT PVT None None 0 OTH OTH None None Allergic to milk 0 None OTH PVT None None Allergies - food 1 CBC PVT UNK 4 PVT PVT 1 L arm formed OTH a blister OTH at site after 48 hours; RNone arm bruised Rheumatoid after 48 hours Arthritis; Asthma 1 PVT PVT None Amoxil; Nuts 0 PVT PVT Albuterol prn None mild asthma Seasonal 0 PVT UNK None None 0 OTH OTH None None 0 OTH UNK None Known Dx of Eczema age 11 3 None OTH UNK None None Poison Oak tx'd with Prednisone 10mg 8/17/09 PVT PVT None PUB PUB None reported None 0 Electrolytes;PVT glucose nl. PVT None None 1 PVT PVT SINEMET; Parkinson's MIRAPEX Allergy-sulfa; disease Parkinson's disease; Osteoarthritis 1 PVT PUB 1 None MIL MIL None None None 1 None PVT PUB Asthma NOS w/o status asthmatics 1 None PVT PVT None None OTH UNK None 1 PVT UNK None None 0 PUB PUB None Denied Denied 0 PVT PUB None None 3145 Clinical observation PVT PUB Unknown None 1 Glucose PLASMA, UNK 80 mg/dL; UNK Ureanone Nitrogen PLASMA, none 14 none mg/dL; Creatinine PLASMA, 0.9 mg/dL; Urea Nitrogen/C 14 Blood work PVT done continuously OTH throughout the six weeks 7 None PVT PUB None None None 0 PrednisonePUB 20 mgm #6PVT 3/2/1; BENADRYL PRN. None Asthma; Allergic fever/sore~Tetanus to AUGMENTIN Toxoid (no brand name)~U 2 UNK PVT PVT Unknown No concomitant medications A0806120A or relevant medical history. N 0 PVT PUB None None None 1 PVT OTH None None 0 OTH PUB 1 None MIL OTH 7 PVT OTH 6pm 8/20/09 No
0 Unknown OTH OTH Unknown Unknown WAES0909USA00557 None PVT UNK ADVAIR The patient had no illness at the ###time of vaccination and sh 0 CT Scan; CBC PUB9/27/09UNK Hospital records received Headaches9/27/09 DOS 8/31/09 toHospital 9/2/09. records LABS and received DIAGNOSTICS: DOS 8/31/09 CBC to -9/2/09. MPV 6 9 MRI being done, PVT results PVT pending None Autism OTH PVT None None 1 None PUB PUB Unknown None Allergic to PCN; ? Latex allergy None PVT PVT None For well child None care 0 PVT UNK SEASONALE None (BCP) 154 None UNK UNK None None 0 Bloodtests, UNK CT, MRI, EEG, UNK ENT-Doctor twice, x-rays. All None these9/29/09 tests were Medical donerecords betweenreceived April and from May dates 2009. of 9/29/ serv 7 to be seen by PVT her neurologist UNK 1 PVT PVT TRISPRINTEC none 0 UNK PVT None None None 0 None PUB PUB None None None 0 Pulse Ox 97-98% PVT on Room PUB air None@ Vaccine Had similar3/19/09~Measles reaction 3/19/09 to + Mumps MMR; Congenital + Rubella hydrocep (no brand 0 UNK PVT None None/Body Temp 98.3 1 PUB PUB no no 0 PUB UNK 0 PVT UNK None "head cold"None known 0 UNK UNK 1 None performed. PUB UNK None. None. 81 9/15/09 PCP UNK medical records UNK received NoneDOS 7/10/07 No. 9/15/09 to 8/24/09. None. PCP medical 9/15/09 LABS Fainting~HPV and records PCPDIAGNOSTICS: medical received (Gardasil)~2~13~Patient records DOS Rapid received 7/10/07 Strep to DOS (+). 8/24/09. 7/10/07 MonoP 6 All laboratory UNK tests were UNK normal. Bun flaxseed and Creatinine oilNo 2000mg illnesses were perat day, normal. time vitamin of Dehydration vaccination b6 tablet once was ruled a day, out. prozac Temperature 20 mg once wasa 9 5 UNK PVT guillaine-barre~Influenza (Seasonal) (no brand 5 PUB PUB acetaminophen noneatenolol, obestity, glipizide, HTN, HCTZ, PVD,lisinopril, DJD, diverticulitis, methocarbamol,pioglitazone, hyperlipid, onychom 1 PVT UNK Amoxicillin (amoxicillin), 1 Depression NKDA 500 DIAZ, mg,HEATHER capsule Elavil 09/07/2009 (amitriptyline), 2 Diabetes 25 mg, tablet Mellitus 0 PVT PVT None Reflux, Asthma, environmental allergies, food allergies-mil 0 PVT PVT Flonase None 0 PVT PVT None 0 none. PVT UNK 1 PUB UNK 53 None. I do UNK have copies UNK of all medical Yaz history until 3/17/08. None from 01/08/2004 Femcon Nonebeginning to theNone~ time 3/17/08. of()~~0~Patient her Anaprox death that asI needed. can provide if needed. 8 MRI of headPVT and spineUNK +/- contrast with smallNone areas of intensity. LP with CSF normal, including evaluation for oligo 11 PVT PVT none none none fever of 104~Measles + Mumps + Rubella (no b 0 n/a UNK UNK none none none 0 UNK PVT Friedreich's Ataxia Diagnosed March 2009 0 UNK UNK Zoloft - 50 mg Patient hadnone flu/virus symptoms the prior week but was not suffering fro 0 MIL PVT n/a none seasonal allergies 1 UNK UNK none knownnone none known 0 allergic reaction UNK from influenza UNK vaccine 1 PVT UNK Chest pain 0 visited doctor, UNK no testsPVT lisinopril, hydrochlorothiazide, none Iodine allergy, maxide, nausea, essential atenolol, weakness, hypertension, probenecid, aches~Influenza baby gout,aspirin asthma (Seasona 52 Doctors performed UNK many UNK tests andNone. we came 9/18/09 back None. PCP with 9/18/09 medical noNone. answers. PCP records 9/18/09 medical Other received PCP records than medical DOS positive received records 10/2/06 results DOS received tofor 6/27/08. 10/2/06 numerous DOS to Ortho 6/27/08 10/2/06 yeast Tri3 UNK OTH OTH Unknown A0806613A 0 BP @ 1407PVT 130/80; BPPVT @ 1410 160/82; BP @ Diarrhea; 1425 164/82 Weight Penicillin lossAllergy; Emphysema; High BP; Renal Failure 0 Blood Pressure, OTH stablePVT 1 PVT UNK DEPO-PROVERA; Not ill- 9/9/09 PROCTOFOAM NKDA - None 0 Wt - 103#; Oral PUBTemp -PVT 97.4 none asthma 0 PVT UNK 2 None PVT UNK None None None Sever fever and seisure~Measles + Mumps + R None PVT PVT None None None
1 WBC 22.3; PVT GRAN 89.0 OTH (Drawn 9/9/09 after visit) Elevated WBC count 0 PUB PUB ZOVIRAX 200mg Cold symptoms divided None by 5xday; MOTRIN; Antihistamine 0 OTH PUB Unknown None None 0 Blood workOTH UNK None 0 UNK UNK none none none 3 Crp 8.40 911ccl PVT 127 (normal UNK on 9/10/09)AST FLUOXETINE, None Co4FLUTICASONE, ALT 94 HTN, (38 & NASH/fatty 52KETOCONAZOLE, on 9/10/09) liver allergy (>) quick to LISINOPRIL-HCTZ, FEXOFENADINE strep 7.4, 15.2, 275 METAM (increas 0 None UNK UNK 0 PVT PUB SYNTHROID None Preterm 27 weeks; GERD; Hypothyroid None PUB PUB None Febrile seizure Dx at 9 months old Unknown OTH OTH Unknown None WAES0909USA00464 0 None OTH OTH Surgery WAES0909USA00635 cervical smear, OTHabnormal OTH Unknown Pregnancy NOS (LMP = Unknown) WAES0909USA00783 120 Unknown. 9/18/09 OTH Hospital OTH records hormonal receivedcontraceptives DOS 5/27/09 9/18/09 to 6/4/09. Hospital LABS records andWAES0909USA00762 DIAGNOSTICS: received DOS 5/27/09 CT - Abnormal. to 6/4/09. Ve 87 Unknown OTH OTH Unknown Unknown 9/29/09 Received WAES0909USA00753 medical records w/PMH: idiop 0 Unknown OTH OTH Fear of needles WAES0909USA00773 0 N/a MIL UNK None Allergies to strawberry, eggs, outside and inside, sinusitis, 1 PVT PVT none none allergic to sulfa 0 None UNK MIL Bacitracin 500U/g None topical Acne. ointment. Metatarsalgia. none~ Hydocodone/Acetaminophen ()~NULL~~In No known allergies. Patient|unknown~ 7.5-500mg ()~NUL PRN 435 Still doing tests. UNK Will have UNKmri and eeg. LABS none, and healthy DIAGNOSTICS: none 9/15/09 Cranial Received CAT medical Scan Unremarkable. records w/Menactra, CervicalLot Spi# 1 She had a sonogram UNK showing UNK ileocolic none intussesseption None which Nonewas not reducible with air enema. She went to the OR 0 PVT PVT 1 PVT PVT valtrex none knownnone knowncellulitis~Tdap (Adacel)~NULL~25~In Patient 0 PUB UNK Hydroxychloroquine none 200 Allergies: mg TabXylocaine Take 1 Tablet, HCl:Hives, PO 2X Rashweekly-Iodine ASA--Calcium : Hives, Ra 2 PUB PUB ALLERGY TO CEFZIL 0 PUB UNK Hydroxychloroquine None Oral Overlap - ASA-Hydroxychloroquine syndrome - lupus, Sjogren's, Oral -restasis RA c/beye CVA drops and 0.0 h/o 0 PVT UNK 0 PUB PUB none, at 4 mo. allergies: immunizations zithromax, "took seasonal 2 months to recover and be back 0 Upon examination UNK a blood UNKtest showed None WBCsNone within normal Chronic limits. neck Patient's pain; spondylosis vitals were checked of lumbarand region. the patient ha 2 PUB PVT 0 None UNK UNK None Celiac Sprue None~ Disease ()~~0~Patient 1 n/a PUB PVT n/a none n/a 23 EKG, CT scan, PUBnumerous PVTlabs Vitamins None None 0 None PVT UNK Fluoride drops None PVT PVT none 0 PVT PVT NA NA Previous GERD Similar reaction~DTaP (no brand name)~4~1~I 1 PVT PVT NONE NONE 0 PUB UNK Sulfa allergy Culture (results: OTH S. pneumococcus) OTH Concomitant was doneUnknown on medications an unspecified Relevant weredate. not medical reported. history USWYEH10816209 was not provided. UNK UNK ### 18 UNK UNK Prenatal vitamins No medical history, allergies, or ### medical conditions; no pre 27 MRI head; EEG; PVT Echo;PVT carotid ultrasound. None 10/1/09 10/1/09 Consultant Consultant Allergies records records to PCN. received received 10/1/09 DOS DOS Consultant 8/28/09. 8/28/09. records LABS Fatigue, and received DIAGNOS leg stiffne DO 53 PUB UNK None None 2 CBC PVT PVT Claritin PRNNone 2 previous febrile seizures OTH PUB None None None 0 PVT PVT Lisinopril - HCTZ; Oxaprizin-600mg 0 Unknown OTH PVT Warmness Unknown feeling 2 None PVT PVT MVI; CLARITIN None None 0 PVT OTH None No Peanuts - anaphylaxis 2047 PVT PUB Fluoride; Multivitamins None None 1 None takenUNK PVT None None 1 PVT PVT Well child check NKA
7/30/09 HCS=Positive MIL MIL 0 OTH UNK LISINOPRIL No No No~ ()~~0.00~Patient 2 PVT PVT None Well child cheek 2 PVT PVT Well Child Check NKDA 1 PVT OTH None None Hgb, trait 6 None PVT PVT None Hospitalized 8/18 to 8/20 with UTI with bacteremia and fev 1 None MIL MIL Allergra None ASA/PCN A+ 1 PVT UNK None None 0 None PVT UNK None None 0 PVT PUB MYCOLOGDiaper cream rash to diaper area PVT UNK None None 18 PVT PUB MultivitaminNone DEMEROL 1 28 wk gestation; PUB CXR after PVT event with Oral poss Fe aspiration; Growing Preemie Hct 28after wk gest event at 24.8 delivery; (chronic anemia anemia of prematurity of premat) 0 None. Patient PVT was advised PVT by administrator Estradiol, Cymbalta, that None. it was generic anNone. allergic Wellbutrin reaction. None.~ Advised ()~NULL~~In to take Patient Benadryl and ibuprofen 586 9/22/09 Pneumo UNK StudyUNK SAE report hospitalization COPD DOS 8/24/09 9/22/09to Pneumo 8/27/09.Study LABSSAE andreport DIAGNOSTICS: hospitalization C. Diff. DOSCult 8/2 UNK PVT none 1 Asymptomatic PVTUTI present UNKat timevitamins, of vaccine. temazepam none-only All other routine asymptomatic, (PRN) none lab work none~ undiagnosed was()~NULL~~In normal. UTI Patient|none~ ()~NULL~~I 0 PUB PUB PT. HAS HISTORY KEFLEX,CECLOR. OF GLAUCOMA. PT HAS GLAUCOMA. 0 UNK UNK Adderall 15mg None daily, Dextrostat ADHA 5mg prn 0 No labs were PVT performed PVT on her doctor budesonide visit onNone (RHINOCORT 9.10.09. AQUA) 32 MCG/ACT NASAL SUSP cetirizine-p 1 PUB PVT BCP None none none~ ()~NULL~~In Patient 0 NONE UNK UNK TYLENOL AS NONE NEEDED NONE SC0928 1 PUB PVT Shellfish, peanuts 1097 PUB PUB 0 PVT UNK 1 none PUB PUB none none; reports seasonal "felt fine" allergies 0 none PUB PUB Depakoate;none aspirin; psych Emphysema meds Sister is allergic to eggs does not take seasona 0 UNK UNK unknown none patient could not receive injections in left arm due to a prev 1 Had PPD placed UNK the same PUB date and None time of MMR Nonevaccination. None PUB UNK None None 0 OTH PVT None None 1 None OTH OTH None 0 PUB PUB Allergy to high dose NAPROXEN 7 OTH OTH None reported or observed. Pt did have a rash 5 hours before inj. 7 OTH PVT none 0 Blood pressu OTH 106/60 mmHG; PVT Pulse 65 BPM None -10 None OTH PVT None allergic to fur; apples 1 PUB PUB None None 9 PVT PUB None 2 PVT UNK None None 0 PVT PVT ACETAMINOPHEN No Omphalitis; Umbilical Hernia 1 UNK PVT None 1 Awaiting results OTH PVT OTH PUB 1 None PUB UNK None None None 1 PVT PUB 6 None PVT PVT LOTREL; VYTORIN; None NKDA GLYMPRIDE; B COMPLEX; ASA 0 none PVT PVT None None 0 OTH PVT 0 OTH OTH Lisinopril 2 OTH UNK None None
1 PVT PUB Albuterol inhaled None solution None 0 None OTH PVT SINGULAIRAsthma; 10mg; PROVENTIL Influenza Asthmaprevention HFA MDI (PRN) 42 OTH PUB None was not aware she was pregnant 1 PVT PUB 1 PUB PVT None None 1 None PVT PUB None None 0 PUB PUB None None None 0 None PVT PUB None None Autism 0 OTH UNK 0 PVT PVT None None None 0 PUB OTH LEXAPRO None 5mg/daily Allergic to sulfa; Denies any other medical conditions 0 PVT UNK None None 1 CBC w/diff;PVT Flu test; Strept PVT test, all normal 1 UNK PVT Unknown Allergy to penicillin and DIFLUCAN 1 PVT PUB none none 1 Seeing pt today PVT 9-11-09 PVT for office visit - givennone prednisone. Asthma; Hypothyroidism; depression 1 PUB UNK MIL OTH None 19 7/20/09, CRP, UNK 11.0 H; UNK CMP wnl except none 105 H, none AST 50 H;environmental CBC wnl except allergies WBC (self 11.8 diagnosed); H; 7/20/09, CT migraine Lumbar headac Spine 1 OTH OTH Unknown NKDA; NKFA 1 WBC 9.5, 72% UNKneutrophils; UNK CMP normal, UA none normal, CXR none including PMH: none spine noted. normal, Lyme negative; CSF 0 WBC, 0 R 0 none PVT PVT none none none 0 UNK PVT 10 Possible Non-viral MIL Pustulosis MIL N/A NKA 1 UNK UNK non listed no no, howeverna~ patient's ()~NULL~~In husband Patient|na~ mentions the ()~NULL~~In next day she Sib 0 n/a UNK UNK prilosec prnnone none 1 chemistry/serology PVT demonstrate PVT elevated digoxin, amylase diltiazem,morphine, acute and pancreatitis lipase no known prior ondansetron allergies, to injection; dementia SGOT and (ageSGPT related) elevated slightly d 51 UNK UNK None Allergies: Metal (dermatitis), antihistamine/decongestant c 0 None. Called PVT Dr. OfficeUNK regarding None fever, as is None listed on the None CDC form and was told that it couldn't be from the nasal 0 UNK UNK veraspimil 240 ear infection mg cozaar chronic week 50mg preceding asthma/high amoxycillin measle like blood 500mg rash~Measles pressure/anxiety + Mumps disorder/majo + Rubella 1 MIL MIL 0 PUB PVT none none none 6 PUB PVT 5 mg crestor none daily serious reaction to polio vaccine~Polio Virus, O 1 PVT PUB FLONASE; None CLARITIN;Chronic MV2; SENOKOT; constipation; MIRALAX; Renal allergies CASTER OIL OTH OTH No other medications Colitis Ulcerative MA20092378 OTH OTH No other medications Unknown Ulcerative colitis MA20092379 10 10/13/09 Received OTH MROTH from Hematologist. Diagnostics/Labs: No known Platelets medical 1(L),history. RBC 4.26(L), Concomitant ### WBC 12.6(H), drugs and Neutrophi illness 0 Unknown OTH OTH None None WAES0909USA01041 21 None OTH OTH Unknown WAES0909USA00746 33 beta-humanOTH chorionic, OTH 11/17/08, positive None Pregnancy NOS (LMP = 10/20/2008) WAES0811USA02648 730 magnetic resonance, OTH 01/??/08, OTH was None diagnosed with mild None CHIARI malformationsWAES0908USA04768 and the rest of the MRI was norma 0 Unknown OTH OTH ORTHO EVRA None WAES0909USA00694 DAP and gave to 18 month old instead UNKof DTAP. UNK Letters too similar or rather same in just different order. Mom said child had diarrhea for 2 1 PUB PUB None None Asthma-type s/s, 1 year AR0931 ago, resolved. Allergy to Penicillin 9 None OTH UNK None None None OTH PVT prenatal 0 PUB UNK 1 PUB PUB None Multiple Rx None~ allergies ()~~0~Patient|None~ ()~~0~Sibling 0 PUB UNK 1 PUB UNK None 19 PVT PUB BENADRYL
0 None 11 3 None 620 None None None None None None None None None None None None None None
PVT PVT None None None PVT UNK None None PUB PUB None Febrile Seizure Dx at 19 months old PVT UNK Cough OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None None OTH OTH None None None UNK UNK None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None None OTH OTH None None None 3 NONE PVT PVT BENADRYL;ALLEGRA SEASONALEXERCISED ALLERGIESINDUCED ASTHMA 10 none UNK UNK none no none 2 Pt is havingUNK a liver panel UNK drawn this none am but upon nonecalling mom NKA-none this am, medical mom conditions reports pt is reported less jaundiced and continu 1 PUB PUB None None 1 UNK UNK SC0922 2 PUB PUB Unknown unknown 2 Biopsy - SEVERE UNK SPONGIOTIC UNK DERMATITIS Zonegran, Keppra, None WITHMiralax, PROMINENT GlobalPoly-Vi-Sol developmental INTRAEPIDERMAL delay, Chromosome BLISTER FORMATION abnormality, se A 1 PVT PUB None None None 0 PVT PVT Tenormin 50mg Nonedaily, Vitamin Allergic D to 50,000 beans and IU once peanuts; a week nitrofurantoin; --C-sulfa ant 0 PVT PVT none congenital hypotonia, developmental delay. 0 UNK UNK allergy congestion allergies seasonal 0 PVT UNK 0 none, she did UNK not seekPVT medical care followingnone the vaccine no known allergies, hx of hiatal hernia 1 UNK UNK none none none 0 PVT PVT Trileptal and Complex Lamectal, Partial Complex twice, Epilepsy daily. Partial - no Epilepsy symptoms at time of FluMist. 1 NONE PVT PUB ALBUTEROL NONE PRN REACTIVE AIRWAY
1 None None None None None None None
UNK UNK zicam takenDenies 9/6/09 allergy to peanuts OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None OTH OTH None None None 1 PVT UNK 1 UNK UNK Lyrica 75mgDenied HS and illness Flexeril Cervical 10mg Herniated HS Disk, Scleroderma(no treatment), Allerg 1 PUB UNK Yaz None Allergic/Sensitive none~ to ()~NULL~~In penicillin and Patient Bactrim 1 PVT PVT None None None 0 PVT UNK None None None none~ ()~NULL~~In Patient 2 none PVT UNK None NO None described above~Influenza (Seasonal) (FluMis 11 UNK UNK none beforegurd the vaccination 9/16/09 Received medical records w/PMH: Circumci 0 NONE PUB PUB NONE NONE NONE 0 blood work,PVT arthrocentesis, UNK arthoscopically samples nothingshouler relevant Sulfa joint drug fluid allergy. all indicating Nothinginflammation, else of possible but relevance. stains and cul 0 None PUB PVT None Vomit Asthema None OTH OTH None None None None OTH OTH None None None Not known PVT PVT None No Common variable immune deficiency 0 OTH PVT Albuterol; Singulair None Asthma 0 OTH PVT LIPITOR; Folic None acid Aspirin; ADVIL allergies 0 None PVT PUB None None Hypospadias; GERD 2 Viral culturePVT PVT None None Known 0 That evening PVT more HAPVT + confusion. NoTo ER. Head No CT normal. PeanutLabs allergy dizzy~HPV normal. Discharged (no brand name)~2~0~Patient with concussion diagnos 1 PVT UNK None None 1 PVT PVT Albuterol; Claritin None Asthma 1 PVT PVT ADVAIR; ALBUTEROL; None Asthma LORATADINE 0 BP 123/96, OTH 118/92 PVT No known allergies/conditions OTH PVT 0 PUB PUB None None 0 OTH PVT None None None OTH UNK 0 PVT PVT None None None 1 None PVT PVT Ambien; Nortriptyline; None Zoloft; Migraine Topamax; Birth control IA090021 - 10mg 0 None PVT PVT Birth Control None - YAZ Seasonal - allergies - PCN; IA090020 Sulfa. 1 none PVT PVT none no none IA090019 1 None PVT PVT LEXAPRO None None 0 None PVT PVT Vicodin; Synthroid; None Ambien Allergy- Erythromycin hypothyroid 1 None PVT PVT LAMICTAL;None Hormone replacement Seizures - 9 yrs 1 None PVT PVT ADVAIR Ear Infection Asthma - Z pack 0 None PVT PVT IMITREX; YAZ; NoneCEIEXA. Hay fever; Migraines. 1 None PVT PVT None None Allergies - environmental 0 OTH PVT PROPECIA None indicated PUB PUB None None Known 0 None OTH PVT Requip; Zestoretic; Mild Nausea Tramadol, Hypertension, Prednisone; prior GI Estradiol; bleed (unspecified) Klonopin anxiety, allergy 1 PVT PVT None None 1 OTH PVT ZYRTEC; Vita None reported ULTRAM; FLOXIN; BACTRIM 0 No tests were OTH performed OTH (patient did TOPROL not have XL None recent 50mg blood once Allergic po pressure qD; toCOZAAR dextrose; med changes) 50mg Hypertension once po qD 0 PVT PUB SINGULAIRnone None ID09019
1 None 7
PUB UNK None None None~ ()~~0~Patient|Had ID09018 seizure, 2X a996 age PVT PUB None ID09020 PVT PVT Fish hook in finger ID09022 2 PVT PVT None None ID09021 0 OTH PUB None reported ADVIL 0 None PVT OTH HCT2; LOPRESSOR. None Allergy to PCN 0 None PVT UNK None None 0 PUB PVT None None None 0 PVT PVT NONE NONE NONE 7 None PVT PVT CRESTOR; ESTRACE;Allergies; PROMETRLM; Penicillin, LABETATOR. CECLOR; VICODIN; BIWIN. OTH PVT None None 69 UNK UNK 9/21/09 Medical dermographia~HPV records received (Gardasil)~~13~Patient DOS 9/10/07 to 11/8/07. 0 PVT UNK Actonel, Evista, no Levothyroxine, none Calcium, Vit D, Omeprazole. 1 EKG showed MIL irregular MIL rythem andNone blood workNone showed elevated None enzymes. 2 PVT PUB None NC09039 0 PVT UNK Local Site Reaction NKDA; as of 2005- functional NC09037 murmur 1 PVT PUB REGLAN, HYDROXYZINE, Bipolar, PROLOL manic depression, NC09040 cleft palate 0 PVT PUB none NC09038 1 OTH OTH unknown none unknown PVT PVT None None 3 PUB PUB None PCN 0 Unknown OTH OTH morphine Lymphoma; Radiotherapy WAES0909USA00700 443 Unknown OTH OTH CLARITIN; Drug SUDAFED hypersensitivity; Reactive airways WAES0909USA00549 disease 0 None OTH OTH vitamins (unspecified) Pregnancy NOS (LMP = Unknown) WAES0908USA04775 0 PUB UNK none Asthma 1 OTH PUB None 1 PUB OTH CEPHALEXIN Resolving 250 UTI None PVT UNK Thumb laceration None 1 none PUB PUB none none 0 OTH PVT None 0 OTH OTH None Denies None 0 OTH OTH None Denies None 32 OTH PVT None None 1 none PVT PVT Hydrochlorothiazide; none Atenolol; hyperlipidemia Lorazepam; ZOLOFT; WELLBUTRIN; cyclobenza 2 OTH OTH 0 None MIL UNK AUGMENTIN sinusitis Egg; Milk; Seasonal 1976~Influenza allergic(Seasonal) rhinitis (no brand name)~1 0 All per parent PVT report PVT None None Fish allergy, seasonal allergies. 2 OTH PVT ALPRAZOLAM; No METFORMINR; None CRESTOR; CARVETILOL; MTX; RANITIDINE; 0 OTH OTH No No 0 PVT UNK Well visit Being treated with BACTRIM for impetigo OTH UNK Cough 12 PVT PVT ORTHOTRICYCLEN None LO. Anemia in past . None PUB PVT None None 0 None PUB PVT None None 1 PUB OTH none no no UNK UNK 2 None done.PVT PUB No medication None Club Foot 0 PVT PVT Asthma 3 PVT UNK Vitamins/Herbs None None 1 PUB PUB None None None 0 OTH UNK Synthroid, Nexium, None Lipitor; NoneDivan; Metformin
11 10/16/09 Received PVT hospital PUB records and DC summary No/had otitis forNone dates media 10/16/09 9/14/09 at hospto Received admission 9/22/09.hospital Diagnostics/Labs: records and CXR(-), DC summa CT b 0 UNK PUB None 0 OTH UNK 2 UNK PUB DEPAKOTE; None Phenobarb; Seizure Vit C;disorder BP med OTH UNK LIPITOR; Ramipril; No Atenolol; No Alendronate 0 Rapid strepPVT & cult was UNK (-) No No 2 PUB UNK 3 None PVT PVT EPI PEN PRN None Walnuts 1 PVT PVT LIPITOR; LOVAZA; Neuropathic BENENID; Hyperlipidemia; pain NEURONTIN; Insomnia; PROZAC; Hypogonadism. TRAZODONE. 8 MRI; Echo; PVT TEE; clotting PVT labs (P) None None None 1 OTH PVT No 1 PVT PVT None 0 None PVT OTH None None 0 OTH PVT PREVACID;No LAMICTAL Grass allergy 0 Abnormal- Cellulitis OTH PUB None 1 None PUB PUB None No None 3 None PVT PUB None None None OTH PVT Lovastatin Pt reported she fainted in antibiotic response to "shot" in h 2 None PUB PUB None Fibromyalgia for 6 yrs 1 OTH PVT None 3 OTH PVT BONIVA 0 OTH PVT ALCHOLOLNone 25 mg 10 Hypertension HS 1 PUB PUB No No UNK UNK None Sinus infection None 600 Was in Hospital UNK for 5 days, UNK they ran all the relevant none test for none blood clots. Then went to clinic, and they ran numerous 0 PUB PUB none none SC0921 1 PUB PVT MILD COLD 0 PUB PUB 10 EEG completed PUB on September PUB 14th with results pending 0 PUB PUB 1 PVT PVT Toprol, Diova, Allegra, Hyperlipidemia, ASA, Lisinopril, NIDDM, Actos, Simvastatin OA, HTN 24 Vaccine dates: PUB Feb 27/07, PVT Apr 27/07, Sept 07/07 none 1 PVT PVT NA Asthma 2 PVT PVT Pt had a rash none. on arms and torso. 5 Unknown UNK UNK Lipitor 20MG N/A 1 daily forPatient 2 years states duration N/A~ that ()~~0~Patient he has a history of compressed disk bu MRI on 09/10/2009. UNK 9/18/09 UNK Medical records (Middle School) 9/18/09 DOS Medical 3/14/08 records to 11/14/08. (MiddleLABS School) andDOS DIAGNOSTICS 3/14/08 to 1 0 UNK UNK 0 Subsequently PVT tested for PVT egg allergy pre-existing peanut allergy 6 n/a UNK UNK Simcor 500/20 None 1 everyPatient day, Lipofen states None~ 150 mild ()~~0~Patient Mg seasonal 1 everyallergies day, Loradatadine 10 MG 1 EEG's (5 orUNK 6) only theUNK last 2 have none shown normal none with medication. none. Dislocated none~ Tested shoulder, ()~~0.00~Patient|none~ on a regular irregular basis periods. since()~~0.00~Siblin 8/15/2008. Migraine hea La 3 None PUB PUB None None None 0 No blood tests PVT PVT Aspirin; Flecainide; Metoprolol Sulfa; MACROBID 0 OTH PVT PENICILLIN allergy None PVT PVT None None None 1 MIL MIL NONE NONE NONE 2 PVT PVT none none noted 0 UNK UNK none none none. Numbness after taking Percocet. 11 UNK UNK None 0 PVT PVT None None None 0 PVT PVT none none none 13 I took patient UNK back to his UNK pediatrician none when the none hives firstI appeared recall thatand he had he confirmed hives oncethat or twice patient before has hives. but only Hefor re
0 na UNK UNK na na na 0 none UNK PUB Benadryl post none reaction.Kabuki Also take syndrome, Xopenex asthma, when ill, h/oprilosec multipleand pneumonias atrovent includ 2 none, just the PVT Doctor looking PVT at it. Asmacort, singulair, none protonix, Asthmaflonase, doxepin, fish oil, multi-vitamin 0 CBC, sed rate PVTnormal. PVT CELEXA 20mg /day toAnxiety treat anxiety - started CELEXA 10/27/08 0 UNK UNK None 0 PVT PVT none Penicillin; CECLOR; lymphangioma left orbital area 17 Plt count 6000 PVT PUB No No 1 N/A PUB PUB None None 0 PVT PUB No PUB PVT N/A N/A 0 N/A OTH PVT None None 0 PUB OTH NORVASC,Ear HCTZ, itching FLEXERIL, Asthma, T NEUROTIN, BP, arthritis, ULTRACET, depression,PROSIQ Acid Reflux 0 OTH OTH Penicillin, Darvon, Codeine, had pace maker which pt infor 0 Vital signs Normal PUB @ ER. PVTBP 100/87. None Discharged Anxiety/Panic w OralPenicillin Benadryl AttacksAllergy & Dexamethasone. 1 None UNK PVT None None None 3 OTH PUB None None 2 PVT PVT None NKDA 0 OTH OTH None None 0 N/A PVT PUB None None 0 OTH OTH 85 None PVT PVT None None None 0 Per EMS - BP OTH and pulse OTH , normal None None None 0 No actual syncope; OTH reports OTH signs of ASA, dizziness 81 mgNone or @wooziness HS; PAXIL, Hx asthma; 25 mg recent @ HS Dx bronchitis 8/09 went on PREDISON PUB PUB None 0 Exam; vision PVT normal PVT MOTRIN None None 1 Right upperPVT quadrant ultrasound. PVT None Latex allergy; HTN; A-fib; Hypothyroid; Depression; Anxiet 0 None PVT PVT None (+) SinusitisAsthma; Allergic rhinitis 0 PVT UNK 0 PVT PVT N/A N/A N/A 0 PUB UNK None None PUB PUB No Food allergy to nuts 2 None PUB PVT Ketlek antibiotic Nonegiven on Allergies same day to Sulfa 1 None PUB PVT None None None 0 N/A PVT PUB Well child N/A 0 OTH PVT 1 9-3-09 Pt reports PUB BP 124/68. PUB Hx ofTylenol chronicES back No Ibuprofen pain-Takes Chronic Tylenol back ES-Ibuprofen pain daily AM & PM. 26 Have not been PVTtold to get PVTtest for this condition None 0 None MIL MIL ZURTEC 1/2 None Tsp HS seasonal allergic rhinitis 32 Hx shinglesOTH five years OTH ago. 0 PUB PVT Prenatal Vits, Tylenol Pregnant, gallstones 0 None PUB PUB Claritin Seasonal-Allergies None 0 None PVT PVT Xopenex PRN, NoneImitrex Pediazole PRN Susp 0 None PUB PVT None (very Environmental healthy) allergies/eczema (out growing it now). 0 OTH PVT 0 OTH PVT None that would No causeType such2problem. diabetes, no~ ()~~0.00~Patient allergic to penicillin, topical iodine, strawb 1 PVT PVT Prenatal Vitamins none 30 weeks pregnant H/H 52.7/39; PVT WBC 6500; PVT pH 228; VA 20/20 ou Congen hip dysplasia 0 PUB PUB None None 0 CBC PVT PVT None Unknown OTH OTH Unknown Unknown WAES0909USA01369 1 None PVT UNK None Allergic to latex & rubber.
0 None PVT OTH None None Migraine; Eczema, atopic 1 None PVT PVT CLARITIN None Seasonal Allergies; Tourettes. 0 Lab work within PVT normalUNK limits. PULMICORT 0.5 mg; ALBUTEROL Asthma 25 mg/sml. 4 None PVT PVT None None None 0 PVT OTH Albuterol Allergy to PCN, Amoxil 1 PVT OTH 1 PVT UNK ALLEGRA-D 24 Hour 180-240 VICOPROFEN; mg Tablet Ciprofloxacin Extended Release Tabs; Codeine 24 Hour; derivatives; Aspirin 81F 0 PUB PVT None None 0 UNK PVT Atenelol 50mg None 1xd; Plavix 198470Quad mg 1xd; None~ Bypass; Pravastatan ()~NULL~~In 1994 Double 80mg Patient|None~ bypass; 1xd; Lisinopril 2000()~NULL~~ Diagnosed 20mg 2x 0 ADVERSE PVT REACTIONUNK TO FLU SHOT. NONE NONE NONE 2 None MIL PVT Estrodial 1mf None once a day, Latex Calcium supplements, vitamens 0 n/a PUB PUB none none / nka 2 CBC WAS DRAWN, PVT PLATELETS PUB AND WBC NONE WERE LOW. NONE MONO CAME BACK NEGATIVE. 2 PVT PVT CEREBRAL PALSY 5 PUB PVT 1 PVT PVT NONE N/A N/A 0 Not applicable. PUB PUB Not applicable Penicillin, Demerol, Percocet 2 HAS BEENUNK REFEREDUNK TO ALLERGIST SINTHROID, N/A BCP LATEX AND BEE ALLERGY 9/17/09 Received medical re 0 None PUB PVT None Known None known None Known 0 PUB PVT None None BACTRIM CECLOR IVP DYE KEFLEX SEASONAL ALLE 0 PUB PVT none none 0 In #13 - I have PVTno ideaUNK the manufacturer On 9/14ofhad the none taken vaccination fioricet sulpha but forto migraine hit submit - 3 Idoses have to forchoose. a total of Again.. 5 pills.DON'T On 9/15 KNOW in th 0 None PUB PUB None None 0 None UNK UNK Poison ivy none 2 PUB PUB None None. JustSeasonal some minor allergies pain 0 UNK PUB none NONE NONE 1 PUB MIL none no none 0 none UNK UNK none mild asthma 35 PVT PVT Warfarin, Lipitor, none Prilosec,Synthriod Hypertension, Afib, Hypothriodism, Anemia, Hypercholeste 0 UNK PVT HCTZ, thyroid none replacement HTN, hypothyroidism 0 UNK PVT NONE 1 PVT PUB none short stature 5 PVT PVT 0 PUB PUB 1 PUB PVT 0 n/a UNK PVT non none asthma 24 Negative LP, UNK Mono spot, UNK EBV titers, Strep Screen, NONECBC,LACTOSE CMP, UA, INTOLERANCE CMV titers, Mumps 9/17/09 titers.Received 9/17/09 Received medical rec m 2 unknown PUB PUB unknown none knownunknown 761 PUB PVT altace, lipitor none hypertension 1 Returned toPVT physiciansUNK office on 09/11/09. None No Nodiagnostic illness atNone. tests time of or vaccination. lab data collected. Physician measured affected 0 UNK UNK 0 UNK UNK None None Depression, ADHD 1 OTH UNK COREG; Trazodone; None Sertraline; heart attack Alprazolam; 3/09; broken BUDEPRION R ankle; neuropathy XL; LYRICA 0 OTH PVT Atenolol; Chlorthalidone None Unknown physician diagnosed conditions. 0 None PVT PVT ALBUTEROL No No 0 OTH UNK 0 9/16/09 at 5:53pm OTH - doing OTHwell strongly None believes None was reaction Noneto vaccine. 1 OTH PUB Lorazepam; Lunesta 3 UNK UNK 0 No known history PUB of allergy PVT to eggs. Pt does have history Environmental of environmental allergies allergies. 1 OTH UNK Denies None
1 0
PUB OTH None None PVT PVT Conjunctivitis Adenoviral/Rhinitis PVT PVT None None none~ ()~~0.00~Patient PVT PVT None None 3 None PVT PVT None None None 0 Err:508 OTH OTH CRESTOR;No LEVITRA; acute illness; FLOMAX; "Not sick" ZETIA; lisinopril; Gemfibrozil 0 OTH OTH 0 UNK UNK 0 OTH PUB Isosorbide; none Methotrexate; LEVEMIR; NOVALOG; COMBIVENT; Potassium; Furo None PVT PVT TYLENOL; No CELEBREX; apparent NKDA/ TRAMADOL; HA; Arthritis; PREVACID; Carpal tunnel; ALLEGRA; Hip knee; AMITRIPTYLIN Back surge OTH OTH None None 1 UNK PUB None 1 None PVT PVT None None Asthma 0 PVT PVT healthy Exercise induced asthma; allergic rhinitis 0 OTH OTH None None reported until after vaccination. 0 None PVT PUB None None None 0 OTH OTH SINGULAIRNone CECLOR; arm Mold;swelling~Influenza Deg Disk Disease(Seasonal) (no brand n 1 PVT OTH FEMARA; HCTZ; No LISINOPRIL; AMOXICILLIN. ZOCOR. 1 OTH OTH Calcium +D; Multivitamin; NKA; Glucosamine osteopenia; migraine headaches; mixed incontinenc 0 PUB PVT Coumadin, 1lanoxin, week before cardizen Sinus hadcomes CD, sinus toprol and infection XL, goes, aspirin. stomach ulcer, kidney problems, o 3 UNK UNK N/A No Ear infections Fever, resolved swelling by ear & vomitting~Measles tubes. + Mumps 1 MIL MIL Topical meds None for eczema Mild eczema. No known allergies 1 Chest X-ray; UNK Blood work UNK 10/5/09 Medical records Viral illness received Premature; (non-febrile) w/LABS:GERD; CXR c/w Hxatelectasis of apnea; Hx vs pneumonia. of tachypneaWBC 10/5/09 17. 48 magnetic resonance, PVT ?/?/07, OTH no complications; Unknown vascular imaging, None HPV#3 ?/?/07, given no complications; 12/14/07, WAES0907USA04940 Lot#diagnostic 0890F, RAlaboratory, n Unknown OTH OTH ALDARA. 9/28/09 Wart. Genital PCP medical warts. records received WAES0909USA01170 DOS 8/24/08 to 9/18/09. Oral c 16 complete blood OTHcell, 09/04/09, OTH 8000 vitamins /L; complete (unspecified) Pregnancy blood cell, 10/1/09 NOS 09/??/09, (LMP Medical = 7/1/2009) 11600 records /LWAES0909USA01378 received w/PMH: childhood chick Unknown OTH OTH Unknown Unknown WAES0909USA01466 0 Unknown. 9/25/09 OTH PCPOTH medical records Unknown received DOS 8/21/09. Convulsion. LABS and DIAGNOSTICS: WAES0909USA01474 PPD - Results pending not reportedUNK UNK not reported ### 0 26 August 2009: UNK computed UNK axial tomography (CAT), (results Patient not has reported). a penicillin allergy.### not reportedUNK UNK Unknown ### 10 PUB PUB UNK UNK 1 None MIL UNK CAD, s/p CABG, Iodine,BPH, atorvastatin GERD, HTN 0 none UNK UNK NONE NONE NONE SC0927 1 UNK UNK No 2 PUB UNK None None 3 WBC 5.9, Neutrophils PVT 11.0%, PVT Lymphocytes None 75.0%, None platelets None150. 0 PUB PVT History of PAD 759 original TSH UNK was < 0.1.UNK LABS andnone DIAGNOSTICS: none Free PCN, T4 4.6Asthma ng/dl Graves (H) T3Disease~HPV 672 ng/dl (H) TSI (Gardasil)~3~12.00~Pat 247% (H) Thyroglob 0 PUB UNK mom deniesmom reports history of downs syndrome 0 UNK UNK None None SC0923 1 PUB PVT asthma 0 UNK PVT 34 Lyme test, JRA, UNK Thyroid UNK testing, CMV, Xyzal,EBV Xopenex, AdvairAsthma, Uticaria Pigmentosa 9/21/09 Medical records rec 0 PUB PVT None Gentamycin 1 PVT UNK 0 PVT PUB none none PUB OTH None 0 BP readingsOTH 9:38am 122/80, UNK 9:43am 122/80; 9;48 am 108/72 3 PVT PVT None Dairy allergy in past; Peanut allergy at present
0 PUB OTH None None None known None~ ()~~0~Patient 0 None needed PVT PVT None 1 UNK UNK None None. Had shingles in 12/08. 2 None PVT PVT None 0 OTH PVT LEVOTHYROXINE; None VERAPAMIL None 1 PVT PUB No 135 PVT PUB None None None 1 PVT PUB Runny noseNKA; & dryleft cough ear cavernous hemangioma. 2 None PVT PVT Mebendazole Pin100mg worms None None PUB PVT None None None 0 None PVT PUB None No 5 UNK UNK none none Exercise induced none~ asthma.Allergy ()~~0.00~Patient|none~ to amocicillin. ()~~0.00~Siblin 1 None UNK UNK None None None/unknown 3 SHOT REACTION PVT (ICD-786.05) UNK discussed CYMBALTA topical none 60 MG treatmetn, CPEP Current (DULOXETINE ice Allergies: nsaid (motrin. ! STEROIDS HCL) alleve) one tablet monitor * FLU daily VACCINATION for PROTONIX fever return 40 ifPEN reM 0 None UNK UNK Yaz - BCP, Getting Glucosmainr overNone aChondroitin cold, States was relaxed SC0924 0 UNK PVT 0 UNK UNK NA None per ptShe said she's allergic to dairy products and eggs 0 Client also received PUB 2.4UNK milliunits of None Penicillin Starting G, approx. treatment None 30 minutes for Late priorLatent to theSyhphilis. administration of Twinrix. 0 PVT PVT prenatal vitamin none sulfa 2 none PVT PVT NO 0 None PVT PVT Benadryl given Glossitis after reaction. Epilepsy, Hypothyroidism 0 chest xray and UNKEKG UNK Zoloft, Imitrex, denies Tropramax, Allergies,migraine Allergy shots weekly headaches 0 PUB PUB Allergy to PCN 2 PUB PVT none none 0 UNK PUB NKDA, hypertension 2 Not able to UNK reproduce the UNK carpal spasms Maxide,by lisinopril, inflating None sertraline Blood None pressure cuff for one minute on the right arm. 0 PUB PUB 2 PVT UNK being treated for anemia 0 Physical examination UNK UNK Addeeral 20None mg daily, Claritin Reactive 10airway mg daily, disease and Flonase and nasal prn. allergies 3 CXR--LLL PNA UNK PUB Diovan none childhood asthma 1 PVT PVT 8 Viral culture, MIL results pending MIL None None None 1 none PUB PUB None Hypertension 1 none PUB PVT none none 0 None PVT PVT None. None None 6 Normal chest PVT x-ray on PVT 9/14/09 none no none 7 None PVT PUB Spironolactone; BPD Levothyroxine; = Hypothyroid:Prematurity Hyponatremia Chlorothiazide; FeSO4; NaCl; O2 377 Lab studiesMIL 6/1/2009 showed MIL normal None ESR and 6 hr chemistry. GI illness None. Thyroid @ 1-2 PMH: panel weeks Undescended ordered prior to but onset testicle nos/s. results - surgery. available. Cigarettes. Lab studi A 1 OTH OTH None notedNone noted 0 None PVT PVT ATENOLOL, Back PLAVIX, Pain ASA CAO, increased lipids 1 PVT PVT None None 0 PVT PVT 0 PUB UNK None None 0 OTH OTH TRAZODONE None None 0 PVT PUB None No None PVT UNK None PCN; Codeine; HBP; Hypothyroidism; Osteoarthritis; Arthr 0 PVT PVT None None NKDA - Scheumam's hyphosis with Back Pain 2 MIL OTH no None that pt disclosed 0 OTH UNK Denies Migraine headaches 0 NA UNK UNK Welbutrin, Singular, No/Z pacProlonix, 20Asthma-allergic URI Advain, Albuterol to lemon, garlic, gasses, mold, caused wh 1 OTH UNK None
0 Abdominal PVT X-rays (R/OUNK intussuscaption) and None urinalysis done Hydronephrosis; (R/O UTI - has feeding hydronephrosis). problem. UNK UNK None 0 None OTH PUB None 0 No other tests OTH OTH See attached None list Since 8 years old, rhinitis 1 PUB PUB AMOXICILLIN; SinusFLONASE; infection Seasonal ALLEGRA allergies 3 Physical exam PVToffice visits OTH 0 PUB UNK SYBICORT; PULMICORT; Asthma; PROAIR allergies: First forTime~ asthma; cat; mold ()~~60~Patient VALTREX; & dust; palo ZOCOR; verde WARFARIN bloom; rece 0 N/A OTH PUB same~Influenza (Seasonal) (no brand name)~U 0 None PUB UNK Iron/Orthotrycln None Anemic 0 none OTH PVT none none 5 UNK UNK Painful finger Polymyalgia Rheumatica 0 None PVT PVT GOLUCOPHAGE None BID;Hypothyroidism; SYNTHROID 125 premg diabetic daily; LOPOTOR condition. daily. 3 OTH PVT no NKA/none 2 PVT PVT none. allergy to PCN; urinary reflux. 0 Needle electromyography OTH PVTand nerve None conduction Known None studies None No PUB UNK No Duricef 0 PUB PUB NA NA NA 3 OTH PVT OMEPRAZOLE; LOVASTATIN; CILOSTAZOL; CTHYROXINE. 1 PVT PVT Mirena IUDNone unknown None 0 N/A PUB PVT Lisinopril N/A N/A 1 none PVT PVT None None 13 UNK PVT None None 1 None PVT PUB Cough/congestion/Runny nose PVT PVT None 0 "T-7 inflammation." PVT CXR PVT performed MVI; by chiropractor BENADRYL None in prn N Carolina. None (kidney stone 2004) 1 None PUB PUB Unknown None NKA 2 PVT OTH Upper resp Sulfa and sinus drugscongestion, no fever 0 WBC up 13.6 PVT PVT ALLOPURINOL; None BENICAR; Hypertension, labetalol;obesity, BUMEX;rosacea, LIPITOR; dyslipidemia, amlodipine;hx oxycodone gout, mitr OTH PVT None None NKA 1 PVT UNK None None None~ ()~~0.00~Patient 0 None OTH OTH None WAES0909USA01717 4 Unknown OTH OTH ZETIA; folicDiabetes acid; propranolol hydrochloride WAES0909USA01760 PUB UNK 0 None OTH PVT ZYRTEC; ADVAIR; Cold for 24 NUVARING; Hay hours-no fever,fever FLONASE allergies, asthma 0 PVT PVT None None 1 OTH PUB None at time None of vaccination specified None specified 0 PVT PVT None None 1 None OTH OTH None Healthy- noNone complaints 0 CT scan onOTH lymph nodes, PVT9/18/09 None Lupus 2 PVT OTH LOTRIL; VITORYN; None NOREL Dermatitis None~ ()~~0.00~Patient Diagnostic results: OTH 19 May OTH2004: electrodiagnostic Asthma; studies Gastrooesophageal Allergic revealed bronchitis; essentially Reflux Arthroscopy A0604761A normal Disease; findings knees Ingrown bilaterally; with toe no evidence nail; Epididym Motor of 2 10/6/09 Hospital PVT records PUB received service dates (L) 9/17/09 Otitis Media None to 9/19/09. LABS and DIAGNOSTICS: CBC - Polys 53.0% 0 OTH PVT SINGULAIR; None BENADRYL; Asthma; Albuterol Seasonal allergies 0 PVT PVT Asthma 1 UNK PVT none none none~ ()~NULL~~In Patient 1 UNK UNK Unknown None PCN 0 MIL PVT lipitor 40mg,nosynthroid 112mcg. arimadex 1mg, menmtex 1 mg. 0 UNK UNK lisinopril, lasix, not reported protonix, tylenol,cephalosporins potassium and prilosec 0 UNK UNK denied not reporteddenied 1 PVT PVT 2 PVT UNK Unknown Denies Denies
0 PUB PUB UNKNOWNNONE UNKNOWN 0 No problems PVT with 4 month PUBshots (on 9/1/09), when No patient Norefused DtAP but received all other vaccines due 0 PUB UNK 1 none PVT PUB none none none~ ()~NULL~~In Patient 0 PUB UNK 2 NA PVT PVT DIOVAN, FISH NA OIL HYPERTENSION, NA~ ()~NULL~~In HYPERLIPIDEMIA Patient 0 None MIL MIL Acetozolamide None Migraines none~ ()~NULL~~In Patient 1 UNK UNK 1 UNK UNK 2 PUB UNK None None 0 blood tests,UNK chest xrayUNK and nuclear50mg stress lopressor/10mg testlow all kidney normal.function, lipitor/.5mm allergic Only shows toGFR iodine, ativan sign 53 betadine, no of diminished other illness regelan, kidney function which was 0 PUB PVT NONE 0 BP, 120/70;OTH Fingerstik PVT BS, 133 BICITRA; LIPITOR; Diabetic -LEXAPRO; no Diabetes; other illness PROTONIX K+ low; High cholesterol None PUB OTH Otitis externa 2 PVT PVT Sodium fluoride None0.5 mgEczema; daily; FLOVENT Asthma; HFA, Past otitis 2 sprays media; bid;RSV; PROAIR Impetigo; HFA, Sinusi 1 puff PVT UNK 2 None PVT UNK None None None~ ()~~0.00~Patient 0 OTH OTH None None 1 PVT PUB Vitamins; metoclopramide None Reflux; prematurity 1 PUB PVT 1 NA PVT PVT NA NA 1 PVT PUB None No None 1 PVT UNK Allegra-D 12, Desogen. Phentermine, Topamax, Vitamin B-12, Zolpidem Tartratc 0 UNK UNK 0 PVT UNK None notedUnknown to provider 1 Allergen forPVT clam, egg PUB white, cod fish, Nonecorn, milk, None peanut,None shrimp, soybean, walnut, wheat, scallop, sesame seed, a 6 PUB PVT TRAZADONE None None 0 PVT PVT None None None 1 MIL UNK None None 2 PVT PVT Asthma 0 UNK UNK Atrovent 0.6% None Nasal Spray, HTN, Estring Hypercholesterolemia None~ Vag.,()~NULL~~In Flector Top., Patient Hydroxychloroquine Oral, 0 VS 2 HOURS PUB AFTER Incident: PUB O2Lialda sat 100%, and birth None peakcontrol flowsUlcerative 350 pills and 400. colitis BP 120/70 heart rate 70.At the time of evalu PVT PVT daily prescribed n/a medications allergies 0 PUB PVT 0 PVT PVT Levsin 0.125 States mg no Patient states has hx of allergies-has strange reactions to 1 N/A PUB PUB NONE no Codeine AL0919 0 UNK PVT diphenhydramine 50mg/ml 1 PUB PUB MultiVitamins, none Fish Oil none 500 mg cap, ASA 81 mg tab delayed release, Vit. D_1000 0 No tests PUB PVT None None No 1 PUB PUB allergy to penicillin 0 10/12/09-records UNK received-Labs UNK and Home Diagnostics: medications Reported CT include ofthat Chest-no Past patient lasix, Medical PE, avapro wasHistory: Hgb in her and 8.3usual Hypertension, (L), vitamin Hct state b26.2 of (L). health CHF, WBC asthma, 12.6 (H), atrial17. fib 0 UNKNOWNPUB PUB NONE NONE NONE 0 none so farPVT PVT MV with Fl. none and received none Septa on 8/28 for 10 day course 1 MIL MIL 1 CMP, CBCw/Diff, UNK StrepPVT test, Sed rate-Westergren, Nexium 40mg, None Allegra EKG,Asthma, 180, Chest Flonase X-ray, Allergic 2Full sprays Rhinitis, exam each by GERD, PCP nostril, (including Migraines, Symbicort eyes Slow 160/4.5 and intestina ears) 2 in 0 OTH PUB PREMARIN None Swelling, redness, pain~Tetanus Toxoid (no br 0 On 9-19-09PVT I spoke to health PVT professional None andNone gave her the None feedback fever~DTP re my daughters (no brand condition. name)~1~0.00~Patient 0 Cursory neuro OTHexam byPVT MD and bloodwork None onNone 9/17/09. Referred Seasonaltoallergies neurologist. 0 None PVT PVT None None 0 PVT PVT PREDNISONE 40 mg; CROHN'S PENTESAdisease 0 CMP, UA, CBC, PVT underlying PVT UTI None Anal CA-3 months since last chemo
None
OTH PUB VENTOLIN;None HFA; PRN; Asthma; CLARITIN Allergic 10 Rhinitis mg qd PCN due to pollen dust. 7 PUB PVT Crestor, ASA, "Runny Vitamins, nose" ? Calcium Seasonal allergies allergies 0 OTH PVT None Unknown 0 PVT PUB Hx TOF repair 9/8/04 11 PVT PUB None 0 PVT PVT LamotrigineNo 200, budeprion_SR, Seasonal allergies, paroxetine, depression. fluticasone propionate nasal spray, 1 UNK UNK Ativan, Proventil, N/A Claritin, I have Aciphex, no known Metamucil, allergies & to Probiotic. Medications, but have season 9 Per ER: Mildly UNKabnormal UNK EKG; normal Nonetroponin None None 1 PVT PVT none none none 0 PUB UNK Zoloft, trazadone, none abilify Bipolar, generalized anxiety 0 unknown UNK PVT prednisone,none ipatropium,DM, diltia, Asthma, singular, HTN, metformin, SMI/depression, advair, bupropian ADHD, tremors SR, lorazep 1UNK UNK none no none 6 PVT UNK cozaar, amlodipine none besylate,lipitor, penicillin, sulfa, levoxoyl, bees actonel 1 none UNK PVT none none none 0 None UNK UNK Lasix, Potassium, Left earSpironolactone, feltBipolar " plugged Disorder, up," Trazodone, with Anxiety decreased Xanax Disorder, hearing Sleep in Disorder this ear. (has "ve 2 PVT PVT none none 0 UNK UNK Adderall xr headache 30 mg once allergic a day to cephlasporins 0 UNK UNK none none none 0 PUB PUB Vit E, Fish oil, none Flax oil, asthma Garlic, B complex 0 PUB PUB blood pressure nonemedication none 0 Still sick, spoke PVT with a UNK doctor and a nurse. Nono one knowslatex,clindamycin what to do. Keep telling me to take tylonol. I don't think th 2 RLL consolidation PVT on chest PVT X-ray.Mefloquine Negative EIA None given for known group one dose NA one step 250 known and mg,influenza 3/4 tabletAaround and B. the Elevated time ofneutrophil symptom onset count 3 Waiting to speak UNK with pediatric UNK neurologist Trileptol, on children's No 09/21/2009. aspirin moyamoya see disease; above~ operated ()~~0.00~Patient on (piel synagosis) Dec, 200 0 PVT PVT Tylenol at time None of vaccination None at doctor-recommended fever~Influenza (Seasonal) dose (no brand name)~1 0 Taken to Hospital UNK for treatment. UNK Given unknown Tamaflu. (daughter none filling this form out) 1 UNK PVT None None celiac 0 OTH OTH Vitamin-D; Advair None None 0 OTH PVT No 0 None OTH PVT Downs Syndrome; Pulmonary Hypertension 1 PVT OTH None New DX HIV NKDA +; CD4 428 129% 10 UNK UNK 3 None UNK UNK None EX-27 week gestational age- Previously healthy. 0 06-16-09 Blood UNK work reveals UNK Epstein Barr; 6-15-09 - Ultrasound Seasonal abdomen; allergies;5-14-09 Occasional -CT;mild EKG; EBS Upper GI; Blood wo UNK UNK 1 None PVT PVT albuterol sulfate None(25mg/mL) None 0.083% prn 12 PUB OTH None None 1 PVT PVT None No None 0 Home positive PVTstool in PVT office Labs: guiac stoolnone positive, stool PMH: cultues none Allergies were negative : NKDA PVT PVT none 0 OTH PVT None PVT UNK None None 0 CT & CTA PUB UNK No 2 None PUB PUB MYLECON None PRN; NoneNone OR200939 1 PUB PUB None None OR200940 1 PVT PVT None Had egg allergy as infant, ok'd by allergist. Eats eggs. 2 PUB PVT CYMBALTA; METROPOLOL Splenectomy about 11 yrs ago. 1 PUB PUB PUB UNK No aying words again until 3 yrs old. HePVT cont'd to babble. UNK Mom contacted doctor due to event. 194 Unknown OTH OTH Unknown Unknown WAES0909USA01484 49 She has had UNK blood testUNK to see if it None is Thyroid and None the testNone was well within the standards and the only other thing she
1 UNK UNK None sunblock / sunscreen allergy 3 UNK UNK none none 0 Head CT UNK UNK none none none 2 none UNK UNK none none developmental enuresis 1 UNK UNK bancomyacin cellulitis IV synthroid. on allergic left leg celebrex, to: erythromycin, coumadin, zithromyacin cozaar, bee stings: 0 continuous MIL cardiac andMIL SPO2 monitoring, EPI-Pen timed N/Ablood pressure Presbyopia, checks, Anserine EKG, serial Bursitis, blood No glucose allergieslevel listed, checks, No medi p. 0 patient wentUNK to Dr. on 9-16-09 UNK andboniva had INR 150mg, done.Warfarin 2mg, amlodipine5mg, lisinopril 40mg 97 mono - AprilUNK 9, 2009 and UNK June 30,none 2009. Twonone Positive strep Ortho-tryclen tests. Tested Low.positive 10/13/09 Hashimoto's Medical records - 6/30/2009. received, Thyroi Da 0 UNK UNK none GERD, abdominal migranes, chronic pain, peripheral nerv 0 UNK UNK NONE NONE 0 NA UNK UNK None None None that were noted on consent form. UNK PUB PUB Unknown A0807305A 0 UNK OTH PVT Isotretinoin Unknown The subject had previously A0808086A received influenza vaccinations 9 Labs and Diagnostics: PVT PVT UA with 1+CLARITIN; ketones, trace No ZYRTEC protein,Outdoor 2 Urobilinogen, allergies;4+Tic mucus. disorder. UC (+) PMH: for ear 7K Gram tubes,(+) adenoide cocci. 0 OTH PUB None Allergy, PCN; swollen Tetracycline arm at injection site~Pneumo (no brand 0 Not available OTH PVT Not available 1 CT head - calcification PVT PUB posterior occiput; EEG,Seizure normal; MRI None calcification c/w Sturge Weber 2 729.5 Arm Pain OTH UNK None None 0 OTH UNK No No 0 OTH OTH 1 None PVT UNK None 0 None OTH PVT None None None 3 None PVT PVT None Zithromax - Rash IA090022 2 None OTH UNK None None 1 OTH PVT None None 0 UNK UNK Fine (None)None 0 None PVT PUB None None 35 week Premie 0 PVT UNK None multiple allergies include anaphylactic to nuts, ragweed, m 1 none PVT PVT Hypertension ~Hep B (no brand name)~1~55~Patient 0 OTH PVT None None PNC; Codeine; Keflex 0 OTH PVT MultivitaminNone OTC Allergy to: ERYTHROMYCIN & SULFAS (per patient) 1 none PVT PUB None None None 1 PVT PUB None None None 2 PVT PVT HCTZ; Potassium None Hypertension 1 OTH OTH None Sulfa drugs. OTH OTH AVELOX; Parkinson's disease UNK UNK None None 0 none PVT PVT none no EES; Cepradine; Rynatar, allergies 2 PUB UNK none CT200912 0 None UNK PUB none none 1 CMP, CBC,PUB TSH, SEDPVT RATE, PSA No No 0 Unknown OTH PVT None None Reports neurological (local) reaction to other vaccines. 2 OTH PVT 0 PVT PVT No medical history, no concomitant ### medications, no illness 0 not reportedUNK UNK Patient has a history of asthma, ###allergies to penicillin, sulfa 0 OTH PUB Pregnancy 0 PUB UNK Unknown None SEPTRA; CODEINE 0 OTH OTH None None PUB UNK 1 PVT PVT LIPITOR; ARMOUR None THYROID; Sulfa; Penicillin; NORVASC DONNATAL 0 None OTH PUB PRILOSE; CRESTOR; None Acid AMBIEN; reflex;NORVASC; hypertension; DIOVAN; hypercholesterolia; LEXOPRO. depression
2 Given Rx PNR OTHAUGMENTIN PVT / VICODIN None None 1 UNK UNK 1 UNK UNK 1 OTH PVT Emphazema 5 PVT UNK LISINOPRILNone 10MG; SIMVASTATIN- 10MG PVT PVT 1 PUB PUB None None CMP,CBC, PUB CK OTH ADVIL; ACYCLOVIR; None CYMBULTA, None WELLBUTRIN. 0 None OTH OTH None Allergies - seasonal 4 PVT UNK none none none 1 None PVT PVT None None Asthma 0 None PVT PUB None GERD Irritability~DTaP (no brand name)~3~0.20~Sibl 2 None PVT OTH None seen PCN for a & physical. Sulfa. 2 None PUB PVT None None 0 None OTH OTH None None WAES0909USA02121 0 None OTH OTH None None WAES0909USA02188 1 OTH PUB 1st positivePVT Rotavirus test UNK11/6/08. Rotavirus typing at CDC None consistent at the time w/ of vaccine vaccination type; still ROTA ELA Positive. 0 HR > 200; Sinus PVT tachycardia; PUB Normal O2 saturation; PossibleNo mild fever. Exviral 35 10/5/09 +illness; week Hospital prematurity. Borderline records, anemia Delivered DC summary, early secondary received tachy DO 0 NL Chest X-ray; PVT NL EKG; PVTNL pulse ox greaterNone than or equal None. to 90%. 10/5/09 ER report received, service date 9/10 2 EEG; MRI;PVT MRA PUB ELOCON Nephrotic syndrome Nephrotic syndrome; Asthma 0 Pulse oximetry PVT97-100% PVT throughout None episode.neonatal CBC, Urine, acne None CSF, blood cx, EKG, EEG all negative/normal. No furthe 0 OTH PVT Unknown 0 OTH PVT PVT UNK 3 None PVT PUB None 0 OTH OTH MOVIPREP Solution 5 CBC; Lytes;UNK glucose UNK None None ZITHROMAX; Last asthma S/S 4-02, 0 None PVT PVT Viral pharyngitis Peanut allergy (and tree nuts) 1 None PVT PUB Albuterol neb none as needed Asthma 0 OTH OTH HCTZ 25 mg None High cholesterol 0 Unknown OTH PVT LIPITOR; Felodipine; Atenolol; None K+ 1 PVT PUB None None None 0 None OTH PVT Unknown None None 14 A acute episode PVT of altered UNKmental status and None neurologic None sequelae due to acute disseminated encephalomyelitis (AD 0 None PVT PVT None Anemia Anemia, Allergic ~DT +Rhinitis, IPV (noviral brand Syndrome name)~4~4.00~Patient 2/09 6 Zoster, Herpes PVT UNK COUMADIN; None LEXAPRO; Penicillin; Aspirin Codeine; Sulfur; C.H.D. 1 OTH OTH None NKDA 1 None PUB PUB None None None None PVT PVT 1 PVT PVT No No 0 OTH OTH None Vloxx 0 PVT PVT PRILOSEC;None LOPRESSOR; known NoneASA; FLONASE; ESTRADIOL; MVI 0 UNK UNK No Known None NKMA wasp venom 1 None PVT OTH None Shellfish allergy 0 OTH PVT Unknown None Unknown 0 OTH OTH EVISTA; ATENOLOL; S/P TRIANIT/HCTZ; right mastectomy MVI 2005; Hypertension; Osteoporosis. 0 OTH PVT LEVOXYL 75 None mg QD. Hypothyroidism 3 CBC; CMP;PVT UA - see attached PUB ERNone visit/labs 9/4/09 None None 0 none OTH PUB none Osteopenia; tachycardia; mild high cholesterol 0 PVT PUB None Head injury;hyperthium; Hyperthium.head injury.
0 PVT OTH Hospital employee None health. PCN ~Influenza (Seasonal) (no brand name)~1~33.0 3 PVT PVT None None 1 OTH OTH Unknown None None 0 PVT PVT COUMADIN; None PPD Atrial fibrillation; HTN 1 PVT PVT LIPITOR None Hypercholesterolemia 0 Influenza APVT swab sent PVT PUB UNK None RA; Osteo arthritis 1 None OTH OTH None Possible impetigo None in groin - related to hot tub. 1 OTH OTH PUB UNK 2 PVT PVT None None None 0 None OTH PUB Tyl. prior toNone vaccinationNone 2 No PUB UNK NKDA 1 PVT PUB 2 PVT UNK Rynatan Dust allergies 0 NONE PVT PVT SEASONIQUE, NONE PROPANOLOL, KNOWN RED FOOD BUSPAR BREATHING DYE, NUTS DIFFICULTY~Influenza AND SEASONAL MILD (Seasona ALLERG 3 MIL MIL ketoralac tromethamine no codiene, drops, prednisolon floxin acetate drops, moxifloxcian hydrochlo 1 PUB PVT NONE NONE NONE none. only heart PUB clinic monitoring PUB coreg, cozaar, amiodarone, pacemaker-defibrillator lipitor, asprin 4 1.5 cm tender PVT swelling PUB to left lateral thigh; 1 cm swelling on amoxicillin right lateral thigh. Areas red and hard on palpation but 0 PUB PUB HISTORY OF ASTHMA ALLERGY TO PCN 11 As stated above, UNK thereUNK was no findings of bacterial healthy infections. Heart Patient condition was ASD fine10/5/09 one dayMedical then inrecords the hospital received the nex for 1 None PUB PUB No HIV 0 NONE PUB PUB NONE NONE NONE 0 PUB PUB Cardiac meds-post None cardiac Post surgery cardiac None~ surgery ()~NULL~~In Patient 1 none UNK UNK none none none 105 0 Bp 150/101UNK (very high UNK usually runs low Asthma Asthma 2 PVT PVT NONE NONE 1 UNK PUB 0 Labs: CBC:UNK Hct 42 high, UNK CMP: Glucose none 140 high, noneArterialnone blood PMH: gases: none~ none PO2 Allergies: ()~~0.00~Patient|none~ 487 high, NKDA O2 sats 60%()~~0.00~Siblin low, Ua norma 6 none PVT UNK none none 0 none PVT PVT none no none 23 Zostavax administration PVT UNK 0 PVT PVT None 0 UNK UNK Recently recovered Nonspecific fromallergy unknown to "grasses, illness. wheat". 2 PUB PVT 3 UNK PVT unknown None notedNONE 1 UNK UNK Proair; Maxalt; None Seasonique Asthma; allergic to Penicillin 2 UNK UNK 0 NONE PUB PVT NONE EXCEPT NO ILLNESS ASPIRIN HIGH DAYCHOLESTEROL OF NO~ ADMINISTRATION ()~NULL~~In Patient|NO~ NOR RECENTLY ()~NULL~~In S 0 UNK UNK None 0 UNK UNK PMH: Living conditions are reportedly very dirty and bug in 0 UNK UNK NONE Latex AL0920 UNK PUB benicar 20 mg, metoprolol succ er 50, simvastatin 20mg, fluoxetine 10,boniva 15 0 UNK UNK 0 MIL UNK none none 0 UNK UNK Albuterol inhaler. None. Sulfa, seasonal allergies. Has eczema. PUB UNK Compounded None EstrogenNone Progesterone cream topical every day 1 n/a PVT PVT none wellness exam, nonept was not ill. 5 PVT PUB No Primary hypotony 0 UNK UNK ACTOS, ADVAIR, EMPHYSEMA, CARDIZEM BUTORPHANOL HYPERTENSION CD, ERGOCALCIFERAL, TARTRATE, SC0926 DARVOCET, IMDUR, LANOXIN, IODINE, MEP LAS
0 None 0 0 0 10 None 271 1 3 none 2
UNK PVT PUB UNK Crestor 5mgNone qd, Centrum, HighVitamin cholesterol, D 1000iu, Arthritis, Move Minor Freely eczema (glucosamine and chon PUB UNK slight sinus cold PUB UNK Benicar 20 none mg High blood pressure PVT UNK None Runny noseNo PVT PVT None None UNK UNK Lisinopril 40mg none reported Levothyroxine none reported na~ 125mcg ()~NULL~~In Patient MIL MIL HCTZ 25mgnone daily none none~ ()~NULL~~In Patient|none~ ()~NULL~~I OTH PVT Unknown Unknown Unknown OTH PUB 0 OTH PUB 0 OTH OTH CODEINE allergy 0 WBC count:OTH 22,000 OTH None None 0 OTH PVT None 0 OTH PVT None Penicillin and sulfa allergy. 0 None PVT UNK AZELEX cream; None NASONEX; Multiple COPAXONE sclerosis; rosacea inj.; ZOLOFT; ADVAIR; ALBUTEROL 2 PVT PUB 0 OTH OTH None None 0 OTH PVT 1 None OTH OTH No Bradycardia, allergic bronchitis asthma 0 Flu test neg, PVT CBC nl PVT 0 UNK UNK LIPITOR; EFFEXORD; Bronchitis 2Shrimp; weeks SYNTHROID; prior Morphine; LYME; SULFA ALTREX 1 None PVT PVT None None 0 Born with small PVT anteriorPUB Fontanelle, Premature 37-38 wk gestation 0 PVT PVT B complex Vitamins Left sup scapular Solution; Multiple pain CYELOBENZAPRINE sclerosis; pain disorder; HCI asthma; 5 mg tablet; Tietze's PROVENT syndrom 1 UNK UNK 1 UNK UNK 0 PUB UNK UNK UNK 0 OTH PVT BENADRYLSinus 25 mg drainage 2 PUB OTH COUMADINNone Hx blood clots, clotting deficiency 0 BP-120/70.OTH Fingerstik BS-133. PVT Bieta, Lexapril, Diabetic-no Lupipor, Diabetes; other Protonix illness K+ low; high cholesterol 0 PVT PUB None Well visit None 0 Eye exam +PVT stitches PVT ALBUTEROL; None MDI; SINGULAIR Asthma 2 PVT PUB None NKDA 2 Physical exam OTHonly PUB Lasix, Prednisone, None Chantix NKDA->conditions: COPD, hypertension, cholesterol 0 PVT PVT None None None 0 PVT PVT OXYBUTYNIN; NoneCLARITAN; SpinaSINGULAIR; bifida; erythema~Measles V-P Shunt. XOPENEX. + Mumps + Rubella (no bra 0 PVT OTH Concomitant Drug (s) Not Used MEDI0008785 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008816 0 Body temperature, PVT 102.2 OTH Concomitant Drug (s) Not Reported MEDI0008781 0 OTH OTH Concomitant Drug (s) Not Reported MEDI0008799 0 PVT OTH Concomitant Drug (s) Not Reported MEDI0008795
12USA04456 12USA04542 08USA02610 12USA04870 12USA05315 peas. Hx of Dermitits - Eczematous.
pmental disorder (mixed) ergy to avocado k pain x 1 yr.
artery disease)
No~ ()~~0~In Patient ent|None~ ()~~0~In Sibling
ient|NONE~ ()~~0~In Sibling
biotics, watermellon.
G; Hypertension;Hyperlipidemia; Type II diabetes; benign prostatic hypertrophy; Hx Bells palsy; s/p squamous CA of tonsils, with subsequen mbar disc disease; Peripheral neuropathy; Hypothyroidism; Cardiomyopathy; GERD; Cervical disc disease; Nonunion R hip fx-repaired; AO
; and a weak heart due to a viral infection
ons reported
Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2
# 1446U, LA.
rand name)~3~1~In Patient
ar infection 12/15 treated w/antibiotics x 8 days. brand name)~UN~0~In Patient
very healthy before this shot and the only conditions that she had or has is seasonal allergies.
; Carotid Stenosis
ctor prior to immunization with vaccines~ ()~~0~In Patient|Brothers don't get flushot~ ()~~0~In Sibling
nd ceftriaxone 11USA03496 12USA05190 12USA05011 12USA00348 11USA02209 12USA05099 hol, Sulfa, PCN, metal allergy PMH: environmental allergies.
mild asthma, GERD. Known allergy: PCN.
r of 105~Measles + Mumps + Rubella (no brand name)~NULL~1~In Patient
N, A-fib, Sleep apnea-on CPAP. Kidney cancer-partial nephrectomy. Anxiety e not specified (no brand name)~UN~2~In Sibling
12USA05247
e, PCN, Novacaine, E-mycin.
unknown etilogy
EN-JOHNSON SYNDROME~Smallpox (no brand name)~UN~23~In Patient
es:amoxicillin. Obstructive sleep apnea. Tonsillectomy adenoidectomy.
a, obesity, anxiety, angina pectoris, gastritis, OA, platar fasciitis, SSS s/p pacemaker placement 5/08 & revised 6/08, HTN.
ed; H/O drugs use in, child was in D 2/17/09-records received-sickle cell anemia trait recovered, born at 36 wks 1/12/09-records received-Family history, twin sister with DM since age of 2.
duct (benign)
11USA00270
othrax)~5~40~In Patient
ULL~~In Patient
itions: hypertension, hypercholesterolemia. PMH: Allergy to codeine. HTN, Depression, Hyperlipidemia
uma, hypercholesterolemia, chronic migraines, constipation, depression. Allergies: codeine. Family hx: Parkinson's & Alzheimers. Patient|None~ ()~NULL~~In Sibling1
STATE CANCER HYPERLIPIDEMIA HTN Coronary artery disease. hyperlipidemia, hypothyroidism, depression.
~Measles + Mumps + Rubella (MMR II)~1~4~In Patient
01USA00094 05USA00247 12USA02633 01USA00056 04USA02244
12USA02385
03USA00533
nt|none~ ()~~0~In Sibling|none~ ()~~0~In Sibling
al hernia repair. NKDA.
e w/NICU & intubation. ITP at 2-3 yo. Sibling w/intrauterine CVA, cerebral palsy & protein s def; aunt w/DVT; parent & grandparent w/prote
22/2008" per mom and client statement.
t|N/A~ ()~~0~In Sibling
: HTN, High cholesterol.
Dysphagia; Gastrointestinal reflux; High blood pressure; Panic disorder
ure, 12/04; allergic rhinitis, with reactive airway disease; allergies, nuts, oral reaction. PMH: chronic neck pain s/p snowboarding accident. L
lipidemia; sarcoidosis
rand name)~UN~2~In Patient
y of anti-biotics. Recently, dental shots which contain epinephrine. Avelox. Plus, dust, dust mites, and one type of grass.
01USA00339 01USA00354 01USA00096 01USA00389 Obesity; BPH 07/27/04; Sprain/Strain, Back 11/22/04; Stenosis, Spinal 12/16/04; abnormal liver or cardiac enzymes 10/27/05; Screening fo
fa, vibromycin, CELEBREX, TRIMAX, ROBITUSSIN M, MIACALCIN, codeine and LOTREL, rand name)~UN~0~In Patient udes mood disorder, hyperlipidemia, right AKA with phantom limb pain, GERD, major depressive disorder, diabetes, elevated LFTs, and hip
, loss of apetite, vomiting~Tdap (Boostrix)~1~12~In Patient
w normal .Immune dysfunction
11USA03767
oxoids (no brand name)~UN~0~In Sibling
specified (no brand name)~UN~0~In Patient 11USA03927 3 week preemie twin, NICU x 3 weeks Family hx: parents w/hypothyroidism & psoriasis; others w/protein S factor deficiency, DM, HTN, ast of Glycosylation. PMH: Autosomal recessive cutis lax due to congenital defect of glycosylation. Pneumonia. G-tube. Hypotonia
and name)~2~18~In Patient
01USA00781 01USA00809 01USA00452
|NA~ ()~~0~In Sibling|NA~ ()~~0~In Sibling B + IPV (Pediarix)~2~0~In Patient |NA~ ()~~0~In Sibling|NA~ ()~~0~In Sibling
ability~DTaP + HepB + IPV (Pediarix)~1~0~In Patient
~0~In Sibling|FACE FLUSHED, RASH~DTaP + HepB + IPV (Pediarix)~2~0~In Patient on at (afebrile) at time of immunization. PMH: hospitalization for URI 1.5 mos prior to admit. OR, ZESTRIL, LOTENSIN, ZETIA 3/3/09-records received-PMH: morbid obesity. insulin dependent diabetes type 2. hypothyroidism. gout. GENTAMICIN, TETRACYCLINE, ULTRAM (RASH). BIRTH DEFECTS: NONE. MED CONDITIONS: HRT, HIP & BACK ARTHRITIS.
, Chronic migraines, Chronic Vitamin D deficiency, GERD
ardasil)~1~18~In Patient
nd name)~6~14~In Patient
no brand name)~1~73~In Patient
06USA02506 07USA00576 07USA02893 07USA04603 08USA01657 10USA05385 es -- No drug use, alcohol or smoking. Had all her medical check ups!!!
non-smoker; limited alcohol consumption.
01USA00898 01USA00986 01USA01014 12USA03732
MH: Kidney stone. Diverticulitis. history of DJD. Chronic sinusitis.
mononucleosis 2 months ago and several colds since then.
o brand name)~1~1~In Sibling1 ITIS~Hep A (Havrix)~1~4~In Patient
+ IPV (Pediarix)~2~0~In Patient l meningitis 3 weeks prior to flu shot
Mumps + Rubella (MMR II)~1~12~In Patient dication for environmental allergies ral Palsy and followed by Dr. action, told to avoid by physician
kin tested at local allergist office-specific results unknown
0 mcg - once daily, simvastatin tab 20 mg - one daily.
ryl; Tetracycline; No chronic medical conditions
Measles + Mumps + Rubella (no brand name)~1~1~In Sibling
poisoning 2001.
no brand name)~1~5~In Patient ed in therapeutic use, smallpox vaccine (Active) ollen, pet dander
en he was younger
01USA01153 01USA00384 01USA00993
name)~1~0~In Patient
algia, GERD. PMH: NKA. prematurity. Congenital cataract. Fibromyalgia-dx 2/2008. L~~In Patient
actrim and Iodine dye
pitations), Lexapro + Kiwi fruit (throat closes) HX: splenectomy 2002, sinus surgery 1983 + 1984; chronic UTI's treated with post coital antib t OM & ear tube insertion.
ches. PMH: thyroid problems. s, projectile vomiting, arching of back~Hep B (no brand name)~1~0~In Patient
, major depression
gb electrophoresis; refer to cardiology
on, contraception irregular periodsrecently changed from depoprovera to yasmin
12USA08098 01USA01220 01AUS00036 01USA01109 01USA01201 01USA01203 01USA01139 01USA00290
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2 arm~ ()~UN~0~In Patient|N/A~ ()~~0~In Sibling
01USA00619 01USA01342 12USA05078 01USA01615
h Stufflon (medication); High blood pressure (in medication)
sion. L breast cyst-removed. L facial cyst-removed. Allergic to Betadine
(Gardasil)~1~16~In Patient
HepB + IPV (Pediarix)~1~0~In Patient
E, MACRODANTIN, MILD SENSITIVITY TO NEOSPORIN (ON MY ASSESSMENT)
llor~Smallpox (no brand name)~UN~35~In Patient
forward(dime size), Medical conditions: Crebral palsy
media . PMH: PCP records reveal normal childhood illnesses (OM, URI, bronchits) in 1st yr of life. Excessive wt gain noted at 3 months.
OTHYROID past)
L (DIZZY), LORATIDINE (DIZZY), VIAGRA (GI INTOLERANCE) PMH: mild GE reflux, excessive drooling.
T THIS PATIENT OR THE VACCINE. PT IS BEING SEEN AT HOSPITAL
ib (no brand name)~4~1~In Patient|Stirling Goulete~Measles + Mumps + Rubella + Varicella (no brand name)~UN~1~
MRSA(+) abscesses
l forearm fractures, varicella
myalgia; N; S; fatigue
&A age 4. Ovarian cyst. mild scoliosis. Apnea and reflux as infant. Allergy to sulfa
nonucleosis. family hx: arthritis.
2~7~In Patient
12USA02570 12USA02379 12USA02368 12USA02360
12USA02344 12USA02177 10USA05371 09USA01795 05USA00593 04USA04002 04USA00010 03USA00972 02USA04664 12USA03380 12USA03339 12USA03231 12USA03225 12USA02823 12USA02818 12USA02787 12USA02632 12USA02627 12USA02624 12USA02612 12USA02603 12USA02593 12USA04118 12USA04111 12USA04110 12USA04104 12USA03784 12USA03782 12USA03779 12USA03770 12USA03750 12USA03738 12USA03713 12USA03685 12USA03609 12USA03414 12USA03385 12USA04585 12USA04584 12USA04554 12USA04543 12USA04513 12USA04291 12USA04284 12USA04280 12USA04272 12USA04270 12USA04263 12USA04143 12USA04134 12USA04131
12USA04119 12USA05232 12USA05223 12USA05222 12USA05150 12USA05125 12USA05115 12USA05114 12USA05103 12USA05034 12USA04902 12USA04828 12USA04823 12USA04815 12USA04777 01USA00023 01USA00012 12USA05266 12USA05263 12USA05239 01USA00735 12USA04863 12USA04847 12USA04810 12USA04738 12USA02697 12USA02608 12USA02152 12USA02054 12USA02028 12USA01781 12USA01749 12USA01223
rgies to food thought to be related to a birch tree allergy; dust allergies, some nut allergies; gluten sensitivity; several occasions of exercise
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2 atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
state, high cholesterol.
atient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2
ntal delay, seizure disorder,eczema,sleep disturbance,adenoidal hypertrophy,egg allergy
HPV (Gardasil)~2~25~In Patient
none~ ()~~0~Sibling re-auricular skin tag.
; erythromycin; penicillin; polysporin 01USA01598 04USA03264 01USA01174 01USA01835 01USA01603 01USA01746
01USA01749 hma out grew PMH:multiple allergies. Acne. Trauma to hip by sibling jumping on her 6/08, seen in ER & x-rays WNL. nt; TB exposure; PT converter, all, +
01USA01755 01USA01301
01USA00165 ~~0~In Patient
cified (no brand name)~1~0~In Patient
01USA02129 01USA02073 01USA01962 01USA01834 01USA02001 01USA01992
D. Seasonal allergies. depression. s/p sinus surgery. s/p tonsillectomy. Allergies to sulfa, NSAIDS.
eceived wrong vaccine should have been pedarixs. NO reaction or harm noted to patient except patient rece~
ut no recent flares.
blood pressure
in 15 years; multiple medication allergies, sulfa; PHENOBARB; DILANTIN
P (no brand name)~5~5~In Patient
01USA01809 01USA02024 01USA02577 01USA01952 01USA02002 01USA02731
resolved; left ankle swelling; menstrual cramping. mild depression. HPV #2 given 7/18/08, lot # 0063X, IM/LA; HPV #3 given 12/2/08, lot#
B (no brand name)~NULL~0~In Patient
residual effects at time of visit.
refers to as a compromised immune system as a result of a virus that she contracted 2-3 years ago. The virus apparently weakened her im
mie, no prenatal care. Family hx: HTN, asthma.
H: GERD. Cow's milk sensitivity. Constipation
xide, PCN, ASA, Sulfa, Eggs. hospitalized~Influenza (no brand name)~UN~18~In Patient gkins Lymphoma, but it was treated successfully with chemotherapy and radiation in 2007. Patient had no relapses since treatment, and his -had outbreak on arms chickenpox around 1/20/2009
High Blood pressure; MS, in remission
esophageal reflux
12USA00347 01USA02460 (Pneumovax)~2~69~In Patient
H: pneumonia x 2. last one 3 yrs prior. Toxic synovitis at 3yo. Ear tube insertion.
phageal stricture, empyema, RAD, hyperlipidemia. Family hx: both parents w/stroke. ncy. Hypothyroidism. Fatigue. Constipation. Hormone Deficiency. Allergic Rhinitis. Eczema. Kidney stones
tis, migraine headaches hx.
o beestings.
P I & D at age 8m
othyroid; Anxiety
thyroidectomy in the early 1990s.
01USA02427 01USA03131 01USA03143 01USA02676
ia. PMH: hypospadias. chronic ear infections. OM p (Adacel)~1~16~In Sibling1|same sibling Elizabeth~Meningococcal (Menactra)~1~16~In Sibling2 HPV #2 Lot # 0570X, given 9/26/08
ngococcal (Menactra)~1~18~In Sibling1 slipidemia 3. Osteoarthritis 4. Depression 5. Obesity st history of Gluten Sensitivity Diagnoses: remote hx colon cancer, hypothyroidism, Alzheimer's , coronary atherosclerosis, osteoporosis, lip
rin. History of Depression
01USA03149 11USA02650 11USA02652 01USA03112 07USA01140 01USA03330
N; COPD; Obesity; DM; h/o A Fib 2/2/09-records received-PMH:paroxysmal atrial arrhythmias and systemic hypertension syncope, dyslip
yroidism; intermittent pulmonary hypertension; Hypercholesterolemia; osteoporosis
se allergy-anaphylaxis. molds and nuts allergy-watering eyes and sneezing.
nthrax (no brand name)~1~20~In Patient
ema, 786.09,786.05
trial fibrillation, sleep apena and fatigue. remission); Allergy to PCN
01USA03219 01USA03646 01USA03508 01USA02709 . No alcohol or drug use.
IENT HIVES
hinitisis. PMH: remote hx of seizure- lat 2 yrs ago
arly. Small for age, club feet otherwise appeared normal.
of spitting up.
CVA, BPH, ED, Tubular Adenoma, Colonie polyps
ved; fever requiring hospitalization; developmental delays & in special ed class. Had received flu shot prior years w/o reaction. Family hx:
t dermatitis 10/2008, chickenpox, shingles.
ient|NONE~ ()~~0~In Sibling|NONE~ ()~~0~In Sibling
cancer surgery, cardiac cath 2006 WNL, CTS surgery
us & colon polyps, mitral valve disorder, hyperlipidemia, spinal fusion, allergic rhinitis, false (+) hep C.
h), Hypertension, Type II DM, Hypercholesterolemia.
hyperlipidemia, DM, GERD, breast ca, HTN LMP 20 May 2008, vaccination 11 June 2008. +UCG around 15 July 2008.
sulin just 1 week ago.
(no brand name)~1~5~In Patient
01USA03970 01USA03979 01USA03957 01MEX00007 uenza (Fluzone)~3~53~In Patient
uced Asthma
ent|None~ ()~~0~In Sibling|None~ ()~~0~In Sibling
Elevated BP readings Nicotine Dependence Mild PAD Left Shoulder Pain Hemorrhoids aine headache, IUP, 70kg and 69.4" height
sm's; nephrolithiasis; Pituitary (?)
01USA03921 01USA03924 01USA03994 01USA04190 01USA04478 12USA02105 01USA03562 01USA03312 01USA03564 01USA03679 01USA01798 01USA03674 01USA03680 01USA03777
ossible milk allergy
ks. 45 day NICU stay. NKDA
stor Chronic health problems: seizures, immune deficiency, HTN, Right carotid stenosis, hyperlipidemia, bronchistasis
X OF HTN, DIABETES
HPV (Gardasil)~1~12~In Patient
KA until now
k; mild asthma
o brand name)~UN~0~In Sibling
ecords received-history of febrile seizures. mild asthma
ty, alcohol/tobacco use, depression
eived-PMH: asthma, attention deficit hyperactivity disorder.
atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
Patient|none known~ ()~NULL~~In Sibling1
aricella (no brand name)~1~1~In Patient
12USA01983 02USA00048 01USA04400 cohol. I have never been pregnant. No health problems prior to March of 1987. I never have had any accidents or PMH: PTSD/depressio
. recent URI
formation available.
HT SHOULDER
MH: Congenital Hydrocephalus. VP shunt
PMH: chronic back pain.
11USA01317 07USA05579 07USA01777 07USA01095 05USA00246 05USA00144 01USA03341 04USA02904 04USA02907 04USA02908 04USA04868
01USA03519 02USA00303
n, no known allergies
orn at about 37 weeks gestation via C-section delivery as this was a twin gestation. Child was twin A. mother was group B strep positive how ech presentation, 36 wk preemie. Family hx: seizures
gery, depression, hx. of chronic back pain, hip fracture
asil)~3~22~In Patient
iothrax)~7~22~In Patient
econdary to clear, occlusive bandage applied over SPV eschar. 0-120mm - Not extending beyond elbow (In remission); 05/14/2008 Effect, adverse, medicinal/biol subst NOS (Active) o birth defects. Medical conditions: 1) HTN; 2) Hypertriglyceridemia; 3) Nephrolithiasis. Birth defects: None. PMH: Nephrolithiasis. HTN.
S, (Assumed inactive); 07/26/2004, Edema, (Resolved); 07/26/2004, Fever, (Resolved); 07/26/2004, Enlargement, lymph nodes, (Resolved c skin eruption (Resolved)
name)~1~69~In Patient
medications)
02USA00378 02USA00259 01USA04389 02USA00158 02USA00475 02USA00481 02USA00103 02USA00026 01USA03633
02USA00416 09USA02697
d injection monthly for 28 yrs.)
to see again after 1 year of age. ardasil)~2~11~In Sibling ardasil)~2~17~In Sibling
a (Fluarix)~0~48~In Patient m, chronic back pain s/p mva PMH:panic attack
~NULL~~In Patient
~HPV (Gardasil)~1~18~In Patient on immunization record.
Solsate; Zocor; Altac a, DJD - knees, Anemia, Lt bicipital tendon work up pending for RUB pain
02USA01054
er care, maternal drug abuse
02USA00587 02USA00564
02USA00449 02USA00464 12USA00471
Asthma. Seasonal allergies. Acne nd name)~5~54~In Patient|~Hep A (no brand name)~2~0~In Sibling|~Polio Virus, Oral (no brand name)~4~0~In Sibli
TaP + HepB + IPV (Pediarix)~2~0~In Patient
a form of lupus.
der infections. Allergies to Amoxicillin. PCN. 9-records received-History of vaccinaitons 6 monts prior and a visit to Africa. PMH:epilepsy.
Acel-Imune)~2~0~In Patient
tory of congenital defects; No chronic medical conditions PMH: concussion, hernia repair. Smoker. Allergy: sulfa (rash).
opmental delay, V-P shunt for hydrocephalus
02USA01032 02USA01057 02USA01069 02USA01095 02USA00873 02USA00919 01USA00170 04USA05621 02USA00860
nt|none~ ()~~0~In Sibling
dissection (R)
00 it closed 6 months later and another was put in; HBP
+ Rubella (no brand name)~UN~42~In Patient
tation of any birth defects or medical conditions
sed mood 2/24/09-records received-PMH: Chronic tension headaches, neck and shoulder tension. Headaches for many years but now wor
Developmental delay. PPS murmur and previously hospitalized for respiratory distress.
rivax)~2~13~In Sibling1
02USA01092 02USA01085 ercholesterolemia, L colon diverticulosis.
- hyatil hernia - hypothyroid
acne, irregular heavy menses, OCPs, headaches, palpitations x 2 yrs. Family hx: MVP.
Rotateq)~2~0~In Patient
nza (Fluzone)~1~1~In Patient
valve prolapse/mitral regurgitati
Facial assymetry
Degenerative joint disease
Systolic htn
asms in lumbar area. PMH: difficulty falling asleep 4/2008 ap~DTaP (no brand name)~3~1~In Patient
uterine growth retardation, NICU, developmental delays, learning disability, amenorrhea.
ongenital abnl kidney - removed
Bronchitis
Hearing change left 200
B (no brand name)~1~0~In Patient
02USA01061
d bilateral OM which was resolved with oral steroids, antibiotics
and name)~~1~Patient
uenza (no brand name)~NULL~4~In Patient days~Rotavirus (Rotateq)~3~0~In Patient ent|None~ ()~~0~In Sibling d had no fever, but did have sinus problems on day of MMR/Varicella vaccinations.
endent alcohol abuse; tobacco use disorder; pneumonia, organism unspecified - 5-2002; unspecified thrombocytopenia - 5-2002; unspecif OX, TORADOL, PNU-IMUNE IV CONTRAST
d (no brand name)~UN~0~In Patient
URI, sinusitis/som
no brand name)~UN~~In Patient
nt|none~ ()~~0~In Sibling
ention of intractable migraine; Other, mixed, or unspecified drug abuse in remission; Tobacco use disorder; Calculus of kidney; Hepatitis C;
ost rheumatic fever, Hx asthma lergies. 2/27/09-records received- History of panic attacks and anxiety. Hospital records Service dates: 4/1/09 to 4/5/09. (R) knee surgery.
I, reports 'cold' 1-2 weeks prior to vaccines. PMH: DM-recently dx. Migraines. Bicuspid valve AI. NKDA. E, DIVERTICULITIS, LYMPHEDEMA, OSTEOARTHRITIS, S/P HIP REPLACEMENT, S/P APPENDECTOMY, OSTEOPENIA, CHRONIC
, remission since 10/06;migraine HAs; asthma; heart murmur; overweight. Allergy: PCN, cephalosporins, adhesive tape, mountain cedar tre
LEEP/LEETZ; bilat breast augmentation; allergies/hay fever; GERD; contraception. ame)~UN~0~In Patient
PMH: gout. HTN. hyperlipidemia. Allergy to PCN.
02USA01640 02USA01693 02USA01522 01USA03436 02USA02156 11USA06688
02USA01700 02USA01836 02USA01121
tes; codeine; MEPERGAN FORTIS; CIPRO.
ardasil)~1~14~Patient
nd name)~1~0~Patient|none~ ()~~2~Sibling 17/2009 Class: Print Route: Oral Sig: take by mouth. Take two orally daily for 5 days with food; check blood
sugar dailyl
after blood draws in 2005 & 2007
4/6/09 PMH: acne, allergies, possible arthritis, stress fractures. c Ovary Syndrome PMH: exercised induced asthma
s of childhood. PMH: lacrimal duct stenosis/infection.
nza (no brand name)~UN~30~In Patient cognitive impairment. Tinnitus. Headache. PTSD. Major depression recurrent. R knee arthralgia
eight gain). PMH: poor wt gain
roxysmal atrial arrhythmia. Aortic valve replacement. Anti-coagulation
ntly started oral contraception use Yaz 3 weeks prior to onset of symptoms.
dasil)~3~13~Patient
ords received-lactose intolerant to mild and cheese gives GI upset. cholesterol 2/26/09-records received-PMH:low back pain. neck pain. hypothyroidism.
hypermobility
layed speech
02USA02357
02USA02190
02USA01791
02USA02174 moved due to cancer. 02USA02257
ling2|na~ ()~NULL~~In Patient|na~ ()~NULL~~In Sibling1
weeks before. Was on E-ymcin drops. Stopped taking prior to comeing to clinic. Took the drops again few days afterwards.
PMH:seasonal allergies.
malformation Type 1, VP shunt
er vaccinations
, BPD, GERD;
ess with mild jaundice 11/14/08
brand name)~2~6~In Patient rand name)~4~5~In Patient
min; Coenzyme Q-10
itis, seasonal allergies, anaphylaxis to shellfish, and adenoma of the adrenal gland, surgically removed in Mar 08.
d cond: Type I Diabetes, Adrena, Hypertunction, Hypothy
ccine not specified (no brand name)~UN~0~In Patient
~Influenza (no brand name)~UN~0~In Patient brand name)~UN~49~In Patient
diopathic polyarthritis.
Varivax)~2~14~In Sibling
eumo (no brand name)~1~50~In Patient
|No~ ()~~0~In Sibling
CUR gr 3 (L)
e; Oxybutynin; Furosemide; Lisinopril; Lovastatin; Citalopram; Aspirin; Vitamin C; Vitamin E; Vitamin B12; B Complex; cranberry; Cinnamon
lar heart beat; High blood pressure; IBS
, sodium phosphate
ax)~1~0~In Sibling
A; Asthma; Constipation; Esophageal Reflex
ncreased cholesterol
A; Theodore/Hyperlipidemia; Depression; Bipolar.
01USA00323 01USA00324 01USA01206 01USA01951 01USA01953 01USA01966 01USA02430 01USA02433 01USA02724 01USA02746 01USA03061 01USA03138 01USA03733 01USA03797 01USA04170 02USA00407 02USA00406 02USA00083 02USA00068 02USA00031 02USA00020 01USA04442 02USA04426 01USA04422 01USA04407 01USA04393 01USA04391 01USA04385 01USA04376 01USA04368 01USA04367 01USA04253 01USA04188
01USA04169 01USA04124 01USA03986 01USA03895 01USA03981 01USA03962 01USA03954 01USA03943 01USA03940 01USA03934 01USA03906 01USA03830 01USA03709 01USA03695 01USA03688 01USA03572 01USA03670 01USA03669 01USA03655 01USA03654 01USA03641 01USA03640 01USA03550 01USA03543 01USA03541 01USA03523 01USA03516 01USA03509 01USA03506 01USA03501 01USA03498 01USA03494 01USA03441 01USA03440 01USA03437 01USA03348 01USA03315 01USA03292 01USA03289 01USA03288 01USA03159 01USA03127 01USA03113 01USA03100 01USA03098 01USA03097 01USA03093 01USA03077 01USA03066 01USA03059 01USA03056
01USA03051 01USA02938 01USA02772 01USA02752 01USA02751 01USA02738 01USA02737 01USA02713 01USA02707 01USA02700 01USA02699 01USA02690 01USA02575 01USA02567 01USA02535 01USA02502 01USA02494 01USA02463 01USA02390 01USA02385 01USA02384 01USA02133 01USA02114 01USA02093 01USA02043 01USA02042 01USA02018 01USA02008 01USA01986 01USA01979 01USA01978 01USA01971 01USA01963 01USA01947 01USA01860 01USA01832 01USA01823 01USA01820 01USA01813 01USA01810 01USA01808 01USA01796 01USA01793 01USA01766 01USA01758 01USA01741 01USA01731 01USA01652 01USA01631 01USA01626 01USA01623
01USA01616 01USA01610 01USA01588 01USA01517 01USA01508 01USA01340 01USA01321 01USA01318 01USA01310 01USA01304 01USA01294 01USA01258 01USA01227 01USA01221 01USA01181 01USA01176 01USA01148 01USA01143 01USA01142 01USA01138 01USA01134 01USA01128 01USA01027 01USA01024 01USA01020 01USA01008 01USA01005 01USA00984 01USA00872 01USA00856 01USA00808 01USA00803 01USA00802 01USA00796 01USA00457 01USA00375 01USA00366 01USA00365 01USA00353 01USA00352 01USA00349 01USA00342 01USA00341 01USA00318 01USA00315 01USA00309 01USA00308 01USA00307 01USA00289 01USA00200 01USA00188
01USA00173 01USA00154 01USA00061 01USA00052 01USA00041 12USA04853 11USA02352 11USA02127 10USA02628 10USA00870 06USA02226 02USA06329 02USA00364 12USA00292
asles + Mumps + Rubella (no brand name)~UN~0~In Patient (no brand name)~UN~27~In Sibling
nar)~3~1~In Patient
f thyroid s/p thyroidectomy
el)~1~51~In Patient
02USA02263 02USA01655
opause; uterine fibroids : 25 wk premie.
R carotid stenosis; bronchiectasis; immune deficiency IgM; allergies: HCTZ; Simvastatin; CRESTOR
uzone)~1~6~In Patient
roids. Pt. denied allergy to Neomycin or Gelatin. B + IPV (Pediarix)~4~0~In Patient
o diagnosed having Thrombophilia per mother. 2/25/09-records received-PMH: MTHFR mutation. rgy - metronidazole (urticaria)
D for 10 days
by emergency c-section at 29 weeks gestation (12/31/2007) secondary to placenta previa and bleeding. He was born with a birth weight of
02USA02409 02USA02177 02USA02440 ERD); NB hearing screen (L) ear did not pass
eing tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
, Ocular albinism, Hx of Pylonepariti
ow fever (no brand name)~1~41~In Patient
DX: HTN, Depression, and Hyper Cholesterol
OLECTIN, TCN, ZOLOFT, DEMEROL, KEFLEX
no brand name)~1~32~In Patient
Sibling1|None~ ()~NULL~~In Patient|None~ ()~NULL~~In Sibling2 asil)~2~16~In Patient
kle Cell Trait / Chronic Renal Failure / Pulmonic Stenosis and Small ASD /Hyperparathyroidism /Developmental Delay /? Visual Impaired / N
h Failure to gain weight, vaginal bleeding and jaundce at 5 days of age. PMH: none
Vaccine not specified (no brand name)~NULL~~In Patient . Vertigo. Factor V Leiden WNL. Family hx: endometrial ca, CVA. 9/19/08 HPV#1, no lot # available.
l stenosis correction
nose, Atopic dermatitis
cardiovascular disease.
nfection lower abd.
s prior. PMH: eczema
Mumps + Rubella + Varicella (ProQuad)~UN~1~In Sibling
01USA03717 02USA02626 02USA02661 02USA02666 02USA02698 02USA02926 02USA02933 02USA02939 02USA02882
n to any medicine in previous situations. asthma, seasonal allergies.
ed & resolved
oidism, hypertension, degenerative dise disease. 4/3/09-records received-PMH:HTN, arrhythmia with PVCs, hypothyroidism, HRT, GERD,
; penile cancer
onditions: ADHD; Bipolar disorder, DDD, Mild persistent asthma; Obesity; Allergic rhinitis ~1~2~In Patient
une disorder; reactive airway disease; GUILLIAN BARRE syndrome in 2 family members (very distant) on pt's grandfather's side. Both with
reness~Pneumo (no brand name)~1~21~In Patient 02USA03903
reported as Zoster and not as Varicella.
)~2~15~In Patient
ays of life from high fevers, no seizures since 2/18/08 until 2/15/09.
xiety, suicidal ideation history.
y to Augmentin reaction with severe diarrhea.
02USA02413 02USA02932 02USA02974 02USA03097 11USA01322 02USA01674 02USA03098 02USA02699 PMH: Myasthenia Gravis. Diverticulitis. cataracts.
event~ ()~~0~In Patient
la (no brand name)~UN~1~In Sibling
evated PSA, sulfa allergy
osis; emphysema
N; Sulfa; Zithromax; Pineapple
n due to daughter's suicide
Carpal Tunnel Syndrome, Fibromyalgia, Osteopenia, Hypercholesterolemia, Cervical Degenerative Disc Disease, Myofascial Pain Syn
n Acute Coronary Syndrome - Non ST-Elevation MI days in Sept 2008 for fever of unknown source b fractures found at autopsy PMH: 36 wk preemie.
mild language & motor delays. GERD. Birth hx: uncomplicated. Family hx: dyslexia, dysgraphia & spina bifida occulta.
rgy; shellfish allergy DX with GERD; 1/10/09 Acute Bronchitis PMH: RSV
B09) Allergy work-up, which was negative for environmental allergens per skin testing. Normal Pulmonary Function testing. Dx was vasom
02USA03575 02USA03396 A, 0469U; HPV #3 given 2/20/08, LA, 1287U PMH: environmental allergies.
ng|none~ ()~~0~In Sibling|none~ ()~~0~In Patient Allergic to penicillin.
Patient|none sister~ ()~NULL~~In Sibling1|none brother~ ()~NULL~~In Sibling2 cluding congenital CMV, microcephaly, cerebral palsy and pre-existing seizure history. 3/6/09-records received-PMH: CP, seizure disorder
gias less severe~Td Adsorbed (no brand name)~UN~20~In Patient
mandate that drug manufacturers make separate vaccines for Measles, Mumps and Rubella. It would give parents an option over the MMR
02USA02176 occurring brain bleed from birth
MH:bronchitis and whooping cough.
is in 1987); Pecans, Walnuts; Pollen; Dust mites. "Mild verbal tick" emia; elevated LDH
no brand name)~1~0~Sibling gnificant medical history.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
A, acute sinusitis, cough, acne vulgaris tx w/minocin, abdominal pain, diarrhea. Family hx: depression, suicide.
A, SVD, vertex. Preterm labor tx w/steroids. Neonatal jaundice w/tx x 1 wk. Labial adhesion tx w/steroid cream. Colic. EDIS eval @ 11 m
pe, HCTZ, Verapamil
as held breath before.
AD, T&A. Strep pharyngitis. ADD. obesity. Behavior changes 2008
10USA02517 02USA03537 02USA03735 02USA03764 02USA03784 02USA04026 02USA04035 02USA03761
ipidemia; HTN; Rosacea; Urge incontinence; Osteoarthritis; Cataracts; History of gout; Tendonitis.
ease, asthma
mental allergies and asthma ng with my children. PMH: Asthma. : hypertension
|None~ ()~~0~Sibling
sil)~1~13~Patient Allergies; Asthma; GERD
sophagitis, severe acid reflux (GERD), investigating bleeding disorder (no confirmed or denied diagnosis to date), multiple food allergies, no
Recurrent sinusitis, status post rhinoseptoplasty. hepatitis C. Questionalbe history of Epstein-Barr virus infection. Gastroesophageal reflux d
or facial abcess.
esterolemia, lithium-induced renal disease.
diagnosed 5 days after vaccine administered.
02USA04226
02USA03436 02USA03722 02USA04183
d name)~1~0~In Sibling
02USA04059 02USA04441 02USA04580 02USA04384 02USA04455
eated & outgrew them. PMH: Allergy to eggs (flu vax OK before 2008). Food allergies as child
FFEXON; WELLBETRIN; ZOLOFT Numerous ear infections
ion, asthma, rhinitis, renal insufficiency
erpes simplex around her mouth but has never had the virus around nose or eyes.
nd h/o asthma
asthma. Family hx: CAD, DM.
(no brand name)~UN~20~In Patient
02USA04394 02USA04440 02USA04545 02USA04564
COPD-lung reduction surgery. Severe emphysema. Right-sided CVA small residual weakness. Former smoker. oronary artery bypass grafting. COPD. HF, COPD oxygen dependent, pulmonary HTN, hyperlipidemia, HTN, cervical cancer w/hysterectomy, chronic hyponatremia, tobacco abus
reast cancer status post right mastectomy, cervical cancer, glucose intolerance, hypertension, cough with lisinopril, muscle aches with prav
9/09-records received-PMH: Migraines, renal cyst vesus angioma.
exercise-induced asthma
MH:long history of migraine headaches similar in severity. on in yr 2005.
Dx allergies and eczema
penicillin; Cephalosporins; ketones & mocrotides; Busperione; Hydroxyzine hcl
MNICEF; AUGMENTIN
N-D" makes heart flutter); reports cervical spine narrow pathway- not a lot of fluid in my spine. HTN; Increase cholesterol; whiplash history a
02USA01641 03USA00102
o brand name)~1~23~Patient ed hospitalization for apnea; bradycardia; Gastroesophageal reflux. PMH: 30 wk premie. RDS. on TPN.
o brand name)~UN~32~In Patient ~Varicella (no brand name)~1~0~In Patient
osteoarthritis, osteoporosis, sunus node dysfunction, hearing impaired, constipation, atrial fibrillation, mental retardation
itis, depression, degenerative arthritis of knee, NKDA,
arthritis. Hip surgery. Allergies to PCN & Tetracycline
02USA03994 02USA04266 03USA00062 03USA00104 03USA00467 03USA00374 ess test, DM, hypercholesterolemia
patellofemoral syndrome PMH: acne on minocycline x 2 yr; left orbital rim fracture; amblyopia; high triglycerides; dysautonomia; MRSA ce - surgery @ 2 days - fine now
sturbance; Otitis Media; Constipation
ergic to shell fish
les + Mumps + Rubella (MMR II)~5~2~In Patient nomune)~~0~In Patient
azine, adhesives, fish ccal (Menactra)~1~11~In Sibling1
nal allergies. NICU x 2 wks for resp distress as 34 wk preemie. Family hx: food allergies.
PV + Hib (Pentacel)~2~0~In Patient|~ ()~2~0~In Sibling
TX with antibiotics
03USA03327 03USA00423 01USA03522 12USA05084
ncy; tonsillar hypertrophy. Family hx: leg length discrepancy.
and name)~1~11~In Sibling
olerance: codeine (nausea & vomiting) coronary artery disease, hyperlipidemia, hypothyroidism. PMH: hyperlipidemia, CAD s/p stent, hypo
astic bronchitis 1/09 previous febrile seizure on 10/08 and 1/09
TN, hearing impaired Rotavirus (Rotarix)~1~0~In Patient
sels~DTaP (Daptacel)~2~2~In Patient
eipt of MMR~Measles + Mumps + Rubella (no brand name)~1~0~In Patient
Similar episodes occurred one month prior as shaking episode. 03USA00787 03USA00750 03USA00745
H:hypothyroidism, anxiety, smoker. Allergy: lidocaine, cipro.
ERD. Depression. Allergy to Geodon
+ IPV (Pediarix)~2~1~In Patient ; RA; onychomycosis
Motrin, Compazine. Can take erythromycin. No liver or Kidney problems.
ANEMIA, LE VARIX, LE EDEMA, LYMPH ENLARGEMENT
keratosis, hyperlipidemia, rotator cuff tendonitis. Family hx: DM nd name)~1~9~In Patient ergy to eggs.
rdasil)~NULL~~In Patient none~ ()~~0~Sibling|none~ ()~~0~Sibling
pitations, stroke, coronary stent placement, OA & joint pain.
rand name)~1~0~In Sibling1
~1~0~In Patient
arivax)~1~16~In Patient
03USA00963 03USA00563 03USA00757 03USA00933 03USA00740
Vi Polysaccharide (no brand name)~UN~8~In Patient
NO BIRTH/CONGENTIAL DEFECTS, NO CHRONIC MEDICAL CONDITIONS 3/18/09-records received- Allergy to Sulfa-rash. urmur; cleft lip; cleft
DTaP (no brand name)~1~0~Sibling
2 yrs ago; High Cholesterol
rand name)~2~7~In Patient|~Varicella (no brand name)~2~11~In Sibling a (no brand name)~2~7~In Sibling
ORIN (topical)
radiculopathy; Neck pain; Carpal Tunnel Syndrome; Peripheral Neuropathy; Chest pain; Actinic Keratosis; Bunion, right foot; Impaired fast C- Section d/t placental abruption
nvironmental allergies.
rds received-Allergic to Penicillin V Potassium-itch. MH:hypoxic episode at birth NICU.Mother had history of seizures as a child.
|None~ ()~~0~Sibling|None~ ()~~0~Sibling 03USA01427 03USA00564 03USA00934 03USA00921 8 amoxicillin x 10 days. mitral valve prolapse; hypothyroidism PMH: Kidney infection. hyperlipidemia. shingles x 2. Atrial fib w/ablation. cardiac angiogram WNL
brand name)~4~2~In Patient
dical conditions.
bling1|N/A~ ()~NULL~~In Sibling2|N/A~ ()~NULL~~In Patient
a, depression, hypothyroidism, GERD
bdominal pain, H. pylori, lactose intolerance. Allergic rhinitis.
ords received- febrile seizures.
sal syndrome; Obesity; Constipation Hypothyroid; Tetracycline; PCN; SULFA
es (seasonal)
03USA00835 12USA08457 01USA05057 01USA01143
12USA08565 12USA04824 12USA08834 12USA09091 01USA00319 01USA00333 01USA00950 01USA01636 01USA02463 01USA05671 01USA05750 01USA05767 02USA04639 02USA05318 03USA01282 04USA01172 04USA01932 04USA05095 05USA00195 06USA02567 08USA04750 09USA01524 09USA03003 09USA04523 11USA00853 11USA02934 12USA02271
DOS 12/21/07 to 2/26/09. Anemia, c-section, thyroid, PPD(+) placed on INH, pneumonia. Salpingo-oophorectomy. 4/6/09 Records receive
03USA00952 02USA00806 04USA04091
tion preservative.
1st doses of same vaccination~Vaccine not specified (no brand name)~UN~0~In Patient
(no brand name)~UN~0~In Patient
(Varivax)~2~3~Patient
deficiency, GERD, asthma, nonallergic rhinitis, abnormal Pap smear, CIN 1, smoker, s/p c-section delivery x 2 yrs prior. Family hx: asthma esity, Vitamin D Deficiency (mild/treated), Anxiety (mild), remote history of viral meningitis, status post L Ankle fracture (remote) PMH: smok
ood pressure
12USA03381 03USA00854 03USA01644 SV bronchiolitis
easonal allergies No known allergies to meds.
n AZT for 6 weeks and has negative testing for HIV to date. PMH: none.
NAL ALLERGIES
cal conditions
llergies: Betadine, latex. ASCUS 1/30/08.
sorder. PMH: hyperlipidemia, anxiety, low back pain s/p surgery
02USA04090 02USA03978 02USA03082 02USA02902 02USA02647 02USA02385 02USA02251 02USA02243 02USA02170 02USA01794 02USA01704 02USA01652 02USA01525 02USA01491 02USA01091 03USA00060 03USA00014 02USA04196 02USA04614 02USA04623 02USA04624 03USA00004 03USA00009 03USA00013 03USA00033 03USA00052 03USA00057 03USA00076
03USA00096 03USA00106 03USA00120 03USA00502 03USA00274 03USA00134 02USA04579 02USA04576 02USA04551 02USA04538 02USA04537 02USA04531 02USA04526 02USA04519 02USA04518 02USA04517 02USA04500 02USA04481 02USA04477 02USA04453 02USA04362 02USA04356 02USA04044 02USA04071 02USA04072 02USA04176 02USA04180 02USA04190 02USA04195 02USA04198 02USA04249 02USA04250 02USA04252 02USA04343 02USA04346 02USA04350 02USA04032 02USA04019 02USA04004 02USA04000 02USA03917 02USA03801 02USA03797 02USA03770 02USA03739 02USA03734 02USA03713 02USA03633 02USA03603 02USA03589 02USA03555
02USA03553 02USA03545 02USA03544 02USA03536 02USA03528 02USA03115 02USA03112 02USA03108 02USA03107 02USA03106 02USA03105 02USA03094 02USA03093 02USA02975 02USA02682 02USA02694 02USA02704 02USA02705 02USA02709 02USA02879 02USA02904 02USA02914 02USA02929 02USA02935 02USA02937 02USA02962 02USA02969 02USA02669 02USA02388 02USA02175 02USA02184 02USA02194 02USA02197 02USA02212 02USA02237 02USA02269 02USA02274 02USA02276 02USA02390 02USA02426 02USA02649 02USA02167 02USA02030 02USA01667 02USA01676 02USA01682 02USA01699 02USA01707 02USA01775 02USA01813 02USA01815
02USA01871 02USA01879 02USA02003 02USA01614 02USA01435 02USA01468 02USA01470 02USA01481 02USA01500 02USA01507 02USA01517 02USA01531 02USA01588 02USA01615 02USA01625 02USA01635 02USA01636 02USA01653 02USA00928 02USA00931 02USA00934 02USA00935 02USA00938 02USA00942 02USA00951 02USA01036 02USA01062 02USA01064 02USA01080 02USA01104 02USA01115 02USA01120 02USA00924 02USA00894 02USA00485 02USA00488 02USA00535 02USA00570 02USA00575 02USA00579 02USA00589 02USA00619 02USA00628 02USA00849 02USA00858 02USA00881 02USA00883 02USA00476 02USA00470 02USA00462 02USA00461
02USA00455 02USA00450 02USA00427 02USA00426 02USA00425 02USA00287 02USA00281 02USA00256 02USA00221 02USA00215 02USA00185 05USA03343 12USA08122 04USA01176 05USA02898 05USA05753 05USA05935 06USA03410 07USA01851 07USA03262 07USA04636 01USA03966 01USA04179
03USA02000 03USA01794 03USA01668 03USA01845 11USA00715 03USA02039 03USA01841 03USA02062 03USA02038 rmer 34 week preterm infant. amoxicillin at admit. Hives, viral illness, bronchitis, OM, nosebleeds. Family hx: eczema, hypothyroidism, GERD, IBS. ubation, NICU x 1 wk. Recurrent RSV 2 wks prior to admit, seen in ER only.
trait, Incontinentia pigmenti
edicine; central sleep apnea; brain trauma
nus Diphtheria (no brand name)~UN~48~In Patient Adenoids removed for sleep apnea d 101~ ()~~0~In Sibling
phtheria (no brand name)~UN~~In Patient
OM. Left middle ear effusion 12/08. Left lacrimal duct obstruction. 36 wk preemie, mild neonatal feeding difficulty resolved.
MH: eczema.
he did have other medication allergies 4/27/09-records received-PMH:borderline DM and HTN with DVT. allergies to grass, animals, dust.
flux (G-E); Myeloproliferative disorder 5/19/09-records received-PMH: Down Syndrome with transient myeloproliferative disorder. Congenit
s: Pulmonic; Tricuspid; Mitral a, fibromyalgia, cervical CA s/p hysterectomy
03USA02047 03USA02042 03USA01872 03USA01804 03USA02071 03USA02043 03USA01837 03USA01470
ce + body~Measles + Mumps + Rubella (no brand name)~1~1~In Patient No known birth defects.
ON~Anthrax (Biothrax)~1~31~In Patient
uising~Measles + Mumps + Rubella (MMR II)~1~29~In Patient
age 11 and everyother month very heavy and cramping.
eved amoxicillin that was stopped after only 5 days due to rash. y diagnosed with HTN and insulin resistence.
LL~~In Patient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2
lthy and athletic; so healthy she wouldn't drink but maybe two soft drinks a year; she is allergic to the fruit formula given before having a ca
done; Flexeril; Ibuprofen; Latex/Rashes 3/24/09-records received-PMH:allergic reactions in past. T& A, asthma, epilespy, Wolff-Parkinson-
ous only; HSV meningitis, as infant; normal development
01USA00098 12USA03330 12USA03312 01USA00317 12USA04898 12USA03569 12USA03314 12USA02004 12USA01523 12USA00544 12USA00480 12USA00053 11USA03029 11USA02988 11USA02844 11USA02841 11USA02798 11USA02544 11USA02179 11USA01659 11USA01658 11USA00783 11USA00635 11USA00563 01USA03990 10USA03139 10USA03070 10USA02502 10USA02436 10USA02427 10USA01821 10USA00820 10USA00425 10USA00194 10USA00177 01USA00075 10USA00002
08USA05347 08USA03602 09USA04880 09USA04315 09USA03422 09USA03006 09USA01661 09USA01605 09USA00797 08USA05345 08USA04151 08USA03995 07USA05660 07USA05790 08USA03092 08USA02804 07USA05683 07USA05549 07USA04094 07USA04037 08USA04836 07USA02498 07USA01576 07USA01112 10USA01573 01USA02974 02USA05298 01USA03311 01USA04102 01USA04436 02USA02695 02USA03013 02USA03149 03USA01725 03USA03063 03USA04159 04USA00190 04USA00205 04USA02481 04USA03139 07USA00728 05USA00046 05USA00042 04USA03842 05USA00927 05USA04759 05USA04852 06USA00720 06USA00825 06USA02494 06USA03414
06USA08376 07USA00061 07USA00802
03USA02330
03USA02361 03USA02096 03USA02102 03USA02288 03USA02340 03USA02644 06USA01608 07USA00388 PMH:eczema.
one~ ()~~0~In Patient
(Varivax)~1~1~Patient|11/07/2008~Measles + Mumps + Rubella (no brand name)~1~1~Patient 03USA00042 03USA00043 enisia; Pt has hx of HTN, insulin resistance, nonspecific autoimmune disease, brain lesion in left frontal lobe from possible infection in 200
none~ ()~~0~Sibling|none~ ()~~0~Sibling
, Hepatitis B
hylactic reaction. hadenopathy~HPV (Gardasil)~1~17~In Patient Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
DX, Asthma
ladder; malrotation; club feet
d spots on mouth)
03USA02427 07USA00609 03USA02931 01USA00529 03USA02626 03USA02913 03USA02548 03USA02604 03USA02370 03USA02366 03USA02364 03USA02363 03USA02306 03USA02292 02USA03560
umovax)~1~0~Patient
l)~UN~16~In Patient
mps + Rubella (MMR II)~2~1~Patient
ax)~2~10~Patient since but we switched to DTAP!!~Vaccine not specified (no brand name)~UN~0~Patient
IBUPROFEN
cl. "Molds and dust"
blood pressure; Gout. PMH: ETOH abuse. Dementia. COPD. HTN. Gout. OA. lumbar laminectomy. L PTX with thoracotomy and partial g PMH: hives approx 6 mo earlier, cause unknown; dyspnea at rest; eczema. Allergy: lobster.
AUGMENTIN
ginal infections 11/08. Family hx: migraines.
d name)~3~35~Patient
o (Pneumovax)~1~58~In Patient
03USA01874 03USA01790
03USA02848 03USA02914 03USA02570 03USA02249 03USA02300 03USA02305 03USA02329 03USA02563 03USA02567 03USA02860 03USA03197 03USA03220 cords received-Clinical history of patent ductus arteriosus and ventricular septal defect. Slit-like communication between atria. One of twins
02USA01705 02USA01848
100, ASA, Celebrex, Ultram, Sulfa
Allergy: latex.
pertension, hyperlipidemia, gout, PVD, CAD, diabetes hritis in shoulders and hands. ERVE LEFT LEG
Patient|none~ ()~NULL~~In Sibling1
PV (Gardasil)~1~18~In Patient
2 stents implanted in LAD. Hashimoto's thyroiditis in 2000.
vs atrial septal defect
02USA00596 03USA02949 03USA03341 03USA03254 03USA02086 03USA02561 03USA02926 03USA02954 03USA03241 03USA02618
HTN, diverticulosis, fibromyalgia, vitiligo, cholecystectomy, parathyroidectomy, and R tendon repair
ecords received-PMH: ADHD.
e month ago. P (no brand name)~1~0~Patient
None~ ()~~0~Patient
sterol, controlled with meds was on oral antibiotics when admitted. Allergic rhinitis, kidney stone, shoulder & knee arthroscopy. Family Hx: prostate cancer, HTN, MI.
wo years prior to receiving GARDASIL, that's why my MD wanted to administer the vaccine.
rand name)~1~32~Patient
emia, Obesity
ppened before", non specific re date/type~Vaccine not specified (no brand name)~UN~0~Patient
summer; hx of of hives e, secondary to preaclamptic; Birth mother + methamphetamines at 6mos
nd name)~4~1~Patient
V (Gardasil)~1~20~Patient
ission breast cancer; osteoporosis; high cholesterol; insomnia
03USA02034 02USA00936 09USA04651
mia; Allergic; Amitriptyline
s 3/26/09-records received-PMH: sprained thumb and mononucleosis 4/20/09-records received-PMH:Depression PVCs. t, Status post multiple lacunar CVA with residual left side coordination deficit
ancomycin, Verelan, Altace, Cardizem, Tegretol, Reglan. Medical conditions: Heart arrhythmia (pacemaker), Severe leakage of tricuspid va history of high blood pressure
ecords received DOS 3/23/09 to 5/4/09. Laparoscopic knee surgery, gun shot wound to abdomen with surgical repair of small bowel.
llergies, PTSD, multiple medication reactions
n dye, dx: myalgia in 2008
on; Colonic Polyps; Hearing loss; Gout; SOB.
03USA03963 03USA04511 03USA00408
03USA02617 03USA03061 03USA04267 03USA03605 03USA03764
destroyed cartilage; Chronic fatigue syndrome; Mitral valve regurg; Diabetes type II PMH: anxiety, arthritis, LBP, smoker, hyperlipidemia, apparent injury
nt ear infections
04USA02884 05USA01280 05USA02022 eceived-PMH: food allergies and reactions to cephalosporins and amoxicillin, has anaphylaxis. Allergic to lidocaine. Adopted. miles/week). 2) Anxiety and obsessive thoughts.
mia, allergic to adhesive tape
nd name)~NULL~~In Sibling1
ombivax HB)~1~34~In Patient
airway obstruction PMH: ASCAD, DOE, chest pain; aortic stenosis; DM; HTN; hyperlipidemia; obstructive sleep apnea; herniated disks; G ASD; Hypotonia; Intrauterine growth retardation PMH: recent failure to gain weight, nutritional deficits. VSD, hypospadias, CP, torticullis.
al affective disorder; Depression; Foot Pain Chronic; Constipation; Alcohol Abuse; Headache; Abdominal pain, Generalized; Tobacco use D
athy; pelvic pain
03USA00457 03USA03393 03USA03647 03USA04016 03USA03176
03USA03666 03USA03958 03USA04509
+ swelling~DTaP (no brand name)~1~4~Sibling s, swelling~DTaP (no brand name)~1~2~Sibling
t|UNKNOWN TO ME~ ()~~0~Sibling|UNKNOWN TO ME~ ()~~0~Sibling
uding Fainting~HPV (Gardasil)~1~22~Patient dometriosis, migraines
demia, degenerative joint disease PMH: BPH.
d face; flu-like sickness~Tetanus Toxoid (no brand name)~UN~30~In Patient
MH: HTN, hyperlipidemia, PVD.
N and Amoxicillin
o brand name)~1~1~Patient
PMH: GERDs/p pyloric stenosis repair 3/10/09. LFTs & bilirubin elevated
o brand name)~2~7~Patient
o brand name)~1~0~Patient
s or medical conditions. ardasil)~2~15~In Patient
mic, arthritis, anemia,gerd.
nxiety disorder; insulin resistance; Lupus (SLE); migraine disorders; TMJ; chronic pain with arthritis involving hands/neck; asthma/RAD; Glo
wks prior to patients outbreak.
S; CHRONIC DEPRESSION; HYPERLIPIDEMIA; CHRONIC MYALGIAS
03USA04260 03USA04265 03USA04534 03USA04681 03USA03608 05USA01355 08USA02136
mptoms - not treated
TN, hyperlipidemia
done, mycins, sulfa
on 3/27/09. It wasn't listed above History - osteoarthrithis, hypertension, hyperlipidemia, CAD, MI - s/p Bare Mental Stent placement 3/07
able bowel, stomach ulcers
03USA01775 03USA04013 03USA04572 03USA04669 03USA04692 03USA04586 03USA03246 03USA03954 03USA04221 03USA04679 03USA04682 03USA04714 03USA04713 03USA04843 03USA03663
MH: asthma. constipation, obesity
ery. Family hx: CAD
ape; Lactose intolerance; OXYCOTRIN; NEOSPORIN; Meds from horse serum
k, allergic to AMOXICILLIN, ASA, TOPOMAX
CA, COPD, hypertension, chronic neck and back pain in setting DDD, dyslipidemia, erectile dysfunction. NKDA 4/13/09-records received-P
SULFUR ABOUT THE AGE OF 6 AND 7 YEARS OLD - PENICILLIN = STOP BREATHING, LOC, REQUIRED CPR; SULFUR = WEAKNES Hypertension
RGY TO AMOXICILLIN 3/26/07 Allergies to nuts, crab, and sulfa. 4/6/09-records received-Allergies to penicillin, sulfa, peanuts crab and sulfites.
oss Valvular Heart Disease (valve repair not replacement) Hyperlipidemia
nd Poor Feeding~Hep B (no brand name)~1~0~Patient
ocolate; alcohol; talcum powder; peaches; nectarines
03USA04224 03USA04860 03USA04869 03USA04886 03USA01840 01USA02732 03USA04863 03USA04907 03USA04916
two; traumatic birth. I - 2years ago with 1 stent placed; Osteoarthritis; Hypertension; CAD; Hyperlipidemia.
ain; Obesity; GERD
t hospital for rash on thigh with "cream".
ng, upset stomach,sore throat, runny or stopped up nose,weak,pale, and cried most of the time.~HPV (Gardasil
L~13~In Sibling1 n~Zoster (no brand name)~UN~64~In Patient
~12~In Sibling1 NEARLY 5 YEARS AGO; NKA
bumps in legs~DTaP + IPV + Hib (Pentacel)~2~1~In Patient
DOS 3/27/09. Asthma, exercise induced.
DMII; Sciatica; Neuropathy
03USA04905 03USA03214 03USA04710 03USA04678
ED INTRAVASC CONTRAST. PMH: UE DJD, Impingement syndrome, shoulder bursitis, abd pain, diverticulosis, osteopenia, polyarthralgia onia, chronic SDH s/p head trauma, BPH, cardiac disease. Ex-smoker. Allergy: lidocaine.
RROSTENOSIS
ope; Diabetes, HTN, Hyperlipidemia; Osteoarthritis-hands; Parox. atrial fib.; Osteoarthritis-spine
ng and swelling; General anesthesia: Nausea us and was told never to get~ ()~NULL~~In Patient y, hyperbilirubinemia us and was told never to get~ ()~NULL~~In Patient
hrax.~Anthrax (Biothrax)~2~23~In Patient
l pain, dizziness, pale~HPV (no brand name)~3~12~Patient|none~ ()~~0~Sibling|none~ ()~~0~Sibling
holesterol. Allergy: latex.
ar prn; PROAR prn; Ortho Noverex; VERAMYST; REQUIP 03USA05210 03USA05205 03USA01463 03USA05483
Lupus nephritis. renal transplant x 2. Breast CA s/p lumpectomy, R&L hip replacements, L knee replacement. allergies: hydrocodone, Rel
ronchitis at time of vesicular rash. 4/10/09-records received-PMH: asthma.
easles + Mumps + Rubella (no brand name)~2~45~Patient
~DT+IPV+Hib+HepB (no brand name)~2~0~In Patient
of seizures in paternal aunt.
se; High cholesterol; Anxiety; Chronic pain
TIN; allergic rhinitis; obesity; asthma
arivax)~2~8~Sibling 2~11~Sibling
cardiac syndrome X, multiple food allergies (diagnosed by physican allergy specialist), multiple drug allergies, fibromyalgia/
03USA05627
03USA04882 03USA05206 03USA05533 03USA05489 03USA05181 01USA05565 01USA02454
exies 8.9g/dl (11/26/08)
: HTN, asthma. Family hx: HTN.
ing red dye. PMH: Planter's wart on foot, anxiety r/t school work and difficulty focusing, keratosis on arms and allergy sx. Mono-summer 2
uncomplicated. eived-PMH: seasonal allergies. Tonsils and adenoids removed.
04USA00158 04USA00372 04USA00334
ULFONAMIDES) can) - Ate crab 3 days prior to rash.
duced asthma-stable/controled omycin (Feb 2009)
, pollen) S/P acute rheumatic fever
mps + Rubella (no brand name)~2~5~Patient
a)~5~~In Patient
ords state PMH: allergic rhinitis; heartburn; menopause; tinnitus; acute bronchitis, anemia, epistaxis & OM resolved; appendectmy.
()~~1~Patient
adriplegia, multiple joint contractures, bilateral carpal tunnel syndrome, congenital mitral valve prolapse, hemorhoids, constipation, cataract
10USA00442 04USA00519 04USA00310
04USA00203 ever; allergic to SULFA X CODEINE
05USA03810 03USA00673
04USA00488
eciebing allergy shots weekly for 3 1/2 years, No allergies to yeast. I have never had a reaction to any vaccine before this one 4/13/09-reco
RD, high cholesterol
started taking Oral Typhoid prophylaxis starting 4/3/09 rash may be related to this. Patient has not pre existing conditions and no known al
PMH: eczema.
01USA03661 01USA03665 01USA03667 01USA03668 01USA03677 01USA03836 01USA03902 01USA03955 01USA03956 01USA03965
01USA04130 01USA04150 01USA04153 01USA04173 01USA04306 01USA04404 01USA04396 01USA04370 01USA03135 01USA03157 01USA03303 01USA03307 01USA03329 01USA03333 01USA03341 01USA03446 01USA03447 01USA03463 01USA03466 01USA03540 01USA03649 01USA03095 01USA02961 01USA02833 01USA02800 01USA02715 01USA02708 01USA02698 01USA02650 01USA02589 01USA02579 01USA02573 01USA02537 01USA02505 01USA02101 01USA02381 01USA02397 01USA02403 01USA02404 03USA02373 01USA04418 01USA04420 01USA04430 02USA00018 02USA00136 02USA00195 02USA00207 02USA00208 02USA00225 02USA00269 02USA00292
02USA00421 02USA00435 02USA00443 02USA00474 02USA00486 02USA00505 02USA00546 02USA00561 02USA00562 02USA00594 02USA00857 02USA00947 02USA00952 02USA01008 02USA01029 02USA01040 02USA01078 02USA01108 02USA01461 02USA01473 02USA01476 02USA01488 02USA01627 02USA01630 02USA01656 02USA01663 02USA01665 02USA01744 02USA02379 02USA02384 02USA02441 02USA02652 02USA02660 02USA02679 02USA02680 02USA02684 02USA02713 02USA02787 02USA02901 02USA02954 02USA02966 02USA03055 02USA03099 02USA03124 02USA03186 02USA03535 02USA03564 02USA03736 02USA03747 02USA03762 02USA03787
02USA03808 02USA03809 02USA03811 02USA04034 02USA03984 02USA03991 02USA04015 02USA04081 02USA04091 02USA04093 02USA04102 02USA04107 02USA04109 02USA01793 02USA04181 02USA01812 02USA04193 02USA01851 02USA04217 02USA02162 02USA02166 02USA02178 02USA04397 02USA04401 02USA04516 02USA02189 02USA02244 02USA02253 01USA01764 01USA01762 01USA01761 01USA01750 01USA01748 01USA01737 01USA01730 01USA01717 01USA01639 01USA01575 01USA01561 01USA01560 01USA01471 01USA01366 01USA01337 01USA01333 01USA01302 01USA01470 01USA01289 01USA01288 01USA01231 01USA01219 01USA01207
01USA01184 01USA01183 01USA01182 01USA01161 01USA01154 01USA01151 01USA00075 01USA00062 01USA00038 01USA00028 12USA05244 12USA05241 12USA05203 12USA04879 12USA04852 12USA04849 12USA04830 12USA04714 12USA04643 12USA04568 12USA04555 12USA04552 12USA04530 12USA04509 12USA04273 12USA04260 12USA04142 12USA04112 12USA04103 12USA04087 12USA04037 12USA04036 12USA04035 12USA03774 12USA03763 12USA03704 12USA03607 12USA03603 12USA03597 12USA03386 12USA03374 12USA03371 12USA03349 12USA03315 12USA03240 12USA03215 12USA03191 12USA02814 12USA02780 12USA02628 12USA02621
12USA02617 12USA02596 12USA02350 12USA02325 12USA02200 12USA02144 12USA02139 12USA02115 12USA02032 12USA02055 12USA01823 12USA01782 12USA01775 12USA01655 12USA01630 12USA01604 12USA01189 12USA00539 12USA00393 10USA00373 12USA00362 12USA00358 12USA00054 12USA00050 12USA00009 01USA01076 01USA01075 01USA01009 01USA01004 01USA01001 01USA00990 01USA00804 01USA00790 01USA00787 01USA00333 01USA00314 01USA00196 01USA00135 01USA00132 04USA00201 04USA00198 04USA00475 03USA03642 04USA00186 name)~UN~0~Patient
nation GARDASIL 10/18/07 OCP since 11/08. Allergy: possibly sulfa, hives. Family hx: Factor V leiden deficiency. and name)~5~11~Patient
/08 with liver and spleen palpable at rib cage. Allergy to Biaxin
ut, PVD, CAD, diabetes
es. Currently breast feeding. No daycare. Healthy pregnancy and birth.
Morphine,oxycodone,sulfa. Reports swelling of lips cheeks and tongue after 1 1/2 day of pepsid |no~ ()~~0.00~Sibling|no~ ()~~0.00~Sibling
mately 4-6 years of age. n at 30 weeks gestation PMH: alpha thalassemia.
rgy's, penicillin
ed 2007); peritoneal shunt present. 6/15/09 Received hospital medical records for 3/27-3/28/2009 & ER records for 3/25/09. Brain tumor/Me
04USA01379 02USA01068 04USA00618 04USA01122 04USA00236 04USA00813 04USA00610
01USA03627
o first two pertussis, then stopped pertussis.~DTP (no brand name)~2~0~Patient on, Family hx: childhood seizures, migraine HAs. cef, Biaxin,Amoxicillin HX:DM,Hyperlipidemia,HTN,MVP,IBS,Anemia,cervical fusion,hysterectomy,fibrocystic breast disease
PMH: cyclic vomiting & abdominal migraines.
rthritis, knee replacement; Breast cancer 2001
d name)~2~0~Patient
towards mother~ ()~UN~8~Patient
03USA04563 04USA00862 04USA00866 04USA00886 es (epilepsy); severe mental retardation PMH: severe epilepsy since age 2 w/last seizure 2008, BMI 13, decreased vision, stool & urine inc nown cause. RAST testing WNL w/only slight reaction to peanuts. Allergy: PEN, motrin. Family hx: allergic rhinitis, asthma.
0 days on 3-20-09. History enlarged uterus, resolving by follow-up ultrasound
havioral / eval.
besity; sleep apnea; hyperlipidemia
nd name)~UN~11~Patient
tenosis; spitting up & formula changed; strawberry hemangioma left forehead. Family hx: asthma.
on 4/3/09 and was deemed to be in perfect health. She is progressing as expected for her age. She has been walking since 12/25/08, per
ometriosis w/surgery. Family hx: DM.
x 9 months. Bells Palsy 7/2008. Mono 2009. Strep throat. RAD W BACK PAI-L2 FX, ALLERGY :ANCEF,CEPHAZOLIN,KEFLEX
al lung disease, pulmonary fibrosis, chronic pain, chronic pleural effusion, febrile neutropenia, ANCA (+), pulmonary HTN. Allergy: morphine
due to adminstration to BCG as a child. Fibrous lump in breast. Allegies PCN, Codeine, Duraprep
yl. Pt. has history of epilepsy and anxiety.
kin lymphoma left axilla 2003, tx w/chemo & radiation tx completed 2007. Left supraclavicular mass 8/08 tx w/radiation tx completed 10/3/0
Osteoporosis
lba; Asthma; Obesity
04USA00644 04USA00515 04USA01011 04USA00594 03USA00682 04USA01136 04USA01186 04USA01349 04USA01164
RMIN 500 mg oral tablet; CRESTOR 20 mg oral tablet; AMLODIPINE 10 mg oral tablet; IMDUR 120 mg oral tab sr 24hr; TOPROL XL 50
eceived DOS 2/3/07 to 5/7/09. Hairy mole, Pes planus with pain, scar
dasil)~1~0~Patient
ulfa, LISINOPRIL ypertension, osteoarthritis Allergy: NSAIDS
emia~Influenza (no brand name)~1~40~In Patient
cal records reveal: PMH: eczema since 6-8 wks old w/skin infections tx w/antibiotics; constipation; breastfeeding w/formula supplement. Fa
|None~ ()~~0~Sibling Head ache, stuffy nose~Pneumo (no brand name)~1~55~In Patient
has current prescription for epi-pen.
or for macrocephaly WNL. Family hx: allergies. heomalacia, pneumonia, bacterial croup, seasonal allergies. Family hx: HTN, epilepsy, DM, heart disease.
al syndrome w/rash; recurrent bilateral AOM; large anterior fontanelle. Birth hx: Mom on Depo when conceived; Mom smoker & social ETO
brand name)~UN~0~Patient
03USA02289 04USA01356
birth defects. Had endometriosis and ovarian cysts, however had a total abd. hysterectomy in 2003. I have right knee mild arthritis, otherwi
ctomy in 2003 which included resection of 19 lymph nodes. Client had a R breast reconstruction in 2004. Cl reports that she had some lym
disorder, but parent states that he had similar episodes before.
ud's syndrome. PMH: H/A. thyroid nodule with surgery. acne. Raynaud's. folliculitis. herpes zoster 8/07, abnormal brain MRI, ear tubes, a
hma and seasonal allergies 04USA01876 04USA01551 04USA01347
e not specified (no brand name)~~0~Patient
order; hypothyroidism; elevated BP; arthritis; aneurism
dical conditions. 6/17/09 Hospital records and DC summary received DOS 3/25/09 to 3/30/09. Cardiac murmur, shortness of breath, gout, a
icillian. 6/1/09 Rheumatology records DOS 2/18/09 to 5/27/09. Heartburn, tennis elbow, knee pain, chronic fatigue. PMH: environmental a YPOTHROIDISM, HYPERTENSION, HYPERLIPIDEMIA PMH: hypothyroidism, HTN, and hyperlipidemia, knee scope, R inguinal hernia re
2 & in hospice care since 5/08; CAD; PVD; CHF; nicotine dependence & currently smoking; HTN; hyperlipidemia; cervical cancer; pulmona
dryl. Epilepsy
tient|na~ ()~NULL~~In Sibling1|na~ ()~NULL~~In Sibling2
npox, seasonal allergic rhinitis, keratosis pilaris, mild scoliosis, anemia. MH: HTN, A-fib, ovarian CA. Fx tib/fib. NKDA.
02USA04952 03USA00880 03USA01292 03USA01406 05USA04750 06USA02242 07USA03038 07USA03843 08USA04369 08USA04377 09USA01360 02USA01505 02USA04263 03USA01086 03USA01403 03USA05482 03USA05497 03USA05499 03USA05512 03USA05548 03USA05559 03USA05566 04USA00004 04USA00014 03USA02293 04USA00051 03USA02323 04USA00085 03USA02643 04USA00089 03USA03984 03USA04598 03USA01645 04USA00097 03USA01677 03USA01999 03USA02061 03USA02101 03USA02285 03USA02333 03USA02337 03USA01421 03USA01423 03USA01428 03USA01434
03USA01443 03USA01445 03USA01457 03USA01595 03USA01609 03USA01611 03USA01628 03USA01631 03USA01637 03USA01639 03USA02345 03USA02346 03USA02349 03USA02354 03USA02374 03USA02555 03USA02593 03USA02852 03USA02886 03USA02903 03USA02907 03USA02927 03USA02993 03USA03188 03USA03192 03USA03221 03USA03230 03USA03231 03USA03237 03USA03242 03USA03245 03USA03247 03USA03252 03USA03626 03USA03643 03USA03665 03USA03945 03USA03970 03USA03974 03USA03975 03USA03979 03USA03982 03USA03986 03USA04004 03USA04033 03USA04036 03USA04255 03USA04259 03USA04271 03USA04275 03USA04281
03USA04302 03USA04310 03USA04317 03USA04511 03USA04517 03USA04527 03USA04889 03USA04897 03USA04899 03USA04903 03USA04909 03USA04915 03USA04528 03USA04536 03USA04922 03USA04544 03USA04924 03USA04933 03USA04982 03USA05175 03USA05202 03USA05288 03USA04553 03USA05321 03USA04559 03USA05328 03USA04582 03USA04594 03USA04609 03USA04725 03USA04851 03USA04853
04USA02014 04USA02004 04USA02281 04USA02052 04USA01867 04USA02046 01USA05068 04USA02013 04USA02011 04USA02010
04USA02003 04USA01998 04USA01997 04USA01993
04USA01992 hysema. 7/7/09 Hospital records received DOS 3/25/09 to 4/4/09. Parkinsons disease, bipolar disorder, dementia, hypertension, coronary a
rd lump x2-3 mos~DTaP (no brand name)~2~0~Patient
capularis, tx Amoxicillin 500 mg.
aptacel)~1~0~In Patient
nanas, Strawberries, Nectarines Diagnosed with Plantar Fasciitis in heel 4/16/09. Tonsillectomy.
brand name)~1~5~In Patient , dust mites, trees, grass,perfume allergies PCOS, blounts, hypoglycemia, PMH: exudative pharyngitis, metabolic syndrome w/hirsutism, T
ectomy, Non-Hodgkins lymphoma onset 8/01 last chemo 10/01
TaP (no brand name)~2~2~Patient ein intolerance). Family hx: CVA, DM.
peanut, shellfish, fish, tree nut
04USA02081
easonal allergies
04USA02000 04USA02001 04USA02002 04USA02009 04USA02012 04USA01725
odine, latex, morphine, Alphagan, many barbiturates, adhesive tape. Have had corneal transplants for Fuchs' Endothelial Corneal Dystroph
ple ear infections, tubes in ears, Anxiety, encopresis, depression, seizures. himotos, Anxiety, Depression, OCD, eye tics Varicella(Merck) #2 Lot # 1182U given 10/26/07, LA; HPV #2, Lot # 1267U given 11/20/07, IM
(no brand name)~2~0~Patient
dasil)~2~12~Patient
5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
ell fish-mushrooms-molds-fungi; Hypertension.
04USA02836
04USA02298 04USA02303 04USA02789 04USA02794
ONSTIPATION Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
sodes with injections and umbilicus piercing.
ons: None; Birth defects: None
etaproterenol
07USA04419 01USA03372
02USA02446 03USA00415 03USA00427 03USA00454 03USA00457 03USA00536 03USA00539 03USA00547 03USA00572 03USA00589 03USA00747 03USA00761 03USA00774 03USA00792 03USA00860 03USA00891 03USA00901 03USA00904 03USA00914 03USA00926 03USA00928 03USA00936 03USA00937 03USA00956 03USA00962 03USA00966 03USA01098 03USA01124 03USA01138 03USA01155 03USA01367 03USA01378
ATARAX; CODIENE; DEMERO
Family history of asthma and seizures. Previously evaluated for losing his breath at 6 months of age.
ies (pets, pollen, molds); experienced adverse reaction to biaxin, but this was not physician diagnosed. , ASD repair, psoriasis, breast CA
r custodial guard
ouse dust; per allergist.
04USA03237 04USA03291 04USA02392
rol Hypothyroidism ocular migraine imbalance Bipolar disease stable right periclynoid meningioma Urinary incontinence Factor V leiden
therapy, retinoopathy of prematurity, periventricular leukomalacia, 24 week prematurity n 9/16/2005 and diagnosed with severe milk allergy as well as positive skin tests to egg antigen, peanut antigen, and tree nut antigens thma.Patient is not taking any medication at this time.
romyalgia & depression
bites,mild eczema
complications. GERD. airy; eczema. 6/1/09 Hospital records received DOS 4/16/09 to 5/6/09. Fever previous day. Ring worm, eczema, atopic dermatitis. Frequen
s apraxia, sensory integration dysfunction, and had a run of myoclonic seizures 5 years ago.
ochondrial disorder; RAD; ADD; Duane's Syndrome.
name)~1~12~Patient
name)~1~1~Patient
d epilepsy, LBP. Extensive foreign travel x 5 yrs. Family hx: hypotension.
brand name)~UN~1~Patient
04USA03213 04USA03207 04USA02827
TUSSIS~DTaP (Acel-Imune)~2~0~In Patient
yndrome, PTSD, asthma, obesity, GERD, hypothyroidism.
environment ndmother and aunt having "reactions" to DTP several years ago. /11/08 to 2/2/09. Orchidectomy for undescended testicle. 6/8/09 Hospital record (Multiple Sclerosis Center) received DOS 4/1/09. Uveitis, M
PMH:testicular cancer. Chronic alcohol use.
eived 05/06/09 PMH: Recent workup for dizziness
me)~1~5~Patient me)~1~4~Patient
brand name)~1~0~Patient
(Gardasil)~1~0~Sibling
ROMYCET; XANAX; OIL OF OLAY 01USA00777 04USA03453
OF 4/15/09. small for gestational age as of 4/4/08. wheezing as of 3/30/09
P (no brand name)~NULL~2~In Sibling1
Appy. On birth control
pilespy, CAD with mildly elevated calcium score
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
ved without intervention.
09. urinary or chlamydial infection
deferred till now.
fluenza (no brand name)~UN~0~Patient
7; NKA ; recently changed laundry detergent - no other areas had affected. mo (Prevnar)~2~0~Patient
metimes "faints" with shots, but had not indicated this prior to vaccine.~Vaccine not specified (no brand n
04USA03689 04USA03576 04USA03788 04USA03416
symptoms) and Tomatoes eaten in large quantity cause rash & hives
Sibling1|none~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Patient
Dehydration 5/11/09-records received-PMH: GERD. Family history of SIDS approximately 30 years ago.
ecords received DOS 4/27/09 to 7/8/09. Recurrent staph skin infections, gluteal abscess. Acute severe headaches. Smoker. d DOS 4/22/09 to 4/24/09. Gastroesophageal reflux
and was fit tested that day
e not specified (no brand name)~UN~4~Patient
09USA04176
04USA03645 04USA03992 08USA00962
/08 and for bronchiolitis 11/08, otherwise healthy. Anthrax (Biothrax)~2~27~In Patient +reaction to TST (PPD) in the past; not under any treatment for TB or other illnesses at this time.
, 2009; medication helped and all symptoms were gone by October. PMH: ADD, anxitey, exudative pharyngitis, ulcerative tonsillitis, epigas NAL ALLERGIES) MOM STATED MAY BE ALLERGIC TO PENICILLIN
k, trying to take apart frozen fish. on and ADD, no allergies or birth defects known
ative colitis, migraines
b (no brand name)~1~0~Patient|~DTP + IPV + Act-Hib (no brand name)~1~0~Sibling (Gardasil)~2~15~Patient
posure; NKA
ere Bilateral Kidney Reflux as infant/tod
dasil)~1~18~Patient
al x-rays otherwise none
nuresis, hypothyroidism
04USA03499
yrs; well 2006-200
me)~4~2~Patient eumo (Prevnar)~1~0~Patient
s once but now eats them without problems
Allergic rhinitis; anxiety.
(no brand name)~1~2~In Patient
nal allergic rhinitis iasis, low back pain 04USA04339 04USA04222 04USA04218 03USA04872 03USA03976
lergy; Has sarcoidosis
Sulfa, Opioid
DOS 5/2/09 to 5/3/09. Kidney stones removed by cystoscopy, D&C, ovarian cyst removed, surgery to left TMJ, LEEP, breast implants, torn
months shots. Breathing problems, ER visit, was given breathing treatments and diagnosed with asthma. nt also reported, "I had an IV when I had my daughter about 8 years ago and I got cellulitis from it and had to be hospitalized for 6 days wit arm requiring surgical removal of cherry sized mass at injection site. Fever. Very limited range of moti~
cture with associated subdural hemorrhage
VOLTAREN; ? Anti-inflammatory drug.
P + IPV + Hib (Pentacel)~1~0~Patient
04USA04467 04USA04614 04USA03962 03USA05524 05USA06266 uscle spasms, alopecia. Family hx: MI, HTN.
s PMH: Asthma, allergic rhinitis, overweight, ovarian cyst, endometriosis. Laproscopic surg. HTN & chest pain while on OCPs. Allergy: P
e and PCN allergy. Pt otherwise healthy. nt placement; cardiac "problems"; headaches. headaches; skin lesions
e Ants, Polyurethane ords and DC summary received DOS 4/03/09 to 4/17/09. Anxiety and fibromyalgia. 6/9/09 ER records received DOS 4/3/09. Allergies to Cip l records received DOS 3/18/09 to 3/20/09. DVT
tn, hyperlipidemia
spital records received DOS 12/4/08-12/9/08. PMH: hypertension, vitamin B12 deficiency. Shrimp allergy. Kidney stones, knee surgery.
t age 4 y/o, similar reaction occurred. No documentation available.~Vaccine not specified (no brand name)~UN~
b diffciency; DJO.
DOS inpatient 11/25/08 to 11/26/08 and GI consult 3/27/09. Cataract surgery, arthritis. Drug allergies: Penicillin, Keflex, flagyl, clindamycin ngioplasty with stent (DEC 1998 and FEB 2000) 6/24/09 Hematology/Oncology consult received DOS 6/12/08 to 4/16/09. Hypertension, hy
04USA04537 01USA00303 04USA04464 04USA04459 04USA04521
ON AND ASTHMA
GI reflux onset 04/01/2004 and Enviromental Allergies es, mom stated client passed out 2 other times, once when having blood drawn and once when she had an oral surgery.
rying~Hib (OmniHIB)~1~0~In Patient
PMH: heart murmur since birth.
OPD; HTN; Hypothyroidism
e loss of memory - continues to have amnesia for all events prior to this
04USA03995 05USA00040 02USA03044 04USA04193
mild asthma. Family hx of migraines
ous colitis; Osteoporosis; Herniated lumbar disc.
genital ear deformity, hearing loss
bling1|NA~ ()~NULL~~In Sibling2|NA~ ()~NULL~~In Patient
pital records received DOS 1/12/09 to 1/22/09. Shoulder sprain, open wound of head, bursitis, nicotine dependence, sensoineural hearing l
ecords received-Adopted from another country. c ear inf; sleep apnea; FFT; Asthma.
Graves Disease
o seizures for 12 years) gia, Hyperlipidemia, allergic rhinitis 04USA04566
05USA00320 05USA00386
onychomycosis
PMH: ear infection 1/09.
reported after this event.~Vaccine not specified (no brand name)~UN~0~Patient
ardasil)~1~15~Patient
d proto colitis
nce age nine. Acid reflux. Penacillin allergy.
horse serum in the tetanus series 05USA00584 05USA00372 05USA00360 05USA00344 05USA00188 09USA03554 12USA08104 05USA00497 05USA00367 jor surgery on his right shoulder with all the bursae sacs being removed at that time, years ago.
R, OBESITY (BMI MORE THAN 40) kers cause asthma symptoms, coumadin caused rash,welts,Dilacor felt poorly
Inact. (Ipol)~3~4~In Sibling1|SISTER~Measles (Attenuvax)~1~4~In Sibling2
aptacel)~4~4~In Sibling1|BROTHER~Measles + Mumps + Rubella (MMR II)~1~4~In Sibling2
pital records received DOS 5/2/09 to 5/3/09. Allergy to unknown antibiotic - hives. st, since young age.
(no brand name)~3~1~Sibling
traumatic fracture. Rosacea on face.
HTN; and taking PAXIL for menopause.
05USA00539
~DTP (no brand name)~5~4~Patient 05USA00506 05USA00582 05USA00550 OS 7/10/06 to 3/10/09. Hypospadias 05USA00526
ation~ ()~UN~0~Sibling
pilaris; Acne; Convulsions.
upper right arm 12 pervious doses PHINE; ACETAMINOPHEN.
al allergies/Asthma.
isone; BENADRYL
ENCE SYNDROME, OM, CIGARETTE SMOKE EXPOSURE
no brand name)~NULL~~In Patient
esection & colostomy; COPD on home O2; CHF; HTN; GERD; osteoporosis; ex-smoker. Family hx: CHF, DM, COPD. Chronic Stage IV decubitus ulcer. Hep C CKD anemia of ckd chronic shoulder pain;Severe arthrosis of the left shoulder and chronic rotator c stained fluid present at delivery. NB exam showed mongolian spot on buttocks and head molding and extremity cyanosis, otherwise WNL.
asil)~2~12~Patient bar spine L4, L5-S1. PMH: Asthma, disc herniations, concussion 4/2008. 8/13/09 ER records received DOS 11/18/09. PTSD. Herniated dis
well possible bacteria infection and MD treated with antibiotics~DTaP + HepB + IPV (Pediarix)~3~1~Patien
pidemia/osteopenia
cords on vaccinee only - no chronic health problems; NKDA; Contact/PT: No pre-exiting medical conditions. 6/4/09 ER records received DO 02USA00071
tter; Allergies: Antibiotics (FLAGYL); NSAIDS; Beta-adrenergic blocking agent y of almonds, shampoo, gardasil vaccine.
easonal allergies. Sibling2|NONE~ ()~NULL~~In Patient|NONE~ ()~NULL~~In Sibling1
received-Ear infection 1 week prior. Burn to hand from curling iron. Croup 2 months prior. Cough and nasal congestion x 1 week. diarrhea~Measles + Mumps + Rubella (no brand name)~1~1~Patient|decreased speech~Measles + Mumps + Rubella (
d DOS 11/10/08 to 2/24/09. Milk protein intolerance and name)~1~4~Patient s of age. 5/15/09 medical records received (also contains copy of ED records for 5/11/09) DOS 5/11/09 to 5/13/09. Allergy to Rondec 05USA01139 05USA01070 05USA01035 05USA01034 05USA00720 ceived DOS 4/29/09 to 4/30/09. GERD ) (no brand name)~UN~57.00~Patient eceived DOS 5/4/09 to 5/5/09. PMH: appendectomy d DOS 1/22/09 to 2/3/09. Ulcer during childhood. Allergy - bee sting. eceived-PMH:hepatitis A, hernia, hypercholestolemia, hypothyroid, hypertesnion, gastroesophageal reflux disease and obesity.
d DOS 5/12/09 - 5/16/09. Patent foramen ovale.
, Atopic Dermatitis
eafood PMH: asthma, SVT, chole. ANA(+) w/no clear dx. Allergy: zofran(anaphylaxis), demerol, codeine. Family hx: SVT.
LL~~In Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
eceived DOS 1/24/08 to 4/9/09. Tonsillectomy. Infectious mononucleosis, chronic fatigue syndrome. Spinal tap headaches, Strep throat, AD Hearing loss to right ear, and reoccuring UTI's. + Hib (Pentacel)~NULL~~In Patient
dical records received (hosp discharge summary included) DOS 4/29 and 5/1/09 to 5/3/09. Tennis elbow, breast pain. ental delays.
(Pneumovax)~1~65~Patient
gestation Allergies: NKDA birth defects: None
d - uses Albuterol inhaler pm, no steroid inhalers necessary; 2 migraines; 3. bout of Cholecystitis / Cholelithiasis diagnosed at ED in CA on 1 , food, or medication allergies Medical conditions: Sleep APNEA, HTN, Hyper Cholesterolemia. m; allergy to insects; Lyme Disease
otateq)~1~0~Patient
rent sinusitis; allergic rhinitis
s received PMH: back pain.
eceived DOS 12/30/08 - 5/13/09 ADHD, Adjustment Disorder-Depressed, joint pain left leg
L~~In Patient|known known~ ()~NULL~~In Sibling1
vaginal delivery. no significant prenatal or postnatal complications. Birth weight was 7 pounds and 7 ounces., soft palate mucocele diagnos
d Nodular Goiter, and allergic to allergic/dairy products.
had a reaction did not report it~Vaccine not specified (no brand name)~UN~0~Sibling allergies and asthma.
rosis Gerd, varicose veins.
Patient|none~ ()~NULL~~In Sibling1
05USA01427 05USA00689 05USA01449 05USA00483 07USA01442 05USA01250 05USA00574 2 mos-screen passed; No crawl/pincer @ 9 mos 7/7/09 Medical records received DOS 11/20/07 to 3/30/09. Abscess finger. I&D. es~Influenza (no brand name)~~0~Patient|Seizures~Hib (no brand name)~~0~Patient|Polio~Polio Virus, Inact. (n
cardiology and neurology. Two episodes were following blood draws
antibiotic ointment listed in chart
mo (Prevnar)~3~3~In Sibling1 Daptacel)~NULL~4~In Sibling1
story of asthma. GONE BY NOW.
asil)~~15~Patient S 5/15/09. Seasonal Allergies.
eceived DOS 5/15/09 to 5/16/09. Spit-up/emesis, born 2 weeks early. Hx of Prior Limited Abdominal Ultrasound (5/13/090 WNL.
no brand name)~5~5~Patient
No birth effects.
partial nephrectomy; Anxiety state; Epiretinal membrane; Cataract, senile, NSC; Vitreous degeneration/detachment; Arthragia-Pain in joint, 03USA00777 03USA02222 03USA03226 04USA00156 04USA00174 04USA00178 04USA00185 04USA00225 04USA00234
04USA00246 04USA00248 04USA00267 04USA00325 04USA00379 04USA00380 04USA00409 04USA00429 04USA00456 04USA00469 04USA00480 04USA00484 04USA00575 04USA00581 04USA00584 04USA00585 04USA00586 04USA00590 04USA00591 04USA00592 04USA00596 04USA00604 04USA00606 04USA00630 04USA00631 04USA00634 04USA00852 04USA00874 04USA00883 04USA00972 04USA00982 04USA01003 04USA01004 04USA01016 04USA01018 04USA01025 04USA01030 04USA01032 04USA01113 04USA01121 04USA01123 04USA01148 04USA01149 04USA01169 04USA01183 04USA01198 04USA01201 04USA01260 04USA01342 04USA01354 04USA01367
04USA01427 04USA01436 04USA01437 04USA01514 04USA01519 04USA01528 04USA01902 04USA01837 04USA01907 04USA01849 04USA01850 04USA01851 04USA01864 04USA01868 04USA01952 04USA01877 04USA01895 04USA01986 04USA02036 04USA02039 04USA02071 04USA02076 04USA02301 04USA02305 04USA02308 04USA02324 04USA02753 04USA02326 04USA02771 04USA02777 04USA02792 04USA02800 04USA02904 04USA02972 04USA03132 04USA03214 04USA02907 04USA03407 04USA02911 04USA02916 04USA03412 04USA03414 04USA03419 04USA02944 04USA03425 04USA03434 04USA02949 04USA02953 04USA03612 04USA03620 04USA03626
04USA03644 04USA03444 04USA03729 04USA03746 04USA03456 04USA03790 04USA03798 04USA03458 04USA03523 04USA03811 04USA03815 04USA03556 04USA03816 04USA03824 04USA03927 04USA03959 04USA03961 04USA03985 04USA03990 04USA04012 04USA04212 04USA04242 04USA04245 04USA04370 04USA04423 04USA04430 04USA04435 04USA04437 04USA04458 04USA04514 04USA04522 04USA04530 04USA04552 04USA04573 04USA04574 05USA00001 05USA00009 05USA00054 05USA00061 05USA00065 05USA00074 08USA00976 04USA00481 05USA01285 05USA01663 05USA01445 05USA01453 05USA01673 eived- PMH:IgA deficiency, marked number of ear infections and one episode of poorly defined pneumonia. IgMs tend to be low and has va
levated chol, HTN, Osteparosis
me)~4~2~Patient
Patient|NONE~ ()~NULL~~In Sibling1
PMH: frequent HA, thigh abscess w/hospitalization.
atient hospital records received DOS 5/19/09 to 5/21/09. Hypertension, childhood asthma, egg allergy.
orbed (no brand name)~UN~0~Sibling
05USA01825 aired fasting glucose,monoclonal gammopathy, TB bone, chronic shoulder pain, hemorrhoids, blood in stool, cataracts, ex-smoker, acute UR , TONSILLECTOMY AS CHILD, CCY APPY HEMORRHOID; SURGERY RECTAL FISSURE REMOVAL AND RECTAL ABSCESS - emerg
atoma; skull fx 05USA01925 05USA01680 12USA03680 05USA01298
DOS 5/7/2009 and 5/18/09. Evaluation for short stature. Seizure-like activity when very young.
ki Syndrome
none~ ()~~0~Sibling eat Allergy. 6/4/09-records received-PMH-gluten intolerance and gastritis. d feeling irritable.
No pre-existing medical conditions. ripheral vascular disease, depression/anxiety. 6/4/09 Hospital records received DOS 5/18/09 to 5/21/09. hypercholesterolemia, breast canc
nt tachypnea and jaundice
ore the pneumovax.
c illnesses per patient
ds received DOS 6/17/09. Prior convulsion.
yndrome6/5/09-records received-Family history of WPW syndrome.
o chronic medical conditions
l records received DOS 2/25/09 to 2/27/09. COPD.
8/09 Medical records received DOS 4/27/09 to 5/21/09. Heartburn. 6/12/09 Medical records received DOS 4/27/09 to 6/1/09. GERD.
atient|n/a~ ()~NULL~~In Sibling1 NT PAIN , MUSCLE PAIN~Anthrax (Biothrax)~2~20~In Patient
Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2 OPHEN), Benadryl 4 cc
o Ibuprofen but no other medical conditions or birth defects.
n, etc. No food allergies.
cholesterol. Not on immunosuppressants, not immunocompromised -other than type 2DM-
04USA02063 09USA01336 06USA04214 08USA01924 08USA02965 10USA05607 03USA03034 03USA03040 03USA03056 03USA03075 03USA03503 03USA03627 03USA03170 03USA03645 03USA03699 03USA03716 03USA03316 03USA03806 03USA03909 05USA04042 03USA03335 03USA04047 05USA03728 03USA04131 05USA00361 03USA03372 04USA02505 04USA00432 03USA04185
04USA00234 03USA03375 03USA04192 03USA04437 03USA03502 03USA04442 03USA04497 03USA04509 03USA04513 03USA04643 05USA01178 05USA01256 03USA04691 03USA04699 05USA01387 05USA01692 03USA04721 05USA01842 03USA04722 05USA01972 03USA04954 50USA01975 03USA04973 05USA02046 03USA05043 05USA02125 05USA02311 03USA05062 05USA02345 04USA00134 05USA02351 04USA00167 05USA02862 05USA02918 04USA00214 02USA00004 02USA00005 02USA00006 02USA00010 02USA00021 02USA00178 02USA00932 02USA00937 02USA01026 02USA01058 02USA00203 02USA00246 02USA01103 02USA00298 02USA00420 02USA00423
02USA00601 02USA01524 02USA00865 02USA01617 02USA01622 02USA01929 02USA01623 02USA01660 02USA01711 02USA02200 02USA02265 02USA01828 02USA01864 02USA02333 02USA02410 02USA02447 02USA02690 02USA03691 02USA03715 02USA02913 02USA03795 02USA03986 02USA03109 02USA03137 02USA03989 02USA03138 02USA04049 02USA03509 02USA03510 02USA04063 02USA03512 02USA03573 02USA04096 02USA04099 02USA04167 02USA04172 02USA04213 02USA04374 02USA04533 02USA04540 02USA04599 03USA00002 03USA00050 03USA00130 03USA00325 03USA00365 03USA00401 03USA00419 03USA00571 03USA00610 03USA00789
03USA00790 03USA00893 03USA01183 90USA02671 09USA02688 09USA03225 09USA03272 09USA03440 09USA03452 09USA03499 09USA03816 09USA03869 09USA03897 09USA03909 09USA03920 09USA03925 09USA04059 09USA04165 12USA01769 09USA04304 09USA04569 09USA04612 11USA00877 09USA04621 10USA05270 10USA02178 09USA04626 10USA02126 09USA04655 09USA04657 10USA00203 07USA05344 10USA00210 01USA00386 07USA02635 06USA07544 10USA00430 10USA00436 10USA00472 03USA01626 03USA01816 03USA01817 03USA02317 03USA02365 03USA02553 03USA02592 03USA02948 03USA03185 03USA03573 10USA02135 10USA02142
10USA02144 10USA02460 01USA02468 10USA02478 10USA02490 10USA02491 10USA02775 10USA03250 10USA05257 10USA05259 10USA03306 10USA05327 10USA03346 10USA03365 11USA00032 11USA00045 11USA00196 10USA03366 11USA00209 11USA00253 11USA00275 11USA00279 10USA03381 11USA00282 11USA00520 11USA00620 10USA03753 10USA03770 11USA00674 11USA00711 11USA00736 10USA03910 11USA00878 11USA00949 10USA03915 10USA03963 11USA00986 11USA01187 10USA03983 11USA01304 11USA01326 11USA01329 10USA03995 11USA01618 10USA04022 11USA01815 11USA02164 11USA02212 11USA02274 10USA04025 10USA04135
10USA04137 10USA04155 10USA04174 10USA04356 10USA04357 10USA04483 10USA04487 10USA04509 10USA00546 10USA04513 01USA00557 10USA00560 10USA00824 11USA02843 11USA02852 10USA01021 11USA03030 10USA01157 10USA01158 11USA04005 10USA04557 10USA01539 10USA01665 10USA04738 10USA01668 11USA04023 10USA01701 10USA01718 11USA04139 10USA01841 10USA04869 10USA01850 11USA04150 10USA04909 10USA02115 10USA04948 10USA04953 12USA00343 10USA05081 12USA00513 10USA05179 12USA00536 12USA00568 12USA00579 12USA03195 12USA03263 12USA03384 12USA03602 12USA04027 12USA04091 12USA01179
12USA01180 12USA04107 12USA04116 12USA04526 12USA04560 12USA05110 12USA05278 01USA00086 01USA00142 01USA00325 12USA01212 12USA01225 12USA01586 12USA01614 12USA01644 12USA01656 12USA01784 12USA02011 12USA02022 12USA02023 12USA02159 12USA02785 12USA02789 12USA03185 01USA00326 01USA00337 01USA00774 01USA00798 01USA01025 01USA01040 01USA01048 01USA01127 01USA01283 01USA01284 01USA01303 01USA01324 01USA01525 01USA01552 01USA01596 01USA01608 01USA01625 01USA01722 01USA01763 01USA01975 01USA01993 01USA02045 01USA02473 01USA02496 01USA02572 01USA02711 01USA02740
01USA03087 01USA03310 01USA03332 01USA03381 01USA03444 01USA03477 01USA03497 01USA03507 01USA03656 01USA03678 01USA03712 01USA03751 01USA03923 01USA04117 01USA04155 01USA04409 01USA04419 01USA04421 07USA03549 07USA03550 07USA03577 07USA03721 07USA03815 07USA03817 07USA03862 07USA04012 07USA04064 07USA04317 07USA04320 07USA04417 07USA04481 07USA04575 07USA04602 07USA03035 07USA03059 07USA03067 07USA03136 07USA04794 07USA04949 07USA03137 07USA04950 07USA05051 07USA03138 07USA03139 07USA03193 07USA03201 07USA03258 07USA05129 07USA03325 07USA05163 07USA03367
07USA03548 07USA05182 07USA05202 07USA05281 07USA05354 07USA05376 08USA03476 07USA05521 07USA05538 08USA03477 08USA00277 08USA00495 08USA00964 08USA03615 08USA03651 08USA04116 08USA03664 08USA04170 08USA03770 08USA04209 08USA03954 08USA03964 08USA04357 08USA03968 08USA04359 08USA03987 08USA04413 08USA04011 08USA04415 08USA04419 08USA04038 08USA04423 08USA04427 08USA04442 08USA04450 08USA04634 08USA04849 08USA05003 08USA04850 08USA05051 08USA05052 08USA05234 08USA05326 08USA05342 08USA05343 08USA05355 08USA05366 08USA05407 09USA00001 09USA00002 09USA00004
09USA00022 09USA00025 08USA01202 08USA01282 09USA00050 08USA01309 08USA01368 09USA00313 09USA00328 09USA00335 09USA01407 09USA00352 08USA01378 08USA01388 09USA01418 08USA01647 09USA00367 09USA01435 08USA01650 09USA01455 09USA01502 09USA01549 09USA00471 08USA01573 09USA01575 09USA00528 09USA01579 09USA01648 09USA00743 09USA01745 09USA00753 09USA01778 09USA01790 09USA00773 09USA00867 09USA01837 09USA01223 09USA01951 08USA01671 09USA01380 09USA01975 09USA01980 09USA02014 09USA02162 09USA02177 09USA02297 09USA02316 09USA02379 09USA02380 09USA02381 09USA02483
09USA02576 09USA02598 09USA02664 07USA05568 07USA05664 07USA05694 07USA05699 07USA05735 05USA02934 07USA05738 05USA03403 07USA05739 05USA03488 07USA05754 05USA03651 05USA03659 05USA03797 08USA00063 05USA04502 08USA00081 05USA04544 08USA00094 05USA03823 05USA03860 05USA04691 08USA00101 05USA04055 08USA00147 05USA04395 05USA04744 05USA04396 08USA00206 05USA04785 05USA04398 08USA00207 05USA04786 05USA04400 05USA04838 05USA04489 05USA04874 05USA04876 05USA04930 05USA04967 05USA05060 05USA04998 05USA05068 05USA05058 05USA05071 05USA05059 05USA05072 05USA05073
05USA05105 05USA05122 05USA05128 05USA05445 05USA05499 05USA05592 05USA05615 05USA05620 05USA05622 05USA05644 05USA05627 05USA05950 05USA05955 08USA02799 05USA05977 06USA00627 08USA02801 05USA06174 08USA02808 05USA06432 08USA02844 06USA00003 06USA00008 08USA02857 06USA00648 06USA00077 06USA00316 06USA00650 08USA03096 06USA00326 08USA03110 06USA00672 06USA00699 08USA03124 06USA00991 06USA00616 06USA01000 06USA00625 08USA03213 08USA03225 06USA01006 08USA03245 06USA01035 08USA03473 08USA01959 08USA02047 08USA02146 08USA02179 06USA01077 08USA02181 08USA03474
06USA01078 08USA02427 06USA01079 08USA02457 06USA01090 08USA02461 06USA01091 08USA02475 08USA02606 08USA02627 08USA02671 08USA02721 06USA08049 06USA08138 06USA08305 06USA08306 06USA08307 06USA08331 06USA08400 06USA08402 06USA08695 06USA08741 06USA08832 06USA08878 06USA01092 06USA08935 06USA08942 06USA01107 06USA01151 06USA01251 06USA01287 06USA01294 06USA01300 06USA01311 06USA01497 06USA01502 06USA01539 06USA01568 06USA01606 06USA01976 06USA01981 08USA03475 06USA01988 06USA02200 06USA02231 06USA02238 06USA02254 06USA02400 06USA02442 06USA02462 06USA02464
06USA08984 06USA09014 07USA00017 07USA00054 07USA00089 07USA00128 07USA00349 07USA00665 07USA00666 07USA00669 07USA00691 07USA00809 07USA00967 07USA01026 07USA01040 07USA01145 07USA01292 07USA01373 07USA01397 07USA01406 07USA01410 07USA01429 07USA01517 07USA01574 07USA01785 07USA01649 07USA01841 07USA01850 07USA02218 07USA02223 07USA02243 07USA02376 07USA02470 07USA02504 04USA00300 04USA00377 07USA02643 04USA00398 04USA00423 04USA00444 04USA00447 07USA02754 04USA00882 07USA02921 07USA03007 04USA00888 07USA03021 04USA00920 04USA00995 04USA01011 04USA01013
04USA01062 04USA01096 04USA01264 04USA01337 04USA01438 04USA01494 04USA01495 04USA01711 04USA02209 04USA02212 04USA02081 04USA02228 04USA02242 04USA02299 04USA02106 04USA02328 04USA02143 04USA02144 04USA02202 04USA02516 04USA02538 04USA02743 04USA02747 04USA02816 04USA02879 04USA03185 04USA03118 04USA03201 04USA03231 04USA03236 04USA03282 04USA03508 04USA03602 06USA03399 04USA03682 04USA03766 06USA03425 04USA03793 04USA03730 06USA03727 04USA03861 04USA03907 06USA03742 04USA03960 06USA03746 04USA04000 06USA03794 04USA04032 04USA04033 06USA03803 04USA04034
04USA04035 04USA04040 06USA03808 04USA04042 06USA03822 04USA04044 04USA04045 06USA07561 06USA07744 06USA07770 06USA07877 04USA04047 06USA07882 04USA04050 04USA04223 04USA06300 04USA04630 04USA06332 04USA06409 06USA07918 04USA04788 04USA06413 04USA04790 04USA04795 04USA04809 04USA06420 04USA05242 05USA00081 05USA00205 05USA00268 04USA05266 05USA00288 04USA05432 05USA00323 04USA05960 04USA06103 05USA00372 05USA00409 05USA00451 05USA00509 05USA00557 05USA00588 05USA00591 05USA00592 05USA00651 05USA00670 05USA00818 05USA00862 05USA00871 05USA00964 05USA01014
05USA01073 06USA02948 06USA03064 06USA03065 06USA03076 06USA03113 06USA03360
06USA01075
05USA01493
05USA02258 05USA01937 05USA01916
05USA01868
05USA01999 03USA04278 01USA02736
02USA02392
sorder; Kawasaki disease as a child that led to coronary aneurysm that completely resolved per cardiologist. 7/7/09 ER records received D marrow transplant. 5/22/09 Called mother and Maria having no problems. Parent and doc
CAUSES RASH, HIVES, AND TROUBLE BREATHING. ALSO ALLERGIC TO BEE STINGS, SKIN IRRITANTS, CATS, AND RESPIRATOR
enuts,eggs,soy,fish,coconut,sunflower,cherry,strawberry,corn,tomato) avoiding:shellfish,legumes,sesame.Asthma
currently being tx. patient remarked that she now remembers that she once had a topical reaction to neomycin and thinks this reaction may be related to a neo
eat vessel transposition, 06/08 - Orahiop hernia repair
ergic Rhinitis/Conjunctivitis
nstead of subcue??? Could that have caused my indention? Thanks! n at injection site~Measles + Mumps + Rubella (MMR II)~1~1~In Patient|High fever lasting several days, seve
Anthrax (Biothrax)~3~25~In Patient
05USA02502 04USA03617
05USA02285
R hemiparesis; S/P ALTE
pollen/Asthma
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
22/09 to 5/23/09. Tylenol, Benadryl, Motrin
records received DOS 1/5/05 to 6/17/09. Coronary artery disease post myocardial infarction with stent. Anxiety, asthma, obstructive sleep
previous reactions to vaccines.
mia; Osteoarthritis; Alcohol abuse
easles + Mumps + Rubella (no brand name)~1~0~Patient
RIA, FEEDING DYSFUNCTION, CONGENITAL HSV INFECTION
ng; Dermatitis ks~Measles + Mumps + Rubella (no brand name)~1~2~Sibling
smallpox vaccine three different times when she was five years old, but she states it never "took." She d
tation. Delivered by C/S secondary to pregnancy induced hypertension. Birth depression recovering quickly after she received a dose of N Penicillin, allergic rhinitis/seasonallergies, asthma rds received DOS 5/28/09 to 6/9/09. Allergy to codeine.
n for depression but AFTER he received the Anthrax vaccine. Started Wellbutrin in Sept 2008.
; Neuropathy; Osteoarthritis
o immunizations . Reported tiredness/fatigue off and on with headaches. oulder tendonitis, thyroid
es + Mumps + Rubella (no brand name)~1~1~In Patient
05USA02514 05USA02266 05USA02293 05USA02211 05USA01582 04USA03943 04USA03942 10USA05176 05USA03263 03USA01606
go, had bilat. mastectomy. Took tamoxifen for 5 years. Is cancer free. ceived DOS 5/11/09 to 5/15/09. Bilateral wrist fractures. Abdominal pain and fever. Milk allergy. Fell on head several times. Vertical nystagm
dander allergies
cyst & osteopenia.
d DOS 6/13/06 to 2/27/09. Peritonsillar abcess, conjuntivitis chronic allergic.
d, no systemic reaction history to Td 05USA03370 05USA03234 05USA03404
ri~ ()~NULL~1~In Patient ury at birth, Seasonal allergies
ULL~~In Patient hyperglycemia. s/p intestinal resection. LFTs raised. hip fx. NKDA inhaler in youth for a few years but "grew out of sickness.Diagnosed at that time with Asthma.
otty training~Polio Virus, Oral (no brand name)~UN~0~Patient wn allergies
rand name)~UN~0~Patient
ecords received 3/27/08 to 5/7/09. Hysterectomy, 'fish poisoning'.
area at 2 w.o. - resolved.
Patient|None~ ()~NULL~~In Sibling1
migraine, IFG, PMDs
05USA03626 05USA03333
05USA03323
Blood Pressure, tachycardia
s Type I. Persistant hyperglycemia. Tonsillectomy. Benedryl allergy. Insulin pump. Asthma.
mach ache~Meningococcal (Menactra)~1~18~In Sibling1 mache ache, and injection site swelling for Menactra~Meningococcal (Menactra)~1~15~In Sibling1 etanus~Tetanus Toxoid, adsorbed (no brand name)~NULL~11~In Patient ION OF OBSTRUCTION OR GANGRENE; HERNIA OF OTHER SPECIFIED SITES.
imembranes VSD)
Allergy to Amoxicillin o PCN. dematophytosis. GERD ecords received DOS 3/22/09 to 5/29/09. Congenital Hydrocele. hy; hypertension. 6/22/09 Hospital records DC summary received DOS 12/29/08 to 01/11/09. Had cold within the past week. Obesity, herni
sm, Allergy to Morphine Tetvacyeline
05USA03247
/o maternal chlamydia and tobacco, mom with diet controlled gestational diabetes, breech delivery, h/o cellulitis R ankle MRSA, allergic rhin Varivax)~0~1~In Sibling2|Diarrhea and speech/motor regression, VAERS E-29842~Measles + Mumps + Rubella (MMR
Acne on doxycycline. Allergic rhinitis. early death secondary to amebiasis, childhood leukemia, DM, asthma.
s, microtrigonocephaly, structural brain anomalies (absent corpus callosum)
and DC summary received DOS 5/19/09 to 5/20/09. Neonatal jaundice.
ricella (no brand name)~1~1~Patient|upper respiratory~Measles + Mumps + Rubella + Varicella (no brand name)~
yperlipidemia; anemia; GERD; Asthma sis (no brand name)~1~0~Patient
05USA03655 05USA04021
~5~5~In Patient 7/10/09 Hospital outpatient records received 5/25/09 to 7/10/09. Stress fracture, myopia, astigmatism, pain in leg, tendonitis patellar, flat fo
female with stable weight over her high school years. She was a runner who competitively raced and took remarkably good care of herself,
DOS 5/18/09 to 5/20/09. PMH: legally blind R eye.
nistering the anthrax vaccine the first anthrax vaccine cause her vomiting and nausea for 3 days. She had swelling the size of a golf ball s
PMH: Appy, ankle fx, ovarian cyst, blocked duct, UTI.
mps + Rubella (MMR II)~2~4~Patient
chirp registry
and name)~0~1~In Patient e nerves in her rt leg 10/04 Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2 egg; peanut; banana; eczema; and GERD 05USA04048 06USA00249 04USA03633 06USA00042
~2~38~In Patient
ditions: Diabetes/Hypertension/Hyperlipidemia/Obesity/Osteoarthritisdical HAS DIABETES
arivax)~2~4~In Patient SION SYNDROME [310.2] ADVANCE DIRECTIVE INFORMATION [EP888] EXTRINSIC ASTHMA, UNSPEC [493.00] ALLERGIC RHINITI
no previous adverse signs and symptoms with immunizations. none~ ()~~0~Sibling|none~ ()~~0~Sibling
and name)~UN~0~Patient
soy, peanut, wheat, corn, eggs) ADHD.
ospital records received DOS 5/15/09 to 5/16/09. Meconium aspiration syndrome, RSV, reflux.
cation or vaccine given/received gard 3rd injection when 2wks pregnant.
06USA00244 05USA04140 06USA00013 05USA03885
conditions; Father states she has had 1 similar episode of fainting. 7/13/09 Hospital ER records received DOS 5/13/09. Previous syncopal e
ilar as above; no medical treatment)~Typhoid Vi Polysaccharide (no brand name)~1~18~In Patient
mittent cardiac arrhythmia-rapid heart beat and slightly elevated blood pressure 140/90
d DOS 4/9/09 to 4/27/09. Hyperbilirubinemia at birth, phototherapy. Eczema. 7/31/31 Hospital records received DOS 12/15/08 to 6/17/09. N
s, body aches, dizziness, bad mood,~Measles + Mumps + Rubella (no brand name)~1~50~In Patient or medical conditions
es, GERD; IBS; asthma
hrax (Biothrax)~3~3~In Patient y~Pneumo (no brand name)~1~3~Sibling|exsema, hyperactivity~Polio Virus, Inact. (no brand name)~3~3~Sibling nd name)~UN~0~Patient
rythromycin.
06USA00554
06USA00298
06USA00048 06USA00056 06USA00039
ceived DOS 6/6/09. Melanoma.
pital records received DOS 5/15/09 to 5/18/09. Appendectomy. Stab wound. Shortness of breath. al records received DOS 11/15/08 to 11/18/08. Migraines with aura, sinusitis with headaches associated, nonspecific dermatitis. Possible M
()~NULL~~In Patient|none that i know of~ ()~NULL~~In Sibling1|none that i know of~ ()~NULL~~In Sibling2
za (no brand name)~1~56~In Patient
06USA00012 06USA00536 06USA00524 05USA00702 ceived DOS 5/29/09 to 6/1/09. Possible febrile seizures. PMH: 1 episode of brief jerking.
using formula
mps + Rubella (MMR II)~1~1~Patient
nipuncture and once after GARDASIL shot at GYN office
LIUM, SULFA.
ecent pneumonia
none~ ()~~0~Sibling
nization records received DOS 4/23/09 to 6/3/09. OCD, depression, anxiety, suicide attempts. Kidney stones. Weakness, dizziness. Allergy
on, R10 cystic fibrosis, Hdg C.
enopausal; migraine HA's
llergic rhinitis; Asthma 06USA00344 06USA00895
eficiencies; hysterectomy; allergic to shellfish, methyl, latex; seasonal allergies za (no brand name)~UN~43~Patient
r medical history.
hydration~ ()~~0~Patient
under control and was not on any medications.
RAD, urticarial milk allergy. 6/12/09 Medical records received DOS 6/8/09. Hemangioma, atopic dermatitis, pectus excavatum, milk allergy
ved DOS 5/31/09 to 6/1/09. Otitis Media S 6/3/09 and 6/22/09. Chicken pox. Bulemia, depression.
OA; Menopausal
eft to right shunting
birth defects. dical conditions. s: None; Medical conditions: GERD medical conditions.
06USA00687 06USA00544 02USA05190 06USA01158
occasional alcohol use and normal laboratory results except for slightly low WBC, due to methotrexate therapy. Then was the patient's sec
my, Hysterectomy, Cholecystectomy, Tonsillectomy, Dementia, Depression, Hypertension, Stroke
ures. She does have a history of seasonal allergies, but does not take any medication for it. Pt. had a history of allergic reaction to bee stin
sultant records received DOS 6/11/09. Similar episode Jan 08 - jerking, no loss of consciousness, seen in ER.
name)~1~0~Patient|Fever~Pneumo (Prevnar)~1~0~Patient|Fever~DTaP + HepB + IPV (Pediarix)~1~0~Patient|Fever~Ro
nuts no longer per allergist)
h). Initially did not pass newborn heart test but passed at 6 mos of age - normal heart now
01USA05575 01USA03065 06USA01328 04USA02912
none~ ()~~0~Sibling
cified (no brand name)~NULL~22~In Patient sil)~1~17~In Patient
ergic reaction to Influenza vaccine resultin in pneumonia.
DOS 5/28/09 to 5/29/09. Constipation, reflux.
hrive~Hep B (Engerix-B)~2~0~In Patient
and chronic venous stasis resulting in lower extremity cellulitis and ulcerations.
06USA00890 06USA00708 06USA08747 06USA00865 05USA05079 06USA00696 06USA01783
Gout, A-fib, prostate CA, Hyperlipidemia nt may have a digestional allergy to strawberries.
allergic rhinitis, constipation
mmatory; Flagyl; Adhesive tape
nd name)~1~36~Patient
of overdose 2005; ETOH dependence
d 6/11/09 to 6/23/09. Allergic rhinitis. Augmentin causes vomiting.
and name)~1~10~Sibling
s, since age 3-4 wk. mold; dust; trees - pollen
not specified (no brand name)~UN~0~Patient
06USA00130 05USA03639 05USA02240
05USA00980 06USA00258 07USA01443 03USA00128 04USA02086 06USA08328 07USA00352 03USA00005 03USA01240 03USA01849 03USA04686 04USA00153 04USA01441
05USA00193 05USA00220 05USA00239 05USA00270 05USA00342 05USA00366 05USA00380 05USA00383 05USA00387 05USA00500 05USA00510 05USA00521 05USA00528 05USA00529 05USA00538 05USA00561 05USA00563 05USA00570 05USA00572 05USA00707 05USA00733 05USA00944 05USA00950 05USA01104 05USA01112 05USA01140 05USA01261 05USA01306 05USA01307 05USA01432 05USA01443 05USA01447 05USA01464 05USA01625 05USA01633 05USA01662
05USA01665 05USA01684 05USA01721 05USA01879 05USA01888 05USA01902 05USA01923 05USA02012 05USA02013 05USA02018 05USA02021 05USA02029 05USA02230 05USA02247 05USA02253 05USA02260 05USA02572 05USA02728 05USA02843 05USA02892 05USA02921 05USA02951 05USA03183 05USA03218 05USA03240 05USA03248 05USA03257 05USA03276 05USA03359 05USA03367 05USA03371 05USA03380 05USA03385 05USA03402 05USA03625 05USA03635 05USA03670 05USA03677 05USA03692 05USA03695 05USA03777 05USA03812 05USA03847 05USA03861 05USA03862 05USA03865 05USA03883 05USA03904 05USA03905 05USA03906 05USA04039
05USA04056 06USA00009 06USA00010 06USA00011 06USA00103 06USA00112 06USA00118 06USA00135 06USA00139 06USA00143 06USA00242 06USA00243 t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling 06USA01449 06USA01742 06USA01436 05USA01495
ecords received DOS 7/25/06 to 3/13/09. Brown /pink flat lesions on face, scalp. Brown waxy papule left leg. Lentigo on cheek, back, scalp.
erred to derm
ant on 05/18/2009
COPD; AS CAD. brand name)~UN~0~Patient
antrisin; Osteoporosis
ate; Azathiopine
n, HTN, hypothyroidism, laminectomy, hernia repair, CAD w/angioplasty, cholecystectomy, chronic gastroparesis, vertigo, chronic sinus infe
al records received DOS 3/29/09 to 4/1/09. Insulin-dependent diabetes, mononucleosis, fractured tibia.
ords received DOS 5/27/09 to 6/16/09. Second dose Gardasil given 5/27/09 (Lot# 0100Y) no worsening of symptoms.
received DOS 5/24/09 to 5/25/09. Chronic constipation, conjunctivitis, influenza A.
05USA00985 05USA01063 05USA01064
06USA02086 eived DOS 6/10/09. Multiple otitis media. PE tubes.
d DOS 12/26/09 to 1/3/09. Hypertension, Dyslipidemia, TIA, Anxiety disorder, lower extremity spasms. Hysterectomy. 7/22/09 Neuro consu
after shots given~ ()~NULL~1~In Sibling1
occal (Menactra)~1~0~Patient
eceived w/PMH: lactose intolerance. Allergy: codeine (rash).
c neuritis 1988.
llergies. Seasonal & Sulfa drugs.
OS; It appeared that his experience of sxs listed on HPI came before he received his fourth anthrax vaccination.
allergic to codeine PERCOCET
04USA02211 05USA00117 05USA00253 05USA04761 06USA03749 06USA08382 06USA08842 07USA04110 07USA04415 08USA00305 08USA01129 08USA03172 09USA01568 10USA00555 10USA04484 11USA01825 01USA02697 02USA04490 05USA01028 07USA01622 08USA04266 08USA04659 09USA03250 11USA02717 12USA02364 11USA00271 12USA03761 12USA04292 12USA04527 12USA05081 12USA05090 04USA00374 04USA00375 04USA01041 04USA01249 04USA02195 04USA02356 04USA02566 04USA02684 04USA02805 04USA02851
04USA03127 04USA03762 04USA03905 04USA04024 04USA04732 04USA04855 04USA04886 04USA04958 04USA04963 04USA05045 04USA05494 04USA05945 04USA06452 05USA00604 05USA00963 05USA00472 05USA01259 05USA01301 05USA01724 05USA02007 05USA02008 05USA02851 05USA03043 05USA03044 05USA03443 05USA04017 05USA04028 05USA04742 05USA04823 05USA05616 06USA00334 06USA00655 06USA01349 06USA01956 06USA01991 06USA02474 06USA03069 06USA03246 06USA03247 06USA03736 06USA08308 06USA09015 07USA00301 07USA00647 07USA01282 07USA01385 07USA01390 07USA01882 07USA02212 07USA02259 07USA02929
07USA03594 07USA04023 07USA04121 07USA04834 07USA05192 07USA05497 07USA05524 07USA05530 07USA05546 07USA05695 08USA00136 08USA00284 08USA00678 08USA01310 08USA01337 08USA01347 08USA01675 08USA01729 08USA01806 08USA01821 08USA01953 08USA02149 08USA02648 08USA02658 08USA03170 08USA03536 08USA04342 08USA04672 08USA04970 03USA01084 03USA01085 03USA04716 03USA04868 08USA04990 08USA05346 09USA00020 09USA00264 09USA00311 09USA00514 09USA00720 09USA01166 09USA01376 09USA01587 09USA01970 09USA02105 09USA02613 09USA03791 09USA04333 09USA04517 09USA04525 09USA04597
09USA04616 10USA00010 10USA00544 10USA01976 10USA03413 10USA03422 10USA03729 10USA03787 10USA03948 10USA04143 11USA00283 11USA02891 11USA03062 11USA04133 12USA02053 12USA02331 12USA02373 12USA02572 12USA02587 12USA02768 12USA02808 12USA03174 12USA03218 12USA03515 01USA00128 01USA00177 01USA00190 01USA00321 01USA01341 01USA01725 01USA01824 01USA03456 01USA03472 01USA04120 01USA04183 02USA00262 02USA00430 02USA00441 02USA00453 02USA00468 02USA00612 02USA01084 02USA01110 02USA01776 02USA01784 02USA01858 02USA01880 02USA02376 02USA02405 02USA02482 02USA02618
02USA02792 02USA02907 02USA02944 02USA03071 02USA03102 02USA03118 02USA03602 03USA00343 03USA00538 03USA00594 03USA00746 03USA00892 03USA00918 03USA00923 03USA00967 03USA01091 03USA01096 03USA01408 03USA02001 03USA02076 03USA02227 03USA02298 03USA02334 03USA02338 03USA02344 03USA02357 03USA02558 03USA02571 03USA02669 03USA02918 03USA03186 03USA03661 03USA04009 03USA04524 03USA04535 03USA04550 03USA04711 03USA04728 03USA04776 03USA04855 03USA04857 03USA05410 03USA05433
04USA00002 04USA00009 06USA01886 06USA02262
onic airway obstruction, alchohl dependence, chronic hepatitis C, positive PPD, BPH, depression, cocaine dependence, opioid dependence
nfectious Mononucleosis 11/17/05
ospital records received DOS 5/5/09 5/9/09 Nausea, vomiting, and diarrhea.
works night shifts) |None~ ()~~0~Sibling|None~ ()~~0~Sibling
06USA02278
N; gout; Hyperlipidemia; Allergy: LIPITOR/NIASPAN. 7/8/09 consult records received DOS 11/3/08 to 6/13/09. Hearing loss, atherosclerosi
al records PMH: Parainfluenza bronchiolitis w/hospitalization, 3/09. GERD. 33-wk preemie, 17 days in NICU due to respiratory distress. PR
ccine not specified (no brand name)~UN~0~Patient
advance- Doing well on Similac sensitive
d pressure; Glaucoma
10USA02712 06USA02119 06USA02577 06USA02082 06USA02085 06USA02257 02USA04905 06USA02049 06USA02099 06USA02310 06USA01892 06USA02328
ical condition includes heart condition, treated with medication.
bling1|N/A~ ()~NULL~~In Sibling2|N/A~ ()~NULL~~In Patient
GION~Measles + Mumps + Rubella (MMR II)~0~1~In Patient
THER WAS ON DRUGS AND ALCHOHOL USE. AND ALSO BABY HAS GERD.
cousy, greenish. 6/29/09 Medical records received DOS 1/15/08 to 8/20/08. Overfeeding, diarrhea, milk allergy.
on side of injection terribly swollen, arm swollen and red~Tdap (no brand name)~UN~26~Sibling
; s/p surgeries; Hx of SVT. 7/7/09 Hospital records received DOS 6/0/09 to 6/3/09. VSD, ASD, transposition of great vessels. ords received DOS 4/27/09 to 4/28/09. Anxiety disorder. Reaction to general anesthesia.
defect (Atresia)
drome; Anxiety; Spastic colon.
nvironmental allergies
Sibling1|NONE~ ()~NULL~~In Sibling2
04USA05245 10USA02860 03USA03639 06USA01827
04USA04516 07USA03017 08USA03705 06USA02285
Propafenone (dysrhythmia) PMH: A-Fib, hyperlipidemia, hypothyroidism, myopia, pericarditis, pulmonary hypertension, TIA, vitiligo
e, Simvastatin
eceived DOS 6/17/09 6/19/09. History of positive ANA
surgery 3 weeks.
halosporins which he had a reaction to in 2003 or 2004. Several years later, he had taken amoxicillin with no problems.
4/8/09 to 4/9/09. Allergies to milk, peanuts, and eggs. Eczema. Tympanostomy, tubes placed. Adenoidectomy. Multiple ear infections.
06USA02596
t disease; Peripheral neuropathy.
to BACTRIM
06USA02881 06USA02971 06USA03450 06USA01707
Tachycardia.Sinus surgery. appy. Herniated disc w/ surgery. Nausea, diarrhea and vomiting 11/2008.
atrial septal defect, benign heart murmur; allergies-Amoxicillin, OMNICEF.
em and was found to be having seizures before birth while in the womb.
nd name)~NULL~~In Patient
OPED SOME GRUNTING AND SOME RESPIRATORY DISTRESS. JAUNDICE 6/29/09-records received-PMH:born 6 weeks premature. with seborrhoeic dermatitis
ella (no brand name)~1~5~Patient
s received DOS 6/15/09. Headaches
UN~0~Patient hours~DTaP + IPV (KINRIX)~UN~0~In Patient|none~ ()~NULL~~In Sibling1
06USA02582 06USA02844 06USA03651 06USA03729
/16/09 Medical records received DOS 2/08/08 to 7/15/09. Varicose veins, atypical chest pain, dyspnea, joint pain shoulder. hypothyroidism,
Patient|None~ ()~NULL~~In Sibling1 eceived DOS 5/21/09 to 5/24/09. Recent cold symptoms. Frenulum clipped. Hypospadias. Thrush. asles + Mumps + Rubella (MMR II)~0~1~In Patient records received 6/19/09 to 7/8/09. Alcoholism. Drug abuse. History of angioedema. Depression.
e mold, cats, pseudephedrine, erythromycin
6/29/09 PMH: nasal fx. Allergy: Keflex.
baceous nevus. 7/7/09 Hospital records received DOS 6/20/09 to 6/22/09. Global Developmental Delay. Ear infection. DOS 8/6/07 to 6/24/09. ADD. Ingrown toenail. Acute bronchitis. Allergic rhinitis. leukopenia, thrombocytopenia, anemia with no known evidence immunodeficiency PMH: sensorineural hearing loss. Allergy: vancomycin
term twin 3 1/2 wks
/o breast cancer; Anxiety/depression
02USA00127 03USA03943 06USA03355 06USA03836 spital records received DOS 12/28/01 to 12/31/01. Respiratory tract infection with cough, fever, headache, and chest pain. Penicillin allergy B (no brand name)~3~19~Patient
pecific rash). Allergic rhinitis.
S 6/18/09: ADD estation), SGA, hypoglycemia, apnea of prematurity. 7/13/09 DC summary received DOS 2/14/09 to 3/14/09 Discharge Diagnosis: First bor
chronic low back pain, nocturnal cramps, intermittent claudication, decreased hearing, tinea versicolor
t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling
es + Mumps + Rubella (no brand name)~UN~2~Patient|irritability, "zoning" seizures~DTaP (no brand name)~UN~2~Sib
ausea; fatigue onset within 24 hrs following typhoid~Anthrax (no brand name)~~0~Patient
06USA04131 09USA00445 06USA02614
N, ZITHROMAX
n. Has hx of kidney/bladder problems. Pt. reports she has kidney stones in both kidneys.
ed 2003, no recurrence), asthma (stable), environmental allergies ("many" per patient). Previous smoker, quit one year ago.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
thritis, diabetes
p and eye~HPV (Gardasil)~1~9~Sibling
mps + Rubella (no brand name)~1~54~Patient|Dizziness~Measles + Mumps + Rubella (no brand name)~1~54~Patient
.~DTaP (no brand name)~4~2~Patient
10USA01631 06USA03812 06USA04118 06USA04162 Syndrome, 1986 PMH: GBS (20 yrs ago), hyperlipidemia, GER, tubular adenoma of colon. Allergy to sulfa.
ailure; history of (hx) MI, hx 6 vessel CABG; hyperlipidemia; COPD; CAD; obesity; GERD; hx medication adverse events (PCN, niacin, sulfa
d DOS 7/25/07 to 7/08/2009. Penicillin allergy, C. Trachomatis, Anxiety disorder.
atient|?~ ()~NULL~~In Sibling1|?~ ()~NULL~~In Sibling2
~DTaP+IPV+HepB+Hib (no brand name)~1~0~In Patient
. Resolved when he took VIVOTIC.
~DTaP + IPV + Hib (Pentacel)~0~0~Patient
rax (no brand name)~UN~47~Patient
ds PMH: appendectomy, small bowel resection, tonsillectomy. Medical records received 7/7/09 PMH: motor vehicle accident, pleurisy, sulfa
brand name)~4~2~Sibling|Rash~DTP (no brand name)~4~2~Sibling
S 5/22/08 to 1/7/09. Episode of generalized urticaria "shrimp gumbo", heartburn, smoker
eumo (no brand name)~1~72~Patient
04USA01051 05USA00039 06USA04964 06USA05053 06USA05010
back pain, right tibia / fibula fracture requiring ORIF.
rus, Inact. (no brand name)~UN~0~Patient
Hib+HepB (no brand name)~UN~12~Sibling
sles + Mumps + Rubella (no brand name)~UN~5~Sibling (no brand name)~5~7~Sibling
ADRYL, Latex
(no brand name)~4~1~Patient
eceived DOS 7/18/08 to 7/13/09. Fibromyalgia/chronic pain, platelet dysfunction, Lyme disease, orthostatic hypotension. Allergy to Stimate
arivax)~0~1~In Patient V (Gardasil)~NULL~14~In Patient
d an ablation 7/08 eceived DOS 6/21/09 to 6/25/09. Concerns regarding respiratory pattern in newborn nursery. agmatic hernia s/p repair,and shunt
nd name)~1~1~In Patient ords received DOS 6/28/09 to 7/1/09. Migraine headaches.
ain~Hep B (no brand name)~2~19~Patient
10USA00881
06USA02593 none~ ()~~0~Sibling po qd naproxen 500mg
hysterectomy, right carpal tunnel release. Hyperlipidemia. 5 allergies. 7/23/09 Hospital records received DOS 7/1/09 to 7/2/09. Atopic Dermatitis. Loss of consciousness when donating blood. Sibling1|NONE~ ()~NULL~~In Patient
ES AND PNEUMONIA artery atresia congenital
ords received DOS 7/21/06 to 4/6/09. URI. Contact dermatitis on chin. ADHD.
hypertension; DM type II
Minocycline; RETIN A; Acne 06USA05296 06USA05217
ergies. 9/1/09 ER records received DOS 4/30/09. Asthma. ice as newborn. and name)~1~69~In Patient eceived DOS 3/6/08 to 3/7/08. Born by caesarean section. Jaundice. Anal opening mildly displaced. 7/13/09 PCP medical records received
peech/articulation problem
at age 16; No previous hospitalizations, other than related to surgeries; Allergies: Raisins -->generalized itching, BACTRIM -->rash; Surgic
cine~ ()~NULL~~In Patient|None but has only received the DTaP to date~ ()~NULL~~In Sibling1
congenital cataracts, nystagmus, under genetic investigation
h Kasai procedure, oral surgery 05USA04794 06USA07772 12USA02378 06USA04956 06USA05043 06USA05205 06USA05705 06USA05211 06USA05214 06USA05672
vax)~~77.50~Sibling
Patient|none~ ()~NULL~~In Sibling1 Sibling1|NONE~ ()~NULL~~In Patient none~ ()~~0~Sibling|none~ ()~~0~Sibling
Sibling1|NA~ ()~NULL~~In Patient|UNK~ ()~NULL~~In Sibling2
tube - Freq U.T.I's
EROL; AMOXICILLEN; CODEINE
al records received DOS 6/25/09. Neurofibromatosis Type 1. Infantile Spasms. NICU. (L) tibia/fib fracture. Myringotomy tubes. Chronic lung
ation; CHF 8/27/09 Medical records received w/PMH: hypothyroidism; dyslipidemia; obstructive sleep apnea; s/p gastric bypass Roux-en-Y 06USA05684 07USA00006 06USA05165 07USA00183 07USA03163 06USA05239 06USA05566 06USA05633 06USA05780 07USA00186
ords received DOS 6/30/09. Gravida 1, para 0. Chickenpox. Wheezing as a toddler. Smokes. Alcohol. Marijuana. Allergy to a venom.
d" cheese. 8/14/09 MR received from pcp for DOS 3/12/09 OCs, type II DM, HPV (+), ADD, allergies to molds/grass, anxiety/panic attacks.
sulfa, CLARITIN; AUGMENTIN, CEFZIL; Asthma
r skin, peeling of wrists, ankles, palms and soles
rhinitis, eustachian tube dysf.
o brand name)~5~5~Patient
sthma - mild intermittent
S 7/4/09. Palpitations since a child.
Simvastatin; Zolpidem o (Prevnar)~2~0~Patient|anaphylaxis~Rotavirus (Rotateq)~2~0~Patient|anaphylaxis~DTaP + IPV + Hib (Pentacel)~2~0
)~~0~Sibling|0~ ()~~0~Sibling
Fingers~HPV (Gardasil)~2~20~In Patient
eceived DOS 6/30/09 to 7/4/09. Bronchiolitis.
L~~In Patient
orosis; GERD; high cholesterol sil)~2~13~Patient
eign country, just returned to country on a permanent basis with myself, and her father. She suffered with ITP between the ages of 9yrs to 1 perlipidemia; back surgery; BARRETT's esophagus with NISSEN'S fundoplication; vitamins B12 deficiency and diverticulosis. abetes mellitus; Gastroesophageal reflux disease; Osteoarthritis; Obesity; and Coronary artery disease.
07USA00328 07USA00329 07USA00233
8, s/p radiation 9/08. Also fibrocystic breast disease, depression, HTN, osteoporosis, obesity, hypothyroidism, hyperlipidemia, osteoarthritis
GERD, osteopenia, HTN, abnormal liver enzymes ent|0~ ()~NULL~~In Sibling1
nia 3/27/09 evaluated and TX.
07USA00275 06USA05681 07USA00456 06USA05714
she had fainted before but not with immunizations. Patient had received tetanus only as a prior immunization. Iodine. Medical conditions,Diabetes, Hypertension, elevated cholesterol,Hypo-thyroid,occas. anxiety. had episodes of curling into the fetal position on Moms chest clenching his fists, body tightness~DTaP + He
~Patient|unknown~ ()~~0~Sibling Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
ed DOS 7/7/09. Fainting/dizzy after 'shots'. 7/14/09 ER records received DOS 7/7/09. Previous episodes in the past.
tavax)~1~61~Patient
matic bronchitis; esophageal reflux
m, 2 previous doses
EX, FLOVENT; Asthma
07USA00248 07USA00445 07USA00680 07USA00756
ds and discharge summary received for dates of service 7/09/09 to 7/12/09. PMH: None. to bee stings,shellfish,
er--like once a year
medical records for 7/4-7/10/2009. Extensive foreign travel history, recent heparin induced thrombocytopenia, HTN, hypertriglyceridemia, to
. Tubes in ears when younger. Not present now.
dache; asthma; allergies
not specified (no brand name)~UN~1~Patient mycin (Tinnitis)
seizures. 7/31/09 Neurological consultation records received DOS 4/1/02 to 4/07/09. All consultant records are dated prior to the adverse e
07USA00916 07USA00189 07USA00372
spital records received DOS 3/12/09. Hyperlipidemia.
phageal reflux disease, hypertension, sinusitis, aspergillus pneumonia, shingles, urinary tract infection, thrombophlebitis.; Sulfa allergy; Pas
brand name)~NULL~~In Patient
na; DMTZ; Osteoporosis
~DTaP (no brand name)~1~0~Patient
IN = "numbness"; DILANTIN-hepatitis
Allergies; PCN; NIACIN; Xenical
02USA04530 02USA04535 02USA04539 02USA04588 02USA04590 02USA04615 03USA00011 03USA00012 03USA00036 03USA00039 03USA00069 03USA00118 03USA00287 03USA00290 03USA00421 03USA00439 03USA00561 03USA00573 03USA00597 03USA00722 03USA00741 03USA00872 03USA00898 03USA00899 03USA00953 03USA00989 03USA01130 03USA00954 03USA01131 03USA01135 03USA01140 03USA01405 03USA01407 03USA01425 03USA01438 03USA01462 03USA01586 03USA01587 03USA01594 03USA01610 03USA01648 03USA01842 03USA01846 03USA01847 03USA01848 03USA01854 03USA01878 03USA02069 03USA02079 03USA02271 03USA02296
03USA02321 03USA02331 03USA02342 03USA02559
03USA02580 03USA02594 03USA02605 03USA02612 03USA02633 03USA02637 03USA02894 03USA02917 03USA02940 03USA02950 03USA03624 03USA03646 03USA03653 03USA03948 03USA03949 03USA03956 03USA03992 03USA04008 03USA04010 03USA04014 03USA04241 03USA04286 03USA04311 03USA04319 03USA04510 03USA04531 03USA04539 03USA04567 03USA04625 03USA04687 03USA04690 03USA04712 03USA04895 03USA04920 03USA05193 03USA05208 03USA05211 03USA05220 03USA05292 03USA05388 03USA05479 03USA05503 03USA05528 03USA05531 03USA05560 03USA05631
04USA00007 04USA00023 04USA00033 04USA00055 04USA00219 04USA00226 04USA00358 04USA00359 04USA00362 04USA00365 04USA00366 04USA00370 04USA00382 04USA00411 04USA00419 04USA00478 04USA00483 04USA00572 04USA00611 04USA00619 04USA00622 04USA00635 04USA00640 04USA00641 04USA00859 04USA00879 04USA00891 04USA00894 04USA00978 04USA00985 04USA01027 04USA01139 04USA01268 04USA01351 04USA01359 04USA01543 04USA01885 04USA01886 04USA01894 04USA02021 04USA02055 04USA02065 04USA02072 04USA02087 04USA02306 04USA02311 04USA02319 04USA02348 04USA02359 04USA02785 04USA02790
04USA02807 04USA02906 04USA02915 04USA02938 04USA02969 04USA03184 04USA03188 04USA03195 04USA03273 04USA03450 04USA03566 04USA03598 04USA03629 04USA03693 04USA03793 04USA03804 04USA03835 04USA03950 04USA04005 04USA04009 04USA04015 04USA04025 04USA04180 04USA04185 04USA04196 04USA04201 04USA04209 04USA04211 04USA04215 04USA04216 04USA04235 04USA04249 04USA04250 04USA04379 04USA04390 04USA04398 04USA04433 04USA04449 04USA04519 04USA04551 04USA04563 04USA04571 05USA00012 05USA00026 05USA00030 05USA00047 05USA00053 05USA00055 05USA00183 05USA00208 05USA00222
05USA00229 05USA00231 05USA00233 05USA00346 05USA00353 05USA00356 05USA00376 05USA00393 05USA00515 05USA00519 05USA00552 05USA00564 05USA00580 05USA00638 05USA00700 05USA00860 05USA00940 05USA00949 05USA00952 05USA00965 05USA00983 05USA01036 05USA01058 05USA01069 05USA01098 05USA01101 05USA01253 05USA01255 05USA01271 05USA01287 05USA01301 05USA01312 05USA01422 05USA01423 05USA01465 05USA01623 05USA01656 05USA01657 05USA01842 05USA02008 05USA02208 05USA02276 05USA02488 05USA02517 05USA02520 05USA02523 05USA02846 05USA02876 05USA02917 05USA02926 05USA02944
05USA02976 05USA02979 05USA03099 05USA03224 05USA03226 05USA03236 05USA03363 05USA03373 05USA03378 05USA03386
no medical problems. 07USA00742
tavirus (no brand name)~2~0~Patient o brand name)~1~1~Patient 07USA01157
+ Mumps + Rubella (no brand name)~2~2~Patient rass and hay
d for date of service 6/22/09. PMH: Blocked tear duct
avirus (Rotarix)~3~1~Patient
al reflux; Allergic Rhinitis; Allergic Conjunctivitis.
roesophageal reflux.
03USA02916 03USA04731
me - bilateral fasciotomy. 7/29/09 Consultant medical records received DOS 6/30/09. Compartment syndrome of legs - fasciotomies. Ear tub
07USA00699
07USA01326
07USA01296
07USA00930
07USA01222
06USA02621
philic Disease; Eczema; Esophageal reflux
allergies; Celiac disease, osteoarthritis, high titer ANA positive, Depression
medical history
demia PMH: OA, HTN, DM, chronic reflux esophagitis, hyperlipidemia Allergies: Sulfa d prolactin. Has had tenderness, redness, and muscle soreness with previous Td injections.
Gardasil)~1~25~Patient odeine;Negram;Vinegars,onions,Feta and aged things......Hx lupus with osteoarthritis;migraines;
Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
ic to some milk, tomato soup & instant mashed potato's
); mild umbilical hernia
B + IPV (Pediarix)~2~0~Sibling
GAR was 8 becoming 9. Head trauma - contusion.
Pneumo (no brand name)~UN~66~Patient
dasil)~1~12~Patient TYLENOL; IBUPROFEN.
07USA01302
gies. 7/17/09 Hospital records received DOS 6/18/09 to 6/19/09. Tonsillectomy, asthma. Allergies/hives - codeine, penicillins, eggs, dairy.
eceived DOS 7/11/09 to 7/15/09. Mono, allergy to Cefaclor.
mnicef (vomiting, vomiting, rash)
ythromycin, lidocaine, hydrododone, acetaminophen-hydrocodone, demerol, clinoril, xylocaine, egg containing compound, flexeril, tylox, con Sibling1|none~ ()~NULL~~In Sibling2
occasional asthma; Infertility; Environmental allergies; weight concern; GI problems. ng degrees of reactions to vaccinations in past. Medical records would show onset of illnesses after vaccin
POFOL for my colonoscopy. I am not a smoker and have an alcoholic beverage infrequently.
sis; Allergic Rhinitis; Chronic OBST asthma
ots, patient had a febrile seizure associated with having a high temperature. The cause of the fever was not known. Blood work and urine sa
(no brand name)~UN~11~Sibling
08USA04839
07USA01273
enza (no brand name)~UN~53~Patient
d DOS 7/17/09. Phobia of needles. would pass out as a child. Tdap (Adacel)~1~12~In Sibling1 DTaP + IPV (KINRIX)~5~5~In Sibling1
icillin, Levaquin
d DOS 5/1/09 to 6/08/09. Allergic rhinitis, acne. 9/1/09 Consultant Pain Clinic records received DOS 6/5/09 to 7/10/09. Therapy for stress an
osteoarthritis. 7/24/09 Medical records received DOS 2/20/09. Hysterectomy, hypercholesterolemia, malaise, appendectomy, osteoarthritis
04USA01770 05USA02346 05USA04045 07USA04408 08USA01387 10USA02180 10USA03304 10USA05202 11USA03512 05USA04071 06USA01687 06USA01721 06USA01741 06USA01763 06USA01774 06USA01895 06USA01909 06USA01913 06USA02001 06USA02050 06USA02051 06USA02057 06USA02088 06USA02122 06USA02126 06USA02135 06USA02136 06USA02262 06USA02639 06USA02641 06USA02645 06USA02647 06USA02655 06USA02657
06USA02879 06USA02895 06USA02901 06USA02915 06USA02926 06USA02932 06USA02937 06USA02949 06USA02300 06USA02302 06USA02309 06USA02313 06USA02318 06USA02962 06USA02991 06USA02514 06USA03285 06USA03335 06USA02576 06USA02623 06USA03361 06USA03372 06USA03400 06USA03422 06USA03424 06USA03428 06USA03431 06USA03718 06USA03719 06USA03736 06USA03745 06USA03753 06USA03754 06USA03807 06USA03821 06USA03965 06USA04017 06USA04076 06USA04091 06USA04097 06USA04116 06USA04127 06USA04136 06USA04137 06USA04269 06USA04379 06USA04389 06USA04393 06USA04724 06USA04739 06USA04750
06USA04767 06USA04859 06USA04941 06USA04949 06USA04961 06USA04977 06USA04981 05USA04982 08USA04987 06USA04995 06USA04998 06USA05000 06USA05017 06USA05019 06USA05048 06USA05055 06USA05091 06USA05163 06USA05171 06USA05329 06USA05189 06USA05359 06USA05192 06USA05197 06USA05225 06USA05369 06USA05392 06USA05615 06USA05616 06USA05627 06USA05641 07USA00009 06USA05666 07USA00012 07USA00019 07USA00034 06USA05668 07USA00043 06USA05674 07USA00064 07USA00070 06USA05677 06USA05702 07USA00075 07USA00097 07USA00122 07USA00144 07USA00182 07USA00330 07USA01092
V (Gardasil)~3~26~In Patient
site and headaches~HPV (Gardasil)~1~14~In Patient d DOS 7/11/09. Gastroduodenitis, laparoscopic cholecystectomy. recurrent menstrual pain, NSAID use. Hypothyroidism. Alcohol use. Iron 10USA02010 07USA01994 07USA02007 07USA02018 07USA02011 07USA01687
umps + Rubella (no brand name)~1~1~Patient
aP (no brand name)~5~5~Patient
(Pneumovax)~1~59~In Patient hypertension, asthma arivax)~1~14~In Patient
d question of polycystic ovaries
statin 5mg 1 qd
~Influenza (no brand name)~NULL~12~In Patient
DTaP + IPV (KINRIX)~UN~4~Patient
ster (Zostavax)~1~75~Patient
o brand name)~1~1~Patient
05USA02043
07USA01529 07USA01998 07USA02337 07USA02033 07USA02071 disorder; acid reflux disease . PMH: constipation
y g.mom (similar reaction to a vaccine given early in life~DTP (no brand name)~~0~Patient
HYPERCHOLESTEROLEMIA, DIABETES
AIN, RASH, AND INTENSE HEAT.
iculitis. NKDA
e at birth with resp. problems. 5 sets of tube inserted bilateral ears
09 Hospital records received DOS 7/9/09 to 7/10/09. Premature, born at 29 weeks. Placental hypoperfusion. Apnea of prematurity. Respirat
9 Hospital records received DOS 7/9/09 to 7/10/09. 29 week premie. Twin. Placental hypoperfusion. NICU. Respiratory insufficiency, periph
mia; Thrombocytopenia form Valtrex.
YCIN; SEPTRA; PCN'S; Diagnosis: Pervasive Developmental D/O; sleep apnea, Autism Spectrum D/O
P (no brand name)~3~15~Patient
ap (no brand name)~1~12~Patient
edical conditions I'm aware.
06USA01923
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
elbow, lumbar), no PMH allergy. PMH: Tooth infection. Skin graft right 'pinky'.
1/09~Hep A + Hep B (no brand name)~1~0~Patient|Localized reaction 6/1/09~Tdap (no brand name)~1~0~Patient
nza (no brand name)~1~1~Patient
06USA03421
07USA02055 07USA02939
5/09; pregnant EDC 1/6/09 3 1/2 mo.
; Hypertension; Sleep apnea nsciousness~DTaP (Daptacel)~1~0~Patient|allergies, asthma, adhd, learning disabilities, language delay, mot atient|N/A~ ()~NULL~~In Sibling1|N/A~ ()~NULL~~In Sibling2
SSION, HYPERLIPIDEMIA
ecieved DOS 11/30/2008 to 12/03/08. Low back pain with radiation of pain and numbness down right lower extremity, heaviness, pins and
07USA03043 medical records received DOS 5/26/09 to 6/9/09. Fever, throat hurting. 8/17/09 Medical records received w/PMH: absence seizure disorder
Pentacel)~2~0~Patient
n, S/p meningioma resection
N/A~ ()~~0~Sibling|N/A~ ()~~0~Sibling
ers unknown.
ULL~~In Patient
tient|NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In Sibling2
hyperglycemia, PTSD, hyperlipidemia S/P right knee arthroscopic surgery (2006) atient|NO~ ()~NULL~~In Sibling1|NO~ ()~NULL~~In Sibling2 4, HEADACHE, ACHY ARM~Tetanus Diphtheria (no brand name)~6~13~In Patient
atal jaundice.
wks (nodule still present), extremely cranky, would not sleep for days - up very frequently, would not fi
inal pain. 10/8/09 Hospital records 3/16/09 to 3/18/09. Blastocystis hominis infection. Possible Joubert's Syndrome.
Erythromycin
and name)~4~2~Patient|2005~DTaP (no brand name)~5~4~Sibling nus Diphtheria (no brand name)~2~44~Patient
07USA03354 07USA03373 07USA03589
+ Mumps + Rubella (no brand name)~2~4~Patient|03/07/2007~DTaP (no brand name)~4~1~Patient
b (no brand name)~2~0~Patient
07USA03631 07USA03652
07USA03060 07USA03359
07USA02308 07USA02326
none~ ()~~0~Sibling|none~ ()~~0~Sibling
TIENT INTO THE E.R. AT 2 MONTHS OLD AND THEN TO OUR OFFICE AT 7 MONTHS OLD FOR FACIAL BRUISING. THE E.R. THOUG
; Allergies: Altace, daypro, iodine, hydrea, latex, lomotil, sulfa, meloxicam
nt had upset stomach when much younger from the antibiotic Augmentin and reacted nervously or wildly from a "tuss" medication.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
+ Rubella + Varicella (no brand name)~2~4~Sibling
; AVELOX; Breast cancer 2007
d name)~UN~0~Patient
07USA03112 06USA02656
/09 Hospital records received DOS 6/6/09 to 7/06/09. Motrin allergy. Hospitalizations for bronchiolitis and pneumonia. Mastocytosis. Heman vrix)~1~6~In Patient
pital records received DOS 7/11/09 to 7/20/09. Patent Ductus Arterious. Neonatal intensive care. 'Lung disease'.
esity. Plantar fascitis. swelling/edema hands and feet
l rhinitis, breast cancer survivor, 2 successful pregnancies
ook shingles vaccines as precaution
al thyroidectomy 11/07
07USA04214 07USA03645 07USA03675 Rxn to BENADRYL-swells d name)~1~0~Patient|Seizure~Pneumo (Prevnar)~1~0~Patient|Seizure~DTaP + HepB + IPV (Pediarix)~1~0~Patient|Se
wn) and hives with Sulfa drugs.
none~ ()~~0~Sibling
ypertension, Bladder spasms rdasil)~3~13~In Patient
philic gastroenteritis
e~Influenza (no brand name)~UN~26~In Patient
name)~1~15~Patient aches~Smallpox (ACAM2000)~1~24~In Patient eceived DOS 5/29/09. Anxiety. Head injury - Iraq veteran, improvised explosive device explosion.
nactra)~1~20~Patient .~DTaP (no brand name)~4~1~Patient
gestational age) dasil)~2~18~Patient
efore once or twice.
pital at 2 wks. old.
06USA04063 07USA03334 eft ear; High BP. PMH: COPD, high cholesterol. HTN. back surgery.
ed DOS 7/25/09. Allergies: E-Mycin, Penicillin. Bacterial infection. Asthma. ecified (no brand name)~1~0~Patient
eceived DOS 7/20/09 to 7/22/09. Reactive Airway Disease.
il)~1~16~Patient
pital records received DOS 8/5/09 to 8/6/09. In utero drug exposure. Early life neglect.
brand name)~4~2~In Patient
ormone deficiency
eactive airway dz 9/4/09-records received-PMH: allergic to augmentin, wheat (hives), peanuts (rash). Cornealia de Lange Syndrome.
llin allergy, so has never taken it.
lymph glands); EPI (LOC); TEGRETOL (hepatitis); DILANTIN (ataxia at subtherapeutic dose); SANSERT (feet neuropathy); Iodone eyes (h
nnective tissue disorder
ot specified (no brand name)~UN~0~Patient ame)~2~41~Patient brand name)~1~0~Patient 07USA03866
07USA05047
07USA04814
GERD [Gastroesophageal reflux disease]
Heart murmur
Plagiocephaly
mother for treatment; History of febrile seizures till one year ago. None reported after vaccinations.
s causing anaphylaxis after ingestion of milk or milk products, penicillin, and ibuprofen/NSAIDs.
aP (Daptacel)~5~6~In Patient
OTHER ALLERGIES ARE MEDICAL CONDITIONS PER PT'S MOTHER
d DOS 7/22/09 to 7/23/09. One focal seizure on 7/4/09.
t at birth ASD & VSD which she said have closed. Has heart murmur. Denies other health probl.
ALACOL; Carvedilol; ARTHROTEC; RELACON ss, inconsolable crying~DTaP (no brand name)~4~1~Patient
ds received DOS 08/16/06 to 7/20/09. Eye surgery. Caffeine use. Pelvic pain. Oral contraceptives. Penicillin allergy. Hives. Bacterial vagino
recieved DOS 11/23/08 to 11/26/08. Smoker. ug bites arm swells-sensitive. 8/17/09 Hospital records received DOS 7/26/09 to 7/28/09. No prior vaccine reaction. Rash from Amoxicillin.
07USA04864 07USA04871 07USA05126
opathy; Arthritis neuropathy; Hypertension; Migraines; Depression; Glaucome; Hypothyroidism; Asthma; Atopic rhinitis;Fibromylagia; GERD ~In Patient|Unknown~ ()~NULL~~In Sibling1|Unknown~ ()~NULL~~In Sibling2
as~Hep B (no brand name)~2~4~Patient
uitary Surgery 12/2006, Diabetes: Under Control, High Blood Pressure: Under Control. 9/9/09 Prior Medical History - Hospital records receiv
rth until 7 days old; chorioamnionitis from mecomium fluid
A (Havrix)~1~1~Patient spitalized x2 for pneumonia; 1987, S/P splenectomy after traumatic injury; Latent TB - positive PPD converter in March 2009 (not recorded
(no brand name)~2~9~Patient
e)~4~6~Patient
~DTP + IPV (no brand name)~2~1~Sibling|Hard spot, red, fever~Hib + Hep B (Comvax)~1~1~Sibling|Hard spot, re
(Gardasil)~2~15~Patient
er". Penicillin allergy. 'Ear tubes', dental extractions. 07USA05038 07USA03319 07USA04234 07USA04345 07USA04362 eceived. Pneumo / Wyeth Prevnar Lot# D33126 IM 2 Previous doses. Administered on 3/27/09 per vaccine records. 9/23/09 Medical record
ords received DOS 5/15/09 to 5/24/09. Myelomeningocele, ventriculoperitoneal shunt, seizure disorder. Hydrocephalus. Neurogenic bowel d DOS 8/2/09 to 8/5/09. Eye laser surgery. V (Gardasil)~1~14~Sibling
(Gardasil)~1~16~Sibling ella (no brand name)~2~9~Sibling|Rash forehead~Hep A (no brand name)~1~9~Sibling dministration.
od allergy to shrimp and lobster
ear implants inserted at Childrens' Hospital in Birmingham
(no brand name)~NULL~~In Patient
ithromax, Cefzil, melons and bananas.
E tubs; Cleft palate.
nal cyst and fatty liver disease
ODEINE; DILAUDID; Arthritis
cy- Soy formula infancy- WM-at 9ml 07USA04758 10USA04728 07USA05405 08USA00003 07USA04071 07USA05644
Cipro; Augmentin; Clindamycin; Narcotics cause nausea. Patient diagnosis includes Hypertension; Hypothyroidism; GERD; Low back pain; c htheria (no brand name)~6~13~In Patient hypothyroid
rds received DOS 8/12/08 to 7/13/09. Hyperhydrosis, allergic rhinitis, recurrent otitis media, chronic constipation, GERD. 8/17/09 Consultan stent in place keeping my trachea open. I have had 24 medical admissions related to b
d (no brand name)~NULL~~In Patient
pertension, hypothyroidism, dyslipidemia , osteoarthritis
ve fibromyalgia non specific colitits and interstitial cystitis
n for mycosis fungoides tenosis - surgically resolved
n for chest pain. Had UGI. Controls symptoms through diet modification, no medications. Gout. 2004 - Diagnosed based on clinical presen
nknown~ ()~~0~Patient
penia; plantar fascitis; tinnitus
valve, controlled with high BP, VYTORIN to control cholesterol; blood thinner to assist valve, 50% heart function due to the emergency natu
medical records received DOS 10/24/07 to 10/30/07. Tonsillectomy, ectopic heartbeats, hysterectomy, hernia, benign breast biopsy, osteope
us EEG; not allergies, has been raw eggs
06USA04748
07USA05669 07USA05682 08USA00058
rand name)~4~3~Patient
nd name)~1~12~Patient none~ ()~~0~Sibling 0~Patient|None Reported~ ()~~0~Sibling
g~Rabies (RabAvert)~2~8~In Patient
X: ADHD AND IS TAKING ADDERALL XR 20MG 1 QAM AND CLONIDINE 0.1MG QHS. PT. HAS DX:OBESITY AS WELL.
MP ON RT. SIDE SECONDARY TO CONDITION.
unnel syndrome
10USA03151 10USA03209 10USA03324 10USA03681 10USA03742 10USA04978 10USA05305 11USA00059 11USA00680 11USA00890 11USA00896 11USA00903 11USA00907 11USA01139 11USA01642 12USA00522 01USA00144 02USA01799 03USA01440 03USA03638 03USA03645 02USA03729 06USA00286 06USA01049 06USA01241 06USA02894 06USA02898 06USA07565 06USA07568 06USA07732 06USA07736 06USA07821 06USA08865 06USA09012
05USA01623 07USA00408 07USA00831 07USA00845 07USA01192 07USA03005 07USA03096 07USA03097 07USA03320 07USA03677 07USA03837 07USA04021 07USA04071 07USA04073 07USA04128 07USA04404 07USA04828 07USA04830 07USA04938 07USA05269 07USA05671 08USA00513 08USA00992 08USA01259 08USA01705 08USA01940 08USA02145 08USA02583 08USA02621 08USA02641 08USA02675 08USA03612 08USA04048 08USA04242 08USA04684 08USA04828 08USA04971 08USA05316 08USA05370 08USA05487 09USA00032 09USA00048 09USA00085 09USA00331 09USA02160 09USA00337 09USA00805 09USA01236 09USA02521 09USA02624 09USA02626
09USA02630 09USA01415 09USA02766 09USA01447 09USA03151 09USA03172 09USA03215 09USA03216 09USA03819 09USA01583 09USA01662 09USA03863 09USA03866 09USA01821 09USA01855 09USA01935 09USA01945 09USA03888 09USA03927 09USA04150 09USA04166 09USA04173 09USA04197 09USA04522 09USA04643 10USA01827 10USA01844 10USA01845 10USA01854 10USA01859 10USA01995 10USA01996 01USA02006 10USA02028 10USA03065 10USA02030 09USA04790 10USA02038 09USA04791 09USA04852 09USA04922 10USA02075 10USA02076 09USA04968 10USA02124 10USA00198 10USA00321 10USA00443 10USA00448 10USA00482 10USA02125
10USA00486 10USA02187 10USA00524 10USA00525 10USA02394 10USA02479 10USA02695 10USA02778 10USA02784 10USA02797 10USA02891 10USA00547 10USA00645 10USA00701 10USA01153 10USA01200 10USA01683 10USA01715 10USA01762 10USA01813 10USA03140 10USA03150 10USA03163 10USA03172 10USA03232 10USA03238 10USA03312 10USA03314 10USA03338 10USA03352 10USA03399 10USA03401 10USA03423 10USA03561 10USA03616 10USA03664 10USA03673 10USA03713 10USA03803 10USA03858 10USA03859 10USA03865 10USA04002 10USA04020 10USA04111 10USA04158 10USA04316 10USA04317 10USA04320 10USA04324 10USA04337
10USA04352 10USA04363 10USA04371 10USA04374 10USA04396 10USA04401 10USA04477 10USA04478 10USA04592 10USA04594 10USA04685 10USA04783 10USA04903 10USA04918 10USA04920 10USA04935 10USA04944 10USA05190 10USA05083 10USA05120 10USA05159 10USA05164 10USA05228 10USA05286 10USA05310 10USA05337 10USA05340 10USA05362 11USA00039 11USA00048 11USA00069 11USA00073 11USAD0127 11USA00159 11USA00160 11USA00161 11USA00699 11USA00709 11USA00162 11USA00873 11USA00236 11USA00879 11USA00900 11USA00906 11USA00940 11USA00238 11USA00943 11USA01068 11USA00242 11USA01092 11USA01101
11USA00476 11USA01339 11USA00502 11USA00506 11USA00510 11USA01345 11USA00542 11USA01387 11USA00642 11USA00643 11USA00651 11USA01388 11USA01636 11USA01648 11USA01664 11USA02061 11USA02120 11USA01674 11USA02128 11USA01681 11USA01713 11USA01735 11USA01826 11USA01830 11USA01870 11USA02060 11USA02172 11USA02173 11USA02271 11USA02272 11USA02273 11USA02309 11USA02318 11USA02329 11USA02349 11USA02350 11USA02359 11USA02382 11USA02543 11USA02643 11USA02665 11USA02784 11USA02871 11USA02908 11USA02951 11USA02985 11USA03043 11USA03056 11USA03116 11USA03416 11USA03461
11USA03502 11USA03556 11USA03663 11USA03709 11USA03726 11USA03758 11USA03825 11USA03827 12USA00288 12USA00370 12USA00525 12USA00529 12USA00532 12USA00573 12USA01254 11USA03896 12USA01580 11USA03949 11USA03950 11USA03983 11USA03987 11USA03990 12USA01584 11USA04022 11USA04098 11USA04099 11USA04160 11USA04174 12USA01645 12USA00016 12USA01762 12USA00035 12USA01763 12USA01791 12USA01792 12USA01793 12USA01802 12USA01977 12USA01978 12USA01979 12USA01999 12USA02021 12USA02078 12USA02327 12USA02079 12USA02089 12USA02094 12USA02104 12USA02109 12USA02110 12USA02135
12USA02383 12USA02597 12USA03787 12USA04089 12USA04095 12USA04096 12USA04278 12USA04279 12USA04296 12USA04338 12USA04345 12USA04556 12USA04557 12USA04696 12USA05189 12USA05265 12USA02772 12USA02773 12USA02774 12USA03238 12USA03261 12USA03345 12USA03347 12USA03348 12USA03357 12USA03741 12USA03769 01USA00067 10USA00145 01USA00153 01USA00828 01USA01300 01USA01573 01USA01583 01USA01937 01USA01938 01USA01939 01USA01940 01USA01996 01USA02375 01USA02407 01USA02438 01USA02510 01USA03048 01USA03163 01USA03327 01USA03349 01USA03350 01USA03377 01USA03452 01USA03520
01USA03673 01USA03820 01USA03840 01USA03911 01USA04143 01USA04159 01USA04168 01USA04200 01USA04309 01USA04436 01USA04445 02USA00017 02USA00036 02USA00040 02USA00041 02USA00044 02USA00045 02USA00061 02USA00187 02USA00459 02USA00588 02USA00853 02USA00953 02USA01462 02USA01664 02USA01696 02USA01697 02USA01706 02USA01832 02USA02181 02USA02382 02USA02406 02USA02686 02USA02934 02USA02973 02USA03742 02USA03983 02USA04040 02USA04076 02USA04437 02USA04524 02USA04569 02USA04573 02USA04600 03USA00003 03USA00065 03USA00082 03USA00278 03USA00443 03USA01102 03USA01420
03USA01608 03USA01623 03USA02278 03USA02295 03USA02434 03USA02557 03USA02865 03USA02960 03USA03208 03USA03612 03USA03623 03USA03641 03USA03649 03USA03650 03USA03655 03USA03944 03USA04218 03USA04219 03USA04220 03USA04244 03USA05142 03USA05498 04USA00034 04USA00220 04USA00258 04USA00577 04USA01355 04USA01566 04USA02040 04USA02058 04USA02253 04USA02733 04USA02734 04USA02780 04USA02893 04USA03163 04USA03182 04USA03405 04USA03422 04USA03586 04USA03813 04USA03823 04USA03974 04USA04192 04USA04343 04USA04462 04USA04500 05USA00187 05USA00215 05USA00359 05USA00375
05USA00444 05USA00491 05USA00504 05USA00509 05USA00517 05USA00546 05USA00663 05USA00664 05USA00665 05USA00666 05USA00667 05USA00668 05USA00697 05USA00669 05USA00962 05USA00670 05USA01065 05USA01086 05USA00671 05USA00672 05USA01282 05USA01415 05USA01468 05USA00673 06USA01560 05USA01941 05USA02311 05USA00674 05USA04069 06USA00003 06USA00104 05USA00675 06USA00127 05USA00676 05USA00677 05USA00678 05USA00679 05USA00680 05USA00686 05USA00993 08USA00374 08USA00060 eceived 1/27/1986 to 8/3/09. EMG and Nerve conduction studies consistant with Brachial Plexitis 12/3/86. herniorrhaphy. Left testicle surge 2/09 Hospital records received DOS 7/12/09 to 7/14/09. Itchy rash on legs present prior to vaccination. Myringotomy tubes. stavax)~1~84~Patient
specified (no brand name)~UN~0~Sibling lipids; Depression; HTN; TIA; GERD; Anemia; Urinary incontinence
nchitis, glaucoma.
ricella (no brand name)~1~4~Patient
ccine not specified (no brand name)~4~2~Patient
06USA02901
orrhea,Enviromental Allergies, Obesity, Childhood history of Asthma.
ia. 8/20/09 ER records received DOS 7/19/04. Adult ADD. History of boxing with blows to the head. 8/25/09 Consult medical records rec
morphine Medical: MS, CAD, Osteoporosis,
of seizures as infant,
preservatives.
07USA02924 10USA04593 12USA00052 12USA02349
on to vaccine~Varicella (no brand name)~NULL~6~In Patient old) to milk and egg proteins. Asthmatic. Seasonal allergies (allergy shots every two weeks).
eceived DOS 8/3/09 to 8/5/09. Recurrent colds. ani). 8/11/09 Cardiology consult records received DOS 7/16/09 to 3/12/09. Pancarditis. CHF. Allergy to ChloraPrep. Endoscopy. Hypertens
llergies, GER ch delays/conitive delays~Measles + Mumps + Rubella (no brand name)~1~1~Patient
er her body except her face, fever lasting 4 days, lack of appitite, very upset and crying and vomitting~P 08USA00379 08USA00387
08USA00562 07USA02626 08USA00064 08USA00613 08USA00359 08USA00349 08USA00602 03USA00547
Hospital records received DOS 7/30/09. Allergies eggs milk, asthma.
aines PMH: dyslipidemia, tachycardia, MVP, H/A, migraines. asthma, carpal tunnel, restless legs, Vit D deficiency, shingles,arthritis.allergie
d name)~UN~0~Sibling|Rash - fever - Crib death 1 wk after vaccine occured in 1980~DTaP (no brand name)~UN~0~Si
ons to ZOSTAVAX.
but no seizures or meds in 10 years.
d DOS 8/5/09 8/6/09. Contact Lenses. Lupus Erythematosis, lupus nephritis. Allergy: Latex, tape. Depression, Listeria sepsis, Pneumocyst
ive medical illnesses ella (no brand name)~1~5~Patient
+ Mumps + Rubella (no brand name)~1~1~Patient
PERCOCET, PARAFON FORTE DSC to all nuts; tree nuts; seeds; fur bearing animals
07USA05691 08USA00771
ecords w/PMH: Family hx: strong hx of febrile seizures. 9/17/09 Hospital records received DOS 8/9/09 to 8/11/09. Seizure disorder.
mbar spine scliosis + DJD
name)~2~7~Sibling
eeses. PMH: ADD, Anxiety, Sensory integration issues, env allergies. 9/24/09 Hospital operative report DOS 6/12/09. Recurrent tonsillitis,
hritis; Back pain
ame)~3~32~Patient|~Anthrax (no brand name)~6~34~Patient
rds 2/10/02 to 9/09/09. Subcutaneous fatty tumor on back. Fell of bed and struck head. Penicillin, sulfa allergies.
Patient|None~ ()~NULL~~In Sibling1
(KINRIX)~1~5~Patient
rand name)~2~1~In Patient art Rate, Excessive Sweating, Shortness of breath. Dehydration.~Influenza (Fluvirin)~1~25~In Patient
SSALON PEARLS) INDUCED RASH
artilage; Arthritis present
Osteoporosis; Osteoarthritis.
Varicella (Varivax)~1~1~Patient happened before. No further information.~ ()~~0~Patient
ain syndrome, alergic to methadone, morphine
COSE VEINS ON LEFT W/ STASIS DERMATITIS, OBESITY
08USA00614 08USA01032
Hypothyroid; Hyperlipidemia
il, Epinephrine
Pneumo (Prevnar)~2~0~In Patient
and Sesame Oil Allergies (Anaphylaxis); Right Breast Cancer History; Hypercholesterolemia
atient|n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2 Tetanus Diphtheria (no brand name)~UN~6~Patient
e received DOS 6/08 to 6/09. Stomach aches. ation 8/08 - 10/08
ep A (no brand name)~2~2~Patient me)~4~1~Patient
08USA00799 08USA01092 08USA01451 08USA01533
received w/PMH: 41 Preemie, hospitalized with r/o sepsis; eczema 8/4/09 Never experienced these symptoms with previous shots.
ascular dystrophy, chiari malformation
cochlear implant in right ear. Was recieving pneumovax due to scheduled surgery for an implant in the left ear. 8/14/09 Hospital admitting
nital hearing loss. She had a right cochlear implant placed in 1999. She is scheduled for another implant later in September and was recei Adsorbed (DECAVAC)~3~2~In Patient ING PATIENT.
me)~5~5~Patient|~Varicella (Varivax)~2~52~Patient
sick after all his shots~ ()~~0~Patient
to is NAPRASYN -spelling?-. At the 3rd day of taking it for the inflammation in my knees. I broke out with hives.
cheduled allergy shots~ ()~NULL~~In Patient
r care since 2/6/09
brand name)~4~5~Patient
o brand name)~1~3~Patient
ad a bad bruising on R leg after 1st set of vaccines given on 3/16/09 but did not report same to Dr. until
08USA01558 08USA01559 08USA01660 08USA01537 08USA01584
s only checkup.
e pain & oozing~DTaP (no brand name)~NULL~47~In Patient
ULL~~In Patient
o previous vaccinations~ ()~~0~Patient ne, Percocet....depression
ngioedema/allergy; dyslipidemia. 8/21/09 PCP medical records received DOS 8/14/09 to 8/14/09. NSAID induced angioedema. No prior rea za (no brand name)~~7~Sibling
has been having increasing sensitivities to various foods and medications for the past few years. She has been diagnosed with Celiac disea
Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2
ebral palsy; asthma; dysphagia. PMH: CP asthma decreased Bone density
le Asthma. 9/24/09 Infection Disease Consultation medical records received DOS 3/10/08 to 11/27/08. Fall with bruise to right side of face a
egularities, digestive issues, emotional issues~HPV (Gardasil)~1~25~Patient
08USA00788 08USA00793 06USA03683 08USA00966 08USA01712 08USA01582 08USA01901
pisode of wheezing
brand name)~2~14~Patient
se, GERD, cigarette smoker records received: PMH: febrile seizures 2/09.
edical conditions of hypothyroidism and fibromyalgia
Mumps + Rubella (no brand name)~2~5~In Patient
s (receives allergy shots)
arivax)~2~8~Patient
lofenac sodium; Fluorouracil; Kenalog Aerosol solution; Metoprolol succinate; NASONEX; Simvastatin
08USA01904 08USA01599 02USA03594 08USA01696 08USA01728 08USA01924 08USA01957
s, fish, shellfish, mold, dust mites PMH: asthma
epaired; 35 wk gestation
tanus Diphtheria (no brand name)~UN~0~Patient
s; no other conditions reported. 9/2/09 ER records received DOS 7/29/09. Shellfish, environmental allergies. VSD repair as infant. menstru
mps + Rubella (no brand name)~1~1~Patient
pecified (no brand name)~UN~2~Patient|Fever~Vaccine not specified (no brand name)~UN~2~Sibling
nuemathorsis at birth, ventilator for 7 days and chest tubes, premature by 5 weeks, suffered severe reflux at 3 months, severe constipation
ching various unusual neurologic symptoms....optic neuritis and minor paresias....always with complete recovery
elling~Influenza (no brand name)~1~0~Patient
EGA) 9/24/09 Discharge summary received for date of service 8/15/09. PMH: prematurity 31 weeks gestation 765.26A, initally intubated, u oncology medical records received DOS 4/15/08 to 5/15/09. Persistant urticaria, penicillin allergy, allergy cat dander. \ksk
Patient|unknown~ ()~NULL~~In Sibling2|unknown~ ()~NULL~~In Sibling1
, sugar, eggs
es + Mumps + Rubella (no brand name)~1~1~Patient|speech delay~Hep A (no brand name)~1~1~Patient
consultation records DOS 12/19/08 to 8/14/09 Tobacco use, smoked for three years - quit 08/08. Alcohol use. V (Gardasil)~1~11~Patient
08USA02407 08USA02226
~DTP (no brand name)~1~0~Patient
MEDICAL COND
pital records received DOS 8/17/09 to 8/18/09. Seizures. Arachnoid cyst. Cerebral Shunt. No reaction to previous MMR and Varicella vacci
HI; ADVAIR L50 150 1 puff BID; LISINOPRIL LO AD.
enital Defects; Allergy: Shellfish
Thyroiditis; compensated hypothyroidism~HPV (Gardasil)~~12.00~Patient
ess, was prolonged, thus was on Keppra and being weaned off. 8/31/09 Hospital records received DOS 2/5/09 to 2/16/09. PMH: Left vocal
ospital records received service dates 8/18/09 to 8/21/09. Allergy Amoxicillin.
s temporal aneurysm Bronchiolitis 6/25/09 luenza (no brand name)~NULL~~In Patient
eived DOS 7/15/08 to 1/19/09. Minocycline allergy. Fasting glucose elevated. 9/1/09 PCP medical records received 2/17/09 to 7/17/09. Alle
04USA01984 hellfish; Prinivil. 8/27/09 Neurology consult records received DOS 1/2/08 to 7/22/09. Sensitivity to cold in extremities. Hypertension, mid bac
cerated (L) inguinal hernia
s Type 1; Celiac Sprue; Pancreatitis; Increase chol.
l allergies, ovarian cysts, but no other known medical conditions. My youngest daughter had a fever seizure as an infant we think because
ose~Measles + Mumps + Rubella (MMR II)~1~6~In Patient ords and multiple consultations received DOS 7/18/05 to 10/2/08. Exercise-induced asthma. Allergic rhinitis. Allergy to household dust. 10
Patient|None~ ()~NULL~~In Sibling1 V (Gardasil)~1~15~Patient
date of vaccination /08 to 5/27/09. Thyroid cyst. Ovarian Cyst. 10/05/09 Vaccine records received: HPV #2, Merck, given 10/15/08, lot# 1061U, RA; Adacel, S
records w/PMH: Allergy: PCN. tive, metal-rash.
ainted with vaccinations because she has received allergy shots without problems. Child states had not eaten lunch.
drotic eczema~Yellow fever (no brand name)~3~40~In Patient
ous hemangioma.
ed with syncope. Allergic to erythromycin. nhevac B)~1~0~In Patient Hypothyroidism Allergies: none noted I don't have any drug uses or allergies. I haven't had any pre-existing conditions that could cause me to be so severely sick as I am.
xiety; Depression.
CET, CODEINE ge at birth; Seasonal Allergic Rhinitis
to DEMORAL
ATIN - COMBAVENT
ead level done 08USA02717 08USA01951 08USA02263 08USA02768 06USA04117 08USA02786
hyroxine, humalog, insulin, citalopram, simvastatin
der was reported by the mother this day and PHN made multiple attempts to contact her for specific information with no results. Per RN
story of passing out
Seasonal allergies. Bilateral shoulder dystocia as a child. Wisdom tooth extraction. Migraine and tension headaches. Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2
ecified (no brand name)~UN~0~Sibling
TaP + IPV (KINRIX)~9~5~Patient
re headaches, vision-shaking~HPV (Gardasil)~1~18~Patient a-fib, hypothyroidism, diverticulosis TaP + IPV (KINRIX)~UN~5~Sibling records PMH: HTN
llin, Sulfa drugs Patient|none~ ()~NULL~~In Sibling1 PMH: seasonal allergies, kidney stones, tendon release-hand.
sion, mesenteric ischemia, abdominal pain, clinical volume depletion.
and name)~1~0~Patient
08USA02573 08USA02787 08USA02477 08USA02404 08USA02799 08USA03124
lips, a sign of angioedema). PMH of hypertension x 14 years.
HepB + IPV (Pediarix)~UN~2~Sibling
tient|NA~ ()~NULL~~In Sibling1|NA~ ()~NULL~~In Sibling2
rked up for incontentia pigment
n screening form for teen immunization
ived DOS 8/10/09 to 8/30/09. URI, Strep Pharyngitis, Menorrhagia, Sinusitis, Chickenpox.
allergy/immunology and neurology consults, received DOS 8/19/09 to 9/14/09. Rhinorrhea. Strep throat. Premature 35.5 weeks.
o AVA # 7 admin in April 04~Anthrax (Biothrax)~UN~0~Patient
records received DOS 8/20/09 to 8/21/09. Allergies to eggs, dairy, pork, beef, amoxicillin.
d for date of service 9/2/09 PMH: none 08USA03209 08USA03257 08USA03151 08USA03203 08USA03208
Patient|None~ ()~NULL~~In Sibling1|None~ ()~NULL~~In Sibling2
num, GERD, Ischemic Heart Disease, penicillin, aspirin, naproxen, Plavix e diseases; esophageal motility disorders; primary Raynaud's phenomenon; fibromyalgia; anxiety disorder; GERD; major depression; HTN;
ERD. Uterine prolapse just recently repaired. PCN allergy routine screening questions. (No allergies, serious medical conditions, immune system problems, medications, etc.) Child was alert, talkati
ays after birth
ditions: Diabetes, Hypertension, Hypercholesteremia, Atrial Fibrillation, BPH, GERD/ESOPHAGITIS spital records received DOS 11/1/08 to 7/20/09. PMH: Allergy Wellbutrin. Adverse reaction to codeine and Demerol. Mitral valve prolapse. B Intracranial Hemorrage. Croup at 5 months.
A + Hep B (Twinrix)~1~10~In Patient
eived DOS 4/1/08 to 8/18/09. Acne, myopia. 2~0~Patient|~Rotavirus (Rotateq)~2~0~Patient|~DTaP + IPV + Hib (Pentacel)~1~0~Patient
ypercholesterolemia; BPH; ED
nd name)~4~2~Patient
rol; Diabetes; Sleep apnea; Impotence; Hypertension; Dermatitis X)~2~5~Sibling + Rubella (MMR II)~2~5~Sibling|~Varicella (Varivax)~2~5~Sibling|~DTaP + IPV (KINRIX)~2~5~Sibling
t specified (no brand name)~UN~0~Patient
10USA00371
racted sexual
athing problem Renal disease; Stroke. 9/11/09 Hospital records received DOS 10/6/08 to 10/21/08. Known history of recent myocardial infarction. Type 2 D me)~UN~84~Patient
ody~Vaccine not specified (no brand name)~1~1~Sibling
08USA03202 08USA03204 08USA03468
x of childhood seziures. 9/9/09 ED records received DOS 8/25/09. Also Labs from 8/28/09. Febrile seizures. Normal MRI Brain. EEG - Abn
MH: previously healthy
ercholsterolemia, colon polyps
9 Medical records received w/PMH: pyelonephritis. Allergy: amoxicillin. ords received DOS 1/5/07 to 8/7/09. Strep Pharyngitis with fever, nausea and vomiting.
Patient|None~ ()~NULL~~In Sibling1
nd name)~0~76~In Patient
to Amoxicillin
pital records received DOS 8/24/09 to 8/27/09. Anaphylactic reaction to bee stings. Pituitary tumor. 10/16/09 Additional Hospital Record rece
resulting in brief vasculitis~DTaP + HepB + IPV (Pediarix)~2~0~Patient me)~UN~0~Patient
d soon after.
Virus, Inact. (no brand name)~3~1.30~Patient|~Pneumo (no brand name)~4~0.00~Patient
08USA03961 08USA04182 08USA03811 07USA00788 08USA03465
ords received DOS 4/16/08 to 5/15/08. PMH: Wart on hand - Histofreezer - Cryosurgery.
us~Tetanus Toxoid (no brand name)~UN~42~Patient
. "Fainting spells".
9 Medical records an DC summary received for dates 12/25/08 to 1/14/09. PMH: HTN, CHF, CAD, arthritis, cardiomegaly, appendectomy,
URE TO THRIVE
ne w/pertussis component- no seizures since 10 mos old
oarthritis, hard of hearing
Pt. was advised regarding pregnancy.
IRTH SURGERY 7/30/2004 NO RESIDUAL PROBLEMS situ, basal cell carcinoma, HTN, complex migraine with TIA, hyperlipidemia, spondylosis. 9/14/09 ER records received 8/21/09. Hypertensio eived DOS 2/3/09 to 8/19/09. Egg Allergy.
sorder; stable allergic rhinitis; RAD
1998; Asthma; PCN allergy; cughlear implar
e; Ventilator-depend; G - tube. 8/31/09 PCP medical records 7/2/07 to 8/27/09. Severe congenital hypotonia - Carey-Fineman-Ziter Syndro
08USA03925 08USA04230 08USA03108 08USA03802 08USA04086 08USA04199
o brand name)~1~28~Sibling dap (no brand name)~UN~28~Patient|Difficulty Breathing~Yellow fever (no brand name)~1~31~Sibling
mplains of vomiting approx once daily
h cardiac ablation 2004 anemia, choleysystectomy, endometrial biopsy July 28, 2009, No known allergies. Smokes half pack per day.
neumovax)~NULL~72~In Patient
ESOLVED, STREP PHARYNGITIS-RESOLVED,ALLERGIC RHINITIS-CONTROLLED, ASTHMA-CONTROLLED,
r allergies - Sulfa, perhaps bees
uts and cats which all cause angioedema. Bee venom causes hives.
Type 2 diabetes Hepatitis
obacco abuse, MVP. Appendenctomy.
ient|unknown~ ()~~0~Sibling
rial septal defect and pulmonic stenosis; Mild mitral insufficiency; moderate pulmonary insufficiency. PMH: congenital heart defect. Allergic
ical condition
ects; No med. condition d (no brand name)~1~0~Patient
09 to 8/29/09. Poison sumac.
Varivax)~1~15~Patient|Syncope~Tdap (Adacel)~1~15~Patient|Syncope~HPV (Gardasil)~2~15~Patient
d site 3 years ago X)~1~5~Patient
ds received DOS 6/10/09. Trauma (L) elbow with surgical fixation.
ng diagnosis of Cerebral Palsy (Quad) VP Shunt for Non-Communicating Hydrocephalus
ved DOS 12/26/08 to 1/03/09. Cholecystectomy.
below for conditions (dual cardiac valve replacement, full heart block, pacemaker. History of helminthes infection, current Pinworms.
08USA03993 08USA03159 ult received DOS 7/1/09 to 7/20/09. Pneumonia perinatal period. Mood and speech problems (anaphylactic react)PMH: ear tubes. Allergies to eggs, peanuts and chili beans. Anaphylaxis to jelly beans S 10/03/07 to 4/25/09. Back Pain, lumbago. Bulging disk and facet inflammation. Plantar wart. Wart removal. Penicillin allergy.
ost Hx Ulcers.
rual H/A. metabolic syndrome
eived DOS 8/24/09 to 8/26/09 and 9/2/09 to 9/3/09. Ovarian cysts, endometriosis. Hysterectomy. Appendectomy.
her reports no meds for it and that client "outgrew" it. Also client dx with ADHD o brand name)~1~39~In Patient Tissue Disease; Allergies: Penicillin, Demoral
irway constriction to azithromycin, ciprofloxacin, and sulfa antibiotics, PTSD, carpal tunnel
Patient|NO~ ()~NULL~~In Sibling1|NO~ ()~NULL~~In Sibling2 LL~~In Patient
colitis; mononucleosis requiring hospitalization Patient|NONE~ ()~NULL~~In Sibling1|NONE~ ()~NULL~~In Sibling2 tient|NA~ ()~NULL~~In Sibling1
tient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2
cal records received DOS 8/25/08 to 8/31/09. Asthma, allergies. Chronic folliculitis.
nd (Rota 18-24 mths) DIN; Amoxicillin; Aspirin
no brand name)~1~34~Sibling ; Voiding dysfunction
name)~UN~44~Patient
ient|Unknown~ ()~~0~Sibling
Osteoporosis no brand name)~1~0~Patient
08USA04275
08USA04511
08USA04691 e)~1~0~Patient
ecords received DOS 8/20/09 to 9/4/09. Clubfoot. 08USA04714
ported (L) arm weakness had a work/up all was (-).
onal allergies.
(Menactra)~1~12~Sibling|Yes~Influenza (Seasonal) (FluMist)~1~12~Sibling m has history of panic attacks.
(Menactra)~1~12~Sibling|Yes~Influenza (Seasonal) (FluMist)~1~0~Sibling ps + Rubella (no brand name)~1~1~Patient
gococcal (Menactra)~1~13~In Patient hma~Varicella (Varivax)~2~12~In Patient
eceived DOS 8/27/09 to 8/31/09. Constipation. Cough. Noisy breathing. c esophagitis and hypoalbuminemia, as well as food allergies to pork, eggs, soy, wheat and milk.
Patient|none~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Sibling1
COPD, dyslipidemia, GERD, osteoporosis. left knee degenerative arthritis with left total knee arthroplasty in 3/08. Allergies to sulfonamindes
leep disorder
cords received w/PMH: Left knee discomfort and left knee chondromalacia patella.
Hospital records received service dates 8/28/09 to 8/31/09. Asthma. Tonsillectomy.
08USA00396 08USA04708 specified (no brand name)~~1~Sibling ut was an honor student. 9/14/09 Hospital records received DOS 3/13/08 to 7/15/08. Mild spastic diplegia cerebral palsy. Insulin-dependen
cks; Depression ed DOS 11/10/08 and 11/22/08. Caffeine beverages.
s, DC summary received service dates 7/22/09 to 7/23/09. Upper respiratory infection. Baby is exposed to tobacco smoke. Mother has hx o
t|NONE~ ()~~0~Sibling|NONE~ ()~~0~Sibling ULL~~In Patient
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2 za (Seasonal) (no brand name)~0~1~Patient
ved for DOS 8/12/09 to 8/16/09. PMH: Asthma, lipid disorder, cervical spondylosis. ycin, clindamycin,penicillin class,sulfonamides,propoxyphene compound,betadine antibiotic(bacitracin,polymixin B sulfate s Hypertension - controlled w/ Rx
medical con
cal Records and Discharge Summary for Dates of Service 8/28/09-8/30/09. PMH: None. Rickets; Respiratory Distress 9/25/09 Medical records received w/PMH: C-section, 24 wk premature birth for decelerations. Mechanical v de II IVH with VM; PDA ligation; GER; Cholestasis; Anemia (stable)
08USA04882 08USA04339 08USA04943 08USA05014
d"~DTaP + IPV + Hib (Pentacel)~1~0~In Patient ainting and seizures with fever, injury and vaccine.
o brand name)~3~1~In Sibling1
neumo (no brand name)~1~63~In Patient
ient's disease has been well controlled sil)~1~17~In Patient
nd name)~5~4~In Sibling1
luenza (Seasonal) (no brand name)~1~49~In Patient ssure medication
murmur; Pre-maturity. 9/11/09 Autopsy received DOD 07/09/2009. Born at 37-38 weeks gestational age, small for gestational age.
dsorbed (no brand name)~UN~30~Patient
PERLE; Penicillin; Sulfamethoxazole/TMPDS; ENTEX; PARON FORTE; Tetracycline; Codeine; Erythromycin; DARVOCET; FLOXIN; Pneum medical records for 6/8/09 to 6/9/09. Circumcision. Neonatal jaundice.
ceived DOS 8/12/09 to 9/8/09. Eye surgery at 8 months of age.
to amoxicillin
medical records received for date of service 8/30/09 to 9/3/09: PMH: otitis media with treatment 2 weeks prior to episode.
08USA05166
ASTIGMATISM
enal failure (moderate), hyperlipedemia
ceived DOS 9/4/09. Asperger, attention deficit hyperactivity disorder, mood disorder. Previous adverse reactions to vaccines. eceived DOS 9/4/09 to 9/10/09. Chronic renal failure, diabetes mellitus, hypertension, anemia, asthma, peptic ulcer disease, diastolic cong
esssing~Measles + Mumps + Rubella (no brand name)~~2~Patient
none~ ()~~0~Sibling
iring ER visit.~HPV (Gardasil)~1~13.80~In Patient
30 years ago).
d - has VP shunt
cel)~UN~13~Patient
ment at this time
eumo (no brand name)~1~82~Patient
ed DOS 8/4/09 to 8/5/09. Penicillin Allergy.
cent injuries in car accident aggravating previous car accident injury from year ago. Being treated by chiropractic doctor and massage thera Nuts. Allergic reaction to Amoxcicilin
ess,stiffness at the injection site, fever and sleepy~Hep A (no brand name)~2~3~In Patient|swollen at injec on site, redness, fever, bump~Measles + Mumps + Rubella (no brand name)~2~4~In Patient
9 ER records received DOS 9/4/09. Recurrent atrial flutter, coronary artery bypass graft, stent placement, congestive heart failure. Angina.
avirus (no brand name)~3~1~In Patient
sil)~3~16.00~Patient
osis; L3-5 lumbar spinal stenosis; osteoarthritis; osteopenia; Celiac disease; similar neuropathic pain 04/2007-12/2007; Chicken Pox at age 08USA04685 10USA04754 09USA00007 09USA00201
09USA00202 09USA00324 08USA05165 09USA00028 09USA00354
niation; Lyme 8/06. 9/11/09 Hospital records received DOS 2/11/09 to 2/17/09. Lyme disease. Herniated disc. Burns to fingers of left hand.
rand name)~1~1~Patient
or allergies. No history of anaphylaxis or severe allergic reaction.
nsomnia 2' to shift work Family History Aneurysm
ess at birth 9/25/09 Medical records received for DOS 9/1/09 to 9/2/09. PMH: PPHN with intubation at birth, methadone maint. at birth in NIC
VICODIN; conditions: Osteoporosis; lateral epicondylitis (elbow); depression with anxiety; hypothyroidism; nicotine use
uenza (Seasonal) (no brand name)~UN~41~Patient
o receptive delay. PMH: mild expressive speech delay
umo (no brand name)~NULL~72~In Patient
07USA05837 09USA00325 08USA01926 09USA00049 05USA01040 09USA00206 09USA00318
al records received DOS 9/2/09 to 9/3/09: PMH: none p/palate-with repair. 36 week premie. tympanostomy tubes. failed NB hearing screen. Seasonal) (no brand name)~UN~0~Patient
2d hives X 1d~Hep B (no brand name)~2~1~Patient|Fever 102 degrees X 2d hives X 1d~DTaP (no brand name)~2~1~P
Mumps + Rubella (no brand name)~1~0.00~Patient
)~2~0.30~Patient
dness~DTaP + HepB + IPV (Pediarix)~3~3~In Patient
ritis, Hearing and Balance loss, Dermitis, Thyroid.
cords and DC summary received from date of service 11/1/08 to 11/7/08 PMH: anemia, menstral irregularities with heavy flow, short stature
ion; Chronic Pain; ETC.
n ratio - Recurrent - Normal serum protein/electrophesis., onset 2009
nia vaccine with an injection site 'satellite'reaction elsewhere and was told just unusual but not to worry. HAS ALLERGIES TO SULPHA & R accine given in 1968 (arm swelled to twice size and had fever for several days)
ceived 2 doses Hep A vaccine recalled for poss lack of potency. Scoliosis, back pain. Scoliosis brace. Thigh, calf pain. Numbness tingling r
10mg 8/17/09
e; Osteoarthritis
Toxoid (no brand name)~UN~0~Patient
09USA00557
d DOS 8/31/09 to 9/2/09. Allergic rhinitis.
ceived from dates of service 2/2/09 to 8/24/09 PMH: HA, sinusitis, allergic rhinitis.
Mumps + Rubella (no brand name)~UN~0.00~Patient
asil)~2~13~Patient
nza (Seasonal) (no brand name)~1~40~In Patient culitis, hyperlipid, onychomycosis, BPH, low back pain, chronic kidney dz
llergies, food allergies-milk and eggs (pt is a physician assistant and stated the egg allergy was not an issue as she has had flu vaccine in
s + Mumps + Rubella (no brand name)~1~1~In Sibling1
ches~Influenza (Seasonal) (no brand name - brand name unknown)~1~61~In Patient ords received DOS 10/2/06 to 6/27/08. Septal rhinoplasty with tonsillectomy.
High BP; Renal Failure
ure~Measles + Mumps + Rubella (MMR II)~1~1.50~Patient
FEXOFENADINE (increased LFB & liver pain).
09USA00464 09USA00635 09USA00783 09USA00762 09USA00753 09USA00773 tside and inside, sinusitis, border line diabetes.
Patient|unknown~ ()~NULL~~In Sibling1|unknown~ ()~NULL~~In Sibling2 records w/Menactra, Lot #U2670AA, given LA on 6/24/2009.
el)~NULL~25~In Patient Rash- Iodine : Hives, Rash-------------- pt dx Lupus
en's, RA c/b CVA and h/o lupus nephritis
of lumbar region.
P (no brand name)~4~1~In Patient
ltant records received DOS 8/28/09. Carpal tunnel syndrome, abnormal EMG. Anemia.
TI with bacteremia and fever.
f prematurity
ort hospitalization DOS 8/24/09 to 8/27/09. COPD, hypertension, obesity. Smoker. Oxygen dependent.
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
gs does not take seasonal flu vaccine~ ()~NULL~~In Sibling1 ns in left arm due to a previous diagnosis, so both injections were given in the same arm and were given about 2 inches apart, however the
ash 5 hours before inj.
er medical conditions
gnosed); migraine headaches (self diagnosed)
tient|na~ ()~NULL~~In Sibling1|na~ ()~NULL~~In Sibling2
histamine/decongestant combinations, Medical:S/P perthes L hip, asthma (controlled),seasonal allergies
asles + Mumps + Rubella (no brand name)~~0~Patient
olio vaccine~Polio Virus, Oral (no brand name)~1~16~In Patient
09USA01041 09USA00746 11USA02648 08USA04768 09USA00694
|None~ ()~~0~Sibling
omosome abnormality, seizure disorder, VSD repaired PMH: chromosomal abnormalities, global developmental delay, VSD-repaired, G-tu
itrofurantoin; --C-sulfa antibiotics; --C-sulfonamide derivatives
erma(no treatment), Allergic to PCN
uenza (Seasonal) (FluMist)~UN~6~In Patient records w/PMH: Circumcision.
of possible relevance.
name)~2~0~Patient
specified) anxiety, allergy to Levaquin, Penicillin, Bactrim
ICODIN; BIWIN.
Gardasil)~~13~Patient
09USA00700 09USA00549 08USA04775
sonal) (no brand name)~1~22.00~Patient
al records and DC summary for dates 9/14/09 to 9/22/09. PMH: Reactive airway disease, pneumonia, heart murmur. FH: seizures
tic response to "shot" in hip 5 years ago; Known allergy to morphine
School) DOS 3/14/08 to 11/14/08. Ankle sprain. Nasal Congestion. Strep Throat.
ent|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
twice before but only for a day or two and on a very small area. I dont recall if it occurred close to a vaccination.
multiple pneumonias including aspiration, h/o persistent pulmonary HTN (now resolved), horseshoe kidney, h/o cleft palate, feeding aversion
ma left orbital area
on, Acid Reflux pace maker which pt informed later after shot.
8/09 went on PREDISONE then off but rxtn, Nephrotic edema; Hyperglycemia -
hyroid; Depression; Anxiety
(out growing it now).
09USA01369
bs; Codeine derivatives; FLEXERIL; SKELAXIN Sulfa drugs; VICODIN
Patient|None~ ()~NULL~~In Sibling2|None~ ()~NULL~~In Sibling1
17/09 Received medical records w/PMH: T&A. Allergy: Demerol.
EFLEX SEASONAL ALLERGIES MENOPAUSE
m, Anemia, Hypercholesterolemia
7/09 Received medical records w/PMH: Allergy: PEN.
e; neuropathy
nel; Hip knee; Back surgery
za (Seasonal) (no brand name)~UN~0.00~Sibling
aches; mixed incontinence ulcer, kidney problems, osteoporosis, eye problems due to small stroke, brain aneurysm about 10 years ago. During brain surgery had rea mitting~Measles + Mumps + Rubella (no brand name)~1~1.00~Patient
Hx of tachypnea 10/5/09 Medical records received w/PMH: 29 wk preemie w/intubation 07USA04940 09USA01170 09USA01378 09USA01466 09USA01474
V (Gardasil)~3~12.00~Patient
21/09 Medical records received w/:Menactra, Lot# U237BA, given LA 9/14/07; HPV #2, Lot# 1263U given LA 10/12/2007; Fluzone, Lot# U2
rgy at present
ent|none~ ()~~0.00~Sibling
* FLU VACCINATION PENICILLIN COMPAZINE TYLENOL PHENERGAN
roducts and eggs
le - surgery. Cigarettes. Alcohol use. Caffeine use. Acne. Contact Lens-Induced Corneal disorder. Elevated triglycerides. Heel fracture, had
dism; Osteoarthritis; Arthralgia with Back Pain
gasses, mold, caused wheezes in past
sonal) (no brand name)~UN~75.00~Patient
dyslipidemia, hx gout, mitral insufficency
09USA01717 09USA01760
dia; RSV; Impetigo; Sinusitis
n B-12, Zolpidem Tartratc
-has strange reactions to certain elements.
on, CHF, asthma, atrial fibrillation, and kidney stones. Allergies include sulfa. 10/12/09-records received-PMH: Obesity, hypertension, cong
Migraines, Slow intestinal motility in~Tetanus Toxoid (no brand name)~1~0.00~Patient name)~1~0.00~Patient
dications, but have seasonal allergies. Three years ago I was diagnosed with anxiety. I have grown up with asthma.
on, ADHD, tremors high blood pressure - moderate - controlled by meds arthritis
er, Sleep Disorder (has "very little REM time")
sonal) (no brand name)~1~1~In Sibling1
eviously healthy.
y allergist. Eats eggs.
09USA01484
yacin cozaar, bee stings: atrial fibrillation, arthritis o allergies listed, No medications listed
dical records received, Dates of Service 4/19/09-8/10/09. PMH: Streptococcal infection 4/9/09, ear infections, mononucleosis 4/12/09, Alle onic pain, peripheral nervous system disorder, anemia, type 2 diabetes, poly cystic ovarian disease
PMH: ear tubes, adenoidectomy. seasonal allergies on site~Pneumo (no brand name)~1~61~Patient
lactic to nuts, ragweed, molds, cats me)~1~55~Patient
SULFAS (per patient)
tion to other vaccines.
holesterolia; depression
brand name)~3~0.20~Sibling
09USA02121 09USA02188
ered early secondary tachycardia and concern for infection. Jaundiced at birth.
name)~4~4.00~Patient
ertension; Osteoporosis.
gh cholesterol
) (no brand name)~1~33.00~Patient
ULTY~Influenza (Seasonal) (no brand name)~NULL~30.00~In Sibling1
dical records received for dates of service 7/23/09 to 7/28/09. PMH: VSD
ent|none~ ()~~0.00~Sibling
atient|NO~ ()~NULL~~In Sibling1
tedly very dirty and bug infested.
g, fluoxetine 10,boniva 150 mg,
Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2
asthma; Tietze's syndrome.
rtension, cholesterol Mumps + Rubella (no brand name)~1~1.40~Patient
of tonsils, with subsequent excision and resolution therapy; s/p excision of basal cell, epithelioma of right ear; Hypothyroidism; Hx of pulmo nion R hip fx-repaired; AODM; BPH; MOTRIN; MYCARDIS; PREVACID; FLOMAX; trimethoprim 1/7/09-records received-PMH: CHF, pancr
n's & Alzheimers.
ent & grandparent w/protein s deficiency; parent w/no hx of thrombosis & not on coumadin; grandparent w/recurrent thrombosis.
snowboarding accident. LOC after baseball strike to R eye. Wisdom teeth extraction.
es 10/27/05; Screening for Colon Cancer 04/28/06; Neuropathy, Peripheral 06/07/06; Arthritis, NOS/DJD/Osteoarthritis, S 06/19/06; Varicos
es, elevated LFTs, and hip arthralgia.
deficiency, DM, HTN, asthma be. Hypotonia
e 2. hypothyroidism. gout. hypertension. osteoarthritis of knee. BACK ARTHRITIS.
eated with post coital antibiotics
gain noted at 3 months.
eral occasions of exercise induced asthma;
PV #3 given 12/2/08, lot# 0651X, IM/LA; MMR#2 given 12/2/08, lot # 1083X, SQ/RA.
parently weakened her immune system and she says she is more susceptible to colds etc. now. Pt says she sees a rhuematalogist for this
es since treatment, and his latest WBC count the week of the ZOSTAVAX administration was normal. Patient's physician wanted patient to
sclerosis, osteoporosis, lipoprotein deficiencies
pertension syncope, dyslipidemia, GERD, morbid obesity,emphysema, congestive heart failure, pancreatitis, degenerative arthritis, mild valv
w/o reaction. Family hx: congenital heart defect.
or PMH: PTSD/depression; chronic night sweats; chronic poly-joint pain; 35# weight loss due to abd pain & decreased appetite; seizure di
group B strep positive however child's blood culture was negative at 72 hours at time of the discharge to home. Renal ultrasound done duri
MH: Nephrolithiasis. HTN. Hypertriglyceridemia. L shoulder pain 2' to labrum tear
t, lymph nodes, (Resolved); 07/26/2004, Shortness of breath, (Resolved); 07/26/2004, Pericarditis, acute NOS, (Resolved); 06/01/2004, Pa
r many years but now worse. Double vision. Stated always had tracking issues with reading. Strep throat 5/7/07.Allergy to penicillin.
Hearing change left 2007
Head injury 12/07
Blue nodule right 2nd pip finger 2/08
Bacterial endocarditis 1983
Lyme disease
openia - 5-2002; unspecified essential hypertension; colon polyps; hypercholesterolemia; disorder of bone and cartilage, unspecified - 5/19
lus of kidney; Hepatitis C; Hypothyroidism; Anemia
4/5/09. (R) knee surgery.
STEOPENIA, CHRONIC RHINORRHEA, ALLERGIES: PENICILLIN, ADHESIVE TAPE
e tape, mountain cedar tree pollen.
ood
sugar dailyl
CLINDAMYCIN 300 MG CAP
plex; cranberry; Cinnamon; Iron; Multivitamin; Garlic; One daily men vitamin; M
born with a birth weight of 1.45 kilograms. He also had Trisomy 21, imperforate anus, colostomy at 3 days of age, hypospadia, hypothyroidi
elay /? Visual Impaired / Nissen Fundoplication / Gastrostomy Placement / Sickle Cell Trait / GERD / Hypospadius / Premature Birth, 34 we
othyroidism, HRT, GERD, chronic low back pain with sciatica, osteoarthritis. 4/16/09-records received-PMH migraine headaches and daily
ndfather's side. Both with paralysis.
ease, Myofascial Pain Syndrome
on testing. Dx was vasomotor rhinnitis.
MH: CP, seizure disorder and Congenital CMV. Chronic constipation.
s an option over the MMR shot or no shot. The MMR is too much at one time.
Colic. EDIS eval @ 11 mo for mild motor/language delays; picky eater. Family hx: seizures, HTN, CAD, high cholesterol, hypoglycemia,
multiple food allergies, no known drug allergies 3/16/09-records received-PMH: 31 week premie in NICU on ven, severe GER, eosinophilc
Gastroesophageal reflux disease.
ponatremia, tobacco abuse, urticarial vasculitis, depression.
il, muscle aches with pravachol, colonscopy. Allergy to sulfonamides causes rash.
esterol; whiplash history arthritis; cervical disk degeneration; congenital defect
; dysautonomia; MRSA cellulits/abscess left thigh 9/08; tonsillectomy; PE tubes. Family hx: asthma, allergies, migraines, SLE, melanoma,
emia, CAD s/p stent, hypothyroidism, anxiety, heart cath, cholecystectomy, bladder surgery. Allergies to EES and macrolides.
to Sulfa-rash.
n, right foot; Impaired fasting glucose; Low back pain; Hypertension; S/P Total Hysterectomy; S/P Removal of Appendix; S/P Anesthesia fo
. cardiac angiogram WNL 1/08. Family hx: autoimmune disorder
y. 4/6/09 Records received PMH: hypothyroidism; arthritis, C6-7 DDD; chronic fatigue; joint pain.
prior. Family hx: asthma, DVTs, factor V Leiden heterozygous, MI, colon cancer. cture (remote) PMH: smoker; daily alcohol. Allergy: PCN, rash. Family hx: Hashimoto's, DM, HTN.
s to grass, animals, dust.
erative disorder. Congenital heart disease.
a given before having a catscan; we discovered that whe she was hospitalized for severe abdominal going to her side
pilespy, Wolff-Parkinson-White syndrome ablation. Allergies to penicillin, hydrocodone, Flexeril, ibuprofen.
m possible infection in 2005
h thoracotomy and partial pneumonectomy. R renal insufficiency
etween atria. One of twins.
rostate cancer, HTN, MI.
ere leakage of tricuspid valve, Moderate leakage of mitral valve, peripheral neuropathy, Type II Diabetes, Hiatal hernia, reflux, gastroparesi
epair of small bowel.
, smoker, hyperlipidemia, asthma, allergic rhinitis, cervical disc degeneration, sensorineural hearing loss, prostate cancer. Allergy: ace inhib
apnea; herniated disks; GERD; COPD. Recent ex-smoker. Allergy: PCN, tetanus, tetracycline & now pneumovax. ospadias, CP, torticullis.
eneralized; Tobacco use Disorder; Fatigue; Bacterial Pneumonia; Weight loss; Staphylococcal Infection; Back Pain; Hyperkalemia. Allergie
ds/neck; asthma/RAD; Glossitis episodes
/13/09-records received-PMH: chronic obstructive pulmonary disease,low back pain, coronary artery disease. Tobacco user. Hyperlipidemia
PR; SULFUR = WEAKNESS IN LEG; WAS HOSPITALIZED.
osteopenia, polyarthralgia, allergic rhinitis, knee pain, pharyngitis, back pain, JDD, hemorrhoids, rectal bleeding, BPH, TURP, conjunctivitis
ergies: hydrocodone, Relafen, metoclopramide, Vicodin.
lergy sx. Mono-summer 2007
d; appendectmy.
ids, constipation, cataracts OU, CVA. PMH: CVA, CP, quadriplegia, cataract, pyelonephritis, osteoporosis. mental retardation, Vit D deficie
fore this one 4/13/09-records received-PMH:migraines.
onditions and no known allergies.
or 3/25/09. Brain tumor/Meningioma resection, resultant hydrocephalus, VP shunt placement with 2 revisions.
ed vision, stool & urine incontinence, malaria 2008.
alking since 12/25/08, performs a few examples of sign language, recognizes family members, understands her name when called, dances
ry HTN. Allergy: morphine, sulfa, ASA, levaquin, latex.
diation tx completed 10/3/08.
b sr 24hr; TOPROL XL 50 mg oral tab sr 24hr; ASPIRIN 325 mg oral tab ec.
w/formula supplement. Family hx: parent w/asthma, seasonal rhinitis & drug allergies.
Mom smoker & social ETOH during pregnancy. Family hx: autism.
knee mild arthritis, otherwise healthy.
orts that she had some lymphedema on the Right side post surgery which resolved completely with chiropractic care.
al brain MRI, ear tubes, arm fx, nasal fx./
hortness of breath, gout, ankle swelling, numbness in feet and hands, Type-2 diabetes, hypertension, hyperlipidemia, triglyceridemia. L sho
e. PMH: environmental allergies, obesity, hirsutism, acne, on BCP. cope, R inguinal hernia repair. NKDA.
cervical cancer; pulmonary HTN; cutaneous T-cell lymphoma; urticarial vasculitis; hyponatremia; depression; hysterectomy; arterio-bifemo
, hypertension, coronary artery disease, BPH, atrial fibrillation, coumadin coagulopathy, hiatal hernia, sleep apnea, knee surgeries.
c syndrome w/hirsutism, Type II DM w/peripheral neuropathy, metromenorrhagia, morbid obesity, Blount's disease w/left tibial lengthenins &
dothelial Corneal Dystrophy and responded to prednisone eye drops with high Intraocular Pressure.
1267U given 11/20/07, IM/LA; HPV #3, Lot #1978U given 3/28/08, IM/LA. 5/1/09 Received vaccine & PCP medical records of 11/07-1/09.
ontinence Factor V leiden Allergies TETANUS - Rash CEPHALEXIN - Thrush, Hives Erythromycins - VOMITING,
and tree nut antigens
atopic dermatitis. Frequent fevers, vomiting, runny nose and cough. Syndactyly fingers bilateral.
ved DOS 4/1/09. Uveitis, Mycarditis.
ulcerative tonsillitis, epigastric pain, GERD, HA, fatigue, stiff neck, environmental allergies, vocal cord nodules, right shoulder AC strain.
EEP, breast implants, torn left meniscus knee, 6 miscarriages, hypercoagulability state. Allergies to ibuprofen, phenergan.
hospitalized for 6 days with antibiotics..."
while on OCPs. Allergy: PCN, keflex, levaquin.
OS 4/3/09. Allergies to Cipro, prednisone. Panic attacks; fatigue; lupus. PPD (+).
stones, knee surgery.
Keflex, flagyl, clindamycin. 4/16/09. Hypertension, hypercholesterolemia, coronary artery disease, BPH, hernia repair, psoriatric arthritis, Baker's cyst, chronic kidney d
ce, sensoineural hearing loss, arthropathy shoulder, tendonitis rotator cuff, bronchopneumonia, pulmonary infections, chest pain. 6/2/09 Ho
ulder and chronic rotator cuff injury, neurogenic bladder; allergies to PCN and linezolid cyanosis, otherwise WNL. Currently in NICU
8/09. PTSD. Herniated disks.
09 ER records received DOS 5/5/09. Asthma, T&A, wisdom tooth extraction. 6/9/09 PCP medical records received DOS 5/4/09 to 5/8/09. Va
estion x 1 week.
. Allergy to Rondec
e and obesity.
adaches, Strep throat, ADD, ruptured ovarian cyst. Rheumatoid arthritis. Has abused alcohol and used drugs. 7/27/09 Hospital records rec
iagnosed at ED in CA on 12/24/08 - dietary recommendations given, no surgery performed.
t palate mucocele diagnosed April 2005 evaluated by ENT and treated conservatively. Surgical History: circumcision as a newborn. Hosp
cess finger. I&D.
5/13/090 WNL.
nt; Arthragia-Pain in joint, NOS; Pain back (postural); Myofascial pain syndrome; Urethral stricture, meatal stenosis s/p urethroplasty (90)
tend to be low and has variable white counts.
acts, ex-smoker, acute URI. 7/13/09 Hospital records received DOS 3/2/09 to 3/6/09. Coronary artery disease, hyperlipidemia. ECTAL ABSCESS - emergent cardiac path - STENT placed OM3, PTCA to PLA 11/26/08 - DR - colonoscopy - proctitis OTHER: CROHN'S
olesterolemia, breast cancer post lumpectomy and radiation therapy
9 to 6/1/09. GERD.
09 ER records received DOS 5/22/09. ADD, T&A.
CATS, AND RESPIRATORY ALLERGENS AS WELL. PAST MEDICAL HISTORY: 1. Schizoaffective disorder with bipolar features. 2. Gen
on may be related to a neomycin allergy. When filling out the consent & release form she hadn't thought about topical ADR.
asthma, obstructive sleep apnea, hypertension, GERD, MVA, headaches.
she received a dose of Narcan in delivery room. Cord pH7.37. Intubated due to respiratory failure. Received one dose of surfactant and e
eral times. Vertical nystagmus. Neck pain.
past week. Obesity, herniated disc, neuropathy secondary to unknown causes. Hypertension.
ankle MRSA, allergic rhinitis
g, tendonitis patellar, flat foot, shin splint, pes planus, nicotine dependence.
kably good care of herself, ate well and exercised regularly. Her medical history was remarkable only for a history of strep throat and resultin
ng the size of a golf ball size, bruising that last couple weeks. The technician told her to pretend he wasn't giving her the shot. She believe
3.00] ALLERGIC RHINITIS NOS [477.9]
13/09. Previous syncopal episodes.
OS 12/15/08 to 6/17/09. Nasal congestion, nonproductived cough. Fever, upper respiratory infection. Umbilical hernia, completely reducible
cific dermatitis. Possible Marfan syndrome, high-arched palate, shoulder subluxation and hyperlax finger joints. Nasoseptal deformity with o
eakness, dizziness. Allergy - Lamictal. 8/3/09 Consultant medical records received DOS 12/12/08 to 6/29/09. Tremor with intention, obsessi
us excavatum, milk allergy, food allergy, anemia, RAD. Records include prior chest x-ray and blood test for lead.
hen was the patient's second PNEUMOVAX vaccine. She had received her first such vaccine around 12/2001 without any adverse effect. S
allergic reaction to bee stings (swelling and pruritis at sting site) and poison oak (both successfully treated with Benedryl).
igo on cheek, back, scalp. Seborrheic dermatitis. Hepatitis C. Actinic keratosis.
vertigo, chronic sinus infection.
omy. 7/22/09 Neuro consult records received PMH: migraine HAs, HTN, hyperlipidemia, CTS. Allergy: PCN. Family hx: daughter w/MS; he
dence, opioid dependence
earing loss, atherosclerosis coronary, idio periph neuropathy, essential hypertension, hyperlipidemia, gout, diverticulosis of colon.
to respiratory distress. PROM.
nsion, TIA, vitiligo
ultiple ear infections.
born 6 weeks premature.
shoulder. hypothyroidism, vaginitis.
loss. Allergy: vancomycin. Family hx: bleeding disorder.
hest pain. Penicillin allergy.
harge Diagnosis: First born twin, small for gestational age, Preterm very low birthweight newborn, Low risk of sepsis, breech presentation, A
events (PCN, niacin, sulfa, ACE inhibitor).
le accident, pleurisy, sulfa allergy
ension. Allergy to Stimate. Head trauma. Leg injury. Irregular menses. 7/1/09 Received medical records w/PMH: Excercise-induced asthma
en donating blood.
P medical records received DOS 11/19/07 to 9/17/08. Reflux, hiccups, gassy. Presacral dimple. Discharge from umbilicus. Total Bilirubin 16
BACTRIM -->rash; Surgical History: Adenoidectomy, age 3; L) Knee arthroscopy, 1999; R) inguinal herniorraphy, 1999. PMH: inguinal he
otomy tubes. Chronic lung disease, gross motor delay, hypotonia, GERD. 26 week premie. gastric bypass Roux-en-Y; overweight
Allergy to a venom.
ss, anxiety/panic attacks. 8/24/09 ER records received DOS 4/21/09 - 4/22/09. hypothyroidism, hypoglycemia. Tonsillectomy, pyloric steno
ween the ages of 9yrs to 12yrs old, but has had no symptoms in the last 7 years. She is a social smoker, 10 - 15 cigarettes a day, and a so
perlipidemia, osteoarthritis. Previous allergies/ADR reported to PCN, sulfa, Quibron, Fosamax, Actonel. 7/23/09 Hospital outpatient records
N, hypertriglyceridemia, tonsillectomy. Allergy: augmentin, heparin. Family hx: RA, fatty liver, HTN. 10/13/09 Received hospital medical re
ated prior to the adverse event onset. Unprovoked generalized seizure disorder at age 3. Febrile seizures. Partial seizures with generalizati
hlebitis.; Sulfa allergy; Past surgical history: Hysterectomy, right breast biopsy which was benign, and a toe bunion removed.
egs - fasciotomies. Ear tubes. Allergic esophagitis possibly to dairy products.
, penicillins, eggs, dairy.
mpound, flexeril, tylox, contrast dye, marcaine Hcl
n. Blood work and urine samples and x-rays could not help in finding a cause of the fever. This was the only seizure she has ever had.
0/09. Therapy for stress and anxiety. Asthma. Depression with suicidal thoughts. PMH: Intermittent shortness of breath. Hypersensitivity to
pendectomy, osteoarthritis, rosacea, total hip replacement, endometriosis. Alcohol use. Sulfa allergy.
oidism. Alcohol use. Iron deficiency anemia. Tubal pregnancy. Tonsillectomy. Allergies: Lactose intolerant, Seasonal, Strawberries, wheat.
ea of prematurity. Respiratory insufficiency, CPAP and O2.
ratory insufficiency, peripheral pulmonic stenosis, anemia of prematurity, intraventricular hemorrhage and associated periventricular leukom
mity, heaviness, pins and needles sensation. Left knee arthroscopy for meniscal tear. Seasonal allergies. Left thumb surgery for injured ten
absence seizure disorder.
UISING. THE E.R. THOUGHT THERE WAS A PROBLEM WITH ABUSE AND NEGLECT AND CONTACTED CHILD PROTECTIVE SERVI
uss" medication.
nia. Mastocytosis. Hemangioma.
e Lange Syndrome.
europathy); Iodone eyes (hives everywhere including throat); MORPHINE (overall itching and hallucinations); Betadine (blistering immediate
gy. Hives. Bacterial vaginosis
on. Rash from Amoxicillin. Attended camp. Contact with cat and reptiles. Lactose free diet.
hinitis;Fibromylagia; GERD; Lumbosacral back pain;pre-diabetes; Asymptomatic cholelithiasis; Cognitive decline; and Dizziness.
y - Hospital records received DOS 1/4/09 to 1/7/09. Assessment: Acute sialadenitis, leukoplakia of lower lip, hypertension, coronary artery d
March 2009 (not recorded as positive). Positive Quantiferon gold in April 2009; Hx of travel abroad during summer of 2008 with hx of last pri
ds. 9/23/09 Medical records received for date of service 7/22/09 to 7/23/09 Left inguinal hernia repair
halus. Neurogenic bowel and bladder with history of multiple urinary tract infections. MACE and Monte, Tonsillectomy and adenoidectomy.
m; GERD; Low back pain; chronic pedal edema; Hysterectomy.
GERD. 8/17/09 Consultant records and labs received DOS 11/18/08 to 8/10/09. Ear infections. Dental extraction.
d based on clinical presentation (Left great toe pain which responded to INDOCIN). Upper extremity numbness and weakness, early to mi
due to the emergency nature of the valve surgery which has been raised 10% in 3 years due to healthy life-style and athletic activities prior
ign breast biopsy, osteopenia.
rhaphy. Left testicle surgery, vasectomy.
nsult medical records received w/PMH: family hx: MS, ALS, melanoma. 9/3/09 Medical records received w/PMH: anxiety, rash, MVA 2004.
ep. Endoscopy. Hypertensive heart disease. 9/29/09 Medical records received from ID physician for date range: 11/9/08 to 8/28/09 PMH: L
y, shingles,arthritis.allergies: PCN, sulfa, EES, NSAIDS and other meds
steria sepsis, Pneumocystis. Biopsies. Diffuse glomerulonephritis.
. Seizure disorder.
2/09. Recurrent tonsillitis, hypertrophic tonsils. Tonsillectomy performed. 10/8/09 Neurology and cardiology consults service dates 2/6/08 t
/14/09 Hospital admitting record DOS 8/12/09. Congenital hearing loss. Cochlear implant left ear. Tonsillectomy and adenoidectomy.
September and was receiving this injection as prophylaxis prior to surgery. Medical records received 8/17/09 PMH: congenital hearing loss
angioedema. No prior reactions to vaccines.
agnosed with Celiac disease and does not eat anything with gluten. The mother states the child also has been diagnosed with Osteoperos
ruise to right side of face at age 5 yrs.
D repair as infant. menstrual cramps.
nths, severe constipation at 3 1/2 months - released from GI specialist on 7/31/2009 and pulmanary specialist on 8/13/2009 due to excellen
5.26A, initally intubated, umbilical hernia 553.1A, neonate jaundice, feeding difficulty 783.3D, ICD-9 codes, V65.49BADL, E869.4C, 780.39
MMR and Varicella vaccines. Multiple other prior vaccinations with no side effects.
2/16/09. PMH: Left vocal cord paralysis, stridor following birth.
d 2/17/09 to 7/17/09. Allergy to nuts. 9/21/09 Received medical records w/PMH: acne under treatment. migraines. Allergy: tetracycline. F
es. Hypertension, mid back pain, rosacea, hyperlipidemia, environmental allergy. Allergies to Prinivil, Pro-Banthine, allergy to shellfish, Eryt
n infant we think because of the pertussis in the APT shot. She also had ADHD. My middle daughter -the one who had no reaction to the sh
gy to household dust. 10/5/09 Vaccine records received: Hep A #1, SKB, given 10/1/08, lot# AHAVB246AA, LA. Flu shot, Conn, given 1
lot# 1061U, RA; Adacel, Sanofi, given 10/15/08, lot# C2768BA, LA; Twinrix, given 10/15/08, no lot # provided.
verely sick as I am.
ith no results. Per RN
re 35.5 weeks.
; major depression; HTN; personal history of exposure to Persion Gulf Region; Adjustment disorder unspecified; sexual abuse of adult(DSM
tc.) Child was alert, talkative, and cooperative while here.
ol. Mitral valve prolapse. Breast lump. Smoker.
ardial infarction. Type 2 Diabetes Mellitus. Diabetic neuropathy and retinopathy. Diabetic nephropathy. Hyperlipidemia. Bilateral ankle surge
mal MRI Brain. EEG - Abnormal. Born 32 weeks gestation. Inguinal hernia repair. Circumcision.
ional Hospital Record received, Dates of Service 8/24/09-8/27/09. PMH: None
omegaly, appendectomy, knee replacement.
ived 8/21/09. Hypertension. Atrial Fibrillation. Allergies - Pink eye drop medication. Sulfamethoxazole, Zestril.
rey-Fineman-Ziter Syndrome. Ventilator dependant entire life. Cerebral atrophy. Tracheostomy, gastrostomy. Bulbar palsy. Tube fed. Reac
kes half pack per day.
Type 2 diabetes Hepatitis C, s/p treatment with pegasys and copegus Migraines, Hypothyroid s/p thyroidectomy for Hashimoto's thyroiditis
nital heart defect. Allergic reaction to MMR or DTaP
current Pinworms.
icillin allergy.
Allergies to sulfonamindes causes rash. Naproxen anaphylaxis. Ibuprofen-hives, ACE inhibitors-cough. NSAIDS tongue swells throat closed
al palsy. Insulin-dependent diabetes mellitus.
o smoke. Mother has hx of vaginal herpes and took Valtrex prior to delivery. Mother took Zoloft during last trimested of pregnancy.
B sulfate
medical conditions:Cancer of breast,osteoarthritis,GERD,chondromalacia patella
celerations. Mechanical ventilation. SGA, PDA, RDS, IVH, hypotension, anemia, apnea, ileus, hyperbilirubinemia, electrolyte imbalance, th
gestational age.
RVOCET; FLOXIN; Pneumonia shot
er disease, diastolic congestive heart failure, CVA, hyperlipidemia. BPH, anemia, obesity.
doctor and massage therapist in affected area. Was injected with muscle relaxer in July 2008 at same medical clinic after first car accident
tive heart failure. Angina. Type 2 diabetes, hyperlipidemia, non-Hodgkins lymphoma, pacemaker with internal defibrillator. Appendectomy. S
2007; Chicken Pox at age 43
rns to fingers of left hand. Allergic to bee stings. Alcohol use.
adone maint. at birth in NICU, feeding difficulties, raspy breathing with color changes.
h heavy flow, short stature with growth hormone treatment, Oral contraceptives.
ERGIES TO SULPHA & RED DYES. CONDITIONS: TBI, OCCASIONAL B/L LOWER EDEMA. ORTHO/NEUROPATHOIES s/p x 11yrs,NE
pain. Numbness tingling right foot, insomnia. Sacroiliac joint syndrome. Adverse reaction to Valium. Eye rolling and facial twitching. Myoclo
he has had flu vaccine in the past and wanted to proceed).
inches apart, however the reaction occured lower down on the arm
delay, VSD-repaired, G-tube feeds, seizure d/o
mur. FH: seizures
ft palate, feeding aversion, GT with Nissen, multiple placement of ear tubes
ring brain surgery had reaction to 1 of the following medications: seldane, hismanal, sotals, variomycin, rocephin, erythromycin, estrioxene,
12/2007; Fluzone, Lot# U2448AA given 11/21/07 LA
cerides. Heel fracture, had fracture, dislocated right knee.
besity, hypertension, congestive heart failure, asthma, permanent pacemaker, appendectomy, cholecystectomy, hysterectomy, kidney ston
ononucleosis 4/12/09, Allergic to Penicillin.
pothyroidism; Hx of pulmonary nodule. PMH: Organic heart disease s/p CABG, known RBBB. HTN, dyslipidemia, Type 2 DM, BPH, hx eceived-PMH: CHF, pancreatitis, UTI, Diabetic, coronary stents. Stroke.
ent thrombosis.
thritis, S 06/19/06; Varicosity, Leg (NOS) 05/18/07; Ulcer, Lower Extremity 09/21/07; Elevated Liver or Cardiac Enzymes 09/21/07; Obe
s a rhuematalogist for this condition and will try to contact them as to the condition's effect on vaccinations and vis versa.
ysician wanted patient to be vaccinated.
nerative arthritis, mild valvular regurgitation and COPD. Smoker.
eased appetite; seizure disorder due to MVA w/head injury approx 1985; CAD; HTN; hyperlipidemia; hypothyroidism; asthma; kidney
enal ultrasound done during newborn or should he show an extra renal ureteral pelvis but no hydronephrosis. Birth weight was
Resolved); 06/01/2004, Pain in joint, unspecified site, (Resolved) PMH: Allergy: sulfa, environmental allergies.
llergy to penicillin.
is 1983
Lyme disease - clinically 6/08
artilage, unspecified - 5/19/08; bone density generic - 1-13-04; cytopath smear cerv/vag, manual - 12-11-03; colonoscopy- 1-29-04; ey
hypospadia, hypothyroidism, pulmonary hypertension, ASD/VSD, PDA ligation 1/13/08, pulmonary vein stenosis and other problems at bi
s / Premature Birth, 34 weeks /Hx of aspiration pneumonia
aine headaches and daily headaches for 20 years.
holesterol, hypoglycemia, migraines.
severe GER, eosinophilc esophagitis, mutliple food allergies. RAD. Family history of epilepsy.
graines, SLE, melanoma, DM, HTN, enlarged heart, hypothyroidism.
pendix; S/P Anesthesia for Tubal Ligation/Transection; FX closed lateral malleolus; Health Maintenance exam; Hyoerlipidemia; Antihy
ernia, reflux, gastroparesis, CHF records received-4/13/09-PMH:coronary disease. Multiple pulmonary nodules stable greater th
cancer. Allergy: ace inhibitors, guaiffenesin, biaxin, xanax, codeine, wellbutrin, effexor, prozac, lortab, protoni
in; Hyperkalemia. Allergies Effexor; Prozac; Wellbutrin; Nortriptyline HCL
bacco user. Hyperlipidemia. Hypertension.
BPH, TURP, conjunctivitis, glaucoma, CVA, GERD, venous insufficiency, erectile dysfunction, joint effusion, kidney calculus, R inguinal
al retardation, Vit D deficiency, MVP
ame when called, dances, etc. She is in the 75th percentile for height and the 93rd percentile for weight as of 4/3/09.
mia, triglyceridemia. L shoulder surgery, Inguinal herniorrhaphy, throat polyp removal.
sterectomy; arterio-bifemoral bypass, 2002. Allergy: risedronate, rash. Family hx: DM, MI, HTN, CAD.
a, knee surgeries.
e w/left tibial lengthenins & reshaping via cage, left gastrocnemius contracture, bronchitis, URI, sleep apnea, restless leg syndrom
cal records of 11/07-1/09. Hypothyroidism, 23# weight loss, anxiety, depression, HAs, dizziness. Family hx: parent w/MS, tics, OCD.
ht shoulder AC strain.
er's cyst, chronic kidney disease. Hep B surface antibody (+). Asthma with sulfa drugs.
ons, chest pain. 6/2/09 Hospital inpatient records received DOS 1/11/09 1/21/09. Rotator cuff injury, sensononeural hearing loss
d DOS 5/4/09 to 5/8/09. Vaginal discharge.
27/09 Hospital records received DOS 5/9/09 to 5/11/09. Allergies to hydrocodone and provigil. Babesiosis.
ision as a newborn. Hospitalization/Major Diagnostic Procedure: Denies Past Hospitalization. Family History: Father:
s s/p urethroplasty (90)
yperlipidemia. octitis OTHER: CROHN'S DISEASE TIA HYPOKALEMIA HYPERTENTION GLAUCOMA -DR - Echo 6/2/08 - ER 608, Grade 2 diastolic dys
h bipolar features. 2. Generalized anxiety disorder with panic attacks. 3. Borderline personality disorder. 4. ADHD. 5. History of arrhythm
e dose of surfactant and extubated after a few hours to room air. Sepsis ruled out. Feeder and grower. 7/15/09-records receiv
of strep throat and resulting tonsillectomy and adnoidectomy at age 10 and a knee injury from a bike accident after her sophomor
her the shot. She believed the vaccinator misunderstood what she told him.
ernia, completely reducible.
asoseptal deformity with obstruction. MRI shows slight ectasia of ascending thoracic aorta. Multiple dermal nevi - biospy demonst
mor with intention, obsessive-compulsive dysfunction, mood disturbance. Allergy to Lacmictal. Kidney stone. Flexion of torso occuring m
hout any adverse effect. She has rheumatoid arthritis and was recommended for a second vaccine because of being on immune suppress
mily hx: daughter w/MS; heart disease, cancer, migraines, Parkinson's.
culosis of colon.
sis, breech presentation, Apnea of prematurity resolved. Born 33-6/7 Week. C-Section. During hospital stay infant was hypoglycem
Excercise-induced asthma.
mbilicus. Total Bilirubin 16.2 MG/DL (H)
1999. PMH: inguinal hernia 1995. Dural/epidural thoracic angiolipomas malformation
nsillectomy, pyloric stenosis as infant.
cigarettes a day, and a social drinker, 1 - 2 days a week, average 4-6 drinks. She has had no other medical conditions.
ospital outpatient records received DOS 6/12/09 to 7/8/09. Major depression, and vitamin D deficiency. Hypertension. Allergies
eceived hospital medical records and discharge summary for dates of service 6/22/09-7/1/09. PMH: as above.
seizures with generalization. Tonic-Clonic Seizures. Jaw/face/teeth injured - multiple surgeries. Side to side, in and out j
ure she has ever had.
reath. Hypersensitivity to sounds and light. Lower back pain. Wrist fracture. Chickenpox. Environmental allergies. Milk allerg
onal, Strawberries, wheat.
ated periventricular leukomalacia.
mb surgery for injured tendon. Left ankle surgery for spurs.
ILD PROTECTIVE SERVICES. OUR OFFICE ORDERED BLOOD WORK FOR BLOOD DISCRASIA AND EASILY BRUISING. BLOOD WO
adine (blistering immediately); LYRICA (weight gain-i.e. 10 lbs in 4 days, spontaneous bruising legs, chest and arms); Persantine (immedia
and Dizziness.
rtension, coronary artery disease post coronary artery bypass graft, dyslipidemia, type 2 diabetes mellitus uncontrolled, GERD,
of 2008 with hx of last prior negative PPD in 2007 post-deployment. After VACCINE: Taking 4-month course of RIFAMPIN, with follo
omy and adenoidectomy. Allergies - penicillin, latex.
and weakness, early to mid - 1990s - Had evaluation including lumbar puncture and MRI of spine with questionable history of syrinx. (
nd athletic activities prior to the surgery. AMIODARON to calm A-fib, had stopped the A-fib near the beginning of the year b
anxiety, rash, MVA 2004. CSF leak 1983. Extensive foreign travel.
11/9/08 to 8/28/09 PMH: Lyme Disease, Babesia, EBV as a child/teen.
ults service dates 2/6/08 to 6/1/2009. ECG - Normal Sinus Rhythm. Sleep disorder Patient presents with hypersomnolence.
and adenoidectomy.
H: congenital hearing loss w/cochlear implant right ear. Seizures 2008 w/normal EEG. Allergic: PCN.
agnosed with Osteoperosis, Juveneille Arthritis, Fybromyalgia and Asthma. The child has also recently had surgery to her nasal
8/13/2009 due to excellent reports on both! Birth weight 7 lbs 11.7 oz 5 weeks early and 0 siblings.
49BADL, E869.4C, 780.39B, 502079.
s. Allergy: tetracycline. Family hx: cancer & leukemia.
e, allergy to shellfish, Erythromycin. Alcohol use.
o had no reaction to the shot- also had ADD but no other medical conditions.
Flu shot, Conn, given 10/1/08, lot# U278414A.
sexual abuse of adult(DSM-IV 995.83)
emia. Bilateral ankle surgery. Immobility. History of lumbar degenerative disk disease. Hypertension.
bar palsy. Tube fed. Reactive airway disease. Constipation, conjuctivitis, atopy. Bilateral clubbed feet. Seizures, GERD, chronic lun
for Hashimoto's thyroiditis Vertigo Depression Hyperlipidemia
ongue swells throat closed. Ciprofloxin-diarrhea and vomiting.
ed of pregnancy.
, electrolyte imbalance, thrombocytopenia, renal failure, respiratory failure, pulmonary HTN, pneumonia, sepsis, tracheitis, femu
inic after first car accident.
brillator. Appendectomy. Sulfa allergy.
PATHOIES s/p x 11yrs,NECK,SHOULDER, SPINE, LOWER.
nd facial twitching. Myoclonic jerking, anxiety, hallucinations, headaches. Panic attacks. Asthma. Vertigo. Injured should
erythromycin, estrioxene, ees.
hysterectomy, kidney stones, atrial fibrillation, 1 pack per day for 10 years smoking history, history of binge drinking. DVT of
Type 2 DM, BPH, hx
nzymes 09/21/07; Obe
sm; asthma; kidney
th weight was
oscopy- 1-29-04; ey
and other problems at bi
yoerlipidemia; Antihy
able greater th
y calculus, R inguinal
ess leg syndrom
nt w/MS, tics, OCD.
al hearing loss
608, Grade 2 diastolic dysfunction.
HD. 5. History of arrhythmia, possibly SVT. Followed b
ecords receiv
er her sophomor
biospy demonst
on of torso occuring m
eing on immune suppressant
t was hypoglycem
sion. Allergies
Y BRUISING. BLOOD WORK WAS NOT DONE. PARENTS ARE NON-COMPLIANT WITH MEDICAL ORDERS. PARENTS BROUGHT CH
ms); Persantine (immedia
rolled, GERD,
RIFAMPIN, with follo
e history of syrinx. (
ry to her nasal
GERD, chronic lun
racheitis, femu
PARENTS BROUGHT CHILD
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